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USMLE Step 1 > Stuff You Missed > Flashcards

Stuff You Missed Flashcards

1
Q

Risk Factors for Aspiration Pneumonia

A
  • Elderly people with altered mental status
  • Dysphagia (due to neuro deficit)
  • GERD
  • Mechanical compromise of mechanical defenses (e.g. impaired cough reflexes)
  • Protracted vomiting
  • Large volume tube feedings in recumbent position
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2
Q

ECF/ICF conditions: Loss of isotonic fluid

A

e.g. GI hemorrhage
- no change in osmolarity
- normal ICF + decrease ECF
aka isosmotic volume contraction

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3
Q

ECF/ICF conditions: ingestion of hypotonic fluid

A

e. g. ingestion of large amts of water
- decreased osmolarity
- increase in ICF and increase in ECF
- causes expansion of volume w/o changing osmolarity

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4
Q

ECF/ICF conditions: hypertonic saline infusion

A

Increased osmolarty,

  • decrease in ICF and increase in ECF
  • high osmolarity causes shift of H2O from ICF
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5
Q

Fructose 2,6 Bisphosphate

A

Induces PFK-1 and inhibits gluconeogenesis by inhibiting fructose 1,6 bisphosphate conversion to fructose 6 phosphate.
High concentrations of Fructose 2,6 BP inhibits gluconeogenic conversion of alanine to glucose.
Fructose 2, 6 BP is regulated by PFK-2 and Fructose 2,6 BPase

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6
Q

4 gluconeogenic irreversible enzymes

A

Fructose 1, 6 BPase (in cytosol, Fructose 1,6 BP to Fructose 6-P)
Pyruvate carboxylase (in mito, Pyruvate to Oxaloacetate)
Glucose 6 Phosphotase (in ER, Glucose 6 P to glucose)
Phosphenoenol carboxylase (in cytosol, oxaloactetate to phosphoenolpyruvate)

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7
Q

Effect of exogenous administration of thyroid hormone

A
  • Decrease in TSH (via feedback inhibition)
  • Increase in T3
  • Decrease in T4 and rT3 (inactive form of thryoid) - as thryoid gland doesn’t have to secrete hormone
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8
Q

Most common reason of elevated alpha fetal protein

A

Dating error / underestimation of gestational age

This can be confirmed by fetal ultrasound

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9
Q

Perchlorate

A

Blocks iodide absorption for thyroid hormone production via competitive inhibition

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10
Q

Metatyropone administration results in ACTH surge because it causes decreases in cortisol production (T/F)

A

True

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11
Q

What other cancers do you check for if the patient has a family history of pheochromoctomas?

A

Always check for MEN2a and MEN2b cancers.
MEN 2a: pheochromocytoma, medullary cancer of the thryoid, parathyroid cancer

MEN2b: medullary thyroid cancer, pheochromocytoma, oral/intestinal ganglioneuromatosis (associated with marfanoid habitus)

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12
Q

Disease: 47 XXY and expected symptoms

A

Klinefelter’s syndrome

  • gynecomastia
  • infertile
  • tall
  • small firm testes
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13
Q

Pancreatic islet amyloid deposition is characteristic of which DM?

A

Type 2 DM

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14
Q

Microscopic/Genetic characteristics of type 1 DM?

A

Pancreatic islet leukocyte infiltrate
Strong HLA II correlation (but not as strong as DM2)
Antibodies against islet deposition

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15
Q

Characteristics of hyperparathyroidism

A

-Subperiosteal resorption with cystic degneration

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16
Q

Rx for young women with hirsuitism

A

Spironolactone (anti-androgen effects)
Flutamide (inhibits to testosterone receptors)
Finasteride (5-alpha reductase inhibitor)

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17
Q

Insulin to avoid postprandial hyperglycemia

A

Lispro, Aspart, Glulisine

45-75 minutes against postprandial hyperglycemia

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18
Q

Hypoglycemia can be precipitated by what kind events?

A

Exercise induced glucose uptake

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19
Q

Most common cause of elevated creatinine kinase

A

Hypothyroidism

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20
Q

Common causes of elevated creatinine kinase

A
  1. hypothyroidism
  2. autoimmune diorder (dermatomyelitis/polymyelitis)
  3. Muscular dystrophy (Duchenne dystrophy)
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21
Q

Thiazolidinediones

A

binds to PPAR-gamma nuclear transcriptase activator

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22
Q

Type of insulin needed for DKA

A

Regular insulin (peaks in 2-4 hours)

  • Presents as volume depletion (hypotension and tachycardia)
  • Ketones and glucose in urine
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23
Q

Why methadone is preferred drug for heroin overdose

A

Mu receptor agonist.
Long acting, potent with good oral bioavailability
Has long half life to prolong withdrawal symptoms

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24
Q

Physostigme

A

Administered for atropine toxicity -

can reverse both CNS (dilated and non-reactive pupils) and peripheral symptoms (sinus tachycardia)

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25
Q

Atropine use in elderly

A

If elderly has poor renal clearance, can result in reduced clearace
delirium and psychosis can result from muscarinic blockade

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26
Q

Atropine toxicity

A 
Hyperthermia
Mydriasis
Cyclopegia
Bronchodilation
Tachycardia
Constipation
Urinary retention
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27
Q

Benzodiazipines

A

bind to GABA-A receptors in CNS and enhance inhibitory effect of GABA
Used as hypnotic (to treat insomnia), anxiolytic ( for panic attacks/anxiety disorders), and anti-convulsants

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28
Q

Short acting benzos (<10 hrs)

A

Alprazolam, Triazolam, Oxazepam

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29
Q

Medium benzons (10-20 hrs)

A

Estazolam, Lorazepam, Temazepam

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30
Q

Long acting (days)

A

Chlordiazepoxide, Clorazepate, Diazepam, Flurazepam

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31
Q

Long acting benzo issues

A

Associated with severe daytime drowsiness (higher risk of falls). Slower clearance causes less withdrawal (lower risk of physical dependence)

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32
Q

Vitamin B6/Levadopa

A

Vitamin B6 increases the peripheral metabolism of levadopa

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33
Q

Wine and cheese with depressed patient taking atypical antidepressants!

A

Hypertensive crisis caused by MAO-inhibitor tyramine crisis

Tyramine - sympathomimetic is normally metabolized in GI tract but MAO inhibitors block the degradation so it gets in to systemic circulation.

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34
Q

Jimson Weed

A

produces anticholinergic effects - atropine poisoing (tachycardia, myadrisis, slowed GI motiolity, bronchodilation, urinary retention, hallucinations

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35
Q

Phenytoin side effects

A

Gingival hyperplasia - caused by increased expression of PDGF which stimulates proliferation of gingival cells and alveolar bone. Also causes ataxia and nystagmus

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36
Q

“On-off phenomenon” of Parkinson’s disease

A

Pts may experience moments of muscle rigidity and then periods of regular movement on levadopa treatment. UNPREDICTABLE and dose-dependent. Higher doses are not always beneficial

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37
Q

Acute neonatal narcotic withdrawal presentation

A

Pupillary dilation, rhinorrea, sneezing, nasal stuffiness, diarrhea, nausea, and vomiting

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38
Q

Thiopental

A

short-acting barb that affects GABA receptors and increases inhibitory potential
Highly lipid soluble. Accumulation in brain within 1 minute causes loss of consciousness. It is then redistributed to SKELETAL MUSCLE and ADIPOSE TISSUE

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39
Q

SSRIs

A

Sertaline is an SSRI. SSRIs have better side effect profiles than TCAs. Sexual dysfunction is common side effect and limits their use for patients

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40
Q

Drugs most effective for motion sickness.

A

Anti-muscarinic and anti-histamines because motion sickness triggers muscarinic M1 and histamininc H1 pathways. (e.g. Scopolamine - antimuscarninc drug). Meclizine and dimenhydrinate are also effective at preventing that

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41
Q

Olanzapine

A

atypical antipsychotic. SE: weight gain

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42
Q

Clozapine

A

atypical antipsychotic: Agranulocytosis and seizures. (Do weekly WBC profiles)

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43
Q

Status epilepticus

A

recurrent or continuous generalized tonic-clonic seizures that last for more than 30 minutes w/o return to consciousness. Can result in HTN, tachycardia, arrhythmias, and lactic acidosis

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44
Q

Tx for status epilepticus

A
  1. Benzos are 1st line choice. LORAZEPAM preferred.
  2. Phenytoin is administered simultaneously to precent recurrece.
  3. (If needed), phenobarbital may be added
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45
Q

Phenytoin mechanism of action

A

inhibits neuronal high frequency by reducting ability of Na to recover for inactivation

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46
Q

Beta cell response via sympathetic activation

A

Alpha adrenergic receptors - INHIBIT insulin release

Beta-adrenergic activation - PROMOTES insulin secretion

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47
Q

Phenoxybenzamine

A

Long acting alpha blocker – commonly used for treatment of pheochromocytomas

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48
Q

Diphenhydramine

A

antihistaminic (H1 blocker) – has anticholinergic effect that can stop insulin secretion induced by PS stimulation

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49
Q

Propanolol

A

non-selective Beta blocker

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50
Q

Oxybutinin

A

anticholinergic agent used for treatment for overactive bladder (urge incontinecne)

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51
Q

Common P-450 inducers

A

Barbituates, Rifampin, Carbamezapine, Griseofulvin, and chronic alcoholic consumption.

*Will lower dose of other P450 metabolized medication

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52
Q

Common P-450 inhibitors

A

Isoniazd, Cimetidine, Macrolides (e.g. erythromycin, ciprofloxacin) , Azole antifungals, and Grapefruit juice

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53
Q

Severe complication of halogenated anesthetics (halothane, enflurane, isoflurane, sevoflurane)

A

Massive hepatic necrosis (elevated ALT, AST and bilirubin level). Due to direct injury and by halothane metabolits and formation of autoantibodies against liver proteins

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54
Q

Reye’s syndrome liver effects

A

Seen in 5-10 years old associated with salicyate overdose

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55
Q

Intrahepatic cholestasis

A

associated with billiary duct obstruction. Characteristic for primary sclerosing cholangitis and primary billiary cirrhosis

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56
Q

Most common cause of death in TCA overdose

A

Refractory hypotensio and cardiac arrhythmias. Inhibition of fast sodium channels in cardiac myocytes (and His-Purkinje system) is the major underlying cellular event. Fluid resuscitaton with normal saline and hypertonic NaHCO3 is necessary

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57
Q

Serotonin syndrome

A

Hyperthermia, tachycardia, muscle rigidity, mycoclonus, diaphoresis

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58
Q

Akathasia

A

movement disorder characterized by inner restlenss and inability to stand in one position. Can be due to antipsychotic therapy.

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59
Q

Treatment of choice for Listeria monocytogenes

A

Ampicillin. (Not sensitive to cephalospporins)

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60
Q

Ceftriaxone coverage for 2 month old w/ fever, irritability and vomiting

A

N. meningitidis, Strep. pneumoniae, Group B strep. H. influenzae

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61
Q

Side effects for 1st generation antihistamines

A

Muscarinic (blurry vision, dry mouth, urinary retention), Seroternergic (appetite stimulation), and alpha adrenergic (postural dizziness). Also lipophilic so can cause BBB.

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62
Q

Rx for elderly patient w/ poor vision and hx of frequent falls suffers a rash

A

Second generation antihistamine (e.g. fexofenadine) because they have minimal sedative and anti-muscarininc effects

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63
Q

Rx of hyperpyrexia in 8 year old

A

Cold blankets. Cannot administer aspirin as can cause Reye’s syndrome. Body temperature greater than 40 degress may lead to permanent brain damage.

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64
Q

Bacterial vaginosis

A

associated w/ Gardnerella vaginalis

  • loss of lactobacilli and overgrowth of of mixed anaerobes
  • addition of KOH to discharge makes fishy smell more prominent (whiff test)
  • Clue cells on wet mount
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65
Q

Candida albicans

A

common cause of fungal vaginits
present with vaginal pruritis, curd-like discharge, and labial erythema
-no additional odor with KOH
- discharge has yeast forms and pseudohyphae

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66
Q

Choriocarcinoma

A

malignant tumor from trophoblast

- causes abnormal vaginal bleeding, UTERINE ENLARGEMENT, and increased hCG

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67
Q

Common site of metastasis for choriocarcinoma

A

Choriocarcinoma spreads hematogenously. Lungs most common site

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68
Q

Choriocarcinoma: Histology

A

abnormal proliferation of syncytiotrophoblasts and cytotrophoblasts. No villi are present.

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69
Q

Choriocarcinoma: Gross exam

A

Soft yellow white mass with extensive areas of hemorrhage and necrosis

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70
Q

Hyperplastic endometrium

A

associated with prolonged exposure to estrogen
PCOS, estrogen-producing tumors (e.g. granulosa cell tumors) and estrogen replacement therapy.
Sx: abnormal, irregular bleeding

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71
Q

Endometrial adenocarcinoma: Histology

A

disorganized glands of neoplastic COLUMNAR cells. Occurs in postmenopausal women and presents in vaginal bleeding.

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72
Q

Malignant teratomas

A

contain tissue elements resembling immature cartilage
Can occur in ovaries but NOT in uterus
Sx: abdomnial pain and ovarian mass BUT no bleeding

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73
Q

Carcinosarcomas

A

Malignant mixed mullerian tumors of uterus.

Composed of epithelial (endometrial-type glands) and mesenchymal (sarcomatous) elements

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74
Q

Sx: acute polynephritis

A

flank and abdominal pain, fever, shaking chills, nausea and vomiting
CVA tesnderness.
Urinanalysis: WBC casts, bacteruria. and hematuria

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75
Q

Hypertensive nephrosclerosis

A

causes arterial intimal fibropasia, arteriolar hyalinizations, and long with interstitial fibrosis

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76
Q

Renal Cell Carcinoma

A

Clear cell carcinoma is most common subtype. Appears a rows of homogenous sheets/rows of cuboidal or low columnar cells with translucent centers

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77
Q

Common causes of nongonoccal urethritis

A

Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma and Trichomonas species

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78
Q

Rx of Gononoccal Urethritis

A

Ceftriaxone

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79
Q

Rx of nongonoccocal urethritis

A

Azithromycin

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80
Q

Why can’t you use ceftriaxone to treat nongonoccal urethritis?

A
  • Chlamydia trachomatis - lacks peptidoglycan layer within cell wall
  • Another common pathogen of NGU, Ureaplasma urealyticus lacks a cell wall
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81
Q

Drugs that inhibit dihydrofolate reductase, thus prevent reduction of folic acid to tetrahydrofolate reductase

A

Trimethoprim, Methotrexate. Pyrimethamine

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82
Q

Trimethoprim

A

inhibits dihydrofolate reductase thus prevention reduction of folic acid to tetrahydrofolate. Restricts microbial growth and used in conjuction with sulfonamide b/c sulfonamide inhibits production of folic acid in another pathway

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83
Q

Pyrimethamine

A

effective anti-malaria. and in treatment of toxoplasmosis because it inhibits parasitic dihydrofolate reductase

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84
Q

Imipenem

A

binds to >1 penicillin binding proteins thus inhibiting peptidoglycan synthesis in bacterial cell walls. Bacteria lyse themselves because cell autolytic enzymes still work.
Used with cilastatin to prevent renal metabolism of imipenem by inhibiting dihydropeptidase on renal tubule brush border

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85
Q

Adenomyosis

A

presence of endometrial glandular tissue within the myometrium. Affects middle aged parous women.
Sx: enlarged uterus with normal appearing endometrial tissue. Menorrhagia and dysmenorrhea are common symptoms

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86
Q

Enterobiasis

A

aka pinworms.
Sx: young children with perianal itching, discovered with “Scotch tape test”
Prsence of oval, assymetrically flattened eggs with bean shaped appearance

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87
Q

Rx of enterobiasis

A

Albendazole or Mebendazole is first-line treatment.

*Pyrantel pamoate as an alternate agent in pregnant patients

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88
Q

Rx of Loa loa (loasis) and Wuchereria bancrofti (lymphatic filariasis) infections

A

Diethylcarbamazine

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89
Q

Strongyloides stercoralis (Strongyloidiasis) and Onchocerca volvulus (oncoceriasis)

A

Ivermectin

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90
Q

Rx of Schistomiasis, Clonorchiasis, Paragonimiasis

A

Praziquantal

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91
Q

Mechanism for enterococci resistance to aminoglycosides (e.g. gentamicin)

A

Enterococci produce aminoglycoside modifying enzymes that transfer different chemical groups (acetyl, adenal, or phosphate) to the aminoglycosie molecule and impair antibiotic binding to ribosomal subunits.

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92
Q

Enterococci mechanism of penicillin resistace

A
  1. Production of B-lactamase

2. Production of low affinity penicillin binding protein

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93
Q

Enterococci mechanism of vancomycin resistance

A

Enterococci produce ligases that alter the D-alanyl D-alanine cell wall target of Vancomycin. Famous one switches for D-alanine D-lactate for D-alanyl D-alanine to prevent vancomycin resistnce

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94
Q

Fluroquinolone mechanism of resistance

A

mutations in DNA gyrase or topoisomerase genes prevent fluoroquinoline binding (e.g ciprofloxacin)

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95
Q

Hypospadias

A

incomplete fusion of urethral (urogenital) folds results in hypospadias, an abnormal opening of the urethra proximal to glans penis along ventral shaft

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96
Q

Epispadas

A

abnormal opening of urethra on dorsal surface . Results from faulty position of genital tubercle

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97
Q

Hydrocele

A

development of fluid filled peritoneal sac within scrotum that results from incomplete obliteration of the processus vaginalis

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98
Q

Venous drainage of gonal veins

A

Right: Right testes/ovarian vein –> IVC
Left: Left testicular/ovarian vein –> Left renal vein –> IVC

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99
Q

Endometriosis

A
  • presence of endometrial glands and stroma outside the uterus.
    Sx: dysmenorrhea (painful menstrual period), dyspareunia, and infertiility
    -
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100
Q

Endometrosis: Pathology

A

“Chocolate cysts” - collections of old blood form in endometriomas
Nodularity of uterosacral ligaments and fixed retroversion

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101
Q

Common sx of Turner syndrome

A

Primary amenorrhea
High arched palate
Widely spaced nipples
Streaked gonads (ovarian dysgenesis)

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102
Q

Turner Syndrome

A 
Monosomy (45 XO) accounts for majority of cases - due to mitotic error in early development
46 XX (with partial deletion of one X chromosome).
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103
Q

Uniparental disomy

A

individual inherits two copies of a chromosome from one parent and no copies of chromosome from other parent. Seen in Prader-Willi (paternal deletion) and Angelman’s Syndrome (maternal deletion)

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104
Q

Trinucleotide repeat

A 
Fragile X syndrome (CGG repeats)
Myotonic Dystrophy (CTG repeats)
Huntington disease (CAG repeats)
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105
Q

Polycystic Ovarian Syndrome: Sx

A

Oligomenorrhea, Obesity, Hirsuitism, and Polycystic ovaries.

*Increased risk of developing endometrial adenocarcinoma and type 2 DM

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106
Q

Causes of septic arthritis in sexually young adults

A

Commonly caused by N. gonorrhoeae (intracellular organisms) that have high neutrophil content

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107
Q

Sx of Neisseria gonorrhoae

A

common cause of septic arthritis in young adults
presents with assymetric arthritis - primarly involves knees, elbows, and distal joins
In men: urethritis
In women: PID, infertility, and ectopic pregnancy

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108
Q

Common cause of septic arthritis in children and non-sexually active young adults

A

Staph aureus

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109
Q

Blood supply of upper 1/3 of the ureter

A

Renal artery. Distally, the ureter is supplied from branches of the aorta, illiac, gonadal, and vesical arteries

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110
Q

Hyaditaform mole

A

Gestational trophoblastic disease. Occurs to fertilization of ovum with no genetic material

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111
Q

Complete hyaditiform mole

A

has no fetal structures and composed of large and edematous and disordered chorionic vill that appear as “grape-like structures). Have 46 XX karyotype – all from father

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112
Q

Partial hyaditiform mole

A

shows some gross formation of detal structures.

Results from fertilization of an ovum (with some genetic material) by two or more sperm results in 69 XXX or 69 XXY

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113
Q

Pathogen associated with dark urine and facial puffiness, Minor skin infxn weeks ago and resolved weeks. Urinanalysis has RBC casts

A

Pt has PS Glumerulonephritis. Commonly caused by Group A Strep/ Strep pyogenes (gram + cocci, that B-hemolytic and bacitracin sensitive)

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114
Q

Lymph nodes from testes drain where?

A

Para-aortic lymph nodes

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115
Q

Lymph nodes from scrotum drain where?

A

Superficial inguinal lymph nodes

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116
Q

Lymph from glans penis and clitoris drain where?

A

Superficial inguinal lymph nodes

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117
Q

Sx: Pelvic Inflammatory Disease

A

Fever greater than 38 C
Rebound abdominal tenderness
Purulent endocervical discharge
Cervical motion and adnexal tenderness

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118
Q

Molluscum contagiosum

A

Associated with chronic, localization infection in which firm, dome-sahaped, umbilicated papules erupted on the skin.

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119
Q

Common pathogens associated with PID

A

Chlamydia trachomatis and Neisseria gonorrhae

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120
Q

Pronephros

A

developed during 4th week – non-functional, fully regresses

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121
Q

Mesonephros

A 
developed in 4th week
becomes Mesonephric (Wolfian) duct
becomes Male GU components (except prostate)
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122
Q

Metaneprhos

A

developed in 5 - 6th week
Mesonephric duct forms a diverticulum called ureteric bud

Mesoderm around ureteric bud forms metanephric vessicles (blastema)

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123
Q

Mesonephric duct - Adult derivaive

A

Collecting ducts, calices, renal pelvis, ureters

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124
Q

Mesoderm

A

Renal parenchyma

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125
Q

E. coli virulence factor associated with UTIs

A

P fimbriae - permit the adhesion of E coli to uroepithelium

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126
Q

E. coli virulence factor associated with watery diarrhea

A

Heat-stable/Heat-labile toxin: promote fluid an electrolyte secretion from intestinal epithelium

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127
Q

E. coli virulence factor associated with bacteremia/septic shock

A

Lipopolysaccharide - macrophage activation causes widespread release of IL-1, IL-6, and TNF-alpha

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128
Q

E. coli virulence factor associated with neonatal meningitis

A

K1 capsular polysaccharide - prevents phagocytosis and complement mediated lysis

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129
Q

E.coli virulence factor associated with BLOODY gastroenteritis

A

Verotoxin (Shiga-like toxin) - inactivates 60S component halting ribosomal protein synthesis and causing cell death

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130
Q

Cystinuria

A

inborn defect of the transporter of cystine, ornthinine, arginine, and lysine. It is inherited in autosomal recessive fashion. Clinical manifestation: nephrolithiasis presents renal colic

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131
Q

Sx syphillis

A

sexually active young adut with single genital ulcer. Lesion is indurated and painless.

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132
Q

First line treatment for syphillis

A

Penicillin - structural analog for D-ala D-ala. Inhibits transpeptidases which catalyzes crossliknking step in peptidoglycan wall.

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133
Q

Medium for Neisseria Gonorrhoae

A

Thayer-Martin VCN - inhibits the growth of gram + organisms, gram - organisms, other than Neiserria and fungi

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134
Q

Differential media

A

differentiate cutlured organisms based on their metabolic and biochemical properties. MacConkey and EMB black agar

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135
Q

Pre-eclampsia triad

A

After 20th week of pregnancy, hypertension, proteinuria, and edema.

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136
Q

Femoral hernias

A

Are inferior to inguinal ligament, lateral to pubic tubercle, and medial to femoral vein. Present with groin discomfot or manifest with a bulge on the upper thigh

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137
Q

Rx for Chagas disease (Trypanosoma cruzi)

A

Nifurtimax

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138
Q

Most common cause of fetal hydronephrosis

A

Inadequate recanalization of ureteropelvic junction, the junction between the kidney and the ureter

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139
Q

Direct inguinal hernia

A

lie MEDIAL to inferior epigastric vessels

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140
Q

Indirect inguinal hernia

A

lie LATERAL for inferior epigastric vessels

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141
Q

Urge incontinence (or overactive bladder syndrome)

A

is caused by uninhibited bladder contractions (detrussor instability). It results in a sense of urgency. Use therapy with antimuscarinic drugs

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142
Q

Rx for BPH

A

Alpha-1 blockers - such as doxazosin, prazosin, and terazosin. Cause relaxation of smooth muscle relaation in arterial and venous walls, leading to a decrease in peripheral vascular disease. Antimuscarinic drug (targeting M3 receptors)

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143
Q

Aromatase

A

converts androgens into estrogens in the ovaries, testes, placenta, and other peripheral tissues. Genetic deficiency of this enzyme leads to an inability to synthesize estrogen. It presents with maternal virilizaton during pregnancy and masculinization.

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144
Q

Log change after addition of competitive agnoist

A

change in E50 to the right

no change in Emax

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145
Q

Log dose-response curve change after addition of non-competitive agonist

A

Change in Emax – it shifts down

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146
Q

Clear cell carcinoma

A

variant of renal carcinoma -composed of large, round or polygonal cells with clear cystoplasm.
Triad: hematuria, flank pain, and palpable mass

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147
Q

Common causes of childhood rash

A
  1. Parvovirus
  2. Measles
  3. Scarlet fever
  4. Rubella
  5. Roseola
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148
Q

Common cause of acute hemorrhagiv cystitis in children

A

Adenovirus

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149
Q

UTI Sz:

A

Dysuria and hematuria

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150
Q

Imperforate hymen - presentation

A

primary amenorrhea in a patient with fully developed secondary sexual characteristic suggests the presence of an anatomic defect in the genital tract, most commonly an imperforate hymen or a mullerian duct anomaly

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151
Q

Pudendal nerve block

A

method of anesthesia during childbirth. Provide anesthesia to majority of the perineum

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152
Q

Pudendal nerve derivation

A

S2-S4 nerve roots - innervates to the perinerium and genital (of both sexes) as motor innervation to the sphincter urethrae and external anal sphincter

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153
Q

Sequelae of mucopurulent cervicitis

A

Mucopurulent cervicitis with cervical motion tenderness is a frequent indicator of PID caused by N. gonorrhaw or Chlamydia trachomatis. PID can potentially leads to ectopic pregnancy and infertility due to salgpingitis leads to scarring of fallopian tubes if not treated appropriately.

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154
Q

Associated with primary amenorrhea with fully developed secondary characteristics

A

Suggests anatomical defect

    • imperforate hymen
    • Mullerian duct abnormality
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155
Q

Koilocytosis

A

hallmark of HPV infection

pyknotic or superficial or immature squamous cells with dense, irregularly staining cytoplasm and perinuclear clearing

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156
Q

Can Turner’s Syndrome can become pregnant?

A

Yes, but with donor oocyte.

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157
Q

Exposure odds ration

A

used tom cpmpare exposure of ppl with disease and those without disease

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158
Q

Carcinoid tumors

A

Tumor cells have eosinophilic cytoplasm and oval to round nuclei. Minimal to no variation .

  • Derived from enterochromaffin cells (endocrine) cells of intestinal mucosa.
  • Can secrete hormone-like substances (e.g. insulin, gastrin, serotonin, bradykinin)
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159
Q

Replication cycle of Hep B

A

dsDNA –> template +RNA –> progeny double DNA

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160
Q

Causative agents for hepatocellular carcinoma

A

Hepatitis B (DNA virus), Hepatitis C (RNA virus)

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161
Q

Where are dietary lipids digested and absorbed?

A

Lipids are Digested in the Duodenum and are Absorbed in the Jejuneum

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162
Q

Site of bile and B12 absorption

A

Terminal ileum

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163
Q

Urease breath test

A

Noninvasively tests for H pylori infection. Patient consumes Carbon 13 urea and his breath is then monitored for Carbon 13 labeled carbon dioxide, which would indicate presence of H. pylori product urease in the stomach

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164
Q

Acute calculous cholecystitis

A

Sx: upper abdominal pain, fever, and fever.
Laporotamy reveals partially necrotic gallbladder
-initiated by obstruction of gallbladder neck or cystic duct caused inflammation of stones in gallbladder

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165
Q

Process of acute calculous cholecystitis

A
  1. Inflammation of gallbladder wall by stones obstructing gallbladder neck or cystic duct
  2. Stones disrupt mucosal layer of gall bladder exposing it to bile salts
  3. Prostaglandins further incite inflammation of mucosa and deeper tissues leading hypomollity
  4. Distention leads to ischemia of gallbladder
  5. Bacteria invade the injured and necrotic tissue causing an infection
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166
Q

Discuss Shigella invasion of gut

A

Invades GI mucosa by first gaining access to M cells in Peyer’s patces in the ileum via endocytosis. Shigella lyses endosome, multiplies, and spreads LATERALLY to other epithelial cells, causing cell death and ulceration with hemorrhage and diarrhea

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167
Q

Lactase deficiency

A
  • Characterized by osmotic diarrhea
  • Intestinal brush border enzyme unable to break down lactose into glucose and galactose
  • Undigested lactose is unabsorbable osmotic substance and its accumulation leads to secretion of water into gut lumen
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168
Q

Causative agents of osmotic diarrhea

A
  • Polyethylene glycol, Lactose in lactase deficient patients, Magnesium hydroxide (and other magnesium containing products)
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169
Q

Discuss hormone-induced gallstones in pregnant women

A

Estrogen-induced hypersecretion and progesterone-induced gallbladder hypomotility are responsible for increased incidence of gallstones in pregnant women

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170
Q

CEA and Colon Cancer

A
  • Produced in embryonic pancres, liver, and intestine and detected in minute amounts in healthy adults.
    • Cannot be used as a screening marker, used to detect disease recurrence
  • Increased in COLON, PANCREATIC, GASTRIC, and BREAST malignancies
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171
Q

Common causes of nightblindness

A
  • Hereditary retina pigmentosum
  • Toxic retinopathy to phenothiazines
  • Vitamin A deficiency
  • Congenital rubella, syphillis, or other infections
  • Diabetic retinopathy
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172
Q

Causes of Vitamin A deficiency

A

May result from fat soluble vitamin malabsorption.

e.g. pancreatic insufficiency, biliary obstruction, celiac sprue

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173
Q

Iron absorption

A

Takes place in duodenum and proximal jejeunum

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174
Q

Gastrojejunectomy may cause malabsorption of which vitamins

A 
Vitamin B12 (because IF is bound to B12 in duodenum)
Folate
Fat soluble vitamins
Calcium
Iron
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175
Q

Location of B-oxidation of fatty acids

A

Mitochondria

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176
Q

HmG CoA lyase

A

Mitochondrial enzyme that is reponsible for ketogenesis from HMG CoA. HmG CoA results from degradation of leucine (ketogenic amino acid)

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177
Q

Location of citric acid cycle

A

Mitochrondria

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178
Q

Ornithine transcarbomamoylase

A

Catalyzes second step of urea cycle where ornithine and carbamoyl phosphate are combined to form citrulline. Takes place in mitochondria

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179
Q

Pyruvate carboxylation

A

-

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180
Q

Treatment for acute lead and mercury poisoning

A

CaNa2EDTA - forms complexes with mono-, di- , trivalent ions

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181
Q

Treatment for cyanide poisoning

A

Amyl nitrite. Forms methoglobin that binds cyanide ions forming non-toxic compound cyanomethoglobin preventing cyanide from binding to mitochondrial enzymes (Complex IV in ETC) in tissue

182
Q

Deferoxamine

A

Chelating agent used to treat iron poisoning. This kind of poisoning may occur with thalassemia patients receiving blood transfusions or patients consuming large quantities of iron

183
Q

Hyperplastic poly

A

Well-differentiated mucosal cells that from glands and crypts

184
Q

Hamartomatous polyps

A

Non-neoplastic polyps that consist of mucosal glands, smooth muscle and connective tissue.

185
Q

Inflammatory polyps

A

Non-neoplastic polyps seen in UC and Crohn’s disease. Composed of regenerated mucosal tissue

186
Q

Lymphoid polyps

A

Non-neoplastic polyps seen in children. Consist of intestinal mucosaa infiltrated w/ lymphocytes

187
Q

Treatment for arsenic poisoing

A

Dimercaprol - displaces arsenic ions from sulfylhydril groups of enzymes and facilitates their excretion

188
Q

Sx of arsenic poisoning

A

Stomach pains, vomiting, delirium and garlic order on breath

189
Q

Pathogenesis of Wilson’s disease

A

Excess of non-ceruloplasmin bound Cu which accumulates in liver, CNS lenticular nucleus, and cornea

190
Q

Treatment of Wilson’s Disease

A

Chelation therapy with penicillamine removes excess non-bound Cu

191
Q

Sx: Wilson’s Disease

A

Tremor, gait instability
Elevated serum liver transaminases
- Decreased ceruloplasmin

192
Q

Location of H. pylori

A

Greatest concentration in prepyloric area of gastric antrum

193
Q

Hepatitis D method of invasion

A
  • Referred to as delta agent, Hep. D must be coated by HBsAg of Hep B virus for infection. Can arise from acute co-infection of Hep B virus or as superinfection of Chronic Hep B carrier.
194
Q

Patients undergoing gastrectomy require life-long supplementation of which vitamin

A

Vitamin B12 (water-soluble vitamin)

195
Q

Results of lactose tolerance test for lactase deficient patients

A

Lactase deficient patients have INCREASED stool osmotic gap, increased breath hydrogen content, and decreased stool pH upon lactose challenge.
- Occurs because bacterial fermentation of lactose produces short chain Fa and excess amts of hydrogen

196
Q

Periodic, non-peristaltic contractions of esophagus

A

Diffuse esophageal spasm. May cause dysphagia and chest pain. Must do complete cardiac workup to rule out angina

197
Q

Hep E virus

A

unenveloped single stranded RNA virus spread through fecal-oral route. Seen in Asia, sub-Saharan africa.
Usually self-limited and not associated with chronic liver disease
- High mortality rate among pregnant women

198
Q

P450 inducers

A

Rifampin, Griseofulvin, Barbituates, Carbamazepine, and Phenytoin

199
Q

Discuss adenomatous polyps and aspirin

A

Although screening and timely excision of adenomatous polyps are best method.
Some adenometous polyps are linked to increased COX-2 activity thus aspirin (COX2 inhibitor) may decrease adenematous polyp formation.

200
Q

Microscopic signs of acute pancreatitis

A
  • Focal areas of fat necrosis, calcium necrosis, interstitial edema
201
Q

Susceptibility of Clostridium difficule

A

Due to absence of normal microflora of gut (can be caused by excessive antibiotics). Lack of microflora allow C. difficile to overgrow and produce Toxin A and Toxin B – can result in pseudomembranous colitis or transient diarrhea

202
Q

Causes of hepatic encephalopathy

A

Secondary to increased levels of ammonia in circulation. Often precipitaated by stressor that alters ammonia balance (e.g. GI bleeding, hypovolemia, metabolic alkalosis, hypoxia, sedative usage, hypoglycemia)

203
Q

Tx of hepatic encephalopathy

A

Lactulose. Bacterial action of lactulose will acidify colonic contents, which converts absorable ammonia into nonabsorbable ammonium ion (an ammonia trap)

204
Q

Hepatic abcess

A

fluid filled cavity in liver in conjunction with fevers, chills, and RUQ abdominal pain.
- Often caused by Staph aureus due to hematogenous seeding of liver

205
Q

Cancer risk with type B gastritis

A
  • Associated with increased risk of gastric adenocarcinoma and MALT lymphoma
  • Type B gastritis affects antrum and usually result of H. pylori
206
Q

Hindgut

A

Encompasses distal 1/3 of transverse colon, descending colon, sigmoid colon, and rectum
- Receive main arterial blood supply from inferior mesenteric artery

207
Q

Side effects of halothanes

A

May present like highly lethal hepaitis

- Patients present with elevated aminotransferase levels, prolonged prothrombin time, and eosinophilia

208
Q

Primary Billiary Cirrhosis

A

Chronic liver disease characterized by AUTOIMMUNE destruction of intrahepatic bile ducts and cholestsis

  • In precirrhotic stage, bile ducts are destroyed by granulomatous inflammation and heavy portal tract infiltrate of macrophages
  • Similar to those with graft vs. host diseae
209
Q

Microscopic effects of serious acetaminophen overdose

A

Liver failure and centrilobular necoris

210
Q

Budd- Chiari syndrome

A

Increased hepatic blood pressure due to occlusion of IVC or hepatic vein. Causes hepatomegaly, abdominal pain and ascites.
- Centrilobular necrosis and congestion observed microscopically

211
Q

Stages of Adenocarcinoma development

A
  1. Normal mucosa to small polyp (APC mutation)
  2. Increase in size of polyp (K-ras)
  3. Malignant transformation of polyp (p53)
212
Q

1st part of duodenum

A
  • near L1

- not retroperitoneal

213
Q

2nd part of duodenum

A
  • courses inferiorly from L1 to L3
  • near head of panreas
  • ampulla of Vater empties here
214
Q

3rd part of duodenum

A

courses horizontally to L3, abdominal aorta, and IVC

- close to uncinate process of pancreas and superior mesenteric artery and vein

215
Q

Transmission of Hepatitis A

A

Fecal-oral route. Frequently seen in contaminated water or food (e.g. raw or steamed shellfish)

216
Q

Hep A

A

RNA picornavirus with incubation of 30 days. Transmission via fecal-oral route.
Commonly found in contaminated food (e.g. raw shellfish in U.S>)

217
Q

Rhinoviruses

A

are picornoviruses.

Are acid-labile (not functioning if pH < 5.0) thus can’t colonize stomach (pH t cause gastroenterisis

218
Q

Abnormal rotation and fixation of midgut results in these 2 conditions

A
  1. Intestinal obstruction ( due to compression of adhesion bands) - can result in bilious
  2. Midgut volvulus - intestinal ischemia due to twisting around the blood vessels
219
Q

Explain gynecomastia in cirrhotic male patients

A
  • Cirrhotic liver unable to metabolize circulating androstenedione, thus increased estrogen
  • Increased estrogen leads to gynecomastia
  • Increase in sex hormone binding hormones, which bind free testosterone leaving more free estrogen
  • Hyperestrinism leads to spider angiomata, testicular atrophy and decreased body hair
220
Q

Giarda lambia infection

A

Injures duodenal and jejunal mucosa by adhering to intestinal brush border nd relase molecules that induce mucosal inflammatory response
Secretory IgA, impairs adherence of Giardia lambia
- IgA deficiency predisposes patients to Giarda

221
Q

Hemochromatosis - Pathogenesis

A

Genetic mutation in HFE prevents expression of HFE protein on BL side of intestinal cells where it normally binds to transferrin and regulates transferrin/Fe complex endocytosis into the cells.
- As a result, unregulated amts of Fe are absorbed gastrointestinally

222
Q

Complications of Hemochromatosis

A

Liver cirrhosis and Hepatocellular carcinoma

223
Q

TATA Box

A

Important for transcription initiation

224
Q

Transcription

A

mRNA to proteins

225
Q

Translation

A

DNA to mRNA

226
Q

Bioavailability of drug

A

fraction of administed drug that reaches systemic circulation in chemically unchanged form. In non-IV route always less than 1

227
Q

Formula for Bioavailability

A

Area Under oral curve x IV dose / area under IV curve x oral dose

228
Q

Hirschsprung’s disease

A
  • manifest in first few days of life
  • Sx: failure to pass meconium, bilious vomiting, abdominal distention, persistent constipation
  • Myenteric and submucosa plexi are absent in affected segment
229
Q

Diffuse stomach cancer

A

Signet ring carcinoma (Gastric carcinoma)

  • Linitis plastica infiltrates stomach wall and displays signet ring pattern. Cells are full of abundant.
  • Plaque like appearance and are ill-defined.
230
Q

Lab indicators of chronic alcohol abuse

A

AST:ALT ratio >2
Macrocytosis: (MCV > 100fl) - this is secondary to poor nutrition such as Vitamin B12 or folate deficiency
- Elevated GGT (gama-glutamultransferase)

231
Q

Calcium levels in acute pancreatitis

A

Hypocalcemic because large amounts of calcium bind to free fatty acids and are depositied in the necrotic areas of pancreas.
Hypocalcemia is a marker of the severity of pancreatitis

232
Q

Wilson’s disease

A
  • autosomal recessive disorder, characterized by poor Cu excretion
  • low ceruloplasmin levels
  • Sx: Kayser-Fleischer rings in eye - due to Cu deposition in the Descemet’s membrane of eye
  • Cu can cause atrophy of basal ganglia and lead to neurological symptoms
233
Q

Organisms that cause diarrhea with small inoculum

A 
Shigella (> 10 cells)
Cambylobacter jejuni (500 cells)
Entamoeba histolytica (> 1 organism)
Giardia lambia (> 1 organism)
234
Q

Shigella infection

A
  • can survive in acidic environments (stomach, bile)
  • bind to intestinal mucosal M cells for attachment and invastion
  • incubation period 24 to 72 hours
  • begins with watery diarrhea progresses to abdominal pain, bloody diarrhea, and tenesmus (urge to defecate with little stool passage)
235
Q

Esophageal varices

A

Portal circulation: Left gastric vein

Systemic circulation: Esophageal vein

236
Q

Hemorrhoids

A

Portal circulation: Superior rectal vein

Systemic circulation: Middle & inferior rectal vein

237
Q

Caput medusae

A

Portal circulation: Paraumbilical veins

Systemic circulation: Superficial & inferior epigastric vein

238
Q

Middle aged Causasian femal with long history of pruritis and fatigue now develops pale stool and xanthelasma (fat deposits underneath the skin). Presentation suggestive of what?

A

Primary billiary cirrhosis

239
Q

Primary Biliary Cirrhosis

A

Chronic liver disease characterized by autoimmune destruction of intrahepatic bile ducts and cholestasis.

  • Insiduous onset. Commonly found in middle aged woman
  • Pruritis (esp. at night) is first symptom.
  • Physical findings: hepatosplenomagal, portal hypertension, and osteopenia may develop
240
Q

Portal vein thrombosis

A

Causes portal hypertension, splenomegaly and varicosities at portocaval anastomoses. Does not cause histological changes to hepatic paranchyma.
- Causes obstruction of portal venous flow upstream from liver –> portal hypertension thus leaving liver unaffected

241
Q

Male with hx of ulcerative colitis presenting with fatigue and high alkaline phosphotase suggests what?

A

Primary sclerosing cholangitis - look for “onion skin” bile duct fibrosis and dilation with “beading” of intra- and extrahepatic bile ucts

  • Patients may have hypergammaglobunemia (IgM)
242
Q

Methods to inactivate/disinfect Hep A

A

Hep A transmitted via fecal-oral route so improved sanitary conditions are essential.

  • Water chlorination
  • Bleach (1:100 dilution)
  • Formalin
  • UV radiation
  • Boiling for 85 C for one minute
243
Q

Oral bioavailability is dependent on which factors

A
  • Absorptive properties of drug
  • First pass metabolism (via enzymes present in gut wall lumen and in liver).
    • Drugs from gut must pass through portal circulation to reach systemic circulation
    • If drug undergoes high 1st pass metabolism in liver, bioavailability of drug will be low
244
Q

Rectal drug administration vs. Oral drug administration

A

Unlike oral administration, rectal administration partially avoids 1st pass metabolism. Roughly 2/3 of rectal drug bypasses portal circulation to enter systemic drug thus increasing bioavailability.

Rectum drained by superior, middle, and inferior rectal veins. S. rectal vein drains into portal circulation via IMA. Middle & inferior rectal veins enter systemic circulation via internal illiac and internal pudendal vein
_

245
Q

Signs of achalasia

A

Decreased esophageal body peristalsis
Poor relaxation of LES
- Presents with progressive dysphagia, food regurgitation, and aspiration
- “Bird’s beak, barium swallow”

246
Q

Intestinal atresia

A
  • Atresia below duodenum ARE NOT CONGENITAL MALFORMATIONS.
  • Result of vascular occlusions IN UTERO.
  • Decreased perfusion leads to ischemia of segment of bowel, with narrowing or obliteration
247
Q

Apple-peel atresia

A

Refers to intestinal atresia (or atresia of GI tract below duodenum)

  • Are not congenital malformations but the result of vascular occlusions in utero
  • Ischemia leads to narrowing of bowel segment
248
Q

Annular pancreas

A

results from improper rotation and fusio of ventral and dorsal pancreatic buds.
- May cause duodenal stenosis

249
Q

Sx of apple-peel atresia

250
Q

Brunner’s gland

A
  • Found in submucosa of duodenum

- Secrete alkaline mucus into ducts that empty into crypts of Lieberkuhn

251
Q

Peyer’s Patches

A

unencapsulated lymphoid aggregates specific to the ileum

252
Q

Ribavirin

A
  • tx for Hepatitis C
  • induces lethal hypermutation, inhibiting RNA polymerase, and iosine monophospate dehydrogenase (depleting GTP), causing defective 5’-cap formation on viral mRNA transcripts, and modulating more effective immune response
253
Q

Tx for Chronic Hepatitis C

A
  • Interferon Alpha and Ribavrin
254
Q

Ribavirin Mechanism

A
  • Multifactorial
    1. Phosphorylated by adenosine kinase to ribavirin metabolites and can pair well with uracil or cytosine. This causes lethal hypermutation
    2. Direct inhibition of HCV RNA polymerase
    3. Deplete pools of GTP
    4. Causes defective 5’ cap formation on viral mRNA transcripts, and therefore inefficient viral translation
    5. Enhances Th1 cell-mediated immunity
255
Q

Confounding bias

A

Can be avoided in case-control studies by matching cases with controls which share same variables (e.g. race, sex, age) except for disease/exposure

256
Q

NOD2 mutation in Crohn’s disease

A

Increases the activity of NF-kB protein that increases cytokine production

257
Q

Result of terminal ileum involvement in Crohn’s disease’s pathology on terminal ileum

A

Patients with Crohn’s disease affecting terminal ileum are prone to gall stones (sx: cholicky RUQ pain).
Terminal ileum involved in bile acid recycling, but inflamed terminal ileum = more bile acid lost in feces.
Less bile acid for new bile, and ratio of cholesterol/bile acid increases. Cholesterol precipitates as gallstones.

258
Q

Cavernous hemangioma

A

most common benign liver tumor, typically found in 30-50 years old

  • congenital malformations that enlarge by ectasia
  • Well circumscribed masses of spongy consistency.
  • Patients typically assymptomatic but may have RUQ fullness
259
Q

Cavernous hemangioma

A

Tumors consist of cavernous blood-filled vascular spaces of variable size lined by single epithelial layer

260
Q

Cyanotic congenital heart disease

A 
5 T's 
Tetralogy of Fallot
Tricuspid atresia
Transposition of Great Vessels
Truncus Arteriousis 
Total Anomalous Pulmonary Venous Return
261
Q

Non-cyanotic heart disease

A

Atrial septal defect
Ventral septal defect
Patent Ductus Arteriosus
Aortic Coarctation

262
Q

Tetralogy of Fallot

A
  • Stenosis of pulmonary outflow due to assymetric division of truncus arteriosus
  • Results in right to left intracardiac shunting
    **Squatting increases systemic vascular resistance, thus meaning raising arterial pressure
    If PDA is present, this increases pulmonary blood flow via ductus (compensatory left to right shunt)
263
Q

Tetralogy of Fallot

A

Must be present:

  • pulmonary stenosis
  • VSD
  • right ventricular hypertrophy
  • overriding aorta
264
Q

Maple Syrup Urine Disease

A
  • caused by defect in alpha-keto acid dehydrogenase, leading to inability to degrade branced chain amino acids beyond alpha keto-acid state
  • Results in dystonia and poor feeding and “maple syrup scent” in neonate’s urine within first few days of life
265
Q

Tx for Maple Syrup Urine Disease

A

Dietary restriction of branched-chain amino acids

266
Q

Sx for Prinzmetal’s (variant) angina

A
  • Episodic and transient anginal chest pain at night
  • accompanied by temporary ST elevations
  • Coronary artery vasospasm may occur near areas of atherosclerosis
  • Ergonovine test most sensitive for vasopasm
267
Q

Ergonovine test

A
  • most sensitive test for coronary vasopasm (Prinzmetal’s (variant) angina
268
Q

Ergonovine

A
  • ergot alkaloid that constricts vascular smooth muscle by stimulating both alpha-adrenergic and serotonergic receptors.
  • Can induce vasopasms, chest ain, and ST segment elevations Prinzmetal’s angina
269
Q

pure MOTOR hemiparesis caused by

A

infarct in POSTERIOR LIMB of internal capsule

270
Q

pure SENSORY stroke caused by

A

infarct in ventroposterolateral or ventroposteromedial thalamus

271
Q

Ataxia-hemiplegia syndrome caused by

A

infarct in the base of the pons

272
Q

Dysarthria-clumbsia hand syndrome caused by

A

infarct in the base of the pons or genu of the internal capsule

273
Q

Lacunar infarcts

A
  • small ischemic infarcts (<15mm), usually involving basal ganglia, pons, internal capsule or deep white matter of the brin.
  • Often due to hypertensive arterioscleroris of small, penetrating arterioles
274
Q

Vertical diplopia

A
  • patient has trouble reading newspaper or walking downstairs
  • characterized by trochlear nerve palsy
  • Superior Oblique
275
Q

Lesion in Medial Longitudinal Fasiculus

A

Associated with internuclear ophthalmoplegia, which presents with impaired horizontal eye movement and weak adduction of affected eye with simultanous adduction nystagmus of contralateral eye

276
Q

CMV presentation in immunocompentent patients

A

Mononucleosis-like syndrome that is Monospot NEGATIVE

277
Q

CMV presentation in immunocompromised patients

A
  • Severe retinitis
  • Pneumonia
  • Esophagitis
  • Colitis
  • Hepatitis
278
Q

Amytrophic Lateral Sclerosis

A
  • causes both upper and lower motor neuron lesions
  • Loss of anterior horns of spinal cord (LMN) causes muscle weakness and atrophy
  • Demyelination of lateral cortical spinal tract (UMN) leads to spasticity and hypereflexia
279
Q

Tx for ALS

A

Rilulzole - decreases glutamate release

280
Q

Mental Status Exam - Testing for Orientation

A

Providing name, location, and current date

281
Q

Mental Status Exam - Test for Comprehension

A

Following multi-step commands

282
Q

Mental Status Exam - Test for Concentration

A

Reciting months of year backwards, Serial 7s, spelling “WORLD” backwards

283
Q

Mental Status Exam - Test for Short Term Memory

A

Recalling three unrelated words after 5 minutes

284
Q

Mental Status Exam - Test for Long Term Memory

A

Providing details of significant life events

285
Q

Mental Status Exam - Test for Languae

A

Writing a sensible sentence containing a noun and a verb

286
Q

Mental Status Exam - Test for Visual Spacial

A

Drawing a clock face

287
Q

Congenital Torticollis

A
  • noted by 2 - 4 weeks of age, when child prefers to hold head tilted to one side
  • Result of malposition of head in utero or birth trauma
  • Rarely due to spinal abnormalities
288
Q

Maternal hypertension has what potential effects on baby?

A

Assymetric growth restriction, characterized by normal or almost normal head size with reduced abdominal circumference

289
Q

Sx of acute intermittent porphyria

A
  • Abdominal pain and neurological manifestations
  • No photosensitivity
  • Urine darkens (port wine color) upon standing
  • Increased urinary ALA (Aminolevulinic Acid) and porphobiinogen (PBG)
290
Q

Rate limiting enzyme in heme biosynthesis

A

ALA synthase - catalyzes reaction to condense succinyl CoA + glycine to form ALA

291
Q

Acute Intermittent Porphyria

A
  • deficiency of HMB synthase which converts porphobillinogen (PBG) to hydroxymethylbilane (HMB)
292
Q

Enzyme deficiencies in early part of porphyrin synthesis (BEFORE condensation of porphobilinogen) causes what symptoms?

A

Neurological symptoms WITHOUT photosensitivity

293
Q

Enzyme deficiencies in the latter stages of porphyrin synthesis (AFTER porphobillinogen synthesis) causes what type of symptoms?

A

Photosensivity. Exposure of urine to light in patients excreting excess quanities of porphyrinogen results in light induced formation of pophyrins and darkening color of urine

294
Q

What substances suppress ALA synthase activity?

A

Glucose.

- Glucose loading suppresses ALA synthase, thus alleviating abdominal pain and neuropsychiatric manifestationas of AIP

295
Q

What substances enhance ALA synthase activity

A

Alcohol, Barbituates, Hypoxia . They can exacerbate AIP

296
Q

Beta- blockers have what effect on the cardiac cycle? How does this appear on EKG?

A
  • Beta-blovkers slow AV conduction

- Delayed AV conduction causes PR interval prolongation

297
Q

Noise-induced hearing loss results from what?

A

Trauma to the stereocilliated hairs of the Organ of Corti.

Usually prolonged exposure to sounds > 85dB

298
Q

Transduction of mechanical auditory forces

A
  1. Sound reaches the middle ear by vibrating tympanic membrane
  2. Vibration transferred to oval window by ossicles
  3. Vibration of oval window causes virbration of basilar membrane, which bends air cilia towards tectorial membrane
  4. Hair cell bending causes oscillating hyperpolarization and depolarization of auditory nerve, thus creating nerve impulses from sound
299
Q

Discuss phosphodiesterase inhibitors and cardiac contractility

A

Phosphodiesterase inhibitors increase cardiac contractility via increased intracellular cAMP .

  • cAMP increases intracellular calcium in cardiac myocytes normally metabolized by phosphodiesterases.
  • In vascular smooth muscle, increased cAMP vauses vasodilation
300
Q

Mutation sites associated with early onset Alzheimer’s

A
  1. APP gene on chromosome 21
  2. Presenilin 1 gene on chromosome 14
  3. Presenillin 2 gene on chromosome 1
301
Q

Late onset Alzheimer’s gene is associated with what genotype

A
  • Apolipoprotein E4
302
Q

Familial hypercholesteremia

A
  • Autosomal dominant disorder
  • associated with defect in LDL receptor
  • leads to decreased hepatic LDL uptake and severe elevation in total cholesterol and LDL levels
303
Q

Paroxysmal supraventricular tachycardia

A
  • common dysrhytmia which occurs in patients with no other heart disease
  • caused by a re-entrant circuit in the AVE node
  • Usually treated with adenosine (in-patient setting), but vagal maneuvers (such as carotid massage or Valsalva) work too
304
Q

Tx for Paroxysmal supraventricular tachycardia

A 
Adenosine (in-hospital)
Vagal maneuvers (carotid massage or valsalva)
305
Q

Carotid sinus baroreceptor decreases in which states

A
  • Decreases in low-pressure states, causing increased stimulation of sympathetic nervous system, increased heart rate, and total peripheral vascular resistance
306
Q

Neurofibromatosis Type 1 (NF1 - von Recklinghausen’s disease)

A
  • common autosomal disorder resulting from defect of NF-1 gene on chromosome 17
  • cutaneous and subcutaneous neurofibromas are common
  • tumors are from Schwann cells, derived from neural crest
307
Q

Neuroectoderm derivatives

A 
CNS neurons
Neurohypophosis (posterior pituitary)
Retina
Pineal gland
Preganglionic Autonomic fibers
Astrocytes
Ependymal Cells and Choroid plexus
308
Q

Endoderm derivatives

A

Thyroid tissues (descent from tongue)
Epithelial linings of GI tract, lung, urethra, bladder, and outer/middle ear
- Most of liver, pancreas, lungs

309
Q

Surface ectoderm

A

Skin (epidermis) and its appendages
Nasal and oral epithelium
Anal epithelium to ABOVE dentate line
Lens and Cornea

310
Q

Notochord derivative

A

Nucleus pulposus - in intervertebral discs

311
Q

Mesoderm

A

Gives rise to muscles, bones, blood, genital tissue, dermis and most organ systems.
* No epithelial tissues

312
Q

Arnold-Chiari malformaton

A
  • due to underdevelopment of posterior fossa
  • small fossa causes parts of cerebellym and medulla to herniate through foramen magnum
  • There are two types
313
Q

Arnold-Chiari malformation - type I

A
  • underdevelopment of posterior fossa
  • low-lyng cerebellar tonsils extend below foramen magnum into vertebral canal
  • may be asymptomatic in infants, but manifests as headaches and cerebellar symptoms (ataxia)
314
Q

Arnold-Chiari malformation - type II

A
  • more severe and symptomatic during neonatal period
  • characterized by abnormally formed cerebellym and medulla
  • both the cerebellar vermis and medulla extend downward
  • myelomeningocele and hydrocephalus are ALWAYS present
315
Q

Sx of Arnold Chiari malformation - type II

A
  • symptoms of compressed medulla (e.g. difficulty swallowing, dysphonia, stridor, apnea)
  • Lumbar myelomeningocele leads to leg paralysis
  • Untreated hydrocephalus leads to mental impairment
316
Q

Guillain- Barre syndrome

A
  • demyelinating syndrome of peripheral nerves characterized by ascending muscle weakness and paralysis
  • 30% instances attributed to Campylobacter jejuni infection, common cause of diarrhea
317
Q

Tx of chronic dry cough caused by ACE Inhibitor (-pril)

A

Replacment of ACE inhibitor with an angiotensin receptor blocks (e.g. losartan)

318
Q

Indications for ARB

A
  • Treatment for hypertension and diabetic nephropathy

- Don’t interfere with bradykinin catabolism thus won’t cause chronic cough associated with ACE inhibitors

319
Q

Aspirin

A
  • used to treat angina pectoris
  • prevents platelet thrombus by inhibiting thromboxane A2 synthesis and platelet aggregation
  • allergic reaction: shortness of breath and wheezing
320
Q

Tx for patients with angina pectoris who allergic to aspririn (sx of shortness of breath and wheezing)

A

Clopidogrel - antiplatelet agent that inhibits platelet surface ADP receptor.

321
Q

Streptokinase

A

thrombolytic agen used in acute management of thromboembolic event such as CV accidents and myocardial infarctions

322
Q

Occlusion of right coronary artery leads to what? EKG depiction?

A
  • Transmural ischemia of inferior wall of left ventricle

- ST elevation in leads II, III, and aVF and possible sinus node dysfunction

323
Q

Occlusion of proximal LAD leads to what? EKG depiction?

A
  • Results in transmural anteroseptal ischemia of the left ventricle
  • ST elevation on leads V1-V4
324
Q

Occlusion of LCX leads to what? EKG depiction?

A
  • Results in transmural lateral wall ischemia of left ventricle
  • ST elevation in V5-V6 and possibly I and aVL
325
Q

Occlusion of left main coronary artery leads to what? EKG depiction?

A
  • Transmural ischemia of the interventricular septum and left ventricle wall
  • ST elevation in all V leads (V1 - V6) and possible leads I and aVL
326
Q

Why is skeletal muscle resistant to Ca channel blockers unlike cardiac and smooth muscle?

A

Because it does not require influx of intracellular calcium for excitation-contraction coupling.
-Cardiac and smooth muscle depend on extracellular calcium entering the cell via voltage-gated Ca L-type cells for excitation-contraction coupling

327
Q

Targets of Ca channel blockers

A

Voltage gated L-type calcium channels on cardiac and smooth muscle cells.

328
Q

Discuss skeletal muscle contraction

A
  • Depolarization of cell membrane opens L-type Ca channels present on myocyte’s T-tubule system
  • Results in opening of RyR1 calcium channels present within sarcoplasmic membrane, resulting in release of Ca from SR
  • NO SIGNIFICANT INFLUX of EXTRACELLULAR Ca
329
Q

Thenar muscles

A

Think “OAF” pollicis

  • Opponens pollicis
  • Abductor pollicis brevis
  • Flexor pollicis brevis
330
Q

Thenar muscles innervation

A

Innervated by median nerve

331
Q

Hypothenar muscles

A

Think “OAF” digiti minimi

  • Opponens digiti minimi
  • Abductor digiti minimi
  • Flexor digiti minimi
332
Q

Hypothenar muscles innervation

A

Ulner nerve

333
Q

Dorsal interosseous muscles

A

Think “DAB”

Abduct fingers

334
Q

Palmar interosseous muscles

A

Think “PAD”

Adduct fingers

335
Q

Lumbrical muscles

A
  • flex at MCP joint

- extend PIP and DIP joints

336
Q

3rd and 4th interosseous muscles innervation

A
  • This includes ring finger and pinky

- Innervated by ulnar nerve

337
Q

1st and 2nd interosseous muscle innerrvaton

A
  • This includes index and middle finger

- Innervated by median nerve

338
Q

Rotator cuff muscles

A 
SIts (small t for teres minor)
Supraspinatus
Infraspinatus
teres minor
Subscapularis
339
Q

Supraspinatus muscle

A
  • abducts arm for first 10-15 degrees before deltoid takes over
340
Q

Infraspinatus muscle

A
  • Laterally rotates arm

- Involved in pitching injury

341
Q

teres minor

A
  • ADducts arm

- Laterally rotates arm

342
Q

Subscapularis muscle

A
  • ADducts muscle

- Medially rotates arm

343
Q

Innervation of rotator cuff muscles

344
Q

Unhappy triad injury

A
  • Common in contact sports, due to lateral force on planted leg
  • Consists of ACL, MCL, and lateral meniscus tear
345
Q

ACL

A

ligament attaches:

  • ANTERIOR tibial surface
  • LATERAL condyle of femur
346
Q

PCL

A

ligament attaches:

  • POSTERIOR tibial surface
  • MEDIAL condyle of femur
347
Q

Lateral EPIcondylitis of humerus

A
  • commonly known as “tennis elbow” due to repetitive damage of elbow and tendons
348
Q

Medial EPIcondylitis of humerus

A
  • commonly known as “golfer’s elbow” due to repetitive damage of elbow and tendons
349
Q

Organization of Brachial Plexus

A 
Think "Randy Travis Drinks Cold Beer"
R-oots
T-runks
D-ivisions
B-ranches
350
Q

Roots of Brachial Plexus

351
Q

Trunks of Brachial Plexus

A
  • Upper
  • Middle
  • Lower
352
Q

Branches of Brachial Plexus

A

Extensors: Axillary and Radial
Flexors: Musculocutaneous, Median, Ulnar
-

353
Q

Erb’s palsy

A
  • Lesion of upper trunk of brachial plexus (C5-C6)

- Seen in infants following trauma during delivery or football player landing on space between head and shoulder

354
Q

Sx of Erb’s palsy

A
  • Waiter’s tip
  • Limb hangs by side (paralysis of abductors)
  • Medially rotated (paralysis of lateral rotators)
  • Forearm is pronated (loss of biceps)
355
Q

Klumpke’s palsy

A
  • childbirth/embryological defect affecting lower trunk of brachial plexus (C8, T1)
  • Cervical rib can compress subclavian artery and inferior trunk, resulting in thoracic outlet syndrome
356
Q

Sx of Thoracic Outlet Syndrome

A
  • Atrophy of thenar and hypothenar muscles
  • Atrophy of interosseous muscles
  • Sensory deficits on MEDIAL side of forearm and hand
  • Disappearance of radial pulse upon moving head towards ipsilateral side of lesion
357
Q

Carpal tunnel syndrome

A

Injury to median nerve

*Note palm sensation is not affected as palmar cutaneous branch of median nerve doesn’t run through carpal tunnel

358
Q

Axillary nerve . Roots? Typical Injury?

A

C5, C6

  • Fractured surgical neck of humerous
  • Dislocation of humeral head
359
Q

Axillary Nerve Injury

  • Motor Deficit?
  • Sensory Deficit?
A

Motor Deficit: Deltoid - Can’t abduct arm at shoulder

Senosry: Over deltoid muscle

  • Atrophied deltoid
360
Q

Radial Nerve

  • Roots?
  • Typical Injury?
A
  • C5 - T1
  • Fracture at midshaft of humerous
  • Saturday Night Palsy (extended compression of axilla by back of chair or crutches)
361
Q

Radial Nerve Injury

  • Motor Deficit?
  • Sensory Deficit?
A 
Motor Nerve Deficit: - Loss of "BEST" extensors
B-rachioradialis
E-xtensors of wrist and fingers
S-upinator
T- riceps

Sensory Nerve Deficit: Loss of sensation in posterior arm and dorsal hand and thumb

362
Q

Sign of Radial Nerve Injury:

A

Proximal injury: wrist drop and tricep weakness

Distal injury: wrist drop only

363
Q

Median Nerve

  • Roots?
  • Typical Injury
A

C5 - C8, T1

- Fracture of supracondylar humerous (proximal lesion)

364
Q

Median Nerve Injury

  • Motor Deficit?
  • Sensory Deficit?
A

Motor Deficit: Failure to oppose thumb,
Unable to laterally flex finger, unable to radially flex wrist

Sensory Deficit: Loss of sensation in dorsal and palmar aspects of lateral 3.5 fingers, thenar eminance

365
Q

Median Nerve Injury Sign

A
  • Ape Hand

- Pope’s blessing

366
Q

Ape Hand

A

Proximal median nerve lesion

- Loss of opponens pollicis muscle function thus unable to oppose (abduct) thumb

367
Q

Pope’s Blessing

A

Proximal median nerve lesion

  • Unable to laterally flex finger and unable to oppose thumb
  • When asked to make a fist, 1st, 2nd, and 3rd fingers remain extended and thumb remains unopposed
368
Q

Ulnar nerve (Roots, Typical Injury)

A
  • C8, T1
  • Fracture of medial epicondyle of humerus “funny bone” (proximal lesion)
  • Injury to hook of hamate
369
Q

Ulnar Nerve Injury

  • Motor Deficits
  • Sensory Deficits
A

Motor Deficit: Unable to medially flex finger, unable to do ulnar wrist flexion

Sensory Deficit: Loss of sensation on medial 1.5 fingers, and loss of sensation on hypothenar eminance

370
Q

Sign of ulnar nerve injury

A

Radial deviation of wrist upon wrist flexion

- Ulnar claw (inability to extend 4th and 5th finger when trying to open hand)

371
Q

Ulnar claw

A

Caused by injury to ulnar nerve at hook of hamate (e.g. falling onto outstretched hand)
- Distal ulnar nerve lesion - loss of medial lumbrical function - inability to extend 4th and 5th digits

372
Q

Median claw

A

Caused by carpal tunnel syndrome or dislocated lunate

- Distal median nerve lesion, loss of lateral lumbricals function, 2nd and 3rd are clawed at attempted extension

373
Q

Musculocutaneous (Roots, Typical Injury)

A

C5 - C7

- Injured by upper trunk compression

374
Q

Musculocutaneous Nerve Injury (Motor and Sensory Deficits)

A

Motor deficit: Loss of biceps, brachialis, coracobrachialis, loss of flexion of arm at elbow

Sensory deficit: Loss of sensation in lateral forearm

375
Q

Klumpke’s total claw

A

Lesion of lower trunk (C8, T1) of brachial plexus

  • Clawing of all fingers
  • Loss of function of ALL lumbricals
  • forearm finger flexers (median nerve w/ C5 - C7) and finger extensors (fed by radial nerve) are unopposed
376
Q

Long Thoracic Nerve

A

innervates seratus anterior - anchors scapula to thoracic cage
- Used for abduction above horizontal position

377
Q

Injury to Thoracic Nerve

A

Can be injured during mastectomy

- Winged scapula and ipsilateral lymphedema

378
Q

Obturator Nerve (Roots, Cause of Injury?)

A

L2-L4

Injured by anterior hip dislocation

379
Q

Sx of Obturator Nerve Injury

A

Motor Deficit: Unable to ADduct thigh (Patients present with externally rotated and abducted thigh)

Sensory Deficit: Loss of sensation in medial thigh

380
Q

Femoral Nerve (Roots, Cause of Injury)

A

L2 - L4

Injured by pelvic fracture

381
Q

Sx of Femoral Nerve Injury

A

Motor Deficit: Unable to flex thigh and unable to extend leg

Sensory Deficit: Loss of sensation in anterior thigh and medial leg

382
Q

Common Peroneal Nerve (Roots, Cause of Injury)

A
  • L4 - S2

- Injured by trauma or compression of lateral aspect of leg or fibula neck fracture

383
Q

Sx of Common Peroneal nerve injury

A

Motor Deficit: Unable to evert and dorsiflex foot, and unable to extend toe
- Pt presents with slapped feet

Sensory Deficit: Loss of sesnation of anterolateral leg and dorsal aspect of foot

384
Q

Superior gluteal nerve (Roots, Cause of injury

A

L4 - S1

- Injured by posterior hip dislocation (e.g. slamming into dash board) or polio

385
Q

Sx of superior gluteal nerve injury

A

Motor: Unable to ABduct thigh
Trandelenburg sign - contralateral hip drops when standing on leg ipsilateral to lesion site

  • No Sensory deficit
386
Q

Tibial Nerve (Roots, Cause of Injury)

A

L4 - S3

- Knee trauma (esp. to popliteal area)

387
Q

Sx of Tibial Nerve Injury

A

Motor Deficit: Unable to invert and plantarflex foot

Sensory Deficit: Loss of sensation on sole of foot

388
Q

Inferior gluteal nerve (root, cause of injury)

A

L5 - S2

Posterior hip dislocation

389
Q

Sx of Inferior Gluteal nerve Injury

A

Motor deficit: Unable to jump, climb stairs or rise from seated position. Can’t push downward

390
Q

Lateral sural cutaneous nerve

A

Cutaneous branch of tibial nerve

- Supplies sensation to calf

391
Q

Most likely diagnosis:

Patient presents with first time seizure with family hx of skin cancer and lesion on axilla

A

Melanoma – malignancy of melanocytes (derived from neural crest)

392
Q

Cause of hypercalcemia in sarcoidosis

A

Caused by increased extra renal formation of 1,25 dihydroxy Vitamin D by activated macrophages

  • This suppresses PTH secretion
393
Q

Niacin (Vitamin B3 is synthesized from which amino acid?

A

Tryptophan.

Niacin makes NAD+

394
Q

Deficiency of Vitamin B3 (Niacin) presents as what?

A
  • Pellagra (3 D’s) -

Dermatitis, Diarrhea, and Dementia

395
Q

Arginine is a precursor for which substances?

A 
Nitric Oxide
Urea
Ornithine
Agmatine
Creatinine
396
Q

Hydroxylation of proline and lysine residues for collagen formation occurs where?

A

IN RER and requires Vitamin C as a co-factor.

*Note terminal peptide cleavage and collagen occur in extracellular space

397
Q

Sx of Vitamin C deficiency

A

Gingival bleeding
Petechiae
Ecchmymoses (bruises)
Perifollicular hemorrhages

398
Q

BRAF

A

protein kinase involved in signaling pathways for melanocyte proliferation/
BRAF V600E is common in patients with melanoma

399
Q

Gene mutations associated with Glioblastoma

A

Overexpression of growth factor PDGF, EGFR, IGF, TGF

400
Q

Actinic keratosis

A

Develop in chroncically exposed areas of skin.
LEsions consist of erythematous papules with central scale and a “sandpaper” like texture
- Can convert to SCC in 1% of cases

401
Q

Pityriasis rosea

A
  • Herald patch that presents as brown/pink scaly patch with central clearing on trunk, neck, or extremities
  • Followed by development of maculopapular rash in “Christmas tree” distribution
402
Q

Methotrexate

A
  • preferred disease modifying treatment for moderate to severe rheumatoid arthritis
  • inhibits dihydrofolate reductate to reduce folic acid synthesis
  • ## Side effect: mouth ulcers, hepatotoxicity, myelosuppresion, increased risk for infections
403
Q

Hydroxychloroquine

A
  • used to treat mild rheumatoid arthritis but frequently used in SLE
404
Q

Type I muscle fibers

A
  • require actions requiring low-level sustained force (e.g. postural maintance)
  • primarily aerobic metabolism, thus high myoglobin (oxygen storage) and mitochondria
405
Q

Type II muscle ffiber

A
  • generate rapid forceful pulses of movement
  • ## derive ATP energy though ANAEROBIC glycogenolysis and subsequent glycolyis
406
Q

Zidovudine

A
  • also known as AZT and treats HIV infxn
  • nucleoside reverse transcriptase inhibitor
  • Is incorporated into viral genome as thymidine analog
  • doesn’t have 3’OH group, making 3’ - 5’ phosphodiesterase bond formation
407
Q

Prepatellar bursitis

A
  • dubbed “housemaid’s knww)
  • commonly seen in roofers, carpenters, plumbers
  • sx: knee pain, erythema, swelling, and inability to kneel on affected side
408
Q

Anserine bursitis

A

Presents with pain along medial aspect of kneww

- Results from overuse in atheletes or chronic trauma from heavy patients

409
Q

Porcelain gallblader

A
  • describes bluish, brittle calcium laden gallbladder that develop in patients with chronic cholecystis
  • usually found by accident
  • patients are HIGH risk for gallbladder carcinoma and thus should have cholecystectomy
410
Q

Definitive test for acute cholecystitis

A

Positive HIDA test confirms cystic duct obstruction

- Nonobstructive billiary stones seen on ultrasound are suggestive but not diagnostic

411
Q
  • Child who presents with febrile maculopapular rash that begins in face and spreads to trunk. Also has posterior auricular lymphadenopathy
A

Rubella - associated with Togavirus

412
Q

Sx of parvovirus

A
  • One of 5 childhood rash disease

- Characterized by redness in cheeks (“slapped cheeks”) followed by maculopapular rash on extremities and trunk

413
Q

All patients beginning treatment with TNF-alpha should be tested for what disease?

A

TB - as TNF alpha can reactivate latent TB

414
Q

Psoas abscess

A
  • can be the result of hematengous or lymphatic spread of infection
  • patients present with fever, back or flank pain, inguinal mass or difficulty walking
  • pain exacerbated by movements that stretch psoas muscle to be stretched or extended
415
Q

Psoas sign

A

Pain caused by extension or stretch of psoas muscle such as hip extension - due to inflammation of psoas muscle
- Patients usually try to prevent psoas extension with hip flexion or lumbar lordois

416
Q

Presbyopia

A
  • Occurs to due sclerosis of lens
  • Age-related condition that occurs 40-50 years of age
  • Difficulty reading fine print, eye strain after rading and need to hold objects farther from eye
  • In myopic (near-sighted) ppl, this can improve distant vision
417
Q

Accomodation of lens

A
  • change in optical power of lens to maintain image focused on retina
  • when eye is focused on near object, contraction of ciliary muscle causes relaxation of zonular fiber allowing lens to relax and assume more convex shape
418
Q

Femoral head osteonecrosis

A

Associated with vasculitis, corticosteroid therapy, sickle cell disease, and alcholism

  • Can occur in children in Legg-Calve Perthes disease
419
Q

Vitamin deficiency in children

A
  • Aside from perifollicular hemorrhages, easy bruisng, and gum disease, children present with bony deformities and subperiosteal thinning
420
Q

Muscles used when sitting up from supine position

A
  • External abdominal oblique and rectus abdominus, and hip flexors
  • Psoas major, Psaos minor, and illiacus are important for hip flexus
  • Rectus femoris, satorius, tensor fascia lata, and medial compartment of thigh are important for hip flexion
421
Q

Adverse effects of chronic corticosteroid administration

A

Atrophy/thinning of dermis that is associated with loss of dermal collagen, drying, cracking and/or tightening of skin, telangiectasia and ecchymoses.

422
Q

PCL

A
  • attaches posterior tibial surface to medial condyle of femur
  • prevents posterior displacement of tibia relative to femur
  • positive drawer test - allows posterior displacement of tibia
423
Q

Correlation co-efficient

A

ranges between -1 and 1

  • decscribes the STRENGTH and POLARITY of an association
  • positive correlation, if X gets bigger then Y gets bigger (vice versa)
  • negative correlation, if X gets bigger, then Y gets smaller (vice versa)
424
Q

CREST Syndrome

A

C-alcinosis
R-eynaud’s phenomenon
E-sophageal dysmotility (associated w/ CREST)
S-clerodactyly (non-pitting edema of hands)
T-elangiectasia

425
Q

Antibodies associated with CREST syndrome

A
  • Anti- centromere
426
Q

Antibodies associated with systemic sclerosis

A

Anti-DNA topoisomerase (Scl-70)

427
Q

Karposi’s sarcomi is associated with which virus?

A
  • Associated with HHV-8
  • occurs in HIV patients which are infected by HHV-8
  • Lesions are found on extremities, head, and neck and are dark brown/violet in color
428
Q

Atopic dermatitis

A
  • Common childhood inflammatory disorder that presents red papules ad plaques in response to environmental antigens
  • associated with other atopic disease like allergic rhinitis and asthma
429
Q

A-delta fibers

A

thin, myelinated fibers which detect pain and temperature

- associated with sharp pain and represent afferent portion of reflex arc that allows withdrawal from harmful stimuli

430
Q

Intrafusal fibers

A
  • also known as muscle spindles
  • connected in PARALLEL with extrafulal fibers
  • innervated by group 1a and II sensory axons and are sensitive to changes in muscle length
431
Q

Muscle spindles and stretch reflex

A

Muscle spindles mediate stretch flex. so that when muscle is streched, there is a monosynaptic activation of alpha motor neuron (of same muscle), causing contraction that resists stretch

432
Q

Muscle spindle system

A

Feedback system that monitors and maintains muscle length

433
Q

Golgi tendon system

A

feedback system that monitors and maintains muscle tone.
GTOs (in SERIES with contracting extrafusal muscle fibers) are sensitive to increases in muscle tension but are insensitive to passive stretch.

434
Q

Panician corpuscles

A
  • rapidly adapting mechano receptors located in subcutaneous tissue of skin, mesentary, peritoneum, and joint capsules
435
Q

PABA-containing suncreens protect skin from which types of ultraviolet radiation?

436
Q

UVB radiation

A
  • major cause of ultraviolet radiation burns (sunburns), histological skin damage, UVR-induced immunosuppression, skin aging, photocarcinogenesis that damage skin components and cellular DNA
437
Q

Zinc-oxide sunscreens protect against which UV wavelentghts

A

UVB, UVAI and UVAII wavelenghts

438
Q

Psoriasis

A
  • characterized by hyperparakeratosis, acanthosis, rete ridge elongation, mitotic activity above basal layer and thinned stratum granulosum
  • may form Munro microabcesses (spongiotic clusters in perakeratotic structures
439
Q

Valsalva manuever

A
  • increases vagal tone and can be used to abolish paroxysmal supraventricular tachycardia (common arrhythmia in ppl w/o other heart problems)
  • RECTUS ABDOMINUS is important muscle in achieving the increased intraabdominal and intrathoracic
440
Q

Gluteus maxiumus

A
  • innervated by ingeror gluteal nerve and major hip extensor
441
Q

Gluteus minimus

A
  • innervated by superior gluteal nerve

- prevents contralateral (non-weightbearing) side of pelvis from dipping when that leg is elevated off ground

442
Q

Collagen synthesis

A
  1. Pro alpha-collagen enters RER
  2. Hydroxylation of selected proline and lysine residues (Vitamin C dependent)
  3. Glycosylation of selected lysine residues
  4. Assembly of pro-a-chains into triple helix
  5. Secretion of pro-collagen into Golgi and extrusion to ECM
  6. N- and C- terminal propetide cleave by propeptidase
  7. Collagen fibril
  8. Covalent cross-links for mature collagen fiber by LYSYL Oxidase
443
Q

Lysyl oxidase

A

After procollagen extrusion into ECM, and N- and C- terminal propeptide cleave, LYSYL OXIDASE forms covalent cross-links to form mature collagen fibers

444
Q

Defective N- and C- termini of procollagen

A
  • Forms soluble collagen that doesn’t cross-link with other collagen moclules
  • Results in joint laxity, loss skin, and easy bruisability seen in Ehrlos-Danlos
445
Q

Region in sacromere that only contains thick myosin filaments

A

H-band

- part of A-band on either side of M line where myosin thick filaments do not have any overlapping actin filaments

446
Q

Which region(s) of sarcomere do not shorten during muscle contraction

A

A band - region where thick myosin filaments overlap with thin actin filaments

447
Q

Which region(s) of sarcomere shorten during muscle contraction

A

H- band (only region with only thick myosin filaments)

I - band region with only thin actin filaments

448
Q

Indications for urosuric agents

A
  • Probenecid and sulfinpyrazone
  • only effective in patients with good renal function and adequate renal flow
  • should avoided in those excrete excessive amts of uric aid (>700 mg/24 hrs) to prevent uric acid stones or those with kidney stones
449
Q

Indications for long-term therapy

A
  1. Macroscopic tophaceous deposits
  2. More than 3 episodes of gout/year
  3. Uric acid stones
  4. Gross elevation of serum uric acid levels
450
Q

Allopurinol

A
  • ## best long-term treatment choice for chronic tophaceous group regardless of urinary excretion of acid

USMLE Step 1 (34 decks)

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