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Step1 > Things I struggle with Part 3 > Flashcards

Things I struggle with Part 3 Flashcards

1
Q

VPL nucelus

A

spinothalamic and dorsal columns/medial lemniscus- pain and termpature, pressure, touch, vibration, proprioception. first degress somatosensory

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2
Q

VPM nucelus

A

trigemenial and gustatosy- facial and taste sensation

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3
Q

LGN nucleus

A

CNII for ision

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4
Q

medial geniculate nucleus

A

superior olive and inferior colliculus of the tectum for hearing

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5
Q

ventral lateral nucelus

A

basal ganlgia and cerebellam for motor

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6
Q

limbic system- what are parts of it and function

A

hippocampus, amygdala, cingulate gyrus, and feeding, feeling, fighting, fleeing, fucking

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7
Q

mesocortical pathway

A

decreased activity leads to the negative symptoms of schizophrenia

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8
Q

mesolimbic pathway

A

increased activity leads to positive sympotms- target of anyipsychotic drugs

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9
Q

nigrostriatal patwhay

A

decreased activity leads to EPS symptoms-

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10
Q

tuboinfundibular pathway

A

decreased activity leads to increased prolactin

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11
Q

cerebeller lesion affects ipsi or contral

A

ipsilateral lesion=ipsi defect

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12
Q

the nuclei of the cerebellum from the lateral to mesail

A

dentate, emboliform, globose, fastigal

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13
Q

lateral cerebellar lesions do what

A

affect voluntary movement of extremities when injured there is propensity to fall towards the injured side

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14
Q

medial lesions of the cerebellum do waht

A

involvement of midline structures- tranquil ataxia, nystagmus, head tilting- bilateral axial defects

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15
Q

what does the basal ganglia do

A

it provides feed back to the cortex to modulate the movemetn

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16
Q

excitatory pathway of the basal ganglia

A

cortical inputs stimulate the striatum, stimulating the release of GABA which inhibits GABA release from the GPi disinhibiting the thalamus via GpI to increase motion

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17
Q

inhibitory pathway of the basal ganglia

A

cortical inputs stimulate the stiratum releasing GAB that disinhibits STN via GPe inhibition and STN stimulates GPi to inhibit the thalamus so decreased motion

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18
Q

dopamine in the basal ganglia

A

it binds D1 and this stimulates the excitatory pathway and D2 binds the inhibitory pathway to increase motion

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19
Q

athetosis

A

slow writhing movements especially with the fingers from the basal ganglia- writhing snake like movements

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20
Q

chorea

A

sudden jerky movemntts thatare purposeless from the basal ganglia

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21
Q

dystonia

A

sustains involuntar muscle contractions- like writers cramp and blepharspams eye lid twitch

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22
Q

essential tremor

A

high frequency tremor sustained with posture worsened with movement- contant tremor that tends to run in families-patients self medicate with alcohol- decreased tremor amplitude- beta blockers and primidone

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23
Q

hemibalsimus

A

sudden wild flailing of one arm and ipsilateral leg- contralaterla sub thalamic nucelus-

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24
Q

intention tremor

A

slow zigzag motion when posting extending toward a sudden target- tremor with movement from cerebellar dysfunction

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25
Q

myoclonus

A

sudden, brief uncontrolled muscle contraction- jerks, hiccupus, commong in metabolic abnormalities as enal and liver failure

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26
Q

resting tremor

A

uncontrolled moment of distal appendages- noticeble in hands and tremor is alleviated by movement

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27
Q

parkinson disease

A

degeneration of CNSs associtatd with Lewy bodies composed of alpha synuclein- intracellular eosinophilic inclusions and loss of dopaminergic neurons- depigmentation of substantial nigra- has tremor, rigidity, akinesia, postural instability, shuffling gait

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28
Q

Huntington disease

A

AD- CAG repear on the fourth chromosome- manifest between 30-50 and it is choreiform movements, aggression, depression, dementia- initially mistake for substance abust. increased dopamine, decreased GABA, neural death from NMDA-R binding and glutamate excitotoxicity. There is atrophy of the caudate and putamen with hydrocephalus ex vacuo.

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29
Q

what happens with the huntington gene

A

mediated gene causes transcriptional silencing and causes increased in histone deacetylation, which silence genees fro neuronal survival

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30
Q

confluent speech with intact comprehension but cannot repeat- what aphasia

A

brocaas area

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31
Q

fluent speech, impaired comprehension, impaired repetition- what aphasia

A

wenicke

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32
Q

fluent speech fluidity, intact comprehension cannot repeat- what aphasia

A

conduction aphasia- it is from damage to the arcuate fasiculus

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33
Q

nonfluent speech, impaired comprehension, impaired repetition- what aphasia

A

global- arcuate fasiculus, braca nad wernicke areas

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34
Q

nonfluent, intact comprehension, intact repetition- what aphasia

A

transcortical motor aphasia- affecting frontal lobe around broads are but broca is spared

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35
Q

fluent, impaired, intact- what aphasia

A

transcortical sensory- affects the temporal lobe around whence area but wenches area is spared

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36
Q

nonfluent, impaired comprehension, repetition intact- what aphasia

A

broca and wrench areas and arcuate fascicles remain intact surrounding watershed areas are affected

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37
Q

disinhibited behavior with hyperphagia, hyper sexuality, hyperorality associated with HSV1- where is the lesion

A

amygdala lesion-kluver bucy

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38
Q

hemispatial neglect syndrome- agnosia of the contralateral side of the world- where is the lesion

A

nondominant parietal cortex

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39
Q

agraphia, acalculia, finger agnosia, left and right orientation- where is the lesion

A

dominant parietal cortex

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40
Q

reduced levels of arousal and wakefullness- where is the lesion

A

reticular formation

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41
Q

confusion, opthalmoplegia, ataxia, memory loss (anterograde and retrograde), and confabulation and personality changes- where is the lesion

A

mamillary bodies

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42
Q

when B1 is given with glucose what is not fixed in wernicke korsakoff

A

the memory problems are not fixed

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43
Q

what enzyme is decreased with Werknicke B1 deficiency

A

eryhtrocyte transkelotase is decreased

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44
Q

tremor at rest, chorea, athetosis - where is the lesion

A

it is in the basal ganglia

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45
Q

intention tremor, limb ataia, loss of balance, damage to cerebellum fall towards lesion- where is the lesion

A

cerebellar hemisphere

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46
Q

what is degeneration of the cerebellum most commonly from

A

chronic alcohol

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47
Q

truncal ataxia and dysarthria- where is the lesion

A

cerebellar vermis which is central located because the middle parts are always affecting the middle

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48
Q

contralateral hemiballisums- where is the lesion

A

it is from sub thalamic nucelus

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49
Q

anterograde amnesia- inability to make new memories- where is the lesion

A

hippocampus bilaterally

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50
Q

eyes look away from the lesion- where is the lesion

A

it is paramedian pontoon reticular formation

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51
Q

eyes look away from the lesion- where is the lesion

A

frontal eye fields

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52
Q

what supplies the central sulcus of the brain

A

ACA

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53
Q

what supplies the outside of the brain

A

MCA

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54
Q

how do you treat increased intracranial pressure with ventialtion

A

if you hyperventilate the patients then there is vasoconsticrion and decreased blood flow and decreased intracranial pressure

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55
Q

watershed areas of the brain

A

between ACA and MCA and PCA

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56
Q

obstruction of the R brachiocephalic

A

impaired drainage of the right subclavlian and IJV so it drains to the right lymphatic drug and this leads right sided congestion and encouragement

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57
Q

contralateral paralysis and sensory loss of the face and upper limb, aphasia if dominant usually the left, and it is the left hemisphere. hemineglect if lesion is nondominat- what vessel is occluded

A

middle cerebral artery

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58
Q

contralateral paralysis and sensory loss of lower limb cam have some behavioral and urinary incontience- what vessel is occluded

A

anterior cerebral artery

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59
Q

contralateral paralysis and or sensory loss- face and body. absence of cortical signs like neglect, aphasia, visual field loss- what vessel is occluded

A

lenticulostriate artery

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60
Q

what does the lenticulostriate artery supply

A

the internal capsule and striatum

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61
Q

where do saccular aneurysms tend to be

A

bifurcatiosn at the circle of willis

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62
Q

wehere is the most common saccular aneurysm

A

it is at the ASA and ACA but and can cause subarachnoid hemorrhage

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63
Q

where is the aneurysm that squashes CNIII

A

from posterior communicating artery

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64
Q

charcot bouchard microanerusysm

A

associated with chronic hypertension affects small vessels in the basal ganglia and thalamic and not seen on agiogram. wit acute hypertesnive get intracerebral hemorrhage, and creates deep hemorrhage. The HTN leads to hyalinization and fibrosis of the vessel wall leads to bright sports on CT

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65
Q

what is the aneurysm causing- bitemporal hemianopia, and visual acuity defects- if ruptured it leads to contralateral lower extremity hemiparesis and sensory defects

A

ACA

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66
Q

what is the aneurysm causing- down and out and mydriasis, see ptosis and out

A

posterior communicating artery

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67
Q

what is the aneurysm causing- rupture leads to ischemia causing contralateral upper extremity and facial hemiparesis, sensory defits

A

middle cerebral artery

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68
Q

what causes- neuropathic pain and initial paresthesias followed by weeks to months of allodynia (painless stilmuli causes extreme pain, dyestheias

A

central post stroke pain syndrome of the thalamus

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69
Q

rupture of middle meningeal artery due to skull fracture, lucid itneraval and rapid expansion leading to transtentoral herniation and CNIII palsy- lens shaped lesion

A

epidural hematoma

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70
Q

rupture of riding brains from mild trauma, cerebral atrophy, elderly alcoholoism- crescent shaped crosses sutures

A

subdural hemtoma

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71
Q

rupture of aneurysm or AV malformation leading to rapid course and worse headache, bloody or yellow tinged spinal tap. 4-10 days after hemorrhage, vasospasm can occur leads to ischemic infarct

A

subarachnoid hemorahage

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72
Q

what do you give when there is a subarachnoid hemorrhage

A

nigedopine to prevent ischemic infarct

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73
Q

systemic HTN, and amyloid nagioathy recurrent locar hemorrahge storoke, vascultitis, neoplasm, reperfusion is from ischemic stroke, occurs in basal gnaglia, and internal capsule can be lobar or from lacuna strokes

A

intraparenchymal hemorrhage

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74
Q

what happens to the brain after 12-48 hours of ischmia

A

red neucons

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75
Q

24-48 hours of ischemia

A

necosis and neutrophils

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76
Q

3-5 days after ischemia

A

macrophages

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77
Q

1-2 weeks after ischemia

A

reactive gliosis, vacualr proliferation

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78
Q

more than 2 weeks after ischmia

A

glial scar and astocytes surround the cystic cavity

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79
Q

venous sinus thrombosis

A

increased intracranial pressure, and headache, seizures, focal neurologic deficits. May lead to venous hemorrhage associated with hyper coagulable states like pregnancy, OCP use ,factor V leiden

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80
Q

where are the arachnoid granulations located

A

superior saggittal sinus

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81
Q

what do you see if the cerebral aqueduct is blocked

A

the fourth ventricle is normal but the third and lateral ventricles are dilated

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82
Q

idiotpathic intracranial hypertension- pseudotumor cerebri

A

increased ICP with no apparent cause on impaging- increased with woman of child bearing age, vitamin A excess, danazol, tetracycline, obese- headache diplopia from Vi without change in mental status

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83
Q

why are their transient vision changes with pseudo tumor cerebri

A

transient vision changes from impaired axoplasmic flow in optic nerves that is worse with valsalva maneuvers

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84
Q

communicating hydrocephalus

A

decreased CSF absorption by arachnoid grannies from meningitis

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85
Q

normal pressure hydrocephalus

A

wacky, wobbley, wet- urinary incontinence, ataxia, cognitive dysfunction- elderly- increased CSF pressure but does not result in increased subarachnoid space volume. Expansion of centrical of the corona radiata

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86
Q

noncommunicating hydrocephalus

A

causes by structural blockage of CSF circulation in the ventricular system aka stenos of the aqueduct of selves like colloid cyst or forma on of monro

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87
Q

ex vacuo ventriculomegaly

A

appearance of CSF increase on imaging but actually due to decreased brain tissue and neuronal atrophy like advance HIV, AD, or Picks- ICP is normal

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88
Q

vertebral disc herniation

A

nucelus pulposis squirts out and it causes ocompression usually of s1 which causes absent ankle reflex

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89
Q

nerves C1-C7 it above the corresponding vertebrae. and the others exit below there.

A

In the c spine, the nerves sit on top and after C8 they exist below

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90
Q

where does the spinal cord end on adults

A

L1-L2

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91
Q

where is the lumbar puncture performed

A

L3-L4-5 or L4-L5

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92
Q

where in the dorsal columns are the arms and legs

A

arms are lateral legs are central

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93
Q

what is the lateral corticospinal tract

A

saracl and cervical

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94
Q

what is in the anterior corticospinal tract

A

voluntary motor

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95
Q

what does the anterior spinothalamic do

A

crude touch, pressure

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96
Q

what is the lateral spinothalamic doing

A

pain and temperature

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97
Q

dorsal columns: path and function

A

ascending pressure, vibration, fine touch, proprioception- sensory nerve ending-cell body in dorsal root ganglion- enters the ipsilateral DC- ispisalteral nucleus cuneatus or gracilis and decussated n the medulla and ascendds contra laterally in the medial lemmings then synapses at the VPL in the sensory cortex

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98
Q

spinothalamic: path and function

A

sensory ad and c fibers cell body in dorsal root ganglia, and enters the spinal cord and ipsilateral gray matter- decussate the anterior white commissure and ascends contralleraterlly VPL in the thalamus to the sensory cortexx- pain termapreue for lateral tract
anterior -crude touch and pressure

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99
Q

lateral coricospinal: path and function

A

decending is voluntary movement- UMN cell body in the motor cortex then internal capsule then pyramidal decussation and descends contralaterlly and cell body is in the anterior horn of the spinal cord

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100
Q

what are characteristics of LMN lesions

A

weak, atrphy, fasiculations, decreased reflexes, decreased tone, no babinski, flaccid paralysis

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101
Q

what are the characteristics of UMN lesions

A

hyperreflized, babinski, spastic paralysis, increased tone, no atrophy or fasiculations

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102
Q

clasp knife spasticity

A

can be caused by stroke to the internal capsule leading to pure motor weakness on contralateral side of arm, leg, face, and other UMN sides can be present

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103
Q

congential degeneration of anterior horns of spinal cord with LMN lesions only. Floppy baby syndrome with marked hypotonia and tongue fascinations. Influential type median death is around 7 months. It is autosomal recessive

A

Werdnig Hoffman syndrome

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104
Q

combined UMN and LMN deficits with no sensory or bowel/bladder dysfunction- due to loss of cortical and spinal cord motor neurons, can be caused by defect in superoxide dismutase 1, and commonly presents as asymetric limb weakness, fascinations, eventual atrophy

A

ALS

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105
Q

spares the dorsal columns and lesser tract in the upper throacic ASA territory is watershed area as the artery of Adamkiewisz supples the AS before T8

A

complete occlusion of the anterior spinal artery

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106
Q

degeneration and dymyleination of dorsal columns and roots progressive sensory ataxia and impaired proprioception- poor coordination. Associated with chariot joints, shooting pain, argyll robertson pupil

A

tertiary syphillus causing tabes dorsalis

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107
Q

syrinx expands and damages anterior white commissure of spinothalamic tract- bilateral loss of pain and temperature sensation in cpae like distribution seen with chair I malformation

A

syringomeyelia

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108
Q

subacute comobines degneration-demylination of spinocerebellat tracts lateral corticospinal tracts, dorsal collumns- ataxic gait an dimparied position and vibration sense

A

B12 deficiency

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109
Q

caused by poliovirus from fecal oral transmission. replicated in the oropharynx and small intestine spreading via bloodstream to CNS. Infection causes anterior horn destruction of spinal cord and LMN death- LMN lesion- weakness, hypotonia, flaccid paralysis, fascinations, hyporeflexia, muscle atrophy, increased WBC, increased slight of protein in the CSF and WBC in the CSF- virus is recovered from the stool or throat

A

poliomyelitis

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110
Q

AR recessive GAA repeat on chromosome 9 leading to gratin genre issues- degradation of multiple spinal tract and muscle weakness. Lose vibration sense, proprioception, staggering gait, frequent flailing, nystagmus, dysarthria, pets caves, hammer toes, diabetes, hyeprtrphic cardiomyopathy and kyphoscoliosis

A

friederich ataxia

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111
Q

what is the most common cause of death of friderich ataxia

A

it is from hypertrophic cardiomyopathy

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112
Q

what does the gene for friederich ataxia do

A

it is part of DNA replication and repair and leads to mitochondrial dysfunction

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113
Q

hemisection of the spinal cord so ipsilateral UMN sings below lesion level from corticospinal. Ipsilateral loss of tactile and vibration below lesion from dorsal column damage, contralateral pain and temperature loss below the level of the lesion from spinothalamic tract, ipsilateral loss of all sensation at the level of the lesion, ipsilateral LMN signs- if it is above T 1 then it could lead to hroner syndrome

A

Brown squared syndrome

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114
Q

rupture discleading to low back pain radiating to one or both of the legs ,saddle anesthesia, loss of anal wink, bowel and bladder dysfunction, loss of ankle jerk and plantar flexion

A

cauda equina

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115
Q

what is the anal wink level relfex

A

S4

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116
Q

compression at L2 leading to flaccid paralysis of the bladder and rectum leading to saddle anesthesia and impotence

A

conus medularis syndrome

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117
Q

what is the dermatome for the nipple

A

T4

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118
Q

what is the dermatome for the belly button

A

T10

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119
Q

what is the dermatome for the inguinal ligament

A

L1

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120
Q

what is the dermatome for knee caps down the leg

A

L4

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121
Q

what is the S,23,4, dermatomes

A

erection and sensation of penile and anal zones

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122
Q

what is the biceps reflex

A

C5,5

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123
Q

what is the triceps reflex

A

C7,8

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124
Q

what is the patella reflex

A

L3,4

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125
Q

what is the achilles reflex

A

S1,2

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126
Q

what is the anal wink reflex

A

S3,S4

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127
Q

moro reglex

A

hang on for life

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128
Q

rooting reflex

A

head moves toward one side if cheek is stroked

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129
Q

sucking reflex

A

sucking response on roof of mouth

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130
Q

palmar reflex

A

curling fingers in hang

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131
Q

plantar reflex

A

dorsiflexion of large toe and fanning of other toes with plantar stimulating. Babinski reflex is in the child but in adult it is from UMN lesion

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132
Q

galant reflex

A

smoking along one spine while newborn is in suspension

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133
Q

S1 radiculopathy

A

compression by disc herniation. posterior thigh and calf lateral foot and sensation. weakness of thigh extension, knee flexion, absent ankle jerk

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134
Q

L5 radiculopathy

A
  • weakness of dorsiflexion, inversion and eversion of the foot and toe extension. No missing reflexes
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135
Q

what is parinaud sudnrome

A

paralysis of conjugate vertical gaze due to lesion of the superior colliculus- store, hydrocephalus, pinealoma

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136
Q

what does the interior colliculi do

A

it is from auditory

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137
Q

what does superior colliculus do

A

conjugate vertical gaze

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138
Q

what cranial nerve passes through the cribriform plate

A

CN I

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139
Q

what cranial nerve passes through the optic canal

A

CN II

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140
Q

what cranial nerve passes through the superior orbital fissure

A

V1, IV, III, VII

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141
Q

what cranial nerve passes through the foramen rotundum

A

v2

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142
Q

what cranial nerve passes through the foramen ovale

A

V3

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143
Q

what cranial nerve passes through the internal auditory meatus

A

VI, VIII

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144
Q

what cranial nerve passes through the jugular foramen

A

IX, X, XI,

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145
Q

what cranial nerve passes through the hypoglossal canaal

A

XII

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146
Q

what cranial nerve passes through the foramen magnus

A

XI

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147
Q

what does the nucleus solitarius do

A

visceral sesory information like taste, barorectoptions, and gut distention from VII, IX, X

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148
Q

what does the nucleus ambiguous do

A

motor innervation of pharynx, larynx, upper esophagus, swallowing palate elevation- aka swallow and speech

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149
Q

what odes the dorsal motor nucleus do

A

sends autonomic parasympathetic fibers to heart, lungs, upper GI

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150
Q

corneal reflex: afferent and efferent

A

afferent V1 and efferent is VII

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151
Q

lacrimation reflex: afferent and efferent

A

afferent V1 and efferent is VII

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152
Q

jaw jerk reflex: afferent and efferent

A

afferent V3 and efferent V3

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153
Q

pupillary reflex: afferent and efferent

A

afferent II and efferent is III

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154
Q

gag reflex: afferent and efferent

A

afferent Ix and efferent x

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155
Q

if the jaw is deviating is it towards or away from the lesion- and what is the nerve involved

A

it is jaw towards the lesion and it is from a CNV motor lesion

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156
Q

uvula deviates is it towards or away from the lesion- and what is the nerve involved

A

away from the lesion and it the vagus nerve for the lesion

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157
Q

the head is weak at turning and there is shoulder droop is it on the same side or way and what is the nerve

A

CN XI lesion and the head turns away from the lesion and shoulder droops on the side of the lesion

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158
Q

the tongue deviates is it towards or away from the lesion- and what is the nerve involved

A

the tongue deviates towards the side of the lesion and due to weakened tongue muscles on the side of the lesion

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159
Q

what are the muscles of mastication

A

masseter, temporalis, and medial pterygoid.

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160
Q

what innervates the muscles of mastication

A

V3

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161
Q

if the facial nerve lesion spares the forehead, where is the lesion

A

destruction of motor cortex or connection between motor cortex and facial nucleus in pons to contralateral paralysis of lower muscles of facial expression. Forehead is spared due to its bilateral UMN innervation

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162
Q

if the facial nerve lesion is full face, where is the lesion

A

it is a destruction of the facial nucleus or CN VI anywhere along the side of the course. Ipsiplateral paralysis of the upper and lower muscles of face. It also leads to hyperacusis

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163
Q

what causes hyperacusis

A

increased sound from paralysis of stapedius has high pitched sounds from facial nerve palsy

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164
Q

What can cause Bells Palsy

A

it can be from lyme disease, herpes simplex, herpes zoster, sarcoidosis, tumors, diabetes mellitus, treatment si acyclovir and corticosteroids

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165
Q

what are the signs of bells palsy

A

impaired eye closure, eyebrow sag, can’t smile, can’t frown, no nasolabial fold, decreased tearing, hyperacusis, decreased taste on the posterior part of the tongue

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166
Q

what CN are in the cavernous sinus

A

II, IV, V1, VI and V2

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167
Q

cavernous sinus syndrome

A

opthalmoplegia, decreased corneal sensation, orner syndrome, and occasional decreased maxillary sensation. can be secondary to pituitary tumor or mass effect carotid cavernous fistula cavernous sinus thrombosis related to primary infection.

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168
Q

which nerve in the cavernous sinus is most susceptible to injury

A

VI

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169
Q

what infections are most common in cavernous sinus

A

staph aureus, mucor, strep, rhizopus,

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170
Q

what are some of the symptoms of palsies with II, IV, VI

A

common with proptosis, conjunctival swelling, impaired ophthalmic draining

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171
Q

what order are they on the sides down the cavernous sinus

A

III, Iv, VI, V1, V2 down the sides and the trochlear is right next to the internal carotid artery

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172
Q

where is low frequency heard in the inner ear

A

low frequency heard at apex near helicotrema

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173
Q

where is high frequency heard in the inner ear

A

high frequency heard best at the base of the cochlea

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174
Q

conductive hearing loss

A

abnormal bone>air and localizes to the affected ear

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175
Q

sensorineural hearing loss

A

air>bone and localizes to the unaffected ear

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176
Q

the rinne test

A

it is to test for bone conduction

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177
Q

the weber test

A

it is the test for the midline of the fork and it localizes to one side or the other

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178
Q

what is a cholesteatoma and were dos it come from

A

it is a lesion of the tympanic membrane that can rupture the middle ear- it is an overgrowth of desquamated keratin debris within the middle ear that may erode the ossicles and the mastoid air cells- conductive hearing loss

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179
Q

what forms the superior of the orbit

A

thick orbital plate of the frontal bone

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180
Q

what forms the lateral side of the orbit

A

zygomatic bone and sphenoid wings form it

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181
Q

what forms the orbital floor

A

it is a think wall that separates from maxillary sinus- break common- the inferior rectus herniate into the maxillary sinus

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182
Q

what forms the medial wall of the orbit

A

ethmoid and lacrimal bones fracture and medial rectus gets trapped

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183
Q

what does the trabecular outflow do in the eye

A

it drains through the trabecular meshwork through the canal of scheme and episcleral vasculature and it can increase with M1 agonist

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184
Q

uveosceleral outflow

A

it drains into the uvea and sclera and increased prostaglandin agonist

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185
Q

aqueous hunmor production

A

produced by non pigmented epithelium on ciliary body- decreased by beta blockers, alpha 2 agonists, and accarbonic anhydrase inhibiotrs

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186
Q

hyperopia

A

eye too short for refractive power of cornea and lens- light focusses behind the retina

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187
Q

myopia

A

eye is too long, so it focusses in front of retina

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188
Q

astigmatism

A

abnormal curvature of the cornea and different refractive power at different axis

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189
Q

presbyopia

A

age related impaired accomindation focusing on near objects, and primarily die to decreased lens elasticity and often nessicitates reading glasses

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190
Q

cataract

A

painless often bilateral opacification of the lens. decreased vision. Acquired risk factors of increased age, smoking, excessive sunlight, prolonged corticosteroid use, diabetes, trauma, infection

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191
Q

what are the congenital risk factors for cataracts

A

galactosemia, galactokinase deficiency, trisomies, toche infections like rubella, marfan syndrome, alport syndrome, myotonic dystrophy, and NF2

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192
Q

open angle glaucoma

A

increased with age, race, family history, and painless and more common. Primary cause is unclear. secondary is blocked trabecular network from EBC or RBC can be from blocked retinal elements

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193
Q

closed angle glaucoma

A

primary is enlargement or forward movement of the lends against the central iris and obstruction of normal flow o fhumor through the pupil and flip builds up behind the virus pushing the peripheral iris against the cornea. it impedes frlow through the trabecular netwrk. Secondary is from hypoxia and retinal disease

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194
Q

chronic closure

A

asymptomatic with damage to optic nerve and peripheral vision

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195
Q

acute closure

A

true ophthalmic emergency. increased IOP pushes the iris forward and angle closes abruptly and very painful red eye, sudden vision loss, halos around lights, rock hard eye frontal headache

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196
Q

what do you not give with acute closure glaucoma

A

do not give epinephrone because of mydriatic effect

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197
Q

conjunctivitis

A

inflammation of conjunctiva and red eye .Allergic itchy eyes bilateral and could be from bacterial which treat and see pus. Viral is from adenovirus and sparse mucus discharge and swollen pre auricular node self-resolving

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198
Q

uveitis

A

inflammation of urea and it can have pus accumulated in the anterior chanmber of the ye and can be associated with system inflammatory disdeae

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199
Q

age related macular degeneration

A

degeneration of the macula and central area of the retina causes distorting and loss of central vision.

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200
Q

what is dry age related macular degeneration

A

deposition of yellowish extracellular material in and between bruch membrane and retninaly pigment epithelium with gradual vision loss and prevent progression with vitamins

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201
Q

what is wet age related macular degeneration

A

it is rapid loss of vision due to bleeding secondary to choroidal neovascularization treat with anti-vegf this is called ranibizumab

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202
Q

diabetic retinopathy and difference between non proliferative and proliferative

A
  • retinal damage de to chronic hyperglycemia.
  • nonproliferative- damaged capillaries leak bloos and lipids and fluid seep into retina causing hemorrhage and macular edema. Treat with blood sugar control
  • proliferative- chronic hypoxia results in new blood vessel formation with resultatt traction on tretina
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203
Q

retinal vein occlusion

A

blockage of central or branch retinal vein due to compression from nearby arterial atherosclerosis and retinal hemorrhage and venous engorgement and edema in the affected area

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204
Q

retinal detachment

A

separation of the neurosensory layer of the retina from the outermost pigmented epithelium and degradation of photoreceptors and vision loss. May be secondary to retinal breaks, diabetic traction, inflammatory effusions. visualized on fundoscopy as crinkling of retinal issue and changes in vessel direction. Breaks are more common with high myopia or head trauma. Often proceed by flashes and floaters. It has eventual monocular loss of vision like a curtain draw down

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205
Q

central retinal artery occlusion

A

acute painless monocular vision loss, and retina is cloudy with attenuated vessels and cherry red spot at fovea- center of the macula- theres an embolic source from carotid artery atherosclerosis, vegetations, patent foramen ovale

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206
Q

what signs of reflex would you see on central retinal artery occlusion

A

no constriction of other eye with direct light because of destroyed retinal ganglial cells

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207
Q

retinitis pigmentosa

A

inherited retinal degneration. Painless progressive vision loss beginning with night blindness and rods are affected first- bone spicule shaped deposits around the macula

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208
Q

retinitis

A

retinal edama, necorsis, and leads to scar

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209
Q

what are the causes of retinitis

A

CMV, HSV, VZV and can be bacterial or parasitic or associated with immunosuppression

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210
Q

papiledema

A

optic disc swelling usually bilateral with increased ICP and it is engaged blind spot and elevated opt disc with blurred margins

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211
Q

miosis- what is the reflex

A

first neuron is the dinger wasteful nucleus to the chillily ganglia via CNIII and second neuron is short ciliary nerves to pupillary sphincter muscles

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212
Q

where is the origination of the Edinger westfall nucleus

A

it is in the midbrain

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213
Q

myadriasis

A

dilation it is from sympathetic.

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214
Q

marcus gunn pupil

A

afferent pupil light defect due to optic nerve damage or severe retinal injury. decreased bilateral pupillary constriction when light is shone in affected eye relative to unaffected eye.

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215
Q

horner syndrome

A

sympathetic denervation of the face- ptosis, anhidrosis, miosis- pan coast tumor, brown squared, late stage syringomyelia

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216
Q

what CN innervates the lateral rectus

A

CN VI

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217
Q

what CN innervates the superior oblique

A

CN IV

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218
Q

what CN innervates superior rectus, inferior rectus, , medial recturs, and inferior oblique

A

CN III

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219
Q

what motion does the superior oblique perform

A

it abducts, interest, and depresses while adducted

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220
Q

internuclear opthalmoplegia

A

when looking left, the left nucleus of the CNVI fires, which contacts the left lateral rectus and stimulates the contralateral right nucleus of the CNIII via the right MLF to contract the right medial rectus. Convergence stays normal

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221
Q

AD

A

most common cause of dementia in the elderly. Increased risk with ApoE2 decree and increased risk with APOE4. App, presenilin and have an increase risk. see widespread cortical atrophy, and narrowing of gyro and widening of the sulk. There is decreased ACh. Senile plaques are in the grey matter and extracellular beta amyloid core. May cause amyloid angiopathy and intracranial hemorrhage. AB synthesized by the cleavage of APP. Neurofibbrillary tangles are intracellular hyperphosphorylated tau proteins. Number of tangles determines how bad the disease is

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222
Q

why are people with downs at an increased risk of AD

A

they have an extra APP gene on chromosome 21

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223
Q

frontotemporal dementia

A

early changes in personality and behavior or aphasia. Aphasia is from primarily progressive aphasia. May have associated movement disorders. ALS like UMN/LMN degeneration. Previously called pick disease. Ave frontotemporal dementia and lobe degeneration. Inclusions of hyperphosphorylated taw protein and round eosinophilic lesions and TDP43 postiive

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224
Q

Lewy body dementia

A

initially dementia and visual hallucinations followed by parkinson like deatures- intracellular levy bodies with insoluble aggregates of alpha synuclein primarily in the cortex

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225
Q

vascular dementia

A

multiple arterial infarcts and or chronic ischemia. It is a step wise decline in cognitive function and impairment. It is theseoncd most common cause. Look at MRI which shows multiple cortical and subcortical infarcts

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226
Q

CJD

A

rapidly progressive dements with myoclonus. Spongiform cortex and protons from beta pleated sheet which is resistant to degradation

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227
Q

what are some other causes of dementia

A

HIV, hypothyroidism, vitamins B1, B3, or B12, wilson disease NPH

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228
Q

Central pontine myelinosis

A

acture paralysis, dysarthria, dysphaga, diplopia, loss of consciousness- caused locked in syndrome- massive axonal degeneration in pontine white matter. Secondary to osmotic changes. Commonly iatrogenic from rapid correction of hyponatremia.

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229
Q

what happens if hypernatremia is corrected too quickly

A

it causes edema and herniation

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230
Q

Charcot triad

A

scanning speech, intention tremor, incontinence, internuclear ophthalmoplegia, nystagmus

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231
Q

what is the CSF sign of MS

A

it is oligoclonal banding in the CSF.

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232
Q

what is seen on MS MRI

A

it is gold standard and there are periventricular plaques with destruction of cons. multiple white matter lesions.

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233
Q

pseudobulbar palsy

A

associated with MS. There is dysarthria, dysphagia, dysphonia, impaired tongue, facial movements

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234
Q

acute inflammatory demyelinating polyradiculopathy

A

GBS subtype that is an autoimmune condition attacking the schwann cells and inflation and demyelination of the peripheral nerve fibers. results in symmetric ascending muscle weakness/paralysis and beginning in lower extremtities. Can have some autonomic dysregulation. Increased CSF protein count. Associated with campylobacter jejuni and viral causes. Need respiratory support

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235
Q

acute disseminated post infectious encephalomyelitits

A

multifocal periventricular inflamtion and demyelination after infection or vaccination- rapidly progressive multifocal neurologic symptoms altered mental status

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236
Q

Charcot Marie Tooth

A

hereditay motor and sensory neuropath- progressive herditary nerve disorders related to defective production of proteins involved in the structure oand function of peripheral nerve or the myelin sheath. Typically autosomal dominant inherticane pattern associated with foot deformities, lower extremity weakness and sensory deficits

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237
Q

Krabbe disease

A

AR- lysosomal storage disorder due to degiceinct of galactocerebrosidase. buildup of glactocerebroside and pyochosine destroys myelin sheath. It is peripheral neuropathy, and developemental delay, optic atrophy and globoid cells

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238
Q

Metachromatic leukodystrophy

A

ar lysosomal strage disorder of arylsulfatase A deficiency. Buildup of sulfates impaired production and destruction of myelin sheath. Find central and peripheral demyelination with ataxia and dementia

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239
Q

PML

A

demyelination of the CNS due to destruction of oligodendrocytes and it is from reactivation of JC virus in MS or AIDs rapidly progressive and fatal from natalizumab and rituximab

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240
Q

adrenoleukodystrophy

A

X linked disorder of disrupted metabolism of long chain fatty acids and build up in nervous system, adrenal gland, testes- leads to long term coma death, and adrenal crisis

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241
Q

partial siezures

A

affect a single area of the brain and commonly originate from the temporal lobe often proceeded by an aura

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242
Q

simple partial

A

consciousness stays intact but it is only motor sensory and autonomic psychic

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243
Q

complex partial seizure

A

lose consciousness

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244
Q

epilepsy

A

a disorder of recurrent seizures fertile are not it

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245
Q

status epilepsy

A

continous or recurring siezures that may result in brain injury>5 min

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246
Q

causes of seizures by age: children adults, elderly

A
  • children- genetic infection, febrile, trauma, congenital, metabolic
  • adults-tumor, trauma, stroke, infection
  • elderly- stroke ,tumor, trauma, metabolic infection
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247
Q

absence seizures

A

3hx frequency and no postictal confusion- treat with ethosuximide- staring spells

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248
Q

myoclonic seizures

A

repeated jerks

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249
Q

tonic clonic seizures

A

alternating stiffening and movement

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250
Q

tonic seizures

A

just tensing

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251
Q

atonic seizures

A

drop seizures where they fall to the floor

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252
Q

cluster headaches

A

unilateral in young male smokers, 15 minute 3 hour repetitive- repetitive brief headaches excruciating periorbiral pain with lacrimation and rhino rhea or Horners syndrome

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253
Q

treatment for cluster headahces

A

sumatriptan and O2

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254
Q

CNS tunmor that is in the cerebal hemispheres can cross the corpus collosum and its pseudopalisading pelomophic tumors cells with central areas of necrosis and hemorrhage and positive for GFAp

A

glioblastoma multiforme- grade IV astrocytoma

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255
Q

benign primary brina tumor. most often occurs near surfaces of brain and pasasagittal region arises from arachnoid cells it is extra acial- and may have a dural attachment often asmyptomati but can have focal neurological signs and seizures- see psammoma bodies which are calcifications

A

meningioma

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256
Q

cerebellla tumor associated with VHL and it is found with retinal angiomas- can produce erythropoetin like polycythmia- thin walled capillaries with minimal parenchyma

A

hemangioblastoma

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257
Q

cerebellopontine angle typically but can be from other peripheral nerves. vestibular is CNVVIII- bilateral vestibular are in NF2 are S100

A

these are schwannomas

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258
Q

rare slow growing tumors of fried egg cells, chicken wire capillaries and are in the frontal lobes

A

olidendroglioma

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259
Q

usually a prolactinoma with biemporal hemianopia with lactotrophy cells

A

piutiary adenoma

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260
Q

what brain lesion do AIDs patients tend to get

A

CNS lymphoma single ring enhancing lesion are high grade, poor prognosis and positive for EBV

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261
Q

pineal mass

A

germinoma with mass effect and cause obstruct hydrocephalus

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262
Q

well circumscribed in children found in posterior fossa like cerebellum- may be supratentorial and positive for GFAP= see rosenthal fibers- eosinophilic corkscrew fibers- cystic and solid

A

pilocytic astrocytoma

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263
Q

highly malignant cerebellar tumors a form of primitive neuroectodermal tumor can compress fourth ventricle causing noncommunicating hydrocephalus can send drop metastases to spinal cord- midline posterior fossa- increased intracranial pressure and cerebella dysfunction- homer wright rosettes and small blue cells

A

meduloblastoma

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264
Q

perivascular rosettes and rod shaped belpharoplasts- basal ciliary bodies found near the nucleus- can be in the 4th ventricle

A

ependymoma

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265
Q

childhood tumor with bitemporal heianopia- childhood supratentorial tumor- slow benign tumor of super cellar region with cyst and calcification and motor oil in the cells from ruthless pouch and have calcification and cholesterol crystals

A

craniopharyngioma

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266
Q

tumor of pineal gland causing compression of the tectum and vertical gaze palsy and obstructive hydrocephalus and compression of cerebral aqueduct and processors puberty and increased beta HCG- similar to seminoma

A

pinealoma

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267
Q

cingulate and subflacine herniation

A

flax cerebra can compress anterior cerebral artery

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268
Q

central herniation

A

downward transtentorial hernaition- durrette hemorrhage from basilar artery rupture- caudal displacement of the brainstem

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269
Q

uncal herniation

A

CNIII palsy with blow pupil, down and out

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270
Q

cerebellar tonsil herniation

A

coma and death and go through the foramen magnum

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271
Q

trigmeinal neuralgia

A

sudden pain in CN V stabbing and electric shock in short bursts from chewing, tooth brush ,temperature changes, carbamazepoins is first line and decrease NA channel recovery to decreased firing of neurons. CBC monitor for aplastic anemia

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272
Q

DRESS syndrome

A

2-8 weeks post drug exposure- fever, lymphadenopathy, facial edema, mobeliform skin rash and confluent erythema, actor I neurhoathy, cough, increased ALT and eosinophilia

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273
Q

what is the path of the ACL and what test do you use for ACL injury

A

it is from the lateral femoral tubercle to the anterior tibia- you should use the anterior drawer or Lachman test for it

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274
Q

what is the path of the PCL and what test do you use for PCL injury

A

PCL is from medial femoral condyle to the posterior tibia. Use the posterior drawer test

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275
Q

what is injured if the there is lateral force placed on the knee and it starts to bed that way from valgus force

A

it is an MCL tear

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276
Q

what is injured if there is varus force applied to the knoee and the lateral space widens

A

LCL

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277
Q

for the McMurray test, if there is external rotation applied and pain then its the

A

medial meniscus

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278
Q

for the McMurray test, if there is internal rotation applied and pain then its the

A

lateral meniscus

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279
Q

Osgood Schlatter: where is the injury, what should you feel on testing, and what is the repetitive stress from

A

there is an overuse injury to the secondary ossification centre of the apophysis f the tibial tubercle. Knee pain in adolescent and pain and swelling at the tibial tubercle and at the insertion of the patellar ligament which connects the tibia to the patella and quadriceps can avlse. This can lead to a callus formation at this tendon. It is from repetitive use of the quadriceps and from jumping

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280
Q

what is the function of the patella

A

it improves knee extension and provides nutrients to distal femur cartilage.

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281
Q

if the patella is broken, what movement cannot be performed

A

extension of the knee against gravity and there is a palpable gap in extension

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282
Q

what is injured in the unhappy triad and what causes this injury

A

ACL, MCL, medial meniscus- due to lateral force applied to a planted leg

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283
Q

what causes prepattellar bursitis and what is the inflammation

A

it is inflammation of the from and largest bursal sac of synovial fluid- it is from repeated trauma or pressure from excessive kneeling like gardening or housemaids

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284
Q

where is a Baker cyst and what is the common related condition

A

it is a popliteal collection in gastrocneumus-semimenbranous bursa and communciated with the synovial space and related to chronic joint disease

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285
Q

what are the muscles of the rotator cuff

A

supraspinatur, infraspinatus, subscapularis, teres minor

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286
Q

what motion does supraspinatus perform, when is it injured and what nerve innervates it

A

it does shoulder abduction and it is the most common injury should test the can test and its innervated by the supra scapular nerve

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287
Q

what motion does infraspinatus perform, when is it injured and what nerve innervates it

A

It is the lateral or external rotator of the shoulder and it is from a pitching injuryy and its innervated by the supra scapular nerve

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288
Q

what motion does theres minor perform, when is it injured and what nerve innervates it

A

it adducts and internally rotaties the arm/lateral rotation- it is from the axillary nerve

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289
Q

what motion does subscapularis perform, when is it injured and what nerve innervates it

A

it medially rates the arm so internal rotation and adduction- its from the sub scapular nerves

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290
Q

what is the repeated motion for medial epicondylitis

A

it is repeated flexion of the wrist

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291
Q

what is the repeated motion for lateral epicondylitis

A

repretitive extension so repetitive wrist extension

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292
Q

what is a scaphoid injury from and why

A

it is from the fall on the outstretched hand. It is in the anatomical snuff box, and it is retrograde blood supply. It sits on the radius and it is closest to the thumb

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293
Q

where is the lunate injury and why

A

it is from fall on the outstretched hand with acute carpal tunnel syndrome from dislocation- it is on the radius more medial than the scaphoid but next door

294
Q

what is the hamate injury and why

A

it is the hook of the hamate which dits close to the fingerso n the pinky side and it causes lunar nerve injury

295
Q

carpal tunnel involves which nerve and ligament

A

medain nerve entrapment by the transverse carpal ligament- it is causing paresthesia, pain and numbness in the thinner eminence atrophy but sensation here is spared

296
Q

who gets guyot canal syndrome and what nerve is there

A

ulnar nerve issue and its in cyclists

297
Q

what is a shoulder dislocation

A

the head of the humerus rotates out of the glenoid

298
Q

what is a shoulder seperation

A

clavicle separates from acromion and cricoid process of the scapula

299
Q

anterior should dislocation can damage what- how to test for damage

A

axillary nerve and posterior circumflex artery- lose feeling in the deltoid

300
Q

what causes posterior shoulder dislocation

A

seizures

301
Q

hip disloaction is from what and what does it damage

A

it is from a MVA and there are medial and lateral circumflex femoral arteries and femoral vein damage and sciatic nerve, and head of femur

302
Q

what nerve and artery is injured with the fracture of the surgical neck of the humerus and anterior dislocation of the humerus

A

axillary nerve and circumflex arteries

303
Q

what nerve and aftery is injured from pitching or shoulder dislocation

A

musculocutanous nerve

304
Q

what nerve and artery is injured by mid shaft frcture of the humber, compression of the axilla, and crutches or saturday night palsy, supracondylar fracture with anterolateral displacement of the proximal fracture fragment

A

radial nerve- it is the deep brachial artery with the mid shaft break of the humerus

305
Q

supracondylar fracture anteromedial of the humerus, carpal tunnel, and distal wrist laceration- nerve and artery

A

median nerve sometimes the brachial

306
Q

fracture of the medial epicondyle of the humerus fractured hook of hamate- what nerve is injured

A

ulnar nerve

307
Q

superficial laceration of the palm- nerve injury

A

recurrent branch of the median nerve

308
Q

what nerve injury leads to flat deltoid, loss of arm abduction and loss of sensation of deltoid and lateral arm

A

axillary nervve

309
Q

what nerve injury leads to loss of forearm flexion, and supination and loss of sensation over lateral forearm

A

musculocutanous nerve

310
Q

what nerve injury leads to wrist drop aka loss of elbow, wrist, and finger extension, decreased grip strength, loss of sensation over postior arm and forearm and dorsal hand

A

radial nerv

311
Q

what nerve injury leads to ape hand and pope blessing, loss of wrist flexion, and flexion of lateral fingers, and thumb opposiotn, and lumbricals, loss of sensation over lateral fingers nan tingling when pushing on carpal tunnel

A

median nerve

312
Q

what nerve injury leads to loss of wrist flexion, flexion of medial finders and abductio and adduction of all fingers

A

ulnar nerve

313
Q

what nerve injury leads to loss of thanr muscle group so thumb stuff

A

recurrent branch of median nerve

314
Q

what causes the lesion and where is the lesion when the arm hangs by the side with abduction, lateral rotation, flexion and supination

A

lateral traction on neck during delivery, or trauma in adults- lesion-Erbs palsy is the avulsion of the C5-6 roots

315
Q

what causes the lesion and where is the lesion when the hand is a total claw hand

A

in infants its from upward force during delivery and adults it is from trauma when grabbing a tree branch and it accuses the C8-T1

316
Q

what causes the lesion and where is the lesion when there is atrophy of the intrinsic hang useless esteemi and pain and edema from vascular compression

A

it is from the cervical rib. Pan coast tumor, repetitive overhead exercises- lower trunk and subclavian vessels

317
Q

what causes the lesion and where is the lesion when inability to anchor the scapular to the thoracic cage and cannot abduct arm above horizontal

A

it is a lesion of the long thoracic nerve (C5-C7) and this is the innervation of the serrates anterior which is at the 4-5 intercostals on the midaxillary line it is damaged by axillary nerve dissection after mastectomy or stab wounds

318
Q

what muscles are paralyzed by an anterior shoulder dislocation or humeral neck fracture

A

it is the axillary nerve so the deltoid and the theres are paralyzed

319
Q

what is going on when there is pain at the costosternal angel wit palpation and worse with repetitive activity- prolonged pain

A

costotchondriasis

320
Q

what is the risk with a COPD patient with an inter scalene nerve block

A

can paralyze the phrenic nerve which is C3,4,5

321
Q

what is the ulnar claw from

A

it is the extension of the 1-3 fingers at rest, but the 4-5 cannot relax because of a distal ulnar nerve injury

322
Q

what is the pope hand from

A

it is that way when patient tries to make a fist because the 1-3 cannot bend so there is a proximal median nerve injury

323
Q

what is the median claw

A

1-3 are bunched up and 4-5 can extend- it is a distal median nerve injury

324
Q

what is the ok gesture from

A

it is a proximal ulnar nerve injury so the fingers can’t curl up

325
Q

what do the dorsal inteossei do

A

dorsals abduct

326
Q

what do the palmar interossei do

A

palmar adduct

327
Q

what nerve does pelvic surgery injure

A

obturator nerve

328
Q

what nerve does pelvic fracture injure

A

Femoral nerve

329
Q

what nerve does trauma or compression of lateral aspect of leg and fibular neck fracutre- cast compression-injure

A

common perennial nerve

330
Q

what nerve does intramuscular injection to upper medial gluteal region injure

A

superior gluteal

331
Q

what nerve does posterior hip dislocation injure

A

inferior gluteal nerve

332
Q

what presents as decreased medial sensation of the thigh and decreased adduction

A

obturator

333
Q

what presents as decried thigh flexion and leg extension

A

femoral nerve

334
Q

what causes foot drop that is inverted at resd and with a stopgap gate and loss of sensation to the dorsum of the foot

A

common perennial nerve

335
Q

what causes inability to curl toes and loss of sensation on the sole of the foot and eversion of the foor

A

tibial

336
Q

what causes trendeleberg gait and the lesion is contralateral to the side of the hip drop

A

superior gluteal

337
Q

what causes difficulty climbing stairs, rising from seated and loss of hip extension

A

inferior gluteal

338
Q

what does the people nerve do

A

everts and dorsiflextes- PED

339
Q

what does the tibial do

A

inversts and plantarflexes TIP

340
Q

where do you find the pudenal nerve and what can injuryy do

A

find it at the ischial spine and it is the landmark for injection if injured it can led to incontience and painful sex

341
Q

what runs through the sciatic foramen

A

the piriformis, gluteal arteries, internal pudendal ,ecstatic nerve

342
Q

piriformis syndrome

A

sciatica from enlarge piriformis

343
Q

ankle sprain injures what ligament

A

it hurts the anterior talkofibular ligament

344
Q

what motion does the illipsoas perform and what levels does it run from

A

psoas is T12 through L5 and can have an abscess back there it performs hip flexion so sit up

345
Q

what performs hip flexion

A

illipsoas ,rectus femoris, tensor fascia lata

346
Q

what performs hip extension

A

gluteus maximus, semitendinouss, semimembranosis, biceps femoris

347
Q

what performs hip abduction

A

gluteus medius nad gluteus minimus

348
Q

what performs hip adduction

A

adductor brevis, longus, and magnus

349
Q

what nerve roots are compressed if there is weakness of knee extension, and decreased patellar reflex

A

L3-4

350
Q

what nerve roots are compressed if there is weakness of dorsiflexion, difficulty heel-walking

A

L4-L5

351
Q

what nerve roots are compressed if there is weakness of plantar flexion, difficulty in toe-walking, and decreased achilles reflex

A

L5-S1

352
Q

what is the tibial nerve run with

A

popliteal artery

353
Q

what can injure the popliteal artery

A

posteiro dislocation of the knee

354
Q

what does anterior compartment syndrome mess up-what nerve and artery are compromised

A

it is bad foot extension, anterior tibial artery, deep perennial nerve so decreased sensation between first and second toes so decreased dorsiflexion, foot drop, and claw foot.

355
Q

what parts of the sarcomere contract

A

H and I bands between the Z lines

356
Q

what does Ca bind to in the muscle

A

it binds to troponin C and it moves the tropomysin off so the myosin and actin can bind

357
Q

what cocks the myosin head

A

it is the hydrolysis of ATP to ADP

358
Q

Type 1 muscle fibers

A

slow twitch with high mitochondria and myglobin

359
Q

type 2 muscle fibers

A
  • fast twithc fibers with increased anaerobic glyoclysis
360
Q

what do high levels of PTH do

A

resorb bone

361
Q

what do low levels of PTH do

A

it keeps bone building going

362
Q

what does estrogen do to bone

A

it inhibits the apoptosis of the osteoblasts and induces the apoptosis of the osteoclasts

363
Q

what is MLCK inhibited by

A

dihydropyridine CC< epinephrine, and prostaglandin E2

364
Q

what is mutation does a kid with short limbs and normal torso and head have and what does this mutation do. What are the risk factors for the mutation

A

activating mutation of FGF3 and it decreases chondrocyte growth and increase paternal age and AD can be the mutations

365
Q

what is OI from and what is the defective from and why are their sclera blue

A

it is from a defect in type 1 collage, and it is AD and it has multiple fractures and blue sclera from the exposure of choroidal veins. there is also hearing loss

366
Q

what is osteopetrosis from and what is the mutation in, and what do you treat it with

A

it is defect of bone resportion and thick heavy bone with that cracks. It is poor last fucntion and it is from a carbonic anhydrase mutation which decreases the ability of the bone to create an acidic environemnet to resole the Ca from the bone. Can create hearing loss, compression of CN and hydrocephalus and RTA, Treat with bone marrow transplant

367
Q

Ricketts and osteomalacia

A

it is defective mineralization of the bone due to decreased vitamin D. It can be decreased in serum and poor diet, and malabsorption, and liver and renal failure. IN children there is pigeon breast, frontal bossing, and rosary on the chest, and bowed legs. Osteomalacia and weak bone with increased fracture and decreased CA, decreased phosphate, and increased PTH. increased alkaline phosphatase.

368
Q

what increases the alkaline phosphatase

A

blasts are active which increases the alkaline phosphatase activity

369
Q

osteoporosis

A

increased breaks and it is dependent on peak bone mass. It is diet, d receptror and exercise determines the peak bone mass. has bone paine, features in weight berarign areas

370
Q

when does bone mass peak

A

30 years old

371
Q

what are the labs for osteoporosis

A

it is normal labs

372
Q

Pagets disease

A

inbalance between clast and blast activity. Overactivity of the class usually kicked off by viral illness then the clasts eventually cause mixed then it is blast activity. only involves 1-2 bones. It is from sclerotic bone that fractures easily. Lamellar mosaic bone. Increased hat size, hearing loss, lion face, increased all phos

373
Q

what are the bad outcome from pagets

A

it is high output cardiac failure or osteosarcoma from the screwed up blasts

374
Q

how to treat Pagets

A

it is treated with calcitonin and bisphosphinates which decreases the activity of the clasts

375
Q

where do kinds get osteomyelitits

A

metaphysis

376
Q

where do adults get osteomyelitits

A

epiphysis

377
Q

what patients get pseudomonal osteomyelitits

A

it is from diabetic or IV drug use

378
Q

avascular necrosis

A

from decreased flow or trauma and fracture shock or sickle cell can cause osteoarthtitis and fracture

379
Q

osteoma

A

surface of face like Gardners. It is fibroelastosis in peritoneum.

380
Q

osteoid ostemoa

A

benign osteorid tumor with a rim of a reactive bone cortex of long bone in diaphysis- get bone pain that gets better at aspirin. radiolucent with reactive core

381
Q

osteoblastoma

A

larger arise in the vertebrae and does not respond to aspirin

382
Q

osteochrondroma

A

cartilage/bone tumor from lateral projection of growth plate. like like pedunculate mass off the bone. it is continuous with the marrow space. can go to chrondrosarcoma

383
Q

osteosarcoma

A

malignancy of the bone and teens and elderly with bimodal development. It is Rb and pages, radiation of the metaphysics of long bone of distal femur or proximal tibia. Pathologic fracture or bone pain and swelling. Creates a pereosteal tending and Codmans angle is important and has hay sunburst appearance.

384
Q

what is the morphological feature of osteosarcoma

A

Creates a pereosteal tending and Codmans angle is important and has hay sunburst appearance. and cells are pleomorphic and produce lots of osteoid pink

385
Q

Giant cell bone tumor

A

tumor of multinucleated giant cells and stream cells. Occurs in the young adult at the epiphysis and its soap bubble lesion. It is locally aggressive tumor and can recur

386
Q

Ewing sarcoma origin

A

neuroectoderm

387
Q

ewing sarcoma

A

it is neuroectoderma in the medulla at the diaphysis and it is in male kids

388
Q

ewing sarcoma morphology

A

it is onion skinning lesion with small blue cells and it looks like lymphocytes can have fevver

389
Q

what is the translocation for Ewing sarcoma

A

11:22 translocation

390
Q

chrondroma

A

bening in medullar of small bones of the hands and feet

391
Q

chondrosarcoma

A

middle of pelvis or central skeleton

392
Q

what kind of mets in the bone are blastic

A

prostate

393
Q

degenerative bone disease

A

it is i progressive destruction of bone and articular cartilage eburnation, and can be from age and obesity, and hits the hip, lumbar spine, and knees, DIP and PIP, and it is worse during the day.

394
Q

Rheumatoid arthritis

A

middle age women and HLADR4- synovititis causing a panes formation, and it has joint fusion, and contraction of pants can cause deviation. Worse in he morning but better wit activity. Joint narrows, loss of cartilage, and osteopenia, and increased fever, malaise, weight loss, and myalagia. rheumatoid nodules- central necroses with histiocytes. Baker cysts and pleural effusion

395
Q

what is the Ra antibody

A

it is IGM against Fc portion of IgG.

396
Q

what is ankylosing spondylitits

A

sarcoiliac joint fusion, males, low back pain, uveitis, and fusion of the spine. can get aortic dilation

397
Q

Reiters arthrtitis

A

can’t see, can’t pee, can’t climb a tree- after GI or STD

398
Q

what is the presentation no infective arthritis

A

it is neisseria and staph aureus

399
Q

what is psoriatic arthritis

A

axial, peripheral with sausage fingers

400
Q

what are the causes of gout (why does it happen)

A

from increased uric acid or not excreted in the kidney

401
Q

what can increase uric acid

A

tumor breakdown

402
Q

Lesch Nyhan

A

decreased HGPRt but increased PRPP

403
Q

renal insufficiency gout

A

can’t excrete the uric acid

404
Q

what do the crystals look like

A

negatie biofringent and it is parallel and yellow needles

405
Q

gout what are the depositions from

A

it is monosodium rate crystals

406
Q

chronic gout- what shoes up

A

tophi with debris and giant cell recactio with white chalky lesion

407
Q

pseudo gout what are the crystals and what are they made of

A

it is rhomboid crystals and it is calcium pyrophosphate and its weakly positive under polarized light

408
Q

dermatomyositits

A

gastric carcinoma and it is bilateral proximal weeks, can’t comb hair or climb stairs, heliotropic rash, malaria rash, and red papillose on elbows, knuckles, knees. increased CK, anti-o1,

409
Q

where is the inflammation in the muscle fascicel

A

it is perimysial inflammation along the muscle edges

410
Q

where is the muscle fasicle inflammation in polymyositits

A

endomysela inflammation

411
Q

polymyositits

A

it is muscle only involvement which is not skin involved at all

412
Q

what is the genetic issue with Duchenne muscular dystrophy

A

deletion of dystrophin gene

413
Q

Ducheene muscular dystrophy

A

it is calf pseudo hypertrophy and proximal weakness starting at one years old

414
Q

what is the function of dystrophin

A

it is the anchor between muscle cells and extracellular matrix

415
Q

what is the genetic issue in Becker

A

it is a mutation in dystrophin, so it still produces some dystrophin

416
Q

Myasthenia gravis

A

it is a postsynaptic issue. It is against the postsynaptic, so ACh cannot bind. It is no ache, and ptosis and double vision, muscle weakness is wore with use- thymoma and thyme hyperplasia

417
Q

Lambert Eaton syndrom

A

presynaptic Ca channel is affected. Paraneoplastic from small cell lung cancer. decreased ACh release. weakness improves with use and it does not happen with the eyes

418
Q

what is the dominant cell of liposarcoma

A

lipoblast

419
Q

what muscle tumor is associated with TS

A

cardiac rhabdomyoma

420
Q

where can a rhabdomyosarcoma be and what marker is here

A

it is in the heart of vagina and desmin positive

421
Q

what are the layers of the epidermis deep to superficial

A

it is basalis, spinosum, granulosum, corneus.

422
Q

atopic dermatitis

A

it is eczema and red itchy wet wit small vesicles. HSN1

423
Q

contact dermatitis

A

HSN4 and it is from an irritant

424
Q

acne vulgaris- what is the bug

A

it is from chronic inflammation no the hair follicles and sebaceous glands. It is in the hair share and paces breakdown the stuff with lipases

425
Q

benzyl peroxide

A

it kills the pacnes

426
Q

what does vitamin A do for acne

A

it decreases the keratin production

427
Q

psotiasis

A

extensor surfaces, it is scale due to excess keratin and from trauma, and is HLA-C. hyperplasia of Keratinocytes. and parakeratosis, and longer dermal papilla. peel off skin and it bleeds.

428
Q

how to treat psoriasis

A

it is treated with PUVA- psoralen and UVA light

429
Q

lichen planus

A

purple polygonal papules, planar with white lines in the oral music and on the wrists and elbows. Inflammation at the DE junction and sawtooth pattern

430
Q

what is lichen planus associated with

A

HCV

431
Q

pemphigus vulgaris

A

IGG against desmoglein and it creates intraepidermal blisters and acantholyis from the basal layer staying attached. It is IGG fishnet. oral blisters when Q-tip is drug across it

432
Q

bullous pemphigoid

A

detroy the hemidesmosomes and it blisters and has ED junctions and so large tense bullae. Oral is spared

433
Q

erythema multiforme

A

HSR with target rash and bull assocaited with white central necroses. Can be fro SLE, or drug reaction or malignant

434
Q

if the erythema multiform is associated with oral mucosa what is the lesion

A

it is from SJS

435
Q

what is TEN

A

sloughing of skin from SJS and from adverse drug reaction

436
Q

subbereic keratosis

A

it is stuck on coin lesions and this is a revised lesion of pseudocysts with pink swirls

437
Q

what is the cause and name for sudden onset sobererc keratosis

A

it is the lesser treat sign and it is from gastric or GI cancer

438
Q

acnathosis nigricans

A

velvet skin with epidermal hyerplasia- DM or gastric cancer

439
Q

BCC risks, and what is seen

A

all is uvb exposure,and it is elevated nodule with central ulcer and telangtactase, and upper lip and nodule of basal cell with peripheral palisading. excise

440
Q

SCC risk and what does it look like

A

it is UVB and from immunosuppressant, arsenic, chronic inflame of skin, ulcerated noudle hits the lower lip, treat wit hexcision

441
Q

actinic keratosis

A

precursor to SCC, scaly plaque on the back, neck , face

442
Q

keratoacanthoma

A

well defined SCC that rapidly develops then regresses. it is cup shaped with central ulcer full of keratin debris

443
Q

vitiligo

A

autoimmune destruction of the metlanocutes. can be see in a white person that can’t tan

444
Q

albinism

A

congential lack of pigment lack of tyrosine so normal metlanocytes

445
Q

what is increased in freckles

A

iti can be increased number of melanosomes

446
Q

junctional nevus

A

it is grown at the DE junction- child

447
Q

compound nevus

A

it is down to D but in the E

448
Q

intradermal nevus

A

it is down into the dermal only so it is adult

449
Q

melanoma

A

assymtery, broad irrusialt, color, big diameter

450
Q

phase of melanoma growth

A

radial growth and vertical

451
Q

what determines how bad the melanoma is

A

depth

452
Q

lentigo malgina

A

melanoma is only at junction good prog

453
Q

superficial melanoma

A

early radial phase- good prog

454
Q

nodular melanoma

A

early vertical phase- bad

455
Q

acral lentiginous

A

it is on the nails and toes, which is not associated with sun light and it is in darker skinned people

456
Q

impetigo

A

honey colored crusts with strep pyogenes and staph aureaus

457
Q

cellulitis

A

dermal infection and it is trauma or insult

458
Q

necrotiszing fascitis

A

it is necrosis of subcutaneous tissue and due to infection of flesh eating bacteriaa causes creptitis, and surgical emergency

459
Q

staph scalded skin syndrome

A

it is from exfoliative tons a and B and removes the stratum granulosum- staph

460
Q

where does TEN hit

A

the DE junction

461
Q

veruca

A

warts with hPV

462
Q

what is mollucusm contangiousum

A

large umbilicate pustule and it has inclusions called inclusion bodies

463
Q

what is the typical arm fractures of osteoporosis

A

it is dinner fork fracture of the radius

464
Q

what group has higher bone density

A

african american femaes

465
Q

progressive groin and hip pain with exacerbation of wait bearing and decreased range of motion

A

avascular necrosis of bone

466
Q

polyostatic fibrosis

A

bone mineral replaced by collagen Part of Macune albright syndrome

467
Q

Macune Albright Syndrome

A

precocious puberty, and cafe au last spots and polyostatic fibrosis

468
Q

what are the levels in primary hyperparathyoidism

A

it is increased serum calcium, decreased phase, increased ALP,ad increased PTH

469
Q

what are the levels in secondary hyperparathyoidism

A

decreased CA, increased phos, increased ALP, and increased PTH from CKD

470
Q

what are the levels in hypervitamin D

A

it is increased CA, and increased phos, and decreased PTH

471
Q

what are the genetic predispositions to osteosarcoma

A

it is PAgets, ratiation, RB and Li-Fraumani which is a p53 mutaiton

472
Q

what medication can exacerbate gout

A

thiazide diuretics

473
Q

Sjogren syndrome

A

autoimmune disorder characterized by destruction of exocrine glands and it is expecially of the lacrimal and salivary glands by lymphocytic infiltrate

474
Q

what are the complications of Sjogren

A

it is dental caries, MALTomas, and lymphoma

475
Q

how do you diagnose it and what are the antibody markers

A

it is diagnosed by lip biopsy and it has anti SSA (ro) and SSB la

476
Q

what are the findings associated with Sjogrens

A

inflammatory joint pain, keratoconjunctiitis, xerostomia and bilateral parotid enlargement

477
Q

gonoccocal arthritis triad

A

polyarthralgias, tenosynovitits, and dermatitis, pustules

478
Q

what should you look for with AS to diagnose progress in

A

it is with a chest XR to look at if it gets worse in thoracic to prevent chest wall movemetn

479
Q

SLE presentation

A

rash, joint pain, fever- female of reproductive age and african american descent

480
Q

libman sachs endocarditis

A

nonbacterial verrucous thrombi usually on the mitral or aortic valve

481
Q

lipus nephritis

A

it is homerular deposition of complexes hematural and proteinuria

482
Q

what are the symptoms of SLE

A

rash, arthritis, serositits, hematologic disroders, oral nasal ulvers, renal disease, photosensitivity, antinuclear antibodies, immunologic disorder, nuerologic disorder

483
Q

what is the sensitive test and specific test of SLE

A

sensitive- ana

specific- anti dSDNA or Anti smith

484
Q

what does SLE do to complement

A

decreased complete form increased consumption of the immune complexes

485
Q

antiphopholipid syndrome

A

an be with SLE- thrombosis, spontaneous abortion, anticardiolipin and anti b2 glycoprotein antibodies- can be false positive on VDRL

486
Q

mixed CT disorder

A

SLE, systemic scleoriss, and polymyositis- associatd wit hanti-U1 RNP antibodies

487
Q

sarcoidosis

A

widespread noncaseating granulomas- elected ACE, and elevated CD4/CD8- bilateral adenopathy and coarse reticular opacities. Extensive hailer and mediastinal adenopathy. It is associated with restrictive long disease, and erythema podium, lupus perinea on skin, and bell palsy, epithelium granulomas, uveitis, hypercalcemia. increased 1 alpha hydroxylate mediated vitamin D activation.

488
Q

what cytokines are active in sarcoid

A

it is Th1 and iL2 and IFN gamma increased so macrophages to granulam

489
Q

what are the lab levels of calcium and vitamin D for sarcoidoisis

A

increased 1,5 vitamin D, decreased PTH and increased Ca

490
Q

polymyalgia rheumatica

A

pain and stiffness in shoulders and hips with fever, males weight loss no weakness associated with temporal arteritis

491
Q

what is the vacillates associated with polymyalgia rheumatica

A

temporal arteritis

492
Q

fibromyalgia

A

females 20-50 and chronic musculoskeletal pain at stiffness, paresthesia, poor sleep, fatigue, and cognitive disturbance, and some fatigue and neurospych symptoms

493
Q

what specific part of the NMJ does MA hit

A

the postsynaptic Nicotinic at receptors

494
Q

myositis ossificans

A

hetertrpic ossification of skeletal muscle following muscle trauma- presents as suspicious mass at site of known trauma or as incidental finding on radiology

495
Q

scleroderma diffuse

A

widespread skin involvement rapid progression and early visceral involvement, anti scl70 and anti DN toposionmerase I

496
Q

limited scleroderma

A

limited skin involvement confined to fingers and gave. Also sclerodactyl, calcinocis, wryness, esophageal dysmotily, and telangatase- pulmonary HTN from deposition of collage

497
Q

what is the antibody for limited scleroderma

A

anti-centromere

498
Q

Ryanauds phenomenon

A

decreased blood flow to hands due to arteriolar vessel vasospasm i response to cold or stress, white and blue to red- raunaud is secondary to SLE, Crest or mixed CT disorder. it is the limited form of crest

499
Q

what do you treat raynauds with

A

CCB

500
Q

hyperkeratosis

A

thickness increased of strum corneum

501
Q

parakeratosis

A

hyperkeratosis with mention of nuclei in statum coneum

502
Q

hypergranulosis

A

increased thickness of stratum grnaulosum

503
Q

spongiosis

A

epiderma accumulation of edematous fluid in intercellular spces

504
Q

acantholysis

A

operation of epidermal cells

505
Q

acanthosis

A

epderma hyperplasi and increased spinosum

506
Q

rosacea

A

inflammatory facial skin disorder characterized by erythematous papillose and pustules but no comedones- may assocaited with facial flushing in response to extremal stimuli- alcohol and heat- phymatous rosacea and cause rhinopehyma deformation of the nose

507
Q

urticaria

A

hives prurutic wheals that form after mast cell degranulation. supeficial dermal edema and lymphatic channel draining

508
Q

angiosarcoma

A

rare blood vessel malignancy occurring in the head, neck and breast usually in elderly on unexposed areas- chronic psomastectomy lymphadeam

509
Q

what is the associated with hepatic angiosarcoma

A

it is vinyl chloride and arsenic exposure

510
Q

what is the marker for angiosarcoma

A

CD31

511
Q

bacillary angiomatosis

A

benign capillary skin papillose in AIDS from bartonella henselae infection looks like kaposi but has neutrophilic infiltration

512
Q

cherry hemangioma

A

benign capillary hemangioma of elderly does not regress increase wit hage

513
Q

cystic hygroma

A

cavernous lymphagioma of the neck- translucent and it is in turners

514
Q

glomus tumor

A

bening red blue tumor under finger nails arises from bodied smooth muscle cells of the thermoregualtor gloms body

515
Q

kaposi sarcoma

A

endothelial malignancy most commonly associated wit skin , but mouth GI tract, and respirator tract, HHV8 and HIV. mistaken for bacillary angiomatousin but has lymphocytic infiltrate

516
Q

pyogenic granuloma

A

polypoid capillary gemanioma that can ulcerate and bleed associated with trauma and pregnancy

517
Q

strawberry hemangioma

A

bening capillary hemangioma of infancy and appear in first few weeks of life, and grows and rapidly regress spontaneously by 5-8 years

518
Q

erysipelas

A

it is infection involving the upper dermis and superficial lymphatics usually from strep progenies and present with well defined demarcation between infection and normal skin

519
Q

what organisms most often cause abscesses

A

it is staph aureus usually

520
Q

why does erythema multiform happen

A

it is from the immune deposition in the skin which causes the reaction.

521
Q

what viruses are often a cause of erythema multiform it is usually

A

hsv

522
Q

scaly erythematous plaques in the shape of a christmas tree on the trunk

A

pityriasis rosea

523
Q

what drug can you use for specific mutations of melanom

A

veruafenib- BRAF kinase inhibitor

524
Q

what is the origin of melanocytes

A

neural crest cells

525
Q

when does lung development start

A

4 weeks

526
Q

what can errors in the embryonic period of lung development lead to

A

TE fistula

527
Q

when is the pseduoglandular phase of lung development and what happens

A

it is 5-16 weeks. It is incompatible with life. it is endodermal tubes to terminal bronchioles

528
Q

when is the cannilicular phase and what does it do

A

terminal bronchioles and respiratory bronchioles and alervelor dructs. airways increase in diameter

529
Q

at what phase and week can respiration be capable

A

it is at 25 weeks and its in the cannilicular phase

530
Q

what is the saccular phase and what does it do

A

it is development of pneumocytes. it is 26 weeks to brith

531
Q

how is breathing in utero accomplished

A

it is breathing by aspiration.

532
Q

what can causes pulmonary hypoplasia

A

diaphragmatic hernia or bilateral renal agencies which leads to poorly developed bronchial tree with abnormal histology

533
Q

what is a bronchogenic cyst, where are they located

A

mediastinal mass in a child and it is from abnormal bugging can be infected or cause respiratory distress from compression of other structures

534
Q

what are the cells that line the alveoli and are thin for gas exchange

A

type 1 pneumocytes

535
Q

what cells secrete pulmonary surfactant and decrease alveolar surface tension and decrease lung recoil and increase the lung compliance. Proliferate in the face of damage

A

type II pneumocytes

536
Q

what are club cells

A

nonaffiliated low columnar/cuboidal cells with secretory granules. Secrete a component of surfactant and degrade toxins and act as reserve cells

537
Q

when do alevoli have a tendency to collapse

A

when they have a decreased radius according to lap laces law, they have an increased collapsibility.

538
Q

what is the main component of surfactant

A

dipalmitoylphosphotidylcholine

539
Q

what can you give to mother and when to increase surfactant production

A

48 hours before delivery give steroids

540
Q

what does neonatal distress syndrome look like

A

alveloar collapse from increased surface tension and ground glass appearance on imaging

541
Q

what is the screening for fetal lung development

A

it is L/S ratio of greater than 2 and foam stability test. Amniotic fluid is placed in ethanol and shaken

542
Q

what does persistently low O2 cause

A

PDA

543
Q

risk factors for neonatal RDS

A

prematurity, maternal diabetes from increased insulin, c section form decreased glucocorticoids produced form the baby

544
Q

what can therapeutuc supplemental O2 cause in an infect

A

it can cause retinopathy of prematurity, intraventiruclar hemorrhage, bronchopulmonary dysplasia. The retinopathy is from increased O2 and the intraventricular hemorrhage is from the immature germinal matrix rupturing

545
Q

what composes the conducting zone of the lung, what is the function and what are the epithelium made of

A

it is large airways of nose, pharynx, larynx, trachea, and bronchi- small airways are bronhioles to terminal bronchioles- it is warming humidifying, and filtering the air, but it does not permit in gas exchange so it is anatomic dead space. It is pseudo stratified because it has cilia to remove particles and then traditions to cuboidal cells at the terminal bronchioles. Smooth muscle gets to the terminal bronchioles

546
Q

what composes the respiratory zone, and what are the epithelium and what clears the area of debris

A

it is respiratory bronchioles, alveolar ducts, and alveoli, and it participates in gas exchange. It has alveolar macropahges to clear the debris.

547
Q

what happens to the resistance as you move down the airways

A

it decreases the resistance since the tubes are in parallel

548
Q

a person aspirates while reclining in bed, where does it go

A

the superior segment of the inferior Right lobe

549
Q

a person aspirates while sitting up in bed, where does it go

A

the inferior segment of the inferior right lobe

550
Q

how many lobes do the right and left lung have

A

the right lung has 3 and the left lung has 2 and a lingula

551
Q

what structure is at T8

A

IVC

552
Q

what structure is at T10

A

esophagus, vagus

553
Q

what is at T12

A

aorta, thoracic duct, and azygous vein

554
Q

where does pain from diaphragm irritation go to

A

shoulder which is C5 and trapezius which is C3 and 4

555
Q

what bifurcates at C4

A

common carotid

556
Q

what bifurcates at T4

A

trachea

557
Q

what bifurcates at L4

A

abdominal aorta

558
Q

formula for minute ventialtion

A

Ve=Vt x RR

559
Q

formula for alveolar ventilation

A

VA= (Vt-Vd) x RR

560
Q

elastic recoil

A

tendency for the chest wall to want to go out and the lung to pull in

561
Q

when are the elastic forces equal

A

at the FRC

562
Q

At FRC what is the airway and alveolar pressures

A

it is 0 and the intrapleural pressure is negative to prevent the pneumothorax and PVR is the lowest

563
Q

compliance of the lungs

A

change in lung volume for a pressure change. It is inversely proportional to the stiffness.

564
Q

what are high lung compliance states

A

lung is easier to fill and its with normal aging and emphysema

565
Q

what are low lung compliance states

A

lung is harder fill so edema, pneumonia, fibrosis

566
Q

what does surfactant do to compliance

A

it increases compliance

567
Q

hysteresis

A

it is lung inflation following a different curve than the lung deflation curve due to need to overcome surface tension forces in inflation

568
Q

what is the taut form of hemoglobin

A

iti s the deoxygenated form that promotes the release of oxygen

569
Q

what is the relaxed form of hemoglobin

A

it is a form that has high affinity to grab O2

570
Q

what favors the taut form over relaxed

A

increased Cl, H, Co2, 2-3 BPG, and temperature increased

571
Q

why does fetal hemoglobin have higher affinity

A

it is does not respond to 2-3BPG

572
Q

what type of iron is in hemoglobin

A

the F2 iron is in normal O2

573
Q

what is the ferric iron and what does it do if its in hemoglobin

A

it is Fe3 and it has an increased affinity for cyanide and its called methemoglobin

574
Q

chocolate colored blood and cyanosis

A

methemoglobinemia

575
Q

what can induce metheglobinemia

A

it can be induced by nitrites plus thiosulfate or benzocaine and can be used to treat cyanide poisoning

576
Q

treatment for metheglobinemia

A

methylene blue and vitamin C

577
Q

what level does not change with metheglobinemia

A

PaO2

578
Q

carboxyhemoglobin

A

form of Hb bound to CO in place of O2. It decreases the oxygen binding capacity and so decreased unloading to tissue. treat with O2

579
Q

what is positive coopertivity

A

after one O2 binds to hemoglobin it increases affinity of binding for the others

580
Q

does myoglobin have cooperatvity

A

no

581
Q

what things cause Hb right shift

A

acid, Co2, exercise, 2-3 BPG, altitude, temperature

582
Q

Left shift

A

can be from increased EPO and erthyrocytosis or fetal hemoglobin

583
Q

what lab values do not change with changes in the hb content of the blood

A

PaO2 and O2 saturation

584
Q

what is the hb concentration, o2 sat, PaO2, total O2 content: Co poisoning

A

Hb concentration: normal
%O2- decreased
PaO2- normal
total O2 content- decreased

585
Q

what is the hb concentration, o2 sat, PaO2, total O2 content: anemia

A

Hb concentration: decreased
%O2- normal
PaO2- normal
total O2 content- decreased

586
Q

what is the hb concentration, o2 sat, PaO2, total O2 content: polycythemia

A

Hb concentration: increased
%O2- normal
PaO2- normal
total O2 content- increased

587
Q

perfusion limited lung:

A

gas equilibrates early on the capillary so it is can only increase if flow is increased

588
Q

diffusion limited lung:

A

emphysema, fibrosis, CO- gas does not equilibrate by the time blood reaches the end of the capillary

589
Q

DCLO

A

extend to which oxygen passes from air sacs into the blood

590
Q

diffusion area is decreased in

A

emphysema

591
Q

alveolar wall thickness is increased in

A

pulmonary fibrosis

592
Q

equation for pulmonary vascular resistance

A

PVR= P(pul artery)-P(left atrium)/CO

593
Q

alveolar gas equation

A

PAo2=PIO2-PaCO2/R

594
Q

when can increased A-a gradient occur

A

hypoxemia causes shunting, V/Q mismatch, fibrosis

595
Q

what decreases O2 delivery to the tissue

A

decreased CO, Co poisoning, hypoxemia, anemia

596
Q

what decreases PaO2 with normal A-a gradient

A

high altitude, hyperventilation aka opioid use

597
Q

what decreases PaO2 with an increased A-a gradient

A

V/Q mismathc, diffusion limitation like fibrosis, right to left shunt

598
Q

ischmia or loss of blood flow is from

A

impeded blood flow or decreased venous drainage

599
Q

what can obesity do to breathing

A

hyperventilation from increased CO2 and no A-a gradient

600
Q

what is the difference in zone one of the lung

A

it is wasted ventilation because there is less perfusion

601
Q

what makes the V/Q mismatch less

A

exercise from vasodilatin

602
Q

why does TB like the apex of the lung

A

extra O2 hangs out up there

603
Q

when does the V/Q equal 0

A

when there is an obstruction, so extra O2 does not help because it can’t get to the alveoli.

604
Q

when is the V/q equal to infinity

A

it is equal to infinity when there is not enough perfusion. It can be improved by increasing O2 content

605
Q

what are the ways that CO2 is carried in the eblood

A

HCo3, carboaminohemoglobin when the CO2 binds the N terminus of global. which is in the taut state, and dissolved in the blood

606
Q

Haldane effect

A

oxygenation of Hb promotes dissociation of H+ from Hb. This shifts equillibrium toward CO2 formation therefore Co2 is released from RBCs

607
Q

Bohr effect

A

increased H+ from the tissue metabolism shifts the curve right to unload O2

608
Q

what does the body do in response to high altitude

A

it decreased PaO2, increased ventilation, decreased Pa CO@, respiraotry alkalosis, altitude sickness

609
Q

what are the signs of acute altitude sickness

A

it is headache, fatigue, acute cerebtal edema, and pulmonary edema from vasofialtion in the brain and vasoconstriction of the lungs from shunting which increases the pressure leading to edema

610
Q

chronicly what does high altitude do

A

it increases ventilation, increased 2,3BOG, increased EPO, and increased cellular mitochondria, increased renal excretion of HCO3 which is also augmented by acetazolamide which is compensation for the respiratory alkalosis

611
Q

what does chronic hypoxic pulmonary vasoconstriction lead to

A

pulmonary hypertension and RVh

612
Q

what happens to the levels of PaO2, PaCO2, venous Co2 and venous O2

A

there is no change in PaO2, and PCo2, but the venous content of Co2 increases and the venous content of O2 decreases

613
Q

what is the most common viral cause of rhinitis

A

adenovirus

614
Q

what type of HSN is allergic rhinitits and what is seen histologically

A

it is HSN1 . see eosinophilic inclusions and associated with asthma and eczema.

615
Q

child with nasal polyps what might you be worried about

A

CF

616
Q

if there is asthma and nasal polyps, what should you not give him

A

aspirin

617
Q

adolescent male with profuse nose bleeding

A

it is angiofibroma- benign tumor of nasal mucosa

618
Q

nasopharygeal carcinoma

A

it is a EBV associated tumor with cervical lymphadenopathy and pleomorphic and keratin positive cells of epithelial cells in the lymphocytes

619
Q

acute epiglotitis

A

HIb is the cause and there is airway inflammation, drooling, dysphagia, and insipraory stridor and protect airway

620
Q

larygneotraceheal bronchitis

A

parainfluenza with seal back cough

621
Q

vocal cord nodules

A

it is excessive use, mixed tissue, and hoarsness and it is bilateral

622
Q

laryngeal papilloma and cause and histology

A

it is HPV 6,11- koilocytes and multiple in kids and single in adults

623
Q

laryngeal carcinoma

A

squamous cell cancer from epithelial lining and cause alcohol, smoking, hoarseness, stridor, and some increased risk of HPV

624
Q

risk factors for pneumonia

A

impaired cough, decreased mucocilliary elevator, and circus can known down the cilia which causes risk of superinfection. mucus plug

625
Q

symptoms of pneumonia

A

fever, chills, sputum, pleuritic chest pain from increased bradykinin and PGE2, decreased breath sounds, dull to percussion, and increased WBC

626
Q

what are the common causes of lobar pneumonia

A

klebsiella from aspiration in alcoholics, elderly, and diabetics and have thick mucoid capsule and currant jelly sputum and abscess.
strep pneumo is common in old people

627
Q

are the stages of lobar pneumonia and what do they look like

A
  • congestion-dilated vessels and edema
  • red hepatization- neutrophils and blood increased RBC leads to the consolidation
  • grey hepatization- RBC get broken down still consolidated
  • resolution- scar leads to increased activity of pneumocytes II
628
Q

Bronchopneumonia causes and what does it look like and which are associated with

A
  • staph aureus- number 1 cause of virus knock out the elevator. Can cause empyema(infection in pleura in the infection), and abscess
  • hib- COPD
  • pseudomonas- it is CF
  • moraxella- community or COPD
  • legionella- water source- silver stain and intracellular organism
629
Q

interstitial pneumonia causes are presentation

A

diffuse inflammation of air sac is atypical. It has a mild URI and decrease sputum and cough, and low fever. Empty air sacs, and neutrophils in the interstitium,

  • mycoplasma- can cause IgM hemolytic anemia and no cell wall
  • chlamydia- teenagers
  • RSV- neonates
  • CMV- post transplant
  • influenza- old people increased risk of pneumonia
  • coxiella- atypical farmer or vets- high fever- cattle placenta lots of spore- rickettsia without rash
630
Q

aspiration pneumonia- where does it occur and what causes it

A

anaerobe- bacteriodes, fusiform, and peptococcus- right lower lobe abscess

631
Q

TB primary infection

A

Ghon ocmplex, fibrosis, calcification of hillier LN, and lower lobe. positive PPD and sub pleural and hillier.

632
Q

secondary TB

A

AIDs, age increase the likelihood of reactivation. Apex for increased O2 and foci of caseating necrosis, and military TB which seeds other organs. Fever, night sweats, caveating necrosis granulomas, look for acid fast positive

633
Q

what part of the brain does TB seed

A

base of brainstem

634
Q

what does TB cause in the kidney

A

sterile pyuria

635
Q

what does TB in the bone cause

A

Potts disease

636
Q

what does airway obstruction lead to in terms of values

A

decreased FVC, decreased FEV1, decreased ration, and increased TLC

637
Q

Chronic bronchitis presentation

A

it is 3 months over 2 years from smoking large areas. It is glandualr hyperplasia leading to increased mucus which forms plus and then leads to cough and increased PaCO2 and decreased PaO2, and

638
Q

chronic bronchitis complications

A

increased risk of infections and for pulmonate, clamp down to shunt from O2 low region and move it to other areas, but if its all over from disease all over can create increased RH work which led to right heart hypertrophy and failure.

639
Q

emphysema presentation

A

destroy alveolar sacs from exchange so increased collapse because cant have enough elastic roil to stay open. It is dyspnea, airway collapse of small ones, purse lips for increased back pressure to prevent trapping, and pink offer ,weight loss from increased breathing work ,and wide chest from increased chest pull out

640
Q

what is emphysema pathophysiology of smoking caused

A

centracinar emphysema- it is increased proteases because of the extra inflammation which is more than the alpha 1 can handle

641
Q

what is the pathophysiology of alpha 1 antitrypsin

A

it is no protection from protease damage because too much proteases. It is panacean emphysema and lower lobe pneumonia get cirrhosis from misfolded protein build up in the hepatocytes and this causes pink PAS positive globules. these are in the endoplasmic reticulum

642
Q

what is the gene for alpha 1 anti-trypsin and what is the difference with a heterozygote and homozygote

A

-PiM is normal allele and the common mutation is PiZ. If you are homozygous, you will get it. There is PiZ and PiM together then it is you are heterozygous so should not smoke, but need to keep lungs protected because some increased risk from decreased production,

643
Q

what are the cytokines that induce asthma

A

TH2, IL4-IgE, IL5-eosinophils, IL10- inhibit Th1, and so increased Th2

644
Q

pathophysiology of asthma

A

it is re-exposure causes cross linking of IgE and this activates mast cells and dump histamine and causes vasodilation,in venues and it causes fluid from posterior capillary venues. Leukotriene C4, D4,E4- constriction and inflammation leads to bronchoconstriciton and perpetuats the constriction.

645
Q

what is it called if asthma doesn’t want to stop

A

status asthmaticus

646
Q

bronchiectaasis

A

abnormal dilated airways - lose tone and air trapping whorls because the air can’t get out. Large airspaces and necrotizing inflammation and damage to the wall

647
Q

who gets bronchiectasis

A

CF (thick sputum), Kartageners (dynein arm less movement), tumor or foreign body, necrotizing infection like Kleb, and allergic bronchopulmonary aspergillum (asthmatics or CF gets HSN reactions to aspergillum.

648
Q

what are the complications of bronchiectasis

A

hypoxia and cor pulmonale, and secondary amyloidosis

649
Q

foul smelling sputum, dyspnea, cough

A

bronchiectasis

650
Q

what are the lab values for restrictive lung diease

A

decreased TLC, decreased FVC, decreased FEV, and increased ration

651
Q

idiopathic lung fibrosis what causes it and cytokine and symptoms

A

TGF-beta from injured pneumocytes induce fibrosis and can be from bleomycin, amnioderone, dyspnea, progressive cough, and sub pleural fibrosis, honey comb lungs

652
Q

coal workers lung

A

carbon to the macrophages, shrunken lung

653
Q

what is associated with coal workers lung

A

rheumatoid arthritis

654
Q

what is seen with mild carbon

A

build up in macrophages, and anthracosis, and hilar LN, and common with just polution

655
Q

silicosis patient, what does it inhibit, and what are they at increased risk of

A

sand blaster and miners, impaired phagolysossome in macrophages, and increased risk of TB in the upper lobes

656
Q

beryllium lung

A

aerospace injury, non caseating granulomas like sarcoid. increased risk of lung cancer

657
Q

asbestosis

A

constuction, plummer, ship year, fibrosis of the lung and pleura increased risk of lung cancer and mesothelioma

658
Q

what are the cells seen in a sample of asbestos exposure

A

ferruginous bdies which are iron barbells

659
Q

sarcoid what causes it and histology and symptoms

A

systemic non-caseating granulomas, black female and CD4 + T cell response, and Cutaenous nodules, uveitis, and asteroid bodies, Sjogrens syndrome, and lung can become less compliant. dyspnea, cough, increased ACE in suerm, hypercalcemia, treat with steroids and can resolve without it

660
Q

why does sarcoid cause hypercalcemia and what other conditions can cause it

A

it increases activation of vitamin D because it has 1 alpha hydroxylase activity and it is increased in anywhere that has noncaseating granulomas

661
Q

what can cause HSN pneumonitis and what are the features

A

it is fever, cough, dyspnea, and remove exposure and it gets better. granulomas form- eosinophilic granulomas and it is pigeon breeders comtimes

662
Q

what is seen with pulmonary HTN

A

it is increased MAP and the women with exertion dyspnea

663
Q

primary pulmonary HTN

A

young adult females, increased BMPR2 inactivation leads to increased vascular smooth muscle

664
Q

causes of secondary pulmonary HTN

A

it is hypoxemia, increased surface tension, and so increase volume current like congenital heart disease

665
Q

ARDs

A

damage to alveolar cap interface and protein fluid forms hyaline membrane like dense pink. Increased diffusion barrier so hypoxemia, and increased surface tension so collapse air sacs. Diffuse white out o lung

666
Q

what are the causes of ARDS

A

sepsis, infection, shock, trauma, aspiration, pancreatitis, DIC, HSN, drugs

667
Q

pathogenesis of ARDs

A

activation of neutrophils inducing protease mediated damage and free radical damage to type I and II penumocytes

668
Q

what do you treat ARDS wit hand what are the complications

A

PEEP to prevent collapse and complication increased fibrosis

669
Q

neonatal RDs

A

inadequate surfactant so increased surface tension.

670
Q

what are the populations at risk for neonatal RDs

A

premature before 34 weeks, C section from decreased stress, and maternal diabetes because insulin prevents surfactant activation

671
Q

what is seen on the XR for NRDS

A

hazy granularity

672
Q

what is the main component of surfactant

A

lecithin has phosphatidylcholine mainly

673
Q

what is the complications of NRDS

A

it is necrotizing enterocolitis, and PDA

674
Q

what can supplemental O2 do in a neonate

A

retina with free radical injury and bronchopulmonary dysplasia

675
Q

what is the bad part of cigarette smoke causing cancer

A

polycyclic aromatic hydrocarbons

676
Q

what do you look for if there is a mass on lesion on the lung

A

look at old XR to see if anything has changed

677
Q

what are the benign lung lesions and what can cause them

A

benign hamartomas and grnulomas (histoplasma and TB)

678
Q

what are hamartomas composed of

A

calcified on imaging and has cartilage and lung tissue

679
Q

small cell lung cancer what does it look like

A

poor differentiated small cells, central tumor on smokers and increased mitosis

680
Q

small cell lung cancer: what are the paraneoplastic syndromes

A

ADH, ACTH, and Lambert Eaton (presynaptic calcium channels)

681
Q

squamous cell carcinoma histology

A

keratin pearls and intracellular bridges which are desmosomal connections

682
Q

where is the squamous cell tumor and what are the paraneoplastic syndromes

A

PTHrP and increased Ca, and central tumor of male smokers

683
Q

large cell tumor histology

A

poor differentiation with poor prognosis

684
Q

bronchioloalveloar tumor

A

tumor on small airway and malignant Clara cells and peripheral looks like pneumonia and walls of alveoli are replaced by tall columnar cells

685
Q

carcinoid tumors

A

neuroendocrine tumors and polyp mass on the bronchi positive chromogranin

686
Q

what cancer is involved or moves to the pleura

A

adenocarcinoma

687
Q

what are some of the complications of lung cancer

A

pleural involvement (adenocarcinoma), obstruction of the SVC, phrenic or laryngeal nerve, pan coast tumor (pinpoint pupil, and anhidrosis of the forehead , and ptosis

688
Q

where does a lung tumor met to

A

adrenal glands

689
Q

which way does the trachea go on a spontaneous pneumothorax

A

it is an emphysematous bleb and young male and trace goes towards it

690
Q

which way does the trachea go in a tension pneumothorax

A

penetration causses a one way valve the trachea goes away from it.

691
Q

mesothelioma

A

pleural tumor that encases the lung. it is dyspnea, and chest pain, rind around the lung- asbestos exposure

692
Q

where do the maxillary sinuses drain to

A

middle meatus

693
Q

epistaxis where is the life threatening bleed from

A

posteior segment in the sphenopalatine artery branch of maxillary artery

694
Q

what are the typical HEENT tumors and what causes them

A

squamous cell cancer and HPV16 usually multiple tumors

695
Q

Virchow triad

A

stasis, hypercoagulability, endothelial damage

696
Q

D dimer is used to rule out DVT why

A

high Sn and low Sp

697
Q

who to treat DVT

A

heparin and LMWH for the first bit then use warfarin and rivaroxaban

698
Q

aviation what happens to the lung and body

A

G forces that are positive then increased blood to lower body and blackout at 4-6 Gs and scpaship is 8-9 so use G suit or change the angle. G- is all the blood to the head

699
Q

space what happens to the body

A

prolonged light leads to decreased BV and RBC and muscle street, decreased CO, and Ca and phos decrease

700
Q

nitrogen narcosis does what

A

N dissolves into neural membrane leading to decreased neuronal excitability act drunk

701
Q

decompression sickness

A

nitrogen is liquid in blood and comes out if start to come up to fast occluding vessels leading to dizziness, paralysis, sycope, and and SOB and pulmonary edema

702
Q

pulmonary emobolism

A

hypoxemia, resp alk, and sudden onset chest pain, dyspnea, and tachypena and tachycardia.

703
Q

what are typical histology of PE

A

it is lines of zahn which are interdigitating areas of pink platelets and red RBC and the thrombus is formed before death

704
Q

what are the types of emobil

A

fat, air, thrombus ,bacteria, amniotic fluid, tumor

705
Q

what causes fat emoboli

A

it is from bone fractures or liposuction. hypoxemia, neurologic abnormalitiy, and petechial rash

706
Q

amnitic fluid emboils is from

A

DIC and postpartum

707
Q

air embolus

A

from bends and it is treated with hyperbaric O2

708
Q

what can cause sudden death in a PE

A

it is a saddle embolus

709
Q

what stain is used for asbestosis

A

it is prussian blue

710
Q

why does TB have increased risk with silicosis

A

the silicosis impairs the phagolysosome of the macrophages which increases the infectious potential of TB

711
Q

why does pancreatitis cause ARDS

A

it is from increased cytokines and pancreatic enzymes so neutrophils get into the intersitium chasing pulmonary edema and exudate and free radical damage

712
Q

what happens to the lung and PCWP during ARDS

A

normal PCWP decreased lung complicate and V/Q mismatch

713
Q

sleep apnea

A

repeated cessation of breathing>10 seconds during sleeping disrupted sleep and daytime somnolence. Normal PaO2 during the day. Nocturnal hypoxia leading to systemic/pumonary hypertension and arrhythmia atrial fib and flutter. sudden death and hypoxia nadi increased EPO and increased eryhtropoesis

714
Q

obstructive sleep apnea

A

repiraoty effort against airway obstruction, associated with obesity, loud snoring, caused by excess paraphayrngeal tissue in adults, adenotonsillar hypertrophy in children, Weight loss and Cpap

715
Q

what can kinda of nerve stimulator do you use for sleep apnea

A

hypoglosal stimulator

716
Q

central sleep apnea

A

norespiratory effort due to CNS injury/toxicity, HF, and opioids

717
Q

obesity hypoventilation sydnrome

A

obestity, hypoventilation, decreased RR, decreased PaO2, and increased PaCO2 during sleep, increased PaCo2 during waking hours from retention

718
Q

what are increased and decreased values in pulmonary HTN

A

increased endothelia, decreased NO, and decreased prostacyclin

719
Q

what heart sounds are heard with pulmonary HTN

A

accentuation of S2 from increased VR and increased JVP, and peripheral edema and hepatic congestion

720
Q

what is transudate pleural effusion

A

decreased protein content due to increased hydrostatic pressure or decreased oncotic pressure like nephrotic syndrome and cirrhosis

721
Q

what is exudate pleural effusion

A

increased protein content, cloudy, due to malignancy, pneumonia, collagen vascular disease,e trauma occurs with increased vascular permeabiltiy and must be drained due to infection risk

722
Q

lymphatic pleural effusion is from what

A

thoraci duct injury from trauma or malignancy, milky appearing fluid increased triglycerides

723
Q

lung abcess

A

aspiration of oropharyngeal contes like loss of consciousness like alcoholics or epileptics or bronchial obstruction. Air fluid levels on CXR

724
Q

lung abscess with upright lesion where

A

basal segments of right lower lung

725
Q

lung abscess with supine lesin

A

posterior segments of right lobe or superior segment of right lower lobe

726
Q

is smoking a risk factor for mesothelioma

A

no

727
Q

why does pulmonary destruction happen with abscess

A

partially because of the release of lysosomal enzymes by neutrophils and macrophages it helps kills the pathogen and clean debris but can cause parenchymal damage as well

728
Q

treatment for lung abscess

A

clindamycin

729
Q

what structures does Pancoast tumor compress

A

recurrent laryngeal nerve, superior cervical ganglia, superior vena cava, and sensorimotor deficit

730
Q

SVC syndrome

A

an obstruction of the SVC that impairs blood drainage from the head with jugular distention, and upper extremity edema, and caused by malignancy, and thrombosis of indwelling catheter, and can raise intracranial pressure if obstruction is severe and headaches, and dizziness and increased risk of aneurism and rupture of intracranial arteries

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