things you always forget

Question 1

acid bases at altitude?

Answer 1

ALtitude= ALkalosis (resp)

driven by chemoreceptors, sense low O2 –> hyperventilate

compensate: loose bicarb

Question 2

cystinuria: amino acids?

Answer 2

COLA (dibasic)
cysteine, ornithine, lysine, arginine

defect in reabsoprtion in PCT and intestine

Question 3

whats sequela of cystinuria?

Answer 3

kidney stones!
high concentration of cysteine creates HEXAGONAL STONES
all others are soluble

Question 4

which inborn errors of metabolism have intellectural disability?

Answer 4

homocyteinuria (distinguish from marfans)
MSUD
PKU

Question 5

homocystinuria, what are the pathways

Answer 5

homo –> methionine (methionine synthase)

homo –> cysteine (cystathione synthase) –> give B6, B12, cysteine

Question 6

satellite phenomenon

Answer 6

can streak sheep blood plates with Staph A –> hemolysis will provide factors V and X for h. flu

Question 7

DKA acid base

Answer 7

low pH, low bicarb, high co2

metabolic acidosis with compensatory respiratory alkolosis

Question 8

normal Aa gradient

Answer 8

high altitude
alveolar hypoventilation (opiods)

Question 9

high Aa gradient

Answer 9

v/q mismatch
r–> L shunt
impaired diffusion

Question 10

osteosarcoma

Answer 10

bimodal: 10-20 and > 65
KNEEEEE + metaphysis of long bones
sunburst pattern
risk: pagets, li fraumeni,

Question 11

most common BONE METS

Answer 11

prostate= breast > thyroid > testes > lung > kidney

Question 12

blastic mets? lytic mets? both? labs that go with them

Answer 12

blastic= prostate --> high alk phos (because building bone)
lytic= lung --> high ca (because breaking down bone)

Question 13

most common tumors to MET to BRAIN

Answer 13

lung > breast > skin (melanoma) > kidney (rcc)

Question 14

most common MET to LIVER

Answer 14

colon > stomach > panc> breast > lung

Question 15

where do sarcomas met? where do carcinomas met?

Answer 15

sarcomas like blood

carcinomas like lymphatics

Question 16

exceptions to carcinomas? aka carcinomas that DONT spread through lymphatics?

Answer 16

RCC
follicular of thyroid
hepatocellular

Question 17

ovarian and gonadal vein drainage

Answer 17

LEFT (renal vein) IS LONGER so that go to the RENAL VEIN

RIGHT goes RIGHT into the IVC

Question 18

INdirect hernia

Answer 18

goes through INternal ring, then external –> it takes the long route

covered by all 3 spermatic fascial layers

lateral to inf epigastric becuase the deep ring is lateral

Question 19

direct hernia

Answer 19

wants to take the short cut so it goes straight through abdominal wall and into external ring

medial to inf epigastric vessels

only covered by external sperm fascia

happens in older men cause muscles are weak

Question 20

what type of hernia is more common in women?

Answer 20

FEMoral= females

Question 21

whats hesselbachs triangle and how do hernias relate?

Answer 21

inguinal ligament, inf epigastric vessels, later wall of rectus abd

INDIRECT are lateral
DIRECT go straight through
FEMORAL are below (they go below the inguinal ligament)

Question 22

RA big hits

Answer 22

• path= cyotkines lead to PANNUS formation
• HLA-DR4
• improves with use
• joint space narrowing, soft tissue swelling, subchondral cysts
• MCP, PIP WRIST!!!!

Question 23

joints the Ra effects

Answer 23

MCP
PIP
WRIST

Question 24

how does tx approach differ from RA to osteo?

Answer 24

RA can be systemic –> glucocorticoids, and DMARDS (tnf-a)

Osteoarthritis only effects joints –> NSAIDS, acetaminophen