UW3 Flashcards
Reversal of opiod
Naloxone
loss of coordination, nystagms and acute brain syndrome (disorientatin, poor judgement, memory loss). Associated with trauma
Substance induced psychosis from PCP abuse
endocardial cushion defect (ASD, regurgitant AV valves) is seen in what developmental disorder
Down syndrome
Hypertrophic cardiomyopathy is seen in what developmental defect
Friedreich ataxia
Situs inversus
Kartagener
Cystic medial necrosis (aortic dissection), Mitral valve prolapse
Marfan
valvular obstruction due to cardiac rhabdomyoma
Tuberous sclerosis
Aortic coarctation and bicuspid valve
Turner syndrome
difficulty rising from chairs and combing hair are examples of
Proximal muscle weakness
bilateral stiffness of shoulder and pelvic girdle muscles, fever, weight loss and increased sed rate. Associated with temporal arteritis
Polymyalgia Rheumatica
Drug abuse: violent, dissociations, nystagmus, ataxia
PCP
Drug abuse: visual hallucinations
LSD
Drug abuse: Chest pain, seizures, mydriasis
Cocaine
Drug abuse: violent, psychosis, choreiform movements, tooth decay
Methamphetamine
Drug abuse: increased appetite, impaired time perception, conjuctival injection
Marijuana
Drug abuse: Depressed mental status, Miosis, Respiratory depression
Heroin
course of the Median nerve in the forearm
Between the flexor digitorium superficialis and flexor digitorum profundus
Denervation of Median nerve leads to what deformity
loss of thenar eminence and “ape hand”
Course of the musculocutaneous nerve
Between the biceps brachi and coracobrachialis. Injury results in inability to flex
Course of the ulnar nerve
Between the flexor carpi ulnaris and flexor digitorium profundus in forearm. Between olecranon and medial epicondyle of humerus
Injury to ulnar nerve
claw hand deformity due to paralysis of intrinsic hand muscles
Course of the radial nerve
through the supinator near the head of the radius. Injury causes wrist drop (loss of extensors)
Number of people who must be treated before an adverse event occurs
Number needed to harm= 1/attributable risk
Attributable risk
Event rate of treatment - control
How is flow related to the radius in a vessel?
Inversly proportional raised to the 4th power
Mechanism of Digoxin
Block NaK ATPase and decrease AV nodal conduction by increased PS tone (vagal)
Low plasma sodium and osmolality, inappropriately concentrated urine, increased urinary sodium and normal body volume ( RAS intact)
SIADH ( small cell lung cancer)
What can be used to determine if malabsorption is due to pancreatic or intestinal pathology?
D-xylose (can be absorbed without amylase)
What does the deep peroneal nerve innervate?
Extensors and great dorsiflexors
What does the superficial peroneal n. innervate?
Peroneal muscles and skin of the toes
Compression or leg fracture causing foot drop
Damage to the common peroneal n ( crosses lateral neck of fibula)
Damage to femoral nerve
Loss of knee jerk
Damage to tibial nerve
Loss of plantar flexion (motor to popliteus and flexors of the foot)
Overflow incontinence
Impaired detrusor contractility or bladder outlet obstruction
Stages of lobar pneumonia
Congestion (24 hr), Red hepatization (2-3 days), Gray hepatization ( 4-6 dyays), resolution
High doses of ACHEi with no improvement with edrophonium
Cholinergic Crisis
What is the mechanism of cholinergic crisis?
High doeses of ACHEi increases AcH in synapases causes excessive stimulation that results in muscles that are refractory to future impulses. Presents as muscle weakness that does not improve with edriphonium
vitamin deficiency that appears similar to B12 but without megaloblastic anemia, hypersegmented neutrophils or increased serum methylmalonic acid
Vitamin E
PKU
Phenylalanine hydroxylase. Requires BH4
Maple syrup urine disease
branched chain ketoacid dehydrogenase
Alkaptonuria
Deficiency of homogentisic acid oxidase
splitting of S2 that does not change with respiration
ASD
Systolic ejection murmur that increases with standing
Hypertrophic cardiomyopathy ( decreased in size of left ventricular outflow tract)
Splitting of S1 accenutated on inspiration
delayed closure of tricuspid. Seen in Right BBB or tricuspid stenosis
Power of a study
Ability to detect a difference between groups when a different truly exists. Increases when sample size
Full bladder sensation and inability to pass a foley
Urethral injury
Autoregulation of BP in coronary arteries is mostly controlled by
Nitric oxide and adenosine
Impaired balance, difficulty speaking with elevated transaminases
Wilsons disease. Kayser Flesicher ring
Treatment of DKA
Insulin and normal saline ( drops potassium due to intracellular shift of K)
Mitochondrial diseases display variability in clincal findings. What explains this?
Heteroplasmy ( condition of having different organellar genomes in a single cell)
Monoclonal antibody that binds IgE
Omalizumab
Monoclonal antibody that binds TNF
Infiximab, adalimumab
Decoy TNF receptor
Etanercept
Monoclonal antibody that binds HER2/neu
Trastuzumab
Hydrocephalus, intracranial calcifications and chorioretinitis
Congential Toxoplasma
What determines the potency of an anesthetic?
Minimal alveolar concentration (MAC) percentage that renders 50 percent of patients unresponsive to stimuli
What determines the onset of action for an anesthetic?
Blood/gas partition
SE of statins
hepatitis and myopathy
SE of niacin
cutaneous vasodilation, hyperglycemia (acanthosis nigricans), hyperuricemia, Hepatitis
SE of Fibric acid
Gallstones, myopathy
Bile acid binding resins
GI upset, Hypertrigyceride, malabsorption
peripheral displacement of nuclei, dispersion of Nissl substance in neurons indicate
Axonal regeneration
Burkitt lymphoma is a proliferation of what type of cells?
B cell proliferation. EBV can increase c-myc translocation (8,14)
Atrophic skin changes, cold induced vasospasm
CREST Syndrome (sclerodactylyl and Raynaud)
CREST Syndrome
Calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly, Telangietasia (anti-centromere antibody)
What does an accented heart sound over left sternal border suggest
pulmonary coponent of second heart sound suggests increase in pulmonary artery pressure and pulmonary hypertension
Diffuse injury to pulmonary microvasculature or alveolar epithelium, resulting in increased pulmonary capillary permeability and leaky alveolocapillary membrane
ARDS
ARDS
increased pulmonary capillary permeability leads to interstitial and alveolar exudate and edema. Decreases lung compliance, increases work of breathing and V/Q mismatch. Normal capillary wedge pressure.
tall stature, gynecomastia and small, firm teste
Klinefelter
Arachnodactyly, scoliosis, aortic root dilation
Marfan
Short broad fingers, transverse palmar crease
Down Syndrome
Macrosomia, large jaw, large ears, thin face, macroorchidism, mental retardation
Fragile X (CGG)
If the 95% CI for the mean difference between 2 variables includes 0
Null hypothesis is not rejected so there is no significant difference
If the Cl between 2 groups overlap, is there a significant difference?
no
If 95% CI for a RR or OR includes 1 is the null hypothesis rejected?
no
Percentage indicating the actual difference in event rate between control and treatment groups
Absolute risk reduction
Percentage indicating relative reduction in treatment event rate compared to control
Relative risk reduction (ARR/ control rate)
Ratio of the probability of an event occurring in the treatment group compared to the control group
Treatment rate/ Control rate
number of individuals that need to be treated to prevent a negative outcome in one patient
Number needed to treat (NNT= 1/ARR)
treat anemia due to chronic renal failure
Epo
Koilonychia
Spoon nails seen in iron deficiency
polyuria, polydipsia, volume depletetion, hyperglycemia, low bicarb, high anion gap, decrease sodium
DKA
What electrolyte must you monitor in DKA?
Potassium
Plantar flexion
Tibial (Gastrocnemius, soleus, plantaris)
Inversion of the foot
Tibal n (tibialis posterior)
Tibial nerve innervates
Flexors of the lower leg, flexors of the toes and skin of the sole of the foot
Course of the tibial nerve
Branch of the sciatic that goes through the popliteal foxxa
Key findings of DIC
Prolonged PT and PTT, Thrombocytopenia, microangiopathic hemolytic anemia, low fibrinogen, elevated fibrin split products, low factor 5 and 8
Penetrating injury to the second intercostal space at L. sternal border
Pulmonary trunk
Penetrating injury to the 4th intercostal space in the midclavicular line
left lung and left ventricle
stab would to the back immediate right of the vertebral body
IVC
penetrating injury at left sternal border at 4th intercostal space
Right ventricle
Gastric erosions
Do not penetrate the muscularis mucosa
Gastric ulcer
Extend into the submucosal layer and the muscularis propria
Basement membrane splitting
Membranoproliferative GN and alport syndrome
Diffuse thickening of glomerular capillary walls
Membranous glomerulopathy
Linear IgG and C3 deposits on IF
Goodpasture
narrow, high arched palate, low hairline, low set ears, bicuspid aortic valve, horseshoe kidney, cubitus valgus
Tuners Syndrome
individual inherits 2 copies of a chromosome from one parent and no copies from the other
Uniparental disomy (Prader Willi and Angelman)
Infection + hypotension, tachycardia, tachypnea and temperature
Septic shock
Early sepsis
Increased cardiac output, peripheral vasodilation and warm extremities
stimulates neutrophil migration to site of inflammation
Leukotriene B4
Stimulates growth and differentiation of stem cells in bone marrow
IL 3
Stimulates growth of B cells and increases TH2 t helper T cel
IL 4
Anti-inflammatory cytokine produced by macrophages and TH2 helper T cell
IL 10
Produced by T cells and recruits leukocytes and activate phagocytosis
INF gamma
Function of the 16s rRNA
initiation of protein synthesis. Binds Shine Dalgarno sequence in mRNA and allow mRNA and 30 risomal subunit to bind
Midshaft humerus fracture
Deep brachial artery and radial nerve
Short acting BZD
Alprazolam, Triazolam, Oxazepam
Medium acting BZD
Estazolame, Lorazepam, Temazepam
Long acting BZD
Chlordiazepoxide, clorezepam, Diazepam, Flurazepam
Transference
unconscious shifting of emotions associated with one person to another
Acting out
unconcious wishes or impulses are expressed through actions
Projection
misattributing ones own unacceptable thoughts and feelings to another
Pancreatitis with respiratory distress
ARDS from diffuse injury to pulmonary microvasculature and kealy alveolocapillary membranes ( exudate and necrotic tissue make up hyaline membrane)
Crackles (rales)
Alveolar edema and atelectasis
Cytokeratin is used as IHC marker for what cells
Epithelial cells
MPO is used as a marker for what type of cells?
Myeloid cells
Vimentin is used as a marker for what type of cell?
Vimentin
Chromogranin is used as a marker for what type of cell?
Neuroendocrine
stimulated by decrease in pH of CSF ( increased paCO2) increases respiration
Central chemoreceptors
Senses PaO2 and stimulated by hypoxemia
Peripheral chemoreceptor
C fibers that regulate duration of inspiration depending on degree of lung distension to prevent from hyperinflation
Pulmonary stretch receptors (Hering Bruer reflex)
TCA toxicity
sodium bicarbonate
Barbituate poisoning
Diuretic with urinary alkalization