4/1 Neuro, Endocrine, Psych Flashcards Preview

STEP1 Flashcards > 4/1 Neuro, Endocrine, Psych > Flashcards

Flashcards in 4/1 Neuro, Endocrine, Psych Deck (106):
1

Acne, infertility, anovulation

PCOS

2

Myasthenic crisis

Intubate them!
triggered by infection or other stressor--> profound weakness of respiratory muscles

3

old man with acute unilateral pain in eye with decreased vision, pupil dilation, conjunctival injection and tearing

Acute angle closure glaucoma

tx: beta antagonist (carteolol, timolol)

4

What do the boxes mean on EKG?

small box=0.04 sec
large box=0.2 sec

(300, 150, 100, 75, 60, 50)

Normal QT interval 2 large boxes

5

Prolonged QT interval DD

Drugs
Genetic:
-Romano-ward syndrome (AD)
--Jervell and lange-Nielsen syndrome (AR + deafness)

6

contraindication for sumatriptan

ischemic heart disease, stroke, prinzmetal angina, uncontrolled HTN
(vasoconstrictive MOA)

7

LLQ pain, focal colonic thickening, increased soft tissue density of pericolonic fat, fever, leukocytosis

Acute diverticulitis

8

Glomus body

small encapsulated neuromuscular organ found in dermis of nail bed, pads of fingers and toes and ears

thermoregulation

9

physiology of urticaria

increased perm of microvasculature leading to edema of the superficial dermis

mixed inflammatory infiltrate surrounding superficial dermal venules

10

Spongiosis

intercellular epidermal edema
eczematous dermatitis

11

What are janeway lesions?

Associated with infective endocarditis

contender macular erythematous lesions on palms and soles

Cause: septic embolization from valvular vegetation's
i.e. microabscesses

12

what causes osler nodes?

IE
immune complex deposition in the skin

PAINFUL

13

Renal metabolism of what aa maximizes acid excretion in the setting of acidosis ?

Glutamine to glutamate--> producing ammonium and bicarb to buffer acids in blood

14

goal of a granuloma?

wall off offending agent

15

Left frontal lobe injury

apathy and depression along with changed personality

16

Right frontal lobe injury

disinhibited behavior with changed personality

17

Treatment for delirium

Haloperidol if necessary

delirium is acute onset and waxing and waining

18

mechanism of action of PCP

N-methyl-D-aspartate receptor antagonist

inhibit reuptake of NE, DA, 5-HT

19

treatment for phobia

CBT

20

Psychodynamic psychotherapy

developing insight into unresolved conflicts that started in childhood

21

major depression criteria

SIG E CAPS
Sleep disturbances
decreased Interest
Guilt or worthlessness
Energy decreased
Concentration
Appetite/weight changes
decreased Psychomotor
Suicidal ideations

depressed mood

22

Mania criteria

DIG FAST
Distractibility
Irresponsibility
Grandiosity
Flight of ideas
Activity towards a goal increased
decreased need Sleep
Talkative or pressured speech

23

tx for tourette syndrome

Atypical antipsychotics, tetrabenazine, clonidine

24

TCAD suffix

-ipramine, -iptiline, -oxepin

25

tx for serotonin syndrome

cyproheptadine

26

RA, neck pain, stiffness, radicular pain

Atlantoaxial joint subluxation


Chronic RA can involve the cervical spine

27

What can worsen cervical spine subluxation?

extension of the neck during endotracheal intubation

compression of the spinal cord and/or vertebral arteries

28

What sites degenerate in Friedrich ataxia?

Spinocerebellar and lateral corticospinal tract-->ataxia and spastic muscle weakness

Degeneration of dorsal columns and dorsal root ganglia

29

Mutations in SOD1

familial ALS

30

what is broken down to make propionic acid

Valine, Isoleucine, threonine, methionine, cholesterol, odd-chain FA

31

MAOIs

Tranylcypromine
Phenelzine
Isocarboxozid
Selegiline

SE: Hypertensive crisis

32

When is K+ ion permeance highest in the neuron?

During the repolarization phase

33

what is the length constant for an axon?

Also called the space constant
measure of how far along an axon an electrical impulse can propagate

Myelin increases space constant by decreasing charge dissipation (increasing membrane resistance)

myelin also increases conduction velocity

34

Lateral nucleus of the hypothalamus

mediates hunger

damage=anorexia

35

ventromedial nucleus of the hypothalamus

mediates satiety

damage=hyperphagia

36

Arcuate nucleus of the hypothalamus

secretes DA, GHrH and GnRH

37

supraoptic nucleus of the hypothalamus

ADH and oxytocin

38

Decerebrate posture

Injury below the red nucleus (midbrain, pons)

extensors predominate

39

Treatment for malnourished alcoholic

Give Thiamine with glucose

Thiamine is cofactor for enzymes involved in glucose metabolism--> glucose w/o thiamine can make wernicke worse

40

kid with severe intellectual disability, seizures and hypo pigmented substantia viagra, locus ceruleus, vagal nucleus dorsalis

PKU

decreased melanin synthesis
catecholaminergic brain nuclei produce neuromelanin

41

Ulcerative colitis

ULCCCERS
Ulcers
Large intestines
Continuous
Carcinoma
Crypt abscess
Extends proximally
Red diarrhea
Sclerosing choliangitis

42

Smooth muscle contraction vs. skeletal muscle

Smooth muscle uses voltage gated ca channels to activate calmodulin and then myosin light chain kinase--> phosphorylates myosin--> contraction

In skeletal muscle there is no phosphorylation of myosin instead the actin binds directly to the myosin in order to contract

43

Side effects of PPI

Atrophic gastritis (hypergastrinemia)
GI issues
carcinoid tumors
HA

44

Which drug is contraindicated in the presence of cholesterol gallstones?

Fibrates
increase the amount of cholesterol in the bile

45

Where are VIPomas usually found?

In the tail of the pancreas

VIP increases water and electrolyte secretions in the small intestines and relaxes smooth muscle

46

Primary treatment for Enterococcus

Ampicillin

HHELPSS kill enterococci
H. influenza
H. pylori
E. coli
Listeria
Proteus mirabilis
Salmonella
Shigella

47

Trendelenburg gait

superior gluteal

48

Treatment for B. cereus

Supportive because it is a preformed toxin

49

Vasogenic cerebral edema vs. cytotoxic

Vasogenic--> BBB damaged (Trauma tumors, inflammation, HTN, high altitude)

Cytotoxic--> BBB intact, disruption of metabolism
ischemic stroke, Reye's, toxins, hypothermia, encephalopathy
Swelling of cells

50

treatment for Huntington

Tetrabenazine and reserpine--> inhibit VMAT--> less dopamine release

Haloperidol--> D2 receptor antagonist

51

Synaptophysin

transmembrane glycoprotein found in presynaptic vesicles of neurons, neuroectodermal and neuroendocrine cells.

52

Galactocerebroside accumulation

Krabbe dz

progressive neurodegenreation with peripheral neuropathy and optic atrophy

53

what is responsible for the the toxic effects of N. meningitis?

Lipooligosaccharide (LOS)

levels of LOS in the blood correlate with morbidity and mortality

54

Where does the rabies virus bind?

Nicotinic ACh receptor

55

SE of inhaled anesthetics

Halothane--hepatotoxicity

Methoxyflurane--neprhotoxicity

enflurane--proconvulsant

N2O--expansion in body cavity

Malignant hyperthermia

56

MAO of ketamine

block NMDA R

57

MOA Propofol

potentiates GABAa and inhibits NMDA R

used for sedation in ICU, rapid anesthesia and short procedures

58

Esters

procaine, cocaine, tetracaine

59

Amides

-Caine with an extra i

nerve block in small myelinated first

1)pain, 2)temperature 3)touch 4)pressure

60

Vitamin E deficiency

ataxia (degeneration of spinocerebellar tracts)
loss of position and vibration sense (degeneration of dorsal columns)
loss of deep tendon reflexes (peripheral nerves)

hemolysis

can look like Friedreich ataxia

61

Poliomyelitis

damage to anterior horn--> asymmetrical flaccid paralysis and hyporeflexia

sensation preserved

62

mandibular nerve function

Motor and sensory!

muscles of mastication + tensor veil palatine and tensor tympani
sensation to TMJ and teeth and floor of mouth

63

Maxillary nerve function

mainly sensory to cheeks, nares, upper lip and teeth and the pharyngeal palate and max sinus

64

optic tract lesions

contralateral homonymous hemianopia

afferent pupillary defect
(swinging flashlight test)

65

Lesion to lateral geniculate nucleus

contralateral homonymous hemianopia

NORMAL pupillary light reflex

66

Kulchitsky cells

Enterochromaffin cells

Activated by gastrin to produce Histamine to activate acid secretion in the stomach

67

ANP, BNP

released in response to increased volume
check on RAAS

relaxes smooth muscle via cGMP--> increases GFR decreases renin

68

Metoclopramide

D2 agonist
treat nausea and vomiting

increases gastric motility

69

Metolazone

thiazide like drug for CHF and HTN

70

Rosacea

inflammatory facial skin redness with papule and pustules

facial flushing with alcohol and heat

71

Pityriasis rosea

"Herald patch" followed by scaly erythematous plaques

self resolves

72

Warm agglutinin

IgG (warm weather is Greater)

chronic hemolytic anemia seen in SLE and CLL

73

Cold agglutinin

IgM
acute anemia triggered by cold (periphery)
mycoplasma pneumonia and mono

74

Renal cell carcinoma pathogenesis

Loss of VHL--> increased IGF-1 (growth) and HIF (increase VEGF and PDGF) (angiogenesis)

75

Regulation of Hormone-sensitive lipase

Activated by catecholamines (epi) and ACTH

inhibited by insulin

releases TGs from adipose tissue

76

Where is glucose synthesized?

Liver
Kidney

(from odd chain fatty acids)

77

Mutation causing beta thalassemia

point mutation in splice site and promoter sequences--> decreased beta globin synthesis

mRNA defect

78

21-hydroxylase deficiency

usually early onset but can be late onset and less severe

high renin and 17-hydroxyprogesterone

hypotension and hyperkalemia

Infancy--salt wasting
childhood--precocious puberty
adulthood--clitoral enlargement and hirsutism

79

Blistering cutaneous photosensitivity

Porphyria cutanea tarda

Deficiency in uroporphyrinogen decarboxylase

increased uroporphyrin (tea-colored urine)

(defect in heme synthesis)

80

Pathophys of Hemochromatosis

Mutation C282Y or H63D on HFE gene (A3)

increased intestinal absorption of iron (over active transferrin)

81

Post MI complications day 1-3

fibrinous pericarditis

friction rub

82

Post MI complications day 4-7

Rupture!
ventricular wall (cardiac tamponade)
inter ventricular septum
papillary muscle

83

Effects of hCG in men

stimulates leydig cells to synthesize testosterone

tx for hypogonadism or fertility

84

lesion in internuclear ophthalmoplegia

ipsilateral medial longitudinal fasciculus

85

first sign of puberty in females

breast bud development

THEN pubic hair

86

First sign of puberty in males

testicular enlargement

87

Pelvic splanchnic

Parasympathetic to rectum and sigmoid colon

damage--constipation

88

where does heme synthesis take place?

mitochondria and the cytoplasm

89

Which nerves are in the anterior compartment of the leg?

Deep peroneal
Anterior tibial

90

Endothelin

Vasoconstrictor that increases BP

increased in pulmonary hypertension and hypertrophic cardiomyopathy (along with c-jun and beta-mysocin heavy chain)

balanced by NO and prostacyclin

91

Lab findings for primary hyperaldosteronism

Normal Na (aldo escape)
HTN
Hypokalemia
metabolic alk

92

effect of hypokalemic alkalosis

weakness and paresthesias

93

In pancreatic beta cells what activates the potassium channels?

ATP made from glycolysis

94

What is Reverse T3

in active form of T3 that is made from conversion or T4

95

Immune effects of corticosteroids

Neutrophilia (due to degranulation
Immunosuppression
increased risk of infection

96

MOA meglitinides

block the closing of ATP-dependent K+ channel in pancreatic beta cells

increase insulin release

97

role of DHT

Development of the external male genitalia
prostate
male pattern baldness

produced via 5-alpha reductase

deficiency=male pseudohermaphroditism

98

Role of human parental lactogen (hPL)

modifies metabolic state of mother during pregnancy to supply baby with energy

anti-insulin-->Insulin resistance!!!

99

Squamous cell carcinoma paraneoplastic syndromes

PTHRP and dermatomyositis
hypercalcemia--> kidney stones

100

effect of hypocalcemia

QT prolongation
tetany
seizures

101

treatment for severe hypocalcemia

1. Mg (need to replace otherwise won't absorb Ca)
2. Ca2+
3. activated Vit D (calcitriol)

102

Small cell lung cancer paraneoplastic syndromes

ADH, ACTH, GH

103

Membranous nephropathy on histology

Sub epithelia spikes and domes

104

Diabetic eye injury

Retinopathy
Vitreous Hemorrhage

Causes: trauma, retinal tear, vitreous detachment
or retinal neovascularization (DM)

diminished red reflex

105

treatment for vitreous hemorrhage

partial or total vitrectomy

106

Child with lytic bone lesion and skin rash or recurrent otitis media

Langerhans cell histiocytosis
proliferation of DC
s-100+

Birbeck granules