DIT other - no pics Flashcards
(194 cards)
1
Q
P450 inhibitors - mneumonic
A
CRACK AMIGOS Cipro Amiodarone Ritonavir (protease inhibitor) Cimetidine Ketoconazole Acute alcohol use Macrolides (erythromycin) Isoniazid Grapefruit juice Omeprazole Sulfonamides
2
Q
P450 inducers - mnuemonic
A
Guiness, Carona, and PBRs induce Chronic Alcoholism Griseofulvin Carbamezepine Phenytoin Barbituates Rifampin St. John's Wort (vs depression) Chronic alcoholism
3
Q
R-L Shunts (early cyanosis)
A
5 T's persistent Truncus arteriosis Transposition of the great vessels Tricuspid atresia Tetralogy of Fallot Total anomalous pulmonary venous return
4
Q
Pregnant mother conditions cause congenital defects
A
lithium - Ebstein anomaly
alcohol - TF, VSD, ASD, PDA
pregestational diabetes - Transposition of great vessels
5
Q
Congenital baby conditions with congenital defects
A
congenital rubella - PDA, Pulmonary artery stenosis
DiGeorge - TF, TA
Turner Syndrome - coarctation aorta, bicuspid aortic valve
Trisomy 21 - endocardial cushion defect (creates 4 chambers but leaves 2 small openings)
6
Q
HF - L vs R
A
Left - Sx are pulmonary related (pulm edema, DOE, cardiac dilation, orthopnea, paroxysmal nocturnal dyspnea)
Right - Sx are peripheral related (JVD, peripheral edema, hepatic congestion/nutmeg liver)
7
Q
Tx acute CHF - mnuemonic
A
NO LIP NO Oxygen Loop diuretics Inotropic Drugs Positioning
8
Q
CHF drugs that prove survival benefit vs Symptomatic
all these drus are used for chronic tx
A
ACEI ARBs Aldosterone inhibitors (spironolactone) Selective B blockers (carvedilol) \\\\ Diuretics Digoxin Vasodilators
9
Q
Starling forces on capillaries/what causes them (4)
A
inc Pc -CHF, venous thrombosis, vein compression
inc Kf - septic shock, toxins, burns
inc interstitial oncotic P - lymphatic obstruction
dec interstitial onctotic P - liver dz, pr malnutrition, nephrotic syndrome
10
Q
ECG - axis lead positions and nrm/left/right axis deviation strategy
A
aVR, aVF, aVL - make a Y (going clockwise) right - aVL, I bottom - II, avF (mid), III left - aVR strategy: 1 - positive deflection, use std position and go out 90 degrees both directions for 180 total 2 - negative deflection, flip std position and go out 180 3 - match the leads, area of most overlap = nrm/left/right left deviation = -30 to -90 nrm = -30 to + 90 right deviation = +90 to +180 *remember electric goes down to left
11
Q
Diffuse scleroderma
A
anti-Scl-70 / anti-DNA Topoisomerase 1 Abs
12
Q
CREST syndrome
A
anti-centromere Ab
13
Q
Sjogren Syndrome
A
Dry - eyes, mouth arthritis "cant see, cant spit, cant climb shit" anti-SSA (anti-Ro) anti-SSB (anti-La)
14
Q
Polymyositis
A
anti-Jo-1 Abs
15
Q
Pemphigus vulgaris - mnemonic
A
“DAMN is a vulgar word”
desmosomes, mouth lesion, + nikolsky sign,
histo: Acantholysis (loss intracellular connections)
16
Q
Which drugs are eliminated zero order? mnemonic
A
PEA (top of P looks like a zero)
Phenytoin
Ethanol
ASA
17
Q
F pelvic ligaments (5):
A
Cardinal lig - cervix to pelvic sidewall (w/ uterine vessels B/V)
Infundibulopelvic lig - “suspensory lig of ovary”, ovary to pelvic side wall (w/ ovarian vessels B/V) *risk torsion
Ovarian lig - ovary to uterus (from gubernaculum)
Round lig of uterus - PATH: uterus, through inguinal canal, to labia majorum (from gubernaculum)
Broad lig - connects everything to the pelvic wall (uterus, fallopian tube, ovaries), covers everything (ovarian lig, round lig, infundibulopelvic lig)
18
Q
Major pelvic nerves (2)
A
pudendal - M/S (helps w/base penis muscle ejaculation) cavernous nerves (ANS - penis errection), from: inf hypogastric plexus -> posterior plexus -> cav N's (can cut during prostate Sxx)
19
Q
gonad drainage - veins
A
right ovary/teste -> right gonadal vein -> IVC
left ovary/teste -> left gonad vein -> L renal V -> IVC
(*bc left gonad vein is longer, higher P, greater chance “bag of worms” vericocele)
20
Q
Artery supply to gonads and penis
A
AA -> ovarian/testicular A’s
Internal iliac A supplies most penis
21
Q
gonadal lymph drainage
A
O/T -> paraaortic LN’s
- upper 2/3 vagina, uterus, cervix, prostate to ext/int iliac LN (hypogastric)
- low 1/3 vagina/scrotum ->superficial inguinal nodes
22
Q
hessel back triangle
A
inguinal ligament, lateral border rectus abdominus, inf epigastric vessels
23
Q
femoral hernia
A
NAVeL
“e”
24
Q
Testicular pathology: major features seminoma embryonal yolk sac choriocarcinoma teratoma leydig sertoli testicular lymphoma
A
seminoma - fried egg (like koilocyte), most common
embryonal - nrm AFP, inc hCG, painful, alveolar or tubular appearance, papillary convolutions
yolk sac - schill-duval bodie (glomer), inc AFP, <3yo
choriocarcinoma - inc hCG, syncytiotrophoblasts
teratoma - teeth and hair
leydig - test secretions, crystaloids of Ranke, gold/brown, gyncomastia (peripheral to E)
sertoli - E secretions (Peutz-Jager)
testicular lymphoma - most common old man met
25
sarcoma botryoides - mnemonic
"Grab and Bunch of Grapes"
| -embryonalrhabdomyosarcoma
26
Endometritis - px, hx
```
inflame, inf
acute = post-partum =C-section/abortion
chronic = PID, retained foreign body
**HISTO** - Plasma cells in endometrium
tx - broad abx
```
27
endometriosis - key features
endometrioma - chocolate cyst
| "gun powder burn" - laparoscopy
28
leiomyoma - Histo
"whorled pattern"
29
theca-luteal cyst, increase what?
B-hcG
30
PCOS
2/3 Sx Dx
1 - Oligo-ovulation or anovulation (irreg menstrual or infertility)
2 - Hyperandrogenism (hirsutism, doesn't need to be virilizaiton)
3 - US: see enlarged ovary with cysts (string of pearls sign)
Risk = unopposed estrogen
Tx - progestins, spironolactone, metformin,
clomiphene (for fertility) - SERM, blocks E feedback at AP = inc LH, FSH
SFx - hot flashes, visual issues
#1 cause infertility in F
31
Asherman syndrome
Post-op intrauterine adhesions (ex - post D&C)
| -reason for infertility
32
Hormonal changes in PCOS
- Inc LH (LH:FSH ration inc >2)
- inc adrogens
- inc Estrone
- dec sex horome-binding globulin (more H free in system)
- inc insulin (this activates androgen production)
33
Mittelschmerz
midcycle pelvic pain associated with ovulation
34
epithelial tumor - serous cyst adenocarcinoma
psammoma body
fallopian-tube-like epithelium
"lined with fallopian tube-like epithelium"
35
epith tumor - mucinous
pseduomyxoma peritinei (abundant mucus ascities)
36
epith tumor - endometrioid
co-occurrence with endometrial CA
| looks like endometrial tube glands
37
epith tumor - clear cell
cells w/clear cytoplasm
38
epith tumor - brenner
hammertoma
contain urinary-tract like epitheliu
"Brenner = Bladder"
39
Germ cell tumor - teratoma
```
sebaceous, hair
dermoid cyst (nrm tissue) vs malig type(immature tissue)
struma ovarii - hyperthyroidism
```
40
germ cell tumor - dysgerminoma
makes hCG, LDH
| fried eggs HISTO
41
germ cell tumor - yolk sac
endometrial sinus tissue
inc AFP
schiller-duval bodies (glomerulus - central vessel surrounded by tumor cells)
42
germ cell tumor - choriocarcinoma
make hCG
| met to lung
43
sex cord stroma tumor - granulosa theca cell tumor
make E -> precocious puberty/post-meo bleed
yellow (cholesterol)
Call-Exner body (granulosa cells surround oocyte trying to make follicle = rosettes surround eiosinophilic spaces"
44
sex cord stromal tumor - sertol-leydig cell tumor
make androgen/testosterone -> virilization
yellow
looks like seminiferous tubules
45
sex cord stromal tumor - fibroma
Gross appearance - firm/encapsulated
| *Meigs syndrome: ovary tumor, ascities, hydrothorax
46
sex cord stromal tumor - thecoma
make E -> precocious puberty/post meno bleed
| spindle cells
47
Mom serum testing - quad screen TII 15-20wk
AFP - abd wall defects (gastrochesis, omephacele)
- neural tube defects
- multiple gestation
- incorrect dating
Also check: estrol (placenta), hCG, inhibin
48
Quad screen - finds: Down Syndrome, Edward, Patau
AFP, B-hCG, estriol, inhibin
down, down, down, Edward Syndrome (18)
down, up, , down, up Down Syndrome (21)
(follows pattern, alpha order)
Patau Syndrome (13)
B-hCG - down
PAPPA - down
nuchal translucency - up (also with 21)
49
Polyhydramnios - whats it mean/cause?
```
Esophageal/duodenal atresia
Anencephaly
Multiple gestations
uncontrolled maternal DM
congenital infection (ToRCHEs) - Parvovirus B19
Fetal anemia due to Rh alloimmunization
```
50
Oligohydramnios
Placental insufficiency
Bilateral renal agenesis --> POTTER sequence
Obstruction urine outflow (pre-urethral valves)
51
Placental implantation abn types "3" with saying
placenta accrete - adheres
increta - invades
percreta - penetrates
52
HELLP Syndrome
Hemolysis, Elevated Liver enzymes, Low Platelets
53
Double Y
| 47, XYY
M
tall
severe acne
*anti-social behavior
54
Cri-de-Clut syndrome
microcephaly
high pitched crying like mewing cat
5p deletion
55
William sydrome
```
think Will Ferrel in Elf
"elfian facies"
hypercalcemia
very friendly with improved social skills
CV - valve defects
microdeletion long chrome 7
```
56
Klienfelter vs Turner Syndrome
KS - M, XXY, tall, long extremities, testicular atrophy, gyno issues
TS - F, XO, web neck, short, amenorrhea
57
Five branches facial nerve - mnemonic
```
To Zanzibar By Motor Car
temporal
zygomatic
buccal
mandibular
cervical
```
58
Familial adenomatous polypsos
MT APC gene
59
Gardner syndrome
"gardener growing bumpy plants everywhere"
60
Hereditary hemorrhagic telangiectasia
recurrent epistaxis due to abn blood vessel formation
61
HD -"c"
Cognitive decline, caudate atrophy, chorea, CAG repeats, Chromosome 4, average age 40, dec aCh
62
Neurofibromatosis type 1
mt gene chrome 17
café-au-lait spots, neural tumors, lisch nodules
Autosomal Dominant
63
neurofibromatosis type II
bilateral acoustic neuroma
| mt chrom 22
64
Genetic anticipation Dz's (4)
HD, myotonic dystrophy, fragile X syndrome, fredreich ataxia
65
Fabry dz
x-linked recessive
def alpha-galactosidase - accum ceramide trihexoside
peripheral neuropathy, renal failure HTN, CM, angiokeratomas
66
Gaucher dz
AR
lysosomal storage Dz
def glucocerebrosiase -> accum glucocerebroside
hepatosplenomegaly, thrombocytopenia, painful bone lesions
*prominenet blue cytoplasmic fibrils HISTO
67
Niemann-Pick Dz
AR
def sphingomelinase
hepatosplenomegaly, cerebellum defects (ataxia, dysarthria, dysphagia)
*cherry red spot - on macula
68
Tay-Sachs Dz
AR
def hexosaminidase A -> accum GM2 ganglioside
worsening mental and physical **no hepatosplenomegaly
cherry red spot on macula
69
Krabbe Dz
AR
def galactocerebrosidase -> accum galactocerebroside
vs myelin sheaths -> periph neurop, seizures
sx start 3-6mo, die 2 yo
70
Metachromatic leukodystrophy
def Arylsulfatase
vs myelin sheath, dementia, vision loss
die after 1 yo
71
Hurler syndrome
AR
def alpha-L-iduronidase -> sulfate accum
coarse facial features, hepatosplenomegaly, looks like dwarfism, corneal clouding
72
Hunter syndrome
x-linked recessive
def iduronate sulfatase -> sulfate accum
mild form Hurler
"Hunters see clearly and aggressively aim for the X"
73
X-linked recessive disorders - mnemonic
```
Oblivious Female Will Give Her Boys Her (x)Linked Disorders
Ocular albinism
Fabry dz
Wiskott-Aldrich
G6PD deficiency
Hunter syndrome
Bruton agammaglobulinemia
Hemophilia A/B
Lesh-Nyhan Syndrome
Duchenne muscular dystrophy
```
74
lateral medullary syndrome
(Wallenberg syndrome)
spinothalamic tract damage
spinal trigeminal nucleus damage: loss pain and temp over ipsilateral face
nucleus ambiguous damange (CN IX, X)
Descending sympathetic tract dmg: ipsilateral horner syndrome
vestibular nuclei damage: vertigo, nystagmus, N/V
inf cerebellar peduncle damage: ipsilateral cerebellar defects (ataxia, past pointing)
75
Weber syndrome
anterior midbrain infarction -> occlusion of paramedical branches of the posterior cerebral artery
cerebral peduncle lesion:
corticobulbar tract dmg: dysphagia, dysphonia, dysarthia
corticospinal tract dmg: contralateral spastic hemiparesis
CN III palsy: ipsilateral ptosis, pupillary dilation, later strabismus (eye looks down and out)
76
HACEK organisms
```
infective subacute endocarditis
Haemophilus
Aggrigatibacter
Cardiobacterium
Eikenella
Kingella
```
77
most common cause of meningitis
streptococcus pneumoniae
78
TORCH inf
T – Toxoplasmosis / Toxoplasma gondii
2. O – Other infections (see below)
3. R – Rubella
4. C – Cytomegalovirus
5. H – Herpes simplex virus-2 or neonatal herpes simplex
```
Coxsackievirus
HSV
Chlamydia
HIV
Parvovirus B19
Syphilis
```
79
Sonic hedgehog gene
anterior / posterior limb
Produced at base of limbs in zone of polarizing activity. Involved in patterning along anteroposterior axis and CNS development; mutation can cause holoprosencephaly
80
Wnt-7 gene
dorsal/ventral limb
Produced at apical ectodermal ridge (thickened ectoderm at distal end of each developing limb). Necessary for proper organization along dorsal-ventral axis.
81
FGF gene
limb lengthening
Produced at apical ectodermal ridge. Stimulates mitosis of underlying mesoderm, providing for lengthening of limbs.
82
Homeobox (Hox) genes
cranial/caudal skeleton alignment
Involved in segmental organization of embryo in a craniocaudal direction. Code for transcription factors. Hox mutations appendages in wrong locations.
83
chlamydophila psittici
psittacosis - fever, dry cough
spread by birds
"psittici Parrots"
84
G-, slow vs fast fermenters: mnemonic
"macConKEE'S"
Fast = KEE: Klebsiella, E. coli, Enterobacter
Slow = C/S: Citrobacter, Serratia
85
Raw Chicken transmission + reptiles
raw chk - salmonella, campylobacter
| reptiles (turtles) - salmonella
86
enteric diarrhea - major path
inc cAMP, inc cGMP -> electrolytes out of interstitum into lumen, followed by water --> watery diarrhea
87
mnemonic for hand and foot rash
```
"You drive Kawasaki, CARS with your feet and hands"
Kawasaki
Coxsackie A
Rocky mountain spotted fever
Secondary syphilis
```
88
syphilis screening FP (VDRL, RPR)
```
VDRL
Virus (EBV)
Drugs
Rheumatic fver
Lupus (any AI dz)/Leprosy
```
89
Rifampin "4 R's"
RNA polymerase inhibitor
induce p450 (hepatotoxicity)
Red-orange secretions
Rapid resistance if used alone
90
Isoniazid
target mycolic acid
Sfx: hepatotoxicity, peripheral neuropathy, SHIPP*
**always give with Vit B6 (pyridoxine)
91
Pyrazinamide
TB tx
| Sfx - hepatotoxicity, hyperuricemia
92
Ethambutol
TB tx
| sfx - optic neuropathy (green-blue blindness, loss visual acuity)
93
Mycobacterium avium-intracellulare (MAI)
CD4 <50
| prophylaxis Azythromycin
94
Negative PPD? TN, FN
TN - nontuburcular mycobacterium, sarocoidosis
| FN - ImS, Rx (GCs)
95
Rickettsial triad
fever, headache, rash
96
Reactive arthritis - who gets it?
Chlamydia
| G - enteric: campylobacter, salmonella, shigella, yersinia
97
3 types of atypical PNA
Legionella
chlamydophilus
**Mycoplasma pneumonia
98
Which organisms do not take up Gram stain?
mycoplasma - no cell wall
treponema - too small
chlamydia/legionella - intracellular
mycobacterium - very high lipid content
99
```
Lymphatic drainage:
arm + lateral breast
lateral dorsal foot
thigh
stomach
duodenum + jejunum
sigmoid colon
upper rectum
lower rectum (above PTL)
lower rectum (below PTL)
testes
scrotum
right arm + right head
```
```
arm + lateral breast - axillary nodes
lateral dorsal foot - popliteal
thigh - superficial inguinal
stomach - celiac
duodenum + jejunum - superior mesenteric
sigmoid colon - inferior mesenteric
upper rectum - pararectal
lower rectum (above PTL) - internal iliac
lower rectum (below PTL) - superficial iliac
testes - para-aortic
scrotum - superficial inguinal
right arm + right head - right lymphatic duct
```
100
peyer's patches - only found here
ilieum - lamina propria + submucosa
101
HLA - DR3 + DR4
type 1 DM, paracrine cells
102
langherhan cell excessive proliferation
tennis racket cells
103
```
Surface molecules expressed:
dendritic cells:
NK cells:
Tcell:
CD8+:
TH:
Macrophage:
B cell:
```
dendritic cells: CD40, MHC I, MHC II, B7 (80/86)
NK cells: CD16 (vs Ab coated cells), CD 56
Tcell: CD3, TCR, CD28
CD8+: CD3, TCR, CD8
TH: CD3, TCR, CD28, CD4, CD40L
Macrophage: CD14, MHC II, B7, CD40
B cell: CD19/20/21, CD40, B7, MHC II, IgM, IgG
104
FOXP3 MT
```
x-chrome
txn factor -> control Treg
MT = IPEX syndrome
Immune dysregulation
Polyendorinopathy
Enteropathy
X-linked
```
105
```
Heart defects assoc w disorder:
Chromosome 22q11:
Trisomy 21:
Congenital rubella:
Turner syndrome:
Marfan syndrome:
```
Chromosome 22q11 : truncus arteriorsus, ToF
Trisomy 21: endocardial cushion
Congenital rubella: PDA, pulm artery stenosis
Turner syndrome: coarc aorta, bicuspid valve
Marfan syndrome: aortic insufficiency
106
VDJ recombination - controlled by:
RAG1/2 act on Recombination Signal Sequences flank VDJ coding regions
107
Live attenuated vaccines mnemonic:
| "Attention! Please Vaccinate Young Infants with MMR Regularly"
```
"Attention! Please Vaccinate Young Infants with MMR Regularly"
attenuated vaccine
varicella
yellow fever
intranasal influenza
MMR
rotavirus
```
108
Can give live vaccines to HIV pts with CD4 ABOVE 200
varicella
yellow fever
MMR
109
Egg vaccines
yellow fever
| influenza
110
Inactivated/killed vaccines (4)
IM flu
hep A
rabies
salk/ polio
111
Why do we conjugate thyroid independent Ag vaccines?
LPS (g -) = independent endotoxin, weak immune response, we CONJUGATE with a peptide to induce stronger immune response (w T cells)
112
HSR
TI - Ag onto IgE on mast cells and basophils
TII - Ab to cell Ag (complement, macrophage, NK)
TIII - Ab vs soluble Ag (immune complex deposition)
*arthus rxn - dermal vaccine=local necro and immune complex deposition
TIV - T cell mediated, delayed
113
C3a
stim mast cells and basophils = dec BP, inc edema
114
macrophage CD14 vs CD40
CD 14 - bind LPS, secrete: IL1/6/TNFa/IL12, APC
| CD 40 - kills: phagocytosis, Ab-dep cell mediate cytotoxicity, form granuloma
115
Dx eosinophilia
| "CANADA-P"
```
CANADA-P
Collagen vascular Dz
Atopic Dz
Neoplasm
Adrenal insufficiency
Drugs
Acute interstitial nephritis
Parasites
```
116
IL 4
"bEG Four it"
IgE, IgG
+B cell proliferation, Th0->Th2
117
IL 5
SNOT
| inc IgA, inc complement, B cell proliferation
118
T cell diseases:
(DiGeorge)
Chronic mucocutaneous candidiasis
IL-12 receptor deficiency
```
Chronic mucocutaneous candidiasis
-T cell dysfunction vs C. albicans
tx: ketoconazole
IL-12 receptor deficiency
mycobacterial and fungal inf
```
119
Bruton agammaglobulinemia
x-linked
B cell deficiency -> no tyrosine kinase gene, low lvl Ig's
-recurrent bacterial inf after 3-6mo
120
Selective Ig deficiencies
IgA def #1
- appear healthy
- assoc atopy, asthma
121
Severe combined immunodeficiency (SCID)
```
adenosine deaminase deficiency
defect early stem cell differentiation
Px: triad
1-severe recurrent inf
2-chronic diarrhea
3-failure to thrive
*no thymic shadow on x-ray
```
122
Ataxia-telangiectasia (A's and T's)
| ATAXIA
```
IgA deficiency, T cell deficiency
ATAXIA
Ataxia
Telangectiasia, Tracking eye difficulty
Acute leukemias and lymphoma risk
X-ray sensitivity
IgA deficiency
AFP inc
```
123
Wiskott-Aldrich syndrome "WAITER"
```
WAITER
W
A
ImD
Thrombocytopenia and purpora
Eczema
Reccurent pyogenic inf
*no IgM vs bacterial capsular polysaccharides
*dec/abn small platelets
```
124
Chronic granulomatous Dz
x-linked
lack NADPH oxidase - phagocytes cant destroy catalase positive microbs (s. aureus, aspirgillus)
Dx - negative nitroblue tetrazolium test
(will not see yellow to blue oxidation)
Tx - bacrtim, itraconazole
125
Chediak-Higashi syndrome
def LYST gene (lysosomal transport)
def phagocytic lysosome -> see giant cytoplasmic granules in PMNs
Pain Triad:
1-partial albinism
2-recurrent respiratory tract and skin inf
3-neurologic Ds
126
Hyper-IgE syndrome (Job)
```
MT - STAT3 (JAK/STAT pathway)
impaired neutrophils
high lvl IgE and eosinophils
Px triad:
1-eczema
2-recurrent cold s. aureus
3-coarse facial features: prom forhead (frontal bossing)/broad nose, "doughy" skin
**retain primary teeth --MANY TEETH
```
127
Leukocyte adhesion deficiency syndrome
Abn integrins -> inability to phagocytes to exit circulation
| **delayed separation of umbilical cord (after a couple of months)
128
G prs and their paths
Gq ->PLA2->PIP3->DAG->PrKC
->IP3->inc Ca->PrKC
Gs->inc adenylate cyclase->inc cAMP->PrKA
Gi->inhib adenylate cyclase
129
Tuberous sclerosis
```
AD, incomplete penetrance
MT TSC1 (hamartin pr), TSC2 (tuberin pr)
Px triad: seizures, ID, angiofibromas
*hypomelanotic macules (ash-leaf spots)
*assoc with tumors everywhere
```
130
Trigeminal neuralgia
"lightning pain" to light touch
| tx - carbamazepine or anticonvulsant
131
Status epilepticus tx
benzodiazepine (lorazepam) --rev w flumazenil
132
tx eclampsia
MgSO4
133
S-Weber syndrome
congential neuro and skin dz
MT - GNAQ gene
mech: vascular malformations/too many capilaries
px: *port-wine* stain on face, glaucoma, seizure
CN V1/2
134
Polio
ant horn
Sx - LMN
Dx - CSF: inc pr, nrm glucose, lymphocytic pleocytin
135
spinal muscular atrophy (wendy-hoffman)
AR
ant horn
infantile flaccid paralysis
136
MS
vs oligodendrocytes (AI), anywhere in CNS
F 20-30
charcot's triad: scanning speech, nystagmus, intention tremor
MLF injury
CSF: inc pr (Ig LC's)
137
ALS
**NO sensory deficit
2: motor N ant horn, cotricospinal tract
MT - SOD1
Px: UMN, LMN
tx - Riluzole (vs presynaptic glutamate release)
138
Tabes Dorsalis
3 syphilis
lose dorsal column
+ Romberg
139
Ant Spinal Artery Occlusion
no pain/temp
complete motor paralysis below lesion
+UMN/LMN
140
syryngomyelin
```
myelin sheath (or tonisilar herniation), CSF obstruction
cervical "cape-like distribution" - lose pain/temp in UE
```
141
Brown-sequarde syndrome
hemisection SC
Ipsilateral loss: UMN sx below lesion, loss tactile/vibration/proprioception, loss pain/temp at site and 2/3 segments below
Contralateral loss: pain/temp starting 2/3 segments below lesion
*LMN sx at level of lesion
142
VPL
VPM
LGN
MGN
VPL - sensory
VPM - movement
LGN - light/visual
MGN - music/auditory (medial)
143
deep nuclei of cerebellum from medial to lateral
| mnemonic
"Fast Gerbils Exercise Daily"
| Fastigial, Globose, Emboliform, Dentate
144
General flow info through cerebellum
strx for major output
side of body with lesion
General flow info through cerebellum:
input (cerebral cortex, SC)->cerebellar cortex->deep nuclei->out targets (VLN)
strx for major output:
sup cerebellar peduncle->cont VL thalamus
side of body with lesion:
ipsilateral motor loss
145
vestibulocerebellum
spinocerebellum
cerebrocerebum
vestibulocerebellum - balance
spinocerebellum - posture stability
cerebrocerebum - lesion-loss of coordination(intention tremor)
146
substantia nigra pars compacta lesion
hypokinesia, chorea
147
subthalamic nucleus lesion
hemibalismus
148
Synthesis meperidine - sfx
MTPP - metabolized to MPP (by MAO)
destroys DA cells in substantia nigra -> PD Sx
Tx with seleginine -> inhibits MAO
149
```
Reflexes
achielles
patella
triceps
bicep
```
achielles - S1
patella - L4
triceps - C7
bicep - C5
150
```
Merkel
Meissner
Ruffini
Pacinian
Free nerve ending
```
Merkel-slow, static pressure, superficial/hair/melanocyte
Meissner-rapid, light touch, superficial
Ruffini-slow, pressure position, deep/spindle
Pacinian-rapid, vibration, deep/onion
Free nerve ending - A-delta: rapid, sharp-cold
- C-fiber: slow, dull-warm
151
flow of aqueous humor
ciliary body
from posterior chamber -> anterior chamber -> trabecular meshwork
glaucoma = obstruction in path
152
acute vs open angle glaucoma
acute - lens goes fwd, emergency, "angry eye" inc pressure, tx with lazer (holes for humor) (st-timolol)
open - dec permeability of trabechular meashwork
cup:disk ratio (should be less than 50%), gradual loss peripheral vision, chronic
Dx - tonometry
Tx - Beta blockers, PG (other - alpha antagonists, acetazolamide, cholinergic agonist - pilocarpine)
153
cataract
-lens becomes opacified
| bilateral, painless decrease vision, gain near sightedness
154
macular degeneration
age related decrease central vision
dry - druse accum between retina and choroid
wet - rapid, neovascularization
tx - stop smoking, antioxidants
155
cotton wool spots
retinal ischemia (DM)
156
DM retinopathy
cotton wool spots, well defined yellow exudates
| progressive - see neovascularizaiton
157
retinal detachment
trauma/DM
"floaters, lights"
pale appearance
158
central retinal artery occlusion
see pale with cherry red spot macula
| bc ischemia
159
brain lesion
frontal eye
PPRF
superior colliculus
frontal eye - eyes toward lesion
PPRF - eyes away from lesion
superior colliculus -Nerd who is good at calculous
-paralysis of upward gaze
160
uveitis - causes
inf - CMV, toxo, cat scratch
| PAIR
161
Weber and Rinne test
Weber - sensorineural hearing loss (contralateral)
| Rinne - conductive hearing loss (ipsilateral)
162
acute otitis externa
wetness / swimmers ear
| pseudomonas, s aureus
163
acute otitis media
bacterial/viral
TM immobility +
s pneumo, nontypable H flu
tx - amox, claulanic acid, cephalosporins
164
cholesteatoma
keratin debris in middle ear -> erosion
chronic middle ear inf
"pearly" lesion behind TM
165
Vertigo
benign paroxysmal positional vertigo
Meniere dz
central vertigo
benign paroxysmal positional vertigo - debris vestibule
Meniere dz - intermittent vertigo, tinnitus, hearing loss
central vertigo - brainstem and cerebellum lesion
166
```
Tongue
origin
taste
sensation
motor
```
```
anterior 2/3
origin - brachial arch 1
taste - CN 7
sensation - CN V3 (maxillary)
motor - CN 12
```
```
posterior 1/3
origin - brachial arch 3+4
taste - CN 9 (back = CN 10)
sensation - CN 9
motor - CN 12
```
167
Glossitis
vit B and iron deficiencies
168
Whats in saliva?
```
alpha amylase
bicarb
mucin
IgA
growth factor
```
169
Sialadenitis
s. aureus, s. viridans
170
tumors of salivary gland
most in parotid gland
#1 - pleomorphic adenoma with "pleomorphic epithelial and mesenchymal cells, can lead to CN 7 injury"
Mucoepidermoid carcinoma -#1 malignant
Location of tumor:
if in parotid gland = 30% chance malignancy
if in salivary gland = 70% chance malignancy
171
Nose tx
intranasal steroids
172
cocaine and nose
potent vasoconstrictor -> ischemia -> perforation of nasal mucosa
173
cleft lip
| cleft palate
cleft lip - failure fuse: maxillary, medial nasal processes
cleft palate - L/M + nasal
lateral and medial palatine process + nasal septum
174
Innervation and blood supply to GI tract
foregut
midgut
hindegut
foregut
-E, stomach, 1/2 duodenum, liver, panc, GB
-celiac trunk blood, PSNS-vagus, SNS-splanchnic
midgut
-3/4 duodenum, ileum, appendix, prox 2/3 colon (flexur)
-sup mesenteric A, PSNS-vagus, SNS-splanchnic
hindegut
-distal 1/3 colon, rectum to pectinate line
-IMA blood, PSNS - pelvic splanchnic, SNS-lumbar splanchnic
175
malrotation of midgut
appendix and cecum in upper abd, assoc with volvulus
| around SMA
176
boerhaver syndrome
complete tear of esophagus
177
Plummer-vinson syndrome
1 - dysphagia (E web)
2 - glossitis
3 - Fe def anemia
tx - dilation E, iron supplementation
178
Esophageal diverticula (3)
zenker - above UES, false
traction - midpoint, true
epiphrenic - below LES, false
179
Bx E with large, pink intranuclear inclusions and host cell chromatin that pushed to the edge of the nucleus
HSV esophagitis
180
Bx E with enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo
CMV esophagitis
181
Bx E = lack of ganglion cells between inner and outer muscular layers
(lack Auchbach plexus)
| Achalasia
182
A PAS stain on Bx of E = hyphate organisms
candida esophagitis
183
E adenocarcinoma
| E SCC
E adenocarcinoma - most common CA in U.S.
| E SCC - most common CA worldwide
184
Receptors on parietal cells
```
H2 (Gs) for ECL cells
Gi for PG
Somatostatin R
CN X receptors
-M3 R
-cholecystokinin Type B
```
185
what induces G cells to secrete gastrin?
Tryptophan, Phenylalanine, Calcium (hypercalcemia increases gastrin secretion)
186
Arteries off celiac trunk (3) + (3) + (2)
```
Celiac trunk:
-left gastric artery
-splenic A
-common hepatic A
Off Common hepatic A
-proper hepatic A
-right gastric A
-gastroduodenal A
Off gastroduodenal A
-right gastro-omental A
-anterior/superior pancreaticoduodenal A
```
187
P450 Substrates - mnemonic
```
"Always Think When Outdoors"
Anti-epileptics
Theophylline
Warfarin
OCPs
```
188
Segmented viruses = ?
Segmented = reassortment
This causes genetic shift (instead of drift = pt MT)
orthomyxovirus, reovirus, bunyavirus, reovirus (rotavirus most common), arenavirus
*are capable for genetic shifts... rapid, huge swaps of:
hemaglutnin and neuramidase
189
Adult Brain Tumors - mnemonic + 3
MGM Studios
met - #1 brain CA
Glioblastoma - astrocytes, GFAP+, cerebral hemisphere, image: irreg mass, necro center, surrounded by edema
histo: pseudopalisading pattern
Meningioma - arachnoid cells, brain surface, risk with NeuroFibro II
histo - whorled pattern, psammona bodies
Schwannoma - benign, sheath tumor
*acoustic neuroma -CN8
+S100, NeuroFibro II
Oligodendroglioma - frontal lobes
histo: perinuclear halos, fried-egg
(also seen with HSV and seminoma)
Pituitary Adenoma
```
Hamangioblastoma
-von-hipple-lindau syndrome
+/- EPO --> PV
Hist: foamy cell
bilateral renal cell CA**
```
190
Pediatric tumors - mnemonic
Prepubescent Minds Eaten with Cancer
Pilocytic Astrocytoma - +GFAP, posterior fossa
histo: rosenethal fibers (eiosinophils, corkscrew looking fibers)
Medublastoma = +/- 4th ventricle compression
histo: Homer-Wright rosette (fiber in center)
Ependymoma - +/- 4th ventricle compression
histo: peri-vascular pseudo-rosette (vessel middle)
Craniopharynegioma - Rathke's pouch,
+/- compression optic chiasm, *supratentorial tumor 1
191
Neck anatomy - triangles
Posterior: SCM, Trap, clavicle
contains - brachial plexus, subclavian vein, ext jugular, inf omohyoid
Anterior: mandible, midline, SCM
contains - posterior/anterior digastric muscles, middle-sternothyroid muscle, sternohyoid muscle, superior omohyoid muscle (-> becomes inf omohyoid)
192
Collagen
strong, slippery, stretchy, BM
```
1 = bone, scar tissue
2 = cartilage (eye)
3 = B/V, skin, uterus, granulation tissue
4 = basement membrane
```
193
Cavernous Sinus - mnemonic
```
O TOM CA(T)
Oculomotor nerve
Trochlear nerve
Opthalmic (V1)
Maxillary (V2)
Internal carotid A
Abducens N
```
194
BMPR2 Gene MT
Primary Pulmonary HTN
