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1

P450 inhibitors - mneumonic

CRACK AMIGOS
Cipro
Amiodarone
Ritonavir (protease inhibitor)
Cimetidine
Ketoconazole
Acute alcohol use
Macrolides (erythromycin)
Isoniazid
Grapefruit juice
Omeprazole
Sulfonamides

2

P450 inducers - mnuemonic

Guiness, Carona, and PBRs induce Chronic Alcoholism
Griseofulvin
Carbamezepine
Phenytoin
Barbituates
Rifampin
St. John's Wort (vs depression)
Chronic alcoholism

3

R-L Shunts (early cyanosis)

5 T's
persistent Truncus arteriosis
Transposition of the great vessels
Tricuspid atresia
Tetralogy of Fallot
Total anomalous pulmonary venous return

4

Pregnant mother conditions cause congenital defects

lithium - Ebstein anomaly
alcohol - TF, VSD, ASD, PDA
pregestational diabetes - Transposition of great vessels

5

Congenital baby conditions with congenital defects

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

HF - L vs R

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

Tx acute CHF - mnuemonic

NO LIP
NO
Oxygen
Loop diuretics
Inotropic Drugs
Positioning

8

CHF drugs that prove survival benefit vs Symptomatic
(all these drus are used for chronic tx)

ACEI
ARBs
Aldosterone inhibitors (spironolactone)
Selective B blockers (carvedilol)
\\\\
Diuretics
Digoxin
Vasodilators

9

Starling forces on capillaries/what causes them (4)

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

ECG - axis lead positions and nrm/left/right axis deviation strategy

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

Diffuse scleroderma

anti-Scl-70 / anti-DNA Topoisomerase 1 Abs

12

CREST syndrome

anti-centromere Ab

13

Sjogren Syndrome

Dry - eyes, mouth
arthritis
"cant see, cant spit, cant climb shit"
anti-SSA (anti-Ro)
anti-SSB (anti-La)

14

Polymyositis

anti-Jo-1 Abs

15

Pemphigus vulgaris - mnemonic

"DAMN is a vulgar word"
desmosomes, mouth lesion, + nikolsky sign,
histo: Acantholysis (loss intracellular connections)

16

Which drugs are eliminated zero order? mnemonic

PEA (top of P looks like a zero)

Phenytoin
Ethanol
ASA

17

F pelvic ligaments (5):

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

Major pelvic nerves (2)

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

gonad drainage - veins

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

Artery supply to gonads and penis

AA -> ovarian/testicular A's
Internal iliac A supplies most penis

21

gonadal lymph drainage

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

hessel back triangle

inguinal ligament, lateral border rectus abdominus, inf epigastric vessels

23

femoral hernia

NAVeL
"e"

24

Testicular pathology: major features
seminoma
embryonal
yolk sac
choriocarcinoma
teratoma
leydig
sertoli
testicular lymphoma

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