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Flashcards in facts from sim test 4.30 Deck (75):
1

venous drainage to anal canal above/below the pectinate line

above: superior rectal vein -> inferior mesenteric -> portal circulation

below: middle & inferior rectal vein -> internal pudendal -> inferior mesenteric -> internal iliac -> IVC

2

most likely site for external hemorrhoids

posterior canal -- poor perfusion

3

coarctation murmur

systolic, best auscultated in interscapular region

due to turbulent flow through narrow lumen

4

braf v600e mutation in? rx?

melanoma!. mutation in BRAF kinase.

rx: vemurafenib: BRAF kinase inhibitor

5

origin of gut tube lining from esophagus to above pectinate line

endoderm

6

VACTERL syndrome

mesodermal origins

vertebral defects
anal atresia
cardiovascular defects
tracheoesophageal fistula
renal defects
limb defects (bone & muscle)

7

luminal epithelial derivatives: endoderm

lung, liver, gallbladder, pancreas, eustachian tube, thymus, parathyroid, thyroid follicular

8

toxic shock syndrome toxin (TSST-1) vs. toxic shock-like toxin

both toxin shock syndrome

TSST-1: staph aureus

Toxic shock-like toxin: S. pyogenes

both superantigens

9

arthus reaction

local subacute antibody mediated HSR Type III reaction.

intradermal injection of antigen induces antibodies, form antigen-antibody complexes in skin.

edema, necrosis, complement activation

10

Streptococcus mitis

alpha-hemolytic strep in mouth

11

modifications made in golgi (3)

1. add N-olgosaccharides in asparagine
2. adds O-oligosacch on serine/threonine
3. mannose-6-phosphate to traffic to lysosomes

12

endosomes

sorting center for material from outside cell or from golgi -- send to lysosome for destruction or back to membrane/golgi

13

I cell disease: defect & presentation

inherited.

defective in mannose-6-phosphotransferase --> lysosomal proteins secreted extracellular

presentation:
1. coarse facial features
2. clouded cornea
3. restricted joint movement.

high plasma levels of lysosomal enzymes.

often fatal

14

COPI vesicle trafficking protein

golgi -> golgi (retrograde)

gogi -> ER

15

COPII vesicle trafficking protein

golgi -> golgi anterograde

ER to golgi

16

clathrin

trans-golgi -> lysosomes; plasma membrane -> endosomes

--> receptor mediated endocytosis

17

peroxisome

membrane-enclosed organelle involved in catabolism of

1. very long chain fatty acids,
2. branched chain fatty acids, &
3. amino acids

18

recurrent fungal and myobacterial infection?

IL-12 receptor deficiency
autosomal recessive

reduced Th1 response

reduced IFN-gamma

19

mnemonic for branchial arches

chew (1),
then smile (2),
then swallow stylishly (3),
or simply swallow (4), &
then speak (4)

20

1st branchial arch

M

cartilage: meckel cartilage: Mandible, Malleus & incus, spheno-Mandibular ligament

muscles: muscles of Mastication (temporalis, Masseter, lateral & Medial pterygoid), mylohyoid, anterior belly of digastric, tensor tympani, tensor veli palatini

CN: V2 and V3

21

treacher-collins

1st arch neural crest fails to migrate -> mandibular hypoplasia and facial abnormalities

22

2nd branchial arch

S
Reichert cartilage:
Stapes, Styloid process, lesser horn of hyoid, Stylohoid ligament

mucles of facial expression, stapedius, stylohyoid, plastysma, belloy of digastric

CN: VII

23

congenital pharyngocutaneous fistula

persistence of cleft & pouch --> fistula between tonsilar area and lateral neck

24

3rd branchial arch

cartilage: greater arch of the hyoid

muscle: stylopharyngeus

CN IX: glossopharyngeal

25

4th branchial arch

(w/ 6th for cartilage): thyroid, cricoid, arytenoid, cornuculate, cuneiform

muscle: most PHARYNGEAL constrictors; laryngeal: CRICOTHYROID, levator veli palatini

CN X: superior laryngeal branch (swallow)

26

6th branchial arch

(w/ 4th for cartilage): thyroid, cricoid, arytenoid, cornuculate, cuneiform

muscle: all intrinsic muscle of LARYNX, EXCEPT CRICOTHYROID.

CN X: recurrent laryngeal branch (speak)

27

which branchial arches make up the posterior 1/3 of tongue

arches 3 & 4

28

mnemonic for branchial pouches

ears, tonsils bottom to top
1. ear (endoderm-lined structures: middle ear cavity, eustachian tube, mastoid air cells)

2. tonsil: epithelial lining of palatine

3. dorsal wings: inferior parathyoid
ventral: wings: thymus

4: dorsal wings: superior parathyroids

4th & 5th pouch -- parafollicular cells of medullary thyroid

29

cleft lip follows failed fusion of..

maxillary & medial nasal processes (primary palate)

30

cleft palate follows failed fusion of..

two lateral palatine processes

or lateral palatine process w/ nasal septum / medial palatine fossa

31

kinase vs. phosphorylase

kinase: adds phosphate using ATP

phosphorylase: adds inorganic phosphate w/o consuming ATP

32

how do epi & glucagon increase glycogenolysis

both increase adenylate cyclase -> cAMP -> PKA -> glycogen phosphorylase kinase -> glycogen phosphorylase -> glucose from glycogen

33

what stimulates glycogen phosphorylase kinase (3)

1. PKA (from glucagon/epi stim)
2. Ca2+/calmodulin complex
3. Ca2+ directly

34

anti-Ro, anti-La
or
anti-SSA, anti-SSB

Sjorgen syndrome

35

anti-Jo, anti SRP, anti-Mi-2

polymyositis, dermatomyositic

36

anti-Scl-70
or
anti-DNA topo I

Scleroderma (diffuse)

37

anti-smooth muscle

autoimmune hepatitis

38

1st generation sulfonylurea (2)

tolbutamide
chlorpropamide

39

2nd generation sulfonylurea (3)

glyburide
glimepride
glipizide

40

what stimulates Th17 formation

TGF-beta & IL-6

41

what stimulates Treg formation

TGF-beta

42

TGF-beta (3)

1. anti-inflammatory
2. TH17 formation (w/ IL-6)
3. Treg formation

43

regulation of nf-kB

normally inhibited by IkB, released when ikB is phoshparylated.

nfKb then goes to nucleus --> transcription factor

44

carbon dioxide transport in RBC

1. HCO3- (90%)

2. carbaminohemoglobin: co2 bound to hb at n-terminus of globin (not heme) --> favors O2 unloading by stabilizing taut form (5%)

3. dissolved CO2 (5%)

45

carboxyhemoglobin, methemoglobin, carbaminohemoglobin

carboxyhemoglobin: CO in place of O2

methemoglobin: Fe3+, does not bind O2 as readily (high affinity for cyanide)

carbaminohemoglobin: CO2 bound to Hb at N-terminus of globin (NOT HEME). CO2 binding favors taught form (oxygen unloading)

46

haldane effect

lungs: oxygenation of Gb promotes dissociation of H+ from Hb (shifts equilibrium towards CO2 formation --> release)

47

Bohr effect:

peripheral tissue, H+ from tissue shifts curve to right, unloading O2

48

majority of CO2 carried as

HCO3-

49

SLE presentation

usu: rash, joint pain, fever

RASH OR PAIN

rash: malar or discoid
arthritis
soft tissue/serositis
hematologic disorder (cytopenia

oral-nasopharyngeal ulcer
renal disease, raynaud

photosensitivity, positive VDRL
antinuclear antibodies
immunosuppressants
neurologic disorder (seizure, psychosis)

50

renal disease in lupus

nephrotic: membranous nephropathy

nephritic: diffuse proliferative glomerulunephropathy

51

cause of death in lupus (3)

1. cardiovascular disease
2. immunosuppresion
3. renal disease

52

gingival hyperplasia side effect (4)

phenytoin, verapamil, cyclosporine, nifedipine

53

metoclopramide

D2 receptor antagonist

INCREASE resting tone, contractility, LES tone, motility

does not influence colon transport time.

use: diabetic / postsurgery gastroparesis, antiemetic

toxicity: antiparkinson. interact w/ digoxin and diabetic meds.

54

irradiated blood? washed?

irradiate: destroys DNA (WBC) prevents graft vs. host

washed: remove all plasma, less often done

55

autosomal dominant polycystic kidney disease vs. hydronephrosis

hydronephrosis: smooth surface

ADPKD: rough and bumpy surface

56

tanner stages

1: childhood (prepubertal)
2: pubic hair (pubarche) and breast bud (thelarche)
3: pubic hair darkens & curly, penis size/length increase, breast enlarge (adrenarche)
4: penis width increasese, darken scrotal skin, development of glans, raised areolae
5: adult: areola are no longer raised

57

HTN, bradycardia, and respiratory depression

cushing reaction

1. increased cranial pressure constricts arterioles --> cerebral ischemia --> reflex sympathetic increase in perfusion pressure -- HTN
2. HTN increases stretch --> reflex baroreceptor induced bradycardia

58

baroreceptor innervation (aortic arch & carotid)

carotid sinus: glossopharyngeal (both high & low)

aortic arch: just high

both go to solitary nucleus

59

describe hypotension detection at carotid sinus

hypotension -> less stretch -> decreased glossopharyngeal firing in solitary nucleus of medulla

1. relieves tonic inhibition on sympathetic
2. decreases firing of parasympathetic

--> vasoconstriction, increase HR, contracility, BP

60

describe hypertension detection at carotid sinus:

hypertension -> increased stretch -> increased afferent glossopharyngeal firing in solitary nucleus

1. tonic inhibition of sympathetic
2. stimulation of parasympathetic

decrease HR (increased AV node refractory)

(aortic arch & vagus will also respond)

61

what stimulates carotid & aortic chemoreceptor (peripheral)

1. PO2 < 60mmHg
2. increased PCO2
3. low blood pH

62

what stimulates central chemoreceptors?

1. pH
2. PCO2

(not directly to O2

63

CREST

calcinosis, raynaud phenomenon, esophageal dysmotility, scerlodactylyl, telangiectasia

anti-centromere

64

side effects of niacin (3)

1. hyperuricemia
2. hyperglycemia
3. facial flushing

65

sorbitol dehydrogenase in tissues. lens? schwann cells, retina, & kidney?

usu glucose -> sorbitol (w/ aldolase reductase &NADPH)

sorbitol -> fructose
w/ sorbitol dehydrogenase & NAD+

most tissues have sufficient sorbitol dehydrogenase

lens: less active, can be overwhelmed

schwann cells, retina, kidney: much less active, but exists!

66

arteries coming off of celiac trunk

1. common hepatic
2. splenic
3. left gastric (near lesser curvature). anastomose w/ right gastric (from common hepatic) & gives off esophageal branch

67

common hepatic splits into (3)

1. gastroduodenal -> anterior superior & posterior superior pancreaticoduodenal artery & right gastricepiploic (around greater curvature)

2. hepatic artery proper

3. right gastric artery -> less curvature, anastomose w/ left gastric

68

inferior epigastric artery comes off of

external iliac artery

69

ulcer on posterior wall of duodenum can cause bleeding from..

gastroduodenal artery (from common hepatic, from celiac trunk

70

ruptured ulcer on lesser curvature of stomach results in bleeding from

left gastric (from celiac)

71

what does the ventral pancreatic bud contribute? dorsal bud?

main pancreatic duct & pancreatic head (uncinate process specf)

everything else: body, tail, isthmus, accessory pancreatic duct --> dorsal bud

72

special embryology of spleen

supplied by foregut (celiac artery) but arises from mesentary of stomach --> MESODERM

(pancreas, liver, gallbladder, etc --> endoderm

73

histology of abetalipoproteinemia

decrease synthesis of apolipoprotein B-48, can't make chylomicrons. decreased secretion of cholesterol, VLDL into blood stream --> fat accumulation in enterocytes

failure to thrive, acanthocytosis, ataxia, night blindness

74

Wernicke's area specifically located

posterior section of superior temporal gyrus

75

diabetic neuropathic pain is often..

BURNING