General knowledge (qbanks, first aid etc) Flashcards

Question

What are the autoantibodies in SLE, nonspecific

Answer 1

anti-nuclear

Answer 2

anti-Scl-70 (anti-DNA topisomerase I)

Answer 3

anti-smooth muscle

Answer 4

anti-SSA, anti-SSB (anti-Ro, anti-La)

Answer 5

anti-TSH receptor

Answer 6

anti-U1 RNP (ribonucleoprotein)

Answer 7

c-ANCA (PR3-ANCA)

Answer 8

IgA anti-endomysial, IgA anti-tissue transglutaminase

Answer 9

p-ANCA (MPO-ANCA)

Answer 10

Rheumatoid factor (antibody, most commonly IgM, specific to IgG Fc region), anti-CCP

Answer 11

Staphylococcus, Burkholderia cepacia, Serratia, Nocardia. Candida and aspergillus too.

Answer 12

sepsis from bacteria or CMV, EBV, JCV,VZV, chronic infection with resp/GI viruses. Also candida, PCP

Answer 13

``` SHiNE SKiS - Strep pneumoe, Hemophilus i B, neisseria meningitidis, E. coli, Salmonella, Klebsiella pneumo, strep B. Enteroviral encephalitis, polio virus (dont get live vaccine!) GI giardiasis (no IgA). ```

Answer 14

X-linked (Bruton) agammaglobulinemia, Selective IgA deficiency, Common variable immunodeficiency

Answer 15

Defect in BTK, a tyrosine kinase gene. no B cell maturation. X linked recessive and increased in Boys. Recurrent bacterial and enteroviral infections after 6 months (decreased maternal IgG).

Answer 16

unknown but most common primary immunodeficiency. Majority asymptomatic. Can see airway and GI infections, Autoimmune disease, Atopy, Anaphylaxis to IgA containing products. IgA levels low but not IgG or IgM.

Answer 17

Defect in B cell differentiation. Many causes. Can be acquired in 20s-30s; increased risk of autoimmune disease; bronchiectasis, lymphoma, sinopulmonary infections. Decreased plasma cells, decreased immunoglobulins.

Answer 18

Thymic aplasia (DiGeorge Syndrome), IL-12 receptor deficiency, Autosomal dominant hyper IgE syndrome (Job syndrome), Chronic mucocutaneous candidaisis.

Answer 19

Also known as DiGeorge syndrome. 22q11 deletion; failure to develop 3rd and 4th pharyngeal pouches -> absent thymus and parathyroids. Tetany (hypocalcemia), recurrent viral/fungal infections (T-cell deficiency), conotruncal abnormalities (e.g. tetralogy of Fallot, truncus arteriosus). Decreased T cells, decreased PTH, decreased Ca+2. Absent thymic shadow on CXR. 22q11 deletion by FISH.

Answer 20

Decreased TH1 response. Autosomal recessive. Disseminated mycobacterial and fungal infections; may present after administration of BCG vaccine. Decreased IFN-gamma.

Answer 21

Deficiency of Th17 cells due to STAT3 mutation -> impaired recruitment of neutrophils to sites of infection. FATED: coarse Facies, cold (non-inflamed) staphyloccocal Abscesses, retained primary Teeth, increased IgE, Dermatologic problems (eczema). Increased IgE, decreased IFN-gamma.

Answer 22

T-cell dysfunction. many causes. Noninvasive Candida albicans infections of skin and mucous membranes. Absent in vitro T cell proliferation in response to Candida antigens. Absent cutaneous reaction to Candida antigens.

Answer 23

Severe combined immunodeficiency, Ataxia-telangiectasia, Hyper-IgM syndrome, Wiskott-Aldrich syndrome

Answer 24

several types including defective IL-2R gamma chain (most common, X-linked), adenosine deaminase deficiency (autosomal recessive). Failure to thrive, chronic diarrhea, thrush. Recurrent viral, bacterial, fungal, and protozoal infections. Tx: bone marrow transplant (no concern for rejection). Decreased T-cell receptor excision circles (TRECs). Absence of thymic shadow (CXR), germinal centers (lymph node biopsy), and T cells (flow cyt)

Answer 25

Defects in ATM gene leading to double strand DNA breaks and cell cycle arrest. Triad: cerebellar defects (Ataxia), spider Angiomas (telangiectasia), IgA deficiency. Increased AFP and decreased IgA, IgG, and IgE. Lymphopenia, cerebellar atrophy.

Answer 26

Most commonly due to defective CD40L on Th cells = class switching defect. X - linked recessive. Severe pyogenic infections early in life; opportunistic infection with pneumocystis, Cryptosporidium, CMV. Increased IgM, decreased IgG, IgA, and IgE.

Answer 27

Mutation in the WAS gene X-linked recessive. T cells unable to reorganize actin cytoskeleton. WATER: Wiskott-Aldrich: Thrombocytopenic purpura, Eczema, Recurrent infections. Increased risk of autoimmune disease and malignancy. Decreased to normal IgG, IgM. Increased IgE, IgA. Fewer and smaller platelets.

Answer 28

Leukocyte adhesion deficiency (type 1), Chediak-Higashi syndrome, Chronic granulomatous disease

Answer 29

Defect in LFA-1 integrin (CD18) protein on phagocytes; impaired migration and chemotaxis; autosomal recessive. Recurrent bacterial skin and mucosal infections, absent pus formation, impaired wound healing, delayed separation of umbilical cord (greater than 30 days). Increased neutrophils, absence of neutrophils at infection sites.

Answer 30

Defect in lysosomal trafficking regulator gene (LYST). Microtubule dysfunction in phagosome-lysosome fusion; autosomal recessive. Recurrent pyogenic infections by staphylococci and streptococci, partial albinism, peripheral neuropathy, progressive neurodegeneration, infiltrative lymphohistiocytosis. Giant granules in neutrophils and platelets. Pancytopenia. Mild coagulation defects.

Answer 31

``` Defect of NADPH oxidase leading to decreased reactive oxygen species (superoxide) and absent respiratory burst in neutrophils; X-linked recessive. Increased susceptibility to catalase positive organisms (PLACESS for your CATS): Pseudomonas, Listeria, Aspergillus, Candida, E. coli, S. aureus, Serratia. Abnormal dihydrorhodamine (flow cyt) test. Nitroblue tetrazolium dye test is negative (test out of favor). ```

Answer 32

T cell and antibody mediated damage that is irreversible. Heart: atherosclerosis Lungs: bronchiolitis obliterans. Liver: vanishing bile ducts Kidneys: vascular fibrosis, glomerulopathy.

Answer 33

Maculopapular rash, jaundice, diarrhea, hepatosplenomegaly. | Usually in bone marrow and liver transplants because those are rich in lymphocytes.

Answer 34

Carotid sinus - dilatation of the internal carotid artery just above bifurcation of common artery. Afferent fibers come from Hering's nerve, which is a branch of the glossopharyngeal nerve (CN IX). Aortic arch baroreceptors - fibers run within the vagus nerve (CN X). Both sets of afferents terminate in the solitary nucleus of the medulla. Remember: aortic arch only senses increase in BP while carotid barorceptors sense increases and decreases in BP. Decreased pressure means less stretch which means less baroreceptor firing and increased efferent sympathetic firing. Increased pressure means increased stretch and increased baroreceptor firing.

Answer 35

Cerebral amyloid angiopathy. More benign clinical course than hemorrhagic strokes associated with hypertension (those are oarger and then to involve the basal ganglia vs. being in the lobar areas)

Answer 36

Failure or destruction of myeloid stem cells: - radiation and drugs (benzene, chloramphenicol, alkylating agents, antimetabolites) - viral agents (parvovirus B19, EBV, HIV, HCV) - Fanconi anemia (DNA repair defect) - idiopathic (immune mediated, primary stem cell defect); may follow acute hepatitis.

Answer 37

1. Pilocytic astrocytomas are most common. Low grad neoplasms from astrocytomas. Cerebellum is most common location. Cystic with tumor nodule protruding from the wall. On imaging studies, pilocytic astrocytoma appears as a mass with both solid and cystic components on T1. On histo, pilocytic astrocytes and Rosenthal fibers are seen. Good prognosis. 2. Medulloblastomas: second most common brain tumor. Most common malignant one. In cerebellum (most commonly vermis). Solid and composed of sheets of blue small blue cells with hyperchromatic nuclei and scant cytoplasm - forming Homer-Wright rosettes. This tumor is highly malignant with poor prognosis. 3. Ependymomas: third most common child tumor. Lining of ventricle and can obstruct flow of ventricle. Presents with hydrocephalus. On histo, there is tumor with gland like structures like rosettes (perivascular rosettes).

Answer 38

Benign tumor. 20-40 years old. Epiphyseal end of long bones. Locally aggressive benign tumor often around knee. "Soap bubble" appearance on x-ray. Multinucleated giant cells.

Answer 39

Most common benign tumor. Exostosis. Males <25 years old. Mature bone with cartilaginous cap. Rarely transforms to chondrosarcoma.

Answer 40

2nd most common primary malignant bone tumor (after multiple myeloma). Bimodal distribution: 10-20 years old (primary), > 65 yrs old (secondary). Predisposing factors: Paget disease of bone, bone infarcts, radiation, familial retinoblastoma, Li-Fraumeni syndrome (germline p53 mutation). Metaphysis of long bones, often around knee. ``` Codman triangle (from elevation of periosteum) or sunburst pattern on x-ray. Aggressive. Treat with surgical en bloc resection (with limb salvage) and chemotherapy ```

Answer 41

Boys < 15 years old. Commonly appears in diaphysis of long bones, pelvis, scapula, and ribs. Anaplastic small blue cell malignant tumor. Extremely aggressive with early metastases, but responsive to chemotherapy. "Onion skin" appearance in bone. Associated with t(11;22) translocation. 11 + 22 = 33 (Patrick Ewing's jersey number)

Answer 42

Rare, malignant, cartilaginous tumor. Men 30-60 years old. Usually located in pelvis, spine, humerus, tibia, or femur. Malignant cartilaginous tumor. May be of primary origin or from osteochondroma. Expansile glistening mass within the medullary cavity.

Answer 43

Weak, wordless, wanting, wary. Deprivation for >6 months can lead to irreversible changes. Severe deprivation can result in infant death.

Answer 44

Onset before age 18. Sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for >1 year. Coprolalia (involuntary obscene speech) found in only 10-20%. Associated with OCD and ADHD. Tx: antipsychotics and behavioral therapy.

Answer 45

X-linked disorder. Seen almost exclusively in girls (affected males die in utero or shortly after birth). Symptoms present around 1-4 years of age: regression characterized by loss of development, loss of verbal abilities, intellectual disability, ataxia, and stereotyped hand-wringing.

Answer 46

Alzheimer's: Decreased ACh Anxiety: Increased norepinephrine, Decreased GABA and Serotonin. Depression: Decreased norepinephrine, serotonin, and dopamine. Huntington disease: Decreased GABA, ACh. Increased dopamine. Parkinson disease: Decreased dopamine. Increased serotonin and ACh. Schizophrenia: increased dopamine.

Answer 47

Depression in the elderly can present like dementia (pseudodementia).

Answer 48

In alcohol withdrawal (e.g. formication - sensation of bugs crawling on one's skin). Also seen in cocaine abuse.

Answer 49

Chronic mental disorder with psychosis, disturbed behavior, and thought and decline in functioning that lasts > 6 months. Increased dopamine, decreased dendritic branching. Brief psychotic disorder - less than 1 month, usually stress related. Schizophreniform disorder - 1-6 months Schizoaffective disorder - at least 2 weeks of stable mood with psychotic symptoms, plus a major depressive, manic, or mixed (both) episode. 2 subtypes: bipolar or depressive. Frequent cannabis use is associated with psychosis/schizophrenia in teens. Presents early in men (early 20s) vs women (late 20s/early 30s).

Answer 50

``` Lasts at least 1 week. Manics DIG FAST Distractibility Irresponsibility - seeking pleasure no matter what Grandiosity - inflated self-esteem Flight of ideas - racing thoughts Increase in goal-directed Activity/psychomotor Agitation. Decreased need for Sleep. Talkativeness or pressured speech. ```

Answer 51

Not as severe as manic episode (no social/occupational disruption). Lasts at least 4 consecutive days.

Answer 52

dysthymia and hypomania; milder form of bipolar disorder lasting at least 2 years.

Answer 53

``` Must have 6-12 months. at least 5 of the following 12 symptoms for at least 2 weeks during an episode. SIG E CAPS Sleep disturbance Loss of Interest (anhedonia) Guilt or feelings of worthlessness Energy loss and fatigue Concentration problems Appetite/weight changes Psychomotor retardation or agitation. Suicidal ideations. ``` Patients with depression have the following sleep changes: decreased slow wave sleep, decreased REM latency, Increased REM early in cycle, Increased total REM sleep, repeated nighttime awakenings, early-morning awakening (important screening question).

Answer 54

Persistent depressive disorder | Depression, often milder, lasting at least 2 years.

Answer 55

``` mood reactivity (can feel briefly happy in response to positive events), reversed vegetative symptoms (hypersomnia and weight gain), leaden paralysis (heavy feeling in arms/legs), and long-standing interpersonal rejection sensitivity. Treatment is MAO inhibitors and SSRIs. ```

Answer 56

``` SAD PERSONS Sex (male) age (teenagers or elderly) Depression Previous Attempt Ethanol or drug use loss of Rational thinking Sickness (med illness, 3 or more prescription meds) Organized plan No spouse (divorced, widowed, single...no children) Social Support Lacking. ``` Women try more often, but men succeed more often

Answer 57

Uncontrollable anxiety for at least 6 months that is unrelated to a specific person. Sleep disturbance, fatigue, GI disturbance, and difficulty concentrating. Tx: SSRIs, SNRIs, buspirone, cog behavioral therapy.

Answer 58

A, B, and C. Weird, Wild, and Worried Weird: Paranoid, Schizoid, Schizotypal Wild: Antisocial, Borderline, Histrionic, Narcissistic Worried: Avoidant, Obsessive-compulsive, Dependent.

Answer 59

Antibiotics (trimethoprim, sulfonamides, and dapsone), local anesthetics (articaine and prilocaine) and others such as aniline dyes, metoclopramide, chlorates, and bromates. Chloroquine, primaquine. Ingestion of compounds containing nitrates.

Answer 60

Type 1 - skin, bone (made by osteoblasts), tendons, fascia, cornea, and most other organs. late wound repair. bONE. Decreased production in osteogenesis imperfecta type 1. Type 2- Cartilage (including hyaline) and vitreous humor, nucleus pulposus. carTWOlage. Type 3 - blood vessels, uterus, and skin. fetal tissue, granulation tissue. Type 3 deficient in the uncommon, vascular type of Ehlers-Danlos syndrome (ThreeE D). Type 4 - basement membranes, basal lamina, lens. Four under the FLOOR. Efective in Alport syndrome and targeted by autoantibodies in Goodpasture syndrome. Type 5 - minor component of interstitial tissues and blood vessels.

Answer 61

Produced at base of limbs in zone of polarizing activity. Involved in patterning along anterior-posterior axis. Involved in CNS development; mutation can cause holoprosencephaly.

Answer 62

Produced at apical ectodermal ridge (thickened ectoderm at distal end of each developing limb). Necessary for proper organization along dorsal-ventral axis.

Answer 63

Produced at apical ectodermal ridge. Stimulates mitosis of underlying mesoderm, providing for lengthening of limbs.

Answer 64

Involved in segmental organization of embryo in a craniocaudal direction. Hox mutations -> appendages in wrong locations.

Answer 65

Day 0: Fertilization and initiating embryogenesis Within week 1: hCG secretion begins around time of implantation of blastocyst Within week 2: bilaminar disc (epiblast, hypoblast). 2 weeks = 2 layers Within week 3: Trilaminar disk. 3 weeks = 3 layers. Gastrulation (establishing of the ectoderm, mesoderm, endoderm. Primitive streak formation begins this process) Weeks 3-8 (embryonic period): Neural tube forms by neuroectoderm and closes by week 4. Organogenesis and extremely susceptible to teratogens. Week 4: Heart begins to beat. Upper and lower limb buds begin to form. Week 6: Fetal cardiac activity visible by transvaginal ultrasound. Week 10: Genitalia have male/female characteristics.

Answer 66

Adenohypophysis (from Rathke pouch and where craniopharyngioma comes from- tumor with cholesterol crystals and calcifications); lens of eye; epithelial linings of oral cavity, sensory organs of ear, and olfactory epithelium; epidermis; anal canal below pectinate line; parotid, sweat, and mammary glands.

Answer 67

Brain (neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, ependymal cells, pineal glands), retina and optic nerve, spinal cord. Think CNS.

Answer 68

PNS (dorsal root ganglia, cranial nerves, celiac ganglion, Schwann cells, ANS), melanocytes, chromaffin cells of adrenal medulla, parafollicular cells (C) cells of thyroid, pia and arachnoid, bones of skull, odontoblasts (cells that produce dentin in the dental pulp), aorticopulmonary septum. Think PNS and non-neural structures nearby.

Answer 69

Muscle, bone, connective tissue, serous linings of body cavities (e.g. peritoneum), spleen (derived from foregut mesentery), cardiovascular structures, lymphatics, blood, wall of gut tube, vagina, kidneys, adrenal cortex, vagina, kidneys, adrenal cortex, dermis, testes, ovaries. Notochord induces ectoderm to form neuroectoderm (neural plate). Its only postnatal derivative is the nucleus pulposus of the intervertebral disc.

Answer 70

``` VACTERL Vertebral defects Anal Atresia Cardiac Defects Tracheo-Esophageal fistula Renal defects Limb defects (bone and muscle) ```

Answer 71

Gut tube epithelium (including anal canal above the pectinate line), most of the urethra (derived from urogenital sinus), luminal epithelial derivatives (e.g. lungs, liver, gall bladder, pancreas, eustachian tube, thymus, parathryoid, thyroid follicular cells).

Answer 72

Agenesis: absent organ due to lack of primordial tissue. Aplasia: absent organ despite presence of primordial tissue. `

Answer 73

Hypoplasia: incomplete organ development; primordial tissue present. Deformation: extrinsic disruption; occurs after the embryonic period. Disruption: secondary breakdown of a previously normal tissue or structure (e.g. amniotic band syndrome). Malformation: Intrinsic disruption; occurs during the embryonic period (weeks 3-8).

Answer 74

Before 3 weeks: all or none effects 3-8 week: most susceptible here because it is the embryonic period(organogenesis) after 8 weeks: growth and function affected.

Answer 75

renal damage

Answer 76

absence of digits, multiple anomalies.

Answer 77

CN VIII toxicity. | A MEAN GUY hit the baby in the car.

Answer 78

Neural tube defects, craniofacial defects, fingernail hypoplasia, developmental delay, IUGR

Answer 79

vaginal clear cell adenocarcinoma, congenital mullerian anomalies.

Answer 80

Neural tube defects

Answer 81

Ebstein anomaly (atrialized right ventricle)

Answer 82

Aplasia cutis congenita - focal absence of epidermis

Answer 83

Fetal hydantoin syndrome: microcephaly, dysmorphic craniofacial features, hypoplastic nails and distal phalanges, cardiac defects, IUGR, intellectual disability.

Answer 84

Discolored teeth. | TEETHracyclines

Answer 85

``` Limb defects (phocomelia, micromelia - "flipper" limbs) LIMB defects with tha-LIMB-domide ```

Answer 86

Inhibition of maternal folate absorption -> neural tube defects. valproATE inhibits folATE absorption

Answer 87

Bone deformities, fetal hemorrhage, abortion, ophthalmologic abnormalities. do not wage WARFARE on the baby; keep it HEPpy with HEParin (does not cross placenta).

Answer 88

Common cause of birth defects and intellectual disability; fetal alcohol syndrome: CNS damage, facial abnormalities like long philtrum and maxillary hypoplasia. Problem with cell migration.

Answer 89

Genetic: Down's syndrome Inherited: Fragile X Congenital: Alcohol

Answer 90

Abnormal fetal growth and fetal addiction; placental abruption.

Answer 91

A leading cause of low birth weight in developed countries; associated with preterm labor, placental problems, IUGR, ADHD

Answer 92

Congenital goiter or hypothyroidism (cretinism)

Answer 93

Caudal regression syndrome (anal atresia to sirenomelia (legs are fused together)), congenital heart defects (transposition of the great vessels), neural tube defects (anencephaly).

Answer 94

Extremely high risk for spontaneous abortions and birth defects (cleft palate, cardiac abnormalities).

Answer 95

Microcephaly, intellectual disability.

Answer 96

One of the leading causes of congenital malformations in the US. Intellectual disability, pre- and postnatal developmental retardation, microcephaly, holoprosencephaly, facial abnormalities (smooth philtrum, thin upper lip, small palpebral fissures (distance under eye), hypertelorism (distance between eyes increased)), limb dislocation, and heart defects (ventricular septal defects - cell migration problem).

Answer 97

0-4 days - cleavage between 2 cell and morula. Dichorionic, diamniotic (placenta may be fused). 4-8 days - cleavage between morula and blastocyst. Monochorionic diamniotic. 8-12 days - cleavage between blastocyst formed embryonic disc. Monochorionic monoamniotic. > 13 days - monochorionic monoamniotic conjoined twins.

Answer 98

Forms at 3rd week. Duct between fetal bladder and yolk sac (allantois which becomes the urachus) patent urachus - urine discharge from umbilicus urachal cyst - partial failure of urachus to obliterate; fluid-filled cavity lined with uro-epithelium, between umbilicus and bladder. Can lead to infection and adenocarcinoma. vesicourachal diverticulum - outpouching of bladder.

Answer 99

normally obliterates at 7th week. Normally connects yolk salk to mid-gut lumen. Vitelline fistula - meconium discharge from umbilicus Meckel diverticulum - partial closure, with patent portion attached to ileum (true diverticulum). May have ectopic gastric mucosa and/or pancreatic tissue -> melana, periumbilical pain, and ulcers. Can also get a cyst here if closed on both ends.

Answer 100

Develop into the arterial system. 1st: part of MAXillary artery (branch of external carotid). 1st arch is MAXimal 2nd: Stapedial artery and hyoid artery. Second is Stapedial 3rd: Common Carotid artery and proximal part of internal Carotid artery. C is 3rd letter of alphabet. 4th: On left, aortic arch; on right, proximal part of subclavian artery. 4th arch (4 limbs) = systemic. 6th: Proximal part of pulmonary arteries and (on left only) ductus arteriosus. 6th arch is pulmonary and the pulmonary-to-systemic shunt (ductus arteriosus).

Answer 101

``` Branchial clefts (or grooves) are derived from ectoderm. Branchial arches - derived from mesoderm (muscles, arteries) and neural crest (bone, cartilage). Branchial pouches - derived from endoderm ``` CAP covers from outside to inside - Clefts, arches, pouches (ectoderm, mesoderm, endoderm).

Answer 102

1st cleft develops into external auditory meatus. 2nd through 4th clefts form temporary cervical sinuses, which are obliterated by proliferation of 2nd arch mesenchyme. Persistent cervical sinus -> branchial cleft cyst within lateral neck.

Answer 103

Think of all the M's. Chew Cartilage: Meckel cartilage: Mandible, Malleus, incus, spheno-Mandibular ligament. Muscles: Muscles of Mastication (temporalis, Masseter, lateral and Medial pterygoids), Mylohyoid, anterior belly of diagastric, tensor tympani (attaches to malleus), tensor veli palatani (only muscle of the palate not innervated by the vagus nerve) Nerves: CN V2 and V3. Chews Abnormality: Teacher Collins syndrome - 1st arch neural crest fails to migrate -> mandibular hypoplasia, facial abnormalities When at the restaurant of golden ARCHES, children tend to first CHEW (1), then SMILE (2), then SWALLOW STYLishly (3) or simple swallow (4), and then SPEAK (6)

Answer 104

Think of all the Ss. Smile Cartilage: Reichert cartilage - Stapes, Styloid process, lesser horn of hyoid, Stylohyoid ligament. Muscle: Muscles of facial expression - Stapedius, Stylohyoid, platySma, belly of digastric Nerve: CNVII (facial expression). SMILE Abnormality: Congenital pharyngo-cutaneous fistula - persistance of cleft and pouch -> fistula between tonsillar area and lateral neck When at the restaurant of golden ARCHES, children tend to first CHEW (1), then SMILE (2), then SWALLOW STYLishly (3) or simple swallow (4), and then SPEAK (6)

Answer 105

SWALLOW STYLishly Cartilage: greater horn of hyoid Muscles: Stylopharyngeus (think of stylopharyngeus innervated by glossopharyngeal nerve) Nerve: CN IX (stylo-pharyngeus). swallow STYLishly When at the restaurant of golden ARCHES, children tend to first CHEW (1), then SMILE (2), then SWALLOW STYLishly (3) or simple swallow (4), and then SPEAK (6)

Answer 106

Cartilages: thyroid, cricoid, arytenoids, corniculate, cuneiform. Muscles: 4th arch - most pharyngeal constrictors; cricothyroid; levator veli palatini. 6th - arch all intrinsic muscles of the larynx except cricothyroid. Nerves: 4th arch- CN X (superior laryngeal branch) simply swallow. 6th arch - CN X (recurrent laryngeal branch. speak. Notes: Arches 3 and 4 form posterior 1/3 of tongue; Arch 5 makes no major contributions.

Answer 107

Develops into middle ear cavity, eustachian tube, mastoid air cells. 1st pouch contributes to endoderm-lined structures of ear. Ear, tonsils, bottom-to-top: 1 (ear), 2 (tonsils), 3 (dorsal - bottom for inferior parathyroids...ventral- to for thymus), 4 (top = superior parathyroids)

Answer 108

Develops into epithelial lining of palatine tonsil. Ear, tonsils, bottom-to-top: 1 (ear), 2 (tonsils), 3 (dorsal - bottom for inferior parathyroids...ventral- to for thymus), 4 (top = superior parathyroids)

Answer 109

Dorsal wings - develops into inferior parathyroids. Ventral wings - develops into thymus. 3rd pouch contributes to 3 structures (thymus, left and right inferior parathyroids). 3rd pouch structures end up below 4th pouch structures. Ear, tonsils, bottom-to-top: 1 (ear), 2 (tonsils), 3 (dorsal - bottom for inferior parathyroids...ventral- to for thymus), 4 (top = superior parathyroids)

Answer 110

Dorsal wings - develops into superior parathyroids. Ear, tonsils, bottom-to-top: 1 (ear), 2 (tonsils), 3 (dorsal - bottom for inferior parathyroids...ventral- to for thymus), 4 (top = superior parathyroids)

Answer 111

``` Mutation of germline RET (neural crest cells): Adrenal medulla (pheochromocytoma), parathyroid tumors (3rd/4th pharyngeal pouch), parafollicular cells (medullary thyroid cancer which is derived from neural crest cells; associated with 4th and 5th pharyngeal pouches) ```

Answer 112

Cleft lip - failure of fusion of the maxillary and medial nasal processes (formation of primary palate). Cleft palate - failure of fusion of the two lateral palatine processes or failure of fusion of lateral palatine processes with the nasal septum and/or median palatine process (formation of secondary palate). Cleft lip and cleft palate have two distinct etiologies, but often occur together.

Answer 113

SRY gene on Y chromosome - produces testis determining factor (testes development). Sertoli cells secrete Mullerian inhibitor factor (MIF) that suppresses development of paramesonephric ducts. Leydig cells secrete androgens that stimulate the development of mesonephric ducts.

Answer 114

Results from incomplete fusion of the paramesonephric ducts (vs complete failure of fusion, resulting in double uterus and vagina). Can lead to autonomic defects -> recurrent miscarriages.

Answer 115

Males: DHT causes formation of glans penis and corpus cavernosum and spongiosum. Females: estrogen causes formation of glans clitoris and vestibular bulbs.

Answer 116

Males: DHT causes formation of bulbo urethral glands (of Cowper) and prostate gland. Females: Estrogen causes formation of greater vestibular glands (of Bartholin), urethral and para-urethral glands (of Skene).

Answer 117

Males: DHT causes ventral shaft of penis (penile urethra). Females: estrogen causes labia minora to form.

Answer 118

Males: DHT causes scrotum to form. Females: Estrogen causes labia majora to form.

Answer 119

Epispadias (when opening of penile urethra is on the superior side of penis due to faulty positioning of the genital tubercle vs hypospadias which is on the inferior side due to failure of the urethral folds to close).

Answer 120

Band of Fibrous tissue. Male remnant anchors testes within scrotum. Female remnant becomes Ovarian Ligament + Round Ligament of Uterus

Answer 121

Evagination of peritoneum. Male remnant is the tunica vaginalis (structure that surrounds testis and reaches back to peritoneum through inguinal canal). Female remnant is obliterated. More info: During fetal development, an extension of the peritoneum migrates distally through the inguinal canal with the gubernaculum in the first trimester. Normally, this thin membrane that extends through the inguinal canal and descends into the scrotum (processus vaginalis) is obliterated proximally at the internal inguinal ring, and the distal portion forms the tunica vaginalis. In the majority of cases, the processus vaginalis closes within the first year of life. If it is not obliterated at the internal ring, it is referred to as a patent processus vaginalis, and the tunica vaginalis communicates with the peritoneum, so that peritoneal fluid flows freely between both structures and a communicating hydrocele forms. See here for more: https://online.epocrates.com/u/29241104/Hydrocele/Basics/Etiology

Answer 122

Ovaries/testis - para-aortic lymph nodes Distal vagina/vulva/scrotum - superficial inguinal nodes Proximal vagina/uterus - obturator, external iliac, and hypogastric nodes. Note: uterine vessels drain by internal illiac to external illiac

Answer 123

Infundibulopelvic ligament (suspensory ligament of ovaries) - ovaries to lateral pelvic wall. Contains ovarian vessels. Must ligate during oophorectomy to avoid bleeding. Ureter courses retroperitoneally close to gonadal vessels. At risk of injury during ligation of ovarian vessels. Cardinal ligmanet - cervix to side wall of pelvis. Contains uterine vessels. Ureter at risk of injury during ligation of uterine vessels in hysterectomy. Round ligament of the uterus - uterine fundus to labia majora. Derivative of gubernaculum. Travels through round inguinal canal; above the artery of Sampson. Broad ligament: mesosalpinx (superior to ovaries reaching around falopian tubes), mesovarium (surrounding ovary), mesometrium (inferior to ovary and reaching towards uterine surface). Connects uterus, fallopian tubes, and ovaries to pelvic side wall. Contains ovaries, fallopian tubes, and round ligaments of uterus. Ovarian ligament (connects ovary to superior portion/fundal portion of uterus) - medial pole of ovary to lateral uterus. A derivative of guvernaculum. Uterosacral ligament - connects at cervical area of uterus.

Answer 124

Vagina: Stratified squamous epithelium, nonkeratinized Ectocervix: Stratified squamous epithelium, nonkeratinized Endocervix: Simple columnar epithelium Transformation zone: squamocolumnar junction (most common area for cervical cancer) Uterus: simple columnar epithelium with long tubular glands Fallopian tubes: Simple columnar epithelium, many ciliated cells, a few secretory (peg) cells Ovary, outer surface: Simple cuboidal epithelium (germinal epithelium covering surface of ovary).

Answer 125

Erection - Parasympathetic nervous system (pelvic nerve): NO -> increased cGMP and smooth muscle relaxation -> vasodilation -> proerectile Norepinephrine - increased Ca+2 -> smooth muscle contraction -> vasoconstriction -> antierectile Emission: Sympathetic nervous system (hypogastric nerve) Ejaculation: visceral and somatic nerve (pudendal nerve). Erectile nerve involves S2-24 (i.e. the pudendal nerve).

Answer 126

From outer to inner: Spermatogonia, primary spermatocytes, secondary spermatocytes, spermatids. Sertoli cells line seminiferous tubules

Answer 127

secrete inhibin -> inhibit FSH. Secrete androgen binding protein -> maintain local levels of testosterone Tight junctions between adjacent Sertoli cells form blood blood-testis barrier -> isolate gametes from autoimmune attack. Support and nourish developing spermatozoa. Regulate spermatogenesis. Produce MIF. Temperature sensitive; decreased sperm production and decreased inhibin with increased temperature. Increased temperature seen in varicocele, cryptoorchidism. Convert testosterone and androstenedione to estrogen via aromatase.

Answer 128

Secrete testosterone in the presence of LH; testosterone production unaffected by temperature. Located in the Interstitium. Also contain aromatase.

Answer 129

Ovary makes 17beta-estradiol Placenta makes estriol Adipose tissue makes estrone via aromatization. Potency: estradiol > estrone > estriol In pregnancy: there is a 50 fold increase in estradiol and estrone 1000 fold increase in estriol (indicator of fetal well-being). Estrogen receptors expressed in cytoplasm; translocate to the nucleus when bound by ligand. `

Answer 130

Stage 1: prepubertal Stage 2: enlargement of scrotum and testes; scrotal skin reddens and changes in textures. Stage 3: enlargement of penis (length at first); further growth of testes Stage 4: Increased size of penis with growth in breadth and development of glans; testes and scrotum larger, scrotal skin darker. Stage 5: adult genitalia.

Answer 131

Stage 1: prepubertal Stage 2: breast bud stage with elevation of breast and papilla; enlargement of areola. Stage 3: Further enlargement of breast and areola; no separation of their contour. Stage 4: Areola and papilla from a secondary mound above level of breast. Stage 5: Mature stage: projection of papilla only, related to recession of areola

Answer 132

Stage 1: Prepubertal (the pubic area may have vellus hair, similar to that of forearms) Stage 2: Sparse growth of long, slightly pigmented hair, straight or curled, at base of penis or along labia. Stage 3: Darker, coarser and more curled hair, spreading sparsely over junction of pubes. Stage 4: Hair adult in type, but covering smaller area than in adult; no spread to medial surface of thighs. Stage 5: Adult female in type and quantity, with horizontal upper border.

Answer 133

Increased estrogen, increased GnRH receptors on anterior pituitary. Estrogen surge then stimulates LH release -> ovulation (rupture of follicle). Increased temperature (progesterone induced). Mittelschmerz: refers to transient mid-cycle ovulatory pain; classically associated with peritoneal irritation (e.g. follicular swelling/rupture, fallopian tube contraction). Can mimic appendicitis.

Answer 134

Good for infants < 6 months old. Contains maternal IgA, macrophages, and lymphocytes. Breast milk reduces infant infections and is associated with decreased risk for the child to develop asthma, allergies, diabetes mellitus, and obesity. Exclusively breast fed infants require vitamin D supplementation. Breast feeding also decreases maternal risk of breast and ovarian cancer, and facilitates mother-child bonding.

Answer 135

Source: synctiotrophoblast of placenta Function: Maintains the corpus luteum (and thus progesterone) for the 1st trimester by acting like LH (otherwise no luteal cell stimulation, and abortion results). In the 2nd and 3rd semesters, the placenta synthesizes its own estriol and progesterone and the corpus luteum degenerates. alpha subunit structurally identical to alpha subunits of LH, FSH, and TSH. Beta subunit is unique (pregnancy tests detect Beta subunit). hCG is increased in multiple gestations and pathological states (e.g. hydatidiform mole, choriocarcinoma).

Answer 136

DHT and testosterone (testis); AnDrostenedione (ADrenal). Potency: DHT > testosterone > androstenedione testosterone: differentiation of genitalia except prostate (epididymis, vas deferens, seminal vesicles) Growth spurt: penis, seminal vesicles, sperm, muscle, RBCs. Deepening of voice Closing of epiphyseal plates (via estrogen converted from testosterone) Libido DHT: early - differentiation of penis, scrotum, prostate Late - prostate growth, balding, sebaceous gland activity (androgen receptors in these hair follicle areas stimulating this gland and this is why men get acne more). DHT comes from testosterone through 5alpha-reductase (finasteride inhibits this). Androgens converted to estrogen by cytochrome P-450 aromatase (primarily in adipose tissue and testis). Exogenous testosterone causes inhibition of hypothal-pituitary-gonadal axis and causes less testoterone intratesticularly -> decreased testicular size -> azoospermia.

Answer 137

seen in males with XXY, 1:850 Dysgenesis of seminiferous tubules -> decreased inhibin -> increased FSH Abnormal Leydig cell function -> decreased testosterone -> increased LH -> increased estrogen. Testicular atrophy, eunuchoid body shape, tall, long extremeties, gynecomastia, female hair distribution. May present with developmental delay. Presence of inactivated X chromosome (Barr body). Common cause of hypogonadism in infertility workups.

Answer 138

seen in females with XO. "Hugs and Kisses" XO from Tina Turner Menopause before menarche. Decreased estrogen leads to increased LH and FSH. Can result from mitotic or meiotic error. Can be complete monosomy (45,XO) or mosaicism (e.g. 45,XO/46,XX). Pregnancy is possible in some cases (oocyte donation, exogenous estradiol-17B and progesterone). ``` Short stature (if untreated), ovarian dysgenesis (streak ovary), shield chest, bicuspid aortic valve, preductal coarctation (femoral < brachial pulse, notched ribs), lymphatic defects (results in webbed neck or cystic hygroma; lymphedema in feet, hands), horseshoe kidney (gets stuck on IMA). Most common cause of primary amenorrhea. No Barr Body. ```

Answer 139

XYY, 1:1000 Phenotypically normal, very tall, severe acne, antisocial behavior (seen in 1-2% of XYY males). Normal fertility. Small percentage diagnosed with autism spectrum disorders.

Answer 140

46,XX or 47XXY Also called ovotesticular disorder of sex development. BOth ovary and testicular tissue present (ovotestis_; ambiguous genitalia. Very rare.

Answer 141

Complete Mole: 46,XX; 46,XY. hCG very very increased, with large uterine size, 2% chance of converting to choriocarcinmoa, no fetal parts, enucleated egg + single sperm (with duplicated paternal DNA) or 2 different sperm, 15-20% malignant disease, vaginal bleeding/enlarged uterus/hyperemesis/pre-eclampsia/hyperthyroidism, honeycombed uterus or clusters of grapes on imaging. Otherwise known as snowstorm on ultrasound. Partial Mole: 69, XXX or XXY or XYY. slightly increased hCG, fetal parts present, uterine size not increased, low risk of malignancy, 2 sperm + 1 egg, vaginal bleeding/abdominal pain. Fetal parts seen on imaging. Tx: dilation and curretage and methotrexate.

Answer 142

remember if before 20 weeks it might be molar pregnancy. Otherwise need to have hypertension (>140/90) and proteinuria (>300mg/24hr). Treat with antihypertensives (alpha-methyldopa, labetolol, nifedipine, hydralazine). Deliver at 37 wks if mild or more severe at 34 weeks. Use Magnesium sulfate to prevent seizure. NOTE: don't forget about HELLP

Answer 143

``` Abruptio placentae. Premature separation (partial or complete) of placenta from uterine wall before delivery of infant. Risk factors: trauma (e.g. motor vehicle accident), smoking, hypertension, pre-eclampsia, cocaine abuse. ``` Concealed is towards uterine fundus (i.e. no blood coming out through cervix). Apparent would show hemorrhage out of cervix. Presentation: abrupt, painful bleeding (concealed or apparent) in third trimester; possible DIC, maternal shock, fetal distress. Life threatening for mother and fetus.

Answer 144

Defective decidual layer -> abnormal attachment and separation after delivery. Risk factors: prior C-section, inflammation, placenta previa. Types are determined by depth of penetration: Placenta accreta: placenta ATTACHES to myometrium without penetrating it; most common type. Placenta increta - placenta penetrates INTO myometrium. Placenta percreta - placenta penetrates ("PERFORATES") through the myometrium and into uterine serosa (invades entire uterine wall); can result in placental attachment to rectum or bladder. Presentation: no separation of placenta after delivery -> massive bleeding. Life threatening for mother.

Answer 145

Attachment of placenta to lower uterine segment. Lies near (marginal), partially covers (partial), or completely covers internal cervical os. Risk factors: multiparity, prior C-section.

Answer 146

Most often in amupulla of fallopian tube. Suspect with history of amenorrhea, lower-than-expected rise in hCG based on dates, and sudden lower abdominal pain; confirm with ultrasound. Often clinically mistaken for appendicitis. Pain with or without bleeding. Risk factors: history of infertility, salpinigits (PID), ruptured appendix, prior tubal surgery.

Answer 147

fetal malformations (esophageal/duodenal atresia, anencephaly; both result in inability to swallow amniotic fluid), maternal diabetes, fetal anemia, multiple gestations

Answer 148

associated with placental insufficiency, bilateral renal agenesis, or posterior urethral valves (in males) and resultant inability to excrete urine. Any profound oligohydramnios can cause Potter sequence.

Answer 149

Atypical physical appearance of fetus due to oligohydramnios experience in womb. Also associated with ARPKD because this presents with infants and significant renal failure in utero can lead to this. Can be caused by ARPKD, posterior urethral valves, bilaterial renal agenesis. Oligohydramnios leads to compression of developing fetus -> limb deformities, facial anomalies (low-set ears and retrognathia), and compression of chest -> pulmonary hypoplasia (cause of death). Clubbed feet, pulmonary hypoplasia, and cranial abnormalities. Babies who cant PEE get POTTER syndrome. POTTER associated with: Pulmonary hypoplasia (less amniotic fluid leads to less stretch of the lungs) Oligohydramnios (trigger) Twisted face (flat face from less fluid so face pushed up against wall) Twisted skin Extremity defects Renal failure (in utero)

Answer 150

HPV 16/18 (the E6/E7 variant with p53/RB involvement, respectively) Usually pap smear or bleeding post coital. risk factors: multiple sexual partners (#1), early sex, smoking, or HIV infection. Invasive carcinoma is usually found on pap smear which shows koilocytes (raisinoid nuclei with perinuclear halo clearing). Catches it before progression to invasive carcinoma. Lateral invasion can block ureters causing renal failure.

Answer 151

Inflammation of endometrium (plasma cells/lymphocytes) associated with retained products (vagina/C-section/miscarriage/abortion or foreign body like IUD). Retained material promotes bacterial invasion from vagina or intestinal tract. Tx: gentamicin+clindamycin with/without ampicillin.

Answer 152

Remember: it's non-neoplastic endometrial glands/stroma outside of endometrial cavity (ovary, pelvis, peritoneum). Blood filled chocolate cyst in ovary. Cyclic pelvic pain and pain on bleeding, urinating, and defecating. Dysmenorrhea, infertility and NORMAL SIZED UTERUS. Tx: NSAIDs, OCP, progestins, GnRH agonists, surgery.

Answer 153

Extension of endometrial tissue (glandular) into the uterine myometrium. Caused by hyperplasia of the basalis layer of the endometrium. Dysmenorrhea, menorrhagia. Uniformly, ENLARGED AND SOFT globular uterus. Tx: hysterectomy

Answer 154

Outer to inner: Endometrium (epithelium, Stratum functionalis with the stratum basalis below it touchign myometrium), myometrium, perimetrium.

Answer 155

Abnormal endometrial gland proliferation usually caused by excess estrogen stimulation. Increased risk for endometrial carcinoma. Manifests as postmenopasual vaginal bleeding. Risk factors: anovulatory cycles, hormone replacement therapy, PCOS, granulosa cell tumor.

Answer 156

Most common gynecologic malignancy. Peak occurrence at 55-65 years old. Clinically presents with vaginal bleeding and preceded by endometrial hyperplasia. Risk factors include prolonged use of estrogen without progestins, obesity, diabetes, hypertension, nulliparity, and late menopause. Increased myometrial invasion and decreased prognosis.

Answer 157

Most common tumors in females. Presents with multiple discrete tumors. Increased incidence inblacks. Benign smooth muscle tumor; malignant transformation is rare. Estrogen sensitive - tumor size increases with pregnancy and decreases after menopause. Peak occurence at 20-40 years old. May be asymptomatic, cause abnormal uterine bleeding, or result in miscarriage. Severe bleeding can lead to iron deficiency anemia. Does not go to leiomyosarcoma though. Whorled pattern of smooth muscle with well-demarcated borders .

Answer 158

Incidence: endometrial > ovarian > cervical (data in the US...cervical cancer is most common worldwide). Worst prognosis: Ovarian > cervical > endometrial.

Answer 159

Pregnancy, PCOS, obesity, HPO axis abnormalities, premature ovarian failure, hyperprolactinemia, thyroid disorders, eating disorders, female athletes, Cushing syndrome, adrenal insufficiency.

Answer 160

Distention of unruptured graafian follicle. May be associated with hyperestrogenism and endometrial hyperplasia. Most common ovarian mass in young women.

Answer 161

Hemorrhage into persistent corpus luteum. Commonly regresses spontaneously.

Answer 162

Often bilateral/multiple. Due to gonadotropin stimulation. Associated with choriocarcinoma and moles.

Answer 163

Blood vessel rupture in cyst wall. Cyst grows with increased blood retention; usually self-resolves.

Answer 164

Mature teratoma. Cystic growths filled with various types of tissue such as fat, hair, teeth, bits of bone, and cartilage.

Answer 165

Endometriosis within ovary with cyst formation. Varies with menstrual cycle. When filled with dark, reddish-brown blood it is called a chocolate cyst.

Answer 166

Most common adnexal mass in women > 55 years old. Can be benign or malignant. Arises from surface epithelium, germ cells, and sex cord stromal cells. Majority of malignant tumors are from epithelial cells. Majority (95%) are epithelial (serous cystadenocarcinoma most common). Risk increases with advanced age, infertility, endometriosis, PCOS, genetic predisposition (BRCA-1 or BRCA-2 mutation, HNPCC, strong family history).. Risk decreases with previous pregnancy, history of breastfeeding, OCPs, tubal ligation. Presents with adnexal mass, abdominal distention, bowel obstruction, pleural effusion. Diagnose surgically. Monitor progression by measuring CA-125 levels (not good for screening).

Answer 167

Most common ovarian neoplasm. It is benign. Thin-walled, uni- or multilocular. Lined with fallopian-like epithelium. Often bilateral.

Answer 168

Benign ovarian neoplasm. | Multiloculated, large. Lined by mucus-secreting epithelium.

Answer 169

Benign ovarian neoplasm Mass arising from growth of ectopic endometrial tissue. Complex mass on ultrasound. Presents with pelvic pain, dysmenorrhea, dyspareunia.

Answer 170

Benign ovarian neoplasm. Germ cell tumor, most common ovarian tumor in women 20-30 years old. Can contain elements from all 3 germ layers; teeth, hair, sebum are common components. Can present with pain secondary to ovarian enlargement or torsion. Can also contain functional thyroid tissue and present as hyperthyroidism (struma ovarii).

Answer 171

Benign ovarian neoplasm. Think B's for Brenner. Looks like Bladder. Solid tumor that is pale yellow-tan in color and appears encapsulated. "Coffee Bean' nuclei on H&E stain.

Answer 172

Benign ovarian neoplasm Bundles of spindle-shaped fibroblasts. Meigs syndrome - triad of ovarian fibroma, ascites, and hydrothorax. Pulling sensation in groin.

Answer 173

Benign ovarian neoplasm. Like granulosa cell tumors, may produce estrogen. Usually present as abnormal uterine bleeding in a postmenopausal woman (perhaps due to estrogen stimulation and endometrial hyperplasia?).

Answer 174

Malignant ovarian neoplasm Aggressive, contains fetal tissue, neuroectoderm. Immature teratoma is mostly typically represented by immature/embryonic-like neural tissue. Mature teratoma are more likely to contain thyroid tissue.

Answer 175

Most common sex cord stromal tumor. Malignant ovarian neoplasm. Predominantly women in their 50s. Often produce estrogen and/or progesterone and present with abnormal uterine bleeding, sexual precocity (in pre-adolescents), breast tenderness. Histology shows Call-Exner bodies (resemble primordial follicles).

Answer 176

Malignant ovarian neoplasm | Most common ovarian neoplasm, frequently bilateral. Psammoma bodies.

Answer 177

Malignant ovarian neoplasm | Pseudomyxoma peritonei-intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor.

Answer 178

Malignant ovarian neoplasm Most common in adolescents. Equivalent to male seminoma but rarer. 1% of all ovarian tumors; 30% of germ cell tumors. Sheets of uniform "fried egg" cells. hCG and LDH are tumor markers.

Answer 179

Malignant ovarian neoplasm. Rare; can develop during or after pregnancy in mother or baby. Malignancy of trophoblastic tissue (cytotrophoblasts, syncytiotrophoblasts); no chorionic villi present. Increased frequency of theca-lutein cysts. Presents with abnormal B-hCG, shortness of breath, hemoptysis. Hematogenous spread to lungs. Very responsive to chemotherapy.

Answer 180

Endodermal sinus. Malignant ovarian neoplasm Aggressive, in ovaries or testes and sacrococcygeal area in young children. Most common tumor in male infants. Yellow, friable (hemorrhagic), solid mass. 50% have Schiller-Duval bodies (resemble glomeruli). AFP = tumor marker.

Answer 181

Malignant ovarian neoplasm GI malignancy that metastasizes to the ovaries, causing a mucin secreting signet cell adenocarcinoma (usually from diffuse stomach adenocarcinoma).

Answer 182

Squamous cell carcinoma - usually secondary to cervical SCC; primary vaginal carcinoma rare. Clear cell adenocarcinoma - Affects women who had exposure to DES in utero. Sarcoma botryoides (rhabdomyosarcoma variant) - affects girls < 4 years old; spindle-shaped tumor cells that are desmin.

Answer 183

``` Connective tissue - Vimentin Muscle - DesMin Epithelial Cells - Cytokeratin Neuroglia - GFAP Neurons - Neurofilaments ```

Answer 184

Nipple - Paget disease, breast abscess. Lactiferous sinus - intraductal papilloma, abscess/mastitis Major duct - fibrocystic change, DCIS, invasive ductal carcinoma. Terminal duct - tubular carcinoma. Lobules - lobular carcinoma.

Answer 185

Benign breast tumor. Stromal. Small mobile firm mass with sharp edges. Most common tumor in those <35 years old. Increased size and tenderness with increased estrogen (e.g. pregnancy, prior to menstruation). Not a precursor to breast cancer.

Answer 186

Benign breast tumor. Lactiferous sinus. Small tumor that grows in lacterifous ducts. Typically beneath areola. Serous or bloody nipple discharge. Slight (1.5-2x) increased risk for carcinoma.

Answer 187

``` Benign breast tumor. Stromal. Large bulky mass of connective tissue and cysts. "Leaf-like" projections. most common in 6th decade. Some may become malignant. ```

Answer 188

Commonly postmenopausal. Usually arise from terminal duct lobular unit. Overexpression of estrogen/progesterone receptors or c-erbB2 (HER2, an EGF receptor) is common; triple negative (ER neg, PR neg, and Her2/Neu neg) more aggressive. Type affects therapy and prognosis. Axillary lymph node involvement indicating metastasis is the single most important prognostic factor. Most often located in the upper outer quadrant of breast. Risk factors: increased estrogen exposure, increased total number of menstrual cycles, older age at first live birth, obesity (increased estrogen exposure as adipose tissue converts androstenedione to estrone), BRCA1 and BRCA2 gene mutations, African American ethnicity (increased risk for triple neg breast cancer).

Answer 189

noninvasive malignant breast tumor Major duct. Fills duct lumen. Arises from ductal atypia. Often seen as microcalcfications on mammography. Early malignancy without basement membrane penetration.

Answer 190

noninvasive malignant breast tumor | Ductual, caseous necrosis. Subtype of DCIS.

Answer 191

noninvasive malignant breast tumor Nipple Results from underlying DCIS. Eczematous patches on nipple. Paget cells = large cells in epidermis with clear halo on histology. Suggests underlying DCIS. Also seen on vulva, though does not suggest underlying malignancy.

Answer 192

invasive malignant breast tumor Major duct. Firm, fibrous, "rock-hard" mass with sharp margins and small, glandular, duct-like cells. Grossly, see classic "stellate" infiltration. Worst and most invasive. Most common (76% of all breast cancers).

Answer 193

invasive malignant breast tumor Lobules Orderly row of cells ("Indian file"). Often bilateral with multiple lesions in the same location.

Answer 194

invasive malignant breast tumor | Fleshy, cellular, lymphocytic infiltrate. Good prognosis.

Answer 195

invasive malignant breast tumor Dermal lymphatic invasion by breast carcinoma. Peau d'orange (breast skin resembles orange peel); neoplastic cells block lymphatic drainage. 50% survival at 5 years.

Answer 196

common cause of breast lumps from age 25 to menopause. Presents with pre-menstrual breast pain and multiple lesions, often bilateral. Fluctuation in size of mass. Usually does not indicate increased risk of carcinoma. Types: Fibrosis: hyperplasia of breast stroma. Cystic - fluid filled, blue dome. Ductal dilation. Sclerosing adenosis - increased acini and intralobular fibrosis. Associated with calcifications. Often confused with cancer. increased risk (1.5-2x) of developing cancer. Epithelial hyperplasia - increase in number of epithelial cell layers in terminal duct lobule. Increased risk of carcinoma with atypical cells. Occurs in women > 30 years old.

Answer 197

breast abscess; during breast-feeding increased risk of bacterial infection through cracks in the nipple. S. aureus is the most common pathogen. Treat with dicloxacillin and continued breast-feeding.

Answer 198

A benign, usually painless lump; forms as a result of injury to breast tissue. Abnormal calcification on mammography; biopsy shows necrotic fat, giant cells. Up to 50% of patients may not report trauma.

Answer 199

Occurs in males. Results from hyperestrogenism (cirrhosis, testicular tumor, puberty, old age). Klinefelter drugs: Spironolactone, marijuana [Dope], Digitalis, Estrogen, Cimetidine, Alcohol, Heroin, Dopamine D2 antagonists, Ketoconazole. Some Dope Drugs Easily Create Awkward Hairy DD Knockers.

Answer 200

men > 50 years old Smooth, elastic, firm nodular enlargement of the periurethral lobes (lateral and middle), compressing urethra into vertical slit. PResents with increased frequency of urination, nocturia, difficulty starting and stopping the stream of urine and dysuria. May lead to distention and hypertrophy of the bladder, hydronephrosis, and UTIs. Increased PSA. Tx: alpha1-antagonists (terazosin, tamsulosin), which cause relaxation of smooth muscle; finasteride (reduces DHT production)

Answer 201

In late disease it can become osteoblastic mets in bone result in lower back pain and increase in serum ALP and PSA. Remember total PSA is increased in disease and there is a decrease in fraction of free PSA. Prostatic acid phosphatase (PAP) can also be increased.

Answer 202

Dilated veins in pampiniform plexus as a result of increased venous pressure; most common cause of scrotal enlargement in adult males; most often on the left side because of increased resistance to flow from left gonadal vein drainage into the left renal vein; can cause infertility because of increased temperature; "bag of worms" appearance . Diagnose by ultrasound. Tx: varicocelectomy, embolization by interventional radiologist.

Answer 203

95% of all testicular tumors. Young men. Risk factors: cryptorchidism, Klinefelter. Can present as a mixed germ cell tumor. Testicular mass that does not transilluminate!

Answer 204

male Germ cell tumor Malignant; painless, homogenous testicular enlargement; most common testicular tumor, most common in 3rd decade, never in infancy. Large cells in lobules with watery cytoplasm and a "fried egg" appearance. Increased placental ALP. Radiosensitive. Late metastasis, excellent prognosis.

Answer 205

male Germ cell tumor Yellow, mucinous. Aggressive malignancy of testes, analogous to ovarian yolk sac tumor. Schiller Duval bodies resemble primitive glomeruli. Most common testicular tumor in boys <3 years old.

Answer 206

male Germ cell tumor Malignant, increased hCG. Disordered syncytiotrophoblastic and cytotrophoblastic elements. Hematogenous metastases to lungs and brain (may present with "hemorrhagic stroke" due to bleeding into the metastasis. May produce gynecomastia or symptoms of hyperthyroidism (hCG is an LH and TSH analog).

Answer 207

male Germ cell tumor Unlike in females, mature teratoma in adult males may be malignant. Benign in children. increased hCG and/or AFP in 50% of cases.

Answer 208

male Germ cell tumor Malignant, hemorrhagic mass with necrosis; painful; worse prognosis than seminoma. Often glandular/papillary morphology. "Pure" embryonal carcinoma is rare; most commonly mixed with other tumor types. May be associated with increased hCG and normal AFP levels when pure (increased AFP when mixed)

Answer 209

male non-germ cell tumor Contains Reinke crystals; usually androgen producing, gynecomastia in men, precocious puberty in boys. Golden brown in color.

Answer 210

male non-germ cell tumor | androblastoma from sex cord stroma.

Answer 211

male non-germ cell tumor | most common testicular cancer in older men. Not a primary cancer, arises from lymphoma mets to testes. Agressive.

Answer 212

Lesions in the serous covering of testis present as testicular masses that can be transilluminated (vs cancers) Hydrocele - increased fluid secondary to incomplete obliteration of processus vaginalis Spermatocele - dilated epididymal duct.

Answer 213

More common in Asia, Africa, and South America Percursor in situ lesions: Bowen disease (in penile shaft, presents as leukoplakia), erythroplasia of Queyrat (cancer of glans, presents as erythroplakia), Bowenoid papulosis (presents as a reddish papules). Associated with HPV, lack of circumcision.

Answer 214

Trauma, sickle cell disease (sickled RBCs get trapped in vascular channels), medications (anticoagulants, PDE-5 inhibitors, antidepressants, alpha-blockers, cocaine).

Answer 215

Property of first order elimination. Drug infused at steady rate takes 4-5 half lives to reach steady state. It takes 3.3 half-lives to reach 90% half life time = 0.693 * Vd / CL.

Answer 216

CL = rate of elimination of drug / Plasma drug concentration = Vd * Ke (elimination constant).

Answer 217

Loading dose = Cp * Vd / F. Cp = Target plasma concentration at steady state.

Answer 218

Cp * CL * tau / F. where Cp is target plasma concentration at steady state. tau is the dosage interval (time between doses), if not administered continuously.

Answer 219

Decrease maintenance dose but loading does is usually unchanged.

Answer 220

Only on half life. Little dependence on loading or maintenance doses!

Answer 221

Zero order: constant amount of drug eliminated per unit time. Linear relationship with time. Examples: Phenytoin, Ethanol, and Aspirin (PEA, which is round like a ZERO-order). First order: Rate of elimination is directly proportional to the drug concentration (constant fraction of drug eliminated per unit time). Cp decreases exponentially with time.

Answer 222

Ionized species are trapped in urine and eliminated. Neutral forms are reabsorbed. Examples: phenobarbital, aspirin, methotrexate. PAM These get trapped in basic environments so can treat overdose with bicarbonate.

Answer 223

Ionized species are trapped in urine and eliminated. Neutral forms are reabsorbed. Examples: amphetamines. Trapped in acidic environments so use ammonium chloride for overdose.

Answer 224

Reduction, oxidation, hydrolysis with cytochrome P450 usually yield slightly polar, water-soluble metabolites (often still active). Geriatric patients lose phase 1 first.

Answer 225

Conjugation (Glucuronidation, Acetylation, Sulfation) usually yields very polar, inactive metabolites (renally excreted). Geriatric patients have GAS (phase II). Patients who are slow acetylators have greater side effects from certain drugs because of decreased metabolism.

Answer 226

Measurement of the safety of a drug: TD50/ED50 = median toxic dose/median effective dose. Therapeutic window: measure of the clinical drug effectiveness for a patient. Think of two curves (one for the drug effectiveness and a shifted one for toxicity. The window is the extent to which you can ride up on the effectiveness curve without going to much further into the toxicity curve) Safer drugs have higher TI values. Drugs with low TI values include digoxin, lithium, theophylline, and warfarin. In animals, the lethal median dose is used instead of toxic dose. TITE: Therapeutic Index = TD50/ED50.

Answer 227

First all presynaptic ganglia use cholinergic with nicotinic receptors. Parasympathetic ganglia are close to their organ while sympathetic ganglia are more centrally located. Parasympathetic - uses cholinergic muscarinic receptors on their target organ. Includes smooth muscle and cardiac muscle; gland cells; nerve terminals. Sympathetic: 1) Cholinergic muscarinic receptors on sweat glands. 2) Nor-epinephrine stimulating alpha and beta receptors on smooth muscle and cardiac muscle, gland cells, and terminals. 3) Dopamine receptors on renal vasculature and smooth muscle 4) Nicotinic cholinergic receptors on adrenal medulla, which directly releases epinephrine and nor-epinephrine into circulation. Somatic: Nicotinic cholinergic innervation on skeletal muscle.

Answer 228

Alpha1, alpha2, beta1, beta2. QISS Alpha1 - increased vascular smooth muscle contraction, increased pupillary dilator muscle contraction (mydriasis), increased intestinal and bladder sphincter muscle contraction. Alpha2 - decreased sympathetic outflow, decreased insulin release, decreased lipolysis, increased platelet aggregation. Beta1 - increased heart rate, contractility, renin release, increased lipolysis Beta2 - Vasodilation, bronchodilation, increased heart rate, contractility, lipolysis, and insulin release. Decreased uterine tone (tocolysis), ciliary muscle relaxation, increased acueous humor production. QISS and QIQ until you're SIQ of SQS

Answer 229

M1, M2, M3. QIQ M1 - CNS, enteric nervous system M2 - decreased heart rate and contractility of the atria M3 - Increased exocrine gland secretions (e.g. lacrimal, salivary, gastric acid), increased gut peristalsis, increased bladder contraction, bronchoconstriction, increased pupillary sphincter muscle contraction (miosis), ciliary muscle contraction (accomodation). QISS and QIQ until you're SIQ of SQS

Answer 230

D1, D2. SI (of SIQ) D1 - relaxes renal vascular smooth muscle. D2 - modulates transmitter release especially in brain.

Answer 231

H1, H2. QS (of SIQ and SQS). H1 - increased nasal and bronchial mucus production, increased vascular permeability, contraction of bronchioles, pruritus, and pain H2 - increased gastric acid secretion. QISS and QIQ until you're SIQ of SQS

Answer 232

V1, V2. QS (of SQS). V1 - increased vascular smooth muscle contraction V2 - increased H20 permeability and reabsorption in the collecting tubules of the kidney (V2 is found in the 2 kidneys). QISS and QIQ until you're SIQ of SQS

Answer 233

Receptor activates Phospholipase C which activates conversion of PIP2 to DAG and IP3. DAG activates Protein kinase C. IP3 activates release of Ca causing increase in intracellular Ca+2 and smooth muscle contraction.

Answer 234

Gs feeds into activating adenylyl cyclase while Gi inhibits it. Adenyl cyclase converts ATP to cAMP, which then goes onto activate protein kinase A which increases intracellular Ca+2 in the heart and inhibits myosin light-chain kinase (smooth muscle)

Answer 235

Large airways consist of nose, pharynx, larynx, trachea, and bronchi. Small airways consist of bronchioles and terminal bronchioles (large numbers in parallel -> least airway resistance). Warms, humidifies, and filters air but does not participate in gas exchange-> "anatomic dead space." Cartilage and goblet cells extend to end of bronchi. Pseudostratified ciliated columnar cells (beat mucus up and out of lungs) extend to beginning of terminal bronchioles, then transition to cuboidal cells. Airway smooth muscle extend to end of terminal bronchioles (sparse beyond this point).

Answer 236

Lung parenchyma; consists of respiratory bronchioles, alveolar ducts, and alveoli. Participates in gas exchange. Mostly cuboidal cells in respiratory bronchioles, then simple squamous cells up to alveoli. No cilia. Alveolar macrophages clear debris and participate in immune response.

Answer 237

Type 1 pneumocytes: 97% of alveolar surfaces. Line the alveoli. Squamous; thin for optimal gas diffusion. Type 2 pneumocytes: Secrete pulmonary surfactant -> decreased alveolar tension and prevention of alveolar collapse (atelectasis). Cuboidal and clustered. Also serve as precursors to type I cells and other type II cells. Type II cells proliferate during lung damage. Clara cells: non-ciliated; low-columnar/cuboidal with secretory granules. Secrete component of surfactant; degrade toxins; act as reserve cells.

Answer 238

mix of lecithins, most importantly dipalmitoylphosphatidylcholine. Surfactant synthesis begins around week 26 of gestation, but mature levels are not achieved until around week 35. Lecithin to sphingomyelin ratio > 2.0 in amniotic fluid indicates fetal maturity.

Answer 239

While upright - lower portion of right inferior lobe. While supine - superior portion of right inferior lab. Right lung is more common for inhaled foreign body because the right main stem bronchus is wider and more vertical than the left.

Answer 240

Right side has 2: Horizontal fissure: between superior and middle lobes. Oblique fissure: between middle and inferior lobes. Left has one: Oblique fissure between superior lobe and inferior lobe.

Answer 241

At T8: IVC At T10: esophagus, vagus (CN10, 2 trunks) At T12: aorta, thoracic duct, azygous vein. I (IVC) ATE (8) TEN (10) EGGS (esophagus) AT (aorta) TWELVE (12)

Answer 242

Taut in Tissues. Relaxed in Respiratory tract. Taut form has low affinity for O2. Relaxed form has high affinity for O2 (300x).

Answer 243

Oxidized form of Hb (ferric, Fe+3) that does not bind O2 as readily, but has increased affinity for cyanide. Iron in Hb is normally in a reduced state (Fe+2). Methemoglobinemia may present with cyanosis and chocolate colored blood (basically brown). To treat cyanid poisoning, use nitrites to oxidize Hb to methemoglobin, which binds cyanide. Use thiosulfate to bind this cyanide, forming thiocyanate, which is readily excreted. Methemoglobinemia can be treated with methylene blue. Nitrites cause poisoning by oxidizing Fe+2 to Fe+3. Just the 2 of us: ferroUS. Fe+2

Answer 244

Form of Hb bound to CO in place of O2. Causes decreased oxygen-binding capacity with a left shift in oxygen-hemoglobin dissociation curve. Decreased O2 unloading in tissues. CO has 200x greater affinity than O2 for Hb.

Answer 245

A minimum at FRC.

Answer 246

PVR = (Ppulmart -Platrium)/CO Platrium is also the pulmonary wedge pressure. ``` R = 8*n*L/(pi*R^4) n = viscosity of blood. L = vessel length r = vessel radius ```

Answer 247

Hypoxemia (Decreased PaO2) - Normal A-a gradient (High altitude, hypoventilation) and Increased A-a gradient (V/Q mismatch, Diffusion limitation, Right-to-left shunt). Hypoxia (decreased O2 delivery to tissue) - Decreased CO, Hypoxemia, Anemia, CO poisoning. Ischemia (loss of blood flow) - Impeded arterial flow, decreased drainage.

Answer 248

1) HCO3- (90%) 2) Carbaminohemoglobin or HbCO2. CO2 bound to Hb at N-terminus of globin (not heme). CO2 binding favors taut form (O2 unloaded form) (5%) 3) Dissolved CO2

Answer 249

As HCO3- in the plasma. CO2 goes into RBC and gets converted to HCO3- through carbonic anhydrase. HCO3- gets pushed out and Cl- gets brought in.

Answer 250

Haldane effect: CO2 is released from RBCs when oxygenation of Hb occurs in lungs. O2 promotes dissociation of H+ from Hb which drives carbonic anhydrase reaction towards CO2. Bohr effect: In peripheral tissue, increased H+ from tissue promotes loading of O2.

Answer 251

Increased ventilation causing decreased PaCO2. Chronic increase in ventilation. Increased EPO leading to increased hematocrit and Hb (chronic hypoxia). Increased 2,3-BPG (binds to Hb so that Hb releases more O2). Cellular changes (increased mitochondria). Increased renal excretion of HCO3- (e.g. can augment by use of acetazolamide) to compensate for the respiratory alkalosis. Chronic hypoxic pulmonary vasoconstriction results in RVH.

Answer 252

No change in arterial O2 or CO2 but venous CO2 content increases and venous O2 decreases. V/Q ratios in the lung even out. Decreased pH From lactic acidosis.

Answer 253

Obstruction of sinus drainage into nasal cavity -> inflammation and pain over affected areas (typically maxillary sinuses in adults). Most common acute cause is viral URI; may cause superimposed bacterial infection, most commonly S. pneumoniae, H. influenzae, and M. catarrhalis.

Answer 254

Increased risk for cor pulmonale and Caplan syndrome (rheumatoid arthritis and pneumoconioses with intrapulmonary nodules).

Answer 255

Associated with shipbuilding, roofing, and plumbing. "Ivory white" calcified pleural plaques are pathognomonic of asbestos exposure, but are not precancerous. Associated with an increased incidence of bronchogenic carcinoma and mesothelioma. Can show pleural thickening with calcification particularly of the posterolateral mid-lung zones and diaphragm. Interstitial densities in the lower lobes. Can also see small plueral effusions which are exudative and bloody. Affects lower lobes. Asbestos (ferruginous) bodies are golden-brown fusiform rods resembling dumbbells. Asbestos is from the roof (was common in insulation), but affects the base (lower lobes). Silica and coal are from the base (earth), but affect the roof (upper lobe).

Answer 256

Prolonged coal dust exposure -> macrophages laden with carbons -> inflammation and fibrosis. Also known as black lung disease. Affects upper lobes. Anthracosis - asymptomatic condition found many urban dwellers exposed to sooty air. Asbestos is from the roof (was common in insulation), but affects the base (lower lobes). Silica and coal are from the base (earth), but affect the roof (upper lobe).

Answer 257

Associated with foundries, sandblasting, and mines. Macrophages respond to silica and release fibrinogenic factors, leading to fibrosis. It is thought that silica may disrupt phagolysosomes and impair macrophages, increasing susceptibility to TB. Also increased risk of bronchogenic carcinoma. Affects upper lobes. "Eggshell" calcifications of hilar lymph nodes. Birefringent silica particles. Nodular densities. Asbestos is from the roof (was common in insulation), but affects the base (lower lobes). Silica and coal are from the base (earth), but affect the roof (upper lobe).

Answer 258

non-caseating granulomas. Hilar lymph nodes. Systemic organs. Miners and space industry. Looks like sarcoidosis. Increased risk for lung cancer. 8

Answer 259

Mixed type III/IV hypersensitivity reaction to environmental antigen -> dyspnea, cough, chest tightness, headache. Often seen in farmers and those exposed to birds. Granulomatous reaction to organic antigens (pigeon breeder). Chronic leads to interstitial fibrosis. Diffuse nodular interstitial infiltrates on chest x-rays.

Answer 260

Surfactant deficiency -> increased surface tension -> alveolar collapse. Lecithin:sphingomyelin ratio < 1.5 in amniotic fluid is predictive of NRDS. Persistently low O2 tension leads to a risk of PDA. Lecithin like phosphitylcholine. Therapeutic supp of O2 results in retinopathy of prematurity and bronchopulmonary dysplasia (from free radical injury from O2 radicals). Risk factors: prematurity, maternal diabetes (due to increased fetal insulin which inhibits surfactant production), C-section delivery (decreased release of fetal glucocorticoids).

Answer 261

Caused by trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis, or amniotic fluid embolism. Diffuse alveolar embolism results in increased capillary permeability and protein rich leakage into alveoli and noncardiogenic pulmonary edema (normal PCWP). Results in formation of intra-alveolar hyaline membrane. Initial damage due to release of neutrophilic substances (proteases + free radicals) toxic to alveolar wall, activation of coagulation cascade, and oxygen derived free radicals. Free radicals damage type 1 and 2 pneumocytes. Diffuse on x-ray.

Answer 262

A pulmonary hypertension greater than 25 mmHg at rest. Results in arteriosclerosis, medial hypertrophy, and intimal fibrosis of pulmonary arteries. Primary: due to an inactivating mutation in the BMPR2 gene (normally functions to inhibit vascular smooth muscle proliferation); poor prognosis. Secondary: due to COPD (destruction of lung parenchyma); mitral stenosis (increased resistance and increased pressure); recurrent thromboemboli (decreased cross sectional area of pulmonary vascular bed); autoimmune disease (e.g. systemic sclerosis; inflammation -> intimal fibrosis -> medial hypertrophy); left to right shunt (increased shear stress -> endothelial injury); sleep apnea or living at high altitude (hypoxic vasoconstriction). Course: severe respiratory distress leading to cyanosis and RVH; death from decompensated cor pulmonale. Tx: Bosentan or ambrisentan for treatment. Antagonize endothelian 1 receptor leading to dilation. Prostaglandins useful too.

Answer 263

Subtype of adenocarcinoma in situ. CXR often shows hazy infiltrates similar to pneumonia; excellent prognosis. Columnar cells around alveoli. Mucous glands. grows along alveolar septa -> apparent "thickening" of alveolar walls. Growth along bronchioles and clara cells. Arises from clara cells. Peripheral and not related to smoking. X-ray pneumonia like consolidation.

Answer 264

Polyp like mass in bronchus; nests of cells on Histo. Can be peripheral or central. Excellent prognosis. metastasis are rare. Symptoms usually due to mass effect; occasionally carcinoid syndrome (5-HT secretion -> flushing, diarrhea, wheezing). NOT related to smoking. Well differentiated nests of neuroendocrine cells with chromogranin A (secretory neuro granule).

Answer 265

Benign large vessels. Fibrous tissue. Can have epistaxis. `

Answer 266

vocal cords. HPV 6 and 11. Single lesion in adults and multiple in children.

Answer 267

malignancy of pleura associated with asbestosis; results in hemorrhagic pleural effusions and pleural thickening. Psammoa bodies on histo. Mesothelial cells are normally producing pleural fluids.

Answer 268

Causes: S pneumo, Legionalla, Klebsiella, enterics that are aspirated. Aspiration pneumo is usually right lower lobe with anaerobics. Intra-alveolar exudate -> consolidation; may involve entire lung. 1) Congestion 2) Red hepatization (RBCs) 3) Grey hepatiziation 4) Resolution

Answer 269

S. pneumo, S aureus, H. influenzae, Klebsiella. Acute inflammatory infilitrates from bronchioles into adjacent alveoli; patchy distribution involving >1 lobe.

Answer 270

Viruses (influenza, RSV, adenoviruses). Mycoplasma, Legionella, Chlamydia. Diffuse patchy inflammation localized to interstitial areas at alveolar walls; distribution involving >= 1 lobe. Generally follows a more indolent course.

Answer 271

S. aureaus or anaerobes (Bacteroides, Fusobacterium, Peptostreptococcus).

Answer 272

deeply eosinophilic cytoplasm, cell shrinkage, nuclear shrinkage (pyknosis), and basophilia, membrane blebbing, nuclear fragmentation (karyorrhexis), and formation of apoptotic bodies, which are then phagocytosed.

Answer 273

Tissue remodeling and embryogenesis. occurs when a regulating factor is withdrawn from a proliferating cell population (e.g. IL-2 being withdrawn after a completed immunological rxn). Also due to injurious stimuli (radiation, toxins, hypoxia). Changes in proportions of anti- and pro-apoptotic factors lead to increased mitochondrial permeability and cytochrome C release. BAX and BAK are pro-apoptotic proteins; BCL-2 is anti-apoptotic. BCL-2 prevents cytochrome C release by binding to and inhibiting Apaf-1. Apaf1 normally induces activation of caspases.

Answer 274

Ligand receptor interactions (FasL binding to Fas/CD95) immune cell mediated (T cell release of perforin/granzyme) The FasL/Fas interaction is necessary for thymic medullary negative selection. Mutations in Fas increase the numbers of circulating self-reacting lymphocytes due to failure of clonal deletion. After Fas cross links with FasL, multiple Fas molecules coalesce, forming a binding site for a death domain-containing adapter protein, FADD. FADD binds inactive caspases, activating them.

Answer 275

TB, systemic fungi, Nocardia.

Answer 276

Vasculitides (e.g. Henoch-Schonlein purpura, Churg-Strauss syndrome), malignant hypertension; amorphous and pink on H&E.

Answer 277

ATP depletion, Cellular/mitochondrial swelling (decreased ATP leads to decrease in Na/K pump activity), Nuclear chromatin clumping, decreased glycogen, fatty change, ribosomal/polysomal detachment (decreased protein synthesis), membrane blebbing.

Answer 278

Nuclear pyknosis (shrinkage), karyorrhexis (nuclear fragmentation), karyolysis, plasma membrane damage, lysosomal rupture, mitochondrial permeability/vacuolization; phospholipid containing amorphous densities within mitochondria (swelling alone is reversible).

Answer 279

Brain: ACA/MCA/PCA boundary areas (these are watershed areas because they receive dual supply of blood from distal branches of 2 arteries which protects areas from single vessel blockage. However, these are more susceptible to ischemia from systemic hypoperfusion. Hypoxic ischemic encephalopathy affects pyramidal cells of hippocampus and Purkinje cells of cerebellum in addition to watershed areas). Heart: Subendocardium (LV) Kidney: Straight segment of proximal tubule (medulla). Thick ascending limb (medulla). Liver: area around central vein (zone III) Colon: Splenic flexure, rectum. (these two are also watershed areas).

Answer 280

All are reperfusion injury due to oxygen free radicals. ``` Red infarcts (hemorrhagic) are in loose tissues with multiple blood supplies such as liver lungs and intestine. RED for REPERFUSION. ``` White infarcts are in solid tissues with single blood supply such as heart, kindeys, or spleen.

Answer 281

Process involving the cell body following axonal injury. Changes reflect increased protein synthesis in effort to repair the damaged axon. Characterized by: round cellular swelling, displacement of nucleus to periphery, and dispersion of Nissl substance throughout cytoplasm.

Answer 282

Calcium deposition in tissues secondary to necrosis. Is not directly associated with hypercalcemia (i.e. patients are usually normoclacemic). Tends to be localized (e.g. on heart valves). Seen in TB (lungs and pericardium), liquefactive necrosis of chronic abscesses, fat necrosis, infarcts, thrombi, schistosomiasis, Monckeberg arteriolosclerosis, congenital CMV + toxoplasmosis, psammoma bodies.

Answer 283

Widespread (i.e. diffuse, metastatic) deposition of calcium in normal tissue secondary to hypercalcemia (e.g. primary hyperparathyroidism, sarcoidosis, hypervitaminosis D) or high calcium-phosphate product (e.g. chronic renal failure + secondary hyperparathyroidism, long-term dialysis, calciphylaxis, warfarin). Calcium deposits predmoinantly in interstitial tissues of kidneys, lungs, and gastric mucosa (these tissues lose acid quickly; increased pH favors deposition). Patients are usually NOT normocalcemic.

Answer 284

Vasc/Leukocyte E-selectin/Sialyl-Lewis P-selectin/Sialyl-Lewis GlyCAM-1, CD34/L-selectin

Answer 285

Vasc/Leukocyte ICAM-1 (CD54) CD11 or CD18 integrins(LFA-1, MAC-1) VCAM-1 (CD106) VLA-4 Integrin

Answer 286

Vasc/Leukocyte | PECAM-1 (CD31) PECAM-1 (CD31)

Answer 287

Chemotactic products in response to bacteria: C5a, IL-8, LTB4, kalliekrein, platelet-activating factor

Answer 288

Pathologies: Retinopathy of prematurity (e.g. NRDS) Bronchopulmonary dysplasia (e.g. NRDS) Carbon tetracholride, leading to liver necrosis (fatty change) Acetaminophen overdose (fulminant hepatitis, renal papillary necrosis). Iron overload (hemochromatosis) Reperfusion injury (e.g. superoxide), especially after thrombolytic therapy. Red infarcts for example.

Answer 289

A,C and E.

Answer 290

increased collagen synthesis, disorganized collagen arrangement (vs parallel arrangement in hypertrophic scars), extend beyond borders of original scar, and recurs following resection.

Answer 291

secreted by activated platelets and macrophages. Induces vascular remodeling and smooth muscle migrations. Simulates fibroblast growth for collagen synthesis.

Answer 292

stimulates all aspects of angiogenesis. | It's name is misnomer.

Answer 293

Stimulates cell growth via tyrosine kinases (e.g. EGFR, as expressed by ERBB2).

Answer 294

Angiogenesis, fibrosis, cell cycle arrest

Answer 295

Tissue remodeling.

Answer 296

Inflammatory (immediate) - mediated by platelets, neutrophils, and macrophages. Clot formation, increased vessel permeability and neutrophil migration into tissue; macrophages clear debris 2 days later. Proliferative (2-3 days after wound) - mediated by fibroblasts, myofibroblasts, endothelial cells, keratinocytes, macrophages. Deposition of granulation tissue and collagen (Type 3), epithelial cell proliferation, dissolution of clot, and wound contraction (myofibroblasts) Remodeling (1 week after wound) - fibroblasts. Type III collagen replaced by Type 1. Increased tensile strength of tissue.

Answer 297

Th1 cells secrete gamma INF, activating macrophages. TNF-alpha from macrophages induce and maintain granuloma formation. Anti-TNF drugs can, as a side effect, cause sequestering granulomas to breakdown leading to disseminated disease. Always test for latent TB before starting anti-TNF therapy. Bartonella henselae (cat scratch disease). Berylliosis Churg-Strauss syndrome Francisella tularensis Fungal infections (e.g. hisplasmosis, blastomycosis) Granulomatosis with polyangiitis (Wegener) Listeria monocytogenes (granulomatosis infantiseptica) M. leprae (leprosy; Hansen disease). M. tuberculosis. Treponema pallidum (tertiary syphillis) Sarcoidosis Schistosomiasis

Answer 298

products of inflammation (e.g. fibrinogen) coat RBCs and cause aggregation. INcreased ESR: Most anemias, infections, inflammation (e.g. temporal arteritis), cancer (e.g. multiple myeloma), pregnancy, autoimmune disorders (e.g. SLE) Decreased ESR: Sickle cell (changed shape), polycythemia (Increased RBCs "dilute" aggregation factors), CHF (unknown)

Answer 299

Leading cause of fatality from toxicologic agents in children. Mech: cell death due to peroxidation of membrane lipids. Symptoms: Acute - nausea, vomiting, gastric bleeding, lethargy. Chronic - metabolic acidosis, scarring leading to GI obstruction. Tx: chelation (eg. IV deferoxamine, oral defarsirox) and dialysis.

Answer 300

AL (primary) Due to deposition of proteins from Ig Light Chains. Can occur as a plasma cell disorder or associated with multiple myeloma. Often affects multiple organ systems, including renal (nephrotic syndrome), cardiac (restrictive cardiomyopathy, arrhythmia), hematologic (easy bruising), GI (hepatomegaly), and neurologic (neuropathy).

Answer 301

AA (secondary). Fibrils composed of Amyloid A. Seen with chronic conditions, such as RA, IBD, spondyloarthropathy, protracted infection. Often multisystem like AL amyloidosis.

Answer 302

Fibrils composed of B2-microglobulin (part of MHC 1 on all cells and associated with hepcidin in degrading ferroportin) in patients with ESRD and/or longer term dialysis. May present as carpal tunnel syndrome.

Answer 303

heterogenous group of disorders. Example is ATTR neurologic/cardiac amyloidosis due to transthyretin (TTR or prealbumin) gene mutation.

Answer 304

Due to deposition of normal (wild-type) TTR in myocardium and other sites. Slower progression of cardiac dysfunction relative to AL amyloidosis.

Answer 305

AMyloid deposition localized to a single organ. Most important form is amyloidosis in Alzheimer disease due to deposition of amyloid-Beta protein cleaved from amyloid precursor protein (APP). Islet amyloid polypeptide (IAPP) is commonly seen in diabetes mellitus type 2 and is caused by deposition of amylin in pancreatic islets.

Answer 306

It is abnormal aggregation of protein (or fragments) into Beta pleated structures -> damage and apoptosis. Congo red stain shows amyloid deposits within tissue. Congo red stain shows apple-green birefringence under polarized light.

Answer 307

yellow brown wear and tear in normal aging. Formed by oxidation and polymerization of autophagocytosed organellar membranes. Autopsy of elderly person will reveal deposits in heart, liver, kidney, eye, and other organs.

Answer 308

Proportion of positive test results that are true positive. Or probability that person actually has the disease given a positive test result. TP/(TP +FP). PPV varies directly with prevalence or pretest probability. high test probability results in high PPV.

Answer 309

proportion of negative test results that are true negative. Probability that person actually is disease free given a negative test result. TN/(TN +FN). NPV varies inversely with prevalence or pretest probability: high pretest probability -> low NPV.

Answer 310

of new cases in a specified time period/population at risk during same time period. Population AT RISK. So does not include people who are already sick

Answer 311

it's (a/c)/(b/d) where a/c is the odds those with disease were exposed to a risk factor. b/d is the odds those without disease were exposed to a risk factor.

Answer 312

the disease percentages divided by each other. (a/(a+b))/(c/(c+d)) = RR

Answer 313

reduction of risk due to some intervention. RRR = 1 - RR so if intervention like vaccine has 2% risk while non-vaccine has 8% risk then RR = 2/8 = 0.25 so RRR = 0.75. 75% reduction in risk.

Answer 314

The difference in risk between exposed and non-exposed. Amount of disease occurring due to risk factor. AR = a/(a+b) - c/(c+d)

Answer 315

The difference in risk (as opposed to relative). | So if 2% get disease with vaccination and 8% without vaccination then ARR = 6%.

Answer 316

Number of patients who need to be treated for 1 patient to benefit. Calculated as 1/ARR. Number of patients who need to be exposed to a risk factor for 1 patient to be harmed is calculated as 1/AR.

Answer 317

precision - random error | accuracy - systematic error or bias.

Answer 318

a study looking only at inpatients

Answer 319

groups who know they're being studied behave differently than they would otherwise.

Answer 320

self-fulfilling prophecy. Researcher's belief in the efficacy of treatment changes the outcome of that treatment. Observer-expectancy bias Documents what he expects.

Answer 321

subjects in different groups are not treated the same. | Patients in treatment group spend more time in highly specialized hospital units.

Answer 322

multiple/repeated studies cross over studies - subjects act as their own controls Matching - patients in both treatment and control groups have similar characteristics.

Answer 323

Measure "back end" survival. | Adjust survival according to the severity of disease at the time of diagnosis.

Answer 324

Tail is towards the right with mean > median > mode.

Answer 325

Tail is towards the left with mean < median < mode.

Answer 326

The power is the probability of rejecting the null hypothesis when it is false. Otherwise known as seeing a difference when there really is one. Can be increased by increasing sample size, increasing expected effect size, or increasing precision of measurement.

Answer 327

Primary - Prevent disease occurrence (HPV vaccination) Secondary - Screening early for disease (e.g. Pap smear) Tertiary - Treatment to reduce disability from disease (e.g. chemotherapy). Quaternary - identifying patients at risk of unnecessary treatment, protecting from the harm of new interventions.

Answer 328

Married, self-supporting, in the military.

Answer 329

Sex (contraception, STDs, pregnancy) Drugs (addiction) Rock and roll (emergency/trauma)

Answer 330

California supreme court decision requiring physician to directly inform and protect potential victim from harm.

Answer 331

Assessed on new borns at 1 minute and 5 minutes. 10 point scale. based on Appearance, Pulse, Grimace, Activity, Respiration. Greater than 7 is good, 4-6 is assist and stimulate, less than 4 is resuscitate. If score remains less than 4 at later time then there is increased risk for neurological damage.

Answer 332

low birth weight is less than 2500g. Caused by prematurity or intrauterine growth retardation (IUGR). Associated with increased risk of SIDS (sudden infant death syndrome) and with increased mortality. Other problems include impaired thermoregulation and immune function, hypoglycemia, polycythemia, and impaired neuro-cognitive/emotional development. Complications include infections, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, and persistent fetal circulation.

Answer 333

Moro - 3 months (sudden loss of support -> spreading out arms i.e. abduction, unspreading the arms i.e. adduction, and crying) rooting - 4 months (head turn towards stroking of cheek) palmar - 6 months (grabbing something that is put in hand) Babinski - 12 months.

Answer 334

``` 1 months - lifts head up prone 6 months - rolls and sits, passes toys hand to hand 8 months - crawls 10 months -stands 12-18 months - walks ```

Answer 335

6 months - passes toys hand to hand 10 months - Pincer grasp (using thumb and index finger to pick up objects) 12 months - Points to objects

Answer 336

2 months - social smile 6 months - stranger anxiety 9 months - separation anxiety 12 months - Parallel play (Recreation) 24 months - moves away from and returns to mother (Rapproachment) 36 months - core gender identity formed (realization)

Answer 337

4 months - orients first to voice 9 months - orients to name and gestures, object permanence 10 months - says mama and dada 24 months - 200 words, 2 word sentences 3 years - 1000 words 4 years - complete sentences and propositions, can tell detailed stories.

Answer 338

18 months - climbs stairs 20 months - feeds self with fork and spoon 24 month - kicks ball 3 years - rides tricycle 4 years - copies line or circle, stick figures. hops on one foot 5 years - uses buttons or zippers, grooms self.

Answer 339

Sexual changes: Men - slower erection/ejaculation, longer refractory period Women - vaginal shortening, thinning, dryness Sexual interest does not decrease, intelligence does not decrease. Sleep: Decreased REM and slow-wave sleep. Increased sleep onset latency and increased early awakenings. Increase in suicides, decreased vision/hearing/immune system/bladder control Decreased renal, pulmonary, GI function decreased muscle mass, increased fat.

Answer 340

In elderly. High frequency hearing loss due to destruction of hair cells at the cochlear base (preserved low frequency hearing at apex).

Answer 341

pronephros - at 4 weeks it degenerates mesonephros - functions as interim kidney for 1st trimester; later contributes to male genital system. metanephros - permanent; first appears in 5th week of gestations; nephrogenesis continues through 32-36 weeks of gestation. Ureteric bud comes from caudal end of mesonephric duct and gives rise to ureter, pelvises, calyces, and collecting ducts; fully canalized by 10th week. Metanephric mesenchyme comes from when ureteric bud interacts with this tissue; interaction induces differentiation and formation of glomerulus through to distal convoluted tubule. Aberrant interaction between these 2 tissues may result in several congenital malformations of the kidney. Ureteropelvic junction - last to canalize - > most common site of obstruction (hydronephrosis) in fetus.

Answer 342

Due to abnormal interaction between ureteric bud and metanephric mesenchyme. This leads to a nonfunctional kidney consisting of cysts and connective tissue. If unilateral (most common), generally asymptomatic with compensatory hypertrophy of contralateral kidney. Often diagnosed prenatally via ultrasound.

Answer 343

Water under the bridge. Ureters pass under the uterine artery and under ductus deferens. (retroperitoneal) Gynecologic procedures involving ligation of the uterine vessels may damage the ureter -> ureteral obstruction or ureteral leak.

Answer 344

inulin is used for measuring extracellular volume. Radiolabeled albumin is used for plasma volume.

Answer 345

Prostaglandins dilate afferent arterioles Increased GFR and RPF and filtration fraction does not change. NSAIDs inhibit this causing constriction of the afferent arterioles and decreased GFR. can lead to acute renal failure.

Answer 346

angiotensin II constricts the efferent arteriole preferentially. Increased GFR and decreased RPF causing an increased filtration fraction. ACEi blocks this.

Answer 347

Because it causes decreased re-absorption of glucose and amino acids in the proximal tubule.

Answer 348

autosomal recessive disorder. Deficiency of neutral amino acid transporters (like for tryptophan) transporters in the proximal renal tubular cells and on enterocytes. Leads to neutral aminoaciduria and decreased absorption from the gut; results in pellagra like symptoms (diarrhea, dementia, dermatitis); treat with high-protein diet and nicotinic acid (B3).

Answer 349

Reabsorptive defect in PCT. Associated with increased excretion of nearly all amino acids, glucose, HCO3-, and PO4-3. May result in metabolic acidosis (proximal renal tubular acidosis). Causes include hereditary defects (e.g. Wilson disease), ischemia, and nephrotoxins/drugs. Renal tubular defects: The kidneys put out FABulous Glittering Liquid. FAnconi syndrome is the 1st defect - PCT Bartter syndrome is next (thick ascending loop of Henle) Gitelman syndrome is after Bartter - DCT Liddle syndrome is last - collecting tubule

Answer 350

Reabsorptive defect in thick ascending loop of Henle. Autosomal recessive, affects Na+/K+/2Cl- cotransporter. Results in hypokalemia and metabolic alkalosis with hypercalciuria. Renal tubular defects: The kidneys put out FABulous Glittering Liquid. FAnconi syndrome is the 1st defect - PCT Bartter syndrome is next (thick ascending loop of Henle) Gitelman syndrome is after Bartter - DCT Liddle syndrome is last - collecting tubule

Answer 351

Reabsorptive defect of NaCl in DCT. Autosomal recessive. Less severe than Bartter syndrome. Leads to hypokalemia and metabolic alkalosis but without hypercalciuria. Renal tubular defects: The kidneys put out FABulous Glittering Liquid. FAnconi syndrome is the 1st defect - PCT Bartter syndrome is next (thick ascending loop of Henle) Gitelman syndrome is after Bartter - DCT Liddle syndrome is last - collecting tubule

Answer 352

Increased sodium reabsorption in distal and collecting tubules (increased activity of epithelial sodium channel). Autosomal dominant. Results in hypertension, hypokalemia, metabolic alkalosis, and decreased aldosterone. Treatment is amiloride. Renal tubular defects: The kidneys put out FABulous Glittering Liquid. FAnconi syndrome is the 1st defect - PCT Bartter syndrome is next (thick ascending loop of Henle) Gitelman syndrome is after Bartter - DCT Liddle syndrome is last - collecting tubule

Answer 353

Angiotensinogen is made in liver. Renin is made from JG cells (modified smooth muscle of afferent arteriole) in response to decreased renal arterial pressure sensed by JG cells and increased renal sympathetic discharge by B1 receptors. Macula densa cells also sense less sodium delivery and signal to JG cells. Part of B-blocker effect is decreasing BP by inhibiting B1 receptors of the JGA, causing decreased renin release.

Answer 354

Mostly in the lungs.

Answer 355

Released from atria in response to increased volume; may act as a check on renin-angiotensin aldosterone system; relaxes vascular smooth muscle via cGMP, causing increased GFR, decreased renin.

Answer 356

interstitial cells in the peri-tubular capillary bed in response to hypoxia.

Answer 357

proximal tubule cells 25-OH form to 1,25 form via 1alpha-hydroxylase. PTH promotes this.

Answer 358

low plasma Ca, high plasma phosphate, or low 1,25-OH vitamin D.

Answer 359

decreased blood volume via Angiotensin II and increased plasma K+.

Answer 360

``` Causes hyperkalemia. Digitalis hyperOsmolarity Insulin deficiency. Lysis of cells Acidosis B-adrenergic antagonist ``` patient with hyperkalemia? DO Insulin LAB.

Answer 361

``` causes hypokalemia. hypo-osmolarity Insulin (increased Na/K ATPase) Alkalosis B-adrenergic agonist (increased Na/K ATPase) ``` FYI: treatment for hyperkalemia is insulin + glucose.

Answer 362

Sodium - too low: nausea and malaise, stupor, coma. too high: irritability, stupor, coma. Potassium - too low: U waves on ECG, flattened T waves, arrhythmias, muscle weakness. too high: wide QRS and peaked T waves, arrhythmias, muscle weakness. Calcium - too low: tetany, seizures, QT prolongation. Too high: Stones (renal), bones (pain), groans (abdominal pains), psychiatric overtones (anxiety, altered mental status), but not necessarily calciuria. Magnesium - too low: tetany, torsades de pointes. Too high: decreased DTRs, lethargy, bradycardia, hypotension, cardiac arrest, hypocalcemia. Phosphates - too low: bone loss, osteomalacia. too high: renal stones, metastatic calcifications, hypocalcemia.

Answer 363

``` Anion gap: MUDPILES Methanol (formic acid) Uremia Diabetic ketoacidosis Propylene glycol Iron tablets or INH Lactic acidosis Ethylene glycol (oxalic acid) Salicylates (late) ``` ``` Normal anion gap (8-12 mEq/L) HARD-ASS: Hyperalimentation Addison Disease Renal tubular acidosis Diarrhea Acetazolamide Spironolactone Saline infusion ```

Answer 364

``` Respiratory acidosis: Hypoventilation such as: Airway obstruction Acute lung disease Chronic lung disease Opioids, sedatives Weakening of the respiratory muscles. ``` ``` Respiratory alkalosis: hyperventilation such as: Hysteria Hypoxemia (e.g. high altitudes) Salicylates (early) Tumor Pulmonary embolism. ```

Answer 365

loop diuretics Vomiting Antacid use Hyperaldosteronism.

Answer 366

distal with pH > 5.5 defect in ability of alpha intercalated cells to secrete H+. Thus new HCO3- is not generated leading to metabolic acidosis. Associated with hypokalemia, increased risk for calcium phosphate kidney stones (due to increased urine pH and increased bone turnover). Causes: amphotericin B toxicity, analgesic nephropathy, and congenital anomalies (obstruction) of urinary tract.

Answer 367

proximal with pH < 5.5 Defect in proximal tubule HCO3- reabsorption results in increased excretion of HCO3- in urine and subsequent metabolic acidosis. Urine is acidified by alpha intercalated cells in collecting tubule. Associated with hypokalemia. Increased risk for hypophosphatemic rickets. Causes: Fanconi syndrome (e.g. Wilson disease), chemicals toxic to proximal tubule (e.g. lead, aminoglycosides), and carbonic anhydrase inhibitors. Also multiple myeloma.

Answer 368

hyperkalemic, pH < 5.5 Hypoaldosteronism, aldosterone resistance, or K+ sparing diuretics. The resulting hyperkalemia impairs ammoniagenesis in the proximal tubule -> decreased buffering capacity and decreased H+ excretion into urine.

Answer 369

First all casts indicate that hematuria/pyuria is of renal origin and not bladder. RBC casts - Grlomerulonephritis, ischemia, or malignant hypertension. WBC casts - Tubulointerstitial inflammation, acute polynephritis, transplant rejection Fatty casts (oval fat bodies) - Nephrotic syndrome Granular (muddy brown) casts - acute tubular necrosis Waxy casts - advanced renal disease/chronic renal failure..from low urine flow. Hyaline casts - nonspecific, can be a normal finding, often seen in concentrated urine samples. Bladder cancer, kidney stones -> hematuria, no casts. Acute cystitis -> pyuria, no casts.

Answer 370

when increased pH you get calcium phosphate when decreased pH you get calcium oxalate (can come from ethylene glycol). x-ray: radioopaque urine crystals: envelope or dumbbell shaped tx: thiazides or citrate

Answer 371

increased pH. X-ray: radiopaque urine cyrstals: coffin lid. Struvite stones and come from infections with urease positive bugs (Proteus mirabilis, Staphylococcus, Klebsiella) that hydrolyze urea to ammonia -> urine alkalinization Tx: eradication of infection and removal of stone (usually staghorn calculi)

Answer 372

decreased pH. X-ray: radiolucent crystals: rhomboid or rosettes. Decreased urine volume, arid climates, or decreased pH. Tx: alkalinization of urine and hydration.

Answer 373

decreased pH. x-ray: radiolucent crystals: hexagonal usually secondary to cystinuria and can form staghorn calculi. Sodium nitroprusside test positive. Tx: alkalinization of urine and hydration.

Answer 374

originates from proximal tubule cells -> polygonal clear cells filled with accumulated lipids/carbohydrates. Invades renal vein, blocks spermatic vein, and moves to IVC and spreads to lungs and bones. Associated with gene deletion on chromosome 3 (if inherited it is associated with von Hippel-lindau syndrome...which is autosomal dominant and will also present with hemeangioblastoma of cerebellum). RCC = 3 letters = chromosome 3. Associated with paraneoplastic syndromes: ectopic EPO, ACTH, PTHrP

Answer 375

benign epithelial cell tumor. Large eosinophilic cells with abundant mitochondria without perinuclear clearing (vs renal cell carcinoma). Presents with painless hematuria, flank pain, and abdominal mass.

Answer 376

Most common renal malignancy of early childhood (ages 2-4). Contains embryonic glomerular structures. Presents with huge, palpable flank mass and/or hematuria. And hypertension from increased renin. Loss of function mutations of tumor suppressor genes WT1 and WT2 on chromosome 11. Dark blue cells

Answer 377

Beckwith-Widemann syndrome or WAGR complex: Wilms tumor, Aniridia (lack of iris), Genitourinary malformation, and mental Retardation (intellectual disability)

Answer 378

problems with your Pee SAC: Phenacetin, Smoking, Aniline dyes, and Cyclophosphamide. Reminder: with this type there is papillary (low grade to high grade and then invasive) and flat (high grade to invasive due to early p53 mutations)

Answer 379

chronic irritation of the bladder -> squamous metaplasia -> dysplasia and squamous cell carcinoma Risk factors: schistosoma haematobium infection (Mid east), chronic cystitis, smoking, and chronic nephrolithiasis. Presents with painless hematuria.

Answer 380

remember: systemic symptoms not present..i.e. fevers and chills ``` E.coli (most common) Staph saprophyticus Klebsiella Proteus mirabilis - ammonia scent Adenovirus - hemorrhagic cystitis ``` Nitrites show for gram neg esp E. Coli. Sterile pyuria and negative urine cultures suggest urethritis by Neisseria gonorrhea or Chlamydia trachomatis.

Answer 381

ciprofloxacin in severe cases. | Nitrofurantoin for UTIs that are mild.

Answer 382

In chronic polynephritis. Scarring of lower and upper poles. Atrophic tubules release eosinophilic material.

Answer 383

remember: it will present with interstitial inflammation with eosinophils (could be in urine too). Fever rash and hematuria and CVA tenderness. Administering drugs that act as haptens causing hypersensitivity. These include nephritis occurring 1-2 weeks after diuretics, penicillin derivatives, suflonamides, rifampin. Months after using NSAIDs.

Answer 384

``` due to combination of vasospasm and DIC. Obstetric catastrophes (e.g. abruptio placentae) and septic shock. ```

Answer 385

``` injury from toxic substances: aminoglycosides radiocontrast agents lead cisplatin crush injury (myoglobinuria) hemoglobinuria Urate (tumor lysis syndrome) Ethylene glycol ``` Proximal tubule most susceptible to injury.

Answer 386

1. Inciting event 2. Maintenance phase -oligouric. lasts 1-3 weeks; risk of hyperkalemia, metabolic acidosis. Increased anion gap because can't get rid of organic anions. BUN/Creatinine both increased. Death happens in this phase. 3. Recovery phase - polyuric. BUN and creatinine fall. Risk of hypokalemia. 2 types: ischemic and nephrotoxic.

Answer 387

Triggered by recent infection or immune stimulus. Associated with: Diabetes mellitus. Acute pyelonephritis. Chronic phenacetin use (acetaminophen is phenacetin derivative). Sickle cell anemia and trait.

Answer 388

Inherited disease causing tubulointerstitial fibrosis and progressive renal insufficiency with inability to concentrate urine. Medullary cysts usually not visualized; shrunken kidneys on ultrasound. Poor prognosis.

Answer 389

Simple cysts usually found in outer cortex filled with ultrafiltrate. Very common and account for majority of all renal masses. Found incidentally and typically asymptomatic. Complex cysts including those that are septated, enhanced, or have solid components as seen on CT, require follow up or removal due to risk of renal cell carcinoma.

Answer 390

ADPKD: adult dominant form. Presents with flank pain, hematuria, hypertension, urinary infection, progressive renal failure. Death from complications of chronic kidney disease or hypertension (caused by increased renin production). Associated with berry aneurysms, mitral valve prolapse, benign hepatic cysts (cysts in kidney, brain, and liver). Can be associated also with diverticulosis (most common cause of hematochezia). ARPKD: formerly infantile polycystic kidney disease. Infantile presentation in parenchyma. Autosomal recessive. Associated with congenital hepatic fibrosis. Significant renal failure in utero can lead to Potter sequence. Beyond neonatal period, hypertension, portal hypertension, and progressive renal insufficiency.

Answer 391

Thyroglossal duct cyst: presents as anterior midline neck mass that moves with swallowing or protrusion of the tongue Branchial cleft cyst: persistent cervical sinus leading to branchial cleft cyst in lateral neck.

Answer 392

GLUT1: RBC, cornea, brain GLUT2: beta cells in pancreas and liver GLUT4: adipose tissue and skeletal muscle (dependent on insulin for moving to cell membrane) GLUT5: fructose movement in sperm and GI tract.

Answer 393

low Mg+2 causes increased PTH secretion. really low Mg+2 causes decreased PTH secretion. Common causes of low Mg+2: diarrhea, aminoglycosides, diuretics, alcohol use.

Answer 394

Increased pH causes greater affinity of albumin for calcium | Clinical manifestations of hypocalcemia: cramps, pain, paresthesias, carpopedal spasms.

Answer 395

FSH, LH, ACTH, TSH, CRH, bHCG, ADH (V2), MSH, PTH, calcitonin, GHRH, glucagon FLAT CHAMP

Answer 396

ANP, NO (EDRF)

Answer 397

GnRH, Oxytocin, ADH (V1 receptor), TRH, Histamine (H1), Angiotensin II, Gastrin GOAT HAG

Answer 398

Vitamin D, Estrogen, Testosterone, T3/T4, Cortisol, Aldosterone, Progesterone VETTT CAP

Answer 399

Insulin, IGF-1, FGF, PDGF, EGF | This is like the MAP kinase pathway

Answer 400

Prolactin, Immunomodulators (e.g. cytokines IL-2, IL-6, IL-8, IFN), GH This is the JAK/STAT pathway for example. PIG.

Answer 401

Brain maturation Bone growth (synergism with GH) B-adrenergic effects (increased B1 receptors) Basal metabolic rate increased (via increased Na/K ATPase activity = increased oxygen consumption, RR, body temperature) Also increased glycogenolysis, gluconeogenesis, lipolysis. 4 B's.

Answer 402

abdominal distention with firm irregular mass that can cross the midline and usually no hypertension (vs the Wilms tumor of the kidney, which is smooth and unilateral and has hypertension. ). Homovanillic acid (HVA), a breakdown product of dopamine, is increased in urine. Bombesin positive. Rosettes seen on histo with classic small, round, blue/purple nuclei. Associated with N-myc.

Answer 403

``` 10% malignant 10% bilateral 10% extra-adrenal 10% calcify 10% kids ``` remember: adrenal medula tumors are brown while cortex tumors are yellow because of cholesterol. Tx: irreversible alpha antagonists (phenoxybenzamine) and Beta blockers before tumor resection. Alpha blockade before Beta blockers to avoid a hypertensive crisis.

Answer 404

Pot-bellied, Pale, Puffy-faced child, Protruding umbilicus, Protuberant tongue, Poor brain development. Remember: causes include maternal hypothyroidism, iodine deficiency, thyroid agenesis, thyroid dysgenesis, dyshormonogenic goiter (deficient thyroid peroxidase)

Answer 405

Subacute thyroiditis (de Quervain). Remember: it can be hyperthyroid early in course, has increased ESR, pain in jaw and is very tender. Self-limited after flu like illness.

Answer 406

Riedel thyroiditis Remember: in young females vs old (anaplastic carcinoma). Fibrosis can extend to local structures like the airway and mimics anaplastic carcinoma in that regard. It is a part of IgG4 systemic disease and presents as a fixed hard rock like and painless goiter.

Answer 407

thyrotoxicosis if a patient with iodine deficiency goiter is made iodine replete. toxic multinodular goiter can be caused by iodine deficiency or TSH receptor mutation that causes over activation.

Answer 408

Albright hereditary osteodystrophy autosomal unresponsiveness of kidney to PTH. Hypocalcemia, shortened 4th/5th digits, short stature.

Answer 409

Results in extreme hyperpigmentation. Patients who have had an adrenalectomy to treat Cushing's disease. Excess secretion of ACTH from pituitary adenoma that is no longer suppressed by the effect of cortisol.

Answer 410

Folate absorption decreased with oral contraceptives, alcohol, phenytoin, pure vegan diet This is in the jejunum.

Answer 411

In the membranous septum; acyanotic at birth due to left-to-right shunt. remember: The inferior portion of the ventricular septum is muscular and the aorticopulmonary septum is what comes down and fuses with the muscular ventricular septum to form the superior membranous interventricular septum. Endocardial cushions also contribute to atrial septation and membranous portion of the interventricular septum.

Answer 412

neural crest and endocardial cells migrate in to form the aorticopulmonary septum.

Answer 413

Aortic/pulmonary: endocardial cushions of outflow tract | Mitral/tricuspid: derived from fused endocardial cushions of the AV canal.

Answer 414

``` 3-8 weeks: Yolk sac 6-weeks to birth: Liver 10-28 weeks: Spleen 18 weeks to adult: Bone Marrow Young Liver Synthesizes Blood ``` For reference: During Fetus it's mostly alpha and gamma globins with a little of Beta. At birth, gamma form quickly declines and beta form increases.

Answer 415

Umbilical vein: ligamentum teres hepatitis (located in falciform ligament) UmbiLicaL arteries: mediaL umbilical ligament (the Ls) Foramen ovale: fossa ovalis AllaNtois: Urachus-mediaN umbilical ligament (the Ns) Notochord: nucleus pulposus of intervertebral disc.

Answer 416

Early stages: Both SV and HR are increased | Late stages: only HR is increased because SV plateaus

Answer 417

hyperthyroidism, aortic regurgitation, arteriosclerosis, obstructive sleep apnea (increased sympathetic tone), exercise (transient effect).

Answer 418

Holosystolic high pitched blowing murmur: Mitral/tricuspid regurgitation in systole and aortic regurgitation in diastole (early) Holosystolic harsh sounding murmur: VSD and heard best at tricuspid area Continuous machine like murmur: patent ductus arteriosis that is loudest at S2. Can be caused by congenital rubella or prematurity. This is best heard at left infraclavicular area.

Answer 419

hypokalemia or bradycardia.

Answer 420

Romano-Ward Syndrome: autosomal dominant, pure cardiac phenotype (no deafness) Jervell and Lange-Nielsen Syndrome: autosomal recessive, sensorineural defects Both are congenital long QT syndromes: problem with myocardial repolarization typically due to ion channel defects; increased risk of sudden cardiac death due to torsades de pointes.

Answer 421

Happens in Wolff-Parkinson-White syndrome where PR interval is short and there is early ventricular depolarization seen on the EKG. Due to abnormal fast accessory conduction pathway from atria to ventricle (bundle of Kent) bypassing the rate-slowing AV node. Can result in a re-entry circuit -> supraventricular tachycardia.

Answer 422

triad of hypertension, bradycardia, and respiratory depression. Increased intracranial pressure constricts arterioles -> cerebral ischemia and reflex sympathetic increase in perfusion pressure (hypertension) -> increased stretch and reflex baroreceptor induced-bradycardia.

Answer 423

central only sense pCO2 and pH. peripheral sense those + pO2 (when it's less than 60). remember: peripheral chemoreceptors are both the aortic and carotid ones.

Answer 424

lung - organ with largest blood flow (100% of cardiac output) liver - largest share of systemic cardiac output kidney - largest blood flow per gram of tissue heart - largest arteriovenous O2 difference between O2 extraction is ~80% . Therefore increased O2 demand is met by increased coronary blood flow, not by increased extraction of O2.

Answer 425

Heart - adenosine, CO2, NO (vasodilatory) Brain - CO2/pH (vasodilatory) Kidneys - myogenic and tubuloglomerular feedback. Lungs - hypoxia (vasoconstriction) Skeletal muscle - adenosine, CO2, lactate, K+, H+ Skin - sympathetic control which is important for temperature regulation.

Answer 426

The 5 Ts: 1. Truncus arteriosus (1 vessel) - usually with VSD 2. Transposition of great vessels (2 switched vessels) - need VSD, PDA, or patent foramen ovale 3. Tricuspid atresia (3 = Tri). Need both ASD and VSD 4. Tetralogy of Fallot (4 = Tetra) (pulmonary stenosis, RVH (boot shaped heart), overriding aorta, VSD). Squatting helps. 5. TAPVR (5 letters in the name) - Pulmonary veins drain into right heart circulation. Need ASD or PDA to allow for right-to-left shunting to maintain CO.

Answer 427

Both associated with bicuspid aortic valve. Infantile type: aortic narrowing is proximal to insertion of ductus arteriosus (preductal). Associated with Turner syndrome. Adult type: Aortic narrowing is distal to ligamentum arteriosum (post-ductal). Associated with notching of the ribs (collateral circulation), hypertension in upper extremities, and weak, delayed pulses in lower extremities (radiofemoral delay).

Answer 428

VSD (holosystolic harsh murmur) ASD (no heart sound to itself. causes loud S1 and fixed split S2 from fluid overload. defect in septum secondum with missing tissue) PDA (right to left before birth is normal and then becomes left to right after birth when decrease in lung resistance). After a while you get eisenmenger: increased pulmonary blood flow causes remodeling of the vasculature and RVH. Shunt becomes right to left and you get late cyanosis, clubbing, and polycythemia.

Answer 429

truncus arteriousus, tetralogy of fallot think 11 as in first of the five, and 2+2 as in 4 of the five types of right-to-left shunts.

Answer 430

ASD, VSD, AV septal defect. endocardial cushion defects

Answer 431

PDA, Septal defects, pulmonary artery stenosis

Answer 432

Bicuspid aortic valve, coarctation of the aorta (preductal)

Answer 433

MVP, aortic regurgitation, thoracic aortic aneurysm and dissection.

Answer 434

Transposition of the great vessels. | Baby will be hypoglycemic, large for age (causing C-section).

Answer 435

string of beads. A secondary cause of renal disease and thus hypertension.

Answer 436

xanthoma: plaques/nodules composed of lipid laden histiocytes in skin or eyelids (latter being xanthelasma) tendinous xanthoma: lipid deposit in tendon especially in Achilles Note: there is also corneal arcus which are lipid deposits in the cornea.

Answer 437

hyaline: thickening of small arteries in essential hypertension or diabetes mellitus hyperplastic: onion skinning as seen in severe hypertension.

Answer 438

Fenestrated capillary endothelium is for size barrier. Fused basement membrane is lined with heparan sulfate which serves as a negative charge barrier. It's the loss of the negative charge barrier in nephrotic syndrome that causes the loss of protein and albumin that is seen.

Answer 439

Associated with cystic medial degeneration (collagen, elastin, smooth muscle) due to hypertension (older patients) or Marfan syndrome (younger patients). Also seen with tertiary syphillis (due to obliterative endarteritis in the vaso vasorum). Notes: abdominal aortic aneurysm is seen in hypertensive male smokers > 50 years old.

Answer 440

0-4 hours - Arrhythmia, HF, cardiogenic shock, death 4-12 hours - Arrhythmia, HF, cardiogenic shock, death 12-24 hours -Arrhythmia, HF, cardiogenic shock, death 1-3 days - fibrinous pericarditis (neutrophils migrate out to pericardium...only in transmural infarcts). 3-14 days - Structural defects due to macrophage mediated damage (free wall rupture -> tamponade; papillary muscle rupture -> mitral regurg. interventricular septal rupture -> left-to-right shunt). Also can get LV pseudoaneurysm that is a mural thrombus plugging the hole in myocardium. Macrophages show up here. 2 weeks to several months - Dressler syndrome (antibodies against pericardium resulting in fibrinous pericarditis), arrhythmias, true ventricular aneurysm because scar is weak (outward bulging during contraction known as dyskinesia. you can also get mural thrombus).

Answer 441

first 6 hours is ECG Cardiac troponin I rises after 4 hours and is increased for 7-10 days. Much more specific. CK-MB is predominantly found in muscle myocardium and is useful for rediagnosing reinfarction following acute MI because levels return to normal after 48 hours. note: ECG changes include ST elevation (STEMI due to acute transmural infarct), ST depression (subendocardial infarct), and pathological Q waves (evolving or old transmural infarct).

Answer 442

Major causes: sarcoidosis, amyloidosis, postradiation fibrosis, endocardial fibroelastosis (thick fibroelastic tissue in endocardium of young children), Loffler syndrome (endomyocardial fibrosis with a prominent eosinophilic infiltrate), and hemochromatosis (dilated cardiomyopathy also occurs). Note: this presents as diastolic dysfunction with low voltage ECG despite thick myocardium (especially amyloid) and diminished QRS amplititudes.

Answer 443

Acute - S. aureus (high virulence). Large vegetations on previously normal valves and rapid. So virulent that it causes damage. Usually in drug users on tricuspid. Also can see Pseudomonas or candida. This can also shoot emboli to the brain and cause ring enhancing lesion on CT. Subacute - viridans streptococci (low virulence). Smaller vegetations on congenitally abnormal or diseased valves. Can be due to dental procedure. Culture negative - most likely Coxiella burnetti and Bartonella spp. Colon Cancer - Strep bovis Prosthetic valves - S. epidermidis Lupus - Libman-Sachs endocarditis on both sides

Answer 444

Aschoff bodies - granuloma with giant cells Anitschkow cells - enlarged macrophages with ovoid, wavy, rod like nucleus. aka caterpillar cells. ``` Remember JONES criteria J - joints (migratory polyarhritis) O - pancarditis N - nodules in skin E - erythema marginatum S - syndenham's criteria. ``` Pancarditis is: endocarditis (vegetation and fibrosis on valves), myocarditis (Aschoff bodies/granulomas), pericarditis (friction rub).

Answer 445

Temporal is in elderly females while Takayasu is in asian females less than 40 years old. Temporal is involving branches of carotid - headache, jaw pain, blindness while Takayasu involves narrowing of the aortic arch and proximal great vessels. Both involve granulomatous inflammation, increased ESR and corticosteroid treatment.

Answer 446

Young adults, Hepatitis B seropositivity in 30% of patients, fever, weight loss, malaise, headache. GI abdominal pain, renal damage but no pulmonary involvement. Skin lesions and neuro involvement. Immune complex mediated with transmural inflammation of the arterial wall with fibrinoid necrosis (different ages). Innumerable microaneurysms and spasms on arteriogram.

Answer 447

Asian children less than 4 years old. Fever (many days), Cervical lymphadenitis, conjunctival injection, changes in lips/oral mucosa (strawberry tongue), hand-foot erythema, desquamating rash. Coronary artery aneurysms -> thrombosis -> MI, rupture.

Answer 448

Wegener's has upper respiratory, lower respiratory, and renal involvement. c-ANCA. Necrotizing granulomas. Microscopic polyangitis is similar presentation to Wegener except with no nasopharyngeal involvement and no granulomas. p-ANCA. Churg-Strauss: asthma, sinusitis, palpable purpura, peripheral neuropathy (wrist/food drop). Can also involve heart, GI, kidneys, LUNG. Granulomatous, necrotizing vasculitis with eosinophilia. p-ANCA. Increased IgE level.

Answer 449

Triad: Skin - palpable purpura on buttocks/legs Arthralgias GI: abdominal pain, melena, multiple lesions of the same age. Note: most common childhood systemic vasculitis that often follows URI. Vasculitis is secondary to IgA complex deposition. Associated with IgA nepropathy.

Answer 450

From out to in Fibrous pericardium Parietal layer (part of serous pericardium) Pericardial cavity Visceral layer aka epicardium (part of pericardium) Myocardium Endocardium

Answer 451

Both posterior fossa malformations Chiari II: significant herniation of cerebellar tonsils and vermis through foramen magnum with aquaductal stenosis/hydrocephalus. Dandy-Walker: agenesis of cerebellar vermis with cystic enlargement of 4th ventricle (fills the enlarged posterior fossa). Associated with hydrocephalus and spina bifida.

Answer 452

anencephaly: no forebrain, open calvarium (frog like appearance). Increased AFP and polyhydramnios (swallowing centers are not developed so fluid builds up). Type 1 diabetes. holoprosencephaly: sonic hedgehog pathway mutations. Moderate form of cleft lip/palate and can have cyclopia (when prosencephalon doesn't divide into two cavities)

Answer 453

Grossly you have prosencephalon (forebrain), mesencephalon (midbrain), and rhombencephalon (hindbrain) In order you get Telencephalon and diencephalon (from prosencephalon) Mesencephalon (from mesencephalon) Metencephalon and Myelenecphalon (from rhombencephalon) Telencephalon becomes cerebral hemispheres and lateral ventricles. Diencephalon becomes thalamus and third ventricle. Mesencephalon becomes midbrain and aqueduct. Metencephalon becomes pons and cerebellum and upper part of fourth ventricle. Myelencephalon becomes the medulla and lower part of fourth ventricle.

Answer 454

Neuroectoderm: CNS Neurons, ependymal cells, oligodendrocytes, astrocytes (support, K+ metabolism, removal of excess neurotransmitter, component of blood brain barrier, glycogen fuel reserve buffer and reactive gliosis in response to neural injury. Marker is GFAP). Neural Crest: PNS neurons, schwann cells (promotes axonal regeneration and myelination) mesoderm: Microglia (like Macrophages, originate from Mesoderm. scavenger cells that respond to injury by differentiating into large phagocyte cells. When HIV infected they form multinucleated giant cells in CNS.) Note: in neural development, notochord induces overlying ectoderm to differentiate into neuroectoderm and form the neural plate. Neural plate gives rise to the neural plate and neural crest crest cells (where it pinches off bilaterally). Notochord becomes nucleus pulposus of the intervertebral disc in adults. This happens between 18-21 days. Alar plate is dorsal/sensory and basal plate is ventral/motor (just like in the spinal cord).

Answer 455

Anterior 2/3 - 1 and 2nd branchial arches - thus sensation from V3 and taste via VII) Posterior 2/3 - 3rd and 4th branchial arches - thus sensation and taste mostly cranial nerve IX, glossophyrangeal...extreme posterior is vagus, CN X) Motor innervation is all XII, the hypoglossal nerve. Muscles are derived from the occipital myotomes.

Answer 456

Free nerve endings: C (slow, unmyelinated) and Adelta (fast, myeliated). All skin/epidermis/some viscera for pain/temperature. Meissner corpuscles: large myelinated; adapt quickly. In glabrous (hairless) skin for dynamic, fine/light touch; position sense. Pacinian corpuscles: large myelinated;adapt quickly. In deep skin layers, ligaments, joints for vibration and pressure. Merkel discs: large myelinated; adapt slowly. Basal epidermal layer, hair follicles for pressure, deep static tough (shapes/edges), position sense.

Answer 457

three layers Endoneurium - invests single nerve fibers (inflammatory infiltrate here in Guillain Barre) Perineurium - permeability barrier - surrounds a fascicle of nerve fibers. Must be rejoined in microsurgery for limb reattachment. Epineurium - dense connective tissue that surrounds entire nerve (fascicles and blood vessels)

Answer 458

Norepinephrine - locus ceruleus (pons)...stress and panic Dopamine - Ventral tegementum and SNc (midbrain) 5-HT - raphe nucleus (pons, medulla, midbrain) ACh - Basal nucleus of Meynert GABA - Nucleus accumbens (reward center, pleasure, addiction, fear)

Answer 459

Three structures: tight junctions between nonfenestrated capillary endothelial cells Basement membrane Astrocyte foot processes Exceptions: area postreme for vomiting after chemo, OVLT - osmotic sensing, neurosecretory products entering circulation at the neurohypophysis where ADH release is.

Answer 460

Lateral area: hunger. Destruction leads to anorexia and failure to thrive (infants). Inhibited by leptin. Ventromedial area: Satiety. Destruction leads to hyperphagia (can happen in craniopharyngioma). Stimulated by leptin. Anterior: Cooling by parasympathetic. think AC cooling Posterior: Heating by sympathetic. Suprachiasmatic nucleus: circadian rhythm. Supraoptic: where ADH is made. Paraventricular: makes oxytocin. Note: ADH and oxytocin are made in hypothalamus but are stored/secreted in posterior pituitary. OVLT for osmotic sensing and area postrema which responds to emetics are located in hypothalamus.

Answer 461

Awake (eyes open): Beta frequency (highest frequency and lowest amplitude) Awake (eyes closed): Alpha waves Stage 1 of non rem sleep/N1: Light sleep with theta waveform. Stage 2 of non rem sleep/N2: deeper sleep; when bruxism occurs. Sleep spindles and K complexes. Stage 3 of non rem sleep/N3: Deepest non rem sleep (slow wave); when sleep walking/night terrors/bedwetting occurs. Delta (lowest frequency and highest amplitude) REM Sleep: loss of motor tone, increased in O2 brain consumption. dreaming and penile/clitoral tumescence occur; memory processing. Beta waves.

Answer 462

striatum: putamen (motor) and caudate (cognitive) lentiform: putamen and globus pallidus.

Answer 463

it TRAPS your body Tremor (at rest aka pill rolling tremor..this resting tremor is made better by intentional movements), cogwheel Rigidity, Akinesia (or bradykinesia), Postural instability, and Shuffling gait. You see Lewy bodies composed of alpha synuclein (intracellular eosinophilic inclusion) and loss of dopaminergic neurons (i.e. depigmentation) of SNpc. Dementia is late vs lewy body disease which has cortical lewy bodies

Answer 464

Choreiform movements (random movements of muscle from loss of inhibitory action of GABA), aggression, depression and dementia. Can be mistaken for abuse. Decreased levels of GABA and ACh and increased dopamine. Neuronal death occurs through NMDA-R binding and glutamate toxicity and thus atrophy of the caudate. Also may see athetosis - slow, writhing movements especially seen in fingers. snake like movement.

Answer 465

sudden, wild flailing of 1 arm +/- ipsilateral leg. Contralateral subthalamic nucleus (e.g. lacunar stroke). ONLY HALF OF BODY...unlike Huntington's which has entire body and behavioral changes/dementia as well.

Answer 466

abnormal behavior during the sleep phase with REM sleep. | Loss of muscle atonia (paralysis) during intact REM sleep. Unconsciously acting out their dreams.

Answer 467

Action tremor; made worse by holding posture/limb position. Patients tend to self medicate by using EtOH, which decreases tremor amplitude. Treatment is beta blockers and primidone.

Answer 468

It is a slow, zig zag motion when pointing/extending toward a target and is indicative of cerebellar dysfunction.

Answer 469

Lesion of amygdala bilaterally that causes hyperorality, hypersexuality, disinhibited behavior. Associated with HSV1.

Answer 470

Right parietal-temporal cortex: spatial neglect syndrome (agnosia of the contralateral side of the world) Left parietal0temporal cortex: agraphia, acalculia, finger agnosia, and left-right disorientation.

Answer 471

reduced levels of arousal and wakefulness (e.g. coma)

Answer 472

Wernicke-Korsakoff syndrome: confusion, ataxia, nystagmus/ophthalmoplegia. Memory loss (anterograde and retrograde amnesia), confabulation, personality changes. associated with thiamine B1 deficiency and excessive EtOH use. Can be precipitated by giving glucose without B1 to a B1 deficient patient.

Answer 473

Cerebellar hemispheres: intention tremor, limb ataxia, loss of balance; damage to cerebellum results in ipsilateral deficits; fall toward side of lesion. Cerebellar vermis: truncal ataxia, dysarthria.

Answer 474

anterograde amnesia - inability to make new memories

Answer 475

PPRF injury -> eyes look away from lesion. | Frontal eye fields -> eyes look toward lesion.

Answer 476

transcortical motor: like Broca but now repetition is fine transcortical sensory: like Wernicke but now repetition is fine mixed transcortical: nonfluent speech and poor comprehension but good repetition. Broca + Wernicke but with good repetition.

Answer 477

Affects lateral corticospinal tract, medial lemniscus, caudal medulla (i.e. hypoglossal nerve) Contraleteral hemiparesis, less contralateral proprioception, ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally) Stroke commonly bilateral. Medial medullary syndrome - caused by infarct of the paramedian branches of ASA and vertebral arteries

Answer 478

Lateral medulla - vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus, nucleus ambiguus, sympathetic fibers, inferior cerebellar peduncle. Vomiting, vertigo, nystagmus (vestibular nuclei), decreased pain and temperature sensation from ipsilateral face and contralateral body; dysphagia and hoarseness, decreased gag reflex (nucleus ambiguus); ipsilateral Horner syndrome; ataxia, dysmetria (inferior cerebellar peduncle). Lateral medullary syndrome (wallenberg): Nucleus ambiguus effects are specific to PICA lesions. Dysphagia/hoarseness.

Answer 479

Lateral pons- cranial nerve nuclei; vestibular nuclei, facial nucleus, spinal trigeminal nucleus, cochlear nuclei, sympathetic fibers. Middle and inferior cerebellar peduncles. Vomiting, vertigo, nystagmus (vestibular); Paralysis of face, decreased lacrimation, salivation, decreased taste from anterior 2/3 of tongue, decreased corneal reflex. Face-decreased pain and temperature sensation. Ipsilateral decreased hearing. Ipsilateral horner syndrome. Ataxia dysmetria. Lateral pontine syndrome: facial nucleus effects are specific to AICA lesions.

Answer 480

Pons, medulla, lower midbrain, corticospinal and corticobulbar tracts, ocular cranial nerve nuclei, paramedian pontine reticular formation. Preserved consciousness and blinking, quadriplegia, loss of voluntary facial, mouth, and tongue movements. LOCKED IN SYNDROME

Answer 481

ACom: Berry aneurysm that impinges cranial nerves and causes visual field deficits -> bitemporal hemianopia. PCom: CNIII palsy - eye is down and out with ptosis and pupil dilation.

Answer 482

Neuropathic pain due to thalamic lesions. Initial sensation of numbness and tingling followed in weeks to months by allodynia (ordinarily painless stimuli cause pain) and dysaesthesia. Occurs in 10% of stroke patients.

Answer 483

bloody or yellow (xanthochromic) because of bilirubin breakdown products from all the bleeding. Remember: this is the only bleed you can see on the bottom of the brain. Risk of vasospasm due to blood breakdown and so need to treat with nimodipine. Shows up as brightness in the sulci on CT.

Answer 484

Most commonly caused by systemic hypertension. Also seen with amyloid angiopathy, vasculitis, and neoplasm. Typically occurs in basal ganglia and internal capsule (Charcot-Bouchard aneurysm of the lenticulostriate vessels), but can also be lobar.

Answer 485

Hippocampus, neocortex, cerebellum, watershed areas. Irreversible neuronal injury. 12-48 hours: red neurons 24-72 hours: necrosis + neutrophils 3-5 days: macrophages 1-2 weeks: reactive gliosis + vascular proliferation >2 weeks: glial scar/cystic space.

Answer 486

3,4,6 which are the pyrimdal neurons In general the most susceptible areas are these layers in the cortex, hippocampus, purkinje cells of the cerebellum and the watershed areas.

Answer 487

Poliomyelitis and spinal muscular atrophy (werdnig-hoffmann disease, autosomal recessive inheritance...infants die at 7 months. inherited form of polio): LMN lesions only due to anterior horn destruction, flaccid paralysis Multiple sclerosis: due to demyelination; mostly white matter of cervical region; random and asymmetric lesions, due to demyelination; scanning speech, intention tremor, nystagmus. Amyotrophic lateral sclerosis: Combined UMN and LMN deficits with no sensory, cognitive, or oculomotor deficits; both UMN and LMN signs. Superoxide dismutase 1 defect. Commonly presents as fasciculations with eventual atrophy and weakness of hands; fatal.Riluzole can be used for treatment because of less glutamate release. Distinguish from syringomyelia because no sensory loss here. Complete occlusion of anterior spinal artery: spares dorsal columns and lissauer tract; upper thoracic ASA territory is a watershed area, as artery of Adamkiewicz supplies ASA below ~T8. Tabes dorsalis: Caused by tertiary syphilis. Results from degeneration (demyelination) of dorsal columns and roots -> impaired sensation and proprioception and progressive sensory ataxia (inability to sense or feel the legs -> poor coordination). Associated with charcot joints, shooting pain, Argyll Robertson pupils (small bilateral pupils that further constrict to accommodation and convergence, not to light). Exam will demonstrate absence of DTRs and positive Romberg. Syringomyelia: Syrinx expands and damages anterior white commissure of spinothalamic tract (2nd order neurons) -> bilateral loss of pain and temperature sensation (usually C8-T1); seen with Chiari I malformation; can expand and affect other tracts. Vitamin B12/E deficiency: Subacute combined degeneration- demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts; ataxic gait, parethesia, impaired position and vibration sense.

Answer 488

Autosomal recessive trinucleotide repeat - GAA. Chromosome 9 which encodes frataxin (iron binding protein). Leads to impairment in mitochondrial functioning. Degeneration of multiple spinal cord tracts -> muscle weakness and loss of DTRs, vibratory sense, and proprioception. Staggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammer toes, hypertrophic cardiomyopathy (cause of death). Presents in childhood with kyphoscoliosis.

Answer 489

``` Biceps - C5,C6 Triceps - C7,C8 Patella - L3/L4 Achilles - S1,S2 Cremaster reflex (testicles move): L1,L2 Anal wink reflex (winks galore): S3,S4 ```

Answer 490

Moro: Hang on for life- abduct/extend limbs when startled, and then draw together Rooting: movement of head towards one side of cheek or mouth is stroked (nipple seeking) Sucking: sucking response when roof of mouth is touched Palmar: curling of fingers if palm is stroked Plantar: dorsiflexion of large toe and fanning of other toes with plantar stimulation (Babinski sign if in adults) Galant: Stroking along one side of the spine while newborn is in ventral suspension (face down) causes lateral flexion of lower body toward stimulated side.

Answer 491

paralysis of conjugate vertical gaze due to lesion in superior colliculi (e.g. pinealoma). Pineal gland- melatonin secretion, circadian rhythms Superior colliculi - conjugate vertical gaze center. Inferior colliculi - auditory.

Answer 492

corneal: V1 ophthalamic (nasociliary branch) and VII (temporal branch: orbicularis oculi). lacrimation: V1 (loss of reflex does not preclude emotional tears) and VII jaw jerk: V3 sensory from muscle spindle and V3 motor masseter pupillary: II and III gag: IX and X.

Answer 493

CN I: cribriform plate CN II: Optic canal (as well as the opthalmic artery + central retinal vein) CN III, IV, V1, VI: superior orbital fissure (as well as ophthalmic vein, sympathetic fibers) CN V2: Foramen rotundum CN V3: foramen ovale Middle meningeal artery: foramen spinosum CN VII, CVIII: internal auditory meatus CN IX, X, XI: jugular foramen CN XII: hypoglossal canal CN XI: foramen magnum (as well as the brain stem and vertebral arteries).

Answer 494

CN V motor lesion: jaw deviates toward side of lesion due to unopposed force from the opposite pterygoid muscle CN X lesion: uvula deviates away from side of lesion. weak side collapses and uvula points away. CN XI lesion: weakness turning head to contralateral side of lesion (SCM). Shoulder droop on side of lesion (trapezius). CN XII lesion: Tongue deviates toward side of lesion (lick your wounds) due to weakened tongue muscles on the affected side.

Answer 495

uveitis belongs to systemic inflammatory disorders (e.g. sarcoid, rheumatoid, juvenile idiopathic arthritis, TB, HLA-B27) retinitis is usually viral (CMV, HSV, HZV).

Answer 496

Alzheimer's: Widspread cortical atrophy with widened sulci. Senile plaques of B-amyloid coming from APP. Neurofibriliary tangles of hyperphosphorylated tau. Early onset (APP on 21 with D owns, and presenilin 1 and 2) and late onset (ApoE4 increases it while ApoE2 is protective). Amyloid angiopathy also occurs where amyloid plaques in vessels weaken them and cause lobar hemorrhages (usually in the parietal lobe). Pick's disease: frontotemporal atrophy (behavioral and language deficits) with dementia, aphasia, parkinsonian symptoms and changes in personality. Pick bodies with SPHERICAL tau aggregates.

Answer 497

Lewy body dementia: initially dementia and visual hallucinations followed by parkinsonian features that all happen quick (less than 1 year). Alpha synuclein defect. This is in cortex vs in SNpc as with Parkinson's.

Answer 498

Rapidly progressive (weeks to months) dementia with myoclonus (startle myoclonus). Can be sporadic or due to exposure to prion infected tissue. Spongiform cortex. PrPc to PrPsc sheets.

Answer 499

Demyelination of CNS due to destruction of oligodendrocytes (seen as enlarged oligodendrocyte nuclei with glassy amorphic viral inclusions). Associated with JC virus. Seen in 2-4% of AIDS patients (reactivation of latent viral infection). Rapidly progressive, usually fatal. Increased risk associated with natalizumab.

Answer 500

multifocal perivenular inflammation and demyelination after infection (commonly measles or VZV) or certain vaccinations (e.g. rabies, smallpox).

Answer 501

hereditary motor and sensory neuropathy (HMSN). Group of progressive hereditary nerve disorders related to the defective production of proteins involved in the structure and function of peripheral nerves or the myelin sheath. Typically autosomal dominant inheritance pattern and associated with scoliosis and foot deformities (high or flat arches).

Answer 502

X-linked genetic disorder typically affecting males. Disrupts metabolism of very long chain fatty acids (impaired addition of coenzyme A to long chain fatty acids) -> excessive buildup in nervous system, adrenal gland, and testes. Progressive disease can lead to long term coma/death and adrenal gland crisis.

Answer 503

HSV-1 most common cause of fatal spoaradic encelphatlitis. Propensity for temporal lobes of the brain. You see Cowdry type A inclusions which are intranuclear viral inclusion bodies that may be found in both neurons and glia.

Answer 504

distinct nuclear and ill-defined cytoplasmic inclusions specifically suggests CMV. usually in severely immunosuppressed patients and localizes to the paraventricular subependymal regions of the brain.

Answer 505

Otitis media with most common bacteria being Strep pneumo and H. influenzae. Looks like a multilobular mass with ring enhancing borders.

Answer 506

when cleft remains patent, you can get a cyst on the anterior border of the sternocleidomastoid muscle.

Answer 507

Retinoblastoma (classic) Cataracts Severe retinopathy of prematurity - inappropriate proliferation of vessels in the inner layers of the retina because of intensive oxygen therapy (because of premature respiratory distress syndrome) which causes VEGF production and increased blood proliferation (because O2 causes retinal vasoconstriction). Eventually scarring can happen and the white pupillary reflex is seen.

Answer 508

This is seen in glaucoma from the damage caused by high introocular pressure.

Answer 509

retinitis pigmentosa and senile macular degeneration. Drusen deposits are also seen in dry form which is yellowish extracellular material depositing in and beneath Bruch membrane and retinal pigment epithelium. Wet form is from bleeding secondary to choroidal neovascularization.

Answer 510

inappropriate social behavior, loss of the ability to problem solve, and loss of initiative, abstracting ability, concentration and judgement.

Answer 511

Congenital, non-inherited (somatic), developmental anomaly of neural crest derivatives (mesoderm/ectoderm) due to activating mutation of GNAQ gene. Affects small (capillary-sized) blood vessels -> port-wine stain of the face (non-neoplastic birthmark in CN V1/V2 distribution); ipsilateral leptomeningeal angioma -> seizures/epilepsy; intellectual disability; and epscleral hemangioma -> increased IOP -> early onset glaucoma. STURGE-weber: Sporadic, port-wine Stain, Tram track Ca+2 (opposing gyri); Unilateral; Retardation; Glaucoma; GNAQ gene; Epilepsy.

Answer 512

HAMARTOMAS: Hamartomas in CNS and skin; Angiofibromas; Mitral regurgitation; Ash-leaf spots; cardiac Rabhdomyoma; (Tuberous sclerosis); autosomal dOminant; Mental retardation; renal Angiomyolipoma; Seizures, Shagreen patches (Areas of thick leathery skin that are dimpled like an orange peel,pigmented and usually found on the lower back or nape of the neck.). Increased incidence of subependymal astrocytomas and ungual fibromas.

Answer 513

aka von Recklinghausen disease Cafe au lait spots, Lisch nodules (pigmented iris hamartomas), neurofibromas in skin, optic gliomas, pheochromocytomas. Mutated NF1 tumor supressor gene (neurofibromin, negative regulator of Ras) on chromosome 17. Skin tumors of NF-1 are derived from neural crest cells.

Answer 514

Cavernous hemangiomas in skin, mucosa, organs; bilateral renal cell carcinomas; hemangioblastoma (high vascularity with hyperchromatic nuclei) in retina, brain stem, cerebellum; and pheochromocytomas. Autosomal dominant; mutated VHL tumor suppressor gene on chromosome 3, which results in constitutive expression of HIF and activation of angiogenic growth factors.

Answer 515

Inhibits ferrochelatase and ALA dehydratase. Accumulated substrate is protoporphyrin, delta-ALA (blood) Symptoms: microcytic anemia, GI and kidney disease. Children - exposure to lead paint -> mental deterioration. Adults - environmental exposure (battery/ammunition/radiator factory) -> headache, memory loss, demyelination.

Answer 516

Enzyme affected is porphobilinogen deaminase. Accumulated substrate is porphobilinogen, delta-ALA, coporphobilinogen (urine). Symptoms (5 P's): Painful abdomen Port wine-colored urine Polyneuropathy Psychological disturbances Precipitated by drugs, alcohol, and starvation.c Treatment: glucose and heme, which inhibit ALA synthase.

Answer 517

Affected enzyme is uroporphyrinogen decarboxylase. Accumulated substrate is uroporphyrin (tea-colored urine). Blistering cutaneous photosensitivity. Most common porphyria.

Answer 518

``` Defect in heme synthesis. Hereditary: X-linked defect in delta-ALA synthase Causes: genetic, acquired (myelodysplastic syndromes), and reversible (alcohol is most common, lead, vitamin B6 deficiency, copper deficiency, and isoniazid). These inhibit delta-ALA synthase. Ringed sideroblasts (with iron laden macrophages) seen in bone marrow. Increased iron, normal TIBC, increased ferritin. Tx: pyridoxine (B6, cofactor for delta-ALA synthase). ```

Answer 519

PNMT (phenylethanolamine-N-methyltransferase) using SAM as a cofactor

Answer 520

Mutation in one of the DNA repair genes like BRCA pathway (repairs damage induced by cross linking agents). All bone marrow elements are affected. In addition to the often fatal leukemia, pigmentary changes in the skin (cafe au lait spots) and malformations of the heart, kidney, limbs (aplasia of the radius, thumb deformity...also short stature) are associated features.

Answer 521

is a cognitive impairment that results from damage to a specific area of the brain -- the left parietal lobe in the region of the angular gyrus. It may occur after a stroke or in association with damage to the parietal lobe. It is characterized by four primarxy symptoms: a writing disability (agraphia or dysgraphia), a lack of understanding of the rules for calculation or arithmetic (acalculia or dyscalculia), an inability to distinguish right from left, and an inability to identify fingers (finger agnosia). The disorder should not be confused with Gerstmann-Sträussler-Scheinker disease, a type of transmissible spongiform encephalopathy.t Also vs right parietal lobe which presents with left hemineglect, which impairs many self care skills such as dressing and washing. Also difficulty in making things (constructional apraxia), denial of deficits (anosagnosia), and drawing ability.

Answer 522

Flat gamma globulin peak = BTK deficiency (Bruton's Agammaglobulinemia) due to lack of B cell development. High gamma globulin peak = MGUS, Multiple Myeloma or Waldenstrom's macroglobulinemia (the latter is less high yield but the vignette would have something about high viscosity blood oozing from some orifice, whereas multiple myeloma you'd have lytic bone lesions, MGUS you have no symptoms and it's incidental finding). Flat alpha-1 peak = alpha-1 antitrypsin deficiency.

Answer 523

end organ damage, headache, scotoma, oligouria, increased AST/ALT, thrombocytopenia. Results in abnormal placental spiral arteries, results in maternal endothelial dysfunction, vasoconstriction, or hyperreflexia.

Answer 524

precontemplation - not yet knowing there is a problem contemplation - knowing there is a problem, but not ready to do anything about it preparation/determination: getting ready to change behavior action/willpower: changing behaviors maintenance: maintaining the changed behavior relapse: returning to old behaviors and abandoning new changes.

Answer 525

fatal childhood hepatoencephalopathy. Findings: mitochondrial abnormalities, fatty liver (microvesicular fatty change), hypoglycemia, vomiting, hepatomegaly, coma. Associated with viral infection (especially VZV and influenza B). that has been treated with aspirin. Mechanism: Aspirin metabolities decrease Beta oxidation by reversible inhibition of mitochondrial enzyme. Avoid aspirin in children, except those with Kawasaki disease.

Answer 526

``` Work up for MEN1!!! check calcium (PTH tumor), pituitary abnormalities ```

Answer 527

pelvice parasympathetic nerves: The pelvic splanchnic nerves arise from the ventral rami of the S2-S4 and enter the sacral plexus. They travel to their side's corresponding inferior hypogastric plexus, located bilaterally on the walls of the rectum. From there, they contribute to the innervation of the pelvic and genital organs. The nerves regulate the emptying of the urinary bladder and the rectum as well as sexual functions like erection. They contain both preganglionic parasympathetic fibers as well as visceral afferent fibers. They are also at risk when taking out the prostate which is why you risk impotence in these patients. sacral splanchnic nerves: The sacral sympathetic nerves arise from the sacral part of the sympathetic trunk, emerging anteriorly from the ganglia. They travel to their corresponding side's inferior hypogastric plexus, where the preganglionic nerve fibers synapse with the postganglionic sympathetic nervefibers, that ascend to the superior hypogastric plexus, moves on to the aortic plexus and the inferior mesenteric plexus, where they are distributed to the canalis analis. From the inferior hypogastric plexus, they also innervate pelvic organs and vessels. For example the hypogastric nerve comes from here which is responsible for emission (prior to ejaculation which is the pudendal nerve).

Answer 528

Urinary: adrenal glands, kidneys, ureters Circulatory: aorta, IVC Digestive: esophagus (except the part below the diaphgram), rectum (most distal part is sub-peritoneal along with bladder and distal ureters). Head, neck, and body of pancreas (NOT TAIL..these are secondary retroperitoneal). Duodenum and ascending/descending colon (not transverse, sigmoid, cecum).

Answer 529

Borrelia burgderfori (Lyme), Treponema (Syphillis), and Leptospira

Answer 530

Borrelia, Rickettsia, Chlamydia, Trypanosomes, Plasmodium. | Certain Bugs Really Try My Patience.

Answer 531

Fungi (e.g. Pneumocystis), Legionella, Helicobacter pylori

Answer 532

Acid-fast organism (Nocardia, Mycobacterium).

Answer 533

M. pneumoniae

Answer 534

it's a phospholipase (lecthinase) that degrades tissues and cell membranes. leads to myonecrosis and gas gangrene.

Answer 535

Monocytes: Ehrlichiosis Granulocytes: Anaplasmosis Both are vectors that are ticks. Morulae are berry like inclusions.

Answer 536

Coxiella burnetti: no arthopod vector. Tick feces and cattle placent derived releasing spores that get inhaled and then cause atypical pneumonia. no rash, no vector. Closely related to rickettsia.

Answer 537

live vaccines induce cellular immunity (CD8 memory and cytotoxic lymphocutes in circ and in gut) Remember: if it's oral, then you get IgA immunity and killed vaccines basically only get you neutralizing antibodies.

Answer 538

Arthus reaction is: antigen is injected (like a protein) in the skin, antibodies that have been sensitized started to exit small vascular vessels intradermally and form complexes there. PMNs and local inflammation then takes place. severe pain, swelling, induration, edema, hemorrhage, and occasionally by necrosis. Has been reported to occur after diptheria and tetanus vaccinations. Serum sickness: is antigen/antibody complexes form in the blood and go to deposit in the kidneys. treat with immunosuppressants.

Answer 539

First born males.

Answer 540

Nucleus basalis of Meynert, abbreviated NBM and also known as the nucleus basalis, is a group of neurons in the substantia innominata of the basal forebrain which has wide projections to the neocortex and is rich in acetylcholine and choline acetyltransferase. In Parkinson' and Alzheimer's diseases, the nucleus basalis undergoes degeneration. A decrease in acetylcholine production is seen in Alzheimer's disease, Lewy body dementia, Pick's disease, and some Parkinson's disease patients showing abnormal brain function, leading to a general decrease in mental capacity and learning. Most pharmacological treatments of dementia focus on compensating for a faltering NBM function through artificially increasing acetylcholine levels.

Answer 541

Exudative fluid has: The ratio of pleural fluid protein to serum protein is greater than 0.5 The ratio of pleural fluid LDH and serum LDH is greater than 0.6 Pleural LDH is greater than 200 Pleural fluid LDH is greater than 0.6 [4] or ⅔[8] times the normal upper limit for serum. Different laboratories have different values for the upper limit of serum LDH, but examples include 200[9] and 300[9] IU/l.[10]

Answer 542

The thoracic duct is also known as the left lymphatic duct, alimentary duct, chyliferous duct, and Van Hoorne's canal. In adults, the thoracic duct is typically 38-45cm in length and an average diameter of about 5mm. The vessel usually starts from the level of the second lumbar vertebra and extends to the root of the neck. It drains into the systemic (blood) circulation at the left subclavian vein. It also collects most of the lymph in the body other than from the right thorax, arm, head and neck which are drained by the right lymphatic duct.[1] Posterior in line with the esophagus/vertebrae

Answer 543

Brain Lymphoma (PCNSL), also known as micro glioma and primary brain lymphoma, is a primary intracranial tumor appearing mostly in patients with severe immunosuppression (typically patients with AIDS). PCNSLs represent around 20% of all cases of lymphomas in HIV infections (other types are Burkitt's lymphomas and immunoblastic lymphomas). is highly associated with Epstein-Barr virus (EBV) infection (> 90%) in immunodeficient patients (such as those with AIDS and those iatrogenically immunosuppressed), and does not have a predilection for any particular age group. usually presents with seizure, headache, cranial nerve findings, altered mental status, or other focal neurological deficits typical of a mass effect Systemic symptoms may include fever, night sweats, or weight loss. Other symptoms include • diplopia • dysphagia • vertigo • monocular vision loss • progressive dementia or stupor in patients with a non focal neurologic exam and minimal abnormalities on MRI (more common in AIDS patients) • facial hypoesthesia The definitive diagnosis is arrived at from tissue, i.e. a biopsy, by a pathologist. MRI or contrast enhanced CT classically shows multiple ring-enhancing lesions in the deep white matter. The major differential diagnosis (based on imaging) is cerebral toxoplasmosis, which is also prevalent in AIDS patients and also presents with a ring-enhanced lesion, although toxoplasmosis generally presents with more lesions and the contrast enhancement is typically more pronounced. imaging techniques cannot distinguish the two conditions with certainty, and cannot exclude other diagnoses. Thus, patients undergo a brain biopsy

Answer 544

Cytologic examination of urine, blood and sputum with Sudan or Oil Red O staining may detect fat globules that are either free or in macrophages. Note: can be caused by trauma to bone releasing fat or fatty liver.

Answer 545

``` polysaccharide capsule: Strep Pneumo Neisseria Meningitidis NOT gonorrhea Hemophilus Influenza Klebsiella Pneumonia (VERY LARGE CAPSULE!!) Salmonella typhi (but NOT Salmonella enteritidis that causes diarrhea) Pseudomonas aeruginosa Staph aureus Bacterioides fragilis E. coli Group B strep. ``` Non - polysaccharide capsules B anthracis - made of D-glutamate Strep pyogenes - made of hyaluronic acid Non immunogenic capsule Nisseria sialic acid capsule S. pyogenes hyaluronic acid capsule.

Answer 546

Tinea versicolor: caused by Malassezia furfur. Degradation of lipids produces acids that damage melanocytes and cause hypopigmented and or hyperpigmented patches. Occurs in hot humid weather. Tx: topical miconazole, selenium sulfide (Selsun). "Spaghetti and meatball" appearance (hyphae and yeast forms). Other tineae: includes tinea pedis (foot), tinea cruris (groin, tinea corporis (ringworm on body), tinea capitis (head scalp), tinea ugnuiium (oncychomycosis on fingernails) Pruritic lesions with central clearing resembling a ring caused by dermatophytes (Microsporum, Trichophyton, and Epidermophyton). See mold hyphae on KOH prep, not dimorphic.

Answer 547

Cryptococcus neoformans. | Sabs a FUN guy.

Answer 548

Mucormycosis. Disease mostly in ketoacidotic diabetic and leukemic patients. Fungi proliferate in blood vessels when there is excess ketone and glucose, penetrate cribriform plate, and enter brain. Rhinocerebral and frontal lobe abcesses. Headache, facial pain, black necrotic eschar on face; may have cranial nerve involvement. Tx: amphotericin B

Answer 549

Sporotrichosis. Dimorphic cigar-shaped budding yeast that lives on vegetation. When spores are traumatically introduced into skin, typically by a thorn (rose gardeners) causes local pustule/ulcer with nodules that drain along lymphatics (ascending lymphangitis). Little systemic illness. Treatment is itraconazole or potassium iodide. Plant a ROSE in the POT (for potassium).

Answer 550

Medial pontine syndrome Symptoms: contralateral spastic hemiparesis (corticospinal tract), contralateral loss of tactile, vibration, and stereognosis (medial lemniscus), and strabismus aka ipsilateral lateral rectual muscle paralysis - affected eye will look down and toward the nose (abducens nucleus) The abducens nerve lesion affect the down and in eye is specific to inferior pons and thus medial pontine syndrome versus medial medullury syndrome (due to ASA lesion) and definitely different than full blow basilary artery lesion which causes locked in syndrome.

Answer 551

Bálint's syndrome is an uncommon and incompletely understood triad of severe neuropsychological impairments: inability to perceive the visual field as a whole (simultanagnosia), difficulty in fixating the eyes (oculomotor apraxia), and inability to move the hand to a specific object by using vision (optic ataxia) caused by multiple strokes usually in the same area in each hemisphere within the parietal lobe. Can be more likely due to severe hypotension.

Answer 552

form of stroke characterized by oculomotor nerve palsy and contralateral hemiparesis or hemiplagia. Affeted: controlateral parkinsonism (substantia nigra dopaminergic projections to basal ganglia are injured leading to movement disorder of controlateral body), contralateral hemiparesis (corticospinal fibers), difficulty with contralateral lower facial muscles (corticobulbar tract), ipsilateral oculomotor nerve palsy with drooping eyelid and fixed wide pupil pointed down and out leading to diplopia (oculomotor nerve fibers). Caused by occlusion of the paramedian branches of the PCA.

Answer 553

vasa recta

Answer 554

heterophile antibody test for diagnosing serveral rickettsial diseases (these are arthropod borne diseases that are all characterized by rashes).

Answer 555

used to identify toxin producing strains of organisms in the oropharynx that resemble Corynebacterium diptheriae. Used for differentiating pathogen C. diphtheriae and normal flora diphtheroids.

Answer 556

Molluscum contagiosum which is a subset of the pox virus | replicates in the cytoplasm and is DS/liner with complex envelope (called box shaped)

Answer 557

Gastroschisis is abdominal contents through abdominal folds with no peritoneum covering Omphalocele is persistence of herniation of abdominal contents into umbilical cord, sealed by peritoneum and amnion. 6 weeks: midgut herniates through umbilical ring 10 weeks: returns to abdominal cavity + rotates around SMA.

Answer 558

Apple-peel intestinal atresia, also known as type IIIb or Christmas tree intestinal atresia, is a rare form of small bowel atresia in which the duodenum or proximal jejunum ends in a blind pouch and the distal small bowel wraps around its vascular supply in a spiral resembling an apple peel. Often a vast segment of small bowel is absent While apple-peel intestinal atresia is usually reported as an isolated malformation, it has been associated with malrotation. Additionally, syndromic association has been reported with microcephaly and ocular anomalies.

Answer 559

Brunner's glands (or duodenal glands) are compound tubular submucosal glands found in that portion of the duodenum which is above the hepatopancreatic sphincter (Sphincter of Oddi). The main function of these glands is to produce a mucus-rich alkaline secretion (containing bicarbonate) in order to: protect the duodenum from the acidic content of chyme (which is introduced into the duodenum from the stomach); provide an alkaline condition for the intestinal enzymes to be active, thus enabling absorption to take place; lubricate the intestinal walls. In histology, an intestinal crypt (also crypt of Lieberkühn and intestinal gland) is a gland found in the epithelial lining of the small intestine and colon. The crypts and intestinal villi are covered by epithelium which contains two types of cells: goblet cells (secreting mucus) and enterocytes (absorbing water and electrolytes). Intestinal crypts are found in the epithelia of the small intestine, namely the duodenum, jejunum and ileum. Intestinal crypts contain a base of replicating stem cells, Paneth cells of the innate immune system, and goblet cells, which produce mucous. The enterocytes in the mucosa contain digestive enzymes that digest specific food while they are being absorbed through the epithelium. These enzymes include peptidases, sucrase, maltase, lactase and intestinal lipase. This is in contrast to the stomach where chief cells secrete pepsinogen, in the intestine the aforementioned digestive enzymes are not secreted by the cells of the intestine. Also, new epithelium is formed here, which is important because the cells at this site are continuously worn away by the passing food.

Answer 560

foregut and midgut: vagus nerve (T12/L1 and L1 respectively) | hindgut: pelvic (L3)

Answer 561

``` Superior epigastric (internal thoracic/mammary) to inferior epigastric (external illiac) superior pancreaticoduodenal (celiac trunk) to inferior pancreaticoduodenal (SMA) Middle colic (SMA) to left colic (IMA) Superior rectal (IMA) to inferior rectal (internal illiac). ```

Answer 562

Porto to systemic Esophagus: left gastric to esophageal veins and up to the azygous vein Umbilicus: paraumbilical veins to the epigastric veins of the anterior abdominal wall Rectum: superior rectal veins to middle and inferior rectal (these are anorectal varices and not the same as internal hemorrhoids). Can fix with transjugular intrahepatic portosystemic shunt (TIPS).

Answer 563

internal hemorrhoids: IMA to superior rectal artery to superior rectal vein to inferior mesenteric vein to portal vein. Only visceral innervation (inferior hypogastric plexus) so not painful. Lymphatic drainage to internal iliac lymph nodes/inferior mesenteric lymph nodes. external hemorrhoids: inferior rectal artery (from internal pudendal artery) drains to inferior rectal vein to internal pudendal vein to internal iliac vein to IVC. Receive somatic innervation from inferior rectal branch of pudendal vein and are painful. Lymphatic drainage to superficial inguinal nodes. Anal fissure: tear in the anal mucosa below pectinate line causing blood on paper, pain when pooping, usually located posteriorly because it's poorly perfused back there.

Answer 564

Pleomorphic adenoma: benign mixed tumor. most common salivary gland tumor. Presents as painless mobile mass. It is composed of chondromyxoid stroma and epithelium and recurs if incompletely excised or ruptured intraoperatively. Warthin tumor: papillary cystadenoma lymphomatosum. benign cystic tumor with germinal centers. 2nd most common lymphocytic. Mucoepidermoid carcinoma: most common malignant tumor and has mucinous and squamous components. It typically presents as a painless, slow growing mass. facial nerve involvement.

Answer 565

inflammation of the salivary gland. | Stone obstruction can lead to infection like Staph aureus.

Answer 566

Common painful ulcer in oral mucosa from stress | Gray base with redness.

Answer 567

infiltration of eosinophils into the esophagus in atopic patients. Food allergens leading to dysphagia heartburn and strictures. Unresponsive to GERD therapy.

Answer 568

superior laryngeal nerve: cricothyroid muscles (responsible for tensing the vocal cords and phonaton). recurrent laryngeal nerve: innervates all the muscles of the larynx except cricothyroid muscles (responsible for tensing the vocal cords and phonaton). Important muscle here are the posterior cricoarytenoid muscles which are the only muscles capable of opening the vocal cords.

Answer 569

Curling: is decreased blood flow from burns resulting in sloughing of the gastric mucosa. Cushing ulcer: brain trauma resulting in too much vagal stimulation and thus too much acid production. Burned by Curling iron and always Cushion the Brain.

Answer 570

Foamy Whipped creamin a CAN Cardiac symptoms (fluid overload and possibily endocarditis) Arthralgias Neurologic symptoms (dementia, weakness, seizures) PAS positive foamy macrophages in intestinal lamina propria. Macrophages compress lacteals and there is fat malabsorption (chylomicrons cannot make it from enterocytes to lymphatics).

Answer 571

psoriatic: dactylitis, pencil in cup deformity ankylosing: fused spine, uveitis, aortic regurgitation (from aortitis and resulting aneurysm)

Answer 572

diverticulitis - pseuo/false diverticulum (only mucosa and submucosa. Occult blood present with maybe hematochezia. Can also see colovesical fistula (fistual with bladder with air in bladder/urine or even feces in urine). If it ruptures, it can lead to fistula. Note: diverticula in general are occuring at points of focal weakness (like vasa recta where vessels penetrate wall especially in older people). Also associated with low fiber diets.

Answer 573

meconium illeus: In CF, meconium plug obstructs intestine preventing stool passage at birth. Also billous emesis, but constipation is more associated with Hirschprung. Dilated loops of small intestine on imaging. hirschsprung disease: RET mutation and failure of neural crest to migrate with lack of ganglioncells/enteric nervous plexuses (Auerbach and Meissner). Bilious emesis, abdominal distention and failure to pass meconium in first 48 hours (dilated colon proximal to affected area on imaging). Increased risk of Down's.

Answer 574

Adult: E coli Child: Strep pneumo.

Answer 575

Increased AST to ALT ratio: alcoholic hepatitis stellate cell is mediator of fibrosis. Increased ALT to AST ratio is viral hepatitis or NAFLD.

Answer 576

Increased ammonia: GI bleeding, increased protein intake, infection, constipation Decreased ammonia excretion: renal failure, diuretics, post-TIPS). Tx: lactulose, low protein, or rifaximin (kills intestinal bacteria).

Answer 577

HCC/hepatoma: see increased AFP and can have EPO/insulin like factor Cavernous hemangioma: common, benign liver tumor; occurs at age 30-50; biopsy contraindicated because of risk of hemorrhage. Hepatic adenoma: rare, benign liver tumor; related to oral contraceptive use or anabolic steroids; may regress spontaneously or rupture (abdominal pain and shock) Angiosarcoma: malignant tumor of endothelial origin; associated with arsenic, vinyl chloride.

Answer 578

``` Autosomal recessive (chromosome 13). Problem with excreting copper using the hepatocyte copper transporting ATPase (ATP7B). Tx: penicillamine or trientine. ```

Answer 579

onion skin bile duct fibrosis. alternating strictures and dilation with "beading" (both intra and extra hepatic....PBC is only intra). Hypergammaglobulinemia (IgM). Associated with UC, and can lead to secondary biliary cirrhosis and cholangiocarcinoma.

Answer 580

Murphy's sign is pain on breathing in and being palpated in RUQ. Indicative of cholesystitis. Courvoiser's sign is palpable enlarged gallbladder that IS NOT tender (jaundice usually present). Indicates pancreatic cancer usually.

Answer 581

Usually autodigestion of pancrease by enzymes. Causes: GET SMASHED idiopathic, Gall stones, Ethanol, Trauma, Steroids, Mumps (infects pancreas), Autoimmune disease, Scorpion sting, Hypercalcemia (activates enzymes), Hypertriglyceridemia, ERCP, Drugs (e.g. sulfa drugs).

Answer 582

``` Tinkly sounds mean small intestinal obstruction (jejunal or ileal...usually see distended abdomen too). Causes include: hernias adhesions tumors of SI foreign body Meckel's diverticulum Crohn disease Ascaris infection midgut volvulus Intussusception ```

Answer 583

means alpha-1-antitrypsin deficiency (precipitation of the protein in ER) note: PAS positive in duodenum is whipple disease)

Answer 584

reflect copper accumulation in patients in Wilson disease

Answer 585

Sublingual: pure mucinous cells Submandibular: mixture of serous and mucous cells Parotid gland: mostly pure serous cells. As you go from midline to laterally, you go from mucous to serous.

Answer 586

gastric hypertrophy with protein loss, parietal cell atrophy, and increased mucous cells. Precancerous. Rugae of stomach are so hypertrophied that they look like brain gyri. Protein loss is from loss of protein rich mucous and can lead to hypoalbuminemia and peripheral edema. note: associated with TFG beta. also in atrophic gastritis you see metaplasia with goblet cells replacing chief (release pepsinogen...have basally located nuclei towards the side) and parietal cells (look like fried eggs with central nuclei).

Answer 587

Hyperplastic: sawtooth glandular epithelium with proliferation of goblet and columnar epithelial cells Tubular adenoma: pedunculated Tubulovillous adenoma: combines both Villous adenoma: sessile Note: this order is also the malignancy potential from no risk (hyperplastic) to high (30% with villous).

Answer 588

GIP: fats, proteins, carbohydrates CCK: fats and proteins Gastrin: protein in antrum of stomach Motilin: acid entering duodenum and fasting state Secretin: acid entering the duodenum and fatty acids.

Answer 589

cafe-au-lait spots, polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities. Note: Increased production of hormones by glands regulated by the G protein system is due to a mutation in the gene causing continuous activation of stimulatory G protein. This results in the so called "autonomous production" of hormones, including thyroid hormone, cortisol, estrogen and growth hormone. Therefore, hyperthyroidism, Cushing syndrome, precocious puberty in women with premature thelarche (breast growth), premature menarche (beginning of menstrual function), increased speed of growth and growth hormone excess can ensue. Increased serum estrogen concentrations correlate with large ovarian cysts. Ovarian cysts appear and disappear with changing estrogen concentrations, causing menstrual bleeding when estrogen decreases.

Answer 590

IBD, coccidoides immitus, TB, sarcoidosis

Answer 591

Daytime: stimulants like amphetamines and modafinil Nighttime: sodium oxybate Note: considered to be caused by a decrease in orexin production in lateral hypothalamus.

Answer 592

Sensory: slow pain, heat sensation, and olfaction Motor: postganglionic autonomic neurons. These are group C nerve fibers

Answer 593

influenza and retroviruses.

Answer 594

HHV-8: lymphocytic inflammation on biopsy (superficial neoplastic proliferation of vasculature) Bartonella: Biopsy reveals neutrophilic inflammation (superficial vascular proliferation).

Answer 595

internuclear incusions!!!!

Answer 596

Measles is the classic 4 of Koblik's spots, couth, coryza, conjunctivitis and then craniocaudal spread of rash. HHV-6 is high fever that subsides with craniocaudal spread of rash after.

Answer 597

Rocky mountain spotted fever. East coast tick bite. Palms and soles are involved and treat with doxycycline or chloramphenicol.

Answer 598

Keratoderma blennorrhagica - skin lesions commonly found on palms and soles- vesicopustular waxy lesion with a yellow brown color. Note common 3 are conjunctivitis/uveitis, urtheritis/cervicitis, and inflammation of joints (not infection but triggered by an infection like Salmonella, Shigella, Campylobacter and Chlamydia/Gonorrhea).

Answer 599

Think gonorrhea in 2-5 days with chlamydia being the cause after. Need to treat both anyway usually with Ag nitrate and erythromycin.

General knowledge (qbanks, first aid etc) Flashcards

(623 cards)