Kaplan Questions Flashcards
(327 cards)
1
Q
glomeruloid-like cells and eosinophils in a young childs scrotum or ovary
A
yolk sac tumor
- schiller duval bodies
- high alpha-fetoprotein
2
Q
what is the appropriate meal for pts post gastric bypass
A
eat smaller, frequent meals that are low in simple carbohydrates, and high in protein, fiber, and complex carbs
-these pts usually get something called dumping syndrome due to the osmotic effects of eating lots of simple carbs (fruit juice is likely to cause this)
3
Q
rheumatoid factor
A
seen in rheumatoid arthritis and these are directed against the Fc portion of IgG
4
Q
list the second generation antihistamines
A
loratadine, fexofenadine, loratadine, and cetirizine
5
Q
pathophysiology that leads to duodenal atresia
A
failure of recanalization of part of the embryonic gut
ileal atreasia is due to vascular problem in utero
6
Q
creatinine kinase MB vs MM vs BB
A
MB –> cardiac muscle specific
MM –> skeletal muscle specific
BB –> brain damage
7
Q
foramen cecum
A
develops part of the thyroid gland and part of the middle of the tongue
8
Q
side effects of metformin
A
lactic acidosis (in pts with renal insufficiency), GI upset, B12 deficiency
-it can also cause potential weight loss
9
Q
child (usually 2 years old) with large, palpable, nontender mass that is in the superior pole of the kidney and does not cross the renal capsule
-unilateral flank mass with possible hematuria
A
Wilms tumor
-embryonic glomerular structures
10
Q
complications of succinylcholine
A
hypercalcemia, hyperkalemia, and malignant hyperthermia
11
Q
scl antibodies
smith antigen
A
systemic form of scleroderma
systemic lupus erythematosus
12
Q
equation for confidence interval
A
CI = mean +/- Z x (SD/squareroot(n))
95% CI = Z = 1.96
99% CI = Z = 2.58
13
Q
3-hydroxybutarate
A
this is a ketone body
14
Q
inheritance pattern of marfans
A
autosomal dominant
15
Q
cyclobenzaprine
A
- used for muscle spasticity
- acts within CNS (mainly at brain stem)
- structurally related to TCAs
- may cause anticholinergic side effects and sedation
16
Q
what are the endocardial cushions derived from
A
neural crest
-inadequate migration causes a primum defect (ASD)
17
Q
alprostadil vs indomethacin
A
alprostadil –> PGE1 analog
indomethacin –> inhibits prostaglandins and closes the shunt
18
Q
atropine mechanism of action
A
it acts as a muscarinic blocker so it doesnt work at nicotinic sites and therefore doesnt help with muscle paralysis
19
Q
theophylline mechanism of action
A
inhibits PDE and adenosine receptors
20
Q
what causes dilation of the coronary vessels
A
when the heart requires more oxygen it uses more ATP and that gets broken down into adenosine and the increased adenosine concentration causes coronary vessel dilation
21
Q
laboratory studies for diffuse slceroderma vs CREST syndrome
A
diffuse –> anti-Scl-70
CREST –> anti-centromere
22
Q
what is the falciform ligament derived from
A
part of the liver (ligamentum teres hepatis) and its a derivative of the fetal umbilical vein
-also contains patent paraumbilical vein
23
Q
good pasture has antibodies to what
A
antibodies to alpha3-chain of type 4 collagen
24
Q
what does the superior gluteal nerve innervate
A
gluteus medius, gluteus minimus, and tensor fascia latae
25
how to treat dilated cardiomyopathy vs hypertrophic obstructive cardiomyopathy
dilated --> Na+ restriction, ACEi, Beta-blocker, diuretics, digoxin, ICD, heart transplant
hypertrophic cardiomyopathy --> cessation of high-intensity athletics, Beta-blockers, non-dihydropyridine Ca2+ channel blockers, ICD if pt is at high risk
26
describe kimmelstiel-wilson lesions
mesangial periodic acid schiff-positive stain with hyaline masses
27
white pupillary reflex in a baby
- if the child was given oxygen think inappropriate vascular proliferation
- retinoblastoma
- if the child has cataracts too then think rubella
28
how to histologically tell the difference between small cell lung carcinoma and squamous cell carcinoma of the lung
squamous cell has a mass with central necrosis and small cell does not form cavitary lesions with central necrosis
29
what type of reaction does the body have to contact dermatitis/poison ivy
type 4 hypersensitivity --> release of IFN-gamma from activated Th1 cells
30
CD16 and CD56
natural killer cells
31
pt with catheter has kidney stone... what is it made of?
ammonium magnesium phosphate (struvite stone)
staghorn calculi
urease + bugs
32
newborn with cleft palate, rhinitis, and desquamating rash
congenital syphilis
33
rapid plasma reagin +
syphilis
34
what can you give a pt with the jerish-herxhemier reaction after syphilis treatment has been initiated
TNF-alpha inhibitor
35
what gets affected with Rh incompatibility
anemia, high output heart failure, edema, elevated unconjugated bilirubin (which can go to the CNS and cause damage/kernicterus)
36
what is the defect in xeroderma pigmentosum
inability to repair DNA pyrimadine dimers caused by UV exposure
findings: dry skin, extreme light sensitivity, skin cancer
37
baby who is tachypnic and hyperammonia with increase in orotic acid
ornithine transcarbamylase deficiency
* if the pt had orotic acid but regular ammonia then they would have orotic aciduria
- note: there will be absent citrulline
38
when does ovulation occur for a woman no matter how long her cycle is
during the last 14 days of her cycle
39
hemineglect vs hemiplegia
hemineglect --> contralateral problems with parietal (or even frontal) cortex
hemiplegia --> contralateral internal capsule
40
G6PD deficiency inheritance
X-linked recessive
41
why do you give someone lactulose, rifaximin, or neomycin and what are their mechanisms of action
All given for hepatic encephalopathy
lactulose --> intestinal content acidification to increase NH4+ generation
rifaximin or neomycin --> decreases NH3 producing gut bacteria
42
how to treat a pt with acromegaly and what should you expect to see
somatostatin analog
-ex: octreotide
large tongue, deep furrows, large hands and feet, coarse facial features, frontal bossing, impaired glucose tolerance (insulin resistance), hypertension
- increased risk of colorectal polyps and cancer
- increased IGF-1
43
large, binucleated cells with prominent nucleoli with an eosinophilic cytoplasm
reed-sternberg cells
44
pt presents with cystic mass on lateral neck that does not move with swallowing
vs
pt preseting with midline neck mass that does move with swallowing
persistent cervical sinus leading to pharyngeal cleft cyst (lateral neck, anterior to sternocleidomastoid)
vs
thyroglassal duct cyst
45
large white worm that can be coughed up
ascaris lumbricoides (giant worm)
46
sirolimus (aka rapamycin)
mTOR inhibitor that blocks T-cell activation and B-cell differentiation by preventing IL-2 response
- used in pts with kidney transplant
- side effects --> pancytopenia, insulin resistance, hyperlipidemia (NOT NEPHROTOXIC like cyclosporine and tacrolimus)
47
whatre two causes of subarachnoid hemorrhage and why would you think one vs the other
1. Arteriovenous malformation
- pt with history of hereditary hemorrhagic telangectasias (recurrent epistaxis as childhood, seizures, melena, and iron deficiency anemia)
2. Berry aneurysm
- pt with hypertension, connective tissue disorders, and adult polycystic kidney disease
48
lymphatic drainage of lateral vs medial side of the leg
lymph drainage usually follows venous drainage
- lateral side and dorsum of the foot goes to popliteal fossa
- medial side of leg and sole of foot goes to inguinal region
49
where should an intercostal nerve block be administered
just below the rib and lateral to the angle of the rib to be anesthetized
-the nerve is under each rib
50
pt with UTI and subsequent DIC, what will you see in their kidney
diffuse cortical necrosis
51
type 1 vs type 2 muscle fibers
type 1: (ENDURANCE TRAINING) 1 slow red ox, slow twitch, red fibers, increased oxidative phosphorylation (increased myoglobin)
type 2: (STRENGTH TRAINING) fast twitch, white fibers, increased anaerobic metabolism (increased glycogen)
52
what activates the classical complement pathway
antigen-antibody complexes
*unlike the alternative pathway which is activated by the spontaneous hydrolysis of C3 or by antigens directly
53
where do the splenic artery and vein travel
within the splenorenal ligament
- if the spleen is ruptured and these leak they will leak into the peritoneal cavity
- this ligament also contains the tail of the pancreas
54
how to treat CML
imatinib --> tyrosine kinase inhibitor
55
pindolol
- partial beta-1 agonistic properties (intrinsic symphathomimetic activities)
- contraindicated in pts with angina because it does NOT decrease myocardial O2 demand
56
what happens to blood flow during muscle contraction
decreased blood flow and increased vascular resistance because when the muscle is contracting its literally compressing the arteries and causing them to collapse
57
clonidine mechanism of action
alpha 2 agonist
58
what does a heave indicate on cardiac exam
ventricular hypertrophy
- left parasternal = right
- apical heave = left
59
dermacentor tick
rocky mountain spotted fever and franscella tularemia
60
amphetamine mechanism of action
release norepinephrine which stimulates the a1 and beta1 receptors to cause vasoconstriction and increase in heart rate
61
gamma glutamyl transferase
very sensitive indicator of recent alcohol use (elevated even before liver function tests)
62
pathophysiology of reye syndrome
enlarged distorted mitochondria
| -major impact is on liver (microvesicular steatosis) and brain (edema)
63
between LCAD/MCAD and carnitine uptake deficiency what makes you tell the difference
both are hypoketotic hypoglycemia
| BUT if you see a build up in both muscle and serum then you know the carnitine uptake is working fine and vice versa
64
when would you see a positive kussmaul sign
its an increased JVP on inspiration
- constrictive pericarditis
- restrictive cardiomyopathy
- right atrial or ventricular tumors
65
what is one of the most common courses of chronic meningitis
mycobacterium tuberculosis
66
which antihypertensive medications can cause lipid abnormalities
metoprolol and thiazides
67
what will you see pathologically in COPD
loss of elastic recoil of the lung
68
4 parts of medicare
A --> hospitAl insurance and home hospice care
B --> Basic medical Bills
C --> Combo, delivered by approved private Companies
D --> prescription Drugs
69
vital capacity
total amount in lung EXCEPT residual volume
70
impaired copper absorption and transport due to defective ATP7A
-results in brittle "kinky" hair, growth retardation, and hypotonia
Menkes disease
- X-linked recessive connective tissue disease
- leads to decreased activity of lysyl oxidase (copper is a necessary cofactor) --> defective collagen
71
violent retching then pain onset that worsens with deep breaths and swallowing
-subQ crackles on the left side of the neck
Boerhaave syndrome
72
preferred drugs for OCD
SSRI, venlafaxine, and clomipramine
73
preferred drugs for panic disorder
SSRI, venlafaxine, and benzodiazepines
74
what can induce cytochrome p450 (smooth endoplasmic reticulum of the liver)
chronic alcohol use and cigarette smoking
75
what is increased in diabetic ketoacidosis
hyperkalemia
76
type of reaction a person may get after a tetanus shot
| -pt will present with edema, necrosis, and activation of compliment
```
arthus reaction (type III hypersensitivity)
-usually due to intradermal injection of antigen into a presensitized (circulating IgG) individual leads to immune complex formation in the skin
```
77
pt has ataxia, urinary incontinence, and cognitive dysfunction
symptoms potentially reversible with CSF/ventricular shunt placement
78
N-acetylcysteine
- used in acetaminophen overdose
| - replenishes glutathione stores
79
how to treat all tenia mycoses vs tinea unguium treatment
- all others you can use topical azoles
| - tinea unguium (nails) you have to use terbinafine and griseofulvin
80
paralysis of the entire side of the face leads you to think what
bells palsy of the IPSILATERAL pons
81
when you see a pt with fatty poop, especially after part of the small intestine being resected whats the first step you should think about?
possible decrease in vitamins A, D, E, and K because they are fat soluble vitamins (esp if you see a decrease in bile too)
82
serum calcium and phosphate are BOTH decreased... what do you think?
vitamin D deficiency
| -you will also see an increase in PTH
83
crampy abdominal pain followed by hematochezia in an old person
colonic ischemia
- reduction in intestinal blood flow causes ischemia
- usually due to atherosclerosis
- commonly occurs at watershed areas (splenic flexure and distal colon)
- thumbprint sign on imaging due to mucosal edema/hemorrhage
84
what is the initial mechanism of hepatocellular carcinoma
inactivation of tumor suppressor genes
85
what family of hepatitis is more associated with pregnant women
Hep E: hepevirus
```
Note
A: picornavirus
B: hepadenavirus
C: flavivirus
D: defective
```
86
woman with markedly elevated AST and epigastric pain
ischemic heart disease
- AST is found in kidney, heart, liver, and RBCs
- if you see an isolated increase in AST then get an EKG right away
*note that ALT is the more specific one for liver involvement
87
exudative pharyngitis, cervical lymphadenopathy, and diffuse sandpaper-like erythematous rash on trunk and arms
streptococcal pharyngitis
| -lysogenic conversion of toxin
88
whats associated with lysogenic conversion
```
COBEDS
C: Cholera toxin
O: O antigen of salmonella
B: Botulinum toxin
E: Erythrogenic toxin of streptococcus pyogenes
D: Diphtheria toxin
S: Shiga toxin
```
89
side effects of glucocorticoid therapy
hypocalcemia, hypokalemia
fluid retention, hyperglycemia, hypertension
with chronic use: osteoporosis and avascular necrosis
90
what happens to the majority of high grade dysplasias
they stay at the same level of dysplasia (60%)
| -only 10% usually turn into an invasive carcinoma
91
whats a side effect of octreotide therapy
it also blocks TSH release so it can cause hypothyroidism
92
main cause of abdominal aortic aneurysm
atherosclerosis (pulsatile abdominal mass)
| -ultrasound or CT is diagnostic
93
helmet cells/schistocytes
TTP
94
CSF analysis with 14-3-3 protein
creutzfeldt-jacob disease
95
5 Rs of medication
1. right drug
2. right patient
3. right dose
4. right route
5. right time
96
what are the two stages that egg development gets arrested in
prophase I until ovulation
| metaphase II until fertilization
97
whatre the two mechanisms that increase summation to increase the force of a muscle contraction
frequency summation and multiple fiber summation
| -this increases the load that the muscle can lift
98
common causes of fetal loss in first and third trimesters
first --> chromosomal abnormalities
| third --> abruptio placentae and placenta previa
99
what is the major adverse effect of halothane
hepatotoxicity (halothane hepatitis)
- hepatitis with focal to massive hepatic necrosis
- usually just hepatotoxic but can present as hepatitis
100
if the thoracic duct is occluded where will you have edema
entire left side and right lower limb
Lymphatic circulation
-Right upper body: right lymphatic duct --> right subclavian vein
-Rest of body: thoracic duct --> left subclavian vein
101
what causes gastric acid secretion
stimulation of parietal cells by histamine, gastrin, and vagal stimulation
102
how to treat acute prostatitis
ampicillin, fluoroquinolones, or TMP/SMX
-with TMP/SMX watch out for low hemoglobin after due to G6PD deficiency (X-linked recessive)
103
what nerve supplies the posterior half of the external auditory meatus
auricular branch of the vagus nerve
| -stimulation of the this nerve can cause reflexive symptoms such as fainting (vasovagal syncope), coughing, and gagging
104
fibroblast vs myofibroblast
fibroblast --> connective tissue repair and deposition, produce extracellular matrix proteins such as collagen, proteoglycan, and elastin... also promoted by TGF-beta
myofibroblast --> specialized fibroblast cell with smooth muscle cell function containing contractile proteins, also the primary cell type for wound contracture
105
treatment of choice for carcinoid treatment (pts with this get tricuspid valve stenosis)
octreotide (somatostatin analog)
106
abscesses
produced by catalase positive organisms which destroys hydrogen peroxide (substrate for myeloperoxidase)
107
which form of leprosy can be grown in lowenstein jensen agar?
lepromatous leprosy can be grown in L-J agar
| tuberculoid leprosy cannot be grown in L-J agar
108
how to diagnose hypertrophic pyloric stenosis
abdominal ultrasound demonstrating increased pyloric muscle width and length
109
peripheral blood smear shows red granules in enlarged young erythrocytes (schuffner dots) with history of going to africa or south america
malaria
110
what nerve mediates the urge to defecate
pelvic splanchnic nerves which arise from S2 to S4
111
colic and bloody diarrhea in the first week of life
```
necrotizing enterocolitis (premature, low birth weight infants)
-transmural necrosis is seen on histology
```
112
first line treatment for osteoporosis
bisphosphonates
113
difference between myelomeningocele and encephalocele
encephalocele has brain tissue
| myelomeningocele has spinal cord tissue
114
recurrent skin and mucosal bacterial infections, absent pus, impaired wound healing, delayed (>30days) separation of umbilical cord
leukocyte adhesion deficiency (type 1)
- defect in LFA-1 integrin (CD18) protein on phagocytes, impaired migration and chemotaxis
- increased neutrophils in blood but none at infection sites
- AR
115
what type of breast cancer is associated with adherens junctions
mutations in E-cadherin are associated with an increased risk of gastric adenocarcinoma and infiltrating lobular carcinoma
116
pt presents with enlarged gastric rugal folds
| -WAVEE --> Weight loss, Anorexia, Vomiting, Epigastric pain, Edema (due to protein loss)
Menetrier disease (protein losing enteropathy)
- mucous cell hyperplasia
- hyperplasia of gastric mucosa --> hypertrophied rugae (look like brain gyri)
- causes excess mucus production with resultant protein loss and parietal cell atrophy with decreased acid production
- precancerous
117
what is carnitine necessary for
transport of long chain fatty acids into the mitochondria
118
what does protein tyrosine phosphatase 1B
opposes insulin signaling by dephosphorylating the phosphotyrosine residues of the insulin receptor, blocking further transmission
119
scrotal swelling that can be transilluminated
hydrocele (scrotal fluid collection)
-in a baby its usually from failure of obliteration of the process vaginalis
or
-incomplete fusion of the process vaginalis if the fluid is slightly above the testis
120
smudge cells on peripheral blood smear (small mature lymphocytes which are fragile and have ruptured)
B-cell chronic lymphocytic leukemia (CD19 and CD20)
121
nail clubbing, joint pain, fatigue, tenderness of fibula, radius, and ulna (essentially a pt with digital clubbing and arthritis)
hypertrophic osteoarthropathy
- associated with a thoracic malignancy (lung cancer/mesothelioma)
- get a chest radiograph to rule of bronchogenic carcinoma
122
if a pt has gerd and is on meds for that what antibiotic should you avoid giving
for gerd they would be on antacids and if someone is on antacids you should not prescribe fluoroquinolones because iron and calcium limit the absorption of fluoroquinolones
123
what population has the highest risk for gastric cancer and why
immigrant asian population because the high levels of preservatives traditionally found in their diet
- food preservatives, nitrosamines, and polycyclic hydrocarbons found in smoked fish, preserved foods, and red meats
- nitrosamines from red meats are also converted into carcinogens by salivary and gastric reactions
124
what to think of when you see a pt with a mixed acidosis
cardiopulmonary arrest
- respiratory acidosis due to hypoventilation
- metabolic acidosis due to poorly oxygenated tissues leading to lactic acid production
125
pt is unable to look up past the horizontal gaze
lesion of the vertical gaze center in dorsal midbrain
| -possibly due to a pineal gland tumor due to its proximity to the dorsal midbrain
126
what induces growth of the definitive kidney
```
ureteric bud (aka. metanephric duct)
-induces development of the metanephros to give rise to the definitive kidney
```
127
failure to develop what will lead to renal agenesis
ureteric bud
128
explain the mechanism of aspirin induced asthma
aspirin inhibits COX pathway without affecting lipooxygenase pathway --> increase in leukotrienes (bronchoconstriction) and decrease in prostaglandins (bronchodilation)
129
mass in distal esophagus that shows glands that invade into the muscular layer and cells with large, hyperchromatic nuclei
```
esophageal adenocarcinoma (this metaplasia is called barret esophagus)
-usually due to reflux esophagitis
```
130
what does a premature ventricular contraction do to the heart
shorten diastole so you have decreased LV filling time and decreased LV end diastolic volume
3 possible reasons
1. structural anomalies create reentry circuit
2. after-depolarizations that are accentuated by electrolyte abnormalities (ex. hyperkalemia), ischemia, or drugs can be a trigger
3. normal pacemaker properties of purkinje fibers enhanced by electrolyte abnormalities or sympathetic stimulation
-these can lead you to see a wider QRS as well
131
which form of chlamydia is extra vs intracellular
Elementary body = Extracellular
| RetIculate body = Intracellular
132
CD25
one of the chains of the IL-2 receptor
| -binds IL-2 for use as a cell growth factor
133
CD40 vs CD40L
CD40 is on the surface of T cells
CD40L is on the surface of B cells
*these two bind during antigen presentation
134
histology and etiology of fibromuscular dysplasia
string of beads appearance on histology and pts usually present with hypertension and due to renovascular stenosis
-polyarteritis nodosa also as string of beads appearance but this usually affects more than just the kidney and its due to deposition of immune complexes with fibrinoid necrosis and aneurysm dilatations and the pt will present with fever and weight loss as well as abdominal pain
135
anti-glutamic acid decarboxylase antibodies
type 1 diabetes mellitus
| -linked to HLA- D3 and D4
136
what HLA is associated with UC and Crohns
HLA-B27
137
pt presents with anorexia, apathy aggressiveness, poor coordination, abdominal pain, and constipation (sometimes diarrhea)
what enzymes are potentially blocked
LEAD POISONING
Aminolevulinic acid dehydratase (D-Ala)
Ferrochelatase
-this can lead to microcytic, hypochromic anemia due to impaired heme synthesis
138
what is the most common cause of aortic stenosis in an elderly patient
calcification of the aortic valve
- bicuspid aortic valve can also cause this but its rare and usually seen in pts with turner syndrome
- vegetations on the aortic valve can also cause this but this is usually seen in infective endocarditis
139
what bug should you think of in a pt with pneumonia who is also either an alcoholic, diabetic, or with COPD
how do you treat this
Klebsiella
| -treat with third generation cephalosporin (ceftriaxone, cefotaxime, cefpodoxime, and cefazidime)
140
pt with super thick and kinda nodular omentum presents with vague abdominal pain and bloating
-possible breast and colon cancer in the family
peritoneal carcinomatosis
- due to direct spread (transcoelomic) of cancers located in the abdominal cavity
- ovarian carcinoma is the most common cause (BRCA mutation)
141
where does hepatocellular carcinoma usually spread
lungs first via invasion of the hepatic vein system
142
where doe gastrinomas most commonly occur in pts with MEN I
pancreas or duodenum
143
most common primary cardiac tumor in adults vs children
adults: atrial myxoma
children: rhabdomyoma (associated with tuberous sclerosis)-- confirm with desmin
144
most common cause of intellectual disability (mental retardation)
fetal alcohol spectrum disorder
145
what is associated with chromosome 15 abnormalities
autism spectrum disorder
prader willi syndrome
angelman syndrome
146
what activates zinc finger receptors
lipid soluble hormones
147
HER-2
member of the epidermal growth factor receptor family and signals through Ras and MAP kinases
148
inheritance pattern of sturge weber
TRICK QUESTION
| -its sporadic not inherited
149
memory device for MEN 1, 2a, 2b
```
Pit
Pan
Para
Pheo
Medullary carcinoma of thyroid
Mucosal neuroma
```
*note that MEN2b also presents with a pt with a marfanoid habitus
150
tumors in the ileum and liver arising from submucosal layer composed of uniform round cells arranged in trabeculae
carcinoid tumor (neuroendocrine neoplasm usually just in the GI tract) --> if also found on the liver then metastasis has occurred and its called carcinoid syndrome
dx via 24hr 5-HIAA (due to serotonin hypersecretion)
carcinoid heart disease --> right sided endocardial fibrosis with tricuspid valve damage
151
drug for maintenance of cardiac output
dobutamine (beta1 stimulation)
152
chemo induced nausea and vomiting and promotes gastric motility
metoclopramide
153
tranexamic acid
indicated for dental bleeding prophylaxis (acts competitively to inhibit multiple plasminogen binding sites)
154
phytonadione
aka. vitamin K
| - indicated for treatment of hypoprothrombinemia and warfarin stabilization
155
friedreich ataxia
- AR
- GAA trinucleotide repeat
- spinal cord and dorsal root atrophy due to the affect on the large myelinated axons in the peripheral nerves, posterior (dorsal) columns, spinocerebellar tracts, and corticospinal tracts
156
what is seen in the urine in pts with minimal change
massive proteinuria
lipiduria
(note that these pts also have edema, hyperlipidemia, and an increased risk of thrombosis)
157
transplant rejection
hyperacute (type 2 hypersensitivity and complement)
acute (type 4 hypersensitivity and CD4 and CD8 T cells)
chronic (type 2 and 4 hypersensitivity with T cell activation)
158
at what level of blood glucose do you start to have glucosuria (when are SGLT1 and 2 maxed out on absorption)
180-200 (so the levels have to be at least 250)
159
femur tumor with onion skin periosteal reaction in bone
-in younger pt (around 12yo)
(painful growing mass over bone)
Ewing sarcoma
- diaphysis of long bones (especially femur) and pelvic flat bones
- anaplastic small blue cells neuroectodermal origin (resemble lymphocytes)
- aggressive with early metastases but responsive to chemotherapy
-differentiate from conditions withs imilar morphology (lymphoma or chronic osteomyelitis) by testing for t(11;22) (fusion protein EWS-FLI1)
160
what inflammatory disorder can increase the likelihood of getting colorectal cancer
ulcerative colitis (also crohns but mainly think of UC first)
161
how do our vessels react to anemia
anemia leads to hypoxia so arteriolar vessels dilate to allow for more blood flow (unlike the lungs)
162
alveolar ventilation
this is the volume of gas that reaches the respiratory blood-gas interface and participates in gas exchange
(tidal volume - dead space) x respiratory rate
163
ventral wall defects
failure of...
rostral fold closure (ectopia cordis )
lateral fold closure (omaphalocele, gastroschisis)
caudal fold closure (bladder extrophy)
164
child with history of infection with aspergillus and staph aureus
deficiency in NADPH oxidase (chronic granulomatous disease)
| -cause they are both catalase positive
165
second vs third intercostal space on the right side
second --> ascending aorta
| third --> right atrium/SA node
166
what aortic arch parts come from the 4th and 6th derivatives
4 --> aortic arch and proximal part of right subclavian artery
6 --> proximal part of pulmonary artery and ductus arteriosus
167
common cause of conjugated hyperbilirubinemia
choledocholithiasis
| -pt will have dark urine and grayish stool meaning that the conjugated bilirubin never reached the intestine
168
list the JONES criteria and what is this used for
```
used for pts with Strep Pyogenes
J --> joints
O (heart) --> mitral stenosis/valvular disease
N --> nodules subQ
E --> erythema marginatum
S --> sydenhams chorea
```
169
what part is always involved in hirschsprungs
rectosigmoid colon (aka short segment of the rectum)
170
physiology of edema
abnormally increased net filtration pressure
171
how to measure net filtration pressure
what goes out of the capillary - what goes into the capillary
172
whats the pathology of fragile X
expanded trinucleotide repeat
| CGG (Chin Giant Gonads)
173
drug used for hypertension and BPH that can cause orthostatic hypotension on the first dose
alpha1 antagonists like prazosin
174
if you see a pt with celiacs disease what do they have an increased risk of getting
- dermatitis herpetiformis
- intestinal lymphoma
- esophageal squamous cell carcinoma
- non-hodgkin lymphoma
175
what is the content of black pigmented gallstones
high in unconjugated bilirubin (insoluble) and low in cholesterol
- usually associated with hemolytic anemia
- increased enterohepatic cycling of bilirubin
*Note: brown pigmented stones usually come from a biliary tree infection (E-coli, liver fluke) causing a release of microbial beta-glucuronidases (released by injured hepatocytes)
176
bilateral decreased pain and temp in a cape distribution with light touch, vibration, and position sense in tact
- lower motor neurons affected causing atrophy of hand muscles
- upper motor neurons affected causing increased deep tendon reflexes
syringomyelia (syrinx within the cervical spinal cord)
177
fractional excretion of Na for prerenal, intrarenal, and postrenal
prerenal: >1%
intrarenal: >2%
postrenal: >2% (severe)
178
what defect can cause an increased likelihood of colorectal cancer
mismatch repair
| -occurs predominantly in the S phase of cell cycle
179
what are the second line drugs for DM2 if metformin does not work or cannot be used due to the pt having a high creatinine (some sort of renal failure)
sulfonylureas (stimulate pancreatic beta cells)
DPP-4 inhibitors
GLP-1 agonists
Glitazones
180
whats associated with hMLH1 and hMSH2
hereditary nonpolyposis colon cancer
-pts with this have loss of function mutations in hMLH1 and hMSH2 = microsatellite instability/dinucleotide instability
Note: pts are also at an increased risk of endometrium, ovary, stomach, and pancreas cancer
181
what nerve does the following: Oppose, Abduct, and Flex (OAF) for both the thenar and hypothenar
thenar (median nerve)--> thumb
| hypothenar (ulnar nerve) --> pinky
182
what nerve is immediately lateral to the flexor digitorum superficialis tendon
median nerve
183
what nerve does extension of the thumb and what muscles are involved
radial nerve
| extensor pollicis longus and extensor pollicis brevis muscles
184
pt with psoriatic arthritis comes in with eye pain and redness... what do you check?
psoriatic arthritis is associated with HLA-B27 which is also associated with reactive arthritis (cant pee/non-gonococcal urethritis, cant see/anterior uveitis conjunctivitis, cant climb a tree/arthritis)
- cause the pt is coming in with eye pain you would want to check for anterior uveitis (inflammation of middle layer of eye including the iris and ciliary body) via a slit lamp examination
- anterior uveitis can lead to vision loss
185
C3 deficiency
causes defects in opsonization and removal of immune complexes
-pts usually have increased susceptibility to extracellular pathogens that utilize complement for clearance (ex: neisseria meningitis, haemophilus influenzae, and strep pneumo)
186
pt presents with erythematous, itchy, ulcerating lesion of the nipple associated with oozing serousanguinous nipple discharge
- biopsy shows scattered, large cells with abundant cytoplasm within the epidermis of the nipple
- cytokeratin+
paget disease of bone caused by an underlying breast carcinoma
- if palpable mass --> invasive ductal carcinoma
- if no palpable mass --> ductal carcinoma in situ
187
numbness and parasthesias of the leg with difficulty walking
tertiary syphilis with tabes dorsalis
| -you will also see gummas which are granulomas that are predominant in macrophages
188
neuroblastoma vs wilms tumor
neuroblastoma does cross midline and wilms tumor does not
189
if a pt has trouble opening the jaw to resistance what muscle is involved
lateral pterygoid
- acts to pull the mandible forward in the process of jaw opening
- also protracts the mandible and moves it side to side (like in chewing)
190
what muscles are involved to close the jaw
masseter, medial pterygoid, and temporalis
191
what is the only part of the kidney that contains a brush boarder
proximal convoluted tubule
192
superior vs inferior colliculi
superior --> direct eye movements to stimuli (noise/movements) or objects of interest
inferior --> auditory
*your eyes are above your ears*
193
vertical gaze palsy, pupillary light-near dissociation (pupils accommodate but do not react), lid retraction, convergence-retraction nystagmus
parinaud syndrome
| -can result from stroke, hydrocephalus, or pinealoma
194
what damages the mammillary bodies
Wernicke Korsakoff syndrome
195
what is one of the most common side effects of the transurethral resection of the prostate (TURP) procedure and why is it done?
- its done for pts who have BPH
- most pts then suffer from retrograde ejaculation as a result of damage to the internal urethral sphincter
- this is because it is the smooth muscle at the neck of the bladder (at the junction of the bladder and the urethra)
- this is sympathetic smooth muscle making the "shoot" part of ejaculation difficult because it does not block retrograde flow the way it should
196
what is a medication used for headache prophylaxis that is contraindicated in pts with COPD and asthma
propranolol (or other non selective beta blockers) cause it can make exacerbate COPD and asthma due to the beta-2 effects on the lungs
197
how to tell the difference between a direct or indirect inguinal hernia
direct: does not pass through the deep inguinal ring
indirect: does pass through the inguinal ring
to clinically tell the difference b/w direct and indirect have the pt cough while compressing the deep inguinal ring
- direct: if this compression does not prevent the hernia from descending
- indirect: if this compression does prevent the hernia from descending
198
inability to elevate the tongue is as a result of which muscles and what nerves are they innervated by
palatoglossus (CN 10)
| styloglossus (CN 12)
199
what type of cells does the PNS arise from
neural crest cells (make up both sympathetic and parasympathetic)
200
what are the two most important hormones in establishing a pregnancy
hCG and progesterone
| -if progesterone is low then you will be more likely to have recurrent early pregnancy loss
201
very young pt with febrile diarrhea (blood and pus)... can even cause a mini-epidemic
in older pts usually a pseudoappendicitis that presents with right lower quadrant abdominal pain
yersinia enterocolitica
202
how is multiple sclerosis inherited
trick question
| -ITS AUTOIMMUNE
203
x-linked recessive disorder where you cant give certain drugs...
G6PD deficiency!!!!
| -cant give TMP-SMX
204
Th1 activation of macrophages is what type of hypersensitivity
type 4
205
TCA overdose
3 Cs
1. cardiotoxicity --> use sodium bicarb to treat and alkalinize serum
2. convulsions
3. coma
206
how to detect rubella
IgM can be detected in serum within 1-2 days of developing rash
207
child with developmental delay, low serum calcium, high serum phosphate, high serum PTH, and shortened 4th/5th metacarpals
pseudohypoparathyroidism
208
most common form of albinism
deficiency of tyrosinase, blocking melanin production from the aromatic amino acid tyrosine (AR)
-other forms could be due to defective tyrosine transporter and failed neural crest migration
209
significance of diarrhea in an alcoholic pt
loss of bicarb in the feces
210
what type of antibodies do pts with celiac disease have
anti-endomysial antibodies (tissue transglutaminase)
| -associated with HLA-DQ2 and DQ8
211
what type of channel is NMDA
both voltage and ligand gated
212
moro reflex
aka. startle reflex
- extension and abduction of the arms with fingers spread followed by flexion and adduction of the arms
- normal reflex that disappears within 3-6 months
213
when is the only time someone will develop hyperplastic arteriosclerosis
due to untreated malignant hypertension
| -thickening of arteriolar wall media from hyperplasia of myocytes arranged in concentric layers (onion skinning)
214
most common examples of chronic transplant rejection
months to years (lymphocytes --> fibrosis --> destruction)
type 2 and 4 hypersensitivity response
1. lungs: bronchiolitis obliterans
2. heart: accelerated atherosclerosis of graft vasculature
3. kidney: chronic graft nephropathy
4. liver: vanishing bile duct syndrome
215
1. anti-myeloperoxidase
vs
2. anti-proteinase 3 antibodies
NOTE: ANCA =antineutrophil cytoplasmic antibodies
1. aka. p-ANCA
- seen in eosinophilic granulomatosis with polyangitis/Churg-Straus
- involves small to medium sized blood vessels mostly in kidney and GI tract
2. aka. c-ANCA
- seen in pts with granulomatosis with polyangiitis/Wegers
216
if pt presents with lung and kidney problems what should you suspect
good pasture!!!!!
| -antibodies to type 4 collagen
217
most common types of bacterial endocarditis
acute --> staph aureus
| subacute --> strep viridans
218
compare and contrast enfuvirtide to maraviroc
they are both fusion inhibitors
- enfuvirtide blocks gp41
- maraviroc blocks CCR5 on surface of T cells to inhibit its interaction with gp120
219
gelatin-like mucus that fills the peritoneal cavity
psuedomyxoma peritonei
- produced when benign or malignant mucus producing tumor produces this material and it leaks into the peritoneal cavity
- usually originate from the ovary and/or appendix
220
two most common tumors of the appendix
1. carcinoid tumor
| 2. adenocarcinoma (50% found here are of the mucinous type)
221
zones of the liver
zone 1 - periportal zone (closest to blood)
zone 2 - intermediate zone
zone 3 - pericentral vein/centrilobular zone (furthest from blood)
222
currant jelly dark red stools in an infant without a fever and the when babies cry with this they usually draw their legs to their chest to ease the pain
intussusception
- usually at ileocecal junction
- pt will be okay sometimes then not okay and in pain other times (due to the ischemia)
- sausage shaped mass on palpation
- ultrasound and CT may show target sign
- may be associated with IgA vasculitis (HSP) or recent viral infection
223
malrotation of gut
anomaly of midgut rotation during fetal development --> improper positioning of bowel (small bowel clumped on the side) with formation of fibrous bands (Ladd bands)
-can lead to volvulus or duodenal obstruction
224
volvulus
twisting of portion of the bowel around its mesentery which can lead to obstruction/infarction
-can occur all throughout the GI tract
- MIDGUT: infants and children
- SIGMOID: elderly (look for coffee bean sign on x-ray)
225
what produces ACE
produced in lungs by pulmonary endothelial cells
226
explain ethanol induced hypoglycemia
high cytoplasmic NADH/NAD+ ratio
- this ratio inhibits gluconeogenesis
- liver glycogen is exhausted after 30 hours
- note that the NAD+ levels are low in alcoholics cause both alcohol dehydrogenase and acetaldehyde dehydrogenase require NAD+
227
how do your lipoprotein levels change in nephrotic syndrome
hyperlipidemia cause of the massive protein loss
| -you will also have hypoalbuminemia and edema
228
proliferation of glands without atypia
| -sawtooth glandular epithelium composed of proliferated goblet cells and columnar epithelium
```
hyperplastic polyp (90% of all colonic polyps are hyperplastic)
-NO malignant potential
```
229
description of tubular adenoma in the colon
pedunculated
230
description of villous adenoma
sessile and high malignant potential
231
what is AD polycystic kidney disease associated with
- numerous cysts in cortex and medulla of kidney
- flank pain, hematuria, hypertension, urinary infection
- progressive renal failure
- complications: chronic kidney disease, hypertension, berry aneurysms, mitral valve prolapse, benign hepatic cysts, and diverticulosis
-try to treat with ACEi or ARBs
232
if a pt was just put on a new med for hypertension then their kidney function decreases and you have to take them off the drug... what drug is this?
ACEi
233
small, pale-staining, slow-growing, aerobic, gram negative, coccobacili that require cysteine for growth
-assoicated with deer tick and bunnies
francisella tularensis
234
at the basic level... what is a granuloma
type 4 hypersensitivity response
235
atrophy of mucosa in the body and fundus of the stomach along with lymphocytic infiltrate
autoimmune gastritis
- CD4 T cells directed against ATPase
- this can then lead to pernicious anemia and a megaloblastic anemia as well
236
what is a normal PaO2 (someone at sea level with no pulmonary problems)
about 100mmHg
237
what does arterial O2 depend on
hemoglobin levels
238
what is the purpose of running an ELISA
to detect the presence of certain antibodies
239
what must the lumbar puncture needle pass through
skin --> superficial fascia --> deep fascia --> supraspinous ligament --> interspinous ligament --> interlaminar space --> epidural space --> dura --> arachnoid --> subarachnoid space
240
what is the major ion change to know when pts have rhabdomyolysis
they become hyperkalemic
| -this stimulates aldosterone release to promote K+ excretion and sodium reabsorption
241
what does DNA gyrase do
counteracting excessive supercoiling of DNA during replication or transcription
242
what can be treated with uridine
orotic aciduria
243
how to find the stead state concentration of drug thats continuously being infused
Css = dosing rate/CL
244
what does Th1 secrete (virus)
IFN-gamma
| IL-2
245
what does Th2 secrete (parasite)
IL-4,5,6
| IL-10 and 13
246
what does Th17 secrete (bacteria)
IL17,21,22
247
what do Tregs secrete
TGF-beta
IL-10
IL-35
248
what drug can you give to reverse the effects of epinephrine (you have to administer the drug first then epinephrine will not be able to increase blood pressure)
phentolamine (alpha antagonist)
249
what chromosome is neurofibromatosis 1 vs 2 on
1: chromosome 17
2: chromosome 22 (all the 2s)
250
desmin vs vimentin
desmin: marker for skeletal muscle/rhabdomyosarcoma
vimentin: marker for soft tissue sarcomas and mesenchyal tumors
251
composition of molecules that produce the M spike in multiple myeloma
2 gamma heavy chains
| 2 kappa light chains
252
how to treat methemoglobin
methylene blue and vitamin C
253
watery diarrhea in a pt with AIDs who just went camping
cryptosporidium parvum
| -intracellular multiplication within the intestinal epithelium
254
what two things can result from strep pyogenes
1. rheumatic fever (JONES) due to M protein
2. scarlet fever (blanching, sandpaper-like body rash, strawberry tongue, and circumoral pallor in the setting of group A strep pharyngitis) due to erythrogenic/pyrogenic toxin
255
what is one of the most potent activators of macrophages
IFN-gamma
256
what are the three branches that come off of the celiac trunk
1. left gastric artery
2. splenic artery
3. common hepatic artery
257
what is hyperpnea
increased depth and rate of breathing
258
what will you see histologically on a pt with parkinsons vs a pt with rabies
parkinsons --> lewy bodies (a-synuclein/intracellular eosinophilic inclusions) in the substantia nigra
rabies --> negri bodies in cerebellum and hippocampus
259
how does the brain react to changes in PCO2 levels
increase in CO2 = cerebral vasodilation and a decrease in cerebrovascular resistance --> cerebral blood flow increases
decrease in CO2 = cerebral vasoconstriction and an increase in cerebrovascular resistance --> cerebral blood flow decreases
260
what type of rash do pts with lyme disease get
erythema migrans (target rash)
261
what is erythema nodosum
- painful raised inflammatory lesions of subcutaneous fat (panniculitis), usually on anterior shins
- usually idiopathic but can be associated with: sarcoid, coccidioidomycosis, histoplasmosis, TB, strep infections, leprosy, and IBD
262
what parts of the adrenal gland are controlled by ACTH
FR
| zona fasciculata and reticularis
263
what are the possible causes of horner syndrome
anything that denervates the sympathetic system in the face causing ptosis, miosis, and anhidrosis
- apical lung tumor
- aortic dissection
- carotid dissection
- PICA stroke (lateral medullary syndrome)
264
excretion rate of a drug that is freely filtered and neither absorbed or secreted
excretion rate = GFR x plasma concentration
265
pt in pain with scrotal mass that at one point was reducible but now is not and pt also has an elevated ammonia level
inguinal hernia strangulation
- elevated ammonia is from the bacterial proliferation in the damaged tissue
- note that you will also see gram negative bacteria due to enteric flora
266
what is another name for a macrophage
histiocyte
267
when would you see an aschoff body
acute rheumatic myocarditis
268
posterior cord of the brachial plexus
axillary and radial nerves come off the posterior cord
269
how to treat diabetic ketoacidosis
insulin + IV fluids + potassium supplementation
-make sure to supplement potassium cause when the insulin you gave pulls glucose inside of cells it will also pull K in with it which can cause life threatening hypokalemia
270
what separates in meiosis I vs II
I --> homologous chromosomes separate
II --> sister chromatids separate
you can tell which stage nondisjuction occurs by seeing if you have two separate chromosomes from one parent or if you have two from the same of another pt
271
what type of bilirubin can be seen in the urine
conjugated bilirubin can be seen in the urine
| -unconjugated bilirubin is not water soluble so it cannot be seen in the urine
272
RNA virus with retrovirus activity
| pt presents with skin lesions, lymphadenopathy, hepatosplenomegaly, and hypercalcemia
human T cell lymphotrophic virus 1 --> enveloped single stranded RNA retrovirus
- can be transmitted via breast milk or blood exchange
- resides in T cells but NO LYSIS
- 20/30 years after infection the pt usually develops T cell lymphoma/leukemia
- flower shaped nuclei
- Japan and caribbean and sporadically in the USA
273
young pt with changes in personality/behavior/memory, myoclonic jerks, blindness, spasticity
-note that the child is unvaccinated
this is due to measles/rubeola
| -this is a problem called subacute sclerosing panencephalitis (SSPE)
274
high-pitched tinky bowel sounds
small intestinal obstruction
- hernia
- adhesions
- tumor
- meckels
- crohns
- ascaris infections
- midgut volvulus
- intussusception due to tumor
275
pt with very tender prostate gland
acute bacterial prostatitis
| -most commonly due to e.coli cause its so close to the bladder
276
primary hemolytic anemia... what should be on your differential
defects in glycolysis or PPP
277
autosomal recessive glycolytic enzyme deficiency
pyruvate kinase deficiency
- hemolytic anemia
- increased levels of 2,3-BPG
278
drug that vasodilates and decreases insulin release in response to glucose
Diazoxide
- open kATP channels on vascular smooth muscle causing hyperpolarization and vasodilation
- opening kATP channels on pancreatic beta cells results in hyperpolarization and decreased calcium entry through voltage-gated calcium channels, resulting in decreased insulin secretion in response to glucose
279
if you have a pt suffering from amenorrhea what should be the first test you run
progestin challenge
| -the pt probably has anovulation if the progestin challenge triggers menstruation
280
slippage
expansion of DNA via trinucleotide repeat expansion
- this occurs during the S phage
- slippage of DNA polymerase during replication
281
what cranial nerve does salivation
CN 9
282
what drug causes gray baby syndrome
chloramphenicol
- blocks peptidyltransferase at 50S ribosomal subunit
- bacteriostatic
283
what will you see on chest x-ray of a pt with an aortic dissection
widened mediastinum
284
basis of a type 2 hypersensitivity response
cytotoxicity
285
if you think a pt has appendicitis but you go in to do the surgery and they dont... what do they likely have
yersinia enterocolitica
- gram negative bacilli that optimally grows at 25-28C
- contracted via puppy poop or contaminated milk products
286
what are chiari II malformation associated with
myelomeningocele (it always present in these pts)
| -usually in the lumbosacral region
287
list the bacteria that are natural transformers
strep pneumo
haemophilus influ
bacillus
neisseria
288
most common GI emergency in neonates
```
necrotizing enterocolitis (gangrenous bowel)
-prematurity is a key risk factor
```
289
what medication sensitizes Ca2+ sensing receptor (CaSR) in parathyroid gland to circulating Ca2+ --> decreasing PTH
cinacalcet
290
neurotransmitters of sleep
S- serotonin (initiates sleep)
A- acetylcholine (higher in REM/erections in men)
N- norepinephrine (lower in REM)
D- dopamine (arousal and wakefulness)
*note: trigger for REM sleep = ratio of ache/ne
291
pt with ulcerative colitis presenting with p-ANCA
primary sclerosing cholangitis
-concentric "onion skin" bile duct fibrosis --> alternating strictures and dilation with "beading" of intra- and extra- hepatic bile ducts of ERCP, magnetic resonance cholangiopancreatography
292
deep fibular/peroneal nerve
the space in between the 1st and 2nd toes
293
superficial fibular/peroneal nerve
front of leg and dorsum of foot
294
punched out ulcers in the lower esophagus of the pt
herpes simplex virus
295
shallow linear ulcerations in the lower esophagus of the pt
CMV
296
closing quality gap by improving pt care based on scientific knowledge and avoiding waste in equipment and supplies
STEEEP
297
antibodies against glutamic acid decarboxylase
diabetes mellitus type 1
298
what type of T cell is involved in intracellular pathogen responses
Th1
299
how to test for tertiary syphillus
FTA-ABS
| fluorescent treponemal antibody absorption test
300
- memory, insight, judgement, and social behavior deficits
| - and pt becomes relaxed/expressionless facies, tremor, dysarthria, and pupillary abnormalities
neurosyphilus
-tabes dorsalis also happens here (degeneration of the dorsal columns)
301
persistently high levels of bands? (>5%)
bands = immature neutrophils
| persistently high levels indicates extracellular bacterium
302
drug efficacy
maximum effect a drug can produce regardless of dose
303
mechanism of resistance for aminoglycosides
ex: gentamicin, neomycin, amikacin, tobramycin, streptomycin
- bacterial transferase enzymes inactivate the drug by acetylation, phosphorylation, or adenylation (enzymatic inactivation)
304
mycosis fungoides
- skin patches and plaques (cutaneous T-cell lymphoma)
- atypical CD4+ cells with cerebriform nuclei and intraepidermal neoplastic cell aggregates (pautrier microabscess)
may progress to sezary syndrome (T cell leukemia)
305
gastric inhibitory polypeptide
stimulates insulin release
306
histology of a pt with alcoholic hepatitis
mallory bodies --> intracytoplasmic eosinophilic inclusions of damaged keratin filaments (cytoskeletal filaments)
-formed when hepatocytes degenerate and just leave a mass of cytoskeletal filaments
307
where is fusobacterium nucleatum found
oral cavity
| -can be aspirated to cause anaerobic lung abscess
308
what does chronic alcohol use do to your sleep
decreases the amount of time spent in REM
- so in someone who stops drinking they can get REM rebound where they spend a ton of time in REM
- this can also happen with pts taking barbs, stimulants, tricyclic antidepressants, SSRIs, lithium, and moai
309
first line treatment for ulcerative colitis
mesalamine (used in mild acute flares) --> 5-aminosalicylic acid
-olsalazine and sulfasalazine can also be used
310
what gives rise to the spinal cord
neural tube which is divided into alar and basal plates
- alar = dorsal/sensory spinal cord
- basal = ventral/motor spinal cord
311
lateral vs medial medullary syndrome
lateral --> caused by occlusion of the PICA, vertigo, nystagmus, nausea, vomiting, ipsilateral cerebellar signs, dysphagia, dysphonia, loss of pain/temp in ipsilateral face and contralateral body, and horner syndrome
medial --> contralateral spastic hemiparesis, contralateral loss of vibration and position sense, damage to fibers of CN 6
312
lateral vs medial pontine syndrome
lateral --> facial droop and hearing loss
medial --> contralateral hemiparesis of body, contra loss of vibration and position sense
313
what does cushing syndrome do to bones
osteoporosis
314
what comes off of the aorta at T12
celiac artery
315
chronic constipation in an elderly pt.. what part of their colon is more likely to torsion
- "overload" of the sigmoid colon rendering it susceptible to torsion
- then a volvulus can occur (a complete twisting of the bowel)
- then that could lead to bowel infarction
316
endochondral ossification vs membranous ossification
endochondral --> bone formed from cartilage (woven bone to lamellar bone), axial skeleton, appendicular skeleton, base of skull
membranous --> woven bone formed directly without cartilage, bones of calvarium, facial bones, and clavicle
317
nitrates in the urine
gram negative (E.coli, Klebsiella, Proteus)
318
where do corticospinal tract fibers decussate
caudal medulla
| -this is what helps with reflexes (ex: Babinski reflex)
319
flutamide
androgen receptor antagonist
320
what is the most common trisomy that leads to a spontaneous abortion
trisomy 16
-second most common is a full triploidy
321
pt has positive anti-cyclic citrullinated peptide antibodies... what HLA is associated with this
HLA-DR4
322
what type of bleeding in the brain is associated with polycystic kidney disease in adults
pckd is associated with berry aneuyrsms which is associated with subarachnoid hemorrhages
323
when you hear radiation exposure and throat mass what should you immediately think of
papillary thyroid carcinoma
| -has psammoma bodies
324
pt with heart failure becomes diabetic (type 2)
| -what drug is contraindicated in this pt
thiazolidinediones
- sensitizes peripheral tissue to insulin
- can exacerbate heart failure
325
top causes of brain ring enhancing lesion and abscess
staph, strep, bacteroides
326
chronic endometritis
infiltration of lymphocytes, plasma cells, and histiocytes into the endometrium
-important predisposing factors in the US include chlamydia, IUDs, and recent pregnancy
327
dinoprostone
PGE2 analog (increases uterine tone)
