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1

Leads that show anterior wall MI

V1 - V4, V5

2

Leads that show inferior wall MI

II, III, aVF

3

Leads that show lateral wall MI

aVL, V5, V6

4

Leads that show posterior wall MI

need a right precordial lead, V4

5

What artery supplies the anterior wall of heart?

Left anterior descending (LAD)

6

What artery supplies the lateral wall of the heart?

left circumflex artery

7

What artery supplies the inferior wall of the heart?

right coronary artery

8

What artery supplies the posterior wall of the heart?

posterior descending artery

9

WAGR complex

Wilms tumor, aniridia, genitourinary malformations, retardation

10

Different factors that are deficient in Hemophilia A, B, and C

A - Factor 8
B - Factor 9
C - Factor 11

results in increased PTT, hemarthroses, easy bruising, bleeding after trauma

11

Factors measured by PT, factors measured by PTT

PT - I, II, V, VII, X (common and extrinsic)
PTT - XII, XI, IX, VIII, X, V, II (common and intrinsic) --> all factors except 7 and 13

12

Effect on PT and PTT with Vit K def.

increase both

13

Seizures, intellectual disability, angiofibromas (triad)
-also ash leaf spots, hamartomas, cardiac rhabdomyoma, mitral regurgitation

Tuberous sclerosis

-increased risk for subependymal astrocytomas and ungual fibromas

14

Things that cause hemolytic anemia in pts with G6PD def.

"Spleen Purges Nasty Inclusions From Damaged Cells"
-Sulfonamides, Primaquine, Nitrofurantoin, Isoniazid, Fava beans, Dapsone, Chloroquine

15

Classic triad of reactive arthritis

urethritis, conjunctivitis, arthritis (usually following diarrheal infection) -- not the same as septic arthritis

-is a seronegative spondylarthropathy
-caused by shigella, salmonella, yersina, campylobacter, or chlamydia

16

#1 cause of septic arthritis

neisseria gonorrhoeae

17

What effect does leptin generated by adipocytes have on the hypothalamus?

stimulates ventromedial area and inhibits lateral area --> satiety

18

Councilman bodies

viral hepatitis

19

Dementia + eosinophilic inclusions in neurons

Lewy body dementia

20

Tumors associated with Tuberous sclerosis

cardiac rhabdomyosarcoma, renal angiomyolipoma

21

Recurrent sinusitis, situs inversus, bronchiectasis

Kartagener syndrome - defect in dynein arm of cilia, can see infertility too

22

Different types of tissue composed of the four types of collagen

Type 1 - bone, skin, tendon, dentin, cornea (strong)
Type 2 - cartilage, vitreous body, nucleus pulposus (slippery)
Type 3 - blood vessels, uterus, fetal tissue, reticular fibers, scars (stretchy)
Type 4 - basement membrane (BM)

23

What amino acids are high in collagen?

proline, glycine, hydroxyproline

24

Not enough production of Type 1 collagen, autosomal dominant

Osteogenesis imperfecta
-bowed legs, blue sclera, multiple fractures, hearing loss, tooth abnormalities

25

Problem crosslinking collagen, defect in Type I and V collagen

Ehlers-Danlos - hemorrhages, easy bruising, hyperextensible joints, arterial rupture, berry aneurysms

26

Defect in fibrillin, which forms sheath around elastin

Marfan syndrome

27

Berry aneursysms + cystic kidney and liver

Autosomal dominant polycystic kidney disease

28

Mutation in fibroblast growth factor receptor 3

Achondroplasia

29

Default if you don't know inheritance pattern

Dominant - issue in structural gene
Recessive - issue in enzyme activity

30

Cystic medial necrosis of aorta --> aortic incompetence + floppy mitral valve + aortic regurgitation (midsystolic click)

Marfan syndrome
-can see subluxation of lens upward and temporally

31

Cafe-au-lait spots, cutaneous neurofibromas, optic gliomas, pheochromocytomas, pigmented iris hamartomas

NFM 1 (on chromosome 17 - called von Recklinghausen disease)

32

Bilateral acoustic schwannomas, juvenile cataracts, meningiomas, ependyomomas

NFM 2

33

Seizures + intellectual disability + ash-leaf spots

Tuberous sclerosis

34

Different tumors with different MEN syndromes

MEN 1 - parathyroid adenoma, pituitary adenoma, pancreatic tumors
MEN 2A - medullary thyroid cancer, pheocromocytoma, parathyroid adenomas
MEN 2B - medullary thyroid cancer, pheocromocytoma, mucosal neuromas

35

Decrease alpha-fetoprotein and estriol, increase inhibin A and beta-HCG on quad screen; genetic defect due to meiotic nondisjunction

Down syndrome

36

Rocker bottom feet, micrognathia, prominent occiput, intellectual disability, decrease in all quad screen levels

Trisomy 18 - Edward syndrome (election age = 18)

37

Rocker bottom feet, microcephaly, cleft lip/palate, holoprosencephaly, polydactyly, decrease in beta-HCG and PAPP-A

Trisomy 13 - Patau Syndrome (puberty = 13)

38

Microencephaly, intellectual disability, high-pitched crying/mewing (like a kitten), epicanthal folds, VSD

Cri du chat - due to microdeletion of short arm of chromosome 5 (5p-)

39

Elfin facies, hypercalcemia, extreme friendliness with strangers, intellectual disability

Williams syndrome (think about Will ferrel in Elf - nice and friendly + elfin face) - due to deletion of long arm of chromosome 7

40

Increase AFP on quad screen

abdominal wall defect, neural tube defect, multiple gestations, incorrect dating

41

Defects seen in DiGeorge Syndrome

CATCH 22 - cleft palate, abnormal facies, thymic aplasia (recurrent infections), cardiac defects, hypocalcemia (missing parathyroids)
-due to 22q11 deletion and defect in development of 3rd and 4th branchial/pharyngeal pouches

42

Cause of pseudotumor cerebri

Vit A OD -- increase ICP

43

What transports nitrogen in the body?

alanine (to liver), glutamate (to urea cycle)

44

Musty body odor, intellectual disability, growth retardation, seizures, fair skin, eczema

Defect in phenylalanine hydroxylase (aromatic acid metabolism) - PKU
tx = increase tyrosine (becomes essential) + increase BH4 supplement (cofactor)

45

Defect in tyrosinase

Albinism

46

Bugs that don't gram stain well

Mycoplasma, Mycobacteria, Rickettsia, Treponema, Legionella, Chlamydia

47

Encapsulated bacteria

"Even Some Pretty Nasty Killers Have Shiny Bodies" - E. coli, Salmonella, Pseudomonas, Neisseria, Klebsiella, Hib, Strep pneumo, Group B strep (step agalactiae)

48

Bacteria that make spores

Bacillus, Clostridium (need to autoclave to kill spores - 121 C for 15 min with steam)

49

Jones criteria for rheumatic fever

J - joints (polyarteritis)
O - heart shape (pancarditis)
N - nodules
E - erythema marginatum (ring rash that gets bigger)
S - syndenham chorea

50

Causes of neonatal sepsis

E. coli, Group B strep, Listeria

51

Tx pseudomonas

CAMPFIRE - Carbapenems, Aminoglycosides, Monobactams, Polymyxins, Fluoroquinolones, thIrd generation cephalosporin and fourth (ceftazidime, cefepime), Extended-spectrum penicillin (piperacillin, ticarcillin)

52

Arthritis + urethritis + Uveitis

Reactive arthritis
-Chlamydia, Shigella, Salmonella, Yersinia, Campylobacter

53

Perinuclear clearing seen on stain - seen in HPV

koilocytes

54

Organisms not covered by Cephalosporins generation 1-4

LAME - Listeria, Atypicals (mycoplasma, chlamydia), MRSA, Enterococci

55

Covered by 1st gen cephalosporins

PEcK - Proteus, E. coli, Klebsiella and Gram + cocci
Cefazolin, Cephalexin

56

Covered by 2nd gen cephalosporins

HENS PEcK - H. flu, Enterobacter, Neisseria spp., Serratia, Proteus, E. coli, Klebsiella and Gram + cocci
Cefoxitin, Cefuroxime

57

Covered by 3rd gen cephalosporins

Serious Gram (-) = Meningitis, Gonorrhea, Lyme's (Ceftriaxone)

58

Cephalosporins that covers Pseudomonas

Ceftazidime (3rd gen), Cefepime (4th gen)

59

Which protein synthesis inhibitors inhibit which ribosomal subunit?

30S - Aminoglycosides (GNATS), Tetracyclines
50S - Chloramphenicol, Clindamycin, Erythromycin (macrolides), Linozolid

60

Tx anaerobic infections

Above diaphragm - Clindamycin (aspiration pneumo)
Below diaphragm - Metronidazole

61

Drugs with sulfa allergy

"Sulfa Pills Frequenty Cause Terrible Allergy Symptoms" - Sulfonamides, Probenicid, Furosemide, Celecoxib, Thiazides, Acetazolamide, Sulfonylureas

62

4 R's of Rifampin

Ramps up Cyp450, Red/orange body fluids, RNA pol inhibitor, Rapid resistance if used alone

63

What causes persistence of granulomas?

TNF-alpha secreted by macrophages (anti-TNF drugs could cause disseminated dz)

64

Cause of exudate and transudate fluid

Exudate (thick, think extra stuff) - infection, cancer, lymph obstruction
Transudate (thin) - HF, sodium retention, cirrhosis, nephrotic syndrome (too much hydrostatic or not enough oncotic pressure)

65

Anticholinergic Drugs

Atropine, TCAs, H1-blockers (diphenhydramine), antipsychotics
mad as a hatter, dry as a bone, bloated as a toad, tachy as a polyester suit, red as a beet, hot as a hare, blind as a bat

66

How do different drugs impact NE at synaptic cleft?

Amphetamine, ephedrine - reverse pump to cause more NE to be pushed out
Cocaine, TCAs, SNRIs - block reuptake

67

Too much cholinergic activity (i.e. cholinesterase inhibitor poisoning)

everything gets leaky (DUMBBELSS) - diarrhea, urination, miosis, bronchospasm, bradycardia, excitation of skeletal muscle, lacrimation, salivation, sweating
-seen in farmers, tx with pralidoxime + atropine

68

Systolic murmurs

Aortic and pulmonic stenosis, Mitral and tricuspid regurg (both holosystolic), VSD, mitral valve prolapse (midsystolic click)

69

Diastolic murmurs

Aortic regurg (head bobbing, water hammer pulse), pulmonic regurgitation, mitral stenosis (opening snap), tricuspid stenosis

70

What nerves transmit signals from carotid and aortic baroreceptors?

carotid - glossopharyngeal
aortic - vagus
-decrease in pressure leads to increase sympathetic firing (increase HR and BP)

71

What do the central and peripheral chemoreceptors detect?

Peripheral - decrease PO2, increase PCo2, decrease pH
Central - pH and PCo2
-affects respiratory rate

72

Causes of R --> L shunts (blue babies)

5 Ts - Truncus arteriosus, Transposition of the great vessels, Tricuspid atresia, Tetralogy of fallot, Total anomalous pulmonary venous return

73

Things seen in Tetralogy of Fallot

1) Pulmonic valve stenosis
2) RVH - boot shape on CXR
3) Overriding aorta
4) VSD
-due to defect in infundibular septum
-only right to left shunt during crying, fever, exercise due to exacerbation of RV outflow obstruction; squatting improves cyanosis

74

Glut receptors

GLUT-4 = skeletal muscle, adipose (need insulin)
GLUT 2 = Beta islet cells pancreas, liver, kidney, small intestine
GLUT 3 = brain and placenta
GLUT 1 = RBCs, brain, cornea

75

Presentation for Congenital Adrenal Hyperplasias

11beta-hydroxylase def - HTN, masculinization
17alpha-hydroxylase def - HTN, feminization
21alpha-hydroxylase def - masculinization, hypotension, salt wasting

76

Major cause of low Vit D and low calcium

chronic renal failure - can't make active Vit D, can't absorb Ca2+
-will have high PTH

77

Main cause for hypercalcemia

Parathyroid adenoma/hyperplasia

78

Retroperitoneal structures

SAD PUCKER - Suprarenal gland, Aorta/IVC, Duodenum (2-4th part), Pancreas, Ureters, Colon, Kidneys, Esophagus, Rectum

79

Direct vs. Indirect inguinal hernias

Direct - protrudes thru inguinal triangle, medial to epigastric vessels, goes thru superficial ring (older dudes)
Indirect - goes thru deep inguinal ring, superficial inguinal ring, and into scrotum; lateral to epigastric vessels (baby boys due to defect in processus vaginalis)

80

Plummer-Vinson syndrome

esophageal webs + anemia + dysphagia (increased risk of squamous cell carcinoma)

81

Key lab finding with Wilson disease

decrease ceruloplasmin (mutation in ATP7B gene prevents copper transport from hepatocytes)

82

Cirrhosis + diabetes mellitus + skin pigmentation; can cause dilated cardiomyopathy

Hemochromatosis - mutation in HFE gene causes too much iron absorption

83

Most common causes of pancreatitis

increased triglycerides, alcohol, ERCP, gallstones, scorpion sting, mumps

84

Neutrophil chemotactic factors

IL-8, LTB4, Kallikrein, platelet-activating factor, C5a

85

Structure of fetal and adult hemoglobin

fetal - 2 alpha, 2 gamma = HbF (higher affinity for O2, lower affinity for 2,3-bpg)
adult - 2 alpha, 2 beta = HbA1

86

Decreased IQ, growth impairment, abdominal pain, hearing problems, wrist and foot drop, basophilic stippling on smear + microcytic anemia

Lead poisoning - inhibits ALA dehydratase and ferrochelatase

87

Decrease iron, decreased TIBC, increased ferritin

Anemia of chronic dz - iron is sequestered in macrophages due to increased hepcidin

88

Symptoms of TTP

FAT RN - fever, anemia, thrombocytopenia, renal and neuro symptoms
-defect in ADAMTS13 --> can't cleave vWF

89

Reed sternberg cells (owl's eyes), CD15+, CD30+

Hodgkin lymphoma

90

Renal failure + bone lytic lesions/back pain + hypercalcemia + anemia

Multiple Myeloma

91

Causes of ectopic EPO

Pheocromocytoma, Renal cell carcinoma, Hepatocellular carcinoma, Hemangioblastoma

92

Keratin cysts (horn cysts)

Seborrheic keratosis

93

Drugs causing SJS

penicillins, allopurinol, seizure drugs, sulfa drugs

94

Skin cancer that appears as a pink pearly lesion with rolled edges, possible central ulceration; histology shows palisading nuclei

Basal cell carcinoma - unlikely to metastasize

95

Skin cancer that appears as ulcerative lesions on face, lips, ears, hands; histo shows keratin pearls

Squamous cell carcinoma - risk factor is actinic keratosis

96

Skin cancer that commonly originates from moles; histo shows nests of melanocytes; S-100 tumor marker

Melanoma - least common, most likely to metastasize

97

Cause of resp. alkalosis-metabolic acidosis

Salicylates (aspirin)

98

Stabilizes microtubules to prevent neutrophil chemotaxis

Colchicine - tx for acute and preventative gout

99

Bilateral cape-like loss of pain and temp sensation in upper extremities

Syringomyelia - associated with Chiari I malformation, obstructs anterior white commissure at C8-T1

100

Innervations of Tongue

Anterior 2/3 - taste from VII, sensation V3 (branchial arches 1 & 2)
Posterior 1/3 - taste and sensation IX (glossopharyngeal); extreme posterior is CN X (branchial arches 3 & 4)

101

Motor innervation of tongue

CN XII (hypoglossal) does all motor innervation except for palatoglossus (innervated by CN X)

102

Stages of Sleep

awake - beta waves
eyes close - alpha waves
N1 - theta waves
N2 - sleep spindles and K complexes; bruxism
N3 - deepest non-REM, sleepwalking, night terrors, bedwetting; delta waves
REM - beta waves, loss of motor tone; dreaming, night mares, erection, narcolepsy

103

Functions of limbic system

Fleeing, Fighting, Feeling, Fornication, Feeding

104

Lesion in subthalamic nucleus of basal ganglia

hemiballismus (contralateral lacunar stroke)

105

Essential tremor vs. Intention tremor vs. Resting tremor

Essential - occurs with movement and at rest, often familial
Intention - worse with movement (cerebellar dysfunction)
Resting - better with movement (Parkinson)

106

Hemispatial neglect

damage to non-dominant parietal cortex - ignore left side of world if lesion on right

107

Damage to dominant parietal cortex

Gerstmann syndrome - agraphia, acalculia, finger agnosia, left-right disorientation (lesion usually on left side)

108

Cause of subarachnoid hemorrhage

rupture of berry aneurysm - most likely at bifurcation of ACA and anterior comm. artery, trauma or AVM w/ hx of Osler-Weber-Rendu, worst HA of their life, blood in spinal tap

109

Rupture of middle meningeal artery

Epidural hematoma - lucid interval, lens shape that does not cross suture lines, often secondary to skull fracture

110

Rupture of bridging veins

Subdural hematoma - associated with mild trauma in elderly and shaken babies, crescent shape hemorrhage that CROSSES suture lines

111

What is damaged in someone with HTN and intraparenchymal hemorrhage?

basal ganglia and internal capsule

112

Urinary incontinence + dementia/confusion + ataxia with magnetic gait

Normal pressure hydrocephalus - elderly, reversible dementia with shunt (wet, wobbly, wacky)

113

Layers of lumbar puncture

skin --> fascia --> supraspinatous ligament --> interspinous ligament --> flavum ligamentum --> epidural space --> dura --> subdural space --> arachnoid --> subarachnoid (CSF)

114

Staggering gait, frequent falls, DM, hypertrophic cardiomyopathy, kyphoscoliosis in childhood

Fredreich ataxia - trinucleotide repeat in frataxin gene

115

Difference between delusions and hallucinations

Delusions - false belief despite facts stating otherwise
Hallucinations - perception of external stimuli (auditory most common with psych illness)

116

Bipolar I vs. Bipolar II

Bipolar I - at least 1 manic episode +/- hypomanic or depressive episode
Bipolar II - hypomanic and a depressive episode

117

Cafe-au-lait spots, Lisch nodules (pigmented iris hamartomas), cutaneous neurofibromas, optic gliomas, pheocromocytomas

NFN - type 1

-neurofibromas originate from neural crest cells

118

First line tx for open angle glaucoma

latanoprost (PGF2alpha) - increases aqueous humor outflow; can see darkening of the iris (browning)
Timolol (beta blocker) - decrease synthesis

119

Defect in POTTER sequence

Pulmonary hypoplasia
Oligohydramnios
Twisted face
Twisted skin
Extremity defects
Renal agenesis

120

Causes of hyperkalemia

Digitalis, Hyperosmolarity, Lysis of Cells, Acidosis, Beta-blockers, high blood sugar
-see peaked T waves on ECG
-tx with Ca2+ to stabilize heart and then give beta agonist, IV insulin and dextrose, IV bicarb

121

Defect in acidosis and alkalosis

low pH + low HCO3 = metabolic acidosis
low pH + high PCO2 = resp. acidosis
high pH + high HCO3 = metabolic alkalosis
high pH + low PCO2 = resp. alkalosis

122

Compensation for acid-base

metabolic acidosis = hyperventilate (Lower pCO2)
metabolic alkalosis = hypoventilate (raise PCO2)
resp. acidosis = retain HCO3 (delayed effect)
resp. alkalosis = excrete HCO3 (delayed)

123

Neural crest derivatives

MAGIC COPS - Melanocytes, Aorticopulmonary septum, Ganglia, Iris, Cromaffin cells, Cranial nerves, Ossicles/odontoblasts, Parafollicular cells, Sclera

124

Defects seen in Turner syndrome

streak ovary (ovarian dysgenesis), bicuspid aortic valve, coarctation of aorta (femoral