Mini 3 - week 7-11 Flashcards
(1000 cards)
1
Q
What happens if bacteria process UDP-glucuronide?
A
They remove glucuronic acid and it becomes urobilinogen. This is mostly oxidized to stercobilin, but some is reabsorbed to portal circulation and then converted to yellow urolibin and excreted by the kidneys into urine.
2
Q
How does somatic hypermutation happen?
A
AID (activation-induced cytidine deaminase) alterns binding affinity.
3
Q
Describe the structure of the thymus. How does it stain?
A
Thin CT capsule from which trabeculae extend into the parenchyma (divided into lobules). Only has efferent lymphatic vessels. Cortex stains dark, medulla light (less thymocytes).
4
Q
What does the thyroid gland and parathyroid glands produce?
A
Thyroid hormone - rate of metabolism, Calcitonin - rate of calcium metabolism. Parathyroid produces PTH (parathormone) which controls calcium and phosphate metabolism.
5
Q
What % of leukocytes are eosinophils?
A
1-3%
6
Q
What are the ypypes of calvaria fractures?
A
Linear (most common, occurs at impact point and radiates out), Depressed, Comminued (bone broken into several pieces), Countercoup/counterblow (fracture at opposite side of blow).
7
Q
What is inflammation?
A
The first response to infection or trauma. Cytokines releaed, vasodilation, increaed vascular permeability. Rubor (red), calor (warmth), tumor (swelling), dolor (pain).
8
Q
Describe the structure of the spleen.
A
2nd largest immune organ in the body, filters blood of aged and damaged erythrocytes. Enclosed by dense CT capsule from which trabeculae extend into parenchyma. Has only efferent lymph vessels. 75% red pulp and 25% white pulp.
9
Q
Describe the path of the 3rd part of the duodenum.
A
Transverse/inferior/horizontal part. It crosses ~L3 posteriorly under SMA and anteriorly over IVC. It’s the longest part of the duodenum.
10
Q
What is the venous drainage of the liver?
A
The hepatic portal vein (union of SMV and splenic vein). Hepatic veins drain into the IVC.
11
Q
What are some suicide risk assessment/warning signs?
A
Recent threats/actions to harm/kill self, focusing/talking/writing about suicide or death, hopelessness or feeling trapped, reckless behaviour, increased substance use, significant change in behaviour/mood, anxiety, sleep problems.
12
Q
How is iron transported across membranes? Through blood?
A
Ferroxidases cooperate with transporters by turning Fe3+ into Fe2+ so it can move across. Through blood it’s transported with transferrin (2 Fe3+s).
13
Q
What PAMP does TLR2 recognize?
A
Peptidoglycan.
14
Q
What are platelets?
A
Tine 2-4um pieces of a cell. Derived from a megakaryocyte (~10 day lifespan). They have lysosomes, mitochondria, some golgi and ER, an extensive cytoskeleton, and 3 types of granules.
15
Q
What are the three parts of the muscular part of the diaphragm?
A
Sternal (2 muscular slips from xiphoid process), Costal (forms domes, interdigitates with transversus abdominis), Lumbar (arises from medial and lateral arcuate ligaments, forms right and left crura - right is bigger).
16
Q
What is methotrexate?
A
A competitive inhibitor of DHFR.
17
Q
What is the insertion of the transversus abdominis?
A
Pubis via conjoint tendon, linea alba.
18
Q
Describe the caval opening of the diaphragm.
A
Most anterior, T8. IVC, liver lymph vessels, right phrenic nerve pass through.
19
Q
What is the arterial supply and venous drainage to the adrenal glands?
A
Superiorly from the inferior phrenic arteries, middle from the aorta, inferior from the renal arteries. The right suprarenal vein drains into the IVC, the left into the inferior phrenic vein (which goes into the left renal vein).
20
Q
What is a deficiency of Factor XI called?
A
Hemophilia C (no joint bleeding). Autosomal recessive.
21
Q
What are the axillary LNs?
A
Pectoral anteriorly, subscapular posteriorly, humeral laterally. Go to central, then to apical, then to supraclavicular. Efferent vessels form the subclavian lymphatic duct.
22
Q
Where will ovarian cancer usually metastasize to?
A
The lumbar/lateral aortic lymph nodes. Can eventually spread to supravclavicular.
23
Q
What is tyroxine binding protein?
A
It’s the highest affinity T3 and T4 transporter.
24
Q
Describe the symptoms of beta thalassemia.
A
Crew-cut appearance, anemia >6-9 months, retardation of growth and sex maturation, iron overload, splenomegaly, skeletal changes. alpha hemoglobin chains aggregate/precipitate and cause hemolysis. Cells are microcytic and hypochromic.
25
What is the name of the "hilum" of the testes, where the neurovascular structures enter and leave the testes?
Rete testis/mediastinum. It's on the posterior surface.
26
What muscle furrows the brow?
Corrugator supercilii.
27
What are the arteries and veins and lymphatic drainage of the scrotum?
Anterior/posterior scrotal branches of arteries and veins. Drains into superficial inguinal lymph nodes.
28
How do you do a corrected reticulocyte count?
If there is anemia, multiply by Hct/45. Is there is high polychromasia (presence of immature RBCs), divide by 2 again.
29
What is leukopenia ?
Low white blood cells in circulation (not marginating or storage pool!)
30
What are thoracoabdominal nerves?
When spinal nerves pass the costal cartilage they change their names. T7-L1 do this. T12 is subcostal under the 12th rib. L1 divides into the ilioinguinal and ilihypogastric.
31
What is the sympathetic, parasympathetic innervation, general venous and lymphatic drainage to the hindgut?
Lumbar splanchnic nerves L1-L2 and inferior mesenteric ganglion, Vagus nerve, IMV, IM LNs.
32
What is the HbF % in HbSS genotype?
2-20%.
33
What are the borders of the muscular triangle? What does it contain?
Superior belly of omohyoid, SCM, neck midline. Infrahyoid muscles (omohyoid, sternohyoid, thyrohyoid, sternothyroid).
34
What is mesentery?
Connects organs to the posterior abdominal wall, double layer of parietal peritoneum.
35
What is the venous drainage to the diaphragm?
Thoracic surface: pericardiacophrenic, musculophrenic (to internal thoracic), superior phrenic (to IVC or azygos). Abdominal surface: inferior phrenic (right to IVC, left anteriorly to IVC, posteriorly to left renal vein).
36
Describe the midgut/small intestine embryonic development.
Week 5 the midgut rapidly expands into a U-shaped loop around the SMA. The cranial limb forms the distal duodenum, jejunum, upper ileum. The caudal limb forms the rest of ileum and distal midgut. Week 6 the liver growth causes midgut herniation where it rotates 90 degrees counterclockwise around the SMA. Around week 10, the intestines return to the abdominal cavity and rotate another 180 degrees. In month 2, the small intestine lumen proliferates then recanalizes. The tissue rearranges to yield villi and crypts with stem cells. The different cell types are formed by the end of month 6.
37
What's the most common complement deficiency?
C2
38
What are the types of risk for suicide?
Chronic/static or acute/dynamic.
39
How do the red and white pulp of the spleen look histologically?
White pulp darker - red/purple.
40
What is extrophy of cloaca associated with?
More severe than extrophy of bladder. Associated with extrophy of bladder, emphalocele, spinal defect, imperforate anus.
41
Describe initial and acute appendicitis symptoms.
Initial - secretions trapped, stretch visceral peritoneum. Periumbilical region pain. Acute - parietal peritoneum irritated. Pain in McBurney's point.
42
What is a congenital umbilical hernia?
Musculature doesn't close the umbilical ring. Is most common in preemies, can close spontaneously by age 2.
43
Where will testicular cancer eventually metabolize to?
The pre-aortic lymph nodes.
44
Describe the ilohypogastric nerve.
L1. Innervates abdominal muscles and skin of inguinal and pubic region.
45
What do sickle-cell heterozygotes have an advantage against?
Plasmodium falciparum anemia.
46
How do people get Cobalamin/Vitamin B12?
It's made in bacteria, and so it's only available from animal products. It is the rarest vitamin.
47
What are the symptoms of having 30-50% methemoglobin?
Fatigue, confusion, dizziness, tachypnea, palpitations.
48
What is the prothrombin time test?
PT test. It differentiates the extrinsic and common pathways. 12-16s is normal.
49
What is the innervation of quadratus lumborum?
Anterior rami of T12-L4.
50
What does the iliolumbar artery supply?
The posterior abdominal and pelvic wall.
51
Describe hemoglobin alpha and alpha like subunits and where they're made.
Alpha is made starting in the embryonic period but the stem cell location changes from the yolk sac to the liver to the gut to the bone marrow. Zeta bubunits are made in the yolk sac only.
52
What is a hapten?
Something that must be conjugated to a protein carrier to provoke an immune response. Generally only has one epitope.
53
What does the lumbar lymphatic trunk drain and drain into?
The lower limb, pelvis, kidneys, most of abdominal viscera. Enters cisterna chyli (dilated sac at inferior thoracic duct) at L1/L2.
54
What are the anastomoses within the artieres branching from the celiac trunk?
The left and right gastric arteries, also the right and left gastro-omental arteries.
55
What provides cutaneous innervation to the posterior head?
Spinal nerves C2-C3.
56
What are the specific arterial supplies to the different parts of the stomach?
Right and left gastric arteries to lesser curvature, right and left gastro-omental arteries to greater curvature, short/posterior gastric arteries to fundus.
57
What is methemoglobin? What is it used to treat?
Hemoglobin found to ferric iron - cannot bind oxygen, is a deep bluish chocolate brown. Sometimes hemoglobin turns into MetHb spontaneously. An NADH dependent reductase is needed to get it back to Hb. It's used as a treatment for cyanide poisonind (binds cyanide with high affinity, poorly reversible).
58
Describe an epidural hemorrhage.
Often caused bu the meningeal arteries. Blood accumulates uickly. Hematoma is biconvex/disc shaped, and bounded by sutures. Presents s headache, lucid interval for some hours, then drowsiness and coma.
59
Describe all hemolytic anemias.
Ineffective erytoropoiesis (iron absorption increased), increased EPI, erythroid hyperplasia in bone marrow (bony deformities), decreased hemoglobin, increased reticulocytes (if well nourished),
60
What is the parasympathetic innervation to the lacrimal gland?
Stimulates production of fluid.
CN VII has a branch called the greater petrosal nerve (joins with deep petrosal nerve) and branches into nerve of pterygoid canal. THis synapses in the pterygopalatine ganglion. Then the fibers join with the CN V2 zygomatic branch and get to the lacrimal gland.
61
What are thymus-independent antigens?
Stimulate B cells without signal from T cells. LPS, polysaccharide. There is no class switching or affinity maturation so response is limited.
62
What does testosterone do to RBCs?
Increases oxygen carrying capacity.
63
What is a shift to the left?
Increased immature neutrophils in the blood, large # of band cells. Indication of bacterial infection.
64
What is the sympathetic, parasympathetic innervation, general venous and lymphatic drainage to the midgut?
T9-T12 splanchnic nerves and superior mesenteric ganglion, Vagus nerve, SMV, SM LNs.
65
Describe a hematocele.
A collection of blood in the tynica vaginalis (possibly from a ruptured testicular artery). Opaque on transillumination.
66
Where do the ovaries descend to in development?
They descend inferior to the pelvic brim.
67
What are the two types of beta-thalassemia?
Minor/trait (one normal allele), or major/Cooley's Anemia (no normal alleles).
68
What are the retroperitoneal organs? Which of those are secondary?
Only partially wrapped in visceral peritoneum. Suprarenal glands, Aorta and IVC, Duodenum (2nd, 3rd, 4th parts), Pancreas (all but tail), Ureters, Colon (ascending and descending), Kidneys, Esophagus, Rectum (proximal 2/3). The secondary retroperitoneal organs are the Duodenum, Pancreas, Colon.
69
What does the seminal gland/vesicle develop from embryonically?
A later outbudding of the mesonephric duct.
70
Describe the intrinsic pathway of clotting.
Platelets bind to exposed vollagen via glycoprotein Ia/IIa. vwF binds glycoprotein Ib/X/V complex to further anchor platelets. Glycoprotein VI binds collagen and initiates integrin binding the platelet to collagen, and integrin activation stimulates degranulation (release of vWF, ADP, PAF, TxA2, platelet factor 4, polyphosphates). Polyphosphates activate Factor XII (autocleaves). XIIa cleaves XI and prekallikrein. XIa cleaves IX. IXa activates X in the presence of platelet phospholipids, Factor VIII, and Ca2+). Xa activates prothrombin and it becomes thrombin. Thrombin activates Factor XIII and fibrinogen (-\> fibrin). Head to tail non covalent fibrin assembly happens via Factor XIIIa which is a transgluaminase that crosslinks fibrins.
71
Where does breast lymph drain into?
The subareolar lymphatic plexus. 75% to pectoral LNs, 25% to parasternal or subdiaphragmatic.
72
How is deferoxamine administered and excreted?
IM, IV, or SQ. Excreted in urine.
73
How is thrombin involved in fibrinolysis?
it activates the thrombin-activatable fibrinolysis inhibitor.
74
Around what level is the horseshoe kidney?
L3, IMA blocks ascent.
75
How is B12 taken up?
Initially bound to transcobalamin I (TCI) secreted by salivary glands. Then it binds IF secreted by the parietal cells of the stomach. The B12/IF complex is absorbed in the ileum (recovered B12 excreted in bile). In blood B12 is transported in complex with TCII.
76
What is contained by the prevertebral layer of the deep fascia?
Paraspinous muscles, phrenic nerve. It extends laterally as axillary sheath, the anterior extension is the Alar fascia.
77
What is drug efficacy?
Largest effect that a drug can produce, regardless of dose.
78
What is the insertion of the internal obliques?
Pubic via conjoint tendon, ribs 10-12, linea alba.
79
What is myoglobinuria?
Muscle damage, drug abuse, and malignant hypothermia causes myoglobin in blood and urine.
80
What does Th2 secrete?
IL-4, IL-5, IL-13.
81
How is a retrograde urethrogram done?
Contrast shot into the urethra.
82
What does the round ligament of the uterus do?
Holds the fundus forward. Goes through the inguinal canal, inserts into the subcutaneous labia majora.
83
How does hemoglobin stain on a wright stain?
Pink/red.
84
What are the Interstitial cells of Leydig? What are they derived from?
Found between the testis cords, they make testosterone by week 8. They are derived from the mesoderm of genital ridges.
85
What are the branches of CN V1 (Opthalmic division).
Supraorbital, supratrochlear, lacrimal, infratrochlear, external nasal.
86
Describe the lesser omentum.
Double layered structure of visceral peritoneum that connects the transverse colon to the lesser curvature of the stomach. It is divided into the thin membranous hepatogastric ligament and the thick hepatoduodenal ligament, the free edge of which contains the portal triad.
87
What does the deep facial vein drain?
The pterygoid venous plexus.
88
Which kidney is lower?
The right kidney - left is also slightly under rib 11 and they're both under 12.
89
What are the common swollen lymph nodes?
Cervical, axillary, inguinal. Deep ones - jugulodigastric (often associated with tonsilitis), jugulo-omohyoid (often associated with tongue cancer), supraclavicular (the left ones are Virchow's nodes).
90
Describe follicular hyperplasia.
Lymphadenitis with enlarged secondary follicles (activated B-cells, macrophages). Occurs in rheumatoid arthritis, early HIV, toxoplasmosis.
91
What is the action of the transversus abdominis?
Maintains posture and supports abdominal viscera.
92
What's the major change from basophilic erythroblast to polychromatophlic erythroblast?
The polyribosomes decrease the hemoglobin comes in which is acidophilic.
93
How is vWF normally found?
Attached to VIII.
94
What organs comprise the midgut?
2nd, 3rd, 4th part of duodenum, jejunum, ileum, cecum, appendix, ascending colon, proximal 2/3 of transverse colon.
95
What is the insertion of psoas major?
Lesser trochanter of femur.
96
What is a congenital inguinal hernia?
Descent of intestine into scrotum because the connection between the peritoneal cavity and processus vaginalis is not obliterated.
97
What does the lateral sacral artery supply?
The skin and muscle posterior to the sacrum. It travels alonf the posterior pelvic wall.
98
When do blood cells begin developing embryologically? Where do they develop?
3-4th week of gestation blood precursor cells arise from the yolk sac mesoderm. 5th week the liver and spleen are in charge of hematopoiesis. By the 5th month of gestation the blood cells are derived from stem cells in the bone marrow.
99
What is the formed fraction?
All the cells and platelets of blood. 37-54%.
100
How do you get a bifid and an ectopic ureter?
Early splitting of ureteric bud and 2 ureteric buds, respectively. The ectopic uterer may move more caudally and drain outside of the urinary bladder.
101
What is iron a cofactor in in the body?
Heme, cytochromes, catalase, nitrogenase, transferrin, ferritin, lipooxygenases, IRE-BP.
102
What is the location and function of the epididymis?
Posterior surface and superior pole of the testes. It stores sperm until maturation occurs, the tail is continuous with the vas deferens.
103
What do you call a kidney infection?
Pyelonephritis.
104
What % of leukocytes are basophils?
0-0.75%
105
What makes up the reactive part of MCHII?
alpha1 and beta1 subunits.
106
Which IJV is better for a needle/catheter?
The right one, it's straighter.
107
What organs does the H1 receptor work on and what type of receptor is it?
Smooth muscle, Gq
108
What is infectious mononucleosis?
EBV or CMV (causes IM-like illness). Kissing disease. Fever, sore throat, gray-white membrane on tonsils, hepato.splenomegaly, lymphadenopathy in posterior cervical, axillary, and groin LNs. Lab tests in the Paul-Bunnel test show heterophile (nonspecific) IgMs. Few patients may test negative in the first week, is a self-limited issue and will resolve in 4-6 weeks. Potential complication splenic rupture.
109
Where can the urine leak into in a ruptured urethra in males?
Into the peritoneum and accumulate deep to Colles' Fascia and spread under Dartos/Scarpa's fascia. A straddle injury can cause this.
110
How much blood does an average adult have?
5-6L, ~7% of body weight.
111
What is the insertion of the external obliques?
The pubic tubercle, anterior ilac crest, linea alba.
112
List the intrinsic muscles of the eye.
Ciliary muscles (adjust lens thickness), dilator pupillae, sphincter pupillae.
113
How can a testicular carcinoma spread?
Through the lumbar LNs or through the valveless internal venous plexus. Can reach spine, brain, liver.
114
What are some morphological changes in neutrophils due to sepsis or severe inflammation?
Toxic granules (coarser and darker than normal), Dohle bodies (dull grey inclusions that are patches of ER), cytoplasmic vacuoles (phagolysosomes).
115
What is the origin of the external obliques?
Ribs 5-12.
116
What are the contraindications of deferasirox?
Hypersensitivity, impaired renal function, platelet counts below 50,000/mm, advanced malignancies, high-risk myelodysplastic syndromes.
117
What does a2-macroglobulin do?
AKA transcuprein. It is a protease inhibitor of plasmin, thrombin, and kallikrein, also is a carrier of cytokines and growth factors, and is a Zn and Cu transporter.
118
What are selectins?
Adhesion molecules, heterophilic - binds cell to carbo of other cell. Lymphocytes have L-selectins, Endothelial cells have P/E selectins (carb on leukocytes).
119
What is the pelvic floor/diaphragm responsible for?
Supports viscera, resists increases in intraabdominal pressure, controls anal opening, vagina, urethra, raises floor on contraction.
120
Which secondary lymphoid organs are encapsulated?
All of them except MALT and some of tonsils.
121
What are the potential causes of neutropenia?
Inadequate/ineffective granulopoiesis, accelerated destruction or sequestration of PMNs, megaloblastic anemia, drug toxicity (most comomn MCC, alkylating agents, antimetabolites).
122
What is the half-life and dosing schedule of darbepoietin alfa?
21-49 hours, weekly/biweekly.
123
Where does CN I exit the head? What's it called?
Cribiform plate. Olfactory Nerve.
124
What does the superficial epigastric artery branch from? Is it deep to the rectus sheath?
The femoral artery (distal to the inguinal ligament). It is superficial to the rectus sheath.
125
Describe the perineal membrane.
Strong fascia perforated by urethra and vagina, provides attachment for superficial external genitalia.
126
Describe IgG.
Secreted as monomer, 2nd Ig to be secreted in immune response, most abundant type in blood and lymph. Activates classical complement, opsonizes (triggers phagocytosis and ADCC), neutralizes. Can cross the placenta.
127
When does the embryological development of the stomach epithelium take place?
In the late embryonic period. Rugae then pits. Cell type differentiation occurs in the early fetal period, HCl production begins before birth.
128
When does delayed inflammation occur?
Chronic liver disease, all acute phase of inflammation proteins elevate, albumin elevates, gamma globulins elevate.
129
Do the facial veins have valves?
No
130
What vessels are embedded in the parotid gland?
External carotid a., retromandibular v.
131
If basophils and mast cells look basically the same, how do you tell them apart through a microscope?
Generally, if it's in CT its a mast cell, if it's in blood its a basophil.
132
What is the cause of X-SCID?
Defect in gamma chain of several cytokine receptors - IL-7R defect prevents DN thymocyte maturation.
133
What are the anastomoses between the SMA and IMA?
The middle colic and left colic arteries. Form the marginal artery of Drummond.
134
What is the general arterial supply to the pelvic cavity?
The internal iliac artery, but abdominal arteries enter the pelvic cavity (superior rectal (IMA), gonadal (aorta), median sacral (aorta).
135
What does electrophoresis look like in protein losing conditions e.g. nephrotic disease?
All peaks decreased, large proteins lost less than smaller ones. a2-macroglobulin is big (720kDa), lost less.
136
What is Hesselbach's triangle?
A weak area in the posterior inguinal canal between the medial and lateral peritoneal folds. Medial border - lateral wall of rectus abdominis Lateral border - inferior epigastric vessels Inferior border - inguinal ligament
137
What are follicular DCs?
Found in germinal centers, have processes that trap the antigen. Are not antigen presentinc cells. WHen lymphocytes bind the antigens they have on their processes, they suck up GFs to stay alive.
138
How can scalp infections get to the brain?
Layer 4 has a direct route to the cranial cavity via the emissary vein. Bacteria can go to the eye but not the neck because occipitalis inserts into bone.
139
What does a1-antichymotrypsin do?
Inhibits cathepsin G (neutrophils) and chymases (mast cells).
140
How is albumin produced?
In the liver as preproalbumin. In the ER the N-term tail is cleaved, then it is sent to the golgi where there is another N-term cleavage.
141
What are the vestibular glands of the genitals?
Greater/Bartholin's is in the superficial perianal pounch on either side of the vestibule of vagina, and they secrete mucus in arousal. Lesser/Shene's are paraurethral glands on either side of vestibulr of vagina, open into vestibule near urethra and secrete mucus to moisten labia and vestibule.
142
What is the blood supply and lymphatic drainage of the duodenum?
Pancreaticoduodenal arteries, drainage to hepatic portal vein. Lymphatic drainage to celiac and SM LNs.
143
Are there any LNs in the scalp?
No
144
Describe a varicocele.
A dilated pampiniform plexus in the testicles. Common on left (nutcracker syndrome). Looks like a bundle of worms, usually disappears when lying down.
145
What factors use platelet lipids as cofactors?
IX and X.
146
How do you identify reticulocytes on a PBS?
WIth supravital stains. Their presence signifies erythropoiesis.
147
Describe a subarachnoid hemorrhage.
Caused by cerebral arteries. Can result from berry aneurysms. Blood found in the CSF.
148
What is a deficiency of Factor VIII called?
Hemophilia A (x-linked recessive).
149
What does the vaginal artery supply?
Just in women, the inferior bladder and the vagina. Usually branches from the uterine artery.
150
What is Renal Vein Entrapment Syndrome?
The left renal vein becomes trapped between the aorta and SMA. Causes renal venous hypertension and left varicocele.
151
What cytokine induces production of secreted PRRs?
IL-16. Macrophages make it, induced by bacteria. Some examples are SP-A, SP-A, mannose binding lectin, fibrinogen, serum amyloid protein, C-reactive protein.
152
Describe acute iron toxicity and how to treat it.
Almost exclusively seen in young kids that ingest ora tablets. Leading cause of accidental poisoning death in kids \<6. Gastroenteritis, voiting, shock, lethargy, abdominal pain, bloody diarrhea, dyspnea, acidosis, coma, death. Induce vomiting and give iron antidote.
153
What mutations cause deficiency in leukocyte adhesion?
CR3 or CR4 B chain mutation - B chain is shared by CD11 and CD18 family of integrins - lack of adhesion causes neutrophil recruitment deficiency.
154
Describe the thoracolumbar fascia.
Covers deep back muscles. Posterior sheath is thick, lumbar part of posterior sheath extends between the 12th rib and the iliac crest and attaches laterally to the internal obliques and transversus abdominis. Includes quadratus lumborum and psoas fascia.
155
What tooth can the fracture of the angle of the mandible involve?
The alveolus of the 3rd molar. The fracture is also usualy oblique.
156
What does a1-alphatrypsin do?
Inhibits trypsin, elastase (neutrophils), and other proteases.
157
What are the actions of the inferior oblique of the eye?
Elevation, abduction, extorsion.
When eye abducted, only extorsion. WHen adducted, only elevation.
158
How do you treat a hernia?
Herniopathy or herniorrhaphy.
159
What is contained by the Pretracheal/Middle layer of the deep fascia?
Muscular layer has the infrahyoid 'strap' muscles, Visceral layer has pharynx, larynx, trachea, esophagus, thyroid, parathyroid glands, buccinator, constrictor muscles of pharynx.
160
What cells do Th1 cells activate?
Macrophages, increase its killing capacity.
161
What is the half life and dosing schedule of epoietin alfa?
4-13 hours, 3x/week.
162
What is the action of the external obliques?
Bilaterally - flexion of the trunk and compression of viscera. Unilaterally - Lateral flexion and contralateral trunk rotation?
163
What happens if the lumen of the Allantois persists?
Urachal cysts or fistulae or sinus. May include leakage of urine from the umbilicus, UTIs, peritonitis.
164
What organs does the H2 receptor work on and what type of receptor is it?
Stomach, heart, mast cells, Gs
165
What is the structure of hemoglobin?
Tetramers with 2 alpha and 2 beta subunits - each subunit binds a heme which binds an oxygen and oxygen binds cooperatively.
166
Describe congenital A1AT deficiency.
Autosomal recessive. Age of onset 20-50 after an illness that stresses the liver or lungs. Most commonly caused by errors in folding/processing. 1/2500 in all europeans, 3% of all COPD. Pleiotropic gene, most common mutation of severe form is Glu342Lys.
167
What does the bleeding time test identify?
Platelet function disorders.
168
Describe B cell activation by T cells.
T cells go to follicles, reduce CCR7 expression, increase CXCR5 expression. B cells get activated and increase CCR7 expression, migrate and present Ag to Th, which gives signals to isotype switch.
169
What is the tentorial notch?
The anterior free edge of the tentorium cerebelli.
170
Describe basophils.
\<1% of the total leukocyte population. S-shaped nucleus not very visible. Contains heparin and histamine like mast cells. Adds to inflammatory process (histamines, serotonin, prostaglandins, leukotrienes).
171
How are alpha2 macroglobulin and a2 antiplasmin involved in fibrinolysis?
They can inactivate plasmin.
172
What are some protease inhibitors whose increased concentration can result in bleeding disorders?
antithrombin III, antitrypsin, alpha2 macroglobulin.
173
What is epistasis?
Interaction between non-allelic genes "modifier genes". May be underlying reason for some reduced penetrance phenotypes.
174
How many V/D/J chains does the antibody kappa light chain have?
30, 0, 4
175
In what state is iron bound to hemoglobin?
Ferrous (Fe2+)
176
What is formed when the lumen of the Allantois (initiallu continuous with urinary bladder) is obliterated?
The urachus (in adults the median umbilical ligament).
177
What does properdin do?
Plays a role in alternative pathway of complement activation.
178
What is the innervation of iliacus?
Femoral nerve (L2-L4).
179
What is the innocent bystander effect?
When MAC lyses normal cells.
180
What does the urogenital system derive from embryologically?
The intermediate mesoderm located along the posterior abdominal wall. The mesonephric/Wolffian duct first begins as a longitudinal rod that begins cranially and extends caudally.
181
What percent of plasma is beta globulin?
13.4%
182
What is leuvocorin used to treat?
Megaloblastic anemias, palliative treatment of advanced colorectal cancer (with 5-fluorouracil), methotrexate toxicity.
183
What are the symptoms of having 20-30% methemoglobin?
Anxiety, headache, dyspnea on exertion.
184
What are the boundaries of the inguinal canal?
Anterior wall - External oblique aponeurosis. Posterior wall - Transversalis fascia. Floor - Inguinal ligament. Roof - Conjoint tendon.
185
What does orosomucoid do?
AKA acid glycoprotein. Carrier of basic drugs, steroids, protease inhibitors.
186
What arteries are deep to the rectus abdominis?
The superior and inferior epigastric arteries.
187
What are the sites of ureter constriction?
The uteropelvic junction (L2), the uterovesical junction, and the point where it crosses anteriorly over the external iliac artery at the pelvic brim/inlet.
188
What are the potential adverse effects of darbepoietin alfa?
Hypertension, peropheral edema, edema, abdominal pain, dyspnea, cough. Risk for increased mortality/serious cardiovascular events in chronic kidney disease patients, risk for increased mortality and tumour progression in cancer patients.
189
How is oxygen bound to hemoglobin?
In the deoxygenated form, iron is above the porphyrin plane and is further chelated by a second His, moving the alpha helix and causing the alpha and beta subunits to move away from each other. Salt bridges binding identical subunits break, allowing for the subunits to twist with respect to each other. When oxygen binds, iron is foced back into the porphyrin plane and the subunits are placed together again.
190
What is the carotid body?
A chemoreceptor that senses oxygen concentration. A small mass of tissue in the septum of the medial side of the common carotid bifurcation.
191
Describe the classical and alternative complement cascades.
Classical - C1 binds an Ag-Ab complex, splits C2 and C2 into a and b - C4b2b is C3 convertase. It splits C3, C3b joins to form C5 convertase (C4b2b3b). Part of C5 goes to join C6, C7, C8, C9 which creates the MAC (makes holes that lead to lysis). The alternative pathway is when C3 is autocatalyzed (not activated by immunoglobulins).
192
What innervates the cremasteric muscles?
The GSE fibers of the genitofemoral nerve.
193
Where is most lost heme from?
85% from erythrocytes with the remainder from hepatic P450 and other cytochromes.
194
What is arcuatus?
An arcuate uterus. From incomplete fusion of the paramesonephric ducts.
195
What are the 3 peripheral body compartments?
Tissues/organs you want drug to get to, tissue reservoirs, unwanted sites of action.
196
Describe the structure of the large intestine.
Cecum, ascending colon, transverse colon, descending colon, sigmoid colon (to rectum). Right colic (hepatic) flexure and left colic (splenic) flexure. Teniae coli are 3 distinct bands of smooth muscle that run longitudinally - contract to form the Haustra (end at rectosigmoid junction). Haustra internally are called semilunar folds/plicae semilunaris. There are omental/epiploic appendices (small fatty projections). Iliocecal valve are 2 semilunar flaps around a slit-like origin.
197
What are the pros of a bone marrow sapirate and biopsy?
Aspirate - less painful, better cytologic details, report available on the same day.
Biopsy - better architectural details.
198
How do RBCs and WBCs cross into the blood?
WBCs by reverse diapedesis. RBCs enter via pressure gradient - in red BM, veins leaving are smaller than arteries entering so there is a suction that sucks mature RBCs from the stroma to the capillary.
199
Detail the embryological development of the female external genitalia.
Stimulated by estrogen. The genital tubercle forms the clitoris, the urethral folds do not fuse and form the labia minora. The genital swellings enlarge to form the labia majora. The urogenital groove is open and forms the vestibule.
200
What is the origin of the pyramidalis?
Pubic crest.
201
What is another name for the mouth opening formed by the rupture of the oropharyngeal/buccopharyngeal membrane?
Stomodeum.
202
What is acquired volvulvus of the sigmoid colon?
Twisting/rotation of mobile loops. Constipation and ischemia, can cause necrosis and immovable collection of compressed feces.
203
What is blood plasma?
The non-cell components of blood. 46-65% of blood.
204
What is it called when red blood cells are in a tiny capillary and stack up?
Rouleaux.
205
What is fibrinogen factor I?
AKA antithrombin I. A trimer of FGA, FGB, FGG gene products. Cleaved by thrombin to active form fibrin, which inhibits thrombin. It mediates clot formation and wound healing (involved in platelet spreading, endothelial cell spreading, fibroblast proliferation, capillary tube formation).
206
Where does the levator palpebrae superioris originate from and what innervates it?
The sphenoid, CNIII.
207
What does haptoglobulin do?
Binds free hemoglobin, the complex targets hemoglobin for removal by the spleen.
208
Describe IgM.
Secreted as Pentamer, first Ig to be secreted in immune response, found mainly in blood. Strong activator of classical complement.
209
What are antibody isotypes?
Differences in the constant regions of heavy chains.
210
Describe the pro-B cell.
Early does heavy chain DJ recombination, late does VDJ. Heavy chain expressed with surrogate LC (VpreB+gamma5).
211
Describe the anal triangle.
From the ischial spines to the coccyx.
212
How is MHCI processed?
Endogenous antigen binds TAP channel which carries proteins into the R. When it binds TAP, a tapasin binds the antigen onto MHCI. Then the complex is exported to the surface.
213
What does a JAK3 mutation lead to?
SCID.
214
What are the infraperitoneal organs?
They are only partly covered by parietal peritoneum. The distal 2/3 of the rectum, urinary bladder.
215
What cells are in lymphoid tissue besides lymphocytes?
DCs, (APCs derived from monocytes), macrophages (APCs and phagocytes), plasma cells.
216
What is the arcuate line?
Where the transversus abdominis aponeurotic fibers no longer travel posterior to rectus abdominis. It's ~1/3 from the umbilicus to the pubic symphysis.
217
What are protective factors against suicide?
Cultural/religious beliefs/fear of the outcome, future orientation/goals, sense of responsibility to family, impulse control/emotional regulation.
218
What innervates the parotid gland?
CN V3 via the auricotemporal nerve and great auricular nerve. CN IX gives parasympathetic to the otic ganglion, then to the auricotemporal nerve.
219
What's the structure of the rectum/anus?
No mesentery except the appendix. Rectum internally has folds. 3 transverse folds. Anal canal bends 90 degrees posteriorly at penvic diaphragm - anorectal flexure. Divided into upper and lower by pectinate line. There are anal columns (series of longitudinal ridges with superior rectal vessels) with valves at inferior ends. Anal sinuses (small recesses) inferior to valves.
220
What things can go wrong with esophageal development?
A short esophagus (hiatal hernia). Stenosis if recanalization fails. Congenital Barrett's Esophagus/CELLO if there's an arrest in development.
221
What is DAF?
Prevents binding of C2b to C4b and Bb to C3b. They will displace C2b and Bb.
222
What are the ways neutrophils can kill pathogens?
NETS, degranulation, phagocytosis.
223
What does the viscerocranium contain?
Inferior orbit, nasal cavity, oral cavity.
224
What are all the tonsils?
Lingual (base of tongue), pharyngeal/adenoids (roof of nasopharynx), palatine (lateral wall of oropharynx). The palatine ones have crypts from their stratified squamous epithelium covering. ALso have only efferent lymphatic vessels.
225
Describe the esophageal hiatus of the diaphragm.
T10. Muscular sphincter. Esophagus, esophageal vessels, and vagus nerve trunks pass through.
226
What are the adverse effects of epoietin alfa?
Hypertension, fever, headache, puritis, rash, nausea, vomiting, local site injection reaction. Risk for increased mortality/serious cardiovascular events in chronic kidney disease patients, risk for increased mortality and tumour progression in cancer patients.
227
What type of drug is diphenhydramine?
First-gen H1 blocker, antagonist of H1, antagonist also at muscarinic receptors. Given orally, IM, IV, or topically (the only way that can't distribute to the CNS).
228
Where are plasma proteins made? What do globulins do?
In the liver. They do transport, maintain osmotic concentrations, and gamma globulins do immune response.
229
What is the innervation of the ciliary muscles?
CN III (parasympathetic) to ciliary ganglion to short ciliary nerves.
230
How does lymph travel into the LN?
Through the endothelial lined subcaprular and peritrabecular sinuses which lead to the meshwork of medullary sinuses, which fuse and become the efferent lymphatic vessels. In the subcapsular sinuses, DCs/macrophages phagocytose things filtered from lymph.
231
What is the normal adult HbF? What genetic variation makes it persist?
\<1%. Genetic variation at position ~158 of G gammaglobin gene.
232
Describe the the degrees of perianal tears.
Primary- vagina, Secondary - perianal muscles, Tertiary - anal sphincter, Quaternary - rectum.
233
What are overdose risk factors?
Any prescription for an opioid, high dose opioid prescription, poverty, poly-substance use, age, illness, recent abstinence (e.g. jail/detox/treatment).
234
After being absorbed into the intestine, what happens to iron?
It exits back through ferroportion, at which point it is converted back to the ferric form by hephaestia or ceruloplasmin.
235
What percent of plasma is a1 globulins?
5.3%
236
What is the erectile tissue of the genitals?
Crus of penis/clitoris extends into the corpus cavernosum and blub of penis extends into the corpus spongiosum. Corpus spongiosum terminates at the glans penis, the spongy urethra travels through the corpus spongiosum. Crura covered by ischiocavernosus muscle, bulb covered by bulbospongiosus muscle.
237
What's the difference between a full agonist, partial agonist, antagonist, and inverse agonist.
Agonists produce a receptor activation (full to max level, partial to below), antagonists fail to produce activation and also block the effect of agonists, inverse agonists decrease the basal activity of the receptor.
238
Describe fibrinolysis.
Plasminogen becomes enmeshed in the fibrin matrix. It is converted to plasmin by tissue plasminogen activator (tPA, released by endothelial cells), urokinase, kallikrein, Factos XIIa, or factor XIa. The plasmin cleaves the fibrin clots but also requires fibrin as a cofactor.
239
What % of leukocytes are monocytes?
3-7%
240
What is the action of the temporalis?
Anterior part - protraction, posterior part - retraction, whole muscle - closing the mouth.
241
What is an annular pancreas?
Bifid ventral bud, encircles duodenum and can constrict it.
242
What cytokines trigger Th0 differentiation into Th17?
EC pathogens (fungi, bacteria) make DCs produce IL-1, IL-6, IL-23, TGFbeta.
243
What are some causes of ineffective hematopoiesis?
Aplastic anemia, bone marrow cancer.
244
What is the action of the rectus abdominis?
Flexion of trunk and compression of viscera.
245
How much of continence is provided by the internal anal sphincter?
80%.
246
What function does IgD have?
No known function of secreted Ab.
247
What is the nerve supply to the thyroid?
Superior/middle/inferior cervical ganglion.
248
How does pyloric stenosis develop and what are the symptoms?
Hypertrophy of the muscle layer of the pylorus. No stool, dehydration, projectile vomiting in week 2, milk-coloured vomit.
249
Why is stomach cancer difficult to deal with?
Hard to remove all lymph nodes.
250
What is the immune elimination phase of Ab-Ag response?
Formation and removal of Ag-Ab complex.
251
What does B12 do that's related to B9?
B9 is active as THF via DHF reductase (DHFR). B12 is needed for the reaction where methionine synthase turns 5-methyl-THF into THF "folate trap". - The step generating 5-methyl-THF is irreversible.
252
What do the epigenital tubules become in embryonic development?
The efferent ductules.
253
What % of testes descend before birth?
97%. The rest should finish by 3 months of life.
254
What is the Bohr Effect?
At the tissues, CA in RBCs moves the reaction toward the side of H+ and HCO3- and the decreased pH reduces hemoglobin binding affinity.
255
What does the obturator nerve course through? Also what are its nerve roots?
L2-4. It travels with the obturator artery and vein through the obturator canal and courses near the ovary.
256
Describe the red pulp of the spleen.
Filters blood. Has sinusoids and splenic cords of Bilroth. Cords made of reticular fibers. Sinusoids have no reticular cells, all blood has to enter through slits in the wall. Sinusoids lined with stave cells - incomplete basal laminae so cells can fit (at end of lifespan, RBCs can no longer fit and are phagocytosed by macrophages waiting).
257
Describe IgA.
Secreted as monomer and also dimer - dimer facilitates transport across epithelia into secretions. Most predominant ty pe in gut, is found in gut lumen, in secretions, on mucous membranes. Main function is neutralization.
258
What are microfold cells?
Found in GALT/Peyer's Patches. They transfer antigens from the lumen by phago/pinocytosis and present them to DCs/macrophages lying in invaginations of the basal cell surfaces.
259
When does liver and biliary apparatus embryonic development begin? How does it go?
End of week 3/beginning of week 4 - ventral foregut outgrowth (hepatic diverticulum/liver bud). Cranial portion forms the liver and caudal forms the bile duct - outpocketing forms the gallbladder and cystic duct. Hepatic cords form, intermingle with vitelline veins and form hepatic sinusoids,
260
What are abtibody allotypes?
Differences of alleles.
261
Where are B cells activated?
In the boundary of the T cell zone and follicle of the lymph node.
262
What is the difference between guarding and rigidity?
Guarding is voluntary and often with a grimace.
263
How does peritonitis present?
Parietal - sharp, well-localized pain. Visceral - generalized referred pain in dermatome of organ.
264
What shunts are used to treat portal hypertension?
Hepatic portal vein to IVC. Splenic vein to left renal vein.
265
Describe CX3C-chemokines.
Function through CX3CR, includes fractalkine.
266
What are peritoneal adhesions?
Visceral peritoneum abnormally adhering to the parietal peritoneum and the adjacent organ.
267
Describe the aortic aperture of the diaphragm.
Most posterior, T12. Posterior to median arcuate ligament. Aorta, thoracic duct, sometimes Azygos and hemiazygos veins pass through.
268
What is important to find when removing the gallbladder?
The cystohepatic triangle to determine if there's variation in the cystic artery and biliary apparatus. Superior border: liver Medial border: common hepatic duct Lateral border: cystic duct
269
Describe the lacrimal apparatus.
Lacrimal gland at lateral eye, with superior orbital and inferior palpebral part which are separated by the levator palpebrae tendon. Has 6-10 short ducts. At the medial eyelid there is an elevation called the superior and inferior lacrimal papilla. At each one, the opening is the punctum. A short vessel starting at the punctum is called the caaliculus, and it leads to the lacrimal sac. The lacrimal sac drains into the inferior nasal meatus via the nasolacrimal duct.
270
How do you diagnose sickle-cell disease?
Lab values: reduced hemoglobin, increased reticulocytes, Howell-Jolly bodies in PBS, possible sickle cells in PBS, increased WBCs. Can do sickling test. Hemoglobin electrophoresis will show normal HbA2, predominant HbS, present HbF. Person will have icteric sclera, frontal bossing (marrow expansion).
271
Describe M of PK-ADME. What are the major enzymes?
Metabolism - conversion of drug into different chemical substances (metabolites). Mainly in liver and in ER. Major enzymes are CYP (cytochrome P450) and UDP-glucuronosyl transferase (increases soulubility).
272
Describe the embryological development of the female internal genitalia.
Stimulated by estrogen and the absence of testosterone and AMH. The epithelium longitudinally invades the anterolateral surface of the genital ridges. Caudally, the epithelium crosses the mesonephric duct and grows toward the paramesonephric duct on the opposite side - this will become the uterine tubes. The R+L paramesonephric ducts fuse caudally - the tip of the fused part contacts the posterior urogenital sinus wall and forms the sinus tubercle. This will all become the uterus, cervix, upper vagina. The broad ligament is formed when they fuse. The sinus tbercle gives rise to the 2 sinovaginal bulbs which proliferate to form the vaginal plate (canal forms by month 5). The lumen of the vagina is separated from the urogenital sinus by the hymen.
273
What are the layers of the scrotum?
Skin, Dartos muscle (continuous with Scarpa's fascia), 3 spermatic layers.
274
What do the superior and middle thyroid veins run with?
Superior runs with superior thyroid artery, middle runs with inferior thyroid artery.
275
Where do the adrenal glands derive from embryologically?
Cortex from the mesoderm, medulla from the neural crest cells.
276
What does the caudal genital ligament form?
The ovarian ligament and round ligament of the uterus.
277
Describe a subdural hemorrhage.
Often caused by cerebral/meningeal/bridging veins. Hematoma crescent shaped, ignores sutures, creates subdural space. Precipitating trauma may be considered trivial.
278
What is the lymphatic drainage of the large intestine and rectum?
Descending, sigmoid colon, proximal rectum -\> IM LNs. Distal rectum above pectinate line -\> internal iliac LNs. Distal rectum below pectinate line -\> superficial inguinal LNs.
279
What are the iron preparation drugs and how are they administered? What are they used to treat?
Carbonyl iron (oral), Ferrous gluconate (oral), Ferric gluconate (IV), Iron dextran (IV, IM). Treat iron deficiency anemia. Ferric gluconate treats it specifically in people undergoing hemodialysis in conjunction with EPO therapy.
280
What is HbC?
Glu6Lys mutation in beta chain. SC phenotype worse than AS but better than SS. HbAC and HbCC give some protection from Plasmodium falciparum malaria.
281
Where is the obturator nerve in relation to psoas major?
Emerges from the medial border.
282
Do all lymphoid tissue have HEVs?
Yes, except spleen.
283
What is an opsonin?
Attaches to microbe surface and can be recognized by neutrophils/macrophages.
284
What is the Berry ligament?
Condensation of pretracheal fascia that attaches the thyroid to the trachea. The recurrent laryngeal nerve also passes through.
285
What are some things that mess with the pulse oximeter readings?
CO, CN, MetHb, COPD.
286
What is Meckel's/Ileal Diverticulum?
Outpocketing of ileum when vitelline duct persists. Can be inflamed and associated with symptoms resembling appendicitis. 2% of population, ~2 inches, usually within 2 feet of iliocecal valve, often in kids under 2, 2x more common in males.
287
What does the greater auricular nerve innervate?
Skin over parotid gland, mastoid process, interior ear, angle of mandible to mastoid process.
288
What causes sickle-cell anemia and who does it mainly affect?
A Glu-to-Val mutation at amino acid 6 of the beta chain. Is autosomal recessive (just one is 'trait', and affects mostly people of Black African Descent. Must be homozygous to have anemia.
289
What are some ways that microbes have learned to evade complement?
Thick walls, recruitment of host factors ro prevent activation, production of factors mimicking host proteins, production of inflammation inhibitors (e.g. Staphylococcus and CHIPS - chemokine inhibitory protein).
290
What's the major change from polychromatophilic erythroblast to orthochromatophilic erythroblast?
The basophilicity is entirely lost, and the nucleus continues to condense.
291
What is the pretracheal space?
Between investing layer and pretracheal (buccopharyngeal) layer.
292
How is fibrinogen turned into fibrin?
Thrombin cleaves of fibrinopeptides A and B and forms insoluble fibrin.
293
Where are the testes at 12, 28, and 32 weeks into development?
12 - inguinal region. 28 - migrates through inguinal canal. 32 - reaches the scrotum.
294
What organs comprise the hindgut?
Distal 1/3 of transverse colon, descending colon, sigmoid colon, rectum and anal canal above pectinate line.
295
What phenotype do compound HbS/betathalassemia mutation heterozygotes get?
Sickle cell disease, maybe made a little milder by the reduction in hemoglobin concentration.
296
Describe T cell development.
Starts in the thymus, goes to cortex where stromal cells give it signals and it proliferates for a week and acquires CD2 (DN thymocyte). Goes to the subcapsular region, beta chain does VDJ rearrangement, gets associated with CD3 and the preT alpha chain. Proliferates, alpha chain does VJ rearrangement, expresses CD4/CD8 (DP). The DP thymocyte goes back to the cortex, thymic cortical epithelial cells presents antigen - undergoes positive selection and becomes SP. Negative selection is done by bone-marrow DCs and macrophages.
297
What is febrile nonhemolytic transfusion reaction?
Destruction of transfused leukocytes (not completely pure blood sample), causes release of cytokines. Happens up to 2 hours after transfusion. Chills, rigors, fever of over 1 degree C. Mild.
298
What can cause neutrophilia?
Inflammation (infection, burns, MI), drugs like corticosteroids, adhesion and release from marrow stores.
299
Describe cloacal differentiation.
Week 4-6. Results in urinary bladder, urogenital sinus (pelvic part - membranous urethra and prostatic part, phallic part - penile urethra, vestibule of vagina). The distal portion of the mesonephric duct is incorporated into the posterior wall of the developing bladder and forms the Trigone (the rest of the bladder is formed from mesoderm).
300
Where does peritoneum derive from embryologically?
Lateral plate mesoderm. It is made of medothelium.
301
How are T-cell responses terminated?
T cell expresses CTLA-4 which binds B7 better than CD28.
302
What's the first symptom of lymphoma?
Painless swollen lymph nodes.
303
Describe the greater omentum.
4 layered visceral peritoneal structure, connects transverse colon to greater curvature of the stomach. It can move within the peritoneal cavity, is the abdominal policeman.
304
What makes the brain dura mater different fron the spine dura mater?
It has 2 layers - periosteal and meningeal. Also has no epidural fat.
305
What is the superficial lymphatic drainage to the abdominal wall?
Above umbilicus - axillary LNs. Below umbilicus - superfiical inguinal LNs.
306
What is a gastrochisis?
Ventral abdominal wall doesn't fuse at the linea alba. Intestines come out not covered by anything.
307
What is the action of the internal obliques?
Bilaterally - flexion of the trunk and compression of viscera. Unilaterally - Lateral flexion and ipsilateral trunk rotation.
308
What is suicidality?
All suicide related behaviours and thoughts including completing/attempting suicide, suicidal ideation, or communications.
309
How do blood types work?
Fucose transferase adds L-fucose to precursor (if absent, blood type is Oh), then galactosyl transferase adds either N-acetylgalactosamine (A) or D-galactose (B).
310
Where is the gallbladder located? How do all the ducts go?
Anterior under the right lobe of the liver. The right and left hepatic duct form the common hepatic duct. The cystic duct joins it at the gallbladder spinal fold and they become the common bile duct.
311
How do you treat agranulocytosis?
G-CSF, GM-CSF.
312
What PAMP does TLR5 recognize?
flagellin
313
What organs are part of innate immunity?
Skin, respiratory tract, GI tract, GU tract.
314
What are vitamin B12 preparations (including cyacobalamin) used to treat?
Pernicious anemia, vitamin B12 deficiency, increased B12 requirements (pregnancy, thyrotoxicosis, hemorrhage, malignancy, liver or kidney disease).
315
What treatment do you give for cerebral edema?
25% albumin.
316
Describe sinus hyperplasia.
Lymphadenitis with prominent sinusoids, many histiocytes. Common in nodes draining a cancer.
317
What is thromboxane?
The vasoconstrictor that induces vascular spasm.
318
Where is the deep ring of the inguinal canal?
An opening in the posterior wall lateral to the inferior epigastric vessels.
319
What are the branches of CN V3 (Mandibular division).
Auriculotemporal, buccal, mental.
320
Describe embryological development of the stomach.
First appears as fusiform, then dorsal wall undergoes rapid growth to give rapid growth. It then rotates 90 degrees counterclockwise (moving vagus nerves). It also rotates alone the AP axis and the pylorus comes down.
321
What's the difference between a plasma cell and a mature B cell?
Plasma cells secrete IgM, no longer express MHCII, long lived, can no longer respond to antigen.
322
When is LDH elevated?
MI and viral hepatitis.
323
What is the origin of quadratus lumborum?
Medial 1/2 of rib 12 inferior border, tips of lumbar transverse process.
324
How is MHCII processed?
EC protein is processed in lysosome, MHCII is made in the ER and is bound by invariant protein/CLIP. MHCII goes to the golgi and is in a vesicle, merges with lysosome. The antigen replaces CLIP with the help of HLA-DM. Then the complex is exported to the surface.
325
What are stroma?
The site in red BM where cell development occurs. Made of reticular cells/fibers - forms 3D network surrounding discrete hematopoietic cords/islands. The cords contain collagen I and III, fibronectin, laminin, proteoglycans (general ground substance) - thelaminin and fibronectin interact with integrins (the integrins are inactivated when the cell is ready to be released into the bloodstream). Stromal cells produce hematopoietic short-range refulatory molecules induced by colont stimulating factors.
326
What is the conjoint tendon made of?
The medial fibers of the internal oblique aponeurosis and the deeper fibers of the transversus abdominis aponeurosis.
327
What cytokines trigger Th0 differentiation into Th1?
IC pathogens/microbes make DCs produce IL-12 and NK cells produce IFNgamma.
328
What are the lymphatic trunks?
Unpaired intestinal, paired lumbar, bronchomediastinal, subclavian, jugular.
329
What makes something a better antigen?
Better solubility, bigger side, proteins are the best, polysaccharides are ok, nucleic acids and phospholipids weal.
330
What is CD59?
Binds C8 to prevent pore formation.
331
What veins make up the external jugular vein?
The posterior auricular vein and posterior ivision of the retromandibular vein?
332
Where do cranial nerves IX, X, XI exit the head? What are they called?
Jugular foramen. Glossopharyngeal nerve, Vagus nerve, Accessory spinal nerve.
333
What is the structure of cobalamin/B12? What does deficiency result in?
Cobalt-containing pyrrole ring system similar to porphyrins, comes in -CN, -CH3, -deoxyadenosyl. Deficiency results in anemia, later stages show neuropsychiatric symptoms.
334
What is hereditary angioedema?
C1 INH or DAF deficiency. Less serum C3, increase in edema fluid.
335
Describe phagocytosis PRRs.
Also known as scavenger receptors. Bind to bacteria (high mannose affinity), present pathogen derived proteins to T cells and facilitate phagocytosis.
336
What is the difference between folic acid and leuvocorin (folinic acid)?
Leuvocorin does not need DHFR to be converted to active THF. It's unaffected by methotrexate, actively competes with it for transport sites, dusplaces it from intracellular binding sites.
337
What are the ligaments connected to the ovary?
Mesovarium (attaches to lateral pelvic wall, part of broad ligament), Suspensory ligament (to lateral pelvic wall), Ovarian ligament (to the uterus).
338
What does the inferior vesical artery supply?
Just in men, the inferior bladder, prostate, and seminal vesicles.
339
What does a deficiency in folate/B9 result in?
Megaloblastic anemia - common in pregnant women/alcoholics. Loss of appetite, weight loss, weakness, irritability, glossitis. In developing fetuses, it can result in incomplete neural tube closure (spina bifida/anencephaly). This is the most common vitamin deficiency in the US.
340
What do plasminogen activator inhibitor 1 and 2 do?
They can act on tPA and urokinase to stop fibrinolysis.
341
Who is beta-thalassemia common in?
Black Americans, Greeks, Italians, East Asians, Indians.
342
What are the types of anemia?
Aplastic (BM), hemolytic, thalassemia, sideroblastic (inability to use Fe for heme synthesis e.g. B6 deficiency), macrocytic/megaloblastic, anemia of renal disease (low EPO).
343
What are the actions of the inferior rectus of the eye?
Depression, adduction, extorsion.
When eye adducted, only extorsion. When eye abducted, only depression.
344
What muscles flare the nostrils?
Alar part of nasalis and the levator labii superioris alaeque nasi.
345
How does 2,3 BPG affect RBCs?
Is an allosteric regulator - present in RBCs equimolar to hemoglobin. It stabilizes the deoxygenated state and therefore reduces the oxygen binding affinity and induces oxygen offloading.
346
What is the innervation of sphincter pupillae?
CN III to the ciliary ganglion to the short ciliary nerves.
347
List all the branches of the external carotid artery.
Superior thyroid, Ascending pharyngeal, Lingual, Facial, Occipital, Posterior auricular, Maxillary, Superficial temporal.
348
What is neutrophil oxidative burst?
In phagocytosis, NADPH oxidase makes H2O2 and superoxide - myeloperoxidase in lysosomes uses H2O2 to form HOCl (bleach).
349
What is intussuception?
Telescoping of one bowel segment into a distal one. Common in iliocecal junction of infants. Bowel obstruction can cause "currant jelly" stool.
350
What is the first-pass effect?
Amount of drug lost in initial metabolism (by liver).
351
What is the action of psias major?
Flex thigh at hip, balance trunk, flex vertebral column laterally, acts to flex trunk while sitting.
352
What are the symptoms of having 50-70% methemoglobin?
Coma, seizures, arrhythmias, acidosis.
353
What are the paired parietal branches of the abdominal aorta?
Branch posterolaterally and supply muscles. Inferior phrenic (T12), Lumbar (L1-L4), Subcostal (visible at L2 but is actually from the thoracic aorta).
354
What are medullary cords of lymph nodes?
Sites of high antibody production, they have B cells, plasma cells, macrophages.
355
What is the coccygeal plexus?
Made of S4, S5, coccygeal nerves. Provides skin sensation in the anal region.
356
What is the carotid sinus?
A baroreceptor - dilation of the internal carotid. The CN IX is afferent, the CN X is efferent.
357
What is a deficiency of Factor V called?
Parahemophilia.
358
What's the institutional review board?
IRB. It determines the ethicality/legitimacy of a research study including humans. Composed of at least 5 members of varying backgrounds, including a scientist, non scientist, and community member. If the study involves the vulnerable group, it must have a member familiar with the group.
359
What are the layers covering the testes?
Skin, Tunica Dartos, 3 spermatic layers, Tunica vaginalis (parietal and visceral), tunica albuginea.
360
What is MCV?
Mean corpuscular volume. PCV/#RBCs. Determines if cell is micro/normo/macrocytic.
361
What are the borders of the omotrapezoid/occipital triangle? What does it contain?
SCM, clavicle, inferior belly of digastric. Floor is anterior middle scalenes, levator scapulae, splenius capitis. CN XI, nerve point, nerves to muscles of floor, occipital artery, transverse cervical artery, cervical LNs.
362
Briefly describe IgG.
75% of free Igs, has 2 antigen binding sites, has roles in agglutination, opsonization, pathogen recognition, type II and III hypersensitivity.
363
What is chronic granulomatosis disease?
NADPH Oxidase defect - cannot make superoxide.
364
Describe the musculotendinous bands of the diaphragm.
Arise from the anterior surfaces of L1-L3, IV discs, and anterior longitudinal ligaments.
365
What happens if you have delayed anti-Jka antibodies (Kidd blood group)?
Can cause delayed hemolytic transfusion reaction.
366
When are glucagon and insulin detected?
Glucagon week 15, insulin in month 5.
367
What is drug affinity?
How tightly the drug binds to the receptor.
368
Describe an indirect inguinal hernia.
Lateral to the inferior epigastric artery. Originates from deep inguinal ring and goes through the entire inguinal canal - covered by all 3 spermatic cord layers.
369
How is folic acid administered?
Oral is preferred, deep IM, SQ, IV.
370
What are the peritoneal folds?
Medial umbilical, medial umbilical (x2), lateral umbilical (x2).
371
How do the duodenum and head of the pancreas become retroperitoneal?
As the stomach rotates in developmen, they do as well and are pressed against the dorsal body wall.
372
What is contained within the superficial neck fascia?
Fat, nerves, vessels, platysma.
373
What are the effects of diphenhydramine?
Reduction in alergic symptoms (nasal, rash), sedation and anti-Parkinsonian effects via antagonism of CNS muscarinic receptors (can be used as an insomnia short-term therapy), inhibition of nausea, vomiting, vertigo via antagonism of histaminergic and cholinergic signals from vestibular system.
374
What is the type of stem cell all blood cells come from?
PPSC (multipotent hematopoietic stem cell) that switches to myeloid (CFU-GEMM) and lymphoid (CFU-L) progenitors.
375
What are the types of alpha thalassemia?
Hemoglobin H (3/4 gene copies gone), Hemoglobin Barts (4/4 gene copies gone). Hemoglobin barts is lethal without transfusions, causes hydrops fetalis, treated by bone marrow transplantations. beta and gamma hemoglobin chains can form homotetramers so there's not much aggregation.
376
What does the lesser occipital nerve innervate?
Skin of neck and posterosuperior to auricle.
377
What's the major change from proerythroblast to basophilic erythroblast?
Loss of nucleoli (proerythroblast has visible one), cytosol becomes more basophilic. Basophilic erythroblast has lots of polyribosomes.
378
What is the lymph drainage of the pelvic region?
Superior bladder - External Iliac LNs. Inferior bladder and prostate - Internal iliac LNs. Glans penis/clitoris - Deep inguinal LNs. Ovary, uterine tube, fundus of uterus - Lumbar/Aortic LNs.
379
Describe the MI plasma protein profile.
CK and Myoglobin peak in 1st day. LDH slowly increases for first day or 2 followed by rapid decline beginning day 3. AST peaks in 2nd day. Troponin peaks around 2nd day and stays elevated.
380
What are the nerves coming from the nerve point?
Lesser occipital n. (C2), Greater auricular n. (C2-C3), Transverse cervical n. (C2-C3), Supraclavicular n. (C3-C4).
381
How do mandibular fractures usually present - bilaterally or unilaterally?
Bilaterally except for coronoid process ones which are usually singuular?
382
What treatment do you give for anemia?
Packed RBCs.
383
What are the sustenacular cells of Sertoli? What are they derived from?
Found in the seminiferous tubules, produces Mullerian inhibiting substance (AKA anti-Mullerian hormone). (suppresses paramesonephric ducts). They are derived from the surface epithelium of genital ridges.
384
Where is the minor duodenal papilla?
~2cm above the major duodenal papilla.
385
How is the bladder attached to the umbilicus?
The apex is attached by the median umbilical ligament (urachus remnant).
386
What is a chemokine on all bacteria? Why does necrosis induce inflammation?
N-formylated start methionine. Ruptured mitochondria also release these (that's a reason).
387
What is the extrinsic clotting pathway?
When there is damage to non vascular tissue. Factor III (a tissue factor) is a glycoprotein in subendothelial tissue that does not normally touch blood. It contacts blood, then binds Factor VIIa -\> this activates Factor X. Factor Xa + thrombin activates more factor VIIa.
388
In cryptorchid, what are the 4 degrees of ectopic maldescent?
Scarpa's fascia above superficial inguinal ring, root of penis, in perineum, in thigh.
389
What are the borders and floor of the submandibular triangle? What does it contain?
Bellies of digastric, inferior border of mandible. Floor is anterior 2/3 of mylohyoid, post 1/3 of hyoglossus. Submandibular LNs, gland and duct, facial artery and vein, nerve to mylohyoid (via inferior alveolar nerve via V3).
390
What is folic acid used to treat?
Megaloblastic and macrocytic anemias, prevention of neural tube defects in the developing fetus.
391
What is a neoplasm?
Monoclonal proliferation as a result of benign things or cancer.
392
What is a cirrhotic liver?
Hepatocytes replaced by fibrous scar tissue and regenerative nodules.
393
Describe C-chemokines.
Function through XCR, includes lymphoactins.
394
What is the sympathetic innervation of the spleen?
The greater splanchnic and lesser splanchnic nerves.
395
What is the afferent innervation of the anal canal?
Superior - visceral innervation (lumbar splanchnic nerves). Inferior - somatic innervation.
396
What's the largest cause of secondary hypertension?
Renal artery stenosis. Common in elderly.
397
What are NETS?
Neutrophil extracellular traps. Extracellular decondensed DNA in complex with histone/granule proteins expelled to ensnare/kill microbes. Can also serve as the physical barrier to prevent pathogen spread.
398
Describe A of PK-ADME.
Absorption - how drugs proceed from site of administration to central compartment (systemic circulation). Quantitative measurement is bioavailability. IV availability of all drugs is 100%.
399
What does pluripotent and multipotent mean?
Pluripotent - can become all intraembryonic cells. Multipotent - can become all cells of a tissue.
400
Where are lymphocytes usually clustered in MALT?
In the lamina propria.
401
What are the phenotypes from an HbE/Beta+ or HbE/Beta0 genotype?
15% mild thalassemia, mostly intermediate, a few severe - it also depends on the beta allele.
402
How many V/D/J chains does the antibody kappa light chain have?
40, 0, 5
403
What provides autonomic innervation to the pelvis?
Sacral sympathetics (continuation of lumbar sympathetic trunks, produce vasomotion/contraction of internal genitals in orgasm, inhibit defecation). Hypogastric plexi (sympathetic nerve fibers from lower lumbar splanchnics and GVAs. Superior descends into pelvis and divides into left and right hypogastrics). Pelvic splanchnic nerves (join the left and right hypogastrics and sacral splanchnics to form inferior hypogastric plexus, supplies distal transverse, descending, sigmoid colon, rectum, all viscera of pelvis and perineum, increases bladder contraction, rectum peristalsis, erection).
404
What are the arteries of the penis?
Dosral, perianal, artery of bulb, deep arteries that supply corona cavernosa (have Helicine branches).
405
What happens if you are missing the Duffy Fya and Fyb alleles?
They're both binding sites for malaria uptake, missing them prevents malaria uptake.
406
What are the adverse effects of diphenhydramine?
Systemic administration - sedation, thickening of bronchial secretions, less frequently: xerostomia, blurred vision, hypotension, tachycardia, urinary retention. Topical - phorosensitivity, rash, urticaria.
407
What is the origin of transversus abdominis?
Iliac crest, inguinal ligament, thoracolumbar fascia, costall cartilages 7-12.
408
What is elevated in B9 and B12 deficiency?
Homocysteine in both, methylmalonic acid in B12 deficiency.
409
What's another term for IBD?
Crohn's disease.
410
What are the contraindications of diphenhydramine?
Systemic: asthma, cardiovascular disease, glaucoma, urinary obstruction, thyroiddysfunction, neonates and young children. Topical - neonates, preemies, young children, breastfeeding moms.
411
What are the contents of the inguinal canal?
Ilioinguinal nerve, blood and lymph vessels, genital branch of genitofemoral nerve, round ligament of uterus or spermatic cord.
412
Describe E of PK-ADME.
Excretion of drug out of body. Mainly renal. Quantitative measurement is clearance.
413
Detail the embryological development of the male external genitalia.
Influenced by testosterone. The genital tubercle elongates to form a phallus, which pulls the urethral folds forward to form the lateral walls of the urethral groove. The groove extends along the phallus but does not reach the distal part. The epithelial lining of the groove forms the urethral plate. By the end of month 3, the urethral folds fuse over the urethral groove to form the penile urethra (does not extend to the tip of the phallus). By the 4th month, the ectodermal cells from the tip of the glans penetrate in to form the short solid epithelial cord which later obtains a lumen and becomes the external urethral meatus.
414
What is the innervation of psoas major?
Anterior rami of L1-L5.
415
What are the contraindications of epoietin alfa?
Uncontrolled hypertension, anemia in cancer patients not from chemo. Also pure cell aplasia.
416
Where are appendectomy incisions done?
Transverse or grid-iron (muscle splitting\_ incision centered at McBurney's point. Nerves most at risk are iliohypogastric and ilioinguinal.
417
What does the superior ophthalmic vein communicate with?
The facial vein.
418
Describe esophageal varices.
Gastroesophageal portocaval anastomoses. The esophageal veins can rupture. Treat by endoscope to directly inject varices with clotting medicine or by placing a bond to cut off circulation. Black, tarry stool (upper GI bleed), paleness, light-headedness, emesis, symptoms of chronic liver disease.
419
What are suicidal communications?
Direct/indirect expressions of suicidal ideation or intent to harm/kill self, expressed verbally or through writing, artwork, or other means.
420
What are the ASAM treatment patient placement criteria?
0.5 (early intervention), 1.0 (outpatient services e.g. counselling 1-2 hours a week), 2.0 (intense outpatient/partial hospitalization 10-15 hours a week), 3.0 (residential inpatient services 1-6 months), 4.0 (medically managed intensive inpatient e.g. detox, 2-14 days).
421
How efficiently and how is non-heme iron absorbed and what foods is it found in?
\<10% efficiency - done through DMT`1 transporter. It is found in beans, spinach, vegetables.
422
What cytokines trigger Th0 differentiation into Treg?
TGFbeta, IL-10.
423
What does Protein C do?
AKA autoprothrombin IIa AKA Factor XIV. APC inhibits factor Va and VIIIa.
424
How can blood accumulate in the rectus sheath?
Damage to the inferior or superior epigastric arteries.
425
What can cause microcytes?
Lack of Fe, heme, hemoglobin, lead poisoning.
426
What % of leukocytes are lymphocytes?
25-33%
427
What are the actions of the superior rectus of the eye?
Elevation, adduction, intorsion.
When the eye is adducted, only intorsion. WHen eye is abducted, only elevation.
428
What do the mesonephros excretory tubules become in embryonic development?
The epigenital and paragenital tubules.
429
What spaces are made by the folding of the peritoneum in the female pelvic cavity?
Vesociuterine and retrouterine spaces.
430
What are the small apertures of the diaphragm?
Sternocostal triangle (lymphatic and superior epigastric vessels), Right and Left Crural (greater and lesser splanchnic nerves)
431
Where is the superficial ring of the inguinal canal?
An opening in the anterior wall superolateral to the pubic tubercle.
432
What is the deep lymphatic drainage to the abdominal wall?
Accompanies deep veins. External iliac -\> common iliac -\> lumbar -\> cysterna chyli -\> thoracic duct.
433
What do you give as a clotting factor replacement?
Cryoprecipitate or prothrombin complex concentrate.
434
What treatment do you give for hypovolemia?
Plasma - fresh or frozen, also 5% albumin.
435
What is the danger area of the face?
The infection can travel through the opthalmic veins to the cavernous sinuses and cause cavernous sinus syndrome.
436
Where does CN II exit the head? What's it called?
Optic canal. Optic.
437
What are intraepithelial T lymphocytes (IELs)?
They can act like CD8 cells but do not need an APC to present the antigen (are mostly CD8 gammadelta)
438
What is Factor H?
Displaces Factor B of alternative pathway of complement. Works in conjunction with Factor I.
439
Where does the superior epigastric artery branch from? What does it anastomose with?
Internal thoracic artery. The inferior epigastrics.
440
What percent of plasma is gamma globulin?
11%
441
What is Murphy's Kidney Punch?
Tenderness at the costovertebral angle - signifies disease/infection of the kidney.
442
What is the insertion of rectus abdominis?
Costal cartilages 5-7.
443
What organs does the H3 receptor work on and what type of receptor is it?
Nerve endings, CNS, Gi
444
What does the cranial genital ligament form?
The suspensory ligament of the ovary.
445
What makes up the posterior and lateral wall of the pelvic wall?
Posterior wall: piriformis Lateral wall: obturator internus
446
What part of the bladder do the ureters go into?
The fundus.
447
What veins drain the anterior triangle?
Internal jugular vein, Facial vein, Lingual Vein, Anterior jugular vein, External jugular vein.
448
Describe the formation of the glomerulus.
The tip of each collecting tubule branching from the ureteric bud induces development of the metanephric blastema (undergoes mesenchymal -\> epithelial differentiation) and forms renal vesicles. The vesicles become S-shaped, fuse with the ureteric stalks of the collecting tubule, and a pocket develops where the capillaries grow and differentiate into the glomerulus.
449
What is PSA?
Prostate specific antigen. It's elevated in prostate cancer.
450
What % of leukocytes are neutrophils?
Segmented - 54-62%, bands - 3-5%.
451
How is the shape/stability/flexibility of red blood cells maintained?
Actin-spectrin.
452
What are some causes for increased leukocyte release from bone marrow stores?
Infection, endotoxemia, hypoxia.
453
What does a2 lipoprotein do?
Transports cholesterol in HDL.
454
What is C4BP?
Binds C4b - allows recruitment of Factor I.
455
How is the bare area of the liver formed?
When the liver bud extends into the septum transversum.
456
What muscle aponeuroses are anterior to the rectus sheath above the arcuate line?
External oblique and 1/2 of internal oblique.
457
Describe IgE.
Secreted as monomer, binds Fcepsilon on mast cells, eosinophils, basophils - triggers degranulation.
458
How does the hindgut develop embryologically?
The cloacal membrane (endoderm joins with surface ectoderm of protocderm) ruptures in week 7. The cloaca is partitioned into the urorectal septum into the rectum/upper anal canal and urogenital sinus. The lower anal canal develops from an invagination of the protocderm which is why it has a different innervation/epithelium.
459
Describe embryological development of the esophagus.
At the end of week 3, the respiratory diverticulum forms, and the esophagotracheal septum partirions it from the trachea. It lengthens in weeks 4-7. The epithelium proliferates and then recanalizes and goes from simple columnar to stratified columnar to multilayered ciliated to stratified squamous.
460
What is the secondary signal of T cell activation?
B7 binds the CD28 receptor.
461
When is ACP elevated?
The prostate isoform is in prostate cancer.
462
What are the potential adverse effects of deferoxamine?
Hypotension, rash, abdominal pain, injection site reaction.
463
Describe the sacral plexus.
Made up of the lumbosacral trunk (L4, L5), and the S1-S4 ventral rami. It travels down the posterior pelvic wall anterior to the piriformis. Consists of the pudendal nerve (S2-S4), pelvic splanchnic nerves (S2-S4), and to the lower limb - superior (L5-S1) and inferior gluteal nerves (L5-S2), sciatic nerve (L4-S3), posterior femoral cutaneous nerve, nerve to piriformis, nerve to quadratus femoris, nerve to obturator internus.
464
What do you give to give passive immunity?
Igs.
465
What are sinusoids?
The sites in red BM where cells are not developed. Formed by sinusoidal capillaries / venous sinuses. They are lined by endothelial cells on a discontinuous basal lamina. This is where RBCs, WBCs, and platelets enter circulation.
466
Where do the dural venous sinuses drain into?
The internal jugular veins.
467
Describe lymphocytes.
Round, slightly indented, dense heterochromatic. 2nd most abundant WBC, 20-25% of circulating leukocytes. Vary in lifespan. Thin rim of cytoplasm, stains light. All the types look the same on staining (B, T, NK). It's the main cell in lymph - forms adaptive immunity.
468
What type of anemia is sickle-cell?
Normocytic normochromic.
469
What is the origin of the internal obliques?
Thoracolumbar fascia, anterior iliac crest, inguinal ligament.
470
Describe calculi.
Can be renal or ureteric. Risk factor is dehydration, can cause hematuria, hydronephrosis (dilation of renal calyces and pelvis), hydroureter, pain. Remove with lithotripsy.
471
How do iron antidotes work? What are the ones you need to know?
Selectively bind Fe3+ with high affinity to form pharmacologically inactive chelate complex which is then excreted. Deferasirox, Deferoxamine.
472
Where do most prostate cancers arise?
70% in the peripheral zone which is palpable. Benign hyperplasia can also happen.
473
What are the types of pelvic fractures?
Anterior/posterior compression, lateral compression, vertical shear.
474
What is hematemesis?
Vomiting blood. Coffee ground appearance, upper GI bleed.
475
What besides Factor XIIa can activate Factor XI?
Thrombin and also autocleavage.
476
What is plasminogen?
Zymogen of plasmin and angiostatin, activates clotting and fibrinolysis.
477
What makes up the blood flow into the head and through what foramina do these arteries come through?
Vertebral artery (foramen magnum), Branches of common carotid - internal carotid (carotid canal), external carotid/maxillary/middle meningeal (foramen spinosum).
478
What is it called when there are RAG1 and RAG2 mutations?
SCID/Omenn Syndrome - total lack of B and T cells.
479
What are some factor deficiency caused diseases?
Hemophilia, parahemophilia, theombophlebitis, hereditary angioedema, venous thrombosis.
480
What is the action of the pyramidalis?
Tenses the linea alba. Fun fact its absent in 20% of people.
481
What are angiostatins?
Proteolytic fragment of plasminogen, downregulates angiogenesis.
482
What is the origin of psoas major?
Transverse process of lumbar vertebrae, sides of T12-L5 bodies and IV discs,
483
What is damage at or above the sacral promontory most likely to cause?
Sympathetic damage, e.g. "firing blanks".
484
What is didelphys?
Double uterus or vagina. From incomplete fusion of the paramesonephric ducts.
485
Briefly describe IgM.
Pentameric, 10 antigen binding sites, regulates opsonization.
486
Describe a hydrocele.
A collection of serous fluid in the scrotum. Can inflame epididymis, might be congenital and result from the incomplete obliteration of processus vaginalis. Translucent on transillumination.
487
What is iron uptake in the duodenum facilitated by?
Ascorbate, amino acids, citrate, iron deficiency.
488
Describe a renal transplant/
Generally done with the left kidney - renal vessels are connected to external iliac arteries. Old kidney is left in and put in pelvis. Kidneys can be removed by damaging the adrenal gland.
489
What is hydroxyuria?
An experimental drug used in beta thalassemia to increase HbF production.
490
What does the pelvic brim/inlet divide the pelvis into?
Above it is the false/greater pelvis (in the abdominal cavity) and below it is the true/lesser pelvis.
491
Describe D of PK-ADME.
Distribution. Passage of drugs from systemic to peripheral compartment. Qualitative measurement is Vd (volume of distribution).
492
What is the lymphatic drainage of the pancreas?
Celiac and superior mesenteric plexus.
493
What has more off-target effects, 1st or 2nd gen H1 blockers?
2nd.
494
What organs comprise the foregut?
Distal esophagus, stomach, spleen, pancreas, liver, gallbladder, 1st and 2nd part of duodenum.
495
Describe a direct inguinal hernia.
Medial to inferior epigastric artery. Originates from Hesselbach's triangle - travels through medial part of inguinal canal, emerges from superficial inguinal ring. Herniated content only covered by transversalis fascia, endoabdominal fascia, parietal peritoneum.
496
What is hematoglobinuria?
Red blood cell lysis, haptoglobin binds heme so there is a decrease of haptoglobin in blood.
497
What does b2-macroglobulin do?
Binds MHCI and hemochromatosis protein to regulate immune response and iron uptake.
498
Briefly describe IgA.
Rare, mono or multimeric, reculates Fc receptor mediated inflammatory responses (which includes degranulation and ADCC).
499
Where does spleen lymphatic drainage go?
To the celiac LNs.
500
What are the potential adverse effects of iron dextran.
Headache, fever, light-headedness, arthralgia, nausea, vomiting, back pain, flushing, urticaria, bronchospasm. Anaphylaxis.
501
What is the action of quadratus lumborum?
Extends and lateralluy flexes vertebral column, fixes rib 12 on inspiration.
502
How do you get a uterine prolapse?
Loss of support by Cardinal ligament, levator ani, uterosacral ligament.
503
Where does CN V exit the head? What's it called?
V1 through superior orbital fissure, V2 through foramen rotundum, V3 through foramen ovale. Trigeminal nerve.
504
What are the innervations to the diaphragm?
Phrenic nerve (C3-C5). GSA: central is phrenic nerve, peripheral is inter/subcostal.
505
What are the types of chronic lymphadenitis?
Follicular hyperplasia, paracortical hyperplasia, sinus (reticular) hyperplasia, necrotizing lymphadenitis, granulomatous lymphadenitis.
506
What are the types of intestinal atresia?
Issues with recanalization in development - stenosis if incomplete, duplication is failed. Mostly happens in duodenum. Causes GI distention and vomiting.
507
Descrine the broad ligament of the uterus.
2 peritoneal layers. It connects the lateral uterus to the lateral pelvic wall. Mesosalpinx (supports uterine tube), Mesovarium (attaches to ovary), Mesometrium (attaches to uterus).
508
What are the contraindications of deferoxamine?
Hypersensitivity, severe renal disease, anuria.
509
What percentage of serum proteins are complement proteins?
10%.
510
What are the symptoms of neutropenia?
Malaise, chills, fever, weakness, ulcers, enlarged regional LNs.
511
Describe the cysterna chyli.
Anterior to L2, marks beginning of the thoracic duct. Intestinal trunk - G! tract, liver, spleen, pancreas. Lumbar trunk - posterior abdominal wall, kidney, ureter, gonads, uterus, uterine tubes.
512
What cell can bind MHCI-like molecules or altered self ligands?
NK cells.
513
How do monocytes develop?
CFU-GEMM -\> CFU-GM -\> Monoblast (look the same) -\> promonocyte (bluish cytosol, lots of nonspecific granules) -\> monocyte.
514
How does reduced albumin lead to edema?
Albumin normally provides positive oncotic pressure for the movement of water out of the tissues into blood. Reduced albumin allows more water to stay in the tissues.
515
What is leukemoid reaction?
Exaggerated benign leukocyte response. Immature leukocytes in blood circulating leukemia. Caused by severe infecton of some kind. Can differentiate from cancer by high ALP.
516
What are the CN VII 5 terminal branches within the parotid gland? What do they innervate?
Temporal (frontalis, orbicularis oculi, corrugator supercilii), Zygomatic (orgibularis oculi), Buccal (orbicularis oric, buccinator), Marginal mandibular (mentalis, mouth depressors), Cervical (platysma).
517
What is thrombophilia/Laiden's disease?
Point mutation in factor V which makes it resistant to protein C inactivation (causes clot formation).
518
What kind of cells are in the lymph node cortex, paracortex, and medulla?
Cortex mainly B cells, paracortex mainly T cells, medulla mainly plasma cells.
519
What can cause macrocytes?
Lack of folate (megaloblastic anemia), lack of B12 (pernicious anemia).
520
what is the Sampling Reflex/RAIR? What illness is it lost in?
Rectal-anal inhibitory reflex. The rectum distends and the IAS relaxes, and the EAS contracts and allows for sampling of rectal contents. It is lost in Hirschprung Disease.
521
Describe McBurney's point.
RLQ from ASIS to unbilicus indicating the base of the appendix.
522
What are some causes for decreased marginalization of leukocytes? (leukocytosis)
Exercise, catecholamines, glucocorticoids.
523
Where does CN VI exit the head? What's it called?
Superior orbital fissure. Abducens nerve.
524
What is Hematocrit?
The percent by volume of packed RBCs after centrifugation of blood. Normal for males is 40-50%, for females is 35-45%.
525
Where is the lymphatic drainage to the suprarenal glands, kidneys, ureters?
Suprarenal and renal LNs and the LNs of the proximal ureters follow veins and drain to the lumbar/para-aortic LNs. The distal ureters drain to the common/external iliac LNs.
526
What 3 things happen simultaneously when there is a wound?
Platelets recognize collagen and are activated. TxA2 is made in platelets and released in their degranulation. Loss of endothelia activates the intrinsic pathway.
527
What do the supratrochlear and infratrochlear nerves provide sensation to?
S - medial forehead and scalp, I - lateral root of nose.
528
What is Factor I?
If C3b or C4b is on a cell, it'll bind MCP and CR1 which recruit Factor I - inactivates C3b.
529
What innervates the stapedius?
CN VII.
530
What are the half lives of cetirizine, fexofenadine, loratadine?
8-14 hours, 28 hours for descarboethoxyloratadine.
531
What keeps circulating platelets inactive?
Intact endothelium - NO, prostacyclin (prostaglandin I), thrombomodulin (binds thrombin and alters specificity), heparan sulfate on cell surface (antithrombic activity). It's contact with subendothelial tissue and causes platelet adhesion and activation.
532
What is the arterial supply to the diaphragm?
Thoracic surface: pericardiacophrenic, musculophrenic (from internal thoracic), superior phrenic (from thoracic aorta) Abdominal surface: inferior phrenic (from thoracic aorta).
533
What is heparin?
A natural anticoagulant made in the body.
534
What is contained by the investing/superficial layer of the deep fascia?
Trapezius, SCM, muscles of facial expression.
535
How much iron daily is recommended and how much is absorbed?
8-18mg recommended, 1mg absorbed.
536
Where is erythropoietin synthesized?
Kidneys in adults, liver in fetus.
537
What are fragments of complement proteins recognized by when they act as an opsonin?
CR1/CD35.
538
What's better to lacerate, veins or arteries?
Veins, lower pressure.
539
How do you treat anything that involves excess iron absorption?
Iron chelation - deferoxamine and Vitamin C.
540
How do you look at rough [Hb] in a PBS?
Central pallor
541
What are the neck fascia?
Superficial, Deep (Investing/superficial, Pretracheal/middle (muscular and visceral layer), Prevertebral)
542
When should referrals be made?
When there is a clear benefit to the patient. Should not be made to avoid possible death in a hospital, and charges or fee splitting is unethical and potentially illegal.
543
What is deferoxamine used to treat?
Chronic iron overload due to transfusions. Or, off-label, aluminum overload.
544
What are the types of white blood cells / leukocytes? Whuch ones divide?
Granulocytes (neutrophils, basophils, eosinophils) and agranulocytes (monocytes, lymphocytes). Granulocytes is nondividing and apoptose with growth factor withdrawal.
545
Where are the jejunum and ileum located?
Proximal 2/5 LUQ, distal 3/5 RUQ.
546
Roughly what vertebral levels are the kidneys at?
Approximately T12-L3.
547
What are the lab results in anemia?
Reduced RBC, Hb, Hct. Reticulocyte count is reduced in inadequate production anemia, raused in hemolytis/blood loss.
548
Describe the femoral nerve.
L2-L4. Emerges from lateal border of psoas major. Innervates iliacus and anterior thigh.
549
What are darbepoietin and epoietin alfa used to treat?
Anemia associated with chronic kidney disease (most people need iron/folate supplementation with it) chemotherapy-related anemia (only in non-myeloid malignancy). Epoietin alfa can also treat zidovudine related toxicity.
550
What is the Lacunar ligament?
Deeper external oblique aponeurotic fibers pass posteriorly to attach laterally to pubic tubercle.
551
What is pernicious anem -
Due to poor B12 absorption. Same symptoms as megaloblastic anemia (Loss of appetite, weight loss, weakness, irritability, glossitis). Can also include depression, low fever, diarrhea, dyspepsia, weight loss, neuropathy, jaundice, cheilitis, eventually cognitive impairment.
552
What is HbGower (1) and (2)?
1:zeta2epislon2 2: alpha2epsilon2
553
What is erythropoietin?
Made by kidney in response to decreased blood oxygen. It acts on CFU-E surface receptors. HIFs are TFs for EPO.
554
List the anterior divisions of the internal iliac artery.
Obturator (20% from external iliac), Umbilical (gives off superior vesical\_, Inferior vesical, Uterine, Vaginal, Internal pudendal, Inferior gluteal, Middle rectal.
555
When is CK elevated?
Muscle breakdown.
556
What kind of bone marrow do newborns have?
Entirely red. In adults, red is confined just to cancellous bone.
557
What does sickling risk go up with? How much HbS does an RBC need to sickle?
deoxy Hb, high altitude, acidosis, dehydration, hypoxemia. \>60%.
558
What is acute transfusion hemolytic reaction?
ABO mismatch reaction with preformed antibodies - 40% mortality. Fever, chills, nausea, chest pain, back pain, pain at transfusion site, hypotension, dyspnea, oligurea, dark urine.
559
What does Th17 secrete?
IL-17, IL-22.
560
What is thymic involution?
How the thymus is replaced with adipose tissue over time.
561
What are the anterior abdominal wall muscles?
Rectus abdominis and pyramidalis.
562
How much iron do people have in their bodies?
Women - 3.5g Men - 4g
563
What does Th1 secrete?
IFNgamma, IL-12, TNFalpha.
564
How do thymocytes stain in the thymus?
Eosinophilic, oval light-staining nuclei.
565
Where do the pancreatic ducts enter the duodenum?
Main via major duodenal papilla (joins common bile duct). Accessory via minor duodenal papilla. Common bile duct and main pancreatic duct each have a sphincter. The major duodenal papilla has a hepatopancreatic ampulla (of Vater) and a sphincter (of Oddi).
566
What are the branches of CN V2 (Maxillary division).
Infraorbital, zygomaticofacial, zygomaticotemporal.
567
What is the action of iliacus?
Flexes thigh, stabilizes hip, acts to flex trunk while sitting.
568
What is the innervation of the internal obliques?
Anterior rami of T6-L1.
569
What can cause eosinophilia?
IL-5, release of eosinophil chemotactic factor from mast cells in Type I hypersensitivity, allergy, parasites, skin disease, some malignancies, collagen vascular diseases.
570
Describe the Lumbar Plexus.
L1-L5. Posterior rami supply back muscles, anterior are lumbar plexus - supplies skin, part of lower limb, muscles of inferior most trunk. Iliohypogastric n. (L1), Ilioinguinal n. (L1), Femoral n. (L2-L4), Lateral cutaneous nerve of thigh (L2-L3), Genitofemoral n. (L1-L2), Obturator n. (L2-L4).
571
Describe the lectin pathway of omp,ement.
Lectin binds mannose (sugar). It's associated with the serine proteases MASP1 and MASP2. The proteases cleave C4 and C2 and make C3 convertase (C2b4b).
572
What is humoral immunity mediated by?
Antibodies.
573
What is the perineal body the attachment point for?
The levator ani and muscles of the perineum.
574
What are the functions of complement?
Opsonization, inflammation, lysis, B-cell activation, clearance of immune complexes.
575
When do kidneys attain adult position?
They're initially pelvic, but as the abdomen and pelvis develop the kidneys rotate medially 90 degrees and shift to a cranial position. They become retroperitoneal and attain adult position by week 9. As they ascend, the arterial supply changes from the common iliac artery to abdominal aorta. (If the lower vessels don't degenerate, the person might have harmless supernumerary arteries)
576
Describe the opthalmic artery.
Branch of internal carotid. Enters the orbit through the optic canal. Travels posteriolateral to inferiomedial - gives off supratrochlear, supraorbital, lacrimal branches.
577
What are the portocaval anastomoses?
Gastroesophageal - left gastric veins with esophageal veins. (esophageal varices) Paraumbilical - paraumbilical veins and epigastric veins. (caput medusa) Anorectal - superior rectal veins and middle/inferior rectal veins. (hemorroids) Hepatic portal vein and tributaries have no valves, blood can bypass the liver by going in the reverse direction and draining to the IVC via the caval route.
578
What is the peritoneal cavity?
A potential space between the parietal and visceral peritoneum.
579
What are the posterior divisions of the internal iliac artery?
Iliolumbar, Lateral Sacral, and Superior gluteal arteries.
580
What are the types of hysterectomies?
Radical (everything), Total (uterus + cervix), Partial (just uterus).
581
What does the facial artery anastomose with?
The transverse facial artery.
582
What is the name of the position you are in for a gynecological exam?
Lithotomy.
583
What are high-risk groups for suicide?
Groups that are known to have an above average suicide rate.
584
What does a1 lipoprotein do?
It's an apolipoprotein in HDL, activates LCAT.
585
What are formed elements of blood?
RBCs, WBCs, platelets/thrombocytes.
586
What are the symptoms of having 10-20% methemoglobin?
Skin discolouration - especially on the mucous membranes.
587
What are the two alpha thalassemia alleles?
allele 1 - no copies intact (common in SE Asia) allele 2 - 1/2 copies intact (common in Black Americans)
588
What are the contraindications of ferrous gluconate?
Hypersensitivity to it or any of formulation, hemochromatosis, hemolytic anemia.
589
How do platelets/megakaryocytes develop?
CFU-GEMM -\> CFU-Meg. The nucleus becomes highly polyploid (up to 3X the DNA in a normal cell), invaginations of PM form demarcation membranes which break off to form platelets - each cell forms 5-10,000. Megakaryocytes derive from megakaryoblasts, which form thin processes the cross the sinusoid call and fragment at the tips, which liberates the platelets.
590
What are all the tonsils together called?
The ring of Waldeheyer.
591
How is deferasirox administered and excreted?
Orally, through feces via bile.
592
What are the renal blood supply segments?
Apical, anterosuperior, anterioinferior, posterior, inferior.
593
How does firm adhesion / marginalization / pavementing happen after rolling adhesion?
CD18 of cell binds with ICAM1,
594
What does the inferior gluteal artery supply? Describe its course briefly.
The gluteal region. It comes out between the S2 and S3 ventral rami and emerges inferior to the piriformis.
595
What are the actions of the superior oblique of the eye?
Depression, abduction, intorsion.
When eye abducted, only intorsion. When eye adducted, only depression.
596
What are superantigens?
They will bridge MHCII-TCR binding regardless of fit and will result in nonspecific CD4 activation/inflammation. Will end up causing a depleted T cell count.
597
Which bones make up the neurocranium? What does the neurocranium contain?
Frontal, ethmoid, sphenoid, occipital, parietal, temporal. The brain/meninges, vessels, proximal cranial nerves, internal ear.
598
What type of tissue is blood?
A specialized connective tissue.
599
What do lymphatic vessels drain into?
Lymphatic trunks, which drain into the thoracic duct or the right lymphatic duct.
600
What is the venous drainage of the pancreas?
Most drain to splenic vein, some to SMV, all drain to hepatic portal vein.
601
What organs does the H4 receptor work on and what type of receptor is it?
Leukocytes, Gs
602
What is the innervation of the external obliques?
Anterior rami of T7-T12.
603
What is the thyroid ima artery?
10% of people have it, it's an extra thyroid artery arising from the brachiocephalic trunk or aortic arch - runs anterior to trachea.
604
Describe CC-chemokines.
Function through CCR, includes MCP-1, MIP-1, RANTES, eotaxin.
605
Describe the posterior abdominal wall veins.
Tributaries of IVC, begins L5 where the common iliac veins meet. Tributaries correspond to the paired visceral and parietal branches of the aorta.
606
What are the parts of the stomach?
Cardia (T1 when supine), fundus, body, pylorus (antrum at ~L1 and canal) with sphincter.
607
What does the supraclavicular nerve innervate?
Skin over the lateral neck and shoulder.
608
What is the parthal thromboplastin time test?
PTT test. It differentiates the intrinsic and common pathways (kaolin or polyanions are added to the tube). 25-35s is normal.
609
What isotype does IL-4 induce a B cell to switch to?
IgE, IgG4
610
What do NK cells express and release?
CD2, CD56, KAR, KIR, FasL inducibly. releases perforin, granzyme, IFNgamma.
611
Describe the pelvic diaphragm/floor.
Made up of the coccygeus and levator ani (puborectalis, pubococcygeal, iliococcygeus). Contains the pudendal nerve.
612
What is hemolytic disease of the newborn? How is it treated?
Rh- mother second pregnancy/exposure to Rh+. Anemia, immature RBCs in circulation, severe cases edema in utero, after birth continued breakdown - hyperbilirubinemia/jaundice. Give RhoGam to prevent antibody production. Give max 72h after birth, at 28 and 34 weeks in utero. There can be a mild version with incompatibilities.
613
How can kidney agenesis occur?
Early degeneration of ureteric bud, fails to contact and induce metanephric blastema. WT1 can do that.
614
What does the external iliac artery give off before it exits the pelvis posteriorly to the inguinal ligament and turns into the femoral artery?
The inferior epigastric artery (anterior abdominal wall) and deep circumflex iliac artery.
615
What is delayed hemolytic reaction?
Blood type mismatch that is not ABO. No preformed antibodies so reaction is slower. Slight fever, malaise, weakness, light anemia, sometimes hyperbilirubinemia.
616
What are some other genetic things that reduce HbSS severity?
HbF presence, HbC presence, alphathalassemia trait.
617
Where is the prostate?
At the neck of the bladder, where the IUS is.
618
What PAMP does TLR3 recognize?
dsRNA
619
What does serum amyloid A do?
HDL apolipoprotein, immune cell recruitment in acute inflammatory response.
620
What is a psoas test?
Lie on unaffected (so left) side, extend thigh, have the person flex against resistance. Pain is a positive psoas sign (e.g. inflamed appendix).
621
What is HbPortland?
zeta2gamma2
622
What forms the marginal artery of Drummond?
Middle colic arteries from SMA and left colic arteries from IMA.
623
How many people have anemia worldwide?
20-25% babies, 42% women, 26% men. In the US, 9-11% toddlers, adolescent girls, women.
624
What do the jugular lymphatic trunks drain and drain into?
The head and neck. Left drains into the thoracic duct, right joins the right subclavian trunk to form the right lymphatic trunk, which drains into the right lymphatic duct.
625
Describe chronic iron toxicity and how to treat it.
Excess iron deposited in organs. Mostly in those with inherited hemochromatosis or those getting red cell transfusions over long period of time (e.g. thalassemia). Phlebotomy if no anemia, give iron antidote.
626
What are signalling PRRs?
TLRs (macrophages, epithelial cells, DCs on membrane and endosomes) and NLRs (cytosolic).
627
What's a possible symptom of agranulocytosis that results in death in a few days?
Mouth ulcers with pseudomembranes laden with bacteria/fungi.
628
How does CD4 help in CD8 activation?
It makes CD40L and 4-1BBL which bind the APC and make it produce more B7 to better activate CD8.
629
What are some causes of lymphocytopenia?
Drugs (steroids), autoimmune things like SLE, immune deficiency (DiGoerge, AIDS, SCID), endocrine (Cushing's).
630
Describe monocytes.
Largest of the circulating blood cells, 3-8% of the leukocyte population. They are 2-3x the diameter of RBCs. Large, indented, kidney shaped nucleus, bluish-grey cytosol. An avid phagocyte and APC. It differentiates depending on what type of tissue it goes into (mononuclear phagocyte system).
631
Describe the alternative pathway of complement.
C3 autocleaves, C3b binds microbe. Factor B binds C3b. Factor D cleaves B. C3bBb3b is C5 convertase. Properdin stabilizes C3bBb (C3 convertase).
632
When is a basophilic stippling inclusion body seen?
Lead poisoning.
633
What is the function of the developing liver from ~week 6-9?
Hematopoiesis.
634
How many V/D/J chains does the antibody heavy chain have?
65, 27, 6
635
What cells are part of innate immunity?
Epithelia, NK cells, phagocytes (DCs, neutrophils, macrophages).
636
In what circumstances does hematocrit go up?
Polycythemia vera, dehydration, renal tumours.
637
What is colonic diverticulosis? Which part of the colon does it usually happen in and in who?
Outpocketing/false diverticula, acquired mucosal herniations protrude through weak areas of the muscle wall of the colon. Commonly occur on the mesenteric sides of 2 bands of teniae coli due to perforating nutrient arteries. Can become infected and rupture. Found on sigmoid colon in middle aged/elderly people, develop in individuals with low fiber diet.
638
Describe the renal fascia.
The anterior and posterior fuse laterally. The anterior is posterior to the parietal peritoneum, the posterior is posterior to the perirenal fat and anterior to the pararenal fat.
639
What is the subcostal nerve?
The anterior rami of T12. It supplies the external oblique and skin of anterior abdominal wall.
640
What's the venous drainage of the anal canal?
Above the pectinate line: superior rectal vein (into portal venous system). Below the pectinate line: middle rectal vein (into internal iliac veins), inferior rectal veins (into internal pudendal veins, which drain into the internal iliac veins).
641
What is the Canal of Nuck?
In women, incomplete obliteration of processus vaginalis. Can form small abnormal pounch in the peritoneum in the inguinal canal anterior to the round ligament of the uterus - travels into labia majora. Can result in cyst, hydrocele, indirect inguinal hernia. Analogous to patent processus vaginalis in males.
642
What is deferasirox used to treat?
Chronic iron overload due to transfusions, or non-transfusion dependent thalassemias.`
643
How is pain felt in the parietal and visceral peritoneum?
Parietal - localized, visceral - generalized.
644
When do the primordial urinary systems develop and what are they?
Pronephros (non functional) - beginning of week 4, disappears by day 24/25. Mesonephros (functional weeks 6-10), female degenerates, male incorporated into reproductive system, gonads develop medial to it at the genital ridge. Metanephros (appears week 5, functional by week 9), urine is produced week 10 and mixes with amniotic fluid. These systems go cranial to caudal and each one induces development of the next one.
645
What is the innervation of the transversus abdominis?
Anterior rami of T6-L1.
646
What is histamine?
Biogenic amine made by decarboxylation of L-Histidine, stored in high concentration in vesicles. Causes characteristic triple response, acts on 3 cell types- microcirculation smooth muscle cells, capillary/venular endothelium, sensory neurons. Causes edema, characteristic red spot, flare.
647
What are the groupings of substance use disorders?
Substance-related disorders and addictive disorders.
648
What are the two erythropoiesis-stimulating agents you need to know? How are they administered?
Epoietin alfa and darbepoietin alfa (glycosylated form of epoietin alfa). IV or SQ (SQ has a slower rise to peak plasma concentration and also a slower decline).
649
What is a deficiency of Factor IX called?
Hemophilia B/Christmas disease (x-linked recessive).
650
What is intrinsic factor (IF) needed for?
Absorption of B12.
651
What is the difference between enteral and paraenteral drug administration?
Enteral is via GI system (oral, sublingual, anal), paraenteral is any other way of administration.
652
What are the borders of the omoclavicular triangle? What does it contain?
SCM, clavicle, inferior belly of digastric. Subclavian vein, 3rd part of subclavian artery, brachial plexus, phrenic nerve, subscapular artery, transverse cervical artery.
653
When is a Howell-Jolly inclusion body seen?
Anemia, hyposplenia.
654
What is the BCR complexed with?
Igalpha and beta, CD81 - forms complex with CD19 and other surface molecules, CD21/CR2 (recognizes C3d)
655
What do the intestinal lymphatic trunks drain and drain into?
Stomach, intestines, pancrease, spleen, part of liver. In the intestines, lymph mixes with dietary fat to form chyle - SI lacteals collect it. Enters cisterna chyli (dilated sac at inferior thoracic duct) at L1/L2.
656
What is the SMAS?
Superficial musculoaponeurotic system in the face.
657
Describe paracortical hyperplasia.
Lymphadenitis with nterfollicular regions enlarged (activated T-cells). Caused by viral infections (NOT AIDS) e.g. infectious mononucleosis.
658
Where is bone marrow found?
in the sponge/trabecular/cancellous bone and in the medullary cavity of the diaphysis.
659
Describe eosinophils.
Sausage-shaped, bilobed nucleus - generally goes after parasitic infections but is also involved in asthma and allergies. On EM, there is a dark stripe on specific granules. 50% of the total granule protein is major basic protein.
660
How is iron taken up by intestinal cells?
Transferrin-bound iron binds receptors and enters via RME. The free Fe is released, reduced to Fe2\_, and transported to the cytoplasm where it can be stored in ferritin or sent to the mitochondria for incorporation into heme or Fe-S clusters.
661
What percent of plasma is a2 globulins?
8.6%
662
What variations in development of liver/biliary apparatus can you get?
Minor variations in liver lobulation, duplication of gallbladder. Usually asymptomatic and not rally clinically significant.
663
What is the origin of rectus abdominis?
Pubis.
664
What's the difference between pharmacokinetics and pharmacodynamics?
Kinetics is what body does to the drug, dynamics is what drug does to the body.
665
How much methemoglobin causes death?
\>70%.
666
What does the Y chromosome have that turns men into men?
The SRY gene that encodes TDF.
667
Describe the immature B cell.
IgM expressed on the surface, exits bone marrow to go to secondary lymph tissue where it undergoes negative selection. In lymph it gets chemokine signals to survive and mature.
668
What is drug potency?
Amount of drug needed to produce the desired effect.
669
Albumin \> ?
Albumin \> IgG \> Transferrin \> Fibrinogen \> IgA/M \> transport proteins \> protease inhibitors
670
Give a general description of red blood cells. What is their function? How big are they?
Also called erythrocytes. Transport O2 and CO2. Make up 99% of all blood cells. No organelles when mature, biconcave shape. About 8um diameter - less than 6 is a microcyte, over 9 is a macrocyte.
671
What is monocytosis a marker of?
Chronic inflammation from chronic infection of chronic inflammation illnesses.
672
What are hte branches of CN V1?
Nasociliary nerve (anterior ethmoidal n., long ciliary nerves), Frontal nerve (supratrochlear n., supraorbital n.), Lacrimal nerve.
673
What are the CN VII 3 external branches between the stylomastoid foramen and parotid gland?
Posterior auricular n., nerve to posterior belly of digastric, nerve to stylohyoid.
674
What is the marginal zone of the spleen?
The sinuses between the red and white pulp.
675
Describe the veins of the orbit.
Superior and inferior opthalmic veins (inferior is branch of facial vein). They have no valves (bidirectional blood flow), exit through superior orbital fissure).
676
What is non-rotation and mixed rotation of midgut?
Non-rotation is only a 90 degree rotation of the midgut. Intestines end up on wrong side "left-sided colon". Mixed rotation is only a 180 degree rotation of the midgut. Intestines twisted (congenital volvulvus), cecum inferior to pylorus fixed to posterior abdominal wall by peritoneal bands from duodenum.
677
In what cases must a doctor break confidentiality?
Child/elder abuse, significant suicide risk, a serious threat to another person, when the person poses a risk to public safety.
678
Name some negative acute phase proteins.
Albumin, transferrin, transthyretin, retinal-binding protein, antithrombin, transcortin.
679
How many DSM-5 criteria do you need to meet to have a substance use disorder?
2-3 for mild, 4-5 for moderate, 6 or more for severe.
680
What clotting proteins require gamma-carboxyglutamate as a post-trans modification prior to the release from the liver? What does gamma-carboxyglutamate require?
Factors VII, IX, X, prothrombin. Calcium, Vit K (carboxylates).
681
Describe hemoglobin beta and beta like subunits and where they're made.
Beta are made first in the liver and then made in the BM. Delta is made only after birth and it's the beta subunit in HbA2. Epsilon is made in the embryo through early life. Gamma is the fetal subunit and is expressed through early life.
682
What percent of plasma is fibrinogen?
6.5%
683
What does the middle rectal artery anastomose with?
The superior and inferior rectal arteries.
684
What are the primary principles of medical ethics?
Beneficence, nonmaleficence, autonomy, justice.
685
What is the Pringle maneuver?
Clamping the hepatoduodenal ligament in surgery (contains portal triad).
686
What's the major change from orthochromatophlic erythroblast to reticulocyte?
The nucleus is expelled (eaten by macrophage nurse cell), the remaining polyribosomes aggregate to form a stained reticular network (stains with cresyl blue). The reticulocyte is expelled into the blood stream.
687
Describe CXC-chemokines.
Function through CXCR, includes CXCL8(Il-8).
688
What is the fundus of the bladder?
The posterior surface.
689
What is the path of sperm?
Seminiferous tubules -\> straight tubules -\> rete testes/mediastinum -\> efferent ductules -\> head of epididymis.
690
What are the adverse effects of carbonyl iron?
GI discomfort, dark stools, urine discolouration, dental stain.
691
What's the difference in presentatoin of acute and chronic lymphadenitis?
Acute is painful, chronic is not. Acute has red overlying skin.
692
Where can inactive A1AT accumulate?
In the liver, and cause cirrhosis.
693
What is the PALS?
Periarteriolar lymphoid sheath - mostly T cells that line the central arteries/arterioles in the white pulp ofthe spleen.
694
What is Congenital Adrenal Hyperplasia?
CAH. An autosomal recessive condition resulting in androgen overproduction. XX appear masculine, XY does premature puberty.
695
What are peptic ulcers?
Lesion/necrosis in mucosa of the stomach - can cause hematemesis or melena. If on greater curvature, can erode gastric arteries. If on posterior wall, can erode splenic arteries and pancreas. If on anterior wall, can erode liver.
696
What does ceruloplasmin do?
AKA ferroxidase. It is a Cu transporter (responsible for 95% of the Cu transport).
697
How do the TNF cytokine receptor families function?
They converge to activation of NEMO/IKKgamma/NFkappaB modulator. IKKalpha and beta are prebound, beta is phosphorylated, unbinds, is ubiquitinated, and degraded by proteasome. NFkappaB is released (a TF).
698
What is hematochezia?
Bright red fresh blood in the stool. Undigested, lower GI bleed.
699
Where does the linea alba go from/to?
Xiphoid process to pubic symphysis.
700
What are some other blood groups?
Lewis (Le), Anti-U type (hard to find compatible donor), AutoantiP/Donath-Landsteiner, Kell Antigen, Duffy Fya and Fyb alleles (both binding sites for P. vivax, missing them prevents malaria uptake), Kidd blood group anti-Jka (can cause delayed hemolytic transfusion reaction).
701
What is an enzyme that all lysosomes have?
Myeloperoxidase. It uses H2O2 to generate highly reactive bactericidal hypochlorite (bleach) and chloramines.
702
Describe the endopelvic fascia.
CT condensations that passively support the uterus. Uterosacral ligament (cervix to sacrum), Transerse Cervical / Cardinal ligament (cervix to lateral wall of pelvis), Pubocervical ligament (pubis to cervix).
703
How do lymphocytes enter lymph nodes?
Through the high endothelial venule on the paracortex. HEV is cuboidal/columnar lined, and L-selectins bind its addressins.
704
What is blood serum?
All but cells and fibrinogen/fibrin.
705
Describe the peritoneal cavity.
A fluid filled space between the parietal and visceral peritoneum, no structures in it. Made of greater sac (from diaphragm to pelvis, in females opens out through uterine tubes) and lesser sac/Omental bursa (hidden) which communicate via the omental foramen.
706
What is MCH?
Mean corpuscular hemoglobin. Hb/RBC#.
707
What nerves innervate the infrahyoid muscles (omohyoid, sternohyoid, thyrohyoid, sternothyroid).
All ansa cervicalic (C1-C3) except thyrohyoid which is CN XII.
708
How is iron transported throughout the body?
Taking up in duodenum as ferric form, transportd to BM in transferrin, then reduced into ferrous form in ferritin for storage.
709
What is the sensitivity and specificity of the CAGE questions?
Se (43-94%), Sp (78-96%).
710
What's normal blood colloidal osmotic pressure? What's the capillary pressure in filtration and reabsorption?
25mmHg. Filtration: 35mmHg Reabsorption: 18mmHg
711
What do the intestinal bronchomediastinal trunks drain and drain into?
Internal thoracic viscera: heart, lungs, thymus, trachea, part of breasts. Drains into right or left venous angles or right lymphatic duct/thoracic duct.
712
What is under the lateral umbilical peritoneal folds?
The inferior epigastric vessels.
713
What are IgSFs?
Ig-Superfamily of adhesion molecules. Mostly homophilic (cell-cell).
714
What does the superior vesical artery supply?
The superior bladder and vas deferens.
715
What is cavernous sinus syndrome?
CN III, IV, some of V, VI compressed. Opthalmoplegia (loss of eye movement), loss of some sensory to the face, eyes can be proptosed with inflammation. Treat with early and aggressive antibiotics.
716
Describe the anterior quadratus lumborum fascia.
Attaches to the 12th rib, lumbar transverse processes, and iliac crest. It is continuous with the aponeurotic origin of transversus abdominis, adheres inferiorly to iliolumbar ligaments, thickens superiorly to form lateral arcuate ligaments.
717
Describe the development of the testes.
The promitive sex cords differentiate and penetrate deep into the medulla of the indifferent gonads, forming the testis/medullary cords. The testis cords are separated from the surface epithelia by the tunica albuginea. (In the fourth month, they become horseshoe shaped). The rete testis enter the excretory mesonephric tubules (efferent ductules), which connect to the mesonephric/Wolffian ducts (destined to become ductus deferens).
718
What is Hepcidin?
It acts on ferroportin in the intestine, liver, macrophages, and blocks its action - limiting iron absorption. Iron among other things increases it.
719
What are the borders of the carotid triangle? What does it contain?
Omohyoid SCM, posterior belly of digstric. Carotid sheath, deep cervical LNs, ansa cervicalis, CN XI, CN XII, some external carotid branches.
720
Describe spermatic cord torsion.
Most common in adolescents ages 12-16. Pain, swelling, redness, LQ abdomen pain, nausea, fever, emesis. Surgical emergency - should fix testes to scrotal septum 4-6 hours after onset of pain. Can test with cremasteric reflex.
721
What does erythropoiesis require?
Iron, B12, folate.
722
Where are lymphatic plexuses found?
ANywhere capillaries are found except for teeth, bones, CNS.
723
Describe the urogenital triangle.
From the ischiopubic rami to prepuce of the clitoris. Skin, superficial perineal fascia, deep perineal / Colles fascia, superficial perineal pounch, perineal membrane, deep perineal pouch.
724
What are the paired visceral branches of the abdominal aorta?
They branch laterally. Middle suprarenal (L1), Renal (L1), Gonadal (L2).
725
What is the superficial venous drainage to the abdominal wall and what do they drain into?
Superficial epigastric (into great saphenous). Thoracoepigastric (into lateral thoracic). Periumbilical - communicates with thoracoepigastric and paraumbilical.
726
What muscles scrunch your nose up when you are grossed out?
Procerus and transverse part of nasali.
727
Describe the ejaculatory duct.
Seminal gland and vas deferens combine into it and join into the prostatic urethra.
728
How is rolling adhesion done?
The cell's L-selectin binds Sialyl-Lewis on the vessel endothelium. Then the L-selectin is shed, the integrin binds the endothelial E-selection, and it adheres.
729
Where does CN VII exit the head? What's it called?
Enters via internal acoustic meatus, travels through facial canal, exits via stylomastoid foramen. Facial nerve.
730
What does the superior gluteal artery supply? Describe its course briefly.
It is the major blood supply to the muscle and skin of the gluteal region. It travels between the lumbosacral trunk and S1 ventral rami before exiting via the GSF and entering the gluteal region superior to the piriformis.
731
Where do lymphoid organs come from?
Mesenchyme/mesoderm.
732
How efficiently is heme iron absorbed and what foods is it found in?
30% efficiency. Liver and lean meat.
733
What is the cause of X-linked Hyper-IgM syndrome?
A defect in CD40L.
734
Where does CN VIII exit the head? What's it called?
Internal acoustic meatus (doesn't leave head). Vestibulocochlear nerve.
735
What is PCV?
Packed cell volume. Volume of blood cells in centrifuged tube.
736
In what circumstances does hematocrit go down?
Anemia, Iron/B12/folate deficiency, internal bleeding, lymphoma.
737
What are the components of RBCs?
Plasma membrane, cytoskeleton, glycolysis enzymes, Hemoblogin (95% of protein content, 30% of mass).
738
Where do the layers of the gut tube derive from and what are they?
Splanchnic mesoderm (epithelium in endoderm). Mucosa (epithelium, lamina propria, muscularis mucosae), submucosa, muscularis, serosa/adventitia.
739
What are the contraindications of cyanocobalamin? What are the potential adverse effects.
Early Leber's optic nerve atrophy, IV administration is precaution. Limited toxicity, injection site reactions.
740
How is heme degraded?
Heme oxygenase releases Fe2+ from it, protoporphyrin IX broken and becomes biliverdin. Biliverdine reductase (methine to methane) turns it to bilirubin, which is carried to the liver by albumin. Propionic acids of bilirubin are modified and reacted with UDP-glucuronide, and then secreted into bile as bilirubin diglucuronide. In hepatocytes, MRPs (multidrug resistance proteins) send it out and OATPs (organic union transporting polypeptides) bring it back in.
741
What is separated in each type of Le Fort Fracture?
I: palate, II: maxilla, III: maxilla and zygomatic bones.
742
What are the potential adverse effects of deferasirox?
Skin rash, abdominal pain, nausea, vomiting, diarrhea, proteinuria, increased serum creatitine. Renal failure, hepatic failure, GI hemorrhage
743
What is epispadias?
Complete/partial lack of fusion of the urethral folds - abnormal opening or openings along the dorsal surface of the penis. Associated with extrophy of bladder.
744
What innervates the suprarenal glands, kidneys, and ureters?
Suprarenal glands by the celiac plexus (no parasymp.), Kidneys by the renal plexus and the vagus nerve. Ureters by the renal, abdominal aortic, and superior/inferior hypogastric plexi. They also have pain/GVA axons that follow the sympathetic fibers to T11-L2.
745
What are the contraindications of carbonyl iron?
Hemochromatosis, hemosiderosis, hemolytic anemia.
746
What liver enzymes are elevated in liver issues?
ALT, AST, ALP, GGT.
747
What foods is folate/B9 found in?
Green leafy veggies, yeast, liver, some fruits (it's heat labile).
748
What are the layers of the scalp?
Skin, CT (highly vascularized), Aponeurosis (galea aponeurotica), Loose alveolar tissue sponge-like layer filled with potential spaces that may distent with fluid from infection), Pericranium.
749
Describe the development of the ovary.
The primitive sex cords dissociate into pclusters of cells containing primitive germ cells that will later be replaced by vascular stroma. This forms the medulla. By week 7, the surface epithelium proliferates and gives rise to the cortical cords which penetrate the underlying mesoderm. The medullary cords degenerate. By the 4-5th month, cortical cords split into cell clusters that surround the primitive germ cells. The surrounding epithelia become follicular cells and the primitive germ cells become oogonia.
750
Does the gallbladder also have de/recanalization?
Yep.
751
What are the Hassal's Corpuscles?
Thymic corpuscles made of epithelial reticular cells, found in medulla. The central area has necrotic cells.
752
What is the best indicator of anemia?
Hemoglobin. Hematocrit is worse.
753
What is HbF?
alpha2gamma2
754
What can different pancreatic cancers obstruct?
Head (most common) - common bile duct, hepatopancreatic ampulla. Can cause jaundice Neck and body - IVC and hepatic portal vein.
755
What tooth can the fracture of the body of the mandible involve?
Usually passes through the socket of the canine.
756
What are the vestigial remnants of the developing female internal genitalia?
The mesonephric system persists as epoophoron, paroophoron, possibly Gartner cyst.
757
What muscles make up continence?
Puborectalis forms a sling around the anorectal junction, Pubococcygeus compression.
758
Where is pain referred to in the gallbladder?
The right shoulder - the gallbladder also gets GSA fibers of the right phrenic nerve.
759
What is iron uptake in the duodenum competed by?
Pb, Co, Sr, Mn, Zn.
760
What is melena?
Tarry, dark blood in the stool. Partially digested blood.
761
What is the venous drainage of the thyroid?
Superior pole drained by superior thyroid vein -\> IJV. Middle of lobes drained by middle thyroid vein -\> IJV Inferior poles drained by inferior thyroid vein -\> BCV
762
What besides the levator palpebrae does eyelid lifting?
The deepers uperior tarsal muscle. Innervated by the sympathetics from T1 and then the superior cervical ganglion.
763
What happens if you are missing a Kell antigen?
Acanthocytosis, reduced RBC lifespan, muscular dystrophy.
764
What is the sympathetic innervation to the liver?
The hepatic nerve plexus (part of the celiac plexus).
765
What to B cells do post activation?
Proliferation/clonal expansion, isotype switching, affinity maturation, somatic hypermutation.
766
What does the lingual artery run parallel to?
CN XII.
767
What's the major change from reticulocyte to erythrocyte?
The loss of all polyribosomes.
768
What is the name of the test to isolate individual extrinsic muscles of the eye?
H-test.
769
What is the retropharyngeal space?
From clivus to mediastinum, largest interfascial space in neck. True/proper RPS between pretracheal layer and alar fascia. Danger space between alar fascia and prevertebral layer. Infection can spread from pharynx to mediastinum.
770
Where does the inferior epigastric artery branch from? What does it anastomose with?
The external iliac artery. The superior epigastrics.
771
What arteries provide blood to the thyroid?
Superior and inferior thyroid arteries.
772
What is the lymphatic drainage of the liver?
Superficial (associated with bare area) goes to the phrenic or posterior mediastinal LNs. Deep (associated with porta hepatis) go to hepatic or celiac LNs.
773
What is hemostasis?
The mechanism the bodyuses to stop bleeding after injury. Vasoconstriction, platelet plug to stop small wounds, fibrin clot for bigger ones. System is designed to respond fast after a vascular injury with positive localized feedback.
774
What is the equilibration phase of Ab-Ag response?
The Ag is distributed between the vascular and EC compartments.
775
What is the arterial supply and venous drainage of the testicles?
Testicular arteries (arise from aorta at L2), cremasteric arteries and artery of vas deferens exist. The right pampiniform plexus drains into the IVC, left into left renal vein.
776
What is special about the layers of the gallbladder?
Part of the GI tract, but no submucosa.
777
What is the buildup of plasma?
92% water, 7% proteins (54-60% albumin, 35-38% globulins, 4-7% fibrinogen), \<1% regulatory proteins and other solutes.
778
What is the insertion of quadratus lumborum?
Internal lip of iliac crest.
779
Describe the ilioinguinal nerve.
L1. Innervates the abdominal muscles and skin of inguinal and pubic region.
780
Describe the perinephric and paranephric fat.
Perinephric is contained within the renal fascia and is continuous with the renal sinus. Paranephric is external to the posterior renal fascia and is associated with the lumbar region.
781
What muscle does the genitofemoral nerve pierce?
Psoas major.
782
Where does CN III exit the head? What's it called?
Superior orbital fissure. Oculomotor nerve.
783
What are some causes of basophilia?
Type I hypersensitivity, chronic myeloproliferative disease.
784
What is iron uptake in the duodenum inhibited by?
Phytates, tannins, soil.
785
What are new erythrocytes called?
Reticulocytes. Only 1% of RBCs are replaced daily.
786
What is bone marrow sampling done for? Where is it taken from?
To diagnose malignancies, evaluate iron stores (should do serum ferritin test first, evaluation of disseminarted infection.
Posterior iliac crest, can also do anterior, sternum, or anterior tibia in nerbowns.
787
What are the genes for MHCI?
HLA-A, HLA-B, HLA-C.
788
What are gonads derived from embryologically?
The condensation of intermediate mesoderm and proliferation of the coelomic mesoderm.
789
When are pancreatic amylase and lipase elevated?
In acute pancreatitis.
790
Describe the difference between internal or external hemorrhoids.
A result of anorectal portocaval anastomoses - high pressure in rectal veins. Internal are above pectinate line and not painful. External are below pectinate line and are very painful.
791
What is an adjuvant?
A chemical that enhances immune response to an antigen. They prolong persistence, stimulate/modulate immune cells, enhance macrophage function.
792
Where is the cervical plexus/nerve point?
Anterior rami of C1-C4, deep to SCM, anteromedial to levator scapulae. Superficial branches are sensory (nerve point), deep ones are motor.
793
What are the contents of the spermatic cord?
Artery to ductus (vas) deferens, Ductus deference, Lymph vessels, Testicular artery, Cremasteric artery and vein, Obliterated processus vaginalis remnant, Pampiniform plexus, Genital branch of genitofemoral nerve.
794
What are the ADMEs of cetirizine, fexofenadine, loratadine. Any weird metabolism things?
Oral administration only, no CNS distribution, urine and feces excretion. Loratadine is metabolized to descarboethoxyloratadine with 3A4 and CYP2D6.
795
What is cholelithiasis and cholecystitis?
Cholelithiasis are gallstones (RUQ pain, more common in fat fertile females in their forties). Can have jaundice. Cholecystitis is gallbladder inflammation.
796
Who is alpha thalassemias common in?
Black Americans, Southeast Asians.
797
What does elevated ALT/AST mean?
Both elevated in liver disease, AST also elevated in myopathies but less than it is in liver disease. \>1000IU/L acetaminophen toxicity, liver failure, or shock. \<120 and \<1000 in alcohol toxicity, viral hepatitis, liver cancer, sepsis, drug-induced elevation.
798
Describe the omental foramen borders
AKA the epiploic foramen and the foramen of winslow. Anterior - hepatoduodenal ligament Posterior - IVC, right crus of diaphragm Superior - caudate lobe of liver Inferior - 1st part of duodenum
799
What enzyme deficiencies can mess up phagocytic digestion?
G6PD, NADPH Ox (chronic granulomatosis disease), MPO (but it's not clinically significant).
800
Is ferrous iron good to have free?
No, it is toxic.
801
What is formed from the dorsal embryonic mesentery?
Greater omentum, small intestine mesentery, mesoappendix, transverse and sigmoid mesoderm.
802
What is the action of the masseter?
Elevates and protrudes the mandible?
803
How do type I and II cytokine receptor families function?
The cytokine loosely binds, activates JAK-STAT pathway (JAKs join and activate, STATs bind, are phosphorylated, dimerize and become TFs).
804
What isotype does IFNgamma induce a B cell to switch to?
IgG1, IgG3
805
What is contained within the carotid sheath?
Common carotid artery and branches, vagus nerve, internal jugular vein. All 3 layers of the deep fascia of the neck makes it.
806
How can citrate and EGTA lead to poor coagulation?
THey are calcium chelators/
807
What do the renal fascia do in a perinephric abscess?
Acts to block the spread of infection.
808
What is thrombocytopenia?
Lack of platelets in blood. Can be caused by reduced platelet survival, production, dilution (from transfusions), or sequestration.
809
What is a nephron?
The urinary excretory unit. They are formed up until birth.
810
What is the cutaneous innervation to the scrotum?
Anteriorly - ilionguinal nerve (L1) Posteriorly - pudendal nerve (S2-S4)
811
Where does CN XII exit the head? What is it called?
Hypoglossal canal. Hypoglossal nerve.
812
What is the Pectineal ligament?
Most lateral lacunar ligament fibers continue along pecten pubis medial to the femoral canal.
813
What ligament is the tail of the pancreas found in? Where is the pancreas found?
The splenorenal ligament. Head is right of SMA, Uncinate process posterior to SMA, neck behind pylorus, body left of SMA.
814
What is contained within CN II?
The central artery of the retina.
815
What is a fracture of the neck of the condylar process of the mandible usually associated with?
Dislocation of the temporamandibular joint.
816
What is GGT elevated in?
Alcoholism, it's more selective than ALP for cholestasis.
817
What are some possible signs of basilar skull fractures?
Otorrhea/rhinorrhea, anosmia, decreased hearing or deafness, CN VII palsy, retroauricular/mastoid ecchymosis "battle sign" (if fracture line communicates with mastoid air cells), hemotympanum vertigo, periorbital ecchymosis "raccoon eyes".
818
What is cyanocobalamin? How is it administered?
Vitamin B12 preparation. Converted to active form of cobalamin. Preferred administration IM or deep SQ, nasal possible, oral not recommended (poor absorption).
819
Describe the differences between the jejunum and the ileum.
Jejunum is wider diameter, deeper red (needs more blood), not twisted, thick/heavy wall, less mesenteric fat, fewer Peyer's patches, larger taller circular folds (plicae circularis), longer vasa recta, greater density of vascularity. Few large arterial arcades (many short ones in ileum).
820
Where does the inferior oblique of the eye originate?
The anterior orbital margin.
821
When is gamma-glutamyl transferase elevated?
Biliary obstruction, response to toxin exposure, alcoholism and chronic drug abuse.
822
Where are the testes initially attached to before descent and what is descent like?
Influenced by androgens and MIS as well of intraabdominal pressure due to growth. Testes are initially attached to the posterior abdominal wall by the urogenital mesentery. The mesentery at the caudal pole forms the genital ligament and the intraabdominal gubernaculum. In the inguinal region, the intraabdominal gubernaculum terminates and the extraabdominal gubernaculum takes over and extends to the scrotal floor. Testicular arteries descend with it - processus vaginalis is the evagination of the abdominal peritoneum.
823
what is a Cabot's Ring inclusion body?
MTs, spindle remnants.
824
How do NK cells kill?
Failure to bind MHC-I by KIR (perforin, granzyme). ADCC - CD16 binds Ab bound to Ag, NK expresses FasL and activates caspase.
825
Where can you detect pulsations of the large abdominal aortic aneurysm?
To the left of the midline, usually between L2-L4. A large mass will be palpable.
826
Describe embryonic development of the pancreas.
Endodermal outpocketing of ventral and dorsal pancreatic buds. Rotation of gut tube causes bud fusion in week 6. Ventral bud comes to lie posteriorly, makes just the uncinate process. CT and blood vessels form from surrounding mesoderm - ductal systems interconnect. Main duct formed from ventral and distal dorsal duct, accessory duct formed from proximal dorsal duct. Islets develop in month 3 (possibly from neural crest cells).
827
What is Androgen Insensitivity Syndrome?
AIS. Can be partial or complete. Results in feminization/lack of virilization - diagnosed at puberty in absense of menses.
828
What is formed from the ventral embryonic mesentery?
The lesser omentum and liver ligaments.
829
What is the half-life of albumin? What does it do?
20 days. Transports hydrophilic molecules.
830
What do glucocorticoids do in relation to leukocytes?
Decreased marginalization and decreased extravasation into tissues.
831
What are the six assessment dimensions for treatment for substance use problems?
Acute intoxication and/or withdrawal potential, biomedical conditions and complications, emotional. behavioural, or cognitive conditions and complications, readiness to change, relapse, continued use, problem potential, recovery/living environment.
832
What cytokines induce isotype switching to IgA?
TGFbeta, APRIL, BAFF, more.
833
Where is the thyroid gland located?
Largest endocrine gland in the body, level of C5-T1. Anterior to trachea, deep to sternothyroid and sternohyoid.
834
What does the uterine artery supply? Describe its course briefly.
Just in women, the uterus, fallopian tubes, ovaries, vagina. Ascends along the lateral border of hte uterus, anastomoses with ovarian artery at origin of tubes, crosses superiorly over the ureter.
835
What is separation of the pubic symphysis called?
Diastasis.
836
What are the anterolateral abdominal wall muscles?
External and internal obliques, transversus abdominis.
837
What is the deep venous drainage to the abdominal wall and what do they drain into?
Superior epigastric (into internal thoracic). Inferior epigastric (into external thoracic). Paraumbilical (into hepatic portal vein - communicates with periumbilical).
838
What is the insertion of the pyramidalis?
Linea alba.
839
What PAMP does TLR4 recognize?
LPS
840
What makes up the reactive part of MHCI?
alpha1 and alpha2 subunits?
841
What are the genes for MHCII?
HLA-DP, HLA-DQ, HLA-DR.
842
What do the subclavian lymphatic trunks drain and drain into?
Forearm, hand, arm, axilla. Left drains into the thoracic duct, right joins the right jugular trunk to form the right lymphatic trunk, which drains into the right lymphatic duct.
843
What is another name for CD16?
FcgammaIII
844
Describe biliary atresia.
Can be intrahepatic (rarer) or extrahepatic. Extrahepatic is atresia of a duct like the hepatic or bile duct. Can cause jaundice. If you cannot surgically open up the lumen you must replace the liver.
845
What is an omphalocele?
Failure of the intestinal loop to return to the abdomen. Come out of body covered by umbilical cord. Is 'giant' if liver also herniates - associated with other congenital issues. Must deliver via c-section.
846
What is the blood flow through the white pulp of the spleen?
Splenic artery into trabecular artery into central artery/arteriole into the penicillar arterioles (then either into splenic sinusoids or open through sinus walls).
847
When do the anterior, mastoid, posterior, and sphenoid fontanelles close?
18 months, 12 months, 2-3 months, 2-3 months.
848
What is Potter's sequence?
Atypical appearance caused by oligohydramnios. Lack of kidneys, anuria, hypoplastic lungs.
849
What is bicornis?
A bicornate uterus (one cervix). From incomplete fusion of the paramesonephric ducts.
850
How are the cranial nerves distributed in the anterior, middle, and posterior cranial fossa?
Antetior: CN I. Middle: CN II-VI. Posterior: CN VII-XII.
851
How do germinal centers of LNs look?
Lighter staining.
852
What are the layers of the spermatic cord and what are they derived from?
External spermatic fascia (investing fascia of ext. oblique), Cremaster fascia (investing fibers of int. oblique) Internal spermatic fascia (transversalis fascia).
853
Describe the 4th part of the duodenum.
Ascending, mostly retroperitoneal, ascends back to ~L2, terminates at duodenojejunal flexure. Supported by suspensory ligament of Treitz.
854
What innervates the recti of the eye?
Superior, inferior, medial CN III, lateral CN VI.
855
What is the inguinal ligament of Poupart?
Fibrous, thickcned, folded margin of external oblique aponeurosis spanning from the ASIS to the pubic tubercle.
856
What is MCHC?
Mean corpuscular [Hb]. Hb/PCV. Determines hypo/normo/hyperchromicity of cells. Not an anemia indicator
857
Describe the medial umbilical peritoneal folds.
Remnant of the embryological umbilical arteries. Underneath it is the medial umbilical ligaments.
858
What is the origin of iliacus?
Superior 1/3 of the iliac fossa.
859
What are cetirizine, fexofenadine, loratadine?
Second gen H1 blockers. Non sedative antagonists used for allergic reactions.
860
Describe the renal medulla.
Has columns and calyces. 2-3 minor calyces drain into a major one, 2-3 major calyces drain into the renal pelvis. The apex of the renal pyramid is a renal papilla - indents each minor calyx.
861
What is Rhesus protein?
Rh/D. Rh- people do not have preformed antibodies to Rh+.
862
What is the diaphragma sellae?
A dural infolding that covers the pituitary gland.
863
What is ALP elevated in?
Bile duct obstruction (biliary isoform), infiltrative disease, intrahepatic cholestasis, healing fractures, Paget's disease, renal osteodystrophy. Not in hepatic necrosis.
864
What is the innervation of rectus abdominis?
Anterior rami of T6-T12.
865
What is the reflected inguinal ligament?
Superior fibers of the external oblique aponeurosis and lacunar ligament fans upwards crossing the libea alba instead of inserting into the pubic tubercle.
866
List all the beta globulins. What do they do?
Transport proteins (and plasminogen). b2-macroglobulin, plasminogen, angiostatins, properdin, sex hormone binding globulin, transferrin.
867
What are the structural types of chemokines?
C, CC, CXC, CX3C.
868
How do azurophilic things stain?
Reddish blue.
869
What are the contents of the superficial perineal pouch?
Erectile tissues, 3 muscles of external genitalia, Bartholin's/great vestibular glands in females.
870
What are interventions for suicide?
Screening/assessment, psychotherapies, medication, medical treatment.
871
What are the RBC integral membrane protein families?
Glycophorins and Band 3.
872
What muscle aponeuroses are anterior to the rectus sheath below the arcuate line?
All 3 anteriolateral muscle aponeuroses.
873
List all the alpha-1 globulins. What are they?
Mostly protease inhibitors that limit inflammation and vascular dmage. a1-alphatrypsin, a1-antichymotrypsin, orosomucoid, serum amyloid A, a1 lipoprotein.
874
What does a2-antiplasmin do?
Inhibits plasmin and neutrophil elastase.
875
What is suicidal ideation?
Thoughts of harming/killing oneself.
876
What are coumarin and warfarin?
Vitamin K antagonists.
877
In cryptorchid, what are the 4 degrees of arrested descent?
Abdominal cavity (deep to inguinal ring), inguinal canal, superficial inguinal ring, upper scrotum.
878
What are Donath-Landsteiner antibodies?
Antibodies that cause hemolysis when it's cold.
879
What is the modiolus?
"Dimple point" where as many as 9 facial muscles interlace or merge.
880
What are leukemias?
Malignant clones of leukocyte precursors. Occur in lymphoid tissue (lymphocytic) and in bone marrow (myelogenous and monocytic). There is a large release of immature cells, patient is usually anemic and prone to infection.
881
What is extrophy of bladder associated with?
Epispadias.
882
How does Masson's Trichrome stain everything?
Keratin/muscle fibers red, collagen/bone blue/green, cytosol light red/pink, nuclei brown/black.
883
Where are central lines put into?
Subclavian vein.
884
What does Met 358 Arg mutation in A1AT do?
Changes its activity to antithrombin and causes a bleeding disorder. Smoking modifies Met 358 preventing proper maturation and folding.
885
What is poikilocytosis?
Shape variation of RBCs. Can be sickle-cell, microspherocytes, teardrop cells, schistocytes.
886
What happens after PAMP binds PRRs?
Binds MyD88, recruits IRAK and then TRAF6. TAK1 is activated, then the IKK complex is activated.
887
What is cobalamin/B12 result in?
Methionine synthase and methylmalonyl CoA mutase. MCM requires the deoxyadenosyl form and is involved in metabolism of Ile, Val, Met, Thr, thymine, and odd chain FAs. Methionine synthase needs methyl form.
888
Where do erythrocytes develop?
In the bone marrow on the surface of macrophage nurse cells.
889
What innervates the superior and inferior obliques of the eye?
Superior CN IV, Inferior CN III.
890
What is the arterial supply to the ureters?
Descending branches by renal and gonadal arteries. Ascending branches by internal iliac arteries.
891
What does the internal pudendal artery supply?
The main supply to the perineum, perianal muscles, external genitalia, erectile tissues.
892
What is the allantois?
Primitive urine storage that forms when vitelline duct forms during folding.
893
What are Epithelial Reticular Cells (ERCs)?
Join through desmosomes, form support network of thymus for developing thymocytes. Have keratin IFs, build blood-thymus barrier with capillary endothelial cells. Derived from endoderm.
894
What is hypospadias?
Complete/partial lack of fusion of the urethral folds - abnormal opening or openings along the ventral surface of the penis.
895
What are the general differences between innate and active immunity?
Innate is fast, short-lived, nonspecific, expressed by all cells of a particular type. Active is short-lived, slower, and highly specific.
896
Describe the deep perineal pouch.
Space between the pelvic diaphragm and perineal membrane. Contains part of the urethra, nerves and vessels, external urethral sphincter, in males the bulbourethral glands and deep transverse perineal muscles.
897
What is the venous drainage of the stomach and where do the veins go?
Prepyloric veins -\> right gastric veins Gastric veins -\> hepatic portal vein Left gastro-omental and short gastric veins -\> splenic vein Right gastro-omental veins -\> SMV
898
What is heme? Where and how does it bind iron? What happens when it is released through hemolysis?
Porphyrin (protoporphyrin IX) and iron. Iron is added to porphyrin in the BM mitochondria - it is picked up from transferrin. When it is released through hemolysis iron is reloaded onto transferrin and porphyrin is destroyed (90%) or recycled in immature erythrocyte mitochondria.
899
What are 'secretors'?
People that have another fucose transferase so you get A/B/O antigens in fluids besides blood. Being a nonsecretor is autosomal recessive - susceptible to a bunch of bacteria but is protected against the Norwalk virus.
900
What are the types of hemoblogin starting with the very early embryonic form?
HbGower(1) zeta2epislon2 is replaced by HbF alpha2gamma2 by about month 2 of development. At birth, gamma stops being made and beta starts, and by 3-6 months of life, its almost entirely HbA alphabeta.
901
What is the difference between mutations in alpha and beta thalassemias?
Beta are generally small single base mutations, alpha are large deletions.
902
Where do the celiac trunk, SMA, and IMA come from the abdominal aorta?
T12, L1, L3.
903
What is the innervation of dilator pupillae?
T1 to the superior cervical ganglion to the long ciliary nerves.
904
Where is ectopic pancreatic tissue most commonly found?
Duodenum or stomach mucosa. 5% of Meckel's diverticulum have it.
905
What are the contraindications of darbepoietin alfa?
Uncontrolled hypertension, anemia in cancer patients not from chemo.
906
What are the branches of the pudendal nerve?`
Dorsal nerve of penis/clitoris, inferior rectal nerve (sensory to anal triangle, motor to lower 1/3 of anal canal), perineal nerve (sensory to posterior labia/scrotum, motor to perineal pouch contents).
907
What is thrombopenia?
Insufficient platelet concentration/
908
Describe the arcuate ligaments.
Median (forms aortic hiatus, unites crura in front of aorta), Medial (x2, thickening of psoas major fascia between lumbar vertebral bodies and tip of L1 transverse process), Lateral (x2, thickening of quadratus lumborum fascia, more midclavicular, tip of 12th rib).
909
What are the adverse effects of ferric gluconate?
Vomiting, nausea, diarrhea, injection site reaction, cramps, dyspena, cardiovascular instability.
910
Where do the lineae semilunaris go from/to and what does it mark?
From costal cartilage to pubic tubercles. It marks the lateral border of the rectus sheath.
911
What is a Heinz inclusion body?
Denatured hemoglobin.
912
What is the sympathetic, parasympathetic innervation, general venous and lymphatic drainage to the foregut?
T5-T9 spanchnic nerves and celiac plexus, Vagus nerve, Hepatic portal vein, Celiac LNs.
913
Describe the perineum.
A diamond shaped area that is divided into the urogenital and anal triangle.
914
What is the danger area of the face?
Blood can get to the cavernous sinus via the valveless superior/middle.inferior ophthalmic veins. Can cause cavernous sinus syndrome.
915
What do the renal arteries branch into? What do the veins drain into?
The segmental arteries, then the interlobar arteries, then the arcuate arteries. The arcuate veins drain into the interlobar veins then into the segmental veins then the renal veins then the IVC.
916
Describe lymphocytosis.
Caused by infections, autoimmune things, endocrine issues like Graves' disease, maybe malignancies. Will see atypical lymphocytes called Downey cells "ballerina skirts".
917
What signals control AID synthesis?
IL-4 and CD40.
918
Describe the rectus sheath.
The aponeuroses of the anterolateral abdominal muscles. It contains the rectus abdominis muscles, superior and inferior epigastric vessels, T7-T12 anterior rami.
919
In what case do you get hypoalbuminea?
Liver disease, nephrotic syndrome, severe malnutrition.
920
Describe the cremasteric reflex.
Stroke skin of superior medial thigh - ipsilateral teste retracts. GSA - femoral branch of genitofemoral nerve + ilionguinal nerve. GSE - genital branch of genitofemoral nerve
921
What is meconium?
The first defecation of a newborn - dark green/black. Made of hair, bile, fat. Fetuses shouldn't defecate in utero.
922
What are NKT cells?
They recognize a lipid not protein antigen (CD1 not MHCI). Can secrete cytokines or be cytotoxic.
923
Where does face, scalp, neck lymph drain into?
The superficial ring/paracervical collar. Contains the submental, submandibular, parotid, mastoid, occipital LNs. Eventually drains into the deep cervical nodes, which goes into the jugular lymphatic trunk.
924
Where does CN IV exit the head? What's it called?
Superior orbital fissure. Trochlear Nerve.
925
What are the peritoneal recesses?
Paracolic gutters, subphrenic recess, subhepatic space, hepatorenal recess.
926
What are the intermediate cell stages in erythropoeisis? What kind of precursor do they come from?
Proerythroblast, basophilic erythroblast, polychromatophilic erythroblast, orthochromatophilic erythroblast, reticulocyte, erythrocyte. CFU-GEMM -\> CFU-E.
927
What does the transverse cervical nerve innervate?
Skin of anterior cervical region.
928
What treatment do you give for cirrhosis?
Plasma - fresh or frozen.
929
What is pyrosis?
Heartburn, often by GERD, can be associated with a hiatal hernia.
930
What is DiGeorge Syndrome?
Thymic aplasia - a chromosome 22 issue.
931
Describe the structure of the liver.
Largest gland, major lymph producing organ, 9 functional lobes based on blood supply. Right and left lobes divided by falciform ligament (round ligament inferiorly). Interiorly and anteriorly there is the quadrate lobe, posteriorly the caudate lobe. There is the coronary ligament with the triangular ligaments laterally. The visceral surface has the ligamentum venosum. Inferiorly is the porta hepatis. The bare area is not covered by visceral peritoneum.
932
What is the catabolic phase of Ab-Ag response?
Eliminateion of the ag by innate cells, processing and presentation of Ag.
933
Describe the large pre-B cell.
Mu chain transiently secreted as part of pre-B cell receptor.
934
What proteins are part of innate immunity?
Complement, defensins, IFNalpha, beta, gamma, acute phase proteins.
935
What veins drain into the dural venous sinuses?
Bridging veins (drain cerebrum and cerebellum, cross subdural and subarachnoid spaces), Emissary veins (grain through flat bones of skull an connect extravranial veins with intracranial dural sinuses), Meningeal veins, Arachnoid granulations.
936
How many types of hypofibrinogen diseases are there?
More than 6 congenital diseases, 3 forms of acquired.
937
How does gonad development begin?
Genital ridges proliferate and the epithelial cells push into the underlying mesoderm to form the primitive sex cords. In the 3rd week, the primordial germ cells appear along the endoderm in the wall of the yolk sac near the Allantois. 4th week the cells move along the dorsal mesentery of the hindgut. 5th week the cells reach the primitive gonad. 6th week they invade the genital ridges.
938
Describe the positioning of the spleen and the splenic vessels.
LUQ midaxillary. Behind stomach, anterior/medial to left dome of diaphragm and ribs 9-11, superior to kidney and tail of pancreas, laterally is left colic flexure. Splenic artery courses above pancreas, vein courses behind it.
939
How does aspirin cause poor coagulation?
It inhibits TxA2 synthesis in platelets.
940
Where are mature and immature neutrophils stored?
Bone marrow and blood 5:1.
941
Describe the classical pathway of complement.
Ag binds Ab - C1q binds (associated with C1r and C1s) and encourages Ab crosslinking. This recruits and triggers C2 and C4 to form C3 convertase (C2b4b).
942
How do CD8 cells kill?
With FasL or with perforin and granzyme.
943
Describe the embryological development of the male internal genitalia.
Testosterone stimulates it. As mesonephros regresses, excretory tubules become epigenital and paragenital tubules. The epigenital tubules contact rete testis and form efferent ductules. Mesonephric duct becomes main genital duct, which will obtain a muscular coat and become the vas deferens. Later outbudding of mesonephric duct will form the seminal gland/vesicle. The ejaculatory duct forms beyond the seminal gland, and the mesonephtic duct opens caudally into the urogenital sinus.
944
Describe development of the urinary system. Where do the excretory and collecting systems come from?
Ureteric bud - Excretory system (ureter, renal pelvis, minor and major calyces, collecting ducts, 1-3M tubules). Metanephric blastema - Collecting system (Bowman's capsule, PCT, loop of Henle, DCT).
945
Where on the lymph node is the hilum?
The concave surface.
946
What cytokines trigger Th0 differentiation into Th2?
Helminths/worms cause mast cells and eosinophils produce IL-4.
947
What are the adrenal/suprarenal glands attached to? What is their texture?
To the crura, course/rough.
948
What cytokines activate NK cells?
IL-12, IFNalpha, IFNbeta, TNFalpha, IL-15.
949
What is the nervous innervation to the muscles of mastication?
CN V3.
950
What are the contraindications of folic acid?
Pernicious, aplastic, or any normocytic anemias when present with B12 deficiency.
951
Describe the median umbilical peritoneal fold.
Remnant of the embryological urachus, goes from the umbilicus to the urinary bladder. Underneath it is the median umbilical ligament.
952
Describe the venous and lymphatic drainage of the esophagus.
Left gastric vein (drains into portal venous system). Esophageal vein (drains into Azygos). The left gastric LNs drain into the celiac LNs.
953
What is unicollis?
Unicornate uterus. One rudimentary uterine horn. From incomplete fusion of the paramesonephric ducts.
954
What does nitro blue tetrazolium measure?
Killing capacity of phagocytes by ROSs.
955
What is the arterial supply and venous drainage to the scalp?
Occipital a./v., Posterior auricular a./v., Superficial temporal a./v., Supratrochlear a./v., Supraorbital a./v. Also mastoid emissary vein from sigmoid sinus.
956
What are the contraindications of leuvocorin?
Pernicious and other megaloblastic anemias secondary to vitamin B12 deficiency.
957
In what case do you get hemoconcentration of albumin?
Vomiting, diarrhea, severe burns
958
External anal sphincter is extension of levator ani.
Ischioanal fascia is lots of fat, pudendal/Alcock's canal. Base is skin of the perineum, medial wall is levator ani and anal canal, lateral wall is obturator internus.
959
What are the adverse effects and contraindications of cetirizine, fexofenadine, loratadine?
Adverse effects: drowsiness, headache, vomiting. Contraindications are known hypersensitivity to the drugs.
960
What are the anastomoses between the SMA and celiac trunk?
The superior anterior/posterior pancreaticoduodenal arteries and the inferior anterior/posterior pancreaticoduodenal arteries.
961
What is C1INH?
Inhibits C1r and C1s in classical pathway of complement.
962
How is leuvocorin administered?
Oral, IM, IV.
963
What is Hereditary Sherocytosis?
Autosomal dominant condition where spectrin/ankyrin is defective and red blood cells become spherical and fragile. (Ankyrin binds spectrin to the plasma membrane).
964
What is the sympathetic innervation to the lacrimal gland?
Promotes vasoconstriction not fluid.
Superior cervical ganglion is where it begins, travels through internal carotid plexus and forms the deep petrosal nerve (travels with greater petrosal nerve), branches into nerve of pterygoid canal.
965
How do you determine an extra vs intraperitoneal bladder rupture?
By physical exam / mechanism of injury. Can confirm by CT cystogram. Intraperitoneal requires surgery, extraperitoneal requires catheter.
966
How do you tell an ectopic kidney from nephropoptosis?
Nephropoptosis is loss of inferior support. You can tell by the ureter length. 50% of ectopic kidneys are blocked - results in UTI, abdominal lump, abdominal pain.
967
Are cytokines preformed?
No, they are made de novo.
968
Describe the small pre-B cell.
pre-B receptor is intracellular, light chain undergoes VJ rearrangement.
969
Describe the psoas fascia.
Fuses laterally with the quadratus lumborum fascia, continuous with iliac fascia. Thickened superiorly to form medial arcuate ligaments.
970
What percent of plasma is albumin?
55.2%
971
What is the internal and external os?
External is the opening into the vagina, internal/isthmus is the opening of the cervix into the uterus.
972
What is ascites?
Extra fluid (exudate - rich in cellular elements that seems out of inflamed organ/vessel tends) in the peritoneal cavity, treat with paracentesis.
973
What is the parotid sheath made of?
The investing layer of the deep cervical fascia.
974
What are some potential complications with sickle-cell disease?
Splenic infarct (or other infarcts), aplastic crisis (pancytopenia), acute sequestration crisis (splenomegaly, shock, hypovolemia, death in \<30min). Long term: gallstones, susceptibility to infections, splenomegaly in kids, autosplenectomy in adults.
975
What kinds of causes can portal hypertension have?
Suprahepatic, infrahepatic, hepatic.
976
What are leukocyte integrins recognized by when they act as an opsonin?
Mac-1/CD11b/CD18.
977
What are the borders and floor of the submental triangle? What does it contain?
Midline, anterior belly of digastric, hyoid bone. Floor is mylohyoid. Submental LNs, small veins that unite to form internal jugular vein.
978
What is the Haldane effect?
At the lungs, CA moves the reaction toward the side of CO2 and that CO2 is dropped off into the lungs from RBCs.
979
What is the urogenital system derived from embryologically?
A common mesodermal ridge which is located along the posterior wall of the abdominal cavity.
980
What is the Wright Stain?
Methylene blue + Eosin - stains basophilic things blue and eosinophilic things pink.
981
Where does the superior oblique muscle of the eye originate?
The sphenoid, runs through the trochlea.
982
What are the layers of the anterolateral abdominal wall?
Camper's fascia, Scarpa's fascia, 3 muscles, transversalis fascia, extraperitoneal fat, parietal peritoneum.
983
What are the genital ducts at the indifferent stage?
Mesonephric/Wolffian ducts and paramesonephric/Mullerian ducts.
984
How much MetHb is normal to have?
1-2%, \<10% results in no symptoms.
985
What are antibody idiotypes?
Differences in the variable region (antibody binding site).
986
What cytokine triggers T lymphocyte proliferation?
IL-2. Usually they secrete a low affinity receptor for it, then costimulation causes it to secrete IL-2 and also turns its affinity high.
987
What is tie insertion of iliacus?
Lesser trochanter of femur, major tendon of psoas.
988
What is HbE?
Glu26Lys in beta chain. Causes altered splicing (slow intron 1 removal, partial use of alternative splice site around codon 26). Some products are nonfunctional, reduces [Hb]. It's so common its ~30% allele frequency in India/SE Asia and most common in California. HbEE can be classified as a mild thalassemia. HbAE gives some protection from malaria, has a near-normal MCV.
989
List all the alpha-2 globulins. What are they?
Protease inhibitors and transport proteins. Haptoglobin, a2-macroglobulin, ceruloplasmin, tyroxine-binding protein, a2-antiplasmin, Protein C, a2-lipoprotein, angiotensinogen.
990
What is A1AT?
a1-antitrypsin inhibitor. Synthesized in liver, used in intestines to inhibit activated trypsin and other proteases (e.g. elastase).
991
What are the intermediate stages in granulocytopoiesis? How do you tell them apart?
Myeloblast (3-5 prominent nuclei), promyelocyte (azurophilic, nonspecific granules appear), myelocyte (oval or flat nucleus, specific - the last stage at which cell division is possible), metamyelocyte (more specific granules, indented nucleus), band/stab cell, mature.
992
What happens to iron need in pregnancy?
It increases.
993
What are the vestigial remnants of the developing male internal genitalia?
Paraepididymis (from paragenital tubules). Appendix epididymis (from cranial mesonephric duct). Appendix testis and prostatic utricle (from Mullerian duct).
994
What is thrombocytophathy/thrombasthenia?
Abnormal platelet function. Ganzmann Thrombasthenia is a deficiency in glycoprotein II/Factor IIIa. These bind vWF to adhere the protein to ECM.
995
Where do the cystic veins drain into?
The cystic veins (gallbladder) drain into the hepatic portal vein.
996
What do neutrophils look like? What do they do?
Multilobed (3-5) nucleus, lobes connected to each other by slender chromatin threads. They are the first line of defense against bacteria and kill them. They select what to phagocytose because it is coated with antibodies or complement or because it is emitting chemoattractants.
997
What happens if the production of either the alpha like or beta like chains of hemoglobin is reduced?
If by 10% the other one will match, if 50% you will see a surplus of the other.
998
What is the innervation of the pyramidalis?
Anterior rami T12.
999
What is HbA2?
alpha2delta2
1000
How does HbF prevent 2,3 BPG action?
The loss of His in the gamma subunit of HbF prvents this BPG action.
