Step 1 Organ Systems Flashcards
(1031 cards)
1
Q
What innervates the internal oblique?
A
Iliohypogastric n. (T12-L1).
2
Q
What embryological layer does the lung bud derive from?
A
Foregut endoderm.
3
Q
What is Raloxifene?
A
A SERM. ANtagonist at breast and uterus, agonist at bone. Used for osteoporosis.
4
Q
Mutations in what gene predispose to atopic dermatitis?
A
Filoggrin.
5
Q
What is exercise’s effect on PaO2, PAO2, venous O2, venous CO2?
A
No change in PaO2 or PAO2. Increase in venous CO2 and decrease in venous O2.
6
Q
How does an L5/S1 radiculopathy present?
A
Weakness of plantar flexion, difficulty in toe-walking. Decreased Achilles reflex.
7
Q
What is primary CNS lymphoma?
A
B-cell NHL. Most commonly associated with HIV/AIDS.
8
Q
Which gut is the pancreas part of?
A
Foregut.
9
Q
How do you tell if diabetes insipidus is central or nephrogenicW?
A
Give ADH analog. If urine osmolality increases >50%, then it’s central.
10
Q
What syndrome is VIPoma associated with?
A
MEN1.
11
Q
Describe the difference between intestinal and diffuse type gastric cancer.
A
Intestinal: Looks like ulcer with raised margins, associated with H. pylori. Diffuse: Signet ring cells (mucin produced with peripheral nuclei), not associated with H. pylori.
12
Q
What condition can a mucinous cystadenocarcinoma lead to?
A
Pseudomyxoma peritonei.
13
Q
Where does the carotid sinus baroreceptor transmit its signal to?
A
The solitary nucleus via the glossopharyngeal nerve.
14
Q
What is the order of fastest to slowest pacemaker rates in the heart?
A
SA > AV > Bundle of His > Purkinje fibers
15
Q
What is Rotor syndrome?
A
AR conjugated hyperbilirubinemia. Due to impaired uptake and excretion. Mild, no black liver.
16
Q
Is a femoral hernia more common in males or females?
A
Females.
17
Q
What causes a hypertensive crisis and what is the treatment?
A
Eating tyramine-rich food while taking an MAOI. Treatment is Phentolamine, an α-antagonist.
18
Q
What are Stellate/Ito cells and where are they?
A
Liver cells in the space of Disse. They store vitamin A when quiescent and make ECM when activated (are responsible for fibrosis).
19
Q
How do you treat Tourette’s?
A
Antipsychotics, Tetrabenazine.
20
Q
What are the layers of the gut wall? Include the plexi and what they do.
A
Mucosa, Submucosa (has Meissner plexus - secretes fluid), Muscularis externa (has Auerbach plexus - motility), Serosa/Adventitia. Serosa when intraperitoneal, adventitia when retroperitoneal.
21
Q
What is Follicular Lymphoma? What translocation is it associated with?
A
B-cell NHL. t(14;18): heavy chain Ig + BCL-2. ‘Waxing and waning’ lymphadenopathy.
22
Q
What is folie à deux?
A
Shared delusional disorder in close relationships.
23
Q
What is Adult T Cell Lymphoma?
A
T-cell NHL from HTLV. Associated with IV drug users. Cutaneous lesions, lytic bone lesions, hypercalcemia. Common in Japan, west Africa, the Caribbean.
24
Q
Describe Membranous Nephropathy.
A
Nephrotic syndrome. Caused by antibodies to the PLA2 receptor. LM has diffuse capillary/GBM thickening. IF is granular. EM has “spike and dome” appearance of subepithelial deposits. Poor response to steroids.
25
How does pH affect calcium levels in the blood?
Increased pH increases the affinity of albumin to bind calcium - hypocalcemia.
26
What findings do you see in neuroblastoma?
Homer-wright rosettes, increased HVA and VMA in urine, Bombesin and NSE (+).
27
Which liver lobule zone is affected first by metabolic toxins?
Zone III - has high concentration of CYP450
28
What are the symptoms of glucagonoma/α-cell tumour?
Dermatitis (necrolytic migratory erythema), diabetes, DVT, declining weight, depression.
29
What genotype of ALL is associated with improved prognosis?
t(12;21).
30
What is the Splay phenomenon?
Tm for glucose is reached gradually rather than sharply due to the heterogeneity of nephrons.
31
What is a keratoacanthoma?
An SCC variant that grows rapidly over 4-6 weeks and regresses over months.
32
When does the blastocyst implant / hCG production begin?
Day 6.
33
What is the venous drainage of the anus below the pectinate line?
Inferior rectal vein -\> internal pudendal vein -\> internal iliac vein -\> common iliac vein -\> IVC
34
How does pancreatic insufficiency affect fecal elastase?
Decreases.
35
What often precedes Henoch-Schönlein?
A URI.
36
Where is the anus below the pectinate line embryologically derived from?
Ectoderm.
37
What innervates the sartorius?
Femoral n. L2-L4.
38
What are the major hip flexors?
Iliopsoas, rectus feoris, tensor fascia latae, pectineus, sartorius.
39
Describe the falciform ligament.
Connects the liver to the anterior abdominal wall. Contains the ligamentum teres and patent paraumbilical veins.
40
What heart malformation is associated with Williams syndrome?
Supravalvular aortic stenosis.
41
Where does the smooth part of the LA derive from embryologically?
Primitive pulmonary vein.
42
Describe primary biliary cholangitis.
Autoimmune (lymphocytes and granulomas). Anti-mitoch Abs, increased IgM.
43
What is Clozapine and what are its ADEs?
Atypical antipsychotic. Agranulocytosis, seizures.
44
What is koilonychia?
Spoon nail. Seen in iron deficiency anemia.
45
What does inspiration do to heart sounds?
Increases intensity of right heart sounds.
46
What teratogenic effect can tetracyclines have?
Discoloured teeth, inhibited bone growth.
47
What is De Quervain Tenosynovitis?
A noninflammatory thickening of the abductor pollicis longus and extensor pollicis brevis tendons. Pain at radial styloid.
48
What is HbA2?
alpha2 delta2.
49
What are Captopril, Enalapril, Lisinopril, and Ramipril?
ACE inhibitors.
50
Why does the lung inflation curve follow a different curve than the deflation curve?
To overcome ST forces. \*phenomenon is called hysteresis
51
What nerve controls subscapularis and what are its roots?
Upper and lower subscapular nerves. C5&C6.
52
Describe renal oncocytoma.
Arises from collecting duct, large eosinophilic cells with abundant mitochondria. Painless hematuria, flank pain, abdominal mass.
53
Does gout or pseudogout have chondrocalcinosis on xray?
Pseudogout.
54
Describe thoracic outlet syndrome.
Compression of lower trunk of the brachial plexus and the subclavian vessels. Caused by cervical rib or pancoast tumour. Same muscles are affected as Klumpke palsy, intrinsic hand muscles atropy: ischemia, pain, edema.
55
What is the normal A-a gradient?
10-15mmHg
56
Is ECT safe in pregnancy?
Yes.
57
How is heme metabolized?
Heme is turned to biliverdin via heme oxygenase, then turned to bilirubin. Bilirubin is removed from the blood by the liver as a bilirubin-albumin complex, then conjugated with glucuronate via UDP-glucuronosyl transferase. Conjugated bilirubin is then excreted in blood.
58
What do basophils contain in their granules?
Heparin and histamine - LTs are synthesized on demand.
59
What is the difference between endochondral and membranous ossification?
Endochondral first has a cartilaginous model made by chondrocytes, membranous forms woven bone directly which is later remodelled to lamellar bone.
60
What parts of the nephron reabsorb water?
dLOH, CT.
61
What is Cinacalcet?
Sensitizes CaSR in parathyroid gland to decrease PTH levels.
62
What is cryptogenic organizing pneumonia? Does it respond to antibiotics?
Unknown etiology, caused by chronic inflammatory diseases or medication side effects. No response to antibiotics.
63
What is Kallman syndrome?
Defective migration of GnRH-releasing neurons and subsequent failure of development of GnRH-releasing olfactory bulbs.
64
What antibodies are found in polymyositis and dermamyositis?
Nonspecific ANAs, anti-Jo-1 (His-tRNA synthetase), anti-SRP, anti-Mi-2.
65
What kind of injury can damage the recurrent branch of the median nerve?
Superficial palm laceration. Will cause no loss of sensation.
66
What LN does the anus drain to above and below the pectinate line?
Above: internal iliac LN Below: Superficial inguinal LN
67
Are NK cells lymphocytes or monocytes?
Lymphocytes.
68
What are some ADEs of PDE5 inhibitors?
Headache, flushing, dyspepsia, cyanopia.
69
What is pemphigus vulgaris?
AutoAbs to desmoglein in the desmosome.
70
How can you tell between HSV1 and CMV esophagitis?
HSV1 edophagitis has punched-out ulcers, CMV esophagitis has lineat ones.
71
When does the bilaminar disc form and what is it made of?
Week 2 - epiblast and hypoblast.
72
What is the postnatal derivative of the umbilical arteries?
Medial umbilical ligaments.
73
Which atypical antidepressant causes priapism?
Trazodone.
74
What is a craniopharyngioma?
Benign Rathke pouch tumor of surface ectoderm. Has cholesterol crystals, calcifications. Ends up being on pituitary.
75
How do you diagnose and treat peritonitis?
Diagnose: paracentesis with ascitic fluid, absolute neutrophil count \> 250cells/mm3. Treat empirically with a 3rd gen cephalosporin.
76
What is medullary breast carcinoma and what's its prognosis?
Subtype of invasive ductal carcinoma that's fleshy and has a lymphocytic infiltrate. Good prognosis.
77
What artery causes life threatening epistaxis hemorrhages?
Posterior segment of the sphenopalatine artery (branch of the maxillary artery).
78
What can cause sideroblastic anemia?
X-linked ALA synthase defect, EtOH, lead poisoning, B6 deficiency (is ALA synthase cofactor), copper deficiency, Isoniazid, Chloramphenicol.
79
What innervates the triceps surae?
Tibial n. L4-S3.
80
Where do the celiac trunk, SMA, and IMA split off the aorta?
Celiac trunk: T12/L1 SMA: L1 IMA: L3
81
Which cells bind IgE Fcs?
Mast cells.
82
What causes duodenal atresia?
Failure to recanalize. "double bubble" on CXR.
83
What are the histologial phases of lobar pneumonia?
Congestion (d1-2): red-purple, partial consolidation of parenchyma, exudate mostly bacteria. Red hepatization (d3-4): red-brown consolidated exudate with fibrin, bacteria, RBCs, WBCs. Grey hepatization (d5-7): Uniformly grey exudate full of WBCs, lysed RBCs, fibrin. Resolution (d8+)
84
How does Ketoconazole work?
Inhibits steroid synthesis by blocking 17,20-desmolase, 17α-hydroxylase.
85
What provides sensory innervation to the sole?
Tibial n. L4-S3.
86
Where in the nephron is K+ reabsorbed?
PCT and aLOH.
87
Describe the path of oxygenated blood in the fetus.
Enters umbilical vein, by passes hepatic circulation bia ductus venosus, goes to IVC -\> foramen ovale -\> aorta
88
What are the nerve roots of the superior gluteal nerve?
L4-S1.
89
What causes narcolepsy? How do you treat it?
Decreased orexin/hypocretin production in the lateral hypothalamus. Treatment includes nighttime sodium oxybate.
90
What kind of anemia do you see in thalassemias?
Microcytic.
91
What is Bowenoid papulosis?
Reddish papules (carcionoma in situ) of penis - associated with HPV and uncircumcision.
92
How does an L4/5 radiculopathy present?
Weakness of dorsiflexion, difficulty in heel walking.
93
What innervates the pectineus?
Obturator n. (L2-L4) and femoral n. (L2-L4)
94
What are Psyllium and methylcellulose?
Bulk-forming laxatives. Soluble fibers that draw water into the lumen, making a viscous liquid that promotes peristalsis. Causes bloating.
95
What makes up the Hesselbach triangle?
Inferior epigastric vessels, lateral border of rectus abdominis, inguinal ligament.
96
What does bacillary angiomatosis have that kaposi sarcoma doesn't?
Neutrophilic infiltrate.
97
What kind of infants are more prone to necrotizing enterocolitis?
Premature, formula-fed.
98
What cells release EPO?
Interstitial cells in peritubular capillary bed.
99
What comprises the foregut?
GI up until the upper duodenum, spleen, pancreas.
100
What do waxy casts in the urine indicate?
ESRD or chronic renal failure.
101
How does heparin work?
Activates antithrombin. Doesn't cross placenta.
102
Where in the GI is iron absorbed?
Duodenum.
103
What is sclerosing adenosis?
A fibrocystic change in the breasts mostly in premenstrual women. Fibrosis of acini and stroma. Associated with calcifications.
104
What does the LAD supply?
The anterior 2/3 of the IV septum, anterior surface of left ventricle, anterolateral papillary muscle.
105
What does the 1st aortic arch become?
Maxillary artery.
106
What are the nerve roots of the inferior gluteal nerve?
L5-S2.
107
What is the FENa and BUN:Cr of prerenal kidney disease?
FENa \<1%, serum Bun:Cr \>20
108
How do you treat Raynaud's?
CCBs.
109
Describe an embryonal carcinoma.
Malignant germ cell tumor. Painful, hemorrhagic mass with necrosis. Often has glandular/papillary morphology. Increased hCG, normal AFP if pure, can be increased with mixed.
110
Describe Erb palsy.
Upper trunk damage (C5-C6). Arm cannot abduct, is medially rotated, extended, and pronated.
111
Describe ARPKD.
Mutation in PKHD1, cystic dilation of collecting ducts.
112
What type of collagen is the glomerular basement membrane made of?
IV.
113
What do integrins do in the skin?
Bind the basolateral membrane to collagen, laminin, and fibronectin in the basal membrane.
114
What causes achalasia?
Loss of the myenteric/auerbach plexus due to loss of postganglionic inhibitory neurons (produce NO and VIP).
115
Is type 1 muscle slow or fast twitch?
Slow.
116
Where does fertilization occur?
In the ampulla.
117
What is the D-xylose absorption test?
Tests if there is GI mucosal cell damage since the enterocytes can only absorb monosaccharides.
118
What is Löffler endocarditis?
RCM associated with eosinophilic infiltrates.
119
What layer does the vagina derive from?
Lower is endoderm, upper is mesoderm.
120
In what conditions is hCG decreased?
Failing pregnany, Edward syndrome, Patau.
121
What does invasive lobular carcinoma look like on histology?
Orderly 'single-file' row of cells due to loss of expression of E-cadherin.
122
What is theophylline used for and how does it likely work?
COPD, asthma. Likely works as a PDE inhibitor.
123
What are conditions that commonly come with ankylosing spondylitis?
Uveitis and aortic regurgitation. Can cause restrictive lung disease.
124
What are the symptoms of TCA overdose? How do you treat it?
Respiratory depression, hyperpyrexia, increased QT, convulsions, coma, cardiotoxicity. Supportive, monitor. Treat with NaHCO3 to prevent arrhythmia, activated charcoal.
125
What is S. bovis endocarditis associated with?
Colon cancer.
126
What is the effect of progesterone on milk?
Inhibits secretion.
127
How does a platelet plug form?
vWF binds exposed collagen, platelets bind vWF, release ADP, Ca++, TxA2. ADP binding to the P2Y12 receptor induces GpIIb/IIIa expression at PLT surface - fibrinogen binds it and links platelets.
128
Describe type 1 renal tubular acidosis. Urine pH? Serum K+? What can cause it?
Distal. Inability of α-intercalated cells to secrete H+. Urine pH\>5.5, serum K+ lowered. Increased risk for calcium phosphate kidney stones. Can be caued by Amphotericin B toxicity, analgesic nephropathy, congenital issues, autoimmune disease.
129
What are the two types of congenital Long QT Syndrome?
Romano-Ward (AD) Jervell and Lange-Nielsen (AR, sensorineural deafness)
130
How does Ristocetin work?
Activates vWF to bind GpIb. Failure to aggregate in ristocetin assay in vWD and Bernard-Soulier syndrome?
131
How do uric acid and calcium pyrophosphate crystals react to polarized light?
Uric acid are positively birefringent, calcium pyrophosphate are negatively birefringent.
132
What are the layers of the epidermis (getting deeper)?
Statum corneum -\> lucidum -\> granulosum -\> spinosum -\> basale.
133
What is Buprenorphine?
Sublingual partial agonist for maintenance therapy of getting off opioids. Given with IV Naloxone.
134
What is the anastomosis that causes hemorrhoids?
Superior rectal (P) and middle/inferior rectal (S).
135
What is Mantle Cell Lymphoma? What translocation is it associated with?
B-cell NHL. t(11;14): cyclin D1 + heavy chain Ig. Very aggressive.
136
What is the Wolff-Chaikoff effect?
Excessive iodine temporarily decreases thyroid peroxidase (decreased T3 and T4).
137
What provides sensory innervation to the foot dorsum?
Common peroneal n. L4-S2. Superficial to everything but the 1st webspace, deep to the 1st webspace.
138
What kind of cardiomyopathy does myocarditis sometimes lead to?
DCM.
139
What is Liddle syndrome? How do you treat it?
AD GoF defect in Na+ channel causing increased resorption in CT. Metabolic alkalosis, hypokalemia, HTN, decreased aldosterone. Tx=amiloride.
140
How do lung and chest wall compliance change in the elderly?
Lung compliance increases, chest wall compliance decreases.
141
What innervates the peroneus longus and brevis?
Superficial peroneal nerve.
142
What is struma ovarii?
A rare cystic teratoma form with thyroid tissue. Presents with hyperthyroidism.
143
What part of the GI does celiac disease affect?
Distal duodenum and/or proximal jejunum.
144
How does octreotide increase cholelithiasis risk?
CCK Inhibition.
145
What is Aprepitant?
A Substance P antagonist. Blocks NK1 receptors in the brain. Used as a chemotherapy antiemetic.
146
What is the triad of symptoms for vasa previa?
Membrane rupture, painless vaginal bleeding, fetal bradycardia (\<110).
147
What are Cromolyn and Nedocromil and what are they used for?
Mast cell stabilizers - prevent release of inflammatory mediators. Used for bronchospasm prevention not acute bronchodilation.
148
What is the Whipple procedure?
Treatment for pancreatic adenocarcinoma - removal of the head of the pancreas. It also involves removal of the duodenum, a portion of the common bile duct, gallbladder, and sometimes part of the stomach.
149
Describe DPGN.
Can be nephritic or nephrotic. Wire-looping of capilaries on LM. IF granular, EM has subepithelial and sometimes intramembranous immune complexes.
150
What sort of cells are osteoclasts derived from?
Monocytes.
151
Where is the infarction likely if the STE is in leads II+III+aVF?
RCA (inferior).
152
Describe Crohn's disease. Include what cell type mediates it. Does it affect the rectum?
Transmural. Skip lesions. Rectal sparing. "Cobblestone" string sign. Noncaseating granulomas and lymphoid aggregates. Th1 mediated. Kidney stones, gallstones.
153
Compare RA vs OA: Stiffness, effect of use/rest, symmetry, spared joints.
RA stiff in the morning, improves with use, symmetric, MCP spared. OA stiff at the end of the day, improves with rest, asymmetric, DIP and 1st CMC spared,
154
What is pityriasis rosea?
Self-resolving 6-8 weeks. A herald patch followed later by scaly erythematous plaques.
155
How does glomerular filtration work? What filters out what?
Fenestrated capillary endothelium, BM (type IV collagen and heparan sulfate), epithelial layer of podocytes. BM + podocytes = slit diaphragm. Endothelium filters out \>100nm molecules, slit diaphragm filters out \>50-60nm. All three layers prevent entry of negatively charged molecules.
156
What are roth spots?
Spots on the retina as a result of bacterial endocarditis.
157
How do you calculate metabolic acidosis compensation?
PCO2=1.5[bicarb]+8±2.
158
What helps keep a PDA open? What helps close it?
PGE1 & PGE2 help keep open, Indomethacin helps close.
159
What layer does the gallbladder derive from?
Endoderm.
160
What is the function of the lumbricals and which nerves control them?
Flex MCP, extend DIP and PIPs. 1st&2nd: median n. 3rd&4th: ulnar n.
161
What is a macula adherens and what's it made of?
Desmosomes. Made of cadherins.
162
What is anthracosis?
Some carbon accumulated in the lung in many urban dwellers exposed to sooty air.
163
Describe warm vs cold autoimmune hemolytic anemia.
Warm: IgG caused (SLE, CLL, some drugs) Cold: triggered by cold, IgM+complement (CLL, mono, M. pneumoniae).
164
What do parafollicular/C cells of the thyroid produce?
Calcitonin.
165
When is a fetus most susceptible to teratogens?
The "embryonic period" when organogenesis occurs. Week 3-8.
166
What condition has Orphan Annie eyes?
Papillary carcinoma.
167
How does glucose cause insulin release?
Metabolism of glucose generates ATP, K+ channels close, β-cell membrane depolarizes, VG Ca++ channels open, Ca++ influx causes stimulation of insulin exocytosis.
168
What drugs is hepatic adenoma associated with?
Oral contraceptives or anabolic steroids.
169
What is the average survival of pancreatic adenocarcinoma?
~1 year after diagnosis.
170
What is the Haldane effect?
In lungs, oxygenation of hemoglobin promotes dissociation of H+, which shifts the equilibrium toward CO2 formation. CO2 is then released from the RBCs.
171
What is Bowen disease?
Leukoplakia of shaft - precursor to SCC.
172
What is Bartter syndrome? What's it's effect on calcium?
AR aLOH resorptive defect in the NCCK cotransporter. Metabolic alkalosis, hypokalemia, HYPERcalciuria. \*similar to chronic loop diuretic use
173
What is porphyria cutanea tarda? What condition is it associated with?
AD Uroporphyrinogen decarboxylase defect. Uroporphyrin accumulates. Tea-coloured urine, blistering curaneous photosensitivity. Exacerbated with alcohol consumption. Associated with HepC.
174
What innervates the iliacus?
Femoral n. L2-L4.
175
Which bones are made through membranous ossification?
Calvarium, facial bones, clavicle.
176
What is a gallstone ileus?
Gallstone that travels to the GI, obstructs at the ileocecal valve.
177
What are Acarbose and Miglitol? When are they contraindicated?
α-glucosidase inhibitors. They decrease postprandial hyperglycemia. Not recommended if kidney function is impaired.
178
What drugs are associated with pyloric stenosis? What kind of metabolic state can it cause?
Macrolides. It can cause hypokalemic hypochloremic metabolic alkalosis.
179
How does Colchicine work and what is it used for?
Binds and stabilized tubulim to inhibit MT polymeriation - impairs neutrophil chemotaxis and degranulation. Acute gout drug.
180
How does metformin work and what are some major side effects?
It's a biguanide - inhibits glucagon action by inhibiting mGPD. Increases sensitivity to insulin. ADEs: Lactic acidosis, B12 deficiency, weight loss.
181
What are the LAP levels in CML?
Very low.
182
Is mesothelioma associated with smoking?
No.
183
What causes diffuse cortical necrosis?
Acute generalized cortical infarction of both kidneys, likely due to the combination of vasospasm+DIC.
184
What condition has a continuous, "machine-like" murmur?
PDA.
185
What is Zileuton and what is an ADE of it?
5-LOX inhibitor. Hepatotoxic.
186
What are the different types of emphysema associated with?
Centraacinar wth smoking, Panacinar with α1AT deficiency.
187
What is Zollinger-Ellison syndrome?
Gastrin-secreting tumour of pancreas or duodenum.
188
Describe MPGN.
Hematuria. Can be nephritic or nephrotic syndrome. GBM splitting "tram-tracks". Type I is idiopathic, has subendothelial immune complex deposits, granular IF. Type II is due to C3 nephritic factor (IgI that stabilizes C3 convertase). Intramembranous deposits "dense deposit disease".
189
What is the outflow tract derived from embryologically?
Neural crest cells and encocardial cells that have migrated.
190
What are the ADEs for DHP and nonDHP CCBs?
DHPs: Peripheral edema, flushing dizziness nonDHPs: Gingival hyperplasia, cardiac depression, AV block, constipation, hyperprolactinemia
191
What causes bronchogenic cysts?
Abnormal budding of foregut with dilation of terminal or large bronchi. Generally asymptomatic but can drain poorly - airway compression and/or URIs.
192
What are cystine stones like and when do they appear?
Hexagonal. Precipitate with decreased urine pH. Appear in AR condition where cystine-reabsorbing PCT transporter loses its function. Positive sodium nitroprusside test.
193
What are the nerve roots of the axillary n. and how is it damaged?
C5&C6. Humerus surgical neck fracture or anterior dislocation.
194
What is Bernard-Soulier syndrome?
Defect in GpIb, defect in platelet plug formation. Abnormal ristocetin assay.
195
Describe bacterial chronic gastritis.
Antrum and spreads to the body of the stomach. H. pylori. Increased risk of PUD and MALT lymphoma.
196
What layer do the kidneys derive from?
Mesoderm.
197
How do you calculate the O2 content of blood?
(1.34XHbXSaO2)+(0.003XPaO2)
198
What gene mutations are adenomatous polyps associated with?
APC and KRAS.
199
What does the lateral femoral cutaneous nerve supply and what are its roots?
Anterior and lateral thigh. L2-L3.
200
How does hydralazine work and what are some contraindications?
Increases cGMP (vasodilates arterioles \> veins, reduces afterload). Contraindicated in angina/CAD.
201
How do you treat Crohn's?
Corticosteroids, azathioprine, antibiotics, Infliximab, Adalimumab.
202
What is Dextrometorphan?
Antitussive, NMDA antagonist. \*can also cause serotonin syndrome.
203
What is a marker of yolk sac tumor?
AFP. AKA ovarian endodermal sinus tumor.
204
What are Diphenhydramine, Dimenhydrinate, Chlorpheniramine? What are some ADEs?
1st gen reversible H1 blocker (antihistamine). Sedation, antimuscarinic effects, anti-α-adrenergic effects.
205
What innervates the tensor fascia latae?
Superior gluteal n. L4-S1.
206
What does it mean of glomerulonephritis is focal?
Less than half of the glomeruli are involved. Opposite is diffuse.
207
What does the Wolffian Duct turn into?
Seminal vesivles, Epidydimis, Ejaculatory duct, Ductus deferens.
208
What drugs are good for HTN in pregnancy?
Hydralazine, Labetalol, Methyldopa, Nifedipine.
209
What is Monday Disease?
Reexposure on monday to nitrates after a loss of tolerance over the weekend = strong effect.
210
What is Bosentan? What's an ADE of it?
Endothelin receptor antagonist. Hepatotoxic.
211
How does hemochromatosis present?
After age 40 when total body iron is over 20g. Cirrhosis + DM + skin pigmentation 'bronze diabetes'. Can also cause RCM or DCM (reversible), hypogonadism, arthropathy, HCC.
212
What is Pramlintide?
An amylin analog. Causes decreased glucagon, decreased gastric emptying, increased satiety.
213
When do limb buds begin to appear?
Week 4.
214
What is Ethacrynic acid?
A non sulfa loop diuretic. More ototoxic.
215
What is a Zenker diverticulum?
Pharyngoesophageal false diverticulum. Herniation of mucosal tissue at the Killian triangle between the thyropharyngeal and cricopharyngeal parts of hte inferior pharyngeal constrictor. Common mostly in elderly men.
216
What do ALL cells stain positive for?
TdT+, CD10+ (marker of pre-B cells).
217
How do Clopidrogrel, Prasugrel, Ticlopidine work?
Inhibit GpIIb/IIIa receptor by irreversibly blocking P2Y12.
218
What causes hemochromatosis?
AR C282Y mutation \> H63D mutation on HFE gene. Abnormal iron sensing and increased intestinal absorption.
219
Describe the round ligament.
Connects the uterine horn to the labia majora.
220
What are Brunner glands?
Cells in the duodenum that are submucosal, secrete bicarbonate.
221
How does erythromycin affect the GI?
It's a motilin receptor agonist.
222
What is Leflunomide used for? What are some ADEs?
RA, psoriatic arthritis. Diarrhea, HTN, hepatotoxicity, teratogenicity.
223
In liver disease, which is more raised, ALT or AST?
In most ALT, but in alcoholic liver disease AST\>ALT. If this is true in nonalcoholic liver disease, this suggests advanced fibrosis/cirrhosis.
224
What does polymyalgia rheumatica respond to rapidly?
Corticosteroids.
225
What cells produce somatostatin in the GI?
D cells.
226
What is Gilbert syndrome?
AR unconjugated hyperbilirubinemia. Mildly decreased UDP-glucuronosyltransferase conjugation and impaired bilitubin uptake. Asymptomativ or maybe mild jaundice with stress.
227
What are cardiac glycosides used for?
HF and A-fib.
228
What are the nerve roots of the median n.?
C5-T1.
229
What is hPL?
Human placental lactogen AKA chorionic somatomammotropin. Made by syncytiotrophoblast, stimulates insulin production and overall increases insulin resistance.
230
What is acantholysis?
Separation of epidermal cells.
231
Describe Ewing Sarcoma - cells, location, typical demographic.
Anaplastic small blue cells of neuroectodermal origin. t(11;22) - EWS-FL11 fusion protein. 'Onion-skin' periosteal reaction in bone. Diaphysis, pelvic flat bones. Boys \<15.
232
What is Aliskrein?
Direct renin inhibitor.
233
What LNs does the vagina drain to?
Proximal into internal iliac, distal into superficial inguinal.
234
What's the first line treatment for large vessel vasculitides?
Corticosteroids.
235
What nerve controls teres minor and what are its roots?
Axillary n. C5&C6.
236
What is N-acetylcysteine?
Mucolytic (disrupts disulfide bonds), used for Acetaminophen overdose.
237
What is a Leiden mutation?
Factor V resistant to Protein C inactivation. A G-\>A mutation.
238
Which leukotriene increases neutrophil chemotaxis?
LTB4.
239
What fracture locations are likely to damage the ulnar nerve?
Medial epicondyle and hook of the hamate.
240
What usually causes prostatitis in older men?
E. coli.
241
What is Ménétrier Disease?
Hyperplasia of the gastric mucosa - hypertrophied rugae that look like brain gyri. Precancerous excess mucus production (protein loss -\> edema, parietal cell atrophy). Epigastric pain, anorexia, weight loss, vomiting.
242
What is the difference between osteoporosis and osteomalacia?
Osteomalacia has defective mineralization of osteoid. Osteoporosis is normal.
243
What are Propylthyouracil and Methimazole? How do they work and what are they used for?
Thioamides. They block thyrid peroxidase and peripheral 5'deiodinase. Used for hyperthyroidism. Methimazole in the 2nd and 3rd trimester of pregnancy.
244
What parameter does vWD affect?
PTT.
245
How do gastric and duodenal ulcers present re: pain and eating?
Gastric: pain increaess with meals Duodenal: pain decreases with meals
246
What layer does the eustachian tube derive from?
Endoderm.
247
How do you treat cocaine intoxication?
α-blockers, BDZs. Beta blockers not recommended.
248
What is HELLP syndrome?
Hemolysis, Elevated Liver enzymes, Low Platelets. Schistocytes on smear.
249
What is a dysgerminoma and what is the opposite sex equivalent?
Ovarian germ cell tumor. Sheets of 'fried-egg' cells. Markers are hCG and LDH. Male equivalent is Seminoma.
250
Describe midgut rotation in embryological development.
Midgut (lower duodenum to prox 2/3 transverse colon) herniates through umbilical ring in week 6. Rotates 270 degrees counterclockwise around SMA.
251
What is the epithelium in the respiratory system?
Pseudostratified ciliated columnar up until the beginning of terminal bronchioles, when it turns to cuboidal and then transitions to simple squamous.
252
What is Plummer-Vinson syndrome?
Iron-defieincy anemia, esophageal webs, dysphagia.
253
What are some ADEs of Tamoxifen?
Increased risk of thromboembolic events and endometrial cancer.
254
What sort of lung cancer has keratin pearls?
Small cell carcinoma.
255
What muscles do external rotation of the hip?
Iliopsoas, gluteus maximus, piriformis, obturator.
256
How do you treat small cell lung cancer?
Chemo ± radiation.
257
Describe autoimmune chronic gastritis. Is there increased risk of PUD?
Body/fundus of stomach. Antibodies to parietal cells. No increased risk of PUD.
258
What is Gardner Syndrome?
FAP + osseus and soft tissue tumours, congenital RPE hypertrophy, impacted/extra teeth.
259
What are Sildenafil, Vardenafil, and Tadalafil? What are they used for?
PDE5 inhibitors. Used for ED, HTN, and BPH (Tadanafil only).
260
What is a dacrocyte?
A teardrop cell. Found in bone marrow infiltration, thalassemia.
261
What are the common causes of septic arthritis?
S. aureus, Streptococcus, N. gonorrhoeae.
262
How do Alirocumab and Evolocumab work?
PCSK9 inhibitors. Inactivate LDLR degradation.
263
How does α1AT deficiency affect the liver?
Misfolded protein aggregates in the hepatocellular ER result in cirrhosis with PAS+ globules.
264
What is a positive Finkelstein test?
Pain at the radial styloid with active and passive stretch of the thumb tendons. Sign of De Quervain Tenosynovitis.
265
What is a cystic hygroma?
Cavernous lymphangioma of neck, associated with Turner syndrome.
266
Which liver lobule zone is affected first by ingested toxins?
Zone I
267
What do granular casts in the urine indicate?
ATN.
268
What's the first line treatment for Kawasaki?
IVIG and aspirin.
269
What are Conivaptan and Tolvaptan?
ADH antagonists at V2.
270
What are ACE inhibitor ADEs?
Cough, angioedema (due to bradykinin effect), teratogen, increase ceratinine, hyperkalemia, hypotension.
271
Where is the renal issue if the urine osmolality is \>500 (high)?
Prerenal.
272
What are the major hip abductors?
Gluteus medius and minimus.
273
When do fetal movements start?
Week 8.
274
How can gonococcal arthritis present?
Polyarthralgia + tenosynovitis + dermatitis.
275
What is the male homolog of theca internal cells?
Leydig cells.
276
In what heart condition are nitrates contraindicated?
RV infarction.
277
Describe the path of deoxygenated blood in the fetus.
SVC -\> RA -\> RV -\> main PA -\> ductus arteriosus -\> ascending aorta.
278
Where does a femoral hernia protrude from?
Through the femoral canal below the inguinal ligament, below and lateral to the pubic tubercle.
279
What is Wolff-Parkinson-White syndrome?
Abnormal accessory pathway from atria to ventricles that bypasses the AV node "bundle of Kent" so the ventricles partially depolarize earlier. See delta wave, wide QRS.
280
What is a psych use of Prazosin?
Can reduce nightmares in PTSD.
281
What effects does estrogen have on bone?
Inhibits apotosis of bone-forming osteoblasts and induces apoptosis in osteoclasts. Also causes closure of the epiphyseal plate during puberty.
282
What is Legg-Calvé-Perthes disease?
Idiopathic avascular necrosis of the femoral head. Often in males 5-7.
283
What are struvite stones like and when do they appear?
Ammonium magnesium phosphate - shaped like coffin lid. Precipitates with increaesd urine pH. Due to infection with urease+ bug.
284
Describe Silicosis and include which part of the lung it affects.
Upper lobes. Macrophages cause fibrosis. "Eggshell" calcification on CXR. Associated with sandblasting, foundries, mines.
285
Where does prostatis adenocarcinoma generally arise.
Posterior lobe, peropheral zone.
286
What is Auspitz sign?
Pinpoint bleeding from scraping off psoriatic scales (and exposing dermal papillae).
287
What is Naltrexone?
μ-antagonist given IM or nasal spray, for acute OD/relapse prevention once detoxified.
288
What is the postnatal derivative of the ductus venosus?
Ligamentum venosum.
289
What is Loperamide?
μ-opioid agonist used for diarrhea. Poor CNS penetration.
290
What is cavernous hemangioma?
The most common benign liver tumour.
291
What can happen when the urachus remains patent?
Urine discharge from the umbilicus.
292
What nerve is likely to be damaged in a supracondylar fracture of the humerus?
Median n.
293
Where is fetal erythropoiesis conducted?
Yolk sac (3-8 weeks), Liver (6 weeks - birth), Spleen (10-28 weeks), BM (18 weeks to adult).
294
What innervates the plantaris?
Tibial n. L4-S3.
295
Where is the macula densa?
Distal LOH.
296
What part of the nephron does ATII work on mostly and what transporter does it stimulate?
PCT. Na+/H+ exchanger.
297
What is an acanthocyte?
A spur cell. Found in liver disease, abetalipoproteinemia.
298
What does LH do in males?
Stimulates testosterone production by Leydig cells.
299
What condition can cause the meconium to cause an ileus?
Cystic fibrosis.
300
What is the Courvoisier sign?
Enlarged but painless gallbladder with jaundice.
301
What nerve controls the infraspinatus and what are its roots?
Suprascapular n. C5&C6.
302
Describe ADPKD.
Mutation in PKD1/2, cysts in cortex/medulla.
303
What antibodies are present in Sjogren syndrome?
ANAs: SSA (Anti-Ro), SSB (Anti-La). RF (anti-Fc of IgG).
304
What is Alport Syndrome?
X-dominant collagen IV mutation. Nephritic syndrome, hematuria. Eye problems, sensorineural deafness. EM is 'basket weave'.
305
What is the male remnant of the Mullerian duct?
Appendix testis.
306
What autoimmune condition is associated with a deficiency of early complement proteins?
SLE.
307
What is a Meckel diverticulum? How is it diagnosed?
True diverticulum, persistence of the vitelline duct. May contain ectopic gastric mucosa and/or pancreatic tissue. Diagnosed by Tc99 study.
308
What is Risperidone and what are its ADEs?
Atypical antipsychotic. Hyperprolactinemia.
309
What is a glomus tumor?
Benign, painful red-blue tumor commonly under fingernails. Arises from modified SMC of thermoregulatory glomus body.
310
What are the nerve roots of the iliohypogastric nerve?
T12-L1.
311
Where in the esophagus is adenocarcinoma most likely to happen? What are the risk factors?
Lower 1/3. GERD, Barrett esophagus, obesity, smoking, achalasia.
312
How long is the luteal and follicular phase?
Luteal is 14 days, follicular varies.
313
What teratogenic effect can aminoglycosides agents have?
Ototoxicity.
314
What Abs may Crohn's be positive for?
ASCA.
315
When does embryological lung development start?
Week 4.
316
What is the function of the musculocutaneous n.?
Lateral forearm sensation, forearm supination and flexion.
317
What is MetHb and how is it treated?
Fe3+ hemoglobin, binds oxygen less readily but CN more reasily. Treated with Vitamin C and methylene blue.
318
How's the prognosis of lung large cell carcinoma and bronchial carcinoid tumor?
Poor and good respectively.
319
What are the ferritin and TIBC levels in anemia of chronic disease?
Ferritin: increased TIBC: decreased
320
How do you calculate alveolar ventilation?
(Vt-Vd)XRR
321
What are the actions of subscapularis (besides abduction)?
Internal rotation and adduction.
322
What is follicular thyroid carcinoma associated with?
RAS mutations and PAX8-PPARγ translocations.
323
How can you damage the inferior gluteal nerve?
Posterior hip dislocation.
324
What does the 3rd aortic arch become?
Common carotid and proximal internal carotid.
325
What amino acid is needed to make NO?
Arginine.
326
What brain areas is Wernicke Encephalopathy associated with? How can it be accidentally precipitated?
Reversible. Periventricular hemorrhage/necrosis of mammillary bodies. Can be precipitated by giving dextrose before B1 to the b1 deficient.
327
What is neuroleptic malignant syndrome? How do you treat it?
A reaction to some antipsychotics. Myoglobinuria, Fever, Encephalopathy, Vitals unstable, Enzymes increased (eg CK), Rigidity \*MFEVER Treat with Dantrolene, Dopamine antagonists.
328
Where are cannabinoid receptors?
Hypothalamus and nucleus accumbens.
329
How much occlusion does stable angina need to have to cause symptoms?
\>70%
330
What conditions is intussusception associated with?
Rotavirus vaccine, Henoch-Schönlein, recent viral infection (peyer patch hypertrophy).
331
Describe type 2 renal tubular acidosis. Urine pH? Serum K+?
Proximal. Caused by a defect in PCT bicarbonate reabsorption caused by Fanconi syndrome. Urine pH\<5.5, serum K+ lowered.
332
What do eosinophilic casts in the tubules indicate?
Chronic pyelonephritis. "Thyroidization of kidney".
333
What is the Jod-Basedow phenomenon?
Thyrotoxicosis when a patient with a primary deficiency is made iodine replete.
334
What layer does the spleen derive from?
Mesoderm.
335
What's the first line treatment for Polyarteritis Nodosa?
Corticosteroids and cyclophosphamide.
336
What is GpIIb/IIIa?
Fibrinogen receptor on platelets.
337
Describe Asbestosis and include which part of the lung it affects. What cancers does it increase the risk of?
Lower lobes. Ivory white calcified supradiaphragmatic and pleural plaques. Golden brown fusiform rods shaped like dumbbells on Prussian blue stain. Risk of bronchogenic carcinoma \> risk of mesothelioma.
338
What pattern does Anti-U1 RNP Abs create on IF?
Speckled.
339
What do Sertoli cells do?
Secrete inhibin B (inhibits FSH), MIF, ABP (maintains local levels of testosterone), and make the blood-testis barrier. Are temperature-sensitive.
340
What is Tamoxifen?
A SERM. Antagonist at breast, agonist at bone, uterus. Used for ER/PR+ breast cancer.
341
What is Nelson syndrome?
Enlargement of existing ACTH-secreting pituitary adenoma after bilateral adrenalectomy. Hyperpigmentation, headache, bitemporal hemianopsia.
342
What are the nerve roots of the genitofemoral nerve?
L1-L2.
343
What is the most common ovarian neoplasm?
Serous cystadenoma. Benign, often bilateral, lined with fallopian-tube-like epithelium.
344
When do you see target cells?
HbC, Asplenia, Liver disease, thalassemia.
345
What are Schiller-Duval bodies?
Glomeruli-looking bodies of cells in yolk sac tumors.
346
What is a spermatocele?
A cyst due to dilated epididymal duct or rete testis.
347
What is Ulipristal?
An antiprogestin used as emergency contraception.
348
What is TAPVR?
Pulmonary veins drain into the right heart. Cyanotic.
349
What is a gubernaculum and what is the other sex's remnant of it?
Band of fibrous tissue anchoring the testes within the scrotum. Female remnant is ovarian ligament and round ligament of uterus.
350
What are the Cluster A personality disorders?
"Weird": Paranoid, Schizoid, Schizotypal
351
What kind of leukemia can present as a mediastinal mass?
ALL.
352
Is the core of osteoid osteoma radiolucent or radioopaque?
Lucent.
353
What causes physiologic neonatal jaundice and how do you treat it?
Immature UDP-glucuronosyltransferase. Non-UV phototherapy to isomerize unconjugated bilirubin to its water soluble form.
354
How do RPF and RBF relate to each other.
RPF = RBF/1-Hct
355
How does Milrinone work and what is it used for?
PDE3 inhibitor - cAMP accumulates (increased inotropy in cardiomyocytes, inhibition of MLCK activity and general vasodilation in vascular SM). Used short term in acute decompensated HF.
356
What bacteria tend to cause peritonitis?
Aerobic gram(-) or sometimes Strep.
357
What are Furosemide, Bumetanide, and Torsemide? How do they work?
Loop diuretics. Inhibit aLOH NCCK.
358
What are Amiloride and Triamterene?
K+ sparing diuretics - Na+ channel blockers.
359
Where is 25-OH VitD3 converted to 1,25-(OH)2 Vit D3?
PCT.
360
What kind of acidosis does renal tubular acidosis cause?
NAG metabolic acidosis.
361
What is GpIb?
vWF receptor on platelets.
362
What is Misoprostol? What does it do?
PGE1 analog. Causes increased production and secretion of gastric mucous, decreased acid production. Prevents NSAID-caused gastric ulcers, also used off label for labor. Causes diarrhea.
363
What is PCC?
Prothrombin complex concentrate. Has II, VII, IX, X, Protein C and S.
364
What is the postnatal derivative of the umbilical vein?
Ligamentum teres hepatis AKA round ligament.
365
What is porcelain gallbladder?
Complication of chronic cholecystitis. Should be removed because of high cancer rates.
366
What is Boerhaave syndrome?
Transmural and usually distal esophageal rupture with pneumomediastinum due to violent retching.
367
Describe the gastrocolic ligament.
Connects greater curvature of the stomach to transverse colon. Contains gastroepiploic arteries. Part of the greater omentum.
368
What are Anastrozole, Letrozole, Exemestone, and what are they used for?
Aromatase inhibitors. Used for ER+ breast cancer in postmenopausal women.
369
What produces Major Basic Protein (MBP)?
Eosinophils.
370
What can cause RCM?
Postradiation fibrosis, Löffler syndrome, Endocardial fibroelastosis, Amyloidosis, Sarcoidosis, Hemochromatosis.
371
What does the PCL connect?
Medial femoral condyle to the posterior tibia.
372
What are the "ape's hand" and "pope's blessing" hands a sign of?
Median nerve damage at the level of hte wrist.
373
What are the nerve roots of the common peroneal nerve?
L4-S2.
374
What kind of effect can carcinoid syndrome have on the heart and why?
Right sided valvular heart disease. Due to lung MAO-A enzymatic breakdown of 5-HT before heart return.
375
What condition has a fixed S2 split?
ASD.
376
Describe lichen simplex chronicus. Any SCC risk?
Hyperplasia of squamous epithelium. No SCC risk.
377
How much do all the hemoglobin types migrate on a gel and in which direction?
Toward the anode: A\>F\>S\>C
378
What are Loratadine, Fexafenadine, Desloratidine, Cetirizine?
2nd gen reversible H1 blockers. \*Less sedation than 1st gen - decreased entry into CNS.
379
How do Abciximab, Eptifibatide, Tirafiban work?
Inhibit GpIIb/IIIa director.
380
Describe the infundibulopelvic ligament.
Connects the ovaries to the lateral pelvic wall. Contains ovarian vessels.
381
What is Laron syndrome?
Defective GH receptors (increased GH, decreased IGF-1). Short, small head circumference, saddle nose, prominent forehead, delayed skeletal maturation, small genitalia.
382
What are Nateglinide and Repaglinide? How do they effect weight?
Meglitinides. They close the β-cell K+ channel causing the cell to depolarize and insulin to release. Weight gain.
383
Where in the nephron are glucose and amino acids reabsorbed?
PCT.
384
Describe ventricular septation.
1) Muscular IV septum forms 2) aorticopulmonary septum rotates and fuses with muscular IV septum (closes IV foramen) 3) Endocardial cushions separate atria from ventricles (lso contributes to membranous IV septum)
385
What functions does the common peroneal nerve allow someone to do?
Eversion and dorsiflexion of the foot.
386
What muscle is responsible for arm abduction \>90°? And what nerve controls it and what are its roots?
Trapezius. CN XI.
387
What are the types of aortic dissection?
Stanford A: Proximal (AA) - Tx is surgery Stanford B: Distal (DA), below ligamentum arteriosum - Tx is β-blockers then vasodilation.
388
What is Danazol and what is it used for?
Androgen receptor partial agonist used for endometriosis and angioedema.
389
What kind of signalling pathway does ANP work under?
cGMP.
390
What are the three conditions (and their associated genes and chromosomes) associated with Nephroblastoma/Wilms tumor?
WAGR: WT1 mut. Aniridia, GU malformations, mental retardation. Denys-Drash: WT1 mut. Diffuse mesangial sclerosis, male pseudohermaphroditism. Beckwith-Wiedemann: WT2 mut. Macroglossia, organomegaly, hemihyperplasia. WT1 and WT2 on chromosome 11.
391
What does invasive ductal carcinoma look like on histology?
Small glandular cells with 'stellate' infiltration.
392
What is Metoclopramide and what is it used for?
D2 antagonist. Promotes gastric emptying - used for diabetic and postop gastroparesis, antiemesis, persistent GERD.
393
Where in the lung is adenocarcinoma more likely to occur? Is it associated with smokers?
Periphery. More likely in nonsmokers.
394
Describe Acute Poststreptococcal Glomerulosclerosis (symptoms and various imagings).
Type III hypersensitivity, C3 levels down due to consumption. Hypertension, cola-coloured urine, peripheral and periorbital edema. LM enlarged and hypercellular glomeruli, IF granular, EM has subepithelial immune complex humps.
395
What causes anemia of chronic disease?
Inflammation increases hepcidin by the liver, which binds ferroportin on intestinal cells and macrophages. Results in decreased release of iron and decreased iron absorption from the gut.
396
What is Diffuse large B-cell lymphoma?
Most common adult NHL, alterations in Bcl-2 and 6.
397
How do you calculate minute ventilation?
TVXRR
398
Describe Hairy-cell leukemia. What does it stain with? How is it treated?
Mature B-cell tumour. TRAP+. Marrow fibrosis, dry tap on aspiration. Massive splenomegaly and pancytopenia. Treat with Cladribine, Pentostatin.
399
What are the nerve roots of the musculocutaneous n. and how is it damaged?
C5&C6. Upper trunk compression.
400
What does the corpus luteum secrete?
Progesterone.
401
How do you calculate dead space?
VtX[(PaCO2-PeCO2)/PaCO2]
402
What are some ADEs of long acting beta agonists e.g. Salmeterol and Formoterol?
Tremor, arrhythmia.
403
Name some osmotic laxatives.
Magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose.
404
What do neutrophil specific granules contain?
LAP, collagenase, lactoferrin, lysozyme.
405
What are the 2nd gen sunfolynureas?
Glimepiride, Glipizide, Glyburide.
406
Where are plasma cells found?
In the bone marrow - don't normally circulate in the blood.
407
When does the metanephros first appear and when does nephrogenesis continue?
Week 5. Week 32-36.
408
What are the nerve roots of the tibial nerve?
L4-S3.
409
Where is osteoma typically located and what condition is it associated with?
Facial bones. Gardner disease.
410
Describe gastrulation.
Week 3 of development. Trilaminar embryonic disc forms, also neural tube. Epiblast cells invaginate to make primitive streak and endo/meso/ectoderm. Notochord arises from the midline mesoderm, overlying ectoderm becomes neural plate.
411
What causes an umbilical hernia?
Failure of the umbilical ring to close after physiologic herniation of the intestines.
412
Is endocarditis usually bacterial or viral?
Bacterial.
413
What is the Bohr effect?
In the periphery, increased H+ from tissue metabolism causes O2 unloading in RBCs.
414
With what can you estimate eRPF?
PAH clearance.
415
What do peripheral and central chemoreceptors respond to changes in?
Both in pH and PCO2, peripheral also PO2.
416
What has a longer half life, ANP or BNP?
BNP. Used to diagnose HF.
417
Does a cherry hemangioma regress?
No.
418
What are some ADEs of thioamides?
Propylthiouracil and Methimazole. Skin rash, hepatotoxicity, aplastic anemia, agranulocytosis, aplasia cutis with Methimazole.
419
How do fibrate drugs work? What are some ADEs?
They upregulate LPL and also activate PPAR-α to induce HDL synthesis. ADEs: myopathy, cholesterol gallstones (via inhibition of cholesterol 7α-hydroxylase).
420
What are the lab values like in osteoporosis?
Normal.
421
What do hemidesmosomes do?
Connects keratin in basal cells to the underlying basement membrane.
422
What condition is Hodgkin's Lymphoma associated with?
EBV.
423
Where is SLGT1/SGLT2 found and what kind of transporter is it?
Kidney SI. Is a Na+/Glucose cotransporter.
424
What nerves are responsible for emossion and what are their roots?
Hypogastric nerve (SNS): T11-L2
425
Where to the gonadal veins drain into?
Left into left renal vein into IVC, right directly into IVC.
426
What is the path of the sperm?
Seminiferous tubules -\> epidydymis -\> vas deferens -\> ejaculatory duct -\> urethra
427
What is Schizoaffective Disorder?
Schizophrenia criteria + major mood disorder but must have \>2 weeks of psychotic symptoms without mood symptoms.
428
What carcinogens is angiosarcoma associated with?
Arsenic, vinyl chloride.
429
What is the charcot triad?
Jaundice, fever, RUQ pain.
430
What syndromes are in MEN2A?
Parathyroid hyperplasia, Medullary thyroid cancer, Pheochromocytoma.
431
Compare the spread of Hodgkin's Lymphoma and Non Hodgkin's Lymphoma.
HL spread is usually localized, NHL generally has multiple LNs involved and commonly spreads extranodally.
432
Where in the nephron is the PTH-sensitive Na+/phosphate cotransporter located?
PCT.
433
What condition is a bartholin cyst associated with?
Gonorrhea.
434
Where is a baker cyst located?
In the gastrocnemius-semimembranosus bursa. Communicates with the synovial space.
435
How does PTH affect calcitriol production?
Increaess it by stimulating PCT 1α-hydroxylase.
436
What artery supplies the right ventricle?
Right marginal artery.
437
What is melasma/choalasma?
Hyperpigmentation associated with pregnancy or OCPs.
438
What kind of heart sounds does HCM have?
S4, systolic murmur.
439
What are the mitral or tricuspid valves derived from embryologically?
Fused endocardial cushions of the AV canal.
440
What do high 5-HIAA levels in the urine imply?
High serotonin levels, carcinoid tumour.
441
What do dense granules on platelets contain?
ADP, Ca++.
442
What are the nuclei like in BCC?
Palisading.
443
What is the effect of cortisol on insulin?
Increases resistance.
444
How does nephrotic syndrome affect the blood?
Associated with hypercoagulable state due to loss of ATIII in the urine.
445
What is Ondansetron? What's it used for?
5-HT3 antagonist that is a powerful antiemetic. Good for postop vomiting and chemo emesis.
446
What is Budd-Chiari syndrome?
Thrombosis/compression of hepatic veins with centrilobular congestion and necrosis. Can be caused by hepatic tumours.
447
What are the heart's local metabolites?
NO, CO2, O2
448
When do you see bite cells?
G6PD deficiency.
449
What is Caplan syndrome?
Rheumatoid arthritis and pneumoconioses with intrapulmonary nodules.
450
What is hypoxia vs hypoxemia?
Hypoxia is a decreased O2 delivery to tissue. Hypoxemia is a decreased PaO2.
451
What are Reed-Sternberg cells?
Hodgkin Lymphoma cells. Bilobed eye-owls. B-cell origin. CD15+, CD30+.
452
When is hCG detectable and when does it peak?
Detectable in blood 1 week after conception, in urine after 2. Peaks at 8-10 weeks.
453
What is spongiosis?
Epidermal accumulation of edematous fluid in the intercellular spaces.
454
Does diabetic nephropathy cause nephritic or nephrotic syndrome?
Nephrotic.
455
What stimulates the mitosis of the underlying mesoderm under the apical endodermal ridge?
FGF.
456
What is the 'unhappy triad'?
ACL, MCL, and medial meniscus damage. (Lateral meniscus more common).
457
Where is GLUT3 found?
Brain, placenta.
458
Where does most epistaxis take place?
Anterior Kiesselbach plexus (superior labial a., A/P ethmoidal a., greater palatine a.).
459
Describe the ovarian ligament.
Connects the ovary to the uterine horn.
460
How do you treat Ulcerative colitis?
5-aminosalicylic preparations (e.g. Mesalamine), 6-mercaptopurine, Infliximab, colectomy.
461
What is a phyllodes tumor?
Benign breast mass of connective tissue and cysts with 'leaf-like' lobulations.
462
What do α-granules on platelets contain?
vWF, fibrinogen, fibronectin.
463
How do you treat serotonin syndrome?
Cyproheptadine (5-HT2 antagonist).
464
What is Meigs syndrome?
Ovarian fibroma + ascites + hydrothorax. There is a 'pulling' sensation in the groin.
465
What muscles make up the rotator cuff?
Supraspinatus, Infraspinatus, Teres minor, Subscapularis.
466
What substances is transitional cell carcinoma associated with?
Phenacetin, smokine, aniline dyes, cyclophosphamide.
467
What is an annular pancreas?
Abnormal rotation of the ventral bud forms a ring encircling the 2nd part of the duodenum.
468
What kind of drug is Buspirone and what is it used for?
5-HT1A stimulant. Used for GAD.
469
What is the difference between an erosion and an ulcer? (in the context of the gut wall)
Erosion is only mucosa, ulcer can extend to submucosa.
470
What is Burkitt Lymphoma? What translocation is it associated with?
B-cell NHL. t(8;14): c-myc and heavy chain Ig. "Starry sky" appearance.
471
What is the difference between a deformation and a malformation?
Malformation occurs during embryonic period for intrinsic reasons, Deformation occurs after embryonic period for extrinsic reasons.
472
What is the structure of the liver lobules in regard to vasculature?
Central vein in the middle, portal triads on the edges (hepatic artery, portal vein, CBD).
473
What is the innervation of the foregut/midgut/hindgut?
Foregut and midgut: vagus nerve Hindgut: pelvic nerve
474
What are Paneth cells?
GI cells in the crypts of Lieberkühn that secrete defensins, lysozyme, TNF.
475
What layer do the lungs derive from?
Endoderm.
476
Describe the gastrohepatic ligament.
Connects the liver to the lesser curvature of the stomach. Contains gastric vessels. Part of the lesser omentum (separates right greater and lesser sacs).
477
What's the effect of insulin on sodium?
Increases sodium retention in kidneys.
478
Where are there Peyer patches?
Ileum in lamina propria and submucosa.
479
What is AIN?
Pyuria and azotemia after drugs that act as haptens.
480
Describe the processing of insulin.
Preproinsulin made in the RER, then cleaved to proinsulin which is stored in the secretory glands. It's then cleaved, and insulin and C-peptide are exocytosed.
481
How do you treat lithium toxicity?
Discontinue lithium, give NaCl, consider hemodialysis.
482
What are the pronephros and mesonephros?
Pronephros appears in week 4 then degenerates, mesonephros is the interim kidney in the 1st trimester, then later contributes to the male genital tract.
483
What is Tropical sprue?
Like celiac disease but responds to antibiotics.
484
What does a defect in 21 hydroxylase cause?
CAH with deficiency of mineralocorticoid production and production shunted to sex hormones (ambiguity in genetic females).
485
How do you treat preeclampsia in a way that isn't delivery?
Antihypertensives, IV Mg sulfate.
486
What do valsalva phase II and squatting do to intensity of heart sounds for various conditions?
Increases intensity of HCM, earlier click in MVP.
487
What is sarcoidosis and what things are elevated in it?
Immune mediated noncaseating granulomas. Serum ACE elevated and CD4:CD8 ration is elevated in bronchoalveolar lavage fluid.
488
What's the cutoff for gestational hypertension?
\>140/90 after 20th week of gestation.
489
What innervates tibialis anterior?
The deep peroneal nerve.
490
How do you treat hepatic encephalopathy?
Lactulose (to generate more NH4+), Rifaximin or Neomycin (decreases nitrate producing bacteria).
491
What factor is affected in Hemophilia A, B, and C, and what are the inheritances?
A: VIII (XR) B: IX (XR) C: XI (AR)
492
Describe the cardinal ligament.
Connects the cervix to the side wall of the pelvis. Contains uterine vessels.
493
What is bismuth sucralfate?
A GI protectant. Needs acidic environment, binds ulcer base and gives physical protection.
494
What cancer is generally calretinin+?
Mesothelioma.
495
What is Ruxolitinib and what is it used for?
JAK1/2 inhibitor. Treatment for chronic myeloproliferative disorders.
496
What are the symptoms of β-thalassemia?
Anemia (microcytic, hypochromic), chipmunk facies, hepatosplenomegaly.
497
Describe the cells in Langerhans cell histiocytosis?
Functionally immature, don't effectively stimulate primary T-cells via APC. S100+, CD1a+, Birbeck granules (tennis rackets or rod on EM).
498
What is Allopurinol?
Xanthine oxidase inhibitor. Used as a chronic gout drug and also in leukemia and lymphoma to prevent tumor lysis nephropathy.
499
What is hypersensitivity pneumonitis?
Mixed type III/IV hypersensivity reaction to environmental antigen. Often seen in farmers and those exposed to birds.
500
Describe xanthogranulomatous pyelonephritis.
Grossly orange nodules. Is associated with Proteus. Widespread kidney damage.
501
Describe the extrinsic pathway.
VIIa + tissue factor activates Xa and then common pathway.
502
Is there diaphoresis in cholinergic crisis or serotonin syndrome?
Serotonin syndrome.
503
What forms of estrogen are made by the ovary, placenta, and adipose and what are their relative potencies?
Ovary: 17β-estradiol Placenta: estriol Adipose: Estrone Estradiol\>estrone\>estriol
504
What pierces the diaphragm at T8?
IVC, right phrenic n.
505
What nerve provides sensory innervation to the suprapubic region?
Iliohypogastric (T12-L1).
506
How does Bupropion work?
Inhibits NorE and Dopamine reuptake.
507
What do PTT and PT measure?
PTT: Intrinsic pathway PT: Extrinsic pathway
508
Where are bile acids made and what is the enzyme catalyzing the rate-limiting step?
Liver. Cholesterol 7α-hydroxylase.
509
What innervates the foot flexors?
Tibial n. L4-S3.
510
What activates plasminogen?
tPA.
511
How does aldosterone affect α-intercalated cells?
HCO3-/Cl- exchange. Lumen negativity -\> H+ ATPase acticity -\> H+ secretion -\> HCO3-/Cl- exchanger.
512
What is duloxetine used for besodes depression/GAD?
Fibromyalgia.
513
How is FAP inherited and what gene is responsible?
AD. APC.
514
What are the risk factors for a completed suicide?
Sex (male), Age, Depression, Previous attempt, EtOH/drugs, Rational thinking loss, Sickness, Organized plan, No spouse/social support, Stated future intent \*SADPERSON
515
What is the female remnant of the Wolffian duct?
Gartner duct.
516
What Abs may Ulcerative colitis be positive for?
p-ANCA.
517
What is the Tinel sign?
Wrist percussion causes tingling.
518
What does aminocaproic acid do?
Inactivates tPA.
519
How do you treat Wilson disease/copper excess?
Chelation with penicillamine or trientine, oral zinc.
520
What are T-tubules?
Plasma membrane extensions into the sarcoplasmic reticulum.
521
What are posterior urethral valves?
Obstructive membranes that remain in males that can lead to obstruction of the bladder outlet.
522
What nerves are responsible for erection and what are their roots?
Pelvic splanchnic (PNS): S2-S4
523
What lab findings do you find in Antiphospholipid syndrome?
Lupus anticoagulant, anticardiolipin, anti-β2 glycoprotein antibodies.
524
How does Ranotazine work and what is it used for?
Inhibits late phase sodium current - decreases diastolic wall tension and oxygen consumption. Used for refractory angina. \*prolongs QT
525
What are the ADEs of sulfonylureas?
1st gen can have disulfiram-like effects, all can have hypoglycemia and weight GAIN.
526
What is a lecithin-sphingomyelin ratio used to measure and what does it mean?
Used to screen for fetal lung maturity. ≥2 is healthy.
527
Describe Potter Sequence.
Pulmonary hypoplasia, Oligohydramnios (trigger), Twisted face, Twisted skin, Extremity defects, Renal failure.
528
What is a Brenner tumor?
An ovarian usually benign tumor that resembles bladder epithelium. "Coffee-bean" nuclei on H&E.
529
What is the arterial supply of the anus above the pectinate line?
Superior rectal artery from SMA.
530
What is tubuinterstitial kidney disease?
AD progressive renal insufficiency with inability to concentrate urine. Medullary cysts that are usually not visualized, small kidneys on ultrasound. Poor prognosis.
531
What is Takotsubo CM?
'Broken heart syndrome' - DCM, ventricular apical ballooning due to increased SNS stimulation.
532
What is the venous drainage of the anus above the pectinate line?
Superior rectal vein -\> IMV -\> splenic vein -\> portal vein
533
What effect do diuretics have on calcium?
Loop diuretics increase excretion, thiazides decrease excretion.
534
Describe CLL/SLL.
Smudge cells in peripheral smear - autoimmune hemolytic anemia. CD20+, CD23+, CD5+ B cells. Can undergo Richter transformation into an aggressive lymphoma (most commonly diffuse large cell B-cell lymphoma).
535
What is an adherens junction made of?
Cadherins.
536
What is Docusate?
An emollient laxative. Promotes incorporation of water and fat into the stool.
537
What is Schizophreniform Disorder?
≥2 positive symptoms 1-6 mo
538
What is corneal arcus?
Lipid deposits in the cornea.
539
Describe Focal Segmental Glomerulosclerosis.
Nephrotic syndrome. Similar to minimal change disease on EM except LM has segmental sclerosis.hyalinosis. Has inconsistent response to steroids.
540
What is the V/Q at the apex and base of lungs?
Apex = 3 Base = 0.6
541
What are Kimmelstiel-Wilson lesions?
Eosinophilic nodular glomerulosclerosis found in diabetic nephropathy.
542
What precipitates HUS?
Commonly in kids, Shiga=like toxin (EHEC AKA O157:H7). In adults EHEC not required.
543
Where is erythema nodosum most commonly located?
Anterior shins.
544
Describe IgA Nephropathy.
Nephritic syndrome. Episodic hematuria concurrent with respiratory or GI infection. LM has mesangial proliferation. IF and EM have mesangial immune complex deposition.
545
How does ductal carcinoma in situ present on mammography?
Microcalcifications.
546
What innervates the popliteus?
Tibial n. L4-S3.
547
Describe the hepatoduodenal ligament.
Contains the portal triad (hepatic artery, CBD, portal vein). Part of the lesser omentum.
548
What is erysipelas?
Infection of upper dermis and superficial lymphatics. Usually S. pyogenes.
549
What is the normal O2 binding capacity of blood?
20.1mL O2 / dL of blood.
550
What is the Reynolds pentad?
Charcot triad (jaundice, fever, RUQ pain) + shock + altered mental status.
551
What is a "boxer's fracture"?
A metacarpal neck fracture, most commonly in the 4th and 5th.
552
What is the HbA1c cutoff for diabetes mellitus?
\>6.5% is indicative of diabetes.
553
What demographic is most common for ALL, CLL, AML?
ALL: kids CLL: \>60y/o AML: 65 median age
554
How do diuretics affect NaCl?
Urine NaCl increased with all diuretics.
555
How does an L3/4 radiculopathy present?
Weakness of knee extension, decreaesd patellar reflex.
556
Which is more common, an inguinal or femoral hernia?
Inguinal.
557
What muscle is responsible for arm abduction 15-100°? And what nerve controls it and what are its roots?
Deltoid. Axillary n. C5&C6.
558
What is cortisol bound to in the blood?
Corticosteroid binding globulin (CBG).
559
What are the symptoms of Hirschprung disease?
Bilious emesis, abdominal distension, no meconium within 48 hours, squirt sign, empty rectum on digital exam.
560
What is Marginal zone Lymphoma? What translocation is it associated with?
B-cell NHL. t(11;18): associated with chronic inflammation.
561
What does pemphigus vulgaris look like in immunofluorescence?
Reticular 'net-like' pattern.
562
What causes Hirschprung disease?
Lack of enteric nervous plexi in distal colon due to failure of migration of neural crest.
563
What is torsades de pointes?
Polymorphic v-tach.
564
What are the functions of dihydrotestosterone?
Early: differentiation of penis, scrotum, prostate Late: prostate growth, balding, sebaceous gland activity
565
Where in the esophagus is esophageal squamous cell carcinoma most likely to happen? What are the risk factors?
Upper 2/3. Alcohol, hot liquisd, caustic strictures, smoking, achalasia.
566
What are the Cluster B personality disorders?
"Wild": Antisocial, Borderline, Histrionic, Narcissistic
567
What is the most common cause for serous/bloody nipple discharge?
Intraductal papilloma. A benign breast fibroepithelial tumor within the lactiferous ducts.
568
Where does renal cell carcinoma originate?
PCT.
569
What are the symptoms of SVC syndrome?
Facial flushing, blanching after fingertip pressure, JVD, upper extremity edema.
570
Describe osteochondroma and where is it typically located?
Lateral projection of growth plate continuous with marrow space. Covered by cartilagenous cap. Metaphysis.
571
What viruses mediate hairy leukoplakia?
HIV, EBV (in organ transplant recipients).
572
What is a choriocarcinoma?
Trophoblastic tissue malignancy with no chorionic villi. Can occur in mom or baby. Can occur in men too! Increased hCG.
573
What are major ADEs of statins?
Myopathy, hepatotoxicity.
574
Where are bile salts reabsorbed?
Distal ileum.
575
What are Wickham striae?
Mucosal involvement of lichen planus.
576
What develops abnormally to cause developmental hip dysplasia?
Acetabulum.
577
What hormone is increased in ovulation?
Progesterone.
578
How do you treat lead poisoning?
Dimercaprol and EDTA. Succimer in kids.
579
`What is a filtration fraction and what is the normal value?
GFR/RPF. Normal is 20%.
580
Describe the common pathway.
XA (+Va) activates IIa (thrombin) which activates !a (fibrin) which aggregates with calcium and XIII.
581
What type of sleep is sleep terror disorder present in?
Slow-wave (N3) sleep.
582
What HPV proteins cause vulvar carcinoma and how?
E6 - inhibits p53 E7 - inhibits pRB
583
How can a somatistatinoma present?
Diabetes, glucose intolerance, steatorrhea, gallstones, achlorydia.
584
What is pancreas divisum?
Failure of fusion of the ventral and dorsal buds of pancreas. Mostly asymptomatic, but may cause chronic abdominal pain and/or pancreatitis.
585
Describe the histology of medullary thyroid carcinoma.
C-cells in sheets of cells in amyloid stroma (stains with congo red).
586
What tumor marker does melanoma stain positive for?
S-100.
587
What do the dorsal buds of the pancreas turn into?
Body, tail, isthmus, accessory pancreatic duct, makes up head.
588
What is Peyronie disease?
Abnormal penile curvature due to a fibrous plaque in tunica albuginea.
589
What are the 'flizolins'? What are their ADEs? What effect on weight?
SGLT2 inhibitors (diabetes drugs). ADEs: glucosuria!!!, UTIs, vaginal yeast infections, hyperkalemia, dehydration, orthostatic hypotension. Weight loss.
590
What is pseudohyperparathyroidism 1A?
Unresponsiveness of the kidney to PTH. AD, defective Gs in GNAS inherited from the mother. Comes with Albright hereditary osteodystrophy: shortened 4/5th finger, short stature, obesity, developmental delay. If paternally inherited, Albright effects but without end-organ PTH resistance.
591
What is the function of the interossei and what nerve controls them?
Palmar adduct the fingers, dorsal abduct the fingers. Ulnar n.
592
What teratogenic effect can antiepileptics have?
NT defects, cardiac defects, cleft palate, skeletal abnormalities.
593
Where do the trabeculated left and right atria derive from embryologically?
Primitive atrium.
594
What are the actions of teres minor (besides abduction)?
External rotation and adduction.
595
What is Minoxidil and what is it used for?
A direct arteriolar vasodilator. Used for baldness and severe refractory HTN.
596
Describe inflammatory breast cancer.
Lymphatic invasion by breast carcinoma. Neoplastic cells block lymphatic drainage. Peau d'orange due to edema (tightening of Cooper's suspensory ligament).
597
What sort of hypersensitivity is Graves disease?
Type II.
598
Are pemphigus vulgaris and bullous pemphigoid Nikolsky +ve or -ve?
Pemphigus vulgaris +ve, Bullous pemphigoid -ve.
599
What is juvenile polyposis syndrome?
AD condition in kids featuring hamartomatous polyps in GI. Increased risk of colorectal cancer.
600
What are some ADEs of loop diuretics?
Ototoxicity, Hypokalemia, Hypomagnesemia, Dehydration, Allergy (sulfa), metabolic Alkalosis, Nephritis (AIN), Gout. \*OHHDAANG
601
What teratogenic effect can alkylating agents have?
Absence of digits (+ others).
602
What are the rates of the GI areas that create a basal electric rhythm?
Stomach: 3 waves/min Duodenum: 12 waves/min Ileum: 8-9 waves/min
603
What drugs do you avoid in HTM when the person also has asthma?
Nonselective β-blockers (to prevent β2-induced bronchoconstriction). ACE inhibitors (to prevent confusion between drug and asthma cough).
604
What are Exenatide and Liraglutide? What are some ADEs?
GLP-1 analogs. ADEs: pancreatitis, weight loss.
605
What are d-dimers?
Fibrin degradation products. Imply there is clotting going on.
606
What is familial hypocalciuric hypercalcemia?
Defective G-coupled CaSRs in multiple tissues. Excessive renal calcium uptake. Higher calcium levels needed to suppress PTH.
607
What is the blood supply of the retrosigmoidal junction?
Last sigmoid arterial branch from the IMA and also superior rectal artery.
608
What is Senna?
A stimulant laxative that stimulates enteric nerves. Causes melanosis coli.
609
How do diuretics affect blood pH?
K+ sparing diuretics and CA inhibitors decrease it, Loop diuretics and thiazides increase it.
610
What condition is Non Hodgkin's Lymphoma associated with?
HIV/autoimmune diseases.
611
What are Kulchitsky cells?
Small dark blue neuroedocrine cells that comprise small cell/oat cell carcinoma.
612
What does the zona reticularis produce and what regulates it?
Steroids (DHEA). Regulated by ACTH and CRH.
613
Where in the lung is large cell carcinoma more likely to occur? Is it associated with smokers?
Periphery. It IS associated with smokers.
614
Describe vulvar lichen sclerosis. Any SCC risk?
Thinning of epidermis with fibrosis/sclerosis of dermis. Increased risk of SCC.
615
What do Protein C and S do?
Inactivate Factor Va and VIIIa.
616
What is CD14?
Macrophage receptor for Lipid A. Bind to initiate septic shock.
617
What is a Warthin tumour?
Papillary cystadenoma lymphomatosum - a benign salivary gland cystic tumor with germinal centers, typically in smokers.
618
What is the FENa and BUN:Cr of intrinsic kidney disease?
FENa \>2%, serum Bun:Cr \<20
619
What are the causes of acute pancreatitis?
Idiopathic, Gallstones, EtOH, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hypercalcemia/hypetriglyceridemia, ERCP, Drugs. \*IGETSMASHED
620
What is Osler-Weber-Rendu syndrome?
AKA hereditary hemorrhagic telangiectasia. Blanching lesions on skin and mucous membranes, recurrent epistaxis, skin discolourations, AVMs, GI bleeding, hematuria.
621
What is Venurafenib and what is it used for?
A BRAF kinase inhibitor. Can be used in melanoma with a BRAF V600E mutation.
622
What are Bivalirudin, Argatroban, Dabigatran?
Direct thrombin inhibitors.
623
What teratogenic effect can methimazole have?
Aplasia cutis congenita.
624
What are the normal pressures in the LA, LV, RA, RV, PT?
LA: \<12 LV: 130/10 RA: \<5 RV: 25/5 PT: 25/10
625
Why does lead poisoning cause stippling on RBCs?
Inhibits rRNA degradation.
626
Describe an anterior urethral injury.
Bulbar urethra injured from perineal straddle. Presents as blood at meatus and scrotal hematoma. If buck fascia is torn then urine escapes into the perineal space.
627
How does Langerhans cell histiocytosis present?
In childhood as lytic bone lesions and rash or recurrent otitis media with mass in mastoid.
628
What is a Virchow node?
Metastasis from stomach to left supraclavicular node.
629
How does unilateral renal agenesis happen?
Ureteric bud fails to induce differenciation of the metanephric mesenchyme.
630
What are the risk factors for papillary carcinoma?
RET/PTC rearrangements, BRAF mutations, childhood irradiation.
631
Describe the path of the ureter.
Under the gonadal a., over the common iliac a., under the uterine a./vas deferens (retroperitoneal).
632
What is Vortioxetine?
A 5-HT reuptake inhibitor, 5-HT1A agonist and 5-HT3 antagonist. Used for MDD.
633
What is acute intermittent porphyria? How do you treat it?
AD mutatioin in porphobilinogen deaminase (porphobilinogen accumulates). Painful abdomen, port-wine coloured urine, polyneuropathy, psych disturbances, is precipiated by drugs. Treat with hemin and glucose, which inhibit ALA synthase.
634
What are the Cluster C personality disorders?
"Worried": Avoidant, Obsessive-Compulsive, Dependent
635
What is the postnatal derivative of the allantois/urachus?
Median umbilical ligament.
636
What syndromes are in MEN2B?
Marfanoid habitus, Medullary thyroid cancer, Mucosal neuromas, Pheochromocytoma.
637
What are gap junctions made of?
Connexons.
638
What is bullous pemphigoid?
Autoabs to hemidesmosomes.
639
What is Dronabinol?
A synthetic cannabinoid used as an antiemetic in chemo and as an appetite stimulant in AIDS.
640
What nerve is responsible for ejaculation?
Pudendal nerve.
641
What are ANP and BNP released in response to?
ANP: increased BP and atrial pressure. BNP: increased tension.
642
What provides sensory innervation to the medial thigh?
Obturator n. (L2-L4) and genitofemoral nerve (L1-L2).
643
What kind of microorganisms tend to cause rhinosinusitis?
Viral\>bacterial.
644
Describe the splenorenal ligament.
Connects the spleen to the posterior abdominal wall. Contains the splenic arteries and veins and the tail of the pancreas.
645
What is Guyon canal syndrome?
The ulnar nerve is compressed at the wrist. Mostly seen in cyclists.
646
Do pemphigus vulgaris and bullous pemphigoid affect the oral mucosa?
Pemphigus vulgaris yes, Bullous pemphigoid no.
647
What causes gastrochisis and omphalocele? And which is which?
Lateral fold closure in ventral wall. Omphalocele is surrounded by peritoneum.
648
Where does the glans penis drain into?
Deep inguinal LNs.
649
What are some life threatening effects of MDMA?
Hypertension, tachycardia, hyperthermia, hyponatremia, serotonin syndrome.
650
What is TTP? How do you treat it?
Thrombotic thrombocytopenic purpira. Inhibition/deficiency of ADAMS13 (a vWF metalloprotease). Decreaed vWF multimer degradation, large vWF multimers increase platelet aggregation. Treat with steroids, plasmapharesis.
651
What is extramammary paget's in the vulva a sign of?
Intraepithelial adenocarcinoma.
652
Where is GLUT4 found and why is it special?
Skeletal muscle, adipose tissue. Is insulin-dependent.
653
What molecule does calcium bind to in the muscle fiber?
Troponin C.
654
In what conditions is hCG raised?
Multiple pregnancies, Down.
655
What are the possible Crohn's complications?
Fistulas, phlegmon/abscess, strictures, perianal disease.
656
What is a Curling ulcer?
A gastric ulcer in response to brain injury -\> increased vagal stimulation causes increased acid production.
657
What are some ADEs of PPIs?
Risk of C. diff infection, pneumonia, AIN, decreased serum magnesium and calcium absorption.
658
What is the McMurray test and what do its results mean?
Flexion and extension of the knee with rotation of the tibia. Pain, 'popping' on external rotation = a medial meniscus tear. On internal rotation = a lateral meniscus tear.
659
Where is a chondrosarcoma most common?
Medulla of the pelvis and central skeleton.
660
What kind of cells do you see in multiple myeloma?
'Fried egg' monoclonal plasma cells.
661
What is comedocarcinoma?
A subtype of breast ductal carcinoma in situ with central necrosis.
662
What is the Reid index?
Ratio of thickness of mucus secreting glands in bronchial epithelium to the rest of it. \>50 is sign of chronic bronchitis.
663
What are the ADEs of aluminum hydroxide?
Antacid. Constipation, hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures.
664
What innervates the psoas?
Spinal nerves L1-L3.
665
What are the stages of lung development?
Embryonic (w4-7): develops up to tertiary (segmental) bronchi. Pseudoglandular (w5-17): Up to terminal bronchioles, surrounded by modest capillary network. Canalicular (w16-25): Up do alveolar ducts. Surrounded by prominent capillary network. Pneumocytes start to develop at 20 weeks. Saccular (w26-birth): to terminal sacs separated by primary septae. Alveolar (-8yrs): Secondary septation to make adult alveoli.
666
Why is Celecoxib GI protective?
COX2 selective, reversible inhibitor. \*Spares platelet function.
667
What is de Quervain syndrome?
Subacute granulomatous thyroiditis. Self-limited, often following flu-like illness. Tender thyroid. Increaesd ESR, jaw pain.
668
What is Mallory-Weiss syndrome?
Partial thickness mucosal lacerations at the gastroesophageal junction due to vomiting?
669
Describe primary sclerosing cholangitis.
Idiopathic 'onion skin' bile duct fibrosis, classically in middle aged men with IBD. Associated with UC, P-ANCA+, increased IgM.
670
What is the brain's local metabolite?
CO2
671
What can cause DCM?
Mostly idiopathic and familial, but can be Alcohol abuse, Beriberi (wet), Coxsackie B, cocains use, Chagas, Doxorubicin toxicity, hemochromatosis, thyrotoxicosis, sarcoidosis.
672
What is SMA syndrome?
Intermittent intestinal obstruction symptoms when the SMA and aorta compress the transverse/3rd dupdenum.
673
How do you calculate CO? Two ways
HR X SV rate of O2 consumption divided by difference in arterial-venous O2 content
674
How do PGI2 and TxA2 affect platelet aggregation and vascular tone?
PGI2 decreases both, TxA2 increases both.
675
How do left and right colorectal cancer tend to present?
Left: obstructs Right: bleeds
676
What is lichen planus?
Pruritic purple plaques/papules associated with Hep C. Sawtooth infiltrate of lymphocytes at the dermal-epidermal junction. Mucosal involvement manifests as Wickham striae.
677
How does damage to the gluteus maximus present?
Difficulty climbing stairs, rising from a seated position.
678
What are Kupffer cells?
Special liver macrophages in the sinusoids.
679
What is the inheritance of MEN syndromes?
AD.
680
What hormones have effects on PRL and TSH and what are they?
TRH: stimulates TSH and PRL DA: Inhibits TSH and PRL
681
Describe nephrogenesis.
Weeks 32-36. Ureteric bud derived from the caudal end of the mesonephric duct and turns into the ureter, pelvises, calyces, CDs. Fully canalized by week 10. Ureteric bud interacts with the metanephric mesenchyme and induces differentiation and formation of glomerulus up to the DCT. \*uteropelvic junction last to canalize.
682
What is Riedel thyroiditis?
Thyroid replaced by fibrous tissue with inflammatory infiltrate. Considered a manifestation of IgG4-related systemic disease.
683
What cells in the kidney secrete dopamine and what does it do?
PCT cells. At low doses, vasodilates arteries (increases RBF and no change in GFR), at higher doses vasoconstricts.
684
Where is the PNS embryologically derived from?
The neural crest (ectoderm).
685
How does Ezetimibe work?
Prevents cholesterol absorption at SI brush border.
686
What is anti-Scl-70 Ab?
Ab to topoisomerase I. In scleroderma.
687
When do genitalia start to have male/female characteristics?
Week 10.
688
How do you calculate Clearance?
C=UV/P (V=urine flow rate).
689
Describe atrial septation.
1) Septum primum grows towards endocardial cushions (narrows foramen primum) 2) Foramen secundum grows in septum primum (foramen primum disappears) 3) Septum decundum develops 4) Septum secundum expands and covers most of foramen secundum (leaving foramen ovale -- Remaining septum primum forms valve of foramen ovale) 5) Septum primum and secundum fuse into atrial septum
690
What is Turcot syndrome?
FAP/Lynch + malignany CNS tumours.
691
What is acanthosis?
Hyperplasia of the stratum spinosum (e.g. acanthosis nigricans).
692
What is bronchiectasis?
Chronic necrotizing infection or obstruction of bronchi leads to permanently dilated airways. Hemoptysis, digital clubbing.
693
How does LMWH work?
Acts predominantly on Xa.
694
What is adenomyosis and how do you treat it?
Extension of glandular endometrial tissue into the myometrium caused by hyperplasia of basal layer of the endometrium. Uniformly enlarged, soft, globular uterus. Treat with hysterectomy/excision or GnRH agonists.
695
What causes jejunal/ileal atresia?
Disruption of mesenteric vessels leading to ischemic necrosis. "apple peel" on CXR.
696
Scleroderma can cause esophageal dysmotility! Just a reminder!
Put 4.
697
When do the ventral and dorsal buds of the pancreas fuse?
Week 8.
698
What kind of cells are in the krukenberg tumor?
Mucin secreting signet risk cells.
699
What is the Chvostek sign?
Tapping of the facial nerve leading to contraction of hte facial muscle. A sign of hypocalcemia.
700
What is Desmopressin used for?
Central diabetes insipidus, vWD, sleep enuresis, hemophilia A.
701
Where are the parafollicular/C cells derived from embryologically?
Neural crest.
702
What is Sulfasalazine?
Sulfapyridine (antibacterial) + 5-aminosalicylic acid (antiinflammatory). Used for UC/Crohn's. Can cause reversible oligospermia.
703
Which HTN drug can cause cyanide toxicity?
Nitroprusside.
704
What does the prothrombin gene 3'UTR mutation do?
Increases production of prothrombin.
705
What layer does the thymus derive from?
Endoderm.
706
What are the segments of the urethra?
Prostatic, membranous, bulbous, penile.
707
What is a placenta percreta?
Penetrates through into uterine serosa - can even attach to rectum or bladder.
708
What are the phases of Paget disease in bone?
Lytic -\> mixed -\> sclerotic -\> quiescent.
709
What gene is neuroblastoma associated with?
N-MYC.
710
What are uric acid stones like and when do they appear?
Radiolucent, rhomboid/rosettes. Precipitate with decreased urine pH.
711
What causes hereditary pulmonary hypertension?
BMPR2 inactivating mutation. Gene normally inhibits vascular SM proliferation.
712
What does the zona fasciculata produce and what regulates it?
Cortisol. Regulated by ACTH and CRH.
713
What vessel does renal cell carcinoma invade?
Renal vein.
714
What can cause diabetes mellitus?
Unopposed GH and estrogen, corticosteroids "steroid diabetes".
715
What are calcium phosphate stones like and when do they appear?
Wedge-shaped. Precipitate with increased urine pH and hypocitraturia (associated with decreased urine pH).
716
What are the extrapyramidal symptoms of typical antipsychotics and how long do they take to appear?
Acute dystonia (hours-days), Akathisia/restlessness, Parkinsonism (days-months), Tardive dyskinesia (months-years).
717
What conditions can give you macrocytic NONmetaloblastic anemia?
Liver disease, alcoholism, Diamond-Blackfan anemia.
718
What teratogenic effect can x-rays have?
Microcephaly, intellectual disability.
719
How is vWD inherited?
AD.
720
What are the nerve roots of the pudendal nerve?
S2-S4.
721
What are the ADEs of Magnesium hydroxide?
Antacids. Diarrhea, hyporeflexia, hypotension, cardiac arrest.
722
What does the pudendal nerve innervate?
The perineum (sensory), the EUS, and the EAS.
723
What is Behçet Syndrome?
A small vessel vasculitis with high incidence in Turkish/East Mediterraneans. Recurrent aphthous ulcers, genutal ulcers, uveitis, erythema nodosum. Flares last 1-4 weeks, can be precipitated by HSV or parvovirus. Immune complex vasculitis, associated with HLA-B51.
724
What are the actions if infraspinatus (besides abduction)?
External rotation.
725
How do PPIs work and what are they used for?
Irreversibly block H+/K+ ATPase in parietal cells. Used for PUD, gastritis, reflux, Zollinger-ellison syndrome, prophylaxis for stress ulcers.
726
What is a Nikolsky sign?
Separation of epidermis upon manual stroking of skin, seen in Scalded Skin Syndrome, people with renal insufficiency.
727
What is renal papillary necrosis?
Sloughing off of necrotic renal papillae - causes gross hematuria and proteinuria. May be triggered by recent infection or immune stimulus.
728
What are the most likely culture negative endocarditises?
Coxiella, Bartonella, HACEK (Haemophilud, Aggregatibacter, Cardiomacterium, Eikenella, Kingella).
729
What muscle is responsible for arm abduction \>100°? And what nerve controls it and what are its roots?
Serratus anterior. Long thoracic n. C5-C7.
730
What enzymes in heme synthesis does lead poisoning affect? What substances accumulate?
ALA dehydratase and ferrochelatase. ALA and protoporphyrin.
731
How do troponin I and CK-MB rise after an MI?
Troponin I rises after 4 hours, peaks at 24 hours, stays raised for 7-10 days. CK-MB rises after 6-12 hours, peaks at 16-24 hours, returns to normal after 48 hours.
732
What is Leuprolide?
A GnRH agonist.
733
What is the anastomosis that causes caput medusae?
Paraumbilical veins (P) and small epigastric veins of anterior abdominal walls (S).
734
What is Wenkebach heart block?
Mobitz (2nd degree) type 1.
735
What are the major hip extensors?
Gluteus maximus, semimembranosus, semitendinosus.
736
What is cryoprecipitate?
Has fibrinogen, VIII, XIII, vWF, fibronectin. Given for coagulation factor deficiencies.
737
What does sonic hedgehog protein do and what condition can a mutation in it cause?
Produced at the base of limbs in the zone of polarizing activity - involved in CNS development and patterning of AP axis. Mutation can cause holoprosencephaly.
738
What is myelofibrosis?
Bone marrow obliteration due to increased fibroblast activity.
739
How does Niacin work to help with hyperlipidemia?
Inhibits lipolysis in adipose, reduces hepatic VLDL synthesis.
740
What is osteopetrosis?
Defective osteoclast bone resorption (e.g. via mutations in CA) form thick, dense bones prone to fracture. Overgrowth of cortical bone fills the marrow space resulting in pancytopenia and extramedullary hematopoiesis.
741
Describe renal blood flow.
Renal a. -\> segmental a. -\> interlobar a. -\> arcuate a. -\> interlobular a. -\> afferent a. -\> glomerulus -\> efferent a. -\> vasa recta -\> peritubular capillaries -\> venous outflow.
742
Describe the difference between a direct and indirect inguinal hernia.
Indirect: follows path of testes, caused by failure of closure of processus vaginalis. Covered by all 3 layers of spermatic fascia. Goes through internal and external inguinal ring. Emerges lateral to inferior epigastric vessels. Direct: Caused by acquired weakness in transversalis fascia. Covered by external spermatic fascia only. Protrudes through inguinal (Hesselbach) triangle and through external inguinal ring only. Bulges through parietal peritoneum medial to inferior epigastric vessels (but lateral to rectus abdominis).
743
What are the embryological precursors of the SVC?
Right common cardinal vein + right anterior cardinal vein.
744
What is parakeratosis?
Retention of nuclei in the stratum corneum (e.g. psoriasis).
745
Where do you see a 'tree bark aorta'?
Syphilitic heart disease.
746
Describe a bone giant cell tumor.
"Osteoclastoma". Locally invasive benign tumor, in the epiphysis, usually the knee. Expresses RANKL. "Soap bubble" on xray.
747
What is 'barrel chest' a sign of?
Emphysema.
748
What is the arterial supply of the anus below the pectinate line?
Inferior rectal artery from internal pudendal.
749
What does a defect in 11β-hydroxylase cause?
Impaired production of aldosterone and increased 11-deoxycorticosterone. (ambiguity in genetic females). Increaed mineralocorticoid precursors. Increased sex hormones. Increased BP (due to mineralocorticoid effects) and decreased K+! Because decreased renin activity.
750
What are the symptome of cyanide poisoning and how do you treat it?
Almond breath, pink skin, cyanosis. Treat with nitrites (oxidize Fe2+ to 3+ to make MetHb) and then thiosulfate which converts cyanide to thiocyanate (renally excreted).
751
Why do congenital adrenal enzyme deficiencies cause skin hyperpigmentation?
Increased MSH production.
752
What does the PDA supply?
The AV node, posterior 1/3 of the IV septum, posterior 2/3 walls of ventricles, the posteromedial papillary muscle.
753
What do 'malterse crosses' in the urine indicate?
Fatty casts. Nephrotic syndrome.
754
What is Glanzmann thrombocytopenia?
Defect of GpIIb/IIIa - defect in platelet aggregation and plug formation.
755
What thickness is an NSTEMI?
Subendocardial.
756
What layer does the liver derive from?
Endoderm.
757
Where does the conducting zone end?
After the bronchi. No more cartilage and goblet cells.
758
What do CCBs work on?
Ca++L of cardiac and smooth muscle.
759
What are the layers of the placenta?
Fetal inner layer is cytotrophoblast (chorionic villi), outer layer is syncytiotrophoblast. Maternal component is the decidua basalis.
760
What are the 'gliptins'? What are their ADEs and what is their effect on weight?
DPP-4 inhibitors. ADE is mild resp/urinary infections, and they are weight neutral.
761
How does systemic juvenile idiopathic arthritis usually present?
Daily spiking fevers, pink macular rash, uveitis, arthritis, leukocytosis, thrombocytosis, increased ESR and CRP.
762
Where are extragonadal germ cell tumors common?
In midline, mostly in retroperitoneum, mediastinum, pineal, and suprasellar regions. In young kids, sacrococcygeal teratomas are common.
763
Which are more heart selective, DHPs or nonDHPs?
NonDHPs.
764
What is Clomiphine?
A SERM. Hypothalamic ER inhibitor. Used for infertility due to anovulation.
765
What is Pseudo-Pelger-Huet anomaly?
Neutrophils with bilobed nuclei, typically seen after chemo. A type of myelodysplastic syndrome.
766
What does diabetic nephropathy look like on LM?
Mesangial expression, GBM thickening, eosinophilic nodular glomerulosclerosis (Kimmelstiel-Wilson lesions).
767
What does hand grip do to intensity of heart sounds for various conditions?
Increases mitral and aortic regurgitation and VSD murmurs. Decreases intensity of HCM and aortic stenosis, causes a later click in MVP.
768
What is Osgood-Schlatter disease?
"Traction apophysitis" - Overuse injury by repetitive strain and chronic avulsion of the secondary ossification center of the proximal tibial tubercle.
769
Where are plicae circularis?
Distal duodenum, jejunum, proximal ileum.
770
How do inhaled corticosteroids work e.g. Fluticasone?
Inactivate NFκB.
771
How does iron poisoning kill?
Causes cell death due to peroxidation of membrane lipids.
772
Describe what identical twins share depending on the day of cleavage?
≤4d: separate chorion and amnion 4-8d: shared chorion 8-12d: shared amnion and chorion 13+d: conjoined
773
What's longer acting, tiotropium or itratropium?
Tiotropium.
774
What is the Phalen maneuver?
90° wrist flexion causes tingling.
775
What are the low potency typical antipsychotics? What are their specific ADEs?
Chlorpromazine (corneal deposits), Thioridazine (retinal deposits).
776
What is Syndrome of apparent mineralocorticoid excess? How do you treat it?
AR deficiency of 11β-hydroxysteroid dehydrogenase (or licorice eating). That enzyme converts cortisol to cortisone (inactive on mineralocorticoid receptors). Treatment is K+ sparing diuretics.
777
What is Mönckeberg sclerosis?
Benign - calcification of internal elastic lamina and media of medium size arteries. Stiffening without obstruction, 'pipestem' on x-ray, intima not involved so doesn't obstruct blood flow.
778
What is VACTERL?
A mesodermal problem. Vertebral defects, Anal atresia, Cardiac defects, TEF, Renal defects, Limb defects.
779
What are lithium's ADEs?
Hypothyroid, Ebstein anomaly in utero, nephrogenic DI, tremor.
780
What is coronary steal syndrome?
Administration of vasodilators shunts blood to well perfused vessels - ischemia in myocardia perfused by stenosed vessels.
781
How do you calculate ejection fraction?
SV/EDV
782
What is INR calculated from?
PT.
783
What organisms are typically responsible for reactive arthritis?
Shigella, Yersinia, Campylobacter, Chlamydia, Salmonella.
784
What is Fanconi syndrome?
A PCT reabsorbtion defect. May lead to metabolic acidosis, hypophosphatemia, osteopenia.
785
What does anti-SSA in pregnant women with SLE increase the risk of?
Congenital heart block.
786
What's the first line treatment for Wegener's?
Corticosteroids and cyclophosphamide.
787
How does aldosterone affect principal cells?
K+ secretion. Increased ENaC activity -\> lumen negativity -\> K+ secretion.
788
What are Hydrochlorothiazide, Chlorthalidone, Metolazone? How do they work?
Thiazide diuretics. Inhibit DCT NaCl reabsorption.
789
What blood type is gastric cancer associated with?
A.
790
How do you calculate MAP? Two ways
CO X TPR 1/3sys + 2/3dias
791
How does magnesium affect PTH secretion?
Decreased Mg increases PTH secretion (unless its really low in which case decreases it).
792
What do you see on x-ray in rickets?
Epiphyseal widening and metaphyseal cupping/fraying.
793
What is a Curling ulcer?
A gastric ulcer in response to burns -\> hypovolemia causes mucosal ischemia.
794
What's a good drug for COPD?
Muscarinic antagonists.
795
What are Epoprostenol and Iloprost? What side effects does it come with?
Prostacyclin analogs - also inhibits platelet aggregation. ADEs: Flushing, jaw pain.
796
What are Chlorpropamide and Tolbutamide?
1st gen sulfonylureas.
797
How do you differentiate between polymyositis and dermatomyositis?
Polymyositis has CD8 endomysial inflammation, Dermatomyositis has CD4 perimysial inflammation and a malar rash.
798
What teratogenic effect can methylmercury have?
Neurotoxicity.
799
Which UV is involved in sunburns?
UVB.
800
What are the local metabolites in exercise?
CO2, H+, Adenosine, Lactate, K+ (CHALK)
801
What parameter does antithrombin deficiency affect?
Diminishes PTT increase following administration of heparin.
802
What is the Trousseau sign?
Occlusion of the brachial artery causing carpal spasm. A sign of hypocalcemia.
803
What is a hydatidiform mole? Compare the 2 kinds.
Cystic swelling of chorionic villi and trophoblast proliferation. Complete: 46XX/XY (enucleated egg+sperm). More malignant transformation risk, honeycomb uterus. Partial: 69XXY/XYY (2 sperm + 1 egg). Fetal parts.
804
Where are the parts of the brachial apparatus derived from?
Clefts (4) from ectoderm, arches (6) from mesoderm and neural crest, pouches (4) from endoderm.
805
What are some possible negative consequences of supplemental O2 for fetal ARDS?
Retinopathy of prematurity, Intraventricular hemorrhage, Bronchopulmonary dysplasia.
806
What are Call-exner bodies?
Granulosa cells around eosinophilic fluid found in granulosa cell tumors (malignant).
807
What layer does the pancreas derive from?
Endoderm.
808
Where is the anus above the pectinate line embryologically derived from?
Endoderm with the rest of the gut tube epithelium.
809
Where is a chondroma typically located?
Medulla of small ones of hands and feet.
810
What does the zona glomerulosa produce and what regulates it?
Aldosterone. Regulated by Angiotensin II.
811
What converts trypsinogen to trypsin?
Enterokinase/enteropeptidase - a brush border enzyme.
812
What is Teriparatide?
A recombinant PTH analog.
813
What is Lynch syndrome?
AKA HNPCC. AD DNA mismatch repair genes. Proximal colon is always involved. 80% progress to colorectal cancer.
814
Where does the smooth part of the RA derive from embryologically?
Right horn of the sinus venosus.
815
How much O2 can 1g of Hb bind?
1.34mL.
816
What does the 6th aortic arch become?
Proximal pulmonary arteries and ductus arteriosus on left only.
817
What is the Russell sign?
Bulimic dorsal hand calluses.
818
How do you treat ischemic priapism?
Corporal aspiration, surgical decompression, intracavernosal phenylephrine.
819
How do you differentiate between proximal and distal median/ulnar nerve damage?
Proximal damage affects making a fist, distal damage affects extending fingers/at rest.
820
Describe RPGN.
Crescentic on LM. On IF can be granular (PSGN or DPGN), linear (Abs to GBM and alveolar BM - Goodpasture syndrome, type II hypersensitivity), or negative (Pauci-immune - no Ig/C3 deposition).
821
Where is GLUT1 found?
RBCs, brain, cornea, placenta.
822
What is the net fluid flow formula for capillaries?
Jv = Kf [(Pc − Pi) − σ(πc − πi)]. Kf=permeability to fluid σ=permeability to protein
823
Describe Ulcerative colitis. Include what cell type mediates it. Does it affect the rectum?
Only mucosa and submucosa. No skip lesions. Rectum involved. Loss of haustra "lead pipe" on imagine. Crypt abscesses and ulcers, BLEEDING, no granulomas. Th2 mediated.
824
What are azurophilic granules?
Lysosomes. Contain MLP, proteinases, acid phosphatase, β-glucuronidase.
825
Who most frequently gets iliotibial band syndrome?
Runners.
826
What is Trendelenberg sign?
Contralateral pelvic drop to the side of injury. Superior gluteal nerve damage - pelvis tilts because the weight bearing leg cannot hip abduct.
827
Describe electrical conduction in the heart.
SA -\> atria -\> AV -\> bundle of His -\> bundle branches -\> Purkinje fibers -\> ventricles
828
What does the ACL connect?
Lateral femoral condyle to the anterior tibia.
829
What are Club cells?
Nonciliated cuboidal cells with secretory granules in bronchioles. They degrade toxins and secrete some surfactant components.
830
What is Brief Psychotic Disorder?
≥1 positive symptom for \<1 mo
831
What kind of candy is best given for sialolithiasis?
Sour.
832
What are the possible Ulcerative colitis complications?
Fulminant colitis, perforation, toxic megacolon.
833
What can cause a false positive VDRL/RPR?
Antiphospholipid syndrome.
834
What are some ADEs of Danazol?
Weight gain, edema, acne, hirsutism, masculinization, decreased HDL levels, hepatotoxicity, pseudotumor cerebri.
835
How do typical antipsychotics work?
They block D2 causing an increase in cAMP.
836
What vitain deficiency is asociated with carcinoid syndrome?
Niacin.
837
What is the effect of cortisol on IL-2?
Blocks production.
838
What is Demeclocycline? What are some ADEs?
ADH antagonist. Nephrogenic DI, photosensitivity, bone and teeth abnormalities.
839
What is the anastomosis that causes esophageal varices?
Left gastric (P) and azygos (S).
840
Describe Minimal Change Disease.
Nephrotic syndrome. Normal on LM, EM shows effacement of podocyte foot processes. Has excellent response to corticosteroids.
841
What hormones are increased in PCOS?
Testosterone, LH:FSH ratio.
842
What is Mycosis fungoides/Sezary syndrome?
T-cell NHL. Atypical CD4+ that make Pautrier microabscessses (neoplastic cell aggregates).
843
What innervates the cremasteric muscle?
Genitofemoral n. (L1-L2).
844
What sort of findings do you see in a cardiac tamponade?
Pulsus paradoxus, Beck triad (hypotension, distended neck veins, distant heart sounds), low voltage QRS and 'electrical alternans'.
845
What can osteochondroma transform into?
Chondrosarcoma.
846
What's the first line treatment for Microscopic Polyangitis?
Corticosteroids and cyclophosphamide.
847
What is the male homolog of granulosa cells?
Sertoli cells.
848
What is Vilazodone?
A 5-HT1 reuptake inhibitor, 5-HT1A partial agonist used for MDD.
849
What is Erythroplasia of Queyrat?
Carcinoma in situ of glans.
850
What's malignant, a mature or an immature teratoma?
Immature. But in adult males mature can also be malignant.
851
Where are the thyroid follicular cells derived from embryologically?
Endoderm.
852
What vitamin excess has a high risk for spontaneous abortions?
A.
853
What APGAR cutoff requires further evaluation?
\<7
854
What are the glitazones/thiazoldinediones? What are their ADEs?
They bind PPARγ, increase insulin sensitivity and adiponectin levels. ADEs: weight gain, edema, HF, increased fracture risk.
855
Where is GLUT5 found and why is it special?
Sperm cells, GI. Transports fructose.
856
Where does the coronary sinus derive from embryologically?
Left horn of the sinus venosus.
857
What is CREST?
Calcinosis cutis, anti-centromere Abs, Raynaud, Esophageal dysmotility, Telangiectasia.
858
Where do the aortic arch receptors transmit their signals to?
Solitary nucleus via vagus nerve.
859
What causes ectopia cordis?
Rostral fold closure in ventral wall.
860
What is Crigler-Najjar syndrome? What type is less severe?
AR unconjugated hyperbilirubinemia. No UDP-glucuronosyltransferase. Presents early in life, death in a few years. Jaundice, kernicterus. Type I and II - II less severe and responds to phenobarbital.
861
How is renin released?
JG cells in response to: decreased renal perfusion pressure (renal baroreceptors in afferent arteriole), increased renal sympathetic discharge, decreased NaCl delivery to macula densa.
862
What is Febuxostat?
Chronic gout drug. Xanthine oxidase inhibitor.
863
Describe Berylliosis and include which part of the lung it affects.
Upper lobes. Noncaseating granulomas on histology. Common in aerospace and manufacturing industries.
864
What activating mutations are associated with lung adenocarcinoma?
KRAS, EGFR, ALK.
865
What nerve is damaged by a midshaft humerus fracture?
Radial n.
866
How do you treat bipolar besides lithium?
Valproic acid, Carbamazepine, Lamotrigine, atypical antipsychotics.
867
What are the nerve roots of the radial nerve? What are its functions?
C5-T1. Extension of the arm and wrist, sensation over the posterior arm/forearm and dorsal hand.
868
What is heparin-induced thrombocytopenia?
Development of OgGs against heparin-bound PF4.
869
Describe a posterior urethral injury.
Membranous urethra injured from pelvic fracture. Presents as blood at meatus and high-riding prostate. Urine leaks into retropubic space.
870
What are Losartan, Candesartan, and Valsartan?
ATII blockers. Block binding to AT1R. Effects similar to ACE inhibitors but no effect on bradykinin).
871
What findings are in celiac disease?
IgA tTG, anti-endomysial Abs, anti-deamidated gliadin peptide Abs, villous atrophy, crypt hyperplasia, intraepithelial lymphocytosis.
872
What is the vitelline duct? When does it obliterate?
Connects yolk sac to the midgut lumen. Obliterates in 7th week.
873
What are the hypothenar muscles?
Opponens digiti minimi, abductor digiti minimi, flexor digiti minimi.
874
Where is the CNS embryologically derived from?
The neural tube (ectoderm).
875
What is Reye syndrome?
Rare childhood hepatic encephalopathy associated with a viral infection that's been treated with aspirin. Often fatal. Mitochondrial abnormalities, fatty liver, hypoglycemia, vomiting, hepatomegaly, coma.
876
What teratogenic effect can diethylstilbestrol (DES) have?
Vaginal clear cell adenocarcinoma, also congenital Müllerian abnormalities.
877
What teratogenic effect can maternal diabetes have?
Caudal regression syndrome (anal atresia to sirenomelia), congenital heart defects, NTDs, macrosomia, polycythemia, neonatal hypoglycemia.
878
What is a Codman triangle?
An elevation of periosteum on xray found in osteosarcoma.
879
What do parietal cells produce?
IF and HCl.
880
How can you damage the superior gluteal nerve?
IM injection in the superomedial gluteal region.
881
What causes dextrocardia?
A mutation in left-right dynein.
882
How do PGE2 and PGF2 affect uterine tone?
Increase it.
883
What is the Ebstein anomaly?
Displacement of tricuspid valve leaflets into RV. Associated with tricuspid regurgitation, accessory conduction pathways, RHF. Can be caused by in utero exposure to lithium.
884
What is the histology of type 1 and 2 diabetes mellitus?
T1: Islet leukocytic infiltrate T2: Islet amyloid popypeptide (IAPP) deposits
885
What is SElegiline?
A MAO-B selective MAOI. Can be used for Parkinson's.
886
What ion channel is present on RBCs?
A HCO3-/Cl- antiporter.
887
What is a false diverticulum?
Not all the layers of the gut wall, just mucosa and submucosa.
888
What are ADEs of bisphosphonates?
Esophagitis, osteonecrosis of jaw, atypical femoral stress fractures.
889
What does ANP do to the afferent and efferent arterioles?
Dilates afferent and constricts efferent. \*diuresis
890
How does altitude sickness develop?
High altitude has low PO2, which results in a lower PaO2 -\> Increased ventilation -\> decreased CO2 -\> respiratory alkalosis.
891
What are the zones of the liver lobules? Which one is affected first by ischemia?
I (Periportal) II III (Pericentral) - affected first by ischemia
892
What cancer has Reinke crystals?
Leydig cell tumors.
893
What hormone peaks right before ovulation?
LH.
894
What is a zonula adherens?
Tight junction.
895
What is in the femoral ring and sheath and triangle?
Femoral ring contains femoral nerve, artery, vein, lymph node from lateral to medial. Sheath has VAL, triangle has NAV.
896
What innervates the gluteus minimus, medius, maximus?
Minimus and medius: Superior gluteal n. (L4-S1) Maximus: Inferior gluteal n. (L5-S2).
897
What is S1Q3T3?
A sign of pulmonary embolism. Deep S in I, deep Q in III, inverted T in III.
898
What muscle is responsible for arm abduction 0-15°? And what nerve controls it and what are its roots?
Supraspinatus. Suprascapular n. C5&C6.
899
What is the cutoff where ASD becomes PTSD?
1 month.
900
Compare osteoid osteoma and osteoblastoma.
Osteoid osteoma typically in cortex of long bones, osteoblastoma in vertebrae. Osteoid osteoma pain is relieved by NSAIDs, osteoblastoma pain is not.
901
In what population is a slipped capital femoral epiphysis most common?
Obese ~12y/os.
902
Where are the JG cells?
Afferent arteriole.
903
What's the gold standard for an MI within the first 6 hours?
ECG.
904
What is Dubin-Johnson syndrome?
AR conjugated hyperbilirubinemia. Benign, due to defective excretion. Black liver.
905
What is Brugada syndrome?
AD pseudo RBBB and STE in V1-V3. Risk of v-tach and SCD. Most common in Asian males.
906
What innervates the semitendinosus and semimembranosus?
Sciatic n. L4-S3.
907
What does the processus vaginalis turn into?
In females it's obliterated, in males turns into the tunica vaginalis.
908
What does it mean to be a seronegative spondyloarthritis?
No Rheumatoid factor.
909
Where on hemoglobin does CO2 bind?
The N-terminus of globin.
910
Where is the pericardial cavity?
Between the parietal serous and visceral serous layers of the pericardium.
911
What are the thenar muscles?
Opponens pollicis, abductor pollicis brevis, flexor pollicis brevis.
912
What besides the PNS is derived from the neural crest?
Melanocytes, odontoblasts, endocardial cushions, laryngeal cartilage, parafollicular (C) cells of the thyroid.
913
What are the four degrees of alpha thalassemia?
Minima, Minor (trans/cis), HbH (β tetramers), Hemoglobin Barts (γ4s formed).
914
What is pulsus paradoxus?
Systolic BP drops more than 10mmHg during inspiration.
915
What is the CCB of choice for SAH?
Nimodipine.
916
What is the Pringle maneuver?
Compressing the hepatoduodenal ligament (and placing it in the omental foramen to control bleeding.
917
What are Cimetidine, Ranitidine, Famotidine, and Nizatidine? What are they used for?
Reversible H2 blcokers. Used for PUD, gastritis, mild esophageal reflux.
918
What innervates the transversus abdominis?
Ilihypogastric n. (T12-L1).
919
What is TIPS?
Transjugular intrahepatic portosystemic shunt. Done between portal and hepatic vein - shunts blood to systemic circulation (bypassing liver). Can precipitate hepatic encephalopathy (increased portpsystemic passage of nitrogen from the gut).
920
What muscles do internal rotation of hte hip?
Gluteus medius and minimus, tensor fascia latae.
921
What is Waldenstrom Macroglobulinemia?
M-spike. Hyperviscosity syndrome - blurred vision, Raynaud.
922
What kind of murmurs/sounds are in DCM?
S3, systolic murmur.
923
Where is ALP increased?
Cholestasis, infiltrative disorders, bone disease.
924
With what can you approximate GFR?
Inulin clearance, creatinine clearance approximates.
925
What are the semilunar valves derived from embryologically?
The endocardial cushions of the outflow tract.
926
What is Finasteride and what is it used for?
a 5α-reductase inhibitor. Used for BPH and male pattern baldness.
927
What syndromes are in MEN1?
Parathyroid hyperplasia, Pancreatic tumours, Pituitary tumours.
928
What are calcium oxalate stones like and when do they appear?
Envelope/dumbbell. Precipitate with decreased urine pH. Can result from antifreeze.
929
Where is GLUT2 found and why is it special?
Bidirectional! β-cells, liver, kidney, SI.
930
Which type of adenomatous polyp has more malignant potential, tubular or villous?
Villous.
931
How do bile acid resins e.g. Cholestyramine work? What are some ADEs?
Prevent reabsorption of bile acids. ADEs: GI upset, decreased absorption of other drugs and fat soluble vitamins, increased TGs.
932
What is Guaifenesin?
Expectorant (thins respiratory secretions).
933
How does intestinal atresia present?
Bilious vomiting and abdominal distention in first two days of life.
934
Where is the infarction likely if the STE is in leads I+aVF?
LCX (lateral).
935
What is Peutz-Jeghers syndrome?
AD numerous hamartomas in the GI tract along with hyperpigmented mouth, lips, hands, genitalia.
936
What organs are retroperitoneal?
Suprarenal glands, Aorta, Duodenum (2-4th), Pancreas (except tail), Ureters, Colon (descending and ascending), Kidneys, Esophagus, Rectum.
937
How do you calculate FeNa?
excreted Na/filtered Na
938
What's the most common TE anomaly?
Esophageal atresia with distal TEF. Neonates drool, choke, vomit with first feeding - can have cyanosis secondary to laryngospasm.
939
What is Flutamide and what is it used for?
Nonsteroidal AR competitive inhibitor - for prostate carcinoma.
940
Where in the nephron is the PTH-sensitive Na++/Ca++ exhcnager located?
DCT.
941
What pierces the diaphragm at T12?
Aorta, thoracic duct, azygos vein.
942
What innervates the biceps femoris?
Sciatic n. (L4-S3) and Tibial n. (L4-S3) - long head.
943
How do nitrates help in HTN?
vasodilate via NO in vasc SM - dilate veins \>\> arteries.
944
What is the common presentation of reactive arthritis?
Arthritis + conjunctivitis/uveitis + urological manifestations. "can't see, pee, climb a tree".
945
Where is sialolithiasis most likely to occur?
The submandibular gland.
946
What artery supplies the AV node?
PDA.
947
By when does a fetal heart start beating?
Week 4.
948
What layer does the gut tube epithelium derive from?
Wall from mesoderm, lining from endoderm.
949
What are the ferritin and TIBC levels in iron-deficiency anemia.
Ferritin: decreased TIBC: increased
950
What does a defect in 17α-hydroxylase cause?
CAH with deficiency of sex hormones (ambiguity in genetic males) and production shunted to corticoids.
951
What is the foramen cecum?
Normal remnant of the thyroglossal duct (connects thyroid diverticulum to tongue). Can persist as cyst of pyramidal lobe of the thyroid.
952
Where can a neuroblastoma occur?
Anywhere along the sympathetic chain.
953
Where in the GI tract are angiodysplasias most common?
Right colon.
954
What causes secondary biliary cholangitis?
Extrahepatic biliary obstruction.
955
What does the 2nd aortic arch become?
Stapedial artery and hyoid artery.
956
What is Orlistat? What are some ADEs?
Inhibits gastric and pancreatic lipase for weight loss. ADEs: Abdominal pain, flatulence, bowel urgency/frequent bowel movements, decreased absorption of fat-soluble vitamins.
957
What HLA subtypes is Graves associated with
B8 and DR3.
958
What are the nerve roots of the ulnar n.?
C8&T1.
959
What is an echinocyte?
Burr cell. Found in ESRD, liver disease, pyruvate kinase defiiency.
960
What do the ventral buds of the pancreas turn into?
Uncinate process, main pancrearic duct, makes up head.
961
What is a pyogenic granuloma associated with?
Trauma and pregnancy.
962
Where do the smooth parts of ventricles derive from embryologically?
Bulbus cordis.
963
How does the flow-volume loop shift in obstructive and restrictive lung disease?
Obstructive: left Restrictive: right
964
What is found in the DNA of people with serrated GI polyps?
A particular CpG Island Methylator Phenotype (CIMP).
965
What does the lateral circumflex artery supply?
The anterolateral papillary muscle and the lateral and posterior walls of the left ventricle.
966
Where is WNT7 produced and what does it do?
Produced at apical endodermal ridge - needed for proper organization of dorsal-ventral axis during development.
967
Which of osteoposoris, osteopetrosis, Paget, osteomalacia, rickets have increased ALP?
Paget, osteomalacia, rickets.
968
What does bullous pemphigoid look like in immunofluorescence?
Linear pattern at epidermal-dermal junction.
969
What do Chief cells produce?
Pepsin.
970
What is Probenecid?
Chronic gout drug. Inhibits PCT uric acid resorption (also penicillin secretion).
971
What hormones is hCG structurally similar to?
Has the same α subunit as LH, FSH, TSH.
972
Describe Tetralogy of Fallot.
VSD, pulmonary stenosis, overriding aorta, RVH. Cyanotic.
973
What provides sensory innervation to the scrotum and labia majora?
Genitofemoral n. (L1-L2).
974
What are tocolytics? Name some.
Uterine relaxors. Indomethacin, Terbutaline (β2 agonist), Nifedipine.
975
What drugs contraindicate adding an MAOI?
SSRIs, TCAs, St. John's Wort, Meperidine, Dextrometorphan.
976
What are the dihydropyridines?
Amlodipine, Nifedipine.
977
What is osteitis fibrosa cystica?
Bone spaces with brown fibrous tissue - sign of hyperparathyroidism.
978
What is a torus fracture?
Axial force applied to an immature bone resulting in the cortex bubbling on the compression side and fracturing.
979
What innervates the gracilis?
Obturator n. L2-L4.
980
What are bile salts?
Bile acids conjugated to Gly or taurine to make them water-soluble.
981
What is the postnatal derivative of the ductus arteriosus?
Ligamentum arteriosum.
982
What is a Leiomyoma?
Fibroid. Whorled pattern of smooth muscle bundles with well-demarcared bodies. ER-sensitive.
983
What is Wilson disease?
AR ATP7B defect. Copper accumulates, decreased serum ceruloplasmin. Presents before 40: liver, neuro, renal, psych symptoms, Kayser-Fleischer rings in Descernet membrane of cornea, hemolytic anemia.
984
What is Whipple disease?
Tropheryma whipple (IC gram+, PAS+ bacterium) most common in older men. Foamy macrophages in intestinal lamina propria, cardiac symptoms, arthralgias, neuro symptoms, diarrhea/steatorrhea.
985
Describe type 3 renal tubular acidosis. Urine pH? Serum K+?
Hyperkalemic. Caused by hypoaldosteronism or aldosterone resistance. Hyperkalemia leads to decrease NH3 synthesis in PCT -\> ammonium excretion. Urint pH variable but generally \<5.5, serum K up.
986
What are Ladd bands?
Fibrous bands formed as a result of intestinal malrotation.
987
What are some ADEs of Cimetidine and Ranitidine?
Both decrease renal excretion of creatitine. Cimetidine can cross BBB and placenta and is a potent CYP450 inhibitor, also has antiadrenergic effects (gynecomastia).
988
What is tumor lysis syndrome? How do you prevent it?
Potassium release, phosphate release (causing hypocalcemia), increased nucleic acid breakdown leading to hyperuricemia and AKI. Can be prevented with hydration, allopurinol, rasburicase.
989
What is Gitelman syndrome? What is its effect on calcium?
AT DCT NaCl resorption defect. Metabolic alkalosis, hypokelamia, HYPOcalciuria, hypomagnesemia. \*similar to chronic thiazide use
990
What mutation is associated with chronic myeloproliferative disorders?
V617JAK2.
991
Describe the intrinsic pathway.
Collagen, basement membrane, activated platelets activate XIIa -\> XIa -\> IXa (+VIII+vWF) -\> Xa and then common pathway.
992
What is S. epidermidis endocarditis associated with?
Prosthetic valves.
993
What is usually sprained in an ankle sprain?
Anterior talofibular ligament.
994
What is a sequence?
Abnormalities that result from a single embryological event.
995
How do you treat ABO hemolytic disease of the newborn?
Phototherapy or exchange transfusion.
996
What does the 4th aortic arch become?
Left -\> aortic arch Right -\> proximal right subclavian
997
What are the symptoms of lead poisoning?
Lead lines on gingivae (burton lines) and metaphyses, Encephalopathy, Abdominal colic and sideroblastic anemia, Drops (wrist and foot drop).
998
What is the CK for polymyalgia rheumatica?
Normal.
999
What is the most common type of Hodgkin's Lymphoma and what is the type with the best prognosis.
Nodular Sclerosis (most common), Lymphocyte-rich (best prognosis).
1000
What does cromolyn sodium do?
Prevent mast cell degranulation.
1001
What are Montelukast and Zafirlukast and what are they good to use for?
Leukotriene receptor antagonists (CysLT1).
1002
What artery supplies the SA node?
RCA.
1003
Where in the lung is small cell carcinoma likely to occur?
Centrally.
1004
What innervates the adductor muscles - brevis longus, magnus?
Obturator n. L2-L4. Magnus is also innervated by the sciatic nerve. L4-S3.
1005
What is Diamond-Blackfan anemia?
BM fails to make enough blood cells. Anemia in first year of life, increased fetal hemoglobin, decreased all hemoglobins. Short stature, craniofacial abnormalities, upper extremilty malformations, triphalangeal thumbs in 50%.
1006
What is Pegloticase?
Chronic gout drug. Recombinant uricase catalyzing uric acid transformation to allantoin (more water-soluble).
1007
What is Sevelamer?
Nonabsorbable phosphate binder that prevents absorption from the GI.
1008
Describe Carpal Tunnel syndrome.
Median nerve is compressed, thenar eminence atrophies but sensation is spared.
1009
What pierces the diaphragm at T10?
Esophagus, vagus nerve.
1010
Describe AML.
Commonly presents as DIC. Auer rods, MPO+. Cytoplasmic inclusions, esp. in APL (M3 AML). APL RF is t(15;17). Responds to all-trans retinoic acid.
1011
How does FEV1/FVC change in obstructive and restrictive lung disease?
Obstructive: goes down Restrictive: stays the same or even goes up
1012
What's the first line treatment for Buerger's?
Smoking cessation.
1013
What are M cells?
APCs found in Peyer patches.
1014
Where do the apical and basolateral surfaces of the hepatocyte face?
Apical: Bile canaliculi Basolateral: sinusoids
1015
What condition is characterized by 'waxing and waning' lymphadenopathy?
Follicular lymphoma.
1016
What do the alar and basal plate turn into? What regulates their development?
Alar (dorsal) - turns into sensory. TGFβ.
Basal plate (ventral) - turns into motor. SHH.
1017
What does the telencephalon become?
1018
What does the diencephalon become?
1019
What does the mesencephalon become?
1020
What does the metencephalon become?
The pons, medulla, and the upper part of the fourth ventricle.
1021
What does the myencephalon become?
The medulla and the lower part of the fourth ventricle.
1022
What is the difference between a Chiari I and Chiari II malformation? Which conditions are they associated with?
Chiari I is herniation of the cerebellar tonsils and is usually asymptomatic. Chiari II is herniation of the vermis and tonsils and is more severe, presents early in life, causes noncommunicating hydrocephalus.
Chiari I - syringomyelia
Chiari II - myelomeningocele
1023
1024
What is Kluver-Bucy syndrome?
Disinhibited behaviour due to a bilateral lesion to the amygdala. Hypersexuality, hyperphagia, hyperorality. E.g. in HSV1 encephalitis.
1025
What is Parinaud syndrome?
Due to a lesion in the dorsal midbrain.
Vertical gaze palsy, pupillary light-near dissociation, lid retraction, and convergence-retraction nystagmus.
1026
Where is the lesion in decorticate and decerebrate posturing?
Decorticate: above red nucleus
Decerebrate: at or below red nucleus
1027
What is the first line treatment for trigeminal neuralgia?
Carbamazepine.
1028
How do you treat essential tremor?
Nonselective beta blockers.
1029
What is Charcot-Marie-Tooth disease and what is the most common cause?
A hereditary motor and sensory neuropathy. AD. Associated with foot deformities, LE weakness, and sensory deficits.
Most common subtype caused by PMP22 gene duplication.
1030
What causes PML?
Secondary reactivation of latent JC virus infection.
1031
With what drug do you treat ALS?
Riluzole.
