test #17 4.5 Flashcards Preview

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Flashcards in test #17 4.5 Deck (159):
1

what converts NE to E

PNMT, phenylethanolamine-N-methyltransferase

2

dopa stands for..

dihydroxyphenylalanine

3

how does cortisol affect epinephrine secretion?

adrenal venous drainage cortex inwards. cortisol produced in fasiculata will travel into adrenal medulla --> increase expression of gene encoding PNMT.

4

MAO converts..

epinephrine and NE to dihydroxymandelic acid

5

COMT converts..

epinephrine to metanephrine. norepinephrine to normetanephrine

6

Rh- women are treated with what 28 wks into gestation & immediately after? why?

treat with IgG against Rh (D) antigen. RhoGAM. stops mother from mounting immune response to Rh+ baby. small amounts, so IgG does not travel transplacentally & hurt baby.

7

RhoGAM is.. goal of therapy?

IgG against Rh (D) antigen. prevent mom from EVER mounting an immune response to Rh factor. Abs cover fetal erythrocytes & mom will sequester in spleen.

8

what type of immune response is mounted when Rh- mom exposed to Rh antigen in baby? what happens in subsequent pregnancy?

after transplacental fetomaternal hemorrhage, mom will mount maternal Ab response, form memory B-lymphocytes. subsequent prengnancies, Rh+ fetus at risk for hemolytic disease of newborn (erythroblastosis fetalis). maternal IgG anti-Rh antibodies cross placenta, enter fetal circulation, massive hemolysis of fetal erythrocytes.

9

IgG or IgM in RhoGAM? why?

IgG! while IgM is good for promoting agglutination of foreign cells, this isn't so useful bc of low concentration of fetal cells in maternal circulation. IgG does not cause significant transplacental fetal hemolysis bc so little given.

10

somatostatin decreases secretion of.. (5)

(1) secretin (2) CCK (3) glucagon (4) insulin (5) gastrin. insulin is inhibited far more than glucagon. net = hyperglycemia.

11

somatostatin inhibits secretion of both glucagon and insulin. which is inhibited more?

insulin inhibited more. net effect: HYPERGLYCEMIA

12

secretin

adjust secretions from stomach and pancreas (affects environment of duodenum). S cells in crypts of Lieberkuhn in duodenum. also helps regulate duodenal pH (increase bicarb secretion in duodenum and inhibit acid secretion from stomach)

13

somatostatin analogues..

octreotide and lanreotide

14

deltaF508 mutation causes... (2) problems in CFTR

(1) abnormal protein folding and (2) failure of glycosylation. = absent from exocrine ductal cells.

15

protein abnormality of Friedreich's ataxia? important for which 2 things. at what level is this gene affected.

frataxin gene: codes for mitochondrial protein, important for (1) respiratory fxn and (2) iron homeostasis. GAA repeat disruptions TRANSCRIPTION

16

inflixamab

monoclonal Ab that irreversibly binds to & inhibits TNF-alpha

17

what enzyme is exclusively expressed in inflammatory cells?

COX-2

18

allopurinol

xanthine oxidase inhibitor

19

APML is what type of AML?

M3 type

20

what suggests good prognosis in ALL (children)?

presence of CD10 antigen (CALLA)

21

causes of low glucose, high insulin, high c-peptide?

excess sulfonylurea & meglitinide use (stimulates insulin secretion). note: somatostatinoma inhibits insulin far more than glucagon.

22

sulfonylurea & meglitinide?

insulin secretagogues

23

differentiate factitious hypoglycemia (sulfonylurea/meglitinide use) from insulinoma

urine hypoglycemic agent screen

24

presentation of glucagonoma (3)

(1) hyperglycemia (2) anemia (3) necrolytic migratory erythema (raised erythematous rash affecting face, groin, and extremities.

25

pancreatic cholera, or VIPoma (non-beta cell pancreatic islet cell tumor) causes..

results in WDHA syndrome (watery diarrhea, hypokalemia, achlorhydria).

26

what epidemiological measure depends on prevalence?

positive predictive value INCREASES w/ increased prevalence. more common the disease, more likely a patient with a positive test will be a true positive. [NPV: inverse association w/ prevalence, as prevalence increases, NPV decreases

27

which epidemiological values are inherent to the test itself?

sensitivity and specificity.

28

reliability

provision of identical measurements on different occasions separated by short time interval (reproducible)

29

describe acid fast stain process:

1. aniline dye (CARBOLFUCHSIN) -- penetrate wall and bind MYCOLIC ACID 2. treat slide w/ hydrochloric acid & alcohol - will dissolve outer cell membranes of nontuberculous bacteria, but presence of mycolic acids prevents decoliarization

30

describe mycobacterial cell wall

encapsulated w/ mycolic acid -- waxy, long-chain fatty acid, covalently bound to the sugars within the cell wall

31

what two bacteria stain + w/ acid fast carbolfuchsin stain?

nocardia (weakly acid fast) and mycobacteria

32

which two bacteria have mycolic acid in cell wall

nocardia and mycobacteria

33

which two saccharides combine w/ aminoacid chain to form peptidoglycan layer in gram negative and gram positives?

NAM and NAG. N-acetylmuramic acid and N-acetylglucosamine

34

left main coronary covers..

anterior and left lateral surface

35

right dominant coronary circulation? left dominant?

85-90% have posterior descending artery (PDA) from RIGHT coronary. 10%, PDA from circumflex branch of left coronary.

36

which artery supplies the inferior surface of left ventrical (diaphragmatic surface of heart)

PDA (usu from right coronary)

37

LAD supplies (3)

(1) anterior 2/3rd of interventricular septum (2) anterior wall of left ventricle (diagonal branches) and (3) part of the anterior papillary muscle

38

left circumflex of left coronary supplies

lateral and posterior superior walls of the left ventricle

39

acute marginal branches

supply wall of right ventricle. can provide collateral circulation in patients w/ LAD occlusion

40

normal FEV1/FVC?

around 80%

41

rule out test for asthma?

negative methacholine (assessment for bronchial hyperactivity)

42

1st part of the duodenum overlies... 2nd runs from... 3rd overlies... 4th..

1st part: 1st lumbar vertebrae.

2nd part: runs from L1-L3.

3rd: L3, abdominal aorta, and inferior vena cava, close to uncinate process of pancreas and SMA and vein.

4th: courses superiorly and to left of L2 and L3 vertebrae and becomes jejunum past ligament of treitz.

43

what is the only part of the duodenum that is NOT retroperitoneal

1st part of duodenum

44

when does duodenum become jejunum?

past ligament of Treitz.

45

common bile duct

common hepatic duct + cystic duct. courses inferiorly, posterior to pylorus and within the head of the pancreas to drain into the second part of duodenum

46

where does the portal vein form?

retroperitoneally, when splenic vein joins superior mesenteric vein.

47

gastroduodenal artery

arises from common hepatic artery, courses inferiorly, posterior to first part of duodenum. splits into anterior superior pancreaticoduodenal artery and right gastric epiploic

48

anterior branch of obturator innervates? posterior branch?

anterior: gracilis, pectineus, adductors lungus and brevis. posterior: obturator externus & adductor magnus

49

abductors of thigh (2)

tensor fascia lata and sartorius (superior gluteal and femoral n respectively)

50

thigh flexion muscles (4)

psoas, iliacus, tensor fascia lata, sartorius. psoas directly from lumbar plexus. iliacus by femoral n.

51

classic time for obturator n. injury?

pelvic surgery, esp lymph node dissection.

52

nicotinic acid, or niacin, causes flushing & warmth bc...

prostaglandins (aspirin inhbitsi t)

53

vancomycin-induced "red man syndrome" mediated by...

histamine

54

how does capsaicin affect pain? via?

reduces pain by decreasing the level of substance P

55

platelet activating factor

powerful phospholipid activator. produced by a number of cells: neutrophils, basophils, platelets, endotheilal cells. impt mediator of platelet aggregation.

56

head bobbing w/ carotid pulsations also known as..

bounding femoral and carotid pulses marked by distension & quick collapse known as..

bobbing: de Musset sign (see with aortic regurgitation). transfer of momentum from large left ventricular stroke volume to head and neck.

bounding: water hammer pulses

57

delayed, prolonged carotid pulses signifies..

pulsus parvus et tardus. aortic stenosis. can also see systolic vibrations, or carotid "shudder" thrill.

58

rx for excessive tPA / urokinase / streptokinase?

aminocaproic acid

59

four phases of menstrual cycle?

menstrual, follicular, ovulatory, and luteal

60

follicle stimulating hormone (at the start of menstruation) does what 2 things?

(1) stimulates formation of dominant follicle and (2) trigger estrogen secretion.

61

describe hormone progression in menstruation

FSH triggers estrogen.. estrogen triggers luteal surge.. luteal surge triggers progesterone

62

two most immediate physical signs of marijuana use. other signs?

immediate: rapid heart rate and conjunctival injection. also see mild euphoria w/ laughing behaviour, slowed reflexes, dizziness, impaired coordination, short term memory loss

63

pharmacokinetics of marijuana

metabolized in the liver, then distributed and stored in lipophillic tissues & slowly released

64

up to how long can marijuana be detected in urine?

up to 30 days

65

physical sign seen w/ NMDA receptor antagonist (ketamine) use?

hypersalivation!

66

histology of terminal bronchioles

simple cuboidal (no longer pseudostratified ciliate columnar)

67

up until where is cilia present in respiratory tract?

cilia are present through respiratory bronchioles (not in alveolar ducts or alveoli themselves). LAST FEATURE TO DISAPPEAR as epithelium changes (makes sense, needs to be below mucous secretion)

68

histology transition from bronchi to small bronchioles?

bronchioles lack goblet cells, glands, and cartilage plates (w/submucosal mucosa and serous glands)

69

bronchi epithelium

pseudostratified columnar ciliated epithelium w/ goblet cells and submucosal mucoserous glands and cartilage.

70

bronchioles, terminal bronchioles, and respiratory bronchioles lack..

lack goblet cells, glands, and cartilage. terminal bronchiole -- cilated simple cuboidal. cilia persist until end of respiratory bronchiole.

71

3 class 1A antiarrythmic drugs; level of inhibition of phase 0 depolarization; & effect on length of AP.

disopyramide, procainamide, quinidine. intermediate phase 0 block, prolonged AP

72

3 class IB antiarrhythmic drugs; level of inhibition of phase 0 depolarization; & effect on length of AP

lidocaine, tocainide, mexiletine. weak inhibition of phase 0 block, shortened AP.

73

3 class IC antiarrhythmic drugs; level of inhibition of phase 0 depolarization; & effect on length of AP

moricizine, flecanide, and propafenone. strong inhibition of phase 0 block, no effect on AP.

74

lidocaine is highly selective for

class IB drug, selective for rapidly depolarizing cardiac myocytes. rapid binding & release.

75

2 anti-arrythmic effects of propanol

(1) slows conduction through AV node (2) prolongs phase 4 depolarization in cardiac PACEMAKER cells. no affect on ventricular myocyte AP

76

adenosines site of action, mechanism?

primarily acts on AV node; slows conduction and decreases automaticity by hyperpolarizing (K+ channels). does NOT modulate ventricular myocyte AP

77

when clinical suspicion of adrenal crisis (lack of adrenal gland secretions) immediate rx?

glucocorticoids (stress dose of hydrocortisone). no need for wait for biochemical confirmation. note: glucocortoids needed for vasopressors to have an effect!

78

clinical indications for epinephrine (3)

anaphylaxis, severe asthma, cardiac arrest. stimulates both alpha and beta, so not a potent vasoconstrictor

79

clinical indications for dopamine infusion

(1) shock and (2) refractory cardiac failure

80

serum antibodies to PLAR2 (phospholipase A2 receptor) -- a transmembrane protein abundant on podocyte suggests...

glomerulonephritis. involved in idiopathic membranous nephropathy. (not in secondary membranous nephropathy)

81

minimal change disease is possibly due to..

abnormal T cell production of a glomerular permeability factor that affects glomerular capillary wall --> leads to fusion of foot processes and marked proteinuria.

82

Mixed cryoglobulinemia found in..

patients w/ hep C. results in renal disease due to IgM deposition in glomerulus --> basement membrane thickening and cellular proliferation.

83

renal disease in multiple myeloma?

deposition of light chains (cast nephropathy)

84

NPV

of those that test negative, how many are actually disease free?

will vary with pretest probability & negative predictive value.

85

pretest probability & prevalence directly affects..

negative predictive value.

(high probability of having disease, low NPV if negative. low probability of having disease, high NPV.

86

validity of a test measures..

appropriateness of test. does the test measure what its supposed to?

87

congenital QT prolongation (decreased outward K+) predisposes pts to..

syncopal episodes, possibility of sudden cardiac death w/ polymorphic ventricular tachycardia, including torsades de pointes.

88

insulin downstream signaling cascade

receptor tyrosine kinase. autophosphorylation allows for intxn w/ IRS-1/2 (insulin receptor substrate).

89

TNF-alpha induces insulin resistance by...

aberrant phosphorylation of signaling molecules.

activation of serine kinases --> phosphorylate IRS, which inhibits IRS-1 tyrosine phosphorylation by insulin. also phosphorylates insulin receptor.

90

how do thiazolidinediones reduce blood sugar?

insulin sensitization, PPAR-gamma

91

pneumocystis jirovecci (opportunistic HIV infxn) risk factor? prophylaxis?

risk CD4+ <200cells/uL & oropharyngeal candidiasis.

rx: TMP-SMX

92

toxoplasma gondi (opportunistic HIV infxn) risk factor? prophylaxis?

risk: CD4+ < 100cells/uL & positive toxoplasma IgG antibody.

rx: TMP-SMX

93

mycobacterium avium complex (M avium & M intracellulare) opportunistic HIV infxn risk factor? prophylaxis?

risk: CD4+ < 50 cells/uL

rx: azithromycin

94

histoplasma capsulatum (opportunistic HIV infxn) risk factor? prophylaxis?

risk: CD4+ count < 150 cells/uL; endemic area (ohio & mississippi river valley)

rx: itraconazole

95

distinguishing MAC from extrapulmonary TB infxn?

both have nonspecific symptoms of fever, weight loss, and diarrhea in HIV + pt.

but, MAC: marked (1) anemia (2) hepatosplenomegaly and (3) elevated alkaline phosphatase & lactate dehydrogenase levels --> due to wirespread involvement of RES.

96

growth differences between M. tuberulosis and MAC?

MA grows will at high temperatures. optimum growth at 41 C

97

rx for MAC?

azithromycine, rifabutin, ethambutol

98

TMP-SMX prophylaxis in HIV+ patients for.. (2)

(1) pneumocystic jiroveci < 200 (2) toxoplasma gondii < 100

99

mucormycosis grows in..

proliferate in walls of blood vessels (in paranasal sinuses, etc) and cause necrosis of corresponding tissue

100

fungal paranasal sinus infxn due to.. (2)

(1) mucor or (2) invasive aspergeillosis. distinguish w/ light microscopy. mucor = 90. aspergillus = 45

101

pyruvate dehydrogenase deficiency rx?

ketogenic diet recommended (bc carbohydrates may aggravate resultant lactic acidosis). i.e. lysine and leucine

102

amino acid catabolism produces what 2 general intermediates?

removal of amino group forms (1) glucogenic, i.e. intermediates of citric acid cycle or pyruvate or (2) ketogenic, i.e. producing acetoacetate or it's precursors.

some amino acids are both (phenylalanine, isoleucine, tryptophan)

103

which amino acids are both ketogenic and glucogenic?

phenylalanine, isoleucine, tryptophan

104

which amino acids are exclusively ketogenic?

leucine and lysine (would not increase lactic acid).

105

alanine into glycolysis?

non-essential, glucogenic amino acoid. transaminated --> pyuvate

106

serine into glycosis?

nonessential, pyruvate via serine hydratase

107

asparagine into glycolysis?

nonessential, catabolized to ASPARTATE (asparaginase).

aspartate transaminated w/ alpha-ketoglutarate into (1) glutamate (gluconeogenic) and (2) oxaloacetate (TCA intermediate)

108

PDH presentation

mult. possible. form neonatal death to mild episodic symptoms in adulthood.

109

thyroid hormones are..

iodinated amino acids

110

along w/ iodide, what is taken up by NIS (Na+ I- symporter)? (3)

(1) perchlorate (2) pertechnetate (3) radioactive iodine

111

presentation of HbC disease?

usu asymptomatic w/ mild hemolytic anemia and splenomegaly

112

speed of hemoglobin movement during gel electrophoresis?

hemoglobin A (glutamate) > hemoglobin S (valine) > hemoglobin C (lysine)

113

which bodily fluids is HepB in?

detected in all except stool. usu transmitted in blood, but can be in semen, saliva, sweat, tears, breast milk, and pathologic effusions.

114

wide, fixed splitting of S2 that does not vary w/ respiration?

ASD --> increased flow through pulmonary artery. biggest complication: irreversible pulmonary vascular sclerosis

115

for Eisenmenger syndrome to occur..

muscular pulmonary arteries develop laminated medial hypertrophy such that pulmonary VR goes above systemic VR. becomes right-to-left shunt.

reversal of flow due to CHRONIC PULMONARY HTN

116

irreversible concern with ASD?

chronic pulmonary HTN (resultant right ventricular hypertrophy and right atrial enlargement) are in response to pul HTN and are REVERSIBLE.

117

prevent recurrence with primary HSV infxn?

DAILY valacyclovir, acylovir, or famciclovir. reduce recurrences.

118

short course of acyclovir rx during first episode..

reduces duration of viral shedding, time for lesion healing, constitutional symptoms, and local pain. does NOT alter viral latency or recurrence. needs to be AFTER first episode?

119

immunoglobulin therapy used for what virus? in which situation?

combat varicella zoster in (1) immunocompromised (2) neonates whose mothers developed perinatal varicella infxn (3) prophylaxis in pregnant females exposed to varicella

120

how does ANP reduce blood pressure?

peripheral vasodilation, natriuresis, and diuresis.

121

ANP signaling mechanism?

binds to natriuretic peptide receptor A (NPR-A), activate guanylate cyclase forming cGMP.

122

3 tissue effects of ANP

(1) kidney: ANP (a) dilates afferent arteriole, increasing GFR and urinary excretion of Na+ and H20. also, (b) limits Na+ reabsorption in PCT and (c) inhibits renin secretion

(2) adrenal gland: ANP restricts aldosterone secretion (increased Na and H20 excretion)

(3) blood vessels: ANP (a) relaxes vascular smooth muscle in arterioles and venules --> vasodilation. (b) increases capillary permeability, leading to fluid extravasation into the interstitium and decrease in circulating blood volume.

123

what is expected on peripheral blood smear after B12 replacement therapy (in deficient situation)

effective erythropoesis begins immediately & immature erythrocytes are release.

(1) reticulocytes peak early: left shifted & take longer to mature.

(2) anemia takes ~8 wks to correct, due to slower rise in hemoglobin / mature erythrocyte

124

serum haptoglobin levels with B12-deficiency anemia?

usually low due to ineffective erythropoesis and enhanced peripheral destruction.

125

in chronic atrophic gastritis, which hormones are elevated

profound hypochlorydia (due to parietal cell loss --> increased GASTRIN.

126

urea cycle main goal

convert AMMONIA generated from metabolism of alpha-amino acids into UREA.

127

urea cycle overview

5 enzymatic steps, 2 in mitochondrial matrix. 3 in cytosol

128

OTC (ornithine transcarbamoylase) deficiency vs. NAGS (N-acetylglutamate synthase) deficiency

both result in hyperammoninemia. OTC --> elevated carbomoyl phosphate --> orotic acid elevation (pyrmidine synthesis pathway.

NAGS --> hyperammonia w/ elevated ornithine but normal enzyme in rest of urea cycle.

129

3 major causes of hepatocellular carcinoma

(1) hepatitis B or C (2) chronic alcoholism (3) consumption of food contaminants (i.e. aflatoxins)

130

distinguishing cirrhosis from hepatocellular carcinoma

difficult, overlap in clinical presentation: upper abdominal pain, malaise, fatigue, weight loss, sensation of abdominal fullness.

elevated serum-AFP levels present in 50-75% of HCC. can help distinguish.

note: hep C can also have elevated AFP, but continuous rise --> HCC

131

hepatic adenomas. demographic, presentation, association?

young, middle aged women. length history of oral contraceptive use. identified when compains or abdominal pain in epigastrum or RUQ, incidental imaging, or sudden collapse w/ rupture & intraabdominal bleeding

132

GABA is made by.. broken down by... what cofactor is needed for both?

synthesis: glutamate acid decarboxylase (GAD) from glutamate.

breakdown: transamination via GABA transaminase.

both need vitamin B6 (pyridoxal phosphate)

133

3 types of GABA receptors: where, structure of receptor, effect of stimulation

GABAa: brain, ion channel, Cl- influx

GABAb: brain, G-protein, K+ efflux, decreased Ca++ influx, inhibtion of adenylyl cyclase

GABAc: retina, ion channel, Cl- influx

134

zolpidem (ambien), zaleplon, esZopiclone

ZZZ's sleep. activate BZI substype of GABA receptor. reversed by flumenazil. rx: insomnia.

zolpidem shares benzo site on GABAa

135

which 2 anti-epileptics reduce GABA catabolism

valproic acid and vigabatrin

136

GABAb mediates action via..

Gprotein !! :(

137

most common type of malignancy in patients suffering from inflammatory bowel disease, particularly ulcerative colitis?

colorectal carcinoma

138

colitis-associated carcinoma vs. sporadic colorectal carcinoma

colitis-associated: (1) younger, (2) progress from flat & nonpolypoid dysplasia (3) histologically appear mucinous and/or have signet ring morphology (4) develop EARLY p53 and LATE APC [opposite of sporadic] (5) be distributed within the proximal colon (esp w/ crohn's or primary sclerosing cholangitis) 6. be multifocal in nature

colitis-associated usu HIGHER GRADE & more likely to be anaplastic

139

what type of carcinoma is associated with 1st p53 mutation and then APC

colitis-associated colorectal carcinoma

140

alpha-1 antitrypsin is..

serum protein that inhibits several diff proteolytic enzymes (most important neutrophil elastase) and reduces inflammation

141

alpha-1 antitrypsin results in..

panacinar emphysema and liver disease (hepatomegaly, hepatosplenomegaly, cholestasis, elevation of hepatocellular enzymes)

can be asymptomatic until end-stage liver disease.

most severe consequence: cirrhosis and hepatocellular carcinoma

142

diagnosis of alpha-1 antitrypsin deficiency should be suspected in..

all patients w/ premature onset (<50 of chronic bronchitis, emphysema, or dyspnea) as well as nonsmokers w/ COPD.

history of neonatal hepatitis w/ cholestasis should heighten suspiscion

143

fever, jaundice, and anorexia in an IV drug user?

acute viral hepatitis

144

histopathologic findings w/ hepatotropic viruses

panlobular lymphocytic infiltrates, ballooning hepatocytes, hepatocyte necrosis, hepatocyte apoptosis.

apoptotic hepatocytes form round acidophilic bodies = COUNCILMAN bodies, or apoptotic bodies

Kupffer cells phagocytize hepatocellular debris. may appear hypertrophied & laden w/ lipfuscin pigmen in biospy specimen.

hepatocytes accumulate hemosiderin pigment in hemochromatosis.

145

councilman bodies

apoptotic hepatocytes = round acidophilic bodies

146

liquefactive necrosis classically occurs..

in CNS infarcts -- dead tissue digested and removed by autolytic mechanisms. also occurs in suppurative bacterial infxn --> degradation via heterolytic mechanisms

147

fibrinoid necrosis

inflammation and necrosis of arterial walls in vasculitis. immune complex, complement, and plasma proteins form fibrin-like eosinophilic deposits

148

verapamil often used for

rate control in atrial fibrillation w/ rapid ventricular response (bc blocks calcium channels in AV node).

2nd line: digoxin

149

contraindication to the use of non-selective beta-blockers (i.e. propanol) for atrial fibrillation?

severe COPD and asthma

150

most common side effect of amlodipine

peripheral edema.

151

lidocaine is mainly used for what cardiac problem

ventricular arrythmia, esp after an acute MI

152

most frequent adverse reaction to verapamil

constipation and gingival hyperplasia. also bradycardia & heart blocks

153

cardioselective & vascular selectivity of 3 calcium channel blockers

verapamil -- most cardiac.
nifedipine -- most vascular.
diltiazem -- between

154

clinical features of melanoma (ABCDEs)

- A: asymmetry: when bisected, the 2 sides are not identical
- B: border irregularities: uneven edges, pigment fading off
- C: colour variegation: variable mixtures of brown, tan, black & red
- D: > or = 6mm
- E: lesion changing in size, shape, or colour; new lesion

155

melanoma commonly metastasizes to..

brain, GI, bone, liver, and lungs

156

melanocytes are of what embryological origin

neural crest cells

157

mesoderm gives rise to..

dermis, bones, muscles, blood vessels, visceral tissue

158

surface ectoderm..

epidermis & its appendages, mammary glands (modified sweat glands), lens of eye, adenohypophysis.

159

most common metastatic tumors to brain are

lung, renal, and melanoma