Week #1 Flashcards
(118 cards)
1
Q
What is the function of the choroid plexus?
A
CSF production
2
Q
What is a choroid plexus papilloma (CPP)?
A
Benign neoplasm of the choroid plexus villi
3
Q
What age is most commonly affect by CPPs?
A
Children less than 2 y/o
4
Q
What are the major clinical manifestations of a CPP?
A
Hydrocephalus
5
Q
What neuroanatomical structure lies just inferior to the 3rd ventricle?
A
Hypothalamus
6
Q
What hypothalamic nucleus is responsible for satiety?
A
Ventromedial nucleus (VMN)
7
Q
What is the clinical manifestations of damage to VMN e.g. in a CPP putting pressure in the VMN of the hypothalamus?
A
Hyperphagia and weight gain
8
Q
In Bell Palsy, is the effected facial nerve/ facial nerve nucleus on the ipsilateral or contralateral side?
A
Ipsilateral
9
Q
Where is the nucleus of the facial nerve located?
A
The rule of four: there are 4 cranial nerves in the medulla, 4 in the pons and 4 above the pons (2 in the midbrain)
Medulla= 9-12 Pons= 5-8 Midbrain= 3 and 4
10
Q
Are the CN VII nuclei located medially or laterally? What is the mnemonic to remember?
A
Nucleus is located laterally
- Odd motor nuclei do NOT divide equally into 12
- 4 motor nuclei that are in the midline are those that divide equally into 12 except for 1 and 2, that is 3, 4, 6 and 12
11
Q
What is the defect seen in Von Willebrand Disease?
A
Autosomal dominant defect in vWF
12
Q
What is the normal role of vWF in clotting?
A
- vWF is released from storage granules in platelets and endothelial cells. It performs two major roles:
1) mediates the adhesion of platelets to sites of vascular injury
2) binds and stabilizes the procoagulant protein factor VIII
13
Q
What are the expected Bleeding Time (BT), PT, and PTT in Von Willebrand Disease?
A
- BT is increased
- PT is normal
- PTT may be increased or normal
14
Q
What clinical scenario should make you suspicious for von Willebrand Disease?
A
Young woman with menorrhagia (heavy menses) and a family history of the same (autosomal dominant)
15
Q
What is the MOA of ADH? Where does ADH exert its mechanism of action?
A
ADH increases the insertion of aquaporins into principal cells of the collecting tubule in the nephron
16
Q
What type of lung cancer is SIADH associated with?
A
Small cell lung cancer
17
Q
What is the MOA of Acetazolamide?
A
Carbonic anhydrase inhibitor
- Causes “self-limited” NaHCO3 diuresis and decreases total body HCO3-
18
Q
What are the clinical indications for Acetazolamide?
A
1) Glaucoma
2) Urinary alkalinization
3) Metabolic acidosis
4) Altitude sickness
5) Pseudotumor cerebri
19
Q
What adverse effects are associated with Acetazolamide?
A
1) Hyperchloremic metabolic acidosis
2) Paresthesias
3) NH3 toxicity
4) Sulfa allergy
20
Q
What is an alternative name for Adhesive Capsulitis?
A
Frozen Shoulder Syndrome
21
Q
What is Adhesive Capsulitis?
A
Progressive pain and restriction of the should that worsens over the course of a year
22
Q
What is the typical etiology of Adhesive Capsulitis?
A
Prolonged immobility of the shoulder
23
Q
Oxytocin is secreted by what gland? Where is Oxytocin synthesized?
A
Oxytocin is secreted by the posterior pituitary; however, it is synthesized in the hypothalamus
24
Q
What specific nucleus of the hypothalamus makes oxytocin?
A
Paraventricular
25
What is the steroidal precursor to estrogen?
Androstenedione
26
What artery is implicated in lateral medullary infarctions? What is the resulting syndrome called?
Posterior Inferior Cerebellar Artery (PICA)
*Infarction is called "Lateral Medullary Syndrome"
27
What structures receive blood supply from the PICA?
1) Vestibular nuclei
2) Lateral spinothalamic tract- pain and temperature
3) Spinal trigeminal nucleus
4) Nucleus ambiguus
5) SNS fibers
6) Inferior cerebellar peduncle
28
What are the symptoms of a PICA infarction?
1) Vomiting
2) Vertigo
3) Nystagmus (horizontal)--TOWARD lesion
4) Decreased pain and temperature sensation from the ipsilateral face and contralateral body
5) DYSPHAGIA
6) HOARSENESS
7) Decreased gag reflex
8) Ipsilateral horner's syndrome
29
What spinal tract carries pain and temperature sensation?
Spinothalamic
30
Describe the typical presentation of sensory findings in Lateral Medullary Syndrome.
- Loss of pain and temperature to the ipsilateral face
| - Loss of pain and temperature to the contralateral body
31
What is Autosomal Dominant Polycystic Kidney Disease (ADPKD)?
- Adult form of polycystic kidney disease
- Numerous cysts cause bilaterally enlarged kidneys
- Destroys kidney parenchyma
32
What is the typical presentation of ADPKD?
1) Flank pain
2) Hematuria
3) HTN
4) Urinary infection
5) Progressively renal failure
33
What can cause acute flank pain is ADPKD?
Cyst rupture
34
What is the genetic basis for ADPKD?
Autosomal Dominant mutation in:
- PKD1 on chromosome 16*
- PKD2 on chromosome 4
35
What is ADPKD associated with?
1) Berry aneurysm*
2) MVP
3) Benign hepatic cysts
*Also called a saccular aneurysm, this is a round outpouching of the cerebral arteries
36
What age is ARPKD seen in?
This is the childhood form of PKD
37
Where do Saccular (berry) aneurysms occur?
Bifurcations in the Circle of Willis
38
What is the most dreaded complication of a Saccular Aneurysm?
Rupture
39
When a Saccular Aneurysm ruptures, what is the typical result?
Subarachnoid hemorrhage (SAH)
40
How do patient's typical present with a SAH?
"Worst headache of my life"
41
What are the functions of the dorsal and palmar interossei muscles of the hand? What is the mnemonic to remember?
DAB and PAD
Dorsal interossei ABduct
Palmar interossei ADduct
42
What is endometrial hyperplasia?
Abnromal endometrial gland proliferation
43
What usually causes endometrial hyperplasia?
Excess estrogen stimulation
44
How does endometrial hyperplasia present?
Postmenopausal vaginal bleeding
45
What are the risk factors for endometrial hyperplasia?
1) Anovulatory cycles
2) Hormone replacement therapy
3) PCOS
4) Granulosa cell tumor
Also, late menopause, nulliparity, and obesity--these factors increase the risk of unopposed estrogen
46
What does endometrial hyperplasia increase the risk for?
Endometrial carcinoma
47
What is the first line drug therapy for ankylosing spondylitis?
NSAIDs and specifically Indomethicin
48
What is the MOA of Cyclosporin?
- Calcineurin inhibitor that binds to CYCLOphilin
| - This prevents IL-2 transcription
49
What is the other calcineurin inhibitor with a similar MOA to cyclosporine?
Tacrolimus (FK506)
50
What are the indications for both cyclosporine and tacrolimus?
Transplant rejection prophylaxis
51
What are the additional indications for cyclosporine compared to tacrolimus?
1) Psoriasis
| 2) RA
52
What is the classic toxicity associated with the calcineurin inhibitors?
Nephrotoxicity
53
What two adverse effects are seen with cyclosporine and NOT with tacrolimus?
1) Gingival hyperplasia
| 2) Hirsutism
54
Beyond nephrotoxicity, gingival hyperplasia, and hirsutism, what are the other adverse effects associated with cyclosporine?
1) HTN
2) Hyperlipidemia
3) Neurotoxicity
55
There are three major esophageal pathologies that are emergencies associated with alcoholics, what are they?
1) Ruptured esophageal varice
2) Mallory-Weiss Syndrome
3) Boerhaave Syndrome
56
What distinguishes Mallory-Weiss Syndrome from Boerhaave Syndrome?
Mallory-Weiss Syndrome= lacerations of the distal esophagus from violent retching
Boerhaave Syndrome= transmural esophageal rupture of the distal esophagus
57
What is the result of esophageal rupture in Boerhaave Syndrome, and what is the eponym for the physical exam finding that is expected?
Pneumomediastinum= air in the mediastinum
- Results in a Hamman crunch
- Hamman crunch= crackling sound with each heartbeat
58
What is angiodysplasia?
- This is the most common vascular anomaly of the GI tract; it results in PAINLESS hematochezia
- Characterized by tortuous dilation of blood vessels
59
What is tuberous sclerosis?
Neurocutaneous disorder characterized by numerous benign hamartomas
*Note that it affects nearly every organ system
60
What is the inheritance pattern of tuberous sclerosis?
Autosomal dominant
61
What is the hallmark cutaneous manifestation of tuberous sclerosis?
"Adenoma sebaceum" i.e. angiofibromas (cutaneous hamartomas) resulting in flat/ reddish macular lesions on the face that are first mistaken for freckles
62
What tumors are associated with tuberous sclerosis?
1) Giant cell astrocytomas
2) Renal angiomyolipomas
3) Cardiac rhabdomyomas
63
What is the most frequent primary cardiac tumor in children?
Rhabdomyoma
64
What is agoraphobia?
Exaggerated fear of being in open or enclosed placing esp. including:
1) Public transportation
2) Crowds/lines
3) Leaving home alone
65
What are the treatment options for agoraphobia?
1) CBT
2) SSRI
3) MAOI
66
What class of anti-anxiety drugs is best for PRN/ short-acting use?
Benzodiazepines
67
What is the specific mechanism of action of Benzodiazepines?
Enhance GABA
68
Describe the pathophysiology of Achalasia.
- Failure of relaxation in the LES due to loss of the Myenteric Plexus
- Myenteric plexus produces NITRIC OXIDE SYNTHASE
- Increases NO and causes smooth muscle relaxation of the LES
69
What is the pathognomonic finding on barium swallow study in Achalasia?
"Birds beak"
70
What is the etiology of Achalasia?
- Primary is autoimmune, but poorly understood
| - Secondary is from Chagas Disease or malignancy
71
What is the organism that causes Chagas Disease?
T. cruzi
72
What is the mnemonic to remember the levels of disease prevention?
PST
```
Primary= prevention
Secondary= screening
Tertiary= treatment
```
73
What is the Karyotype in Turner's Syndrome?
45, XO
74
What are the classic clinical manifestations of Turner's Syndrome?
1) Short stature
2) Ovarian dysgenesis
3) Shield chest
4) Preductal coarctation
5) Webbed neck
6) Horseshoe kidney
75
Intention tremors are indicative of _____?
Cerebellum dysfunction
76
What organism is the most likely causes of osteomyelitis in a patient with Sickle Cell anemia?
Salmonella and Staphylococcus aureus
77
What is the most appropriate initial antibiotic therapy for a Sickle Cell patient with osteomyelitis? What antibiotics are used for the two most likely pathogens?
1) Ciprofloaxacin - Salmonella
| 2) Vancomycin - S. aureus, including MRSA
78
What are the clinical indications for ECT?
1) Treatment refractory depression
2) Depression with psychosis
3) Suicidal ideation
79
What are the adverse effects associated with ECT?
1) Disorientation
2) Temporal headache*
3) Anterograde and retrograde amnesia
*Most common
80
What genetic mutation is associated with MEN 2A? What is the inheritance pattern for this mutation?
RET (neural crest cells); autosomal dominant
81
What are the three clinical manifestations of MEN 2A?
1) Pheochromocytoma
2) Parathyroid tumor
3) Meduallary thyroid carcinoma
82
What tumor marker is used to evaluate medullary thyroid carcinoma?
Calcitonin; serum levels correlate with tumor mass
83
What is the eponym for the test that is associated with TOS caused by compression of the NVB between the anterior and middle scalenes?
Adson's Test
84
Describe the Adson's Test.
- Patient's pulse is monitored on the affected side
- Extend: elbow and arm
- Externally rotate wrist
- Turn head toward affected arm
*Ask the patient to take a deep breath; if pulse diminishes or is absent, test is positive
85
What paraneoplastic syndrome is associated with Squamous Cell Carcinoma of the lung?
Hypercalcemia produced by PTHrP
86
What are the expected histologic findings in squamous cell carcinoma of the lung?
- Keratin pearls
| - Intercellular bridges
87
What is the mnemonic to remember the etiology of Duchenne Muscular Dystrophy?
Duchene= Deleted Dystrophin
88
What is the genetic basis of DMD?
X-linked frameshift mutation leading to a truncated dystrophin protein
89
What is the normal function of dystrophin?
Anchors muscle fibers in skeletal and cardiac muscle
90
What is the classic presentation of DMD?
- Onset prior to 5 y/o
- Weakness of the pelvic girdle that ascends superiorly
- Waddling gait
- Gower maneuver
91
What is the most common cause of death in DMD?
Dilated cardiomyopathy
92
What is progressive multifocal leukoencephalopathy (PML)?
Demyelination of the CNS due to destruction of oligodendrocytes
93
What is PML associated with?
JC virus infection and AIDS patients
94
What bones form pterion?
1) Frontal
2) Temporal
3) Parietal
4) Sphenoid
95
What is the purpose of the cranial V-spread technique?
Separation of restricted or impacted cranial sutures
96
What is the MOA of Metformin?
Unknown but increases insulin sensitivity
*A "biguanide"
97
What is the clinical indication for Metformin?
First-line therapy for DM-II
98
What is the most serious adverse effect associated with Metformin?
Lactic acidosis
99
When is Metformin contraindicated?
Renal insufficiency b/c it causes lactic acidosis
100
What is the most common adverse effect associated with Metformin?
GI upset
101
What are the first generation sulfonylureas?
1) Chlorpropamide
| 2) Tolbutamide
102
What is the MOA of the sulfonylureas?
1) Inhibition of the K+ channel in pancreatic Beta-cells
2) Cell membrane depolarization occurs
3) Ca++ rushes in
4) Insulin is released
103
Are sulfonylureas used in DM-I or DM-II?
DM-I; require functioning beta-cells
104
What are the adverse effects associated with first and second generation sulfonylureas?
1st generation= disulfram-like effect
| 2nd generation= hypoglycemia
105
What adverse effects are associated with the Ciltaones/thiazolindinediones (TZDs)?
1) Weight gain
2) Edema
3) Hepatotoxicity
4) HF
5) Increased risk of fracture
106
What organism is associated with primary amebic encephalitis?
Naegleria fowleri
107
What is the anterior Chapman point associated with the appendix?
Tip of the right 12th rib
108
What is the posterior Chapman point associated with the appendix?
Transverse process of T11
109
What are the clinical manifestations of Neurofibromatosis Type 1?
1) Cafe-au-lait spots
2) Cutaneous neurofibromas (proliferation of peripheral nerves)
3) Optic gliomas
4) Pheochromcytomas
5) Lisch nodules (pigmented iris hamartomas)
110
What is the genetic basis for NF1?
- Autosomal dominant mutations in NF1 gene
- Chromosome 17*
Note that NF1 is also called "von Rcklinghausen" disease, which has 17 letters in the name
111
What is reactive or secondary thrombocytosis?
Increased circulating platelets due to:
1) Malignancy
2) Trauma
3) Infection
4) S/p splenectomy
5) Iron deficiency anemia
6) Idiopathic causes
112
If a joint aspiration is done in an acute gout attack, what are the expected results? How does this differ from pseudogout?
Aspiration with show needle shaped crystals; however,
- Gout= NEGATIVE birefingence
- Pseudogout= POSTIVE birefringence
113
What are tophi?
Chalky white uric acid deposits under skin
114
What are the four major attachements of the dura to the spinal column?
1) Foramen magnum
2) C2
3) C3
4) S2
115
What ligament is the demarcation point between an upper and lower GI bleed?
Ligament of Treitz
116
What spinal cord levels are associated with sympathetic innervation to the upper GI tract?
T5-T9
117
What is "Chadwick's Sign?"
Bluish vaginal mucosa; an early sign of pregnancy
118
What is an absolute contraindication to Warfarin therapy?
Pregnancy b/c it is a known teratogen
