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Flashcards in Week 2 UWORLD Qs Deck (131):

Morphology + clinical syndrome:

Pseudohyphae w/ blastoconidia - ones you know plus vasc catheters, S/ST infect
Broad based budding - pulm infect may go to skin/bone
Southwest dimorphic - " "
Capsule - meningitis, pulm
R angles - invasive infect - does NOT grow in blood cultures


What is the Potter sequence?

Some renal problem in utero (billet renal agenesis) -> decrease urine output by fetus
Decreased amniotic fluid"
1. Pulm hypoplasia - decreased breath sounds, O2 doesn't improve on vent
2. Flat face
3. Limb deform - club feet


What is androgenetic alopecia? Genetics of this disorder

Most common cause hair loss in M + W
Hormone levels + genetics (polygenic)
Polygeneic inheritance = variable expressivity
AA often seen with char 20, X oy Y therefore can be transmitted XR or AD



X 50 S ribosome subunit of bacteria
Reversible cytopenias:
1. Dose related anemia
2. Leukopenia
3. TCP
**Irreversible aplastic anemia (pancytopenia b/c hypocellular bone marrow)


Drugs that can induce aplastic anemia

= stem cell def --> pancytopenia
Chloramphenicol (antibiotic)


Describe hyper acute vs acute vs chronic cell mediated transplant rejection histo

Hyperacute: vasc fibrinoid necrosis + neutrophil infiltrate of organ capillaries
Acute: dense interstital mononuc infiltrate
Chronic: obliterative fibrosis (graft endo damage med by low grade cell + Ab immune responses over time)


Describe location of:
Erector spinae
Psoas major
Ligamentum flavum
Transversus ab

Erector spinae = back muscle, either side of spine, attaches at spinous processes
Iliacus = comes from iliac crest
Psoas major (+ minor) from T12-L5 -> iliopsoas for hip flexion
LF = connect vertebrae, form post wall of spinal canal
Trans ab = most internal ab muscle


Describe the 3 steps take for treating a status epileptics seizure

1. IV lorazepam (benzo) - fast coverage until pheny kicks in (binds GABA A = Cl- channel, enhance GABA)
2. Simultaneously load phenytoin (X Na channels so can't recover from inactivation)
3. IF 1+2 didn't stop seizure, + phenobarbital


Where in cell are VLCFAs metabolized?

Beta ox - VLCFA breakdown
Alpha ox - branched chain FAs
Zellweger Syndrome = X myelin b/c assume this stuff in xerox, hypotonia, seizures, death within months of presentation
Vs proteasome = break down proteins... duh


Which virus causes billet hemorrhagic necrosis of inf and med temporal lobes?

HSV 1: unilat more common than bial
Not Naegleria fowleri b/c this would have encephalitis not confined to temporal lodes - frontal, temp, brainstem, mening


What is the similarity between heat labile toxin vs cholera toxin? Endotoxin vs exotoxin?

HL (ETEC) similar to cholera - Gs -> increase cAMP
Endotoxin = LPS (GN bacteria)


Name 3 signals to secrete acid. Names of PPIs

Histamine @ H2 + ECLs
ACh from vagus + M3 R on parietal cells
Gastrin @ 1ary CCK b R on ECL cells (increase histamine) or 2ary on parietal cells
PPI = Lansoprazole, omeprazole


Difference between free ribosomes and those on RER. Fxn smooth ER

Free make cytosolic proteins
RER proteins for the membrane or for exocytosis
Smooth = detox, lipid syn, carb metab


Why do preggo women go to the bathroom more?

Increase intra-ab pressure
Preg hormones decrease urethral tone and relax pelvic floor muscles


Type of necrosis after infarct in body vs brain

Body = coag nec (look for no nucleus)
Brain = liquef nec, will be converted to astroglial scar



If vol depleted (chronic diuretic) or HF pts -> significant 1st dose hypotension
Why start ACE at low doses
ACE I only worsen BILAT renal stenosis


Presentation of ulnar nerve injury. Describe nerve course

Sensory loss medial hand (medial 1/5 digits + hypothenar eminence)
Ulnar claw - weakness in wrist FLEX, ADDUCT, finger add/abduct, flex 4th+5th fingers
C8-T1 -> medial epicondyle elbow -> flexi carpi ulnars and medial flex digitorum profundis
Through Guyon's canal = hook of hamate + pisiform


Describe glucose in the nephron - where filtered and absorbed. Describe inulin in the nephron

Filtered @ glomerulus
Reabsorbed @ prox tub
If you X Na coupled transport of glucose @ pro tubule -> clearance would approach GFR (whats filtered = whats excreted, this is how inulin is)
PAH filtered and then also secreted into urine via OAT (used to cal renal plasma flow)


3 genetic diseases that have pheos

MEN 2 - RET gene
Neurofibromatosis - NF1 gene


Describe a polysaccharide vs conjugate vaccine

Polysacc - think killed vaccine - only stim B cell immunity (Abs), esp true in infants b/c immature humoral immunity
Conjugate means you attached the bug to something that boosts immune response - T + B cell immunity


Explain FAS ligand system. If the FAS R/L system of a T cell is not working, what should happen?

Activate T cell -> start express FasL - can bind Fas R on same or adjacent lymphocytes
During clonal expansion, wil undergo apoptosis by this mechanism if in the constant presence of self antigens
Apoptosis via caspases
Mutations of FAS R/L can prevent apoptosis of auto reactive lymphocytes increasing risk of AI


Name molecules involved in neutrophil
Tight adhesion

1. Selections: E/P on endo bind sialyl lewis X of neutrophils (could also roll and attached to previously bound neutrophils = L selectin)
2. Neutrophil integrins + ICAM on endo
3. Platelet endothelial cell adhesion molecule = PECAM 1


Disease that presents with baby whose umbilical cord has delayed separation, and gets recurrent bact skin infections w/ NO PUS

Leukocyte adhesion def - no CD 18 = no integrins = no tight adhesions


Cell surface marker macrophages that binds PAMPs

CD 14


What type of vaccine is the Hib vaccine?

H influ type b - protects against all H influ infections esp meningitis
Conjugated = capsule of Hflu + diphtheria toxin (carrier protein) yields T + B cell immunity


What is positive vs negative selection @ thyroid?

1st = + selection @ cortex (immature T cells) - do you have enough affinity for own MHC aka can you do your job (not enough, apoptosis)
Via **thymic cortical epithelial cells**
2nd = - selection @ medulla (mature T cells) - how much do you react to self antigen - too much affinity = apoptosis
Via **thymic medullary epic cells and dendritic cells**


What is the mutation, inheritance pattern, and triad of symptoms for ataxia telangiectasia

AR - ATM gene mutation - responsible for DNA break repair (ATM = ataxia telang mutated)
Therefore hypersens to X rays since cause double strand DNA breaks -> DO NOT XRAY THESE KIDS IN THE ED
1. Cerebellar ataxia
2. Telangiectasias = superficial distended capillaries that blanch
3. Increase risk sinopulm infections - b/c IgA def


What immune mechanism would make you immune to the flu?

Ab vs hemagglutinin either b/c pre infected with that strain or got the vaccine
These Abs neutralize virus
Other choice might be Ab vs neuraminidase but this isn't main source of protection against reinfection (do decrease extent of viral invasion and shedding)
Remember, T cells response (vs nucleocapsid proteins) is a RESPONSE, doesn't help prevent infection


Name an anti-IgE Ab and it's therapy use

Omalizumab = IgG vs IgE
Use for severe asthma (T1 HST rxn) to prevent future asthma attacks
H1 R antag not for asthma but for allergic symptoms instead


What enzyme helps cut up a protein to be expressed on MHC 1?

Protein + ubiquitin tag
Ubiquitin ligase breaksdown intracell proteins (native and foreign)
Particles are paired to MHC 1 being made in the ER then sent together to membrane


Describe difference between
Anti HBs
Anti HBc IgM
Anti HBc IgG
Anti HBe

1. Long term immunity b/c vaccination or resolve acute Hep B infection
2. Window phase = HBsAg + IgM vs Bs present
3. Present in both chronic + acute infection
4. Chronically infected person w/ low viral rep/infectivity (low viral = anti BeAg, high viral = BeAg)
Acute infect = IgM +/- IgG HBc, HBV DNA + HBeAg = markers active viral rep
Recover from acute = anti HBs + HBc
Chronic infection = IgG HBc with HBsAg present in blood


What serum marker indicates chronic Hep B infection? High viral replication/infectivity of a chronic infection? Chronic infection w/ low viral rep?

HBsAg = surface antigen present > 6mo = chronic infection (therefore if gone within 6 mo acute infection was resolved)
HBeAg = Hep B e antigen = high viral rep
Chronic w/ low viral = no HBe Ag, +anti HBeAg


Meds to prevent vs treat acute cell med graft rejection - what's the histo pattern

T cell rejection = vasculitis of graft vessels with dense lymphocyte infiltrate
Prevent w/ calcineurin Is (cyclosporine or tacrolimus)
Treat w/ corticosteroids added to above


What is the difference in the process and location of VDJ recombination and isotope switching

Bone marrow - VDJ (heavy chain) and VJ (light chain) recomb allows each B cell to make single specific Abs
LNs - somatic hypermutation for affinity maturation + isotyp switching (CD 40 R + CD40 L on activated Th cells)


Describe the mechanism of cell damage in T1-4 HST rxns

T1 - IgE mediated --> histamine
T2 - Ab vs your tissue mediated - pulls in complement etc
T3 - Ab-antigen complex in blood deposits in tissues (post strep GN) activating complement
T4 - CD 4 + CD 8 T cells + macrophages (NO EOS)


Describe symptoms of all 4 steps of blood transfusion rxns

1. Allergic rxn aka the usual
2. Anaphylactic rxn drops BP w/ resp arrest
3. Febrile nonhemolytic transfusion rxn (T2 HST) - nonspecific but FEVER
4. Acute hemolytic transfusion rxn (T2 HST) - flank pain, blood in urine, jaundice


Mechanism of IgA

Prevent mucosal colonization
If bacteria cleave this can bind mucosa - Neisseria, strep pneuma, H influ


Which Abs can cross maternal fetal circulation?

IgG - temp immunity until 6 mo
Baby gets IgA via breast feeding


Describe presentation of selective IgA def

Mucosal def - sinopulm + GI bugs
More concerned about anaphylaxis if given blood transfusion w/ IgA


What is the dendritic cell of the skin

Langerhans cells
Stellar cells w/ intracytoplasmic granules have shape of a tennis racket
Will activate T cells (co sim B7)
Vs Kupffer cells - macrophage of the liver
Vs monocytes -> macrophages in skin that don't have those granules


What is the cell receptor that HIV uses to infect the immune system

CCR5 = chemokine receptor on macrophages and T cells
CD4 + CCR5 binds gp120
Deletion of both copies CCR5 gene = HIV immunity


Where does complement bind Ig?



Explain the 2 inheritance patterns for SCID and the clinical presentation

AR = ADA def
X linked = IL 1 R mutation (cytokine R = 2nd signal for T cell activation)
No T cells --> no B cells
Viral, bacterial, fungal, opportunistic infections
BUBBLE BOY - trt bone marrow transplant


What IL can you give to treat RCC/metastatic melanoma - mechanism

IL2 -> increase NK activity


What cell mediated sarcoidosis

CD 4 T cells in BAL fluid
AA, young, F>M
Cough and dyspnea
Bialt hilar adenopathy -> noncaseating granulomas


What disease fuses your SI jt - what HLA are you looking for? What is a good way to monitor disease progression?

Ankylosing spondylitis - also look for bamboo spine = vertical fusion of vertebrae
Seroneg spondyloathropathies = HLA B27
HLA A, B, C code for MHC 1 proteins (1 letter, MHC 1)
Disease progress via chest expansion due to involvement of T spine and costo joints


Recurrent skin + rest infections
Light skin + silvery hair
Horizontal nystagmus
Giant cytoplasm granules in neutrophils + monocytes

Chediak Higashi syndrome - MY dysfxn
1. Can't fuse phagolysosome
2. Can't move pigment in melanocytes
3. NT can't get to end of axon
4. Granules can't move for exocytosis


Describe how the IVC and ab aorta lay in respect to each other throughout the abdomen

IVC in front of aorta most of the abdomen until get to the femoral bifurcation when drops behind


Post total R hip replacement - leans to R side when walking and when standing on R leg left hip tilts down
Which nerve is impaired

Sup gluteal nerve - glut med, min, and TFL
Stabilize pelvis + aBduct
Weak glut med + min can't contract so unaffected side pelvis sag when standing on affected leg
Pt will lean to the affected side during walking to compensate for hip drop


3 yo boy - intel disability + speech delay
226 CGG trinuc repeats on X chromosome
What it the cause of clinical condition

Fragile X = gene methylation of FMR1 gene = fragile X mental retardation 1
Trinuc repeats -> HYPER methylation -> inactivate the gene -> not transcription -> impaired neural development
Southern blot = DNA to set # repeats


What is the most common benign liver tumor and what does it look like?

Cavernous hemangioma - BENIGN
Single or multiple - generally small
Histo = cavernous blood filled vascular spaces lined by SINGLE layer epithelium
Asymptom or RUQ pain
Vs hepatic adenoma vs HCC


Why would someone say Carvidopa/levadopa's response is unpredictable?

On/off periods
Advanced PD - motor flux can occur indeed on med dosing -> unpredictable
Due to progressive nigrostriatal neurodeg decreases therapeutic window for CD/LD NOT enhanced drug metabolism later in disease


Symptoms for Hpylori infection

Duodenal ulcers (#1 cause)
Recent travel to CHINA
Or chronic NSAID use
Triple therapy to treat: 2 antibiotics + PPI


SE of highly active anti retroviral therapy for HIV

Body fat redistribution
Leaves face and limbs -> moves central


Name 2 bugs w/ toxins that inactivate EF2 via ribosylation -> no protein synthesis

1. C diptheriae = diphtheria toxin
2. Pseudomonas = exotoxin A


What kind of cancer should you be thinking if an older man with osteoBLASTIC lesions in the spine presents?

Osteoblastic lesions will be sclerotic so think:
1. Prostate cancer - older men
2. Small cell lung cancer
3. Hodgkins


Cancers that present with osteolytic bone lesions

= lucent b/c osteoclasts beings stim, more aggressive cancer than those that have osteoblastic lesions
1. Multiple myeloma
2. Non small cell lung cancer
3. Non-hodgkins
4. RCC
5. Melanoma


What cell governs systemic vs cutaneous candida infections?

Cutaneous (including vaginal) = T cells = HIV when CD4 ct drops
Systemic (blood, endocarditis) = neutrophils = chemo pts


Which immune cells attack cells w/ decreased MHC 1 expression?

NK cells


What is the anti-RhD Ab?

Give IgG Ab to Rh - mom w/ Rh + baby
In case some of baby's blood gets into mom's circulation, preformed Ab will take care of it without activating systemic circulation
IgG isn't a big problem here b/c the amt is so small there is no hemolysis in the fetus (since IgG cross placenta)


Where does the IL2 for the second signal on T cells come from?

That T cell!
Bind TCR -> induce transcription of IL2 to act on self
Cyclosporin + tacrolimus = calcineurin Is so can't do this via NFAT
Conversely, balsiliximab + daclizumab block IL2 binding
Sirolimus X mTOR which is the down stream effect of IL 2 binding (don't increase NFkB)
Otherwise could use azothiopurine, MMF or glucocorticoids (x NFkB)


Top 3 cancers by incidence and mortality in men vs women

MEN by incidence
1. Prostate
2. Lung - but this is most deadly (switch 1/2)
3. CRC - #3 for deaths too
WOMEN by incidence
1. Breast
2. Lung " "
3. CRC - #3 deaths too


Describe orthostatic hypotension and the compensatory response - name conditions that cause this

Something drops venous return to heart
Less ventricle filling -> drop CO -> drop BP
Baroreceptor reflex -> sympa tone
@ a1 (VSM) increase TPR
@ B1 (heart) increase HR + contractility
If taking a1 blockers for BPH (treason, doxazosin) hypovol, hyperglycemia, autonomic dysfxn (Parkinsons)


What is weird about the release of catecholamines from the adrenal medulla?

Sympa pre-gang neurons synapse DIRECTLY onto adrenal medulla (no intermediate ganglia)
B/c chromatin cells are modified posting simp neurons (neural crest origin)
Goes through the splanchnic gang but doesn't synapse here
Secrete E 80% > NE 20%


Describe an S3 - how you listen to it and what it means

Comes right after S2
@ apex, L lat decubitus
Either young people/athletes whose hearts are so strong its pushing more blood down from atrial during diastole
Old people indicating LHF b/c blood flow into an overfilled ventricle w high end systolic vol (vol overloaded state in the heart b/c can't pump out leads to vol overload state peripherally)


Describe why you get pulsus paradoxus during cardiac tamponade

Tamponade = extra pericardial fluid prevents ventricles from expanding freely
Therefore, inspo increases venous return to heart
Intravent septum bulges into LV so the RV can accommodate this load (since the heart as a whole is limited by pericardial fluid)
Decreases LV filling = pulsus paradoxus aka BP drops during inspo b/c you're LV vol decreases -> decrease CO -> decrease BP


Describe reactive arthritis
Serum results

Seroneg spondyloarth (HLA B27!!)
Asymm arthritis large its - sterile jt effusion
+/- Keratoderma blenorrhagicum = rash with mucous discharge on palms/soles
Post-infectious: campy, shigella, salmonella, yersinia, chlamydia, bartonella
Aka Reiter synd: can't see can pee can't climb a tree
Cause by deposition of immune complexes


What are you thinking: 15 yo girl
High arched palate
Tanner stage 1 breasts w/ widely spaced nipples

Webbed neck
Coarctation // bicuspid aortic valve
Horseshoe kidney = didn't separate so connecting kidney piece overlays ab great vessels
Ovary dysgenesis = streak gonads = degen follicles and replace w/ fibrosis (why amenorrhea)
Vs PCOD - 2ary amen + hirstuism + obesity
Vs Mullerian agenesis - 1ary amen due to absent Mullerian duct system (no vagina) but normal palate + breast


What thinking:
Prox weakness - can't walk stairs or comb hair
Muscle tenderness
No rash
Biopsy = endomysial mononuc infiltrate w/ patchy muscle fiber necrosis

Anti-Jo Abs = vs histidyl tRNA synthetase
Also ANA
Indep or manifestation of adenocarcinoma
Vs Ab desmoglein -> pemphigus vulgaris = skin blistering + desquamation


Describe primary carnitine def

FAs (acyl CoA synthase) -> ACoA + carnitine -> now can enter mitochondria as acyl-carnitine (will go into TCA cycle)
No carnitine - can't do this
Skeletal + cardiac muscle can't use FA -> ATP
Liver can't make ketone bodies (acetoacetate!!!) if glucose gets low - deficiency will de downstream of the problem
1. Muscle weak
2. Cardiomyopathy
3. Hypoketotic hypoG
4. Increased muscle TGs
Vs. palmitate = FA you eat or make but completely based in cytosol - doesn't have carnitine shuttle problem


Glaucoma is increased IOP due to excess prod (@ciliary body) or decreased outflow of aq humor (out via 1. trabecular outflow or 2. uveoscleral outflow). Name meds to treat (3 classes)

Fundo: see more white at optic disc than you should (increased cup:disc ratio) lose peripheral vision
1st line PG agonist (latanoprost = topical) increase US outflow
2. M agonists - increase trabecular outflow
3. Decrease humor prod via BBers, a2 agonists, carbonic anhydrase Is


Name defect that gives you galactose-emia presenting as infant w/ lethargy, vomiting and jaundice after started breastfeeding

Eat lactose -> glucose + galactose @GI
Galactose (galactose kinase) -> galactose 1 phosphate
HERE can't break down G1P b/c no GALT (G1P uridyl transferase) enzyme
Excess G1P -> galactic acid (broken down by HMP shunt) + galactitol (accum in cells)
Restrict lactose in diet


Describe difference between glioblastoma + oligodendroglioma

Glioblastoma = most common brain tumor adults
@ cerebral hemispheres, may cross as butterfly glioma
Big w/ necrosis + hemm -> watch midline shift
Oligodendroglioma = slow growing tumor of white matter of cerebral hemispheres, think well circumscribed gray masses with calcification


Name carpal bones if looking at top of hand (dorsum)

Thumb: scaphoid, lunate, triquetrum (can't see pisiform)
S + L both articulate w/ radius, FOOSH opten dislocates L w/ median nerve compression (coming thru carpel tunnel)
Thumb: trapezium, trapezoid, capitate, hamate


Cause of hydrocele in babies

Indirect inguinal hernia - don't obliterate processus vaginalis (forms tunica vaginalis) - communicate peritoneum and scrotum
Non-comm hydrocele = PV closed but fluid got trapped in TV on the way down
Comm hydrocele = PV open
Vs. direct inguinal hernia means contents go through ab wall maybe down into scrotum


What pathways does ethanol (aka booze) inhibit that results in drop in BG?

X gluconeogenesis @ liver
B/c increases NADH/NAD+ ratio
Drives/stops reactions increasing:
1. Lactate
2. Malate
During acute binge, BG maintained by glycogenolysis
Chronic binge means you can't make new glucose once those stores have been used
See high ketones


5 structures through superior orbital fissure

3 - oculomotor = adduction (med rectus)
4 - trochlear
5(1) branch - ophthalmic nerve = sensory limb of corneal reflex
6 - abducens
Sup ophthalmic vein
Vs optic canal carrying CN2 only
Vs. foramen rotunda comes out of skull into pterygopalatine fossa carrying 5(2) -> inf orbital fissure -> infraorbital foramen = infraorbital nerve
Vs 5(3) via foramen ovale


Describe what happens to renin, AGT 1 + 2, aldo, and bradykinin on ACE vs ARB

Renin coverts angiotensinogen to AGT1 @ liver
ACE converts AGT 1 -> 2 @ LUNGS
1. Increase renin, AGT1
2. Decrease AGT2, aldo (AGT2 stima aldo release)
3. Increase brady b/c ACE degrades brady = dry cough SE
ARB = AGT 2 blocker (losartan)
1. Increase renin, AGT1, AGT2
2. Decrease aldo
3. No change bradykinin
ARBs vasodilate b/c no AGT2 @ VSM


Explain difference between int + ext hemorrhoids

Int - above dentate line, columnar epi, innervate by inf hypogastric plexus = autonomic aka only response to stretch not pain, temp, touch
Ext - below dentate line, squamous, branch of pudendal = inf rectal nerve so very sensitive to touch temp pain
Dentate line (wavy line) divides upper 2/3 from lower 1/3 rectum


If pt gets infective endocarditis post-dental work, what underlying condition is more impt risk factor: mitral valve prolapse or RHD?

MVP valvular sclerosis and mechanical valves are larger RF in developed world since RHD is so rare


What is DRESS syndrome

After starting anti-convulsants, allopurinol, sulfonamides, and antibiotics
Facial edema
Diffuse red, spotty skin rash
Allergic rxn so high eos
vs. chemo drugs that can cause microangiopathic hemolytic anemia = schistocytes on peripheral smear


Define phenotype mixing

2 viruses in host
Progeny virion have nucleocapsid from 1 strain and unchanged parental genome of the other - no genetic exchange - next gen visions revert to original unmixed phenotypes


If you're going to use atropine to speed up bradycardia, how does this work and what is the CI?

Blocks vagal tone @ SA + AV
CI in glaucoma - M1 block -> dilation = narrow angle -> decrease aqueous outflow
Acute close angle glaucoma may result = unlit eye pain


How do statins work + SE

X HMG CoA reductase
IF can't make more cholesterol, increase clearance of LDL from circulation by liver
Increased LDL receptor cycling allows intrahepatic cholesterol levels to remain normal while blood levels are low
SE: myopathy


Effects on baby if you take this during preg:

Tetracyc - stain teeth
Chloramphenicol - gray baby synd
TMP SMX - neural tube defect (folic acid antag)
Aminoglycosides - ototx, vestibulotox


Symptoms of MS

Get worse in heat: decrease axon transmission
1. Optic problems including painful eye movement
2. Internuc opthalmoplegia (demy MLF)
3. Cerebellar dysfxn
4. Sensory/motor probs - bowel + bladder dysfxn


what 2 substances govern angiogen

Fibroblast growth factor
NOT EGF = mitosis of cells but not BVs


If you're thinking multiple myeloma - what cell will you see in bone marrow

Excess plasma cells
Basophilic - stain purple
Nuclei aren't center
Wagon wheel/clock face dist of nuclear chromatin
> 30% plasma cells = MM


Name the 5 types of hernias

1. Diaphragmatic: congenital, trauma, hiatal, sliding hiatal, paraesophageal
2. Indirect inguinal (men only) - covered by all 3 layers of spermatic fascia (L to inf epigastric)
3. Direct inguinal (M + W) - due to weakness in TRANSVERSALIS FASCIA, covered by ext spermatic fascia
4. Femoral
5. Umbilical - failure of umbilical ring to close "protrusion covered by skin w/ umbilical stump at center" (Down's)


If veins are enlarged in the FUNDUS of the stomach, which veins could be congested to cause this?

Short gastric veins drain to SPLENIC VEIN
Possible w/ chronic pancreatitis, pancreatic cancer or ab tumors
Since splenic vein runs along post surface of pancreas


How many fxnal parts of the duodenum are there and which section lies between the SMA and aorta?

4 sections
Duodenal bulb = pylorus -> neck of GB (sits behind liver + GB) - behind it = gastroduodenal art (ulcer), common biliary duct, portal vein
Section 3 = transverse, under SMA (L3 level)


What part of SI absorbs fat?

JEJUNUM - passive absorption of fat in micelles
Digested @ duodenum b/c add pancreatic enzymes + bile


Where is trypsinogen secreted and activated? How might you become trypsin def?

From pancreas
Brush border enteropeptidase activates -> trypsin (@ jejunum)
Then trypsin activates all other pancreatic proteases
If def b/c don't have fxnal BB enzymes: fat + protein malabsorption -> infant w/ diarrhea, fail to thrive, edema (due to low blood oncotic P)


What stimulates secretin secretion? 2 fxns

Acid stim when hit S cells in pancreas
1. Increase bicarb from pancreas @ DUCTAL CELLS
Big difference: CCK acts a pancreatic acinar cells (imagine flower: stem vs petals)
2. Increase bile secretion


When would you supplement an infant with vit D vs Fe?

Breast milk has no vit K or D
1. Get vit K shot at birth to prevent hmm disease of newborn
2. Supplement w/ vit D if exclusively breastfed + low in weight/length to prevent rickets
Also watch out for babies who get no sun exp or are very dark skinned
+ Fe if preterm or low birthweight b/c [Fe] breast milk decreases over time


Describe how the great vessels, trachea, and esophagus lay in relation to each other in the chest

Great vessels = most ant
Trachea middle = black w/ air
Esophagus most post lying on top of spine -> is typically collapsed w/ no visible lumen


Describe the XR findings for TEE, duodenal atresia, and intestinal atresia

TEE - air in stomach
Duodenal atresia = double bubble (pyloric sphincter)
Intestinal atresia = tripple bubble (PS + ligament of treitz)


If a baby presents with an abd cyst that is connected by a fibrous band to the ileum and the umbilicus - what kind of duct abnormalities are you thinking?

Vitelline duct = connects midgut with yolk sac
1. Persistent duct - get meconium discharge from umbilicus
2. Meckel diverticulum - part of SI still attached and pulled toward = diverticulum
3. Vitelline sinus = partial closure w/ patent portion open at belly button
4. Duct cyst (question stem)


What is your landmark if you can't find the appendix by palpation during removal?

Taniae coli = longitudinal muscle of the colon
Exists as 3 longitudinal bands - contract to form hausta (which aren't helpful b/c they are the same throughout the colon)
Converge at root of the appendix


Ulcer that penetrates through the lesser curve of the stomach would perf what artery

L (upper) or R (lower) gastric - both off celiac trunk


Describe 3 parts of volvulus

Incomplete rotation of the gut in utero results in
1. Cecum in RUQ
2. Fibrous bands connecting the RLQ retroperitoneum to the R colon by passing over duodenum -> SI obstruction = bilious emesis
3. Possible occlusion of SMA due to rotation around it


What are you thinking:
3 days old - green vomit
Normal appearing duodenum
Absence of segment of jejunum + ileum
Remainder of distal ileum winding around thin vasc stalk

INTESTINAL ATRESIA due to vasc occlusion


What causes the pain associated with appendicitis?

Early appendicitis = organ distension = carry by afferents of ANS = visceral ab pain = poorly localized therefore why ppl first present with epigastric pain
Later = irritate ANT parietal peritoneum aka ab wal - more severe pain that shift to more local location


Structures in the hepatoduodenal ligament

Common bile duct
Hepatic art
Portal vein


What is the metyrapone stim test - what does it test for? How does it work?

Tests CRH -> ACTH -> cortisol axis
Block the production of cortisol @ ZFasiculata
SHOULD see a rise in ATCH is the axis is intact
Metyrapone X 11 B hydroxylase - increase 11 deoxycortisol (precursor for the reaction) -> metabolizes as 17 OH corticosteroid -> out via urine
If don't see rise in 11/17 cortisol products you know it is an ADRENAL problem


What are the actions of mifepristone + misoprostol as the dual drug regimen to terminate a pregnancy?

Mifepristone = P antagonist, binds w/ greater affinity than P, necrosis of uterine decida
Misoprostol = PROSTaglandin E1 analog, cervical softening + uterine contractions so pregnancy can be expelled
Vs MTX = folate antagonist, used for ectopic or to term pre if M/M regimen not avail


Describe the problem leading to epispadias vs hypospadias vs bifid scrotum

F urogenital folds (same thing as URETHRAL folds) dont fuse = labial minora
Hypospadias = urethra on BOTTOM of penis (hypo = under) b/c fail fuse urogenital folds
Epispadias = urethra on TOP b/c faulty position of genital tubercle (becomes the penis in M, clitoris in F)
Bifid scrotum = malunion of LABIO SCROTAL folds (labia MAJORA in women)


Name the group of muscles responsible for forearm flex, wrist flex, wrist extension

Wrist extension (origin @ LAT epicondyle "tennis elbow" b/c of backhand) = extensor digitorum + extensor carpi radialis brevis
Wrist flexion (MED epicondyle, "golfer's elbow")
Forearm flex = biceps, brachialis, brachioradialis


What stage is an egg arrested in before fertilization?

3. Metaphase of meiosis 2!!! How released from ovary
Fertilization allows progress to telophase 2 (barr body 2)
2. Makes sense - meiosis 1 gets you half chromosome # (barr body 1)
1. Eggs also arrest in prophase of meiosis 1 before puberty


Describe the presentation and nerve injured by ant dislocation of humerus

Happens when hit arm during throw - ext rot + abduction
1. Flattening of deltoid
2. Protrusion of acromion
Ax nerve injury - abduction of should BEYOND 1st 15 degrees via deltoid and teres minor + sensory to skin over lateral shoulder


Describe complete vs partial hydatidiform moles

Complete "bunch of grapes", snowstorm on US
1. Completely formed - diploid chromosomes aka fertilized
2. Completely a mole - no fetal tissue b/c empty ovum that was fertilized, completely edematous vili
*p 57 negative b/c no maternal genome*
3. Complete covering of vili in blasts = higher BhCG - causes THECA LUTEIN CYSTS
4. Complete risk of choriocarcinoma - why you monitor BhCG after D&C removal
Partial = normal ovum fert by 2 sperm (69 chromosomes) -> fetal tissue present, some vili, focal trophoblastic proliferation, minimal risk for chorio


What would high AFP protein in a preg woman suggest?

Neural tube defects, twins, ab wall defects


Which GP bug presents w/ GREY pharyngeal exudate? Name everything you know about this bug

Clost diptheriae
1. Resp droplets
2. Rods - multiple form V or U shape
3. Metachromatic granules inside that stain red vs the cell blue
4. Toxin riBOWsylates EF2 -> no protein synthesis
5. Toxoid vaccine // treat w/ anti toxin
6. To dx if bacteria present, grow on Loeffler's or cysteine-tellurite agar
7. To det toxic vs non toxic strains do Elek (E lick) test
8. Grey pseudomembranes pharyngitis -> toxin damages nerve fibers can have post pharyngitis paralysis of CNs
9. Cervical LNs = bull's neck
10. Toxin is cardio tox: myocarditis, arrhythmia, heart block


Describe the empty can test for the shoulder

Isolates supra
"Pour one out"
Abduct humerus in parallel to axis of scapula (30 degrees forward flexion) while in full int rotation (thumbs to floor)
Push down - can't stay up supra problem
Supra does 1st 15 degrees abduction until deltoid takes over


What BB do you use for thyroid storm - why?

1. Decrease HR
2. Decrease peripheral conversion T4 -> T3 b/c X iodothyronine deiodinase
Change TH synthesis and release by + iodine and blocking thyroid peroxidase respectively
Remember T3 = active form, binds receptor in the NUCLEUS


Describe how glycogen degradation is increase with skeletal muscle contraction

More glycogen degraded w/ contracting skeletal muscle
Glycogen -> glucose 1 P via glycogen phosphorylase
GP is activated by phosphorylase kinase, 2 things up reg activity of this in skeletal muscle
#1 = Ca from contracting muscle
#2 = E induced increase cAMP
GP is inactivated by phosphoprotein phosphatase
Remember that PK in liver is different and is activated by E/glucagon binding Gs receptors for glycogen breakdown


Describe all of the different blots - how is a Western blot different than ELISA

Southern = DNA, North = RNA, West = protein, SW = DNA binding proteins (TFs)
1. Sep proteins via electrophoresis
2. Move to nitocell membrane + probed Ab for protein of interest
Vs ELISA = testing pts serum directly (vs electrophoresis first)


What factor determine peak bone mass vs bone loss

Peak bone mass = genetics (similar curves with space between)
Bone loss = exercise, diet including alc or smoke, steroid use, premature meno (curves with different slopes)


Why is resting membrane potential -70mV instead of the potential for K = -80mV?

Small number Na channels that allow flow of Na into cells decreasing membrane potential
Remember membrane potential ext by ATP as to put 3 Na out and 2K into cell - high [K] in cell, high [Na] outside


Name 2 meds that should be avoided in pts with hypertrophic CM

HCM gets worse if you decrease LV volume
1. Vasodilators (DHP Ca CBs, nitroG, ACE Is) - decrease TPR, decrease afterload, lower LV vol = more friction between the outflow tract
2. Diuretics = decrease preload so same problem
Meds that reduce LV outflow tract obstruction:
Non-DHP Ca CB, disopyramide, BBers


If you're on prednisone for a long time, what happens to your HPA axis?

Like having a ton of cortisol in circulation = lots of -FB = low CRH, ACTH, cortisol
So pt can't adequately respond to stressful situations - infection, surg - you have to increase dose to prevent steroid def = *hypotension, shock*
Can cause adrenal atrophy - why you need to gradually pull pts off steroid to avoid adrenal insuff


Which anti-emetics do you use for motion sickness vs chemo? Describe SE

Motion sickness
1. Anti-M = scopolamine
2. Ant-H = diphendyramine, meclizine, promethazine
Anti chol SE: blurry vision, dry mouth, urine retent, constipation
1. D R antag = prochlorperazine, metoclopramide = diarrhea
2. S R antag = ondansetron, granisetron
3. NK 1 R antag = aprepitant, fosaprepitant


Mechanism + SE of metaglitinides

= repaglinide, nateglinide
DIABETES - short acting glucose lower
Mech: X ATP dep K channel @ pancreas B cell -> depol -> open Ca channel -> insulin release
Same mech as sulfonylureas
SE: hypoG, weight gain


What is your dx for pt with pancytopenia WITHOUT splenomeg? What does the bone marrow look like?

Aplastic anemia
BM is hypocellular - mostly fat and stroma, "dry tap"
Bone marrow is how you differentiate between this and other pancyto w/o spleno:
- Combined b12 + folate def anemia
- Acute leukemia
- Some myelodysplastic syndromes


Describe metformin mechanism + SE - what are you going to check before starting this med?

X 1st ETC enzyme -> decrease cellular E stores
Causes AMPK activation = less hepatic gluconeo
Increase peripheral glucose utilization
- Increases intestinal production of lactate since these cells can't use ETC for aerobic glycolysis // decreases liver metabolism of lactate since less gluconeo
Check Cr (renal) before starting
CI w/ CHF or alcoholic b/c increase risk SE


Describe the difference between rubeola and rubella

Rubella = TOGAvirus = maculopapular rash begins on face and spreads to trunk/limbs
Spreads fast and does not coalesce like rubeola
**Post auricular and occipital lymphadenopathy**
Rubeola = paramyxovirus = measles = similar but rash may join together and w/o LNs


Describe the hormones levels of pt with cryptorchidism

Undescended testes
Body heat will make seminiferous tubules atrophic - lose Sertoli cells
1. Low sperm count = infertile
2. Sertoli cells not making inhibin to FB to pit -> increase FSH
Leydig cells in tests are in the matrix between tubules and NOT heat sen -> continue to produce testosterone -> feeds back to hypothal = normal LH and testosterone levels (normal sex characteristics + drive)


Describe minimal change disease

Associated with allergies or after an infection or immunization
Overproduction of cytokines: effacement of podocytes on EM
Lose neg charge of GBM - lose ONLY albumin into urine: kid presents with generalized (esp periorbital) edema
Maltese crosses on urine analysis


Equation for renal blood flow

RBF = PAH clearance / renal plasma flow
= (PAH urine/serum x urine flow rate) / 1-Hct


Mechanism and SE of colchicine

X tubulin polymerization (aka the cytoskeleton)
GOUT - treats flares or with allopurinol chronically
SE = DIARRHEA, N, ab pain


Mechanism and SE of warfarin

Mech = X vit K dep coag gactors
Also decreases protein C + S (both anti-coat)
Protein C has short t1/2 so it activity is quickly reduced when you start warfarin
During this time it K factors dominate as PRO coag
SE = warfarin induced skin nec b/c transient hypercoag state that happens when you first start warfarin
Clot that blocks BF to skin -> nec