Will's random shit

Question 1

Baker Cyst

Answer 1

Site is at popliteal artery (Associated with arthritis) = outpouch swelling behind knee of synovial pouch/fluid

Question 2

Most common peripheral artery aneurism

Answer 2

popliteal artery at popliteal fossa

Question 3

Winter’s Formula What is it used for? what is the formula?

Answer 3

Used to evaluate respiratory compensation during metabolic acidosis. Answers the question, is there a concurrent respiratory alkalosis/acidosis? PaCO2= (1.5xbicarb) + 8 +- 2

Question 4

Superior gluteal nerve damage cause s.s

Answer 4

cause: L4-S1; posterior hip dislocation or polio Innervates gluteus medius, minimus, and tensor fascia lata Trendelenburg sign; while walking patient hip will drop to unaffected side cannot abduct thigh

Question 5

Obturator nerve damage Cause s/s

Answer 5

L2-4, anterior hip dislocation Innervates medial thigh. Will have troble with thigh adduction and medial skin sensory

Question 6

Femoral nerve damage Cause S/s

Answer 6

L2-4; pelvic fracture Supplies muscles to anterior thigh and skin (some medial leg) Damage: cannot flex thigh to body or extend leg from knee. -absent patellar reflex

Question 7

Common peroneal vs tibial nerve cause s/s

Answer 7

Both supplied by sciatic (posterior thigh splits into peroneal and tibial) dmg:lateral leg fibular dmg PED: Peroneal, Everts, Dorsiflexes -> Dmg = foot dropPED dmg: knee/tibial trauma TIP: Tibial, Inverts, Plantar flex -> Dmg = cannot stand on TIPtoe

Question 8

Inferior gluteal cause s/s

Answer 8

posterior hip dislocation cant jump, climb stairs, rise from seat…. can’t push down

Question 9

serratus anterior damage and innervation

Answer 9

innervated by long thoracic nerve attatched lateral ribs 1-8 and medial border of scapula dmg -> winging of scapula; holds it in place in order to abduct arm

Question 10

cancellous bone =?

Answer 10

cancellous = spongiosa/spongy bone = trabecular bone

Question 11

cortical bone

Answer 11

hard, supporting bone, most of the peripheral limb bones

Question 12

osteopetrosis

Answer 12

normal bone marrow is filled with spongy bone, bones are harder but more brittle

Question 13

HLA subtype associated with disease HLA-A3

Answer 13

Hemochromatosis HLE gene assoc with C282Y chromosome 6

Question 14

HLA subtype associated with disease HLA-B27 (4)

Answer 14

Psoriasis, Ankylosing spondylitis, Inflammatory Bowel Disease, Reiter’s sundrome(reactive arthritis)

PAIR: seronegative spondyloarthropathies

Question 15

HLA subtype associated with disease HLA-DQ2/DQ8

Answer 15

Celiac disease

Question 16

HLA-DR2 (4)

Answer 16

MS, hay fever, SLE, goodpastures, UC

Question 17

HLA subtype associated with disease HLA-DR3 (2)

Answer 17

DM I, Graves disease

Question 18

HLA-DR4 (2)

Answer 18

RA, DM I

Question 19

HLA-DR5

Answer 19

Pernicious anemia Hashimoto’s thyroiditis

Question 20

HELLP syndrome associations and acronym

Answer 20

Hemolysis (microangiopathic) Elevated Liver enzymes (likely as above) Low Platelets (part of activated coag cascade) -associated with pre-eclampsia

Question 21

Pre-eclampsia risk factors (4) and definition

Answer 21

DFN: HTN, Proteinuria, edema post 20wks up to 6 wks after delivery (occurs in 7% of women) RISKS: HTN, DM, CKD, Autoimmune problems Tx; delivery, bed rest, tx htn, Iv mag if seizures

Question 22

Gardeners syndrome

Answer 22

FAP (chrom 5q, Aut Dom, tumor suppressor) + with osteomas and soft tissue tumors, congenital hypertrophy of retinal pigment

Question 23

Turcot’s Syndrome

Answer 23

FAP + malignant CNS tumors (medulloblastoma/glial cell) Turcot = Turban

Question 24

Trisomy 18

Answer 24

Edwards Syndrome (Election age at 18) 2nd most common trisomy in LIVE births S/S low set ears, clenched fist, prominent brow, microcephally (and basically any neural tube defect), rocker bottom feet, (E)dwards has low Estradiol **death in a year

Question 25

Trisomy 13

Answer 25

Patau's syndrome (Puberty at 13) S/S prosencephally, polydactyly, omphalocele, NUCHAL TRANSLUCENCY \*\*DOES NOT HAVE clenched hands/overlapping fingers \*\*\*Death in a year

Question 26

47 XXX

Answer 26

typically clinically silent

Question 27

Congenital microdeletion of 5p

Answer 27

Cri-du-chat chr5 short arm deletion, S/S microcephaly, mental retardation, high pitch cry/mewing, VSD

Question 28

Williams syndrome

Answer 28

Chr.7 deletion (includes elastin S/S elven facies, intellectual disability, hypercalcemia (increased Vit D sensitivity), well developed verbal skills, too friendly with others. CVD problems

Question 29

Tumor marker PSA

Answer 29

Follow prostate carcinoma. may be elevated in BPH. Questionable as screening tool

Question 30

Tumor marker Prostatic acid phosphatase

Answer 30

Prostate carcinoma. remember that tumor markers shold not be used as primary tool for diagnosis. Have to do histology

Question 31

Tumor marker CEA

Answer 31

nonspecific, but produced by 70% colorectal and pancreatic CA may also be in gastric, breast, medullary thyroid carcinoma

Question 32

Tumor marker alpha fetoprotein

Answer 32

hepatocellular carcinoma nonseminomatous germ cell tumors (yolk sac)

Question 33

Tumor marker b-hcg

Answer 33

hyadidiform mole choriocarcinoma

Question 34

Tumor marker ca-125

Answer 34

Ovarian cancer

Question 35

Tumor marker s-100

Answer 35

melanoma, neural tumors, schwannoma

Question 36

alk phosphatase

Answer 36

metastases to bone, liver, pagets disease of bone

Question 37

bombesin

Answer 37

neuroblastoma, lung, gastric cancer

Question 38

TRAP

Answer 38

hairy cell B cell leukemia

Question 39

CA 19-9

Answer 39

pancreatic adenocarcinoma

Question 40

calcitonin

Answer 40

medullary carcinoma of the thyroid (c cells)

Question 41

Charcot-Bouchard microaneurysm What are they? Where?

Answer 41

Small \< 1mm diameter aneurisms in basal ganglia, internal capsule, thalamus Associated with long standing HTN. \*\*They're intrparenchymal

Question 42

Multiple intraparenchymal hemorrhages in an elderly person Cause?

Answer 42

B-Amyloid cerebral angiopathy. Not associated with systemic amyloidosis or alzheimers.

Question 43

Berry aneurysm/saccular aneurysm

Answer 43

Occurs at bifercations of circle of willis (most commonly ACA). -\> subarrachnoid hemorrhage RISK: ADPKD, ehlers danlos, marfan, smoking, htn

Question 44

end plate potential

Answer 44

The voltage change at the site of NMJ interaction (the immediate response to acetylcholine binding)

Question 45

CD31

Answer 45

PECAM-1: expressed on endothelial cells. Helps migration/diapedesis. \*\* Can be used to differentiate tumor origin

Question 46

CD 16

Answer 46

Fc receptor

Question 47

CD18

Answer 47

Integrin

Question 48

CD 14

Answer 48

LPS PAMP on macrophages

Question 49

munro microabscesses = ?

Answer 49

Neutrophils in stratum corneum in psoriasis

Question 50

parakeratosis

Answer 50

hyperkeratosis with retention of keratinocyte nuclei in stratum corneum (psoriasis) psoriasis also causes acanthosis (stratum spinosum hyperplasia)

Question 51

specialized vs generalized transduction

Answer 51

Lysogenic cycle: virus just chilling specialized is when bacterial gen ends up in viral capsid what was close to the viral insertion point in the DNA Lytic cycle: virus kills cell Generalized is when the cell bursts and random DNA is incorportated during cell death

Question 52

Melanoma common mutation? Tx?

Answer 52

Common BRAF kinase mutation Tx; excision 2nd vemurafenib (BRAF kinase inhib) if BRAF +

Question 53

Achondroplasia mutation inheritance

Answer 53

mutation is activation of FGFR3 which inhibits chondrocytes inherited AD, but usually sporatic mutation, associated with advanced PATERNAL age

Question 54

Osteogenesis Imperfecta Inheritance how blue sclera?

Answer 54

AD usually collagen type I Blue sclera from thin sclera, you can see the choroidal veins (which are part of the vascular network btw the sclera and retina

Question 55

Osteomyelitis seeding children? adults?

Answer 55

Children bacteria seed the metaphysis Adults the epiphysis is most commonly seeded

Question 56

Causes of aseptic necrosis of bone

Answer 56

#Trauma/fx (most common) #steroids #Caisson disease (decompression sickenss with nitrogen occluding bone vasculature

Question 57

Osteomyelitis causes (6)

Answer 57

Staph aureus; most common (90%) N gonnorrhoeae- sex Salmonella- sickle cell pseudomonas- diabetics/drug users Mycobacterium tb- pott's disease (vertebrae)

Question 58

invasive gastroenteritis organisms

Answer 58

salmonella, shigella, campylobacter, EIEC, + enameoba histolytica

Question 59

suprachiasmic nucleus

Answer 59

hypothalamic nuclei: regulates sleep

Question 60

what's the most commonly injured ankle ligament

Answer 60

from INVERSION injury and tear of ATFL, anterior talofibular ligament "always tear first ligament" 2nd: calcaneofibular ligament 3rd: posterior talofibular ligament

Question 61

What is the medial ankle ligament?

Answer 61

deltoid ligament

Question 62

dorsal interosseous muscles do what? palmar interosseous muscles do what?

Answer 62

DAB: Dorsal abduction PAD: palmar adduction

Question 63

Tumors that like to metastasize to bone

Answer 63

Prostate -\> blastic lesions\*\*\* Renal Cell Carcinoma Testicular/Thyroid Lung -\> lytic lesions Breast -\> lytic/blastic "Permanently Relocated Tumors Like Bone" \*\*\*most are lytic except prostate

Question 64

Tuberous Sclerosis findings

Answer 64

HAMARTOMAS Hamartoma's of CNS and skin Adenoma sebaceum (cutaneous angiofibromas) Mitral regurgitation Ash-leaf spots Rhabdomyoma (cardiac, benign) Tuberous sclerosis dOminant (autosomal) Mental retardation Angiomyolipoma (renal) Seizures variabille expressivity, incomplete penetrance hamartin or tuberin protein mutation

Question 65

Pseudogout What deposition and where Diagnosis Tx

Answer 65

Deposition of calcium pyrophosphate in joint space usually of larger joints (knee) Basophilic thomboid crystal weak positive birefringence blue on parallel light (vs gout which is yellow on parallel light) Tx; NSAIDS, steroids, colchicine

Question 66

Actinic keratosis

Answer 66

precursor to squamous cell carcinoma (dysplastic)

Question 67

keratoacanthoma

Answer 67

Squamous cell carcinoma that grows rapidly (4-6 weeks) and may regress spontaneously. characterized by keratin cup filling the center.

Question 68

What is the most common cancer from immunosuppressive therapy?

Answer 68

Squamous Cell carcinoma

Question 69

Which type of sunlight is the worst for cancer dmg? Which type is responsible for sunburns? How about tanning

Answer 69

UVB -\> cancer and sunburns UVA -\> less cancer, tanning

Question 70

What enzyme in the kidney inactivates 25-dihydroxy vitamin D?

Answer 70

24-hydroxylase in the kidney may inactivate it -\> 24,25-dihydroxy vitamin D

Question 71

What are the two ligands for osteoclast differentiation? Where do they come from? What cell lineage do osteoclasts come from?

Answer 71

RANKL and M-CSF (macrophage colony stimulating factor), comes from osteoblasts, the lineage is from mononuclear cells

Question 72

osteoblast cell lineage? chondrocyte cell lineage?

Answer 72

Both come from mesenchymal stem cells

Question 73

What are you thinking if you have a fat tumor with lipoblasts?

Answer 73

lipoblasts= Liposarcoma (most common malignant soft tissue tumor in adults), vs lipoma which is most common benign.

Question 74

What is most common malignant soft tissue tumor in children?

Answer 74

Rhabdomyosarcoma classic site is vagina in female (grape like protrusion)

Question 75

Dermatomyositis S/S Labs associations tx;

Answer 75

proximal muscle weakness with skin symptoms (malar rash, gottron's papules (papules on nuckles), heliotrope rash (eyelids). "mechanic hands, shawl and face rash" CD4+ t cell perimysial inflammation and atrophy. Labs: Increased CK, positive ANA, positive anti-jo-1 \*associated with malignancy (often gastric) Tx; steroids \*\*This condition is in contrast to polymyositis that's endomysial, increased MHC I, no skin involvement. Similar labs and Tx. Not associated with malignancy

Question 76

What is urushiol?

Answer 76

a small substance that acts as a hapten (must attach to random protein to become allergenic) -poison oak, sumac, and Ivy all have urushiol type Iv

Question 77

What does Alpha 1 antitrypsin stain?

Answer 77

Stains purple with PAS (periodic acid schiff) Smoking makes the disease worse by oxidizing and inactivating the antitrypsin at a methionine residue

Question 78

3 causes of HIV esophagitis

Answer 78

1) candida 2) HSV-1 vesicles -\> punched out erosions 3) CMV linear ulcer/erosions

Question 79

HLA DR1

Answer 79

Chrohn's predisposition

Question 80

femoral neck fracture most commonly injures which vessel

Answer 80

the medial circumflex femoral bc it supplies the majority of the blood supply to head and neck (injury = avascular necrosis)

Question 81

What artery supplies the SA and AV nodes?

Answer 81

RCA

Question 82

If you have increased AFP in serum/amniotic fluid, what's a helpful confirmatory test for neural tube defect?

Answer 82

Elevated AChE \*\*these elevations are from failure of neural tube(spinal canal) to close and a persistent connection with the amniotic cavity.

Question 83

signs of anencephaly risks

Answer 83

increased AFP, AChE, polyhydramnios (lost swallowing center in brain) --brain develops normally but acidic amniotic fluid destroys it RISKS: maternal DM I, and low folate

Question 84

Risks of holoprosencephaly

Answer 84

patau's (trisomy 13), fetal alcohol syndrome Sonic Hedgehog mutations

Question 85

GFAP

Answer 85

astrocyte marker (intermediate filament) used to ID tumors ie: glioblastoma benign pilocytic astrocytoma

Question 86

Microglia response to HIV infection in cns

Answer 86

become multinucleated giant cells

Question 87

Large clear fired egg appearance found in (3)

Answer 87

oligodendrocytes koilocytes of HPV infection Seminoma

Question 88

guillan-Barre S/S Damage to what? Risks

Answer 88

S/S ascending bilateral plegia/paresis/paresthesia (hands and feet) Damage to schwann cells Risk: campylobacter or CMV infection

Question 89

Bilateral acoustic neuroma

Answer 89

Neoplasm of schwann cells NF-2

Question 90

Who does reactive gliosis?

Answer 90

Astrocytes (the support cells with fibroblast like scar tissue repair)

Question 91

what embryologic origin are ependymal cells derived from?

Answer 91

Neural ectoderm

Question 92

wallerian degeneration

Answer 92

dmg to axon with proximal retraction and distal degeneration

Question 93

Fenestrated regions of BBB

Answer 93

area postrema -\> vomiting esp after chemo) OVLT- osmotic sensing (organum vasculosum of the lamina terminalis) hypothalamic input and output permeat BBB such as part of neurosecretory product: ADH, oxytocin

Question 94

location of NE production in brain what lvls associated with anxiety and depression?

Answer 94

locus ceruleus (pons) increased in anxiety decreased in depression

Question 95

location of dopamine production in brain lvls assoc with schizo, parkinsons, depression

Answer 95

ventral tegmentum in midbrain (-\> cortex or -\> limbic) SNc -\> neostriatum schizo is increased dopamine mesolimbic (positive symptoms) vs decreased mesocortical (negative symptoms), parkinsons is decreased, depression is decreased

Question 96

Serotonin location and association with anxiety and depression

Answer 96

raphe nucleus (pons) decreased in anxiety and depression

Question 97

ACh CNS location and assoc with alzheimers, huntingtons, REM sleep

Answer 97

ACh is basal nucleus of meynert alzheimers decreased (meynert degeneration) huntingtons decreased REM sleep increased

Question 98

GABA location and assoc with anxiety and huntingtons

Answer 98

Nucleus accumbens (reward center), decreased in anxiety and huntingtons (causes choreoform from excess muscle excitation)

Question 99

Glycine neurotransmitter

Answer 99

main inhibitor in spinal cord GABA is main in CNS

Question 100

Reticular Activating System does what?

Answer 100

mediates attentiveness and consciousness its in midbrain and above

Question 101

Schizophrenia dopamine issues

Answer 101

you have increased dopamine in limbic system -\> positive symptoms you have decreased dopamine in cortex -\> negative symptoms

Question 102

What is the bundle of bilateral nerves that link broca's area in the frontal cortex to wernicke's area in the temporal lobe?

Answer 102

Arcuate fascicles

Question 103

Where does the vagus nerve run in the neck?

Answer 103

Within the carotid sheath with the common carotid and internal jugular vein

Question 104

blood supply to brain stem and cerebellum?

Answer 104

basalar artery (also pontine aa supply pons) and vertebral arteries,

Question 105

Conduction aphasia

Answer 105

poor repetition (cannot repeat no ifs ands or buts) can comprehend and speak fluently dmg; arcuate fasciculus

Question 106

global aphasia

Answer 106

nonfluent aphasia with impaired comprehension. Broca(nonfluent) and wernicke's(fluent) fucked up

Question 107

Dysprosody dmg result

Answer 107

damage is non dominant hemisphere brocas: cannot express emotions/inflection wernicke's: can't understand emotion/inflection

Question 108

Gerstmann syndrome

Answer 108

lesion to dominant angular gyrus (left sided parietal lobe) -agraphia (inability to write) -acalculia (bad math) -R/L disorientation -finger agnosia (can't tell difference)

Question 109

Hemispatial neglect

Answer 109

lesion to nondominant parietal lobe (draw clock on one side, don't shave)... usually right sided

Question 110

Frontal cortex lesion

Answer 110

disinhibition, poor judgement, primitive reflexes

Question 111

prefrontal cortex

Answer 111

poor executive function

Question 112

Frontal eye field lesion (which is in cortex/controls eye movement)

Answer 112

lesion wil deviate eyes ipsilateral to lesion

Question 113

PPRF lesion: paramedian pontine reticular formation pontine area

Answer 113

eyes will deviate contralateral to lesion it's in the medial pons near MLF

Question 114

Superior colliculus lesion (parinaud's syndrome) in brainstem

Answer 114

paralysis of upward gaze (they look downward) can occur from pineal gland germ cell tumor or stroke

Question 115

RAS damage

Answer 115

stupor and coma

Question 116

hippocampus lesion bilaterally limbic system

Answer 116

anterograde amnesia (cannot make new memories)

Question 117

mamimillary body lesion limbic system

Answer 117

wenicke korsakoff: eyes, lies capsize confusion, confabulation, ataxia, memory loss (anterogrand and retrograde amnesia) Don't give glucose without B1 to B1 deficient patient (may precipitate condition

Question 118

amygdala limbic system

Answer 118

bilateral amygdala lesions kluver bucy syndrome: hyperorality (likes putting things in mouth), hypersexual, disinhibited behavior (not afraid), docile, extreme curiosity HSV 1 association

Question 119

Hemiballismus

Answer 119

lesion of subthalamic nucleus lesion involuntary flailing of one arm

Question 120

what cerebellar lesion could produce dysarthria?

Answer 120

cerebellar vermis lesion

Question 121

Nuclei locations of CN's

Answer 121

1 2 forebrain 34 midbrain 5678 pons "5 6 7 8 cheer with pom pons" 9 10 12 medulla 11 spinal cord

Question 122

homonymous hemianopsia

Answer 122

lesion of optic tract (not nerve) with one sided visual loss

Question 123

lesion of center of visual field

Answer 123

lesion of macula (ie macular degeneration)

Question 124

homonymous hemianopsia with macular sparing

Answer 124

lesion of posterior cerebral artery. Macula is spared bc it gets collateral from middle cerebral (its important)

Question 125

myopia

Answer 125

near sighted, predispose to retinal detatchement. retinal detatch also associated with diabetic traction and inflammatory effusions

Question 126

What conditions can cause a facial nerve palsy?

Answer 126

ipsilateral FULL FACIAL paralysis vs motor cortex contralateral lesion of just lower face "Lovely Bella Had An STD" -Lyme disease -Bells palsy = idiopathic -HSV and zoster (likely termed idiopathic) -AIDS -sarcoidosis -tumors -diabetes

Question 127

The second arch contributes to what in the human?

Answer 127

facial nerve muscles (muscles of facial expression) and cnVII

Question 128

Describe motor cortex lesion of face (like in a stroke)

Answer 128

motor cortex contralateral lesion of just lower face bc lower facial muscle is just innervated by contralateral side. Upper face is innervated by both sides of motor cortex So in acute presentation of face check eyebrows!!! if can move it's probably a stroke, if not, likely facial nerve palsy

Question 129

CN V (trigeminal) exit from skull

Answer 129

"Standing Room Only" -superior orbital fissure (w/3,4, 5, 6 -Rotundum -ovale

Question 130

VII-XII exit

Answer 130

In posterior cranial fossa (temporal or occipital bones) VII-VIII internal auditory meatus IX,X,XI through jugular foramen XII hypoglossal canal

Question 131

vagus nerve damage, uvula will deviate which direction?

Answer 131

To the opposite side of damage. Because the vagus elevates the soft papate

Question 132

Nucleus Ambiguous innervation

Answer 132

aMbiguous: MOTOR innervation to pharynx, larynx, upper esophagus. SWALLOW AND SPEECH vaGUS from ambiGUUS IX, X cortical lesions affect both sides, no deviation

Question 133

For hypoglossal lesion, what is the deficit?

Answer 133

CN XII is intrinsic tongue movement. tongue licks the lesion. deviate toward lesion cortical lesions affect both sides, no deviation

Question 134

gag reflex test

Answer 134

CN IX, X IX is afferent, X efferent

Question 135

cavernous sinus lesions

Answer 135

CN III, IV, VI pass through (opthalmoplasia with double vision) + V1 -\> pain upper opthalmic branch V2 also passes through going down and medial: 3,4,V(1),V(2),6 internal carotid and postganglionic sympathetics also present there

Question 136

Tongue sensation and movement

Answer 136

movement: XII somatosensation: trigeminal mandibular branch along with gums (anterior 2/3), post 1/3 is glossopharyngeal taste: ant 2/3 facial, post 1/3 glossopharyngeal, very back vagus

Question 137

Nucleus Solitarius

Answer 137

A vagal nuclei VII, IX, X Sensory: taste, baroreceptors (carotid IX, aortic X), gut distension

Question 138

where do the dorsal columns decussate?

Answer 138

The medulla, becoming the medial lemniscus

Question 139

Vagal Dorsal motor nucleus

Answer 139

X sends parasympathetic to heart, lungs, upper GI

Question 140

Where is the inferior olivary nucleus?

Answer 140

medulla

Question 141

what artery supplies antero-medial part of medulla?

Answer 141

anterior spinal

Question 142

what artery supplies the nucleus ambiguus?

Answer 142

PICA

Question 143

Z = what for the 95% CI and 99% CI

Answer 143

Z= 1.96 Z= 2.58

Question 144

what is the corticobulbar/corticonuclear tract?

Answer 144

brings motor from cortex to brainstem, carrying the non-oculomotor CNervs

Question 145

What does the posterior internal capsule carry?

Answer 145

Most of corticospinal tracts and somatic sensory, visual, and auditory fibers

Question 146

what does the anterior internal capsule carry?

Answer 146

some of the thalamocortical fibers

Question 147

where is the substantia nigra?

Answer 147

midbrain ventral tegmentum is there too (midline midbrain assoc with reward pathways) [http://what-when-how.com/wp-content/uploads/2012/04/tmp15F10\_thumb.jpg](http://what-when-how.com/wp-content/uploads/2012/04/tmp15F10_thumb.jpg)

Question 148

dopamine is increased or decreased in reward pathways?

Answer 148

It's increased (as in drugs of abuse) in the mesolimbic pathway (same area of positive symptoms of psychosis)

Question 149

Leber hereditary optic neuropathy

Answer 149

A mitochondrial inherited disease (heteroplasmy) leads to bilateral vision loss

Question 150

Myoclonic epilepsy with ragged red fibers

Answer 150

Heteroplasmy inherited: myoclonic seizures and myopathy associated with excercise. Skeletal muscle biopsy shows ragged red fibers

Question 151

Mitochondrial encephalopathy with lactic acidosis and stroke like epilepsy (MELAS)

Answer 151

Heteroplasmy: stroke like episodes, muscle weakness, increased serum lactate post exercise and at rest

Question 152

UC difference in crc from sporatic

Answer 152

1) progress from flat nonpolypoid dysplasia 2) early p53 mutation 3) proximal colon involvement 4) mucinous w/signet ring 5) multifocal 6) affect younger pts

Question 153

thymoma differential

Answer 153

1) pure red cell aplasia (or parvo or some lymphocytic leukemia's) autoantibodies 2) myasthenia gravis

Question 154

Rule of 4's

Answer 154

1) 4 medial structures with M -motor (corticospinal) -\> contralateral motor -medial lemniscus -\> contralateral sensory -medial longitudinal fasciculus (MLF) -\> ipsilater internuclear opthalmogplegia -motor cranial nerves (as below) 2) 4 lateral with S -spinocerebellar (coordinates movement ipsilateral) -\> ips ataxia -spinothalamic tract (pain/sense) -\> contralateral affected -sensory nucleus CN V -\> ipsilateral pain/temp on face -sympathetic pathway -\> ipsilateral horners 3) 12 34 5678 9,10,12 11 4) The medial motor CN nuclei divide into 12: 3,4,6,12

Question 155

Wallenberg syndrome

Answer 155

PICA syndrome Lateral medullary lesion: 9 10 12 (some of V) spinothalamic: contralateral pain/temp trigeminal nucleus (huge) : ipsilateral face pain/temp Nucleus ambiguous: difficulty swallowing/hoarse voice descending sympathetic: ipsilateral horners vestibular nucleus: vertigo/nystagmus inferior peduncle (spinocerebellar tract) -\> ataxia

Question 156

What does PICA supply?

Answer 156

Lateral medulla

Question 157

What does AICA supply?

Answer 157

Lateral pons

Question 158

What does anterior spinal artery supply in brainstem?

Answer 158

middle medulla

Question 159

Basal artery supplies?

Answer 159

middle pons; , more specifically the paramedian branches of basalar artery

Question 160

MLF syndrome causes (2)

Answer 160

located in pons, helps eyes track adducting medial rectus palsy in ipsilateral MLF & contralateral abduction lateral gaze nystagmus cause: medial pontine stroke and MS

Question 161

Locked in syndrome causes

Answer 161

only move eyes # stroke of medial pons # central pontine myelinolysis with rapid hyponatremia Na correction =\> find increased signal intensity in pons

Question 162

Weber syndrome

Answer 162

anterior midbrain stroke from occlusion of paramedian branches of posterior cerebral artery infarct peduncles (corticospinal and corticobulbar tracts) -may affect CN III

Question 163

What AA are modified in golgi? and in RER lysosome trafficking?

Answer 163

Golgi: O-oligosaccharides SERINE THREONINE +asparagine: N-oligosaccharides RER: N-oligosaccharides Asparagine glutamine: Lysosome trafficking from golgi of mannose-6-phosphate. DEFECT = I cell disease

Question 164

Limbic system control

Answer 164

"primitive" part of brain + learning 5 Fs Feeding, fleeing, fighting, feeling, fucking

Question 165

anterior hypothalamus nuclei

Answer 165

A/C = anterior cooling -\> thermoregulation Damage =\> hyperthermia

Question 166

suprachiasmatic nuclei

Answer 166

in hypothalamus regulates circadian rhythm "need sleep to be charasmatic"

Question 167

Preoptic area

Answer 167

hypothalamus: secrete GnRH

Question 168

supraoptic nucleus

Answer 168

anterior hypothalamus water balance: ADH damage: central DI

Question 169

paraventricular nucleus

Answer 169

In anterior hypothalamus oxytocin: oxys= quick, tocos = birth +CRH, TRH

Question 170

posterior hypothalamus

Answer 170

if you zap it you become a poikilotherm = cold-blooded, no heat production

Question 171

lateral hypothalamic nucleus

Answer 171

hunger. destruction -\> anorexia (shrink laterally). Inhibited by leptin

Question 172

ventromedial hypothalamic nucleus

Answer 172

satiety. stimulated by leptin. damage=obesity. (grow ventrally) also savage behavior if damaged

Question 173

melatonin secretion? derived from?

Answer 173

pineal gland secretes melatonin from seratonin follows circadian rhythm inhibits sex drive

Question 174

kluver bucy syndrome

Answer 174

bilateral amygdala lesions kluver bucy syndrome: hyperorality (likes putting things in mouth), hypersexual, disinhibited behavior (not afraid), docile, extreme curiosity

Question 175

psuedotumor cerebri

Answer 175

RISK: young obese women, ppl using vitamin A daily pulsatile headache, -retrooccular pain worse on movement N/V papilledema (increased ICP) but no hydrocephalus) vision loss NO TUMOR NO dilation of VENTRICLES LP -\> ICP elevated Tx; weight loss, acetazolamide, serial LP,

Question 176

CSF generation where?

Answer 176

choroid plexus in the ventricles reabsorbed by arachnoid granulation

Question 177

Normal pressure hydrocephalus vs hydrocephalus ex vacuo

Answer 177

Normal pressure has dilated ventricles that compress corona radiata -\> wacky wobbly wet Hydrocephalus ex vacuo no increased ICP, just apparent bc of brain atrophy (alzheimers, HIV, Pick's disease) NORMAL PRESSURE HYDROCEPHALUS IS REVERSIBLE

Question 178

elevated ICP usually damages what CN?

Answer 178

CN III -\> palsy -\> down and out eye presentation

Question 179

spinal cord ends

Answer 179

L1-2

Question 180

LP

Answer 180

L3/4 or 4/5 in children L4/5 L5/S1 L4 vertebra at iliac crest

Question 181

intraventricular hemorrhage of newborn

Answer 181

most common in premature \< 32wks and low birthweight neonates. occurs in first 72hrs of life originates in subgerminal matrix subependymal all newborns \< 32 weeks should be screened by US for this

Question 182

thrombolytic cutoff

Answer 182

4.5 hrs (max 6)

Question 183

carotid sinus carotid body what monitor? what nerve?

Answer 183

carotid sinus = baroreceptor carotid body = chemosensation CNIX watches these

Question 184

sturge weber syndrome

Answer 184

underlying vascular problems with Port wine stain in opthalmic V1 distribution glaucoma, seizures, hemiparesis, intellectual disability AVM from ipsilateral leptomeningeal angiomatosis STURGE stain, sporatic, unilateral portwine stain, glaucoma/GNAQ inactivation, epilepsy

Question 185

what controls the parasympathetic system? sympathetic?

Answer 185

anterior hypothalamus -\> parasympathetic posterior hypothalamus - \> sympathetic

Question 186

Tx tension headache

Answer 186

NSAIDS: naproxen Bilateral, nonpulsatile, over 30 minutes, steady pain without photophobia or phonophobia

Question 187

Tx migraine headaches

Answer 187

-triptans sumatriptan Unilateral, pulsating, +-aura, photophobia and/or phonophobia, made worse by foods with tyramine increased risk stroke

Question 188

-triptan MOA USE SE

Answer 188

serotonin agonist cause vasoconstriction modulate trigeminal nerve neurotransmission USED: take as soon as start/aura migraine (PO) , 2ndline cluster(IV) SE: contraindicated CAD, prinzmetal, pregnancy

Question 189

Tx cluster headache

Answer 189

100% O2 NRB: may abort in 5min, use for 15min 2nd line triptan \*nerve block, steroids \*\*more common in men, unilateral, ptosis, miosis, smokers

Question 190

What conditions will tyramine make worse?

Answer 190

Cause a HTN crisis in MAOi takers migraines

Question 191

Where are VLCFA broken down?

Answer 191

In peroxisomes. Vs in the mitochnodria with LCFA and MCFA. branched chain FA are also broken down here (alpha oxidation)

Question 192

calcified cystic mass in brain?

Answer 192

craniopharyngioma, often filled with brown fluid with cholesterol. lined by stratified squamous epithelium. Rathke's pouch origin

Question 193

length constant of neurons?

Answer 193

how far along an axon an electrical impulse can travel

Question 194

time constant of neurons?

Answer 194

how long it takes for neurons to depolarize, myelin decreases time constant

Question 195

Hageman factor actions?

Answer 195

Factor XII: proinflammatory protein produced by liver 1) Activated upon exposure to subendothelial/tissue collagen which leads to -coagulation cascade -complement activation (through kinin system) -XII @ kallikrein (kinin) -\> @bradykinin -\> pain and vasodilation, some vascular permeability

Question 196

what is a population study?

Answer 196

an ecological study; vs a cross sectional study would use a disease and collect data at a PARTICULAR POINT IN TIME

Question 197

what optic radiation goes through meyers loop?

Answer 197

Meyers loop passes through the temporal lobe and will give you a contralateral upper field defect (goes to lower part of occipital lobe)

Question 198

calcarine fissure

Answer 198

divides visual fields in occipital lobe (upside down and R/L reversed

Question 199

Metastatic cancers to brain location

Answer 199

multiple well circumscribed at grey-white junction Many TOP: Lung, Breast, Kidney

Question 200

meningioma cell

Answer 200

more in adults (female) arachnoid cell, often present with seizure, compress but doesn't invade whorled cells EXPRESSES ER receptor

Question 201

glioblastoma multiforme cell

Answer 201

astrocyte, butterfly glioma, very malignant, GFAP positive with pseudopallisading located cerebral hemisphere

Question 202

Pilocytic asrocytoma

Answer 202

benign tumor of astrocytes in children (most common tumor in children) "nodule growing on cyst wall" GFAP positive

Question 203

Medullaroblastoma cells

Answer 203

malignant, most commonly in children, arising from neuroectoderm

Question 204

salivation from parotid gland

Answer 204

Glossopharyngeal nerve IX

Question 205

brain tumors adults

Answer 205

Metastasis 50% Glioblastoma (astrocytes) Meningioma (arachnoid) Schwannoma + Oligodendroglioma (frontal lobe usually) MGM StudiOs arranged in most common

Question 206

homer wright rosette in what CA

Answer 206

medulloblastoma

Question 207

Perivascular pseudorosette in what cancer

Answer 207

ependymoma ![]()

Question 208

Brain tumors pediatrics

Answer 208

pilocytic Astrocytoma (GFAP\_ medulloblastoma (high grade benign neuroectoderm) ependymoma (ependymal) AME arranged in most common

Question 209

uncal herniation symptoms

Answer 209

CN III compression, outside: parasympathetic dmg -\> mydriasis inside: motor dmg -\> down and out -contralateral homonymous hemianopsia

Question 210

what is ApoE4 associated with?

Answer 210

Late onset alzheimers chr.19

Question 211

3 mutations associated with early onset alzheimers = \<60y/o

Answer 211

APP chr21 Presenilin 1 chr 14 Presenilin 2 chr 1

Question 212

What is ApoE2 associated with?

Answer 212

protective against alzheimers chr.19

Question 213

Ebstein's anomaly

Answer 213

atrialized right ventricle from downward displacement of tricuspid valve. from lithium ingestion early in pregnancy

Question 214

sciatic nerve roots

Answer 214

L4-S3 branches into common peroneal and tibial

Question 215

subluxation

Answer 215

is the incomplete/partial dislocation of a joint

Question 216

ristociton

Answer 216

the test for vWF deficiency. causes vwf to clot platelets (unless you dont have any)

Question 217

somatomedin C is what?

Answer 217

IGF-1

Question 218

most common cause of aseptic meningitis?

Answer 218

#1 is cocksackie virus enteroviruses (picornoviruses) = + sense ssRNA, naked PERCH: polio, echovirus, rhinovirus, cocksackie A (handfootmouth,B (pericarditis), hep A

Question 219

Werdnig-hoffman disease

Answer 219

AR: Inherited degeneration of anterior motor horn. \*SPINAL MUSCLULAR ATROPHY -Presents as floppy baby, death occurs within a few years

Question 220

Differentiation btw ALS and syringomyelia

Answer 220

syringomyelia will involve the spinothalamic (pain and temperature) ALS is only LMN UMN

Question 221

ALS occurance

Answer 221

Mostly sporatic Familial= Zinc-copper SOD mutation with free radical injury to neurons.

Question 222

degeneration of cerebellum and spinal cord tracts with hypertrophic cardiomyopathy

Answer 222

Friedreich's Ataxia #mutation in Frataxin (essential for mitochondrial iron regulation -\> free radical damage) Expansion GAA - cerebellar degen - \> ataxia - multiple spinal tract degeneration -\> sensation/vibration losses, muscle weakness, loss DTR. - presents in childhood -\> wheelchair bound within a few years \*\*Associated with hypertrophic cardiomyopathy

Question 223

How does meningitis cause hydrocephalus, hearing loss, seizures?

Answer 223

All through healing and scarring process, can occlude CSF drainage (like arachnoid granulations), can affect nerve, may cause disturbance in conduction pathways through scarring.

Question 224

Ratio of CSF to Blood glucose

Answer 224

0.6 (2/3)

Question 225

cortical laminar necrosis

Answer 225

A type of global ischemia/infarction of vulnerable regions of pyramidal neurons of cortex 3,5,6,

Question 226

vulnerable areas from global ischemia

Answer 226

cortical layers 3,5,6 hypocampus(temporal lobe): learning long term purkinje layer of cerebellum: integrates sensory perception with motor control

Question 227

embolic vs thrombotic stroke macroscopic histology

Answer 227

thrombotic will be pale stroke (bc thrombus isn't lysed) embolic will be hemorrhagic bc the clot will eventually be lysed

Question 228

ischemic lacunar stroke locations

Answer 228

typically from lenticulostriate vessels coming off of MCA internal capsule (pure motor) thalamus (pure sensory) RISKS of HTN, DM vs basal ganglia for charcot bouchard (can be more diffuse)

Question 229

earliest change in stroke

Answer 229

Red Neurons (12 hrs)

Question 230

xanthochromia and blood on inferior brain

Answer 230

Subarachnoid hemorrhage. yellow is from heme breakdown

Question 231

why is berry aneurism caused so easily?

Answer 231

It's at branch point and lacks media layer (which is present before and after branch point)

Question 232

uncal herniation s/s

Answer 232

#compression CN III (down and out) # compression posterior cerebral artery (contralateral homonymous hemianopsia) #rupture of paramedian (pontine) arteries -\> duret brainstem hemorrhage.. They basically get torn off \*\*uncus is involved with olfaction and memory of smells

Question 233

arylsulfatase A deficiency

Answer 233

lysosomal storage disease central/peripheral demyelination -\> ataxia/dementia

Question 234

Krabbe's disease

Answer 234

lysosomal storage disease galactocerebrosidase deficiency #peripheral neuropathy, developmental delay, optic atrophy, GLOBOID CELLS

Question 235

oligoclonal IgG bands, lymphocytes, myelin basic protein on LP

Answer 235

MS "very high elevation of proteins in CNS" may see lipid laden macrophages that ate the myelin

Question 236

JC virus infection in immunocompromised

Answer 236

PML: progressive multifocal leukoencephalopathy #rapidly progressive neurological signs leading to death

Question 237

Progressive, debilitating encephalitis leading to death. from virus in infancy

Answer 237

Subacute sclerosing panencephalitis from measles -viral inclusions in gray and white matter

Question 238

striatum

Answer 238

putamen (motor) + caudate (cognitive)

Question 239

lentiform

Answer 239

putamen (motor) + globus pallidus

Question 240

subthalamic nucleus does what?

Answer 240

inhibits movement (stimulates GPi)

Question 241

depigmentation of substantia nigra

Answer 241

lewy body accumulation (alpha synuclean eosinophilic intracellular inclusions) with decrease in dopamine and melanin production. melanin as part of that pathway

Question 242

meperidine

Answer 242

demerol (opioid) MPTP -\> MPP(from MAO metabolism) byproduct causes parkinsons through dmg SN from inhibition complex I ETC

Question 243

CD80/86

Answer 243

B7 on dendritic cells

Question 244

what supplies anterior spinal artery?

Answer 244

the aortic artery

Question 246

Amyloid plaque

Answer 246

Called a neuritic plaque seen in alzheimers disease. Is an extracellular accumulation of ABeta amyloid with entangled neuritic processes ![]()

Question 247

neurofibrillary tangle

Answer 247

intracellular phosphorylated tau protein = insoluble cytoskeleton (microtubule organizer); they correlate with degree of dementia Alzheimers

Question 248

Picks disease

Answer 248

picks picks the frontal and temporal early behavioral and language problems findings of ROUND tau protein in neurons that stain with SILVER, they don't survive neuronal death

Question 249

lewy body dementia

Answer 249

EARLY dementia with Parkinsonian features. The alpha synuclein eosinophilic lewy bodies are in the cortex (vs SNpc in Parkinsons) -parkinsonism with dementia and HALLUCINATIONS and possibly repeated syncope

Question 250

corona radiata stretching is classic to

Answer 250

normal pressure hydrocephalus wacky wobbly wet increased CSF without increased ICP

Question 251

spike wave complex on EEG

Answer 251

Creutzfeldt jakob disease (prion) also assoc with rapid dementia (death within year), startle myoclonus, ataxia

Question 252

familial fatal insomnia

Answer 252

inherited prion disease with startle reflex and insomnia

Question 253

cowdry type A inclusion

Answer 253

HSV encephalitis

Question 254

lewy bodies stain with what?

Answer 254

show up as alpha synuclein stained by PAS and ubiquitin (intracellular in parkinsons)

Question 255

pseudodementia

Answer 255

dementia (memory problems) associated with depression The patient often KNOWS they're having difficulty with memory (vs a patient with true dementia)

Question 256

magnetic gait

Answer 256

normal pressure hydrocephalus

Question 257

Screens to rule in dementia

Answer 257

RPR (for syphillis) HIV TSH (hypothyroid) Vitamin B12 MRI brain (multiple infarcts/NPH)

Question 258

most common causes of delerium

Answer 258

drugs (esp think about acetylcholine antagonists) UTI

Question 259

lesch nyhan enzyme deficiency

Answer 259

hypoxanthine-guanine phosphoribosyltransferase tx; Allopurinol (xanthine oxidase inhibitor) s/s spasticity, choreathetoid movements, self mutilation

Question 260

does uremia cause exudative or transudative pleural effusions?

Answer 260

exudative

Question 261

GGT

Answer 261

serum gamma-glutamyltransferase specific indicator of liver damage, sensitive in alcohol use

Question 262

hypocretin 1

Answer 262

neuropeptie only produced in lateral hypothalamus that is low/undetectable in narcolepsy

Question 263

cataplexy

Answer 263

brief loss of muscle tone preceded by strong emotion

Question 264

jaundice occurs at what bilirubin lvl?

Answer 264

\>2.5mg/dL

Question 265

kernicterus bilirubin build up where?

Answer 265

basal ganglia

Question 266

what is required for de novo pyrimidine production?

Answer 266

aspartate and glutamine

Question 267

cori cycle

Answer 267

the glucose -\> pyruvate -\> lactate to lactate -\> pyruvate -\> glucose cycle in muscle/rbc -\> liver

Question 268

alanine cycle

Answer 268

the alanine - pyruvate -\> glucose cycle to recycle ammonia

Question 269

ITP what is it? where is the Ab produced?

Answer 269

autoimmune destruction of platelets Ig aimed at GpIIbIIIa Ab is produced in spleen, macrophages eat platelets in spleen. tx; steroids, IVIG, splenectomy as last resort

Question 270

Undercooked beef will classically give you...

Answer 270

E Coli O157H7 -\> HUS, especially in children verotoxin damages endothelial cells and possibly also ADAMSTS13

Question 271

what does uremia do to clotting?

Answer 271

disrupts adhesion (gpIb) and aggregation (gpIIbIIIa and fibrinogen) of platelets

Question 272

3 steps to activate coagulation (not adhesion/aggregation)

Answer 272

1- activating substance (collagen/thromboplastin) 2- calcium 3-phospholipid membranes

Question 273

most common inherited coag disorder

Answer 273

VWB disease autosomal dominant vwb stabilizes factor VIII abnormal ristocetin PTT changes but no real problems with secondary hemostasis (coagulation

Question 274

ristocetin

Answer 274

aggregates platelets that requires vwf if vwb disease, will not aggregate (unknown mechanisms), but if add vwf (plasma mixing) -\> platelets will aggregate vs bernard soulier syndrome, mixing will NOT improve aggregation

Question 275

cryoprecipitate

Answer 275

given in DIC contains fibrinogem , VWF, factor VIII and XIII

Question 276

where is tPA?

Answer 276

in endothelial cells though kallikrein can also activate plasmin (through hageman factor)

Question 277

plasmin action

Answer 277

destroys fibrin and fibrinogen destroys coag factors blocks platelet aggregation \*\*alpha 2 antiplasmin inactivates plasmin

Question 278

disorders of increased plasmin -\> bleeding

Answer 278

urokinase in radical prostatectomy liver cirrhosis; reduced production of alpha 2 antiplasmin no d-dimer, normal platelets d-dimer = split fibrin, not fibrinogen Tx; aminocaproic acid (blocks plasmin)

Question 279

lines of zahn

Answer 279

present in thrombus that was present before death in area of higher blood flow characterized by lines of fibrin alternating with RBC's can help determine cause of death

Question 280

most common inherited hypercoagulable state

Answer 280

factor V leiden: protein C cannot cleave it

Question 281

prothrombin 2010a

Answer 281

point mutation in prothrombin 3' UTR -\> increased gene expression x2

Question 282

if you give heparin and PTT doesn't rise, what's the problem?

Answer 282

deficiency in ATIII 2,7,9,10,11,12

Question 283

dyspnea, neurologic abnormalities (AMS,seizures), and petechiae over skin, especially the chest,head,neck,axilla

Answer 283

fat embolus in pulm vasculature after bone fx or orthopedic procedure may see retinal fat globules

Question 284

acute intermittent porphyria s/s deficiency tx

Answer 284

5p's Autosomal Dominant port wine urine: darkens on exposure to air/light bc of oxidation painful abdnomen precip by drugs (p450 inducers) psych disturbances polyneuropathy def; porphobilinogen deaminase (hydroxybmethylbilane synthase) tx; glucose and heme to inhibit ALAS

Question 285

alkaptonuria s/s deficiency

Answer 285

aut recessive benign defect in homogentisic acid oxidase which tyrosine -\> fumurate s/s dark connective tissue, brown pigmented sclera, urine turns BLACK on prolonged exposure to air may have arthralgias

Question 286

binding sites HIV EBV Parvovirus B19

Answer 286

HIV: CD4 gp120 EBV CD21 gp350 (the c3d complement receptor) Parvo -\> erythrocyte P antigen (globoside)

Question 287

iron deficiency anemia findings

Answer 287

anemia, koilonychia, pica koionychia is spoon shaped nails increased FEP: free erythrocye protoporphyrin and then all the basics RBC should = nucleus of lymphocyte

Question 288

hepcidin

Answer 288

sequesters iron in storage sites (enterocytes, liver, macrophages) AND decreases EPO

Question 289

parietal cells

Answer 289

pink (chief cells are more blue) assoc with pernicious anemia proton pump

Question 290

tongue in megaloblastic anemia

Answer 290

glossitis (poor turnover) but remember in plummer vinson it can also have glossitis (iron deficiency, glossitis, esoph webs)

Question 291

reticu count in anemia with proper nutrients and capacity

Answer 291

corrected \>3% but have to correct for total RBC correct with retic% x Hct/45 \*45 being a normal hct

Question 292

reticular endothelial system

Answer 292

spleen, liver, lymph nodes

Question 293

13q deletion

Answer 293

associated with CLL

Question 294

abnormal 5 maleimide binding test

Answer 294

hereditary spherocytosis autosomal dominant

Question 295

LDH in hemolytic anemia

Answer 295

increased; duh RBC's use a lot of that

Question 296

can macrophages activate naive T cells?

Answer 296

no, only mature active effectors and memory t cells, and then, only if the macrophages have been induced to (prob with IFN-gamma)

Question 297

gardos (calcium dependent) channel blocker

Answer 297

prevents erythrocyte dehydration by blocking potassium/water efflux from cells this prevents sickling in HbSS

Question 298

CO affect on cells | (carboxyhemoglobin)

Answer 298

1. binds to hgb and prevents O2 from binding 2. prevents o2 release (left shift of dissoc curve) 3. inhibits complex 4 of ETC (which cyanid does too)

Question 299

carbaminohemoglobin is what?

Answer 299

CO2 on hgb

Question 300

metabisulfate

Answer 300

will sickle any cells with HgbS, even in trait

Question 301

hemosiderinuria

Answer 301

occurs days after intravascular hemolysis

Question 302

What are PNH patients at risk of?

Answer 302

10% dvlp AML also iron deficiency anemia

Question 303

stain for heinz bodies with heinz preparation confirmatory test?

Answer 303

shows precipitated hgb to do enzyme conirmatory test, must wait until after the acute episode bc all the current cells will have g6pd

Question 304

cold agglutinin infectious disease causes

Answer 304

Infectious mononucleosus mycoplasma pneumonia

Question 305

basophilia

Answer 305

associated with CML

Question 306

lymphocytic leukocytosis

Answer 306

viral bordetella pertussis: lymphocytosis promoting factor(blocks lymphs from entering lymph node)

Question 307

leukemia

Answer 307

\>20% blasts large, low cytoplasm, high nuclear punched out nucleolus

Question 308

tdt +

Answer 308

lymphoblast ALL t or b

Question 309

MPO+

Answer 309

myeloblast tdt is absent: tdt is a dna polymerase only present in immature lymphocytes

Question 310

cd10

Answer 310

present on B cells think B-ALL

Question 311

B-ALL translocation

Answer 311

Age \<15y/o: peripheral blood and bone marrow involved t12 21 t9;22 less common, poor prognosis (usually that's the translocation in CML) tdt+, CALLA + GOOD PROGNOSIS, responsive to therapy down syndrome \> 5y/o

Question 312

acute monocytic leukemia

Answer 312

an AML that lacks MPO and involves gums of patient -\>bleeding gums

Question 313

CLL markers

Answer 313

CD5 and CD20 (CD 5 is usually only on t cells, but here its' on B) smudge cells -\> SLL if lymph node involved may transform to large B cell lymphoma -\> present with enlarging spleen or lymph node

Question 314

LAP (leukocyte alkaline phosphate) negative positive

Answer 314

negative in CML positive in leukemoid rxn

Question 315

lots of platelets in blood differential

Answer 315

essential thrombocythemia (a type of myeloproliferative disorder) OR iron deficiency anemia

Question 316

acute megakaryoblastic leukemia vs myelodysplastic syndrome vs myelofibrosis vs essential thrombocythemia

Answer 316

myelodysplastic syndrome: precursor to AML, characterized by \<20% blasts in blood acute megakaryoblastic leukemia: an AML disorder, proliferation of megakaryoblasts. arises in down syndrom often before age of 5 myelofibrosis: myeloproliferative disorder with mostly megakaryocytes, JAK2 assoc, PDGF -\> marrow fibrosis essential thrombocythemia: a myeloprolif disorder JAK2 assoc, but pretty much a bunch of platelets

Question 317

sponataneous hemarthroses in vwf disease

Answer 317

DOES NOT OCCUR despite increased PTT

Question 318

shine delgarno kozac sequence

Answer 318

shine delgarno is prokaryotic translation start sequence kozac is sequence assoc with eukaryotic translation starting. requires purine (A or G) 3 base paires up from AUG to work well

Question 319

Birbeck granule

Answer 319

tennis racket on EM of pt with langerhans cell histiocytosis also have S-100

Question 320

reed sternberg cell

Answer 320

CD15 and 30 multilobed nuclei prominent nucleoli a B cell, but not CD20+ hodgkins often has abundant IL5 and eosinophils

Question 321

what monoclonal antibody does multiple myeloma make? ie M spike

Answer 321

usually IgG can be IgA

Question 322

monoclonal IgM macroglobullnemia

Answer 322

B-cell lymphoma Waldenstrom Macroglobulinemia visual and neurologic problems: stroke, retinal bleeding increased risk of bleeding/thrombosis

Question 323

henoch schonlein purpura vs churg strauss

Answer 323

henoch schonlein: IgA deposition following URI: palpable purpura, arthralgia, GI symptoms/bleeding. Self limited. churg strauss IgE, eosinophils, granulomas, pANCA heart, lung kidney invovement has asthma, sinusitis, palpable purpura, peripheral neuropathy

Question 324

renal artery stenosis in young female

Answer 324

fibromuscular dysplasia -\> HTN

Question 325

branchial cleft, arch, pouch

Answer 325

cleft is ectoderm arch is mesoderm pouch is endoderm

Question 326

4 branchial pouches

Answer 326

ears, tonsils, bottom to top 1st pouch: endoderm of middle ear and proximal 2nd pouch: epithelial tonsils 3rd pouch: bottom parathyroids and thymus 4th pouch: superior parathyroid

Question 327

1st arch

Answer 327

Muscles of Mastication Maxillary/Mandibular V nerve Maxillary artery

Question 328

2nd arch

Answer 328

Stapedial artery Smile with CN VII Facial expression

Question 329

3rd arch

Answer 329

Common Carotid don't Choke with CNIX stylopharyngeus

Question 330

4th/6th arch

Answer 330

CN X swallow and speak cartilage and shit of neck

Question 331

developmental Clefts

Answer 331

1st = external auditory meatus 2,3,4 obliterated if persistant = branchial cleft cyst in lateral neck (doesn't move with swallowing like a thyroid cyst)

Question 332

embryo vitelline veins cardinal veins umbilical veins

Answer 332

vitelline -\> portal system cardinal veins -\> systemic veins umbilical veins -\> degenerate to round ligament as part of falciform of liver

Question 333

plaque formation

Answer 333

1) endothelial damage (toxins, HTN) -\> increased permeability 2) lipid deposition 3) macrophage entry 4) platelet, endothelial, macrophage PDGF combined PDGF (GF for fibroblasts, smooth muscle, endothelium) 5) TGF from platelets -\> fibroblast growth factor 6) battle btw macrophage collagenase and collagen from smooth muscle/fibroblasts 7) plaque rupture/thrombosis via coag

Question 334

TGF-alpha TGF Beta PDGF Fibroblast growth factor (FGF) VEGF

Answer 334

TGF-A: epithelial and fibroblast growth TGF-B: fibroblast growth PDGF: GF for endothelium, smooth muscle, fibroblasts FBF: angiogenesis VEGF angiogenesis

Question 335

Fick's principle

Answer 335

CO = rate of O2 consumption/ arterial O2 content - venous O2 content

Question 336

laplace law for heart wall tension

Answer 336

wall tension: Pressure x r / (2xwallthickness)

Question 337

papillary muscle rupture anterior posterior

Answer 337

anterolateral is less common bc it is supplied by LAD and circumflex posterior is supplied by PAD (usually from RCA)

Question 338

dressler syndrome

Answer 338

antibody to pericardium -\> pericarditis arises 1-2months after MI

Question 339

most common congenital heart defect and often why?

Answer 339

VSD fetal alcohol syndrome

Question 340

most common ASD most common with down syndrome

Answer 340

most common = osteum secondum down syndrome = osteum primum

Question 341

PDA associated with congenital infecions

Answer 341

Rubella

Question 342

boot shaped heart

Answer 342

tetralogy of fallot

Question 343

transposition of the great vessels risk factor

Answer 343

maternal diabetes

Question 344

what does glucose do to the lac operon

Answer 344

It decreases cAMP -\> decreases promotor activity on lac operon the regulator makes a repressor for the operator, lactose binds to and releases the reperssor

Question 345

NO vs adenosine artery vs arteriole dilation

Answer 345

coronary artery responsive to NO, arteriole more to adenosine

Question 346

what auscultative finding correlates with severity of mitral regurge?

Answer 346

An S3 bc the murmer may be less with larger regurge orifice and louder with a smaller orifice, but not always and is variable

Question 347

ejection click =

Answer 347

aortic stenosis with crescendo decrescendo systolic ejection a littl after S1

Question 348

midsystolic click

Answer 348

mitral valve prolapse, with crescendo murmur loudest right before S2

Question 349

Opening snap

Answer 349

mitral stenosis abrupt halt in leaflet motion. delayed rumbling late diastolic murmer (a little bit after you hearS2)

Question 350

roth's spot

Answer 350

white spot on retina surrounded by hemorrhage associated with bacterial endocarditis

Question 351

janeway lesions

Answer 351

small, painless, erythematous lesions on palms and soles. associated with bacterial endocarditis septic emboli Vs Osler's are painful and raised lesions

Question 352

anti-DNAse titer

Answer 352

used to diagnose strep pyogenes infection also not ASO as well

Question 353

aschoff bodies with anitchkow cells

Answer 353

Occur in rheumatic fever around myocytes of heart Aschoff body is granuloma with giant cells anitschkow are wavy looking activated histiocytes ![]() ![]() Myocarditis is what kills people in acute phase of rheumatic fever

Question 354

S4 in older adult

Answer 354

sign of less compliance, not always pathological. In younger adult it is ALWAYS pathalogical

Question 355

S3 sound

Answer 355

in younger adults S3 can be normal. In older adults S3 is basically always pathological

Question 356

hyperplastic arteriolosclerosis cause

Answer 356

malignant hypertension onion skinning of small arteries. Different from fibromuscular dysplasia in women

Question 357

most common heart tumor? in adults? in kids?

Answer 357

Most common is metastasis primary Adult = myxoma: tumor of mesenchyme, presents with syncope bc ball and valve obstruction primary kid = rhabdomyoma

Question 358

Hypertrophic cardiomyopathy inheritance

Answer 358

autosomal dominant sarcomere protein usually B myosin heavy chain also assoc with friedreich's ataxia mutation (not inherited)

Question 359

loeffler syndrome

Answer 359

eosinophillic infiltrate with endomyocardial fibrosis. Often in setting of parasitic invasion

Question 360

lymph node drainage upper rectum lower rectum above pectinate line below pectinate line

Answer 360

upper rectum- pararectal nodes lower rectum above pectinate line- internal iliac below pectinate line- superficial iliac

Question 361

normal vital capacity volume normal tidal volume normal total lung capacity normal residual capacity

Answer 361

4.2 L 500mL 6L 1.2L

Question 362

Dead space equation this is the Bohr equation

Answer 362

V(dead space) = Tidal volume x (PaCO2 - PexpiredCO2)/PaCO2 "the volume of inspired air that does not take part in gas exchange" \*\*As PeCO2 approaches PaCO2 -\> less dead space

Question 363

what is the pressure of the airway/alveoli at FRC

Answer 363

pressure is 0 intrapleural pressure is negative

Question 364

compliance change in emphysema/normal aging compliance change in pulm fibrosis/pneumonia/edema

Answer 364

C= V/P compliance increases with emphysema and normal aging decrease with pulm fibrosis/pneumonia/edema

Question 365

Diffusion equation for lungs (and whatever else i guesS)

Answer 365

Vgas diffusion = Area/thickness x diffusionconstant(P1-P2) A decreases in emphysema (but emphysema is more a V/Qmm... increased blood flow for decreased area it encounters) T increases in pulmonary fibrosis Both lead to less diffusion =\> make O2 diffusion limited (partial shunt)

Question 366

pulm HTN diagnosis

Answer 366

\>25mmHg or \>35 during excercise

Question 367

alveolar gas equation

Answer 367

PAO2 = PIO2 - PaCO2/R Or PAO2 = 150 - PaCO2/0.8 A-a gradient = PAO2 - PaO2 = 10-15 normal Cause of increased Aa: shunt, V/Qmm, diffusion

Question 368

Causes of hypoxemia ( normal A-a gradient increased A-a gradient \>15

Answer 368

Normal A-a: high altitude, hypoventilation Increased A-a: V/Qmm (PE) diffusion limitation (fibrosis/emphysema) R/L shunt (VSD/pulm edema/asthma)

Question 369

Haldane effect

Answer 369

Haldane has halitosis (lung effect) In lungs, oxygenation of Hb dissociates H+ from Hb. All that bicarb that you've transported is split into H20 and CO2. CO2 is released. aka shifts equilibrium toward CO2 formation

Question 370

Bohr Effect

Answer 370

The H+ from metabolism (glycolysis mostly as well as conversion of CO2 with H20 to bicarb) shifts dissociation curve to right -\> unload oxygen

Question 371

Tx of methemoglobinemia

Answer 371

methylene blue and Vitamin C acutely Cimetidine (H2 blocker) can be used chronically in a patient that must be on a methgbemia type drug like dapsone

Question 372

normal PaO2/FiO2

Answer 372

300-500 less than 300 indicates gas exchange problem

Question 373

hypoxia causes

Answer 373

ischemia (low blood flow from low cardiac output, impeded arterial flow, reduced venous drainage, shock, embolis) hypoxemia (low inspired O2, hypoventilation, V/Q mismatch, Diffusion problem, R/L shunt) Decreased O2 carrying capacity (CO poison, anemia)

Question 374

Floppy baby with congenital anterior horn degeneration (LMN)

Answer 374

Werdnig Hoffman disease Autosomal Recessive. Median death at 7months

Question 375

what will hypocapnia cause?

Answer 375

low CO2 -\> bronchoconstriction low CO2 in the blood will cause vasodilation in pulmonary vessels

Question 376

type II pneumocyte lamellar body

Answer 376

is the membrane bound intracellular inclusions of cell membrane material loaded with dipalmitoyl phosphatidylcholine

Question 377

hyperammonemia what diseases? MOA of ammonia damage? S/S tx

Answer 377

diseases: liver disease or hereditary (urea cycle def) MOA: - excess NH4 -\> depletes ketoglutarate -\> inhibtion of TCA cycle - NH4 damages lipids (encephalopathy) - and others S/S: tremor (asterixis), slurring speech, blurred vision, lethargy -\> seizure -\> coma-\>death Tx; benzoate or phenylbutyrate bind amino acids -\> secretion OR lactulose (nondigestable sugar) to acidify GI tract and trap NH4 bc bacteria ferment it and broduce lactate

Question 378

Down syndrome quad screen AFP, B-hCG, Estriol, Inhibin A

Answer 378

Decreased AFP increased B-hCG decreased inhibin A -\> decreased Estriol (through lower FSH) +increased nuchal translucency in first trimester

Question 379

Edward syndrome quad screen AFP, B-hCG, Estriol, Inhibin A

Answer 379

AFP decreased, B - hCGH decreased, estriol decreased, NORMAL inhibin A trisomy 18 (election age) clenched hands

Question 380

Patau's syndrome quad screen B-hCG, PAPP-A, nuchal translucency

Answer 380

low B-hCG, decreased PAPP, increasewd nuchal translucency trisomy 13 (puberty) polydactyly, holoprosencephally

Question 381

Myxoma S/S, why?

Answer 381

S/S syncope, positional dyspnea. bc of ball and valve issues. emboli (from easily friable materia) mid diastolic rumble (mitral stenosis type, but the problem is the ball rolling around and causing turbulence during atrial emptying) **IL-6 production -\> constitutional symptoms**

Question 382

radial nerve damage

Answer 382

fracture of spiral groove of humerous radial nerve extends arm and provides dorsal skin innervation C7 mostly

Question 383

nasal polyp differential

Answer 383

repeated bouts of rhinitis cystic fibrosis aspirin intolerant asthma

Question 384

angiofibroma vs nasopharyngeal carcinoma

Answer 384

angiofibroma is recurrent epistaxis, benign tumor of nasal mucosa nasopharyngeal carcinoma: assoc with EBV, biopsy with keratin positive epithelial cells poorly differentiated on background of lymphocytes

Question 385

laryngeopapilloma in adults and children

Answer 385

both from HPV 6,11 adults = single papilloma children = multiple nodules

Question 386

HPV high risk serotypes why?

Answer 386

16,18,31, 33,45 ect E2 normally suppresses E6/7 E6 suppresses p53 E7 suppresses Rb E2 is not active in high risk serotypes these are EARLY (E) expressed proteins by HPV

Question 387

phases of lobar pneumonia

Answer 387

1) congesion 2) red hepatization: exudate, neutrophils, hemorrhage 3) gray hepatization: degredation of red cells 4) resolution:

Question 388

coxiella burnetti infection

Answer 388

vets and farmers atypical pneumonia caused by spores deposited by ticks on cattle and cattle placenta Q fever (high fever, vs atypicals are often low fever) It is a rickettsial organism but is different in that it causes pneumonia, doesnt cause rash, and doesnt need arthropod vector

Question 389

mycoplasma pneumonia

Answer 389

most common cause atypical pneumonia IgM cold hemolytic anemia erythema multiforme no cell wall

Question 390

ghon focus

Answer 390

often just below the pleural lining -\> subpleural tb focus of fibrosis and calcification

Question 391

miliary tb

Answer 391

widespread in lungs and diseeminated tb

Question 392

when tb involves meninges, where is it classically?

Answer 392

base of the brain

Question 393

alpha 1 antitrypsin deficiency

Answer 393

codominant; if homozygous -\> cirrosis from accumulation in RER of liver. more severe in lower lobe vs upper lobe in smokers panacinar vs centriacinar in smoker

Question 394

charcot leyden crystals

Answer 394

show up in asthma = eosinophil production of major basic protein ![]()

Question 395

curschmann spirals

Answer 395

Curschmann's spirals refers to a finding in the sputum of asthmatics which are spiral shaped mucus plugs from subepithelial mucous gland ducts or bronchiole ![]()

Question 396

bronchiectasis what is it? who gets it? s/s

Answer 396

Occurs from necrotizing inflammation/infection of the broncioles/bronchi -\> increased dead space Who gets it: CF, kartageners, tumor, necrotizing infection, allergic bronchopulmonary aspergillous (chronic inflammatory dmg) ![]() s/s cough, dyspnea, foul smelling sputum (poor ciliated function, inflammatory crap, necrotic and rotting) complication = hypoxemia with cor pumonale and scondary amyloidosis (from inflammation) IT IS AN OBSTRUCTIVE DISEASE

Question 397

allergic bronchopulmonary aspergillosis what does it cause? who gets it?

Answer 397

leads to bronchiectasis from chronic allergic inflammation with eosinophil involvement found in pts with asthma or cystic fibrosis

Question 398

caplan syndrome

Answer 398

pneumoconiosis + rheumatoid arthritis the pneumoconiosis (coal, silica, asbestos) increases risk of RA

Question 399

Anthracosis

Answer 399

Pneumoconiosis = restrictive lung disease, risk of cor pulmonale and caplan syndrome anthracosis is coal laden macrophages coal miners lung affects upper lobes

Question 400

silicosis

Answer 400

Pneumoconiosis = restrictive lung disease, risk of cor pulmonale and caplan syndrome sandblasting and mines upper lung (think TB) silica disrupts phagolysosome -\> increased susceptability to TB (ONLY ONE) and to getting bronchogenic carcinoma eggshell calcifications of hilar lymph nodes

Question 401

asbestosis

Answer 401

Pneumoconiosis = restrictive lung disease, risk of cor pulmonale and caplan syndrome Ivory white pleural plaques and asbestos fibers (golden brown fusiform rods look like dumbells, have iron on them) Affects lower lobes associated with bronchogenic carcinoma \> mesothelioma "plaque of lung, plaque of pleura, cancer of lung, cancer of pleura"

Question 402

asteroid body

Answer 402

characteristic of sarcoidosis (granuloma of lung, hilar lymph nodes, other tissues of body), it's within the granuloma ![]() sarcoidosis can also give uveitis, skin nodules and erythema nodosum, can look like sjogren's. can be in any tissue increased ACE, increased Vit D 1alpha hyrdocylase -\> calcium tx with steroids

Question 403

uvea layers

Answer 403

iris: opening of pupil ciliary body : controls shape of lense and aquous humor production choroid: vascular layer of eye

Question 404

hypersensitivity pneumonitis

Answer 404

cheese washer, composter, coffee grinder ,pigeon breeders lung, there are others granulomatous inflammation due to hypersensitivity (high eosinophils) presents fever, cough, dyspnea hours after exposure, resolves if taken away from exposure chronically can produce intersitial pneumonitis

Question 405

plexiform lesion

Answer 405

a consequence of pulmonary htn = grouping of blood vessels Other associations; hypertrophied smooth muscle, some intersitial fibrosis, RVH

Question 406

ARDS mechanism and complication on recovery

Answer 406

underlying theme is neutrophilic activation and free radical damage destroying type I and II pneumocytes MANY CAUSES end up with fluid, neutrophils, hyaline membrane, alveolar collapse Recovery may be complicated by intersitial fibrosis bc stem cell (type II pneumocyte) has been knocked out

Question 407

NRDS associated with 3 syndromes

Answer 407

prematurity, c section, maternal diabetes (insulin inhibits lecithin production)

Question 408

attributable risk percent

Answer 408

ARP = 1-RR/RR

Question 409

calcitriol

Answer 409

1,25 hydroxyvitamin D 1,25 hydroxycholecalciferol

Question 410

ergocalciferol

Answer 410

D2 ingested from plants

Question 411

cholcalciferol

Answer 411

Vit D3

Question 412

urinary acid buffers

Answer 412

NH3-\> NH4+ HPO4 (2-) -\> H2PO4 (-) both are used to keep the pH from dropping too much in the urine

Question 413

adenocarcinoma of the lung

Answer 413

Peripheral mostly most common cancer of nonsmokers and females (smoker or not) K-ras mutation bronchioalveolar subtype (not assoc with smoking, good prognosis, grows along alveola septa (thickening of walls)

Question 414

Squamous cell carcinoma of lung

Answer 414

Central cigarettes (most common lung tumor for male smoker) Hilar mass cavitation hyperCalcemia (PTHrP) production Keratin pearls and intercellular bridges ![]()

Question 415

small cell (oat) carcinoma

Answer 415

Central (male smokers) undifferentiated -\> VERY aggressive may produce: ACTH, ADH, Antibodies (lambert eaton). Amplification of myc oncogens inoperable (all the others generally are) This is a NEUROENDOCRINE TUMOR. kulchitsky cells = small dark blue cells chromogrannin +

Question 416

large cell carcinoma

Answer 416

Peripheral highly anaplastic and undifferentiated poor prognosis Large cell is the name given if the tumor doesnt have keratin pearls/mucinous glands/ intercellular bridges surgical removal. Pleomorphic giant cells

Question 417

Bronchial carcinoid tumor

Answer 417

excellent prognosis, low metastatic rate. Symptoms from mass effect or occasionally seratonin syndrome. these are neuroendocrine cells chromogranin positive

Question 418

coin lesion in lung differential

Answer 418

lung cancer granuloma (Tb, sarcoidosis, histoplasma) bronchial hamartoma (often calcified, with lung parenchyma AND cartilage)

Question 419

bronchioalveolar subtype

Answer 419

bronchioalveolar subtype (not assoc with smoking, good prognosis, grows along alveola septa (thickening of walls), starts in small airways arises from clara cells pneumonia like consolidation

Question 420

UNIQUE site of lung metastasis

Answer 420

adrenal gland

Question 421

ziehl-neelsen carbolfuchsin stain (aniline dye)

Answer 421

this is the acid fast stain of mycobacterium and nocardia

Question 422

silver stain

Answer 422

stains fungi, legionella, helicobacter

Question 423

india ink stain

Answer 423

stains cryptococcus neoformans

Question 424

crystal violet dye

Answer 424

gram stains things positive

Question 425

safranin or fucshin (not carbolfuchsin)

Answer 425

counterstain for gram negatives

Question 426

giemsa

Answer 426

Certain Bugs Really Try my Patience Chlamydia, Borrelia, Rickettsiae, Trypanosomes, Plasmodium

Question 427

dihydrorhodamine flow cytometry

Answer 427

another way other than nitroblue tetrazolium to test for NADPH oxidase deficiency will flouresce green CGD is X linked

Question 428

cystic fibrosis inheritance

Answer 428

Autosomal recessive

Question 429

mallory body

Answer 429

damaged intermediate filament inclusions in liver these would be in hepatitis diseases

Question 430

councilman bodies

Answer 430

an apoptotic eosinophillic swelling hepatocyte from viral hepatitis

Question 431

eosin is acidic and stains basic things that are acidophillic

Answer 431

haematoxylin is basic and stains acid structures that are basophillic

Question 432

minute ventilation

Answer 432

minute ventilation = tidal volume x RR

Question 433

reid index

Answer 433

normal mucus glands \<40% wall thickness Bronchitis is \>50% obstruction is caused by lumenal narrowing because of increased thickness, and mucus production

Question 434

dysplastic kidney

Answer 434

noninherited with renal parenchyma composed of cysts and abnormal tissue (like cartilage) can be unilateral (most common) or bilateral Sue to abnormal interaction btw ureteric bud and metanephric mesenchyme

Question 435

medullary cystic kidney disease

Answer 435

inherited autosomal dominant cysts in kidney bilateral cysts are MEDULLARY, vs PKD wich is CORTEX AND MEDULLA

Question 436

infant with worsening renal failure, htn, portal hypertension

Answer 436

autosomal recessive PKD with hepatic fibrosis in general PKD causes cysts in kidneys, liver, brain (berry aneurisms)

Question 437

acute interstitial nephritis

Answer 437

intrarenal azotemia causes: NSAIDs, PCN, diuretics s/s: oliguria, fever, rash, eosinophilic infiltrate (HSR) renal pallillary necrosis \*\*can become chronic, but is often still reversible

Question 438

horseshoe kidney location association

Answer 438

located about L3 under IMA vs normal L1/L2 associated with Turner Syndrome (XO) predisposed to renal stenosis, uretopelvic junction(last plce to fuse), hydronephrosis occurs 1/500 autopsies

Question 439

what barrier is lost in nephrotic syndrome?

Answer 439

the charge barrier -\> leak of proteins normally repelled

Question 440

filtration fraction

Answer 440

GFR/RPF RPF usuing PAH clearance

Question 441

filtered load

Answer 441

GFR x Px excreted load = filtered - reabsorbed or filtered + excreted excretion rate = V x Ux

Question 442

glucosuria begins at ? Saturation at? max absorption/min?

Answer 442

glucosuria begins at 160mg/dL BGL saturated transporters (Tm) 350mg/ddL max absorption = 200mg/min @Tm

Question 443

hartnup disease

Answer 443

deficiency of neutral amino acid reabsorption (tryptophan) -\> pellagra (diarrhea, dementia, dermatitis) tryptophan -\> B3 with B6 help

Question 444

cystic bone spaces filled with brown firbous tissue with bone pain

Answer 444

osteitis fibrosa cystica = stones, groans, bones due to primary hyperparathyroidism

Question 445

neurofibromatosis type I s/s

Answer 445

s/s cafe au lait spots, lisch nodules (hamartoma of iris with pigmentation), neurofibroma of skin optic glioma, pheochromocytoma, Autosomal dominant 100% penetrant, variable expression Mutated NF1 gene

Question 446

RPF

Answer 446

Using PAH usually RPF = RBF x (1-hct)

Question 447

metabolic alkalosis differential

Answer 447

resp alkalosis (low PCO2) -hyperventilation, salicylates (early) Metabolic - loop diuretics, thiazides (saline responsive)\* high urine chloride - antacid - vomiting (saline responsive)\* low urine chloride - hyperaldosteronism (not saline responsive): high urine chloride \*\*ones that correct with saline bc of volume loss

Question 448

increasing renal afferent resistance on GFR

Answer 448

initially increases until the point where reduced volume due to hydrostatic pressure -\> leads to increased oncotic pressure within the capillary. NO more increase GFR

Question 449

ANP BNP

Answer 449

secreted by atria and ventricles respectively in response to stretch/volume overload increase GFR without increasing Na resorption =\> net loss of sodium and water

Question 450

shifts of potassium digitalis hyper/hypoosmolity insulin cell lysis acidosis B adrenergic agonist/antagonist

Answer 450

Dig= K out of cell (block Na/K) = hyperkalemia K follows water = hyperosm -\> hyperK Insulin increases Na/K= K into cell = hypokalemia Lysis - K out of cell = hyperkalemia Acidosis: H/K exchange: hyperkalemia B agonist: increase Na/Katpase = hypokalemia

Question 451

hypercalcemia

Answer 451

stones(kidney), bones (pain), groans (abd pain), psych overtones(AMS, anxiety)

Question 452

hypermagnesemia

Answer 452

decreased DTR, bradycardia, hypotension, cadiac arrest, hypocalcemia =\> hyperpolarize cell

Question 453

RBC cast

Answer 453

glomerulonephritis, ischemia, malignant htn

Question 454

wbc casts

Answer 454

tubulointerstitial inflammation, acute pyelonephritis, transplant rejection

Question 455

fatty casts oval fat bodies

Answer 455

nephrotic syndrome

Question 456

granular "muddy brown" casts

Answer 456

acute tubular necrosis etiology: renal ischemia (shock, sepsis), crush injury (myoglobinuria), drugs, toxins (lead, aminoglyosides

Question 457

waxy casts

Answer 457

advanced renal disease, chronic renal failure

Question 458

hyaline casts

Answer 458

nonspecific. can be normal, esp in dehdrated patients

Question 459

Focal segmental glomerulosclerosis

Answer 459

A "worse" minimal change disease EM effacement of foot process, LM sclerosis/hyalinosis. NO IF Most common nephrotic syndrome of (esp.hispanics/AAmerican) HIV, heroin, CKD, sickle cell

Question 460

membranous nephropathy LM EM IF

Answer 460

LM: diffuse thickening of CAPILLARY AND GBM EM: spike and dome IF granular subepithelial deposits most common in caucasian adults "bugs drugs tumors rheum" idiopathic, NSAIDS, infections, SLE, tumor

Question 461

minimal change disease

Answer 461

most common in kids LM normal EM foot process effacement Loss of ONLY albumin, not globulins Triggered often by recent infection,immunization, atopic disorders... or "immune stimulus." Responds to corticosteroids. Associated with cytokines and Hodgkin's lymphoma

Question 462

only nephrotic syndrome with excellent response to steroids

Answer 462

minimal change disease

Question 463

every membranous nephrotic syndrome IF

Answer 463

will be granular with IC deposition

Question 464

spike and dome vs lumpy bumpy renal problem

Answer 464

spike and dome = membranous nephropathy, granular IF, subepithelial deposits lumpy bumpy = nephritis, PSGN, subepithelial deposits

Question 465

tram track appearance

Answer 465

membranoPROLIFERATIVE glomerulonephritis type I (subendothelial) or II (intramembranous)

Question 466

C3 nephritic factor association

Answer 466

Type II (intramembranous) membranoproliferative glomerulonephritis C3 nephritic factor stabilized C3 convertase --\> inflammation disease is IC deposits decreased C3

Question 467

alport syndrome

Answer 467

Mutation type IV collagen, x linked -\> split basement membrane (don't confuse with membranous glomerulonephritis) \*glomerulonephritis, deafness, ocular disturbances

Question 468

goodpastures syndrome

Answer 468

type II hypersensitivity antibodies against GBM and alveolar BM linear IF \*\*inflammation, C3 deposition, and fibrinoid necrosis occurs with fibrin leaking through into GMB and bowmen's capsule =\> RPGN with cresents made up of macrophages and fibrin (not collagen!)

Question 469

ceruloplasm

Answer 469

the copper binding agent that is often low in Wilson's disease Note that wilson also can't secrete copper in bile Aurosomal recessive chr.13q mutation ATP7B \*\*liver and neuropsychiatric problems \*renal tubular acidosis (proximal bicarb handling)

Question 470

ceramide trihexoside accuulation

Answer 470

Fabry's disease. Peripheral burning sensation of hands/feet (acroparesthesia) angiokeratomas (dark nonblanching papules/macules btw knee and umbilicus) cardiovascular/renal disease hypohidrosis (diminished sweating) Enzyme deficiency = alpha galactosidase (X-recessive) may treat with enzyme replacement therapy

Question 471

renal plasma flow stays normal over what ranges (due to autoregulation)

Answer 471

100-200mmHg

Question 472

scarring of cortex in upper and lower poles

Answer 472

characteristic of cesicoureteral reflux and chronic pyelonephritis with scarring and fibrosis

Question 473

thyroidization of kidney

Answer 473

atrophic tubules with eosinophillic proteinaceous materia looks like colloid of thyroid SEEN IN chronic pyelonephritis/VUR waxy casts too

Question 474

calcium oxalate stone association to disease

Answer 474

crohns! increased resorption of oxalate

Question 475

two stones that precipitate in alkalinized urine

Answer 475

calcium phosphate ammonium magnesium phosphate

Question 476

radioluscent kidney stone

Answer 476

Uric acid stone UUUUric acid stone is radioLUUUUUcent

Question 477

staghorn calculi in adult in kid

Answer 477

adult: urease +: proteus or klebsiella kid: cystinuria (failure to resorb cysteine)

Question 478

osteomalacia

Answer 478

when you don't mineralize new osteoid layed down by osteoblasts

Question 479

cysts in shrunken kidney risk of cancer

Answer 479

increased risk of renal cell carcinoma in patients with renal failure on dialysis.

Question 480

s/s renal cell carcinoma pathogenesis

Answer 480

triad: hematuria (most common), flank pain, palpable mass can be associated with paraneoplastic symptoms: EPO, renin, ACTH, PTHrH fever and weight loss patho: VHL loss (tumor suppressor)

Question 481

beckwith wiedmann syndrome

Answer 481

wilms tumor (most common in children) neonatal hypoglycemia muscular hemihypertrophy organomegaly (esp tongue) another syndrome is WAGR: wilms tumor, aniridia (absence of iris), genital abnormalities, mental/motor Retardation

Question 482

aniridia

Answer 482

aniridia = absence of iris = WAGR syndrome wilms tumor, aniridia, genital abnormalities, mental/growth Retardation

Question 483

adenocarcinoma of bladder

Answer 483

only really occurs from urachal (allantois) remnant on the superior aspect of bladder (dome) or bladder extrophy with exposure of bladder to outside world often occurs with epispadius or metaplasia from longstanding inflammation

Question 484

aldosterone secretion control

Answer 484

1) ATII 2) hyperkalemia 3) ACTH (a little)

Question 485

RPGN 3 types

Answer 485

1) Goodpastures with IgG and C3 deposits 2) "lumpy bumpy:" PSGN, SLE, IgA nephropathy += Henoch Schonlein purpura 3) pauci immune: wegeners, and maybe churg strauss, microscopic polyangiitis characterized by macrophage infiltrate, fibrin leak, fibroblast proliferation, and parietal cell proliferation

Question 486

immune complex deposition activation of complement

Answer 486

the alternative pathway is activated, which spares C1 and C4 =\> low C3 but higher C1/C4

Question 487

hereditary angioedema

Answer 487

sporatic attacks of swelling lack c1 esterase inhibitor so c1 esterase breaks down C4 and activates compliment Autosomal Dominant

Question 488

pyrogenic exotoxin 3

Answer 488

antigen implicated in PSGN from strep pyogenes

Question 489

verrucae

Answer 489

warts caused by HPV

Question 490

condyloma acuminatum

Answer 490

condyloma "knuckle" refers to genitals condyloma acuminatum = genital warts

Question 491

dermatitis herpetiformis

Answer 491

IgA deposits at the tips of dermal papillae cause herpetic type vesicles associated with celiac disease, from epidermal tissue transglutaminase

Question 492

erythema multiforme

Answer 492

targets with multiple rings and dusky center associations HSV, mycoplasma pneumonia, drugs (sufas), lupus ![]()

Question 493

steven johnson syndrome s/s associations

Answer 493

seperation of DERMAL/EPIDERMAl junction fever, bulla formation, necrosis, sloughing of skin, HIGH MORTALITY RATE may appear as erythema multiforme but progress if \>30% skin = toxic epidermal necrolysis association with medication rxn (lamotragine and others)

Question 494

lymph drainage below pectinate line above pectinate line sigmoid colon lower 1/3 vagina upper 2/3 vagina

Answer 494

below = superficial inguinal lower rectum above pectinate= internal iliac sigmoid colon = colic -\> IMA lower 1/3 vagina -\> superficial inguinal upper 2/3 -\> internal iliac

Question 495

invasive cervical cancer death through?

Answer 495

will often block ureters -\> renal failure bores through anterior uterine wall -\> bladder pap smear great for scc, not adenocarcinom quadravalent vaccine only lasts 5 yrs: still need pap smear

Question 496

lichen sclerosis

Answer 496

thinning of epidermis, fibrosis of underlying dermis leukoplakia (white patch) that's parchment like benign but small risk of scc, post-menoposal

Question 497

lichen simplex chronicus

Answer 497

leukoplakia that is thick/leatherlike hyperplasia of squamous epithelium CHRONIC irritation and scratching benign (NO INCREASED RISK SCC)

Question 498

vulvar leukoplakia differential

Answer 498

lichen simplex chronicus lichen sclerosis vulvar carcinoma (HPV or lichen sclerosis related)

Question 499

paget's vs melanoma

Answer 499

pagets (mamillary or vulva) PAS+, keratin+, S100- melanoma (may be vulva) PAS-, keratin-, S100+ ![]() \*\*Both these are intraepithelial, random cells in the epithelium

Question 500

Adenosis

Answer 500

persistance of columnar epithelium in vagina happened with DES (diethylstilbestrol), leads to clear cell adenocarcinoma of vagina -\> also related to ectopic pregnancies in DES daughter (smooth muscle problems)

Question 501

thalidomide

Answer 501

used for morning sickness, caused limb malformation (phocomelia)

Question 502

p21

Answer 502

cdk inhibitor upregulated by p53

Question 503

HPV high risk infection

Answer 503

smoking and immunodeficiency

Question 504

asherman syndrome

Answer 504

2nd amenorrha from basalis destruction from overaggressive DnC Asher

Question 505

chronic endometritis characteristic cell

Answer 505

plasma cell must be present for dx

Question 506

chocolate cyst

Answer 506

endometriosis in ovary (most common site) accumulation of multiple cycles grow/shed in soft tissue = gunpowder lesion

Question 507

adenomyosis

Answer 507

presence of endometrium in myometrium

Question 508

endometrioid carcinoma

Answer 508

arises from unopposed estrogen and endometrial hyperplasia (\> 50s) in contrast to sporatic (p53 mutation) serous papillary endometrial carcinoma arrising from atrophic endometrium ( \>70y/o ==\> psammoma bodies

Question 509

psammoma bodies

Answer 509

papillary carcinoma of thyroid meningioma papillary serous carcinoma mesotheliom

Question 510

multiple defined white whorly masses

Answer 510

leiomyoma = fibroids ![]() premenopausal (usually asymptomatic but may lead to bleeding) vs leiomyosarcoma: single, often hemorrhage/necrosis, postmenopausal... ARISES DENOVO. NOT FROM Leiomyoma's

Question 511

ovarian follicle

Answer 511

![]()

Question 512

PCOS LH:FSH

Answer 512

LH:FSH \>2 3:1 = diagnostic lots of LH, less FSH high androgen (theca cells) high estrogen (fat aromatization) estrogen feedback inhibits LH & FSH

Question 513

increased AFP schiller duval bodies (resemble glomeruli)

Answer 513

germ cell tumor yolk sac tumor endodermal sinus tumor

Question 514

increased hCG increased LDH associated with turner syndrome

Answer 514

dysgerminoma (ovarian germ cell tumor) equivalent to male seminoma

Question 515

increased hCG early hematogenous spread NO chorionic villi

Answer 515

choriocarcinoma, malignancy of trophoblastic tissue

Question 516

90% of germ cell tumors mature and immature

Answer 516

teratoma: females generally benign mature = teeth/hair ect = mostly benign immature: atypical cells, malignant

Question 517

struma ovarii

Answer 517

a teratoma with functional thyroid tissue -\> hyperthyroidism

Question 518

normal histology endometrium fallopian tube ovary endocervix

Answer 518

endometrium - endometrial cells fallopian - serous columnar ovary- cuboidal from coelomic epithelium endocervix- mucinous columnar \*\*surface epithelial tumors are most common (more than germ cell) endometial tumor is MOST COMMON

Question 519

benign teratoma in women

Answer 519

mature teratoma has to have ALL mature tissue. can have somatic malignancy within mature tissue. most commonly squamous cell immature teratoma (such as containing neuroectoderm is malignant) cystic teratoma is most common germ cell tumor

Question 520

classic BRCA1 ovarian tumor

Answer 520

SEROUS cystadenocarcinoma \*\*also at risk for breast cancer and fallopian tube

Question 521

brenner tumor

Answer 521

contains urothelium benign and bilateral

Question 522

most common germ cell tumor women

Answer 522

cystic teratoma dysgerminoma is most common malignant germ cell tumor

Question 523

reinke crystals

Answer 523

sertoli-leydig cell tumor: androgen production reinke crystals in leydig cells

Question 524

meig's syndrome

Answer 524

ovarian fibromas, pleural effusions, ascites

Question 525

intraperitoneal accumulation of mucous (jelly belly)

Answer 525

pseudomyxoma peritonea can be from ovarian or appendiceal tumor, likely a metastasis from appendix

Question 526

placenta accreta

Answer 526

placental invasion into myometrium -\> diffiulty delivering placenta after birth -\> hysterextomy

Question 527

choriocarcinoma gestational vs sporatic response to chemo

Answer 527

gestational responds well (will have chorionic villi): will melt away sporatic does not (no chorionic villi) will be in ovary (germ cell tumor)

Question 528

urogenital folds make?

Answer 528

male urethra/ventral shaft female labia minora

Question 529

labioscrotal swelling make?

Answer 529

scrotum or labia majora

Question 530

prostate comes from what ?

Answer 530

urogenital sinus (also makes the male glands of cowper and female bartholin/skene glands

Question 531

genital tubercle makes what?

Answer 531

male: glans penis, corpus cavernosum (fill with blood baby) and spongiosum(around urethra) female: glans clitoris and vestibular bulbs (erectile tissue of vestibule)

Question 532

vessels in suspensory ligament

Answer 532

suspensory ligaments of the ovaries ovarian vessels (ligate when ovarian removal) also contains lymphatics and nerves

Question 533

vessels in cardinal ligament (transverse ligament)

Answer 533

Uterin vessels care for ureter injury (goes under uterine vessels)

Question 534

mesosalpinx

Answer 534

broad ligament covering everything

Question 535

round ligament of uterus

Answer 535

contains artery of sampson -\> travels through inguinal canal

Question 536

estriol is a marker of what?

Answer 536

it increases 1000fold in pregnancy, indicates fetal well being produced by the placenta

Question 537

best test for menopause

Answer 537

way increased FSH moderately (and later) increase in LH increased GnRH

Question 538

how does menopause lead to osteoporosis

Answer 538

estrogen inhibits osteoclasts. when low -\> osteoclast haven

Question 539

quellung test

Answer 539

positive capsule swells when specific anticapsular antisera is added along with methylene blue to make it swell halo appears the SHiNE SKiS are positive

Question 540

red on mucicarmine stain

Answer 540

cryptococcus neoformans

Question 541

cord factor = mycoside

Answer 541

correlates with virulence of mycobacterium tuberculosis If lacking they don't cause disease appearance of serpentine cords on growth medium is diagnostic

Question 542

sulfatides from mycobacteria

Answer 542

inhibit phagosome fusion with lysosomes in macrophages virulence feature of mycobacterium tb

Question 543

what bacteria have IgA protease?

Answer 543

H. Flu, Neisseria meningitis, Strep pneumonia

Question 544

where do DNA viruses replicate? exception?

Answer 544

nucleus (except pox); they need the cells polymerases (except pox and HBV.. and HBV is still in nucleus)

Question 545

Where do RNA viruses replicate? exception?

Answer 545

cytoplasm (use of ribosomes) -except influenze and retroviruses(bc it integrates, duh)

Question 546

where does herpes virus get it's unique phospholipid envelope?

Answer 546

The nucleus of the cell (all the herpes viruses)

Question 547

naked viruses

Answer 547

Give a PAPP and CPR to naked Hepe PAPP CPR Hepe Parvo adeno polyoma (JC) papilloma RNA: calici (noro), picorno, reo(rota), hepe (HEV)

Question 548

only dsRNA

Answer 548

reovirus = rotavirus linear dsRNA

Question 549

paramyxovidiridae

Answer 549

enveloped, ss -, nonsegmented parainfluenza - croup, rsv- bronchiolitis (no H or N) measles, mumps

Question 550

klebsiella

Answer 550

enteric non-motile gram negative urease positive, lactose fermenting, catalase negative nosocomial sepsis BAD lobar pnemonia (of sick and alcoholics)

Question 551

vaccines attenuated inactivated adjuvant conjugant

Answer 551

attenuated: live; small yellow chickens, MMR sabin, IN influenza + typhoid and BCGtb inactivated: heat/chemical killed adjuvant: PAMP added to increase immune system response conjugate: covalent link of protein to promote IgG class switch

Question 552

23 valent vs 13 valent pneumococcal vaccine

Answer 552

23 valent( PPSV23) is only polysaccharide only B cell IgM response 13 valent is conjugated to diptheria =\> IgG response/memory \*\*neisseria meningitis and H flu also have polysaccharide (not conjugated) vaccines

Question 553

where is the site of most lipid absorption?

Answer 553

jejunum