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166 Cards in this Set

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Drug class:
Nortriptyline
TCA
Drug class:
Selegiline
MAOI but not used as antidepressant
Drug class:
Bupropion
NDRI--DA reuptake inhibitor
Drug class:
Mirtazapine
Tetracyclic antidepressant
Drug class:
Fluvoxamine
SSRI
Drug class:
Doxepin
TCA
Drug class:
Phenelzine
MAOI
Drug class:
Fluoxetine
SSRI
Drug class:
Clomipramine
TCA
Drug class:
Imipramine
TCA
Drug class:
Amitryptyline
TCA
Drug class:
Milnacipran
SNRI--NE reuptake inhibition
Drug class:
Desipramine
TCA
Drug class:
Sertraline
SSRI
Drug class:
Venlafaxine
SNRI--NE reuptake inhibition
Drug class:
Paroxetine
SSRI
Drug class:
Tranylcypromine
MAOI
Drug class:
Duloxetine
SNRI--NE reuptake inhibition
Drug class:
Citalopram
SSRI
Drug class:
Desvenlafaxine
SNRI--NE reuptake inhibition
Drug class:
Trazodone
Tetracyclic Antidepressant
How does the drug dose response curve change with addition of a competitive agonist compared to a noncompetitive agonist?

Effects on Km, Vmax, efficacy, potency.
Competitive-->right shift; inc Km-->dec potency

Noncomp-->Shift curve down; dec'd Vmax; change in efficacy, not potency.
Worst headache of my life
SAH (berry aneurysm(
Waxy cast in urine
Stasis of urine flow caused by end-stage renal dz
Neuropathy
AV nodal block
Stage 2 Lyme Dz
Port-wine stain in ophthalmic division of trigeminal nerve
Sturge-Weber Syndrome
Urethritis
Conjunctivitis
Arthritis
Can't see
Can't pee
Can't climb a tree

Reiter's Syndrome--HLAB27
Lack of GpIIb/IIIa
Platelet defect
Prolonged bleeding
Glanzmann's Thrombostenia
Painless jaundice
Panc Ca in head of pancreas
Nerve affected:
Injury to shaft of humerus
Radial
Nerve affected:
Injury to surgical neck of humerus
Axillary
Nerve affected:
Injury to supracondyle of humerus
Median
Nerve affected:
Injury to medial epicondyle of humerus
Ulnar
Nerve affected:
Injury to anterior shoulder
Axillary
Nerve affected:
Injury to carpal tunnel
Median
What are the phagocyte immunodeficiencies?
Chronic Granulomatous Dz
Chediak-Higashi
Leukocytic def syndrome
Job's syndrome (hyper IgE)
What are the x-linked immunodeficiencies?
WBC
Wiskott-Aldrich
Bruton's agammaglobinemia
Chronic granulomatous Dz
Hyper IgM syndrome
Which personality disorder:
Excessive need to be taken care of
Submissive
Clinging
Dependent
Which personality disorder:
Low self-confidence
Fears separation, losing support
Dependent
Which personality disorder:
Grandiosity
Feelings of entitlement
Lack of empathy
Narcissistic
Which personality disorder:
Suicide attempts
Unstable mood and behavior
Borderline
Which personality disorder:
Sense of emptiness and loneliness
Impulsiveness
Borderline
Which personality disorder:
Odd appearance, thoughts, behavior
No psychosis
Social awkwardness
Schizotypal
Which personality disorder:
Controlling
Perfectionist
Orderly
Stubborn
Indecisive
Obsessive Compulsive
Which personality disorder:
Criminality
Unable to conform to social norms
Disregard for others' rights
Antisocial
A small study of USMLE test takes for a school revealed scores of 225, 225, 225, 229, 230, 240, and 250, with an average of 232.

What is the mean, median, and mode for these values?

Would this create a positively skewed curve or a negatively skewed curve?
Mean = 232
Median = 229
Mode = 225

Mean > median and mode; thus, positively skewed curve (to right?)
Identify cell:
CD4
Helper T cells
Identify cell:
CD14
Macs
Identify cell:
CD16
NKCs and Macs
Identify cell:
CD19
B cells
Identify cell:
CD3
All T cells, not NKCs
Identify cell:
CD8
Cytotoxic T cells
Hallmark features:
Autism
<IQ
Poor comm/social skills
Repetitive behaviors
Hallmark features:
Rett's disorder
FEMALES only (X-linked dominant-->males die in utero)
Smaller head circumference
Hand wringing
Hallmark features:
Asperger's syndrome
Normal IQ
poor social skills
Sonic Hedgehog Gene:
Location
Role
Base of limbs in zone of polarizing activity

Involved in patterning along anterior-posterior axis

Mediates ectodermal fns
Wnt-7 gene:
Location
Role
Produced at ectoderm at DISTAL end of each developing limb

Necessary for organization along dorsal-ventral axis (limb lengthening)
Homeobox gene:
Role
Segmental organization in craniocaudal direction
Mutation to HOXD-13:
Effects
HOXD-13 is a homeobox gene (segmental organization in craniocaudal direction)

Mutation to this gene-->synpolydactyly (extra fused digit between 3rd/4th fingers)
Embryologic rule of 2's
2nd week of development:
2 germ layers (bilaminar disk): epiblast, hypoblast
2 cavities: amniotic cavity, yolk sac
2 components to placenta: cytotrophoblast, syncytiotrophoblast
Embryologic rule of 3's
3rd week of dev't:
3 germ layers (gastrula):
ectoderm
mesoderm
endoderm
Embryologic rule of 4's
4th week of development:
4 heart chambers
4 limb buds
When is folic acid critical to embryonic development?
Within first 6 weeks of pregnancy; this is when neural tube forms and seals
When are embryos most susceptible to teratogens?

Why?
Weeks 3-8 (embryonic period)

This is when organogenesis occurs; after Week 8, it's just growth.
Rathke's Pouch:
What does it become?
Germ layer?
Adenohypophysis-->Anterior pituitary

Surface ectoderm
Surface ectoderm:
What does it become?
Adenohypohysis from Rathke's pouch
Lens of eye
Oral cavity lining
Epidermis
Salivary, sweat, mammary glands
Neuroectoderm:
What does it become?
Brain (neurohypohysis--POSTERIOR pituitary), CNS neurons, oligos, astrocytes, ependymal cells, pineal gland)
Retina
SC
Neural crest ectoderm:
What does it become?
PNS
Non-neural structures nearby (ANS, dorsal root ganglia, cranial nerves, adrenal cells)
Pia, arachnoid
Bones of skull
Teeth (CREST toothpaste)
SPIRAL septum of heart
This is a Rathke's pouch tumor.
Craniopharyngioma
Endoderm:
Derivatives
Gut tube epithelium, lungs, liver, pacnreas, thmus, parathy
Mesoderm:
Derivatives
Muscle, bone, connective tissue
Serous linings of body cavities
SPLEEN
CV structures
GU
Mesodermal defects
VACTERI
Vertebral defects
Anal atresia
Cardiac defects
Tracheo-Esophageal fistula
Renal defects
Limb defects (bone, muscle(
Deformation vs Malformation
Deformation--extrinsic disruption; occurs after embryonic period

Malformation--intrinsic disruption; occurs during embryonic period (weeks 3-8)
Agenesis vs Aplasia
Agenesis = absent organ due to absent primordial tissue

Aplasia = absent organ despite present primordial tissue
What is hypoplasia?
Incomplete organ dev't, primordial tissue present
What is the "all-or-none" effect of embryogenesis?
When does it occur?
If ingest teratogen before week 3, won't see developmental defects.

All = miscarriage
None = no developmental defects
Describe facies of fetal alcohol syndrome.
Smooth philtrum
Thin upper lip
Flat nasal bridge
Aminoglycosides:
Effect on fetus
CN VIII toxicity
ACE inhibitors:
Effect on fetus
Renal damage
Thalidomide:
Effect on fetus
Limb defects (hand connected directly to shoulder)
Carbamazepine:
Effect on fetus
Inhibition of intestinal folate absorption
Valproate:
Effect on fetus
Inhibition of intestinal folate absorption
Vitamin A:
Effect on fetus
Vitamin A = retinoic acid = Retin-A!!

SPontaneous abortions
Cleft palate, cardiac abnlts
Warfarin:
Effect on fetus
Bone deformities
Fetal hemorrhage
When would embryonic division occur to form:
Diamnotic/dichorionic placentation
Prior to morula--within 3 days of fertilization; will have separate amnion and placenta
When would embryonic division occur to form:
Diamniotic/monochorionic placentation
Division occurs 4-8 days post-fertilization (blastocyst)

Will have 2 amniotic sacs, 1 placenta
When would embryonic division occur to form:
Monoamniotic/monochorionic placentation
Division occurs 8-12 days after fertilization (epiblast/hypoblast)

1 amniotic sac, 1 placenta
Cord entanglement of twins is suggestive of _______.
monoamnionicity
One yolk sac and 2 fetal poles is suggestive of ______.
monoamnionicity
Amniocentesis vs Chorionic Villous Sampling:
Timing
Benefits/Risks
Amniocentesis: 15-17 weeks for genetic evaluation; 0.5% fetal loss

Chorionic villous sampling:
10-12 weeks; 1% fetal loss, limb defects if <9 weeks
Gives you genetic info re: baby sooner, but it's riskier than amnio
This cell secretes hCG.
syncytiotrophoblast
hCG is structurally similar to ____.

How?
LH
FSH
TSH

all share same alpha-subunit
How many and function:
Umbilical artery
Umbilical vein
Umbilical arteries--there are 2; they return deoxygenated blood to placenta

Umbilical vein--just 1; supplies oxygenated blood from placenta to fetus, drains into IVC
Single umbilical artery is associated with ______.
Congenital renal problems (do an u/s)
Urachus:
Origin
Function
Lack of obliteration results in?
allantois-->urachus (duct between bladder and yolk sac)

Failure to obliterate-->patent urachus--urine discharge from umbilicus
OR
-->vesicourachal diverticulum (outpouching of bladder)
Vitelline duct:
Role
Associated defect
Role: connects yolk sac to midgut lumen

If fail to obliterate-->vitelline fistula: meconium discharge from umbilicus (Meckel's diverticulum)
Truncus arteriosus:
Pathophys
What should normally happen?
Neural crest migration-->ridges spiral and fuse to form aorticopulmonary septum-->formation of ascending aorta and pulmonary trunk

Pathophys (truncus arteriosus):
Transposition of great vessels (failure to spiral)--aorta ends up on RIGHT of PA (bad!!)
Tetralogy of Fallot
Persistent Truncus Arteriosus
Outline the pathway by which the cardiac ventricles and their outflow tracts are separated.
Muscular ventricular septum forms to separate ventricles

Truncoconial swellings (ridges) of truncus arteriosus meets, fuse, and zip (superiorly and inferiorly) to form spiral septum (aorticopulmonary septum)

Inferior portion of spiral septum meets muscular ventricular septum to divide ventricles and form aorta/pulmonary aa
Outline the pathway by which the heart tube forms the atria of the four-chambered heart.
Heart tube grows, elongates, folds into S-shape.

Ventricles are in anterior part of S.

Atrial chamber grows, incorporates SVC and PV

Septum primum-->septum secundum (incompletely forms--leaving FORAMEN OVALE)

Cell death in septum primum-->ositum secundum
What embryonic structure divides the left and right atria?
Septum primum and septum secundum
How is blood shunter from RA to LA in embryo?
Through foramen ovale of septum secundum and ostium secundum of septum primum
Where does fetal erythropoiesis occur? Provide chronological order.
Young Liver Synthesizes Blood
Yolk Sac (weeks 3-8)
Liver (6-30 weeks)
Spleen (9-28 weeks)
BM (28 weeks onward)
Which bones synthesize blood cells?
Sternum
Pelvis
Ribs
Tibia, Femur (Long bones)
Skull bones
Describe pathway of fetal circulation.
UV-->Ductus Venosus (bypass liver to IVC)-->IVC
-->RA-->
Majority to LA via FO-->LV-->Aorta-->brain + body
Some to RV-->PA-->Lungs BUT Ductus Arteriosus will shunt it to aorta-->Systemic circuln

Deox'd blood-->Fetal internal iliac aa-->Umbilical arteries-->Placenta
What changes occur in fetal circulation occur after birth?

Describe each change.
1) Infant takes a breath-->dec'd resistance in pulm vasculature-->inc'd LA pressure vs RA pressure (FO closes; now called fossa ovalis)

-Inc'd O2-->dec'd PGs-->closure of Ductus Arteriosus
Why is indomethacin given to neonates?
Indomethacin = NSAID; helps to reduce PGs to close ductus arteriosus.
What are the derivates of the aortic arch (1st-6th)?
1st--MAXIMAL; maxillary artery

Second = Stapedial and hyoid aa

Third = C is third letter of alphabet-->Carotid artery

4th--4 limbs!--systemic circuln; on left: aortic arch, on right: proximal right subclavian artery

(there is no 5th)

6th arch: pulmonary aa and (on left only) ductus arteriosus
Which developmental structure:
Supplies oxygenated blood to fetus
Umbilical Vein
Which developmental structure:
Removes nitrogenous waste from fetal bladder
Urachus
Which developmental structure:
Fetal placental structure that secretes hCG
Syncytiotrophoblast
Which developmental structure:
Maternal component of placenta
decidua basalis
Which developmental structure:
Returns deoxygenated blood from fetal internal iliac aa
Umbilical aa
Which embryologic structure of heart gives rise to:
Ascending aorta and pulmonary trunk
Truncus arteriosus
Which embryologic structure of heart gives rise to:
Coronary sinus
Left horn of sinus venosus
Which embryologic structure of heart gives rise to:
SVC
Right common cardinal vein
Right anterior cadinal vein
Which embryologic structure of heart gives rise to:
Smooth parts of LV and RV
Bulbus cordius
Which embryologic structure of heart gives rise to:
Smooth part of RA
Right horn of sinus venosus
Which embryologic structure of heart gives rise to:
Trabeculated parts of LA and RA
Primitive atria
Trabeculated parts of LV and RV
Primitive ventricle
What structure divides the truncus arteriosus into the aortic and pulmonary trunks?

Cellular origin?
Spiral septum (aorticopulmonary septum)

Neural crest origin
Which fetal vessel has the highest oxygenation?
UV
What is early shunt?
Causes?
Early cyanosis is caused by right-to-left shunt; seen in new borns ("blue babies")

Causes:
5T's
Tetralogy of Fallot
Transposition of great vessels
Truncus arterosus
Tricuspid atresia
Total anomalous pulmonary venous return (TAPVR)
Components of tetralogy of Fallot.
PROVe:
1- pulmonary stenosis (most impt determinant for prognosis)
2- RVH
3- Overriding aorta (overrides VSD)
4- VSD


Early cyanosis caused by inc'd pressure caused by stenotic pulmonic valve.
Boot-shaped heart on x-ray
Due to RVH; seen in tetralogy of fallot
Transposition of great vessels:
What is it?
When is this compatible with life?
Aorta leaves RV (anterior) and pulmonary trunk leaves LV (posterior)-->separation of pulmonary and systemic circulations

Only compatible with life if there's a shunt present (VSD, PDA, patent FO)

Needs surgical intervention.
What is tricuspid atresia?
Absence of tricuspid valve, hypoplastic RV.

Need ASD AND VSD for viability-->right to left shunt-->blue baby (early cyanosis)
What is late cyanosis?
Causes?
Late cyanosis = blue kids
LEFT TO RIGHT SHUNT

VSD--most common
ASD
PDA

Note: early cyanosis = RIGHT TO LEFT SHUNT
Why do late cyanotics take so long to present?
Uncorrected VSD, ASD, PDA causes compensatory vascular hypertrophy-->pulmonary HTN

As pulm resistance increases, shunt reverses from L-->R to R-->L, causing late cyanosis (clubbing, polycythemia)
HTN in upper extremities
Weak pulses in lower extremities
Coarctation of aorta
What is coarctation of the aorta?
Infantile vs adult type
Infantile: aortic stenosis (narrowing) proximal to insertion of ductus arteriosus
TURNER SYNDROME

Adult type:
Aortic stenosis distal to ligamentum arteriosum (remnant of DA). Leads to HTN in upper extrem's, weak pulses in lower extrem's. Can result in aortic regurgitation.
Cardiac defect:
22q11 syndrome
Persistant truncus arteriosus
Tetralogy of Fallot (DiGeorge!!!!)
Cardiac defect:
Trisomy 21
ASD
VSD
AV septal defect (endocardial cushion defect)
Cardiac defect:
Turner Syndrome
Coarctation of aorta (preductal)
Cardiac defect:
Marfan's Syndrome
Aortic insufficiency (late complicaiton)
Cardiac defect:
Infant of diabetic mother
Transposition of great vessels
45 year-old male presents with BP of 160/90 on right arm, 170/92 on left arm
No palpable pulses in feet/ankle

Diagnosis.
Aortic coarctation
Describe blood flow through patent ductus arteriosus.
Blood flow from pulm artery to aorta, bypassing pulm circuln
List subregions and derivatives for:

Mesencephalon
Prosencephalon
Rhombencephalon
Prosencephalon:
Telencephalon-->cerebral hemispheres, lateral ventricles

Diencephalon-->Thalami, hypothal, optic tracts, 3rd ventricle

Mesencephalon-->Midbrain, cerebral aqueduct

Rhombencephalon:
Metencephalon-->Pons, cerebellum, 4th ventricle
Mycencephalon-->Medulla
What lab tests indicate neural tube defects?
Inc'd alpha-fetoprotein and ACh-E in CSF
Branchial apparatus:
Arches vs Clefts vs Pouches--germ layer type, list in order (inside to outside or outside to inside)
CAP (outside to inside):
Clefts = ectoderm
Arches = mesoderm
Pouches = endoderm
Branchial clefts:
What does each develop into?
1st cleft-->external auditory meatus

2nd-4th-->temporary cervical sinuses (later obliterated)
A persistent cervical sinus results in _______.
Branchial cleft cyst within lateral neck
Branchial arch derivates
1-M's, T's--Mandible, malleus incus, muscles of MASTICATION, mylohyoid

2-S's--Stapes, styloid process, stylohyoid

3-Pharyngeal--stylopharyngeus

4th: cricothyroid
6th: everything in larynx except cricothyroid
Branchial pouch derivatives
1st: middle ear
2nd: palatine tonsil
3rd: INFERIOR PARATHY
4th: SUPERIOR PARATHY

Note 4th ends up being more superior than 3rd!
Embryologic pathophys of DiGeorge Syndrome
Aberrant dev't of 3rd and 4th branchial pouches
Describe the development of the thyroid.
Thyroid diverticulum arises from floor of pharynx, descends (drops) into neck

Connected to tongue by thyroglossal duct, which normally disappears (remnant = foramen cecum)
What is the foramen cecum?
Remnant of thyroglossal duct
What is the most common ectopic site of thyroid tissue?
Tongue
Midline neck mass
Moves with swallowing
Thyroglossal duct cyst
What spinal nerves innervate the diaphragm?
C3,4,5 keep the diaphragm alive
Monozygotic twins:
One is pale with HCT of 15%
Other is flushed with HCT of 55%

Cause?
Twin-twin transfusion syndrome--shared umbilical cord/placenta, one twin received more blood than other twin
Cleft-lip:
Which embryonic process failed?
Failure of fusion of maxillary and medial nasal processes
What nerves innervate the branchial arches?
1st arch (Ms and Ts): Maxillary, mandibular division of trigeminal nerve

2nd arch - Facial nerve

3rd arch - Glossopharyngeal nerve

4th and 6th--Vagus and superior laryngeal
Which branchial pouch:
Middle ear, eustachian tubes
1st
Which branchial pouch:
Superior parathyroids
4th
Which branchial pouch:
Inferior parathyroids
3rd
Which branchial pouch:
Epithelial lining of palatine tonsil
2nd
Which branchial pouch:
Thymus
3rd
Which cranial nerve:
Taste in anterior 2/3 tongue
Facial
Which cranial nerve:
Taste in posterior 1/3 tongue
Glossopharyngeal
Which cranial nerve:
Motor function of tongue
Hypoglossal
Which cranial nerve:
Sensation in anterior 2/3 tongue
Mandibular of Trigeminal
Which cranial nerve:
Sensation in posterior 1/3 tongue
Glossopharyngeal
What abnormalities are often found with Arnold-Chiari malformation?
Hydrocephaly
Syringomyelia
Myelomeningocele
Classic presenting symptoms of syringomyelia.
b/l loss of pain and temp sensation in upper extremity

Weakness and atrophy of hand mm
How does presentation of a branchial cleft cyst differ from that of a thyroglossal duct cyst?
Branchial cleft cyst--lateral neck

Thyroglossal cyst--midline neck, moves with swallowing