1A: Dt 5 - 1

Front 1

Drug class:
Nortriptyline

Back 1

TCA

Front 2

Drug class:
Selegiline

Back 2

MAOI but not used as antidepressant

Front 3

Drug class:
Bupropion

Back 3

NDRI--DA reuptake inhibitor

Front 4

Drug class:
Mirtazapine

Back 4

Tetracyclic antidepressant

Front 5

Drug class:
Fluvoxamine

Back 5

SSRI

Front 6

Drug class:
Doxepin

Back 6

TCA

Front 7

Drug class:
Phenelzine

Back 7

MAOI

Front 8

Drug class:
Fluoxetine

Back 8

SSRI

Front 9

Drug class:
Clomipramine

Back 9

TCA

Front 10

Drug class:
Imipramine

Back 10

TCA

Front 11

Drug class:
Amitryptyline

Back 11

TCA

Front 12

Drug class:
Milnacipran

Back 12

SNRI--NE reuptake inhibition

Front 13

Drug class:
Desipramine

Back 13

TCA

Front 14

Drug class:
Sertraline

Back 14

SSRI

Front 15

Drug class:
Venlafaxine

Back 15

SNRI--NE reuptake inhibition

Front 16

Drug class:
Paroxetine

Back 16

SSRI

Front 17

Drug class:
Tranylcypromine

Back 17

MAOI

Front 18

Drug class:
Duloxetine

Back 18

SNRI--NE reuptake inhibition

Front 19

Drug class:
Citalopram

Back 19

SSRI

Front 20

Drug class:
Desvenlafaxine

Back 20

SNRI--NE reuptake inhibition

Front 21

Drug class:
Trazodone

Back 21

Tetracyclic Antidepressant

Front 22

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.

Back 22

Competitive-->right shift; inc Km-->dec potency

Noncomp-->Shift curve down; dec'd Vmax; change in efficacy, not potency.

Front 23

Worst headache of my life

Back 23

SAH (berry aneurysm(

Front 24

Waxy cast in urine

Back 24

Stasis of urine flow caused by end-stage renal dz

Front 25

Neuropathy
AV nodal block

Back 25

Stage 2 Lyme Dz

Front 26

Port-wine stain in ophthalmic division of trigeminal nerve

Back 26

Sturge-Weber Syndrome

Front 27

Urethritis
Conjunctivitis
Arthritis

Back 27

Can't see
Can't pee
Can't climb a tree

Reiter's Syndrome--HLAB27

Front 28

Lack of GpIIb/IIIa
Platelet defect
Prolonged bleeding

Back 28

Glanzmann's Thrombostenia

Front 29

Painless jaundice

Back 29

Panc Ca in head of pancreas

Front 30

Nerve affected:
Injury to shaft of humerus

Back 30

Radial

Front 31

Nerve affected:
Injury to surgical neck of humerus

Back 31

Axillary

Front 32

Nerve affected:
Injury to supracondyle of humerus

Back 32

Median

Front 33

Nerve affected:
Injury to medial epicondyle of humerus

Back 33

Ulnar

Front 34

Nerve affected:
Injury to anterior shoulder

Back 34

Axillary

Front 35

Nerve affected:
Injury to carpal tunnel

Back 35

Median

Front 36

What are the phagocyte immunodeficiencies?

Back 36

Chronic Granulomatous Dz
Chediak-Higashi
Leukocytic def syndrome
Job's syndrome (hyper IgE)

Front 37

What are the x-linked immunodeficiencies?

Back 37

WBC
Wiskott-Aldrich
Bruton's agammaglobinemia
Chronic granulomatous Dz
Hyper IgM syndrome

Front 38

Which personality disorder:
Excessive need to be taken care of
Submissive
Clinging

Back 38

Dependent

Front 39

Which personality disorder:
Low self-confidence
Fears separation, losing support

Back 39

Dependent

Front 40

Which personality disorder:
Grandiosity
Feelings of entitlement
Lack of empathy

Back 40

Narcissistic

Front 41

Which personality disorder:
Suicide attempts
Unstable mood and behavior

Back 41

Borderline

Front 42

Which personality disorder:
Sense of emptiness and loneliness
Impulsiveness

Back 42

Borderline

Front 43

Which personality disorder:
Odd appearance, thoughts, behavior
No psychosis
Social awkwardness

Back 43

Schizotypal

Front 44

Which personality disorder:
Controlling
Perfectionist
Orderly
Stubborn
Indecisive

Back 44

Obsessive Compulsive

Front 45

Which personality disorder:
Criminality
Unable to conform to social norms
Disregard for others' rights

Back 45

Antisocial

Front 46

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?

Back 46

Mean = 232
Median = 229
Mode = 225

Mean > median and mode; thus, positively skewed curve (to right?)

Front 47

Identify cell:
CD4

Back 47

Helper T cells

Front 48

Identify cell:
CD14

Back 48

Macs

Front 49

Identify cell:
CD16

Back 49

NKCs and Macs

Front 50

Identify cell:
CD19

Back 50

B cells

Front 51

Identify cell:
CD3

Back 51

All T cells, not NKCs

Front 52

Identify cell:
CD8

Back 52

Cytotoxic T cells

Front 53

Hallmark features:
Autism

Back 53

<IQ
Poor comm/social skills
Repetitive behaviors

Front 54

Hallmark features:
Rett's disorder

Back 54

FEMALES only (X-linked dominant-->males die in utero)
Smaller head circumference
Hand wringing

Front 55

Hallmark features:
Asperger's syndrome

Back 55

Normal IQ
poor social skills

Front 56

Sonic Hedgehog Gene:
Location
Role

Back 56

Base of limbs in zone of polarizing activity

Involved in patterning along anterior-posterior axis

Mediates ectodermal fns

Front 57

Wnt-7 gene:
Location
Role

Back 57

Produced at ectoderm at DISTAL end of each developing limb

Necessary for organization along dorsal-ventral axis (limb lengthening)

Front 58

Homeobox gene:
Role

Back 58

Segmental organization in craniocaudal direction

Front 59

Mutation to HOXD-13:
Effects

Back 59

HOXD-13 is a homeobox gene (segmental organization in craniocaudal direction)

Mutation to this gene-->synpolydactyly (extra fused digit between 3rd/4th fingers)

Front 60

Embryologic rule of 2's

Back 60

2nd week of development:
2 germ layers (bilaminar disk): epiblast, hypoblast
2 cavities: amniotic cavity, yolk sac
2 components to placenta: cytotrophoblast, syncytiotrophoblast

Front 61

Embryologic rule of 3's

Back 61

3rd week of dev't:
3 germ layers (gastrula):
ectoderm
mesoderm
endoderm

Front 62

Embryologic rule of 4's

Back 62

4th week of development:
4 heart chambers
4 limb buds

Front 63

When is folic acid critical to embryonic development?

Back 63

Within first 6 weeks of pregnancy; this is when neural tube forms and seals

Front 64

When are embryos most susceptible to teratogens?

Why?

Back 64

Weeks 3-8 (embryonic period)

This is when organogenesis occurs; after Week 8, it's just growth.

Front 65

Rathke's Pouch:
What does it become?
Germ layer?

Back 65

Adenohypophysis-->Anterior pituitary

Surface ectoderm

Front 66

Surface ectoderm:
What does it become?

Back 66

Adenohypohysis from Rathke's pouch
Lens of eye
Oral cavity lining
Epidermis
Salivary, sweat, mammary glands

Front 67

Neuroectoderm:
What does it become?

Back 67

Brain (neurohypohysis--POSTERIOR pituitary), CNS neurons, oligos, astrocytes, ependymal cells, pineal gland)
Retina
SC

Front 68

Neural crest ectoderm:
What does it become?

Back 68

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

Front 69

This is a Rathke's pouch tumor.

Back 69

Craniopharyngioma

Front 70

Endoderm:
Derivatives

Back 70

Gut tube epithelium, lungs, liver, pacnreas, thmus, parathy

Front 71

Mesoderm:
Derivatives

Back 71

Muscle, bone, connective tissue
Serous linings of body cavities
SPLEEN
CV structures
GU

Front 72

Mesodermal defects

Back 72

VACTERI
Vertebral defects
Anal atresia
Cardiac defects
Tracheo-Esophageal fistula
Renal defects
Limb defects (bone, muscle(

Front 73

Deformation vs Malformation

Back 73

Deformation--extrinsic disruption; occurs after embryonic period

Malformation--intrinsic disruption; occurs during embryonic period (weeks 3-8)

Front 74

Agenesis vs Aplasia

Back 74

Agenesis = absent organ due to absent primordial tissue

Aplasia = absent organ despite present primordial tissue

Front 75

What is hypoplasia?

Back 75

Incomplete organ dev't, primordial tissue present

Front 76

What is the "all-or-none" effect of embryogenesis?
When does it occur?

Back 76

If ingest teratogen before week 3, won't see developmental defects.

All = miscarriage
None = no developmental defects

Front 77

Describe facies of fetal alcohol syndrome.

Back 77

Smooth philtrum
Thin upper lip
Flat nasal bridge

Front 78

Aminoglycosides:
Effect on fetus

Back 78

CN VIII toxicity

Front 79

ACE inhibitors:
Effect on fetus

Back 79

Renal damage

Front 80

Thalidomide:
Effect on fetus

Back 80

Limb defects (hand connected directly to shoulder)

Front 81

Carbamazepine:
Effect on fetus

Back 81

Inhibition of intestinal folate absorption

Front 82

Valproate:
Effect on fetus

Back 82

Inhibition of intestinal folate absorption

Front 83

Vitamin A:
Effect on fetus

Back 83

Vitamin A = retinoic acid = Retin-A!!

SPontaneous abortions
Cleft palate, cardiac abnlts

Front 84

Warfarin:
Effect on fetus

Back 84

Bone deformities
Fetal hemorrhage

Front 85

When would embryonic division occur to form:
Diamnotic/dichorionic placentation

Back 85

Prior to morula--within 3 days of fertilization; will have separate amnion and placenta

Front 86

When would embryonic division occur to form:
Diamniotic/monochorionic placentation

Back 86

Division occurs 4-8 days post-fertilization (blastocyst)

Will have 2 amniotic sacs, 1 placenta

Front 87

When would embryonic division occur to form:
Monoamniotic/monochorionic placentation

Back 87

Division occurs 8-12 days after fertilization (epiblast/hypoblast)

1 amniotic sac, 1 placenta

Front 88

Cord entanglement of twins is suggestive of _______.

Back 88

monoamnionicity

Front 89

One yolk sac and 2 fetal poles is suggestive of ______.

Back 89

monoamnionicity

Front 90

Amniocentesis vs Chorionic Villous Sampling:
Timing
Benefits/Risks

Back 90

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

Front 91

This cell secretes hCG.

Back 91

syncytiotrophoblast

Front 92

hCG is structurally similar to ____.

How?

Back 92

LH
FSH
TSH

all share same alpha-subunit

Front 93

How many and function:
Umbilical artery
Umbilical vein

Back 93

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

Front 94

Single umbilical artery is associated with ______.

Back 94

Congenital renal problems (do an u/s)

Front 95

Urachus:
Origin
Function
Lack of obliteration results in?

Back 95

allantois-->urachus (duct between bladder and yolk sac)

Failure to obliterate-->patent urachus--urine discharge from umbilicus
OR
-->vesicourachal diverticulum (outpouching of bladder)

Front 96

Vitelline duct:
Role
Associated defect

Back 96

Role: connects yolk sac to midgut lumen

If fail to obliterate-->vitelline fistula: meconium discharge from umbilicus (Meckel's diverticulum)

Front 97

Truncus arteriosus:
Pathophys
What should normally happen?

Back 97

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

Front 98

Outline the pathway by which the cardiac ventricles and their outflow tracts are separated.

Back 98

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

Front 99

Outline the pathway by which the heart tube forms the atria of the four-chambered heart.

Back 99

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

Front 100

What embryonic structure divides the left and right atria?

Back 100

Septum primum and septum secundum

Front 101

How is blood shunter from RA to LA in embryo?

Back 101

Through foramen ovale of septum secundum and ostium secundum of septum primum

Front 102

Where does fetal erythropoiesis occur? Provide chronological order.

Back 102

Young Liver Synthesizes Blood
Yolk Sac (weeks 3-8)
Liver (6-30 weeks)
Spleen (9-28 weeks)
BM (28 weeks onward)

Front 103

Which bones synthesize blood cells?

Back 103

Sternum
Pelvis
Ribs
Tibia, Femur (Long bones)
Skull bones

Front 104

Describe pathway of fetal circulation.

Back 104

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

Front 105

What changes occur in fetal circulation occur after birth?

Describe each change.

Back 105

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

Front 106

Why is indomethacin given to neonates?

Back 106

Indomethacin = NSAID; helps to reduce PGs to close ductus arteriosus.

Front 107

What are the derivates of the aortic arch (1st-6th)?

Back 107

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

Front 108

Which developmental structure:
Supplies oxygenated blood to fetus

Back 108

Umbilical Vein

Front 109

Which developmental structure:
Removes nitrogenous waste from fetal bladder

Back 109

Urachus

Front 110

Which developmental structure:
Fetal placental structure that secretes hCG

Back 110

Syncytiotrophoblast

Front 111

Which developmental structure:
Maternal component of placenta

Back 111

decidua basalis

Front 112

Which developmental structure:
Returns deoxygenated blood from fetal internal iliac aa

Back 112

Umbilical aa

Front 113

Which embryologic structure of heart gives rise to:
Ascending aorta and pulmonary trunk

Back 113

Truncus arteriosus

Front 114

Which embryologic structure of heart gives rise to:
Coronary sinus

Back 114

Left horn of sinus venosus

Front 115

Which embryologic structure of heart gives rise to:
SVC

Back 115

Right common cardinal vein
Right anterior cadinal vein

Front 116

Which embryologic structure of heart gives rise to:
Smooth parts of LV and RV

Back 116

Bulbus cordius

Front 117

Which embryologic structure of heart gives rise to:
Smooth part of RA

Back 117

Right horn of sinus venosus

Front 118

Which embryologic structure of heart gives rise to:
Trabeculated parts of LA and RA

Back 118

Primitive atria

Front 119

Trabeculated parts of LV and RV

Back 119

Primitive ventricle

Front 120

What structure divides the truncus arteriosus into the aortic and pulmonary trunks?

Cellular origin?

Back 120

Spiral septum (aorticopulmonary septum)

Neural crest origin

Front 121

Which fetal vessel has the highest oxygenation?

Back 121

UV

Front 122

What is early shunt?
Causes?

Back 122

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)

Front 123

Components of tetralogy of Fallot.

Back 123

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.

Front 124

Boot-shaped heart on x-ray

Back 124

Due to RVH; seen in tetralogy of fallot

Front 125

Transposition of great vessels:
What is it?
When is this compatible with life?

Back 125

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.

Front 126

What is tricuspid atresia?

Back 126

Absence of tricuspid valve, hypoplastic RV.

Need ASD AND VSD for viability-->right to left shunt-->blue baby (early cyanosis)

Front 127

What is late cyanosis?
Causes?

Back 127

Late cyanosis = blue kids
LEFT TO RIGHT SHUNT

VSD--most common
ASD
PDA

Note: early cyanosis = RIGHT TO LEFT SHUNT

Front 128

Why do late cyanotics take so long to present?

Back 128

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)

Front 129

HTN in upper extremities
Weak pulses in lower extremities

Back 129

Coarctation of aorta

Front 130

What is coarctation of the aorta?
Infantile vs adult type

Back 130

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.

Front 131

Cardiac defect:
22q11 syndrome

Back 131

Persistant truncus arteriosus
Tetralogy of Fallot (DiGeorge!!!!)

Front 132

Cardiac defect:
Trisomy 21

Back 132

ASD
VSD
AV septal defect (endocardial cushion defect)

Front 133

Cardiac defect:
Turner Syndrome

Back 133

Coarctation of aorta (preductal)

Front 134

Cardiac defect:
Marfan's Syndrome

Back 134

Aortic insufficiency (late complicaiton)

Front 135

Cardiac defect:
Infant of diabetic mother

Back 135

Transposition of great vessels

Front 136

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.

Back 136

Aortic coarctation

Front 137

Describe blood flow through patent ductus arteriosus.

Back 137

Blood flow from pulm artery to aorta, bypassing pulm circuln

Front 138

List subregions and derivatives for:

Mesencephalon
Prosencephalon
Rhombencephalon

Back 138

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

Front 139

What lab tests indicate neural tube defects?

Back 139

Inc'd alpha-fetoprotein and ACh-E in CSF

Front 140

Branchial apparatus:
Arches vs Clefts vs Pouches--germ layer type, list in order (inside to outside or outside to inside)

Back 140

CAP (outside to inside):
Clefts = ectoderm
Arches = mesoderm
Pouches = endoderm

Front 141

Branchial clefts:
What does each develop into?

Back 141

1st cleft-->external auditory meatus

2nd-4th-->temporary cervical sinuses (later obliterated)

Front 142

A persistent cervical sinus results in _______.

Back 142

Branchial cleft cyst within lateral neck

Front 143

Branchial arch derivates

Back 143

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

Front 144

Branchial pouch derivatives

Back 144

1st: middle ear
2nd: palatine tonsil
3rd: INFERIOR PARATHY
4th: SUPERIOR PARATHY

Note 4th ends up being more superior than 3rd!

Front 145

Embryologic pathophys of DiGeorge Syndrome

Back 145

Aberrant dev't of 3rd and 4th branchial pouches

Front 146

Describe the development of the thyroid.

Back 146

Thyroid diverticulum arises from floor of pharynx, descends (drops) into neck

Connected to tongue by thyroglossal duct, which normally disappears (remnant = foramen cecum)

Front 147

What is the foramen cecum?

Back 147

Remnant of thyroglossal duct

Front 148

What is the most common ectopic site of thyroid tissue?

Back 148

Tongue

Front 149

Midline neck mass
Moves with swallowing

Back 149

Thyroglossal duct cyst

Front 150

What spinal nerves innervate the diaphragm?

Back 150

C3,4,5 keep the diaphragm alive

Front 151

Monozygotic twins:
One is pale with HCT of 15%
Other is flushed with HCT of 55%

Cause?

Back 151

Twin-twin transfusion syndrome--shared umbilical cord/placenta, one twin received more blood than other twin

Front 152

Cleft-lip:
Which embryonic process failed?

Back 152

Failure of fusion of maxillary and medial nasal processes

Front 153

What nerves innervate the branchial arches?

Back 153

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

Front 154

Which branchial pouch:
Middle ear, eustachian tubes

Back 154

1st

Front 155

Which branchial pouch:
Superior parathyroids

Back 155

4th

Front 156

Which branchial pouch:
Inferior parathyroids

Back 156

3rd

Front 157

Which branchial pouch:
Epithelial lining of palatine tonsil

Back 157

2nd

Front 158

Which branchial pouch:
Thymus

Back 158

3rd

Front 159

Which cranial nerve:
Taste in anterior 2/3 tongue

Back 159

Facial

Front 160

Which cranial nerve:
Taste in posterior 1/3 tongue

Back 160

Glossopharyngeal

Front 161

Which cranial nerve:
Motor function of tongue

Back 161

Hypoglossal

Front 162

Which cranial nerve:
Sensation in anterior 2/3 tongue

Back 162

Mandibular of Trigeminal

Front 163

Which cranial nerve:
Sensation in posterior 1/3 tongue

Back 163

Glossopharyngeal

Front 164

What abnormalities are often found with Arnold-Chiari malformation?

Back 164

Hydrocephaly
Syringomyelia
Myelomeningocele

Front 165

Classic presenting symptoms of syringomyelia.

Back 165

b/l loss of pain and temp sensation in upper extremity

Weakness and atrophy of hand mm

Front 166

How does presentation of a branchial cleft cyst differ from that of a thyroglossal duct cyst?

Back 166

Branchial cleft cyst--lateral neck

Thyroglossal cyst--midline neck, moves with swallowing