2/23-3/2

Front 1

40 yo female, w muscle pain and stiffness all over, it gets worse w exercise..normal strength and joint ROM...tenderness around scapule/lateral epicondl/and bilateral medial knee fat pads...not ablt to sleep/is tired what she got?

Back 1

fibromyalgia!

Front 2

common symptoms of fibromyalgia from FA!

Back 2

women 20-50yo, chronic, widespread musculoskeletal pain w stiffness, parastehsia, poor sleep, & fatigue

Front 3

symmetric pain/morning stiffness MCP/PIP involved- warm, swollen, tender you're thinking?

Back 3

Rheumatoid arthritis!

Front 4

bilateral proximal wekaness, can't climb the stairs, can't comb your hair, heliotrope rash (racoon eyes) grolton nodules, and an incr CK characteristics of?

Back 4

dermatomyotitis

Front 5

Low back stiff and resolves with exercise- usually develops in young males, and PE shows a decrease in flexion of the spine?

Back 5

anklyosing spondylitis

Front 6

pt is >50, w/ morning stiffnedd neck, shoulder, pelvic, wt los fever and incr ESR, occurs in 1/2 pt w temporal arteritis

Back 6

polymyalgia rheumatica

Front 7

woman comes w infertility, acne, hirsutism, HTN, BMI high, irregular menstruation, what would her ovaries appear as?

Back 7

enlarged, PCOS causes subcortical cysts that enlarge ovaries

Front 8

what are the levels of LH, FSH, estrogen, and androgen in a woman w PCOS?

Back 8

LH is increase, FSH is decr, androgens incr, and estrogen is incr

Front 9

what causes the acne, hirsutism, excess sweat w PCOS?

Back 9

theca cells hyperplasia from excess androgens

Front 10

what is the cause of insulin resistance in women w PCOS?

Back 10

some transcription factor after insulin binds does not respond anymore, therefore causing insulin R

Front 11

what kind of endometrium do women with PCOS have?

Back 11

thick due to the excess estrogen causing proliferation

Front 12

if a woman w PCOS wants to get pregnant what do you prescribe?

Back 12

clomiphine- an ERM, will inhibit the production of estrogen from outside sources (ovaries etc.) and stimulate GnRH again to release estrogen-->ovulate etc.

Front 13

woman w PCOS not trying to get pregnant?

Back 13

OCP, this extra estrogen will turn off the GnRH stimulation and cause menses

Front 14

Baby with bilateral retinal hemorrhage and subdural hematoma, what should you be thinking

Back 14

Shaken baby Syndrome

Front 15

Babies have a unique antomy, their head is a lot larger- larger subarachnoid space, and subdural...therefore if you shake the immature brain in the large cavity- it rips the skull and bridging veins

Back 15

subdural hematoma

Front 16

other veins close to the head rupture too such as

Back 16

retinal veins

Front 17

what is associated with fracture of the skull?

Back 17

middle meningeal artery & and subsequent epidural hematoma

Front 18

hemophilia A is associated with

Back 18

soft tissue and joint hemorrhage

Front 19

idiopathic thrombocytopenia purpura is associated with

Back 19

petechia/ecchymoses/bleed quick w injury usually seen after a viral infection

Front 20

bacterial vagionisis most common cause is

Back 20

gardenerella vaginalis

Front 21

alters the normal flora- get a loss of lactobailli and overgrowth of mixed anaerobes, grey "fish" odor with adding KOH and a clue cell on wet mount is

Back 21

bacterial vagionsis

Front 22

gonorrhea and trachomatitis

Back 22

infect together, cervicitis w white discharge--> infect--> PID, on culture you can see N. gonorrhea not trachomatitis

Front 23

MCC fungal vaginitis, white-curd appearance, labial erythema, KOH shows yeast & psuedohyphae, no oder w KOH

Back 23

Candida albicans

Front 24

flagella protozoan, vagina shows yellow-green foam/ full trophozites w flagella on wet mount

Back 24

trichomonas

Front 25

what gene is effected in CF?

Back 25

CFTR

Front 26

What is the mutation mechanisms of CF

Back 26

the release of Cl and water is supressed and instead you release a viscious mucous which is stasis and accumulates

Front 27

what two organs are affected the most with CF?

Back 27

respiratory & pancreas

Front 28

What other systems can get plugged by CF?

Back 28

male repro, salivary glands, & liver

Front 29

How does CF cause problems in respiratory?

Back 29

the increase in viscosity decreases the clearance of bacteria- you're likely to get repeatitive pulmonary infection from pseudomonas

Front 30

what does aspergillus funigatus cause in CF pts?

Back 30

allergic bronchopulmonary aspergillosis w asthma or CF

Front 31

alkaline phosphatase is made by

Back 31

placenta,intestine, bone, & liver

Front 32

How do you differentiate alkaline phosphatase from bone vs liver?

Back 32

electrophoresis & specific monoclonal antibody- bone AP is easily denatured by heat

Front 33

Acid phosphatase is present in

Back 33

osteoclasts- not useful bc of cross-reactivity from other tissues, and is resistant to degradation by tartrate

Front 34

calcitonin or C-cells are a marker for

Back 34

medullary thyroid cancer

Front 35

urinary deoxypyridonline is released by

Back 35

osteoclasts

Front 36

pyridoniline cross-links collagen fibers which is useful for assessing

Back 36

osteoclasts * best way to measure osteoclasts

Front 37

what is hydroxyproline

Back 37

breaks collagen, released by osteoclasts- not useful bc also seen in meats

Front 38

47 XXY, normal neonate--> puberty, primary testicular failure, hyalinization/fibrosis of seminiferous tubules, lack of testosteron syntheiss, small testis, gynecomastia, MR, azoospermia, infertility, tall stature, FSH/LH high, eunuchoid body habitus =

Back 38

Klinefelter syndrome

Front 39

How are all anueplodies formed?

Back 39

meiotic nondisjunction

Front 40

macroochidism, largew jaw, MR =

Back 40

fragile X syndrome

Front 41

arachonodactyly, scoliosis, aortic root dilation=

Back 41

Marfan syndrome

Front 42

short, hypotonia, obese?

Back 42

Prader-willi, microdeletion of chrom 15 from paternal

Front 43

homeless alcoholic, w swollen gums, ecchymoses, & hyperkeratosis what are you thinking?

Back 43

vitamin C deficiency

Front 44

what do you need vitamin C for

Back 44

hydroxylation of proline & lysine -- pro-collagen makes hydroxyproline & hydroxylysine

Front 45

people with scurvy lack

Back 45

collagen cross-linking

Front 46

symptoms of scurvy?>

Back 46

caused by low connectve tissue include" swollen gums, mucosal bleeding, poor wound healing, spots on skin

Front 47

in children's scurve is worse why?

Back 47

can cause hemorrhage of subperisoteal & joint hematomas

Front 48

what is thiamini (b1) used for

Back 48

co-enzyme for dexcarboxylation of pyruvate --> acetyl coA and alpha-ketogluterate --> succinyl coA (citric acid)

Front 49

deficiency in B1 causes

Back 49

neuropathy and high-output heart failure

Front 50

what is B6 used for

Back 50

co-factor with amino acids

Front 51

what is deficiency in B6 cause

Back 51

sebhemorrhic dermatitis, glossitis, & peripheral neuropathy

Front 52

what is B12 used for

Back 52

methionin & making succinyl coA from methyl malonyl coA

Front 53

deficieny in B12

Back 53

megaloblastic anemia- subacute combined degeneration of spinal cord

Front 54

purine deficiency causes

Back 54

decr purines with folate defiencey= decr erthrypoitic to make DNA= megaloblastic DNA

Front 55

Prolactin increases throughout the pregnancy, however no production of lactate- how come?

Back 55

progesterone/estrogen increase by placent and fetal adrenal glands, inhibit lactation- once this seperates and ruptures= lactate

Front 56

What is the role of HCG in pregnancy?

Back 56

keeps corpus luteum to produce progesteronuntil placenta can make it- once the CL is gone, HcG levels drop low- nothing to do w lactation

Front 57

amonrrhea anorexic pts lose what control?

Back 57

pulsatile GnRH release from hypothalamus

Front 58

FSH is responsibile for what in males?

Back 58

spermatogensis & inhibin B

Front 59

which cells does FSh stimulate?

Back 59

sertoli to produce ABP (androgen binding protein) & inhibin B

Front 60

what does ABP do for spermatogenesis?

Back 60

increases local tesosterone which is needed for spermatogenesis

Front 61

What negatively inhibits Lh and FSH in males?

Back 61

testosterone & inhibin

Front 62

no fetal heart tones, pt w vaginal bleeding and 46XX

Back 62

hyatid mole! all paternal chromosome, no fetus embryo

Front 63

honeycomb uterus, enalrges w cluster of grapes appearance

Back 63

hydatidform mole

Front 64

abduction greater than 30 degrees?

Back 64

deltoid muscle

Front 65

rotatoe cuff muscles are

Back 65

supraspinatus, infraspinatus, teres minor, and subscapularis

Front 66

what degree does supraspinatus abduct

Back 66

10-15 degrees

Front 67

what's the test to measure supraspinatus function?

Back 67

empty can test

Front 68

34 yo comes to the ER with R shoulder pain from falling froma tree- X-ray shows fracture in middle 1/3 of his right clavicle, medial clavicle has upward traction by the

Back 68

SCM

Front 69

where does the SCM insert?

Back 69

sterno: manubrium of the sternum
cleido: superior medial (upward traction of medial fracture)
mastoid: mastoid of skull

Front 70

where do the pec majors insert on the clavicle?

Back 70

inferior medial clavicle

Front 71

where does the deltoid inserrt on clavicle?

Back 71

inferior lateral clavicle

Front 72

where does the subclavius insert on clavicle?

Back 72

inferior lateral clavicle

Front 73

where does the trapezius insert on clavicle?

Back 73

superior lateral clavicle

Front 74

Which nerve innervates the SCM and for what function?

Back 74

XI turns the head the opposite way

Front 75

serratus anterior inserts where

Back 75

1-8 ribs and inserts on medial scpula- innervated by long thoracic nerve

Front 76

major and minor rhomboid muscles insety

Back 76

vertebral body/spine and insert medial border scapula

Front 77

pec minor insert

Back 77

3/4/5 ribs on coracoid of scapula

Front 78

subclavius insert

Back 78

on 1st rib and inderior lateral aspect clavicle

Front 79

Low-fever, anorexia, nausea, dark urin, RUQ tenderness, & returning from a foreign region you should think about?

Back 79

HAV

Front 80

Acute viral you see

Back 80

diffuse balloon degeneration, mononuclear cells, & councilman bodies

Front 81

What causes gallstones in pregnant females?

Back 81

estrogen increases cholesterol due to incr in HMG-coA-reductase activity & progresterone slows down gall bladder motility= gallstones

Front 82

37yo 12 weeks in gestation female comes in with glucose of 210 & TG= 232 what is the explanation for these results?

Back 82

HPL causes insulin resistance, proteolysis, lipolysis (mostly in the 3rd trimester) shunts glucose to the fetus & inhibits gluconeogenesis

Front 83

if the mother pancrease can not overcome what is caused by HPL what develops?

Back 83

gestational DM

Front 84

someone w CINIII what's the most important risk factor for them to develop a poor prognosis?

Back 84

multiple sexual partners- usually stems from HPV 16 & 18

Front 85

An immigrant pt comes in at 20 weeks gestation with a rash thats moved from her face--> trunk--> extremities, what is she and her fetus at risk for?

Back 85

She probably doesn't have vaccine for measles, mumps, & rubella- rash spread from head and moves doen--> truncal rash, postauricular lymphadenopathy, fetus is at rish for PDA/hypoplasia/cataracts/deafness/blueberry rash and mom: rash/arthiritis/polyalthralgia

Front 86

Most common reason for an elevated AFP in a pregnant lady?

Back 86

dating error

Front 87

baby comes in "floppy" enlarged tongue, disturbed, and anxious most likely?

Back 87

hypothyroidism

Front 88

How can you get hepatitis B?

Back 88

any body fluid, blood semen tears etc. except stool

Front 89

Tired eyes & anterior medistinal mass most likely

Back 89

MG autoantibodies to post-synaptic membrane

Front 90

Theca cells produce

Back 90

progesterone

Front 91

Granulosa cells produce

Back 91

progesterone & estrogen (b/c have aromatase)

Front 92

what is theca externa?

Back 92

support and connective tissue surrounding theca interna