Bbc Segment 11

Front 1

DOC for MS

Back 1

INF beta

other choices are glatiramer, natalizumab (only when all else has failed)

Front 2

what is werdnig hoffman syndrome

Back 2

infantile spinal mm atrophy
hits babies
destruction of anterior horn cells of spinal cord, atrophic mm dvlp resulting from denervation atrophy

Front 3

what is the cause of friedrich's ataxia

Back 3

AR
GAA trinucleotide repeat on chromosome 9..leads to deficiency of frataxin

ataxia, pes cavus, decrease DTR, babinski, sensory and proprioceptive loss

Front 4

huntington's dz involves atrophy of which parts of the brain

Back 4

caudate, putamen, frontal cortex

caudate the most

Front 5

DOC for ALS

Back 5

riluzole

Front 6

albumino-cytologic dissociation is buzzword for what dz

Back 6

guillain barre

ascending mm weakness and paralysis due to demylination

albumino cytologic dissociation is significantly increased protein concentration w only mild increase in cell count in CSF

Front 7

Pts labs reveal extremely high levels of very long chain fatty acids in the serum
Pt has ADHD, motor and sensory asymmetric neuropathy, spastic paraplegia, cortical blindness, and adrenal insufficiency

Back 7

adrenoleukodystrophy - XLR

hits 10-20 yo
deficiency peroxisomal transporter enzyme so can't break down very long chain FAs

Front 8

the MS plaques in the white matter of the brain tend to localize where

Back 8

around the ventricles

thanks doc benseler!

Front 9

what is marchiagava bignami dz

Back 9

degeneration of corpus callosum and resulting frontal lobe dementia
due to drinking large amts of red wine!

Front 10

what is sheehan's syndrome

Back 10

postpartum pituitary necrosis --> hypopituitarism

Front 11

what is conn's syndrome

Back 11

adrenal adenoma overproduces aldosterone
leads to hypernatremia, hypokalemia, HTN, HAs

Front 12

what tests used to screen and then confirm cushing's syndrome?

Back 12

screen - 24 hr urine cortisol

confrm - dexamethasone suppression test

Front 13

how do you screen for pheochyomocytoma

Back 13

24 hour urine catecholamines
or
better is 24 hour urine metanephrines and normetanephrines (epi/NE metabs)
or
best is 24 hour urine VMA (vanillyl mandelic acid - final metabolite of epi/NE)

Front 14

what is usually the presenting sign of a neuroblastoma

Back 14

enlarging abdomen

later Sx due to mets. can see severe diarrhea bc the neuroblastoma secretes VIP (vasoactive intestinal peptide)

Front 15

what is a neuroblastoma?

Back 15

malignant tumor of adrenal medulla or sympathetic ganglion....produces excess NE.
most common tumor in the kiddies.
the cells are neural crest in origin (primitive SNS cells at diff stages of dvlpmnt)

Front 16

Addison's dz usually autoimmune, but also known to be caused by invasion with what two bugs?

Back 16

mycobacterium tuberculosis
histoplasma capsulatum

Front 17

A tan patient presents w mm weakness and an arrythmia to your ED. Preliminary labs show hypotension, hyperkalemia, and low aldosterone. You look at the tan and think HMM..this could be...

Back 17

Addison's dz (adrenal gland destruction....decreased aldosterone production)

Front 18

what is plummer's dz

Back 18

nodular toxic goiter
post-menopausal, multiparous females
reactivation of isolated nests of thyroid cells...usually no hyperthyroid Sx, just recurrent fatigue, tiredness, malaise

Front 19

what kind of goiter is associated w iodine deficiency

Back 19

diffuse simple

(diffuse toxic in graves dz)
nodular toxic in plummers dz)

Front 20

clinical associations
this thyroiditis is aka fibrous thyroiditis ...thyroid fibroses and becomes nonfxnl in an old person

Back 20

riedel's thyroiditis

Front 21

clinical associations
this thyroiditis usually follows a URI

Back 21

dequervain's thyroiditis aka subacute aka granulomatous thyroiditis

hyperthyroid then hypothyroid Sx

Front 22

what is skier thumb

Back 22

skier thumb, aka gamekeeper thumb is a tear of the ulnar collateral ligament of the thumb

Front 23

according to the american academy of neurology...what are the 3 grades of concussion

Back 23

grade 1 - no LOC, + transient confusion w concussion Sx lasting less than 15 mins

grade 2 - no LOC, + transient confusion w concussion Sx lasting longer than 15 mins

grade 3 - any LOC

Front 24

how do you manage a grade I concussion?

Back 24

remove the Pt from the contest and do not allow him to return to play for the day

Front 25

how do you manage a grade II concussion?

Back 25

remove the Pt from the contest and reexamine him every 5 mins

Front 26

how do you manage a grade III concussion?

Back 26

send to ER in a C -collar

Front 27

what does HMG coA reductase do?

Back 27

this enzyme is the RLS in cholesterol synthesis...turns HMG coA into mevalonate

Front 28

what is the most common cause of a limp in in the 4-10 yo age group

Back 28

avascular necrosis of the capital femoral epiphysis

Front 29

what is a hammer toe

Back 29

hyperextension of metatarsophalangeal and DIP joints of foot w flexion of PIP
(up, down, up)

Front 30

what is claw tow

Back 30

hyperextension of metarsophalangeal joint of foot w flexion of PIP joint
(up, down, - )

Front 31

what is mallet finger

Back 31

partial permanent flexion of DIP of finger due to rupture/avulsion of extensor tendon

Front 32

what are the drugs of choice to treat status epilepticus, and what is there MOA

Back 32

BZDs
increase frequency of GABA mediated Cl- channel opening

also used in anxiety and alcohol detox

Front 33

Pt presents w a Q angle of 17 degrees and worsening knee pn. What is most likely Dx.....genu varum or valgus?

Back 33

genu valgus

=increased Q angle greater than 12 degrees

Front 34

what is coxa valga

Back 34

angle of head of femur is greater than 135 degrees

Front 35

what is genu varum

Back 35

decreased Q angle of knee less than 10 degrees

Front 36

what is coxa vara

Back 36

angle of head of femur is less than 120 degrees

Front 37

what is a big side effect of lithium w respect to the kidneys

Back 37

nephrogenic diabetes insipidus

polyuria, polydipsia Sx

Front 38

what are the normal carrying angle ranges of the elbow for females

Back 38

cubitus valgus = carrying angle >15 degrees

cubitus varus = carrying angle <3 degrees
both usually ASx

Front 39

an adducted ulna causes an increased or decreased carrying angle?

Back 39

aDducted ulna = Decreased carrying angle

Front 40

Pt presentation w high levels of insulin and low levels of C peptide suggests what

Back 40

exogenous insulin administration (factitious disorder)

this Pt is doping himself...normal endogenous insulin comes w C peptide. psych consult time!

Front 41

what is pediculosis

Back 41

lice! in your hair!

Front 42

what is tinea barbae

Back 42

fungal infection of the beard!

Front 43

to treat exhalation dysfunctions of the 1st rib you engage what muscles

Back 43

anterior and middle scalene

Front 44

to treat exhalation dysfucntion of the 2nd rib you engage what muscles

Back 44

posterior rib only

Front 45

to treat an exhalation dysfunctions of ribs 3-5 you engage what muscle

Back 45

pec minor

Front 46

good rule of thumb for cutaneous larva migrans vs scabies

Back 46

cutaneous larva migrans has large tracts and unlikely to pass from family member to family member

scabies, your vignette will probabbly have an itchy family, w small tracts in finger webs and flexor surfaces

Front 47

what muscle do you engage to treat an exhalation dysfunciton of rib 6

Back 47

serratus anterior

Front 48

where is the vermis located

Back 48

in the cerebellum

it is involved in fine alternating motion

Front 49

what is the galbreath technique

Back 49

lymphatic Tx of head for OM

Front 50

what is the activating force in faciltated positional release of the L spine

Back 50

torsion

Front 51

T or F a baby born jaundiced may just have physiologic jaundice of the newborn

Back 51

FALSE

physiologic jaundice dvlps 24-48 hours AFTER BIRTH
jaundice present AT birth is always pathologic

Front 52

mneumonic for liver transaminases seen in hepatitis

Back 52

toAST = alcohol

virALT - viral

AST higher in alcohol
ALT higher in viral

Front 53

what is the most sensitive lab finding for liver failure

Back 53

increased PT/PTT

all coag factors will be decreased xcept vWF (not made in liver, made by endothelial cells)

Front 54

most common benign tumor of liver?

Back 54

hemangioma

Front 55

OCPs can do what to liver

extra - what to gallbladder?

Back 55

liver - hepatic adenoma

gb - gallstones

Front 56

what is budd chiari syndrome

Back 56

thrombosis occluding hepatic vein or hepatic stretch of inferior vena cava

Sx - acute onset abd pn, jaundice, ascites

Front 57

most common malignant hepatic tumor?

Back 57

mets

Front 58

most common primary hepatic malignancy

Back 58

hepatocellular CA
also called hepatoma _ (but it's not benign...historical misnomer)

assoc w increased AFP

Front 59

cholangiocarcinoma, which is bile duct CA, is often seen associated with what

Back 59

clonorchis sinensis (liver fluke) infestation

Front 60

what is a klatskin's tumor

Back 60

cholangiocarcinoma (bile duct CA) occuring where the hepatic ducts fuse to become the common hepatic duct

Front 61

which two pelvis/sacrum findings cause ipsilateral short leg?

Back 61

posterior innominate and unilateral sacral flexion

Front 62

which two pelvis/sacrum findings cause ipsilateral long leg?

Back 62

anterior innominate and unilateral sacral extension

Front 63

Rads describes a butterfly like lesion of the brain, crossing the corpus callosum. You Dx

Back 63

glioblastoma multiforme

the butterfly appearance is pathognomonic

Front 64

craniotabes, rachitic rosary, harrison's groove, pectus carinatum....when you see these signs you should think?>

Back 64

rickets - vit D defic. in kids

craniotabes - thinning of occipital and parietal bones
rachitic rosary - costochondral thickening looks like string of beads
harrison's groove - depression along line of diaphragm insertion into rib cage

Front 65

what is the problem in scurvy

Back 65

vitamin C deficiency so you can't hydroxylate lysine and proline (this step requires vit C) = decreased collagen synthesis = bleed!

Front 66

what is woody leg sign

Back 66

hemorrhage into soft tissues seen in scurvy

Front 67

mosaic pattern of bone on xray should make you think

Back 67

Paget's dz (osteitis deformans)

3 phases - osteolytic, mixed, late phase

Front 68

if you see "brown tumor of bone" you should think

Back 68

osteitis fibrosa cystica

vonrecklinghausen dz of bone

Front 69

what is the clinical triad of McCune Albright Syndrome

Back 69

polystotic fibrous dysplasia (many bones replaced w fibrous tissue), precocious puberty, cafe au lait spots

G protein abnormality leading to hyperPTHism, hyperadrenalism, acromegaly

Front 70

what is legg calve perthe dz

Back 70

aseptic avascular necrosis of head of femur

usually in fat little boys, suddenly get a limp (painless) but their lateral knee hurts

Front 71

what is osgood schlatter dz

Back 71

aseptic avascular necrosis of tibial tubercle

nicole has this

Front 72

what is kohler's bone dz

Back 72

aseptic avascular necrosis of the navicular bone

Front 73

what is the problem in osteopetrosis (aka marble bone dz aka albers schonberg dz)

Back 73

failure of osteoclasts so you get super thick bone

but, lots of Fx bc the thick bone doesnt get good perfusion. can also see anemia (decreased marrow space) and blind/deaf/CN dysfxn bc neural foramina are narrowed

Front 74

the terms sequestrum, involucrum, and brodie's abscess should make you think what dz

Back 74

osteomyelitis

sequestrum - necrotic bone
involucrum - sleeve of new bone surrounding necrotic bone (thus "sequestering" the problem)
brodie's abscess - wall of granulation tissue surrounding involucrum

can see periosteal elevation on xray

Front 75

birbeck granules - what are they and what are the pathognomonic for

Back 75

birbeck granules - tennis racket shaped cytoplasmic structures on EM
seen in histiocytosis X

Front 76

what is histiocytosis X

Back 76

proliferation of histiocytic cells resembling Langerhan's skin cells (Birbeck granules pathonogmonic)

3 types
Leterrer Siwe dz- acute, in children
Hand-Schuller-Christian dz - chronic progressive, in children
Eosinophilic granuloma - best Px, lung

Front 77

what is the clinical triad of Hand Schuller Christian dz

Back 77

skull lesions, diabetes insipidus, exopthalmos

this is the chronic, progressive variant of histiocytosis X (birbeck granules)

Front 78

what is the deficiency enzyme in porphyria cutanea tarda (most common porphyria)

Back 78

uroporphyrinogen decarboxylase

Front 79

during antigen presentation, CD28 on T cells binds to what molecule on B cells?

Back 79

B7

Front 80

what CD molecules are found on all T cells

Back 80

CD3 and CD 2

CD 3 acts as a T cell receptor associated signal transduction molecule

CD 2 helps adhere to other cells and binds LFA 3

Front 81

T2, T3, and T3 correspond with what anatomic landmarks

Back 81

T2 - sternal notch
T3 - spine of scapula
T4 - sternal angle

Front 82

what are two opioid AE"s that are not affected by tolerance

Back 82

constipation
miosis

Front 83

what is the MOA of metronidazole

Back 83

forms toxic metabolites within bacterial cell by a reduction reaction

kills protozoa and anaerobes
GET GAP

Front 84

vignette gives you a Pt with a flank or upper abdominal bruit, you should suspect

Back 84

renovascular HTN

young women w fibromuscular dysplasia or old men w arteriosclerosis

Front 85

where is the chapman reflex for the sciatic nerve found

Back 85

middle of the hamstring

Front 86

what is sialadenitis

Back 86

acute infection of the salivary gland, usually parotid or submandibular

treat w Abx and sialogogues - promote flow of saliva

Front 87

what is sialolithiasis

Back 87

calculus formation in the salivary gland,
most common in Wharton's duct - drains submandibular glands
or stensons duct - drains parotid glands

Front 88

where do we see the buzzword pretibial myxedema

Back 88

hyperthyroid - graves dz

Front 89

what is odynophagia

Back 89

pain on swallowing

Front 90

what kind of menstrual Sx do bulimics usualyl have

Back 90

nada
choose eumenorrhea

Front 91

what is menometrorrhagia

Back 91

excessive bleeding during menses and at irregular times

Front 92

what is metrorrhagia

Back 92

normal bleeding but at irregular times (when you're not supposed to be on your pd)

Front 93

what is a felon (it is a lesion)

Back 93

infection of fingertip pulp, presents as cellulitis or abscess

surgical emergency! I&D immediately bc high pressure can dvlp within septal compartments (septal compartments do not easily distend) and necrosis can ensue

Front 94

what nerve innervates pronator teres and pronator quadratus

Back 94

median nerve

pronator teres - inserts lateral aspect of midshaft of radius
pronatur quadratus - inserts lower quarter of radius

Front 95

what nerve innervates supinator

Back 95

deep branch of radial n

Front 96

what nerve innervates biceps brachii

Back 96

musculocutaneous

Front 97

where, generally, do the two primary supinators, biceps branchii and supinator insert on the radius?

Back 97

proximal end

the major pronators insert on the distal radius
so a mid shaft radius Fx will isolate the two groups -distal radius will pronate and proximal radius will supinate due to unopposed actions

Front 98

disruption of PCA in brain will cause palsy of which CN

Back 98

CN III oculomotor

Front 99

what is MOA of ethosuximide

Back 99

inhibits Na K ATPase
reduciton of T type Ca current

Front 100

what is MOA of phenytoin

Back 100

block Na channels

Front 101

in a respiratory metabolic problem.....do H and HCO3 move in the same direction or opposite directions

Back 101

the axiom is that H and HCO3 change in the same direction in a respiratory acid-base imbalance

Front 102

aortic stenosis is a systolic or diastolic murmur?

Back 102

aortic stenosis is a late systolic ejection murmur w soft A2 on auscultation

mitral regurg is also systolic, but holosystolic

Front 103

mitral stenosis and aortic regurg are systolic or diastolic?

Back 103

diastolic

here is a good mnemonic
MRASS and MSARD
mitralregurg/aortic stenosis systolic
mitral stenosis/aortic regurg diastolic