Boards - Bbc Session 4

Front 1

What do we call the facets on the thoracic vertebrae where superior and inferior ribs connect?

Back 1

Articular facets (AKA Zygopophyseal facets)

Front 2

T/F: The head of rib 11 articulates with the inferior facet for the rib head found on T10... Ie a rib head articulates with 2 vertebrae - the same-numbered vertebrae and the one less numbered vertebrae

Back 2

TRUE

Front 3

Rule of Threes?

Back 3

T1-T3 = transverse process located on the same horizontal plane as the spinous process of that given vertebrae (T12)
T4-T6 = transverse process of any given vertebrae is located half way between that vertebra's spinous process and the spinous process of the vertebrae above it (T11)
T7-T9 = Transverse process at horizontal plane with spinous process directly above it (T10)

Front 4

What are the atypical ribs?

Back 4

1, 2, 11, 12 (it don't have all the anatomical structures of other ribs, like head, neck, tubercle, angle, shaft)

Front 5

What are the true ribs?

Back 5

Ribs that are connected to the sternum by their costal cartilage (ribs 1-7)

Front 6

What are the false ribs?

Back 6

Ribs NOT directly connected by their costal cartilage to sternum (ribs 8-10)

Front 7

What are the floating ribs?

Back 7

Do not connect to sternum at all - ribs 11 and 12

Front 8

Whats the primary motion of the thoracic spine?

Back 8

Rotation

Front 9

What are the different motions of the ribs?

Back 9

Pump-handle (1-5) , Bucket-handle (6-10), caliper (11-12)

Front 10

What are the primary muscles of respiration?

Back 10

Diaphragm, Intercostals (external, internal, innermost, subcostal)

Front 11

What are the secondary muscles of respiration?

Back 11

Scalenes, pec minor, latissimus dorsi, Quadratus lumborum, serratus anterior and posterior

Front 12

Innervation of diaphragm? Where does it originate from?

Back 12

Phrenic nerve originates from C3-C5 nerve roots

Front 13

What do the intercostals do in breathing?

Back 13

Lift the ribs with inhalation, prevent retractions during inspiration

Front 14

What are the two types of rib dysfunction?

Back 14

Inhalation and Exhalation dysfunction

Front 15

Whats the key rib in an inhalation dysfunction?

Back 15

Lowest rib of the group

Front 16

Whats the key rib in an exhalation dysfunction?

Back 16

Highest rib of the group

Front 17

The spine of the scapula is at what thoracic vertebra level?

Back 17

T3

Front 18

The inferior angle of the scapula is at what thoracic vertebra level?

Back 18

T7

Front 19

What are the serum calcium, phosphate, and alkaline phosphatase levels in Osteoporosis? Osteomalacia? Paget's Disease?

Back 19

Osteoporosis - Ca2+ = Normal, Phosphate = Normal, Alkaline Phosphatase = Normal
Osteomalacia = Ca2+ Low, Phosphate = Low, Alk. Phosphatase = High
Paget's Disease = Ca2+ Normal, Phosphate = Normal, Alk. Phosphatase = High

Front 20

What is the most common type of cartilage?

Back 20

Hyaline

Front 21

What type of bone cancer is characterized by being extremely aggressive, primarily affecting the pelvis and long bones (in the marrow cavities) and is more prevalent in young males?

Back 21

Ewing's Sarcoma

Front 22

Why are the calf areas of Duchenne muscular dystrophy pts very large?

Back 22

Hypertrophy with fatty and connective tissue infiltrate

Front 23

What is the most common supratentorial tumor in children?

Back 23

Craniopharyngioma

Front 24

What CNS disorder is marked by bradykinesia, a resting tremor, and rigidity?

Back 24

Parkinson's Disease

Front 25

If one is spastic with much increased DTRs, is the problem probably related to a lower motor neuron lesion or upper motor neuron lesion?

Back 25

Upper

Front 26

What is the typical age of onset for multiple sclerosis? What is the gross anomaly created in this disease that involves the nervous system (ie in a general sense, what does it do to the neurons)?

Back 26

Onset = 20-40

It Demyelinates the nerves

Front 27

What is the primary hormone that is produced in excess in Cushing's Syndrome?

Back 27

Cortisol (vs Cushing's Disease = pituitary tumor = too much ACTH)

Front 28

What general class of adrenal products is produced in excess in Conn's disease, and what is its effect on serum sodium levels?

Back 28

Aldosterone is produced in excess = INC. Serum sodium levels

Front 29

Contrast Grave's disease and Plummer's hyperthyroidism in terms of follicle size and colloid amount in the thyroid

Back 29

Graves = small follicle, Low Colloid
Plummer's Hyperthyroidism = Large follicle, High Colloid

Front 30

What are the four major types of thyroid tumors? Which one is the most common?

Back 30

Papillary, Follicular, Anaplastic, Medullary

Most common = Papillary

Front 31

Are the PTH and Calcium serum levels high, low, or normal in hypoparathyroidism? in pseudohypoparathyroidism?

Back 31

In Hypoparathyroidism = LOW

In Pseudohypoparathyroidism = High PTH, Low Ca2+

Front 32

Is diabetes mellitus type 1 or Diabetes Mellitus type 2 more prone to ketoacidosis? More associated with obesity?

Back 32

Type 1 = more prone to ketoacidosis
Type 2 = more associated with obesity

Front 33

What are the 4 organs involved in MEN Type 1?

Back 33

Pancreas, Pituitary, Parathyroid, Adrenal Cortex

Front 34

What are the ABCs of melanoma?

Back 34

A = Asymmetry
B = Border Irregularity
C = Color Variation

Front 35

What skin disease arises due to autoantibodies directed against the intercellular junctions between keratinocytes?

Back 35

Pemphigus

Front 36

What two organs are most affected by mercury poisoning?

Back 36

Brain and Kidney

Front 37

What guanine analog is the Drug of Choice for treating herpes simplex viruses 1 and 2?

Back 37

Acyclovir

Front 38

What color are gram positive bacteria after Gram staining?

Back 38

Blue-Purple

Front 39

What kind of collitis is a risk after the use of broad-spectrum Abx? What is the causative agent?

Back 39

Pseudomembraneous collitis
Causative agent = C. Difficile

Front 40

The destruction of what organ causes the deaths associated with acetominophen over-dose?

Back 40

Liver

Front 41

Of what are most renal calculi comprised?

Back 41

Ca2+

Front 42

What kind of aneurysm are Marfan's patients most predisposed towards?

Back 42

Dissecting Aortic Aneurysm

Front 43

What type of germ cell tumor is associated with painless enlargement of the testes, and is often curable because of its radiosensitivity?

Back 43

Seminoma

Front 44

What is the causative agent of condyloma acuminata? Condyloma Lata?

Back 44

Condyloma acuminata = HPV

Condyloma lata = Treponema pallidum

Front 45

What is the source of alpha-amanitin?

Back 45

Poison mushrooms and toad stools

Front 46

If a patient presents with a small amount of rectal pain, a significant amount of bright red blood in stool, and numerous pseudopolyps on colonoscopy, from what disease does this pt. suffer?

Back 46

Ulcerative collitis

Front 47

What kind of tumors (besides those seen possibly with associated colon carcinoma) are associated with Turcot's disease?

Back 47

CNS

Front 48

What is the number one cell tumor of men?

Back 48

Seminoma

Front 49

What are the 4 subtypes of Hodgkins Disease and how does this relate to the Reed-Sternberg cell?

Back 49

Lymphocyte Predominant = lowest number of reed-sternberg cell
Nodular Sclerosis
Mixed Cellularity
Lymphocyte Depleted = The worst of these tumors, and thus has the highest number of reed-sternberg cells (ie prognosis relates to number of reed-sternberg cells)

Front 50

What is the inheritance pattern of acondroplasia

Back 50

Autosomal Dominant

Front 51

How do Gilbert and Crigler-Najjar differ in terms of uptake of bilirubin?

Back 51

Gilbert = mildly impaired uptake of bili
Crigler-Najjar = Severely impaired uptake of bili

Front 52

What 3 cell types do C3a and C5a stimulate to release histamine

Back 52

Basophils, Mast cells, Platelets

Front 53

MOA and use of Amantidine

Back 53

MOA - impairs viral uncoating

Use - Influenza A

Front 54

MOA and Use of Interferon?

Back 54

MOA - induces host cell responses that inhibit RNA translation and induce MHC-1 expression

Use - DOC for HBV, HCV

Also used for Hairy Cell Leukemia

Front 55

MOA and Use of Ribavirin?

Back 55

Looks like GTP --> gets involved in transcription --> blocks viral mRNA synth

Use- DOC for HCV

Front 56

MOA and Use of Acylovir?

Back 56

MOA - becomes GTP --> incorporated into DNA --> inhibits DNA polymerase as well as premature DNA termination of the virus

Front 57

MOA and Use of Vidarabine?

Back 57

MOA - imitates ATP --> Incorporates into DNA --> inhibits DNA synth

Use - All herpes group viruses, esp encephalitis, VZV in immunocompromized pts. (second line tx for herpes keratitis)

Front 58

MOA and Use of Ganciclovir?

Back 58

MOA - mimics GTP, inhibits DNA polymerase

Use - CMV retinitis
Bone marrow suppression is a side effect

Front 59

MOA and Use of AZT?

Back 59

Becomes a TTP analog --> inhibits DNA synth

Use - HIV

Front 60

MOA and Use of Protease Inhibitors?

Back 60

MOA - Inhibit cleavage of giant protein (gag-pol-env) that HIV must cut apart to have the functional components of that protein

Use - HIV

Front 61

MOA and use of Non-nucleoside Inhibitors?

Back 61

MOA - prevent fusion between HIV virion and cell.

Use - HIV

Front 62

MOA and Use of Integrase Inhibitors?

Back 62

MOA - inhibit HIV viral integrase enzyme --> prevent integration and insertion of HIV into human DNA

Front 63

MOA and Use of Chemokine co-receptor antagonists (CCR5 antagonists)?

Back 63

MOA - block the CCR5 co-receptor on WBCs targeted by HIV --> prevents entry of virus into cell

Front 64

Use of Neuraminidase inhibitors?

Back 64

Use - Influenza A and B to prophylactically tx contacts of infected people

Front 65

MOA and Use of Foscarnet?

Back 65

MOA - inhibits both DNA polymerase and reverse transcriptase

Use - alternative to ganciclovir for CMV

NOTE: its is nephrotoxic

Front 66

Use of Valganciclovir?

Back 66

Used with ganciclovir for MCV retinits

Front 67

MOA and Use of Trifluridine?

Back 67

MOA - mimics TTP --> incorporated into viral DNA --> inhibit viral DNA synth
Use - HSV

Front 68

Use of Cidofovir?

Back 68

Smallpox and severe adenovirus infections

BUT..
its nephrotoxic and can cause Fanconi syndrome

Administered with a probencid = uses renal transporters to get out = competes with Cidofovir for renal transporters = we can give a lower dose of cidofovir to get the therapeutic effect

Front 69

HIV destroys what cells?

Back 69

CD4 T cells

Front 70

What are the stages of HIV infection?

Back 70

Acute = 3-4 weeks but can take a few months. generalized viral symptoms
Latent = Asymptomatic
Advanced Symptomatic Infection - +HIV test and ONE of the following:
1. <200 CD4 T cells
2. AIDS-defining opportunistic infections
3. AIDS-associated malignancies (Kaposi's sarcoma, brain lymphoma..etc)
4. HIV-complicating infections (TB, etc)

Front 71

PT tests what?

Back 71

Extrinsic pathway

Front 72

PTT tests what?

Back 72

Intrinsic pathway

Front 73

What tests the common pathway?

Back 73

Common pathway

Front 74

Because von willebrand factor also binds _____, we will see a deficiency in what in Von willebrand disease

Back 74

Factor 8

Front 75

Von Willebrand disease will present with what symptoms?

Back 75

Inc PTT and bleeding time
Inc. menstrual bleeding
Bleeding from small cuts, easy bruising

Front 76

Hemophilia A is a lack of what?

Back 76

Factor 8

Front 77

Hemophilia B is a lack of what?

Back 77

Factor 9

Front 78

Vit K deficinecy due to fat malabsorption, Abx, Newborns, or coumadin tx, results in what?

Back 78

Deficiency in Factors "1972" = 10, 9, 7, 2

Front 79

What test do we use to assess Coumadin therapy?

Back 79

PT - do this to test for factor 7 because out of 10, 9, 7, and 2 it will be the first to dec.

Front 80

Why do we give Heparin with Coumadin?

Back 80

Coumadin dec. proteins C and S = inc. clotting b/c things aren't inhibited. After a few days, factor 7 will be depleted so then we can take pt off heparin.
Heparin inhibits factors "1972" = 10, 9, 7, 2 and 12 that are initially clotting the pt

Front 81

What is DIC?

Back 81

Disseminated Intravascular Coagulation = spontaneous activation of coag cascade = intravascular coagulation and organ ischemia as well as consumption of clotting factors to yield mucosal bleeding

Front 82

Define Idiopathic Thrombocytopenic Purpura

Back 82

Loss of platelets

In kids = acute
In adults = chronic

Front 83

Define Thrombotic Thrombocytopenic Purpura

Back 83

Unknown cause - auto-immune?

RBCs are damaged or ruptured
Severe thrombocytopenia
Schistocytes (helmet cells, triagular RBCs)

Hemolysis: Low Hb, High Reticulocyte count, Polychromasia on blood smear, High LDL, fever, ischemic organ damage

Front 84

T/F: If left untreated, Throbotic thrombocytopenic purpura is fatal

Back 84

TRUE

Front 85

What are the signs and symptoms of thrombotic thrombocytoenic purpura?

Back 85

Severe thrombocytopenia, Schistocytes: helmet cells, triangular RBCs, evidence of hemolysis (low Hb, high reticulocytes, polychromasia on blood smear, high LDH), fever, ischemic organ damage

Front 86

Define Spherocytosis

Back 86

Def. in Spectrin = RBCs are not shaped like their usual shape, and instead are spheres. These are functionally normal, but the spleen gets rid of them. Tx = splenectomy which can make this pt susceptible to many other things

Front 87

Define G6PD deficiency

Back 87

G6PD is active in the Pentose PO4 (phosphate) Pathway and allows for removal of ROS. Without G6PD RBCs are susceptible to ROS and thus oxidative damage

G6PD --> NADPH --> 2 G-SH (glutathione) --> 2H2O2 (peroxidase)

Front 88

Sickle cell anemia is due to what amino acid substitution?

Back 88

a single amino acid substitution (valine for glutamate) in the beta globulin chain = more prone to crystalization under certain conditions such as hypoxia, acidosis, dehydration

Front 89

Alpha-Thalassemia is due to what?

Back 89

Dec. synth of alpha globulin chains. Normal pple have 4 alpha-thalassemia alleles - if one allele is missing we get asymptomatic. 2 alleles missing = moderate, 3 alleles missing = more severe microcytic anemia, 4 alleles missing = lethal, no Hb can carry O2

Front 90

What is Beta-Thalassemia due to?

Back 90

Dec. synth of beta globin chains

Jaundice, leg ulcers, splenomegaly

Front 91

What is warm agglutinin disease?

Back 91

Abs against ones own RBCs. Abs are most active at warm temps. Caused by drugs (methyldopa, L-dopa) , malignancies, SLE

Front 92

What is Cold agglutinin disease?

Back 92

Abs against one's own RBCs. Abs are most active at cold temps. Caused by mycoplasma pneumonia, Mononucleosis, Lymphoma, 50% are idiopathic

Front 93

Describe difference between Direct and Indirect Coombs test

Back 93

Direct = measures Ab bound directly to RBC. Indirect measures Ab in serum. Indirect used for determing Rh status of mothers after their first child

Front 94

Whats the cause of megaloblastic anemia?

Back 94

Defective DNA synth (some causes = Diphyllobothrim latum, Poor diet, Type A gastritis)

Front 95

Whats the cause of microcytic anemia?

Back 95

Hb deficiency (ex = lead poisoning, iron def.)

Front 96

Whats the pathway of folic acid to dTMP?

Back 96

Folic acid --> dihydrofolate --> tetrahydrofolate --> methylene tetrahydrofolate (--> methyl tetrahydrofolate --> homocysteine via B12 to methionine) --> dUMP --> dTMP (via thydimylate synthase)

Front 97

Define Plummer Vinson Syndrome

Back 97

Anemia due to long term iron deficiency. Results in esophageal webs = pt can swallow liquid but has trouble swallowing food

Front 98

Define Fanconi Anemia

Back 98

Inability to remove O2 radicals from bone marrow

Symptoms: microcephaly, cafe-au-lait spots, small or absent thumbs, deformed or absent radius bones, recurrent aplastic anemia, high risk leukemia or lymphoma

Front 99

What are Heinz bodies?

Back 99

Denatured Hb in RBCs = assoc. with G6PD deficiency

Front 100

What are Howell-Jolly Bodies?

Back 100

nuclear fragments in RBCs. basolphilic blue granules. Indicate that RBCs are leaving the bone marrow while still immature

= indicate spleen isn't working for example asplenia or splenectomy

Front 101

What does Basophilic stippling mean?

Back 101

tiny blue dots in RBCs, means lead poisoning

Front 102

What are Siderocytes?

Back 102

Extra iron in RBCs, means iron not bound to Hb = Peppenheimer bodies, a result of iron overload secondary to deranged bone marrow function (NOT dietary Fe excess)

Front 103

What do lots of reticulocytes in blood mean?

Back 103

immature RBCs are being released in response to hemorrhage or similar events

Front 104

What kinds of things can cause dec. neutrophil production?

Back 104

bone marrow disease, chemo, HIV-1 infection, Vit B12 or folate def.

Front 105

What can cause inc. destruction of Neutrophils?

Back 105

Felty's syndrome (= variant of rheumatoid arthritis)

Front 106

What can cause Neutrocytosis (inc. neutrophils)

Back 106

Acute inflamm, acute infections, bact. infections, certain cancers, leukemia for neutrophils

Front 107

What can cause Eosinocytosis?

Back 107

Type I hypersensitivities = allergies
Helminthic infections = worm infections

Front 108

What can cause Lymphocytosis

Back 108

Granulomatous disease, viral infections, pertussis

Front 109

What can cause monocytosis?

Back 109

granulomatous diseases, infectious mononucleosis

Front 110

Whats the most common malignancy in children?

Back 110

ALL = Acute lymphocytic Leukemia = over-production of lymphoblasts (immature lymphocytes) --> Lymphadenopathy and Impaired Bone Marrow Function

Front 111

You see Auer rods in myeloblasts. Dx?

Back 111

Acute Myelogenous Leukemia = over-production of cells that can cause leukemia other than lymphocytes

Front 112

Philadelphia chromosome is indicative of what?

Back 112

CML = Chronic Myelogenous Leukemia. Phildelphia Chromo = 9:22 chromosomal translocation such that bcr-abl fusion gene is created.

Associated with low LAP = Leukocyte alkaline phosphatase

Front 113

Define Chronic Lymphocytic Leukemia

Back 113

Mature lymohocytes predominate --> Lymphadenopathy and impaired bone marrow function

Sesary Syndrome is an unusual variant = the leukemia that results from Mycosi Fungoides

Front 114

Markers for Hairy Cell Leukemia?

Back 114

TRAP and CD25

Front 115

How do we tell Hodkin's disease from NON-Hodgkin's?

Back 115

Hodgkin's = Reed-Sternberg cells,

Hodgkins = Leukocytosis of PMNs, Contiguous spread, Nodal involvement, Inc. Reed-sternberg cells depending on the type means poorer prognosis: in order of increasing reed-sternberg cells: Lymphocyte predominance, nodular sclerosis, mixed cellularity, lymphocyte depletion

Front 116

Characteristics of Non-Hodgkins Lymphoma?

Back 116

Widespread adenopathy, hypercalcemia, hepatosplenomegaly, Probably viral etiology, accoc. with bcl-2, spreads to multiple dif. nodes, neutrocytosis