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337 Cards in this Set

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BEHAVIORAL SCIENCE
BEHAVIORAL SCIENCE
2 Equations for sensitivity?
Sn = TP / TP + FN

Sn = 1- false negative rate
2 Equations for specificity?
Sp = TN / TN + FP

Sn = 1 - false positive rate
Equation for PPV?
TP / TP + FP
Equation for NPV?
TN / FN + TN
What does this describe:
# of new cases of a dz
iNcidence
What does this describe:
Total # of cases present @ a given time
Prevalence
1) What's the Pathology:

-Hypnagogic (just before sleep) and/or hypnopompic (just after waking up) hallucinations

-Cataplexy (loss of muscle tone following a strong emotional stimulus)

2) Tx of Narcolepsy?
1) Narcolepsy

2)
-Stimulants (amphetamines, modafinil)
-Sodium oxybate (GHB)
BIOCHEMISTRY
BIOCHEMISTRY
In this disorder, their is a problem w/ nucleotide excision repair -->
no repair of thymidine dimers
Xeroderma pigmentosum
Whats the pathology:
When phagocytes have probs w/ microtubule poymerization -->
Inability to phagosome to fuse w/ lysosome -->
No degredeation of phagocytized material -->
3 P's:
Pyogenic Infxns,
Partial Albinism,
Peripheral Neuropathy
Chediak Higashi Syndrome
What's the pathology:

Problem w/ cilia microtubule Dynein Arms -->
Immotile Cilia -->
Triad of :
1) Situs inversus
2) Chronic Resp Infxn
3) Infertility
Kartagener's
Multiple Fx
+
Blue Sclera
+
Hearing Loss
+
Dental Imperfections
=
?
Type I Osteogenesis Imperfecta
(Prob w/ T I Collagen)
What type of OI is fatal in utero?
Type II
Hyperextensible skin
+
Easy bleeding and bruising
+
Hypermobile joints
+
Berry Aneurysm
+
Organ Rupture
=
Ehlers-Danlos Syndrome
EDS is result of defect in what type collagen?
Type III
Self-Mutilation
+
Gout
=

LNS is result of absent what?
Lesch-Nyhan Syndrome

HGPRT
AUTOSOMAL DOM DISORDERS
AUTOSOMAL DOM DISORDERS
-Defective FGF receptor 3
-Advanced paternal age
Achondroplasia
-BL massive enlargement of kidneys from multiple large cysts

-Flank pain
-hematuria
-HTN
-Progressive renal failure

-Berry Aneurysms
-Mitral valve prolapse
AD polycystic kidney dz
(ADPKD)
-Defective APC gene -->
colon covered in adenomatous polyps

-May progress to colon CA
FAP
-No LDL Receptor

-Elevated LDL
Familial Hypercholesterolemia
-Telangiectasias
-Epistaxis
-Skin discoloration
-AVMs
Osler-Weber-Rendu
(Hereditary Hemorrhagic Telangiectasia)
-Progressive dementia
-Choreiform mvts
-Caudate atrophy
-Dec GABA and ACh in brain
Huntington's
-Fibrillin gene mutation
-Cystic medial necrosis -->
aortic incompetence and dissecting AA
-Floppy mitral valve
-Subluxation of lenses
Marfan's
-cafe-au-lait spots
-neural tumors
-Lisch nodules (pigmented iris hamartomas)
-Skeletal disorders (scoliosis)
NF1
-BL acoustic schwannoma
NF2
-facial lesions (adenoma sebaceum)
-Hypopigmented "ash leaf spots"
-Cortical and retinal hamartomas
-seizures
-mental retardation
-cardiac rhabdomyomas
-Astrocytomas
Tuberous sclerosis
-BL renal cell carcioma
-hemangioblastoma
-Deletion of VHL gene
-Constitutive activation of angiogenic growth factors
von-Dippel-Lindel dz
AUTOSOMAL RECESSIVE DZES
AUTOSOMAL RECESSIVE DZES
CF:

1) What gene is defective?
2) 2 MC IA --> lung infxn?

3) Why are males infertile?
4) which vitamins are deficient?

5) FX on newborns?

6) Tx?
1) CFTR on chromosome 7
2) Pseudomonas, s. aureus

3) Absence of vas deferensQ

4) ADEK
(Fat sol bc dec pancreatic lipase)

5) Meconium Ileus

6) N-acetylcysteine to loosen mucous plugs
-DELETION of dystrophin gene -->
Accelerated muscle breakdown

-Weakness in pelvic girldle
-Calf pseudohypertrophy
-Gower's maneuver
Duchenne's MD
-MUTATED dystrophin gene

-Less severe than Duchenne's
Becker's MD
4 Dz'es resulting from trinucleotide repeats?
fragile X
Friederich's ataxia
Huntington's
Myotonic dystrophy

"X-Girlfriends First Aid Helped Ace My Test"
-Flat facies
-Prominent Epicanthial folds
Simian crease
Down's Syndrome
Downs syndrome = Inc risk what CA?

Inc risk of what neuro dz?
ALL

Alzheimer's Dz
3 causes of down's in order of commonality?
Meiotic non-disjunction --> Trisomy 21

Robertsonian translocation

Downs mosaicism
Describe AFP and b-HCG levels during pregnancy of a down's pt?
dec AFP
Inc b-HCG
US of down's kid shows what?
Nuchal translucency
-High pitched crying (like a cat)
-Microcephaly
-Microdeletion
Cri-du-chat
-Elfin facies
-friendly
-good verbal skills
Williams syndrome
(Elfin facies = movie elf = WILL ferrell)
-Wernicke-Korsakoff:
Confusion, Ophthalmoplegia, Ataxia

-Dry Beri-beri
-Wet beri-beri
B1 (Thiamine) Defic
-Angular chelitis (inflamm of mouth, corners of lips)

-Corneal vascularization
B2 (riboflavin) defic

"2 C's of B2"
Diarrhea
Dermatitis
Dementia


Facial Flushing
B3 (Niacin) Defic
"3 D's of B3"




B3 (Niacin) Excess
-If deficient -->
Convulsions

-Deficiencies caused by INH
B6 (Pyridoxine)
-Absorbed in Terminal Ileum
-Reqs IF for absorption
-Defic -->
Macrocytic, megaloblastic anemia, hyperseg PMNs

-Malabsorption if have diphylobothrium latum

-Dx'ed w/ schilling's test
B12 (Cobalamin) defic
-Defic --> Macrocytic megaloblastic anemia

-Converted to THF
Folic Acid
-Keeps Fe in reduced state so it can be absorbed in gut
-Necesarry for hydroxylation of proline and lyxin when synth collagen

-Defic --> Scurvy =
swollen gums, bruising, dec immune response
Vit C (Ascorbic Acid)
-Stims bone resorption
-Defic leads to rickets in kids and osteomalacia in adults
-Vit D
-Anti-oxidant that protects from free-rad damage (esp to Erythrocytes)

-Defic -->
Spinocerebellar degen
-Vit E

(E for Erythrocytes)
-Catalyzes gamma-carboxylation of glutamic acid

-Made by intestinal flora
Vit K
Inhibs ETHOL-Dehydrogenase
Fomepizole
Inhibs Acetaldehyde dehydrogenase
Disulfuram
(Antabuse)
Why does excess ETHOL -->
HYPOglycemia and fatty change?
ETHOL --> Inc NADH that must be oxidized to NAD +

Oxaloacetate --> Malate regenerates NAD +
but leads to dec gluconeogenesis

Pruvate to Lactate regenerates NAD+ but --> fatty liver
1) 4 aspects of Kwashiorkor?

2) Marasmus is defic of all calory types --> what?
1) MEAL
pro Malnutrition
Edema
Anemia
fatty Liver

2) Muscle wasting
Prob w/ urea cycle -->
orotic acid in blood and urine
OTC defic
(ornithine transcarbamoylase defic)
-Tremor
-Slurring of speech
-Somnolence
-Vomiting
-Cerebral edema
-Blurry vision
Ammonia (NH3) Intox
1) Musty body odor?

2) Et?

3) Tx?
1) PKU

2) Def phenylalanine hydroxylase
OR
Tetrahydrobiopterin cofactor

3) Dec phenylalanine diet
Inc Tyrosine diet
-Black urine
-brown sclera
-dark CT


-What's deficient?
Alkaptonuria


homogenistic acid oxidase
Dec tyrosinase
Albinism
(dec melanin)
What dyslipidemia:

1) Inc Chylomicrons and TGs

2) Inc LDL

3) Inc VLDL and TGs
1) Type I Hyperchylomicronemia

2) Type IIa familial hypercholesterolemia

3) Type IV Hypertriglyceridemia
EMRBYO
EMRBYO
Leading cause of congenital malformations in US
FAS
During what wks of gestation does organogenesis take place?
3-8
-Persistence of pyramidal lobe
-Midline swelling of neck and moves w/ swallowing
-Thyroglossal duct cyst
-Palpable ABD olive
-Non-bilious vomiting @ 2 wks of age
Congenital pyloric stenosis
BL renal agenesis -->
Oligohydramnios -->
pulmonary hypoplasia
Potter's syndrome
-Kidneys trapped under IMA
-Assoc w/ Turner's Syndrome
Horseshoe Kidney
Urethral opening on ventral penis
Hypospadias
Urethral opening on dorsal penis
Erispadias
Urine discharge from umbilicus
Persistence of remnant of allantois (Patent Urachus)
MICRO
MICRO
Argyll- Robertson pupil (Prostitutes pupil - "Accomodates but doesn't react)
Tertiary Syphilis
-Mississippi and Ohio River valleys
-Bird and bat droppings
-Fills up macs
(____ Hides in Macs)
Histoplasmosis
-Mississippi River and Central America
-Inflamm of lung w/ dissemination to skin and bone
-Broad based buds
Blastomycosis
-SW United States and California
-Pneumonia and Meningitis
-Inc after earthquaes
-Spherule filled w/ endospres
Coccidiomycosis
-"Captains wheel"
-Latin America
Paracoccidiodomycosis
-Hyper and hypopigmented macules
-Spaghetti and Meatballs
Tinea Versicolor (Malassezia furfur)
-Acute angle hyphae
-Bronchopulmonary infxn
-Fungus balls (_____gilloma)
Aspergillus
-Only yeast w/ a capsule
-"Soap bubble" lesion in brain
-India Ink
-Cryptococcus
-Diabetics
-Leukemia
-Rhinocerebral and frontal lobe abscesses
-Black eschar
Mucormycosis
Pneumonia in AIDs / HIV (CD4 < 200)
PCP

(Pneumocystic jirovecci)
-Cigar shaped yeast
-Spread by thorn prick
-Pustule or ulcers w/ nodules along lymphatics
Sporothrix Schenckii
Herpes vesicles above the waist
HSV1
Herpes vesicles below the waist
HSV2
Inc risk of Burkitt's lymphoma,
Nasopharyngeal carcinoma,
Latent in B-cells
EBV
-"Owls Eyes" cells
-negative monospot
-Mono-like sx
(Fever, ____, Lymphadnopathy)
CMV
Fever ---> Rash in kids
Roseola (HHV6)
Kaposi's Sarcoma in AIDs
HHV 8
-Fever, pharyngitis, lymphadenopathy
-Positive monospot (heterophile Ab)
-Burkitt's lymphoma
-Nasopharyngeal carcinoma
EBV
-#1 cause of fatal diarrhea in kids
-Winter months
-Rotavirus
-Summer gastroenteritis
-Norwalk virus
-Seal like barking cough
-Croup (Laryngo-tracheo-bronchitis
from
Parainfluenza virus
Cough
Coryza (runny nose)
Conjunctivitis
Koplic spots
Measles (Rubeola) Virus
SSPE
Measles (Rubeola) Virus
POM
Parotitis
Orchitis
Aseptic Meningitis
Mumps Virus
-Bullet shaped capsid w/ negri inclusion bodies

-Photophobia
-Hydrophobia
Rabies virus
How does rabies get to CNS?
Travels retrograde
2 Types Hepatitis virus that are Fecal Oral
A & E
3 Types Hepatitis virus that are blood-borne
B, C, D
Name the Hepatitis Virus:

1) Preggos (Expectant Moms) & Travelers who are expectant

2) Reqs HB co-infection

3) 2 Types that are chronic?

4) IVDU?
1) Hep E

2) Hep D

3) B, C, D

4) Hep C
ENDOCRINE
ENDOCRINE
1) Which GLUT receptor on the following tissue"


A) RBCs and Brain
B) pancreatic beta cells, liver, kidney, small intestine
C) Adipose, Sk. Muscle
A) GLUT-1
B) GLUT-2
C) GLUT-4
1) Excess cortisol secretion?

2) Cushing's syndrome from pituitary adenoma -->
Inc ACTH?

3) Cushing's Syndrome from Small cell lung CA or bronchial carcinopids -->
Inc ACTH?

4) If you have Cushing's syndrome from an adrenal gland tumor, will ACTH be increased or decreased?
1) Cushing's Syndrome

2) Cushing's Dz

3) Ectopic ACTH

4) Dec
-MCC of chronic adrenal insufficiency

-Hyperkalemia
-Hyperpigmentation
-Addison's Dz
-No Hyperkalemia
-Dec ACTH -->No Hyperpigmentation
Secondary adrenal insuffic
Tender thyroid
Subacute thyroiditis
(dequervains)
Thyroid CA w/ psamomma bodies resulting from a RET A Gene Mutation
Papillary thyroid CA
Thyroid CA resulting from parafollicular C cells
Medullary thyroid CA
What Nerve Is Injured:

-Fx'ed surgical neck of humerus
-Dislocated humoeral head
-Deltoid motor deficit (Abduction of arm )
-Sensory deficit over deltoid
Axillary Nerve
What Nerve Is Injured:
-Fx'ed @ midshaft of humerus
-"Saturday night palsy"
Radial Nerve
What Nerve Is Injured:

Proximal Lesion:
fx of supracondylar humerus

Distal Lesion:
Carpal Tunnel Syndrome
Median N
What Nerve Is Injured:
Prox Lesion:
Fx medial epicondyle of humerus

Distal Lesion:
Fx 'ed hook of hamate
Ulnar Nerve
1) Waiter's tip hand = what palsy

2) Which nerve roots?
1) Erb Duchenne's Palsy

2) C5, C6 = Upper trunk of BP
What's The Pathology:

-Failure of longitudinal bone growth --> short limbs and dwarfism

-Constitutive activation of fibroblast growth factor R e (FGFR3)

-Advanced paternal age
Achondroplasia
Distal radius fx also called what?
Colles' fx
Tx for osteoporosis?


CI'ed?
SERMS
Calcitonin
Bisphosphonates
Pulsatile PTH


Glucocorticoids
-What's The Pathology:
Probs w/ osteoclasts -->
Faillure of normal bone resoprtion -->
thickened dense bones that are prone to fx

-Norm alk phos (ALP)
Osteopetrosis
What's The Pathology:

Inc osteoclast activity -->
Inc osteoblast activity -->
abnormal bone formation -->
haphazard laying down of collagen matrix -->
"Cement Lines" which connect normal bone to abnormal bone

-Inc ALP

-Inc blood flow -->
AV shunts -->
High Output CF
Paget's dz of Bone
What's The Pathology:

-Bone repalced by fibroblasts, collagen and irregular bony trabeculae

-McCune Albright syndrome is a form of this dz:
Precocious puberty & cafe-au-lait spots
Polyostotic Fibrous Dysplasia
What's The Pathology:

-Benign tumor
-20-40y y/o
-distal femur and prox tibia
-"Double Bubble" or "Soap Bubble" appearance on x-ray
Giant Cell Tumor
(Osteoclastoma)
-Benign tumor
-Men < 25 y/o
-Mature bone w/ cartilaginous cap
-Along metaphysis
-Malignant transformation is rare
Osteochondroma
(Exotosis)
What's The Pathology:

-Malig tumor
-2nd MC primary malig bone tumor (after malignant myeloma)

-Hx of paget's dz of bone, bone infarcts, radiation, familial retinoblastoma

-CODMAN'S TRIANGLE or SUBURST PATTERN from elevation of periosteum on x-ray
Osteosarcoma
(osteogenic sarcoma)
What's The Pathology:

-Malignant bone tumor
-boys < 15 y/o
-"Onion skinning" of bone
-"Blue cell" Malignant tumor
-11;22 translocation
-Long bones, pelvis, scap, ribs
Ewing's Sarcoma
What's The Pathology:

-Malig Bone Tumor
-Men 30-60 y/o
-May be of primary origin or from osteochondroma
Chondrosarcoma
What's The Pathology:

-Wear and tear of joints -->
Destruction of articular cartialge
-Osteophytes (bone spurs)
-Eburnation (polished, ivory appearance of bone)
-Herenden's Nodes (DIP)
-Bouchard's Nodes (PIP

-Pain after use (like wt-bearing) but no pain w/ rest
Osteoarthritis
What's The Pathology:

-Synovial joints w/ pannus formation
-Sub-Q rheumatoid nodules
-Ulnar deviation
-Baker's cyst behind knee
-TIII hypersensitivity
-anti-IgG
-anti-CCP
-HLA-DR4
-AM stiffness
-Improves w/ use
-Symmetric
Rheumatoid Arthritis
Tx of Rheumatoid Arthritis
NSAIDs
COX-2 Inhibs
Glucocorts
DMARDS (MTX, Sulfasalazine, Hydroxychloroquine)
What's The Pathology:

-Xerophthalmia (dry eyes)
-Xerostomia (dry mouth)
-Arthritis
-anti SSA (anti-RO)
-angi SSB (anti-LA)
Sjogren's Syndrome
What's The Pathology:

-Monosodium urate crystals
-Needle shaped crystals that are negatively bifringent
-Hyperuricemia
-Podagra (involvement of big toe)
-Worse after ETHOL ingestion
Gout
Acute Gout Tx?

Chronic Gout Tx?
NSAIDS, Colchicene

Allopurinol, Febuxostat, Uricosurics
(probenecid)
What's The Pathology:

-Ca pyrophosphate crystals
-Rhomboid crystals that are weakly bifringent
-Large joints
-Pseudogout
Gout or pseudogout:

1) crystals are yellow hwne parallel and blue when perpendicular to light

2) Crystals are yellow when perpendicular and blue when paralell to light
1) Gout

2) Pseudogout
3 IA in infectious arthritis?
s. aureus
Streptococcus
Neisseria gonorrhoeae
What's The Pathology:

-Jt pain and stiffness
-Pencil in cup deformity
-Dactylitis "sausage fingers"
-Derm involvement
Psoriatic arthritis
What's The Pathology:

-Conjunctivitis or anterior uveitis
-Urethritis
-Arthritis
Reiter's Arthritis
(Reactive Arthritis)

"Can't see, can't pee, can't climb a tree"
Give all the aspects of SLE in
"I'M DAMN SHARP"
-Ig (anti-dsDNA, anti-Sm, anti-Phospholipid, anti-histone if Rx induced)
-Malar Rash
-Discoid rash
-ANA
-Mucositis (oropharyngeal ulcers)
-Neurologic disorders
-Serositis (pleuritis, pericarditis)
-Hematologic disorders
-Arthritis
-Renal disorders (Wire loop lesions in kidney w/ immune complex deposition)
-Photosenstivity
What's The Pathology:

-Immune mediated
-Non-casseating granulomas
-Inc ACE
-Black females
-Restrictive lung dz
Sarcoidosis
Tx of sarcodosis?
Steroids
What's The Pathology:
-Pain and stiffness in shoulders and hips
-Pts > 50
-Temporal (giant cell) arteritis
-Inc ESR, Normal CK
-Polymyalgia rheumatica
Tx of polymyalgia rheumatica?
Prednisone
What's The Pathology:

-Widespread musculoskeletal pain
-11 > 18 TPs
Fibromyalgia
Tx of Fibromyalgia?
Pregabalin
Milnacipran
Amytriptylinne
Low dose fluoxetine
What's The Pathology:

-Symmetric proximal muscle weakness pof shoulders and pelvis
-Mediated by CD8 T-cells injuring myofibers
Polymyositis
What's The Pathology:

-Similar to polymyositis but also involves malar rash, Heliotrope rash, "shawl and face" rash and "mechanic's hands"
Dermatomyositis
Both polymyositis and Dermatomyositis are positive for what Ab?
ANA
anti-JO1
Tx?
Steroids
What's The Pathology:

-Auto Ab against POST-SYNAPTIC AChR -->
Ptosis, Diplopia, General Weakness

-Assoc w/ thymoma
-Sx WORSEN w/ muscle use
-Sx reverse w/ AChE Inhibs
Myasthenia Gravis
What's The Pathology:

Auto-Ab against pre-synaptic Ca chann -->
Dec ACh release -->
Prox muscle weak

-Assoc w/ small cell lung CA

-Sx improve w/ muscle use

-Sx NO improve w/ AChE Inhibs
Lambert-Eaton Syndrome
What's The Pathology:

-Fibrosis and collagen deposition throughout the body
-Puffy taut Skin
-No wrinkles

-Widespread skin involvement
-Rapid progression
-Early visceral involvement
-anti-SCL 70 Ab
Diffuse Scleroderma
What's The Pathology:

-Fibrosis and collagen deposition throughout the body
-Puffy taut Skin
-No wrinkles

-Calcinosis
-Raynauds
Esophageal Dysmotility
-Sclerodactyly
-Telangiectasias
-Anti-Centromere Ab
CREST Scleroderma
What type of hypersensitivity is Allergic Contact Dermatitis?
Type IV Hypersensitivity
What's The Pathology:
-Papules and plaques w/ silvery scaling
-Acanthossi w/ parakeratotic scaling
-Inc stratum spinosum
-Dec stratum granulosum
-Positive Auspitz sign (bleeding when scales are scraped off)
-Nail pitting and arthritis
Psoriasis
What's The Pathology:

-Flat, greasy, pigmented squamous epi proliferation w/ keratin-filled cysts

-Looks "pasted on"
Seborrheic keratosis
What's The Pathology:

-Honey crusted lesion
-s. aureus
-s. pyogenes
Impetigo
What's The Pathology:

-Acute, painful spreading infection of dermis and sub-q tissues
-s. aureus
-s. pyogenes
Cellulitis
What's The Pathology:

-White, painless plaques on side of tongue
-CANNOT be scraped off
-Oral hairy leukoplakia
-EBV
What's The Pathology:

-IgG against DESMOSOMES
-Immunofluorescence reveals Ab around cells of epidermis in reticular or net-like pattern
-Intraepidermal bullae w/ flaccid blister
-POSITIVE NIKOLSKY SIGN (Separation of epidermis upon manual stroking of skin)
Pemphigus vulgaris
What's The Pathology:

-IgG Ab against HEMIDESMOSOMES
-Ab are "bullow" the epidermis
-NEGATIVE NIKOLSKY SIGN
Bullous Pemphigoid
What's The Pathology:

-IgA @ tips of dermal papillae
-Celiac's Dz
Dermatitis Herpetiformis
What's The Pathology:

-Mycoplasma pneumonia
-HSV
-Macules, Papules, Vesicles, Target Lesions
Erythema Multiforme
What's The Pathology:

-Fever
-Bulla formation
-Necrosis
-Skin sloughing
-High mortality rate
SJS
A more severe form of SJS is known as
Toxic Epidermal necrosis
What's The Pathology:

-Pruritic, Purple, Polygonal Papules

-Hep C
Lichen Planus
What's The Pathology:

-Premalignant Lesions caused by sun exposure
-Risk of carcinoma is proportional to epithelial dysplasia
-Actinic Keratosis
What's The Pathology:

-Hyperplasia of stratum spinosum
-Hyperinsulinemia from Cushings or DM
-Visceral malignancy
Acanthosis nigricans
What's The Pathology:

-Inflamm of sub-q fat
-Anterior shins
-Coccidiomycosis
-Histoplasmosis
-TB
-Leprosy
-Streptococcal Infxn
-Sarcoidosis
Erythema Nodosum
What's The Pathology:

-"Herald Patch"
-"Christmas Tree" Distribution
-Remits spontaneously
Pityriasis rosea
What's The Pathology:

-excessive sunlight exposure
-Rarely mets
-Keratin Pearls
Sq Cell Carcinoma
What's The Pathology:

-Sun exposure
-Rolled edges
-Central ulceration
-Pearly papules
-Telangiectasias
-"Palisading Nuclei"
Basal Cell Carcinoma
What's The Pathology:

-S-100 tumor marker
-ABCD
Assymetrical
Irregular Border
Color Varation
Diameter > 6 mm
Melanoma
NEUROLOGY
NEUROLOGY
Myelinates MULTIPLE the CNS Axons
Oligodendrocytes
Myelinates ONE PNS Axon
Schwann Cell
Destroyed in MS?

Destroyed in Guillain-Barre
Oligodendrocytes

Schwann Cells
Acoustic neuroma is composed of this type of cell
Schwann cell
NTs of anxiety?
Inc NE
Dec GABA
Dec 5-HT
NTs in Parkinsons
Dec Dopamine
NTs in schizophrenia
Inc Dopamine
NTs in alzheimer's
Dec ACh
NTs in Huntington's
Dec ACh
Dec GABA
Feeding, Fleeing, Fighting, Feeling and Fucking = What part of brain
Limbic System
These structures in the brain:

-Regulate the AMT of mvt -->
Hyperkinesis or Hypokinesis
-Regulate voluntary mvts and postural adjustments
Basal Ganglia
What are the 3 components of the basal ganglia you should know, and what are their effects on mvt?
Thalamus VA and VL nucleus:
Stim mvt

SNPC:
Stim mvt

Subthalamic Nucleus:
Inhibs Mvt
The direct pathway uses what NT and has what effect on mvt?

The indirect pathway has what effect on mvT?
D1; Stims mvt

Inhibs Mvt
1) Is parkinsons a hyper or hypokinetic mvt disorder?
A) TF you probably have a problem w/ what?

2) Pathological finding?

3) TRAP s/s of parkinson's?
"TRAPped inside your own body"
1) Hypokinetic
A) Dopaminergic neurons of the SNPC of the Direct pathway

2) Lewy Bodies

3) Tremor @ rest
Cogwheel rigidity
Akinesia
Postural Instability
Hemiballimus is wild flailing of 1 arm or leg and is the result of a lesion to what basal ganglia?
CL subthalamic nucleus

(remember, Subthalamic nucleus inhibs mvt)
HUNTINGTON's:

1) 2 meanings of CAG for Huntington's

2) 2 s/s?

3) Neuronal death occurs via binding to what receptor?
1) CAG repeat in DNA
Caudate loses ACh and GABA

2) dementia & Chorea

3) NMDA-Receptor
Sudden, jerky, purposeless mvts
Chorea
Slow, writhing mvts of fingers especially
Athetosis
Sudden, brief, muscle contractions
Myoclonus
Tremor when holding a posture

Tx?
Essential / postural tremor

Pts self-mediate w/ ETHOL
beta-blockers
Distal tremor

Ex seen in parkinsons?
Resting tremor

pill-rolling tremor
Where's the Brain Lesion:

-Kluver-Bucy Syndrome
(Hyperorality,Hypersexuality, Disinhibited Behavior)
Amygdala
Where's the Brain Lesion:

-Poor judgment
-Disinhibited (dirty jokes)
-Poor judgment
-Poor logic
Frontal Lobe
Spatial Neglect
Non Dom (usually R) Parietal Lobe
Dec levels of arousal and wakefulness
RAS (midbrain)
Wernicke-korsakoff

Wernicke:
Confusion, Ophthalmoplegia, Ataxia

Korsakoff:
Memory Loss, Confabulation, Personality Changes
Mammillary Bodies
Tremor @ rest, chorea, athetosis
Basal Ganglia
INTENTION TREMOR,
LIMB Ataxia,
Fall TOWARD side of lesion
Cerebellar hemisphere
TRUNCAL Ataxia,
Dysarthria
Cerebellar vermis
CL Hemibalismus
Sub-thal nucleus
Anterograde amnesia
(can't make new memories)
Hippocampus
Eyes look away from lesion
PPRF
Eyes look toward lesion
Frontal eye fields
Paralysis
Dysarthria
Dysphagia
Diplopia
LOC
RAPID CORRECTION OF HYPONATREMIA
Central Pontine Myelinolysis
Can't move mouth to speak
CAN understand / comprehend

(Non-fluent aphasia w/ intact comprehension)
Broca's aphasia
(inferior frontal gyrus)

"Broca's Broken Boca"
Can move mouth
Sentences don't make sense

(Fluent Aphasia)
Wernicke's Aphasia
(Sup Temp Gyrus)

"Wernicke's is wordy but doesn't make sense)
Broca's Aphasia
+
Wernicke's Aphasia
Global Aphasia
Poor repetition of words but fluent speech
Conduction aphasia
(Arcuate Fasciculus)
LABEL COW IN DIT 13
LABEL COW IN DIT 13
Which art of COW:

CL Upper UE & Face Motor Cortex
CL UE & Face Sensory Cortex
Wernicke's and Broca's Areas
MCA
CL LE Motor Cortex
CL LE Sensory Cortex
ACA
(Anterior Communicating Artery)
CL Hemianopsia w/ Macular sparing bc supplies occipital cortex and visual cortex
PCA
(Posterior Cerebral Artery)
MC site of berry aneurysm?
Bifurcation of COW
MC site in COW for Berry aneurysm?

***NOTE: BA assoc w/ ADPKD, EDS, Marfan's Syndrome***
Anterior communicating artery
What type of Intra-cranial Hemorrhage:

-Ruptured Middle Meningeal Art
-LUCID INTERVAL
-Fx'ed temporal bone
-CN III Palsy (eye down and out)
-CT: Biconcave disc not crossing suture lines
-Epidural Hematoma
What type IC Hemorrhage:

-Ruptured bridging veins
-Crescent Shaped hemorrhage that crosses suture lines
-Old, ETHOL-ics, Blunt Trauma, Shaken Baby
Subdural Hematoma
What type IC Hemorrhage:

-Ruptured Aneurysm or AVM
-WORST HA OF LIFE
-Bloody or yellow spinal tap
-Tx w/ nimodipine
Sub-Arachnoid Hemorrhage
What type IC Hemorrhage:

-Systemic HTN, Amyloid Angiopathy, Vasculitis, Neoplasm
-In basal ganglia and internal capsule
Intraparenchymal (HTNsive) Hemorrhage
What type hydrocephalus:

"Wet, Wobbly, Wacky"
Incontinence, Ataxia, Dementia
Normal pressure hydrocephalus
What type hydrocephalus:

Dec CSF absorption by arachnoid villi -->
Inc IC Pressure, Papilledema and herniation -->
Compression of III -->
Dilated pupil that's down and out
Communicating hydrocephalus
What type hydrocephalus:

-Inc CSF in atrophy
(Alzheimer's, advanced HIV, Pick's Dz)
Hydrocephalus ex vacuo
Give the AFFERENT pathway of the:
Dorsal Columns
(Medial Lemnicus)

FOR

Pressure,
Vibration,
Touch,
Proprioception
Sensory Nerve Ending -->
DRG -->
Ips SC Dorsal Column -->

Nucleus Cuneatus
(Upper Body except face)
Nucleus Gracilis
(lower body)
-->
Decussate in Medulla -->

VPL Nucleus of Thalamus -->

Sensory Cortex
Give the AFF pathway of the:

Spinothalamic Tract for:
Pain and Temp
Sensory Nerve Ending -->
DRG -->

Ips Gray Matter of SC -->

DECUSSATES @ ANT White COMMISSURE-->

VPL of Thalamus -->

Sensory Cortex
Give the EFF pathway of the:

Lat Corticospinal Tract for:
descending voluntary mvt of CL limbs
UMN in primary motor cortex -->

Internal Capsule -->

DECUSSATES @ caudal medulla -->

LMN @ ant horn-->

NMJ
Syringomyelia is damage to anterior white commisure of spinothalamic tract -->
BL loss of what?
Pain and temp
Tabes Dorsalis (Tertiary Syphilis) will lead to loss of what part of SC?
Dorsal columns
(FG, FC)
Poliocirus does damage to what part of SC?
Ant horn (LMN)
What's the Pathology:

-UMN and LMN signs
-Defect in superoxide dismutase I
-Fasciculations and eventual atrophy
-Riluzole tx lengthens survival by decreasing presynaptic glutamate release
ALS (Lou Gehrig's Dz)
What's the Pathology:

-Degeneration of dorsal columns
-Tertiary syphilis
-Charcot joints
-Argyll Robertson Pupil
-Dec DTRs
- Pos Romberg
-Sensory ataxis @ night
Tabes Dorsalis
What's the Pathology:

-GAA Repeat that encodes FRATAXIN
-Staggering gait
-Nystagmus
-Dysarthria
-Pes Cavus
-hammer Toes
-Hypertrophic Cardiomyopathy!!
-In kids presents as kyphoscoliosis
Friederich's Ataxia
Hemisection of SC -->

-Ips UMN signs below lesion
-Ips loss of tactile, vibration, proprioception below lesion
-CL pain and temp loss below lesion
-Ips loss of sensation @ level of lesion
-LMN signs @ leel of lesion

-Horner's if above T1
Brown-Sequard Syndrome
Horner's syndrome has what 3 components

3 Lesions of SC above T1 -->
Horner's
Ptosis
Anhidrosis (no sweating)
Miosis (pupillary constriction)

Pancoast Tumor
Brown-Sequard
Late Stage Syringomyelia
1) 2 CN from Midbrain

2) 4 CN from Pons

3) 4 CN from Medulla?
1) III, IV

2) V, VI, VII, VIII

3) IX, X, XI, XII
1) 5 Nerves in the cavernous sinus?

2) What artery passes through cavernous sinus?
1) EOM Nerves + 2
IV, VI, III
V1, V2

2) Internal Carotid Artery
REVIEW WEBER AND RINNE TEST
REVIEW WEBER AND RINNE TEST
MCC conductive hearing loss?
Osteosclerosis:
Overgrowth of inner ear bones (MES) -->
Loss of stapedial reflex
Where's the Lesion:

1) CL paralysis of Lower face ONLY

2) Ips paralysis of upper AND lower face

3) Destruction of facial nucleus or facial nerve -->
Paralysis of ips Upper AND Lower Face
1) UMN Motor Cortex lesion
(Upper face receives BL Innervation from cortex)

2) LMN Lesion

3) Bell's Palsy
6 things --> Bell's Palsy?
ALexanmder graHam Bell had an STD

Aids
Lyme's Dz
Herpes Simplex
Sarcoidosis
Tumors
Diabetes
muscles of mastication:

1) 3 that close jaw

2) 1 that opens?

3) all are innervated by what nerve?
1) Masseter
teMporalis
Medial pterygoid

2) Lateral pterygoid

3) V3
What's the pathology:

Impaired flow of aqueous humor -->
Inc Intraocular pressure -->
Optic disk atrophy w/ cupping
Glaucoma
What's the pathology:

Obstructed outflow of canal of schlemm
Open / wide angle glaucoma
What's the pathology:

Obstruction of flow b/t iris and lens, painful
Closed / narrow angle glaucoma
What's the pathology:

Inc Intracranial pressure -->
Optic disc w/ blurred margins that can be seen in hydrocephalus
papilledema
Which CN is damaged:

-Eye down & out
-Ptosis
-Pupil dilation
-No accomodation
CN III
Which CN is damaged:

-Eye drifts upward -->
Vertical diploplia
(hard to read newsspaper or go downstairs)
CN IV
Which CN is damaged:

Medially directed eye
CN VI
1) What part of CN III CTLs extraocular muscles

2) What part of CN III is involved in FX on eye?

3) What part is messed up if you have a "blown" dilated pupil
1) Outer

2) Inner

3) Inner
Separation of neurosensory layer of retina from pigmented epithelium of retina?
Retinal detachment
What's the pathology:

-Degeneration of macula -->
loss of central vision (scotoma)
ARMD
(Age related macular degeneration)
ARMD that is slow and due to fat deposits -->
gradual loss of vision
Dry ARMD
ARMD that is rapid and due to neovascularization
Wet ARMD
Describe what happens in Intranuclear Ophthalmoplegia
(MLF Syndrome)
Lesion of MLF -->
Medial rectus palsy
TF

On attempted Lat Gaze:
-No abduction of CL eye
-Nystagmus in Adducting eye
INO seen in what pts
MS pts
Name that dementia:

-Elderly
-dec ACh
-Senile plaques composed of EXTRACELLULAR beta-amyloid
-INTRACELLULAR NF Tangles
Alzheimer's
Tx for Alzheimer's:
AChesterase Inhiba:
Donepezil
Galantamine
Rivastigmine

Memantine
Name that dementia:

-Change in perosnality
-poor social conduct
-crass
Pick's Dz
(Frontotemporal Dementia)
Name that dementia:

-Parkinsonism w/ dementia and hallucinations
-Falls
-Syncope
Lewy Body Dementia
-AI inflamm and demyeliation of CNS
-Optic Neuritis
-MLF Syndrome (intranuclear ophthalmoplegia)
-Bowel / Bladder incontinence

-Ing PRO (IgG) in CSF
-Oligoclonal bands are Diagnostic
-MRI ---> Periventricular plaques

MS in a SIN
Scanning speech
Intention Tremor, Ingontinence, INO
Nystagmus
MS
Tx of MS
beta-IFN
Immunosuppression
Natalizumab

Sx:
Neurogenic bladder:
Catherization, Muscarinic Antag

Spasticity:
Baclofen, GABA agonist

Pain: Opioids
-Inflamm and demyelination of PNS and motor fibers

-Ascending muscle weakness
-Autonomic fnctns (CV, b/b) may also be effected

-Inc CSF PRO w/ normal cell count
-Papilledema

-Infxn w/ Campylobacter jejuni or herpes -->
molecular mimicry -->
AI attack

-Tx Plasmapheresis
IVIg
Guillain Barre
(Acute Inflamm demyelinating polyradiculopathy)
What demyelinating dz:

Demyelination from destruction of oligodendrocytes
PML
Demyelination after infxn (cx pox or measles) or after certain vaccs
Acute disseminated encephalomyelitis
2 other demyelinating dz'es, don't think impt

FA 466
2 other demyelinating dz'es, don't think impt

FA 466
What type of seizure:

1) 1 area of the brain effected?

2) Multiple, diffuse areas of brain effected?

3) Partial seizure w/ consciousness intact?

4) Partial seziure w/ impaired consciousness?

5) Blank stare?

6) Quick, repetitive jerks

7) Alternating stiffening and mvt

8) Stiffening

9) Drop seizure (fall to floor)
1) Partial seizure

2) Genrealized seizure

3) Simple Partial Seizure

4) Complex partial seizure

5) Absence Petit mal

6) Myoclonic

7) Tonic - Clonic (grand mal)

8) Tonic

9) Atonic
Name that HA:

1) UL
Pulsating pain
Nausea
Photophobia
Phonophobia
w/ or w/out aura

2) Tx for migraines?
1) Migraine

2) propranolol, NSAIDs, sumatriptan
BL HA
not aggravated by light or noise
no aura
Tension
UL behind eye or periorbital
lacrimation
rhinorrhea
horner's syndrome
Cluster HA
tx for cluster HA
O2
Sumatriptan
-Port wine stain (nevus flemmus) in V1 distribution
-Pheochromocytom
Sturge Weber
HAMARTOMAS

Hamatomas in CNS and Skin
Adenoma Sebaceum
Mitral Regurg
Ash-leaf spots
cardiac Rhabdo (Tuberous Sclerosis)
autOsomal dom
Mental retard
renal Angiomyolipoma
Seizures
Tuberous Sclerosis
-Cafe-au-lait spots
-Mutated NF-1 gene on Ch. 17
NF1
-Cavernous Hemangiomas in skin
-BL renal cell carcinoma
-Mutated tumor suppressor VHL on chromosome 3
von Hippel-Lindau dz
4 MC causes of brain tumors in order of prevalence
Mets
Gliobastoma Multiforme
Meningioma
Schwanoma
Name that adult PRIMARY brain tumor:

-MC primary brain tumor
-grave prognosis
-Stain astrocytes
-"PSEUDOPALASADING" tumor cells
Glioblastoma
Brain tumor w/ psammoma bodies
Meningioma
-Found in NF2
-Localized to CN VIII -->
acoustic _____
-S100 positive
Schwannoma
Name that adult PRIMARY brain tumor:

-Fried egg cells w/ clear cytoplasm (look like koilocytes)
Oligodendroglioma
Name that adult PRIMARY brain tumor:
-Usually a prolactinoma
-Bitemporal heminaopia
-Rathke's pouch
Pituitary adenoma
Name that Childhood brain tumor:

-Posterior fossa
-Rosenthal Fibers - eosinophilic, corkscrew fibers
Astrocytoma
Name that Childhood brain tumor:

-Compresses 4th Vent

-Rosettes or perivascular pseudorosette pattern
Medulloblastoma
Name that Childhood brain tumor:

-Found in and compress 4th ventricle
-Perivascular pseudorosettes
-Ependymoma
Name that Childhood brain tumor:

-Cerebellar tumors
-assoc w/ von Hippel-Lindau syndrome
-Make EPO -->
Secondary polycythemia
Hemangioblastoma
Name that Childhood brain tumor:

-Bitemporal hemianopia
-Supratentorial
-Rathke's pouch
Craniopharyngioma
3 Tx for ADHD?
Methylphenidate (Ritalin)
Amphetamiens (Dexedrine)
Atomoxetine (nonstimulant SNRI)
What type of childhood disorder:
-Repetitive and pervasive behavior violating social norms
(Physical aggresssion, destruction of property)

-After age 18 it's called antisocial personality disorder
Conduct disorder
What type of childhood disorder:

-Hostile, defiant behavior toward authority figures BUT DOES NOT violate social norms
Oppositional defiant disorder
Tx for tourettes?
antipsychotics (haloperidol)
Overwhelming fear of separation from home or an attachment figure
separation anxiety disorder
-Impaired Social Skills
-Impaired intelligence

-More focus on objects than ppl
-Repetitive behavior
Autism
-No social skillls
-NORMAL intelligence
Asberger's

(less serious form of autism)
handwringing
rett's disorder
Give NT prob assoc following:

Anxiety
Inc NE
Dec GABA
Dec 5-HT
Give NT prob assoc following:

Depression
Dec NE
Dec 5-HT
Dec Dopamine
Give NT prob assoc following:

Alzheimer's
Dec ACh
Give NT prob assoc following:

Huntington's
Dec GABA
Dec ACh
Inc Dopamine
Give NT prob assoc following:

Schizophrenia
Inc dopamine
Give NT prob assoc following:

Parkinson's
Dec Dopamine
Inc Serotonin
Inc ACh
What's the Pathology:

-Req's 2 of the following:
*Delusions
*Hallucinations (often auditory)
*Disorganized speech (loose associations)
*Disorganized or catatonic behavior
*Negative Sx:
flat affect, social withdrawal, lack of motivation, lack of speech or thought


-5 Subtypes
*Paranoid (delusions)
*Disorganized (w/ regard to speech, behavior, affect)
*Catatonic
*Undifferentiated
*Residual
Schizophrenia
What type of Schizophrenia:

1) < 1 month?

2) 1-6 mos

3) @ least 2 weeks of stable moood w/ psychotic sx + a major depressive, manir episode
1) Brief psychotic disorder

2) Schizophreniform disorder

3) Schizoaffective disorder
Fixed, persistent NONBIZARRE belief
(non-bizarre = it could happen, but it's not)
Delusional disorder
Give the mnemonic for Major Depressive disorder: need 5/9 for 2 wks
SIG E CAPS D

Sleep disturbance
loss of Interest
Guilty feelings or feelings of worthlessness
loss of Energy
loss of Concentration
Appetite / wt changes
Psychomotor retardation or agittaion
Suicidal ideations
Depressions mood or anhedonia (don't enjoy things anymore)
What type personality disorder:

suspicious
Paranoid
What type personality disorder:

Social withdrawal, content in isolation
Schizoid
What type personality disorder:

strange
Magical thinking
"Dressed like a pickle"
Schizotypal
What type personality disorder:

Violation of rights of others

no remorse
antisocial
What type personality disorder:

Unstable mood and interpersonal relationships
Self mutilation
Borderline
What type personality disorder:


Excessively emotion and excitable

Attention seeking
Histrionic
What type personality disorder:

Entitlement
Lacks empathy
Reacts to criticism w/ rate
Narcissistic
What type personality disorder:

Hypersensitive to rejection
Feels inadequate
Desires relationship
Avoidant
What type personality disorder:

obsessed w/ order, perfection and CTL
Obsessive compulsve
What type personality disorder:

Submissive and clingy
Needs to be taken care of
Dependent
What't substance is being abused and give tx if you can:

1) Inc GGT
AST > ALT

2) CNS Depression
Pupil constriction (pinpoint pupils)
Seizures

3) Marked resp depression

4) tx for benzo OD?

5) Pupil dilation

6) Pupil dilation w/ angina and Sudden Cardiac Death

7) Belligerent
agitation
Homicidal

8) Flashbacks
pupil dilation
1) ETHOL

2) Opioids (morphine, heroin, methadone)
tx: naloxone, naltrexone

3) Barbituates

4) Flumazenil

5) Amphetamines

6) Cocaine
TX: Benzos

7) PCP

8) LSD
What drug:

Euphoria
Inc appetite
Conjunctival injection
Marijuana
1) Caused by thiamine deficiency in ETHOLics

2) Triad of confusion, ophthalmoplegia and ataxia

3) Memory loss, confabulation, personality change
1) Wernicke-Korsakoff

2) Wernicke's Encephalopathy

3) Korsakoff psychosis
LOOK @ YOUR CUT OUT IN 1st AID P. 507 FOR DRUGS EFFECTING AFF AND EFF ARTERIOLE
LOOK @ YOUR CUT OUT IN 1st AID P. 507 FOR DRUGS EFFECTING AFF AND EFF ARTERIOLE
NOTE:

1) NephrItic Syndrome: Inflammation -->
Hematuria, RBC casts,
< 3.5 g PRO in urine / day

2) nephrOtic syndrome:
Fatty casts,
Edema bc > 3.5 g PRO in urine / day
NOTE:

1) NephrItic Syndrome: Inflammation -->
Hematuria, RBC casts,
< 3.5 g PRO in urine / day

2) nephrOtic syndrome:
Fatty casts,
Edema bc > 3.5 g PRO in urine / day
What type of Nephritic Syndrome:

-Enlarged, Hypercellular glomeruli
- "lumpy - bumpy" appearance
-Immune complex humps from IgG, IgM and C3 deposition along GBM and Mesangium

-Peripheral and periorbital edema
-Dark Urine
Acute Post-streptococcal glomerulonephritis
What type of Nephritic Syndrome:

-Result of goodpastures, Wegener's, Microscopic poyangitis

-Cresenct shaped depositis
Rapidly progressive glomerulonephritis
What type of Nephritic Syndrome:

-Wire looping of capps
-IgG based IC
-Result of SLE of MPGN
Diffuse proliferative glomerulonephritis
What type of Nephritic Syndrome:

-Related to Henoch-Shoenlein purpura
-IgA IC in mesangium
Berger's Dz (IgA Nephropathy)
What type of Nephrotic Syndrome:

-Segmental sclerosis and hyalinosis
-HIV
Focal segmental glomerulonephritis
What type of Nephrotic Syndrome:

-Spike and Dome
-SLE
-Adults
Membranous Glomerulonephritis
What type of Nephrotic Syndrome:

-Normal Glomeruli
-Foot process effacement
-Infxn
-Corticosteroids
MinimalChange Dz
What type of Nephrotic Syndrome:

-Congo red stain
-Apple green birefringerence
-Chronic Cond'ns: Multiple Myeloma, TB, RA
Amyloidosis
What type of Nephrotic Syndrome:

-"Tram Track:" appearance of GBM (type I)
-HBV, HCV (Type II)
-C3 Nephritic Factor (Type II)
Membranoproliferative glomerulonephritis
What type of Nephrotic Syndrome:

-Nonenzymatic glycosylation of GBM -->
Inc permeability and thickening

-NEG oif efferent arts --> Inc GFR

-Mesangial expansion +
Eosinophilic nodular glomerulosclerosis +
GBM thickening
= what?
-
Diabetic Nephropathy
-Kidney stone assoc w/ urease positive organisms (proteus mirabilis, Klebsiella, etc)

-Staghorn calculi
Ammonium Magnesium Phosphate Stone
CA assoc w/ Inc paraneoplastic production of EPO, ACTH, PRHrP
Renal Cell Carcinoma
-MC renal malignancy of early childhood

-Deletion of tumor supressor WT1
Wilms Tumor
-MC tumor of urinary tract system
-Painless hematuria
Transitional Cell carcinoma
-Acutely: CVA tenderness
-Chronically: White cell casts
Pyelonephritis
What's the pathology:

-Multiple large, BL Cysts on kidneys
-AD mutation in PKD1
-Assoc w/ polycystic liver dz, berry aneurysms, mitral valve prolapse
ADPKD
(Aut Dom PKD)
REPRODUCTIVE

-See Text
REPRODUCTIVE

-See Text
RESPIRATORY

-see text
RESPIRATORY

-see text