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177 Cards in this Set
- Front
- Back
Right sided heart murmurs increase on
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inspiration
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left sided increase on
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expiration
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Diastolic ARMS
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aortic regurgitation and mitral stenosis
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Vibrio cholera
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gram-neg, pxidase=pos curved rod with polar flagella
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E. coli is a
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lactose fermenting rod
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Salmonella is
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motile rod that doesn’t ferment lactose
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Shigella is a
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non-motile rod that doesn’t ferment lactose
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Pseudomonas is an
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oxidase positive rod that doesn’t ferment
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Myotonic dystrophy
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CTG tri-nucleotide repeat expansion; anticipation due to instability during maternal meiosis; autosomal dominant
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Huntington
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CAG repeat due to instability during paternal meiosis
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Friedrich’s ataxia has
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GAA occurring during both paternal/maternal meiosis
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Brown-Sequard syndrome(hemisection of spinal cord)
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ipsilateral loss of touch, vibration, and proprioception below lesion and contralateral loss of pain/temperature and ipsilateral paralysis below lesion
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First line treatment for gonorrhea is
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ceftriaxone
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First line treatment for chlamydia is
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azithromycin or doxycycline
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Mobitz type II, a form of second degree AV heart block, is defined by
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dropped QRS complexes without a change in PR interval. Associated with previous septal MI or fibrotic disease of cardiac conduction system and generally prevents with syncope
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Pygmalion effect refers to
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phenomenon of groups altering their outcomes in order to meet external expectations
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Hawthorne effect
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results of study altered by fact that subjects are aware that they are being studied
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Exhalation somatic dysfuntion:
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rib 1=anterior/middle scalene; rib 2=posterior scalene; rib3-5=pec minor; ribs6-9=serratus anterior; ribs 10-12=lat dorsi; rib 12=indirectly quadratus lumborus
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Placenta accrete
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occurs when the placenta attaches to the myometrium, and therefore there is no separation of placenta at birth.
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Abruptio placentae
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occurs when the placenta detaches from the implantation site prior to delivery; extremely painful bleeding in 3rd trimester and death of child
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A large percentage of PE originate
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in the femoral vein
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Acidosis shifts the oxy-Hb curve
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to the right
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Subacute thyroiditis
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De Quervain disease; self-limiting hypothyroidism that is typically seen following a viral, flu-like illness
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Cretinism is
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hypothyroidism in kids mostly due to dietary iodine deficiency; pale, puffy faces, protuberant tongue, and potbellied; also mental retardation and stunted growth
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Riedel thyroiditis is
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fibrous tissue replacement of thyroid gland leading to hypothyroidism; fixed, rock-hard, painless goiter
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Ruptured aortic aneurysm
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sudden onset back/flank pain, pulsatile mass, and hypotension; thoracic aneurysms may reveal hoarseness due to compression of L vagus or L recurrent laryngeal nerve
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Pyridoxine (vit B6) deficiency:
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stomatitis, glossitis, cheilosis, irratibility, confusion, and depression; inflammation and fissuring of lips, cheilosis at corners of mouth, atrophy of tongue mucosa, seborrheic dermatitis; cofactor in pyridoxal phosphate mediated enzymatic rxns. Leads to elevated homocysteine; polyneuropathy in adults; required for heme synthesis (coenzyme for ALA synthase)=microcytic, hypochromatic anemia with basophilic stippling
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Riboflavin (B2) deficiency
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cheilosis, angular stomatitis, and glossitis (cracked red lips and inflammation of lining of mouth and tongue, mouth ulcers, sore throat);
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Von Willebrand’s disease
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autosomal dominant in vWF (carrier protein for factor VIII) leads to prolonged PTT and prolonged bleeding time; treated with desmopressin to release stored vWF within endothelium
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Prolonged PTT
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hemophilia (X-linked)
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Prolonged PT
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liver disease and warfarin therapy
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Prolonged bleeding time, PT, and PTT cause
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DIC
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Iron is absorbed in the
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duodenum
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folate is absorbed in the
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jejunum
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B12 is absorbed in the
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ileum
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Fanconi’s syndrome
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(can be due to degraded tetracycline ingestion-accumulate in PCT)=disorder of proximal tubule fxn that results in severe loss of proteins, glucose, essential minerals (like Ca2+ and Mg2+)
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MAC value
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minimum PP in which 50% patients are non-responsive to surgical incision; potency inversely proportional to MAC
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CA 19-9 can be found in 71-73% of
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pancreatic cancers
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CA-125 is elevated in over 80% of
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ovarian cancers
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p-ANCA (perinuclear antineutrophil cytoplasmic antibodies)
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moniter microscopic polyangitis; an autoimmune vasculitis of small-sized arteries
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c-ANCA (cytoplasmic-staining ACA)
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monitor Wegener’s granulomatosis; triad of focal necrotizing vasculitis, necrotizing granulomas in lung and upper airway, and necrotizing glomerulonephritis
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Aspirin is contraindicated in
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gout-both aspirin and uric acid compete at renal trasporters resulting in higher serum levels of uric acid; other things that compete at the same transporter=sulfomamide antibiotics, probenecid, penicillin, and thiazide diuretics
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Tay-Sachs
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deficiency of hexosaminidase A leading to accumulation of GM2 ganglioside within CNS; Lose hearing and vision early, followed by paralysis, death often by 3 years; cherry-red spot on macula (also seen in Niemann-Pick)
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Niemann-Pick
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sphingomyelinase deficiency; cherry-red spot in macula; presents with anemia, fever, neurologic deterioration; also hepatosplenomegaly, lymphadenopathy, and bone marrow suppression
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Gaucher disease
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B-glucocerebrosidase deficiency; hepatospenomegaly, aseptic necrosis of femur, bone crises, and accumulation of glucocerebroside
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Fabry disease
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alpha-galactodisase A deficiency; X-linked; peripheral neuropathy of extremities, angiokeratomase, renal problems, and cardiovascular disease
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Trigeminal neuralgia treatment
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carbamazepine, anti-seizure med that inhibits voltage-gated Na+ channels
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Hereditary hemochromatosis
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autosomal recessive; pigmented skin, diabetes, cirrhosis of the liver; transferrin saturation increased
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Acetazolamide
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carbonic anhydrase inhibitor that works in the proximal convoluted tubule; SE=metabolic acidosis
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Hydrochlorothiazide
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diuretic works in convoluted tubule, inhibits Na/Cl co—transporter decreasing their reabsorption, indirectly increasing K and Ca reabsorption
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Nortriptyline
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inhibits reuptake of norepi; affectst locus coeruleus in pons
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Caudate contains
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GABAergic and cholinergic (excitatory) neurons; dysfxn in huntington’s
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Raphe nuclei neurotransmitter
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serotonergic
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Substantia nigra neurotransmitter
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D1 pars compacta excitatory; D2 pars reticulate inhibitory
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Seborrheic dermatitis
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greasy scales on erythematous base; scalp in neonates (cradle cap)
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Atopic dermatitis causes
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intense pruritus; aka eczema
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Hypertensive crisis can be caused by MAOi with additional intake of
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tyrosine
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Malignant hyperthermia can be caused by
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gas anesthetics (halothan, sevoflurane, desflurane) and succinylcholine; autosomal dominant mutation of ryanodine receptor (intracellular Ca channel receptor); treated with dantrolene
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Neuroleptic malignant syndrome
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adverse rxn to antipsychotics; FEVER=fever, encephalopathy, vital signs unstable, elevated CP, rigidity of muscle; treat with dantrolene
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Tardive Dyskinesia
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irreversible due to antipsychotics; increased in 1st-gen; due to up reg of dopamine receptors (short term high dose or long term low dose); choreiform movements in facial region
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Papillary carcinoma
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most common thyroid cancer; nuclei optically clear (orphan annie eyes); good prognosis
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Yersinia Pestis
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nonmotile, pleomorphic, gram-neg, coccobacillus, nonsporulating; 2-8 day incubation; 7-day course doxycycline and ciprofloxacin
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68% fall within 1 standard deviation of mean in
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standard bell curve
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Osteogenesis imperfect type II
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fatal in utero or within first few hours after birth; multiple fractures, blue sclera, short stature
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Synthesis of surfactant is decreased by
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presence of high insulin levels, occurs in gestational diabetes
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Acute-post strep glomerulonephritis
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enlarged hypercellular glomeruli with ‘lumpy bumpy’ appearance; subepithelial immune complex humps; caused by group A beta-hemolytic strep; presentation=edema, hematuria, hypertension, proteinuria, and acute kidney injury
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Membraneous glomerulonephritis
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diffuse capillaries and glomerular BM thickening; seen in SLE, tumors, infections; results in nephrotic syndrome
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Vasoactive intestinal peptide (VIP) elevated in presence of VIPomas
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non-beta islet cell pancreatic tumors that stimulate intestinal water and electrolyte secretion leading to copious diarrhea
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Posterior chapman point for appendix
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transverse process T11
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Sporotrichosis
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lymphocutaneous disease characterized by ulcerating papule at site of inoculation followed by ascending secondary lymphangitits; dimorphic fungus, cigar-shaped yeast; oral itraconazole or amphotericin B if immunocompromised
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Gardnerella vaginalis
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gram variable rod; gray vaginal discharge with fishy odor with KOH prep; clue cells
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Head and neck levels
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T1-4
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heart levels
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T1-5
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Respiratory levels
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T2-7
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esophagus levels
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T2-8
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Upper GI levels
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T5-9
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Middle GI levels
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T10-11
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Lower GI levels
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T12-L2
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Appendix level
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T12
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Kidney/adrenal levels
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T10-11
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bladder levels
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T11-L2
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Uterus levels
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T10-L2
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Prostate levels
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T12-L2
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Rett syndrome
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deletion of MECP2 gene on X chromosome; almost exclusively in females; 1/23000 live female births; present 1-4 yrs with social interaction regression, inability to speak, midline hand movements; median life expectancy 24 years
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Deletion long arm chromosome 22
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DiGeorge syndrome; abnormal facies (hypertelorism and cleft palate); defect 3rd and 4th branchial pouches; cardiac anomalies-tetrology of fallot
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Deletion short arm chromosome 5
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cri-du-chat syndrome; laryngeal hypoplasia=cry of the cat; microcephaly, hypertelorism, down-slanting palpebral fissures, low-set ears typical
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Hyaline casts in urine
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most common, relatively nonspecific; cylindrical and clear, occur after dehydration or strenuous exercise
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Granular casts
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sensitive for renal damage/ischemia suggesting acute tubular necrosis (ATN)
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Fatty casts
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nephrotic syndrome and chronic renal failure association
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RBC casts
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suggest glomerulonephritis
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WBC casts
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suggest pyelonephritis
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William syndrome
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microdeletion chromosome 7 (includes elastin gene); ‘elfin’ face; dvlp delay with dvlped verbal skills; high calcium (increased sensitivity to vit D)
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Edwards syndrome
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trisomy chromosome 18; mental dvlp delay, rocker-bottom feet, micrognathia, clenched hands, congenital heart defect
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Patau syndrome
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trisomy 13; rocker-bottom feet, microphthalmia, microcephaly, cleft lip, holoprosencephaly, and polydactyly
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Acute promyelocytic leukemia
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M3 subtype of acute myelogenous leukemia; associated with DIC; promyelocytes large myeloblasts with nucleus to cytoplasmic ratio and characteristic folded, bilobed nucleus; contain coarse cytoplasmic azurophilic granules and pink intracytoplasmic rod-like granular structures (Auer rods)
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Acute lymphoblastic leukemia expresses
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CD10; >25% lymphoblasts in bone marrow
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B-cell antigens
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CD19, 20, 22
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T-cell antigens
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CD2, 3, 5
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Efavirenz
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NNRTI (non-nucleoside reverse transcriptase inhibitor) used in HAART; other NNRTIs=delaviridine, nevirapine, rilpivirine
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NRTIs
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abacavir, didanosine, emtricitabine, lamivudine, stuvudine, tenofovir, zalcitabine, zidovudine
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Respiratory and inherent craniosacral motion occur at the
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superior transverse axis of the sacrum (~S2) and at the joint btwn the sphenoid and occipital bones. Inhalation sacral base posterior (counternutation or extension)
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Juxtaglomerular cell tumor (JGCT)
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rare kidney tumor that affects adolescents/young adults; symptoms relating to hypertension and hypokalemia due to renin-secretion by tumor; well-circumscribed with fibrous capsule with yellow or gray-tan color and frequent hemorrhaging; monotonous polygonal cells with entrapped normal tubules; stain positive for renin, vimentin and CD34
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Conn syndrome
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primary aldosteronism caused by adrenal adenoma; hypokalemia, metabolic alkalosis, and low plasma renin; hypertension, weakness, and paresthesias
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Sensitivity
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TP/(TP+FN) ability to detect disease
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Specificity
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TN/(TN+FP) ability to detect absence of disease
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Positive Predictive value
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TP/(TP+FP) probability of positive test being true positive
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Negative Predictive Value
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TN/(FN+TN) probability neg test is true neg
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Cryptococcus neoformans
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encapsulated yeast visible with india ink; acquired via inhalation of bird droppings (pigeons); therapy is 10 weeks amphotericin B + flucytosine; prophylaxis with fluconazole
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Amphotericin B
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broad-spectrum anti-fungal; binds ergosterol and forms pores in fungal cell membrane
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Azoles interfere with
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ergosterol synthesis; bind and inhibit 14a-demethylase
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Treacher-Collins syndrome
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failure of 1st neural crest cells to migrate; causes mandibular hypoplasia
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Decreased FEV1/FVC ratio found in
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obstructive lung diseases (chronic bronchitis and COPD); restrictive diseases have increased ratio because decline in FVC is more than that of FEV1
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Normal P hydrocephalus
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gait difficulty, cognitive disturbance, and urinary incontinence (wet, wacky, wobbly)
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Black dot tinea capitis
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colonizes and invades hair shafts, black dots are debris remaining in hair follicle; caused by Trichophyton tonsurans; does NOT floresce under UV light; KOH exam shows hyphae and fungal spores; treat with oral griseofulvin or terbinafine
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Microsporum canis
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causes tinea capitis, but fluoresces under UV light
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Ataxia-telangiectasia
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defect in DNA repair enzymes; can lead to ataxia, spider angiomas, and IgA deficiency
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Chediak-Higashi syndrome
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defect in neutrophil phagosome lysosome gusion; present with recurrent pyogenic infections, along with albinism and peripheral neuropathy
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Defective CD40L
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inability to class switch, resulting in hyper-IgM syndrome
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Lack of NADPH oxidase
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chronic granulomatous disease; decreases ROS leading to recurrent infection with catalase-positive organisms (S aureus, Pseudomonas aeruginosa, Klebsiella pneumonia)
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SCID
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deficiency in adenosine deaminase; present with recurrent viral, bacterial, fungal, and/or protozoal infections along with chronic diarrhea and failure to thrive
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Fragile X
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dominant X-linked affecting methylation and expression of FMR1 gene; trinucleotide repeats (CGG); mental retardation and autistic-like behavior; long face with large ears, prominent jaw, hypotonia, micropenis, and macroorchidism
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Kallmann syndrome
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lack of embryonic migration of olfactory bulb cells to hypothalamus causing lack of puberty dvlp, lack of secondary sex characteristics, and decreased smell; idiopathic hypogonadotropic hypogonadism resulting from deficiency of GnRH from hypothalamus; decreased GnRH, LH, and FSH
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Prader-Willi syndrome
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deletion on paternally derived chromosome 15 in which maternal chromosome 15 becomes imprinted; hyperphagia, early-onset obesity, hypogonadism, dvlp delay, and hypotonia; small hands and feet, almond-shaped eyes
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Fabere test (aka Patrick’s test)
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assess for sacroiliitis or osteoarthritis of hip; Flexion, Abduction, External rotation, Extension (FAbErE)
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Lachman test assesses stability of
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ACL
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Drugs that can contribute to GERD
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stimulants of B-receptors; alcohol; chocolate; calcium channel blockers; nicotine; fats; caffeine; nitrates; obesity
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Opiate toxicity clinical triad
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CNS depression, respiratory depression, pupillary miosis
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Meniere’s disease
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hydropic dilation due to excess endolymphatic fluid in the chochlea; vertigo, sensorineural hearing loss, and tinnitus; 20-40 yrs old
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Vestibular schwannoma symptoms
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unilateral sensorineural hearing loss, tinnitus, and gait instability
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Furosemide side effects
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hypokalemia, hypovolemia-associated enhancement of uric acid reabsorption in proximal tubule (causing hyperuricemia), calcinuric effects (loops lose calcium=hypercalciuria), hearing loss in ppl with decreased renal fxn, hypokalemic metabolic acidosis, hypomagnesemia, allergic rxns
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Adenomyosis
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glands and stroma within uterus that have invaginated into stratum basilis of uterine wall; enlarged uterus; present with pelvis pain, nenorrhagia, and dysmenorrhea
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Alport syndrome
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type IV collagen defect resulting in ocular disturbances, deafness, and progressive hereditary nephritis
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Ehlers-Danlos syndrome
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faulty type III collagen synthesis and may present with hyperextensible skin, tendency to bleed and hypermobile joints
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Struma ovarii
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specialized monodermal teratoma predominantly composed of mature thyroid tissue
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Dysgerminoma
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comparable to seminoma in males; high association with Turner syndrome; produce human chorionic gonadotropin and/or lactate dehydrogenase; uniform cells with centrally placed nuclei or ‘fried egg’ appearance
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PAS staining in small intestine characteristic of
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whipple disease (bacterium); malabsorption, joint pain, and CNS symptoms
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Onychomycosis
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fungal growth under toenails; occurs in diabetics due to poor circulation; Terbinafine most effective antifungal to treat (inhibits squalene epoxidase, inhibiting enzymatic conversion of squalene into lanosterol)
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Itraconazole
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triazole antifungal that inhibits lanosterol-14a demethylase (converts lanosterol into ergosterol)
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Griseofulvin
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inhibits microtubule formation in fungal cells inhibiting mitosis
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Ciclopirox
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antifungal paint; MOA unknown
|
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Amorolfine
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topical antifungal paint; inhibits ergosterol synthesis
|
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Strep pneumonia is
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alpha hemolytic
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strep pyogenes is
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beta-hemolytic
|
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Polyarteritis nodosa
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systemic vasculitis that affects small and medium arteries (renal, cardiac, GI vessels); hypertension due to renal artery vasculitis; skin lesions in 40%, most on legs; 30% reported history of prior hep B infection (usually within last 6 months)=immune complex induces vascular destruction; treatment=high dose corticosteroids and/or cyclophosphamide
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Buerger’s disease
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thromboangiitis obliterans; medium vessel disease causing segmental thrombosis of peripheral arteries and veins; strong association with smoking; intermittent claudication, Raynaud’s phenomenon, superficial nodular phlebitis
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Henoch-Schonlein purpura
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childhood systemic vasculitis involving small vessels of skin, GI, kidneys, joints; autoimmune via IgA complex formation after recent URI, pharyngeal, or GI infection
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Takayasu’s arteritis
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systemic vasculitis causing granulomatous thickening of aortic arch and/or proximal great vessels; fever, night sweats, skin nodules, ocular disturbances, weak pulses in UE
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Vagal stimulation of stomach acid:
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releases acetylcholine which binds M3 receptor on gastric parietal cell=stimulation of Gq subunit protein which activates phospholipase C=liberates IP3 and diacylglycerol into second messenger form increasing concentration of Ca2+ which stimulates H+/K+ ATPase to secrete more H+ ions into lumen of GI tract
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H2-histamine receptors in gastric parietal cells activate
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protein kinase A causing stimulation of Gs subunit protein
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Stimulation of gastric parietal cells by somatostatin and prostaglandins causes
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stimulation of Gi subunit protein
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Bilateral conductive hearing loss and positive family history
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otosclerosis-overgrowth of middle ear bones, most commonly stapes, which interferes with sound conduction and loss of stapedial reflex when stapes involved
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Placental abruption
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presents as painful bleeding in 2nd or 3rd trimester; premature detachment of placenta from uterine wall; increased risk with tobacco, cocaine use, and hypertension; treatment is immediate delivery
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Placenta accrete
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placenta attaches to myometrium; unable to detach after birth causing copious bleeding after delivery; increased risk with prior c-section or placenta previa
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Placenta previa
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placental attachement at lower uterine segment which partially/completely covers cervical os; painless vaginal bleeding in 2nd/3rd trimester; risk factors prior c-sec and multiparity
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G6PD deficiency is
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X-linked recessive; enzyme that normally protects cells from oxidative damage by converting NADP+ to NADPH; sulfa drugs or fava beans provide oxidative stress and cause physiologic distress
|
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Krukenburg tumor
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bilateral ovarian metastasis from GI tract adenocarcinoma (Japanese, indigestion, sister mary joseph nodule); produces mucin-producing signet ring cells
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Brenner tumor
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benign unilateral ovarian mass; pale tallow-tan and encapsulated; resembles bladder tissue with transitional epithelial cells with ‘coffee bean’ nuclei
|
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Gp120 is the binding protein of
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HIV
|
|
Renal clearance
|
(urine concentration of sub)*(urine formation rate)/(plasma concentration of sub)
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Baroreceptor
|
decrease BP=decrease rate of firing to vasomotor centers of brain stem = increase sympathetic outflow to heart and blood vessels
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Scoliosis is named for the
|
convexity: levoscoliosis displays R sidebending and dextroscoliosis L sidebending
|
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Coccidiodes immitis
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desert southwest US; dimorphic fungus; large spherule multiple, round endospores
|
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Aspergillus:
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halo sign indicative of; dichotomous acture-angle branching hyphae
|
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Blastomyces dermatitidis:
|
single, thick, broad-based budding yeast
|
|
Histoplasma capsulatum:
|
small oval budding yeast with small buds; inhalation of bird/bat droppings
|
|
Pharyngeal arches are comprised of
|
pharyngeal clefts and pouches; clefts are external and pouches internal
|
|
Only clotting factor located exclusively in extrinsic pathway
|
factor VII; elevated PT; autosomal recessive
|
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Positive Predictive value
|
proportion of positive test results who truly have disease; TP/(total P + FP)
|
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Syphilis and vasculature
|
spirochete infects vasa vasorum of ascending/transverse aortic arch; SOB, crushing chest pain, aortic regurg, wide pulse P
|
|
21-a-hydroxylase deficiency causes
|
decrease in cortisol and aldosterone production and increase in sex hormones
|
|
17-a-hydroxylase deficiency causes
|
decrease sex hormones and cortisol, increase in aldosterone
|
|
11-b-hydroxylase deficiency causes
|
similar to 17-a except 11-b builds up and has effects similar to aldosterone
|
|
3-B-hydroxysteroid dehydrogenase causes
|
decrease in all hormones produced by adrenal glands
|
|
Desmolase fxn
|
enzyme that catalyzes conversion of cholesterol into pregnenolone
|
|
Alprostadil (prostaglandin E1)
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used in transposition of great arteries to maintain ductus arteriosus
|
|
Superior gluteal nerve
|
innervates gluteus medius and minimus
|
|
Damage to common peroneal nerve causes
|
foot drop and paralysis of all dorsiflexor and evertors
|