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177 Cards in this Set

  • Front
  • Back
Right sided heart murmurs increase on
inspiration
left sided increase on
expiration
Diastolic ARMS
aortic regurgitation and mitral stenosis
Vibrio cholera
gram-neg, pxidase=pos curved rod with polar flagella
E. coli is a
lactose fermenting rod
Salmonella is
motile rod that doesn’t ferment lactose
Shigella is a
non-motile rod that doesn’t ferment lactose
Pseudomonas is an
oxidase positive rod that doesn’t ferment
Myotonic dystrophy
CTG tri-nucleotide repeat expansion; anticipation due to instability during maternal meiosis; autosomal dominant
Huntington
CAG repeat due to instability during paternal meiosis
Friedrich’s ataxia has
GAA occurring during both paternal/maternal meiosis
Brown-Sequard syndrome(hemisection of spinal cord)
ipsilateral loss of touch, vibration, and proprioception below lesion and contralateral loss of pain/temperature and ipsilateral paralysis below lesion
First line treatment for gonorrhea is
ceftriaxone
First line treatment for chlamydia is
azithromycin or doxycycline
Mobitz type II, a form of second degree AV heart block, is defined by
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
Pygmalion effect refers to
phenomenon of groups altering their outcomes in order to meet external expectations
Hawthorne effect
results of study altered by fact that subjects are aware that they are being studied
Exhalation somatic dysfuntion:
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
Placenta accrete
occurs when the placenta attaches to the myometrium, and therefore there is no separation of placenta at birth.
Abruptio placentae
occurs when the placenta detaches from the implantation site prior to delivery; extremely painful bleeding in 3rd trimester and death of child
A large percentage of PE originate
in the femoral vein
Acidosis shifts the oxy-Hb curve
to the right
Subacute thyroiditis
De Quervain disease; self-limiting hypothyroidism that is typically seen following a viral, flu-like illness
Cretinism is
hypothyroidism in kids mostly due to dietary iodine deficiency; pale, puffy faces, protuberant tongue, and potbellied; also mental retardation and stunted growth
Riedel thyroiditis is
fibrous tissue replacement of thyroid gland leading to hypothyroidism; fixed, rock-hard, painless goiter
Ruptured aortic aneurysm
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
Pyridoxine (vit B6) deficiency:
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
Riboflavin (B2) deficiency
cheilosis, angular stomatitis, and glossitis (cracked red lips and inflammation of lining of mouth and tongue, mouth ulcers, sore throat);
Von Willebrand’s disease
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
Prolonged PTT
hemophilia (X-linked)
Prolonged PT
liver disease and warfarin therapy
Prolonged bleeding time, PT, and PTT cause
DIC
Iron is absorbed in the
duodenum
folate is absorbed in the
jejunum
B12 is absorbed in the
ileum
Fanconi’s syndrome
(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+)
MAC value
minimum PP in which 50% patients are non-responsive to surgical incision; potency inversely proportional to MAC
CA 19-9 can be found in 71-73% of
pancreatic cancers
CA-125 is elevated in over 80% of
ovarian cancers
p-ANCA (perinuclear antineutrophil cytoplasmic antibodies)
moniter microscopic polyangitis; an autoimmune vasculitis of small-sized arteries
c-ANCA (cytoplasmic-staining ACA)
monitor Wegener’s granulomatosis; triad of focal necrotizing vasculitis, necrotizing granulomas in lung and upper airway, and necrotizing glomerulonephritis
Aspirin is contraindicated in
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
Tay-Sachs
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)
Niemann-Pick
sphingomyelinase deficiency; cherry-red spot in macula; presents with anemia, fever, neurologic deterioration; also hepatosplenomegaly, lymphadenopathy, and bone marrow suppression
Gaucher disease
B-glucocerebrosidase deficiency; hepatospenomegaly, aseptic necrosis of femur, bone crises, and accumulation of glucocerebroside
Fabry disease
alpha-galactodisase A deficiency; X-linked; peripheral neuropathy of extremities, angiokeratomase, renal problems, and cardiovascular disease
Trigeminal neuralgia treatment
carbamazepine, anti-seizure med that inhibits voltage-gated Na+ channels
Hereditary hemochromatosis
autosomal recessive; pigmented skin, diabetes, cirrhosis of the liver; transferrin saturation increased
Acetazolamide
carbonic anhydrase inhibitor that works in the proximal convoluted tubule; SE=metabolic acidosis
Hydrochlorothiazide
diuretic works in convoluted tubule, inhibits Na/Cl co—transporter decreasing their reabsorption, indirectly increasing K and Ca reabsorption
Nortriptyline
inhibits reuptake of norepi; affectst locus coeruleus in pons
Caudate contains
GABAergic and cholinergic (excitatory) neurons; dysfxn in huntington’s
Raphe nuclei neurotransmitter
serotonergic
Substantia nigra neurotransmitter
D1 pars compacta excitatory; D2 pars reticulate inhibitory
Seborrheic dermatitis
greasy scales on erythematous base; scalp in neonates (cradle cap)
Atopic dermatitis causes
intense pruritus; aka eczema
Hypertensive crisis can be caused by MAOi with additional intake of
tyrosine
Malignant hyperthermia can be caused by
gas anesthetics (halothan, sevoflurane, desflurane) and succinylcholine; autosomal dominant mutation of ryanodine receptor (intracellular Ca channel receptor); treated with dantrolene
Neuroleptic malignant syndrome
adverse rxn to antipsychotics; FEVER=fever, encephalopathy, vital signs unstable, elevated CP, rigidity of muscle; treat with dantrolene
Tardive Dyskinesia
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
Papillary carcinoma
most common thyroid cancer; nuclei optically clear (orphan annie eyes); good prognosis
Yersinia Pestis
nonmotile, pleomorphic, gram-neg, coccobacillus, nonsporulating; 2-8 day incubation; 7-day course doxycycline and ciprofloxacin
68% fall within 1 standard deviation of mean in
standard bell curve
Osteogenesis imperfect type II
fatal in utero or within first few hours after birth; multiple fractures, blue sclera, short stature
Synthesis of surfactant is decreased by
presence of high insulin levels, occurs in gestational diabetes
Acute-post strep glomerulonephritis
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
Membraneous glomerulonephritis
diffuse capillaries and glomerular BM thickening; seen in SLE, tumors, infections; results in nephrotic syndrome
Vasoactive intestinal peptide (VIP) elevated in presence of VIPomas
non-beta islet cell pancreatic tumors that stimulate intestinal water and electrolyte secretion leading to copious diarrhea
Posterior chapman point for appendix
transverse process T11
Sporotrichosis
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
Gardnerella vaginalis
gram variable rod; gray vaginal discharge with fishy odor with KOH prep; clue cells
Head and neck levels
T1-4
heart levels
T1-5
Respiratory levels
T2-7
esophagus levels
T2-8
Upper GI levels
T5-9
Middle GI levels
T10-11
Lower GI levels
T12-L2
Appendix level
T12
Kidney/adrenal levels
T10-11
bladder levels
T11-L2
Uterus levels
T10-L2
Prostate levels
T12-L2
Rett syndrome
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
Deletion long arm chromosome 22
DiGeorge syndrome; abnormal facies (hypertelorism and cleft palate); defect 3rd and 4th branchial pouches; cardiac anomalies-tetrology of fallot
Deletion short arm chromosome 5
cri-du-chat syndrome; laryngeal hypoplasia=cry of the cat; microcephaly, hypertelorism, down-slanting palpebral fissures, low-set ears typical
Hyaline casts in urine
most common, relatively nonspecific; cylindrical and clear, occur after dehydration or strenuous exercise
Granular casts
sensitive for renal damage/ischemia suggesting acute tubular necrosis (ATN)
Fatty casts
nephrotic syndrome and chronic renal failure association
RBC casts
suggest glomerulonephritis
WBC casts
suggest pyelonephritis
William syndrome
microdeletion chromosome 7 (includes elastin gene); ‘elfin’ face; dvlp delay with dvlped verbal skills; high calcium (increased sensitivity to vit D)
Edwards syndrome
trisomy chromosome 18; mental dvlp delay, rocker-bottom feet, micrognathia, clenched hands, congenital heart defect
Patau syndrome
trisomy 13; rocker-bottom feet, microphthalmia, microcephaly, cleft lip, holoprosencephaly, and polydactyly
Acute promyelocytic leukemia
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)
Acute lymphoblastic leukemia expresses
CD10; >25% lymphoblasts in bone marrow
B-cell antigens
CD19, 20, 22
T-cell antigens
CD2, 3, 5
Efavirenz
NNRTI (non-nucleoside reverse transcriptase inhibitor) used in HAART; other NNRTIs=delaviridine, nevirapine, rilpivirine
NRTIs
abacavir, didanosine, emtricitabine, lamivudine, stuvudine, tenofovir, zalcitabine, zidovudine
Respiratory and inherent craniosacral motion occur at the
superior transverse axis of the sacrum (~S2) and at the joint btwn the sphenoid and occipital bones. Inhalation sacral base posterior (counternutation or extension)
Juxtaglomerular cell tumor (JGCT)
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
Conn syndrome
primary aldosteronism caused by adrenal adenoma; hypokalemia, metabolic alkalosis, and low plasma renin; hypertension, weakness, and paresthesias
Sensitivity
TP/(TP+FN) ability to detect disease
Specificity
TN/(TN+FP) ability to detect absence of disease
Positive Predictive value
TP/(TP+FP) probability of positive test being true positive
Negative Predictive Value
TN/(FN+TN) probability neg test is true neg
Cryptococcus neoformans
encapsulated yeast visible with india ink; acquired via inhalation of bird droppings (pigeons); therapy is 10 weeks amphotericin B + flucytosine; prophylaxis with fluconazole
Amphotericin B
broad-spectrum anti-fungal; binds ergosterol and forms pores in fungal cell membrane
Azoles interfere with
ergosterol synthesis; bind and inhibit 14a-demethylase
Treacher-Collins syndrome
failure of 1st neural crest cells to migrate; causes mandibular hypoplasia
Decreased FEV1/FVC ratio found in
obstructive lung diseases (chronic bronchitis and COPD); restrictive diseases have increased ratio because decline in FVC is more than that of FEV1
Normal P hydrocephalus
gait difficulty, cognitive disturbance, and urinary incontinence (wet, wacky, wobbly)
Black dot tinea capitis
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
Microsporum canis
causes tinea capitis, but fluoresces under UV light
Ataxia-telangiectasia
defect in DNA repair enzymes; can lead to ataxia, spider angiomas, and IgA deficiency
Chediak-Higashi syndrome
defect in neutrophil phagosome lysosome gusion; present with recurrent pyogenic infections, along with albinism and peripheral neuropathy
Defective CD40L
inability to class switch, resulting in hyper-IgM syndrome
Lack of NADPH oxidase
chronic granulomatous disease; decreases ROS leading to recurrent infection with catalase-positive organisms (S aureus, Pseudomonas aeruginosa, Klebsiella pneumonia)
SCID
deficiency in adenosine deaminase; present with recurrent viral, bacterial, fungal, and/or protozoal infections along with chronic diarrhea and failure to thrive
Fragile X
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
Kallmann syndrome
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
Prader-Willi syndrome
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
Fabere test (aka Patrick’s test)
assess for sacroiliitis or osteoarthritis of hip; Flexion, Abduction, External rotation, Extension (FAbErE)
Lachman test assesses stability of
ACL
Drugs that can contribute to GERD
stimulants of B-receptors; alcohol; chocolate; calcium channel blockers; nicotine; fats; caffeine; nitrates; obesity
Opiate toxicity clinical triad
CNS depression, respiratory depression, pupillary miosis
Meniere’s disease
hydropic dilation due to excess endolymphatic fluid in the chochlea; vertigo, sensorineural hearing loss, and tinnitus; 20-40 yrs old
Vestibular schwannoma symptoms
unilateral sensorineural hearing loss, tinnitus, and gait instability
Furosemide side effects
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
Adenomyosis
glands and stroma within uterus that have invaginated into stratum basilis of uterine wall; enlarged uterus; present with pelvis pain, nenorrhagia, and dysmenorrhea
Alport syndrome
type IV collagen defect resulting in ocular disturbances, deafness, and progressive hereditary nephritis
Ehlers-Danlos syndrome
faulty type III collagen synthesis and may present with hyperextensible skin, tendency to bleed and hypermobile joints
Struma ovarii
specialized monodermal teratoma predominantly composed of mature thyroid tissue
Dysgerminoma
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
PAS staining in small intestine characteristic of
whipple disease (bacterium); malabsorption, joint pain, and CNS symptoms
Onychomycosis
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)
Itraconazole
triazole antifungal that inhibits lanosterol-14a demethylase (converts lanosterol into ergosterol)
Griseofulvin
inhibits microtubule formation in fungal cells inhibiting mitosis
Ciclopirox
antifungal paint; MOA unknown
Amorolfine
topical antifungal paint; inhibits ergosterol synthesis
Strep pneumonia is
alpha hemolytic
strep pyogenes is
beta-hemolytic
Polyarteritis nodosa
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
Buerger’s disease
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
Henoch-Schonlein purpura
childhood systemic vasculitis involving small vessels of skin, GI, kidneys, joints; autoimmune via IgA complex formation after recent URI, pharyngeal, or GI infection
Takayasu’s arteritis
systemic vasculitis causing granulomatous thickening of aortic arch and/or proximal great vessels; fever, night sweats, skin nodules, ocular disturbances, weak pulses in UE
Vagal stimulation of stomach acid:
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
H2-histamine receptors in gastric parietal cells activate
protein kinase A causing stimulation of Gs subunit protein
Stimulation of gastric parietal cells by somatostatin and prostaglandins causes
stimulation of Gi subunit protein
Bilateral conductive hearing loss and positive family history
otosclerosis-overgrowth of middle ear bones, most commonly stapes, which interferes with sound conduction and loss of stapedial reflex when stapes involved
Placental abruption
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
Placenta accrete
placenta attaches to myometrium; unable to detach after birth causing copious bleeding after delivery; increased risk with prior c-section or placenta previa
Placenta previa
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
G6PD deficiency is
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
Krukenburg tumor
bilateral ovarian metastasis from GI tract adenocarcinoma (Japanese, indigestion, sister mary joseph nodule); produces mucin-producing signet ring cells
Brenner tumor
benign unilateral ovarian mass; pale tallow-tan and encapsulated; resembles bladder tissue with transitional epithelial cells with ‘coffee bean’ nuclei
Gp120 is the binding protein of
HIV
Renal clearance
(urine concentration of sub)*(urine formation rate)/(plasma concentration of sub)
Baroreceptor
decrease BP=decrease rate of firing to vasomotor centers of brain stem = increase sympathetic outflow to heart and blood vessels
Scoliosis is named for the
convexity: levoscoliosis displays R sidebending and dextroscoliosis L sidebending
Coccidiodes immitis
desert southwest US; dimorphic fungus; large spherule multiple, round endospores
Aspergillus:
halo sign indicative of; dichotomous acture-angle branching hyphae
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
Positive Predictive value
proportion of positive test results who truly have disease; TP/(total P + FP)
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)
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