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190 Cards in this Set
- Front
- Back
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multinucleated giant cells in biopsy of breast lump
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fat necrosis
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presence of active toxoplasmosis
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most likely from reactivation in immunosuppressed state, most primary infections begin in childhood
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osteoarthritis synovium finding
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clear acellular fluid
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anterior interosseus
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innervates the flexor pollicis longus, lateral half of flexor digitorum profundus, and pronator quadratus
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RV failure and dilatation
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most common cause of TV regurge and often secondary to pulmonary HTN or LV failure
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ACE Inhibitor affect on potassium
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increase levels via lowered aldosterone
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sodium absorption in distal tubule
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increased by hyperkalemia
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most common cause of ASD
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failure of fusion of the septum primum and septum secundum
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tumors associated with pseudomyxoma peritonei
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mucinous cystadenoma/adenocarcinoma
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hiso in humans
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seen macrophages
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hip fracture and bed rest
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thromboembolism
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sarcococcygeal teratoma origin
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remnants of the primative streak (contain all 3 germ layers)
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comp of PDA ligation
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left phrenic nerve lesion
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azygous vein
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formed from lumbar and subcostal veins, arches over root of lung to join SVC
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hemizygous and accessory hemizygous veins
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drain most of posterior intercostal veins
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thoracic duct
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on left: drains into left subclavian and drains whole body minus right arm and right side of chest and neck; right: right subclavian drains rest of body
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Wilms tumor, aka:
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Nephroblastoma
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oncocytoma
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benign tumor of ductal cells in kidney
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gamma delta T cell
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do not undergo thymic selection
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Killer inhibitory receptor
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on surface of NK cells, inhibits killing if attached to MHC I
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moro reflex
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startling event, lost at 3-6 months
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palmar grasp reflex
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lost at 1-2 months
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tonic neck reflex
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lost at 7-8 month
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babinksi
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lost at 1 year
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order of lost reflexes: (early-late)
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palmar, moro, neck (PMN), babinski
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sagittal sinus thrombosis
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associated with hypercoagulable states (such as first few weeks postpartum)
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tongue somatic sensation
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V3
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venous vs arterial hematocrit
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slightly great in veins due to chloride shift into RBC as they pass through the vasculature
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tx of carcinoid syndrome
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octreotide = inhibits synthesis and release of tumor hormones
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major constituant of dense granules in eosinophils
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major basic protein - functions in parasite destruction
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eos have
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histaminase and arylsulfatase other enzymes
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histamine from
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basophils and mast cells
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lactoferrin found in
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PMNs, used to kill bacteria
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C5
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flexion abduction lateral rotation of the shoulder and flexion of the elbow
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primordial follicles
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inactive that contain primary oocytes surrounded by a single layer of flattened follicular cells
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primary follicles
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larger and contain central oocyte with one or several cuboidal follicular cells
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secondary follicle
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antrum forms in the primary follicle
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graafian follicle
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mature form - includes cumulus oophorus, corona radiata, theca interna, theca extrena, and zona pellucida
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order of follicle
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primordial, primary, secondary (antrum present), graafian (everything else present)
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only antibody a baby can form in an acute infection
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IgM
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70% adult tumors above tentorium:
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mets>astros (including glio)>mening>pituitary
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mets in brain
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round at junction of cortical gray and white matter
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butterfly lesion
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characteristic of GBM crossing the cerebral hemispheres
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spherical lesion in brain
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either a met or meningioma (found on surface of brain)
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tx of choice for pneumococcus
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penicillin
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exemestane
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aromatase inhibitor, used for estrogen dependent breast cancer
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common cause otits media
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h. inf, strep pneumo, strep pyo
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upward lens dislocation
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marfans
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Cardio
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% of Downs with heart probs
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ostum primum type of ASD is most common
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most common abnormality
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VSD
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heart starts beating
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4 weeks
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touton giant cells
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multinucleated cells (foamy) in xanthomas
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classic ASD
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prominent right ventricular cardiac impulse, systolic ejection murmur in pulmonic area, fixed splitting, L-R shunt V overload of right side
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see digoxin think:
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hypokalemia, toxicicty can cause ventricular dysrhythmias like PVC, also see ST scooping on ECG
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drugs that decrease digoxin
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colestipol (bile acid binding resin), sulfas, phenytoin (via P450), sulfasalazine
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most common cause of SCD
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(sudden cardiac death) ischemic heart disease
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sphenopalatine artery
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terminal branch of maxillary artery
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Endocrine
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hCG levels during pregnancy
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increase until tenth week then drop
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progesterone and estrogen during pregnancy
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increase throughout the pregnancy
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human chorionic somatomammotripin, aka:
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human placental lactogen, increases throughout pregnancy, similar structure to GH, anti insulin, facilitates energy supply of the fetus
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"solid balls" in thyroid
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papillary carcinoma - broken off papillary clusters are considered pathognomic, most common form
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medullary carcinoma
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presence of amyloid on biopsy
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follicular carcinoma
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follicular cells and colloid on biopsy, cant reliably distinguish from thyroid adenoma
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nelson's syndrome
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excessive hyperpigmentation secondary to increased ACTH
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GI
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window period
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neither HBsAg nor HBsAb are present
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pancreas location
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mostly retroperitoneal, tail is not
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dudodenum retroperitoneal
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parts 2-4
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rhodamine positive cytoplasmic granules in liver
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wilsons disease
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PAS positive granules in liver
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alpha-1 antitrypsin deficiency
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mets to inguinal nodes
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anorectal region
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drainage to medial side of horizontal chain of superficial group of inguinal LN
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penis, vagina, anal canal
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rectal/colon cancer drainage
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lymph node: below pectinate line --> inguinal nodes, above pectinate line --> iliac nodes (inside pelvic)
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location of lipoprotein lipase
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surface of vascular endothelium
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pancreatic pseudocyst
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complication of pancreatitis, lined by granulation tissue and collagen, rupture can cause release of digestive enzyme and subsequent GI hemorrhage
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predisposing factors for gastric carcinoma
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pernicious anemia, chronic gastritis, acholrhydria, bacterial overgrowth and neoplstic polyps
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Heme
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transferrin in iron deficiency
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increases
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transferrin in beta thal
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reduced, increased ferritin and plasma iron
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anemia of chornic disease
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associated with increased iron stores: elevated serum ferritin, decreased transferrin, increased BM iron deposits
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elevated leukocyte AP
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myeloid metaplasia
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stage IV hodgkins
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presence of disease outside of lymph nodes
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gp Iib IIIa
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binds fibrinogen (leads to fibrinogen bridging)
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long saphenous vein
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drains into superficial inguinal lymph nodes, most of the venous drainage of the leg
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small saphenous vein
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drains into popliteal fossa - drains the lateral aspect of the dorsum of the foot
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MSK
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rectus femoris arises from
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anterior inferior iliac spine
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grabbing something to break a fall
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lesion of the lower part of brachial plexu that results in klumpke's palsy (C8-T1)
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falling on shoulder
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damage to upper brachial plexus
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cyclobenzaprine
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centrally acting skeletal muscle relaxant structurally related to TCAs, give anticholinergic side effects, used to relieve acute spasm, not in surgical setting
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common interosseous artery
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branches off ulnar artery below antecubital fossa and extends down to the lower third of the forearm
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succinylcholine major side effect
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hyperkalemia as prolongued muscle deploarization can cause increased release of K+ into the ECF; burns extensive injuries spinal cord injuries of muscular dystrophies significantly increase risk
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baclofen
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GABA agonist used as a spasmolytic
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corticosteroid action on bone
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increased osteoclastic resorption and decreased osteoblastic formation
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epiphyseal plate
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cartilage that is radiolucent, the plate can produce a "line" crossing the bone near the end
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primary center of ossification
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middle of diaphysis, create medullary cavity
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secondary center of ossicifation
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cartilage in the epiphyseal plate, carilage cells hypertrophy, secrete collagen, then osteoblasts mineralize it
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zones of cartilage
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resting (normal hyaline cartilage), proliferation (chondrocytes undergo rapid mitosis forming sacks), maturation/hypertrophy (become enlarged contain lots of glycogen and secrete AP), calcification (chondrocytes dead or dying leaving cavities that will later be invaded by bone forming cells)
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endochondrial vs intramembranous ossification
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intramembranous doesn’t involve cartilage
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axillary artery course
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in the axiillary sheath which is surrounded by all three cords of the brachial plexus, aneurysm of the axillary artery can compress all of the cords
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deltoid
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arises from the clavicle and acromion and insert in deltoid tuberosity of the humerus
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Neuro
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rate of growth nerve following transection
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1 mm/day
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parkinsons lesion
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SNc lies between the crus cerebri and the medbrain tegmentun
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red nucleus
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nucleus in the motor system, infput from parvicellular portion of the cerebellum and origin of the magnocellular portion
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MGN
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found in lateral portion of midbrain
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viral encephalitis
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such as herpes, transmitting by mosquitos, see high lymphocytes,
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encephalocele
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herniation of brain through bony defect
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spina bifida aperta
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complete failure of fusion of the neural plate associated with maflformation of the vertebral arches such that the underdeveloped nural plate is covered onwly with skin, no mass lesion present, major neurological defect
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myeloschisis
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protruding spinal cord that you can see
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tumor filling 4th ventricle
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blocks CSF flow that results in increased intracranial pressure : N+V headache rigidity, MS change; in kids medullow and ependymom most frequent
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alterations in medullary function
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cardiorespiratory instability
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characteristic sugar coating
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refers to spread of medulloblastoma to subarachnoid space
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auriculotemporal nerve
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anterior aspect of external ear canal
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auricular branch of X
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posteior aspect of external ear canal
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acanthoemba in brain
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immunosuppressed patients, brain infection with multifocal hemorrhagic necrotizing meningoencephalitis
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nevus flammeus
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wine port stain seen in sturge-weber disease
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sturge weber
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occurs sporadically, resulting from mesodermal and ectodermal development problem
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foramen spinosum
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carries middle meningeal artery
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middle meningeal artery
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tear leads to incresased blood between inner skull and dura leads to blown pupil from pressure on the parasympathetic fibers in the pupil
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superior orbital fissure
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contains the ophthalmic vein and CN III, IV, VI (muscles of the eye)
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parinaud's syndrome
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clinical syndrome of problem with the vertical gaze center, can be caused by pineal tumor
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vertical gaze center
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superior colliculi and pretectal area of the dorsal midbrain
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supreior cerebellar peduncle
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efferents from the cerebellum
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occipital corex lesions
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often spare the macula (collateral blood supply)
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empty sella syndrome
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herniation into the sella causing atrophy of the pituitary generally have sufficient residual pituaitary parenchya to prevent hypopituitarism
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neostigmine and physostigmine MOA
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carbamylation of acetylcholineesterase
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edrophonium MOA
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competitive inhibition of AChE
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phosphorylation of AChE
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as with echothiophate cause irreversible inhibition, insectisides and nerve gasses do this
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amnestic disorder
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limited memory problems, loss of alteration in language and the loss of the ability to plan
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marcus gunn pupil
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constricts to light on contralateral side, not ipsilateral side
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sublacine herniation
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most likely to damage the cingulate gyrus since the falx separates the two hemispheres and the cingulate gyrus is in the medial aspect of the hemisphere above the corpus collosum
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uncal herniation
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midbrain damage and medial temporal lobe damage
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cerebellar tensil herniate into foramen magnum
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tonsillar herniation, medulla can be compressed
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chronic meningitis
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lymphocytes, plasma cells, macrophages, fibroblasts
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location of recurrent laryngeal nerves
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right side under subclavian, left side under the thorax
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renal
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histology of renal cancer
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clear cells - renal cell carcinoma; eosinophilic cells with mitochondria - oncocytoma; hamartomous blood vessels - angiomyolipoma; necrotic bacterial forms in macrophages - malakoplakia (can cause mass lesions in kidney without being a true tumor); embryonic glomerular structures - wilms tumor
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diuretic contraindicated in renal failure
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potassium sparing due to hyperkalemia exacerbation
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contraindicated in nephrotic syndrome
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high dose loop diuretics can cause hypovolemia, decreased perfusion, and acute renal failure
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prerenal azotemia exacerbation
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ACE inhibitors can lead to acute renal failure
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nitrite reactivity
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all enterobacteria, enterococci (gut streptococci) cannot
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creatinine
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only freely filtered and secreted substance in PT
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repro
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pudendal nerve
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leaves pelvis through greater scieatic foramen, waps around ishcail spine and supraspinatous lig to enter lesser sciatic foramen, palpation of ischial spine indicates location for block
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sacrospinus ligament
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separates greater sciatic forament (posterior) from lesser sciatic foramen (anterior)
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bartholin gland cyst
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typically sequela of previous infection, csts lined by transitional epithelium or metaplastic squamous epithelium
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lichen sclerosis
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gray, parchment-like thinned epidermis
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vestibular adenitis
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tender posterior introitus with focal ulcerations
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vulvar squamous hyperplasia
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white plaque
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CMV congenital
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HSM, jaundice, petechiae, brain calcification, high mortality
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first choice for syphilis Dx
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VDRL for stage I and II, FTA-ABS for tertiary
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intraductal papillomas
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small benign neoplastic papillary tumors in larger ducts, near nipple, malignant counterpart = papillary ductal carcinoma of the breast
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complex branching glands versus long narrow coiled glands in endometrium
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complex - complex hyperplasia
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simple (cystic) hyperplasia of endometrium
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cystically dilated glands without cellular atypia
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inflammatory breast CA
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lymphatic invasion, blockage --> peau d'orange
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paget cells
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intraepidermal malignant cells, seen in paget disease of nipple in which ductal CA spreads intraepidermally to the skin of the nipple and areola
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respiratory
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theophylline side effects
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tachycardia, insomnia, agitation
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klebsiella tx
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third gen cephalo: cefotoxime, ceftriaxone, ceftazidime
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findings in sarcoidosis
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uveitis, erythema nodosum, arthritis, central and peripheral neuropathis, cardiomyopathy, hypercalcemia; sx = fatigue exertional dyspnea, non-productive cough
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systemic sclerosis
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involves skin 100%, esophagus 75%
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bilateral fluffy chest infiltrates
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PCP, hat shaped silver stained cyts
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pulmonary edema
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proteinaceous granular precipitate ni alveoli, engorged alveolar capillaries, hemosiderin-laden macrophages
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paramyxovirus genome
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negative sense RNA, carries RNA dep RNA pol with it
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SS- RNA viruses
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all helical capsid ones minus corona (its SS +)
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Ghon complex
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primary TB, usually hilar lymph node involvement
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tuberculous bronchopneumonia
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caused by TB in highly sensitized individuals, aggressive and leads to consolidation without well formed granulomas
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pseudomonas
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gram negative rod encapsulated oxidase positive aerobic
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pseudomonas resistance mech
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mutation of porin protein, restricts flow of many antibiotics; also beta lactam and topoisomerase mutations (both less important than porin mutations)
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gentamicin and chloramphenicol resistance MOA
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acetyltransferase production
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immunity to s pneumo
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IgG antibodies to surface acidic polysaccharide
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immunity to strep pyo
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anti M protein
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C carbohydrate
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used to differentiate beta hemolytic streptococci
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NRDS
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give corticosteroids to mom as soon as preterm delivery becomes evident, acts to increase surfactant formation
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Skin/connective tissue
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central ulceration with rolled edge on sun exposed area
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basal cell carcinoma
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urticaria
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transient, nonpitting erythematous wheals
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verruca vulgaris
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common wart: well demarcated verrucous papules, often on hands
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stasis dermtitis
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complication of lower leg edema, edema, erythema, mild scaling, brwon discoleration, don’t necessarily feel that bad
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lichen simplex chronicus
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very itchy, tends to be localized, not typically accompanied by ankle edema
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nummular dermatitis
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coin-shaped itchy lesions that may involve legs
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seborrheic dermatitis
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diffuse scaling (dandruff) of scalp
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albinism increased risk of which cancer?
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usually squamous cell, also get basal cell
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paget disease in skin
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presence of adenocarcinoma in skin (as with breast cancer)
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shingles tx
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famciclover and valacyclovir are preferred for varicella zoster over acyclovir because of better pharmacodynamics
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oka strain live attenuated vaccine
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for varicella zoster
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pooled immune globulin or VZ immunoglobulin Vzi
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can be given to immunosuppressed patients, not as good for active infections
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