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195 Cards in this Set

  • Front
  • Back
Opportunistic infections in AIDS
Pneumocystis, CMV, Cryptococcus, MAI, TB, Herpes (esophagitis), Candida (thrus, esophagitis), Cryptosporidium
Most Common vitamin deficiency in alcoholics
MC mental deficiency in alcoholics
Football injury caused by clipping from lateral side (of knee) damages what structures?
MCL, medial meniscus, and ACL
Lumbar puncture is performed at what landmark?
Iliac crest
Abnormal passive abduction of the knee indicates damage to what structure?
Anterior in ACL refers to what attachment?
At what level is a lumbar puncture performed?
L3/4 or L4/5
Do the coronary arteries fill during systole or diastole?
Femoral nerve damage manifests what deficit?
Loss of knee jerk
How does the course of the left recurrent laryngeal nerve differ from that of the right?
The left wraps around the arch of the aorta and the ligamentum arteriosum while the right wraps around the subclavian artery.
Where is the appendix located (surface landmarks)?
2/3 of the way from the umbilicus to the ASIS
How many lobes are in the right and left lungs and what are their names?
Right has 3 (superior, middle, inferior); Left has 2 (superior and inferior) and the lingula
Name 5 portal-systemic anastomoses
1.Left gastric-azygous vv.
2.Superior-Middle/Inferior rectal vv.
3.Paraumbilical-inferior epigastric
4.Retroperitoneal-renal vv.
5.Retroperitoneal-paravertebral vv.
Name the hypothenar muscles
Opponens digiti minimi, abductor digiti minimi, flexor digiti minimi
Name the 9 retroperitoneal structures
1.Duodenum(2nd-4th parts)
2.Descending colon
3.Ascending colon
4.Kidney & ureters
7.Inferior vena cava
8.Adrenal glands
Name the rotator cuff muscles
Supraspinatus, Infraspinatus, Teres minor, Subscapularis
Name the thenar muscles
Opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
Obturator nerve damage manifests what deficit?
Loss of hip adduction
Pain from the diaphragm is usually referred where?
Subarachnoid space extends to what spinal level?
The area of the body that contains the appendix is known as what (what point)?
McBurney's point
The femoral triangle contains what structures from lateral to medial?
Femoral nerve, Femoral artery, Femoral vein, Femoral canal (lymphatics)
What dermatome is found around the inguinal ligament?
The kneecaps exist in what dermatome?
The nipples exist in what dermatome?
The recurrent laryngeal nerve arises from what cranial nerve and supplies what muscles?
CN X; supplies all intrinsic muscles of the larynx except the cricothyroid muscle.
The SA and AV nodes are usually supplied by what artery?
Right Coronary Artery (RCA)
The spinal cord ends at what level in adults?
The umbilicus exists in what dermatome?
The xiphoid process exists in what dermatome?
Tibial nerve damage manifests what deficit?
Loss of plantar flexion
What are hernias?
Protrusions of peritoneum through an opening, usually sites of weakness
What are the boundaries of the inguinal (Hesselbach) triangle?
--Inferior epigastric artery
--Lateral border of the rectus abdominus
--Inguinal ligament
What are the manifestations of portal hypertension?
Esophageal varices; hemorrhoids; Caput medusae
What condition is usually associated with portal hypertension?
Alcoholic cirrhosis
What gut regions and structures does the celiac artery supply?
Foregut: stomach to duodenum; liver; gallbladder; pancreas
What gut regions and structures does the Inferior Mesenteric Artery supply?
Hindgut: distal 1/3 of transverse colon to upper portion of rectum
What gut regions and structures does the Superior Mesenteric Artery supply?
Midgut: Duodenum to proximal 2/3 of transverse colon
What is a hiatal hernia?
Stomach contents herniate upward thru the esophageal hiatus of the diaphragm
What is the arterial blood supply difference above and below the pectinate line?
Superior rectal a. (above) and inferior rectal a. (below)
What is the course of a direct inguinal hernia?
Thru weak abdominal wall, into the inguinal triangle, medial to the inferior epigastric artery, thru the external inguinal ring only
What is the course of an indirect inguinal hernia?
Through the internal (deep) inguinal ring and the external (superficial) inguinal ring lateral to the inferior epigastric artery and into the scrotum
What is the course of the ureters?
Pass under the uterine artery or ductus deferens
What is the function of Myenteric plexus? Submucosal plexus?
Myenteric: Coordinates motility along entire gut wall

Submucosal: Regulates local secretions, blood flow, and absorption
What is the function of the JG cells?
Secrete renin and erythropoietin
What is the innervation difference above and below the pectinate line?
Above: visceral innervation; below: somatic innervation
What is the innervation of the diaphragm?
Phrenic nerve (C3,4,5)
What is the macula densa?
Sodium sensor in part of the distal convoluted distal tubule in the juxtaglomerular apparatus of the kidney
What is the Myenteric plexus also known as? Submucosal plexus?
Myenteric: Auerbach's; Submucosal: Meissner's
What is the relationship of the two pulmonary arteries in the lung hilum?
Right: anterior; Left: superior
What is the usual pathology above the pectinate line of the rectum?
internal hemorrhoids (not painful) and adenocarcinoma
What is the usual pathology below the pectinate line of the rectum?
External hemorrhoids (painful) and squamous cell carcinoma
What part of the heart does the LAD supply?
anterior interventricular septum
At what spinal cord level is a vertebral disk herniation most likely to occur?
What structure is in the femoral triangle but not in the femoral sheath?
Femoral nerve
What structures do the broad ligament contain (4)?
-Round ligaments of the uterus
-Uterine tubules
-Uterine vessels
What structures perforate the diaphragm at what vertebral levels?
--IVC at T8
--esophagus, vagal trunks at T10
--aorta, thoracic duct, axygous vein at T12
What usually provides the blood supply for the inferior left ventricle?
Posterior descending artery of the RCA
When do the JG cells secrete renin?
in response to decreased renal BP, decreased sodium delivery to distal tubule, and increased sympathetic tone
Which ligament contains the ovarian vessels?
Suspensory ligament of the ovary
Which lung is the usual site of an inhaled foreign body?
Right lung
From which cells do plasma cells differentiate?
B cells
Into what cell type does a monocyte differentiate in tissues?
Name the three types of leukocytic granulocytes
basophils, eosinophils, and neutrophils
Name the two types of mononuclear leukocytes
Lymphocytes and monocytes
What are 3 functions of a macrophage?
- pagocytosis of bacteria, cell debris, and senescent red cells
- scavenges damaged cells and tissues
- can function as an antigen presenting cell
What are 4 characteristics of the plasma cell morphology?
- Off center nucleus
- Clock face chromatin distribution
- Abundant RER
- Well developed Golgi apparatus
What are 4 morphologic characteristics of lymphocytes?
- Round
- Small
- Densely staining nucleus
- Small amount of pale cytoplasm
What are 4 substances contained within the lysosomes of neutrophils?
- hydrolytic enzymes
- lysozyme
- myeloperoxidase
- lactoferrin
What are 4 types of cells into which T cells differentiate?
- cytotoxic T cells (MHC I, CD8)
- helper T cells (MHCII, CD4)
- suppressor T cells
- delayed hypersensitivity T cells
What are the components of the air-blood barrier?
- Type I pneumocyte
- tight junction
- endothelial cell
What are two names for an increased number of red cells?
Erythrocytosis and polycythemia
What immunoglobulin can bind to the membrane of a mast cell?
What is a reticulocyte?
a baby (developing) erythrocyte
What percentage of leukocytes in the blood exist as basophils?
Less than 1%
What is the basic morphologic structure of an erythrocyte?
Anucleate, biconcave
What is the function of Interferon gamma with relation to macrophages?
Macrophage activation
What is the function of pulmonary surfactant?
lowers alveolar surface tension and prevents atelectasis
What is the importance of the lecithin:sphingomyelin ratio?
> 2.0 in fetal lung is indicative of fetal lung maturity
Are most pericardial effusions serous or hemorrhagic?
BActerial endocarditis of which valve is associated with IV drug abuse?
Characterize EKG changes in an MI
ST elevation (transmural ischemia) and Q waves
What is the most specific protein marker for an MI? Time frame?
Troponin - elevated between 4 hrs and 7-10 days post MI
Describe the onset of Staph. Aureus endocarditis
Rapid, acute onset
Describe the onset of Streptococcus viridans endocarditis
Insidious, subacute onset
How does atherosclerosis progress?
1. Fatty streaks in arteries
2. proliferative plaques
3. complex atheromas
How does Prinzmental's variant angina present?
chest pain at rest
How does stable angina present?
Chest pain with exertion
How does syphilis change the aorta?
Causes dilation of the aorta and valve ring. Can result in aortic aneurysm or aortic valve incompetence
How does unstable/crescendo angina present?
worsening chest pain
To what does HTN predispose one (5)?
Coronary heart dz, CVA, CHF, renal dz, and aortic dissection
What are fat emboli associated with (2)?
long bone fractures and liposuction
What are Janeway lesions?
Small erythematous lesions on palms or soles
What are osler nodes?
tender raised lesions on finger or toe pads
What are the risk factors for HTN (6)?
Age, obesity, diabetes, smoking, genetics, race (black>white>asian)
What are Roth's spots?
round white spots on retina surrounded by hemorrhage
What are the 3 most common sites of an MI?
LAD > RCA > circumflex
What are the 3 types of angina in ischemic heart dz?
stable angina, prinzmetal's variant and unstable/crescendo
What are the 7 types of heart murmurs?
1. Aortic stenosis
2. Aortic regurgitation
3. Mitral stenosis
4. Mitral regurgitation
5. Mitral prolapse
6. Vent. Septal defect
7. Patent ductus arteriosus
What are the findings in temporal arteritis?
1. Unilateral headache
2. Jaw claudication
3. Impaired vision
4. Systemic involvement with polymyalgia rheumatica (in 50% of patients)
What are the findings in Buerger's dz?
Intermittent claudication, superficial nodular phlebitis, cold sensitivity (Raynaud's phenom.), severe pain in affected part; may lead to gangrene
What are the findings in pericarditis (4)?
1. pericardial pain
2. friction rub
3. EKG changes
4. pulsus paradoxicus
What is Pulsus paradoxicus?
A drop of more than 10-12 mmHg of blood pressure during inspiration
What are the findings of Wegener's granulomatosis (3)?
1. C-ANCA positive
2. CXR reveals large nodular lesions
3. hematuria and red cell casts
What are the risk factors of atherosclerosis (4)?
smoking, HTN, diabetes mellitus, and hyperlipidemia
What are the signs of a pulmonary embolus (3)?
chest pain, tachypnea, and dyspnea
What are the symptoms of an MI (5)?
severe retrosternal pain, pain in left arm or jaw, shortness of breath, fatigue and adrenergic symptoms
What are the symptoms of polyarteritis nodosa (6)?
fever, weight loss, malaise, abdominal pain, myalgia, and HTN
What are the types of emboli (6)?
Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor
All viruses are haploid except ____?
Retroviruses, which have 2 identical ssRNA molecules (diploid)
Bites from what 3 animals are more prone to rabies infection than a bite from a dog?
Bat, raccoon, and skunk
Define genetic drift
Minor changes based on random mutations
Define genetic shift
reassortment of viral genome (2+ viruses sharing genomes)
How do the S. Schenckii yeast appear in the pus?
Cigar-shaped budding yeast
How do you diagnose cryptosporidium?
Cysts on acid fast stain
How do you diagnose giardiasis?
Trophozoites or cysts in stool
How does Aspergillus appear microscopically?
Mold with septate hyphae that branch at a V-shaped (45 degree angle) - they are NOT dimorphic
How is Schistosoma transmitted and what disease results?
snails are host; cercariae penetrate skin of humans; causes granulomas, fibrosis, and inflammation of the spleen and liver
What are the 3 main roles of Ig binding to bacteria?
Opsonization; neutralization; complement activation
After exposure to what 4 things are performed (passive) antibodies given?
Tetanus toxin, Botulinum toxin, HBV, or Rabies
All nucleated cells have what class of MHC proteins?
Class I MHC protiens
Anaphylaxis, asthma, or local wheal and flare are possible manifestations of which type of hypersensitivity?
Type I
Anti-gliadin autoantibodies are associated with what disease?
Celiac disease
Anti-Scl-70 autoantibodies are associated with what disease?
diffuse Scleroderma
Autoimmune hemolytic anemia, Rh disease (erythroblastosis fetalis), and Goodpasture's syndrome are examples of what kind of hypersensitivity reaction?
type II hypersensitivity
Class I major histocompatibility complex consists of...
1 polypeptide, with B2-microglobulin
Class II MHC consists of...
2 polypeptides, an alpha and a beta chain
Cytotoxic T cells have CD(?), which binds to class (?) MHC on virus-infected cells
CD8 binds to class I MHC
Define acute transplant rejection.
Cell-mediated due to cytotoxic T lymphocytes reacting against foreign MHCs. Occurs weeks after transplantation.
Define adjuvant
Adjuvants are nonspecific stimulators of the immune response but are not immunogenic by themselves
Define chronic transplant rejection
Antibody-mediated vascular damage (fibrinoid necrosis)--irreversible. Occurs months to years after transplantation
Define hyperacute transplant rejection
Antibody-mediated due to the presence of pre-armed anti-donor antibodies in the transplant recipient. Occurs within minutes after transplantation
Goodpasture's syndrome is associated with what kind of autoantibodies?
anti-basement membrane antibodies
Helper T cells have CD(?) which binds to class (?) MHC on antigen-presenting cells
CD4 binds to class II MHC
IL-4 promotes the growth of B cells and the synthesis of what 2 immunoglobulins?
IgE and IgG
In what immune deficiency do neutrophils fail to respond to chemotactic stimuli?
Job's syndrome
MHC I Ag loading occurs in __(1?)__ while MHC II Ag loading occurs in __(2?)__?
(1) in rER (viral antigens)
(2) in acidified endosomes
Role of TH1 cells?
produce IL-2 (activate Tc cells and further stimulate TH1 cell) and gamma-interferon (activate macrophages)
Role of TH2 cells?
produce IL-4 and IL-5 (help B cells make Ab)
: TB skin test, transplant rejection, and contact dermatitis are examples of what type of hypersensitivity reaction?
Type IV
The 3 kinds of MHC class I genes are...
A, B, and C
The 3 kinds of MHC class II genes are...
What 2 cytokines are secreted by macrophages?
IL-1 and TNF-alpha
What 2 kinds of autoantibodies are specific for systemic lupus?
Anti-dsDNA and anti-Smith
What 3 cytokines are classified as 'acute phase cytokines'?
IL-1, IL-6, and TNF-alpha
What antibody isotype can cross the placenta?
What are the 3 types of APCs?
Macrophages, B cells and dendritic cells
What complement components can cause anaphylaxis?
C3a and C5a
What elements of the complement cascade made the Membrane Attack Complex (MAC)?
C5b, C6, C7, C8, and C9
What Ig is found in secretions as a monomer or a dimer?
What Ig is found in secretions as a monomer or a pentamer?
What immunoglobulin isotype has the lowest concentration in serum?
What immunoglobulin isotype is involved in type-I hypersensitivity reactions?
What immunoglobulin isotype is produced in the primary response to an antigen and is on the surface of B cells?
What interleukin induces naive helper T-cells to become TH2 cells?
What interleukin stimulates the growth of both helper and cytotoxic T-cells?
What kind of autoantibodies are associated with CREST/Scleroderma?
Anti-centromere antibodies
What kind of autoantibodies are known as rheumatoid factor?
anti-IgG antibodies
Which interleukin stimulates the production and activation of eosinophils?
After the first breath at birth, what causes closure of the ductus arteriosus?
An increase in oxygen
After the first breath at birth, what causes the closure of the foramen ovale?
A decrease resistance in pulmonary vasculature causes increased left atrial pressure vs. right atrial pressure
At what time in the course of development is the fetus most susceptible to teratogens?
Weeks 3-8
Deoxygenated blood from the SVC is expelled into the pulmonary artery and ____ ____ to the lower body of the fetus.
ductus arteriosus
Do the cardiovascular structures arise from neural crest (ectoderm), mesoderm, or endoderm?
Do the lungs arise from neural crest (ectoderm), mesoderm, or endoderm?
Do the lymphatics arise from neural crest (ectoderm), mesoderm, or endoderm?
Do the neural crest cells arise from mesoderm, ectoderm, or endoderm?
Do the urogenital structures arise from neural crest (ectoderm), mesoderm, or endoderm?
Does bone arise from neural crest (ectoderm), mesoderm, or endoderm?
Does muscle arise from neural crest (ectoderm), mesoderm, or endoderm?
Does the adrenal cortex arise from neural crest (ectoderm), mesoderm, or endoderm?
From what does the ligamentum teres hepatis arise?
umbilical vein
How does a bicornate uterus form?
Results from incomplete fusion of the paramesonephric ducts
How does a horseshoe kidney form?
Inferior poles of both kidneys fuse, as they ascend from the pelvis during development they get trapped under the inferior mesenteric artery, and remain low in the abdomen
How many arteries and veins does the umbilical cord contain?
- 2 umbilical arteries (carries deoxygenated blood away from fetus)
- 1 umbilical vein (oxygenated blood to fetus)
Meiosis I is arrested in which phase until ovulation?
Most oxygenated blood reaching the heart via IVC is diverted through the ____ ____ and pumped out the aorta to the head.
Foramen ovale
What are the five 2's associated with meckel's diverticulum?
- 2 inches long
- 2 feet from the ileocecal valve
- 2% of the population
- Commonly presents in the first 2 years of life
- May have 2 types of epithelia (gastric and pancreatic)
What does the ductus arteriosus give rise to?
ligamentum arteriosum
What does catalase do? What bacteria have this?
Destroys hydrogen peroxide (major problem for CGD pts);

Staphylococcus, Pseudomonas, Aspergillus, Candida, Enterobacteriaceae
What does IgA protease do? What bacteria have this?
Destroys IgA, promotes colonization of mucosal surfaces; Neisseria, Haemophilus, Streptococcus pneumoniae
What does oxidase do? What bacteria have this?
possession of cytochrome c oxidase; Neisseria and most gram-negatives, except the enterobacteriaceae
What does coagulase do? What bacteria have this?
produces fibrin clot; Staphylococcus aureus and Yersinia pestis
What must be added to the media in order to grow Haemophilus?
Factors X and V
What must be added to the media in order to grow Mycoplasma?
What must be added to the media in order to grow Staphylococcus aureus, group D enterococci and vibrio?
High salt
What must be added to the media in order to grow Francisella, Legionella, Brucella, and Pasteurella?
What antimicrobial agents inhibit bacterial cell-wall synthesis?
penicillins, cephalosporins, imipenem/meropenem, aztreonam, vancomycin
What antimicrobial agents inhibit bacterial protein synthesis?
Aminoglycosides, chloramphenicol, macrolides, tetracyclines, streptogramins, linezolid
What antimicrobial agents inhibit DNA replication or transcription?
Fluoroquinolones, rifampin
What antimicrobial agents inhibit nucleic acid synthesis?
Trimethoprim, flucytosine
What antimicrobial agents inhibit folic acid synthesis?
Sulfonamides, trimethoprim, pyrimethamine
What antimicrobial agents disrupt the cell membrane function?
Azole, polyene antifungal agents
What are the 1st generation penicillins? 2nd? 3rd? 4th?
1st: penicillin G, penicillin V

2nd: methicillin, nafcillin

3rd: ampicillin, amoxicillin

4th: mezlocillin, piperacillin, carbenicillin, ticarcillin