Step 1

Front 1

Cardiac glycosides (digoxin): properties, mechanism, clinical use, toxicity, antidote

Back 1

P: 75% bioavailability, 20-40% protein bound, t1/2 = 40hrs, urinary excretion
M: direct inhibition of Na/K ATPase pump --> indirect inhibition of Na/Ca exchanger/antiport --> increase calcium --> positive inotropy; stimulates vagus nerve
U: CHF (increases contractility), atrial fibrillation (decreases conduction at AV node + depression at SA node)
T: increased parasympathetic activity (nausea, vomiting, diarrhea, blurry yellow vision), arrhythmia
Antidote: slowly normalize K, lidocaine, cardiac pacer, anti-dig Fab fragments, Mg

Front 2

apolipoproteins

1. A1
2. B48
3. B100
4. ApoE
5. ApoCII

Back 2

1. HDL
2. chylomicrons- used to combine w/ TG, PL, CE during chylomicron formation
3. VLDL, IDL: structural role
4. found on LP to bind cell surface R
5. VLDL, turns on LPL

Front 3

Sickle Cell:

HbS

Back 3

E6V (glutamate to valine)

1. decreased electrical charge, so decreased movement speed
2. inc. chance of surviving P. falciparum acute illness

Front 4

Aqueduct of Sylvius

-obstruction?

Back 4

-connects third and 4th ventricles
-obstruction: hydrocephalus affecting both lateral ventricles and third ventricle

Front 5

Foramina of Monroe

Foramen of Luschka

Foramen of Magendie

Back 5

Monroe: lateral ventricle⟿third ventricle

Luschka/Magendie: drain fourth ventricle

Front 6

In utero infection of MUMPS

heart defects

Back 6

endocardial fibroelastosis:
-inc. fibrous and elastic tissue
-thickened endocardium
-mural thrombi
-flattened trabeculae
-a'nl (stenosed) valves

Front 7

CMV fetal infection

Back 7

-incomplete organogenesis of CNS:
1. mental retardation
2. microcephaly, seizures
3. deafness

(you can "C", but you can't hear)

Front 8

Herpes neonatal infection

Back 8

-keratoconjunctivitis
-pneumonitis
-hepatitis
-DIC
-exanthem
-encephalitis

Front 9

Rubella intrauterine infection

Back 9

-patent ductus arteriosus (or pulm. aa hypoplasia)
-cataracts
-deafness
+/- blueberry muffin rash

Front 10

Syphilis intrauterine infection

Back 10

-affects mucocutaneous tissues/bones:
1. snuffles
2. maculopapular desquamative rash
3. hepatosplenomegaly
4. neurosyphilis
5. teeth, bone, eye involvement

Front 11

Cardiovascular:

"sharp, knife life pains"

"stabbing pain..."

Back 11

Dissection Aortic Aneurysm or Pericarditis

-pericarditis relieved by leaning fwd
-pericarditis pain related to breathing

Front 12

Ovarian tumors that produce steroid hormones

Back 12

1. Sertoli-Leydig cell tumors:
male H⟶masculinization
2. Fibroma-Thecoma:
endocrinologic manifestations rare
3. Granulosa cell tumors:
secrete E (precocious puberty or endometrial hyperplasia/fibrocystic change in breast in adult women)

Front 13

secrete placental alkaline phosphatase (PLAP)

Back 13

1. dysgerminomas (ovary)
2. seminomas (testes)

Front 14

Sydenham chorea

Back 14

-hyperextended joints
-hypotonia
-diminished DTR
-tongue fasciculations
-"milk sign": relapsing grip
-if no family hx of huntington⟶dx acute rheumatic fever

Front 15

Murmurs:

Aortic Regurge vs. Aortic Stenosis

Back 15

Regurge:
Diastolic decrescendo

Stenosis: systolic ejection murmur in aorta area, accompanied by thrill, harsh in quality, radiates to carotids

Front 16

Murmurs:

Mitral Regurge vs. Mitral Stenosis

Back 16

Regurge: systolic murmur

Stenosis: diastolic murmur, loud S1 and an opening snap that follows S2

Front 17

Murmurs:

Tricupsid regurgitation

Back 17

-high pitched pansystolic murmur:
loudest in 4th intercostal space
-incr. during inspiration
-reduced in intensity and duration when px is standing and during valsalva maneuver

Front 18

oligodendroglioma

Back 18

-"fried egg cells": tumor cells with round nuclei and cleared cytoplams
-may contain areas of calcification, hemorrhage, or cysts
-middle aged px, both sexes
-cerebral hemispheres
-better prognosis than astrocytomas

Front 19

antibodies:

anticentromere vs. antitopoisomerase

Back 19

Scleroderma

anticentromere: limited systemic sclerosis (no visceral involvement)

antitopoisomerase: diffuse systemic sclerosis

Front 20

UTI/Bacterial prostatis

Etiologic Agents

Back 20

E. Coli (most common)
Klebsiella
Proteus
Psuedomonas
Enterobacter
Serratia
Enterococcus
Staphylococcus

Front 21

Aschoff Bodies

Back 21

Myocardial involvement in Rheumatic Fever:

collections of fibrinoid necrosis, lymphocytes, plasma cells, and histiocytes

resoultion: aschoff bodies replaced by discrete fibrous scars

Front 22

I-cell disease

Back 22

-inherited lysosomal storage d/o
-failure of addition of mannose-6-phosphate to lysosome proteins--> EZ secreted outside cell
Clinical Presentation:
-coarse facial features
-restricted joint movement
-skeletal a'nl: dislocation of hip
-psychomotor retardation
-high plasma levels of lysosomal EZ
-fatal in childhood

Front 23

Organ of Corti

Back 23

houses the hair cells from the cochlear branch of CN VIII
-rest on the basilar membrane

Front 24

Neurofibromatosis 1

Back 24

-Cafe au lait spots
-Lisch Nodules: small, pigmented nodular lesions of hamartomatous nature found in IRIS of px

Front 25

Neurofibromatosis 2

Back 25

-cafe au lait spots
-schwannomas of CN VIII (bilateral)

Front 26

Coarctation of Aorta

Preductal vs. Postductal

Back 26

Preductal (infantile):
-narrowing of aorta PROXIMAL to opening of ductus arteriosus
-causes reversal of flow in intercostal aa-->rib notching

Postductal (adult):
-narrowing of aorta DISTAL to opening of ductus arteriosus
-disparity in pressure between upper and lower extremities
-most common type; allows survival into adulthood

Front 27

Products made in hypothalamus:

1. Supraoptic and paraventricular nuclei
2. arcuate nucleus
3. anterior and medial hypothalamus

Back 27

1. Oxytocin, TRH (mainly PVN)
2. Dopamine, GHRH
3. GnRH

Front 28

adenovirus

Back 28

-naked ICOSAHEDRAL DNA viruses
-affects children and sometimes adults in same household; swimming pools can be a source
symptoms:
1. pharyngoconjunctivitis
2. watery, non-bloody diarrhea
3. URI

Front 29

carcinoma of pancreas:
clinical presenting sx

Back 29

sx usually vague: ab pain
cancer of head of pancreas:
1. jaundice
2. enlarged palpable gallbladder (courvoisier's sign) > no sig. tenderness though
3. Migratory thrombophlebitis (trousseau's syndrome) > redness and tenderness on palpating extremities

Front 30

pancreatic adenocarcinoma:
risk factors
markers

Back 30

Risk Factors:
1. inc. in Jewish and African American males
2. CIGARETTES (but not ETOH!)

Markers: CEA and CA 19-9

Front 31

C1V1=C2V2

Back 31

use to calculate osmolarity of added solution...

Front 32

Testosterone

Functions?

Back 32

1. Differentiation of epididymis, vas deferens, seminal vesicles
2. growth spurt: penis, seminal vesicles, sperm, muscle, RBCs
3. deepening of voice
4. closing of epiphyseal plates (via E converted from T)
5. Libido

Front 33

DHT

Functions

Back 33

Early:
differentiation of penis, scrotum, prostate

Late:
prostate growth, balding, sebaceous gland activity

Front 34

Inhibin

Source?
Function?

Back 34

Source:
Sertoli Cells of the seminiferous tubules

Function:
selective inhibition of FSH release from anterior pituitary

Front 35

facial nucleus location

Back 35

lower pons

Front 36

medulla:
nuclei contained

Back 36

1. Cr. IX
2. Cr. X
3. Cr. XI
4. Cr. XII

Front 37

oculomotor nucleus location

Back 37

Midbrain

Front 38

Klebsiella granulomatis

Back 38

causes granuloma inguinale (rare STD in USA)
-lesions may mimic those of syphilis

Front 39

Why is EPI used to treat anaphylaxis?

Back 39

-causes an inc. in cAMP :
1. decreases mast cell degranulation
2. smooth muscle dilation in airways

Front 40

infant botulism

Back 40

<1 yr old
eyelid drooping
difficulty feeding

neurotoxin: flacid paralysis (inhibits release of Ach)

Front 41

LYSOGENY

what is it?
examples?

Back 41

-stable association between bacterium and temperate phage-->how bacterium can get some of its toxins
examples:
ABCDE:
shigA-like toxin
Botulinum toxin
Cholera toxin
Diptheria toxin
erythrogenic toxin of strep pyogenes

Front 42

Budd Chiari syndrome

Back 42

thrombosis obstructs venous outflow of the liver

Front 43

chloroquine

contraindications/SFX

Back 43

psoriasis

chloroquine-retinopathy

Front 44

digoxin toxicity

Back 44

(used for CHF, atrial fib, atrial flutter)

-n/v
-anorexia
-yellow-green halos in visual field
-cardiac arrhythmias

Front 45

flecainide SFX

Back 45

(class IC to treat ventricular arrhythmia)

-paresthesia
-ataxia
-flushing
-vertigo
-tinnitus
-depression
-worsening of cardiac arrhythmias

Front 46

drugs that can induce lupus

Back 46

procainamide
hydralazine
chlorpromazine
isoniazid
methlydopa
quinidine

Front 47

ataxia telangiectasia

1. clinical presentation
2. etiology

Back 47

clinical:
-telangiectasias of the skin and eyes
-variable immunodef.
-progressive ataxia-->wheelchair bound by adolescence
-high incidence of malignancy, esp. lymphoreticular (hodgkin, NHL, leukemia)

etiology:
-11q22-23 mutation: codes for a tumor suppression gene
-mutation causes inc. sn to ionizing radiation, defective DNA repair, frequent c-somal a'nl

Front 48

Abdominal Layers

Back 48

Sometimes Extra Innings TAke Too long. END PLEASE!

Superficial fascia (camper, scarpa)
External Oblique
Internal Oblique
Transversus abdominalis
Traversalis fascia
Extraperitoneal tissue
peritoneum

Front 49

Thiazides vs. Loop Diuretics

Effect on Calcium

Back 49

Thiazides: Increase Calcium reabsoprtion

Loops: block Ca reabsorption

Front 50

Venous drainage of Gonads

Back 50

Left Ovary/Testis-->left gonadal vein-->left renal vein-->IVC (varicocele more common on LEFT)

Right ovary/testis-->right gonadal vein-->IVC

Front 51

lymphatic drainage of Gonads

Back 51

Ovaries/testes-->para-aortic LN

distal 1/3 of vagina, vulva, scrotum--> superficial inguinal nodes

proximal 2/3 of vagina/uterus--> obturator, external iliac, hypogastric nodules

Front 52

what stains TRAP positive (tartrate-resistant acid phosphatase) and talk about that condition

Back 52

Hairy cell leukemia

-rare chronic B cell leukemia of middle aged men
-pancytopenia, splenomegaly, cells w/ cytoplasmic villi (hairs) in BM, spleen, and peripheral blood

Front 53

S-100 marker

Back 53

1. Melanoma
2. neural tumors
3. astrocytomas

Front 54

CA-125 Marker

Back 54

serous cystadenocarcinoma of the ovary

Front 55

Reiter Syndrome

Back 55

"can't see, can't pee, can't climb a tree"

triad of: conjunctivitis, urethritis, arthritis

autoimmune rxn to previous infxn w/:
shigella, salmonella, yersinia, campylobacter, chlamydia

Front 56

Lymphatic drainage of the body

Back 56

Right lymphatic duct-->right subclavian vein
right arm, right of the chest, right side of head

Thoracic duct-->left subclavian vein:
drains rest of body

Front 57

Inclusion bodies:

Cowdry Type A
Koilocytes
Negri Bodies
Owl-eye inclusions
Guarnieri bodies

Back 57

Cowdry Type A: HSV
Koilocytes: HPV (enlarged nucleus, perinuclear vacoulization)
Negri bodies: Rabies (eosinophilic, intraCYTOplasmic)
Owl Eye Inclusions: CMV (basophilic, intraNUCLEAR)
Guarnieri bodies: poxviruses (intraCYTOplasmic)

Front 58

clue cells; condition associated w/ it?

Back 58

seen in bacterial vaginosis

-caused by Gardnerella vaginalis
-malodorous thin & gray discharge

Front 59

patent foramen ovale vs. atrial septal defect

Back 59

PFO: residual slit like opening between atria; patent to a probe but not hemodynamic significance

ASD: much larger opening; can result in inc. O2 saturation on right side(would not result in systolic murmur)

Front 60

glutamate receptors

Back 60

NMDA receptors: permeable to Ca and Na

ligand gated: activates channel

voltage gated: dep. necessary to expel the Mg ion that plugs the channel

other Receptors: ligand gated cation channels: AMPA, kainate

Front 61

lymphoid stem cells give rise to

Back 61

NK cells
B cells
T cells (helper and cytotoxic)

Front 62

meyloid stem cells give rise to

Back 62

neutrophils
monocytes-->macrophages
dendritic cells
eosinophils
basophils
mast cells
platelets
RBCs

Front 63

Leigh Disease
(subacute necrotizing encephalomyopathy)

Back 63

-a'nl mitochondrial DNA: defective cytochrome oxidase
-mm and brain particularly affected
-intellectual deterioration, weakness, ataxia, seizures
-usu. infants 3mos-2yrs, but can also affect teens and adults

Front 64

Inheritance mode, accumulation of?

Adrenoleukodystrophy

Krabbe Disease

Metachromatic leukodystrophy

Back 64

Adreno: XL; a'nl lipid metabolism (demyelination)

Krabbe: AR; cerebroside accum. in histiocytes of CNS

metachro: AR; sphingolipids in CNS and elsewhere

Front 65

Cushing Triad

Back 65

1. htn
2. bradycardia
3. respiratory depression

d/t inc. ICP which constricts the arterioles; cerebral ischemia stim. sym response-->htn and reflex bradycardia

Front 66

spinocerebella degenerative dz

Back 66

Friedrich ataxia
olivopontocerebellar atrophy

-->ataxia is the prominent symptom

Front 67

involvement of soles and palms by rash

-dz process?

Back 67

Secondary syphilis
-caused by treponema pallidum
-spirillar prokaryote w/ internal flagellum

Rocky Mountain spotted fever
-caused by rickettsia rickettsii
-tick born dz! (think parks, mountains)

Front 68

Trinucleotide Repeat Disorders

1. Name 2
2. Mode of inheritance
3. Etiology

Back 68

1. Huntington's
-AD
-polyglutamate exitoxicity

2. Friedrich ataxia:
-AR
-impaired mitochondrial function

Front 69

Skewed Distributions

Back 69

Positive Skew: Mean > Median > mode
Negative Skew: Median > Mean > mode

-median is a better representation of central tendency than the mean
-mode is least affected by outliers in the sample

Front 70

von Hippel-Landau disease

Back 70

-Autosomal dominant
-mutated tumor suppressor VHL on c3
Presentation:
1. cavernous hemangiomas in skin, mucosa, organs
2. bilateral renal cell carcinoma
3. hemangioblastoma in retina, brain stem, cerebellum
4. pheochromocytomas

Front 71

APGAR scoring

Back 71

Appearance
Pulse
Grimace
Activity
Respiration
-taken at 1 and 5 minutes
-max score 10 (2 for each parameter)

Front 72

oxytocin, vasopressin produced where?

released by?

Back 72

made by hypothalamus, released by posterior pituitary (derived from diencephalic neuroectoderm)

Front 73

adenocarcinomas w/ the worst prognosis

Back 73

pancreatic adenocarcinoma
esophageal adenocarcinoma

Front 74

ways to reduce bias

Back 74

1. blind studies (double blind better)
2. placebo responses
3. crossover studies (each subject acts as own control)
4. randomization

Front 75

hypertension, bradycardia, respiratory depression indicates what?

Back 75

incr. intracranial pressure

what is the pathway that causes this?

Hint 75

incr. intracranial pressure (from whatever mechanism) --> constriction of the arterioles -->causes cerebral ischemia (inc. CO2 levels)--> stimulates reflex sympathetic response to vasoconstrict (brain trying to increase blood flow to brain) --> HYPERTENSION --> results in reflex bradycardia

Front 76

pH, Bicarb, pCO2 profiles:
(w/o compensation)
metabolic acidosis
metabolic alkalosis
respiratory alkalosis
respiratory acidosis

Back 76

Metabolic acidosis: all LOW
metabolic alkalosis: all HI
respiratory alkalosis:
pH= hi, bicarb= low, pCO2= low
respiratory acidosis:
pH= low, bicarb= hi, pCO2= hi