Test

Front 1

adult onset Still’s disease

Back 1

polyarthritis associated with sudden onset of high spiking fever, sore throat, and an evanescent erythematous salmon-colored rash

Front 2

Alagille syndrome

Back 2

inherited cholestatic syndrome, associated with biliary hypoplasia (ductopenia), vertebral anomalies, prominent forehead, deep-set eyes, peripheral pulmonic stenosis

Front 3

Albers-Schönberg disease

Back 3

osteopetrosis or marble bone disease

Front 4

Albright’s hereditary osteodystrophy

Back 4

polyostotic fibrous dysplasia, short stature, round face, skeletal anomalies (brachydactyly), and heterotopic calcification, precocious puberty, café-au-lait spots on skin, low calcium, high phosphate, resistance to elevated PTH levels from mutation in Gs coupling PTH receptor to adenylyl cyclase; also see Archibald’s sign

Front 5

Alder-Reilly anomaly

Back 5

large, dark, pink-purple granules in cytoplasm of neutrophils; AR trait resulting in abnormal granule development in neutrophils resembling severe toxic granulation

Front 6

Alport’s syndrome

Back 6

hereditary nephritis accompanied by nerve deafness and various eye disorders, including lens dislocation, posterior cataracts, and corneal dystrophy

Front 7

Alström’s syndrome

Back 7

obesity, autosomal recessive, childhood blindness due to retinal degeneration, nerve deafness, vasopressin-resistant diabetes insipidus, and in males hypogonadism with high plasma gonadotropin levels (end organ resistance to hormones), also baldness, hyperuricemia, hypertriglyceridemia, aminoaciduria

Front 8

angle of Louis

Back 8

sternal angle

Front 9

Anitschkow myocytes

Back 9

in rheumatic fever, large mesenchymal cells in myocardial lesion

Front 10

Archibald’s sign

Back 10

in pseudohypoparathyroidism of Albert’s hereditary osteodystrophy, characteristic shortening of the fourth and fifth digits as dimpling over the knuckles of a clenched fist

Front 11

Argyll Robertson pupils

Back 11

small irregular pupils; accommodate, but don’t react; absence of miotic reaction to light, both direct and consensual, with preservation of a miotic reaction to near stimulus); usually but not always caused by *CNS syphillis*

Front 12

Arnold-Chiari malformation

Back 12

downward displacement of the cerebellar tonsils and medulla through the foramen magnum, results in pressure atrophy of displaced brain tissue, hydrocephalus from obstruction of the CSF outflow tract, is almost always characterized by the presence of a thoracolumbar meningomyelocele

Front 13

artery of Adamkiewicz

Back 13

artery responsible for anterior spinal syndrome; could be bagged in AAA repair

Front 14

Arthus reaction

Back 14

localized area of tissue necrosis resulting from acute immune complex vasculitis; type III hypersensitivity

Front 15

Aschoff body

Back 15

pathognomonic finding in rheumatic carditis, an area of local fibrinoid necrosis surrounded by inflammatory cells including lymphocytes, plasma cells, and macrophages that later resolve to fibrous scar tissue

Front 16

Asherman’s syndrome

Back 16

intrauterine synechiae, typically occurs after curettage of the uterus, presenting as amenorrhea

Front 17

Asperger’s disorder

Back 17

severe and sustained impairment in social interactions and the development of restrictred, repetitive patterns of behavior, intersts, and activities, but intellectually normal and no language delays, but with abnormalities of spoken language

Front 18

atrial conduction system

Back 18

anterior internodal tract, Bachmann’s bundle middle i.t., Wenckebach’s bundle posterior i.t., Thorel’s pathway

Front 19

Auer rods

Back 19

present in acute myelogenous leukemia or refractory anemia with excess blasts; granules form elongated needles, granules are all azurophilic, contain peroxidase; fused lysosomes

Front 20

Auerbach’s plexus

Back 20

myenteric plexus, between the longitudinal and circular layers of muscle; provides motor innervation to the two muscle layers and secretomotor innervation to the mucosa

Front 21

Auspitz’s sign

Back 21

for psoriasis; sign is positive when slight scratching or curetting of a scaly lesion reveals punctate bleeding points within the lesion; suggests psoriasis, but is not specific

Front 22

Austin Flint murmur

Back 22

diastoic rumble in aortic insufficiency heard in cardiac apex, thought to be due to aortic jet impinging on the mitral valve, causing it to vibrate and also from simultaneous diastolic filling of the left ventricle from the left atrium and aorta tends to close the mitral valve in diastole, producing physiologic stenosis

Front 23

Australia antigen

Back 23

HBsAg, found in the serum of an Australian aborigine

Front 24

Ballance’s sign

Back 24

tender mass in the LUQ due to a spleen hematoma

Front 25

bamboo spine

Back 25

seen in ankylosing spondylitis

Front 26

Banti’s syndrome

Back 26

splenomegaly, hypersplenism, and portal hypertension, noncirrhotic, arises after subclinical occlusion of the portal vein, usually years after occlusive event

Front 27

Bantu siderosis

Back 27

unusual form of iron overloading resembling hereditary hemochromatosis in South African blacks ingesting large quantities of alcoholic beverages fermented in iron utensils

Front 28

Barlow’s maneuver

Back 28

for congenital hip dislocation, patient placed in supine position and attempt made to push femurs posteriorly with knees at 90 degrees/hip flexed and hip will dislocate

Front 29

Barrett’s esophagus

Back 29

esophageal strictures and epithelial metaplasia from squamous epithelium to a specialized columnar epithelium with intestinal metaplasia in 10% of severe GERD

Front 30

Bartter’s syndrome

Back 30

primary elevation in renin due to idiopathic hyperfunction of the juxtaglomerular apparatus but with normal blood pressure

Front 31

basal nucleus of Meynert

Back 31

degenerates in Alzheimer’s; uses ACh

Front 32

Batson's plexus

Back 32

portal vertebral venous communications, may be responsible for isolated bone mets in sacrum or vertebral bodies from colorectal cancer

Front 33

Battle’s sign

Back 33

ecchymoses over the mastoid process in basilar skull fractures

Front 34

BCG

Back 34

Bacille bilié de Calmette-Guérin; Leon A. Calmette, French bacteriologist, 1863-1933; Camille Guérin, French bacteriologist, 1872-1961; attenuated strain of Mycobacterium bovis bacille Calmette-Guérin

Front 35

Beau’s lines

Back 35

horizontal depressions across nail plate, caused by a transient arrest in nail growth, can occur during acute stress (e.g., high fever, circulatory shock, myocardial infarction, pulmonary embolism); will manifest as Beau’s lines as nail grows out

Front 36

Bechterew’s disease

Back 36

ankylosing spondylitis

Front 37

Beck’s triad

Back 37

in pericardial tamponade, distended neck veins, distant heart sounds, hypotension, i.e. rising venous pressure, falling arterial pressure, and decreased heart sounds

Front 38

Beckwith-Wiedemann syndrome

Back 38

exomphalos, macroglossia, gigantism

Front 39

Behcet’s diease

Back 39

aphthous ulcers, genital ulcerations, ocular inflammation (posterior uveitis), erythema nodosum, cutaneous pustular vasculitis, also synoviits, neurologic issues, and thrombophlebitis

Front 40

Bell’s palsy

Back 40

seventh nerve palsy; seen as a complication in diabetes, tumors, sarcoidosis, AIDS, and Lyme disease

Front 41

Bell’s phenomenon

Back 41

when an attempt is made to close the eyelid, the eyeball on the affected side may turn upward

Front 42

Bence Jones proteins

Back 42

free L chains of immunoglobulin seen ins plasma cell dyscrasias (e.g. multiple myelomas), filtered by glomerulus and then reabsorbed tubular cells; proteins are toxic to tubule cells

Front 43

Benedikt syndrome

Back 43

paramedian midbrain syndrome

Front 44

Bennett’s fracture

Back 44

fracture of the base of the first metacarpal with involvement of carpometacarpal joint

Front 45

Bergman’s triad

Back 45

seen with fat emboli syndrome: 1) mental status changes 2) petechiae (often in the axilla/thorax) 3) dyspnea

Front 46

Bernard-Soulier disease

Back 46

absence of Gp Ib/IX, the von Willebrand receptor

Front 47

Bernheim effect

Back 47

in aortic stenosis, right ventricular failure preceding left ventricular failure from hypertrophied ventricular septum bulging into and encroaching on right ventricular filling

Front 48

Bernstein test

Back 48

to test for GERD, acid perfusion test of esophagus with 0.1 N HCl and see if reproduces chest pain; limited sensitivity and specificity though

Front 49

Betz cells

Back 49

large pyramidal cells in layer 5 of primary motor cortex largest neurons in mammalian CNS; 30-40,000 Betz cells in precentral gyrus in one side of the brain

Front 50

Bier block

Back 50

regional anesthesia of an extremity by placing a tourniquet and then infusing local anesthetic into a vein

Front 51

Billroth I

Back 51

antrectomy with gastroduodenostomy

Front 52

Billroth II

Back 52

antrectomy with gastrojejunostomy

Front 53

Billroth’s cords

Back 53

the splenic cords found in the red pulp between the sinusoids

Front 54

Binswanger’s disease

Back 54

subcortical leukoencephaly, is associated with hypertension; it is characterized by the presence of multiple lacunar infarcts and progressive demyelination limited to the subcortical area, with characteristic sparing of cortex

Front 55

Birbeck’s granules

Back 55

aka Langerhans’s granules; a small tennis racket-shaped membrane-bound granule with characteristic cross-striated internal ultrastructure; first reported in Langerhans’s cells of the epidermis

Front 56

Bitot’s spots

Back 56

in vitamin A deficiency, small, circumscribed, lusterless, grayish white, foamy, greasy, triangular deposits on the bulbar conjunctiva adjacent to the cornea in the area of the palpebral fissure of both eyes

Front 57

Bloom’s syndrome

Back 57

severe immunodeficiency, growth retardation, and predisposition to several types of cancers associated with hypersensitivity to a variety of DNA-damaging agents

Front 58

Blount’s disease

Back 58

idiopathic varus bowing of tibia

Front 59

Blumberg sign

Back 59

rebound tenderness

Front 60

Blumer shelf

Back 60

carcinomatous metastasis from a primary site high up in the peritoneal cavity, may accumulate in the stomach, felt through the anterior rectal wall as a hard shelf in the rectovesical or rectouterine pouch (pouch of Douglas)

Front 61

Boas’s sign

Back 61

right subscapular pain due to cholelithiasis

Front 62

Bochdalek's hernia

Back 62

hernia through the posterior diaphram, usually on the left, presents in infancy

Front 63

Boerhaave’s syndrome

Back 63

pressure rupture of the esophagus; can give rise to Hamman’s sign

Front 64

Bohr effect

Back 64

fall in pH leading to decrease in oxygen affinity of hemoglobin

Front 65

Bohr equation

Back 65

Vd/Vt, for determining ratio of physiologic dead space

Front 66

Bonnet’s sign

Back 66

banking of veins distal to AV crossings (grade 3) in hypertensive retinopathy; c.f. with Salus’s sign and Gunn’s sign

Front 67

Bordet-Gengou medium

Back 67

for identifying Bordetella pertussis, medium contains high percentage of blood (20-30%) to inactivate inhibitors in blood; also has potato and glycerol

Front 68

Bornholm disease

Back 68

coxsackie group B virus producing pleurodynia, fever

Front 69

Boston sign

Back 69

in thyrotoxicosis, jerking of the lagging lid

Front 70

Bouchard’s nodes

Back 70

bony spurs at PIP in OA

Front 71

Bowditch staircase

Back 71

increased heart rate increases the strength of contraction in a stepwise fashion as the intracellular calcium increases over several beats

Front 72

Bowen’s disease

Back 72

carcinoma in situ of penis or scrotum, usually presents as a single erythematous plaque, most often on the shaft of the penis or on the scrotum, peak incidence after 50s; or more generally, squamous carcinoma in situ

Front 73

Boxer’s fracture

Back 73

fracture of the metacarpal neck, classically of msall finger

Front 74

Brill-Zinser disease

Back 74

recurrent form of epidemic typhus (Rickettsiae prowazekii); persistently infected as a source

Front 75

Briquet’s syndrome

Back 75

somatization disorder

Front 76

Broca’s area

Back 76

left frontal speech area, important for articulating speech; in Broca’s aphasia, because Broca’s area near motor cortex and underlying internal capsule, a right hemiparesis and homonymous hemianopsia is almost always present in this type of aphasia

Front 77

Brodie’s abscess

Back 77

small, intraosseus abscess that frequently involves the cortex and is walled off by reactive bone

Front 78

Brown-Séquard syndrome

Back 78

Loss of tactile sense, vibration sense, and limb position sense on the ipsilateral side and loss of pain and temperature sense on the contralateral side

Front 79

Brudzinski sign

Back 79

flex the neck, watch the hips and knees in reaction to maneuver positive sign, flexion of hips and knees, suggests meningeal inflammation

Front 80

Brunner’s glands

Back 80

in duodenum, submucosal mucous glands that secrete bicarbonate, glycoproteins, and pepsinogen II, virtually indistinguishable from pyloric mucous glands

Front 81

Brushfield’s spots

Back 81

in Down’s syndrome, small white spots on the periphery of the iris

Front 82

Bruton’s tyrosine kinase

Back 82

mutation causes X-linked agammaglobulinemia (XLA also associated with defect in intact membrane-bound  chain (it’s essential for B-cell development) Btk found only in B cells

Front 83

Budd-Chiari syndrome

Back 83

occlusion of the hepatic vein, associated with polycythemia vera, pregnancy, postpartum state, oral contraceptives, paroxysmal nocturnal hemoglobinuria, and intra-abdominal cancers, particularly hepatocellular carcinoma

Front 84

Burnett’s syndrome

Back 84

far-advanced milk-alkali syndrome, due to long-standing calcium and alkali ingestion; severe hypercalcemia, irreversible renal failure, and phosphate retention, may be accompanied by ectopic calcification

Front 85

Buschke-Löwenstein tumor

Back 85

giant anal condyloma

Front 86

Cabot ring

Back 86

in asplenia or malfunctional spleen, nuclear remnants on red blood cells as a thin, darkly-stained ring that follows the margin of the red cell

Front 87

Caisson disease

Back 87

decompression sickness

Front 88

Call-Exner bodies

Back 88

in granulosa cell tumors, small follicles filled with eosinophilic secretion; an important diagnostic feature

Front 89

Calot’s triangle

Back 89

the area bordered by the 1. cystic duct, 2. common hepatic duct, 3. lower edge of the liver; cystic artery, sometimes hepatic artery found here

Front 90

Campbell de Morgan spots

Back 90

cherry angioma

Front 91

Canale-Smith syndrome

Back 91

childhood disorder, first described in 1967, characterized by lymphadenopathy and autoimmunity; associated with mutations in Fas; implicates gene in accumulation of lymphocytes and the autoimmunity characteristic of the syndrome

Front 92

canals of Hering

Back 92

at the fringes of the portal tract, from the joining of bile canaliculi

Front 93

canals of Lambert

Back 93

direct accessory bronchioalveolar connections

Front 94

Cantlie’s line

Back 94

separates the right and left lobes of the liver—a line drawn from the IVC to just left of the gallbladder fossa

Front 95

Caplan’s syndrome

Back 95

coexistence of rheumatoid arthritis with a pneumoconiosis, leading to the development of distinctive pulmonary lesions that develop fairly rapidly; these nodular lesions have central necrosis surrounded by fibroblasts, macrophages, and collagen; can occur in asbestosis and silicosis

Front 96

carcinoid triad

Back 96

1) flushing 2) diarrhea 3) right-sided heart failure (also bronchospasm)

Front 97

Carey Coombs murmur

Back 97

a blubbering apical mid diastolic murmur occurring in the acute stages of rheumatic mitral valvulitis and disappearing as the valvulitis subsides; Carey Coombs, English physician, 1879-1932

Front 98

Carnett’s test

Back 98

head raise, tenderness persists in abdominal wall condition (rectus hematoma) whereas pain due to intraperitoneal disease lessens

Front 99

Carney syndrome

Back 99

AD complex cardiac myxomas, aggressive biologic behavior, spotty pigmentation, issue with endocrine tumors

Front 100

Caroli’s disease

Back 100

larger ducts of the intrahepatic biliary tree are segmentally dilated and may contain inspissated bile; pure forms are rare; this disease is usually associated with portal tract fibrosis of the congenital hepatic fibrosis type

Front 101

Carrión’s disease

Back 101

see Oroya fever

Front 102

Carvallo’s sign

Back 102

in tricuspid regurgitation, murmur increases with inspiration

Front 103

Castleman’s disease

Back 103

benign lymphoproliferative disorder, characterized by hyperplastic lymphoid follicles with capillary proliferation

Front 104

cat-scratch disease

Back 104

tender regional lymphadenopathy persisting for 3 weeks or longer, frequently preceded by primary skin lesion after contact with kits, appears to be caused by Bartonella (formerly Rochalimaea) henslae, a small, pleomorphic gram-negative bacillus

Front 105

Chadwick’s sign

Back 105

blue-red passive hyperemia of the cervix, characteristic of pregnancy

Front 106

Chagas’s disease

Back 106

zoonosis caused by protozoan parasite Trypanosoma cruzi; causes destruction of the myenteric plexus of the esophagus, duodenum, colon, and ureter, with resultant dilatation of these structures

Front 107

Charcot’s joints

Back 107

neurogenic joint degeneration, can be secondary to syphillis, peripheral neuropathy

Front 108

Charcot’s triad

Back 108

in multiple sclerosis, nystagmus, intention tremor, and staccato speech (or scanning speech)

Front 109

Charcot’s triad

Back 109

in 70% of patients with bacterial cholangitis, right-upper-quadrant pain, jaundice, and fever; c.f. Reynold’s pentad

Front 110

Charcot-Leyden’s crystals

Back 110

crystals in the shape of elongated double pyramids, formed from eosinophils, found in the sputum in bronchial asthma and in other exudates or transudates containing eosinophils

Front 111

Chédiak-Higashi syndrome

Back 111

autosomal recessive disorder, neutropenia, defective degranulation, and delayed microbial killing. Neutrophils and other leukocytes have giant granules (can be seen on blood smears). Effect of microtubule polymerization causes delayed or decreased fusion of lysosomes with phagosomes in leukocytes and thus impairs phagocytosis of bacteria (Robbins 24)

Front 112

Chilaiditi syndrome

Back 112

when redundant loops of transverse colon slip between the liver and diaphragm and cause vovulus

Front 113

Christmas disease

Back 113

hemophilia B, deficiency in factor IX

Front 114

Churg-Strauss syndrome

Back 114

allergic angiitis and granulomatosis involvement in the lung

Front 115

Chvostek’s sign

Back 115

hypocalcemia, in latent tetany, tapping the facial nerve against the bone just anterior to the ear producing ipsilateral contraction of facial muscles

Front 116

Civatte bodies

Back 116

aka colloid bodies; in lichen planus; anucleate, necrotic basal cells becoming incorporated into the inflamed papillary epidermis

Front 117

Clara cells

Back 117

cells found in the epithelium of terminal and respiratory bronchioles, devoid of cilia, present secretory granules in their apex and are known to secrete glycosoaminoglycans that probably protect the bronchiolar lining

Front 118

clay shoveler’s fracture

Back 118

fracture of spinous process of C7

Front 119

Clutton’s joints

Back 119

in congenital syphillis, symmetrical arthrosis, especially of the knee joints

Front 120

Cockayne’s syndrome

Back 120

dwarfism, precociously senile appearance, pigmentary degeneration of the retina, optic atrophy, deafness, sensitivity to sunlight, and mental retardation; autosomal recessive inheritance defect in DNA repair?

Front 121

Codman’s triangle

Back 121

in osteosarcoma, the triangular shadow between the cortex and raised ends of periosteum is known radiographically as Codman’s triangle, and is characteristic but not diagnostic of this tumor

Front 122

Colles’s fracture

Back 122

a fracture of the distal radius that occurs when persons fall with outstretched hands to try to catch themselves

Front 123

conjoint tendon

Back 123

aponeurotic attachments of the transversus abdominis to the pubic tubercle (the classic conjoining of the aponeurosis of the intenal oblique and transversus aponeurosis <4%)

Front 124

Conn’s syndrome

Back 124

primary hyperaldosteronism, caused by an aldosterone-secreting tumor, resulting in hypertension, hypokalemia, hypernatremia, metabolic alkalosis, and low plasma renin

Front 125

Cooley’s anemia

Back 125

homozygous  thalassemia; Mediterranean anemia

Front 126

Coombs test

Back 126

direct, ability of anti-IgG or anti-C3 antisera to agglutinate the patient’s red blood cells; cold reacting antibodies react with anti-C3 (mostly drug-related antibodies, IgM antibodies (generally to polysaccharide), IgG antibodies of low affinity); indirect Coombs, serum of the patient is incubated with normal red cells, though IgM antibodies may agglutinate directly

Front 127

Cooper's hernia

Back 127

hernia through the femoral canal and tracking into the scrotum or labia majus

Front 128

Cori’s disease

Back 128

glycogen storage disease type III, deficiency in debranching enzyme, amylo-1,6-glucosidase, leading to variable accumulation of glycogen in the liver, heart, or skeletal muscle, characterized by stunted growth, hepatomegaly, and hypoglycemia

Front 129

Corrigan’s pulse

Back 129

in aortic regurgitation, pulses are of the water-hammer or collapsing type with abrupt distension and quick collapse, can be exaggerated by raising the patient’s arm

Front 130

Councilman bodies

Back 130

in apoptosis, hepatocytes that round up to form shrunken, pyknotic, and intensely eosinophilic bodies

Front 131

Courvoisier’s law

Back 131

tumors that obstruct the common bile duct result in an enlarged bladder; obstructing stones do not, since the gallbladder is typically too scarred to allow enlargement; present in half of pancreatic CA

Front 132

Cowden disease

Back 132

some rare hereditary cancer on chr 10; associated with mutations in PTEN/MMAC1

Front 133

cri du chat

Back 133

5p-, severe mental retardation, microcephaly, catlike cry, low birth weight, hypertelorism, low-set ears, and epicanthal folds

Front 134

Crigler-Najjar syndrome

Back 134

type I, no hepatic glucoronyltransferase activity, kernicterus, requires liver transplantation; type II, moderate deficiency of glucoronyltransferase, phenobarb induces activity

Front 135

Cronkhite-Canada syndrome

Back 135

diffuse GI hamartoma polyps (i.e., no cancer potential) associated with malabsorption/weight loss, diarhea and loss of electrolytes/protein; signs include alopecia, nail atrophy, and skin pigmentation

Front 136

Crouzon syndrome

Back 136

craniosynostosis correlated in mutations with the extracellular domain of FGFR2

Front 137

Cruveihiler-Baumgarten bruit

Back 137

bruit heard over caput medusa in portal hypertension

Front 138

Cullen’s sign

Back 138

a faintly blue coloration particularly of umbilicus as the result of retroperitoneal bleeding from any cause, but especially in ruptured ectopic pregnancy; also seen in acute pancreatitis (1-2%)

Front 139

Curling’s ulcers

Back 139

stress erosions and ulcers occurring in the proximal duodenum and associated with severe burns or trauma, from ischemia of the gastric mucosa

Front 140

Curschmann’s spirals

Back 140

spirally twisted masses of mucus plugs containing whirls of shed epithelium occurring in the sputum in bronchial asthma; Heinrich Curschmann, German physician, 1846-1910

Front 141

Cushing reaction

Back 141

increase in intracranial pressure cause compression of the cerebral blood vessels and cerebral ischemia, reaction of elevation in pressure with simultaneous reduction in heart rate, respiratory slowing

Front 142

Cushing’s triad

Back 142

signs of increased ICP 1. hypertension 2. bradycardia 3. irregular respirations

Front 143

Cushing’s ulcer

Back 143

acute ulcer of the stomach, proximal duodenum, or esophagus, frequently leads to hemorrhage or perforation, associated with intracranial injury or increases in intracranial pressure, associated with gastric acid hypersecretion

Front 144

Da Costa syndrome

Back 144

neurocirculatory asthenia, pain localized typically to the cardiac apex and consists of dull, persistent ache that lasts for hours, etc.

Front 145

Dalrymple sign

Back 145

retraction of the upper eyelid in Graves’s disease, causing abnormal wideness of the palpebral fissure

Front 146

Dance’s sign

Back 146

empty right lower quadrant in children with ileocecal intussusception

Front 147

Dandy-Walker syndrome

Back 147

hydrocephalus resulting from failure of the foramina Luschka and Magendie to open; associated with an occipital meningocele and agenesis of the cerebellar vermis and splenium of the corpus callosum; associated with warfarin use during pregnancy

Front 148

Dane particle

Back 148

mature HBV virion, 42 nm, double-layered, genome is double-stranded circular DNA, all regions of genome encode stuff

Front 149

Darier’s sign

Back 149

in mastocytosis (urticaria pigmentosa), is positive when a brown macular or a slightly papular lesion becomes a palpable wheal after being vigorously rubbed with the blunt end of an instrument such as a pen; wheal may not appear for 5-10 minutes

Front 150

de Musset’s sign

Back 150

in aortic regurgitation, head bobbing

Front 151

De Quervain’s disease

Back 151

a stenosing tenosynovitis of the thumb extensors and abductors

Front 152

de Quervain’s thyroiditis

Back 152

subacute granulomatous thyroiditis, viral etiology suspected

Front 153

Dejerine-Roussy syndrome

Back 153

thalamic lesions causing sensory loss, spontaneous pain, and perverted cutaneous sensation described in 1906

Front 154

DENNIE’S LINES

Back 154

in atopic dermatitis, an accentuated line or fold below the margin of the lower eyelid

Front 155

Di Guglielmo syndrome

Back 155

a non-nutritive megaloblastic anemia in which malignant red cell precursors are particularly evident

Front 156

Diamond-Blackfan anemia

Back 156

congenital pure red cell aplasia

Front 157

Dick test

Back 157

injection of erythogenic toxin of Strep. pyogenes, positive result in those lacking antitoxin

Front 158

Dieulafoy’s aneurysm

Back 158

AV malformation of the stomach (around 6 cm from the gastroesophageal junction), an uncommon cause of massive GI bleeding, a large submucosal artery erodes the mucosa without any overlying ulceration or other obvious mucosal damage

Front 159

DiGeorge syndrome

Back 159

failure of 3rd and 4th pharyngeal pouches to differentiate into the thymus and parathyroid glands, facial abnormalities result primarily from abnormal development of the first arch components during formation of face and ears

Front 160

dimple sign

Back 160

in dermatofibroma, lateral compression with thumb and index finger produces a depression, or “dimple.”

Front 161

Döhle bodies

Back 161

irregularly shaped greenish inclusions in neutrophil cytoplasm, consisting of ribosomes and/or rough ER and are seen in severe bacterial infections

Front 162

Donath-Landsteiner antibody

Back 162

in paroxysmal cold hemoglobinuria, an antibody associated with syphillis and viral infections, directed against the P antibody complex and can induce complement-mediated lysis; attacks precipitated by exposure to cold and are associated with hemoglobinemia and hemoglobinuria; chills and fever; back, leg, and abdominal pain; headache and malaise; recovery prompt; asymptomatic otherwise

Front 163

Donovan bodies

Back 163

in Calymmatobacterium granulomatis or granuloma inguinale, bodies characterized by multiple organisms filling large histiocytes

Front 164

Dressler’s syndrome

Back 164

pericarditis, possible autoimmune etiology, found to develop 2 weeks to several months after acute MI

Front 165

Druckrey relationship

Back 165

relationship between carcinogen dose and tumor induction time: dtn = k where d is the dose of carcinogen, t is latency period, n is the slope of the double log [plot of carcinogen dose versus induction time, and k is a constant

Front 166

Dubin-Johnson syndrome

Back 166

mostly conjugated hyperbilirubinemia from defect in transport of bilirubin and other organic anions across the canaliculus; other liver function tests normal; accumulation of dark pigment in liver lysosomes

Front 167

duct of Santorini

Back 167

dorsal duct of pancreas, embryologically, the biggest duct, clinically the smaller pancreatic duct

Front 168

duct of Wirsung

Back 168

embryologically confined to the ventral pancreas, becomes functionally the main pancreatic duct after duct fusion occurs; drains the bulk of pancreatic secretion through the major papilla

Front 169

ducts of Luschka

Back 169

small tubular channels found buried within the gallbladder wall adjacent to the liver, communicates with the biliary tree, rarely patent accessory bile secretory ducts

Front 170

dumping syndrome

Back 170

delivery of a large amount of hyperosmolar chyme into the small bowel, usually after vagotomy and a gastric drainage procedure, results in autonomic instability, abdominal pain, and diarrhea

Front 171

Dunphy sign

Back 171

increased pain with coughing in appendicitis

Front 172

Dupuytren’s contracture

Back 172

palmar fibromatosis

Front 173

Duroziez’s sign

Back 173

in aortic regurgitation, systolic murmur heard over the femoral artery when it is compressed proximally and a diastolic murmur when it is compressed distally

Front 174

Ebstein’s anomaly

Back 174

malformation characterized by the downward displacement of the tricuspid valve into the right ventricle due to anomalous attachment of the tricuspid leaflets; associated with maternal exposure to Li

Front 175

Edwards’s syndrome

Back 175

trisomy 18, mental retardation, prominent occiput, micrognathia, low-set ears, rocker-bottom feet, flexion deformities of the fingers, and congenital heart disease

Front 176

Eisenmenger complex

Back 176

a ventricular septal defect with right ventricular hypertrophy, severe pulmonary hypertension, and frequent straddling of the defect by a misplaced aortic root

Front 177

Eisenmenger syndrome

Back 177

cardiac failure with significant right to left shunt producing cyanosis due to higher pressure on the right side of the shunt; usually due to the Eisenmenger complex any anomalous circulatory communication that leads to obliterative pulmonary vascular disease; or maybe

Front 178

Ellsworth-Howard test

Back 178

for diagnosis of pseudohypoparathyroidism, can administer PTH

Front 179

Elschnig spots

Back 179

yellow (early) or hyperpigmented (late) patches of retinal pigment epithelium overlying infarcted choriocapillaris lobules in hypertensive retinopathy

Front 180

Emery Dreifus muscular dystrophy

Back 180

proximal weakness with quite pronounced muscle contractions and by severe cardiac arrhythmias which may cause sudden death

Front 181

Epsom salts

Back 181

magnesium sulfate, laxative

Front 182

Epstein’s pearls

Back 182

small, white cysts along the median raphe of the hard palate

Front 183

Epstein-Barr virus

Back 183

EBV binds to CD21 found on epithelial cells and B cells; however a large number of T suppressor cells and EBV specific cells are seen as atypical lymphocytes

Front 184

Erb palsy

Back 184

C5 and C6 nerve roots

Front 185

Erlenmeyer’s flask deformity

Back 185

seen in osteopetrosis, where the ends of long bones are bulbous

Front 186

erythroplasia of Queyrat

Back 186

carcinoma in situ of the glans penis Auguste Queyrat, French dermatologist, born 1872

Front 187

Evan’s syndrome

Back 187

ITP and immunohemolytic anemia

Front 188

EWART’S SIGN

Back 188

in large pericardial effusion, dullness to percussion of the left lung over the angle of the scapula may occur; due to compressive atelectasis by the large pericardial sac

Front 189

Ewing’s sarcoma

Back 189

onion skinning

Front 190

facies Hippocratica

Back 190

the mask of death following peritonitis, i.e. as a result of vomiting and depressed circulation, the face becomes pinched and anxious, the cheeks hollow, and the eyes dim and beringed with dark circles

Front 191

factor V Leiden

Back 191

Arg(506)  Gln, results in resistance to cleavage by activated protein C (an anticoagulant), found in 20% of patients with venous thromboembolism, 6% of U.S. population

Front 192

Fanconi’s anemia

Back 192

autosomal recessive, predisposal to aplastic anemia, progressive bone failure at age 5-7, congenital malformations

Front 193

Fanconi’s syndrome

Back 193

generalized dysfunction of proximal renal tubule leading to glycosuria, hyperphosphaturia, hypophasphatemia, aminoaciduria, and systemic acidosis; may be associated with out-dated tetracyclines

Front 194

farmer’s skin

Back 194

cutis rhomboidalis nuchae

Front 195

Felty’s syndrome

Back 195

the combined features of rheumatoid arthritis, splenomegaly, and neutropenia, and leg ulcers; associated with HLA-DR;

Front 196

Ferguson’s reflex

Back 196

anesthesia in ob, interruption of oxytocin release in response to cervical dilatation may cause uterine inhibition

Front 197

fifth disease

Back 197

erythema infectiosum, associated with parvovirus B19 infection, characterized by “slapped cheeks” and erythematous lacy eruption on the trunk and extremities; other 4 childhood rash diseases: measles, rubella, scarlet fever, and roseola (herpesvirus VI)

Front 198

Fisher’s syndrome

Back 198

ataxia with ophthalmoplegia and areflexia; a form of polyneuroradiculitis

Front 199

Fitz-Hugh-Curtis syndrome

Back 199

associated with spread of gonococci or chlamydiae: perihepatitis manifested by right upper quadrant or bilateral upper abdominal pain and tenderness and occasionally by a hepatic friction rib

Front 200

foramen of Magendie

Back 200

midline foramen exiting out of fourth ventricle

Front 201

foramen of Winslow

Back 201

anteior portal triad; posterior IVC and right crus of diaphragm; superior caduate lobe; inferior superior part of duodenum, portal triad

Front 202

foramina of Luschka

Back 202

two laterally placed foramens exiting out of fourth ventricle

Front 203

foramina of Monro

Back 203

connects each of the lateral ventricles with the third ventricle

Front 204

Foster Kennedy syndrome

Back 204

optic atrophy, contralateral papilledema, and anosmia; may be associated with olfactory groove meningioma

Front 205

Fothergill’s sign

Back 205

in rectus sheath hematomas, tender mass that does not cross the midline and remains palpable when patient tenses the rectus muscle (bluish discoloration not usualy seen until 3 or 4 days)

Front 206

Fox's sign

Back 206

in hemorrhagic pancreatitis, ecchymosis of the inguinal ligament due to blood tracking from the retroperitoneum and collecting at the inguinal ligament

Front 207

Franklin’s disease

Back 207

gamma heavy chain disease, characterized by LAD, fever, anemia, malaise, HSM, and weakness, most distinctive symptom palatal edema

Front 208

Freidreich’s foot

Back 208

seen in Freidreich6s ataxia, pes cavus with hammer toe

Front 209

Friedreich’s ataxia

Back 209

a spinocerebellar degeneration, AR manifesting at 11 years, a less common AD 20 years; initial symptoms, gait ataxia, hand clumsiness, dysarthria, DTRs absent (extensor plantar present), joint position and vibratory sense impaired, sometimes loss of pain and temperature, paralyzed over course of 20 years, high incidence of diabetes and hypertrophic cardiomyopathy (dilated less common) and arrhythmias

Front 210

Froment’s sign

Back 210

dx of ulnar nerve lesion; caused by flexor pollicus longus (median nerve) which comes into action when the patient attempts to grip a flat object between the thumb and the hand, and causes flexion at the interphalangeal joint

Front 211

Gaisböck’s syndrome

Back 211

stress polycythemia, combination of modest elevation in hematocrit and normal red cell mass; unknown etiology, seen in hard-driving middle-aged males, usually smokers, who in addition tend to be overweight and hypertensive

Front 212

Galeazzi fracture

Back 212

fracture of the radius at the junction of the middle and distal thirds accompanied by disruption of the distal radioulnar joint

Front 213

Gallavardin effect

Back 213

midsystolic murmur of AS may be well transmitted to the apex, especially in older patients where it becomes harsh and slightly higher pitched, the so-called Gallavardin effect

Front 214

Gallivardin’s phenomenon

Back 214

systolic ejection murmor in aortic stenosis best heard in aortic area, often disappears over sternum, reappears in apical area, mimicking mitral regurgitation

Front 215

Gandy-Gamna nodules

Back 215

in congestive splenomegaly, organization of focal hemorrhages giving rise to foci of fibrosis containing deposits of iron and calcium salts encrusted on connective tissue and elastic fibers

Front 216

Gardner’s syndrome

Back 216

familial adenomatous polyposis (now realized all patients with FAP have extraintestinal manifestations), exhibiting intestinal polyps identical to those in FAP combined with 1. sebaceous cysts, 2. osteomas (particularly of the mandible, skull, and long bones), 3. desmoid tumors; mutation in adenomatous polyposis coli (APC) gene in 5q

Front 217

gastrinoma triangle

Back 217

a triangle where more than 90% of extrapancreatic gastrinomas are located bordered by 1. Third portion of duodenum, 2. Cystic duct, 3. Pancreatic neck

Front 218

Gaucher’s disease

Back 218

AR, mutations in glucocerebrosidase gene on 1q21, enzyme cleaves glucose residue from ceramide; type I, chronic non-neuronopathic form, splenic and skeletal involvement

Front 219

Gerota’s fascia

Back 219

fascia surrounding the kidney

Front 220

Gerstmann-Straussler-Scheinker syndrome

Back 220

slow central nervous system disease with same mutation, point mutation in codon 102 of prion protein as CJD

Front 221

Ghon lesion

Back 221

primary area of tuberculosis infection

Front 222

Gibbs-Donnan equilibrium

Back 222

in RBCs, biocarbonate ions diffusing out and chloride diffusing in

Front 223

Gilbert’s syndrome

Back 223

with the exception of hemolytic anemias, most common cause of mild unconjugated hyperbilirubinemia from mild decrease glucoronyltransferase activity, responds to phenobarbital, affects up to 7% of population

Front 224

glands of Montgomery

Back 224

sebaceous glands of areola

Front 225

Glanzmann’s thrombasthenia

Back 225

Gp IIb/IIIa receptor for fibrinogen missing

Front 226

Glauber’s salt

Back 226

sodium sulfate, laxative

Front 227

Glisson's capsule

Back 227

liver capsule

Front 228

glycogen storage diseases

Back 228

type I, von Gierke’s disease type II, Pompe’s disease type III, Cori’s disease type V, McAdle’s syndrome

Front 229

Goetz sign

Back 229

in PDA, jet of unopacified blood from aorta into opacified blood of pulmonary artery

Front 230

Goldie-Coldman hypothesis

Back 230

malignant cells likely to acquire spontaneous resistance to cytotoxic drugs as they progressively grow and divide, even without any exposure to those drugs

Front 231

Goodpasture’s syndrome

Back 231

glomerulonephritis characterized by linear deposits of antibody along the glomerular basement membrane, antibodies interact with alveolar wall, leads to pulmonary hemorrhage and pulmonary fibrosis; Goodpasture antigen, resides in the noncollagenous portion of the 3 chain of collagen type IV; high prevalence of DRW15/DQW6

Front 232

Goodsall’s rule

Back 232

anal fistulae course in a straight path anteriorly and take a curved path posteriorly

Front 233

Gorham-Stout disease

Back 233

vanishing or disappearing bone disease; IL-6 has pathogenetic role

Front 234

Gottron’s papules

Back 234

violaceous papules over knuckle prominences found in dermatomyositis

Front 235

Gower’s maneuver

Back 235

Duchenne’s muscular dystrophy, patient using hands to help himself get up

Front 236

Grey Turner’s sign

Back 236

local areas of discoloration about the umbilicus and particularly in the region of the *loins*, in acute hemorrhagic pancreatitis (1-2%) and other causes of retroperitoneal hemorrhage

Front 237

Griffith’s sign

Back 237

in thyrotoxicosis, lag of the lower lids during elevation of the globes

Front 238

Grotton’s lesions

Back 238

in dermatomyositis, scaling erythematous eruption or dark red patches over the knuckles, elbows, knees

Front 239

Gunn’s sign

Back 239

tapering of veins on either side of AV crossing in hypertensive retinopathy (grade 3); c.f. Salus’s sign and Bonnet’s sign

Front 240

Gunther’s disease

Back 240

AR congenital erythropoietic porphyria from decreased URO synthase activity, hemolytic anemia, cutaneous lesions

Front 241

Guthrie test

Back 241

for dx of PKU, a bacterial assay for phenylalanine

Front 242

Hailey-Hailey disease

Back 242

benign familial chronic pemphigus

Front 243

Haldane effect

Back 243

deoxygenated hemoglobin having a greater affinity for CO2 than oxygenated hemoglobin

Front 244

Ham’s test

Back 244

for diagnosing paroxysmal nocturnal hemoglobinuria, uses increased sensitivity of PNH-affected RBCs to lysis by complement; introduced in late 1930’s

Front 245

Hamman’s sign

Back 245

mediastinal crunch is a series of precordial crackles synchronous with the heart beat, not with respiration. Best heard in the left lateral position, it is due to mediastinal emphysema (pseudomediastinum), seen with Boerhaave’s syndrome

Front 246

Hamman-Rich syndrome

Back 246

idiopathic pulmonary fibrosis; immune complex disease with progressive fibrosis of the alveolar wall

Front 247

Hampton’s hump

Back 247

pulmonary infarction is classically described as wedge-shaped infiltrate that abuts the pleura; often associated with a small pleura effusion that is usually exudative and may be hemorrhagic; not specific

Front 248

Hampton’s line

Back 248

radiolucent collar of granulation tissue across the base of an ulcer

Front 249

Hand-Schüller-Christian triad

Back 249

in multifocal Langerhans’ cell histiocytosis, triad of calvarial bone defects, diabetes insipidus, and exophthalmos

Front 250

hangman’s fracture

Back 250

fracture of pars interarticularis of C2, hyperextension injury

Front 251

Hansen’s stain

Back 251

special stain used to detect eosinophiluria on the urine sediment

Front 252

Harrison’s groove

Back 252

during active rickets, the protuberant rachitic abdomen pushes the plastic lower ribs outward on a fulcrum formed by the costal attachments of the diaphragm; the line of bending forms a groove or sulcus in the rib cage

Front 253

Hartnup disease

Back 253

an autosomal recessive disorder in which there is a reduction of small-intestinal and renal transport of certain neutral amino acids, including (trp, a precursor of niacin), causing elevated amino acid excretion in urine and feces

Front 254

Hashimoto’s thyroiditis

Back 254

first described in 1920, goitrous chronic autoimmune thyroiditis; in areas with sufficient iodine, elevated TSH is often viewed as evidence of chronic autoimmune thyroiditis as well as antithyroid antibodies; antithyroglobulin antibodies in 60% of patients and antithryoid microsomal antibodies in 95%

Front 255

Hatchcock’s sign

Back 255

upward pressure applied to the angle of the mandible (ramus) produces tenderness with mumps but no tenderness with adenitis

Front 256

Hawthorne effect

Back 256

the effect (usually positive or beneficial) of being under study, upon the persons being studied; their knowledge of the study often influences behavior [city in Illinois; site of the Western Electric plant]

Front 257

Heberden’s nodes

Back 257

characteristic in women, but not in men, represent prominent osteophytes at the distal interphalangeal joints in OA (enlargments of tubercles at the articular extremities of the distal phalanges

Front 258

Heerfordt-Waldenström syndrome

Back 258

sarcoidosis associated with fever, parotid enlargement, anterior uveitis, and facial nerve palsy

Front 259

Heineke-Mukulicz pyloroplasty

Back 259

longitudinal incision through all layers of the pylorus, sewed closed in a transverse direction to make the pylorus nonfunctional (used after truncal vagotom)

Front 260

Heinz bodies

Back 260

seen in unstable hemoglobin and oxidant stress; precipitates of denatured hemoglobin on red blood cells; *only visible* when blood is supravital stained (crystal violet); not seen on routine blood smears

Front 261

hemoglobin Bart’s

Back 261

four  globin chains, seen in hydrops fetalis ( thalassemia), very high oxygen affinity

Front 262

hemoglobin Lepore

Back 262

no  chain;  chain by - hybrid

Front 263

hemoglobin Portland

Back 263

22

Front 264

Henoch-Schönlein purpura

Back 264

systemic hypersensitivity disease of unknown cause characterized by purpuric rash, colicky abdominal pain (presumably due to focal hemorrhages into the GI tract), polyarthralgia, and acute glomerulonephritis; may result from deposition of circulating immune complexes within stuff; hypersensitivity purpura, etiology group A streptococci

Front 265

Hering’s nerve

Back 265

carotid sinus nerve, CN IX, carries information to the vasomotor center in the brainstem

Front 266

Hering-Breuer reflex

Back 266

stretch receptor (in smooth muscle of airways) reflex, responsible for apnea, i.e. decreased breathing frequency, as a result of lung inflation

Front 267

Herlitz syndrome

Back 267

epidermolysis bullosa lethalis; mutation that prevents the folding of laminin 5 Gillis Herlitz, Swedish pediatrician, born 1902

Front 268

Hesselbach’s triangle

Back 268

where direct inguinal hernias occur, bound by the inguinal ligament, inferior epigastric a., and rectus abdominus muscle

Front 269

Hill’s sign

Back 269

in aortic regurgitation, refers to popliteal cuff systolic pressure exceeding brachial cuff pressure by more than 60 mm Hg

Front 270

Hippocratic fingers

Back 270

clubbing

Front 271

Hirano bodies

Back 271

in Alzheimer’s, intracytoplasmic proximal dendritic eosinophilic inclusions consisting of actin

Front 272

Hirschprung’s disease

Back 272

megacolon; congenital disorder characterized by colonic dilatation proximal to an aganglionic, contracted distal colon and rectum; caused by gestational failure of neural crest cells to migrate to distal colon; an AD form has been reported with mutations of the RET gene, and an AR form with mutation of the endothelin-B-receptor gene

Front 273

Hoffman sign

Back 273

thumb adduction in response to flexion of the distal phalanx of the third digit, an example of abnormal upper limb reflex caused by *damage to the descending cortical fibers*

Front 274

Hollenhorst plaques

Back 274

cholesterol emboli visible as small bright flecks lodged in arterial bifurcations in retina

Front 275

Holmes-Adie syndrome

Back 275

Adie’s pupil, frequently affects young women, benign familial disorder that may be associated with depressed DTRs (especially in legs), segmental anhidrosis, orthostatic hypotension, or cardiovascular autonomic instability, may be caused by degeneration of ciliary ganglion, followed by aberrant reinnervation of the pupilloconstrictor muscles

Front 276

Homan’s sign

Back 276

deep thrombi in the larger outflow veins, causing edema of the foot and ankle and producing pain and tenderness on compression of the calf muscles (by either squeezing the calf muscles or forced dorsiflexion of the foot)

Front 277

Hoover’s sign

Back 277

a modification in the movement of the costal margins during respiration, caused by a flattening of the diaphragm; suggestive of empyema or other intrathoracic condition causing a change in the contour of the diaphragm

Front 278

Horner’s syndrome

Back 278

enophthalmos, ptosis, miosis, and anhidrosis, unilateral; small (miotic) pupil associated with mild ptosis (of the upper lid, not as pronounced as with oculomotor lesions) and sometimes loss of sweating (anhidrosis); if present since infancy, the ipsilateral iris is lighter and blue (heterochromia iridis); topical 4% cocaine will dilate normal pupil but not a desympathectomized pupil

Front 279

Howell-Jolly body

Back 279

in asplenia or malfunctional spleen, *nuclear remnants* on red blood cells as small, round, darkly-stained nuclear fragments; no special stains necessary; may be seen in 30-50% of adults but not in children with untreated celiac sprue

Front 280

Howship’s lacunae

Back 280

resorption pits on bone formed by osteoclasts

Front 281

Howship-Romberg sign

Back 281

pain along the inner aspect of the thigh; seen with an obturator hernia due to nerve compression

Front 282

Hurler’s syndrome

Back 282

AR mucopolysaccharidosis that is caused by deficiency of -L-iduronidase, with consequent accumulations of the mucopolysaccharides heparan sulfate and dermatan sulfate in the heart, brain, liver, and other organs; progressive deterioration, hepatosplenomegaly, dwarfism, gargoyle-like facies, stubby fingers, corneal clouding, progressive mental retardation, and death by age 10

Front 283

Hürthle cells

Back 283

in Hashimoto’s thyroiditis, deeply stained colloid or clusters of these oncocytes having an abundant, brightly eosinophilic granular cytoplasm, thought to represent a degenerated state of the follicular epithelium

Front 284

Hutchinson freckle

Back 284

lentigo maligna, a nonfamilial precursor to lentigo maligna melanoma

Front 285

Hutchinson’s teeth

Back 285

smaller and more widely spaced than normal and are notched on their biting surfaces; sign of congenital syphillis

Front 286

Hutchinson-Guilford syndrome

Back 286

aka progeria a condition in which the normal development of the first year is followed by gross retardation of growth, with a senile appearance characterized by dry wrinkled skin, total alopecia, and bird-like facies; genetics unclear

Front 287

Imerslund-Grösbeck syndrome

Back 287

an autosomal recessive condition where transport inward of cobalamin from ileal receptors is faulty; associated with megaloblastic anemia, proteinuria, renal tubular defects, and various congenital abnormalities of the renal pelvis and ureter

Front 288

infarct of Zahn

Back 288

in occlusion of an intrahepatic branch of portal vein, sharply demarcated area of red-blue discoloration, not infarct, not necrosis, only marked stasis in distended sinusoids, with secondary hepatocellular atrophy

Front 289

Irish’s node

Back 289

left axillary adenopathy associated with metastatic disease, e.g. gastric CA

Front 290

Isaacs’s syndrome

Back 290

continuous muscle stiffness, rippling muscle movements (myokymia), delayed relaxation following muscle contraction

Front 291

Ito cells

Back 291

vitamin A fat-storage cells, of mesenchymal origin found in the space of Disse; during development of cirrhosis, they become activated, transform into fibroblast-like cells

Front 292

Jaccoud’s arthritis

Back 292

in SLE, ulnar deviation of the fingers, swan neck deformities, and subluxations, initially reversible but can become fixed

Front 293

Jackson-Weiss syndrome

Back 293

craniosynostoses as well as limb defects, mutations if FGFR2, broad great toes

Front 294

Janeway lesions

Back 294

in infective endocarditis; nonpainful, small, erythematous or hemorrhagic macules or nodules of palms or soles; more common in acute bacterial endocarditis but occur in subacute bacterial endocarditis

Front 295

Jansen metaphyseal chondrodysplasia

Back 295

an autosomal dominant form of dwarfism resulting from an activating mutation in the PTHrP receptor, premature ossification from acceleration of the transition from proliferative to hypertrophic chondrocytes

Front 296

Jarisch-Herxheimer reaction

Back 296

sudden fevers, rigors, and persistent hypotension following antimicrobial treatment of louse-borne relapsing fever (Borrelia recurrentis (spirochete) infection) or syphilis; treatment with anti-TNF- Fab before penicillin suppresses this reaction (NEJM 335:311)

Front 297

Jod-Basedow phenomenon

Back 297

thyroid hyperfunction induced by excess iodine ingestion in patients with various thyroid disorders; Jod German for iodine; K. A. Von Basedow

Front 298

Joffroy sign

Back 298

in thyrotoxicosis, absence of forehead wrinkling with upward gaze, the head being tilted down; disorder of the arithmetic faculty in the early stages of organic brain disease

Front 299

Jolly test

Back 299

good test for distinguishing between Lambert-Eton syndrome and myasthenia gravis. Friedrich Jolly, German neurologist, 1844-1904

Front 300

Jones’s fracture

Back 300

fracture at the base of the fifth metatarsal diaphysis

Front 301

Kallman’s syndrome

Back 301

anosmia; hypogonadotropic hypogonadism stemming from failure of LHRH-expressing neurons to migrate, etc.

Front 302

Kanavel's sign

Back 302

four signs of tenosynovitis: 1. affected finger held in slight flexion; 2. pain over volar aspect of affected finger tendon upon palpation; 3. swelling of affected finger; 4. pain on passive extension of affected figner

Front 303

Kartagener’s syndrome

Back 303

a triad of sinusitis, bronchiectasis, and situs inversus; also associated with ciliary dysfunction; Manes Kartagener, Swiss physician, 1897-1975

Front 304

Kasabach-Merritt syndrome

Back 304

capillary hemangioma associated with thrombocytopenic purpura and extensive and progressively enlarging vascular malformations which may involve large portions of their extremities; bleeding commonly develops in the first year of life, secondary to chronic DIC triggered by stagnant blood flow through the tortuous abnormal vessels; anemia caused by red cell damage as blood passes through deformed vessels of the tumor

Front 305

Kawasaki’s disease

Back 305

acute febrile illness of infants and children, characterized by cutaneous and mucosal erythema and edema with subsequent desquamation, cervical lymphadenitis, and complicated by coronary artery aneurysms (20%)

Front 306

Kayser-Fleischer rings

Back 306

a greenish yellow pigmented ring encircling the cornea just within the corneoscleral margin, seen in hepatolenticular degeneration, due to copper deposited in Desçemet’s membrane (posterior limiting layer of cornea); seen in *Wilson’s disease* (with neurologic involvement) and other cholestatic hepatic diseases

Front 307

Kearns Sayre syndrome

Back 307

a mitochondrial disease, salient features are progressive opthalmoplegia with retinal pigmentation degeneration and heart block

Front 308

Kehr’s sign

Back 308

pain in the left shoulder associated with splenic rupture

Front 309

Kelly’s sign

Back 309

visible peristalsis of the ureter in response to squeezing or retraction; used to identify the ureter during surgery

Front 310

Kerckring’s valves

Back 310

plicae circulares (lining of small intestine)

Front 311

Kerley B lines

Back 311

a radiographic evidence of pulmonary venous hypertension, horizontal linear opacities on chest radiograph often found in the periphery due to separation of the interlobular space, as seen in pulmonary edema or fibrosis, reflecting thickening of, or fluid in, lymphatic vessels in interlobular septae, a consequence of interstitial edema; also seen in lymphangitic spread of malignancies

Front 312

Kernig sign

Back 312

flex patient’s leg at both hip and knee, and then straighten knee; positive sign—pain and increased resistance to extending knee  suggests meningeal irritation

Front 313

Kernohan notch

Back 313

tentorial edge, pressure against seen in uncal herniation

Front 314

Kiesselbach’s plexus

Back 314

vascular plexus on the anterior nasal septum, bleeding from, leads to most common form of epistaxis

Front 315

Kikuchi’s disease

Back 315

histiocytic necrotizing lymphadenitis, characterized by cervical lymphadenopathy with tenderness, fever, and night sweats

Front 316

Kimmelstiel-Wilson disease

Back 316

intercapillary glomerulosclerosis from diabetes; lesion is PAS-positive material deposited at periphery of glomerular tufts

Front 317

Klatskin tumors

Back 317

tumors arising from the part of the common bile duct between the cystic duct junction and the confluence of the right and left hepatic ducts at the liver hilus; notable for their slow growing behavior, marked sclerosing characteristics, and the infrequent occurrence of distal metastases

Front 318

Kleihauer-Betke test

Back 318

testing for the presence of fetal blood cells in maternal circ

Front 319

Kleine-Levin syndrome

Back 319

a rare form of periodic hypersomnia associated with bulimia, occurring in males aged 10 to 25 years, characterized by periods of ravenous appetite alternating with prolonged sleep (as long as 18 hours), along with behavioral disturbances, impaired thought processes, and hallucinations; acute illness or fatigue may precede an episode, which may occur as often as several times a year

Front 320

Klumpke palsy

Back 320

C8-T2 nerve roots

Front 321

Klüver-Bucy syndrome

Back 321

1937 bilateral removal of temporal lobe (including amygdala and hippocampal formation) in monkeys, animals became tame, showed a flattening of emotions, exhibited remarkable oral tendencies (they put all manner of objects into their mouths), enormous increase in sexual behavior, including mounting of inappropriate objects and species, compulsive tendency to react to every object, failed to recognize familiar objects

Front 322

Koebner’s phenomenon

Back 322

referring to physical trauma (rubbing or scratching) as a major factor in eliciting *psoriasis lesions*; also depigmented, sharply demarcated papules in vitiligo following minor trauma; may also be seen in *lichen planus*

Front 323

Köhler’s bone disease

Back 323

aseptic necrosis of the navicular bone

Front 324

koilocyte

Back 324

characteristic cytoplasmic vacuole, hallmark of infection by papillomavirus

Front 325

Koplik’s spots

Back 325

pathognomonic exanthem in measles

Front 326

Korotkoff sounds

Back 326

sounds heard in between systolic and diastolic pressure; origin related to the spurt of blood passing under the cuff and meeting a static column of blood

Front 327

Korsakoff’s syndrome

Back 327

profound memory loss; mammillary bodies as well as portions of medial thalamus believed to be destroyed from thiamine deficiency accompanying alcoholism

Front 328

Kostmann syndrome

Back 328

inherited neutropenia, responds to G-CSF, may be due to environmental insults in bone marrow, characterized typically by a granulopoeisis impairment at the promyelocyte stage

Front 329

Krukenberg’s tumor

Back 329

metastatic GI neoplasia to the ovaries, produces bilateral metastases of mucin-producing, signet-ring cancer cells, most often of gastric origin

Front 330

Kübler-Ross dying stages

Back 330

denial, anger, bargaining, grieving, acceptance

Front 331

Kulchitsky’s cells

Back 331

neuroendocrine argentaffin cells present along the bronchial epithelium, particularly in the fetus and neonate; small cell carcinoma has granules similar to Kulchitsky’s cells

Front 332

Kussmaul’s respiration

Back 332

paroxysmal air hunger, associated with acidosis, especially DKA

Front 333

Kussmaul’s sign

Back 333

in constrictive pericarditis, jugular vein becomes more distended during inspiration (normally, jugular venous pressure decreases with inspiration since blood drains into heart with inspiration); though most common contemporary cause is severe right-sided heart failure (JAMA 1996: 275:632); generally negative in cardiac tamponade

Front 334

Kveim test

Back 334

an intradermal test for the detection of *sarcoidosis*, done by injecting Kveim antigen (a saline suspension of human sarcoid tissue prepared from the spleen of an individual with active sarcoidosis) and examining skin biopsies after 3 and 6 weeks; positive test, a noncaseating granulomnatous reaction; sensitivity 35-88%, specificity 75-99% Morton A. Kveim, Norweigian physician, born 1892

Front 335

Laennec’s cirrhosis

Back 335

in alcoholic cirrhosis, residual parenchymal nodules that protrude like “hobnails” from the surface of the liver

Front 336

Laplace’s law

Back 336

wall tension = pressure x radius (thus colon perforates preferentially at the cecum because of the increased radius and resultant increased wall tension)

Front 337

Laron dwarfism

Back 337

autosomal recessive, growth hormone receptor defects, low IGF-1 levels

Front 338

Lasègue’s sign

Back 338

when patient is supine with hip flexed, dorsiflexion of ankle causing pain or muscle spasm in the posterior thigh indicates lumbar root or sciatic nerve irritation

Front 339

Laurence-Moon-Biedl syndrome

Back 339

obesity, retinitis pigmentosa, metal retardation, skull deformities, polydactyly, and syndactyly

Front 340

Legg-Calvé-Perthes disease

Back 340

self-limiting hip disorder of children, 4-8 y.o. (M:F 8:1) involving vascular compromise of the capital femoral epiphysis; perhaps some aseptic necrosis action too

Front 341

Leiner’s disease

Back 341

seborrheic erythroderma associated with diarrhea and failure to thrive and to generate C5a chemotactic factor

Front 342

leprechaunism

Back 342

1 in 4 million births, associated with elfin-like facies, decreased subcu adipose tissue, acanthosis nigricans, and growth retardation, failure to thrive, and early death, insulin resistance

Front 343

Leriche’s syndrome

Back 343

aortoiliac occlusive disease producing distal ischemic symptoms and signs, e.g. pulseless femoral artery: 1. claudication of buttocks, 2. impotence, 3. atrophy of buttocks (seen with iliac occlusive disease)

Front 344

Lesch-Nyan syndrome

Back 344

a complete lack of hypoxanthine guanine phosphoribosyl transferase (HGPRT, involved in salvage pathway in purine synthesis), X-linked, hyperuricemia, severe neurologic deficits with mental retardation, self-mutilation, and in some cases gouty arthritis

Front 345

Leser-Trélat sign

Back 345

the sudden appearance and rapid increase in the number and size of seborrheic keratoses with pruritus; associated with internal malignancy

Front 346

Letterer-Siwe disease

Back 346

acute disseminated Langerhans’ cell histocytosis; associated with development of cutaneous lesions that resemble a seborrheic eruption secondary to infiltrations of Langerhans’ histocytes over the front and back of the trunk and on the scalp; concurrent hepatosplenomegaly, lymphadenopathy, pulmonary lesions, and eventually destructive osteolytic bone lesions

Front 347

Levine’s sign

Back 347

when describing angina, defining the constricting discomfort with a clenched fist over sternum; q.v. angina for sens and spec; Samuel A. Levine, U.S. cardiologist, 1891-1966; designated hand movements 80% sens 49% spec; Levine sign itself 14% sens for cardiac pain (BMJ 1995;311:1660)

Front 348

Lewy bodies

Back 348

eosinophilic intracytoplasmic bodies in neurons of substantia nigra and locus ceruleus present in Parkinson’s disease

Front 349

Lhermitte’s sign

Back 349

sudden electric-like shocks extending down the spine on flexing the head; may result from toxic effects of radiation; (may be found in vitamin B6 toxicity); (may be found in vitamin B12 deficiency)

Front 350

Libman-Sacks disease

Back 350

in systemic lupus erythematosus, intense mitral and tricuspid valvulitis with development of small, sterile vegetations

Front 351

Li-Fraumeni syndrome

Back 351

mutant p53 allele inherited, predisposition toward breast carcinomas, sarcomas, and brain tumors

Front 352

ligament of Trietz

Back 352

the suspensory muscle of the duodenum which supports the duodenojejunal flexure

Front 353

lines of Zahn

Back 353

thrombi formed within a cardiac chamber or the aorta, may have apparent laminations, produced by alternating layers of paler platelets admixed with some fibrin, separated by darker layers containing more red cells

Front 354

Lisch nodules

Back 354

in type I neurofibromatosis, pigmented iris hamartomas

Front 355

Lissauer’s tract

Back 355

small diameter primary sensory axons (presumably mediating pain and temperature senses) on their way into the dorsal horn

Front 356

Littre's hernia

Back 356

hernia involving a Meckel's diverticulum

Front 357

Löffler’s syndrome

Back 357

simple pulmonary eosinophilia, characterized by transient pulmonary lesions, eosinophilia in the blood, and a benign clinical course; lungs show alveoli whose septa are thickened by an infiltrate composed of eosinophils and occasional interspersed giant cells, but there is no vasculitis, fibrosis, or necrosis; associated with ascaris, strongyloides

Front 358

Löfgren’s syndrome

Back 358

sarcoidosis associated with erythema nodosum and fever and transient arthritis, bilateral hilar adenopathy; 10-15% of sarcoidosis present this way

Front 359

Looser’s zones

Back 359

radiolucent narrow lines that lie either at right angles or obliquely to the cortical outlines of bones and often transect them; bilateral and symmetric, found at the axillary margins of the scapula, lower ribs, neck of the proximal femurs, and posterior regions of the proximal ulnas; related either to stress fractures or to mechanical erosion by penetrating nutrient arteries; aka Milkman’s fractures

Front 360

Lovibond’s angle

Back 360

the angle made by the proximal nail fold and the nail plate

Front 361

Löwenstein-Jensen’s medium

Back 361

for growing out M. tuberculosis; contains malachite green, a triphenlyamine die like crystal violent, inhibits growth of unwanted organisms during 6 week incubation period as well as complex nutrients

Front 362

Lown-Ganong-Levine syndrome

Back 362

enhanced AV node pathways

Front 363

Ludwig’s angina

Back 363

aggressive infectious process of the submandibular, sublingual, and submental fascial spaces frequently occuring as a result of infection from 2nd and 3rd lower molar; 54% mortality in preantibiotic era, now 4% described in 1836 by Wilhelm Frederick von Ludwig

Front 364

Lugol’s solution

Back 364

iodine and KI

Front 365

Lund’s node

Back 365

lymph node found in Calot's triangle, aka Calot's node

Front 366

Lutembacher’s syndrome

Back 366

atrial septal defect with mitral stenosis; though mitral stenosis is often of rheumatic origin

Front 367

Lynch syndrome I

Back 367

AD produces multiple colon cnacers 2 to 3 decades earlier, predilection for proximal colon; Lynch syndromes most common forms of familial colon cancer, 5-10% of all cases of colon cancer

Front 368

Lynch syndrome II

Back 368

cancer family syndrome, all features of Lynch I with early onset of carcinoma at other sites including endometrium, ovaries, and stomach

Front 369

MacCallum’s plaques

Back 369

irregular thickenings, usually in the left atrium, from subendocardial lesions, usually exacerbated by regurgitant jets

Front 370

Maffucci’s syndrome

Back 370

endochondromatosis associated with soft tissue hemangiomas; associated with ovarian carcinomas and brain gliomas; essentially Ollier’s disease with hemangiomas

Front 371

Mallory body

Back 371

“alcoholic hyalin,” an eosinophilic intracytoplasmic inclusion in liver cells that is characteristic of alcoholic liver disease but seen in many other conditions as well (e.g., primary biliary cirrhosis, Wilson’s disease, chronic cholestatic syndromes, focal nodular hyperplasia, and hepatocellular carcinoma); inclusions composed largely of intermediate filaments of prekeratin

Front 372

Mallory-Weiss tears

Back 372

small defects in gastroesophageal junction, from violent retching and beef with alcoholic gastritis, can bleed like crazy, 87% occur below gastroesophageal junction; bleeding stops 90% without intervention

Front 373

Malta fever

Back 373

brucellosis

Front 374

Maltese cross

Back 374

fat droplets in urine

Front 375

Marcus Gunn pupil

Back 375

afferent pupillary defect, pupil dilates instead of constricts because of optic nerve defect

Front 376

Marie-Strümpell disease

Back 376

refers to ankylosing spondylitis in Europe

Front 377

Marjolin's ulcer

Back 377

squamous cell carcinoma ulceration overlying chronic osteomyelitis or burn scar

Front 378

Markle sign

Back 378

jar tenderness in abdomen from heel drop as a localizing sign of peritoneal irritation; described in 1973

Front 379

Mayer-Rokitansky-Küster-Hauser syndrome

Back 379

absence of vagina from abnormality of müllerian development

Front 380

May-Hegglin anomaly

Back 380

neutrophils with large pale blue inclusions resembling Döhle bodies, giant platelets; rare AD asymptomatic trait

Front 381

Mazzotti reaction

Back 381

reaction to proteins released by dying onchocerca, including fevers, rashes, ocular damage, joint and muscle pain, and lymphangitis as well as hypotension, pyrexia, respiratory distress, and prostration

Front 382

McArdle’s syndrome

Back 382

glycogen storage disease V, deficiency in muscle phosphorylase, with consequent glycogen accumulation in skeletal muscle, produces painful muscle cramps and muscle weakness following exercise

Front 383

McBurney’s point

Back 383

one-third the distance from the ASIS to the umbilicus

Front 384

McBurney’s sign

Back 384

tenderness at McBurney’s point in appendicitis

Front 385

McCune-Albright syndrome

Back 385

triad of irregular café au lait spots, fibrous dysplasia of long bones with cysts, and precocious puberty

Front 386

Means-Lerman scratch

Back 386

in hyperdynamic heart (as in hyperthyroidism), a systolic scratch occasionally heard in the second left intercostal space during expiration, presumed to be secondary to rubbing together of normal pleural and pericardial surfaces

Front 387

Meckel scan

Back 387

99Tc pertechnetate scan that selectively tags acid secreting cells (gastric mucosa); it is used most often for unexplained bleeding in infants and young adults

Front 388

Meckel’s cartilage

Back 388

branchial arch 1

Front 389

Meckel’s diverticulum

Back 389

persistence of vitelline duct, contains all 3 layers of bowel (mucosa, submucosa, muscularis propria), antimesenteric, present in 2% of population, usually within 30 cm of ileocecal valve; the five 2s: 2” long, 2 feet from ileocecal valve, 2% of population, commonly persists in first 2 years of life, may have 2 types of epithelia

Front 390

Mees’s lines

Back 390

horizontal white bands of the nails seen in chronic arsenical poisoning, and occasionally in leprosy; R.A. Mees, 20th century Dutch physician

Front 391

Meigs’s syndrome

Back 391

unusual combination of hydrothorax, ascites, and ovarian fibroma

Front 392

Meissner’s plexus

Back 392

submucous plexus; innervates glandular epithelium, muscularis mucosa, intestinal endocrine cells, and submucosal blood vessels

Front 393

Mendelson’s syndrome

Back 393

chemical pneumonitis after aspiration of gastric contents

Front 394

Ménétrier’s disease

Back 394

giant cerebriform enlargement of the rugal folds of the gastric mucosa, results from profound hyperplasia of the surface mucous cells with accompanying glandular atrophy, most often encountered in men (3:1), 40s-60s, sometimes in children, may produce epigastric discomfort, weight loss, and sometimes bleeding related to superficial rugal erosions, gastric secretions mostly mucous, little HCl, may be sufficient protein loss to produce hypoalbuminemia

Front 395

Méniere’s disease

Back 395

1. fluctuating sensorineural loss, classically involving the low frequencies; 2. Vertiginous episodes; 3. Aural pressure; 4. Tinnitus that is most frequently described roaring; pathologic changes are said to consist of a dilation of the endolymphatic system that leads to a degeneration of the delicate vestibular and cochlear hair cells

Front 396

Menke’s disease

Back 396

X-linked, problem in the distribution of copper in the body, amount of copper and ceruloplasmin in serum reduced, excess of copper in intestinal mucosa, muscle, spleen, and kidney; usually fatal by age 3

Front 397

Metzer index

Back 397

MCV/RBC ratio; >13 iron def, < 13 thalassemia

Front 398

Meyer’s loop

Back 398

a portion of the optic radiations subserving vision from the superior field coursing rostrally within the temporal lobe before heading caudally to the primary visual cortex; lesions produce contralatteral upper quarantanopia (pie in the sky)

Front 399

Mikulicz’s syndrome

Back 399

bilateral inflammatory enlargement of the parotid, submaxillary, and sublingual, and lacrimal glands and xerostomia, secondary to sarcoid, leukemia, lymphoma, etc.

Front 400

Milkman’s fractures

Back 400

In osteomalacia, radiolucent narrow lines that lie either at right angles or obliquely to the cortical outlines of bones and often transect them; bilateral and symmetric, found at the axillary margins of the scapula, lower ribs, neck of the proximal femurs, and posterior regions of the proximal ulnas; related either to stress fractures or to mechanical erosion by penetrating nutrient arteries; aka Looser’s zones

Front 401

Mirrizi’s syndrome

Back 401

extrinsic obstruction of the common bile duct from a cystic duct gallstone

Front 402

mitral facies

Back 402

malar flush with pinched and blue facies in mitral stenosis

Front 403

Möbius syndrome

Back 403

congenital facial paralysis with or without limb defects associated with misoprostol use

Front 404

Modigliani syndrome

Back 404

thyroid in normal position but people with long curving necks enhance prominence and palpation of thyroid

Front 405

Mönckeberg’s arteriosclerosis

Back 405

ring-like calcifications within the media of medium-sized to small muscular arteries (femoral, tibial, radial, and ulnar arteries, genital arteries), occurs almost exclusively in individuals over 50 years old; doesn’t narrow lumen, distinct from atherosclerosis

Front 406

Mondor’s disease

Back 406

thrombophlebitis of superficial breast veins

Front 407

Monge’s disease

Back 407

chronic mountain sickness, loss of high altitude tolerance after prolonged exposure, characterized by extreme polycythemia, exaggerated hypoxemia, and reduced mental and physical capacity; relieved by descent

Front 408

Monsel’s solution

Back 408

ferric subsulfate

Front 409

Monteggia fracture

Back 409

fracture of the proximal third of the ulna with a dislocation of radial head

Front 410

Mooren corneal ulcers

Back 410

chronic, painful ulcers, involves circumference of peripheral cornea and may progress to vision loss; associated with hep C

Front 411

Morgagni's hernia

Back 411

anterior parasternal diaphragmatic hernia, right more common than left

Front 412

Morrison’s pouch

Back 412

hepatorenal recess; the most posterior cavity in the peritoneal cavity

Front 413

Mucha-Habermann disease

Back 413

pityriasis lichenoides et varioliformis acuta, scattered necrotic papules and vesicles that can resemble insect bites but usually are more generalized and symmetric

Front 414

Muehrcke’s nails

Back 414

paired narrow horizontal white bands that are immobile as nail grows; seen in hypoalbuminemia, nephrotic syndrome

Front 415

Müller’s maneuver

Back 415

reverse Valsalva

Front 416

Müller’s sign

Back 416

in aortic regurgitation, systolic pulsations of the uvula

Front 417

Müller-Lyer illusion

Back 417

the two horizontal lines stuff with arrows

Front 418

Munro’s microabscesses

Back 418

in psoriasis, when neutrophils form small aggregates within the parakeratotic stratum corneum

Front 419

Murphy’s sign

Back 419

a sharp increase in tenderness with a sudden stop in inspiratory effort, sign of acute cholecystitis

Front 420

Myerson’s sign

Back 420

persistent blinking with glabellar stuff

Front 421

Nägele’s rule

Back 421

means of estimating date of delivery by counting back 3 months from the first day of the last menstrual period and adding seven days; full term 38 weeks after fertilization, 40 weeks after LNMP

Front 422

Nardi test

Back 422

narcotic-indcued stimulation or spasm reproducing the abdominal pain and amylase elevation of relapsing pancreatitis (for inferring sphincteric disease in any pancreatic or biliary ductal system without a gallbaldder), presumably accurate in the diagnosis of perisphincteric disease

Front 423

Negri bodies

Back 423

in rabies virus-infected brain neurons, eosinophlic cytoplasmic inclusions

Front 424

Nelson’s syndrome

Back 424

enlargement of a pituitary adenoma in a patient with Cushing’s disease whose adrenals have been removed from loss of feedback inhibition of cortisol

Front 425

nerve endings

Back 425

FREE includes Merkel cell associated: found in the epidermis as small aggregates called tactile corpuscles (Merkel cell has neural crest and squamous properties); ENCAPSULATED includes Meissner’s: asymmetrical, lamellated; Pacinian: symmetrical, lamellated; Ruffini: no lamellation

Front 426

nevus of Ota

Back 426

pigmentation mostly involves the skin and mucous membranes innervated by the first and second branches of the trigeminal nerve

Front 427

Niemann-Pick disease

Back 427

unifying feature, lysosomal accumulation of sphingomyelin and cholesterol, type A&B (*deficiency of sphingomyelin-cleaving enzyme sphingomyelinase*) and type C&D (enzyme normal or nearly normal, defect in esterification and transport); type A, 75-80% of all cases, extensive neurologic involvement, marked visceral accumulations of sphingomyelin, and progressive wasting and early death within the first 3 years of life); half have cherry red spot in macula as in Tay-Sachs

Front 428

Nikolsky’s sign

Back 428

a peculiar vulnerability of the skin in pemphigus vulgaris; the apparently normal epidermis may be separated at the basal layer and rubbed off when pressed with a sliding motion

Front 429

Nissl bodies

Back 429

in neurons, rough ER

Front 430

Nissl stain

Back 430

stains cell bodies dye binds to acid groups, in particular the RNAs of the ribosomes located within the cell body; Franz Nissl, German medical student at time

Front 431

Norwalk virus

Back 431

outbreak in a school in Norwalk, Ohio in 1969

Front 432

nucleus of Darkschewitsch

Back 432

an ovoid cell group in the ventral central gray substance rostral to the oculomotor nucleus, receiving fibers from the vestibular nuclei by way of the medial longitudinal fasiculus; projections are not known, although some cross in the posterior commissure

Front 433

obturator sign

Back 433

pain upon internal rotation of the legg with the hip and knee flexed; seen in appendicitis, pelvic abscess

Front 434

Ogilvie’s syndrome

Back 434

massive idiopathic non-obstructive dilatation of the colon

Front 435

Ollier’s disease

Back 435

syndrome of multiple enchondromas

Front 436

Ondine’s curse

Back 436

after a mythological tale in which the suitor of Neptune’s daughter was cursed to lose automatic control over all bodily functions

Front 437

Oroya fever

Back 437

from Bartonella bacilliformis, sandfly vector Phlebotomus found in valleys of the Andes mountains, 600-2500 m, profound *intravascular hemolytic* anemia of a few weeks’ duration, associated with lesions called verruga peruana resembling Kaposi’s sarcoma; aka Carrión’s disease

Front 438

Ortner’s syndrome

Back 438

hoarseness from compression of left recurrent laryngeal nerve by a greatly dilated left atrium (e.g., in mitral stenosis), enlarged tracheobronchial lymph nodes and dilated pulmonary artery

Front 439

Ortolani’s sign

Back 439

in congenital hip dislocatin, rotate hip with patient in supine position and hip abducted; a “clunk” or “click” represents congenitally dislocated hip

Front 440

Osborn wave

Back 440

EKG with distinctive convex “hump” at J point associated with hypothermia

Front 441

Osglood-Schlatter’s disease

Back 441

epiphysitis of tibial tubercle resulting from repeated powerful contractions of the quadriceps seen in adolescents with open physis

Front 442

Osler’s nodes

Back 442

tender to painful, purplish, split pea-sized, subcutaneous nodules in the pulp of the fingers and/or toes and thenar and hypothenar eminences; transient, disappearing within several days (5% of patients); in acute bacterial endocarditis, associated with minute infective emboli; aspiration may reveal the causative organism; in subacute bacterial endocarditis, associated with immune complexes and small-vessel arteritis of skin

Front 443

Osler’s sign

Back 443

palpable brachial or radial artery when cuff > systolic pressure

Front 444

Osler-Weber-Rendu disease

Back 444

hereditary hemorrhagic telangiectasia, larger lesions can be a source of chronic blood loss, systemic emboli, hypoxemia, hepatic dysfunction, and a high-output cardiac failure; important risk factor for brain abscess, especially in affected patients with clubbing, cyanosis, and/or polycythemia; bust out aminocaproic acid (an antifibrinolytic agent)

Front 445

Ouchterlony reaction

Back 445

double diffusion with antigen and antibody stuff

Front 446

Paget’s disease of bone

Back 446

osteitis deformans, characterized by an initial osteolytic stage followed by a mixed osteoclastic-osteoblastic stage, which ends with a predominance of osteoblastic activity and evolves ultimately into a burnt-out quiescent osteosclerotic stage; increased alkaline phosphatase and increased urine hydroxyproline

Front 447

Pancoast’s tumor

Back 447

apical lung cancers in the superior pulmonary sulcus tend to invade the neural structures around the trachea, including the cervical sympathetic plexus, and produce a group of clinical findings that include severe pain in the distribution of the ulnar nerve and Horner’s syndrome on the same side of the lesion

Front 448

Paneth cells

Back 448

in small intestine crypts, cells with apically oriented bright eosinophilic granules and which appear to play a role in the mucosal immune system

Front 449

Pappenheimer bodies

Back 449

small dark blue irregularly shaped granules often in clusters, composed of iron, seen in sideroblastic anemia following splenectomy

Front 450

Parinaud’s oculoglandular syndrome

Back 450

preauricular node enlargement associated with chronic granulomatous conjunctivitis

Front 451

Parinaud’s syndrome

Back 451

lid retraction caused by tumors in the pineal region; associated with lesions in s. colliculus and pretectal area causing paralysis of upward and downward gaze, pupillary disturbances, and absence of convergence; compression of cerebral aqueduct resulting in noncommunicable hydrocephalus

Front 452

Parkland formula

Back 452

total body surface area % burned x kg x 4; _ in first 8 hours, second _ given next 16 hours

Front 453

Pastia’s sign

Back 453

associated with scarlet fever (GAS or S. aureus rarely); finely punctate erythema has become confluent (scarlatiniform) on the lower trunk and thighs with petechiae having a linear configuration in the inguinal regions

Front 454

Patau’s syndrome

Back 454

trisomy 13, mental retardation, microcephaly, microphthalmia, brain abnormalities, cleft lip and palate, polydactyly, rocker-bottom feet, and congenital heart disease

Front 455

Paul-Bunnell-Davidsohn test

Back 455

extension of classic Paul-Bunnell test for heterophil antibody; antibodies not absorbed by guinea pig kidney cells but cause sheep erythrocytes to agglutinate

Front 456

Pautrier’s microabcesses

Back 456

q.v. Sézary-Lutzner cells

Front 457

Pel-Ebstein fever

Back 457

in Hodgkin’s disease, unusual systemic manifestation of a periodic fever that is present for some days, remits, and then returns

Front 458

Pelger-Hüet anomaly

Back 458

seen in blood of AML (e.g., M2) or myelodysplastic syndromes or inherited as autosomal recessive trait and maybe sideroblastic

Front 459

Pelizeus-Merzbacher disease

Back 459

mutation in proteolipid protein on X chromosome; results in hypomyelination confined to the CNS, seizures, mental retardation, and death in childhood

Front 460

pentalogy of Cantrell

Back 460

Diaphragmatic defect (hernia), Cardiac abnormality, Omphalocele, Pericardium malformation/absence, Sternal cleft

Front 461

Peutz-Jeghers syndrome

Back 461

rare AD syndrome characterized by multiple hamartomatous polyps scattered throughout the entire GI tract and melanotic mucosal and cutaneous pigmentation around the lips, oral mucosa, face, genitalia, and palmar surfaces; patients have increased risk of carinomas of pancreas, breast, lung, ovary, and uterus

Front 462

Peyronie’s disease

Back 462

penile fibromatosis, a palpable induration or mass appears on the dorsolateral aspect of the penis. It may cause eventually abnormal curvature of the shaft or constriction of the urethra, or both

Front 463

Pfeiffer syndrome

Back 463

craniosynostoses as well as limb defects, mutations in FGFR1, broad thumbs, broad great toes

Front 464

Phalen’s maneuver

Back 464

median nerve compression, palmar flexion of the wrist for 1 minute exacerbates or reproduces symptoms; 75% sens 47% spec

Front 465

pheochromactyoma rule of 10s

Back 465

10% bilateral, 10% malignant, 10% in children, 10% extraadrenal, 10% have multiple tumors

Front 466

pheochromacytoma triad

Back 466

1. palpitations 2. headache 3. episodic diaphoresis

Front 467

Philadelphia chromosome

Back 467

seen in 95% of chronic myelogenous leukemia (210 kD tyrosine kinase), 2-5% childhood ALL (180 kD TK), higher percent in adult; reciprocal and balanced translocation between chr22 (bcr, breakpoint cluster region) and chr9 (c-abl); c-abl-bcr encodes a chimeric protein with tyrosine kinase activity; genomic imprinting, chr9 paternal and chr22 maternal

Front 468

Pick’s disease

Back 468

more frequent in women, characterized by marked cortical atrophy, especially of the temporal and frontal lobes, by swollen neurons, and by Pick bodies, round intracytoplasmic inclusions consisting of neurofilaments

Front 469

Pierre Robin syndrome

Back 469

micrognathia and abnormal smallness of the tongue, often with cleft palate, severe myopia, congenital glaucoma, and retinal detachment; French pediatrician, 1867-1950

Front 470

Pittsburgh pneumonia agent

Back 470

Legionella micdadei

Front 471

Plummer’s disease

Back 471

toxic multinodular goiter

Front 472

Plummer’s nail

Back 472

onycholysis as a sign of hyperthyroidism, especially when it affects the ring finger

Front 473

Plummer-Vinson syndrome

Back 473

from iron deficiency, a microcytic hypochromic anemia, atrophic glossitis, and esophageal webs (upper esophagus); 10% develop squamous cell carcinoma

Front 474

Poiseuille’s law

Back 474

flow proportional to fourth power of radius, inversely proportional to length

Front 475

Poland syndrome

Back 475

amastic asociated with hypoplasia of ipsilateral musculature and chest wall

Front 476

Polle syndrome

Back 476

children who are abused by being given laxatives

Front 477

Pompe’s disease

Back 477

type II glycogen storage disease, deficiency in -1,4-glucosidase (lysosomal enzyme) with consequent accumulation of glycogen, especially in the liver, heart, and skeletal muscle, characterized by cardiomegaly, muscle hypotonia, and splenomegaly, death from cardiorespiratory failure before age 3

Front 478

pores of Kohn

Back 478

connections between alveoli

Front 479

Pott’s disease

Back 479

tuberculous involvement of the spine

Front 480

Pott’s fracture

Back 480

fracture of distal fibula

Front 481

Potter’s sequence

Back 481

from oligohydramnios (from e.g. renal agenesis, amniotic leak) leading to amnion nodosum, fetal compression which leads to pulmonary hypoplasia, altered facies, positioning defects of feet, hands, and breech presentation

Front 482

Poupart’s ligament

Back 482

inguinal ligament

Front 483

Prader-Willi syndrome

Back 483

deletion of 15(q11-q13), paternally derived

Front 484

Prehn's sign

Back 484

elevation of painful testicle decreases pain of epididymitis

Front 485

Prinzmetal’s angina

Back 485

variant angina occurs at rest, manifests on EKG as episodic ST segment elevations, caused by coronary artery spasms with or without superimposed coronary artery disease. patients more likely to develop ventricular arrhythmias

Front 486

psammoma bodies

Back 486

papillary thyroid cancer

Front 487

psoas sign

Back 487

pain elicited by extending the hip with the knee in full extension, seen with appendicitis and psoas inflammation

Front 488

Puestow procedure

Back 488

in chronic pancreatitis, surgical decompression of a dilated main pancreatic duct providing pain relief

Front 489

Puestow procedure

Back 489

for chronic pancreatitis, side-to-side anastomosis of the pancreas and jejunum, thereby decompressing dilated main pancreatic duct and providing pain relief

Front 490

Purtscher’s angiopathic retinopathy

Back 490

in acute pancreatitis, sudden and severe loss of vision due to posterior retinal artery occlusion with aggregated granulocytes; discrete flame-shaped hemorrhages with cotton-wool spots; also seen in fat embolization; first described in 1919 by Othmar Purtscher

Front 491

Quellung reaction

Back 491

swelling of bacterial capsule when exposed to antibody; used for diagnosis of S. pneumoniae, H. influ type B, N. meningitidis groups A and C

Front 492

Quinicke’s sign

Back 492

in aortic regurgitation, capillary pulsations detected by pressing a glass slide on the patient’s lip or by transmitting a light through the patient’s fingertips

Front 493

Rabson-Mendenhall syndrome

Back 493

congenital syndrome characterized by insulin resistance, acanthosis nigricans, and growth retardation; associated with developmental abnormalities of bones and teeth, PCOD, genitomegaly, and pineal gland hyperplasia; associated with mutation in insulin receptor

Front 494

raccoon eyes

Back 494

bilateral black eyes in basilar skull fracture

Front 495

Ramsay Hunt syndrome

Back 495

herpes zoster infection of the geniculate ganglion; facial nerve involvement (ear, palate, pharynx, or neck); pain and vesicles appear in external auditory canal, and patients lose their sense of taste in anterior 2/3 of tongue while developing ipsilateral facial palsy

Front 496

Ranke complex

Back 496

combination of Ghon lesion and involved lymph nodes in tuberculosis

Front 497

Rapoport-Luebering shunt

Back 497

in red blood cells, pathway converting 1,3-diphosphoglyceric acid to 2,3-DPG and then to 3-phosphoglyceric acid; enzyme is diphosphoglycerate synthetase; 2,3-DPG reduces affinity of hemoglobin for oxygen; 2,3-DPG rises with alkalosis and decreases with acidosis, result of effect of pH on enzyme

Front 498

Rathke’s pouch

Back 498

a divertic involved in develoment of pituitary gland, vestigial remnants lead to craniopharyngioma

Front 499

Rebuck skin window

Back 499

dermal abrasion technique for testing tissue penetration of neutrophils, scraping forearm, then putting coverslip over it, checking glass for neutrophils

Front 500

Reed-Sternberg cells

Back 500

in Hodgkin’s lymphoma, giant macrophage-like cells with two nuclei

Front 501

refeeding syndrome

Back 501

hypokalemia, hypomagnesemia, and hypophosphatemia after refeeding a starved patient

Front 502

Refsum’s disease

Back 502

AR; phytanic acid accumulates as a result of an absence of the enzyme -phytanic acid -hydroxylase involved in its catabolism; give patient’s large amounts of nicotinic acid or triparanol, chemicals that inhibit lipid synthesis; dryness and scaling similar to the appearance of icthyosis develop

Front 503

Reichert’s cartilage

Back 503

branchial arch 2

Front 504

Reid index

Back 504

comparing the relative thickness of the mucous glands with the total thickness of the airway wall; increased in patients with chronic bronchitis (normally < 0.4)

Front 505

Reinke crystals

Back 505

in 25% of Leydig cell tumors, intracytoplasmic rod-shaped crystalloids

Front 506

Reinke’s edema

Back 506

vocal cord polyposis in female smokers, 50s-70s

Front 507

Reiter’s syndrome

Back 507

In 1916, Reiter described a triad of arthritis, urethritis, and conjunctivitis; 80% possess HLA-B27; associated with Shigella flexneri; ReA develops in 20% of exposed B27+ individuals; subset of reactive arthritis; triad present in 1/3 of patients; incidence estimated as 3.5/100K in males under age of 50; balanitis circinata (penis) and keratoderma blenorrhagica

Front 508

renal columns of Bertin

Back 508

the spaces between adjacent pyramids where cortical tissue extends into

Front 509

Renshaw cells

Back 509

inhibitory cells in the ventral horn of the spinal cord

Front 510

Reye’s syndrome

Back 510

rare disease characterized by fatty change in liver and encephalopathy that in its most severe forms may be fatal; associated with VZV and influenza virus B in children given aspirin

Front 511

Reynold’s pentad

Back 511

Charcot’s triad plus altered mental status and shock in cholangitis

Front 512

Richter syndrome

Back 512

the evolution of chronic lymphocytic leukemia to a large cell lymphoma with high fever, weight loss, enlarging lymph nodes, and hepatosplenomegaly

Front 513

Riedel’s lobe

Back 513

in some persons, especially those with a lanky build, the liver tends to be somewhat elongated so that its right lobe is easily palpable as it projects downward toward the iliac crest; such elongation, called Riedel’s lobe

Front 514

Riedel’s thyroiditis

Back 514

unknown etiology, marked by glandular atrophy, hypothyroidism, and replacement of the thyroid by fibrous tissue with adhesion to surrounding structures

Front 515

Riggler’s sign

Back 515

see wall of bowel in perforation

Front 516

Riley-Day syndrome

Back 516

hereditary sensory and autonomic neuropathy type III (familial dysautonomia), recessive disorder that commences in infancy and is characterized by conspicuous autonomic dysfunction (absent tearing, labile temperature, and blood pressure), and accompanied by absent taste sensation, impaired pain and temperature sensation, and areflexia

Front 517

Rinne test

Back 517

sensorineural loss, AC>BC conduct loss, BC>AC

Front 518

Ritter’s disease

Back 518

Staph scaled skin syndrome

Front 519

Roger’s disease

Back 519

small congenital VSD defect <0.5 cm in diameter (most are muscular); Henri L. Roger, French physician, 1809-1891

Front 520

Rokitansky-Aschoff sinuses

Back 520

small outpouchings of the gallbladder mucosa that may penetrate into and through the muscle wall; prominence in the settings of inflammation and gallstone formation (e.g. chronic cholecystitis) suggests that they are acquired herniations

Front 521

Romaña’s sign

Back 521

in Chagas disease, unilateral periorbital edema and swelling of the eyelid associated with reduviid bug of eye

Front 522

Romberg test

Back 522

patient stands feet together, eyes open and then closes both eyes for 20 to 30 sec without support; checking for cerebral ataxia; positive test indicative of grossly impaired joint sensation in the legs

Front 523

Rosenbach’s sign

Back 523

in thyrotoxicosis, tremor of the closed eyelids

Front 524

Roth’s spots

Back 524

in bacterial endocarditis and other retinal hemorrhagic conditions, a round white spot surrounded by hemorrhage (secondary to microemboli in endocarditis)

Front 525

Rotor’s syndrome

Back 525

poorly defined defects in hepatic uptake and storage of bilirubin; resembles Dubin-Johnson syndrome, but liver pigment missing

Front 526

Rotter’s lymph nodes

Back 526

lymph nodes between the pectoralis minor and pectoralis major

Front 527

Rovsing’s sign

Back 527

pain in the right lower quadrant during left-sided pressure suggests appendicitis; so does right lower quadrant pain on quick withdrawal (referred rebound tenderness)

Front 528

Russel bodies

Back 528

endoplasmic reticulum of plasma cells engaged in active synthesis of immunoglobulins may become hugely distended, producing large, homogenous eosinophilic inclusions called Russell bodies

Front 529

RUSSELL’S SIGN

Back 529

lanugo, dry skin, hand calluses, associated with purging and bulimia

Front 530

Sabouraud’s agar

Back 530

for growing fungi, low pH of medium and chloramphenicol and cycloheximide

Front 531

Saint’s triad

Back 531

1. cholelithiasis, 2. hiatal hernia, 3. diverticular disease

Front 532

Salus’s sign

Back 532

deflection of veins at AV crossings in hypertensive retinopathy (grade 2); c.f. Bonnet’s and Gunn’s sign

Front 533

Samter’s triad

Back 533

nasal polyps, bronchial asthma, aspirin sensitivity

Front 534

Santos’s syndrome

Back 534

Hirschsprung’s disease with renal agenesis, polydactyly, hypertelorsim, and deafness

Front 535

Scahmberg’s disease

Back 535

idiopathic capillaritis in which inflammation weakens capillaries, causes petechial lesions like cayenne pepper

Front 536

SCHAMROTH’S WINDOW TEST

Back 536

for testing clubbing

Front 537

Schatzki’s ring

Back 537

esophageal rings and webs in lower esophagus, located at or just above the squamocolumnar junction; most common cause of intermittent solid food obstruction

Front 538

Schaumann’s bodies

Back 538

laminated concretions composed of calcium and proteins, seen in granulomatous diseases (e.g. sarcoidosis)

Front 539

Schick’s test

Back 539

for testing immune status to Cornyebacterium diphtheriae, intradermal injection of 0.1 mL of purified standardized toxin; if no inflammation, antitoxin present

Front 540

Schilling test

Back 540

measuring cobalamin absorption by determining the fraction of an orally administered dose of radioactive cobalamin excreted in urine over 24 to 48 hours

Front 541

Schirmer’s test

Back 541

measures quantity of tears secreted in 5 minutes in response to irritation from a filter strip placed under each lower eyelid; normal young person moistens 15 mm; 33% of elderly wet only 10 mm in 5 minutes; in Sjögren’s syndrome, <5 mm in 5 min, 85% sensitivity, 85% specificity

Front 542

Schlesinger’s solution

Back 542

morphine and scopolamine

Front 543

Schmidt metaphyseal chondrodysplasia

Back 543

mutation in collagen X, mechanical pressure reduces growth

Front 544

Schmidt’s syndrome

Back 544

type II polyglandular syndrome, coexistent adrenal and thyroid disease, sometimes accompanied by IDDM

Front 545

Schober test

Back 545

measures distraction between 2 marks on the skin during forward flexion in ankylosing spondylitis

Front 546

Schwartz’s dictum

Back 546

no acid, no ulcer

Front 547

sclerosing osteomyelitis of Garr

Back 547

typically develops in the jaw, associated with extensive new bone formation that obscures much of the underlying osseous structure

Front 548

Scott syndrome

Back 548

defect in primary homeostasis, prolonged PT, deficient in platelet coagulant activity which provides the phospholipid surface and landing pad for prothrombinase in the presence of calcium

Front 549

Seligmann’s disease

Back 549

 heavy chain disease, characterized by infiltration of the lamina propria of the small intestine with lymphoplasmacytoid cells that secrete truncated  chains

Front 550

Senear-Usher syndrome

Back 550

pemphigus erythematosus; a localized variety of pemphigus foliaceus confined to seborrheic sites

Front 551

Sengstaken-Blakemore tube

Back 551

tube a double-balloon system, one for stomach, one for esophagus, for tamponade of bleeding varices

Front 552

Sever’s disease

Back 552

apophysitis of the calcaneus, common (but frequently source of heel pain), condition occurs before or during the peak growth spurt, often resolves two weeks or two months after initiation of conservative treatment

Front 553

Sézary’s syndrome

Back 553

rare special variant of cutaneous T-cell lymphoma characterized by generalized or universal erythroderma, peripheral lymphadenopathy, and cellular infiltrates of atypical lymphocytes (Sézary cells) in the skin and blood

Front 554

Sézary-Lutzner cells

Back 554

found in cutaneous T-cell lymphoma, T-helper cells that characteristically form band-like aggregates within the superficial dermis and invade the epidermis as single cells and small clusters (Pautrier’s microabcesses)

Front 555

Sheehan’s syndrome

Back 555

postpartum pituitary necrosis, syndrome results from sudden infarction of the anterior lobe precipitated by obstetric hemorrhage or shock (pregnancy, pituitary enlarges to almost twice its normal size, compressing blood supply)

Front 556

Shiraz dwarfism

Back 556

zinc deficiency, in Iran, short stature and aspermia

Front 557

Shohl’s solution

Back 557

alkalinizing solution in hyporeninemic hypoaldosteronism associated with renal tubular acidosis associated with diabetic nephropathy

Front 558

Shulman’s syndrome

Back 558

eosinophilic fascitis

Front 559

Shwartzman reaction

Back 559

two iv injections of sublethal lipopolysaccharide, 24 hrs apart, causing DIC in rabbits; TNF obligatory mediator

Front 560

Shy-Drager syndrome

Back 560

degenerative disorder characterized by parkinsonian features (leading to postural hypotension, anhidrosis, disturbance of sphincter control, impotence, etc.) And signs of more widespread neurologic involvement (pyramidal or lower motor neuron signs and often a cerebellar deficit)

Front 561

Siegrist streaks

Back 561

linear hyperpigmented areas over choroidal vessels in hypertensive retinopathy

Front 562

sign of Cabrera

Back 562

nochin at 0.05s in ascending limb of S wave in V3, V4; 27% sens for MI

Front 563

signe de Dance

Back 563

in intussusception, in the common entercolic variety, almost from the beginning of the illness the right iliac fossa will appear empty on palpation due to the taking up of the cecum into the advancing invagination

Front 564

silk glove sign

Back 564

indirect hernia sac in the pediatric patient; the sac feels like a finger of a silk glove when rolled under the examining finger

Front 565

Simmond’s disease

Back 565

pituitary cachexia (e.g. from Sheehan’s syndrome)

Front 566

Sims-Huhner test

Back 566

post coital test, done 2-4 hrs after intercourse to assess number and motility of sperm that have entered the cervical canal

Front 567

singers’s nodule

Back 567

is a small, benign laryngeal polyp, usually induced by chronic irritation, such as excessive use of the voice, and is associated most commonly with heavy cigarette smoking; is usually localized to the true vocal cords

Front 568

Sipple’s syndrome

Back 568

MEN type IIa; pheochromacytoma, medullary carcinoma of the thyroid, and hyperparathyroidism due to hyperplasia or tumor

Front 569

Sister Mary Joseph nodule

Back 569

abdominal carcinoma, especially gastric, may metastasize to the navel; Sister Joseph, in the early days of the Mayo Clinic, noted periumbilical nodules in patients with intraabdominal cancer

Front 570

Sjögren’s syndrome

Back 570

lymphocytic infiltration affects salivary and lacrimal glands and is associated with dry mouth and dry eyes (keratoconjunctivitis sicca); may have either interstitial pulmonary fibrosis or a lymphocytic infiltration of the alveolar walls (may have a malignant transformation with the development of a lymphoma)

Front 571

Skirrow’s medium

Back 571

contains vancomycin, trimethoprim, cephalothin, polymixin, and amphotericin B; for growing e.g. Campylobacter

Front 572

Smith’s fracture

Back 572

opposite of Colle’s fracture; fracture of the distal radius, but from falling on the dorsum of the hand

Front 573

Sneddon’s syndrome

Back 573

livedo reticularis associated with stroke-like episodes

Front 574

Somogyi phenomenon

Back 574

rebound hyperglycemia following an episode of hypoglycemia due to counterregulatory hormone release

Front 575

space of Retzius

Back 575

the preperitoneal space anterior to the bladder

Front 576

Spigelian hernia

Back 576

hernia through the linea semilunaris, aka spontaneous lateral ventral hernia

Front 577

spiral valves of Heister

Back 577

found in the neck of the gallbladder, where tiny folds of mucosal epithelium coalesce to form these valves, may assist in retaining bile between meals

Front 578

St. Anthony’s fire

Back 578

ergotism; disease caused by excess ergot alkaloid; classically an epidemic caused by consumption of grain that’s contaminated by the ergot fungus; any of several inflammations or gangrenous conditions of the skin (erysipelas)

Front 579

St. Vitus’s dance

Back 579

q.v. Sydenham’s chorea

Front 580

Stauffer’s syndrome

Back 580

elevation of LFTs due to cholestasis in renal cell carcinoma

Front 581

Steele-Richardson-Olszewski syndrome

Back 581

aka progressive supranuclear palsy

Front 582

Stein-Leventhal syndrome

Back 582

polycystic ovarian disease

Front 583

Stellwag’s sign

Back 583

incomplete and infrequent blinking in Graves’s disease

Front 584

Stevens-Johnson syndrome

Back 584

extensive and symptomatic febrile form of erythema multiforme, more common in children; 1-6 cases/million person-years

Front 585

Stewart-Treve syndrome

Back 585

lymphedema following mastectomy leading to lymphangiosarcoma

Front 586

Stickler syndrome

Back 586

mild spondyloepiphyseal dysplasia, osteoarthritis, and sensorineural hearing loss, some forms associated with a dominant negative mutation in the human COL11A2 gene encoding the 2(XI) chain

Front 587

Still’s murmur

Back 587

described by George Still in 1909; normal vibratory midsystolic murmur; innocent murmur

Front 588

Stokes-Adams attacks

Back 588

fainting spells associated with complete heart block (or other types of bradycardia)

Front 589

Sturge-Weber syndrome

Back 589

association of port-wine stain with vascular malformations in the eye (glaucoma) and leptomeninges and superficial calcifications of the brain; attributed to faulty development of certain mesodermal and ectodermal elements, and associated with mental retardation, seizures, hemiplegia, and radiopacities in the skull

Front 590

Sweet’s syndrome

Back 590

acute febrile neutrophilic dermatosis or Sweet syndrome, initially described in 1964 by Robert Sweet. It is characterized fever, neutrophilic leucocytosis, abrupt appearance of erythematous, painful, cutaneous plaques and dense dermal infiltrate consisting of mature neutrophils without vasculitis signs.

Front 591

Sydenham’s chorea

Back 591

aka St. Vitus’s dance A postinfectious chorea appearing several months after a streptococcal infection with subsequent rheumatic fever. The chorea typically involves the distal limbs and is assoc. with hypotonia and emotional lability. Improvement occurs over weeks or months and exacerbations occur without assoc. infection occurrence.

Front 592

Sylvian aqueduct

Back 592

cerebral aqueduct of the midbrain that connects the third and fourth ventricle

Front 593

Takayasu’s disease

Back 593

aortic arch syndrome, pulseless disease; panartertis of the great vessels that’s most common in Asian women

Front 594

Tamm Horsfall protein

Back 594

uromodulin, major component of renal casts; 30-50 mg secreted per day by cells in thick ascending limb; homologous to GP2, a protein secreted from the acinar cell and a major component of plugs in noncalcific chronic pancreatitis

Front 595

Tay-Sachs disease

Back 595

autosomal recessive; GM2 gangliosidosis, results from mutations that affect chr15 and cause a severe deficiency in hexosaminidase A; blindness and cherry-red spot

Front 596

Terry’s nails

Back 596

mostly whitish with a distal band of reddish brown; may be seen with aging and in people with chronic diseases such as cirrhosis of the liver, congestive heart failure, and non-insulin-dependent diabetes; seen in 10% of uremics

Front 597

tetralogy of Fallot

Back 597

1. ventricular septal defect; 2. infundibular, valvar, or supravalvar pulmonic stenosis; 3. an anteriorly displaced aorta that receives blood from both ventricles; 4. right ventricular hypertrophy

Front 598

Thompson's test

Back 598

verifies if gastroc-soleus complex intact; squeeze calf belly, foot should plantar flex

Front 599

Thomsen’s disease

Back 599

myotonia congenita

Front 600

Tietze syndrome

Back 600

discomfort localized in swelling of the costochondral and costosternal joints, which are painful on palpation; may be perceived as breast pain

Front 601

Tinel’s sign

Back 601

a sensation of tingling or pins and needles felt in distal extremity when percussion is made over the site of an injured nerve; it indicates a partial lesion or early regeneration of the nerve; 60% sens, 67% spec

Front 602

Todd's paralysis

Back 602

transient hemiparesis in postictal period, suggests focal brain lesion as cause, warrants further investigation

Front 603

Towne’s view

Back 603

AP view with the X ray tube angled caudad to show the occipital bone

Front 604

Traube’s sign

Back 604

in aortic regurgitation “pistol shot sounds” referring to booming systolic and diastolic sounds over the femoral artery

Front 605

Traube’s space

Back 605

a crescentic space about 12 cm wide, bounded medially by the left border of the sternum, above by an oblique line from the 6th costal cartilage to the lower border of the 8th or 9th rib in the mid-axillary line and below by the costal margin; the percussion tone here is normally tympanitic, because of the underlying stomach, but is modified by pulmonary emphysema, a pleural effusion, or an enlarged spleen

Front 606

Treacher Collins syndrome

Back 606

first arch syndrome, mandibulofacial dysplasia, caused by AD gene, resulting in malar hypoplasia with down-slanting palpebral fissures, defects in the lower eyelids, deformed external ears, and sometimes abnormalities of the middle and internal ears

Front 607

Trousseau’s sign

Back 607

in hypocalcemia and latent tetany, carpal spasm induced by occluding the brachial artery for 3 min with an inflated BP cuff

Front 608

Trousseau’s syndrome

Back 608

migratory thrombophlebitis, may be encountered with deep-seated cancers, most often with carcinomas of the pancreas or lung

Front 609

Turcot’s syndrome

Back 609

rare variant of familial adenomatous polyposis, with combination of adenomatous colonic polyposis and tumors of the CNS, mostly gliblastoma multiforme

Front 610

Tzanck smear

Back 610

cytologic technique most often used in the diagnosis of herpesvirus infections (simplex or varicella-zoster); multinucleated giant cells suggest the presence of herpes; named after Arnault Tzanck

Front 611

unhappy triad

Back 611

lateral knee injury resulting in ACL tear, MCL tear, and medial meniscal injury

Front 612

van den Bergh reaction

Back 612

used to distinguish between unconjugated and conjugated bilirubin; bilirubin pigments are exposed to sulfanilic acid to generate diazo conjugates, forming chromogenic products

Front 613

van der Woude syndrome

Back 613

an AD condition in which lip pits are seen in all gene carriers but only some individuals have cleft lips with or without cleft palate owing to variable expressivity

Front 614

van Wyk-Grumbach syndrome

Back 614

primary hypothyroidism associated with precocious puberty and galactorrhea

Front 615

van’t Hoff’s law

Back 615

for calculating osmotic pressure

Front 616

vein of Mayo

Back 616

vein overlying pylorus

Front 617

veins of Retzius

Back 617

numerous small veins in the retroperitoneum that connect the retroperitoneal viscera to the posterior abdominal wall; dilated in portal hypertension

Front 618

Vincent’s infection

Back 618

acute necrotizing ulcerative gingivitis, occurring in patients with decreased resistance to infection, from concurrent infection with the symbiotic bacteria Fusobacterium fusiforme and Borrelia vincentii

Front 619

Virchow’s node

Back 619

supraclavicular adenopathy associated with a malignancy, often on left side, associated with stomach cancer among other neoplasms

Front 620

Virchow’s triad

Back 620

predisposing factors in thrombus formation 1. endothelial injury, 2. hypercoagulability 3. stasis or turbulence of blood flow

Front 621

Virchow-Robin spaces

Back 621

perivascular spaces in brain; become unusually widened in edema of the brain

Front 622

Volkmann contracture

Back 622

contraction of forearm flexores because of compartment syndrome sequelae

Front 623

von Gierke’s disease

Back 623

glycogen storage disease type I, deficiency in glucose-6-phosphatase, results in hepatomegaly and hypoglycemia

Front 624

von Graefe sign

Back 624

in Graves’s disease, lag of the upper eyelid as it follows the rotation of the eyeball downward

Front 625

von Hippel-Lindau disease

Back 625

hemangioblastoma or cavernous hemangioma of the cerebellum, brain stem, or retina, adenomas, and cysts of the liver, kidney, pancreas, and other organs, 35% develop renal cell carcinoma, 3p

Front 626

von Myenburg complexes

Back 626

close to or within portal tracts, these are small clusters of modestly dilated bile ducts embedded in a fibrous, sometimes hyalinized stroma; these bile duct “microhamartomas” contain inspissated bile concrements and may communicate with the biliary tree; rather common and usually without clinical significance

Front 627

von Recklinghausen’s disease

Back 627

neurofibromatosis

Front 628

von Recklinghausen’s disease of bone

Back 628

generalized osteitis fibrosa cystica; hallmark of severe hyperparathyroidism, including increased bone cell activity, peritrabecular fibrosis, and cystic brown tumors

Front 629

von Willebrand’s disease

Back 629

deficiency in von Willebrand factor

Front 630

von Zumbusch psoriasis

Back 630

aka generalized acute pustular psoriasis

Front 631

Waardenburg’s syndrome

Back 631

Hirschprung’s disease characterized by deafness, white forelock, abnormal pigmentation (maybe heterochromia) due to developmental defect caused by defective neural crest migration; mutation in PAX3 gene or endothelin-B-receptor gene

Front 632

Waldenström’s macroglobulinemia

Back 632

marked by diffuse, leukemia-like infiltration of the bone marrow by lymphocytes, plasma cells, and hybrid forms that synthesize a monoclonal IgM, leading to macroglobulinemia; disease of old age, macroglubilinemia giving rise to visual impairment, neurologic problems, bleeding, cryoglobulinemia; hyper viscosity

Front 633

Waldeyer’s throat ring

Back 633

the broken ring of lymphoid tissue, formed of the lingual, facial, and pharyngeal tonsils, commonly involved in non-Hodgkin’s lymphoma and rarely in Hodgkin’s disease

Front 634

Wallenberg syndrome

Back 634

infarction in posterior inferior cerebellar artery (PICA), lateral medulla 1. lesion in nucleus ambiguus, difficulty in swallowing and hoarseness, loss of gag reflex 2. vestibular nucleus, dizziness and nystagmus 3. trigeminal, loss of pain and temperature on inpsilateral 4. inferior cerebellar peduncle, ipsilateral limb ataxia 5. anterolateral system, reduced pain and temperature on contraleral limb 6. ipsilateral Horner’s syndrome hiccup, for reasons not known solitary nucleus may also be destroyed, leading to loss of taste on ipsilateral half of tongue

Front 635

Warburg effect

Back 635

in malignant transformation, increased anaerobic glycolysis leads to increased lactic acid production

Front 636

Warthin’s tumor

Back 636

papillary cystadenoma lymphomatosum, parotid gland involved, benign, more in males than females, 50s-70s

Front 637

Warthin-Finkeldey cells

Back 637

in measles pneumonia, cells with multiple nuclei and eosinophilic intranuclear inclusions

Front 638

Warthin-Starry stain

Back 638

a silver stain, will stain H. pylori, Bartonella henselae

Front 639

Waterhouse-Friderichsen syndrome

Back 639

with N. meningitidis or gonococci, pneumococci, or Staph.: a form of septicemia characterized by hypotension leading to shock; DIC with widespread purpura, adrenocortical insufficiency associated with massive bilateral adrenal hemorrhage

Front 640

Weber syndrome

Back 640

medial midbrain syndrome

Front 641

Weber test

Back 641

sensorineural loss, sound from normal ear conduct loss, sound from affected ear

Front 642

Weber-Christian disease

Back 642

relapsing febrile nodular nonsuppurative nonvasculitic panniculitis (an inflammatory reaction in the subcutaneous fat)

Front 643

Wegener’s granulomatosis

Back 643

systemic vasculitis, presumed autoimmune, defined by a clinical triad of manifestations that includes involvement of the upper airways, lungs, and kidneys and by a pathological triad consisting of necrotizing granuloma in the upper respiratory tract and lungs, vasculitis involving both arteries and veins, and focal glomerulonephritis; untreated, mean survival 5 months, 1 year mortality 82%; treat with Bactrim; 1) pulm hemorrhages, 2) iron def anemia, 3) glomerulonephritis

Front 644

Weibel-Palade bodies

Back 644

found only in endothelial cells of vessels larger than capillaries; granules contain von Willebrand’s factor (VIII) and P-selectin

Front 645

Weigert stain

Back 645

iron hematoxylin, preceded by a dichromate mordant, stains myelin

Front 646

Weil-Felix reaction

Back 646

Proteus cell wall O antigens, such as OX-2, OX-19, and OX-K, cross-reacting with antigens of several species of rickettsiae

Front 647

Well’s syndrome

Back 647

eosinophilic cellulitis, characterized by recurrent cutaneous swellings which resemble acute bacterial cellulitis, and by distinctive histopathological changes. Skin lesions show dermal eosinophilic infiltration and the characteristic “flame figures” are composed of eosinophil major protein deposited on collagen bundles

Front 648

Werdnig-Hoffman syndrome

Back 648

infantile progressive spinal muscular atrophy autosomal recessive lower motor neuron disease that manifests clinically in infancy

Front 649

Wermer’s syndrome

Back 649

MEN type I, hyperplasias or tumors of the thyroid, parathyroid, adrenal cortex, pancreatic islets, or pituitary

Front 650

Werner’s syndrome

Back 650

A disorder consisting of scleroderma-like skin changes, bilateral juvenile cataracts, progeria, hypogonadism, and diabetes mellitus; autosomal recessive inheritance

Front 651

Wernicke’s area

Back 651

important cortical center for recognizing speech, found in the superior temporal gyrus

Front 652

Wernicke’s encephalopathy

Back 652

chronic alcoholics, thiamine deficiency (alcohol impairs thiamine absorption) ataxia, global confusion, ophthalmoplegia, and often nystagmus; sometimes, thiamine deficiency, can lead to a particular focal necrotizing encephalopathy affecting the hypothalamus, medial thalamus, and oculomotor nuclear groups in the periventricular brainstem; can be *precipitated by the administration of glucose* to patient depleted of thiamine; after treatment with thiamine, a minority of patients have profound memory deficit  Korsakoff’s syndrome

Front 653

Westermark’s sign

Back 653

in chest film, an abrupt tapering of a vessel caused by pulmonary embolism, focal oligemia

Front 654

Wharton’s duct

Back 654

submandibular duct

Front 655

Whipple procedure

Back 655

pancreaticoduodenectomy with cholecystectomy, truncal vagotomy, choledochojejunostomy, pancreaticojejunostomy, gastrojejunostomy

Front 656

Whipple’s disease

Back 656

small intestinal mucosa laden with distended macrophages in the lamina propria, PAS positive granules, with no inflammation; gram+ actinomycete Tropheryma whippelii

Front 657

Whipple’s triad

Back 657

in insulinoma, 1) attacks precipitated by fasting or exertion 2) fasting blood glucose <50 mg/dL 3) sx relieved by glucose administration

Front 658

white lines of Toldt

Back 658

the peritoneal reflections of the ascending and descending colon

Front 659

Wickham’s striae

Back 659

in lichen planus, papules are highlighted by a shiny surface with a lacy white pattern

Front 660

Widal test

Back 660

in salmonellosis, rise in antibody titer in patient’s serum

Front 661

Williams’s syndrome

Back 661

supravalvular aortic stenosis, mental retardation, elfin facies, association with hypercalcemia due to abnormal sensitivity to vitamin D, idiopathic hypercalcemia of pregnancy, loquacious personality, abnormally sensitive hearing

Front 662

Wilms’s tumor

Back 662

WT-1, cancer suppressor gene on 11p13

Front 663

Wilson’s disease

Back 663

hepatolenticular degeneration due to mutation in gene involved in incorporation of copper into ceruloplasmin and excretion of copper into bile; Kayser-Fleischer ring; gene on chr 13, cation transporting P-type ATPase; incidence 1:200,000, diagnosis based on decrease in serum ceruloplasmin, increased urinary excretion of copper, increase in hepatic copper content; 40% have neurologic findings (Parkinson’s, psychosis) and subclinical liver

Front 664

Wintrobe indices

Back 664

mean cell volume; mean cell hemoglobin; mean cell hemoglobin concentration

Front 665

Wiskott-Aldrich syndrome

Back 665

X-linked characterized by triad of eczema, thrombocytopenia (from autoantibodies), and repeated infections; failure to express sialic acid-rich glycoprotein, sialophorin or CD15, ending in early death

Front 666

Wolff-Chaikoff effect

Back 666

when increasing doses of iodide inhibit organification and hormonogenesis of thyroid hormone

Front 667

Wolff-Parkinson-White triad

Back 667

1) wide QRS complex, 2) relatively short PR interval, 3) slurring of initial part of QRS delta wave

Front 668

Wright's maneuver

Back 668

looking for thoracic outlet obstruction: evaluating the radial pulse at the wrist with the shoulder in external rotation and abduction, positive sign if it reproduces shoulder and arm symptoms and obliterates radial pulse

Front 669

Zenker’s diverticulum

Back 669

a pharyngeal diverticulum from premature contraction of the cricopharyngeus muscle on swallowing, leads to progressive UES narrowing, leading to a posteriorly directed hypopharynx; causes progressive food stasis and dysphagia

Front 670

Zollinger-Ellison syndrome

Back 670

hallmark, circulating hypergastrinemia; gastric acid hypersecretion and severe peptic ulcer diathesis secondary to unbridled release of gastrin from a gastrinoma; associated with peptic ulcers and diarrhea; 60% malignant, only 20% resectable; 25% of gastrinoma patients have MEN I; >80% of gastrinomas found in gastrinoma triangle

Front 671

Antianginal therapy

Back 671

p.319

Front 672

Name four determinants of the level of myocardial oxygen consumption

Back 672

There are five: end diastolic volume, blood pressure, heart rate, contractility, ejection time

Front 673

Do nitrates affect preload or afterload?

Back 673

preload

Front 674

Do Beta-blockers affect preload or afterload?

Back 674

afterload

Front 675

What is the effect of nitrates on: diastolic volume, blood pressure, contractility, heart rate, ejection time?

Back 675

decrease EDV, decrease BP, increase contractility (reflex response), increase HR (reflex response), decrease ejection time

Front 676

What is the effect of Beta-blockers on: diastolic volume, blood pressure, contractility, heart rate, ejection time?

Back 676

increase EDV, decrease BP, decrease contractility, decreased HR, increase ejection time

Front 677

The effects of using nitrates and Beta-blockers together will: a) decrease myocardial oxygen demands by the same amount as using either alone, b) decrease myocardial oxygen demands by an amount greater than if each were used alone, or c) have no effect on myocardial oxygen demand

Back 677

b) Decrease myocardial oxygen demands by an amount greater that if each were used alone

Front 678

Nifedipine blocks -- channels

Back 678

calcium

Front 679

In its effects on myocardial oxygen consumption, is Nifedipine similar to Nitrates or B-blockers?

Back 679

Nitrates (Nifedipine is similar to Nitrates)

Front 680

In its effects on myocardial oxygen consumption, is Verapamil similar to Nitrates or B-blockers?

Back 680

B-blockers

Front 681

Nitroglycerine, isosorbide dinitrate

Back 681

p.319

Front 682

Dose nitroglycerin dilate arteries or veins more?

Back 682

Veins&gt;&gt;arteries

Front 683

Does nitroglycerin increase or decrease cGMP in smooth muscle?

Back 683

Increase

Front 684

In industrial exposure to nitroglycerine, weekend withdrawal is characterized by which three symptoms?

Back 684

Tachycardia, dizziness , and headache (&quot;Monday disease&quot;)

Front 685

Toxic dosage of nitroglycerine causes which three symptoms?

Back 685

Tachycardia, hypotension, headache

Front 686

Cardiac drugs: sites of action

Back 686

p.320

Front 687

Digitalis has its action on which cell membrane transporter?

Back 687

Na/K ATPase

Front 688

Ryanodine has its action on which channel?

Back 688

Calcium release channel in the sarcoplasmic receptor

Front 689

Calcium enters cardiac cells through which channel?

Back 689

Voltage-gated calcium channel

Front 690

Cytoplasmic calcium concentrations in cardiac cells can be decreased by sequestering calcium in the sarcoplasmic reticulum. Calcium enters the SR through which transporter?

Back 690

Calcium pump in the wall of the SR

Front 691

Calcium channel blockers have their effect on which calcium transporters?

Back 691

Voltage-gated calcium channel

Front 692

Parkinson's dz

Back 692

Nigrostriatal dopamine depletion

Front 693

Perosteal elevation on x-ray

Back 693

pyogenic osteomylitis

Front 694

Putz-Jeghers syndrome

Back 694

benign polyposis

Front 695

Peyronie's dz

Back 695

Penile fibrosis

Front 696

Myosite disarray

Back 696

Hypertrophic
Cardiomyopathy
Wdfaf
Afdaf

Front 697

In the ventricular action potential, what causes the Phase 0 rapid upswing?

Back 697

opening of voltage gated Na channels

Front 698

In the phase 2 plateau, Ca++ influx triggers Ca++ release from the SR causing ….

Back 698

myocyte contraction

Front 699

What effect does Ach have on HR?

Back 699

decrease

Front 700

What effect do catecholamines have on HR

Back 700

increase

Front 701

Name 4 things that increase contractility:

Back 701

catecholamines, digitalis, an increase in intracellular Ca++, or a decrease in extracellular Na+

Front 702

What effect does increased afterload have on myocardial oxygen demand?

Back 702

increased

Front 703

how do catecholamines increase contractility?

Back 703

increase the activity of Ca++ pump in the SR

Front 704

What effect will and MI have on contractile state of the heart?

Back 704

decrease

Front 705

what does S1 correspond to?

Back 705

mitral and tricuspid valve closure

Front 706

what does S2 correspond to?

Back 706

aortic and pulmonary valve closure

Front 707

what does S3 correspond to?

Back 707

the end of rapid ventricular filling

Front 708

what is S3 associated with?

Back 708

dilated CHF

Front 709

what is S4 and what does it indicate?

Back 709

an atrial kick associated with a hyptertrophic ventricle (high atrial pressure/stiff ventricle)

Front 710

what is the a wave?

Back 710

atrial contraction

Front 711

what is the c wave?

Back 711

RV contraction when the tricuspid valve bulges into atrium

Front 712

what is the v wave?

Back 712

increase in atrial pressure due to filling against a closed tricuspid valve

Front 713

what is physiologic S2 splitting

Back 713

aortic valve closes just before the pulmonic - the difference is increased on inspiration

Front 714

what is paradoxical splitting

Back 714

when the split is heard on expiration instead of inspiration … associated with aortic stenosis

Front 715

what is meant by "HIZ" shrinkage

Back 715

the H, I, and Z band decrease in length on muscle contraction, the A band (myosin) stays the same length

Front 716

describe the pathway of smooth muscle contraction

Back 716

ap - > sm muslce depolarization - > open Ca++ channels -> increase in cytosol Ca++ -> Ca++ bind Calmodulin -> activates MLCK -> relaxation ->MLCP forms a cross bridge and contraction by binding myosin to actin - > MLCK relaxes … cycle continues while Ca is present.

Front 717

in an EKG, what does the P wave represent?

Back 717

atrial depolarization

Front 718

in an EKG, what does the PR segment represent?

Back 718

conduction delay through the AV (200 msec)

Front 719

in an EKG, what does the QRS complex represent?

Back 719

ventricular depolarization(120 msec)

Front 720

in an EKG, what does the QT interval represent?

Back 720

mechanical contraction of the ventricle

Front 721

in and EKG, what does the T wave represent?

Back 721

ventricular repolarization

Front 722

do you see atrial repolarization on an EKG?

Back 722

no, it is masked by the QRS complex

Front 723

in an EKG, what does the ST segment represent?

Back 723

isoelectric, ventricles are depolarized

Front 724

on an EKG, what is a U wave?

Back 724

caused by hypokalemia

Front 725

what is Wolff-Parkinson-White syndrome

Back 725

when an accessory conduction pathway exists from atria to ventricle (bundle of Kent) - bypasses the AV node and ventricles partially depoliarize earlier giving rise to a delta wave. WPW syndrome may lead to recurrent entry and SVTs.

Front 726

What do you see on and EKG with atrial fibrillation?

Back 726

chaotic erratic baseline with no disrete P waves in between iregularly spaced QRS complexes

Front 727

What do you see on an EKG with atrial flutter?

Back 727

sawtooth, identical back to back P waves

Front 728

How many kinds of AV block are there?

Back 728

4: 1st degree, mobitz I, mobitz II, complete

Front 729

What is 1st degree AV block?

Back 729

asymptomatic - PR interval longer than 200 msec

Front 730

What is mobitz II AV block?

Back 730

driooed beats not proceeded by a progressively lengthening PR interval. Pathological … can progress to complete block

Front 731

What is mobitz I AV block?

Back 731

progressive PR lengthening until a beat is dropped … usually asymptomatic

Front 732

what is a 3rd degree AV block

Back 732

complete AV block, atria and ventricles beat independently … rx with pacemaker

Front 733

what is v-fib

Back 733

completely erradic rhythm with no identifiable waves, fatal without immediate defibrillation

Front 734

what is the normal right atrial pressure?

Back 734

5

Front 735

what is the normal left atrial pressure

Back 735

12 (approx with pcwp - swan-ganz)

Front 736

what is the normal right ventricular blood pressure?

Back 736

25/5

Front 737

what is the normal pulmonary artery pressure?

Back 737

25/10

Front 738

what is the normal left ventricular pressure?

Back 738

130/10

Front 739

what is a normal aortic blood pressure?

Back 739

130/90

Front 740

of the total body weight, what proportion is blood?

Back 740

8% … the rest is body fluids and tissues

Front 741

of the total body blood, what proportion is plasma?

Back 741

55% plasma … the rest is hematocrit.

Front 742

what is serum?

Back 742

plasma without clotting factors

Front 743

what is the makeup of plasma?

Back 743

91.5% water, 7% protein, salts, lipids, enzymes, and vitamins

Front 744

what is the makeup of plasma proteins?

Back 744

55% albumin, 38% globulin, 7% fibrinogen

Front 745

what are the three kinds of cells in hematocrit?

Back 745

erythrocytes, leukocytes, and platelets

Front 746

what is the typical makeup of WBCs in the blood?

Back 746

40-70% PMNS, 20-40% lymphocytes, 2-10% monocytes, 1-6% eosinophils, <1% basophils

Front 747

what is the net filtration pressure

Back 747

Pnet=[(Pc-Pi)-(πc-πi)]

Front 748

what are 4 common causes edema?

Back 748

increased capillary pressure, decreased plasma proteins, increased capillary permeability, or increased interstitial colloid pressure

Front 749

what is a common cause of increased capillary pressure

Back 749

heart failure

Front 750

what is a common cause of decreased plasma proteins

Back 750

nephrotic syndrome or liver failure

Front 751

what may cause increased capillary permeability?

Back 751

toxins, infections, burns

Front 752

what could cause increased colloid presure?

Back 752

lymphatic blockage

Front 753

what are the three structures in the carotid sheath?

Back 753

internal jugular v. (lateral), common carotid a. (medial), vagus n. (posterior)

Front 754

in most cases, what supplies the SA and AV nodes?

Back 754

RCA

Front 755

80% of the time, what supplies the inferior portion of the LV via the PD artery?

Back 755

RCA (right dominant)

Front 756

when do the coronary arteries fill?

Back 756

during diastole

Front 757

what supplies the anterior interventricular septum?

Back 757

LAD

Front 758

what is the most posterior part of the heart? enlargment can cause what?

Back 758

left atrium; dysphagia

Front 759

what artery gives off large obtuse marginal branches that supply the lateral and posterior walls of the LV?

Back 759

circumflex

Front 760

what supplies the anterior 2/3 of IV septum, apical portion of anterior papillary muscle, and the anterior surface of the LV?

Back 760

LAD

Front 761

where does the RCA travel?

Back 761

in the right AV groove

Front 762

what supplies the inferior and posterior wals of the ventricles and the posterior 1/3 of the IV septum?

Back 762

posterior descending (typically a branch of RCA)

Front 763

Cardiac output = ?

Back 763

stroke volume x heart rate

Front 764

what is the Fick principle?

Back 764

CO = rate of O2 consumption/ (arterial O2 content - venous O2 content)

Front 765

how do you calculate mean arterial pressure?

Back 765

CO x TPR = 1/3SBP + 2/3 DBP

Front 766

pulse pressure = ?

Back 766

systolic - diastolic (approx SV)

Front 767

stroke volume = ?

Back 767

CO/HR = EDV-ESV

Front 768

what variables affect stroke volume?

Back 768

contractility, afterload, and preload - SV CAP

Front 769

what effect does increased intracellular calcium have on contractility and SV?

Back 769

increases contractility and SV

Front 770

how does decreased extracellular sodium affect contractility and SV?

Back 770

increases contractility and SV

Front 771

5 things that decrease contractility and SV?

Back 771

B1 block, heart failure, acidosis, hypoxea/hypercapnea, Ca++ channel blockers

Front 772

what effect does digitalis have on contractility and SV?

Back 772

increases them

Front 773

preload is equal to what volume?

Back 773

end diastolic volume

Front 774

afterload is equal to what presure?

Back 774

systolic arterial pressure (proportional to peripheral resistance)

Front 775

what effect do venous dilators (e.g. nitroglycerin) have?

Back 775

decrease preload

Front 776

what effect do vasodilators (e.g. hydralazine) have?

Back 776

decrease afterload

Front 777

this increases slightly with exercise, increased blood volume (overtransfusion), and excitement (sympathetics)

Back 777

preload

Front 778

ejection fraction = ?

Back 778

SV/EDV = (EDV-ESV)/EDV = index of contractility

Front 779

ejection fraction is normally greater than or equal to?

Back 779

55%

Front 780

resistance is directly proportional to what?

Back 780

viscosity

Front 781

resistance is inversely proportional to what?

Back 781

radius to the 4th power

Front 782

delta P = ?

Back 782

Q x R

Front 783

resistance = ?

Back 783

[delta P/Q]/[8xviscosityxlengthxr to the 4th]

Front 784

what does viscosity mostly depend on? when is it increased?

Back 784

hematocrit: incrased in polycythemia, hyperproteinemic states (e.g. multiple myeloma), hereditary spherocytosis

Front 786

when in the cardiac cycle is O2 consumption highest?

Back 786

isovolumetric contraction

Front 787

this is the period between mitral valve closing and aortic valve opening

Back 787

isovolumetric contraction

Front 788

this is the period between aortic valve opening and closing

Back 788

systolic ejection

Front 789

this is the period between aortic valve closing and mitral vale opening

Back 789

isovolumetric relaxation

Front 790

when does rapid filling occur?

Back 790

just after mitral valve opens

Front 791

when does slow filling occur?

Back 791

just before mitral valve closes

Front 792

when is JVD seen?

Back 792

right heart failure

Front 793

what is cardiac muscle contraction dependent on?

Back 793

extracellular calcium, which enters the cells during plateau of action potential and stimulates calcium release from the sarcoplasmic reticulum (calcium-induced calcium release)

Front 794

what is the plateau in the cardiac muscle action potential due to?

Back 794

calcium influx

Front 795

where does the pacemaker action potential occur?

Back 795

SA and AV nodes

Front 796

what accounts for the automaticity of the SA and AV nodes?

Back 796

slow diastolic depolarization - membrane potential spontaneously depolarizes as Na+ conductance increases (funny channel)

Front 797

what determines heart rate?

Back 797

slope of phase 4 in the SA node

Front 798

what are the peripheral chemoreceptors? what do they respond to?

Back 798

carotid and aortic bodies - they respond to decreased (less than 60 mmHg)/increased PCO2, decreased pH of blood

Front 799

what do central chemoreceptors respond to?

Back 799

changes in pH and PCO2 of brain interstitial fluid, which in turn are influenced by arterial CO2

Front 800

what does the aortic arch respond to? how does it transmit and to where?

Back 800

responds to increased BP; transmits via vagus to medulla

Front 801

how and to where does the carotid sinus transmit information?

Back 801

via glossopharyngeal to the medulla

Front 802

how do the central chemoreceptors respond to increased intracranial pressure?

Back 802

hypertension (sympathetic response) and bradycardia (parasympathetic response)

Front 803

what organ receives the larges share of systemic cardiac output?

Back 803

liver

Front 804

what organ receivest eh highest blood flow per gramof tissue?

Back 804

kidney

Front 805

how does the heart meet increased O2 demand?

Back 805

incrased coronary blood flow, not by increased extraction of O2

Front 806

hypoxia in the pulmonary vasculature causes what?

Back 806

vasoconstriction (unique because in other organs hypoxia causes vasodilation)

Front 807

what are the local factors in the heart that determine autoregulaton?

Back 807

O2, adenosine, NO

Front 808

what are the local factors in the brain that determine autoregulation?

Back 808

CO2 (pH)

Front 809

how do the kidneys determine autoregulation?

Back 809

myogenic and tuboglomerular feedback

Front 810

what local factors determine autoregulation in skeletal muscle?

Back 810

lactate, adenosine, K+

Front 811

what is the most important mechanism for determining autoregulation in the skin?

Back 811

sympathetic stimulation - temperature control

Front 812

what is the effect of carotid massage?

Back 812

incrases pressure on carotid artery - increasing stretch and leading to decreased HR

Front 813

what is the ultimate consequence of baroreceptors sensing hypotension?

Back 813

vasoconstriction, incrased HR, contractility, and BP - important in the response to severe hemorrhage

Front 814

sound of mitral and tricuspid valve closure

Back 814

S1

Front 815

In the ventricular action potential, what causes the Phase 0 rapid upswing?

Back 815

opening of voltage gated Na channels

Front 816

In the phase 2 plateau, Ca++ influx triggers Ca++ release from the SR causing ….

Back 816

myocyte contraction

Front 817

What effect does Ach have on HR?

Back 817

decrease

Front 818

What effect do catecholamines have on HR

Back 818

increase

Front 819

Name 4 things that increase contractility:

Back 819

catecholamines, digitalis, an increase in intracellular Ca++, or a decrease in extracellular Na+

Front 820

What effect does increased afterload have on myocardial oxygen demand?

Back 820

increased

Front 821

how do catecholamines increase contractility?

Back 821

increase the activity of Ca++ pump in the SR

Front 822

What effect will and MI have on contractile state of the heart?

Back 822

decrease

Front 823

what does S1 correspond to?

Back 823

mitral and tricuspid valve closure

Front 824

what does S2 correspond to?

Back 824

aortic and pulmonary valve closure

Front 825

what does S3 correspond to?

Back 825

the end of rapid ventricular filling

Front 826

what is S3 associated with?

Back 826

dilated CHF

Front 827

what is S4 and what does it indicate?

Back 827

an atrial kick associated with a hyptertrophic ventricle (high atrial pressure/stiff ventricle)

Front 828

what is the a wave?

Back 828

atrial contraction

Front 829

what is the c wave?

Back 829

RV contraction when the tricuspid valve bulges into atrium

Front 830

what is the v wave?

Back 830

increase in atrial pressure due to filling against a closed tricuspid valve

Front 831

what is physiologic S2 splitting

Back 831

aortic valve closes just before the pulmonic - the difference is increased on inspiration

Front 832

what is paradoxical splitting

Back 832

when the split is heard on expiration instead of inspiration … associated with aortic stenosis

Front 833

what is meant by "HIZ" shrinkage

Back 833

the H, I, and Z band decrease in length on muscle contraction, the A band (myosin) stays the same length

Front 834

describe the pathway of smooth muscle contraction

Back 834

ap - > sm muslce depolarization - > open Ca++ channels -> increase in cytosol Ca++ -> Ca++ bind Calmodulin -> activates MLCK -> relaxation ->MLCP forms a cross bridge and contraction by binding myosin to actin - > MLCK relaxes … cycle continues while Ca is present.

Front 835

in an EKG, what does the P wave represent?

Back 835

atrial depolarization

Front 836

in an EKG, what does the PR segment represent?

Back 836

conduction delay through the AV (200 msec)

Front 837

in an EKG, what does the QRS complex represent?

Back 837

ventricular depolarization(120 msec)

Front 838

in an EKG, what does the QT interval represent?

Back 838

mechanical contraction of the ventricle

Front 839

in and EKG, what does the T wave represent?

Back 839

ventricular repolarization

Front 840

do you see atrial repolarization on an EKG?

Back 840

no, it is masked by the QRS complex

Front 841

in an EKG, what does the ST segment represent?

Back 841

isoelectric, ventricles are depolarized

Front 842

on an EKG, what is a U wave?

Back 842

caused by hypokalemia

Front 843

what is Wolff-Parkinson-White syndrome

Back 843

when an accessory conduction pathway exists from atria to ventricle (bundle of Kent) - bypasses the AV node and ventricles partially depoliarize earlier giving rise to a delta wave. WPW syndrome may lead to recurrent entry and SVTs.

Front 844

What do you see on and EKG with atrial fibrillation?

Back 844

chaotic erratic baseline with no disrete P waves in between iregularly spaced QRS complexes

Front 845

What do you see on an EKG with atrial flutter?

Back 845

sawtooth, identical back to back P waves

Front 846

How many kinds of AV block are there?

Back 846

4: 1st degree, mobitz I, mobitz II, complete

Front 847

What is 1st degree AV block?

Back 847

asymptomatic - PR interval longer than 200 msec

Front 848

What is mobitz II AV block?

Back 848

driooed beats not proceeded by a progressively lengthening PR interval. Pathological … can progress to complete block

Front 849

What is mobitz I AV block?

Back 849

progressive PR lengthening until a beat is dropped … usually asymptomatic

Front 850

what is a 3rd degree AV block

Back 850

complete AV block, atria and ventricles beat independently … rx with pacemaker

Front 851

what is v-fib

Back 851

completely erradic rhythm with no identifiable waves, fatal without immediate defibrillation

Front 852

what is the normal right atrial pressure?

Back 852

5

Front 853

what is the normal left atrial pressure

Back 853

12 (approx with pcwp - swan-ganz)

Front 854

what is the normal right ventricular blood pressure?

Back 854

25/5

Front 855

what is the normal pulmonary artery pressure?

Back 855

25/10

Front 856

what is the normal left ventricular pressure?

Back 856

130/10

Front 857

what is a normal aortic blood pressure?

Back 857

130/90

Front 858

of the total body weight, what proportion is blood?

Back 858

8% … the rest is body fluids and tissues

Front 859

of the total body blood, what proportion is plasma?

Back 859

55% plasma … the rest is hematocrit.

Front 860

what is serum?

Back 860

plasma without clotting factors

Front 861

what is the makeup of plasma?

Back 861

91.5% water, 7% protein, salts, lipids, enzymes, and vitamins

Front 862

what is the makeup of plasma proteins?

Back 862

55% albumin, 38% globulin, 7% fibrinogen

Front 863

what are the three kinds of cells in hematocrit?

Back 863

erythrocytes, leukocytes, and platelets

Front 864

what is the typical makeup of WBCs in the blood?

Back 864

40-70% PMNS, 20-40% lymphocytes, 2-10% monocytes, 1-6% eosinophils, <1% basophils

Front 865

what is the net filtration pressure

Back 865

Pnet=[(Pc-Pi)-(πc-πi)]

Front 866

what are 4 common causes edema?

Back 866

increased capillary pressure, decreased plasma proteins, increased capillary permeability, or increased interstitial colloid pressure

Front 867

what is a common cause of increased capillary pressure

Back 867

heart failure

Front 868

what is a common cause of decreased plasma proteins

Back 868

nephrotic syndrome or liver failure

Front 869

what may cause increased capillary permeability?

Back 869

toxins, infections, burns

Front 870

what could cause increased colloid presure?

Back 870

lymphatic blockage

Front 871

what are the three structures in the carotid sheath?

Back 871

internal jugular v. (lateral), common carotid a. (medial), vagus n. (posterior)

Front 872

in most cases, what supplies the SA and AV nodes?

Back 872

RCA

Front 873

80% of the time, what supplies the inferior portion of the LV via the PD artery?

Back 873

RCA (right dominant)

Front 874

when do the coronary arteries fill?

Back 874

during diastole

Front 875

what supplies the anterior interventricular septum?

Back 875

LAD

Front 876

what is the most posterior part of the heart? enlargment can cause what?

Back 876

left atrium; dysphagia

Front 877

what artery gives off large obtuse marginal branches that supply the lateral and posterior walls of the LV?

Back 877

circumflex

Front 878

what supplies the anterior 2/3 of IV septum, apical portion of anterior papillary muscle, and the anterior surface of the LV?

Back 878

LAD

Front 879

where does the RCA travel?

Back 879

in the right AV groove

Front 880

what supplies the inferior and posterior wals of the ventricles and the posterior 1/3 of the IV septum?

Back 880

posterior descending (typically a branch of RCA)

Front 881

Cardiac output = ?

Back 881

stroke volume x heart rate

Front 882

what is the Fick principle?

Back 882

CO = rate of O2 consumption/ (arterial O2 content - venous O2 content)

Front 883

how do you calculate mean arterial pressure?

Back 883

CO x TPR = 1/3SBP + 2/3 DBP

Front 884

pulse pressure = ?

Back 884

systolic - diastolic (approx SV)

Front 885

stroke volume = ?

Back 885

CO/HR = EDV-ESV

Front 886

what variables affect stroke volume?

Back 886

contractility, afterload, and preload - SV CAP

Front 887

what effect does increased intracellular calcium have on contractility and SV?

Back 887

increases contractility and SV

Front 888

how does decreased extracellular sodium affect contractility and SV?

Back 888

increases contractility and SV

Front 889

5 things that decrease contractility and SV?

Back 889

B1 block, heart failure, acidosis, hypoxea/hypercapnea, Ca++ channel blockers

Front 890

what effect does digitalis have on contractility and SV?

Back 890

increases them

Front 891

preload is equal to what volume?

Back 891

end diastolic volume

Front 892

afterload is equal to what presure?

Back 892

systolic arterial pressure (proportional to peripheral resistance)

Front 893

what effect do venous dilators (e.g. nitroglycerin) have?

Back 893

decrease preload

Front 894

what effect do vasodilators (e.g. hydralazine) have?

Back 894

decrease afterload

Front 895

this increases slightly with exercise, increased blood volume (overtransfusion), and excitement (sympathetics)

Back 895

preload

Front 896

ejection fraction = ?

Back 896

SV/EDV = (EDV-ESV)/EDV = index of contractility

Front 897

ejection fraction is normally greater than or equal to?

Back 897

55%

Front 898

resistance is directly proportional to what?

Back 898

viscosity

Front 899

resistance is inversely proportional to what?

Back 899

radius to the 4th power

Front 900

delta P = ?

Back 900

Q x R

Front 901

resistance = ?

Back 901

[delta P/Q]/[8xviscosityxlengthxr to the 4th]

Front 902

what does viscosity mostly depend on? when is it increased?

Back 902

hematocrit: incrased in polycythemia, hyperproteinemic states (e.g. multiple myeloma), hereditary spherocytosis

Front 904

when in the cardiac cycle is O2 consumption highest?

Back 904

isovolumetric contraction

Front 905

this is the period between mitral valve closing and aortic valve opening

Back 905

isovolumetric contraction

Front 906

this is the period between aortic valve opening and closing

Back 906

systolic ejection

Front 907

this is the period between aortic valve closing and mitral vale opening

Back 907

isovolumetric relaxation

Front 908

when does rapid filling occur?

Back 908

just after mitral valve opens

Front 909

when does slow filling occur?

Back 909

just before mitral valve closes

Front 910

when is JVD seen?

Back 910

right heart failure

Front 911

what is cardiac muscle contraction dependent on?

Back 911

extracellular calcium, which enters the cells during plateau of action potential and stimulates calcium release from the sarcoplasmic reticulum (calcium-induced calcium release)

Front 912

what is the plateau in the cardiac muscle action potential due to?

Back 912

calcium influx

Front 913

where does the pacemaker action potential occur?

Back 913

SA and AV nodes

Front 914

what accounts for the automaticity of the SA and AV nodes?

Back 914

slow diastolic depolarization - membrane potential spontaneously depolarizes as Na+ conductance increases (funny channel)

Front 915

what determines heart rate?

Back 915

slope of phase 4 in the SA node

Front 916

what are the peripheral chemoreceptors? what do they respond to?

Back 916

carotid and aortic bodies - they respond to decreased (less than 60 mmHg)/increased PCO2, decreased pH of blood

Front 917

what do central chemoreceptors respond to?

Back 917

changes in pH and PCO2 of brain interstitial fluid, which in turn are influenced by arterial CO2

Front 918

what does the aortic arch respond to? how does it transmit and to where?

Back 918

responds to increased BP; transmits via vagus to medulla

Front 919

how and to where does the carotid sinus transmit information?

Back 919

via glossopharyngeal to the medulla

Front 920

how do the central chemoreceptors respond to increased intracranial pressure?

Back 920

hypertension (sympathetic response) and bradycardia (parasympathetic response)

Front 921

what organ receives the larges share of systemic cardiac output?

Back 921

liver

Front 922

what organ receivest eh highest blood flow per gramof tissue?

Back 922

kidney

Front 923

how does the heart meet increased O2 demand?

Back 923

incrased coronary blood flow, not by increased extraction of O2

Front 924

hypoxia in the pulmonary vasculature causes what?

Back 924

vasoconstriction (unique because in other organs hypoxia causes vasodilation)

Front 925

what are the local factors in the heart that determine autoregulaton?

Back 925

O2, adenosine, NO

Front 926

what are the local factors in the brain that determine autoregulation?

Back 926

CO2 (pH)

Front 927

how do the kidneys determine autoregulation?

Back 927

myogenic and tuboglomerular feedback

Front 928

what local factors determine autoregulation in skeletal muscle?

Back 928

lactate, adenosine, K+

Front 929

what is the most important mechanism for determining autoregulation in the skin?

Back 929

sympathetic stimulation - temperature control

Front 930

what is the effect of carotid massage?

Back 930

incrases pressure on carotid artery - increasing stretch and leading to decreased HR

Front 931

what is the ultimate consequence of baroreceptors sensing hypotension?

Back 931

vasoconstriction, incrased HR, contractility, and BP - important in the response to severe hemorrhage

Front 932

sound of mitral and tricuspid valve closure

Back 932

S1

Front 933

2. Which hypothalamic nucleus is involved in ovulation?

Back 933

Arcuate Nucleus: generates GnRH → FSH, LH

Front 934

6. What cells of the corpus luteum secrete progesterone and estrogen?

Back 934

theca lutein cells
(formerly called theca interna cells prior to ovulation)
granulosa lutein cells
(formerly called granulosa cells prior to ovulation)
(granulosa lutein cells and theca lutein cells are collectively called luteal (lutein) cells)

Front 935

7. What is the 2 cell theory of estridiol production?

Back 935

Theca cell stimulated by LH
Cholesterol → androstendione (desmolase)
Androstendione → granulose cell
Granulosa cell stimulated by FSH
Androstendione → estrogen (aromatase)

Front 936

What uterine pathology matches the following description: • excess unopposed estrogen is the main risk factor

Back 936

Endometrial hyperplasia and carcinoma

Front 937

• What uterine pathology matches the following description: What uterine pathology matches the following description: menorrhagia with an enlarged uterus and no pelvic pain

Back 937

Leiomyoma

Front 938

• What uterine pathology matches the following description: pelvic pain that is present only during menstruation

Back 938

Endometriosis

Front 939

• What uterine pathology matches the following description: diagnosed by endometrial biopsy in clinic

Back 939

Endometrial hyperplasian and carcinoma

Front 940

• What uterine pathology matches the following description: definitive diagnosis and treatment is by laproscopy

Back 940

Endometriosis

Front 941

• What uterine pathology matches the following description: menstruating tissue within the myometrium

Back 941

Adenomyosis

Front 942

What uterine pathology matches the following description: • malignant tumor of the uterine smooth muscle

Back 942

Leiomyomasarcoma

Front 943

• What uterine pathology matches the following description: most common gynecologic malignancy

Back 943

Endometrial carcinoma

Front 944

13. What are the 4 main categories of ovarian tumors? (FA p448 - FA p449)

Back 944

epithelial (65% of ovarian tumors, 90% of ovarian cancers)
germ cell
stromal
metastatic (GI, breast, endometrium)

Front 945

What are the main types of epithelial cell ovarian tumors (which account for 65% of ovarian tumors and 90% of ovarian cancers)?

Back 945

serous,
mucinous,
endometroid,
clear cell,
Brenner,
mixed
(hint: MY Med Students Consistently Beat Exams

Front 946

What are the main types of germ cell ovarian tumors?

Back 946

teratoma,
dysgerminoma,
endodermal sinus,
choriocarcinoma

Front 947

What are the main types of stromal/sex cord ovarian tumors?

Back 947

granulosa-theca cell,
Sertoli-Leydig cell,
fibroma

Front 948

• What ovarian tumor matches the following statement: produces AFP

Back 948

Yolk sac

Front 949

• What ovarian tumor matches the following statement: estrogen secreting → precocious puberty

Back 949

Granulosa theca cell tumor

Front 950

• What ovarian tumor matches the following statement: intraperitoneal accumulation of mucinous material

Back 950

Mucinous cyst andenocarcinoma

Front 951

• testosterone secreting → virilization

Back 951

Leydig cell tumor

Front 952

• What ovarian tumor matches the following statement: psammoma bodies

Back 952

Serouscyst adenocarcinoma

Front 953

• multiple different tissue types

Back 953

Teratoma

Front 954

• What ovarian tumor matches the following statement: lined with fallopian tube-like epithelium

Back 954

Serous cyst adenocarcinoma

Front 955

• What ovarian tumor matches the following statement:ovarian tumor + ascites + pleural effusions

Back 955

Fibromas

Front 956

• What ovarian tumor matches the following statement: Call-Exner bodies

Back 956

Granulos cell tumor

Front 957

• What ovarian tumor matches the following statement:resembles bladder epithelium

Back 957

Brenner tumors looks like bladder

Front 958

• What ovarian tumor matches the following statement:elevated hCG

Back 958

Choriocarcinoma or disgerminoma

Front 959

15. HYQ (FA p438): obese woman presents with hirsutism and increased levels of serum testosterone what is the diagnosis

Back 959

PCOS

Front 960

16. HYQ: pt with polycystic ovarian disease is most at risk for developing which type of CA? ~

Back 960

Endometrial carcinoma

Front 961

18. HYQ: under what circumstances would you expect to see an elevated LH? (3)

Back 961

Right before ovulation and LH surge
PCOS
Menopause

Front 962

What breast pathology fits the following description: most common breast tumor in women under 25

Back 962

Fibroadenoma

Front 963

What breast pathology fits the following description: most common breast mass in postmenopausal women

Back 963

Invasive ductal carcinoma

Front 964

What breast pathology fits the following description: most common breast mass in premenopausal women

Back 964

Fibrocystic disease

Front 965

What breast pathology fits the following description: most common form of breast cancer

Back 965

Infiltrating ductal carcinoma

Front 966

What breast pathology fits the following description: small, mobile, firm mass with sharp edges in 24 yr old woman

Back 966

Fibroadenoma

Front 967

What breast pathology fits the following description: histological "Ieaflike projections"

Back 967

Phylloides tumor

Front 968

What breast pathology fits the following description: signet ring cells

Back 968

LCIS

Front 969

What breast pathology fits the following description: loss of e-cadherin cell adhesion gene on chrom 16

Back 969

Invasive lobular carcinoma

Front 970

What breast pathology fits the following description: always ER(+) and PR(+)

Back 970

LCIS

Front 971

What breast pathology fits the following description: commonly presents with nipple discharge

Back 971

Intraductal papilloma

Front 972

What breast pathology fits the following description: eczematous patches on nipple

Back 972

Paget’s

Front 973

What breast pathology fits the following description: multiple bilateral fluid-filled lesions with diffuse breast pain

Back 973

Fibrocystic change

Front 974

What breast pathology fits the following description: firm, fibrous mass in a 55 yr old woman

Back 974

Invasive ductal carcinoma

Front 975

3. What are the pros and cons of oral contraceptive pill use? (FA p453)

Back 975

Cons: increase triglycerides, increase hypercoagulable state

Front 976

• State whether the following statement described estrogen or progesterone: production of thick mucus that inhibits entry of sperm into the uterus

Back 976

Progesterone

Front 977

• State whether the following statement described estrogen or progesterone: uterine smooth muscle relaxation

Back 977

Progesterone

Front 978

• State whether the following statement described estrogen or progesterone: follicle growth

Back 978

Estrogen

Front 979

• State whether the following statement described estrogen or progesterone: maintenance of pregnancy

Back 979

Progesterone

Front 980

• State whether the following statement described estrogen or progesterone: hepatic synthesis of transport proteins

Back 980

Estrogen

Front 981

• State whether the following statement described estrogen or progesterone: withdrawal leads to menstruation

Back 981

Progesterone

Front 982

6. When does beta-hCG appear in the urine during pregnancy? (FA p443)

Back 982

4 week after menstruation
2 weeks after conception

Front 983

7. What hormonal changes are seen during menopause? (FA p444)

Back 983

↑ FSH and LH
↑ GnRH
↓ estrogen

Front 984

8. What is the underlying cause of PCOS? (FA p448) What are the clinical manifestations? What is the treatment

Back 984

Mech: ↑ LH production leads to annovulation, hyperandrogenism due to deranged steroid syntheisis
CM: ↑ LH, ↓ FSH, ↑ testosterone
Amenorrhea, infertility, obesity, hirsutism
↑ risk endometrial cancer
TX:
OCPs
Clomiphene
Metformin
Spironolactone

Front 985

• What testicular tumor is described by the following statement: composed of cytotrophoblasts and syncytiotrophoblasts

Back 985

Choricarcinoma

Front 986

• What testicular tumor is described by the following statement: may present initially with gynecomastia

Back 986

Leydigcell tumor

Front 987

• What testicular tumor is described by the following statement: elevated AFP

Back 987

Embryonic carincoma
Yolk sac

Front 988

• What testicular tumor is described by the following statement: elevated hCG

Back 988

Embryonic carcinoma
Choriocarcinoma

Front 989

• What testicular tumor is described by the following statement: most common testicular tumor

Back 989

Seminoma

Front 990

• What testicular tumor is described by the following statement: most common testicular tumor in infants and children up to 3yrs of age

Back 990

Leydid cell tumor

Front 991

• What testicular tumor is described by the following statement: most common testicular tumor in men over age 60

Back 991

Spermatic seminoma

Front 992

• What testicular tumor is described by the following statement: histologic appearance similar to kiolocytes (cytoplasmic clearing)

Back 992

Seminoma

Front 993

• What testicular tumor is described by the following statement: histologically may have alveolar or tubular appearancesometimes with papillary convulutions

Back 993

Embryonal carcinoma

Front 994

• What testicular tumor is described by the following statement: composed of multiple tissue types

Back 994

Teratoma

Front 995

• What testicular tumor is described by the following statement: histologic endodermal sinus structures (Schiller-Duval bodies)

Back 995

Yolk sac

Front 996

• What testicular tumor is described by the following statement: What testicular tumor is described by the following statement: 25% have cytoplasmic rod-shaped crystalloids of Reinke

Back 996

Leydig cell

Front 997

• androgen producing and associated with precocious puberty

Back 997

Leydig cell or sertoli

Front 998

\

Front 999

33. HYQ: 55 y/oman undergoing treatment for BPH has increased testosterone and decreased DHT as well as gynecomastia and edema what is the drug?

Back 999

5 α reducatse inhibitor

Front 1000

6. What is the difference between androgen insensitivity and 5-alpha-reductase deficiency? (FA p445)

Back 1000

AI: will not become male
5ARD: will become male at puberty

AI: normal appearing female with rudimentary vagina, and testes in labia majora. Levels of testosterone, estrogen and LH are all high
5ARD: unable to convert testosterone to DHT. Ambiguous genitalia until puberty

Front 1001

8. How many carbon molecules are found on testosterone and on andostenedione? (FA p277)

Back 1001

19

Front 1002

9. What structures develop from the mesonephric duct system? (FA p131)

Back 1002

SEVEN UP

Front 1003

• What is the male homologue to the following female structure? vestibular bulbs

Back 1003

Corpus spongiosum
(arises from urogenital sinus)

DHT for male; estrogen for female

Front 1004

• What is the male homologue to the following female structure? labia minora

Back 1004

Ventral shaft of penis
(arises urogenital folds)

DHT for male; estrogen for female

Front 1005

• What is the male homologue to the following female structure? Bartholin glands

Back 1005

Bulbouretral glands (of Cowper)
(arises from urogenital sinus)

DHT for male; estrogen for female

Front 1006

• What is the male homologue to the following female structure? urethral and paraurethral glands (of Skene)

Back 1006

Prostate gland
(arises from urogenital sinus

DHT for male; estrogen for female

Front 1007

What is the male homologue to the following female structure? Glans clitoris

Back 1007

Glans penis
(arises from genital tubercle)

Front 1008

What is the male homologue to the following female structure? Labia majora

Back 1008

Scrotum
(arises from labioscrotal swelling)

Front 1009

Which two drugs inhibit cGMP phosphodiesterase, leading to smooth muscle relaxation in the corpus cavernosum and penile erection?

Back 1009

Sildenafil and Verdenafil --they fill the penis

Front 1010

What class of drugs are used tto treat erectile dysfunction

Back 1010

cGMP Inhibitors

Front 1011

CGMP inibitors taken with ____have a high risk of liofe-threeatening hypotension

Back 1011

nitrates

Front 1012

Which drugs is a partial agonist of estrogen recpetors in the pituitary gland, stimulating increase in LH and FSH, which stimulates ovulation to treat infertility

Back 1012

clomiphene

Front 1013

Clomiphene's side effects include:

Back 1013

Hotflashes, ovarian enlargment, multiple simultaneous pregnancies, visual disturbances

Front 1014

What abortifacient is a competitite inhibitor of preogestins at progesterone recpetor and may lead to heavy menstrual-like bleeding?

Back 1014

Mifepristone (RU486)

Front 1015

The advantage of this drug is that it is reliable, decreases incidence of ectopic pregnancy, decreases risk of pelvic infections, and regulates menses; however it also puts you in a hypercoagulable stat and may increase your trigylcerides, weight, and blood pressure

Back 1015

Oral Contracpetices - syntheitc progestins/estrogen

Front 1016

MOA finasteride

Back 1016

5-alpha reductase blocker
Uses :bph and baldness

Front 1017

MOA flutamide

Back 1017

competitive inhibitor of androgen at testosterone receptor
Uses: prostate carcinoma

Front 1018

MOA ketoconazole in reproductive system

Back 1018

blocks 17,20 lyase and 3-beta-hydroxylase, inhibiting steroid synthesis

Front 1019

uses of finasteride

Back 1019

BPH male pattern baldness

Front 1020

uses of flutamide

Back 1020

prostate cancer

Front 1021

uses of ketoconazole

Back 1021

pcos, to prevent hirsutism

Front 1022

MOA leuprolide

Back 1022

GnRH analog with agonist properties when used in pulsatile manner antagonist properties when used in continuous fashion
Leuploride can be used in Lieu of GnRH

Front 1023

uses for leuprolide

Back 1023

infertility (pulsatile) prostate cancer (continuous, used with flutamide) uterine fibroids

Front 1024

toxicity of leurpolide

Back 1024

antiandrogen n/v

Front 1025

MOA sildenafil

Back 1025

inhibits cGMP phosphodiesterase --> increased cGMP --> maintains smooth muscle relaxation in corpus cavernosum --> increased blood flow and erection

Front 1026

clinical use of sildenafil

Back 1026

erectile dysfunction

Front 1027

toxicity of sildenafil

Back 1027

blue-green color vision h/a flushing dyspepsia LIFE THREATENING HYPOTENSION IN PTS TAKING NITRATES!!!!!

Front 1028

MOA clomiphene

Back 1028

partial estrogen agonist at pituitary gland this stimulates LH and FSH release → ovulation

Front 1029

use of clomiphene

Back 1029

fertility treatment

Front 1030

toxicity of clomiphene

Back 1030

hot flashes ovarian enlargement multiple pregnancies visual disturbances

Front 1031

MOA mifepristone

Back 1031

competitive inhibitor of progestin at progesterone receptors

Front 1032

use of mifepristone

Back 1032

prevents implantation of fetus

Front 1033

toxicity of mifepristone

Back 1033

heavy bleeding GI effects abdominal pain

Front 1034

risks associated with HRT

Back 1034

endometrial cancer, if regimen is just with estrogen

Front 1035

Spironolactone MOA and Use

Back 1035

MOA: inhibits steroid binding
use PCOS

Front 1036

Side effects of Ketoconalzole and Spironolactone

Back 1036

Gynecomastia
amenorrhea

Front 1037

Dinoprostone

Back 1037

PGE2 analog causing cervical dilation and uterine contraction, inducing labor

Front 1038

Ritodrine/terbutaline

Back 1038

Β 2 agonists that relax the uterus

Front 1039

Anastrozole

Back 1039

Armoatase inhibitor used in postmenopausal women with brease cancer

Front 1040

Testosterone uses

Back 1040

Treat ER + brease cancer
Stimulation of anabolism to promote recovery after brun or injury

Front 1041

Lipid probile changes with testosterone

Back 1041

↑ LDL
↓ HDL
(unfavorable, estrogen is favorable)

Front 1042

Estrogens (ethinyl estradiol, DES, mestranol) and cancer

Back 1042

Used in men with androgen dependent prostate cancer. Contraindicated in women with ER + breast cancer

Front 1043

Tamoxifene
MOA

Back 1043

Antagonist on breast tissue

Front 1044

Tamoxifene use

Back 1044

Treat ER+ breast cancer

Front 1045

Raloxifen USE and MOA

Back 1045

Agonist on bone, reduces resporption of bone

Usead to treat osteoporosis

Front 1046

What are the Estrogen partial agonists (selective estrogen receptor modulators SERMS?)

Back 1046

Clomiphene
Tamoxifene
raloxifene