The Unforgettables

Front 1

fibroadenoma

Back 1

- benign breast tumor
- small, mobile, painless, firm mass. well demarcated from breast tissue
- occurs in females < 25
- not a precursor to breast cancer

Front 2

intraductal papilloma

Back 2

- benign small tumor that grows in lactiferous ducts, typically BENEATH THE AREOLA
- serous/ bloody nippple discharge.
- slight increased risk for carcinoma

Front 3

ductal carcinoma in situ

Back 3

- malignant, cells display high nuclear to cytoplasm ratio, fills ductal lumen.
NO BASEMENT MEMBRANE PENETRATION.

Front 4

invasive ductal carcinoma

Back 4

- firm, fibrous mass. small, glandular duct like cells
- malignant cells have invaded basement membrane using collagenases and hydrolases
- WORST & MOST INVASIVE

Front 5

medullary carcinoma of the breast

Back 5

-fleshy, cellular lymphatic infiltrate
-GOOD PROGNOSIS

Front 6

inflammatory carcinoma

Back 6

- DERMAL LYMPHATIC INVASION by breast carcinoma
- peau d'orange

Front 7

pagets disease of breast

Back 7

- malignant
- eczematous patches on nipple. paget cells = large cells w/ clear halo
- suggests underlying ductal carcinoma in situ or invasive ductal

Front 8

mitral/tricuspid regurge

Back 8

- holosystolic blowing murmur
- loudest @ apex/ radiates to axilla

Front 9

aortic stenosis

Back 9

- crescendo-decrescendo systolic ejection murmur following ejection click
-radiates to carotids/apex

Front 10

mitral prolapse

Back 10

- late systolic murmur with midsystolic click
-loudest @ S2

Front 11

aortic regurge

Back 11

- high pitched blowing diastolic murmur

Front 12

mitral stenosis

Back 12

- diastolic murmur
- follows opening snap
- best heard in left lateral decubitus

Front 13

PDA

Back 13

- continuous "machine like" murmur

Front 14

X linked recessive diseases

Back 14

1. duchenne's muscular dystrophy
2. bruton's agammaglobulinemia
3. wiskott-aldrich syndrome
4. fragile x syndrome
5. ocular albinism
6. Fabry's disease
7. Hemophilia A & B
8. Lesch-Nyan syndrome

Front 15

Hodgkin lymphoma- Nodular sclerosing type

Back 15

- few RS cells, mad lymphocytes
- women > men
- good prognosis

Front 16

non hodgkin lymphoma- follicular lypmhoma

Back 16

- B cells
- t (14;18) bcl-2 expression

Front 17

non hodgkin mantle cell lymphoma

Back 17

- b cells, CD5+
- t(11;14)
- poor prognosis

Front 18

burkitt's lymphoma

Back 18

- B cells
- t(8;14) c-myc (go see mike in 814 cuz he got burkitt's lymphoma)
- "starry sky" appearance = sheets of lymphocytes with some macs
- associated with EBV

Front 19

leukemia staging bullshit

Back 19

ALL stage L1: lymphoblasts w/ uniform nuclei & scant cytoplasm
ALL stage L2- lymphoblasts w/ irregular nuceli, more cytoplasm than type L1
AML type M1- undifferentiated myeloblastic leukemia. leukemic cells do not show cytoplasmic granulation
AML type M2- differentiated myeloblastic leukemia. cells show some granulation
AML type M3- promyelocytic leukemia. cells resembling promyelocytes w/ abundant granulation.
M5- monoblastic
M6- erythrocytic
M7- megakaryocytic

Front 20

Exposure to this substance in utero increases risk for developing vaginal clear cell carcinoma

Back 20

DES (diethylstilbestrol)

Front 21

lead poisoning inhibits what two dumb ass enzymes?

Back 21

ferrochelatase (adds iron to protoporphyrin)
ALA dehyrdase

Front 22

T helper cell activation

Back 22

1. foreign body is phagocytosed by APC
2. foreign antigen is presented on MHC II and recognized by TCR on Th cell (signal 1)
3. Costimulatory signal is given by interaction of B7 (on the APC) & CD28 on the T-cell (signal 2)

Front 23

cytotoxic T cell activation

Back 23

1. endogenously synthesized proteins are presented on MHC I and recognized by TCR on Tc cell
2. IL-2 from Th activates Tc cell to kill virus infected cell

Front 24

B cell class switching

Back 24

1. IL-4, IL-5, or IL-6 from Th2 cell
2. CD 40 receptor activation by bindgin CD40 ligand on Th cell

Front 25

P450 inducers

QBSPRGC

Back 25

quinidine
barbituates
st. john's wort
phenytoin
rifampin
griseofulvin
carbamazepine

Front 26

P450 inhibtors

Back 26

sulfonamides
isoniazid
cimedtidine
ketoconazole
erythromycin
grapefruit juice

Front 27

Macrophages secrete these 5 cytokines:
what do these cytokines do?

Back 27

IL-1- stimulate T cells, causes acute inflammation, pyrogenic, activates endothelium to express adhesion molecules, induces chemokine production to recruit leukocytes
IL-6- stimulates production of acute phase reactants & immunoglobulins
IL-8- major chemotactic factor for neutrophils
IL-12- activates NK cells & Th1 cells
TNF-alpha- **mediates septic shock**, causes leukocyte recruitment, vascular leak

Front 28

T cells make the following cytokines:

what do these cytokines do?

Back 28

IL-2- stimulates growth of helper and cytotoxic T cells
IL-3 (activated T cells)- supports growth & differentiation of bone marrow stem cells (fx similar to GM-CSF)
IL-4 (Th2 cells)- promotes growth of B cells, enhances class switching to IgE, IgG
IL-5 (Th2 cells)- enhances B cell class switching to IgA, stimulates production and activation of eosinophils
IL-6 (Th2)- stimulates production of acute phase reactants and immunoglobulins
IL-10 (T reg cells)- inhibits actions of activated T cells
IFN-γ (Th1 cells)- stimulates macrophages

Front 29

B cells make this one cytokine and what does it do?

Back 29

IL-12- activated NK cells and Th1 cells

Front 30

relative risk

Back 30

incidence rate of GETTING the disease among people exposed to the risk factor/incidence rate of getting the disease among people not exposed to the risk factor

[a/(a+b)]/[c/(c+d)]

- so for example, if you get a relative risk = 10, that means if you have are exposed to the risk factor then you're risk of getting the disease is 10x that of one who is not exposed to the risk factor.

Front 31

attributable risk

Back 31

the DIFFERENCE bet. exposed and nonexposed groups

a/a+b - c/c+d

Front 32

odds ratio (used for a case control study: disease vs. non disease)

Back 32

odds of HAVING the disease in the exposed group compared to the unexposed

ad/bc = (a/b)/(c/d)

Front 33

sensitivity

Back 33

- proportional of people with the disease who test (+)

a/(a+c)

Front 34

specificity

Back 34

- proportion of people without the disease who test (-)

d/(b+d)

Front 35

(+) predictive value

Back 35

- proportion of (+) TEST results that are true positives
(probabililty that dude really has the disease given a (+) result)

a/(a+b)

Front 36

(-) predictive value

Back 36

- proportion of (-) TEST results that are true negatives
probability you're actually disease free given a (-) result

d/(d+c)/

Front 37

type 1 error (alpha)

Back 37

- seeing a difference when there is NONE
-mistakenly reject the null
- false (+)

Front 38

type II error (beta)

Back 38

- saying that there is no effect when there is one
- fail to reject the null
- false (-)

Front 39

power (1-beta)

Back 39

- seeing a difference when there ACTUALLY IS ONE
- increase n and increase power

Front 40

selective beta 2 AGonists- stimulate only beta 2 receptors
-results in bronchodilation, vasodilation, decreased uterine tone, increase HR, contractility, increase lipolysis, increase glucagon release

Back 40

metoproteronol
albuterol
salmeterol
terbutaline

MAST
*note- ritodrine can also be used to decrease premature uterine contractions

Front 41

selective beta 1 ANTAGonists

Back 41

acebutolol
atenolol
betaxolol
esmolol
metoprolol

Front 42

after 1 hr of intense exercise, muscle is likely to show what

Back 42

↓ O2
↓ myoglobin saturation (cuz it had to release O2 for energy usage)
↑ VEGF mRNA expression b/c this will initiate angiogenesis, which will lead to new blood vessels which will increase blood flow to oxygen hungry muscle tissue

Front 43

torsades de point

Back 43

shifting sinusoidal waveforms on ecg
- can progress to v-fib
- predisposed by long QT interval

Front 44

Wolff-Parkinson-White syndrome

Back 44

a.k.a. ventricular preexcitation syndrome
- see an ECG delta wave
- caused by accessory conduction pathway from atria to ventricle (bundle of Kent) bypassing AV node
- can cause supraV-Tach

Front 45

atrial fibrillation

Back 45

-chaotic baseline/ no discrete P waves, irregularly spaced QRS complexes
-give warfarin

Front 46

atrial flutter

Back 46

sawtooth appearance of ecg
-use class IA (QPD), IC (FEP) or class III

Front 47

1st degree AV block

Back 47

prolonged PR interval

Front 48

2nd degree AV block
Mobitz Type I (Wenckebach)

Back 48

prolonged lengthening of the PR interval until a beat is dropped

Front 49

2nd degree AV block
Mobitz Type II

Back 49

abrupt nonconducted P waves

Front 50

3rd degree (complete) heart block

Back 50

atria and ventricles beat independently of each other
P waves bear no relation to the QRS complexes

LYME DISEASE

Front 51

through what nerve does the aortic arch transmit info to the MEDULLA about changes in BP?

Back 51

vagus

Front 52

through what nerve does the carotid sinus transmit info to the MEDULLA about changes in BP

Back 52

CN IX

Front 53

what causes tetrology of fallot

Back 53

anterosuperior displacement of the infundibular septum (failure of AP septum to align)

pulm stenosis is the most important determining factor for prognosis cuz it determines how bad the other symptoms are

Front 54

which type of arteriolosclerosis is benign and does not cause obstruction

Back 54

Monckeberg- calcification of the media of arteries

Front 55

name an autoimmune phenomenon that causes fibrinous peridcarditis

Back 55

Dressler's syndrome
usually happens post MI

Front 56

what the fuck is an Aschoff body and what is it a sign of?

Back 56

Aschoff bodies are areas of focal interstitial myocardial inflammation that is characterized by fragmented collagen and fibrinoid material. Anitschkow cells are also present. It's basically a granuloma w/ giant cells and it is a sign of rheumatic fever (type II hypersensitivty)

Front 57

what is pulsus paradoxus and what is it a sign of

Back 57

it is when there is a decrease in amplitude of the pulse on inspiration and it is a sign of cardiac tamponade

-also seen in asthma, obstrucitve sleep apnea, pericarditis, croup

Front 58

name of granulomatous vasculitits that displays eosinophilia

Back 58

CHURG-STRAUSS syndrome (p-ANCA)
-involves lungs, heart. skin, kidneys, nerves
asthma is common

Front 59

what is the most common form of childhood systemic vasculitis?

Back 59

Henoch-Schonlein puprura
- skin rash (palpable purpura) on ass/legs
- arthralgia
- inestinal hemorrhage
- abdominal pain, melena
-follows URIs
- IgA immune complexes**

Front 60

what is a life threatening complication of ketoacidosis?
hint: involves an infectious agent

Back 60

life threatening mucormycosis cause by Rhizopus, Absidia, or Mucor (wide angle branching)

Front 61

these nuclear changes occur in apoptosis. They are also indicators of irreversible cell injury

hint: 3 of them (PKK)

Back 61

pyknosis- nuclear shrinkage & basophilia
karyorrhexis- nuclear fragmentation
karyolysis- nuclear fading

Front 62

how EXACTLY does type III hypersensitivity work?

Back 62

immune complexes deposit in tissues and activate COMPLEMENT, which attracts neutrophils. Neutrophils come in and release lysosomal enzymes. THEY are the ones that cause the damage.

Front 63

what FOUR conditions are psammoma bodies seen in

Back 63

1. papillary carcinoma of thyroid
2. serous cystadenocarcinoma of ovary
3. meningioma
4. malignant mesothelioma

Front 64

what other malignancy does EBV cause besides Burkitt's lymphoma?

Back 64

nasopharyngeal carcinoma (squamous)

Front 65

which anti-cancer drug causes CN VIII damage

Back 65

cisplatin (works by cross linking DNA)

Front 66

what the fuck are Roth's spots and what are they indicative of?

Back 66

Roth spots- round white spots on retina surrounded by hemorrhage. they result from small fibrin clots that break off from the vegetations on the heart valves.
-indicative of bacterial endocarditis

Oslers nodes also can manifest (tender nodules on finger/toe pads)

Janeway lesions too (small erythematous lesions on palms/soles)

Front 67

what are the 3 levels of disease prevention?

Back 67

primary- prevent disease occurrence
secondary- early detection of a disease
tertiary- reduce disability from the disease

Front 68

Sleep waves
awake (eyes open)
awake (eyes closed)
1. light sleep
2. deeper sleep, bruxism
3-4.Deepest, non REM sleep (night terrors)
REM

Back 68

(eyes open)- beta (highest frequency, lowest amplutude)
awake (eyes closed) - alpha
1. light sleep- theta
2. deeper- sleep spindles, K complexes
3-4. deepest, non REM (bedwetting, night terrors)- delta
REM- beta

Front 69

what NTs modulate sleep?

Back 69

ACh- important for REM sleep
serotonin- important for initiating sleep
NE- reduces REM sleep

Front 70

circadian rhythm is controlled by which hypothalamic nucleus

Back 70

suprachiasmatic
- also controls ACTH secretion

Front 71

bethanechol

Back 71

-cholinomimetic
- direct muscarinic agonist
-resistant to AChesterase

-acitvates bowel & bladder. used for postoperative & neurogenic ileus and urinary retention

Front 72

carbachol

Back 72

muscarinic agonist

-used for glaucoma, pupil contraction, release intraocular pressure

Front 73

pilocarpine

Back 73

stimulates sweat, tears, saliva
- used to diagnose cystic fibrosis
-resistant to AChesterase

Front 74

methacholine

Back 74

challenge test for the diagnosis of asthma

Front 75

how do AChesterase inhibitors work?

they all end in "igmine" except ecothiphate

Back 75

they inhibit AChesterase by carbamylation of it

ecothiophate causes irreversible inhibition of AChesterase by phosphorylating it

Front 76

neostigmine

Back 76

- AChesterase inhibitor
- no CNS penetration
- activate bowel/bladder for ileus
- myasthenia gravis tx
- reversal of neuromuscular junction blockade

Front 77

pyridostigmine

Back 77

-Achesterase inhibitor
- long acting myasthenia gravis tx
- no CNS penetration

Front 78

edrophonium

Back 78

used to diagnose myasthenia gravis
very short acting

Front 79

physostigmine

Back 79

- pentrates CNS
- used for glaucoma
-used for atropine overdose

Front 80

ecothiphate

Back 80

-phosphorylates AChesterase causing irreversible inhibition
- used for glaucoma

Front 81

cholinesterase inhibitor poisoining
-too much PNS

Back 81

symptoms: diarrhea, urination, miosis, bronchospasm, bradycardia, excitation of skeletal muscle, salivation

**Tx: give atropine to block muscarinic receptors BUT also must give PRALIDOXIME (regenerates active cholinesterase) to prevent the risk of muscle paralysis w/ the muscarinic blockade

Front 82

what endocrine hormones induce cAMP?

HINT: FLAT CHAMP

Back 82

FSH
LH
ACTH
TSH
CRH
hCG
ADH (V2-kidney)
MSH
PTH
calcitonin, glucagon
β1, β2, D1, H2

Front 83

what endocrine hormones induce cGMP?

Back 83

ANP
EDRF
NO

Front 84

what induces IP3?

hint: GGOAT

Back 84

GHRH
GnRH
oxytocin
ADH (v1)
TRH
α1, H1, M1, M3

Front 85

what endocine hormones induce tyrosine kinase?

Back 85

insulin
GH
IGF-1
FGF
PDGF
prolactin

Front 86

what drug can directly inhibit insulin release?

Back 86

clonidine- α2 AGonist

Front 87

what ligament contains the portal triad? and what does it connect?

Back 87

Hepatoduodenal ligament
- connects the liver to duodenum
-contains hepatic artery, portal vein, common bile duct
- lies in the free edge of the lesser omentum

Front 88

what ligament can be cut to access the lesser sac of the stomach? what does it connect?
what structures does it contain?

Back 88

gastrohepatic ligament
-connects liver to lesser sac
- contains the gastric ateries

Front 89

what major GI artery lies at the T12, L1 level?
what does it supply

Back 89

celiac artery
- supplies stomach to 1st part of the duodenum
- supplies liver, pancreas, gall bladder (spleen as well, which is not derived from endoderm)

Front 90

what major GI artery lies at L1 level?
what does it supply

Back 90

superior mesenteric artery
- distal duodenum to proximal 2/3 of transverse colon

Front 91

what major GI artery lies at L3?
what does it supply?

Back 91

inferior mesenteric artery
- supplies distal 1/3 of transverse colon to upper portion of the rectum

Front 92

what area of the GI tract is considered the watershed region?

Back 92

splenic flexure

Front 93

if the abdominal aorta is blocked, what arterial anastamoses can compensate?

Back 93

internal thoracic ↔ superior epigastric ↔ inferior epigastric

Front 94

if celiac trunk is blocked, what arterial anastamoses compensate?

Back 94

superior pancreaticoduodenal ↔ inferior pancreaticoduodenal

2 more important ones:

middle colic ↔ left colic
superior rectal ↔ middle rectal

Front 95

what portosystemic anastomoses presents w/ a clinical sign of esophageal varices?

Back 95

the left gastric vein ↔ esophageal vein

(esophagus is the site of the anastomoses)

Front 96

what portosystemic anastomoses presents w/ a clinical sign of caput medusae?

Back 96

paraumbilical veins ↔ superficial & inferior epigastrics

(umbilicus is site of anastomoses)

Front 97

what portosystemic anastomoses result in internal hemorrhoids?

Back 97

superior rectal ↔ middle & inferior rectal veins

Front 98

what shunt can relieve portal HTN

Back 98

a portocaval shunt between the LEFT RENAL vein and the SPLENIC vein

Front 99

lymph drainage of upper limb, lateral breast

Back 99

axillary lymph node

Front 100

lymph drainage of stomach

Back 100

celiac lymph nodes

Front 101

lymph drainage of the duodenum, jejunum

Back 101

superior mesenteric

Front 102

lymph drainage of sigmoid

Back 102

colic -inferior mesenteric

Front 103

lymph drainage of lower rectum, anal canal above the pectinate line

Back 103

internal iliac

Front 104

lymph drainage of anal canal below pectinate line

also drains scrotum & thigh

Back 104

superficial inguinal nodes

Front 105

lymph drainage of testes

Back 105

para-aortic lymph nodes

Front 106

lymph drainage of lateral side of dorsum of foot

Back 106

popliteal

Front 107

why do infants get indirect inguinal hernias?

Back 107

failure of the processus vaginalis to close (when it fails to FUSE you get hydrocele)

indirect inguinal hernia is LATERAL to the inferior epigastric vessels, goes into the scrotum, and is covered by all 3 layers of spermatic fascia

Front 108

what type of hernia protrudes through hesselbach's triangle?

Back 108

a direct inguinal hernia
- enter through abdominal wall MEDIAL to the inferior epigastric vessels
- goes through external inguinal ring only
-only covered by external spermatic fascia

Front 109

what hormone stimulates pancreatic secretion

Back 109

CCK
- makes pancrease secrete everything (lipases, proteases)
- made by I cells (located in the duodenum)
- stimulate gall bladder contraction to release bile into the bile duct
- stimulated by fatty foods, amino acids

THIS IS THE ONLY GI HORMONE THAT DECREASES GASTRIC EMPTYING

Front 110

these cell types live in the body of the stomach

Back 110

parietal cells
chief cells

Front 111

these cell types located in the ANTRUM of the stomach

Back 111

G cells
mucous cells

Front 112

these cell types reside in the duodenum

Back 112

S cells (secretin)
I cells (CCK)
Kcells (GIP)

Front 113

what hormone decreases all manner of secretions in the GI?

Back 113

somatostatin decreases:
- gastric acid secretions
- pepsinogen secretion
- pancreatic secretion
- small intestine fluid secretion
- insulin & glucagon release

somatostain release is stimulated by acid, and inhibited by decreased vagal stimulation
- used to treat carcinoid and VIPomas

Front 114

what the fuck is GIP?

Back 114

glucsose-dependent insulinotropic peptide
- made by K cells in duodenum
- ↓ gastric acid secretion
- increases ↑ insulin release
- stimulated by ORAL glucose

Front 115

parasympathetic ganglia in the GI secrete what hormone?

Back 115

VIP
- ↑ intestinal H2O & electrolyte secretion
- ↑ relaxation of GI smooth muscle
- relaxes lower esophageal sphincter
- inhibited by adrenergic input, stimulated by distention and vagal stimulus
VIPoma comes from pancreas and cause diarrhea

Front 116

what helps to maintiain low bacterial counts in the small intestine?

Back 116

migrating motility complexes (MMCs)

Front 117

what other hormone will a gastrinoma affect?

Back 117

secretin- secretion will ↑ b/c of ↑ acid presence

Front 118

salivary gland tumors- 3 types

Back 118

1. pleomorphic adenoma- most common, painless, benign, high rate of recurrence
2. warthin's tumor- benign, trapped in lymph node
3. mucoepidermoid carcinoma- malignant

Front 119

what in the hell is Plummer Vinson syndrome and why should I give a shit?

Back 119

It is a triad of:
1. dysphagia (due to esophageal webs)
2. glossitis
3. iron deficiency anemia (chronic)

it can increase your risk for squamous cell carcinoma of the esophagus

Front 120

what is menetriere's disease?

Back 120

it's GASTRIC HYPERTROPHY with:
- protein loss
-parietal cell atrophy
- hyperplasia of mucous neck cells
it's precancerous
rugae of stomach get so hypertrophied they can look like brain gyri

Front 121

Major differences between Chrons disease & uclerative colitis

Back 121

Chrons
- can affect any portion, usually terminal ileum, spares rectum
-transmural inflammation (all 3 GI layers)
- cobblestone mucosa, string sign on barium enema
- NONCASEATING GRANULOMAS
- fistulas, strictures
-malabsorption
extraintestinal manifestations: polyarthritis, erythema nodosum, ankylosing spondulitis

Ulcerative colitis
- AUTOIMMUNE
- no granulomas
- in the COLON, rectal involvement
- mucosal/submucosal inflammation only
- pseudopolyps, "lead pipe"
- crypt abcesses, ulcers
- toxic megacolon
- COLERECTAL CARCINOMA
- sclerosing cholangitis, pyoderma gangrenosum

Front 122

familial adenomatous polyposis

Back 122

-autosomal dominant
-mutation of APC gene on chromosome 5
- always involves rectum
can present w/ 2 syndromes:
1. Gardner's syndrome- FAP w/ osseus & soft tissue tumors, retinal hyperplasia
2. Turcot's syndrome- FAP with brain involvement (glioma & medulloblastoma)

Front 123

peutz-jeghers syndrome

Back 123

benign polyposis syndrome
- increased risk of colerectal cancer and other visceral malignancies (breast, ovary, pancres)
- small pigmented macules all over mucosa
- hamartomatous polyps of colon & SI, hyperpigmented mouth, lips, hand, genitalia

Front 124

what enzyme conjugates bilirubin?
what syndrome do you get when there is decreased activity of this enzyme?
what syndrome do you get when this enzyme is absent?

Back 124

UDP-glucuronyl transferase
Gilbert's syndrome is from decreased activity of the enzyme so you have elevated unconjugated bilrubin

Crigler-Nijjar syndrome type 1 is from absence of the enzyme. presents early in life and patients die in a few years from kernicterus

Front 125

what syndrome makes your liver look black?

Back 125

Dubin Johnson's syndrome
-conjugated hyperbilirubinemia due to defective liver excretion
-benign

Front 126

if I say "bronze diabetes", you should automatically think of

Back 126

hemochromatosis
- iron deposition in the organs
- triad of: cirrhosis, diabetes mellitus, skin pigmentation
- can cause CHF, hepatocellular carcinoma
- can be autosomal recessive OR can be caused by chronic transfusion therapy such as in someone with β-thalassemia major
- ↑ ferritin, ↑ iron, ↓ TIBC (↑ transferrin saturation)
tx: DEFEROXAMINE

Front 127

anti-mitochondrial antibodies should make you think of..

Back 127

primary biliary cirrhosis
- autoimmune
- severe obstructive jaundice (conjugated hyperbilirubinemia)
- steatorrhea, pruritis, hypercholesterolemia
- ↑ ALP
- associated w/ CREST syndrome of scleroderma

Front 128

what parasite can cause pigmented gallstones and thereby cause inflammation of the biliary tract?

the little bitch can also cause cholangiocarcinoma

Back 128

clonorchis sinesis

Front 129

what are migratory thrombophlebitis, CA 19-9 & courvoisier's sign indicative of?

Back 129

Pancreatic adenocarcinoma
migratory thrombophlebitis- pain on palpation of the extremities (trousseau's syndrome)

2. courvoisier's sign- palpable gall bladder

Front 130

what 3 parts of the TCA cycle produces CO2 + NADH

Back 130

1. the rate limiting step
isocitrate becomes α-ketoglutarate
- enzyme: isocitrate dehydrogenase
ADP stimulates it.
NADH inhibits it

2. α-ketoglutarate to succinly CoA via the enzyme α-ketoglutarate dehydrogenase

3. malate dehydrogenase

Front 131

absent pus formation should make you think of what immune deficiency?

Back 131

Leukocyte Adhesion deficiency syndrome
- autosomal recessive
- defect in integrin proteins of phagocytes, so they can't bind ICAM-1 on endothelium
- recurrent bacterial infection
- ABSENT PUS FORMATION
- neutrophilia (if less phags are binding then more are circulating in the blood)
- DELAYED SEPARATION OF UMBILICUS

Front 132

pigmented iris hamartomas

Back 132

NF type 1- "lisch nodule"
autosomal dominant

Front 133

what muscle protects the brachial plexus from injury when you break your clavicle?

Back 133

subclavius muscle

Front 134

What part of the brachial plexus do these nerves derive from?

median
musculocutaneous
axillary
radial
ulnar

Back 134

median- lateral AND medial cords
musculocuntaneous- lateral only
axillary- posterior only
radial- posterior only
ulnar- medial only

Front 135

what immune cell expresses CD16 & CD56 as cell surface markers?

And why is the cell so hot?

Back 135

NK (natural killer) cells
- express, CD16, 56
- can lyse cells that do not express MHC-I. Almost all nucelated cells express except RBCs cause they ain't got no nucleus, so if something infects an RBC, the ONLY lymphocyte that can handle the situation is the NK cell

Front 136

what is factor V leiden?

Back 136

hereditary thrombosis syndrome in which production of a mutant factor V cannot be degraded by protein C

Front 137

how do platelets adhere to damaged endothelium (this is the first step of platelet plug formation)

Back 137

vWF mediates linking of platelet GpIb receptor to exposed subendothelial collagen

Front 138

what factors influence patelet aggregation

Back 138

TxA2- released by platelets, it ↑ platelet aggregation (aspirin inhibits COX thereby inhibiting TxA2 synthesis)

PGI2 & NO ↓ aggregation

Front 139

what accounts for the specificity of ABO blood groups?

Back 139

the ABO specifics are due to carbohydrate on glycolipids and glycoproteins in erythrocyte membrane
- these glycoproteins/ glycolipids are the "antigens" expressed on the RBC giving its specific type.

Front 140

what is the rate limiting enzyme of heme synthesis?

Back 140

ALA synthase (rate limiting enzyme)
- it takes succinyl CoA + glycine and converts it to δ-aminolevulinic acid
- it requires vitamin B6

Front 141

What are the two types of autoimmune anemia?

Back 141

1. Warm agglutinin (IgG)
- CHRONIC anemia seen in SLE, CLL, or with certain drugs (methyldopa)
- mostly extravascular hemolysis

2. Cold agglutinin (IgM)
- ACUTE anemia
- seen in mycoplasma pneumoniae infection, mononucleosis
- erythroblastosis fetalis- that Rh shit...

Front 142

Explain how the direct Coomb's test works

Back 142

anti-Ig AB is added to the patients RBCs. They agglutinate if the patient's RBCs are coated w/ Ig

Front 143

how does an indirect Coomb's test work

Back 143

NORMAL RBCs are added to the patient's serum and agglutination occurs if the patient's serum has anti-RBC surface Ig.

Front 144

what the hell is paroxysmal nocturnal hemoglobiinuria

Back 144

caused by DAF deficiency in RBC membrane. DAF= decay accelerating factor. It helps prevent complement activation on self cells. Decreased DAF ;eads to complement mediated lysis of RBCs and intravascular hemolysis
- ↑ sensitivity of RBCs to the lytic activity of complement
- ↑ urine hemosiderin

Front 145

what blood labs do you see in DIC

Back 145

↑ PT
↑ PTT
↑ fibrin split products
↓ platelets
↓ fibrinogen levels (cuz it's being used up like crazy)

Front 146

What the hell is going on with TTP?

Back 146

-deficiency of vWF cleaving metalloproteinase (ADAMTS 13)
- excess large vWF multimers
- ↑ platelet aggregation, thrombosis, shistocyte formation
- ↑ LDH, ↑ unconjugated bilirubin
- ↑ bleeding time of course
- normal PT & PTT

TTP displays a pentad of:
fever
thrombocytopenia (due to splenic sequestration of opsonized platelets)
neuro symptoms
renal symtoms
microangiopathic hemolytic anemia

the main difference between this and HUS is the absence of neuro sx in HUS

Front 147

↓ platelets,↑bleeding time

Back 147

thrombocytopenia
or
Bernard-Soulier disease
- defect in GpIb

Front 148

↑ PTT

Back 148

Hemophilia A or B

Front 149

↑ bleeding time normal/↑ PTT

Back 149

von willebrand disease
- deficiency of vWF; defect in platelet to collagen adhesion, vwF also carries factor VIII so levels of VIII can be ↓ and mimic hemophilia

Front 150

↑ PT, ↑ PTT

Back 150

vitamin K deficiency (or too much warfarin)
or
administration of a thrombolytic agent

Front 151

normal platelet count, ↑ bleeding time

Back 151

Glanzmann's thrombasthenia
- ↓ GpIIb/IIIa causes defect in platelet-platelet aggregation but platelet count is normal.

Front 152

what are the cell markers for Reed Sternberg cells

Back 152

CD30
CD15

Front 153

What are the hallmark clinical signs of Hodgkins lymphoma?

Back 153

RS cells
painless lympadenopathy
single group of nodes, contiguous spread
constitutional symptoms: fever, night sweats, weight loss
mediastinal lympadenopathy
50% associated w/EBV

Front 154

If you see mad lymphocytes but few RS cells, as well as bands of fibrosis in the lymph node, what type of Hodgkin lymphoma we talkin about?

Back 154

Nodular sclerosing type
- good prognosis
- happens in women > men

Front 155

what causes the "punched out" lesions in multiple myeloma?

Back 155

IL-6 release by the plasma cell activates osteoclasts

Front 156

what random ass neoplasm can mimic multple myeloma nut it limited to the lungs & nasopharynx

Back 156

a plasmacytoma (fuck you)

Front 157

what is the translocation for the M3 type of AML

Back 157

t(15:17)

Front 158

translocation for Ewing's sarcoma

Back 158

t(11:22)

Front 159

if you see a smudge cell, what comes to mind?

Back 159

CLL
- mostly older adults. >60
- lymphadenopathy, hepatosplenomegaly,
- smudge cells
- warm antibody automimmune hemolytic anemia

Front 160

what the fuck is histiocytosis X (Langerhans cell histiocytosis)?

Back 160

apparently it's a proliferative disorder of dendritic (langerhans) cells from the monocyte lineage
- defective cells express S-100 & CD1a
- birbeck granules (tennis rackets) on EM

Front 161

what muscarinic antagonist should you give to someone who suffers from motion sickness?

Back 161

scopolamine (works in CNS)

Front 162

what nicotinic blocker prevents vagal responses to changes in BP?

Back 162

hexamethonium
-nicotinic antagonist
- ganglion blocker

toxicity: severe orthostatic hypoTN, blurred vision, constipation, sexual dysfunction

Front 163

why are β blockers good for angina pectoris?

why are they good for HTN?

Back 163

they're good for angina b/c they ↓ HR & contractility so they ↓ O2 consumption of heart muscle.

good for HTN b/c they ↓ CO, and ↓ renin secretion (beta-1 effect)

Front 164

how do you treat cyanide poisoning?

how do you treat theophylline poisoning?

Back 164

cyanide- nitrites, hydroxycobalamin, thiosulfate

theophylline- beta blocker

Front 165

these drugs can cause agranulocytosis (neutropenia)

Back 165

clozapine- atypical anti-psychotic
carbamazepine- anti seizure med
colchicine- gout
propylthiouracil, methimazole- hyperthyroidism

Front 166

these drugs cause aplastic anemia- pancytopenia, hypocellularity of all cell lines, predominance of fat cells and marrow stroma
- retic count < 1%

Back 166

chloramphenicol- antibiotic (gray baby)
benzene
NSAIDS
carbamazepine- anti seizure
vinblastine- cancer drug (inhibit microtubule formation)

Front 167

these drugs can cause megaloblastic anemia

Back 167

phenytoin
methotrexate
sulfa drugs

what do they all have in common?
they fuck with folate synthesis which is important for DNA syn, which when impaired, causes meg. anemia

Front 168

which drugs can cause acute cholestatic hepatitis?

Back 168

macrolides (erythromycin, azithromycin, clarithromycin)
- reversibly bind 23S portion of 50S ribosome, blocking translocation and protein synthesis

Front 169

these diuretics can give you/ exacerbate gout

Back 169

furosemide & thiazides

b/c they both can cause hyperuricemia

Front 170

these drugs can cause SLE like syndrome

note*- you will not see anti dsDNA antibodies in the patient. Instead you will see antihistone, which is the hallmark of drug induced lupus

Back 170

hydralazine- vasodilator
procainamide- class IA anti-arrythmic
INH
phenytoin
chlorpromazine- anti-psychotic
quinidine

Front 171

this antibiotic can cause intersitial nephritis

Back 171

methicillin

Front 172

rotator cuff muscles

Back 172

supraspinatus- helps deltoid abduct arm
infraspinatus- LATERAL rotation
teres minor- adduct/ laterally rotate
subsacpularis- medial rotation

Front 173

which nerve help mediate flexion/extension at the elbow?

Back 173

C5

Front 174

a midshaft fracture of the humerus is gonna fuck up what nerve and what will be the problems you see?

hint: injury to this nerve is also seen by use of crutches

Back 174

radial nerve (C5-C8, posterior cord)
- no wrist extension
- no finger extension at MCP joints
- no supination (radial nerve passes through supinator muscle)
- no thumb extension/abduction
- loss of triceps reflex
- no sensation on dorsum of hand

note: subluxation of the radius bone can also fuck up the nerve

Front 175

what nerve will be compressed by a supracondylar fracture of the humerus and what deficits will you see?

Back 175

median nerve (C6-C8, T1)

- it innervates flexor carpi radialis, so impaired wrist flexion and wrist deviates to ulnar side when you try to flex it

-supplies 1st & 2nd lumbricals so you won't be able to flex those digits

-can't oppose thumb (innervates the abductor pollicis brevis- *not to be confused w/ the abductor pollicis longus which is innervated by the radial nerve)

- thenar wasting

- no sensation on palmer 1st 3 1/2 digits & finger tips

Front 176

what nerve gets compressed by carpal tunnel syndrome? same nerve gets compressed if there is a dislocation of the lunate

Back 176

median nerve
- no wrist flexion

Front 177

what nerve is damaged with a fracture of the medial epicondyle of the humerus? also damaged if you fracture the hook of hamate (usually by falling onto an outstretched hand)?

Back 177

ulnar nerve

proximal lesion (epicondyle fracture)- no wrist flexion (deviate to radial side)
- no medial finger flexion

distal lesion (hamate)
- no abduction/adduction of fingers cuz ulnar nerve innervates the interossei muscles
- no ADDUCTION of the thumb (ulnar nerve innervates the adductor pollicis of the thumb)
- no extension of the 4th & 5th digits
- no sensation @ hypothenar eminence
ulnar claw hand when asked to STRAIGHTEN fingers

bottom line- ulnar is responsible for ADDUCTION of all digits, no matter where they are

Front 178

difficulty flexing elbow indicates what nerve is fucked up?

Back 178

musculocutaneous
- supplies sensation to the lateral forearm
- C5-C7

Front 179

if you suffer anterior hip dislocation, which nerve have you likely damaged?

Back 179

obturator nerve(L2-L4); responsible for:
- thigh adduction
- sensory deficit will be in the medial thigh

Front 180

a pelvic fracture will cause what nerve imjury?

Back 180

femoral nerve (L2-L4); responsible for:
- thigh flexion
- leg extension @ the knee
- lose sensation over anterior thigh and medial leg

Front 181

Trauma to the lateral aspect of the leg OR a fibula neck fracture will damage what nerve?

Back 181

Common peroneal- splits into:

1. superficial peroneal- innervates skin of dorsum

2. deep peroneal- innervates the muscles that dorsiflex & evert, mediates toe extension (except big toe)
- damage will manifest as foot drop
- sensory loss over dorsum of foot, anterolateral leg
- wasting of the muscles of the anterior compartment of the leg (tibialis anterior, extensor hallucis, extensor digitorum, peroneus tertius)

Front 182

knee trauma OR compression below medial maloeolus will cause damage to what nerve?

Back 182

tibial nerve- innervates posterior compartment of the leg
- responsible for plantar flexion, foot inversion, toe flexion
- will have sensory loss on sole of foot and CAN'T STAND ON TIP TOES

Front 183

a posterior hip dislocation fucks up what nerve?

Back 183

superior gluteal nerve
- innervates gluteus medius & minimus (which are important stabilizers of the legs)
- responsible for thigh abduction

Front 184

a posterior hip dislocation can also affect this nerve which if damaged results in an inability to climb stairs, jump, and rise from a chair

Back 184

inferior gluteal nerve
- innervate gluteus maximus (your main ass muscle)

Front 185

during muscle contraction, which bands shorten, which ones stay the same?

Back 185

H bands shorten- just myosin filaments
I band shortens- just actin filaments
Z band shortens- length of the sarcomere

A band is where they both overlap and it stays the same length

Front 186

what cellular processes mediate muscle relaxation?

Back 186

calcium binding to calsequestrin, a Ca binding protein in the sarcoplasmic reticulum. Calsequestrin brings calcium back into the SR thus maintaining the calcium gradient.

Front 187

A 65 year old man presents with auditory hallucinations saying he "hears the voice of god." He also seems to talk without much expression or emotion. He claims that his neighbors are actually aliens who will kidnap him. He has had these thoughts and this behaviour for the last 2 years. In the ED, he is given an injection but a few hours later his vitals are noted to be: BP 190/100; P 120; Temp 103; RR 21. A CPK is ordered and is found to be very elevated. What medication should be administered ASAP?

A. Dantrolene Sodium
B. Haloperidol
C. Clozapine
D. Benztropine
E. Amantadine

Back 187

answer: A

this man has signs of neuroleptic malignant syndrome (rigidity, myoglobinuria, autonomic instability, hyperpyrexia), which can occur after administration of anti-psychotics.

use dantrolene to treat- it prevents Ca release from the sarcoplasmic reticulum
- u can also use DA agonists

Front 188

where is the source of osteblasts in bone?

Back 188

mesenchymal cells in the PERIOSTEUM

Front 189

what is the difference between endochondral ossification and membranous ossification?

Back 189

endochondral (long bones)- cartilaginous model of bone made first, then osteblasts/osteoclasts remodel it to woven bone, then lamellar bone

membranous (flat bones- skull, face)- woven bone formed DIRECTLY then remodeled into lamellar bone

Front 190

what two bone abnormalities have normal lab values?

Back 190

osteoporosis & osteopetrosis
normal PTH, Ca, ALP, and phosphate

osteoporosis- reduction in bone mass in spite of normal bone mineralization. sparse trabeculae

osteopetrosis- failure of bone resorptions so you end up with thick ass bones that still break easily
- abnormal function of osteoclasts
- ↓ marrow space can cause anemia, thrombocytopenia, infection
- GENETIC DEFICIENCY OF CARBONIC ANHYDRASE II
- can cause cranial nerve impingement & palsies cuz of narrow foramen

Front 191

In rickets, besides ↓ vitamin D, ↓ Ca, and ↓ phosphate, what other lab abnormality might be seen

Back 191

increase osteoblasts (b/c their trying to compensate for the bad mineralization of bone matrix)

Front 192

what the fuck are "brown tumors" and what are they indicative of

Back 192

brown tumors- cystic spaces in bone lined by osteoclasts, filled with fibrous stroma and sometimes blood

they tell you the person has osteitis fibrosa cystica, which is caused by hyperPTHism
↑ PTH
↑ Ca
↑ ALP
↓ phosphate

Front 193

what bone disease manifests as only an ↑ ALP?

Back 193

Paget's disease (osteitis deformans)
- ↑ in both osteblast/clast activity
- possibly viral origin (paramyxovirus)
- mosaic bone pattern
on X- ray you see:
↑ bone density, cortical thickening, overgrowth of bone, skull enlargement
- ** the ↑ blood flow from ↑ arteriovenous shunts can cause high output CHF
- this bitch can predispose you to OSTEOGENIC SARCOMA!!!

Front 194

what's another name for McCune Albright syndrome?

Back 194

polyostotic fibrous dysplasia
- bone is replaced by fibroblasts, collagen, and irregular bony trabeculae
- it looks radiolucent on x-ray and you see unmineralized connective tissue
- happens often in young girls
-precocious puberty, cafe-au-lait spots, short stature

Front 195

this benign tumor is most commonly found at the epiphyseal end of long bones and is often found around the KNEE or distal femur

Back 195

GIANT CELL TUMOR (osteoclastoma)
- characterized by oval/spindle shaped cells intermingled w/ multinucleated giant cells
- peak incidence 20-40
- soap bubble appearance on x-ray
- often recurs after tx

Front 196

this is the most common benign tumor of bone

Back 196

osteochondroma (exostosis)
- mature bone w/ a cartilagenous cap
- usually in men <25
- commonly originate from long metaphysis
- it can undergo malignant transformation but this is a rare complication

Front 197

other benign bone tumors
osteoma
osteoid osteoma
osteoblastoma
enchonroma

Back 197

osteoma
-associated w. Gardner's syndrome (FAP). new bone grows on a piece of bone

osteoid osteoma- interlacing woven bone surrounded by osteoblasts (tibia & femur)

osteoblastoma- like osteoid osteoma but in the vertebral column (so why the fuck did they give it a different name?)

enchondroma- benign neoplasm found in intramedullary bone

Front 198

familial retinoblastoma is a predisposing factor for this common malignant bone tumor

Back 198

osteosarcoma
- males 10-20
- METAPHYSIS on long bones (distal femur, proximal tibia)
- ↑↑ ALP
- codman's Δ or sunburst pattern on x-ray
paget;s infarcts, radiation also predispose
- early hematogenous spread to lungs, liver, brain

Front 199

if given no other clues in the question, how can you tell the difference bet ewing sarcoma & osteosarcoma

Back 199

osteosarcoma- metaphysis
ewing- diaphysis

Front 200

if a patient comes in with a stiff spine and you see fusion of vertebral joints on x-ray, what do they have?

Back 200

ankylosing spondylitis (bamboo spine)
- HLA-B27
- no Rh factor involved here
- chronic inflammation of the spine & sacroiliac joints
- they can get AORTIC REGURGE, AV block, uveitis
- also seen in patients w/ chronic inflammatory bowel disease (chron's/ ulcerative colitis)

Front 201

What is the triad of Reiter's syndrome

Back 201

1. conjunctivitis/ uveitits
2. urethritis
3. arthritis
"can't see, can't pee, can't climb a fuckin tree"

this syndrome is often associated w/ intestinal or venereal infection so common bugs to watch out for are campylobacter jejuni and chlamydia

Front 202

what are all the antibodies associated with lupus?

Back 202

antinuclear (ANA)
anti dsDNA
anti smith
antihistone- indicative of drug induced lupus

Front 203

what disease can mimic myasthenia gravis but you know it's not that when administration of AChE inhibitors don't work

Back 203

Lambert-Eaton syndrome
- autoantibodies to presynaptic Ca channel results in decreased ACh release

AND

symptoms IMPROVE w/ muscle use

Front 204

which leukotriene mediates neutrophil chemotaxis?

Back 204

LTB4
the others mediate bronchoconstriction

Front 205

PGI2 mediates what?

Back 205

↓ platelet aggregation
↓ uterine tone
causes vasodilation

Front 206

PGE2 mediates what?
these ones keep PDA open

Back 206

↓ vascular tone
↑ pain
↑ uterine tone (can cause dysmenorrhea, used for abortion)
↑ temp
↑ GI mucous production

Front 207

what is a cardiac complication of duchenne's muscular dystrophy

Back 207

dilated cardiomyopathy

Front 208

cartilage growth is stimulated by what 3 hormones

Back 208

thyroid hormone
growth hormone
testsoterone

it is inhibited by estrogen & cortisol

Front 209

what artery is medial to the biceps brachii (which helps in flexion & supination)

Back 209

brachial artery

Front 210

what antibiotic class can worsen the symptoms of myasthenia gravis

Back 210

aminoglycosides cuz they have anti-cholinergic effects

Front 211

what artery supplies blood to the head of the femur

Back 211

medial femoral circumflex artery

Front 212

intercostal groove structures from superior to inferior

Back 212

vein
artery
nerve

so poke ABOVE the rib if you're doing a thoracotamy

BUT if you are trying to anesthetize the nerve, poke below just lateral to the mid clavicular line

Front 213

what is a major complication of succinyl choline administration

Back 213

Hyperkalemia
- it is a depolarizing agent so during prolonged muscle depolarization, muscle can release a lot of K
- see tall, peaked T waves on EKG, biphasic QRS complexes

Front 214

what intracellular protein would you stain for to confirm a diagnosis of rhabdomyosarcoma?

Back 214

desmin- only found in skeletal muscle cells. It is a component of their intermediate filaments.

Front 215

Bell's palsy can be a manifestation of what infection?

Back 215

Lyme disease
- bell's palsy and other systemic manifestations tend to occur around stage 2 of the disease

Front 216

which muscle closes the jaw?

which ones open it?

Back 216

lateral pterygoid- closes jaw

3 Muscles: Medial pterygoid, teMporalis, Masseter all act to close jaw

Front 217

a scaphoid fracture (hand) causes what?

Back 217

pain in skin covering the anatomical snuff box (random ass shit...)

Front 218

what is the unhappy knee triad?

Back 218

A common football injury occurs when the person is clipped from the lateral side and the following 3 structures are damaged:

medial collateral ligament
anterior cruciate ligament
medial meniscus

Front 219

what does the flexor digitorum longus do?

Back 219

serves to flex the 2nd-5th toes, and also inverts the foot
innervated by the tibial nerve

Front 220

what muscle extends the great toe?

Back 220

extensor hallucis longus
innervated by the peroneal nerve

Front 221

What are the main differences in timing of the schizo disorders?

Back 221

schizoaffective- at least 2 WEEKS
- stable mood w/ psychotic symptoms + a major depressive episode

schizophreniform- 1-6 months

brief psychotic disorder- less than 1 month (stress related)

schizophrenia- > 6 months

Front 222

what is used to treat OCD?

Back 222

SSRIs: fluoxetine, sertraline, paroxetine, citalopram

clomipramine- TCA

Front 223

what drugs are used to treat generalized anxiety disorder (uncontrollable anxiety for > 6 months)

Back 223

benzodiazepines

buspirone- they love using this one cuz it does not interact w/ alcohol and it has no abuse potential

SSRIs:fluoxetine, sertraline, paroxetine, citalopram

Front 224

somatoform disorders are characterized by physical symptoms w/ no identifiable physical cause.

what is characteristic of somatization disorder?

Back 224

variety of complaints in multiple organ systems:
4 pain
2 GI
1 sexual
1 pseudoneurologic

Front 225

somatoform disorders are characterized by physical symptoms w/ no identifiable physical cause.

what characterizes conversion disorder?

Back 225

motor or sensory symptoms, often following an acute stressor

Front 226

Cluster A personality disorders:
paranoid
schizoid
shizoptypal

Back 226

odd or eccentric. Inability to develop meaningful social relationships. NO PSYCHOSIS

paranoid- pervasive distrust & suspiciousness

schizoid- VOLUNTARY social withdrawal, cold, content w/ social isolation

schizotypal- eccentric appearance, odd beliefs/magical thinking

Front 227

cluster B personality disorders
antisocial
borderline
histrionic
narcissistic

Back 227

DRAMATIC, emotional, erratic

antisocial- disregard for & violation of rights of others, criminality

borderline- unstable mood & interpersonal relationships, impulsiveness, splitting

histrionic- excessive emotion, attention seeking, sexually provocative, overly concerned w/ appearance

narcissistic- grandiosity, sense of entitlement, lacks empathy, needs admiration, reacts to criticism w/ RAGE

Front 228

cluster C personality disorders
avoidant
obsessive compulsive
dependent

Back 228

anxious/ fearful

avoidant- hypersensitive to rejection, socially inhibited, feelings of inadequacy, desires relationships w/ others

obsessive compulsive- preoccupation w/ order, perfectionism

dependent- submissive & clingly, need to be taken care of, low self confidence, cannot express disagreement

Front 229

what is the most sensitive indicator of alcohol use?

Back 229

gamma-glutamyltransferase

Front 230

if you think someone may be high off amphetamine or PCP but you're not sure which, what's the one clue that tips you off its PCP?

Back 230

nystagmus!
jackasses on PCP will have vertical & horizontal nystagmus
-they will also be belligerent, impulsive

Front 231

what drug class is used for anorexia/bulemia

Back 231

SSRIs

Front 232

during an abdominal surgery you need to access the splenic artery. what ligament do you cut?

Back 232

splenorenal ligament
- connects spleen to posterior abdominal wall
- contains splenic artery & vein

Front 233

the ventricles are completely depolarized during which isolelectric portions of the ECG?

Back 233

ST segment

Front 234

what are the clinical signs of caridac tamponade?

Back 234

pulsus paradoxus- decrease in amplitude of pulse during inspiration

-hypotension
- increase venous pressure (JVD)
- distant heart sounds
- increased HR

Front 235

if a woman is pregnant with a fetus that has down's syndrome, what will her pregnancy screen look like?

Back 235

↑ β-hCG
↑ inhibin A
↓ α-fetoprotein
↓ estriol

Front 236

what 3 structures form the blood brain barrier?

Back 236

1. tight junction between NONFENESTRATED capillary endothelial cells
2. basement membrane
3. astrocyte processes

Front 237

what two brain areas have no BBB

Back 237

area postrema- vomiting after chemo
OVLT- osmotic sensing

Front 238

what are the repeat sequences for the main trinucleotide repeat disorders?

Back 238

Huntington's disease- CAG
Fragile X- CGG
Friedrich's atxia- GAA
myotonic dystrophy- CTG

Front 239

a lesion in the subthalamic nucleus will cause what types of movements?

Back 239

hemiballismus- sudden, wild, flinging movements
- due to loss of inhibition from the globus pallidus
- problem will be on contralateral side

Front 240

what other problem can someone with wernicke's aphasia present with?

Back 240

upper quadrantanopia
- since wernicke's area often contains optic radiation fibers from the left LGN, sometimes they will also present with this visual impairment

Front 241

A patient comes in with a type of aphasia. His fluency is fine and his comprehension is fine but he cannot repeat words. Where is his lesion?

Back 241

arcuate fasiculus
- this is a conduction aphasia. the arcuate fasiculus connects broca's & wernicke's area

broca's aphasia
-inferior frontal gyrus
- nonfluent speech w/ intact comprehension

wernicke's aphasia
- superior temporal gyrus
- fluent speech w/o comprehension

in all aphasia's the person cannot repeat

Front 242

an infarct of what area cause pure MOTOR hemiparesis?

Back 242

internal capsule
- supplied by the lateral striate arteries (divisions of the middle cerebral artery)
- lateral striate also supply the caudate, putamen, globus pallidus

Front 243

which cerebral artery is actually NOT part of the circle of willis?

Back 243

middle cerebral artery
- terminal branch of the internal carotid artery
- supply trunk, arm & face areas of the sensory & motor cortices

infarct will result in:
- contralateral face & arm paralysis, and sensory loss
-aphasia if infarct is on the left
- left sided neglect if parietal lobe affected
- quadrantanopia or homonymous hemianopia if the optic radiations are affected

Front 244

what cerebral artery supplies the leg, foot area of the motor & sensory cortices?

Back 244

anterior cerebral artery

Front 245

what cerebral artery supplies the visual cortex

Back 245

posterior cerebral artery
- infarct results in homonymous hemianopia

Front 246

if a patient has an infarcted posterior inferior cerebellar artery, what neuro signs are they likely to present with?

Back 246

Wallenberg's syndrome (lateral medullary syndrome)
- ↓ pain & temp sensation on contralateral side of the body (spinothalamic)
- ipsilateral dysphagia, ↓ gag, vertigo, diploplia, nystagmus, vomiting
- ipsilateral Horner's syndrome
- ipsilateral loss of pain & temp on the face

Front 247

what neuro signs will be present in a patient with an infarcted anterior spinal artery

Back 247

MEDIAL medullary syndrome
- contralateral hemiparesis of the lower extremities and trunk (corticospinal)
- ↓ proprioception on the contralateral side (medial lemniscus)
- ipsilateral damage to the tongue from CN XII damage

Front 248

which conditions cause only lower motor neuron symptoms due to destruction of the anterior horns?

Back 248

polio

werdnig-hoffman disease
- aka "infnatile spinal muscular dystrophy"
- babies die before 1 yr
- autosomal recessive
- presents @ birth as floppy baby, TONGUE FASICULATIONS
- fibrillation potentials seen on EMG

Front 249

what is the treatment for ALS and how does it work?

Back 249

riluzole
- it inhibits glutamatergic neurotransmission

Front 250

what spinal cord lesion presents as a loss of pain & temp in a capelike distribution

Back 250

syringomyelia
- crossing fibers of spinothalamic tract damaged

Front 251

a defect in this enzyme can cause ALS

Back 251

superoxide dismutase

ALS
-both LMN & UMN signs
- MOTOR DEFICIT ONLY
- no sensory, cognitive impairment
- also can be caused by betel nut ingestion
tx: riluzole

Front 252

this is a cardiac complication of friedrich's ataxia

Back 252

hypertrophic cardiomyopathy

Front 253

friedrich's ataxia

Back 253

-autosomal recessive
- trinucleotide repeat disorder (GAA, frataxin gene), leads to an impairment in mitochondrial functioning
- staggering gait, frequent falling ("tendency to fall")
- nystagmus, dysarthria
- impaired position & vibration sense
- degeneration of nerve tissue in spinal cord (dorsal columns, demyelination of lateral corticospinal tracts too)

Front 254

what are the foramina of the 3 branches of CN V?

Back 254

CN V- trigeminal nerve
V1- opthalmic branch passes through the superior orbital fissure
V2- maxillary branch passes through the foramen rotundum
V3- mandibular branch passes through the foramen ovale

Front 255

afferent & efferent limb of the jaw jerk reflex

Back 255

afferent: V3
efferent: V3

Front 256

nucleus solitarious contains which cranial nerves?

Back 256

CN 7, 9, 10
carries sensory info about tastes, baroreceptors, gut distention

Front 257

nucleus ambiguous contains which cranial nerves?

Back 257

CN 9, 10, 11
somatic visceral efferent (swallowing, palate elevation)

Front 258

what passes through the superior orbital fissure?

Back 258

CN 3, 4, V1, 6, opthalmic vein

Front 259

what do CN 7, 8 pass through?

Back 259

internal auditory meatus

Front 260

which cranial nerves pass through the jugular foramen?

Back 260

9-11

note: CN 9 lies in the tonsilar fossa. Fuck with it and you lose taste to posterior 2/3 of tongue

Front 261

what is cavernous sinus syndrome?

Back 261

impingement of the cranial nerves in the cavernous sinus do to mass effect

CN 3.4, V1, V2, 6 lie in the cavernous sinus as well as the cavernous portion of the internal carotid artery

symtoms: opthalmoplegia, opthalmic and maxillary sensory loss

Front 262

if you have a pituitary tumor that is growing like crazy, who's the first cranial nerve to get fucked up?

Back 262

CN 6 (abducens)

why?
because it's the most medial and will be affected first by mass effect in the cavernous sinus

Front 263

why do you get hyperacusis with a CN 7 lesion?

Back 263

b/c of paralysis to the stapedius muscle. CN 7 innervates the stapedius which serves to dampen sound so if it's fucked up, you will hear sounds louder than you should

Front 264

what is the difference between conductive and sensorineural hearing loss?

Back 264

conductive
- bone conduction > air conduction
- weber localizes to affected ear

sensorineural
- air conduction > bone
- weber localizes to normal ear

Front 265

which dementia is localized to the frontotemporal area of the brain

Back 265

Pick disease
-dementia, aphasia, parkisonian aspects
- pick bodies*- intracellular aggregated tau protein
- frontotemporal lobe atrophy only

Front 266

startle myoclonus, spongiform cortex, and rapidly progressing dementia should make you think of

Back 266

Creutzfeldt-Jakob disease
- rapidly progressing (weeks-months)
- startle myoclonus
- SPONGIFORM CORTEX
- prion disease, no cure

Front 267

what is the treatment for multiple sclerosis?

Back 267

β-interferon

Front 268

Multiple sclerosis

Back 268

Autoimmune demyelination of CNS- Th1 reacts against CNS myelin and activates macrophages to eat oligodendrocytes
Can present with:
- optic neuritis (sudden loss of vision)
- MLF syndrome (internuclear opthalmoplegia)
- hemiparesis
- bladder/bowel incontinence (that sucks..)
- ** relapsing & remitting course

Findings include:
↑ IgG in CSF
- periventricular plaques (ares of oligodendrocyte loss and reactive gliosis)

tx: beta interferon & immunosuppressive therapy

Front 269

what demyelinating disease is associated with the JC virus (naked, DNA virus- polyomavirus)

Back 269

PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY
- demyelination of CNS
- rapidly progressive

Front 270

this lysosomal storage disease is also a demyelinating disease

Back 270

Metachromatic leukodystrophy
- deficiency in arylsulfatase A
- accumulation of cerebroside sulfate or other sulfatides leads to impaired production of myelin sheath
- ataxia, dementia,

Front 271

I am so sick of hearing the name Charcot-Marie Tooth

what the fuck is this shit!?

Back 271

aka: hereditary motor & sensory neuropathy
- a group of hereditary nerve disorders related the the defective production of proteins involved in the structure & function of peripheral nerves or myelin sheath
(that's a vague ass description...)

Front 272

what should you use for status epilepticus?

Back 272

benzodiazepines

Front 273

what are the main differences between the two types of vertigo?

vertigo = illusion of movement

Back 273

peripheral vertigo
- inner ear problem (semicircular canals fucked up)
- could be Meniere's disease- ↑ endolymph in inner ear
- testing will show DELAYED HORIZONTAL NYSTAGMUS

central vertigo
- brain stem or cerebellum fucked up (vestibular nuclei, posterior fossa tumor)
- testing shows immediate nystagmus in any direction

Front 274

port wine stains on the skin and leptomingeal angiomas should make you think of?

Back 274

sturge-weber syndrome
- congenital disorder
- can cause glaucoma, seizures, retardation

Front 275

Tuberous sclerosis

Back 275

hamartomas in skin, CNS, organs
CARDIAC RHABDOMYOMA
RENAL ANGIOLIPOMA
SUBEPENDYMAL GIANT CELL ASTROCYTOMA
mitral regurge, seizures
hypopigmented "ash leaf" spots
sebaceous adenoma

Front 276

if you see a pigmented iris hamartoma, what is it? what disease is it associated with? what are other complications of the disease?

Back 276

The pigmented iris hamartomas are Lisch nodules.

Neurofibromatosis Type 1
- autosomal dominant (chrom 17)
- cafe-au-lait spots
- skin lesions (neurofibromas)
- associated w/ PHEOCHROMOCYTOMA
- skeletal disorders
- OPTIC PATHWAY GLIOMAS

Front 277

what autosomal dominant disease is associated with hemangiomas and bilateral renal cell carcinoma?

Back 277

Von Hippel Lindau
- hemangiomas in skin, mucosa, organs
- bilateral renal cell carcinoma***
- RETINAL HEMANGIOBLASTOMAS
- brain stem, cerebellar, medulla hemangioblastomas

Front 278

the description of pseudopalisading pleomorphic tumor cells that border central areas of necrosis should make you think of what fucked up disease

Back 278

gliobastoma multiforme
- stage 4 astrocytoma
- can cross corpus callosum ("butterfly glioma"

Front 279

if you see spindle cells concentrically arranged in a whorled pattern & PSAMMMOMA BODIES, what's the problem?

Back 279

meningioma
- arises from arachnoid cells
- it's one of the four conditions that psammoma bodies are seen in

Front 280

"fried egg cells"

Back 280

oligodendroglioma
small round nucleus with clear cytoplasm

Front 281

this CNS tumor resembles tooth enamel

Back 281

craniopharyngioma
- benign, looks like fuckin tooth enamel!
- can cause diabetes inspidus
- supratentorial
- often confused w/ pituitary adenoma b/c of location and can cause similar vision problems
-derived from a remnant of RATHKE'S PUCH

Front 282

this type of herniation can compress the anterior cerebral artery

Back 282

cingulate herniation
- it's a herniation under the falx cerebri (dura that goes down midline of brain)
- it can also compress the cingulate gyrus

Front 283

uncal herniation can produce this clinical signs

Back 283

uncus = medial temporal lobe

uncal herniation
- medial temp lobe herniates inferiorly through tentorial notch
- compression on CN III (ipsilateral dilated pupil & ptosis)
- complresson of middle cerebellar penduncle
- compression of ipsilateral posterior cerebral artery (contralateral homonymous hemianopia)
-hemiplegia

Front 284

You have a patient with bipolar disorder and you are treating her with the drug of choice for this condition. What lab values should you periodically check in her blood?

Back 284

the drug: lithium

lithium can cause HYPOTHYROIDISM so periodically check TSH levels (which would be elevated).

The question could be asked in a different context in which the patient comes in with signs of hypothyroid and they wanna know what med she is on.

Front 285

which drug acts by inhibiting metabolism of the neurotransmitter responsible for parkinson's disease?

Back 285

selegiline- inhibits MOA type B** which is involved in dopamine metabolism

MOA type A metabolizes NE and 5-HT

Front 286

which drug can be used for an acute attack of closed angle glaucoma?

Back 286

acetazolamide
- carbonic anhydrase inhibitor
- ↓aqueous humor secretion

can also use the following for acute attacks
pilocarpine (muscarinic agonist)
mannitol- omsotic diuretic

Front 287

in the structure of urea, where do the 2 nitrogens and carbon come from

Back 287

N1- comes from NH4+
N2- comes from aspartate
the carbon comes from CO2

Front 288

rate limiting enzyme of the urea cyle

Back 288

carbamoyl phosphate synthetase I

Front 289

cyclophosphamide & ifosfamide are 2 alkylating agents that can cause a particular complication that can be partially prevented with MESNA

Back 289

HEMORRHAGIC CYSTITIS

Front 290

what 2 amino acids are found in nucleosomes?

Back 290

arginine
lysine

Front 291

what amino acids contribute nitrogen in purine formation?

Back 291

glutamte
glycine
aspartate

Front 292

what is the rate limiting enzyme for pyrimidine synthesis

Back 292

carbamoyl phosphate syntetase II

Front 293

in prokaryotes, which DNA polymerase degrades the RNA primer?

Which one replicates a new DNA strand?

Back 293

DNA polymerase I degrades RNA primer

DNA polymerase III replicates

Front 294

what's the genetic defect in hereditary nonpolyposis colerectal cancer (HNPCC)

Back 294

a defect in mismatch repair of DNA

Front 295

in collagen synthesis, what enzyme is responsible for crosslinking tropocollagen molecules and what disease do you get if you are deficient in this enzyme?

Back 295

lysyl oxidase

Menkes disease
- x linked recessive, symptoms appear during infancy
- depigmented hair
-copper deficiency
- facial, ocular, vascular, cerebral manifestations
- mutation in ATP7A→defect in copper transport→abnormally low activity of lysyl oxidase (b/c it is a copper containing enzyme)→ defect in collagen fibril synthesis

Front 296

which form of osteogenesis imperfecta is fatal in utero?

Back 296

type II

Front 297

what syndrome is characterized by hereditary nephritis and deafness?

Back 297

alport syndrome
- defect in type IV (basement membrane) collagen
- may also have ocular disturbances
- type IV collagen important for BM of kidneys, ears, & eyes

Front 298

in addition to berry aneurysms, what is another complication people with APKD can get?

Back 298

mitral valve prolapse

Front 299

what is used to loosen mucous plugs in CF patients?

Back 299

N-acetylcysteine

Front 300

what are the only purely ketogenic amino acids?

Back 300

lysine
leucine
use for treatment in pruvate dehydrogenase deficiency

Front 301

oxidative phosphorylation poison

electron transport inhibitors

Back 301

rotenone
cyanide
antimycin A
carbon monoxide

Front 302

oxidative phosphorylation poison

ATPase inhibitors

Back 302

oligomycin

Front 303

oxidative phosphorylation poison

uncoupling agents

Back 303

2,4-DNP
aspirin
thermogenin in brown fat

Front 304

what can use you to treat hyperammonemia

Back 304

benzoate
or
phenylbutyrate

Front 305

what is cystinuria and how should you treat it?

Back 305

- defect of renal tubular amino acid transporter for cysteine, ornithine, and lysine in the PCT of kidneys
- can get cystine kidney stones (staghorn calculi)

tx: acetazolamide to alkanize the urine

Front 306

what are the differences between Types 1, 2, and 4 renal tubular acidosis?

Back 306

Type 1- defective H/K ATPase
- inability to secrete H by intercalated cells of the cortical collecting duct
- can lead to HYPOKALEMIA & acidemia

Type 2: defect in proximal tubule HCO3 reabsorption
- can lead to HYPOKALEMIA

Type 4- Hypoaldosteronism
- leads to inhibition of ammonia excretion in proximal tubule
- HYPERKALEMIA

Front 307

where is tubular fluid the most hypotonic

Back 307

at the macula densa (junction of thick ascending limb @ DCT)

Front 308

what artery does the ureter cross anterior to as it enters the pelvis?

Back 308

external iliac

Front 309

how can NSAIDS cause renal failure

Back 309

they inhibit the production of prostaglandins which keep the afferent arterioles dilated to maintiain GFR

Front 310

diffuse proliferative glomerulonephritis is commonyl see in what chronic condition

Back 310

SLE
- subendothelial DNA-antiDNA immune complexes
- granular IF
- most common cause of death in lupus

Front 311

what's the most common cause of nephrotic syndrome in ADULTS?

Back 311

membranous glomerulonephritis
- see diffuse capillary & basement membrane thickening
- on EM you see SPIKE & DOME appearance which results from extension of the basement membrane between & around the immune complexes
- little response to corticosteroids

Front 312

what's the most common glomerular disease in the HIV/ IV drug abuser population

Back 312

focal segmental glomerular sclerosis
-

Front 313

What are struvite stones composed of? and infections by what organisms cause them?

Back 313

struvite stones are composed of ammonium magnesium phosphate
-can form staghorn calculi
- radiOPAQUE
-they are caused by infection with urease (+) bugs such as:
proteus vulgaris
staphylococcus
klebsiella

Front 314

what four conditions can cause renal papillary necrosis?

Back 314

1. diabetes mellitus
2. acute pyelonephritis
3. chronic phenacitin use
4. sickle cell anemia- high osmolarity of vasa recta favors sickling of erythrocytes. resultant ischemia causes papillary necrosis

Front 315

these two drugs can cause fanconi's syndrome

Back 315

cisplatin
expired tetracycline

Fanconi's syndrome- decrease proximal tubule transport of amino acids, glucose, phosphate, uric, acid, protein, and electroytes
- other causes include wilson's disease, and glycogen storage diseases

Front 316

which diuretic should you use if you have a patient that has a sulfa allergy?

Back 316

ethacrynic acid
- works just like furosemide

furosemide, thiazides, and acetazolamide are all sulfa drugs

Front 317

Two days after recovering from the "flu", a 35 year-old woman experiences numbness and tingling of the lower limbs. Over the following day, the numbness becomes accompanied by weakness and spreads to the upper extremities. Which of the following test results will confirm the presumptive diagnosis?

A. Positive FTA-ABS test
B. Positive Edrophonium challenge
C. LP evidencing decreased glucose
D. LP evidencing albumino-cytologic dissociation
E. Positive culture for C. jejuni

Back 317

answer: D (increased CSF protein with normal cell count)

The patient evidences signs most consistent with Guillain-Barre syndrome (GBS), an autoimmune response activated by an infection. While, C.ampylobacter jejuni is a typical agent that causes GBS, there are many reasons why a patient could have a positive culture for C.jejuni that do not involve GBS and there are many causes of GBS other than C. jejuni. The hallmark finding in GBS is albumino-cytologic dissociation. The source of the increased protein count is the autoantibodies in the CSF.

Front 318

A 38 year old woman with a 15 year history of drug abuse who is being treated for fever, cough, and shortness of breath, develops dementia, hemiparesis, ataxia, aphasia, and dysarthria over the course of 5 days. MRI reveals multiple white matter lesions. Over the course of 2 weeks, the woman’s condition worsens, Despite aggressive treatment, she lapses into a coma and soon dies. At autopsy, histologic examination of her brain tissue reveals gigantic, deformed astrocytes and oligodendrocytes with abnormal nuclei.

What is the most likely cause of this woman’s CNS symptoms?

A. Autoimmune attack of myelin sheaths
B. A double-stranded circular DNA virus
C. A single-stranded linear RNA virus
D. An autosomal recessive lysosomal storage disease
E. A proteinaceous infectious particle

Back 318

answer: B

The correct answer is (B). JC virus is a ubiquitous polyomavirus that causes progressive multifocal leukoencephalopathy (PML). PML is associated with severely immunocompromised states. Most cases are seen in patients with AIDS. The disease can have a very rapid course, progressing over days or weeks. A CD4 count less than 100 is an especially poor prognostic sign in these patients. Characteristic histologic findings include giant astrocytes, and oligodendrocytes with enlarged nuclei and nuclear inclusions. Radiographic findings include numerous white matter lesions of varying sizes in the cerebral and cerebellar hemispheres. Answer (A) alludes to multiple sclerosis a demyelinating disease defined by multiple white matter lesions separated over time and space. Answer (C) refers to HIV encephalitis, which progresses slowly over a course of months. Answer (D) refers to metachromatic leukodystrophy, an autosomal recessive lysosomal storage disease that causes both peripheral and central demyelination in children. Answer (E) refers to prion disease, which would reveal spongiform encephalopathy.

Front 319

what would the joint fluid of an RA patient look like

Back 319

Synovial analysis will show findings consistent with an inflammatory process (clear/yellow fluid; <2000 WBC; 50-70% PMNs).

Front 320

A 28-year-old man presents to the emergency room complaining of shortness of breath and coughing up bright red blood. He reports several months of dry cough and fatigue. On examination, blood pressure is 150/98 mmHg, and respiratory rate is 28/min. Laboratory examination is remarkable for a BUN of 30 mg/dL and creatinine of 2.9 mg/dL. Kidney biopsy confirms the diagnosis.

Which of the following human leukocyte antigens (HLA) is most strongly associated with this patient's disease?

Back 320

answer: A

This patient is suffering from Goodpasture's syndrome, characterized by pulmonary hemorrhage and glomerulonephritis. This disease is associated with major histocompatibility complex (MHC) class II antigen HLA-DR2. The DR2 antigen is also associated with allergy, multiple sclerosis, and narcolepsy. The underlying pathology in this disorder is an autoimmune attack against basement membrane antigens—it is also known as anti-glomerular basement membrane disease—explaining the often-simultaneous involvement of the lungs and kidneys. Kidney biopsy with immunohistochemical staining provides diagnosis.

HLA-DR3 (choice B) is associated with celiac disease, insulin-dependent diabetes, and systemic lupus erythematosus.

HLA-DR4 (choice C) is associated with pemphigus vulgaris, rheumatoid arthritis (relative risk 4), and insulin-dependent diabetes mellitus.

HLA-DR5 (choice D) is associated with juvenile rheumatoid arthritis and pernicious anemia.

HLA-DR7 (choice E) is associated with psoriasis.

Front 321

Diseases associated with HLA-DR2

Back 321

Goodpastures (type II hypersensitivity)
SLE (type III hypersensitivity)
Multiple sclerosis (type 4)

Front 322

Diseases associated with HLA-A3

Back 322

hemochromatosis

Front 323

Diseases associated with HLA-B27

Back 323

psoriasis
ankylosing spondylitis
IBD
reiter's syndrome

Front 324

Diseases associated with HLA-B8

Back 324

Graves Disease

Front 325

Diseases associated with HLA-DR3

Back 325

Diabetes mellitus type 1

Front 326

Diseases associated with HLA-DR4

Back 326

Rheumatoid arthritis DM type 1

Front 327

Diseases associated with HLA-DR5

Back 327

pernicious anemia
hashimoto's thyroiditis

Front 328

Diseases associated with HLA-DR7

Back 328

steroid responsive nephrotic syndrome

Front 329

what skin condition is associated with celiac disease?

Back 329

Dermatitis herpetiformis is a condition seen commonly in patients with celiac disease. It is characterized by pruritic papulovesicles on the trunk and the arms. On biopsy, characteristic granular deposits of IgA on the basement membrane are seen.

Front 330

deficiency of what complement component leads to hereditary angioedema?

Back 330

C1 esterase

Front 331

a deficiency of C5-C8 can cause

Back 331

Neisseria bacteremia

Front 332

deficiency of C3 leads to

Back 332

severe, recurrent pyogenic & respiratory tract infections, especially with Haemophilus influenza

Front 333

what blood is the best donor for PLASMA?

Back 333

AB+
O- is the best donor for RBCs

A 38-year-old woman with history of Factor V Leiden deficiency, multiple deep venous thromboses, placement of IVC filter, and depression presents with syncope, severe pallor and abdominal distention after overdosing on her warfarin in a suicide attempt. Due to the severe bleeding, the patient requires fresh frozen plasma (FFP) to reverse the anticoagulation, but her blood type is unknown. Which of the following FFP types can be safely given?

A. A+
B. AB+
C. B-
D. O+
E. O-

Answer: B

Fresh frozen plasma (FFP) is indicated in severe bleeding to reverse anticoagulation. The woman has signs of hypovolemic shock and probable intra-abdominal bleeding that requires rapid correction. FFP contains clotting factors that are deficient in patients on warfarin (namely II, VII, IX, X). Plasma also contains antibodies to A and B antigens on RBCs. A and B antigens are glycosphingolipids. People with type A blood will produce antibodies to B antigen, people with type B blood will produce A antibodies, and people with type O blood will produce both. Similarly, people with Rh- type blood will produce antibodies to Rh factor. All these antibodies will be present in the plasma; therefore AB+ is the universal donor for PLASMA because it does not contain any ANTIBODIES. You may remember that O- is the universal donor for RBC because it does not contain any ANTIGENS. Incidentally, transfusion is not required to incite production of antibodies. Many foods, viruses, and bacteria can trigger sensitization to AB and Rh factors, so it is important to protect patients with unknown blood types by giving the universal donors.

Front 334

A child receives several vaccinations before the start of the school year. Shortly thereafter, he experiences a fever, joint pains, a rash and itching. The parents insist on a blood test, which reveals multinucleated giant cells with eosinophilic cytoplasmic and nuclear inclusion bodies. This is most likely a reaction to which vaccine?

A. Flu vaccine
B. Measles vaccine
C. Meningitis vaccine
D. Pneumococcal vaccine
E. Tetanus vaccine

Back 334

answer: B

The live measles vaccine can cause mild measles symptoms, including multinucleated giant cells (a laboratory test for measles virus). Meningitis vaccine may cause pain and redness at the infection site. Tetanus vaccine may cause a type IV allergic reaction at the infection site 24-48 hours after injection. Flu vaccine may cause flu-like symptoms. Some individuals may have a type I anaphylactic reaction to an egg protein used in the vaccine; persons with egg allergies should not get the flu vaccine. Pneumococcal vaccine may cause tenderness or redness at the injection site, fever, and joint aches.

Front 335

what necrotixing immune complex inflammatory disease of MEDIUM sized arteries is sometimes associated with Hep B infection

Back 335

polyerteritis nodosa

Front 336

what medication should you give to a patient experiencing urinary incontinence?

Back 336

oxybutynin or glycopyrrolate
-reduce urgency in mild cystitis and reduce bladder spasms
- oxybutynin is antispasmadic and has inhibits the muscarinic action of ACh on smooth muscle

Front 337

why do you not wanna give spironolactone to someone who has sustained a crush injury

Back 337

because with a crush injury the muscle cells are releasing K so the person is likely to be hyperkalemic so spironolactone (a K sparing diuretic will only make it worse)

Front 338

in β-thalassemia, why is the β chain underproduced?

Back 338

underproduced due to mutations in splice sites and promoter sequences

Front 339

what mediates HYPERacute rejection?

Back 339

antibodies

Front 340

thymus independent antigens

Back 340

these are antigens that lack a peptide component, therefore they cannot be presented on MCH molecules to T cell. So only igM Abs are made in response to them and there is no immunologic memory

e.g. polysaccharide capsular antigen, LPS cell envelope

Front 341

thymus dependent antigens

Back 341

these antigens contain a protein component and induce class switching and immunological memory

e.g. conjugated H.influenza vaccine

Front 342

helper T cell surface markers

Back 342

CD3
CD4
TCR
CD28
CD40

Front 343

how do α a and β interferon inhibit viral protein synthesis

Back 343

they produce a ribonuclease that inhibits viral protein synthesis by degrading viral mRNA not host mRNA.

β-interferon is used to treat MS

Front 344

what is the autoantibody associated with type 1 diabetes

Back 344

anti-glutamate carboxylase

Front 345

name all substances chemotactic for neutrophils

Back 345

C5
IL-8
Leukotriene B4 (LTB4)
kallikrein

Front 346

granuloma formation is mediated by what 2 cytokines

Back 346

IL-2
IFN gamma

Front 347

how do free radicals induce cell injury

Back 347

membrane lipid peroxidation
protein modification
DNA breakage

Front 348

these tumors metastasize to the brain

hint: Lots of Bad Stuff Kills Glia

Back 348

Lung
Breast
Skin
Kidney
GI

Front 349

these tumors metastasize to the liver

hint: Cancer Sometime Penetrates Benign Liver

Back 349

Colon
Stomach
Pancreas
Breast
Lung

Front 350

these tumors metastasize to bone

hint: PTTBLK

Back 350

Prostate
Thyroid
Testes
Breast
Lung
Kidney

Front 351

drugs that display zero order kinetics

Back 351

phenytoin
ethanol
aspirin (@ high doses)

Front 352

what muscarinic antagonist is used in the treatment of asthma

Back 352

ipratroprium (inhibit M3 receptor)

Front 353

these 2 muscarinic antagonists decrease bladder incontinence by reducing urgency and reducing bladder spasm

Back 353

oxybutynin
glycopyrrolate

Front 354

these muscarinic antagonists can be used for peptic ulcer treatment

Back 354

methscopolamine
pirenzepine
propantheline

Front 355

which ligament contains the ovarian vessels?

Back 355

suspensory ligament of the ovaries
- connects ovaries to lateral pelvic wall
- contains ovarian vessels

Front 356

which ligament contains the uterine vessels?

Back 356

transverse cervical ligament (aka cardinal ligament...why does everything have 2 fucking names!!?)
- connects cervis to side wall of pelvis
- contains uterine vessels

Front 357

which ligament contains NO structures

Back 357

round ligament- connects uterus to labia majora
- derivative of the gubernaculum

Front 358

what ligament contains the ovaries, fallopian tubes, and round ligament

Back 358

the broad ligament
- connects he uterus, f tubes, and ovaries to pelvic side wall

Front 359

what muscle controls urine flow?

Back 359

pubococcygeus muscle
- surround anus, bladder opening, vagina
- extends from the pubic bone to the coccyx

Front 360

the acrosome, tail, and neck of the sperm are derived from what intracellular structures?

Back 360

acrosome- golgi apparatus
tail- centrioles
neck- mitochondria

Front 361

what are the components of JIZZ?
that's right...jizz

Back 361

Jizz= sperm, seminal vesicle fluid, prostatic secretions, and bulbourethral glands
- prostatic secretions contain acid phosphate, citric acid, Ca, and ZINC. it contributes to 20-30% of seminal fluid
- bulbourethral glands make jizz viscous & mucous
- seminal vesicles contribute fructose for sperm to eat. this is 60% if the seminal fluid

Front 362

what are the two hormones that sertoli cells secrete?

Back 362

inhibin- (inhibits FSH)
ABP- androgen binding protein maintains testosterone levels

Front 363

what are the two phases of meiotic development that the ovary is arrested in and when do they occur?

Back 363

primary oocytes begin meiosis during fetal life and remain arrested in PROPHASE of MEIOSIS 1 until puberty (ovulation)

oocytes remain arrested in METAPHASE of MEIOSIS 2 until it's time to fuck and get fertilized

Front 364

where does fertilization most commonly occur

Back 364

ampulla of fallopian tube

Front 365

You're a dude with a small dick, small balls and a female fat distribution (sucks for you..)
Your labs look like this:
↑ FSH
↑ LH
↑ estrogen
↓ testosterone

what do you have

Back 365

Klinefelter's syndrome (47 XXY)
- presence of inactivated X chromosome
- long extremities, titties, female hair & fat distribution
- DYSGENESIS OF SEMINIFEROUS TUBULES, abnormal leydig cell function
the cells of your testes look all kinds of fucked up
- due to nondisjunction of sex chromosomes

Front 366

what syndrome is associated with preductal coarctation of the aorta?
it's also the most common cause of primary amenorrhea

Back 366

turner's syndrome
- streak ovaries, webbed neck
- neonates present with cystic hygromas
↑ FSH
↑ LH
↓ estrogen (cuz you aint got no ovaries to make it)

Front 367

↑ testosterone
↑ estrogen
↑ LH

Back 367

androgen insensitivity syndrome
- defectin androgen receptor results in a normal looking female with a short vagina
- no uterus
- testes present in body (need to be removed to prevent malignancy)

Front 368

what enzyme deficiency gives you "penis at 12" phenomenon

Back 368

5α-reductase deficiency
- this enzyme converts testosterone to DHT (needed for differentiation of penis, scrotum & prostate)
- you have ambiguous genitalia until puberty when ↑ testosterone finally causes masculinzation of your shit

Front 369

complete mole vs. partial mole

Back 369

Complete mole: 46, XX or 46 XY
↑↑↑↑ hCG
↑ uterine size
no fetal parts
2 sperm/ empty egg
2% convert to choriocarcinoma

Partial mole: 69 XXY (triploid)
↑ hCG
fetal parts
2 sperm + 1 egg

Front 370

what is the most common cause of recurrent miscarriage in the FIRST TRIMESTER

Back 370

chromosome abnormalities

note: in the first WEEKS, it's usually due to low progesterone levels

Front 371

what is the most common cause of recurrent miscarriage in the SECOND TRIMESTER

Back 371

bicornuate uterus

Front 372

the HELLP syndrome of pregnancy refers to

Back 372

Hemolysis
Elevated LFTs
Low Platelets

Front 373

A woman suffers from HTN during her pregnancy. Why is it important to know the timing of when this is occuring?

this is assuming that she never had preexisting HTN problems

Back 373

Preeclampsia (HTN, edema, proteinuria) usually happens AFTER 20 WEEKS.
If a preggie is having HTN before 20 weeks, something else is up, usually a hytatidiform mole

Front 374

what is a possible etiology of preeclampsia

Back 374

placental ischemia due to lack of trophoblastic invasion of spiral arteries in myometrium

Front 375

what is given as pharmacotherapy for preeclampsia?

Back 375

IV Mg sulfate and diazepam
- ideal treatment is to deliver ASAP but that's depends on where she is in gestation
- also bed rest, salt restriction, and tx of HTN

Front 376

what are the 2 anti-HTN meds that you can give to preggies?

Back 376

hydralazine- dilator (but can cause SLE like syndrome)
methyldopa- α2 agonist

Front 377

a prior C section can predispose you to this pregnancy complication

Back 377

placenta accreta
-defective decidual layer allows placenta to attach to myometrium
- massive bleeding after delivery
- impaired placental separation after delivery

can also predispose you to placenta previa
- attachment of placenta to lower uterine segment
-PAINLESS bleeding

Front 378

which gynecological cancer has the worst prognosis

Back 378

ovarian (then cervical then endometrial)

incidence: endometrial then ovarian then cervical

Front 379

↑ LF/FSH ratio
↑ testosterone

if a woman has these labs, what does she likely have

Back 379

polycystic ovarian syndrome
- ↑LH production leads to anovulation and hyperandrogenism
-enlarged bilateral cystic ovaries
findings:
amenorrhea, infertility, hirsutism, obesity, insulin resistance (↑ risk of DM)

tx: BC, gonadotropin analogs, clomiphene, surgery

Front 380

follicular cyst

Back 380

distention of unruptured graafian follicle. may be associated with hyperestrinism and endometrial hyperplasia

Front 381

corpus luteum cyst

Back 381

hemorrhage into persisten corpus luteum, menstrual irregularity

Front 382

theca-lutein cyst

Back 382

due to gonadotropin stimulation
bilateral
**associated with choriocarcinoma & moles

Front 383

this germ cell tumor often appears in the sacrococcygeal area of young children

Back 383

endodermal sinus tumor (yolk sac tumor)
- ↑ AFP, maligant
- schiller-duval bodies (glomeruloid structures)

Front 384

this monodermal teratoma contains functional thyroid tissue and can present as hyperthyroidism

Back 384

struma ovarii

Front 385

what the hell is pseudomyxoma peritonei?

Back 385

it's an intraperitoneal accumulation of mucinous material from a mucinous cystadenocarcinoma

Front 386

this benign tumor can look like bladder epithelium

Back 386

Brenner tumor

Front 387

What is Meig's syndrome?

Back 387

triad of:
ovarian fibroma
ascites
hydrothorax
- pulling sensation in the groin

Front 388

this vaginal carcinoma effects girls < 4 yrs of age and has spindle shaped tumor cells that are desmin (+)

Back 388

sarcoma botryoides

Front 389

what is the single most important prognostic factor in breast cancer?

Back 389

axillary node involvement

other indicators:
estrogen/progesterone receptor (+)= better prognosis
hyperexpression of erb-B2 (HER-2)- poor prognosis

Front 390

What are the 4 main types of fibrocystic disease?

these changes occur in women > 30 yrs of age

Back 390

1. fibrosis- hyperplasia of breast stroma
2. cystic- fluid filled, **BLUE DOME cyst**
3. sclerosing adenosis- proliferation of small ducts (acini) and intralobular fibrosis
4. **epithelial hyperplasia**- ↑ in # of epithelial cell layers in terminal duct lobule. ↑ risk of carcinoma with ATYPICAL CELLS

Front 391

↑ total PSA, ↑ free PSA

Back 391

benign prostatic hyperplasia

Front 392

↑ total PSA, ↓ free PSA, ↑ PAP (prostatic acid phosphatase)

Back 392

prostatic adenocarcinoma
most often in posterior lobe
metastasis to bone (pt complain of low back pain, ↑ ALP)

Front 393

reinke crystals should make you think of..

Back 393

leydig cell tumor
-benign
- secretes testosterone (precocious puberty in boys, gynecomastia in men)

Front 394

what are the 3 tunica vaginalis lesions?
all can be transilluminated (vs. testicular tumors)

Back 394

1. varicocele- dilated veins in pampiniform plexus- can cause infertility

2. hydrocele- ↑ fluid due to imcomplete fusion of tunica (*when it doesn't fuse at all you get congenital inguinal hernia)

3. spermatocele- dilated epididymal duct (communication between epididymis & tunica vaginalis)

Front 395

penis carcinoma: bowen's disease

Back 395

gray, SOLITARY, crusty plaque on shaft of penis/scrotum
not to be confused with

bowenoid disease- mutliple papular lesion

Front 396

penis carcinoma it situ- erythroplasia of queyrat

Back 396

red velvety plaques on penis

Front 397

when disease causes a bent penis due to acquired fibrous tissue formation

Back 397

peyronie's disease

"i know a guy named peyronie with a bent penis)

Front 398

which 2 amino acids are required during periods of growth?

Back 398

arginine and histidine

Front 399

muscles of inspiration during exercise

Back 399

external intercostals
scalene muscles
sternomstoids

Front 400

muscles of expiration during exercise

Back 400

internal/external obliques
rectus abdominus
transversus abdominus
internal intercostals

Front 401

most common cause of LOBAR pneumonia

Back 401

pneumococcus
- intra-alveolar exudate produces consolidation in the lung

Front 402

2-3 days after a subarachnoid hemorrhage, what therapy should you give a person?

Back 402

calcium channel blocker b/c there is a risk of vasospasm

Front 403

which lung adenocarcinoma is NOT associated with smoking?

Back 403

bronchioalveolar
- can present like pneumonia

Front 404

what causes duodenal atresia

Back 404

failure of recanalization of the the smal bowel
- polyhydraminos in pregnancy
- BILIOUS vomiting b/c bile is still able to enter the duodenum

Front 405

What class of drugs should you not give to a patient that suffers from GERD

Back 405

bisphosphonates
etidronate, pamidronate, alendronate, risedronate
- used

Front 406

what obstetric complication is associated with cocaine use

Back 406

abruptio placenta

Front 407

what 2 drugs should be used for cyanide poisoning?

Back 407

nitrites- oxidize hemoglobin to methhemoglbin, which binds cyanide and will thus allow cytochrome oxidase to function. Cyanide inhibits cytochome oxidase and therefor inhibits electron transport

also use thiosulfate b/c it binds cyanide and becomes thiocyanate, which is renally excreted

Front 408

a defect in the BMPR2 gene is associated with what condition?

Back 408

primary pulmonary hypertension

Front 409

what drug can be used to prevent altitude sickness

Back 409

acetazolamide
- it increases renal excretion of bicarbonate. this helps compensate for the respiratory alkalosis one gets at high altitude

Front 410

when is surfactant most abundantly made by type 2 pneumocytes

Back 410

after the 35th week

Front 411

name all the causes of acute (adult) respiratory distress syndrome

Back 411

DIC
sepsis
shock
gastric aspiration
uremia
acute pancreatitis
amniotic fluid embolism

Front 412

keratin pearls and intercellular bridges in lung pathology are indicative of

Back 412

squamous cell carcinoma of the lung

Front 413

which lung cancer develops in a prior site of inflammation

Back 413

brochial adenocarcinoma

Front 414

which lung cancer can lead to lambert eaton syndrome (autoantibodies against Ca channels)?

Back 414

small (oat) cell carcinoma
- most malignant, worst prognosis
- ectopic secretion of ADH/ACTH

Front 415

in addition to causing atypical pneumonia, what other problems is legionella associated with?

Back 415

it can also infect the kidney and cause interstitial nephritis leading to ↓ renin production from damage to the JGA apparatus. this can lead to hyponatremia

Front 416

top 3 causes of transitional cell carcinoma

Back 416

1. SMOKING
2. aniline dye ingestion
3. cyclophosphamide

chronic phenacitin use

in urine you see RBCs but no RBC casts