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166 Cards in this Set
- Front
- Back
Drug class:
Nortriptyline |
TCA
|
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Drug class:
Selegiline |
MAOI but not used as antidepressant
|
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Drug class:
Bupropion |
NDRI--DA reuptake inhibitor
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Drug class:
Mirtazapine |
Tetracyclic antidepressant
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Drug class:
Fluvoxamine |
SSRI
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Drug class:
Doxepin |
TCA
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Drug class:
Phenelzine |
MAOI
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Drug class:
Fluoxetine |
SSRI
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Drug class:
Clomipramine |
TCA
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Drug class:
Imipramine |
TCA
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Drug class:
Amitryptyline |
TCA
|
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Drug class:
Milnacipran |
SNRI--NE reuptake inhibition
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Drug class:
Desipramine |
TCA
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Drug class:
Sertraline |
SSRI
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Drug class:
Venlafaxine |
SNRI--NE reuptake inhibition
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Drug class:
Paroxetine |
SSRI
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Drug class:
Tranylcypromine |
MAOI
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Drug class:
Duloxetine |
SNRI--NE reuptake inhibition
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Drug class:
Citalopram |
SSRI
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Drug class:
Desvenlafaxine |
SNRI--NE reuptake inhibition
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Drug class:
Trazodone |
Tetracyclic Antidepressant
|
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How does the drug dose response curve change with addition of a competitive agonist compared to a noncompetitive agonist?
Effects on Km, Vmax, efficacy, potency. |
Competitive-->right shift; inc Km-->dec potency
Noncomp-->Shift curve down; dec'd Vmax; change in efficacy, not potency. |
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Worst headache of my life
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SAH (berry aneurysm(
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Waxy cast in urine
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Stasis of urine flow caused by end-stage renal dz
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Neuropathy
AV nodal block |
Stage 2 Lyme Dz
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Port-wine stain in ophthalmic division of trigeminal nerve
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Sturge-Weber Syndrome
|
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Urethritis
Conjunctivitis Arthritis |
Can't see
Can't pee Can't climb a tree Reiter's Syndrome--HLAB27 |
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Lack of GpIIb/IIIa
Platelet defect Prolonged bleeding |
Glanzmann's Thrombostenia
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Painless jaundice
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Panc Ca in head of pancreas
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Nerve affected:
Injury to shaft of humerus |
Radial
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Nerve affected:
Injury to surgical neck of humerus |
Axillary
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Nerve affected:
Injury to supracondyle of humerus |
Median
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Nerve affected:
Injury to medial epicondyle of humerus |
Ulnar
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Nerve affected:
Injury to anterior shoulder |
Axillary
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Nerve affected:
Injury to carpal tunnel |
Median
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What are the phagocyte immunodeficiencies?
|
Chronic Granulomatous Dz
Chediak-Higashi Leukocytic def syndrome Job's syndrome (hyper IgE) |
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What are the x-linked immunodeficiencies?
|
WBC
Wiskott-Aldrich Bruton's agammaglobinemia Chronic granulomatous Dz Hyper IgM syndrome |
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Which personality disorder:
Excessive need to be taken care of Submissive Clinging |
Dependent
|
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Which personality disorder:
Low self-confidence Fears separation, losing support |
Dependent
|
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Which personality disorder:
Grandiosity Feelings of entitlement Lack of empathy |
Narcissistic
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Which personality disorder:
Suicide attempts Unstable mood and behavior |
Borderline
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Which personality disorder:
Sense of emptiness and loneliness Impulsiveness |
Borderline
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Which personality disorder:
Odd appearance, thoughts, behavior No psychosis Social awkwardness |
Schizotypal
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Which personality disorder:
Controlling Perfectionist Orderly Stubborn Indecisive |
Obsessive Compulsive
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Which personality disorder:
Criminality Unable to conform to social norms Disregard for others' rights |
Antisocial
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A small study of USMLE test takes for a school revealed scores of 225, 225, 225, 229, 230, 240, and 250, with an average of 232.
What is the mean, median, and mode for these values? Would this create a positively skewed curve or a negatively skewed curve? |
Mean = 232
Median = 229 Mode = 225 Mean > median and mode; thus, positively skewed curve (to right?) |
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Identify cell:
CD4 |
Helper T cells
|
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Identify cell:
CD14 |
Macs
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Identify cell:
CD16 |
NKCs and Macs
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Identify cell:
CD19 |
B cells
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Identify cell:
CD3 |
All T cells, not NKCs
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Identify cell:
CD8 |
Cytotoxic T cells
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Hallmark features:
Autism |
<IQ
Poor comm/social skills Repetitive behaviors |
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Hallmark features:
Rett's disorder |
FEMALES only (X-linked dominant-->males die in utero)
Smaller head circumference Hand wringing |
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Hallmark features:
Asperger's syndrome |
Normal IQ
poor social skills |
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Sonic Hedgehog Gene:
Location Role |
Base of limbs in zone of polarizing activity
Involved in patterning along anterior-posterior axis Mediates ectodermal fns |
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Wnt-7 gene:
Location Role |
Produced at ectoderm at DISTAL end of each developing limb
Necessary for organization along dorsal-ventral axis (limb lengthening) |
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Homeobox gene:
Role |
Segmental organization in craniocaudal direction
|
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Mutation to HOXD-13:
Effects |
HOXD-13 is a homeobox gene (segmental organization in craniocaudal direction)
Mutation to this gene-->synpolydactyly (extra fused digit between 3rd/4th fingers) |
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Embryologic rule of 2's
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2nd week of development:
2 germ layers (bilaminar disk): epiblast, hypoblast 2 cavities: amniotic cavity, yolk sac 2 components to placenta: cytotrophoblast, syncytiotrophoblast |
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Embryologic rule of 3's
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3rd week of dev't:
3 germ layers (gastrula): ectoderm mesoderm endoderm |
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Embryologic rule of 4's
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4th week of development:
4 heart chambers 4 limb buds |
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When is folic acid critical to embryonic development?
|
Within first 6 weeks of pregnancy; this is when neural tube forms and seals
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When are embryos most susceptible to teratogens?
Why? |
Weeks 3-8 (embryonic period)
This is when organogenesis occurs; after Week 8, it's just growth. |
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Rathke's Pouch:
What does it become? Germ layer? |
Adenohypophysis-->Anterior pituitary
Surface ectoderm |
|
Surface ectoderm:
What does it become? |
Adenohypohysis from Rathke's pouch
Lens of eye Oral cavity lining Epidermis Salivary, sweat, mammary glands |
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Neuroectoderm:
What does it become? |
Brain (neurohypohysis--POSTERIOR pituitary), CNS neurons, oligos, astrocytes, ependymal cells, pineal gland)
Retina SC |
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Neural crest ectoderm:
What does it become? |
PNS
Non-neural structures nearby (ANS, dorsal root ganglia, cranial nerves, adrenal cells) Pia, arachnoid Bones of skull Teeth (CREST toothpaste) SPIRAL septum of heart |
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This is a Rathke's pouch tumor.
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Craniopharyngioma
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Endoderm:
Derivatives |
Gut tube epithelium, lungs, liver, pacnreas, thmus, parathy
|
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Mesoderm:
Derivatives |
Muscle, bone, connective tissue
Serous linings of body cavities SPLEEN CV structures GU |
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Mesodermal defects
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VACTERI
Vertebral defects Anal atresia Cardiac defects Tracheo-Esophageal fistula Renal defects Limb defects (bone, muscle( |
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Deformation vs Malformation
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Deformation--extrinsic disruption; occurs after embryonic period
Malformation--intrinsic disruption; occurs during embryonic period (weeks 3-8) |
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Agenesis vs Aplasia
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Agenesis = absent organ due to absent primordial tissue
Aplasia = absent organ despite present primordial tissue |
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What is hypoplasia?
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Incomplete organ dev't, primordial tissue present
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What is the "all-or-none" effect of embryogenesis?
When does it occur? |
If ingest teratogen before week 3, won't see developmental defects.
All = miscarriage None = no developmental defects |
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Describe facies of fetal alcohol syndrome.
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Smooth philtrum
Thin upper lip Flat nasal bridge |
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Aminoglycosides:
Effect on fetus |
CN VIII toxicity
|
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ACE inhibitors:
Effect on fetus |
Renal damage
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Thalidomide:
Effect on fetus |
Limb defects (hand connected directly to shoulder)
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Carbamazepine:
Effect on fetus |
Inhibition of intestinal folate absorption
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Valproate:
Effect on fetus |
Inhibition of intestinal folate absorption
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Vitamin A:
Effect on fetus |
Vitamin A = retinoic acid = Retin-A!!
SPontaneous abortions Cleft palate, cardiac abnlts |
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Warfarin:
Effect on fetus |
Bone deformities
Fetal hemorrhage |
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When would embryonic division occur to form:
Diamnotic/dichorionic placentation |
Prior to morula--within 3 days of fertilization; will have separate amnion and placenta
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When would embryonic division occur to form:
Diamniotic/monochorionic placentation |
Division occurs 4-8 days post-fertilization (blastocyst)
Will have 2 amniotic sacs, 1 placenta |
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When would embryonic division occur to form:
Monoamniotic/monochorionic placentation |
Division occurs 8-12 days after fertilization (epiblast/hypoblast)
1 amniotic sac, 1 placenta |
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Cord entanglement of twins is suggestive of _______.
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monoamnionicity
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One yolk sac and 2 fetal poles is suggestive of ______.
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monoamnionicity
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Amniocentesis vs Chorionic Villous Sampling:
Timing Benefits/Risks |
Amniocentesis: 15-17 weeks for genetic evaluation; 0.5% fetal loss
Chorionic villous sampling: 10-12 weeks; 1% fetal loss, limb defects if <9 weeks Gives you genetic info re: baby sooner, but it's riskier than amnio |
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This cell secretes hCG.
|
syncytiotrophoblast
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hCG is structurally similar to ____.
How? |
LH
FSH TSH all share same alpha-subunit |
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How many and function:
Umbilical artery Umbilical vein |
Umbilical arteries--there are 2; they return deoxygenated blood to placenta
Umbilical vein--just 1; supplies oxygenated blood from placenta to fetus, drains into IVC |
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Single umbilical artery is associated with ______.
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Congenital renal problems (do an u/s)
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Urachus:
Origin Function Lack of obliteration results in? |
allantois-->urachus (duct between bladder and yolk sac)
Failure to obliterate-->patent urachus--urine discharge from umbilicus OR -->vesicourachal diverticulum (outpouching of bladder) |
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Vitelline duct:
Role Associated defect |
Role: connects yolk sac to midgut lumen
If fail to obliterate-->vitelline fistula: meconium discharge from umbilicus (Meckel's diverticulum) |
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Truncus arteriosus:
Pathophys What should normally happen? |
Neural crest migration-->ridges spiral and fuse to form aorticopulmonary septum-->formation of ascending aorta and pulmonary trunk
Pathophys (truncus arteriosus): Transposition of great vessels (failure to spiral)--aorta ends up on RIGHT of PA (bad!!) Tetralogy of Fallot Persistent Truncus Arteriosus |
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Outline the pathway by which the cardiac ventricles and their outflow tracts are separated.
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Muscular ventricular septum forms to separate ventricles
Truncoconial swellings (ridges) of truncus arteriosus meets, fuse, and zip (superiorly and inferiorly) to form spiral septum (aorticopulmonary septum) Inferior portion of spiral septum meets muscular ventricular septum to divide ventricles and form aorta/pulmonary aa |
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Outline the pathway by which the heart tube forms the atria of the four-chambered heart.
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Heart tube grows, elongates, folds into S-shape.
Ventricles are in anterior part of S. Atrial chamber grows, incorporates SVC and PV Septum primum-->septum secundum (incompletely forms--leaving FORAMEN OVALE) Cell death in septum primum-->ositum secundum |
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What embryonic structure divides the left and right atria?
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Septum primum and septum secundum
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How is blood shunter from RA to LA in embryo?
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Through foramen ovale of septum secundum and ostium secundum of septum primum
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Where does fetal erythropoiesis occur? Provide chronological order.
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Young Liver Synthesizes Blood
Yolk Sac (weeks 3-8) Liver (6-30 weeks) Spleen (9-28 weeks) BM (28 weeks onward) |
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Which bones synthesize blood cells?
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Sternum
Pelvis Ribs Tibia, Femur (Long bones) Skull bones |
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Describe pathway of fetal circulation.
|
UV-->Ductus Venosus (bypass liver to IVC)-->IVC
-->RA--> Majority to LA via FO-->LV-->Aorta-->brain + body Some to RV-->PA-->Lungs BUT Ductus Arteriosus will shunt it to aorta-->Systemic circuln Deox'd blood-->Fetal internal iliac aa-->Umbilical arteries-->Placenta |
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What changes occur in fetal circulation occur after birth?
Describe each change. |
1) Infant takes a breath-->dec'd resistance in pulm vasculature-->inc'd LA pressure vs RA pressure (FO closes; now called fossa ovalis)
-Inc'd O2-->dec'd PGs-->closure of Ductus Arteriosus |
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Why is indomethacin given to neonates?
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Indomethacin = NSAID; helps to reduce PGs to close ductus arteriosus.
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What are the derivates of the aortic arch (1st-6th)?
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1st--MAXIMAL; maxillary artery
Second = Stapedial and hyoid aa Third = C is third letter of alphabet-->Carotid artery 4th--4 limbs!--systemic circuln; on left: aortic arch, on right: proximal right subclavian artery (there is no 5th) 6th arch: pulmonary aa and (on left only) ductus arteriosus |
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Which developmental structure:
Supplies oxygenated blood to fetus |
Umbilical Vein
|
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Which developmental structure:
Removes nitrogenous waste from fetal bladder |
Urachus
|
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Which developmental structure:
Fetal placental structure that secretes hCG |
Syncytiotrophoblast
|
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Which developmental structure:
Maternal component of placenta |
decidua basalis
|
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Which developmental structure:
Returns deoxygenated blood from fetal internal iliac aa |
Umbilical aa
|
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Which embryologic structure of heart gives rise to:
Ascending aorta and pulmonary trunk |
Truncus arteriosus
|
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Which embryologic structure of heart gives rise to:
Coronary sinus |
Left horn of sinus venosus
|
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Which embryologic structure of heart gives rise to:
SVC |
Right common cardinal vein
Right anterior cadinal vein |
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Which embryologic structure of heart gives rise to:
Smooth parts of LV and RV |
Bulbus cordius
|
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Which embryologic structure of heart gives rise to:
Smooth part of RA |
Right horn of sinus venosus
|
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Which embryologic structure of heart gives rise to:
Trabeculated parts of LA and RA |
Primitive atria
|
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Trabeculated parts of LV and RV
|
Primitive ventricle
|
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What structure divides the truncus arteriosus into the aortic and pulmonary trunks?
Cellular origin? |
Spiral septum (aorticopulmonary septum)
Neural crest origin |
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Which fetal vessel has the highest oxygenation?
|
UV
|
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What is early shunt?
Causes? |
Early cyanosis is caused by right-to-left shunt; seen in new borns ("blue babies")
Causes: 5T's Tetralogy of Fallot Transposition of great vessels Truncus arterosus Tricuspid atresia Total anomalous pulmonary venous return (TAPVR) |
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Components of tetralogy of Fallot.
|
PROVe:
1- pulmonary stenosis (most impt determinant for prognosis) 2- RVH 3- Overriding aorta (overrides VSD) 4- VSD Early cyanosis caused by inc'd pressure caused by stenotic pulmonic valve. |
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Boot-shaped heart on x-ray
|
Due to RVH; seen in tetralogy of fallot
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Transposition of great vessels:
What is it? When is this compatible with life? |
Aorta leaves RV (anterior) and pulmonary trunk leaves LV (posterior)-->separation of pulmonary and systemic circulations
Only compatible with life if there's a shunt present (VSD, PDA, patent FO) Needs surgical intervention. |
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What is tricuspid atresia?
|
Absence of tricuspid valve, hypoplastic RV.
Need ASD AND VSD for viability-->right to left shunt-->blue baby (early cyanosis) |
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What is late cyanosis?
Causes? |
Late cyanosis = blue kids
LEFT TO RIGHT SHUNT VSD--most common ASD PDA Note: early cyanosis = RIGHT TO LEFT SHUNT |
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Why do late cyanotics take so long to present?
|
Uncorrected VSD, ASD, PDA causes compensatory vascular hypertrophy-->pulmonary HTN
As pulm resistance increases, shunt reverses from L-->R to R-->L, causing late cyanosis (clubbing, polycythemia) |
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HTN in upper extremities
Weak pulses in lower extremities |
Coarctation of aorta
|
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What is coarctation of the aorta?
Infantile vs adult type |
Infantile: aortic stenosis (narrowing) proximal to insertion of ductus arteriosus
TURNER SYNDROME Adult type: Aortic stenosis distal to ligamentum arteriosum (remnant of DA). Leads to HTN in upper extrem's, weak pulses in lower extrem's. Can result in aortic regurgitation. |
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Cardiac defect:
22q11 syndrome |
Persistant truncus arteriosus
Tetralogy of Fallot (DiGeorge!!!!) |
|
Cardiac defect:
Trisomy 21 |
ASD
VSD AV septal defect (endocardial cushion defect) |
|
Cardiac defect:
Turner Syndrome |
Coarctation of aorta (preductal)
|
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Cardiac defect:
Marfan's Syndrome |
Aortic insufficiency (late complicaiton)
|
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Cardiac defect:
Infant of diabetic mother |
Transposition of great vessels
|
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45 year-old male presents with BP of 160/90 on right arm, 170/92 on left arm
No palpable pulses in feet/ankle Diagnosis. |
Aortic coarctation
|
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Describe blood flow through patent ductus arteriosus.
|
Blood flow from pulm artery to aorta, bypassing pulm circuln
|
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List subregions and derivatives for:
Mesencephalon Prosencephalon Rhombencephalon |
Prosencephalon:
Telencephalon-->cerebral hemispheres, lateral ventricles Diencephalon-->Thalami, hypothal, optic tracts, 3rd ventricle Mesencephalon-->Midbrain, cerebral aqueduct Rhombencephalon: Metencephalon-->Pons, cerebellum, 4th ventricle Mycencephalon-->Medulla |
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What lab tests indicate neural tube defects?
|
Inc'd alpha-fetoprotein and ACh-E in CSF
|
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Branchial apparatus:
Arches vs Clefts vs Pouches--germ layer type, list in order (inside to outside or outside to inside) |
CAP (outside to inside):
Clefts = ectoderm Arches = mesoderm Pouches = endoderm |
|
Branchial clefts:
What does each develop into? |
1st cleft-->external auditory meatus
2nd-4th-->temporary cervical sinuses (later obliterated) |
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A persistent cervical sinus results in _______.
|
Branchial cleft cyst within lateral neck
|
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Branchial arch derivates
|
1-M's, T's--Mandible, malleus incus, muscles of MASTICATION, mylohyoid
2-S's--Stapes, styloid process, stylohyoid 3-Pharyngeal--stylopharyngeus 4th: cricothyroid 6th: everything in larynx except cricothyroid |
|
Branchial pouch derivatives
|
1st: middle ear
2nd: palatine tonsil 3rd: INFERIOR PARATHY 4th: SUPERIOR PARATHY Note 4th ends up being more superior than 3rd! |
|
Embryologic pathophys of DiGeorge Syndrome
|
Aberrant dev't of 3rd and 4th branchial pouches
|
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Describe the development of the thyroid.
|
Thyroid diverticulum arises from floor of pharynx, descends (drops) into neck
Connected to tongue by thyroglossal duct, which normally disappears (remnant = foramen cecum) |
|
What is the foramen cecum?
|
Remnant of thyroglossal duct
|
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What is the most common ectopic site of thyroid tissue?
|
Tongue
|
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Midline neck mass
Moves with swallowing |
Thyroglossal duct cyst
|
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What spinal nerves innervate the diaphragm?
|
C3,4,5 keep the diaphragm alive
|
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Monozygotic twins:
One is pale with HCT of 15% Other is flushed with HCT of 55% Cause? |
Twin-twin transfusion syndrome--shared umbilical cord/placenta, one twin received more blood than other twin
|
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Cleft-lip:
Which embryonic process failed? |
Failure of fusion of maxillary and medial nasal processes
|
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What nerves innervate the branchial arches?
|
1st arch (Ms and Ts): Maxillary, mandibular division of trigeminal nerve
2nd arch - Facial nerve 3rd arch - Glossopharyngeal nerve 4th and 6th--Vagus and superior laryngeal |
|
Which branchial pouch:
Middle ear, eustachian tubes |
1st
|
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Which branchial pouch:
Superior parathyroids |
4th
|
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Which branchial pouch:
Inferior parathyroids |
3rd
|
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Which branchial pouch:
Epithelial lining of palatine tonsil |
2nd
|
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Which branchial pouch:
Thymus |
3rd
|
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Which cranial nerve:
Taste in anterior 2/3 tongue |
Facial
|
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Which cranial nerve:
Taste in posterior 1/3 tongue |
Glossopharyngeal
|
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Which cranial nerve:
Motor function of tongue |
Hypoglossal
|
|
Which cranial nerve:
Sensation in anterior 2/3 tongue |
Mandibular of Trigeminal
|
|
Which cranial nerve:
Sensation in posterior 1/3 tongue |
Glossopharyngeal
|
|
What abnormalities are often found with Arnold-Chiari malformation?
|
Hydrocephaly
Syringomyelia Myelomeningocele |
|
Classic presenting symptoms of syringomyelia.
|
b/l loss of pain and temp sensation in upper extremity
Weakness and atrophy of hand mm |
|
How does presentation of a branchial cleft cyst differ from that of a thyroglossal duct cyst?
|
Branchial cleft cyst--lateral neck
Thyroglossal cyst--midline neck, moves with swallowing |