First Aid Funfacts

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ACE Inhibitors (teratogen effect)
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Renal damage
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Alkylating agents (teratogen effect)
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Absence of digits, multiple anomalies
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Aminoglycosides (teratogen effect)
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CN VIII toxicity (A mean guy hit the baby in the ear)
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Carbamazepine (teratogen effect)
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Neural tube defects, craniofacial defects, fingernail hypoplasia, developmental delay, IUGR
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Diethystilbestrol (DES) (teratogen effect)
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Vaginal clear cell adenocarcinoma, congenital Mullerian anomalies (T shaped uterus)
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Folate antagonists (teratogen effect)
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NTDs
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Lithium (teratogen effect)
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Ebstein’s anomaly (atrialized right ventricle)
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Phenytoin (teratogen effect)
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Fetal hydantoin syndrome: microcephaly, dysmorphic craniofacial features, hypoplastic nails and distal phalanges, cardiac defects, IUGR, mental retardation
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Tetracyclines (teratogen effect)
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Discolored teeth, growth retardation
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Thalidomide (teratogen effect)
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Limb defects (flipper limbs)
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Valproate (teratogen effect)
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Inhibition of maternal folate absorption (NTDs)
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Warfarin (teratogen effect)
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Bone deformities, fetal hemorrhage, abortion, ophthalmologic abnormalities (use HEPARIN in pregnancy!!)
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Alcohol (teratogen effect)
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Fetal alcohol syndrome *leading cause of birth defects and mental retardation
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Cocaine (teratogen effect)
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Abnormal fetal development and fetal addiction, placental abruption, renal a genesis, heart defects
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Smoking (teratogen effect)
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Preterm labor, placental problems, IUGR, ADHD
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Iodide (teratogen effect)
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Congenital goiter or hypothyroidism (cretinism)
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Maternal diabetes (teratogen effect)
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Caudal regression syndrome (anal atresia to sirenomelia- legs fused together “mermaid syndrome”), congenital heart defects, NTDs, hypertrophic CM, macrosomia, hypoglycemia
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Vitamin A (teratogen effect)
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Extremely high risk for spontaneous abortions and birth defects (cleft palate, cardiac abnormalities)
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X-rays (teratogen effect)
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Microcephaly, mental retardation
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Bugs that stain with Giemsa
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Chalmydia, Borrelia, Rickettsia, Trypanosomes, Plasmodium (Certain bugs really try my patience)
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Bugs that stain PAS+
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Stains glycogen, mucopolysaccharides- used to diagnose Whipples disease (Tropheryma whipplei)
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Bugs that stain Ziehl-Neelson (carbol fuschion)
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Acid-fast organisms (Nocardia, Mycobacterium)
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Bugs that stain with India Ink
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Cryptococcus neoformans (mucicarmine can also be used to stain thick polysaccharide capsule red)
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Bugs that stain with silver stain
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Fungi (PCP), Legionella, H. pylori
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What bug needs chocolate agar with factors V (NAD+) and X (hematin)
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H. influenza
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What bug needs Thayer-Martin (VPN) media?
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N. gonorrhea, N. meningitidis (VPN- vancomycin inhibits gram positives, Polymyxin inhibits most gram negs, Nystatin inhibits fungi)
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What bug needs Bordet-Gengou (potato) agar?
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Bordetella pertussis (BORDET needs BORDET)
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What bug needs Tellurite plate or Lofflers media?
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Corynebacterium diptheria (Cysteine-Tellurite agar – forms black colonies)
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What bug needs Lowenstein-Jensen agar?
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M. Tb
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What bug needs Eaton’s agar?
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M. Pneumoniae
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What bugs form pink colonies on MacConkeys agar?
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Lactose-fermenting enterics (E. Coli, etc)
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What bug can grow on eosin-methylene blue (EMB) agar as green colonies with metallic sheen?
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E. Coli
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What bug grows on charcoal yeast extract buffered with cysteine and iron?
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Legionella
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What bug grows on Sabouraud’s agar?
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Fungi (Sab’s a FUN guy?)… never heard of a guy named Sab
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Encapsulated bacteria
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Strep pneumo, H. influenza type B, Neisseria meningitidis, E. Coli, Salmonella, Klebsiella pneumo, group B strep (SHiNE SKiS) Capsules = ANTIPHAGOCYTIC virulence factor opsonized and cleared by spleen, increased risk in asplenic patients
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Catalase + organisms
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Pseudomonas, Listeria, Aspergillus, Candida, E. coli, Staph aureus, Serratia *increased risk in chronic granulomatous disease (NADPH oxidase deficiency) You need PLACESS for your CATs
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Bacteria producing Protein A
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Staph aureus (prevents opsonization), binds Fc portion of Ig
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Bacteria producing IgA protease?
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Strep pneumo, H influenza type B, Neisseria (SHiN) enzyme cleaves IgA
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Bacteria producing M protein
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Group A strep prevents phagocytosis
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Conjugated vaccines
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Strep pneumo, Neisseria, H. influenza *conjugate to diptheria toxin or tetanus toxin
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Bacteria that inhibit protein synthesis with exotoxin against EF-2
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Corynebacterium diptheria Pseudomonas aeruginosa
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Bacteria that inhibit protein synthesis by inactivating the 60S ribosome
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Shigella EHEC (shiga like toxin)
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Bacteria that increase fluid secretion via exotoxins
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ETEC (heat labile LT toxin) over activates cAMP (inc. Cl- secretion), ST toxin over activates cGMP (decrease NaCl reabsorption) Bacillus anthracis (edema factor) – increases cAMP Vibrio cholerae (cholera toxin)- increases cAMP
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Bacteria that use exotoxin to inhibit phagocytosis
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Bordatella pertussis (Pertussis toxin)- increase cAMP, disables Gi, impairs phagocytosis
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Bacteria that inhibits release of NT via exotoxin
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Clostridium tetani (Tetanospasmin)- prevents release of inhibitory GABA leading to muscle rigidity and lock jaw Clostridium botulinum (botulinum toxin)- prevents release of ACh leading to flaccid paralysis
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Bacteria that use exotoxin to lyse cell membranes
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Clostridium perfringens (Alpha toxin, lecithinase)- phospholipase degrades cell membranes Strep pyogenes (streptolysin O)- degrades cell membranes, lyses RBCs
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Bacteria that use super antigens to cause shock
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Staph aureus (TSST-1)- bring MHC class II and TCR in proximity causing overwhelming release of IFNgamma and IL-2 (toxic shock syndrome, scalded skin syndrome (exfoliatin), food poisoning (enterotoxin) Strep pyogenes (exotoxin A)- same mechanism, causes toxic shock syndrome
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What endocrine hormones use cAMP signaling pathway?
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FLAT ChAMP FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2), MSH, PTH Calcitonin, GHRH, glucagon
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What endocrine hormones use cGMP signaling pathway?
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ANP, NO (EDRF) **think vasodilators
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What endocrine hormones use IP3 signaling pathway?
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GGOAT GnRH, GHRH (sometimes), Oxytocin, ADH (V1), TRH, histamine (H1), ATII, gastrin *also alpha1-rec, M1 and M3 (HAV 1 M&M)
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What endocrine hormones use steroid receptor signaling pathway?
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Vitamin D, Estrogen, Testosterone, T3/T4, Cortisol, Aldosterone, Progesterone *VETTT CAP
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Nuclear receptors
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Thyroid hormone, Retinoids, PPAR, Fatty acids
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Cytoplasmic receptors
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Steroids, Androgens, Estrogen
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What endocrine hormones use intrinsic tyrosine kinase signaling pathway?
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Insulin, IGF-1, FGF, PDGF, EGF **MAP-Kinase pathway (think growth factors)
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What endocrine hormones use receptor-associated tyrosine kinase signaling pathway?
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Prolactin, Immunoglobulins (cytokines IL2, IL6, IL8, IFN), GH **Jak-STAT pathway (PIG)
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What adrenergic receptors use Gi signaling?
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M2, alpha2, D2 (MAD 2’s) *Decreased cAMP
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What adrenergic receptors use Gq signaling?
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H1, alpha1, V1, M1, M3 (HAV 1 M&M) *IP3 mechanism
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What adrenergic receptors use Gs signaling?
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B1, B2, D1, H2, V2 *Increased cAMP
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Thyroid receptor
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thyroxine-binding globulin (TBG) and it has a nuclear receptor
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Hashimotos thyroiditis is associated with:
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Hypothyroidism Ab against thyroid peroxidase, antithyroglobulin Ab HLA-DR5 Hurthle cells, lymphocytic infiltrate, germinal center Increased risk B cell lymphoma
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Cretinism associated with:
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5 P’s Pot-belly, puffy face, pale, protruding umbilicus, protuberant tongue (severe fetal hypothyroidism)
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Subacute (de Quervains) thyroiditis is associated with:
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Self-limited hypothyroidism following flu-like illness *Granulomatous inflammation *PAINFUL, inc. ESR, jaw pain
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Reidels thyroiditis is associated with:
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Hypothyroidism due to replacement by fibrous tissue *PAINLESS + antithyroid peroxidase Ab
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Graves disease associated with:
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Autoimmune hyperthyroidism Thyroid-stimulating Ig, opthalmopathy, pretibial myxedema *HLA-B8, Dr3
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Papillary thyroid carcinoma
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Most common thyroid cancer Empty-appearing nuclei (orphan annie) Psammoma bodies Nuclear grooves *EXCELLENT PROGNOSIS
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Follicular thyroid carcinoma
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Uniform follicles WITH INVASION through capsule Can spread hematogenously to lung/bone
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Medullary thyroid carcinoma
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From parafollicular “c” cells Produces calcitonin Sheets of cells in amyloid stroma Associated with MEN 2A and 2B
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Undifferentiated/anaplastic thyroid carcinoma
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Most malignant, very aggressive, worst prognosis Universally FATAL
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Hot thyroid nodules
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Graves, toxic goiter (rarely malignant)
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Cold thyroid nodules
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cyst, adenoma, cancer
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Thyroglobulin
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Marker for papillary and follicular thyroid cancer
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Pseudohypoparathyroidism
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Albright’s hereditary osteodystrophy AD, kidney unresponsiveness to PTH Hypocalcemia, short 4th/5th digits, short stature *Not correctable w/ exogenous PTH
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Chvosteks sign
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Tapping of facial nerve –> contraction of facial muscles (hypocalcemia, tetany)
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Trousseaus sign
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Occlusion of brachial artery with BP cuff –> carpal spasm
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Sonic hedgehog gene controls:
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patterning along anterior-posterior axis, CNS development (failure –> holoprosencephaly)
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Wnt-7 gene controls:
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organization along dorsal-ventral axis
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FGF gene controls:
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lengthening of limbs, stimulates mitosis of mesoderm
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Homeobox gene controls:
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segmental organization of the embryo in cranio-caudal direction, Hox mutations lead to appendages in the wrong locations (ex. Hand-foot-genital syndrome)
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Surface ectoderm derivatives
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adenohypophysis (Rathke’s pouch), lens of eye, epithelial lining of oral cavity, sensory organs of ear and olfactory epithelium, epidermis, anal canal below pectinate line, parotid, sweat and mammary glands
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Neuroectoderm derivatives
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brain (neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, ependymal cells, pineal gland), retina and optic nerve, spinal cord
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Neural crest derivatives
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PNS (DRG, cranial nerves, celiac ganglion, schwann cells, ANS), melanocytes, chromaffin cells of adrenal medulla, parafollicular (C) cells of thyroid, pia and arachnoid, bones of skull, odontoblasts, aorticopulmonary septum
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Mesoderm derivatives
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muscle, bone, connective tissue, serous lining of body cavities (ex. peritoneum), spleen (derived from foregut mesentery), cardiovascular structures, lymphatics, blood, wall of gut tube, wall of bladder, urethra, vagina, kidneys, adrenal cortex, dermis, testes, ovaries
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Mesodermal defects
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VACTERL Vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal defects, limb defects (bone and muscle)
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Endoderm derivatives
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Gut tube epithelium (including anal canal above the pectinate line), luminal epithelial derivatives (lungs, liver, gallbladder, pancreas, eustachian tube, thymus, parathyroid, thyroid follicular cells)
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Fetal alcohol syndrome
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Mental retardation, microcephaly, holoprosencephaly, facial abnormalities, limb dislocation, heart and lung fistulas
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Dizygotic twins placenta
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dichorionic, diamniotic
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Most common monozygotic twin placenta type
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monochorionic, diamniotic (cleavage occurs at day 4-8 in 75% of monozygotic twin pregnancies)
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Urachal duct
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duct between bladder and yolk sac (derived from allantois) failure of obliteration can cause patent urachus (urine discharge from umbilicus), vesicourachal diverticulum (bladder outpouching), urachal sinus, urachal cyst
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Vitelline duct (omphalomesenteric)
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connects yolk sac to the midgut lumen failure of vitelline duct to close causes vitellines fistula (meconium discharge from umbilicus), meckels diverticulum, enterocyst
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1st aortic arch derivatives
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Maxillary artery Muscles of mastication, mylohyoid, anterior belly of digastric, tensor tympani, tensor veli palatini CN V2, V3 Meckels cartilage- mandible, malleus, incus, sphenomandibular ligament
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2nd aortic arch derivatives
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Stapedial artery and hyoid artery Muscles of facial expression (stapedius, stylohyoid) CN VII Reichert’s cartilage- stapes, styloid process, lesser horn of hyoid, stylohyoid ligament
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3rd aortic arch derivatives
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Common carotid artery, part of internal carotid artery Stylopharyngeus CN IX (glossopharyngeal nerve) Cartilage- greater horn of hyoid
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4th aortic arch derivatives
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L side- aortic arch R side- proximal part of R. subclavian artery Pharyngeal constrictors, cricothyroid, levator veli palatini CN X (superior laryngeal branch) Cartilage- thyroid, cricoid, arytenoids, corniculate, cuneiform
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6th aortic arch derivatives
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Proximal part of pulmonary arteries and ductus arteriosus on left All intrinsic muscles of larynx (except cricothyroid) CN X (recurrent laryngeal branch) Cartilage (same as 4th arch)
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1st branchial pouch
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middle ear cavity, eustachian tube, mastoid air cells endoderm lined structures of the ear
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2nd branchial pouch
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epithelial lining of palatine tonsil
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3rd branchial pouch
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thymus (ventral wings) inferior parathyroids (dorsal wings)
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4th branchial pouch
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superior parathyroids (dorsal wings)
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DiGeorge syndrome
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aberrant development of 3rd and 4th pouches, leads to T cell deficiency and hypocalcemia (failure of parathyroid development) –> tetany, fungal/viral infections
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MEN2A
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Ret mutation (neural crest cells) -adrenal medulla (pheochromocytoma) -parathyroid tumor (3rd/4th pharyngeal pouch) -parafollicular cells (medullary thyroid cancer)
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Cleft lip
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failure of fusion of maxillary and medial nasal processes (maxillary prominences with intermaxillary segment) formation of primary palate
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Cleft palate
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failure of fusion of lateral palatine processes, nasal septum, and/or median palatine process (formation of secondary palate)
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Vagina and ectocervix epithelium
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stratified squamous
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Endocervix epithelium
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simple columnar epithelium
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Uterine epithelium
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simple columnar epithelium, pseudostratified tubular glands
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Fallopian tube epithelium
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simple columnar, ciliated
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Ovary epithelium
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simple cuboidal epithelium
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What is in the suspensory ligament of ovary?
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ovarian vessels (can damage ureter when ligating ovarian vessels in oophorectomy)
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What is in the cardinal ligament?
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uterine vessels (can damage ureter when ligating uterine vessels during hysterectomy)
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What is in the round ligament of the uterus?
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Artery of Sampson connects uterine fundus to labia majora
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What is in the broad ligament?
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ovaries, fallopian tube, round ligament of uterus *mesosalpinx, mesometrium, mesovarium
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Emission and ejaculation are controlled by what nerves?
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emission- sympathetic NS (hypogastric) ejaculation- visceral & somatic nerves (pudendal nerve)
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Meiosis I of oocyte is arrested in what stage until ovulation?
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PROPHASE I (primary oocyte) 46 2N, 4C
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Meiosis II of oocyte is arrested in what stage until fertilization?
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METAPHASE II (secondary oocyte) 23 1N, 2C
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Down Syndrome triple screen:
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Low urine estriol Low serum AFP High serum bHCG
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HPV mechanism
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E6 gene product: destruction of p53 E7 gene product: destruction of Rb high risk 16 & 18
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General ovarian cancer marker
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CA-125, monitors progression and recurrence
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Surface ovarian tumors
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Serous cystadenoma (benign) Serous cystadenocarcinoma (malignant) Mucinous cystadenoma (benigh) Mucinous cystadenocarcinoma (malignant)
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Tumor marker for choriocarcinoma
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hCG
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Granulosa cell tumor
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secretes estrogen (precocious puberty in kids, endometrial hyperplasia- adults) Call-exner bodies- follicles with eosinophilic secretions abnormal uterine bleeding
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Krukenberg tumor
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GI malignancy with mets to bilateral ovaries (diffuse type)
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Meig’s syndrome
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triad of ovarian fibroma, ascites and hydrothorax
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Which ovarian tumor resembles urothelium?
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Brenner tumor (pale, yellow-tan encapsulated tumor)
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What tumors cause mets to the ovary?
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Krukenberg (GI mets, mucinous signet rings) Pseudomyxoma peritonei (mets from appendix, mucinous tumor)
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Where does lymph from lower 2/3 of vagina drain to?
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Inguinal nodes
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Where des lymph from the upper 1/3 of vagina drain to?
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Regional iliac nodes
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Adenosis
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Persistance of columnar epithelium in the upper 1/3 of vagina, increased risk with in-utero DES exposure, and increased risk of clear cell adenocarcinoma
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Complete mole
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46 XX, 46 XY (sperm fertilize enucleated egg and then paternal DNA duplicates), very high beta-hCG, may progress to choriocarcinoma “snowstorm appearance” on ultrasound
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Partial mole
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69 XXX, 69 XYY, 69 XXY 2 sperm fertilize one egg high beta-hCG low risk of malignancy may contain fetal parts
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Choriocarcinoma response to chemo
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Sporadic (germ cell tumor)- poor response to chemo Gestational (post-molar pregnancy)- good response to chemo
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Calcifications on mammogram
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DCIS Sclerosing adenosis Fat necrosis
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Which breast cancer involves the dermal lymphatics?
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Inflammatory breast cancer Peau d’orange very poor prognosis, tumor has accessed lymph nodes (may look similar to acute mastitis)
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Which breast cancer has lymphocytic infiltrate?
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Medullary breast cancer
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Mutation in lobular carcinoma of breast
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CDH1 mutation, lack e-cadherin discohesive cells
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Her2 receptor
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cell surface growth factor receptor
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Poor prognosis breast cancer
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ER, PR, HER2 negative “triple negative”
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BRCA1
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Increased risk medullary carcinoma of the breast Ovarian carcinoma (serous) Fallopian tube carcinoma
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BRCA2
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Breast cancer in males (assoc. w/ Klinefelters) (and female breast/ovarian cancer)
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Yolk sac tumor marker
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AFP Schiller-Duval bodies (glomeruloid)
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beta-hCG mimics
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thyroid hormone
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Choriocarcinoma metastasis
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rapidly metastasizes into the blood goes to the lung
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Teratomas
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Benign in females Malignant in males *produce AFP or B-hCG
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Most common cause of testicular mass in male >60 years old
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Testicular lymphoma (diffuse large B cell lymphoma)
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Choriocarcinoma tumor marker
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Beta-hCG
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Prostatic adenocarcinoma mets
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bone mets (lumbar spine) osteoBLASTIC lesions- sclerotic
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Thigh ADduction
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Obturator (L2-L4) nerve innervates adductors longus, brevis, magnus & gracilis muscles injury due to ANTERIOR hip dislocation
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Thigh ABduction
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Superior gluteal (L4-S1) nerve innervates gluteus medius and minimus injured by POSTERIOR hip dislocation
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Thigh FLEXORS
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Femoral nerve (L2-L4) Iliacus & psoas muscles (lumber ventral rami L2-L3) Rectus femoris, sartorius (femoral nerve) Tensor fascia lata
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Thigh EXTENSORS
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Inferior gluteal nerve (L5-S2) Gluteus maximus (inf gluteal nerve) Long head of biceps femoris (sciatic-tibial nerve)
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Sciatic nerve splits into:
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common peroneal, tibial
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Functions of common peroneal nerve
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PED (foot eversion, dorsiflexion) injury –> foot drop, slap, loss of sensation on dorsum of foot
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Functions of tibial nerve
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TIP (foot inversion, plantar flexion) injury –> foot eversion and dorsiflexion, loss of sensation on sole of foot
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Site of pudendal nerve block
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Ischial spine (S2-S4)
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Leg extension controlled by which nerve?
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Femoral
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Leg flexion controlled by which nerves?
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sciatic (tibial) and others
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Thigh movements overall:
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ADduction- obturator nerve ABduction- superior gluteal nerve Flexion- femoral nerve Extension- inferior gluteal nerve
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Osteoclast markers:
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urinary deoxypyridinoline hydroxyproline tartrate resistant acid phosphatase
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Osteoblast marker:
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Alk phosphatase (bone specific)
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Mutation in achondroplasia
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Activating mutation in FGF3R (sporadic or AD) inhibits chondrocyte proliferation
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Mutation in osteopetrosis
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Carbonic anhydrase II (failure of normal bone resorption)
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Potential complications of Paget’s disease of bone
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High output cardiac failure Osteogenic sarcoma Hearing loss
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Osteomyelitis affects what part of bone?
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Kids (metaphysics of long bones) Adults (epiphysis of long bones)
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Most common causes of osteomyelitis
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S. aureus, N. gonorrhea Salmonella (sickle cell) Tb (Pott’s disease) Pseudomonas (foot puncture) Pasturella (dog/cat bite)
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Most common sites of AVN
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Femoral & humoral head Scaphoid & lunate wrist bones Talus “crescent sign”
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Common tumor in bone epiphysis
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Giant cell tumor (osteoclastoma) BENIGN “double bubble” appearance
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Common tumor in bone metaphysis
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Osteosarcoma (malignant), young males, Codman’s triangle sign Osteochondroma (benign)- young males, mature bone with cartilaginous cap
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Common tumor in bone diaphysis
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Ewing’s sarcoma (malignant), young males Anaplastic small blue cell tumor Extremely aggressive, onion skin appearance Also chondrosarcoma (malignant)
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HLA associated with RA
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HLA-DR4
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Joint findings in RA
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Pannus formation (MCP, PIP) Subcutaneous nodules Ulnar deviation of fingers Subluxation Baker’s cysts **does NOT involve DIP *Pain improves with use
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Joint findings in osteoarthritis
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Subchondral cysts, sclerosis Osteophytes Eburnation Heberdens nodes (DIP), Bouchards nodes (PIP) *Pain improves with rest
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Sjogren’s syndrome
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Autoimmune destruction of exocrine glands Triad: xeropthalmia, xerostomia, arthritis Unilateral parotid enlargement, inc. risk of B-cell lymphoma SS-A (Ro), SS-B (La)
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Gout
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Monosodium urate crystals precipitate in joints due to hyperuricemia 90% underexcretion Needle shaped, negatively birefringent, yellow crystals under parallel light
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Pseudogout
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Calcium pyrophosphate crystals Rhomboid, weakly positively birefringent, blue when parallel to light
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Seronegative spondyloarthropathies (HLA-B27 positive)
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Psoriatic arthritis (dactylitis, pencil-in-cup deform) Ankylosing spondylitis (sacroiliac & vertebral fusion, uveitis, aortic regurg, restrictive lung disease) IBD Reactive arthritis- conjunctivitis, urethritis, arthritis Bechets
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Bechets
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Recurrent apthous & genital ulcers, uveitis, e. nodosum, inflammatory arthritis
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Common cause of death in SLE
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Nephritis (most commonly diffuse proliferative glomerulonephritis) *renal failure, infection
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Antiphospholipid syndrome
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Anticardiolipin (false + syphilis test) Lupus anticoagulant (falsely increased PTT) Patient is HYPERcoagulable, DVT, stroke, placental thrombosis, hepatic vein thrombosis
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Drug induced lupus marker
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Anti-histone Ab *Hydralazine, isoniazid, procainamide
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Polymyositis
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Progressive symmetrical proximal muscle weakness ENDOmysial inflammation CD8+ T cells
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Dermatomyositis
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Malar rash, Gottron’s papules, heliotrope rash, “shawl & face” rash, mechanics hands PERImysial inflammation CD4+ T cells Increased risk of lung, GI cancer
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Marker of polymyositis, dermatomyositis
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anti-Jo-1 Ab Increased CK
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Myasthenia gravis
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Ab against post-synaptic Ach receptor Symptoms: ptosis, diplopia, weakness WORSENS with muscle use Assoc. with thymoma, thymic hyperplasia
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Eaton-Lambert Syndrome
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Ab against pre-synaptic Ca2+ channels (decrease Ach release) Symptoms: proximal muscle weakness IMPROVES with muscle use Assoc. with small cell lung cancer
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What do you use to test for myasthenia gravis?
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Edrophonium (short acting anti cholinesterase)
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Diffuse scleroderma marker
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anti-Scl-70 (anti-DNA topoisomerase I Ab)
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CREST syndrome
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Calcinosis, Raynauds, Esophageal dysmotility, Sclerodactyly, Telangectasia Anti-centromere Ab “C” is for CREST
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Spongiosis
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Seen in acute eczematous dermatitis edema, lymphocytes, eosinophils “weeping” vesicles
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Hyperkeratosis
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Increased thickness of stratum CORNEUM (psoriasis, chronic eczema)
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Parakeratosis
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Hyperkeratosis with retention of nuclei in stratum corneum (psoriasis)
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Acantholysis
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Separation of epidermal cells (pemphigus vulgaris)
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Acanthosis
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Epidermal hyperplasia (increased spinosum)- acanthuses nigricans, psoriasis
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Dermatitis
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Inflammation of the skin (Atopic dermatitis)
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Albinism
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NORMAL melanocyte number, decreased melanin production because of low tyrosinase activity (or failure of neural crest migration during development)
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Vitiligo
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Complete depigmentation in areas due to decreased NUMBER of melanocytes (autoimmune destruction)
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Solar lentigo
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Increased NUMBER of melanocytes brown macules in the elderly
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Freckle
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normal number of melanocytes, INCREASED NUMBER OF MELANOSOMES, increased melanin pigment
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Eczema
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Type I HSR (IgE mediated) pruritic eruption on skin acute- weeping vesicles chronic- dry, thick skin
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Allergic contact dermatitis
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Type IV HSR Spongiosis
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Leser-Trelat sign
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sudden appearance of multiple, seborrheic keratoses Indicates underlying malignancy (GI, lymphoid)
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Auspitz sign
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pinpoint bleeding from exposure of dermal papillae when psoriatic scales are scraped off
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Bullous pemphigoid
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Tense blisters Ab against hemidesmosomes (BPAG1,2) Linear IF Spares oral mucosa
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Pemphigus vulgaris
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Flaccid blisters, + Nikolsky sign IgG against desmoglein 3 and/or 1 (desmosomes) Netlike IF Involves oral mucosa
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Dermatitis herpetiformis
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IgA deposits at tips of dermal papillae Assoc. w/ celiac disease Neutrophils at tips of dermal papillae “micro abscesses”
question

Pemphigus vulgaris & bullous pemphigoid are Type ? HSR
answer

Type II HSR
question

Dermatitis herpetiformis is Type ? HSR
answer

Type III HSR
question

Erythema multiforme and SJS are Type ? HSR
answer

Type IV HSR Cytotoxic CD8+ T cell mediated
question

Actinic keratosis
answer

Precursor to SCC small, erythematous papules, plaques HYPERKERATOSIS, PARAKERATOSIS
question

Lichen planus is associated with?
answer

Hep C
question

Necrotizing fasciitis caused by:
answer

Strep pyogenes “flesh eating bacteria”
question

Impetigo caused by:
answer

S. aureus, S. pyogenes Honey colored crusts
question

Basal cell nevus syndrome
answer

mutation in PATCHED –> 50-100 BCC
question

Basal cell carcinoma
answer

Most common skin cancer, PATCHED mutation in 90% Sun exposed areas Pink, pearly nodules, telangectasias, rolled borders, central crusting, ulceration Palisading nuclei on histo classic location: upper lip *excellent prognosis
question

Squamous cell carcinoma
answer

2nd MC skin cancer, p53 mutations in 90% sunlight, immunosuppression, arsenic Ulcerative, red lesions, with scales (lower lip) can metastasize histology shows KERATIN pearls
question

Melanoma
answer

Significant risk of mets S-100 tumor marker Activating mutation in BRAF kinase *Leading cause of death due to skin cancer Worse prognosis with nodular and acrolentigenous types, better prognosis with superficial and lentigo types
question

Hypertensive retinopathy
answer

copper wiring AV nicking
question

Diabetic retinopathy
answer

hemorrhage, exudates, microaneurysms, vessel proliferation **SORBITOL causes damage
question

Xeroderma pigmentosum
answer

AR mut in NER of thymidine dimers from sun exposure
question

Deamination
answer

cytosine –> uracil adenine –> xanthine guanine –> hypoxanthine *repair with base excision
question

HNPCC
answer

AD defect in DNA mismatch repair
question

Ataxia telangiectasia
answer

AR defect in ATM gene that codes for DNA repair enzymes triad: cerebellar defect (ataxia), spider angiomas, IgA deficiency Inc. AFP
question

alpha-amanitin (amanita phalloides)
answer

death cap mushroom, inhibits RNA Pol II severe hepatotox. if ingested
question

beta-thalassemia
answer

splice site mutation
question

I cell disease
answer

lysosomal storage disease, failure of addition of mannose-6-P to lysosome proteins *coarse facial features, clouded corneas, restricted joint movement, fatal in childhood
question

Chediak Higashi
answer

AR mutation in LYST (MT dependent sorting of endosomal proteins) –> recurrent pyogenic infections, partial albinism, peripheral neuropathy, giant granules in leukocytes
question

Kartageners
answer

immotile cilia due to dynein arm defect infertility, bronchiectasis, recurrent sinusitis, situs inversus
question

Neuroendocrine tumor markers
answer

Chromogranin A Neuron specific enolase Synaptophysin
question

Histo stain- cytokeratin
answer

epithelium
question

Histo stain- vimetin
answer

connective tissue
question

Histo stain- desmin
answer

muscle
question

Histo stain- GFAP
answer

neuroglia
question

Histo stain- neurofilaments
answer

neurons
question

Inhibitors of Na+/K+ ATPase
answer

Oubain (binds K+ site) Digoxin (inhibit Na+/K+ directly)
question

Cartilage defects
answer

Type I (osteogenesis imperfects) Type III (ehlers-danlos) Type IV (Alport syndrome)
question

Ehlers-Danlos syndrome
answer

Defective Collagen types I & III hyperextensible skin, bleeding tendency, hypermobile joint, joint dislocation, berry aneurysm, organ rupture MCC death = AORTIC DISSECTION
question

Alport syndrome
answer

Type IV collagen defect Nepritis & deafness X-linked recessive
question

Marfans
answer

AD fibrillin-1 defect tall, long extremities, pectus excavatum, hypermobile joints, arachnodactyly, cystic medial degen of aorta (AI, dissecting aorting aneurysm), MVP, lens sublux. MCC death = AORTIC DISSECTION/aneurysm
question

karyotype can be performed on:
answer

blood, bone marrow, amniotic fluid, placental tissue *looks at metaphase chromosomes
question

Blotting techniques
answer

Southern- DNA Northern- RNA Western- Protein Southwestern- DNA-binding protein (c-Jun, c-Fos)
question

Allelic heterogeneity
answer

different mutations at same locus cause similar phenotypes (ex. duchenne and becker muscular dystrophy)
question

Phenotypic heterogeneity
answer

mutation at SAME gene leads to different phenotype
question

Heteroplasmy
answer

presence of normal and mutated mtDNA, variable expression of mitochondrial inherited disease
question

Uniparental disomy
answer

offspring receives 2 copies of chrom from 1 parent heterodisomy- meiosis I error isodisomay- meiosis II error *consider in individual manifesting recessive disorder with only 1 carrier parent
question

Prader-Willi syndrome
answer

*paternal allele NOT expressed ONLY MATERNAL EXP. (chrom 15) mental retardation, hyperphagia, obesity, hypogonadism, hypotonia
question

Angelmans syndrome
answer

*maternal allele NOT expressed ONLY PATERNAL EXP (chrom 15) mental retardation, seizures, ataxia, inappropriate laughter
question

X-linked dominant disorders
answer

Hypophosphatemic rickets
question

Mitochondrial inheritance
answer

Lebers hereditary optic neuropathy Myoclonic epilepsy with ragged red fibers (MERRF) Mitochondrial encephalopathy with stroke and lactic acidosis (MELAS)
question

ADPKD on which chrom?
answer

Chrom 16 (AD)
question

FAP on which chrom?
answer

Chrom 5 (AD)
question

Hereditary hemorrhagic telangiectasia (osler-weber-rendu synd)
answer

AD inherited disorder of blood vessels telangectasias, epistaxis, skin discolorization, AVM
question

Huntington’s disease on which chrom?
answer

Chrom 4 (AD)
question

NF type 1 on which chrom?
answer

Chrom 17 (AD) Cafe-au-lait spots, neural tumors, lisch nodules, scoliosis, optic pathway gliomas
question

NF type 2 on which chrom?
answer

Chrom 22 (AD) bilateral acoustic schwanommas, juvenile cataracts
question

Tuberous sclerosis
answer

AD facial lesions (adenoma sebaceum), hypopigmented ash leaf spots, cortical/retinal hamartoma, seizures, mental retardation, renal cysts, renal angiomyolipomas, cardiac rhabdomyomas, astrocytomas
question

VHL disease is on which chrom?
answer

Chrom 3 (AD) constituitively active HIF, inc. angiogenesis via VEGF hemangioblastomas (retina, cerebellum, medulla), bilat renal cell carcinoma
question

AD diseases
answer

achondroplasia, ADPKD, FAP, familial hypercholesterolemia type IIA, hereditary hemorrhagic telangiectasia, hereditary spherocytosis, Huntington’s disease, Marfans, MEN, NF1, NF2, tuberous sclerosis, VHL disease, OI type 1, hereditary angioedema
question

Diagnosis of CF
answer

Chrom 7 CFTR, del Phe from 508 Degradation of channel before reaching cell surface *nasal transepithelial gradient is more NEG than normal (increased Na+ abs) *inc conc of Cl- in sweat test
question

Deaths due to CF
answer

cardiopulmonary complications (pneumonia, bronchiectasis)
question

AR diseases
answer

albinism, ARPKD, CF, glycogen storage diseases, hemachromatosis, mucopolysaccharidoses (ex. hunters), PKU, sickle cell, sphingolipodoses (ex. fabrys), thalassemias
question

X-linked recessive disorders
answer

Brutons agammaglobulinemia, Wiskott-aldrich syndrome, Fabry’s, G6PD def, ocular albinism, Lesch-Nyhan, Duchenne & beckers muscular dystrophy, Hunter’s syndrome, hemophilia A & B, ornithine transcarbamoylase def *Be Wise Fools GOLD Heeds Silly HOpe
question

MCC of death in muscular dystrophy
answer

respiratory failure
question

Trinucleotide repeat disorders
answer

Fragile X (CGG)n Friedreichs ataxia (GAA)n Huntingtons (CAG)n Myotonic dystrophy (CTG)n
question

Pregnancy screen in Down Syndrome
answer

Low AFP & estriol High B-hCG and inhibin A Increased nuchal translucency
question

Pregnancy screen in Edwards syndrome (trisomy 18)
answer

Low AFP, B-hCG, estriol normal inhibin A
question

Pregnancy screen in Pataus (trisomy 13)
answer

Low free B-hCG, Low PAPP-A Increased nuchal translucency
question

Cri-du-chat
answer

Microdel. of short arm of chrom 5 microcephaly, mod-severe mental retardation, high pitch cry, epicanthal folds, cardiac abnormalities (VSD)
question

Williams syndrome
answer

Congen microdeletion of long arm of chrom 7 elfin facies, intellectual disability, hypercalcemia, well dev. verbal skills, extreme friendliness w/ strangers, cardiovascular problems
question

Microdel. of chrom 22q11
answer

CATCH-22 cleft palate, abnormal facies, thymic aplasia, cardiac def, hypocalcemia (parathyroid aplasia)
question

What vitamins are lacking in breast milk?
answer

D & K
question

Vit A deficiency
answer

Night blindness, dry skin, vulnerability to infection (ex. measles)
question

Vit A excess
answer

arthralgia, HA, fatigue, skin changes, sore throat, alopecia *TERATOGENIC
question

Vit B1 (thiamine) is used for:
answer

Pyruvate dehydrogenase alpha-ketoglutarate dehydrogenase Transketolase Branch chain AA dehydrogenase
question

Vit B1 (thiamine) deficiency:
answer

*occurs in alcoholics Wernicke-Korsikoff: confusion, opthalmoplegia, ataxia, + confabulation, personality change, memory loss (perm) Dry beri-beri- polyneuritis, symm muscle wasting Wet beri-beri- high output heart failure, edema
question

Vit B2 (riboflavin) deficiency
answer

Cheilosis, corneal vascularization
question

Vit B3 (niacin) is derived from which AA?
answer

TRYPTOPHAN + requires B6 and B2
question

Niacin deficiency (Vit B3)
answer

glossitis pellagra: diarrhea, dermatitis, dementia (caused by Hartnups disease, carcinoid synd, isoniazid therapy)
question

Vit B5 (pantothenate) deficiency
answer

dermatitis, eteritis, alopecia, adrenal insuff. (B5 used for steroid synthesis, synth of Vit A & D, cholesterol, AA, FA, and protein)
question

Vit B6 (pyridoxine) function
answer

used in transamination, decarboxylation, glycogen phosphorylase (synth. of cystathionine, heme, niacin, histamine, serotonin, GABA, epi, NE)
question

Vit B6 deficiency
answer

Convulsions, hyperirritability, peripheral neuropathy, sideroblastic anemia *Isoniazid gives you a B6 deficiency, so supplement
question

Vit B7 (biotin) function
answer

Carboxylation reactions (pyruvate carboxylase, acetyl CoA carboxylase, propionyl CoA carboxylase)
question

Vitamin B9 (folic acid) use
answer

converted to THF for 1-C transfers/methylation reactions, DNA and RNA bases
question

Vit B9 (folic acid) deficiency
answer

NTDs Macrocytic, megaloblastic anemia
question

Vit B12 (cobalamin) function
answer

cofactor for homocysteine methyltransferase & methylmalonyl-CoA mutase
question

Vit B12 (cobalamin) deficiency
answer

Macrocytic, megaloblastic anemia hypersegmented PMNs neurologic symptoms (paresthesia, subacute combined degen) *caused by malabsorption, pernicious anemia, absence of terminal ileum
question

Regeneration of methionine from homocysteine depends on:
answer

Vit B12, folate
question

Vit E deficiency
answer

Erythrocyte fragility Posterior column and spinocerebellar tract demyelination (ataxia) *seen in CF, abetalipoproteinemia
question

Vitamin K deficiency
answer

neonatal hemorrhage (inc. PT and PTT) must supplement because it is low in breastmilk
question

Zinc deficiency
answer

delayed wound healing, hypogonadism, decreased hair, dysgeusia, anosmia acrodermatitis enteropathica (rare inherited zinc def)
question

Kwashiorkor
answer

protein malnutrition edema, anemia, fatty liver
question

Marasmus
answer

energy malnutrition tissue/muscle wasting, loss of subcutaneous fat
question

What pathways happen in mitochondria?
answer

FA oxidation, acetyl CoA production, TCA cycle, ox phos
question

What pathways happen in cytoplasm?
answer

Glycolysis, FA synthesis, HMP shunt, protein synthesis (RER), steroid synthesis (SER), cholesterol synthesis
question

What pathways happen in both mito and cytoplasm?
answer

Heme synthesis, Urea cycle, Gluconeogenesis (HUGS need BOTH people)
question

Arsenic inhibits…
answer

lipoic acid *vomiting, rice water stools, garlic breath
question

Pyruvate dehydrogenase complex deficiency
answer

Mutation in X-linked gene for E1-alpha subunit of PDC *neurologic defects in infancy Treat with ketogenic nutrients (lysine, leucine) bypass PDC
question

Inhibitor of Complex I
answer

Rotenone
question

Inhibitor of complex III
answer

Antimycin
question

Inhibitor of complex IV
answer

cyanide, CO
question

Inhibitor of complex V (ATPase)
answer

Oligomycin
question

Decouplers of ox-phos
answer

2,4-DNP, aspirin, thermogenin in brown fat
question

1 NADH = how many ATP
answer

2.5
question

1 FADH2 = how many ATP
answer

1.5
question

Total ATP from malate-aspartate shuttle vs. glycerol-3-phosphate shuttle
answer

malate-aspartate = 32 glycerol-3-phosphate = 30
question

HMP shunt occurs where?
answer

CYTOPLASM lactating mammary glands, liver, adrenal cortex (fatty acid and steroid synthesis), RBCs
question

What is the defect in chronic granulomatous disease?
answer

NADPH oxidase deficiency infections by catalase + organisms (S. aureus, Aspergillus) NBT test will not turn blue (clear = abnormal)
question

Sucrose =
answer

glucose + fructose
question

Fructose intolerance- deficiency is?
answer

Aldolase B Accumulate Fructose-1-P which is toxic to liver hypoglycemia, jaundice, cirrhosis, vom, hepatomegaly
question

Deficiency in essential fructosuria
answer

fructokinase benign, asymptomatic fructose appears in blood & urine
question

Deficiency in galactokinase deficiency
answer

galactokinase… DUH mild condition, galactose in blood and urine infantile cataracts
question

Deficiency in classic galactosemia
answer

galactose-1-phosphate uridyltransferase buildup of galactose-1-P, galactitol in eye cataracts, failure to thrive, jaundice, hepatomegaly, mental retardation Tx = exclude GALACTOSE & LACTOSE
question

Lactose =
answer

glucose + galactose
question

sorbitol accumulation causes:
answer

osmotic damage (cataracts, retinopathy, peripheral neuropathy) seen in diabetes
question

Essential AA
answer

*Must be supplied in diet Glucogenic: Met, Val, His Glucogenic/ketogenic: Ile, Phe, Thr, Trp Ketogenic: Lys, Leu
question

Acidic AA
answer

Asp and Glu (negatively charged at body pH)
question

Basic AA
answer

Arg, Lys, His
question

AA with 3 titratable proteins
answer

Basic: His, Arg, Lys Acidic: Asp, Glu Cys, Tyr
question

Which AA donates NH4+ for urea cycle?
answer

Aspartate
question

Which AA is hydrolyzed in the final step of urea acid cycle?
answer

Arginine
question

Which AA commonly accepts NH3 groups?
answer

Glutamate
question

Which AA are increased in histones?
answer

Arg and Lysine (bind neg charged DNA)
question

Ammonia intoxication
answer

tremor, slurred speech, somnolence, vom, cerebral edema, blurred vision (treat with benzoate, phenyl butyrate, lactulose)
question

AA derivatives of phenylalanine
answer

Phe –> Tyrosine –> dopa –> dopamine –> NE –> epi
question

AA derivatives of tryptophan
answer

Niacin (requires B6) Serotonin (requires BH4)
question

AA derivatives of histidine
answer

histamine (uses B6)
question

AA derivatives of glycine
answer

heme (uses B6)
question

AA derivative of arginine
answer

Creatinine Urea NO
question

AA derivatives of glutamate
answer

GABA (B6) Glutatione Glut + Asp = pyrimadine Glut + Asp + glycine = purine (2 rings)
question

What AA becomes essential in PKU?
answer

tyrosine (remove phenylalanine from diet)
question

What enzyme is deficient in PKU?
answer

phenylalanine hydroxylase tetrahydrobterin cofactor (malignant PKU)
question

What enzyme is deficient in alkaptonuria?
answer

homogentisic acid oxidase (dark tissues, arthralgias)
question

What enzyme is deficient in albinism?
answer

tyrosinase or tyrosine transporter
question

Enzyme deficiencies in homocysteinuria
answer

Cystathionine synthase (decrease Met, inc Cysteine, B12 and folate in diet) Homocysteine methyltransferase (requires B12)
question

Homocysteinuria has genetic heterogeneity with …
answer

Marfans (osteoporosis, mental retardation, tall stature, kyphosis, lens subluxation, atherosclerosis)
question

Cysteinuria
answer

defect of renal tubular AA transporter for COAL (cysteine, ornithine, arginine, lysine) in the PCT leads to renal staghorn caliculi
question

What AA can’t be degraded in maple syrup urine disease?
answer

Leucine, Isoleucine, Valine “I Love Vermont maple syrup”
question

Hartnup disease leads to:
answer

pellagra (decreased tryptophan uptake)
question

Enzyme deficiency in Von Gierke’s disease (type I)
answer

glucose-6-phosphatase (glucose -6-P to glucose)
question

Enzyme def. in Pompe’s disease (type II)
answer

lysosomal alpha-1,4 glucosidase (acid maltase) -cardiomegaly, trashes LIVER, HEART, MUSCLE
question

Enzyme def. in Cori’s disease (type III)
answer

Debranching enzyme (alpha-1,6 glucosidase)
question

Enzyme def. in McArdles disease (type V)
answer

Skeletal muscle glycogen phosphorylase *painful muscle cramps, myoglobinuria with exercise
question

Enzyme deficiency in Fabry’s disease
answer

alpha-galactosidase A (ceramide trihexoside accum) XR peripheral neuropathy, angiokeratoma, renal/cardiovascular disease
question

Enzyme deficiency in Gaucher’s disease
answer

Glucocerebrosidase (glucocerebroside accum) AR HSM, aseptic necrosis of femur, bone crises, Gaucher cells
question

Enzyme deficiency in Neimann-Pick disease
answer

Sphingomyelinase (sphingomyelin accum) AR progressive neurodegen, HSM, cherry red spot, foam cells
question

Enzyme deficiency in Tay-Sachs disease
answer

Hexosaminidase A (GM2 ganglioside accum) AR progressive neurodegen, cherry red spot, lysosomes with onion skin, NO HSM
question

Enzyme deficiency in Krabbe’s disease
answer

Galactocerebrosidase (galactocerebroside accum) AR peripheral neuropathy, dev. delay, optic atrophy, globoid cells
question

Enzyme def. in Metachromatic leukodystrophy
answer

Arylsufatase A (cerebroside sulfate) AR Central/peripheral demyelination, ataxia, dementia
question

Enzyme def. in Hurlers syndrome
answer

alpha-L-iduronidase (heparan sulfate, dermatan sulfate) AR developmental delay, gargoylism, airway obstruction, corneal clouding, HSM
question

Enzyme def. in Hunters
answer

Iduronate sulfatase (heparan sulfate, dermatan sulfate) XR Mild hurlers + aggressive behavior (no corneal clouding)
question

Ketones
answer

acetoacetate, B-hydroxybutyrate *produced during prolonged starvation, DKA, alcoholism
question

What cells can’t use ketones?
answer

RBC & liver cells
question

Starvation- order of energy production
answer

Between meals (hepatic glycogenolysis) Starvation 1-3 days (glycogenolysis, adipose release of FFA, hepatic gluconeogenesis from lactate, alanine, odd-chain FFA) After 3 days (adipose- ketones, then protein degradation)
question

Mutation in Type I hyperchylomicronemia
answer

AR Lipoprotein lipase def. or altered apo C-II (can’t degrade TG in circulating CM and VLDL) *pancreatitis, HSM, eruptive/pruritic xanthomas
question

Mutation in Type IIa hypercholesterolemia
answer

AD LDL-Receptor absent or decreased *accel. atherosclerosis, tendon xanthomas, corneal arcus
question

Mutation in type IV hypertriglyceridemia
answer

AD hepatic overproduction of VLDL *pancreatitis
question

Abetalipoproteinemia
answer

AR Mutation in microsomal triglyceride transfer protein (MTP), decreased B-48 and B-100 decrease CM and VLDL synthesis and secretion, accum lipid in enterocytes –> FTT, steatorrhea, acanthocytosis, ataxia (vit E), night blindness (vit A)
question

Obligate aerobes
answer

Nocardia, pseudomonas aeruoginosa, mycobacterium tb, bacillus (Nagging Pests Must Breathe)
question

Obligate anaerobes
answer

Clostridium, Bacteroides, Actinomyces (lack catalase/ SOD) Anaerobes Cant Breathe Air
question

Obligate intracellular bugs
answer

Chlamydia, Rickettsia
question

Facultative intracellular bugs
answer

Salmonella, Neisseria, Brucella, Mycobacterium, Listeria, Francisella, Legionella, Yersinia pestis “Some Nasty Bugs May Live FacultiveLY”
question

Urease positive bugs
answer

Cryptococcus, H. pylori, Proteus, Ureaplasma, Nocardia, Klebsiella, S. epidermidis, S. saprophyticus (CHuck norris hates PUNKSS)
question

Which bugs invade gut mucosa? (bloody, inflamm diarrhea)
answer

Salmonella, shigella, Yersinia enterocolitica, EIEC, campylobacter jejuni
question

Bugs with preformed exotoxin
answer

Staph aureus (enterotoxin) Bacillus cereus (cereulide) *starts and ends quickly
question

Bacteria that are lysogenized with phage
answer

ABCDE ShigA like toxin Botulinum toxin Cholera toxin Diptheria toxin Erythrogenic toxin (Strep pyogenes)
question

Endotoxin that causes shock in gram neg bacteria
answer

Lipid A (IL1, TNFalpha, NO, C3a, C5a, DIC)
question

Dominant flora of skin
answer

Staph epidermidis (also corynebacterium, pseudomonas)
question

Dominant flora of nose
answer

Staph epidermidis, colonized by Staph aureus
question

Dominant flora of mouth
answer

Viridans strep
question

Dominant flora of dental plaque
answer

Strep mutans
question

Dominant flora of colon
answer

Bacteroides fragilis > E. coli
question

Dominant flora of vagina
answer

Lactobacillus, colonized by E. coli, group B strep, candida, corynebacterium
question

Bug that mimics appendicitis
answer

Yersinia enterocolitica (mesenteric adenitis) Campylobacter jejuni
question

MCC of pneumonia in neonates (<4 weeks)
answer

Group B strep E. coli
question

MCC of pneumonia in kids 4 weeks – 18 years old
answer

RSV (viruses) Mycoplasma Chlamydia trachomatis (infants – 3yrs) C. pneumoniae (school aged children) Strep pneumo “Runts may cough chunky sputum”
question

MCC of pneumonia in adults 18-40
answer

S. pneumo H. influenza Anaerobes, viruses, mycoplasma
question

MCC of pneumo in the elderly
answer

S. pneumo Influenza virus Anaerobes H. influenza gram neg rods
question

Nocosomial pneumonia
answer

staph, enteric gram neg rods (E. coli, pseudomonas, klebsiella)
question

Immunocompromised patients pneumonia
answer

Staph, enteric gram neg rods, fungi, viruse, PCP (HIV)
question

Aspiration pneumonia
answer

anaerobes (fusobacterium, peptostreptococcus, bacteriodes)
question

Alcoholic pneumonia
answer

S. pneumo, klebsiella, staph
question

CF pneumonia
answer

PSEUDOMONAS S. aureus S. pneumo
question

Postviral pneumonia
answer

Staph H. influenza Strep pneumo
question

Atypical pneumonia
answer

Mycoplasma, Legionella, Chlamydia
question

MCC meningitis in newborns
answer

Group B strep E. coli Listeria
question

MCC meningitis in children (6 mo-6 yr)
answer

Strep pneumo N. meningitidis H. influenza type B Enterovirus (coxsackie, echovirus)
question

MCC meningitis in 6-60 year olds
answer

Strep pneumo N. meningitis (#1 in teens) Enterovirus HSV
question

MCC of meningitis in people over 60
answer

S. pneumo Gram neg rods Listeria
question

HIV meningitis
answer

Cryptococcus, CMV, toxoplasmosis, JC virus
question

Bugs infecting unimmunized children
answer

Rash- rubella, measles Meningitis- H influenza type B Pharyngitis- C. diptheriae Epiglottitis- H. influenza type B
question

Tetralogy of Fallot
answer

Pulmonary stenosis Overriding aorta RVH VSD **These kids SQUAT to increase PVR and reduce R–>L shunt and cyanosis
question

Increased lung volumes in COPD
answer

RV, FRC, TLC (FVC is decreased)
question

Renal blood flow (RBF) =
answer

RPF / (1-Hct)
question

FF =
answer

GFR/ RPF
question

Orthostatic hypotension is mediated by which adrenergic receptor?
answer

alpha-1 CONTRACTS SM and prevents orthostatic hypotension
question

alpha-1 activity
answer

contract SM mydriasis stimulate glycogenolysis
question

alpha-2 activity
answer

inhibit NT release DECREASE sympathetic outflow Platelet aggregation Contract some vascular SM inhibit lipolysis and insulin release
question

beta-1 activity
answer

Increase HR and contractility stim. RENIN release
question

beta-2 activity
answer

BRONCHODILATION UTERINE RELAXATION Vasodilation Stimulates glycogenolysis Increase HR and contractility INCREASE AQUEOUS HUMOR PROD. Stimulate INSULIN RELEASE Increase lipolysis
question

Which 2 RNA viruses replicate in the nucleus?
answer

Influenza (SS neg linear RNA, 8 segment virus) HIV (SS + linear RNA retrovirus)
question

Microsatellite instability can lead to?
answer

HNPCC (colorectal cancer)
question

Reactivated CMV in HIV patient causes:
answer

Retinitis Colitis Esophagitis
question

Testes lymph drains to
answer

para-aortic
question

Glans penis lymph drains to:
answer

deep inguinal
question

Stomach lymph drains to:
answer

celiac
question

T cell + selection occurs in:
answer

CORTEX of spleen
question

T cell – selection occurs in:
answer

MEDULLA if spleen
question

MHC Class I
answer

HLA A, B, C CD8 T cells expressed on all nucleated cells antigen presented w/ alpha chain and beta-2-microglobulin
question

MHC Class II
answer

HLADR, DP, DQ CD4 T cells expressed on APCs antigen is degraded following release of invariant chain in acidified endosome (presented w/ alpha and beta chain)
question

HLA DQ2/DQ8
answer

Celiac disease
question

HLA DR2
answer

MS, hay fever, SLE, goodpastures
question

HLA DR3
answer

DM1, Graves disease
question

HLA DR4
answer

RA, DM1
question

HLA DR5
answer

Pernicious anemia, Hashimotos thyroiditis
question

HLA A3
answer

Hemochromatosis
question

Helper T cell produces
answer

IL-12 (act TH1 cell) IL-4 (act TH2 cell)
question

T(reg) cells
answer

Express CD3, CD4, CD25 Activated Treg produce IL-10, TBF-B
question

2 major opsinins in bacterial defense
answer

C3b, IgG
question

C1 esterase inhibitor deficiency
answer

Hereditary angioedema (dont use ACE-I!)
question

C3 deficiency
answer

recurrent pyogenic sinus & respiratory tract infxns
question

C5-C9 deficiency
answer

Recurrent Neisseria infections
question

DAF deficiency
answer

complement overactivity, lysis of RBC, paroxysmal nocturnal hemoglobinuia (PNH)
question

What bugs do antigenic variation?
answer

Salmonella Borrelia (relapsing fever) N. gonorrhea (pilus protein) Influenza Hep C (vary envelope protein) Parasites (trypanosomes)
question

Passive immunity
answer

IgA in breast milk Antitoxins (tetanus, botulism, HBV, rabies) Humanized monoclonal Ab
question

Active immunity
answer

natural infection vaccines toxoid
question

Live attenuated vaccine
answer

cellular response strong, lifelong immunity *may revert to virulent form MMR, polio (sabin), varicella, yellow fever
question

Inactivated/killed vaccine
answer

humoral immunity *stable, safer, requires booster Hep A, polio (salk), rabies
question

Serum sickness
answer

Fever, urticaria, arthralgias, proteinuria, lymphadenopathy, 5-10 days after antigen exposure (ex. sulfonamides)
question

Type III HSR
answer

SLE, RA PAN, PSGN, Serum sickness, Arthus reaction
question

Type II HSR
answer

AIHA pernicious anemia ITP eryhtroblastosis fetalis acute hemolytic transfustion rxn RF, Goodpastures bullous pemphigoid, pemphigus vulgaris
question

Type IV HSR
answer

MS Guillain Barre synd. GVH disease PPD (Tb) Contact dermatitis
question

Anti-histone Ab
answer

Drug induced lupus
question

Anti-centromere Ab
answer

Scleroderma (CREST)
question

Anti-Scl 70 Ab
answer

Scleroderma diffuse
question

Antimitochondrial Ab
answer

primary biliary cirrhosis
question

Anti-Jo-1, Anti SRP, anti-Mi-2 Ab
answer

Polymyositis, Dermatomyositis
question

Anti-SSA (anti-Ro), Anti-SSB Ab (anti-La)
answer

Sjogrens
question

Anti-U1-RNP Ab
answer

mixed conn tissue disorder
question

anti – smooth muscle Ab
answer

autoimmune hepatitis
question

anti-glutamate decarboxylase Ab
answer

T1 DM
question

c-ANCA
answer

Wegeners
question

p-ANCA
answer

microscopic polyangiitis, Churg-Strauss
question

Hyper IgE syndrome
answer

Th1 cells fail to produce IFN-gamma FATED- course Facies, Abscesses, retained primary teeth, inc. IgE, derm problems
question

SCID
answer

defective IL-2 receptor (X linked) Adenosine deaminase deficiency (AR) FTT, chronic diarrhea, thrush, recurrent infxns, absent thyrmic shadow, germinal centers Treat w/ bone marrow tx
question

Ataxia telangectasia
answer

Defect in ATM gene (DNA repair enzymes)- AR triad: cerebellar defects, spider angiomata (telangectasia), IgA def *Increased AFP
question

Hyper IgM syndrome
answer

Defective CD40L on helper T cells, cant class switch severe pyogenic infections (treat w/ IVIG)
question

Wiskott-Aldrich syndrome
answer

X linked def. in WASP gene (T cells cant reorganize actin skel) TIE Triad: Thrombocytopenic purpura, Infections, Eczema High IgE and IgA (low IgM)
question

Leukocyte adhesion def (type I)
answer

Defect in LFA-1 integrin (CD18) protein on phagocytes, problem with tight adhesion recurr bacterial infxn, ABSENT PUS FORMATION, delayed sep of umbilical cord Neutrophilia
question

Chediak Higashi syndrome
answer

AR Defect in LYST (lysosomal trafficking regulator gene), recurr. PYOGENIC infxns by staph, strep partial ALBINISM, peirpheral neuropathy *Giant granules in neutrophils
question

Chronic granulomatous disease
answer

Usually X linked Lack of NADPH oxidase (absent resp. burst), decreased ROS Inc sus to catalase + organisms (S.aureus, E. coli, Aspergillus, Pseudomonas, Serratia, Nocardia) *abnormal DHR flow cytometry test *Nitroblue tetrazolium test no longer performed (but abnormal)
question

Graft vs. host disease
answer

Graft T cells attack host organs Maculopapular rash, jaundice, HSM, diarrhea *bone marrow & liver tx
question

Coagulative necrosis
answer

heart, liver, kidney
question

Liquefactive necrosis
answer

brain, bacterial abscess, pleural effusion, wet gangrene
question

caseous necrosis
answer

Tb, systemic fungi
question

spider bite?
answer

coagulative necrosis
question

fatty necrosis
answer

peripancreatic fat
question

fibrinoid necrosis
answer

blood vessels
question

gangrenous necrosis
answer

dry (ischemic coagulative) wet (bacteria) limbs & GI tract
question

Reversible cell injury
answer

Dec ATP synthesis Cell swelling (impaired Na+/K+ pump)- increased Na+ and Ca2+ in cell nuclear chromatin clumping decreased glycogen fatty change ribosome detachment
question

Irreversible cell injury
answer

nuclear pyknosis, karyolysis, karyorrhexis Ca2+ influx (caspase act) plasma mem damage lysosomal rupture mito permeability release of CK dystrophic calcifications
question

Areas most susc. to ischemia
answer

ACA/MCA/PCA boundary Subendocardium Straight seg. of proximal tubule + TAL (medulla) Area around central vein of liver splenic flexure, rectum pyramidal cells of hippocampus, purkinje cells
question

Red (hemorrhagic) infarcts
answer

liver, lung, intestines
question

Pale (white) infarcts
answer

heart, kidney, spleen
question

Leukocyte extravasation
answer

Rolling- selectin (endothelium) – Sialyl Lewis X Tight binding- ICAM-1 (endothelium) – LFA-1, MAC-1 Diapedesis (PECAM-1 – PECAM-1) Migration- LTB4, IL8, C5a, kallikrein
question

Free radical scavengers
answer

Catalase, SOD, glutatione peroxidase antioxidants (Vit A, C, E) Vit A neutralizes LDL-ox Vit C neutralizes pollutants/cig smoke
question

High ESR
answer

Infxn, inflammation (temporal arteritis) cancer, pregnancy, SLE
question

Low ESR
answer

Sickle cell, polycythemia, CHF
question

Systemic amyloid
answer

AL (primary)- Ig light chains (plasma cell disorder, MM or systemic)
question

AA (secondary)
answer

RA, IBD, spondyloarthropathy Amyloid A SAA –> AA
question

Dialysis related amyloid
answer

B2 microglobulin
question

Heritable amyloid
answer

ATTR (neuro, cardiac) TTR gene mutation
question

Senile
answer

normal TTR slow progression cardiac dysfunction
question

Alzheimers amyloid
answer

B-amyloid APP –> B-amyloid
question

Malignant tumors:
answer

Detatch from cells by decreased E-cadherin Adhere to BM via laminin Invade BM (collagenases, MMP) Stim. angiogenesis Lack contact inhibition (med by cadherins, catenin) Metastasize!
question

Transitional cell carcinoma
answer

Bladder, ureter, renal pelvis
question

Oncogenes with tyrosine kinase prod.
answer

abl (CML), Her2/neu, ret
question

Oncogenes with transcription factor products
answer

c-myc (Burkitts lymphoma) L-myc (lung tumor) N-myc (neuroblastoma, small cell lung ca)
question

Oncogene with GTPase activity
answer

ras (MAP-kinase), colon cancer
question

Oncogene with anti-apoptotic activity
answer

Bcl2 (follicular and undifferentiated lymphomas)
question

Li-Fraumemi assoc with:
answer

p53 mutation early breast cancer, soft tissue sarcoma
question

HNPCC assoc with:
answer

DNA mismatch repair genes (AD) increased risk colorectal cancer WITHOUT previous polyps
question

VHL syndrome associated with:
answer

Deletion on chrom 3p HIF-1 nuclear transcription mutation, increases VEGF cerebellar hemangioblastoma, retinal angioma, bilateral RCC, bilat pheochromocytoma
question

TSG mutations assoc w/ melanoma
answer

p16, BRAF
question

Blooms syndrome
answer

Mutation in helicase gene RecQL3 photosensitivity, short stature, erythema, telangectasia CHROMOSOMAL INSTABILITY
question

Sites where metastasis is > primary cancer
answer

LLL BB Lung, Liver, Lymph nodes Brain, Bone
question

Pathways of cancer dissemination
answer

1. lymphatic spread (carcinomas) 2. hematogenous spread (sarcoma) 3. seeding (ovarian, peripheral lung canc, glioblastoma multiforme)
question

What blocks uptake of choline into cholinergic nerve terminal?
answer

hemicholinium
question

What blocks uptake of Ach into vesicles?
answer

Vesamicol
question

What blocks release of Ach from nerve terminal?
answer

Botulinum toxin
question

What blocks tyrosine –> DOPA
answer

metyrosine
question

What blocks dopamine uptake into vesicles in the noradrenergic nerve terminal?
answer

reserpine
question

What blocks release of NE from norad nerve term?
answer

guanethidine, bretylium
question

What increases release of NE from norad nerve term?
answer

amphetamines
question

What inhibits reuptakes of NE at the nerve terminal?
answer

Cocaine, TCA, amphetamine
question

Diaphragmatic hiatus’s
answer

T8: IVC T10: Esophagus & Vagus (2 trunks) T12: Aorta, Thoracic duct, Azygos vein (the red, white, and blue at 12)
question

Heart sounds: inspiration increases
answer

intensity of right heart sounds
question

Heart sounds: expiration increases
answer

intensity of left heart sounds
question

Heart sounds: handgrip increases
answer

(systemic vasc. resistance) increases MR, AR, VSD, MVP
question

Heart sounds: valsalva/sudden standing increases
answer

MVP, HCM (decreases venous return)
question

Heart sounds: rapid squatting DECREASES
answer

MVP, HCM (decreases venous return, increases preload)
question

Ejection click
answer

AS also pulsus parvus et tardus crescendo-decrescendo systolic ejection murmur
question

Midsystolic click
answer

MVP late systolic crescendo murmur
question

Opening snap
answer

MS delayed rumbling late diastolic murmur
question

murmur with bounding pulses, head bobbing
answer

AR high pitch, blowing diastolic decrescendo murmur
question

continuous machine like murmur
answer

PDA
question

congenital long QT synd
answer

Jervell & Lange-Nielsen syndrome (sensorineural deafness, syncopal episodes) Romano Ward Syndrome- AD
question

Wolf-parkinson white synd
answer

pre-excitation syndrome accessory conduction bypasses AV node SVT, short PR, Delta wave, wide QRS
question

Aflutter treatment
answer

class IA, IC, III (b-blocker or Ca2+ channel bloacker for rate control)
question

2nd degree heart block
answer

Mobitz type I (asymptomatic) Mobitz type II (dropped beats not preceded by change in length of PR), treat w/ pacemaker
question

Aortic arch receptors
answer

responds to increase in BP via VAGUS nerve
question

Carotid sinus receptors
answer

responds to changes in BP with glossopharyngeal (CN IX) nerve
question

Coarctation of aorta (preductal) assoc with:
answer

Turners syndrome
question

PDA associated with:
answer

congenital rubella
question

Differential cyanosis associated with:
answer

PDA (late cyanosis in lower extremities)
question

Heart defect associated with 22q11 syndromes
answer

truncus arteriosus, TOF
question

Heart defects assoc w/ down syndrome
answer

ASD, VSD, AV septal defect (endocardial cushion defect)
question

Heart defect assoc w. congenital rubella
answer

septal defects, PDA, pulm artery stenosis
question

Heart defect assoc w/ marfans syndrome
answer

aortic insuff. & dissection
question

Heart defect assoc. w/ infant of diabetic mother
answer

transposition of great vessels
question

Abdominal aortic aneurysm assoc. with
answer

ATHEROSCLEROSIS
question

Thoracic aortic aneurysm assoc with
answer

HTN, cystic medial necrosis (MARFANS), tertiary syphilis
question

MCC of aortic dissection
answer

HYPERTENSION! also seen in connective tissue disorders (ehlers danlos, marfans)
question

What do you use to diagnose Printzmetals angina?
answer

Ergonovine (alpha agonist, 5HT agonist)
question

Normal HTN in elderly
answer

age related decrease in compliance of aorta –> SYSTOLIC HTN
question

Causes of dilated CM
answer

Infectious myocarditis Alcohol Doxorubicin Wet beriberi Chagas disease Hemachromatosis *SYSTOLIC dysfunction ECCENTRIC HYPERTROPHY *can be caused by AD mut in dystrophin (cytosksel proteins)
question

Causes of restrictive CM
answer

Amyloidosis Sarcoidosis Metastatic cancer Inborn metabolic error Hemachromatosis (both) *DIASTOLIC dysfunction
question

Evolution of MI
answer

0-4 hr- MINIMAL CHANGE! 4-12 hr- early coag necrosis, edema, hemorrhage, wavy fibers 12-24 hours- coag necrosis, marginal contraction band fibrosis 1-5 d-coag necrosis, neutrophil infiltrate 5-10 d-macrophage phagocytosis 10-14 d-granulation tissue, neovasc 2 weeks-2mo -collagen deposition and scar dormation
question

Most common sites of coronary occlusion
answer

LAD > RCA > circumflex
question

Transmural infarct
answer

ST elevation pathologic Q waves
question

Anterior wall infarct (LAD)
answer

V1-V4
question

Anteroseptal infarct (LAD)
answer

V1-V2
question

Anterolateral infarct (LCX)
answer

V4-V6
question

Lateral wall infarct (LCX)
answer

I, AvL
question

Inferior wall infarct (RCA)
answer

II, III, aVF
question

Posterior wall infarct (PDA)
answer

V6
question

Mi complications
answer

Early- arrythmia, CHF exacerbation, cardiogenic shock 1-3 days- fibrinous pericarditis 3-7 days- ventricular wall rupture, IV septum rupture, vent aneurysm after 2 weeks- Dressler’s syndrome (autoimmune pericarditis)
question

Causes of hypertrophic CM
answer

*AD mut in B-myosin heavy chain (cardiac sarcomere gene)- hypertrophied IV septum –> outflow tract obstruction assoc w/ Friedreich’s ataxia disordered myocardial fibers *DIASTOLIC DYSFUNCTION Concentric hypertrophy S4, systolic murmur, normal EF
question

Lofflers syndrome
answer

endomyocardial fibrosis with prominant eosinophilia (restrictive CM)
question

What drugs reduce mortality in CHF?
answer

ACE-inhib B-blockers ARB Spironolactone
question

ANP and BNP respond to:
answer

volume overload/CHF
question

Endocarditis bugs
answer

S.aureus- prev normal valves, rt sided, IVDA Viridans- dental procedures (low virulence) S. epidermidis- prosthetic valves S. bovis- assoc w/ colon cancer Enterococci- assoc w/ GU procedures
question

Tricuspid valve endocarditis
answer

S. aureus, Pseudomonas, Candida
question

MCC of early death in rheumatic fever
answer

MYOCARDITIS!
question

Acute pericarditis
answer

widespread ST elevation or PR depression sharp pain aggrevated by inspiration relieved by sitting up/leaning forward friction rub
question

Cardiac tamponade
answer

distant heart sounds pulsus paridoxus inc. JVD hypotension, inc HR
question

MC adult cardiac primary tumor
answer

myxoma (LA)
question

MC childhood cardiac tumor
answer

Rhabdomyoma assoc. with tuberous sclerosis
question

Major consequence of Kawasaki disease
answer

Coronary aneurysm–> MI in young child Treat with ASPIRIN!!
question

Sturge-Weber disease
answer

Port-wine stain (nevus flammeus) on face leptomeningeal angiomatosis seizures, galucoma *congenital vasc. disorder affecting small vessels
question

Liver angiosarcoma associated with
answer

VINYL CHLORIDE, ARSENIC, thorium dioxide these are malignant tumors
question

Cavernous hemangioma
answer

Benign lesion of liver/spleen small vessel endothelium (found in cerebellum/ retina in VHL disease)
question

Bilateral renal angiomyolipoma is associated with
answer

tuberous sclerosis!
question

ADH and Oxytocin go from hypothalamus to post. pit via?
answer

NEUROPHYSINS
question

Posterior pituitary derived from?
answer

Neuroectoderm (neurohypophysis)
question

Anterior pituitary derived from?
answer

Ectoderm (Rathke’s pouch) its the adenohypophysis
question

Anterior pituitary produces
answer

FLAT PeG + MSH FSH, LH, ACTH, TSH, Prolactin, GH
question

GLUT distribution
answer

GLUT1- RBC, brain GLUT2- B cells, liver, kidney, SI GLUT4- skel muscle, adipose (insulin dep)
question

Can brain use ketones?
answer

Yes, only in starvation!
question

Can RBCs use ketones?
answer

NO!! They have no mitochondria for aerobic metabolism
question

Insulin release is increased by:
answer

hyperglycemia, GH, B2 agonists
question

Insulin release is decreased by:
answer

hypoglycemia, somatostatin, alpha-2 agonists
question

What inhibits glucagon release?
answer

insulin, somatostatin, hyperglycemia
question

Dopamine does what to prolactin?
answer

INHIBITS secretion
question

What factors increase prolactin release?
answer

Estrogen Serotonin ACh Opiates TRH
question

Biceps reflex
answer

C5
question

Triceps reflex
answer

C7
question

Patella reflex
answer

L4
question

Achilles reflex
answer

S1
question

Enzyme deficiency in Tay Sachs
answer

AR Hexosaminidase A (buildup of GM2)
question

Enzyme def in Gauchers
answer

AR Glucocerebrosidase (buildup of glucocerebroside)
question

Enzyme def in Fabrys
answer

XR alpha-galactosidase A (buildup of ceramide trihexoside)
question

Enzyme def in Niemann Pick
answer

AR Sphingomyelinase (buildup of sphingomyelinase)
question

Enzyme def in Metachromic leukodystrophy
answer

AR Arylsulfatase A (buildup of sulfatides)
question

Enzyme def in Krabbes
answer

AR Galactocerebrosidase (galactocerebroside)
question

Enzyme def in Hurlers disease
answer

AR alpha-L-iduronidase (buildup of heparan sulfate, dermatan sulfate) gargoylism, airway obst., corneal clouding, HSM
question

Enzyme def in Hunters disease
answer

XR Iduronate sulfatase (buildup of heparan sulfate, dermatan sulfate)
question

CMV binds what cell receptor?
answer

Cellular integrins
question

EBV binds what cell receptor?
answer

CR2 (CD21)
question

HIV binds what cell receptor?
answer

CD4, CXCR4/CCR5
question

Rabies virus binds what cell receptor?
answer

Ach
question

Rhinovirus binds what cell receptor?
answer

ICAM1 (CD54)
question

Somatostatin inhibits:
answer

GH, TSH insulin, glucagon, gastrin
question

Somatostatinoma presents like:
answer

Achlorhydria Cholelithiasis Steatorrhea
question

VIPoma presents like:
answer

Watery diarrhea Hypokalemia Achlorhydria **WDHA syndrome
question

Retroperitoneal structures
answer

SAD PUCKER Suprarenal gland, Aorta (& IVC), Duodenum (2nd, 3rd parts), pancreas (except tail), uterers, colon (descending, ascending), kidneys, esophagus (lower 2/3), rectum (lower 2/3)
question

Hepatoduodenal ligament connects and contains?
answer

connects liver to duodenum contains portal triad: PORTAL VEIN, HEPATIC ARTERY, COMMON BILE DUCT “pringle maneuver” stops bleeding
question

Gastic banding surgery goes through?
answer

LESSER omentum gastrohepatic & hepatoduodenal ligaments
question

Whats in gastrohepatic ligament?
answer

Gastric arteries
question

Leyers of digestive tract
answer

Mucosa (epithelium, lamina propria, musc. mucosa) Submucosa Muscularis externa Serosa
question

Submucosal plexus (Meissners)
answer

controls secretory activity
question

Myenteric plexus (Auerbachs)
answer

controls muscle contractions
question

SMA syndrome
answer

transverse (3rd) part of duodenum is trapped between SMA and aorta leading to intestinal obstruction
question

Abdominal aorta branches
answer

Celiac trunk (T12) SMA (L1) L. renal artery (L1) IMA (L3) Bifurcation of aorta (L4)
question

GI blood supply
answer

Foregut- Celiac artery, vagus nerve Midgut- SMA, vagus nerve Hindgut- IMA, pelvic nerve
question

Portosystemic anastamosis
answer

1. paraumbilical to epigastric (caput medusae) 2. left gastric to esophageal (esophageal varices) 3. superior rectal to middle/inferior rectal (internal hemorrhoids)
question

Hemorrhoids
answer

Internal = PAINLESS (drain to portal system) External = PAINFUL (drain to IVC), lymph to superficial inguinal nodes
question

Liver zones
answer

Zone 1 (periportal)- viral hep Zone 3 (pericentral vein)- ischemic injury, alcoholic/toxic injury, P450 system
question

Duadonal associations
answer

Part 1- gastroduodenal artery Part 2- head of pancreas Part 3 (transverse)- SMA syndrome (trapped between SMA and Aorta)
question

Indirect inguinal hernia
answer

through deep inguinal ring, superficial inguinal ring, and into the SCROTUM *failure of processus vaginalis to close (can form hydrocele also) LATERAL to inf. epigastric artery
question

Direct inguinal hernia
answer

through Hesselbachs triangle, through abdominal wall , goes through superficial inguinal ring only covered by external spermatic fascia MEDIAL to IEA
question

Whats the leading cause of bowel incarceration?
answer

Femoral hernia
question

Parts of SI
answer

DUODENUM- secretes alkaline fluid, lipid digestion, Fe absorption JEJUNUM- more goblet cells, lipid absorption, folate abs. ILEUM- peyers patches, B12 abs
question

GI hormones
answer

Gastrin (G cells- stomach antrum) CCK (I cells- duodenum, jejunum) Secretin (S cells- duodenum) Somatostatin (D cells- panc islets, GI mucosa) GIP (K cells- duodenum, jejunum) VIP (parasymp ganglia) NO Motilin (SI)
question

Saliva
answer

High HCO3-, K+ hypotonic
question

Which AA stimulate gastrin release?
answer

Phenylalanine, Tryptophan
question

Absorption of Glucose & Galactose
answer

SGLT1 (Na + dependent)
question

Absorption of Fructose
answer

Facilitated diffusion (GLUT5)
question

Fe absorbed in
answer

Duodenum
question

Folate absorbed in
answer

Jejunum
question

B12 absorbed in
answer

Ileum
question

Sucrose is broken down into
answer

fructose and glucose
question

benign salivary gland tumors
answer

pleomorphic adenoma (cartilage + epithelium) warthins tumor (cystic tumor w/ germinal centers)
question

malignant salivary gland tumor
answer

mucoepidermoid carcinoma- mucionous and squamous components painful mass, involves facial nerve
question

Achalasia has loss of which plexus?
answer

Myenteric (auerbachs)
question

Achalasia increases risk of:
answer

esophageal SCC
question

GERD increases risk of:
answer

esophageal adenocarcinoma
question

Precursor lesions to SCC of the oral cavity
answer

Leukoplakia Erythroplakia (vascularized, more suggestive of dysplasia)
question

Whipples disease
answer

Infxn with Tropheryma whipplei PAS + foamy macrophages in intestinal lamina propria (PAS stains glycoprotein) CAN- cardiac symptoms, arthralgias, neuro sympt.
question

Celiac sprue has IgA against
answer

endomysium tissue transglutaminase gliadin (assoc. with dermatitis herpetiformis)
question

Erosions only go into the:
answer

mucosa
question

Ulcers go through the
answer

submucosa
question

Type A gastritis
answer

FUNDUS/BODY autoantibodies to parietal cells pernicious anemia, achlorhydria
question

Type B gastritis
answer

ANTRUM H. pylori increase risk of MALT lymphoma
question

Menetriers disease
answer

gastric hypertrophy with protein loss, parietal cell atrophy, inc. mucous cells PRECANCEROUS
question

Mets of intestinal type gastric cancer
answer

Sister mary joseph nodule (subcut. periumbilical mets)
question

Mets of diffuse type gastric cancer
answer

Krukenbergs tumor- bilat mets to ovaries
question

Major risk factors for intestinal type gastric cancer
answer

H. pylori, NITROSAMINES, achlorhydria, chronic gastritis, type A blood
question

Duodenal ulcer
answer

pain DECREASED with meals 100% assoc w/ H. pylori generally benign seen in ZE syndrome, hypertrophy of brunners glands
question

Gastric ulcer
answer

pain INCREASED with meals 70% assoc. w/ H pylori increased risk of cancer
question

Rupture of ulcer on lesser curvature of stomach
answer

Bleeding from left gastric artery
question

Perforation of duodenal ulcer (posterior wall)
answer

Bleeding from gastroduodenal artery
question

Chrons is mediated by
answer

TH1
question

Ulcerative colitis is mediated by
answer

TH2
question

“L. sided appendicitis”
answer

diverticulitis LLQ pain, fever, leukocytosis can lead to colovesical fistula
question

Zenkers diverticulum
answer

herniation of mucosal tissue at Killians triangle (btwn thyropharyngeal and cricopharyngeal parts of inf. pharyngeal constrictor) FALSE divertivulum -halitosis, dysphagia, obstruction
question

Cause of intussusception and pancreatitis in children
answer

LYMPHOID HYPERPLASIA
question

Hirschsprings disease
answer

need to biopsy SUBMUCOSA to diagnose (rectal suction biopsy) failure of neural crest cell migration to colon (always involves rectum) –> early constipation, inability to pass stool lack of ganglion cells/enteric nerve plexuses
question

Failure of recanalization of small bowel =
answer

duodenal atresia seen in down syndrome
question

What increases risk of malignancy for colon polyps?
answer

VILLOUS histology, larger SIZE increased epithelial dysplasia
question

Peutz Jegher syndrome
answer

STK11 gene mutation AD multiple hamartomas in GI tract hyperpigmented mouth, lips, hands, genitals increased risk colon, breast, gyn, other visceral malignancies
question

Most common locations of colon cancer
answer

RECTOSIGMOID > ascending > descending
question

Ascending colon cancer symptoms
answer

iron deficiency anemia, weight loss, occult blood exophytic mass
question

Descending colon cancer symptoms
answer

infiltrating mass, partial obstruction, hematochezia, colicky pain APPLE CORE/ napkin ring lesion
question

Rectal adenocarcinoma
answer

THIN STOOL
question

HNPCC syndrome
answer

AD mut in DNA mismatch repair gene (MLH1, MSH2) assoc. with microsatellite instability pathway
question

Adenoma-carcinoma sequence
answer

1. Loss of APC (colon at risk) 2. Mut in k-RAS (leads to adenoma, increased size of polyp) 3. Loss of p53, DCC (formation of carcinoma) *increased COX also increases risk
question

Consequences of cirrhosis
answer

Liver failure – hypoalbuminemia, edema, lack clotting factors, hyperammonium, decreased catabolism of estrogen (leads to gynecomastia, test. atrophy, spider angiomata), portal hypertension
question

Histologic findings of acute hepatitis
answer

Ballooning degeneration Councilman bodies (eosinophilic)
question

Histological findings in alcoholic hepatitis
answer

swollen & necrotic hepatocytes neutrophil infiltration Mallory bodies (intracytoplasmic eosinophilic inclusions)
question

Liver tumor associated with arsenic, polyvinyl chloride
answer

Liver angiosarcoma MALIGNANT
question

Liver tumor assoc. with aflatoxin, hep B & C, Wilsons, A1aT def, etc
answer

Hepatocellular carcinoma MALIGNANT
question

Carbon tetrachloride associated with:
answer

Centrilobular necrosis, fatty change of liver
question

Defect in Dubin-Johnson syndrome
answer

MRP2 (active transport of conjugated bili out of liver) –> black liver, benign
question

Mutation in Wilsons disease
answer

AR mut of ATP7B copper accum in liver, brain, CORNEA, kidneys, joints
question

Mutation in hemachromatosis
answer

AR mut in C282Y or H63D in HFE gene Assoc w/ HLA-A3 cirrhosis, “bronze” diabetes, CHF, HCC, testicular atrophy, degen joint disease
question

Gallstones
answer

Cholesterol stones (80%) PIgment stones- black (hemolysis), brown (infection)- E. coli, ascaris, clonorchis
question

Factors that increase gallstone formation
answer

Female, Fat, forty, fertile estrogen fibrates, bile acid resins
question

Factors that decrease gallstone formation
answer

High bile salts, high phosphatidyl choline, high 7alpha-hydroxylase
question

Causes of pancreatitis
answer

GET SMASHED gallstones, ethanol, trauma, steroids, mumps, autoimmune disease, scorpion sting, hypercalcemia, hyperTG, ERCP, drugs (sulfa)
question

Pancreatic pseudocyst lined by
answer

GRANULATION TISSUE
question

Whats elevated in acute pancreatitis?
answer

amylase lipase (higher specificity)
question

Trousseaus syndrome (pancreatic cancer)
answer

migratory thrombophlebitis, redness and tenderness on palpation of extremities HYPERCOAGULABILITY
question

Courvoisiers sign
answer

obstructive jaundice with palpable, nontender gallbladder
question

What is the charge barrier of the glomerular BM?
answer

heparan sulfate
question

Sites of mets in renal cell carcinoma
answer

LUNG, BONE
question

What cell type does renal cell carcinaoma originate from?
answer

proximal tubule cells POLYGONAL CLEAR CELLS filled w/ lipid and carbs
question

Paraneoplastic syndromes assoc. with RCC
answer

EPO, ACTH, PTHrP
question

Beckwith Wiedmann Synd
answer

Wilms tumor Neonatal hypoglycemia muscular hemihypertrophy organomegaly
question

Wilms tumor
answer

Del. of tumor suppressor gene (WT1) most common renal malignancy of childhood palpable flank mass, hematuria
question

WAGR syndrome
answer

Wilms tumor Aniridia GU malformaiton Mental retardation
question

Transitional cell carcinoma assoc.
answer

Phenacetin, Smoking, analine dyes, cyclophosphamide multifocal, tends to RECUR
question

Acute pyelonephritis treatment
answer

Ciprofloxacin VUR repair
question

what causes interstitial nephritis
answer

diuretics, penicillin deriv., sulfonamides, rifampin HSR, eosinophils in urine
question

what causes acute tubular necrosis?
answer

aminoglycosides, amphotericin B, contrast dye, heavy metals, ethylene glycol, urate also renal ischemia, crush injury
question

Stages of ATN
answer

1. Inciting event (dec GFR, oliguric) 2. Maintenance phase (oliguric, hyperKalemia, vol overload) 3. Recovery phase (polyuric, hypokalemia, volume depletion), re-epitheliazation of tubules
question

Signs of chronic renal failure
answer

Waxy broad casts Fixed specific gravity Free water clearance = 0 Inc. BUN and creatinine (UREMIA)
question

ADPKD is associated with:
answer

berry aneurysms, MVP, benign liver cysts
question

When will you see shrunken kidneys on ultrasound?
answer

Medullary cystic disease (AD) Chronic renal failure
question

Prolonged urinary tract obstruction leads to:
answer

Hydronephrosis atrophy of renal parenchyma fibrosis, mononuclear infiltrate, tubular atrophy
question

NTD markers
answer

High AFP High AChE in amniotic fluid
question

Anencephaly markers
answer

high AFP polyhydramnios
question

neurons stain + for
answer

synaptophysin
question

astrocyte marker
answer

GFAP
question

what cells are destroyed in MS?
answer

oligodendrocytes
question

what cells are destroyed in Guillain-barre?
answer

schwann cells
question

unmyelinated nerve fibers
answer

group C
question

Endoneurial inflammation
answer

Guillain-barre syndrome
question

NE
answer

locus ceruleus (pons) inc in anxiety, low in depression
question

Dopamine
answer

ventral tegmentum, SNc high in schizophrenia, low in parkinsons and depression
question

5-HT
answer

raphe nucleus (pons) low in anxiety, low in depression
question

ACh
answer

basal nucleus of meynert low in alzheimers, low in hunting tons high in REM sleep
question

GABA
answer

nucleus accumbens (reward center, pleasure) Low in anxiety, low in huntingtons
question

vomiting center
answer

area postrema (dorsal surface of medulla)
question

areas not protected by BBB
answer

OVLT (senses osmolarity) area postrema (emetic center)
question

supraoptic nucleus
answer

ADH
question

paraventricular nucleus
answer

oxytocin
question

Hypothalamus
answer

Lateral- hunger Ventromedial- satiety Anterior- cooling (parasymp) Posterior- heating (symp) Suprachiasmatic nucleus- circadian rhythm
question

Thalamus
answer

VPL- sensation body VPM- sensation/taste face LGN- vision (CNII) *LIGHT = L MGN- hearing *MUSIC = M VL- motor (basal ganglia) **everything except OLFACTION relays through the thalamus
question

Dopamine in the basal ganglia
answer

FACILITATES movement activates direct pathway (D1) inhibits indirect pathway (D2)
question

Parkinsons
answer

low dopamine Lewy bodies (alpha-synuclein) tremor, cogwheel rigidity, akinesia, postural instability
question

Huntingtons
answer

low GABA, low ACh, low SP high dopamine Chorea, CAG repeats, caudate degen.
question

Treatment for essential tremor
answer

B-blockers, primidone
question

Conduction aphasia
answer

damage to arcuate fasciculus
question

PCO2 in the brain
answer

cerebral vasodilator
question

MCA lesion
answer

Upper limb/face sensory and motor loss Aphasias
question

ACA lesion
answer

lower limb sensory and motor loss urinary incontinence
question

Lateral striate stroke
answer

contralat hemiparesis, hemiplegia
question

ASA lesion
answer

“medial medullary syndrome” contralat hemiparesis of lower limbs ipstilat hypoglossal dysfunction
question

PICA lesion
answer

“lateral MEDULLARY synd” Vom, vertigo, nystagmus DYSPHAGIA, HOARSENESS, dec. gag reflex ipsilat. horners, ataxia, dysmetria CN V, VIII, IX, X, XI
question

AICA lesion
answer

“lateral PONTINE synd” Vom, vertigo, nystagmus, ataxia, dysmetria PARALYSIS OF FACE (dec. lacrimation, dec taste from ant 2/3 tongue, dec CORNEAL reflex) ipsilat. horners
question

PCA lesion
answer

contralat hemianopia with MACULAR SPARING
question

AComm lesion
answer

common site of saccular aneurysm visual field defects
question

Pcomm lesion
answer

berry aneurysms CN III palsy “down and out”, ptosis, mydriasis
question

rupture of berry aneurysms cause
answer

SUBARACHNOID HEMORRHAGE (WHOML) assoc. with ADPKD, ehlers-danlos, marfans
question

Charcot-Bouchard microaneurysm is associated with
answer

chronic HTN causes small vessel hemorrhagic stroke (basal ganglia, thalamus, IC)
question

Amyloid angiopathy causes
answer

LOBAR hemorrhage
question

Bright areas on non contrast CT indicate:
answer

hemorrhage
question

Normal pressure hydrocephalus
answer

Inc. subarachnoid space volume (no inc. in pressure) Stretch cortical fibers of corona radiate –> TRIAD: urinary incontinence, ataxia, cognitive dysfunction (“wet, wobbly, wacky”)
question

Lumbar puncture
answer

between L3-L4, L4-L5 dont pierce the pia!
question

Lateral horn found at
answer

T1-L2
question

ALS defect
answer

SOD1 mutation UMN & LMN defects anterior horn- LMN lesion lateral corticospinal tract- UMN lesion
question

Tabes dorsalis
answer

Degen of DORSAL columns Impaired sensation and proprioception, progressive sensory ataxia Charcot’s joints, shooting pain, Argyll Robertson pupil absent DTR, + Romberg caused by tertiary syphilis
question

Subacute combined degeneration
answer

B12 or Vit E def. Demyelination of dorsal columns, lat corticospinal tracts, spinocerebellar tracts ataxia, paresthesia, impaired position & vibratory sense
question

Werdnig hoffman disease
answer

AR, congenital degen of anterior horn leading to LMN defects “floppy baby” hypotonia, tongue fasciculations, death ~7 months
question

Friedreich’s ataxia
answer

AR trinuc repeat “GAA” frataxin gene, impaired mito function (iron homeostasis, respiratory function) staggering, falling, dysarthria, nystagmus, pes cavus, HYPERTROPHIC CM, kyphoscoliosis
question

Germinoma
answer

pineal gland tumor precocious puberty, obstructive hydrocephalus parinaud syndrome (vertical gaze paralysis)
question

Facial nerve palsy (complete)
answer

Ipsilateral facial paralysis Inability to close eye on involved side Decreased tearing ipsilat. Increased salivation ipsilat. HYPERACUSIS (stapes oscillates more widely) Loss of taste on ant 2/3 of tongue
question

Presbycusis
answer

High freq sensorineural hearing loss in elderly loss of hair cells at base of cochlea
question

What makes the aqueous humor?
answer

ciliary epithelium
question

CN III damage (oculomotor)
answer

eye looks “down and out” ptosis, mydriasis, loss of accommodation
question

CN IV damage (trochlear)
answer

eye moves upward contralateral head tilt problems going down stairs
question

CN VI damage (abducens)
answer

medially directed eye, can’t abduct internal strabismus (horizontal diplopia)
question

test obliques while…
answer

ADDUCTING eye
question

Miosis controlled by
answer

CN III parasympathetic (short ciliary nerves to pupillary sphincter muscles)
question

Mydriasis controlled by
answer

sympathetic long ciliary nerve to pupillary dilator muscles
question

Marcus Gunn pupil
answer

**AFFERENT pupillary defect decreased bilat pupillary constriction when light shone in affected eye (swinging flashlight test)
question

Treatment for “wet” macular degeneration
answer

anti-VEGF (ranibizumab, pegaptanib)
question

Hemianopia with macular sparing
answer

PCA infarct
question

Alzheimers treatment
answer

Cholinesterase inhibitors (donepezil) Vit E (anti ox) NMDA receptor antag (memantine)
question

Pilocytic astrocytoma
answer

Rosenthal fibers CYSTIC + SOLID GFAP positive found in cerebellum benign tumor found in kids
question

Medulloblastoma
answer

Homer-wright rosettes, solid, small blue cells MALIGNANT cerebellar tumor in kids drop mets to SC
question

Ependymoma
answer

childhood brain tumor ependymal cells of 4th ventricle perivascular PSEUDOROSETTES can cause hydrocephalus
question

Hemangioblastoma
answer

Cerebellar tumor seen in VHL can produce EPO “foamy cells”
question

Craniopharyngioma
answer

benign childhood brain tumor derived from RATHKEs pouch calcifications common SUPRAtentorial
question

S-100 positive tumors
answer

schwannoma, melanoma, neuroblastoma

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