Reversible cell injury
-hypoxia impairs oxidative phosphorylation resulting dec ATP
-Low ATP disrupts key cellular fxns like Na/K pump (results in sodium and water buildup in the cell) and Ca2+ pump (resulting in Ca2+ buildup in the cytosol of the cell) and aerobic glycolysis (
What are the two major neurotransmitters involved in pain sensation?
-substance P and glutamate
-enkaphalin inhibits substance P
Where are the descending motor pathways in the spinal cord?
-motor pathways run along the lateral aspect of the ventral part of the spinal cord (see orange/red in pic)...basically posterior ventral laterally lol
-i believe motor decussates in the brainstem but this is a spinal cord slice so any lesion here would b
if diabetic because hypoglycemic and passes out, what do you give the pt?
-give glucagon which stimulates glucose production in liver
-hypoglycemia is low glucose in the blood
Atherosclerosis
-disease of elastic arteries and large and medium sized muscular arteries
-most common in the abdominal aorta > coronary artery > popliteal artery > carotid artery > circle of Willis (A CoPy Cat named Willis)
What is the most common vessel involved in ischemic bowel disease?
-SMA!
Kallikrein pathway
-Kallikrein -> bradykinin which leads to inc vasodilation, inc permeability, inc pain
-invovled in factor XIIa pathway and so
-if bleeding and have no history of bleeding but have prolonged PTT, then might be deficient in unnecessary factor of intrinsic p
If you have a rare disease, what is the shortcut for when doing a hardy weinberg problem?
-you can assume that q = 0 so therefore p = 1; to calculate the heterozygote case then you can do 2(1)(actual q value)
Charcot-Marie-Tooth
-hereditary motor and sensory neuropathy
-group of progressive hereditary nerve disorders related to the defective production of proteins involved in the structure and function of peripheral nerves or myelin sheath
-typically autosomal dominant and associ
What is the flow equation?
-> Q (flow) = Area (A) x rate (V)
-remember that cm^3 = mL
Pseudofolliculitis barbae
-medical term for razor bumps
-foreign body inflammatory facial skin disorder characterized by firm, hyperpigmented papules and pustules that are painful and pruritic
-located on cheeks, jawline, neck
-commonly occurs as a result of shaving (razor bumps),
What causes an increase in lymphatic flow?
-think about the hydrostatic pressure equation
-either an inc in hydrostatic pressure (due to as occurs when venous pressures become elevated by gravitational forces, volume expanded states, in heart failure or with venous obstruction)
-or a dec in oncoti
What is the most likely affected tissue in the heart by a myocardial infarc?
-the ventricles
What can happen 3-14 days after an MI?
-free wall rupture--> tamponade
-papillary muscle rupture-->mitral regurg
-interventricular septal rupture-->L to R shunt-LV pseudoaneurysm
What is a vitamin based drug that can treat dyslipidemia?
-niacin
-MOA is anatongizes VLDL cholesterol secretion
Leukotriene C4, D4, E4
-trigger vasoconstriction, vascular permeability, and bronchospasm-->involved in asthma pathogenesis
-leukotrienes in general cause asthma
Reye syndrome pathophys
-causes hepatic encephalopathy and affects the mt-->mt not working so cannot preform urea cycle--> buildup of ammonia-->ammonia affects brain and you get a wet head (cerebral edema)
-other things happen too
Enfuvirtide
fusion inhibitor (gp41)
Syringomyelia (Syrinx)
-known for causing loss of pain and temperature sensation as one of the first symptoms due to damage of the anterior white comissure of the spinothalamic tract (2nd order neurons) --> bilateral symmetrical loss of pain and temp sensation in cape-like dist
Which are the vitamins D versions are already activated? as in does not need conversion of 1-alpha hydroxylase in the kidney?
-vit. D tablets
-you need activation though for vit. D from sunlight and plants
T or F: morphine is metabolized to active metabolites that accumulate
-leads to an inc effect from accumulation of a couple of days
-chronic use can be lethal due to metabolization of morphine which leads to active metabolites that accumulate (e.g. Moprhine-6-glucuronide (M6G) is a major active metabolite of morphine, and a
What kind of injury can you when you experience sudden pain from weight lifting?
-inc weight lifting and holding your breath increases intra-abdominal pressure and this pressure will be transferred to the CSF in the spinal cord which causes a disc herniation (rupture of an intervertebral disc)
What is uniparental disomy?
-Offspring receives 2 copies of a chromosome from 1 parent and no copies from the other parent
-angelman and prader-willi syndrome are ex of disorders that can be caused by uniparental disomy
Collagen types quick mneumonic
-Type I: strong
-II: slippery
-III: bloody
-IV: bm
internal ribosome entry site (IRES)
-A site within an mRNA sequence where a ribosome can bind and initiate translation
-allows for translation initiation in the middle of a messenger RNA (mRNA) sequence as part of the greater process of protein synthesis
What is the purpose of the 5' cap?
-cap is modified guanine nucleotide and it protects the transcript from being broken down
-also helps the ribosome attach to the mRNA and start reading it to make a protein
See graph...what is B?
-B is when you start eating...immediately when you start eating, grehlin starts going down
-C might be at the end of your meal and D when you are digesting
What does Gs activate?
-this activates adenylyl cyclase to increase camp....think about the vibrio sketch and the Gs
-also somatotroph adenoma can inc Gs activity
-remember that GTPase inactivates G proteins
Left coronary artery artery branches into what?
-LAD and circumflex
T or F: Type II pneumocytes serves as stem cell precursors for 2 cell types (type I and II) + proliferate during lung damage AND secrete surfactant from lamellar bodies
-T!
-secrete surfactant from lamellar bodies
When a kid has stroke like episodes and hypotonia...what should you think?
-mitochondrial disease like MERF or MELAS
-these mt diseases have heteroplasmy which is variable expression in mitochondrial diseases
Anytime you see muscle weakness and cramping after exercise, what should you think?
-mcHurdle--McArdle!
-no rise in lactic acid--> could be because if we cannot even break down glycogen to glucose to get pyruvate, we can't even turn pyruvate to lactate via lactate dehydrogenase. And also, without anaerobic metabolism, you fatigue quickly
Vitamin E
-Vitamin E refers to a group of fat-soluble vitamins including tocopherol and tocotrienol, for which the exact biological function is poorly understood.
-Vitamin E excess has can alter the function of vitamin K, enhancing warfarin's anticoagulant effects.
zero order vs first order elimination
-Zero Order: Constant amount (linear) eliminated (like if 2 gets eliminated every hour, then 4 gets eliminated by two hours, regardless of concentration)
First Order: Constant proportion (geometric, or linear if log scale) (so like if you start with 100 a
Why does the vocal cords close immediately after laryngeal irritation?
-bc this is a reflex to prevent aspiration of foreign body from going further into trachea so GLOTTIS closes and vocal cords contract to shut the larynx
T or F: Testosterone makes your prostate grow
-T!
-that is why you can remove testes is you have a prostate tumor or problem and whatnot
-this will cause the prostate cells to shrink (scattered shrunken cells)
ligamentum flavum
What is normal BUN:creatinine ratio?
-> 20:1
-if have higher than this, then pre-renal azotemia
-if have lower than this, post-renal azotemia
How do you kill phagocytosed bacterial organisms? intracellular killing
-usein NADPH oxidase which initiates respiratory burst
-used to kill catalase positive bacteria
What bugs bud/budding?
-fungi!
-candida albicans is an elliptical purple budding organism (apparently some fungi like yeast can take up gram stain)
-on sheep's blood agar, grows grey colonies
Male sexual response (erection reflex arc)
-afferent is pudendal nerve (both sensory so ext genitalia and anus and both urethral and anal external sphincter; motor for various pelvic muscle and external sphincters)
-efferent is sacral parasympathetic nerve
What do parietal cells look like on microscopy?
-parietal cells have a central round nucleus, acidifilic cell, nice round plumpy (B) appearance
-chief cells is elongated and more basophilic (C)...chief is dark
Zollinger-Ellison syndrome
-malignant islet cell tumor secreting gastrin;
-peptic ulcers-->could get black stools
-will not be relieved by PPIs bc ectopic gastrin being produced so not under regulation
-tumor in the pancreas
contemplation vs. precontemplation
-contemplation: acknowledging that there is a problem, but not yet ready or willing to make a change
-pre-contemplation: not yet acknowledging that there is a problem
Gram negative vs. gram positive structure
-gram negative: outer membrane
neuronal degeneration
-destruction and death of nerve cells and tissue loss that cause memory failure, personality changes, problems carrying out daily activities and other symptoms of Alzheimer's disease
-Over time, the brain shrinks in size
-someone like a retired boxer can
T or F: In patients with a horseshoe kidney it gets stuck below the IMA and it cannot ascend so there are two possibilities: Either a low implantation of the renal arteries or the formation of multiple renal arteries. It is a detail for the surgeon to con
-T!
small cell lung cancer histology discription
-Round / oval blue cells with minimal cytoplasm; usually small to medium sized
-infiltrating sheets of cells
T or F: Renal papillary necrosis is a common application of sickle cell disease which cause gross hematuria
-T!
Lineweaver-burk plot
What are the effects of Ace Inhibitors/ARBS?
-(1) Dilate efferent arteriole
-(2) ? ? GFR
-(3) ? Aldosterone release
-(4)? ? Na+/HCO3- reabsorption in PCT
-they do the opposite of angiotensin II
How do deficiencies in CD55 and CD 59 cause hemolysis in Paroxysmal nocturnal hemoglobinuria?
-cause complement activation-->intravascular hemolysis (dec CD 55 and 59 on RBC surface)--> activation of complement pathway including MAC--> RBC lysis
-so can treat with eculizumab but this targets MAC so need to vaccinate against neisseria first (bc of
Hepatic encephalopathy (HE)
-caused by dec hepatic metabolism of ammonia due to protosystemic shunting of blood in cirrhosis
-hyperammonemia is characteristically associated with asterixis, a "hand-flapping" tremor noticed with outstretched arms and extended wrists
-lactulose inc in
Schiller duval bodies
-Glomeruloid-like structures seen on histology of Yolk Sac (endodermal sinus) tumors
-papillary structures with a central vessel
What are hirudins such as bivalrudin successful in the treatment of HIT?
-not inhibited by platelet factor 4
-independent of antithrombin III
-forms a compact stoichiometric complex with one molecule of thrombin, neutralizing the actions of thrombin
axillary sheath contents
sheath is extension of fascia
contains :
--axillary artery and branches
--axillary vein and tributaries
--brachial plexus (cords and branches)
-if there is an axillary aneurysm in this area, the cord (like medial cord for ex) would be most affected
What is one procedure used in the control of postpartum hemorrhage?
-ligation of the internal iliac artery
Salicylates poisoning causes what type of acidosis/alkalosis?
-early--causes hyperventilation
-late--causes high anion gap metabolic acidosis (can start occuring after several hours)
Smudge cells on peripheral smear
CLL/SLL
REM rebound
-phenomenon is characterized by an increase in the number and intensity of dreams for several days after discontinuation of the drug in question
-dreaming happens in REM
-drugs that dec the amount of REM are alcohol, barbiturates, and phenothiazine can ca
PCOS lab levels
-inc LH:FSH ratio
-inc LH causes inc androgen production which leads to hirsutism and acne
-elevated androgen production results in formation of several immature cystic follicles
Acanthosis nigricans
-a condition characterized by dark, thick, velvety skin in body folds and creases
-acanthosis = hyperplasia of the stratum spinosum of the epidermis)
-can be seen in patients with underlying cancers, and also in obese and diabetic patients
-important cuta
What is seroconversion and how do you test for it?
-seroconversion refers to the presence of antibodies in an individual's blood that specifically recognize a pathogen with which the individual has been infected
-western blotting can be used to identify the presence of antibodies
ATP and cAMP relationship?
-if cAMP inc, then ATP decreases
What increases hydrostatic pressure in the kidney? is it either constricting the efferent arteriole or dilating the afferent arteriole?
-constricting the efferent arteriole
-also filtration fraction increases as a result of efferent arteriolar constriction; afferent arteriolar dilation has little effect on filtration fraction
pseudoachalasia
-associated with esophageal malignancy and produces symptoms of solid and liquid dysphagia, regurgitation, chest pain, weight loss (>15 lbs), advanced age at symptom onset (>50 yrs)
-manometry findings includ elevated LES pressure and absence of peristals
radioiodinated serum albumin (RISA), deuterium-labeled water (D2O), and radioactive Na+ can measure what compartments?
-RISA measures plasma volume
-D2O measures total body weight
-radioactive Na+ measures ECF (think like this salt goes to kidneys and gets filtered so in ECF)
-ISF cannot be determined by measurement of a substance so must calculate using ECF = ISF + plasm
May-Thurner Syndrome (MTS)
-compression of the left common iliac vein between the right common iliac artery and the L5 vertebra
-compression of the left common iliac vein inc the risk of DVTs in the left lower extrem due to venous outflow obstruction
-females, pt with spinal abnorm
flutamide*******
-A nonsteroidal competitive inhibitor at androgen receptors.
-Used for prostate carcinoma
-in pic on the sofa so NOT the anabolic steroids
-in pic, the drugs on the sofa are androgen receptor antagonists
How to calculate odds ratio?
-ad OR bc (mneuonic)
Traumatic aortic rupture
-often caused by rapid declaration that occurs in MVCs or suicide jumping off building attempts
-The most common site of injury is the arortic isthmus, which is tethered by the ligamentum arteriosum making it more immobile so more prone to injury and rupt
Chikungunya virus
-togavirus
-co-infection with dengue virus can occur
-may also present with flu-like symptoms (fever, malaise), joint pain (arthralgias which can persist even after infection resolution), and rash
-transmitted by mosquitoes (Aedes aegypti and Aedes albopi
Disseminated histoplasmosis
-progressive extrapulmonary infection that may cause pancytopenia due to bone marrow infiltration
-risk factors for disseminated histoplasmosis include immunosuppression, extremes of age, and exposure to bird or bat droppings
triptyline" or "pramine" are suffixes for what kind of drugs?
-TCAs
TCA toxicity
-treat painful diabetic neuropathy
-can result in convulsions, ocoma, cardiotoxicity, respiratory depression, and hyperpyrexia
-sodium bicarbonate is the antidote for cardiotoxicity caused by TCA-mediated inhibition of cardiac fast Na+ channels
What drug can block premonitory symptoms of hypoglycemia?
-well when you low on glucose (like when you're hungry af, you are gittery....so palpitations, tremor, nervousness and tachycardia are premonitory symptoms)
-propanolol can block these symptoms bc non selective beta adrenergic
-so the use of cardioselecti
Anabolic steroids
-in pic these drugs are anabolic so they are by the weights
-in pic, testosterone derivs usually end in "sterone"
-in pic, anabolic steroids end in "drolone"...so drooling guy who is lonely
-the red is complications/bad side effects of the drugs
-the yell
BPH drug treatment
-finasteride
-5-alpha reductase inhibitor
-can cause gynecomastia and sexual dysfunction
-use to treat BPH and male pattern baldness
late stage of type I hypersensitivity reaction
-a few hours after the immediate response ensues, a late phase reaction occurs which is mediated by downstream products of the arachidonic acid cascade such as prostaglandins and leukotrienes
-influx of macrophages producing interleukin-1 (IL-1), IL-6, an
What effect does vitamin D tablets have on calcium?
-inc re-absorption of Ca2+ and PO4 2- in the kidney and GI
oral mucosa is composed of what bugs?
-aerobes: streptococcus and klebsiella
-anaerobes: peptostreptococcus, fusobacterium, prevotella, bacteroides
-if have aspiration pneumonia (alcoholic), then involves infection with normal oral flora
Amphetamine intoxication
-SNS effect
-serotonin like syndrome
-pupillary dilation, euphoria, anorexia, fever, HTN
costochondritis??????
-an inflammation of the cartilage that connects a rib to the sternum
-sharp, well-localized pain (chest pain and tenderness) that is reproducible on palpation of costal cartilage
-history of recent exercise/exertion/chest wall trauma
dysthymic disorder
-a mood disorder involving a pattern of comparatively mild depression that lasts for at least two years
What is the hypercalcemia in sarcoidosis due to?
-extra 1-alpha hydroxylase produced in the granulomas may lead to hypervitaminosis D
What are the risk factors for pancreatic adenocarcinoma?
-Smoking
-Alcohol
-Chronic pancreatitis
What is the biggest risk factor for osteoporosis?
-GENDER
-smoking if we are talking about BEHAVIORAL risk factors
pelvic splanchnic nerves
-aka pelvic parasympathetic nerves (pelvic splanchnic nerves)
-parasympathetic nerve fibers that arise from S2, S3 and S4 nerve roots of the sacral plexus
-regulate the emptying of the urinary bladder, control opening and closing of the internal urethral
When in doubt, flank pain radiating to groin with nausea and vomiting is always..?
-kidney stone!
Chediak-Higashi syndrome
-Auto Recessive
- Giant granules in neutrophils, infections, oculocutaneous albinism
-lysosomal trafficking is disrupted-->lysosome is unable to fuse with phagosome-->phagocytosed microbe never reaches lysosome-->microbe not destroyed
-impaired phagolysos
brief psychotic disorder
-Psychotic disturbance involving delusions, hallucinations, or disorganized speech or behavior but lasting less than 1 month; often occurs in reaction to a stressor.
posterior communicating artery aneurysm compresses....?
-causes ipsilateral CN III palsy which leads to mydriasis (blown pupil) and may also see ptosis, "down and out eye
medial cerebral artery rupture
-ischemia in the MCA distribution which leads to a contralateral upper extremity and lower facial hemiparesis, sensory deficits
anterior communicating artery aneurysm/compression
-bitemporal hemianopia (compression of optic chiasm), visual acuity deficits
-if rupture--> ischemia in the ACA distribution-->contralateral lower extremity hemiparesis, sensory deficits
myxoma
-most common primary cardiac tumor in adults
-90% occur in the atria (mostly the LA)
-usually described as a "ball valve" obstruction in the LA (associated with multiple syncopal episodes)...may look pedunculated
-IL-6 production by tumor-->constitutional
what causes eosinophils to be found in urine?
-interstitial nephritis
-classically eosinophilia when caused by drugs that act like haptens
-drugs that cause interstitial nephritis include 5 P's: Pee (diuretics), pain-free (NSAIDs), penicillins & cephalosporins, PPIs, and rifamPin
PCOS hormone levels
-usually pts are fat so inc insulin
-hyperinsulinemia and/or insulin resistance hypothesized to alter hypothalamic hormonal feedback response-->inc LH:FSH ratio
--inc LH: FSH ratio-->inc androgens-->inc testosterone
Most common bug that causes bacterial meningitis in pts 18+ is?
-Strep pneumo!!
Dextromethorphan
-cough suppressant (antitussive)
-less opioid-related (poppy seed bagel bc it's an opioid agonist) sedation and respiratory depression, dextromethorphan can be very useful for symptomatic relief of cough
-main ingredient in robitussin (robotrippin--when p
How to dec risk of additional fractures in a pt with osteoporosis?
-do WEIGHT bearing exercises like freaking walk outside
What are the three encapsulated bacteria sickle cell pts are at risk of getting sick from?
-strep pneumo
-H. influe
-Neisseria meningitis
What is a sensitivity test used for?
-SNOUT
-used to rule out disease...So for screening purposes tests you should always have a HIGH SENSITIVITY
Absolute Risk Reduction (ARR)
The difference in risk (not the proportion) attributable to the intervention as compared to a control
cross-sectional
-happening at one point in time
-no mention of follow-up
When is a girl or boy considered to have precocious puberty?
-girls younger than 8 years old
-boys younger than 9 years old
Anytime you see zollinger ellison in the question stem, what should you always consider?
-MEN 1 SYNDROME!!!!!
-bc zollinger ellison is a gastrinoma which is the most common pancreatic problem of men 1's 3P's
-other P's are pituitary (prolactinoma) and parathyroid gland (renal calculi and whatnot)
What disease causes osteoblastic lesions vs osteoclastic lesions?
-prostate cancer mets causes osteoBLASTIC lesions
-multiple myeloma causes osteoCLASTIC lesions
When it hurts to breath deeply, how will that affect respiration rate, tidal volume, and airway resistance?
-tidal volume will be less bc pt will breathe shallow breaths bc deep ones hurt too much
-respiration rate will inc to compensate for shallow breathing (need to maintain O2 coming in)
-airway resistance is unchanged
Hallmark of RA
-hallmark: synovitis leading to formation of pannus (inflamed granulation tissue)
How to tell if you have SIADH via lab values?
-hyponatremia (Na+ is under 135)
-plasma osmolality is less than 280
-watch out for this if you see HYPONATREMIA
Fetal karyotyping confirmatory test order?
-Chorionic villus sampling (9-14 weeks)
-amniocentesis (15-22 weeks)
-percutaneous umbilical cord sampling (18-22 weeks)
-see pic (first three bullets are screening tests)
T or F: At week 16, your belly should be big but 3 inches below belly-button
-T!
-at 20 weeks, stomach should be expanded to belly-button
Lead poisoning
-lead inhibits ferrochelatase and ALA dehydratase which dec heme synthesis and inc RBC protoporphyrin
-also inhibits rRNA degradation-->RBC's retain aggregates of rRNA (basophilic stippling in PERIPHERAL BLOOD SMEAR)
-symptoms: LEAD (Lead Lines--on gingiv
meningioma
-originates from arachnoid mater
-most common primary CNS tumor in adults
-gross appearance: well-circumscribed, round
-most commonly fold in dural folds (falx cerebri, tentorium cerebelli, venous sinuses)--also includes interhemispheric fissure
Histological changes you see when you biopsy a painless chancre ulcer lesion?
-characterized by mononuclear cell infiltrate dominated by plasma cells with scattered histiocytes
-also see obliterative endarteritis with thickened small vessels due to proliferation of endothelial cells and fibroblasts
Histology of condyloma lata in a syphilis patient?
-resembles condyloma acuminatum, and characterized by prominent epidermal hyperplasia, more edema, chronic inflamm infiltrate, but less keratinization, minimal if any koliocytosis
Histology of gummas
-gummas: caseous necrosis, chronic inflammatory cell infiltrate, obliterative endarteritis
-healed gummas: become noncontractile scars with arching fibrosis
cardiac index
-ratio of cardiac output to body surface area (CO/BSA)
biliary atresia
-failure to form or early destruction of extrahepatic biliary tree
-leads to biliary obstruction within th e first 2 months of life
-presents with jaundice (conjugated) and progresses to cirrhosis
If you dec blood supply to both kidneys (say blood loss in automobile collision), then what would be responsible for dec in urine output?
-dec blood to kidneys-->infarct and cells die-->ATN--> dead cells slough off and block tubule so less pee (necrotic cells plug tubules; obstruction decreases GFR
-ATN causes are ischemia (often preceeded by pre-renal azotemia) or nephrotoxicity
Picture frame vertebrae tells you what?
-this is cement lines of paget's disease
vascular conductance
-opposite of vascular resistance
-is volume/pressure
-so inc during exercise
if baby fails to poop or has small bowel obstruction in the first 2 days of life, you should think of?
-meconium ileas (it's this if another sibling has cystic fibrosis)
-hirschsprung disease
-duodenal atresia
-Meconium ileus is a bowel obstruction that occurs when the meconium in your child's intestine is even thicker and stickier than normal meconium, cr
Silver stain is used for what bug?
-fungi (coccidioides, Pneumocystis jirovecii)
-legionella,
-H. pylori!!!
conversion disorder
-is a mental condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation
-loss of sensory or motor function (e.g. paralysis, blindness, mutism), often following an acut
Holoprosencephaly is associated with what?
-Trisomy 13 and FAS
-holoprosencephaly (cephalic disorder in which the prosencephalon (the forebrain of the embryo) fails to develop into two hemispheres)
Patau Syndrome
-Affected patients typically have severe intellectual disability (developmental delay), as well as various physical abnormalities. Notable findings include cutis aplasia, gastroschisis/omphalocele, holoprosencephaly (microcephaly and cyclopia), microphtha
Slowing of mental activity, big tongue, weight gain, constipated is what disease?
-hypothyroidism (myxedema)
Dermatome responsible for sensation over the lateral left foot and fourth and fifth toes
-S1
Bullemia nervosa symptoms
-recurring episodes of binge eating with compensatory purging behaviors at least weekly over the last 3months
-BMI often abnormal or slightly overweight (vs. aneroxia)
-associated with parotid gland hypertrophy (may see inc in serum amylase), enamel erosi
uncompensated acid base problem will show what values?
-the compensating values will be normal
-so if have an uncompensated respiratory acidosis, then bicarb will be in the normal range (22-26)
Flutamide
-is an anti-androgen
-non-steroidal competitive inhibitor at androgen receptors
-used for prostate cancer
When you treat DKA with insulin and IV fluids, what happens to the metabolite levels?
-insulin drives K+ to inside the cell, thereby lowering K+ in serum
-arterial pH will increase as insulin decreases ketones production
-serum HCO3- inc as blood pH inc
-blood PCO2 increases as part of compensation
-BUN will decrease as renal failure will
What mild pain reliever is NOT contraindicated with gastric ulcers?
-acetaminophen
-NSAIDS ARE CONTRAINDICATED (except celecoxib?)
Advantages of RCT vs PCS (prospective cohort study)?
-prospective cohort looks at a specific exposure to a substance (environmental toxin, drug, etc.), and asks "Who will develop this disease if exposed?" PCS's look attempt to find a relative risk associated with an exposure. They do not take into account t
Manifestations of alcohol withdrawal:
3-36 hr : tremors (the first manifestation) and other minor symptoms similar to other depressants
6-48 hr : seizures
12-48 hr : hallucinations (usually visual)
48-96 hr : delerium tremens (autonomic instability, fever, visual hallucinations, confusion, an
What is SIGECAPS used for?
-assessment of major depressive disorder
cDNA
-Complementary DNA
-DNA produced synthetically by reverse transcribing mRNA
-Because of eukaryotic mRNA splicing, cDNA contains no introns
Where is smooth muscle located in the lungs?
-bronchioles
What adverse effects does vinblastine cause?
(1) Peripheral neuropathy
(2) Paralytic ileus/Constipation
(3) Alopecia
(4) Myelosupression
T or F: burn scars and skin grafts lack eccrine glands, limiting the ability to sweat
-T
-can put pt at risk of getting hyperthermia if out and about on a hot summer day
CO poisoning
-odorless gas from fires, car exhaust, or gas heaters
-tx 100% O2, hyperbaric O2
-symptoms: headache, dizziness; multiple individuals may be involved (i.e. family), classically associated with bilateral globus pallidus lesions on MRI although rarely seen
What causes cancer in regards to tumor suppressor genes vs. proto-oncogenes?
-tumor suppressor genes block tumor formation by regulating cell growth so a deletion or loss of function mutation within these genes can lead to cancer
-proto-oncogenes are normal cellular genes and cancers involving these genes are usually due to gain-o
What does the APC gene do?
-tumor suppressor gene that regulates the bifunctional protein catenin (important for cell adhesion and transcription of genes important for proliferation)
-So APC promotes degradation of catenin by phosphorylation via GSK3b
complex hyperplasia without atypia vs. simple hyperplasia without atypia
-simple hyperplasia without atypia--cystic hyperplasia or mild hyperplasia where there is cystic dilated glands, non-neoplastic, due to anovulatory cycles
-complex hyperplasia without atypia is adenomatous hyperplasia in which there is overcrowding, close
what is the gene frequency of an x-linked recessive mutation in males?
-the same as the frequency of males born with the x-linked disease
Dandy-Walker malformation
-agenesis of cerebellar vermis-->cystic enlargement of the 4th ventricle that fills the enlarged posterior fossa
-enlarged posterior fossa, embryonic maldevelopment of the cerebellum and 4th ventricle
-enlarged head circumference, hypotonia, and muscle sp
Which benzodiazepines are more likely preferred in liver disease pts?
-lorazepam, oxazepam, and temazepam (LOT)--use these guys a LOT with pts with liver disease
Pt has HIV with low CD4 levels and meningitis...what does pt have?
-pt has cryptococcus neoformans (which is apparently monomorphic)
-and is also common in IC pts, especially in those with CD4 count less than 50
T or F: statistically speaking, the most common cause of meningitis in adult patients regardless of HIV status remains Streptococcus pneumoniae
-T!
What is the order of gene transfer for Hfr cells to F- recipients during conjugation?
-order of gene transfer is from oriT toward tra (but it is never possible for the entire chromosome to successfully cross the conjugal bridge
In an Hfr cell, where are the drug resistant genes?
-in the chromosome of a cell that has a stably integrated episome
What is responsible for establishing midline in the CNS?
-sonic hedgehog--signaling molecules essential for normal embryogenesis that has two primary functions--first, establishes a midline in the CNS (failure of SHH can lead to holoprosencephaly) and second, establishes the anteroposterior axis along a limb
What is directly involved in limb length determination in embryogenesis?
-fibroblast growth factor
-other functions include cell proliferation, migration, and differentiation
What is involved in organizing the limb in the dorsal ventral axis?
-Wnt-7
-produced in the apical ectodermal ridge at the end of the limb bud
What is alpha-1 antitrypsin deficiency characterized by?
-codominant inheritance pattern
-dec serum AAT--an enzyme produced in the liver
-emphysema secondary to inc elastase activity
-liver disease secondary to intracellular accumulation of abnormal AAT
hallmarks of ARDS
-acute dyspnea, hypoxemia, bilateral radiographic opacities
-pathological hallmark is diffuse alveolar damage
-sepsis is the most common cause of ARDS
Creutzfeldt-Jakob disease
-rapidly progressive (weeks to months) dementia with myoclonus ("startle myoclonus") and ataxia
-spongiform cortex (vacuolization without inflammation
-commonly see periodic sharp waves on EEG and inc 14-3-3 protein in CSF
-symptoms: rapidly progressive a
What is used for the prophylaxis of asthma?
-salmeterol bc has a slower onset of action with a longer duration (known as a LABA = Long Acting Beta-2 Agonist)
-is a beta-2 agonist, which acts by increasing cAMP levels
Woman with palpitations, shortness of breath, weight loss, hypertension, tachycardia, inc reflexes, inc thyroxine and period 6 weeks ago suggests what?
-stauma ovarii
Where is oxytocin produced and stored?
-produced in cell bodies of hypothalamic neurons in the paraventricular nucleus
-stored in posterior pituitary gland in Herring bodies, specialized nerve endings in gland
A vaginal pH greater than 4.5 may be associated with what?
-6.0 = bacterial vaginosis
-7.0 = trichomonas vaginalis
-8.0 = presence of cervical mucus or semen
Elevated alpha fetoprotein levels in maternal serum during gestation are associated with?
-open neural tube defect
-normal alpha fetoprotein level is found within spina bifida oculta
primary dysmenorrhea
-painful menses, crampy, lower abdominal pain during menses without a clear explanation of symptoms
-dx of exclusion
-high prevalence, with 50% to 90% of reproductive-age women experiencing painful menses making it the most common gynecologic condition--m
Clue cells on wet mount
Choriocarcinoma in a man
-a form of testicular germ cell tumor
-malignant, inc hCG
-disordered synctiotrophobloastic cytotrophoblastic elements
-hematogenous mets to lungs and brain
-may produce gynecomastia, symptoms of hyperthyroidism
What are the risk factors for endometrial cancer?
-obesity
-nullparity
-early menarche
-late menopause
-unopposed estrogen replacement therapy
-PCOS
-breast cancer (including tamoxifen therapy)
-HNPCC
-estrogen producing tumors
Is tobacco use a risk factor or protective factor for endometrial carcinoma?
-protective factor!
Patients with cystitis can also develop bacteremia, which can lead to ________ and _________?
-acute respiratory distress
What test is used to determine the HLA class I expression of recipient and potential donor cells in order to select the most compatible match, thereby diminishing the chance of graft rejection?
-microcytotoxicity
What does Huntington's and Friedreich ataxia have in common?
-they both have similar pathogenesis (both are trinucleotide repeats)
Neuropores fail to fuse at what week which can lead to neural tube defects?
-week 4
When does the bilaminar disc form?
-week 2 (think bi-laminar)
-this forms two layers: the epiblast and hypoblast
When is fetal cardiac activity visible by transvaginal US?
-week 6 (6 kind of looks like a heart with pulmonary artery coming off of it)
When do fetal movements start?
-week 8 (gait at week 8)
Uterine anatomy (ligaments and vessels)
-infundibulopelvic ligament = suspensory ligament of the ovary
-cardinal ligament carries uterine vessels
-round ligament = uterine horn to labia majora (deriv of gubernaculum and travels through round inguinal canal)
-broad ligament is a fold of peritone
Paget disease of the breast picture
Full differential for abnormal uterine bleeding
-PALM-COEIN
virchow node
-involvement of left supraclavicular node by metastasis from stomach
Krukenberg tumor
-Gastric adenocarcinoma with ovarian metastases
Sister Mary Joseph nodule
-subcutaneous periumbilical metastasis
Blumer shelf
-Palpable hardness on rectal examination, due to metastatic cancer of the rectouterine pouch (pouch of Douglas) or rectovesical pouch
Adnexal (ovarian) torsion
-twisting of ovary and fallopian tube around the infundibulopelvic ligament and and ovarian ligament--this compresses the ovarian vessels in the infundibulopevic ligament which are a branch off abdominal aorta
risk factors for placenta previa
-typically manifests as painless vaginal bleeding after 20 weeks of gestation
-risk factors = prior cesarean section delivery, inc number of prior pregnancies, twin gestation, and history of curettage for spontaneous or elective abortion
Developmental milestones
The blood color between abruptio placentae and placenta previa
-abruptio placentae has manifests as painful vaginal bleeding that appears dark red due to the darker appearance of venous blood
-placenta previa has bright red blood
uterine rupture
-associated with abdominal pain and vaginal bleeding, it occurs only during labor
Lymphocytic infiltration and scant stroma in breast
-medullary carcinoma
Proliferation of normal looking epithelial cells in breast describes?
-epithelial hyperplasia which is a type of fibrocystic change
solid pattern with an area of central necrosis on microscopy of breast
-comedocarcinoma
-which is a subtype of DCIS with a cheesy consistency and central necrosis
Mayer-rokitansky-k�ster-hauser syndrome
-aka mullerian agenesis
-presents with lack of menstruation by age 16 in the setting of normal secondaryr sexual characteristic and a blind vaginal pouch on physical exam
-caused by a congenital absence of the paramesonephric (Mullerian) duct in utero
Differential for primary amenorrhea where uterus is absent?
-mullerian agenesis
-andorgen insensitivity syndrome
-5-alpha reductase deficiency
Pelvic anatomy nerves you need to know (pelvic n., hypogastric n., pudendal n.)
-pelvic n. is PSNS (S2-S4)--> erection, controls detrusor muscle
-hypogastric n. is SNS (T11-T12)-->emission, internal urethral sphincter
-pudendal n. is somatic-->expulsion, external urethral sphincter, external anal sphincter
Langerhan Cell Histiocytosis
-collective group of proliferative disorders of Langerhan cells
-presents in a child as lytic bone lesions and skin rash or as recurrent otitis media with mass involving the mastoid bone
-cells are functionally immature and do not effectively stimulate pr
How to get from DCIS to IDC (invasive ductal carcinoma)?
-Ductal carcinoma in situ (DCIS) is an early stage of cancer in which the cancerous growth is still confined to its original site of formation and has not yet spread to surrounding tissues or organs.
-For DCIS to progress to IDC it must pass through the b
Neuroblastoma
-most common adrenal medulla tumor in children
-arise from crest cells
-can also develop anywhere along sympathetic chain ganglia
-contain N-myc amplifications
-symptoms are fever, abdominal mass and pain, weight loss, bone pain, and opsoclonus-myoclonus
Slip execution failure vs lapse execution failure
-slip is an error of attention
-lapse occurs as a result of an error in memory
Treatment for mumps
-analgesics and supportive care
-no cure for mumps
-but preventable due to MMR vaccine
swollen mildly tender left testicle + infertility....likely diagnosis?
-varicocoele
-Valsalva maneuver cause an increased pressure in the pampiniform plexus and will exacerbate the symptoms of a varicocoele
Leiomyosarcoma
-malignant neoplasm of the smooth muscle of the uterus
-histologic findings of atypia and a high degree of mitosis
-vaginal bleeding in a postmenopausal woman raises suspicion for a neoplasm of the GU and requires eval
-spindle shaped cells
-is a type of
T or F: Although neurosyphilis can occur at any time after initial infection, it is more likely to present with tertiary syphilis
-T
-tertiary syph can cause meningoencephalitis which is best recognized as thickening of the meninges
What chromosome is ADPKD affect?
-mutation in PKD1 (85% of cases) on chromosome 16
-mutation in PKD2 (15% of cases) on chromosome 4
What chromosome does recessive polycystic kidney disease affect?
-chromosome 6
Von hippel-lindau affects what chromosome?
-chromosome 3 (3 words!)
mutation on chromosome 9 is associated with?
-tuberous sclerosis
What structure runs on the superior surface of the spermatic cord?
-ilioinguinal nerve (innervates the scrotum or labia majora, root of penis, small portion of upper antero-medial thigh)
Probenecid MOA
-Inhibits reabsorption of uric acid in PCT and inhibits secretion of penicillin
Treatment for aspirin toxicity
-charcoal and sodium bicarb
Spermatic cord layers and derivs of those layers
-ICE tie
-internal spermatic fasci (transversalis fascia), cremasteric muscle and fascia (internal oblique), and external spermatic fascia (external oblique)
T or F: Inguinal surgery can result in accidental ligation of the vas def or obstruction caused by scar tissue, resulting in disordered sperm transport (often manifest as infertility)
-T
MUDPILES
Anion Gap Acidosis
Methanol (formic acid)
Uremia
DKA
Propylene glycol
INH or iron tablets
Lactic acidosis
Ethylene glycol (oxalic acid)
Salicylates (late)
HARDASS
Normal anion gap metabolic acidosis:
Hyperalimentation
Addison's disease
Renal tubular acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline infusion
Transitional cell carcinoma
-The most common histology of bladder cancer
-painless gross hematuria, weight loss, night sweats
-On histopathology, an increased number of epithelial cell layers occur within the papillary foldings of the mucosa, as well as loss of cell polarity, abnorm
What genetic disease has low estrio, b-hcg, alpha feto-protein
-chromosome 18 abnormality (edward's syndrome)
What are the b-hcg, estriol, AFP, and inhibin levels of chromosomal abnormalities like Down syndrome, Edward's syndrome, and Patau syndrome?
-everything is dec except in trisomy 21 where you have inc levels of b-hcg and inhibin A
What type of hypersenstivity reaction is polyarteritis nodosa?
-Type 3 hypersensitivity
Tanner stages development
complications of placental abruption
-DIC, maternal shock, and fetal distress
Thinning of the glomerular basement membrane
-alport syndrome
Thickening of glomerular basement membrane without immune deposits
-diabetic nephropathy
What is responsible for extrapyramidal side effects?
-D2 receptor blockade
-D2 receptors are negatively coupled to adenylate cyclase (remember SwIng mneumonic?), which decreases cAMP levels....so blocking this would inc cAMP levels like seen in typical antipsychotics
Adult onset of myotonic dystrophy
-auto dom disorder with CTG trinucleotide repeat (>50 repeats)
-clinical features = frontal balding, eyelid and facial muscle atrophy, cataracts, distal muscle weakness, cardiac defects, infertility and insulin resistance
-myotonia = delayed muscle relaxa
Developmental reflexes
-palmar grasp --hand has 5 fingers so less than 5 months
-lower extremity involvement is like 8 months or later
-hands stuff is earlier, lower extrems is later, and foot is latest with babinksy
What neurotransmitter is important for induction of REM sleep?
-Acetylcholine
-can remember NTs associated with sleep by mnemonic "SANDman":
-S erotonin: helps initiate sleep
-A cetylcholine: higher during REM sleep + associated with erections in men
-N orepinephrine (NE): lower during REM sleep; ratio of Ach and Ne
AIDS, seizure, ring enhancing lesions....
-Toxoplasma (YOU ALWAYS MISS THIS)
-usually has multiple ring enhancing lesions (unlike lymphoma)
Herpesvirus, poliovirus, rabies virus, and tetanus toxin use _________ transport to establish latency and _________ transport to establish secondary/reactivated infection
-use retrograde transport to establish latency
-use anterograde transport to establish secondary/reactivated infection
Progressive multifocal leukoencephalopathy
-Infection of immunosuppressed patients (AIDS, transplants, leukemics) caused by reactivation of JC virus
-infects oligodendrocytes, causing demyelination
-extensive mutlifocal lesions in the hemispheric or cerebellar white matter
-symptoms: aphasia, hemi
Neurosyphilis
-can be asymptomatic or can present variably with tabes dorsalis or general paresis (general paralysis of the insane)
-develop mental deterioration that precedes motor system deterioration, leading eventually to general paralysis with mustism and incontin
Arteriovenous malformations
-Most common type of brain vascular malformation.
-Abnormal tangle of arteries directly connected to veins without intervening capillaries.
-Most present with hemorrhage or seizures.
-can be associated with hereditary hemorrhagic telangiectasia (HHT), aka
Angle-closure glaucoma
-occurs because of closure of a preexisting narrow anterior chamber angle, as is commonly found in elderly, hyperopes, and Asians
-symptoms can be triggered when a patient's pupils dilate, for ex when entering a dark room or if pt takes a drug with antich
T or F: the cerebellum is responsible for the fine-tuning of movements and balance
-T!
-a lesion of the vermis results in truncal ataxia, manifesting as a wide-based "drunken gait"
-lesions of the lateral hemispheres of the cerebellum will affect movement of the extremities
Neuroectoderm derivatives
-(Think "CNS + Brain") Brain: neurohypophysis (posterior pituitary), CNS neurons, oligodendrocytes, astrocytes, ependymal cells, pineal gland, Retina, Spinal cord
O-CAPPERS
Oligodendrocytes
CNS
astrocytes
posterior pituitary
pineal gland
ependymal cells
r
MOA of loop diuretics
-inhibits Na+/K+/2Cl- cotransport at TAL (thick ascending loop)
Wernicke-Korsakoff syndrome
-thiamine deficiency (will also affect pyruvate dehydrogenase bc it uses thiamine as a cofactor)
-characterized by ophthalmoplegia, ataxia, confusion, severe memory deficit, and confabulation
-deficiency of this vitamin can also cause damage to peripheral
Benzodiaxepine overdose
-causes dose-dependent CNS depression
-sedative-hypnotic agents that exert anxiolytic muscle relaxant, anticonvulsant, and amnestic effects by potentiating action of GABA in CNS
-sedative-hypnotic toxidrome--altered consciousness, mild respiratory depress
Pregnancy causes what change in respiration?
-causes hyperventilation (respiratory alkalosis)
-changes that occur in respiratory system during pregnancy are necessitated by the increased oxygen demand of mom and fetus
-changes mediated by progesterone which causes an inc in central chemoreceptor sen
Superior laryngeal nerve innervation
-Motor innervation (external branch): cricothyroid muscle (can tense vocal cords to inc pitch)
-Sensory innervation (internal laryngeal nerve): above the vocal cords
Recurrent laryngeal nerve innervation
-Motor innervation: all intrinsic muscles except for circothyroid muscle
-Sensory innervation: below the vocal cords
Cerebellar atrophy, spider angiomas, and IgA deficiency
-Ataxia-telangiectasia
-triad is cerebellar atrophy (gait abnormalities), spider angiomas (telangiectasia), and IgA deficiency (recurrent sinopulmonary infections)
-defective ATM gene located on chromosome 11q22.3
-ATM gene prevents cells with double stra
Why does creatinine clearance overestimate GFR?
-creatinine is freely filtered and secreted by the proximal tubule epithelium, so its clearance overestimates GFR
Type 1 Renal Tubular Acidosis
-at Collecting duct and affect the Alpha-intercalated cells causing a deficiency in H+ secretion
-urine findings:
1. Basic (pH > 5.5)
2. High K+ (K+ is secreted instead of H+)
3. Low NH4+
4. Low citrate
5. Calcium phosphate kidney stones
-causes: Lithium,
Retinopathy of prematurity
-occurs almost exclusively in preterm infants
-major risk factors: prematurity and prolonged high oxygen therapy
-high oxygen results in vasoconstriction of retina vessels, resulting in ischemia which stimulates VEGF production and inc bv proliferation as
White pupillary reflex differential
-retinoblastoma (classically)
-cataracts (rubella infection)
-retinopathy of prematurity
Powassan virus
-only arthropod virus transmitted by ticks (board question) most of the others are via mosquitoes
-spread by bite of an infected groundhog, squrrel or deer tick
-many with this are asymptomatic
-symptoms develop from 1 week to 1 month and initial symptoms
Fever, costovertebral angle pain, nausea and/or vomitting
-classic triad of pyelonephritis symptoms
-pyelonephritis is a kidney infection related to a UTI (infection begins in urethra or bladder and travels to one or both kidneys)--more complicated UTI now
-so tx: use ciprofloxacin, levofloxacin, or ceftriaxone
What type of autoimmune reaction is multiple sclerosis?
-autoimmune type 4 hypersensitivity reaction against myelin basic protein
-TH1 (t helper lymphocytes) secrete interferon gamma, which activates macrophages, resulting in demyelination
Where is Ghrelin produced and where does does it act on?
-produced by X/A-like cells in oxyntic glands of gastric fundus mucosa
-stimulates arcuate and lateral hypothalamic nuclei
Tumor markers for seminomas
-LDH
-B-hCG
-PALP
MOA of methamphetamine and amphetamine
-inducing dopamine and norepinephrine release
-methamphetamine is an indirect agonist--> inc amount of dopamine and NE in the synapse by reversing the direction of their re-uptake pumps on pre-synaptic neurons
Where is the nucleus propulsus derived from?
-notochord
Neural crest derived cells
-MOTEL PASSES
Phencyclidine intoxication
-aka angel dust...aka PCP
-presents with nystagmus, reckless behavior/impaired judgement, disorientation, detachment, hypertension, tachycardia, mydriasis, and lack of response to painful stimuli, distortions of body image
-so basically causes pscho-motor
What is the radial nerve responsible for?
-extension at the joints of the upper extremity
-supination of the forearm
What muscles and corresponding nerves cause abduction of the thumb?
-abductor pollicis longus (radial n.)
-abductor pollicus brevis (median n.)
What muscles are involved with pronation?
-brachioradialis (radial n.) - minor role
-pronator teres and pronator quadratus (median n.) - major role
Bleeding into the ventricular space is what dx?
-subarachnoid hemorrhage--> ruptered aneurysm or bleeding vascular malformation introduces blood into ventricular space
St. Louis Encephalitis
-most cases in eastern and central US
-transmission via mosquitos from birds to humans
-causes flu-like illness and meningoencephalitis (no photophobia, headaches, fever, nuchal rigidity, confusion, seizures, SIADH)
After primary infection, where does the JC virus remain inactive?
-in the kidneys and lymphoid organs (it is thought that activation and development of PML occurs in the setting of profound cellular immune dysfunction)
T or F: Wernicke's patients cannot repeat things
And what are some other characteristics of Wernicke
-T! they have an inability to repeat
-in contrast with Broca aphasia, these pts are unaware of their deficits
-Wernickes also has a common associated feature: a contralateral visual field defect (particularly in of the right upper quadrant) bc of interrup
Why does Chlamydia grow intracellularly?
-Bc cannot synthesize its own ATP, so needs to grow intracellularly in host cells
What does CSF show in Guillian Barre syndrome due to campylobacter infection?
-inc CSF protein and normal cell count!
What is found in CSF during a Guillain-Barr� syndrome due to a campylobacter infection?
-increased CSF protein and a normal cell count (albuminocytologic dissociation)
Eosinophils seen in urine with a fever, rash, and oliguria....what is this characteristic of?
-characteristic of acute interstitial nephritis! (AIN)
-symptoms can arise days to weeks after starting drug
-AIN can progress to papillary necrosis
-caused by NSAIDs, antibiotics ((most common) such as penicillins (esp methicillin), cephalosporins and su
If you pierce through the internal jugular vein and damage structures located posterior to the carotid sheath....what would you most likely hit?
sympathetic nerve fibers within the sympathetic trunk
Tay-Sachs disease
-deficiency of ?-hexosaminidase A, which leads to a buildup of GM2 ganglioside within cells
-accumulation of GM2 ganglioside leads to the destruction of nerve cells
-signs and symptoms include neurodegeneration , developmental delay, and the appearance of
Niemann-Pick disease
-accumulation of sphingomyelin within cells
-Different signs and symptoms occur depending on where the sphingomyelin accumulates
-In contrast to Tay-Sachs disease, sphingomyelin builds-up in the liver and spleen and leads to hepatosplenomegaly
-foam cells
Why do some brain bleeds take longer for symptoms to appear whereas other bleeds don't?
-bc it must be a venous bleed and maybe not arterial
-slower venous bleeding, so may take longer for symptoms to appear
Chiari malformation type I vs. type II
-type I is more common than type II but mostly asymptomatic
-type I symptoms = cerebellar tonsils herniate into the foramen magnum
-type II (arnold-chiari type) = parts of the hindbrain, cerebellar vermis, and fourth ventricle herniate into the foramen
myoepithelial cells in the breast can tell you what about tumors being benign vs. malignant?
-myoepithelial cells are present between the stroma and epithelial cells; since invasive lesions grow into the stroma in the breast, they are no longer surrounded by myoepithelial cells
-benign tumors like intraductal papillomas (fibrovascular projections
Age-related macular degeneration
-pt present with loss of central vision (changes can cause either slow or sudden loss)--peripheral fields and color vision are preserved
-two types of macular degeneration: dry (atrophic)--pigmentary changes on macula, no scarring or hemorrhage; wet (exud
Chronic open angle glaucoma is characterized by a loss of progressive peripheral or central vision field loss?
-peripheral!
Retinal detachment
-can usually be seen as a raised area of retina (unless there has been hemorrhage into the vitreous)
-pts present complaining of multiple new floaters
-surgical repair is necessary
Herpes neonatal encephalitis
-most commonly acquired during passage through birth canal of a woman with active lesions
-involves the temporal lobes and may progress to involve more sites
-pts present 1-2 weeks after birth with lethargy, seizures and bulging anterior frontanelle; vesi
Lissencephaly
-rare brain malformation in which the sulci and gyri of the cerebral cortex are absent or decreased
-caused by the failure of neuronal migration from the germinal matrix of cerebral ventricles
-clinical manifestations: feeding issues, psychomotor retardat
What is the most common CNS tumor?
-metastatic carcinoma
-hall of all brain and spinal cord tumors are metastatic
-a tumor located at cortical gray and white matter junctions is indicative of mets
-can be single or multiple lesions
What are the functions of CN IX?
-glossopharyngeal
-salivation (parotid gland)
-taste and tactile sensation of posterior one-third of the tongue
-tactile sensation from external ear, pharynx, middle ear, and auditory tube
-input from carotid sinus/body
-motor efferents to stylopharyngeus
Ramsay Hunt syndrome
-caused by reactivation of latent varicella zoster virus in CN 7 and commonly occurs in immunosuppressed patients
-can also infect CN 8 (bc in close prox to CN7)
-spread to CN 8 results in hearing loss, and painful, erythematous cutaneous eruptions that b
Infections with HIV pt with CD4 < 100
-ABCCCC, EMT
-Aspergillus--cavitation/infiltrates of chest
-Bartonella--rash
-Candida
-CMV--CREEP, owl eye, cotton wool spots
-Cryptococcus--meningitis (look for photophobia)
-Cryptosporidium--diarrhea
-EBV--lymphoma ring enhaving lesion
-Mycobacterium av
Infections with CD< 200
-histoplasma
-HIV
-JC virus reactivation
-Pneumocystic j.
Infections with CD 4 < 500
-Candida
-EBV - oral hairy leukoplakia (not scrapable)
-HHV-8 - biopsy shows lymphocytic inflammation
-HPV
What antidepressant drug can also treat tremors of Parkinsons?
-TCAs!!
-Parkinson's is caused by dopamine depletion, leading to imbalance of dopamine and acetylcholine (low DA, too high Ach)
-TCA's help restore the imbalance of dopamine and acetylcholine in pts with parkinsons by blocking the effect of acetylcholine
Craniopharyngioma
-most common non-glial brain tumor of children
-tumors arise from epithelial crests derived from Rathke's pouch (which later forms anterior pituitary gland)
-partly cystic mass filled with dark brown fluid; produces an oily substance
-calcification is key
Cerebellar pontine angle--what CNs are nearest?
-CN 7 and CN 8 are nearest to this angle
T or F: HPV 6 and 11 are considered low-risk types and are associated with benign warts and CIN I/Low grade squamous intraepithelial lesion
-T!
Pt with oligomenorrhea and hirsutism...what disease?
-This is PCOS
-associated with insulin resistance, leading to hyperinsulinemia which induced ovarian granulosa cells to express extra LH hormone receptors, leading to inc in ovarian androgen production as well as dec synth of sex hormone-binding globulin
Why can cutaneous infections flow into the cavernous sinus?
-bc veins o f the face communicate with the superior ophthalmic vein
-if you look at pic, the ophthalmic vein looks like it is connected to cavernous sinus
What is the most common viral encephalitis in the US?
-HSV-1
-cowdry bodies = eiosinophilic intranuclear viral inclusions (see pic)...looks like clear fluid surrounding the purple/pink mound with a purple outline
-affects temporal and frontal lobe
What CSF lab levels help determine that dx is viral encephalitis?
-lymphocytes and erythrocytes are elevated
How do pts get infected with taenia solium?
-pts become infected by ingesting eggs contained in human feces-contaminated water or food, or by auto-infection (transmits eggs from perianal area to the mouth via fingers ew)
Functional hypothalamic amenorrhea
-exercise induced
-severe caloric restriction, inc energy expenditure, and or stress-->functional disruption of pulsatile GnRH secretion which dec LH, FSH, and Estrogen
-pathogenesis: dec leptin (due to dec fat) and inc cortisol
-administration and withdr
What is the renal threshold for glucose falling into the urine?
-threshold is 180-200 mg/dL
-plasma glucose levels above this range cause glucosuria
Bowen disease
-form of penile SCC in situ
-thick, flat, white lesion
Bowenoid papulosis
-form of penile SCC in situ
-multiple reddish-brown raised papular lesions
Erythroplasia of Queyrat
-form of penile SCC in situ
-single or multiple shiny red plaques
Tuberoinfundibular pathway
-transmits dopamine from the arcuate nucleus of the hypothalamus to the pituitary gland via dopamine release into the median eminence and subsequent circulation through the hypothalamic-hypophyseal portal system
-infundibulum refers to hypothal and poster
Mesocortical pathway
-transmits dopamine from VTA (midbrain) to prefrontal cortex
-dec activity in this pathway leads to "negative" schizo symptoms
Mesolimibic
-transmits DA from VTA to ventral striatum (includes nucleus accumbens and olfactory tubercle
-inc activity here-->positive schizo symptoms
Retinohypothalamic pathway
-not part of DA pathways
-photic neural input pathway involved in circadian rhythms of mammals
Central pontine myelinolysis
-aka osmotic demyelination syndrome
-nearly always iatrogenic condition characterized by demyelination of the central pons following overly rapid correction of severe hyponatremia
-pts may develop rapidly evolving spastic para-or quadriparesis often accom
Paralysis of the entire side of the face indicates what type of CN 7 lesion?
-ipsilateral LMN lesion
Paralysis of the lower half of the face indicates what type of CN 7 lesion
-contralateral UMN lesion
HIV with multicentric ring enhancing lesions in the brain...what is dx?
-CNS lymphoma (bc HIV)
Drugs that trigger acute angle glaucoma
-Antihistamines, antidepressants, antipsychotics, antivertigo, muscle relaxants, parkinosonism, antidiarrheal, urinary incontinence, opioids, anticholinergics
Cavernous sinus thrombosis
-rare and can present with fever, chills, headache, and cranial nerve palsies
-cavernous sinus receives venous drainage from mid-facial region and the sinuses
-as a result of this drainage pattern, the venous blood in the cavernous sinus can carry bacteri
Lactobacillus
-gram positive anaerobic rods that breaks down glycogen to form lactic acid, lowering pH, thereby inhibiting pathogen growth
-predominant vaginal microbiota in healthy women of reproductive age--during this period, inc levels of estrogen stimulate glycoge
vulvovaginal candidiases is more symptomatic in what kind of pts?
-pts who are pregnant, diabetic, obese, immunosuppressed, on oral contraceptives, or corticosteroids, or have had broad-spectrum antibiotic therapy
For a hypophysectomy, through what structure do you need to resect the pituitary transnasally?
-through sphenoid sinus
-NOT cavernous bc there's so many important stuff in there that you don't wanna hit!
Craniopharyngioma is derived from what?
-odontogenic epithelium (remnants of Rathke pouch)
-microscopically, these look very similar to cells that produce tooth enamel
Visual field defects
central scotomas
-Diminished vision or visual loss in the center of the visual field
-occurs in the case of macula involvement
What is the process that initiates penile erection
-initiated by the PSNS which stimulates the erection by releasing Ach, which increases NO production
-NO facilitates increased blood flow to the corpus cavernosa
What maintains an erection?
-compression and occlusion of venous outflow by the swelling erected tissues sustains an erection for as long as NO levels remain high
Essential tremor
-progressive, bilateral, largely symmetric postural tremor of the upper extremities that is not associated with other neuro symptoms
-essential tremor can be successfully treated by propranolol or primidone
Atonic seizures
-sudden loss of muscle tone --> falls to the floor
What shape microorganisms is T. gondii?
-Crescentic microorganisms
piriform cortex
-brain region involved in smell
-signal transmitted through olfactory neurons, axons travel through cribriform plate of ethmoid bone to synapse with mitral cells in olfactory bulb-->transmitted to piriform cortex (3 in pic - where uncus is)
Immune Reconstitution Inflammatory Syndrome (IRIS)
-an inflammatory response associated with pre-existing infections in HIV-positive pts after infections in HIV-positive pts after ART
-clinical symptoms associated with IRIS will resemble the symptoms of the specific pre-existing infection
-self-limited bu
Transient, shock-like facial pain....what dx?
-trigeminal neuralgia
Dawson fingers
-an MRI feature in MS showing lesions radiating from the corpus callosum
-demyelinating periventricular plaques
Chronic meningitis is mostly likely due to?
-Mycobacterium tuberculosis
-other causes include other indolent meningeal infxns such as syphilis, brucellosis, and chronic fungal infections
Meningitis lab values to help you figure out dx
-fungus has more mild levels when compared to bacteria
-Viral has normal glucose and slightly elevated pressure
A lesion to the thalamus would most likely cause what symptoms?
-sensory loss bc thalamus primarly processes sensory info for distribution to cortical structures
Pure motor deficits involve what structure of the brain?
-internal capsule
Bitemporatl hemianopia is caused by?
-most commonly occurs as a result of tumors located in the mid-optic chiasm
-since the adjacent structure is the pituitary gland, some common tumors causing compression are pituitary adenomas and craniopharyngiomas
-another relatively common neoplastic ca
Guillain-barre syndrome - disease process
-affects peripheral nerves and nerve roots, usually through demyelination
What is the drug of choice for eclamptic seizures?
-magnesium sulfate
Characteristics of intracranial abscess
-hematogenous dissemination: most common route of spread
-direct spread of contiguous foci is also possible
-organisms: staph, strep, bacteroides, and others
Differential for brain enhancing lesion?
-Toxoplasmosis
-primary CNS lymphoma
-brain mets
-abscess
Subependymal giant cell astrocytoma (SEGA) is pathognomonic for what?
-tuberous sclerosis
-SEGA is a peculiar astrocytic tumor that grows from the wall fo the lateral ventricles, and contains the large ganglioid cells
Where is the chemoreceptor trigger zone located?
-located in the area postrema on the floor of the fourth ventricle (vomiting center located in the lateral reticular formation of the medulla - remember needs to be outside BBB)
What innervates the tensor tympani and stapedius
-tensor tympani innervated by CN V3
-stapedius innervated by CN 7
Bilateral white opacifications, painless worsening of vision, inc headlight glare...what id dx?
-cataracts
In general, cerebellar and temporal lobe abscesses are potential complications of what?
-of otitis media (they seem close in space ya know?)
What can usually occur within the first 10 days of a subarachnoid hemorrhage and what drug do you usually give?
-cerebral vasospasm can lead to cerebral ischemia and stroke, and usually occurs within the first 10 days after SAH
Perinaud syndrome is found in what CNS path disease?
-pinealoma
What chromosome does retinoblastoma affect?
-chromosome 13
Zika virus
-enveloped, single stranded, positive sense RNA flavivirus
-transmitted by Aedes mosquito bites, blood transfusion, sexual contact, and maternal fetal transmission
-majority infections are asymptomatic
-symptoms - flu like symptoms with rash, low grade fe
What is a short term drug for general anxiety disorder?
-benzodiazepines
The median nerve passes through what muscle?
-pronator teres
-proximal to the wrist, the median nerve passes between the two heads of the pronator teres muscle
Water based bug that can cause seizure and altered sense of smell
-Naegleria fowleri--free living amoeba found in warm, freshwater lakes
-likes the cribriform plate (where CN 1 is--so smell problems)
-tissue form of the organism is an ameboid trophozite
What is the treatment for illness anxiety disorder?
-psychosocial treatments and CBT are most effective