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Dimpleuworld 11

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gubavula's version from 2016-10-18 20:39

Brain

Question Answer
Atriovenous malformationsIntracranial hemorrhage in children
Cerebral amyloid angiopathyMost common cause of Lobar/cortical(occipital,parietal) hemorrhage in the elderly
Charcout bouchardChronic hypertension with hemorrhagic stroke. Ct shows right away intraparnchymal hyperdensity(Basal ganglia, cerebellar nuclei, thalamus, pons
Cardiac arrest pt with decreased alertness with no focal neurologic deficits but instead watershed infarcts in perfusion zonesHypoxic encephalopathy
Progressive headache, nausea, vomiting, non localizing neurologic symptoms(confusion)Hypertensive encephalopathy
Abrupt onset of severe headache & associated with subarchnoid hemorrhageSaccular Aneurysm
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Question Answer
Iyr old boy (Less than 2yr old) presenting with cough and difficulty breathing, wheezing/crackles with scattered rales throughout, Low grade fever, tachypnea, peaking 3-5 daysViral Bronchiolitis -> RSV
Inspiratory stridor with seal like cough/ brassy or barking cough/ less common than RSVParainfluenza ->PaRaMyxovirus
G+ cocci that synthesize dextrans from sucroseS.mutans, S.Sanguinis -> Compilcation Subacute bacterial endocarditis in defective heart valves AFTER DENTAL PROCEDURE
Baby with macrosomia,hypoglycemia, jitterness & irritabilityBeta cell hyperplasia leading to increase insulin release
Fetal effects of gestational DMEmbryopathy NTD, Heart Defects / Placental vasculopathy - Asphyxia,Growth restriction, Polycythemia / Increased fetal Insulin - Macrosomia, Hypertrophic cardiomyopathy, Hypoglycemia
A pt with a history with cholecystectomy a week ago, presents to clinic with nausea, fever, fatigue, anorexia, with abnormal liver grossHalothane Induced liver damage -> Fulminant Hepatits -> Elevated aminotransferase & Prolonged prothrombin time
Dual phospholipid bilayer membranes with foldings(Cristae)Mitochondria
Long folded membranes that are coated with ribsomes giving it a rough speckled appearanceRER
Found freely floating in the cytoplasm and bound to endoplasmic reticulumRibosomes -> found in the nucleolus
Turner syndromePaternal Meiotic Nondisjunction
Polycythemia(erythrocytosis)Men >52% or Women >48%
Increase in RBC MASSAbsolute Polycythemia
Normal RBC MASS OR Decrease in PLASMA VOLUMERelative erythrocytosis
Fatigue, Itching, hepatomegaly, Alkaline phosphatase elevated, Anti-Mitochondrial antibodies+Primary Biliary Cholangitis -> Patchy lymphocytic inflammation with destruction bile ducts and necrosis and micronodular regeneration of periportal tissues
Destruction of small and mid sized intraheptatic bile ducts with resulting cholestasisPrimary Biliary Cholangitis -> SAME HISTOPATHOLOGIC SEEN IN GVHD
Liver failure with centrilobular necrosis that can extend to entire lobuleAcetamenophen Overdose
Hepatocellular swelling and necrosis, mallory bodies, neutrophilic infiltration, fibrosisAlcoholic hepatits
Occlusion of hepatic veins leading to increased hepatic pressure, hepatomegally with reddish purple parenchyma, centrilobular congestion and necrosisBudd-Chiari Syndrome
Panlobular microvesicular steatosisReye Syndrome
Herpes Simplex Encephalitis TXAcyclovir -> Inhbit viral DNA Polymerase
Cardinal veins give rise toSuperior vena cava
Pulmonary truck arise fromtruncus arteriosus(neural crest migration -splitting into aorta & pulmonary)
Centriacinar EmphysemaSmoking pts with COPD affecting upper lung
Panacinar emphysemaA1 antitrypsin deiciency affecting lower lung
A pt who is having sudden nset chest pain, dyspnea, pain with deep breaths, thin tall pt in acute distressSpontaneous pneumothroax -> Apical Subpleural blebs
A pt who doubles her dose when having a bad day and skips dose when have a good day should beEducated about the risks of irregular dosing
A pt who doesnt take her medications because she forgets to take them should beGiven a proper written instructions on how to take the medication
Boy with bilateral breast enlargementgynecomastia-estradiol, tall, in special education classlearning difficulties, testicles small & firmhypogonadismKlinefelter syndrome
Klinefelter syndrome labsHIGH LH & FSH / LOW Testosterone
Galactokinase DeficiencyGalactose -> Galactose 1-P / Mild & NO liver or renal involvements, galatose in urine & blood, cataracts, "failure to track objects OR lack of smile"
Classic GalactosemiaGalactose1-p -> Glucose 1-p / Severe & Liver & renal involvements, cataracts, failure to thrive, jaundiceicterus/hepatomegaly
Ubiquitination deficiency leads toParkinsons Alzheimers other neurodegenerative disorder
Hormone highest after ovulationProgesterone
PancarditisInflammation of all 3 layers of heart. Complication of acute rheumatic fever
Knee pain and then a week later elbow painmigratory arthritis, with new holosystolic murmurmitral regurgitation, + Anti-streptolysin O titers leading to acute decompensation due to(Pancarditis) -> Acute rheumatic fever due to S.Pyogenes
Receptor(killing of cancer cells by t-cells recognizing tumor antigen) blocked for melanomaanti-PD1 OR anti-CTLA4
PKU amino acidPhenylanine
Propionic acidemia amino acidValine,Isoleucine, Threonine, Methionine, Cholestrol & odd chain fatty acids ->NEED B7 as cofactor
Leukemic cells or reapidly dividing cells amino acidAsparginine
Type 1 HypersensitivityHistidne
KetogenicLysine
Lesser curvature of stomach and adjustable gastric bandLesser Omentum
Greater curvature of stomach hasGreater Omentum
Falciform ligamentAttaches liver to anterior body will
Post meal InsulinLAG -> 0-4HRS
DKA insulingRegular -> 0-6
Cranial Nerve 3 PalsyDown & Out/ Light shine on one eye doesn't constrict the other / Ptosis Drooping of the affected eyelid
Corneal reflex absent seen inCN V1 & CN VII
Inability to close eyeCN VII
Inward deviation of eyeCN VI
CalcivirusesNorwalk -> Viral Gastroenteritis
Pt who presents with fatigue, malaise, weakness with a hx of Diabetes I & Hypothyroidism with high MCV and low hemoglobin & HematocritVit B12 deficiency
Autoimmune gastritis B12 MOADecrease Parietal cell Mass -> Due to Increase Gastrin & Decrease Gastric acid(achlorhydria- increase pH) -> Vitamin B12 deficiency
Pernicious anemia B12 MOADecrease Parietal cell mass -> Increase Gastrin and Increase PH -> Decrease Intrinsic factor
41 YR old with down syndrome who presents with alzhemiers has what increased?Neuronal Amyloid precursor protein -> Early Onset disease -> Neurofibrillary tangles"TAU" & extracellular amyloid-beta plaques
Familial or Late onset Alzheimers Disease has what increased?Serum apolipoprotein E
10 yr old who recently migrated to USA presenting with ataxia, myoclonus, visual problems, acting strangely and having difficulty at school, RNA VIRUS contain hemmaglutinSubacute Sclerosing Panencephaltis(Within years) -> Measles -> paraMyxovirus -> CSF shows oligonal bands
Creutzfeldt-Jakob diseaseRapid dementia caused by prions or misfolded proteins, older pts usually or younger pts who ate infected meat, spongiform transformation of the cerebral cortex
Progressive Multifocal leukoencephalopathyInfectious demyelinating disorder by JC VirusDD-DNA of polyomavirus in immunocompromised pts
Progressive Supranuclear palsyParkinson related neurodegeneration of frontal cortex & midbrain -> Rapidly progressing gait, falls, executive function loss, vertical gaze palsy with TAU proteins
68 yr old with urgency,, frequency, weak urinary stream, straining on micturition pts kidney is most like to showBOO -> Bladder outflow obstruction -> Due to BPH -> Kidney shows parenchymal pressure atrophy
Light Microscopy of heart 12 days laterGranulation and neovascularization
White/yellow plaques on colonic mucosa, and biopsy shows that the plaques composed of fibrin & inflammatory cellsClostridium Difficile Collitis -> He required hospitalization & antibiotics for pneumonia
Splitting of S2 that does change with respirationASD
Systolic ejection murmur that increases in intensity with standingHypertrophic cardimyopathy -> Decrease in left ventricular outflow tract
Splitting of S1 that is accentuated on respirationTricuspid stenosis
Early diastolic decrescendo murmurAortic regurgitation
Recurrent nose bleeds, ulcerpoor wound healing, hyperkeratosiscorkscrew hair, bleeding in joints, scattered ecchymosees, swollen gums, homelessVitamin C deficiency
60 yr old at ER due to severe abdominal pain, nausea, vomiting, low pH, Bicarb & PaCO2, High lactic acid(Metabolic acidosis), CT scan shows distal ileal wall thickening & lack of enhancement with contrastAcute Mesentric Ischemia -> Due to decreased activity of enzyme Pyruvate Dehydrogenase due to accumulation of NADH & increased activity of enzyme Lactate Dehydrogenase
Combined hormonal contraceptivesPILL/PATCH/RING leads toSuppressing GnRH in the hypothalamus -> low FSH & LH
60 yr old with tibial pain and hearing difficulty local tenderness and lumpy protrubancePagets disease -> Excessive osteoclast(very large, multinucleated) activation -> RANK-L nuclear factor Kappa B ligand
Bone pain, hearing lossPagets disease -> Excessive breakdown of bone due to osteoclasts -> Confirm osteoclasts by 100+ nuclei -> Differentiation of osteoclast is through Nuclear kappa factor B -> DOC -Denusomab
Pudendal blockInjection medial to ischial spine through the sacrospinous ligament
High Potency PsychoticsHaloperidol/Fluphenazine -> Extrapyrimidal sxacute dystonia,akathsia, parkinsonism
Low Potency PsychoticsChlorpromazine, Thioridazine -> Sedation,Anti-cholinergic, Orthostatic Hypotension(a-adrenergic blockade)
Thayer martin agarMedium containing vancomycinbacterial growth,colisting-bacteria, nystatinyeast, trimethoprimproteus species VCNNeisseria Gonorrhea
Rugal thickening with acid hypersecretionZolinger elison syndrome
Progressive mucosal atrophyChronic gastritis due to H.pylori lead to diffuse gland atrophy and intestinal metaplasia
Unintentional weight loss, epigastric discomfort aftermeals with nausea, family history of peptic ulcerSignet ring Carcinoma for of gastric adenocarcinoma(No Glands & leather-bottle stomach)-> Infiltration growth within the stomach wall
Well formed glands with columar or cuboidal cells, grow as nodularpolupoid, well-demarcated masses that expand rapidly within gastric lumenIntestinal type adenocarcinomas
Pregnant women HepatitsHepatits E -> Unenveloped RNA virus
Glutathione peroxidaseREDUCE free radical breakdown
Reperfusion injuryCell membrane damage or inflammation,Oxygen free radical generation, Mitochondrial change(NOT same as mitochondrial vacuolization)
Scattered cells within a vascular mucopolysacharide stromaAtrial Myxoma
Normal Aging lung valuesTLC - Unchanged, FVC(Forced air out), Residual volume - Increase, Decrease chest wall compliance BUT Increase in lung compliance
Ethmoid sinusMedial to the eye near eye booger
Maxillary sinusBehind cheeks
Frontal sinusAbove eye brows
Inferior Nasal ConchaBottom of the nose
Superior Nasal ConchaTop of the nose
Normal gloumerliMinimal change disease usually in children
Basement membrane splittingMembranoproliferative glomerulonephritis -> Lobular apperance with proliferating mesangial cells
Uniform diffuse capillary wall thickeningNephrotic syndrome -> Membranous glomerulonephropathy
Effect modificationStroke is high in smokers who take tamoxifen verse compared to untreated women who smoke. In non smokers tamoxifen didnt cause stroke. Smoking status MoDifIed the effect
Neuromuscular lesionstonic clonic seizures,vision loss,ragged skeletal muscle fibers, lactic acidosisMitochondrial encephalopathy -> Mom will affect all offspring, Dad will not pass to any offspring
GranulomaIL-12, TNF-a, Interferon-y
TAT gene HIVViral replication
NEF gene HIVDecrease expression of MHC class I
CCR5 gene HIVEnables HIV to enter
3yr old with fatigue, difficulty walking with increase use myopathy, Low glucose/Negative Urine ketonesHypoketotic hypoglycemia, High creatine kinase muscle breakdown, muscle biopsy shows very low carnitine content,heart murmur cardiomyopathy/ Elevated muscle triglyceridesCarnitine deficiency -> Lack of Acetoacetate(Ketone)
Hypoketotic hypoglycemia conditionsCarnitine Deficiency OR Medium chain acyl-CoA Deficiency(AcylCoA dehydrogenase)
Patient who is angry at his wife acting in overly loving manner toward her insteadReaction formation
Bone biopsy shows haphazardly oriented segments of lamellar bonewith prominentcement lines OR Mosaic pattern of lamellar bonePagest disease -> Osteoclasts
Primary active transportNa/K atpaseDigoxin, H/K atpasePPI, Ca Atpasedigitalis
SOB, Retroorbital pain,myalgias, cleans out animal waste, Low platelets, high AST & ALTCoxiella Burnetii -> Air contaminated of animal waste
Sitting up musclesExternal abdominal obliques, rectus abdominis, hip flexorspsoas major, iliacus, psoas minor
warfarin monitor withPT
Heparin monitor withPTT
Piriform recess significanceFish bone get stuck -> Internal laryngeal nerve -> Cough reflex
Internal rotation of shoulder innervated by thoracodorsal nerveLatissmus Dorsi
Whiplash injury commonly injure what muscleTrapezius -> elevate rotate and stabilize scapula
Muscle injured due to falls or overuse in older ptsInfraspinatus -> Suprascapular nerve -> external rotate
Organism requires acellular medium enriched with cholestrol to growMycoplasma Pneumonia
Chocolate agarheat lysed blood agar, supplemented with Factor Xhematin, factor VNAD+H.Influenza
L-cysteine supplemented agar to growLegionella Penumophilia
Ground glass infiltrates on xray, NEED silver stainPneumocystis jirovecii
Apical ion transportV.Cholera
Cell membrane integrityC.Perfringes -> Lecithinase
older pt treated with clindamycin for cellulits presents with diarrhea and abdominal crampC.Difficile -> Cytoskeleton integrity
MOA of Xa inhibitor apiXabanProlong ptt & pt BUT not thrombin time
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Vitamins
Question Answer Column 3
B1 ThiamineDecarboxylation of a-keto acids(Carbohydrate metabolism)Beri Berineuropathy, heart failure / Wernicke Korsakoff syndrome
B2 RiboflavinMitochondrial Hydrogen carrierAngular cheilosis, stomatitis, glossitis, Normocytic anemia
B3 NiacinHydrogen receptorDermatits, Dementia, Diarrhea, Neuropathy
B6 Pyridoxine Transamination of amino acidsCheilosis, stomatitis, glossitis
B9 FolateHydroxymethyl/fomyl carrierMegaloblastic anemia, NTD
B12 CobalaminIsomerase & methyltransferase cofactor( DNA & Methionine synthesis)Megaloblastic anemia, Neuropathy
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