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poxidicu's version from 2016-06-07 03:27

Circle of Willis

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LabelAnswer
AAnterior cerebral artery
BAnterior comm artery
COpthalmic artery
DMiddle cerebral artery
EInternal carotid
FPosterior communicating
GPosterior cerebral
HSuperior cerebellar
IAnterior inferior cerebellar
JPontine
KBasilar
LPosterior Inferior cerebellar
MVertebral
NAnterior spinal
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Vaginitis

DiagnosisExaminationLabsTx
Gardnerella vaginalisThin, off-white discharge with fishy odor, No Inflammationph>4.5, Clue cells, Positive whiff testMetrondiazole
Trichomonas vaginalisThin, yellow-green malodorous frothy discharge, Inflammationph>4.5, Saline Microscopy(Wet mount) Metrondiazole and treat partner
Candida albicansThick cottage cheese discharge, InflammationNormal ph 3.8-4.5, pseudophyaeFluconazole
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Leprosy

Question Answer
TuberculoidMild
TuberculoidTh1
TuberculoidMacrophages kill M.Leprae
TuberculoidDamages skin & cutaneous nerves, small number of well demarcated plaques with decreased sensation
+Lepromin testTuberculoid due to STRONG Th1
LepramatousSevere
LepramatousDissemeniated
LepramatousTh2 acid fast bacili accumulation within macrophages
LepramatousNumerous poorly demarcated plaques all over the body
Lepromin testDifferentiate Tuberculoid or Lepramatous
-Lepromin testLepramatous due to WEAK Th1
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Stroke

Anterior circulation

ArterySx
MCA-CONTRA Upper limb(Motor and sensory)
-Wernicke's and Broca's area
Anterior cerebral arteryCONTRA Lower limbs (Motor and sensory)
Lateral striates(off MCA)-Go to Striatum and internal capsule
-CONTRA hemiplegia=2ndary HTN(Lacunar infarct)=bc they are small.
ASA-Lateral corticospinal(movement)(A)=CONTRA hemiparesis(Lower Limb)

-Caudal medulla=hypoglossal nerve=IPSI dysfunction(deviates IPSI)
PICerebellarA1)Lateral medulla
-Spinothalamic tract=Limb+Face(Decre pain and Temp)
-Nucleus ambiguus(CN9, 10,11)=
-Inferior cerebellar peduncle
-IPSI horners


(UNIQUE TO PICA)
AICerebellarA
1)Lateral pons
-Facial nucleus=
*paralysis
* decre Ant 2/3 taste
*IPSI hearing affected
-Spinal trigeminal = Decre pain and temp in face


(UNIQUE TO AICA)
PCA-CONTRA hemianopsia w/ macular sparing
AComm->stroke
-VF defects
PComm-Aneurysm> stroke
-CN3 palsy"Down and Out"
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Milestones

AgeGross MotorFineMotorLanguageSocial
1yrStands well, Walks first steps, Throws ball2finger pincer graspSays first words mama & dadaSeparation anxiety, follows 1 step command with gesture
18monthsRuns, kicks ballBuilds tower of 2-4 cubes, removes clothing10-25word vocaulary,Indentify more than 1 body partUnderstands "mine", Begins pretend play
2yrWalks up/down stairs with both feet on each step, jumpsBuilds 6 cube tower, copies a line,turns page50+ word vocabulary, 2-word phrasesFollows 2 step command, parallel play, begins toilet training
3yrWalks up/down stairs with alrenating feet/ Ride tricycleCopes a circle, Uses utensils3word sentences, Speech 75% intelligibleKnows age/gender/ Imaginative play
4yrBalances and hops on 1 footCopes a squareIdentifies colors, speech 100% intelligibleCooperative play
5yrSkips, walks backwardCopies a triangle, ties shoes laces, prints letters, independent dressing and bathingCounts to 10, 5 word sentencesHas friends, completes toilet training
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CV

Question Answer
Drugs that cause "Lupus-like sx"DIL: "Hi, I Masterbate Quite Profusely Too..... Come See!!!"---Drug-induced lupus

H-Hydralazine
I-Isoniazid
---------------------------------------
M-Methyldopa, Minocycline
Q-Quinidine
P- Procainamide, phenytoin
T-Terbinafine
----------------------
C-Chlorpromazine
S-Sulfasalazine
What is side (R or L) is affected FIRST by CT?Right side because the RV walls are thinner...but ultimately CO is compromised
Kussmaul sign with CT or CP?Kussmual sign=Increase in JVP during inspiration

Seen with BOTH

1)CT=PP & Beck's triad:
- HypoTN(Less blood flow to systemic)
-Muffled Heart sounds
-JVD

2) CP=no Beck's triad
What does twitching when a BP cuff is used mean?


What role does Mg2+ play?
What is the other test called?
-TrOusseau sign= LOW Ca2+(Too Low)

-Mg is a cofactor in adenyl cyclase in the parathyroid

-Decreased Mg2+ levels cause decrease cAMP and therefore decreased PTH.

-Chvostek sign is one of the signs of tetany seen in hypocalcemia. It refers to an abnormal reaction to the stimulation of the facial nerve
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Transplant rejections

Question Answer
Ischemia and necrosis-Hyperacute(minutes)
-Preformed(Type2 HS) from recipient
Vasculitis of graft cells and Interstitial lymphocytic infiltration-Acute(weeks)
-Reversible with immun suppress.
T cell and AB mediated-Months to years(Chronic)
-Obliterative vascular fibrosis
-MHC-nonself appears as MHC self with antigen
Macupapular rash, jaundice, H/S, diarrhea.

Seen in which types?
G-vs -H
-Length varies
-Bone and Liver transplant(RICH in lymphoctes)
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CreatineKinase

Question Answer Column 3
Glucocortico induced myopathyProgressive muscle weakness & atrophy withoutpain / Lower extremity muscles not involved-CK
Polymyalgia RheumaticaMuscle pain & stifness in shoulder neck & pelvic gridle / Worse in morning & with activity-CK
Inflammatory Myopathies(Dermatomyositis,polyomositis)Skin rash, Inflammatory arthritis,proximal muscle weakness↑CK
StatinProximal weakness & muscle pain few weeks after starting statin↑CK
Hypothyroid myopathyDelayed tendon reflex, myoedema(localized bump arise after precussion with reflex hammer)↑CK
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Apolipoproteins

Question Answer
ApoA-ILCAT Activation(cholestrol esterification)
ApoB-48Chylomicron assembly and secretion by the intestine
ApoB-100ldl particle uptake by extrahepatic cells
ApoC-IILipoprotein lipase activation
ApoE-3 & -4VLDL and chylmicron remnant uptake by the liver
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Viral

Question Answer
Double stranded DNA -> RNA Dependent DNA polymerase activity -> Progeny Double stranded DNAHepatits B
Non enveloped single stranded DNAParvovirus B19
Double stranded DNA -> EnvelopedHepadna(HBV),Herpesvirus(vzv,hsv-1,2),Poxvirus(smallpox)
Double stranded DNA -> Non-envelopedAdenovirus, papova(HPV),polyoma(JC,BK)
Enveloped Double stranded DNA virusEBV
Enveloped - stranded RNA virusInfluenza, Paramyxovirus, Rhabdovirus
Single stranded RNA virus, +senseCoxsackie
Double stranded RNA virus, + senseRota virus
+sense viruses VS -senseCan be translated into proteins VS Cant be translated
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Heart Murmurs

Question Answer
Holosystolic Murmur left sternal borderVSD
Fixed wide splitting of S2ASD
Continous MurmurPDA
Holosystolic Murmur on cardiac apex radiating to the axillaMR
Opening snap diastole with midsystolic rumble cardiac apexMS
Ejection murmur increases with standing upHCM
Ejection murmur decreases with standing upValvular Aortic Stenosis
S3Normal in young/pregnant - Abnormal can cause restrictive cardiomyopathy, Heart failure
S4Normal in adults - Acute Mi, Ventricular Hypertrophy
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Upper vs Lower

Question Answer
Muscle weakness with increased toneU
SpasticityU
Clasp Knife RigidityU
HyperreflexiaU
Upgoing Plantar reflexes(+Babinski)U
Flaccid ParalysisL
AreflexiaL
AtrophyL
FasciculationL
Poliomyelitis & Werdnig HoffmanL
ALSA&L
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Hypertension

Question Answer
HypertensionCharcot
Basal Ganglia, Cerebellum, Thalamus, PonsCharcot
<1mmCharcot
Intracerebral HemorrhageCharcot
Neurological problems with headacheCharcot
ADPKD, Ehlers-DhanosSaccular
Circle of willisSaccular
2-25MMSaccular
Subarachanoid HemorrhageSaccular
Sudden severe headache with no nuerologic signsSaccular
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Pressure

Question Answer
Right Atrium0-8
Right Ventricle4-25
PA9-25
Left Atrium2-12
Left Ventricle9-130
Aorta70-130
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Injury

Question Answer Column 3 Column 4 Column 5
EpiduralMiddle Meningeal ArterySkull & DuraLucid Interval followed by loss of consciousnessBiconvex Hematoma
SubduralBridging Cortical VeinsDura & ArachnoidGradual Headache & confusionCrescent Shaped moon
SubarachnoidAneurysm or Malformation of Posterior & Communicating ArteryArachnoid & PiaSevere headache/NuchalRigidityBlood in basal Cisterns
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Osmolarity

Question Answer Column 3 Column 4
ConditionUrine osmolarity post dehydrationUrine OS post vasopressin(adh)Serum Sodium
Normal>800<10% increaseNormal
Complete neurogenic Inspidious<300>50% increase>142
Nephrogenic Inspidious<300<50%increase>142
Primary Polydipsia(psychogenic)>500<10% increase<137
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Hypersensitivity

Question Answer Column 3 Column 4
Type 1IgE Cell surface-bound antibody bridging by antigenBasophils, MastcellAllergies, Anaphylaxis
Type 2IgG, IgM Antibody-dependent cell mediated cytotoxcityPhagocytes, Complement Mediated cell injuryAutoimmune Hemoolytic anemia(Bloodtransfusion), Goodpasture Syndrome
Type 3Deposition of Antibody-Antigen ComplexesNeutrophils,Complement activationPSGN,Lupus Nephritis, Serum Sickness
Type 4Cd8+ T lymphocyte mediated hypersensitivityTcell/MacrophagesContact dermatitis, Tuberculin Skin Test
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Osteomyelitis

Question Answer Column 3 Column 4
Childhood ageHematogenous seeding during an episode of bactremiaS.Aureus, S.PyogenesLong Bones
Sickle CellHematogenous seeding to infarcted boneSalmonella, S.AureusLong Bones
Pott DiseaseHematogenous seeding from lungsM. TuberculosisVertebrae
Diabetes MellitusContiguous spread from infected foot ulcerPolymicrobialBones of feet
Recumbent pts with impaired mobilityContiguous spread from pressure soresPolymicrobialSacrum Heel
Recent trauma or orthopedic surgeryDirect InoculationPolymicrobialVariable
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Cognitive test

Question Answer
OrientationProviding name, location and current date
ComphrensionFollowing Multistep commands
ConcentrationReciting months of the year backwards
Short termRecalling 3 unrelated words after 5 minutes
Long termSaying in detail a story from past
LanguageWriting full sentence with noun verb agreement
Executive FunctionDrawing a clock oriented to the time requested
Visual SpatialDrawing interesting pentagons
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Prevention

Question Answer Column 3
PrimaryPreventing a diseaseHealth Promotion - regular exercise, no smoking, weightloss
SecondaryDetecting a disease process before symptomsIndividual case finding(pap) OR Community Screening(healthfair)
TeritaryTreat disease to prevent progression/complicationsDisability Limitation(Diabetes control) OR Rehabilitation(Physical Therapy)
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Muscle aches

Question Answer Column 3
Anklosying SpondylitisProgressive pain and stiffness of spine, sacrolitisHLAB27 positive
FibromyalgiaDiffuse muscle pain, fatigue, neuropsychatric complains20-55yr old
Polymyalgia RheumaticaBilateral pain and stiffness in shoulders and hips with weightloss, fever Malaise50+ with Increased ESR
DermatomysitisBilateral proximal muscle weakness with violaceous eruption on the eyelids and kuncklesIncreased Creatine kinase
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Immunodeficiency Disorders

Question Answer
Ataxia-TelangiextasiaAtaxia, Telangiextasias, Sinopulmonary Infections
Chediak - HigashiOculocutaneous albinism, Pyogenic infections, Progressive neurological dysfunction.
Chronic GranulomatousSevere bacterial & fungal infections, Granuloma formation
DiGeorge syndromeCongenital heart disease, Dysmorphic facies, Hypocalcemia
Severe Combine ImmunodeficiencySevere Bacterial & viral infections in infancy, Chronic diarrhea, Mucocutaneous candidiasis
C5-C9 deficiencyRecurrent Neisseria infection
Wiskott-AldrichRecurrrent infections that worsen with age, Easy bleeding, Eczema
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Micro

Question Answer
NOvobiocinNO StRESs -> Saprophyticus Resistant/ Epidermis Sensitive
OptochinOVRPS -> Viridians Resistant/ Pneumonia Sensitive
BacitracinB-BRAS -> groupBstrep Resistant(Agalactiae) / groupAstrep Sensitive(Pyogenes)
Hippurate Test +, PYR -S Agalactiae (Group B)
Hippurate Test -, PYR+S Pyogenes (Group A)
Elk Test + / Metochromatic GranulesC Diptheria
Rusty Sputum S Pneumonia
Long Branching Filaments similiar to FungiNocardia(Soil), Actinomyces(Oral,GI)
SNAP txSulfonamides Nocardia/ Actinomyces Penicillin
Serpentine CordM Tuberculosis
Lactose is KEYmackonKEY agar
mackonKEESKlebsiela, Ecoli, Enterobacter, Serratia
MeninGococciMaltose & Glucose
Cherry Red epiglotis or xray thumb print signhaEMOPhillus influenzae
Does NOT ferment SorbitolEHEC
GBS & Reactive Arthritis sequeleC Jejuni
Catalase, Urease, Oxidase +H.pylori
VDRL false+Viral(EBV, HEP)/ Drugs/ RF/ Lupus & Leprosy
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