vehezine's version from 2015-04-25 17:06

Circle of Willis



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


: Leprosy
Question Answer
TuberculoidMacrophages kill M.Leprae
TuberculoidDamages skin & cutaneous nerves, small number of well demarcated plaques with decreased sensation
+Lepromin testTuberculoid due to STRONG Th1
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


Anterior circulation

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.


Question Answer
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

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

PCA-CONTRA hemianopsia w/ macular sparing


Question Answer
-VF defects
PComm-Aneurysm> stroke
-CN3 palsy"Down and Out"


Question Answer
Tanner stages1) prepubertal, elevation of only the papilla of the breast, fine villus hair

2)Begin puberty, palpable breast buds, enlarged areola, minimal course hair

3) Elevation of breast contour with areolar enlargement

4) 2ndary mound on the breast (areola)

5)Adult breast contour, recession of the areola to general contour of breast
Would you give a person who has WPW Procainamide?Yes, because it does NOT slow down conductance thru AV node= decrease chance of deviating towards accessory pathway and leading to V-fib(Like: Beta blocker, Adenosine, Verapamil, Digoxin, )(Bad AV Diffusion )
If a man was stabbed just to the right of mid-line of the thorax and he experienced a R-sided hydro-pneumothorax with these levels:

RBC=1000 cells
Cultures =neg

what would you suspect was hit ?
The HIGH TAG suggest Thoracic duct.
-Courses thru the diaphragmatic hiatus into the thorax ascending midline.

-Drains upper left and B/L LE vs the upper right= right lymphatic duct

-Emptying into the LEFT internal jugular vein
Drug X is a B1 antag but a M2 and M3 agonist

What will happen to HR if
1. X alone
2 X w/ atropine
3 X w/ tri-me-tha-phan
1=HR decrease

2=Decrease HR; atropine blocks M2-3

3= Decrease HR; Trimethaphan=ganglionic blocker= BARORECEPTOR-mediated reflexes. BUT the HR changes are due to direct binding of cardiac receptors
(Try-me not tha Gang)


Question Answer
If a pt comes to you w/ HA and heart palp and he's currently on digoxin and furosemide

ECG= flattenned T-waves and irreg rhythm

What can u give him to treat it?
Pt has hyPOkalemic metab alkalosis= S/e of thiazide and Loops

Vs HYPERkalemia=Peaked T-waves

Tx: give Spironolactone
Tx for RF. Acute vs ChronicAcute: Penicillin and salicylates

Chronic: valve repair
The order at which these enzymes rise during MI(best enzyme to use for Dx)

1. Troponin I (6hrs)
3. AST when CK-MB begins to decline(On CK's ASS)
4. LDH(2-7days)(Last )
Bradycardia TxAtropine

Or DE and EPI for Atropine resistant cases
Drug interaction btw Digoxin and QuinidineDigoxin levels will INCREASE

*premature ventricular contraction
* AV nodal block
*Slow Ventricular response


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

M-Methyldopa, Minocycline
P- Procainamide, phenytoin
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

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

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)


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↑CK


Question Answer
Cocaine vs Amphetamine MOACocaine=inhibits reuptake of DA, NE, 5-HT

Amphetamine=Increases release of NE(via Alpha-1), DA, 5-HT

NE=Peripheral effects
DA=Central effects(Homer)
What drugs would be use to regulated this condition?

How would uncontrolled Pulm disease affect you tx?

This pt has A-fib
-Need AV-nodal blocking drugs=Use Beta-blockers or Ca2+ channel blockers

-Pulm ds= lean towards Ca2+ blockers, because Beta-blockers could exacerbate bronchoconstriction
If you compared Insulin levels in 2 groups:
1) Received Oral glucose
2) Received IV glucose

Which one would have a HIGHER Insulin level?

Would drugs utilize this phenomena?
-Oral Glucose levels would produce HIGHER Insulin levels

-Oral glucose=stim Incretin release(GIP, GLP)

-Incretin=stim Beta cells to release more insulin

-Exenatide, Liraglutide=mimic incretins

-Sitag-liptin=inhibits DPP-4=leads to blocked incretin degradation


Question Answer
If a 16 y/o girl has not begun her menstruation, has small breast, scant pubic hair and No Uterus..what are you suspecting?

What associated sx may they come in with?

What is her karyotype?
-Androgen Insensitivity syndrome

-Phenotypically she is female..but her testes have NOT descended

-May come in with Primary Amenorrhea or Inguinal hernia

-She has a female genitalia, vaginal pouch, but NO uterus

-Karyotype=46, XY
What is Mean Systemic filling Pressure?
if someone lost ALOT of blood would you want them to increase or decrease MSFP to cope with blood loss?How?
-MSFP=Is the Pressure that exist in the circulation when the heart has stopped and the blood has distributed equally.
-MSFP=measures "tightness" of a circulation

-So if someone loss alot of blood you would want them to Increase MSFP=The more the system appears filled.

-You can increase MSFP by utilizing the "stored" blood in the veins and venules=Constrict Veins=increase Venous Return
Prinzmetal vs Stable anginaPrinzmetal= occurs at rest

Stable=Only during activities
In Type 1 DM what 2 regulatory mechanism are lost?

What are the "backup 2" utilized?When would they be utilized?
-Type 1 DM=regulation of hypoglycemia via Insulin and glucagon.

-The "backup 2": Epinephrine(Acute) and Cortisol(Chronic)

-Epinephrine=stim hepatic glycogenolysis via Beta-2 receptors

-Cortisol=stim hepatic gluconeogenesis and lipolysis; but this takes time
How does 11 beta hydroxylase deficiency affect deoxycorticosterone levels?-It would actually INCREASE deoxycorticosterone levels.

-deoxycorticosterone is a precursors to Cortisol(Which would decrease)


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


Question Answer
Double stranded DNA -> Template+RNA -> Progeny Double stranded DNAHepatits B
One stranded DNA -> Template double stranded DNA -> Progeny one stranded DNAParvovirus B19
Non enveloped single stranded DNAParvovirus B19
Double stranded DNA -> Template double stranded DNA -> Progeny double stranded DNAPapovirus,Adenovirus,Herpesvirus,Poxvirus
Non enveloped Double stranded DNA virusAdenovirus
One stranded +RNA -> Template -RNA -> Progeny one stranded +RNAPoliovirus
One stranded +RNA -> Template double stranded DNA -> Progeny one stranded +RNARetrovirus
One stranded -RNA -> Template +RNA -> Progeny one stranded -RNAInfluenza,Measles, Rabies
Enveloped Double stranded DNA virusEBV
Enveloped - stranded RNA virusInfluenza, Paramyxovirus, Rhabdovirus

Heart Murmurs

Question Answer
Holosystolic Murmur left sternal borderVSD
Fixed wide splitting of S2ASD
Continous MurmurPDA