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Puworld 12

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gubavula's version from 2016-08-21 04:29

Eye

NerveMuscleFunctionLesion Sx
CN IIISuperior rectus, Medial rectus, Inferior rectus, Inferior oblique, Levator palpebraeAdduction,Depression,Elevation & External rotationEye deviated downward & laterally, Ptosis, Dilation of pupil
CN IVSuperior ObliqueAbduction, Depression & Internal rotationEye deviated upward
CN VILateral RectusAbductionEye deviated medially
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Sensory

Question Answer
TibialPlantar foot
Common peronealDorsal foot & Anterolateral leg
Deep peronealBetween great toe & second toe
ObturatorMedial thigh
FemoralAnterior thigh & Medial leg
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Arche
Aortic archCNDerivatives
1TrigeminalMaxillary Artery
2FacialStapedial artery(regresses)
3GlossopharyngealCommon carotid artery, Internal carotid artery
4Superior laryngeal nerveAortic arch, Subclavian arteries
5ObliteratedObliterated
6Recurrent laryngeal nervePulmonary arteries, Ductus arteriosus
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Question Answer
Obstructive sleep apnea complicationsSystemic hypertension, Pulmonary hypertension, Right heart failure
Pt with acute arthritis, recurrent renal colic, high serum uric acid, best prophylatic long term agentAllopurinol
Probenicid(Uricosuric agents)Second line for chronic management but Contraindicated in pt with history of renal stones
Glucocorticosteriods acute goutONLY if NSAIDS or Colcheine are not tolerated pts
Upright glass tube anticoagulated red blood cells fall at a certain rateErythrocyte sedimentation rate -> Inflammation
Cytokines responsible for systemic inflammatory responseIL-1, IL-6, TNF-a
Bradykinin & Substance PVasodilation,increases vascular permeability,mediates pain
Excessive activation of transmembrane cation channel causing a buildup of intracellular calcium, depletion of substance PCapsaicin
Prevalence affects what?Positive predictive value or Negative predictive value
NPV increases whenPrevalence decreases
PPV Increases whenPrevalence increases
Retrosternal discomfort & disphagia, smokes cigarettes, obese, abnormal Esophagus & Lower esophageal sphinctor / Increased toneAchalasia -> Reduced number of inhibitor ganglion cells
Important risk factor for anthersclerosis & hypertensionDiabetes mellitus
Aortic disection greatest risk factorHypertension
4yr old with fever for 5days, lips are crackedmucositis, bilateral conjunctivitis, Nonpitting edema with bright red tongueKawasaki Disease -> Coronary Artery Aneurysm
AlzhemiersDecreased levels of acetylcholine in nucleus of basalis of Meynert & Hippocampus
Women after pregnancy complains of fecal incontinence,perineal pain, decreased anal sphinctor tone, loss of anal wink reflex, sexual dysfunctionPudendal nerve injury
Negative selection T-LymphocytesAfter positive selection occurs in the thymic medulla
Positive selection T- lymphocytesBefore negative selection occurs in the thymic cortex
T cell maturation occurs in Thymic Cortex - involves interaction of T- cell with Thymic cortical epithelial cells isPositive Selection
T cell maturation occurs in Thymic Medulla involves interaction of T - cells with Thymic medullary epithelial &Dendritic cells isNegative Selection
RBC's without central pallor Hereditary spherocytosis -> Decreased haptoglobin Increased Mean corpuscular hemoglobin concentration
Any form of hemolysis(sickle cell, hereditary spherocytosis)Decreased haptoglobin
Cortisol bindsIntracellularly
Insulin resistance(Velvety skin) is due toIncrease free Fatty acids -> Impairing insulin dependent glucose uptake
Carbon diaoxide effect on cerebral vesselsVasodilator
Lowering PaCO2(Carbondioxide) in the brainIncrease cerebral vascular resistance -> Increase ICP
Increasing PaCO2 in the brainDecreases cerebral vascular resistance -> Decrease ICP
Mitral valve leaflets with multiple small vegetations on both valvular surfaces / Glomerular capillary basement membrane thickening with wire-loop changes SLE -> Libman sacks endocarditis
Only stone you cant see on xray but on ultrasoundUric acid stone -> yellow/brown -> Diamond or rhombus ->
Uric acid stone risk factorsLow urinary pH, Low urine volume, High uric acid production
Uric acid stone - low urine volumeEpisodes of dehydration due to fluid loss in ileostomy
Uric acid stone - High uric acid productionLymphoproliferative disorders, gout, high cell turnover
An elderly who goes through intubation after urosepsis presents on the 3rd day with fever, right jaw pain, firm swelling of the postauricular area on the right side of extending to the mandibleSuppurative Parotits -> Diagnose with serum marker amylase due to the fact parotid gland release amylase
Pt who presents with excessive bruising shows abnormal platelet aggregometry / defect in platelet surface glycoprotein receptor that normally binds fibrinogenGpIIb/IIIa deficiency -> Abciximab is a blocker of this receptor
Hypothyroidism labsTSHIncreased / Free T4Decreased / Total T3Normal
Hepatits B surface antigen + & Heptatits D RNA +Coating of viral particles -> Hep B surface antigen coat Hep D antigen of Hep D virus to infect hepatocytes & multiply
Medical error - Pt had a different strain of pneumonia & was being treated by the wrong medicationPatient handoffs must be done in a way that the first Dr needs to communicate properly with the 2nd dr who he is transferring pt too
Nitroglycerin EffectLV-ED-P Decrease, Peripheral venous capacity Increase, Systemic vascular resistance Decrease
Pt does not take her hypertension medication & only takes when she feels her body tells her, is superstitiousmagical thinking, lives alone, has few friends, anxious & makes little eye contactSchizotypal personality disorder
Pt with low blood glucose & High Insulin & C-peptideInsulinoma or Taking too much sulfonurea(diabetes medication)
Pt with low blood glucose & High insulin & low C-peptideExogenous Insulin overdose
IgE independent mast cell degranulationOpiods, Radiocontrast agents, vancomycin through protein kinase A/Ip3 Kinase
IgE dependent mast cell degranulationEnvironmental exposures, foods, vespid stings, beta lactam & sulfonamides antibiotics
Retinal artery occlusion pathwaycherry red spot maculaInternal carotid -> Opthalamic artery -> Retinal artery
Cutis Aplasiasmall round punched out lesions with an overlying thin membrane on pts scalp, small head Holoproencephal, Microcephaly, polydactlyextra finger , omphalocelePatau Syndrome 13 -> Meiotic Disjunction
Young pt with right knee effusion,erythema & tenderness, synovial fluid leukocyte count for more than 100,000/mm & absent crystalsSeptic arthritis -> Antibiotic
Prominent occiput, low set ears, clenched hands with overlapping fingers, limited hip abductionEdwards 18
Elfin faces, extroverted personality, supravalvular aortic stenosisWilliams syndrome
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Lactase deficiency causes: Primary - Genetics OR Secondary - ~Inflammation(celiac disease) /Infection(Giardiasis)
Question Answer
Atriovenous FistulaIncrease volume BUT NOT pressure -> High output cardiac failure(Increase Preload or Decrease afterload)
VitiligoAbsence of melanocytes in skin
SchwanomaElongated cells with regular oval nuclei with a biphasic pattern consisting of areas dense cellularity interspersed with less dense myxoid regions
Cerebellar functionMotor planning, coordinatiion-> Impaired Dysdiachokinesia(Impaired rapid alternating movements), Limb dysmetria(Limb overshoot or undershoot), Intention tremor
Pt who presents with a history of recent weight loss, with pH 7.1, with urine ketonesdiabetic ketoacidosis is complaining of fever, headache, eye pain, with black necrotic eschar adherent to the inferior turbinateMucormycosis -> Mucosal biopsy -> Broad ribbon like nonseptate hyphae with right angle branching
Fever, mouth ulcers, low hemoglobin, low platelets, low leukocytesMethotrexate antidote-> Folinic acid
Cardiac tamponade clinical signsBecks triad - Jugular venous distention, Hypotension, DiMiNished heart sounds / Pulsus paradoxus - Pulse undetectable during inspiration
Cardiac tamponade causesMalignancy, Radiation, Infection - Viral Tb HIV, Drug -Hydralazine, Isonazid, Connective tissue diseases
Long term treatment for cysticfibrosisPancreatic Lipases -> Prevent ARDS -> DEATH
Treatment for InsomniaSleep Hygeine, Cognitive Behavorial therapy, Remelteon
Insomnia treatment in ElderlyRemelteon -> Melatonin Agonist -> High affinity to melatonin receptors in the suprachiasmatic nucleus
Caffeine appetite supplements"Explain that weight loss supplements are poorly regulated & have potential risks"
Breast cancer tx Estrogen receptorTamoxifen
Breast cancer tx Tyrosine Kinase receptorTrastuzumab -> HER2 Human Epidermal Growth factor receptor & Estrogen + & Progesteone +
Breast cancer post menopause Peripheral Aromataze enzymeAnastrozole -> Estrogen & Progestrone +
Denosumab for bone cancerReceptor activator of nuclear factor kappa-B ligand
BevacizumabVascular endothelial growth factor -> metastatic cancer for lung & colon
COPD complication from giving high flow oxygenOxygen induced Hypercapnia(Increased CO2)
Oxygen induced hypercapnia(Increased CO2) causes are1. Increased oxygen leads to pulmonary vasodilation leading to increased physiologic dead space 2. Hyperoxia reduces peripheral chemoreceptors stimulation resulting in decreased respiratory rate & minute ventilation
BrocaBroken Speech but can comprehend
WernickeCant understand but can speak
Middle top of the cerebral hemispherePartial focal seizure -> Numbness/Paresthia/ touch, temperature pain vibration/ of the contralateral body
Iron storage & release done by what cellsHepicidin released from the Hepatic parenchymal cells
Increased Erythropoiecies haveLow hepcidin levels
High iron levels & inflammatory conditionsIncrease hepicidin levels
Low hepicidin levels increaseIron absorption & stimulate iron release by macrophages
Erythrocyte chloride is increased on theVenous side
Binding of oxygen to hemoglobin releaseH+ OR CO2
Ring enhancing lesions on MRINocardia, Toxoplama gondii, Lymphoma
Cavitary pneumonia, Immunocompromised, Branching filaments on stain, g+ catalase + rod shaped bacteria, ring enhancing lesions, branching filamentsNocardia
S3Mitral regurgitation severity & CHF
S4Hypertrophic cardiomyopathy
Little boy presenting with fever, generalized tonic clonic seizures, without regaining consiousness Best Drug for managementStatus Epilepticus -> Caused by febrile OR meningitis -> DOC Benzodiazepine Enhanced postsynpatic chloride influx
Little boy presenting with fever, generalized tonic clonic seizures, without regaining consiousness Long term ManagementPhenytoin -> Blockade of presynaptic voltage gated sodium channels
Cholestrol stones due toLow bile acid & phospholipids
Rapid weight lossBile stasis & increased cholestrol mobilization -> Risk of gall stone formation
Estrogen replacement therapy SXGallstone due to Estrogen increase cholestrol & Progesterone decrease bile acid secretion / slows gallbladder motility
52yr old lady with several months of episodic abdominal discomfort & nausea especially after fatty meal, BMI33, abdominal ultrasound is small non obstructing gallstoneCholestrol stone -> Tx Cholecystectomy or Hydrophilic bile acids
Fat Jeffs Lung volume & capacityRestrictive Lung disease -> Respiratory Rate Increased, FEV1 Decreased, FVC Decreased, ERV Decreased, RV Normal, TLC Decreased~
Obstructive Lung diseaseRV Increased, FVC Decreased, FEV1 Super decreased, FVC Decreased, FEV`/FVC ratio Decreased
Restricitve lung diseaseLung volumes Decreased, FVC & TLC Decreased, FEV1/FVC ratio 80% <
Anterior Cerebral arteryFrontal & Parietal lobes -> Contralateral motor & sensory deficits of lower extremities & behavioral changes, urinary incontience
A form of hypothyroidismHashimoto thyoriditis
51yr old female fatigability, weight gain, constipation, mild diffuse, enlargement of thyroid glandHashimoto Thyroiditis -> Mononuclear parenchymal infiltration with well-developed germinal centers with hurthle cells(large eosinophilic cells filled with granular cytoplasm)
Enlarged nodule in thyroid on a normal ptPapillary thyroid cancer
Pt after a viral upper respiratory infection with painful tender thyroid gland & sign of hyperthyroidismSubacute(deQuervain granulomatous)Thyroiditis Mixed cellular infiltration with occasional multinucleated giant cells
Older women81 with intermittent abdominal pain, vomiting bowel pain, small bowel obstructionabdominal distention, tenderness, high pitched bowel sounds & a cholestrol containing mass at the ileocecal valveGallstone Ileus Air in the biliary tree(pneumobilia)
Pt elderly with chronic back pain using analgesics such as naproxen mild proteinuria & creatinine with bilateral shrunken & irregular kidneys with few papillary calcificationsChronic Interstitial Nephritis -> Complication Ishemic Papillary necrosis due to constriciton of vasa recta
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Question Answer Column 3
Extensive valve calcification with impaired leaflet mobilityAortic Stenosis in a 75yr oldHarsh ejection type systolic murmur at the base of heart radiating to neck with S4 due to HCM
Fusion of valve commissures due to repetitive inflammationRheumatic valve disease in earlier ageMitral valve
Infectious vegetations attached to the valve cuspsAortic regurgitation due to infective endocarditisDecrescendo high pitched blowing diastolic murmur that begins after A2
Myxomatous valve degeneration with leaflet prolapseMitral valve prolapseNon ejection click & mid to late systolic murmur
Hypertrophic of basal interventricular septum with subaortic obstructionHCMHarsh crescendo-decresendo murmur heard best at the apex
Holosystolic Murmur best heard at the apex of the heart that radiates to the axillaMitral regurgitationBest indicator of this condition - Presence of audible S3
Presense of midsystolic clickMitral valve prolapseSudden tensing of chordae tendineae
S2 to opening snap time intervalMitral stenosisIndicator of the severity of mitral valve stenosis
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Drug

Question Answer
FluoroquinoloneDNA Gyrase with altered A subunit, Impaired influx/Increased Eflux
AminoglycosideMutated Porin, Mutated Ribosonal subunits protein, Aminoglycoside modyfying agents
Methicillin resistant Staph AureusPenicillin binding protein with reduced antibiotic affinity - Transpeptidases
VancomycinPeptidoglycan cell wall with amino acid modification / Impaired Influx/Increased efflux
Extended spectrum Beta lactamasePlasmid ocngugation with drug resistance gene
MacrolidesRibosome with methylated 16s RNA
RifamycinsMutated RNA polymerase
TetracyclinesInactivated enzyme, impaired influx or increased eflux
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