current quiz

Where does the N-terminal sequence send stuff to?

•Mitochondria

How do you treat lithium OD?

•Sodium polystyrene sulfonate

AD: who is affected most? How does it manifest? Who can

transmit?•M=F

•Manifests in the heterozygote and homozygote

•Both parents can transmit the dz

What two enzymes are needed for synthesis of B12?

•Methylmalonyl CoA Mutase

•Homocysteine Methyl Transferase

What is the deficiency caused by this vitamin B6?

•Neuropathy

•seizures

What does a deficiency in Zinc cause?

•Dysgusia

•Decreased sperm

•Dry skin

•Dry hair

What is vitamin A a cofactor for? What is the other cofactor

needed?•PTH

•The other cofactor is Mg+

Synthesis of 1,25-D-hydroxycholecalciferol requires?

•Vit D

What are loose associations?

•Ideas switch subjects, incoherent

What is double depression?

•Depression followed by dysthymia

How does myopathic muscle dz present?

•Proximal weakness and pain

What is illusion

•Misinterprets stimulus (magician)

What is atonic cerebral palsy?

•No muscle tone

•floppy

What does warfarin inhibit?

•Vitamin K

Why should you wait 30 min after a meal before swimming?

•All the blood in gut and skeletal mm have ran out of ATP

What is Klinefelter’s?

•XXY 47

•Tall

•Gynecomastia

•Infertility

•↓ testosterone

What are the most common non-cyanotic heart dzs?

•VSD

•ASD

•PDA

•coarctation

What values do you see in obstructive pulmonary dz?

•pO2 nl

•pCO2 ↑

•pH ↓

Where is CK-BB found?

•Brain

What do you think when you see both serum Ca and Phosphate ↓

•Vit D deficiency

With Inflammation…what happens <24 hours?

•swelling

What are the enzymes that show after an MI?

•Troponin I

•CKMB

•LDH

What do you see in the serum with the low volume state?

•K+ decreases

•Na+ decreases

•Cl- decreases

•pH increases

•BP increases

AR: who does it show in? When is the onset? What is the

penetrance?•Does not show up in parents

•Might be in siblings/2nd degree relatives

•Onset early in life

•Complete penetrance

What pathway does warfarin affect?

•Extrinsic pathway

What cyanotic heart dz is associated with mom taking

lithium during preg?•Ebstein’s anomaly

Why do we only have 6 hours to use tPA?

•Body has irreversible cell injury

What does a deficiency in Vit E cause in newborns?

•Retinopathy

What is the third MI enzyme to appear? When does it

appear/peak/gone•LDH

•Appears in 1 day

•Peaks in 2 days

•Gone in 3 days

What are the different second messenger systems?

•cAMP•cGMP

•IP3/DAG•Ca:Calmodulin

•Ca+•Tyrosine Kinase

•NO

What dzs have pulmonary eosinophilia?

•Aspergillosis

•strongyloides

Where is a Bokdalek hernia located?

•Back of diaphragm

Where is a Morgagni hernia located?

•Middle of diaphragm

What dzs have respiratory alkalosis?

•Restrictive lung dz

What dzs have metabolic acidosis

•MUDPILES•Methanol•Uremia

•DKA•Paraldehyde

•Infxn•Lactic acidosis•Ethylene glycol

•salicylates

What does grunting tell you

•Restrictive lung dz

•Blowing collapsed alveoli open

What is bronchitis

•Lots of sputum

•Blue bloater

What is aspergillosis

•Allergy to mold, dead plants, compost piles

Who gets silicosis?

•Sandblasters

•glassblowers

Who gets beryliosis

•Radio

•TV

•welders

Who gets anthracosis

•Coal workers

•Massive fibrosis

•Does not ↑ CA risk

What are the clues for squamous cell CA

•Smoker

•High PTH

•High calcium

What does bronchealveolar CA look like? What is it due to?

•Looks like pneumonia

•Due to pneumoconiosis

On an EKG, ST means…

•Ventricle contraction

•Phase 2

•Calcium

What is the second MI enzyme to appear? When does it

appear/peak/gone•CK-MB

•Appears in 6 hours

•Peaks in 12 hours

•Gone in 24 hours

Where is CK-MM found?

•muscle

What causes lateral bowing of the legs?

•Rickets

What is cyclothymia?

•Dysthymia w/ hypomania

What is the vitamin pneumonic?

•The Rich Never Lie about Panning Pyrite Filled Creeks

•Thiamine, Riboflavin, Niacin, Lipoic Acid, Pantothenic acid,

Pyridoxine, Folate, Cyanocobalamine

How is heparin administered? What is it the DOC for?

•Administer via IV

•DOC for DVT

What are the essential fatty acids?

•Linolenic

•Linoleic

What can Wilson’s dz be confused with?

•Huntingtons

•HD has anticipation, trinucleotide repeats (CAG) and affects the

caudate.

•Accounts for 90% of movement disorders

Cofactor for all transaminases?

•B6

What is chromium needed for?

•Insulin action

Diptheria: what does it cause? What do you give for tx?

•Causes heart block

•Give antitoxin

•Never scrape membrane!

What is the clue for cGMP?

•Parasympathetic

•Anabolic

What is Ebstein’s Anomaly?

•Tricuspid prolapse

•Due to mom taking lithium in pregnancy

What dz looks like B3 deficiency?

•Hartnup Dz

•Tryptophan deficiency, which is needed to make niacin!

What is a heavy chain composed of?

•myosin

What is Chovstek’s sign?

•Tap on facial nerve muscle spasm

How is warfarin activated?

•Tissue activated

What is Myasthenic syndrome?

•Aka Lambert-Eaton

•Get stronger as the day goes on

•Stronger w/ EMG

•Not small cell CA

What do Ca channel blockers do to the EKG

•Widen P

•PR interval is longer

What are the toxicities of Warfarin?

•Bleeding

•Teratogenic

•Drug-drug interactions

What values do you see in restrictive pulmonary dz?

•pO2 ↓

•pCO2 ↓

•pH ↑

Cofactor for all carboxylases?

•biotin

What band of the sarcomere does not change length?

•A band

What happens when a pt is on prednisone for >7 days?

•Immunocompromised

What is the MOA of Methotrexate?

•Inhibits dihydrofolate reductase

•Inhibits DNA synthesis in the S phase of cycle

•Prevents reduction of folic acid needed to produce THF

What does heparin inhibit?

•Protamine Sulfate

Deficiency in Methylmalonyl CoA Mutase leads to…and why!

•Neuropathy

•Recycles myelin

What is uses tyrosine kinase?

•Used by insulins

•used by all growth factors

What dzs have cherry red macula?

•Niemann Pick

•Tay Sachs

•Sandhoffs

What is the most common cause of meningitis in : 0-2 months

•#1 - Group B strep (agalactiae)

•#2 – E. coli

•#3 - Listeria

What is the function of CN V2? What if lesioned?

•Mixed function•General sensation of palate, nasal cavity, maxiallry face and maxiallary

teeth•If lesioned: loss of general sensation

in skin over maxilla and maxiallary teeth

Which direction does the jaw deviate in CN V3 lesion?

•Towards the weak side

What is trigeminal neuralgia?

•Intractable pain in V2 or V3 territory

What happens if VI is lesioned? Where does it enter/exit the

cranium? What does it innervate?•Lesioned

–Diplopia (internal strabismus)–Loss of parallel gaze

(pseudoptosis)

•Exits the superior orbital fissure

•Innervates the orbit

What do we call a lesion of VII?

•Bell Palsy

Where does CN VII enter/exit the cranium? Where do the branches leave? What does it innervate?

•Internal auditory meatus•Branches leave through the skull in stylomastoid foramen, petrotympanic

fissure, or hiatus of facial canal•Innervates

–Face–Nasal and oral cavity

What muscle does IX go to? What happens if lesioned? Where does it enter/exit the

cranium?

•Goes to stylopharyngeus

•If lesioned loss of gag reflex with X

•Exits jugular foramen

CN X –sympathetics to head: what is it’s function?

•Motor•Rasies eyelid (superior tarsal muscle)

•Dilates pupil•Innervates sweat glands of face and

scalp•Constricts blood vessels in head

Where does the sympathetic portion of X enter/exit cranium?

What does it innervate?•Carotid canal on internal carotid

artery

•Innervates–Orbit–Face–scalp

What is CN XII? What is it’s funciton? What happens if

lesioned?•Hypoglossal

•Moves the tongue

•Tongue points toward pathology on protrusion

What happens if there is a lesion to the optic nerve?

•Unilateral blindness

What happens if there is a lesion to the optic chiasm?

•Bitemporal hemianopia

What is a berry aneurysm due to in the circle of willis?

•SUBARACHNOID hemorrhage

What is the clue for a Subarachnoid hemorrhage

•Worst headache of my life!

What does the diencephalon originate from

•forebrain

Where does the telencephalon originate from?

•Forebrain (prosencephalon)

What originates from the mesencephalon?

•Midbrain

•aqueduct

What originates from the metencephalon

•Pons

•cerebrum

What does the jugular foramen contain?

•CN IX

•CN X

•CN XI

•Internal jugular vein

•Spinal accessory nerves

What does the hypoglossal canal contain?

•CN XII

•Hypoglossal nerve

What does the carotid canal contain?

•Internal carotid artery

What does malunion mean?

•A fracture that heals in an abnormal position

Which CN is responsible for turning the head and shrugging

the shoulders?•CN XI

What CN controls sensory fibers for vision?

•CN II

If there is a lesion in the frontal lobe will you have motor or

sensory defects?•motor

What is B3 deficiency?

•Pellegra•4D’s

•Dementia•Diarrhea

•Dermatitis•Death

Name the ion that goes with:P wave? QRS? ST?

•Ca

•Na

•Ca

In EKG, Q wave means…

•Septum

•Phase 0

•sodium

What is required for the conversion of methylmalonyl CoA

to Succinyl CoA•B12

What is hallucination?

•False sensory perception

•Usually auditory

•Formication = bugs crawling under skin…see in alcohol withdrawal and cocaine OD

What can lithium do to mom?

•Nephrogenic DI

What do you need Cu for?

•Collagen synthesis

What is perseveration

•Keeps repeating same word

What do tPA, Streptokinase, and Urokinase inhibit

•Aminocaproic acid

What is Duchenne’s Muscular Dystrophy

•Dystrophin frameshift

•Gower sign

•Calf pseudohypertrophy (fat deposition)

What is the light chain composed of?

•Actin

What are the symptoms of the low energy state?

•Everything slows down!•Mental retardation, dementia, HF, pericardial

effusion, WEAKNESS, SOB, vasodilation, impotence, urinary retention, constipation, dry skin, brittle nails, hair loss, suppressed BM, vascular endothelium breaks, lung infxns, PCT breakdown, N/V/D, oliguria, ↓ sperm,

germ cells CA, atrophic breasts and endometrium

What is MS?

•Anti-myelin Ab

•Young woman w/vision problems

•Sxs come and go

What is the first MI enzyme to appear? When does it

appear/peak/gone•Troponin I

•Appears in 2 hours

•Peaks in 2 days

•Gone in 7 days

What is the typical incidence with 2 risk factors

•50%

What is trisomy 13?

•Patau’s

•Polydactyly

•High arch Palate

•Pee problems

•holoprosencephaly

What do you think if serum Ca and Phosphate change in

opposite directions?•PTH problems

•↑ Ca HyperPTH

•↓CaHypoPTH

What is myotonic dystrophy?

•Bird beak face

•Can’t let go when they shake hands

What murmur has bounding pulses?

•Head bobbing

•Wide pulses

•Bounding pulse

•Quinkes pulse

•Aortic regurgitation

MCC pneumonia 18-40 years

•Mycoplasma

•Chlamydia pneumonia

•Strep pneumonia

What is Adrenal Leukodystrophy?

•Carnitine shuttle problem

•Adrenal failure

What are the causes of restrictive cardiomyopathy

•Sarcoid

•Amyloid

•Hemochromatosis

•Cancer

•Fibrosis

What murmur has fixed wide splitting?

•ASD

What is B5?

•Pantothenic acid

•No deficiency

AR: how is it transmitted? Are there malformation present?

What type of defect?•Horizontal transmission

•Physical malformations are uncommon

•Enzyme defect

Inflammation: What happens on day 7?

•Fibroblasts show up

What is B12?

•Cyanocobalamine

What are the 3 main concepts causing a widened S2 splitting?

•↑ pO2

•Delayed opening/closing of the pulmonary valve

•↑ volume in the right ventricle

What has a machine like murmur?

•PDA

What is asthma in a child less than 2 called

•bronchiolitis

What is seen in every restrictive lung dz and low volume state?

•Tachypnea

•↓ pCO2

•↓ pO2

•↑ pH

AD: how is it transmitted? Is there a malformation present?

What type of defect?•Vertical transmission

•Physical malformation is common

•Structural defect

What is pernicious anemia?

•Anti-IF AB

•Vit B12 def megaloblastic anemia

On an EKG, what is the p wave representing?

•atrial contraction

•Phase 0

•Calcium

What are the antioxidants?

•Vitamin E (#1)

•Vitamin A

•Vitamin C

•Betakeratine

What is vit B1 called?

•Thiamine

What is the most common cause of vit C deficiency?

•Diet deficient in citrus fruit, green veggies or just overcooking the

green veggies!

What are the atypicals?

•Chlamydia

•Ureoplasma

•Mycoplasma

•legionella

What organ needs selenium?

•heart

What murmurs increase on expiration?

•VSD

•Mitral

•Aortic

Synthesis of Rhodopsin requires…?

•Vit A

What is the incidence of rare disease in the general population

•1-3%

What are the most common cyanotic heart dzs?

•Transposition of the great arteries•Tetrology of Fallot•Truncus Arteriosus•Tricuspid Atresia

•Total anomalous pulmonary venous return•Hypoplastic left heart syndrome

•Ebstein’s anomaly•Aortic atresia

•Pulmonary atresia

What are the vitamin K dependent clotting factors?

•10•9•7•2

•Protein C•Protein S

What trace element is an enzyme in glycolysis

•Manganese

What is Wernicke’s Encephalopathy?

•Alcoholic thiamine deficiency of the temporal lobe

What is clanging?

•Words that sounds alike

What is the best source of B2?

•Milk

•Also from FAD

Why do we stop CPR after 20 minutes?

•Brain has irreversible cell injury

Is Warfarin long acting or short acting?

•Long half life, 8-10 hours to act.

What is metachromatic leukodystrophy?

•Arylsulfatase deficiency

•Kid with MS presentation

What is circumstanciality

•Digresses, but finally gets back to the point

What are the 2 enzymes used by B12?

•Homocystine methyl transferase

•Methyl malonyl-coA mutase

What is ALS?

•Middle age male

•Fasiculations

•Descending paralysis (check on this)

•No sensory problems

What is neologisms?

•New words

Deficiency in homocysteine methyl transferase leads to…and

why is that bad?•Megaloblastic anemia

•Need it for nucleotide synthesis!

What is word salad?

•Unrelated combination of words

How is major depression diagnosed?

•Need 5 of the “SIGE CAPS”, lasts >2 weeks•Sleep disturbances: wake in am

•Interest/libido lost•Guilt

•Energy loss•Concentration lost

•Appetite lost•Psychomotor agitation•Suicide (hopelessness)

Decarboxylation of α ketoacids requires…

•thiamine

When does the carboxylation of glutamic acid occur? What is

needed?•Used in synthesis of blood

clotting factors

•Requires vit K

What are the mitochondrial dzs?

•Leber’s – atrophy of the optic nerve

•Leigh’s – subacute necrotizing encephalomyelopathy

What is vitamin C needed for?

•Collagen synthesis

What do you use for rapid reversal of heparin?

•Protamine sulfate

What is Guillane-Barre

•Ascending paralysis

•2 weeks post UTI

What is the typical incidence of dz with 3 risk factors?

•90%

What are the 4 D’s of pellegra?

•Diarrhea

•Dementia

•Dermatitis

•Death

•B3 deficiency!

What is Freidrich’s ataxia?

•Retinitis pigmentosa

•scoliosis

What is required for the conversion of methionine from

homocysteine?•B12

What is Myasthenia gravis?

•Gets weaker as day goes

•Stronger w/ edophonium

•Weaker w/ EMG

•Rule out Thymoma

What is the clue for rusty colored sputum?

•Strep pneumonia (pneumococcus)

What is Ataxia Telangectasia?

•Spider veins

•IgA deficiency

What is the MCC of atypical pneumonia in 0-2 months?


Can you use heparin in pregnancy?

•Yes, does not cross placenta

What needs B1 as a cofactor?

•3 DHs

•Pyruvate DH

•Alpha ketoglutarate DH

•Branch chain amino acid DH

•Transketolase

What is werdnig-Hoffman?

•Fasciculations in a newborn

•No anterior horns

AR: how are they acquired? When does that occur?

•Almost all are inborn error of metabolism

•Occur only when both alleles at a locus are mutant

Where is CK-MB found?

•heart

Who do you need to give B6 to?

•Pts on INH!

What symptoms does the “less likely to depolarize” state have?

•Brain: lethargy, confusion, depression

•Skeletal M: weakness, SOB•SM: constipation diarrhea

•Cardiac: hypotension, bradycardia

What is trisomy 18?

•Edward’s

•Rocker bottom feet

What is schizoid personality disorder?

•Recluse, don’t want to fit in

What will you see on xray with croup? What is clue symptom?

•Steeple sign

•Barking cough

What do you get with ↓ thiamine?

•Beri Beri

•Wet = high CO HF

•Dry = no HF

•Wernicke’s Encephalopathy

•Wernicke’s Korsakoff

Mitochondrial dzs: who are affected? Who passes it on? Who

has no transmission?•All offspring affected

•Mom passes it on

•Dad has no transmission

What is Becker’s MD?

•Dystrophin missense

•Sxs appear >5yo

What is PLAN F?

•TPP – Thiamine – B1

•Lipoic Acid – B4

•CoA – Pantothenic acid – B5

•NAD – Niacin – B3

•FAD – Riboflavin – B2

Another name for Vit C?

•Ascorbic Acid

What is cystic fibrosis?

•Meconium ileus

•Steatorrhea

•bronchiectasis

What organs do not require insulin?

•BRICKLE•Brain•RBC

•Intestine•Cardiac, cornea

•Kidney•Liver

•Exercising muscle

What do Na channel blockers do to the EKG?

•Widen QRS

What dzs have respiratory acidosis?

•Obstructive lung dz

What are the plasma catecholamines

•Epi

•NE

•Dopamine

What type of anemia is seen in B6 deficiency?

•sideroblastic

MCC of pneumonia 40-65

•Strep pneumonia

•H. influenza

•anaerobes

What are the periods of rapid growth (rapid dividing cells)

•Birth-2 months

•4-7 years

•puberty

What is Ca+ needed for?

•Muscle contraction

•Axonal transport

•2nd messenger

Inflammation: What happens at 24 hours?

•Neutrophils show up

What dzs have trinucleotide repeats?

•Huntington’s

•Fragile X

•Myotonic Dystrophy

•Friedreich’s ataxia

What is required for the degradation of cystathionine?

•Vitamin B6

What is the clue for Wilson’s dz?

•Hepato/lenticular degeneration–hepato = liver

–lenticular = basal ganglia (putamen and globus pallidus)

•Kayser Fleishner rings

•Ceruloplasmin deficiency

Name some causes for a widened S2 split

•Blood transfusion•↑ tidal volume•Giving oxygen

•R sided heart failure•Pregnancy

•IV fluids•ASD/VSD

•Deep breathing•Hypernatremia

•SIADH•Pulmonary regurg

•Pulmonary stenosis•RBBB

What are the 5 hormones produced by small cell (oat cell)

lung CA•ACTH

•ADH

•PTH

•TSH

•ANP

What will you see on xray with epiglotitis? What is key

symptom?•Thumb sign on xray

•drooling

What is Turners?

•XO•Web neck

•Cystic hygroma•Shield chest

•Coarctation of aorta•Rib notching

When is angular stomatitis seen?

•B2 deficiency

What organ needs tin?

•hair

What is the clue for NO?

•Nitrates

•Viagra

•ANP

•LPS

What is function? What if lesioned? Where enter/exit

cranium? What does it innervate?CN II•Optic

•Sensory for sight•Anopsia if lesioned (visual field defect)

•Loss of light reflex with CN III•Only nerve affected by MS•Exit/Enter via optic canal


What do you measure for carcinoid syndrome

•Serotonin

•5-HIAA

What metabolizes fat soluble drugs?

•liver

What is Bipolar II

•Depression with Hypomania (no psychosis)

What dz do you get if you have too much Cu?

•Wilson’s dz

What is tracheitis?

•Look toxic

•Grey pseudomembrane

•leukocytosis

Where enter/exit cranium? What does it innervate? CN IV

•Superior orbital fissure


Where enter/exit cranium? What does it innervate?

CN III•Superior orbital fissure


What is Vitamin E needed for?

•Hair

•Skin

•Eyes

•Protect against free radicals

•#1 antioxidant

What drugs cause pulmonary eosinophilia?

•Nitrofurantoin

•sulfonamides

What is Mg a cofactor for?

•All kinases

•Also, for the parathyroid (along with vit A)

What does CN IX innervate?

•Neck

•Pharynx/tongue

What is stable angina?

•Pain with exertion (atherosclerosis)

MCC of pneumonia in the elderly

•Strep pneumonia

•Viruses

•Anaerobes

•H. influenza

•G- rods

What are the most common symptoms of the low energy

state?•Weakness and SOB

What is CN VIII? What is it’s function?

•Vestibulocochlear•Sensory function

•Hearing•Linear acceleration (gravity)•Angular acceleration (head

turning)

What will happen if V3 is lesioned?

•Loss of general sensation in skin over mandible, mandibular teeth,

tongue, weakness in chewing

CN V1: what does it innervate? Where does it enter/exit the

cranium?•Innervates orbit and scalp

•Exit/enters at superior orbital fissure (ophthalmic division)

What does Vit D do with Ca+

•Controls Ca+

•Absorbs Ca+ from GI

•Reabsorbs Ca+ in kidneys

•Controls osteoblastic activity

What is hyaluronic acid?

•Glycosaminoglycan chain that helps form proteoglycans

What does the foramen spinosum contain?

•Middle meningeal artery–Branch of the maxillary artery

What is bronchiectasis

•Bad breath

•Purulent sputum

•Hemoptysis

•Dissolving the alveoli by bacteria

What are the toxicities of Warfarin?

•Bleeding

•Teratogenic


CF: what test is used to detect CF? what is nl value? Abnl

value? Heterozygous value?•Pilocarpine sweat test

•Measures Cl- •test value of >60 indicates

presence of dz•Nl test value is <20

•Heterozygous person is 30-60

What ion corresponds with:T wave? U wave?

•K

•Na

What are the most common signs of the low energy state?

•Tachypnea and dyspnea

What is Trousseau’s sign?

•BP check causes carpal spasm migratory thrombophlebitis

What happens if X is lesioned?

•Nasal speech•Nasal regurgitation

•Dysphagia•Palate drop

•Uvula points AWAY from pathology•Hoarseness/fixed vocl cord•Loss of gag reflex (with IX)

•Loss of cough reflex

What is Prinzmetal’s angina?

•Intermittent pain (coronary artery spasm)

What is dysthymia?

•Low level sadness >2 yrs

•“Eor”

MCC of pneumonia in 6 wks to 18 years?

•RSV (infants only)

•Mycoplasma


•Strep pneumonia

What is B4?

•Lipoic Acid

•No problems with deficiency

When does Physis disappear?

•Once growth is complete

What is Pellagra?

•Niacin deficiency

•Dermatitis

•Diarrhea

•Dementia

•Death

What is sinusitis symptom?

•Teeth pain worse with bending forward

What are the clues for asthma?

•Wheeze on expiration

•IgE

•eosinophils

What metabolizes Water soluble drugs?

•kidney

Where do you fine: janeway lesions

•toes

What are drugs that blast the BM?

Vinblastine Anilate Bone Cells

•Vinblastine

•AZT

•Benzene

•Chloramphenicol

What things make the membrane LESS likely to depolarize?

•HypOKalemia

•Hypermagnesemia

•Hypercalcemia (except atrium)

•Hypernatremia

What is CN XI? What is it’s function?

•Accessory

•Functions to–Turn head to opposite side

(sternocleidomastoid)–Elevate and rotate scapula

(trapezius)

What originates from the myerencephalon?

•Medulla

Where does V3 enter/exit cranium? What does it innervate?

•Foramen ovale

•Infratemporal fossa

What is a characteristic feature of cancellous (spongy) bone?

•trabeculae

What is XXX syndrome?

•47 XXX

•Nl female

•Two barr bodies

What dz corresponds with this inclusion body…

•Barr body

•Nl female

What cyanotic heart dz is boot shaped?

•Tetrology of fallot

What is Korsakoff psychosis?

•Alcoholic thiamine deficiency

What is vitamin C deficiency?

•Scurvy!

What does Vit D deficiency cause?

•Kids = Ricketts

•Adults = osteomalacia

What does Vit A deficiency cause?

•Nightvision problems (night blindness)

•Hypoparathyroidism ↓Ca, ↑Phosphate

What is delusion

•One falsely held belief

What is a paranoid personality disorder?

•Suspicious about everybody, use projection

What is the clue for cAMP

•It is the 90%

•Sympathetic

•CRH (cortisol)

•Catabolic

What CN senses smelling?

•CN I

What is CN VI? What is it’s function?

•Abducens nerve

•Motor function

•Lateral rectus abducts eye

What is CN X? What is it’s function?

•Vagus•Mixed function

•Muscles of palate and pharynx for swallowing EXCEPT tensor palate (V) and stylopharyngeus (IX)

•All muscles of larynx (phonates)•Senses larynx and laryngopharynx

•Senses Larynx and GI tract•To GI tract smooth muscles and glands in foregut and

midgut

What is laryngomalacia?

•Epiglottis rolls in from side-to-side

Newborn meningitis is caused by

•Group B strep (agalactiae)

•E. coli

•Listeria

Inflammation: what happens at 3-6 months?

•Fibroblasts are gone

Where are the T-tubules located?

•Cardiac muscle: Z line

•Skeletal muscle: A-I junction

What pathway does heparin affect? What should you follow?

•Intrinsic pathway

•Follow the PTT

What drugs dilate veins and arteries?

•ACE inhibitors

•Nitrates

What does Zinc do?

•Taste buds

•Hair

•Sperm function

What is Kwashiorkor?

•Malabsorption

•Big belly (ascites)

•Protein deficiency

What is a nonunion fracture

•Fracture that does not heal within 6 months

What are THF derivatives used in?

•Purine nucleotide synthesis

•Methylation of dUMP dTMP

What are the 3 low volume states with acidosis rather than alkalosis

•RTA

•Diarrhea

•DKA

What are the cells of neural crest origin

•Parafollicular cells of thyroid•Odontoblasts (predentin)

•Pseudounipolar cells•Spiral membrane of heart

•Chromaffin cells•All ganglion cells (schwann, adrenal medulla)

•Melanocytes•Laryngeal/tracheal cartilage

What must you rule out with ↓ AVO2?

•AV fistula

•vasodilation

Where does the mannose-6-P send stuff to?

•lysosome

What is the clinical use of warfarin?

•Chronic anticoagulation

What is Marasmus?

•Starvation

•Skinny

•Calorie deficiency

What is another name for sertoli cells

•Sustentacular cells

What are the different types of emphysema and their causes

•Bullous: s. aureus, pseudomonas

•Centroacinar: smoking

•Distalacinar: aging

•Panacinar: α-1-antitrypsin def

How is heparin activated?

•By the blood

What is the clue for Ca:Calmodulin

•Used by smooth muscle for contraction by distention

What is the function of CN V3?

•Mixed function•General sensation of anterior 2/3 of

tongue, mandibular face and mandibular teeth

•Motor: muscles of mastication and anterior belly of digastric, mylohyoid,

tensor tympani, tensor palatine

What is B6?

•Pyridoxine

What is variable expression?

•Phenotype is different in different individuals with the same gene

What things make the membrane MORE likely to depolarize?

•Hyperkalemia

•HypOMagnesia

•HypOCalcemia (except atrium)

•HypONatremia

Where does the Pre label send stuff to?

•ER

What type of acidosis do you see with obstructive pulmonary dz?

•Respiratory acidosis

What is tracheomalacia?

•Soft cartilage

•Stridor since birth

What is CN IX? What is it’s function?

•Glossopharyngeal•Mixed function•Sense pharynx

•Carotid sinus/body•Salivates (parotid glands)

•Tastes and senses posterior 1/3 of tongue

What CN has sensory fibers for Face and motor fibers for muscles of mastication?

•CN V

What originates from the hindbrain?

•Metencephalon

•myerencephalon

What tracts are affected by a deficiency in methyl malonyl coA

mutase?•Dorsal columns

•Cortical spinal tracts

•Affected because they are the longest and need the most myelin

What is Bipolar I?

•Depression with Mania (psychosis)

What is CN V called

•Facial

What is CN VII? What is it’s function?

•Facial•Mixed function (motor and sensory)

•Muscles of facial expression•Posterior belly of diagastric•Stylohyoid and stapedius

•Taste anterior 2/3 of tongue/palate•Salivates (submandibular and sublingual glands)

•Tears (lacrimal glands)•Mucous (nasal and palatine glands)

What are physical signs of B2 deficiency

•Angular stomatitis

•Angular cheliosis

•Corneal neurovascularizations

Which CNs control eye movement?

•CN III

•CN IV

•CN VI

What are the toxicities of Heparin?

•Bleeding

•Thrombocytopenia


6 hormones produced by the placenta

•hCG•Inhibin

•Human Placental lactogen (HPL)•Oxytocin (drug lactation, pit gland produces it

also)•Progesterone

•Estrogen•Relaxin

What is the MOA of heparin?

•Catalyzes the activation of antithrombin III

•Decreases thrombin and Xa

Most common cause of death in the low energy state?

•Heart failure

On an EKG, U wave means…

•Ventricle resetting

•Phase 4

•sodium

What originates from the diencephalon?

•Thalamus

•3rd ventricle

What are the trace elements?

•Chromium

•Selenium

•Tin

•Manganese

Is heparin long acting or short acting?

•Short half life

•Starts acting immediately

What is Hartnup’s?

•No tryptophan Niacin + serotonin

•Presents like pellagra

•Can mimic corn-rich diet

What are signs of tamponade

•↓ breath sounds

•↓ BP

•↑ JVD

On an EKG, PR interval means…

•AV node (the pause)

•Phase 2

•sodium

What is function of CN III

•Oculomotor•Moves eyeball in all directions

•Adduction most important action•Constricts the pupil (sphincter

pupillae)•Accomodation (ciliary muscle)

•Raises eyelid (levator palpebrae)

Who is affected in the family with an x-linked dz

•Maternal grandfather

•Maternal uncles

What does calcium do?

•Neuronal function

•Atria depolarization

•Smooth m contractility

What vitamin is deficient with pernicious anemia and has a

neuropathy?•B12

What are the different branches of CN V?

•V1 = opthalmic

•V2 = maxillary

•V3 = mandibular

Inflammation: what happens in 1 month?

•Fibroblasts peak

What is Nihilism?

•The world has stopped!

Inflammation: what happens on day 4?

•T cells and macrophages show up

What needs B6 as a cofactor?

•All transaminases!

What does the optic canal contain?

•Opthalmic artery

•Central retinal vein

•CN II

What are the risk factors for lung cancer?

•Smoking

•Radon

•2nd hand smoke

•Pneumoconiosis (except anthracosis)

What is MS?

•Anti-myelin Ab

•Middle aged female with vision problems

What is myasthenia gravis?

•Anti-AChr Ab

•Female w/ ptosis

•Weaker as the day goes on

What is IP3/DAG used by and for?

•Smooth muscle for contraction

What is XYY syndrome?

•47 XYY

•Tall aggressive male

What dzs do we screen for at birth?

Please Check Before Going Home•PKU•CAH

•Biotinidase•Galactosemia

•Hypothyroidism

When is warfarin absolutely contraindicated?

•Pregnancy, because it can cross the placenta

What CN controls tongue movement?

•CN XII

What is Choreoathetosis?

•Dance like movements

•Wringing of hands

•Quivering voice

What is the most common cause of B12 deficiency?

•Pernicious Anemia

What are the macrocytic anemias?

•B12•Folate

•Reticulocytosis•EtOH

•Hemolytic anemias•Chemo

•Anticonvulsants•myelodysplasia

What disease manifest with Cu deficiency?

•Minky kinky hair syndrome

What are the x linked dominant diseases?

•Na-resistant rickets (kidney leaks phosphorus), waddling gait

•Pseudohypoparathyroidism: sausage digits, osteodystrophy

What are the most common causes of meningitis in: 2 months

– 10 years•#1 – strep pneumonia

•#2 – neisseria meningitidis

What does the posterior condylar canal contain?

•Large emissary vein

What part of the brain deals with problem solving?

•Frontal lobe

What is polio?

•Child

•Asymmetrical fasiculations

•2 weeks after gastroenteritis

On an EKG, R means…

•Anterior wall of ventricles

•Phase 0

•Sodium

What is penetrance?

•The % of people who have the gene that also exhibit the

phenotype.

•If they have the gene but not the dz ↓ penetrance

What are the clues for epiglottitis? What is the MCC?

•Stridor

•Fever

•Thumb sign on xray

•MCC = H. influenza type B

What are the causes of eosinophilia

•Neoplasms

•Allergies/asthma

•Addison’s dz

•Collagen vascular dz

•parasites

What are the vit K dependent clotting factors? Shortest ½

lives?•2,7,9,10

•Protein C and S•Protein C has shortest ½ life: 6

hours•Protein 7 has next shortest: 2

days

What is the max heart rate (for anybody…)

•220-age

What is function? What if lesioned? Where enter/exit

cranium? What does it innervate? CN I

•Olfactory

•Sensory for smell

•Anosmia if lesioned

•Enter/exit cribriform plate

•Innervates nasal cavity

What are the only 3 pansystolic murmurs and when are they

heard?•MR – ↓ on insp, ↑ on exp

•TR - ↑ on insp, ↓ on exp

•VSD - ↓ on insp ↑ on exp

What does chlamydia pneumonia cause?

•Interstitial pneumonia

What is the only cause of ICP that does not cause herniation?

•Pseudotumor cerebri

What originates from the telencephalon?

•Cerebral hemispheres

•Lateral ventricles

What are the vitamins from the GI that are nl flora?

•Folate

•Vit K

•Biotin

•Panothenic acid

•Helps with absorption of B12

What if lesioned? CN IV

•Weakness looking down with adducted eye

•Trouble going down stairs

•Head tilts away from lesioned side

CN V2: where does it enter/exit the cranium? What does it

innervate?•Exit enter: foramen rotundum

•Innervates pterygopalatine (leaves by openings to face, oral

and nasal cavity)

If pt has a visual field defect with cognitive disturbance? What part

of the brain will be affected?•Temporal or parietal lobe

How is warfarin administered?

•PO

On an EKG, S means…

•Posterior wall

•Phase 0

•sodium

What enzyme does Zanthein Oxidase need?

•Maganese

What happens if the sympathetic part of CN X is lesioned? What

do we call this?•Eyelid droop (ptosis)

•Constricted pupis (miosis)

•Loss of sweating (anhydrosis)

•Flushed face

•Called: Horners syndrome

What is good about new LMWH?

•Act more on Xa

•Have better bioavailability

•2-4 times longer half life

•Can be administered subQ and don’t need lab monitoring

Where does the Pro label send stuff to?

•golgi

What is the dosage for streptokinase (push and drip)

•750K IV push

•750K drip

Where do you find Small cell CA? what are other features

•Most common at carina

•Malignant

•Cushing’s

•SIADH

•SVC syndrome

What is the triad of carcinoid syndrome

•Flushing

•Wheezing

•diarrhea

What is the dosage of tPA? (push and drip)

•20 mg IV push

•40 mg drip

How does a neurogenic muscle dz present?

•Distal weakness and fasiculations

What is the first vitamin to run out with dz of rapidly dividing cells?

•Folate

What does hyperresonance tell you

•Air in lungs

What does it mean to see a physis on radiograph?

•Means the skeleton is not fully mature

What are the causes of croup and bronchiolities

•Parainfluenza

•Adenovirus

•Influenza

•RSV

What are the clues to scurvy?

•Bleeding gums

•Bleeding hair follicles

Inflammation: What happens at day 3?

•Neutrophils peak

What happens if VII is lesioned

•Corner of mouth droops•Can’t close eye

•Can’t wrinkle forehead•Loss of blink reflex

•Hypeacusis•Loss or alteration of taste (ageusia or

dysgusia)•Eyes dry and red

What are the clinical uses of heparin?

•Immediate anticoagulation of pulmonary embolism, stroke,

angina, MI, DVT

Who gets asbestosis

•Shipyard workers

•Pipe fitters

•Brake mechanics

•Insulation installers

What is the MOA of Warfarin?

•Interferes with nl synthesis and γ carboxylation of Vit K dependent

clotting factors via Vit K antagonism

How do you detect pulmonary embolus?

•Tachypnea

•↑ V/Q scan

•EKG: S1 Q3 T3

Pyruvate decarboxylase requires what as a cofactor?

•thiamine

What is B3 called?

•Niacin

What does the hydroxylation of purines require?

•Vitamin C

Where does CN X enter/exit cranium? What does it innervate?

•Exits jugular foramen

•Innervates–Neck

–Pharynx/larynx–Thorax/abdomen

What is B2 called?

•Riboflavin

What type of receptors do all sphincters in the body have?

•alpha-receptors

What does warfarin do to the PT?

•Prolongs it

On an EKG, T wave means…

•Ventricle repolarization

•Phase 3

•K

What happens if you lesion CN XI? Where does it enter/exit

crainum? What does it innervate?•Lesioned:

–Weakness turning head to opposite side

–Shoulder droop

•Enters via Jugular foramen

•Innervates the neck

Cofactor for all kinases?

•Magnesium

Cystic Fibrosis: What is the treatment?

•Pilocarpine (which is also used for glaucoma)

What dzs have metabolic alkalosis

•Low volume states

•Vomiting

•Diuretics

•GI blood loss

What does the foramen ovale contain?

•CN V3

AD: where is the new mutation?When is the onset?

•New mutation is often in germ cells of older fathers

•Onset is often delayed (ex. Huntingtons)

What if lesioned? CN III

•Diplopia•Loss of parallel gaze

•Dilated pupil•Loss of light reflex

•Loss of near response•ptosis

What are the clues for IP3/DAG

•Neurotransmitter

•GHRH

•All hypothalamic hormones except cortisol

What does the foramen magnum contain?

•Vertebral arteries

•Brain stem

•Spinal roots of CN XI

•Spinal cord

What do you need to know about large cell CA?

•Large cells!

What is the function of CN V1? If lesioned?

•Mixed function•General sensation (touch, pain, temp)

of forehead, scalp and cornea•If lesioned:

•Loss of general sensation of the forehead/scalp

•Loss of blink reflex w/ VII

What are the most common causes of meningitis

corresponding with >21 yo?•N. meningitidis

Where does CN XII enter/exit the cranium? What does it innervate?

•Hypoglossal canal

•tongue

What are the mitochondrial dzs?

•Leigh’s (progressively ↓ IQ, seizure, ataxia, deficiency of

cytochrome oxidase)

•Leber’s Hereditary optic atrophy

What symptoms does the “more likely to depolarize state” have

•Brain: psychosis, seizures, jitteriness

•Skeletal muscle: spasms, tetany

•SM: diarrhea constipation

•Cardiac: tachycardia, arrhythmias

What gives you differential pulses?

•coarctation

What is schizotypal personality disorder?

•Magical thinking, bizarre behavior

Too much Vit A will cause…

•Hyperparathyroid ↑Ca, ↓Phosphate•Moans and Groans (pancreatitis)

•Bones (PTH munches bones)•Stones

•Pseudotumor cerebri (↑ CSF production from chorichoid plexus)

What is the deficiency caused by this vitamin(B12)? What

deficiency causes it?•Neuropathy

•Pernicious anemia

What streptococcus causes SBE?

•viridans

Facts about diphtheria

•ADP ribosylates EF-2•Stops cell synthesis

•G+•Gets exotoxin from virus via

transduction•Heart block

•Its toxoid therefore give antitoxin

Clue for Ricketts?

•Lateral bowing of the legs

•X linked dominant

What causes a neuropathy when deficient and also needed for

transaminase?•B6

What systems does mitochondrial inheritance affect? Why does it

affect these?•CNS

•Heart

•Skeletal muscles

•These have uneven cytokinesis during meiosis or oogenesis

Who gets byssinosis

•Cotton workers

What happens if CN VIII is lesioned? Where does it

enter/exit cranium? What does it innervate?

•Lesion = loss of balance, nystagmus

•Enters in the internal auditory meatus

•Innervates the inner ear

How is warfarin activated?

•Tissue activated

What is biotin a cofactor for?

•All carboxylases

What are the most common causes of meningitis

corresponding with 10-21 yo?•N. meningitidis

What is unstable angina?

•Pain at rest (transient clots)

•Meds don’t help

•Pain is more severe

•Pain is more frequent

What is tangentiality?

•Wanders off topic

What is the typical incidence of a rare dz w/ 1 risk factor

•10%

What type of anemia is seen with folate deficiency?

•Megaloblastic

•No neuropathy

What drugs cause dysgeusia?

•Li (?)

•Metronidazole

•Clarithromycin

•Mg

What electrolytes does the low volume state have?

•↑ total Na

•↓ serum Na (dilutional effect)

•↓Cl

•↓ K

What is folate used for?

•Nucleotide synthesis (THF)

What are the 4 facts of Fanconi syndrome

•Problem in proximal tubule

•Can’t reabsorb

•Low energy state causing anemia

•Can be due to old tetracycline

What is function? CN IV

•Trochlear•Motor

•Superior oblique•Depresses and abducts the

eyeballs•intorts

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