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How many Chromosomes do somatic cells contain?
Somatic Cells contain 46 chromosomes and divide by mitosis.
What are the S/Sx of Pericarditis?
Sharp Stabing pain relieved by leaning forward. EKG shows diffuse ST elevations c upright T waves. And Pain is related to breathing as opposed to a dissecting aortic aneurysm (pain is not associtated c breathing but is relieved by leaning forward)
What is Reye’s Syndrome?
 Reye’s Syndrome: post viral derangement of metabolism associated c enlarged distorted mitochondria in many tissues. Most significant clinically are the effects on the liver and brain. Liver there is a reduction in the activity of many key biochemical pathways (citric acid cycle, urea cycle, and beta ox of FA). The disruption of these pathways produces a very extensive microvesicular steatosis (fatty change) that is characteristic liver finding. In the Brain, edema is a prominent feature, and the astrocytes show mitochondrial disruptions by EM.
CX: Postviral infection, Aspirin.
What muscles do we use to open our mouth?
Open: Lateral pterygoid (arise from infratemporal surface of the greater wing of the sphenoid bone, and from Lateral pterygoid plate) they pull the mandible forward in the process of opening the jaw. They also protract the mandible and move it from side to side)
Close: Masseter, M. pterygoid, and Temporalis.
How does CEA become released in Colon Ca?
CEA is a glycoprotein that is found in GI mucosal cells and pancreatobiliary system secretions. It becomes elevated when breaks in the mucosal bm occur d/t tumor growth. Cirrhosis and Pancreatitis can also cx elevations.
Once tumor is excised CEA should decrease⬦if it becomes elevated then the tumor is most likely back!
What is acantholysis?
Seperation of keritinocytes from their neighbors. As seen in dx like Pemphigus Vulgaris. This is an autoimmune dx in which antibodies attack desmoglein. Desmoglein is the transmembrane cadherin that forms the intercellular linkages at desmosomes.
What percentage of our daily intake of salt do we excrete from our kidneys?
95% from Kidneys
5% Sweat and Feces
S/Sx of a Atrial Myxoma?
Obstruction of the mitral valve giving a “plopping” sound during mid systole. Pt will have had several episodes of syncope
Bx: tumors are composed of scattered mesenchymal cells in a prominent myxoid background.
Innervations of the Median Nerve⬦
Thenar compartment muscles at the base of the thumb (Abductor Pollicis brevis, Flexor Pollicis brevis, and opponens pollicis.
What would happen if you destroyed Parietal Cells in the Stomach?
You would have a decrease in IF and Gastric Acid production Pernicious (B12def) Macrocytic Anemia and more Bacterial Growth (dt decreased acid production)
Pineal tumor leading to upward gaze palsy is dt compression of what?
Parinaud’s syndrome: Paralysis of conjugate upward gaze caused by a lesion at the level of the superior colliculi; Bell phenomenon is present.

Pineal Tumors can also compress the cerebral aqueduct Noncommunicating hydrocephalus (bilateral papilledema)
What is the difference between Primary and Secondary Adrenal Insufficiency?
Both result in decreased Aldosterone

Primary Adrenal Insufficiency (aka Addisons Dx) result from any dx that destroys the Adrenal Cortex.
CX: #1 Autoimmune, Infections, Malignancies

Secondary Adrenal Insufficiency differs in 2 ways
1. It is dt Pituitary or Hypothalamus problem resulting in a decrease in ACTH
2. It does not result in skin hyperpigmentation. The hyperpigmentation seen in Addisons Dx is dt increase in production of the ACTH precursors which stimulate melanocytes.
In a women suffering from Sheehan Syndrome...what are the most important hormones to give her to prevent life threatening complications?
Glucocorticoids and Thyroid Hormone
What hormonal lab values would you expect to see in a Turner's Pt?
High FSH Levels because they are lacking feedback inhibition from the Ovaries.
Name 2 diseases associated with HLA B27?
Psoriatic Arthritis
Reiter's Syndrome -->cant see (anterior uveitis) cant pee (urethritis) and cant climb a tree (arthritis)
If someone had Postrenal azotemia what would their BUN/Cr ratio be?
High greater than the normal 12-20 in a person on a normal diet.
What is Trousseau's Sign?
Migrating Thrombophelbitis
Define Gynecomastia
Benign proliferation of ductal and stromal elements of the breast.

It is the MC breast mass in Men!
What is Achalasia?
It is an aquired esophageal motility disorder that develops slowly.
It is dt the loss of inhibitory neurons of the esophageal body and the lower esophageal sphincter.

The result is decreased peristalsis and increased lower esophageal tone.
What would cause a fricton rub to be heard on a pt post MI?
Dressler Syndrome: This is thought to be an autoimmune complication resulting in Fibrous Pericarditis.
What thyroid Carcinoma would be responsible for lowering Ca levels in a pt?
Medullary Thyroid Cancer. This is because this cancer arises in the Parafollicular or "C" Cells of the Thyroid. These cells are responsible for secreting Calcitonin (Calcium lowering hormone).
Medullary Carcinoma is also associated with MEN 2a and 2b syndromes. Therefore, you can have Pheochromocytoma arise as well!
What virus causes Poliomyelitis and what are the signs and symptoms?
Poliovirus which is a Picornavirus and is spread by fecal oral contact.
It can then spread cause paralysis by infecting the alpha motor neurons of the anterior horn of the spinal cord

Early S/Sx:
malaise and flu like symptoms with a sore throat.
How do the sleep patterns of elderly persons differ from younger persons?
They tend to have more arousals and nightly awakenings.
Within what peritoneal structure is the cystic ligament located?
The Hepatoduodenal ligament

The cystic artery is a branch of the Right Hepatic A. which is a branch of the Proper Hepatic A.
Describe the location of the inguinal canal?
It is above the inguinal ligament, The opening (Deep Inguinal Ring) is located one half inch above the midpoint of the inguinal ligament. The exit of the inguinal canal (Superficial Inguinal ring) is superiolateral to the pubic tubercle.
What is the MOA for Bleomycin?
Bleomycin complexes with Fe and O2 --> Forming Cytotoxic Free Radicles --> DNA strand scission.

It can cx Pulmonary FIbrosis!!!

It is marrow sparring.
What is the MOA for Methotrexate?
Antimetabolite --> It inhibits DHF reductase (S phase)

Cx BMSuppression.

*Seems to be able to help out our healthy cells by rescuing leukovorin (folinic acid).
What is the MOA for Cyclophosphamide?
Alkylating agent- attacks guanine N7 --> dysfunctional DNA

What is the MOA for Cisplatin?
Alkylating agent- cross links DNA strands

***BM Sparring!
Nephro and Neurotoxic
What is the MOA for Doxorubicin?
It is an intercalator, forms free radicles, inhibits topoisomerase.

Cx BMSuppression and Delayed CHF (Dexrazoxane is an iron chelator that can prevent FR from forming)
What is the MOA for 6-Mercaptopurine?
It is a purine antimetabolite (S phase) bioactivated by HGPR transferase

CX BMSuppression

**Requires Bioactivation so Ca cells have developed resistance by reducing the activation of these Rx
What is the MOA for Vincristine and VinBlastine?
They decrease microtubular polymerzation --> Spindle poisons (M Phase)

VinBlastine Cx BMS
Vincristine does not but is neurotoxic.
What is the MOA for Procarbazine?
It is an alkylating agent

Cx BMS and is leukemogenic
What is the MOA for 5-FU?
It is a pyrimidine antimetabolite that is bioactivated to inhibit thymidylate synthetase.

**Bioactivated so Ca cell can resist drug by decreasing bioactivation.
Warfarin Treatment can lead to a deficiency in what substance that is integral for subsequent activation of Vitamin K dependent Clotting Factors?
Warfarin is a synthetic analog of Vitamin K. It inhibits the formation of gamma-carboxyglutamate clotting factors (they are made by Vitamin K dependent carboxylation of glutamic acid residues)
What are the signs and symptoms of Guillian Barre Syndrome and what is the treatment of choice?
Hx of Upper Respiratory Tract infection (or any viral infection) Followed by progressive loss in sensation of the lower extremities.

TX: Intravenous Immunoglobulin.
What is the best treatment for Hyperkalemia?
Tx pt with Insulin and Glucose.

Insulin because it is capable of activating K pumps to pump K into cells. But you have to give Glucose as well because giving Insulin can cx the pt to be hypoglycemic.
What happens to Blood Pressure during Cardiac Tamponade?
Pts exibit Pulsus Paradoxus (and INcreased difference in BP between Inhalation and Exhalation).
When Pt inhales the intrathoracic pressure decreases, blood rushes into the Right Side of the Heart and the Right Ventrical Fills. Because of the Decrease in Pressure the Septum deviates into the Left Ventrical and it therefore does not fill as much...thus decreasing the SYSTOLIC BP.
What heart abnormality would you expect to see in a child with Pickwickean Syndrome?
You would expect to see RIGHT VENTRICAL HYPERTROPHY. THis is because the Pulmonary Vascular bed will constrict dt Alveolar Hypoxia. Therefore the Right heart has to pump against a greater pressure.
Name two colon polyps that are considered to be PreCancerous.
Villous Adenoma and Tubular Adenoma. The Villous Adenoma is considered to have greater malignant potential.
What is the causitive agent of Molluscum contagiosum?
What is the earliest time in embryogenesis that the notocord is present?
It is a week 3 event.
What is the drainage of the Left Ovary? The Right?
The Left Ovary drains first to the L Ovarian Vein then into the Internal Iliac Vein then into the IVC.

The Right Ovary drains into the R Ovarian Vein and then directly into the IVC.
What are some signs of Chronic Anemia?
Skin atrophy and koilionycia (spoon nails)
Fatty Change in...Cardiac Myocytes, Renal PCT cells and Centilobar Hepatocytes
Degeneration of basal ganglia and cerebral cortex are also often noted.
What are some side effects of long term use of Prednisone?
Hypocalcemia, Fluid Retention, Hypokalemia, Hypernatremia

Also some adverse Rxns:
Adrenal Insufficiency
Cushingoid Syndrome
Muscle weakness and atrophy
Where in the brain is the primary sensory cortex?
It is in the Postcentral Gyrus

Medial portion = Foot
Most lateral portion= Larynx
Where in the brain is the primary motor cortex?
It is in the Precentral Gyrus

Medial portion = Foot
What are some signs and symptoms of a bicuspid aortic valve?
It is present at birth and it may be completely assymptomatic. Dr will here an immediate Diastolic murmur dt aortic valve insufficiency.
Describe a Reed Sternberg Cell.
Lg binucleated cells with prominent nucleoli.
What type of arthritis has Quadraplegia as a common complication of the course of the disease?
Link to Osteopathy...

as the disease progresses pts often have degeneration of the Posterior Longitudinal Ligament of the Vertebral column therefore they are prone to subluxation of the AA joint.
(this is also why you should never do Cervical HVLA on a rheumatoid arthritis pts)
What chromosomal translocation is often associated with AML M3?
t15:17 q22:11
What chromosomal translocation is often associated c Burkitts Lymphoma?
t8:14 q24:32
Where do more than 50% of intraparenchymal hemorrhages associated with Hypertension occur in the brain?
Basal Ganglia and Internal Capsule
What is a common cause of Unstable angina?
Thrombosis or a Coronary Vessel that may or may not be associated with underlying atherosclerosis.

Thrombotic agents are particulary helpful for these pts.
What bursa is involved when a pt has a Baker's Cyst?
Semimembranous Bursa

It is between the Semimembranosus Tendon and the Medial Head of the Gastroc
This is very common in the elderly
What antineoplastic drugs are associated with CHF?
Doxirubicin and Daunurubicin
What antineoplastic drugs are associated with renal dysfx and acoustic dysfx?
What is the DRUG OF CHOICE for empiric treatment of S. pneumoniae Pneumonia?
What do you call it when gall stones are lodged in the Common Bile Duct?

The symptoms of this are colicky RUQ pain, jaundice, and uncongugated bilirubinemia. If the biliary tree becomes infected...Life Threatening Cholangitis can result
Name the tubes for the passage of bile from the Gallbladder to the Duodenum.
Gallbladder --> Cystic Duct --> Joins with the common Hepatic Duct (R adn Left Hepatic Duct) to become the Common Bile Duct --> Pancreaticoduodenal Duct into the Ampulla
How are the lymph nodes of the groin divided?
They are divided into a superficial and deep group. The Superficial group are further divided into a Vertical and horizontal chain.

It is important to remember that the Penis, Vagina and Anal Canal drain into the Medial side of the Horizontal brain of the Superficial Nodes.
What lymph nodes do stomach Tumors typically metastasize to?
They typically metastasize to supraclavicular nodes (aka Virchow or sentinal nodes)
A pt comes in with slow, effortful and telgraphic speech with many common nouns and verbs. They can however still comprehend verbal and written language. What is this called and what area of the brain does a lesion like this associate with?
Broca's Aphagia (Remember...BBB..Broca and wernickes what???)

This is in the Frontal Lobe
High Sensitivity tests are better suited for what while High Specificity tests are better suited for what?
High Sensitivity Tests: Screen because they pick up lots of People who have the disease

High Specificity Tests: Confirmatory tests because they are good at determining who does NOT have the disease.
What intracellular pigment is a normal consequence of aging?
What part of the nervous system derives from Neural Crest cells?
The Peripheral Nervous System

Schwann Cells
Pseudounipolar cells of spinal and Cranial Nerve Ganglia
Autonomic ganglia
Pia and Arachnoid
Chromaffin cells of the adrenal gland (epinephrine producers)
Lesch Neihans Syndrome is considered a deficit in metabolism of what?
Purine Metabolism.
What class of antidepressants can cause severe headache and malignant HTN after eatting Wine, Bread and Cheese?

ex. Tranylcypromine
What can you give someone who is allergic to procaine.
If they are allergic to an ester give them an amide.

Amides have 2 I in the name...
lIdocaIne and bupIvacaIne
The classic triad of symptoms in a Wiscott Aldrich Child?
Eczema, Thrombocytopenia, and Recurrent Infections

They are also at risk of developing Malignant Lymphoma later down the line.
Name some organisms likely to cause Osteomyelitis in a sickle cell pt?
Staph aureus (MC) Gram (+) cocci

Salmonella spp. G(-) rod
What is the first ligament to be torn during an inversion injury to the ankle?
The Anterior talofibular ligament

The Lateral Collateral Ligament is what will be torn
-Posterior Talofibular lig
-Calcaneofibular lig
A type II inversion sprain of the ankle would imply injury to what two ligaments?
Anterior talofibular and calcaneofibular ligament
What is the most accurate imaging study for Adenomyosis?
MRI or a Transvaginal US (mostly to ro other things)
What is the only Tx for Adenomyosis?
A hysterectomy
A 3yo with microcytic hypochromic anemia with basophilc stippling would have what diagnosis?
Lead Poisoning
What is the location of the tender point for iliacus?
Seven centimeters medial to the ASIS
African American male with chest pain, deep bone pain, painful swelling of the hands and feet, dyspnea and fever?
Sickle cell crisis
How is sickle cell inherited?
Autosomal recessive
Just before a sickle cell crisis what is the most common objective finding?
What would you find in the CSF of a Guillian Barre pt?
Increased protein
What enzyme is deficient in Maple Syrup Urine Disease?
Alpha Ketoacid dehydrogenase
What enzymes are increaed in someone with Maple Syrup Urine Disease?
Leucine, Isoleucine, Valine
What is the name of the test to determine if RhoGam is necessary?
Kleihauer Betke Test- This test stains mom and baby blood differently to determine how much Fetal Maternal Mixing has occured
What is the only scenario in which Asprin can be given to children?
Kawasaki Disease

Aspirin can cause Reye's Syndrome
Know the following Chaman's Pts

Stomach (acidity)
Stomach (peristalsis)
Stomach- acid: L 5th IC space

Liver: R 5th and 6th IC space

Gallbladder: R 6th IC space

Sto- peristalsis: L 6th IC

Spleen: L 7th IC

Pancreas: R 7th IC

Appendix: anterior tip of 12 rib

Adrenals: Anterior 2" superior and 1' lateral to umbilicus

Kidneys: 1" superior and 1' lateral to umbilicus

Colon: lateral IT band from the greater trochanter to its attachment to the knee

Sigmoid colon is on proximal left IT Band
Know all sympathetic innervations

-Stomach, Liver, gallbladder, spleen, portions of the pancreas and 1st and 2nd part of duodenum
-Portions of the pancreas and 3rd and 4th portions of the
-Neck: T1-T4
-Lungs: T2-T7
-Esophagus: T2-T8
-Stomach et al: T5-T9
-Duodenum--> Prox TC: T10-T11
-Dist TC--> Rectum: T12-L2
-Appendix: T12
-Upper ureters: T10-T11
-Lower ureters: T12-L1
-Adrenal Medulla: T10
-Uterus and cervix: T10-L2
-Prostate: T12-L2
-Upper Ex: T2-T6
-Lower Ex: T11-L2
In older men what is the MCC Epididymitis?
E. Coli or any other thing that can cause a UTI or Prostatitis

In younger men Gonorrhea and Chlamydia are the culprits
Pulmonary Stenosis, VSD, hepatosplenomegaly, jaundice and "blueberry muffin baby" are common symptoms of what congenital infection?
Rubella (Togavirus- (+) RNA virus
Where can mercury poisoning be detected?
What are some common causes of Steven Johnsons Syndrome?
Antibiotics are the most common cause of SJS, followed by analgesics, cough and cold medication, nonsteroidal anti-inflammatory drug (NSAID), psycho-epileptics, and antigout drugs.
What is the most important reservoir of Trichinella in the US?
Pigs (Trichinella spiralis)
What Helmith can cause Rectal Prolapse, Anemia and Rectal Bleeding?
Trichuris trichuria
What HIV retroviral drug has been shown to cause pancreatitis?
Didanosine (can also cause peripheral neuropathy, abdominal cramps)
What are the corresponding levels of calcium, phosphate and PTH in a child with Ricketts?
Decreased calcium, decreased phosphate, and increased PTH
What Vitamin is Thiamine?
What is the triple screen profile for Trisomy 21 using MSAFP, Estriol, and beta-hCG as markers?
Decreased MSAFP, Decreased Estriol, Elevated beta-hCG
What is the most common reason to see early deceleration on a Fetal Monitor?
Early decelerations are most commonly seed due to increaed vagal tone secondary to fetal head compression during contractions.

Variable decelerations are likely dt umbilical cord compression

Late decelerations are most worrisome resulting from uteroplacental insufficiency
What is the role of indomethacin as a tocolytic agent?
Indomethacin is an NSAID that blocks cyclooxygenase and decreases the level of prostaglandins to forestall labor with minimal maternal side effects.
The shortest anteroposterior diameter of the pelvic inlet, which is the distance between the sacral promontory and the midpoint of the pubic symphysis is also known as what measurement?
Obstetric Conjugate

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