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Drills July 20,25
| Question | Answer |
|---|---|
| Arterial irrigation | Inferior mesenteric artery |
| Ischemic necrosis in | Watershed area at splenic area or sigmoid rectum |
| Inferior mesenteric artery irrigation | Second portion of duodenum to transverse colon 2/3 proximal |
| Inferior mesenteric artery from | Splenic to pectin line Linda pectinia |
| Below pectinate line hemorrhoid | External innervation of pudental nerve painful plexus S2-S4 pudental nerve plexus |
| Fever, leukocytosis, lower quadrant pain | Cholangitis, |
| Murphy sign | Palpation of the upper right quadrant pain to palpation |
| Enfisematous colancistitis | Surgery must be done |
| Parasite that can produce chonlangiocarcinoma | Chlonorchis sinesis |
| Schisotoma manzoni produce | Hypertension portal |
| Mansoni and Japonicum has | Iron deficiency anemia |
| Silicine nodules has | Collagen |
| Asbestos produce calcification in diafragma | Mesotelioma |
| Bronchogenic can occur in asbestosis but | Do not affect pleura |
| Ferrogenous body are color | Golden brown |
| Asbestosis affect | Lower lobes bilateral |
| X-ray affectation of lower lobes and | Alpha 1 antitrypsina obstructive due to ephisema |
| Asbestosis patron pulmonar | Restrictivo |
| FV1/FVC > o normal a 70% = | Restrictivo lung pattern |
| FV1/FVC ratio <70% = | Obstructive lung pattern |
| Asthma lung pattern | Obstructive |
| Asthma DLCO | High |
| Asthma | Respiratory alkalosis bilateral pulmonary wheezing |
| In ASTHMA DLCO is high due to | ⬆️increase volume in blood from the lung capillaries and ⬆️increase vascularization |
| Alfa 1 receptor stimulated | .. |
| Histamine | Vasodilator |
| Tyrosine kinase | Phosphorylase |
| Translocation 11-14 | Mantle cell lymphoma |
| 11-18 | Maltoma mucose associate lymphoid tissue |
| Maltoma pathologies | Sjrogen, hashimoto, h pylori |
| KIT receptor activation | GI tract |
| Gastroduodenal artery | Pancreatitis it bleeds |
| Pancreas is an organ | Retroperitoneal |
| Streptococcus pharyngitis | Cervical Lymphadenopathy pre auricular, anterior of ear tender |
| Mononucleosis | Posterior auricular lymphadenopathy |
| Strep Pyogened medication | Penicillin and amoxicillin |
| Complications of strep Pyogenes | Rheumatic fever (hypersensibilidad 2) and PSGN |
| Mitral stenosis pathology | Left atrium is elevated Pulmonary capillary wedge pressure is HIGH |
| Molecular mimicry? | .. |
| Dilatation of left auricular can produce | Esofagitis and cause hoarseness |
| Prostaglandin E2 or bradykinin (PGE2) | Pain mediator |
| Neuropathic pain | Substance P |
| Pericarditis | Elevation ST all leads |
| Pericarditis auscultation | Pericardial friction rub, chest pain improves leaning foward, gets worst with deep inspiration |
| Get worst with deep inspiration in the following chest pain generalized | Pericarditis, Pleuritis, Pulmonary embolism |
| If localized pain in chest | Chostochondritis |
| Jones criteria | .. |
| Erythema migrans | Lyme disease |
| Rheumatic fever tx | Penicillin G benzatinica IM |
| Pt with Rheumatic fever not complicated give | Penicillin until 5 yr old or 21 yr old intramuscular |
| Pt with carditis due to rheumatic fever treat with affectation of any valve | Penicillin for 10 yrs every 4 weeks |
| If carditis with affectation of valve treatment | Penicillin for 10 years every month |
| Treat pharyngitis to prevent? | Rheumatic fever |
| Skin infections like impentigo an cause? | PSGN but do not cause rheumatic fever |
| Antibiotics do not prevent | PSGN |
| Risk factor for osteoarthritis | Previous surgery |
| Nodules de Bouchard? | proximal Interphalangeal joint (PIP joints) |
| Nodules de heberden? | DIP joints (Distal Interphalangeal joints) |
| Interphalangeal distal joints (nodules Heberden) | OA |
| Lupus | Mainly young women, pancytopenia, malar rash,hypersensitivity 2 and 3 |
| Osteoarthritis OA first treatment | Acetaminophen then NSAIDS |
| Aschbodies | . |
| Lyme disease , target lesion or bull eyes | Spirochete inhibit 30 S ribosomal moa of tx (doxycycline) kid’s amoxicillin |
| Rotavirus vaccine contraindicated if antecedent of HS or Meckel diverticulum due to | Risk of Intussuception |
| Encephalopathy due to lyme | 2nd or third phase can cause bilateral bells palsy |
| Rotavirus vaccine | 2,4,6 months to give |
| Granulomatous with polyangitis | Wegener |
| Minimal change disease nephrotic Sx | Podocytes affected, kids, responds to glucorticoides, IL-13 affect the podocytes |
| TH17 chronic mucocutaneos | AIRE |
| JOG syndrome | STAT 3 mutation |
| TH17 | AIRE and mucocutaneos |
| Parvovirus B19(ssDNA naked) taxonomy | Rheumatoid arthritis like syndrome (ssDNA)unilateral naked |
| Pregnant women that work with kids if acquired parvovirus B19 the baby can get | Hydrops fetalis |
| Masc 42 yr joint pain glucose 200, infertility, hyperpigmentation, S3 | Hemochromatosis pseudogaout |
| Gene affected in hemochromatosis | HFE only TIBC is low |
| Acute tubular necrosis finding | Muddy brown cast due to proximal covulatuted tubule slougish |
| Acute tubular necrosis the ratio | <20 renal |
| Prerenal azotemia hypovolemic >20 ⬆️⬆️⬆️urea (7-18) /⬆️creatinine (0.6-1.2) | Due to isquemia |
| Hypovolemia due to chronic isquemia | Acute tubular necrosis |
| ⬆️ urea (7-18) ⬆️creatinine (0.6-1.2) = 20 | Renal |
| Fat embolism in long bones | Pulmonary embolism, petechiae rash, hypotension, tachycardia, JVD |
| Dermatitis de contacto | Hypersensitivity 4, nickel, poison Ivy, lymphocytes T, 72 hrs after exposure |
| Dilated cardiomyopathy causes | Shagas, doxorubicin, viral coxsackievirus type B, cocaine, hemochromatosis, postpartum |
| Lupus complement C3 finding | Is ⬇️low |
| Polyarteriris nodosa viruses (PAN) | Hep B and Hep C |
| Immunodeficiency X link aggammaglobulinemia | BTK boys Burton tyrosine Kinase, after 6 mos of age maternal antibodies IgG declines |
| Common variable immunodeficiency | … |
| Wiscott Aldrich finding | IgA …risk of leukemia and lymphoma |
| Telengiectasia and ? | Ataxia Telengiectasia |
| X link, NADPH deficiency, respiratory burst? Serratia, Aspergillus | CGD |
| Celularidad del granuloma | Hypersensibilada type 4, macrophages, T cell |
| In caseating granulomas you find | necrosis |
| Defect CD 18 protein on phagocytes, integrin (LFA-1) | Leukocytes adhesion deficiency (type 1) |
| Vasodilation there’s rubor..it can be induced by | Histamine, bradikyn, PGE2 |
| Acute inflammation que media la rubor | PGE prostaglandin if infection, urticaria Histamine, angioedema Bradykinin |
| Defect of ADA | SCID |
| Dihydroryadomine test y Nitro test | Chronic granulomatous disease |
| Interferon Alpha | Treatment of hep B and C |
| Interferon B | For Multiple sclerosis |
| INF alpha | Antiviral B |
| INF Beta | Brain (multiple sclerosis) |
| INF y gamma | Granulomas (CGD) |
| Catalase + organisms | Serratia,Aspergillus, pseudomonas, nocardia, s. Aureus, E. coli, Candida, klebsiella |
| Cold abscesses | LAD leukocyte adhesion (Cd18). deficiency and HyperIgE (job) (Th17 def) |
| Atelectasia mediastinum deviates towards | The affected side ipsilateral |
| Foreign body aspiration the mediastinum deviates | Contralateral displacement if hyperinflation |
| Aorta is an organ | Retroperitoneal |
| Cancer testicular ⬆️beta? | Teratoma |
| Leuprolide and Goserilin moa | GnRH agonist used as pulsatile (used for tumor flare)(GnRH receptor in pituitary causes ⬇️FSH and ⬇️LH ⬇️estrogen in females ⬇️testosterone |
| Used of gonadotropin Releasing Hormone analogs (LEUprolide, goserelin, nifarelin) | Uterine fibroids, endometriosis, precocious puberty, prostate cancer, infertility, Pulsatile for Pregnancy, Continous for Cancer |
| Testicular tumor, Mature, malignant in adults males, Benign in children and females? | Teratoma Germ cell tumor |
| From umbilical up only right side thoracic conduct | Lymphatic Duct Drains Which Side? Body Regions Drained Thoracic Duct Left and entire lower body Left head/neck, left chest, left arm, abdomen, both legs Right Lymphatic Duct Right only (upper quadrant) Right head/neck, right arm, right chest |
| Right side thoracic conduct | Drain hemibody left side umbilicus towards up |
| Rheumatoid arthritis which is the antibody | Anti cyclic citrullinated peptide antibody ⬆️ESR |
| Hidroxychloroquine moa | Inhibit interlukins, can cause retinopathy |
| Rheumatoid arthritis TNF-alpha inhibitors | Etanercept, Adalimumab, certolizumab, golimumab, infliximab |
| Etanercept TNF-alpha inhibitor moa for RA | Fusion protein for TNF-alpha+ IgG, Fc produced by recombinant DNA |
| Chron | Boca a ano ulceras |
| Gonorrhea tx | Ceftriaxone |
| Arthritis urethritis conjunctivitis | Syndrome of Reitter (Clamydia) |
| Leptin produce | Satiety no more food |
| Ghrelin acts in which nucleus | Lateral nucleus |
| Leptin acts in which nucleus | Medial |
| Azoles moa | Inhibit 14 Alfa demithelase |
| Hydrocelle the liquid is | Processus vaginalis |
| Varicocele transluminate | No, distention of pampiniform plexus |
| Inguinal direct hernia localize medial to inferior epigastric vessel | Affects the scrotum, reduce hernia |
| Inguinal hernia direct protrude to testicles | Lateral medial ring |
| Strangulation hernia is | Femoral direct hernia |
| All good or all bad | Splitting |
| Squizoide | No friends lonely |
| Squizotypal | Magical thinking, Walter Mercado, shiny colors |
| Histrionic personality disorder | Dress sexually provocative labile crying |
| Skin cancer in upper lip papula telegcietcasia, metastasis to cervical ganglia | Basal cell carcinoma |
| Keratosis actinica | Adults with high sun exposure, premalignant lesion |
| Malignant melanoma metastasis to cerebrum (hyperpigmented cells, multiple cells) | Abcde Asymmetry Border Change in color Diameter 6mm Evolution too fast |
| Melanoma markers | KRAF, HMB45, S100/V600 |
| Hodge gene affected mutation in inferior and superior extremities | CDKN2A, micrognathia, cleft palate |
| Plumber Vison | • ↓ Iron → impaired epithelial regeneration → mucosal thinning → esophageal webs + glossitis |
| If laying down and had a foreign object where in the right lung it goes | Posterior superior lobe |
| Pneumonia for bronchoaspiration which organism | Strep pneumonia |
| Pneumonia due to alcohol which organism | Klebsiella currant jelly, anaerobes, |
| Microorganism that produce diarrhea with pneumonia | Legionella pneumophila |
| Inspiratory stridor? | ..omega shape at the epiglottis,trachea laryngomalasia |
| Angina de Ludwig cause | Fusobacterium |
| Cancer at the tip of the tongue | Submentonian |
| Taste of sensation of the third of tongue | Facial nerve 7 |
| Aprepitan side effect and moa? | .. |
| Ondaserton moa? | 5HT 3 inhibitor |
| Mallory atresia? | .. |
| Crigler Najjar high bilirubin | Indirect bilirubin |
| Gilbert | Inhibition of UDP transpferase |
| Celiac disease? | … |
| Simple cyst in gallbladder > 3 cm in babies | Can produce cancer |
| Porcelain gallbladder what to do | Adenocarcinoma of gallbladder you must take vesicular out |
| Stasis biliar has a deficiency of which vitamins | ADEK liposolubles |
| Psudotumor cerebri or idiopathic hypertension | Young women, obesity BMI >30 headache |
| ⬇️ total lung capacity TLC. ⬇️ Forced Vital Capacity. ⬇️ Residual Volume pulmonary function test | Restrictive process affecting lung parenchyma (interstitial lung disease) or chest wall (severe kyphosis). Volumes reduce ⬇️⬇️⬇️ due to poor distensibility of the lungs (collagen deposition) and or thoracic cage (spine deformity). |
| Pulmonary function test ⬇️ Total lung capacity ⬇️ Forced vital capacity. ⬆️ Residual volume | Restrictive process due to Neuromuscular disease (amyotrophic lateral sclerosis, Myasthenia gravis). TLC ⬇️ due to inspiratory muscle (diaphragm) weakness and RV ⬆️ due to expiratory muscle (internal intercostals) weakness. |
| Pulmonary function test ⬆️Total lung capacity ⬇️ Forced vital capacity ⬆️ Residual volume | COPD chronic obstructive pulmonary disease is characterized by ⬆️elevated residual volume (air trapping), ⬆️TLC (hyperinflation) and ⬇️ Reduced forced vital capacity |
| Inhibit platelet aggregation and adhesion to the vascular endothelium and cause vasodilation | Prostacyclin (prostaglandin I 2 (PGI 2) |
| Takes place via VON Willebrand factor acting as connector that binds platelets to collagen | Adhesion platelet |
| Release and acts as vasoconstrictor and potent stimulator of platelet aggregation | Thromboxane A2 (adenosine also stimulates platelet aggregation) |
| Used in treatment of pulmonary hypertension, peripheral vascular disease, Raynaud syndrome | Synthetic Prostacyclin, Epoprostenol |
| Synthesized by liver, activated by exposed collagen following damage to endothelial cells, activates intrinsic pathway coagulation and fibrinolysis | Hageman factor (XII) |
| Converts kininogen into bradykinin | Kallikrein |
| Regulates the coagulation cascade inactivating factor Va and VIII a | Protein C vitamin K dependent |
| Occur in early stage of DMD Duchenne muscle Dystrophy | Hypertrophy of muscle fibers |
| Myopathies such as carnitine palmitoyltransferase deficiency has accumulation of | Lipid accumulation within muscles fibers |
| Characteristic of histologic feature of polymyositis and dermatomyositis, condition of proximal muscle weakness without distal pseudohypertophy? | Prominent inflammatory infiltrate |
| Muscle fibers with irregular contour and blotchy appearance seen in mitochondrial myopathies | Ragged red fibers |
| Marfan lens | Up and out |
| Homocysteinuria AR | Deficiency Cystathionine B |
| Homocysteinuria with stroke, defect in beta cystathione | Cannot convert homocysteine to cysteine (Krebs cycle) |
| Marfan in heart can produce | Mitral valve prolapse systolic mid systolic click in the apex, mitral regurgitation |
| Mitral regurgitation in marfan can irradiate to | Axilla |
| Marfan fibrillin defect can also cause | Aorta dilation in xray finding widening mediastinum, dilated valve, can lead to aortic regurgitation |
| Pneumothorax spontaneous finding | Auscultation ⬇️decrease breath sounds in percussion Hyperressonance |
| Pneumothorax at tension right side the cardiac chamber camera is in the left lung in Marfan | Left ventricle is compress ⬇️ CO sympathetic it’s activated causing tachycardia reflex |
| Spontaneous rupture can cause | Sub pleural blebs |
| Right or left lung needle goes to | 2nd midclavicular needle space or 5th midaxillary |
| Pneumothorax tension of collapse the left lung | Right atrium |
| Primary ciliary diskinisia | Defect in DYNEIN another name kartagener |
| Bronchiectasis | Infection in repetition |
| Cystic fibrosis | Infection that repeat, CFTR, CL channel, delta 508, west outside dry nares inside |
| If thick mucus in epithelium what happens CF | Can develop infection |
| Failure to thrive, the first thing that affect is | Weight then height at the end the cephalic diameter |
| Murmur systolic murmur 5th space inter coastal in apex | Kartagener , dextrocardia mitral regurgitation. |
| Organ prone to develop rupture after trauma | Spleen intraperitoneal organ |
| Spleen peritoneal organ can produce peritonitis and produce rebound next to do | Surgery |
| Neuroblastoma? | N-Myc, bombensin, cromogranin |
| Neuroblastoma in children can cause and is also a neuroendocrine tumor | Opsoclonus myoclonus in children |
| Raccoon eyes | .. |
| Palpable mass no pain with ictericia | Pancreatic CA |
| CA pancreatic can cause which paralysi | De Layden |
| Pheochromocytoma with hypertensive crisis | …. |
| Neuroblastoma is the pheochromocytoma in | Children with HTN |
| Pheochromocytoma… | Methanephrines, MTV, vanillmandelic |
| Liddle syndrome? | .. |
| In adult Neuroblastoma which is also a neuroendocrine tumor can produce | Small cell lung cancer SCLC |
| PCOS estrogen is | ⬆️high normal FSH ⬆️GnRH ⬆️LH |
| Menopause women how’s the estrogen and FSH | ⬇️estrogen ⬆️FSH |
| Pheochromocytoma with HTN treatment | B2 agonist which causes vasodilation (isoproterenol, albuterol) |
| Receptor physiology alpha 1 /2 mi,m2, m3 , dopaminergic | … |
| Pemphigus vulgaris, age (40-60 yrs of age)hypersensitivity 2 | Mouth, rupture of Bullae, nikolsky sign positive, net like pattern, chronic, IgG, desmoglein, lateral Desnuda (desmosome) lateral side by side keratinocytes |
| Pemphigus bullous (>60 yrs) hypersensitivity 2 | Bullae is tense don’t rupture, hemidesmosome in between keratinocyte and membrane basal, anti-epidermal junction, separation of base membrane |
| Kinesin travels | Anterograde travels to periphery shingles varicella zooster |
| Varicella zooster rash maculopapular, can complicated to in children | Pneumonia and produce encephalitis |
| Transmission form of varicella | Droplets or direct form |
| Varicella family | Herpes you kill with aciclovyr, inhibit thymidilate kinase, dna polymerase |
| Varicella doses in children | 2 doses 1yr and 4 yr |
| Cutaneous larva migrans | Cause by hookworms, anchylostoma and necatur americanus, barefoot transmission |
| Anemia mycrocitic can be cause mainly by | Necatur parasite barefoot |
| 8-14 translocation lymphoma | Burkitt |
| Follicular lymphoma over expression of | Bcl2 |
| Mantle cell lymphoma 11-14 | D-cyclin |
| Lymphoma Hodgkin you find CD 12 CD 30 | Red Stemberg RS, OWL eyes |
| Molluscum contagiosum | Pox virus umbillication, ideation, DNA double stranded envelope replicate in Cytoplasm |
| Liquen | .. |
| Dermatitis seborreic | .. |
| Human T lymphocyte virus, young people, Caribbean,Japan, hypercalcemia, rash, fever, biopsy you find | Adult cutaneous T cell lymphoma |
| TP53 is a | Tumor suppressor gene se use a E6 |
| E7 se use a RB gene along with elongation factor | HPV and you have E7 the elongation factor gets liberated to the nucleus to DNA to transcribe and causes neoplasia. |
| Pemphigus Vulgaris affect | Oral mucosa |
| Dermatitis herpetiformes | Due to celiac disease |
| Treatment for dermatitis herpetiforme | Dapsone |
| G6PD (X linked ressesive) deficency medication that can activate (IS THE PAIN Mnemonic) | Nitraforuantoine |
| Sickle cell anemia | You will never get Malaria because there’s not good quality RBC (it has banana shape or moon shape) |
| Sickle cell trait hemoglobin S | below 50 |
| Sickle cell anemia treatment | Folic acid, hydroxyurea |
| Cause mc of sepsis in sickle cell anemia in children | Strep pneumonia |
| Gingival stomatitis | Herpes HSV 1, bitemporal lobe encephalitis (bitemporal amigdala) kluber byce Sx (herpetic witlow) |
| Pick disease where’s the cerebral atrophy | Frontal temporal dementia |
| Kluvver Bucci Sx can be confuse by pick disease | Dishinibition, hyperorailty, hypersexuality |
| Pick disease in cerebral spinal fluid you find in CSF | TDP 43 |
| Herpetic Withlow? | ..dentist |
| Herpagina which organism | Virus Cocsakie A picornaviruses RNA ss linear no segmented, enveloped |
| Herpangina affect | Tongue and soft palate very painful, droplet transmission |
| Enterovirus transmission | Fecal oral |
| Rhinovirus only transmission that is | .. |
| Skin staph aureaus medication | Mupirocin cream |
| Impetigo hypersensitivity 3, with Bullae agent that cause | Staph aureus |
| Measles rash cervicocaudal transmitted b | Droplets (cough, coriza, conjunctivitis) koplick, use vit A |
| Retinoic acid acts in | Intranuclear goes directly to nucleus |
| Measles virus can complicate and produce | Encephalitis and pneumonia giant cell pneumonia via droplets, rash cervical caudal |
| Measles after 7- 10 yr pt come with neurologic problems | Panencephalitis |
| Lymphadenitis with warthin Finkeldey giant cells (fused lymphocytes) in a background you see | Paracortical hyperplasia |
| Melanoma treatment | Excision wide borders and mohs, medication Pembrolizumab (inhibit pd1 programmed death ligand 1) |
| Melanoma other treatments | BRAF (Vemurafenine) CTL4 (Iplimumab) |
| Rubella encephalopathy post auricular rash can produce | Cataract, patent ductus (machine like continuous murmur)hearing loss pancilodiastolic murmur flu flu flu |
| PDA to leave it open treatment | Prostaglandin, Alprostradil |
| To close PDA treatment | oxygen, indomethacin |
| Scarlet fever can be confuse with ? Scarlet fever never last >5 days | Kawasaki |
| Kawasaki kid <5 yrs, rash in groin, fever more than > 5 days, edema | Kawasaki to see aneurysm |
| Chorea de sydhann sypersitivity | Type 2 |
| Guillen barre hypersensitivity type 2, infection can be cause by which organism | Mycoplasma or campilobacter jejuni |
| Guillain Barre syndrome more than > 2month, ascending symmetric sensory and motor deficits that progress over a period greater than 2 months. | Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) |
| Bloom Sx defect in which enzyme | Helicase (unwinds DNA) |
| Spinal muscular atrophy deficiency enzyme | SMN1 |
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Lillithys