Terms in this set (118)
which artery to ligate to stop vaginal bleeding?
internal iliac (the uterine artery branches from this)
internal pudendal artery supplies
branches off the internal iliac artery, providing blood to the external genitalia.
external iliac artery
main blood supply to legs
It passes down along the brim of the pelvis and divides into two large branches - the inferior epigastric artery and a deep circumflex artery. These vessels supply blood to the muscles and skin in the lower abdominal wall.
median sacral artery
posterior branch of the distal abdominal aorta that descends to supply structures in the pelvis.
L4 and L5, sacrum, coccyx and superoposterior rectum
branch of the anterior division of the internal iliac artery. It provides vascular supply within the pelvis and lower limb.
NSAIDs affect on GFR
work at AFFERENT arteriole
2 causes of aortic stenosis?
-age related calcification
-early onset calcification of bicuspid aortic valve in younger pt.
concentric hyertrophy is associated with which type of murmur?
MOA of dantrolene
dec release of Ca from sarcoplasmic reticulum
age of child?
standing holding table
makes you thin
gives you hunGer
Rndomized controlled study of 2000 patients with insomnia is conducted to evaluate the efficacy of a new medication to treat this condition. Ten subjects from both the control and treatment groups do not complete the study are are not included in the analysis. Treatment group able to fall asleep 5 minutes faster than control (p=0.001). Neither group report an improvement in quality of life. Conclude that new med is efficacious in treating insomnia. Type of error?
Failure to distinguish between statistical significance and clinical significance
-clinical sig is NOT measuered in statistical ways. We can clearly see that tehre is NO difference cliniclly among the 2 groups
predominantly in South America
40yo M with interstitial pulmonary fibrosis has greater maximal expiratory flow rate than predicted. Which best explains this?
Answer: Increased radial traction on airways
Increased Radial Traction wich will lead to Collapsing Pressure.
Using laplase equation we haveWallTension = P x R / 2W
Recall that Elastic Recoil = Collapsing Pressure = Change in Pressure / Change in Vol Compliance = Change in Vol / Change in Pressure
Compliance and Elastic Recoil are inversely related.
hypotension in presence of tachycardia with low PCWP
CXR: widened aortic arch
unequal BP in arms
diastolic murmur at L. sternal border (aortic regurg)
which diuretic is given with loops?
spiroloactone (K sparing)
***Spironolactone will potentiate yur loop diuretic coz remember loops makes u lose Na+ and water which stimulates aldosterone release and reabsoption of water which follows Na+ so u wanna block this aldosterone effect
dec intestinal chol absorption
Prevent intestinal reabsorption of bile acids; liver must use cholesterol to make more
Bile acid resins
Cholestyramine, colestipol, colesevelam
Upregulate LPL-->INC TG clearance
Activates PPAR-α to induce HDL synthesis
Gemfibrozil, bezafibrate, fenofibrate
Inhibits lipolysis (hormone- sensitive lipase) in adipose tissue; reduces hepatic VLDL synthesis
Niacin (vitamin B3)
Inactivation of LDL-receptor degradation, increasing amount of LDL removed from bloodstream
only the epidermis, or outer layer of skin. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and usually consists of an increase or decrease in the skin color.
involve the epidermis and part of the dermis layer of skin. The burn site appears red, blistered, and may be swollen and painful.
destroy the epidermis and dermis and may go into the subcutaneous tissue. The burn site may appear white or charred
damage the underlying bones, muscles, and tendons. There is no sensation in the area since the nerve endings are destroyed.
Fourth degree burns
15yo girl 1-day hx redness and painful skin following sunbathing. She used sunblock. No medications. Physical exam: severe erythema of back and extremities, no blisters. Dx?
Polymorphic marker with 3 alleles (1, 2, 3) tightly linked to the gene for polycystic kidney disease. A pedigree is shown. If III, 1 is unaffected by this disease this patient most likely a carrier of which of the following markers?
(page 31 PDF)
-bind hydroxyapetite in bone
-inhibit osteoclast activity
uvula elevation, which nerve?
19yo M in MVC. Penetrating wound to right cerebral cortex with paralysis of the left lower extremity, fracture of right mid humerus with severing of the radial nerve, and a fracture of right tibia. After 10 weeks, DTR strongest in which locations?
Left Achilles tendon
Penetrating wound to the RIGHT Cerebral Cortex with complete paralysis of the "LEFT Lower Extremity"
*Since this is due to UMN Lesion , the paralyzed LEFT Lower Extremity will show "HYPERreflexia"
42 year old woman with 1 month history of abdominal pain after eating fatty meals. jaundice, RUQ tenderness. Which liver functions will increase?
cholesterol synthesis (this is an example of a "fat, female, forty for gallbladder disease=cholelithiasis)
cold (IgM and complement)
anemia triggered by cold; seen in CLL, Mycoplasma pneumoniae infections, and infectious Mononucleosis ("cold weather is MMMiserable").
RBC agglutinates may cause painful, blue fingers and toes with cold exposure.
Compound is taken up by bacterial cells. No energy is necessary for uptake, and the compound is not concentrated in the cell. Which describes this mechanism of transport?
carrier mediated diffusion
38yo F with 2-year hx of pain and heavy flow with menses causes her to miss work. Ibuprofen not effective. One 6yo daughter; unable to conceive another child. PE shows mildly enlarged left ovary and retroflexed uterus. U/S shows substantial evidence of ovarian cysts and one peritoneal cyst. Bx of cyst will show?
prolif endometrial tissue (endometriosis)
Glands and stroma outside of the uterine cavity.
Look for Pain during menstruation periods only and family Hx of Infertility.
If found @ ovaries, the ovaries will look some what larger and will have the clasic Chocolate Cysts.
-Endometriosis causes adhesions and that leads to traction (retroflexed uterus)??
Herald patch" followed days later by other scaly erythematous plaques, often in a "Christmas tree"distribution on trunk
Multiple plaques with collarettescale. Self-resolving in 6-8 weeks.
Inflammatory facial skin disorder characterized by erythematous papules and pustules , but no comedones.
May be associated with facial flushing in response to external stimuli (eg, alcohol, heat). Phymatous rosacea can cause rhinophyma (bulbous deformation of nose).
PS output to inner genitalia and to lower GIT
enters the sympathetic chain at T10-L2.
responsable for emission
The hypogastric nerve
Cutaneous innervation below the pectinate line and external anal sphincter.
inferior rectal nerve
. Old man with 2 year history of decrased force of his urinary stream and increase frequency. BUN is 55 and Creatinine is 5. Ultrasound of Urinary tract shows bilateral hydronephrosis and dilated ureters. What is the mechanism of this patient's renal failure?
Increased hydrostatic pressure in Bowman space
increased hydrostatic pressure is due to back up of fluid all the way from the bladder to bowman space. Hence the hydronephrosis and dilation of ureters
21yo M in ED with excruciating anal pain for 4 hours. Exam shows 15-mm, blue tinged rounded mass at anal margin. Represents thrombus in a tributary of which blood vessel?
- Inferior rectal vein
Female newborn at 36 weeks gestation has respiratory distress.
- Endotracheal and NG tubes placed.
-Xray shows nasogastric tube in left hemithorax, mediastinum displacement to right, absence bowel gas in abdomen. Which embryological event led to these findings?
incomplete formation of pleuroperitoneal membrane??
In the trunk,_______ forms the erector spinae muscles,
_______ forms the trilaminar thoracic and abdominal walls,
Ten years after total gastrectomy, 60yo man difficulty walking. Diffuse spasticity in arms and legs, impaired proprioception in his feet, increased muscle stretch reflexes in arms and knees, absence of muscle stretch reflexes in ankles, bilateral extensor plantar responses. Which vitamin is deficient?
total gastrectomy causes parietal cell deficiency, which relates to an inability of Intrinsic factor production and decreased ability for vitamin B-12 uptake in the ileum
a scaly plaque, is a precursor to squamous cell carcinoma.
Associated with excessive exposure to sunlight, immunosuppression, chronically draining sinuses, and occasionally arsenic exposure.
Commonly appears on face , lower lip , ears, hands.
Locally invasive, may spread to lymph nodes,
and will rarely metastasize.
Ulcerative red lesions with frequent scale.
Histopathology: keratin "pearls" .
sq cell CA
47yo F with psoriasis for follow-up. Was given several topical creams, to be used in specified sequence twice daily. No improvements apparent at this appointment. How to begin discussion of compliance?
most people find it difficult to adhere to a routine, how did you do"
32yo M with 6-month hx of low back pain and stiffness, worse in morning and improve during the day; the pain radiates to his buttocks but not down his legs. Back stiffness if he sits for prolonged periods. Which to confirm diagnosis?
Xray of sacroiliac joints
resp alkalosis +metabolic acidosis
salicylate poisoning (aspirin)
Protein found in brown adipose tissue of mice causes leak of H ions inward across inner mitochondrial membrane. Effect of this protein on oxidative phosphorylation and energy metabolism?
- Increased ratio of oxygen consumption to ATP generation
(Oxygen still being consumed at normal rate to create proton gradient. But some of these protons are leaking across inner mitochondrial membrane instead of passing through ATP synthase)
40yo F with 1-year hx of episodes of crampy abdominal pain, intermittent diarrhea, and rectal bleeding with passage of mucus. BMI 18. Abdomal exam: diffuse tenderness with no rebound. Sigmoidoscopy shows diffuse ulcers. Initial Rx?
UC, Crohn disease (colitis component).
27yo F with vaginal bleeding for 3 weeks. First pregnancy ended with a spontaneous abortion 8 months ago. No Rx since dilatation and curettage at that time. PE shows enlarged uterus, beta-hCG markedly increased. Ultrasonagraphy of pelvis shows material within the endometrial cavity and no intrauterine pregnancy. CT scan shows a necrotic intrauterine mass and metastatic nodules in the lungs. Site of Origin?
- Trophoblastic tissue
4yo boy two bacterial urinary tract infections past year. Physical exam normal. Radiologic studies show dilation of left ureter and renal pelvis, minimal left-sided renal function. Left nephrectomy done. Photo: dilated renal pelvis and ureter. Which is cause of renal disease?
- Congenital ureteral obstruction
HIV ELISA positive
HIV western blot positive
HIV viral load <50
- Infection with HIV-2
Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows petechial rash, microcephaly, and hepatosplenomegaly. Serologic test for CMV: IgG + in mother, + in newborn; IGM - in mother, + in newborn. Explanation?
28yo F at 18 weeks' gestation has palpitations. Labs show increased serum total thyroxine (T4) concentration. Best test to confirm hyperthyroidism?
- Free T4
Sequence surrounding the first two exons of the human beta-globin gene shown, with exons in bold. Translation start codon is underlined. A mutation from G-->A at position 355 is most likely to lead to beta-thalassemmia by which mechanism?
- Disruption of normal splicing by creation of a new 3' splice site??
treatment for OCD
5. A female newborn delivered 38 weeks Apgar scores 8 and 8 at 1 and 5 minutes. Physical exam shows bulging, fluid filled mass approx. 5 cm in diamtere in the midline over the lumbosacral region. There are no spontaneous movements of the lower extremities. This abnormality most likely occured because of abnormal embryonic development during which of the following periods postconception (in days)?
15 to 40
closure of the lower end of the neural tube occurs around day 27 (spina bifida)
35yo woman abnormal Pap smear. Cervical biopsy shows microinvasive cervical carcinoma. Which microscopic features led to dx?
- Neoplastic cells in sub-basement membrane connective tissue
microinvasive cancer as any lesion in which neoplastic cells invade the stroma, in one or more sites, to a depth of ≤3 mm below the base of the epithelium, without lymphatic or blood vessel involvement
. 30yo woman 20 weeks gestation, uncomplicated pregnancy. Fundal height is greater than expected for gestational age. Ultrasound shows increased amniotic fluid. Which abnormality is cause?
- Tracheoesophageal atresia
recruitment of neutrophils
32yo F G2P1 at 7 weeks' gestation with vaginal bleeding for 3 days and increasingly severe left abdominal pain for 18 hours. Direct and rebound tenderness with guarding in left lower quadrant. Cervical os is closed. serum beta-hCG is 6000. U/S shows empty uterus. Dx?
Ectopic pregnancy OR hydatiform mole?
(if mole would see snowstorm appearance)
Skin between eye and upper lip numb. Double vision look upward. Nerve damaged causing sensory loss?
- Maxillary division of trigeminal nerve
29yo F with 5-week hx of fatigue and 4-day hx of heart palpitations and anxiety. Has primary hypothyroidism Rx with triiodothyronine, but she has doubled the dose because of fatigue. TFT will show which?
- TSH DECREASED, Free thyroxine DECREASED, Free triiodothyronine INCREASED
she is 48 and still having menses.
it presents as uterine bleeding (excessive) and ofcourse seen typically in menses since estrogen is elevated at that time.
-> class III -> torsades des points
Neuro exam shows right eye does not adduct past the midline on horizontal gaze when looking to the left. When convergence is tested, the right eye is able to adduct past the midline. Rightward horizontal gaze is normal. Lesion is where?
55yo M with sepsis. Appears anxious and confused. Rx with vancomycin and ceftriaxone initiated in ED. T 39.8, P 132/min, BP 85/48. PE shows warm, flushed skin. No aedema. Administrer which solutions?
boost the BP asap, so 0.9% normal saline; 3% too hypertonic, don't need the sugar
how is third degree heart block treated (The atria and ventricles beat independently of each other.)
17yo boy with 8-kg weight gain during the past year. No medical illness. BMI is 32. He asks, "Do you think that my weight gain is inherited from my father?" Appropriate response?
- "Yes, your weight gain can be caused by genes and environment combined."
60yo M in ED for sudden onset of acute abdominal pain and tenderness, nausea, vomiting, and bloody diarrhea 2 hours ago. He has a Hx of cirrhosis and hepatocellular carcinoma. BP 99/50. Loss of bowel sounds. Surgery shows small intestine with dark purple-red hemorrhagic appearance. Cause?
mesenteric venous thrombosis? GO OVER
-difficulty breathing and vomiting
-type 1 diabetes on insulin.
-Pulse 90, respirations 30 and deep, bp 90/60.
Physical shows dehydration.
Labs: Na+ 130, K+ 6.5, HCO3 5, glucose 500, pH 7.2, pCO2 25 mm Hg.
Which compound stimulated hormone-sensitive lipase in adipocytes causing accumulation of metabolites causing acidosis?
DKA is caused due to the lack of insulin.
-So stress hormones like epinephrine, cortisol activate the hormone-sensitive lipase.
-In an attempt to provide FFAs for gluconeogenesis.
hormone sensitive lipase (TG--> FFA) is inhibited by
30. Study of breast cancer in women. Hundred healthy women observed for 10 years. Goal is to determine if number of family members who previously received dx of breast cancer correlates with incidence of future development of cancer. Best design?
5yo M with chronic bronchitis in ED after being unresponsive. Found bottles of albuterol, ampicillin, codeine, and theophylline bedside. T 37.2 C, p 112/min, respirations are 6/min, BP 95/60. Acute Rx should include?
naloxone (due to resp depression)
80yo F with suspected temporal arteritis (TA). ESR is 100, Pretest probability for TA is 50% in this patient. In the evaluation of TA, ESR has a sensitivity of 99% and specificity of 60%. Based on the restults of the ESR testing, most appropriate next step?
- Additional testing to confirm the diagnosis of TA
35yo man increasingly depressed, impulsive and difficult over past year. Grimaces intermittently with rapid, jerking, purposeless movements of fingers. Historical factor relevant in dx?
- Family history of a similar illness
34yo man lightheaded after running 12 miles of marathon hot day. Pulse 130 bp 80/60. Which changes to autonomic nervous system occurred?
- Sympathetic efferent activity increased, parasympathetic efferent activity decreased
hypotension > less strech > decrease firing barorecpt > low para > (and maybe un-blocked symp rise)
G- Lower limb representation is on medial side
Patient is 38 y/o 1 week history of water, itchy eyes and runny nose. He is a crane operator. PE shows inflamed nasal mucosa. No congestion in lower lung. Treatment?
CHOICES: Bromopheniramine, Diphenhydramine, Hydroxyzine, Loratadine, Ranitidine
the 3 are first generation anti Histamine which have antimuscarinic effect and it wouldn't helP him since his job is a crane operator and Ranitidine is for peptic ulcer disease
12yo boy immersed up to his neck in 60F water for 20 minutes. Physiological changes?
Central volume increases, ADH decreases, ANP increases
****Swimming in cold water will constrict your peripheral vessels (increase Central Volume) and this will lead to a higher volume coming into your atria, which is where your ANP is released due to increased stretch (ANP up). ANP will then oppose the release of ADH.
is a branch of the mandibular nerve, which is itself the third branch of the trigeminal nerve.
supply sensation to the lower teeth.
The inferior alveolar nerve (sometimes called the inferior dental nerve)
Physician sad to inform patient of progression of carcinoma to the terminal phase. Physician's face makes patient cry and ask, "It's bad news, isn't it?" Which is best response?
Yes, it is (be honest with patient)
1-week-old girl. screening showed a possible defect in fatty acid oxidation. PE normal. Next step?
Measurement of serum acylcarnitine concentrations
Neurofibromatosis type 1 is what mode of inheritance??
Autosomal dominant disorder ...
most hyperplastic polyp found in
70yo M dies in a motor vehicle collision. Was undergoing evaluation for occult blood in the stool. Photo of transverse colon shown. Dx?
A process (not just a document/signature) that requires:
-Disclosure: discussion of pertinent
Understanding: ability to comprehend
-Capacity: ability to reason and make one's
own decisions (distinct from competence, a
-Voluntariness: freedom from coercion and
ammonium phosphate Mg
Angiogenesis, fibrosis, cell cycle arrest BY
Sudden, wild flailing of 1 arm +/− ipsilateral leg
6-week-old girl with 6-day hx of vomiting small amount of milk 2 to 3 times daily. 50 %ile for length and weight. Cause?
parotid gland enlargement is associated with?
Cross-link DNA at guanine N-7.
affects DNA replication
A guy with chrons disease. You give antibiotics and prednisone, he got better in 3 weeks, in addition to resolving the infection, the most likely MOA of this pharmacotherapy is which of the following?
T-lymphocyte function - Crohn's has Th1 mediated lymphoid aggregates and non caseating granuloma formation
65yo F with 20-year hx of osteoarthritis of the hands now has pain radiating down the distal anterior thigh, knee, medial leg, and food. Bony outgrowth of vertebrae compressing one of the spinal nerves is suspected. Nerve root in which intervertebral foramina is effected?
if CI crosses 1 then
null is NOT Rejected
40 yo woman has a mole on her back that has increased in size during the past 4 mo. PE shows Raise irregular lesion with variegated black-tan pigmentation and ill-defined margins. Examination of tissue from the tissue shows pleomorphic, hyperchromatic cells within clear islands that tend to coalesce and are present at all levels of the epidermis, with extension into the paipillar dermis.
What is it?
a. basal cell carcinoma
b. blue nevus
c. cafe au lait spot
d. intradermal nevus
e. lentigo simplex
g. seborrheic keratosis
Border irregularity, Variegated black-tan color, Evolution over time are 3/5 cardinal characteristics of melanoma grossly. Histology describes melanoma.
Blood cultures grow nonhemolytic, catalase-negative, gram-positive cocci in pairs and chains. Which organism?
68yo F with T2DM and hypertension that has eben poorly controlled despite hydrochlorothiazide treatment. BP 150/96, Labs show serum glucose concentration of 130 and proteinuria. In addition to current Rx, which is most appropriate pharmacotherapy?
- Lisinopril (can be used for proteinuria)
17yo girl 1-day shortness of breath, weakness and muscle tenderness. Did triathlon previous day. BMI 19. Temperature 38 C (100.4 F), respirations 20, bp 150/90. Physical bilateral crackles lower lobes, muscle tenderness. Creatinine 4. Urinalysis 3+ protein, 4+ hemoglobin. Patient's condition is from increased release of which substance?
-She had rhadbomyolysis due to the marathon and that causes release of myoglobin. This is what damages the kidney.
58yo man supraventricular tachyarrhythmia refractory to pharmacotherapy gets ablation of accessory excitatory pathway in atrial endocardium. Which area should be avoided to leave sinoatrial (pacemaker) node intact?
- The junction of the superior vena cava and the right atrium
depression in the anteratrial septum b/w right and left atrium
inferior to opening of coronary sinus
AV Node location
Guy lifting weights suddenly experiences painful swelling right inguinal area. Picture of resected part of small intestine. Dx?
strangulation <--- small intestine herniated and painful due to ischemia
a 15 year old girl who recently emigratd from india to the physicisn bcz of several lesion on neck for two years . physical examination shows a hypopigmentd hypoesthetic area over the left side of forhead. biosp specimen of a lesion shows acid fast bacilli. which of following best explain wht the casual organism result in dermal rather in vesceral infection??
(Lepromatosis likes the cold area)
look at aveolar image
A- endothelial cell blood vessel
B- RBC's in blood vessel
C- Type 1 pneumocyte
d- Type II pneumocyte (notice granules)
lobar pneumonia (inc or dec fremitus)
C.DIF TOxin in fecal fat
PsEsudomembranes of fibrin and inflammatory debris
ovaries dont secrete estrogen
65yo F with widely metastatic breast cancer unresponsive to chemo. No family. "close friend," at all her visits and now she is moved to inpatient hospice after she decides she wants no further curative therapy. Says, "We can't bear to be apart. It would be cruel to separate us now.". Which response is appropriate?
"The two of you seem to have a very important relationship. Of course you may stay together."
GNG happens in
A healthy 70-year-old woman has participated in a longitudinal study of the effects of aging on performance during pulmonary function tests for the past 50 years. She has undergone a complete set of tests, including arterial blood gas analysis, every 5 years. Which of the following sets of changes represents this woman now compared with her results at the age of 20 years?
Residual volume- UP
Arterial PO2- Down
Alv-Art PO2 Diff- UP
Eelderly have increased compliance - so increased residual volume, and also decreased arterial pO2 with high A-a gradient.