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name of nerve that innervates muscles that abduct and adducts fingers


peaked T waves on EKG


part of nervous system damaged in ALS

motor neurons

damage to these fibers causes "pie in the sky"

meyers loop

likely dx if amniocentesis shows increased hCG

down's syndrome

likely dx if amniocentesis shows increased alpha fetoprotein

neural tube defect (NTD)

S. aureus Toxic shock syndrome toxins and mechanism

TSST-1 and enterotoxin B (incite host immune factors: TNF, IL1)

genetics of cystic fibrosis

autosomal recessive (deletion of phenylalanine residue) defective cAMP regulated chloride channel

genetics of fragile X syndrome

X linked recessive expansion on CGG trinucleotide repeat

genetics of sickle cell anemia

autosomal recessive missense mutation of hemoglobin B subunit (valine for glutamic acid)

genetics of down syndrome

meiotic nondisjunction of chromosome 21 pair

homocysteine increases in what deficiency

folate deficiency (as well as B12, B6 deficiency)

ligamentous attachment of distal clavicle torn in dislocation

acromioclavicular ligament

some DOCs for tourette's

pimozide (neuroleptic); clonidine; guanfacine

cosyntropin stimulation test checks what

cortisol response to cosyntropin (synthetic ACTH)

parasite causing African "river blindness"

O. volvulus (onchocerciasis)

dog parasite causing blindness

T. canis (toxocariasis)

parasite causing cerebral hypoxia due to sticky RBCs

P. falciparum

parasite causing keratits in contact lens wearers


mechanism of cyanide toxicity

binds Fe+3 and cobalt, inactivating cytochrome oxidase, inhibiting oxidative phosphorylation

drug approved for tx of cyanide intoxication


mechanism of action for hydroxocobalamin

binds cyanide to form cyanocobalamin which undergoes renal excretion

coagulation factors decreased by heparin use

inactivates thrombin and factors IXa and Xa (primarily neutralizing Xa)

drug used for prophylaxis of TB in immunocompromised pt


drug used for prophylaxis in people who have had contact w/ pts w/ TB

isoniazid; rifampin

midshaft humerus crushed from behind, what artery most likely injured?

profunda brachi artery (artery in radial groove)

what drug used to tx giardia causes a disulfuram-like rxn w/ alcohol


auer rod is a clue to what diagnosis

acute promyelocytic leukemia (AML

most likely cause of lymphadenitis from bug bite on lower extremity

wuchereris bancrofti infection (filariasis)

urea positive breath test most likely due to

H. pylori infection

fibrosis of the appendix is most likely due to

chronic inflammation

portacaval anastomosis shunting through the paraumbilical veins seen in alcoholics

caput medusa

why does pt w/ emphysema purse lips when breathing

decreased air trapping by creating positive pressure in lungs during exhalation

pt w/ diabetes insipidus does not respond to desmopressin. this indicates

nephrogenic diabetes insipidus

drug for pt who is afraid of public speaking & being in public


pt is obsessive about details and a perfectionist but not compulsive w/ rituals or anxious. Dx?

obsessive compulsive personality disorder

facial nerve exits the skull via

stylomastoid foramen

T4, T3, and TSH levels in graves disease

elevated T4 and T3 and depressed TSH

muscle overlying thyroid cut in surgical approach


type of stroke causing vertigo, nausea, tinnitis & syncope


causes of abruptio placentae (premature separation)

trauma, maternal hypertension, clotting abnormalities, cocaine use

cause of placenta accreta (placenta is retained after birth)

placental villi penetrate deep into uterine wall

cause of spontaneous painless bleeding in placenta previa

low implantation of placenta in uterus; mild contractions cause partial separation of placenta overlying os

teratogenic effect of warfarin (vit K antagonist)

nasal cartilage hypoplasia from abnormal osteocalcin due to failed carboxylation of carboxyglutamic acid

when during pregnancy is folic acid most important & how much?

1st month when neural tube forms (closes day 22); 400 micrograms per day

most common cause of mental deficiency

maternal alcohol abuse

teratogenic effect of smoking and mechanism

IUGR (intrauterine growth restriction); nicotine constricts uterine blood vessels

teratogenic effect of exogenous progestin exposure during pregnancy


teratogenic effect of mothers exposed to DES diethylstilbestrol

female babies develop adenocarcinoma of the vagina

teratogenic effect of tetracycline

yellow teeth

teratogenic effect of streptomycin


teratogenic effect of valproic acid

neural tube defects, facial, heart and limb abnormalities

teratogenic effect of maternal rubella (german measles)

deafness, cataracts, cardiac defects

teratogenic effect of maternal toxoplasmosis infection

intracranial calcifications & chorioretinitis

baby has wide spaced, peg-shaped upper central incisors, and abnormal face shape. what was mother infected w/

syphilis (hutchinson teeth)

vitamin deficient in pt whose anemia improves w/ B12 supplementation but still has peripheral neuropathy


dermatome of upper lateral region of arm

C5 dermatome

dermatome of palmar pad of thumb

C6 dermatome

dermatome of pad of middle finger

C7 dermatome

dermatome of pad of little finger

C8 dermatome

dermatome of skin on medial aspect of elbow

T1 dermatome

neoplasms associated w/ EBV

lymphomas & nasopharyngeal carcinoma

characteristic pain in small bowel obstruction

crampy abdominal pain w/ crescendo-decrescendo pattern

characteristic pain in mesenteric infarct

pain that is out of proportion to physical findings

what causes hematemesis to appear like "coffee grounds"

conversion of hemoglobin to hematin by hydrochloric acid

cause of hematemesis in a bulimic patient

mallory-weiss tear (esophageal)

cause of massive hematemesis in an alcoholic

ruptured esophageal varices

most common causes of hematemesis in pregnancy

GERD, gastritis, and ulcers

MOA of amphotericin B (& nystatin)

binds ergosterol in membrane causing leakage of intracellular contents from fungal cell

MOA of flucytosine

inhibits thymidylate synthase (conversion of dUMP to dTMP) step of fungal DNA synthesis

MOA of ketoconazole (and other azoles)

inhibits fungal p450 enzyme (14 alpha demethylase) blocking demethylation of lanosterol to ergosterol

MOA of caspofungin

inhibits fungal cell wall 1,3 D glucan synthesis

MOA of terbinafine

inhibits fungal squalene epoxidase decreasing ergosterol synthesis

MOA of griseofulvin

disrupts fungal mitotic spindle inhibits mitoses (fungistatic)

infection causing skin ulceration 2-3 weeks after exposure to contaminated "fish tank" or "swimming pool"

mycobacterium marinum

infection causing skin ulceration w/ lymphagenic spreading pattern after "gardening" wound

sporothrix schenchkii

most frequent cause of human fungal infection. Characteristic blastoconida and budding yeast (psuedohyphae)

candidia albicans

thick gelatinous, encapsulated 5-10 micometers yeast (india ink halo) causing meningioencephalitis and its route of infection

cryptococcus neoformans; inhalation (common in AIDS)

septae hyphae w/ acute angle branching forming brown fungal balls in pulmonary cavities

aspergillus fumigatus

nonseptae, irregularly wide (6-50 micrometers) fungal hyphae w/ frequent right angle branching in sinuses and lungs

zygomycosis (mucormycosis)

infection causing fever and hemolytic anemia from tick bite, forms characteristic "maltese cross" tetrads in RBCs

babesia microti

sandfly protozoa causing chronic inflammatory cutaneous, visceral, or mucous membrane infection by infecting macrophages

leishmania species (donovani)

slender bloodstream parasites causing large, red, rubbery chancre to form at site of african tsetse fly bite followed by "sleeping sickness"

trypanosoma brucei

protozoa causing acute myocarditis following triatomine (reduviid) bug bite dug to amastigote pseudocyst formation

trypanosoma cruzi (chagas disease)

worm that penetrates skin, travels to lungs then up the trachea, then is swallowed where it infects the duodenal crypts causing diarrhea. endemic to southeast USA

strongyloides stercoralis

seizure illness from ingested eggs or rare pork, w/ characteristic "scolex hooklets". think of what?

taenia solium (neurocysticercosis)

nematode from rare pork that forms cysts in skeletal muscle

trichinella spiralis (trichinosis)

necrotizing vasculitis that affects the lungs and kidneys; PR3-cANCA positive

wegener's granulomatosis

immunological non-infectious necrotizing vasculitis of small to medium muscular arteries sparing the pulmonary circulation, associated w/ hep B

polyarteritis nodosa (PAN)

difference btwn wegener's granulomatosis and polyarteritis nodosum (PAN)

wegener's affects lungs, PAN does not

most important piece of information determining type of tx of lung cancer

are mediastinal nodes involved? if no, then surgical resection; if yes the radiation and chemo

major predisposing risk factor for hepatocellular carcinoma


viral risk factor for hepatocellular carcinoma

Hep B, Hep C

deficiency associated w/ hepatocellular carcinoma

a1-antitrypsin deficiency

mineral disorder associated w/ hepatocellular carcinoma

hereditary hemochromatosis

fungal toxin associated w/ hepatocellular carconoma

aspergillus aflatoxin B1 (causes p53 mutation)

chemical associated w/ hepatic angiosarcoma

vinyl chloride

receives lymph from the gluteal region, lower abdominal wall, perineum, and superficial regions of the lower limb ands superficial tissues of penis and clitoris

superficial inguinal nodes

receives lymph from glans penis or glans clitoris, labia minora & inferior vagina

deep inguinal nodes

lymph from testes drains to

preaortic & lateral aortic

hostility, defiance, and disobedience toward authority figures that lasts beyond 6 months

oppositional defiant disorder

classic triad of impaired attention, impulsivity and excessive motor activity


small gram negative bacteria that multiply in host endothelial cell cytoplasm, manifesting vasculitis


infection causing high fever, myalgias, nausea, headache and rash appearing first on wrists and ankles, 1-2 weeks after tick bit in america. Dx? Tx?

rocky mountain spotted fever (rickettsia rickettsii); doxycycline

infection causing high fever, myalgias, nausea, headache and rash, 1-2 weeks after flea bites in rat infested area

typhus (rickettsia typhi)

tx of acute asthma in the emergency department

oxygen & albuterol



FEV1sec/FVC in restrictive lung disease

normal to increased

while viral conjunctivitis can be caused by coxsackievirus, enterovirus, EBV, HSV and HZV, most cases of "pink eye" are caused by


common agents of chronic ear infections

pseudomonas aeruginosa, S. pneumoniae, H. influenze, S. aureus, M. catarrhalis

hyaline mold associated w/ chronic sinusitis


infection causing stridor, drooling, and pharyngitis in a child w/ questionable immunization

haemophilus influenzae type b (epiglottitis)

parental and fetal serotypes in erythroblastosis fetalis

mother is Rh negative, father is Rh positive, baby inherits Rh positive from father

mechanism of erythroblastosis fetalis

mother makes anti Rh agglutinins that diffuse through placenta and cause hemolysis in baby (type II)

signs of erythroblastosis fetalis

jaundiced & anemic at birth (NOT parvovirus B19. this causes hydrops fetalis)

Tx of neonate w/ erythroblastosis fetalis

repeated transfusions w/ Rh negative blood

Tx of mother to prevent erythroblastosis fetalis

Rh immunoglobulin globin, an anti-D antibody that prevents B cell antibody production; give at 28-30 weeks gestation

failure to maintain self-tolerance resulting in anti bodies to self constituents w/ facial rash exacerbated by UV light


cytokine mediators of fever

TNF, IL1 and PGE2

indirect mediator of bronchospasm in allergic pts via activation of sensory nerves


stimulates the leydig (interstitial) cells of the testes to produce testosterone by inducing formation of sterol carrier proteins that shuttle cholesterol to the outer mitochondrial membrane


this hormone stimulates the sertoli cells to synthesize androgen binding protein, aromatase, growth factors and inhibins


function of progestin in oral contraceptives

causes negative feedback on the pulsing of GnRH by hypothalamus

Hemophilia A is lacking

factor VIII

Hemophilia B is lacking

factor 9

lab value abnormality in both hemophilia A and B

prolonged PTT (intrinsic pathway)

mechanism of DIC in mother when fetus dies

tissue factor released from dead fetus enters maternal circulation

HPV types associated most w/ cervical cancer

16 and 18

mechanism by which HPV causes cervical cancer

E6 protein inactivates p53 suppressor gene and E7 protein binds Rb suppressor gene

vertebral level of splenic flexure

T12 vertebral body

persistent PDA manifests as what in adults

pulmonary hypertension resulting in right heart failure (eisenmenger's syndrome)

enzyme deficiency causing gout (as well as lesch-nyhan syndrome)

hypoxanthine guanine phosphoribosyl transferase (HGPRT)

large aggregations of urate crystals surrounded by an intense inflammatory reaction of macrophages, lymphocytes, and large foreign body giant cells

gouty tophi

microscopic appearance of gout crystals

long needle shaped negatively birefringent

Tx of acute gout

indomethacin, colchicine, glucocorticoids

most common primary infection site of cryptococcus & coccidioides


cranial nerve signaling accommodation and pupillary constriction

CN 3 from edinger-westphal nucleus

schwannoma occuring at the cerebellopontine angle, attached to the vestibular branch of CN8, presenting w/ tinnitus & hearing loss

acoustic neuroma

cell that produces primary structure affected by multiple sclerosis

oligodendrocytes (myelin)

DOC for adult w/ campylobacter infection


deficiency resulting in lack of inhibition of leukocyte elastase causing emphysema

a1 antitrypsin

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