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{{c1::Koilocytes}} have characteristic {{c2::perinuclear}} halos that are hallmarks of {{c3::HPV}} infectionsPhoto credit: Ed Uthman from Houston, TX, USA, CC BY 2.0, via Wikimedia Commons* Very apparent in Condyloma Acuminatum Watch Human Papillomavirus (Papillomaviridae) Watch Cervical NeoplasiaWatch associated Bootcamp video - Female Pathology: Cervical Pathology Watch associated Bootcamp video - Infectious Diseases of the Skin: Viral Infectious Conditionsf3d57a5d-81a0-4979-9b19-24459106e648
What is the most common type of cervical carcinoma? {{c1::Squamous cell carcinoma (80%)}}- Adenocarcinoma is 15% of cases - Both are related to HPVWatch Cervical Neoplasia Watch Human Papillomavirus (Papillomaviridae)Watch associated Bootcamp video - Opportunistic Infections: HPV Carcinoma, Reactivation Tuberculosis, Burkitt Lymphoma41898c91-e995-4797-bba7-a1c462143a70
{{c1::Subacute endocarditis}} is a cardiac complication caused by {{c3::group D Streptococci (Enterococcus faecalis and Enterococcus faecium)}} following {{c2::GI}} or {{c2::GU}} procedures- Suspect after patient undergoes cystoscopy and develops endocarditis symptoms - Subacute endocarditis with enterococci is common after GI / GU procedures (normal flora of colon and urogenital tract)Watch Enterococcus faecium & faecalisWatch associated Bootcamp video - Enterococcus Watch associated Bootcamp video - Typical Endocarditis Pathogens035baf54-9af4-43c3-9c0a-3c2fd35f084c
{{c1::Toxoplasmosis}} is a CNS protozoal infection that presents with brain abscesses in {{c2::immunocompromised (e.g. HIV)}} patients; seen as ring-enhancing brain lesions on CT/MRI- Toxoplasmosis presents w/ multiple lesions; primary CNS lymphoma presents with a solitary lesion - *In HIV patients, toxoplasmosis & primary CNS lymphoma are the most common causes of ring-enhancing brain lesions on CT or MRI Photo credit: Carnero et al., CC BY 4.0, via Insights into Imaging, modified by croppingWatch Toxoplasma gondiiReview Primary CNS Lymphoma (PCNSL)Watch associated Bootcamp video - Toxoplasma Watch associated Bootcamp video - Infectious Neuropathology: Infectious Cerebral Lesions Watch associated Bootcamp video - Opportunistic Infections: Toxoplasmosis, Primary CNS Lymphoma, Cryptococcal Meningitisae350ddf-85ca-40ed-a771-88e7fab762b4
Which herpesvirus is associated with nasopharyngeal carcinoma? {{c1::EBV (HHV-4)}}Especially in East Asian populationsWatch Epstein-Barr Virus (Herpesviridae)Watch Epstein-Barr Virus (Herpesviridae)93c1aeb5-f1d7-45da-99d7-ff472a84fcee
Which 2 bacteria are the most common causes of pelvic inflammatory disease (PID)? {{c1::Chlamydia trachomatis}} (subacute; often undiagnosed); {{c2::Neisseria gonorrhoeae}} (acute)- AKA salpingo-oophoritis - This can cause scarring which can lead to infertility or ectopic pregnanciesWatch Neisseria gonorrhoeae [Old Version]Watch Neisseria gonorrhoeaeWatch associated Bootcamp video - Neisseria Gonorrhoeae Watch associated Bootcamp video - Chlamydia Trachomatis Serotypes and Disease Variantscd3eb2fb-cab3-4fa5-a0f6-f92889e55700
Ondansetron is used to treat {{c1::chemotherapy}} or {{c1::post-operative}} induced nausea and vomitingWatch Antiemetic Agents [Old Version]Watch Antiemetic AgentsWatch associated Bootcamp video - Cerebellar Pathology Watch associated Bootcamp video - Antiemeticsa9301ef5-9a3d-411c-9c44-fe6f6387b5de
Prolactin {{c2::inhibits}} ovulation and spermatogenesis by decreasing synthesis and release of {{c1::GnRH}}Thus, prolactin indirectly inhibits FSH and LH productionWatch Hyperpituitarism Watch Anterior Lobe of the PituitaryWatch associated Bootcamp video - Hypothalamic Nuclei Watch associated Bootcamp video - Anterior and Posterior Pituitary: Anterior Pituitary Function Watch associated Bootcamp video - Pregnancy and Menstruation: Pregnancy Physiologydcd29012-c418-4185-977a-71fee9f65448
What is the effect of alkalemia on free, ionized Ca2+ concentration? {{c1::Decreased}}Less H+ binds to albumin, leaving more sites for Ca2+ to bind → hypocalcemiaWatch associated Bootcamp video - Calcium98b89dca-de11-403f-bb3f-6df254923465
What is the treatment for a patient with symptomatic primary hyperparathyroidism? {{c1::Parathyroidectomy}}or <50 years old; if no surgical intervention then follow calcium, creatinine, and DXA testingWatch Parathyroid Gland DisordersWatch associated Bootcamp video - Hyperparathyroidism5bb77290-137a-47dc-97a6-9d4ddbbf36a0
Humoral hypercalcemia of malignancy is treated with IV fluids, calcitonin, and {{c1::zoledronic acid::specific}} (preferred) or {{c1::pamidronate::specific}}"Zoledronic acid (Zoledronate) is preferred over pamidronate because of its superior efficacy, longer duration of action, and ease of administration (shorter infusion, 15 minutes vs. 2 hours) Per UpToDate: ""The inconvenience of prolonged IV treatment and the relatively weak potency of etidronate (which this card previously said) have diminished its utility, and it is not generally recommended unless other bisphosphonates are not available"""Watch Bisphosphonates, Raloxifene, Denosumab, CalcitoninWatch associated Bootcamp video - Hyperparathyroidism9080c2ec-4781-4310-9f48-3987f2f1ff24
{{c2::Familial hypocalciuric hypercalcemia (FHH)}} is caused by inactivating mutations of the {{c1::Ca2+-sensing receptors}} that regulate PTH secretion- Presents with decreased urinary Ca2+ excretion and increased serum Ca2+ (as the name suggests) - Specifically, these receptors are coupled to GqWatch Calcium DisordersWatch associated Bootcamp video - Familial Hypocalciuric Hypercalcemiada7487e1-9b41-4705-9aa1-f0176cef4dd8
Hypopituitarism may be caused by {{c1::Sheehan}} syndrome, which is a(n) {{c2::pregnancy}}-related {{c3::infarction}} of the pituitary gland- Pregnancy-induced growth of pituitary (estrogen stimulates hyperplasia of lactotrophs), as well as the minimal vascularity of the pituitary gland, make the pituitary susceptible to hypoperfusion - Therefore, heavy postpartum bleeding will manifest with hypoperfusion of the pituitaryWatch Hypothalamic & Pituitary Dysfunction Etiologies Watch Anterior Lobe of the PituitaryWatch associated Bootcamp video - Hypopituitarism Watch associated Bootcamp video - Secondary Adrenal Insufficiency10227db6-ec7e-4c81-9737-e8177cb2325a
During pregnancy, the size of the pituitary gland {{c1::doubles}}, but blood supply does not increase significantlyThus, increased risk of infarction (Sheehan syndrome)Watch Hypothalamic & Pituitary Dysfunction EtiologiesWatch associated Bootcamp video - Hypopituitarism Watch associated Bootcamp video - Secondary Adrenal Insufficiency708ab313-45f8-48aa-9da3-dd9c2b74f6fd
{{c1::Nephrogenic}} diabetes insipidus is characterized by polyuria and polydipsia with an inability to {{c3::concentrate}} urine due to {{c2::lack of response to ADH}}Two subtypes: - Complete nephrogenic diabetes: complete unresponsiveness of the kidneys to ADH - Partial nephrogenic diabetes: slow but steady rise in urine osmolality with increasing serum osmolality after water deprivation. DDAVP still fails to increase urine osmolality. The urine osmolality remains low (< 500 mOsm/L) - Whereas, central diabetes insipidus is due to lack of ADH - Note: Central diabetes insipidus has been renamed arginine vasopressin deficiency (AVP-D)* Generous pee stream = polyuria Watch Diabetes Insipidus & SIADH Watch Production of Hypoosmotic UrineWatch associated Bootcamp video - Diabetes Insipidus Watch associated Bootcamp video - Electrolytes: Sodium19e51991-61d1-42b3-96f4-603fb9e00374
SIADH is characterized by {{c1::euvolemic::volume}} {{c1::hyponatremia::Na+ level}} with continued urinary Na+ excretionBody responds to water retention with decreased aldosterone, causing normal volumes (euvolemic) but decreased sodium (hyponatremia)Watch Osmolality & Sodium Disorders Watch Diabetes Insipidus & SIADHWatch associated Bootcamp video - Endocrine: SIADH Watch associated Bootcamp video - Endocrine: Hyponatremia Watch associated Bootcamp video - Electrolytes: Sodium97a2804f-9867-471e-ba1a-29fdec94627e
Graves disease is associated with {{c1::exophthalmos}} which occurs due to activation of retro-orbital {{c2::fibroblasts}}"- Activated T cells release cytokines (TNF-α, IFN-γ) which activate fibroblasts (along with TRAb to a lesser degree), causing increased secretions of glycosaminoglycans - GAG deposition leads to osmotic muscle swelling, muscle inflammation, and increased adipocyte count → eyes being pushed out, dysfunction of extraocular muscles causes restricted extraocular movements and diplopia - Visible appearance causes appearance of a ""stare"" Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ"* activated T cells release cytokines which activate fibroblasts, causing increased secretions of glycosaminoglycans, which are osmotic Watch Hyperthyroidism Overview & Graves Disease Watch Pathophysiology of Thyroid HormonesWatch associated Bootcamp video - Hyperthyroidism: Graves Disease0e5dae79-6628-40ca-b412-9a5d17d748e5
"What are the ""4 P's"" used to treat thyroid storm? 1. {{c1::Propranolol::β-blocker}} 2. {{c1::Propylthiouracil (PTU)::Antithyroid agent}} 3. {{c1::Prednisolone::Corticosteroid}} 4. {{c1::Potassium iodide::Lugol iodine}}"Propranolol - blocks sympathetic effects and peripheral conversion of T4 to T3 (inhibits 5' deiodinase) PTU - blocks thyroid hormone synthesis and ↓ peripheral conversion of T4 to T3 Prednisolone - inhibits peripheral conversion of T4 to T3 (inhibits 5' deiodinase) and prevents exophthalmopathy Potassium iodide - Inhibits proteolytic cleavage of T3 and T4 from thyroglobulin → inhibits thyroid hormone release (Wolff-Chaikoff effect)Watch Propylthiouracil, Methimazole, LevothyroxineWatch associated Bootcamp video - Hyperthyroidism: Graves Diseaseyedb52767-c209-48f3-9205-d4e3e3535ac2
The most common cause of congenital hypothyroidism in the U.S. is {{c1::thyroid dysgenesis}}- Thyroid dysgenesis refers to an underdeveloped (i.e., hypoplasia, aplasia) or ectopic thyroid - Congenital hypothyroidism was historically known as cretinism Other causes include: - Antibody mediated maternal hypothyroidism - Thyroid agenesis (NOT the same as thyroid dysgenesis)Watch Hypothyroidism Overview & Hashimotos ThyroiditisWatch associated Bootcamp video - Hypothyroidism: Other Causes Watch associated Bootcamp video - Thyroid and Parathyroid Developmentccbb99d8-b861-460a-a747-2010e980a48d
What is the most common cause of primary hyperparathyroidism? {{c1::Parathyroid adenoma (>80%)}}Other causes include sporadic hyperplasia and parathyroid carcinoma* extends via local invasion or metastasis Watch Parathyroid Gland DisordersWatch associated Bootcamp video - Hyperparathyroidism6519e8c0-76f5-41cc-9cdf-8cc2c8eb26ab
What is the most common cause of secondary hyperparathyroidism? {{c1::Chronic kidney disease (CKD)}}Phosphate builds up in the blood and binds free calcium* excess PTH secreted by kidneys Watch Parathyroid Gland DisordersWatch associated Bootcamp video - Hyperparathyroidism08b9591d-6e27-41c1-874a-3bc353eef119
Diabetic ketoacidosis (DKA) is associated with {{c1::Kussmaul}} respirations, which is rapid/deep breathing to compensate for metabolic {{c2::acidosis}}Watch Diabetic Ketoacidosis (DKA) & Hyperosmolar Hyperglycemic State (HHS) Watch Acid/Base Disorders Watch Metabolic AcidosisWatch Acute Dyspnea DDx: Non-Respiratory EtiologiesWatch associated Bootcamp video - Energy Production: Tricarboxylic Acid Cycle: Key Enzymes Watch associated Bootcamp video - Diabetic Ketoacidosisc7bb067e-1c99-4717-a9b9-977a735b9f78
What type of acidosis will a patient with diabetic ketoacidosis experience? {{c1::High anion gap metabolic acidosis}}"""MUDPILES"""* due to accumulation of ketones (organic acids) Watch Acid/Base Disorders Watch Diabetic Ketoacidosis (DKA) & Hyperosmolar Hyperglycemic State (HHS) Watch Metabolic AcidosisWatch associated Bootcamp video - Metabolic Acidosis Watch associated Bootcamp video - Ketones: Ketoacidosis Review and Ketogenolysis Watch associated Bootcamp video - Diabetic Ketoacidosis4d62b253-b077-4609-a279-5ec587cf1ff7
What demographic is most commonly associated with hyperosmolar hyperglycemia state (HHS)? {{c1::Elderly with T2DM, especially with limited ability to drink}}Frequently presents with severe hyperglycemia and increased serum osmolality without acidosis/ketonemia (still have insulin which suppresses ketone production)Watch Diabetic Ketoacidosis (DKA) & Hyperosmolar Hyperglycemic State (HHS)Watch associated Bootcamp video - Diabetes Types I and II Watch associated Bootcamp video - Hyperosmolar Hyperglycemic Statebb7affff-4800-4cc0-a0f4-46755fbb8a5f
Hyperosmolar hyperglycemic non-ketotic state often presents with glucose levels > {{c1::600}} mg/dL and increased serum osmolarity (> 320 mOsm/kg)vs. DKA, which usually has glucose < 600 and serum osmolarity < 320Watch Diabetic Ketoacidosis (DKA) & Hyperosmolar Hyperglycemic State (HHS)Watch associated Bootcamp video - Hyperosmolar Hyperglycemic State001e53ab-654c-4617-a0a8-99a01c331caf
If a patient has Zollinger-Ellison syndrome, gastrin levels will {{c1::increase}} after administration of secretin (secretin stimulation test)Secretin normally suppresses gastrin secretion; elevated levels indicate an ectopic sourceWatch Pancreatic Cancer & Islet Cell TumorsWatch associated Bootcamp video - Zollinger Ellison Syndrome803e1ca0-8ebc-465f-a941-bfcd8388b08e
Elevated levels of {{c1::5-HIAA}}, a metabolite of serotonin, in the urine is indicative of a(n) {{c2::carcinoid}} syndrome- Abbreviation for 5-hydroxyindoleacetic acid - For this reason, 5-HIAA levels are the best initial test for carcinoid syndromeWatch Carcinoid Tumor & Small Bowel NeoplasmsWatch associated Bootcamp video - Carcinoid Tumors738ad0a5-7621-46cf-84c5-1964cb90bf03
{{c1::Primary}} hyperaldosteronism is characterized by high aldosterone and {{c2::low}} renin- This results in resistant hypertension; renin is downregulated via high blood pressure - NO direct edema due to aldosterone escape mechanism (aldosterone upregulates ENaC, increased BV causes atria to release ANP to downregulate ENaC)Watch Adrenocortical Hyperfunction Hyperaldosteronism & HypercortisolismWatch associated Bootcamp video - Hyperaldosteronism Watch associated Bootcamp video - Cardiology RAAS Regulation037b7648-6505-4d31-ab26-d87c5d0d06bc
{{c1::Secondary}} hyperaldosteronism is characterized by high aldosterone and {{c2::high}} renin- Seen in patients with renovascular hypertension and juxtaglomerular cell tumor (due to independent activation of renin-angiotensin-aldosterone system), as well as causes of edema (cirrhosis, heart failure, nephrotic syndrome) - EDEMA present due to NO aldosterone escape mechanism (even if ANP is elevated, ATII is still increasing Na+ reabsorption via Na+ / H+ exchanger)Watch Adrenocortical Hyperfunction Hyperaldosteronism & HypercortisolismWatch associated Bootcamp video - Hyperaldosteronism5686a3cf-834b-4d30-ba8c-97d6ab761bc2
What is the most common tumor of the adrenal medulla in children? {{c1::Neuroblastoma}}The median age of diagnosis is 18 monthsWatch Pheochromocytoma & NeuroblastomaWatch associated Bootcamp video - Adrenal Neoplasmsb3fc4a49-3e05-4757-b1d7-e6357090bee3
Neuroblastoma originates from {{c2::neural crest}} cells and can occur anywhere along the {{c1::sympathetic chain}}vs Wilms tumor (nephroblastoma) which originates from kidneysWatch Pheochromocytoma & NeuroblastomaWatch associated Bootcamp video - Germ Layers Watch associated Bootcamp video - Adrenal Neoplasms1f2b17ee-b3f6-4f14-a5e2-ba8ce240c95e
The most common presentation for a(n) {{c1::neuroblastoma}} is abdominal distention with a firm, {{c2::irregular::regular/irregular}} mass that {{c2::can}} cross the midlinevs Wilms tumor which is smooth and unilateralWatch Pheochromocytoma & NeuroblastomaWatch associated Bootcamp video - Adrenal Neoplasms58020286-acd3-43cd-a899-223b79ecbbc3
"Neuroblastoma may present with {{c1::opsoclonus-myoclonus}} syndrome, sometimes referred to as ""dancing eyes, dancing feet"""Watch 'Opsoclonus', JAMA Network, via Youtube (0:23)Watch Pheochromocytoma & NeuroblastomaWatch associated Bootcamp video - Adrenal Neoplasms8812ac09-7f70-4cb9-b9f2-e63384396f8b
Neuroblastoma is characterized by increased levels of {{c1::homovanillic acid (HVA)}} and {{c1::vanillylmandelic acid (VMA)}} in the urine (catecholamine metabolites)Review Catecholamine Synthesis & BreakdownWatch associated Bootcamp video - Adrenal Neoplasms8977b15a-fc9b-470b-b141-fdd985882b60
In {{c1::androgen insensitivity}} syndrome a person is genotypically XY but has {{c2::female}} external genitalia, {{c2::present::present/absent}} testes, and breasts- i.e. the presence of the lower vagina, clitoris, and labia as well as testes - Testes are often cryptorchid, other male internal genitalia are missing - Looks like 5α-reductase, but breasts are present due to lack of androgen receptors causing elevated testosterone - Elevated testosterone is unable to inhibit breast development and is aromatized to estrogenWatch associated Bootcamp video - Disorders of Sexual Development Part 1 Watch associated Bootcamp video - Pregnancy and Menstruation: Menstrual Cycle Disorders29d3148d-cd47-4499-bddd-9468569b522b
In {{c2::5α-reductase deficiency}}, a genotypically XY individual is born with {{c1::female or ambiguous}} external genitalia and {{c1::male}} internal genitalia, with no breast development during puberty- Results in an inability to convert testosterone → dihydrotestosterone (DHT) - Most individuals develop increasingly ambiguous external genitalia at puberty due to increasing levels of testosterone (e.g., clitoromegaly) - Compared with androgen insensitivity syndrome, which presents with breast development - This card has changed multiple times. Most recently, this card stated that these patients have ambiguous external genitalia. AMBOSS confirms mostly female but sometimes more ambiguous. (4/18/23)Watch associated Bootcamp video - Disorders of Sexual Development Part 1 Watch associated Bootcamp video - Adrenal Cortex Pathways Overview Watch associated Bootcamp video - 5-α-reductase deficiency0ed8560a-99a4-4739-88d7-c4b55aee074b
What is the effect of increased estrogen on levels of LDL? {{c1::Decreased}}Watch associated Bootcamp video - Pregnancy and Menstruation: Hormones of Pregnancy4a5b5dee-8585-4c70-89e1-bad7aaf05fcd
At ovulation, cervical mucus {{c1::increases}} in quantity and becomes more {{c1::watery}} and penetrable by spermDuring the luteal phase of menstruation, cervical mucus becomes more thick (less watery) and less penetrable by spermWatch associated Bootcamp video - Pregnancy and Menstruation: Menstrual Cycle3dba12e9-6b49-41e5-8e58-cd983a6bd459
During the luteal phase of menstruation, cervical mucus becomes more {{c1::thick (less watery)}} and {{c1::less}} penetrable by spermAt ovulation, cervical mucus increases in quantity and becomes more watery and penetrable by spermWatch associated Bootcamp video - Pregnancy and Menstruation: Menstrual Cycledd1f9dc3-ede1-471f-8629-ca8f67243197
Why does lactation not occur during pregnancy, even though prolactin levels are increasing? {{c1::Progesterone and estrogen downregulate prolactin receptors on the breast}}- After pregnancy and delivery, a sharp decrease in progesterone / estrogen stops prolactin inhibition (milk production occurs) - Note: Per AMBOSS, a sharp decline in mainly progesterone is what drives increased milk productionWatch associated Bootcamp video - Pregnancy and Menstruation: Hormones of Pregnancy Watch associated Bootcamp video - Pregnancy and Menstruation: Pregnancy Physiologycfc24932-b9d3-4877-8f0c-964080c36a91
{{c1::Mittelschmerz}} is transient mid-cycle ovulatory pain that may mimic appendicitis- Classically associated with peritoneal irritation (e.g. follicular swelling/rupture, fallopian tube contraction) - e.g. on day 10-14 (corresponding with the time of ovulation)d6df7f8f-638d-49d8-9e12-4f475b0ef7bf
The {{c1::Apgar score}} is an assessment of newborn vital signs following labor via a 10-point scale evaluated at 1 minute and 5 minutes0 Points1 Point2 PointsAppearancePale or blueExtremities bluePinkPulseNo pulse<100 bpm≥100 bpmGrimaceNo response to stimulationGrimaces of weak cryCries and pulls awayActivityNo movementArms, legs flexed Active movement RespirationNo breathing Slow, irregularStrong cryf46036d7-e90d-490e-a346-d39c0554b8fe
Breastfeeding reduces maternal risk of {{c1::breast}} and {{c1::ovarian}} cancer- Also facilitates mother-child bonding... aww - Also associated with decreased risk of childhood cancer in the infantWatch Benign Breast Disorders Watch Breast CancerWatch associated Bootcamp video - Female Pathology: Breast Cancer Overview1504ebbf-f505-430e-8ddf-1953a851b844
Very elevated levels of {{c1::FSH}} is specific for menopause>30; due to loss of negative feedback on FSH due to resistant ovarian follicles (i.e decreased estrogen) and lack of feedback from inhibinWatch AmenorrheaWatch Menopause & Hormone Replacement Therapyf288efd7-222f-4225-b7dc-f52999427207
Menopause before age 40 suggests {{c1::primary ovarian insufficiency::what condition?}}- AKA premature ovarian failure - Can occur in women who smoke or those receiving chemotherapy/radiationWatch Amenorrhea Watch Hypothalamic & Pituitary Dysfunction Clinical ManifestationsWatch associated Bootcamp video - Pregnancy and Menstruation: Menstrual Cycle Disorders0fc15a4d-9ace-4c85-b03e-aa1a339ad0f6
The {{c1::Bartholin}} gland is present on each side of the vaginal canal and produces mucus-like fluid that drains via ducts into the lower vestibulePhoto credit: Nicholasolan at English Wikipedia, CC BY-SA 3.0, via Wikimedia Commons* note: bartholin air ducts are on the lateral arches Watch Vulvar & Vaginal LesionsWatch associated Bootcamp video - Fetal Development: Disorders of Genital Embryology Watch associated Bootcamp video - Fetal Development: Female Anatomy Watch associated Bootcamp video - Female Pathology: Internal Vaginal Pathologya2dd05ca-57eb-479d-9d7b-67a1e249d9b5
Does lichen sclerosus present with increased risk for squamous cell carcinoma? {{c1::Yes, slightly increased risk}}"In contrast, lichen simplex chronicus presents with no increased risk for SCC Photo credit: #15553, via CDC PHIL Photo credit: #6541, via CDC PHIL"Watch Vulvar & Vaginal Lesions Watch Actinic Keratosis, Squamous Cell Carcinoma & Basal Cell CarcinomaWatch associated Bootcamp video - Female Pathology: Vaginal Skin Pathology4c67c0ad-d0d3-4ea2-a46d-f157b5896a04
Lichen {{c3::simplex chronicus}} presents as {{c1::leukoplakia}} with {{c2::thick, leathery}} vulvar skinPhoto credit: kilbad, CC BY 3.0, via Wikimedia CommonsWatch Vulvar & Vaginal LesionsWatch associated Bootcamp video - Female Pathology: Vaginal Skin Pathologyea7c3636-a051-4b7a-8fdc-aebf940ba843
Vulvar carcinoma presents as {{c1::leukoplakia}}; a biopsy may be required to distinguish carcinoma from other causes (e.g. lichen sclerosus and lichen simplex chronicus)Watch Vulvar & Vaginal LesionsWatch associated Bootcamp video - Female Pathology: Vaginal Skin Pathology Watch associated Bootcamp video - Female Pathology: Vaginal Cancer6af9d8ca-6559-4a7f-bd98-80b6b0bce93a
Non-HPV related vulvar carcinoma arises, most often, from long-standing lichen {{c1::sclerosus}}Chronic inflammation and irritation eventually lead to carcinomaWatch Vulvar & Vaginal Lesions Watch Actinic Keratosis, Squamous Cell Carcinoma & Basal Cell CarcinomaWatch associated Bootcamp video - Female Pathology: Vaginal Skin Pathologye7fdf5f0-451e-4d12-8beb-28f973297036
Paget disease (of the vulva and nipple) presents as {{c1::erythematous}}, {{c1::pruritic}}, {{c1::ulcerated}} skinPhoto credit: Lily Chu, National Naval Medical Center Bethesda, Public domain, via Wikimedia CommonsWatch Breast CancerWatch associated Bootcamp video - Female Pathology: Benign Breast Tumors8c65a5f3-a887-44ed-8af3-6f5e26bfe03e
Does extramammary Paget disease of the vulva often present with underlying carcinoma? {{c1::No}}However Paget disease of the nipple does present with underlying carcinoma Photo credit: Asmouki et al., CC BY 3.0, via Hindawi Case Reports in Oncological MedicineWatch Breast CancerWatch associated Bootcamp video - Female Pathology: Vaginal Cancer14caae49-0961-46f8-98f8-617d80b9ec7a
Extramammary Paget disease of the vulva may be distinguished from melanoma by the following immunohistological features: 1. PAS {{c1::+::+/-}} 2. Keratin {{c1::+::+/-}} 3. S100 {{c1::-::+/-}}- Keratin is present in epithelial cells, therefore indicates carcinoma - PAS is a stain for mucous-producing cells. Clinically they rarely test PASWatch Breast CancerWatch associated Bootcamp video - Female Pathology: Vaginal Cancerydda50c8a-3afd-4ddf-925d-4f035a215417
During normal development, {{c1::squamous}} epithelium from the lower 1/3 of the vagina grows upward to replace {{c1::columnar}} epithelium lining the upper 2/3 of the vaginaThus, the vaginal canal all becomes squamous epithelium*presence of columnar epithelium after birth is known as adenosis (e.g. DES exposure) Watch Vulvar & Vaginal LesionsWatch associated Bootcamp video - Female Pathology: Vaginal Cancer42a2f179-b756-4d8f-a159-8d98e4d2144d
Vaginal {{c1::adenosis}} is the focal persistence of {{c2::columnar}} epithelium in the upper 2/3rd of the vagina* In place of normal squamous epithelium Watch Vulvar & Vaginal LesionsWatch associated Bootcamp video - Female Pathology: Vaginal Cancer7892e966-5093-46cd-bee4-31213c74b164
{{c2::Embryonal rhabdomyosarcoma}}, also known as {{c3::sarcoma botryoides}}, presents with bleeding and a(n) {{c1::grape}}-like mass protruding from the vagina or penis of a child"Botryoides = ""like a bunch of grapes"" Photo credit: Dayyabu et al., CC BY 4.0, via Int J Case Rep Images"* rare malignant mesenchymal proliferation of immature skeletal muscle Watch Vulvar & Vaginal LesionsWatch associated Bootcamp video - Female Pathology: Vaginal Canceraf1f2798-dd76-4e84-a9ad-5125280b8089
Vaginal squamous cell carcinoma is usually secondary to {{c1::cervical}} SCCc6c864b5-c5fb-440c-bbd9-f2782157406b
The ectocervix is lined by {{c1::non-keratinized stratified squamous}} epithelium- Whereas the endocervix is lined by columnar epithelium - Ectocervix on the left, endocervix on the right Photo credit: Ed Uthman, CC BY 2.0, via Flickr Photo credit: Lee et al., CC BY 4.0, via Journal of Obstetrics and Gynaecology Cases - Reviews Female Reproductive Tract EpitheliumOrgan/TissueHistologyVulvaStratified squamous epithelium VaginaStratified squamous epithelium (non-keratinized)EctocervixStratified squamous epithelium (non-keratinized)Transformation ZoneSquamocolumnar junctionEndocervixSimple columnar epitheliumUterusSimple columnar epithelium (with tubular glands)Fallopian TubeSimple columnar epithelium (ciliated)Ovary (outer surface)Simple cuboidal epithelium (germinal)Watch Cervical NeoplasiaWatch Cervicitis & PID SOAPsdda6756b-3143-43df-bce4-443ab6aa564b
The endocervix is lined by {{c1::simple columnar}} epithelium- Whereas the ectocervix is lined by non-keratinized stratified squamous epithelium - Ectocervix on the left, endocervix on the right Photo credit: Ed Uthman, CC BY 2.0, via Flickr Photo credit: Lee et al., CC BY 4.0, via Journal of Obstetrics and Gynaecology Cases - Reviews Female Reproductive Tract EpitheliumOrgan/TissueHistologyVulvaStratified squamous epithelium VaginaStratified squamous epithelium (non-keratinized)EctocervixStratified squamous epithelium (non-keratinized)Transformation ZoneSquamocolumnar junctionEndocervixSimple columnar epitheliumUterusSimple columnar epithelium (with tubular glands)Fallopian TubeSimple columnar epithelium (ciliated)Ovary (outer surface)Simple cuboidal epithelium (germinal)Watch Cervical NeoplasiaWatch Cervicitis & PID SOAPsf2d5ddef-6472-444e-96aa-39769d0c4621
The {{c1::transformation zone}} is the squamocolumnar junction between the ectocervix and the endocervixMost common area of cervical cancer; sampled in Pap test Ectocervix on the left, endocervix on the right Photo credit: Ed Uthman, CC BY 2.0, via Flickr Photo credit: Lee et al., CC BY 4.0, via Journal of Obstetrics and Gynaecology Cases - Reviews Female Reproductive Tract EpitheliumOrgan/TissueHistologyVulvaStratified squamous epithelium VaginaStratified squamous epithelium (non-keratinized)EctocervixStratified squamous epithelium (non-keratinized)Transformation ZoneSquamocolumnar junctionEndocervixSimple columnar epitheliumUterusSimple columnar epithelium (with tubular glands)Fallopian TubeSimple columnar epithelium (ciliated)Ovary (outer surface)Simple cuboidal epithelium (germinal) Photo credit: Ed Uthman from Houston, TX, USA, CC BY 2.0, via Wikimedia CommonsWatch Cervical NeoplasiaWatch Cervicitis & PID SOAPs204f59e6-ad12-4d71-8c52-5ca517fb5b27
What are the high-risk strains of HPV? {{c1::16, 18, 31, 33::4}}Watch Human Papillomavirus (Papillomaviridae)Watch associated Bootcamp video - Female Pathology: Cervical Pathology Watch associated Bootcamp video - Opportunistic Infections: HPV Carcinoma, Reactivation Tuberculosis, Burkitt Lymphomaf2851fe8-f2e7-44de-83cc-b6245a55aea4
High-risk HPV strains produce {{c2::E6}} protein, which increases destruction of {{c1::p53}}Watch Human Papillomavirus (Papillomaviridae) Watch Cervical NeoplasiaWatch associated Bootcamp video - Infectious Diseases of the Skin: Viral Infectious Conditionsddc61295-8e2b-4d6c-be3c-b2f6be4c9f49
High-risk HPV strains produce {{c1::E7}} protein, which increases destruction of {{c2::Rb (specifically p105-Rb)}}- Rb and p53 are tumor suppressors that inhibit the G1-S transition in the cell cycle - Conveniently, E6 inhibits p53; E7 inhibits Rb - 6 before 7; P before RWatch Cervical Neoplasia Watch Human Papillomavirus (Papillomaviridae)Watch associated Bootcamp video - Infectious Diseases of the Skin: Viral Infectious Conditionsb701fba9-6fec-4d75-99dc-20c39ba0f669
What is the extent of epithelial involvement by immature dysplastic cells in CIN I? {{c1::Less than 1/3}}low-grade CIN; high-grade CIN involves > 1/3 epithelium and includes CIN II and III - CIN I is now classified as Low Grade Squamous Intraepithelial Lesion (LSIL)Watch Cervical NeoplasiaWatch associated Bootcamp video - Female Pathology: Cervical Pathologyb0a573f6-05dc-46e3-a6d4-c7e527980666
Which subtype of cervical carcinoma is associated with HPV? {{c1::Both :)::Adenocarcinoma or Squamous cell carcinoma}}Watch Cervical Neoplasiaf222f5bf-cd77-4cbb-8925-378885ec4048
The second most common subtype of cervical carcinoma is {{c1::adenocarcinoma}} (15%)Most common is squamous cell carcinomaWatch Cervical Neoplasia54bb37db-aae8-4520-81f0-ffd522bd8833
Advanced cervical carcinoma tumors often invade through the anterior uterine wall into the bladder, blocking the {{c1::ureters}}May lead to hydronephrosis and renal failure, which is a common cause of death in cervical carcinoma patientsWatch Cervical NeoplasiaWatch associated Bootcamp video - Female Pathology: Cervical Pathology582d763d-ec18-41fe-aaa4-a128b9a93768
High-grade dysplasia on pap smear is characterized by {{c1::dark::color}} nuclei with a(n) {{c1::high}} nuclear:cytoplasmic ratioPhoto credit: Photomicrograph by Ed Uthman, MD. 20 July 2006 Euthman 20:24, 29 November 2006 (UTC), Public domain, via Wikimedia CommonsWatch associated Bootcamp video - Female Pathology: Cervical Pathology35293993-a888-4b7e-8e28-4645c3e7a230
What is the most common cause of hematochezia in adults? {{c1::Diverticulosis}}Second most common cause is angiodysplasiaWatch Large Bowel & Appendiceal DisordersWatch associated Bootcamp video - Diverticulosis and Angiodysplasiabb00d2fd-8adb-462d-ac3f-8dd0e875720c
What is the most supported theory for the etiology of endometriosis? {{c1::Retrograde menstruation}}- Menstrual blood containing endometrial cells flows back into the fallopian tubes / pelvic cavity instead of out of the body; these endometrial cells then implant at an ectopic site - It can travel to the ovaries (simple cuboidal cells) - It can travel to the peritoneum (simple squamous epithelium), and from there it can travel anywhere in contact with the peritoneum Photo credit: Endometriosis_loc_ger.svg: *Female_anatomy.svg: Tsaitgaistderivative work: Hic et nunc (talk)derivative work: Hic et nunc, CC BY-SA 3.0, via Wikimedia CommonsWatch Abnormal Uterine Bleeding (AUB) & EndometriosisWatch associated Bootcamp video - Female Pathology: Endometriosis and Postpartum Endometritis7d118373-1477-4f3e-8dab-be473fcc248e
What is the gross appearance of an ovarian endometrioma? {{c1::Chocolate cyst (blood-filled)}}Cystic lesion in the ovary filled with accumulated menstrual products Photo credit: Hic et nunc, Public domain, via Wikimedia CommonsWatch Abnormal Uterine Bleeding (AUB) & EndometriosisWatch associated Bootcamp video - Female Pathology: Endometriosis and Postpartum Endometritis Watch associated Bootcamp video - Female Pathology: Ovarian Cysts5aa42471-e8d4-490f-9e75-8ed4eebfc4c9
"When endometriosis spreads to soft tissue, it appears as ""{{c1::gunpowder}} lesions"""Photo credit: See page for author, Public domain, via Wikimedia CommonsWatch Abnormal Uterine Bleeding (AUB) & EndometriosisWatch associated Bootcamp video - Female Pathology: Endometriosis and Postpartum Endometritis6245a60a-fd2f-4baa-bfad-0ee91ec70ef3
The presence of endometrial tissue (endometriosis) in the uterine myometrium is known as {{c1::adenomyosis}}Presents with dysmenorrhea, menorrhagia, uniformly enlarged, soft, globular uterusWatch Abnormal Uterine Bleeding (AUB) & EndometriosisWatch associated Bootcamp video - Female Pathology: Adenomyosis, Endometrial Hyperplasia, and Asherman Syndromed957ec84-2984-4235-9ac8-cbdd799df7d4
The most important predictor for endometrial hyperplasia progression to carcinoma is {{c1::cellular atypia}}Watch Abnormal Uterine Bleeding (AUB) & Endometriosisd7712578-33c2-48f9-b061-cbd7a140f8df
Gross examination of {{c1::leiomyoma (fibroid)}} shows multiple, well-defined, white, whorled masses that may distort the uterus and impinge on pelvic structuresLeiomyosarcoma is usually a single mass with hemorrhage or necrosis Photo credit: Ed Uthman from Houston, TX, USA, CC BY 2.0, via Wikimedia CommonsWatch Abnormal Uterine Bleeding (AUB) & EndometriosisWatch associated Bootcamp video - Female Pathology: Uterine Cancerbc4659ff-306f-48ad-b798-6f61e7b73961
What is the precursor lesion for leiomyosarcoma? {{c1::None}}Arises de novo; leiomyosarcomas do not arise from leiomyomas*Leiomyosarcoma when malignant Watch Abnormal Uterine Bleeding (AUB) & EndometriosisWatch associated Bootcamp video - Female Pathology: Uterine Cancer60455291-baae-4d79-b4ca-d3970dbe0918
Gross exam of {{c1::leiomyosarcoma}} often shows a uterus with a single lesion with areas of necrosis and hemorrhagevs. multiple, well-defined, white, whorled masses (leiomyoma) Photo credit: Mikael Häggström, M.D., CC0, via Wikimedia Commons*Leiomyosarcoma when malignant Watch Abnormal Uterine Bleeding (AUB) & EndometriosisWatch associated Bootcamp video - Female Pathology: Uterine Cancer7cb0f2c8-145c-4c23-a675-1b1a0314d22f
Degeneration of ovarian follicles may result in follicular {{c1::cysts}}Small numbers of follicular cysts are common in women and have no clinical significanceWatch Ovarian Cysts & Epithelial Ovarian CancerWatch associated Bootcamp video - Female Pathology: Ovarian Cystsdf6603f6-6967-403b-ba07-32f5848f9049
Polycystic ovarian syndrome often has a LH:FSH ratio {{c1::≥2}}Watch Repro Hormones Overview & Polycystic Ovary Syndrome (PCOS)Watch associated Bootcamp video - Female Pathology: Polycystic Ovarian Syndrome0f55b667-e83a-4a62-af6a-93630cb167c0
In polycystic ovarian syndrome (PCOS), increased {{c1::LH}} production causes excess {{c2::androgen}} production (from theca cells), resulting in {{c3::hirsutism}}PCOS is the most common cause of hirsutism in females Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch Repro Hormones Overview & Polycystic Ovary Syndrome (PCOS)Watch associated Bootcamp video - Female Pathology: Polycystic Ovarian Syndrome3a876b2f-4b74-474a-b0a1-8932430a1215
Polycystic ovarian syndrome (PCOS) is a condition characterized by at least 2/3 of the following criteria: - Clinical or laboratory* evidence of {{c1::hyperandrogenism}} - {{c1::Oligoovulation and/or anovulation}} - {{c1::Polycystic ovaries}} on ultrasound"- AKA the Rotterdam criteria - Patients have features of androgen excess, ovarian dysfunction, insulin resistance, and obesity - Because hyperandrogenism is highly variable in presentation, elevated testosterone without clinically severe signs is sufficient for #1 - Note that if you already have 1 and 2, you don't need U/S!"Watch Repro Hormones Overview & Polycystic Ovary Syndrome (PCOS)Watch associated Bootcamp video - Female Pathology: Polycystic Ovarian Syndromeyf624c089-da00-4dba-a03b-5f39a2353c06
Patients with polycystic ovarian syndrome have increased risk of {{c1::endometrial}} carcinoma, secondary to unopposed effects of estrogen- Excess androgen leads to anovulatory cycles (prevents dominant follicle formation), leading to decreased progesterone secretion; additionally estrone production from adipose tissue - Imbalance leads to long-term risk for endometrial hyperplasia and adenocarcinoma*(Estro-grow right next to endometrial cancer crab) Watch Abnormal Uterine Bleeding (AUB) & Endometriosis Watch Repro Hormones Overview & Polycystic Ovary Syndrome (PCOS)Watch associated Bootcamp video - Female Pathology: Polycystic Ovarian Syndrome Watch associated Bootcamp video - Pharmacology: Hormone Replacement Therapy361985c7-51cc-477e-a96c-5c80783eb846
The two most common subtypes of ovarian surface epithelial tumors are {{c1::serous}} and {{c1::mucinous}}; both usually cysticClassically named based on type of fluid produced (i.e. serous = water or mucinous = mucus)Watch Ovarian Cysts & Epithelial Ovarian CancerWatch associated Bootcamp video - Female Pathology: Ovarian Cancer Subtypese48f4ffd-0f8b-488f-a654-1eb5bda1d254
What is the most common benign ovarian tumor? {{c1::Serous cystadenoma}}Lined with fallopian tube-like epithelium; often bilateralWatch Ovarian Cysts & Epithelial Ovarian CancerWatch associated Bootcamp video - Female Pathology: Ovarian Cancer Overviewc4fb86de-a198-48d4-aa4f-7334b9d54b4d
{{c1::BRCA1}} mutation carriers have increased risk for {{c2::serous}} adenocarcinoma of the {{c3::ovary}} and {{c3::fallopian tube}}BRCA1 carriers often elect to have a prophylactic salpingo-oophorectomy (along with prophylactic mastectomy due to the increased risk for breast cancer)Watch Ovarian Cysts & Epithelial Ovarian CancerWatch associated Bootcamp video - Female Pathology: Ovarian Cancer Overview Watch associated Bootcamp video - Cellular Injury and Neoplasia: Oncogenes and Tumor Suppressor Genes Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Oncogenes and Tumor Suppressor Genesbfa856da-9da0-4b05-a662-ab10ae793882
What is the most common malignant ovarian neoplasm? {{c1::Serous cystadenocarcinoma}}- Frequently bilateral; psammoma bodies may be present Surface epithelial tumors: - Most common benign → Serous cystadenoma - Most common malignant → Serous cystadenocarcinoma Germ cell tumors: - Most common benign → Dermoid cyst - Most common malignant → Dysgerminoma - Note: Surface epithelial tumors are more common than germ cellWatch Ovarian Cysts & Epithelial Ovarian CancerWatch associated Bootcamp video - Female Pathology: Ovarian Cancer Subtypes519d271b-f663-4422-935f-6cc02c381edd
{{c1::Mucinous}} cystadenocarcinoma may present with {{c2::pseudomyxoma peritonei}}, which is an intraperitoneal accumulation of {{c1::mucinous}} material, usually from a GI, ovarian, or appendiceal tumorPhoto credit: Li et al, CC BY 2.0, via Wikimedia Commons Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Ovarian Cysts & Epithelial Ovarian CancerWatch associated Bootcamp video - Female Pathology: Ovarian Cancer Subtypes5ba580bd-3f8d-4364-a9bd-4fe61b7c3a70
One type of a rare ovarian surface epithelial tumor is a(n) {{c1::Brenner}} tumor, which is composed of bladder-like epithelium (AKA {{c2::urothelium}})Brenner = Bladder Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia Commons"* nuclei have ""coffee-bean"" appearance Watch Ovarian Cysts & Epithelial Ovarian Cancer"Watch associated Bootcamp video - Female Pathology: Ovarian Cancer Subtypesb06f991b-ea86-4d93-b812-325adb92d1d7
"Brenner tumors are solid, encapsulated ovarian tumors with a yellow-tan appearance; they have ""{{c1::coffee bean}}"" nuclei on H&E stain"Brenner = Bean Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia CommonsWatch Ovarian Cysts & Epithelial Ovarian Cancer3cba5e66-a1bf-4247-abbe-ede3f08a953e
What serum tumor marker is useful for monitoring treatment response and recurrence of ovarian neoplasms? {{c1::CA-125}}- This protein is produced by ovarian epithelia and is usually markedly elevated in cancerous ovarian cells compared to normal cells - Thus not good for screening, as other conditions that disrupt ovarian epithelia (e.g. endometriosis) will cause increased release of CA-125 into the bloodstreamWatch Ovarian Cysts & Epithelial Ovarian CancerWatch associated Bootcamp video - Female Pathology: Ovarian Cancer Overview2a754936-f18e-47f4-98e1-10d1e321be9f
{{c1::Struma ovarii}} is a cystic teratoma composed primarily of {{c2::thyroid}} tissue and thus may cause {{c2::hyperthyroidism}}Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia CommonsWatch Ovarian Neoplasms (Germ Cell & Sex Cord Stromal Tumors)Watch associated Bootcamp video - Female Pathology: Ovarian Cancer Subtypes36fbbc82-4575-4bad-9f63-deb62f26d2f3
What serum marker is characteristically elevated in endodermal sinus (yolk sac) tumor? {{c1::Alpha-fetoprotein (AFP)}}Egg YOLK has a lot of PROTEINWatch Ovarian Neoplasms (Germ Cell & Sex Cord Stromal Tumors) Watch Testicular Disorders & CancerReview Yolk Sac TumorWatch associated Bootcamp video - Female Pathology: Ovarian Cancer Subtypese1161e5c-e7cf-406c-bad1-3986d6488ac0
Choriocarcinoma is a small, hemorrhagic tumor with early, diffuse {{c1::hematogenous}} spread, especially to the {{c1::lungs}}- Presents as hemoptysis, shortness of breath; may also metastasize to the brain - Unlike gestational choriocarcinomas, non-gestational choriocarcinomas respond poorly to chemotherapy Photo credit: Rejlekova et al., CC BY 4.0, via Frontiers in EndocrinologyWatch Hydatidiform Mole & ChoriocarcinomaWatch associated Bootcamp video - Germ Cell Tumors5177e7ad-99bd-4eab-9521-6d26323d44ee
{{c1::Granulosa}} cell tumor is an ovarian sex cord stromal tumor that often produces {{c2::estrogen}} and {{c2::inhibin}}- Often produces estrogen and/or progesterone - Tumor marker: increased inhibin Symptoms vary with age; but can present with: - Postmenopausal bleeding (due to endometrial hyperplasia - thickened endometrium can be seen on ultrasound) - Sexual precocity (in pre-adolescents) - Breast tenderness Blue overlay: granulosa cells; yellow overlay: Call-Exner bodies Photo credit: left; Nephron, CC BY-SA 3.0, via Wikimedia Commons, right; AMBOSS, CC BY-SA 3.0Watch Ovarian Neoplasms (Germ Cell & Sex Cord Stromal Tumors)Watch associated Bootcamp video - Female Pathology: Ovarian Cancer Subtypes4a0f60b1-dcf0-402b-b6af-f0b6f2bfa783
Histologically, {{c2::granulosa}} cell tumors are characterized by {{c1::Call-Exner}} bodies, which are {{c2::granulosa}} cells arranged in follicle / rosette-like collections around eosinophilic fluid, resembling primordial follicles"- Small cuboidal cells in sheets with gland-like structures containing acidophilic material - These cells typically have ""coffee bean"" nuclei Blue overlay: granulosa cells; yellow overlay: Call-Exner bodies Photo credit: left; Nephron, CC BY-SA 3.0, via Wikimedia Commons, right; AMBOSS, CC BY-SA 3.0"Watch Ovarian Neoplasms (Germ Cell & Sex Cord Stromal Tumors)Watch associated Bootcamp video - Female Pathology: Ovarian Cancer Subtypes924c9f01-99a1-4cea-b920-5eb7b535b473
{{c2::Sertoli-Leydig}} cell tumor is a rare ovarian sex cord-stromal cell tumor that may produce androgens, thus causing {{c1::hirsutism/virilization}} in women- AKA androblastoma - Contrast with thecoma (AUB in postmenopausal females) and granulosa cell tumor (precocious puberty, endometrial hyperplasia, postmenopausal bleeding, breast tenderness) Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia CommonsWatch Ovarian Neoplasms (Germ Cell & Sex Cord Stromal Tumors)Watch associated Bootcamp video - Female Pathology: Ovarian Cancer Subtypesfe449744-b0c6-4112-92a3-16766028c97f
{{c1::Fibromas}} are benign sex cord stromal tumors of fibroblasts (bundles of spindle-shaped cells)Solid tumor with white bands (fibrosis) Photo credit: Ed Uthman, MD., Public domain, via Wikimedia CommonsWatch Ovarian Neoplasms (Germ Cell & Sex Cord Stromal Tumors)Watch associated Bootcamp video - Female Pathology: Ovarian Cancer Subtypes2213b373-c982-4f54-a41f-b7e18a39dbc0
{{c1::Meigs}} syndrome is a triad of: - {{c2::Ovarian fibroma}} - {{c2::Ascites}} - {{c2::Hydrothorax (pleural effusion)}}A benign ovarian tumor (fibroma) with clinical signs typically associated with ovarian malignancy (ascites + pleural effusion)* Thecoma-fibromas appear yellow on gross pathology due to theca cells Watch Ovarian Neoplasms (Germ Cell & Sex Cord Stromal Tumors)Watch associated Bootcamp video - Female Pathology: Ovarian Cancer Subtypesac09a1cf-3277-4ea7-a331-238c8f97c347
{{c1::Krukenberg}} tumor is a metastatic mucinous tumor that involves both {{c3::ovaries}}; most commonly due to metastatic {{c2::gastric carcinoma (diffuse type)::specific}}Characterized by mucin-secreting signet ring cell adenocarcinoma Photo credit: Für den Autor, siehe, Public domain, via Wikimedia CommonsWatch Ovarian Cysts & Epithelial Ovarian CancerWatch associated Bootcamp video - Esophageal and Gastric Pathology: Malignant Gastric Pathology40f1ffa3-3496-4637-b2b3-a6ed6f3e72c6
Primary mucinous tumors of the ovary (a type of epithelial tumor) are usually {{c1::uni::uni/bi}}lateral, whereas Krukenberg tumors are usually {{c1::bi::uni/bi}}lateralWatch Ovarian Cysts & Epithelial Ovarian CancerWatch associated Bootcamp video - Esophageal and Gastric Pathology: Malignant Gastric Pathologycf269334-e3e5-483a-b7a9-37b455ba15be
Which ovarian/testicular neoplasm is characterized histologically by Schiller-Duval bodies (glomeruloid-like structures)? {{c1::Endodermal sinus (yolk sac) tumor}}Photo credit: above; Jensflorian, CC BY-SA 3.0, via Wikimedia Commons, below; AMBOSS, CC BY-SA 3.0 Blood vessel (red overlay) surrounded by germ cells (blue overlay)Watch Ovarian Neoplasms (Germ Cell & Sex Cord Stromal Tumors) Watch Testicular Disorders & CancerReview Yolk Sac TumorWatch associated Bootcamp video - Female Pathology: Ovarian Cancer Subtypesfaeffe25-9ff9-4089-9367-84f4c6b3db5a
What is the most common site for an ectopic pregnancy? {{c1::Ampulla of the fallopian tube::Specific}}Image licensed by Physeo and used with permission. Purchase full access here.Watch Gestational DisordersWatch Ectopic PregnancyWatch associated Bootcamp video97103e14-4e82-4333-8751-6601675d4116
Spontaneous abortion is most often due to {{c1::chromosomal}} anomalies, especially {{c1::trisomy 16}}Trisomy Sixteen = Spontaneous abortionWatch Early Pregnancy Lossdcfe179f-953d-4b60-91dc-c52f067a4123
Placenta {{c1::previa}} is attachment of the placenta to the lower uterine segment over the {{c2::internal cervical os}}- Often requires C-section for birth - A low-lying placenta is one which is < 2 cm from the internal cervical os Photo credit: OpenStax College, CC BY 3.0, via Wikimedia CommonsWatch Gestational DisordersWatch associated Bootcamp videoeb9bd012-dd0d-401b-a714-ae694208306b
Placenta {{c1::accreta}} is the abnormal attachment of the placenta to the myometrium, without penetrating itA-I-P (ABC order) Accreta, Increta, Percreta most common type; risk factors include prior C-section, inflammation, and placenta previa Photo credit: TheNewMessiah at English Wikipedia, Public domain, via Wikimedia Commons, resolution enhanced by AI* most common type; risk factors include prior C-section, inflammation, and placenta previa Watch Gestational DisordersWatch associated Bootcamp videoe51c8ab7-1349-47f8-914b-a262074a3228
Placenta accreta (or increta / percreta) presents with no separation of the placenta after delivery and {{c1::heavy post-partum bleeding}}- Usually caught on ultrasound prior to delivery - On delivery, the placenta will be removed in pieces via manual vac - Postpartum bleeding may cause Sheehan syndrome (postpartum pituitary gland necrosis due to hypovolemic shock after childbirth, resulting in ischemic necrosis of the pituitary gland)Watch Gestational DisordersWatch associated Bootcamp video Watch associated Bootcamp video - Secondary Adrenal Insufficiency8a6aaef4-be68-4a70-95c3-cd7e53ecc712
{{c1::Gestational hypertension}} is a blood pressure >140/90 mmHg after the 20th week of gestation without proteinuria, pre-existing hypertension, or end-organ damage* If before 20 weeks may be due to pre-existing hypertension Watch Gestational Disorders2e680e1c-ec74-41cd-b7e6-4873899639dd
{{c1::Eclampsia}} is defined as preeclampsia with {{c2::seizures}}maternal death due to stroke, intracranial hemorrhage, or ARDSWatch Gestational DisordersWatch Etiology of Seizures0a2e693b-1cce-4637-9172-8b921e4662df
{{c2::HELLP}} syndrome is a manifestation of severe {{c1::preeclampsia}} that presents with {{c3::hemolysis}}, {{c3::elevated liver enzymes}}, and {{c3::low platelets}}This triad may present clinically as anemia, RUQ pain, and bruising / bleedingWatch Gestational DisordersWatch associated Bootcamp video4d8926c2-8da4-4412-bdad-65532a71bfa4
Complete hydatidiform mole presents with a(n) '{{c1::snow-storm}}' appearance on ultrasoundPhoto credit: Mikael Häggström, CC0, via Wikimedia CommonsWatch Hydatidiform Mole & ChoriocarcinomaWatch associated Bootcamp video - Molar Pregnancy051b4685-da2f-46af-a2b3-94661f47f688
A(n) {{c1::complete}} hydatidiform mole is characterized by {{c2::46}} chromosomes- XX (∼90% of cases) or XY - Two sperm fertilizes empty egg - “completely” from dad (46 chromosomes)Watch Hydatidiform Mole & ChoriocarcinomaWatch associated Bootcamp video - Molar Pregnancy60a1e2c7-1d76-4296-a23a-8d2623868764
A(n) {{c1::partial}} hydatidiform mole is characterized by {{c2::69}} chromosomesXXX, XXY or XYYWatch Hydatidiform Mole & ChoriocarcinomaWatch associated Bootcamp video - Molar Pregnancy366f3550-9178-4685-b0e7-249b095afc0c
A(n) {{c1::partial}} hydatidiform mole most commonly consists of {{c2::2}} sperm with {{c2::1}} eggor one sperm that duplicates its chromosomesXXX, XXY or XYY Watch Hydatidiform Mole & ChoriocarcinomaWatch associated Bootcamp video - Molar Pregnancyfcf149a5-8fcf-4d04-a8d9-553192948d1c
A(n) {{c1::complete}} hydatidiform mole most commonly consists of {{c2::1}} sperm that {{c2::duplicates}} within a(n) {{c2::enucleated}} egg (85%, karyotype 46, XX)or two sperm that fertilize an enuclated egg (15%), which may result in an XY karyotypeenucleate- to remove the nucleus from (a cell) Watch Hydatidiform Mole & ChoriocarcinomaWatch associated Bootcamp video - Molar Pregnancy00164fc2-77cc-4861-bd70-a77275245487
What is the next step in treatment of a hydatidiform mole if hCG levels remain elevated after D&C? {{c1::Methotrexate}}Watch Hydatidiform Mole & Choriocarcinoma Watch Methotrexate, Leucovorin, 5-fluorouracil, HydroxyureaWatch associated Bootcamp videoe53341dc-61a2-4895-a733-32a6727c5bcf
{{c1::Cryptorchidism}} is the failure of the testicle to descend into the scrotal sacWatch Testicular Disorders & CancerWatch associated Bootcamp video - Cryptorchidism (Musculoskeletal) Watch associated Bootcamp video - Cryptorchidism and Testicular Torsion (Reproductive)e5ae7b17-a248-45ed-8432-d25b6029aab5
{{c2::Testicular torsion}} commonly presents in 12-18 year olds with sudden testicular pain, {{c3::high-riding}} testis, and absent {{c1::cremasteric reflex}}"- This form is known as the ""adult form"" (12-18 years old) - These boys are going through puberty and testes are growing in size"* Nausea/vomiting may be present, as well Watch Testicular Disorders & CancerWatch associated Bootcamp video - Cryptorchidism and Testicular Torsiona7bf39e7-14e8-45c4-aad8-1ac7a6a447b1
Varicocele is associated with left-sided {{c1::renal cell}} carcinoma- RCC often invades the left renal vein, causing increased venous pressure and decreased venous drainage from left spermatic vein - Unilateral varicoceles that fail to empty when a patient is recumbent should raise suspicion for an underlying mass that obstructs venous flow from gonadal vein to renal vein - May also present with hematuria, fever, and thrombocytosisWatch Renal Cell Carcinoma & Nephroblastoma Watch Testicular Disorders & CancerWatch associated Bootcamp video - Varicocele Watch associated Bootcamp video - Renal Cell Carcinoma Watch associated Bootcamp video - Testicular Fluid Collectionsff870c05-4d20-47c9-8c99-8db8c3c3077c
"Congenital hydrocele (""communicating hydrocele"") occurs due to incomplete obliteration of the {{c1::processus vaginalis}} (infants)"- The processus vaginalis is an evagination of peritoneum that is pulled by the testis as it descends into the abdomen and into the scrotum, this then obliterates to trap and cover a part of the testis - Failure to obliterate completely results in peritoneal fluid being able to collect in the tunica vaginalis - These usually resolve spontaneously by 1 year of age; however, patients can develop indirect inguinal hernias later in life Photo credit: OpenStax College, CC BY 3.0, via Wikimedia CommonsWatch Testicular Disorders & Cancer Watch Inguinal CanalWatch associated Bootcamp video - Hydrocele & Hematocele of the Testes Watch associated Bootcamp video - Testicular Fluid Collections Watch associated Bootcamp video - Inirect Inguinal Herniasa2c224be-8dca-4580-a49b-74c38ca56c49
{{c1::Acute (lactational) mastitis}} is due to a bacterial infection of breast, usually by {{c2::Staphylococcus aureus}}Watch Benign Breast DisordersWatch associated Bootcamp video - Female Pathology: Benign Breast Conditionsfde886e1-f320-45a4-8b54-8e6229164f5f
Fibrocystic change presents as a(n) '{{c1::lumpy}}' breast that may be painful- Usually in upper outer quadrant and often bilateral and multifocal; often co-occurs with breast cysts - In contrast, fibroadenoma is a singular solid, well-defined massWatch Benign Breast DisordersWatch associated Bootcamp video - Female Pathology: Benign Breast Conditions716ad5b0-de34-42a9-b706-f92158f158f2
What is the relative risk of developing invasive breast carcinoma with fibrosis and cysts (fibrocystic changes)? {{c1::No increased risk}}Non-proliferative: - Apocrine metaplasia = No ↑ risk - Fibrosis and cysts = No ↑ risk Proliferative: - Sclerosing adenosis = 1.5-2x ↑ risk - Epithelial hyperplasia = 1.5-2x ↑ risk - Atypical epithelial hyperplasia = 5x ↑ riskWatch Benign Breast DisordersWatch associated Bootcamp video - Female Pathology: Benign Breast Conditions615a1d51-14e2-48f8-9fca-3ad8bad77bb4
What is the relative risk of developing invasive breast carcinoma with apocrine metaplasia (fibrocystic changes)? {{c1::No increased risk}}Metaplasia: abundant pink cytoplasm and slightly larger than normal cells Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia Commons Non-proliferative: - Apocrine metaplasia = No ↑ risk - Fibrosis and cysts = No ↑ risk Proliferative: - Sclerosing adenosis = 1.5-2x ↑ risk - Epithelial hyperplasia = 1.5-2x ↑ risk - Atypical epithelial hyperplasia = 5x ↑ riskWatch Benign Breast DisordersWatch associated Bootcamp video - Female Pathology: Benign Breast Conditions6c5a03bd-8a92-4f9b-bd27-35a2b0773039
What is the relative risk of developing invasive breast carcinoma with sclerosing adenosis (fibrocystic changes)? {{c1::1.5-2x increased risk}}Non-proliferative: - Apocrine metaplasia = No ↑ risk - Fibrosis and cysts = No ↑ risk Proliferative: - Sclerosing adenosis = 1.5-2x ↑ risk - Epithelial hyperplasia = 1.5-2x ↑ risk - Atypical epithelial hyperplasia = 5x ↑ riskWatch Benign Breast DisordersWatch associated Bootcamp video - Female Pathology: Benign Breast Conditionsb3b1bd43-5a68-41ed-8eaa-75fa4488e25a
What is the relative risk of developing invasive breast carcinoma with epithelial hyperplasia (fibrocystic changes)? {{c1::1.5-2x increased risk}}Non-proliferative: - Apocrine metaplasia = No ↑ risk - Fibrosis and cysts = No ↑ risk Proliferative: - Sclerosing adenosis = 1.5-2x ↑ risk - Epithelial hyperplasia = 1.5-2x ↑ risk - Atypical epithelial hyperplasia = 5x ↑ riskWatch Benign Breast DisordersWatch associated Bootcamp video - Female Pathology: Benign Breast Conditionsd0e9b485-537a-44ee-b591-bf71a69d2f76
What is the relative risk of developing invasive breast carcinoma with atypical epithelial hyperplasia (fibrocystic changes)? {{c1::5x increased risk}}Non-proliferative: - Apocrine metaplasia = No ↑ risk - Fibrosis and cysts = No ↑ risk Proliferative: - Sclerosing adenosis = 1.5-2x ↑ risk - Epithelial hyperplasia = 1.5-2x ↑ risk - Atypical epithelial hyperplasia = 5x ↑ riskWatch Benign Breast DisordersWatch associated Bootcamp video - Female Pathology: Benign Breast Conditions74e87455-e45b-4dbd-86f7-e439ee33c73b
A(n) {{c1::fibroadenoma}} is a benign small, well-defined, firm, rubbery, mobile breast mass composed of fibrous tissue and glands- Arises from intralobular stroma; stromal growth may trigger epithelial proliferation - On histology, seen as epithelial proliferation occurring in a single TDLU, surrounded by a fibroblastic / myxoid stroma with an intact basement membrane, stroma encircles and sometimes compresses glandular and cystic spaces; hyalinizes with age - On mammogram: well circumscribed round breast mass is seen Photo credit: No machine-readable author provided. KGH assumed (based on copyright claims)., CC BY-SA 3.0, via Wikimedia Commons Photo credit: S Bhimji MD, CC BY-SA 4.0, via Wikimedia CommonsWatch Benign Breast DisordersWatch associated Bootcamp video - Female Pathology: Benign Breast Tumors296fab65-c87e-475d-bbe6-2f627c6d1158
Size and tenderness of a fibroadenoma of the breast increases with exposure to {{c1::estrogen}}- Seen mostly during reproductive years: grows with pregnancy and may be painful during menstrual cycle, shrink with menopause - Develop in lobules of the breast; well-defined, solid, mobile massWatch Benign Breast DisordersWatch associated Bootcamp video - Female Pathology: Benign Breast Tumors4deb42bf-16ed-464e-8262-51e57337c83b
{{c1::Phyllodes}} tumor is a fibroadenoma-like tumor with overgrowth of the fibrous component, causing '{{c2::leaf-like}}' projectionsPhoto credit: Nephron, CC BY-SA 3.0, via Wikimedia CommonsWatch Benign Breast DisordersWatch associated Bootcamp video - Female Pathology: Benign Breast Tumorsbabe0e07-e80e-49e6-bdc2-d62cde2d3eaf
Ductal carcinoma in situ (DCIS) is detected as {{c1::microcalcifications}} on mammographyCells at center of tumor often die (due to lack of blood supply) and develop dystrophic calcifications Photo credit: Papantoniou et al., CC BY 2.0, via Wikimedia Commons, modified by croppingWatch Breast CancerWatch associated Bootcamp video - Female Pathology: Benign Breast Tumors24302d78-0aaa-4ce2-a165-f5f73fac5bbc
{{c1::Comedocarcinoma}} is a subtype of DCIS (breast) that is characterized by high-grade cells with {{c2::dystrophic calcification}} in the center of ducts immediately surrounded by central {{c2::necrosis}}Central necrosis is surrounded by large tumor cells with pleomorphic nuclei; this is a HIGH RISK tumor Photo credit: hindawi [Ductal Carcinoma In Situ: What the Pathologist Needs to Know and Why (hindawi.com)], modified by croppingWatch Breast CancerWatch associated Bootcamp video - Female Pathology: Benign Breast Tumorsa858b16a-49eb-449d-bc22-a9118f2fc661
Paget disease of the nipple is almost always associated with an underlying {{c1::carcinoma (e.g. DCIS)}}Thus, order a diagnostic mammogramWatch Breast CancerWatch associated Bootcamp video - Female Pathology: Benign Breast Tumors3416fd7f-e02f-4405-9609-4a40c22c91a5
One subtype of invasive ductal carcinoma (breast) is {{c1::inflammatory}} breast carcinoma, which is characterized by an erythematous and swollen breast that does not resolve with {{c2::antibiotics}}Important distinguishing feature from mastitis Photo credit: Levine et al., CC BY 3.0, via MDPI Cancers, modified by croppingWatch Breast CancerWatch associated Bootcamp video - Female Pathology: Invasive Breast Carcinomasb713ef8e-65b2-45f1-b84c-015debbb8bfc
{{c1::Inflammatory}} breast carcinoma, a subtype of invasive ductal carcinoma, is characterized by cancer within dermal {{c2::lymphatics}}This leads to swollen breast Photo credit: Levine et al., CC BY 3.0, via MDPI Cancers, modified by croppingWatch Breast CancerWatch associated Bootcamp video - Female Pathology: Invasive Breast Carcinomas610fc0d1-6ad9-4d1f-ad0a-f3739e6caacc
The gross appearance of inflammatory breast cancer is often described as resembling a(n) {{c1::orange peel (Peau d'orange)}} (due to invasion of lymphatic spaces)- Dimpling of skin, similar to orange rind; caused by tumor invasion of skin (dermal) lymphatic vessels, lymphedema leads to tightening of Cooper's suspensory ligament - Additionally, direct invasion of the dermis results in skin changes with erythema - This is in contrast to the dimpling of the skin due to tumor infiltration of the cooper ligament - e.g. dimpling, pitting, edematous, erythematous, painful - Due to invasion of lymphatic spaces Photo credit: Soroush Seifirad, CC BY-SA 3.0, via WikidocWatch Breast Cancer Watch Breast & AxillaWatch associated Bootcamp video - Female Pathology: Invasive Breast Carcinomasf381818a-666e-4db5-aa63-daa693ce6e82
{{c1::Lobular carcinoma in situ (LCIS)}} is the proliferation of cells in the lobules of the breast with {{c2::no invasion}} of the basement membraneWas previously classified as a premalignant lesion, but now considered benign according to 8th edition of the AJCC TNM cancer staging system; however, it is still considered a risk factor invasive breast cancerWatch Breast CancerWatch associated Bootcamp video - Female Pathology: Benign Breast Tumors2b99a6de-1ce3-4f98-90ec-e2158efc47f9
Invasive lobular carcinoma grows in a(n) {{c1::single-file}} pattern due to lack of E-cadherin- Lines of cells = Lobular - Cells may exhibit signet-ring morphology; no duct formation Photo credit: hindawi [Unusual Metastatic Patterns of Invasive Lobular Carcinoma of the Breast (hindawi.com)] Photo credit: Ed Uthman, CC BY 2.0, via FlickrWatch Breast CancerWatch associated Bootcamp video - Female Pathology: Invasive Breast Carcinomas Watch associated Bootcamp video - Female Pathology: Benign Breast Tumorse42fe036-3d27-417c-83b1-07c3e43a39eb
Females with BRCA1 mutations have increased risk for which types of cancer? {{c1::Breast, ovarian, and fallopian tube::3}}- These are involved in mediating dsDNA repair; BRCA 1 & 2 MCC familial pancreatic adenocarcinoma Watch Breast CancerWatch associated Bootcamp video - Female Pathology: Breast Cancer Overview Watch associated Bootcamp video - Cellular Injury and Neoplasia: Oncogenes and Tumor Suppressor Genes Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Oncogenes and Tumor Suppressor Genesce18656c-1e55-46ba-a37f-a8d436a48617
Male breast cancer is associated with {{c1::BRCA}} mutations and {{c1::Klinefelter}} syndromeBRCA 1 or BRCA2Watch Breast CancerReview Klinefelter SyndromeWatch associated Bootcamp video - Female Pathology: Breast Cancer Overview Watch associated Bootcamp video - Cellular Injury and Neoplasia: Oncogenes and Tumor Suppressor Genes Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Oncogenes and Tumor Suppressor Genes0eaf0b00-41e4-4636-ac34-1d590de06331
What is the most common gynecologic cancer in the U.S.? {{c1::Endometrial}}Compare to cervical cancer (most common gynecologic cancer worldwide) Endometrial > ovarian > cervicalWatch Abnormal Uterine Bleeding (AUB) & Endometriosise4b8179a-52ee-4c7b-b40d-a0931ff050e2
{{c2::Klinefelter}} syndrome is most commonly characterized by a(n) {{c1::47}},{{c1::XXY}} karyotype- Most commonly caused by a meiotic non-disjunction event during parental gametogenesis - Can have somatic mosaicism variant (due to mitotic nondisjunction) Photo credit: User:Nami-ja, Public domain, via Wikimedia CommonsWatch Testicular Disorders & CancerReview Klinefelter SyndromeWatch associated Bootcamp video - Chromosomal Disorders9a1a8dcf-f4a5-486d-bb09-ae1fe0b4bcfe
Which sex chromosome disorder is associated with gynecomastia, female hair distribution, tall/long extremities and eunuchoid body shape in a male? {{c1::Klinefelter syndrome (47,XXY)}}Is also associated with testicular atrophy Photo credit: Malcolm Gin (photographer), CC BY-SA 3.0, via Wikimedia CommonsWatch Testicular Disorders & CancerReview Klinefelter SyndromeWatch associated Bootcamp video - Chromosomal Disorders38d06890-22c2-4be8-835d-ee1ddfed4e6a
Which sex chromosome disorder is associated with short stature, shield chest, and webbed neck in a female? {{c1::Turner syndrome}}Other findings: - Primary amenorrhea - Absent thelarche/menarche (Thelarche = breast development) - Lymphatic defects: cystic hygroma (soft, compressible mass that transilluminates) - Horseshoe kidney - Bicuspid aortic valve - Streak ovary- Low set posterior hairline - Narrow, high-arched palate Photo credit: Johannes Nielsen, CC BY 2.0, via Wikimedia Commons, modified by censoring and cropping; Imen Mehri Turki, CC BY 4.0, via Wikimedia CommonsChromosomal Syndromes: Turner Syndrome SOAP - Lesson - SketchyReview Turner SyndromeWatch associated Bootcamp video - Chromosomal Disorders Watch associated Bootcamp video - Growth Hormone Deficiency Watch associated Bootcamp video - Pregnancy and Menstruation: Menstrual Cycle Disordersed767797-feec-48dd-89e6-97c253e95767
Placental {{c2::aromatase}} deficiency can present with maternal {{c1::virilization}} during pregnancyFetal androgens can cross the placentaWatch associated Bootcamp video - Disorders of Sexual Development Part 2b1a3e8c3-ff3e-4dd4-913e-f00ee61bea75
{{c2::Kallmann}} syndrome is characterized by a defective migration of {{c1::GnRH}}-producing neurons and defective formation of the {{c1::olfactory bulb}}- During normal embryonic development GnRH neurons migrate from their origin in the olfactory bulb to the hypothalamus; anything that impairs the development of olfactory nerves prevents the progression of GnRH neurons into the hypothalamus - Kallman syndrome is most commonly due to a defect in KAL1 (ANOS1) - This encodes the Anosmin-1 protein expressed in the brain, spinal cord, and kidney that contributes to normal migration of nerve cells, and is a chemoattractant for fetal olfactory epithelial cellsWatch AmenorrheaWatch associated Bootcamp video - Disorders of Sexual Development Part 2 Watch associated Bootcamp video - Hopothalamic Disorders Watch associated Bootcamp video - Pregnancy and Menstruation: Menstrual Cycle Disorders7322dd4b-dbd6-4472-acde-b37a75c73930
Kallmann syndrome presents as {{c1::infertility}} in males and {{c1::amenorrhea}} in females; {{c2::anosmia}} may be present in both sexes- Due to defective migration of GnRH-producing neurons (thus decreased FSH, LH, and testosterone) and olfactory bulb formation - About 4x more common in males than femalesWatch AmenorrheaWatch associated Bootcamp video - Disorders of Sexual Development Part 2 Watch associated Bootcamp video - Hopothalamic Disorders Watch associated Bootcamp video - Pregnancy and Menstruation: Menstrual Cycle Disorders5b73ffee-6bef-4881-b60e-4f24826af465
{{c2::Turner}} syndrome is most commonly characterized by a(n) {{c1::45}}, {{c1::XO}} karyotype- Most cases are caused by sperm lacking X chromosome due to meiotic nondisjunction Other causes include: - Short arm deletion (46 X,del(Xp)) - Isochromosome 46 X,i(Xq) - Somatic mosaicism (45XO,46XX) - Turner's somatic mosaicism is the most common diagnosed mosaicism affecting sex chromosomes; these patients typically have a milder form of Turner syndrome or can be asymptomaticChromosomal Syndromes: Turner Syndrome SOAP - Lesson - SketchyWatch associated Bootcamp video - Chromosomal Disorders Watch associated Bootcamp video - Pregnancy and Menstruation: Menstrual Cycle Disorders43984e32-0c65-4185-9ef4-e6f31a6983c1
{{c2::Bisphosphonates (first-line)::First-line}} and {{c2::calcitonin (second-line)::second-line}} are useful in the management of {{c1::Paget disease}}, which is characterized by uncontrolled osteoclast resorption with secondary disorganized bone formation"- Calcitonin is used in patients who cannot tolerate bisphosphonates - Calcitonin Cancels (inhibits) osteoClast function (anti-PTH) - Bisphosphonates induce apoptosis of osteoclasts when osteoclast phagocytose bisphosphonate and ""blow up"" - Look for isolated ALP increase in Paget"Watch Osteoporosis & Paget Disease of Bone Watch Bisphosphonates, Raloxifene, Denosumab, Calcitonin Watch Bone Formation and RepairWatch associated Bootcamp video - Osteitis Deformans (Paget disease of the bone)df5ae189-45af-42b0-b013-818ac652faa6
What psychiatric medication is a common cause of drug-induced nephrogenic diabetes insipidus? {{c1::Lithium}}Treat with amilorideWatch Diabetes Insipidus & SIADH Watch ADH, DDAVP, ADH receptor antagonistsWatch associated Bootcamp video - Diabetes Insipidus814e7596-2d34-4a21-96f0-0ad6ca9f6e7a
How do plasma volume and RBC volume change during pregnancy? Plasma volume {{c1::increases}} by {{c1::50%}} RBC volume {{c1::increases}} by {{c1::30%}}This disparity results in a mild dilutional anemia, which is protective in the case of postpartum hemorrhageWatch associated Bootcamp video - Pregnancy and Menstruation: Menstrual Cycle Watch associated Bootcamp video - Pregnancy and Menstruation: Pregnancy Physiology7f8957a2-3270-459b-bb9e-b7a976307045
How does insulin resistance change during pregnancy? {{c1::Increase}}Due to increased levels of human placental lactogen; physiologically this allows maternal glucose to freely cross the placenta and be consumed by the fetus for energyWatch Gestational DisordersWatch associated Bootcamp video - Pregnancy and Menstruation: Menstrual Cycle Watch associated Bootcamp video - Pregnancy and Menstruation: Pregnancy Physiologyacc68b12-7c79-4319-bdfa-d1460d24afc0
Compared to normal, what changes detected by a neonatal quad screen would be indicative of trisomy 21 (Down syndrome)? AFP: {{c1::decreased}} Estriol: {{c1::decreased}} β-hCG: {{c1::increased**}} Inhibin A: {{c1::increased**}}** = different from trisomy 18 (Edwards) and trisomy 13 (Patau) TrisomyPatau (13)Edward (18)Down (21)First Trimesterβ-hCG↓↓↑PAPP-A↓↓↓Second Trimesterβ-hCG↔↓↑Inhibin A↔↔ or ↓↑α-fetoprotein (AFP)↔↓↓Estriol↔↓↓Watch Down SyndromeReview Down Syndrome (Trisomy 21)Watch associated Bootcamp video - High Yield Genetic Disorders: Autosomal Trisomiesyf76d794b-a358-4b88-9347-ba6a1975d3aa
Compared to normal, what changes detected by a neonatal quad screen would be indicative of trisomy 18 (Edward syndrome)? AFP: {{c1::decreased}} Estriol: {{c1::decreased}} β-hCG: {{c1::decreased}} Inhibin A: {{c1::low-to-normal}}Decreased hCG and low-to-normal inhibin A help differentiate trisomy 18 from trisomy 21 (increased hCG and inhibin A) TrisomyPatau (13)Edward (18)Down (21)First Trimesterβ-hCG↓↓↑PAPP-A↓↓↓Second Trimesterβ-hCG↔↓↑Inhibin A↔↔ or ↓↑α-fetoprotein (AFP)↔↓↓Estriol↔↓↓Watch Edwards & Patau SyndromesReview Edwards Syndrome (Trisomy 18)Watch associated Bootcamp video - High Yield Genetic Disorders: Autosomal Trisomiesy0f904d6c-e7ad-4669-9563-1ae34c3fdede
Amniocentesis may be done as early as {{c1::15}} to {{c1::20}} weeks- vs. chorionic villus sampling (CVS) which is performed at 10-13 weeks - Amniocentesis can do karyotyping, AFP (alpha fetoprotein)0f0e8631-a7ec-4b39-8c8e-9a6ebff64624
Chorionic villus sampling may be done as early as {{c1::10}} to {{c1::13}} weeks- Earlier than amniocentesis* - More dangerous; can't test AFPf1ea6fa8-c60e-44eb-933c-0fd6ead56174
One risk factor for placenta accreta is a prior {{c1::C-section}}, which results in a scar that lacks a healthy {{c1::decidua basalis}} layer- Allows for direct myometrial attachment by villous tissue, preventing normal placental separation after fetal delivery - Previous D&C and advanced maternal age are also risk factorsWatch Gestational DisordersWatch associated Bootcamp video6c796867-334c-4b8f-8fa4-f36fc385ec51
Gestational diabetes is a result of increased insulin resistance due to elevated levels of {{c1::human placental lactogen (hPL)}} during pregnancyUsually doesn't develop until after 24 weeks (can be as early as 20 weeks)Watch Gestational DisordersWatch associated Bootcamp video32c4310a-94a5-4275-b58b-cc2e9060fae6
What level of proteinuria is diagnostic of preeclampsia? {{c1::≥ 300 mg/day}}(or a protein/creatinine ratio ≥ 0.3)Watch Gestational Disorders174650be-2d3f-4b46-a856-1ca02bff6557
What is the most common cause of postpartum hemorrhage? {{c1::Uterine atony}}Massive bleeding may lead to Sheehan syndrome 4-T's Uterine aTony (most common)Trauma (lacerations, incisions, uterine rupture)Thrombin (coagulopathy)Tissue (retained products of conception)Watch Gestational DisordersWatch associated Bootcamp video6ecbc4cb-8e97-4dec-8a2f-38d5ce3dbd25
Gynecomastia is associated with: Increased levels of {{c1::estrogen}} (e.g. {{c3::cirrhosis::liver}}) Decreased levels of androgens (e.g. {{c2::Klinefelter}} syndrome) Testicular tumors (e.g. {{c4::Leydig}} cell tumor)- Cirrhosis causes decreased liver metabolism of estrogens - Klinefelter is male hypogonadism (thus decreased testosterone)Watch Cirrhosis Pathogenesis & Clinical Manifestations Watch Ovarian Neoplasms (Germ Cell & Sex Cord Stromal Tumors)Review Klinefelter SyndromeWatch associated Bootcamp video - Female Pathology: Benign Breast Conditions24318033-4f8f-467c-ba33-8739cf5b5f02
Which ovarian neoplasm is most commonly associated with an increased LDH? {{c1::Dysgerminoma}}Watch Ovarian Neoplasms (Germ Cell & Sex Cord Stromal Tumors)Watch associated Bootcamp video - Female Pathology: Ovarian Cancer Subtypes6ae1196f-a4b2-4c6c-b47d-6f3978a44796
{{c1::Kartagener}} syndrome is a(n) {{c3::autosomal recessive::inheritance}} disease characterized by immotile cilia due to a(n) {{c2::dynein arm}} defect- Subtype of primary ciliary dyskinesia - Dynein is important for cilia function, thus anything that requires cilia will be dysfunctional (organogenesis, mucociliary tract, fallopian tubes)Review Kartagener Syndrome (Primary Ciliary Dyskinesia)Watch associated Bootcamp video - Cytoskeleton Watch associated Bootcamp video - Primary Ciliary Dyskinesiaf27541ba-6d61-440d-954a-9638239168e7
Which developmental pathology is characterized by bronchiectasis, recurrent sinusitis, and situs inversus? {{c1::Kartagener syndrome}}An example of situs inversus is dextrocardia on CXR Photo credit: Nevit, CC BY-SA 3.0, via Wikimedia CommonsWatch Asthma & BronchiectasisReview Kartagener Syndrome (Primary Ciliary Dyskinesia)Watch associated Bootcamp video - Primary Ciliary Dyskinesia6f0a4ee9-bf67-47f4-ac9a-2f63d15f9d29
Osteogenesis imperfecta is characterized by multiple recurrent {{c1::fractures}} with minimal trauma- Treat with bisphosphonates to reduce fracture risk - May occur during the birth process; can mimic child abuse, as both can present with bruisingWatch Congenital Bone Disorders Osteogenesis Imperfecta, Achondroplasia & OsteopetrosisReview Osteogenesis Imperfecta (Brittle Bone Disease) Review BisphosphonatesWatch associated Bootcamp video - Osteogenesis Imperfectad9e2cf9b-79ee-4c9d-8cf9-1599e1737e3c
{{c2::Osteogenesis imperfecta}} may present with {{c1::blue sclerae}} due to translucent connective tissue over choroidal veins- Type 1 collagen in sclera is orthogonal causing it to appear creamy/white covering the choroidal veins - It usually results from autosomal dominant mutations in the genes that encode the α1 and α2 chains of type I collagen Photo credit: Herbert L. Fred, MD and Hendrik A. van Dijk, CC BY-SA 3.0, via Wikimedia CommonsWatch Congenital Bone Disorders Osteogenesis Imperfecta, Achondroplasia & OsteopetrosisReview Osteogenesis Imperfecta (Brittle Bone Disease)Watch associated Bootcamp video - Osteogenesis Imperfectac266219b-d9f4-4e97-945e-1e3cf4778ec4
Osteogenesis imperfecta may present with {{c1::hearing loss}} due to abnormal ossiclesBones of the middle ear fracture easilyWatch Congenital Bone Disorders Osteogenesis Imperfecta, Achondroplasia & OsteopetrosisReview Osteogenesis Imperfecta (Brittle Bone Disease)Watch associated Bootcamp video - Osteogenesis Imperfecta57380f28-b028-4498-8569-28662cd1c7c3
Some forms of osteogenesis imperfecta have tooth abnormalities, including opalescent teeth that wear easily due to lack of {{c1::dentin}}This is known as dentinogenesis imperfecta Photo credit: hindawi [Clinical Aspects, Imaging Features, and Considerations on Bisphosphonate-Related Osteonecrosis Risk in a Pediatric Patient with Osteogenesis Imperfecta (hindawi.com)]Watch Congenital Bone Disorders Osteogenesis Imperfecta, Achondroplasia & OsteopetrosisReview Osteogenesis Imperfecta (Brittle Bone Disease)Watch associated Bootcamp video - Osteogenesis Imperfecta9edae298-df9f-4646-8d38-21c2abeae628
Both Prader-Willi and Angelman syndrome are due to a mutation or deletion of genes on chromosome {{c1::15}}Confirmation of diagnosis is with genetic testingWatch Disorders of Imprinting (Prader Willi & Angelman Syndromes)Review ImprintingWatch associated Bootcamp video - High Yield Genetic Disorders: Disorders of Imprinting8ed8358a-c702-46ce-b3e8-8e2558762af5
In {{c2::Prader-Willi::Prader-Willi OR Angelman}} syndrome, the {{c1::maternal}} gene is imprinted and the {{c1::paternal}} gene is mutated/deleted- This affects the SNRPN / necdin genes - Prader-Willi = paternal deletionWatch Disorders of Imprinting (Prader Willi & Angelman Syndromes)Review ImprintingWatch associated Bootcamp video - High Yield Genetic Disorders: Disorders of Imprinting83df51e3-c350-4a85-9288-097a192041ca
In {{c2::Angelman::Prader-Willi OR Angelman}} syndrome, the {{c1::paternal}} gene is imprinted and the {{c1::maternal}} gene is mutated/deletedThis affects the UBE3A gene Snowangels are imprints of Man (paternal gene is imprinted) Photo credit: wikilectures [Angelman Syndrome - WikiLectures]Watch Disorders of Imprinting (Prader Willi & Angelman Syndromes)Review ImprintingWatch associated Bootcamp video - High Yield Genetic Disorders: Disorders of Imprinting2dd01620-e6b9-4df0-9669-e0b13db2b827
What pathology is characterized by insatiable appetite (hyperphagia), obesity, intellectual disability, and hypogonadism? {{c1::Prader-Willi syndrome}}- Complications include OSA, T2DM, choking episodes secondary to hyperphagia, gastric disention/rupture - Other features include hypotonia (weak suck as an infant), short stature, facial dysmorphia (almond-shaped eyes, narrow forehead, downturned mouth w/ thin upper lip), developmental delay, and behavioral problems (temper tantrums, skin picking) Photo credit: Fanny Cortés M1, M. Angélica Alliende R1,a, Andrés Barrios R1,2, Bianca Curotto L1,b, Lorena Santa María V1,c, Ximena Barraza O3, Ledia Troncoso A2, Cecilia Mellado S4,6, Rosa Pardo V, CC BY 4.0, via Wikimedia CommonsWatch Disorders of Imprinting (Prader Willi & Angelman Syndromes)Review ImprintingWatch associated Bootcamp video - High Yield Genetic Disorders: Disorders of Imprintinge44ce76c-4b6e-4457-ace9-1ceb178c10c5
What pathology is characterized by inappropriate laughter, seizures, ataxia, and severe intellectual disability? {{c1::Angelman syndrome}}"AKA ""happy puppet"" syndrome"Watch Disorders of Imprinting (Prader Willi & Angelman Syndromes)Review ImprintingWatch associated Bootcamp video - High Yield Genetic Disorders: Disorders of Imprintingb7108b0a-365e-4932-bc2a-6f8884d799f7
What pathology is associated with microcephaly, intellectual disability, and a high-pitched cry? {{c1::Cri-du-chat syndrome}}- Caused by deletion of the short arm of chromosome 5 - Also may have epicanthal folds and cardiac abnormalities (VSD)Review Cri du Chat SyndromeWatch associated Bootcamp video - High Yield Genetic Disorders: Microdeletionsa29e72ad-8b3c-495a-b95d-136b2d607b85
"What pathology is associated with ""elfin"" facies, intellectual disability, and extreme friendliness with strangers? {{c1::Williams syndrome}}"Also may have cardiovascular problems and hypercalcemia (due to increased sensitivity to vitamin D) Photo credit: Abidi et al., CC BY 2.0, via Pan African Medical JournalMicrodeletion Syndromes: 22q11 Deletion Syndrome & Williams Syndrome SOAPs - Lesson - SketchyReview Williams SyndromeWatch associated Bootcamp video - High Yield Genetic Disorders: Microdeletions1078a2bb-d27e-46a8-b392-bf4191d94b32
What protein is defective in Marfan syndrome? {{c1::Fibrillin (scaffold for elastin)}}Connective tissue disorder affecting skeleton, heart, and eyesWatch Aortic DissectionReview Marfan SyndromeWatch associated Bootcamp video - Cardiac Considerations of Marfan Syndrome Watch associated Bootcamp video - Marfan Syndrome477cf1a5-25a2-44fb-84c7-61d407500d1d
Marfan syndrome typically presents with subluxation of the lenses {{c1::upward::direction}} and {{c1::outward::direction}}- vs. homocystinuria which is usually downward and inward - Patients with findings suggestive of lens dislocation in the setting of minimal (or absent) trauma should receive screening echocardiography due to suspected Marfan diagnosis Superolateral displacement of lens (green overlay): Photo credit: Imrankabirhossain, CC BY-SA 4.0, via Wikimedia Commons (left); AMBOSS, CC BY-SA 4.0 (right)Review Marfan Syndrome Review HomocystinuriaWatch associated Bootcamp video - Cardiac Considerations of Marfan Syndrome Watch associated Bootcamp video - Marfan Syndrome Watch associated Bootcamp video - Homocystinuria: Presentation, Diagnostics, and Managementc677df98-3164-4c07-8b5d-2653645dfa6c
What pathology is associated with an enlarged jaw, testes, and ears? {{c1::Fragile X syndrome}}Also associated with autism, mitral valve prolapse, and a long face Photo credit: Peter Saxon image 1, image 2, CC BY-SA 4.0, via Wikimedia Commons, modified by censoringWatch Fragile X SyndromeReview Fragile X SyndromeWatch associated Bootcamp video - High Yield Genetic Disorders: Trinucleotide Repeat Expansion Diseasesfad2b6ec-7b80-4586-8761-49f4ea91d51a
What is the second most common cause of genetic intellectual disability? {{c1::Fragile X syndrome}}"- #1 is Down syndrome - However, Fragile X syndrome is the #1 cause of inherited intellectual disability (Down syndrome is typically sporadic)"Watch Fragile X SyndromeReview Fragile X SyndromeWatch associated Bootcamp video - High Yield Genetic Disorders: Trinucleotide Repeat Expansion Diseases Watch associated Bootcamp video - Developmental Disorders: Intellectual Disordersb35749a0-dc6a-45d9-b73f-67306ae97b40
What pathology is associated with intellectual disability, prominent epicanthal folds, and a single palmar crease? {{c1::Down syndrome}}- Also presents with flat facies and a gap between the first two toes - Upslanting palpebral fissures and brushfield spots in the eyes Photo credit: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Public domain, via Wikimedia Commons Photo credit: WurdBendur, CC BY-SA 4.0, via Wikimedia CommonsWatch Down SyndromeReview Down Syndrome (Trisomy 21)Watch associated Bootcamp video - High Yield Genetic Disorders: Autosomal Trisomiesd6c83a83-7c24-4721-93ce-13b107b8ea9c
The findings in {{c1::Patau syndrome (trisomy 13)}} may be remembered with the mnemonic Children Have Awful Prognosis w/ Patau: {{c1::Cleft lip/palate::C}} {{c1::Holoprosencephaly::H}} {{c1::Aplasia cutis::A}} {{c1::Polydactyly::P}} {{c1::Polycystic kidney disease::P (kidney)}}- These patients have SEVERE intellectual disability, microphthalmia, microcephaly due to defects in fusion of the prechordal mesoderm (results in severe midline defects) - They are also are typically born with congenital heart disease; death usually occurs by age 1Watch Edwards & Patau SyndromesChromosomal Syndromes: Trisomy 18 & Trisomy 13 SOAPs - Lesson - SketchyReview Patau Syndrome (Trisomy 13)Watch associated Bootcamp video - High Yield Genetic Disorders: Autosomal Trisomiesy7813a46b-1d3a-45a0-9db8-6309f75cd5da
The findings in Patau syndrome (trisomy 13) may be remembered with the mnemonic {{c1::Children Have Awful Prognosis w/ Patau}}- Cleft palate - Holoprosencephaly - Aplasia cutis - Polydactyly - Polycystic kidney disease - These patients have SEVERE intellectual disability, microphthalmia, microcephaly due to defects in fusion of the prechordal mesoderm (results in severe midline defects) - Also, they are typically born with congenital heart disease; death usually occurs by age 1Watch Edwards & Patau SyndromesReview Patau Syndrome (Trisomy 13)Watch associated Bootcamp video - High Yield Genetic Disorders: Autosomal Trisomies2a56d1dd-3d82-485e-a3c6-aa3375d0fb6e
Does aortic stenosis cause a systolic or diastolic murmur? {{c1::Systolic murmur}}Starts after the first heart sound and typically ends before the A2 component of the second heart sound Photo credit: Madhero88, CC BY-SA 3.0, via Wikimedia CommonsWatch Aortic Stenosis & RegurgitationWatch associated Bootcamp video - Aortic Stenosis9d502676-6089-495d-8098-44ef4aef98e0
What is the shape of a murmur due to aortic stenosis? {{c1::Crescendo-decrescendo}}Note: these patients have a soft S2, and an ejection click may be present if severely stenotic Photo credit: Madhero88, CC BY-SA 3.0, via Wikimedia CommonsWatch Aortic Stenosis & RegurgitationWatch associated Bootcamp video - Aortic Stenosisa03ff010-3895-44e8-abdc-47421bc5d45e
Where is a murmur due to aortic stenosis the loudest? {{c1::Aortic area (right 2nd ICS)}}Watch Aortic Stenosis & RegurgitationWatch associated Bootcamp video - Aortic Stenosis Watch associated Bootcamp video - Cardiac Cycle : Auscultation2b92b1a9-7572-4204-bc72-32d0357828a2
A murmur due to {{c2::aortic stenosis}} may radiate to the {{c1::carotid}} arteriesRadiation of common murmurs Aortic stenosis Carotid arteries Bicuspid aortic valve Neck Mitral regurgitation Axilla Tricuspid regurgitation Right sternal border* Mitral regurgitation radiates to the axilla Watch Aortic Stenosis & RegurgitationWatch associated Bootcamp video - Aortic Stenosis26b993c9-3a35-427f-be7d-2bdb24efcd13
Does mitral/tricuspid regurgitation cause a systolic or diastolic murmur? {{c1::Holosystolic murmur::Specific}}Watch Mitral Valve Regurgitation & Prolapse Watch Aortic Stenosis & RegurgitationWatch Mitral Regurgitation & Mitral Valve Prolapse SOAPWatch associated Bootcamp video - Classic Disorders Watch associated Bootcamp video - Mitral Regurgitation4bb533df-a98d-4c6b-bbc8-99aa5dc29c1e
"A holosystolic high-pitched ""blowing"" murmur is indicative of what pathology? {{c1::Mitral / tricuspid regurgitation}}"Watch Mitral Valve Regurgitation & Prolapse Watch Aortic Stenosis & RegurgitationWatch Mitral Regurgitation & Mitral Valve Prolapse SOAPWatch associated Bootcamp video - Classic Disorders Watch associated Bootcamp video - Mitral Stenosis Watch associated Bootcamp video - Tricuspid Regurgitationd10e7615-1ec0-4944-91d8-ee7764b5dc0c
Where is a murmur due to mitral regurgitation the loudest? {{c1::Apex (mitral area) - left 5th ICS at the midclavicular line}}Holosystolic murmur (vs. mitral stenosis which presents as a diastolic murmur in this area) Photo credit: Madhero88, CC BY-SA 3.0, via Wikimedia CommonsWatch Mitral Valve Regurgitation & Prolapse Watch Aortic Stenosis & RegurgitationWatch Mitral Regurgitation & Mitral Valve Prolapse SOAPWatch associated Bootcamp video - Mitral Regurgitation Watch associated Bootcamp video - Cardiac Cycle : Auscultation096fd35c-03bd-4529-beef-ad5bfee66410
A murmur due to {{c2::mitral regurgitation}} may radiate to the {{c1::axilla}}Radiation of common murmurs Aortic stenosis Carotid arteries Bicuspid aortic valve Neck Mitral regurgitation Axilla Tricuspid regurgitation Right sternal border Photo credit: Madhero88, CC BY-SA 3.0, via Wikimedia CommonsWatch Mitral Valve Regurgitation & ProlapseWatch Mitral Regurgitation & Mitral Valve Prolapse SOAPWatch associated Bootcamp video - Mitral Regurgitation4b9ba737-7d22-411b-96a2-1259a23ab9f1
Does mitral valve prolapse cause a systolic or diastolic murmur? {{c1::Late systolic (with midsystolic click)::specific}}Watch Mitral Valve Regurgitation & ProlapseWatch Mitral Regurgitation & Mitral Valve Prolapse SOAPWatch associated Bootcamp video - Mitral Valve Prolapsef9e7f087-c760-42b3-b065-cecbb47d10fb
What is the shape and timing of a murmur due to mitral valve prolapse? {{c1::Late systolic crescendo}}Watch Mitral Valve Regurgitation & ProlapseWatch associated Bootcamp video - Mitral Valve Prolapse21f3664f-592c-499d-87a1-c63b07a346e9
Where is a murmur due to mitral valve prolapse the loudest? {{c1::Apex (mitral area)}}Most commonly left 5th ICS in the midclavicular lineWatch Mitral Valve Regurgitation & ProlapseWatch associated Bootcamp video - Mitral Valve Prolapse Watch associated Bootcamp video - Cardiac Cycle : Auscultation572796db-bd1b-4fae-8d20-455300b33e1b
Does a ventricular septal defect cause a systolic or diastolic murmur? {{c1::Holosystolic murmur::Specific}}"""Harsh-sounding murmur"" Photo credit: Centers for Disease Control and Prevention, Public domain, via Wikimedia Commons"Watch associated Bootcamp video - Ventricular Septal Defect06a99a89-3e17-417d-9856-33d499e301ea
Where is a murmur due to ventricular septal defect the loudest? {{c1::Tricuspid area (left lower sternal border / 4th left ICS)}}Harsh-sounding holosystolic murmur Photo credit: Centers for Disease Control and Prevention, Public domain, via Wikimedia CommonsWatch associated Bootcamp video - Ventricular Septal Defect Watch associated Bootcamp video - Cardiac Cycle : Auscultation83f14580-b4a3-41ed-93b0-38a1e0d8ff00
Does aortic regurgitation cause a systolic or diastolic murmur? {{c1::Diastolic}}Photo credit: Madhero88, CC BY-SA 3.0, via Wikimedia CommonsWatch Aortic Stenosis & RegurgitationWatch associated Bootcamp video - Aortic Regurgitationd655a10b-6292-48e5-895f-dc5aa9c8587c
What is the shape and timing of a murmur due to aortic regurgitation? {{c1::Early diastolic decrescendo}}Due to blood shunting back through the aortic valve during diastole Photo Credit: By Madhero88 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9663236Watch Aortic Stenosis & RegurgitationWatch associated Bootcamp video - Aortic Regurgitationee8d714c-abb4-4ae9-b365-c9d87f07c7b1
Does mitral stenosis cause a systolic or diastolic murmur? {{c1::Diastolic}}Watch Mitral Stenosis, Acute Rheumatic Fever & Rheumatic Heart DiseaseWatch Mitral Stenosis SOAPWatch associated Bootcamp video - Mitral Stenosis1e62845f-6ffc-46df-a810-b8ec19c19089
A delayed, rumbling late diastolic murmur is indicative of what pathology? {{c1::Mitral stenosis}}Delayed diastolic murmur b/c as ventricles are filling there is a stenosed MV that increases and then decreases in pressure as diastole ends with closure of the MVWatch Mitral Stenosis, Acute Rheumatic Fever & Rheumatic Heart DiseaseWatch Mitral Stenosis SOAP Watch Hemoptysis DDxWatch associated Bootcamp video - Mitral Stenosis90757ad8-0694-43d8-9fa2-52b12b579db7
A diastolic murmur with an opening snap is most likely indicative of what pathology? {{c1::Mitral stenosis}}Due to abrupt halt in leaflet motion in diastole, after rapid opening due to fusion at leaflet tipsWatch Mitral Stenosis, Acute Rheumatic Fever & Rheumatic Heart DiseaseWatch Mitral Stenosis SOAPWatch associated Bootcamp video - Mitral Stenosisf3ee346e-7290-464b-a8d8-75ec33b5a25d
A continuous, machine-like murmur is indicative of what pathology? {{c1::Patent ductus arteriosus}}"- Occurs during both systole and diastole; this is best heard in the left infraclavicular region - May also have S3 and apical diastolic rumble (secondary to increased volume flowing across mitral valve) Photo Credit: Blausen.com staff (2014). ""Medical gallery of Blausen Medical 2014"". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436., CC BY 3.0, via Wikimedia Commons"Watch Left to Right ShuntsWatch associated Bootcamp video - Patent Ductus Arteriosus Watch associated Bootcamp video - Valvular Disease: Valvular Disease - Overview Watch associated Bootcamp video - Pregnancy and Menstruation: Fetal Circulation29af31f7-325a-4383-9c2a-04207ae7aa7d
What is the likely cause of this murmur? {{c1::Aortic stenosis}}Systolic crescendo-decrescendo murmur at the left sternal border can also be caused by HOCM Photo credit: Madhero88, CC BY-SA 3.0, via Wikimedia CommonsWatch Aortic Stenosis & RegurgitationWatch associated Bootcamp video - Aortic Stenosisbe640535-cef2-411d-88f5-1edd0417b2fe
What is the likely cause of this murmur? {{c1::Mitral valve prolapse}}If you want to be the MVP, your team has to CLICKWatch Mitral Valve Regurgitation & ProlapseWatch associated Bootcamp video - Mitral Valve Prolapseaec8f81d-a766-4636-a799-0327b3fe9fd4
What is the likely cause of this harsh-sounding murmur? {{c1::Ventricular septal defect}}Note: mitral and tricuspid regurgitation present with a high-pitched blowing holosystolic murmur MR: loudest at the apex TR and VSD: loudest at tricuspid area Photo credit: Centers for Disease Control and Prevention, Public domain, via Wikimedia CommonsWatch Left to Right ShuntsWatch associated Bootcamp video - Ventricular Septal Defect03a74c82-67a7-4d0f-af55-565b953554e5
What is the likely cause of this murmur? {{c1::Aortic regurgitation}}Photo credit: Madhero88, CC BY-SA 3.0, via Wikimedia CommonsWatch Aortic Stenosis & RegurgitationWatch associated Bootcamp video - Aortic Regurgitationa4e43e23-6313-4627-b54c-c9de8649bfcf
What is the most likely cause of this murmur? {{c1::Mitral stenosis}}Watch Mitral Stenosis, Acute Rheumatic Fever & Rheumatic Heart DiseaseWatch Mitral Stenosis SOAPWatch associated Bootcamp video - Mitral Stenosisaf6b264d-be24-4eb3-a1ff-a4dd122fa327
What is the likely cause of this murmur? {{c1::Patent ductus arteriosus}}Watch associated Bootcamp video - Patent Ductus Arteriosus Watch associated Bootcamp video - Valvular Disease: Valvular Disease - Overviewb3477dae-4c13-45b5-94b6-9c311a33c12f
What demographic is classically affected by Takayasu arteritis? {{c1::Young Asian females (< 40)}}"MRI below shows a ""thickened, enhancing aortic wall consistent with large vessel vasculitis"" Photo credit: Dr Laughlin Dawes, CC BY-SA 3.0, via Wikimedia Commons"Watch Large & Medium Vessel VasculitidesWatch associated Bootcamp video - Takayasu Arteritisdfaaa402-2597-47f6-98f7-847df4d64693
What demographic is classically affected by Kawasaki disease? {{c1::Asian children < 4 years old}}Watch Large & Medium Vessel VasculitidesWatch associated Bootcamp video - Kawasaki Disease0c5e5626-2f93-4992-8c66-5359ae930d9a
"The symptoms of {{c1::Kawasaki}} disease may be remembered with the mnemonic ""CRASH and burn"": {{c1::Conjunctivitis (bilateral)::C}} {{c1::Rash (polymorphous → desquamating)::R}} {{c1::Adenopathy (unilateral; cervical lymph nodes)::A}} {{c1::Strawberry tongue (oral mucositis)::S}} {{c1::Hand-foot erythema and edema::H}} & {{c1::Fever ≥ 5 days::Burn}}"Kawasaki disease criteria: fever ≥5 days with ≥4 of the CRASH symptoms above Photo credit: Dong Soo Kim, CC BY-SA 4.0, via Wikimedia CommonsWatch Large & Medium Vessel VasculitidesWatch associated Bootcamp video - Kawasaki Diseasey88ab271d-90d5-48bb-9d00-3f6b15757d05
The symptoms of Kawasaki disease may be remembered with the mnemonic {{c1::CRASH and burn}}Conjunctivitis (bilateral) Rash (polymorphous → desquamating) Adenopathy (unilateral; cervical lymph nodes) Strawberry tongue (oral mucositis) Hand-foot erythema and edema & Burn: Fever ≥ 5 days Kawasaki disease criteria: fever ≥5 days with ≥4 of the CRASH symptoms above Photo credit: Dong Soo Kim, CC BY-SA 4.0, via Wikimedia CommonsWatch Large & Medium Vessel VasculitidesWatch associated Bootcamp video - Kawasaki Disease9296e348-21ea-4475-8f2d-c5a8a6e12055
Treatment for Kawasaki disease includes {{c1::aspirin}} and {{c1::IVIG}}- Disease is self-limiting - Aspirin is given for its antithrombotic properties; this is an exception to the rule that children should never be given aspirinWatch Large & Medium Vessel VasculitidesWatch associated Bootcamp video - Kawasaki Disease2b20c2bc-0774-4a6e-b62b-6049f76fb886
What is the treatment for Buerger disease? {{c1::Smoking cessation}}- Small / medium vessels are affected; not amenable to revascularization (bypass, angioplasty) - Buerger disease is also known as thromboangiitis obliteransWatch Large & Medium Vessel VasculitidesWatch associated Bootcamp video - Thromboangiitis Obliteransb636381a-3ff6-476e-acf1-1188b6399534
IgA vasculitis (Henoch-Schönlein purpura) is a vasculitis that occurs secondary to {{c1::IgA immune complex}} depositionWatch Small Vessel VasculitidesWatch associated Bootcamp video - IgA Vasculitis (Henoch-Schonlein Purpura)5fed1b59-60fe-4a6d-8f93-fdae25c19b2a
What is the treatment for most cases of IgA vasculitis (Henoch-Schönlein purpura)? {{c1::Supportive care (the disease is most often self-limited)}}Severe cases may require hospitalization and medical therapy (e.g., steroids)Watch Small Vessel VasculitidesWatch associated Bootcamp video - IgA Vasculitis (Henoch-Schonlein Purpura)7b8a2214-b55e-4a76-bc26-4bb21caddf79
Hypertensive {{c1::urgency}} is defined as severe hypertension (≥180 / ≥120 mmHg) without acute end-organ damageWatch HypertensionWatch associated Bootcamp video - Hypertension Variants53b64981-c6a2-428a-9a1a-507de1004fe3
Where is a murmur due to aortic regurgitation the loudest? {{c1::Left sternal border (Erb's point)}}- Diastolic murmur - Note: pulmonic regurgitation may be heard in the same area; will increase with inspiration (typically caused iatrogenically by pulmonic stenosis repair) Photo credit: Madhero88, CC BY-SA 3.0, via Wikimedia CommonsWatch Aortic Stenosis & RegurgitationWatch associated Bootcamp video - Aortic Regurgitation Watch associated Bootcamp video - Cardiac Cycle : Auscultation23a0c46a-2d83-41dd-8133-e7bcfcd8b001
Where is a murmur due to atrial septal defect the loudest? {{c1::Pulmonic area (left upper sternal border)}}Systolic ejection murmurWatch associated Bootcamp video - Atrial Septal Defect Watch associated Bootcamp video - Cardiac Cycle : Auscultationfd2ada91-d004-48e6-bb5e-30a98d5c1c04
One complication that may occur {{c3::2}} - {{c3::7}} days post-MI is {{c1::papillary muscle rupture}}, which often causes {{c2::mitral regurgitation}}- Due to macrophage-mediated structural degradation - Presents with sudden-onset pulmonary edema, hypotension, and a systolic murmur (cardiac apex) - Ischemia → papillary muscle rupture → mitral regurgitation leading to pulmonary edema *Posteromedial papillary muscle is supplied by the PDA (assuming right-dominant look for RCA infarct, ST elevations from leads II, III, and aVF can be seen) Photo credit: Zorkun, CC BY-SA 3.0, via Wikidocs Timeline Complication ExtraDays to monthsArrhythmiaCommon cause of death post-MI1-3 daysFibrinous pericarditisFriction rub< 1 weekPapillary muscle rupturePosteromedial, mitral regurgitationInterventricular wall ruptureVSD, ↑O2 sat in the RV< 2 weeksVentricular pseudoaneurysmContained within the pericardiumVentricular free wall ruptureCardiac tamponade2 weeks - monthsTrue ventricular aneurysmContains all 3 layersDressler syndromeAutoimmune mediated fibrinous pericarditisWatch Acute Myocardial Infarction & Post MI Timeline Watch Mitral Valve Regurgitation & Prolapse Watch Aortic Stenosis & Regurgitation Watch Coronary Circulation: Clinical CorrelatesWatch MI Complications SOAP Watch Mitral Regurgitation & Mitral Valve Prolapse SOAPWatch associated Bootcamp video - Post-Myocardial Infarction Timeline Watch associated Bootcamp video - Mitral Regurgitationbc8fed63-b9cd-43c4-aad1-af60c2bd2fed
{{c1::True ventricular aneurysm}} is a complication that may occur months after an MI and increases risk for mural {{c2::thrombus}}"- Slow blood flow in LV → thrombi formation - Thrombi can embolize to the heart, brain, spleen, and kidneys - Also ventricular ""asynergy"" - dyskinesia (paradoxical wall motion into aneurysm) and akinesia (lack of wall motion) both impair LV function → heart failure Outward bulge with contraction associated with fibrosis Pictured: True ventricular aneurysm Photo credit: Patrick J. Lynch, medical illustrator, CC BY 2.5, via Wikimedia Commons"Watch Acute Myocardial Infarction & Post MI TimelineWatch MI Complications SOAPWatch associated Bootcamp video - Post-Myocardial Infarction Timeline28579ec0-9304-4d1d-ae85-4dbf816a75e8
The combination of right ventricular hypertrophy and pulmonary hypertension in response to left-to-right shunting results in shunt {{c1::reversal}}Watch Left to Right ShuntsWatch associated Bootcamp video - Pulmonary Hypertension38b32cd7-a539-41d0-8cce-74158897ee5b
Compared to right-to-left shunts, left-to-right shunts lead to cyanosis at a(n) {{c1::later}} age"""blue kids"" Left to Right → LateR age"Watch Left to Right ShuntsWatch associated Bootcamp video - Acyanotic Congenital Heart Defects Overview755a3618-b941-46fb-9be5-5eeacf931134
What is the most common congenital heart defect? {{c1::Ventricular septal defect (VSD)}}VSD > ASD > PDA isolated condition in 12/10000 births Photo credit: Centers for Disease Control and Prevention, Public domain, via Wikimedia CommonsWatch Left to Right ShuntsWatch associated Bootcamp video - Ventricular Septal Defect4fcfc962-aadb-4bbf-a59c-97dd7284f4e5
Ventricular septal defect (VSD) results in a(n) {{c1::left}}-to-{{c1::right}} shunt- Size of defect determines extent of shunting and age at presentation - Can cause late cyanosis → polycythemia Photo credit: Centers for Disease Control and Prevention, Public domain, via Wikimedia CommonsWatch Left to Right ShuntsWatch associated Bootcamp video - Ventricular Septal Defect2b0b45c9-21b0-4885-8e7b-55cc54c212e6
Smaller ventricular septal defects are often {{c1::asymptomatic}} and may close spontaneously, but on physical exam will present with a(n) {{c2::murmur}}"- These murmurs become audible around 4-10 days as pulmonary vascular resistance continues to decline, permitting left-to-right shunting - These are known as restrictive VSDs; however, these typically generate lots of turbulence due to high pressure and small size, generating a harsh murmur (""smaller the hole, the bigger the thrill"") Photo credit: Centers for Disease Control and Prevention, Public domain, via Wikimedia Commons"Watch Left to Right ShuntsWatch associated Bootcamp video - Ventricular Septal Defecte92bc495-e3bf-47ee-be89-4affea03b8a9
Larger ventricular septal defects may lead to left ventricle {{c1::overload}} and, consequently, {{c2::heart failure}}Photo credit: Centers for Disease Control and Prevention, Public domain, via Wikimedia CommonsWatch Left to Right ShuntsWatch Chronic Heart Failure SOA Part 2Watch associated Bootcamp video - Ventricular Septal Defectafad2fd0-0670-4666-b9ab-69ac8d4fed74
Atrial septal defect (ASD) results in a(n) {{c1::left}}-to-{{c1::right}} shuntCan cause late cyanosis Photo credit: van Gaal Dr et al., CC BY 2.0, via BMC Cardiovascular UltrasoundWatch Left to Right ShuntsWatch associated Bootcamp video - Atrial Septation Watch associated Bootcamp video - Atrial Septal Defect19956181-4848-45b5-97c7-55804a604610
What effect does atrial septal defect (ASD) have on S2 splitting? {{c1::Causes a wide, fixed split}}- Increased blood in right heart delays closure of pulmonary valve - Fixed splitting is a delayed pulmonic sound, regardless of inspiration Photo credit: van Gaal Dr et al., CC BY 2.0, via BMC Cardiovascular UltrasoundWatch Left to Right ShuntsWatch associated Bootcamp video - Atrial Septal Defect Watch associated Bootcamp video - Atrial Septation Watch associated Bootcamp video - Cardiac Cycle : Heart Soundsec0c9192-b1e0-4d96-9dc5-702653b3e595
In the neonatal period, a patent ductus arteriosus becomes a(n) {{c1::left}}-to-{{c1::right}} shunt as pulmonary vascular resistance decreases- Volume overload → progressive LVH and HF - Despite volume overload, LV contractility is normal* causing blood flow to go from Aorta to pulmonary arteries → through neonate lungs → back to LA → LV → systemic circulation * Open Air Ductus Watch Left to Right ShuntsWatch associated Bootcamp video - Blood Physiology : Pulmonary Vascular Resistance Watch associated Bootcamp video - Pattent Ductus Arteriosus30cdfa02-e402-4be8-9b00-d0868c8d88ef
Patency of a patent ductus arteriosus is maintained by {{c1::PGE}} synthesis and low O2 tension- Includes both PGE1 and PGE2 - Pathoma: PGE Keeeps the PDA openWatch Left to Right ShuntsWatch associated Bootcamp video - Patent Ductus Arteriosusb3ef2553-cd5c-46e1-bf1f-b4e4dd3117e5
Uncorrected patent ductus arteriosus may eventually result in late cyanosis in the {{c1::lower}} extremities- AKA differential cyanosis - Occurs in the lower extremities because PDA arises after the major branches of the aortic archWatch Left to Right ShuntsWatch associated Bootcamp video - Patent Ductus Arteriosus894dc601-b386-4387-b2a1-015aaf01a321
Treatment of a patent ductus arteriosus involves {{c1::indomethacin::specific drug}}, which decreases PGE, resulting in PDA closure"- ""ENDomethacin ENDs the PDA"" - Use NSAIDs to block COX-2 mediated PGE2 synthesis (this prostaglandin keeps the ductus arteriosus patent) - Ibuprofen also appropriate"Watch Left to Right Shunts Watch Prostaglandins, Prostacyclin, Bosentan, PDE5 InhibitorsWatch associated Bootcamp video - Patent Ductus Arteriosuse81cb7d9-0fa4-42b1-a09b-76bcecf7a505
"{{c1::Tetralogy of Fallot}} is a congenital heart disease that can be remembered by the mnemonic ""PROVe"": {{c1::Pulmonary infundibular stenosis::P}} {{c1::Right ventricular hypertrophy::R}} {{c1::Overriding aorta::O}} {{c1::Ventricular septal defect (VSD)::V}}"Overriding aorta is the positioning of the aorta directly over the VSD Photo credit: OpenStax, CC BY 4.0Watch Right to Left ShuntsWatch associated Bootcamp video - Tetralogy of Falloty20734db7-a297-407a-b2ed-ac4a0e5381a3
Tetralogy of Fallot is a congenital heart disease that can be remembered by the mnemonic {{c1::PROVe}}Pulmonary infundibular stenosis Right ventricular hypertrophy Overriding aorta Ventricular septal defect (VSD) Overriding aorta is the positioning of the aorta directly over the VSD Photo credit: OpenStax, CC BY 4.0Watch Right to Left ShuntsWatch associated Bootcamp video - Tetralogy of Fallot3e6c4f56-301d-4ee6-8875-ba29d9c0e2ba
Tetralogy of Fallot results in a(n) {{c1::right}}-to-{{c1::left}} shunt with {{c2::early::early/late}} central cyanosisBlood flows across the VSD into the aorta Photo credit: OpenStax, CC BY 4.0Watch Right to Left ShuntsWatch associated Bootcamp video - Tetralogy of Fallot4d204e8f-8bf0-47e2-a6e3-91ee5d0c8659
The degree of shunting in tetralogy of Fallot is determined by the degree of {{c1::right ventricular outflow tract obstruction (from pulmonary stenosis)}}- Severe RVOT obstruction typically presents shortly after birth with cyanosis - Moderate RVOT obstruction may present during childhood Photo credit: OpenStax, CC BY 4.0Watch Right to Left ShuntsWatch associated Bootcamp video - Tetralogy of Fallot90e65f20-8ed6-4bf7-ad7e-c0d96cf082dd
{{c2::Tetralogy of Fallot}} is characterized by a(n) {{c1::boot}}-shaped heart on CXRBoot shape due to RV hypertrophy Photo credits: Medicalpal, CC BY-SA 4.0, via Wikimedia CommonsWatch Right to Left ShuntsWatch associated Bootcamp video - Tetralogy of Fallot4462df4b-09f6-4929-8556-ef3564d0ba39
"Patients with tetralogy of Fallot often experience ""{{c1::tet}} spells"" which may be caused by crying, fever, and exercise due to exacerbation of RV outflow obstruction"- Children will experience blue skin during crying or feeding- i.e. crying ↑ pulmonary stenosis and increases pulmonary resistance, so more deoxygenated blood shunted across VSD to aorta, worsening cyanosisWatch Right to Left ShuntsWatch associated Bootcamp video - Tetralogy of Fallot468e560c-1a8e-40b5-94d9-b8530667a78e
Patients with tetralogy of Fallot may {{c1::squat}} in response to cyanotic spells, which decreases right-to-left shunting by increasing {{c2::systemic vascular resistance (SVR)}}- This prolonged squatting causes pressure to rise in the aorta / LV, resulting in a higher proportion of the RV output to enter the pulmonary circulation - Increases afterload* The resistance of the entire systemic vasculature is called the total peripheral resistance (TPR) or systemic vascular resistance (SVR) (used interchangably) Watch Right to Left ShuntsWatch associated Bootcamp video - Tetralogy of Fallote122b9ea-148f-4f9a-aace-6b95eb1bbc52
{{c3::D-transposition of the great vessels (TGV)}} is characterized by the {{c1::pulmonary artery}} arising from the left ventricle and {{c1::aorta}} from the right ventricle"- In the normal heart the aorta is posterior and to the right of pulmonary artery - In D-TGV the aorta forms anterior, and right of pulmonary artery - In L-TGV, the right ventricle and left ventricle have also been transposed (thus given the moniker ""corrected"") Photo credit: Ntsinjana et al., CC BY 2.0, via BMC Journal of Cardiovascular Magnetic Resonance, modified by cropping Photo credit: Centers for Disease Control and Prevention, CC0, via Wikimedia Commons"Watch Right to Left ShuntsWatch associated Bootcamp video - Transposition of the Great Vessels Watch associated Bootcamp video - Truncus Arteriosus2c53e641-820b-4719-ab0e-ef7617599247
D-transposition of great vessels (TGV) is an example of a(n) {{c1::right}}-to-{{c1::left}} shuntCauses early cyanosis and shortness of breath Photo credit: Centers for Disease Control and Prevention, CC0, via Wikimedia CommonsWatch Right to Left ShuntsWatch associated Bootcamp video - Transposition of the Great Vessels78704179-2d23-45f7-8650-a3107cc747b8
{{c1::Persistent truncus arteriosus}} is a congenital heart disease characterized by a single large vessel arising from both ventricles before eventually splittingCaused by failure of the conotruncal septum to form Photo credit: Centers for Disease Control and Prevention, Public domain, via Wikimedia CommonsWatch Right to Left ShuntsWatch associated Bootcamp video - Cyanotic Congenital Heart Disease Watch associated Bootcamp video - Truncus Arteriosusdcaed532-63fb-44a8-b163-57446e78c309
Persistent truncus arteriosus is an example of a(n) {{c1::right}}-to-{{c1::left}} shuntCauses early cyanosis; deoxygenated blood from RV mixes with oxygenated blood from LV before pulmonary and aortic circulations separate Photo credit: Centers for Disease Control and Prevention, Public domain, via Wikimedia CommonsWatch Right to Left ShuntsWatch associated Bootcamp video - Transposition of the Great Vessels Watch associated Bootcamp video - Truncus Arteriosusa8c44f5d-3089-4f80-a8b1-2ddd52a761f8
Tricuspid atresia requires both {{c1::ASD}} and {{c1::VSD}} for viabilityWatch Right to Left ShuntsWatch associated Bootcamp video - Tricuspid Atresia5361996d-64f4-439d-b1de-c874612bbd82
{{c1::Ebstein anomaly}} is a congenital heart disease characterized by downward displacement of tricuspid leaflets into the right ventricle- Classically described as atrialization of the right ventricle - Associated with prenatal lithium exposure Image licensed by Physeo and used with permission. Purchase full textbook here.Watch Right to Left Shuntse7f242db-be8a-4ea2-a971-b595e1da167d
Ebstein anomaly is associated with tricuspid {{c2::regurgitation}} and right {{c1::heart failure}}Watch Right to Left Shunts3fa6b8b8-cb65-4c1a-88aa-df46cad79087
{{c1::Total anomalous pulmonary venous return (TAPVR)}} is a congenital heart disease characterized by drainage of pulmonary veins into the right circulationPhoto credit: Centers for Disease Control and Prevention, Public domain, via Wikimedia CommonsWatch Right to Left ShuntsWatch associated Bootcamp video - Total Anomalous Pulmonary Venous Return3e4cf695-8cf2-4506-b1ad-1d36164ad2e7
Total anomalous pulmonary venous return (TAPVR) is associated with {{c1::ASD}} and sometimes PDA to allow for right-to-left shuntingShunting allows for maintenance of cardiac output Photo credit: Centers for Disease Control and Prevention, Public domain, via Wikimedia CommonsWatch Right to Left ShuntsWatch associated Bootcamp video - Total Anomalous Pulmonary Venous Returndeecb6c8-b96e-4e21-bd5e-86fe4860bcec
The major criteria for the diagnosis of rheumatic fever are the {{c2::J♥NES}} criteriaJoints - migratory polyarthritis ♥ - carditis Subcutaneous Nodules on extensor surfaces Erythema marginatum Sydenham chorea Diagnosis of rheumatic fever: 1. Evidence of a recent GAS infection (ASO titer / anti-DNase B titer / bacterial culture) AND 2. Either 2 major OR 1 major and 2 minor Jones criteria Major JONES criteria include - Joints: migratory polyarthritis - ♥ or carditis (endocarditis, myocarditis, pericarditis) - Nodules (subcutaneous) on extensor surfaces (e.g. forearms, elbow, knee) - Erythema marginatum rash as pink rings on the trunk / limbs - Sydenham chorea (rapid movement, esp. of hands and face)Watch Streptococcus pyogenes (Group A Strep) Watch Mitral Stenosis, Acute Rheumatic Fever & Rheumatic Heart DiseaseWatch Mitral Stenosis SOAPWatch associated Bootcamp video - Acute Rheumatic Fever Diagnostics and Management Watch associated Bootcamp video - Mitral Stenosis4cb20af2-f6ef-481c-b3b6-d717399b31f9
What bacteria is the most common cause of endocarditis in IV drug users? {{c1::Staphylococcus aureus}}Watch Staph aureusWatch Staph aureusWatch associated Bootcamp video - Staphylococcus Aureus Toxins, Disease, Antibiotics Watch associated Bootcamp video - Typical Endocarditis Pathogensa4be8076-f7d7-43a6-bacd-b03cb853bd32
Which heart valve is most frequently involved in bacterial endocarditis? {{c1::Mitral valve}}Mitral valve (most common) > aortic valve > tricuspid valve > pulmonary valveWatch Mitral Valve Regurgitation & ProlapseWatch associated Bootcamp video - Principles of Infective Endocarditis Watch associated Bootcamp video - Mitral Regurgitation206affa6-a844-4849-8981-6e7fb817bb3d
Which heart valve is most frequently involved in infective endocarditis in IV drug users? {{c1::Tricuspid valve}}Associated with S. aureus, Pseudomonas, and CandidaWatch Staph aureusWatch Staph aureusWatch associated Bootcamp video - Staphylococcus Aureus Toxins, Disease, Antibiotics Watch associated Bootcamp video - Typical Endocarditis Pathogens Watch associated Bootcamp video - Tricuspid Regurgitation1ec69efb-9230-44cb-9e36-8edbda3f5242
{{c2::Streptococcus bovis (gallolyticus)}} infection is associated with subacute endocarditis in patients with underlying {{c1::colorectal carcinoma}}"- ""Bovis in the blood, cancer in the colon"" - Clostridium septicum is also associated with colon cancer"Watch Streptococcus gallolyticus (Group D Strep)Watch associated Bootcamp video - Additional Streptococci Watch associated Bootcamp video - Typical Endocarditis Pathogens Watch associated Bootcamp video - Colorectal Cancer Watch associated Bootcamp video - Typical Endocarditis Pathogensf5e6e1d4-d607-477f-b3ab-85caa0a7a6a4
What is the most common symptom of bacterial endocarditis? {{c1::Fever}}Mnemonic: FROM JANEWatch associated Bootcamp video - Infective Endocarditis Diagnostics2f45dc98-e2f1-413b-99c9-e3e29e419ba6
One symptom associated with bacterial endocarditis is {{c1::Roth spots}}, which are round, white spots on the retina surrounded by hemorrhageMnemonic: FROM JANE Photo credit: Wathek et al., CC BY 3.0, via Contemporary Challenges in Endocarditis Photo credit: Jonathan Trobe M.D. [http://kellogg.umich.edu/theeyeshaveit/opticfundus/roth_spot.html] (CC BY 3.0)Watch associated Bootcamp video - Staphylococcus Aureus Toxins, Disease, Antibiotics Watch associated Bootcamp video - Infective Endocarditis Diagnostics23fe11a1-cfec-477c-8a29-eea228a78b9d
One symptom associated with bacterial endocarditis is {{c1::Osler nodes}}, which are tender, raised lesions on the finger or toe pads"mnemonic: FROM JANE; ""Ouch, Ouch, Osler"" Osler Nodes Photo credit: Roberto J. Galindo, CC BY-SA 4.0, via Wikimedia Commons Janeway Lesions Photo credit: Warfieldian, CC BY-SA 4.0, via Wikimedia Commons"Watch associated Bootcamp video - Infective Endocarditis Diagnostics2bb6ca1f-3ebf-49da-83e4-301673d406cc
One sign associated with bacterial endocarditis is {{c1::murmur}}, which occurs as blood flows over vegetations on the heart valve- Mnemonic: FROM JANE - Regurgitant murmursWatch associated Bootcamp video - Infective Endocarditis Diagnostics98a4b691-a3c2-4a7e-a4b8-dab3feb8d7bf
One symptom associated with bacterial endocarditis is {{c1::Janeway lesions}}, which are small, nontender, erythematous lesions on the palm or sole- They are the result of septic embolization from valvular vegetations and are composed of bacteria, neutrophils (microabscesses), necrotic material, and subcutaneous hemorrhage - Mnemonic: FROM JANE - Janeway lesions (left) vs Osler nodes (right) Photo credit: Warfieldian, CC BY-SA 4.0, via Wikimedia Commons Photo credit: Roberto J. Galindo, CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Staphylococcus Aureus Toxins, Disease, Antibiotics Watch associated Bootcamp video - Infective Endocarditis Diagnostics04c76025-3d5f-45b7-a8c9-b79ca5f64653
Bacterial endocarditis may cause {{c1::anemia of chronic disease}}, which occurs as a result of increased release of hepcidinmnemonic: FROM JANE; ACD is a microcytic anemia with high ferritin and low serum iron* inflammation leads to inhibition of iron release from ferritin Watch Iron Deficiency Anemia & Anemia of Chronic Disease2664961d-4369-48d2-97e6-53bc0a1003b8
One symptom associated with bacterial endocarditis is {{c1::splinter hemorrhages}} in the nail bedMnemonic: FROM JANE; occurs due to embolization of septic vegetations Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ Photo credit: Splarka, Public domain, via Wikimedia CommonsWatch associated Bootcamp video - Staphylococcus Aureus Toxins, Disease, Antibiotics Watch associated Bootcamp video - Infective Endocarditis Diagnosticsae140f7c-d297-4f1d-8f85-b3c9220dc110
One symptom associated with bacterial endocarditis is septic {{c1::emboli}}- Emboli may obstruct the systemic or pulmonary arterial circulation; they can also cause metastatic infection - Mnemonic: FROM JANE; may cause various nodes/lesions associated with bacterial endocarditisWatch associated Bootcamp video - Staphylococcus Aureus Toxins, Disease, Antibiotics Watch associated Bootcamp video - Principles of Infective Endocarditis Watch associated Bootcamp video - Infective Endocarditis Diagnosticsbe81538d-303a-4f70-8303-90ba29ee3213
Where is a murmur due to hypertrophic cardiomyopathy best heard? {{c1::Left sternal border}}On physical exam: Systolic ejection murmur (crescendo-decrescendo) with a sustained apex beat, S4 gallop, and paradoxical split of S2Watch Hypertrophic CardiomyopathyWatch Hypertrophic Cardiomyopathy SOAPWatch associated Bootcamp video - Hypertropic Obstructive Cardiomyopathyb91ae120-aea1-486e-99c5-63d68608377b
The Cushing reflex is a triad of {{c1::hypertension, bradycardia, and irregular respirations::3}} due to increased {{c4::intracranial}} pressure- Some sources may also interchange widening pulse pressure for HTN OR respiratory depression for irregular respirations; all are correct - The Cushing reflex leads to the Cushing triad - Increased ICP constricts arterioles → ischemia → decreased pH and increased CO2 → compensatory peripheral vasoconstriction (hypertension) → bradycardia (baroreceptor reflex) - Symptoms are the OPPOSITE of shockWatch Intracranial Hypertension (ICH)Watch Bradycardia DDx and SOAP Watch Epidural Hematoma Watch Intraparenchymal HemorrhageWatch associated Bootcamp video - Intracranial Hypertension Watch associated Bootcamp video - Infectious Neuropathology: Bacterial Meningoencephalitisd0644ac6-b524-4227-9982-96ca1082ef3f
How do PCWP and preload change during hypovolemic shock? {{c1::Severely decreased}}Watch associated Bootcamp video - Shock: Hypovolemic Shock51a0a9fa-11e6-4129-9059-a19005e9d26a
How does cardiac output change during hypovolemic shock? {{c1::Decreased}}- Not enough blood in the system to maintain normal cardiac output - This will be reflected in the arterial baroceptors, which will have a decreased firing rate (less volume surging through to stretch baroreceptors)Watch Cardiovascular Response to HemorrhageWatch associated Bootcamp video - Shock: Hypovolemic Shock9d179002-c4d0-47c2-9a7f-e62bab21cd0e
How do SVR and afterload change during hypovolemic shock? {{c1::Increased}}- The drop in effective circulating volume in the circulation is detected which leads to increased SNS activity, driving constriction of arterioles in the vasculature in an attempt to return BP to normal (increasing SVR) - Because there is increased SNS activity, there will also be an increase in pulmonary vascular resistance (some alpha-1 receptors in pulmonary vessels)Watch associated Bootcamp video - Shock: Hypovolemic Shock93edbdd5-e1f1-442d-b009-f751d469ce50
How do SVR and afterload change during cardiogenic and obstructive shock? {{c1::Increased}}SVR stands for systemic vascular resistance (formerly known as TPR)Watch associated Bootcamp video - Shock: Obstructive Shock Watch associated Bootcamp video - Shock: Cardiogenic Shock4c8150d8-0d54-42e4-a195-5de976c968ca
How do SVR and afterload change during distributive shock? {{c1::Severely decreased}}SVR stands for systemic vascular resistance (formerly known as TPR)Watch associated Bootcamp video - Shock: Shock Overview3c87e4c8-9384-41b3-9f82-7bae163b98c1
What is the most common cause of acute pericarditis? {{c1::Idiopathic (presumed viral)}}other causes include confirmed infection, neoplasia, autoimmune, uremia, cardiovascular, radiation therapyWatch Pericarditis & Constrictive PericarditisWatch Acute Pericarditis SOAPWatch associated Bootcamp video - Constrictive Pericarditis545847e6-cee9-44a5-a1d6-b65667048af6
One factor that predisposes to digoxin toxicity is {{c1::hypokalemia}}, which increases binding of digoxin to Na+-K+ ATPasePotassium and digoxin bind to the same location on Na+-K+ ATPase. If potassium goes down, then digitalis can bind more and exert more effects on Na+-K+ ATPase → arrhythmiasWatch DigoxinWatch DigoxinWatch associated Bootcamp video - Heart Failure: Pharmacologic Targets Watch associated Bootcamp video - Sodium-Potassium Pumpf983a5f5-deab-4c0e-8a69-e73542f2f9f0
{{c3::Nimodipine}} is a Ca2+ channel blocker that is used to prevent cerebral {{c2::vasospasm}} following a(n) {{c1::subarachnoid hemorrhage}}Subarachnoid hemorrhage most commonly occurs due to rupture of an aneurysmWatch Calcium Channel Blockers Watch Epidural Hematoma, Subdural Hematoma, & Subarachnoid HemorrhageReview DihydropyridinesWatch associated Bootcamp video - Epidural and Subdural Hematoma9c9e636e-dcc3-4d9e-8313-207da227f2c7
Nitroprusside is associated with {{c1::cyanide}} poisoning, which may present as - {{c2::Lactic acidosis}} - {{c2::Seizures}} - Altered mental statusRisk factors for cyanide toxicity due to nitroprusside include prolonged infusion (> 24 hours) and high rates (5-10 μg/kg/min), as well as chronic kidney diseaseWatch Primary Hypertension & Hypertensive EmergencyReview Cyanide Poisoning Review NitroprussideWatch associated Bootcamp video - Antihypertensives Watch associated Bootcamp video - Blood Physiology : Abnormal Oxygen Levels1da35c51-800d-4b36-aea6-ac8e146cf76e
What hematological complication is associated with nitrates? {{c1::Methemoglobinemia}}- Due to nitrites, which may oxidize Fe2+ to Fe3+ - Nitrites may also come from dietary intake or polluted/high altitude H2OWatch NitratesWatch NitratesWatch associated Bootcamp video - Antihypertensives Watch associated Bootcamp video - Blood Physiology : Abnormal Oxygen Levels0212118a-c067-49f4-86ba-f0ae8faf9b99
{{c1::Methemoglobinemia}} may present with {{c3::cyanosis::skin}} and {{c2::chocolate}}-colored bloodPhoto credit: Biggs et al., CC BY 4.0, via Journal of Education & Teaching - Emergency Medicine; Thomas M. Nappe, Anthony M. Pacelli, and Kenneth Katz, CC BY-SA 4.0, via Wikimedia Commons (modified by cropping)Watch O2 TransportWatch associated Bootcamp video - Blood Physiology : Abnormal Oxygen Levels08852fce-4563-4144-9518-fe157894a09d
Induced-{{c1::methemoglobinemia}} (i.e. {{c3::nitrites}} followed by {{c3::thiosulfate}}) may be used to treat {{c2::cyanide}} poisoning- Methemoglobin has a high affinity for cyanide (makes cyanmethemoglobin), and thiosulfate transforms cyanide to thiocyanate (which can be renally excreted) - Contraindicated in the setting of concomitant CO poisoningWatch Fire-Related ToxicityReview Cyanide PoisoningWatch associated Bootcamp video - Energy Production: Electron Transport Chain Watch associated Bootcamp video - Blood Physiology : Abnormal Oxygen Levels Watch associated Bootcamp video - Energy Production: Clinical Implications of the Electron Transport Chain9faf1be1-ce34-4495-b2c3-07dcfffd6616
Methemoglobinemia is associated with the following parameters: - {{c1::decreased (typically to 85%)}} SaO2 - {{c1::decreased}} O2 content - {{c1::normal}} PaO2 - {{c1::decreased}} PaCO2"- Standard pulse oximetry is unable to detect methemoglobin, thus creating a falsely low oxygen saturation (vs. co-oximetry, which can detect hemoglobin, methemoglobin, and carboxyhemoglobin) - Unbound O2 (PaO2) is still normal - the oxygen simply cannot bind to Fe3+ and cannot be released to tissues once bound to MetHb (thus causing cyanosis) - O2 saturation typically at 85% due to a ""saturation gap"" → caused by absorption wavelength - PaCO2 is decreased due to hyperventilation"Watch associated Bootcamp video - Blood Physiology : Abnormal Oxygen Levelsy8358a037-e5c2-42d9-a991-3f0fbbbb97d7
{{c1::Aspirin-exacerbated respiratory disease (AERD)}} is characterized by a triad of: Asthma Chronic/recurrent rhinosinusitis Nasal polyps- Also known as the Samter triad - Seen in 10% of adults with asthma; due to shunting of the arachidonic acid pathway toward the leukotriene pathway - Previously referred to as aspirin-induced or intolerant asthma, but UWorld has changed the name - FA 2023 states COX-inhibitor sensitivity instead of chronic/recurrent rhinosinusitis - Mnemonic: RAN (Rhinosinusitis (chronic/recurrent), Asthma, Nasal polyps)Watch Asthma & BronchiectasisWatch Chronic Asthma SOAWatch associated Bootcamp video - Asthma780cd42d-8f67-4bc7-a402-50c1d2224d09
Acute {{c1::epiglottitis}} presents with high fever, sore throat, and {{c2::drooling}} with dysphagiaPhoto Credit: 藤澤孝志, CC BY-SA 3.0, via Wikimedia CommonsWatch Haemophilus influenzaeWatch Stridor DDxWatch associated Bootcamp video - Lung Pathology Fundamentals : Introduction to Respiratory Infectionseb15fd2b-643f-4580-8d24-b02ff68b6ec7
Acute epiglottitis may present with muffled voice and inspiratory {{c1::stridor}}Watch 'Child with inspiratory stridor', Romaine F. Johnson, MD PHD, via Youtube (0:17)Watch Stridor DDxWatch associated Bootcamp video - Lung Pathology Fundamentals : Introduction to Respiratory Infectionsf020e6dc-051f-40f0-afce-a61152cca375
{{c2::Obstructive}} lung diseases are characterized by a(n) {{c1::decreased}} FEV1/FVC ratioFEV1 is very decreased and FVC is decreased, resulting in an overall decrease (i.e. FEV1/FVC <70%)Watch COPD & Emphysema Watch Pulmonary Function TestingWatch PFTs How-To Watch Chronic Dyspnea DDx Part 1Watch associated Bootcamp video - Obstructive Lung Disease Basics Watch associated Bootcamp video - Air Physiology : Flow-Volume Loops32322b9f-e6ac-4e12-b9a5-012fefc44b92
Obstructive lung diseases are characterized by a(n) {{c1::increased}} total lung capacityIncreased compliance (from loss of elastin) → destruction of interalveolar septa → alveolar enlargement → increased TLC (lung hyperinflation)Watch COPD & Emphysema Watch Pulmonary Function TestingWatch associated Bootcamp video - Obstructive Lung Disease Basics Watch associated Bootcamp video - Air Physiology : Flow-Volume Loops2bf0a23c-e2dc-4ae4-808d-a99194dd79e4
{{c3::Chronic bronchitis}} is defined as a(n) {{c1::productive cough}} lasting ≥ {{c2::3}} months per year for ≥ {{c2::2}} years"- Coughing up ""cups"" of mucus - Cigarette smoking is the leading cause"Watch COPD & EmphysemaWatch COPD SOAP Watch Cough DDxWatch associated Bootcamp video - COPD075cfdd9-7e8c-4a2c-a9f3-509348581cce
Allergic bronchopulmonary aspergillosis (ABPA) is usually seen in individuals with {{c1::asthma}} or {{c1::cystic fibrosis}}IgE-mediated type I hypersensitivity reaction which leads to EosinophiliaWatch Aspergillus fumigatus Watch Asthma & BronchiectasisWatch associated Bootcamp video - Asthma761e5930-f9f6-44da-84bc-fcb801c2a624
Bronchiectasis may present with dyspnea, cough with {{c1::blood (hemoptysis)}}, and purulent sputumInflammation → rupture vesselsWatch Asthma & BronchiectasisWatch Bronchiectasis SOAP Watch Cough DDx Watch Hemoptysis DDxWatch associated Bootcamp video - Primary Ciliary Dyskinesia06d9e087-1ece-40a4-a62c-2f04768d9876
Bronchiectasis is associated with recurrent infections and {{c1::foul}}-smelling, {{c2::purulent}} sputum- Definitive diagnosis requires high-resolution CT chest - Possible causes include chronic mycobacteria infection, immunodeficiency (eg, hypogammaglobulinemia), and autoimmune disease (eg, Sjögren syndrome)Watch Asthma & BronchiectasisWatch Bronchiectasis SOAP Watch Chronic Dyspnea DDx Part 1 Watch Cough DDx Watch Hemoptysis DDxWatch associated Bootcamp video - Primary Ciliary Dyskinesiada86f5ef-94c4-4b6a-9751-8986cea38246
Bronchiectasis may cause digital {{c1::clubbing}}Watch Asthma & Bronchiectasis138ebfbb-bc78-4a79-add6-b87a9c7b1cb3
{{c1::Restrictive}} lung diseases are characterized by a FEV1/FVC ratio {{c2::≥}} 70%- FEV1 and FVC either decrease in equal proportion or FVC decreases slightly more than FEV1 - Therefore, ratio is normal or slightly increasedWatch Restrictive Lung Disease (Overview) Watch Pulmonary Function TestingWatch associated Bootcamp video - Restrictive Lung Disease Basics Watch associated Bootcamp video - Air Physiology : Flow-Volume Loops2f7bcee7-ffb3-4cff-9fc2-6ddb240ae326
Restrictive lung diseases are characterized by a(n) {{c1::decreased}} total lung capacityWatch Restrictive Lung Disease (Overview) Watch Pulmonary Function TestingWatch PFTs How-ToWatch associated Bootcamp video - Restrictive Lung Disease Basics Watch associated Bootcamp video - Air Physiology : Flow-Volume Loops6c1b388e-1381-42d2-835f-3516d07293e0
{{c2::Idiopathic pulmonary fibrosis}} eventually results in diffuse fibrosis with end-stage '{{c1::honeycomb}}' lung on CTPhoto credit: Hodler et al., CC BY 4.0, via Disease of the Chest, Heart, and Vessels 2019-2022Watch Idiopathic Pulmonary FibrosisWatch associated Bootcamp video - Pulmonary Fibrosis5efe6da5-d2de-48cc-a2c5-a8ce83f1bc97
"{{c1::Asbestosis}} presents with ""ivory white"", calcified supradiaphragmatic and pleural plaques"- This is pathognomonic of asbestosis; also have increased risk for pleural effusions - Pleural plaques are consistent with asbestosis, but do NOT necessarily suggest mesothelioma!* Sketchy mislabeled (should be pointing to buttons on the blue coat) Watch PneumoconiosesWatch Other High-Yield DPLD/ILDWatch associated Bootcamp video - Pneumoconiosis740a6dfe-9e85-41b0-bb4e-f29da1757e47
Sarcoidosis is a systemic disease characterized by widespread {{c1::noncaseating}} granulomasPhoto Credit: Ed Uthman, MD, CC BY-SA 2.0, via Wikimedia CommonsWatch Sarcoidosis & BerylliosisWatch SarcoidosisWatch associated Bootcamp video - Sarcoidosis96d07667-55a3-4f3b-baae-441e80b6911a
Sarcoidosis is associated with {{c1::hypercalcemia}} due to increased {{c2::1α-hydroxylase}} activity in epithelioid histiocytes- Activates vitamin D - Can occur in any disease with many noncaseating granulomas (e.g. berylliosis)Watch Sarcoidosis & BerylliosisWatch associated Bootcamp video - Sarcoidosis46b11e85-8797-40f4-b72e-0d49c0bd1427
Sarcoidosis is associated with elevated serum levels of the enzyme {{c1::angiotensin converting enzyme (ACE)::lung}}Produced in the granulomasWatch Sarcoidosis & BerylliosisWatch associated Bootcamp video - Sarcoidosis61c7ea85-53b6-4b3c-b4b9-0928ca5ca233
{{c2::Neonatal respiratory distress}} syndrome is respiratory distress due to inadequate {{c1::surfactant}} levels- Surfactant deficiency → diffuse atelectasis → V/Q mismatch (R-L intrapulmonary shunting) - V/Q mismatch responsive to supplemental O2Watch Surfactant & Surface Tension of AlveoliWatch associated Bootcamp video - Air Physiology: Surfactant Watch associated Bootcamp videoa6d9c34e-d598-4a42-893c-80f9a0354144
Neonatal respiratory distress syndrome (NRDS) is associated with {{c1::premature}} birth- Surfactant production doesn't begin until at least week 20 - Surfactant levels are insufficient until around week 35Watch associated Bootcamp video - ARDS and NRDSe0d28e5b-b981-4f6e-8e35-93e9ac7e8535
Neonatal respiratory distress syndrome (NRDS) is associated with {{c1::maternal diabetes}} due to increased levels of fetal {{c2::insulin}}Insulin inhibits surfactant productionWatch associated Bootcamp video - ARDS and NRDS59eb2e41-40ff-4604-939f-1eebe05f43c5
"Neonatal respiratory distress syndrome is associated with diffuse granularity of the lung with a(n) ""{{c1::ground-glass}}"" appearance on CXR"Photo Credit: Mikael Häggström, M.D. , CC0, via Wikimedia Commons DiagnosisTransient tachypnea of the newborn (TTN)Respiratory distress syndromePersistent pulmonary hypertensionPathophysiologyAlveolar fluid not cleared properly at birthAlveolar collapse and atelectasis due to lack of surfactantRight to left shunting due to high pulmonary vascular resistance resulting in hypoxiaClinical featuresTachypnea resolves by day 2Respiratory distress (premature birth)Tachypnea and cyanosisChest x-rayPerihilar linear streaking bilaterallyGround glass (reticulogranular), air bronchograms, decreased lung volumesClear lung fields, decreased pulmonary vascularityWatch associated Bootcamp video - ARDS and NRDS0d7a2c84-13ac-475f-b4fe-059cfd4143d0
What GI pathology is associated with neonatal respiratory distress syndrome (NRDS) due to hypoxemia? {{c1::Necrotizing enterocolitis}}Watch Congenital GI DisordersWatch associated Bootcamp video - ARDS and NRDS Watch associated Bootcamp video - Neonatal Disorders2d93699f-8536-493d-aa67-c12587a513c6
{{c2::Small cell}} lung carcinoma may produce the posterior pituitary hormone {{c1::ADH}} leading to {{c1::SIADH}}"- May also produce anterior pituitary hormone ACTH leading to Cushing syndrome - ""Small cell, Smokers, ""S""entral, paraneoplastic Syndromes"""ADH is behind the table → posterior pituitary Watch Lung Carcinoma Watch Diabetes Insipidus & SIADHWatch associated Bootcamp video - Pulmonary Small Cell Carcinoma Watch associated Bootcamp video - Endocrine SIADH83e740c7-cb48-4808-8611-7e72d3b2e16a
One complication associated with lung cancer is {{c1::superior vena cava::vascular}} syndrome due to compression of the {{c1::SVC}}- Most commonly due to mediastinal masses (thymoma / mediastinal lymphadenopathy), less commonly due to right upper lobe lung / superior sulcus tumors - Patients will present with headache, dizziness, dyspnea, JVD, and position-dependent facial edemaWatch Lung Carcinoma Watch Superior Vena CavaWatch associated Bootcamp video - Venous Drainage Obstruction Watch associated Bootcamp video - Lung Cancer Basics7fcfecf7-d422-431c-a994-2ebacbab4b3e
Superior vena cava (SVC) syndrome is characterized by impaired drainage of the upper extremities, resulting in {{c1::edema}} and dilated collateral veins in the {{c2::upper torso}}- Blood is trapped in venous circulation leaving less blood to go through pulmonary circulation → shortness of breath - Increased pressure in the SVC vein causes blood flow to get rerouted through collaterals which become engorged and dilate, trapping blood in the venous system Collaterals include: - Internal (mammary) thoracic vein (where anterior intercostal veins drain with back up resulting in the blanchableness of anterior chest) - Lateral thoracic vein - Esophageal veins - Azygos vein (blood is rerouted through azygos to drain into IVC) Photo Credit: EMAHKempny, CC BY-SA 4.0, via Wikimedia CommonsWatch Lung Carcinoma Watch Superior Vena CavaWatch associated Bootcamp video - Lung Cancer Basics Watch associated Bootcamp video - Venous Drainage Obstructionf3944d83-9356-48c1-8469-5e769fcfb60c
Superior vena cava (SVC) syndrome is characterized by impaired drainage of the head & neck, resulting in {{c2::facial plethora}} and {{c1::jugular venous distention}}- Fluid build-up in the head is dangerous because it can lead to cerebral edema → ischemia → Cushing reflex - Fluid build-up in the neck is dangerous because it can compress the trachea, larynx, and esophagusWatch Lung Carcinoma Watch Superior Vena CavaWatch associated Bootcamp video - Lung Cancer Basics Watch associated Bootcamp video - Venous Drainage Obstructiond2e79e5b-6a61-4d39-8872-c9e3c2c2bf4a
Pneumothorax presents with {{c1::decreased}} tactile fremitus on the affected sidePhoto credit: Stead et al., CC BY 4.0, via CureusWatch PneumothoraxWatch associated Bootcamp video - Lung Pathology Fundamentals : Lung Physical Exam Watch associated Bootcamp video - Pneumothoraxb6a08787-ca1a-4906-a746-69b3d1847c6c
Pneumothorax presents with {{c1::hyper}}resonance on the affected sideDue to low density of air compared to normal lung tissue Photo credit: Stead et al., CC BY 4.0, via CureusWatch PneumothoraxWatch associated Bootcamp video - Lung Pathology Fundamentals : Lung Physical Exam Watch associated Bootcamp video - Pneumothorax024226ba-9d95-42ad-afee-7aa30a46ec3f
Pneumothorax presents with {{c1::diminished}} breath sounds on the affected sidePhoto credit: Stead et al., CC BY 4.0, via CureusWatch PneumothoraxWatch associated Bootcamp video - Lung Physical Exam Watch associated Bootcamp video - Pneumothorax6bdc31d6-67b0-4d5a-8e85-36d91f0f6d3c
{{c1::Pulmonary adenocarcinoma}} is the most common type of primary lung carcinoma (40%)Adenocarcinoma (40%) > squamous cell carcinoma (30%) > small cell carcinoma (15%) > large cell carcinoma (10%) > carcinoid tumor (5%)Watch Lung Carcinoma Watch Lung CarcinomaWatch associated Bootcamp video - Pulmonary Non-Small Cell Carcinoma5588bf2e-6da7-485f-a518-2cea3a3a4749
{{c1::Immune thrombocytopenic purpura (ITP)}} is due to autoimmune production of Ig{{c2::G}} against {{c3::GPIIb/IIIa}} receptor on platelets- Presents clinically as petechiae, mucocutaneous bleeding, and isolated thrombocytopenia (w/o hepatosplenomegaly) - Whereas, Glanzmann thrombasthenia is due to deficient platelet GPIIb/IIIa* 2 balls 3 strikes (GP2b3a) Watch Quantitative Platelet DisordersReview Immune Thrombocytopenic Purpura (ITP)Watch associated Bootcamp video - Platelet Disorders89ecd56a-f8ff-4d97-90c8-0f4ca624b378
The treatment for refractory cases of immune thrombocytopenic purpura (ITP) is {{c1::splenectomy}}Eliminates both the source of the antibody and the site of platelet destructionWatch Quantitative Platelet DisordersReview Immune Thrombocytopenic Purpura (ITP)Watch associated Bootcamp video - Platelet Disordersa7a950a0-298c-4054-a925-7f1238d18b88
"The pentad of classical symptoms seen in {{c1::thrombotic thrombocytopenic purpura (TTP)}} may be remembered using the mnemonic ""FAT RN"": {{c1::Fever::F}} {{c1::Anemia (microangiopathic hemolytic Anemia)::A*}} {{c1::Thrombocytopenia::T*}} {{c1::Renal symptoms::R}} {{c1::Neurologic symptoms::N}}"- *However, only MAHA and thrombocytopenia are required for diagnosis - Fever in 20% of patients - Renal symptoms in 50% of patients, more common in HUS - Neurologic symptoms in 67% of patients, more common in TTP - HUS presents with similar symptoms, almost always characterized by normal PT / PTT - Fever due to inflammation from small vessel occlusion and tissue damage - Patients can have Burr cells due to kidney damage - TTP can occur during pregnancy or in the postpartum periodWatch Quantitative Platelet DisordersReview Thrombotic Thrombocytopenic Purpura (TTP)Watch associated Bootcamp video - Thrombotic Microangiopathiesy50214777-a288-4ef8-bf67-42694a6125f3
The pentad of classical symptoms seen in thrombotic thrombocytopenic purpura (TTP) may be remembered with the mnemonic {{c1::FAT RN}}Fever Anemia (microangiopathic hemolytic Anemia) Thrombocytopenia Renal symptoms Neurologic symptoms - Fever in 20% of patients - Renal symptoms in 50% of patients, more common in HUS - Neurologic symptoms in 67% of patients, more common in TTP - *However, only MAHA and thrombocytopenia are required for diagnosis; HUS presents with similar symptoms, almost always characterized by normal PT / PTT - Fever due to inflammation from small vessel occlusion and tissue damage - Patients can have Burr cells due to kidney damage - TTP can occur during pregnancy or in the postpartum periodWatch Quantitative Platelet DisordersReview Thrombotic Thrombocytopenic Purpura (TTP)Watch associated Bootcamp video - Thrombotic Microangiopathies62081631-0188-4a81-b1aa-16837c36e8c8
What is the treatment for thrombotic thrombocytopenic purpura (TTP)? {{c1::Plasma exchange}}, {{c2::glucocorticoids}}, {{c3::rituximab}}- Plasmapheresis is removing proteins (i.e., auto antibody) from the body - Rituximab decreases IgG - TTP is often due to an acquired autoantibody against ADAMTS13Review Thrombotic Thrombocytopenic Purpura (TTP)Watch associated Bootcamp video - Thrombotic Microangiopathies26e3558e-5234-430a-8a84-8e87efa315d9
{{c2::Hemolytic uremic}} syndrome is classically seen in {{c3::children::demographic}} with {{c1::E. coli O157:H7}} dysentery, which results from exposure to undercooked beef- Shiga-like toxin produced by E. coli O157:H7 → toxin absorbed through GI mucosa → toxin binds to endothelial cells (particularly in glomerulus) → platelet activation and aggregation → shearing of RBCs as they cross microthrombi - Most recent information showed the verotoxin inhibits ADAMTS13Watch Quantitative Platelet DisordersReview Hemolytic Uremic Syndrome (HUS)Watch associated Bootcamp video - Thrombotic Microangiopathies Watch associated Bootcamp video - Escherichia Colicc788aa6-7575-4a7c-b768-610350b2dd20
Hemophilia {{c1::A}} is a coagulation disorder due to a genetic factor {{c2::VIII}} deficiency"Pathoma: ""A""-ght"Watch Inherited Coagulation DefectsReview Hemophilia A Review Intrinsic Pathway of CoagulationWatch associated Bootcamp video - Hemophiliad3c7a6bd-4967-4724-8705-85c41d1cfd66
What is the mode of inheritance of hemophilia A? {{c1::X-linked recessive}}Watch Inherited Coagulation DefectsReview Hemophilia AWatch associated Bootcamp video - Hemophilia28476fe4-7331-4079-8c6d-bdbbcb129cc8
Which coagulation disorder presents with recurrent hemarthroses, spontaneous / easy bruising, and bleeding after surgery? {{c1::Hemophilia (A, B, C)}}- Macrohemorrhage - Chronic hemarthrosis can result in degradation of the knee / weight bearing - Clinical severity depends on degree of deficiency Photo credit: Balfousias et al., CC BY 3.0, via Cureus Image licensed by Physeo and used with permission. Purchase full access here.Watch Inherited Coagulation DefectsReview Hemophilia AWatch associated Bootcamp video - Hemophiliaeb83453a-f571-4fdf-8bc0-2fadb1d57f0d
Hemophilia {{c1::B (Christmas disease)}} is a coagulation disorder due to a genetic factor {{c2::IX}} deficiencyWatch Inherited Coagulation DefectsReview Hemophilia B Review Intrinsic Pathway of CoagulationWatch associated Bootcamp video - Hemophilia4002ae75-91d9-4ec3-ac48-7989e2608ddf
What is the mode of inheritance of hemophilia B? {{c1::X-linked recessive}}- Hemophilia A & B = X-linked Recessive - Hemophilia C = Autosomal RecessiveWatch Inherited Coagulation DefectsReview Hemophilia BWatch associated Bootcamp video - Hemophiliaedfc2531-ee45-4002-ab8a-6cdbc8080286
Treatment for hemophilia A: Mild: {{c1::desmopressin}} Severe: {{c1::Factor VIII concentrate}}Hemophilia B and C are treated with recombinants to their respective factor deficiencies SeverityClinical findingsEnzyme ActivityMildHematoma with significant trauma5% to 50%ModerateHematoma with mild trauma1% to 5%SevereSpontaneous hematoma<1%Watch Inherited Coagulation DefectsReview Hemophilia AWatch associated Bootcamp video - Hemophilia5d87a93d-68ce-4f5b-a8b1-2d37d08ead66
Hemophilia (A, B, C) presents with {{c1::normal}} PT and {{c1::increased}} PTTIntrinsic pathway coagulation defectWatch Inherited Coagulation DefectsReview Hemophilia A Review Hemophilia B Review Intrinsic Pathway of CoagulationWatch associated Bootcamp video - Hemophiliabad7fb0c-6419-4106-9099-277321f776ae
In hemophilia A, mixing normal plasma with the patient's plasma (mixing study) {{c1::does::does/doesn't}} correct the PTT- Normal plasma replaces the deficient factor VIII - vs. factor VIII inhibitor where it doesn't correct the PTTWatch Inherited Coagulation DefectsWatch associated Bootcamp video - Mixing Studies, Ristocetin, and D-dimer Watch associated Bootcamp video - Hemophilia Watch associated Bootcamp video - Bleeding Time, Prothrombin Time, INR, and Partial Thromboplastin Time2056393a-d606-4235-9c86-7a00ac0c7953
Which coagulation factors have decreased activity due to vitamin K deficiency? {{c1::2, 7, 9, 10::4}}II, VII, IX, XWatch Vitamin KSketchy Physiology: HematologyReview Vitamin K Biochemistry Review Vitamin K DeficiencyWatch associated Bootcamp video - Vitamin K Dependent Coagulation Factors549bcfd2-3003-4771-9f44-8bdba1398e62
What proteins have decreased activity due to vitamin K deficiency? {{c1::Protein C and protein S::2}}- Protein S and C Stop Clotting - Protein S levels are decreased during pregnancyWatch Vitamin K Watch Acquired Coagulation DefectsSketchy Physiology: HematologyReview Vitamin K Biochemistry Review Vitamin K DeficiencyWatch associated Bootcamp video - Vitamin K Dependent Coagulation Factors1e31bfcb-efaa-4612-a228-dd6c3fb6f2fe
Vitamin K deficiency may occur in {{c1::newborns}} due to lack of {{c2::colonic bacteria}} that normally synthesize vitamin KVitamin K injection is given prophylactically to all newborns at birth to prevent hemorrhagic disease of the newbornWatch Vitamin K Watch Acquired Coagulation DefectsReview Vitamin K Deficiency Review Vitamin K BiochemistryWatch associated Bootcamp video - Vitamin K Dependent Coagulation Factors95006b10-fd99-487d-9fe9-3d2eff5bcf7a
Vitamin K deficiency presents with {{c1::increased}} PT and {{c1::normal or increased}} PTT- PTT may be increased in severe cases of vitamin K deficiency - PTT is less sensitive than PT (since factor VII levels drop first) - Vitamin K deficiency is essentially like a patient on warfarin* Raised PoTaToes(PTT) and Paper Towels (PT) Watch Vitamin K Watch Acquired Coagulation DefectsSketchy Physiology: HematologyReview Vitamin K DeficiencyWatch associated Bootcamp video - Vitamin K Dependent Coagulation Factors1e0a014c-573f-46a1-a7a2-0101d5f4e572
{{c2::Von Gierke}} disease is caused by a deficiency of the enzyme {{c1::glucose-6-phosphatase}}- Glucose-6-Phosphatase is important for liver regulation of blood glucose - Thus G6P will build up in the liver, and be shunted into all available pathways - Pathways dependent on G6Pase outside of gluconeogenesis will also be affected Image licensed by Physeo and used with permission. Purchase full access here.Watch Glycogen Storage DiseasesReview Von Gierke (Type I)Watch associated Bootcamp video - Gluconeogenesis: Pathway Watch associated Bootcamp video - Von Gierke Disease5cf4cb6e-3449-439b-a068-0fd7852ca1b5
Von Gierke disease is associated with increased blood {{c1::lactate}}, {{c1::triglycerides::lipid}}, and {{c1::uric}} acid- Excess pyruvate is shunted into triglyceride synthesis - Cori (Lactate) Cycle fails because the liver cannot form glucose from 2 pyruvates, resulting in lactate building up in the blood - Lactic acid is an organic anion, and is a counter ion for uric acid at the URAT1 antiporter on the apical surface of the collecting duct; thus the more lactate secreted into the urine, more uric acid reabsorbed into the blood Image licensed by Physeo and used with permission. Purchase full access here.Watch Glycogen Storage DiseasesReview Von Gierke (Type I)Watch associated Bootcamp video - Gluconeogenesis: Pathway Watch associated Bootcamp video - Von Gierke Diseased348a0ad-a6a6-4d42-bafe-7083db28e843
Treatment of Von Gierke disease includes frequent oral {{c1::glucose}} or {{c2::cornstarch}} between mealsCornstarch is a glucose polymer, this will prevent hypoglycemia from developing Image licensed by Physeo and used with permission. Purchase full access here.Watch Glycogen Storage DiseasesWatch associated Bootcamp video - Gluconeogenesis: Pathway Watch associated Bootcamp video - Von Gierke Diseasef8b39b0e-c621-46b7-862a-29913346569a
Treatment of von Gierke disease includes avoidance of {{c1::fructose}}, {{c2::galactose}}, sucrose, and lactoseFructose and galactose both lead to increased glucose-6-phosphate, which increases G6P accumulation in the liver Image licensed by Physeo and used with permission. Purchase full access here.Watch Glycogen Storage DiseasesWatch associated Bootcamp video - Gluconeogenesis: Pathway Watch associated Bootcamp video - Von Gierke Disease69b820bd-48a2-4ff4-b04b-5d3d7872e74a
In {{c2::obstructive::obstructive or restrictive}} lung disease, the flow volume loop shifts toward the {{c1::higher::higher/lower}} volume side*some graphs display to the left, others to the right - in obstructive lung disease it will head to whichever side is higher Shape changes PEF is markedly reduced Downslope is blunted Inspiration is reducedWatch Pulmonary Function TestingWatch PFTs How-To Watch Chronic Dyspnea DDx Part 1Watch associated Bootcamp video - Obstructive Lung Disease Basics Watch associated Bootcamp video - Air Physiology : Flow-Volume Loopsc6e00f5a-d549-4e46-ad2d-05bd23b69617
In {{c2::restrictive::obstructive or restrictive}} lung disease, the flow volume loop shifts toward the {{c1::lower::higher/lower}} volume side*some graphs display to the left, others to the right - in restrictive lung disease it will head to whichever side is lowerWatch Pulmonary Function TestingWatch PFTs How-To Watch Chronic Dyspnea DDx Part 2Watch associated Bootcamp video - Restrictive Lung Disease Basics Watch associated Bootcamp video - Air Physiology : Flow-Volume Loopscdd0daaa-038a-4926-937a-a790ccb0e98e
What effect may sleep apnea secondarily have on RBC levels? {{c1::Increased (polycythemia)}}- Chronic hypoxia induces the release of EPO causing increased erythropoiesis - Can lead to facial plethora (red discoloration of face)Watch associated Bootcamp video - Sleep Apneac422e397-20de-4034-805d-3f8cdc5fe5b1
{{c2::Transudative}} pleural effusion may be caused by increased {{c1::hydrostatic}} pressure (e.g., heart failure)e.g., hypoalbuminemia, CHF Light's CriteriaTransudative pleural effusionExudative pleural effusionProtein (pleural / serum)≤ 0.5> 0.5LDH (pleural / serum)≤ 0.6> 0.6Common causes- Cirrhosis (low albumin) - Nephrotic syndrome (low albumin) - Congestive heart failure- Infection (TB, fungal, empyema, parapneumonic) - Malignancy - Pulmonary embolismWatch Acute Respiratory Distress Syndrome (ARDS)Watch Pleural Effusion DDxWatch associated Bootcamp video6d712360-7ada-4fdb-b26b-38a311c638fd
{{c2::Transudative}} pleural effusion may be caused by decreased {{c1::oncotic}} pressure (e.g., nephrotic syndrome, cirrhosis)Light's CriteriaTransudative pleural effusionExudative pleural effusionProtein (pleural / serum)≤ 0.5> 0.5LDH (pleural / serum)≤ 0.6> 0.6Common causes- Cirrhosis (low albumin) - Nephrotic syndrome (low albumin) - Congestive heart failure- Infection (TB, fungal, empyema, parapneumonic) - Malignancy - Pulmonary embolismWatch Acute Respiratory Distress Syndrome (ARDS)Watch Pleural Effusion DDx Watch Nephrotic Syndrome SOAPWatch associated Bootcamp video - Pleural Effusion80d78089-54e9-41f4-8b49-03041c54cc06
{{c2::Transudative}} pleural effusion is characterized by {{c1::low}} protein contentLight's CriteriaTransudative pleural effusionExudative pleural effusionProtein (pleural / serum)≤ 0.5> 0.5LDH (pleural / serum)≤ 0.6> 0.6Common causes- Cirrhosis (low albumin) - Nephrotic syndrome (low albumin) - Congestive heart failure- Infection (TB, fungal, empyema, parapneumonic) - Malignancy - Pulmonary embolismWatch Acute Respiratory Distress Syndrome (ARDS)Watch Pleural Effusion DDxWatch associated Bootcamp video - Pleural Effusionec6824b7-5f47-48d3-94a3-1ed15a342958
An empyema is defined as {{c1::pus in the pleural space}}, and is most commonly caused by {{c2::S. pneumoniae::community-acquired}} or {{c2::S. aureus::hospital-acquired}}; treatment includes {{c3::drainage}} and {{c3::broad-spectrum antibiotics}}- Typically seen as a complication of pneumonia; can also arise due to TB, chest surgery, or trauma - Empiric antibiotic treatment for community acquired* empyema includes ceftriaxone AND (metronidazole OR clindamycin) - In hospital acquired** empyema, add MRSA/Pseudomonal coverage (e.g. vancomycin AND cefepime AND metronidazole) *community-acquired = S. pneumoniae + anaerobic bacteria **hospital-acquired = S. aureus + PseudomonasWatch PleuraWatch Parapneumonic Effusion & Empyema SOAPWatch associated Bootcamp video - Pleural Effusionabf11179-26a1-467f-976d-73a2f34c79df
{{c2::Exudative}} pleural effusion is characterized by {{c1::high}} protein contentLight's CriteriaTransudative pleural effusionExudative pleural effusionProtein (pleural / serum)≤ 0.5> 0.5LDH (pleural / serum)≤ 0.6> 0.6Common causes- Cirrhosis (low albumin) - Nephrotic syndrome (low albumin) - Congestive heart failure- Infection (TB, fungal, empyema, parapneumonic) - Malignancy - Pulmonary embolismWatch Acute Respiratory Distress Syndrome (ARDS)Watch Pleural Effusion DDxWatch associated Bootcamp video - Pleural Effusionb34e541b-1786-4529-b214-c4b030025ee3
What adverse effect is associated with inhaled corticosteroids? {{c1::Oropharyngeal candidiasis}}Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia CommonsWatch Asthma TherapyWatch associated Bootcamp video - Asthma Treatments Watch associated Bootcamp video - Infectious Diseases of the Skin: Candida Watch associated Bootcamp video - Infectious Diseases of the Skin: Fungal Infectious Conditions Watch associated Bootcamp video - Opportunistic Infections: Localized Kaposi Sarcoma, Oropharyngeal Candidiasis, Oral Hairy Leukoplakia98b1e022-c272-458f-a28e-9e06b4b0589b
{{c1::Theophylline}} is a methylxanthine that may be used for asthma therapynarrow therapeutic window that may be altered by drugs/illness that inhibit liver CYP-450Watch Asthma TherapyWatch associated Bootcamp video - Asthma Treatments Watch associated Bootcamp video - Phosphodiesterase Inhibitors5fcbd5de-5b7d-4575-b85a-6d21dac6abfb
Theophylline may have CNS side effects including {{c1::nervousness}} and {{c1::tremor}}More serious side effects include tachyarrhythmia (due to antagonization of α1 receptors) and seizuresWatch Asthma TherapyWatch associated Bootcamp video - Asthma Treatments Watch associated Bootcamp video - Phosphodiesterase Inhibitorsa80d5310-d6a0-45a6-b8a2-1fe71f028b2d
Theophylline can cause {{c1::tachycardia::HR}}Narrow therapeutic window that may be altered by drugs/illness that inhibit liver CYP-450Watch Asthma TherapyWatch associated Bootcamp video - Asthma Treatments Watch associated Bootcamp video - Phosphodiesterase Inhibitors4da56510-8811-41f1-b284-e46ab7b45f97
What is the treatment for an acute, severe asthma exacerbation? {{c1::SABA + SAMA + corticosteroids + supplemental O2::4}}- Supplemental O2 added per AMBOSS and GINA guidelines (Sept 2023) - SABA = Short-acting β2 agonist (i.e. albuterol) - SAMA = Short-acting muscarinic antagonist (i.e. ipratropium) - Oral steroids (prednisone) preferred, but can use IV (prednisone or methylprednisolone) too - Additional bronchodilation with one-time infusion of IV magnesium sulfate may be added if no improvement appreciated after an hour - For patients suspected of having an anaphylactic reaction or unable to use inhaled bronchodilators for severe asthma exacerbation, give epinephrine; can repeat every 20 minutes for up to 3 dosesWatch Asthma TherapyWatch Acute Asthma Exacerbation SOAPWatch associated Bootcamp video - Asthma Treatments7032af67-c159-4f40-84b0-30d3f7f4f619
What is the mode of inheritance of cystic fibrosis? {{c1::Autosomal recessive}}Watch Autosomal Recessive DiseasesWatch Cystic Fibrosis SOAReview Cystic Fibrosis OverviewWatch associated Bootcamp video - Cystic Fibrosis Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemia3c857180-2083-4608-a326-dd09b2a688cd
{{c3::Cystic fibrosis}} is due to a defect in the {{c1::CFTR}} gene on chromosome {{c2::7}}Watch Cystic Fibrosis SOAReview Cystic Fibrosis Overview Review Cystic Fibrosis ComplicationsWatch associated Bootcamp video - Cystic Fibrosis Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemia74829437-69df-45ed-87a0-aa74127fc9c3
Cystic fibrosis most commonly occurs due to a(n) {{c2::in-frame}} deletion of {{c1::Phe508}}- This results in a impaired post translational processing: improper folding and glycolyslation of CFTR results in misfolded protein that gets retained in the RER and marked for proteasomal degradation - Thus there is decreased CFTR transported to the cell membrane; decreased Cl secreted at mucosal epithelium, decrease Cl reabsorbed at sweat glandsWatch Cystic Fibrosis SOAReview Cystic Fibrosis OverviewWatch associated Bootcamp video - Cystic Fibrosis Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemia27bd0932-a92c-4927-b62b-13c3333ce5b5
What organism is responsible for recurrent pulmonary infections in an infant cystic fibrosis patient? {{c1::Staphylococcus aureus}}- Most common organism for < 20 years is Staphylococcus aureus; for > 20 years is Pseudomonas aeruginosa - Although S. aureus is more common in children and Pseudomonas in adults, empiric treatment should cover both organisms regardless of age - S. aureus is covered with IV vancomycinWatch Staph aureus Watch Vancomycin Watch Pseudomonas aeruginosaWatch Cystic Fibrosis SOAReview Cystic Fibrosis ComplicationsWatch associated Bootcamp video - Cystic Fibrosis Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemia74a6e5f4-4d16-4d5c-95af-be8f44b979eb
What organism is responsible for recurrent pulmonary infections in an adult cystic fibrosis patient? {{c1::Pseudomonas aeruginosa}}- Most common organism for < 20 years is Staphylococcus aureus; for > 20 years is Pseudomonas aeruginosa - Although S. aureus is more common in children and Pseudomonas in adults, empiric treatment should cover both organisms regardless of age - Chronic pneumonia in cystic fibrosis patients is associated with biofilms, an area in which Pseudomonas is a starWatch Pseudomonas aeruginosaWatch Cystic Fibrosis SOAReview Cystic Fibrosis Complications Review Pseudomonas aeruginosa: OverviewWatch associated Bootcamp video - Cystic Fibrosis Watch associated Bootcamp video - Pseudomonas Aeruginosa Watch associated Bootcamp video - Pediatric and Additional Pneumonia Pathogens Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemia Watch associated Bootcamp video - Fundamentals of Bacteriology: Bacterial Adherence and Motility5ae17b5f-0a0b-4103-bea2-7963c30dd27b
Cystic fibrosis may cause {{c1::pancreatic}} insufficiency, resulting in malabsorptionWatch Cystic Fibrosis SOAReview Cystic Fibrosis ComplicationsWatch associated Bootcamp video - Pancreatic Insufficiency Watch associated Bootcamp video - Cystic Fibrosis Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemia1b0071a5-9ae3-4c6c-8063-20ba6e83c7eb
Cystic fibrosis may cause malabsorption with {{c1::steatorrhea::bowel condition}} and consequent {{c1::fat}}-soluble vitamin deficienciesWatch Vitamin AWatch Cystic Fibrosis SOAReview Vitamin K Deficiency Review Cystic Fibrosis ComplicationsWatch associated Bootcamp video - Cystic Fibrosis Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemia9e73262f-426e-4f6f-841a-501dbb81963f
Cystic fibrosis may cause {{c1::biliary}} cirrhosis and/or {{c2::liver}} diseaseWatch Cystic Fibrosis SOAWatch associated Bootcamp video - Cystic Fibrosis Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemia9d719e52-3f61-452d-8c2c-bf4dd236eb9b
"Cystic fibrosis may present as {{c1::meconium ileus (10-20% of patients)}} in newborns due to abnormally thick (""inspissated"") stool"- Cystic fibrosis is the most common cause of meconium ileus (90% of cases due to CF) - Abnormally thick stool (plugs and obstructs the intestine at birth; results in abdominal distension and vomiting) - Air fluid levels can be seen on x-ray - Because you are constantly swallowing air, air is going through GI - Due to obstruction, air and fluid get mixed up in bowels → air fluid levelsWatch Cystic Fibrosis SOAReview Cystic Fibrosis ComplicationsWatch associated Bootcamp video - Cystic Fibrosis Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemia114254d9-ba34-46ca-b274-c17fdf57613d
Cystic fibrosis may cause {{c1::infertility}} in men due to congenital bilateral absence of the {{c2::vas deferens}}- 95% of male are infertile; CFTR mutations are likely responsible for abnormal development of wolffian structures, resulting in vasal agenesis and defective sperm transport - Spermatogenesis may be unaffected, thus can have children with assisted techniques Photo credit: OpenStax, CC BY 4.0Watch Cystic Fibrosis SOAReview Cystic Fibrosis ComplicationsWatch associated Bootcamp video - Cystic Fibrosis Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemia31c0d946-14cb-4f69-b89a-a03fe82833c5
Is spermatogenesis possible in a patient with cystic fibrosis? {{c1::Yes}}infertility in males with cystic fibrosis is due to absence of vas deferens, not lack of spermatogenesisWatch Cystic Fibrosis SOAReview Cystic Fibrosis ComplicationsWatch associated Bootcamp video - Cystic Fibrosis Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemiaa11dc3fe-13fd-4097-89c7-54810287c317
Cystic fibrosis may cause {{c1::subfertility}} in women due to abnormally thick {{c2::cervical mucus}} and amenorrheaThick cervical mucus is harder for the sperm to travel throughWatch Cystic Fibrosis SOAWatch associated Bootcamp video - Cystic Fibrosis Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemiaafac9b65-0953-4f1a-8eb2-68d10ea9e429
Treatment of cystic fibrosis includes {{c1::azithromycin}}, which is used as an anti-inflammatory agentWorks by inhibiting phospholipase A2 in alveolar macrophagesWatch Cystic Fibrosis ManagementWatch MacrolidesReview Cystic Fibrosis ComplicationsWatch associated Bootcamp video - Cystic Fibrosis Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemia0688742e-a528-4646-9609-13e0819bd87c
Treatment of cystic fibrosis includes nebulized {{c1::hyper}}tonic saline, which facilitates mucus clearingWatch Cystic Fibrosis ManagementWatch associated Bootcamp video - Cystic Fibrosis Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemiafb7b5376-68b4-4155-b215-b2e0d55802c7
Treatment of cystic fibrosis includes aerosolized {{c1::dornase alfa (DNase)}}, which hydrolyzes DNA in mucus causing decreased viscosityWatch Cystic Fibrosis ManagementWatch associated Bootcamp video - Cystic Fibrosis Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemiabbdac14d-2243-4c7a-b2e6-a735883ef4b5
Treatment of cystic fibrosis includes chest {{c1::physiotherapy}}, which aids in mucus clearanceWatch Cystic Fibrosis ManagementWatch associated Bootcamp video - Cystic Fibrosis Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemiab5edec96-9f84-45c0-801b-08f475ae8e09
{{c2::ACE}} inhibitors may cause a(n) {{c1::dry cough}} due to lung irritation, secondary to increased {{c3::bradykinin}}Switch to an ARB if patient reports coughWatch ACE Inhibitors, ARBs, AliskirenWatch Cough DDxWatch associated Bootcamp video - RAAS Pharmacologic Targets Watch associated Bootcamp video - ACEi, ARBs, Direct Renin Inhibitors63130fba-99cc-4e99-8a25-b61d9a0f03e0
What acid-base disturbance is associated with hyperkalemia? {{c1::Acidosis::Acidosis/Alkalosis}}- ECF → ICF (insulin, β-agonists)- ICF → ECF (hyperosmolarity, exercise, cell lysis)Watch Potassium DisordersWatch associated Bootcamp video - Electrolytes: Potassium9e0010eb-a495-4499-a41c-eabb132c4d78
What effect do loop diuretics have on serum Ca2+ levels? {{c1::Decreased (hypocalcemia)}}- e.g. furosemide; may be useful in the treatment of hypercalcemia - due to increased Ca2+ excretion (rare due to PTH response to feedback) Photo Credit: Image licensed by Physeo and used with permission. Purchase full access here.Watch Loop Diuretics Watch Calcium DisordersWatch associated Bootcamp video - Loop Diureticscc1afc2f-cdd8-4e6d-b449-e1037ce4ca91
The plasma anion gap represents unmeasured ions in serum and is equal to {{c1::[Na+] - ([HCO3-] + [Cl-])::formula}}- Na+, HCO3-, and Cl- are measured; non-measured anions must exist to maintain electroneutrality - Average ~ 11-12 mEq/L Photo Credit: Dr. Agnibho Mondal, CC BY-SA 4.0, via Wikimedia CommonsWatch Acid/Base Disorders Watch Metabolic AcidosisWatch associated Bootcamp video - Acid-Base Physiology Overview44801425-ada8-487a-bfaf-ce4c11b9152c
The primary abnormality in Potter sequence is {{c1::oligo}}hydramniosWatch Congenital & Cystic Kidney Disease Watch Polyhydramnios & OligohydramniosWatch associated Bootcamp video - Developmental Anomalies Watch associated Bootcamp video - Embryologic Defects74ffc6f2-f8d0-4c84-a536-18ffb34a614c
In Potter sequence, oligohydramnios leads to pulmonary {{c1::hypoplasia}}- Most common cause of death in infants with Potter sequence - Due to the lack of normal alveolar distention by aspirated amniotic fluidWatch Congenital & Cystic Kidney Disease Watch Polyhydramnios & OligohydramniosWatch associated Bootcamp video - Developmental Anomalies Watch associated Bootcamp video - Embryologic Defects0280fe3b-b917-4418-b40f-99f263857650
In prerenal azotemia, the BUN:creatinine ratio is {{c1::>}} 20Due to increased reabsorptionWatch Renal Function Tests & Acute Kidney Injury (AKI)Watch associated Bootcamp video - Prerenal AKI9a06c966-8fa1-4cc6-8713-be199ab1645e
"{{c2::Acute tubular necrosis}} is associated with {{c1::epithelial cell}} casts and {{c1::granular ""muddy brown""}} casts in the urine""Epithelial cell cast (image 1); Granular ""muddy brown"" cast (image 2): Photo credit: Mohsenin V., CC BY 4.0, via Wikimedia Commons, resolution enhanced via AI; Mohsenin V., CC BY 4.0, via Wikimedia Commons"Watch Acute Tubular Necrosis (ATN)Watch associated Bootcamp video - Urinary Casts Watch associated Bootcamp video - Acute Tubular Necrosis8ce0fdba-9e5a-4a96-b07b-91f685d258e4
"Drugs that cause {{c1::acute interstitial nephritis}} may be remembered with ""DRAINS"": {{c1::Diuretics::D}} {{c1::Rifampin::R}} {{c1::Antibiotics (penicillins & cephalosporins) / Allopurinol::A (2)}} {{c1::Inhibitors (PPIs)::I}} {{c1::NSAIDs::N}}{{c1::Sulfa drugs::S}}"Occurs days to weeks after starting a drug* Sulfonamides mislabeled (should point to kid holding sulfer eggs) Watch Tubulointerstitial NephritisWatch associated Bootcamp video - Acute Interstitial Nephritisyccd751dd-00f1-43cd-a20e-d8b4628b0314
Drugs that cause acute interstitial nephritis may be remembered with the mnemonic {{c1::DRAINS}}Diuretics Rifampin Antibiotics* / Allopurinol Inhibitors (PPIs) NSAIDsSulfa drugs *Penicillins and cephalosporins Occurs days to weeks after starting a drug* Sulfonamides mislabeled (should point to kid holding sulfer eggs) Watch Tubulointerstitial NephritisWatch associated Bootcamp video - Acute Interstitial Nephritis7f172368-098a-4830-aa13-9974c8fb7d7e
Minimal change disease (lipoid nephrosis) is rarely secondary to {{c1::Hodgkin lymphoma::malignancy}}Hodgkin lymphoma is associated with massive overproduction of cytokines from Reed-Sternberg cellsWatch Nephrotic SyndromeReview Hodgkin LymphomaWatch associated Bootcamp videoce70b833-6d0a-429c-9f6e-e2b19c74632b
{{c1::Focal segmental glomerulosclerosis (FSGS)}} is the most common cause of {{c3::nephrotic}} syndrome in {{c2::Hispanics::ethnicity}} and {{c2::African Americans::ethnicity}}Watch Nephrotic SyndromeWatch Nephrotic Syndrome SOAPWatch associated Bootcamp video5564a919-fef6-4244-93b4-1674b0ed29e8
Which type of nephrotic syndrome is commonly seen secondary to solid tumors? {{c1::Membranous nephropathy}}Watch Nephrotic SyndromeWatch associated Bootcamp video8c31e379-fcb3-4c93-a82e-22c974126bc5
Type {{c3::II}} MPGN is associated with {{c1::C3 nephritic factor}}, an autoantibody that stabilizes {{c2::C3 convertase}}Leads to overactivation of complement and thus inflammationWatch Nephritic SyndromeWatch Glomerulonephritis SOAPWatch associated Bootcamp video3a7c5386-aa93-4657-a796-8dcf1ff8afc4
{{c2::Goodpasture syndrome}} is a form of rapidly progressive glomerulonephritis (RPGN) that presents with a(n) {{c1::linear}} pattern on immunofluorescencePhoto Credit: WikiDoc, CC BY-SA 3.0Watch Small Vessel Vasculitides Watch Nephritic SyndromeWatch Glomerulonephritis SOAPReview Goodpasture SyndromeWatch associated Bootcamp video6966b443-bd7f-4586-b379-591c9bc69608
{{c3::Goodpasture}} syndrome occurs due to antibodies against the {{c1::glomerular}} and {{c1::alveolar}} {{c2::basement membranes}}Antibodies are specifically against the alpha 3 chain of type IV collagenWatch Nephritic Syndrome Watch Small Vessel VasculitidesWatch Other High-Yield DPLD/ILD Watch Glomerulonephritis SOAPReview Goodpasture SyndromeWatch associated Bootcamp video393d3f5a-a408-4094-9f52-9f756cfaab1e
What is the most common cause of glomerulonephritis in adults? {{c1::IgA nephropathy (Berger disease)}}Watch Nephritic SyndromeWatch Glomerulonephritis SOAPWatch associated Bootcamp videobaa0ce8a-12dd-4f86-a6bb-c5d21f3a6a9a
{{c1::Alport}} syndrome is an inherited defect in type {{c2::IV}} collagen- AKA hereditary nephritis - Al-FOUR-t syndromeReview Alport SyndromeWatch associated Bootcamp videob82069ce-9201-4602-b1ab-97593ea39c56
{{c3::Alport}} syndrome is characterized by {{c1::thinning/thickening}} and {{c2::splitting}} of the glomerular basement membraneSplitting and basket-weaving shown below Photo credit: Wang et al., CC BY 4.0, via Hindawi BioMed Research International Electron microscopy identifying a split lamina densa (top left) Photo Credit: Lai et al., CC BY 4.0, via Case Reports in NephrologyReview Alport SyndromeWatch associated Bootcamp video6ba61468-cde6-49f2-9fb9-ce591d6dc89e
UTI with sterile pyuria suggests {{c1::urethritis}} due to {{c3::Chlamydia trachomatis}} or {{c2::Neisseria gonorrhoeae}}- Symptoms of dysuria without other UTI symptoms - Can lead to infertility (PID) - Sterile pyuria = WBCs without growth on standard urine culture and microscopy (must diagnose with NAAT) - Gonorrhea does not always show up on gram stainWatch Chlamydia trachomatis, Chlamydophila pneumoniae & Chlamydophila psittaci Watch Neisseria gonorrhoeae [Old Version]Watch Neisseria gonorrhoeaeWatch associated Bootcamp video - Neisseria Gonorrhoeae Watch associated Bootcamp video - Chlamydia Trachomatis Serotypes and Disease Variants66a0aa94-6f17-419b-bbb7-4521be7d2c7a
Acute pyelonephritis may present with {{c1::WBCs}} in the urine ± {{c1::WBC}} castsPhoto credit: Mohsenin V., CC BY 4.0, via Wikimedia CommonsWatch Cystitis, Pyelonephritis & Prostatitis SOAWatch associated Bootcamp video - Acute Pyelonephritis5f53dfee-8b64-4155-b155-3835c8edc94f
What is the most common type of kidney stone? {{c1::Calcium stone (80%)}}- Calcium (80%) > ammonium magnesium phosphate (struvite) (15%) > uric acid (5%) - Calcium oxalate more common than calcium phosphateWatch Calcium Oxalate Stones & Calcium Phosphate StonesWatch associated Bootcamp video - Calcium Stones1497eb2c-5690-45b2-af2b-bc0e50a3c424
Uric acid kidney stones precipitate with {{c1::low}} urine pHWatch Magnesium Ammonium Phosphate (MAP) Stones, Uric Acid Stones, & Cystine StonesWatch associated Bootcamp video - Uric Acid Stonesfea70daf-eb14-4f86-b7e8-fa29b6a3518d
Treatment of uric acid kidney stones involves {{c1::alkalinization}} of urinee.g. potassium bicarbonate Renal stonesTypeEtiologyRadiologyFeatures Calcium oxalateHypercalciuria, Crohn's diseaseRadiopaqueMost common type Calcium phosphateRenal tubular acidosis, hyperparathyroidismRadiopaqueCan form more readily in alkalinized urine StruviteUTI secondary to urease + organism (e.g., Proteus, Klebsiella)RadiopaqueWomen affected more, can form staghorn calculi (outlining renal pelvis) Uric acidLow urinary pH, gout, chemotherapy, patients with ileostomiesRadiolucentCan be treated by increase urinary pH (e.g., alkalinizing agents)Watch Magnesium Ammonium Phosphate (MAP) Stones, Uric Acid Stones, & Cystine StonesWatch associated Bootcamp video - Uric Acid Stonesd59b585c-4498-4c97-b275-89ead9d54b77
What is the most common renal malignancy of early childhood (ages 2-4)? {{c1::Nephroblastoma (Wilms tumor)}}Watch Renal Cell Carcinoma & NephroblastomaWatch associated Bootcamp video - Principles of Oncology and Therapeutics: Oncogenes and Tumor Suppressor Genes Watch associated Bootcamp video - Wilm's Tumor Watch associated Bootcamp video - Cellular Injury and Neoplasia: Oncogenes and Tumor Suppressor Genesc09408a4-8581-4b7a-b843-a20f85bca558
WAGR syndrome is a combination of: {{c1::Wilms tumor::W}} {{c1::Aniridia (absence of iris)::A}} {{c1::Genitourinary abnormalities::G}} {{c1::Range of developmental delay::R}}- Associated with WT1 gene deletion - Aniridia depicted below: Photo credit: The original uploader was Gardar Rurak at English Wikipedia., CC BY-SA 3.0, via Wikimedia CommonsWatch Renal Cell Carcinoma & NephroblastomaWatch associated Bootcamp video - Wilm's Tumorya949489e-a778-49c0-8c91-8491eccba8c2
Clinical features of Beckwith-Wiedemann syndrome can be remembered by {{c1::HOT BOIL}}Hemihypertrophy (hemihyperplasia) Organomegaly Tongue (macroglossia) Blastomas* Omphaloceles Intellectual disability Low BGL (hypoglycemia) *Nephroblastoma > hepatoblastoma Beckwith-Wiedemann - Boiling Water Also polyhydramnios and mid-face hypoplasiaWatch Renal Cell Carcinoma & NephroblastomaWatch associated Bootcamp video - Wilm's Tumorf60275b1-fa84-467f-a0da-2db5fc45ed2b
"Clinical features of {{c1::Beckwith-Wiedemann}} syndrome can be remembered by ""HOT BOIL"": {{c1::Hemihypertrophy (hemihyperplasia)::H}} {{c1::Organomegaly::O}} {{c1::Tongue (macroglossia)::T}} {{c1::Blastomas*::B}} {{c1::Omphaloceles::O}} {{c1::Intellectual disability::I}} {{c1::Low BGL (hypoglycemia)::L}}"*Nephroblastoma > hepatoblastoma Beckwith-Wiedemann - Boiling Water Also polyhydramnios and mid-face hypoplasiaWatch Renal Cell Carcinoma & NephroblastomaWatch associated Bootcamp video - Wilm's Tumoryc6ec7232-df36-47a5-804f-bb55a9c2d760
How do serum K+ levels change in Bartter syndrome? {{c1::Decreased (hypokalemia)}}Watch associated Bootcamp video - Loop of Henlee9b30442-e9fd-4011-b9e6-d9d0a93c51a4
Which electrolyte disturbance causes wide QRS and peaked T waves on ECG? {{c1::High K+ (hyperkalemia)}}Watch Potassium DisordersWatch associated Bootcamp video - Electrolytes: Potassiumb0227fe1-d8b0-4509-aadb-2765c6c34768
The causes of high anion gap metabolic acidosis may be remembered with the mnemonic {{c1::MUDPILES}}Methanol (→ formic acid) Uremia Diabetic ketoacidosis Propylene glycol Iron tablets or Isoniazid Lactic acidosis Ethylene glycol (→ oxalic acid) Salicylates (late) - Also can be caused by oxoproline (from chronic acetaminophen use) - Besides lactic acidosis (endogenous lactic acid), metabolic acidosis can be caused by exogenous lactic acid* ferric ions become hydrated and release protons → metabolic acidosis Watch Tuberculosis Drugs Watch Acid/Base Disorders Watch Metabolic AcidosisWatch associated Bootcamp video - Ethanol Metabolism: Applications Across Biochemistry Watch associated Bootcamp video - Metabolic Acidosisa0570960-ea99-42cf-b3a5-d53f6a8bf996
The causes of {{c1::high}} anion gap metabolic acidosis may be remembered with the mnemonic MUDPILES: {{c1::Methanol (→ formic acid)::M}} {{c1::Uremia::U}} {{c1::Diabetic ketoacidosis::D}} {{c1::Propylene glycol::P}} {{c1::Iron tablets::I}} or {{c1::Isoniazid::I}} {{c1::Lactic acidosis::L}} {{c1::Ethylene glycol (→ oxalic acid)::E}} {{c1::Salicylates (late)::S}}- Also can be caused by oxoproline (from chronic acetaminophen use) - Besides lactic acidosis (endogenous lactic acid), metabolic acidosis can be caused by exogenous lactic acid* ferric ions become hydrated and release protons → metabolic acidosis Watch Tuberculosis Drugs Watch Acid/Base Disorders Watch Metabolic AcidosisWatch associated Bootcamp video - Ethanol Metabolism: Applications Across Biochemistry Watch associated Bootcamp video - Metabolic Acidosisy13e213bc-275e-435b-9f5a-7cd2263952b4
The presence of RBC casts / dysmorphic RBCs in the urine indicates that hematuria/pyuria is of {{c1::glomerular}} or {{c2::renal tubular}} origin- If the glomerulus is damaged, then protein can pass through it - Non-glomerular = blood without protein or dysmorphic cells / casts Photo credit: Mohsenin V., CC BY 4.0, via Wikimedia Commons, modified by enhancing resolution via AI and croppingWatch associated Bootcamp video588b1723-338a-4087-b120-f0adc3f6a88a
Which type of cast is classically seen in glomerulonephritis and hypertensive emergency? {{c1::RBC casts}}Photo credit: Mohsenin V., CC BY 4.0, via Wikimedia Commons, modified by enhancing resolution via AI and croppingWatch Nephritic SyndromeWatch Glomerulonephritis SOAPWatch associated Bootcamp videoc25123c3-c4df-4908-aa8e-d7d4bdbfc6bb
{{c1::Hyaline}} casts are nonspecific and are often seen in concentrated urine samples (can be a normal finding)Photo credit: Chu-Su et al., CC BY 4.0, via Scientific ReportsWatch Nephritic SyndromeWatch associated Bootcamp video2fa4465a-1d75-4f4a-b480-ed7d0db7e05f
{{c1::Kawasaki}} disease may also be referred to as mucocutaneous lymph node syndromeWatch Large & Medium Vessel VasculitidesWatch associated Bootcamp video - Kawasaki Disease84148718-4f83-4a78-8306-4fc80d0b2e87
{{c2::Loop}} diuretics may cause {{c1::oto}}toxicityWatch Loop DiureticsWatch associated Bootcamp video - Loop Diureticsd4a23c7a-b08a-4146-992c-450c8e8e5889
Thiazide diuretics may cause {{c1::hyper}}calcemia as an adverse effect"- Due to increased reabsorption- Mild (usually < 12 mg/dL) ""hyperGLUC: hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia"" Photo Credit: Image licensed by Physeo and used with permission. Purchase full access here."Watch Thiazides Watch Calcium DisordersWatch associated Bootcamp video - Thiazide Diuretics8c75b614-44d9-414e-9592-d587bc04be35
Which type of nephrotic syndrome is most commonly seen in HIV patients? {{c1::Focal segmental glomerulosclerosis (FSGS)}}Also seen with heroin use, obesity, etcWatch Nephrotic SyndromeWatch Nephrotic Syndrome SOAPWatch associated Bootcamp video694615b9-ad00-4a54-aae3-d37f5596ecb2
What inclusion body may be seen inside the RBCs of patients with G6PD deficiency? {{c1::Heinz bodies}}Blood smear shows bite cells (left) and Heinz bodies (right) Photo Credit (left): Author: N. J. Wheeler, Jr, USC DCP; (right): “Heinz Body” by Timothy F. Herman; Muhammad U. Javaid., StatPearls [Internet]. is licensed under CC BY 4.0Watch G6PD Deficiency & Autoimmune Hemolytic Anemia (AIHA) Watch Pentose Phosphate Pathway & G6PD DeficiencyReview G6PD DeficiencyWatch associated Bootcamp video - G6PD Deficiency Watch associated Bootcamp video - Pentose Phosphate Pathway: Uses of NADPH and Clinical Implicationse8ee463d-b487-4833-876b-fbb33de9ca2b
Heinz bodies form due to precipitation of denatured {{c1::hemoglobin}} within RBCs- This card previously said globin chains (updated March 2024) - Hb sulfhydryl groups donate an electron to hydrogen peroxide, forming hemoglobin crosslinks - Classically associated with G6PD deficiency Photo credit: Ailuromancy, Public domain, via Wikimedia CommonsWatch G6PD Deficiency & Autoimmune Hemolytic Anemia (AIHA)Watch associated Bootcamp video - G6PD Deficiency Watch associated Bootcamp video - Pentose Phosphate Pathway: Uses of NADPH and Clinical Implications6cb30086-f5e2-4120-b497-10c29f845e03
Medium chain acyl-CoA dehydrogenase (MCAD) and primary carnitine deficiency are characterized by {{c1::hypo}}ketotic, {{c1::hypo}}glycemia- Due to impaired β-oxidation (ATP is needed for gluconeogenesis; acetyl CoA is needed for ketogenesis) - Occurs during periods of fasting (treatment is to avoid fasting)Review MCAD Deficiency Review Systemic Primary Carnitine DeficiencyWatch associated Bootcamp video - Lipid Metabolism: Disorders of Fatty Acid Metabolism5cc02f75-7056-486b-bc38-6ca0cd39935c
The enzyme {{c1::glucocerebrosidase (β-glucosidase)}} is deficient in {{c2::Gaucher}} diseaseReview Gaucher DiseaseWatch associated Bootcamp video - Gaucher Diseasec2b4ddc9-d3a1-4b07-897e-94ed20d436fe
The enzyme {{c1::α-galactosidase A}} is deficient in {{c2::Fabry}} diseaseReview Fabry DiseaseWatch associated Bootcamp video - Fabry Diseaseadebd70a-3617-40a1-b716-1076e1fe02b1
What is the mode of inheritance of Fabry disease? {{c1::X-linked recessive}}Review Fabry DiseaseWatch associated Bootcamp video - Fabry Disease7195df10-5c84-42ae-a625-44646c9c5e93
Early Fabry disease presents with a triad of: - {{c1::Peripheral neuropathy}} - {{c2::Angiokeratomas}} - {{c3::Hypohidrosis}}Photo credit: Ldmochowski, CC BY-SA 4.0, via Wikimedia CommonsReview Fabry DiseaseWatch associated Bootcamp video - Fabry Disease6faaf3e3-cca6-40c3-8257-f736c0c4a284
The enzyme {{c1::galactocerebrosidase}} is deficient in {{c2::Krabbe}} diseaseReview Krabbe DiseaseWatch associated Bootcamp video - Krabbe Disease3bcda5c3-3a7f-4fe7-9730-df912bc25bf7
"Which lysosomal storage disease is characterized by an ""onion skin"" lysosome? {{c1::Tay-Sachs disease}}"Review Tay-Sachs and Niemann-PickWatch associated Bootcamp video - Tay-Sach's Disease7b69a986-b00b-49b7-8744-c4f6ad237c4b
"Which lysosomal storage disease is characterized by ""foam cells"" (lipid-laden macrophages)? {{c1::Niemann-Pick disease}}"Pick at foam bubbles to pop them Niemann-Pick cell in the spleen Photo credit: W.CC, CC BY-SA 4.0, via Wikimedia CommonsReview Tay-Sachs and Niemann-PickWatch associated Bootcamp video - Niemann-Pick Disease0169e8c0-29ef-4d4b-a991-7d0da603c1fd
Which lysosomal storage disease is characterized by a cherry red spot on the macula and hepatosplenomegaly? {{c1::Niemann-Pick disease}}Photo credit: Jonathan Trobe, M.D., CC BY 3.0, via Wikimedia CommonsReview Tay-Sachs and Niemann-PickWatch associated Bootcamp video - Niemann-Pick Diseasede870655-90b2-4312-b04d-df315f84668c
Which lysosomal storage disease is characterized by macrophages resembling crumpled tissue paper? {{c1::Gaucher disease}}Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia CommonsReview Gaucher DiseaseWatch associated Bootcamp video - Gaucher Disease8f43a73c-5402-437a-aa13-8bd3e861aaba
Which lysosomal storage disease is associated with osteoporosis, bone crises, avascular necrosis, and pancytopenia? {{c1::Gaucher disease}}- Bone crises = extreme pain due to bone lesions - Pancytopenia secondary to increased blood cell consumption by enlarged spleen - Bone pathologies due to lysosomal proteolytic enzymes and inflammatory mediators that are destructive to boneWatch Sphingolipidoses: Gaucher Disease, Metachromatic Leukodystrophy, and Krabbe DiseaseReview Gaucher DiseaseWatch associated Bootcamp video - Gaucher Diseaseab60a608-8087-40fa-b0ee-42f38c37e5af
Which lysosomal storage disease may present with progressive renal failure and cardiovascular disease? {{c1::Fabry disease (late)}}Review Fabry DiseaseWatch associated Bootcamp video - Fabry Diseasef52a9de8-299c-4b95-baac-034fad974dbf
Which lysosomal storage diseases have an X-linked recessive inheritance? {{c1::Fabry disease, Hunter syndrome::2}}Review Hurler and Hunter Syndromes Review Fabry DiseaseWatch associated Bootcamp video - Fabry Disease Watch associated Bootcamp video - Mucopolysaccharidosescf7565be-b991-4822-9237-23fe5b3b85b4
What lysosomal storage disease presents with optic atrophy? {{c1::Krabbe disease}}Review Krabbe DiseaseWatch associated Bootcamp video - Krabbe Diseaseaabd3b90-f617-46b4-bb5c-1cdfc3da2113
What is the mode of inheritance of homocystinuria? {{c1::Autosomal recessive}}Watch HomocystinuriaReview Homocystinuria Small cart holding cyst (Autosomal recessive) Review Homocysteine MetabolismWatch associated Bootcamp video - Thrombophilias Watch associated Bootcamp video - Marfan Syndrome Watch associated Bootcamp video - Homocystinuria: Pathophysiologybd93b7b9-511c-4e09-aaf7-303720522308
{{c2::Homocystinuria}} is a metabolic disorder that may present with {{c1::marfanoid}} habitus, however with lens dislocation that subluxes {{c3::downward::direction}} and {{c3::inward::direction}}- They also have long limbs, chest deformities, osteoporosis in childhood - However, distinguish from Marfan by the fact that these patients clot more easily, lens subluxation is not up and out, and have mental deficitsWatch HomocystinuriaReview Homocystinuria Review Homocysteine MetabolismWatch associated Bootcamp video - Thrombophilias Watch associated Bootcamp video - Marfan Syndrome Watch associated Bootcamp video - Homocystinuria: Presentation, Diagnostics, and Management2ff5d211-f2c2-40a7-b727-7adcfd7d4850
Homocystinuria may present with {{c1::intellectual}} disability, osteoporosis, and kyphosisIntellectual disability is an important distinguishing feature from Marfan syndrome (homocystinuria may present with Marfanoid habitus)Watch HomocystinuriaReview HomocystinuriaWatch associated Bootcamp video - Thrombophilias Watch associated Bootcamp video - Marfan Syndrome Watch associated Bootcamp video - Homocystinuria: Presentation, Diagnostics, and Management70b5ce0a-0857-43da-849e-b5852f7f54e9
Homocystinuria causes increased risk for {{c1::thrombosis}} and {{c1::atherosclerosis}}, which may cause stroke and MI- Due to increased serum homocysteine - Significant morbidity and mortality are due primarily to thromboembolismWatch HomocystinuriaReview HomocystinuriaWatch associated Bootcamp video - Thrombophilias Watch associated Bootcamp video - Marfan Syndrome Watch associated Bootcamp video - Homocystinuria: Presentation, Diagnostics, and Management830928ec-8fee-4561-b5cf-92fa291bbc59
Which type of lung carcinoma may present with cavitations on CXR? {{c1::Squamous cell carcinoma}}Watch Lung CarcinomaWatch associated Bootcamp video - Pulmonary Non-Small Cell Carcinomaadac46f9-bb34-4f8e-b751-31e287657ba8
"The symptoms of {{c1::Lesch-Nyhan}} syndrome may be remembered with the mnemonic ""HGPRT"": {{c1::Hyperuricemia::H}}{{c1::Gout::G}}{{c1::Pissed off (aggression, self-mutilation)::P}}{{c1::Red/orange crystals::R}}{{c1::Tense muscles (dystonia)::T}}"- HGPRT is the enzyme that patients with Lesch-Nyhan are deficient in - Intellectual disability is also common with Lesch-Nyhan syndromeReview Lesch-Nyhan SyndromeWatch associated Bootcamp videoyb523ad2e-7919-423f-be19-6c459abe7e47
The symptoms of Lesch-Nyhan syndrome may be remembered with the mnemonic {{c1::HGPRT}}Hyperuricemia Gout Pissed off (aggression, self-mutilation) Red/orange crystals Tense muscles (dystonia) HGPRT is the enzyme that patients with Lesch-Nyhan are deficient inReview Lesch-Nyhan SyndromeWatch associated Bootcamp video7c0b2d8d-0a92-4085-bd01-46b3915b895b
One sign of vitamin {{c2::A}} deficiency is night {{c1::blindness (nyctalopia)}}Watch Vitamin AReview Vitamin C (Ascorbic Acid) Deficiency and ExcessWatch associated Bootcamp video - Vitaminsc3589406-4756-49fc-82d4-37ecae5881af
One sign of vitamin {{c2::A}} deficiency is corneal degeneration, known as {{c1::keratomalacia}}Photo Credit: Bijan et al., CC BY 4.0, via Wikimedia CommonsWatch Vitamin AReview Vitamin C (Ascorbic Acid) Deficiency and ExcessWatch associated Bootcamp video - Vitaminsbe8222f5-608a-4928-bb9e-835097c37929
One sign of vitamin {{c2::A}} deficiency is {{c1::Bitot spots}} on conjunctiva due to {{c3::squamous}} metaplasia of conjunctival epithelium"Goblet / columnar epithelium undergoes metaplasia to keratinizing squamous epithelium Photo credit: Bajyeroju et al., CC BY 2.0, via NCBI Photo credit: PHIL CDC Public domain, ID# 6189"Watch Vitamin AReview Vitamin C (Ascorbic Acid) Deficiency and ExcessWatch associated Bootcamp video - Vitamins Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Metaplasia5ec05258-a929-4ac2-9c6f-46d214c79293
Severe deficiencies of vitamin {{c2::B3}} can lead to {{c1::pellagra}}Review Hartnup Disease Review Vitamin B3 (Niacin) Biochemistry Review Vitamin B3 (Niacin) Deficiency and ExcessWatch associated Bootcamp video - Vitaminsb6ad2bbb-92f9-4227-acbf-05cd776d7a9e
Vitamin B9 (folate) deficiency most commonly occurs due to {{c1::pregnancy}}, {{c2::alcohol use disorder}}, or drugs (e.g. phenytoin, trimethoprim, methotrexate)- Folate is obtained from green veggies and some fruits and absorbed in the jejunum Causes of folate deficiency: - Malnutrition/poor diet: often seen in alcohol use disorder (most common nutritional cause of folate deficiency in the US) and the elderly- Malabsorption - Hemolytic anemia (increased requirement)Review Vitamin B9 and B12 Deficiencies Review De Novo Pyrimidine SynthesisWatch associated Bootcamp video - Vitamins Watch associated Bootcamp video - Folate (Vitamin B9) Deficiencya69cc78d-5c8c-42cd-acce-62d4bf8abfbd
What type of anemia is seen with vitamin B9 (folate) deficiency? {{c1::Macrocytic, megaloblastic anemia}}Review Vitamin B9 and B12 DeficienciesWatch associated Bootcamp video - Absorption of Folate Watch associated Bootcamp video - Activated Methyl Group Cycle: Clinical Implications Watch associated Bootcamp video - Vitamins Watch associated Bootcamp video - Folate (Vitamin B9) Deficiency26a458d6-083a-4c05-b20c-1043531dde30
Vitamin B9 (folate) deficiency is characterized by {{c1::normal}} methylmalonic acid levelsImportant distinguishing feature from B12 deficiency (B12 helps convert methylmalonic acid to succinyl-CoA) Deficiency SymptomsVitamin B9 (Folate)Vitamin B12 (Cobalamin)PMNsHypersegmentedHypersegmentedMethylmalonic AcidNormal↑Homocysteine↑↑AnemiaMacrocyticMacrocyticNeurological SymptomsNormalSubacute combined degeneration & psychiatric symptomsWatch Megaloblastic Anemia Folate Deficiency & Vitamin B DeficiencyReview Vitamin B9 and B12 DeficienciesWatch associated Bootcamp video - Homocysteine Metabolism Watch associated Bootcamp video - Folate (Vitamin B9) Deficiencyf78ce716-7868-404c-8fa3-fd2d201122c9
What parasite is associated with vitamin B12 deficiency? {{c1::Diphyllobothrium latum}}"""don't fill the bathroom"""* Diphyllobothrium is a genus of tapeworms which can cause diphyllobothriasis in humans through consumption of raw or undercooked fishReview Vitamin B9 and B12 DeficienciesWatch associated Bootcamp video - Cobalamin (Vitamin B12) Deficiencyebb9d2e1-5996-45d0-896e-6b1038af1a9a
What type of anemia is seen with vitamin B12 (cobalamin) deficiency? {{c1::Macrocytic, megaloblastic anemia}}Review Vitamin B9 and B12 DeficienciesWatch associated Bootcamp video - Cobalamin (Vitamin B12) Deficiencye88482d5-7660-4437-9379-e044bc9ea3cb
What is the clinical manifestation of vitamin C deficiency? {{c1::Scurvy}}These patients can't hydroxylate pro-alpha chains (hydroxylation of proline or lysine requires vitamin C), thus they can't form the triple helix and the nascent collagen is degraded in the cell without being secretedWatch Vitamin CReview Vitamin C (Ascorbic Acid) Deficiency and ExcessWatch associated Bootcamp video - Vitamins8b8c5c41-429f-45be-ba31-334968b27e88
What vitamin deficiency is commonly characterized by swollen gums, bruising, petechiae, and hemarthrosis? {{c1::Vitamin C deficiency (scurvy)}}- Blood vessel fragility leads to easy bleeding - Bruising is due to defective collagen (subendothelial collagen activates platelets by binding VWF / activates XII →XIIa) Photo Credit: Centers for Disease Control and Prevention, Public domain, via Wikimedia CommonsWatch Vitamin CReview Vitamin C (Ascorbic Acid) Deficiency and ExcessWatch associated Bootcamp video - Vitamins26a2e125-e484-49c5-a116-c2ea9417e287
Scurvy (vitamin C deficiency) is associated with poor {{c1::wound}} healingWound healing requires proper collagen synthesisWatch Vitamin CReview Vitamin C (Ascorbic Acid) Deficiency and ExcessWatch associated Bootcamp video - Vitamins8f796761-1d16-495b-b790-85448ac466f6
Oxybutynin and tolterodine are primarily used to treat {{c1::urgency incontinence (overactive bladder)}}Reduces bladder spasms and urgency incontinence (overactive bladder) via relaxation of the smooth muscle of the ureter and bladder wall (detrusor muscle)Watch Muscarinic AntagonistsWatch associated Bootcamp video - Micturition Overview Watch associated Bootcamp video - Urge Incontinence Watch associated Bootcamp video - Muscarinic Antagonistsdb7b9d25-9ae6-4807-a3d0-3d82c91b9636
{{c2::β}}-adrenergic blockers are a first-line option for {{c1::migraine}} prophylaxisFirst-line options: β-blockers or anticonvulsants (e.g., topiramate or valproate) TypeLocationFindingsTiming (hr)TreatmentTensionBilateralBand-like constant pain4 - 6 NSAIDs AmitriptylineMigraineUnilateral Aura, photophobia, phonophobia, nausea, vomiting, throbbing pain4 - 72NSAIDs Triptans* Dihydroergotamine* β-blockers (prophylaxis)ClusterUnilateral Lacrimation, rhinorrhea, ptosis, miosis Multiple headaches per day per week then remission15 min - 3100% O2 or sumatriptan*Avoid in pregnant patientsWatch Beta BlockersReview Migraine HeadachesWatch associated Bootcamp video - Beta Adrenergic Antagonists33533d41-e797-4cf6-95fb-ab5dcbe9b932
What hookworms are associated with iron deficiency anemia? {{c1::Ancylostoma duodenale and Necator americanus::2}}Photo credit: Ed Uthman, CC BY 2.0, via FlickrWatch Intestinal Nematodes: Enterobius, Ancylostoma, Necator, Ascaris, Strongyloides, and Trichinella Watch Iron Deficiency Anemia & Anemia of Chronic DiseaseWatch associated Bootcamp video - Iron Deficiency Anemia Watch associated Bootcamp video - Hookworm2404799c-5f6d-4114-945f-c2ae21bfeb00
What surgical procedure is associated with iron deficiency anemia (IDA)? {{c1::Gastrectomy}} * Bonus: Why?* Due to decreased acid, which normally maintains iron in the Fe2+ state (more readily absorbed than Fe3+)Watch Iron Deficiency Anemia & Anemia of Chronic DiseaseWatch associated Bootcamp video - Iron Deficiency Anemia68cdffdd-9204-46dc-9732-4356732c2d9c
Early stages of iron deficiency cause a(n) {{c1::normocytic::MCV}} anemiabone marrow makes fewer, but normal-sized, RBCsWatch Iron Deficiency Anemia & Anemia of Chronic DiseaseWatch associated Bootcamp video - Iron Deficiency Anemia6952835b-2dcf-4e26-ada8-4b9850ff603c
Later stages of iron deficiency cause a(n) {{c1::microcytic::MCV}} anemiabone marrow makes smaller and fewer RBCs Photo credit: Ed Uthman, CC BY 2.0, via FlickrWatch Iron Deficiency Anemia & Anemia of Chronic DiseaseWatch associated Bootcamp video - Iron Deficiency Anemia8ff92d51-dfdf-4583-9811-b12b01305271
In addition to symptoms of anemia, iron deficiency may also present with {{c1::pica}} and/or {{c2::koilonychia (spoon nails)}}Pica is the consumption of non-food substances (pagophagia-cravings for ice); image shows koilonychia Photo Credit: CHeitz, CC BY 2.0, via Wikimedia CommonsWatch Iron Deficiency Anemia & Anemia of Chronic DiseaseWatch associated Bootcamp video - Iron Deficiency Anemia9ef99f8c-7270-44a8-8d45-d3db1965bd04
{{c1::Thalassemia}} is an anemia due to decreased synthesis of {{c2::globin chains}}Watch Microcytic Anemia: Overview & ThalassemiasWatch associated Bootcamp video - ⍺-Thalassemia27c16f1e-e4c4-4161-9aff-f0459b3e46f2
Thalassemia is a cause of {{c1::microcytic::MCV}} anemia- Usually <70 μm3 - Due to decreased production of globin chains - Thalassemia = tiny (microcytic)Watch Microcytic Anemia: Overview & ThalassemiasWatch associated Bootcamp video - ⍺-Thalassemia4a6d8a0f-8eea-4ada-9f18-7a71a7c97d7a
{{c3::β}}-thalassemia is most commonly seen in individuals of {{c2::Mediterranean}} descentHeavily affected countries/regions include Greece, Turkey, Italy, France, Spain, North Africa, and West AsiaWatch Microcytic Anemia: Overview & ThalassemiasWatch associated Bootcamp video - β-Thalassemia929a5faa-95d3-47ab-9acc-e539c9f7f60e
Diagnosis of {{c3::β-thalassemia minor}} is confirmed by an isolated increase in {{c1::HbA2}} ({{c2::> 3.5}}%) on electrophoresisNormal is 2.5%; may also have slightly elevated HbF and slightly decreased HbAWatch Microcytic Anemia: Overview & ThalassemiasWatch associated Bootcamp video - β-Thalassemiace781f18-d995-4431-9a24-dfff2ff480f5
Impaired division of granulocytic precursors in {{c2::megaloblastic}} anemia leads to {{c1::hypersegmented}} neutrophils- ≥6 lobes - The presence of even a single neutrophil with more than 6 lobes should raise suspicion of megaloblastic anemia Photo Credit: Ed Uthman from Houston, TX, USA, CC BY 2.0, via Wikimedia CommonsWatch Megaloblastic Anemia Folate Deficiency & Vitamin B DeficiencyWatch associated Bootcamp video - Folate (Vitamin B9) Deficiency3336066d-563f-4100-90b8-6889d6ae54ae
One cause of folate deficiency is increased demand, which is often seen with {{c1::pregnancy}}, {{c2::hemolytic}} anemia, and cancerWatch Megaloblastic Anemia Folate Deficiency & Vitamin B DeficiencyReview Vitamin B9 and B12 DeficienciesWatch associated Bootcamp video - Folate (Vitamin B9) Deficiencya5691fd7-8c01-4bfe-8fca-45b87ef2a4bc
Folate deficiency is characterized by {{c1::macrocytic::MCV}} RBCsDeficiency SymptomsVitamin B9 (Folate)Vitamin B12 (Cobalamin)PMNsHypersegmentedHypersegmentedMethylmalonic AcidNormal↑Homocysteine↑↑AnemiaMacrocyticMacrocyticNeurological SymptomsNormalSubacute combined degeneration & psychiatric symptomsReview Vitamin B9 and B12 DeficienciesWatch associated Bootcamp video - Folate (Vitamin B9) Deficiency4da16a7c-a58f-4a20-94a2-2b33ebcf323a
Vitamin B12 deficiency takes {{c1::years::time}} to develop while vitamin B9 (folate) deficiency takes {{c1::months::time}}"- B12 deficiency takes years due to large hepatic stores - Dietary B12 deficiency rarely occurs, only in strict vegans (no eggs or milk) - Folate deficiency takes months because body stores are minimal, ""Folate Finishes Faster"""Review Vitamin B9 and B12 DeficienciesWatch associated Bootcamp video - Folate (Vitamin B9) Deficiency Watch associated Bootcamp video - Cobalamin (Vitamin B12) Deficiency0d079422-f154-4d18-9735-416b4c77864f
What is the most common etiology of vitamin B12 deficiency? {{c1::Pernicious anemia}}Autoimmune destruction of parietal cells (chronic autoimmune gastritis) leads to intrinsic factor deficiencyWatch Megaloblastic Anemia Folate Deficiency & Vitamin B DeficiencyReview Vitamin B9 and B12 DeficienciesWatch associated Bootcamp video - Gastrointestinal Secretions Watch associated Bootcamp video - Cobalamin (Vitamin B12) Deficiency42ee748b-7ea1-48a0-9f48-9fd0e2789573
Vitamin B12 deficiency is characterized by {{c1::increased}} serum methylmalonic acidImportant distinguishing feature from folate deficiency Deficiency SymptomsVitamin B9 (Folate)Vitamin B12 (Cobalamin)PMNsHypersegmentedHypersegmentedMethylmalonic AcidNormal↑Homocysteine↑↑AnemiaMacrocyticMacrocyticNeurological SymptomsNormalSubacute combined degeneration & psychiatric symptomsWatch Organic Acidemias Watch Megaloblastic Anemia: Folate Deficiency & Vitamin B DeficiencyReview Vitamin B9 and B12 DeficienciesWatch associated Bootcamp video - Cobalamin (Vitamin B12) Deficiency8192df46-0b0d-47e8-9e2d-5d0959484782
Normocytic anemia with {{c2::intra}}vascular hemolysis is associated with {{c1::decreased}} serum haptoglobin- Haptoglobin is consumed as it binds free hemoglobin - Haptoglobin is a serum protein that binds free hemoglobin for removal by the reticuloendothelial systemWatch Intravascular Hemolysis Overview & Paroxysmal Nocturnal Hemoglobinuria (PNH)Watch associated Bootcamp video - Hemolysis01f9bc38-2142-4db6-ab19-6263586bfc1b
{{c1::Hereditary spherocytosis}} is due to an inherited defect of RBC cytoskeleton-membrane tethering proteinsWatch Extravascular Hemolysis Overview & RBC Membrane DefectsReview Hereditary SpherocytosisWatch associated Bootcamp video - Hereditary Spherocytosisae583326-4d37-47b8-a373-f64a5790728c
Spherocytes are less able to maneuver through splenic sinusoids and are thus consumed by {{c1::splenic macrophages}}e.g. hereditary spherocytosis; results in anemia Photo credit: Ed Uthman, CC BY 2.0, via FlickrWatch Extravascular Hemolysis Overview & RBC Membrane DefectsReview Hereditary SpherocytosisWatch associated Bootcamp video - Hereditary Spherocytosise57658d1-93de-4a19-95ec-86ad7c7b155d
What is the treatment for severe or refractory hereditary spherocytosis? {{c1::Splenectomy}}- Spherocytes aren't problematic; problem is consumption by the spleen - Most cases can be managed with supportive care (e.g. folic acid supplementation, blood transfusions as needed)Watch Extravascular Hemolysis Overview & RBC Membrane DefectsWatch associated Bootcamp video - Hereditary Spherocytosis2c031ed9-34db-4ac7-8ac3-0e8a2f1b89ea
Do spherocytes persist following splenectomy in a patient with hereditary spherocytosis? {{c1::Yes}}Splenectomy is a treatment for EXTRAvascular hemolysis, however, spherocytes persist due to underlying genetic defect* Sharp farming implements: splenectomy is a treatment for EXTRAvascular hemolysis, however, spherocytes persist due to underlying genetic defect Watch Extravascular Hemolysis Overview & RBC Membrane DefectsWatch associated Bootcamp video - Hereditary Spherocytosis4e85f8fd-66cf-4706-a4f1-3349e149fe4a
Diagnosis of sickle cell anemia is confirmed by hemoglobin {{c1::electrophoresis::test}}Watch Sickle Cell DiseaseWatch associated Bootcamp video - Sickle Cell Anemia Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemia9dae3221-1064-4b37-9cfa-f6d4e26665d6
Hydroxyurea is useful in the treatment of sickle cell anemia because it increases levels of {{c1::HbF}} (typically >15%)- Unknown mechanism - ↑ HbF → ↓ HbS → ↓ pain crises, need for transfusions, and episodes of acute chest syndromeWatch Sickle Cell DiseaseWatch associated Bootcamp video - Blood Physiology: Hemoglobin Watch associated Bootcamp video - Sickle Cell Anemia Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemia2eaaaca3-540f-44cf-8c26-6cf65b9a9510
{{c1::Paroxysmal nocturnal hemoglobinuria (PNH)}} may be confirmed via {{c3::flow cytometry}}, which detects a lack of CD{{c2::55}} and CD{{c2::59}}DAF = CD55 MIRL = CD59* CD55= DAF, CD59= MIRL Watch Complement System DisordersWatch associated Bootcamp video - Paroxysmal Nocturnal Hemoglobinuria Watch associated Bootcamp video - Complement Disorders40fa9073-0798-474a-9e63-fa1145471c8b
What is the main cause of death in patients with paroxysmal nocturnal hemoglobinuria? {{c1::Venous thrombosis}}- e.g., hepatic, portal, or cerebral thrombosis Mechanisms - Hemolysis → free hemoglobin binds NO → vasoconstriction + oxidative stress → platelet aggregation - Hemolysis → oxidative stress → activation of vessel endothelium → platelet aggregation - Platelet destruction → release of cytoplasmic contents into circulation → thrombosisWatch Intravascular Hemolysis Overview & Paroxysmal Nocturnal Hemoglobinuria (PNH)Watch associated Bootcamp video - Paroxysmal Nocturnal Hemoglobinuria Watch associated Bootcamp video - Complement Disorders4e41afcb-fecd-4a92-bf9c-6f5cc43d2a5b
What class of drugs is contraindicated in patients with G6PD deficiency? {{c1::Sulfa drugs::Besides anti-malarials or NSAIDs}}Other drugs contraindicated in patients with G6PD include anti-malarials (e.g. primaquine), NSAIDs, isoniazid, etc.Watch G6PD Deficiency & Autoimmune Hemolytic Anemia (AIHA) Watch Pentose Phosphate Pathway & G6PD DeficiencyReview G6PD DeficiencyWatch associated Bootcamp video - G6PD Deficiency Watch associated Bootcamp video - Pentose Phosphate Pathway: Uses of NADPH and Clinical Implications Watch associated Bootcamp video - Antiparasitics: Chloroquine-Resistant and Exo-Erythrocytic Antimalarials66628b8c-fb45-45cb-8a72-10661349d436
IgM-mediated hemolytic anemia is commonly associated with {{c1::Mycoplasma pneumoniae}} infection and {{c2::infectious mononucleosis}}- Also known as cold agglutinin hemolytic anemia (CAHA) - IgM: Mycoplasma, MononucleosisWatch G6PD Deficiency & Autoimmune Hemolytic Anemia (AIHA)Review Mycoplasma pneumoniaeWatch associated Bootcamp video - Mycoplasma and Ureaplasma233ba5eb-d8a1-4548-be2d-885b2c39bd5f
Aplastic anemia may be caused by {{c2::Fanconi}} anemia, which occurs due to a(n) {{c1::dsDNA repair}} defect, resulting in bone marrow failure- Defect in homologous recombination (double-stranded break repair) - DsDNA breaks can be detected by the FA core complex, acting as a nidus to recruit BRCA repair enzymes Photo Credit: Chaya5260, CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Aplastic Anemiacbc8df75-0086-4a70-ad38-fdb080444cdf
{{c2::Fanconi}} anemia is associated with short stature, café-au-lait spots, and malformed forearms and/or {{c1::thumbs}}- Thumbs with a very thin base of attachment - Radial clubhand = malformed forearms Photo credit: Rage et al., CC BY 4.0, via Scientific ResearchWatch associated Bootcamp video - Aplastic Anemia5fdcbeff-929c-4c66-b43b-7c9eae2abfbe
Fanconi anemia is associated with an increased risk of developing {{c1::cancer (e.g. tumors, leukemia)}}Defect in mechanism to repair dsDNA breakWatch associated Bootcamp video - Aplastic Anemia460c537b-c1d1-434a-b75b-5338724872d0
The levels of TBG and total thyroid hormone are {{c1::decreased}} with {{c2::hepatic}} failure, {{c3::steroid}} use, and {{c4::nephrotic}} syndrome- Due to decreased TBG synthesis by the liver - Decreased TBG is detected via increased resin uptake (T3 resin uptake test)8376899e-3d7f-4034-8d65-62bbc3bbc787
"The autonomic nervous system usually reaches its target via {{c1::two::#}} neuron(s)"*There are some exceptions; this is a simplified version CNS → preganglionic nerve fiber → ganglion → postganglionic nerve fiber → targetWatch associated Bootcamp video - Autonomic System Overview Watch associated Bootcamp video - Autonomic System Signaling15d72548-4bcc-4094-ae7a-6c7b99309f6a
The pre-ganglionic neurons of the ANS have cell bodies in the {{c1::central}} nervous system*there are some exceptions- this is a simplified version CNS → preganglionic nerve fiber→ ganglion → postganglionic nerve fiber → targetWatch Cells of the Nervous SystemWatch associated Bootcamp video - Autonomic System Overview Watch associated Bootcamp video - Autonomic System Signaling7482744c-fbe3-4bc4-a1af-e511668e9c42
The post-ganglionic neurons of the ANS have cell bodies in the {{c1::peripheral}} nervous system*there are some exceptions—this is a simplified version CNS → preganglionic nerve fiber→ ganglion → postganglionic nerve fiber → targetWatch Cells of the Nervous SystemWatch associated Bootcamp video - Autonomic System Overview Watch associated Bootcamp video - Autonomic System Signalingb1bdff74-6a09-4df4-b523-ca2457c80782
All pre-ganglionic neurons utilize {{c1::acetylcholine}} as their neurotransmitterSketchy Physiology: Autonomic Nervous System Sketchy Physiology: Autonomic Nervous SystemWatch associated Bootcamp video - Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA Watch associated Bootcamp video - Autonomic System Overview Watch associated Bootcamp video - Autonomic System Signalingeda09594-d242-47a8-b9b6-709b6941fb1d
The acetylcholine from pre-ganglionic neurons of the ANS binds to {{c1::neural nicotinic (NN)}} receptorsWatch Cholingeric Receptors (Cholinoreceptors)Watch associated Bootcamp video - Autonomic System Overview Watch associated Bootcamp video - Autonomic System Signaling Watch associated Bootcamp video - Receptor Physiology97d2f20c-ad90-4d17-9d9c-91b77dbba46f
All post-ganglionic {{c2::parasympathetic}} neurons utilize {{c1::acetylcholine}} as their neurotransmitterSketchy Physiology: Autonomic Nervous SystemWatch associated Bootcamp video - Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA Watch associated Bootcamp video - Autonomic System Overview Watch associated Bootcamp video - Autonomic System Signaling24d9ba2e-3180-4a52-a7b1-cc68216a25d9
The acetylcholine from post-ganglionic neurons of the ANS binds to {{c1::muscarinic (M)}} receptorsWatch Cholingeric Receptors (Cholinoreceptors)Watch associated Bootcamp video - Autonomic System Overview Watch associated Bootcamp video - Autonomic System Signalingb3b853aa-82c7-4155-90cb-15d3faa26cf6
"The somatic nervous system reaches its target via {{c1::one::#}} neuron(s)"Watch associated Bootcamp video - PNS - Somatic Division Watch associated Bootcamp video - Autonomic System Overview Watch associated Bootcamp video - Autonomic System Signaling8d2db97d-86fe-4242-a80e-74c00c2598a0
The somatic nervous system utilizes {{c1::acetylcholine}} as its neurotransmitterWatch associated Bootcamp video - Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA Watch associated Bootcamp video - Autonomic System Overview Watch associated Bootcamp video - Autonomic System Signaling209fff7c-85fb-42cc-938b-9da27301323b
The acetylcholine from the somatic nervous system binds to {{c1::muscle nicotinic (NM)}} receptors in the NMJ of skeletal muscleWatch Myasthenia Gravis & Lambert Eaton Myasthenic Syndrome Sketchy Physiology: Cellular Physiology Watch Cholingeric Receptors (Cholinoreceptors)Watch associated Bootcamp video - Skeletal Muscle Depolarization Watch associated Bootcamp video - Autonomic System Overview Watch associated Bootcamp video - Autonomic System Signaling Watch associated Bootcamp video - Receptor Physiology62a3ff22-650c-49bb-8b2a-f1b208e5b70e
Nerves of the somatic nervous system innervate {{c1::skeletal muscle}}Watch Major Divisions of the Nervous SystemWatch associated Bootcamp video - Autonomic System Overview Watch associated Bootcamp video - Autonomic System Signalingf664c8ea-1593-4695-868d-ab84d77480e0
Which cranial nerves carry parasympathetics? {{c1::III, VII, IX, X::4}}OriginCranial nerves III, VII, IX Cranial nerve XPelvic splanchnic nerves (S2, S3, S4)Site of SynpaseFour cranial gangliaTerminal ganglia (in or near the walls of the viscera)Terminal ganglia (in or near the walls of the viscera)InnervationGlands and smooth muscle of the headViscera of the neck, thorax, foregut, and midgut Hindgut and pelvic viscera (inclusing bladder and erectile tissue)Watch Cranial Nerve VII (Facial Nerve) Watch Cranial Nerve IX (Glossopharyngeal) Watch Cranial Nerve X (Vagus)Review Oculomotor Nerve (CN III) Review Facial Nerve (CN VII)Watch associated Bootcamp video - Autonomic System Overviewa923f64b-8a98-4764-9206-6ced985a0f3e
Which sacral nerves carry parasympathetics? {{c1::S2 - S4}}pelvic splanchnic nerves (S2-S4) OriginCranial nerves III, IV, IXCranial nerve XPelvic splanchnic nerves (S2, S3, S4)Site of SynpaseFour cranial gangliaTerminal ganglia (in or near the walls of the viscera)Terminal ganglia (in or near the walls of the viscera)InnervationGlands and smooth muscle of the headViscera of the neck, thorax, foregut, and midgut Hindgut and pelvic viscera (inclusing bladder and erectile tissue)Watch associated Bootcamp video - Micturition Overview Watch associated Bootcamp video - Autonomic System Overview6b4bfded-d6fb-4d5e-b83a-106120a32c14
All pre-ganglionic sympathetic neurons can synapse in {{c1::sympathetic chain (paravertebral)}} gangliamay occur in ganglia at the same or different segmental level of the chainSketchy Physiology: Autonomic Nervous SystemWatch associated Bootcamp video - Autonomic System Overview1f6dcb9e-f8ff-48fc-bec5-47af868280c6
What type of cells are neurons? {{c1::Permanent (do not divide in adulthood)::Labile, stable, or permanent?}}Cell Types Characteristics Examples Permanent cells Remain in G0 phase Regenerate via cell differentiation from stem cells Neurons Cardiac muscle cells Quiescent stable cells Can enter G1 phase from G0 phase when stimulated Hepatocytes Lymphocytes Labile cells Rapidly dividing cells Short G1 phase & never enter G0 phase Fast cell turnover, makes them vulnerable to chemotherapy Epithelial cells in mucous membranes, skin Hematopoietic tissueWatch associated Bootcamp video - Neuronal Mechanics62dab370-522f-4b8c-9ea9-edf4ef79c8ad
{{c1::Glial}} cells refer to the non-neuronal cells of nervous systeme.g. oligodendrocytes, astrocytes, Schwann cells, microglia, etc. Photo credit: OpenStax, CC BY 4.0Watch Cells of the Nervous SystemWatch associated Bootcamp video - Cell Types Watch associated Bootcamp video - Neuronal Mechanicsca5c65bc-56b6-4789-b88f-fd6038056b27
{{c2::Oligodendrocytes}} are responsible for myelinating axons of neurons in the {{c1::central}} nervous systemPhoto credit: OpenStax, CC BY 4.0Watch Multiple Sclerosis Watch Cells of the Nervous SystemWatch associated Bootcamp video - Cell Typesa2d9597b-f651-4632-ab1f-54c8d966c8f6
Each oligodendrocyte can myelinate {{c1::many}} axon(s)One oligodendrocyte can myelinate ~ 30 axons Photo credit: OpenStax, CC BY 4.0Watch Cells of the Nervous SystemWatch associated Bootcamp video - Cell Typesf1a8b09f-a8dc-4678-bcb7-2310ad8ad219
What protein is used as an astrocyte marker? {{c1::Glial fibrillary acidic protein (GFAP)}}Watch associated Bootcamp video - Cell Types Watch associated Bootcamp video - Cytoskeleton Watch associated Bootcamp video - Adult Tumor General Principles078cd60b-ac81-4f8b-bf4d-5ed919cefc44
{{c2::Astrocytes}} are glial cells that are responsible for {{c1::reactive gliosis}} in response to neural injuryThey may fill up the extracellular space left by degenerating neurons by forming an astroglial scar Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Cell Typesac97a11f-07e9-4f70-8569-a1b54b2e85e2
{{c2::Schwann cells}} are responsible for myelinating axons of neurons in the {{c1::peripheral}} nervous systemWatch Cells of the Nervous SystemWatch associated Bootcamp video - Cell Types Watch associated Bootcamp video - Sorbitol and the Polyol Pathway489b480e-d3ec-4913-a84d-bdaed54b8c5f
Each Schwann cell can myelinate {{c1::one}} axon(s)- One cell myelinates one internodal segment of a single axon - SchwaONEWatch Cells of the Nervous SystemWatch associated Bootcamp video - Cell Types01711f77-2b78-4316-a383-824b2c163539
In myelinated cells, nodes of {{c2::Ranvier}} increase conduction velocity via {{c1::saltatory}} conduction- These nodes are sites of high capacitance and low resistance - Myelin decreases membrane capacitance (reduces amount of charge stored by membrane) and increases membrane resistance (reduces charge leakage through the membrane) in axon segments between nodes of RanvierWatch Cells of the Nervous SystemWatch associated Bootcamp video - Neuronal Conduction920decf0-bfd1-4f03-9def-796c16b6816e
At the nodes of Ranvier, there is a high concentration of {{c1::Na+}} channelsThus, this is a site of inward currentWatch Action Potentials Watch Cells of the Nervous SystemWatch associated Bootcamp video - Neuronal Conduction1e1b9ba2-0dd5-4d18-98c4-8aeb59b313bc
Myelin wraps and insulates axons, thus {{c1::increasing}} the space (length) constant- This is a measure of how far along an axon an electrical impulse can propagate without requiring active regeneration by ion channels (e.g. till a depolarizing current will spread along a nerve and decay it to 1/3 its original potential) - Myelin reduces charge dissipation across the membrane, allowing electrical impulse from individual sodium channels to travel farther (allowing activation of more distant channels) - In multiple sclerosis, the space constant is decreased (due to demyelination)Watch Cells of the Nervous SystemWatch associated Bootcamp video - Neuronal Conductiona10d1e0c-c8fa-40ec-b17b-f1f867b3c830
Myelin wraps and insulates axons, thus {{c1::decreasing}} the time constant- The time constant indicates how quickly a cell membrane depolarizes in response to an inward current - Myelin decreases membrane capacitance (reduces amount of charge stored by membrane) and increases membrane resistance (reduces charge leakage through the membrane) in axon segments between nodes of RanvierWatch Cells of the Nervous SystemWatch associated Bootcamp video - Neuronal Conduction3e310158-6ca6-4f0f-905f-7f663c1d3da2
Some ependymal cells differentiate into choroid epithelial cells, which produce {{c1::cerebrospinal fluid (CSF)}}These cells are continuous with the choroid plexusWatch Blood-Brain Barrier & CSF Watch Cells of the Nervous SystemWatch associated Bootcamp video - Cerebellum and Ventricles Anatomical Considerations2e07be5a-b05d-4047-b7c1-f881417d8197
Which type of glial cell is a derivative of mononuclear phagocytes? {{c1::Microglia}}Phagocytic scavenger cells of CNS Photo credit: OpenStax, CC BY 4.0Watch Cells of the Nervous SystemWatch associated Bootcamp video - Cell Types3173d155-b5f5-4e05-b4d8-fb9462234d5a
{{c1::Microglia}} fuse to form multinucleated giant cells in the CNS when infected by {{c2::HIV}}- Initially, HIV-infected monocytes cross BBB and become perivascular macrophages that release HIV-derived proteins / inflammatory cytokines - Microglia form nodules around these macrophages and fuse to form giant cells and nodules - Chronic HIV encephalitis is due to nodules of these multinucleated microgliaWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Cell Typesb13184f5-ec07-4aba-97a2-2672f9cd6b9a
Which molecular motor protein is used for retrograde axonal transport? {{c1::Dynein}}i.e. from axon terminal to cell body Photo credit: Duncan J.E., Goldstein L.S.B., CC BY 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Neuronal Mechanics Watch associated Bootcamp video - Cytoskeleton57022b70-ce44-4085-8688-318cee83be63
Non-polar and lipid-soluble substances cross the blood-brain barrier rapidly via {{c1::diffusion}}e.g. O2, CO2Watch Blood-Brain Barrier & CSF895dfd0b-5cf7-4f95-b4de-870f9078c2f8
{{c2::Glucose}} and {{c3::amino acids}} cross the blood-brain barrier slowly via {{c1::carrier-mediated}} transport mechanismsWatch Blood-Brain Barrier & CSF90bdf06b-65c8-4069-ade1-c8dbb1a68f90
Na+ and K+ ions cross the blood-brain barrier via {{c1::ion channels}}Watch Blood-Brain Barrier & CSFd8d83db3-c8d8-4f42-9d37-4565110e1459
{{c2::Distal}} to a site of CNS or PNS axon injury there is {{c1::Wallerian}} degeneration- Anterograde degeneration of the axon usually begins within a few days after lesion onset - This is the disintegration of the axon and myelin sheath with macrophages removing debris Photo credit: Frontiers [https://doi.org/10.3389/fncel.2017.00022]Watch associated Bootcamp video - Wallerian Degeneration528be91c-04b3-42e2-a746-f3f708bbe86e
In response to axon damage, the neuron cell body undergoes {{c1::axonal reaction}}, which is the swelling of the cell body and dispersion of Nissl substance ({{c2::chromatolysis}})- The nucleus also moves to the periphery - These are the changes seen in the neuronal body after the axon is severed- This becomes visible in 24 to 48 hours after injury; maximal changes in neuronal body occur approximately 12 days after the injury Photo credit: Frontiers [https://doi.org/10.3389/fncel.2017.00022]Watch associated Bootcamp video - Wallerian Degenerationc5d24883-5990-4534-bfdb-19898679731f
Axons that are myelinated by {{c1::Schwann cells}} have the potential to regenerate following injurySchwann cell doesn't degenerate, which provides a scaffold for regeneration and remyelination of the axonWatch associated Bootcamp video - Wallerian Degeneration Watch associated Bootcamp video - Cell Typesbbba983c-db49-4fbb-a80d-7253c1b8dc47
Axons that are myelinated by {{c1::oligodendrocytes}} do not have the potential to regenerate following injuryOligodendrocytes do NOT have a robust system of removing axonal (myelin debris): - BBB results in slow recruitment of phagocytic macrophages / microglia - Myelin-producing oligodendrocytes become inactive or undergo apoptosis and do not assist with phagocytosis - These inactive oligodendrocytes produce myelin-associated inhibitory factors and myelin debris is not removed Astrocytes also proliferate to form a glial scar, blocking axonal growth and releasing myelin inhibitory factors Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Wallerian Degeneration Watch associated Bootcamp video - Cell Typesf419062b-b112-4451-96a4-615a92523fd0
The lateral ventricles drain into the {{c1::3rd ventricle}} via the {{c2::foramen of Monro}}Watch HydrocephalusWatch associated Bootcamp video - Hydrocephaluse61889b8-9c89-487b-b912-5e32e68d3c56
The 3rd ventricle drains into the {{c1::4th ventricle}} via the {{c2::cerebral aqueduct (of Sylvius)}}Watch HydrocephalusWatch associated Bootcamp video - Hydrocephalus4734e7e3-ffa3-481d-bd85-bb8aa66d907f
The CSF in the 4th ventricle may enter the {{c1::subarachnoid space}} via the lateral {{c2::foramina of Luschka (2)}}- Medial = Magendie - Lateral = LuschkaWatch HydrocephalusWatch associated Bootcamp video - Hydrocephalusf631ccfc-a8e9-461f-8ea8-c859020c51c3
The CSF in the 4th ventricle may enter the {{c1::subarachnoid space}} via the medial {{c2::foramen of Magendie (1)}}- Medial = Magendie - Lateral = LuschkaWatch HydrocephalusWatch associated Bootcamp video - Hydrocephaluse8adccf2-c2de-4792-a6d8-114941252e1e
CSF in the subarachnoid space is reabsorbed through {{c1::arachnoid granulations}}, which drain into {{c2::dural venous sinuses}}- Fluid is drained into there from the fourth ventricle through the foramina of Luschka / Magendie - These can be damaged by bacterial infections of the meninges (causing a communicating high pressure hydrocephalus) Photo Credit: OpenStax image 1, image 2, CC BY 4.0, via Wikimedia CommonsWatch Hydrocephalus Watch MeningesWatch associated Bootcamp video - Hydrocephalusec91022d-4122-42ee-b70b-54b7ed0ac28b
Which dural venous sinus is the main location of CSF return via arachnoid granulations? {{c1::Superior sagittal sinus}}Photo credit: OpenStax, CC BY 4.0Watch MeningesWatch associated Bootcamp video - Cerebellum and Ventricles Anatomical Considerations03362a15-0531-48fe-a0b5-beedc68900b2
Treatment for tetanus includes {{c1::antitoxin}}, metronidazole ± vaccine booster; may also give diazepam for muscle spasms and debride the woundAntitoxin = Human tetanus immunoglobulin (HTIG)Watch associated Bootcamp video - Clostridium Tetani7ce39399-0f90-474c-a8aa-32a6d1bd4696
Nerves C1 - C7 exit {{c1::above::above or below}} the corresponding vertebrae.g. C2 exits above vertebra C2 - C8 exits below vertebra C7 and above vertebra T1; there is no corresponding C8 vertebraWatch associated Bootcamp video - Spinal Cord Anatomical Considerations Watch associated Bootcamp video - Spinal Anatomyefd12ae1-29e5-43cb-bf2e-f7986b42f3b1
The L2 nerve exits {{c1::below}} the L2 vertebrae.g., all nerves outside of cervical nerves exit belowWatch associated Bootcamp video - Spinal Cord Anatomical Considerations Watch associated Bootcamp video - Spinal Radiculopathyaf103be8-f7f9-4db9-94ee-77c891ee2f63
Inside the spinal cord, {{c1::gray}} matter is centrally locatedWatch Major Divisions of the Nervous SystemWatch associated Bootcamp video - Spinal Cord Anatomical Considerations8bba13dc-416f-4b50-8c16-4d8337d72db8
Inside the spinal cord, {{c1::white}} matter is peripherally locatedWatch Major Divisions of the Nervous SystemWatch associated Bootcamp video - Spinal Cord Anatomical Considerationse0e70c03-cd8b-41e8-81f1-8e0ff9bf0702
Which matter in the spinal cord contains functionally similar axons called tracts or fasciculi? {{c1::White matter}}Watch associated Bootcamp video - Spinal Cord Anatomical Considerationsd34b3421-5b0d-4815-806c-b5b0f69eaf83
In adults, the spinal cord ends at the lower border of the {{c1::L1}} - {{c1::L2}} vertebraeTherefore, lumbar punctures are usually done at L3-L5 Image licensed by Physeo and used with permission. Purchase full access here.Watch associated Bootcamp video - Spinal Cord Anatomical Considerations3023b2ba-c5c4-4c48-9812-c2bde07a9b82
Lumbar puncture is usually performed between {{c1::L3}} and {{c1::L5}}"- At the level of the cauda equina; the goal is to sample the CSF without damaging the spinal cord - Place the patient in the recumbent position, then draw a line between the highest points of the iliac crests to identify the L4 vertebral body, then typically insert the needle into the L4/L5 space ""To keep the cord alive, keep the needle between L3 and L5"" Image licensed by Physeo and used with permission. Purchase full access here."Watch MeningesWatch associated Bootcamp video - Lumbar Puncture and Epidural Anesthesia Watch associated Bootcamp video - Spinal Cord Anatomical Considerations Watch associated Bootcamp video - Infectious Neuropathology: Atypical Meningoencephalitis9afcf391-8c8e-45f7-a16e-118668fc02f8
The neuronal cell bodies of the dorsal roots of spinal nerves are found in {{c1::dorsal root ganglia}}Watch associated Bootcamp video - Spinal Cord Anatomical Considerationsb88cc8e1-0eeb-494c-a746-87b6ef8ff5ba
The neuronal cell bodies of the ventral roots of spinal nerves are found in the {{c1::ventral horn}} of the spinal cordWatch associated Bootcamp video - Spinal Cord Anatomical Considerations64c98aa2-52f0-4fbc-a435-06c6896e9f4d
The {{c1::conus medullaris}} is the caudal end of the spinal cord; ends at L2 vertebra in adultsImage licensed by Physeo and used with permission. Purchase full access here.Watch associated Bootcamp video - Cauda Equina vs Conus Medullaris Syndromed4283106-85ae-4bff-a4d8-d64e20298565
The {{c1::cauda equina}} comprises the nerve roots of lumbar, sacral, and coccygeal spinal nerves below the conus medullarisPhoto credit: Henry Gray, Public domain, via Wikimedia Commons Image licensed by Physeo and used with permission. Purchase full access here.Watch Meninges Watch Lumbosacral NervesWatch associated Bootcamp video - Cauda Equina vs Conus Medullaris Syndrome876dfbda-f69d-4d5d-80a5-1c75c68383cb
Within the ventral horn, alpha and gamma motor neurons that innervate {{c2::flexors}} are located more {{c1::dorsally}}Flexors - Dorsally Extensors - Ventrally Proximally - Medially Distally - LaterallyWatch associated Bootcamp video - Muscle Proprioception9545c150-bfb5-4ad5-8380-bb4c2e8ae8b8
Within the ventral horn, alpha and gamma motor neurons that innervate {{c2::extensors}} are located more {{c1::ventrally}}Flexors - Dorsally Extensors - Ventrally Proximally - Medially Distally - LaterallyWatch associated Bootcamp video - Muscle Proprioception6e780873-600f-4524-9eca-6dfd3b02273b
Within the ventral horn, alpha and gamma motor neurons that innervate more {{c2::proximal}} structures are located {{c1::medially}}Flexors - Dorsally Extensors - Ventrally Proximally - Medially Distally - LaterallyWatch associated Bootcamp video - Muscle Proprioceptiondf229917-db8c-4162-b2e5-167f6602549c
Within the ventral horn, alpha and gamma motor neurons that innervate more {{c2::distal}} structures are located {{c1::laterally}}Flexors - Dorsally Extensors - Ventrally Proximally - Medially Distally - LaterallyWatch associated Bootcamp video - Muscle Proprioception301c4fa2-45df-4de8-8a5c-d8fda50d741a
How many neurons are required for the lateral corticospinal tract pathway (voluntary muscle movement)? {{c1::Two (UMN & LMN)}}Photo credit: OpenStax, CC BY 4.0Review Corticospinal TractWatch associated Bootcamp video - Muscle Proprioception Watch associated Bootcamp video - Descending Tracts99008e6b-012b-4118-902c-c48eda0a1f2a
The fibers in the corticospinal tract leave the cerebral cortex in the {{c2::posterior}} limb of the {{c1::internal capsule}}The internal capsule carries all axons in and out of the cortex Photo credit: OpenStax, CC BY 4.0Review Corticospinal TractWatch associated Bootcamp video - Descending Tractsfad2a9f7-4a05-4c05-b9d6-0bc048770fa8
Most (80-90%) of the corticospinal tract fibers decussate just below the {{c2::caudal medulla}} at the {{c1::pyramidal}} decussationThe decussation happens at the caudal medulla-spinal cord junction Photo credit: OpenStax, CC BY 4.0 Image licensed by Physeo and used with permission. Purchase full access hereWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaReview Corticospinal TractWatch associated Bootcamp video - Descending Tractsbc334b82-dd8e-43d8-af99-a9d26f3eed05
Upper motor neurons synapse with the cell bodies of lower motor neurons in the {{c1::ventral (anterior)}} horn of the spinal cordWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaReview Corticospinal TractWatch associated Bootcamp video - Motor Neurons46019fe9-c60d-4ef5-9dc2-80b1d5dd6f26
{{c2::Lower::Lower/Upper}} motor neurons are always {{c1::ipsi::ipsi/contra}}lateral to the muscle they innervateImage licensed by Physeo and used with permission. Purchase full access here.Review Corticospinal TractWatch associated Bootcamp video - Motor Neurons6f9c45fc-6bdd-4518-9301-99da9fe406ba
Upper motor neurons initially descend {{c1::contra::ipsi/contra}}lateral to the LMNs they innervateContinue ipsilaterally after the pyramidal decussation Image licensed by Physeo and used with permission. Purchase full access here.Review Corticospinal TractWatch associated Bootcamp video - Motor Neurons754f11dd-027d-4c29-90ee-f32be0423db5
The {{c1::corticospinal}} tract in the brain is responsible for voluntary movement of {{c2::contra}}lateral limbsPhoto credit: OpenStax, CC BY 4.0Review Corticospinal TractWatch associated Bootcamp video - Descending Tractsa5305a37-8289-4027-b741-bdfa5144d750
The motor component of skeletal muscle reflexes is mediated by {{c1::lower::upper or lower}} motor neuronsWatch associated Bootcamp video - Motor Neuronse14affc1-15ee-4962-a53b-9ee1687b2623
{{c1::Upper}} motor neurons provide descending control over reflexesWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Motor Neurons2b9c4e12-d3eb-4587-8955-2a05ac129b73
In the muscle stretch reflex, some Ia afferent fibers stimulate {{c1::agonist::agonist or antagonist}} muscles causing muscle contractione.g. the quadriceps in the knee-jerk reflex *muscle spindle senses stretchWatch associated Bootcamp video - Muscle Proprioceptionc6457d21-99cf-4ae8-b75c-48f726c0299a
In the muscle stretch reflex, some Ia afferent fibers inhibit {{c1::antagonist::agonist or antagonist}} muscles through interneurons causing muscle relaxatione.g. the hamstrings in the knee-jerk reflex *muscle spindle senses stretchWatch associated Bootcamp video - Muscle Proprioceptioncb3690df-7a2c-41b7-8b39-22f5ba211439
The inverse muscle stretch reflex uses {{c1::Golgi tendon}} organs to monitor muscle {{c2::tension}}when a muscle exerts too much force, GTOs inhibit contraction of the muscle, preventing damage to the musculoskeletal systemWatch associated Bootcamp video - Muscle Proprioceptiona5dd935c-1011-4ac0-a7f1-4a71e45deabc
In the inverse muscle stretch reflex, some Ib afferent fibers inhibit {{c1::agonist::agonist or antagonist}} muscles causing muscle relaxationWatch associated Bootcamp video - Muscle Proprioceptiondc0324a3-0a38-41e4-bbf7-75ce762ff21e
The {{c1::Achilles}} reflex tests nerve roots {{c2::S1}} and {{c2::S2}} ({{c3::tibial}} nerve)"""S1, S2, buckle my shoe"" Photo credit: OpenStax, CC BY 4.0"Watch Lumbosacral NervesWatch associated Bootcamp video - Reflex and Spinal Level Watch associated Bootcamp video - Spinal Radiculopathy85764626-3536-468d-bee9-e219b9471fe8
The {{c1::patellar}} reflex tests nerve roots {{c2::L2}} - {{c2::L4}} (femoral nerve)"""L2, L3, L4, kick the door"" Photo credit: OpenStax, CC BY 4.0"Watch Femoral NerveWatch associated Bootcamp video - Reflex and Spinal Level Watch associated Bootcamp video - Spinal Radiculopathy5b0078f4-6ee0-46bd-a7f7-3c124618b550
The {{c1::biceps}} reflex tests nerve roots {{c2::C5}} and {{c2::C6}} (musculocutaneous nerve)"- ""C5, C6, pick up sticks"" ***brachioradialis reflex test is C6 - This test is performed by quickly tapping a reflex hammer against the biceps brachii tendon as it passes through the cubital fossa; this activates the muscles stretch receptors that communicate via the musculocutaneous nerve with LMNs in the anterior horn of C5-C6 Photo credit: OpenStax, CC BY 4.0 Photo credit: OpenStax, CC BY 4.0"Review Brachial PlexusWatch associated Bootcamp video - Reflex and Spinal Level Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Musculocutaneous Nerve Watch associated Bootcamp video - Spinal Radiculopathy5b60b731-f3e4-4e87-988c-83173ade1990
The {{c1::triceps}} reflex tests nerve roots {{c2::C6}}, {{c2::C7}}, and {{c2::C8}} ({{c3::radial}} nerve)"- ""C6, C7, C8, lay them straight"" - Some sources may not list C6; however, it is included here since FA 2024 lists these 3 Photo credit: OpenStax, CC BY 4.0"Review Brachial PlexusWatch associated Bootcamp video - Reflex and Spinal Level Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Radial Nerve Watch associated Bootcamp video - Spinal Radiculopathyd280cd72-d05e-42b0-9a2f-dc343bfcb5fa
The {{c1::cremasteric}} reflex tests nerve roots {{c2::L1}} and {{c2::L2}}"""L1, L2, testicles move"""Watch associated Bootcamp video - Reflex and Spinal Level1059495f-e434-4eb9-8636-ed1b8d50d2c9
The {{c1::anal wink}} reflex tests nerve roots {{c2::S3}} and {{c2::S4}}"""S3, S4, winks galore"" Anal wink reflex, Clinical Examination Videos, via Youtube (0:46)"Watch Lumbosacral NervesWatch associated Bootcamp video - Reflex and Spinal Level76dcbb10-5a1f-442b-b452-5c8df57c228d
Do upper motor neuron lesions present with weakness? {{c1::Yes}}Watch associated Bootcamp video - Motor Neuron Lesionsb2a06c66-023d-42ca-8cbd-161cd03f2007
Do upper motor neuron lesions typically present with atrophy? {{c1::No*}}*may have atrophy due to disuse of musclesWatch associated Bootcamp video - Motor Neuron Lesions33add294-aca0-4f09-b7c0-705ad94aa73d
Do upper motor neuron lesions present with fasciculations? {{c1::No}}Random twitches of denervated motor units; visible beneath the skin Photo credit: Dr. Osama Shukir Muhammed Amin FRCP (Glasg), used with permission.Watch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Motor Neuron Lesions Watch associated Bootcamp video - Anticholinesterase Poisoningca824cae-5831-448b-9f3e-2b3602179ea4
{{c2::Upper}} motor neuron lesions may cause {{c1::hyper}}reflexiaupper motor neuron = everything up (tone, DTRs, toes) Video credit: Meegada et al., CC BY 3.0, via Cureus, modified by converting into GIFWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Motor Neuron Lesionsb6998fc4-a0b6-45f9-afcc-13899fe26143
{{c2::Upper}} motor neuron lesions may cause {{c1::increased}} toneupper motor neuron = everything up (tone, DTRs, toes)Watch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Motor Neuron Lesionsb4e591a9-6b1f-44b1-8f3f-4c72730f516a
Do upper motor neuron lesions present with the Babinski sign? {{c1::Yes}}i.e. extension of large toe and fanning of other toes with plantar stimulation Positive Babinski sign below Photo credit: Paul Marquis,, via Ortho Eval Pal, used with permissionWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Motor Neuron Lesions1348a0ef-ff45-445e-b09c-342b19cc0b2e
{{c2::Upper}} motor neuron lesions may cause {{c1::spastic::spastic or flaccid}} paralysisWatch associated Bootcamp video - Motor Neuron Lesions512826d8-1c37-4d37-9724-34dc25b42066
Which motor neuron lesion presents with clasp knife spasticity {{c1::Upper::Upper or Lower}}rapid decrease in resistance when attempting to flex a jointWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Motor Neuron Lesionsb8ce758a-49aa-4b88-8b2c-02f48ce0b99f
Do lower motor neuron lesions present with weakness? {{c1::Yes}}Watch associated Bootcamp video - Motor Neuron Lesions919b049e-e59e-46a9-b76f-2f3d4379f726
Do lower motor neuron lesions present with atrophy? {{c1::Yes}}Watch associated Bootcamp video - Motor Neuron Lesionsb5242612-ca79-4e5d-9a66-2b10d305fa2e
Do lower motor neuron lesions present with fasciculations? {{c1::Yes}}Random twitches of denervated motor units; visible beneath the skin Photo credit: Dr. Osama Shukir Muhammed Amin FRCP (Glasg), used with permission.Watch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Motor Neuron Lesions Watch associated Bootcamp video - Anticholinesterase Poisoningbb5f3c00-d1a3-4c8f-adf2-29d1fa574cae
{{c2::Lower}} motor neuron lesions may cause {{c1::hypo}}reflexialower motor neuron = everything down (tone, DTRs, toes)Watch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Motor Neuron Lesions9386ed57-0e93-4cd7-bef0-dab03a5ff508
{{c2::Lower}} motor neuron lesions may cause {{c1::decreased}} tonelower motor neuron = everything down (tone, DTRs, toes)Watch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Motor Neuron Lesionse2ee6661-2c84-42d5-a4e9-4b4a3b6ab1b6
Do lower motor neuron lesions present with the Babinski sign? {{c1::No}}lower motor neuron = everything down (tone, DTRs, toes) Positive Babinski sign below Photo credit: Paul Marquis,, via Ortho Eval Pal, used with permissionWatch associated Bootcamp video - Motor Neuron Lesions67a3d2e6-409c-48f6-82f2-959cbb8a942d
{{c2::Lower}} motor neuron lesions may cause {{c1::flaccid::spastic or flaccid}} paralysisLower motor neuron = everything down (tone, DTRs, toes)Watch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Motor Neuron Lesionsbc04557b-cfb2-4be3-8cd9-c1dc5c0d54c8
In what demographic is a Babinski reflex normal? {{c1::Infants}}Positive Babinski sign below Photo credit: Paul Marquis,, via Ortho Eval Pal, used with permissionb90b522d-d410-4a21-b1ee-ac4c80897d5a
LMN lesions cause {{c1::ipsi}}lateral flaccid paralysis at the level of the lesionImage licensed by Physeo and used with permission. Purchase full access here.Review Corticospinal TractWatch associated Bootcamp video - Motor Neuron Lesionsfbe1725b-07a3-4e3a-8c5c-3e5ec0feec61
UMN lesions in the spinal cord cause {{c1::ipsi}}lateral spastic paralysis at levels below the lesionImage licensed by Physeo and used with permission. Purchase full access here.Review Corticospinal TractWatch associated Bootcamp video - Motor Neuron Lesions6a528f36-77c7-4ceb-afc1-4cb46d2bfbc7
UMN lesions in the cerebral cortex cause {{c1::contra}}lateral spastic paralysis at levels below the lesionImage licensed by Physeo and used with permission. Purchase full access here.Review Corticospinal TractWatch associated Bootcamp video - Motor Neuron Lesions8506edac-be44-4025-b91f-798627b625f8
How many neurons are required for the dorsal column-medial lemniscus pathway? {{c1::Three}}Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Dorsal Column - Medial Lemniscus845738bd-960b-4102-92bf-be8fbf47c052
The {{c5::dorsal column - medial lemniscus}} tract carries information for {{c1::pressure}}, {{c2::vibration}}, {{c3::fine (discriminative) touch}}, and {{c4::proprioception}}Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Dorsal Column - Medial Lemniscusde9db267-88d8-45d3-8f18-68afb7d442d7
The 1st-order neuron of the dorsal column - medial lemniscus tract synapses with a(n) {{c2::ipsi}}lateral {{c1::nucleus cuneatus}} or {{c1::nucleus gracilis}}Ascending tracts synapse and then cross Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Dorsal Column - Medial Lemniscus619fcb08-fe9b-496d-a3f6-b0920d1c764f
The nucleus cuneatus and nucleus gracilis are located in the {{c1::caudal medulla}}Photo Credit: Anatomy & Physiology, via Oregon State UniversityWatch associated Bootcamp video - Dorsal Column - Medial Lemniscus2a10f207-2410-4b45-94c2-03952a701a07
The {{c2::2nd}}-order neuron of the dorsal column - medial lemniscus tract decussates in the {{c1::caudal medulla}}Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Dorsal Column - Medial Lemniscusaf213254-c3bb-45a6-9067-d62648671217
The {{c2::2nd}}-order neuron of the dorsal column - medial lemniscus tract ascends {{c1::contra}}laterally in the medial lemniscus (brainstem and above)Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Dorsal Column - Medial Lemniscus8983e265-f2ab-4b90-8b15-c73118eff618
The axons of the 2nd-order neurons of the dorsal column tract coalesce into an axon bundle, known as the {{c1::medial lemniscus}}Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Dorsal Column - Medial Lemniscus45143413-6dc7-4f78-b8d2-a9ac52f3c99c
The 2nd-order neurons of the dorsal column - medial lemniscus tract synapse in the {{c1::ventral posterolateral (VPL)}} nucleus of the {{c2::thalamus}}Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Dorsal Column - Medial Lemniscus Watch associated Bootcamp video - Diencephalon Overviewd449ded8-de9c-4915-842b-4b0649c78e58
The 3rd-order neuron of the dorsal column - medial lemniscus tract travels to the {{c1::primary somatosensory cortex (postcentral gyrus)}}located in the most anterior portion of the parietal lobe Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Dorsal Column - Medial Lemniscus Watch associated Bootcamp video - Parietal Lobebd6f8531-5b9b-49bb-a57e-54003d6036e0
The fasciculus {{c2::gracilis}} is the {{c1::medial::medial or lateral}} dorsal columnWhereas the lateral column is the fasciculus cuneatus Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Dorsal Column - Medial Lemniscusc3584e9f-c908-4344-8051-c502a133bca9
The fasciculus {{c2::cuneatus}} is the {{c1::lateral::medial or lateral}} dorsal columnWhereas the medial column is the fasciculus gracilis Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Dorsal Column - Medial Lemniscus45589dd1-0810-4bae-a249-ff41514250c2
The fasciculus {{c2::gracilis}} carries input from the spinal level {{c1::T6}} and below"""Fall (below) from grace (gracilis)"""Watch associated Bootcamp video - Dorsal Column - Medial Lemniscus896b0a44-5488-4aae-93da-48b48cf1a62d
The fasciculus {{c2::cuneatus}} carries input from the spinal level {{c1::T5}} and aboveWatch associated Bootcamp video - Dorsal Column - Medial Lemniscus7ec359cc-a6be-4180-9b69-fc4eceea5381
Lesions of the dorsal column - medial lemniscus tract in the spinal cord present on the {{c1::ipsi}}lateral side below the lesionloss of position, vibratory, and pressure sensations, and 2-point discrimination; may also lose ability to identify the characteristics of an object using the sense of touch (astereognosis)Review Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Dorsal Column - Medial Lemniscus0e2f36d9-be80-4f36-8d5b-40a9db0627bb
Lesions of the dorsal column - medial lemniscus tract in the thalamus and cerebral cortex present on the {{c1::contra}}lateral side below the lesionloss of position, vibratory, and pressure sensations, and 2-point discrimination; may also lose ability to identify the characteristics of an object using the sense of touch (astereognosis)Review Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Dorsal Column - Medial Lemniscusc0aedfb4-fe8b-487f-a299-3a9e838eb1de
How many neurons are required for the spinothalamic tract (anterolateral system) pathway? {{c1::Three}}Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Spinothalamic TractWatch associated Bootcamp video - Spinothalamic Tract59f81565-3d38-4064-9b6d-da75527fd514
The {{c2::lateral spinothalamic}} tract carries information for {{c1::pain}} and {{c1::temperature}} from the body and limbsWhereas the anterior spinothalamic tract carries crude (non-discriminative) touch and pressure Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Spinothalamic TractWatch associated Bootcamp video - Spinothalamic Tracte8934761-ebed-46b7-994d-b70f37e31ba4
The anterior spinothalamic tract carries information for {{c1::crude (non-discriminative) touch}} and {{c1::pressure}}The lateral spinothalamic tract carries pain and temperatureReview Spinothalamic TractWatch associated Bootcamp video - Spinothalamic Tract319238ad-f6c4-4f26-a147-0d4eb3f8e6a3
The 1st-order neuron of the spinothalamic tract synapses with a(n) {{c2::ipsi}}lateral cell body in the {{c1::dorsal horn}} of the spinal cordascending tracts synapse and then cross Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Spinothalamic TractWatch associated Bootcamp video - Spinothalamic Tracte1e22aad-998d-4df4-a55b-7d0f764802a9
The {{c2::2nd}}-order neuron of the spinothalamic tract decussates at the {{c1::anterior white commissure}}Ascending tracts synapse and then cross Photo Credit: Anatomy & Physiology, via Oregon State University Photo credit: BruceBlaus, CC BY-SA 4.0, via Wikimedia CommonsReview Spinothalamic TractWatch associated Bootcamp video - Spinothalamic Tractacca558f-d670-4bdd-a50c-9bc11103a21f
The {{c2::2nd}}-order neuron of the spinothalamic tract ascends {{c1::contra}}laterally in the spinal cordPhoto Credit: Anatomy & Physiology, via Oregon State UniversityReview Spinothalamic TractWatch associated Bootcamp video - Spinothalamic Tract529160af-85d1-4366-8dec-d78a3297099a
The 2nd-order neurons of the spinothalamic tract synapse in the {{c1::ventral posterolateral (VPL)}} nucleus of the {{c2::thalamus}}Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Dorsal Column (Medial Lemniscus) Review Spinothalamic TractWatch associated Bootcamp video - Spinothalamic Tract932c120d-de7a-412c-8749-270106677846
The 3rd-order neuron of the spinothalamic tract travels to the {{c1::primary somatosensory cortex (postcentral gyrus)}}Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Spinothalamic TractWatch associated Bootcamp video - Spinothalamic Tract2e0e89c8-54ed-4781-b045-3ab3210ada0b
Any unilateral lesion of the spinothalamic tract in the spinal cord or brain stem will present on the {{c1::contra}}lateral side 1-2 segments below the lesionImage licensed by Physeo and used with permission. Purchase full access here.Review Spinothalamic TractWatch associated Bootcamp video - Spinothalamic Tract50b97f8e-7993-4b5d-95c2-4bc70ee5c5ba
The spinocerebellar tracts carry unconscious {{c1::proprioceptive}} input from the {{c2::ipsi}}lateral muscle spindles and golgi tendon organs (GTOs) to the cerebellumi.e. dorsal spinocerebellar and cuneocerebellar tracts Photo credit: Images licensed by Physeo and used with permission. Purchase full access hereWatch associated Bootcamp video - Spinocerebellar Tracte047b1e8-24ed-47c8-8861-13ee0054244d
The dorsal spinocerebellar and cuneocerebellar tracts enter the cerebellum via the {{c1::inferior cerebellar peduncle}}Thus lesion to the inferior cerebellar peduncle may result in ipsilateral ataxia and dysmetria Photo credit: Images licensed by Physeo and used with permission. Purchase full access hereWatch associated Bootcamp video - Spinocerebellar Tractfc827393-2cfe-47a1-a06f-ab0f2ea9d349
{{c1::Brown-Sequard}} syndrome is caused by hemisection of the spinal cordThe patient has a lesion on their right side, which has resulted in the following symptoms at the labeled locations: - Black bar: Hypotonic paralysis and loss of all sensation. - Orange area: Spastic paralysis, loss of vibration and proprioception (position sense), and loss of fine touch. - Green area: Loss of pain and temperature sensation. Photo Credit: Rhcastilhos, CC BY-SA 3.0, via Wikimedia Commons; Image licensed by Physeo and used with permission. Purchase full access here.Watch associated Bootcamp video - Central Cord Syndromeab480b40-bdb3-4e8d-b547-e6cb3d93ab4f
Brown-Sequard syndrome presents with {{c1::ipsi::ipsi/contra}}lateral {{c2::upper::upper/lower}} motor neuron signs below the level of the lesion (due to corticospinal tract damage)e.g. weakness, spastic paralysis, positive babinski The patient has a lesion on their right side, which has resulted in the following symptoms at the labeled locations : - Black bar: Hypotonic paralysis and loss of all sensation. - Orange area: Spastic paralysis, loss of vibration and proprioception (position sense), and loss of fine touch. - Green area: Loss of pain and temperature sensation. Photo Credit: Rhcastilhos, CC BY-SA 3.0, via Wikimedia Commons Photo credit: Image licensed by Physeo and used with permission. Purchase full access here.Watch associated Bootcamp video - Central Cord Syndromea1a3e81b-0500-47f5-bc5c-78997d7ad8dd
Brown-Sequard syndrome presents with {{c1::ipsi::ipsi/contra}}lateral loss of vibration, proprioception, and touch below the level of the lesion (due to dorsal column damage)The patient has a lesion on their right side, which has resulted in the following symptoms at the labeled locations : - Black bar: Hypotonic paralysis and loss of all sensation. - Orange area: Spastic paralysis, loss of vibration and proprioception (position sense), and loss of fine touch. - Green area: Loss of pain and temperature sensation. Photo Credit: Rhcastilhos, CC BY-SA 3.0, via Wikimedia Commons Photo credit: Image licensed by Physeo and used with permission. Purchase full access here.Watch associated Bootcamp video - Central Cord Syndrome10d4e70e-753d-4c14-a17e-bb3623c23f73
Brown-Sequard syndrome presents with {{c1::contra::ipsi/contra}}lateral loss of pain and temperature below the level of the lesion (due to spinothalamic tract damage)The patient has a lesion on their right side, which has resulted in the following symptoms at the labeled locations : - Black bar: Hypotonic paralysis and loss of all sensation. - Orange area: Spastic paralysis, loss of vibration and proprioception (position sense), and loss of fine touch. - Green area: Loss of pain and temperature sensation. Photo Credit: Rhcastilhos, CC BY-SA 3.0, via Wikimedia Commons Photo credit: Image licensed by Physeo and used with permission. Purchase full access here.Watch associated Bootcamp video - Central Cord Syndromea8d0cfec-0d82-4196-b09b-5cf55bee0ffe
If the lesion in Brown-Sequard syndrome occurs above T1, patients may present with {{c2::ipsi}}lateral {{c1::Horner}} syndromeDue to hypothalamospinal pathway damage (e.g. due to Brown-Sequard syndrome, late-stage syringomyelia) Photo credit: Image licensed by Physeo and used with permission. Purchase full access here.Watch associated Bootcamp video - Central Cord Syndrome964e799b-7b31-467a-a409-5db4ea37b8c1
Sensory fibers containing pain and temperature information ascend or descend 1 - 2 spinal segments in {{c1::Lissauer's}} tract before synapsing in the dorsal horn with a 2nd-order neuronAlso known as the posterolateral tract Photo credit: Image licensed by Physeo and used with permission. Purchase full access here.Watch associated Bootcamp video - Spinothalamic Tract218231af-615f-4704-98b8-298ff9b0388c
{{c2::Poliovirus}} infection causes selective destruction of {{c1::lower::upper/lower}} motor neuronsTherefore presents with signs of LMN lesion (weakness, hypotonia, flaccid paralysis, hyporeflexia, fasciculations, etc.)Watch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Poliomyelitis Watch associated Bootcamp video - Infectious Neuropathology: Infectious Spinal Cord and Neuromuscular Junction1d5c00cd-8797-453b-b8bb-ef8c0fcdfe1c
Which horn of the spinal cord is most affected by poliovirus infection? {{c1::Ventral (anterior) horn}}Photo credit: Image licensed by Physeo and used with permission. Purchase full access here.Watch associated Bootcamp video - Poliomyelitis Watch associated Bootcamp video - Infectious Neuropathology: Infectious Spinal Cord and Neuromuscular Junction75ce15c7-0f69-4e2c-8e7e-1f21752ae76a
{{c1::Spinal muscular}} atrophy is the congenital degeneration of the {{c2::anterior}} horns of the spinal cordSurvival of Motor Neuron protein (encoded by SMN1 gene) is important for function of anterior hornsWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Werdnig Hoffman Disease21d99a33-0f2e-4bac-932f-3636e14be176
Werdnig-Hoffmann syndrome (type 1 spinal muscular atrophy) is caused by a(n) {{c1::autosomal recessive}} inherited mutation in the SMN1 gene on chromosome {{c2::5q}}, which facilitates the assembly of {{c3::snRNPs}}"- SMN1 encodes a protein (""Survival of Motor Neuron"") involved in a complex which facilitates the assembly of snRNPs which are utilized in the spliceosome - Patients who survive with SMN1 mutations do so owing to the fact that the SMN2 gene also produces the same product as SMN1 but at low levels - Novel gene therapies have been approved to treat SMA type 1, doing so either via replacing the SMN1 gene (ZolgenSMA) or increasing SMN2 conversion to SMN1 via alternative splicing (nusinersen/Spinraza)"Watch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Werdnig Hoffman Diseasec9839cc8-21d4-4f9c-9e6c-0c219f76b61e
Werdnig-Hoffmann disease is the infantile form (type 1) of {{c1::spinal muscular atrophy (SMA)}}Watch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Werdnig Hoffman Disease13aceff0-6302-4a86-a24c-c04bdcc684b4
"Werdnig-Hoffmann disease (type I SMA) presents as a(n) ""{{c1::floppy baby}}"" with marked hypotonia and {{c2::tongue}} fasciculations""- Infants have flaccid ""frog-like"" posture Tongue fasciculations: Photo credit: Dr. Osama Shukir Muhammed Amin FRCP (Glasg), used with permission. Photo credit: Osmosis, CC BY-SA 4.0, via Wikimedia Commons Watch 'Floppy Baby', Cure SMA, via Youtube (1:15)"Watch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Werdnig Hoffman Diseasee13f6a8a-f14d-4fed-b8e2-b01dd70d076f
Does spinal muscular atrophy damage upper or lower motor neurons? {{c1::Lower}}Photo Credit: Part of larger photo from Nadezdha D. Kiriyak, CC BY 4.0, via Wikimedia CommonsWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Werdnig Hoffman Diseasea5e8e56a-2129-40f3-a388-fba2a9fb3e3c
Tabes dorsalis may present with progressive sensory {{c1::ataxia}} due to impaired proprioception"Impaired lower extremity proprioception leads to poor coordination; results in a ""high-step stride"""Watch Treponema pallidumWatch associated Bootcamp video - Neurosyphilis (Neurology) Watch associated Bootcamp video - Neurosyphilis (Microbiology) Watch associated Bootcamp video - Infectious Neuropathology: Infectious Spinal Cord and Neuromuscular Junctiond1d9d442-2dc3-4f03-a8da-452c85ce931d
Tabes dorsalis presents with {{c1::absence}} of deep tendon reflexes (DTRs)Degeneration of the dorsal columns of the spinal cord caused by tertiary syphilisWatch associated Bootcamp video - Posterior Cord Syndrome Watch associated Bootcamp video - Infectious Neuropathology: Infectious Spinal Cord and Neuromuscular Junction6af67325-a91a-4bf6-9fda-225c7cb3570c
Tabes dorsalis is associated with {{c1::Argyll Robertson}} pupils- AKA pupillary light-near dissociation; reactive to accommodation but not light - Due to damage to the pretectal nuclei (involved in light reflex but not a part of accommodation reflex) Photo credit: Chainwit., CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Neurosyphilis (Neurology) Watch associated Bootcamp video - Neurosyphilis (Microbiology)04b89ec9-f621-4693-bef7-07cada722d5b
Does amyotrophic lateral sclerosis (ALS) damage upper or lower motor neurons? {{c1::Both :)}}- Dysarthria, dysphagia, asymmetric limb weakness, fasciculations, atrophy due to LMN degeneration (loss of anterior horn nuclei) - Pseudobulbar palsy, dysarthria, dysphagia, emotional lability, spastic gait, clonus due to UMN degeneration (loss of brainstem motor nuclei and degeneration of lateral corticospinal tracts) ALS is characterized by: - Spinal muscular atrophy, which is progressive and related to involvement of the ventral horn - Primary lateral sclerosis, which is related to involvement of the corticospinal tract. This can present with increased tone and reflexes, spastic paralysis of the lower limbs, and flaccid paralysis of the upper limbs. - ALS-related changes is common in the cervical enlargement Photo credit: Modified OpenStax, CC BY 4.0, via Wikimedia CommonsWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich Ataxiaa73c4b1b-59c1-40e4-a217-49a9a9a8ab33
Amyotrophic lateral sclerosis (ALS) typically begins at {{c1::cervical}} levels of the spinal cordALS monster attacking robots neck Watch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich Ataxia317bd4ab-090e-4e71-9e9d-c3c8cdc4acbe
ALS presents with asymmetric {{c2::flaccid::spastic or flaccid}} paralysis in the {{c1::upper}} limbs- Due to damage of the LMNs at the level of the lesion - Asymmetric, but symptoms present bilaterally - vs. spastic paralysis in the lower limbsWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich Ataxia27512119-cb9d-4e02-a5a0-91254e71b366
ALS presents initially with asymmetric {{c2::spastic::spastic or flaccid}} paralysis in the {{c1::lower}} limbs- Due to damage of the corticospinal tract below the lesion - Asymmetric, but symptoms present bilaterally - vs. flaccid paralysis in the upper limbsWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich Ataxia95724d57-59a8-4e9c-b9f3-6b095c522041
Does ALS present with symmetric or asymmetric weakness? {{c1::Asymmetric}}ALS is AsymmetricWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich Ataxia2ac17347-c856-47e5-b54b-e15c0304f4bf
An early sign of ALS is atrophy and weakness involving the {{c1::hands}}Due to LMN degeneration in cells of anterior hornWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich Ataxia3d04079d-ecad-4d67-932d-fe22c1f54c79
What sensory deficits does ALS present with? {{c1::None :)}}Important distinguishing feature from syringomyelia and anterior spinal artery occlusionWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich Ataxiae6a14e7f-5a03-4fd0-8d7e-aafe1fb260bb
Familial cases of {{c2::amyotrophic lateral sclerosis (ALS)}} may be associated with {{c1::zinc-copper superoxide dismutase 1 (SOD1)}} mutations, which leads to free radical injury in neuronsWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich Ataxiae4929882-74e2-4d24-9d7e-c81db8e1a812
Which areas of the spinal cord are spared in a complete occlusion of the anterior spinal artery? {{c1::Dorsal column}} and {{c2::Lissauer tract}}- Anterior spinal artery occlusion is more common at the mid-thoracic levels - Can lead to spastic bladder - All signs would be bilateral in nature - Lissauer tract is also known as posterolateral tract Photo credit: Modified OpenStax, CC BY 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Anterior Cord Syndromede6749a2-aaf3-40ae-9a0b-32eb14733d04
Anterior spinal artery occlusion results in signs of bilateral {{c1::upper}} motor neuron lesion below the infarcte.g. spastic paralysis - Initial spinal shock causes flaccid paralysis below lesion. Weeks later presents with LMN defect at level of lesion and UMN damage below lesion Photo credit: Modified OpenStax, CC BY 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Anterior Cord Syndrome092866a4-f5e3-44eb-b030-b4e8cdbc41e1
What sensory deficits are associated with anterior spinal artery occlusion? {{c1::Loss of pain and temperature::2}}Important distinguishing feature from ALS; proprioception, vibration, etc. are spared Photo credit: Modified OpenStax, CC BY 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Anterior Cord Syndromec34a34e5-3699-4ea2-943e-cc5181fa631f
{{c2::Spastic}} bladder results from lesions {{c1::above}} the sacral spinal cord levelsDetrusor muscle responds to a minimum amount of stretch, causing urge incontinenceWatch associated Bootcamp video - Anterior Cord Syndrome Watch associated Bootcamp video - Urge Incontinence15443cf7-0e75-4212-ae38-9e48c740cc5f
{{c2::Atonic}} bladder results from lesions {{c1::at the level of}} the sacral spinal cord- ATonic - from lesions AT the level - Loss of contraction of the detrusor muscle results in a full bladder with a continuous dribble of urine from the bladderWatch associated Bootcamp video - Anterior Cord Syndrome Watch associated Bootcamp video - Micturition Overviewedbadd34-4834-40ef-97c4-244223bf34c6
{{c2::Subacute combined degeneration}} is a spinal cord lesion most commonly seen with vitamin {{c1::B12}} deficiency- Causes ataxic gait, paresthesia, impaired position/vibration sense Vitamin E deficiency (e.g. abetalipoproteinemia) causes a similiar presentation (spinocerebellar and dorsal column involvement) but without: - Hypersegmented neutrophils - Megaloblastic anemia, - ↑ methylmalonic acid - Involvement of the lateral corticospinal tract - Copper deficiency (e.g. Menkes) presents similarlyWatch Megaloblastic Anemia Folate Deficiency & Vitamin B DeficiencyReview Vitamin B9 and B12 DeficienciesWatch associated Bootcamp video - Cobalamin (Vitamin B12) Deficiency Watch associated Bootcamp video - Additional Causes of Dementiad37821ce-e26d-42fe-8b03-7f4a023adfc1
{{c1::Syringomyelia}} is a dilated, fluid-filled, cystic cavity within the central canal of the spinal cord- The widened bubble or cavitation first damages neural fibers passing near the center of the spine - Can be secondary to tumor / trauma (whiplash) or congenital (associated with Chiari malformations) Photo credit: File:Syringomyelia.jpg: Cyborg Ninja at English Wikipedia (uploaded by User:ToNToNi Derivative work: User:SUM1, CC BY 4.0, via Wikimedia CommonsWatch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & SyringomyeliaWatch associated Bootcamp video - Central Cord Syndrome6dae73cc-cce3-4432-b17c-a217fddaffaf
Syringomyelia results in damage to the {{c2::spinothalamic}} tract 2nd-order neurons crossing in the {{c1::anterior white commissure}}Syringomyelia:- Typically, there is cavitation of the cord in the cervical region - At the level of the lesion, there is bilateral loss of pain and temperature - The disease progresses to cause muscle weakness, flaccid paralysis, and atrophy of the upper limb muscles due to the destruction of ventral horn cells Photo credit: Modified OpenStax, CC BY 4.0, via Wikimedia Commons Photo credit: File:Syringomyelia.jpg: Cyborg Ninja at English Wikipedia (uploaded by User:ToNToNiDerivative work: User:SUM1, CC BY 4.0, via Wikimedia CommonsWatch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & SyringomyeliaWatch associated Bootcamp video - Central Cord Syndrome5b92a444-eed4-4608-8066-3e8380717547
"{{c4::Syringomyelia}} results in {{c3::bi}}lateral loss of {{c1::pain}} and {{c1::temperature}} sensation in a(n) ""{{c2::cape-like}}"" distribution"- Pain loss may present as cuts not felt - Temperature loss may present as burns not felt Photo credit: Internet Archive Book Images, No restrictions, via Wikimedia Commons Photo credit: Modified OpenStax, CC BY 4.0, via Wikimedia Commons Photo credit: File:Syringomyelia.jpg: Cyborg Ninja at English Wikipedia (uploaded by User:ToNToNiDerivative work: User:SUM1, CC BY 4.0, via Wikimedia CommonsWatch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & SyringomyeliaWatch associated Bootcamp video - Central Cord Syndromef396f316-da2b-4e32-b34f-da8e871eb9eb
Syrinx expansion in syringomyelia may lead to damage to the {{c1::lower::lower/upper}} motor neurons of the anterior horn- Causes muscle atrophy and weakness with decreased muscle tone and impaired reflexes - May also causes paresis of paravertebral muscles resulting in a scoliosis Photo credit: Modified OpenStax, CC BY 4.0, via Wikimedia Commons Photo credit: File:Syringomyelia.jpg: Cyborg Ninja at English Wikipedia (uploaded by User:ToNToNiDerivative work: User:SUM1, CC BY 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Central Cord Syndrome759e4fe6-57a4-40e8-88cf-d5fa670b6eb4
Syrinx expansion in syringomyelia (late stage) may cause {{c1::Horner}} syndromeDue to disruption of the lateral horn Photo credit: Fion Bremner, CC BY 4.0, via Frontiers in Neurology (above); Kikkeri et al., CC BY 3.0, via Cureus (below)Watch associated Bootcamp video - Central Cord Syndrome8d7cb135-5815-4f01-9afb-9ac8f7070979
What neural tract is responsible for the sympathetic innervation of the face? {{c1::Hypothalamospinal tract}}- AKA descending hypothalamic fibers AKA sympathetic fibers - If tract is lesioned, Horner syndrome develops w/ ptosis, miosis, anhidrosis Photo credit: Image licensed by Physeo and used with permission. Purchase full access here.418cd7c9-d39e-4442-bf72-2d15a1eeada3
{{c2::Syringomyelia}} is a spinal cord lesion that arises with trauma and tumors or in association with {{c1::Chiari I}} malformationSYRINGe has 1 needle Photo credit: Modified OpenStax, CC BY 4.0, via Wikimedia CommonsPhoto credit: File:Syringomyelia.jpg: Cyborg Ninja at English Wikipedia (uploaded by User:ToNToNiDerivative work: User:SUM1, CC BY 4.0, via Wikimedia CommonsWatch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & SyringomyeliaWatch associated Bootcamp video - Central Cord Syndrome3c1503e5-9ccf-4648-afd6-f186dc35b3f0
Chiari {{c2::I}} malformation is characterized by downward displacement of the {{c1::cerebellar tonsils}} through the foramen magnumCerebellar tonsillar ectopia > 3 - 5 mm Photo credit: Hellerhoff, CC BY-SA 3.0, via Wikimedia CommonsWatch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & Syringomyeliabe906215-a9ce-4afb-8a9f-a3601525d400
{{c1::Friedreich ataxia}} is a trinucleotide repeat disorder that causes degeneration of the cerebellum and multiple spinal cord tractsThus, causing: - Ataxia (cerebellum damage / spinocerebellar tract damage) - Loss of vibratory sense / proprioception (dorsal column damage) - Muscle weakness and loss of DTRs (lateral corticospinal tract and dorsal root ganglia damage)Watch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Cerebellar Pathology822a3b2c-4750-4f1c-83fb-aa96da296e3d
What is the mode of inheritance of Friedreich ataxia? {{c1::Autosomal recessive}}Watch Autosomal Recessive Diseases Watch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Cerebellar Pathologya9a0a60a-c097-4d4f-a964-bab9537634e6
Friedreich ataxia is caused by a mutated {{c1::frataxin}} gene on chromosome {{c2::9}}Watch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Cerebellar Pathology830d8f4b-ce07-47fd-8abc-4e1c580f1216
The frataxin gene is essential for {{c1::mitochondrial}} {{c2::iron}} regulationMutation of this gene (Friedreich ataxia) results in iron build up with free radical damageWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch associated Bootcamp video - Cerebellar Pathology0d818ca5-dee2-496f-9947-76a34c922a0b
The most common cause of death in Friedreich ataxia is {{c1::heart failure}} due to {{c1::hypertrophic cardiomyopathy}}Friedreich ataxia also may cause staggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammer toes, and diabetes mellitusWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch Hypertrophic Cardiomyopathy SOAPWatch associated Bootcamp video - Cerebellar Pathology3ef0f908-a874-44ac-b154-6abc3cb528c5
Friedreich ataxia patients often have {{c1::pes cavus::foot type}} with {{c1::hammer}} toesRemember, also seen in Charcot-Marie-Tooth (HMSN) so be careful to differentiate Photo credit: Benefros at English Wikipedia, CC BY-SA 3.0, via Wikimedia CommonsWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaWatch Bones & Ligaments of Ankle & FootWatch associated Bootcamp video - Cerebellar Pathology1a930174-f536-479b-9588-57f168081e19
{{c1::Neural tube}} defects arise due to failure of the neuropores to fuse by the {{c2::4th}} week of pregnancyLeaves a persistent connection between the amniotic cavity and the spinal canalWatch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & SyringomyeliaWatch associated Bootcamp video - Embryologic Cranial and Spinal Defects3b40c677-87cc-49f5-aec4-1c872d3b64db
{{c2::Neural tube}} defects are associated with low {{c1::folate}} levels prior to conception and during pregnancyFolate = vitamin B9Watch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & SyringomyeliaWatch associated Bootcamp video - Folate (Vitamin B9) Deficiency Watch associated Bootcamp video - Embryologic Cranial and Spinal Defects3c4c4b31-abb3-4ccd-a762-0684e6c07e3c
Open neural tube defects are detected during prenatal care by {{c2::elevated}} {{c1::alpha-fetoprotein (AFP)}} levels in the amniotic fluid and maternal blood"- This card used to say ""neural tube defects"", but AMBOSS confirms only open NTD's have elevated AFP's (Jul 2023) - *Exception: spina bifida occulta (normal AFP)"Watch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & SyringomyeliaWatch associated Bootcamp video - Embryologic Cranial and Spinal Defects6d4b5822-6326-4801-a6a2-3af8a381cdb4
Elevated {{c1::acetylcholinesterase (AChE) and alpha-fetoprotein (AFP)::2}} in amniotic fluid are helpful confirmatory tests for suspected neural tube defects when ultrasound findings are inconclusive- Initial screening test at 16-18 weeks looks for increased maternal serum AFP - Fetal AChE/AFP in CSF flows through defect into amniotic fluidWatch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & SyringomyeliaWatch associated Bootcamp video - Embryologic Cranial and Spinal Defects26187cd5-09b0-417f-9b0b-a450428ba52e
What pathology is associated with disruption of the cranial end of the neural tube? {{c1::Anencephaly}}Photo credit: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Public domain, via Wikimedia CommonsWatch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & SyringomyeliaWatch associated Bootcamp video - Embryologic Cranial and Spinal Defects4871b521-5488-43f4-a825-bda223e170fc
Anencephaly may result in {{c1::poly}}hydramniosSwallowing is impaired due to lack of a swallowing center in the brain Photo credit: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Public domain, via Wikimedia Commons* defect of swallowing center in the brain → decreased swallowing of amniotic fluid Watch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & SyringomyeliaWatch associated Bootcamp video - Embryologic Cranial and Spinal Defects955801d3-10a5-4ade-8e7e-7f894770611d
{{c1::Holoprosencephaly}} is due to failure of the forebrain to divide into 2 cerebral hemispheresExample of malformationWatch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & Syringomyelia69a0951a-e3f8-449a-8cb3-347500196162
The severe form of holoprosencephaly results in {{c1::cyclopia (one eye)}} and a primitive nasal structure (proboscis)Midfacial clefts seen as well Photo credit: BC Hirst & GA Piersol, Public domain, via Wikimedia Commons Photo credit: Dingana et al., CC BY 4.0, via Clinical Medical Reviews and Case ReportsWatch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & Syringomyelia8df20dc9-7122-4415-b951-fa9fcb100f96
Holoprosencephaly is seen in {{c1::Patau}} syndrome and {{c2::fetal alcohol}} syndrome- In Patau (trisomy 13), there is a defect in the fusion of the prechordal mesoderm, an integral embryo structure affecting growth of midface, eyes, and forebrain → catastrophic midline defects - FAS: alcohol disrupts retinoic acid activity → impairment of neural crest cell migrationWatch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & SyringomyeliaReview Patau Syndrome (Trisomy 13)Watch associated Bootcamp video - Teratogenic Medications Watch associated Bootcamp video - High Yield Genetic Disorders: Autosomal Trisomies835f44e1-b560-419f-a4fa-9311a95f5c0b
What pathology is associated with disruption of the caudal end of the neural tube? {{c1::Spina bifida}}Photo credit: Centers for Disease Control and Prevention, Public domain, via Wikimedia CommonsWatch associated Bootcamp video - Embryologic Cranial and Spinal Defectsccaf77fc-4a68-45cf-94c2-5eac4845b176
Which form of spina bifida is associated with a tuft of hair or skin dimple at the level of the bone defect? {{c1::Spina bifida occulta}}other potential cutaneous manifestations include hemangioma or nevus Photo credit: OpenStax, CC BY 4.0, via Wikimedia CommonsWatch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & SyringomyeliaWatch associated Bootcamp video - Embryologic Cranial and Spinal Defects54bb2b7a-79e8-430d-9d57-6734256e7a42
Spina bifida occulta is characterized by {{c1::normal}} levels of AFP in uteroThe exception to the rule of increased AFP with neural tube defectsWatch associated Bootcamp video - Embryologic Cranial and Spinal Defectsa48e0152-12f7-44de-95dc-40b113c7d295
{{c2::Cerebral aqueduct}} stenosis is the most common cause of {{c1::hydrocephalus}} in newbornsPhoto credit: OpenStax, CC BY 4.0Watch HydrocephalusWatch associated Bootcamp video - Hydrocephalusdf1a5ecf-2058-42ca-a863-45cd6f8b57dc
{{c2::Dandy-Walker}} malformation is caused by failure of the 4th ventricle to close, which leads to congenital hypoplasia of the {{c1::cerebellar vermis}}- Disruption of HOX gene expression in rhombencephalon disrupts mesenchymal development in the metencephalon - This disrupts angiogenesis, causing choroid plexus to undergo excessive development - Overgrown choroid plexus disrupts microglia with phagocytic activity required for midline formation of the vermis → agenesis of the vermis Photo Credit: Helmut Januschka [CC BY-SA 3.0] (left); Hellerhoff [CC BY-SA 3.0] (right)Watch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & SyringomyeliaWatch associated Bootcamp video - Cerebellar Pathology61556909-0730-456d-88ee-4beda1cb0677
{{c3::Dandy-Walker}} malformation presents as a massively dilated {{c1::4th ventricle}} and an absent {{c2::cerebellar vermis}}- Remaining cerebellum is hypoplastic (cerebellar hemispheres) - Enlarged posterior fossa is noticeable Photo Credit: Helmut Januschka [CC BY-SA 3.0] (left); Hellerhoff [CC BY-SA 3.0] (right)Watch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & SyringomyeliaWatch associated Bootcamp video - Cerebellar Pathologye70ecd38-1089-45a9-ae28-99f1ed127c4b
Chiari {{c2::II}} malformation is characterized by downward displacement of the cerebellar {{c1::vermis}}, {{c3::tonsils}}, and the {{c4::medulla}} through the foramen magnum- Cerebellar compression can manifest with ataxia and dizziness - Medullary compression may result in dysphagia, stridor, and apnea Photo credit: Rekate HL, CC BY 2.0, via Wikimedia Commons Photo credit: Hellerhoff, CC BY-SA 3.0, via Wikimedia CommonsWatch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & SyringomyeliaWatch associated Bootcamp video - Cerebellar Pathology0485b9bb-d48a-4cbb-951f-45fec87c9395
Chiari {{c2::II}} malformation is often associated with lumbosacral {{c1::myelomeningocele}}Causes paralysis/sensory loss at and below the level of the lesionWatch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & SyringomyeliaWatch associated Bootcamp video - Embryologic Cranial and Spinal Defects Watch associated Bootcamp video - Cerebellar Pathology1da4b628-ba8e-4151-a25d-bfe5d991b316
What bacteria causes lymphocytosis via production of lymphocytosis-promoting factor? {{c1::Bordetella pertussis}}Blocks circulating lymphocytes from leaving the blood to enter the lymph nodeWatch Bordetella pertussisWatch associated Bootcamp video - Bordetella Pertussis0c2fa4b9-2bf0-42bd-9e65-95c25b011e9f
The {{c2::monospot}} test detects IgM {{c1::heterophile}} antibodies that cross-react with horse or sheep RBCsUsually turns positive within 1 week after EBV infection; may be negative with infectious mononucleosis due to CMVWatch Epstein-Barr Virus (Herpesviridae) Watch Cytomegalovirus (Herpesviridae)Watch associated Bootcamp video - Opportunistic Infections: Cytomegalovirus, Disseminated Mycobacterial Non-Tuberculous Disease6c88a806-69a5-4bfc-99fd-a0dec781adc9
Patients with infectious mononucleosis are advised to avoid {{c1::contact sports}} for one month- Due to risk of splenic rupture - Patients are also at risk of atraumatic splenic ruptureWatch Epstein-Barr Virus (Herpesviridae)35d80721-fd03-4023-a23a-5e60cfad72a5
Acute leukemia is defined as a neoplastic proliferation of blasts {{c1::> 20}}% in the bone marrow* Common manifestation of B-cell ALL Watch Acute Myeloid Leukemia (AML) & Chronic Myeloid Leukemia (CML) Watch Acute Lymphoblastic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), Hairy Cell Leukemia & Adult T cell LeukemiaWatch associated Bootcamp video - Acute Myeloid Leukemia Watch associated Bootcamp video - Acute Lymphoid Leukemia8b6b3744-4202-4263-ba9d-63e8c0dfd41b
{{c2::Lympho}}blasts are characterized by positive nuclear staining for {{c1::TdT}}, which is a(n) {{c3::DNA polymerase}}- Marker of pre-T and pre-B cells - Absent in myeloid blasts and mature blastsWatch Acute Lymphoblastic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), Hairy Cell Leukemia & Adult T cell LeukemiaWatch Acute Lymphocytic Leukemia (ALL)Watch associated Bootcamp video - Acute Lymphoid Leukemia85f1ef36-1e06-474c-8ec4-81affa92a01e
What demographic is most commonly associated with acute lymphoblastic leukemia (ALL)? {{c1::Children::age group}}vs. AML, which typically arises in older adultsWatch Acute Lymphoblastic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), Hairy Cell Leukemia & Adult T cell LeukemiaWatch Acute Lymphocytic Leukemia (ALL)Watch associated Bootcamp video - Acute Lymphoid Leukemiae9e4750e-9110-4776-ac5a-3b5415e88da5
{{c3::T}}-ALL usually presents in {{c1::teenagers::age group}} as a(n) {{c2::mediastinal}} mass, thus it is often referred to as acute lymphoblastic lymphomaT for T-ALL and Teenagers Presents with: - Lymphadenopathy - Mediastinal mass (thymus and often associated with pleural effusions) - SVC-like syndrome - Tracheal obstruction (difficulty breathing) Photo Credit: Mohankumar Kurukumbi, Roger L Weir, Janaki Kalyanam, Mansoor Nasim, Annapurni Jayam-Trouth., CC BY 2.0, via Wikimedia CommonsWatch Acute Lymphoblastic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), Hairy Cell Leukemia & Adult T cell LeukemiaWatch Acute Lymphocytic Leukemia (ALL)Watch associated Bootcamp video - Acute Lymphoid Leukemia7ac7b845-ad0c-4a49-9e08-97fa2d301fb7
The abnormal promyelocytes seen in APL/APML contain numerous primary granules that increase risk for {{c1::disseminated intravascular coagulation (DIC)}}Auer rods can activate the coagulation cascade; DIC is common presentation Photo Credit: JulieJenksButteCollege, CC BY-SA 4.0, via Wikimedia CommonsWatch Acquired Coagulation Defects Watch Acute Myeloid Leukemia (AML) & Chronic Myeloid Leukemia (CML)Review Acute Promyelocytic Leukemia (APL)Watch associated Bootcamp video - Acute Myeloid Leukemiac701668a-68b0-458c-88c4-de0d3afea993
Which cranial nerves are NOT located in the brain stem? {{c1::I and II::2}}Some sources also include CN XI in this listWatch Cranial Nerves I & II (Olfactory & Optic)Review Olfactory Nerve (CN I)Watch associated Bootcamp video - Rule of 4saeba5853-b90f-4e03-91da-98a548521c7c
Which cranial nerves are located above the pons? {{c1::I, II, III, and IV::4}}Note: CN I and II are not located in the brain stem; III and IV are in the midbrainWatch Cranial Nerves I & II (Olfactory & Optic) Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Review Olfactory Nerve (CN I) Review Optic Nerve (CN II) Review Oculomotor Nerve (CN III) Review Trochlear Nerve (CN IV)Watch associated Bootcamp video - Rule of 4s913d8a45-5b61-41a4-81ef-df19a10c3bce
Which cranial nerves are located in the pons? {{c1::V, VI, VII, and VIII::4}}Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens) Watch Cranial Nerve V (Trigeminal) Watch Cranial Nerve VII (Facial Nerve) Watch Cranial Nerve VIII (Vestibulocochlear)Review Abducens Nerve (CN VI) Review Facial Nerve (CN VII)Watch associated Bootcamp video - Rule of 4sd3edabb7-1636-4a95-96a4-a6134829fb30
Which cranial nerves are located in the medulla? {{c1::IX, X, XI*, and XII::4}}CN XI is located proximal, but not within, the medulla, thus intramedullary lesions do not affect the spinal accessory nerveWatch Cranial Nerve IX (Glossopharyngeal) Watch Cranial Nerve X (Vagus) Watch Cranial Nerve XI (Accessory) Watch Cranial Nerve XII (Hypoglossal)Review Glossopharyngeal Nerve (CN IX)Watch associated Bootcamp video - Rule of 4s0d2006e8-79be-49e5-9fd6-426e0c9fadbd
Which cranial nerve nuclei are located medially? {{c1::III, IV, VI, and XII::4}}"""factors of 12, except 1 and 2"" Photo credit: OpenStax, CC BY 4.0"Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens) Watch Cranial Nerve XII (Hypoglossal)Watch associated Bootcamp video - Rule of 4s723bfbfa-3129-4aa2-8872-7a9c629392b0
The cranial nerve nuclei that exit {{c2::medially}} are {{c1::motor::motor, sensory, or mixed}} CNsi.e. CN III, IV, VI, and XII Photo credit: OpenStax, CC BY 4.0Watch Cranial Nerves OverviewWatch associated Bootcamp video - Rule of 4s743e99b1-0554-4e0a-ae07-85612ce04316
The superior colliculi help coordinate {{c1::conjugate vertical}} gazeWatch associated Bootcamp video - Midbrain, Pons, and Medullafcee255a-011c-4fca-b5c8-290420952fbc
The {{c1::superior}} colliculi direct eye movements to stimuli (noise / movements) or objects of interest- Involved in conjugate vertical gaze - The tectospinal tract originates here to mediate reflex movement of the head to auditory / visual stimuliWatch associated Bootcamp video - Midbrain, Pons, and Medulla2b424993-5435-4295-a81f-77bcbf3b22ed
The {{c1::inferior}} colliculi are auditory structuresWatch associated Bootcamp video - Midbrain, Pons, and Medulla25ba73de-2b99-4291-aa54-01aaa78ee2bb
Cranial nerve {{c1::I}} is the {{c2::olfactory}} nervePhoto credit: Patrick J. Lynch, medical illustrator, CC BY 2.5, via Wikimedia CommonsWatch Cranial Nerves Overview Watch Cranial Nerves I & II (Olfactory & Optic)Review Olfactory Nerve (CN I)Watch associated Bootcamp video - Cranial Nerve I2a275598-ec2d-47a0-8966-0a514ddc6d73
Cranial nerve {{c1::II}} is the {{c2::optic}} nerveWatch Cranial Nerves I & II (Olfactory & Optic)Review Optic Nerve (CN II)Watch associated Bootcamp video - Cranial Nerve IIb41ad86e-855f-4cee-b4e0-69378ab1979c
Lesions to CN {{c1::II (optic)}} result in loss of the sensory limb of the light reflexWatch Cranial Nerves I & II (Olfactory & Optic)Review Optic Nerve (CN II)Watch associated Bootcamp video - Cranial Nerve II4fdb788f-403b-41f9-b2ea-f9189f83c596
Cranial nerve {{c1::III}} is the {{c2::oculomotor}} nerveWatch Cranial Nerves Overview Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Review Oculomotor Nerve (CN III)Watch associated Bootcamp video - Cranial Nerve III58feafd1-fa65-42b2-83ec-ac8f8576d33a
Which cranial nerve innervates the superior rectus muscle? {{c1::CN III (oculomotor)}}Photo credit: OpenStax, CC BY 4.0Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Review Oculomotor Nerve (CN III)Watch associated Bootcamp video - Cranial Nerve IIIae3499b3-f6a7-4287-a76f-997020ee2660
Cranial nerve III (oculomotor) contributes to pupillary {{c1::constriction::dilation or constriction}}via innervation of the sphincter pupillaeWatch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Review Oculomotor Nerve (CN III)Watch associated Bootcamp video - Cranial Nerve IIIa8970311-35ad-4807-ab65-c06b20165bcc
What cranial nerve innervates the levator palpebrae superioris muscle? {{c1::CN III (oculomotor)}}Functions to elevate the upper eyelid (opens the eye)Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Review Oculomotor Nerve (CN III)Watch associated Bootcamp video - Cranial Nerve IIIbda4fcbb-f526-4bd7-bf17-ce8c3807a81c
The {{c2::motor}} component of CN III is located {{c1::centrally::centrally or peripherally}}- Motor = Medial - Parasympathetic = PeripheralReview Oculomotor Nerve (CN III)Watch associated Bootcamp video - Cranial Nerve III38de3170-793c-454f-aa6e-35222f5e7b25
The {{c2::parasympathetic}} component of CN III is located {{c1::peripherally::centrally or peripherally}}- Motor = Medial - Parasympathetic = PeripheralReview Oculomotor Nerve (CN III)Watch associated Bootcamp video - Cranial Nerve III01cce00f-c277-45ad-95bb-f2d2b955ea17
Which CN III fibers are affected first by vascular disease? {{c1::Motor::Motor or Parasympathetic}}Decreased diffusion of oxygen and nutrients to interior fibers from compromised vasculature that resides on outside of nerve; e.g. diabetes mellitusReview Oculomotor Nerve (CN III)Watch associated Bootcamp video - Cranial Nerve IIIc0640c3b-3983-4aaa-a9e1-fdba8a88c190
Which CN III fibers are affected first by compression? {{c1::Parasympathetic::Motor or Parasympathetic}}- e.g. posterior communicating artery aneurysm, uncal herniation - While the motor fibers are first affected by vascular diseaseWatch Intracranial Hypertension (ICH) Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens): Clinical CorrelatesReview Oculomotor Nerve (CN III)Watch associated Bootcamp video - Cranial Nerve III Watch associated Bootcamp video - Brain Herniation7b35cc4d-936d-444f-bb17-b6524133263f
"Lesions to CN {{c2::III (oculomotor)}} result in ptosis and a(n) ""{{c1::down}} and {{c1::out}}"" gaze"- Gaze due to unopposed action of the lateral rectus and superior oblique - Ptosis due to denervation of levator palpebrae superioris Photo credit: Danko et al., CC BY 4.0, via Journal of Education and Teaching - Emergency Medicine Photo credit: Wang Y, Wang XH, Tian MM, Xie CJ, Liu Y, Pan QQ, Lu YN, CC BY 4.0, via Wikimedia CommonsWatch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens): Clinical CorrelatesReview Oculomotor Nerve (CN III)Watch associated Bootcamp video - Cranial Nerve IIIe65f9b3b-2fb9-4c37-9269-1ad9f4f9e248
Lesions to CN {{c1::III (oculomotor)}} result in loss of the motor limb of the light reflexWatch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens): Clinical CorrelatesReview Oculomotor Nerve (CN III)Watch associated Bootcamp video - Cranial Nerve III53032672-41ca-4797-a683-f178f3b7031f
"Lesions to CN III (oculomotor) may result in a(n) ""{{c1::blown/dilated::size}}"" pupil"i.e. mydriasis e.g., aneurysm compressing the superficial parasympathetics in the periphery of CN IIIWatch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens): Clinical CorrelatesWatch associated Bootcamp video - Cranial Nerve III19afb768-2538-48b6-8768-312d379ba50a
Lesions to CN {{c1::III (oculomotor)}} result in inability to accommodate (cycloplegia)Ciliary muscles responsible for accomodation innervated by CN IIIWatch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens): Clinical CorrelatesWatch associated Bootcamp video - Cranial Nerve IIIc46d4b1d-75ab-4ee3-858f-2f9f47d23506
Cranial nerve {{c1::IV}} is the {{c2::trochlear}} nerveWatch Cranial Nerves Overview Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Review Trochlear Nerve (CN IV)Watch associated Bootcamp video - Cranial Nerve IVde2c61a3-a4a3-4e0e-a29b-ae39baf95cd6
CN {{c2::IV (trochlear)}} contributes to eye movement via innervation of the {{c1::superior oblique}} muscle"""LR6, SO4, all the rest 3"" Photo credit: OpenStax, CC BY 4.0"*Picture the impressive (superior) obliques on Thor in the sketch (not actually pictured but maybe helpful)* Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Review Trochlear Nerve (CN IV)Watch associated Bootcamp video - Cranial Nerve IVeb8f8e69-64e8-4b93-8956-70cb1a1cbcb5
The strongest action of the superior oblique muscle is {{c1::depression}} while {{c2::adducted}}Photo credit: OpenStax, CC BY 4.0Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Watch associated Bootcamp video - Cranial Nerve IVa9238737-70b2-46d5-b46f-811bf05d99d1
Lesions to CN IV (trochlear) may present with head tilting {{c1::away from::towards/away from}} the lesioned eyePhoto credit: OpenStax, CC BY 4.0Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens): Clinical CorrelatesReview Trochlear Nerve (CN IV)Watch associated Bootcamp video - Cranial Nerve IV76951743-27bb-4139-bca6-a6290b6f2eb4
Lesions to CN IV (trochlear) result in {{c1::upward}} movement of the eye, particularly with contralateral gazeDue to lack of depression in the adducted position (superior oblique muscle is damaged) Photo credit: Eugene Helveston, CC BY 3.0, via Community Eye Health Photo credit: OpenStax, CC BY 4.0Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens): Clinical CorrelatesWatch associated Bootcamp video - Cranial Nerve IV8b306977-fa74-495c-9925-0d735fe7da78
Which cranial nerve lesion presents with difficulty walking downstairs? {{c1::CN IV (trochlear)}}- Because it's hard for them to look down (loss of depression and intorsion) (can't see the floor without CN IV) - Reading a book is also difficultWatch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens): Clinical CorrelatesReview Trochlear Nerve (CN IV)Watch associated Bootcamp video - Cranial Nerve IVb210103c-4a97-4439-b1c5-6e0b7b3276b2
Cranial nerve {{c1::VI}} is the {{c2::abducens}} nerveWatch Cranial Nerves Overview Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Review Abducens Nerve (CN VI)Watch associated Bootcamp video - Cranial Nerve VI88b7d087-ce67-4fa6-82a3-7583f454b901
CN {{c2::VI (abducens)}} contributes to eye movement via innervation of the {{c1::lateral rectus}} musclePhoto credit: OpenStax, CC BY 4.0Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Review Abducens Nerve (CN VI)Watch associated Bootcamp video - Cranial Nerve VI0f4b07e7-1196-4dac-b3b4-0b4783b0cb1e
Lesions to CN {{c2::VI (abducens)}} result in a medially-directed eye (at rest) that cannot {{c1::abduct}}Right CN VI palsy in right gaze; right eye abducted to midpoint due to weak abduction from the superior oblique Right CN VI palsy: Video credit: Jonathan Trobe, CC BY 3.0, U-M Kellogg Eye Center in Ann Arbor, modified by converting into GIF Photo credit: OpenStax, CC BY 4.0Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Review Abducens Nerve (CN VI)Watch associated Bootcamp video - Cranial Nerve VI2ba6332d-f560-4ac8-b94d-6999d7fae19d
The {{c2::superior oblique}} muscle is isolated by having the patient {{c1::adduct}} and {{c1::depress}} their eye"""Obliques go opposite"": left SO and IO are tested with the patient looking to the right Photo credit: OpenStax, CC BY 4.0"Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Watch associated Bootcamp video - Cranial Nerve IVa171e038-023e-4fa2-a366-4b3c7594eaba
The {{c2::inferior rectus}} muscle is isolated by having the patient {{c1::abduct}} and {{c1::depress}} their eyePhoto credit: OpenStax, CC BY 4.0Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Watch associated Bootcamp video - Cranial Nerve IIIa4237fff-6577-4608-8ff0-ad3c97ba786a
The {{c2::inferior oblique}} muscle is isolated by having the patient {{c1::adduct}} and {{c1::elevate}} their eye"""Obliques go opposite"": left SO and IO tested with patient looking right Photo credit: OpenStax, CC BY 4.0"Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Watch associated Bootcamp video - Cranial Nerve III23964ebf-8677-4751-a9d7-3aa11c268b0d
The {{c2::superior rectus}} muscle is isolated by having the patient {{c1::abduct}} and {{c1::elevate}} their eyePhoto credit: OpenStax, CC BY 4.0Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Watch associated Bootcamp video - Cranial Nerve IIIe2f5a0f0-b2b7-4d8b-b6e1-0d39287ad350
Cranial nerve {{c1::V}} is the {{c2::trigeminal}} nerveWatch Cranial Nerves Overview Watch Cranial Nerve V (Trigeminal)Review Trigeminal Nerve (CN V)Watch associated Bootcamp video - Cranial Nerve Vc471b0f8-cfc4-40f1-b8d1-f343094a6894
Which branch of the trigeminal nerve provides general sensation to the forehead, scalp, and cornea? {{c1::Ophthalmic (V1)}}Damage to this nerve results in corneal anesthesia Photo credit: Henry Vandyke Carter , Public domain, via Wikimedia CommonsWatch Cranial Nerve V (Trigeminal)Review Trigeminal Nerve (CN V)Watch associated Bootcamp video - Cranial Nerve V03f9c1bd-33de-4cdf-b2f4-6700371eaf3f
Which branch of the trigeminal nerve provides general sensation to the palate, nasal cavity, maxillary face, and maxillary teeth? {{c1::Maxillary (V2)}}- This nerve traverses the foramen rotundum to the pterygopalatine fossa - Courses through the inferior orbital fissure to appear on the face at the infraorbital foramen as the infraorbital nerve Photo credit: Henry Vandyke Carter , Public domain, via Wikimedia CommonsWatch Cranial Nerve V (Trigeminal)Watch associated Bootcamp video - Cranial Nerve V6dcc823b-1e29-40e8-b216-541db3d440b2
Which branch of the trigeminal nerve provides general sensation to the jaw and bottom teeth? {{c1::Mandibular (V3)}}Goes through the mental foramen Photo credit: Henry Vandyke Carter , Public domain, via Wikimedia CommonsWatch Cranial Nerve V (Trigeminal)Review Trigeminal Nerve (CN V)Watch associated Bootcamp video - Cranial Nerve Vece7f50d-4b08-4c49-b383-0846f8094413
Which cranial nerve provides somatosensation to the anterior 2/3rds of the tongue? {{c1::Mandibular branch of trigeminal (V3)}}- The lingual nerve is the branch of V3 that gives anterior sensation to the tongue - The alveolar nerve branch continues to provide sensation to the lower teeth and gives off the mental nerve - The mental nerve provides sensation to the chin and lower lipWatch Cranial Nerve V (Trigeminal)Review Trigeminal Nerve (CN V)Watch associated Bootcamp video - Cranial Nerve V2739ed1d-974f-4e5c-91b9-5a686c77fc0a
Which cranial nerve provides motor innervation to the muscles of mastication? {{c1::Mandibular branch of trigeminal (V3)::specific}}i.e. masseter, temporalis, medial pterygoid, and lateral pterygoidWatch Cranial Nerve V (Trigeminal) Watch Muscles of MasticationReview Trigeminal Nerve (CN V)Watch associated Bootcamp video - Cranial Nerve V9c53c6c3-38b6-4c83-91b9-5a259a6e75b2
The {{c1::masseter}}, {{c2::temporalis}}, and {{c3::medial pterygoid}} muscles are responsible for {{c4::closing}} the jaw (muscles of mastication)Innervated by the mandibular branch of the trigeminal nerve (V3) Photo credit: OpenStax, CC BY 4.0Watch Muscles of Mastication7b1f17bf-bbfc-4950-9af4-a60074d278e2
The {{c1::lateral pterygoid}} muscle is responsible for {{c2::opening}} the jaw (muscles of mastication)"- **Protruding - Innervated by the mandibular branch of the trigeminal nerve (V3) - ""Laaaateral"" Photo credit: OpenStax, CC BY 4.0"Watch Muscles of Masticationb703a98a-af23-4ecc-8321-3cc42d6a7ba2
Lesions to CN {{c2::V3 (trigeminal)}} result in deviation of the jaw {{c1::toward}} the side of the lesionDue to unopposed force from the opposite pterygoid muscleWatch Cranial Nerve V (Trigeminal Nerve): Clinical Correlates Watch Muscles of MasticationWatch associated Bootcamp video - Cranial Nerve V556ff4c3-8775-4365-a23a-6abbeb09d5d8
What cranial nerve pathology causes repetitive, unilateral, shooting pain in a distribution of CN V lasting < 1 minute? {{c1::Trigeminal neuralgia (tic douloureux)}}- Triggered by chewing, talking, touching certain parts of the face - Treat with carbamazepine (or oxcarbazepine)Watch Cranial Nerve V (Trigeminal Nerve): Clinical CorrelatesReview Trigeminal Neuralgia Review CarbamazepineWatch associated Bootcamp video496b1234-ab84-42da-9317-a45e4aa56e35
Episodes of trigeminal neuralgia (tic douloureux) typically last {{c1::< 1 minute}}- Episodes often increase in intensity and frequency over time - First-line therapy = carbamazepine or oxcarbazepineWatch Cranial Nerve V (Trigeminal Nerve): Clinical CorrelatesReview Trigeminal Neuralgia Review CarbamazepineWatch associated Bootcamp video643fc15b-bfb8-4df8-8282-f5ec9a1c4f71
Cranial nerve {{c1::VII}} is the {{c2::facial}} nerveFive branches that split off within the parotid gland (temporal, zygomatic, buccal, mandibular, and cervical)Watch Cranial Nerves Overview Watch Cranial Nerve VII (Facial Nerve)Review Facial Nerve (CN VII)Watch associated Bootcamp video - Cranial Nerve VII491a85d1-10e2-4ffa-8f46-b81f5324f244
Which cranial nerve provides taste to the anterior 2/3rds of the tongue? {{c1::Facial nerve (CN VII)}} *bonus: which branch?*Chorda tympani branchWatch Cranial Nerve VII (Facial Nerve)Review Facial Nerve (CN VII)Watch associated Bootcamp video - Cranial Nerve VII5050e397-04c3-4e2c-a706-eb5106eb7d65
Which cranial nerve provides innervation to the muscles of facial expression? {{c1::Facial nerve (CN VII)}}Watch Cranial Nerve VII (Facial Nerve)Review Facial Nerve (CN VII)Watch associated Bootcamp video - Cranial Nerve VIIb823b996-c9fe-417b-8099-b19a407ecbd2
CN {{c2::VII (facial)}} provides parasympathetic innervation to the {{c1::lacrimal}} gland for tear formation * Bonus: which branch?* Greater petrosal branchWatch Cranial Nerve VII (Facial Nerve)Review Facial Nerve (CN VII)Watch associated Bootcamp video - Cranial Nerve VII9e98dbec-44f4-4870-b300-0110126b249c
CN {{c2::VII (facial)}} provides parasympathetic innervation to the {{c1::submandibular}} and {{c1::sublingual}} glands for salivation *bonus: which branch?*chorda tympani branchWatch Cranial Nerve VII (Facial Nerve)Review Facial Nerve (CN VII)Watch associated Bootcamp video - Cranial Nerve VIIe472483a-2e88-40aa-9f1c-05b377704780
Which cranial nerve innervates the orbicularis oculi muscle (facilitates eyelid closing)? {{c1::Facial nerve (CN VII)}}Watch Cranial Nerve VII (Facial Nerve)Review Facial Nerve (CN VII)Watch associated Bootcamp video - Cranial Nerve VIIdf086ad4-d3c1-40f5-9ef4-6afd94212eac
CN {{c2::VII (facial)}} innervates the {{c1::stapedius}} muscle, which facilitates auditory volume modulationThus CN VII lesions may cause hyperacusisWatch Cranial Nerve VII (Facial Nerve)Review Facial Nerve (CN VII)Watch associated Bootcamp video - Cranial Nerve VII59b7a4aa-ae32-4a4c-80ef-33f455901d4a
Cranial nerve {{c1::VIII}} is the {{c2::vestibulocochlear}} nerveWatch Cranial Nerves Overview Watch Cranial Nerve VIII (Vestibulocochlear) Watch AuditionReview Vestibulocochlear Nerve (CN VIII)Watch associated Bootcamp video - Cranial Nerve VIII47ff9661-c13e-4c20-9ecd-45da9ebb01ca
Cranial nerve {{c1::IX}} is the {{c2::glossopharyngeal}} nerveWatch Cranial Nerves Overview Watch Cranial Nerve IX (Glossopharyngeal)Review Glossopharyngeal Nerve (CN IX)Watch associated Bootcamp video - Cranial Nerve IXd640d8ee-5ab2-4353-bcc6-bff66e765eb1
Which cranial nerve provides taste to the posterior 1/3rd of the tongue? {{c1::Glossopharyngeal nerve (CN IX)}}Watch Cranial Nerve IX (Glossopharyngeal)Review Glossopharyngeal Nerve (CN IX)Watch associated Bootcamp video - Cranial Nerve IXe3f21d6b-502b-4c43-beca-e4fca476bbec
Which cranial nerve provides somatosensation to the posterior 1/3rd of the tongue? {{c1::Glossopharyngeal nerve (CN IX)}} *where else does this nerve innervate?*Tonsillar region and upper pharynx (afferent portion of gag reflex)Watch Cranial Nerve IX (Glossopharyngeal)Review Glossopharyngeal Nerve (CN IX)Watch associated Bootcamp video - Cranial Nerve IX0343e03e-a35d-4a0d-a9c4-8173d8dfe28c
CN {{c2::IX (glossopharyngeal)}} provides parasympathetic innervation to the {{c1::parotid}} gland(s) for salivation- Inferior salivary nucleus → CN IX preganglionic fibers → [lesser petrosal n.] otic ganglion → postganglionic parasympathetic fibers → [auriculotemporal n., V3] parotid gland - NOT sublingual or submandibular (facial nerve)Watch Cranial Nerve IX (Glossopharyngeal)Review Glossopharyngeal Nerve (CN IX)Watch associated Bootcamp video - Cranial Nerve IX1960f33a-ef74-43cc-a7ac-b58a5a91d339
Cranial nerve {{c1::X}} is the {{c2::vagus}} nerveWatch Cranial Nerves Overview Watch Cranial Nerve X (Vagus)Review Vagus Nerve (CN X)Watch associated Bootcamp video - Cranial Nerve Xe3921af4-706e-461b-991d-6a91cd275e59
Which cranial nerve is most responsible for swallowing and soft palate elevation? {{c1::Vagus nerve (CN X)}}Watch Cranial Nerve X (Vagus) Watch PharynxReview Vagus Nerve (CN X)Watch associated Bootcamp video - Cranial Nerve Xd4687ab0-2875-4296-98ce-e935851b6efd
Lesions to CN {{c2::X (vagus)}} result in deviation of the uvula {{c1::away from}} the side of the lesionThe weak side collapses and the uvula points awayWatch Cranial Nerve X (Vagus)Review Vagus Nerve (CN X)Watch associated Bootcamp video - Cranial Nerve X105b366b-c84f-47ec-990d-3eeb16969eca
Cranial nerve {{c1::XI}} is the {{c2::accessory}} nerveWatch Cranial Nerves Overview Watch Cranial Nerve XI (Accessory)Review Accessory Nerve (CN XI)Watch associated Bootcamp video - Cranial Nerve XI70b3b59c-aa35-4d03-9f91-a5943aceb062
CN {{c3::XI (accessory)}} provides motor innervation to the {{c1::sternocleidomastoid}} and {{c2::trapezius}} musclesresponsible for head turning and shoulder shrugging, respectivelyWatch Cranial Nerve XI (Accessory) Watch SternocleidomastoidReview Accessory Nerve (CN XI)Watch associated Bootcamp video - Cranial Nerve XI82ce9f5f-9791-47f9-8c95-703dd8af2348
Lesions to CN {{c2::XI (accessory)}} result in weakness turning the head to the {{c1::contra::ipsi/contra}}lateral side of the lesionWatch Cranial Nerve XI (Accessory) Watch SternocleidomastoidWatch associated Bootcamp video - Cranial Nerve XI58bb9095-b561-439d-87b7-2df414f3f4a9
Cranial nerve {{c1::XII}} is the {{c2::hypoglossal}} nerveWatch Cranial Nerves Overview Watch Cranial Nerve XII (Hypoglossal)Review Hypoglossal Nerve (CN XII)Watch associated Bootcamp video - Cranial Nerve XII7573bb27-0ad7-4a10-82a5-f00c897049c6
What is the function of CN XII (hypoglossal)? {{c1::Tongue movement}}Innervates the styloglossus, hyoglossus, genioglossus, and intrinsic tongue muscles; palatoglossus is innervated by CN X Photo credit: OpenStax, CC BY 4.0Watch Cranial Nerves Overview Watch Cranial Nerve XII (Hypoglossal)Review Hypoglossal Nerve (CN XII)Watch associated Bootcamp video - Cranial Nerve XIIcd8fd731-c8c7-4643-a041-83157e168a7a
Lesions to CN {{c2::XII (hypoglossal)}} result in deviation of the tongue {{c1::toward::toward/away from}} the side of the lesion"""Lick your wounds""; due to weakened tongue muscles (e.g. genioglossus) on affected side Photo credit: Mukherjee SK, Gowshami CB, Salam A, Kuddus R, Farazi MA, Baksh J, CC BY 2.0, via Wikimedia Commons"Watch Cranial Nerve XII (Hypoglossal)Review Hypoglossal Nerve (CN XII)Watch associated Bootcamp video - Cranial Nerve XIIfde036d0-8659-4e3e-b12c-994a785e1eea
{{c2::Chronic lymphocytic}} leukemia is associated with {{c1::smudge}} cells and increased lymphocytes on blood smear- Due to collapse of fragile tumor cells during slide preparation - CLL = Crushed Little Lymphocytes Lecture NotesPhoto credit: Mikael Häggström, M.D., CC0, via Wikimedia Commons; Dr Graham Beards, CC BY-SA 3.0, via Wikimedia CommonsWatch Acute Lymphoblastic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), Hairy Cell Leukemia & Adult T cell LeukemiaReview Chronic Lymphocytic Leukemia (CLL)Watch associated Bootcamp video - Chronic Lymphocytic Leukemiab0d5fd7f-7156-446d-a407-595815b512e9
Does hairy cell leukemia typically present with lymphadenopathy? {{c1::No}}"""Trapped in the red pulp and marrow so it can't get to where its supposed to go"""Watch Acute Lymphoblastic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), Hairy Cell Leukemia & Adult T cell LeukemiaReview Hairy Cell Leukemia (HCL)Watch associated Bootcamp video - Hairy Cell Leukemiaabfd96e2-c07c-4146-9ca7-935e22759f27
The {{c1::Edinger-Westphal}} nucleus gives rise to pre-ganglionic {{c2::parasympathetic}} axons that travel with CN III (oculomotor)Innervates the pupillary sphincter muscle and the ciliary muscle Photo credit: OpenStax, CC BY 4.0Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Watch associated Bootcamp video - Visual Pathway Overview Watch associated Bootcamp video - Midbrain, Pons, and Medulla2c4a131c-854c-43a1-8942-582adab6942e
The {{c3::Edinger-Westphal}} nucleus provides parasympathetic innervation to the {{c1::pupillary sphincter}} and {{c2::ciliary}} musclesThus mediates pupillary constriction and accommodation Photo credit: OpenStax, CC BY 4.0Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Watch associated Bootcamp video - Visual Pathway Overview Watch associated Bootcamp video - Midbrain, Pons, and Medulla5db9210b-0759-4197-a3ce-6aea8f5e66c4
Which cranial nerve decussates prior to exiting the brainstem? {{c1::CN IV (trochlear)}}decussates in the superior medullary velumWatch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Review Trochlear Nerve (CN IV)Watch associated Bootcamp video - Cranial Nerve IV Watch associated Bootcamp video - Midbrain, Pons, and Medulla3d9aee77-f3db-4cdd-870e-982b2861733d
Which part of the brainstem contains the nuclei of CN III and IV? {{c1::Midbrain}}CN III nucleus in rostral midbrain; CN IV nucleus in caudal midbrainReview Oculomotor Nerve (CN III) Review Trochlear Nerve (CN IV)Watch associated Bootcamp video - Cranial Nerve III Watch associated Bootcamp video - Midbrain, Pons, and Medullac346d45c-f6af-48cb-884b-ee2ca37a204c
Which part of the brainstem contains the nuclei of CN V, VI, VII and VIII? {{c1::Pons}}Review Trigeminal Nerve (CN V)Watch associated Bootcamp video - Midbrain, Pons, and Medulla8356c917-59a6-4ef0-a375-d5d89c3ae58a
The {{c1::dorsal vagal}} nucleus sends parasympathetic fibers to the heart, lungs, and upper GI tractAKA the dorsal motor nucleusReview Dorsal Motor NucleusWatch associated Bootcamp video - Cranial Nerve X Watch associated Bootcamp video - Midbrain, Pons, and Medulla649d4bcb-c19c-40fc-8901-a8bdb462ce35
The nucleus {{c1::solitarius}} receives visceral sensory information (e.g. taste, baroreceptors, gut distention)- Solitarius = Sensory - AKA the solitary nucleus or nucleus tractus solitariusReview Nucleus Tractus SolitariusWatch associated Bootcamp video - Midbrain, Pons, and Medulla Watch associated Bootcamp video - Pressure and Flow Physiology : Sensory Receptors of Vasculature6d222786-2218-49f0-bcbe-7153259013a7
The nucleus {{c1::ambiguus}} supplies motor innervation of the pharynx, larynx, and upper esophagus (e.g. swallowing, palate elevation)Nucleus aMbiguus = MotorReview Nucleus AmbiguusWatch associated Bootcamp video - Midbrain, Pons, and Medulla35e80952-1872-4a15-9680-19d984ca89aa
Which part of the brainstem contains the nuclei of CN IX, X and XII? {{c1::Medulla}}Review Hypoglossal Nerve (CN XII)Watch associated Bootcamp video - Midbrain, Pons, and Medulla47230a17-8c2f-441d-924d-93c1963fa39b
The medial lemniscus is initially positioned {{c1::medially::medially or laterally}} in the caudal medullaReview Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Midbrain, Pons, and Medulla3b0aac79-de3b-4c33-b130-51b753cb4bad
The medial lemniscus is positioned more {{c1::laterally::medially or laterally}} as it ascends through the midbrainCourses laterally to meet with the spinothalamic tract; both travel to the VPL nucleus in the thalamus Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Midbrain, Pons, and Medulla386a6e2d-1d5f-485d-9701-d5076a83ae82
Lesions to the medial longitudinal fasciculus (MLF) cause {{c1::internuclear ophthalmoplegia (INO)}}Conjugate horizontal gaze palsy Left INO shown below Photo credit: Thebault et al., CC BY 4.0, via Cureus, modified by converting into GIF Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Multiple Sclerosis15caebaf-93b3-440a-ace6-15d7d8bb0e3b
The corticospinal tract is located {{c1::medially::medially or laterally}} throughout the brainstemPhoto credit: OpenStax, CC BY 4.0Review Corticospinal TractWatch associated Bootcamp video - Descending Tracts78c2abde-e9ce-4e94-bdd5-904b3e72afdc
Horner syndrome presents with ptosis due to denervation of the {{c1::superior tarsal}} muscleSympathetic denervation Photo credit: Silva et al., CC BY 4.0, via Cureus Photo credit: Images licensed by Physeo and used with permission. Purchase full access here.Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens): Clinical Correlates7e43f8c9-b8f7-435b-ba44-7bd25e4dabb6
Horner syndrome is associated with lesions of the spinal cord above {{c1::T1}}- Requires admission for emergency surgery Horner syndrome can be caused by damage to any portion of hypothalamospinal tract - 1° lesion: damage to ciliospinal center of budge (C8-T1/T2) [Brown Sequard, late-stage syringomyelia, Wallenberg, pontine hemorrhage] - 2° lesion: compression of stellate ganglion (C2) [Pancoast tumor] - 3° Lesion: ICA dissection (very painful) Photo credit: Images licensed by Physeo and used with permission. Purchase full access here.Watch Brachial Plexus InjuriesReview Posterior Inferior Cerebellar Artery (PICA)6e46d1db-3bf4-4ad5-a38a-930e8febf0f5
Horner syndrome is a triad of ptosis, miosis, and anhidrosis due to {{c1::sympathetic}} denervation of the faceDamage to hypothalamospinal tract: - 1° lesion: Pontine hemorrhage; Wallenberg's; spinal cord lesion above T1 - 2° lesion: pancoast tumor compressing the stellate ganglion - 3° lesion: ICA dissection (painful) Photo credit: Images licensed by Physeo and used with permission. Purchase full access here.Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens): Clinical Correlates132ccf44-c8c2-4311-846f-3944589c7b70
The {{c2::spinal trigeminal}} nucleus receives information about {{c1::pain}} and {{c1::temperature}} from the ipsilateral faceSpinal trigeminal nucleus is a caudal continuation of the main sensory nucleus Photo credit: Neurosurgery Wiki, CC Attribution-Share Alike 4.0 International, [Link] Photo credit: Henry Vandyke Carter , Public domain, via Wikimedia CommonsWatch associated Bootcamp video - Cranial Nerve V4107fd48-e292-43ea-a8cb-59ccc68469e0
The {{c2::mesencephalic}} nucleus of V receives {{c1::proprioceptive}} input from the faceJaw jerk reflex: Photo credit: Photo credit: Dr. Osama Shukir Muhammed Amin FRCP (Glasg), used with permission.Watch Cranial Nerve V (Trigeminal)Watch associated Bootcamp video - Cranial Nerve V1fb3d338-3cde-4fee-ae9e-dec9b344c920
The 2nd-order neurons of trigeminal nerve nuclei synapse in the {{c1::ventral posteromedial (VPM)}} nucleus of the thalamusPhoto credit: Neurosurgery Wiki, CC Attribution-Share Alike 4.0 International, [Link] Photo credit: Henry Vandyke Carter , Public domain, via Wikimedia CommonsWatch associated Bootcamp video - Diencephalon Overview24318cd4-0c56-4fb3-ba6d-47e3ce0a4b42
Lesions to CN V result in loss of facial sensations on the {{c1::ipsi::ipsi/contra}}lateral sidee.g. loss of pain and temperature sensation (spinal trigeminal nucleus), loss of tactile sensation (main sensory nucleus), and/or muscle weakness (motor nucleus)Watch Cranial Nerve V (Trigeminal Nerve): Clinical CorrelatesReview Trigeminal Nerve (CN V)Watch associated Bootcamp video - Cranial Nerve V8b3ffc77-8bb2-44ea-8835-f207b78b3208
{{c1::Corticobulbar}} tracts serve as a source of UMN innervation of LMNs in cranial nerve nucleiInfluence all brain stem nuclei that innervate skeletal muscle (e.g. CN V, VII, X, XI, XII) Photo credit: partial image, John.Tuthill, CC BY-SA 4.0, via Wikimedia Commons Photo credit: BruceBlaus, CC BY-SA 4.0, via Wikimedia Commonsc9fc8954-c008-4997-bdb0-355292171b25
The corticobulbar innervation of facial motor neurons to muscles of the {{c1::upper::lower/upper}} face is {{c2::bi::uni/bi}}laterale.g. muscles used to wrinkle the forehead and shut the eyes Photo credit: Patrick J. Lynch, medical illustrator, CC BY 2.5, via Wikimedia Commons Photo credit: Images licensed by Physeo and used with permission. Purchase full access hereWatch associated Bootcamp video - Descending Tractsb2cb64ff-66a2-4a23-9563-d94ec3b1758d
The corticobulbar innervation of facial motor neurons to muscles of the {{c1::lower::lower/upper}} face is {{c2::contra::ipsi/contra}}laterale.g. muscles used to smile and flare the nostrils Photo credit: Patrick J. Lynch, medical illustrator, CC BY 2.5, via Wikimedia Commons Photo credit: Images licensed by Physeo and used with permission. Purchase full access hereWatch associated Bootcamp video - Descending Tracts4ccdf859-3bdf-44e6-ae38-3827a04a935e
{{c3::Upper}} motor neuron lesions of the facial nerve result in {{c2::contra::ipsi/contra}}lateral paralysis of the {{c1::lower}} muscles of facial expression- E.g. destruction of motor cortex or connection between motor cortex and facial nucleus - Forehead is spared due to bilateral UMN innervation Photo credit: Patrick J. Lynch, medical illustrator, CC BY 2.5, via Wikimedia Commons Photo credit: Images licensed by Physeo and used with permission. Purchase full access hereWatch Cranial Nerve VII (Facial): Clinical CorrelatesReview Facial Nerve (CN VII)Watch associated Bootcamp video - Cranial Nerve VII77b880df-9678-4678-903d-188ba55ef6cb
{{c3::Lower}} motor neuron lesions of the facial nerve result in {{c2::ipsi::ipsi/contra}}lateral paralysis of the {{c1::upper and lower}} muscles of facial expressione.g. destruction of the facial nucleus or CN VII anywhere along its course Photo credit: Patrick J. Lynch, medical illustrator, CC BY 2.5, via Wikimedia Commons Photo credit: Images licensed by Physeo and used with permission. Purchase full access hereWatch Cranial Nerve VII (Facial): Clinical CorrelatesReview Facial Nerve (CN VII)Watch associated Bootcamp video - Cranial Nerve VII8fcb1f37-c502-4a2c-b80d-cf97f12020b0
When facial nerve palsy is idiopathic, it is called {{c1::Bell}} palsy- Primary (idiopathic) is most common cause of peripheral facial nerve palsy - Secondary causes include Lyme disease, herpes simplex, herpes zoster (Ramsay Hunt syndrome), sarcoidosis, tumors (parotid gland), diabetes mellitus - Pseudomonas-induced otitis externa in diabetes / immunocompromised state can cause spread into deeper tissues (facial nerve palsy, mastoid, base of the skull); can be fatalWatch Cranial Nerve VII (Facial): Clinical CorrelatesReview Facial Nerve (CN VII)Watch associated Bootcamp video - Cranial Nerve VII Watch associated Bootcamp video - Pseudomonas Aeruginosa356b09c5-36c3-48b4-80bb-6a7beaa9bc87
{{c1::Ramsay Hunt}} syndrome is a combination of {{c2::herpes zoster (shingles)}} and {{c3::facial nerve palsy}}- AKA herpes zoster oticus - Presents as painful, erythematous rash in auditory canal and ipsilateral facial paralysis (spread to CN VII and CN VIII)Watch Cranial Nerve VII (Facial): Clinical CorrelatesReview Facial Nerve (CN VII)Watch associated Bootcamp video - Varicella Zoster0f2187aa-b23f-4a56-9678-52bdc24f0ad4
Treatment for facial nerve palsy may include {{c1::corticosteroids}} and {{c2::acyclovir}}- Acute-onset, progressive, unilateral weakness of the upper and lower face; may have prodrome of auricular pain - Acyclovir due to possibility that HSV reactivation causes the palsy - Most patients have a gradual recovery of functionWatch Cranial Nerve VII (Facial): Clinical CorrelatesReview Facial Nerve (CN VII)Watch associated Bootcamp video - Cranial Nerve VII13df14b1-380d-4c36-85ef-3637cd7cadd3
The {{c1::cochlea}} is a spiral-shaped structure in the inner ear that contains the organ of {{c2::Corti}}Photo credit: OpenStax, CC BY 4.0, via Wikimedia CommonsWatch Ear Watch AuditionWatch associated Bootcamp video - Auditory Fundamental Conceptsd58634e1-5b89-4c77-84a6-2c8f80d8fabe
The organ of Corti lies on the {{c1::basilar}} membrane of the cochlea and is bathed in the endolymph contained in the scala mediaPhoto credit: OpenStax, CC BY 4.0, via Wikimedia CommonsWatch Ear Watch AuditionWatch associated Bootcamp video - Auditory Fundamental Concepts011cb16c-3b27-4ad3-bfde-22e677d3f59b
The organ of Corti contains two types of receptor cells: {{c1::inner}} and {{c1::outer hair}} cellsThree outer hair cells and one inner hair cell per organ Photo credit: Madhero88, CC BY-SA 3.0, via Wikimedia CommonsWatch Ear Watch AuditionWatch associated Bootcamp video - Auditory Fundamental Concepts872b0ac4-cd82-43dc-bbff-0ee120733969
Bending of cilia in response to basilar membrane vibration produces a change in {{c1::K+}} conductance of the hair cellBending in one direction causes depolarization; bending in the other direction causes hyperpolarization **Causes Ca2+ to enter which causes NT release Mechanism of auditory transduction Sound waves → vibration of organ of corti → bending of cilia on hair cells → change in K+ conductance of hair cell membrane → oscillating receptor potential (cochlear microphonic) → intermittent glutamate release → intermittent action potentials in afferent cochlear nerves De-ward the kinocilium Photo credit: Cochleae, CC BY-SA 4.0, via Wikimedia CommonsWatch AuditionWatch associated Bootcamp video - Auditory Fundamental Concepts40064050-2588-4a83-ac79-03b7262aeda1
{{c2::High}} frequencies are best heard at the {{c1::base}} of the cochlea (basilar membrane)Photo credit: OpenStax, CC BY 4.0, via Wikimedia CommonsWatch Ear Watch AuditionWatch associated Bootcamp video - Auditory Fundamental Concepts10fe5d93-e216-4db5-9bce-cb1a04a6d762
{{c2::Low}} frequencies are best heard at the {{c1::apex}} of the basilar membrane (near the helicotrema)The helicotrema is wide and flexible Photo credit: OpenStax, CC BY 4.0, via Wikimedia CommonsWatch Ear Watch AuditionWatch associated Bootcamp video - Auditory Fundamental Conceptsbe3b1a5e-e0bc-47f3-9fb9-f7ac2abf82b0
If there is unilateral {{c1::conductive}} hearing loss, the Weber test localizes to the {{c2::affected}} ear- i.e. vibration is heard louder in the affected ear - Conduction deficit masks the ambient noise in the room, allowing the vibration to be better heardWatch associated Bootcamp video - Weber and Rinne Testsb189fae7-479f-41e8-8b2f-84ac6653a6d6
If there is unilateral {{c1::sensorineural}} hearing loss, the Weber test localizes to the {{c2::unaffected}} eari.e. vibration is heard louder in the unaffected earWatch associated Bootcamp video - Weber and Rinne Tests4d5bad76-83d2-45c9-97c2-1dcd928a331f
If there is unilateral {{c1::conductive}} hearing loss, the Rinne test demonstrates {{c2::bone}} > {{c2::air}} conductioni.e. no air conduction after bone conduction is gone (abnormal)Watch associated Bootcamp video - Weber and Rinne Tests Watch associated Bootcamp video - Primary Ciliary Dyskinesiaf044127c-172e-4d16-98d5-161c6d83c2ef
If there is unilateral {{c1::sensorineural}} hearing loss, the Rinne test demonstrates {{c2::air}} > {{c2::bone}} conductioni.e. air conduction is present after bone conduction is gone (normal)Watch associated Bootcamp video - Weber and Rinne Tests Watch associated Bootcamp video - Primary Ciliary Dyskinesia07b7ac24-e280-4e11-839f-61a582a8ef2e
Causes of {{c1::conductive}} hearing loss include obstruction, otosclerosis, and otitis media- Passage of sound waves through external or middle ear is interrupted - Otosclerosis = inherited inability to amplify sound due to bony overgrowth of the stapes (hearing loss)Watch associated Bootcamp video534965d6-d6f8-4cae-81ae-50bdc8bcaf96
Presbycusis is a form of age-related, {{c2::sensorineural}} hearing loss, often at {{c1::higher}} frequencies- Due to destruction of hair cells at the cochlear base - High age, high frequencyWatch associated Bootcamp video - Sensorineural Hearing Lossd5d973e9-3e52-43c0-a6f0-6090b644a75f
The {{c1::spiral}} ganglion contains cell bodies whose peripheral axons innervate hair cells of the organ of CortiPhoto credit: What-when-who, CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Auditory Fundamental Conceptsc90596a5-8b5b-48cb-9574-bb552048e95d
The central axons from the spiral ganglion form the {{c1::cochlear}} part of CN VIIICentral axons are Cochlear Photo credit: What-when-who, CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Cranial Nerve VIII8110638c-5475-4e08-9506-4e3c2001e573
Axons of cells in the cochlear nuclei {{c2::bi}}laterally innervate the {{c1::superior olivary}} nuclei in the ponsThe superior olivary nuclei are the first auditory nuclei to receive binaural input; helps localize sound Photo credit: Jonathan E. Peelle, CC BY 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Auditory Fundamental Concepts6775bdfa-016c-49bf-b16d-37158b963689
The auditory input from the superior olivary nucleus travels via the {{c1::lateral lemniscus}} to the {{c2::inferior colliculus}} (midbrain)- Each lateral lemniscus carries information derived from both ears - Input from contralateral ear predominates Photo credit: Jonathan E. Peelle, CC BY 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Auditory Fundamental Conceptsfbd8c5ad-50c1-451c-ae2e-348fa95cf893
The inferior colliculus sends auditory information to the {{c1::medial geniculate body}} of the thalamusPhoto credit: What-when-who, CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Diencephalon Overview63e91ee4-19e9-4112-843d-c6346d16bc33
The auditory information from the medial geniculate body projects to the {{c1::primary auditory cortex}} of the superior temporal gyrusPhoto credit: What-when-who, CC BY-SA 4.0, via Wikimedia CommonsWatch AuditionWatch associated Bootcamp video - Diencephalon Overviewe6ea2fd3-bdfb-4a38-8877-b089995a96d0
Vestibular-evoked nystagmus begins with a slow deviation {{c1::toward::toward or away from}} the lesione.g. left lesion → right nuclei are unopposed and act as if stimulated → eyes slowly turn toward left Photo credit: House, Earl Lawrence. Pansky, Ben., Public domain, via Wikimedia Commons8dfda645-6544-44ba-a7c1-5be3004d0f83
Vestibular-evoked nystagmus is characterized by a fast corrective phase {{c1::away from::toward or away from}} the lesione.g. left lesion → slow deviation towards left → eyes quickly turn right; fast response mediated by the cortex Photo credit: House, Earl Lawrence. Pansky, Ben., Public domain, via Wikimedia Commons07517e3e-7ad7-450b-9efb-8bd34061abb6
{{c2::Cold}} water irrigation of the ear produces nystagmus to the {{c1::opposite}} side (caloric test)"- The expected direction of nystagmus (fast component) can be remembered with ""COWS"": Cold Opposite, Warm Same - Unilaterally reduced or absent caloric response suggests a peripheral cause"cec6e67e-8493-4b7a-b8f6-3e5b52d5cd63
{{c2::Warm}} water irrigation of the ear produces nystagmus to the {{c1::same}} side (caloric test)"- The expected direction of nystagmus (fast component) can be remembered with ""COWS"": Cold Opposite, Warm Same - Unilaterally reduced or absent caloric response suggests a peripheral cause"f4b2c887-19a6-4679-894c-0a7eb438b560
The {{c1::medial longitudinal fasciculus (MLF)}} is a pair of tracts that allows for crosstalk between CN {{c2::VI}} and CN {{c2::III}} nucleiCoordinates both eyes to move in the same direction (conjugate horizontal gaze) Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Midbrain, Pons, and Medullaf98e24a5-4bbe-4595-a11f-907ff7543ea8
One control center for horizontal gaze is located in the {{c1::frontal eye field}}, which is responsible for {{c2::contra}}lateral gazeWatch associated Bootcamp video - Multiple Sclerosis57263a26-fd31-4f17-95f5-163fbd4f1113
One control center for horizontal gaze is located in the {{c1::paramedian pontine reticular formation (PPRF)}}, which is responsible for {{c2::ipsi}}lateral gazePhoto credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Multiple Sclerosis9d628007-0de1-42cb-bd84-4367db24340d
The {{c2::frontal eye}} fields send axons that decussate and synapse on neurons of the contralateral {{c1::paramedian pontine reticular formation (PPRF)}}5b367592-1a73-46d3-ba8a-6e01e2c8f8c1
The paramedian pontine reticular formation (PPRF) sends axons to synapse with cell bodies of the ipsilateral {{c1::abducens}} nucleusThus, causing abduction (via lateral rectus) of the ipsilateral eye Photo credit: OpenStax, CC BY 4.0Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Watch associated Bootcamp video - Multiple Sclerosis91cba376-0387-4f94-8426-0054edb9e02e
The abducens nucleus sends axons that course within the contralateral {{c2::medial longitudinal fasciculus (MLF)}} to reach the {{c1::oculomotor}} nucleusthus causing adduction (via medial rectus) of the contralateral eye Photo credit: OpenStax, CC BY 4.0Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Watch associated Bootcamp video - Multiple Sclerosisd0c7433f-d47e-4665-873b-1b539020f478
Lesions to the paramedian pontine reticular formation (PPRF) result in eyes that look {{c1::away from}} the side of the lesione.g. right PPRF lesions → eyes cannot look right → look left Photo credit: OpenStax, CC BY 4.0555cd1f9-6710-436a-a87a-5af4d847d93f
Lesions to the frontal eye fields result in eyes that look {{c1::towards}} the side of the lesione.g. right frontal eye field lesion → eyes cannot look left → look rightWatch associated Bootcamp video - Frontal Lobe606ef898-082b-4237-857c-8845890b5952
Lesions to the abducens nucleus may be accompanied by complete, ipsilateral {{c1::facial}} paralysis in addition to symptoms from the abducens/PPRF lesionDue to looping of facial nerve around the abducens nucleusWatch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens): Clinical Correlates1b3dc075-7f50-472c-92af-b6dbb0a84dc2
The medial longitudinal fasciculus (MLF) is {{c1::heavily::heavily or lightly}} myelinatedmust communicate quickly so eyes move at the same timeWatch associated Bootcamp video - Midbrain, Pons, and Medulla9b9473ee-8816-4683-ae7d-fc522890642d
What neurological pathology commonly causes medial longitudinal fasciculus lesions? {{c1::Multiple sclerosis}}Left INO shown below Photo credit: Thebault et al., CC BY 4.0, via Cureus, modified by converting into GIF Photo credit: OpenStax, CC BY 4.0Watch Multiple SclerosisWatch Multiple Sclerosis: Clinical PresentationWatch associated Bootcamp video - Multiple Sclerosis3f44500c-8a7b-46aa-8d8c-742069428ca6
Internuclear ophthalmoplegia (INO) results in inability to {{c1::adduct}} the {{c2::ipsi}}lateral eyee.g. right INO = impaired adduction of right eye with left gaze while the contralateral eye abducts with nystagmus Due to lesion of the MLF Left INO shown below Photo credit: Thebault et al., CC BY 4.0, via Cureus, modified by converting into GIFWatch Multiple SclerosisWatch Multiple Sclerosis: Clinical PresentationWatch associated Bootcamp video - Multiple Sclerosisf39ff07b-423f-414e-8c66-c7bc71f9c19f
Internuclear ophthalmoplegia results in {{c1::nystagmus}} of the {{c2::contra}}lateral eyee.g. right INO = nystagmus of left eye (CN VI overfires to stimulate CN III) Left INO shown below Photo credit: Thebault et al., CC BY 4.0, via Cureus, modified by converting into GIFWatch Multiple SclerosisWatch Multiple Sclerosis: Clinical PresentationWatch associated Bootcamp video - Multiple Sclerosis0e22b6b5-cc80-4e41-ba11-1c23a102109e
Internuclear ophthalmoplegia (INO) has normal {{c1::convergence}}, which is a distinguishing feature from a CN III lesionCN III lesion would also result in ptosis and mydriasis, in addition to lack of convergenceWatch associated Bootcamp video - Multiple Sclerosis251afe45-c4fa-48ab-bfd9-fa4d28928927
What arteries supply the medial medulla? {{c1::Anterior spinal artery or vertebral artery::2}}Photo credit: OpenStax, CC BY 4.0Review Anterior Spinal Artery (ASA)Watch associated Bootcamp video - Midbrain, Pons, and Medulla3611e545-e0a1-4cd6-852b-d7e0e6800eac
What artery supplies the lateral medulla? {{c1::Posterior inferior cerebellar artery (PICA)}}Photo credit: OpenStax, CC BY 4.0Review Posterior Inferior Cerebellar Artery (PICA)Watch associated Bootcamp video - Midbrain, Pons, and Medullab27270a6-9425-4890-8774-333c865ea331
What artery supplies the medial pons? {{c1::Basilar artery (via paramedian pontine branches)}}Photo credit: OpenStax, CC BY 4.0 Photo credit: Cuoco JA, Hitscherich K, Hoehmann CL. Brainstem vascular syndromes: A practical guide for medical students. Edorium J Neurol 2016;3:4–16. [https://www.edoriumjournalofneurology.com/archive/2016-archive/100008N06JC2016-cuoco/100008N06JC2016-cuoco-full-text.php]Watch associated Bootcamp video - Midbrain, Pons, and Medulla0bc6cc0d-81d9-4b45-942a-511c3a612875
What artery supplies the lateral pons? {{c1::Anterior inferior cerebellar artery (AICA)}}also receives superior cerebellar artery rostrally Photo credit: OpenStax, CC BY 4.0Review Anterior Inferior Cerebellar Artery (AICA)Watch associated Bootcamp video - Midbrain, Pons, and Medulla12b90b95-e483-40e9-af13-0345806b62cf
What artery supplies the medial and lateral midbrain? {{c1::Posterior cerebral artery (PCA)}}Via paramedian (medial) and circumferential branches (lateral)Watch associated Bootcamp video - Midbrain, Pons, and Medulla59c39757-bdd2-4db0-aa4d-12464771f2ed
"Rules of 4: There are four {{c5::midline}} structures that start with ""M"" 1. {{c1::Motor pathway (corticospinal tract)}} 2. {{c2::Medial lemniscus}} 3. {{c3::Medial longitudinal fasciculus (MLF)}} 4. {{c4::Motor nuclei/nerves (CN III, IV, VI, XII)}}"The motor nuclei all divide equally into 12Watch associated Bootcamp video - Rule of 4s13963be0-7d78-49e1-a80d-013ba699cb82
Rules of 4: Lesions in the brain stem that affect the {{c1::corticospinal tract}} result in {{c2::contra::ipsi/contra}}lateral weakness of the arm and legReview Corticospinal TractWatch associated Bootcamp video - Rule of 4s2265cc09-44fd-425c-b7d9-18053ae5e468
Rules of 4: Lesions in the brain stem that affect the {{c1::medial lemniscus}} result in {{c2::contra}}lateral loss of vibration sense and proprioception in the arm and legReview Anterior Spinal Artery (ASA) Review Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Rule of 4sf7fc5072-9dc4-4f53-80b1-4b6710c723c4
Rules of 4: Lesions in the brain stem that affect the {{c1::medial longitudinal fasciculus (MLF)}} result in {{c2::ipsi}}lateral internuclear ophthalmoplegiaLeft INO shown below Photo credit: Thebault et al., CC BY 4.0, via Cureus, modified by converting into GIF Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Rule of 4sc88c452e-27dd-406c-bed3-e3e6d0d6293f
Rules of 4: Lesions in the brain stem that affect the cranial motor nuclei or nerves typically result in {{c1::ipsi}}lateral loss of the affected nervenote: CN IV decussates immediately therefore damage to the trochlear nucleus would present contralaterallyWatch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens): Clinical CorrelatesWatch associated Bootcamp video - Rule of 4s171df448-a069-48d0-9c35-1097b615542b
"Rules of 4: There are four {{c5::lateral}} structures that start with ""S"" 1. {{c1::Spinocerebellar}} pathway 2. {{c2::Spinothalamic}} tract 3. {{c3::Spinal trigeminal}} nucleus 4. {{c4::Sympathetic (hypothalamospinal)}} pathway"Watch associated Bootcamp video - Rule of 4s81f6be52-977a-4549-aa27-79a837ec256b
Rules of 4: Lesions in the brain stem that affect the {{c1::spinocerebellar pathway}} result in {{c2::ipsi}}lateral ataxia of the arm and legPhoto credit: Images licensed by Physeo and used with permission. Purchase full access hereWatch associated Bootcamp video - Rule of 4s3d12e4b1-7f6d-4c05-b87f-e4da2c84e116
Rules of 4: Lesions in the brain stem that affect the {{c1:: lateral spinothalamic tract}} result in {{c2::contra}}lateral alteration of pain and temperature in the arm and legPhoto Credit: Anatomy & Physiology, via Oregon State UniversityReview Spinothalamic TractWatch associated Bootcamp video - Rule of 4sc5ce18ab-b505-43af-a9d7-b90de24d3ac6
Rules of 4: Lesions in the brain stem that affect the {{c1::spinal trigeminal nucleus}} result in {{c2::ipsi}}lateral alteration of pain and temperature on the face in the distribution of CN Vnote: the paper states sensory nucleus of V, I think spinal trigeminal nucleus is more accurateWatch associated Bootcamp video - Rule of 4s578822cb-81cf-43c2-beb8-e50f3cbdd7b9
Rules of 4: Lesions in the brain stem that affect the {{c1::sympathetic pathway}} result in {{c2::ipsi}}lateral Horner syndromePhoto credit: Fion Bremner, CC BY 4.0, via Frontiers in Neurology (above); Kikkeri et al., CC BY 3.0, via Cureus (below) Photo credit: Images licensed by Physeo and used with permission. Purchase full access here.Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens): Clinical CorrelatesWatch associated Bootcamp video - Rule of 4s7f9aa06d-94cb-44b3-89ed-a1d37c7b8efd
What syndrome is associated with lesion of the following areas? 1. Corticospinal tract 2. Medial lemniscus 3. Hypoglossal nerve (CN XII) {{c1::Medial medullary syndrome}}"- AKA inferior alternating hemiplegia - The medial ""M"" tracts and CN XII suggests medial medulla Manifests with: - Contralateral hemiparesis of the body - Contralateral loss of proprioception - Ipsilateral tongue deviation on protrusion"Watch Cranial Nerve XII (Hypoglossal)Review Anterior Spinal Artery (ASA)Watch associated Bootcamp video - Medullary and Pontine Syndromes1a100113-a7bf-4366-952a-e34cf4a49c57
{{c2::Lateral medullary (Wallenberg)}} syndrome is caused by: - Occlusion of the {{c1::posterior inferior cerebellar}} artery - Most commonly due to traumatic vascular dissection / occlusion of the distal {{c3::vertebral}} arteryRemember, vertebral is more common, but PICA may be more boards-relevantReview Posterior Inferior Cerebellar Artery (PICA)Watch associated Bootcamp video - Medullary and Pontine Syndromes68393070-32ac-41d1-8d5a-96b4f93d8436
What syndrome is associated with lesion of the following areas? 1. Spinothalamic tract 2. Spinal trigeminal nucleus 3. Hypothalamospinal tract 4. Nucleus ambiguus (CN IX, X) 5. Vestibular nucleus (CN VIII) 6. Inferior cerebellar peduncle {{c1::Lateral medullary syndrome (Wallenberg)}}"the lateral ""S"" tracts and CN X involvement suggest lateral medulla; note: the vestibular portion of CN VIII is more commonly associated with lateral medullary lesions"Review Nucleus Ambiguus Review Posterior Inferior Cerebellar Artery (PICA)Watch associated Bootcamp video - Medullary and Pontine Syndromes9b8f3757-d6af-4d12-b397-99f20ea9df14
Lesion to which artery affects the nucleus ambiguus? {{c1::Posterior inferior cerebellar artery (PICA)}}"e.g. lateral medullary (Wallenberg) syndrome; ""Don't pick a (PICA) horse (hoarseness) that can't eat (dysphagia)"""Review Nucleus Ambiguus Review Posterior Inferior Cerebellar Artery (PICA)Watch associated Bootcamp video - Medullary and Pontine Syndromes52a39e1b-5e76-4cea-b3b8-3923203152fe
What syndrome is associated with lesion of the following areas? 1. Corticospinal tract 2. Medial lemniscus 3. Abducens nerve (CN VI) {{c1::Medial pontine syndrome}}"- AKA middle alternating hemiplegia - The medial ""M"" tracts and CN VI suggests medial pons; larger lesions may involve the facial nerve as well - Medial pontine syndrome involves occlusion of the paramedian branches of the basilar artery. Involvement of: - Corticospinal tract may present as a contralateral spastic hemiparesis - Medial lemniscus may present as a contralateral loss of tactile, position, and vibration sense - Fibers of CN VI (abducens) may present as a medial strabismus"Watch associated Bootcamp video - Medullary and Pontine Syndromes84907f37-c1cd-43a5-9d03-b593ddb5ddb3
What syndrome is associated with lesion of the following areas? 1. Spinothalamic tract 2. Spinal trigeminal nucleus 3. Hypothalamospinal tract 4. Facial nucleus (CN VII) 5. Cochlear nucleus (CN VIII) 6. Vestibular nucleus (CN VIII) 7. Middle and inferior cerebellar peduncles 8. Labyrinthine artery {{c1::Lateral pontine syndrome (Marie-Foix)}}"the lateral ""S"" tracts and CN VII involvement suggest lateral pons"Review Anterior Inferior Cerebellar Artery (AICA)Watch associated Bootcamp video - Medullary and Pontine Syndromes25bb98a3-5dee-41a9-ab48-6b50c12a75be
Lesion to which artery affects the facial nucleus? {{c1::Anterior inferior cerebellar artery (AICA)}}"e.g. lateral pontine syndrome; ""facial droop means AICA's pooped"""Review Anterior Inferior Cerebellar Artery (AICA)Watch associated Bootcamp video - Medullary and Pontine Syndromes52ec784b-4814-41fa-a64e-c1dac38785c4
{{c1::Vestibular schwannoma (acoustic neuroma)}} is a slow-growing tumor that typically arises from Schwann cells in the vestibular nerveWatch Cranial Nerve VIII (Vestibulocochlear)Review SchwannomaWatch associated Bootcamp video - Vestibular Schwannoma Watch associated Bootcamp video - Vertigo: Central and Peripheral Vertigob0c5688d-2a72-4172-8162-0031aeedb9e7
What syndrome is associated with lesion of the following areas? 1. Corticospinal tract 2. Corticobulbar tract 3. Fibers of CN III {{c1::Medial midbrain syndrome (Weber)}}"The medial ""M"" tracts and CN III suggests medial midbrain Thus manifests with : - Contralateral spastic hemiparesis - Contralateral hemiparesis of lower face - Ipsilateral oculomotor palsy"Watch associated Bootcamp video - Medullary and Pontine Syndromes27153815-f5a7-4313-94b9-071962992aa0
{{c2::Parinaud}} syndrome is characterized by a(n) {{c1::conjugate vertical gaze}} palsy due to a lesion in the {{c3::dorsal midbrain}} (e.g., stroke, hydrocephalus, pinealoma)- Structures damaged include superior colliculus / riMLF / pretectal nuclei; these patients cannot look up - May also have pupillary light-near dissociation and impaired convergence due to damage to pretectal nuclei - Dorsal midbrain (AKA Parinaud) syndrome is associated with a tumor in the pineal region. When involving the superior colliculus or pretectal area, this may present with an upward gaze palsy and pupillary abnormality. When involving the cerebral aqueduct, this may present with a noncommunicating hydrocephalus. Photo credit: Luciobgomes, CC BY-SA 4.0, via Wikimedia CommonsWatch Hydrocephalus Watch Pediatric CNS TumorsReview PinealomaWatch associated Bootcamp video - Other Disorders of the Diencephalon0cf25d1d-9d4b-47df-bcc8-078bd4bd236b
The {{c1::raphe nucleus}} of the reticular formation is responsible for synthesis of {{c2::serotonin}}- Plays a role in mood, aggression, and the induction of non-rapid eye movement (non-REM) sleep - Located in the pons Photo credit: Marshall Strother, Patrick J. Lynch, medical illustrator, CC BY 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA804f5252-4277-42fe-85ba-7894125ce68e
The {{c1::locus coeruleus}} of the reticular formation is located in the {{c3::posterior rostral pons}} and is responsible for synthesis of {{c2::norepinephrine}}- Sends projections to most brain areas involved in the control of cortical activation (arousal) - Also involved in control of mood, sleep-wake states, cognition, and autonomic function - Specifically, located near the lateral floor of the fourth ventricle Photo credit: Breton-Provencher et al., CC BY 4.0, via Frontiers in Neural Circuits, modified by croppingWatch associated Bootcamp video - Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABAc15795cd-97dc-414e-86e6-e451bb5b5cee
The vestibular nuclei send axons to ipsilateral antigravity muscles via the lateral {{c1::vestibulospinal}} tract to maintain upright and balanced posturePhoto credit: Corneil and Camp, Creative Commons Attribution License (CC BY), [Link]f8cb6686-7743-4581-ace5-6f0f8ce03605
The cerebellum consists of a midline {{c1::vermis}} and two lateral {{c2::hemispheres}} on each sidei.e. an intermediate and lateral hemisphere Photo credit: OpenStax College, CC BY 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Cerebellum and Ventricles Anatomical Considerationsa3671acd-2051-415d-bdbe-657ba5613499
The {{c1::vermis}} of the cerebellum controls the truncal and proximal musculature of limbsWhereas intermediate controls posturing, and lateral controls motor planning Photo credit: OpenStax College, CC BY 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Cerebellum and Ventricles Anatomical Considerations5791b1c9-851c-4dfd-968b-030da1273c38
The {{c1::intermediate hemisphere}} of the cerebellum controls distal musculature"""Intermediate hemisphere"" is the medial region of the hemisphere Photo credit: OpenStax College, CC BY 3.0, via Wikimedia Commons"Watch associated Bootcamp video - Cerebellum and Ventricles Anatomical Considerations48ff5709-8bbd-4cdf-b751-44358c9da738
The {{c1::flocculonodular lobe}} of the cerebellum is involved in control of balance and eye movementsVia input from vestibular nuclei Photo credit: OpenStax College, CC BY 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Cerebellum and Ventricles Anatomical Considerations4f3ddea1-8aa8-4b5c-ac55-ee6a0d4edb99
The cerebellum receives {{c3::ipsi}}lateral proprioceptive information from the {{c1::spinal cord}} via the {{c2::inferior cerebellar}} peduncle- Processed in the vermis and intermediate hemisphere - Thus lesion to the inferior cerebellar peduncle may result in ipsilateral ataxia and dysmetria Photo credit: Images licensed by Physeo and used with permission. Purchase full access hereWatch associated Bootcamp video - Cerebellum and Ventricles Anatomical Considerations42399f2f-edd0-4ad0-a5f0-ef6a2d776690
The cerebellum receives {{c3::contra}}lateral input from the {{c1::cerebral cortex}} via the {{c2::middle cerebellar}} peduncleProcessed in the lateral hemisphere Photo credit: Images licensed by Physeo and used with permission. Purchase full access hereWatch associated Bootcamp video - Cerebellum and Ventricles Anatomical Considerationsc08c01ec-3432-4ff2-a120-b69baf7bb350
The dentate nucleus sends axons that decussate in the {{c1::superior cerebellar peduncle}} and then synapse in the contralateral {{c2::ventral lateral (VL)}} nucleus of the thalamusThe VA/VL nuclei get input regarding motor info from the basal ganglia and cerebellum, and then output it to the motor cortex of the cerebrum Photo credit: Peter L.E. van Kan, KINES 531: Neural Control of Movement, licensed under a Creative Commons Attribution 4.0 International License Photo credit: Images licensed by Physeo and used with permission. Purchase full access here.Watch associated Bootcamp video - Cerebellum and Ventricles Anatomical Considerations18f54280-6bda-4e2c-a534-76bc37893537
Which movement disorder presents as a slow, zigzag motion when pointing/extending toward a target? {{c1::Intention tremor}}Watch associated Bootcamp video - Sensory vs Cerebellar Ataxia9bdf0bf2-28ac-4ea8-aa5d-49f23e5a8bf9
Lesions that involve the {{c3::lateral::medial or lateral}} cerebellum produce a number of dysfunctions, mostly involving the {{c1::ipsi::ipsi/contra}}lateral {{c2::extremities (distal musculature)}}Structures affected could be - cerebellar hemispheres (lateral + intermediate) - dentate nucleusWatch associated Bootcamp video - Sensory vs Cerebellar Ataxiaece04177-bc31-4ea0-902f-2b913975b93b
Patients with lateral cerebellar lesions have propensity to fall {{c1::toward}} the lesioned sideWatch associated Bootcamp video - Sensory vs Cerebellar Ataxiaed222360-0e37-424a-beee-504b90cb7cb8
One sign of lateral cerebellar lesion is {{c1::dysmetria}}, which is the inability to stop a movement at the proper place (e.g. finger to nose)Watch associated Bootcamp video - Sensory vs Cerebellar Ataxia75cc8877-e5b2-40a8-abee-acf1ed0f18e2
One sign of lateral cerebellar lesion is {{c1::dysdiadochokinesia}}, which is the reduced ability to perform alternating movements quickly (e.g. pronation and supination of forearm)Watch associated Bootcamp video - Sensory vs Cerebellar Ataxia1d2cf7f0-0caf-469e-a4b9-757a38dc6115
Lesions that involve the {{c2::medial}} cerebellum generally result in {{c1::bi::uni/bi}}lateral motor deficits affecting truncal and proximal musculatureStructures include: Vermis / Fastigial nuclei - Truncal ataxia (wide-based cerebellar gait, patients have difficult getting their feet to plant narrowly together, so they have to plant with feet apart) Flocculonodular lobe - Gaze evoked, up/down beat (vertical) nystagmus - VertigoWatch associated Bootcamp video - Sensory vs Cerebellar Ataxiad36f25d9-2f5c-4909-a4a2-d8328b3cf486
Do patients with cerebellar lesions sway with their eyes open or closed? {{c1::Both :) (negative Romberg sign)}}Important distinguishing feature from dorsal column lesions (sway with eyes closed only; positive Romberg sign)Watch associated Bootcamp video - Sensory vs Cerebellar Ataxiaf72470f9-4fff-4795-bcaa-b900f224af36
Do patients with dorsal column lesions sway with their eyes open or closed? {{c1::Closed only (positive Romberg sign)}}important distinguishing feature from cerebellar lesions (sway with eyes open and closed) Positive Romberg, neurosigns.org, via Youtube (0:16)Watch associated Bootcamp video - Sensory vs Cerebellar Ataxia39f70f11-497d-48e7-9fbc-a13c21103c1e
Which part of the brain modulates skeletal muscle movement? {{c1::Basal ganglia}}Watch associated Bootcamp video - Basal Ganglia Anatomical Considerations1ed76437-fe06-4e28-876a-be6f4d33d84e
One component of the basal ganglia is the {{c1::striatum}}, which consists of the {{c2::putamen::motor}} and {{c3::caudate nucleus::cognitive}}Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Basal Ganglia Anatomical Considerationsf2c5d106-6e35-489e-883e-1b7598b4fc26
One component of the basal ganglia is the {{c1::lentiform nucleus}}, which consists of the {{c2::putamen}} and {{c3::globus pallidus}}Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Basal Ganglia Anatomical Considerations1f274497-10cf-4b75-965d-096efd29a51b
The globus pallidus is divided into a(n) {{c1::internal}} and {{c1::external}} segmente.g. globus pallidus internus (GPi) and externus (GPe)Watch associated Bootcamp video - Basal Ganglia Anatomical Considerations46b6b70e-ef4a-4b85-a059-6dfc74afd46d
One component of the basal ganglia is the {{c1::substantia nigra}}, which is located in the rostral {{c2::midbrain}}The substantia nigra is split into two structures that help facilitate movement: - Pars Compacta (Can move; releases dopamine onto the putamen to stimulate the excitatory pathway [D1] and inhibit the inhibitory pathway [D2]) - Pars Reticulata (Retards move; helps the GPi to inhibit the VA/VL thalamus to turn off muscle actions destructive against complex movement suggested by the premotor cortex)Watch associated Bootcamp video - Basal Ganglia Anatomical Considerations7ee7cae2-f05e-4cb5-bfb2-1aff238fca53
One component of the basal ganglia is the {{c1::subthalamic nucleus}}, which is located in the diencephalonWatch associated Bootcamp video - Basal Ganglia Anatomical Considerations206b6c41-c8d9-41cc-b5e4-20ee82d55fff
The {{c1::direct}} basal ganglia pathway facilitates movementUseful for initiating movement - GPe = globus pallidus externus - GPi = globus pallidus internus - STN = subthalamic nucleus - SNr = pars reticulata portion of substantia nigra - SNc = pars compacta portion of substantia nigra Photo credit: Access for free at OpenStax CC BY 4.0Watch associated Bootcamp video - Basal Ganglia Circuits13e9d1a4-f751-4cd4-bd95-5848cc51a635
In both the direct and indirect basal ganglia pathways, neurons from the cerebral cortex lead to {{c2::excitation}} of neurons of the {{c1::striatum}}- GPe = globus pallidus externus - GPi = globus pallidus internus - STN = subthalamic nucleus - SNr = pars reticulata portion of substantia nigra - SNc = pars compacta portion of substantia nigra Photo credit: Access for free at OpenStax CC BY 4.0Watch associated Bootcamp video - Basal Ganglia Circuitsd2d4f5a4-938c-4554-9f95-e8c60f9120e4
In the direct basal ganglia pathway, the neurons of the striatum lead to {{c2::inhibition}} of neurons of the {{c1::globus pallidus internus}}- GPe = globus pallidus externus - GPi = globus pallidus internus - STN = subthalamic nucleus - SNr = pars reticulata portion of substantia nigra - SNc = pars compacta portion of substantia nigra Photo credit: Access for free at OpenStax CC BY 4.0Watch associated Bootcamp video - Basal Ganglia Circuitsc4c9d879-ede4-4a43-878a-3cfa9b77e1b8
{{c1::Inhibition}} of the globus pallidus internus results in excitation of the ipsilateral {{c2::ventral lateral (VL)}} nucleus of the thalamus (basal ganglia pathway)i.e., direct basal ganglia pathway - GPe = globus pallidus externus - GPi = globus pallidus internus - STN = subthalamic nucleus - SNr = pars reticulata portion of substantia nigra - SNc = pars compacta portion of substantia nigra Photo credit: Access for free at OpenStax CC BY 4.0Watch associated Bootcamp video - Basal Ganglia Circuits01c02b3d-0f6d-40a9-b548-d20b4018764a
The {{c1::indirect}} basal ganglia pathway inhibits movementUseful for suppression of unwanted movement - GPe = globus pallidus externus - GPi = globus pallidus internus - STN = subthalamic nucleus - SNr = pars reticulata portion of substantia nigra - SNc = pars compacta portion of substantia nigra Photo credit: Access for free at OpenStax CC BY 4.0Watch associated Bootcamp video - Basal Ganglia Circuits915e81cf-d445-450c-ada9-5a398c73c954
In the indirect basal ganglia pathway, the neurons of the striatum lead to {{c2::inhibition}} of neurons of the {{c1::globus pallidus externus}}- GPe = globus pallidus externus - GPi = globus pallidus internus - STN = subthalamic nucleus - SNr = pars reticulata portion of substantia nigra - SNc = pars compacta portion of substantia nigra Photo credit: Access for free at OpenStax CC BY 4.0Watch associated Bootcamp video - Basal Ganglia Circuits9e7f073f-d606-49e0-a8e5-55a18d740561
In the indirect basal ganglia pathway, inhibition of the globus pallidus externus leads to {{c2::excitation}} of neurons of the {{c1::subthalamic nucleus}}- GPe = globus pallidus externus - GPi = globus pallidus internus - STN = subthalamic nucleus - SNr = pars reticulata portion of substantia nigra - SNc = pars compacta portion of substantia nigra Photo credit: Access for free at OpenStax CC BY 4.0Watch associated Bootcamp video - Basal Ganglia Circuits10c3eaea-4a62-4b2b-9fcb-2c274f2a02a3
In the indirect basal ganglia pathway, the neurons of the subthalamic nucleus lead to {{c2::excitation}} of neurons of the {{c1::globus pallidus internus}}- GPe = globus pallidus externus - GPi = globus pallidus internus - STN = subthalamic nucleus - SNr = pars reticulata portion of substantia nigra - SNc = pars compacta portion of substantia nigra Photo credit: Access for free at OpenStax CC BY 4.0Watch associated Bootcamp video - Basal Ganglia Circuits8dd73d7c-1077-4cfa-b0bb-6a3271ce8ab1
{{c1::Excitation}} of the globus pallidus internus results in inhibition of the ipsilateral {{c2::ventral lateral (VL)}} nucleus of the thalamus (basal ganglia pathway)i.e., indirect basal ganglia pathway - GPe = globus pallidus externus - GPi = globus pallidus internus - STN = subthalamic nucleus - SNr = pars reticulata portion of substantia nigra - SNc = pars compacta portion of substantia nigra Photo credit: Access for free at OpenStax CC BY 4.0Watch associated Bootcamp video - Basal Ganglia Circuitsb01cbd32-a405-4f9d-a6a2-4127f5ebb60f
Which part of the basal ganglia sends dopaminergic neurons to the striatum to alter activity of both basal ganglia pathways? {{c1::Substantia nigra pars compacta}}- GPe = globus pallidus externus - GPi = globus pallidus internus - STN = subthalamic nucleus - SNr = pars reticulata portion of substantia nigra - SNc = pars compacta portion of substantia nigra Photo credit: Access for free at OpenStax CC BY 4.0Review Nigrostriatal PathwayWatch associated Bootcamp video - Basal Ganglia Circuitsddbfb4cd-75e8-4371-9199-52da8425bfd0
Dopamine excites the {{c1::direct}} basal ganglia pathway through {{c2::D1}} receptors"Thus facilitating movement; ""D1-Receptor = D1Rect pathway"" - GPe = globus pallidus externus - GPi = globus pallidus internus - STN = subthalamic nucleus - SNr = pars reticulata portion of substantia nigra - SNc = pars compacta portion of substantia nigra Photo credit: Access for free at OpenStax CC BY 4.0"Watch associated Bootcamp video - Basal Ganglia Circuits Watch associated Bootcamp video - Other Involuntary Signaling Systems Watch associated Bootcamp video - Membrane Proteins Watch associated Bootcamp video - Receptor Physiology566369db-25d6-4692-b469-3537b7753f34
Dopamine inhibits the {{c1::indirect}} basal ganglia pathway through {{c2::D2}} receptorsThus facilitating movement - GPe = globus pallidus externus - GPi = globus pallidus internus - STN = subthalamic nucleus - SNr = pars reticulata portion of substantia nigra - SNc = pars compacta portion of substantia nigra Photo credit: Access for free at OpenStax CC BY 4.0Watch associated Bootcamp video - Basal Ganglia Circuits Watch associated Bootcamp video - Other Involuntary Signaling Systems Watch associated Bootcamp video - Membrane Proteins Watch associated Bootcamp video - Receptor Physiology8c2ef7d2-6206-442e-95fc-7902a64b4da2
{{c2::Cholinergic}} neurons within the striatum stimulate the {{c1::indirect}} basal ganglia pathwayThus inhibiting movement - GPe = globus pallidus externus - GPi = globus pallidus internus - STN = subthalamic nucleus - SNr = pars reticulata portion of substantia nigra - SNc = pars compacta portion of substantia nigra Photo credit: Access for free at OpenStax CC BY 4.0Watch associated Bootcamp video - Basal Ganglia Circuits1fc6219a-d8c8-4aac-a843-b3937bb7d099
Which movement disorder presents as sudden, wild flailing of 1 arm ± the leg on the same side? {{c1::Hemiballismus}}disruption in the indirect basal ganglia overstimulates the direct basal ganglia, producing excess muscle movement; contralateral lesionWatch associated Bootcamp video - Disorders of the Basal Ganglia9baa67fb-d0ce-4015-9807-1e4126e38ab2
Hemiballismus results from a lesion to the {{c2::contra}}lateral {{c1::subthalamic}} nucleus (e.g. lacunar stroke)i.e., right subthalamic nucleus lesion causes hemiballismus of left sideWatch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Lacunar Infarction07fb6074-1f24-432a-9c07-aebd3ed019bc
Visual acuity is highest at a central point of the retina, called the {{c1::fovea}}The fovea is within the macula Photo credit: Rhcastilhos. And Jmarchn., CC BY-SA 3.0, via Wikimedia CommonsWatch The Retina and Phototransductiond9bc2128-8a5b-4bd1-a6ad-e6d731b7456a
Light is focused in a depression within the macula, called the {{c1::fovea}}Photo credit: Yandle, CC BY 2.0, via FlickrWatch The Retina and Phototransductionb5ddb2b0-d677-455f-8424-a8b16142bda9
Aqueous humor production is decreased with β {{c1::antagonists::agonists or antagonists}}Watch Sympathomimetics Watch Adrenergic Receptors (Adrenoreceptors)Watch associated Bootcamp video - Beta Adrenergic Antagonistsac149b77-ca22-415a-85b8-3bc3c692457a
Aqueous humor production is decreased with α2 {{c1::agonists::agonists or antagonists}}Watch Sympathomimetics Watch Adrenergic Receptors (Adrenoreceptors)78986dea-41a5-4d36-aa9c-07fb861be85b
Aqueous humor production is decreased by {{c1::carbonic anhydrase::enzyme}} inhibitorsWatch associated Bootcamp video - Carbonic Anhydrase Inhibitors020c49c2-f80f-4047-bc1c-7a8b667810cb
What is the predominant autonomic receptor on the pupillary sphincter muscle? {{c1::M3}}Stimulation causes miosis; inhibition causes mydriasisWatch Cholingeric Receptors (Cholinoreceptors)21f5efca-5018-4cf0-91df-00d028b6b42a
What is the predominant autonomic receptor on the pupillary dilator muscle? {{c1::α1}}Stimulation causes mydriasis; inhibition cause miosis6285283f-92da-4c73-9321-adb598a6293c
What is the predominant autonomic receptor on the ciliary muscle? {{c1::M3}}- Stimulation causes accommodation (near vision); relaxation allows focus for far vision - M3 helps you see clearLYWatch Cholingeric Receptors (Cholinoreceptors)eb03f3a6-65a8-482f-9f77-35f3bd981e64
Is the pupillary sphincter muscle under parasympathetic or sympathetic control? {{c1::Parasympathetic}}Watch PNS Effects on Organ Systemsa3153a25-43a4-4dde-a09f-1edaa5dd40b9
A(n) {{c1::relative afferent pupillary defect (RAPD)}} is characterized by decreased bilateral pupillary constriction when light is shone in the affected eye relative to the unaffected eye"- Also known as a ""Marcus Gunn"" pupil - This means that there is a problem picking up light in one of the eyes (afferent pupillary defect) - Can be due to damage to optic nerve (optic neuritis) or severe retinal injury RAPD in right eye: Video credit: Jonathan Trobe, CC BY 3.0, via U-M Kellogg Eye Center in Ann Arbor, modified by converting into GIF"Watch Multiple SclerosisWatch Multiple Sclerosis: Clinical PresentationWatch associated Bootcamp video - Multiple Sclerosis39109390-b86c-43ee-80a5-e8a1fef1550d
"{{c2::Marcus Gunn}} pupil is tested with the ""{{c1::swinging flashlight}}"" test""- Shine light in normal eye → constrict - Shine light in affected eye → apparently dilation due to ""weaker"" stimulus carried through CN II RAPD in right eye: Video credit: Jonathan Trobe, CC BY 3.0, via U-M Kellogg Eye Center in Ann Arbor, modified by converting into GIF"Watch Multiple SclerosisWatch Multiple Sclerosis: Clinical PresentationWatch associated Bootcamp video - Multiple Sclerosis6fc207a5-3e1f-4274-93ba-2641daa4ca6f
The visual fields are subdivided into which two hemifields? {{c1::Nasal}} and {{c1::temporal}}Photo credit: OpenStax, CC BY 4.0Watch Visual Fields and ProcessingWatch associated Bootcamp video - Visual Pathway Overview7065b890-9f58-475f-bdc8-25aff36548bb
Visual images perceived in the nasal hemifield will stimulate cells on the {{c1::temporal}} half of the ipsilateral retina (and vice versa)i.e. images from the temporal hemifield stimulate the nasal retina Photo credit: OpenStax, CC BY 4.0Watch Visual Fields and ProcessingWatch associated Bootcamp video - Visual Pathway Overview599a368b-6864-4c3e-b8a6-e12fc1baf77f
At the {{c2::optic chiasm}}, 60% of the optic fibers from the {{c1::nasal}} half of each retina cross and project into the contralateral {{c3::optic tracts}}Thus it is the temporal image that decussatesWatch Cranial Nerves I & II (Olfactory & Optic) Watch Visual Fields and ProcessingWatch associated Bootcamp video - Visual Pathway Overvieweb8347e0-1dc2-4a37-bc79-1e48081d0568
Most fibers in the optic tract project to the {{c1::lateral geniculate body}} of the thalamusOther fibers project to the superior colliculi (reflex gaze), the pretectal (light reflex), and the suprachiasmatic nucleus of the hypothalamus (circadian rhythms)Watch Cranial Nerves I & II (Olfactory & Optic) Watch Visual Fields and ProcessingWatch associated Bootcamp video - Visual Pathway Overviewb80ff99f-a21d-4d66-8fd3-48c0a3d4b511
The axons from the lateral geniculate body that project to the {{c1::primary visual (striate)}} cortex are known as optic {{c2::radiations}}Watch Visual Fields and ProcessingWatch associated Bootcamp video - Optic Radiation Lesion Watch associated Bootcamp video - Occipital Lobe5850d41c-13b1-41a4-a98c-f2e64c852682
Visual information from the {{c3::inferior}} retina travels in {{c1::Meyer's loop (temporal lobe)}} before synapsing in the {{c2::lingual}} gyrus- i.e. images from the upper contralateral visual field; travels around inferior horn of lateral ventricle - Inferior retina = lingual gyrusWatch associated Bootcamp video - Optic Radiation Lesion Watch associated Bootcamp video - Temporal Lobee8ca8c5c-27d0-4352-8f7e-5c90a9ade7be
Visual information from the {{c2::superior}} retina travels in the dorsal optic radiation (parietal lobe) before synapsing in the {{c1::cuneus}} gyrusi.e. images from the lower contralateral visual field; travels via internal capsuleWatch associated Bootcamp video - Optic Radiation Lesion Watch associated Bootcamp video - Parietal Lobec43a821a-bcfe-4e6d-b54e-2acc94ed00b2
What visual deficit results from complete lesion of the optic nerve (e.g. central retinal artery occlusion, central retinal vein occlusion)? {{c1::Ipsilateral anopia}}Watch associated Bootcamp video - Optic Nerve Lesiond2fc3662-fac2-4395-aa4d-5a508c4f777e
What visual deficit results from a lesion of the optic nerve just lateral to the optic chiasm (e.g. medially expanding ICA aneurysm)? {{c1::Ipsilateral nasal hemianopsia}}The optic fibers from the temporal retina are damaged, resulting in nasal hemianopiaWatch associated Bootcamp video - Optic Nerve Lesion Watch associated Bootcamp video - Peri-chiasmal Lesionsb1dc178e-e4c0-4d0c-a0e7-a3309bea0b76
What visual deficit results from lesion of the optic chiasm (e.g., pituitary adenoma, craniopharyngioma)? {{c1::Bitemporal hemianopsia}}- Other causes include anterior communicating artery aneurysm - Pituitary adenoma begins as superior quadrantanopia (develops from the bottom); craniopharyngioma begins as inferior quadrantanopia (begins from the top)Watch Hypothalamic & Pituitary Dysfunction EtiologiesReview CraniopharyngiomaWatch associated Bootcamp video - Optic Chiasm Lesion Watch associated Bootcamp video - Endocrine Pituitary Embryology Watch associated Bootcamp video - Hypopituitarism30a043f3-a5b4-4c8b-b693-7b12123fbca6
Lesion to areas after the optic chiasm result in {{c1::bin}}ocular and homonymous {{c1::contra}}lateral deficits in visionWatch associated Bootcamp video - Optic Chiasm Lesione9603fb5-4397-429b-b9db-3e3f89d070ac
What visual deficit results from lesion of the optic tract or lateral geniculate body? {{c1::Contralateral homonymous hemianopsia}}- These areas are supplied by the anterior choroidal artery (branch of the ICA) - Those with optic tract lesions will also have a decreased pupillary light reflexWatch associated Bootcamp video - Lateral Geniculate Lesion198bbec4-d7e3-461d-b030-0163149f9428
"What visual deficit results from a lesion of Meyer loop (e.g. temporal lesion, MCA occlusion)? {{c1::Contralateral homonymous superior quadrantanopia (""pie in the sky"")}}"- Can be caused by an inferior segment of the M2 MCA stroke (supplies temporal lobe) - Meyer loop carries information from the inferior retina (superior visual field)Watch Localizing A Stroke: MCAReview Middle Cerebral Artery (MCA)Watch associated Bootcamp video - Optic Radiation Lesion Watch associated Bootcamp video - Temporal Lobe3bfd36f3-b841-43ee-9938-5880f507a7f8
"What visual deficit results from a lesion of the dorsal optic radiation (e.g. parietal lesion, MCA occlusion)? {{c1::Contralateral homonymous inferior quadrantanopia (""pie on the floor"")}}"Dorsal optic radiation carries information from the superior retina (inferior visual field)Watch Localizing A Stroke: MCAWatch associated Bootcamp video - Optic Radiation Lesion Watch associated Bootcamp video - Parietal Lobe89e07a15-a165-4575-ab47-1890f22de9b2
What visual deficit results from PCA occlusion affecting the primary visual cortex? {{c1::Contralateral homonymous hemianopsia with macular sparing}}- If in the dominant hemisphere, presents also with alexia without agraphia (AKA pure alexia; severe reading deficits but other language related skills are intact) - Macula is spared due to collateral blood supply from the middle cerebral arteryReview Posterior Cerebral Artery (PCA)Watch associated Bootcamp video - Visual Cortex Lesion Watch associated Bootcamp video - Occipital Lobe2960cd94-56c9-4dde-a5a9-eff47f57c78a
The macula is spared during posterior cerebral artery (PCA) infarct due to collateral circulation with the {{c1::middle cerebral}} arteryWatch associated Bootcamp video - Visual Cortex Lesion78997410-5407-4714-83c7-bf26d4b339fc
What visual deficit results from lesion of the macula? {{c1::Central scotoma}}"- Macula is quite sensitive to intense light, trauma, aging, and neurotoxins (e.g. ethambutol), also seen in macular degeneration; lesion #7 - Other causes include damage to optic disc / nerve (optic neuritis - e.g. ethambutol) or retina"Watch associated Bootcamp video - Visual Cortex Lesion Watch associated Bootcamp video - Pyrazinamide, Ethambutol, Dapsone, and Clofaziminee7b722cb-44e9-4f20-82f7-2ffd5670cd54
Chronic myeloid leukemia (CML) is distinguished from a leukemoid reaction (benign neutrophilia) by presence of increased {{c1::basophils::cell type}}Leukemoid reactionChronic myeloid leukemiaBasophilsAbsencePresenceBone marrowNormal/hypercellular with increased bands/early mature neutrophil precursorsIncreased immature cellsWatch Acute Myeloid Leukemia (AML) & Chronic Myeloid Leukemia (CML)Review Basophils Review Chronic Myelogenous Leukemia (CML)Watch associated Bootcamp video - Chronic Myeloid Leukemia205ab0f1-f02d-41f4-b3af-3030daf87fad
Chronic myelogenous leukemia (CML) is distinguished from a leukemoid reaction (benign neutrophilia) by a(n) {{c2::negative}} {{c1::leukocyte alkaline phosphatase (LAP)}} stain- Granulocytes in leukemoid reaction are LAP positive - *LAP is in secondary granules of granulocytes (neoplastic cells don't bother to make these)Watch Acute Myeloid Leukemia (AML) & Chronic Myeloid Leukemia (CML)Review Chronic Myelogenous Leukemia (CML)Watch associated Bootcamp video - Chronic Myeloid Leukemia05636a1d-ab49-42ca-bbed-a055a3848ace
Treatment for polycythemia vera: First-line: {{c1::phlebotomy}} Second-line: {{c1::hydroxyurea}}Without treatment, death usually occurs within one year"sketchy japanese cross out ""oxy"" hydrorock area (blocking ribonucleotide reductase) Watch Myeloproliferative Neoplasms & Myelodysplastic Syndromes"Watch associated Bootcamp video - Polycythemia Vera & Essential Thrombocythemia00de2855-313e-4d9e-954a-5e6fa7e68d85
Polycythemia vera is characterized by {{c1::decreased}} EPO- Due to negative feedback suppressing renal EPO production - Important distinguishing feature from secondary polycythemiaWatch PolycythemiaWatch associated Bootcamp video - Polycythemia Vera & Essential Thrombocythemia01a09b41-9f9c-466e-8154-cf2ea6418397
Multiple myeloma is associated with {{c1::increased::increased/decreased}} serum proteinDue to increased immunoglobulin productionWatch Plasma Cell NeoplasmsReview Multiple MyelomaWatch associated Bootcamp video - Multiple Myeloma122efb6e-0124-4736-bd98-080e9c0d0642
Multiple myeloma is associated with {{c1::rouleaux formation}} of RBCs on blood smear"- Increased serum protein (i.e paraprotein) decreases charge between RBCs (like ""poker chips"") - Paraprotein gap = serum protein - serum albumin; if greater than 4 this supports multiple myeloma Photo credit: Gabriel Caponetti, CC BY-SA 3.0 (left), via Wikimedia Commons; AMBOSS, CC BY-SA 3.0 (right)"Watch Plasma Cell NeoplasmsReview Multiple MyelomaWatch associated Bootcamp video - Multiple Myelomab64e6938-e56a-4c9c-869e-181448645981
"The signs/symptoms of {{c1::multiple myeloma}} may be remembered with the mnemonic ""CRAB"": {{c1::hyperCalcemia::C}} {{c1::Renal insufficiency::R}} {{c1::Anemia*::A}} {{c1::Bone lytic lesions::B}} / {{c1::Back pain::B}}"*The anemia may be due to decreased bone marrow AND/OR decreased EPO from renal failure CRAB CriteriaCalcium (hypercalcemia) >11 mg/dL or >1 mg/dL above the ULNRenal insufficiency: GFR <40 mL/min or serum creatinine >2 mg/dLAnemia: Hb <10 g/dL or more than 2 g/dL below the LLNBone lesions: ≥1 osteolytic lesions on imaging Case courtesy of Ashesh Ishwarlal Ranchod, Radiopaedia.org. From the case rID: 170092Watch Plasma Cell NeoplasmsReview Multiple MyelomaWatch associated Bootcamp video - Multiple Myelomaya4e404d3-05e8-447f-a4d3-37e77cfe03a2
The signs/symptoms of multiple myeloma may be remembered with the mnemonic {{c1::CRAB}}hyperCalcemia Renal insufficiency Anemia* Bone lytic lesions / Back pain *The anemia may be due to decreased bone marrow AND/OR decreased EPO from renal failure CRAB CriteriaCalcium (hypercalcemia) > 11 mg/dL or > 1 mg/dL above the ULNRenal insufficiency: GFR < 40 mL/min or serum creatinine > 2 mg/dLAnemia: Hb < 10 g/dL or more than 2 g/dL below the LLNBone lesions: ≥ 1 osteolytic lesions on imagingWatch Plasma Cell NeoplasmsReview Multiple MyelomaWatch associated Bootcamp video - Multiple Myeloma8a425538-0117-4fdf-8d55-599555f312c3
The M spike seen in {{c2::Waldenstrom macroglobulinemia}} is due to monoclonal Ig{{c1::M}}Important distinguishing feature from multiple myeloma (typically IgG or IgA)Watch Plasma Cell NeoplasmsReview Waldenstrom Macroglobulinemia Review Multiple MyelomaWatch associated Bootcamp video - Additional Plasma Cell Dyscrasias230b27c0-812b-4cd5-b94b-e306201e7108
Waldenstrom macroglobulinemia typically presents with {{c1::visual}} and {{c1::neurologic}} deficits without the CRAB* symptoms of multiple myeloma- e.g., retinal hemorrhage, stroke; due to serum hyperviscosity - Exception is that WM does present with anemia* - Multiple myeloma may also present with symptoms of hyperviscosity, but this is very rare!Watch Acquired & Inherited Thrombosis Syndromes Watch Plasma Cell NeoplasmsReview Waldenstrom Macroglobulinemia Review Multiple MyelomaWatch associated Bootcamp video - Additional Plasma Cell Dyscrasiasaef7a7ff-9fdb-4791-b2c4-a4775c8c12da
What is the destination of the ventral posterolateral (VPL) nucleus of the thalamus? {{c1::Primary somatosensory cortex}}Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Diencephalon Overviewf92ee8fb-eb2c-4b2b-a14f-6724383a30b5
Which thalamic nucleus receives input from the trigeminal nerve and gustatory pathway? {{c1::Ventral posteromedial (VPM)}}"- Thus, receives face sensation and taste - ""Very Pretty Makeup goes on the face (VPM)"""Watch Cranial Nerve V (Trigeminal)Watch associated Bootcamp video - Diencephalon Overviewa83d46f9-e9d0-4c6d-9855-e4cae49e03d2
What is the destination of the ventral posteromedial (VPM) nucleus of the thalamus? {{c1::Primary somatosensory cortex}}Watch associated Bootcamp video - Diencephalon Overviewe2de6420-b0ce-4913-bf2e-ae0a8000ace9
Which thalamic nucleus receives visual input from CN II? {{c1::Lateral geniculate body (LGB)}}"""Lateral = Light"""Review Optic Nerve (CN II)Watch associated Bootcamp video - Diencephalon Overviewfa843a8e-3476-4509-90c4-4e65291345ba
What is the destination of the lateral geniculate body (LGB) of the thalamus? {{c1::Primary visual cortex (calcarine sulcus)}}Watch Visual Fields and ProcessingWatch associated Bootcamp video - Diencephalon Overview Watch associated Bootcamp video - Occipital Lobe6e5e2654-92d7-4e96-b8be-b6c2e22e64b4
Which thalamic nucleus receives auditory input from the inferior colliculus and superior olive? {{c1::Medial geniculate body (MGB)}}"""Medial = Music"""Watch associated Bootcamp video - Diencephalon Overviewab2e9156-95dd-43d3-8a86-2db29e6ac659
What is the destination of the medial geniculate body (MGB) of the thalamus? {{c1::Primary auditory cortex (temporal lobe)}}Watch AuditionWatch associated Bootcamp video - Diencephalon Overviewfd7d9916-aa55-4b02-aa36-5096232c375c
Which thalamic nuclei receive motor input from the basal ganglia and cerebellum? {{c1::Ventral anterior (VA) / Ventral lateral (VL)::2}}Watch associated Bootcamp video - Diencephalon Overviewad749ed6-eee1-4a9e-b396-71ba6b1541ea
What is the destination of the ventral anterior (VA) / ventral lateral (VL) nuclei of the thalamus? {{c1::Premotor and primary motor cortex::2}}- BAsAl gAngliA → VA → premotor cortex - CerebeLLum & basaL gangLia → VL → primary motor cortex and premotor cortexWatch associated Bootcamp video - Diencephalon Overview39998eaf-8c77-49ac-a390-3af8b3b6ded1
{{c1::Thalamic}} pain syndrome is caused by a(n) {{c1::thalamic}} stroke that manifests with pure {{c2::contralateral::ipsilateral or contralateral}} sensory loss and initial paresthesias followed in weeks to months by: - Abnormal, unpleasant sense of touch ({{c3::dysesthesia}}) - Hypersensitivity to pain ({{c4::allodynia/hyperalgesia}})- AKA central post-stroke pain syndrome or Dejerine–Roussy syndrome - Occurs in 10% of stroke patients - Full loss of all sensory modalities on face, arms, and legs of contralateral side - Pains will arrive in paroxysms or exacerbated by touchWatch associated Bootcamp video - Disorders of the Thalamusa0f9a236-bff5-42d4-ae2f-87ab7b244342
The {{c1::supraoptic}} nucleus of the hypothalamus primarily makes ADHLesions here cause diabetes insipidus *per NBME form 30 ADH can also be released from the paraventricular nuclei SAD POX: Supraoptic = ADH, Paraventricular = oxytocin* may also secrete oxytocin to a lesser extent Watch Diabetes Insipidus & SIADHWatch associated Bootcamp video - Neurology Hypothalamic Nuclei Watch associated Bootcamp video - Hypothalamus Watch associated Bootcamp video - Posterior Pituitary Function7b615181-513d-40e2-a913-c212cddac8a3
The {{c1::paraventricular}} nucleus of the hypothalamus primarily secretes oxytocinAlso secretes CRH and TRH SAD POX: Supraoptic = ADH, Paraventricular = oxytocinWatch Diabetes Insipidus & SIADHWatch associated Bootcamp video - Neurology Hypothalamic Nuclei Watch associated Bootcamp video - Hypothalamus Watch associated Bootcamp video - Posterior Pituitary Function3fbc16c5-6e0a-4b05-8cea-68549df99234
The {{c1::suprachiasmatic}} nucleus of the hypothalamus is responsible for the {{c2::circadian rhythm}}, which regulates the sleep cycleCircadian rhythm controls nocturnal release of norepinephrine, melatonin, ACTH, and prolactin (mnemonic: N-MAP)Watch associated Bootcamp video - Neurology Hypothalamic Nuclei Watch associated Bootcamp video - Hypothalamus0ae906ed-0097-4cf6-97db-a6ccaf336817
Circadian rhythm: The suprachiasmatic nucleus releases {{c1::norepinephrine}}, which stimulates the {{c2::pineal}} gland to secrete {{c3::melatonin}}Darkness causes norepinephrine release onto pinealocytes, resulting in melatonin secretion and increased sleep driveWatch associated Bootcamp video - Neurology Hypothalamic Nuclei Watch associated Bootcamp video - Hypothalamus379018b3-c0f8-4c34-a954-da9a469a1992
The {{c1::ventromedial}} area of the hypothalamus is responsible for {{c2::satiety}}Stimulated via leptin, inhibited via ghrelinWatch associated Bootcamp video - Neurology Hypothalamic Nuclei Watch associated Bootcamp video - Hypothalamus545408fd-78cb-4e1c-b469-034684f5a2f3
The {{c1::lateral}} area of the hypothalamus is responsible for {{c2::hunger}}"- ""Lat's eat"" - Lateral area is stimulated by ghrelin, inhibited by leptin"Watch associated Bootcamp video - Neurology Hypothalamic Nuclei Watch associated Bootcamp video - Hypothalamus69001894-001e-4170-9441-c5a3ccc8154a
The {{c1::anterior}} hypothalamus senses elevated body temperatures and mediates responses to dissipate heatA/C = Anterior CoolingWatch associated Bootcamp video - Neurology Hypothalamic Nuclei Watch associated Bootcamp video - Hypothalamus3f631d7e-cf32-4c05-a9c5-420a510e0652
The {{c1::posterior}} hypothalamus senses decreased body temperatures and mediates responses to conserve heatThe past (posterior) is cold (senses ↓ temperature)Watch associated Bootcamp video - Neurology Hypothalamic Nuclei Watch associated Bootcamp video - Hypothalamus3f0b20e6-980e-429f-80eb-38cd6b65e6e9
{{c3::Lesions}} of the {{c2::dorsomedial}} hypothalamic nucleus results in {{c1::hypophagia}} and {{c1::hypodipsia}}"This card previously stated ""Stimulation of the dorsomedial nucleus of the hypothalamus results in savage behavior and obesity""; however, there is no evidence of this in AMBOSS, FA 2022, or supporting literature"Watch associated Bootcamp video - Hypothalamic Nuclei Watch associated Bootcamp video - Hypothalamus66337270-f740-4f9e-b48a-475a9241c608
{{c1::Circumventricular organs (CVOs)}} are structures in the brain that are characterized by extensive vasculature and lack of blood-brain barrierCVOs allow for the linkage between the central nervous system and peripheral blood flow; e.g. area postrema, OVLTWatch Blood-Brain Barrier & CSFWatch associated Bootcamp video - Cerebellum and Ventricles Anatomical Considerationsb2e99725-4257-45b2-ab42-86d91dfadbdd
The {{c2::organum vasculosum of the lamina terminalis (OVLT)}} is a circumventricular organ that senses changes in serum {{c1::osmolarity}}4b39943e-d51d-42cb-a3bf-4c5741a69f7c
The {{c2::area postrema (chemoreceptor trigger zone)}} is a circumventricular organ found in the medulla that responds to {{c1::emetics}}Watch associated Bootcamp video - Cerebellar Pathology Watch associated Bootcamp video - Antiemetics9a23b0f9-137c-46fa-b183-5938d8346637
{{c1::Acute lymphoblastic}} leukemia is associated with the t(12;21) translocationSpecifically the B-ALL subtypeWatch Acute Lymphoblastic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), Hairy Cell Leukemia & Adult T cell LeukemiaWatch Acute Lymphocytic Leukemia (ALL)Watch associated Bootcamp video - Acute Lymphoid Leukemiae7d81a27-48ca-4453-9216-4e9b33884a04
The motor/sensory areas corresponding to the face are located in the {{c1::lateral::medial or lateral}} aspects of the pre-/post-central gyridistorted appearance due to certain body regions being more richly innervated Photo credit: File:1421 Sensory Homunculus.jpg: OpenStax Collegederivative work: Popadius, CC BY 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Frontal Lobe Watch associated Bootcamp video - Parietal Lobec88876cc-551d-43a6-be1e-fcb74b109c60
The motor/sensory areas corresponding to the upper limbs are located in the {{c1::lateral::medial or lateral}} aspects of the pre-/post-central gyriDistorted appearance due to certain body regions being more richly innervated Photo credit: File:1421 Sensory Homunculus.jpg: OpenStax Collegederivative work: Popadius, CC BY 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Frontal Lobe Watch associated Bootcamp video - Parietal Lobecacb2288-e045-4e59-bb22-0e693061ec4a
The motor/sensory areas corresponding to the lower limbs are located in the {{c1::medial::medial or lateral}} aspects of the pre-/post-central gyriDistorted appearance due to certain body regions being more richly innervated Photo credit: File:1421 Sensory Homunculus.jpg: OpenStax Collegederivative work: Popadius, CC BY 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Frontal Lobe Watch associated Bootcamp video - Parietal Lobe927a701a-9fcf-49a8-bd3d-092b7f54474e
The lateral aspect of the pre-/post-central gyrus is supplied by the {{c1::middle cerebral}} arteryWatch associated Bootcamp video - Frontal Lobea5052aeb-afaa-4d7e-90a9-296a2fcd5d61
The medial aspect of the pre-/post-central gyrus is supplied by the {{c1::anterior cerebral}} arteryWatch associated Bootcamp video - Frontal Lobe6c62f0da-1ff8-4e6c-b6d2-f4a30cd92c74
Which cerebral artery supplies the medial surface of the frontal/parietal lobes? {{c1::Anterior cerebral artery}}Review Anterior Cerebral Artery (ACA)Watch associated Bootcamp video - Frontal Lobec7ac3bd0-c476-49c0-a267-ecb6573d1521
Which cerebral artery supplies the anterior four-fifths of the corpus callosum? {{c1::Anterior cerebral artery}}the genu (front) and truncus (middle) comprise the anterior 4/5 of the the corpus callosum - Thinner axons in the genu connect the prefrontal cortex between the two halves of the brain - Thicker axons in the truncus of the corpus callosum, interconnect areas of the motor cortex, with proportionately more of the corpus callosum dedicated to supplementary motor regions including Broca's area373176c1-a8e4-43b2-b338-05d87b6b5478
Which cerebral artery supplies most of the lateral surface of the cerebral hemisphere? {{c1::Middle cerebral artery}}Watch associated Bootcamp video - Stroke Presentation by Territory5a6f9d24-4b9f-4080-b401-d9f3c7eb5190
Which cerebral artery supplies the occipital lobe? {{c1::Posterior cerebral artery}}Uniquely, bilateral damage to the occipital lobes can result in cortical blindness, with patients sometimes presenting with confabulations and anosognosia (e.g. unaware of blindness)Review Posterior Cerebral Artery (PCA)Watch associated Bootcamp video - Occipital Lobe5bbda900-b8d3-4719-a1ff-3fcda3922128
Which cerebral artery supplies the inferior temporal lobe? {{c1::Posterior cerebral artery}}- The MCA supplies the superior temporal lobe - The inferior temporal gyrus is involved in representation of complex object features, such as global shape, face perception, and in the recognition of numbersWatch associated Bootcamp video - Temporal Lobeb0b29d99-d8b8-487b-b136-8322d5f072df
Which cerebral artery supplies the splenium of the corpus callosum? {{c1::Posterior cerebral artery}}- Splenium is the posterior end of the corpus callosum that's near the cerebellum; allows for communication between the two halves of the parietal lobe and the visual cortex (occiptal lobe) - thus strokes of splenium in the dominant hemisphere result in alexia without agraphia - can write but they can't read (pure word blindness) Image(s) provided by www.radiologyassistant.nl. Used with permission.8518efeb-23cb-49f5-b721-83e8c0985213
The areas between the ACA/MCA, PCA/MCA ({{c2::cortical}} border zone) and the deep/superficial branches of the MCA ({{c3::internal}} border zone) represent {{c1::watershed}} zones"Global ischemia to the brain (hypoxic encephalopathy due to cardiogenic shock or heavy anemia) can result in watershed infarcts This presents with a bilateral ""man-in-a-barrel"" - Upper leg weakness and upper arm weakness - Sparing of hands / face/ and feet (like a person is trapped in a barrel) - Defects in higher-order visual processing (e.g., cortical blindness)"Frog's feet = watershed areas Watch Ischemic & Hemorrhagic StrokeWatch Localizing A Stroke: ACAWatch associated Bootcamp video - Types of Stroke03e0d65a-8622-479d-8082-fcaa3b8ca824
Damage to the ACA-MCA watershed zone results in bilateral {{c1::proximal extremity}} weakness"- Leads to ""man in a barrel syndrome"" (e.g. weakness of upper arm/shoulder and upper leg/trunk) - The internal border zone (highlighted in red) is the zone between the superficial and deep vascular territories of the middle cerebral artery (M2 branches vs M1 branches respectively)"Watch Localizing A Stroke: ACAWatch associated Bootcamp video - Types of Stroke346e489e-f650-430b-802b-724cc55eb0f0
Neurons of the {{c1::prefrontal}} cortex are involved in organizing and planning the intellectual and emotional aspects of behaviorWatch associated Bootcamp video - Frontal Lobe3c2d7bba-23aa-4ec6-84a4-c4ce288c3b97
Lesions to the {{c1::frontal}} lobe may result in disinhibition, apathy, and deficits in concentration, orientation, and judgementWatch associated Bootcamp video - Frontal Lobecef5bcec-e8ec-43fa-9987-ff429af4f31e
Lesions to the {{c1::frontal}} lobe may present with re-emergence of primitive reflexesWatch associated Bootcamp video - Frontal Lobe2fd85573-bae5-42e5-993f-b949d911d379
"The language centers are found in the ""dominant"" hemisphere, which is most commonly the {{c1::left}} hemisphere (80%)"Note: hemispheric dominance does NOT = handedness - 99.9% of right-handed people are left hemisphere dominant - 70% of left-handed people are left hemisphere dominante28ce87e-148f-4a02-b0e7-7ff65bbc31cd
Which cerebral artery supplies the language centers (Broca area, Wernicke area)? {{c1::Middle cerebral artery}}The superior division of the M2 segment of MCA supplies Broca's (frontal lobe) The inferior division of the M2 segment of MCA supplies Wernicke's (temporal lobe)Review Middle Cerebral Artery (MCA)Watch associated Bootcamp video - Frontal Lobe9070fa74-36ba-460f-aab3-c1bd6b755e4d
"Which ""language center"" is the center for motor speech? {{c1::Broca area}}"Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Frontal Lobef55d239e-03cb-4091-b7b4-dcc3a3ef9754
"Which ""language center"" is located in the inferior frontal gyrus of the frontal lobe? {{c1::Broca's area}}"Watch associated Bootcamp video - Frontal Lobe32f036a6-d4a8-4bbc-ad48-ab19e2745199
"Which ""language center"" is the center for language comprehension? {{c1::Wernicke's area}}"Watch associated Bootcamp video - Temporal Lobe3157e3f6-bf0e-4d70-ab2f-3786858d08c9
"Which ""language center"" is located in the superior temporal gyrus of the temporal lobe? {{c1::Wernicke's area}}"Watch associated Bootcamp video - Temporal Lobe2fb5deff-dd3a-44e5-97a7-713d0726a9fe
{{c1::Aphasia}} is a higher-order language deficit (inability to understand, speak, read, and/or write) caused by pathology in the language centers of the brainLanguage centers are most commonly found in the left hemisphereWatch associated Bootcamp video - Stroke Presentation by Territory305fdd89-0bc2-4050-b186-36a5c5399d42
{{c1::Dysarthria}} is a motor inability to speakIn the setting of an acute stroke, perform a dysphagia screeningWatch associated Bootcamp video - Stroke Presentation by Territoryb41aabbe-85f8-4cb3-9d1f-721dcdca5eae
Broca aphasia (expressive) is characterized by {{c1::nonfluent::fluent or nonfluent}} speechi.e. agrammatic speech BROCA is BROKEN speech Watch 'Broca Aphasia', Neurosigns.org, via YouTube (1:57)Watch associated Bootcamp video - Stroke Presentation by Territory1b58ac2a-66ee-4103-84a1-939815a5edd7
Broca aphasia (expressive) is characterized by {{c1::intact::intact or impaired}} comprehensionWatch associated Bootcamp video - Stroke Presentation by Territory4e12a363-0c54-40ef-a430-b4bc2bc00b53
Broca aphasia (expressive) is characterized by {{c1::impaired::intact or impaired}} repetitionWatch associated Bootcamp video - Stroke Presentation by Territory85a80c4a-6f98-4ad0-a3ae-7ee398d420c5
Wernicke aphasia (receptive) is characterized by {{c1::fluent::fluent or nonfluent}} speechWatch 'Wernicke Aphasia', Tactustherapy, via Youtube (1:30)Watch associated Bootcamp video - Stroke Presentation by Territory707d70f0-a9fe-4c50-953c-90be89ca5622
Wernicke aphasia (receptive) is characterized by {{c1::impaired::intact or impaired}} comprehensionWatch associated Bootcamp video - Stroke Presentation by Territory7cfd3d95-1f6c-4ba9-8818-9310bc28cd26
Wernicke aphasia (receptive) is characterized by {{c1::impaired::intact or impaired}} repetitionWatch associated Bootcamp video - Stroke Presentation by Territory2ccc18dc-32bd-4a66-94be-3f50f404ec11
Conduction aphasia is characterized by {{c1::fluent::fluent or nonfluent}} speechWatch associated Bootcamp video - Parietal Lobeca60acdd-70f6-471a-afb7-7f97f6b2c179
Conduction aphasia is characterized by {{c1::intact::intact or impaired}} comprehensionWatch associated Bootcamp video - Parietal Lobe46a9a13e-b77e-440d-ae0c-ccfe17588c07
Conduction aphasia is characterized by {{c1::impaired::intact or impaired}} repetitionWatch associated Bootcamp video - Parietal Lobedc755f4b-861c-4068-a605-b6af66f56aaa
Conduction aphasia is caused by damage to the {{c1::arcuate fasciculus}}, which is a large fiber bundle that connects Broca's area with Wernicke's areaPhoto credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Parietal Lobe0cc20a1e-58df-4a9e-8a04-82c5fcf6a4a8
Transcortical motor aphasia is characterized by {{c1::nonfluent::fluent or nonfluent}} speechWatch associated Bootcamp video - Stroke Presentation by Territory225cbdb2-94d4-4953-bbcc-a2135d266227
Transcortical motor aphasia is characterized by {{c1::intact::intact or impaired}} comprehensionWatch associated Bootcamp video - Stroke Presentation by Territorya7b8872a-cb55-4459-b7b7-6e22023aaca4
Transcortical motor aphasia is characterized by {{c1::intact::intact or impaired}} repetitionWatch associated Bootcamp video - Stroke Presentation by Territory5bfae512-61fa-4ca4-b742-658925dccdc1
{{c1::Transcortical motor}} aphasia is caused by damage to the areas around Broca's area; Broca's area itself is sparedWatch Localizing A Stroke: ACAWatch associated Bootcamp video - Stroke Presentation by Territoryd3cdcfe3-550f-44ac-bde1-fe6870c39179
Transcortical sensory aphasia is characterized by {{c1::fluent::fluent or nonfluent}} speechWatch associated Bootcamp video - Stroke Presentation by Territorya61ef7bb-1540-4a7b-a30a-75309d0e8b07
Transcortical sensory aphasia is characterized by {{c1::impaired::intact or impaired}} comprehensionWatch associated Bootcamp video - Stroke Presentation by Territory09f4e4f5-b96d-47f0-983a-636329f283d4
Transcortical sensory aphasia is characterized by {{c1::intact::intact or impaired}} repetitionWatch associated Bootcamp video - Stroke Presentation by Territory71a19d8c-b5ee-4e39-a98d-8a6ed951876e
{{c1::Transcortical sensory}} aphasia is caused by damage to the areas around Wernicke's area; Wernicke's area itself is sparedWatch associated Bootcamp video - Stroke Presentation by Territory37c232cb-db1d-45d8-829f-74984611b29e
{{c3::Gerstmann}} syndrome is caused by lesion to the {{c4::angular}} gyrus of the {{c2::dominant}} {{c1::parietal}} cortex- This is typically (80%) of the time the left parietal cortex; the angular gyrus is part of the parietal association cortex which integrates multisensory information to comprehend events and solve problems - Characterized by agraphia, acalculia, finger agnosia, and left-right disorientationWatch associated Bootcamp video - Parietal Lobe6e725cba-5a4f-49bb-9306-cdc811a4042c
{{c1::Gerstmann}} syndrome is characterized by agraphia, acalculia, finger agnosia, and left-right disorientationDue to dominant parietal cortex lesion - Agraphia = loss in the ability to communicate through writing - Acalculia = loss in the ability to learn / comprehend mathematics - Finger agnosia = inability to distinguish fingers on the handWatch associated Bootcamp video - Parietal Lobe0ffc2cc1-8477-432f-9e46-3cbad0302e12
Hemispatial neglect syndrome is caused by lesion to the {{c2::non-dominant}} {{c1::parietal}} cortex- Characterized by neglect of the contralateral half of the body - Can also present with constructional and dressing apraxia Photo Credit: Eliran t, CC BY-SA 4.0 (Image 1) & (Image 2), via Wikimedia CommonsWatch Localizing A Stroke: MCAWatch associated Bootcamp video - Parietal Lobe39c9e56e-c168-4f17-bb1e-79e64aa163dd
{{c2::Hemispatial neglect}} syndrome is characterized by inability to process sensory information (agnosia) of the {{c1::contra}}lateral half of the worldPhoto Credit: Eliran t, CC BY-SA 4.0 (Image 1) & (Image 2), via Wikimedia CommonsWatch Localizing A Stroke: MCAWatch associated Bootcamp video - Parietal Lobe19c5b6bb-b187-47fd-aedd-9ace840a8946
Strokes involving the {{c2::anterior}} cerebral artery may cause paralysis and sensory loss of the {{c3::contra}}lateral {{c1::lower}} limb- Due to damage of the sensory and motor cortices on the medial aspect of the homunculus - May also have behavioral symptoms and urinary incontinence if the frontal micturition center is involved (e.g., medial frontal lobe, cingulate gyrus) - Whereas, strokes involving the middle cerebral artery may cause paralysis and sensory loss of the contralateral upper limb and faceWatch Localizing A Stroke: ACAReview Anterior Cerebral Artery (ACA)Watch associated Bootcamp video - Stroke Presentation by Territory1d3f3269-3509-422d-a666-908f8e66c95f
Strokes involving the {{c3::middle}} cerebral artery may cause paralysis and sensory loss of the {{c2::contra}}lateral {{c1::upper}} limb and {{c1::face}}- Due to damage of the sensory and motor cortices on the lateral aspect of the homunculus - Whereas, strokes involving the anterior cerebral artery may cause paralysis and sensory loss of the contralateral lower limbWatch Localizing A Stroke: MCAReview Middle Cerebral Artery (MCA)Watch associated Bootcamp video - Stroke Presentation by Territoryf78b14f1-3065-4f89-b2df-333992286b37
Strokes involving the {{c2::middle}} cerebral artery may cause aphasia if they occur in the {{c1::dominant}} hemispheredue to damage of the temporal lobe (Wernicke area) or frontal lobe (Broca area)Watch Localizing A Stroke: MCAReview Middle Cerebral Artery (MCA)Watch associated Bootcamp video - Stroke Presentation by Territory48d47049-76a7-4a82-a3ef-326858984ba4
Which anterior circulation stroke causes paralysis/sensory loss of the face and upper limb with cortical signs (e.g. aphasia, neglect)? {{c1::Middle cerebral artery stroke}}Without cortical signs = lacunar stroke to posterior limb of internal capsule (cortical signs think of surface of brain)Watch Localizing A Stroke: MCAReview Middle Cerebral Artery (MCA)Watch associated Bootcamp video - Stroke Presentation by Territorybfe0af26-1459-4045-8858-b885b7d6beea
Which anterior circulation stroke causes contralateral paralysis & sensory loss of the entire body without cortical signs (e.g. aphasia, neglect)? {{c1::Lacunar stroke}}"- Lacunar stroke = lack of cortical signs - Most commonly due to occlusion of lenticulostriate arteries, which supply the internal capsule, caudate nucleus, putamen, and globus pallidus Image description: ""Left: T2W image demonstrating a small lacunar infarct in the left thalamus (arrow). Right: FLAIR image where the infarct is hardly seen."" Image(s) provided by www.radiologyassistant.nl. Used with permission."Watch Ischemic & Hemorrhagic StrokeReview Lenticulostriate ArteryWatch associated Bootcamp video - Stroke Presentation by Territory Watch associated Bootcamp video - Internal Capsule459f0a5c-ce07-427c-830e-0373faebc779
Which part of the limbic system is responsible for learning and memory? {{c1::Hippocampus}}The neurotransmitter nitric oxide is thought to participate in the formation of new memories Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Diencephalon Overviewfc6b7c32-dc1d-4e29-b2b9-43527966fffe
Which part of the limbic system is responsible for attaching an emotional significance to a stimulus? {{c1::Amygdala}}Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Diencephalon Overview789ca5c8-e816-4401-b14d-83a6d2d95047
Bilateral lesions of the {{c1::hippocampus}} result in {{c2::anterograde amnesia}}, which is the inability to create new memoriesWatch associated Bootcamp video - Diencephalon Overview2c42c2e1-fd77-4cc8-9237-7eb8a44f5e8f
{{c1::Kluver-Bucy}} syndrome is characterized by disinhibited behavior, such as hyperphagia, hypersexuality, and hyperoralityWatch associated Bootcamp video - Other Disorders of the Diencephalon28e81d41-3f92-48f8-b532-aec17c260e8b
Bilateral lesions of the amygdala (and thus {{c2::Kluver-Bucy}} syndrome) are associated with {{c1::HSV-1}} encephalitisWatch Herpes Simplex Virus Types 1 & 2 (Herpesviridae)Watch associated Bootcamp video - Other Disorders of the Diencephalonedf813cc-12f4-4dce-afe2-67198bad6171
Wernicke-Korsakoff syndrome can be induced iatrogenically by giving {{c1::glucose}} without thiamine to a B1 deficient patient (e.g. alcohol use disorder or malnourishment)Watch Vitamin B1Watch associated Bootcamp video - Memory, Dissociation, and Orientation: Amnesia Watch associated Bootcamp video - Diencephalon: Hopothalamic Disorders Watch associated Bootcamp video - Substance Misuse: Alcohol Watch associated Bootcamp video - Ketones: Ketoacidosis Review and Ketogenolysisc44ab7f7-228b-4eac-86de-5e7613e27361
ID Vessel: {{c1::Anterior spinal artery (ASA)}}Watch associated Bootcamp video - Circle of Willis8756f8ab-8738-49f3-a21e-81b2987505d2
ID Vessel: {{c1::Posterior inferior cerebellar artery (PICA)}}Review Posterior Inferior Cerebellar Artery (PICA)Watch associated Bootcamp video - Circle of Willis3d586d0f-45ef-485e-902c-0187511d69f8
ID Vessel: {{c1::Anterior inferior cerebellar artery (AICA)}}Watch associated Bootcamp video - Circle of Willisae7c5511-2cac-4ad3-8b9e-7129ec71c814
ID Vessel: {{c1::Vertebral artery}}Watch associated Bootcamp video - Circle of Willisd5216419-779c-4587-b615-9b9cb861afbd
ID Vessel: {{c1::Basilar artery}}Watch associated Bootcamp video - Circle of Willis989707c2-0dc5-4fb4-a4e5-e9f5e7572281
ID Vessel: {{c1::Superior cerebellar artery}}Watch associated Bootcamp video - Circle of Willisfacb3daf-b55a-411d-979c-76a8d6205ebf
ID Vessel: {{c1::Posterior cerebral artery}}Watch associated Bootcamp video - Circle of Willisf552f6dd-61ec-4dca-b2e6-7dafaaf10351
ID Vessel: {{c1::Posterior communicating artery}}Watch associated Bootcamp video - Circle of Willisd93d5b78-eacd-44a3-87a5-b23919bac176
ID Vessel: {{c1::Anterior cerebral artery}}Watch associated Bootcamp video - Circle of Willisfe1709da-2dd9-422a-97c1-497e1ccb8a7f
ID Vessel: {{c1::Anterior communicating artery}}Watch associated Bootcamp video - Circle of Willis4e3ed509-24bf-4cfc-9823-07551e8309f8
ID Vessel: {{c1::Middle cerebral artery}}Watch associated Bootcamp video - Circle of Willisc2acb8f0-544b-4768-82fe-bd185d1ab7c2
The most common cause of bacterial meningitis in adolescents is {{c1::Neisseria meningitidis}} infectionEnteroviruses (e.g., coxsackie or echoviruses) are the most common cause of all types of meningitis in all patient groups Bacterial Meningitis - Most Common CausesAgeBacteriaNeonatesGroup B streptococci > Escherichia coli > Listeria monocytogenesChildrenStreptococcus pneumoniaeAdolescentsNeisseria meningitidisAdultsStreptococcus pneumoniaeElderlyStreptococcus pneumoniae > Listeria monocytogenesWatch Neisseria meningitidisWatch associated Bootcamp video - Neisseria Meningitidis Watch associated Bootcamp video - Infectious Neuropathology: Bacterial Meningoencephalitisbb69c755-94e6-481f-9aef-9f5c1faba5d6
The most common cause of bacterial meningitis in adults and the elderly is {{c1::Streptococcus pneumoniae}} infectionEnteroviruses (e.g., coxsackie or echoviruses) are the most common cause of all types of meningitis in all patient groups Bacterial Meningitis - Most Common CausesAgeBacteriaNeonatesGroup B streptococci > Escherichia coli > Listeria monocytogenesChildrenStreptococcus pneumoniaeAdolescentsNeisseria meningitidisAdultsStreptococcus pneumoniaeElderlyStreptococcus pneumoniae > Listeria monocytogenesWatch associated Bootcamp video - Streptococcus Pneumoniae Watch associated Bootcamp video - Infectious Neuropathology: Bacterial Meningoencephalitisa8944691-dbf7-494d-9678-88c5c601bed7
What is a common cause of meningitis in an unvaccinated child? {{c1::H. influenzae type B}}Watch associated Bootcamp video - Haemophilus4d021715-5f33-47e2-8021-6cfd6bb79162
In addition to S. pneumoniae infection, meningitis in the elderly is also commonly caused by infection with gram negative rods and {{c1::Listeria monocytogenes}}Bacterial Meningitis - Most Common CausesAgeBacteriaNeonatesGroup B streptococci > Escherichia coli > Listeria monocytogenesChildrenStreptococcus pneumoniaeAdolescentsNeisseria meningitidisAdultsStreptococcus pneumoniaeElderlyStreptococcus pneumoniae > Listeria monocytogenesWatch associated Bootcamp video - Lysteria Monocytogenes Watch associated Bootcamp video - Infectious Neuropathology: Bacterial Meningoencephalitis2c567ee2-162b-44eb-914a-1430b2ae0504
Meningitis presents with a classic triad of: - Altered {{c1::mental status}} - {{c1::Nuchal}} rigidity - High {{c1::fever}}- Headache, photophobia (especially with viruses) and vomiting may also be present - Note: Classic triad only presents together in ~50% of patients, often not present in neonates - This is the classic triad according to UWorld. AMBOSS and other sources list the classic triad as headache, fever, and nuchal rigidityWatch associated Bootcamp video - Infectious Neuropathology: Introduction to Meningoencephalitisyd20414ae-45a1-4fc9-a257-805eeb13b4e3
Which type of meningitis presents with decreased glucose and increased PMNs in the CSF? {{c1::Bacterial meningitis}}CSF Analysis in Meningitis NormalViralBacterialTuberculousCryptococcalOpening pressure5 - 18 cm H2ONormal or ↑↑↑↑↑↑↑Glucose40 - 75 mg/dLNormal↓↓↓Protein15 - 45 mg/dLNormal or ↑↑↑↑Cell count & differentialCell count < 5/mm3Leukocyte count 10 - 500/mm3 ↑ lymphocytesLeukocyte count > 1000/mm3 ↑ granulocytes (> 80%)30 - 300/mm3 ↑ lymphocytes (predominant), granulocytes, & mononuclear cells20 - 200/mm3 ↑ lymphocytesAppearanceClear fluidClear fluidCloudy, purulent fluidClear fluid w/ spiderweb clotCloudy fluidGram stain & cultureNo organisms detectedNo organisms detectedPositive gram stain and culture*No organisms detected—Lactate1.2 - 2.1 mmol/LVariable↑↑↑↑*Bacterial Gram Stain - Meningococci: gram-negative diplococci- Pneumococci: gram-positive diplococci- Listeria: gram-positive rods- Haemophilus influenzae: gram-negative coccobacilliWatch associated Bootcamp video - Infectious Neuropathology: Introduction to Meningoencephalitis7a963ba0-35f1-4729-97be-15a00c024738
Which type of meningitis presents with decreased glucose and increased lymphocytes in the CSF? {{c1::Fungal / TB meningitis}}CSF Analysis in Meningitis NormalViralBacterialTuberculousCryptococcalOpening pressure5 - 18 cm H2ONormal or ↑↑↑↑↑↑↑Glucose40 - 75 mg/dLNormal↓↓↓Protein15 - 45 mg/dLNormal or ↑↑↑↑Cell count & differentialCell count < 5/mm3Leukocyte count 10 - 500/mm3 ↑ lymphocytesLeukocyte count > 1000/mm3 ↑ granulocytes (> 80%)30 - 300/mm3 ↑ lymphocytes (predominant), granulocytes, & mononuclear cells20 - 200/mm3 ↑ lymphocytesAppearanceClear fluidClear fluidCloudy, purulent fluidClear fluid w/ spiderweb clotCloudy fluidGram stain & cultureNo organisms detectedNo organisms detectedPositive gram stain and culture*No organisms detected—Lactate1.2 - 2.1 mmol/LVariable↑↑↑↑*Bacterial Gram Stain - Meningococci: gram-negative diplococci- Pneumococci: gram-positive diplococci- Listeria: gram-positive rods- Haemophilus influenzae: gram-negative coccobacilliWatch associated Bootcamp video - Infectious Neuropathology: Introduction to Meningoencephalitis33f3ddbc-5b62-4993-acc3-10c6ea27fc56
Bacterial meningitis may lead to high pressure hydrocephalus, hearing loss, and seizures, secondary to {{c1::fibrosis}}Communicating hydrocephalus due to inflammation and fibrosis of arachnoid granulationsWatch Intracranial Hypertension (ICH) Watch HydrocephalusWatch associated Bootcamp video - Infectious Neuropathology: Introduction to Meningoencephalitise290def1-5b06-4594-82da-307eea30ce4d
Meningitis is treated empirically with {{c1::ceftriaxone}} and {{c2::vancomycin}}; add {{c3::ampicillin}} if Listeria is suspectedWatch associated Bootcamp video - 3rd, 4th, and 5th Generation Cephalosporins Watch associated Bootcamp video - Empiric Antibiotics in Meningitis, Cystitis, and Pyelonephritis11d58544-5654-44ae-bee1-4ad1465ffc34
Moderate global cerebral ischemia typically affects the: - {{c1::Hippocampus}} (most vulnerable) - {{c2::Neocortex}} - {{c3::Cerebellum (Purkinje cells)}} - {{c4::Watershed}} areasPyramidal neurons of the hippocampus (temporal lobe) are the first damaged out of the aforementioned structures (important in long term memory → memory impairment)Watch Ischemic & Hemorrhagic StrokeWatch associated Bootcamp video - Types of Stroke4cd82ede-faf1-4da3-806a-da9dee9306d3
Cerebral ischemia of the neocortex typically affects layers {{c1::III}}, {{c1::V}}, and {{c1::VI}}, causing {{c2::cortical laminar}} necrosisAffects the pyramidal layers of the neocortexWatch Ischemic & Hemorrhagic StrokeWatch associated Bootcamp video - Types of Stroke2bbc1826-b9cf-472e-b45a-a352e130f01f
Irreversible damage due to cerebral ischemia begins after {{c1::5}} minutes of hypoxiaNeurons don't store glycogen, so they are highly susceptible to ischemia (they will quickly run out of energy stores)Watch associated Bootcamp video - Histologic Timeline of Stroke94903395-edfa-4995-9652-8dc956dfd0ef
{{c2::Thrombotic}} ischemic strokes result in a(n) {{c1::pale::color}} infarct at the periphery of the cortexBlood does not re-enter the cortex, therefore, infarct remains paleWatch Ischemic & Hemorrhagic StrokeWatch associated Bootcamp video - Histologic Timeline of Strokead5e2794-0cb3-4cea-9e5e-198bf357c82c
{{c2::Embolic}} ischemic strokes result in a(n) {{c1::hemorrhagic (red)::color}} infarct at the periphery of the cortexBlood re-enters the infarct following fibrinolysisWatch Ischemic & Hemorrhagic StrokeWatch associated Bootcamp video - Types of Stroke0475f002-c759-4dea-928f-43559fb56e07
{{c2::Lacunar}} strokes often occur secondary to {{c1::hyaline arteriolosclerosis}}, a complication of uncontrolled hypertension and diabetes mellitusThe primary causes of lacunar infarcts are: - Lipohyalinosis occurs secondary to leakage of plasma proteins through damaged endothelium and is characterized by hyaline thickening of the vascular wall, collagenous sclerosis, and accumulation of mural foamy macrophages - Microatheromas result from atherosclerotic accumulation of foamy macrophages within the intimal layer of a penetrating artery near its origin off the parent vessel - These changes predispose to small vessel occlusion and infarction of CNS tissue with liquefactive necrosis and the formation of a fluid-filled cavityWatch Diabetes Mellitus Chronic Complications Watch Ischemic & Hemorrhagic StrokeWatch associated Bootcamp video - Lacunar Infarctiona0ec0cc3-a943-4666-9359-1dd3f0da377a
{{c2::Intraparenchymal}} hemorrhage most commonly occurs due to rupture of {{c1::Charcot-Bouchard microaneurysms}}, secondary to chronic hypertension and diabetesChronic hypertension causes hyaline arteriosclerosis of lenticulostriate vessels (lipohyalinosis), weakening the vessel wall Charcot-Bouchard microaneurysm: Photo credit: Jamali et al., CC BY 4.0, via Journal of the Belgian Society of RadiologyWatch Ischemic & Hemorrhagic StrokeWatch associated Bootcamp video - Intraparenchymal Hemorrhage4703b6be-a602-4606-94eb-389c88409d11
{{c2::Intraparenchymal}} hemorrhage typically occurs in the {{c1::basal ganglia}} and internal capsule, but can occur in the thalamus, cerebral hemispheres, brainstem, and cerebellumImage showing basal ganglia hemorrhage Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Intraparenchymal HemorrhageWatch associated Bootcamp video - Intraparenchymal Hemorrhagecaae845c-e8d2-4615-907e-c3bfcf0b3931
Which type of intracranial hemorrhage is seen in the image below? {{c1::Subarachnoid hemorrhage}}Photo credit: Lipothymia, CC BY-SA 3.0(left);James Heilman, MD,CC BY-SA 3.0, via Wikimedia Commons (right) CT scans show hyperdensity in the center (Crab of Death sign), corresponding to blood in the subarachnoid basal cisterns / sulci Photo credit: Image(s) provided by www.radiologyassistant.nl. Used with permission. (left); Shazia Mirza and Sankalp Gokhale, CC BY 4.0, via Wikimedia Commons (right)Watch Epidural Hematoma, Subdural Hematoma, & Subarachnoid Hemorrhage Watch Intracranial & Extracranial HemorrhagesWatch associated Bootcamp video - Epidural and Subdural Hematoma3f7c30cc-e523-42bb-847b-a85b086055aa
Subarachnoid hemorrhage presents with sudden {{c1::headache}} and nuchal rigidity"Thunderclap headache / ""worst headache of my life"" Photo credit: Lipothymia, CC BY-SA 3.0, via Wikimedia Commons Image(s) provided by www.radiologyassistant.nl. Used with permission"Watch Epidural Hematoma, Subdural Hematoma, & Subarachnoid Hemorrhage Watch Intracranial & Extracranial HemorrhagesWatch associated Bootcamp video - Epidural and Subdural Hematoma27496a7d-de83-4643-a3bb-38b02a2d94bd
"Which type of intracranial hemorrhage presents as the ""worst headache of my life""? {{c1::Subarachnoid hemorrhage}}"Photo credit: Lipothymia, CC BY-SA 3.0, via Wikimedia Commons Image(s) provided by www.radiologyassistant.nl. Used with permissionWatch Epidural Hematoma, Subdural Hematoma, & Subarachnoid Hemorrhage Watch Intracranial & Extracranial HemorrhagesWatch associated Bootcamp video - Epidural and Subdural Hematoma0c4b5021-dbea-425f-8ce3-629550d2c9a3
{{c2::Subarachnoid}} hemorrhage is characterized by a(n) {{c1::yellow (xanthochromic)}} spinal tapdue to bilirubin breakdown from hemoglobin Photo credit: William Laborde, MD, Brandon Mong, MD, and Joel Mosley, MD, CC BY 4.0, via Wikimedia CommonsWatch Epidural Hematoma, Subdural Hematoma, & Subarachnoid HemorrhageWatch associated Bootcamp video - Epidural and Subdural Hematomaf9c4108c-0d44-497e-9477-fac52c7d81a7
{{c2::Subarachnoid}} hemorrhage is frequently due to rupture of a(n) {{c1::berry (saccular) aneurysm}}- All the arteries (circle of Willis, etc.) are within the subarachnoid space (underlying defect in the tunica media) - Cigarette smoking and hypertension are risk factors Photo credit: Image(s) provided by www.radiologyassistant.nl. Used with permission.* - Berry aneurysms are thin-walled saccular outpouchings that lack a media layer, increasing the risk for rupture (located around anterior circle of Willis a branch of points of anterior communicating artery) Watch Epidural Hematoma, Subdural Hematoma, & Subarachnoid Hemorrhage Watch Intracranial & Extracranial HemorrhagesWatch associated Bootcamp video - Epidural and Subdural Hematomaaf1f5bde-6177-4975-aa32-164cd30fa9ec
Less common causes of subarachnoid hemorrhage include {{c1::arteriovenous (AV)}} malformations and an anticoagulated state"More commonly due to aneurysm rupture (#1 non-traumatic cause) or trauma (#1 cause overall) Image(s) provided by www.radiologyassistant.nl. Used with permission. Photo credit: Sackey et al., CC BY 3.0, via Cureus"Watch Epidural Hematoma, Subdural Hematoma, & Subarachnoid HemorrhageWatch associated Bootcamp video - Epidural and Subdural Hematoma6d0be90e-588d-4cc2-a648-e746b71d50a0
Subarachnoid hemorrhage is associated with increased risk of developing communicating high pressure {{c1::hydrocephalus}}- Patients may present with confusion, headache, incontinence, gait instability and cognitive deterioration - CT scan will show increased CSF pressure and ventricular dilationWatch Epidural Hematoma, Subdural Hematoma, & Subarachnoid Hemorrhage Watch Hydrocephalus Watch Intracranial & Extracranial HemorrhagesWatch associated Bootcamp video - Epidural and Subdural Hematomad8c313e8-e4ab-4ea4-bb85-669e5c0a3c41
The most common site for a(n) {{c2::berry (saccular)}} aneurysm is at the junction of the {{c1::anterior communicating}} and {{c1::anterior cerebral}} arteriesIn general, bifurcations in the circle of Willis are at the highest risk for a saccular aneurysm Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Epidural Hematoma, Subdural Hematoma, & Subarachnoid HemorrhageWatch associated Bootcamp video - Types of Aneurysms and Locationed9aecf5-46d2-44d3-8dd5-3131695214f5
What connective tissue disease is associated with berry aneurysms? {{c1::Ehlers-Danlos syndrome}}Marfan syndrome is also believed to be associated with berry aneurysmsWatch Epidural Hematoma, Subdural Hematoma, & Subarachnoid HemorrhageReview Ehlers-Danlos SyndromeWatch associated Bootcamp video - Types of Aneurysms and Location Watch associated Bootcamp video - Ehlers Danlos Syndrome59150d7e-ec77-43aa-8304-bf248741198a
What renal pathology is associated with berry aneurysms? {{c1::Autosomal dominant PKD}}Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Congenital & Cystic Kidney DiseaseReview ADPKDWatch associated Bootcamp video - Autosomal Dominant Polycystic Kidney Disease162f3d3a-7b8c-4a61-913e-4a3c36fd6a04
Saccular aneurysms of the {{c1::anterior}} communicating artery may cause compression of the optic chiasm- Causes bitemporal hemianopsia - Saccular aneurysms of the posterior communicating artery may cause compression of the CN IIIWatch Epidural Hematoma, Subdural Hematoma, & Subarachnoid HemorrhageWatch associated Bootcamp video - Types of Aneurysms and Locations Watch associated Bootcamp video - Optic Chiasm Lesionea271606-940d-4f86-97ea-5f43afe20aa1
Saccular aneurysms of the {{c1::posterior}} communicating artery may cause compression of CN III"- Thus, causing ipsilateral CN III palsy (mydriasis, ptosis, ""down and out"" eye) - Saccular aneurysms of the anterior communicating artery may cause compression of the optic chiasm Photo credit: Image(s) provided by www.radiologyassistant.nl. Used with permission."Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens): Clinical CorrelatesWatch associated Bootcamp video - Types of Aneurysms and Locationf3db9883-257a-4b34-af7e-d422dc8e6993
{{c2::Epidural}} hematoma is due to rupture of the {{c1::middle meningeal}} artery (branch of maxillary artery)- Middle meningeal artery supplies most of the dura mater (anterior and posterior supply a small portion) - Happens fast (vs. subdural which happens slowly) - Typically during trauma to the pterion Photo credit: Juan Sales-Llopis, Neurosurgery Wiki (www.operativeneurosurgery.com) Photo credit: Nadezdha D. Kiriyak, CC BY 4.0, via Wikimedia CommonsWatch Epidural Hematoma, Subdural Hematoma, & Subarachnoid Hemorrhage Watch Intracranial & Extracranial HemorrhagesWatch Epidural HematomaWatch associated Bootcamp video - Epidural and Subdural Hematoma92db7c66-4272-46bf-8176-fa8505a6f531
{{c2::Epidural}} hematoma is characterized by a(n) {{c3::hyper}}dense {{c1::lens (biconvex)}}-shaped collection of blood on CT- Also may be described as a biconvex disc - In contrast, subdural hematomas are characterized by a crescent-shaped collection of blood on CT - Because the epidural space is separated by dural attachments to suture lines, blood can spread in epidural space up to the suture line → if severe, hematoma bulges through the suture line → midline shift Photo credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia CommonsWatch Epidural Hematoma, Subdural Hematoma, & Subarachnoid Hemorrhage Watch Intracranial & Extracranial HemorrhagesWatch Epidural HematomaWatch associated Bootcamp video - Epidural and Subdural Hematomaaf1623a0-259a-4b9a-a5dc-2aac01873d00
{{c2::Epidural}} hematoma often presents with a loss of consciousness followed by a(n) {{c1::lucid}} interval for up to 48 hours"""talk and die syndrome"" - Initial loss of consciousness: Due to disruption of the brainstem arousal centers (RAS) - Second loss of consciousness: Due to expanding hematoma and mass effect. - Lucid interval: Interval between the first and second LOC. May last minutes to hours Image(s) provided by www.radiologyassistant.nl. Used with permission."Watch Epidural Hematoma, Subdural Hematoma, & Subarachnoid Hemorrhage Watch Intracranial & Extracranial HemorrhagesWatch Epidural HematomaWatch associated Bootcamp video - Epidural and Subdural Hematomadebf5b4d-a335-44d9-b7ce-5c1134f7c456
Can epidural hematomas cross suture lines? {{c1::No}}important distinguishing feature from subdural hematoma Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Epidural Hematoma, Subdural Hematoma, & Subarachnoid Hemorrhage Watch Intracranial & Extracranial HemorrhagesWatch Epidural HematomaWatch associated Bootcamp video - Epidural and Subdural Hematomaaeea96b4-3c8f-4b4c-a0f8-3ba81f2f9de2
{{c2::Subdural}} hematoma is due to tearing of {{c1::bridging veins}} that lie between the dura and arachnoidHappens slowly (vs epidural which happens quickly) Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia CommonsWatch Epidural Hematoma, Subdural Hematoma, & Subarachnoid Hemorrhage Watch Intracranial & Extracranial HemorrhagesWatch Subdural HematomaWatch associated Bootcamp video - Epidural and Subdural Hematomae10f6546-0d65-43fc-886c-a092e2a12956
Acute subdural hematomas are often caused by {{c1::trauma::general}} and appear {{c2::hyper}}dense on CT- e.g. high-energy impact - Whereas chronic subdural hematomas appear hypodense on CT Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia CommonsWatch Epidural Hematoma, Subdural Hematoma, & Subarachnoid Hemorrhage Watch Intracranial & Extracranial HemorrhagesWatch Subdural HematomaWatch associated Bootcamp video - Epidural and Subdural Hematomaa9a008c9-78fd-4971-aa80-39258830d717
Chronic subdural hematomas appear {{c1::hypo}}dense on CT- e.g. mild trauma, cerebral atrophy, elderly, alcohol use disorder - Whereas acute subdural hematomas appear hyperdense on CT Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia CommonsWatch Epidural Hematoma, Subdural Hematoma, & Subarachnoid Hemorrhage Watch Intracranial & Extracranial HemorrhagesWatch Subdural HematomaWatch associated Bootcamp video - Epidural and Subdural Hematomad4db8686-f93a-4b3d-861d-7297d8259af4
Chronic subdural hematoma is more common in {{c2::alcohol use disorder}} and {{c3::the elderly}} due to {{c1::cerebral atrophy}}, which stretches the bridging veinsWatch Epidural Hematoma, Subdural Hematoma, & Subarachnoid HemorrhageWatch Subdural HematomaWatch associated Bootcamp video - Epidural and Subdural Hematoma5a1c1ef2-6622-4758-8e5c-d24a3bb94b6f
Which type of intracranial hemorrhage is most often seen in shaken baby syndrome? {{c1::Subdural hematoma}}subarachnoid hemorrhage is also possible Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Epidural Hematoma, Subdural Hematoma, & Subarachnoid Hemorrhage Watch Intracranial & Extracranial HemorrhagesWatch Subdural HematomaWatch associated Bootcamp video - Epidural and Subdural Hematoma6f8ab8d1-1ae2-439b-9bf5-cbcdbc4df337
{{c2::Subdural}} hematoma is characterized by a(n) {{c1::crescent (concave)}}-shaped hemorrhage on CTIn contrast, epidural hematomas are characterized by a lens (biconvex)-shaped collection of blood on CT Photo credit: Evbayiro, CC BY 4.0, via CureusWatch Epidural Hematoma, Subdural Hematoma, & Subarachnoid Hemorrhage Watch Intracranial & Extracranial HemorrhagesWatch Subdural HematomaWatch associated Bootcamp video - Epidural and Subdural Hematoma738787dd-066d-461d-a61c-79cc0de9ae7f
Can subdural hematomas cross suture lines? {{c1::Yes}}important distinguishing feature from epidural hematoma Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Epidural Hematoma, Subdural Hematoma, & Subarachnoid Hemorrhage Watch Intracranial & Extracranial HemorrhagesWatch Subdural HematomaWatch associated Bootcamp video - Epidural and Subdural Hematoma5eda9ccf-9369-4805-a5e5-b4be754b0227
{{c2::Subfalcine (cingulate)}} herniation involves displacement of the cingulate gyrus under the {{c1::falx cerebri}}Watch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Brain Herniation6b0c0def-2e89-42b7-bed3-6d10f392cf30
{{c2::Subfalcine}} herniation may result in compression of the {{c1::anterior}} cerebral artery, which causes infarctionThis will lead to contralateral lower extremity weakness with NO pupillary involvementWatch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Brain Herniationf3df61ac-749c-4cd6-9fd4-3036fece7435
Uncal herniation involves displacement of the medial temporal lobe (uncus) under the {{c1::tentorium cerebelli}}"- Expanding space-occupying lesions within the temporal lobe can lead to this - Can compress oculomotor nuclei resulting in a ""down and out"" eye pathology"Watch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Brain Herniation72309fd3-38b4-4067-95c1-6c48dbbae603
"{{c1::Uncal}} herniation may cause compression of CN III, leading to an ipsilateral dilated pupil with a ""down and out"" gaze"- Dilated pupil: CN III PNS gone - Visual loss: ipsilateral PCA - May also have hemiplegia/quadriplegia: contralateral cerebral peduncle compression at Kernohan notch → ipsilateral paralysisWatch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Brain Herniatione09e2aa1-9687-4a1c-a918-d6eaed755d1e
{{c2::Uncal}} herniation may cause compression of the {{c1::posterior}} cerebral artery, causing infarction of the occipital lobeResults in contralateral homonymous hemianopsia with macular sparingWatch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Brain Herniation93337be3-5c64-4a09-96c4-228f236faaf3
Uncal herniation typically compresses the {{c1::cerebral peduncle}} on the same side of the herniation resulting in a(n) {{c2::contra}}lateral paresis- Same side results in contralateral paresis because the fibers decussate below the medulla; patients initially have flaccid paralysis with hyporeflexia → spasticity / hyperreflexia in days to weeks due to (spinal shock) - Specifically, the anterior portion of the cerebral peduncle - the crus cerebri - is being compressed (contains the motor tracts)* Sketchy is showing the severe caseWatch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Brain Herniatione33c301b-8cf8-44f5-9537-563c93dca4b2
If uncal herniation is so severe that it compresses the opposite cerebral peduncle, it may cause a(n) {{c1::ipsi}}lateral paresis known as the {{c2::Kernohan}} phenomenonUncal herniation more commonly causes a contralateral paresis (e.g., herniation of the left uncus causes right sided motor deficits) When severe enough, uncal herniation may cause Kernohan phenomenon (false localization sign) which presents with ipsilateral motor deficits (e.g., herniation of the left uncus causes left sided motor deficits), and rarely, a contralateral CN III palsyWatch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Brain Herniationa027449e-f098-4ce7-9970-4f8e36c718c0
Which leukodystrophy presents with optic atrophy and globoid cells? {{c1::Krabbe disease}}Also presents with peripheral neuropathy and developmental delay (less specific)Review Krabbe DiseaseWatch associated Bootcamp video - Krabbe Disease4f3b0f12-5da5-4bbc-8f1a-052f223bfea2
{{c3::Adrenoleukodystrophy}} disrupts the peroxisomal metabolism of {{c1::very long-chain fatty acids (VLCFA)}}, resulting in excessive buildup in the nervous system, adrenal gland, and {{c2::testes}}Initial symptoms in childhood: - Adrenal insufficiency (often first sx) - Hyperactivity - Hyperpigmentation of skin Progression: - Progressive demyelination → muscle stiffness - Sexual dysfunctionReview AdrenoleukodystrophyWatch associated Bootcamp video - Energy Production: Peroxisome Watch associated Bootcamp video - Fatty Acid Degradation: β-Oxidation Watch associated Bootcamp video - Fatty Acid Degradation: β-Oxidationd9d9f9dc-ffea-4c81-a98f-74dccafdc3f5
What demographic is most commonly affected by multiple sclerosis? {{c1::Females in their 20s and 30s::sex, age}}Multiple sclerosis may manifest initially or undergo exacerbation during the postpartum periodWatch Multiple SclerosisWatch Multiple Sclerosis: Clinical PresentationWatch associated Bootcamp video - Multiple Sclerosis10836b83-ea11-4517-97fa-3c17cc7d4ed8
"What CNS pathology is characterized by ""multiple lesions in time and space""? {{c1::Multiple sclerosis}}"- MS classically follows a relapsing-remitting course, with periods of relative stability alternating with relapsing neurologic deficits - e.g. optic neuritis (vision loss, pain), transverse myelitis (motor/sensory loss below lesion with incontinence), INO Photo credit: Monthly_multiple_sclerosis_anim.gif: Waglione, derivative work: Garrondo, Public domain, via Wikimedia CommonsWatch Multiple SclerosisWatch Multiple Sclerosis: Clinical Presentation Watch Multiple Sclerosis: Evaluation & ManagementWatch associated Bootcamp video - Multiple Sclerosis6f2d191f-72d2-480f-9aa6-1e933f7f60e0
Multiple sclerosis may cause {{c1::optic neuritis}}, resulting in sudden loss of vision and {{c2::Marcus Gunn}} pupils"- Classic cause of Marcus Gunn pupils - Results in decreased bilateral pupillary constriction when light is shone in affected eye relative to unaffected eye - Optic neuritis causes lesion in the ""afferent"" light reflex limb RAPD in right eye: Video credit: Jonathan Trobe, CC BY 3.0, via U-M Kellogg Eye Center in Ann Arbor, modified by converting into GIF"Watch Multiple SclerosisWatch Multiple Sclerosis: Clinical PresentationWatch associated Bootcamp video - Multiple Sclerosis142391b9-7b03-4400-830c-17b30a77e244
Does multiple sclerosis cause hemiparesis or hemisensory symptoms? {{c1::Both :)}}- Patients may display pyramidal weakness, as well as sensory manifestations affecting the trunk or one or more extremity - Can be either or both due to involvement of the cerebral white matter (typically periventricular)Watch Multiple SclerosisWatch associated Bootcamp video - Multiple Sclerosis7ab5ed5d-2d34-411e-bfcc-ae8605d6beba
Multiple sclerosis may present with {{c1::bowel::organ}} and {{c1::bladder::organ}} dysfunction due to involvement of the ANS- Initially multiple sclerosis presents with urgency incontinence after a few weeks of demyelination of spinal cord above the sacral region → loss of higher center control of micturition and thus lead to detrusor hyperreflexia (frequent urge to urinate and pass small amount of urine) - As the disease progresses, the bladder can become atonic and dilated leading to overflow incontinence - Patients can also have sexual dysfunction - Urinary incontinence or interrupted stream can be caused by detrusor sphincter dyssynergiaWatch Multiple SclerosisWatch Multiple Sclerosis: Clinical PresentationWatch associated Bootcamp video - Multiple Sclerosis Watch associated Bootcamp video - Overflow Incontinence640e2f78-d9f4-4a37-adf2-52e59ece3d1f
What imaging modality is the gold standard for diagnosis of multiple sclerosis? {{c1::MRI}}Photo credit: Monthly_multiple_sclerosis_anim.gif: Waglione, derivative work: Garrondo, Public domain, via Wikimedia CommonsWatch Multiple SclerosisWatch Multiple Sclerosis: Evaluation & ManagementWatch associated Bootcamp video - Multiple Sclerosis7706cd3a-4ff9-427b-8598-db8bbce08a82
What MRI finding is associated with multiple sclerosis? {{c1::Periventricular plaques}}- AKA Dawson's fingers - seen in corpus callosum (fingers that branch off)- Areas of oligodendrocyte loss and reactive gliosis with preservation of axons → visualized as grey matter in white matter on brain biopsy Photo credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia CommonsPhoto credit: Veela Mehta, Wei Pei, Grant Yang, Suyang Li, Eashwar Swamy, Aaron Boster, Petra Schmalbrock, David Pitt, CC BY 2.5, via Wikimedia CommonsWatch Multiple SclerosisWatch Multiple Sclerosis: Clinical Presentation Watch Multiple Sclerosis: Evaluation & ManagementWatch associated Bootcamp video - Multiple Sclerosis634c49ae-d88b-4cc4-b49a-07a2fa9e6272
{{c1::Oligoclonal}} bands of IgG on high resolution electrophoresis is diagnostic of {{c2::multiple sclerosis}}While oligoclonal bands in CSF may be found in other pathologies (infections (Lyme disease), autoimmune diseases, brain tumors, and lymphoproliferative diseases), board resources (AMBOSS, FA 2022) exclusively focus on the association with MSWatch Multiple SclerosisWatch Multiple Sclerosis: Evaluation & ManagementWatch associated Bootcamp video - Multiple Sclerosis08dcfb8d-9c24-4900-a3e2-c5d48711b1f0
Multiple sclerosis is characterized by increased levels of {{c1::myelin basic}} protein in the CSFWatch Multiple SclerosisWatch Multiple Sclerosis: Evaluation & ManagementWatch associated Bootcamp video - Multiple Sclerosis56d568c3-72dd-4eaa-aad8-f67433eccfbe
{{c2::Multiple sclerosis}} is characterized grossly by {{c1::gray}}-appearing plaques in the white matter- Appear on imaging as scattered, ovoid lesions - Gray plaques due to demyelination of white matter → grey matter underneath - Caused by damage to oligodendrocytes in CNSWatch Multiple SclerosisWatch associated Bootcamp video - Multiple Sclerosisb7aa7bc4-6938-404c-8198-c88720d443a1
Multiple sclerosis symptoms are often worsened upon exposure to {{c1::heat::temperature}}- e.g. hot shower, exercise; known as Uhthoff's phenomenon - UtHOFF phenomenon: Often presents as a female who takes a Hot shower, and then feels OFF (very fatigued)Watch Multiple SclerosisWatch Multiple Sclerosis: Clinical PresentationWatch associated Bootcamp video - Multiple Sclerosis20815891-3d42-4c36-a399-1600e827f93a
Long-term treatment of multiple sclerosis with disease-modifying therapies stops {{c1::relapses}} and halts/slows progression of disease (options include interferon β, glatiramer, and natalizumab)- IFN-β decreases blood brain barrier permeability - glatiramer is a MBP analog that shifts Th1 phenotype to Th2 phenotype - natalizumab is an a4-integrin inhibitor that prevents T cells from extravasatingWatch Multiple SclerosisWatch Multiple Sclerosis: Evaluation & ManagementWatch associated Bootcamp video - Multiple Sclerosisec464cb4-2dee-4e34-a01e-221fb02b7b2a
{{c2::Subacute sclerosing panencephalitis (SSPE)}} is due to slowly progressing, persistent infection of the brain by {{c1::measles}} virus- Diagnosed with anti-measles antibodies in CSF - Typically presents as a kid who had measles/was never vaccinated, then 5-15 years later develops personality changes, seizures, myoclonus, ataxia, coma or deathWatch Measles, Mumps, Parainfluenza Viruses (Paramyxoviridae)Watch associated Bootcamp video - Additional Diseases of Demyelination Watch associated Bootcamp video - Infectious Childhood Rashes (Chickenpox, Measles, Rubella)986da01a-e216-438e-af84-d8fcf69434d0
{{c2::Osmotic demyelination syndrome (ODS)}} is also referred to as {{c1::central pontine myelinolysis}}Watch Osmolality & Sodium DisordersWatch associated Bootcamp video - Medullary and Pontine Syndromes Watch associated Bootcamp video - Additional Diseases of Demyelination1debc411-a30f-459b-95be-8d7bd7bdbaa1
Osmotic demyelination syndrome (ODS) is characterized by massive axonal demyelination of the {{c1::pons::brain stem area}}- Brain does not have enough time to return osmolyte levels to normal in its parenchyma, resulting in a mass shift of fluid out of the pons (to attempt to restore serum osmolarity) Hyperintensity in pons with pathgnomonic trident shape seen in ODS: Photo credit: Jto410, CC BY-SA 3.0, via Wikimedia Commons (left); AMBOSS, CC BY-SA 3.0 (right)Watch associated Bootcamp video - Medullary and Pontine Syndromes Watch associated Bootcamp video - Additional Diseases of Demyelination5f8d319d-b218-4437-b2c3-9ea3c50c6428
Rapid correction of {{c1::hypo}}natremia results in {{c2::osmotic demyelination syndrome (ODS)}}"- This is caused by overly rapid intravenous correction of hyponatremia - ""from low to high, your pons will die"" - In context of chronic low plasma sodium, the brain compensates by decreasing the levels of osmolytes (inositol, betaine, glutamine, glucose) so that brain cells can remain relatively isotonic and not absorb too much fluid - With correction of hyponatremia with IV fluids, extracellular tonicity increases, followed by an increase in intracellular tonicity (by cells making more intracellular osmolytes) - If correction is too rapid, not enough time is allowed for brains cells to adjust to new tonicity - Not enough time to increase osmolytes- Therefore, the intracellular water will be pulled out to balance the extracellular tonicity - This can lead to cellular dysfunction and central pontine myelinolysis - Myelin sheaths in the pons becomes damaged"Watch Osmolality & Sodium DisordersWatch associated Bootcamp video - Endocrine: SIADH Watch associated Bootcamp video - Endocrine: Hyponatremia Watch associated Bootcamp video - Electrolytes: Sodium Watch associated Bootcamp video - Neurology: Additional Diseases of Demyelination Watch associated Bootcamp video - Neurology: Medullary and Pontine Syndromesf091cd4a-e532-4514-8946-a8aefce02e4a
Rapid correction of {{c1::hyper}}natremia results in {{c2::cerebral edema / herniation}}"""from high to low, your brain will blow"""Watch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Electrolytes: Sodium Watch associated Bootcamp video - Medullary and Pontine Syndromesaed29082-fba3-4a1a-951a-9419e7ef053b
"Osmotic demyelination syndrome classically presents as ""{{c1::locked-in}}"" syndrome"Other symptoms include acute paralysis, dysarthria, dysphagia, diplopia (without loss of consciousness)Watch Osmolality & Sodium DisordersWatch associated Bootcamp video - Medullary and Pontine Syndromes Watch associated Bootcamp video - Additional Diseases of Demyelination0ef217eb-5de7-4972-9496-5e45b354d59c
"""Locked-in"" syndrome is typically caused by stroke of the {{c1::basilar}} artery"Results in lesions of the pons, medulla, lower midbrain, corticospinal and corticobulbar tracts, ocular cranial nerve nuclei, PPRFReview Basilar ArteryWatch associated Bootcamp video - Medullary and Pontine Syndromes91febfc9-ab88-4c07-8f2c-3dad17a3ef3a
"""Locked-in"" syndrome presents with {{c1::quadriplegia}} and loss of voluntary facial, mouth, and tongue movements"Due to damage of the corticospinal tracts and corticobulbar tractsReview Basilar ArteryWatch associated Bootcamp video - Medullary and Pontine Syndromes19863f31-dae3-4e6b-9fa5-25a51651994e
"What movements are still possible in patients with ""locked-in"" syndrome? {{c1::Vertical eye movement, blinking::2}}"Horizontal eye movement is lost due to damage to the PPRF and CN VI nucleiWatch Osmolality & Sodium DisordersReview Basilar ArteryWatch associated Bootcamp video - Medullary and Pontine Syndromes35cff07b-0e0e-4a70-8d93-2e453ff5c39c
What is the most common cause of dementia in the elderly? {{c1::Alzheimer disease}}Watch Alzheimer Disease & DementiaWatch associated Bootcamp video - Alzheimer Dementia1d746067-c723-4ef3-9583-157209c84f70
The {{c2::ε4}} allele of apolipoprotein E is associated with {{c1::increased::increased or decreased}} risk for Alzheimer diseaseWhile the ε2 allele is associated with decreased riskWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Alzheimer Dementia5a40eabe-c39a-48d2-b09f-dffae652ba73
The {{c2::ε2}} allele of apolipoprotein E is associated with {{c1::decreased::increased or decreased}} risk for Alzheimer diseaseWhile the ε4 allele increases riskWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Alzheimer Dementiac7137edc-5610-48e6-80df-c52b9e061432
Patients with {{c1::Down}} syndrome have an increased risk for developing Alzheimer diseaseAmyloid beta (Aβ) is derived from amyloid precursor protein (APP), which is encoded on chromosome 21Watch Alzheimer Disease & DementiaReview Down Syndrome (Trisomy 21)Watch associated Bootcamp video - Alzheimer Dementia Watch associated Bootcamp video - High Yield Genetic Disorders: Autosomal Trisomiese0512d5e-7f32-4ecc-a4a3-e4308176e313
Early-onset familial cases of Alzheimer disease are associated with mutations in {{c1::presenilin-1}} and {{c1::presenilin-2}}- PREsenilin mutations = PRE-mature Alzheimer disease - Early-onset familial Alzheimer disease also associated with mutations in APP gene on chromosome 21 - Contrast with Apo-E4 mutation, which is associated with late-onset familial Alzheimer diseaseWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Alzheimer Dementia04c1847c-fefe-408e-b1d1-2bb1f97a4067
Alzheimer disease is characterized histologically by {{c1::neuritic (senile)}} plaques in gray matterPhoto credit: Jensflorian, CC BY-SA 3.0, via Wikimedia CommonsWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Alzheimer Dementia2313f1c1-4f48-43b2-ae78-7c9aafa81be4
The neuritic plaques seen in Alzheimer disease are composed of {{c1::amyloid beta (Aβ)}} with entangled neuritic processes- Amyloid β → neuritic (senile) plaques - Tau protein → neurofibrillary tangles Neuritic plaque in the center (black) Photo credit: Jensflorian, CC BY-SA 3.0, via Wikimedia Commons Two neuritic plaques. Neurites are darkly stained. Pink elements include the plaque cores Photo credit: Tulemo, CC BY-SA 4.0 via wikipedia.orgWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Alzheimer Dementia6545d41f-3729-4f03-8d3e-f6d88dc86d26
Amyloid beta (Aβ) is derived from {{c1::amyloid precursor}} protein, which is encoded on chromosome {{c2::21}}Thus, increased risk of Alzheimer disease in Down syndrome patientsWatch Amyloidosis Watch Alzheimer Disease & DementiaWatch AmyloidosisReview Down Syndrome (Trisomy 21)Watch associated Bootcamp video - Alzheimer Dementia Watch associated Bootcamp video - High Yield Genetic Disorders: Autosomal Trisomiesbeafe79c-ebef-492b-9687-38c8e6489c95
The APP receptor on neurons is occasionally broken down by {{c1::beta}} cleavage, resulting in formation of amyloid beta (Aβ)Watch Alzheimer Disease & DementiaWatch associated Bootcamp video - Alzheimer Dementia115f8dc0-ac51-4b3a-abd8-bed1ae271196
The amyloid beta (Aβ) in Alzheimer patients may deposit around vessels, causing {{c1::amyloid angiopathy}}Amyloid angiopathy increases risk for intraparenchymal hemorrhage Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia CommonsWatch Amyloidosis Watch Ischemic & Hemorrhagic Stroke Watch Alzheimer Disease & DementiaWatch associated Bootcamp video - Alzheimer Dementiad3742ccc-d8af-4a54-a2aa-be8ea9d0c565
What feature of Alzheimer disease is represented in the image below? {{c1::Senile plaque (neuritic plaque)}}- Amyloid β → neuritic (senile) plaques - Tau protein → neurofibrillary tangles Photo credit: Jensflorian, CC BY-SA 3.0, via Wikimedia CommonsWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Alzheimer Dementia0dddfef2-be04-40a3-9be4-0425e74e9ad6
Alzheimer disease is characterized by {{c1::neurofibrillary tangles}}, which are intracellular aggregates of {{c2::hyperphosphorylated}} {{c3::tau}} protein- Amyloid β → neuritic (senile) plaques - Tau protein → neurofibrillary tangles Photo credit: Patho, CC BY-SA 3.0, via Wikimedia CommonsWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Alzheimer Dementia2451ae9d-4ff7-457f-81a0-5d0fdffaf996
The tau protein that aggregates in Alzheimer disease normally functions as a(n) {{c1::microtubule}}-associated proteinNo longer functional after hyperphosphorylationWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Alzheimer Dementia6a9304f1-51c9-4a9b-8b53-bcf097dc52a8
What feature of Alzheimer disease is represented in the image below? {{c1::Neurofibrillary tangles}}A collection of intracellular aggregates composed of hyperphosphorylated tau Photo credit: Patho, CC BY-SA 3.0, via Wikimedia CommonsWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Alzheimer Dementia97d8ade5-74ef-4cbd-b6ce-f6f9b27f5521
Vascular dementia is characterized by a step-wise decline in cognitive ability with {{c1::late}}-onset memory impairmentvs. Alzheimer disease, which has a more gradual declineWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Vascular Dementia8392fef6-30f0-4d8c-afd6-270baeecb6f1
What is the 2nd most common cause of dementia in the elderly? {{c1::Vascular dementia}}Alzheimer disease is the most commonWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Vascular Dementiafb92c8bd-b3df-407a-b8f8-4087d81e09c8
Vascular dementia is characterized by presence of multiple cortical and/or subcortical white matter {{c1::infarcts}} on MRI or CTBrain damage caused by multiple strokes Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Alzheimer Disease & DementiaWatch associated Bootcamp video - Vascular Dementiab002b77a-a2f6-46e0-8bc8-96434b047716
{{c2::Frontotemporal dementia (Pick disease)}} is a degenerative disease of the frontal and temporal cortex- Pick disease is now called frontotemporal dementia - Parietal and occipital lobe are spared (vs. Alzheimer disease)Watch Alzheimer Disease & DementiaWatch associated Bootcamp video - Frontotemporal Dementiafbb2c053-e648-489b-9d24-5042f97cf5ce
{{c2::Frontotemporal dementia (Pick disease)}} is characterized by {{c1::round::shape}} aggregates of hyperphosphorylated tau protein known as {{c3::Pick bodies}}; may be seen with silver stainPhoto credit: Jensflorian, CC BY-SA 3.0, via Wikimedia Commons and Jensflorian, CC BY-SA 3.0, via Wikimedia Commons vs. neurofibrillary tangles in Alzheimer disease: Photo credit: Patho, CC BY-SA 3.0, via Wikimedia CommonsWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Frontotemporal Dementiaee0a8dca-3941-4551-8133-97b25fd66196
Frontotemporal dementia (Pick disease) may have ubiquitinated {{c1::TDP-43}} inclusions seen on histologyTDP-43 is involved in DNA transcription and repairWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Frontotemporal Dementia2d1bc07c-6313-41b5-95ad-8a65c10f9814
{{c3::Frontotemporal}} dementia is characterized by {{c1::behavioral}} and/or {{c2::language}} symptoms early in the disease course- Due to involvement of the frontal and temporal lobes, respectively; progresses to dementia Symptoms may include: - Inappropriate social behaviors - Hyperorality (e.g., binge eating) - Loss of interest in activities - Compulsive behaviors (e.g., hoarding)Watch Alzheimer Disease & DementiaWatch associated Bootcamp video - Frontotemporal Dementia9b91a731-bd61-4c71-82af-91a6f0339c9e
{{c3::Parkinson}} disease is characterized by degeneration of {{c1::dopaminergic}} neurons in the {{c2::substantia nigra}} of the basal gangliaImpairs the direct basal ganglia pathwayWatch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseReview Nigrostriatal PathwayWatch associated Bootcamp video - Parkinson Disease Watch associated Bootcamp video - Ubiquitin-Proteasome Watch associated Bootcamp video - Disorders of the Basal Ganglia6407b916-2911-4863-b7ad-51bcc64aca75
What contaminant in illicit drugs historically is associated with Parkinson disease? {{c1::MPTP}}"- ""May Predispose To Parkinson"" - Metabolized to MPP+, which can destroy the substantia nigra and cause parkinsonian symptoms"Watch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch associated Bootcamp video - Parkinson Disease Watch associated Bootcamp video - Disorders of the Basal Gangliaf59627f6-d867-46bb-860e-0abf513fba34
The motor clinical features of Parkinson disease may be remembered with the mnemonic {{c1::TRAPSS}}Tremor (pill-rolling tremor at rest; disappears with movement) Rigidity (cogwheel rigidity in the extremities) Akinesia/bradykinesia (slowing of voluntary movement; expressionless face) Postural instability Shuffling gait, Small handwriting (micrographia)Watch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Parkinson Disease64df84d0-b9c7-4cf4-b64a-35a151d47a02
"The motor clinical features of {{c1::Parkinson}} disease may be remembered with the mnemonic ""TRAPSS"": {{c1::Tremor (pill-rolling tremor at rest; disappears with movement)::T}} {{c1::Rigidity (cogwheel rigidity in the extremities)::R}} {{c1::Akinesia/bradykinesia (slowing of voluntary movement; expressionless face)::A}} {{c1::Postural instability::P}} {{c1::Shuffling gait, Small handwriting (micrographia)::S (x2)}}"Parkinson tremor: Photo credit: Dr. Osama Shukir Muhammed Amin FRCP (Glasg), used with permission.Watch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Parkinson Diseaseye171bebc-9ab8-431e-a5cb-944806428fa3
Which movement disorder symptom presents as an uncontrolled movement of distal appendages at rest that is alleviated by intentional movement? {{c1::Resting tremor}}"- Most noticeable in hands; e.g. ""pill-rolling"" tremor of Parkinson disease - Contrast with essential tremor & intention tremor, which are worse with movement Parkinson tremor: Photo credit: Dr. Osama Shukir Muhammed Amin FRCP (Glasg), used with permission."Watch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch associated Bootcamp video - Parkinson Disease Watch associated Bootcamp video - Disorders of the Basal Ganglia5ca85781-09d2-470e-bb23-8162d4febf5a
{{c3::Parkinson}} disease is characterized histologically by {{c1::Lewy bodies}}, which are round, eosinophilic inclusions composed of {{c2::α-synuclein}}Think of Parkinsynuclein Photo credit: Suraj Rajan, CC BY-SA 3.0, via Wikimedia CommonsWatch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch associated Bootcamp video - Parkinson Disease Watch associated Bootcamp video - Disorders of the Basal Gangliaeffd8221-7c04-4292-b59b-4572737b4674
What feature of Parkinson disease is represented in the image below? {{c1::Lewy body}}Photo credit: Suraj Rajan, CC BY-SA 3.0, via Wikimedia CommonsWatch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch associated Bootcamp video - Parkinson Disease Watch associated Bootcamp video - Disorders of the Basal Ganglia25cb1149-9f20-4a3e-ab49-f0756dd75ead
Early-onset dementia with parkinsonian features is suggestive of {{c1::Lewy body}} dementia- What distinguishes this from Parkinson's is that the dementia occurs before parkinsonism; otherwise considered dementia secondary to Parkinson disease (dementia with Lewy bodies) - 2nd most common neurodegenerative disorder (after Alzheimer), shortened life expectancy relative to Alzheimer patients Parkinson-Plus SyndromesTypeDementia with Lewy bodiesMultiple system atrophy (MSA)Progressive supranuclear palsyCorticobasal degeneration (CBD)DefinitionParkinsonism and dementia <1 year apartNeurodegeneration of the substantia nigraNeurodegeration of the midbrain-diencephalic junction, cerebellum, and cortex (mildly)Neurodegeneration of cortex and basal gangliaImportant Clinical SignsDementia, Parkinsonism, Visual hallucinationsMotor abnormalities, Autonomic dysfunction (incontinence, orthostatic hypotension), cerebellar dysfunctionVertical gaze palsy (esp downward gaze), Postural instability (↑ falls)Alien limb phenomenon (can't recognize own limb), asymmetric motor apraxiaPathology/ImagingLewy bodies in cortexHot cross bun sign on MRIHummingbird sign on MRIAsymmetric cortical atrophy + bilateral basal ganglia atrophyWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Lewy Body Dementia Watch associated Bootcamp video - Ubiquitin-Proteasome Watch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Parkinson Disease3d7fc75b-f983-431f-8a0a-074f5ee72023
Lewy body dementia is characterized initially by dementia with {{c1::fluctuating}} cognition / alertness, a(n) {{c2::REM::which stage}} sleep behavior disorder, {{c3::visual}} hallucinations, followed by parkinsonian features"""haLewycinations"" - 2nd most common neurodegenerative disorder (after Alzheimer), shortened life expectancy relative to Alzheimer patients Parkinson-Plus SyndromesTypeDementia with Lewy bodiesMultiple system atrophy (MSA)Progressive supranuclear palsyCorticobasal degeneration (CBD)DefinitionParkinsonism and dementia <1 year apartNeurodegeneration of the substantia nigraNeurodegeration of the midbrain-diencephalic junction, cerebellum, and cortex (mildly)Neurodegeneration of cortex and basal gangliaImportant Clinical SignsDementia, Parkinsonism, Visual hallucinationsMotor abnormalities, Autonomic dysfunction (incontinence, orthostatic hypotension), cerebellar dysfunctionVertical gaze palsy (esp downward gaze), Postural instability (↑ falls)Alien limb phenomenon (can't recognize own limb), asymmetric motor apraxiaPathology/ImagingLewy bodies in cortexHot cross bun sign on MRIHummingbird sign on MRIAsymmetric cortical atrophy + bilateral basal ganglia atrophy"Watch Alzheimer Disease & DementiaWatch associated Bootcamp video - Lewy Body Dementia Watch associated Bootcamp video - Ubiquitin-Proteasomeab0378ec-fc73-4f38-988f-6166c5c21b99
{{c3::Huntington}} disease is characterized by degeneration of {{c1::GABAergic}} neurons in the {{c2::caudate nucleus}} and putamen of the basal gangliaPhoto credit: Frank Gaillard, CC BY-SA 3.0, via Wikimedia CommonsWatch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseReview Huntington DiseaseWatch associated Bootcamp video - Additional Diseases of Demyelination Watch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Additional Causes of Dementiac97d453f-a1fc-49ee-814f-89dc143e3e1a
What is the mode of inheritance of Huntington disease? {{c1::Autosomal dominant}}Watch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseReview Huntington DiseaseWatch associated Bootcamp video - Additional Diseases of Demyelination Watch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Additional Causes of Dementia730c5424-ae53-4897-86be-b2e7ba6ea9bd
Huntington disease is caused by expanded trinucleotide repeats of CAG in the {{c1::huntingtin}} gene on chromosome {{c2::4}}HUNT = 4 lettersWatch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseReview Huntington DiseaseWatch associated Bootcamp video - Additional Diseases of Demyelination Watch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Additional Causes of Dementia8a49b206-c27d-4a40-9042-84b95497d8c5
Further expansion of CAG repeats (Huntington disease) occurs during {{c1::spermatogenesis}} in males, which leads to anticipation in future generationsThus, patients who develop the disease from their father tend to develop the disease earlier in lifeWatch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch associated Bootcamp video - Additional Diseases of Demyelination Watch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Additional Causes of Dementiaa1c75d32-94fc-4620-891c-969051bb06af
What movement-related symptoms are associated with Huntington disease? {{c1::Chorea}} and {{c1::athetosis}}Chorea - involuntary jerky movements Athetosis - involuntary writhing Choreoathetosis: Photo credit: Dr. Osama Shukir Muhammed Amin FRCP (Glasg), used with permission. Athetosis: Photo credit: Dr. Osama Shukir Muhammed Amin FRCP (Glasg), used with permission.Watch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseReview Huntington DiseaseWatch associated Bootcamp video - Additional Diseases of Demyelination Watch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Additional Causes of Dementia1fb54d1f-ea6a-4a08-a7d6-a437971f74b2
Which movement disorder symptom presents as sudden, jerky, purposeless movements? {{c1::Chorea}}Seen with Huntington disease and acute rheumatic fever (sydenham chorea); both pathologies damage the basal ganglia Watch 'Sydenham Chorea', NEJM via Youtube (0:24)Watch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseReview Huntington DiseaseWatch associated Bootcamp video - Additional Diseases of Demyelination Watch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Additional Causes of Dementiaa30be9ab-e1d4-4cf1-8d71-c95650f215fb
Which movement disorder presents as slow, writhing movements, especially in the fingers? {{c1::Athetosis}}"""writhing, snake-like movement""; seen with Huntington disease Left hand athetosis: Photo credit: Dr. Osama Shukir Muhammed Amin FRCP (Glasg), used with permission."Review Huntington DiseaseWatch associated Bootcamp video - Additional Diseases of Demyelination Watch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Additional Causes of Dementiafd1c6347-0a5d-4204-894e-691a36d0a2d5
Symptoms of Huntington disease typically manifest between ages {{c1::20}} and {{c1::50}}Watch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseReview Huntington DiseaseWatch associated Bootcamp video - Additional Diseases of Demyelination Watch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Additional Causes of Dementia7834ea69-f983-4267-b7c9-b147c5dd1070
Neuronal death in Huntington disease occurs via NMDA-R binding and {{c1::glutamate}} excitotoxicityIncreased Ca2+ influx causing death of neuronsWatch associated Bootcamp video - Additional Diseases of Demyelination Watch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Additional Causes of Dementia0753ecf9-f8c1-491b-904c-46ef58168963
What type of hydrocephalus may be seen with Huntington disease? {{c1::Hydrocephalus ex vacuo}}dilation of the ventricles secondary to caudate and putamen atrophy Photo credit: Frank Gaillard, CC BY-SA 3.0, via Wikimedia CommonsWatch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseReview Huntington DiseaseWatch associated Bootcamp video - Additional Diseases of Demyelination Watch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Additional Causes of Dementia7bec7cf5-b9e0-4699-82ca-b2fbc8a00165
In normal pressure hydrocephalus, CSF pressure is {{c1::episodically}} elevatedPhoto credit: Nevit Dilmen, CC BY-SA 3.0, via Wikimedia CommonsWatch HydrocephalusWatch Normal Pressure HydrocephalusWatch associated Bootcamp video - Hydrocephalus Watch associated Bootcamp video - Additional Causes of Dementia7967c2c1-563b-4514-9b6b-ea0e1fe58d19
{{c4::Normal pressure}} hydrocephalus classically presents with a triad of: {{c1::Urinary incontinence}} {{c1::Gait apraxia}} {{c1::Dementia}}"- ""Wet, wobbly, and wacky"" - Sometimes reversible - Urinary incontinence is caused by disruption of the periventricular pathways that transmit inhibitory impulses from the cortex to the sacral micturition center - Apraxia is a motor disorder caused by damage to the posterior parietal cortex, where the individual has difficulty with motor planning to perform tasks / movements (without sensory loss or paralysis)"Watch HydrocephalusWatch Normal Pressure HydrocephalusWatch associated Bootcamp video - Hydrocephalus Watch associated Bootcamp video - Additional Causes of Dementia8be258e5-2e99-4bc5-a2cf-52e1314ab6ae
{{c2::Normal pressure}} hydrocephalus often presents with a characteristic {{c1::magnetic}} gait- This is gait apraxia - Apraxia is a motor disorder caused by damage to the posterior parietal cortex, where the individual has difficulty with motor planning to perform tasks / movements (without sensory loss or paralysis)Watch HydrocephalusWatch Normal Pressure HydrocephalusWatch associated Bootcamp video - Hydrocephalus Watch associated Bootcamp video - Additional Causes of Dementiad694c178-2448-46f5-a2a4-4397da53f020
What is the definitive treatment for normal pressure hydrocephalus? {{c1::Ventriculoperitoneal (VP) shunting}}- Transfers CSF from ventricles to peritoneal cavity - Serial lumbar punctures may be done to bridge to definitive therapy Photo Credit: Cancer Research UK, CC BY-SA 4.0, via Wikimedia CommonsWatch HydrocephalusWatch Normal Pressure HydrocephalusWatch associated Bootcamp video - Hydrocephalus Watch associated Bootcamp video - Additional Causes of Dementia35884852-522f-488a-b78a-e94d8cf698ad
{{c1::Spongiform}} encephalopathy is a degenerative disease due to the aggregation and intracellular spread of abnormal {{c2::prion}} proteinse.g., Creutzfeldt-Jakob, Mad-Cow Disease, Kuru, Familial Fatal Insomnia (hereditary), Gerstmann-Straussler-Scheinker Syndrome (hereditary) Photo credit: OpenStax, CC BY 4.0Watch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch associated Bootcamp video - Creutzfeldt-Jakob Disease Watch associated Bootcamp video - Infectious Neuropathology: Infectious Cerebral Lesionsb3519b41-bdba-4ec0-8070-1dd1ddc2419e
Prion protein is normally expressed in CNS neurons in a(n) {{c2::α-helical}} conformation, known as {{c1::PrPc}}Photo credit: OpenStax, CC BY 4.0Watch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch associated Bootcamp video - Creutzfeldt-Jakob Disease697ba953-c1d2-4a3d-928c-da4e6371348c
Prion disease arises with conversion to a(n) {{c2::β-pleated}} conformation, known as {{c1::PrPsc}}Photo credit: OpenStax, CC BY 4.0Watch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch associated Bootcamp video - Creutzfeldt-Jakob Diseaseb949c858-4261-4f11-8cb6-9f3b5f9646a5
What is the most common form of spongiform encephalopathy? {{c1::Creutzfeldt-Jakob disease (CJD)}}Photo credit: DRdoubleB, CC BY-SA 3.0, via Wikimedia CommonsWatch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch associated Bootcamp video - Creutzfeldt-Jakob Diseaseb5500408-d912-48a1-b8a2-06fc937bc803
Creutzfeldt-Jakob disease (CJD) presents as {{c1::rapidly::speed}} progressive dementia with ataxia and myoclonus- Progresses within weeks to months - Diagnosis is typically confirmed on postmortem brain biopsy (gold standard), however genetic testing for the prion protein (PRNP) is now being usedWatch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch associated Bootcamp video - Creutzfeldt-Jakob Disease78704458-3d7a-4499-97c1-0e895e5a09cc
"What movement symptom is associated with Creutzfeldt-Jakob disease? {{c1::Myoclonus (""startle myoclonus"")}}"Watch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch associated Bootcamp video - Creutzfeldt-Jakob Disease7973603d-2c61-436d-89d2-df8526e53d8a
Which movement disorder presents as a sudden, brief, uncontrolled muscle contraction? {{c1::Myoclonus}}- e.g., jerks, hiccups - May be seen with Creutzfeldt-Jakob disease and renal/liver failure - May also be seen in traumatic settings, e.g., cardiac arrest causing prolonged cerebral hypoxia (posthypoxic myoclonus)Watch associated Bootcamp video - Creutzfeldt-Jakob Disease1e8c3c1d-c72e-4edf-b8bf-108672ddcbab
{{c2::Creutzfeldt-Jakob}} disease is characterized by periodic {{c1::sharp wave}} complexes on EEGTypical periodic bursts of triphasic sharp waves throughout the entire EEG: Photo credit: See page for author, CC BY 2.0, via Wikimedia CommonsWatch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch associated Bootcamp video - Creutzfeldt-Jakob Diseaseefbe83ca-6833-4d1c-afa7-180e20694574
Fatal {{c1::familial insomnia}} is an inherited form of a prion disease characterized by severe insomnia and an exaggerated startle responseWatch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch associated Bootcamp video - Creutzfeldt-Jakob Diseasea6e1da33-71d6-4708-88dc-c10071654b61
{{c2::Metastatic}} CNS tumors characteristically present as multiple, well-circumscribed lesions at the {{c1::gray-white}} junctionTypically manifests as headache, focal neurologic dysfunction, cognitive change, or seizure Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Adult CNS TumorsWatch associated Bootcamp video - Adult Tumor General Principles77748ebf-4de2-45d7-9ac7-12f24c1705d1
Cancer of what organ most commonly metastasizes to the brain? {{c1::Lung}}Lung > Breast > Prostate > Melanoma > GI (pathoma says lung, breast, kidney)Watch Adult CNS TumorsWatch associated Bootcamp video - Adult Tumor General Principles8e0a54a2-57fd-4b27-b902-e34bbe08b262
Glioblastoma multiforme (GBM) is a(n) {{c1::malignant::benign or malignant}} tumor of {{c2::astrocytes}}- Also known as grade IV astrocytoma (high grade) - > 95% of cases due to over-expression of EGFRWatch Adult CNS TumorsReview Glioblastoma Multiforme (Grade IV Astrocytoma)Watch associated Bootcamp video - Glioblastoma Multiforme100c8f89-4f2c-4ee1-bf71-3330f5c05431
What is the most common primary malignant CNS tumor in adults? {{c1::Glioblastoma multiforme (GBM)}}Ring-enhancing butterfly shape can be seen on imaging from crossing of corpus callosumWatch Adult CNS TumorsReview Glioblastoma Multiforme (Grade IV Astrocytoma)Watch associated Bootcamp video - Glioblastoma Multiformec3974576-a1a8-489d-8e84-4f4dac7cadf2
"{{c3::Glioblastoma multiforme}} is a CNS tumor that usually arises in the {{c2::cerebral hemispheres}} and characteristically crosses the {{c1::corpus callosum (""butterfly glioma"")}}"Photo credit: Finneran et al., CC BY 4.0, via Cureus Photo credit: Christaras A, CC BY-SA 3.0, via Wikimedia Commons Photo credit: Sbrandner, CC BY-SA 4.0, via Wikimedia CommonsWatch Adult CNS TumorsReview Glioblastoma Multiforme (Grade IV Astrocytoma)Watch associated Bootcamp video - Glioblastoma Multiforme64af83dc-3246-4ffe-8c5b-1910cec37ccc
"Glioblastoma multiforme is characterized histologically by ""{{c1::pseudopalisading}}"" tumor cells, which are tumor cells surrounding regions of {{c2::necrosis}}, hemorrhage, and / or {{c3::microvascular}} proliferation"- Pseudopalisading occurs because the necrosis (pink) and hemorrhage pushes the tumor cells out - Palisading, in contrast, occurs because of natural formation in a fence-like manner (can happen with many other types of cancers) Pseudopalisading: Photo credit: No machine-readable author provided. KGH assumed (based on copyright claims)., CC BY-SA 3.0, via Wikimedia Commons (left); AMBOSS, CC BY-SA 3.0 (right) Photo credit: Jensflorian, CC BY-SA 3.0, via Wikimedia CommonsWatch Adult CNS TumorsReview Glioblastoma Multiforme (Grade IV Astrocytoma)Watch associated Bootcamp video - Glioblastoma Multiforme8f909478-8dd8-4ee0-bb4f-1c95af05cb8e
The tumor cells of glioblastoma multiforme stain positive for {{c1::GFAP}}Watch Adult CNS TumorsReview Glioblastoma Multiforme (Grade IV Astrocytoma)Watch associated Bootcamp video - Adult Tumor General Principles Watch associated Bootcamp video - Glioblastoma Multiformeb80fb4bf-cae7-46a4-9438-34946cb7bafb
What is the most common primary benign CNS tumor in adults? {{c1::Meningioma}}Rare in children Photo credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia CommonsWatch Adult CNS TumorsWatch associated Bootcamp video - Meningioma7b2bb917-65f1-4a54-9df5-8bb490b5fa31
Which sex is more commonly affected by meningioma? {{c1::Female}}Presents younger in NF2 Photo credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia CommonsWatch Adult CNS TumorsWatch associated Bootcamp video - Meningiomaea05872d-7a03-4dba-b9ad-46160f819446
Meningiomas are often asymptomatic but may present with {{c1::seizures}} or focal neurologic signsDue to a round mass attached to the dura Photo credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia CommonsWatch Adult CNS TumorsReview MeningiomaWatch associated Bootcamp video - Meningiomaf0634167-e7d6-48df-bd20-a2c4884f4e21
Which CNS tumor is characterized histologically by a whorled pattern ± psammoma bodies? {{c1::Meningioma}}Photo credit: Dr. Roshan Nasimudeen / via PHIL CC BY-SA and Mikael Häggström, CC0, via Wikimedia CommonsWatch Adult CNS TumorsReview MeningiomaWatch associated Bootcamp video - Meningioma Watch associated Bootcamp video - Cellular Injury and Neoplasia: Calcification Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Calcification804ec721-6f22-499f-8333-c317e1cf2854
Meningiomas most often occur near surfaces of the brain, especially {{c1::parasagittal}} regionsPhoto credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia CommonsWatch Adult CNS TumorsReview MeningiomaWatch associated Bootcamp video - Meningiomadc0f6c36-0af2-46c2-bfa3-bd947d4720a5
"Imaging of {{c2::meningioma}} (CNS tumor) reveals a round mass attached to the {{c1::dura (via a ""tail"")}}"Image(s) provided by www.radiologyassistant.nl. Used with permission. Photo credit: Русский: Всеволод Лучанский (vvray), CC BY-SA 3.0 , via Wikimedia CommonsWatch Adult CNS TumorsReview MeningiomaWatch associated Bootcamp video - Meningiomac7e7fd46-95d1-48dc-8bfc-2d2632f561d0
Imaging of oligodendroglioma typically reveals a(n) {{c2::calcified}} tumor in the white matter, usually involving the {{c1::frontal}} lobeOn gross examination, appear as well-circumscribed gray masses with calcification (yellow overlay below) Photo credit: RadsWiki, CC BY-SA 3.0, via Wikimedia Commons (left); AMBOSS, CC BY-SA 3.0 (right) Photo credit: RadsWiki, CC BY-SA 3.0, via Wikimedia CommonsWatch Adult CNS TumorsReview OligodendrogliomaWatch associated Bootcamp video - Oligodendrogliomab97af828-370c-4697-be17-b50893cdb36f
"{{c2::Oligodendroglioma}} is a primary CNS tumor characterized histologically by ""fried egg"" cells with a(n) ""{{c1::chicken-wire}}"" capillary pattern"OliEGGodrendroglioma Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia CommonsWatch Adult CNS TumorsReview OligodendrogliomaWatch associated Bootcamp video - Oligodendroglioma53d0cfdb-c208-4e73-aae3-d6ffc22ab1eb
Pilocytic astrocytoma is a(n) {{c1::benign::benign or malignant}}, well-circumscribed tumor of {{c2::astrocytes}}Photo credit: Hafez, CC BY 2.0, via BMC and Marvin 101, CC BY-SA 3.0, via Wikimedia CommonsWatch Pediatric CNS TumorsReview Pilocytic AstrocytomaWatch associated Bootcamp video - Pilocytic Astrocytomaa011444a-da50-4387-8dfb-7048493a5802
What is the most common primary CNS tumor in children? {{c1::Pilocytic astrocytoma}}Pilocytic = PrevalentWatch Pediatric CNS TumorsReview Pilocytic AstrocytomaWatch associated Bootcamp video - Pilocytic Astrocytoma487b4dd8-d33f-40f1-8218-9b506ef743ea
Pilocytic astrocytomas are most often found in the posterior fossa, such as the {{c1::cerebellum}}; may be supratentorialPhoto credit: Hellerhoff, CC BY-SA 3.0, via Wikimedia CommonsWatch Pediatric CNS TumorsReview Pilocytic AstrocytomaWatch associated Bootcamp video - Pilocytic Astrocytomad50e326c-9a7c-4ea2-8731-e2033004731a
Imaging of {{c2::pilocytic astrocytomas::CNS tumor}} reveals a(n) {{c1::cystic}} lesion with a mural nodule most commonly in the cerebellum"- Pilo""cystic"" astrocytoma - Cystic portion = black; white = solid Image(s) provided by www.radiologyassistant.nl. Used with permission."Watch Pediatric CNS TumorsReview Pilocytic AstrocytomaWatch associated Bootcamp video - Pilocytic Astrocytoma29303093-bed8-4b1f-ac2d-285d05e5cedb
Biopsy of a(n) {{c1::pilocytic astrocytoma}} shows eosinophilic, corkscrew fibers, known as {{c2::Rosenthal}} fibers- These stain GFAP+ - Also may have eosinophilic granular bodies Rosenthal fibers (blue overlay): Photo credit: Marvin 101, CC BY-SA 3.0, via Wikimedia Commons (left); AMBOSS, CC BY-SA 3.0 (right) Photo credit: Marvin 101, CC BY-SA 3.0, via Wikimedia Commons (left); AMBOSS, CC BY-SA 3.0 (right)Watch Pediatric CNS TumorsReview Pilocytic AstrocytomaWatch associated Bootcamp video - Pilocytic Astrocytoma8505dabc-e5d0-4179-8b61-36250f8ef24f
Medulloblastoma is a(n) {{c1::malignant::benign or malignant}} tumor derived from {{c2::granule}} cells of the {{c3::cerebellum}}Photo credit: DeSouza et al., CC BY 4.0, via Frontiers in Oncology, modified by croppingWatch Pediatric CNS TumorsReview MedulloblastomaWatch associated Bootcamp video - Medulloblastomab47bb6fd-4c97-4646-81ed-cc4199dab588
{{c2::Craniopharyngioma}} is a CNS tumor that arises from epithelial remnants of {{c1::Rathke pouch (oral ectoderm)}}- Rathke pouch is an invagination of the ectoderm that protrudes from the roof of the mouth - This is the embryological structure that the anterior pituitary derives (and descends) from, thus craniopharyngioma can technically occur anywhere from the pituitary gland up to the base of the 3rd ventricleWatch Hypothalamic & Pituitary Dysfunction Etiologies Watch Pediatric CNS TumorsReview CraniopharyngiomaWatch associated Bootcamp video - Craniopharyngioma Watch associated Bootcamp video - Endocrine Pituitary Embryology Watch associated Bootcamp video - Hypopituitarism3a1d03a6-9f62-4561-8cca-a5ae0bc75e44
Craniopharyngioma typically presents as a(n) {{c1::supra}}tentorial mass in a(n) {{c2::child::age group}} or {{c2::young adult::age group}}- There is a second peak of occurrence in adults age 50–75 - Papillary craniopharyngioma in adults which do not recur, vs. adamantinomatous craniopharyngiomas in children that do recur and calcifyWatch Hypothalamic & Pituitary Dysfunction Etiologies Watch Pediatric CNS TumorsReview CraniopharyngiomaWatch associated Bootcamp video - Craniopharyngioma Watch associated Bootcamp video - Hypopituitarismdb5b165c-bf8c-44d2-b7cd-5d3ee7d6f11f
Which CNS tumor compresses the optic chiasm, causing bitemporal hemianopsia, in children? {{c1::Craniopharyngioma}}May be confused with pituitary adenoma (more common in adults) Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Hypothalamic & Pituitary Dysfunction EtiologiesReview CraniopharyngiomaWatch associated Bootcamp video - Craniopharyngioma Watch associated Bootcamp video - Optic Chiasm Lesion Watch associated Bootcamp video - Hypopituitarismfd179ae8-677e-4bef-a719-f2c5072232aa
"Which CNS tumor is characterized by cholesterol crystals found in ""motor-oil""-like fluid within the tumor? {{c1::Craniopharyngioma}}"- Also exhibit cystic spaces, and hemorrhage - Yellow viscous fluid resembles machine oil due to presence of protein and cholesterol crystals (not shown, MRI below for reference only) Photo credit: Hellerhoff, CC BY 3.0, via Wikimedia CommonsWatch Hypothalamic & Pituitary Dysfunction EtiologiesReview CraniopharyngiomaWatch associated Bootcamp videoa74cee29-e180-4a73-a98d-556bffddd760
Craniopharyngiomas commonly {{c1::calcify}}, which is visible on imaging and histology"On histology; - Dystrophic calcification is seen - Cysts are lined by cords / nests of stratified squamous epithelium with peripheral palisading and internal areas of lamellar ""wet"" keratin Image description: ""Micrograph showing the characteristic features of an adamantinomatous craniopharyngioma - cystic spaces, calcifications, and ""wet"" keratin, HPS stain"" Image credit(s): Nephron, CC BY-SA 3.0, via Wikimedia Commons Image(s) provided by www.radiologyassistant.nl. Used with permission."Watch Hypothalamic & Pituitary Dysfunction Etiologies Watch Pediatric CNS TumorsReview CraniopharyngiomaWatch associated Bootcamp video - Craniopharyngioma Watch associated Bootcamp video - Hypopituitarismbfee34b4-1f5f-4ae8-8fae-883c3384ec10
Are craniopharyngiomas benign or malignant? {{c1::Benign}}Watch Hypothalamic & Pituitary Dysfunction Etiologies Watch Pediatric CNS TumorsReview CraniopharyngiomaWatch associated Bootcamp video - Craniopharyngioma Watch associated Bootcamp video - Hypopituitarismbcf0a7a6-9d80-4a2c-8360-6df0459326ad
{{c2::Zollinger-Ellison}} syndrome is a(n) {{c1::gastrinoma}} of the pancreas (non-β cells) or duodenumMay be associated with MEN 1Watch Pancreatic Cancer & Islet Cell Tumors Sketchy Physiology: Gastrointestinal PhysiologyWatch associated Bootcamp video - Zollinger Ellison Syndrome7c801254-eca2-4ab4-adef-b3ad3b889ad7
{{c2::Zollinger-Ellison}} syndrome is diagnosed with a positive {{c1::secretin stimulation}} test- Secretin stimulates the release of gastrin by gastrinoma cells - In contrast, normal gastric G cells are inhibited by secretinWatch Pancreatic Cancer & Islet Cell TumorsWatch associated Bootcamp video - Zollinger Ellison Syndromec75ee334-c476-4a1e-b131-cb9e02dffeaa
VIPoma is characterized by a triad that can be remembered with the mnemonic {{c1::WDHA}}- Watery Diarrhea - Hypokalemia - Achlorhydria - Thus known as WDHA syndrome (Watery Diarrhea, Hypokalemia, Achlorhydria)Watch Pancreatic Cancer & Islet Cell TumorsWatch associated Bootcamp video - Primary Digestive Hormones Watch associated Bootcamp video - Octreotide Watch associated Bootcamp video - Secondary Digestive Hormonescb1a2e40-01c2-46e7-9471-43684074fa68
"{{c2::VIPoma}} is characterized by a triad that can be remembered with the mnemonic ""WDHA"": {{c2::Watery Diarrhea::WD}} {{c2::Hypokalemia::H}} {{c2::Achlorhydria::A}}"Thus known as WDHA syndrome (Watery Diarrhea, Hypokalemia, Achlorhydria)Watch Pancreatic Cancer & Islet Cell TumorsWatch associated Bootcamp video - Primary Digestive Hormones Watch associated Bootcamp video - Octreotide Watch associated Bootcamp video - Secondary Digestive Hormonesy72fff767-0c16-4a75-bf60-2ff38bba0692
{{c1::Behçet}} syndrome is characterized by a triad of: - Recurrent {{c2::aphthous}} ulcers - {{c2::Uveitis}} - {{c2::Genital}} ulcers- Classically presents in a young adult of Turkish, Middle Eastern, or Asian descent - Other manifestations include thrombosis and skin lesions (e.g. erythema nodosum) - Use colchicine to prevent recurrence - Mnemonic: Turkish RUG (Recurrent aphthous ulcers, Uveitis, Genital ulcers)Watch associated Bootcamp video - Behcet Disease26665cbd-2e17-4a7b-9b14-ad1984695203
{{c1::Sialadenitis}} is inflammation of a salivary glandPhoto credit: Chandak et al., CC BY 3.0, via Hindawif0cda360-ed0a-48bb-9831-c2c9ec316188
Esophageal atresia with distal tracheoesophageal fistula (TEF) presents with {{c1::polyhydramnios}} in uteroAtresia leads to non-swallowing of amniotic fluid Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Polyhydramnios & OligohydramniosWatch associated Bootcamp video - Tracheoesophageal Defects Watch associated Bootcamp video - Introduction to the Respiratory System : Tracheoesophageal Defectsabc2f5ea-1137-40ae-a94f-2f348b7c132e
Esophageal atresia with distal TEF may present with abdominal distention due to {{c1::air}} in the stomach (visible on CXR)Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Congenital GI DisordersWatch associated Bootcamp video - Tracheoesophageal Defects Watch associated Bootcamp video - Introduction to the Respiratory System : Tracheoesophageal Defects50c9e6d9-3ab8-40eb-aa76-5f90db99498c
Esophageal atresia with distal TEF is characterized by failure to pass a(n) {{c1::nasogastric}} tube into the stomachNG tube placement failure is a useful diagnostic tool as a resultWatch Congenital GI DisordersWatch associated Bootcamp video - Tracheoesophageal Defects Watch associated Bootcamp video - Introduction to the Respiratory System : Tracheoesophageal Defects57643724-487c-4e80-bfd1-e0ff02691f51
Esophageal varices arise secondary to {{c1::portal hypertension}}In portal hypertension, the left gastric vein backs up into the esophageal vein, resulting in varicesWatch Portal Circulation: Clinical CorrelatesWatch associated Bootcamp video - Veins, Anastomoses, and Hemorrhoids2d20f9f2-c591-4482-aef2-b636dedb4558
Does achalasia present with dysphagia for solids or liquids? {{c1::Both solids and liquids :)}}- Important distinguishing feature from obstruction (solids only) - This leads to putrid breathWatch Esophageal Dysmotility & CancerWatch Esophageal Dysmotility & CancerWatch associated Bootcamp video - Esophageal and Gastric Pathology: Swallowing Pathologyf35b672a-79ca-4ab1-a5d3-9568e69c9f63
Which type of esophageal cancer is associated with obesity, GERD, and Barrett esophagus? {{c1::Adenocarcinoma::SCC or Adenocarcinoma}}Adenocarcinoma requires metaplasia to occur first Photo credit: Mikael Häggström, M.D., CC0, via Wikimedia Commons (left); Maione et al., CC BY 4.0, via MDPI Diagnostics (right)Watch Esophageal Dysmotility & CancerWatch Esophageal Dysmotility & CancerWatch associated Bootcamp video - Esophageal and Gastric Pathology: Malignant Esophageal Disordersae5a13a7-490f-4c59-a061-44b1a88e3ba0
The most common causes of squamous cell carcinoma of the esophagus are {{c1::alcohol}} and {{c1::tobacco smoke}}Watch Esophageal Dysmotility & CancerWatch Esophageal Dysmotility & CancerWatch associated Bootcamp video - Esophageal and Gastric Pathology: Malignant Esophageal Disorders3b60d5e4-b4a4-477f-afd4-561e98e9fbbc
Which type of esophageal cancer is associated with esophageal injury (e.g. lye/caustic ingestion)? {{c1::Squamous cell carcinoma::SCC or Adenocarcinoma}}Photo credit: Brooks et al., Public Domain, via PLOS Medicine* irritants on table Watch Esophageal Dysmotility & Cancer* irritants on table Watch Esophageal Dysmotility & CancerWatch associated Bootcamp video - Esophageal and Gastric Pathology: Malignant Esophageal Disordersf1266b29-2806-427b-8fe5-19d8ae5211aa
{{c1::Eosinophilic esophagitis}} is characterized by eosinophilic infiltration of the esophagus, often in {{c2::atopic}} patientsPhoto credit: Nephron, CC BY-SA 3.0, via Wikimedia Commons; Samir at the English-language Wikipedia, CC BY-SA 3.0, via Wikimedia CommonsWatch Structural Esophageal Disorders & GERDWatch associated Bootcamp video - Esophageal and Gastric Pathology: Esophagitisdd9a58d0-b331-43f6-8092-9a35dd5352a9
{{c2::Eosinophilic esophagitis}} presents with esophageal {{c1::rings}} and linear furrows, often seen on endoscopyPhoto credit: Samir at the English-language Wikipedia, CC BY-SA 3.0, via Wikimedia Commons* Linear lines down eosinophilic boy's cape: linear furrows and esophageal rings Watch Structural Esophageal Disorders & GERDWatch associated Bootcamp video - Esophageal and Gastric Pathology: Esophagitis7b5cc19a-03be-47cd-9749-ff4bc9b1f09a
Eosinophilic esophagitis classically presents with dysphagia and food impaction in response to {{c1::food allergens}}- Associated with atopy (e.g., asthma, atopic dermatitis) - Management includes dietary therapy (e.g. allergen avoidance, elimination diet), PPIs, and topical glucocorticoids (e.g. fluticasone, budesonide) Photo Credit: Rebecca Liu, AnkiHubWatch Structural Esophageal Disorders & GERDWatch associated Bootcamp video - Esophageal and Gastric Pathology: Esophagitisdac7e5fc-cb17-4024-9528-4aaa96f5c1fd
Does eosinophilic esophagitis respond to GERD therapy (e.g. PPIs)? {{c1::Sometimes*, since 50% of patients do not respond to acid suppression therapy}}- A 2-month PPI trial is no longer recommended for diagnostic evaluation (May 2023) - However, endoscopy with esophageal biopsy is still required for diagnosisWatch Structural Esophageal Disorders & GERDWatch associated Bootcamp video - Esophageal and Gastric Pathology: Esophagitisd5e8c2bf-5110-429d-a890-63ed01a79cbc
{{c1::Gastroschisis}} is a congenital malformation characterized by extrusion of abdominal contents through the anterior abdominal wallTypically to the right of the umbilicus Photo credit: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Public domain, via Wikimedia Commons* vs. omphalocele which herniates through umbilicus * gastroschisis is exposed to amniotic fluid in the uterus Watch Congenital GI DisordersWatch associated Bootcamp video - Ventral and Abdominal Wall Defects84e80cf2-46c9-48e4-8b60-fe62fa595a9a
{{c1::Omphalocele}} is caused by failure of the herniated intestines to return to the body cavity during embryologic developmentPhoto credit: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Public domain, via Wikimedia Commons Photo credit: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Public domain, via Wikimedia CommonsWatch Congenital GI DisordersWatch associated Bootcamp video - Ventral and Abdominal Wall Defects2b1a52bc-738a-49ea-bde9-cd71adcdf77a
What demographic is associated with pyloric stenosis? {{c1::First-born males}}Watch Congenital GI DisordersWatch associated Bootcamp video - Atresias and Pyloric Stenosis5815b2f6-bf92-49e5-a376-81205eaa4c90
How soon after birth does pyloric stenosis typically present? {{c1::~ 2 - 6 weeks}}- 1 month ± 2 weeks, if that is easier to remember - Takes time for hypertrophy to develop; helps distinguish from intestinal atresia (bilious vomit within 1-2 days)Watch Congenital GI DisordersWatch associated Bootcamp video - Atresias and Pyloric Stenosis70384248-7676-4f19-acff-3cbcdf3e0329
Pyloric stenosis typically presents with {{c1::nonbilious::bilious or nonbilious}}, projectile vomitingnonbilious vomiting is an important distinguishing feature from intestinal atresia (bilious)Watch Congenital GI DisordersWatch associated Bootcamp video - Atresias and Pyloric Stenosis5ef6a81d-cb81-40f6-92d6-1609b4e4c411
"{{c2::Pyloric stenosis}} often presents with a palpable ""{{c1::olive}}-like"" mass in the epigastric region of the abdomen"Watch Congenital GI DisordersWatch associated Bootcamp video - Atresias and Pyloric Stenosis0a6dc66e-e4b2-48eb-bd93-fe6f8efdd88d
Pyloric stenosis may present with visible {{c1::peristalsis}}Watch associated Bootcamp video - Atresias and Pyloric Stenosis58024943-5032-424b-bfae-20d71c882ea6
What drug class is associated with pyloric stenosis? {{c1::Macrolides (antibiotics)}}Either through direct administration or through breast milkWatch associated Bootcamp video - Atresias and Pyloric Stenosis Watch associated Bootcamp video - Macrolidesf19d748b-7f87-4af0-a8dc-32b9896cc30f
What acid-base disturbance is associated with pyloric stenosis? {{c1::Hypokalemic, hypochloremic metabolic alkalosis::Specific}}- Secondary to vomiting of gastric acid and subsequent volume contraction - Seen in any condition with frequent vomiting - Fix electrolytes before surgeryWatch associated Bootcamp video - Atresias and Pyloric Stenosis Watch associated Bootcamp video - Metabolic Alkalosise4d76dfe-d728-445a-8a9b-8f0cd5c0d862
What is the treatment for pyloric stenosis? {{c1::Surgical excision (pyloromyotomy)}}Watch associated Bootcamp video - Atresias and Pyloric Stenosis59399b25-3474-47fb-8296-6887ffb03c1a
{{c2::Duodenal}} ulcers present with epigastric pain that {{c1::improves}} with mealsDue to increased HCO3- secretion in preparation for digestionWatch Acute & Chronic Gastritis & Peptic Ulcer DiseaseWatch associated Bootcamp video - Esophageal and Gastric Pathology: Gastritis and Peptic Ulcers Watch associated Bootcamp video - Gram Negative Curved Bacilli: Helicobacter Pyloribf112d11-5ac8-449e-b02c-528024fe28dc
Intestinal atresia presents with abdominal distention and {{c1::bilious::bilious or nonbilious}} vomitinge.g. duodenal, jejunal, ileal atresia; bilious vomiting is an important distinguishing feature from pyloric stenosis (nonbilious)Watch Congenital GI DisordersWatch associated Bootcamp video - Atresias and Pyloric Stenosise7fd1cdd-5aad-4c40-aada-035349dbdd75
How soon after birth does intestinal atresia typically present? {{c1::~ 1 - 2 days}}- e.g. duodenal, jejunal, ileal atresia - Helps distinguish from pyloric stenosis → nonbilious vomit within 2 - 6 weeksWatch Congenital GI DisordersWatch associated Bootcamp video - Atresias and Pyloric Stenosisa353b3aa-685a-4a8d-8184-408cc1931f98
{{c2::Duodenal}} atresia is associated with {{c1::Down}} syndromeReview Down Syndrome (Trisomy 21)Watch associated Bootcamp video - Atresias and Pyloric Stenosis Watch associated Bootcamp video - High Yield Genetic Disorders: Autosomal Trisomies2243293a-511e-46af-9754-c12bdb54a88d
Duodenal atresia presents with {{c1::poly}}hydramnios in uteroAtresia leads to non-swallowing of amniotic fluid* Tied-off duodenal diaper bag Watch Congenital GI Disorders Watch Polyhydramnios & OligohydramniosWatch associated Bootcamp video - Atresias and Pyloric Stenosis36625158-c506-4aa2-b8b2-387ab4c81fd7
"{{c2::Duodenal atresia}} is characterized by dilation of the stomach and proximal duodenum with a(n) ""{{c1::double bubble}}"" sign on X-ray""- Two bubbles as the duodenum is separated from the stomach by the pyloric sphincter - The ""double bubble"" sign classically is associated with duodenal atresia, but may also appear in annular pancreas and midgut volvulus - vs jejunal atresia which is associated with ""triple-bubble"" sign Photo credit: Hellerhoff, CC BY-SA 4.0, via Wikimedia Commons"Watch Congenital GI DisordersWatch associated Bootcamp video - Atresias and Pyloric Stenosis74006a6c-500f-447d-a568-a75983442e2d
Jejunal and ileal atresia occur due to disruption of {{c1::mesenteric}} vessels during development, which causes ischemic necrosis and segmental resorption- Vascular accidents can be due to intestinal pathology (malrotation, gastroschisis, omphalocele) and/or maternal factors (vasoconstrictive drug, smoking) - Necrotic tissue is resorbed, leaving behind a proximal blind end of bowel, and the distal portion to the blind end assumes a spiral configuration around an ileocolic vessel"* may be described as ""apple-peel"" atresia, which occurs when the superior mesenteric artery is obstructed Watch Congenital GI Disorders"Watch associated Bootcamp video - Atresias and Pyloric Stenosis5ac42526-e97e-43c6-916d-c1aea3dfe1ea
Meckel diverticulum arises due to persistence of the {{c1::vitelline duct}}AKA omphalomesenteric duct* Violinist: vitelline duct (omphalomesenteric duct, connects ileum to yolk sac during fetal life) Watch Congenital GI DisordersWatch associated Bootcamp video - Meckel's Diverticulum Watch associated Bootcamp video - Pregnancy and Menstruation: Placenta and Umbilical Cord057a4790-7ec8-4c0b-a148-41e7feea0de2
"Meckel diverticulum is associated with the ""rule of {{c1::2s}}"""2 times as likely in males 2 inches long 2 ft from the ileocecal valve 2% of the population presents in first 2 years of life 2 epithelia: gastric (most common) and/or pancreaticWatch Congenital GI DisordersWatch associated Bootcamp video - Meckel's Diverticulumc8e4135c-0f16-4c74-b24e-e0be8856dcdb
Meckel diverticulum is two times more likely to occur in {{c1::males::sex}}Watch Congenital GI DisordersWatch associated Bootcamp video - Meckel's Diverticulumd98ba428-dc30-4fd7-b229-475abfd0cd7c
Meckel diverticulum may contain ectopic acid-secreting {{c1::gastric mucosa}} and/or {{c2::pancreatic}} tissue- 2 types of epithelia (gastric and pancreatic) - Acid may damage the Meckel diverticulum, resulting in brisk, painless bleedingWatch Congenital GI DisordersWatch associated Bootcamp video - Meckel's Diverticuluma3121d90-52e2-4dad-a652-e79284c9a4f5
{{c2::Meckel}} diverticulum is diagnosed using a(n) {{c1::99mTc-pertechnetate}} study for uptake by heterotopic gastric mucosa- 99mTc-pertechnetate study is a type of nuclear scintigraphy - Heterotopic = presence of ectopic tissue plus retention of original tissue type - Increased uptake of 99mTc-pertechnetate in the periumbilical / RLQ is characteristic of Meckel diverticulumWatch Congenital GI DisordersWatch associated Bootcamp video - Meckel's Diverticulumcab96dad-b583-4166-925f-3ad3aed45f40
{{c1::Intussusception}} is telescoping of a(n) {{c2::proximal::proximal or distal}} bowel segment into a(n) {{c2::distal::proximal or distal}} segmentPhysical exam may reveal sausage shaped mass in the right lower quadrant Photo credit: Olek Remesz (wiki-pl: Orem, commons: Orem), CC BY-SA 3.0, via Wikimedia Commons Photo credit: Lee et al., CC BY 4.0, via Journal of Education and Teaching - Emergency Medicine Photo credit: Vasiliadis et al., CC BY 2.0, via World Journal of Surgical OncologyWatch Small Bowel Obstruction, Ileus & HerniasWatch associated Bootcamp video - Intussusception67e4e43c-8f47-42c1-89ee-b042c908f7f6
In children with a recent history of rotavirus or adenovirus infection, a common cause of intussusception is {{c1::lymphoid hyperplasia}}- Peyer's patches hypertrophy in response to viral infection, which acts as a lead point for intussusception - Meckel diverticulum (most common in children) - ∼ 75% of intussusception cases are idiopathicWatch Small Bowel Obstruction, Ileus & HerniasWatch associated Bootcamp video - Intussusception526599f1-6fd6-4923-ab1b-48b0457bb239
What is the most common pathologic lead point for intussusception in children over 2? {{c1::Meckel diverticulum}}- Should be suspected in older children that develop intussusception, especially if it recurs - Under the age of two it most commonly occurs without any structural cause (sometimes associated with viral infections)- Peyer's patch hypertrophy can also lead to intussusception; remember intussusception can also be idiopathicWatch Small Bowel Obstruction, Ileus & Hernias Watch Congenital GI DisordersWatch associated Bootcamp video - Intussusception33a8829c-2124-4d9c-bd73-1b515abfcc69
What is the most common lead point for intussusception in adults? {{c1::Intraluminal mass or tumor}}- 90% of adults with intussusception have pathological lead point (usually idiopathic in children) - Overall, intussusception is less common in adults Photo credit: Vasiliadis et al., CC BY 2.0, via World Journal of Surgical OncologyWatch Small Bowel Obstruction, Ileus & HerniasWatch associated Bootcamp video - Intussusception953955e5-e0b8-451b-95c5-975f68612ae9
Where in the GI tract does intussusception most commonly occur? {{c1::Ileocecal junction}}Photo credit: Olek Remesz (wiki-pl: Orem, commons: Orem), CC BY-SA 3.0, via Wikimedia Commons Photo credit: Vasiliadis et al., CC BY 2.0, via World Journal of Surgical OncologyWatch Small Bowel Obstruction, Ileus & HerniasWatch associated Bootcamp video - Intussusception Watch associated Bootcamp video - Small Bowel Obstructione04c9f69-da05-404d-b7eb-fc6468f1f1c5
"Intussusception results in compromised blood supply, which causes {{c2::intermittent::frequency}} abdominal pain with ""{{c1::currant jelly}}"" stool""- Pain is intermittent because the intussuscepted bowel temporarily stops contracting - ""Currant jelly"" stool is depicted below Photo credit: Gosai et al., CC BY 4.0, via Cureus, modified by cropping"Watch Small Bowel Obstruction, Ileus & HerniasWatch associated Bootcamp video - Intussusception8b05d38e-f3e7-40b8-99de-212b8d51d375
"Intussusception is characterized by a(n) ""{{c1::bull's-eye (target sign)}}"" appearance on ultrasound"Photo credit: de:Benutzer:Kalumet, selbst erstellt, CC BY-SA 3.0, via Wikimedia CommonsWatch Small Bowel Obstruction, Ileus & HerniasWatch associated Bootcamp video - Intussusception3a543a2f-e8fa-4bac-b5fe-d06749a15fac
{{c2::Celiac}} disease is immune-mediated damage of small bowel villi due to {{c1::gluten}} exposureGluten is present in wheat and grains; also known as gluten-sensitive enteropathy and celiac sprueWatch associated Bootcamp video - Celiac Disease21c0be0f-1adf-4165-9575-8e5a896a2d4a
{{c2::Celiac}} disease is associated with {{c1::dermatitis herpetiformis}}, which are small, herpes-like vesicles on the skinDue to cross-reactivity between anti-gliadin IgA antibodies and transglutaminase at the dermal basement membrane Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch associated Bootcamp video - Celiac Disease Watch associated Bootcamp video - Inflammatory Diseases of the Skin: Autoimmune Blistering Conditionscb8982be-f09b-431e-b628-736ce645b5fb
{{c4::Celiac}} disease is classically associated with Ig{{c5::A}} antibodies against {{c1::endomysium}}, {{c2::tissue transglutaminase (tTG)}}, and/or {{c3::deamidated gliadin}}CeliAc disease = IgAWatch associated Bootcamp video - Celiac Disease8676357d-f319-42e5-8ec3-b0deb6cd77ab
In patients with IgA deficiency and celiac disease, Ig{{c1::G}} antibodies against endomysium, tTG, or deamidated gliadin are useful for diagnosisWatch associated Bootcamp video - Celiac Disease6bb1a527-546f-4176-9e6f-586bf1df7d9e
Celiac disease is characterized histologically by {{c1::flattening}} of {{c2::villi}}"Described as ""villous atrophy"" Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia Commons"Watch associated Bootcamp video - Celiac Disease18c2c62f-6f50-45e5-90e8-d32acb3e2cd2
Celiac disease is associated with increased risk for small bowel carcinoma and {{c1::T-cell}} lymphoma- Presents as refractory disease despite good dietary control - T-cell lymphoma = enteropathy-associated T-cell lymphoma (EATL)Watch associated Bootcamp video - Celiac Disease105c872a-cd00-48a4-a773-fd5b5d46a1d6
Is celiac disease associated with normal or decreased urinary excretion of D-xylose (D-xylose test)? {{c1::Decreased}}- D-xylose is a monosaccharide that only depends on viable mucosa (not enzymatic breakdown) for absorption in the proximal small bowel. Excretion is decreased with mucosal defects and bacterial overgrowth - vs. pancreatic insufficiency → normalWatch associated Bootcamp video - Celiac Disease607f3db8-12dc-40cd-b985-41703d0fef74
The granules in macrophages in Whipple disease stain positive for {{c1::PAS}} and are {{c2::diastase}} resistantPAS-positive material in the lamina propria of the small intestine is a classical biopsy finding for Whipple disease Photo credit: Dr. Don Xu, Hrach Harutyunyan, CC BY-SA 4.0, via Wikimedia CommonsReview Whipple's DiseaseWatch associated Bootcamp video - Infectious Malabsorption Watch associated Bootcamp video - Fundamentals of Bacteriology: Gram Stain Procedure8eb56bda-4958-4334-add5-e3a9c01ab22a
Which malabsorption syndrome is associated with PAS positive, foamy macrophages? {{c1::Whipple disease}}Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia Commons Photo credit: Dr. Don Xu, Hrach Harutyunyan, CC BY-SA 4.0, via Wikimedia CommonsReview Whipple's DiseaseWatch associated Bootcamp video - Infectious Malabsorption276b3271-c126-4351-b5f7-48f45217b754
Whipple disease classically involves the {{c1::lamina propria::mucosal layer}} of the small bowelOther common sites include the synovium of joints (arthritis), cardiac valves, lymph nodes, and CNS Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia Commons Photo credit: Dr. Don Xu, Hrach Harutyunyan, CC BY-SA 4.0, via Wikimedia CommonsReview Whipple's DiseaseWatch associated Bootcamp video - Infectious Malabsorption2cb43f78-2766-4f7f-b62f-052c1302f395
The extraintestinal symptoms of Whipple disease may be remembered with the mnemonic {{c1::Foamy Whipped cream in a CAN}}Cardiac symptoms Arthralgias Neurologic symptoms - Foamy refers to the characteristic foamy macrophages - Other common symptoms are lymphadenopathy, chronic cough, and GI symptoms Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia CommonsReview Whipple's DiseaseWatch associated Bootcamp video - Infectious Malabsorption15f9b6b5-372f-4501-9f62-14ef8c37c5cf
"The extraintestinal symptoms of {{c1::Whipple disease}} may be remembered with the mnemonic ""Foamy Whipped cream in a CAN"": {{c1::Cardiac symptoms::C}} {{c1::Arthralgias::A}} {{c1::Neurologic symptoms::N}}"- Foamy refers to the characteristic foamy macrophages - Other common symptoms are lymphadenopathy, chronic cough, and GI symptoms Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia CommonsReview Whipple's DiseaseWatch associated Bootcamp video - Infectious Malabsorptiony931c380f-c2ae-45c2-b785-c5bc0c82588f
Is pancreatic insufficiency associated with normal or decreased urinary excretion of D-xylose (D-xylose test)? {{c1::Normal}}- D-xylose is a monosaccharide that only depends on viable mucosa (not enzymatic breakdown) for absorption in the proximal small bowel. Excretion is decreased with mucosal defects and bacterial overgrowth - vs. celiac disease → decreasedWatch associated Bootcamp video - Pancreatic Insufficiency3db4865e-0a23-4cec-9969-2908407f8abe
"The symptoms of {{c1::carcinoid}} syndrome may be remembered with the mnemonic ""Be FDR"": {{c1::Bronchospasm::Be}} {{c1::Flushing::F}} {{c1::Diarrhea::D}} {{c1::Right-sided heart disease::R}}"- Also wheezing - Symptoms arise due to excess serotonin and kallikrein (both cause vasodilation) and tryptophan being used to make serotonin and results in niacin deficiency (pellagra) - Serotonin: causes diarrhea. May stimulate fibroblasts and lead to heart valve fibrosis - Histamine: flushing - Kallikrein: flushing - Prostaglandins: stimulate intestinal secretions - Tachykinins: flushing and diarrheaWatch Carcinoid Tumor & Small Bowel NeoplasmsWatch associated Bootcamp video - Carcinoid Tumors Watch associated Bootcamp video - Tricuspid Regurgitationy3ef6a2f9-9dc7-4d2f-b21e-74167eae5d66
The symptoms of carcinoid syndrome may be remembered with the mnemonic {{c1::Be FDR}}Bronchospasm Flushing Diarrhea Right-sided heart disease - Also wheezing - Symptoms arise due to excess serotonin and kallikrein (both cause vasodilation) and tryptophan being used to make serotonin and results in niacin deficiency (pellagra) - Serotonin: causes diarrhea. May stimulate fibroblasts and lead to heart valve fibrosis - Histamine: flushing - Kallikrein: flushing - Prostaglandins: stimulate intestinal secretions - Tachykinins: flushing and diarrheaWatch Carcinoid Tumor & Small Bowel NeoplasmsWatch associated Bootcamp video - Carcinoid Tumorsd6bd015e-d0cc-4bb1-a6e6-54dc05e5e1a3
{{c1::Ulcerative colitis::IBD}} is characterized by continuous colonic lesions that always involve the rectumPhoto credit: Theron Price, CC BY-SA 3.0, via Wikimedia CommonsWatch Crohns Disease & Ulcerative ColitisWatch associated Bootcamp video - Ulcerative Colitis5b68665c-c4a4-4422-a6b1-8fdbcfeb6f5d
{{c2::Crohn disease::IBD}} is characterized by {{c1::skip}} lesions, which can occur anywhere from the mouth to the anusImage(s) provided by www.radiologyassistant.nl. Used with permission.Watch Crohns Disease & Ulcerative ColitisWatch associated Bootcamp video - Crohn's Disease8caab3d1-615b-425b-be20-e27d25f5a81d
Which form of inflammatory bowel disease typically spares the rectum? {{c1::Crohn disease}}Watch Crohns Disease & Ulcerative ColitisWatch associated Bootcamp video - Crohn's Disease618efb63-2395-4e20-9e84-a365e8edbfc2
{{c2::Ulcerative colitis::IBD}} is characterized histologically by {{c1::crypt abscesses}} with neutrophils, ulcers, and bleedingUlcerative colitis crypt abscess (1st) vs Crohn disease granuloma (2nd): Photo credit: Mikael Häggström, CC0, via Wikimedia Commons Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia CommonsWatch Crohns Disease & Ulcerative ColitisWatch associated Bootcamp video - Ulcerative Colitisde65d105-2766-4f19-b885-17bc605c767b
{{c2::Crohn disease::IBD}} is characterized histologically by lymphoid aggregates with {{c1::noncaseating granulomas}}- Crohn disease is also called granulomatous enterocolitis - Crohn disease granuloma Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia Commons, edited by cropping Ulcerative colitis crypt abscess Photo credit: Mikael Häggström, M.D. Author info - Reusing images- Conflicts of interest: NoneMikael Häggström, M.D.Consent note: Consent from the patient or patient's relatives is regarded as redundant, because of absence of identifiable features (List of HIPAA identifiers) in the media and case information (See also HIPAA case reports guidance)., CC0, via Wikimedia CommonsWatch Crohns Disease & Ulcerative ColitisWatch associated Bootcamp video - Crohn's Diseasea2acbb55-b9f0-4e28-ac88-6fb97d74abad
{{c1::Hirschsprung}} disease is characterized by defective relaxation and peristalsis of the rectum and distal sigmoid colonRectum and anus are 100% involved, 75% of time in sigmoid colonWatch Congenital GI DisordersWatch associated Bootcamp video - Neonatal Disordersc75f0098-d9eb-4f4f-b1c9-41947a0200c5
{{c2::Hirschsprung}} disease is a congenital megacolon associated with {{c1::Down}} syndromeReview Down Syndrome (Trisomy 21)Watch associated Bootcamp video - Neonatal Disorders Watch associated Bootcamp video - High Yield Genetic Disorders: Autosomal Trisomies696ae808-0d67-4c6f-9b87-8d8d06e0e927
{{c2::Hirschsprung}} disease occurs due to a congenital failure of {{c1::ganglion}} cells to descend into the myenteric and submucosal plexusGanglion cells are derived from the neural crest; neural crest cells moved caudally along vagal nerve fibers, present in wall of proximal colon at 8th week of gestation, and in rectum by 12th weekWatch Congenital GI DisordersWatch associated Bootcamp video - Neonatal Disordersb1ce39ae-3dd6-4bc1-88ac-16f56a055238
Hirschsprung disease may present with abdominal distention and {{c1::bilious::bilious or nonbilious}} vomitingWatch associated Bootcamp video - Neonatal Disorders2807cae6-a9f0-4ad3-ae06-3bc374596a27
"Hirschsprung disease is characterized by {{c2::explosive expulsion of feces}} (""squirt sign"") and an empty {{c1::rectum}} on digital rectal exam"- May also present with forceful expulsion of gas on rectal exam - Long segment of affected colon classically present in the newborn period with delayed passage of meconium - Short aganglionic colonic segment, symptoms often develop in infancy or early childhood and include chronic, refractory constipation and poor growth or failure to thriveWatch Congenital GI DisordersWatch associated Bootcamp video - Neonatal Disorders2d18545b-af11-4352-9cc8-9e7d06e8814c
"Hirschsprung disease is characterized by massive dilation of the bowel {{c1::proximal::proximal or distal}} to the aganglionic segment, resulting in a ""transition zone"""Photo credit: Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Congenital GI DisordersWatch associated Bootcamp video - Neonatal Disorders7f206ef9-f313-4f55-a724-cbb84449e47a
{{c2::Hirschsprung}} disease is diagnosed by absence of ganglionic cells on {{c1::rectal suction}} biopsy- Suction needed to biopsy submucosa (deeper, where ganglion cells are) - This is the gold standard!Watch associated Bootcamp video - Neonatal Disordersbdbca81c-b840-4d29-aca1-1e4a518ffb2b
Treatment of Hirschsprung disease involves {{c1::resection}} of the involved bowelSevere cases require colostomy (perforation, full colon involvement)Watch associated Bootcamp video - Neonatal Disorders1461c9f9-17cc-47d4-80d0-577b0c3161cb
What segment of the GI tract is most commonly affected by diverticulosis? {{c1::Sigmoid colon}}Photo credit: melvil, CC BY-SA 4.0, via Wikimedia CommonsWatch Large Bowel & Appendiceal DisordersWatch associated Bootcamp video - Diverticulosis and Angiodysplasia715d307e-cd1d-4cb8-848b-7ea719a13e86
Is irritable bowel syndrome related to structural abnormalities? {{c1::No}}Colonoscopy reveals normal colonic mucosaWatch associated Bootcamp video - Irritable Bowel Syndrome81645e38-f4d0-462f-9cc7-ebb07aa38fd3
Lynch syndrome is an autosomal dominant condition associated with increased risk for {{c1::colorectal}}, {{c2::endometrial}}, {{c3::ovarian}}, and gastric cancers"- To help you memorize it ""CEO of gastric cancer"" - Prophylactic hysterectomy and bilateral oophorectomy are recommended at age 40 or after childbearing is complete (patients with a uterus should have annual endometrial biopsies beginning at age 30-35)"* minor risk for small bowel, hepatobiliary, & skin cancers Watch Colorectal Polyps & Cancer Watch Abnormal Uterine Bleeding (AUB) & Endometriosis Watch Ovarian Cysts & Epithelial Ovarian CancerReview Lynch SyndromeWatch associated Bootcamp video - Hereditary Polyposis00809fcb-4ca2-443d-b695-017824fdfd48
Screening for colorectal carcinoma in low-risk patients begins at {{c1::45}} years of age (e.g. colonoscopy, fecal occult blood (stool guaiac test))- Other alternatives include cologuard, fecal immunochemical testing (FIT), flexible sigmoidoscopy, and CT colonography - This card previously said 50 years old, but the recommended age was changed to 45 in 2021 (USPSTF)Watch Colorectal Polyps & CancerWatch associated Bootcamp video - Colorectal Cancerf88538cc-2d62-47ab-9a6a-f766a0effc86
Screen patients with a first-degree relative with colon cancer via colonoscopy starting at age {{c1::40}} or starting {{c2::10}} years prior to their relative's presentation (whichever is earlier)- Repeat more frequently; every 3-5 years - First degree relative is a parent, sibling, or child - Grandfather who developed colon cancer at age 40 does NOT count! NOT a first degree relative!Watch Colorectal Polyps & CancerWatch associated Bootcamp video - Colorectal Cancer662a3b1c-8b36-4b06-b7e9-750a8a018654
What is the most common cause of small bowel obstruction in those with prior abdominal surgeries? {{c1::Bowel adhesion}}- Whereas hernias are the most common cause in patients without prior abdominal surgery - Adhesions are the most common cause of SBO overall Photo Credit: Hic et nunc, Public domain, via Wikimedia Commons* most commonly due to previous surgery Watch Small Bowel Obstruction, Ileus & HerniasWatch associated Bootcamp video - Small Bowel Obstructiona0316326-5c1c-49b6-abb6-bca39e57a0b1
{{c2::Necrotizing enterocolitis}} is a GI pathology seen in premature, {{c1::formula}}-fed infants with immature immune systems- Immune immaturity: Initiation of enteral feeding → introduction of bacteria to bowel → excessive proliferation due to compromised immune clearance - GI immaturity: Impaired mucosal barrier function → bacteria invades the bowel wall → inflammation and ischemic necrosis of the terminal ileum and colon - As the disease progresses, bowel becomes congested and gangrenous with formation of intramural gas collections Prognosis: - Up to 30% of mortality, especially when disease is complicated by intestinal perforation - Increased risk for strictures and bowel obstructionWatch Congenital GI DisordersWatch associated Bootcamp video - Neonatal Disordersf9178a36-ba8c-43a8-a6a1-edc207d22a7d
{{c2::Necrotizing enterocolitis (NEC)}} is characterized by necrosis of intestinal mucosa with possible perforation, which can lead to: - Free air in the bowel wall ({{c1::pneumatosis intestinalis}}) - Free air in the abdomen ({{c1::pneumoperitoneum}}) - Portal venous gas on imagingPneumatosis intestinalis (seen on abdominal x-ray as thin curvilinear areas of lucency), in an infant with abdominal distension and bloody stools, is diagnostic for NEC Pneumatosis intestinalis (left) / Pneumoperitoneum (right) Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch associated Bootcamp video - Neonatal Disorders1645b26a-10a7-424a-8e0b-9087b85fa95b
"Intestinal malrotation results in improper positioning of the bowel with improper formation of fibrous ""{{c1::Ladd}} bands"""- Ladd bands are physiologic and exist normally - In malrotation, they cause abnormal fixation of the ascending colon, which may constrict the duodenum and is often associated with volvulus of the midgut Photo Credit: Grassi et al., CC BY-SA 4.0, via Wikimedia CommonsWatch Congenital GI DisordersWatch associated Bootcamp video - Small Bowel Obstruction8c517c8e-fcf7-4d13-9829-7d833d2b10c9
Acute {{c1::pancreatitis}} is diagnosed by 2 of 3 criteria: - Acute epigastric pain that radiates to the back - Increased serum amylase or lipase to 3× upper limit of normal - Characteristic imaging findingsWatch Acute & Chronic PancreatitisWatch associated Bootcamp video - Acute Pancreatitis472d527a-5fac-44fe-9e0a-59e1bd4616c3
Elevation of which pancreatic enzyme is more specific for acute pancreatitis? {{c1::Lipase::Amylase or Lipase}}Elevated amylase could also be seen with damage to the salivary glandWatch Acute & Chronic PancreatitisWatch associated Bootcamp video - Acute Pancreatitisfe9a34ca-5798-424c-a143-f40de557a614
What is the most common cause of chronic pancreatitis in children? {{c1::Cystic fibrosis}}Watch Acute & Chronic PancreatitisWatch Cystic Fibrosis SOAWatch associated Bootcamp video - Chronic Pancreatitis Watch associated Bootcamp video - Pancreatic Insufficiencyc65d6d34-2e7c-46a0-946b-6d9929b87e80
{{c2::Chronic}} pancreatitis is characterized by atrophy and dystrophic {{c1::calcification}} of pancreatic parenchyma on imaging- In alcohol-related chronic pancreatitis, alcohol induces secretion of protein-rich fluid; proteinaceous secretions precipitate within pancreatic ducts forming ductal plugs that may calcify - Preferred imaging is CT or MRCP Photo credit: Hellerhoff, CC BY-SA 3.0, via Wikimedia CommonsWatch Acute & Chronic PancreatitisWatch associated Bootcamp video - Chronic Pancreatitis Watch associated Bootcamp video - Cellular Injury and Neoplasia: Calcification Watch associated Bootcamp video - Pancreatic Insufficiency Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Calcificationfbc39d99-f991-4185-8ba9-2fe3b76356db
{{c3::Pancreatic}} adenocarcinoma often presents as obstructive {{c1::jaundice}} with a(n) pain{{c2::less}}, palpable gallbladder- Courvoisier sign; occurs with tumors that arise in the head of the pancreas (most common location) - Painless because this is a chronic condition, head chronically obstructs the bile duct and bile flow backs up and distends the gallbladder over time (no acute distension) - Other symptoms include pruritus, pale stools, and dark urine (obstructive jaundice)Watch Pancreatic Cancer & Islet Cell TumorsWatch associated Bootcamp video - Pancreatic Malignanciesc103ea38-e6d5-4ad9-91c7-0da8dadedbe4
Which type of gallstone can be the result of rapid weight loss? {{c1::Cholesterol gallstone::Cholesterol or Pigment}}- Very low calorie diets with decreased caloric intake and rapid weight loss can lead to bile stasis (due to lack of CCK release from poor oral intake) and increased cholesterol mobilization - similar mechanism to that of cholecystitis occurring with a patient on TPN - e.g., patients with Roux-en-Y gastric bypass surgery (patients often receive prophylactic ursodeoxycholic acid for 6 months to reduce risk of gallstone development) - Weight loss causes body to secrete extra cholesterol into bile → ↑ risk for cholesterol stonesWatch associated Bootcamp video - Gallstones060b18ef-2ca9-48f5-8896-e73bd607899a
Gallstones may be treated with elective {{c1::cholecystectomy}} if symptomatic- Asymptomatic do not require it, elective laparoscopic cholecystectomy can be done in patients at risk for cancer (porcelain gallbladder, native Americans) - if patients do not want to undergo surgery, may be given ursodiolWatch associated Bootcamp video - Gallstones Watch associated Bootcamp video - Malignant Biliary Disorders99648360-de08-4700-9c9b-dce85cafbbb4
{{c4::Ascending cholangitis}} classically presents with the Charcot triad of: {{c1::Jaundice}} {{c1::Fever}} {{c1::RUQ pain}}Also may have hypotension and altered mental status (Reynolds pentad)Watch Gallbladder & Biliary Tract DiseaseWatch associated Bootcamp video - Gallstonese1261eba-a51f-4f0e-aea5-9869b0994bab
The most common cause of bacterial meningitis in children is {{c1::Streptococcus pneumoniae::not neonates}} infectionBacterial Meningitis - Most Common CausesAgeBacteriaNeonatesGroup B streptococci > Escherichia coli > Listeria monocytogenesChildrenStreptococcus pneumoniaeAdolescentsNeisseria meningitidisAdultsStreptococcus pneumoniaeElderlyStreptococcus pneumoniae > Listeria monocytogenesWatch associated Bootcamp video - Infectious Neuropathology: Bacterial Meningoencephalitis6008553a-ac03-4d49-b4c9-1d1223c7cb83
Which nervous system cell is typically damaged by Guillain-Barré syndrome? {{c1::Schwann cells}}Watch Guillain Barre & Charcot Marie ToothWatch associated Bootcamp video - Guillain-Barre Syndrome Watch associated Bootcamp video - Cell Types0da84107-e2cf-4009-8b25-df71407c7137
Infarction and/or neoplasm of the blood-brain barrier destroys endothelial cell tight junctions, causing {{c1::vasogenic edema}}Photo credit: Drahreg01, CC BY-SA 4.0, via Wikimedia CommonsWatch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Histologic Timeline of Strokee00b51b8-1ab5-4938-82f4-39f312d97ce3
The {{c2::ventral tegmentum}} and {{c3::substantia nigra pars compacta}} are responsible for the synthesis of {{c1::dopamine}}Review Mesocortical PathwayWatch associated Bootcamp video - Dopaminergic Pathwaysadbced75-c4c1-4958-89f8-52b594b92ca7
"{{c2::Blockage}} of the mesocortical dopamine pathway results in increased ""{{c1::negative}}"" symptoms of schizophrenia"e.g. anergia, apathy, lack of spontaneityReview Mesocortical PathwayWatch associated Bootcamp video - Dopaminergic Pathways7a39f8da-beaa-45af-9cf7-8dc03ebdd098
"{{c2::Stimulation}} of the mesolimbic dopamine pathway results in increased ""{{c1::positive}}"" symptoms of schizophrenia"- E.g. delusions, hallucinations - Thus, blockage of this pathway (anti-psychotics) relieves symptomsReview Mesolimbic PathwayWatch associated Bootcamp video - Dopaminergic Pathways Watch associated Bootcamp video - Metoclopramide2923b1be-623e-451b-a3ea-09738bbc7087
{{c2::Blockage}} of the nigrostriatal dopamine pathway results in increased {{c1::extrapyramidal}} symptoms- E.g., dystonia, akathisia, parkinsonism, tardive dyskinesia - Seen with dopamine antagonistsReview Nigrostriatal PathwayWatch associated Bootcamp video - Dopaminergic Pathways Watch associated Bootcamp video - Metoclopramide6e72186d-8c8f-49bb-b4a3-bad780dc6cbb
{{c2::Blockage}} of the tuberoinfundibular dopamine pathway results in symptoms of {{c1::prolactin}} excess- e.g. decreased libido, sexual dysfunction, galactorrhea, gynecomastia (men) - Dopamine normally inhibits prolactin releaseWatch Hypothalamic & Pituitary Dysfunction Clinical ManifestationsReview Tuberoinfundibular PathwayWatch associated Bootcamp video - Dopaminergic Pathways Watch associated Bootcamp video - Metoclopramide Watch associated Bootcamp video - Hyperprolactinemiac720bbda-b367-4fcf-bf3c-c8aa9a6c84ea
The {{c2::basal nucleus of Meynert::brain region}} is responsible for the synthesis of {{c1::acetylcholine}}Responsible for memory and cognitionWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABAb9165b82-638f-47b6-9879-b0a7d0afcd87
What pathology is characterized by degeneration of the basal nucleus of Meynert? {{c1::Alzheimer disease}}thus decreased levels of ACh in Alzheimer diseaseWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA Watch associated Bootcamp video - Alzheimer Dementia2542e5fc-c673-459b-a331-835b46b839d9
{{c1::GABA}} is the main {{c2::inhibitory}} neurotransmitter of the CNSWatch associated Bootcamp video - Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA5932925d-eb30-4ba0-896b-1a819a30c83f
The {{c2::nucleus accumbens::brain region}} is responsible for synthesis of the neurotransmitter {{c1::GABA}}Photo credit: Leevanjackson, CC BY-SA 4.0, & Article by Thorsten Grund, Konrad Lehmann, Nathalie Bock, Aribert Rothenberger, Gertraud Teuchert-Noodt., CC BY 2.0, via Wikimedia CommonsWatch associated Bootcamp video - Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA28104774-efd0-4ffd-9dfc-93f50458f34e
{{c1::Glycine}} is the main {{c2::inhibitory}} neurotransmitter of the spinal cordWatch associated Bootcamp video - Ion Channel Inhibitors and Activators52d480de-f0ba-4216-8c62-473a3262b795
{{c1::Glutamate}} is the main {{c2::excitatory}} neurotransmitter of the CNSWatch associated Bootcamp video - Ion Channel Inhibitors and Activators9609226c-9fb4-4cfe-a604-83bebefef812
The {{c1::reticular activating system (RAS)}} is formed by the reticular formation, locus coeruleus, and raphe nucleusWatch associated Bootcamp video - Midbrain, Pons, and Medullab79a6376-4da2-4f50-a69f-7114a4c065d9
Lesion of the {{c1::reticular activating system (RAS)::midbrain}} results in reduced levels of arousal and wakefulness (i.e. {{c2::coma}})Watch associated Bootcamp video - Midbrain, Pons, and Medulla0a033a2e-83cc-4965-ac8c-0fb820f4c53c
Which cranial nerve (and branch) is responsible for the afferent limb of the corneal reflex? {{c1::CN V1 (nasociliary br. of ophthalmic)}}While CN VII is responsible for the efferent limb Photo credit: Gaurav Sinha, CC BY-SA 4.0, via Wikimedia CommonsWatch Cranial Nerve V (Trigeminal)Review Trigeminal Nerve (CN V)Watch associated Bootcamp video - Cranial Nerve V6c3bb93b-eb5c-4942-b04f-9541b1eb0b89
Which cranial nerve (and branch) is responsible for the efferent limb of the corneal reflex? {{c1::Bilateral CN VII (temporal br. via orbicularis oculi muscle)}}Whereas, CN V1 is responsible for the afferent limb Photo credit: Gaurav Sinha, CC BY-SA 4.0, via Wikimedia CommonsWatch Cranial Nerve VII (Facial Nerve)Review Facial Nerve (CN VII)Watch associated Bootcamp video - Cranial Nerve VIIe992cca9-ad47-4c61-a76e-c71f813c9685
Which cranial nerve is responsible for the afferent limb of the gag reflex? {{c1::CN IX (glossopharyngeal)}}While CN X (vagus) is responsible for the efferentWatch Cranial Nerve IX (Glossopharyngeal)Review Glossopharyngeal Nerve (CN IX)Watch associated Bootcamp video - Cranial Nerve IX4682278b-8bee-43a6-ba4c-9c367a10652a
Which cranial nerve is responsible for the efferent limb of the gag reflex? {{c1::CN X (vagus)}}While CN IX (glossopharyngeal) is responsible for the afferentWatch Cranial Nerve X (Vagus)Watch associated Bootcamp video - Cranial Nerve Xac715a69-30d4-4ce2-b3cd-aee3388930ce
What nerve(s) are found on the lateral walls of the cavernous sinus? {{c1::CN III, IV, V1, V2}}Oculomotor, trochlear, ophthalmic, and maxillary, respectively Photo credit: Henry Vandyke Carter, Public domain, via Wikimedia CommonsWatch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens) Watch Cranial Nerve V (Trigeminal)Watch associated Bootcamp video - Cavernous Sinus Thrombosis Watch associated Bootcamp video - Mucor and Rhizopus6c90f17f-71d8-4ceb-aa70-e4d8eb1b1fa1
What nerve(s) are found medially within the cavernous sinus? {{c1::CN VI (abducens)}}Photo credit: Henry Vandyke Carter, Public domain, via Wikimedia CommonsWatch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Watch associated Bootcamp video - Cavernous Sinus Thrombosis Watch associated Bootcamp video - Mucor and Rhizopus41dc36ea-4d78-4ec7-b98a-56e419bfb586
In addition to CNs, the cavernous sinus also contains portions of the {{c1::internal carotid}} artery and {{c2::hypothalamospinal tract}} fibers en route to the orbit- Sympathetic fibers of the superior cervical ganglion (3rd neuron of HTS tract) travel within the carotid plexus - Thus, a carotid dissection (very painful) can cause Horner syndrome Photo credit: Henry Vandyke Carter, Public domain, via Wikimedia CommonsWatch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Watch associated Bootcamp video - Cavernous Sinus Thrombosis5d8d1119-cf84-40f5-a73c-cde2e2d818a6
Cavernous sinus syndrome may present with variable {{c1::ophthalmoplegia}} due to compression of various CNse.g. CN III, IV, and VI Photo credit: Henry Vandyke Carter, Public domain, via Wikimedia CommonsWatch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens): Clinical CorrelatesWatch associated Bootcamp video - Cavernous Sinus Thrombosis7570b51f-08a9-4b61-9504-fb138e968bc1
Cavernous sinus syndrome may be seen secondary to {{c1::pituitary}} tumor mass effectWatch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens): Clinical CorrelatesWatch associated Bootcamp video - Cavernous Sinus Thrombosis9f67be23-e9f1-4f24-9d61-61255850883a
{{c2::Idiopathic intracranial hypertension}} is also known as {{c1::pseudotumor cerebri}}Watch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Idiopathic Intracranial Hypertension9e9253f9-119d-437f-8a6d-507ac10fb583
{{c1::Idiopathic intracranial hypertension}} is characterized by increased ICP with no apparent cause on imaging (e.g. no hydrocephalus, obstruction of CSF outflow)> 200 mm H2O in a non-obese patient or > 250 mm H2O in an obese patientWatch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Idiopathic Intracranial Hypertensioncbfcb0ac-5d4f-4a84-95d1-23774515ab35
Idiopathic intracranial hypertension is associated with vitamin {{c1::A}} excesse.g. isotretinoin useWatch Intracranial Hypertension (ICH)Review Vitamin C (Ascorbic Acid) Deficiency and ExcessWatch associated Bootcamp video - Idiopathic Intracranial Hypertension656e47c6-0a07-4810-b81c-510f5d5dc706
Idiopathic intracranial hypertension can be associated with use of certain drugs, such as {{c1::tetracyclines}}, {{c2::danazol}}, and {{c3::isotretinoin}}""" ITOAD"" Watch Intracranial Hypertension (ICH)"Watch associated Bootcamp video - Idiopathic Intracranial Hypertension Watch associated Bootcamp video - Androgen Modulators83eaa175-bb94-4caf-91af-44a654507c45
Idiopathic intracranial hypertension may present with symptoms of daily {{c1::headache}}, as well as transient visual changes that are exacerbated by the {{c2::Valsalva}} maneuver- e.g. exacerbation by bending forward / coughing; this results in increased intracranial pressure - Patients may also have diplopia from CN VI palsy - CN VI palsy due to compression of high blood pressure of ventricles impinging on ventral output of CN VI nerve fibers; no change in mental statusWatch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Idiopathic Intracranial Hypertensionb7f512a5-5666-4a36-98dd-29b8520ed866
Idiopathic intracranial hypertension may present with bilateral symmetric {{c1::papilledema}} on fundoscopy- Optic nerve is covered by all three meninges (since optic nerve is an outgrowth of the CNS tissue) so increased ICP can be transmitted to the optic nerve - This results in orthograde axoplasmic flow stasis at the optic nerve head, building up pressure causing loss of axons → optic atrophy Photo credit: Jonathan Trobe, M.D. - University of Michigan Kellogg Eye Center, CC BY 3.0, via Wikimedia CommonsWatch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Idiopathic Intracranial Hypertension35301041-93ab-480d-8adc-b59a5bb03da5
Conservative treatment of idiopathic intracranial hypertension includes {{c1::weight loss}}Watch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Idiopathic Intracranial Hypertensionce492296-6801-44c9-8945-3c2be8a7ba61
Pharmacologic treatment of idiopathic intracranial hypertension often involves {{c1::acetazolamide}}Acetazolamide ± furosemide to decrease ICP Topiramate to decrease seizuresWatch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Idiopathic Intracranial Hypertension90fe7da4-6b00-4610-bfd7-4749a2c5b188
One treatment for refractory idiopathic intracranial hypertension is {{c1::optic nerve sheath fenestration::eye}} surgery- Relieves tension caused by increased CSF in the meninges surrounding the optic nerve - The two main surgical procedures in idiopathic intracranial hypertension are optic nerve sheath fenestration (ONSF) and cerebrospinal fluid (CSF) shunting procedures (e.g. VP shunt) Photo credit: Xue X, Zhou C, Gao Y, Ji X and Zhang X (2023), CC BY 4.0, Via FrontiersWatch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Idiopathic Intracranial Hypertensiona655b82a-458c-4f16-8086-8288968b3af9
What is a worrisome sequela of idiopathic intracranial hypertension if left untreated? {{c1::Vision loss}}- Due to increased ICP being transmitted to optic nerve, impairing the optic nerve axoplasmic flow - Optic nerve is an outgrowth of the brain, thus it is covered by all three layers of the meninges (creating the optic nerve sheath)Watch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Idiopathic Intracranial Hypertensionaa27519c-7e43-4ad6-8858-e839c2bd3f7f
Which intracranial hemorrhage commonly presents in premature infants and low birth weight infants within the first 72 hours of life? {{c1::Intraventricular hemorrhage}}- Also known as germinal matrix hemorrhage - In premature infants, poor autoregulation of blood flow occurs here - blood vessels get large and can rupture into ventricles - Usually occurs during first 5 days of life, can cause clots that obstruct foramen of monro, cause a non-communicating hydrocephalusWatch associated Bootcamp video - Intraventricular Hemorrhagec2c6713b-4d0c-4b8e-bd2f-b4ccb6a3974c
{{c1::Focal (partial)}} seizures affect a single area of the brainMay secondarily generalize (both simple and complex)Watch Broad-Spectrum AntiepilepticsWatch associated Bootcamp video - Focal Seizure35123455-d949-4983-97f8-f0970ea0324b
Focal (partial) seizures most commonly originate in the {{c1::medial temporal}} lobeFocal seizures used to be called partial seizuresWatch associated Bootcamp video - Focal Seizure7cfd206e-7539-4300-bf8d-b7777446cd0c
{{c2::Focal impaired awareness seizures (FIAS)*}} is a seizure disorder often preceded by a(n) {{c1::aura}}"e.g., motor aura (thumb twitching – motor cortex; Jacksonian seizure – ""marching"" of seizure from distal limb to face) e.g., sensory aura (wave-like sensation in head – frontal lobe; visual hallucinations – occipital lobe) e.g., autonomic aura (epigastric rising sensation – mesial temporal lobe; tingling – parietal lobe / somatosensory cortex) e.g., psychic aura (déjà vu – temporal lobe) *Previously called complex partial seizures"Watch Broad-Spectrum AntiepilepticsWatch associated Bootcamp video - Focal Seizure6db16b9b-aef4-4c19-881b-b418757fabc1
Which type of generalized seizure is characterized by a blank stare? {{c1::Absence seizures}}Can appear to be daydreaming or staring, thus may seem as if child is not paying attention in schoolWatch EthosuximideWatch associated Bootcamp video - Generalized Seizurefca3810a-edea-4410-998d-6a95f20c5c61
{{c1::Absence}} seizures are characterized by impaired consciousness with no postictal confusionCan be seen in childhood absence epilepsy, which presents with hundreds of absence seizures throughout the day that can be triggered by hyperventilation and subsides before adulthoodWatch EthosuximideWatch associated Bootcamp video - Generalized Seizure305b6884-1231-4335-8cd8-85c94bed79a4
{{c2::Absence}} seizures are characterized by {{c1::3}} Hz spike-and-wave discharges on EEGIn contrast, tonic-clonic have 10 Hz activity during tonic phase, and slow waves during clonic phase Photo credit: Bromfield EB, Cavazos JE, Sirven JI, editors., CC BY-SA 4.0, via Wikimedia CommonsWatch EthosuximideWatch associated Bootcamp video - Generalized Seizurec08444fe-3254-4d3c-9980-fb0c9ea1ffd0
{{c1::Myoclonic}} seizures are characterized by quick single or repetitive muscle jerksCan be seen in juvenile myoclonic epilepsy; the hallmark of this being myoclonic jerks awakening from sleep that manifest with shock-like, irregular movements of both armsWatch Valproate, topiramate, lamotrigine, levetiracetam [Old Version]Watch Broad-Spectrum AntiepilepticsWatch associated Bootcamp video - Generalized Seizure1ac44a86-b0a0-4af0-9f5c-90cba3321976
{{c1::Tonic-clonic}} seizures are characterized by alternating stiffening and movement- Patients have a sudden loss of consciousness with extension of back and rhythmic, repetitive, and symmetric movements - Patients may also have incontinence and tongue bitingWatch associated Bootcamp video - Generalized Seizure4139a3fc-520b-4eaa-b0e2-f39bbfc7827e
"{{c2::Atonic}} seizures are characterized by sudden loss of muscle tone, thus known as ""{{c1::drop}}"" seizures"Watch associated Bootcamp video - Generalized Seizure8326c655-e1d6-4e43-9ddc-65af26a73b53
{{c1::Generalized convulsive status epilepticus (GCSE)}} is seizure activity for ≥ 5 minutes or ≥ 2 times without fully {{c2::regaining consciousness}} between episodesGCSE requires immediate treatment due to high risk of neuronal injury and death Treatment protocol: 1A) Treat with an IV or IM benzo to abort, followed by fosphenytoin to prevent seizure recurrence 1B) At the same time, maintain ABCs (airway, breathing, and circulation) 2) Follow with an MRI or CT to look for obvious abnormalities 3) EEG if the patient fails to regain consciousness - looking for nonconvulsive status epilepticus (silent seizures)Watch associated Bootcamp video - Status Epilepticus4cb05424-9c90-45e5-abc2-d26f73d8c039
Cluster headaches are {{c1::uni}}lateralTypeLocationFindingsTiming (hr)TreatmentTensionBilateralBand-like constant pain4 - 6 NSAIDs AmitriptylineMigraineUnilateral Aura, photophobia, phonophobia, nausea, vomiting, throbbing pain4 - 72NSAIDs Triptans* Dihydroergotamine* β-blockers (prophylaxis)ClusterUnilateral Lacrimation, rhinorrhea, ptosis, miosis Multiple headaches per day per week then remission15 min - 3100% O2 or sumatriptan*Avoid in pregnant patientsReview Cluster HeadacheWatch associated Bootcamp video - Cluster Headachede6e7e79-15d4-46d8-ae65-499fc97479a2
Cluster headaches generally last from {{c1::15 minutes}} to {{c1::3}} hoursvs. trigeminal neuralgia, which lasts <1 min TypeLocationFindingsTiming (hr)TreatmentTensionBilateralBand-like constant pain4 - 6 NSAIDs AmitriptylineMigraineUnilateral Aura, photophobia, phonophobia, nausea, vomiting, throbbing pain4 - 72NSAIDs Triptans* Dihydroergotamine* β-blockers (prophylaxis)ClusterUnilateral Lacrimation, rhinorrhea, ptosis, miosis Multiple headaches per day per week then remission15 min - 3100% O2 or sumatriptan*Avoid in pregnant patientsReview Cluster HeadacheWatch associated Bootcamp video - Cluster Headache64af851e-dff2-437a-bb6d-a4fc7ae0fd49
{{c2::Cluster}} headaches are more common in {{c1::males::sex}}- Important distinguishing feature from tension headaches and migraines - Also more common in smokersReview Cluster HeadacheWatch associated Bootcamp video - Cluster Headache92c5e0a4-8ade-4b19-831b-dae09e802e0f
{{c1::Cluster}} headaches are characterized by repetitive, brief headaches that occur seasonallyE.g., multiple headaches per day for a few weeks, followed by months of remission TypeLocationFindingsTiming (hr)TreatmentTensionBilateralBand-like constant pain4 - 6 NSAIDs AmitriptylineMigraineUnilateral Aura, photophobia, phonophobia, nausea, vomiting, throbbing pain4 - 72NSAIDs Triptans* Dihydroergotamine* β-blockers (prophylaxis)ClusterUnilateral Lacrimation, rhinorrhea, ptosis, miosis Multiple headaches per day per week then remission15 min - 3100% O2 or sumatriptan*Avoid in pregnant patientsReview Cluster HeadacheWatch associated Bootcamp video - Cluster Headache38f07140-7069-41d2-9231-cffe6b67acb5
Cluster headaches are associated with excruciating {{c1::periorbital::location}} painReview Cluster HeadacheWatch associated Bootcamp video - Cluster Headache75018dfa-3657-45e1-ba0f-d16478afdd05
{{c3::Cluster}} headaches may be associated with {{c1::lacrimation}} and {{c2::rhinorrhea}}TypeLocationFindingsTiming (hr)TreatmentTensionBilateralBand-like constant pain4 - 6 NSAIDs AmitriptylineMigraineUnilateral Aura, photophobia, phonophobia, nausea, vomiting, throbbing pain4 - 72NSAIDs Triptans* Dihydroergotamine* β-blockers (prophylaxis)ClusterUnilateral Lacrimation, rhinorrhea, ptosis, miosis Multiple headaches per day per week then remission15 min - 3100% O2 or sumatriptan*Avoid in pregnant patientsReview Cluster HeadacheWatch associated Bootcamp video - Cluster Headache42a180a6-1b1f-4ae8-9aea-9e90207ed820
{{c2::Tension}} headaches are {{c1::bi}}lateralImportant distinguishing feature from migraine and cluster headaches (unilateral) TypeLocationFindingsTiming (hr)TreatmentTensionBilateralBand-like constant pain4 - 6 NSAIDs AmitriptylineMigraineUnilateral Aura, photophobia, phonophobia, nausea, vomiting, throbbing pain4 - 72NSAIDs Triptans* Dihydroergotamine* β-blockers (prophylaxis)ClusterUnilateral Lacrimation, rhinorrhea, ptosis, miosis Multiple headaches per day per week then remission15 min - 3100% O2 or sumatriptan*Avoid in pregnant patientsReview Tension HeadacheWatch associated Bootcamp video - Tension Headachebe72f263-4cf5-4f36-9ed7-01339425b5f0
Tension headaches generally last from {{c1::4}} to {{c1::6}} hoursCan last > 30 min to a couple of days TypeLocationFindingsTiming (hr)TreatmentTensionBilateralBand-like constant pain4 - 6 NSAIDs AmitriptylineMigraineUnilateral Aura, photophobia, phonophobia, nausea, vomiting, throbbing pain4 - 72NSAIDs Triptans* Dihydroergotamine* β-blockers (prophylaxis)ClusterUnilateral Lacrimation, rhinorrhea, ptosis, miosis Multiple headaches per day per week then remission15 min - 3100% O2 or sumatriptan*Avoid in pregnant patientsReview Tension HeadacheWatch associated Bootcamp video - Tension Headachee633f803-4f8d-4a16-ac37-34ab39ed4fc3
Tension headaches are more common in {{c1::females::sex}}Review Tension HeadacheWatch associated Bootcamp video - Tension Headache46eb0cec-323a-493a-ae4a-3d378e8cc616
Do tension headaches cause throbbing or constant pain? {{c1::Constant/steady pain}}Important distinguishing feature from migraines (throbbing pain)Review Tension HeadacheWatch associated Bootcamp video - Tension Headacheb2aea4a8-94b0-4e4a-ad33-2942d7595b69
Are tension headaches associated with photo- and/or phonophobia? {{c1::Yes, however only one is present at a time::Specific}}- This card used to say no, but AMBOSS and FA23 confirms that one of either photophobia or phonophobia may be present (Sept 2023) - Important distinguishing feature from migraines TypeLocationFindingsTiming (hr)TreatmentTensionBilateralBand-like constant pain4 - 6 NSAIDs AmitriptylineMigraineUnilateral Aura, photophobia, phonophobia, nausea, vomiting, throbbing pain4 - 72NSAIDs Triptans* Dihydroergotamine* β-blockers (prophylaxis)ClusterUnilateral Lacrimation, rhinorrhea, ptosis, miosis Multiple headaches per day per week then remission15 min - 3100% O2 or sumatriptan*Avoid in pregnant patientsReview Tension HeadacheWatch associated Bootcamp video - Tension Headache3d510908-6f5f-41ef-a5be-30d3c574a21d
Migraines are {{c1::uni}}lateralTypeLocationFindingsTiming (hr)TreatmentTensionBilateralBand-like constant pain4 - 6 NSAIDs AmitriptylineMigraineUnilateral Aura, photophobia, phonophobia, nausea, vomiting, throbbing pain4 - 72NSAIDs Triptans* Dihydroergotamine* β-blockers (prophylaxis)ClusterUnilateral Lacrimation, rhinorrhea, ptosis, miosis Multiple headaches per day per week then remission15 min - 3100% O2 or sumatriptan*Avoid in pregnant patientsWatch MigraineReview Migraine HeadachesWatch associated Bootcamp video - Migraine24379b5f-e2d5-4152-9d12-2075ff00f849
Migraines generally last from {{c1::4}} to {{c1::72}} hoursTypeLocationFindingsTiming (hr)TreatmentTensionBilateralBand-like constant pain4 - 6 NSAIDs AmitriptylineMigraineUnilateral Aura, photophobia, phonophobia, nausea, vomiting, throbbing pain4 - 72NSAIDs Triptans* Dihydroergotamine* β-blockers (prophylaxis)ClusterUnilateral Lacrimation, rhinorrhea, ptosis, miosis Multiple headaches per day per week then remission15 min - 3100% O2 or sumatriptan*Avoid in pregnant patientsWatch MigraineReview Migraine HeadachesWatch associated Bootcamp video - Migraineccecff41-9cf3-4f87-a972-954b153c4a91
Migraines are more common in {{c1::females::sex}}Watch MigraineReview Migraine HeadachesWatch associated Bootcamp video - Migrained3a2448a-9418-4b00-a853-24ea222b7524
Do migraines cause throbbing or constant pain? {{c1::Throbbing pain}}Important distinguishing feature from tension headaches TypeLocationFindingsTiming (hr)TreatmentTensionBilateralBand-like constant pain4 - 6 NSAIDs AmitriptylineMigraineUnilateral Aura, photophobia, phonophobia, nausea, vomiting, throbbing pain4 - 72NSAIDs Triptans* Dihydroergotamine* β-blockers (prophylaxis)ClusterUnilateral Lacrimation, rhinorrhea, ptosis, miosis Multiple headaches per day per week then remission15 min - 3100% O2 or sumatriptan*Avoid in pregnant patientsWatch MigraineReview Migraine HeadachesWatch associated Bootcamp video - Migrainecd7707de-0efd-41ef-b858-82c26f7c4cf0
Are migraines associated with auras? {{c1::Yes (~20%)}}Watch MigraineReview Migraine HeadachesWatch associated Bootcamp video - Migrainebb6dd09c-681e-41bc-a068-e31885e3c668
Migraines typically present as a pulsating pain with {{c1::nausea}}, {{c2::photophobia}}, or {{c3::phonophobia}}"- ""POUND: pulsatile, one-day duration, unilateral, nausea, disabling"" - Diagnosed clinically (no labs/imaging needed if patient has classic symptoms and normal neurologic exam) TypeLocationFindingsTiming (hr)TreatmentTensionBilateralBand-like constant pain4 - 6 NSAIDs AmitriptylineMigraineUnilateral Aura, photophobia, phonophobia, nausea, vomiting, throbbing pain4 - 72NSAIDs Triptans* Dihydroergotamine* β-blockers (prophylaxis)ClusterUnilateral Lacrimation, rhinorrhea, ptosis, miosis Multiple headaches per day per week then remission15 min - 3100% O2 or sumatriptan*Avoid in pregnant patients"Watch MigraineReview Migraine HeadachesWatch associated Bootcamp video - Migraine432d8377-4df8-4756-8efe-dce660edfb42
The pathophysiology of migraine headaches is related to release of vasoactive peptides, {{c1::substance P}}, and {{c2::calcitonin gene-related peptide (CGRP)}}Review Migraine HeadachesWatch associated Bootcamp video - Migraine21c3fb26-f7a4-4268-bd0c-8f8ddcd80479
What EEG waveform is emitted when awake with eyes open? {{c1::Beta (highest frequency, lowest amplitude)}}"""BATS Drink Blood"""Watch associated Bootcamp videoab96b34f-01cc-4647-8067-77998264a426
What EEG waveform has the highest frequency and lowest amplitude? {{c1::Beta}}b7ddf79f-0dc3-414d-afa2-09871b990b74
What EEG waveform is emitted when awake with eyes closed? {{c1::Alpha}}"""BATS Drink Blood"""Watch associated Bootcamp videoab7b4ed0-4299-435b-b276-7dd7f3756aa3
Stage {{c1::N1}} of non-REM sleep is described as light sleepWatch associated Bootcamp videoe88c71d5-e748-4050-853c-0eb2bf5c34d9
What EEG waveform is emitted during light sleep (N1)? {{c1::Theta waves}}"""BATS Drink Blood"""Watch associated Bootcamp video8ebe9512-ad56-49bc-984e-6b4e65809825
Stage {{c1::N2}} of non-REM sleep is described as deeper sleepWatch associated Bootcamp video56e303ab-0c86-4b18-833a-229a0f24b67b
Which stage of sleep does bruxism (teeth grinding) occur? {{c1::Stage N2}}Too much chew in N2Watch associated Bootcamp video7bee45c0-238e-47e8-8823-4100c547b93d
"Stage {{c1::N3}} of non-REM sleep is described as the deepest non-REM sleep (""slow-wave"" sleep)"Watch associated Bootcamp video60598547-14a6-4170-b55a-b8a4543c60b0
"What EEG waveform is emitted during deep ""slow wave"" sleep (N3)? {{c1::Delta (lowest frequency, highest amplitude)}}""""BATS Drink Blood"""Watch associated Bootcamp video63d880ae-8f6a-41be-abfb-8f968ed6e544
What sleep EEG waveform has the lowest frequency and highest amplitude? {{c1::Delta}}Watch associated Bootcamp video978d4732-07f3-4bf2-b449-94e9ecfbdf59
Which stage of sleep do sleepwalking and night terrors occur? {{c1::Stage N3}}Flee in N3Watch associated Bootcamp video3c2ffde1-e468-41eb-8071-96b524fd9067
Which stage of sleep does bedwetting occur? {{c1::Stage N3}}Pee in N threeWatch associated Bootcamp video46e41482-424b-443c-aa9c-1e4fa2e4a46f
Which stage of sleep do young adults spend the most time in? {{c1::Stage N2 (45%)}}N2 (45%) > N3 and REM (25% each) > N1 (5%)Watch associated Bootcamp video229084be-20be-4d6a-bdf4-f46ffc2bce9d
What neurotransmitter is increased during REM sleep? {{c1::Acetylcholine (thus increased vagal tone)}}REM is increased with acetylcholine and decreased with norepinephrineWatch associated Bootcamp video936feeab-bc2a-4c10-9f9c-cf3b7782d2ec
Depression is associated with {{c1::increased}} total REM sleepAlso have increased REM early in the sleep cycle (↓ REM latency)Watch associated Bootcamp video73fe94f9-916e-43c8-9262-bf796ac3a448
Sleep in the elderly is associated with {{c1::decreased}} REM sleepWatch associated Bootcamp videoc8661ed1-9a54-4047-bc6e-979dd04fc306
Both the elderly and depressed experience {{c1::decreased}} slow wave sleep (stage N3)Watch associated Bootcamp video40b40fdd-fbb6-4260-a1db-461ec1ed0d9d
Both the elderly and depressed experience {{c1::increased}} early awakenings (terminal insomnia)also have repeated nighttime awakeningsWatch associated Bootcamp video687c3f5b-5661-405f-8467-c98c1c9232fd
What is the effect of alcohol on REM and slow-wave sleep (N3)? {{c1::Decreased REM and slow-wave sleep}}Watch associated Bootcamp videodbc97550-948b-49b6-945b-9f75c753227f
What are the pharmacological treatment options for nocturnal enuresis? First-line: {{c1::desmopressin}} Second-line: {{c1::imipramine}}- Desmopressin decreases urine production during sleep (ADH analog) - Desmopressin preferred due to side effects of imipramine - ≥ 5 yo → rule out organic causes → lifestyle modification and behavioral training → enuresis alarm ± pharmacotherapy (desmopressin > imipramine) if ≥ 7 yoWatch ADH, DDAVP, ADH receptor antagonists Watch Tricyclic AntidepressantsWatch associated Bootcamp video - Sleep and Psychosomatic Conditions Watch associated Bootcamp video - Tricyclic Antidepressants20fd98d0-cb94-4eed-89d1-93199757214a
Primitive reflexes are inhibited by a mature/developing {{c1::frontal}} lobeWatch associated Bootcamp video - Frontal Lobee86750ad-de34-4941-b8b1-6e36e90feddf
Do the toes of a healthy adult dorsiflex or plantar flex in response to plantar stimulation? {{c1::Plantar flex (downward)}}Dorsiflexion signifies UMN lesion (Babinski sign) Photo credit: Picryl [https://picryl.com/media/lawrence-1960-204-c695f6] Positive Babinski sign below Photo credit: Paul Marquis,, via Ortho Eval Pal, used with permission59b0766b-524a-412d-805a-fd3b55cdada3
What dermatome includes the thumbs? {{c1::C6}}6 letters in THUMBS8d078706-057b-4d0a-9193-bc1728fb7f6e
What dermatome is found at the nipple? {{c1::T4}}"""T four (for) teets"" Photo credit: OpenStax, CC BY 4.0"2bb35c27-7b86-4647-b38e-f368aa5a7140
What dermatome is found at the umbilicus? {{c1::T10}}"""belly butTEN"" Photo credit: OpenStax, CC BY 4.0"b821157e-d9fb-4713-ab7a-c31a12313a72
What dermatome includes the kneecaps? {{c1::L4}}Photo credit: OpenStax, CC BY 4.0a9cb7a18-7746-4b8b-a429-7b8831637b1e
Which movement disorder presents as subjective restlessness and an intense urge to move? {{c1::Akathisia}}Can be seen with neuroleptic use or as a side-effect of Parkinson disease treatmentWatch associated Bootcamp video - Extrapyramidal Effectsc95bad1e-c06a-44e3-9f44-277464942940
"Which movement disorder presents as ""flapping"" motion upon extension of the wrists? {{c1::Asterixis}}"Seen most commonly in hepatic encephalopathy Video credit: Dr. Robert Laureno, CC BY-SA 4.0, via Neurosigns.org, used with permission0bdf1b9f-b27e-41fb-8bb0-fd8cdfc9a963
Which movement disorder presents as sustained, involuntary muscle contractions? {{c1::Dystonia}}- e.g. Writer's cramp, blepharospasm, torticollis - Sustained contractions lead to muscle hypertrophyWatch associated Bootcamp video - Disorders of the Basal Gangliadd82ab4b-4542-4581-8245-3f3fcd504516
{{c1::Blepharospasm}} is a form of focal dystonia that involves involuntary contraction of the eyelids- Benign essential blepharospasm is a specific subtype characterized by repetitive blinking and squinting and is associated with dysfunction of the basal ganglia - Causes the orbicularis oculi muscle and other periocular muscles to contract, which leads to increased bilateral eyelid closure Photo credit: Ruth Ellison, CC BY 2.0, via Wikimedia Commons Watch 'Blepharospasm', Parkinson's Disease & Disorders Clinic, via Youtube (0:34)Watch associated Bootcamp video - Disorders of the Basal Gangliae6a7c176-d6c2-4e6e-894c-de19d68e1040
{{c1::Torticollis (cervical dystonia)}} is a form of dystonia that involves involuntary contracture of the neck- Caused by contracture of the SCM → head tilts to the affected side and rotates to the unaffected side - Typically noted in the first 3 months of life (due to fibrosis), but can occur later (due to spasms)Watch SternocleidomastoidWatch associated Bootcamp video - Disorders of the Basal Gangliabb174341-61a3-46ed-831a-38ee0cb8e0ba
Which movement disorder presents as a high-frequency tremor with sustained posture (e.g., outstretched arms)? {{c1::Essential tremor}}- Tremor classically with movement, but also seen at rest in ~ 15% of patients - Clinical diagnosis; no additional workup or imaging indicated if dx is clear5165dbb0-ebfe-4326-b95c-6eef9b119ce5
Essential tremor is {{c1::worsened::relieved or worsened}} with movement or when anxiousImportant distinguishing feature from resting tremor (better with movement)19f98faa-4898-46b7-af42-ecb6a89ea2c0
Patients with essential tremor often self-medicate with {{c1::alcohol}}, which decreases tremor amplitudeAlcohol and primidone (barbiturates) both allosterically activate GABAA receptorsWatch Barbituratesbb0e3827-64ea-45d8-b371-c1fa84c1aaa3
What is the first-line treatment for essential tremor? {{c1::Non-selective β-blockers (e.g. propranolol)}}Also may use primidone (a barbiturate)Watch Beta blockersb26a9385-f8e3-4d45-a8a8-ac0b0298c013
Which type of sensory receptor senses pain and temperature? {{c1::Free nerve endings (e.g. C, Aδ)}}Watch associated Bootcamp video - Sensory Receptors94377b9d-d992-4c0a-85c5-1eb9d41e508f
Which peripheral nerve layer must be rejoined in microsurgery for limb attachment? {{c1::Epineurium}}This card previously said perineurium, but most surgeons will just suture the epineurium because it achieves the same success rates and has fewer complications Photo credit: Bahmad et al., CC BY 4.0, via MDPI Current Oncology1003ce24-be25-456f-bd4d-b27ccfc3b8c6
Cerebral perfusion is primarily driven by changes in {{c1::PCO2}}- Recall that CO2 is a vasodilatory metabolite - CHALKWatch associated Bootcamp video - Intracranial Hypertensionac4c5bc7-604c-4417-9bd2-14737b4000e0
PO2 {{c2::increases}} cerebral perfusion pressure only when < {{c1::50}} mmHgWatch associated Bootcamp video - Intracranial Hypertension31d98edd-637d-48fe-9322-db07a3ab6fa1
Cerebral perfusion pressure (CPP) is equal to the difference between {{c1::MAP}} and {{c1::ICP}}- i.e. CPP = MAP - ICP; - MAP = mean arterial pressure - ICP = intracranial pressureWatch associated Bootcamp video - Intracranial Hypertension2f5a441e-da1b-4b23-9346-bf8249c6bd15
Cerebral perfusion pressure is decreased with {{c1::increased}} ICPvia CPP = MAP - ICPWatch associated Bootcamp video - Intracranial Hypertension3afbd1ef-c5a1-4c90-ba0e-9c6f2f0adac6
Therapeutic {{c1::hyper}}ventilation may be used to treat acute cerebral {{c2::edema}} unresponsive to other interventions- Hyperventilation decreases PCO2, which causes vasoconstriction with consequent decreases in cerebral blood flow and ICP (e.g., use for patient with TBI / basilar skull fracture) - Thus, use mechanical ventilator to achieve PaCO2 of 26-30 mmHgWatch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Intracranial Hypertension72c279ed-3e0c-4847-afc1-949f5bb4a2e0
Vertebral disc herniation typically affects the nerve {{c1::below}} the level of herniatione.g. L3-L4 disc herniation spares L3 nerve and involves L4 nerve **The same holds true for cervical herniation as well (e.g. C3-C4 involves the C4 nerve)Watch Lumbosacral NervesWatch associated Bootcamp video - Spinal Disc Herniation Watch associated Bootcamp video - Spinal Radiculopathyc7299a49-f15a-4325-9898-ce1901ddcee5
MPTP, a contaminant in illicit drugs, is metabolized to {{c1::MPP+}}, which causes Parkinsonian symptomsWatch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Parkinson Diseasee7dbdaeb-8d1d-4959-b327-57d57b013944
Which area of the brain is particularly sensitive to damage early in Alzheimer disease? {{c1::Hippocampus}}- Hippocampal atrophy is evident even in the early stages of the disease and can be detected by brain MRI - Basal Nucleus of Meynert (cholinergic neurons) and diffuse cortical neurons are also sensitive to damage but are not noted early in disease courseWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Alzheimer Dementiaa1e48cf0-4299-4081-a19c-2157478a4aa3
{{c2::Creutzfeldt-Jakob}} disease is associated with increased {{c1::14-3-3}} protein in CSFWatch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch associated Bootcamp video - Creutzfeldt-Jakob Disease59368ca6-2952-43fa-a56d-2782cbef0895
Multiple sclerosis is associated with a sensation of a(n) {{c2::electric shock}} running down the spine upon {{c1::neck}} flexion (Lhermitte phenomenon)Watch Multiple SclerosisWatch Multiple Sclerosis: Clinical PresentationWatch associated Bootcamp video - Multiple Sclerosis620f0127-a294-4799-9c36-8ad2312f4d05
Acute inflammatory demyelinating polyradiculopathy is the most common subtype of {{c1::Guillain-Barré}} syndromePredominant sub-type (60–80%) Treat with IVIG or plasmapheresisWatch Guillain Barre & Charcot Marie ToothWatch associated Bootcamp video - Guillain-Barre Syndromedc29df58-d48f-4b25-b26c-cd1b9ebbe8e6
{{c2::Guillain-Barré}} syndrome results in {{c3::symmetric::symmetric/asymmetric}} {{c1::ascending::ascending or descending}} muscle weakness/paralysis with {{c2::hypo}}reflexia- Reduced or absent reflexes - Sometimes may involve sensory abnormalities as wellWatch Guillain Barre & Charcot Marie ToothWatch associated Bootcamp video - Guillain-Barre Syndrome9a2a05e7-6f4b-486e-8fa8-946637ef4924
Guillain-Barré syndrome is associated with {{c1::decreased}} deep tendon reflexes (DTRs) beginning in the lower extremitiesWatch Guillain Barre & Charcot Marie ToothWatch associated Bootcamp video - Guillain-Barre Syndrome4cc8c130-24bf-4878-8b01-59a9be07b954
Guillain-Barré syndrome may be associated with cardiopulmonary irregularities and fluctuations in {{c1::blood pressure}} (autonomic dysfunction)Respiratory depression (paralysis of respiratory muscles) is typically what causes fatalityWatch Guillain Barre & Charcot Marie ToothWatch associated Bootcamp video - Guillain-Barre Syndromef450ce7e-17d1-47a0-825d-6fb2aaaa3d7a
Guillain-Barré syndrome is associated with {{c1::increased}} CSF protein and {{c1::normal}} cell count, which may cause papilledemaIncreased CSF protein + normal cell count is known as an albuminocytologic dissociationWatch Guillain Barre & Charcot Marie ToothWatch associated Bootcamp video - Guillain-Barre Syndrome156b7486-654a-47aa-a830-9501e5eabddb
The bugs that are associated with {{c1::Guillain-Barré}} syndrome are ICE MyCZ: {{c1::Influenza virus::I}} {{c1::CMV::C}} {{c1::EBV::E}} {{c1::Mycoplasma pneumoniae::My}} {{c1::Campylobacter::C}} {{c1::Zika virus::Z}}COVID-19 infection has also been reported to cause Guillain-Barré syndromeWatch Guillain Barre & Charcot Marie ToothWatch associated Bootcamp video - Guillain-Barre Syndrome Watch associated Bootcamp video - Mycoplasma and Ureaplasmay09cf542c-41c6-49f2-95bc-197ed5e80a07
The pathogens that are associated with Guillain-Barré syndrome can be remembered with the mnemonic {{c1::ICE MyCZ}}Influenza virus CMV EBV Mycoplasma pneumoniae Campylobacter Zika virus COVID-19 infection has also been reported to cause Guillain-Barré syndromeWatch Guillain Barre & Charcot Marie ToothWatch associated Bootcamp video - Guillain-Barre Syndrome Watch associated Bootcamp video - Mycoplasma and Ureaplasmab3382fdd-49d6-47f9-a432-48d507866a5a
In addition to respiratory support, Guillain-Barré syndrome may be treated with {{c1::IVIG}} and {{c1::plasmapheresis}}- Steroids are not helpful in treating Guillain-Barré syndrome - In children, plasmapheresis is only recommended with rapidly progressing or severe diseaseWatch Guillain Barre & Charcot Marie ToothWatch associated Bootcamp video - Guillain-Barre Syndromec8615ff4-5bb3-42cf-80de-06aad09e4936
Are steroids useful in the management of Guillain-Barré syndrome? {{c1::No}}Treat with supportive care, IVIG, and plasmapheresisWatch Guillain Barre & Charcot Marie ToothWatch associated Bootcamp video - Guillain-Barre Syndrome4faca1d4-2f7a-40d8-839a-3b5d1b9149d6
Acute disseminated encephalomyelitis (ADEM) presents with {{c1::rapidly}} progressive multifocal neurologic symptoms and altered mental statusf4e6ba8e-e638-476e-8dc9-2a2cc13994c0
{{c2::Charcot-Marie-Tooth}} disease is also known as {{c1::hereditary motor and sensory neuropathy (HMSN)}}Watch Guillain-Barré & Charcot-Marie-ToothReview Charcot-Marie-Tooth DiseaseWatch associated Bootcamp video - Additional Diseases of Demyelination1894ee30-9dc5-4c6a-878f-9f138a0e5741
What is typically the mode of inheritance of Charcot-Marie-Tooth disease? {{c1::Autosomal dominant}}Defect in structural protein (PMP22) of the peripheral nervesWatch Guillain-Barré & Charcot-Marie-ToothReview Charcot-Marie-Tooth DiseaseWatch associated Bootcamp video - Additional Diseases of Demyelination3d59b332-41f4-41d9-8380-de64f966e7b3
What structural foot abnormalities are associated with Charcot-Marie-Tooth disease? {{c1::Pes cavus}} and {{c1::hammer toes}}Pes Cavus depicted Photo credit: Benefros at English Wikipedia, CC BY-SA 3.0, via Wikimedia CommonsWatch Guillain-Barré & Charcot-Marie-ToothWatch Bones & Ligaments of Ankle & FootReview Charcot-Marie-Tooth DiseaseWatch associated Bootcamp video - Additional Diseases of Demyelinationca9bfbaa-51c0-48a6-ab70-a91c7f18b138
Charcot-Marie-Tooth disease may present with lower extremity weakness (e.g. {{c1::foot drop}}) and sensory deficits"- CMT mostly affects the lower extremities - Common peroneal neuropathy → foot drop and lower leg atrophy (giving an ""inverted bottle"" appearance with a ""stork"" like contour) - Recall, nerves that supply muscles not only release neurotransmitters to activate them, but growth factors / neuropeptides to keep muscles alive Photo credit: Benefros at English Wikipedia, CC BY-SA 3.0, via Wikimedia Commons"Watch Guillain-Barré & Charcot-Marie-ToothReview Charcot-Marie-Tooth DiseaseWatch associated Bootcamp video - Additional Diseases of Demyelinationeea2abe5-56a6-49bc-aeb1-242b5dd566c7
Sturge-Weber syndrome is a developmental anomaly of {{c2::neural crest}} derivatives due to somatic {{c1::mosaicism}}Watch Sturge Weber & Tuberous Sclerosis958f9aba-d777-4f0d-a4ce-658a12f7c21b
Is Sturge-Weber syndrome inherited or sporadic? {{c1::Sporadic (somatic mosaicism)}}Watch Sturge Weber & Tuberous Sclerosisc94ff207-e7c2-4e57-991d-5ad2fd70a3c2
{{c2::Sturge-Weber}} syndrome is caused by an activating mutation in one copy of the {{c1::GNAQ}} geneSTURGEWatch Sturge Weber & Tuberous Sclerosis31538a26-0876-413d-992b-58423dc4fe3a
{{c1::Sturge-Weber syndrome}} is a neurocutaneous disorder associated with a(n) {{c2::port-wine stain}} of the face (nevus flammeus)"- Non-neoplastic birthmark- Blanchable, red patch - Respects midline - Does not regress Photo credit: Xingtao Wang, Chunlai Tian, Xingguang Duan, Ying Gu, Naiyan Huang, ""A Medical Manipulator System with Lasers in Photodynamic Therapy of Port Wine Stains"", BioMed Research International, vol. 2014, Article ID 384646, 10 pages, 2014. https://doi.org/10.1155/2014/384646"Watch Sturge Weber & Tuberous SclerosisWatch associated Bootcamp video - General Principles: Skin Lesions60c798cd-4747-4c86-98c6-716216390164
"The characteristics of {{c1::Sturge-Weber}} syndrome may be remembered with the mnemonic ""STURGE"": {{c1::Sporadic, port-wine Stain::S (2)}} {{c1::Tram track calcifications (opposing gyri)::T}} {{c1::Unilateral::U}} {{c1::Restricted intellectual development::R}} {{c1::Glaucoma, GNAQ gene::G (2)}} {{c1::Epilepsy::E}}"Port wine stain: Photo credit: Wang et al., CC BY 3.0, via BioMed Research International, right; Salim et al., CC BY 3.0, via Clinical Medical Image Library, modified by censoring Tram-track calcifications depicted below Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Sturge Weber & Tuberous Sclerosisyb5096704-f432-4a4f-b25e-ef3b4a2f5e4f
The characteristics of Sturge-Weber syndrome may be remembered with the mnemonic {{c1::STURGE}}"Sporadic, port-wine Stain Tram track calcifications (opposing gyri) Unilateral Restricted intellectual development Glaucoma, GNAQ gene Epilepsy Port wine stain: Photo credit: Xingtao Wang, Chunlai Tian, Xingguang Duan, Ying Gu, Naiyan Huang, ""A Medical Manipulator System with Lasers in Photodynamic Therapy of Port Wine Stains"", BioMed Research International, vol. 2014, Article ID 384646, 10 pages, 2014. https://doi.org/10.1155/2014/384646"Watch Sturge Weber & Tuberous Sclerosisb288f99a-895b-46ff-b5a5-92d93057494a
{{c2::Sturge-Weber}} syndrome is also known as {{c1::encephalotrigeminal angiomatosis}}Watch Sturge Weber & Tuberous Sclerosis4d1cec1b-8957-4157-bf04-25ecc314284b
"The characteristics of {{c1::tuberous sclerosis}} may be remembered with the mnemonic ""HAMAARTOMAS"": {{c1::Hamartomas in CNS and skin::H (benign growths)}} {{c1::Angiofibromas (adenoma sebaceum)::A (face)}} {{c1::Mitral regurgitation::M (valvular pathology)}} {{c1::Ash-leaf spots (hypopigmented macule)::A (earliest cutaneous finding)}} {{c1::Astrocytomas (giant cell)::A (CNS tumor)}} {{c1::cardiac Rhabdomyoma::R (cardiac tumor)}} {{c2::Tumor suppressor genes (TSC1 and TSC2)::T (genes)}} {{c2::autosomal dOminant::O (inheritance)}} {{c2::Mental challenges (intellectual disability)::M (development)}} {{c2::renal Angiomyolipoma::A (renal mass)}} {{c2::Seizures::S (neurologic)}}, {{c2::Shagreen patches::S (lower back)}}"This card was previously all 1 cloze, however, 1 new cloze has been added to reduce card burden. Please make sure to unsuspend the new cards (Apr 2024) - Death most commonly occurs secondary to neurologic impairment (i.e. seizures, aspiration PNA, hydrocephalus) - 1st: Hypopigmented macules (Ash leaf spot), 2nd: Shagreen patch and 3rd: periungual fibroma of tuberous sclerosis Photo credit: Portocarrero et al., CC BY 4.0, via Wikimedia CommonsWatch Sturge Weber & Tuberous SclerosisReview Tuberous SclerosisWatch associated Bootcamp video - Hydrocephalusycf0aa67f-400d-456b-8bce-54107e2ab86d
The characteristics of tuberous sclerosis may be remembered with the mnemonic {{c1::HAMAARTOMAS}}Hamartomas in the CNS and skin Angiofibromas (adenoma sebaceum) Mitral regurgitation Ash-leaf spots (hypopigmented macule) Astrocytomas (giant cell) cardiac Rhabdomyoma Tumor suppressor genes (TSC1 and TSC2) autosomal dOminant Mental challenges (intellectual disability) renal Angiomyolipoma Seizures, Shagreen patches 1st: Hypopigmented macules (Ash leaf spot), 2nd: Shagreen patch and 3rd: periungual fibroma of tuberous sclerosis Photo credit: Portocarrero LKL, Quental KN, Samorano LP, Oliveira ZNP, Rivitti-Machado MCDM, CC BY 4.0, via Wikimedia CommonsWatch Sturge Weber & Tuberous SclerosisReview Tuberous SclerosisWatch associated Bootcamp video - Hydrocephalusebbfcf0a-60fe-422a-955e-44a670616d04
What feature of tuberous sclerosis is seen in the image below? {{c1::Angiofibromas (adenoma sebaceum)}}Photo credit: Herbert L. Fred, MD and Hendrik A. van Dijk, CC BY-SA 3.0, via Wikimedia Commons HAMAARTOMAS Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch Sturge Weber & Tuberous SclerosisReview Tuberous Sclerosisbc196a58-3dbf-47c1-960f-e961c475ef7a
What feature of tuberous sclerosis is seen in the image below? {{c1::Ash-leaf spots (hypopigmented macule)}}1st: Hypopigmented macules (Ash leaf spot), 2nd: Shagreen patch and 3rd: periungual fibroma of tuberous sclerosis Photo credit: Portocarrero LKL, Quental KN, Samorano LP, Oliveira ZNP, Rivitti-Machado MCDM, CC BY 4.0, via Wikimedia Commons, modified by croppingWatch Sturge Weber & Tuberous SclerosisReview Tuberous Sclerosisbdd2112c-7187-4605-9a0f-d973473215a4
What feature of tuberous sclerosis is seen in the image below? {{c1::Shagreen patches (patches of localized leathery thickenings)}}Photo credit: Portocarrero LKL, Quental KN, Samorano LP, Oliveira ZNP, Rivitti-Machado MCDM, CC BY 4.0, via Wikimedia Commons, modified by cropping - 1st: Hypopigmented macules (Ash leaf spot), 2nd: Shagreen patch and 3rd: periungual fibroma of tuberous sclerosisWatch Sturge Weber & Tuberous SclerosisReview Tuberous Sclerosis3c8f8cac-d3ee-4ed3-9a45-6b98eb71cb36
{{c2::Tuberous sclerosis}} is a neurocutaneous disorder associated with {{c1::ungual fibromas}}, which are flesh-colored lumps emerging from nail folds- 1st: Hypopigmented macules (Ash leaf spot), 2nd: Shagreen patch and 3rd: periungual fibroma of tuberous sclerosis Photo credit: Portocarrero LKL, Quental KN, Samorano LP, Oliveira ZNP, Rivitti-Machado MCDM, CC BY 4.0, via Wikimedia CommonsWatch Sturge Weber & Tuberous SclerosisReview Tuberous Sclerosis72b497ed-09a5-4036-86ed-0ae6e17fe4e2
What astrocyte-derived CNS tumor is associated with tuberous sclerosis? {{c1::Subependymal giant cell astrocytomas (SEGA)}}HAMAARTOMAS Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Sturge Weber & Tuberous Sclerosis055e7b74-2572-4d7b-a2f6-7e2e8014eeaf
The NF1 tumor suppressor gene normally codes for neurofibromin, a negative regulator of {{c1::Ras}}Neurofibromin is a Ras GTPase-activating protein (GAP)Watch Neurofibromatosis5580e447-4876-4b40-8132-6fac3e6d546b
What is the mode of inheritance of neurofibromatosis I and II? {{c1::Autosomal dominant}}- Chromosome 17 for NF1 - Chromosome 22 for NF2Watch NeurofibromatosisReview Von Recklinghausen Disease (NF I) Review Neurofibromatosis Type II (NF II)ba718c65-f2ff-4b67-ad58-708e37f2495b
What cutaneous findings are associated with neurofibromatosis I? {{c1::Cafe-au-lait spots}} and {{c2::cutaneous neurofibromas}}"- Cafe-au-lait spots (french for ""coffee with milk"" spots) are seen at birth-2 years - Cutaneous neurofibromas occur during puberty (these are made of Schwann cells and are soft rubbery nodules); these arise from small nerves in the dermis Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ"Watch Pheochromocytoma & Neuroblastoma Watch NeurofibromatosisReview Von Recklinghausen Disease (NF I)1b19a921-d50d-4f65-8124-7431840d48fd
Neurofibromatosis {{c2::I}} is associated with optic glioma and {{c1::Lisch nodules (pigmented iris hamartomas)::eye findings}}Annual ophthalmicogical screening exam + MRI brain/orbits for any new onset vision changes Photo credit: The Armed Forces Institute of Pathology, Public domain, via Wikimedia Commons Photo credit: Dimitrios Malamos, CC BY 4.0, via Wikimedia CommonsWatch NeurofibromatosisReview Von Recklinghausen Disease (NF I)353258b2-46ff-4948-8ba3-3430c827b50f
Neurofibromatosis type {{c2::I}} is also known as {{c1::von Recklinghausen}} diseaseWatch NeurofibromatosisReview Von Recklinghausen Disease (NF I)61fbbe30-8425-4885-b6e6-40f186eee103
{{c2::Neurofibromatosis II}} is a neurocutaneous disorder associated with {{c1::bilateral acoustic neuroma (vestibular schwannomas)::ear findings}}Other symptoms of NF-2 include juvenile cataracts, meningiomas, and ependymomasWatch NeurofibromatosisReview Neurofibromatosis Type II (NF II) Review Schwannoma Review EpendymomaWatch associated Bootcamp video - Vestibular Schwannoma1bd36543-6083-493d-99e6-e941064bde2b
Neurofibromatosis {{c2::II}} is associated with juvenile {{c1::cataracts::eyes}}Type two causes ca-two-ractsWatch NeurofibromatosisReview Neurofibromatosis Type II (NF II)f98f6b0b-3edb-4fe2-b34a-c6ded752528c
"The characteristics of {{c1::von Hippel-Lindau}} disease may be remembered with the mnemonic ""HARP"": {{c1::Hemangioblastomas in retina, brain stem, cerebellum, spine::H (4 locations)}} {{c1::Angiomatosis (e.g. cavernous hemangiomas in skin, mucosa, organs)::A}} {{c1::bilateral Renal cell carcinoma::R}} {{c1::Pheochromocytoma::P}}"Hemangioblastomas are clumps of capillaries - High vascularity with hyperchromatic nuclei - When occurs in the retina, can lead to retinal detachment, treat with argon laser phototherapy and cryotherapy if symptomatic - Bright red on gross examination (well-circumscribed, benign, no invasion) Renal cell carcinomas are clear cell carcinomas, patients also develop renal cysts Pheochromocytomas manifest as excess adrenaline and tendency to be aggressive* VHL disease: mutated VHL disallows HIF1alpha to ubiquitinate and prevent angiogenesis, thus there is a proliferation of hemangioblastomas Watch Pheochromocytoma & Neuroblastoma Watch Adult CNS TumorsReview von Hippel-Lindau (VHL)y464e7ce1-3bb3-4751-8c81-e563079364e8
The characteristics of von Hippel-Lindau disease may be remembered with the mnemonic {{c1::HARP}}Hemangioblastomas (clumps of capillaries) - Form in the retina, brain stem, cerebellum, and/or spine - High vascularity with hyperchromatic nuclei - When occurs in the retina, can lead to retinal detachment, treat with argon laser phototherapy and cryotherapy if symptomatic - Bright red on gross examination (well-circumscribed, benign, no invasion) Angiomatosis (e.g. cavernous hemangiomas in skin, mucosa, organs) Bilateral Renal cell carcinomas - Clear cell carcinomas - Patients also develop renal cysts Pheochromocytomas - Manifest as excess adrenaline and tend to be aggressive* VHL disease: mutated VHL cannot ubiquitinate HIF1alpha for degradation and therefore cannot prevent angiogenesis → proliferation of hemangioblastomas Watch Pheochromocytoma & Neuroblastoma Watch Adult CNS TumorsReview von Hippel-Lindau (VHL)a7500201-684d-4c6e-beb2-172c38a3cf00
Pituitary adenoma is most commonly from adenoma of {{c1::lactotrophs (prolactinoma)}}causing hyperprolactinemiaWatch HyperpituitarismReview Pituitary AdenomaWatch associated Bootcamp video - Hyperprolactinemiaa58edbf3-1715-4d06-af88-caea378fc1fd
Pituitary adenoma may cause hypopituitarism in the setting of pituitary {{c1::apoplexy}}- i.e. spontaneous hemorrhage of a pituitary tumor - Pituitary adenomas may also cause hyperpituitarismWatch Hypothalamic & Pituitary Dysfunction EtiologiesReview Pituitary AdenomaWatch associated Bootcamp video - Hypopituitarismbfd13751-f08f-4e13-84f3-8121513c29ef
Pituitary adenoma is characterized by hyperplasia of {{c1::only one::one or multiple}} type(s) of endocrine celli.e. lactotroph, gonadotroph, somatotroph, corticotrophWatch Hypothalamic & Pituitary Dysfunction Etiologies62ed1b17-0b11-4e4b-884b-5c29ba418593
{{c3::Pinealoma::CNS tumor}} may cause {{c2::precocious puberty}} in boys due to {{c1::β-hCG}} productionWatch Pediatric CNS TumorsReview PinealomaWatch associated Bootcamp video - Other Disorders of the Diencephalon033ca15d-e9b3-43f5-a9b8-4b80ba140593
{{c1::Cauda equina}} syndrome is a spinal cord lesion due to compression of spinal roots from {{c2::L2}} and belowUsually caused by intervertebral disc herniation or tumorsWatch Lumbosacral NervesWatch associated Bootcamp video - Cauda Equina vs Conus Medullaris Syndrome2963e507-c5f7-444e-882b-83e7c4718bbf
"{{c2::Cauda equina}} syndrome may be associated with ""{{c1::saddle (S3-S5)}} anesthesia"""Conus medullaris syndrome presents similarly, but may result in perianal anesthesia that is bilateral. Also more commonly results in impotenceWatch Lumbosacral NervesWatch associated Bootcamp video - Cauda Equina vs Conus Medullaris Syndromee92b219b-c539-40d0-a448-5929f34354b3
Cauda equina syndrome is treated with emergent {{c1::surgery}} and {{c1::steroids}}Watch Lumbosacral NervesWatch associated Bootcamp video - Cauda Equina vs Conus Medullaris Syndromead7ae7f6-3497-4b7e-b93a-799de031e267
ID Eye Structure: {{c1::Optic cup}}Photo credit: ignis, CC BY-SA 3.0, via Wikimedia Commons2232aec3-5f98-485b-b5de-73023e56d38e
ID Eye Structure: {{c1::Optic disc}}Photo credit: ignis, CC BY-SA 3.0, via Wikimedia CommonsWatch The Retina and Phototransduction598c4000-4d3c-443e-ad00-70e57154c5c4
ID Eye Structure: {{c1::Macula}}Photo credit: ignis, CC BY-SA 3.0, via Wikimedia CommonsWatch The Retina and Phototransduction02409d05-2b73-486f-abba-ab74bf551448
ID Eye Structure: {{c1::Fovea}}Photo credit: ignis, CC BY-SA 3.0, via Wikimedia CommonsWatch The Retina and Phototransductionf99130ff-1e05-4618-8d40-3ec7d133ce91
ID Eye Structure: {{c1::Retinal artery}}Photo credit: ignis, CC BY-SA 3.0, via Wikimedia Commons422e3db0-9740-4d95-8a6c-23506127785f
ID Eye Structure: {{c1::Retinal vein}}Photo credit: ignis, CC BY-SA 3.0, via Wikimedia Commons6f94da58-91a9-46b3-8cb9-f3f6d8a28791
{{c1::Allergic}} conjunctivitis is characterized by bilateral itchy eyesIgE-mediated response to allergens; treatment involves avoidance of the triggering agent and topical agents (e.g. antihistamines, mast cell stabilizers) Photo credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia Commons92526388-f527-4c78-aea5-b08ac1767484
"{{c2::Hyperopia}} is a refractive error that is also known as ""{{c1::far}}-sightedness"""Here, the focal point is behind the retina Photo credit: National Institute of Health, Public domain, via Wikimedia Commons0d206749-7378-42e1-a82c-f5f76f4e69a6
"{{c2::Myopia}} is a refractive error that is also known as ""{{c1::near}}-sightedness"""- Here the focal point is in front of the retina - Can see near objects clearly Photo credit: National Eye Institute, National Institutes of Health, CC BY 2.0, via Wikimedia Commonsd9fd93b2-d96e-4ff8-8362-b20e32a4ec78
{{c1::Presbyopia}} is aging-related impaired {{c2::accommodation}}- To focus on near objects, you must be able to make your lens become more curved (accomplished through the process of accommodation) - If you cannot accommodate correctly, you won't be able to focus on near objects Far object → ciliary muscle relaxed → suspensory ligaments tightened → lens gets flatter Near object → ciliary muscle contracted → suspensory ligaments relaxes → lens is more curved035c3ca4-5e6b-47f3-90d4-f27214213209
Presbyopia is primarily due to {{c1::decreased}} lens elasticity, changes in lens curvature, and decreased strength of ciliary musclePatients are unable to focus on near objects0688809e-b79a-4b79-aa0b-b26428a3b217
{{c1::Cataracts}} are painless, often bilateral, opacifications of the {{c2::lens}}Photo credit: Imrankabirhossain, CC BY-SA 4.0, via Wikimedia Commons46c4943c-c351-4d49-8361-89d0cf9bb480
{{c2::Glaucoma}} is characterized by optic disc atrophy with characteristic {{c1::cupping}}Healthy nerve - bright area in the middle = physiologic cup, normally <1/3 or 1/2 of entire optic disc In glaucoma: - cupping gets much bigger than normal, takes up almost the whole size of the optic disc - Increased cup to disc ratio due to thinning of outer rim of optic nerve head (loss of ganglion cell axons) Normal (left); glaucomatous optic nerve with cupping (right) Photo credit: Hsu et al., CC BY 4.0, via MDPI Life, modified by cropping Photo credit: Grech et al., CC BY 4.0, via Hindawi0c27bd17-dbac-4018-a3b5-cc6e8370f72e
Glaucoma is frequently associated with elevated {{c1::intraocular}} pressurevs. papilledema which occurs due to increased intracranial pressureWatch Anatomy of the Eye0660b699-55dc-43d0-8ad2-2324793b983a
Glaucoma is associated with progressive {{c1::peripheral::central/peripheral}} visual field loss if untreatedvs. macular degeneration, which causes progressive central visual field loss32a173af-6c90-4d49-bf7c-74a336b14546
{{c1::Closed}}-angle glaucoma is caused by obstruction of normal aqueous flow through the pupilFluid builds up behind the iris, pushing the peripheral iris against the cornea and impeding flow through the trabecular meshwork Photo credit: Jonathan Trobe, M.D., CC BY 3.0, via Wikimedia Commons0a4346cd-1465-4ff0-84f7-7996f1ee8ee1
{{c2::Acute angle-closure}} glaucoma is characterized by sudden vision loss with {{c1::halos}} around lightsCan also include headache, blurred vision, and eye painba247cf8-bfe1-4be6-9835-1d52b9a0b49b
Uveitis may present with conjunctival redness and {{c1::hypopyon}}, which is the accumulation of pus in the anterior chamberPhoto credit: EyeMD (Rakesh Ahuja, M.D.)., CC BY-SA 2.5, via Wikimedia Commons159140d9-7df4-445c-a685-674bd791a21d
Uveitis is associated with HLA-{{c1::B27}} disordersWatch associated Bootcamp video - Seronegative Spondyloarthritis Overview05da6261-b81e-4dfb-a990-2aea374bccf5
Age-related macular degeneration causes distortion (metamorphopsia) and eventual loss of {{c1::central}} visionvs. glaucoma, which causes progressive peripheral visual field loss; think about macula being the central part of retina Photo credit: Wikimedica commons [Christine Blume, Corrado Garbazza & Manuel Spitschan, CC BY 4.0, via Wikimedia Commons] Photo credit: Wikimedica commons [Rhcastilhos. And Jmarchn., CC BY-SA 3.0, via Wikimedia Commons]Watch associated Bootcamp video - Optic Nerve Lesion2f44242e-52bf-4102-9252-50ed82456be2
Which type of macular degeneration is more common (>80%)? {{c1::Dry (nonexudative)::Dry or Wet}}Watch associated Bootcamp video - Optic Nerve Lesion8af8ef13-2f2d-45dd-a18d-77bd2e5c5698
{{c2::Dry macular degeneration}} is characterized by {{c1::drusen}}, which is deposition of yellowish extracellular material in between Bruch's membrane and the retinal pigment epithelium- Dry, Drusen, Deposition Photo credit: Jmarchn, CC BY-SA 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Optic Nerve Lesiona7a2bd88-62f0-4474-b08d-b1ad925734df
Dry macular degeneration is treated with {{c1::multivitamin}} and {{c2::antioxidant}} supplements; also smoking cessation if applicablecd5d6309-e274-49cc-9c58-5fad7947f05b
Wet macular degeneration is treated with smoking cessation (if applicable) and {{c1::anti-VEGF}} injectionse.g. ranibizumab28a22e14-3e58-43e9-9027-8a209862178a
{{c1::Nonproliferative}} diabetic retinopathy is characterized by leakage of blood from damaged capillaries, resulting in hemorrhages and macular edema- Background/Simple Retinopathy: microaneurysms, hemorrhages, exudates, and retinal edema - Pre-proliferative retinopathy: cotton wool spots - Proliferative/ malignant retinopathy: newly formed vessels Fundoscopic findingsDiabeticHypertensiveHemorrhagesMultipleFewRetinaWetDryExudatesMultipleRareEdemaExtensiveRareFlame shaped HemorrhagesRareCommonCotton Wool spotsFewMultipleVisually abnormal blood vessels in retinaVeinsArteries Photo Credit: Lois N, McCarter RV, O’Neill C, Medina RJ and Stitt AW (2014) Endothelial progenitor cells in diabetic retinopathy. Front. Endocrinol. 5:44. doi: 10.3389/fendo.2014.00044, CC BY 3.0Watch Diabetes Mellitus Chronic ComplicationsWatch associated Bootcamp video - Diabetic Complicationsd26b141e-6e4c-4f45-b901-a36f9d55fe02
What is the treatment for nonproliferative diabetic retinopathy? {{c1::Blood glucose control}}ba1f3387-b669-4483-a274-4ded8f5e9db7
{{c1::Proliferative}} diabetic retinopathy results in new blood vessel formation with resultant traction on the retina- Because PDR is a chronic microvascular complication of persistent hyperglycemia - The presence of retinal neovascularization in a diabetic patient with albuminuria and/or decreased GFR supports dx of diabetic nephropathy Photo credit: http://www.nei.nih.gov/photo/eyedis/index.asp, Public domain, via Wikimedia CommonsWatch Diabetes Mellitus Chronic ComplicationsWatch associated Bootcamp video - Diabetic Complicationsc40c6d33-bc12-47f2-9ebb-589a07663133
Proliferative diabetic retinopathy is treated with peripheral retinal {{c1::photocoagulation}}, surgery, and/or anti-VEGF therapyPhoto credit: http://www.nei.nih.gov/photo/eyedis/index.asp, Public domain, via Wikimedia CommonsWatch Diabetes Mellitus Chronic ComplicationsWatch associated Bootcamp video - Diabetic Complications22a88965-a5b7-4339-91d6-d84d2f46e081
Retinal {{c1::detachment}} is due to separation of the neurosensory layer of the retina (rods, cones) from the outer pigment epithelium layerLeads to degeneration of photoreceptors with resultant vision loss Photo credit: Unknown, Public domain, via Retina Gallery Photo credit: Unknown, Public domain, via Retina Galleryca60e197-fbe5-4a4e-bb22-eaf70c58a31e
{{c1::Retinal detachment}} is visualized on fundoscopy as crinkling retinal tissue and changes in vessel directionPhoto credit: Unknown, Public domain, via Retina Gallery; Unknown, Public domain, via Retina Galleryfbb37fd6-067e-4cbf-a997-2f24b2eb0436
Retinal detachment is more common in patients with pathological {{c1::myopia}} and/or history of head {{c2::trauma}}Pathological (high) myopia is a high-degree nearsightedness usually defined as myopia with a refractive error greater than -6 Risk of retinal detachment in individuals with myopia: >3 diopters (-3) = 10x risk 1–3 diopters (-1 to -3) = 4x risk Photo credit: Unknown, Public domain, via Retina Gallery Photo credit: Unknown, Public domain, via Retina Galleryf7500282-c44d-4cb1-ab16-c729c62ba50a
"Retinal {{c2::detachment}} is often preceded by posterior vitreous detachment, which presents with ""{{c1::flashes}}"" and ""{{c1::floaters}}"""Photo credit: Unknown, & Unknown, Public domain, via Retina Galleryaee458b8-d833-498c-a2d7-99019e83892a
Central retinal artery occlusion is characterized by acute, {{c1::painless::painful or painless}} monocular vision lossd8e90635-0417-4f25-83d7-f4f28652fd3d
"{{c2::Central retinal artery}} occlusion is characterized by a pale retina with a(n) {{c1::""cherry red"" spot}} at the fovea"The fovea is thin, allowing for visualization of the choroid blood vessels Photo credit: Achim Fieß, Ömer Cal, Stephan Kehrein, Sven Halstenberg, Inez Frisch, Ulrich Helmut Steinhorst, CC BY 2.0, via Wikimedia CommonsWatch associated Bootcamp video - Optic Nerve Lesiona4a97ebc-29fd-41ed-8e0a-a6decee15e3e
Patients with central retinal artery occlusion should be evaluated for a(n) {{c1::embolic}} source (e.g. carotid artery atherosclerosis, cardiac vegetation, patent foramen ovale)7fa8de07-662a-4d58-8019-2362f558d623
{{c2::Retinoblastoma}} is an ocular malignancy associated with a(n) {{c1::white}} reflex, rather than the normal red reflexCalled leukocoria (“cat's eye pupil”) Photo credit: Isabelle Aerts,corresponding author1 Livia Lumbroso-Le Rouic,2 Marion Gauthier-Villars,3 Hervé Brisse,4 François Doz,1 and Laurence Desjardins2, CC BY 2.5, via Wikimedia Commons Photo credit: J Morley-Smith, Public domain, via Wikimedia CommonsWatch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Growth Regulation Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Growth Regulation Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Oncogenes and Tumor Suppressor Genes801a699c-b239-4538-ada6-544ef8552d27
Retinitis pigmentosa is a painless, progressive vision loss beginning with {{c1::night blindness (nyctalopia)}} and loss of {{c1::peripheral::central/peripheral}} visionRods are affected firstdb69f270-d0e0-490f-a21e-9b39f3472452
{{c1::Retinitis pigmentosa}} is characterized by bone spicule-shaped deposits around the macula"May be described as ""optic disc pallor and attenuation of retinal vessels with focal areas of discoloration bilaterally"" Photo credit: Christian Hamel, CC BY 2.0, via Orphanet Journal of Rare Diseases"fb42296f-79b8-46d6-bf9c-88dff1d20424
Papilledema presents with {{c2::transient}} vision loss associated with changes in head position, and is secondary to increased {{c1::intracranial}} pressure"- vs. glaucoma, which occurs due to increased intraocular pressure - Vision loss worsens with increased cerebral blood flow (supine, prone) and improves with standing - Patients also have a headache and enlargement of their ""blind spot"" - Optic nerve is covered by all three meninges (since optic nerve is an outgrowth of the CNS tissue), so increased ICP can be transmitted to the optic nerve Photo credit: Jonathan Trobe, M.D. - University of Michigan Kellogg Eye Center, CC BY 3.0, via Wikimedia Commons"Watch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Idiopathic Intracranial Hypertensiondff4b12b-d140-46a5-b7b6-0ef524a2f194
On fundoscopy, {{c1::papilledema}} is characterized by optic disc swelling / elevation with blurred margins (usually bilateral)- Enlargement of the optic disc → enlarged physiologic blind spots - Absence of a physiological cup is also noted - Venous engorgement also present Photo credit: Jonathan Trobe, M.D. - University of Michigan Kellogg Eye Center, CC BY 3.0, via Wikimedia Commons Photo credit: Koripalli et al., CC BY 3.0, via Cureus Photo credit: Bhatt et al., CC BY 2.0, via Journal of Medical Case ReportsWatch Intracranial Hypertension (ICH)Watch associated Bootcamp video - Idiopathic Intracranial Hypertension17d7fd97-7c89-42c9-93c2-a1318a4277eb
Contralateral homonymous hemianopsia with macular sparing is a visual deficit associated with {{c1::posterior cerebral}} artery infarctMacula is spared due to collateral blood supply from the middle cerebral arteryReview Posterior Cerebral Artery (PCA)Watch associated Bootcamp video - Visual Cortex Lesion Watch associated Bootcamp video - Medullary and Pontine Syndromes093a040f-82d0-4997-a820-95bd7c6278a1
Contralateral homonymous hemianopsia is a visual deficit associated most commonly with a lesion of the {{c1::optic tract}} or {{c2::lateral geniculate body}}Patients with optic tract lesions will have deficits in the pupillary light reflex as wellWatch Localizing A Stroke: MCAWatch associated Bootcamp video - Visual Cortex Lesion329e81c3-ff1c-4a2b-95fd-76195f1a6ac3
Contralateral homonymous inferior quadrantanopia is a visual deficit associated with lesion of the {{c1::parietal}} lobe (e.g. MCA infarct)Damages fibers in the dorsal optic radiationWatch Localizing A Stroke: MCAWatch associated Bootcamp video - Optic Radiation Lesion Watch associated Bootcamp video - Parietal Lobe5ab42c1e-0503-499e-b8d1-e420abcb07fb
Contralateral homonymous superior quadrantanopia is a visual deficit associated with lesion of the {{c1::temporal}} lobe (e.g. MCA infarct)- Damages fibers in Meyer's loop - Soup (superior) has a high temp (temporal)Review Middle Cerebral Artery (MCA)Watch associated Bootcamp video - Optic Radiation Lesion Watch associated Bootcamp video - Temporal Lobe675318ca-244c-4abe-b66b-1cb4c0ea6561
{{c1::Cholesteatoma}} is an overgrowth of {{c2::keratinized squamous epithelium}} within the middle ear space"- Often presents with painless otorrhea - May be described as a white pearly mass behind the tympanic membrane - Treatment is surgical excision - Primary cholesteatoma: due to chronic negative pressure in the middle ear, causing retraction pockets in the tympanic membrane that become cystic and accumulate squamous cell debris - Secondary cholesteatoma: due to tympanic membrane perforation (otitis media) allowing migration of squamous epithelium into the middle ear This card used to say ""desquamated keratin debris,"" but that wording is not accurate for all types of cholesteatomas, and UW/AMBOSS/FA23 now use broader language (Jan 2024) Photo credit: Michael Hawke MD, CC BY 4.0, via Wikimedia Commons"Watch EarWatch associated Bootcamp video - Conductive Hearing Loss8782b157-0e51-488b-965f-b62c9fd1b3a8
Cholesteatoma may eventually lead to erosion of the ossicles and mastoid air cells, resulting in {{c1::conductive::sensorineural or conductive}} hearing lossWatch EarWatch associated Bootcamp video - Conductive Hearing Loss83d39537-2891-4ce2-b031-8b10763f75fc
Peripheral vertigo is most commonly due to {{c1::benign paroxysmal positional vertigo (BPPV)::condition}}, which is diagnosed with a positive Dix-Hallpike maneuverBPPV: Episodic vestibular syndrome caused by misplaced otoliths in the vestibular apparatus; triggered by movement (e.g., lying down, reclining) Duration: ≤ 90 seconds Dix-Hallpike: Specific sequential maneuvers used to provoke symptoms (nystagmus) If positive, treat with Epley maneuverWatch Vertigo (Central vs Peripheral)Watch associated Bootcamp video - Benign Paroxysmal Positional Vertigo Watch associated Bootcamp video - Peripheral vs Central Vertigo Watch associated Bootcamp video - Vertigo: Central and Peripheral Vertigof355ac73-b602-4365-8fe1-3b507c852d21
{{c1::Ménière}} disease is a triad of: - Recurrent {{c2::vertigo}} - {{c2::Tinnitus}} - Unilateral {{c2::hearing loss}}- AKA Idiopathic endolymphatic hydrops - Due to imbalances of the fluid and electrolyte composition of endolymph (increased volume in endolymphatic system) as endolymph leaks into perilymph - Hearing loss is sensorineural and low frequencies - Usually also presents with ear pain and fullnessWatch Vertigo (Central vs Peripheral)Watch associated Bootcamp video - Meniere Disease Watch associated Bootcamp video - Vertigo: Central and Peripheral Vertigo1fe4422c-90f9-484e-a165-4783f95a7cbd
{{c3::Peripheral}} vertigo is characterized by {{c1::delayed::delayed/immediate}} nystagmus in the {{c2::horizontal}} direction with positional testingPhoto credit: Mr.Polaz, CC BY-SA 4.0, via Wikimedia CommonsWatch Vertigo (Central vs Peripheral)Watch associated Bootcamp video - Peripheral vs Central Vertigo Watch associated Bootcamp video - Vertigo: Central and Peripheral Vertigof62f3ece-17b8-4083-b2cc-245ed89aa26c
{{c3::Central}} vertigo is characterized by {{c1::immediate::delayed/immediate}} nystagmus in {{c2::any}} direction with positional testingMay have: - Directional or purely vertical nystagmus (upbeat or downbeat) - Skew deviation (eyes are slightly misaligned) - Diplopia & dysmetria (as a result of the skew deviation) - And/or focal neurologic findings Photo credit: Student BSMU, CC BY-SA 3.0, via Wikimedia CommonsWatch Vertigo (Central vs Peripheral)Watch associated Bootcamp video - Peripheral vs Central Vertigo Watch associated Bootcamp video - Vertigo: Central and Peripheral Vertigo2305c770-d9ad-48d6-9df1-ca14a3950970
{{c1::Classical conditioning}} is a type of conditioning where a natural response is elicited by a conditioned/learned stimulus that was previously presented with an unconditioned stimuluse.g. Pavlov's dog: unconditioned stimulus = food conditioned stimulus = bell natural response = salivationWatch associated Bootcamp video9d657c41-4e2a-4403-9b13-a9a61d15761d
Which type of conditioning usually deals with involuntary responses? {{c1::Classical conditioning}}Whereas operant conditioning usually deals with voluntary responsesWatch associated Bootcamp videoeb378ac9-d43b-4346-8bdc-17a9972564c0
Which type of conditioning usually deals with voluntary responses? {{c1::Operant conditioning}}Whereas classical conditioning usually deals with involuntary responsesWatch associated Bootcamp videoffc7bf9a-6098-4d93-8f5b-6e4272374c77
Which operant conditioning technique involves addition of a stimulus in efforts to increase behavior? {{c1::Positive reinforcement}}- i.e. target behavior is followed by a desired reward - Positive = give something - Negative = take away something - Reinforcement = ↑ behavior - Punishment = ↓ BehaviorWatch associated Bootcamp video759e7249-ad9e-41fb-9b87-40c33814603b
Which operant conditioning technique involves removal of a stimulus in efforts to increase behavior? {{c1::Negative reinforcement}}- i.e. target behavior is followed by removal of an aversive stimulus - Positive = give something - Negative = take away something - Reinforcement = ↑ behavior - Punishment = ↓ BehaviorWatch associated Bootcamp video7572b6dc-1f04-4a96-ba9d-fdb2f5f6bf15
Which operant conditioning technique involves addition of a stimulus in efforts to decrease behavior? {{c1::Positive punishment}}- i.e. repeated application of an aversive stimulus to extinguish unwanted behavior - Positive = give something - Negative = take away something - Reinforcement = ↑ behavior - Punishment = ↓ BehaviorWatch associated Bootcamp video0d0c8f68-1546-4759-a11b-c8aaf3d4a220
Which operant conditioning technique involves removal of a stimulus in efforts to decrease behavior? {{c1::Negative punishment}}- i.e. removal of a desired reward to extinguish unwanted behavior - Positive = give something - Negative = take away something - Reinforcement = ↑ behavior - Punishment = ↓ BehaviorWatch associated Bootcamp video4caff1d3-b66e-487a-bc13-a6b7d81a589a
{{c1::Transference}} is characterized by the patient projecting feelings about formative or other important persons onto the physician"- e.g. psychiatrist is seen as a parent Example of transference: - When patient says ""He is short just like my dad"" Countertransference: - When doctor says ""My dad would say something like that"""Watch associated Bootcamp video72587002-5345-4f0d-950f-c9a7b53ec026
{{c1::Countertransference}} is characterized by the doctor projecting feelings about formative or other important persons onto the patient"- e.g. patient reminds physician of younger sibling Example of transference: - When patient says ""He is short just like my dad"" Countertransference: - When doctor says ""My dad would say something like that"""Watch associated Bootcamp video04da75be-821e-4a4d-a84e-cbec9b269335
Which ego defense is defined as expressing unacceptable feelings and thoughts through actions? {{c1::Acting out (immature defense)}}- This includes attention seeking behavior and socially inappropriate behavior - e.g., tantrums, child with sick parents misbehaves at school, adolescent engages in promiscuous sex during parents' divorceWatch associated Bootcamp video4b982bb3-30b8-4e5b-b87b-731e2ebf02db
Which ego defense is defined as avoiding the awareness of some painful reality? {{c1::Denial (immature defense)}}- Refusing to accept an unpleasant reality - e.g., a patient with cancer plans a full-time work schedule despite being warned of fatigue during chemotherapy, heavy drinker believes she drinks sociallyWatch associated Bootcamp video150d6147-5ff3-45cb-a450-8f55b8459234
Which ego defense is defined as redirection of emotions/impulses to a neutral person or object? {{c1::Displacement (immature defense)}}e.g., a teacher is yelled at by the principal; she then goes home and criticizes her husband's dinner selection rather then confronting the principalWatch associated Bootcamp video5a262184-f1ad-4e08-82f1-d64b66e32832
Which ego defense is defined as temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress? {{c1::Dissociation (immature defense)}}- Dissociation is a detachment from reality; often sudden onset after triggering event (e.g., rape); patient has incomplete or no memory of traumatic event and they may appear detached with flat effect / may lose track of time - e.g., a victim of sexual abuse suddenly appears numb and detached when exposed to their abuser; patient has incomplete or no memory of traumatic eventWatch associated Bootcamp video03d826d4-ce0d-4214-a6c4-2a45e5e121e4
Which ego defense is defined as partially remaining at a more childish level of development? {{c1::Fixation (immature defense)}}- As opposed to regression, which is an involuntary turning back to an early mode of dealing with the world - e.g., a surgeon throws a tantrum late in the operating room because the last case ran very late; oral fixation (thumb sucking, eating, chewing pencils)Watch associated Bootcamp video190d5a01-a934-41d5-a76e-8c2618d0fc10
Which ego defense is defined as expressing extremely positive thoughts of self/others while ignoring negative thoughts? {{c1::Idealization (immature defense)}}"- Classically done with childhood events - e.g., a patient boasts about his physician and his accomplishments while ignoring any flaws; ""our family vacations were always amazing"""Watch associated Bootcamp video3a7be187-4b02-4e2e-b570-413945541c88
Which ego defense is defined as a largely unconscious expression of the characteristics, qualities, or traits of another person or group that is perceived to be more powerful / prestigious? {{c1::Identification (immature defense)}}- Mimicking behavior of someone else, can be positive or negative - e.g., a resident starts putting his stethoscope in his pocket like his favorite attending, instead of wearing it around his neck like before; child of abusive father becomes child abuser himselfWatch associated Bootcamp videofd916282-5801-4330-b36e-e26764d813ce
Which ego defense is defined as using facts and logic to emotionally distance oneself from a stressful situation? {{c1::Intellectualization (immature defense)}}- As opposed to rationalization, which is proclaiming logical reasons for actions usually performed for other reasons - e.g., in a therapy session, a patient diagnosed with cancer focuses only on rates of survival; spouse going through divorce cites divorce statistics to friends to avoid admitting sadness (fallacious reasoning) - For example, explaining spouse behavior by technical or neurological terms. This way patient switches his experience from an emotional to an intellectual level and thus postpones confrontation with the reality of situation.Watch associated Bootcamp videoa2394ed7-04d4-4a60-8ce5-d25c5e5c550c
Which ego defense is defined as separating feelings from ideas and events? {{c1::Isolation of affect (immature defense)}}- Isolating a distressing memory / event and failing to experience the emotions of event - e.g., describing murder in graphic detail with no emotional responseWatch associated Bootcamp video1e47be15-2771-4ac7-8a87-5f247f1228fd
Which ego defense is defined as demonstrating hostile feelings in a non-confrontational manner? {{c1::Passive aggression (immature defense)}}- Showing indirect opposition - e.g., disgruntled employee is repeatedly late to work, but won't admit it is a way to get back at the managerWatch associated Bootcamp videob6e95a16-78a5-4ef9-ace8-3d03fd92aab1
Which ego defense is defined as misattributing one's own unconscious, undesired thoughts or feelings to another person who does not actually have them? {{c1::Projection (immature defense)}}- As opposed to displacement, where you redirect emotions or impulses to a neutral object - Projection allows an individual to be relieved of unacceptable feelings without the internal conflict that would occur with self expression - e.g., a man who wants to cheat on his wife accuses his wife of being unfaithfulWatch associated Bootcamp videodf335483-af05-449c-a1ae-7fb8aaf2b9be
Which ego defense is defined as proclaiming logical reasons for actions actually performed for other reasons (usually to avoid self-blame)? {{c1::Rationalization (immature defense)}}- Distorting events so outcome is positive - e.g., after getting fired, claiming that the job was not important anywayWatch associated Bootcamp video97232767-1a6b-4223-8ba0-0a6ee1e6a0fe
Which ego defense is defined as unconsciously replacing an idea or feeling with its opposite? {{c1::Reaction formation (immature defense)}}- e.g., a patient with sexual thoughts enters a monastery - As opposed to sublimation (mature defense), which is replacing an unacceptable wish with a course of action that is similar to the wish but doesn't conflict with one's value systemWatch associated Bootcamp video3a61cdb3-80b8-44aa-876c-f020555d2e76
Which ego defense is defined as involuntarily reverting to the behavior of a younger person/child? {{c1::Regression (immature defense)}}- As opposed to fixation, which is partially remaining at an earlier stage of development - Seen in children under stress such as illness, punishment, or birth of new sibling (e.g., bedwetting in a previously toilet-trained child while hospitalized)Watch associated Bootcamp video70fcdbc6-c3fb-42ad-88fa-bc534a962a64
Which ego defense is defined as involuntarily withholding an idea or feeling from conscious awareness? {{c1::Repression (immature defense)}}- As opposed to suppression (mature defense), where you intentionally withhold an idea or feeling from conscious awareness - e.g., a 20-year-old does not remember going to counseling during his parents' divorce 10 years earlierWatch associated Bootcamp videoc15941f2-dfed-492b-b160-a455573b9ef2
Which ego defense is defined as believing that people are either all good or all bad at different times due to intolerance of ambiguity? {{c1::Splitting (immature defense)}}e.g., a patient says that all the nurses are cold and insensitive but that the doctors are warm and friendlyWatch associated Bootcamp videoc80c0460-420f-47ad-ab30-3a1f2aa6438c
{{c2::Splitting}} is a major defense mechanism seen in patients with {{c1::borderline}} personality disorder- This is black and white thinking (always - never), these patients cannot hold opposing views - Relationships are either all good (my boyfriend is a perfect angel) OR all bad (my boyfriend is evil and I hate him) - Can alternate by dayWatch associated Bootcamp videobfb1e4f2-3fad-4b7b-8099-24a08d0775b6
Which ego defense is defined as replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one's value system? {{c1::Sublimation (mature defense)}}- As opposed to reaction formation, which is replacing an unacceptable wish by an unconscious emphasis on its opposite - e.g., teenager's aggression toward their parent is redirected to perform well in sportsWatch associated Bootcamp video243bf0b0-a4ce-44a7-8b1f-181b129a2e11
Which ego defense is defined as alleviating negative feelings via unsolicited generosity which provides gratification? {{c1::Altruism (mature defense)}}e.g., mafia boss makes large donation to charityWatch associated Bootcamp video157eab15-8e74-4f40-a04d-9655f89b69b2
Which ego defense is defined as intentionally withholding an idea or feeling from conscious awareness (temporary)? {{c1::Suppression (mature defense)}}- As opposed to repression, which is defined as unintentionally withholding an idea or feeling from conscious awareness - e.g., choosing to not worry about the big game until it is time to playWatch associated Bootcamp video36fbe97e-831c-42cd-a322-5bd0c80f4521
Which ego defense is defined as appreciating the amusing nature of an anxiety-provoking or adverse situation? {{c1::Humor (mature defense)}}e.g., nervous medical student jokes about the boardsWatch associated Bootcamp video4ef6abe8-2698-40e7-9b6e-1d93776e84ba
"The mature mechanisms of ego defense may be remembered with the mnemonic ""SASH"": {{c1::Sublimation::S}} {{c1::Altruism::A}} {{c1::Suppression::S}} {{c1::Humor::H}}"Mature because they don't impair social functioning and in many cases help improve social functioningWatch associated Bootcamp videoy399bc76d-24ca-46d3-a895-cd9c7d76b901
The mature mechanisms of ego defense may be remembered with the mnemonic {{c1::SASH}}Sublimation Altruism Suppression Humor Mature because they don't impair social functioning and in many cases help improve social functioningWatch associated Bootcamp video168e00fd-8b6b-41b3-8e37-4f9b3a35f3d1
Long-term infant deprivation of affection may result in {{c1::reactive attachment}} disorder, where the infant is emotionally withdrawn and unresponsive to comfort"- Does not ""react"" (infant withdrawn/unresponsive to comfort) - vs. disinhibited social engagement disorder (go up to everyone)"c99334d7-d27d-4479-a555-109ba29e46c4
Evidence of {{c3::shaken baby syndrome}} includes {{c1::subdural}} hematomas, {{c2::retinal}} hemorrhages, cervical spine injury, and posterior rib fractures"- The head findings in shaken baby syndrome are known as abusive head trauma - Subdural hematomas occur because the bridging veins have not yet fully developed and are weak still - Retinal hemorrhages may be seen below: Photo credit: Tatiana Tarules Azzi, Leandro Cabral Zacharias, Sérgio Luis Gianotti Pimentel, ""Spontaneous Absorption of Extensive Subinternal Limiting Membrane Hemorrhage in Shaken Baby Syndrome"", Case Reports in Ophthalmological Medicine, vol. 2014, Article ID 360829, 3 pages, 2014. https://doi.org/10.1155/2014/360829"Watch Epidural Hematoma, Subdural Hematoma, & Subarachnoid Hemorrhage Watch Intracranial & Extracranial HemorrhagesWatch associated Bootcamp videof7c0d6c6-5396-48c9-bf1d-20a939a138f6
Children who are victims of physical abuse often avoid {{c1::eye contact}} on examConsider child abuse in adolecents who exhibit abrupt shifts in behavior especially unsafe sexual activitiesWatch associated Bootcamp video79f1db95-2319-4ed3-a4d0-68c8d980fb43
Attention-deficit hyperactivity disorder (ADHD) has an onset before age {{c1::12}}More common in malesWatch associated Bootcamp videodd6e15d8-cfef-4ca1-a503-72210437648c
{{c1::Attention-deficit hyperactivity disorder (ADHD)}} is characterized by hyperactivity, impulsivity, and/or inattention in multiple settings (school, home, places of worship, etc.) for {{c2::≥ 6 months::duration}}Limited attention span and poor impulse control but generally not hostile; teacher and parent behavior rating scales can be helpfulWatch associated Bootcamp video3bec6d83-7a73-49ed-9421-49d317c22730
Attention-deficit hyperactivity disorder (ADHD) continues into adulthood in {{c1::50}}% of cases- adults have more prominent inattention and impulsivity, less hyperactivity - may be previously undiagnosed, so it is important to obtain childhood historyWatch associated Bootcamp videod9ce8e8a-91b7-4a72-bc85-b5769d04fd4c
Autism spectrum disorder is associated with {{c1::increased}} head/brain sizeWatch associated Bootcamp video871b142a-1a80-4f61-9081-1d64b8a97b2c
What is the mode of inheritance of Rett syndrome? {{c1::X-linked dominant}}Watch Rett SyndromeReview Rett SyndromeWatch associated Bootcamp video63ef1160-8bb8-4c83-bc0b-09fa2ac1b563
The majority of cases of {{c2::Rett}} syndrome are caused by de novo mutations in {{c1::MeCP2}}MeCP2 recognizes methylated CpG dinucleotides and recruits other proteins (like HDACs) to silence the target gene Photo credit: Frontiersin [https://doi.org/10.3389/fnmol.2017.00316]Watch Rett SyndromeReview Rett SyndromeWatch associated Bootcamp videoad5c8f77-187d-4375-9dfb-bb5318647e5f
Rett syndrome presents with {{c1::regression}}, including loss of development and verbal abilities- Normal development until 5-18 months - Deceleration of head growth is a classic feature and can be an early sign Additional findings include: - Stereotypical hand movement - Gait abnormality - Microcephaly - Seizure - Breathing abnormalities - Sleep changes - Autistic featuresWatch Rett SyndromeReview Rett SyndromeWatch associated Bootcamp video6eda8abc-c3b0-4e49-8763-41d24b466d2e
{{c2::Rett}} syndrome often presents with verbal regression, intellectual disability, ataxia, and stereotyped {{c1::hand-wringing}}Other hand movements include: - Hand-to-mouth licking - Grabbing of clothing or hair Additional findings include: - Gait abnormality - Microcephaly - Seizure - Breathing abnormalities - Sleep changes - Autistic features - Retturn to early developmental stageWatch Rett SyndromeReview Rett SyndromeWatch associated Bootcamp video3238d425-f048-4f42-ae17-9fc26ea999d1
Rett syndrome symptoms usually become apparent between ages {{c1::1}} to {{c1::4}}- Rett has one syllable and four letters - Characterized by normal development until age 5-18 monthsWatch Rett SyndromeReview Rett SyndromeWatch associated Bootcamp video32e79ef4-be8a-4d5a-84fc-69fa7257d7d1
{{c1::Conduct}} disorder is a childhood disorder characterized by repetitive and pervasive behavior that violates the basic rights of others or societal normse.g. aggression to people and animals, destruction of property, theft ≥ 18 → Antisocial personality disorder (requires history of conduct disorder before 15)Watch associated Bootcamp video87291446-7826-47cb-a45c-d39f01607c2b
After age 18, {{c2::conduct}} disorder is often reclassified as {{c1::antisocial}} personality disorderWatch associated Bootcamp videoad8a790e-7ae1-4289-ba57-d35cdb031fe6
What is the treatment for both conduct disorder and antisocial personality disorder? {{c1::Psychotherapy (e.g. CBT)}}Watch associated Bootcamp video - Anger Disorders Watch associated Bootcamp video - Therapy46ae1669-bec7-49a5-a2ca-e270ffc3a79e
{{c1::Oppositional defiant}} disorder is a childhood disorder characterized by an enduring pattern of hostile, defiant behavior towards authority figures in the absence of serious violations of societal norms for {{c2::≥ 6 months::duration}}They deliberately annoy others and blame others for their mistakes / misbehaviorWatch associated Bootcamp video14362c6a-7762-47e4-bcd3-fa7e10770248
What is the treatment for oppositional defiant disorder? {{c1::Psychotherapy (e.g. CBT) and parent management training::2}}Watch associated Bootcamp video - Anger Disorders Watch associated Bootcamp video - Therapyff1d3e49-8c61-4f50-9f7d-1a76439cb67b
{{c2::Tourette}} syndrome is a childhood disorder characterized by sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for {{c1::> 1 year::duration}}- If only one type of tic (motor or vocal) is present, it is termed chronic or transient tic disorder - Tics are typically preceded by a premonitory urge and are exacerbated by stress and fatigueWatch associated Bootcamp video112eeac6-6914-4c43-b769-549faa323f4a
The onset of Tourette syndrome symptoms is before age {{c1::18}}- Most commonly presents between age 6-15 - More commonly in boysWatch associated Bootcamp video7e5f724e-9b59-442f-af1d-cf2aba0fe589
What other psychiatric disorders are associated with Tourette syndrome? {{c1::OCD and ADHD::2}}Watch associated Bootcamp video4d60ffb2-18fe-49fb-b783-016755548c9f
Pharmacological treatment for intractable and distressing tics in Tourette syndrome may include {{c1::high-potency antipsychotics}}e.g. haloperidol, fluphenazine, pimozide; other treatment options include α2 agonists, tetrabenazine, and atypical antipsychoticsWatch associated Bootcamp video - Isolating Developmental Disorders Watch associated Bootcamp video - Typical Antipsychotics01a2de08-c061-4fd4-bc1f-783a20ad3761
Pharmacological treatment for intractable and distressing tics in Tourette syndrome may include {{c1::α2}}-adrenergic agonistse.g. guanfacine, clonidine; other treatment options include antipsychotics and tetrabenazineWatch Alpha DrugsWatch associated Bootcamp videoad9a873e-faf3-4842-ace7-77ecb14ed0c0
{{c1::Disruptive mood dysregulation}} disorder is a childhood disorder characterized by severe and recurrent temper outbursts out of proportion to a situation, in addition to anger/irritability outside of outburstsDisruptive mood dysregulation disorder and intermittent explosive disorder are mainly distinguished by persistent irritability or anger between outbursts, which is only seen in DMDDWatch associated Bootcamp video8237ff7c-f868-4045-a843-deacc2e7b382
The onset of disruptive mood dysregulation disorder (DMDD) symptoms is before age {{c1::10}}Diagnosis is not made prior to age 6 or after age 18Watch associated Bootcamp videof0113d28-717b-45b7-83a9-e5b4c87a12c8
What neurotransmitter is decreased in Alzheimer disease? {{c1::Acetylcholine}}Watch Alzheimer Disease & DementiaWatch associated Bootcamp video - Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA Watch associated Bootcamp video - Alzheimer Dementia8b62c6c4-8732-4548-b437-d39cce375f7e
What neurotransmitters are decreased in depression? {{c1::Serotonin, norepinephrine, and dopamine::3}}Neurotransmitters Decreased by Sadness (depression)Watch associated Bootcamp video - Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA420ec817-e16c-4610-ab95-4e5924142313
What neurotransmitter is increased in anxiety? {{c1::Norepinephrine}}Watch associated Bootcamp video - Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA5659676b-a3e6-4075-97a9-f72d42505a33
What neurotransmitters are decreased in anxiety? {{c1::Serotonin}} and {{c2::GABA}}Watch associated Bootcamp video - Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA6ce5cc55-86b9-4f3e-944d-26f849496954
What neurotransmitter is increased in Huntington disease? {{c1::Dopamine}}Review Huntington DiseaseWatch associated Bootcamp video - Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA Watch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Additional Causes of Dementiade4b28b7-60a5-416e-8b44-794ce7110e77
What neurotransmitters are decreased in Huntington disease? {{c1::GABA}}, {{c1::acetylcholine}}, and substance P"""GAsP"""Review Huntington DiseaseWatch associated Bootcamp video - Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA Watch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Additional Causes of Dementiad95006cf-c2ff-4190-b65f-1f795d5ee077
What neurotransmitter is increased in Parkinson disease? {{c1::Acetylcholine}}Watch associated Bootcamp video - Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA Watch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Parkinson Disease74b9a8c3-2cb7-4d21-89b1-933fa5fe0132
What neurotransmitters are decreased in Parkinson disease? {{c1::Dopamine}} and {{c2::serotonin}}As Parkinson disease progresses, it eventually degrades the raphe nucleus causing a decrease in serotonin levelsWatch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseReview Nigrostriatal PathwayWatch associated Bootcamp video - Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA Watch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Parkinson Diseasefdc43560-4846-4adf-9508-40b1d00bc58d
What neurotransmitter is increased in schizophrenia? {{c1::Dopamine}}Watch associated Bootcamp video - Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA80fbc6b1-e196-429d-9dee-06deadeaeb94
{{c1::Dissociative}} amnesia is an inability to recall important personal information, usually subsequent to severe trauma or stressWatch associated Bootcamp videof54752fd-33f2-466d-92f2-b5e90ecf0e84
{{c1::Dissociative fugue}} is an abrupt traveling or wandering during a period of dissociative amnesia; associated with traumatic circumstancesThis leads to significant distress / impairment; is not a result of substance abuse or general medicationsWatch associated Bootcamp video97e3cb98-dafa-4924-ac66-f99fc658b902
{{c1::Dissociative identity}} disorder is characterized by the presence of 2 or more distinct identities or personality states, usually following psychological trauma- e.g., history of sexual abuse, PTSD, depression, substance abuse, borderline personality, somatoform conditions - Previously known as multiple personality disorder - May present as recurrent memory gaps, derealization, and auditory hallucinationsWatch associated Bootcamp video2665b3a8-91c8-4732-8c34-dfe9f777ca95
{{c1::Depersonalization/derealization}} disorder is characterized by persistent feelings of detachment from one's own body, thoughts, perceptions, and actions or one's environment- Patient feels disconnected from their own interactions with the world around them - Depersonalization = detachment from one's own body, thoughts, perceptions, and actions (de-PERSON) - Derealization = detachment from one's environment (de-REAL environment)Watch associated Bootcamp video66256cdc-d599-4de8-b03c-2e9d9bdcce16
"Which psychiatric disorder is characterized by acute onset ""waxing and waning"" level of consciousness? {{c1::Delirium::Delirium or Dementia}}"Watch associated Bootcamp video30f08787-9b92-4e04-90d5-4df03caae13a
{{c2::Delirium::Dementia or Delirium}} is associated with a(n) {{c1::diffuse, slowing}} pattern on EEGEEG: normal in dementia, abnormal in delirium. [delirium = brain is going haywire temporarily]Watch associated Bootcamp video67ecffa9-e37d-4589-89a2-4800fdc05df4
{{c2::Dementia::Dementia or Delirium}} is associated with a(n) {{c1::normal}} pattern on EEGWatch associated Bootcamp video - Alzheimer Dementia98cb9f22-af36-4c35-b643-3f7b0329b0c7
What GI pathology is an irreversible cause of dementia? {{c1::Wilson disease}}AKA hepatolenticular degenerationWatch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Copper Transport Disordersf9a31fe9-cafa-4f4a-afd2-0e227a6bcebd
What infectious disease is an irreversible cause of dementia? {{c1::HIV}}- Presents with subcortical symptoms - e.g., basal ganglia or nigrostriatal dysfunction (slowed movement, difficult with smooth limb movements)Watch Alzheimer Disease & DementiaWatch associated Bootcamp video - Additional Causes of Dementia Watch associated Bootcamp video - Opportunistic Infections: HIV-associated Dementia and Neuropathy, Histoplasmosis, Coccidioidomycosisceec257a-2ed2-459a-ba67-e16df229af32
In elderly patients with suspected dementia, measure {{c1::TSH}} and {{c2::vitamin B12}} levels to rule out other possible causesWatch associated Bootcamp video - Alzheimer Dementiae21140a7-c62c-47e7-a1fd-8f264ee35fb7
In elderly patients with suspected dementia, perform screening for {{c1::depression}} to rule out other possible causesWatch associated Bootcamp video - Alzheimer Dementia613de767-985f-4a21-aa34-be3f46531aac
What endocrine pathology is a reversible cause of dementia? {{c1::Hypothyroidism}}Watch associated Bootcamp video - Alzheimer Dementia14665fb6-eb39-47e9-8c09-6fb5a8cb12d7
What infectious disease is a reversible cause of dementia? {{c1::Neurosyphilis}}Watch Treponema pallidumWatch associated Bootcamp video - Alezheimer Dementia Watch associated Bootcamp video - Neurosyphilis (Neurology) Watch associated Bootcamp video - Neurosyphilis (Microbiology)8ecb2e3d-a0fb-4454-8076-207bc6287233
What form of hydrocephalus is a reversible cause of dementia? {{c1::Normal pressure hydrocephalus}}Watch HydrocephalusWatch associated Bootcamp video - Additional Causes of Dementia52e1c157-4cce-4f6c-a4e7-d1098b77d704
{{c1::Illusions}} are misperceptions of real external stimulivs. hallucinations, which are perceptions in the absence of external stimuliWatch associated Bootcamp video224f3402-5dea-4bd8-a777-05d52391d7a1
{{c1::Olfactory}} hallucinations often occur as an aura of temporal lobe epilepsy and in brain tumorsWatch associated Bootcamp video0e25b1ea-c2aa-40c8-a1d6-2d9c07b226a4
Gustatory hallucinations are rare, but may be seen in {{c1::focal-onset temporal lobe epilepsy::specific}}False perception of taste (usually unpleasant)Watch associated Bootcamp videod56592ca-6d4c-4dbf-8d11-440c4a163dc9
{{c1::Tactile}} hallucinations are common in {{c2::alcohol}} withdrawal and {{c3::stimulant}} use (e.g. cocaine, amphetamines)"e.g. delusional parasitosis (bugs under skin), ""cocaine crawlies"""Watch associated Bootcamp video - Psychosis Watch associated Bootcamp video - Alcohol Withdrawalcde1a997-1ff4-48cb-90f3-cc3d1cc5e669
{{c1::Hypnagogic}} hallucinations occur while going to sleep; sometimes seen in narcolepsy"""hypnaGOgic, GOing to sleep"""Watch associated Bootcamp video8fa3b4d4-107f-47b3-b06e-b65be40243e4
{{c1::Hypnopompic}} hallucinations occur while waking from sleep; sometimes seen in narcolepsy"""Hypnopompic, pompous upon awakening"""Watch associated Bootcamp videofb905a72-252e-40bd-ba61-e0f7d18fe406
"Diagnosis of schizophrenia requires at least {{c1::2::#}} of the following for at least 1 month, and 1 of these must include {{c1::#1 to #3::# range}}: + Positive symptoms + 1. {{c2::Delusions}} 2. {{c3::Hallucinations}} 3. {{c4::Disorganized speech}} 4. Disorganized or catatonic behavior 5. Negative symptoms"- Diagnosis of schizophrenia also requires that the disturbance persists in some form (not necessarily meeting the above criteria) for at least 6 months - Negative symptoms include affective flattening, avolition, anhedonia, asociality, or alogia - Alogia = poverty of speech, Avolition = lack of interest in goal directed behaviorWatch associated Bootcamp videoa8930445-6de6-4a8f-a140-9236176aab3e
{{c2::Brief psychotic}} disorder is symptoms of schizophrenia lasting {{c1::< 1 month::duration}} with ≥ 1 {{c3::positive}} symptomWatch associated Bootcamp video4c3855d6-6a15-484a-816a-41c04524ec35
{{c2::Schizophreniform}} disorder is symptoms of schizophrenia lasting from {{c1::1}} to {{c1::6::duration}} monthsWatch associated Bootcamp video84ecc5e8-131e-43f4-ac4e-bd76f62301bb
If episodes of psychosis only occur during a major mood episode, the diagnosis is either {{c1::major depressive disorder with psychotic features}} or {{c2::bipolar disorder with psychotic features}}Watch associated Bootcamp video884be98f-bc42-44cb-a46d-10ac44e9c652
Are hallucinations involving a dead relative during a period of bereavement considered normal? {{c1::Yes (within 6 months)}}- e.g., hearing the dead person speak (common) - Especially if patient is a child under the age of 6 (typically do not understand finality of death)Watch associated Bootcamp videod9527cc1-5bdb-46cd-8c39-b11c9ad87931
Is schizophrenia more common in males or females? {{c1::Males}}Presents earlier in males as well - late teens to early 20s in males - late 20s to early 30s in femalesWatch associated Bootcamp video5fb6c645-e72d-4d59-bdc9-10c5961d3173
{{c1::Delusional}} disorder is a fixed, persistent, false belief system lasting ≥ {{c2::1 month::duration}} with otherwise normal functioning- e.g. a woman who genuinely believes she is married to a celebrity when, in fact, she is not - Hallucinations and disorganization are absent; this is a persistent overriding delusion with a specific themeWatch associated Bootcamp videoa4c5ea98-2b02-410b-a74d-26f926c7cfab
Delusional disorder typically presents with {{c1::non-bizarre::bizarre or non-bizarre}} delusionsi.e. theoretically possible, but not plausible vs. schizophrenia is more associated with bizarre delusionsbd444731-d394-421c-8c18-16da5e9d93c4
Delusions can be shared by individuals in close relationships; termed {{c1::folie à deux}}Ex: The Joker and Harley Quinnf5fcd82c-8df7-4037-b2c2-2acbf09693a4
A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood with persistently increased activity or energy for at least {{c1::1 week::duration}}Diagnosis requires at least three DIG FAST criteria as well Distractibility Impulsivity/Indiscretion* Grandiosity (inflated self-esteem) Flight of ideas (racing thoughts) Agitation/increased Activity Sleeplessness Talkativeness or pressured speech *Seeks pleasure without regard to consequences (hedonistic)Watch associated Bootcamp video2cfc36a0-5e4b-4fb5-88e0-3738eee28d67
"Diagnosis of a(n) {{c1::manic episode}} requires an elevated and/or irritable mood for at least {{c1::1 week::length of time}} plus at least {{c1::three::#}} ""DIG FAST"" criteria: {{c2::Distractibility::D}} {{c2::Impulsivity/Indiscretion*::I}} {{c2::Grandiosity (inflated self-esteem)::G}} {{c2::Flight of ideas (racing thoughts)::F}} {{c2::Agitation/increased Activity::A}} {{c2::Sleeplessness::S}} {{c2::Talkativeness or pressured speech::T}}"*seeks pleasure without regard to consequences (hedonistic)Watch associated Bootcamp videoyd3866e00-3040-45b8-8473-5e19831a1bee
Diagnosis of a manic episode requires an elevated and/or irritable mood for at least 1 week plus at least three {{c1::DIG FAST::mnemonic}} criteriaDistractibility Impulsivity/Indiscretion* Grandiosity (inflated self-esteem) Flight of ideas (racing thoughts) Agitation/increased Activity Sleeplessness Talkativeness or pressured speech *Seeks pleasure without regard to consequences (hedonistic)Watch associated Bootcamp videoe5d41f1f-b93c-417a-8a0b-f3a9d3fc6f92
Do patients with manic episodes need to be hospitalized? {{c1::Yes (psychiatric emergency)}}- 50% are psychotic; prone to extremely dangerous behavior - Psychotic features must present with mood symptoms (if psychotic features are present in the absence of mood symptoms, consider schizoaffective)Watch associated Bootcamp videobe8acc28-ae25-4b38-8e48-078ce53af0d1
A(n) {{c1::hypomanic}} episode is similar to a manic episode except mood disturbance doesn't cause marked impairment in social or occupational functioningThese patients exhibit a noticable change in behavior but are often very productive despite requiring less sleep (elevated mood, excess energy, hyperactivity, decreased need for sleep, inflated self-esteem)Watch associated Bootcamp videof78cf804-2917-46d4-ac00-ddb6ddb316a7
A hypomanic episode must last at least {{c1::4}} consecutive daysWatch associated Bootcamp video54733aa6-3970-42a7-b03a-3f0995f6c607
Does a patient with bipolar disorder typically return to normal mood and functioning between episodes? {{c1::Yes}}Bipolar 1 (one episode of mania) - Usually major depressive episodes occur additionally Bipolar 2 (one episode of hypomania and one episode of depression) - Depression is usually more severe and occurs more frequentlyWatch associated Bootcamp video52961e6e-dc40-41d8-b6e4-16054e95f211
Use of {{c2::antidepressants}} in patients with {{c3::bipolar}} disorder can precipitate acute {{c1::mania}}All antidepressants carry this risk; thus if a patient becomes manic / hypomanic on antidepressant therapy, stop the antidepressant and initiate a mood stabilizerWatch associated Bootcamp video251d5c1a-4275-4863-923b-3f24083ef7f4
{{c1::Cyclothymic}} disorder is a milder form of bipolar disorder lasting at least {{c2::2 years::duration}}, fluctuating between mild depressive and hypomanic symptoms- Symptoms must continue for at least two years - Minimal return to baseline (< 2 months per 2 years); i.e., constant cycling EpisodicChronicDownsMajor depressive disorderDysthymiaUps (and usually downs)Bipolar 1 and 2CyclothymiaWatch associated Bootcamp video2bd834ea-b1e9-4802-b6d3-e80e5a7ba5f5
Does a patient with cyclothymia typically return to normal mood and functioning between episodes? {{c1::No}}- Minimal return to baseline (< 2 months per 2 years); i.e., constant cycling - Symptoms must continue for at least two years EpisodicChronicDownsMajor depressive disorderDysthymiaUps (and usually downs)Bipolar 1 and 2CyclothymiaWatch associated Bootcamp videof8fcb104-4c51-4a4a-9826-c8ced575fdc8
"{{c1::Major depressive}} disorder episodes are characterized by {{c1::depressed}} mood or {{c1::anhedonia}} and at least {{c1::4}} other ""SIG E CAPS"" symptoms lasting {{c1:: ≥ 2 weeks::duration}} {{c2::Sleep changes::S}} {{c2::Interest decreases (anhedonia)::I}} {{c2::Guilt or feelings of worthlessness::G}} {{c2::Energy loss or fatigue::E}} {{c2::Concentration problems::C}} {{c2::Appetite/weight changes::A}} {{c2::Psychomotor impairment or agitation::P}} {{c2::Suicidal ideations::S}}"- ≥ 5 symptoms required for diagnosis - At least one must be anhedonia or depressed mood - Anhedonia and depression count towards the ≥ 5 symptom requirement (e.g., Anhedonia + 4 other symptoms = 5)ya115ffcb-5f62-4421-bdff-c084dac66ab0
Major depressive disorder episodes are characterized by depressed mood or anhedonia and at least 4 other {{c1::SIG E CAPS}} symptoms lasting ≥ 2 weeksSleep changes Interest decreases (anhedonia) Guilt or feelings of worthlessness Energy loss or fatigue Concentration problems Appetite/weight changes Psychomotor impairment or agitation Suicidal ideations ≥ 5 symptoms required for diagnosis - At least one must be anhedonia or depressed mood - Anhedonia and depression count towards the ≥ 5 symptom requirement (e.g., Anhedonia + 4 other symptoms = 5)5ac78e5f-7909-4d5f-b9e8-eeeecda92393
What is the first-line treatment for major depressive disorder? {{c1::CBT + SSRIs}}- Mild depression: typically CBT alone - Moderate and severe depression: CBT + SSRI - May also consider SNRIs, mirtazapine, and bupropion (second line)Watch associated Bootcamp video - Major Depressive Disorder Watch associated Bootcamp video - SSRIs Watch associated Bootcamp video - Therapy3782df2e-4d22-46c6-bfd1-54048da189fe
Atypical depression is associated with {{c1::mood reactivity}}, which is being able to experience improved mood in response to positive events, albeit brieflyImportant distinguishing feature from melancholic depressionWatch associated Bootcamp videoe17dac14-05ad-485a-b80c-f5b688ba78f6
Atypical depression is associated with {{c1::hyper}}phagiaimportant distinguishing feature from melancholic depressionWatch associated Bootcamp videof95b29d4-9395-49f4-9d74-814d683f4a19
{{c2::Atypical}} depression is associated with {{c1::leaden paralysis}} (feeling of heaviness in limbs) and sensitivity to rejectionWatch associated Bootcamp video65be598c-601e-481e-86ff-f0c87bc8a0fb
What is the first-line treatment for atypical depression? {{c1::CBT and SSRIs}}Watch associated Bootcamp video - Major Depressive Disorder Watch associated Bootcamp video - Therapy Watch associated Bootcamp video - SSRIs60a34318-45bd-49a8-b2c2-9e435beb9df0
{{c1::MAO inhibitors}} are an effective treatment for atypical depression, but not first-line due to their risk profileWatch associated Bootcamp video - Major Depressive Disorder Watch associated Bootcamp video - MAOIs4d4dfdbe-af84-48b1-a850-3fb12569536b
The onset of postpartum mood disturbances is typically within {{c1::4}} weeks of delivery"- If the onset is within 4 weeks, the DSM-5 specifier ""with peripartum onset"" is used - In clinical practice, the term ""postpartum depression"" is used to describe depression that begins in the first 12 months - Major depressive episode is defined as ≥5 SIG E CAPS symptoms"7a903fbe-c0e0-4cb8-84ef-27034e429189
Postpartum {{c1::blues}} is characterized by depressed affect, tearfulness, and fatigue starting 2-3 days after delivery for < {{c2::2}} weeks- Reassure and monitor; return if they do not resolve spontaneously after 2 weeks or start having SI - Increased risk of postpartum depression - 50 - 85% incidence rate; usually resolves within 10 days - Signs of anhedonia (eg, inability to enjoy) would be more of a sign of MDD0a39332c-7f17-4ff1-a52d-08251e407959
What is the treatment for postpartum blues? {{c1::Supportive}}Follow up to assess for possible postpartum depression5c251079-7f52-4a21-aad0-7a668065f026
Postpartum {{c1::depression}} is characterized by depressed affect, anxiety, and poor concentration for ≥ {{c2::2}} weeks"- 10 - 15% incidence rate - If onset is within 4 weeks, the DSM-5 specifier ""with peripartum onset"" is used - In clinical practice, the term ""postpartum depression"" is used to describe depression that begins in first 12 months - Major depressive episode defined as ≥5 SIG E CAPS symptoms"a62d4179-a6dd-4880-b09f-30a17dd8656e
What is the treatment for postpartum depression? {{c1::Cognitive behavioral therapy (CBT) and/or SSRIs}}The U.S. Food and Drug Administration recently also approved Zulresso (brexanolone) injection for intravenous (IV) use for the treatment of postpartum depression (PPD) in adult women, this is the first drug approved by the FDA specifically for PPDWatch associated Bootcamp video - Therapy Watch associated Bootcamp video - SSRIs2fdbb599-c4af-4845-92fa-c19374149416
Postpartum {{c1::psychosis}} is characterized by mood-congruent delusions, hallucinations, and thoughts of harming the baby or self within {{c1::4 weeks}} after giving birth- 0.1 - 0.2% incidence rate - However, UWorld states that it is 2 weeks, while AMBOSS states 2-4 weeks, and FA23 states 4 weeks (Jul 2023)d6810b08-5934-47ca-9bb0-54798c47f0ae
Risk factors for postpartum psychosis include {{c1::first}} pregnancy, history of bipolar or psychotic disorder, family history, and recent discontinuation of psychotropic medication757ea2f6-ea64-4e87-9b5d-8f02959ef63c
What is the treatment for postpartum psychosis? {{c1::Hospitalization and antipsychotics::2}}may use electroconvulsive therapy if insufficient110c70af-0ca5-4e5b-ab5e-40651253b649
Can a person with grief meet the criteria for major depressive episode? {{c1::Yes}}Still considered major depressive episode and treated as such (e.g. CBT + SSRIs), even if they are grievingf2256a43-cfe1-405d-a7b2-655cb9bfde3c
Adverse effects of electroconvulsive therapy include temporary headache, disorientation, and partial {{c1::amnesia}}; usually resolves within 6 months65b572ea-e164-4d9e-83af-bbef8480290e
Is electroconvulsive therapy safe to use in pregnant and elderly individuals? {{c1::Yes}}a2a9c8b2-6150-4af0-9b47-a8dac92d4b14
What is the most common cause of meningitis in neonates? {{c1::Group B Strep (Streptococcus agalactiae)}}Will not present with classic signs (stiff neck, etc.) Most common bugs in neonates: Newborn GEL (GBS > E.coli > Listeria) Bacterial Meningitis - Most Common CausesAgeBacteriaNeonatesGroup B streptococci > Escherichia coli > Listeria monocytogenesChildrenStreptococcus pneumoniaeAdolescentsNeisseria meningitidisAdultsStreptococcus pneumoniaeElderlyStreptococcus pneumoniae > Listeria monocytogenesWatch Streptococcus agalactiae (Group B Strep)Watch associated Bootcamp video - Streptococcus Agalactiae Watch associated Bootcamp video - Infectious Neuropathology: Neonatal Meningoencephalitis Watch associated Bootcamp video - Infectious Neuropathology: Bacterial Meningoencephalitis6c9af48d-15b7-4fc0-b31b-a47ae2f09cac
Neonatal {{c1::abstinence}} syndrome occurs due to exposure to opiate drugs while in the mother's womb- presents as an irritable, sweaty, tachypneic baby - treat with morphine or methadoneWatch Opioids, Naloxone, NaltrexoneWatch associated Bootcamp video - Teratogenic Medications Watch associated Bootcamp video - Opioidsa25de424-959e-4ff1-8b85-ab56170fa36c
Neonatal abstinence syndrome presents with diarrhea, sweating, irritability, and {{c1::tachypnea::respiratory rate}}- Other possible symptoms include high-pitched cry, poor sleeping, tremors, sneezing, and vomiting - Treat with morphine or methadoneWatch Opioids, Naloxone, NaltrexoneWatch associated Bootcamp video - Teratogenic Medications Watch associated Bootcamp video - Opioids19a37459-10ae-4331-bd08-b64e67c04d8c
"The risk factors for {{c1::suicide completion}} may be remembered with the mnemonic ""SAD PERSONS"": {{c1::Male::S (Sex)}} {{c1::Teenage::A (Age)}} or {{c1::Elderly::A (Age)}} {{c1::Depression::D}} {{c2::Previous attempt (highest risk factor)::P}} {{c2::Ethanol or drug use::E}} {{c2::Rational thinking impaired (psychosis)::R}} {{c3::Sickness (medical illness)::S}} {{c3::Organized plan::O}} {{c3::No spouse or other social support::N}} {{c3::Stated future intent::S}}"This card previously only had 1 cloze, however, 2 new clozes were added to decrease card burden. Please unsuspend the new cards (Apr 2024)Watch associated Bootcamp videoyf5f3b46d-1abd-45ae-8d1d-511b55a42fae
The risk factors for suicide completion may be remembered with the mnemonic {{c1::SAD PERSONS}}Sex: Male Age: Teenage or Elderly Depression Previous attempt (highest risk factor) Ethanol or drug use Rational thinking impaired (psychosis) Sickness (medical illness) Organized plan No spouse or other social support Stated future intentWatch associated Bootcamp video876533bf-e3bc-4c69-86d5-7bd04ec72a7c
"Which ""SAD PERSONS"" risk factor carries the highest risk for suicide? {{c1::Previous attempt}}"Strongest predictive factor of future suicideWatch associated Bootcamp video19d736af-e8bb-4db7-8a20-efa6b88a2676
{{c1::Firearms}} in the house are an independent risk factor for suicide completionAssociated with a 3x increase in suicide completionWatch associated Bootcamp video2910990f-2ecf-40ef-9fe4-cfc7d3e4b0e9
Which sex attempts suicide more often? {{c1::Females}}Whereas males complete suicide more oftenWatch associated Bootcamp videoce24512a-ddf7-487c-92c5-308beb09cdb2
Which sex completes suicide more often? {{c1::Males}}Whereas females attempt suicide more oftenWatch associated Bootcamp video566a7806-aa49-48b4-bc47-9562f25065e0
Diagnosis of {{c2::panic}} disorder requires at least one unexpected panic attack without a known trigger, followed by at least {{c1::one month::duration}} of preoccupations with the attack- e.g., persistent concern of additional attacks, worrying about consequences of the attack, behavioral change related to the attack - Spontaneous and unexpected, not attributable to medications, substances, or another mental disorders (e.g., social anxiety disorder, specific phobias)Watch associated Bootcamp video5fc20efb-da36-4c9e-9fbe-8ea39d7c6270
Panic attacks may be treated acutely with {{c1::benzodiazepines}}Use short-acting benzos to cause a rapid relief of symptoms This card previously also had propranolol, however, UWorld confirms that there is no evidence that propranolol works for panic attacksWatch Benzodiazepines & FlumazenilWatch associated Bootcamp video - Anxiety and Panic Disorders Watch associated Bootcamp video - Benzodiazepines0438f01d-3dfd-4691-a632-0aba3c104119
What is the first-line treatment for specific phobia(s)? {{c1::Exposure therapy (a form of CBT)}}- AKA systematic desensitization - Per AMBOSS: Benzodiazepines (preferred) or SSRIs may be used for bridge therapy until CBT is available or if patients prefer medicationWatch associated Bootcamp videocd17b315-aded-42eb-bf88-76e4ee70a053
{{c1::Social anxiety}} disorder is a phobia characterized by exaggerated fear of embarrassment in public situations (e.g. public speaking, using public restrooms)Watch associated Bootcamp videoec372b33-cf40-4db1-939d-be98f476f983
First-line treatment for social anxiety disorder includes {{c1::CBT or SSRIs/SNRI (e.g., venlafaxine)::2}}Initial treatment is based on patient preference and/or availability of CBT - No/partial response to SSRI/SNRI w/ no history of SUD → clonazepam (benzodiazepine) - No/partial response to SSRI/SNRI with history of SUD → phenelzine (MAO inhibitor)Watch associated Bootcamp video - Phobias Watch associated Bootcamp video - SNRIs Watch associated Bootcamp video - Therapy Watch associated Bootcamp video - SSRIsff129a26-4fcc-4a9a-a1bd-7314f0ac7bd4
What is the first-line treatment for the performance-only subtype of social anxiety disorder? {{c1::CBT}} ± either {{c1::benzodiazepines}} or {{c1::β-blockers}}- Choice of first line therapy is based on patient preference and/or the availability of CBT - First line treatment for social anxiety disorder: CBT and/or SSRI/SNRI - Social anxiety disorder (SAD): social situation where one may be scrutinized by others (e.g., meeting new people at a party, eating in public) - Performance-only SAD: fear/anxiety restricted only to public speaking or performing in front of crowdsWatch associated Bootcamp video - Phobias Watch associated Bootcamp video - Benzodiazepinesa24f26ee-a304-491a-a783-be01f2686202
{{c1::Agoraphobia}} is characterized by irrational fear, anxiety, and/or avoidance while facing or anticipating ≥ 2 specific situations (e.g. open/closed spaces, public transportation)Symptoms stem from concern that escape or help may be unavailable23530605-1ce8-4a06-a861-363e52d3c4da
What is the first-line treatment for agoraphobia? {{c1::CBT + SSRIs::2}}Second line treatment is long-acting benzo (e.g. clonazepam)Watch associated Bootcamp video - Phobias Watch associated Bootcamp video - Therapy Watch associated Bootcamp video - SSRIse577e015-d36a-45f6-b6ce-e92e12a11cd6
What is the first-line treatment for generalized anxiety disorder? {{c1::CBT and/or SSRIs/SNRI}}Treatment depends on symptom severity, treatment availability, and the patient's preferenceWatch SSRIs, SNRIs, cyproheptadineWatch associated Bootcamp video - Anxiety and Panic Disorders Watch associated Bootcamp video - Therapy Watch associated Bootcamp video - SSRIs Watch associated Bootcamp video - SNRIs00fe6d99-63e6-406c-b72e-46b37e321f4f
"To be diagnosed with {{c1::generalized anxiety disorder}}, patients must exhibit 3/6 of the following symptoms over the course of at least 6 months, which can be remembered with the mnemonic ""Worry WARTS"" {{c1::Wound up (irritability)::W}} {{c1::Worn out (fatigue)::W}} {{c1::Absentminded (difficulty concentrating)::A}} {{c1::Restlessness::R}} {{c1::Tension in muscle::T}} {{c1::Sleep disturbance::S}}"Although the diagnosis of GAD in adults requires uncontrollable worry accompanied by 3 additional symptoms (eg, restlessness, fatigue, irritability), only 1 additional symptom is required in children and adolescentsWatch associated Bootcamp videoybf638c16-2126-4fe0-aabd-40fe73fd8668
To be diagnosed with generalized anxiety disorder, patients must exhibit 3/6 of the following symptoms over the course of at least 6 months, which can be remembered with the mnemonic {{c1::Worry WARTS}}Wound up (irritability) Worn out (fatigue) Absentminded (difficulty concentrating) Restlessness Tension in muscle Sleep disturbance Although the diagnosis of GAD in adults requires uncontrollable worry accompanied by 3 additional symptoms (eg, restlessness, fatigue, irritability), only 1 additional symptom is required in children and adolescentsWatch associated Bootcamp videoe31c772a-c7b7-40e9-86f3-6df6c5e5c7bd
What is the first-line treatment for adjustment disorder? {{c1::Psychotherapy (CBT)}}- Medication can be added if CBT fails - Treatment of adjustment disorder with CBT focuses on developing coping mechanisms and improving the individual's response to and attitude about the stressful situationWatch associated Bootcamp video - Anxiety and Panic Disorders Watch associated Bootcamp video - Therapy42db3ebf-5562-463c-8d65-632e398b4834
{{c1::Obsessive-compulsive}} disorder is characterized by recurring intrusive thoughts, feelings, or sensations that cause severe distress and is temporarily relieved by the performance of repetitive actionsWatch associated Bootcamp videofe797575-010b-4b8d-a6e2-13748b6e9d58
Patients with obsessive-compulsive disorder are ego{{c1::dystonic}}- This means their behavior is inconsistent with their own beliefs or attitudes - Important distinguishing feature from obsessive-compulsive personality disorder (ego-syntonic)Watch associated Bootcamp video1ecb6a48-8d5d-40e4-ab40-5f9e66f92282
{{c1::Body dysmorphic}} disorder is a preoccupation with a minor or imagined defect in appearance, causing significant emotional distress or impaired functioningPatients often repeatedly seek cosmetic treatmentba403274-ca2e-42c7-9def-fe6fddbe3dab
"The symptoms of {{c1::post-traumatic stress disorder (PTSD)}} may be remembered with the mnemonic ""DREAMS"": - {{c1::Disinterest in usual activities::D}} - {{c1::Reexperience (intrusive) of event::R}}, Reckless behavior - {{c1::Event preceding symptoms::E}} - {{c1::Avoidance of associated stimuli::A}}, Angry outbursts - {{c1::Month or more of symptoms::M}} - {{c1::Sympathetic arousal (hypervigilance)::S}}, Sleep disturbance"Dissociative subtype PTSD can also present with symptoms of depersonalization, derealization, and even psychosis-like experiencesWatch associated Bootcamp videoyc4d61443-2b1b-4a59-9aec-83116b790c48
The symptoms of post-traumatic stress disorder (PTSD) may be remembered with the mnemonic {{c1::DREAMS}}Disinterest in usual activities Reexperience (intrusive) of event, Reckless behavior Event preceding symptoms Avoidance of associated stimuli, Angry outbursts Month or more of symptoms Sympathetic arousal (hypervigilance), Sleep disturbance The dissociative subtype of PTSD can also present with symptoms of depersonalization, derealization, and even psychosis-like experiencesWatch associated Bootcamp video7f0278f1-713b-41f2-839f-b8ece8e202a1
PTSD is diagnosed if the disturbance lasts {{c1::> 1 month::duration}} with significant distress or impaired social-occupational functioningWatch associated Bootcamp videob2df7746-70e0-4f85-9394-7a46000b98e7
What drug may be used to reduce nightmares in PTSD? {{c1::Prazosin}}SSRIs/SNRIs remain first-line for treatment for PTSDWatch Alpha DrugsWatch associated Bootcamp video - Anxiety and Panic Disorders Watch associated Bootcamp video - Alpha Adrenergic Antagonists06634ddc-6882-44d4-8bfa-4d8af4768000
{{c2::Acute stress}} disorder is characterized by symptoms of PTSD that last between {{c1::3 days}} and {{c1::1 month::duration}}Do not confuse with brief psychotic disorder which is > 1 day and ≤ 1 monthWatch associated Bootcamp video878533d1-572c-4144-b5f5-63c3d4502c9e
What is the treatment for acute stress disorder? {{c1::Psychotherapy (CBT)}}- Even before initiating CBT, best initial approach is to educate on different reactions to trauma - Pharmacotherapy is usually not indicatedWatch associated Bootcamp video - Anxiety and Panic Disorders Watch associated Bootcamp video - Therapyf0cee60a-d596-4180-9037-f777c0068ab1
{{c1::Malingering}} is when a patient {{c2::consciously::consciously/unconsciously}} fakes, profoundly exaggerates, or claims to have a disorder in order to attain a secondary (external) gain (e.g. avoid work, obtain compensation)- Characterized by poor compliance with treatment or follow-up of diagnostic tests - Intentional production of symptoms is motivated by secondary gain, such as avoiding work, receiving f‌inancial compensation, evading arrest, or obtaining drugs001b33e7-bc82-4cae-806b-926c5d161d20
"{{c1::Factitious}} disorders are when a patient {{c2::consciously*::consciously/unconsciously}} creates physical and/or psychological symptoms in order to assume a ""sick role"" and get medical attention and sympathy (primary/internal gain)"*The goal is to get medical attention and sympathy (primary gain) even though the motivation is unconsciousWatch associated Bootcamp video918893d6-5e92-4559-8cff-d6a6d27929ba
{{c1::Factitious disorder imposed on self}} is a factitious disorder characterized by a history of multiple hospital admissions and willingness to undergo invasive proceduresAlso known as Munchausen syndrome Patient complains of medical symptom that has no medical basisPatient believes there is something wrong (they are mistaken)Patient is lying and knows there is nothing wrongConversion disorder (stress leads to motor or sensory alteration)Factitious disorder (faking sick because they crave the sick role)Somatic symptom disorder (many unexplained complaints)Malingering (lies for gain)Illness anxiety disorder (mild/nonexistent symptoms cause fear of serious illness)Watch associated Bootcamp videobb074280-28a3-4db5-9048-cde8554f0ba5
{{c1::Factitious disorder imposed on another}} is a factitious disorder characterized by illness in a child or elderly patient that is caused or fabricated by the caregiver- AKA Munchausen syndrome by proxy - Motivation is to assume a sick role by proxy Patient complains of medical symptom that has no medical basisPatient believes there is something wrong (they are mistaken)Patient is lying and knows there is nothing wrongConversion disorder (stress leads to motor or sensory alteration)Factitious disorder (faking sick because they crave the sick role)Somatic symptom disorder (many unexplained complaints)Malingering (lies for gain)Illness anxiety disorder (mild/nonexistent symptoms cause fear of serious illness)Watch associated Bootcamp video7c0f5c26-8a6a-46b5-b2fd-b812a78fa63b
The illness production and motivation in somatic symptom disorder are {{c2::unconscious::conscious or unconscious}} drives- Symptoms are not intentionally produced or feigned - Important distinguishing feature from malingering and factitious disordersWatch associated Bootcamp videoa924b570-ac86-4cda-8af5-c4b2ae0c6858
{{c1::Illness anxiety}} disorder is an excessive preoccupation with acquiring or having a serious illness, often despite medical evaluation and reassurance; minimal somatic symptomsalso known as hypochondriasis Patient complains of medical symptom that has no medical basisPatient believes there is something wrong (they are mistaken)Patient is lying and knows there is nothing wrongConversion disorder (stress leads to motor or sensory alteration)Factitious disorder (faking sick because they crave the sick role)Somatic symptom disorder (many unexplained complaints)Malingering (lies for gain)Illness anxiety disorder (mild/nonexistent symptoms cause fear of serious illness)Watch associated Bootcamp videoe95f6ddc-8982-4d31-8101-7012f73910d2
{{c1::Conversion}} disorder is an alteration in sensory or motor function (e.g. tremor, paralysis, blindness, mutism) not fully explained by a neurological condition, often following an acute stressorAKA functional neurologic symptom disorder Patient complains of medical symptom that has no medical basisPatient believes there is something wrong (they are mistaken)Patient is lying and knows there is nothing wrongConversion disorder (stress leads to motor or sensory alteration)Factitious disorder (faking sick because they crave the sick role)Somatic symptom disorder (many unexplained complaints)Malingering (lies for gain)Illness anxiety disorder (mild/nonexistent symptoms cause fear of serious illness)Watch associated Bootcamp videoe292d49a-c9dc-4d0b-9523-ddd79065ac7e
"Patients with conversion disorder are often aware, but indifferent towards their symptoms (e.g. blindness, mutism); known as ""{{c1::la belle indifférence}}"""Absence of this symptom does not exclude conversion disorder61c8c86e-aee8-48fb-9f1f-2d53dd01e706
False pregnancy, or {{c1::pseudocyesis}}, is the belief that one is pregnant, alongside physical signs and symptoms of pregnancy, but no clinical evidence of a fetus- Cyesis = pregnancy - Symptoms include morning sickness, weight gain, amenorrhea, and breast tenderness - Diagnostics reveal negative ultrasound + undetectable serum β-hCGWatch associated Bootcamp video - SSRIs000ba39b-526b-4025-b65f-fc1badb24d8b
What are the first-line pharmacologic treatments for panic disorder? {{c1::SSRIs or SNRIs::2}}- Benzodiazepines may be used in acute settings - SNRIs such as venlafaxineWatch SSRIs, SNRIs, CyproheptadineWatch associated Bootcamp video - SSRIsc2afbeae-18c9-4275-b289-49480fd5711d
What endocrine pathology is rarely caused by SSRIs? {{c1::SIADH}}Watch SSRIs, SNRIs, CyproheptadineWatch associated Bootcamp video - Electrolytes Sodium Watch associated Bootcamp video - Endocrine SIADH Watch associated Bootcamp video - SSRIsf8942333-3ce1-40ae-be18-4e4a9cc7d245
"The symptoms of {{c4::serotonin}} syndrome can be remembered with the ""3 A's"": 1. Neuromuscular {{c1::hyperActivity}}* 2. {{c1::Autonomic}} stimulation** 3. Psychomotor {{c1::Agitation}}***"*e.g. clonus, hyperreflexia, hypertonia, tremor, seizure **e.g. hyperthermia, diaphoresis, diarrhea ***e.g. anxiety, restlessness, agitated delirium Clonus seen below Photo credit: Paul Marquis,, via Ortho Eval Pal, used with permission Video credit: Meegada et al., CC BY 3.0, via Cureus, modified by converting into GIFWatch SSRIs, SNRIs, CyproheptadineWatch associated Bootcamp video - Trazodone Watch associated Bootcamp video - SSRIs Watch associated Bootcamp video - Psychiatric Emergencies290ec4dc-dea9-4316-86c7-8dfcb4ef3952
What abnormal movement is associated with serotonin syndrome? {{c1::Clonus}}Important distinguishing feature from neuroleptic malignant syndrome Photo credit: Paul Marquis,, via Ortho Eval Pal, used with permissionWatch SSRIs, SNRIs, CyproheptadineWatch associated Bootcamp video - Psychiatric Emergencies72f159f1-173d-4fe4-9e91-8a5d7cbc744b
Cardiac toxicity (e.g. prolonged QRS interval, arrhythmia) secondary to tricyclic antidepressant toxicity is prevented or treated with the administration of {{c1::sodium bicarbonate (NaHCO3)}}- Indicated if QRS > 100 ms or presence of arrhythmia - Increases serum pH and extracellular sodium, which alleviates fast sodium channel blockadeWatch Tricyclic AntidepressantsWatch associated Bootcamp video - Tricyclic Antidepressants Watch associated Bootcamp video - Pharmacological Toxicity and Treatmentfb45b250-49cd-444c-ab7d-101233ed2c7f
Which atypical antidepressant may cause seizures in anorexic/bulimic patients? {{c1::Bupropion}}Decreases seizure threshold, thus patients with electrolyte abnormalities (e.g. patients with anorexia or bulimia) are at increased susceptibilityWatch Bupropion, Mirtazapine, TrazodoneWatch associated Bootcamp video - Bupropion30d97a54-5d18-49c0-9d1a-d6aa1918ce15
{{c2::Valproic acid}} is an anti-epileptic that may cause GI distress, weight gain, hepatotoxicity, and/or {{c1::pancreatitis::organ}} as adverse effectsWatch Valproate, topiramate, lamotrigine, levetiracetam [Old Version]Watch Broad-Spectrum AntiepilepticsWatch associated Bootcamp video - Antiepileptic Medicationsee3f7ea9-7d5c-428a-8329-1fa95d23daed
People with cluster {{c1::A}} personality disorders are described as odd or eccentricCluster A → Weird (Psychotic disorders) Cluster B → Wild (Mood and/or substance abuse) Cluster C → Worried (Anxiety disorders) Photo credit: Flickr [https://www.flickr.com/photos/snipergirl/2564392691]Watch associated Bootcamp videoc7839c99-5816-4e5e-b31a-8855933a2cce
Which cluster of personality disorders is characterized by an inability to develop meaningful relationships? {{c1::Cluster A}}e.g., paranoid, schizoid, and schizotypal Photo credit: Flickr [https://www.flickr.com/photos/snipergirl/2564392691]Watch associated Bootcamp video690f692e-9e39-4b35-b031-ca7bb7436ae2
Cluster {{c2::A}} personality disorders have a genetic association with {{c1::schizophrenia}}Cluster A for schizophreniA Cluster A → Weird (Psychotic disorders) Cluster B → Wild (Mood and/or substance abuse) Cluster C → Worried (Anxiety disorders) Photo credit: Flickr [https://www.flickr.com/photos/snipergirl/2564392691]Watch associated Bootcamp video5a6a006c-9cea-43cf-b4e8-a3ccdb068e71
Which personality disorder is characterized by pervasive distrust and suspiciousness of others, with a profoundly cynical view of the world? {{c1::Paranoid personality disorder (cluster A)}}They tend to project onto others Photo credit: Flickr [https://www.flickr.com/photos/snipergirl/2564392691]8d8afc33-f532-4b13-b36b-10696dfe19dc
Which personality disorder is characterized by voluntary social withdrawal with limited emotional expression? {{c1::Schizoid personality disorder (cluster A)}}Schizoid avoids relationships Photo credit: Flickr [https://www.flickr.com/photos/snipergirl/2564392691]605d8867-3a32-4860-abff-0fb744b50cc0
Are patients with schizoid personality disorder content with social isolation? {{c1::Yes}}important distinguishing feature from avoidant personality disorderWatch associated Bootcamp video0996aaf9-f060-4b83-a750-8df9899351ec
Which personality disorder is characterized by eccentric appearance, interpersonal awkwardness, and odd beliefs/magical thinking? {{c1::Schizotypal personality disorder (cluster A)}}Photo credit: Flickr [https://www.flickr.com/photos/snipergirl/2564392691]2902d07d-da92-4686-98b7-53202ae59318
People with cluster {{c1::B}} personality disorders are described as dramatic, emotional, or erraticCluster A → Weird (Psychotic disorders)Cluster B → Wild (Mood and/or substance abuse)Cluster C → Worried (Anxiety disorders)Watch associated Bootcamp video12309d95-1c89-4167-8ef9-adb7d81ab1b0
Cluster {{c3::B}} personality disorders have a genetic association with {{c1::mood}} disorders and {{c2::substance use disorder}}Cluster A → Weird (Psychotic disorders)Cluster B → Wild (Mood and/or substance abuse)Cluster C → Worried (Anxiety disorders)Watch associated Bootcamp video64f328ed-ffd0-4f65-a41c-978aa95e2fb6
Which personality disorder is characterized by impulsivity, criminality, and disregard for/violation of rights of others with lack of remorse? {{c1::Antisocial personality disorder (cluster B)}}4dd8b4b7-1aab-4c4a-8056-109ae6feccd6
Antisocial personality disorder can only be diagnosed if the patient is {{c1::≥ 18}} years old and has a history of conduct disorder before age {{c2::15}}Conduct disorder if < 18 years oldWatch associated Bootcamp video9cd14ce3-1898-4e76-b834-4bd1de7ab515
Which personality disorder is characterized by unstable mood and relationships and a sense of emptiness? {{c1::Borderline personality disorder (cluster B)}}c93ada5d-c167-4fa3-b80c-f1cc74132716
Which cluster B personality disorder has a high rate of self-mutilation and suicide? {{c1::Borderline personality disorder}}110a21a6-c425-4a2f-a6b8-3ea2453aeea4
What is the treatment for borderline personality disorder? {{c1::Dialectical behavioral therapy (DBT)}}Another important aspect of treating borderline personality disorder is seeing the patient jointly as a team to minimize the tendency for splitting (ego-defense) to interfere with treatmentWatch associated Bootcamp video - Cluster B Personality Disorders Watch associated Bootcamp video - Therapy09c4e3a7-e556-4b9e-963f-a70d237fca67
Which personality disorder is characterized by excessive emotionality/excitability and sexually provocative behavior? {{c1::Histrionic personality disorder (cluster B)}}Watch associated Bootcamp video5d3ac2fd-2b58-4621-b366-041694a47521
Which personality disorder is characterized by grandiosity, sense of entitlement, and lack of empathy? {{c1::Narcissistic personality disorder (cluster B)}}Watch associated Bootcamp videof9470543-3b19-44c3-b63b-66cc2c0ebee7
Patients with {{c1::narcissistic}} personality disorder often require excessive admiration and react to criticism with rage226c9431-4da5-4623-a7fc-0c166681d61b
People with cluster {{c1::C}} personality disorders are described as anxious or fearfulCluster A → Weird (Psychotic disorders)Cluster B → Wild (Mood and/or substance abuse)Cluster C → Worried (Anxiety disorders)Watch associated Bootcamp video6cdbd8a6-5091-4337-98fb-3abfde1ba531
Cluster {{c2::C}} personality disorders have a genetic association with {{c1::anxiety}} disordersCluster A → Weird (Psychotic disorders)Cluster B → Wild (Mood and/or substance abuse)Cluster C → Worried (Anxiety disorders)Watch associated Bootcamp video45e4b091-9c12-4574-85c1-7cd1144ac00b
Which personality disorder is characterized by social withdrawal with hypersensitivity to rejection and feelings of inadequacy? {{c1::Avoidant personality disorder (cluster C)}}"""It's better if I avoid social situations"" Compared to schizoid personality disorder where they often want to avoid social situations"c6ece1f8-0186-47e3-b075-5e413d1c69dd
Are patients with avoidant personality disorder content with social isolation? {{c1::No}}Patients desire relationship with others; important distinguishing feature from schizoid personality disorderWatch associated Bootcamp videobaeb978c-f281-42ba-82ca-e08a0e90f70b
Which personality disorder is characterized by preoccupation with order, perfectionism, and control? {{c1::Obsessive-compulsive personality disorder (OCPD) (cluster C)}}Does NOT involve compulsions performed in response to intrusive obsessionsWatch associated Bootcamp videoa6916fb1-7b9f-4b92-bc0d-d92b1cbbd5fb
Patients with obsessive compulsive personality disorder are ego{{c1::syntonic}}, which means their behavior is consistent with their own beliefs or attitudes- Egosyntonic behaviors help achieve goals of the ego (which mediates desire [id] and superego [rules, society]) - Important distinguishing feature from obsessive-compulsive disorder (egodystonic)Watch associated Bootcamp videoc80036a0-4432-4ac7-aef3-f51c4f54a87f
Which personality disorder is characterized by low-self confidence with an excessive need to be taken care of? {{c1::Dependent personality disorder (cluster C)}}0dffe68d-cd0f-4338-9bb0-9bd80d3d5e54
Patients with {{c1::dependent}} personality disorder are typically submissive and clingyWatch associated Bootcamp video286cded2-ef48-4ad5-90c0-7dbb09ba2ebf
{{c2::Anorexia nervosa}} is defined as excessive dieting, exercise, or binge eating/purging with BMI {{c1::< 18.5}} kg/m2- BMI < 18.5 in patients > 20 years old - BMI < 5th percentile in patients ≤ 20 years old - Differentiate from bulimia nervosa which has normal/increased body weightWatch associated Bootcamp video2d3185d8-712d-418f-ade9-674dd02bbdad
Anorexia nervosa/strenuous exercise is associated with {{c1::amenorrhea}} in females due to loss of pulsatile GnRH secretionFunctional hypothalamic amenorrheaWatch associated Bootcamp video36ae67a9-b3f0-4872-9ef8-1b1bc691cbd4
Anorexia nervosa may present with {{c1::anemia::RBC count}} and electrolyte disturbances- Hyponatremia from drinking a lot of water - Hypokalemia if purgingWatch associated Bootcamp video1b598996-9872-4c5c-a8e4-10d78e49e41a
What is the first-line therapy for anorexia nervosa? {{c1::Nutritional rehabilitation and psychotherapy::2}}Hospitalization may be required for: - BMI < 15 - Weight < 70% of ideal body weight - Cardiac dysfunction - Complications of malnutrition (e.g., seizures, pancreatitis) - May use SSRIs for comorbid depression - vs. SSRIs for bulimia nervosaWatch associated Bootcamp video792adb4b-33e7-475b-8a78-3aa43acd22c2
The massive insulin surge in refeeding syndrome results in {{c1::hypo}}phosphatemia, {{c1::hypo}}kalemia, and {{c1::hypo}}magnesemia- Massive insulin spike stimulates the Na+-K+ ATPase pump and anabolic pathways (also consuming large quantities of thiamine) - Massive ATP depletion also depletes 2,3 BPG → RBCs can't offload O2 properly - Insulin promotes cellular uptake of phosphorus, K+, and Mg2+, which can cause arrhythmias and cardiopulmonary failure due to low serum levelsWatch associated Bootcamp video - Anxiety, Truama, and Stress Disorders Watch associated Bootcamp video - Electrolytes: Phosphateb812d212-43a6-4490-ab46-d137adeaf4f7
Bulimia nervosa is defined as binge eating with recurrent inappropriate compensatory behaviors occurring weekly for at least {{c2::3 months::duration}}- Must have BMI > 18.5 kg/m2 and > 10th percentile - If BMI falls below 18.5 kg/m2 it is considered anorexia nervosaWatch associated Bootcamp videoaffaf868-0175-48e8-a2bf-ed1be6b27374
Bulimia nervosa is characterized by electrolyte disturbances and metabolic {{c1::alkalosis}}- Sequelae of purging (e.g. vomiting, laxatives, diuretics) - Purging causes loss of stomach acid, which when replenished causes HCO3- to be put into the blood in exchange for Cl- (alkaline tide), along with contraction alkalosis due to fluid loss (also resulting in hypokalemia) - These patients will have a low urinary chloride (< 20)Watch Acid/Base DisordersWatch associated Bootcamp video - Metabolic Alkalosis Watch associated Bootcamp video - Eating Disorders0efcf000-d2dd-4738-a8e6-f8b282520d31
Bulimia nervosa is an eating disorder that may present with {{c1::dorsal hand}} calluses from induced vomiting (Russell sign)- May also be seen with the binge eating/purging subtype of anorexia nervosa - Scars from scratching on teeth Photo credit: Kyukyusha, Public domain, via Wikimedia CommonsWatch associated Bootcamp video7c7b5a9d-86d0-4c51-8356-75eb1d06b603
{{c1::Gender dysphoria}} is persistent cross-gender identification that leads to persistent distress with sex assigned at birthWatch associated Bootcamp video14312e42-15cc-41d1-b6a5-a95f661f0841
Do patients with erectile dysfunction due to psychological etiologies have nocturnal penile tumescence? {{c1::Yes}}- e.g., performance anxiety; nothing is wrong with their physiological mechanism - These patients have sudden onset of erectile dysfunction and morning erectionsWatch associated Bootcamp videoe7b73286-ae55-41e3-9d38-600e6ac2b637
Do patients with erectile dysfunction due to medical etiologies have nocturnal penile tumescence? {{c1::No}}- e.g., depression, diabetes, STIs or drugs (antipsychotics, SSRIs, ethanol, antihypertensives) - Failure of sexual function first occurs intermittently, and later becomes more persistentWatch associated Bootcamp video51490cb6-e886-4411-b739-a829ba7b4a36
{{c1::Sleep terror}} disorder is characterized by inconsolable periods of terror with screaming in the middle of the night (stage N3 sleep)- Without recall of dream content - Compare with nightmare disorder (REM sleep and they remember) - Cause unknown, but triggers include emotional stress, fever, or lack of sleep; usually self-limitedWatch associated Bootcamp video430241a4-608c-4d12-8878-02117d1120f2
Do patients with sleep terror disorder have any memory of the arousal episode? {{c1::No}}Occurs during non-REM sleep; important distinguishing feature from nightmaresWatch associated Bootcamp video7828c187-fe40-4148-a322-0d0bedf13af2
Do patients with nightmares have any memory of the scary dream? {{c1::Yes}}Nightmares occur during REM sleep; important distinguishing feature from night terrors NightmareNight TerrorIn REM Between sleep cyclesCrying and moving doesn’t occur Crying and increased respiration occurRequires comforting Fear reaction occur quicklyPerson remembers the dream Person doesn'tWatch associated Bootcamp video74f58b6b-c8fc-4a4a-8c86-423a20133c8a
The primary symptoms of narcolepsy are excessive daytime {{c1::sleepiness}} and {{c2::sleep attacks}}- Diagnose with a sleep study (polysomnography) - These patients have a rapid-onset, overwhelming sleepiness that leads them to fall asleep during day often at inappropriate time (sleep attacks); not tired when waking in morning - This is a neurologic disorder of sleep-wake cycles (sleep during wakefulness / wakefulness during sleep)Watch Narcolepsy DrugsWatch associated Bootcamp video3bf54b88-d877-4e42-b6ce-8469275c5666
Narcolepsy type 1 is caused by decreased {{c1::hypocretin (orexin)}} production in the {{c2::lateral}} hypothalamusWatch Narcolepsy DrugsWatch associated Bootcamp video7695bd16-a8b9-495b-b7cc-23791d137c29
Narcolepsy is characterized by nocturnal and narcoleptic sleep episodes that start with {{c1::REM}} sleep (sleep paralysis)Photo credit: Tash510, CC BY-SA 3.0, via Wikimedia CommonsWatch associated Bootcamp video8675a75b-500a-4af4-a16b-8fdc6f6e1eff
{{c2::Narcolepsy type 1::Specific}} is associated with {{c1::cataplexy}}, which is the loss of all muscle tone following a strong emotional stimulus (e.g. laughter)- Narcolepsy type 1 does not require cataplexy for a diagnosis; can also be diagnosed with low orexin levels - Narcolepsy type 2 does not have cataplexy or low orexin levelsWatch Narcolepsy DrugsWatch associated Bootcamp videodb5394cd-9c4f-4fb1-a041-3b533ee43205
Treatment of narcolepsy may involve nighttime {{c1::sodium oxybate (GHB)}}Watch associated Bootcamp videof19c9946-bd18-4794-9ac9-47f9181f2a66
Which stage of change is characterized by not yet acknowledging that there is a problem? {{c1::Precontemplation}}Watch associated Bootcamp video66a09283-1778-4919-b519-ba6c6b6cfd88
Which stage of change is characterized by acknowledging there's a problem, BUT not yet ready or willing to make a change? {{c1::Contemplation}}Watch associated Bootcamp videoe237f1fe-a92f-4f1c-9ff4-11fa2eebeee7
Which stage of change is characterized by getting ready to change behavior? {{c1::Preparation/determination}}Watch associated Bootcamp videobda1e955-0c02-4b97-bdab-4419a1dd5ad4
Which stage of change is characterized by changing behaviors? {{c1::Action/will power}}Watch associated Bootcamp video0fb725cc-15f3-4804-9c67-2e11a8585bd4
Which stage of change is characterized by maintaining the behavioral changes? {{c1::Maintenance}}Watch associated Bootcamp video4435a791-ed63-4368-96af-9e8430b93e5a
Which stage of change is characterized by returning to old behaviors and abandoning new changes? {{c1::Relapse (does not always happen)}}Watch associated Bootcamp video9a1ecad6-7fca-4acd-aedf-f5e751b2e0d7
"Neuroleptic malignant syndrome (NMS) is often characterized by a generalized ""{{c1::lead-pipe}}"" rigidity"Watch First-Generation AntipsychoticsWatch associated Bootcamp video - Extrapyramidal Effects Watch associated Bootcamp video - Psychiatric Emergencies80fe76d6-3cb8-4b73-8379-e458012a71ac
Neuroleptic malignant syndrome (NMS) may be treated with {{c1::dantrolene*}} or a(n) {{c2::D2}}-receptor agonist (e.g. {{c2::bromocriptine}}) if refractory- *However, discontinuation of the causative agent is the most critical intervention, as well as intensive supportive care - Start with benzodiazepines along with dantrolene in moderate/severe cases (then followed by addition of bromocriptine or amantadine) - UTDWatch Skeletal Muscle RelaxantsWatch associated Bootcamp video - Extrapyramidal Effects Watch associated Bootcamp video - Psychiatric Emergencies Watch associated Bootcamp video - Metoclopramide507f6491-c54f-4afc-a3eb-570a329f7ec8
Which serotonin receptor is antagonized by many atypical antipsychotics? {{c1::5-HT2A}}The added serotonin receptor binding of SGAs (in addition to D2 antagonism) reduces the likelihood of extrapyramidal side effectsWatch Second-Generation AntipsychoticsWatch associated Bootcamp video - Atypical Antipsychotics3f5877aa-2bf9-4e03-b1dd-506376e7e6cb
What is the treatment of choice for treatment-resistant schizophrenia and schizoaffective disorder? {{c1::Clozapine}}Only appropriate after failing 2 other drugs (refractory schizophrenia)Watch Second-Generation AntipsychoticsWatch associated Bootcamp video1678240c-922f-466c-b9bf-0e9de9091559
What are the first-line medical treatments for chronic persistent symptoms of restless legs syndrome? {{c1::Gabapentin or pregabalin (alpha-2-delta Ca2+ channel inhibitors)}}- Dopamine agonists (pramipexole, ropinirole, rotigotine or cabergoline) are an alternative, especially in patients at increased risk for side effects from a gabapentinoid Other treatment options: - Lifestyle changes (abstinence from coffee, nicotine, and alcohol) - Discontinue the offending agent (e.g., dopamine antagonists) - Supplemental iron (if serum ferritin <75 ng/mL) - Treatment of underlying conditionsWatch Parkinsonism DrugsWatch Gabapentin & PregabalinWatch associated Bootcamp video - Parkinson Diseasea6544ed7-19f0-4b41-9009-8d5abc246796
What drug intoxication presents as emotional lability, slurred speech, ataxia, and blackouts? {{c1::Alcohol}}Watch associated Bootcamp video - Alcoholcb17296b-2d7f-4285-bbce-fec90c0dae84
What complication of alcohol withdrawal may occur during the 48 - 96 hour time period? {{c1::Delirium tremens (5% of cases)}}note: timeline in extra is from UWorld and differs slightly from the sketchy video Watch Benzodiazepines & FlumazenilWatch associated Bootcamp video - Alcohol Withdrawal238e7519-1d41-42be-a1f8-8a202f2c8c4a
What is the treatment for delirium tremens? {{c1::Benzodiazepines}}e.g. chlordiazepoxide, lorazepamWatch associated Bootcamp video - Alcohol Withdrawal07911515-1d2e-4cbb-aa1f-74131d14effd
What drug intoxication presents as respiratory and CNS depression, pinpoint pupils, and decreased gag reflex? {{c1::Opioids}}Decreased respiratory rate is the best predictor of intoxicationright side = overdose, left side (pool) = withdrawal Watch Opioids, Naloxone, NaltrexoneWatch associated Bootcamp video - Opioids9eddf9d2-6c93-4666-9248-27f92d76f95c
What drug withdrawal is associated with yawning? {{c1::Opioid withdrawal}}Watch Opioids, Naloxone, NaltrexoneWatch associated Bootcamp video - Opioids2d6e39d5-2f4d-4f4f-9bc9-409246e151bc
"What drug withdrawal is associated with piloerection (""goosebumps"")? {{c1::Opioid withdrawal}}"Watch Opioids, Naloxone, NaltrexoneWatch associated Bootcamp video - Opioidsd0e60c90-9829-45cb-a0eb-69231ade499f
What drug class is the most common cause of drug overdose death? {{c1::Opioids (e.g. fentanyl)}}Deaths typically involve illicit high-potency synthetic opioids (e.g. fentanyl) Photo Credit: Mplanine, CC BY-SA 4.0, via Wikimedia CommonsWatch Opioids, Naloxone, NaltrexoneWatch associated Bootcamp video - Opioidsd764bb8b-c54d-4f75-9c86-6482db8f3379
What is the treatment for opioid overdose? {{c1::Naloxone}}- This is a high binding affinity μ-opioid antagonist, which results in reversal of toxicity in 1-3 minutes (naloxone is rapid-acting; naltrexone is not) - Must give parenterally; if given orally it will be completely inactivated by 1st pass metabolismWatch Opioids, Naloxone, NaltrexoneWatch Bradycardia DDx and SOAPWatch associated Bootcamp video - Opioids Watch associated Bootcamp video - Pharmacological Toxicity and Treatment1a1726a5-6c1c-4bce-bde9-8134313c9d8c
{{c1::Methadone}} is a long-acting full agonist oral opiate used for opioid detoxification or long-term maintenance therapy- Risk of QT prolongation - Buprenorphine is a partial agonist that can also be usedWatch Opioids, Naloxone, NaltrexoneWatch associated Bootcamp video - Opioid Classification067ee8fe-4ea8-47df-bcfd-5368d85fa6a2
What combination drug may be used for maintenance therapy following opioid detoxification? {{c1::Buprenorphine-naloxone (suboxone)}}naloxone is added to lower IV abuse potentialWatch Opioids, Naloxone, NaltrexoneWatch associated Bootcamp video - Opioid Classification3efa3858-40db-4266-a687-d41e00921ba1
{{c1::Naltrexone}} is a long-acting μ-opioid antagonist used for relapse prevention once detoxified from opiates- Therefore aids in maintaining abstinence - Whereas naloxone is used to treat acute opioid toxicityWatch Opioids, Naloxone, NaltrexoneWatch associated Bootcamp video - Opioid Classification4984697a-2daa-4efb-9949-1eca1cc3f85e
What drug intoxication presents as pupillary dilation, grandiosity, vasospasm, and paranoia that lasts for less than one hour? {{c1::Cocaine}}Important distinguishing feature from amphetamines, which have a longer durationWatch associated Bootcamp video - Benzodiazepines Watch associated Bootcamp video - Indirect Sympathomimetics02948482-f640-491e-805d-cd41df3fc708
What is the treatment for cocaine intoxication? {{c1::Benzodiazepines}}, {{c2::α-blockers}}- Note: β-blockers are contraindicated - Mnemonic: α-blockers are αcceptable; β-blockers are βannedWatch Alpha drugsWatch associated Bootcamp video - Benzodiazepines Watch associated Bootcamp video - Indirect Sympathomimetics7ef93d6e-070a-45ec-92ce-bc450729878d
What drug intoxication presents as violence, psychomotor agitation, analgesia, and nystagmus? {{c1::Phencyclidine (PCP)}}- Patients initially may appear catatonic and rigid (PCP is a sedative hypnotic / dissociative anesthetic that generally acts as a downer), but these patients can quickly become violent and have superhuman strength - MOA: blocks NMDA receptors and inhibits reuptake of dopamine, NE, 5HT = SNS effects (like stimulants) - Also may present with impulsivity, tachycardia, hypertension, psychosis, delirium, and seizuresWatch associated Bootcamp video - Phencyclidine442b486d-d42f-4c7a-b947-11c4541bd60f
What eye movement is associated with phencyclidine (PCP) intoxication? {{c1::Nystagmus}}Photo credit: Student BSMU, CC BY-SA 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Phencyclidine92e83471-bd70-48b4-acbb-0f0d5e916c09
What is the treatment for PCP intoxication? First-line: {{c1::Benzodiazepines}} Second-line: {{c2::Rapid-acting antipsychotics}}Watch associated Bootcamp video - Benzodiazepines9894c019-eeb6-4456-af13-01ea3b604c28
What drug intoxication presents as perceptual distortion (visual, auditory), depersonalization, and possible flashbacks? {{c1::Lysergic acid diethylamide (LSD)}}May present with anxiety, paranoia, and psychosisWatch associated Bootcamp video - LSD84a45440-4a60-4622-91b8-3ddafa34831b
What drug intoxication may present as conjunctival injection, tachycardia, increased appetite, paranoid delusions, and dry mouth? {{c1::Marijuana}}- Paranoid delusions and vital sign abnormalities are less common - May also present with euphoria, anxiety, perception of slowed time, impaired judgment, social withdrawal, and hallucinations - Cannabis produces effects that last 1-4 hours by stimulating (THC - active compound) cannabinoid receptors (CB1 and CB2) Conjunctival injection: Photo credit: P33tr at English Wikipedia, Public domain, via Wikimedia CommonsWatch associated Bootcamp video - Cannabis22115dfe-e0f4-4b05-b116-4dcdeed3ac4a
Dronabinol (synthetic cannabinoid) is used clinically as a(n) {{c1::appetite stimulant}} for HIV-related anorexiaAlso an antiemetic for cancer patients on chemoWatch associated Bootcamp video - Cannabisb3297918-33df-4af4-852a-9c56aee94b44
What drug intoxication presents as disinhibition, heightened emotional/tactile sensation, and teeth clenching? {{c1::MDMA (ecstasy)}}May also present with euphoria, distorted sensory and time perception, hyperactivity, hypertension, hyperthermia, hyponatremiaWatch associated Bootcamp video - MDMA40c464c3-cd1a-4954-a1dc-b3eed337d760
Life-threatening effects of MDMA (ecstasy) include hyperthermia and {{c1::hyponatremia::Na+ levels}}- Also may cause life-threatening hypertension and tachycardia; treat with normal saline and cooling - Hyponatremia due to ↑ fluid intake and ↑ ADH release → seizure/death (MDNA) - Also may cause life-threatening hypertension and tachycardia (may precipitate serotonin syndrome) → Think: SNS + serotonin syndromeWatch associated Bootcamp video - Endocrine Hyponatremia Watch associated Bootcamp video - MDMA26122b94-9a36-4aba-bcfc-73c70de19b22
Life-threatening effects of MDMA (ecstasy) include {{c1::serotonin}} syndrome- Also may cause life-threatening hypertension and tachycardia; treat with normal saline and cooling - Hyponatremia due to ↑ fluid intake and ↑ ADH release → seizure/death (MDNA) - Also may cause life-threatening hypertension and tachycardia (may precipitate serotonin syndrome) ⇒ Think: SNS + serotonin syndromeWatch associated Bootcamp video - MDMA Watch associated Bootcamp video - Psychiatric Emergenciesacd9f26c-0fdc-4fee-8822-3f9a079e6da5
What long-term pharmacologic treatment of alcohol use disorder acts as a deterrent? {{c1::Disulfiram}}Support groups, such as Alcoholics Anonymous, are also helpful in sustaining abstinenceWatch associated Bootcamp video - Alcohol Watch associated Bootcamp video - Ethanol Metabolism: Pathway Watch associated Bootcamp video - Ethanol Metabolism: Applications Across Biochemistrya9d7f744-ccfb-4d4a-9a72-46729ad28ad5
Long-term pharmacologic treatment of alcohol use disorder may include {{c1::naltrexone}} or {{c2::acamprosate}}, which reduce cravings- Support groups, such as Alcoholics Anonymous, are also helpful in sustaining abstinence - Diarrhea is a side effect of acamprosateWatch Opioids, Naloxone, NaltrexoneWatch associated Bootcamp video - Alcohol8f9b11f7-0326-4134-b46a-7ee2369a0a15
{{c1::Riluzole}} is a treatment for {{c2::amyotrophic lateral sclerosis (ALS)}} that increases survival by decreasing {{c3::glutamate}} excitotoxicity- Na+ channel blocker that acts by inhibiting glutamate release in the CNS, thereby decreasing its excitotoxicity - Extends survival time and/or time to tracheostomy - Also slows functional declineWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich Ataxia0f4932cd-1d63-4bee-9628-0a1ca94efd1f
Acute management of {{c3::cluster}} headaches includes {{c1::100% O2::1st line}} and {{c1::sumatriptan::2nd line}}- Whereas acute management of migraine headaches includes NSAIDs, triptans, or dihydroergotamine - Triptans considered 2nd line due to slower onset and side effects TypeLocationFindingsTiming (hr)TreatmentTensionBilateralBand-like constant pain4 - 6 NSAIDs AmitriptylineMigraineUnilateral Aura, photophobia, phonophobia, nausea, vomiting, throbbing pain4 - 72NSAIDs Triptans* Dihydroergotamine* β-blockers (prophylaxis)ClusterUnilateral Lacrimation, rhinorrhea, ptosis, miosis Multiple headaches per day per week then remission15 min - 3100% O2 or sumatriptan*Avoid in pregnant patientsOxygen goes to the TOP near the clusters (100% O2) Watch Triptans & MigraineReview Triptans Review Cluster HeadacheWatch associated Bootcamp video - Cluster Headached087d439-80f4-4d89-b951-73921717eff7
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Why did the can crusher quit his job? {{c1::It was SODA PRESSING}}9bdfcc62-5ca2-4dd6-a452-3f0b70a7f540
What do you call a fake noodle? {{c1::An IMPASTA!}}7b5a1d6d-0fec-4c19-99e0-1691ee2bf59f
Good luck studying for your shelf or step 2 or whatever exam it may be! If you score well - congratulations! If your score isn't quite what you had hoped, congratulate yourself on how hard you worked and know that life will find a way to work itself out. Medical student and physician depression/suicide is a major epidemic that isn't talked about enough. If you think someone you know is feeling down, ask how they're doing! If you're feeling down, please don't be afraid to ask for help. I hope you have found these decks useful. May your medical career have many successes. With love, Zanki {{c1:::')}}- 988: The Suicide and Crisis Lifeline provides 24/7, free and confidential support for people in distress. Call or text if you or someone you know is struggling or in crisis. 988 Suicide & Crisis Lifeline - National Alliance on Mental Illness (NAMI): Provides support and resources for individuals struggling with mental health issues. Home | NAMI: National Alliance on Mental Illness - FreeCBT: This free app provides a simple framework for self-guided cognitive behavioral therapy (CBT), helpful for managing stress and anxiety. ‎FreeCBT on the App Store (apple.com) - CBT-i Coach: Developed by the US Department of Veterans Affairs, this free app offers a framework for cognitive behavioral therapy for insomnia (CBT-i) to improve sleep habits, learn more about sleep, and improve your sleep environment—critical for medical students CBT-i Coach on the App Store (apple.com) - Remember that these resources are supplemental and are meant to augment rather than replace qualified help from a mental health professional3f42a3a2-0753-41ba-bf7d-838636bf713c
Guillain-Barré syndrome results in {{c1::inflammation}} and segmental {{c2::demyelination}} of peripheral nerves and motor fibers- Including cranial nerves III-XII - Endoneurial inflammatory infiltrate will be seen light microscopy - MRI spine will be normal (or may show enhancement of anterior nerve roots/cauda equina) because CNS is unaffectedWatch Guillain Barre & Charcot Marie ToothWatch associated Bootcamp video - Guillain-Barre Syndromec136682f-b789-4608-9aee-58099cc72c01
Development of an effective treatment that cures a disease causes {{c1::no change in}} incidence and {{c1::decreased}} prevalenceWatch associated Bootcamp video - Interpreting Prevalence and Incidencedc4b8c1e-6bd9-4e44-a4ed-85e3d8b166fc
Development of an effective vaccine for disease causes {{c1::decreased}} incidence and {{c1::decreased}} prevalenceWatch associated Bootcamp video - Interpreting Prevalence and Incidence43e65bea-319e-47da-8aa7-bb982f483f85
If people with a chronic disease live longer, there is {{c1::no change in}} incidence and {{c1::increased}} prevalenceWatch associated Bootcamp video - Interpreting Prevalence and Incidence44962f3a-5351-4239-b233-37ec601ea1f0
{{c1::Case-control}} studies are observational studies that compare a group of people with disease to a group without disease"- Looks to see if odds of prior exposure or risk factor differs by disease state; asks, ""What happened?"" - Important that you are picking case and controls based ONLY on disease status"Watch associated Bootcamp video166a6276-8dd7-41a7-a284-2b0d63c6bef4
Case-control studies are almost always {{c1::retro}}spectiveWatch associated Bootcamp video061b9f80-485f-4dda-acd1-11a5f706d868
{{c2::Case-control}} studies are useful for measuring {{c1::odds ratio (OR)}}- Case contrOl = Odds ratio - CohoRt = Relative Risk e.g. patients with COPD had higher odds of a history of smoking than those without COPD CharacterCross-sectionalCase-controlCohortTimeOne time pointRetrospectiveRetrospective or prospective CausalityNoYesYesPrevalenceYesNoNoIncidenceNoNoYesRole of diseasePrevalence of diseaseBegins with itEnds with itData analysisChi-squared in order to get associationOdds ratio in order to assess riskRelative risk to estimate riskAssessesAssociation of disease and risk factorsMultiple risk factors for single diseaseOne risk factor affecting multiple diseases Case Control: Patient by disease - Odds ratio Cohort: Patients by exposure - Relative RiskWatch associated Bootcamp video - Longitudinal Studies Watch associated Bootcamp video - Odds Ratio4c57532b-c948-4f7a-a4d4-9cc2d81d2588
{{c1::Cross-sectional}} studies are observational studies that determine the prevalence of exposure and outcome/disease at a specific point in time"- Asks, ""what is happening?"" - Can show association, but not causality - Exposure and outcome are determined simultaneously therefore no data on temporal relationship between exposure and outcome"Watch associated Bootcamp video346e20e2-6a4f-46b5-9589-bdddc7d25c42
Are cross-sectional surveys useful for measuring incidence and/or prevalence? {{c1::Prevalence}}CharacterCross-sectionalCase-controlCohortTimeOne time pointRetrospectiveRetrospective or prospectiveCausalityNoYesYesPrevalenceYesNoNoIncidenceNoNoYesRole of diseasePrevalence of diseaseBegins with itEnds with itData analysisChi-squared in order to get associationOdds ratio in order to assess riskRelative risk to estimate riskAssessesAssociation of disease and risk factorsMultiple risk factors for single diseaseOne risk factor affecting multiple diseasesWatch associated Bootcamp video6f694579-7003-4013-aa55-d746450fa802
{{c1::Cohort}} studies are observational studies that compare groups with a given exposure or risk factor to a group without such exposure- Looks to see if exposure or risk factor is associated with later development of disease or prognosis of a disease - Can be either retrospective or prospective Aim: Study of the incidence rate and whether a certain exposure is associated with the outcome of interest Study method: 1. Gather participants with common characteristics 2. Classify them into two groups: exposed and unexposed 3. Compare the incidence of the outcome of interest between the two groupsWatch associated Bootcamp videob0da576b-78ea-45f1-8d3e-041b21de5c59
Which type of observational study can be retro- or prospective? {{c1::Cohort study}}Watch associated Bootcamp videof2c7c6c4-6d1d-4768-b8b6-7bfb9753e46e
{{c1::Cohort}} studies are useful for calculating relative risk (RR)"- CohoRt = Relative Risk - Case contrOl = Odds ratio - ""Smokers had a higher risk of developing COPD than nonsmokers"" CharacterCross-sectionalCase-controlCohortTimeOne time pointRetrospectiveRetrospective or prospectiveCausalityNoYesYesPrevalenceYesNoNoIncidenceNoNoYesRole of diseasePrevalence of diseaseBegins with itEnds with itData analysisChi-squared in order to get associationOdds ratio in order to assess riskRelative risk to estimate riskAssessesAssociation of disease and risk factorsMultiple risk factors for single diseaseOne risk factor affecting multiple diseases"Watch associated Bootcamp video - Longitudinal Studies Watch associated Bootcamp video - Relative Risk86ed926d-8969-4919-9408-b883fd57c9a6
Are cohort studies useful for measuring incidence and/or prevalence? {{c1::Incidence}}Studies whether a given exposure is associated with the outcome of interest CharacterCross-sectionalCase-controlCohortTimeOne time pointRetrospectiveRetrospective or prospectiveCausalityNoYesYesPrevalenceYesNoNoIncidenceNoNoYesRole of diseasePrevalence of diseaseBegins with itEnds with itData analysisChi-squared in order to get associationOdds ratio in order to assess riskRelative risk to estimate riskAssessesAssociation of disease and risk factorsMultiple risk factors for single diseaseOne risk factor affecting multiple diseasesWatch associated Bootcamp video2c2a6297-c0f0-4705-859e-ec102510f556
Phase {{c1::I}} of clinical trials assesses safety, toxicity, pharmacokinetics, and pharmacodynamicsUses a small number of healthy volunteers or patients with the disease of interestWatch associated Bootcamp video05f0de9f-74a9-4ae4-87cb-20219b5165be
Phase {{c1::I}} of clinical trials uses a small number of healthy volunteers or patients with disease of interestWatch associated Bootcamp videof1befa9f-3f1e-4bc0-88d3-d465ac9dcaba
Phase {{c1::II}} of clinical trials assesses optimal dosing, treatment efficacy, and adverse effectsUses a moderate number of patients with a disease of interestWatch associated Bootcamp video4889ae3f-6827-497b-813c-ed036ecdc4e5
Phase {{c1::II}} of clinical trials uses a moderate number of patients with a disease of interest949deb47-7c22-49cd-b746-dce46e3e4f85
Phase {{c1::III}} of clinical trials uses a large number of patients randomly assigned either to a treatment under investigation or the best available treatment (or placebo)Watch associated Bootcamp videoa38781f7-549a-4c7d-97ff-5c758e292daa
Phase {{c1::III}} of clinical trials assesses efficacy compared to the standard of care- uses a large number of patients randomly assigned either to a treatment under investigation or the best available treatment (or placebo)Watch associated Bootcamp video81cacfe3-52b6-4c51-a9a1-c5ede1887df8
Phase {{c1::IV}} of clinical trials is the postmarketing surveillance of patients after a treatment is approved"- detects rare or long-term adverse effects - asks ""can the treatment stay?""; primarily monitored by personal physician"Watch associated Bootcamp videob31cfcd4-9ed0-4275-823b-a198d09f1278
Phase {{c1::IV}} of clinical trials detects rare or long-term adverse effects"asks ""can the treatment stay?""; primarily monitored by personal physician"Watch associated Bootcamp video5b7bb5b0-5856-41f4-8e24-15c29cdbaf97
{{c1::Sensitivity}} is the probability that when the disease is present, the test is positive- i.e. the proportion of all people with disease who test positive (true-positive rate) - Sensitivity = True Positives/(True Positives + False Negatives) - PPV and NPV use the prevalence of a disease to determine the likelihood of a test diagnosing that specific disease, whereas sensitivity and specificity are independent of prevalenceWatch associated Bootcamp video - Sensitivity and Specifictyd557777c-beb6-4c35-81d9-38938c60034b
Sensitivity values approaching 100% is desirable for ruling {{c1::OUT::in or out}} disease"- ""SNOUT: highly SeNsitive test rules OUT disease"" - e.g. if a highly sensitive test is negative, it rules out that disease"Watch associated Bootcamp video - Sensitivity and Specifictyd57860a5-d195-47b1-9e63-d192c790cc07
{{c2::False negative}} rate = {{c1::1 - sensitivity}}- Thus when sensitivity is 100%, FN rate is zero (A) - Sensitivity = True Positives/(True Positives + False Negatives) - Specificity = True Negatives/(True Negatives + False Positives)Watch associated Bootcamp video - Sensitivity and Specificty4772edb0-a1bf-421e-991e-b991849befed
A high {{c1::sensitivity::sensitivity or specificity}} test is useful for screening in diseases with low prevalenceA high specificity test is useful for confirmation after a positive screening testWatch associated Bootcamp video - Sensitivity and Specificty2bf0eb83-bb97-49b9-b2a3-c2b57e1ca3b8
{{c1::Specificity}} is the probability that when the disease is absent, the test is negative- i.e. the proportion of all people without disease who test negative (true-negative rate) - Specificity = True Negatives/(True Negatives + False Positives) - Sensitivity = True Positives/(True Positives + False Negatives) - PPV and NPV use the prevalence of a disease to determine the likelihood of a test diagnosing that specific disease, whereas sensitivity and specificity are independent of prevalenceWatch associated Bootcamp video - Sensitivity and Specifictya358efe0-34ef-4819-bb3a-f859641af616
Specificity values approaching 100% is desirable for ruling {{c1::IN::in or out}} disease"- ""SPIN: highly SPecific test rules IN disease"" - e.g. if a highly specific test is positive, it rules IN that disease"Watch associated Bootcamp video - Sensitivity and Specificty458be760-0497-446b-9d52-83f5b5dc486e
{{c2::False positive}} rate = {{c1::1 - specificity}}- Thus when specificity is 100%, FP rate is zero (C) - Specificity = True Negatives/(True Negatives + False Positives) - Sensitivity = True Positives/(True Positives + False Negatives)Watch associated Bootcamp video - Sensitivity and Specificty0e19d575-f6bb-4dc9-bcf3-ef3cf3422593
A high {{c1::specificity}} test is useful for confirmation after a positive screening testWatch associated Bootcamp video - Sensitivity and Specificty1ebdd594-164b-4ad4-94c3-95ca6fb443e4
{{c1::Positive predictive value}} is the probability that when the test is positive, the disease is present- i.e. probability that person who has a positive test actually has the disease (if the test result is positive, what is the probability that a patient has the disease) - PPV = True Positives/(True Positives + False Positives)Watch associated Bootcamp video - Positive and Negative Predictive Valuesf6b9366e-3ee7-4abb-8dd8-97f865379e63
{{c1::Negative predictive value}} is the probability that when the test is negative, the disease is absent- i.e. probability of truly not having a disease when then test result is negative - NPV = True Negatives/(True Negatives + False Negatives) - Specificity is the probability that when the disease is absent, the test is negativeWatch associated Bootcamp video - Positive and Negative Predictive Values5daacc4c-3820-4fa1-8c87-f48ac3a7db2a
Which type of observational study is best for studying rare diseases? {{c1::Case-control studies}}Watch associated Bootcamp video903c85e6-cd19-44f3-ad30-7758ea8afe6e
{{c1::Precision (reliability)}} is the consistency and reproducibility of a testWatch associated Bootcamp videoe3242cea-1a23-4825-aa95-59d42b2f7bed
Precision may also be referred to as {{c1::reliability}}Watch associated Bootcamp video917bbfea-d562-4464-8ab3-423859191ec4
{{c1::Accuracy (validity)}} is the trueness of test measurementsCalculated as accuracy = (TP + TN) / (TP + FP + TN + FN)Watch associated Bootcamp video2295bd89-27ca-46af-b87f-e8476420371d
Accuracy may also be referred to as {{c1::validity}}Watch associated Bootcamp videoc80674ad-cf61-43d0-bb12-2fedd40c4f80
Below is an example of {{c1::high}} precision and {{c1::low}} accuracy:Watch associated Bootcamp video65e79f30-198e-4542-bc43-42abaae6ebd0
Below is an example of {{c1::low}} precision and {{c1::high}} accuracy:Watch associated Bootcamp video7f6557f2-6d5e-432a-8279-d1f6f404f25a
{{c1::Likelihood}} ratios can be multiplied with pretest odds of disease to estimate posttest oddsLR is the likelihood that a given test result would be expected in a patient with the target disorder compared to the likelihood that the same result would be expected in a patient without the target disorderWatch associated Bootcamp video - Likelihood Ratioc1cbcb7f-2a1a-4fb4-9a66-353d313337c0
What equation is used to calculate odds ratio using the table below? {{c1::OR = (A/C) / (B/D) = (A*D) / (B*C)}}i.e. the odds of a certain exposure given an event (e.g. disease; a/c) vs the odds of exposure in the absence of that event (e.g. no disease; b/d)Watch associated Bootcamp video - Odds Ratioa0651914-04c4-475f-a3c5-7c5a0d30bbad
What equation is used to calculate relative risk using the table below? {{c1::RR = [a/(a+b)]/[c/(c+d)]}}i.e. the risk of developing disease in the exposed group divided by risk in the unexposed group (RR-1) × 100 = X% increased chance of occurringWatch associated Bootcamp video - Relative Risk4ad4e49d-bd36-45d1-b169-57918f13a746
21% of smokers develop lung cancer vs. only 1% of nonsmokers Relative risk = {{c1::21}}21/1 = 21Watch associated Bootcamp video - Relative Riskb05a1d03-457b-4f15-a111-8cd5ae0130c3
For rare diseases (low prevalence), {{c1::odds ratio}} approximates relative risk- A mathematical assumption in case-control studies, this principle is known as the rare disease assumption - in addition to the rare disease assumption, OR also approximates RR (regardless of disease incidence) when the cases and controls used in a study are representative of individuals with and without the disease in the overall population (with regard to the exposure of interest)1ecc9475-442a-4099-b1aa-648bbfc7f619
{{c1::Attributable}} risk is defined as the difference in risk between exposed and unexposed groups- i.e. the proportion of disease occurrences that are attributable to the exposure - Absolute risk reduction is the difference in risk attributable to an intervention compared to a control - Relative risk reduction is the proportion of risk reduction attributable to an intervention compared to a controlWatch associated Bootcamp video - Additional Calculations with Relative Risk94258bf6-2f25-4477-a28f-7aa4ce10160f
If 21% of smokers develop lung cancer vs. only 1% of nonsmokers Attributable risk = {{c1::20%}}21 - 1 = 20 20% of the lung cancer risk in smokers is attributable to smokingWatch associated Bootcamp video - Additional Calculations with Relative Risk7245a72c-068f-4d12-ba1c-bf3fbe1a8a5b
If 2% of patients who receive a flu shot develop the flu, while 8% of unvaccinated patients develop the flu: Relative risk reduction = {{c1::75% (0.75)}}RRR = 1 - RR RR = 2/8 = .25Watch associated Bootcamp video - Additional Calculations with Relative Risk32d8945d-6bdd-4c8f-99ae-76524265ba98
{{c1::Absolute}} risk reduction is the difference in risk attributable to an intervention compared to a control"Also called the risk difference (RD) ARR Example: If 10% of people who receive a placebo vaccine develop flu vs 3% of people who get the real flu vaccine, ARR = 10% - 3% = 7% = 0.07 ARR = ERcontrol - ERtreatment ER = event rate = (# events / # of subjects) RRR = the proportion of risk reduction attributable to an intervention as compared to a control"Watch associated Bootcamp video - Additional Calculations with Relative Risk468470bb-8648-408a-b140-58f98d25c91c
If 2% of patients who receive a flu shot develop the flu, while 8% of unvaccinated patients develop the flu: Absolute risk reduction = {{c1::6% (.06)}}"ARR = ERcontrol - ERtreatment ER = event rate = (# events / # of subjects)"Watch associated Bootcamp video - Additional Calculations with Relative Riskaf121fd0-024d-4d58-9d9a-f5f41758547f
The number needed to treat (NNT) is equal to {{c1::1/ARR}}i.e. the number of patients who need to be treated for 1 patient to benefit; lower number = better treatment - Absolute risk reduction is the difference in risk attributable to an intervention compared to a control (Control group event rate Experimental group event rate) Example: If 10% of people who receive a placebo vaccine develop flu vs 3% of people who get the real flu vaccine ARR = 10% - 3% = 7% = 0.07 NNT = 1/0.07 = 14.3Watch associated Bootcamp video - Additional Calculations with Relative Riskcda01cbb-3c46-4841-9e59-29490b2e8ea7
Physiological neonatal jaundice occurs due to transiently low {{c1::UDP-glucuronosyltransferase}} activity at birthFA 2022 refers to this as benign neonatal hyperbilirubinemia There is: - Increased bilirubin production due to hemolysis - Decreased bilirubin conjugation due to the low UDP-glucuronosyltransferase activity - Increased enterohepatic circulation due to β-glucuronidase activity deconjugating the bilirubin (increasing reabsorption)Watch Lab Evaluation of Liver Injury & HyperbilirubinemiaWatch associated Bootcamp video - Jaundicea7b7a32b-c8eb-4516-a94b-2f966250b616
In physiological neonatal jaundice, unconjugated bilirubin deposits in the brain, especially in the {{c1::basal ganglia}}Photo credit: Muago, CC0, via Wikimedia Commons, modified by censoring and croppingWatch Lab Evaluation of Liver Injury & HyperbilirubinemiaWatch associated Bootcamp video - Jaundice1bc3b514-1a23-4585-b582-45123c934900
Does Gilbert syndrome result in unconjugated or conjugated hyperbilirubinemia? {{c1::Unconjugated}}Watch Lab Evaluation of Liver Injury & HyperbilirubinemiaWatch associated Bootcamp video - Jaundice2c98b200-5979-4d84-8e6f-747b74de332a
Does Crigler-Najjar syndrome result in unconjugated or conjugated hyperbilirubinemia? {{c1::Unconjugated}}Due to absence of UDP-glucuronosyltransferase, which normally converts UCB → CBWatch Lab Evaluation of Liver Injury & HyperbilirubinemiaWatch associated Bootcamp video - Jaundice6c7af8cc-a124-4df7-97d4-41bfe45bf6fd
Does Dubin-Johnson syndrome result in unconjugated or conjugated hyperbilirubinemia? {{c1::Conjugated}}- Normal LFTs and CBC - Due to a defect in hepatic secretion of conjugated bilirubin into the biliary systemWatch Lab Evaluation of Liver Injury & HyperbilirubinemiaWatch associated Bootcamp video - Jaundicec48666a7-6ec5-42b2-83ba-7b804441a021
Does Rotor syndrome result in unconjugated or conjugated hyperbilirubinemia? {{c1::Conjugated}}- Normal LFTs and CBC - Due to a defect in hepatic secretion of conjugated bilirubin into the biliary system - Dubin-Johnson is impaired disposal (excretion) of conjugated bilirubin - Rotor syndrome is impaired hepatic retention (storage) of conjugated bilirubinWatch Lab Evaluation of Liver Injury & HyperbilirubinemiaWatch associated Bootcamp video - Jaundice3ffdb3f0-4d9b-4098-b89c-6661d67672b8
Cirrhosis is often complicated by {{c1::portal}} hypertension* due to increased intrasinusoidal pressure from fibrosisWatch Cirrhosis Pathogenesis & Clinical Manifestations Watch Portal Circulation: Clinical CorrelatesWatch associated Bootcamp video - Cirrhosisc530a030-937a-4b12-a5af-5bb58fb5c60d
What is the most common cause of portal hypertension in Western countries? {{c1::Cirrhosis}}Watch Cirrhosis Pathogenesis & Clinical Manifestations Watch Portal Circulation: Clinical CorrelatesWatch associated Bootcamp video - Cirrhosis6b476ccf-a6a3-4bd2-a29b-e6b0ef6602fe
Portal {{c2::hypertension}} may lead to {{c1::portosystemic}} shunts, which can result in esophageal varices, gastric varices, anorectal varices, and caput medusaealso called portocaval shuntsWatch Cirrhosis Pathogenesis & Clinical Manifestations Watch Portal Circulation: Clinical CorrelatesWatch associated Bootcamp video - Cirrhosis01e0d512-fb43-4478-9a2b-51573b012b74
Portal hypertension may lead to congestive {{c1::splenomegaly}} and hypersplenismThe spleen drains into the portal vein via the splenic veinWatch Cirrhosis Pathogenesis & Clinical ManifestationsWatch associated Bootcamp video - Cirrhosis6456bb78-833f-4284-bde3-fae196fe9a3f
Increased {{c1::estrogen}} in cirrhosis may lead to {{c2::spider angiomas}} and {{c3::palmar erythema}} (dermatologic symptoms)* Increased estrogen results in vasodilation of arteries and veins (usually on trunk, face, and arms -upper body) - Spider angiomas consist of a bright red central papule surrounded by several outwardly radiating vessels that blanch with pressure and refill centrifugally upon release Due to rise in estradiol: - Increased adrenal production of androstenedione - Increased aromatization to estrone and eventual conversion to estradiol- Increased SHBG (preferentially binds testosterone) Spider angiomas seen below Photo credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia Commons and Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ* Increased estrogen results in vasodilation of arteries and veins (usully on Trunk, Face, and Arms -upper body) Watch Cirrhosis Pathogenesis & Clinical ManifestationsWatch associated Bootcamp video - Cirrhosisc6b5f253-4576-4f4a-a3c2-f2c7df0201d1
Increased estrogen in cirrhosis may lead to {{c1::testicular}} atrophy and {{c1::gynecomastia}} in males, as well as {{c2::amenorrhea}} in females (reproductive symptoms)In addition to hyperestrogenism, direct gonadal injury (toxicity) & hypothalamic-pituitary dysfunction can contribute to hypogonadism → decreased libido, erectile dysfunction, testicular atrophyWatch Cirrhosis Pathogenesis & Clinical ManifestationsWatch associated Bootcamp video - Cirrhosis739fcd5b-d53a-48f7-b141-0522d8a23e29
Cirrhosis may present with peripheral edema secondary to {{c1::hypoalbuminemia}}Cirrhosis = ↓ albumin production by liver = ↓ oncotic pressure = ↑ edema (fluid out)* due to decreased synthesis of albumin (impaired synthetic function of liver) Watch Cirrhosis Pathogenesis & Clinical ManifestationsWatch associated Bootcamp video - Cirrhosisda90c3e1-847e-4a72-90b7-01e118634bde
{{c1::Non-alcoholic fatty}} liver disease is associated with obesity and metabolic syndromeRecently changed to metabolic dysfunction-associated steatotic liver disease (MASLD)Watch Alcoholic & Non alcoholic Fatty Liver DiseaseWatch associated Bootcamp video - Alcoholic Hepatitis and NASH2103d906-b785-4a36-85fa-5cb811666287
What is a common cause of death in hemochromatosis? {{c1::Hepatocellular carcinoma}}Via progression to cirrhosis from iron overloadWatch Hereditary Hemochromatosis & Wilson's DiseaseWatch associated Bootcamp video - Genetic Hepatic Disorders44e0aa83-a773-4fbf-8e94-dd59d4f44f4a
{{c2::Wilson}} disease is caused by a(n) {{c1::autosomal recessive::inheritance}} defect in ATP-mediated hepatocyte {{c3::copper}} transportWatch Autosomal Recessive DiseasesWatch associated Bootcamp video - Menkes Disease Watch associated Bootcamp video - Copper Transport Disorders Watch associated Bootcamp video - Disorders of the Basal Ganglia98d0379b-09d5-4168-99ec-0a565bc75926
Wilson disease is also known as {{c1::hepatolenticular degeneration}}Watch Hereditary Hemochromatosis & Wilson's DiseaseWatch associated Bootcamp video - Copper Transport Disorders Watch associated Bootcamp video - Disorders of the Basal Gangliae1216404-2117-4f4e-855b-dd84f7a461c2
Wilson disease is characterized by accumulation of copper, especially in the {{c1::liver}}, brain, cornea, and kidneysCopper-mediated production of hydroxyl free radicals leads to tissue damageWatch Hereditary Hemochromatosis & Wilson's DiseaseWatch associated Bootcamp video - Menkes Disease Watch associated Bootcamp video - Copper Transport Disorders Watch associated Bootcamp video - Disorders of the Basal Gangliaab6095fb-35d7-48df-b3db-0c0a65a158c2
{{c2::Wilson}} disease often presents with neuropsychiatric manifestations, due to copper deposition and resultant cystic degeneration in the {{c1::putamen}} and other adjacent structures (e.g. thalamus, brain stem)- e.g., dysarthria, dystonia, tremor, parkinsonism, behavioral changes, dementia, chorea - Copper deposition results in atrophy of the basal gangliaWatch Hereditary Hemochromatosis & Wilson's DiseaseWatch associated Bootcamp video - Copper Transport Disorders Watch associated Bootcamp video - Disorders of the Basal Gangliaa1c4722c-c363-4f5f-8459-0df571f1f601
{{c3::Wilson}} disease presents with {{c1::Kayser-Fleischer rings}} due to copper deposits in {{c2::Descemet membrane}} of the cornea- Kayser-Fleischer rings may be visualized on slit lamp examination if not seen on visual inspection - Descemet membrane lies between the corneal proper substance (stroma) and the endothelial layer of the cornea (type IV collagen) Photo credit: Herbert L. Fred, MD, Hendrik A. van Dijk, CC BY 3.0, via Wikimedia Commons Photo credit: Jonathan Trobe, CC BY 3.0, via U-Michigan The Eyes Have ItWatch Hereditary Hemochromatosis & Wilson's DiseaseWatch associated Bootcamp video - Copper Transport Disorders Watch associated Bootcamp video - Disorders of the Basal Gangliaee754c91-045f-4527-96bc-bd9097ed594b
Wilson disease is characterized by {{c1::decreased}} serum ceruloplasmin- And ↑ urinary copper - Damaged hepatocytes release copper into blood and urineWatch Hereditary Hemochromatosis & Wilson's DiseaseWatch associated Bootcamp video - Menkes Disease Watch associated Bootcamp video - Copper Transport Disorders Watch associated Bootcamp video - Disorders of the Basal Ganglia7f9c57d6-ad36-41a7-aa82-e4d7c4b70477
What type of drugs are penicillamine and trientine? {{c1::Copper chelators}}Watch Hereditary Hemochromatosis & Wilson's DiseaseWatch associated Bootcamp video - Copper Transport Disorders Watch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Environmental Toxins and their Treatments7f36ea2f-7742-4178-86cd-ca674af3c232
{{c2::Wilson}} disease may be treated with oral {{c1::zinc}} or chelating agents (e.g. penicillamine, trientine)- Zinc blocks enteric copper absorption - Penicillamine binds free copper forming a water soluble complex, which increases urinary excretion of copperWatch Hereditary Hemochromatosis & Wilson's DiseaseWatch associated Bootcamp video - Copper Transport Disorders Watch associated Bootcamp video - Disorders of the Basal Ganglia81728c65-70eb-4c90-95c5-16b8b7058bab
Does biliary tract disease (e.g. PBC, PSC) result in unconjugated or conjugated hyperbilirubinemia? {{c1::Conjugated}}BILIgoat has collar = conjugated Watch Primary Biliary Cholangitis & Primary Sclerosing CholangitisWatch associated Bootcamp video - Jaundice8a8af7ed-e49d-444e-a451-254cc78aa511
{{c3::Primary biliary cholangitis}} is a(n) {{c1::autoimmune}} granulomatous destruction of {{c2::intra}}hepatic bile ducts- Previously known as primary biliary cirrhosis - Whereas PSC affects both intra- and extra-hepatic ductsWatch Primary Biliary Cholangitis & Primary Sclerosing CholangitisWatch associated Bootcamp video - Benign Biliary Disorders13ac1be0-cfea-47d0-96b9-83c44d97e43e
"Primary sclerosing cholangitis (PSC) is characterized by a(n) ""{{c1::beading}}"" appearance of intra- and extrahepatic bile ducts on ERCP and MRCP"Due to alternating strictures and dilation Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Primary Biliary Cholangitis & Primary Sclerosing CholangitisWatch associated Bootcamp video - Benign Biliary Disordersc1cc3d88-7ba8-4534-a341-d8ffd596dba1
{{c2::Primary sclerosing}} cholangitis is associated with {{c1::p-ANCA}} antibodyWatch Primary Biliary Cholangitis & Primary Sclerosing CholangitisWatch associated Bootcamp video - Benign Biliary Disordersf918b4dc-489c-44fe-aa33-def1b6c6a7d1
{{c2::Reye}} syndrome is fulminant liver failure and encephalopathy in children with viral illness who take {{c1::aspirin}}- Thus, avoid aspirin in children, except for Kawasaki disease - Importantly, avoid bismuth subsalicylate (Pepto Bismol) in pediatric patients which contains aspirin (salicylate) as a main ingredient!Watch Alcoholic & Non alcoholic Fatty Liver DiseaseWatch Antidiarrheal AgentsWatch associated Bootcamp video - Drug-Induced Hepatic Pathology9bb40508-a0bf-4690-b851-55cb0b769ec6
Reye syndrome presents with {{c1::micro}}vesicular fatty change in the liver, hypoglycemia, vomiting, hepatomegaly, and eventually coma/death- vs. hepatic steatosis, which is characterized by macrovesicular fatty change - Secondary to damaged mitochondria in hepatocytes → impaired urea cycle → accumulation of ammoniaWatch Alcoholic & Non alcoholic Fatty Liver DiseaseWatch associated Bootcamp video - Drug-Induced Hepatic Pathology72128ea3-a2ba-477c-8556-16b5176d0c5b
Which is more common, primary liver tumors or metastasis to the liver? {{c1::Metastasis}}most common sources include colon, pancreas, lung, and breastWatch Liver Tumors & Hepatocellular CarcinomaWatch associated Bootcamp video - Malignant Hepatic Pathologyb8fb898a-b0d1-41ee-a174-1a0af83f8d59
{{c2::Spontaneous bacterial peritonitis}} is diagnosed by paracentesis with ascitic fluid absolute neutrophil count > {{c1::250}} cells/mm3Watch Cirrhosis Pathogenesis & Clinical ManifestationsWatch associated Bootcamp video - Cirrhosis0ca4fdd6-c234-43db-ae64-50ff7c4ad0a3
Elevated γ-glutamyl transpeptidase (GGT) is associated with {{c1::alcohol}} useSerum γ-glutamyl transferase (GGT) is a sensitive indicator of alcohol useWatch Lab Evaluation of Liver Injury & Hyperbilirubinemia Watch Alcoholic & Non alcoholic Fatty Liver DiseaseWatch associated Bootcamp video - Alcoholic Hepatitis and NASH Watch associated Bootcamp video - Alcohol2e832589-ee08-4339-9c54-ad53993fb6c8
Congenital {{c1::umbilical hernia}} is a failure of umbilical ring to close after physiologic herniation of the intestinesmany close spontaneously; these hernias are covered by skin (distinguishing feature from omphalocele, which is covered by a peritoneal sac) Photo credit: Saltanat ebli, CC0, via Wikimedia Commons Photo credit: Saltanat, CC0, via Wikimedia CommonsWatch associated Bootcamp video - Ventral and Abdominal Wall Defects5443af2b-52f3-4041-b590-d7593ef42bdd
{{c2::Caput medusae}} results from portosystemic shunting between the {{c1::paraumbilical}} veins (portal) and small {{c1::epigastric}} veins of the abdominal wall (systemic)- Paraumbilical veins (inferior veins of Sappey) in the ligamentum teres hepatis (in the falciform ligament) → left branch of portal vein - Small epigastric veins - superficial epigastric vein → great saphenous → femoral / small epigastric veins → external iliac → IVC Photo credit: Pei-Ming Yang, M.D., Ph.D., and Ding-Shinn Chen, M.D., Attribution, via Wikimedia CommonsWatch Portal Circulation: Clinical CorrelatesWatch associated Bootcamp video - Veins, Anastomoses, and Hemorrhoids028905d7-fc47-456c-b6d9-5bc3cda43bf9
Tumors that arise in the {{c1::head}} of pancreas can cause obstruction of the common bile duct, leading to an enlarged gallbladder with painless jaundiceusually ductal adenocarcinoma; Courvoisier sign *other symptoms include pruritus, pale stools, and dark urine (obstructive jaundice)Watch Pancreatic Cancer & Islet Cell TumorsWatch associated Bootcamp video - Pancreatic Malignancies Watch associated Bootcamp video - Malignant Biliary Disordersc5e8964c-a7b3-40df-8f94-46c329516113
Congenital {{c2::diaphragmatic}} hernias occur due to a defect in the {{c1::pleuroperitoneal membrane}}*These typically occur on the left side because the liver stabilizes the right side Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia CommonsWatch Congenital GI DisordersWatch associated Bootcamp video - Diaphragmatic Hernias Watch associated Bootcamp video - Introduction to the Respiratory System : Tracheoesophageal Defectsbe7b46bb-d8cd-469f-bac4-d50183cb90f6
Diaphragmatic hernias typically occur on the {{c1::left::left or right}} sidedue to protection of right hemidiaphragm by the liverWatch Congenital GI DisordersWatch associated Bootcamp video - Diaphragmatic Herniase2017016-b0a8-4ac7-9b49-b2053f58416a
The best way to visualize Kayser-Fleischer rings in Wilson disease is via {{c1::slit-lamp}} examinationPhoto credit: Herbert L. Fred, MD, Hendrik A. van Dijk, CC BY 3.0, via Wikimedia Commons Photo credit: Jonathan Trobe, CC BY 3.0, via U-Michigan The Eyes Have ItWatch Hereditary Hemochromatosis & Wilson's DiseaseWatch associated Bootcamp video - Copper Transport Disorders Watch associated Bootcamp video - Disorders of the Basal Gangliacec9e39e-034b-49be-b310-838db635f63f
Serum sickness presents with fever, urticaria, arthralgia, proteinuria, and lymphadenopathy {{c1::1}} - {{c1::2}} weeks after antigen exposure- These patients have low serum C3 and C4 levels - Most commonly caused by β-lactams and sulfa drugs - Symptoms typically resolve with withdrawal of the offending agent - Serum sickness-like reaction will be nearly identical, but fever is lowerWatch Monoclonal Antibody TherapyWatch associated Bootcamp video - Type III Hypersensitivity Reactions3752fd09-464d-4e34-814c-cf771cebd44f
What type of hypersensitivity reaction is serum sickness? {{c1::Type III HSR (immune complexes)}}Immune complexes deposit in vessels → activate complement → neutrophils → vasculitis and fibrinoid necrosisWatch associated Bootcamp video - Type III Hypersensitivity Reactionse9fd24f5-7178-495e-a02b-48514b580897
What type of hypersensitivity reaction is allergic contact dermatitis (e.g. poison ivy, nickel allergy)? {{c1::Type IV HSR (CD4 & CD8 mediated)}}- Poison ivy produces urushiol, which covalently binds to proteins on keratinocytes - Sensitization phase: Langerhans cells uptake haptens (random skin proteins covalently bind urushiol), travel to draining lymph nodes, and interact with CD4+ / CD8 T cells (takes 10-14 days) - Following sensitization / re-exposure to urushiol, the hapten is taken up by skin cells (e.g. keratinocytes), which are targeted by CD8 CTLs Photo credit: Nunyabb at English WikipediaW, Public domain, via Wikimedia CommonsWatch Type IV Hypersensitivity ReactionWatch associated Bootcamp video - Hypersensitivities: Type IV Hypersensitivity Reactions Watch associated Bootcamp video - Inflammatory Diseases of the Skin: Atopic and Allergic Diseasesc8b94937-acae-4e02-a80f-2a27020fb4c3
Which type of transplant rejection presents with maculopapular rash, jaundice, diarrhea, and hepatosplenomegaly? {{c1::Graft-versus-host-disease (GVHD)}}Graft-versus-Host-Disease causes GI problems (diarrhea and jaundice), Hepatomegaly, and Derm problems (maculopapular rash)Review Graft vs Host Disease (GVHD)Watch associated Bootcamp video - Graft vs Host Disease5cd02181-3d05-42df-8adb-17fe4baeacc9
{{c2::Leukocyte adhesion deficiency (type 1)::Specific type}} is due to a defect in {{c1::LFA-1 integrin (CD18)::specific}} protein on phagocytesWatch Phagocytic Cell DisordersReview Leukocyte Adhesion Deficiency (LAD)Watch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)8e55be09-fce1-4979-8a7c-c0644572bd60
Which immunodeficiency presents with delayed separation of the umbilical cord (>30 days)? {{c1::Leukocyte adhesion deficiency}}Watch Phagocytic Cell DisordersReview Leukocyte Adhesion Deficiency (LAD)Watch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)2150cc59-2be1-455c-9631-366496b0a0d5
Leukocyte adhesion deficiency is characterized by {{c1::absent}} neutrophils at infection sitesWatch Phagocytic Cell DisordersReview Leukocyte Adhesion Deficiency (LAD)Watch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)894ff73f-4ba0-4807-a059-b647bc1e3907
Leukocyte adhesion deficiency is characterized by recurrent bacterial infections (skin and mucosal) with absent {{c1::pus}} formation- Patients also have impaired wound healing and severe periodontal disease - Pus = dead neutrophils - No neutrophil out = no pusWatch Phagocytic Cell DisordersReview Leukocyte Adhesion Deficiency (LAD)Watch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)baf7b4d0-70ce-4e81-9e70-44e4017e6356
Chédiak-Higashi syndrome is caused by a defect in the {{c2::lysosomal trafficking regulator (LYST)}} gene, resulting in impaired {{c1::phagolysosome}} formationLYST defect results in impaired protein traffickingWatch Phagocytic Cell DisordersReview Chediak-Higashi SyndromeWatch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)2313d3df-30f9-4d09-8d7b-9eff055a68b3
Which immunodeficiency is characterized by giant granules in leukocytes and platelets? {{c1::Chédiak-Higashi syndrome}}Due to fusion of granules arising from the Golgi apparatus Photo credit: Gopaal et al., CC BY 4.0, via Cureus Photo credit: Hindawi [https://www.hindawi.com/journals/crim/2010/967535/]Watch Phagocytic Cell DisordersReview Chediak-Higashi SyndromeWatch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)0c0f7462-d250-4210-b0da-d4b44bf89293
{{c2::Chronic granulomatous disease (CGD)}} is due to a defect in {{c1::NADPH oxidase}}Watch Phagocytic Cell DisordersReview Chronic Granulomatous Disease (CGD)Watch associated Bootcamp video - Staphylococcus Aureus Principles Watch associated Bootcamp video - Respiratory (Oxidative) Burst: Clinical Implications83934d26-e400-4ae5-ae6e-f3c20dba0341
What is the most common mode of inheritance of chronic granulomatous disease (CGD)? {{c1::X-linked recessive}}Can also be autosomal recessiveWatch Phagocytic Cell DisordersReview Chronic Granulomatous Disease (CGD)Watch associated Bootcamp video - Respiratory (Oxidative) Burst: Clinical Implications5d45ead7-d70b-4a3f-979e-0a3d94b2aae4
{{c2::Chronic granulomatous}} disease is characterized by recurrent infection and granuloma formation with {{c1::catalase}}-positive organismsHigh-risk catalase positive infections in patients with chronic granulomatous disease: - Staph aureus - Burkholderia (pseudomonas) cepacia* - Serratia marcescens - Nocardia - Aspergillus *Pathoma highlights B. cepaciaWatch Phagocytic Cell DisordersReview Chronic Granulomatous Disease (CGD)Watch associated Bootcamp video - Staphylococcus Aureus Principles Watch associated Bootcamp video - Nocardia Watch associated Bootcamp video - Respiratory (Oxidative) Burst: Clinical Implicationsb7c7c98e-c78b-418b-861f-cedab930b5e2
Which immunodeficiency may be diagnosed with the dihydrorhodamine test or nitroblue tetrazolium test? {{c1::Chronic granulomatous disease (CGD)}}- DHR: assesses production of superoxide radical by measuring conversion of DHR to rhodamine (fluoresces green); stimulate cells with PMA - Thus, cells with deficient NADPH oxidase will exhibit decreased green fluorescence - NBT: dye turns blue if NADPH oxidase is functional; stays colorless / yellow if NADPH oxidase is defective - Properly functioning neutrophils produce ROS, that reduce yellow NBT to dark blue formazan, that precipitates within cells Normal = purple-blue Abnormal = yellowWatch Phagocytic Cell DisordersReview Chronic Granulomatous Disease (CGD)Watch associated Bootcamp video - Respiratory (Oxidative) Burst: Clinical Implicationsa4a0737e-99c7-4aa1-b789-07b87c35c09d
What chromosomal deletion is associated with DiGeorge syndrome? {{c1::22q11 microdeletion}}Watch B Cell Disorders & DiGeorge SyndromeMicrodeletion Syndromes: 22q11 Deletion Syndrome & Williams Syndrome SOAPs - Lesson - SketchyReview DiGeorge Syndrome295cc92e-d18c-4a2d-961a-481fbaeb5935
"The features of a chromosome 22q11 microdeletion may be remembered with the mnemonic ""CATCH 22"": {{c1::Cleft palate::C}} {{c1::Abnormal facies (retrognathia)::A}} {{c1::Thymic aplasia::T}} {{c1::Conotruncal abnormalities (truncus arteriosus, tetralogy of Fallot)::C}} {{c1::Hypocalcemia (lack of parathyroids)::H}} 22: chromosome affected"Remember, DiGeorge is just one of the 22q11 microdeletion syndromes, facies and cleft palate do NOT need to be present for DiGeorgeWatch B Cell Disorders & DiGeorge SyndromeMicrodeletion Syndromes: 22q11 Deletion Syndrome & Williams Syndrome SOAPs - Lesson - SketchyReview DiGeorge Syndromey04c2c3ee-660b-43c5-bdfa-c4f1433bac90
The features of a chromosome 22q11 microdeletion may be remembered with the mnemonic {{c1::CATCH 22}}Cleft palate Abnormal facies (retrognathia) Thymic aplasia Conotruncal abnormalities (truncus arteriosus, tetralogy of Fallot) Hypocalcemia (lack of parathyroids) 22: chromosome affected Remember, DiGeorge is just one of the 22q11 microdeletion syndromes; facies and cleft palate do NOT need to be present for DiGeorgeWatch B Cell Disorders & DiGeorge SyndromeMicrodeletion Syndromes: 22q11 Deletion Syndrome & Williams Syndrome SOAPs - Lesson - SketchyReview DiGeorge Syndrome8e603d59-70d8-4dbd-95d2-6ae0fac36970
What enzyme deficiency is associated with severe combined immunodeficiency (SCID)? {{c1::Adenosine deaminase (ADA) deficiency}}Results in buildup of adenosine, which is toxic to lymphocytesWatch associated Bootcamp video - SCID0d8f9dcb-6cf3-4594-b77e-09d73bf511e3
Severe combined immunodeficiency (SCID) may be caused by a defective {{c1::IL-2}} receptor (most common)"NOTE: The real error is ""IL-2R gamma chain"" which leads to defective IL-7 (and IL-15 → NK cells) signalling"Watch Combined B & T Cell DisordersReview IL-2Watch associated Bootcamp video - SCID Watch associated Bootcamp video - Cytokines: Proinflammatory Cytokinese9dbc540-7e36-46e3-8fc1-16c5fec3114b
Which immunodeficiency presents with recurrent infection, failure to thrive, chronic diarrhea, and thrush? {{c1::Severe combined immunodeficiency (SCID)}}- Susceptible to viral and fungal infections due to no T cells - Susceptible to bacterial and protozoal infections due to no B cells Immunodeficiency syndromes Condition T cell count B cell count IgG IgA IgM IgE Selective IgA deficiency Normal Normal Normal ↓ Normal Normal Job syndrome (hyper-IgE syndrome) ↓ Th17 cells Normal Normal Normal Normal ↑ CD40 ligand deficiency (hyper-IgM syndrome) Normal Normal ↓↓ ↓↓ Normal / ↑ ↓↓ Wiskott-Aldrich syndrome Normal Normal ↓ / normal ↑ ↓ / normal ↑ Common variable immunodeficiency Normal Normal ↓ ↓ ↓ ↓ X-Iinked (Bruton) agammaglobulinemia Normal ↓ ↓ ↓ ↓ ↓ Severe combined immunodeficiency Absent Absent ↓ ↓ ↓ ↓ Transient hypogammaglobulinemia of infancy Normal Normal ↓ Normal Variable ↑Watch Combined B & T Cell DisordersWatch associated Bootcamp video - SCIDebc9b042-838a-45aa-9335-0113b332d65e
What is the definitive treatment for severe combined immunodeficiency (SCID)? {{c1::Stem cell transplant}}No concern for rejection; other options include antimicrobial prophylaxis, IVIG, and sterile isolationWatch Combined B & T Cell DisordersWatch associated Bootcamp video - SCIDd7516aca-0c3a-4a94-8a65-1c653f9fdf3c
Which immunodeficiency is characterized by decreased T-cell receptor excision circles (TRECs)? {{c1::Severe combined immunodeficiency (SCID)}}TRECs are small circles that are created by T cells which indicate maturity, reduced amounts indicate immunodeficiencyWatch Combined B & T Cell DisordersWatch associated Bootcamp video - SCID193d9f9f-b365-4cf6-a246-96fc608b14c1
Severe combined immunodeficiency (SCID) is characterized by absent {{c1::T cells}} on flow cytometryAlso has dysfunctional B cells Immunodeficiency syndromes Condition T cell count B cell count IgG IgA IgM IgE Selective IgA deficiency Normal Normal Normal ↓ Normal Normal Job syndrome (hyper-IgE syndrome) ↓ Th17 cells Normal Normal Normal Normal ↑ CD40 ligand deficiency (hyper-IgM syndrome) Normal Normal ↓↓ ↓↓ Normal / ↑ ↓↓ Wiskott-Aldrich syndrome Normal Normal ↓ / normal ↑ ↓ / normal ↑ Common variable immunodeficiency Normal Normal ↓ ↓ ↓ ↓ X-Iinked (Bruton) agammaglobulinemia Normal ↓ ↓ ↓ ↓ ↓ Severe combined immunodeficiency Absent Absent ↓ ↓ ↓ ↓ Transient hypogammaglobulinemia of infancy Normal Normal ↓ Normal Variable ↑Watch Combined B & T Cell DisordersWatch associated Bootcamp video - SCID7db1c7eb-603f-44ec-bf97-f9a1ee6ba04e
{{c2::X-linked (Bruton) agammaglobulinemia}} is caused by a defect in the {{c1::Bruton tyrosine kinase (BTK)}} geneResults in failure for pre- and pro-B cells to matureWatch B Cell Disorders & DiGeorge SyndromeReview Bruton (X-linked) AgammaglobulinemiaWatch associated Bootcamp video - B-cell and T-cell Variants30932213-4890-479c-8917-2f7787c3f8ec
Which immunodeficiency is characterized by absent B cells in peripheral blood? {{c1::X-linked (Bruton) agammaglobulinemia}}- Due to disordered B-cell maturation; pro- and pre-B cells cannot mature - Markedly reduced CD19+ B-cells on flow cytometry Immunodeficiency syndromes Condition T cell count B cell count IgG IgA IgM IgE Selective IgA deficiency Normal Normal Normal ↓ Normal Normal Job syndrome (hyper-IgE syndrome) ↓ Th17 cells Normal Normal Normal Normal ↑ CD40 ligand deficiency (hyper-IgM syndrome) Normal Normal ↓↓ ↓↓ Normal / ↑ ↓↓ Wiskott-Aldrich syndrome Normal Normal ↓ / normal ↑ ↓ / normal ↑ Common variable immunodeficiency Normal Normal ↓ ↓ ↓ ↓ X-Iinked (Bruton) agammaglobulinemia Normal ↓ ↓ ↓ ↓ ↓ Severe combined immunodeficiency Absent Absent ↓ ↓ ↓ ↓ Transient hypogammaglobulinemia of infancy Normal Normal ↓ Normal Variable ↑Watch B Cell Disorders & DiGeorge SyndromeReview Bruton (X-linked) AgammaglobulinemiaWatch associated Bootcamp video - B-cell and T-cell Variants4cbf24be-2198-46a1-b100-b5888ee5288c
Which immunodeficiencies are characterized by absent/scanty lymph nodes and tonsils? {{c1::X-linked (Bruton) agammaglobulinemia}} and {{c1::severe combined immunodeficiency (SCID)}}Immunodeficiency syndromes Condition T cell count B cell count IgG IgA IgM IgE Selective IgA deficiency Normal Normal Normal ↓ Normal Normal Job syndrome (hyper-IgE syndrome) ↓ Th17 cells Normal Normal Normal Normal ↑ CD40 ligand deficiency (hyper-IgM syndrome) Normal Normal ↓↓ ↓↓ Normal / ↑ ↓↓ Wiskott-Aldrich syndrome Normal Normal ↓ / normal ↑ ↓ / normal ↑ Common variable immunodeficiency Normal Normal ↓ ↓ ↓ ↓ X-Iinked (Bruton) agammaglobulinemia Normal ↓ ↓ ↓ ↓ ↓ Severe combined immunodeficiency Absent Absent ↓ ↓ ↓ ↓ Transient hypogammaglobulinemia of infancy Normal Normal ↓ Normal Variable ↑* due to decrease in B lymphocyte maturation; decreased Ig of all classes Watch B Cell Disorders & DiGeorge SyndromeReview Bruton (X-linked) AgammaglobulinemiaWatch associated Bootcamp video - SCID Watch associated Bootcamp video - B-cell and T-cell Variantsf0fa9cd6-025b-474f-98b1-f56f6cd62a17
When does X-linked agammaglobulinemia typically present? {{c1::6 months after birth}}- Due to decreased maternal IgG - Presents with recurrent bacterial, enterovirus, and Giardia infections - X-linked agammaglobulinemia = siX months after birthWatch B Cell Disorders & DiGeorge SyndromeReview Bruton (X-linked) Agammaglobulinemiad3228b80-fbd9-44ee-b61e-846848178505
Which immunodeficiency is characterized by no B-cell maturation? {{c1::X-linked (Bruton) agammaglobulinemia}}- Presents with recurrent bacterial, enterovirus, and Giardia infections - No maturation means B cells are absent / low (in contrast to CVID where B-cell differentiation is defective, and so plasma cells are reduced) Immunodeficiency syndromes Condition T cell count B cell count IgG IgA IgM IgE Selective IgA deficiency Normal Normal Normal ↓ Normal Normal Job syndrome (hyper-IgE syndrome) ↓ Th17 cells Normal Normal Normal Normal ↑ CD40 ligand deficiency (hyper-IgM syndrome) Normal Normal ↓↓ ↓↓ Normal / ↑ ↓↓ Wiskott-Aldrich syndrome Normal Normal ↓ / normal ↑ ↓ / normal ↑ Common variable immunodeficiency Normal Normal ↓ ↓ ↓ ↓ X-Iinked (Bruton) agammaglobulinemia Normal ↓ ↓ ↓ ↓ ↓ Severe combined immunodeficiency Absent Absent ↓ ↓ ↓ ↓ Transient hypogammaglobulinemia of infancy Normal Normal ↓ Normal Variable ↑Watch B Cell Disorders & DiGeorge SyndromeReview Bruton (X-linked) AgammaglobulinemiaWatch associated Bootcamp video - B-cell and T-cell Variants6a59d5bf-16e1-4a1b-bc61-bb7d8c0ec196
Which immunodeficiency is characterized by no B-cell differentiation into plasma cells? {{c1::Common variable immunodeficiency (CVID)}}Thus, decreased plasma cells and immunoglobulins, but B-cells are still present (vs. X-linked agammaglobulinemia) Immunodeficiency syndromes Condition T cell count B cell count IgG IgA IgM IgE Selective IgA deficiency Normal Normal Normal ↓ Normal Normal Job syndrome (hyper-IgE syndrome) ↓ Th17 cells Normal Normal Normal Normal ↑ CD40 ligand deficiency (hyper-IgM syndrome) Normal Normal ↓↓ ↓↓ Normal / ↑ ↓↓ Wiskott-Aldrich syndrome Normal Normal ↓ / normal ↑ ↓ / normal ↑ Common variable immunodeficiency Normal Normal ↓ ↓ ↓ ↓ X-Iinked (Bruton) agammaglobulinemia Normal ↓ ↓ ↓ ↓ ↓ Severe combined immunodeficiency Absent Absent ↓ ↓ ↓ ↓ Transient hypogammaglobulinemia of infancy Normal Normal ↓ Normal Variable ↑Watch B Cell Disorders & DiGeorge SyndromeWatch associated Bootcamp video - B-cell and T-cell Variants76bdf40e-4298-4549-9558-e5a8d631c9d9
What is the most common primary immunodeficiency? {{c1::Selective IgA deficiency}}Associated with celiac disease Immunodeficiency syndromes Condition T cell count B cell count IgG IgA IgM IgE Selective IgA deficiency Normal Normal Normal ↓ Normal Normal Job syndrome (hyper-IgE syndrome) ↓ Th17 cells Normal Normal Normal Normal ↑ CD40 ligand deficiency (hyper-IgM syndrome) Normal Normal ↓↓ ↓↓ Normal / ↑ ↓↓ Wiskott-Aldrich syndrome Normal Normal ↓ / normal ↑ ↓ / normal ↑ Common variable immunodeficiency Normal Normal ↓ ↓ ↓ ↓ X-Iinked (Bruton) agammaglobulinemia Normal ↓ ↓ ↓ ↓ ↓ Severe combined immunodeficiency Absent Absent ↓ ↓ ↓ ↓ Transient hypogammaglobulinemia of infancy Normal Normal ↓ Normal Variable ↑* B cells fail to differentiate into IgA secreting plasma cells Watch B Cell Disorders & DiGeorge SyndromeReview Selective IgA DeficiencyWatch associated Bootcamp video - Selective IgA Deficiency1d25de55-ee6e-4ce9-8dbc-7ca6aa513368
Patients with {{c1::IgA}} deficiency may develop {{c2::anaphylaxis}} to IgA-containing products (e.g., blood transfusions, gammaglobulins)Immunodeficiency syndromes Condition T cell count B cell count IgG IgA IgM IgE Selective IgA deficiency Normal Normal Normal ↓ Normal Normal Job syndrome (hyper-IgE syndrome) ↓ Th17 cells Normal Normal Normal Normal ↑ CD40 ligand deficiency (hyper-IgM syndrome) Normal Normal ↓↓ ↓↓ Normal / ↑ ↓↓ Wiskott-Aldrich syndrome Normal Normal ↓ / normal ↑ ↓ / normal ↑ Common variable immunodeficiency Normal Normal ↓ ↓ ↓ ↓ X-Iinked (Bruton) agammaglobulinemia Normal ↓ ↓ ↓ ↓ ↓ Severe combined immunodeficiency Absent Absent ↓ ↓ ↓ ↓ Transient hypogammaglobulinemia of infancy Normal Normal ↓ Normal Variable ↑Watch B Cell Disorders & DiGeorge SyndromeReview Selective IgA DeficiencyWatch associated Bootcamp video - Selective IgA Deficiency75a9fb09-aead-4ce4-a2e9-c724427679b0
{{c2::Hyper-IgM}} syndrome is most commonly due to mutated {{c1::CD40L}} on Th cellsClass-switching defect Immunodeficiency syndromes Condition T cell count B cell count IgG IgA IgM IgE Selective IgA deficiency Normal Normal Normal ↓ Normal Normal Job syndrome (hyper-IgE syndrome) ↓ Th17 cells Normal Normal Normal Normal ↑ CD40 ligand deficiency (hyper-IgM syndrome) Normal Normal ↓↓ ↓↓ Normal / ↑ ↓↓ Wiskott-Aldrich syndrome Normal Normal ↓ / normal ↑ ↓ / normal ↑ Common variable immunodeficiency Normal Normal ↓ ↓ ↓ ↓ X-Iinked (Bruton) agammaglobulinemia Normal ↓ ↓ ↓ ↓ ↓ Severe combined immunodeficiency Absent Absent ↓ ↓ ↓ ↓ Transient hypogammaglobulinemia of infancy Normal Normal ↓ Normal Variable ↑Watch Combined B & T Cell DisordersReview Hyper-IgM SyndromeWatch associated Bootcamp video - Hyper-IgM, Hyper-IgE, and Wiskott-Aldrich Syndrome60a474d4-2711-4a1f-bb1c-6004471a9194
Which immunodeficiency presents with defective class switching? {{c1::Hyper-IgM syndrome}}Thus, resulting in increased IgM with decreased IgA, IgG, and IgE Immunodeficiency syndromes Condition T cell count B cell count IgG IgA IgM IgE Selective IgA deficiency Normal Normal Normal ↓ Normal Normal Job syndrome (hyper-IgE syndrome) ↓ Th17 cells Normal Normal Normal Normal ↑ CD40 ligand deficiency (hyper-IgM syndrome) Normal Normal ↓↓ ↓↓ Normal / ↑ ↓↓ Wiskott-Aldrich syndrome Normal Normal ↓ / normal ↑ ↓ / normal ↑ Common variable immunodeficiency Normal Normal ↓ ↓ ↓ ↓ X-Iinked (Bruton) agammaglobulinemia Normal ↓ ↓ ↓ ↓ ↓ Severe combined immunodeficiency Absent Absent ↓ ↓ ↓ ↓ Transient hypogammaglobulinemia of infancy Normal Normal ↓ Normal Variable ↑Watch Combined B & T Cell DisordersReview Hyper-IgM SyndromeWatch associated Bootcamp video - Hyper-IgM, Hyper-IgE, and Wiskott-Aldrich Syndrome70ef5057-7be4-4159-977a-affddac7da84
What is the mode of inheritance of hyper-IgM syndrome? {{c1::X-linked recessive}}Watch Combined B & T Cell DisordersReview Hyper-IgM SyndromeWatch associated Bootcamp video - Hyper-IgM, Hyper-IgE, and Wiskott-Aldrich Syndrome0b63be73-18dd-441d-9539-da1fd904d2f7
Hyper-IgM syndrome is characterized by absent {{c1::germinal centers}} on lymph node biopsyImmunodeficiency syndromes Condition T cell count B cell count IgG IgA IgM IgE Selective IgA deficiency Normal Normal Normal ↓ Normal Normal Job syndrome (hyper-IgE syndrome) ↓ Th17 cells Normal Normal Normal Normal ↑ CD40 ligand deficiency (hyper-IgM syndrome) Normal Normal ↓↓ ↓↓ Normal / ↑ ↓↓ Wiskott-Aldrich syndrome Normal Normal ↓ / normal ↑ ↓ / normal ↑ Common variable immunodeficiency Normal Normal ↓ ↓ ↓ ↓ X-Iinked (Bruton) agammaglobulinemia Normal ↓ ↓ ↓ ↓ ↓ Severe combined immunodeficiency Absent Absent ↓ ↓ ↓ ↓ Transient hypogammaglobulinemia of infancy Normal Normal ↓ Normal Variable ↑Watch Combined B & T Cell DisordersReview Hyper-IgM SyndromeWatch associated Bootcamp video - Hyper-IgM, Hyper-IgE, and Wiskott-Aldrich Syndrome60674c06-dce8-4f90-aca7-679999027093
What is the mode of inheritance of Wiskott-Aldrich syndrome? {{c1::X-linked recessive}}\ Watch Qualitative Platelet Disorders Watch Combined B & T Cell DisordersReview Wiskott-Aldrich SyndromeWatch associated Bootcamp video - Hyper-IgM, Hyper-IgE, and Wiskott-Aldrich Syndrome1cfcbda0-d76e-4f60-9475-b60e88dac30c
Wiskott-Aldrich syndrome is characterized by inability for leukocytes and platelets to reorganize their {{c1::actin}} cytoskeletonResults in defective antigen presentation Immunodeficiency syndromes Condition T cell count B cell count IgG IgA IgM IgE Selective IgA deficiency Normal Normal Normal ↓ Normal Normal Job syndrome (hyper-IgE syndrome) ↓ Th17 cells Normal Normal Normal Normal ↑ CD40 ligand deficiency (hyper-IgM syndrome) Normal Normal ↓↓ ↓↓ Normal / ↑ ↓↓ Wiskott-Aldrich syndrome Normal Normal ↓ / normal ↑ ↓ / normal ↑ Common variable immunodeficiency Normal Normal ↓ ↓ ↓ ↓ X-Iinked (Bruton) agammaglobulinemia Normal ↓ ↓ ↓ ↓ ↓ Severe combined immunodeficiency Absent Absent ↓ ↓ ↓ ↓ Transient hypogammaglobulinemia of infancy Normal Normal ↓ Normal Variable ↑Watch Combined B & T Cell DisordersReview Wiskott-Aldrich SyndromeWatch associated Bootcamp video - Hyper-IgM, Hyper-IgE, and Wiskott-Aldrich Syndrome7d3b6aad-dccf-4c5c-bc1f-51ddbe3e8e98
What classes of immunoglobulin are increased in Wiskott-Aldrich syndrome? {{c1::IgA and IgE}}The Wiskott-Aldrich syndrome mnemonic is WATER, so think of the A and E in WATER Immunodeficiency syndromes Condition T cell count B cell count IgG IgA IgM IgE Selective IgA deficiency Normal Normal Normal ↓ Normal Normal Job syndrome (hyper-IgE syndrome) ↓ Th17 cells Normal Normal Normal Normal ↑ CD40 ligand deficiency (hyper-IgM syndrome) Normal Normal ↓↓ ↓↓ Normal / ↑ ↓↓ Wiskott-Aldrich syndrome Normal Normal ↓ / normal ↑ ↓ / normal ↑ Common variable immunodeficiency Normal Normal ↓ ↓ ↓ ↓ X-Iinked (Bruton) agammaglobulinemia Normal ↓ ↓ ↓ ↓ ↓ Severe combined immunodeficiency Absent Absent ↓ ↓ ↓ ↓ Transient hypogammaglobulinemia of infancy Normal Normal ↓ Normal Variable ↑Watch Combined B & T Cell DisordersReview Wiskott-Aldrich SyndromeWatch associated Bootcamp video - Hyper-IgM, Hyper-IgE, and Wiskott-Aldrich Syndrome0191123b-c151-4a55-b754-7cd0cdcb6fe1
"The features of {{c1::Wiskott-Aldrich}} syndrome may be remembered with the mnemonic ""WATER"": {{c1::WAS gene mutation::W}} {{c1::Actin cytoskeleton & Antigen-presenting cell dysfunction::A (2)}} {{c1::Thrombocytopenia (fewer and smaller platelets)::T}} {{c1::Eczema::E}} {{c1::Recurrent (pyogenic) infections::R}}"- Increased IgE and IgA - Normal or decreased IgG or IgM Immunodeficiency syndromes Condition T cell count B cell count IgG IgA IgM IgE Selective IgA deficiency Normal Normal Normal ↓ Normal Normal Job syndrome (hyper-IgE syndrome) ↓ Th17 cells Normal Normal Normal Normal ↑ CD40 ligand deficiency (hyper-IgM syndrome) Normal Normal ↓↓ ↓↓ Normal / ↑ ↓↓ Wiskott-Aldrich syndrome Normal Normal ↓ / normal ↑ ↓ / normal ↑ Common variable immunodeficiency Normal Normal ↓ ↓ ↓ ↓ X-Iinked (Bruton) agammaglobulinemia Normal ↓ ↓ ↓ ↓ ↓ Severe combined immunodeficiency Absent Absent ↓ ↓ ↓ ↓ Transient hypogammaglobulinemia of infancy Normal Normal ↓ Normal Variable ↑Watch Qualitative Platelet Disorders Watch Combined B & T Cell DisordersReview Wiskott-Aldrich SyndromeWatch associated Bootcamp video - Hyper-IgM, Hyper-IgE, and Wiskott-Aldrich Syndromey871186db-ed64-4d6a-8e6c-9e26aff4fdaf
The features of Wiskott-Aldrich syndrome may be remembered with the mnemonic {{c1::WATER}}WAS gene mutation Actin cytoskeleton & Antigen-presenting cell dysfunction Thrombocytopenia (fewer and smaller platelets) Eczema Recurrent (pyogenic) infections - Increased IgE and IgA - Normal or decreased IgG or IgM Immunodeficiency syndromes Condition T cell count B cell count IgG IgA IgM IgE Selective IgA deficiency Normal Normal Normal ↓ Normal Normal Job syndrome (hyper-IgE syndrome) ↓ Th17 cells Normal Normal Normal Normal ↑ CD40 ligand deficiency (hyper-IgM syndrome) Normal Normal ↓↓ ↓↓ Normal / ↑ ↓↓ Wiskott-Aldrich syndrome Normal Normal ↓ / normal ↑ ↓ / normal ↑ Common variable immunodeficiency Normal Normal ↓ ↓ ↓ ↓ X-Iinked (Bruton) agammaglobulinemia Normal ↓ ↓ ↓ ↓ ↓ Severe combined immunodeficiency Absent Absent ↓ ↓ ↓ ↓ Transient hypogammaglobulinemia of infancy Normal Normal ↓ Normal Variable ↑Watch Qualitative Platelet Disorders Watch Combined B & T Cell DisordersReview Wiskott-Aldrich SyndromeWatch associated Bootcamp video - Hyper-IgM, Hyper-IgE, and Wiskott-Aldrich Syndromebd8f372f-671a-47b6-9e5a-294b85a56b08
{{c2::C1 esterase inhibitor}} deficiency results in {{c1::hereditary angioedema}}- C1 inhibitor (AKA C1-esterase inhibitor) normally inhibits kallikrein, which is responsible for conversion of HMWK to bradykinin - Deficiency leads to high levels of serum bradykinin → episodes of swelling and edema - Can treat with icatibant (bradykinin B2 receptor antagonist), C1-inhibitor concentrate, or ecallantide (kallikrein inhibitor) Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia CommonsWatch Complement System DisordersWatch associated Bootcamp video - Complement Disorders912ab59e-3ec0-48da-9c9a-01e4cbfc2c01
Which complement protein is decreased in C1 esterase inhibitor deficiency? {{c1::C4}}C1-inhibitor regulates the C1 complex, thus unregulated C1 complex consumes lots of C4 and C2 to make C3 convertase (C4b2b)* due to uninhibited cleavage (activation) of downstream complement proteins (C2 & C4), thus using up complement factors Watch Complement System DisordersWatch associated Bootcamp video - Complement Disordersc4d88ba4-a858-4f8e-8ff7-cea546cdf304
Which complement deficiencies result in an increased risk for Neisseria infection? {{c1::Terminal complement deficiencies (C5b-C9)}}- MAC is the main defense against Neisseria - CH50 assay is the initial test for patient with suspected complement deficiencyWatch Complement System DisordersWatch associated Bootcamp video - Neisseria Gonorrhoeae Watch associated Bootcamp video - Complement Disorders079dd7f7-ebfa-441e-a5bd-74b10d77641f
{{c2::Lupus anticoagulant}} is an antiphospholipid antibody that results in a falsely {{c1::elevated}} {{c3::PTT}}"- Because these antibodies bind to phospholipids, they may prolong the PTT (an in vitro clotting test that requires phospholipids) - PTT will not correct when mixed with normal plasma (mixing study); prolonged PTT is an in vitro artifact - ""Falsely"" elevated because patients are in a hypercoagulable, NOT, hypocoagulable state - LuPus anTicoagulanT falsely elevates PTT"Watch Acquired & Inherited Thrombosis Syndromes Watch Autoimmune Disease Overview & Systemic Lupus Erythematosus (SLE)Watch associated Bootcamp video - Mixing Studies, Ristocetin, and D-dimer Watch associated Bootcamp video - Rheumatologic Diseases: Systemic Lupus Erythematosus Watch associated Bootcamp video - Antiphospholipid Syndrome29f3ac0d-9cfa-4607-806e-b4211e7723d3
What anti-ribonucleoprotein antibodies are associated with Sjögren syndrome? {{c1::Anti-SSA (Ro) and SSB (La) antibodies::Full name (short name)}}i.e. anti-Sjögren's syndrome A and B; may be seen with other autoimmune disorders as well (e.g. SLE) Diagnosis requires evidence of dry mouth/eyes and evidence of the aforementioned antibodies or histologic evidence of lymphocytic sialadenitisWatch Sjogren's Syndrome, Systemic Sclerosis & Mixed Connective Tissue DiseaseWatch associated Bootcamp video - Rheumatologic Diseases: Sjogren Syndrome83ebbea6-5618-4253-bd35-b7ce2c03d08c
Sclerosis of what organ is the most common cause of death in scleroderma? {{c1::Lungs}}- May cause interstitial lung disease (alveolar basement membrane inflammation and fibrosis) or pulmonary arterial hypertension (vasculopathy → lumen narrowing) - ILD associated with diffuse scleroderma, PAH associated with CREST syndrome - Second most common cause is kidney involvement (sclerodermal renal crisis)Watch Idiopathic Pulmonary Fibrosis Watch Sjogren's Syndrome, Systemic Sclerosis & Mixed Connective Tissue DiseaseWatch associated Bootcamp video - Scleroderma and Mixed Connective Tissue Diseasea45f4da3-67cb-45d9-9caf-1d1d6f81023e
{{c2::Anti-smooth muscle}} autoantibodies are associated with {{c1::autoimmune hepatitis type 1}}- High levels of autoantibodies (typically IgG) result in hypergammaglobulinemia and a gamma gap (total protein - albumin = >4 g/dL), a helpful characteristic feature (not seen in all cases) - On histology, lymphocytes and plasma cell infiltration can be seen - Primary biliary cholangitis: antimitochondrial antibodies - Primary sclerosing cholangitis: pANCA - Hashimoto: antimicrosomal antibodiesWatch associated Bootcamp video - Benign Biliary Disorders2be1cf9a-2aa7-432c-90e0-3bf43f5e0df8
{{c2::Osteomalacia}} is due to impaired mineralization of {{c1::osteoid}}- As opposed to impaired hyaline cartilage mineralization in rickets or decreased bone MASS in osteoporosis - Osteoblasts produce osteoid, which is normally mineralized with Ca2+ and PO43- to form boneWatch Osteomalacia & RicketsWatch associated Bootcamp video - Osteomelacia/Rickets Watch associated Bootcamp video - Vitamin D Deficiencyd041c9a8-fae7-4792-a181-7a3b2040c2ab
What is the most common cause of osteomalacia/rickets? {{c1::Vitamin D deficiency}}e.g. decreased sun exposure, poor diet, malabsorption, liver failure, renal failureWatch Osteomalacia & RicketsReview Vitamin D Deficiency and ExcessWatch associated Bootcamp video - Osteomelacia/Rickets Watch associated Bootcamp video - Vitamin D Deficiency52b735a0-3fc5-4f72-bc39-0d6a5f5bb516
Rickets may present with {{c1::rachitic rosary}} due to osteoid deposition at the costochondral junction"""Bead like"" Photo credit: Frank Gaillard, CC BY-SA 3.0, via Wikimedia Commons"Watch Osteomalacia & RicketsReview Vitamin D Deficiency and ExcessWatch associated Bootcamp video - Osteomelacia/Rickets Watch associated Bootcamp video - Vitamin D Deficiency4ae158d4-b369-47ba-95fe-dbd9233162b6
Rickets may present with frontal bossing and {{c1::craniotabes (soft skull)}}Frontal bossing is an enlarged forehead Photo credit: US Federal Government, Public domain, via Wikimedia Commons Watch 'Rickets - Signs & Symptoms', Dr Vikram Yadav, via Youtube (2:34)Watch Osteomalacia & RicketsWatch associated Bootcamp video - Osteomelacia/Rickets Watch associated Bootcamp video - Vitamin D Deficiencyd706a070-8a37-42d4-913c-a56ec451bd14
Rickets may present with pathologic genu {{c1::varum}}"AKA ""bow legs"" Photo credit: The original uploader was Mrich at English Wikipedia., CC BY-SA 1.0, via Wikimedia Commons"Watch Osteomalacia & RicketsReview Vitamin D Deficiency and ExcessWatch associated Bootcamp video - Osteomelacia/Rickets Watch associated Bootcamp video - Vitamin D Deficiencycd946960-271c-4a8e-900b-dc80e3b0e8a5
What MSK pathology is associated with metaphyseal cupping/fraying? {{c1::Rickets}}Photo credit: Frank Gaillard, CC BY-SA 3.0, via Wikimedia Commons, image has been modified by decreasing grain and adding arrowsWatch Osteomalacia & RicketsWatch associated Bootcamp video - Osteomelacia/Rickets978fa8a5-d2f6-492d-b204-cc964a8a48da
"What MSK pathology is associated with ""Looser zones"" (pseudofractures) on X-ray? {{c1::Osteomalacia/rickets}}"Photo credit: Gamache et al., CC BY 3.0, via Sage JournalsWatch Osteomalacia & RicketsWatch associated Bootcamp video - Osteomelacia/Ricketsfc17f950-90b4-4da6-bdf2-f8ae8b8f52b5
Osteomalacia/rickets is characterized by {{c1::decreased}} serum Ca2+Important distinguishing feature from osteoporosisWatch Osteomalacia & RicketsReview Vitamin D Deficiency and ExcessWatch associated Bootcamp video - Osteomelacia/Rickets Watch associated Bootcamp video - Vitamin D Deficiency13edd71e-dcee-41b2-8565-72ad4f5130d3
Osteomalacia/rickets is characterized by {{c1::increased}} serum PTHImportant distinguishing feature from osteoporosis* ALP also increased to create an alkaline environment for bone mineralization. Watch Osteomalacia & RicketsReview Vitamin D Deficiency and ExcessWatch associated Bootcamp video - Osteomelacia/Rickets Watch associated Bootcamp video - Vitamin D Deficiencyd49202f8-78ae-4575-80c7-2485367314d1
Paget disease of bone (osteitis deformans) often presents with {{c1::hearing}} loss due to CN impingement from foramen narrowingMay also have bone pain, leg bowing, and headaches No known treatment for reversalWatch Osteoporosis & Paget Disease of BoneWatch associated Bootcamp video - Osteitis Deformans (Paget disease of the bone)1fe74bd4-1617-4b7c-9e9c-ac2a33cbf640
What is the most common site for osteonecrosis (avascular necrosis)? {{c1::Femoral head}}due to insufficiency of the medial circumflex femoral arteryf1ce7c5e-d848-442e-9848-8251ef938d03
Osteoid osteoma typically arises in the {{c1::cortex}} of the {{c2::diaphysis}} of long bones (e.g. femur)Important distinguishing feature from osteoblastoma, which arises in vertebrae Tumor TypeLocationGiant cell tumorEpiphysis of long bones (often knee region)OsteosarcomaMetaphysis of long bones (often around knee)Ewing sarcomaDiaphysis of long bones (particularly the femur; other locations: pelvis, scapula, ribs)Osteoid osteomaCortex of the diaphysis of long bones (e.g. femur)OsteoblastomaVertebraeOsteochondromaBenign w/ an overlying cartilage capWatch Benign Bone TumorsReview Osteoid Osteoma vs OsteoblastomaWatch associated Bootcamp video - Osteoma & Osteoid Osteoma03c1185c-736f-4941-8952-c48e7c5af320
Osteoid osteoma presents with bone pain that is worse during the {{c2::night}} and that {{c1::DOES::does/doesn't}} resolve with NSAIDs- Important distinguishing feature from osteoblastoma - Nocturnal bone pain due to production of prostaglandins by tumorWatch Benign Bone TumorsReview Osteoid Osteoma vs OsteoblastomaWatch associated Bootcamp video - Osteoma & Osteoid Osteomae865a4cd-c2de-417d-9ccb-9be141c5723a
Osteoblastoma presents with bone pain that {{c1::does NOT::does/doesn't}} resolve with NSAIDsImportant distinguishing feature from osteoid osteomaWatch Benign Bone TumorsReview Osteoid Osteoma vs OsteoblastomaWatch associated Bootcamp video - Osteoblastomab9d0918f-07ba-448e-af15-f6ce87b9717e
{{c1::Osteochondroma}} is a benign bone tumor with an overlying cartilage capExostosis are sessile (no stalk) or pedunculated (with a stalk) Photo credit: Lucien Monfils, CC BY-SA 3.0, via Wikimedia Commons (left); AMBOSS, CC BY-SA 3.0 (right) Image(s) provided by www.radiologyassistant.nl. Used with permission. Tumor TypeLocationGiant cell tumorEpiphysis of long bones (often knee region)OsteosarcomaMetaphysis of long bones (often around knee)Ewing sarcomaDiaphysis of long bones (particularly the femur; other locations: pelvis, scapula, ribs)Osteoid osteomaCortex of the diaphysis of long bones (e.g. femur)OsteoblastomaVertebraeOsteochondromaBenign w/ an overlying cartilage capWatch Benign Bone TumorsWatch associated Bootcamp video - Osteochondroma & Enchondroma5db5648b-a26c-4d3a-9a0e-d06e5158fe00
Osteochondroma arises as a lateral projection of the {{c1::growth plate (metaphysis)}}This is continuous with the marrow space and is covered by a cartilaginous capExostosis = outgrowth of bone Photo credit: Hellerhoff, CC BY-SA 3.0, via Wikimedia CommonsWatch Benign Bone TumorsWatch associated Bootcamp video - Osteochondroma & Enchondroma64e167f6-62f7-4bf4-89e7-d9a69b5ca032
The peak incidence for primary osteosarcoma is in {{c1::teenagers (10-20 years old)::specific}}*Due to time of adolescent growth spurtWatch Malignant Bone TumorsReview OsteosarcomaWatch associated Bootcamp video - Osteosarcoma52ace996-3eeb-425e-a0a6-1bf2f4f83b86
The peak incidence for secondary osteosarcoma is in {{c1::the elderly (>65 years old)}}e.g. secondary to Paget disease of bone, bone infarcts, radiation, familial retinoblastoma, and/or Li-Fraumeni syndromeWatch Malignant Bone TumorsReview OsteosarcomaWatch associated Bootcamp video - Osteosarcoma646235d3-ec7c-482c-8fbb-03cf6dc41637
What MSK pathology predisposes to osteosarcoma? {{c1::Paget disease of bone (osteitis deformans)}}Paget disease → ↑ bone remodeling → ↑ risk of osteosarcomaWatch Malignant Bone TumorsWatch associated Bootcamp video - Osteitis Deformans (Paget disease of the bone) Watch associated Bootcamp video - Osteosarcoma1b134682-7bd0-4294-9a26-998e72b5fe40
What inherited cancer syndromes are associated with osteosarcoma? {{c1::Li-Fraumeni syndrome and familial retinoblastoma::2}}* Paget disease not an inherited cancer Watch Malignant Bone TumorsReview Li-Fraumeni Syndrome (LFS)Watch associated Bootcamp video - Osteosarcoma Watch associated Bootcamp video - Cellular Injury and Neoplasia: Oncogenes and Tumor Suppressor Genes Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Oncogenes and Tumor Suppressor Genesa8c4fa58-fbdd-47e3-9b8d-a6a0081f08d1
Osteosarcoma arises in the {{c1::metaphysis}} of long bones, often around the {{c2::knee::body location}}i.e. distal femur or proximal tibia Tumor TypeLocationGiant cell tumorEpiphysis of long bones (often knee region)OsteosarcomaMetaphysis of long bones (often around knee)Ewing sarcomaDiaphysis of long bones (particularly the femur; other locations: pelvis, scapula, ribs)Osteoid osteomaCortex of the diaphysis of long bones (e.g. femur)OsteoblastomaVertebraeOsteochondromaBenign w/ an overlying cartilage capWatch Malignant Bone TumorsReview OsteosarcomaWatch associated Bootcamp video - Osteosarcomaf475a0c0-e3cc-42e3-8218-bb661ed8501e
Imaging of osteosarcoma may reveal elevation of periosteum, which is known as {{c1::Codman triangle}}Photo credit: User:Ajimsha619, CC BY-SA 3.0, via Wikimedia CommonsWatch Malignant Bone TumorsReview OsteosarcomaWatch associated Bootcamp video - Osteosarcomaaeaffb73-7e3a-4529-915d-503a3e744dde
"What bone tumor is characterized by a ""sunburst"" pattern and Codman triangle on X-ray? {{c1::Osteosarcoma}}"Photo credit: Scott Dulebohn, MD, S Bhimji MD, CC BY 4.0, via Wikimedia CommonsWatch Malignant Bone TumorsReview OsteosarcomaWatch associated Bootcamp video - Osteosarcoma6ee3eb73-a3f0-44de-b249-0538dde35106
Giant cell tumor arises in the {{c1::epiphysis}} of long bones, often in the knee regionTumor TypeLocationGiant cell tumorEpiphysis of long bones (often knee region)OsteosarcomaMetaphysis of long bones (often around knee)Ewing sarcomaDiaphysis of long bones (particularly the femur; other locations: pelvis, scapula, ribs)Osteoid osteomaCortex of the diaphysis of long bones (e.g. femur)OsteoblastomaVertebraeOsteochondromaBenign w/ an overlying cartilage capWatch Benign Bone TumorsWatch associated Bootcamp video - Giant Cell Tumor (Osteoclastoma)806518e1-0ee1-40fd-85e9-68758f2274d9
"Giant cell tumor (osteoclastoma) is associated with a(n) ""{{c1::soap bubble}}"" appearance on X-ray"Photo Credit: WikiDoc by Maria Villarreal, CC BY-SA 3.0Watch Benign Bone TumorsWatch associated Bootcamp video - Giant Cell Tumor (Osteoclastoma)b9220c51-311b-43b2-a7f3-5631f0a47d55
"Which bone tumor is associated with a ""soap-bubble"" appearance on X-ray? {{c1::Giant cell tumor (osteoclastoma)}}"Photo Credit: WikiDoc by Maria Villarreal, CC BY-SA 3.0Watch Benign Bone TumorsWatch associated Bootcamp video - Giant Cell Tumor (Osteoclastoma)3a1c5e7c-fc87-4625-a709-dcd5fadc77c6
Ewing sarcoma arises in the {{c1::diaphysis}} of long bones (particularly the femur); other locations include pelvic {{c2::flat bones}}, scapula, and ribsTumor TypeLocationGiant cell tumorEpiphysis of long bones (often knee region)OsteosarcomaMetaphysis of long bones (often around knee)Ewing sarcomaDiaphysis of long bones (particularly the femur; other locations: pelvis, scapula, ribs)Osteoid osteomaCortex of the diaphysis of long bones (e.g. femur)OsteoblastomaVertebraeOsteochondromaBenign w/ an overlying cartilage capWatch Malignant Bone TumorsWatch associated Bootcamp video - Ewing Sarcoma7992caa0-69a2-48e2-bcdc-7511f8667705
"Ewing sarcoma is associated with a(n) ""{{c1::onion-skin}}"" appearance of periosteum on X-ray""- The technical term for this is lamellated periosteal reaction (a central, poorly defined lytic lesion surrounded by concentric layers of new bone) - VS the ""sunburst"" of osteosarcoma ""Ew an onion"""Watch Malignant Bone TumorsWatch associated Bootcamp video - Ewing Sarcoma1c6cce6a-2243-41c8-8c88-9050a96dab60
{{c2::Ewing sarcoma}} is a bone tumor that is associated with t({{c1::11}};{{c1::22}}) translocationCauses a fusion protein (EWS-FLI-1)Watch Malignant Bone TumorsWatch associated Bootcamp video - Ewing Sarcoma6e85f57f-e13e-4a30-9f96-6352e179704b
One complication of long standing rheumatoid arthritis is {{c1::subluxation}} of the {{c1::cervical}} spine- This is a potentially lethal feature of RA - Erosions in C1/C2 can occurWatch Rheumatoid ArthritisWatch associated Bootcamp video - Rheumatologic Diseases: Rheumatoid Arthritisba534e3c-7293-4a92-bd02-48831e7dfeea
The seronegative spondyloarthropathies may be remembered with the mnemonic {{c1::PEAR}}Psoriatic arthritis Enteropathic arthritis (IBD) Ankylosing spondylitis Reactive arthritis - Negative for rheumatoid factor - Have a strong genetic association with HLA-B27Watch associated Bootcamp video - Seronegative Spondyloarthritis Overview Watch associated Bootcamp video - Inflammatory Disease of the Skin: Red Plaque Diseasefef56419-8260-4f39-bf1e-239ed9d57541
"The seronegative spondyloarthropathies may be remembered with the mnemonic ""PEAR"" {{c1::Psoriatic arthritis::P}} {{c1::Enteropathic arthritis (IBD)::E}} {{c1::Ankylosing spondylitis::A}} {{c1::Reactive arthritis::R}}"- Negative for rheumatoid factor - Have a strong genetic association with HLA-B27Watch associated Bootcamp video - Seronegative Spondyloarthritis Overview Watch associated Bootcamp video - Inflammatory Disease of the Skin: Red Plaque Diseaseya67632bc-7ae1-45c1-aed3-7984d2d7e4ad
What bacteria typically causes septic arthritis in older children and adults? {{c1::Staphylococcus aureus}}- Gram-negative bacteria (e.g. Pseudomonas) is more common in patients with a history of IVDA - Staphylococcus aureus accounts for ~40% of cases, next most common cause is streptococci species (~28%)Watch associated Bootcamp video - Septic Arthritis4a3274a7-615a-4e4a-9118-dffed08bea23
{{c2::Pseudogout}} classically presents with {{c1::cartilage calcification (chondrocalcinosis)}} on X-rayPhoto credit: Taokinesis (Pixabay profile)Annotated by Mikael Häggström, CC0, via Wikimedia CommonsWatch Gout & PseudogoutWatch Gout & PseudogoutWatch associated Bootcamp video - CPPD/Pseudogoutd3684819-e6ad-4175-b8fc-0b4cde9b1f82
{{c1::Polymyalgia rheumatica}} is characterized by sudden onset pain and stiffness in the {{c2::proximal}} muscles {{c2::without::with or without}} muscular weakness- Proximal muscles = shoulders and hips - May also have systemic symptoms (e.g. fever, malaise, weight loss); lack of weakness helps distinguish from dermato- and polymyositis - Associated with elevated CRP and ESR with normal CK Photo credit: Twisp, Public domain, via Wikimedia CommonsWatch associated Bootcamp video - Polymyalgia Rheumaticacbb182b2-f70e-4744-98bc-099e2837918e
What is the treatment for polymyalgia rheumatica? {{c1::Low-dose glucocorticoids}}- Typically results in rapid relief of symptoms - vs. giant cell arteritis, which requires high-dose; if PMR does not improve rapidly with steroids, another diagnosis should be suspectedWatch associated Bootcamp video - Polymyalgia Rheumaticaed00560e-7ddf-46c9-9aee-7aa507104f8e
X-linked muscular dystrophy is characterized by muscle wasting and replacement of skeletal muscle by {{c1::adipose}} tissuee.g. Duchenne and Becker muscular dystrophy Photo credit: Dr. Edwin P. Ewing, Jr., Public domain, via Wikimedia CommonsWatch Muscular DystrophiesReview Duchenne and Becker Muscular DystrophyWatch associated Bootcamp video0cfa19c0-5fe0-4b72-a322-eacfcf464817
What gene is defective in X-linked muscular dystrophy (e.g. Duchenne, Becker)? {{c1::Dystrophin (DMD) gene}}Myotonic dystrophy = Autosomal dominant Image licensed by Physeo and used with permission. Purchase full access here.Watch Muscular DystrophiesReview Duchenne and Becker Muscular DystrophyWatch associated Bootcamp videoae04e479-bd22-4599-8924-ea6d68997a8b
What is the mode of inheritance of Duchenne and Becker muscular dystrophy? {{c1::X-linked recessive}}"Hence referred to as ""X-linked muscular dystrophy"""Watch Muscular DystrophiesReview Duchenne and Becker Muscular DystrophyWatch associated Bootcamp video78efd62c-e956-4c69-abba-b20077a017df
{{c1::Duchenne}} muscular dystrophy is typically due to frameshift or non-sense mutations, resulting in a truncated or absent dystrophin protein"""Duchenne = Deleted Dystrophin"" (vs. Becker, where dystrophin is mutated)"Watch Muscular Dystrophies Watch DNA MutationsReview Duchenne and Becker Muscular DystrophyWatch associated Bootcamp video3f7bfdc0-43f6-4197-a870-55f4b8a13d3e
{{c1::Becker}} muscular dystrophy is typically due to a non-frameshift deletion, resulting in a partially functional dystrophin proteinTherefore, dystrophin is mutated but NOT deleted (vs. Duchenne)Watch Muscular DystrophiesReview Duchenne and Becker Muscular DystrophyWatch associated Bootcamp videocf1e72c6-39a7-4371-acef-b2b9594d9f19
{{c2::Duchenne muscular dystrophy (and later onset in BMD)}} classically presents with {{c1::pseudohypertrophy}} of calf muscles- Due to fibrofatty replacement of muscle - They look strong, but they aren't Watch 'Muscular Dystrophy', NEJM, via Youtube (1:02) Photo credit: Duchenne, Guillaume-Benjamin, Public domain, via Wikimedia CommonsWatch Muscular DystrophiesReview Duchenne and Becker Muscular DystrophyWatch associated Bootcamp video1e604cb5-2be7-4033-8bb4-a7ce6da3f890
{{c1::Duchenne}} muscular dystrophy typically presents before 5 years of ageWatch Muscular DystrophiesReview Duchenne and Becker Muscular DystrophyWatch associated Bootcamp videoa6ababcf-57b6-4ebb-967c-e83f162b24f9
Duchenne muscular dystrophy is associated with increased serum {{c1::creatine kinase (CK)}} and {{c2::aldolase}}Obtaining CK level is a good initial screening test (before definitive diagnosis with genetic analysis)Watch Muscular DystrophiesReview Duchenne and Becker Muscular DystrophyWatch associated Bootcamp videobb363fb8-1849-4169-888d-724be6308a0b
The most common cause of death in Duchenne muscular dystrophy is {{c1::heart failure}} due to {{c1::dilated cardiomyopathy}}- Death usually results from cardiac or respiratory failure - Echocardiogram and ECG are indicated at time of diagnosis to screen for dilated cardiomyopathy and conduction abnormalitiesWatch Muscular DystrophiesReview Duchenne and Becker Muscular DystrophyWatch associated Bootcamp videob24ddfc5-15fa-44ea-a5ec-72ea52079b85
{{c1::Becker}} muscular dystrophy typically presents in adolescence or early adulthood- Presents as a milder form of Duchenne muscular dystrophy - Duchenne is Deadly, Becker is BearableWatch Muscular DystrophiesReview Duchenne and Becker Muscular DystrophyWatch associated Bootcamp videof4b65cb9-a895-4f6f-b04d-2d7fd0816669
Duchenne muscular dystrophy classically presents with the {{c1::Gower}} sign, in which a patient uses their upper extremities to help stand upMay also be seen in other muscular dystrophies and inflammatory myopathies (e.g. polymyositis)Watch Muscular DystrophiesReview Duchenne and Becker Muscular DystrophyWatch associated Bootcamp videobc9faf51-9223-4a63-bcf7-61a180c23493
{{c1::Myotonic dystrophy (type 1)}} is due to CTG trinucleotide repeat expansion in the {{c2::DMPK}} geneDystrophia myotonica protein kinase (DMPK) gene* DaMProcK: dystrophia myotonica protein kinase (DMPK) gene * CoTtaGe expansion: Myotonic Dystrophy is caused by CTG trinucleotide repeat expansion in the DMPK gene Watch Muscular DystrophiesReview Myotonic DystrophyWatch associated Bootcamp video26374869-57b6-4021-8a97-eef0caac751e
What is the mode of inheritance of myotonic dystrophy? {{c1::Autosomal dominant}}- myOtonic = dOminant - DuchEnne muscular dystrophy, BEcker muscular dystrophy = X-linked rEcessiveWatch Muscular DystrophiesReview Myotonic DystrophyWatch associated Bootcamp video27849a0d-c74f-4037-a3b4-88ba77ad1702
"The symptoms of {{c1::myotonic dystrophy}} may be remembered with the mnemonic ""CTG"": {{c1::Cataracts::C}} {{c1::Toupee (early balding in men)::T}} {{c1::Gonadal atrophy::G}}"Other symptoms include myotonia, muscle wasting, and arrhythmias Watch 'Myotonic Dystrophy', NEJM Group, via Youtube (0:53)Watch Muscular DystrophiesReview Myotonic DystrophyWatch associated Bootcamp videoy3a370237-82ba-4ffa-9708-6ef95faacffd
The symptoms of myotonic dystrophy may be remembered with the mnemonic {{c1::CTG}}Cataracts Toupee (early balding in men) Gonadal atrophy Other symptoms include myotonia, muscle wasting, and arrhythmiasWatch Muscular DystrophiesReview Myotonic DystrophyWatch associated Bootcamp video3e2e0b38-1091-46eb-9066-6d4eb8ddbe05
{{c2::Myasthenia gravis}} is caused by autoantibodies to {{c1::post}}synaptic {{c1::ACh receptors}} at the NMJ- Importantly, these antibodies (IgM and/or IgG) block activation resulting in a reduced number of functional acetylcholine receptors at the neuromuscular junction - This results in a decreased end plate potential (not allowing muscle cells to depolarize) since there are less postsynaptic cation channels that can now open in response to acetylcholineWatch Myasthenia Gravis & Lambert Eaton Myasthenic SyndromeWatch associated Bootcamp video - Myasthenia Gravis Watch associated Bootcamp video -Type II Receptor Binding Hypersensitivity Reactions and Coombs Test381fb152-6e07-47df-a347-c8a9ad0fc881
Myasthenia gravis presents with muscle weakness that {{c1::worsens}} with muscle useAKA muscle fatigability - When a motor nerve releases its neurotransmitters, it needs time to reuptake acetylcholine from synaptic cleft - However given frequent, repeated contractions, not enough time for acetylcholine to be replenished in axon terminal, and the amount of acetylcholine released gets smaller and smaller - In a normal person, it would take exercise for this to manifest, however in a person with MG, they are dealing with a decreased amount of motor end plate receptors so this manifests with normal activity (less sites to bind and cause muscle contraction), resulting in a decreased end plate potentialWatch Myasthenia Gravis & Lambert Eaton Myasthenic SyndromeWatch associated Bootcamp video - Myasthenia Gravisa1e9b73c-f4da-4a59-b695-dd9a8265d391
Myasthenia gravis classically involves the eyes, leading to {{c1::ptosis}} and {{c1::diplopia}}Photo credit: Mohankumar Kurukumbi, Roger L Weir, Janaki Kalyanam, Mansoor Nasim, Annapurni Jayam-Trouth., CC BY 2.0, via Wikimedia CommonsWatch Myasthenia Gravis & Lambert Eaton Myasthenic SyndromeWatch associated Bootcamp video - Myasthenia Gravis2b42b4e7-ac5f-48c7-abf4-3723a733ea91
Do the symptoms of myasthenia gravis improve with administration of an AChE inhibitor (e.g. edrophonium)? {{c1::Yes}}Watch Myasthenia Gravis & Lambert Eaton Myasthenic SyndromeWatch associated Bootcamp video - Myasthenia Gravis Watch associated Bootcamp video - Cholinomimetics - Anticholinesterases2d9838ff-f51b-4e6d-967e-314eae5aae9a
Myasthenia gravis may present as a paraneoplastic syndrome associated with {{c1::thymoma (may also have thymic hyperplasia)}}- Symptoms improve with removal of the thymus - Whereas Lambert-Eaton myasthenic syndrome (LEMS) is commonly a paraneoplastic syndrome associated with small cell lung cancerWatch Myasthenia Gravis & Lambert Eaton Myasthenic SyndromeWatch associated Bootcamp video - Myasthenia Gravis5abb6a8c-17c3-41e1-acaf-14c615cda170
{{c2::Lambert-Eaton myasthenic syndrome (LEMS)}} is caused by autoantibodies to {{c1::pre}}-synaptic {{c1::voltage-gated calcium channels (VGCC)}} at the NMJ- Leads to impaired ACh release - Treatment includes blocking K+ channel to get more Ca2+ influx (prolonged AP) or AChE inhibitor Photo credit: Huang K, Luo Y-B and Yang H (2019) Autoimmune Channelopathies at Neuromuscular Junction. Front. Neurol. 10:516. doi: 10.3389/fneur.2019.00516Watch Myasthenia Gravis & Lambert Eaton Myasthenic SyndromeWatch associated Bootcamp video - Lambert-Eaton Syndrome5eb7bdd7-6a48-41ed-8816-524807f4520e
Lambert-Eaton myasthenic syndrome presents with muscle weakness that {{c1::improves}} with muscle useMore depolarization → more forced acetylcholine releaseWatch Myasthenia Gravis & Lambert Eaton Myasthenic SyndromeWatch associated Bootcamp video - Lambert-Eaton Syndromee0fc2813-2adf-43dc-8f53-0a413e62aa49
Is the tensilon test (administration of edrophonium) very useful in diagnosis of Lambert-Eaton? {{c1::No}}Administration of edrophonium has a minimal effect, as this will just increase the contraction of a person with LEMS, as opposed to reversing the symptoms of a person with MGWatch Myasthenia Gravis & Lambert Eaton Myasthenic SyndromeWatch associated Bootcamp video - Lambert-Eaton Syndrome Watch associated Bootcamp video - Cholinomimetics - Anticholinesterasesc3aadcb8-58ff-43b0-b4e3-910a744041c5
Atopic dermatitis (eczematous) usually appears on the extensor surfaces and {{c1::face}} in infancy- Extensor surfaces and face in infancy, flexural surfaces in children and adults - These are red, weeping / crusted lesions involving the face, scalp, and extensor surfaces; the diaper area is usually spared Photo credit: Gzzz, CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Inflammatory Diseases of the Skin: Atopic and Allergic Diseases53825591-97aa-49f6-8156-efec0a9e67f6
Atopic dermatitis (eczematous) often manifests as lichenification on {{c1::flexor}} surfaces in children and adultse.g. antecubital fossa; whereas psoriasis typically presents on the extensor surfaces Lichenification depicted (first image) Photo credit: Gzzz, CC BY-SA 4.0, via Wikimedia CommonsPhoto credit: User:Madhero88, CC BY-SA 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Inflammatory Disease of the Skin: Atopic and Allergic Diseases Watch associated Bootcamp video - Female Pathology: Vaginal Skin Pathology2074eed2-1922-4654-ba8e-99dcc12683b5
Pemphigus vulgaris is due to Ig{{c2::G}} antibodies against {{c1::desmoglein (3 and 1)::specific antigen}}- Desmoglein is a cadherin protein of the desmosome that offers cohesions between keratinocytes - Inactivation of desmoglein → loss of desmosomes → epidermolysis (especially stratum spinosum) leads to structurally weak blister formation Photo credit: Mohammad2018, CC BY-SA 4.0, via Wikimedia Commons; Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch associated Bootcamp video - Inflammatory Diseases of the Skin: Autoimmune Blistering Conditions72e084b6-a7d2-453e-a7ae-29f9f8d57ff4
Is pemphigus vulgaris associated with a positive Nikolsky sign (separation of epidermis with manual stroking of skin)? {{c1::Yes}}Nikolsky Sign (+) vs. (-): Since the splitting occurs at the desmosomes in Pemphigus, which are halfway up the epidermis, the skin can slough off; compare with Bullous, where the epidermis is still thick and thus does not slough off Photo credit: Mohammad2018, CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Inflammatory Diseases of the Skin: Autoimmune Blistering Conditions23c249f8-cb8f-493a-ad24-c9c60a5e7560
Bullous pemphigoid is due to Ig{{c1::G}} antibodies against hemidesmosome components (BP180 & BP230)May have autoantibodies against type XVIII collagen or bullous pemphigoid antigen Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ Photo credit: Mohammad2018, CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Inflammatory Diseases of the Skin: Autoimmune Blistering Conditions1776747b-5451-4e42-829f-a84d6292ca81
Which blistering skin disorder is characterized by a linear pattern on immunofluorescence? {{c1::Bullous pemphigoid}}Photo credit: Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ Photo credit: Mohammad2018, CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Inflammatory Diseases of the Skin: Autoimmune Blistering Conditions5db340d3-f60d-4f39-bc80-8eedd83887b3
Dermatitis herpetiformis may be treated with {{c1::dapsone}} and a gluten-free dietImage(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch associated Bootcamp video - Aautoimmune Blistering Conditions Watch associated Bootcamp video - Pneumocystis Watch associated Bootcamp video - Inflammatory Diseases of the Skin: Autoimmune Blistering Conditions Watch associated Bootcamp video - Pyrazinamide, Ethambutol, Dapsone, and Clofazimine7560e3ac-71a2-439d-93fb-1cb53ed1dc35
The targetoid appearance of erythema multiforme is due to central epidermal {{c1::necrosis}}, surrounded by erythemaPhoto credit: Puppy123456, Public domain, via Wikimedia Commons Photo credit: Katerina et al., CC BY 3.0, via Open Access TextWatch associated Bootcamp video - Inflammatory Diseases of the Skin: Reactive Disease Watch associated Bootcamp video - Mycoplasma and Ureaplasma3c9a66b6-574b-4600-9fad-d6e884785a20
{{c2::Erythema multiforme}} is a blistering skin disorder most commonly associated with {{c1::HSV}} infectionMay also be seen with drugs (e.g. penicillin, sulfonamides), autoimmune disease, and malignancy Photo credit: Puppy123456, Public domain, via Wikimedia Commons Photo credit: Katerina et al., CC BY 3.0, via Open Access TextWatch associated Bootcamp video - Inflammatory Diseases of the Skin: Reactive Disease Watch associated Bootcamp video - Infectious Diseases of the Skin: Herpes Simplex and Varicella Infections Watch associated Bootcamp video - Infectious Diseases of the Skin: Herpes Simplex and Varicella Infections Watch associated Bootcamp video - Mycoplasma and Ureaplasmabedc00a9-199a-419d-8d55-7e69d02424ca
"Which skin disorder can present as a raised, discolored plaque with a waxy, ""stuck on"" appearance? {{c1::Seborrheic keratosis}}"- Benign lesion → if diagnosis is obvious from clinical appearance, no further workup/biopsy needed - These have a variable appearance from nearly flat macules to raised wart-like lesions ranging in size (mm → cm)- They typically have a velvety to greasy surface and well-demarcated border Photo credit: Image licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ Photo credit: Lmbuga , Public domain, via Wikimedia CommonsWatch associated Bootcamp video - Additional Dermatologic Disorders: Benign Dark Skin Lesions600af912-74d9-42ce-8fe2-c225f1c2434a
"Which skin disorder presents with epidermal hyperplasia and darkening of the skin (""velvet-like"" skin)? {{c1::Acanthosis nigricans}}"typically involves the axilla, neck, or groin *can be a paraneoplastic syndrome, but not typically Photo credit: Mark F. Brady; Prashanth Rawla., CC BY-SA 4.0, via Wikimedia CommonsWatch Diabetes Mellitus Chronic ComplicationsWatch associated Bootcamp video - Additional Dermatologic Disorders: Benign Dark Skin Lesions Watch associated Bootcamp video - Female Pathology: Polycystic Ovarian Syndrome6b4f76df-104a-4f78-a8cd-c6bac23f0455
Acanthosis nigricans is typically associated with {{c1::insulin}} resistance or visceral malignancy (esp. gastric carcinoma)- e.g. diabetes mellitus, obesity, Cushing syndrome, endocrinopathy - Keratinocytes have an IGF-1 receptor, thus both insulin and insulin-like-growth factor-1 can activate Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch Diabetes Mellitus Chronic ComplicationsWatch associated Bootcamp video - Additional Dermatologic Disorders: Benign Dark Skin Lesions Watch associated Bootcamp video - Female Pathology: Polycystic Ovarian Syndromeba443eaa-6400-46e5-84d5-a2e229b23be3
Basal cell carcinoma is characterized histologically by nodules of basal cells with peripheral {{c1::palisading}}Photo credit: Mikael Häggström, M.D. Author info - Reusing images- Conflicts of interest: NoneMikael Häggström, M.D.Consent note: Consent from the patient or patient's relatives is regarded as redundant, because of absence of identifiable features (List of HIPAA identifiers) in the media and case information (See also HIPAA case reports guidance)., CC0, via Wikimedia CommonsWatch Actinic Keratosis, Squamous Cell Carcinoma & Basal Cell CarcinomaWatch associated Bootcamp video - Malignant Skin Disorders: Skin Cancer2568d492-172d-442d-a9b5-bd055fb2dbb1
Squamous cell carcinoma of the skin is characterized histologically by formation of {{c1::keratin pearls}}vs. keratin pseudocysts/keratin-filled cysts/ horn cysts in seborrheic keratosis Photo credit: Calicut Medical College, CC BY-SA 4.0, via Wikimedia Commons Photo credit: Kelly Nelson (Photographer), Public domain, via Wikimedia Commons Photo credit: Unknown photographer/artist, Public domain, via Wikimedia CommonsWatch Cervical Neoplasia Watch Actinic Keratosis, Squamous Cell Carcinoma & Basal Cell CarcinomaWatch associated Bootcamp video - Malignant Skin Disorders: Skin Cancer Watch associated Bootcamp video - Female Pathology: Vaginal Cancer73f9a440-d5a4-4c5f-8466-91bb2e4fbed8
"The ABCDEs of melanoma are: {{c1::Asymmetry::A}} {{c1::Border irregularity::B}} {{c1::Color variation::C}} {{c1::Diameter ≥ 6 mm::D (≥#)}} {{c1::Evolution over time::E}}"Color variation - Red = local inflammation and vessel dilation - Brown/black = neoplastic melanocytes - White/gray = melanocyte regression (apoptosis/treatment response) - An important exception is the nodular subtype of melanoma which tends to grow vertically and therefore often presents with few of the ABCDE criteria Photo credit: Unknown photographer, Public domain, via Wikimedia Commons Photo credit: See page for author, Public domain, via Wikimedia Commons* ABCDE papers on front table: ABCDE's of melanoma Watch Malignant MelanomaWatch associated Bootcamp video - Malignant Skin Disorders: Melanomay365bff6d-b28f-446e-b161-ffe63e79467f
Which infectious skin disorder is a superficial bacterial skin infection characterized by painful, non-itchy pustules and honey-colored crusting? {{c1::Impetigo}}Photo credit: Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch Streptococcus pyogenes (Group A Strep)Watch associated Bootcamp video - General Principles: Skin Lesions Watch associated Bootcamp video - Infectious Diseases of the Skin: Bacterial Infectious Diseases Watch associated Bootcamp video - Infectious Childhood Rashes (Impetigo, Molluscum, Scarlet Fever)79f0abc0-2db6-4322-a01e-c8f886f3a5d0
Bullous impetigo has bullae and is usually caused by {{c1::S. aureus}} infection- Dry, honey-crusted flaccid bullae without erythema; develops crusted erosion - When caused by S. aureus, this is a localized form of Staphylococcal scalded skin syndrome with bulla formation being another effect of exfoliative toxin - Nikolsky sign is negative; a positive sign might suggest SSSS Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ Photo credit: Littlekidsdoc, CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Infectious Diseases of the Skin: Bacterial Infectious Diseases Watch associated Bootcamp video - Infectious Childhood Rashes (Impetigo, Molluscum, Scarlet Fever)7607f8d0-3f22-4e71-b7d0-28f471a467fa
"Which skin disorder begins as a ""herald patch"" followed days later by other scaly, erythematous plaques in a ""Christmas tree"" distribution on the trunk? {{c1::Pityriasis rosea}}"- Multiple plaques with collarette scale; self-resolving in 6-8 weeks - Pityriasis rosea and pityriasis versicolor do not involve the hands and soles while syphilis does Photo credit: Aceofhearts1968, Public domain, via Wikimedia Commons Photo credit: James Heilman,MD, CC BY-SA 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Inflammatory Disease of the Skin: Red Plaque Disease Watch associated Bootcamp video - Tinea: Malassezia1e7244a9-de99-4e5e-a674-979a1c02901b
What vascular tumor is a benign capillary hemangioma seen in adult individuals? {{c1::Cherry hemangioma}}- Small, bright red cutaneous papules that appear in patients during adulthood - Consist of dilated capillaries and postcapillary venules in the papillary dermis - Do not regress spontaneously Photo credit: Midasblenny, CC BY-SA 4.0, via Wikimedia Commons Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch associated Bootcamp video - Additional Dermatologic Disorders: Vascular Tumors926a293e-8807-4b32-9946-52cb4cacbca4
Do cherry hemangiomas regress? {{c1::No}}Whereas strawberry hemangiomas do regress Photo credit: Midasblenny, CC BY-SA 4.0, via Wikimedia Commons Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch associated Bootcamp video - Additional Dermatologic Disorders: Vascular Tumorsc64b9b4b-99ef-4658-be24-bf73bfb80e5a
The anti-coagulants {{c1::protein C}} and {{c1::S}} are reduced early in warfarin therapy, leading to a(n) {{c2::hyper}}coagulable stateProteins C and S have shorter half-lives than factors II, VII, IX, and XWatch WarfarinWatch WarfarinWatch associated Bootcamp video - Anticoagulation0b52beef-e484-471a-a73d-0cdf2aa200cc
For rapid reversal of warfarin, administer {{c1::prothrombin complex concentrates (PCC)}} (preferred) or {{c1::fresh frozen plasma (FFP)}} with {{c3::IV vitamin K}}- PCC is preferred over FFP if both are available - Only use PCC/FFP if patient on warfarin is actively bleeding (use vitamin K if patient has a supratherapeutic INR but is not bleeding) - Vitamin K to resynthesize clotting factors in liver; PCC results in rapid reversal of warfarin (factors II, VII, IX, and X) ; FFP can be considered if PCC is not available but is slower/requires more volume infusionWatch WarfarinWatch WarfarinWatch associated Bootcamp video - Anticoagulationa326cc03-e690-4c04-9301-26e93c83895f
What is the cause of a hypercoagulable state in a patient on heparin therapy? {{c1::Heparin-induced thrombocytopenia (HIT)}}Due to IgG antibodies against heparin-platelet factor IV complexes which activate the platelets to cause thrombosisWatch Quantitative Platelet Disorders Watch Heparin, LMWH, Fondaparinux, Direct Thrombin Inhibitors, Xa InhibitorsWatch HeparinWatch associated Bootcamp video - Anticoagulation977fa5f4-3c7c-4f8a-99b8-9bb5d14f5656
What MSK pathology is associated with heparin use? {{c1::Osteoporosis}}Watch Osteoporosis & Paget Disease of Bone Watch Heparin, LMWH, Fondaparinux, Direct Thrombin Inhibitors, Xa InhibitorsWatch HeparinWatch associated Bootcamp video - Anticoagulation561cd68b-74a9-45d9-a133-893a01a6280a
"Aspirin may cause a ""pseudoallergy"" due to excess {{c1::leukotriene}} synthesis"- Associated with asthma or nasal polyps - Treat these patients with an anti-platelet inhibitor instead (e.g. clopidogrel) Samter triad: 1) Cross reactivity to other COX-1 inhibitors; general tolerance to COX-2 inhibitors 2) Chronic rhinosinusitis and nasal polyps: Hyposmia and anosmia, hyperplastic sinusitis, and recurrent nasal polyps 3) Bronchial asthma: More severe and difficult to control with increased death risk Photo credit: © MathieuMD / Wikimedia CommonsWatch Antiplatelet AgentsWatch Chronic Asthma SOAWatch associated Bootcamp video - Antiplatelet Medications Watch associated Bootcamp video - Asthma826932db-2fcd-4d04-84b7-495f49d70844
Dual-antiplatelet therapy with aspirin and ADP receptor inhibitors is used to prevent coronary stent {{c1::thrombosis}}- e.g. aspirin and a P2Y12 receptor blocker (e.g. clopidogrel, prasugrel, ticagrelor) - > 30 days in patients who receive a bare metal stent, > 12 months in patients who receive a drug-eluting stent (the stent undergoes slower endothelialization = higher risk of rethrombosis) - Bare metal stent: After placement, endothelial cells begin to cover the bare surface of the stent (stent endothelialization) → the exposure time of the foreign, thrombogenic material is limited → reduced risk of stent thrombosis → shorter period of post-placement anticoagulation needed. Thus, bare metal stents are better suited to patients who are not compliant with long-term oral medications and/or those who may need to undergo a surgery in the near futureWatch Antiplatelet AgentsWatch ADP Receptor InhibitorsWatch associated Bootcamp video - Antiplatelet Medicationsf71b718e-7eec-4bed-8c6d-d00ce6a52e2c
What acid-base disorder is seen with early phases of aspirin toxicity? {{c1::Respiratory alkalosis}}Salicylates stimulate respiratory drive by stimulating the medullary respiratory centerWatch NSAIDs Watch Acid/Base Disorders Watch Respiratory AlkalosisWatch associated Bootcamp video - Antiplatelet Medications Watch associated Bootcamp video - Respiratory Alkalosis Watch associated Bootcamp video - Pharmacological Toxicity and Treatment7d6d9dfe-0d6d-4c54-913e-d36e1d50fd1e
What is the leading cause of intellectual disability in the U.S.? {{c1::Fetal alcohol syndrome}}Most common chromosomal/genetic cause is Down syndrome (followed by Fragile X syndrome) Photo credit: Teresa Kellerman, CC BY-SA 3.0, via Wikimedia Commons, modified by censoringWatch associated Bootcamp video - Teratogenic Medications584d3324-fc12-4418-8815-e08b27ecba23
What selection bias occurs when specifically selecting patients from a hospital? {{c1::Berkson bias}}Hospital patients are generally less healthy than the general populationWatch Errors & BiasesWatch associated Bootcamp video8b51e925-2222-4529-96c2-e775ba43de07
What type of bias is likely to occur when asking patients with disease vs. patients without disease about prior risk factors? {{c1::Recall bias}}Patients with disease are more likely to recall exposures; reduce this bias by decreasing time from exposure to follow-upWatch Errors & BiasesWatch associated Bootcamp videoddb85d86-eac4-42bb-87d7-3baa3e76b3d4
What phenomenon/bias occurs when patients change their behavior in response to their awareness of being observed? {{c1::Hawthorne effect}}"- AKA the observer effect - ""HA""-thorne = ""HA"", laughing at you! You change your behavior because someone is watching you"Watch associated Bootcamp videobf2f9043-785c-4fc0-8ad7-57699d7d9af8
What type of bias is caused by early detection being confused with increased survival? {{c1::Lead-time bias}}"- lEAd-time = EArlier disease - LenGTh-time= LiGhTer disease - Early detection makes it seem as though survival has increased (you have a ""lead"" on the cancer with early detection, artificially increasing survival), but the natural history of the disease has not been impacted NB. -The average time from breast lump detection to death is about five years -Screening tests discover cancer earlier -Time from detection to death is about seven years - Lead time is the time difference between cancer detection by a screening test and time of diagnosis by symptoms or prior method of diagnosis Photo credit: Mcstrother, CC BY 3.0, via Wikimedia Commons"Watch associated Bootcamp videocc7b5598-e406-49f5-b1be-9167c5444970
What type of bias is caused by increased detection of diseases (e.g. cancer) with a more benign course? {{c1::Length-time bias}}- LEAd-time = EArlier disease - LenGTh-time= LiGhTer disease - This is seen in tests that detect long latency periods, and thus potentially missing out on diseases with shorter latency periods that become symptomatic earlier - e.g. a slowly progressive cancer is more likely detected by a screening test than a rapidly progressive cancerWatch associated Bootcamp video344fcafe-7318-4a7e-b889-eb2b514b6e96
Which measure of dispersion describes the dispersion of sample data in relation to the sample data mean? {{c1::Standard deviation}}Standard error describes the dispersion of sample data in relation to the population meanWatch associated Bootcamp video - Measures of Dispersion72accc66-457c-4850-8278-bbdb6ca9a514
Which measure of dispersion describes the dispersion of sample data in relation to the population mean? {{c1::Standard error}}Standard deviation describes the dispersion of sample data in relation to the sample data meanWatch associated Bootcamp video - Measures of Dispersionbf0e711d-591f-4ea1-8f51-a0f00993e399
As the sample size increases, the standard error {{c1::decreases}}i.e. the data set mean is approaching the population meanWatch associated Bootcamp video - Measures of Dispersionc24759e0-535e-43ee-b376-b134e5399e70
How does the width of a 95% confidence interval change with a decreased sample size? {{c1::Increased width}}CI = x̄ ± zα/2 × σ/√nwhere:- x̄ is the sample mean- σ is population's standard deviation- zα/2 : z value for the desired confidence level α (from the area under normal curve table)Watch associated Bootcamp video - Confidence Intervalsa9cf4964-a82f-423e-93d0-4336514284c8
What type of error is stating that there is an effect when none exists? {{c1::Type 1 error (false-positive error)}}- i.e. telling a man he's pregnant - Researchers reject the null hypothesis when the null hypothesis is really true - Represented by alpha (α) - Type 1 = false Positive; type 2 = false Negative (the letter P has 1 leg; N has 2)Watch associated Bootcamp video - Hypothesis Testing Watch associated Bootcamp video - Testing Errors5d8a10fc-b5c1-4aed-9e4f-b724a5a28df1
What type of error is stating that there is NO effect when one DOES exist? {{c1::Type 2 error (false-negative error)}}- i.e. telling a pregnant woman she's not pregnant - This is failing to reject the null hypothesis when it is truly false, causing an investigator to miss a true relationship - Denoted by beta (β) - Type 1 = false Positive; type 2 = false Negative (the letter P has 1 leg; N has 2)Watch associated Bootcamp video - Hypothesis Testing Watch associated Bootcamp video - Testing Errors539f93ac-cb1d-4ec2-b444-b41af31066e2
The probability of making a type 1 error is represented by {{c1::alpha (α)}}- α is the 1st letter (type 1) - Typically set at 0.05; i.e. there is less than 5% chance that the data will show something that is not really there (thus if p <0.05, the result is said to be statistically significant) - Alpha is the maximum probability of making a type I error that a researcher is willing to accept - Type 1 error = false-positive errorWatch associated Bootcamp video - Hypothesis Testing Watch associated Bootcamp video - Testing Errorsbaa0c61f-1476-40ca-b523-f90b3e6527e8
The probability of making a type 2 error is represented by {{c1::β}}- β is the 2nd letter (type 2) - Typically set at 0.20; i.e. there is less than 20% chance that the data will NOT show something that is really there - False-negative errorWatch associated Bootcamp video - Hypothesis Testing Watch associated Bootcamp video - Testing Errors4aefb25f-0345-4c58-ae9b-a4f6328f14b5
The statistical power of a study is calculated by {{c1::1 - β}}- This represents a study's ability to detect a difference when one exists i.e. rejecting the null hypothesis when the alternative hypothesis is true - β is the probability of a type 2 error (false-negative error)Watch associated Bootcamp video - Testing Errorsf0cce3f1-0e1b-4c30-a008-938354bfa044
The power of a study is increased with {{c1::increased}} sample sizeResults in a narrower confidence intervalWatch associated Bootcamp video - Testing Errorsf98f7ca1-eedd-4dd3-9080-a7f7233d1d25
What statistical test is used to check differences between the means (quantitative) of TWO groups (qualitative)? {{c1::t-test}}- e.g. comparing the mean blood pressure between men and women - Whereas, checking differences between the means of three or more groups = ANOVAWatch associated Bootcamp video - Nominal Independent Variables53b4c985-87ea-44ea-baf6-37a03268e167
What statistical test is used to check differences between the means of THREE or more groups? {{c1::Analysis of variance (ANOVA)}}e.g. comparing the mean blood pressure between members of three different ethnic groupsWatch associated Bootcamp video - Nominal Independent Variablese111bac3-bd1c-4f28-b9a3-f053d260c575
What statistical test is used to test the association between two or more categorical variables? {{c1::Chi-square test}}- e.g. comparing the percentage of members of 3 different ethnic groups who have essential hypertension - This is the only important test for categorical variablesWatch associated Bootcamp video - Nominal Independent Variablese25284cd-bb73-4ec9-a951-301d145e24dd
By what age does an infant develop stranger anxiety? {{c1::9 months}}"Developmental MilestonesAgeGross MotorFine MotorLanguageSocial/Cognitive2 months• Lifts head/chest in prone position• Hands unfisted 50% of the time• Alerts to voice/sound • Makes noises• Social smile • Recognizes parents • Eyes track past midline4 months• Head control • Props up on forearms• Brings hands to midline/mouth • Holds objects if placed in palm• Responds to voice • Coos (vowel sounds)• Enjoys looking around (at hands, at objects)6 months• Sits momentarily propped on hands (tripod position) • Rolls over• Reaches for toys • Puts objects in mouth• Vocalizes (squeals, blows raspberries)• Laughs • Recognizes familiar faces9 months• Sits independently• Raking grasp • Transfers objects hand to hand• Babbles (consonant sounds) • Responds to name• Stranger anxiety • Separation anxiety1 year• Pulls to stand • Cruises• Pincer grasp• Says ""mama"" or ""dada"" • Waves ""bye"" • Understands ""no""• Plays ""pat-a-cake"" • Looks for hidden object15 months• Takes a few steps independently• Stacks 2 blocks• Says 1 or 2 words (plus ""'mama"" & ""dada"")• Follows 1-step command with gesture • Points to get something • Shows affection18 months• Walks easily • Climbs on/off furniture• Scribbles • Feeds with fingers• Says ≥ 3 words (plus ""mama"" & ""dada"")• Follows 1-step command without gesture • Imitates caregiver2 years• Runs • Kicks ball • Walks up stairs• Uses spoon• Says 2-word phrases• Knows 2 body parts • Parallel play30 months• Jumps• Removes clothes • Turns pages• Says ≥ 50 words• Follows 2-step command • Identifies 1 color correctly3 years• Walks up stairs alternating feet • Rides tricycle• Dresses with help • Uses fork • Copies circle• Says ≥ 3-word sentences • Speech 75% intelligible• Knows age/sex • Cooperative play4 years• Catches large ball• Tripod pencil grasp• Says ≥ 4 word sentences • Names colors• Imaginative play5 years• Hops on 1 foot• Buttons clothes • Writes some letters• Speech 100% intelligible • Counts to 10 • Speaks in full sentences• Understands rules and taking turns"Review 6 Months72957576-2b16-4fdd-b3ef-20982281aa9b
By what age does an infant develop separation anxiety? {{c1::9 months}}- This is an overwhelming fear of separation from home or attachment figure ≥ 4 weeks; have already developed a social smile and stranger anxiety - Normal behavior up to age 3-4Review 9 Monthsfad9ca86-668c-4e41-8d84-7ffdc87e1f26
What type of disease prevention are vaccination and health promotion? {{c1::Primary}}i.e. prevent a disease before it occursWatch associated Bootcamp video - Disease Preventionf636c534-8e98-4e3c-8c4b-d012e8f7bd8a
What type of disease prevention is screening for disease (individual or community)? {{c1::Secondary}}- Screen early for and manage existing but asymptomatic disease - Screening is SecondaryWatch associated Bootcamp video - Disease Preventiond08acecb-1da2-46fd-bf4e-3eaa6dd34fdf
What type of disease prevention is treatment to reduce complications from disease that will have long-term effects? {{c1::Tertiary}}e.g. chemotherapy, disability limitation (blood sugar / BP control in diabetes), rehabilitation (physical therapy after stroke)Watch associated Bootcamp video - Disease Prevention62c91115-2f28-402a-8056-1d44456857b1
What type of disease prevention is identifying patients at risk of unnecessary treatment? {{c1::Quaternary}}e.g. electronic sharing of patient records to avoid duplicating recent laboratory and imaging studiesWatch associated Bootcamp video - Disease Prevention365fe38b-1309-4291-8717-622733c049e6
Combined oral contraceptives are contraindicated in women ≥ 35 years old who {{c1::smoke}}Specifically those smoking ≥15 cigarettes per dayWatch Intro to ContraceptionWatch associated Bootcamp video - Contraceptionf860cb46-7941-4fb0-a22e-24a700a6a336
What is the most effective emergency contraception? {{c1::Copper intrauterine device}}Copper IUD > ulipristal pill > levonorgestrel pill (plan B) > OCPsWatch Intro to ContraceptionWatch associated Bootcamp video - Contraception4be0dd2f-eaa2-45db-8e4c-3a06df3ede4f
What neurological side effect is associated with danazol? {{c1::Idiopathic intracranial hypertension}}AKA pseudotumor cerebri""" ITOAD""- Watch Intracranial Hypertension (ICH)"Watch associated Bootcamp video - Idiopathic Intracranial Hypertension Watch associated Bootcamp video - Androgen Modulatorsc391e48d-a635-4d01-a594-a77004d8c24c
Which non-megaloblastic macrocytic anemia presents with rapid-onset anemia within the 1st year of life? {{c1::Diamond-Blackfan anemia}}- Also known as congenital pure red cell aplasia or congenital hypoplastic anemia - Due to an intrinsic defect in erythroid progenitor cells with normal WBC and platelet counts; patients may have other abnormalities including triphalangeal thumbs Photo credit: Jansen87, CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Non-megaloblastic Anemiac535df74-92d0-423d-8d0a-7e376ae1c431
{{c2::Porphyria cutanea tarda}} is due to deficiency of the enzyme {{c1::uroporphyrinogen decarboxylase (UROD)}}"- Results in dermatological symptoms (deficiency occurs after porphobilinogen conversion) - Can also be caused by hepatitis C (""C"" for Cutanea) - Can be worsened by alcohol and HIV"Watch Heme Synthesis Watch PorphyriasReview Heme Synthesis Review Porphyria Cutanea Tarda (PCT)21fd72f9-2fa0-48e9-a74e-9db4b6d2bd28
What is the most common porphyria? {{c1::Porphyria cutanea tarda}}- Treat with phlebotomy (to remove excess iron stores) and low-dose hydroxychloroquine - May be the start of the vampire legend (drank blood for heme and avoid sun)Watch PorphyriasReview Porphyria Cutanea Tarda (PCT)82e535e2-5786-4761-b017-007ff6b60d4b
Medicare is for: - Patients ≥ {{c1::65}} years - Patients with {{c1::end-stage renal}} disease - Patients with {{c1::amyotrophic lateral}} sclerosis - Patients < {{c1::65}} with certain disabilitiesReview Medicare vs Medicaidydf22c72c-5d6e-4b2f-b86e-97028b354fec
Medi{{c1::caid}} is state/federal assistance for people with limited income/resources- Covers the homeless, undocumented immigrants, pregnant women, and low-income families - Policies on Medicaid coverage for undocumented immigrants vary from state to stateReview Medicare vs Medicaidf0b15ef0-f4aa-431e-b233-096117891145
Hospice care is available for patients whose life expectancy is ≤ {{c1::6 months::time}}Per UWorld: curative and life sustaining treatments must also be stoppedWatch associated Bootcamp video - Disease Preventionc124fb88-e11c-4e54-a5fe-5bbd350215d7
Which type of medical error analysis involves a retrospective approach, applied after failure to prevent recurrence? {{c1::Root cause analysis}}- Uses records and participant interviews to identify all underlying problems that led to an error - Aims to identify what, how, and why an undesirable outcome occurred - First step is to collect data to obtain complete information about event or eventsWatch associated Bootcamp video - Medical Errors7c7b6130-c52b-4e52-8b69-607f4a58c8e7
Which type of medical error analysis involves a forward-looking approach to prevent failure occurrence? {{c1::Failure mode and effects analysis}}Uses inductive reasoning to identify all the ways a process might failWatch associated Bootcamp video - Medical Errorscd6c8fc5-bc22-4e4b-a101-d8cadf687641
What two formulas are used to calculate drug clearance? {{c1::CL = rate of elimination of drug / plasma drug concentration}} = {{c1::Vd × Ke (elimination constant)}}Watch associated Bootcamp video - Drug Elimination801a5d09-07ed-478a-9269-456e7bc27d69
What is the next step for blunt abdominal trauma in a hemodynamically unstable patient with a positive FAST examination (e.g. free intraperitoneal fluid)? {{c1::Exploratory laparotomy}}To assess for splenic or liver injury that might be causing hemorrhage/fluid accumulationc04b411c-dc57-4515-86ef-55f8847ebb35
What imaging modality is useful for hemodynamically stable patients with blunt abdominal trauma and a positive FAST exam? {{c1::CT scan of the abdomen}}Helps distinguish blood from urine or ascites and can help quantify the amount of intraperitoneal blood15119f76-c5e8-4111-8323-c7a2718dcd5d
Bursitis is characterized by pain with {{c1::active::active and/or passive}} range of motionImportant distinguishing feature from septic arthritis (pain with BOTH active and passive ROM)ac3aced4-109a-4d71-a0c4-0cca458c76eb
What bacteria is typically responsible for acute prepatellar bursitis? {{c1::Staphylococcus aureus}}- From repetitive friction/trauma - Therefore drain + give antibiotics - Aspiration of bursal fluid can be performed to differentiate septic from sterile (ie, noninfectious) bursitis; fluid should be sent for cell count, Gram stain, culture, and crystal analysis Photo credit: Hirji et al., CC BY 2.0, via Journal of Clinical Imaging Science2f3ec9c7-17ec-4ab8-9947-25159db49fde
If gram stain and culture of bursal fluid in a patient with prepatellar bursitis is negative, what is the next step in management? {{c1::NSAIDs and activity modification (rest and elevation)::2}}Consider compression or bursal aspiration for significant swelling Septic bursitis treatment: Antibiotics and bursal aspiration Photo credit: Hirji et al., CC BY 2.0, via Journal of Clinical Imaging Science9fa4eff5-16d8-4dbd-96be-9cc4bad4545c
If gram stain and culture of bursal fluid in a patient with prepatellar bursitis is positive, what are the next steps in management? {{c1::Drainage and systemic antibiotics::2}}often due to Staph aureus Photo credit: Hirji et al., CC BY 2.0, via Journal of Clinical Imaging Sciencee7603a48-98c0-4748-a480-dc1fb7b9f820
Is septic arthritis characterized by pain with active or passive range of motion? {{c1::Both :)}}Important distinguishing feature from bursitis (pain with active ROM only)9d437f2e-2f89-4c80-94be-35eb1caa181f
Positive pressure mechanical ventilation causes an acute {{c1::increase::increase/decrease}} in intrathoracic pressure, which {{c1::decreases::increases/decreases}} RV preload by compressing the IVC- Loss of RV preload can lead to sudden cardiac death - In the setting of decreased CVP (e.g. hypovolemic shock) → acute loss of RV preload with resultant sudden cardiac death In addition... - Decreased RV preload & increased intrathoracic pressure (RV afterload) → decreased LV preload - Decreased MAP (baroreceptor effect) & decreased LV transmural pressure → decreased LV afterload83e6806c-a59e-41cc-8ef9-3e406b4eb10d
"What are the most common peripheral artery aneurysms? {{c1::Popliteal::#1}} and {{c1::femoral::#2}}"Frequently associated with abdominal aortic aneurysms5e845dc0-c53b-4f6d-a86f-a7fff5d08fb3
What is next step for blunt abdominal trauma with GI perforation identified on CT? {{c1::Exploratory laparotomy}}Free air (pneumoperitoneum) Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons Grade 4 liver laceration Photo credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia Commonse72d79f6-ef74-4380-92ca-ad56267e761a
Blunt abdominal trauma may result in damage to the {{c1::mesenteric}} blood supply, leading to subsequent necrosis and eventual GI perforationOccurs several days after the initial event (vs. penetrating trauma which presents acutely); need urgent ex lap Free air (pneumoperitoneum) Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons Grade 4 liver laceration Photo credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia Commons6fcb41dd-65b9-4839-8f17-207f6b09eac7
"The medial border of the ""anatomic snuffbox"" is bounded by the {{c1::extensor pollicis longus}}"7445c4f8-be54-496d-967e-22d01f1514c1
"The lateral border of the ""anatomic snuffbox"" is bounded by the {{c1::extensor pollicis brevis}} and the abductor pollicis longus"71a346ae-6338-4132-8e11-0e2eb26c8bee
What is the next step for a ruptured ovarian cyst with hemoperitoneum in a hemodynamically unstable patient? {{c1::Exploratory laparoscopy or laparotomy}}- Suturing or cauterization of the ruptured section or cystectomy - Stable patients → observe/analgesics28a31856-87a0-4825-9bb6-96d2901f99d8
Physical examination of a ruptured ovarian cyst shows unilateral {{c1::lower}} quadrant tenderness ± hemoperitoneum- Begins after strenous activity - Bleeding → acute abdomen Photo credit: BruceBlaus, CC BY-SA 4.0, via Wikimedia Commonsee79ffc9-8e83-49c9-b44d-958e55c77082
What type of neuromuscular blocking agent should be used in patients with upregulated post-synaptic ACh receptors (e.g. skeletal muscle trauma, burn injury, stroke)? {{c1::Non-depolarizing agents (e.g. vecuronium, rocuronium)}}Competition with ACh Photo credit: Lumen Learning [https://courses.lumenlearning.com/wm-biology2/chapter/neural-stimulation-of-muscle-contraction/] Mechanism: 1- Competitive binding of a nondepolarizing muscle relaxant to the acetylcholine receptor 2- Acetylcholine binding is prevented 3- Receptor channel for ions doesn't open The elimination of the nondepolarizing muscle relaxant via the blood and lymph signals the end of the effect following the temporal latency period. An alternative is to administer a cholinesterase inhibitor, which will decrease the rate of ACh breakdown, increase the amount of ACh in the synaptic cleft, bind to receptors preferentially, and restore normal impulse transmission.624b2b91-cd94-4c6a-9795-140a80c45509
What anesthetic is associated with neurotoxicity in patients with vitamin B12 deficiency? {{c1::Nitrous oxide}}N2O inactivates vitamin B12, resulting in inhibition of methionine synthasea55404ef-57e3-4cb6-a8e2-86a4124a43a0
What demographic is most commonly associated with umbilical hernia? {{c1::African-American infants}}25319018-d21b-48ab-818b-1f54cc697a20
Does gastroschisis typically require surgical intervention? {{c1::Yes (surgical emergency)}}ff201930-3a40-480a-aaa1-8a4baacc98fd
Does omphalocele typically require surgical intervention? {{c1::Yes (surgical emergency)}}eb2adc89-db98-4d9a-ba90-bbc8c7cf6248
What abdominal mass presents in newborns as a soft, moist, pink, pedunculated lesion after the umbilical cord has separated? {{c1::Umbilical granuloma}}a101513f-9d79-4732-9222-726f3b917245
What is the treatment of choice for umbilical granuloma? {{c1::Silver nitrate}}d6920105-0442-4661-9ee5-e30bba28daa5
Which metatarsal is most commonly injured by stress fractures? {{c1::2nd metatarsal}}especially in athletes and military recruits (sudden increase in activity → more load especially in 2nd metatarsal)2b79c8f0-9673-473d-aea7-d6cc05e8a315
Which metatarsal has an increased risk for nonunion following a stress fracture, thus requiring more aggressive treatment? {{c1::5th metatarsal}}- Typically managed with casting or internal fixation - Compare with conservative therapy for other metatarsals42237da5-7de6-4fb1-9713-88733ce55c58
What major artery must be examined for injury following a clavicular fracture? {{c1::Subclavian artery}}- Especially if there's a bruit → CT angiography - May also damage the brachial plexus - Middle fractures → conservative treatment - Distal fractures / unstable fracture → ORIF “Image licensed by Physeo and used with permission. Purchase full access here.” Photo credit: English: Nicholas Zaorsky, M.D., CC BY-SA 3.0, via Wikimedia Commons What additional vascular imaging study is recommended if this noninvasive imaging is abnormal? Additional vascular imaging is advised if the ABI is less than 0.9. Formal contrast angiography (FCA), CTA, and duplex ultrasonography are available options (see table below). CTA is currently the preferred test (of choice) due to its accessibility, speed, and noninvasiveness. Formal contrast arteriography is invasive (needs direct femoral artery puncture) and delays management by necessitating the referralto an interventional radiology team. StudyProsConsCTAQuick, accessible, and non-invasiveSmall/distal arteries are difficult to visualise; an intravenous contrast agent injection is used.Duplex USPrecise, non-invasiveOperator-reliant; not easily accessibleContrast arteriographyHighly sensitive and specificCostly, time-consuming, and invasive; involves intra-arterial contrast media InjuryArtery affectedCharacteristicsDislocations of the shoulder girdleAxillary arterySeizures can cause posterior dislocations, which are more likely to injure the axillary nerve. Axillary artery damage commonly accompany anterior dislocations which are more commonClavicle fractureSubclavian arteryPatients may also have hemothorax or pneumothorax. Supracondylar fractureBrachial arteryMore frequently affects children and, if ignored, can lead to Volkmann's contracturePelvic fractureBranches of internal iliac artery (superior gluteal and internal pudendal) The superior gluteal artery is more likely to be the source of arterial bleeding when there are severe posterior fractures. Injury to the internal pudendal artery can arise from severe anterior fractures, which is a major source of blood loss. Both injuries can cause major blood loss and hemorrhagic shockHip dislocationFemoral arteryPosterior dislocations manifest as an internally rotated and adducted leg with an increased incidence of sciatic nerve injury. Anterior dislocations present with externally rotated and abducted legs with an increased risk of femoral artery injury. Also, risk of avascular necrosis if combined with femoral head fractureKnee dislocationPopliteal arteryPatients with posterior dislocation experience arterial injury more commonly than those with anterior dislocation.Tibial plateau fracturePopliteal arteryPatients with medial injuries get arterial damage more commonly than those with lateral injuries.Watch associated Bootcamp video - Shoulder and Elbow: Clavicle Fractures490d576a-2b65-435d-bb56-94b5cc28dd7d
What nerve bundle must be examined for injury following a clavicular fracture? {{c1::Brachial plexus}}e.g. motor function of hand/arm “Image licensed by Physeo and used with permission. Purchase full access here .”42e4b2a7-c0a1-488a-ad56-521d3f2f9459
Are fractures of the middle-third of the clavicle typically treated operatively? {{c1::No}}- Fractured during FOOSH / athletic events - Treated non-operatively with a brace, rest, and ice; careful neurovascular examination is required to rule out underlying brachial plexus and/or subclavian artery injury - Unstable lateral fractures may need to be surgically fixed “Image licensed by Physeo and used with permission. Purchase full access here .” Photo credit: English: Nicholas Zaorsky, M.D., CC BY-SA 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Shoulder and Elbow: Clavicle Fracturesb2fe5117-f2f0-4ce3-9f2b-31b3af4b4139
Is post-operative ileus characterized by a clear transition point on abdominal X-ray? {{c1::No}}"Both small and large bowel dilation → uniform distribution of gas w/o air-fluid levels Photo credit: Caroline Chua, Shilpa Gurnurkar, Yahdira Rodriguez-Prado, Victoria Niklas, ""Prolonged Ileus in an Infant Presenting with Primary Congenital Hypothyroidism"", Case Reports in Pediatrics, vol. 2015, Article ID 584735, 4 pages, 2015. https://doi.org/10.1155/2015/584735"a0842941-3e57-4524-ae44-f2caaa3ad62d
Is small-bowel obstruction characterized by a clear transition point on abdominal X-ray? {{c1::Yes}}Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons29690866-eb46-4589-9101-7a662660c5e2
What vital signs (BP, HR) are concerning for hemorrhage following blunt abdominal or thoracic trauma? {{c1::Hypotension and/or tachycardia}}6341d3f8-3b9f-472f-86cd-de24926a8d05
What is the most sensitive test for diagnosis of MCL tear? {{c1::MRI}}- Soft tissue = MRI - Generally reserved for patients being considered for surgical intervention07c3b1b1-56d9-4428-8c38-f33a568b895c
What is the non-operative management for uncomplicated MCL tears? {{c1::Analgesics and POLICE (Protection, Optimal Loading, ice, compression, elevation)::2}}44dbe765-9adc-4666-86a1-afe32ba2196f
MCL tear is characterized by medial knee tenderness and {{c1::valgus::valgus or varus}} laxity on physical exam4d748656-92c3-4b08-a98a-3cfb48b24eba
What is the likely cause of gastric outlet obstruction in a patient with a history of acid ingestion? {{c1::Pyloric stricture}}- Acid causes stricture formation 6-12 weeks after the resolution of the acute injury - Characterized by early satiety, nausea, non-bilious vomiting, weight loss, and abdominal succussion splash (block outflow)18be424f-8554-402c-a0c0-5781e607e505
Sphincter of Oddi dysfunction produces recurrent, episodic pain in the {{c1::right upper}} quadrant or epigastric region with elevations in AST/ALT/ALP- Visualization of a dilated common bile duct in the absence of stones favors this diagnosis - Seen after surgery/pancreatitis and causes functional stenosis/dyskinesia of the sphincter Photo credit: Biliary_system.svg: Vishnu2011derivative work: Vishnu2011, Public domain, via Wikimedia Commonsdb0d979d-544e-4238-a09d-78176a2b290a
What is the gold standard for diagnosis of sphincter of Oddi dysfunction? {{c1::Sphincter of Oddi manometry}}Photo credit: Biliary_system.svg: Vishnu2011derivative work: Vishnu2011, Public domain, via Wikimedia Commonsf86824c6-53b4-4c65-a1f1-d967ae3b10b9
What is the treatment of choice for sphincter of Oddi dysfunction? {{c1::Sphincterotomy}}Photo credit: Biliary_system.svg: Vishnu2011derivative work: Vishnu2011, Public domain, via Wikimedia Commonsccaaf4b3-6934-488a-8f15-99bc7471944f
What is a common early clinical feature of compartment syndrome? {{c1::Paresthesia (pins/needles)}}- Due to sensory nerve ischemia - Followed by sensory and motor deficits later on4a94310c-21e0-41e3-b2c5-ff96385245f5
What is the most likely diagnosis for a hard, immobile mass on the hard palate of a young individual? {{c1::Torus palatinus (benign bony growth)}}Photo credit: Photo taken by dozenist CC BY-SA 3.0, via Wikimedia Commons - Can increase in size throughout life - No medical or surgical therapy is required unless the growth interferes with eating/speecha1c28066-e0b3-44bb-9ec3-0b9816427afa
What is the best initial step in the management of a hemodynamically stable patient with hemoptysis and a high clinical suspicion for tuberculosis? {{c1::Respiratory isolation}}e.g. endemic area, upper lobe involvementWatch Hemoptysis DDx70e33853-d8d9-47fe-9817-9054acb9a11c
Diaphragmatic rupture is more common on the patient's {{c1::left}} sideDue to congenital weakness in left posterolateral region and liver's protective effects on right; CXR showing a nasogastric tube in the pulmonary cavity is diagnostic (since stomach is displaced upward into lungs) An X-ray showing the spleen in the left lower portion of the chest cavity (X and arrow) after a diaphragmatic tear Photo credit: Hariharan D, Singhal R, Kinra S, Chilton A, CC BY 2.0, via Wikimedia Commons8cdae5ae-3101-44c4-aa46-768d6a293f2e
What imaging modality can confirm the diagnosis of diaphragmatic rupture in patients with suggestive X-ray findings? {{c1::CT scan (chest, abdomen)}}9be443b9-76f8-468c-baaa-5bebd19afd1b
Early spread of nasopharyngeal carcinoma to the {{c1::cervical}} lymph nodes is commonWatch Epstein-Barr Virus (Herpesviridae)9688b3c2-2eb4-40fa-a868-4d4f7c187b5a
Which region of the bladder may cause chemical peritonitis if ruptured by blunt trauma? {{c1::Dome of the bladder}}this part of the bladder borders the peritoneal cavity, so rupture spills urine into peritoneum → diffuse abdominal pain and referred pain to ipsilateral shoulder due to peritoneal irritation17f09eae-c359-4224-868f-f48cf27bd799
Which thyroid medication(s) can cause agranulocytosis? {{c1::Propylthiouracil (PTU) AND methimazole}}Look for a patient off of their thyroid medications who develops sore throat and feverWatch Propylthiouracil, Methimazole, LevothyroxineWatch associated Bootcamp video - T3, T4 Synthesis and Pharmacology89b1364b-2eae-4bf0-8f54-54b55a4f6abe
How does PaCO2 change in patients with atelectasis? {{c1::Decreases}}Due to hyperventilation to compensate for hypoxemia (therefore, presents with respiratory alkalosis)2c8423e5-aa9e-49bc-a156-bc2909dc02ba
Symptoms of atelectasis (e.g. dyspnea, tachypnea) typically manifest on post-operative days {{c1::2}} and {{c1::3}}Most common within 72 hours of surgery, can appear up to 5 days post-op467eab93-4c25-46a4-903b-c9fa91fd5fb7
Pre-operative smoking cessation should ideally occur at least {{c1::4-8 weeks}} prior to surgery- Some studies have found that even 1 day of smoking cessation prior to surgery may improve outcomes - At the minimum, smoking cessation should be strongly encouraged by providers to improve surgical outcomes9dd73b50-2483-455e-b0ae-8c60bbe0f8bd
What breathing instrument is useful for preventing post-operative atelectasis and pneumonia? {{c1::Incentive spirometer}}- Atelectasis is due to retained airway secretions, ↓ lung compliance, pain, and meds that prevent deep breathing - Incentive spirometry promotes lung expansion Photo credit: Stefan Bellini, CC0, via Wikimedia Commons0ff13bc7-c7e7-4aa4-a7e8-2e7a88ac8869
What is the first step in the management of a necrotizing surgical site infection? {{c1::Surgical exploration and debridement}}"Adjunctive therapies including broad-spectrum antibiotics, adequate hydration, and tight glycemic control are also important Signs and symptoms suggestive of necrotizing surgical site infection: - Pain, edema, or erythema spreading beyond the surgical site - Systemic signs such as fever, tachycardia, or hypotension - Paresthesia or anesthesia at the edges of the wound - Purulent, cloudy-gray discharge (""dishwater drainage"") - Subcutaneous gas or crepitus"4f1849a9-b35d-4716-822b-c1300fedd92f
Necrotizing surgical site infections are usually {{c1::poly::mono- or poly-}}microbiala3e4c341-a80d-4610-8642-f74379b7f62d
What acid-base disturbance typically occurs with acute mesenteric ischemia? {{c1::Metabolic acidosis (elevated lactate)}}Watch Intestinal Ischemia & Angiodysplasia28f6ea52-baec-4aa8-9061-f401436e1371
What is the most likely diagnosis given a patient with swollen, erythematous skin, pain out of proportion to physical exam, systemic signs such as hypotension/fever, and the CT findings below? {{c1::Necrotizing fasciitis}}"Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons - CT shows air in deep tissue - Rapidly spreading group ""A Streptococcus"" or multipathogen fascial plane infection that causes significant soft tissue damage and systemic infection - ""H/P"" : erythematous, warm, and swollen skin; loss of sensation in affected tissue; fever; crepitus in infected skin; purple staining; bullae over infected region - Lab results show elevated WBC, ESR, and CRP; culture during operation is helpful in identifying the pathogen - Radiology: Air collections under the skin can be found using computed tomography (CT) or X-rays - Treatment: Quick surgical debridement, incision, and drainage; intravenous antibiotics - Complications include gangrene, sepsis, and significant mortality (30% of patients) Photo credit: Piotr Smuszkiewicz, Iwona Trojanowska and Hanna Tomczak, CC BY 2.0, via Wikimedia Commons"Watch associated Bootcamp video - Systemic Infectious Dermatologic Pathology (Toxic Shock Syndrome, SSSS, Necrotizing Fasciitis) Watch associated Bootcamp video - Infectious Diseases of the Skin: Bacterial Infectious Diseasese7f0f2f4-3547-4bf4-9da3-7942b58062e3
Patients who develop ischemic colitis often have extensive underlying {{c1::atherosclerotic}} disease60b85a1e-4906-45d3-a18b-5e22d7596a49
CT findings indicative of ischemic colitis include colonic wall {{c1::thickening (edema)}} and fat {{c1::stranding}}Also may have air (pneumatosis) in the bowel wall, as evidenced below Photo credit: Hellerhoff, CC BY-SA 4.0, via Wikimedia Commons58892779-107f-46dd-904a-efcbe6b0658d
Patients with septic arthritis of the hip will often present with the affected joint held in {{c1::flexion, abduction, and external rotation::3 positions}} to reduce pain- Decreased intrarticular pressure → pain relief - This card used to say that flexion was more painful than extension, but patients with septic arthritis generally have pain with all ranges of motion, both active and passive, so the card was edited to test on common presentation (February 2024)71788ae3-f062-4b0c-9207-38930a122f53
What imaging modality is used for diagnosis of a psoas abscess? {{c1::CT scan of abdomen and pelvis}}"""Psoas sign"" ‒ pain on passive extension of the right hip ‒ is a sensitive marker for psoas abscess this is not specific as it can be due to any retroperitoneal irritation or inflammation of the psoas - not specific for appendicitis OR psoas abscess Ichiro Tsuboi, Tetsuya Yumoto, Tatsuya Toyokawa, Katsunori Matsueda, Joichiro Horii, Hiromichi Naito, Atsunori Nakao, ""Staphylococcus aureus Bacteremia Complicated by Psoas Abscess and Infective Endocarditis in a Patient with Atopic Dermatitis"", Case Reports in Infectious Diseases, vol. 2017, Article ID 4920182, 4 pages, 2017. https://doi.org/10.1155/2017/4920182"c6fb3332-0819-4092-b438-4277f5d2a370
Which types(s) of shock is/are characterized by increased mixed venous O2 saturation (SvO2)? {{c1::Septic shock, anaphylactic shock}}- Septic shock: ↓ use of O2 in mitochondrial ETC + ↓ O2 delivery and extraction - Anaphylactic shock: hyperdynamic circulation with inability to fully extract oxygen - Contrast with neurogenic shock, which will have ↓ SvO2Watch associated Bootcamp video - Shock: Septic Shock Watch associated Bootcamp video - Shock: Anaphylactic Shock564be43c-3af7-4f34-8d7a-bb12f43e2cd0
What is the next step in management for a patient with a perforated viscus? {{c1::Urgent exploratory laparotomy}}Photo credit: Cerevisae, CC BY-SA 4.0, via Wikimedia Commons Diagnosis confirmed with upright X-ray of chest and abdomen showing this finding762dc107-ed92-4ea4-8da5-1267740f6c99
What is the fluid of choice to restore volume quickly in the management of septic shock? {{c1::Isotonic crystalloid (IV 0.9% saline or lactated Ringer's)}}- Septic shock leads to ↓ TPR, so need more perfusion to tissue by increasing BP > 90 - Reverse the hypotension due to third spacingWatch associated Bootcamp video - Shock: Septic Shock4bb3be69-f4bd-4b2a-a1b5-5b4af78b847e
What Staphylococcus species is typically the cause of delayed-onset (3-12 months) prosthetic joint infection? {{c1::S. epidermidis}}- EpiDErmidis is DElayed-onset - Infections are due to less virulent organisms and present with chronic pain9ebaea30-e28c-403f-b677-a7a7b6007a40
Which Staphylococcus species is typically the cause of acute-onset (< 3 months) prosthetic joint infection? {{c1::S. aureus}}infections are due to more virulent organisms and present with acute painfd8b79b4-a80b-42e4-bbd5-e7fae7d37274
"The differential diagnosis for an anterior mediastinal mass can be remembered with the ""4 Ts"": {{c1::Thyroid neoplasm::T}} {{c1::Thymic neoplasm (thymoma)::T}} {{c1::Teratoma (and other germ cell tumors)::T}} {{c1::Terrible lymphoma::T}}"e46a3221-cdaf-45cb-9610-3dee725dd816
Seminomatous germ cell tumors often present with {{c1::normal}} AFP and {{c1::normal}} β-HCG levelsCan have elevated β-HCG in rare cases if the tumor contains syncytiotrophoblast cellscdd2afd6-3d8a-4fc8-becc-d4612756084d
Non-seminomatous germ cell tumors often present with {{c1::elevated}} AFP and {{c1::elevated}} β-HCG levelsNon-seminomas include yolk sac tumor, choricocarcinoma, and embryonal carcinoma427c65ab-3517-4571-bb73-6efc438f29f7
What imaging modality should be used to confirm placement of a central venous catheter tip? {{c1::Chest X-ray}}"- Place in the lower SVC - Identify possible injury (pneumothorax, venous perforation, pericardial tamponade) - This step may be omitted in the setting of an uncomplicated ultrasound-guided CVC placement Photo credit: Mikael Häggström, CC0, via Wikimedia Commons Photo credit: BruceBlaus. When using this image in external sources it can be cited as:Blausen.com staff (2014). ""Medical gallery of Blausen Medical 2014"". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436., CC BY 3.0, via Wikimedia Commons"387f5e2f-af95-4b3f-9c02-876345b90a98
What is the ideal placement for a central venous catheter tip? {{c1::Lower superior vena cava}}Photo credit: Glynda Rees Doyle and Jodie Anita McCutcheon, from Clinical Procedures for Safer Patient Care, CC BY 4.0, via Wikimedia Commons7bca56fb-9e91-4e15-88fe-d01a3ebda013
What is the first step in the management of cervical spinal trauma? {{c1::Spinal immobilization}}- Logroll to hard backboard (supine) & apply rigid cervical collar → restrict c-spine motion until injury is ruled out (either clinically or with imaging) - Important to remove any face shields, mouthguards, etc. for possible airway access if this can be done with minimal manipulation of the cervical spined7973e74-6e75-4928-82e5-442383fb5071
What imaging modality is best for confirming a meniscal tear? {{c1::MRI}}soft tissue9a0585e4-af3e-4d22-b91c-747e52849479
What is the management for a young patient with persistent symptoms due to a meniscal tear? {{c1::Surgery (after evaluation by MRI)}}older patients can be managed conservatively (rest, NSAIDs)0fa0686c-e50a-49b7-bb4b-0a5b6187717f
What is the management for older and/or mildly symptomatic patients with meniscal tears? {{c1::Rest/activity modification}}98fd0ff1-20a9-400e-a84d-9a20bae04bd1
Which tibial pathology presents with a diffuse area of tenderness on palpation? {{c1::Shin splints (medial tibial stress syndrome)::Shin splints/Stress fracture}}Important distinguishing feature from tibial stress fractures (point tenderness) Photo credit: InjuryMap, CC BY-SA 4.0, via Wikimedia Commons27199ef5-5822-4acb-86bb-59265479fc41
Immediately after a severe burn, most infections are due to gram-{{c1::positive}} organismse.g. staph from hairf0b14e0a-3b54-49d8-91a6-ed265dcddf37
After > 5 days following a severe burn, most infections are due to gram-{{c1::negative}} organisms or fungie.g. pseudomonas, candidada3d49f9-327c-4381-be4f-e190ed80c266
Change in appearance of a burn wound or loss of a viable skin graft is often the earliest sign of wound {{c1::infection}}e.g. partial-thickness injury turns into full-thickness injury other signs include systemic symptoms (tachycardia, hypotensive, fever or low temperature, oliguria)dc04536e-e79b-454b-8dc8-bc53ddf691ca
What is the initial screening test for blunt aortic trauma? {{c1::Chest X-ray}}should be ruled out in patients with blunt deceleration trauma (MVA or fall from > 10 feet) Photo credit: Stephanie C Torres-Ayala, Guido E. Santacana-Laffitte, Jose Maldonado, CC BY 4.0, via Wikimedia Commonse1d63605-1533-415e-9d83-422421dad21f
What is the most sensitive finding on imaging indicative of blunt aortic trauma? {{c1::Mediastinal widening}}Common symptoms include anxiety, tachycardia, and hypertension; CXR may also show left-sided hemothorax Mediastinal widening due to lymphoma: Photo credit: Doc James, CC BY-SA 4.0, via Wikimedia Commons56193b9e-f2eb-4dec-8a18-575ee68c87eb
Patient presents with migratory abdominal pain, McBurney point tenderness, nausea/vomiting, fever, and leukocytosis {{c1::CT scan::Next step in management}}UWorld: even if symptoms are obvious for appendicitis and Alvarado score >4, CT scan before surgery is still recommended1c424c52-b630-4b9c-b7a7-720625417c4f
Initial hematuria is suggestive of {{c1::urethral}} damage- Clots also suggest bleeding in bladder/ureters Image licensed by Physeo and used with permission. Purchase full access here.923b0653-305b-48ba-8773-9122216d89c7
Terminal hematuria is suggestive of {{c1::bladder}} or {{c1::prostate}} damagef5bcd87b-a3e3-4e76-9b38-80c42ca94980
Total hematuria is suggestive of {{c1::kidney}}, {{c1::bladder}}, or {{c1::ureter}} damagef1cbf0f6-e549-43b2-a443-15233638f618
What nerve is responsible for foot eversion and dorsiflexion? {{c1::Common peroneal (fibular) nerve}}"""PEDs"": Peroneal Eversion Dorsiflexion [Everting Fibs]"Watch Common Peroneal (Fibular) Nerve2f67a8f2-d72a-457e-a7f4-c69a8743603b
What nerve provides sensation to the webspace between the 1st and 2nd toes? {{c1::Deep peroneal (fibular) nerve}}- AKA superficial/deep peroneal nerve - The rest of the dorsum is supplied by the superficial fibular nerve Photo credit: (Annotated) Alice Roberts, CC BY 2.0, via Wikimedia CommonsWatch Common Peroneal (Fibular) Nerve4dbf25b5-00d5-462f-8363-18769b62f5f0
What preventive measures are useful for preventing post-operative acute suppurative parotitis? {{c1::Adequate fluid hydration and oral hygiene}}3cc9e0ad-e9c4-472d-9c14-00b55228626c
Does anterior cord syndrome result in loss of vibration and proprioception? {{c1::No}}Posterior cord is sparedWatch associated Bootcamp video - Anterior Cord Syndrome596bc66b-77fd-4256-a578-0bb99195b298
Does anterior cord syndrome result in loss of pain and temperature? {{c1::Yes}}Watch associated Bootcamp video - Anterior Cord Syndromea2906e5f-fad9-44eb-8265-ef6ac1930ca0
Anterior cord syndrome initially presents with bilateral {{c1::flaccid::spastic or flaccid}} paralysis- Part of spinal shock (bilateral flaccid paralysis + loss of pain/temp below level of injury) - UMN signs (e.g. spastic paralysis, hyperreflexia) develop over days to weeksWatch associated Bootcamp video - Anterior Cord Syndromeabedd5e2-f1ad-4030-8fe1-3ac66b2242fb
What is the initial step in the management of a small-bowel obstruction? {{c1::Conservative (NPO, nasogastric tube suction, IV fluids)}}- Uncomplicated/simple bowel obstruction → continue nonoperative management - Complicated bowel obstruction → immediate surgery after stabilizing with measures listed above (risk of ischemia/necrosis)d9bdb7ca-e0d9-4081-9909-24df3c2997a5
What imaging modality should be used to evaluate a suspected urethral injury (e.g. penile fracture)? {{c1::Retrograde urethrogram (assesses the urethra with X-ray after injection of contrast)}}"- Extravasation of contrast from urethra is diagnostic of urethral injury, symptoms may include blood at the meatus, dysuria, urinary retention, high-riding prostate - Followed by surgery Posterior Urethra Rupture (Contrast given through catheter fills bladder without outflow): Wojciech Marks, S. Dawid, J. Lasek, Z. Witkowski, K. Gołąbek-Dropiewska, M. Stasiak, ""Posterior Urethra Rupture: Contrast-Enhanced Computed Tomography Scan and Urethrocystography Demonstrations"", Case Reports in Urology, vol. 2012, Article ID 109589, 4 pages, 2012. https://doi.org/10.1155/2012/109589 Urethrogram showing a urethra stricture in a man: Photo credit: STofffuchs, CC BY 3.0, via Wikimedia Commons - Urethral injury almost only affects men, is frequently accompanied by a pelvic fracture, and can manifest as bleeding at the meatus - An additional clinical finding could be a scrotal hematoma - The feeling of needing to urinate yet being unable to, as well as a ""high-riding"" prostate on rectal examination, are symptoms of posterior injuries - The crucial point in any of those situations is that a retrograde urethrogram should be performed rather than inserting a Foley catheter (which could exacerbate an already existing damage) - Another diagnostic indicator of urethral damage would be if someone had accidentally tried to pass a Foley catheter and encountered resistance"56da13b3-91b2-4b1d-a853-17e320321b2a
Are penile fractures typically managed medically or surgically? {{c1::Surgically}}Medical management of penile fractures has a higher rate of complicationse3857646-9741-4cf9-8bcf-eb37e885caeb
What imaging modality is used to determine the need for urgent surgical intervention in patients with ischemic colitis (e.g. extensive bowel damage, perforation)? {{c1::CT scan}}Shows wall thickening and fat stranding21f66616-d129-4d6c-bfba-9924b554e817
What is the next step in management for a hemodynamically stable patient with penetrating abdominal trauma, rebound tenderness and guarding? {{c1::Exploratory laparotomy}}- Rebound tenderness and guarding are signs of peritonitis, which is an indication for urgent exploratory laparotomy in patients with penetrating abdominal trauma - Other indications are hemodynamic instability, evisceration, and blood from an NG tube or rectal examef562a0a-d54b-4c16-ace5-887c06bf101f
Which motor nerve is most commonly damaged during an axillary lymphadenectomy? {{c1::Long thoracic nerve}}"- May also be damaged by deep lacerations to the axillary region; causes ""winged scapula"" - Per UWorld: the intercostobrachial nerve (sensory) is the most frequently injured nerve overall during axillary lymph node dissection Photo credit: Dwaipayanc at the English-language Wikipedia, CC BY-SA 3.0, via Wikimedia Commons"Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Brachial Plexus Overview Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Winged Scapula7469e6ed-6e26-4791-87d1-20be374da7d7
Duodenal hematomas classically develop in pediatric patients {{c1::24}} - {{c1::48}} hours after an initial blunt abdominal trauma, causing epigastric pain and vomitingsymptoms due to failure to pass gastric contents beyond the obstructing duodenal hematoma112ebea1-7a27-43f6-b82b-036271fc71e0
Management of a duodenal hematoma typically involves {{c1::gastric decompression (NG tube)}} ± parenteral nutrition- Decompression of backed up intestinal contents, parenteral to bypass blockage - Surgery or percutaneous drainage may be considered to evacuate hematoma if non-operative management failsb89def2e-cab7-45e4-b778-55526b27428e
If a patient develops a whistling noise during respiration following rhinoplasty, what is likely the diagnosis? {{c1::Nasal septal perforation}}Likely resulting from a septal hematoma (more common) or septal abscess (less common) Photo credit: S Bhimji MD, CC BY 4.0, via Wikimedia Commonsbddda481-7274-43fd-9326-649db14d001a
When should older patients with hip fractures undergo definitive surgical correction? {{c1::As soon as reasonably possible}}- Early intervention = ↓ Mortality - May delay up to 72 hours to evaluate surgical risk and ensure medical stability (e.g. pulmonary edema, heart failure, pleural effusion) Photo credit: Booyabazooka, CC BY-SA 3.0, via Wikimedia Commons03ce05be-0140-4c6d-86a7-39d8420f222d
What is the initial management for a large spontaneous pneumothorax (apex-to-cupola distance ≥ 3 cm) in a hemodynamically stable patient? {{c1::Chest tube}}"This card previously stated ""needle decompression"". Only unstable patients get needle decompression. (May 2023) Stable pneumothorax treatment depends on size and risk factors Small pneumothorax (apex-to-cupola distance < 3 cm): - Low risk (no underlying lung disease): observation (repeat chest x-ray in 4-6 hours) - Higher risk (underlying lung disease): observation or chest tube Large pneumothorax (apex-to-cupola distance ≥ 3 cm): Chest tube regardless of risk Unstable pneumothorax is usually treated as a tension pneumo Suspected tension pneumothorax: Needle thoracostomy → tube thoracostomy (chest tube)"583efafc-6015-4b90-be73-3cae7b6cbb96
What imaging modality is typically used to diagnose acute cholecystitis? {{c1::Ultrasound}}CT scan also be used but is less sensitive; HIDA scan is useful when US findings are indeterminate Photo credit: Cerevisae, CC BY-SA 4.0, via Wikimedia Commons647eabc3-db53-44d8-b568-9d6a4336ebcb
When should patients with uncomplicated biliary colic have a cholecystectomy? {{c1::Electively}}Watch associated Bootcamp video - Gallstonesad8a5b4e-ecd1-4450-a445-27f5e78f45ed
Patients who present with acute onset back pain, syncope, and profound hypotension should be evaluated for a presumptive diagnosis of {{c1::ruptured abdominal aortic aneurysm (AAA)}}Surgical emergencyWatch Aortic Aneurysm4568a94c-74e1-4515-b232-9fdce87164c1
Atelectasis commonly occurs post-operatively due to {{c1::shallow::depth}} breathing and weak cough secondary to pain- Shallow breathing cannot recruit alveoli at the base of lungs - Causes hypoxia with resultant tachypnea and low CO2f9d32e05-a540-4abf-b7cf-5850f146387d
Hyperventilation may be used to lower intracranial pressure by decreasing {{c1::PaCO2}}, causing vasoconstrictionless CO2 = less blood needed to come in to carry CO2 away9697c4de-73f2-4f71-85ce-316f7b155b61
What rash is pictured in the image below? {{c1::Stasis dermatitis (secondary to venous insufficiency)}}Photo credit: No machine-readable author provided. Cardiologist61 assumed (based on copyright claims)., Public domain, via Wikimedia Commons Venous ulcerations, edema, stasis dermatitis3fc146a4-c566-4961-9e1e-1911f381e130
Pancreatitis with a(n) {{c2::ALT}} > 150 U/L is suggestive of {{c1::gallstone pancreatitis}}Use ultrasound imaging to localize gallstones727a87a7-1fe1-4826-b0e0-a32ef94fd481
In stable patients, packed RBC transfusion is indicated once the hemoglobin drops below {{c1::7}} g/dLHigher thresholds (e.g. < 9 g/dL) may be required for unstable patients with acute coronary syndromes or active bleeds/hypovolemiad07892b3-ee58-473f-ad35-c47c5a39e992
Platelet counts ≥ {{c1::50,000/mm3}} provide adequate hemostasisPlatelet transfusion is generally reserved for patients with active bleeds and platelet counts < 50,000/mm3 or < 10,000 with no bleeding206b629b-7399-423d-8297-63401f438963
What is the preferred initial management for a minimally symptomatic patient with a small newly diagnosed pancreatic pseudocyst? {{c1::Observation and symptom management*}}*Nonopioid analgesics for pain, antiemetics for nausea Follow-up imaging in 3-6 months Endoscopic drainage is indicated for chronic (> 6 wks) or large (> 5 cm) pseudocysts as well as persistent and/or severe symptomsWatch Acute & Chronic Pancreatitis641a8f97-0d81-426e-9455-04af0bccf48a
What is the preferred initial management for symptomatic patients with a pancreatic pseudocyst (e.g. abdominal pain, vomiting)? {{c1::Endoscopic drainage::include ROA}}Drainage is also warranted in patients with evidence of infection (e.g. fever, leukocytosis) and pseudoaneurysm; asymptomatic patients may be managed with an NPO diet and expectant management Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons2782b1b2-ce1a-4667-8b5f-bf3437e773b8
What imaging modality is used for the definitive diagnosis of syringomyelia? {{c1::MRI}}Soft tissue spinal cord = MRI2b7ed071-438f-4c8f-bbc6-b4fa5e2fe7f4
Are most cases of urethral injury treated with immediate or delayed surgical repair? {{c1::Delayed}}Typically treated with temporary urinary diversion by suprapubic catheter, followed by delayed repair0806fc72-9b3c-48c0-a1c3-aafbe87d54aa
What initial imaging modality is used to diagnose GI perforation? {{c1::Upright X-ray of chest and abdomen}}Showing free air under diaphgram0c67878c-d308-4f73-9639-a31cec1203f3
Which type of brain tumor typically appears as a well-circumscribed, calcified, extra-axial, dural-based mass in a female? {{c1::Meningioma}}Extra-axial = external to brain parenchyma Contrast-enhanced CT Photo credit: Glitzy queen00, Public domain, via Wikimedia Commons Image(s) provided by www.radiologyassistant.nl. Used with permission. Photo credit: Русский: Всеволод Лучанский (vvray), CC BY-SA 3.0 , via Wikimedia Commonsb1d4c2dd-457f-4de1-a82a-2bcbfd2d38aa
What is the most common blood transfusion reaction? {{c1::Febrile non-hemolytic reaction}}ec72b6df-37e3-4759-931e-d2d1b5c40053
What is the first test used to evaluate splenic injury in a hemodynamically stable patient? {{c1::CT scan w/ IV contrast}}While FAST exam is generally reserved for unstable patients3f32c064-f9a3-4288-8454-538adc59de2d
If a hemodynamically stable and alert patient with suspected splenic injury due to blunt abdominal trauma has a normal FAST exam despite high suspicion of intraabdominal injury (e.g. LUQ pain), what is the next step? {{c1::CT scan of abdomen}}- Signs of splenic injury include history of blunt abdominal trauma + evidence of hemorrhage (left-sided abdominal pain, hypotension, left shoulder referred pain, guarding) - Patients with suspected splenic injury secondary to blunt abdominal trauma without signs of peritoneal irritation may be monitored with serial abdominal exams79ee783f-f34c-432a-9d4e-2236c66f2032
What is the first imaging test used to evaluate splenic injury in a hemodynamically stable patient with altered mental status after blunt abdominal trauma? {{c1::CT scan (abdomen and pelvis)}}- In stable patients with AMS, the FAST exam is often skipped - Head CT will likely also be obtained at the same time - Intubation MUST be considered before sending patient to CT96aa108c-6fb7-491e-8da4-09be1da3f2ba
Any penetrating wound below the {{c1::4th}} intercostal space is considered to involve the abdomen46fb48dd-f901-48f0-aae4-00679f58defc
What is the next step in management for a hemodynamically unstable patient with penetrating trauma to the 6th intercostal space and an equivocal FAST exam? {{c1::Exploratory laparotomy}}9353da93-4b0f-4447-8326-55b3f0ca3f9c
{{c1::Retropharyngeal}} abscess often presents with neck pain, odynophagia, and fever following penetrating trauma to the posterior pharynx (e.g. fish bone)May also have nuchal rigidity and bulging of the pharyngeal wallWatch Stridor DDx12afabde-25e8-4e86-ba5d-c0e5b777d5eb
What diagnosis is suggested by the CT image below? {{c1::Ruptured AAA}}James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons symptoms include hypotension and abdominal or back pain7555d677-ee0f-43ce-b645-b561f38c6d04
What disease often manifests in young males as a painful, fluctuant mass above the anus in the intergluteal region with associated mucoid/bloody discharge? {{c1::Pilonidal disease}}Photo credit: GiggsHammouri, CC BY 3.0, via Wikimedia Commons Photo credit: Jonathanlund, CC BY-SA 4.0, via Wikimedia Commons First image = Pilonidal cyst Second image = Pilonidal abscess Due to an occluded, infected hair follicle; most frequently affects males age 15-30, obese individuals, those with sedentary lifestyles, and those with deep gluteal clefts Pilonidal disease - Common in young men with more body hair - Aetiology of pilonidal cyst/sinuses: unclear, but thought to form after repeated activity involving sweating and friction of the skin above the coccyx in the superior gluteal cleft. -Hair follicle infection in this area has the potential to spread subcutaneously and result in an abscess that ruptures to create a pilonidal sinus tract. -Hair and debris may then accumulate in a chronic sinus tract, leading to repeated infections as well as foreign body reactions. -Pain, swelling, and purulent discharge appear in the midline postsacral intergluteal region (sacrococcygeal skin) when a sinus becomes acutely infected. - It is treated through drainage of abscess and excision of sinus tract.3560c006-a0de-47a5-8131-32fbdf941d41
How does ejection fraction change with hypovolemic shock? {{c1::Increased}}Due to compensatory sympathetic response, which increases SVR, HR, and EF [think about less blood coming in and more being pumped out via SV thanks to SNS] EF = SV/EDV = (EDV-ESV)/EDVWatch associated Bootcamp video - Shock: Hypovolemic Shock163ce9dd-4687-47a9-a408-22006595d16c
Compartment syndrome is characterized by pain out of proportion to injury, especially with {{c1::passive::active/passive}} stretchingPain with passive stretching is a classic early finding5f0dceda-95ab-41bc-b9dc-ce2ab7ca6aa2
Burn victims with oropharyngeal inflammation/blistering or carboxyhemoglobin levels > {{c1::10}}% should be {{c2::intubated::treatment}} to prevent upper airway obstruction by edema- Other indications for intubation include burns on the face, singeing of eyebrows, oropharyngeal carbon deposits, stridor, and history of confinement in a burning building; the supraglottic airway is very sensitive to direct thermal injury with subsequent edema, which can cause obstruction - Ten = tubeWatch Fire-Related ToxicityWatch Stridor DDx3366c500-d743-46c3-91c0-e120eaebad57
Pancreatic cancer classically presents with constant and/or gnawing epigastric pain that is worse during the {{c1::night::morning/night}}Other classic signs include jaundice, anorexia with weight loss, and migratory thrombophlebitis in the setting of chronic pancreatitisWatch associated Bootcamp video - Pancreatic Insufficiency563370b4-e5b8-48bf-b79d-1221e3cde972
How does baseline body temperature change in patients with cirrhosis? {{c1::Decreased (hypothermic)}}Thus any temperature > 100 °F (37.8 °C) warrants investigationf69f59b8-420c-47c0-aef9-b965b85f5542
What does an abnormal Reitan trail test (timed connect-the-numbers test) indicate? {{c1::Altered mental status}}Useful for detecting subtle mental status changes4324469b-c251-4533-aafc-ce46d3b5471d
What is the likely diagnosis in a patient with cirrhosis and ascites who presents with low-grade fever, diffuse abdominal discomfort, and altered mental status (AMS)? {{c1::Spontaneous bacterial peritonitis}}"- Protein-rich ascites fluid breeds bacteria → fever, abdominal pain, altered mental status - May also have paralytic ileus, hypotension, and hypothermia with severe infection; thought to occur due to translocation of enteric organisms across the intestinal wall - AMS can be seen with the ""connect-the-numbers"" test"Watch Cirrhosis Pathogenesis & Clinical Manifestationscb3a1008-85a9-42e3-9a58-b4df47d41250
What is the likely diagnosis in a patient on warfarin who complains of weakness and back pain with new-onset anemia (CT below Red arrow)? {{c1::Retroperitoneal hematoma}} {{c1::::}}"Photo credit: Monarch Shah, John Paul Colombo, Sanya Chandna, Haris Rana, ""Life-Threatening Retroperitoneal Hematoma in a Patient with COVID-19"", Case Reports in Hematology, vol. 2021, Article ID 8774010, 4 pages, 2021. https://doi.org/10.1155/2021/8774010 CT abdomen pelvis sagittal and coronal view: large right-sided retroperitoneal hematoma extending along the psoas musculature and the lateral abdominal wall"b983d269-0459-47bb-a60a-9b2968c7a2ca
Acute liver failure is defined as all of the following without underlying liver disease (e.g. cirrhosis): - Severe acute liver injury (AST & ALT > {{c1::1000}}) - Hepatic {{c1::encephalopathy}} - Impaired synthetic function (INR ≥ {{c1::1.5}})- The presence of hepatic encephalopathy differentiates acute liver failure from acute hepatitis - Subacute liver failure is characterized by liver failure within 3-26 weeks of symptoms onset - Fulminant liver failure occurs within 1-3 weeksy76258c44-eec8-4a83-8c3a-5cb5876eb17a
The most common causes of acute liver failure are {{c1::drug toxicity}} and {{c2::acute viral hepatitis}}b8032c50-e4ee-4863-a2ba-34791b2e7457
The presence of elevated fasting serum gastrin (> 1000 pg/mL) with normal gastric acid (pH < 4) suggests a diagnosis of {{c1::Zollinger-Ellison}} syndrome- Fasting serum gastrin means off PPIs - Check gastric acid levels because failure of stomach acid secretion (pH > 4) may cause increased gastrin - Gastrin level < 110 pg/mL rules out gastrinoma; values in between 110 - 1000 pg/mL require secretin stimulation testing - Should be suspected in patients with multiple stomach ulcers and thickened gastric folds on endoscopy67cda7b5-13d6-44ba-a5ae-4243f9fae931
Which trace mineral deficiency manifests as impaired taste, alopecia, and pustular skin rash? {{c1::Zinc deficiency}}- Other features of zinc deficiency include hypogonadism, impaired wound healing, and immune dysfunction - Rash is often found periorally - Risk factors for deficiency include malabsorption, bowel resection, poor nutritional intake, and parenteral nutrition Photo credit: Hua W, Zou J, Zhuang Y and Zhou T (2022) Case report: Acrodermatitis enteropathica result from a novel SLC39A4 gene mutation. Front. Pediatr. 10:972030. doi: 10.3389/fped.2022.97203088ff9a9f-e1fb-4c45-b69f-6e0d6a941908
What is the colonoscopy screening recommendation for patients with inflammatory bowel disease? Begin {{c1::8 years after diagnosis}} and repeat every {{c1::1-3 years}}- May begin at 12-15 years post-diagnosis if only left colon involved - Prophylactic colectomy is advised if dysplasia is identified4571c535-4066-4516-8261-dffa1cd56995
What is the colonoscopy screening recommendation for patients with familial adenomatous polyposis and known polyps? Begin at {{c1::10-15}} years old and repeat q{{c1::1y}}- Proctocolectomy delayed until early adulthood for children or at the time of diagnosis for adults - Severe disease (e.g., high grade dysplasia, high numbers of polyps) necessitates earlier surgery - FAP almost always involves the rectum, so flexible sigmoidoscopy may be considered in place of colonoscopy if there are no known polyps - EGD is indicated every 6m-4y starting at 25–30 years old6a65a115-5a11-469d-be5f-3963ecb84d50
What infectious disease should be considered in patients with regional pain and hyperesthesia/allodynia without evidence of disease in local internal organs? {{c1::Herpes zoster (Shingles)}}- The pain may precede the rash by several days - May be precipitated by stress (e.g. chemo)4081a031-8b54-4ffa-bac6-709e9562b885
What CT or ultrasound finding is often found in patients with acute cholangitis? {{c1::Dilated common bile duct}}Photo credit: Cerevisae, CC BY-SA 4.0, via Wikimedia Commons3142cbce-1184-49e7-814e-8e6cdc533a2e
What imaging modality is preferred for the diagnosis of acalculous cholecystitis? {{c1::Ultrasound}}- Showing pericholecystic fluid / gallbladder wall thickening - Abdominal CT scan or HIDA scans are more sensitive and specific; use if US is unclearf2bb79f5-7f2f-4b8b-a6d5-ee443f645e2f
Conjugated hyperbilirubinemia with predominantly elevated {{c1::AST/ALT}} is suggestive of intrinsic liver diseasec1b73902-309b-41fe-b6d2-af9e5bda51fa
Conjugated hyperbilirubinemia with predominantly elevated {{c1::alkaline phosphatase}} is suggestive of intra- or extra-hepatic cholestasis- Extrahepatic cholestasis → biliary dilation - Intrahepatic cholestasis → no biliary dilation36322d61-5670-4dd5-b33d-8cfd61978109
Conjugated hyperbilirubinemia with {{c1::normal}} AST/ALT and alkaline phosphatase is suggestive of inherited bilirubin metabolism disordersThe hereditary hyperbilirubinemias are: - Gilbert syndrome - Crigler-Najjar syndrome, type I - Dubin-Johnson syndrome - Rotor syndrome166064d8-fe6d-4221-a669-d6c67dc677bb
What is the cause of hypotension in severe acute pancreatitis? {{c1::Increased vascular permeability}}Release of activated pancreatic enzymes and inflammatory mediators → widespread vasodilation, increased vascular permeability, and subsequent third spacingWatch associated Bootcamp video - Acute Pancreatitisf357a51d-24aa-4d30-b5fe-627722164936
What is the likely diagnosis for an adult with episodic, painless dark maroon-colored stool? {{c1::Angiodysplasia}}- Typically right-sided (vs. diverticulosis, which is typically left-sided with passage of bright red blood); anemic patients may be treated with cautery - Associated with aortic arch stenosis, renal disease, and vWD Photo credit: Joachim Guntau (=J.Guntau), CC BY-SA 3.0, via Wikimedia CommonsWatch Intestinal Ischemia & AngiodysplasiaWatch associated Bootcamp video - Diverticulosis and Angiodysplasiab3111a67-640d-4616-bb31-a6961778e9b3
Angiodysplasia is more common in patients with advanced {{c1::renal}} disease, {{c2::aortic stenosis::valvular disease}}, and von Willebrand diseaseAortic stenosis is due to disruption of vWF multimers as they traverse the turbulent valve space Photo credit: Joachim Guntau (=J.Guntau), CC BY-SA 3.0, via Wikimedia Commons1754d74d-12d7-451e-8dd1-2809cbc6ce6d
What is the likely cause of a solitary liver lesion in a patient with iron deficiency anemia and positive fecal occult blood screen? {{c1::Liver metastasis (from CRC)}}- Colorectal cancer (CRC) → anemia, FOB - While multiple hepatic nodules are typically seen, solitary lesions are not uncommon59dd6b03-fb47-4827-bc0d-d8943c5c12e9
What are the agents used to lower NH3 levels in hepatic encephalopathy? First-line: {{c1::Lactulose}} Second-line: {{c1::Rifaximin}}- Lactulose converts NH3 to NH4+ (non-absorbable) - Rifaximin reduces amount of ammonia-producing bacteria - Neomycin may be used to treat HEWatch LaxativesWatch associated Bootcamp video - Laxativesaa424cdf-9dd8-44bd-90c3-3a1f4006be01
What is the recommended management for variceal hemorrhage if there is no further bleeding after endoscopic therapy? {{c1::Secondary prophylaxis (β-blocker) with repeat endoscopic band ligation 1-2 weeks later::2}}Endoscopic therapy → band ligation, sclerotherapy to stop active bleedinge92980ec-3cd6-4e8a-a825-c5baba950975
{{c1::Pseudoachalasia}} describes a narrowing of the distal esophagus secondary to causes other than denervation- e.g. malignancy - Clues pointing to pseudoachalasia include significant weight loss, rapid symptom onset (< 6 months), and presentation at age > 6037c45eee-d5e1-46fc-b70e-b75af3bf62fe
What test is used to differentiate between achalasia and pseudoachalasia (e.g. malignancy)? {{c1::Endoscopy}}- Unable to push endoscope through the LES if there's malignancy (pseudo) - Thus, endoscopy is recommended to exclude malignancy in all patients with suspected achalasia5897bb14-702a-484e-a1b5-9e6b37fdaa96
What pathological finding is found in the CT scan below (arrow)? {{c1::Porcelain gallbladder}}"Photo credit: Hellerhoff, CC BY-SA 3.0, via Wikimedia Commons Described as a ""calcium-laden gallbladder wall with bluish color and brittle consistency"" Image(s) provided by www.radiologyassistant.nl. Used with permission."Watch Gallbladder & Biliary Tract DiseaseWatch associated Bootcamp video - Malignant Biliary Disorders4d73a54d-194f-412e-b014-8a7b7019d0ba
What is the likely diagnosis in a patient with a history of alcohol use and chronic, intermittent epigastric abdominal pain that is relieved by leaning forward? {{c1::Chronic pancreatitis}}- Other common symptoms caused by loss of pancreatic secretions include steatorrhea, weight loss, and diabetes - Treat with pancreatic enzyme supplementation and alcohol cessationWatch associated Bootcamp video - Pancreatic Insufficiency Watch associated Bootcamp video - Chronic Pancreatitis09e6f897-a79f-4e69-9916-af4f6071af0f
Do tumors in the body/tail of the pancreas typically present with jaundice? {{c1::No}}41379b3b-7f6d-46d7-b96c-bcecc8a05ac2
What is the likely diagnosis in a patient with GERD who complains of difficulty swallowing solid foods and has symmetric, circumferential narrowing on barium swallow? {{c1::Esophageal stricture}}- Stricture is a response to GERD acid → can improve GERD symptoms due to blockage of acid - Other causes of peptic strictures include radiation, systemic sclerosis, and caustic ingestion - Biopsy is necessary to rule out malignancy (typically asymmetric narrowing)e1d0b704-504b-40af-a2c8-55a8f792a46c
What is the likely diagnosis in a patient with severe RUQ/shoulder pain that occurs after fatty meals and resolves within 6 hours? {{c1::Biliary colic}}Quick resolution, lack of fever, abdominal tenderness on palpation, and leukocytosis help distinguish this process from acute cholecystitisWatch Gallbladder & Biliary Tract DiseaseWatch associated Bootcamp video - Gallstones70623851-fca9-4ed1-8863-19cffa20d6f2
What imaging modality is preferred for detecting pancreatic tumors of the head (e.g. jaundiced patients)? {{c1::Abdominal ultrasound}}Contrast with CT scan for body/tail of pancreas936c24ba-ab2e-43cc-8e43-bd82772414b1
What imaging modality is preferred for detecting pancreatic tumors of the body/tail (e.g. non-jaundiced patients)? {{c1::Abdominal CT scan}}ultrasound is less sensitive for visualizing the pancreatic body/tail due to overlying bowel gas302b6342-e659-4584-b3b4-ae45040b09a5
"The symptoms of pellagra can be remembered as the ""3 D's"": {{c1::Dermatitis (hyperpigmented, scaly skin in sun-exposed areas) Diarrhea Dementia}}"Causes include malnutrition, isoniazid use, carcinoid syndrome (due to deficiency of tryptophan), and Hartnup disease (impaired absorption of tryptophan) Photo credit: Herbert L. Fred, MD, Hendrik A. van Dijk, CC BY-SA 3.0, via Wikimedia Commons Photo credit: Amedeo John Engel Terzi, FAL, via Wikimedia Commons4295d274-e7e6-441c-8515-27e5f0aad4d7
How often should patients with an average risk for colon cancer be screened if using fecal occult blood testing? {{c1::Annually}}ScreeningUSPST F*IntervalFeaturesColonoscopyYesEvery 10 yearsDetects lesions that are less than 0.5 cm in size by visualising the entire rectum and colon. It is also able to obtain samples and remove polyps. Colonoscopy is used as a follow-up test when other tests are inconclusive. It requires anaesthesia. There is 0.2% perforation riskFlexible sigmoidoscopyYesEvery 5 years and FOBT every 3 yearsConfined only to the lower third of the colon, and require sedation. It is able to remove polyps and is used to take biopsies. If FOBT is positive, colonoscopy must be doneFecal occult blood test (FOBT)YesEvery yearThere are two modalities: -Traditional hemoccult chemical tests, which need dietary changes three days beforehand. The other is the more recent immunochemical tests, which may be performed at home but require colonoscopy follow-up in the event of a positive result.Barium enema with sigmoidoscopyNoEvery five yearsAs the rectum is difficult to be visualized, sigmoidoscopy is a mandatory in addition to Barium enema. It only detects 50% of polyps larger than 1 cm. Sedation is not needed. Mucosal inflammation is difficult to detect. It can be helpful if colonoscopy is insufficient due to anatomical or pathologic limitations.CT colonographyNoEvery five yearsIt requires intestinal preparation, does not require sedation; it may identify incidental abnormalities (such as extracolonic neoplasms or abdominal aortic aneurysms). It is as likely as colonoscopy to detect lesions 10 mm or bigger, but may be less sensitive for smaller adenomas. It also does not allow for biopsy or polypectomy.Capsule endoscopyNoEvery five yearsIt has low sensitivity and specificity. Unable to obtain biopsies. It is less invasive but requires more intensive bowel preparation. Unavailable for screening in the USA*US Preventive Services Task Force recommendations052f200a-9bbb-4d9f-975c-46e49493a402
How often should patients with an average risk for colon cancer be screened if using flexible sigmoidoscopy with fecal occult blood testing? {{c1::Sigmoidoscopy every 5 years with FOBT every 3 years}}ScreeningUSPST F*IntervalFeaturesColonoscopyYesEvery 10 yearsDetects lesions that are less than 0.5 cm in size by visualising the entire rectum and colon. It is also able to obtain samples and remove polyps. Colonoscopy is used as a follow-up test when other tests are inconclusive. It requires anaesthesia. There is 0.2% perforation riskFlexible sigmoidoscopyYesEvery 5 years and FOBT every 3 yearsConfined only to the lower third of the colon, and require sedation. It is able to remove polyps and is used to take biopsies. If FOBT is positive, colonoscopy must be doneFecal occult blood test (FOBT)YesEvery yearThere are two modalities: -Traditional hemoccult chemical tests, which need dietary changes three days beforehand. The other is the more recent immunochemical tests, which may be performed at home but require colonoscopy follow-up in the event of a positive result.Barium enema with sigmoidoscopyNoEvery five yearsAs the rectum is difficult to be visualized, sigmoidoscopy is a mandatory in addition to Barium enema. It only detects 50% of polyps larger than 1 cm. Sedation is not needed. Mucosal inflammation is difficult to detect. It can be helpful if colonoscopy is insufficient due to anatomical or pathologic limitations.CT colonographyNoEvery five yearsIt requires intestinal preparation, does not require sedation; it may identify incidental abnormalities (such as extracolonic neoplasms or abdominal aortic aneurysms). It is as likely as colonoscopy to detect lesions 10 mm or bigger, but may be less sensitive for smaller adenomas. It also does not allow for biopsy or polypectomy.Capsule endoscopyNoEvery five yearsIt has low sensitivity and specificity. Unable to obtain biopsies. It is less invasive but requires more intensive bowel preparation. Unavailable for screening in the USA*US Preventive Services Task Force recommendations24363fd5-a5fd-49a3-874c-f78dad7e6c81
How often should patients with an average risk for colon cancer be screened if using colonoscopy? {{c1::Every 10 years}}c68d5e2a-2f2d-4b8a-9698-3db64d540bbd
What is the likely diagnosis in a patient with history of HTN, T2DM, and hyperlipidemia who complains of postprandial epigastric pain, food aversion, and weight loss ± bloating and nausea? {{c1::Chronic mesenteric ischemia}}"- ""Intestinal angina"" - May also present with abdominal bruit - Usually due to atherosclerosis of the celiac or superior mesenteric arteries leading to insufficient blood supply to the gut (patients will have history of several risk factors including smoking, HTN, diabetes, and dyslipidemia)"Watch Intestinal Ischemia & Angiodysplasiad7b665a8-0da8-4731-9c7e-a04e9b4df7f8
Lactose intolerance is characterized by low stool pH and {{c1::high::low or high}} stool osmotic gapDue to fermentation products (stool pH) and unmetabolized lactose and organic acids (osmotic gap)Watch Lactase Deficiencyb28d3df7-69f6-43f2-b47d-01907ae7144e
Lactose intolerance is characterized by a(n) {{c1::positive::positive or negative}} stool test for reducing substances16e4227f-ef02-417c-ba9e-121a05e271e8
Pleural fluid analysis in Boerhaave syndrome is typically exudative with low pH and very high {{c1::amylase}} (> 2,500 IU/L)Due to saliva in the esophageal contentsWatch associated Bootcamp video - Esophageal and Gastric Pathology: Esophageal Tearsf349ed88-613a-40e5-b61f-e07642150a77
How do levels of gamma-glutamyltransferase (GGT) and ferritin typically change in alcoholic hepatitis? {{c1::Increased}}GGT is an enzyme found in the liver and other cells; ferritin is an acute phase reactant620d7d72-2eb7-4719-9196-2839fb63807d
What is the likely underlying cause of peptic ulcer disease in a patient who has emigrated from a low-income country? {{c1::H. pylori infection}}symptoms include dyspepsia, nausea, and post-prandial fullnessWatch associated Bootcamp video - Helicobacter Pylorifd006cfe-8d82-4e70-a630-2edf669ca2ed
What is the next step in management for a patient with acetaminophen toxicity that develops worsening acute liver failure despite N-acetylcysteine treatment? {{c1::Refer to liver transplant center}}- This is an ethically complicated issue - However, if there is no history of psychiatric illness or previous suicide attempt, liver transplantation is typically pursuedWatch NSAIDsWatch Acetaminophen Toxicitya5a4db01-279c-4a4a-b5da-4ae891ed33b7
What is the likely diagnosis in a patient with obesity and diabetes who presents with hepatomegaly and mildly elevated LFTs in the absence of other causes for secondary hepatic fat accumulation? {{c1::Non-alcoholic fatty liver disease (NAFLD)}}- Diagnosis of exlcusion; get ultrasound to rule out other causes - No curative treatment → manage with lifestyle changes (weight loss, diet, exercise) & addressing comorbidities - Recently renamed metabolic dysfunction-associated steatotic liver disease (MASLD)Watch Alcoholic & Non alcoholic Fatty Liver Disease9be21505-402a-457c-a797-427f1c9caec4
{{c2::Cholesterol}} emboli may result in skin complications, such as {{c1::livedo reticularis}} and {{c1::blue toe}} syndrome"e.g. after a vascular procedure (cardiac cath, angiography, angioplasty, endovascular grafting) Photo credit: Nantsupawat T et al, CC BY-SA 3.0, via Wikimedia Commons Blue toe syndrome: Photo credit: Owlia et al. (2012), ""Ischemic Toes after Venous Thromboembolism: A Difficult Differential Diagnosis with Good Response to Combination Therapy—A Case Report"", Case Reports in Medicine, vol. 2012, Article ID 403685, 3 pages, 2012. https://doi.org/10.1155/2012/403685"910bc58e-99d9-4057-b1ca-e9c537620eb5
Cholesterol emboli may result in GI complications, such as acute {{c1::pancreatitis}} and mesenteric ischemiae.g. after a vascular procedure (cardiac cath)aa4a6ad1-56f1-43aa-b384-ef9e6eeb5784
What is the treatment for acute pancreatitis from uncorrectable causes (e.g. ischemia, atheroemboli)? {{c1::Supportive care (analgesics and IV fluids)}}Watch associated Bootcamp video - Acute Pancreatitis4ded657a-b637-43b3-8b7f-939115a9eb8e
Non-alcoholic fatty liver disease is associated with peripheral {{c1::insulin}} resistanceLeads to increased peripheral lipolysis and thus increased hepatic uptake of FFAs8269ada7-ecc2-4a39-a2e8-a27604de2943
Serum triglycerides generally must be > {{c1::1,000}} mg/dL to cause pancreatitis- Can also cause eruptive xanthomas; diagnosis confirmed with a fasting serum lipid profile and treated with statins In acute pancreatitis, if triglycerides are: - ≥500 mg/dL: consider insulin infusion - >1000 mg/dL or severe pancreatitis (e.g. lactic acidosis, hypocalcemia): plasmapheresisWatch associated Bootcamp video - Lipid Metabolism: Familial Dyslipidemias1bb30cc4-c953-4203-9001-fea65a0b29b8
A(n) {{c2::low::high/low}} stool osmotic gap is indicative of {{c1::secretory::osmotic/secretory}} diarrhea- < 50 mOsm/kg; due to increased secretions of ions (e.g. bacterial/viral infection, congenital disorders of ion transport, post-surgical changes) - Secrete more into stool, so subtract a larger number = smaller stool osmotic gap - Stool osmotic gap = plasma osmolality - 2 × (stool sodium + stool potassium)60984336-a562-4921-8a33-9cedc52f9895
A(n) {{c2::high::high/low}} stool osmotic gap is indicative of {{c1::osmotic::osmotic/secretory}} diarrhea> 100 mOsm/kg; due to non-absorbed and unmeasured osmotically active agents in the GI tract (e.g. lactose intolerance) - Osmotic substances count as osmoles Stool osmotic gap = plasma osmolality - 2 × (stool sodium + stool potassium)fb9365e2-7a92-4332-82bc-66d69700f0b8
Large-volume diarrhea that occurs during sleep or fasting is characteristic of {{c1::secretory::osmotic/secretory}} diarrheaSecrete all the time!cae78919-6581-4416-af26-83fc072c3a2d
What musculoskeletal pathologies are associated with primary biliary cholangitis? {{c1::Osteoporosis Osteomalacia::2}}- Precise etiology is not clear; possibly associated with vitamin D deficiency secondary to fat malabsorption - Patients should have DEXA scan to establish baseline bone density - Other complications include malabsorption and hepatocellular carcinomaWatch associated Bootcamp video - Benign Biliary Disorders24ef5d14-03bc-4e78-9681-029e761ab711
What is the likely diagnosis in a patient with alcohol use disorder who presents with epigastric pain and hematemesis following multiple episodes of vomiting (normal X-ray)? {{c1::Mallory-Weiss tear}}- Increase in intraabdominal pressure during vomiting → longitudinal tear in the mucosa often near the GE junction - Most heal spontaneously* due to increased intragastric pressure from vomiting; *Hiatal hernia is a risk factor Watch Structural Esophageal Disorders & GERDWatch Nausea and Vomiting of Pregnancycad9dd7e-5f77-4bc4-9959-f51d85b42bec
What test/imaging study is used to diagnose a Mallory-Weiss tear? {{c1::Endoscopy}}Photo credit: Samir, CC BY-SA 3.0, via Wikimedia Commons* due to increased intragastric pressure from vomiting; *Hiatal hernia is a risk factor Watch Structural Esophageal Disorders & GERDdc51a826-4aa0-4ea5-9114-59a8ad12e393
What is the likely diagnosis in a patient with sudden-onset odynophagia and retrosternal pain with discrete ulcers with normal-appearing surrounding mucosa in the mid-esophagus? {{c1::Pill esophagitis}}- Caused by medications that directly damage the esophageal mucosa - Stellate erosions in the midesophagus Photo credit: Zezos et al., CC BY 4.0, via Canadian Journal of Gastroenterology and HepatologyWatch associated Bootcamp video - Esophageal and Gastric Pathology: Esophagitis04d6463c-c457-4194-92c2-d397c93f5b2b
What are the next steps in management for an elderly patient with newly discovered iron deficiency anemia? {{c1::Colonoscopy and endoscopy}}New IDA in an elderly patient is considered to be from GI blood loss until proven otherwise (polyps, cancer, angiodysplasia)f485ad2e-4e49-4e69-9432-540e2b8b27ba
Should patients with cirrhosis undergo a screening endoscopy for varices? {{c1::Yes}}Can determine the risk of variceal hemorrhage and indicate strategies for prevention of hemorrhagedc64511a-ce8a-42bc-8569-111513503685
All patients with cirrhosis should have a screening ultrasound every {{c1::6 months::duration}} ± alpha-fetoproteinScreening for hepatocellular carcinomafdb35298-f1b9-496b-aa03-1af963ce2e4f
What dietary habits increase the risk of diverticulosis complications (e.g. hemorrhage, diverticulitis)? {{c1::Red meat consumption, high fat, low fiber diets::3}}"- NSAIDs, obesity, and possibly smoking are also correlated with increased complications - Avoiding consumption of ""high-residue"" foods (nuts, seeds, popcorn) was previously suggested to these patients as a preventative strategy; this was found to be without merit, and is now an outdated recommendation"796dfef8-cbbe-4091-b64c-22f4c898e263
What is the likely diagnosis in a young woman with alternating constipation / diarrhea and chronic abdominal pain that is relieved after a bowel movement? {{c1::Irritable bowel syndrome}}Watch Large Bowel & Appendiceal Disordersfbb2a2b3-6297-43a0-8a22-b7af2178b998
"The presence of an ""abdominal succussion splash"" after ≥ 3 hours of fasting suggests a diagnosis of {{c1::gastric outlet obstruction}}"- The physician places the stethoscope over the upper abdomen and rocks the patient back and forth at the hips; the splash is due to the retained food - Definitive diagnosis requires upper endoscopy with NG suctioning to decompress the stomach815db066-f550-43c0-805b-74692cde707e
After DRE, what is the next step in evaluation of minimal bright red blood per rectum in a stable patient < 40 years old with no risk factors for CRC? {{c1::Anoscopy}} and/or {{c1::sigmoidoscopy}}- Sigmoidoscopy was added to this card per AMBOSS. UWorld prefers anoscopy. (May 2023) - Often due to hemorrhoids - > 40 yo, red flags, or nondiagnostic sigmoidoscopy → colonoscopy Photo credit: Mikael Häggström, Public domain, via Wikimedia Commonsfd953584-fcc2-4b88-b87e-05883ef049d5
What is the next step in evaluation of bright red blood per rectum in patients 40 - 49 years old with no risk factors for CRC? {{c1::Sigmoidoscopy or colonoscopy::2 choices}}2cd9bad9-e5bf-4298-b2e4-59d680e03b62
Hepatic hydrothorax is a possible complication of cirrhosis that results in transudative pleural effusions due to small defects in the {{c1::diaphragm}}, especially on the right- Right-sided due to a less muscular hemidiaphragm - Symptoms of dyspnea, cough, pleuritic chest pain, hypoxemiaWatch Pleural Effusion DDx678a3212-b21c-49e2-b32a-46e262c53b6c
{{c1::Hepatopulmonary}} syndrome results from intrapulmonary vascular dilations in the setting of chronic liver diseaseCauses platypnea (dyspnea while upright) and orthodeoxia (oxygen desatting when upright)186d7814-897a-4f04-b26f-464ab4d40002
Patients with hepatopulmonary syndrome typically have increased dyspnea or O2 desaturation while {{c1::upright::lying down or upright}}Known as platypnea and orthodeoxia, respectively7e90a11d-da38-4042-bb5b-342fe185872c
A positive urine bilirubin assay is typically indicative of a buildup of {{c1::conjugated}} bilirubin- Conjugated bilirubin is water soluble, so it shows up in urine, causing it to turn dark - Compare with urine urobilinogen which is (+) when UCB is increased DisorderUrobilinogenBilirubin TypeUrine BilirubinHemolysisIncreasedIndirect/unconjugatedNoneObstructionNoneDirect/conjugatedIncreased (dark urine)Liver DiseaseVariableMixedIncreased (usually) Photo credit: Michlwt, CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Jaundice38222c4c-4b54-44ef-b686-4e7a127d8422
What is the next step for establishing the diagnosis in a patient with conjugated hyperbilirubinemia and predominantly elevated alkaline phosphatase? {{c1::Abdominal imaging (US or CT)}}Presence of biliary dilatation is suggestive of extrahepatic cholestasis; absence of biliary dilatation suggests intrahepatic cholestasis7aca8f5a-5552-416f-b006-d9bf0e9a66f9
What is the appropriate interpretation of the following serological test results: HBsAg: Negative Anti-HBs: Positive Anti-HBc: Positive Anti-HBe: Positive {{c1::Recovery phase HBV infection}}Presence of anti-HBe indicates recovery phase rather than full recovery0961c61f-4af5-4c46-9487-4a63a1e9b904
What characteristics of colonic adenomatous polyps suggest greater malignant potential? {{c1::Sessile (non-pedunculated) growth and villous histology::1 growth pattern, 1 histology}}"- Villous shown below with finger-like projections - Other signs of malignant potential include large size (≥ 1 cm) and high number (≥ 3 concurrent adenomas) - ""VILL""-ous = ""VILL""-ain (per Pathoma) Photo credit: The Juan Rosai Collection, CC0, via Wikimedia Commons"3487b28c-18de-4e89-bed8-b90aee486ec6
What antibiotic should be started for patients with a first episode of non-fulminant C. difficile colitis? {{c1::Oral fidaxomicin or vancomycin::2}}- Fidaxomicin is recommended over vancomycin because of its higher clinical response rate and lower recurrence rates - First-line treatment for fulminant CDI is high-dose oral vancomycin (addition of IV metronidazole can be considered as well)Watch Clostridioides difficile [Old Version]Watch MacrolidesWatch associated Bootcamp video - Clostridioides Difficile Watch associated Bootcamp video - Glycopeptides (including Vancomycin) Watch associated Bootcamp video - Empiric Antibiotics in GI, Skin, Bone, and Hematogenous Infections6bad082e-999e-47a4-89dc-b79faa7eb01f
What combined antibiotic regimen can be used for C. difficile colitis in patients with multiple recurrences? {{c1::Vancomycin followed by rifaximin}}Alternatives to this treatment option include oral vancomycin (prolonged course), oral fidaxomicin, or fecal microbiota transplant6790fec4-b278-4a3e-8eda-176f4b2bff85
What is the initial management for a young patient with suspected GERD who has a bitter taste and substernal chest pain after meals? {{c1::PPI trial}}Compare to older patient with risk factors → endoscopy6643a6fc-73d4-4295-be3d-fa9615207edc
What is the first-line treatment for autoimmune hepatitis? {{c1::Oral glucocorticoids}}- Type 1 AIH: Anti-smooth muscle antibodies (ASMA) + ANA - Type 2 AIH: Anti-liver-kidney microsomal-1 antibody (Anti-LKM-1) and anti-liver cytosol antibodies-1 (ALC-1)61470791-11ac-41c9-be49-85040c38be44
What is the likely diagnosis in a female with frequent, watery, nocturnal diarrhea and melanosis coli on colonoscopy? {{c1::Factitious diarrhea (laxative abuse)}}- Typically in a healthcare worker; diagnosis is supported by positive stool screen for laxatives - Dark discoloration due to lipofuscin in macrophages Photo credit: Zhao et al., CC BY 4.0, via Frontiers in SurgeryWatch associated Bootcamp video - Stimulants and Emollients48ed5af9-4f8e-4c24-9d67-190940cf29ec
What serologic markers should be measured to diagnose acute HBV infection? {{c1::HBsAg and anti-HBc IgM::2}}- Both are elevated during the initial infection - Anti-HBc will remain elevated during the window periodWatch Hepatitis B Viral Basics & Infectious Diseases (Hepadnaviridae)37b16aa2-ebe2-4077-96ee-56622cd11c2d
How does the BUN:creatinine ratio change in patients with upper GI bleed? {{c1::Increased}}Possibly due to increased urea production (intestinal breakdown of Hb) and increased urea reabsorption (due to hypovolemia)bb407c74-588f-4c7c-97ce-208d4d03b2c7
Which form of inflammatory bowel disease may present with aphthous ulcers and perianal skin tags/fissures? {{c1::Crohn disease}}dea80e71-2fd1-4851-80f0-c270bf660a4f
What is the likely diagnosis in a patient with sudden-onset dyspnea, dysphagia, and scattered urticaria? {{c1::Upper airway obstruction (e.g. laryngeal edema)}}Physical exam may reveal stridor and harsh respiratory sounds; however, wheezing is typically absentWatch Acute Dyspnea DDx: Respiratory Etiologies8758b308-f0b4-4d39-a838-f677beddaa11
What is the likely diagnosis in a post-operative patient with hypotension, JVD, and new-onset right bundle branch block? {{c1::Massive pulmonary embolism}}- Massive PE is PE plus hypotension and/or acute right heart strain (e.g. JVD, RBBB) - Hypotension: not enough blood to the left heart - Right heart strain: blocked right heart outputWatch Deep Vein Thrombosis & Pulmonary EmbolismWatch associated Bootcamp video - Conduction Blocks: Bundle Branch Blocks Watch associated Bootcamp video - DVT and Pulmonary Embolism2fea039c-70d9-4115-91d0-faddfbeaccae
Massive pulmonary embolism may result in {{c1::obstructive}} shock and cor pulmonaleRight heart strain causes RV dysfunction with decreased return to the left heart, causing LV dysfunctionWatch Deep Vein Thrombosis & Pulmonary EmbolismWatch Pulmonary Embolism SOAPWatch associated Bootcamp video - DVT and Pulmonary Embolism9e7a4a74-9cec-4a13-b7bc-db6000ef6a76
The modified Wells criteria is used to assess pretest probability of acute {{c1::pulmonary embolism}}- Well's criteria for PE Images licensed by Physeo and used with permission. Purchase full access here.Watch Pulmonary Embolism SOAPce970cbe-b896-47b6-8dea-db1b2fe836bb
A modified Wells score > {{c1::4}} suggests that pulmonary embolism is likelyImages licensed by Physeo and used with permission. Purchase full access here.6126890f-72f2-4760-b68c-743ddd8306c3
If a patient with airway obstruction has significant reversal of symptoms with an inhaled bronchodilator, they likely have {{c1::asthma::asthma or COPD}}COPD typically has partial reversal or non-reversal of symptomsWatch Chronic Asthma SOA Watch PFTs How-To Watch Chronic Dyspnea DDx Part 17a133052-c90e-4e9e-ae59-f4a881199890
The primary long-term intervention for persistent asthma is daily inhaled {{c1::corticosteroids}}vs. a long-acting anticholinergic inhaler (COPD) Uncontrolled asthma severityAsthma severitySymptom prevalance & SABA useNight wakingsTherapy stageInterventionIntermittent≤2 days/week≤2 times/monthStep 1SABA PRNMild persistent>2 days/week (not daily)3-4 times/monthStep 2Low dose ICSModerate persistentDaily>1 time/week (not nightly)Step 3Low dose ICS + LABASevere persistentMultiple daily uses4-7 times/weekStep 4 or 5Medium* dose ICS + LABA*Step 5: High Dose ICS + LABAWatch Asthma Therapy6e24dc1f-475f-4519-8638-f8f14bc6e1ea
The primary long-term intervention for COPD is a daily long-acting {{c1::antimuscarinic}} inhaler- e.g. tiotropium; may be combined with a SABA for greater symptom relief - Tiooootropium is loooong-actingWatch Muscarinic Antagonists15219300-c022-4173-9ca7-089ffec26d7c
Oxygenation, and thus PaO2, in mechanically ventilated patients may be improved by increasing the {{c1::FiO2}} or {{c2::PEEP}}- PEEP prevents alveolar collapse so that there's more alveoli available for oxygen - FiO2 should be limited to < 60% (oxygen → free radical damage)2879844c-48f6-4553-8d21-f12176c6f09e
What ventilator setting change is best to improve oxygenation in a patient with the following settings: FiO2: 70% PEEP: 5 mmHg VT: 400 mL RR: 24/min {{c1::Increase PEEP}}If high levels of FiO2 (> 60%) are required to maintain oxygenation, PEEP should be increased to allow for reductions in FiO2 as oxygenation improves8141b592-83bb-4985-bc8a-df2242c0cf42
What test/imaging study should be ordered first to evaluate an older patient with a 30 pack-year smoking history and recurrent episodes of pneumonia in the same anatomic location? {{c1::CT scan of the chest}}- In patients > 50 with significant smoking history (≥ 30 pack-years), it is essential to evaluate for lung malignancy - CT scan has better sensitivity than CXR to assess for malignancy - Airway obstruction → bacterial buildup Lung Cancer ScreeningRecommended TestLow-dose chest CT every yearAge50 - 80Who?≥ 20-pack year history AND Currently smoking or quit within the last 15 yearsStop screeningQuit smoking ≥ 15 years OR Limited life expectancya325a3e1-43bf-456d-b1bf-16c60dae73d1
Exudative pleural effusions are characterized by a(n) {{c1::> 0.5 (high)}} pleural/serum protein ratioParapneumonic effusions UncomplicatedComplicatedEtiologySterile fluid in pleural spaceBacteria in pleural spacepH≥ 7.2< 7.2Glucose>60mg/dL<60mg/dLWBC≤ 50,000/mm3> 50,000/mm3Gram stain & cultureNegativeTypically false negative (not enough bacteria - would be positive with empyema)TreatmentAntibioticsAntibiotics + drainageWatch Acute Respiratory Distress Syndrome (ARDS)Watch associated Bootcamp video - Pleural Effusion4e5c0e1c-9c80-4bd0-96a9-9537c3208c72
Transudative pleural effusions are characterized by {{c1::< 0.6 (low)}} pleural / serum LDH ratioOr pleural LDH < 2/3 upper normal limit of serum LDH Light's CriteriaTransudative pleural effusionExudative pleural effusionProtein (pleural / serum)≤ 0.5> 0.5LDH (pleural / serum)≤ 0.6> 0.6Common causes- Cirrhosis (low albumin) - Nephrotic syndrome (low albumin) - Congestive heart failure- Infection (TB, fungal, empyema, parapneumonic) - Malignancy - Pulmonary embolismWatch Acute Respiratory Distress Syndrome (ARDS)Watch associated Bootcamp video - Pleural Effusionb75026e8-8d3a-40fe-8c3f-fecba3eeabc4
Exudative pleural effusions are characterized by {{c1::> 0.6 (high)}} pleural / serum LDH ratioOr pleural LDH > 2/3 upper normal limit of serum LDH Light's CriteriaTransudative pleural effusionExudative pleural effusionProtein (pleural / serum)≤ 0.5> 0.5LDH (pleural / serum)≤ 0.6> 0.6Common causes- Cirrhosis (low albumin) - Nephrotic syndrome (low albumin) - Congestive heart failure- Infection (TB, fungal, empyema, parapneumonic) - Malignancy - Pulmonary embolismWatch Acute Respiratory Distress Syndrome (ARDS)Watch associated Bootcamp video - Pleural Effusion6999cd5a-7da7-4346-b7a5-c1faaad425ad
Which type of parapneumonic effusion, uncomplicated or complicated, is characterized by pH < 7.2? {{c1::Complicated}}Bacteria generate lactate Parapneumonic effusions UncomplicatedComplicatedEtiologySterile fluid in pleural spaceBacteria in pleural spacepH≥ 7.2< 7.2Glucose>60mg/dL<60mg/dLWBC≤ 50,000/mm3> 50,000/mm3Gram stain & cultureNegativeTypically false negative (not enough bacteria - would be positive with empyema)TreatmentAntibioticsAntibiotics + drainageWatch Pleural Effusion DDx Watch Parapneumonic Effusion & Empyema SOAPe5372307-bbfc-446c-80ad-47b0450456a7
What is the general treatment for uncomplicated parapneumonic effusion? {{c1::Antibiotics}}Complicated parapneumonic effusions: prevent progression to empyema with early therapeutic thoracentesis (consider surgery consult) Parapneumonic effusions UncomplicatedComplicatedEtiologySterile fluid in pleural spaceBacteria in pleural spacepH≥ 7.2< 7.2Glucose>60mg/dL<60mg/dLWBC≤ 50,000/mm3> 50,000/mm3Gram stain & cultureNegativeTypically false negative (not enough bacteria - would be positive with empyema)TreatmentAntibioticsAntibiotics + drainageWatch Parapneumonic Effusion & Empyema SOAP1e7086af-f6bb-462e-a97b-88a09b44ed02
What is the general treatment for complicated parapneumonic effusion? {{c1::Antibiotics and drainage (e.g. chest tube)::2}}Parapneumonic effusions UncomplicatedComplicatedEtiologySterile fluid in pleural spaceBacteria in pleural spacepH≥ 7.2< 7.2Glucose>60mg/dL<60mg/dLWBC≤ 50,000/mm3> 50,000/mm3Gram stain & cultureNegativeTypically false negative (not enough bacteria - would be positive with empyema)TreatmentAntibioticsAntibiotics + drainageWatch Parapneumonic Effusion & Empyema SOAPd5bbd34a-332e-4fd0-9253-03ded8eeb1cf
What asthma severity is characterized by SABA use ≤ 2 days a week with ≤ 2 nighttime awakenings a month? {{c1::Intermittent asthma}}Rule of 2 (like for the Sith) To distinguish between intermittent and persistent asthma, apply the rule of twos. Two symptoms or fewer or SABA use for a week, two nocturnal awakenings per month or less, two episodes or less needing oral steroid in a year. Uncontrolled asthma severityAsthma severitySymptom prevalance & SABA useNight wakingsTherapy stageInterventionIntermittent≤2 days/week≤2 times/monthStep 1SABA PRNMild persistent>2 days/week (not daily)3-4 times/monthStep 2Low dose ICSModerate persistentDaily>1 time/week (not nightly)Step 3Low dose ICS + LABASevere persistentMultiple daily uses4-7 times/weekStep 4 or 5Medium* dose ICS + LABA*Step 5: High Dose ICS + LABAWatch Chronic Asthma Management885ad268-1b60-4a43-9379-3ec791da066a
What is the recommended treatment regimen for patients with intermittent asthma? {{c1::SABA as needed}}e.g., albuterol Uncontrolled asthma severityAsthma severitySymptom prevalance & SABA useNight wakingsTherapy stageInterventionIntermittent≤2 days/week≤2 times/monthStep 1SABA PRNMild persistent>2 days/week (not daily)3-4 times/monthStep 2Low dose ICSModerate persistentDaily>1 time/week (not nightly)Step 3Low dose ICS + LABASevere persistentMultiple daily uses4-7 times/weekStep 4 or 5Medium* dose ICS + LABA*Step 5: High Dose ICS + LABAWatch Chronic Asthma Management28a4aee3-9cdc-4a50-9904-d30a4f945294
What asthma severity is characterized by SABA use > 2 days a week (not daily) with 3 - 4 nighttime awakenings a month? {{c1::Mild persistent asthma}}Rule of 2 broken (> 2 / month) Uncontrolled asthma severityAsthma severitySymptom prevalance & SABA useNight wakingsTherapy stageInterventionIntermittent≤2 days/week≤2 times/monthStep 1SABA PRNMild persistent>2 days/week (not daily)3-4 times/monthStep 2Low dose ICSModerate persistentDaily>1 time/week (not nightly)Step 3Low dose ICS + LABASevere persistentMultiple daily uses4-7 times/weekStep 4 or 5Medium* dose ICS + LABA*Step 5: High Dose ICS + LABAWatch Chronic Asthma Managementf8ceafc1-fedd-4f51-a8d9-cfc80f642126
What is the recommended treatment regimen for patients with mild persistent asthma? {{c1::Daily low-dose ICS and SABA as needed}}Uncontrolled asthma severityAsthma severitySymptom prevalance & SABA useNight wakingsTherapy stageInterventionIntermittent≤2 days/week≤2 times/monthStep 1SABA PRNMild persistent>2 days/week (not daily)3-4 times/monthStep 2Low dose ICSModerate persistentDaily>1 time/week (not nightly)Step 3Low dose ICS + LABASevere persistentMultiple daily uses4-7 times/weekStep 4 or 5Medium* dose ICS + LABA*Step 5: High Dose ICS + LABAWatch Chronic Asthma Management4ab3c431-371c-4baa-9f72-98d5d0e23390
What asthma severity is characterized by SABA use daily with >1 nighttime awakening a week (not nightly)? {{c1::Moderate persistent asthma}}Uncontrolled asthma severityAsthma severitySymptom prevalance & SABA useNight wakingsTherapy stageInterventionIntermittent≤2 days/week≤2 times/monthStep 1SABA PRNMild persistent>2 days/week (not daily)3-4 times/monthStep 2Low dose ICSModerate persistentDaily>1 time/week (not nightly)Step 3Low dose ICS + LABASevere persistentMultiple daily uses4-7 times/weekStep 4 or 5Medium* dose ICS + LABA*Step 5: High Dose ICS + LABAWatch Chronic Asthma Management399efcbf-ee6e-41e2-8d62-d802911b0f41
What is the recommended treatment regimen for patients with moderate persistent asthma? {{c1::Daily LABA, daily low-dose ICS, SABA as needed}}Or daily medium-dose ICS with SABA PRN Uncontrolled asthma severityAsthma severitySymptom prevalance & SABA useNight wakingsTherapy stageInterventionIntermittent≤2 days/week≤2 times/monthStep 1SABA PRNMild persistent>2 days/week (not daily)3-4 times/monthStep 2Low dose ICSModerate persistentDaily>1 time/week (not nightly)Step 3Low dose ICS + LABASevere persistentMultiple daily uses4-7 times/weekStep 4 or 5Medium* dose ICS + LABA*Step 5: High Dose ICS + LABAWatch Chronic Asthma Management5025a2f3-e940-4f17-b704-2bb09531b45a
What is the likely diagnosis in a patient with COPD who develops sudden-onset dyspnea and chest pain with unilaterally decreased breath sounds (no tracheal deviation)? {{c1::Secondary spontaneous pneumothorax}}Chronic destruction of alveolar sacs leads to formation of large alveolar blebs, which can eventually rupture and leak air into pleural space Photo credit: en:User:Clinical Cases, CC BY-SA 2.5, via Wikimedia CommonsWatch PneumothoraxWatch Pneumothorax & Tension Pneumothorax SOAP31fe520e-6534-4ade-8ed1-00f94da3fa92
The three most common causes of chronic cough are {{c1::upper-airway cough syndrome (postnasal drip)}}, {{c2::asthma}}, and {{c3::GERD}}Watch Asthma & Bronchiectasis Watch Structural Esophageal Disorders & GERDWatch Cough DDx228f0983-702d-48fb-adaf-81d31e376ea7
The diagnosis of upper-airway cough syndrome (post-nasal drip) is confirmed by elimination of nasal discharge and cough with the use of {{c1::first-generation H1 receptor antagonists (e.g. chlorpheniramine)}}- Decrease nasal secretions which normally mechanically stimulates the afferent limb of cough reflex - An alternative treatment regimen is a combined antihistamine-decongestant (e.g. brompheniramine and pseudoephedrine); if symptoms don't get better in 2-3 weeks, get further imaging/diagnostics9a72a2b0-f8f2-427d-a67b-2d7c6c0de42d
What is the most significant risk factor for tuberculosis in the U.S.? {{c1::Immigration from an endemic area}}18d10f83-542e-4807-a513-777e6cdc71a1
Patients with COPD who have resting PaO2 ≤ {{c1::55}} mmHg or SaO2 ≤ {{c1::88}}% are candidates for long-term home O2 treatment- Prolongs survival and improves quality of life - Also indicated for patients with PaO2 ≤ 59 mm Hg or SaO2 ≤ 89% in patients with cor pulmonale, evidence of right heart failure, or hematocrit >55%867bfe14-836a-4812-a180-2bb6b3398a9a
The pathogenesis of bronchiectasis involves a(n) {{c1::airway}} insult with impaired bacterial clearance- Impaired bacterial clearance (e.g. immunodeficiency, structural airway defect) Examples of airway insult - Airway obstruction (e.g., cancer, foreign body) & mucostasis (e.g., CF, ABPA) - Immunodeficiency (e.g., decreased Ig) & autoinflammatory disease (e.g., Sjögren syndrome) - Chronic/past infection (eg, mycobacteria) or toxic inhalationWatch Bronchiectasis SOAPWatch associated Bootcamp video - Primary Ciliary Dyskinesia Watch associated Bootcamp video - Aspergillus Diagnostics and Management79e8552b-e244-4e8b-8964-406f48aee98a
What test/imaging study is the best diagnostic test for bronchiectasis? {{c1::High-resolution CT (HRCT) scan of the chest}}Characteristic findings include bronchial dilation, lack of airway tapering, and bronchial wall thickening (arrows) Photo credit: Hellerhoff, CC BY-SA 3.0, via Wikimedia Commons Three red arrows were added to image* seen on CT/CXR as crowded bronchial markings extending to edge of lung periphery Watch Asthma & BronchiectasisWatch Bronchiectasis SOAP Watch Hemoptysis DDxWatch associated Bootcamp video - Primary Ciliary Dyskinesia00e845e9-b6cc-482b-90e3-053fc3e59cc8
What is the underlying etiology for aspiration pneumonia in patients with impaired consciousness and/or advanced dementia? {{c1::Impaired swallowing and cough reflex::2}}Presents with slow-onset foul-smelling sputum, periodontal disease1e8c7825-6c06-4bdb-a8b9-8285e454b315
When using a ventilator, prolonged FiO2 levels > {{c1::60}}% are associated with oxygen toxicity- Forms free radicals and causes atelectasis - Thus it is usually preferable to increase PEEP to allow for lower levels of FiO2 if oxygenation needs to be increased (recall PEEP and FiO2 are the two main ways to increase PaO2)4464b811-5bd1-4c03-92b2-1b2234c5b364
When using a ventilator, the goal is to keep SpO2 between {{c1::88}} - {{c1::95}}%89d67283-bb29-4b19-b6e5-d1b731184c11
When using a ventilator, the goal is to keep PaO2 between {{c1::55}} - {{c1::80}} mmHge3ac6485-46f1-4651-b78f-c9ef72332788
How does lung compliance change in patients with ARDS? {{c1::Decreased}}due to loss of surfactant and increased elastic recoil of edematous lungs Photo credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia CommonsWatch Compliance of the Respiratory System: Part 1Watch associated Bootcamp video - Air Physiology : Compliancec461f20d-fc66-44d9-908d-41ea64a1aa30
How does pulmonary arterial pressure change in patients with ARDS? {{c1::Increased (pulmonary hypertension)}}due to hypoxic vasoconstriction, destruction of lung parenchyma, and compression of vascular structures from PEEP64d0744f-b78b-42e0-9c5c-8873e67dcde6
What is the likely diagnosis given the flow-volume loop below? {{c1::Fixed upper airway obstruction (e.g. laryngeal edema)}}characterized by flattening of the top and bottom of the curve due to decreased airflow rate during inspiration and expirationWatch PFTs How-ToWatch associated Bootcamp video - Air Physiology : Flow-Volume Loopsa1fdf9a3-d497-432c-8d85-daeb34870f2e
What is the likely underlying etiology of hypoxemia in patient with respiratory acidosis and normal A-a gradient? {{c1::Hypoventilation}}vs. other causes, such as PE and atelectasis, which present with respiratory alkalosis and an increased A-a gradientWatch Hypoxemia & HypoxiaWatch associated Bootcamp video - Blood Physiology : A-a Gradientb9a89d13-ddc9-4e67-82ea-0dbf05fbc2c7
What is the likely diagnosis in a patient with repeated episodes of fever, dyspnea, and cough after exposure to environmental antigens (e.g. farmers, bird droppings, molds)? {{c1::Hypersensitivity pneumonitis}}- Acute episodes → SOB, cough within hours of exposure - Chronic → weight loss, clubbing, honeycombing of the lung DiseasesCausative AgentSourceHot tub lungMycobacterium avium complexMist from hot tubsSuberosisPenicillum glabrumMoldy cork dustBird fancier's (pigeon breeders) lungAvian proteinsFeathers / bird droppingsBagassosisThermophilic ActinomycetesPressed sugarcaneCheese washer's lungP. roquefortiCheese casingsFarmer's lungThermophilic Actinomycetes, Aspergillus, Saccharopolyspora rectivirgulaMoldy hayHumidifier lungBacillus subtilus / cereus, Naegleria gruberiMist generated by a machine from standing waterbbe2aff5-a65c-4860-9a29-93c39e2f2c60
What is the best treatment for hypersensitivity pneumonitis? {{c1::Avoidance of the responsible antigen}}E.g., birds in bird fancier's lung DiseasesCausative AgentSourceHot tub lungMycobacterium avium complexMist from hot tubsSuberosisPenicillum glabrumMoldy cork dustBird fancier's (pigeon breeders) lungAvian proteinsFeathers / bird droppingsBagassosisThermophilic ActinomycetesPressed sugarcaneCheese washer's lungP. roquefortiCheese casingsFarmer's lungThermophilic Actinomycetes, Aspergillus, Saccharopolyspora rectivirgulaMoldy hayHumidifier lungBacillus subtilus / cereus, Naegleria gruberiMist generated by a machine from standing water4d26c1b8-8c3a-45dc-8b8d-5fffea6af9e2
What is the likely diagnosis in a patient with a past medical history of Hodgkin lymphoma status-post chemotherapy/radiation who presents with cough, dyspnea, and chest pain (imaging below)? {{c1::Secondary malignancy}}Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons - There is an 18.5-fold increased risk for developing a second cancer in HL patients compared to the general population (likely related to chemo- and/or radiation therapy at a young age); most common sites are lung, breast, thyroid, bone, and GI - Most of these appear to be more closely related to the treatment effect (i.e. radiation, chemotherapy) than the diagnosis itselff96eabaf-49e0-4aae-bd4d-e9f463c336dc
What imaging modality is typically used to diagnose pneumonia? {{c1::Chest X-ray}}- Think about pneumonia if you hear crackles - Diagnosis requires presence of lobar, interstitial, or cavitary infiltrate on imaging; CXR should be acquired before administering empiric antibioticsWatch Pneumonia SOA79ff8a34-1c00-49b3-9267-71e13f39e301
What is the likely diagnosis in a patient on high-doses of β2 agonists (e.g. albuterol, epinephrine) who develops muscle weakness? {{c1::Hypokalemia}}- β-agonists drive potassium into cells, causing hypokalemia - Other potential side effects include tremor, palpitations, and headache*3.5-5 mEq/L Watch Potassium DisordersWatch associated Bootcamp video - Electrolytes: Potassiumd23379d4-b82a-4ec4-b1b3-b260363a1ecd
An endotracheal tube that is advanced too far will preferentially enter into the {{c1::right::left or right}} mainstem bronchusCauses asymmetric chest expansion and markedly decreased breath sounds on the left side; treat by pulling the tube back slightly496bb365-be4d-4c13-96f5-761a2c0abe4c
What is the likely diagnosis in a patient with anosmia, bronchospasm and nasal congestion following aspirin ingestion? {{c1::Aspirin-exacerbated respiratory disease (AERD)}}Most often seen in patients with a history of asthma or chronic rhinosinusitis with nasal polyposis Aspirin/NSAID TriadAspirin/NSAID Hypersensitivity- COX-1 inhibitors cross reactivity - Tolerance of COX-2 inhibitorsNasal Polyposis with Chronic Rhinosinusitis- Recurrent nasal plyps - Hyposmia/anosmia - Hyperplastic panisinusitisAsthma- Severe - Difficult to controlWatch associated Bootcamp video - Asthma70295028-af34-4048-8e70-0a83d6900312
What is the best initial step in management for a stabilized patient with likely PE (modified Wells criteria) who has no absolute contraindications to anticoagulation? {{c1::Begin anticoagulation (e.g. IV heparin)}}If there is no contraindication to anticoagulation, it should precede diagnostic imaging in patients with likely PE, especially when in moderate distress9c6463ea-6d77-444c-a1c4-b6785504a73f
What is the best initial step in management for a stabilized patient with unlikely DVT/PE (low pretest probability on modified Wells criteria) who has NO absolute contraindications to anticoagulation? {{c1::Obtain diagnostic test (e.g. D-dimer assay)}}If the patient is hemodynamically stable with symptoms of DVT/PE, you need to assess the Wells' score for DVT/PE; If the risk is low, obtain D-dimerWatch Pulmonary Embolism SOAPWatch associated Bootcamp video - Bleeding Time, Prothrombin Time, INR, and Partial Thromboplastin Time91cd6138-20b0-4cfb-a727-b5f8acce14f0
What is the best initial step in evaluation/management for a stabilized patient with suspected PE who has absolute contraindications to anticoagulation? {{c1::CT pulmonary angiography (CTPA)}}If CTPA is positive, patients should receive appropriate treatment (e.g. IVC filter)fad11464-6087-4fb1-80bf-95f215e877ee
What is the next step in management for a smoker with progressive dyspnea, weight loss, and evidence of pleural effusion on CXR? {{c1::Diagnostic thoracentesis}}Photo credit: Yale Rosen from USA, CC BY-SA 2.0, via Wikimedia Commons - Undiagnosed pleural effusion is best evaluated with thoracentesis to determine if the fluid is transudative or exudative; exudative → further evaluation needed - Exception: in patients with evidence of CHF (e.g. weight gain, pedal edema, bibasilar crackles), the first step is a trial of diureticsWatch Parapneumonic Effusion & Empyema SOAPece460ff-198e-438b-8c19-c51fc15e71b6
Patients with COPD have an increased work of breathing due to hyperinflation of their lungs demonstrated by a(n) {{c1::flattened}} diaphragm on chest X-rayThe flattened diaphragm has more difficulty contracting to expand the thoracic cavity and generate a negative intrathoracic pressure Photo credit: Mikael Häggström, M.D. Author info - Reusing images- Conflicts of interest: None Mikael Häggström, M.D.Consent note: Written informed consent was obtained from the individual, including online publication., CC0, via Wikimedia Commons58732368-f1d9-4196-a533-b7311895f1c5
What is the first-line therapy for obesity hypoventilation syndrome? {{c1::Nocturnal positive-pressure ventilation}}30bfea66-9bbb-4ba5-be2c-8e65c015f6ba
What is the likely diagnosis in a patient with previous TB infection who presents with months of weight loss, fatigue, and hemoptysis without night sweats, fever, or chest pain (imaging below)? {{c1::Chronic pulmonary aspergillosis}}Photo credit: Sakhuja et al., CC BY 4.0, via Cureus - Imaging shows halo sign: nodules with surrounding ground glass opacities; thing on the right lung is a aspergilloma (fungus ball) - Previous TB creates a cavity for aspergillus - Diagnosis is made with Aspergillus IgG serology in the setting of characteristic symptoms and radiographic findings (below)Watch Aspergillus fumigatusWatch Hemoptysis DDx643dbcd4-3c30-47ae-a797-ffd7322f9a3c
What is the first-line treatment for patients with exercise-induced bronchoconstriction who exercise a few times per week? {{c1::Short-acting β-agonists 10-20 minutes before exercise}}- Use ICS + LABA or anti-leukotriene if exercising daily - The diagnosis is confirmed with exercise bronchoprovocation challenge562a1acf-9387-4bbb-baf3-9d648b176f25
What is the first-line treatment for patients with exercise-induced bronchoconstriction who exercise daily? {{c1:: ICS + LABA 10-20 mins before exercise OR Anti-leukotriene agents 2 hours pre-exercise (or daily)::2 Treatment Regimens}}Use short-acting β-agonists if only needed a few times per week22dc8aa3-950a-47ce-8e5a-44f4516a86dc
What is the best treatment to minimize the development of life-threatening complications in patients with anaphylaxis (e.g. hypotension, upper airway edema)? {{c1::Intramuscular epinephrine 1:1000 (1 mg/mL)::include ROA}}- IV epinephrine is indicated for patients with anaphylaxis who do not respond to initial IM epinephrine (IV is associated with a higher risk of cardiovascular arrhythmia) - α1 stimulation for vasoconstriction (increases blood pressure and reduces edema) - β2 stimulation for bronchiole dilation - Some cases require additional doses of epinephrine for refractory symptoms - Can also use H1/H2 blockers, albuterol, steroidsa9d96811-8d0b-4303-9043-b966e0b3bc14
What is the likely diagnosis in a patient who smokes and has coronary artery disease that presents with shortness of breath, bibasilar crackles, low CO2 and respiratory alkalosis? {{c1::CHF exacerbation}}Low CO2 and respiratory alkalosis due to tachypnea helps differentiate from COPD exacerbation, which causes high CO2 and respiratory acidosisWatch Acute Decompensated Heart Failure SOAP Watch Chronic Heart Failure SOA Part 3479024ab-a894-4446-933d-32d32da383cc
What is the likely diagnosis in a plumber with months of progressive dyspnea, bibasilar crackles, and clubbing? {{c1::Asbestosis}}"- Asbestos is a set of six naturally occurring silicate minerals, which all have in common their eponymous asbestiform habit: i.e. long, thin fibrous crystals, with each visible fiber composed of millions of microscopic ""fibrils"" that can be released by abrasion - Asbestos was once hailed a miracle material as it was an extremely good insulator; thus was infused into cement, woven into mats / fabrics, or used as insulation for house building Watch Pneumoconioses"99ed35d0-628d-4173-a906-240415aa2dd0
What is the likely diagnosis in a patient with significant smoking history that presents with shortness of breath, bilateral wheezing, high CO2 and respiratory acidosis? {{c1::COPD exacerbation}}High CO2 and respiratory acidosis help differentiate from CHF exacerbation, which causes low CO2 and respiratory alkalosisWatch COPD & EmphysemaWatch Acute COPD Exacerbation SOAP Watch Acute Dyspnea DDx: Respiratory EtiologiesWatch associated Bootcamp video - COPDefdbde3b-2915-4722-a4d5-96cae9eec7a8
What is the likely cause of leukocytosis with neutrophilic predominance in a patient being treated for asthma exacerbation? {{c1::Glucocorticoid side effect}}Glucocorticoids cause mobilization of marginated neutrophils, while decreasing the number of other circulating lymphocytesWatch Glucocorticoidsfebde5f4-0cac-4844-a6d2-fe5cfed53ef9
What is the likely diagnosis in an immigrant with progressive dyspnea, orthopnea, palpitations, and an elevated left main bronchus on CXR? {{c1::Rheumatic heart disease}}Mitral stenosis results in left atrial enlargement, predisposing to arrhythmia (palpitations, AFib) and elevation of the left main bronchusWatch associated Bootcamp video - Mitral Stenosis02ef35c7-131f-4c25-b7e7-abe878cbe0f9
The initial pathophysiology of a massive PE involves dilation and hypokinesis of the {{c1::right}} ventricle with subsequent dysfunctionCan also see a small low volume left ventricle60d82c28-7a89-482c-a7f0-d8e8f0e8adbd
What is the likely diagnosis in a young woman with exertional dyspnea and enlargement of the pulmonary arteries and right ventricle on CXR? {{c1::Primary pulmonary hypertension}}Push against more afterloadWatch Chronic Dyspnea DDx Part 31128c1a5-253e-4a1f-ad65-ea7233b80084
Features of a high-risk solitary pulmonary nodule include size ≥ {{c1::2}} cm, age > {{c2::60}}, and smoking cessation within the last 5 years (or current smoker)high-risk: size >2cm, age >60, smoking within last 5 years (or currently) intermediate risk: size 0.8-2cm; age 40-60, smoked within 5-15 years (or currently) low risk: size <0.8cm, age <40, no smoking for 15+ years (or never smoked)223998cd-6c81-4add-bd88-792ea1904a89
Features of an intermediate-risk solitary pulmonary nodule include size {{c1::0.8}} - {{c1::2}} cm, age {{c2::40}} - {{c2::60}}, and smoking cessation within the last 5 - 15 years (or current smoker)High-risk: size >2cm, age >60, smoking within last 5 years (or currently) Intermediate risk: size 0.8-2cm; age 40-60, smoked within 5-15 years (or currently) Low risk: size <0.8cm, age <40, no smoking for 15+ years (or never smoked)Watch Hemoptysis DDx9889ddea-bfed-4e7d-a202-b85446b0ba47
What is the recommended management after chest CT for solitary pulmonary nodules with high malignancy risk? {{c1::Surgical excision}}Smoking history, age, > 2 cm size00938074-702d-4235-8c88-ad0ad8d7c8fe
What is the recommended management after chest CT for solitary pulmonary nodules < 0.8 cm with intermediate malignancy risk? {{c1::Serial CT scan}}i.e. no smoking history, youngere5751e05-9d09-450b-b184-10278b08d970
What is the recommended management after chest CT for solitary pulmonary nodules ≥ 0.8 cm with low to intermediate malignancy risk? {{c1:: FDG-PET or Biopsy::2}}- High metabolic activity → excise - Non-suspicious lesions can be followed with serial CT7716d8ef-e911-47bd-b579-90d7ae1781cd
Bradycardia, hypoventilation, and decreased shivering are associated with {{c1::moderate::severity}} hypothermia- Body temp 82-90 °F (27.7-32.2 °C) - The bradycardia seen with hypothermia is often refractory to treatment with atropine/cardiac pacing, but improves with correction of hypothermiaWatch Bradycardia DDx and SOAPe9f48d0c-3811-418e-a281-27fa1cda3e15
Tachycardia, tachypnea, and increased shivering are associated with {{c1::mild::severity}} hypothermiaSeen with temperatures between 90-95 °F (32.2-35 °C)d9a77de5-969b-4134-b5dc-e5dc10b0556f
Coma and cardiovascular collapse are associated with {{c1::severe::severity}} hypothermiaseen with temperatures < 82 °F (27.7 °C)051f45cd-1936-42c8-b5d4-1cc232a0732c
Which warming technique is preferred for patients with mild hypothermia (32–35°C (89.6–95°F))? {{c1::Passive external warming}}Remove wet clothing, cover with blankets26cc90fd-f97b-4f37-a6ab-353472c74a34
Which warming technique is preferred for patients with moderate hypothermia (28–32°C (82.4–89.6°F))? {{c1::Active external warming}}warm blankets, heating pads, warm bathsb800fbb7-5a72-41df-aca8-cc42b6199121
Which warming technique is preferred for patients with severe hypothermia? {{c1::Active internal warming}}Warmed pleural or peritoneal irrigation, warmed humidified oxygenc6c99773-52d1-4a12-94b2-d0b6d7842b79
In addition to rewarming techniques, hypotensive patients with hypothermia should receive warmed {{c1::IV fluids}}bradycardia is often refractory to atropine due to decreased reactivity of pacemaker cells but is responsive to rewarming4cd49930-4fba-4189-a689-f232e7e09a80
In mechanically ventilated patients, peak inspiratory pressure (PIP) is equal to the sum of {{c1::resistive pressure (resistance)}} and {{c1::plateau pressure (compliance)}}Peak inspiratory pressure is what you measure as the TV is being delivered0510c870-ac51-4917-bb30-84009f647a79
In mechanically ventilated patients, an increased peak pressure with an unchanged plateau pressure suggests {{c1::increased airway resistance}}e.g. bronchospasm, mucus plug, endotracheal tube obstruction - it doesn't involve the lung itself and therefore doesn't change the plateau pressure Recall: plateau pressure = elastic pressure + PEEP (a) Elastic pressure ~ compliance of lung (b) PEEP calculated with expiratory hold maneuver34cb00f0-03fc-4ea8-af34-10dd7b841455
In mechanically ventilated patients, an increased peak pressure with an increased plateau pressure suggests {{c1::decreased compliance}}e.g. pulmonary edema, atelectasis, pneumonia, pneumothorax Recall: plateau pressure = elastic pressure + PEEP (a) Elastic pressure ~ compliance of lung (b) PEEP calculated with expiratory hold maneuverf51f508c-19d6-4af8-8648-2278b1554c74
Ventilation, and thus PaCO2, in mechanically ventilated patients may be altered by changing either {{c1::respiratory rate}} or {{c2::tidal volume}}Measure of pulmonary minute ventilation (how fast you breathe x how much per breath)Watch associated Bootcamp video - Air Physiology : Airflow and Airway Resistance724cd6d8-41c7-49a2-ac03-c58b0b68bb66
In general, tidal volumes in mechanically ventilated patients should be about {{c1::6-10}} mL/kg of ideal body weight- This card previously stated 6 mL/kg. AMBOSS states 8–12 mL/kg ideal body weight while UTD states 4-10 mL/kg. (Jun 2023) - Obese individuals do not have larger lungs. Use ideal body weight. DO NOT use the measured body weight. If you do, lungs can go POP :(0054db96-4ff6-4af8-8f4c-210c516487de
What ventilator setting change is best to improve respiratory alkalosis in a 70 kg patient with respiratory alkalosis with the following settings: FiO2: 40% PEEP: 5 mmHg VT: 450 mL RR: 18/min {{c1::Decrease RR}}The patient is on an appropriate tidal volume (70 kg × 6 mL/kg = 420 mL); thus, decreased RR is the most appropriate management to fix the respiratory alkalosiseebca596-a489-4ad1-95a7-39414aae94c6
What is the likely diagnosis in an infant with upper respiratory symptoms, wheezing/crackles, and respiratory distress? {{c1::Bronchiolitis}}Treatment is supportive in the absence of dehydration and/or severe respiratory symptoms!Watch associated Bootcamp video - Lung Pathology Fundamentals : Introduction to Respiratory Infections104a8408-111c-41be-8420-b1ed38b858d1
Infants age < 2 months with bronchiolitis are at high risk of developing {{c1::apnea}} and/or respiratory failureMay administer prophylactic nirsevimab/palivizumab for patients with very high risk for complicationsWatch Respiratory Syncytial Virus & Human Metapneumovirus (Pneumoviridae)adeb6fd3-ba83-4c02-aaea-1760eff86046
An infant with a fever, runny nose, and cough has the X-ray findings below. What does the arrow on the CXR point to? {{c1::Thymus}}Photo credit: Nevit Dilmen, CC BY-SA 3.0, via Wikimedia Commons a large thymic silhouette is a normal finding on frontal CXR in children < 3 years1fc8877d-3806-4340-8c5c-a7267b0ef3bd
What is the next step in management for a young patient who is taking PPIs and presents with chronic nocturnal cough without post-nasal drip, fever, dyspnea, weight loss, or response to H1 blockers? {{c1::Pulmonary function tests}}- Taking PPIs → unlikely to be GERD - This patient likely has asthma and should be assessed with PFTs to assess bronchodilator responseece83086-b7a8-40e0-a7c9-ab2bf0e6fd66
Chronic bronchitis-predominant COPD is characterized by a(n) {{c1::normal}} DLCOAlso has prominent vascular markings on CXR vs. emphysema, which has decreased vascular markings and low DLCO (destroyed tissue, markings) DefinitionCXR findingsDLCOChronic Bronchitis>3 months/year of productive cough for >2 years consecutivelyflattened diaphragm, prominent bronchovascular markingsNormalEmphysemausually centriacinar (respiratory bronchiole dilation sparing distal alveoli)hyperinflated chest, decreased vascular markingsDecreased (alveolar damage)Asthma Chronic airway inflammationNot usually recommended; may reveal air trapping & bronchial thicknessNormal/Increasedff4d0477-7488-4826-a9f4-2610c76a7b7f
Emphysema-predominant COPD is characterized by a(n) {{c1::low}} DLCO- Emphysema = destruction of tissue → ↓ DLCO, vascular markings - Also has decreased vascular markings on CXR vs. chronic bronchitis, which has increased vascular markings and normal DLCO DefinitionCXR findingsDLCOChronic Bronchitis>3 months/year of productive cough for >2 years consecutivelyflattened diaphragm, prominent bronchovascular markingsNormalEmphysemausually centriacinar (respiratory bronchiole dilation sparing distal alveoli)hyperinflated chest, decreased vascular markingsDecreased (alveolar damage)Asthma Chronic airway inflammationNot usually recommended; may reveal air trapping & bronchial thicknessNormal/Increasedcbb22445-8b8b-4fd5-94bc-adf04bfa77a0
The CURB-65 criteria helps guide treatment and treatment location for patients with community-acquired pneumonia: C: {{c1::Confusion}} U: {{c1::BUN ≥ 20 mg/dL (urea > 7 mmol/L)}} R: {{c1::Respirations ≥ 30/min}} B: {{c1::Blood pressure (systolic < 90 or diastolic ≤ 60 mmHg)}} 65: Age ≥ 65+1 for each criteria met Score 0 or 1: Outpatient treatment Score ≥ 2: Inpatient treatment Score ≥ 3: Consider ICU CURB-65 criteria calculatorWatch Pneumonia Managementy3d3904b3-eb6e-4d7d-9e76-3c8f7e47b7d5
What is the recommended empiric treatment for healthy patients with community-acquired pneumonia in an outpatient setting? {{c1::Amoxicillin}} or {{c1::doxycycline}} or {{c1::macrolide*}}* only in areas where pneumococcal macrolide resistance rates are known to be < 25%. (due to increasing resistance) - AMBOSS - This card previously did not include amoxicillin. AMBOSS and UTD confirm that amoxicillin is considered a first-line option (4/12/23) - Note: Some sources recommend treating these patients with amoxicillin PLUS doxycycline or a macrolide - Recommendations for empiric treatment of patients with comorbidities or patients requiring hospitalization differ slightlyWatch Ampicillin, Amoxicillin, Piperacillin, Ticarcillin Watch Cephalosporins Watch Tetracyclines Watch Macrolides [Old Version]Watch Pneumonia Management3219cd41-5202-499c-a7af-6cd0e500c3f7
What is the recommended empiric treatment for patients with community-acquired pneumonia in an inpatient setting? {{c1::Respiratory fluoroquinolone (e.g. moxifloxacin)::Monotherapy}} or {{c1::β-lactam*}} PLUS {{c1::macrolide}} or {{c1::doxycycline}}*Cephalosporin or Ampicillin-sulbactam - Need macrolide/doxy/fluoroquinolone to cover atypicals (legionella, mycoplasma)Watch Ampicillin, Amoxicillin, Piperacillin, Ticarcillin Watch Fluoroquinolones Watch Tetracyclines Watch Macrolides [Old Version]Watch Pneumonia ManagementWatch associated Bootcamp video - Fluoroquinolonesb8be7b97-50e5-4883-9f06-c4c8a31496e5
What type of pleural effusion, transudative or exudative, is characterized by pH 7.40 - 7.55? {{c1::Transudative}}- Normal pleural fluid pH is 7.60 - Exudative effusions typically have lower pH (7.30 - 7.45) Light's CriteriaTransudative pleural effusionExudative pleural effusionProtein (pleural / serum)≤ 0.5> 0.5LDH (pleural / serum)≤ 0.6> 0.6Common causes- Cirrhosis (low albumin) - Nephrotic syndrome (low albumin) - Congestive heart failure- Infection (TB, fungal, empyema, parapneumonic) - Malignancy - Pulmonary embolismWatch Acute Respiratory Distress Syndrome (ARDS)Watch Pleural Effusion DDx3cec3fef-0422-4a8e-8d1b-93c8f8d85329
What type of pleural effusion, transudative or exudative, is characterized by pH 7.30 - 7.45? {{c1::Exudative}}- Normal pleural fluid pH is 7.60 - Transudative effusions typically have slightly lower pH (7.40 - 7.55) - Exudative effusions have even lower pH (7.30 - 7.45) due to lactate production by bacteria/infection Light's CriteriaTransudative pleural effusionExudative pleural effusionProtein (pleural / serum)≤ 0.5> 0.5LDH (pleural / serum)≤ 0.6> 0.6Common causes- Cirrhosis (low albumin) - Nephrotic syndrome (low albumin) - Congestive heart failure- Infection (TB, fungal, empyema, parapneumonic) - Malignancy - Pulmonary EmbolismWatch Acute Respiratory Distress Syndrome (ARDS)a115296a-dd6f-4435-bedb-d596950bbac0
What is the most important risk factor for neonatal respiratory distress syndrome (NRDS)? {{c1::Prematurity}}Other risk factors include male sex, perinatal asphyxia, maternal diabetes, and C-section774366ae-82e7-4639-99d5-20ab58c20a2d
What is the recommended management for amniotic fluid embolism syndrome? First-line: {{c1::supportive (e.g. respiratory, hemodynamic support, correct anemia/coagulopathy)}} Sometimes requires {{c1::urgent cesarean delivery}}1a52a9aa-40a6-42cb-9121-4482d6dfd3da
What is the initial treatment for a child with severe respiratory distress and signs of epiglottitis? {{c1::Endotracheal intubation}}Administer broad-spectrum antibiotics after the patient is stabilized58a9c81d-cffb-4f53-89d8-e7be1c154356
Patients with hypovolemia often have {{c1::decreased}} levels of urine sodiumDue to RAAS activation; hypovolemia may manifest as orthostatic hypotension/syncope; aldosterone reabsorbs Na+and excretes H+/K+a5b46188-7eb0-47db-80f6-9326db2f259d
How do the following pressures change with pulmonary embolism? RA pressure: {{c1::increased}} Pulmonary artery pressure: {{c1::increased}} LA wedge pressure: {{c1::decreased or normal}}- Decreased LA pressure (measured as PCWP) suggests an intrinsic pulmonary process → obstructive shock (↓ blood to LA) - An increased PCWP suggests left-sided heart failure leading to right-sided heart failure - Normal PCWP reflects normal left ventricular function, suggesting that the elevated pulmonary pressures seen are due to an intrinsic pulmonary processWatch Deep Vein Thrombosis & Pulmonary Embolismy458995c7-e961-405c-9c9c-7886b981ea41
How does the A - a gradient change in patients with a decreased DLCO? {{c1::Increased}}443dd748-4309-45b2-84ec-836901e9d48c
What is the recommended management for solitary pulmonary nodules with stable size and appearance for over 2-3 years on imaging? {{c1::Reassurance; no further testing required}}dd902be2-1dde-4ee0-90d0-ee8a44761ea2
The presence of digital clubbing in patients with COPD should prompt a search for {{c1::occult malignancy}}COPD itself, with or without hypoxemia, does NOT cause clubbing292c6ebc-6cb0-42ae-894b-717b4438021e
The most common causes of secondary digital clubbing are {{c1::lung malignancy}}, cystic fibrosis, and right-to-left cardiac shuntsDue to megakaryocytes that skip normal fragmentation in pulmonary circulation; trapped in distal fingertips and release PDGF/VEGF → connective tissue hypertrophy88176c1c-d515-4b90-b4c3-55a65895ca2e
What is the likely diagnosis in an obese patient with daytime somnolence, morning headaches, and normal daytime CO2? {{c1::Obstructive sleep apnea}}normal daytime CO2 helps distinguish from obesity hypoventilation syndrome (elevated daytime CO2)d58c0362-aad8-459f-ae47-892419607168
What is the next step in management for a young patient who presents with chronic nocturnal cough with a sensation of liquid dripping into the back of the throat? {{c1::Oral first-generation H1 blocker::include ROA}}- This patient likely has upper-airway cough syndrome (post-nasal drip) and should be treated empirically - Decrease nasal secretions which normally mechanically stimulates the afferent limb of cough reflex - An alternative treatment regimen is a combined antihistamine-decongestant (e.g. brompheniramine and pseudoephedrine); if symptoms don't get better in 2-3 weeks, get further imaging/diagnosticsda20f63c-6dc1-46ce-a39a-efb3925e033a
What type of V/Q mismatch may occur in patients with pneumonia? {{c1::Right-to-left intrapulmonary shunt}}Shunted deoxygenated blood due to lack of alveolar ventilation (they're filled with junk) → hypoxemia that cannot be corrected by oxygen Reasoning: - Infection (e.g. pneumonia, sepsis) leads to the production of inflammatory cytokines that disrupt hypoxic pulmonary vasoconstriction, increasing blood flow to infected lung areas - Adding 100% will improve right side, but left side is still <99%, and they will eventually mix, causing hypoxemia - Compare with V/Q mismatch (e.g. secondary to PE or COPD), which does improve with 100% oxygen - There is no mixing with the deoxygenated blood on the left sideWatch associated Bootcamp video - Air Physiology: Ventilation and Dead Space7c15b037-2fa5-4a81-ade8-8e16f1ae2620
What ventilator setting change is best for a 65 kg patient with the following ABG and ventilator settings: pH: 7.42 PaO2: 105 mmHg PaCO2: 37 mmHg FiO2: 80% PEEP: 7 mmHg VT: 380 mL RR: 14/min {{c1::Decrease FiO2}}- FiO2 should be reduced to prevent oxygen toxicity; in general FiO2 < 60% is considered safe - When lowering FiO2, a compensatory increase in PEEP may be required to maintain adequate oxygenation!138e9049-2dee-409e-9d64-776f8cf720b9
Normal or high PaCO2 in a patient with an acute asthma exacerbation is suggestive of impending {{c1::respiratory failure}}D/t muscle fatigue; demonstrates an inability to maintain adequate ventilation as patients should be hyperventilating and should have low PaCO2Watch Acute Asthma Exacerbation SOAP002b00a2-6ee2-4672-a674-fa13dcf0d934
What are the next steps in management for a patient with acute respiratory failure due to COPD exacerbation who fails to improve with medical management? Initial: High flow nasal cannula (HFNC) to maintain SaO2 88% - 92% If no improvement: {{c1::Non-invasive positive pressure ventilation (NIPPV)}}- CPAP and BIPAP are both types of NIPPV - Consider high flow nasal cannula only if the condition is not immediately life threatening - Maintain a low threshold for intubation and mechanical ventilation - NIPPV may be contraindicated (e.g. AMS, agitation, hemodynamic instability)Watch Acute COPD Exacerbation SOAPebdd72dd-1c7f-495b-b6a1-89ff4ce7bb99
What is the next step in management for a patient with acute respiratory failure due to an acute COPD exacerbation who fails to improve with non-invasive positive pressure ventilation (NIPPV)? {{c1::Endotracheal intubation and mechanical ventilation}}- Intubation may be warranted prior to trial of NIPPV if condition is immediately life threatening or if NIPPV is contraindicated (e.g., AMS, agitation, hemodynamic instability) - If patient is not tolerating NIPPV and condition is not immediately life threatening, consider high flow nasal cannulaWatch Acute COPD Exacerbation SOAP90a54803-8823-4906-97c8-85bc960a6c7d
What is the likely diagnosis in a patient with pneumonia that presents with continued symptoms despite adequate antibiotic coverage and loculation on CXR? {{c1::Complicated parapneumonic effusion}}Requires drainage plus antibiotics Parapneumonic effusions UncomplicatedComplicatedEtiologySterile fluid in pleural spaceBacteria in pleural spacepH≥ 7.2< 7.2Glucose>60mg/dL<60mg/dLWBC≤ 50,000/mm3> 50,000/mm3Gram stain & cultureNegativeTypically false negative (not enough bacteria - would be positive with empyema)TreatmentAntibioticsAntibiotics + drainageWatch Parapneumonic Effusion & Empyema SOAP08a76bf8-b306-4dc7-9f96-4b3d599fc7bf
What physiologic change helps compensate for chronic respiratory acidosis and hypercapnia in patients with COPD, sleep apnea, or obesity hypoventilation syndrome? {{c1::Increased renal HCO3- retention}}i.e. compensatory metabolic alkalosis after > 2 days8e5c5822-5962-453f-ac2f-1ebdb2d95ce0
Which part of the mediastinum are neurogenic tumors usually found? {{c1::Posterior mediastinum::Anterior, Middle, Posterior}}Other posterior mediastial masses include enteric cysts, lymphomas, diaphragmatic hernias, esophageal tumors, and aortic aneurysms Photo credit: Jmarchn, CC BY-SA 3.0, via Wikimedia Commonsc369c2f2-39b7-4b2c-a1bd-72362ccb9fdc
What risk factor acts synergistically with asbestos to increase risk of lung cancer? {{c1::Smoking}}Asbestos alone increases risk by nearly 6-fold; smokers with asbestos exposure have a nearly 59-fold increased riskWatch Pneumoconioses8047cba5-f63c-4f12-ae21-5ad2ef42d3a3
What is the pathophysiologic mechanism underlying worsening hypoxemia when a patient with lobar pneumonia lies on the affected side? {{c1::Increased intrapulmonary shunting}}Lying on the affected side increases blood flow (Q) to this area due to gravity, but ventilation (V) is poor due to consolidation from pneumonia, thus worsening the V/Q ratio → more shunting of the blood from right to left without being oxygenatedc1f5cd17-7da6-4a3a-9f8b-a6fd3515d848
What is the likely diagnosis in a young patient with chronic nasal congestion and dry cough without an identifiable trigger, eye symptoms, itching, or sneezing? {{c1::Non-allergic rhinitis}}Diagnosis is typically clinicalfe3a2db8-9977-40c1-8720-dcb331368e51
What is the initial management for patients with non-allergic rhinitis? {{c1::Intranasal antihistamine or glucocorticoids::2}}Severe requires both6ac48b11-2147-4e47-9d68-fea312c20158
What type of V/Q mismatch is worsened in COPD patients with O2-induced CO2 retention? {{c1::Dead space}}At baseline, hypoxic vasoconstriction shunts blood away from non-functional alveoli; supplemental O2 increases blood flow to these areasWatch Acute COPD Exacerbation SOAPWatch associated Bootcamp video - Air Physiology: Ventilation and Dead Space Watch associated Bootcamp video - COPD8b786648-418c-4f17-94db-43b8fe1b8f30
What is the underlying cause of low glucose in complicated parapneumonic effusions? {{c1::High metabolic activity of leukocytes and/or bacteria}}Parapneumonic effusions UncomplicatedComplicatedEtiologySterile fluid in pleural spaceBacteria in pleural spacepH≥ 7.2< 7.2Glucose>60mg/dL<60mg/dLWBC≤ 50,000/mm3> 50,000/mm3Gram stain & cultureNegativeTypically false negative (not enough bacteria - would be positive with empyema)TreatmentAntibioticsAntibiotics + drainage776d65e2-e557-44b2-9095-31eea00942e9
Injury to the {{c1::axillary}} nerve ({{c2::C5-C6::nerve roots}}) is commonly due to: - Fracture at {{c3::the surgical neck of the humerus}} - {{c4::Anterior dislocation}} of the humerusFractured surgical neck of humerus - Common in elderly, nerve runs below humeral head and wraps around the surgical neck of the humerus - More dangerous than dislocation b/c can disrupt blood supply to the humeral head (anterior / posterior humeral circumflex artery) → avascular necrosis Anterior shoulder dislocation - Caused by arm being abducted and extended with a force being applied to arm that originates from behind (posterior) - e.g. someone blocking a basketball shot, someone tackling while a person is throwing a football Photo credit: Paul Marquis,, via Ortho Eval Pal, used with permission, modified by censoringWatch associated Bootcamp video - Shoulder and Elbow: Humerus Fractures Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Axillary Nerve58a35173-1ccc-4a6e-9613-7ffcdd3401b7
"Injury to the {{c1::radial}} nerve ({{c2::C5-T1::nerve roots}}) can be caused by: - {{c3::Midshaft}} fracture of the humerus - Compression of the {{c4::axilla}} - ""{{c5::Nursemaids}} elbow"" - ""{{c6::Finger}}"" drop""Midshaft fracture of the humerus - Damage of the nerve in the spiral groove of the humerus; deep brachial artery is at risk of damage - Triceps brachii are spared and sensory nerves over posterior arm / forearm are unaffected (nerves that supply these have already been given off); thus supination is the most impacted Compression of the axilla - Due to incorrect use of crutches or passing out with arm over chair Radial head subluxation (""nursemaids elbow"") - Longitudinal traction applied to an extended an pronated arm (e.g. by nursemaid pulling vigorously at childs arm) can lead to annular ligament slipping over the head of the radius and impinging deep radial nerve - Causes lateral elbow pain, weakness, no sensory deficits or wrist drop Finger Drop - Repetitive pronation / supination of forearm (e.g. screwdriver use) - Palsy in deep radial nerve (extensors of finger and wrist)"Watch associated Bootcamp video - Shoulder and Elbow: Humerus Fractures Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Radial Nervea407ced0-18c4-4476-89cd-ce45b86dcd5c
{{c1::Median}} nerve ({{c2::C5-T1::nerve roots}}) injury is commonly due to: - {{c5::Anteromedial}} {{c5::supracondylar}} fracture of the humerus ({{c3::proximal::proximal or distal}} lesion) - {{c4::Carpal tunnel}} syndrome ({{c3::distal::proximal or distal}} lesion) - {{c4::Wrist}} laceration ({{c3::distal::proximal or distal}} lesion)"Anteromedial supracondylar fracture of the humerus - Supracondylar ridges are immediately proximal to lateral / medial epicondyles - Most common pediatric elbow fracture - Typically caused by fall on outstretched elbow - Results in sensory deficits in medial distribution, loss of thumb opposition, flexion of lateral fingers and lumbricals of 2nd / 3rd digits - Patients have a ""pope's blessing"" hand sign upon patient making a fist - Because brachial artery is paired with median nerve here, brachial artery can be damaged resulting in Volkmann's Ischemic Contracture (uncontrolled flexion in hand muscles as flexors become fibrotic and short) - MRI elucidates Carpal tunnel syndrome or wrist laceration - Result in a ""median claw lesion"" (distal median nerve lesion - test distal lesion by having patients extend from a fist)"Watch associated Bootcamp video - Shoulder and Elbow: Humerus Fractures Watch associated Bootcamp video - Childhood Musculoskeletal Pathology: Pediatric Fractures Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Median Nerve Watch associated Bootcamp video - Distortions of the Hand4a6b86ab-60ca-43ee-add2-2969d6150a16
"Injury to the {{c1::ulnar}} nerve ({{c2::C8-T1::nerve roots}}) commonly occurs due to: - Fracture of the {{c3::medial epicondyle}} of humerus ({{c4::proximal::distal or proximal}} lesion) - Fractured {{c3::hook of hamate}} ({{c4::distal::distal or proximal}} lesion) (from fall on outstretched hand - ""FOOSH"")""- Fracture of the medial epicondyle of the humerus results in ""OK gesture"" lesion (proximal ulnar lesion - test proximal lesion by having them make a fist) - Fracture of the hook of hamate results in ""Ulnar Claw"" lesion (distal ulnar lesion - test distal lesion by having them extend fingers from a fist) Photo credit: Mikael Häggström., CC0, via Wikimedia Commons"Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Ulnar Nerve Watch associated Bootcamp video - Fractures and Dislocations Watch associated Bootcamp video - Distortions of the Hand20a5fc1e-22ca-443c-bbc3-9e7571387142
What is the likely diagnosis in a patient with lethargy and asterixis with the laboratory findings below? BUN: 78 mg/dL Albumin: 3.8 g/dL AST: 38 U/L ALT: 44 U/L Creatine kinase: 32,000 U/L {{c1::Uremic encephalopathy}}Normal urea: 9-20; buildup of urea due to CKD can cause these symptoms072aaa45-1e17-45ac-811d-699a01cded11
Common causes of asterixis include {{c1::hepatic encephalopathy}}, {{c2::uremic encephalopathy}}, and {{c3::hypercapnia}}- Liver: ammonia intoxication since liver can't detoxify - Uremic: kidney can't excrete urea - Treat the underlying condition Video credit: Dr. Robert Laureno, CC BY-SA 4.0, via Neurosigns.org, used with permissione5484229-9ba3-4413-8937-57c4e85de4b2
What is the likely diagnosis in a patient with anasarca, pulmonary edema, hematuria, and proteinuria (1+)? {{c1::Acute nephritic syndrome}}The presence of hematuria and pulmonary edema helps distinguish nephritic syndrome from other causes of edema (e.g. hypoalbuminemia, cirrhosis, heart failure)Watch Glomerulonephritis SOAPbf5cc73b-1e86-448c-8c49-88f8b07e6355
Patients with acute nephritic syndrome develop edema due to {{c1::glomerular damage}}, resulting in decreased GFR and increased Na+/H2O retentionCan't pee fluid outWatch Glomerulonephritis SOAPcd8942e0-7561-428b-a534-68a086972663
What is the best test to screen for the initial stages of diabetic nephropathy? {{c1::Urine test for microalbumin:creatinine ratio}}- Either spot or timed urine collection for microalbumin - Preferred over dipsticks since dipsticks only detect excess urinary protein when > 300mg/24hr (macroalbuminuria) and thus are not useful for screening* Late renal disease may manifest as severe albuminuria with reduced GFR120db928-bb6e-4ba2-b238-833f9c181422
What is the initial step in management for a post-operative patient with acute kidney injury and oliguria (< 250 mL urine in 12 hours)? {{c1::Bedside bladder scan to assess for urinary retention}}5720e724-8871-46f5-8a81-8d6921301dd5
What is the likely diagnosis in a middle-aged patient with chronic renal failure, a palpable right flank mass, and an enlarged liver? {{c1::Autosomal dominant polycystic kidney disease (ADPKD)}}The right kidney is lower and easier to palpate than the left; liver can also be cystic; other symptoms of ADPKD include intermittent flank pain, hematuria, UTIs, and nephrolithiasis Photo credit: Agnello et al., CC BY 4.0, via Insights into ImagingWatch Congenital & Cystic Kidney DiseaseReview ADPKDa6297685-a5e7-41ca-8a81-d34559fe71b7
Drugs with anti-{{c1::cholinergic}} properties can cause urinary retention by preventing detrusor muscle contraction and urinary sphincter relaxationtreatment of patients experiencing urinary retention involves urinary catheterization and discontinuing the medicationWatch associated Bootcamp video - Micturition Overview Watch associated Bootcamp video - Urge Incontinence4904b935-1233-44ed-914c-477bd2f9c143
What is the likely diagnosis in an elderly patient taking several medications that develops abdominal pain and suprapubic fullness? {{c1::Urinary retention}}- Treat with catheterization and d/c medication - Due to anticholinergic properties of drugs such as TCAs, which prevent detrusor muscle contraction and urethral sphincter relaxation → pee cannot go out465cd724-e3e4-40aa-bb46-737336953c22
What is the long-term treatment for severe hypercalcemia (> 14mg/dL or symptomatic)? {{c1::Bisphosphonates (e.g. zoledronic acid, pamidronate)}}Symptoms include weakness, GI distress, and neuropsychiatric symptomsWatch associated Bootcamp video - Calciumd2f7e87d-f305-470e-8937-738d995c4903
Calcium gluconate or IV insulin with glucose is typically reserved for hyperkalemia in patients with any of the following: - ECG changes - K+ ≥ {{c1::6.5}} mEq - rapidly rising K+Review Insulin Overview6203026c-5c7d-4aa3-b939-d531a90f8361
What classes of anti-hypertensive drugs are associated with hyperkalemia? {{c1::ACE inhibitors and ARBs}}Other commonly implicated drugs are non-selective β-blockers, cardiac glycosides, NSAIDs, and K+-sparing diuretics - less Na+ in, less H+/K+ out8b8e3d19-23bc-4868-9cf7-cf8ce4dd6d39
What class of autonomic drugs are associated with hyperkalemia? {{c1::Non-selective β-blockers}}82cae426-21da-43be-822c-f001a75ac602
What is the likely diagnosis in an afebrile elderly male with BPH who experiences agitation and lower abdominal tenderness 2 days after surgery? {{c1::Acute urinary retention}}- Diagnosis is confirmed by bladder ultrasound - Treatment is insertion of a Foley catheter36b0d4bd-95ea-4a5d-a3cd-a9afb4a336f1
Diagnosis of acute urinary retention is confirmed by bladder ultrasound demonstrating ≥ {{c1::300}} mL of urine- Treat with catheter placement - In reality, the volume of residual urine considered to be significant varies in the literature, ranging from 50 to 300 mL. It is also dependent on age, sex, and chronicity of retention (higher threshold for acute retention). Thus, look for other signs on U/S like bladder distention or wall thickening alongside clinical judgmentc6194f51-5066-4040-be98-8bd924e88032
What is the likely diagnosis in a patient with lower extremity edema, 4+ proteinuria, and a kidney biopsy demonstrating dense deposits within the GBM? {{c1::Membranoproliferative glomerulonephritis (MPGN) type II}}"Also known as ""dense deposit disease"" due to persistent alternative pathway complement activation"Watch Glomerulonephritis SOAPa206bdf8-ccfe-4f17-aca6-1633ae048581
What is the treatment of choice for euvolemic hypernatremia? {{c1::5% dextrose (preferred)::preferred}} or {{c1::0.45% saline}}- For free water supplementation - Correct volume first if not euvolemic (saline, diuretic), and then correct hypernatremia - D5W ~ pure H2O with dextrose to dilute [Na+]f46b3a12-08d4-4ad8-b78a-375eda8b745c
What is the likely diagnosis in a patient with cor pulmonale treated with loop diuretics that develops elevated creatinine and BUN? {{c1::Prerenal acute kidney injury}}- Due to decreased CO and renal perfusion - Suggested by BUN:creatinine ratio > 203ee15658-a98a-4ff1-bf04-86fc3734cfe8
What acid base disturbance is present given the ABG below? pH: 7.29 PaCO2: 50 mmHg HCO3-: 24 mEq/L {{c1::Respiratory acidosis}}Low pH with a primary rise in CO2 is indicative of respiratory acidosis9b23568f-d5d8-4a00-b229-4b4325698c16
What is the most common form of drug-induced chronic renal failure? {{c1::Analgesic nephropathy}}Suggested by elevated creatinine with urinalysis showing hematuria or sterile pyuria (WBCs without bacteria)Watch Tubulointerstitial Nephritis88914f0b-74e0-41be-9ab8-eca4a78bf313
What are the most common renal pathologies seen with analgesic nephropathy? {{c1::Papillary necrosis Chronic tubulointerstitial nephritis::2}}- Papillary necrosis → hematuria - Tubulointerstitial nephritis → polyuria, sterile pyuria, WBC casts, proteinuria* Triangle pointing to renal papillary necrosis Watch Tubulointerstitial NephritisWatch associated Bootcamp video - Renal Papillary Necrosis8fc616d1-c4ae-4f6d-8104-09e66383f7bf
How does urine pH change in patients with respiratory alkalosis? {{c1::Increase (alkalinized urine)}}The kidney compensates for respiratory alkalosis by preferentially excreting bicarbonate in the urineWatch Respiratory AlkalosisWatch associated Bootcamp video - Respiratory Alkalosisebaa184e-d43f-4f21-81c2-6ab5ddb0b05c
What antibiotic is associated with hyperkalemia and elevated serum creatinine? {{c1::Trimethoprim}}- Due to blockade of epithelial Na+ channels (ENaC) in the collecting tubule; less Na+ in = less H+/K+ out - TMP also inhibits creatinine secretionWatch Trimethoprim/Sulfamethoxazole53975e7c-0c66-4382-b92a-f60f47da40e7
What is the likely diagnosis in a patient with tuberculosis who presents with hypotension, hyponatremia, hyperkalemia, hypercalcemia, hyperpigmentation, and eosinophilia? {{c1::Primary adrenal insufficiency}}The most common cause of primary adrenal insufficiency is: - Developed countries = autoimmune adrenalitis - Developing countries = tuberculosis - Eosinophilia is a nonspecific finding sometimes seen with adrenal insufficiency as cortisol normally facilitates eosinophil migration from the bloodstream into the tissues - Other symptoms include fatigue and GI distress742fead4-dcf3-40ca-94fe-d58a4d5078af
What type of casts are characteristic of chronic renal failure? {{c1::Broad and waxy casts::2}}Waxy casts are shiny translucent tubular structures formed in the dilated tubules of enlarged nephrons that undergo compensatory hypertrophy in response to reduced renal massWatch Chronic Kidney Disease (CKD)cd23230b-70c0-4bdf-9c0e-6ac916ca61af
What is the likely diagnosis in an elderly patient with diabetes with non-anion gap metabolic acidosis, hyperkalemia, and mild renal insufficiency? {{c1::Type 4 (hyperkalemic) renal tubular acidosis}}Most common in elderly patients with poorly controlled diabetes (damage to the juxtaglomerular apparatus results in hyporeninemic, hypoaldosteronism) = less Na+ in, less H+/K+ out7cfd3aba-69fa-41a4-84b6-4e4dd8b15cc1
What is the likely cause of acute kidney injury in patients receiving IV acyclovir? {{c1::Renal tubular obstruction (crystal-induced AKI)}}Due to precipitation in the renal tubules; treat with IVFWatch Acyclovir, Valacyclovir, Famciclovira74e93b2-e82f-4ac4-9287-06f0c6ca11b2
Patients age > 35 with gross hematuria should be evaluated for urological neoplasms with diagnostic imaging (CT urography or US) followed by {{c1::cystoscopy}}- CT urography preferred due to higher sensitivity than US for carcinomas of the renal pelvis and ureters - Cystoscopy may include biopsy ± CT scan for stagingc3eaeb1a-4690-4543-a9b6-a788f02452f2
What is the likely diagnosis in a young female with hypokalemia, metabolic alkalosis, normotension, and low urine Cl-? {{c1::Surreptitious vomiting}}- Lose HCl and KCl via stomach - Low urine Cl- helps distinguish vomiting from other causes of hypokalemia, alkalosis, and normotension (e.g., diuretic abuse, Bartter syndrome, and Gitelman syndrome which all have high urinary chloride) - Other etiologies include nasogastric suctioning and prior diuretic use1e8a4b0f-f871-4014-83bc-8daba4ba62f8
What is the current recommended screening regimen for bladder cancer? {{c1::Not recommended, even in patients with significant smoking and family histories}}60140bb7-d0e8-4e34-8263-afe8d0635b62
Dietary recommendations for patients with renal calculi include increased fluid intake, decreased {{c1::Na+}} intake, and normal Ca2+ intake5c02beb8-113a-49d3-9aa8-a4cf5a81ad04
Saline-responsive metabolic alkalosis is characterized by urine chloride {{c1::< 20}} mEq/L- Think about volume loss, activation of the RAAS, causing Na+ in and H+/K+ out. Cl- follows Na+ so Cl- is low in the urine. - Treatment involves addressing the underlying cause and giving normal saline - restoring volume stops the RAAS and decreases H+/K+going out, improving potassium and alkalosisb38022c8-2d26-4475-bb06-5c168bbdfa4c
Saline-resistant metabolic alkalosis is characterized by urine chloride {{c1::> 20}} mEq/L- Think about primary activation of the RAAS → more Na+ in, H+/K+ out, with kidneys responding by excreting more Na+/Cl- - Cushing's produces cortisol, which has mineralocorticoid activity - Associated with excess mineralocorticoid activity; treatment involves addressing the underlying causec039c0f4-79e3-4854-9b78-e8208a27e195
High anion gap metabolic acidosis in a patient with hypoperfusion is suggestive of {{c1::lactic acidosis}}e.g. shock, hypotension6e5be382-244b-49f0-8db4-27dbf9f42e20
What classes of medications are used for analgesia in patients with kidney stones? 1st line: {{c1::NSAIDs (with normal renal function)}} 2nd line: {{c1::Opioids}}NSAIDs (e.g. ketorolac) Opioids (e.g. morphine): Recommended for refractory pain or patients with contraindications to NSAIDsb6b1a806-3c5d-477c-9831-0acf3343ee8e
What treatment provides the most rapid reduction in serum K+ in patients with hyperkalemia? {{c1::IV insulin and glucose}}Results in an intracellular potassium shift (transiently); other options include inhaled β2 agonists and sodium bicarbonateReview Insulin OverviewWatch associated Bootcamp video - Sodium-Potassium Pump Watch associated Bootcamp video - Electrolytes: Potassium09eff918-4b21-4148-a09f-7496f567d040
What effect does intracellular magnesium have on renal K+ secretion? {{c1::Decreased K+ secretion}}Via inhibition of renal outer medullary potassium (ROMK) channelsWatch associated Bootcamp video - Electrolytes: Magnesiumd1200055-319e-4200-be09-76a56fed75fa
The pathologic hallmark of diabetic nephropathy is nodular glomerulosclerosis (with Kimmelstiel-Wilson nodules), but {{c1::diffuse glomerulosclerosis}} is more commonDiabetic nephropathy is characterized by proteinuria and progressive decline in GFRWatch Nephrotic Syndrome SOAP24324952-f420-4aba-b5d3-1f935d4dbc54
What is the likely diagnosis in a patient with poorly controlled diabetes that presents with overflow incontinence with a high post-void residual volume (> 50 mL)? {{c1::Diabetic autonomic neuropathy}}Symptoms include dribbling and poor urinary streamWatch Diabetes Mellitus Chronic ComplicationsWatch associated Bootcamp video - Overflow Incontinence Watch associated Bootcamp video - Diabetic Complications9ae689a0-4154-4f0a-aff7-58f1edda2b7f
The {{c1::lateral femoral cutaneous}} nerve ({{c2::L2-L3::nerve roots}}) provides - Sensory innervation to the {{c3::anterior and lateral thigh}} - Motor innervation to the {{c4::nothing}}NO motor innervation; don't be fooled! Image licensed by Physeo and used with permission. Purchase full access here.94472962-4287-472c-9874-d8073652af90
Injury to the lateral femoral cutaneous nerve (meralgia paresthetica) is commonly due to {{c1::tight clothing}}, {{c1::obesity}}, or {{c1::pregnancy}}- Can be injured during hyperflexion of the thighs in the lithotomy position for pelvic surgery or a vaginal delivery - Decreased anterior and lateral thigh sensation; wear looser pants! - Diabetes mellitus is also a risk factor Image licensed by Physeo and used with permission. Purchase full access here.7880a670-3fe4-4443-ba42-4f5a313060d5
The {{c1::obturator}} nerve ({{c2::L2-L4::nerve roots}}) provides: - Sensory innervation to the {{c3::medial thigh::very specific}} - Motor innervation to the thigh {{c4::adductor}} musclesThigh adductor muscles: - Obturator externus - Adductor longus, adductor brevis, adductor magnus - Gracilis - PectineusWatch Lumbosacral Nervesfb4069d9-a534-42c2-aea6-7a0f10ba83c3
The {{c1::common fibular}} nerve ({{c2::L4-S2::nerve roots}}) provides: - Sensory innervation to the {{c3::lateral leg}} and {{c3::dorsum of the foot}} - Motor innervation to the {{c4::short head of the biceps femoris::proximal}}, {{c4::tibialis anterior}}, and {{c5::extensor muscles of the digits}}- AKA the common peroneal nerve; this is the most commonly injured leg nerve - Common does short head of the biceps femoris - Superficial branch does lateral, deep branch does anteriorWatch Common Peroneal (Fibular) Nerveea119dd8-974b-4f4f-8a04-6780f07b898d
The {{c1::tibial}} nerve ({{c2::L4-S3::nerve roots}}) provides: - Sensory innervation to the {{c3::sole of the foot}} - Motor innervation to the {{c4::triceps surae (gastrocnemius and soleus)}}, {{c4::plantaris}}, {{c5::popliteus}}, {{c5::flexor muscles of the foot}}, and {{c6::tibialis posterior}}Tibialis posterior is the major muscle involved in foot inversion3041fcde-d911-4f7c-9c0b-e4f2d45666a9
What is the treatment of choice for mild hypovolemic hypernatremia? {{c1::D5½NS (5% dextrose in 0.45% saline)}}vs. 0.9% saline in severe (AMS, dehydrated)c6316e64-16f2-4bea-b7e7-b421a7575d18
What acid-base disorders are associated with aspirin (salicylate) toxicity? Early: {{c1::pure respiratory alkalosis}} Late (> 12 hours): {{c1::mixed respiratory alkalosis and metabolic acidosis}} with {{c1::normal}} pH- Respiratory alkalosis due to increased respiratory drive; metabolic acidosis due to increased production/decreased elimination of organic acids and anaerobic metabolism; use Winter formula to make sure there's two coexisting primary issues - Symptoms of fever, tinnitus, tachypnea Early: aspirin stimulates medullary respiratory center Medium: aspirin is an acid and dissociates and causes increased lipolysis + inhibits citric acid cycle, forming lactic acid and causing metabolic acidosis The PaCO2 will be lower than the predicted respiratory compensation by Winter formula due to concurrent respiratory alkalosisWatch Acid/Base Disorders40087cc3-6daf-42b4-adb8-a1e7371e646a
What is the likely diagnosis in a patient with a recent infection who presents with fever and rash with WBC casts and eosinophiluria on urinalysis? {{c1::Drug-induced acute interstitial nephritis}}"- The patient's infection is likely being treated with an antibiotic that precipitated the nephritis - Treatment is to discontinue the offending agent - AIN etiologies are Allergic, Infectious, or ""N""-filtrative"17aafd49-4dae-45ec-8849-d28084afb428
Correction of serum sodium (both hypo- and hyper-natremia) should not exceed a rate of {{c1::0.5}} mEq/L/hrAnd thus should not exceed 12 mEq/L/24 hours3aeda317-a01b-48d8-92c3-e4df18d714ff
What is the most common cause of abnormal hemostasis in patients with chronic renal failure? {{c1::Platelet dysfunction}}Secondary to uremiaWatch Qualitative Platelet Disordersa31e3ce5-eae8-4899-a577-dc39813ad85d
What hematologic laboratory values are consistent with abnormal hemostasis due to chronic renal failure? PT: {{c1::Normal}} PTT: {{c1::Normal}} Platelet count: {{c1::Normal}} Bleeding time: {{c1::Prolonged}}Underlying cause is platelet dysfunction Proposed mechanism - ↑ urea → arginine shunted to guanidinosuccinic acid (GSA), precursor to nitric oxide - ↑ nitric oxide → ↓ vWF secretion by endothelial cells → ↓ platelet adhesion - ↑ nitric oxide → ↓ ADP and TXA2 / ↓ activation of GplIb/Illa → ↓ platelet activation and aggregationy33aa0562-e027-45ec-a3d7-a932262bdabe
What is the likely underlying etiology of kidney disease with arteriosclerotic lesions of renal arterioles? {{c1::Hypertension}}- Hypertension first manifests as nephrosclerosis (arteriole damage) and evolves to glomerulosclerosis (loss of glomerular capillary surface area) - Compare with BM thickening, mesangial expansion, and increased ECM in diabetes7a01ecef-f7c7-4981-a837-2dedc97b7ff4
What is the likely underlying etiology of kidney disease with GBM thickening, mesangial expansion, and glomerular sclerosis? {{c1::Diabetic nephropathy}}Compare with hypertension which first manifests as nephrosclerosis (arteriole damage) and evolves to glomerulosclerosis (loss of glomerular capillary surface area)a7cefb9b-cbaa-499c-b1ff-2a16755862ac
What is the earliest renal abnormality seen in diabetic nephropathy? {{c1::Glomerular hyperfiltration}}Hyperfiltration is also the major pathophysiologic mechanism of glomerular injury (too much push pressure damaging the kidneys); GBM thickening is the first quantifiable changef29b3fbf-2b2f-4d5d-a51c-689965211792
Injury to the {{c1::inferior gluteal}} nerve presents as difficulty {{c2::climbing stairs}} and {{c2::rising from a seated position}} due to loss of {{c3::hip extension::which movement}}badaa867-7ef4-49e2-925c-473fd17157b5
The {{c1::radial}} nerve travels with the {{c2::deep brachial}} artery around the {{c3::midshaft of the humerus}}- These travel together through the triangular interval - Deep brachial (profunda brachii) branches off the brachial artery high in the arm, passes inferior to teres major, then travels through the spiral groove with the radial nerve Photo credit: OpenStax, CC BY 4.0 Photo credit: OpenStax College, CC BY 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Shoulder and Elbow: Humerus Fractures Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Radial Nervee6ea5448-b4f1-4444-b5c0-3d3e14e02478
What drug should be discontinued in an acutely ill patient with sepsis and acute kidney injury taking low-dose aspirin, atorvastatin, metformin, and sitagliptin? {{c1::Metformin}}Nephrotoxins such as NSAIDs and metformin increase the risk of lactic acidosis in those who have sepsis/acute kidney injuryWatch Metformin, Thiazolidinediones, Pramlintide, SGLT2 InhibitorsReview Metformina8eda2ec-9728-4330-951a-bbe25faf9ec5
Should patients with uncomplicated cystitis be treated before a urine culture is obtained? {{c1::Yes}}Urine culture is only necessary if first-line treatments fail (e.g. TMP-SMX, nitrofurantoin, fosfomycin) or it is a complicated cystitis / pyeloWatch Cystitis, Pyelonephritis & Prostatitis ManagementWatch associated Bootcamp video - Fosfomycin, Daptomycin, and Polymyxins133a26ac-9db9-43f9-a68e-292ff716d9fb
Should patients with complicated cystitis be treated before a urine culture is obtained? {{c1::No*}}*You do not have to wait for the results to come back to treat empirically. When results come back, you may adjust treatment. However, you should still obtain the urine sample before starting empiric therapy to allow for accurate diagnosis of the pathogen (antibiotics can cause a false negative) Factors that make cystitis complicated include diabetes, pregnancy, renal failure, hospital-acquired, indwelling catheter, recent procedure, immunosuppression, and urinary tract obstructionWatch Cystitis, Pyelonephritis & Prostatitis SOAe8d44dd8-1ae9-41d1-89d4-427e2161b436
Complicated cystitis in otherwise stable, non-pregnant patients may be managed with oral {{c1::fluoroquinolones}}More severe infections may require IV broad-spectrum antibiotics (e.g. ceftriaxone) while awaiting culture resultsWatch Fluoroquinolonesfcfe7568-11ac-42e9-bcac-8dcd9962a3ed
Should patients with pyelonephritis be treated before a urine culture is obtained? {{c1::No}}834c8ffa-dbd5-4ab1-b2e6-d71a0363e92d
What is the likely diagnosis in a young female with orthostatic hypotension, hyponatremia, and hypokalemia with high urine Na+ and K+? {{c1::Diuretic abuse}}- Increased secretion of water and electrolytes (e.g. furosemide) leads to high levels of urinary sodium/potassium - Normally, dehydrated patients with hyponatremia and hypokalemia will have reduced urine Na+/K+ because they are reabsorbed4e831014-48d5-4b6b-9f81-415a3f49a16a
How do the following laboratory values change in a patient with hypovolemia? ADH: {{c1::Increase}} Renin: {{c1::Increase}} Aldosterone: {{c1::Increase}}- Non-osmotic release of ADH due to AT2, hypovolemia and hypotension. [goal is to replete volume] - Renin/aldosterone due to decreased renal perfusion → RAAS - Results in hypovolemic hyponatremia due to retention of a relative excess of total body water - Treat hypovolemic hyponatremia with normal saline to treat hyponatremia, restore euvolemia → shut-off non-osmotic ADH releaseWatch associated Bootcamp video - Endocrine Hyponatremiayd5a5a3db-8437-4e37-9a42-4ed81f8e058d
What renal pathology is likely present in an asymptomatic patient with the CT below? {{c1::Simple renal cyst}}Photo credit: Hg6996, CC0, via Wikimedia Commons Often discovered incidentally; does not require further evaluation4e6e5e1d-9a2c-4bce-a41e-89c083f08ed5
What is the recommended management for an asymptomatic simple renal cyst? {{c1::Reassurance (no follow-up required)}}Photo credit: Hg6996, CC0, via Wikimedia Commons0f56975a-59af-4e5b-9e07-fad4ac24e98c
What is the likely diagnosis in a patient 3 days s/p renal transplant who presents with oliguria, elevated creatinine/BUN, lymphocytic infiltration on biopsy, and normal serum cyclosporine levels? {{c1::Acute transplant rejection}}5c881b4a-047c-431c-818c-c8161705124d
What is the typical volume state (hypo, eu-, or hyper-volemic) of patients with hypercalcemia? {{c1::Hypovolemic}}Due to polyuria (from Ca2+-induced nephrogenic DI) and decreased oral intake; avoid loop diuretics as they can worsen volume depletione1dbe414-a4c3-42ae-95a2-585e54ea9893
What is the recommended treatment for a patient with metabolic alkalosis and hypokalemia secondary to recurrent vomiting? {{c1::IV saline and potassium::2}}- Volume resuscitation with normal saline removes stimulus for the RAAS (↓ aldosterone → ↓ H+/K+ out) - Metabolic alkalosis occurs due to loss of gastric acid or excessive bicarbonate intake - High blood pH (>7.4), elevated serum bicarbonate (>25), and a base excess - Correcting metabolic alkalosis involves potassium chloride intakeed6c4808-54bc-4f7a-a034-667c3f58cf29
What is the initial therapy for patients with hypertension and renal artery stenosis? {{c1::ACE inhibitors or ARBs::2}}- Think about stopping the activation of RAAS - Side effect: ↓ AT2 levels, which dilates efferent arterioles and decreases GFR - An acceptable rise in serum creatinine is < 30%: blockage of AT2 → ↓ efferent arteriole constriction → ↓ GFR + ↑ creatinine - Renal artery stenting or surgical revascularization is reserved for patients who fail to achieve adequate BP control with medical therapye21ac4e7-96d2-43f3-a91d-62ea72f34595
Which diuretics are commonly co-administered to cirrhotic patients with volume overload and ascites? {{c1::Furosemide and spironolactone::2}}May result in hypokalemia, metabolic alkalosis, and prerenal AKIWatch associated Bootcamp video - Cirrhosis65c2bda3-8ade-4adb-9ce9-8644014dc7c9
Hypokalemia may be caused by increased intracellular entry of K+, which can occur with insulin, β-adrenergic {{c1::agonists}}, and hematopoiesisMay also occur with GI losses and renal K+ wasting (e.g. hyperaldosteronism, diuretics)*3.5-5 mEq/L Watch Potassium DisordersReview Insulin OverviewWatch associated Bootcamp video - Electrolytes: Potassium6f1ae00a-8609-4a7e-bb80-fd2e37091e70
What is the likely diagnosis in a patient with intermittent flank pain, low-volume voids, and occasional episodes of high-volume voids? {{c1::Obstructive uropathy}}- Flank pain due to renal calculi - High-volume voids occur due to the large volume of retained urine overcoming the obstruction (post-obstructive diuresis) - Can lead to renal failure in patients with only one functioning kidney - Can lead to hypokalemia with excessive diuresis → weakness840324b0-bf68-472e-9bbc-862a3f38f582
What class of autonomic drugs may be useful for treating and facilitating passage of ureteric kidney stones (in addition to IV hydration and analgesics)? {{c1::α1-blockers (e.g. tamsulosin)}}- α receptors are found on the distal ureter, base of the detrusor, bladder neck, and urethra -α1-blockers act on the distal ureter to relax muscle spasm secondary to stone impaction → easier to pass stone - cholinergic receptors are found on the dome of the bladder, contraction of which facilitates voiding; these receptors are not known to be present on the ureterWatch associated Bootcamp video - Tamsulosin, Minoxidil, Tocolytics Watch associated Bootcamp video - Micturition Overview2b1a1377-d6cd-4415-b638-971d48a01ec5
What is the likely diagnosis in a chronic atrial fibrillation patient taking furosemide, metoprolol, digoxin, and warfarin who presents with diarrhea, nausea, decreased appetite, and arrhythmias? {{c1::Digoxin toxicity}}May also present with vision changes (specifically xanthopsia, AKA yellow vision)Watch Digoxin8b064c91-8519-4f99-9859-b0fbfb86d993
The CHA2DS2-VASc score is useful for assessing thromboembolic risk and anticoagulation needs in patients with {{c1::non-valvular atrial fibrillation::diagnosis}} C: {{c1::Congestive heart failure}} H: {{c1::Hypertension}} A2: {{c1::Age ≥ 75* (2 points)}} D: {{c1::Diabetes mellitus}} S2: {{c1::Stroke/TIA/thromboembolism* (2 points)}} V: {{c1::Vascular disease (prior MI, PAD, or aortic plaque)}} A: {{c1::Age 65-74}} Sc: {{c1::Sex category (female)}}Valvular atrial fibrillation requires warfarin regardless of the score Risk of stroke: • 0 points (male) or 0-1 point (female): low risk; no antithrombotic therapy • 1 point (male) or 2 points (female): intermediate risk; none or oral anticoagulant • ≥ 2 points (male) or ≥ 3 points (female): high risk; oral anticoagulant CHA2DS2-VASc scoring toolyc2e2a9bc-ed32-4e0f-a7b9-9f36918c5afb
What is the initial treatment for chronic venous insufficiency? {{c1::Conservative measures (e.g. leg elevation, exercise, compression therapy)}}current guidelines require diagnosis of CVI confirmed by identification of venous reflux in the deep venous system on duplex ultrasound prior to any attempts at treatment26f3d314-ac2d-4a53-89ca-974c702b5abb
What is the likely diagnosis in a post-MI patient that presents a few weeks later with chest pain that improves while leaning forward and diffuse ST elevation on ECG? {{c1::Dressler syndrome (a type of pericarditis)}}Believed to be due to immunologic phenomena; malaise, fever, and elevated ESR may also be presentWatch Acute Myocardial Infarction & Post MI TimelineWatch MI Complications SOAP Watch Acute Pericarditis SOAPWatch associated Bootcamp video - Post-Myocardial Infarction Timeline004090bc-c938-4869-8615-2b99df6d64fc
Cold-water immersion relieves symptoms of paroxysmal supraventricular tachycardia by decreasing {{c1::AV node conductivity}}PSVT is most commonly due to an AV node re-entry circuit; vagal maneuvers increase parasympathetic tone, slowing AV node conductivity and terminating the AV nodal re-entry tachycardiaWatch Narrow-Complex Tachycardia 1: Intro & pSVT SOAPWatch associated Bootcamp video - Ventricular Arrhythmias: Supraventricular Tachycardia16a07bc8-5fcc-42f0-8d38-0372ff27de73
Cor pulmonale is impaired function of the right ventricle due to {{c1::pulmonary hypertension}}- i.e., mean pulmonary artery pressure (mPAP) > 20 mmHg - Usually occurs due to chronic lung disease (COPD)Watch Chronic Heart Failure SOA Part 31d1db9c9-8954-4e1d-92b6-a316825e0ed6
What is the likely diagnosis in a young patient with recent uveitis, complete AV heart block, and bilateral midfield lung opacities on CXR? {{c1::Cardiac sarcoidosis}}Due to noncaseating granulomas infiltrating the myocardium; can result in arrhythmia, cardiomyopathy (restrictive early, dilated late), heart failure, and sudden cardiac deathWatch Sarcoidosis31051f71-f45f-4d7b-8818-2902c5139721
What is the likely diagnosis in a patient with peripheral edema, ascites, JVD without inspiratory decline, and pericardial calcifications on CXR? {{c1::Constrictive pericarditis}}- Increased JVP without inspiratory decline is known as Kussmaul sign - May also have prominent x & y descents on jugular venous pulse tracings and a pericardial knock (diastolic sound after S2) on PE* chest radiation causes fibrosis Watch Dilated & Restrictive Cardiomyopathy Watch Pericarditis & Constrictive Pericarditisd4bcebb4-8356-48e8-9b78-4fda67b04543
The combination of atrial tachycardia with AV block is highly indicative of {{c1::digitalis}} toxicityDigitalis causes both an increased ectopy in the atria or ventricles (→ atrial tachycardia) and an increased vagal tone (→ AV block)3b52d174-71fd-4938-b345-5597c6885d70
What is the likely diagnosis in a young patient with a smoking history that presents with episodic chest pain that resolves spontaneously and is associated with transient ST-segment elevation during the episodes? {{c1::Vasospastic angina}}Formerly known as Prinzmetal angina; typically occurs in young (age < 50) smokers with minimal risk factors for CAD6b8b969e-3d2e-4ff5-b2b6-0b3c574836ef
What two drugs/drug classes are used for dual anti-platelet therapy? {{c1::Aspirin and P2Y12 receptor blockers (e.g. clopidogrel)}}Reduces risk of cardiovascular death, stent re-thrombosis, and recurrent MIc7c62fa7-a2b8-4283-9be9-e32852124a9e
What is the likely diagnosis in a hypotensive patient requiring IV fluids/pressors to maintain BP that develops cool extremities and the skin findings below? {{c1::Pressor-induced vasospasm (e.g. norepinephrine)}}Photo credit: Collections - GetArchive, public domain α1 agonist properties → vasoconstriction; diagnosis is suggested by symmetric duskiness and coolness of all finger tipsfc10c86f-2169-4375-a65e-4089fa4ec078
What is the likely diagnosis in a young patient from a developing country that presents with dyspnea, hemoptysis, and occasional palpitations? {{c1::Mitral stenosis (from rheumatic heart disease)}}- Left atrial enlargement due to mitral stenosis predisposes to atrial fibrillation and thromboembolic complications (e.g. stroke) - Hemoptysis due to erosion of the bronchial arteriesWatch Mitral Stenosis SOAP Watch Hemoptysis DDxWatch associated Bootcamp video - Mitral Stenosis907235ca-4ff4-46b3-8438-725369629084
What is the likely cause of syncope in a young patient with occasional chest pain, dyspnea, and a crescendo-decrescendo systolic murmur along the left sternal border without carotid radiation? {{c1::Hypertrophic obstructive cardiomyopathy (HOCM)}}Syncope in HOCM is multifactorial and can be due to: - Outflow obstruction (interventricular septal hypertrophy) - Arrhythmia - Ischemia - Ventricular baroreceptor response that inappropriately causes vasodilation - Compare with aortic stenosis heard at right second intercostal radiating to carotidsWatch Hypertrophic CardiomyopathyWatch Hypertrophic Cardiomyopathy SOAP510ce373-f18a-4a41-83cf-073a9271e9c4
What is the likely diagnosis in a patient status-post coronary angiogram that presents with abdominal pain, AKI, eosinophilia, and purple mottling of both feet? {{c1::Cholesterol embolism}}- Invasive vascular procedures can mechanically dislodge atherosclerotic plaques and send microemboli everywhere; the kidney is at a high risk for injury - Common complications include renal failure, skin manifestations, cerebral/intestinal ischemia, and Hollenhorst plaques (ocular involvement); treatment is supportive and involves statin therapy to prevent recurrent cholesterol embolism - Can also present as blue toe and livedo reticularis with normal peripheral pulses513ec9e6-9b5d-4716-aa5f-c6382c0372be
Dobutamine improves symptoms of decompensated heart failure by increasing {{c1::myocardial contractility}}Leads to improved ejection fraction and reduced LV end-systolic volume, thus reducing symptoms of HF (e.g. pulmonary edema)Watch Acute Decompensated Heart Failure SOAPWatch associated Bootcamp video - Direct Sympathomimeticsf9954765-2d0d-4bdc-a947-69add9582caf
What is the likely diagnosis in a patient with a recent URI that presents with syncope, dyspnea, and the ECG findings below? {{c1::Pericardial effusion}}Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons Electrical alternans with sinus tachycardia is highly specific for large pericardial effusion, which may result in cardiac tamponade Image(s) provided by www.radiologyassistant.nl. Used with permission. Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons0963b708-4d94-4e14-aaca-7a19afa3b7c9
What is the recommended management for a patient with a smoking/drinking history and atrial premature beats discovered on routine ECG (asymptomatic)? {{c1::Avoid alcohol and tobacco}}This is a benign arrhythmia that doesn't require treatment, however smoking/alcohol/caffeine/stress may precipitate PACsWatch Narrow-Complex Tachycardia 1: Intro & pSVT SOAP38795d99-d6d2-4518-95b8-a5c7a3fe7546
What is the likely diagnosis in an adult patient with hypertension and palpable bilateral, non-tender, upper abdominal masses on physical exam? {{c1::Autosomal dominant PKD (cysts enlarge over time)}}Diagnosis is confirmed with imaging (e.g. ultrasound, CT, MRI) showing lots of cysts! Photo credit: Agnello et al., CC BY 4.0, via Insights into Imaging* Sketchy error: should say ADPKD Watch Congenital & Cystic Kidney DiseaseReview ADPKDWatch associated Bootcamp video - Autosomal Dominant Polycystic Kidney Diseasea0fae0c7-a784-425b-b500-602d0f49fcdc
What is the likely diagnosis in a patient with upper extremity hypertension, brachial-femoral pulse delay, and a continuous interscapular murmur? {{c1::Coarctation of the aorta}}Continuous murmur due to collateral vessels2e3af964-7890-4516-ad17-d14ad8ee6f2f
What is the recommended management for costochondritis? {{c1::Conservative}}i.e. reassurance and symptomatic pain managementcf3067f9-8544-4668-a0af-739afdb9b198
What is the likely diagnosis in an ischemic cardiomyopathy patient on antiarrhythmics that presents with progressive dyspnea, non-productive cough, and bilateral infiltrates on X-ray without JVD or peripheral edema? {{c1::Amiodarone-induced interstitial pneumonitis}}Usually occurs within months of starting therapy; restrictive lung disease with reduced DLCOWatch Chronic Dyspnea DDx Part 2Review Amiodaronef2b2acda-2aa7-4bdb-afe5-e98da402eca6
How do the following parameters change in LV systolic dysfunction (CHF)? Cardiac output: {{c1::Decreased}} Systemic vascular resistance: {{c1::Increased}} Left ventricular EDV: {{c1::Increased}}y55914756-1de5-4e67-a8fc-ed6557e3b77d
What is the likely diagnosis in a patient status-post lung biopsy that presents with severe shortness of breath and chest pain with a decreased cardiac output and increased PCWP? {{c1::Cardiogenic shock (secondary to MI)}}- Elevated PCWP is indicative of cardiac etiology (helps rule out pulmonary etiologies, such as pneumothorax and pulmonary embolus since less blood is flowing to the LA) - Backup of blood into the lungs causes pulmonary edema - Perioperative MI is common in patients undergoing noncardiac surgery; intraoperative hemorrhage requiring blood transfusion increases the riskWatch associated Bootcamp video - Shock: Cardiogenic Shockfae65ea3-f804-4b96-9e0a-835b11f3a757
What is the likely cause of the imaging findings below in an IV drug user with a history of fever, cough, and tricuspid regurgitation? {{c1::Septic pulmonary emboli}}Photo credit: Hindawi, CC BY 4.0Watch associated Bootcamp video - Tricuspid Regurgitation67b8c3f1-d5a4-494f-aea4-c3e7b7ef0eeb
What abnormal heart sound is associated with a stiff left ventricle (e.g. LV hypertrophy due to prolonged hypertension)? {{c1::S4}}"Often referred to as the ""ten-nes-see"" sound, which corresponds to S4-S1-S2"Watch Aortic Stenosis & Regurgitation Watch HypertensionWatch Hypertrophic Cardiomyopathy SOAPWatch associated Bootcamp video - Cardiac Cycle : Heart Sounds Watch associated Bootcamp video - Aortic Stenosis Watch associated Bootcamp video - Heart Failure : Diastolic Heart Failured6e17db6-3592-4ea6-9611-f5f663df3112
Tumor lysis syndrome results from the fulminant release of tumor cell contents into the plasma, resulting in the following problems - {{c1::Hyper}}kalemia - {{c1::Hyper}}phosphatemia - {{c1::Hypo}}calcemia - {{c1::Hyper}}uricemia due to increased {{c1::nucleic}} acid breakdown"Mnemonic: ""PUKE Calcium"" Phosphorus, Uric acid, potassium (K+) Elevated, Calcium decreased - Hypocalcemia is due to increased complexation/sequestration by phosphate - Hyperuricemia can lead to acute tubular necrosis which causes acute kidney injury"Watch Gout & Pseudogout Watch Gout DrugsWatch Gout & PseudogoutWatch associated Bootcamp video - Tumor Lysis Syndromey13c5a87f-c0ad-4e2c-bdc5-9c2102be77fa
What level does a 2nd degree, Mobitz type I heart block typically occur? {{c1::AV node}}Watch Bradycardia ECG InterpretationWatch associated Bootcamp video - Conduction Blocks : Atrioventricular Blocks6abf75c8-25cc-4efa-82e2-d6e41325fcf8
2nd-degree, Mobitz type I heart block has a(n) {{c1::low}} risk to develop into complete heart blockThus treatment typically is observationWatch associated Bootcamp video - Conduction Blocks : Atrioventricular Blockse3b77b0a-ac3c-4d3f-beb7-ff40a17c2b6b
What level does a 2nd degree, Mobitz type II heart block typically occur? {{c1::Below the AV node (e.g. bundle of His)}}Watch Bradycardia ECG InterpretationWatch associated Bootcamp video - Conduction Blocks : Atrioventricular Blocksa930d976-4c13-4f2d-b7c0-e5d0a1a60d75
2nd-degree, Mobitz type II heart block has a(n) {{c1::high}} risk to develop into complete heart blockThus treatment typically consists of a pacemakerWatch associated Bootcamp video - Conduction Blocks : Atrioventricular Blocks995daa85-a117-4a93-ae2c-c4c76d215375
What is the most effective non-pharmacologic measure to decrease blood pressure in an overweight, diabetes patient with significant tobacco/alcohol use? {{c1::Weight loss}}All the extra resistance is reduced; other effective measures include the DASH diet, low Na+ intake, moderation of alcohol intake, regular exercise, and smoking cessation3d730727-3024-4ac6-a9a4-4f031e4c09a7
What is the recommended management for a hemodynamically stable Wolff-Parkinson-White syndrome patient with atrial fibrillation? {{c1::Procainamide}}May also use other anti-arrhythmic drugs that do not cause AV block (e.g. IV ibutilide) because AV-node blockers promote more conduction through the accessory pathway → ↑ rapid ventricular responseWatch Class I A-C Antiarrhythmics Watch Class III AntiarrhythmicsWatch Wide-Complex Tachycardia SOAPWatch Class 1A AntiarrhythmicsWatch associated Bootcamp video - Ventricular Arrhythmias : Wolff-Parkinson-White Syndrome3f695387-82c9-4fd2-ae5b-18bab034dada
What is the recommended management for a hemodynamically unstable Wolff-Parkinson-White syndrome patient with atrial fibrillation? {{c1::Electrical cardioversion}}- Unstable = cardiovert! - Stable = procainamide Photo credit: Jmarchn, CC BY-SA 3.0, via Wikimedia CommonsWatch Narrow-Complex Tachycardia 1: Intro & pSVT SOAP Watch Wide-Complex Tachycardia SOAP5ae6d009-4074-4c7c-85e5-349570c10713
What is the likely diagnosis in a male with a history of SLE that presents with epigastric burning provoked by exertion and relieved by rest? {{c1::Atypical angina}}- Epigastric pain that is prompted by exertion and relieved by rest is suggestive of atypical angina - It is not typical angina because the pain isn't retrosternal - Systemic lupus erythematosus is a known risk factor for accelerated atherosclerosis and premature coronary heart diseasee75e0f5d-9ad2-4bd8-964f-80349169ebea
What is the primary mitral valve abnormality in patients with hypertrophic obstructive cardiomyopathy? {{c1::Systolic anterior motion of the mitral valve}}- Accelerated blood flow out of the ventricle sucks the mitral valve leaflet toward the interventricular septum, resulting in left ventricular outflow tract obstruction (harsh crescendo-decrescendo systolic murmur) - Imagine squeezing the outflow tract with the septum and the valveWatch Hypertrophic Cardiomyopathy SOAPaae02f5f-5145-4a4a-beff-6b840f9f78a9
What physiologic effect results in increased intensity of a murmur due to hypertrophic obstructive cardiomyopathy? {{c1::Decreased preload}}e.g. valsalva maneuver, standing, nitroglycerin administrationWatch Hypertrophic CardiomyopathyWatch Hypertrophic Cardiomyopathy SOAPd793e3ba-1c77-4dda-b33a-a09f7b888443
Ascending aortic aneurysms are most often due to {{c1::cystic medial necrosis}} (due to HTN and aging) and/or {{c2::connective tissue}} disorders- While descending aortic aneurysms are usually due to underlying atherosclerosis - Cystic medial degeneration occurs in normal aging, but is accelerated in Marfan syndromeWatch Aortic AneurysmWatch associated Bootcamp video14f9e3eb-390c-4d5a-93b5-9f6725560086
Descending aortic aneurysms are usually due to underlying {{c1::atherosclerosis}}- While ascending aortic aneurysms are most often due to cystic medial necrosis (due to HTN and aging) and/or connective tissue disorders - Tunica media has small, cleft-like spaces that become filled with amorphous extracellular matrixWatch Aortic AneurysmWatch associated Bootcamp videod19b1766-4ff1-4d3f-80a2-375faf5aa905
What is the preferred abortive treatment for episodes of vasospastic angina? {{c1::Sublingual nitroglycerin::include ROA}}Watch Stable Angina, Vasospastic Angina, & Acute Coronary Syndromes (UA, NSTEMI, STEMI)Watch Nitrates9f16d29f-c874-4a53-a866-88fc44d44a99
What is the likely diagnosis in a chronic renal failure patient that presents with pleuritic chest pain that improves when leaning forward? {{c1::Uremic pericarditis::specific}}- The classic ECG finding of diffuse ST elevation is typically absent due to lack of myocardial inflammation; typically urea > 60 mg/dL - > 50% of cases are accompanied by pericardial effusion, so cardiac tamponade should be ruled out prior to dialysis initiationWatch Acute Pericarditis SOAPa3cf7737-3e02-419c-8108-d3427c0e11c4
Patients with CHF often have preferential vasoconstriction of {{c1::efferent}} renal arteriolesDue to activation of the RAAS and production of angiotensin II; causes increased intraglomerular pressure to maintain adequate GFR0a534097-f373-497d-926b-7069c70a7f56
What artery is likely obstructed given the ECG below? {{c1::Right coronary artery}}Photo credit: Raxwal et al., CC BY 4.0, via CureusWatch associated Bootcamp video - Conduction Blocks : Cardiac Conduction Blood Supply42738d28-9cdc-4200-869d-c2b75ead3a45
What is the likely diagnosis in a patient with dizziness, weakness, and the ECG findings below? {{c1::Complete heart block}}Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons Should be managed with a temporary pacemaker; a permanent pacemaker is indicated if no reversible causes of heart block are found on further evaluation2fb7daeb-4c7f-49d0-b2a8-151cbe431ec8
What is the likely underlying cause of an early decrescendo diastolic murmur in a young patient in the U.S. with a family history of heart disease? {{c1::Congenital bicuspid aortic valve}}Aortic regurgitation; typically best heard while the patient is sitting up, leaning forward, and holding a breath in full expiration9b86fa0e-240c-434a-9284-6886c5f738d3
What physical exam maneuver is useful for distinguishing between cardiac- and liver disease-related causes of lower extremity edema? {{c1::Hepatojugular reflux}}- Positive reflux is suggestive of cardiac causes (e.g. heart failure) - The RV cannot accommodate an increased preload after pushing the belly - It is also seen in tricuspid regurgitation, constrictive pericarditis, cardiac tamponade, and inferior vena cava obstruction Photo Credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia CommonsWatch Congestive Heart Failure Clinical ManifestationsWatch Dilated & Restrictive Cardiomyopathy SOAPs8dd22e26-d880-4491-82ef-0164c51e18d4
What is the likely diagnosis in a patient with a recent URI that presents with JVD, hypotension, non-palpable PMI, and clear lungs (CXR below)? {{c1::Pericardial effusion}}Photo credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia Commons Typically appear on CXR as an enlarged and globular cardiac silhouette with clear lung fields (~ tamponade when you can't fill) Image(s) provided by www.radiologyassistant.nl. Used with permission. Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commonsdf8261e1-cfed-4604-9010-e469c32c2dfb
What is the likely diagnosis in a patient on post-MI day 5 that presents with acute onset chest pain and profound shock with signs of cardiac tamponade? {{c1::Ventricular free wall rupture}}Free wall rupture at Five days Timeline Complication ExtraDays to monthsArrhythmiaCommon cause of death post-MI1-3 daysFibrinous pericarditisFriction rub< 1 weekPapillary muscle rupturePosteromedial, mitral regurgitationInterventricular wall ruptureVSD, ↑O2 sat in the RV< 2 weeksVentricular pseudoaneurysmContained within the pericardiumVentricular free wall ruptureCardiac tamponade2 weeks - monthsTrue ventricular aneurysmContains all 3 layersDressler syndromeAutoimmune mediated fibrinous pericarditisWatch MI Complications SOAP80548d15-11e8-4cc6-ae79-b07c57568b8f
What is the recommended lipid-lowering therapy for patients < 75 that have clinically significant atherosclerotic disease? {{c1::High-intensity statin}}Watch Statins3ceb5dd9-6c67-44b1-b097-36b214689d79
What is the recommended therapy for patients > 75 that have clinically significant atherosclerotic disease? {{c1::Moderate-intensity statin}}Watch Statins95e9800c-614c-478e-a0c6-5965d59ae44a
Patients aged 40-75 with 1 or more CVD risk factors and an estimated 10-year ASCVD risk ≥ {{c1::10}}% should be started on a moderate-intensity statin"- USPSTF Grade B: ≥10%- USPSTF Grade C: 7.5-10% (USPSTF recommends that clinicians selectively offer a statin for the primary prevention of CVD due to smaller likelihood of benefit in this group)- Card previously said 7.5% - Card previously said moderate to high intensity, but per USPSTF: ""There are limited data directly comparing the effects of different statin intensities on health outcomes. A majority of the trials reviewed by the USPSTF used moderate-intensity statin therapy. Based on available evidence, use of moderate-intensity statin therapy seems reasonable for the primary prevention of CVD in most persons."" USPSTF"Watch Statinscbb91ca2-c4e7-4eb7-a9c4-c8c3fa2d9611
What class of anti-arrhythmic is characterized by prolonged QRS durations at faster heart rates? {{c1::Class I (especially class IC)}}Enhanced effect at faster heart rates is known as use dependence - this is because the drug has less time to dissociate from Na+ channels (tightly hold the Na+ can) → more blocked channels → slower depolarization → widened QRS complex Action potential Class Ia (red graph): Photo credit: Ksheka, CC BY-SA 3.0, via Wikimedia Commons3de21018-c432-418c-a45e-e8fea27b5e77
What class of anti-arrhythmic is characterized by prolonged PR intervals at faster heart rates? {{c1::Class IV (CCBs)}}- Enhanced effect at faster heart rates is known as use dependence (similar to class I) - Class IV anti-arrhythmics block non-DHP L-type calcium channels at the SA/AV Node - Prolong phase 0 (dependent on calcium): ↓ HR, ↑ PR interval due to ↓ AV node conductionWatch Class 4 Antiarrhythmicsbe4f7362-9475-49f8-a919-8d98adb04c57
What is the likely diagnosis in a patient on post-MI day 3 that presents with pleuritic chest pain that improves when leaning forward with clear lungs on auscultation? {{c1::Peri-infarction pericarditis}}- ECG typically reveals diffuse ST-segment elevation - AKA postinfarction fibrinous pericarditis or early infarct-associated pericarditis Photo credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia CommonsWatch MI Complications SOAP Watch Acute Pericarditis SOAP574542ac-6734-4f9f-a324-859b36e43da8
What is/are the treatment(s) of choice for peri-infarction pericarditis? {{c1::Supportive (acetaminophen ± high-dose aspirin)}}- NSAIDs (except aspirin) and corticosteroids are typically avoided due to impairment of collagen deposition and increased risk of post-MI complications like ventricular wall rupture (vs. Dressler syndrome) - Diagnostic workup includes echo to assess for effusions and other post-MI complications - Prevented with early coronary reperfusion therapyWatch MI Complications SOAP Watch Acute Pericarditis SOAPa058074a-551b-4799-8fd6-ead120701ce6
What is the preferred initial management for symptomatic patients with hypertrophic obstructive cardiomyopathy? {{c1::β-blockers::First-line}} {{c1::Non-dihydropyridine Ca2+ channel blockers::Second-line}}- However, dihydropyridine CCBs are contraindicated - Verapamil or disopyramide can be used as additional therapy in patients with persistent symptoms; these ↓ HR and therefore prolong diastolic filling thus decreasing outflow obstructionSketchy Pharmacology: Autonomics (β-blockers) Watch Beta blockers Watch Hypertrophic CardiomyopathyWatch Hypertrophic Cardiomyopathy SOAPWatch Class 2 Antiarrhythmics Watch Class 4 Antiarrhythmicse95e8f11-e579-4d53-959e-02d6df1940ad
What is the recommended treatment for a hemodynamically stable patient with a history of panic attacks that presents with chest tightness, lightheadedness, and the ECG below? {{c1::Adenosine}}Photo credit: Kalumet, selbst erstellt, CC BY-SA 3.0, via Wikimedia Commons Despite the history of panic attacks, this patient's ECG is consistent with supraventricular tachycardia due to irregular P wave morphology (vs. sinus tachycardia in panic attacks, which has regular P wave morphology)Watch Class V AntiarrhythmicsWatch Narrow-Complex Tachycardia 1: Intro & pSVT SOAPWatch AdenosineWatch associated Bootcamp video - Ventricular Arrhythmias: Supraventricular Tachycardia5480c743-60fb-45cc-a660-c36702d699da
What is the best initial management for a hemodynamically stable patient with palpitations and the ECG findings below? {{c1::IV amiodarone::include ROA}}- This patient has wide-complex tachycardia, likely a sustained monomorphic ventricular tachycardia (SMVT) - Alternative agents include procainamide or sotalolWatch Wide-Complex Tachycardia SOAPReview AmiodaroneWatch associated Bootcamp video - Ventricular Arrhythmias : Monomorphic Ventricular Tachycardia, Ventricular Fibrillationd4819ef0-ca69-48e9-8334-3779aa36726a
What is the likely diagnosis in a patient with a history of recent MI or peripheral arterial disease that presents with pain, pallor, paresthesias, pulselessness, poikilothermia, and paralysis in one limb? {{c1::Acute limb ischemia}}- Most commonly due to arterial thrombosis or embolism - Echocardiogram to look for embolic etiology (e.g., atrial fibrillation with thrombus, valvular disease, or heart failure) - History and physical exam to look for thrombotic etiology (e.g., PAD, stent thrombosis, use of pressors) - Treat with thrombolysis/embolectomy - Pain is often the initial symptom → pulselessness is a critical feature → paralysis indicates a poor prognosisWatch Peripheral Artery DiseaseWatch associated Bootcamp video - Peripheral Artery Diseasef3ec5c82-518e-4948-82c7-212fc1abe8d9
What is the likely diagnosis in a patient 2 months post-MI that presents with CHF and persistent ST elevations/deep Q waves on ECG? {{c1::Ventricular aneurysm}}Aneurysm leads to LV enlargement → complications (HF, angina, arrhythmias, embolization due to mural thrombus, MR) Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia CommonsPhoto credit: Patrick J. Lynch, medical illustrator, CC BY 2.5, via Wikimedia CommonsWatch MI Complications SOAPb0855458-434a-4e73-b832-906e44f2f48c
What is the likely diagnosis in a young, active patient that suddenly collapses while exercising and presents with a temperature of 106 °F, confusion, and respiratory distress? {{c1::Exertional heat stroke}}- Defined as a temperature > 104 °F (>40 °C) and CNS dysfunction (AMS); dehydration, hypotension, and tachycardia are common along with systemic effects (seizures, ARDS, DIC, hepatic/renal failure) - In elderly patients the definition & presentation are similar, but it generally occurs in the absence of exercise (e.g., hot sauna)d5e4b5b2-0e09-4f2e-9fe7-a0274decffc1
What is the recommended cooling technique for patients with exertional heat strokes? {{c1::Ice water immersion}}Imagine exerting athlete being hit by ice; this rapidly cools the person offee95920e-c685-4cb6-8ac1-ac6c7d2407a1
What is the recommended cooling technique for patients with non-exertional heat strokes? {{c1::Evaporative cooling (e.g. spraying lukewarm water while fans blow air on skin)}}- Presents similarly to exertional heat stroke but in the absence of strenuous activity - Often elderly patients - Tx of exertional heat stroke: cold water immersiondfea9484-5c8b-4985-95f5-68d2a5e4460f
What is the next step in management for an asymptomatic adult with an early diastolic murmur at the left sternal border that is best heard with expiration? {{c1::Transthoracic echocardiogram}}Diastolic and continuous murmurs are usually due to an underlying pathologic cause and their presence should prompt further evaluation (vs. a mid-systolic murmur in a young, asymptomatic adult, which is likely benign and requires no further evaluation)38fc2f35-80c7-4929-8ba6-21f29d304f4a
Features of severe aortic stenosis include a(n) {{c1::late}}-peaking systolic murmur and a(n) {{c2::soft}} second heart sound (S2)- Super stenotic → need a higher LV pressure before the valve opens and the murmur is heard - Also may have pulsus parvus et tardus; early-peaking systolic murmur is suggestive of mild to moderate AS - Imagine the stiff aortic valve not closing very well and making a soft sound (MTAP) - Pulsus parvus et tardus, soft S2, and mid-late peaking systolic murmurWatch associated Bootcamp video - Classic Disorders Watch associated Bootcamp video - Aortic Stenosis79cf4062-2bb5-42f6-b478-eab534af618a
What is the likely cause of LAD artery occlusion in a patient with recent stent placement in the LAD artery? {{c1::Stent thrombosis}}- Likely due to medication non-compliance - Premature discontinuation of antiplatelet therapy is the strongest predictor of stent thrombosis after intracoronary stent implantation08b2610a-03bd-4f7e-bf86-c85dff5e0e2b
Which drug class is first-line for treatment of chronic stable angina? {{c1::β-blockers}}- Decrease myocardial O2 demand by reducing contractility and heart rate - Second-line alternatives include nondihydropyridine CCBs, long-acting nitrates, and ranolazine (if β-blockers are contraindicated or do not provide adequate symptom control)Watch ACS Intro & Stable Angina SOAPWatch Nitrates Watch Ranolazine2a5fd6a1-8e8a-4fe3-8d8c-470924d95a46
Percutaneous coronary intervention (PCI) is recommended for patients with acute STEMI within {{c1::12}} hours of symptom onset and within {{c1::90}} minutes from first medical contact to device time at a PCI-capable facilityOr 120 minutes from first medical contact to device time at a non-PCI-capable facility (to allow time for transport) Photo credit: https://www.scientificanimations.com/wiki-images, CC BY-SA 4.0, via Wikimedia CommonsWatch STEMI Managementc0e31a38-4b13-4179-85da-2166941ee64a
What is the recommended reperfusion therapy for patients with STEMI that present within 12 hours of symptom onset but cannot undergo PCI? {{c1::Fibrinolysis}}fibrinolysis is associated with higher rates of recurrent MI, intracranial hemorrhage, and mortality compared to PCIWatch STEMI Management8e8b0d75-085d-4239-bf6b-347f2ae0a625
What is the recommended diagnostic test for patients with chest pain that have high risk for CAD? {{c1::Coronary angiography}}Start these patients on appropriate medical therapy Photo credit: Maria A Pantaleo, Anna Mandrioli, Maristella Saponara, Margherita Nannini, Giovanna Erente, Cristian Lolli and Guido Biasco : Development of coronary artery stenosis in a patient with metastatic renal cell carcinoma treated with sorafenib. BMC Cancer, 2012, 12:231 doi:10.1186/1471-2407-12-231 Published: 11 June 2012, CC BY 2.0, via Wikimedia CommonsWatch ACS Intro & Stable Angina SOAPd9e6ba03-0bfa-4ccf-97c7-b87203272906
What is the likely cause of bradycardia, AV block, and diffuse wheezing in a CAD patient that has attempted suicide? {{c1::β-blocker overdose}}Other symptoms include hypotension, hypoglycemia, delirium, seizures, and cardiogenic shockWatch Bradycardia DDx and SOAP6a4b5e2b-8722-4dec-9c8e-dc5b20c4267c
What abnormal RBC may be seen in patients with scleroderma renal crisis (SRC)? {{c1::Schistocytes}}- Due to microangiopathic hemolytic anemia (MAHA); also may show thrombocytopenia - Scleroderma = Schistocyte Photo credit: Central Hematology Laboratory Hemostasis Research Laboratory Bern University Hospital & University of Bern, CC BY-SA 4.0, via Wikimedia CommonsWatch Introduction to Acute Kidney Injury (AKI))7351765d-13f3-42dd-8218-ac6cf9468a8a
Atypical symptoms associated with MI are more common in {{c1::women}}, {{c1::the elderly}}, and {{c1::people with diabetes}}e.g. abdominal pain, nausea/vomitingWatch ACS Intro & Stable Angina SOAP860a9c69-0e42-4e00-9a3e-a5ec055f5af0
In addition to history and physical, patients initially diagnosed with hypertension should have the following basic testing, which can be remembered by the mnemonic HELP CUT blood pressure: {{c1::HbA1c/Fasting glucose::H}} {{c1::ECG (baseline)