Histoplasma capsulatum -- despite the name, a 2-5um yeast with no true capsule. Regional to Mississippi/Ohio river valleys. Causes tuberculous illness with calcifying lung lesions.
CN IV lesion: Can be caused by trauma to frontal bone; diplopia worse on downgaze; can be ameliorated by tucking chin in ("pathetic nerve palsy").
Punishment is using a stick. Positive reinforcement is using a carrot. Extinction is taking away a carrot. Negative reinforcement is taking away a stick.
Metabolic acidosis triggers hyperkalemia (potassium shift from inside cell to outside). This causes depolarized cells, possibly culminating in ventricular fibrillation.
Listeriosis causes spontaneous abortion. Avoid unpasteurized soft cheese (i.e. Brie) and deli meats during pregnancy.
In primary hypothyroidism, TRH and TSH are already high. Injection of TRH leads to exaggerated response (surprising to me). In hypothalamic hypothyroidism, there is a delayed rise in TSH.
Epstein-Barr virus: mononucleosis, nasopharyngeal carcinoma, Burkitt's lymphoma, primary CNS lymphoma.
"Double-bubble" sign: duodenal atresia, annular pancreas. Duodenal atresia more common in Down syndrome.
Diagnosis of syphilis. Primary syphilis: chanchroid biopsy and darkfield microscopy; Secondary syphilis (bronze maculopapular rash over entire body, including mucous membranes, soles, and palms; also condylomata lata -- flat warty growth on perineum): non-specific serologic tests (VRDL -- cheap, so use first) and specific (FTA-ABS, microhemoagglutinin); Tertiary syphilis (gummas in nervous system and vasculature): specific serologic tests (nonspecific may be negative).
Hypocalcemia: Muscle cramps, perioral and extremity tingling, carpopedal spasm (Trousseau's sign of hypocalcemia), Chvostek's sign.
Gastroschisis versus omphacele: both are abdominal herniations with elevated alpha-feto protein. Gastroschisis will not be covered by peritoneum.
Retroperitoneal organs: SAD PUCKER
Suprarenal glands (as in adrenal glands)
Aorta/IVC
Duodenum (not first part)
Pancreas (except tail, in splenorenal ligament)
Ureters
Colon (only ascending/cecum and descending)
Kidneys
Esophagus
Rectum
Esophagus
Rectum
Embryonic factoids
Mullerian duct forms ovaries, Fallopian tubes, uterus, and proximal 2/3 of vagina. In males, Sertoli cells secrete Mullerian inhibiting factor.
Mullerian duct forms ovaries, Fallopian tubes, uterus, and proximal 2/3 of vagina. In males, Sertoli cells secrete Mullerian inhibiting factor.
The falciform ligament / round ligament of the liver is the remnant of the umbilical vein.
The ligamentum arteriosum is the remnant of the ductus arteriosus.
The ligamentum venosum is the remnant of the ductus venosum, which shunts blood from the umbilical vein to the inferior vena cava, bypassing the liver.
The median umbilical ligament is the remnant of the urachus, the connection between the embryonic urinary bladder and the allantois.
The medial umbilical ligaments (lateral to median) are the remnant of the umbilical arteries.
The lateral umbilical ligament is not important to embryology but is an important landmark to use to differentiate direct (medial to ligament) from indirect (lateral to ligament) inguinal hernias, since it overlies the inferior epigastric artery, which arises from the external iliac (not to be confused with the superficial epigastric artery, which arises from the femoral artery).
Meckel's diverticulum is the remnant of the vitelline or omphalomesenteric duct. It may become inflamed (appendicitis-like), present as lower GI bleeding, or act as a nidus for intussusception and volvulus.
Median nerve injury at wrist (suicide attempt for example): denervation of thenar muscles -- flexor pollicis brevis (MP flexion); abductor pollicis brevis; opponens pollicis. Adduction of thumb is controlled by adductor pollicis (ulnar nerve) and thumb flexion at IP joint is controlled by flexor pollicis longus (median nerve proximal to injury site).
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