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Pass Program Clues “You ain’t told me squat till you tell me the CLUE!!!” What are the 5 bacteria causing Heart Block? • Lyme Disease • Salmonella typhii (typhoid) • Chagas Disease (Whipple’s) • Legionella • Diptheria • • Lets Stop Doing Long Contractions What bacteria cause Reiter’s Syndrome? • Shigella • IBD – Crohn’s • Chlamydia • Yersina • • Reiter & Crohn Saw Yersina and got Chlamyia What are the Low Complement bugs causing Cryoglobuniemia? • Influenzae • Adenovirus • Mycoplasma • Hepatitis C • EBV • • I AM HE What are the drugs induced SLE? • Hydralazine • INH • Phenytoin • Procainamide • Penicillamine • Ethosuximide • • H I PPPE What are the drugs that Blast the BM? • AZT • Benzene • Chloramphenicol • Vinblastine • • Vinblastine Anilate Bone Cells What are the Comma Shaped bugs? • Vibrio • Campylobacter • Listeria • H. pylori

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• • Campylobacter Has Very Long Comma Genes
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What is the cresent shaped protozoa? • Giardia lamblia What bacteria looks like Chinese letters? • Corynebacter What are the TB Rx? • Rifampin • Pyrazinamide • INH • Ethambutanol • Streptomycin • • RESPI What are the 6 Low Complement assocs. with Nephrotic Syndrome? • Serum Sickness • PSGN • SLE • SBE • Cryoglobinemia • MPGN II •
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What drugs Induce p450? • BAG 4 CPR QTS • Car Grabs Queens Tets to Rev Up • Alcoholic doing drugs and stinking up car • Barbiturates • Alcohol • Griseofulvin • Carbamazapine • Rifampin • Quinidine • Tetracycline • Sulfa drugs • What drugs Inhibit p450? • I Do SMACK Quinolones • INH • Dapsone • Spirolactones • Macrolides • Amiodarone • Cimetidine • Ketoconazole • Quinilones What drugs are P450 Dependent? • Warfarin

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Estrogen Phenytoin Theophylline Digoxin Theo came from war & dig inside WDEPT taking Estrogen & now is Phenytoin

What disease is a Neutophil Deficiency? • CGD What is another name for CGD? • Chronic Granulomatous disease • NADPH Oxidase deficiency What are the Side effects of Statins? • Myositis • Hepatitis • Increased liver enzymes What are the painful genital Lesions? • Chancroid • Herpes • Lymphogranuloma inguinale What is the painful chancroid lesion due to? • Hemophilus ducreyi What are the 4 hormones with disulfide bonds? • Prolactin • Insulin • Inhibin • GH • • I PIG on BONDS What are the Hookworms? • Necatur americanis • Enterobius vermicularis • Ankylostoma duodenale • Trichuris trichurium • Ascaris lumbercoides • Strongyloides • • Hooks AS NEAT What are the X-Linked enzyme Deficiencies? • G6-PD • CGD • Pyruvate dehydrogenase Def. • Fabry’s • Hunter’s • Lesch-nyhan • Lesch-Nyhan Hunter Puts Fabrys on G6 Clothes

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What diseases do we screen for at birth? • Please • Check • Before • Going • Home • PKU • CAH(Congential Adrenal Hyperplasia) • Biotinidase • Galactosemia • Hypothyroidism HLA-Antigens • HLA-DR2= Narcolepsy, Allergy, Goodpasture’s, MS • HLA-DR3= DM, Chronic Active Hepatitis, Sjogren’s, SLE, Celiac Sprue • HLA-DR3 & 4= IDDM(Type I) • HLA-DR4= Rheumatoid Arthritis, Pemphigus Vulgaris • HLA-DR5= JRA, Pernicious Anemia • HLA-DR7= Nephrotic Syndrome(Steroid induced) • HLA-Antigens • HLA-DR 3 & B8=Celiac Disease • HLA-A3= Hemochromatosis(chromo. 6, point mut.-cysteine>tyrosine) • HLA-B8=MG • HLA-B13= Psoriasis • HLA-B27= Psoriais(only if w/arthritis) Ankylosing Spondylitis, IBD, Reiter’s, Postgonococcal Arthritis • HLA-BW 47= 21 alpha Hydroxylas def.(Vit.D) • What are the actions of Steroids? • Kills helper T-cells & eosinophils • Inhibits Macrophage migration • Inhibits Mast cell degranulation • Inhibits Phospholipase A • Stimulates protein synthesis • Stablizes endothelium What are the causes of Monocytosis? • Salmonella (typhoid) • TB • EBV • Listeria • Syphillis E. Coli is the most common cause of what? • UTI • Spontaneous bacterial peritonitis • Abdominal abscess

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3/29/2012 • Cholecystitis • Ascending cholangitis • Appendicitis 29 What are the one dose treatments for Gonorrhea? • Ceftriaxone • Cefixime • Cefoxine • Ciprofloxin • Oflaxacin • Gatifolxacin What is the one dose treatment for Chlamydia? • Azithromycin What are the “Big Mama” anaerobes? • Strep bovis • Clostridium melanogosepticus • Bacteriodes fragilis What are the “Big Mama” Rx? • Clindamycin • Metranidazole • Cefoxitin What “big mama” bugs are associated with colon cancer? • Strep. Bovis • Clostridium melanogosepticus 1 30 31 32 33 34 What do you see in the serum with low volume state? • K+? • Decreases • Na+? • Decreases • • • • • • • • • • • What are psammoma bodies? • Calcified CA’s In what diseases are Psammoa Bodies present? Cl-? Decreases pH? Increases BP? Increases 2 35 36 5 .

3/29/2012 • • • • 37 Papillary carcinoma of the Thyroid Serous cystadenocarcinoma of the ovary Meningioma Mesothelioma What are the Urease (+) Bacteria? • Proteus • Pseudomonas • Ureaplasma urealyticum • Nocardia species • Cryptococcus neoformans • H.penia? • #1 = Virus • #2 = Drugs What is seen in the Salmonella Triad? • High Fever • Rose spots (rash) • Intestinal fire What drugs cause Myositis? • Rifampin • INH • Predinsone • Statins What are the 7 Gram -encapsulated bacteria? • Some • Strange • Killers • Have 38 39 40 41 42 43 44 45 46 1 6 . pylori What types of stones are formed from Proteus? • Struvite (90%) What type of motility do Proteus have? • swarming What are 5 indications of Surgery? • Intractable pain • Hemorrhage (massive) • Obstruction (from scarring) • Perforation What drugs cause Cardiac Fibrosis? • Adriamycin (Doxyrubicin) • Phen-fen What drug is used to tx cardiac fibrosis? • Dozaroxsin What is the MCC of any ….

3/29/2012 2 • • • • • • • • • • Pretty Nice Capsules Salmonella Strep.C.D • Aflatoxin • Vinyl chloride • Ethanol • Carbon Tetrachloride • Anyline Dyes • Smoking • Hemochromatosis • Benzene • Schistomiasis • • • What are the 9 Live Vaccines? • Measles • Mumps • Rubella • Oral Polio (sabin) • Rotavirus • Small pox • BCG • Yellow fever • Varicella • 50 1 2 7 . Pneumo (gr+) Klebsiella H. influenza Pseudomonas Neisseria Cryptococcus 47 What is the Jones Criteria for Rheumatic Fever? • SubQ nodules • Polyarthritis • Erythema marginatum • Carditis • Chorea What are the causes of Eosinophilla? • Neoplasms • Allergies/Asthma • Addison’s Dz • Collagen Vascular Dz • Parasites 1 48 49 2 What are the Risk Factors for Liver CA? • Hep B.

3/29/2012 51 1 2 What are the Killed Vaccines? • SIR Hep A • Salk (polio) • Influenza • Rubella • Hepatitis A What are the IgA Nephropathies? • Henoch-Schoenlein P. (HSP) • Alport’s • Berger’s What are the Drugs that cause Autoimmune hemolytic anemia? • PCN • α-methyldopa • Cephalosporins • Sulfa • PTU • Anti-malarials • Dapsone What are the drugs that cause Autoimmune thrombocytopenia? • ASA • Heparin • Quinidine What are the enzymes that show after an MI? • Troponin I • CKMB • LDH 52 53 54 55 56 1 2 What is the first MI enzyme to appear? • Troponin I • Appears • Peaks • Gone • • 2 hrs • 2 days • 7 days What is the 2nd MI enzyme to appear? • CK-MB • Appears • Peaks • Gone • • 6 hrs • 12 hrs • 24 hrs What is the 3rd MI enzyme to appear? 57 1 2 58 8 .

3/29/2012 1 • • • • LDH Appears Peaks Gone 2 • • 1 day • 2 days • 3 days What bacteria have Silver Stains? • Legionella • Pneumocysitis carinii • H. pylori • Bartonella henseslae (lymph node) • Candida (yeast) What are the sulfa containing drugs? • Sulfonamides • Sulfonylurea • Celebrex What is another name for celebrex? • Celecoxib What type of inhibitor is Celebrex? • COX 2 specific What COX-2 specific drug can you give to a pt with sulfa allergy? • Vioxx (Rofecoxib) What drugs inhibit dihydrofolate reductase? • Pyremethamin/Sulfadiazine • Trimethoprim/Sulfamethoxazole What drugs cause Pulmonary Fibrosis? • Bleomycin • Bulsufan • Amiodarone • Tocainide What are the macrophage deficiency diseases? • Chediak-Higashi • NADPH-oxidase deficiency What are the SE of Loops and Thiazides? • Hyperglycemia • Hyperuricemia • Hypovolemia • Hypokalemia 59 60 61 62 63 64 65 66 67 68 1 2 What are the SE of Loop diuretics? • OH DANG • Ototoxicity • Hypokalemia 9 .

3/29/2012 • • • • 69 1 Dehydration Allergy Nephritis (interstitial) Gout What are the only 3 Pansystolic Murmurs and when are they heard? • MR • TR • • • • VSD Decrease on inspiration (^exp) Increase on inspiration Decrease on inspiration (^exp) 2 70 1 2 Macrophages in various organs • Brain • Lung • Liver • Spleen • Kidney • Lymph nodes • Skin • Bone • CT • Mircoglia • Type I pneumocyte • Kupffer cell • RES • Mesangial • Dendritic • Langerhans • Osteoclasts • Histiocytes or • Giant cells or • Epithelioid cells What are the 7 Rashes of the Palms & Soles? • TSS • Rocky Mountain Spotted Fever • Coxsackie A (Hand/Foot & mouth dz) • Kawasaki • Syphillis • Scarlet Fever • Staph Scalded Skin Syndrome What is seen in every restrictive lung dz and low volume state? • Tachypnea • Decrease pCO2 • Decrease pO2 • Increase pH 71 72 10 .

3/29/2012 73 What are the different 2nd messenger systems? • cAMP • cGMP • IP3/DAG • Ca:Calmodulin • Ca+ • Tyrosine kinase • NO What is the clue for cAMP? • It is the 90% • Sympathetic • CRH (cortisol) • Catabolic What is the clue for cGMP? • Parasympathetic • Anabolic • What are the clues for IP3/DAG? • Neurotransmitter • GHRH • All hypothalamic hormones xc cortisol • Used by what and for what? • Smooth muscle for contraction What is the clue for Ca:Calmodulin? • Used by smooth muscle for contraction by distention What is the clue for Ca+? • Used by Gastrin only What is the clue for Tyrosine Kinase? • Used by Insulins • Used by ALL growth factors What is the clue for NO? • Nitrates • Viagra • ANP • LPS What are the T & B cell deficiencies? • WAS • SCID • CVID • HIV • HTLV-1 What are the CLUES for WAS? • Thrombocytopenia • IL-4 • Infection 74 75 76 77 78 79 80 81 82 11 .

3/29/2012 • Eczema • Decrease IgM • IgE??? 83 What are the CLUES for SCID? • Framshift/Nonsense mutation • Adenosine deaminase deficiency • T-cell>B-cell • Bacterial infections • Fungal infections What are the CLUES for CVID? • Late onset • Frameshift/Missense mutation • Tyrosine Kinase deficiency What are the CLUES for HIV & HTLV-1? • T-cell>B-cell • CD4 rich • Brain • Testicles • Cervix • Blood vessels What are the inhibitors of Complex 1 of the ETC? • Amytal • Rotenone What are the inhibitors of Complex 2 of the ETC? • Malonate What are the inhibitors of Complex 3 of the ETC? • Antimycin D What are the inhibitors of Complex 4 of the ETC? • CN• CO • Chloramphenicol What are the inhibitors of Complex 5 of the ETC? • Oligomycin What are the ETC chemical uncouplers? • DNP • Free Fatty acids • Aspirin What type of uncoupler is Aspirin? • Physical uncoupler What are the 4 sources of Renal Acid? • Plasma • Urea cycle • Collecting ducts • Glutaminase 84 85 86 87 88 89 90 91 92 93 12 .

3/29/2012 94 What is the one dose tx for Hemophilus ducreyi? • Azithromycin 1 gram po • Ceftriazone 250 mg im What is the one dose tx for Chlaymdia? • Azithromycin 1 gram po What is the one dose tx for Candidiasis? • Ketoconazole 150mg What is the one dose tx for Vaginal Candidiasis? • Difluccan 1 pill What is the one dose tx for Trichomonas? • Metronidazole 2 grams What is the one dose tx for Gardnerella? • Metronidazole 2 grams What are the 3 cephalosporins & doses used as one dose treatments for Gonorrhea? • Ceftriaxone 250 mg im • Cefixime 400 mg po • Cefoxitin 400 mg po What are the 3 Quinolones & doses used as one dose treatments for Gonorrhea? • Ciprofloxacin 500 mg po • Ofloxacin 400 mg po • Gatifloxacin 400 mg im What are the 4 enzymes needed to break down glycogen? • Phosphorylase (Pi) • Debranching enzyme • Alpha-1.6 –Glucosidase • Phosphatase What are the 2 enzymes needed to make glycogen? • Glycogen synthase • Branching enzyme What are the branching enzymes? • Glycogen alpha-1.4 glycosyl transferase 95 96 97 98 99 100 101 102 103 104 13 .

3/29/2012 • Glycogen alpha-1.6 glycosyl transferase 105 What is the rate limiting enzyme in the break down of glycogen? • Phosphorylase (Pi) What values do you see in obstructive pulmonary dz? • pO2? Normal • pCO2? Normal or increased • pH? Decreased What values do you see in restrictive pulmonary dz? • pO2? Decreased • pCO2? Decreased • pH? Increased What type of acidosis do you see with obstructive pulmonary dz? • Respiratory acidosis 1 106 107 108 109 2 What are the Lysosomal Storage Disease & what is the deficiency? • Fabry’s • Krabbe’s • Gaucher’s • Niemann – Pick • Tay-Sachs • Metachromatic leukodystrophy • Hurler’s • Hunter’s • α – galactosidase • Galactosylceramide • β – glucocerebrosidase • Sphingomyelinase • Hexosaminidase • Arylsulfatase • α – L – iduronidase • Iduronidase sulfatase What dz’s are associated with HLA B27? • Psoriasis • Ankylosing spondylitis • IBD (Ulcerative colitis) • Reiter’s Syndrome What HLA is Psorisis w/RA associated with? • HLA-13 110 111 112 1 What are the Glycogen Storage Diseases & the deficiency? • Von Gierke’s 14 .

3/29/2012 • Pompe’s • Cori’s • McArdle’s • Glucose – 6 – phosphate 2 • α – 1 – 4 glucosidase • Debranching enzyme • • Glycogen phosphorylase 113 What are 6 places of the TCA cycle where amino acids feed in/out? • Pyruvate? • Glycine • Alanine • Serine • • • • • • • Acetyl CoA ? Phenylalanine Isoleucine Threonine Tryptophan Lysine Leucine 114 What are 6 places of the TCA cycle where amino acids feed in/out? • Alpha-KG ? • Glutamate • Glutamine • • • • • Succinyl CoA? Phenylalanine Tryptophan Tyrosine 115 What are 6 places of the TCA cycle where amino acids feed in/out? • Fumerate ? • Proline • Oxaloacetate? • Aspartate • Asparigine 116 What are the 4 steps of B-oxidation? • • Oxidation – 7 NADH – 21 ATP • Hydration 15 .

7FADH – 14 ATP • Thiolysis – 8 AcCoA – 96ATP 131 ATP – 2 (to bring it • 117 in) What are the blood gases in neuromuscular disease (= restrictive blood gases)? • pO2? Decreased • pCO2? Decreased • PCWP? Decreased (b/c it’s a pressure problem) • Respiratory Rate? Increased • pH? Increased • SZ? Increased What are 5 Hormones produced by small cell (oat cell) lung CA? • ACTH • ADH • PTH • TSH • ANP What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-smith • Anti cardiolipin • Anti-ds DNA • SLE 118 119 120 What Autoimmune Disease has the following Autoimmune Antibodies? • Anti – histone? • Drug induced SLE 121 What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-topoisomerase? • PSS (Progressive Systemic Sclerosis) • 122 What Autoimmune Disease has the following Autoimmune Antibodies? • Anti TSH receptors? • • Graves What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-centromere? • • CREST 123 16 .3/29/2012 • Oxidation .

3/29/2012 • • 124 What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-GBM? • • Goodpasture’s What does Goodpastures have antibody to? • Type IV collagen What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-mitochondria? • • Primary biliary cirrhosis What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-hair follicle? • • Alopecia areata What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-IgG? • • Rheumatoid arthritis What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-myelin receptors? • MS • 125 126 127 128 129 130 What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-gliaden? • Anti-gluten? • Celiac sprue • 131 What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-islet cell receptor? • DM Type I • 132 What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-melanocyte? • Viteligo • 133 What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-ACh receptor? 17 .

3/29/2012 • MG • 134 What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-ribonuclear protein? • Mixed Connective Tissue dz (MCTD) • 135 What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-parietal cell receptor? • Pernicious anemia • 136 What does Pernicious Anemia have antibody to? • Intrinsic factor What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-epidermal anchoring protein receptors? • • Pemphigus vulgaris What does Pemphigus vulgaris have antibody to? • Intercelluar junctions of epidermal cells What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-epidermal basement membrane protein? • Bullous pemphigoid 137 138 139 140 What do you see with bullous pemphigoid? • IgG sub-epidermal blisters • Oral blisters • What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-platelet? • ITP • 141 142 What does ITP have antibody to? • Glycoprotein IIb/IIIa • 143 What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-thyroglobulin? • Anti-microsomal? • Hashimoto’s • 144 What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-smooth muscle? 18 .

drug use association) 149 150 19 .3/29/2012 • Anti-scl-70? • Scleroderma • 145 What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-rho (SS-A)? • Anti-la? • Sjogren’s • 146 What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-proteinase? • C-ANCA? • Wegener’s 147 What Autoimmune Disease has the following Autoimmune Antibodies? • P-ANCA? • Polyarteritis nodosa 148 What antigen & immunoglobulin is Polyarteritis nodosa associated with? • Hepatitis B antigen • IgM • What are the viruses that directly cause CA and which CA do they cause? • Papilloma virus? Cervical CA • EBV? Burkitts Nasopharyngeal CA • HepB & C? Liver CA • HIV? Kaposi’s Sarcoma What are the 7 Nephrotic Patterns seen with every Vasculitis? • Clot in front of renal artery? Renal artery stenosis • Clot off whole renal artery? Renal failure • Inflamed glomeruli? Glumerulo nephritis • Clot in papilla? Papillary necrosis • Clot off medulla? Interstitial nephritis • Clot off pieces of nephron? Focal segmental GN (HIV.

Urokinase inhibit? • Aminocaproic acid • What doe Warfarin inhibit? • Vitamin K • What does Heparin inhibit? • Protamine Sulfate • What is the dosage of tPA? • IV push? • 20mg • • Drip? • 40mg What is the dosage for Streptokinase? • IV push? • 750K • • Drip? • 750K What is Urokinase used for? • Used ONLY for such things as: • Feeding tubes 154 155 156 157 158 159 160 161 20 . change disease • • 2 wks post URI What is the most common vasculitity leading to rapidly progressive glomerulonephrosis? • Goodpasture’s • 152 153 What is the most common malignant renal tumor in children? • Wilm’s tumor What is the most common malignant renal tumor in adults? • Adenocarcinoma What is the most common renal mass? • Cyst What is the most common renal disease in Blacks/Hispanics? • Focal Segmental GN What is the most common nephrotic disease in adults? • Membranous GN Thrombolytics & Inhibitors • What does tPA. Streptokinase.3/29/2012 • Clot off lots of nephrons? Rapidly Progressive GN 151 What is the most common nephrotic disease seen in kids and when does it occur? • Min.

3/29/2012 • Central lines • Fistulas 162 What is Alopecia Areata? • Loss of a patch of hair What is Alopecia Totalis? • Loss of ALL hair on head “bald” What is Alopecia Universalis? • Loss of hair on entire body “hairless” What is Loffler syndrome? • Pneumonitis with endocarditis = pulmonary infiltrate with severe eosinophilia What is Loffler syndrome also known as? • PIE syndrome What are the 5 Parasites associated with Loffler Syndrome? • Necator americanus • Ankylostoma duodenale • Shistosomiasis • Strongyloides • Ascaris lumbricoides What happens when a patient is on prednisone for > 7 days? • • Immunocompromised What are 2 enzymes used by B12? • Homocystine methyl transferase • Methyl malonyl-coA mutase What does Mitochondrial inheritance mean? • No male transmission • All females pass it on Who are 4 pt’s who would be susceptable to pseudomonas and staph infxns? • Burn patients • Cystic fibrosis • DM • Neutropenic patients In a neutropenic patient. what do you cover for? • cover 1x for Staph aureus during 1st week • cover 2x for Pseudo after 2nd week What are the 3 main concepts causing a widened S2 splitting? • Increased pO2 • Delayed opening/closing of the pulmonary value • Increased volume in the right ventricle What are causes for a widened S2 splitting? • Blood transfusion 163 164 165 166 167 168 169 170 171 172 173 174 21 .

3/29/2012 • • • • • • • • • • • • 175 Increased Tidal Volume Giving O2 Right sided heart failure Pregnancy due to increase volume IV fluids ASD/VSD Deep breathing Hypernateremia SIADH Pulmonary regurge Pulmonary stenosis Right bundle branch block What are the 8 common cavities of blood loss? • Pericardium • Intracranial • Mediastinum • Pleural cavity • Thighs • Retroperitoneum • Abdominal cavity • Pelvis What is the special list for Penicillin? • Gram + • Basement membrane suppressor • Works on simple anaerobes • The #1 cause of anaphylaxis • Causes interstial nepritits • Causes nonspecific rashes • Acts as a hapten causing hemolytic anemia What is the #1 cause of anaphylaxis? • Penicillin What are the Chron’s Gifts? • Granuloma • Ileum • Fistula • Transmural • Skip Lesion What are the negative-stranded RNA Clues? • Prodromal period before symptoms = 1-3 weeks • Why is there a prodromal period? • Because must switch to positive stranded before replication What are the clues for positive stranded RNA? • Symptoms within 1 week or less • EXCEPTIONS: • Hanta • Ebola • Yellow fever 176 177 178 179 180 22 .

Rickets (X-linked dominant) • Fabrys • Hunters What are the 7 B-cell deficiencies? 182 183 184 185 186 187 188 23 .3/29/2012 • They are -ve stranded = don’t have to switch to positive before replicating 181 What are the Most common cyanotic heart diseases? • Transposition of the great arteries • Tetrology of Fallot • Truncus Arteriosus • Tricuspid Atresia • Total anomalous pulmunary Venous Return • • Hypoplastic Left heart syndrome • Ebstein’s anomaly • Aortic atresia • Pulmonary atresia What cyanotic heart disease is – boot shaped? • Tetrology of Fallot What cyanotic heart disease is associated with mom taking lithium during pregnancy? • Ebstein’s Anomaly What things make the membrane less likely to depolarize? • Hypokalemia • Hypermagnesemia • Hypercalcemia (except atrium) • Hypernatremia What things make the membrane more likely to depolarize? • Hyperkalemia • Hypomagnasemia • Hypocalcemia (except atrium) • Hyponatremia What is Plan F? • TPP – Thiamin – B1 • Lipoic Acid – B4 • CoA – Pantothenic acid – B5 • FAD – Riboflavin – B2 • NAD – Niacin – B3 • What are the 8 x-linked inherited diseases? • Bruton’s Agammaglobulinemia • CGD (NADPH def) • DMD • Color Blindness • G6PD • Hemophilia • Lesch-Nyhan • Vit D resist.

3/29/2012 • • • • • • • 189 Bruton’s agammaglobulinemia CVID (Common Variant Imm. Def) Leukemias Lymphomas SCID WAS Job Buckley Syndrome What is the Tyrosine kinase deficiency? • Bruton’s agammaglobulinemia What are the B-cell deficiencies with T-cell overlap? • SCID • WAS • Job Buckley Syndrome What are the 4 itchiest rashes? • Scabies • Lichen Planus • Urticaria • Dermatitis Herpetiformis Tumor Markers/Oncongenes I • L-myc? • Small cell lung Ca • • • • • • • • • • C-myc? Promyelocytic leukemia (Burkitt’s lymphoma) N-myc? Neuroblastoma Small cell lung CA C-able? CML ALL 190 191 192 193 Tumor Markers/Oncongenes II • C-myb? • Colon CA • AML • • • • C-sis ? Osteosarcoma Glioma Fibrosarcoma 194 Tumor Markers/Oncongenes III 24 .

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Tumor Markers/Oncongenes IV • • • • • • • • Erb-B2? Breast CA Ovarian CA Gastric CA Ret? Medullary CA of thyroid Men II & III Papillary carcinoma

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Tumor Markers/Oncongenes V • Ki-ras? • Lung CA • Colon CA • Bcl-2? • Burkitts • Follicular lymphoma • Erb? • Retinoblastoma

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What are 6 Hormones produced by the placenta? • hCG • Inhibin • Human placental lactogen (HPL) • Oxytocin (drug lactation, pit gland prod it also) • Progesterone • Estrogen • Relaxin •

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What is cancer grading? • Severity of microscopic change • Degree of differentiation What is cancer staging?

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What are the rashes associated with cancer and what cancer are they associated with? • • Urticaria/Hives? • Any CA, especially lymphoma • Pagets Ds (ulcers around nipples) • • Seborrheic keratosis (waxy warts)? • Colon CA • HIV if sudden increase in number • Normal with aging What are the rashes associated with cancer and what cancer are they associated with?

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• Actinic keratosis? – Dry scaly plaques on sun-exposed skin • Squamous Cell CA of skin • • Dermatomyositis? – violacious, heliotropic rash, malar area • Colon CA •
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What are the rashes associated with Cancer and the cancer they are associated with? • • • Akanthosis nigricans? – dark lines in skin folds • Any visceral CA • End organ damage • • Erythema nodosum? – ant aspect of legs, tender nodules • Anything granulomatous • NOT assoc. w/ bacteria • What is carried by HDL? • Apo E • Apo A • Apo CII • L-CAT – lecithin cholesterol acetyl transferase • Cholesterol – from periphery to liver

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What is carried by VLDL? • Apo B-100 • Apo E • Apo C II • • Triglcyerides (95%) • Cholesterol (5%) What is carried by IDL? • Apo B-100 • Apo E • Apo CII • Triglycerides (< VLDL) • Cholesterol (>VLDL)

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What is carried by LDL? • Apo B-100 • • Cholesterol – from liver to tissue • • NOT a good thing!!!!! What do chylomicrons carry? • Apo A • Apo B-48 • Apo E • Apo C II • • Triglycerides from: • GI to liver (25% of the time) • GI to endothelium (75% of the time) Which lipoprotein carries the most cholesterol? • • • LDL • Where are the AVMs? • Clue = HEAL • Heart? • Machinery murmur • Elbow? • Fistula from dialysis in renal disease • Abdomen/Brain? • Von Hippel-Lindau = clot off with coils • Increase incidence of Renal cell CA on chrom 3

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• Lungs? • Osler Weber Rendu Syndrome
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What is the Ranson’s criteria for acute pancreatitis (at admission)? • Glucose > 200 • Age > 55 • LDH >350 • AST > 250 • WBC > 16,000 What is the Ranson’s criteria for acute pancreatitis (at less than 48 hrs)? • Calcium <8 mg/dl • HCT drop > 10% • O2 < 60 (PaO2) • Base deficit > 4 • BUN > 5 mg/dl • Sequestration > 6L What 2 diseases is pilocarpine used for? • CF • Glaucoma – Painful, red, teary eye What is dysguzia? • Problem with sense of taste What are 3 causes of dysgusia? • Metronidazole • Clarithromycin • Zinc deficiency What is the triad of Carcinoid syndrome? • Flushing • Wheezing • diarrhea What do you measure for carcinoid syndrome? • Serotonin – 5-HIAA Where are the 2 most common places a carcinoid tumor is found? • Pancreas • Ileum • What are the phage mediated toxins? • Mnemonic: BEDS • Botulinum • Erythrogenic toxin – from strep pyogenes • Diptheria • Salmonella – Has O antigen •

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3/29/2012 219 What is the story used to remember the segmented RNA viruses? • I sprayed ORTHO on my BUNYA at the ARENA down in REO to kill SEGMENTED WORMS Name the 3 major types of adhesion molecules • ICAMs • Integrins • Selectins • What does IgCam do? • Bind proteins What do integrins do? • Stop the leukocytes What do selectins do? • Bind carbohydrates • Mediate the rolling to slow leukocytes down What are the functions of adhesion molecules? • Homing of lymphocytes – tells lymphocytes where to go • Inflammation • Cell-cell interaction • Primary allergic response is due to what? • Contact What cells are present in the first 3 days? • Neutrophils • The next cells to show up are? • B-cells • What do B-cells make? • IgM 220 221 222 223 224 225 226 227 What day does IgM show up? • Three • • IgM peaks at what day? • 14 • • When does IgM leave? • In 2 months What shows up in 2 wks (14 days)? • IgG • • When does IgG peak? • In 2 months • 228 29 .

3/29/2012 • When does IgG leave? • In 1 year 229 What is Secondary Allergic response is due to? • MEMORY • What shows up at day 3? • IgG with 5x concentration • Has the highest affinity • • When does IgG peak? • In 5 years • • When does IgG leave? • In 10 years What Ig has the hightest affinity? • IgG What are the risk factors for Esophageal/Gastric CA? • Smoking • Alcohol • Nitrites • Japanese • What are the risk factors for bladder CA? • Smoking • Aniline dyes • Benzene • Aflatoxin • Cyclophosphamide • Schistosomiasis • 2 diseases: • Von Hippel-Lindau • Tubular sclerosis What is the NBT test? • Nitro Blue Tetrazolium test • What is it used for? • Screening CGD • What does a –ve test indicate? • +ve for the disease What disease corresponds with the following inclusion bodies? • Howell-Jolly? • Sickle cell • Heinz? • G-6-P-D • Zebra? 230 231 232 233 234 235 30 .

3/29/2012 • Niemann pick 236 What disease corresponds with the following inclusion bodies? • Donovan? • Leishmaniasis • Mallory? • Alcoholism • Negri? • Rabies 237 What disease corresponds with the following inclusion bodies? • Councilman? • Yellow fever • Call-exner? • Ovarian tumors – granulosa origin 238 What disease corresponds with the following inclusion bodies? • Lewy? • Parkinsons • • Pick? • Pick’s disease • • Barr body? • Normal female • What disease corresponds with the following inclusion bodies? • Aschoff? • Rheumatic fever • • Cowdry type A inclusions? • Herpes virus • • Auer rods? • AML • • • • What disease corresponds with the following inclusion bodies? • Globoid? • Krabbe’s lysosomal storage disease • • Russell? • Multiple myeloma 239 240 31 .

3/29/2012 • 241 What disease corresponds with the following inclusion bodies? • Schiller-Duvall? • Yolk sac tumor • • Basal bodies? • Only found in smooth mm What are the 4 types of hypersensitivities? • Mnemonic? • ACID • Type I • Anaphylaxis/Atopic • Type II • Cytotoxic (Humoral) • Type III • Immune complex mediation • Type IV • Delayed hypersensitivity/Cell mediated 242 243 What are the Characteristics of Type I hypersensitivity? • Atopic • IgE (Asthma) binds to mast cell • IgA activates IP3 cascade degrading mast cells What are the Characteristics of Type II hypersensitivity? • Humoral • What are examples of type II? • Rh disease • Goodpastures • Autoimmune hemolytic Anemia • All Autoimmune diseases – except RA and SLE • What are the Characteristics of Type III hypersensitivity? • Ag-Ab complement • What are examples of Type III? • RA • SLE • Vasculitides • Some GN? • What are the Characteristics of Type IV hypersensitivity? • Cell mediated 244 245 246 32 .

3/29/2012 • • • • 247 What are examples of Type IV? TB skin test Contact dermatitis Transplant rejection What structures have no known function? • Appendix • Epithalamus • Palmaris longus – muscle • Pancreatic polypeptide – hormones in F-cells What diseases can progress to RPGN? • Goodpastures • Wegeners • DM • HTN What are causes of papillary necrosis? • Vasculitis • AIDS Cytic fibrosis Questions? • Tx? • Pilocarpine • also used for glaucoma • Test used to detect CF? • Pilocarpine sweat test • What ion does this test measure? • Cl• Definitive presence of disease has a test value of what? • >60 248 249 250 251 Cytic fibrosis Questions? • What is the value in a normal person? • <20 • What is the value in a heterozygous person? • 30 – 60 • What chromosome is the CF gene on? • Chrom 7 • What Second messenger is used? • IP3/DAG 252 What are the gram +ve spore formers? • Bacillus anthracis • Clostridium perfringens 33 .

massive. nodular deposits – lung. Mediterranean fever 258 Types of amyloid found in various Systemic amyloidoses: • Pre-albumin/transthyretin? • Cardiomyopathic hereditary forms – senile systemic amyloidosis • Neuropathic hereditary syndromes Types of amyloid found in various Local amyloidoses: • ANP fibrils are caused by? • Senile cardiac amyloisosis • Cerebral amyloid in Alzheimer’s disease/Down’s? • Cerebral amyloidosis 259 260 Types of amyloid found in various Local amyloidoses: • Calcitonin precursors? • Medullary CA of thyroid • AL from light chains? • Isolated.3/29/2012 • Clostridium tetani • Clostridium melangosepticus • What is the chemical in spores? • Calcium dipocholinate 253 What does strep mutans ferment? • Lactic acid What type of receptors do all sphincters in the body have? • Alpha-receptors Strep. urogenital tract 261 What type of dementia do you get in Pick’s dis? • Frontotemporal dementia 34 . skin. Salivarius ag is used for what test? • Cold agglutinin testing – IgM Types of amyloid found in various Systemic amyloidoses: • AA amyloid? • Chronic active disease • AL amyloid from Ig light chain? • Myeloma 254 255 256 257 Types of amyloid found in various Systemic amyloidoses: • Beta 2 microglobulin? • Chronic hemodialysis • AA amyloid from SAA? • Nephrotic hereditary forms – eg.

3/29/2012 262 Describe Pick’s disease • Atrophy of frontal and temporal cortex with sparing of remaining neocortical regions What 3 things do Pick bodies contain? • Altered neurofilaments • Tau protein • ubiquitin What drugs can cause a disulfiram reaction? • Mnemonic? • CLAM • Chloramphenicol • Lactams – Cefamandole – Cefoperazone • Antabuse – disulfiram • Metronidazole • 263 264 265 What is the mode of action of the Clostridium botulinum toxin? • Prevents pre-synaptic release of Ach • How do babies get it? • From spores in honey or molasses • How do adults get it? • From canned food 266 What are 3 Toxins of Bacillus? • Lethal factor – (black necrosis) • Protective factor • Edema factor Who has Poly-D Glutamic acid? • Anthracis • Cereus Name that B-blocker: • B1-selective? • A–M • Non-selective? • N–Z • Exceptions? • Carbetalol and Labetolol are non-selective What are the 4 facts of Fanconi Syndrome? • Problem in proximal tubule • Can’t reabsorb • Low energy state causing anemia • Can be due to old tetracycline Where is glutaminase found? 267 268 269 270 35 .

3/29/2012 • In the collecting duct of the kidney • • What does glutmainase help the kidney absorb? • Ammonia if the liver fails 271 Name 3 anatomical spots where renal stones get stuck: • Hilum • Pelvic brim • Entering the bladder Renal failure is the most common cause of death in what 3 diseases? • SLE • Endometrial CA • Cervical CA What is the rate-limiting enzyme in the urea cycle? • Carbamoyl synthase I • • Where is it found 90% of the time? • Liver • Where is it found 10% of the time? • Collecting duct of the kidney 272 273 274 What type of charge does heparin have? • -ve charge What type of charge does protamine sulfate have? • +ve charge • What is it used for? • Reversing the effects of heparin 275 276 What is commonly seen in all vasculitides? • T-cells and macrophages • Schistocytes • Decreased platelets • Decreased RBCs • Bleeding from mucosal surfaces • Bleeding from skin and GI • Petechiae • Ecchymoses What happens if you expose the blood to the basement membrane? • The following deveop: • Clots • DIC • Pulmonary embolism • DVT • MI • Stroke Signs and symptoms in all vasculitides • Tachypnea and SOB 277 278 36 .

meningitidis What is the MOA of Vancomycin? • Cell wall inhibitor • Binds irreversibly to Phopholipase carrier • Bacteriacidal • Covers all gram +ves • Linezolid What is the MOA of Warfarin? • Blocks vitamin k dependent gamma-carboxylation of prothrombin and factors 2.3/29/2012 • • Most common cause of death? • Heart failure 279 What is the MOA of Erythromycin? • Inhibits the translocation step of ribosomal protein synthesis What is the MOA of Chloramphenicol? • Inhibits ribosomal peptidyl transferase in prokaryotes What is the MOA of Puromycin? • Inhibits elongation by binding to “A” site and prematurely terminating chain growth in pro and eukaryotes • What is the MOA of Streptomycin? • Causes misreading of code during initiation in prokaryotes What is the MOA of Tetracycline? • Prevents binding of aminoacyl-t-RNA to ribosome on prokaryotes therefore inhibiting initiation • What is the MOA of Cyclohexamide? • Inhibits ribosomal peptidyl transferase in eukaryotes – cell wall inhibitor • What is the MOA of Rifampin? • Blocks B-subunit of RNA polymerase • Prophylaxis for contacts of N. 10. proteins C&S • What is the MOA of Clindamycin? • Blocks translation by binding the 50S subunit Hemolytic properties of Streptococcus: • What type of hemolysis is alpha hemolysis? • Partial hemolysis • What color is it’s zone? • Green • What type of hemolysis is beta-hemolysis? • Complete hemolysis 280 281 282 283 284 285 286 287 288 289 37 . 7. 9.

Streptokinase • What type of hemolysis is gamma-hemolysis? • No hemolysis • What color is it’s zone? • Red 291 What are the 5 notable things about RTA I? • High urine PH (??????not sure about this) • Acidosis • UTI s • Stones • Babies die < 1 yr old What are 3 notable things about RTA II? • Acidosis – urine PH = 2. normal is 5-6 • Hypokalmia • Patients have NO carbonic anhydrase • • What are 3 notable things about RTA III? • It is a combination of RTA I & III • Normal urine pH • Hypokalemia What are 3 notable things about RTA IV? • Seen in diabetics • Hyperkalemia • NO aldosterone b/c JG apparatus has infarcted What are the members of Streptococcus Group D? • Viridans • Mutans • Sanguis • Salivarius • Bovis What Steptococcus has green pigment? • Viridans What Streptococcus causes SBE? • Viridans What Streptococcus causes cavities? • Mutans 292 293 294 295 296 297 298 38 .3/29/2012 290 Hemolytic properties of Streptococcus: • What color is it’s zone • Clear – eg.

Bronchitis.3/29/2012 299 What do you see in Nephritic Syndrome? • HTN • Hematuria • RBC casts What do you see in Nephrotic Syndrome? • Increase Edema • Increase Lipidemia • Increase Cholesterolemia • Increase Coagulability • Decrease serum Albumin • Increase urinary Albumin What is the #1 cause of Sinusitis. Otitis. Pneumo • What is the #2 cause? • Hemophilus influenza • What is the #3 cause? • Neisseria meningitides • 300 301 302 What is the #1 method to paralyze cilia? • Viruses • Which are secondary to what? • Bacterial infections • What is the #2 method to paralyze cilia? • Smoking 303 If you develop gastroenteritis within 8hrs of eating what are the most common likely bugs? • Staph aureus • Clostridium perfringens • Bacillus cereus…. Pneumonia? • Strep.from what? • Fried rice Gastroenteritis within 8hrs of eating what toxin? • Preformed What does Clostridum tetani inhibit? • Release of glycine from spinal cord • What physical finding would you see? • Lock jaw • What is the tx? • Antitoxin and Toxoid • Where is it injected? 304 305 39 .

coli • Then? • Proteus • Then? • Klebsiella Newborn meningitis is caused by? • Group B Strep (agalactiae) • E.3/29/2012 • Injected in different areas of body 306 The Most common cause of UTI is? • E. coli • Followed by? • Proteus • Followed by? • Klebsiella 307 The most frequent cause of UTI in females between 5-10? • Staph saprophyticus • Why? • They stick things in themselves • • • • 18-24 yoa? Staph saprophyticus Why? Because they stick things inside themselves • Why no UTI’s after 24? • Because women are use to penises and Staph saprophyticus lives on penis (becomes part of normal flora). coli • Listeria 310 311 312 40 . aureus What is the triad of SSSS? • Shock • Rash • Hypotension Most common cause of UTI? • E. 308 Staph aureus is the most common cause of what bone disease? • Osteomyelitis • Because of what? • Collagenase • 309 What is the Most Common cause of infections one week post burn injury? • • Staph.

Agalactiae) • E.3/29/2012 313 What is normal rectal flora from mom • Group B Strep (Strep. then becomes deadly. coli • Listeria What is associated with colon CA? • Clostridium melanogosepticus • Strep bovis • What color pigment is produced? • Black 314 315 What Ig do you look for with affinity? • IgG • What about Avidity? • IgM 316 What is transduction • Virus inject it’s DNA into bacteria 317 What is transformation? • Virus injects it’s DNA into it bacteria in a hospital or nursing home setting. Conjuction occurs only with what? • Bacteria with Pili What causes mutiple cerebral abscesses in newborns? • Citrobacter What are the 2 gram –ves that are strict anaerobes? • Hemophilus influenza • Neisseria What type of complement problem do you have in recurrent infections with encapsulated organisms? • • C3 What does complement fight against? • • Gram negative bacteria What do you see in serum with prerenal failure and what are the values? • BUN • >20 • Fractional Na+ excertion • <1% • Creatine • >40 318 319 320 321 322 323 41 .

Group B – Strep agalactiae • Strep.3/29/2012 324 What do you see in Renal failure and what are the values? • BUN • 10-15 • Fractional Na+ excretion • >2% • Creatinine • <20 325 What is the extravasation order? • Pavementing • Margination • Diapediesis • Migration What is the rate limiting enzyme for Glycolysis? • • PFK-1 What is the rate limiting enzyme of Gluconeogenesis? • • Pyruvate Carboxlyase If treating a disease that initiates the cell mediated response. what next? Fungal Mycobacterium Protozoa Parasite Neoplasm 326 327 328 329 What bugs can you pick up during birth? • Step. Pneumonia • Herpes simplex virus • Neisseria gonorrhea • Chlyamydia What is another name for Adenoma sebaceum? • • Perivascular angiofibromata What is another name for Addison’s? • Primary Adrenocoritcal Insufficiency What is another name for Alkaptonuria? 330 331 332 42 . what are you treating first? • Viral • • • • • • • If resistant to tx.

3/29/2012 • Ochronosis 333 What is another name for Churg-Strauss? • Allergic Granulomatosis • Angiitis What is another name for Craniopharyngioma? • Ameloblastoma • What is Ameloblast? • Tooth material 334 335 What is another name for Chrons? • Regional enteritis • Granulomatous ileitis • Ileocolitis What is another name for DeQuervain’s? • Subacute Granulomatous Thyroiditis What is another name for Intraductal Ca? • Comedo Ca What is another name for I-Cell Disease? • Mucolipidosis II What is another name for Kawassaki Disease? • MLNS • Mucocutaneous Lymph Node Syndrome What is another name for Leydig cells? • Interstitial cells What is another name for Sertoli cells? • Sustentacular cells What is another name for Temporal arteritis? • Giant cell arteritis (granulomatous) What is another name for Waldenstrom’s macroglobulinemia? • Hyperviscosity syndrome HHV I causes? • Oral • Trigeminal ganglia HHV II causes? • Genital • Sacral plexus HHV III causes? • Varicella zoster HHV IV causes? • EBV • Mononucleosis 336 337 338 339 340 341 342 343 344 345 346 347 43 .

• What pathway does it affect? • Extrinsic pathway • • What does it do to PT? • Prolongs • • PT • Answer the following questions about Coumadin/Warfarin. • Administration? 349 350 351 352 353 354 355 356 44 . • What is the MOA? • Interferes with normal synthesis and gama carboxylation of Vit. • • Is it long or short acting? • Long half-life • 8-10 hours to act Answer the following questions about Coumadin/Warfarin. K dependent clotting factors via vitamin K antagonism. • What are the toxicities? • Bleeding • Teratogenic • Drug-drug interactions • • How is it activatied? • Tissue activated Answer the following questions about Coumadin/Warfarin. • Clinical use? • Chronic anticoagulation • • Contra-indication? • Pregnancy because it can cross the placenta Answer the following questions about Coumadin/Warfarin.3/29/2012 • Burkitt’s 348 HHV V causes? • CMV • Inclusion bodies HHV VI causes? • Roseola • Duke Disease • Exanthem subitum HHV VII causes? • Pityriasis rosea HHV VIII causes? • Kaposi’s sarcoma Answer the following questions about Coumadin/Warfarin.

DVT. stroke.3/29/2012 • po • • 357 What are the Vitamin K dependent clotting factors? • II • VII • IX • X • Protein C • Protein S Answer the following questions about Heparin. • • Drug of choice for what? • DVT 358 359 360 361 362 45 . • Administration? • I. • What are the toxicities? • Bleeding • Thrombocytopenia • Drug-drug interactions • • How is it activatied? • Blood activated Answer the following questions about Heparin. • • Contra-indication? • Can be used during pregnancy because it does not cross the placenta Answer the following questions about Heparin. • Clinical use? • Immediate anticoagulation of pulmonary embolism. MI. • What pathway does it affect? • Intrinsic pathway • • What value should you follow? • PTT • Answer the following questions about Heparin. angina. • What is the MOA? • Catalyzes the activation of antithrombin III • Decreases thrombin and Xa • • Is it long or short acting? • Short half-life • Acts immediately Answer the following questions about Heparin.V.

3/29/2012 • 363 Answer the following questions about Heparin. • What is good about the newer low-molecular-weight heparins? • They act more on Xa • Have better bioavailability • Have 2 to 4 times longer half life • Can be administered subcutaneously and without laboratory monitoring. What do you use for rapid reversal of heparinization? • Protamine sulfate How do you treat Lead Poisoning? • Dimercaprol How do you treat Benzodiazepine poisoning? • • Flumazenil How do you treat Anticholinesterase poisoning? • • Pralidoxime How do you treat Iron poisoning? • • Deferoxamine How do you treat Opioid poisoning? • • Naloxene How do you treat Barbituate poisoning? • • Bicarbonate • Doxapram What does Doxapram do? • Activates the respiratory center in the brain What is the treatment for Hypercholesterolemia? • Provostatin • Atrovastatin • Lovastatin • Simvastatin What statin is renally excreted? • Provastatin What statins do you have to follow liver enzymes every 3 months? • Atrovastatin • Lovastatin • Simvastatin What do statins inhibit? • HMG-CoA reductase 364 365 366 367 368 369 370 371 372 373 374 375 46 .

Kidney stones • Due to What? • Alcohol 378 379 380 What are 4 causes of severe pain (in order)? • 3.3/29/2012 • When is it most active? • 8:00pm on 376 If statins are insufficient what do you add? • Cholestipol • Cholestyramine • If nothing works what do you give? • Probucol • Niacin • 377 What are the side effects of Niacin? • Flushing • Itching What 2 statins bind bile salts? • Cholestipol • Cholestyramine • What are 4 causes of severe pain (in order)? 1.Ischemic bowel • What is symptom? • Bloody diarrhea 381 What are 5 causes of SIADH? • Small cell Ca of lung • Increased intracranial pressure • Pain (most common) • Drugs • Hypoxic Lung Disease/Restrictive Lung disease What drug causes SIADH? • Carbamazepine What are the cells of neural crest origin? • Parafollicular cells of thyroid • Odontoblasts (predentin) 382 383 47 .AAA • How is this described? • Ripping pain down back 4.Pancreatitis • Due to What? • ETOH 2.

3/29/2012 • • • • • • 384 Pseudounipolar cells Spiral membrane of heart Chromaffin cells All Ganglion cells (Schwann. Adrenal medulla) Melanocytes Laryngeal/Tracheal cartilage What are the triple repeat diseases? • Huntington’s • Fragile X • Myotonic Dystrophy • Prauder Willie • Spinal/bulbar muscular atrophy (Fredicks ataxia) How do you determine the maximum sinus rate? • 220 .age What are the 3 low volume states with acidosis rather than alkalosis? • RTA • Diarrhea • Diabetic ketoacidosis (DKA) What are the causes of Croup & Bronchiolities? • Parainfluenza • Adenovirus • Influenza • RSV What is asthma in a child less than 2 called? • Bronchiolitis What are the 4 D’s of Pellagra? • Diarrhea • Dermatitis • Dementia • Death What are the uric acid stones? • Cysteine • Ornithine • Lysine • Arginine What is happening in the Atrium? • Phase 0? • Depolarization • Phase 1? • No name • Phase 2? 385 386 387 388 389 390 391 48 .

3/29/2012 • Plateau phase (A-V node) • 392 What is happening in the Atrium? • • • • • • Phase 3? Repolarization Phase 4? Automaticity (S-A node) 393 What do Na+ channels do to the EKG? • Wider QRS What does Ca+ do to the EKG? • Wider P-wave • Longer PR interval What are the types of kidney stones? • Calcium oxalate (phosphate) stones • Struvite stones • Uric acid stones • Cysteine stones • Oxalate stones What percent of kidney stones are calcium oxalate? • 80% If you find oxalate stones in the following what should you think of? • 3 y/o white male? • CF • • 5 y/o black male? • Celiac Sprue If you find oxalate stones in the following what should you think of? • Adult male? • Whipple’s • Adult male or female? • Crohn’s • 394 395 396 397 398 399 If oxalate stones found in CF what is the most common cause? • In 0-20 y/o? • Malabsorptin • • What age do they die? • Young 1 400 Answer the following questions about pseudogout? • What type of crystals are present? • Calcium pyrophosphate 49 .

6 dPhosphatase • G-6-Phosphatase What are 3 enzymes seen ONLY in glycolysis? • Hexokinase • PFK-1 • Pyruvate kinase 402 403 404 405 406 407 408 409 50 .3/29/2012 • Where are they found? • Joint spaces 2 • • • • Answer the following questions about pseudogout? • Who gets it? • Older patients M=F • Tx? • Colchicine 401 1 2 • • • • What are the most common non-cyanotic heart disease? • VSD • ASD • PDA • Coarctation What murmur increases on expiration? • VSD • Mitral What murmur has fixed wide splitting? • ASD What murmur has bounding pulses? • PDA What gives you differenital pulses? • Coarctation What is increased incidence in Turners? • Coarctation What are 4 enzymes never seen in glycolysis? • Pyruvate carboxylase • PEP carboxykinase • F-1.

Aureus • Pseudomonas What are the 2 bacteria with toxins that inhibit EF-2? • Pseudomonas • Diptheria How does Diptheria work? • It ADP ribosylates EF2 inhibiting protein synthesis • Is it Gram +/-? • + • Where and how does it get its exotoxin? 416 417 418 419 420 51 .3/29/2012 410 What are 2 hormones that are acidophilic? • Prolactin • GH What are the partially acid fast Gram +ve? • Nocardia What are the partially acid fast Protozoa? • Cryptosporidium What are the septic emboli of SBE? • Mycotic aneurysm • Roth spots • Janeway lesions • Osler’s nodes • Splinter hemorrhages • Endocarditis 1 411 412 413 414 Where are the following lesions found? • Janeway lesions? • Toes • Osler’s nodes? • Fingers • Roth spots? • Retina 2 415 What is the most common cause of endocarditis? • Strep. viridans What causes microsteatosis? • Acetaminophen • Reye Syndrome • Pregnancy What causes macrosteatosis? • Alcohol What are 2 bacteria that release elastase? • Staph.

flat bones • 424 425 What are the stages of erythropoiesis? • 8 mo gestation? • Long bones • 1 yr old? • Long bones • 426 If long bones become damaged after 1 yr what takes over? • Spleen can resume erythropoieses causing splenomegaly 52 .3/29/2012 • From virus via transduction 421 How does Diptheria work? • What does it cause? • Heart block • What do you give for Tx? • Antitoxin • Never scrape membrane 422 1 What are the different types of Emphysema and their causes? • Bullous? • Staph aureus • Pseudomonas • Centroacinar? • Smoking • • What are the different types of Emphysema and their causes? 2 423 1 • Distalacinar? • Aging • Panacinar? • Alpha-1 antitrypsin def 2 • • What are the stages of erythropoiesis? • 4 mo gestation? • Yolk sac • 6 mo gestation? • Spleen. liver.

P. Clue 4 Bio Stat In EKG P-wave Represents? • Atrium contraction • Phase zero • Calcium In EKG P-R Interval means? • AV Node • Phase 2 • Sodium In EKG Q-Wave means? • Septum • Phase 2 • Sodium In EKG R-upstoke means? • Anterior wall • Phase 2 • Sodium In EKG S-down stroke means? • Posterior wall • Phase 2 • Sodium In EKG S-T Interval means? 430 431 432 433 434 435 436 437 53 .3/29/2012 427 What ions correspond with the following EKG? • P-wave? • Ca+ • QRS complex? • Na+ • S-T? • Ca+ 428 What ions correspond with the following EKG? • T-wave? • K+ • U-wave? • Na+ 429 What do Na+ channel blockers do to the EKG? • QRS What do Ca+ channel blockers do to the EKG? • Widens P-wave • PR interval longer P.

3/29/2012 • Ventricle • Phase 2 • Calcium 438 In EKG T-wave means? • Ventricle • Phase 3 • Potassium • In EKG U-wave means • Ventricle • Phase 4 • Sodium 4 DZ associated with HLA-DR 2? • Narcolepsy • Allergy (hay fever) • Goodpasture • MS 5 DZ associated with HLA-DR 3? • DM • Chronic active Hepititis • Sjogrens • SLE • Celiac sprue DZ associated with HLA-DR 3&4? • IDDM (DM Type 1) DZ associated with HLA-DR 4? • Rheumatoid Arthritis • Pemphigus Vulgaris DZ associated with HLA-DR 5 • JRA (JUV RA) • Pernicious anemia DZ associated with HLA-DR 7? • Nephrotic syndrome (Steroid induced) DZ associated with HLA-DR 3 and HLA-B 8? • Celiac Disease DZ Associated with HLA-A3? • Hemochromatosis – chromosome 6 – point mutation Cystine to Tyrosine DZ Associated with HLA-A 3? • Myasthenia gravis DZ Associated with HLA-B 13? • Psoriasis 5 DZ Associated with HLA-B 27? 439 440 441 442 443 444 445 446 447 448 449 450 54 .

Pneumonia • MCC of Pneumonia in 40 yrs to 65 yrs of age? • Strep pneumonia • H.influenza • Gr –ve rods What are 4 Clues for IgA? • Monomer in blood • Dimer in secretion • Located on mucosal surface • Found in secretion What are Clues for IgD? • Only functions as surface marker for Mature B-Cell What are Clues for IgE? • Immediate hypersensitivity/anaphylaxis 452 453 454 455 456 457 458 459 55 .3/29/2012 • Psoriasis – only if with arthritis • Ankylosing Spondylities • IBD – Ulcerative Cholitis • Reiter’s • Post gonococcal arthritis 451 DZ Associated to HLA-BW 47 • 21 alpha hydroxylase deficiency – Vit. D Facts about Diphtheria • ADP ribosylates EF-2 • Stops cell synthesis • Gr +ve • Gets exotoxin from virus via transduction • Heart block • Its toxoid therefore give antitoxin MCC of Pneumonia in 6wks to 18 yrs? • RSV (infants only) • Mycoplasma • Chlamydia pneumonia • Strep pneumonia MCC Pneumonia in 18 yrs to 40 yrs of age? • Mycoplasma • Chlamydia pneumonia • Strep. influenza • Anaerobes MCC of pneumonia in the Elderly? • Strep pneumonia • Viruses • Anaerobes • H.

Gamma What does TH2 Secrete? • IL-4 • IL-5 • IL-6 • IL-10 What does TH-0 secrete? • TH-1 462 463 464 465 466 467 468 469 56 .3/29/2012 • • • • • • • 460 Parasite defense Worms Fc region binds to mast cells and basophils Allergies Does Not fix complement What are Clues for IgG? • Highest affinity • Memory respond at day 3 five times the concentration • Peaks in 5 years last for 10 years • Opsonizes • Activates complement • 2nd to show up in primary response • Only one to show up for secondary respond • Most abundant Ig in newborn • Antigenic differences in heavy chain and site of di-sulfide bond • 4 subclasses G1 to G4 • 461 What are Clues for IgG1? • Crosses placenta due to fc portion What are Clues for IgG2? • Most common sub-class deficiency • Patient susceptible to encapsulated organisms What are Clues for IgG3? • Most memory antibody What are Clues for IgG4? • Only IgG NOT fixing complement What are Clues for IgM? • Responds in primary response • Most efficient in agglutination and complement fixation • Defenses against bacteria and viruses What do Macrophages release? • MHC II What does TH1 secrete? • IL-2 • IF.

.3/29/2012 • TH-2 470 MHC-1 are also called what? • CD8 • CD8 becomes T-cytotoxic cells All T-Cells express what? • CD-3 • For what? • Signal transduction • CD-2 • For what? • Adherence 471 472 What do CD-4 cells Become? • T helper cells What do CD-8 cells Become? • T cytotoxic cells Neutrophils produce what enzymes and what is their action? • Myeloperoxidase • NADPH • Will kill ALL Gr+ve – Ex.Hydrogen peroxide kills gr+ What do T-cells stimulate? • Clue 4x7=28 • CD-4 • B-7 • CD-28 • 473 474 475 476 What are the Clues for Type-1 Hyperlipidemia? • Increased Chylomicron • Deficiency of Lipoprotein lipase enzyme • Defect in liver only What are the Clues for type-2 hyperlipedimia? • Increased LDL • Two types IIa and IIb • Type IIa Receptor deficiency for LDL or missing B-100 • Type II-b (LDL and VLDL problems) enzyme deficiency for LDL at adipose. Receptor problem for VLDL. Most common in General Population What are the Clues for type-3 Hyperlipedimia? • Increased IDL • Receptor problem for APO-E What are the Clues for Type-4 hyperlipedimia? • Increased VLDL • Lipoprotein lipase enzyme deficiency at adipose tissue 477 478 479 57 .

Jones critera ERYTHEMIA CHRONICUM MIGRANS • Lymes disease • Target lesions (bulls eye) MEASLES • Morbiliform rash • Preceded by cough • conjunctiivitis ROSEOLA • Fever x 2 day • Followed by rash • ONLY ONE WITH RASH FOLLOWING FEVER (HHV 6) ERYTHEMA NODOSUM • Anterior aspect of leg • Redness • Tender nodules Erythema multiforme • Red macules. target lesions • Causes: allergy. face • Can cause what? • Pancreatitis Description of Rashes ERYTHEMA MARGINATUM • Little red spots w/ bright red margins • Sandpapery • RF. viruses • Mild: MCC virus. skin peels off SEBORRHEIC DERMATITIS • Scaly skin with oily shine on headline SEBORRHEIC KERATOSIS • Stuck on warts • Due to aging 481 482 483 484 485 486 487 488 489 490 491 58 .3/29/2012 480 What are the Clues for Type-5 hyperlipedimia? • Combination of Types 1&4 • Increased Chylomicron and VLDL • Enzyme and receptor deficiency at C-II • Most common in diabetics What is a Xanthoma? • Deposition of Cholesterol on elbows • Can cause what? • CAD What is a Xanthelasma? • Deposition of Triglycerides on eyelids. #2 drugs (sulfas) • Moderate: Stevens-Johnsons Syndrome • Severe: Toxic epidermal necrolysis .

with flare up of celiac sprue • TYPHOID FEVER • SEEN WITH SALMONEALLA INFXN • Rose spots assoc. with diarrhea • Assoc.K.A. thighs • Assoc. upside down christmas tree • Tx: Griseofulvin What do you see in SCABIES? • Linear excoriations on belt line and finger webs • What is the tx? • Lindane • Permethrin What is a T-CELL DEFICIENCY? 493 494 495 496 497 498 499 500 501 502 59 . with intestinal fire DERMATOMYOSITIS • Heliotropic rash ERYSIPELAS • Reddened area on skin w/ raised borders • DOES NOT BLANCH TINEEA CRURIS • Redness • Itchy groin PITYRIASIS ROSEA • Herald patch= dry skin patches that follow skin lines • HHV 7 TINEA VERSICOLOR • Hypopigmented macules on upper back • Presents in a V pattern • A.3/29/2012 492 PSORIASIS • HLA-B27 • Extensor surfaces • Silvery white plaques • Scaly skin • Pitted nails VARICELLA ZOSTER HHV 3 • STAGES • Red macules • Papules • Vesicles • Pustules then scabs • Different stages may appear at same time • DERMATITIS HERPATIFORMIS • Rash and blisters on ant.

3/29/2012 • • • • • • • 503 DiGeorges What ion imbalance will they have? Hypokalemia What did not form? 3rd and 4th pharyngeal pouch What chromosome? Deletion on chromosome 22 T-CELL DEFICIENCY • HIV • Also B-cell but less so What is MYCOSIS FUNGOIDES? • NOT A FUNGUS • Non-Hodgkins form of cutaneous T-cell lymphoma What is the job of CHYLOMICRONS? • Transport TG’s from GI to liver and endothelium What is the job of VLDL? • Transports TG’s from liver to adipose What is the job of IDL? • Transports TG’s from adipose to tissue What is special about LDL’s? • ONLY ONE THAT CARRIES CHOLESTEROL What do you develop with HYPERTRIGLYCERIDEMA? • XANTHELASMA • • Where are they located? • On eyelids and eyebrows What do you develop with HYPERCHOLESTEROLEMIA? • Xanthomas • • Where are they located? • elbows Where is VLDL made? • ONLY ONE MADE IN THE LIVER What are IDL AND LDL formed from? • ARE BREAK DOWN PRODUCTS OF VLDL What are the clues for HEMOPHILIUS INFLUENZA? • Gram -/+? • Pleomorphic gram (-) rods • What pattern? • “school of fish pattern” • What type is most common? • Type A – 80% What are the clues for HEMOPHILIUS INFLUENZA? 504 505 506 507 508 509 510 511 512 513 514 60 .

meningitides • (adolescent years only) What are the most common causes of MENINGITIS corresponding with the following ages? • 10yrs. coli • #3. n. n.21 yrs? • #1. strep pneumonia • #2. Group B strep (agalactiae) • #2. E. meningitides What are the most common causes of MENINGITIS corresponding with the following 516 517 518 519 520 521 61 .3/29/2012 • • • • 515 Capsule or no capsule? non-encapsulated Invasive or non invasive? non-invasive What are the clues for HEMOPHILIUS INFLUENZA? • Most common cause of what? • Sinusitis • Otitis • Bronchitis What are the clues for HEMOPHILIUS INFLUENZA? • What is the 2nd most common type? • TYPE B – 20% • Encapsulated or non encapsulated? • Encapsulated • What does it have in its capsule? • Polyribosyl phosphate in capsule • Contains IgA protease What are the clues for HEMOPHILIUS INFLUENZA? • • Invasive or non invasive? • Invasive • What does it cause most often? • #1 cause of epiglottitis • What are the signs of epiglottitis? • Stridor • Fever • Thumb sign on xray What are the most common causes of MENINGITIS corresponding with the following ages? • 0-2 months? • #1.10 years? • #1. Listera What are the most common causes of MENINGITIS corresponding with the following ages? • 2 Months.

3/29/2012 ages? • > 21 years old? • #1 S. Pneumonia vaccine.6 months • What strain does it cover? • Covers 23 strains (98% cases) Answer the following about the Strep. saprophyticus? • No pigment What is the clue for RUSTY COLORED SPUTUM? • Strep.B cell deficiency? • Job Syndrome: • IL-4 • Hyper IgE • What do they look like? • Red hair • Fair complexion 62 . Pyogenes • Small Intestine Infections? • Say E. • Indications? • Anyone> 65y/o • Anyone splenectomized – Sickle cell anemia • Anyone with end-organ damage – CF – RF – Nephrotic Syndrome STREP PYOGENES is the most common cause of what? • MCC of all throat infections • #2 MCC of all what? • Skin infections except lines What are the STAPHYLOCOCCUS PIGMENTS? • St. epidermidis? • White pigment • St.4. pneumoniae 522 Answer the following about the Strep. Pneumonia – pneumococcus Clues for GENERAL INFECTIONS • Skin Infections? • Say Staph. Aureus • Throat Infections? • Say Strep. coli 523 524 525 526 527 528 What disease is a NEUTROPHIL DEFICIENCY & T. aureus? • Gold pigment • St. Pneumonia vaccine. • At what age is it given? • Given at 2.

3/29/2012 • Female 529 What are the NEUTROPHIL DEFICIENCY? • NADPH-OXIDASE DEF (CGD) • NEUTROPENIA • MYLOPEROXIDASE • Job-Buckley Syndrome What Hepatitis B antigen is found with an acute/recent infection? • HbC antigen • HbS antigen What Hepatitis B antigen & antibody is found with an acute/recent infection? • • HbC antigen • HbS antigen • HbC antibody What Hepatitis B antigen is found with Recent immunization within the past 2wks? • • HbS antigen ONLY What Hepatitis B antibody is found with Recent immunization two wks after and can be due to vaccination immunity from a long time ago? • • HbS antibody ONLY What Hepatitis B antibody & antigen is found with past disease but now immune? • • HbC antibody • HbS antibody • HbS antigen What Immunogloblin is found in Hepatitis B immunity? • • IgG What Hepatitis B antigen/antibody is found in the chronic carrier state? • • HbS antigen for >6months • Can be with or without HbS antibody What Hepatitis B antigen is found with the infectious state? • • HbE antigen What Hepatitis B antibody is found with the non-infectious state? • • HbE antibody If patient has recovered from Hepatitis B what antigen will they have? • • NEGATIVE HbS antigen If patient is a chronic carrier what antigen will they have? 530 531 532 533 534 535 536 537 538 539 540 63 .

3/29/2012 • • POSITIVE HbS antigen 541 What does the “window period” build in Hepatitis B? • • HbE antibody • IgM HbC antibody • What disappears? • HbS antigen • • 542 What is the incubation period for Hepatitis B? • • 4 to 26 wks • Average @ 8wks • How long is the acute disease period in Hepatitis B? • • 4 to 12 wks How long is the convalescence period in Hepatitis B? • • 4 to 20 wks How long is the recovery period for Hepatitis B? • • YEARS Answer the following about HIV? • MC infection? • CMV • MCC of death? • PCP • What is p41 used for? • Just a marker Answer the following questions about HIV? • What does Gp120 do? • Attachment to CD4 • What is Pol used for? • Integration • What is reverse transcriptase used for? • Transcription • What are p17 & p24 antigens used for? • Assembly • Answer the following questions about HIV? • What is the normal CD4 count? • 800-1200 • What can the CD4 count be up to in children? 543 544 545 546 547 548 64 .

3/29/2012 • 1500 • When do you begin treating with 2 nucleotide inhibitors and 1 protease inhibitor? • <500 – (child at 750) 549 Answer the following questions about HIV? • AIDS is defined as a CD4 count of what? • <200 • With a CD4 count of <200 what do you tx for? • PCP • What do you treat for when CD count is <100? • Mycobacterium aviam intracellular What are the Antioxidants? • Vitamin E – #1 • Vitamin A • Vitamin C • Betakertine What is Vitamin A a cofactor for? • Parathyroid • • Along with what other cofactor? • Mg+ Too much Vitamin A will cause what? • Hyperparathyroid – Increase Ca+ – Decrease Phosphate • What will be the symptoms? • Goans • Moans • Bones • Stones Too much Vitamin A will cause what? • Pseudotumor Cerebri – Increase CSF production from Chorichoid Plexus What is the only cause of ICP that does not cause herniation? • Pseucotumor cerebri What does Vitamin A deficiency cause? • • Nightvision problems/nightblindness • • Hypoparathyroidism – Decrease Ca+ – Increase Phosphate What is Vitamin B1? • THIAMINE • 550 551 552 553 554 555 556 65 .

3/29/2012 • • • • • 557 What do you get with a decrease in thiamine? Beri Beri What is the most common cause in US? ETOH What do you get with Vitamin B1 deficiency? • Wet Berry Berry • With heart failure • • Dry Berry Berry • Without heart failure What do you get with Vitamin B1 deficiency? • Wernicke’s Encephalopathy • Wernicke’s Korsakoff 558 559 What is Wernicke’s Encephalopathy? • • Alcoholic thymine deficiency of the Temporal Lobe What is Wernicke’s Korsakoff? What needs B1 as a Cofactor? • 3 Dehydrogenases • Pyruvate dehydrogenase • Alpha ketoglutarate dehydrogenase • Branch chain amino acid dehydrogenase • • Transketolase What is B2 • Riboflavin • • What is a physical sign of this deficiency? • Angular stomatitis • Angular cheliosis • Corneal Neurovasculazations What is the best source of B2? • Milk • Also from FAD What is B3? • Niacin • • What is the clue? • Diarrhea • Dermatitis • Dementia • Death What is the disease that presents like B3 deficiency? • Hartnup Disease 560 561 562 563 564 565 66 .

3/29/2012 • • • • • • 566 What is deficient in this disease? Tyrptophan What is typtophan needed for? Needed for niacin formation What is B4? • Lipoic acid • • What is the deficiency caused by this vitamin? • Not one 567 What is B5? • Pantothenic acid • • What is the deficiency caused by this vitamin? • You guessed it…nothing What is B6? • Pyridoxine • • • • • • What is the deficiency caused by this vitamin? Neuropathy Seizures Who do you need to give B6 to? Patient on INH 568 569 What type of anemia is seen with B6 Deficiency? • Sideroblastic What needs B6 as a cofactor? • ALL transaminases What is B12? • Cyanocobalamine • • What is the deficiency caused by this vitamin? • Pernicious anemia • Neuropathy What is the most common cause of vitamin B12 deficiency? • Pernicious anemia What 2 enzymes are needed for synthesis of B12? • Methylmalonyl CoA Mutase • Homocysteine Methyl Transferase Deficiency in Methylmalonyl CoA Mutase leads to what? • • Neuropathy • • Why? 570 571 572 573 574 67 .

RIBOFLAVIN deficiency What are the 4 D’S of pellegra? • DIARRHEA • DERMATITIS • DEMENTIA • DEATH What causes a NEUROPATHY WHEN DEFICIENT & also needs TRANSAMINASE? • PYRIDOXINE B6 What vitamin is deficient with PERNICIOUS ANEMIA & NEUROPATHY? • B12 CYANOCOBALAMINE What is the first vitamin to run out with disease of rapidly dividing cells? • • Folate • • What type of anemia is seen with Folate deficiency? • Megaloblastic anemia • • With neuropathy? • NO NEUROPHATHY • • What else is Folate used for? • Nucleotide synthase (THF) What is another name for Vitamin C? • Ascorbate acid What is Vitamin C needed for? • Collagen synthesis What happens with Vitamin C deficiency? • Scurvy What is the CLUE for Scurvy? • Bleeding gums • Bleeding hair follicles What is the most common cause of Vitamin C deficiency? • Diet deficient in citrus fruit • Diet deficient in green vegetables • Over cooked green vegetables 576 577 578 579 580 581 582 583 584 585 586 68 .3/29/2012 • Because it recycles myelin 575 Deficiency in Homocystiene Methyl Transferase leads to what? • Megaloblastic anemia • • What else is this enzyme needed for? • Nucleotide synthesis When is ANGULARE STOMATOSIS seen? • VITAMIN B2.

3/29/2012 587 What does Vitamin D do with Ca+? • Controls Ca+ • Absorbes Ca+ from GI • Reabsorbs Ca+ in Kidneys • • Controls osteoblastic activity What does Vitamin D deficiency cause in Children? • Ricketts • • What does it cause in ADULTS? • Osteomalcia What is the CLUE for RICKETTS? • Lateral Bowing of the Legs • X-linked dominant What is Vitamin E needed for? • Hair • Skin • Eyes • Protection against free radicals • #1 antioxidant What does a deficiency of Vitamin E cause in newborns? • • Retinopathy What are the vitamins from GI that are normal flora? • Folate • Vitamin K – 90% • Biotin • Panothenic acid • Helps with absorption of B12 • What are the Vitamin K dependent clotting factors? • 1972 • Protein C • Protein S • • Which one has the shortest half-life? • Protein C • • Which one has the 2nd shortest half-life? • 7 What are the TRACE elements? • Chromium • Selenium • Manganese Molebdenum 588 589 590 591 592 593 594 69 .

3/29/2012 • Tin • • • 595 What is Chromium needed for? • Insulin action What organ needs Selenium? • Heart What trace element is an enzyme in glycolsis? • Manganese Molebdenum What organ needs Tin? • Hair What does a deficiency in Zinc cause? • Dysguzia • Decrease sperm • Dry hair • Dry skin Cofactor for ALL Kinases? • Mg+ Cofactor for ALL Carboxylases? • Biotin Cofactor for ALL Transaminases? • Pyridoxine – B6 What is Biotin a cofactor for? • ALL carboxylases What is Mg+ a cofactor for? • ALL kinases • Parathyroid along with Vitamin A What is Ca+ needed for? • Muscle contraction • Axonal transport • 2nd messengers What tracts are affected due to deficiency in Methyl Malonyl CoA Mutase? • • Dorsal Columns • Cortical Spinal Tracts • • Why are these affected? • Because they are the longest • Because they need the most myelin What enzyme does Zanthein Oxidase need? • 596 597 598 599 600 601 602 603 604 605 606 607 70 .

3/29/2012 • Maganese Molebdenum 608 How are drugs that are bioavailable ALWAYS excreted? • By the liver • Always Hepatotoxic How are soluble drugs ALWAYS excreted? • By the kidney • Always nephrotoxic What are the 5 P’S OF COMPARTMENT SYNDROME? • Pain • Pallor • Paresthesia • Pulselessness • Poikilothermia • What are 5 skin infections were Strep. Pyogenes is the number one cause? • Lympangitis • Impetigo (not bullous) • Necrotizing fascitis • Erysepelas • Scarlet fever What are 5 skin infections were Staph. aureus is the number two cause? • Lympangitis • Impetigo (not bullous) • Necrotizing fascitis • Erysepelas • Scarlet fever • What is the #1 bacteria causing infection associated in shunts and central lines? • • Staph epidermitis What is the #1 bacteria causing infection in peripheral lines? • Staph aureus Why do we need E. B12 • Synthesis of: • -Vitamin K • -Biotin • -Folate • -Pantothenic acid –B5 Answer the following questions about RESTRICTION ENZYMES? • Trypsin cuts where? • cuts to R of • Arg • Lys 609 610 611 612 613 614 615 616 71 . COLI in the gut? • Absorption of Vit.

3/29/2012 • • • • • 617 Chymotrypsin cuts where? cuts to R of bulky aa’s (aromatics) Phe Tyr Trp Answer the following questions about RESTRICTION ENZYMES? • Elastase cuts where? • Cuts to R of (“SAG”) • Ser • Ala • Gly • CNBr cuts where? • Cuts to R of • Methionine 618 Answer the following questions about RESTRICTION ENZYMES? • Mercaptoethanol cuts where? • Cuts to R of: disulfide bonds – Cysteine – methionine Answer the following questions about RESTRICTION ENZYMES? • Aminopeptidase cuts where? • Cuts to R of • amino acid terminal • Caboxypeptidase cuts where? • Cuts to L of • carboxy terminal 619 620 What is THE ONLY LIVE VACCINE INDICATED IN AIDS PATIENTS? • MMR What VACCINE is NOT GIVEN IF pt. is Allergic to EGG? • MMR & INFLUENZA What VACCINE is NOT GIVEN IF patient HAS YEAST ALLERGIES? • Hepatitis B What 3 VACCINES DROP OUT AFTER 6 YEARS OF AGE? • Hib • Diphtheria • Pertussis What is the MC STRAIN OF STREP PYOGENES TO CAUSE GN? • Strain 12 What 2 substances are in NEUTROPHILS? • Myeloperoxidase • NADPH Oxidase 621 622 623 624 625 72 .

therefore.3/29/2012 626 MACROPHAGES CONTAIN what SUBSTANCE? • NADPH Oxidase • • Which means they only kill what? • Kills only G -ve What do MACROPHAGES SECRETE? • IL-1 • IL-6?? What DRUGS CAUSE PAINFUL NEUROPATHY? • DDI>DDC • Pancreatitis What are the MITOCHONDRIAL DISEASES? • Leigh’s Disease • What is another name? • Subacute necrotizing encephalomyelopathy • What are the signs & symptoms? • Progressively decreasing IQ • Seizure • Ataxia • What is the deficiency? • Cytochrome oxidase deficiency What are the MITOCHONDRIAL DISEASES? • Leber’s Hereditary Optic Atrophy (LHON) • They all die 627 628 629 630 631 What is the ONLY G +ve WITH ENDOTOXIN? • Listeria • • • • • What part is toxic? Lipid A Does it cross the placenta? Yes 632 What does Listeria activate? • T-cells & Macrophages. have granulomas 633 What are the Associations in contracting the Listeria bug? • Raw cabbage • Spoiled milk • Migrant workers 73 .

3/29/2012 634 What are the PERIODS OF RAPID GROWTH/RAPIDLY DIVIDING CELLS? • • Birth – 2 months • 4 – 7 years old • Puberty What is THE ONLY IMMUNE DEFICIENCY WITH LOW CALCIUM and Increase Phosphate? • DiGeorge’s Syndrome What are the BASIC AMINO ACIDS? • Lysine • Arginine What are the ACIDIC AMINO ACIDS? • Glutamate • Aspartate What are the Ketogenic + Glucogenic Amino Acids? • Phenylalanine • Isoleucine • Trptophan • Threonine What are the AROMATIC AMINO ACIDS? • Phenylalanin • Tyrosine • Tryptophan What are the AMINO ACIDS with DISULFIDE BONDS? • Met • Cyst What are the “KINKY” AMINO ACID? • Proline What are the SMALLEST AMINO ACID? • Gly What are the AMINO ACIDS with O-BONDS? • Serine • Threonine • Tyrosine What are the AMINO ACIDS with N-BONDS? • Asparagine • Glutamine What are the BRANCHED-CHAIN AMINO ACIDS? • Leu • Iso • Val What are the KETOGENIC AMINO ACIDS? • Leu 635 636 637 638 639 640 641 642 643 644 645 646 74 .

3/29/2012 • Lys 647 What CONDITIONS are ASSOCIATED WITH HLA-B27? • Psoriasis (with arthritis) • Ankylosing Spondylitis • Irritable Bowel Syndrome • Reiter’s Syndrome What is associated with HLA-B13? • Psoriasis with out arthritis What are the ORGANISMS WITH IgA PROTEASE (resistant to IgA)? • Strep. Pneumoniae • H. influenza • Neisseria catarrhalis What do EOSINOPHILS SECRETE? • Histaminase • Arylsulfatase • Heparin • Major Basic Protein What do MAST CELLS SECRETE? • In an Acute Reaction? • Histamine • • In a Late Reaction ? • SRS-A • ECF-A What is the MCC of ATYPICAL PNEUMONIA? • 0 – 2 months? • chlamydia pneumonia • • What does chlamydia pneumonia cause? • Intersitital pneumonia What is the CLUE for HEART BLOCK? • High temperature with NORMAL pulse rate! • (This should never be! Each degree ↑ in temp. → 10 beats/min ↑ in pulse rate) What are the clues for IL-1? • FEVER • NONSPECIFIC ILLNESS • RECRUITS TH CELLS for LINKING with MHC II COMPLEX • SECRETED BY MACROPHAGES What are the clues for IL-2? • MOST POTENT OF THE Interleukins • RECRUITS EVERYBODY 648 649 650 651 652 653 654 655 656 75 .

3/29/2012 • • • • MOST POWERFUL CHEMO-ATTRACTANT MUST BE INACTIVATED When must you inactivate it? PRIOR TO TRANSPLANTATION by cyclosporin • SECRETED BY TH1 CELLS 657 What are the clues for IL-3? • ENERGIZED MACROPHAGES • CAUSES B-CELL PROLIFERATION • LABELED BY THYMIDINE (USE POKEWEED MITOGEN OR ENDOTOXIN) • SECRETED BY ACTIVATED T CELLS What are the clues for IL-4? • B-CELL DIFFERENTIATION • RESPONSIBLE FOR CLASS SWITCHING • SECRETED BY TH2 CELLS What are the clues for IL-5 thru 14? • They do exactly what IL-1 thru IL4 What are the clues for IL-10? • SUPPRESSES CELL-MEDIATED RESPONSE (tells macrophages and fibroblasts to stay away if bacterial) • INHIBITS MAC ACTIVATION What are the clues for IL-12? • PROMOTES CELL-MEDIATED RESPONSE (recruits macs & fibroblasts if NOT bacterial) • ACTIVATES NK CELLS TO SECRETE IF-γ • INHIBITS IL-4 INDUCED IgE SECRETION • CHANGES TH CELLS to TH1 CELLS – secretes IL-2 & IF-γ → inhib. TH2. therefore. defective protein synthesis Summary of clues for IF-α? • Increase NK activity • Increase MHC class I & II • Decrease protein synthesis • Decrease viral replication and growth What are the clues for IF-B? • Where is it from? • FIBROBLASTS • Increase NK activity 658 659 660 661 662 663 664 76 . therefore. ↑ host defenses against delayed hypersensitivity What are the clues for IF-α? • Where is it from? • LEUKOCYTES • ↓VIRAL REPLICATION AND TUMOR GROWTH • ↑ NK ACTVITY – secretes perforins and granzymes to kill infected cell • ↑MHC CLASS I & II EXPRESSION • ↓ PROTEIN SYNTHESIS – translation inhibited.

3/29/2012 • Increase MHC class I & II • Decrease protein synthesis • Decrease viral replication and growth 665 What are the clues for IF-gama? • Where is it from? • T-CELLS & NK CELLS • ↑ NK ACTIVITY • ↑MHC CLASS I & II • ↑ MACROPHAGE ACTIVITY • CO-STIMULATES B-CELL GROWTH & DIFFERENTIATION • ↓ IgE SECRETION What are the clues for TNF-alpha? • Where is it from? • MONOCYTES & MACROPHAGES • What is another name for TNF-alpha? • CACHECTIN • INDUCES IL-1 • ↑ ADHESION MOLECULES & MHC CLASS I ON ENDOTHELIAL CELLS • PYROGEN • INDUCES IF-γ SECRETION • CYTOTOXIC/CYTOSTATIC EFFECT What are the clues for TNF-beta? • Where is it from? • T-CELLS • What is another name for it? • LYMPHOTOXIN • • CYTOTOXIC FACTOR 666 667 668 What are the clues for TGF-α? • Where is it from? • SOLID TUMORS (CARCINOMA > SARCOMA) • MONOCYTES • What is another name for it? • TRANSFORMING GROWTH FACTORS 669 What are the clues for TGF-α? • What does it INDUCE? • ANGIOGENESIS • KERATINOCYTE PROLIFERATION • BONE RESORPTION • TUMOR GROWTH • What is it mainly for? 77 .

3/29/2012 • MAINLY FOR TUMOR GROWTH • 670 What are the clues for TGF-β? • Where is it from? • PLATELETS • PLACENTA • KIDNEY • BONE • T & B CELLS What are the clues for TGF-β? • • • • What INDUCES it? FIBROBLAST PROLIFERATION COLLAGEN FIBRONECTIN SYNTHESIS 671 672 What are the clues for TGF-β? • What INHIBITS it? • NK • LAK • CTL • T & B CELL PROLIFERATION What are the clues for TGF-β? • What ENHANCES it? • WOUND HEALING • ANGIOGENESIS What are the clues for TGF-β? • What does it suppress? • SUPPRESSES IR AFTER INFECTION & PROMOTES HEALING PROCESS • What is it mainly for? • MAINLY FOR WOUND HEALING 673 674 675 What does LAK stand for? • LYMPHOKINE ACTIVATED KILLER CELLS What does CTL stand for? • CYTOTOXIC T-LYMPHOCYTES What does mitochondrial inheritance affect? • CNS • Heart • Skeletal muscle • • Why does it affect these particular places? • Due to uneven cytokinesis during meiosis or oogenesis Answer the following about Mitochondrial diseases? • Who are affected? 676 677 678 78 .

3/29/2012 • • • • • • • 679 All offspring Who passes the disease? MOM Who has no transmission? Dad Answer the following about Autosomal Recessive inheritance? • Who does it show in? • Not parents • Siblings/uncles may show disease • • When is onset? • Early in life (childhood diagnosis) • • Is it complete on incomplete penetrance? • COMPLETE Answer the following about Autosomal Recessive inheritance? • How are they acquired? • Almost ALL are inborn error of metabolism • • When does it occur? • Only when both alleles at a locus are mutant Answer the following about Autosomal Recessive inheritance? • How is it transmitted? • Horizontal Tm • • Are there malformations present? • Physical malformations are uncommon • • What type of defect? • Enzyme defect Answer the following about Autosomal Dominant inheritance? • Who does it affect the most? • M=F • • How does it manifest? • Heterozygote state • • Who can transmit the disease? • Both parents Answer the following about Autosomal Dominant inheritance? • Where is the new mutation? • Often in germ cells of older fathers • • When is onset? 680 681 682 683 79 .

• What happens at day 4? • T cells and Macrophages show up • • What happens at day 7? • Fibroblasts show up • • What happens in 1 month? • Fibroblast peak Immune System Time Line for viral & cell-mediated. • What happens at 3-6 months? • Fibroblasts are gone What is the general CLUE for any Lysosomal Storage Disease? • • Lysosomal Inclusion Bodies 685 686 687 688 689 690 80 . • What happens <24hrs? • Swelling • • What happens at 24 hrs? • Neutrophils show up • • What happens at day 3? • Neutrophils peak Immune System Time Line for viral & cell-mediated.3/29/2012 • Often delayed (adult diagnosis) – Example = Huntington’s 684 Answer the following about Autosomal Dominant inheritance? • What is penetrance? • Reduced penetrance • • How is it expressed? • Variable expressin – Different in each individual Answer the following about Autosomal Dominant inheritance? • How is it transmitted? • Vertical TM • • Is there malformation present? • Physical malformation common • • What type of defect? • Structural Who is affected in the family with an X-Linked disease? • • Maternal grandfather • Maternal uncle Immune System Time Line for viral & cell-mediated.

Jew • Gargols • Gaucher cells – Macrophages looking like Crinkeled paper • Erlin myoflask legs • Pseudohypertrophy • What is missing in Fabrys? • Alpha-galactosidase • • What accumulates? • Ceramide Trihexoside What are the CLUES for Fabrys? • X-Linked recessive • Presents with cataracts as a child • Presents with renal failure as a child What is missing in Krabbes? • Galactosylceramide B-Galactosidase • • What accumulates? • Galactocerebrosidase • Where? • Brain 694 695 696 697 What are the CLUES for Krabbes? 81 .3/29/2012 691 What are the Lysosomal Storage diseases? • Gauchers • Fabrys • Krabbe • Tay Sachs • Sandhoffs • Hurlers • Hunters • Neiman Pick • Metachromatic Leukodystropy What is missing in Gauchers? • Beta-Glucocerberosidase • • What Accumulates? • Glucocebroside • • • • • Where? Brain Liver Bone Marrow Spleen 692 693 What are the CLUES for Gauchers? • Ask.

3/29/2012 • Early death • Globoid bodies – Fat cells 698 What is missing in Tay Sachs? • Hexoseaminidase A • • What accumulates? • GM2 Ganglioside • What is the CLUE for Tay Sachs? • Ask. Jews • Cherry red macula • Death by 3 What is missing in Sandhoffs? • Hexoseaminadase A & B What is missing in Hurlers? • Iduronidase What are the CLUES for Hurlers? • Corneal Clouding • Mental Retardation What is missing in Hunters? • Iduronate Sulfatase What are the CLUES for Hunters? • Mild mental retardation • No corneal clouding • Mild form of Hurlers • X-linked recessive What is missing in Niemann Picks? • Spingomyelinase • • What accumulates? • Spingomyelin • Cholesterol What are the CLUES for Niemann Picks? • Zebra bodies • Cherrry red macula • Die by 3 What is missing in Metachromatic Leukodystrophy? • Arylsulfatase A What is the CLUE for Metachromatic Leukodystrophy? • Visual Disturbance • Presents like MS in 5 to 10 years of age What are the Glycogen Storage Diseases? 699 700 701 702 703 704 705 706 707 708 709 82 .

3/29/2012 • • • • • • 710 Von Gierkes Andersons Corys McCardles Pompes Hers What is deficient in Von Gierkes? • G-6-Pase Deficiency What is the CLUE for Von Gierkes? • Big Liver • Big Kidney • Severe hypoglycemia • Can NEVER raise their blood sugar • What is deficient in Andersons? • Branching enzyme deficiency What is the CLUE for Andersons? • Glycogen will be ALL LONG chains on liver biopsy What is missing in Corys? • Debranching enzyme What is the CLUE for Corys? • Glycogen from liver biopsy will be ALL SHORT branches What is missing in McCardles? • Muscle phosporalase What is the CLUE for McCardles? • Severe muscle cramps when exercising • High CPK What is missing in Pompes? • Cardiac alpha-1.4 glucocydase What is the CLUE for Pompes? • Heart problems • Die early What is missing in Hers? • Liver phosphoralase What is the CLUE for Hers? • Big Liver • NO big kidney Pagets disease is associated with what cancer? • Intraductal Ca What MUST you rule out with a decrease AVO2? • • AV Fistula • Vasodilation 711 712 713 714 715 716 717 718 719 720 721 722 723 83 .

what should you be thinking? • • Lead poisoning What are the Microcytic Hypochromic Anemias? • Iron deficiency • Anemia of Chronic disease • Lead poisoning • Hemoglobinopathy • Thallasemia’s • Sideroblastic anemia • • TAIL 725 726 727 728 729 730 731 732 733 734 735 84 .18? • Follicular lymphoma What are the causes of restrictive cardiomyopathy? • Sarcoid • Amyloid • Hemochromatosis • Cancer • Fibrosis • • Thanks STAN!! What are the CLUES for Vasulitis or Intravascular Hemolysis? • Shistocytes – Burr cells – Helmet cells What is the CLUE for Extravascular Hemolysis? • Splenomagely Where is Glucose 6-Pase present? • Adrenal • Liver What is the Heinz body CLUE? • G6PD If you see the CLUE basophilic stippling.22? • CML What is translocation 11.22? • Ewing’s sarcoma What is translocation 8.3/29/2012 724 What diseases have a cherry red macula? • • Tay Sachs • Sandhoffs • Niemann Pick What is translocation 9.14? • Burketts lymphoma What is translocation 14.

3/29/2012 • • 736 What is primary sideroblastic anemia due to? • Genetic • AD What is secondary Sideroblastic anemia due to? • Blood transfusions What are the Microcytic Hyperchromic Anemia’s? • Hereditary Spherocytosis What are the Normocytic Normochromic Anemia’s? • Acute hemorrhage • Anemia of Chronic Disease • Hypothyrodism – Early • Renal Failure • • What are the Macrocytic anemia’s? • Folate deficiency • B12 deficiency • Reticulocytosis • ETOH • Hemolytic Anemias • Chemo Treatment • Anticonvulsants • Myelodysplasia What are the anticonvulsants causing a Macrocytic Anemia? • Phenytoin • Ethusuximide • Carbamyazapine • Valproate What anemia is caused by blood transfusions? • Sideroblastic anemia What is the problem if you see Eliptocytes? • Something is wrong with the RBC membrane – Extravascular • Heridatary Ellitocytosis • Increased RET count What disease do you get if you have an EXCESS in Cu+? • Wilson’s Disease What is the CLUE for Wilson’s Disease? • Hepato/Lenticular Degeneration • Kayser Fleishner Rings – Copper in eyes 737 738 739 740 741 742 743 744 745 85 .

3/29/2012 • Hepato = Liver 86 .

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