Section

Topic

Cardiology

Pericardial Effusion

Gastroenterology

Diverticulosis / Lower GI hemorrhage

Oncology

Thyroid Carcinoma (Differentiate between them, routes of invasion, histological

features, etc)

Ob/Gyn

Preventative Medicine (Management of atypical squamous cells of

undetermined significance) - algorithm for Pap smears and cervical screening

Surgery

Infectious Disease; Acute bacterial parotitis; Review all postoperative

complications

Neurology

Dementia

Infectious Disease

Psuedomonas Aeruginosa infection - otitis exertna

Psychiatry

Living will

Pediatrics

Septic Arthritis

Ob/Gyn

Ruptured ectopic pregnancy

Respiratory

Aspiration Pneumonia

Ob/Gyn

Rubella Vaccination

Neurology

Parkinsons

Hematology

Iron Deficiency Anemia

Musculoskeletal

Radial nerve injury

Nephrology

Hypochloremic Hypokalemic Metabolic Alkalosis

Cardiology

Perivalvular abcess and heart murmurs

Ob/Gyn

Cervical cancer screening

Cardiology

Heart block

Neurology

Subdural Hematoma

Section

Topic

Gastroenterology

Esophagitis (Drug induced)

Neurology

Myasthenia Gravis

Neurology

Diffuse axonal injury

Infectious Disease

Trichinellosis

Neurology

Trauma (Glasgow coma scale)

Musculoskeletal

Psoriatic Arthritis

Infectious Disease

Endocarditis

Gastroenterology

Zollinger-ellison syndrome

Oncology

Basal Cell Carcinoma (of eyelid)

Gastroenterology

Hepatitis (viral)

Nephrology

Minimal change disease

Infectious Disease

Actinomycosis

Cardiology

Edema in CHF

Gastroenterology

Achalasia

Gastroenterology

Diarrhea

Pediatrics

Necrotizing enterocolitis

Pediatrics

Meckel's Diverticulum

Infectious Disease

HIV

Section

Topic

Gastroenterology

Toxic Megacolon (inflammatory bowel disease, ulcerative colitis)

Gastroenterology

Perforated Peptic Ulcer

Gastroenterology

Polyps and colonoscopy

Gastroenterology

Intussusception

Gastroenterology

Pancreatic cancer

Gastroenterology

Inflammatory Bowel Disease

Gastroenterology

Zinc deficiency

Gastroenterology

Scleroderma

Cardiology

Torsades de pointes (prolonged QT interval)

Poisoning

Methanol poisoning

Poisoning

Ethylene Glycol poisoning

Poisoning

TCA overdose

Gastroenterology

Isoniazid Hepatotoxicity

Section

Topic

Gastroenterology

Acute Hepatitis B infection

Gastroenterology

Acute hepatic injury

Gastroenterology

Emphysematous Cholecystitis

Gastroenterology

Hepatitis C (newly diagnosed)

Gastroenterology

Asymptomatic cholelithiasis

Gastroenterology

Ascites (SAAG)

Gastroenterology

Post operative cholestasis

Gastroenterology

Pancreatic cancer

Gastroenterology

Primary Biliary Cirrhosis

Gastroenterology

Hepatitis C during pregnancy

Cardiology

Prolonged QT Syndrome

Renal

Pottassium citrate monohydrate

Microbio

Alpha Hemolytic organisms (optochin sensitive, bile soluble)

Cardio

Murmur Radiation

Pharma

Bosentan

Pharma

Pyridostigmine

Section

Topic

Endo

Insulin and C-peptide

Inflammmation

Rheumatoid Arthritis

Microbio

Clostridum Perfrigens

Renal

Acute Tubual Necrosis (ATN)

Psych

Schizoid personalty disorder

Pharma

Acetaminophin Overdose

Pharma

HIV Protease Inihibitor (-navir) resistenance

Opthomology

Oculomotor nerve palsy

GI

Inferior pharyngeal constrictor muscle

Pharma

Chlorpheniramine (1st gen antihistamine)

Musculoskeletal

Dystophin

Endocrine

Endogenous Insulin

Endocrine

Metyrapone Stimulation Test

Endocrine

Exocrine Glands

Section

Topic

Hematology

X-linked agammaglobulinemia (XLA)

GI

Curling vs Chushing Ulcer

GI

Lipid Absoprtion

Genetics

Polygenic Inheritence

Microbio

Mucormycosis

Psych

Aytipical Depression

Pharma

Hereditary Angioedema

GI

Hepatic Angiosarcoma

Anatomy

Hemorrhoid drainage

Immunology

Secondary TB

Neuro

Demyelination (eg multiple sclerosis)

Cardio

Nitroprusside

GI

Gallstones

Section

Topic

Genetics

Potter Sequence

Microbio

Aedes Aegypti Mosquito

Immunology

Opsonization

Renal

Tumor Lysis Syndrome

GI

Colon Cancer

Immunology

Nuclear factor-kappa B (NF-B)

Pharma

Zanamivir

Pharma

Lamotrigine

Genetics

Small nuclear ribonucleoproteins (snRNPs)

Genetics

Ataxia-telangiectasia

Endocrine

Male LH and FSH

Psych

Neuroleptic Malignant Syndrome (NMS)

Immunology

Neisseria species

Section

Topic

Biochem

Kozak consensus sequence

Hematology

Thalassemia

Pharma

ADHD Drugs

Pharma

Thiazide diuretics

GI

Carcinoid Tumors

GI

Intraabdominal Infections

Neuro

Cryptococcus Neoformans

GI

Pancreatic pseudocyst

Biochem

Topoisomerase

Pharma

DRESS syndrome

Anatomy

Thoracic Outlet Syndrome

Pharma

Cilostazol

Genetics

DiGeorge Syndrome (velocardiofacial syndrome)

GI

Lactase Deficiency

Cardio

Subclavian Steal Syndrome

Section

Topic

Anatomy

Lymph Drainage

Pharma

Key (Abused) Drug Use Signs

Endo

Adrenal Crisis

Cardio

Nitrates

Repro

Ectopic Pregnancy

Genetics

Northern Blot

Cardio

Atrial Natriuretic peptide (ANP)

Anatomy

Anal fissures

Cardio

Mitral Regurgitation

Neuro

Synaptophysin

Neuro

Vomiting Reflex

Respo

Chemoreceptors

Microbio

Acute Bacterial Parotitis

Cardio

Exercise

Microbio

Ether

Section

Topic

Endo

Primary adrenal insufficiency (Addison's Disease)

Endo

Thyroid Hormones

Cardio

Digoxin Toxicity

Respo

Elastase

Microbio

Tuberculosis

Neuro

Vernet (jugular foramen) Syndrome

Microbio

Streptococcus pyogenes

Pharma

Minimal Alveolar Concentration (MAC)

Pharma

Arteriovenous Concentration Gradient

Microbio

Sarcoidosis

Patho

Carcinoid Syndrome

Patho

Fat Embolism Syndrome

Section

Topic

Endo

Leptin

Pharma

Fungal drugs

Pharma

Sirolimus

Endo

SIADH

Endo

Congential Hypothyroidism

Biochem

Glycerol Kinase

Patho

Humoral Hypercalcemia of Malignancy (HHM)

GI

Hyperammonemia

Patho

Leukocyte Adhesion Deficiency

Patho

Leukemoid Reaction

Anatomy

Kindney Development

Anatomy

Topography of the Lungs

Neuro

Middle Cerebral Artery (MCA)

Section

Topic

Neuro

Insomnia

Pharma

Reye Syndrome

Biochem

Propionic Acid

Anatomy

Neural Tube Defects (NTDs)

Pharma

Verapamil

Endo

Protein Kinase A

Neuro

Lacunar infarcts

Pharma

Fenoldopam

Patho

Rett Syndrome

Patho

Glomus Tumor

GI

Chronic Mesenteric Ischemia

Hematology

Paroxysmal Noctutnal Hemoglobinuria (PNH)

Repro

Gyne Procedures

Musculoskeletal

Junctions and associated protein

Section

Topic

Microbio

Steroid producing cells

GI

Acute Pancreatitis

Biochem

Sorbitol conversion

Gyne

Gestational Choriocarcinoma

Microbio

Enterohemorrhagic Escherichia Coli (EHEC) O157:H7

Neuro

Alzheimer's Disease Treatment

Neuro

CNS Dopaminergic Systems

Immunology

Anaphylaxis

Anatomy

Cricothyrotomy

Neuro

Antipsychotic Side Effects

Pharma

Bortezomib

Renal

Chronic Kidney Disesase(CKD)

Pharma

HIV Drugs

Section

Topic

Respo

Aspiration Syndromes

GI

Gallstone Formation

Cardio

Infarction

Repro

Caudal Regression Syndrome

Neuro

Neuron Location

Neuro

Action Potentials (Equilibrium potentials)

Cardio

Superior Vena Cava Syndrome

Cardio

S3 heart sound

Cardio

Dobutamine

Psych

Clozapine

Gyne

Ovarian Torsion

Respo

Malignant Mesothelioma

Neuro

Craniopharyngiomas

Gyne

Female Reproductive Histology

Pharma

Anesthesia

Genetics

Ionizing radiation

Section

Topic

Neuro

Deep Intracerebral Hemorrhage

Hematology

Methemoglobinemia

GI

Hepatic Encephalopathy

Gyne

Menopause

GI

Systemic Mastocytosis

Renal

Cystinuria

Pharma

Norepinephrine Extravasation

Pharma

Sleep insomnia in Elderly (Ramelteon)

Renal

Renal Angiomyolipoma

Anatomy

Fibronectin

Microbio

Vitamin E Deficiency

Neuro

Parkinson Drugs

Section

Topic

Neuro

Gerstmann Syndrome

Pharma

Antimuscarinic Drugs

Cardio

Hypertrophic Cardiomyopathy

What to review

Pericardial effusion can occur days to months after sugery and is referred to as postpericardiotomy syndrome. Presents
with hypotension, distended jugular veins, and distant heart sounds (becks triad)

Diverticulosis is the most common cause of lower GI hemorrhage in the elderly patient. Bleeding from diveritulcosis is
painless. Distinguish from diverticulitis which includes abdominal pain, infectious symptoms, and less bleeding.

Invasion of the capsule is required to differentiate follicular cancer from follicular adenoma. Follicular thyroid cancer has
a propensity to invade blood vessels and metastesize to distal organs.
For women age 21-24y/o with ASCUS finding on pap: repeat cytology in 1 year; for women > 25y/o: HPV. If positive,
then do colposcopy. If negative, HPV test in 3 years.
Review all post-op complications and how to prevent them

Differentiate between different types of dementia; presentation, symptoms, imaging. Delerium vs Dementia.
Review infections which diabetics are predisoposed to
Review living will vs advanced directives vs healthcare surrogate
Review post infectious complications including septic arthritis
Review pelvic pain and bleeding differentials
Review aspiration pneumonia, causes, and mechanism
Review prenatal / perinatal vaccinations for women of childbearing age
Review treatment and symptoms of parkinsonism (especially anticholinergics)
Differentiate between different types of anemia based on age group and history (iron deficiency anemia in patients
taking NSAIDS due to gastric irritation, chronic blood loss through the GI tract, and hence iron deficiency.
Review nerve injuries to the upper and lower extremities (Radial nerve injury associated with midshaft humeral fracture)
Review all types of metabolic abnormalities, their causes, and their lab values
Review acute endocarditis and heart murmurs (development of a new conduction abnormality in a patient with infective
endocarditis should raise suspicion for perivalvular abscess with extension into the AV node)
Review when and whom to screen when with Pap Smear (cytology), HPV test, and vaccines (cancer screening should
start at 21, routine HPV testing is not indicated for women <30. vaccine recommended for all girls and women age 9-26
regardless of HPV status or sexual activity.)
Review findings of all heart blocks on EKG
Review types of hematoma, clinical presentation, and CT findings

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What to review
Review drugs which cause drug-induced esophagitis (Tetracyclines, Aspirin / NSAIDS, alendronate, Potassium
Chloride, quinidine, iron)
Review presentation for MG and other neuromuscular junction disorders

Review different types of hemorrhages and brain accidents from various injuries (diffuse axonal injury is most significant
cause of morbidity in patients with traumatic brain injuries; frequently due to traumatic deceleration injury. Most diffuse
axonal injury occars at gray-white matter junction.)
Review infectious diseases (trichinellosis presents with GI complaints followed by triad of periorbital edema, myositis,
and eosinophilia.)
Review components of glasgow coma scale and how its calculated

Treatment for right sided endocarditis from IV drug abuse: Vancomycin, not clindamycin.
Steatorrhea may develop in ZE syndrome since increased production of stomach acids may deactivate pancreatic
enzymes, leading to malabsorption.
Basal cell carcinoma presents as slow growing papule with pearly, rolled borders. Most common malignant tumor of the
eyelid.
Cirrhosis should be suspected in any patient presenting with stigmata of chronic liver disease. Chronic alcohol abuse,
viral heptatis, and NAFLD are the most common underlying causes of cirrhosis in the US.
Membranous nephropathy is the most commonly associated nephropathy with carcinoma, however nephrotic syndrome
is a well known complication of Hodghkins Lymphoma, usually caused by minimal change disease.
Cervicofacial actinomycosis commonly presents in the mandibular region with yellow granular pus (sulfur granules.)
Diangosis is confirmed by gram stani. Penicillin is preferred therpay.
Most important contributor of edema in CHF is renal sodium retention, which results from activation of RAAS. Activation
of this system results in renal hypoperfusion secondary to decreased cardiac output.
After barium studies show birds beak appearance, you should perform endoscopy to exclude malignancy which can
have a similar presentation.
Various causes of diarrhea and their treatment. Know the locations of various pathogens (ie: South america --> giardia.)
In Giardia, the trophozoites form adhesive disks and cause malabsorption.
Increased gastric residual volume, vomiting, and abdominal distention in a preterm neonate are highly suspicious for
necrotizing enterocolitis. Hallmark findings on x-ray include pneumatosis intestinalis (intraluminal air) and portal venous
air.
Painless hematochoezia in a young toddler is usually due to meckel's diverticulum. Diagnose this with technetium 99
pertechnetate scan.
Primary HIV infection can present with mononucleosis like syndrome consisting of fever, night sweats,
lymphadenopathy, arthralgias, and diarrhea.

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What to review
IBD is the most likely diagnosis in a patient with subacute to chronic presentation of abdominal pain, tenesmus, and
bloody diarrhea. In patients with IBD and worsening symptoms accompanied by signs of sepsis, toxic megacolon
should be considered and Abdominal X-ray should be ordered to confirm.
Chemical peritonitis should be considered in patients presenting with sudden onset of severe epigastric pain that
spreads over the entire abdomen. Upright or abdominal radiographics will reveal free air under the diaphragm.
Most colon cancers develop from polyps. RIsk factors for polyps developing into malignancy are villous adenoma,
sessile adenoma and size greater than 2.5cm. Hyperplastic polyps are non-neoplastic and do not require further
workup.
Ultrasound is the first line modality in diagnosing intusussectpion. A positive target sign should prompt reduction with air
or water soluble contrast enema.

Pancreatic cancer should be suspected in patients with a history of chronic pancreatitis who develop abdominal pain
and weight loss. Ultrasound of the abdomen is useful in patients with jaundice to exclude biliary obstruction. CT scan of
the abdomen is preferred for patients without jaundice.
Chronic inflammatory diarrhea is typically associated with inflammatory changes in the blood (anemia, elevated ESR,
acute phase reactants, reactive thrombocytosis.) Blood and leukocyte positive stool is another important finding.
Zinc deficiency may result from chronic TPN or malabsorption. Symptoms include alopecia, skin lesions, abnormal
taste, and impaired wound healing.
Absence of peristaltic waves in lower 2/3 of esophagus and a significant DECREASE in LES tone are characteristic for
esophageal dysmotility associated with scleroderma. Manometric findings in achalasia include decrease or absent
peristaltic waves and INCREASED LES tone.

Torsades de points is a polymorphic ventricular tachycardia which occurs in the setting of prolonged QT interval seen in
patients with familial long QT syndrome, malnourished patients, and in patients taking certain drugs. Treatment of
torsades de points includes cessation of offending agents and initiation of magnesium sulfate.
Most servere consequences of methanol intoxication are vision loss and coma. Physical exam of methanol intoxication
reveals optic disc hyperemia while lab reveals anion gap metabolic acidosis. Increased osmolar gap is also seen.

Ethylene Glycol is associated with hypocalcemia and calcium oxalate deposition in the kidneys. This leads to flank pain,
hematuria, oliguria, acute renal failure and anion gap metabolic acidosis. Treatment involves administration of
fomepizole or ethanol to achieve ADH inhibition, sodium bicarbonate to alleviate acidosis, and hemodialysis in the case
of acidosis and/or end organ damage.
TCA overdose is characterized by CNS depression, hypotension, and anticholinergic effects including dilated pupils,
hyperthermia, and intestinal ileus. It can also cause QRS prolongation on EKG. Patients should be given sodium
bicarbonate.

Approximately 10-20% of patients on INH will develop mild aminotransferase elevation within the first few weeks of
treatment. This hepatic injury is self limited and will resolve without intervention. Some patients might develop INH
hepatits which would require a change of drugs to second-line antituberculosis regimen.

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What to review

Reviewed

Active Hep B infection typically presents with positive HbSAg, HbEAg, and no HbSAb. Health care workers explosed to
blood from HB patients should receive post exposure prophylaxis. Unvaccinated individuals should receive both HB
vaccine and Hb Immune globulin as soon as possible.
Transaminase levels > 1000 are most often due to acute viral hepatitis, ischemica hepatopathy ("shock liver"), or toxic
liver injury (especially acetaminophen.)
Emphysematous cholecystitis is a common form of acute cholecystitis in elderly diabetic males. It arises due to infection
of the gallbladder with gas-forming bacteria (Clostridium perfringens)
All patients with newly diagnosed Hep C infections should be evaluated for antiviral treatment. Liver biopsy should be
offered prior to treatment because it offers best predictor of disease progression and helps assess likely response to
treatment.

Asymptomatic gallstones should not be treated. Laparoscopic cholecystectomy is the treatment of choice for
symptomatic gallstone disease. Ursodeoxycholic acid is a medical treatment used to dissolve gallstones in individuals
who are symptomatic but poor surgical candidates.
Serum ascites albumin gradient (SAAG) is used to distinguish between portal hypertension and other causes of ascites.
SAAG greater than 1.1 g/dL is consitent with portal HTN. Increased capillary hydrostatic pressure from backup of blood
in portal HTN results in ascites.
Postoperative cholestasis can develop afer prolonged surgery categorized by hypotension, extensive blood loss into
tissues, and massive blood replacement.
Abdominal CT is sensitive and specific for diagnosis of pancreatic cancer. Use this after ultrasound; before ERCP.
Ursodeoxycholic acid is the most commonly used drug in treatment of primary biliary cirrhosis as it relieves symptoms
and lengthens transplant-free survival time. Liver transplanation however is the sole defintive cure for PBC. Anti
mitochondrial antibodies are positive in PBC.
The overall incidence of vertical transmission of HCV is approximately 2-5%. All patients, including pregnant patients,
with chronic Hep C should receive vaccinations against Hep A and Hep B if not already immune. Breastfeeding is safe.
Treatment: Propanolol and pacemarker

Given in renal tublar acidosis (RTA), leads to dec HCO3, renal ammoniagensis suspected, what is the
source of ammonia? Gluatime
Strep Mitis, Strep Mutans = no capsule
AS = Carotids

MR= Axilla

Strep Pneumoniae = encapsulated

TR= Right sternal border

Bosentan is a competitive antagonist of endothelin-1 at the endothelin-A (ET-A) and endothelin-B (ET-B)
receptors. It is used for the treatment of idiopathic pulmonary arterial hypertension (it is given to
patients while waiting for lung transplant)hepatotoxic, teratogenic, may cause anemia.
Antibodies form against NICOTINIC acetylcholine receptors

What to review
The level of C-peptide in the blood can show how much insulin is being made by the pancreas. C-peptide
does not affect the blood sugar level in the body.
Diagnosis is made by presence of autoantibody (igM) reactive with IgG - THIS IS HOW RF FACTOR
WORKS..Anti-CCP is also used and more specific
Patient with CRUSH INJURY, extensive myonecrosis, gram positive rod (with few neutrophils)
Most common acute kidney injury in hospitalized patients. ISCHMEIC = secondary to dec reneal blood
flow (hypotenstion, shock, HF) NEPHROTOXIC = secondary to release of toxic substances
(aminoglycosides, radiocontrast), crush injury..patient generally develops immediate severe
OLIGURIA, presents on microscopy with degenerating epithelial cells and dirty brown granular casts
A personality disorder characterized by a lack of interest in social relationships, a tendency towards a
solitary lifestyle, secretiveness, emotional coldness, and apathy. For example owns excessive number of
cats and prefers their company
In the case of N-acetyl-p-benzoquinone imine (NAPQI), the reactive cytochrome P450-reactive metabolite
formed by paracetamol (acetaminophen), which becomes toxic when GLUTATHIONE is depleted by an
overdose of acetaminophen, glutathione is an essential antidote to overdose. Glutathione conjugates to
NAPQI and helps to detoxify it
Resistance is most likely caused by mutation in a gene that is critical for PROTEIN PROCESSING
Patient will present with eye in out (or down and out) position, cause can be aneurysm of the posterior
communicating artery
The Inferior pharyngeal constrictor, the thickest of the three constrictors, arises from the sides of the
cricoid and thyroid cartilage. Similarly to the superior and middle pharyngeal constrictor muscles, it is
innervated by the MOTOR FIBERS of the vagus nerve (cranial nerve X), specifically, by branches from the
pharyngeal plexus and by neuronal branches from the recurrent laryngeal nerve
Most likely adverse effect after 4 weeks of administration is dowsiness
Dystrophin is a rod-shaped cytoplasmic protein, and a vital part of a protein complex that connects the
CYTOSKELETON of a muscle fiber to the surrounding extracellular matrix through the cell membrane.
Absence can present with difficulty running, climbing chairs, rising from sitting position
If normal insulin in the body is 5-20 units and endogenous insulin is given the body (pancreas) will
'shutdown' (negative feedback) to ensure there is not an overproduction of inlsulin. If fasting insulin is
measured after endogenous insulin is given it will be BELOW the normal value.
Although not commonly used, the metyrapone stiumulation test is a sensitive indicator of hypothalamicpituitary-adrenal (HPA) axis integrity. Metyrapone blocks cortisol synthesis by inhibiting 11-Bhyrdoxylase, which converts 11-deoxycortisol to cortisol in the zona fasciculata. As a result, the
reduction in cortisol levels following metrapone administration causes an INCREASE in pituitary ACTH
secretion
Merocrine - cells secrete via exocytosis (salivary, eccrine/apocrine sweat glands)Apocrine - cells
secrete via membrane bound vesicles (mammary gland)..Holocrine - cell lysis releases entire
contents of the cytoplasm & cell membrane (sebaceous gland (eg in acne), meibomian glands)

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What to review
In XLA, a mutation in the Burton tyrosine kinase gene causes failure of bone marrow pre-B cells (CD19+,
CD20+) to develop into mature, circulating B lymphocytes (CD19+, CD20+, CD21+). Patients with CLA
have LOW or ABSENT B cells in the peripheral blood and lymphoid tissues and panhypogammaglobulinemia (ie, VERY LOW igG, igM and IgA). As a result they are at a higher risk of
infection with pyogenic (encapsulated) bacteria.
Ulcers arising in the proximal duodenum in associationwith severe trauma/burns are called Curling's
ulcers. Ulcers arising in the esophagus, stomch or duodenum in patients with intracranial injury are
particularly prone to perforation and are called Cushing's ulcers. Cushing's ulcers are a consequence of
direct vagus nerve stimulation caused by raised intracranial pressure, resulting in acetylcholine release
and hypersecretion of gastric acid.
Dietary lipids (triglycerides, phospholipids, cholesterol esters) are primarily DIGESTED in the duodenum
via the action of pancreatic enzymes (lipase, phospholipase A2, cholesterol esterase. Bile salts emulsify
lipid breakdown products, forming water soluble micelles that facilitate lipid ABSORPTION in the jejunum.
Medical conditions with polygenic inheritance include: Androgenetic alopecia, epilepsy, glaucoma,
hypertension, ischemic heart deisease, schizophrenia, type II diabetes mellitus
Can present with facial pain, headache and BLACK NECROTIC eschasr in the nasal cavity in a patient with
diabetic ketoacidosis. Histological exam (muscle biopsy) is necessary for diagnosis
Characterized by mood reactivty, leaden paralysis (patient's arms and legs feel very heavy), rejtion
sensitivity (overly sensitive to slight criticism) and the reversed vegetative signs of increased sleep and
appetite.
Autosomal dominant condition that causes painless, non-pitting, well circumscrubed edema. Patient will
have decreased levels of C1 and C4 esterase inhibitors. ACE inhiitors are CONTRAINDICATED in these
patients.
Associated with exposure to carcinogens such as arsenic, thorotrast and polyvinyl chloride. Turmor cells
express CD31 which is a PECAM1 (platelet endothelial cell adhesion molecule).
Internal hemorrhoids (above the dentate line) drain into the middle & superior rectal veins, which
communicate with the internal iliac & inferior mesenteric veins. External hemorrhoids drain via the
inferior rectal vein into the internal pudendal vein, which communicates with the internal iliac veins
CD14 is a surface marker of the moncyte-macrophage cell linage.CD4 and CD8 are surface markers of
T-helper and T-killer cells, respectively.
The length constant is a measure of how far along an axon and electrical impulse can propagate. A lowlength constant reduces the distance and impulse can travel. Myelination increases the length constant
and descreases the time constant, both of which improve axonal conduction speed. Demyelination thus
imparis stimulus transmission.
Short acting balanced venous and arterial vasodilator that decreases BOTH preload and afterload. Since
these changes are balanaced, stroke volume is maintained.
Choleystectomy is the preferred treatment for symptomatic gallstones. For medical or nonsurgical
treatment, the best option is hydrophilic bile acids/bile acid supplements (eg ursodeoxcholic acid) which
reduce biliary cholesterol secretion and increase biliary bile acid concentration, which promotes gallstone
dissolution by improving cholesterol solubility.

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What to review
Results from a RENAL anomaly that causes decresed fetal urine output leading to oligohydraminos. The
lack of amniotic fluid causes compression of the fetus (characteristic facies and limb abormalities) and
pulmonary hypoplasia, which is the most common cause of death.
A mosqutio that can spread dengue fever, chikungunya (presents as febrile illness with flulike symptoms,
prominent polyarthralgia/arthritis (hands, wrists, ankles) and a diffuse macular rash), zika fever and
yellow fever viruses.
Opsonization occurs when host proteins such as immunoglobulins or complement bind to the surface of
foreign cells (eg, bacteria) to promote phagocytosis. The MOST IMPORTANT opsonins (coating proteins)
are immunoglobulin igG and complement C3b.
When a large number of tumor cells are destroyed during chemotherapy, intracellular ions, such as
potassium, phosphorous and uric acid are releasesed into the serum and then filtered by the kidneys. The
LOWEST pH along the nephron is found in the distal tubles and collecting ducts; so these are the
segments of the nephron obstructed by uric acid crystals.
Right sided colon cancer usually grow as exophytic masses and present with occult bleeding and
symptops of iron deficiency anemia. Left sided colon cancers tend to infiltrate the intestinal wall and
encircle the lunmen, causing constipation and symptoms of intestingal obstruction. Rectosigmoid
involvement oftens causes hematochezia.
NF-B family of transcription factors plays important roles in the immune system. NF-B family members
regulate the expression of cytokines, inducible nitric oxide synthase (iNOS), cyclo-oxygenase 2 (COX-2),
growth factors and inhibitors of apoptosis. IB releases NF-B after undergoing phosphorylation.
Zanamivir is a neuraminidase inhibitor used in the treatment and prophylaxis of influenza caused by
influenza A and B viruses. Zanamivir works by binding to the active site of the neuraminidase protein,
rendering the influenza virus unable to escape (virion release) its host cell and infect others.
An anticonvulsant mood stabilizer. It is associated with risk of benign skin rash that can progress to
serious rash (inlcuding Steven-Johson syndrome).
Important compents of the SPLICEOSOME, a molecule which removes introns from pre-mRNA during
processing within the nucleus.
Autosomal recessive disorder resulting from a defiect in DNA repair genes. The DNA of these patients is
hypersensitive to IONIZING RADIATION. Can present with cerebellar atrophy. Manifestations include
cerebellar ataxia, oculocutaneous telangiectasias, repeated sinpulmonary infections and increased
indcidince of malignancy.
Both LH and FSH are produced by the gonadotroph cells of the anterior pituitary. LH stimulates the
release of testosterone from the Leydig cells of the testes; FSH stimulates the release of inhibin B from
the Sertoli cells of the testes. Testosterone has a negative feedback effect on LH and GnRH secretion,
and inhibin B suppresses FSH secretion.
NMS is a life threatening adverse reaction to antipsychotic medication. It presents clinically with diffuse
muscle rigidity, high fever, autonomic instability (HTN, tachycardia) and altered sensorium. Lab findings
include elevated creatine kinase due to rhabdomyolysis. Best treated with drugs that inhibit calcium
release from the sarcoplasmic reticulum of skeletal muscle (dantrolene).
Patients with deficiences of the complement factors (ie., C5b-C9) that form the membrane attack
complex (MAC) often experience recurrent infections by Neisseria.

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What to review
Occurs on eukaryotic mRNA and is defined by the following sequence: (gcc)gccRccAUGG, in which R is
either adenine or guanine. This sequence helps initiate TRANSLATION at the methionine start codon
(AUG).
Results in hypochromic, microcytic anemia due to decreased globin chain synthesis
Stimulant drugs, including methylpenidate and amphetamines, are first line drugs for school aged
children with ADHD. They work by increasing release of norepinephrine and dopamine from vesicualr
storage sites and blocking norephinephrine and dopamine uptake at synapses in the prefrontal cortex.
Thiazide diuretics RAISE serum calcium, uric acid, glucose, cholesterol and triglyceride levels. They
LOWER serum sodium, potassium and magnesium levels.
Composed of islands or sheets of uniform cells with eosinophilic cytoplasm and oval to roundstippled
nuclei. They are often derived from NEUROENDOCRINE cells in the GI tract.
Intraabdominal infections are polymicrobial, with Bacteroides fragilis and E. coli being the most
prominent organisms isolated.
Causes meningoencephalitis in HIV+ patients. The latex agglutination test detects the polysaccharide
capsule antigen of Cryptococcus and is used for diagnosis. India ink staining of the CSF shows round or
oval budding yeast.
A common complication of acute pancreatitis. It is a collection of fluid rich in enzymes and inflammatory
debris. Its walls consist of granulation tissue and fibrosis. Unlike true cysts, pseudocysts are not lined by
epithelium.
Topoisomerase I makes single stranded nicks to relieve negative supercoiling, while Topoisomerase II
induces transient breaks in both DNA strands simultaneously to relieve both positive and negative
supercoiling.
Drug reaction with eosinophila and systemic symptoms (DRESS) syndrome typically occurs 2-8 weeks
after exposure to high risk drugs such asn anticonsulvants, allopurinol, sulfonamides and antibiotics.
Patients typically develop fever, generalized lymphadenopathy, facial edema, diffuse skin rash,
eosinophilia and internal organ dysfunction.
Thoracic outlet syndrome (TOS) is due to compression of the lower trunk and the brachial plexus in the
scalene triangle, the psace borred by the anterior and middle scalene muscles and the first rib.
Symptoms include upper extremity numbness, tingling and weakness.
Cilostazol reduces platelet activation by inhibiting platelet phosphodiesterase, the enzyme responsiblefor
the breakdown of cAMP. It is also a direct arterial vasodilator.
Caused by a chromosome 22q11.2 microdeletion. Due to defective develtopment of pharyngeal pouches
3 and 4. Clinical features include (CATCH): Contruncal cardiac defects (ToF, trucus aerteriousus,
interrupted aortic arch), Abnormal facies, Thymic hypoplasia/aplasia (T-cell deficinecy), Craniofacial
deformities (cleft palate), Hypocalcemia/Hypoparathyroidism. The paracortex region in lymph nodes are
poorly developed in DiGeorge Syndrome. Fluresecene in situ hybridization is the 'gold standard' for
detecting microdeletion.
Can be due to an inherited autosomal receissive disorder, progressive non-persistence of lactase
expresssion in adulthood or inflammatory disorers affecting the intestinal brush border. Undigested
lactose causes osmotic diarrhea and acidification of the stool.
Occurs due to secer stenosis of the procmial subclavia artery, which leads to REVERSAL in blood flow
from the contraleteral vertebral artery. Patients may have symptoms related to arm ischemia in the
affected extremity (eg, exercise induced fatigue, pain, paresthesias) or vertebrobasilar insufficiency.

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Lymphatic drainge of the rectum proxmial to the anal dentate line occurs via the inferior mesenteric and
internal iliac lymph nodes. Areas distal to the dentate line drain primary into the inguinal nodes.
Phencyclidine (PCP) = nystagmus (horizontal or vertical)....LSD = visual halluciantionsCocaine =
chest pain, seizures. Methampetamine = tooth decay, choreform movements. Marijuana (THC,
cannabis) = increased appetite, impartied time perception, conjuntival injection (red eye).... Heroin =
depressed mental status, miosis, respiratory depression
Characterized by severe hypotension and refractory shock, along with abdominal pain, vominting,
weakness and fever. In addition to aggressive fluid resucitation, treatment requires immediate
glucocorticoid supplementation.
Decrease left ventricular end diastolic pressure, increase peripheral venous capacitance and decrease
systemic vascular resistance.
Characterized by implantation outside oft eh uterus. Uterine curettage would revela decidualized
endometrium only, consistent with dilated, coiled endometrial glands and vascularized edematous
stroma. NO embryonic or trophoblastic tissue (eg, no villi).
The best method for determining whether a gense is being expressed/transcribed is to analyze for the
presence of its mRNA using a Northern blot.
Secreted by atrial cardiomyocytes in response to atrial stretch induced by hypertension and
hypervolemia. ANP causes peripheral vasodilation and increased urinary excretion of sodium and water.
Neprilysin inhibitors prevent degredation of ANP therefore enhanching its effects.
Anal fissures are longitudinal tears in the mucosa. Most fisssures occur at the posterior midline distal to
the dentate line, likely due to decreased blood flow in this area.
Presents with decreased afterload, increased preload and increased left ventricular ejection fraction
Synaptophysin in a protein found in the presynaptic cescile of neurons, neuroendocrine and
neuroectodermal cells. CNS tumors of neuronal origin frequently stain positively for synaptophysin on
immunohistology. Neoplasms of glial origin (astrocytomas, ependymomas and oligodendrogliomas) stain
for GFAP
The area postrema in the fourth ventricle regulates the vomiting reflex. There are 5 main receptors,
including M1 muscarinic, D2 dopamenergic, H1 histaminic, 5-HT3 serotonergic and NK1 neurokinin 1
receptors. 5-HT3 and NK1 receptor antagonists are very useful in chemotherapy induced vomiting.
Central chemoreceptors located in the medulla are stimulated by decreased pH in the surrounding CSF.
BBB is relatively impermeable to H+, blood pH has liffe effect on central chemoreceptors, while CO2
readily diffuses the BBB. Thus increased PaCO2 is the major stimulator of central chemoreceptors.
Peripheral chemoreceptors found in the carotid and aortic bodies are the primary sites for sensing
arterial PaO2 and are stimulated by hypoxemia (eg, COPD).
Occurs most commonly in elderly postoperative patients who are intubated or dehydrated. Staph aures
is the most common bacterial etiology. Diagnosis can be confirmed by imagin and elevated serum
amylase level (with a normal serum lipase and NO evidence of pancreatitis).
During exercise there is increased heart rate, cardiac output and repiratory rate. ARTERIAL levels of
PaO2 and PaCO2 remain relativley close to resting during exercise while VENOUS oxygen is decreased
and VENOUS carbon dioxide is increased.
Ether and other organic solvents dissolve the lipid bilayer that makes up the outer viral envelope. Loss of
infectivity after ether exposure is a characteristic feature of ENVELOPED viruses.

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Patients with DM1 are prone to developing other autoimmunes diseases inlcuding Hasimoto thyroiditis,
Grave's disease and Addison's disease. Addison's disease presents with electrolyte imbalances inlcuding
hyponatremia, hyperkalemia, hyperchloremia, and non anion gap metabolic acidosis
An increase in estrogen activity, as seen in pregnancy or post-menopausal estrogen replacement
therapy, increases levels of thyroxine-binding globulin. This leads to an INCREASE in TOTAL thyroid
hormone levels, but feedback cotrol maintains normal levels of free (active) thyroid hormone.
Presents with nonspecific GI (anorexia, nausea, vomiting) and neurologic (fatigue, confusion, weakness)
symptoms. Changes in color vision are a more specific but rarer finding. Life threatening ventricular
arrhythmias are the most serious complication.
Alveolar fluid contains neutral proteases (eg, elastases) that are derived from infiltrating neutrophils
(neutrophil elastase inhibited by alpha 1 antitrypsin) and alveolar macrophages (macrophage elastase
inhibited by tissue inhibitors of metalloproteinases (TIMPs)). These proteases can cause destruction of
terminal lung parenchyma (eg, emphysea) when secreted in excess or if left unchecked by deficient
antiprotease activity.
In mycobacterium tuberculosis specific T lymphocytes are activated with CD4+ TH1 cells playing a
pivital role. The CD4+ TH1 cells stimulate macrophages, endowing them with the ability to kill
intracelluar tuberculosis organisms.
Caused by lesions of the jugular foramen which is characterized by the dysfunction of cranial nerves IX, X
and XI. Symptoms include dysphagia, hoarsness, loss of gag reflex on the ipsilateral side and deviation
of the uvula toward the normal side.
Protein M is the major virulence factor for Streptococcus pyogens. It inhibits phagocytosis and
complement activation, mediates bacterial adherence and is the target of type specific humoral
immunity to S. pyogenes.
Potency of an anesthetic is defined by the minimal alveolar concentration (MAC), the alveolar
concentration that prevents movement of 50% of the patients exposed to noxious stimuli. Potent
anesthetics have LOW MACs.
The arteriovenous concentration gradient reflects the overall tissue solubility of an anesthetic.
Anesthetics with high tissue solubility are characterized by large arteriovenous concentration gradients
and SLOWER onset of action.
Is characterized by accumulation of activated macrophages and formtion of noncaseting granulomas
within the affected tissues (most commonly lungs). Chest xray will show bilateral hilar adenopthy and
diffuse interstitial infiltrates may also be seen. Sarcoid granulomas produce ACE and 1,25-dihydroxycholecalciferol (active form of Vit. D), so patients often have elevated ACE levels and
hypercalcemia/hypercalciuria. In pulmonary sarcoidosis, the accumulation of CD4+ cells in areas of
active disease results in the predominance of CD4+ T cells and high CD4+/CD8+ ratio (>2:1) in
bronchoalvelor lavage fluid.
Typically presents with episodic flushing, secretory diarrhea and wheezing. It can lead to pathgnomonic
plaque-like deposits o fibrous tissue on the right-sided endocardium, causing tricuspid regurgitation,
pulmonic valculopathy and right-sided heart failure. Elevated urinary 5-hydroxyindoleacetic acid (5-HIAA)
can confirm the diagnosis.
The clinical triad of acute-onset neurologic abnormalities, hypoxiema and a petechial rash in a patient
with severe long bone and/or pelivc fractures is strong suggestive of fat embolism syndrome. It most
commonly occures 24-72 hours afrer the injury but can develop up to 2 weeks later.

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Leptin is a protein hormone produced by adiopocytes in proportion to the quantity of fat stored. Leptin
acts on the arcute nucleus of the hypothalamus to inhibit production of neuropeptide Y (decreasing
appetite) and stimulate production of alpha-MSH (increasing satiety). Mutations in the leptin gene or
receptor result in hyperphagia and profound obesity.
.A major polysaccharide component of the fungal cell WALL is 1,3-beta-D-glucan. Capsofungins and
other echinocandin antifungals (eg, micafugin) block glucan synthesis. Amphotericin B & Nysatin both
bind ergosterol in the fungal cell MEMBRANE and leading to pore formation and cell lysis. Azoles inhibit
the synthesis of ergosterol.
Binds to the immunophilin FK-506 binding protein (FKBP) in the cytoplasm, forming a complex that binds
and inhibts mTOR. Inhibition of mTOR signaling BLOCKS interleukin-2 signal trandsduction and
PREVENTS cell cycle progression and lympocyte proliferation.
SIADH is characterized by low plama sodium and osmolality, inappropriately concentrated urine and
clinically NORMAL body fluid volume. An important cause of SIADH is a paraneoplastic effect secondary
to small cell carinoma of the lung. The profound hyponatremia that occurs in SIADH can cause
headache, weakness, altered mental status and seizures.
Is usually asymptomatic at birth. After maternal T4 wanes, infants develop constipation, lethargy,
hypotonia, macroglossia, an umbilical hernia and a large anterior fontanelle. Treatment with
levothyroxine by age 2 weeks can normalize cognitive and physical development.
Glycerol prodecuded by degredation of triglycerides in adipose tissue can be used by glycerol kinase in
the liver and kidney to synthesize glucose during gluconeogenesis.
Patient presents with hypercalcemia but no focal lytic bone lesions. HHM is caused by secretion of
parathyroid hormone-related peptide (PTHrP). PTHrP causes increased bone resportion and decreased
renal excretion of calcium.
Excess ammonia in the blood crosses the blood brain barier and is taken up by astrocytes, increasing
GLUTAMINE production.
Due to absence of CD18 antigens necessary for the formation of integrins. Clinical features are caused
by failure of leukocyte chemotaxis and include recurrent skin and mucosal infections without purulence,
delayed separation of the umbilical cord and persistent leukocytosis.
Leukemoid reaction is a benign leukocytosis (>50,000) that occurs in response to an underlying condition
such a severe infection/hemorrhage, malignancy (eg, leukemia), or acute hemolysis. Leukocyte alkaine
phosphatase levels are normal or increased. Peripheral smear can show increased bands, early mature
neutrophil precursors (eg, myelocytes) and light blue granules (eg, Dohle bodies) in the neutrophils.
Development of the metanephros, or true kidney, begins with formation of the metaneprhic diverticulum
(urteric bud), which sprouts off the caudal portion of the mesonephric duct. The urteric bud gives rise to
the collecting system of the kidney, including the collecting tubules and ducts, major and minor calyces,
renal pelvis and the ureters. The metanephric blastema gives rise to the glomeruli, Bowman's space,
proximial tubles, the loop of Henle and distal convulated tubules.
Lungs (& visceral pleura) end at the 6th rib in the midclavicular line, 8th rib in the midaxillary line and
10th rib in the paravertebral line. Parietal pleura end at the 8th rib mid clavicular line, 10th rib
midaxillary line and 12th rib paravertebal line. Liver injury on the right side can occur if a needle is
inserted below the 9th rib at the midaxillary line.
Occlusion of the MCA typically leads to contralateral hemiplegia of the face and uppler limb with relative
preservation of the lower limb. If the occluded MCA is in the dominant (usually left) hemisphere, aphasia
may also occur.

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Non-pharmacolgic treatments for insomina include sleep hygiene (eliminate caffeine and alcohol),
stimulus control (eliminating bedroom activities and getting into bed only when sleepy), sleep restriction
and cognitive behavioral therapy.
Occurs in children with febrile illness treated with salicylates (asprin). It consits of hepatic failure and
encephalopathy. The characteristic histological finding is microvesicular steatosis of hepatocytes without
inflammation and cerebral edema.
Propionyl CoA is derived from amino acids (isoleucine, valine, threonine, methionine), odd-numbered
fatty acides and cholesterol side chains. Congenital deficiency of propionyl CoA carboxylase, the enzyme
responsible for the coversion of propinoyl CoA to methylmalonyl CoA, leads to the development of
propionic acidema. It can present in newborns as lethargy, vomiting and hypotonia during the first few
days of life.
NTDs occur when the neural tube fails to fuse in the region of the anterior or posterior neuropores. This
leads to persistent communication between the spinal canal and the amniotic cavity. Leakage of alphafetoprotein AND acetylcholinesterase occurs, which allows for prenatal diagnosis of NTDs.
Skeletal muscle is resitant to calcium channel blockers because it has little dependence on extracellular
calcium influx.
Protein Kinase A is responsible for the intracelluar effects of the G protein-mediated adenylate cyclase
second messenger sytstem. Hormone receptors that use this system include the TSH, glucagon and PTH
receptors. Protein kinase A also phosphorylates proteins that bind to the regulatory regions of genes on
DNA.
Lacunar infarcts are small ischemic infarcts (<15 mm in diameter) involving the deep brain structures
(eg, basal ganglia, pons) and subcoritcal white matter (eg, internal capsule, corona radiata). They are
primarily caused by chronic hypertension, which predisposes arterioles to undergo lipohyaloinsis,
microatheroma formation and occulusion (hypertensive arteriolar sclerosis).
Is a selective peripheral dopamine-1 receptor agonist. It is given intravenously to lower blood pressure in
hypertensive emergency, especially in patients with renal insufficiency. Fenoldopam causes arteriolar
diltion, increases renal perfusion and promotes diuresis and natriuresis.
Characterized by loss of speech and motor skills, deceleration of head growth and stereotypic hand
movements after a period of normal development. It affects mainly girls and is associated with
mutations in the MECP2 gene.
A benign glomus tumore (glomangioma) can produce a very tender, small (a few millimeters in
diameter), red-blue lesion under the nail bed. This type of tumor originates from the modified smooth
muscle cells that control the thermoregulatory functions of dermal glomus bodies.
Is characterized by athrosclerosis of the mesenteric arteries, resulting in diminished blood flow to the
intestine after meals. This causes postprandial epigastric pain ("intestinal angina") with associated food
aversion/weight loss. Its pathogenesis is similar to angina pectoris.
The triad of hemolytic anemia, hypercoagulability and pancytopenia suggests PNH. PNH results from
acquired mutation in the PIGA gene that causes absence of the glycosylphosphatidylinositol (GPI) anchor
and associated deficiency of CD55 and CD59 complement inhibitor proteins.
The suspensory ligament of the ovary must be ligated during an oophorectomy to prevent heavy
bleeding. The round ligaments are clamped and divided to enter the peritonem of the broad ligament
during a hysterectomy.
Gap juntion = connexins, Tight juntions = caludins and occludin, Adherens junction = cadherins,
Desmosomes = cahderins (eg, desmogleins and desmoplakin), Hemidesmosomes = integrins.

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In contrast to the rough ER, the smooth ER contains enzymes for steroid and phospolipid biosynthesis.
All steroid producing cells (eg, cells in the adrenals (ACTH), gonads and liver) contain well developed
SMOOTH ER.
AFTER gallstones, alcohol abuse is the second most common cause of acute pancreatitis. Alcohol abuse
will present with a >2 AST:ALT ratio and absence of gallstones.
Aldose reductase converts glucose into sorbitol, which is further metabolized into fructose by sorbitol
dehydrogenase (sometimes referred to as polyol dehydrogenase).
Malignant tumor that arises from trophoblasts. The tumor causes abnormal vaginal bleeding, uterine
enlargement and significantly increased B-hCG. The lungs are the most common site of distal
metastatsis. Histolgy will show proliferation of cytotrophoblasts and syncytiotrophoblasts.
E. coli strain that does NOT produce glucuronidase and does not ferment sorbitol on sorbitol containing
MacConkey agar. It is a common cause of bloody diarrhea and HUS. Associated with consumption of
undercooked beef. EHEC elabtorates Shiga like toxin which inactivate the 60s ribosomal subunit. Unlike
EIEC, EHEC does NOT invade the intestinal mucosa. Unlike ETEC, EHEC does not produce heat-labile
toxin (LT) or heat-stable toxin (ST).
MRI findings of cortical atrophy and the absence of other reversible causes of dementia point to a clinical
diagnosis of Alzheimer's Disease. Current specific therapies include cholinesterase inhibitors (Donepezil),
antioxidants (Vitamin E) and NMDA receptor antagonists (memantine).
The major dopaminergic pathways in the brain include the MESOLIMBIC and MESOCORTICAL pathways
(regulate cognition and behavior), the NIGROSTRIATAL pathway (regulates coordination of voluntary
movements), and the TUBEROINFUNDIBULAR pathway (inhibits prolactin secretion). Disruption of the
tuberoinfundibular pathway by D2 receptor blocking antipsychotics may cause hyperprolactinemia with
galactorrhea and amenorrhea.
Is the result of widespread mast cell and basophil degranulation and then release of preformed
inflammatory mediators, including HISTAMINE and TRYPTASE. Tryptase is relatively specific to mast cells
and can be used as a marker for mast cell activation.
The cricothyrotomy incision passes through the skin, superficial cervical fascia, pretracheal fascia and
then cricothyroid membrane.
Extra pyramidal side effects = acute dystonic reaction (sudden-onset, sustained muscle contraction),
akathisia (subjective restlessness with inabailty to sit still), drug induced parkinsonism (tremor, rigidity,
bradykinesia, masked facies). Tardive dyskinesia = involuntary movements after chronic use (lip
smacking, chorethetoid movements. Neuroleptic malignant syndrome = fever, rigidity, mental status
changes, autonomic instability.
Is a boronic acid containing dipetide proteasome inhibtor that causes cell apoptosis. It is used to treat
multiple myeloma.
CKD with mineral bone disease usually presents with increased PO4, increased PTH (secondary
hyperparathyroidism) and decreased calcitriol levels. Patients can be asymptomatic or develop
weakness, bone pain and fractures.
Reverse transcriptase inhibitors (efavirenz, tenofovir, lamivudine) = impair complementary DNA
synthesis, lack a 3' OH group. Fusion inhibitors (enfuvirtide) = drugs that bind to gp41, inhibit fusion of
viral and host membranes. Integrase inhibitors (-tegr-, ltegravir) = impair messenger RNA transcription.
Protrease inhibitors (-navir, saquinavir, ritonavir) = impair polyprotein cleavage and prevent maturation
of new viruses. CCR5 receptor inhibitors (maraviroc) = blocks viral attachment and entry into CD4+ T
cells and macrophages (associated with gp120).

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Pneumonia is caused by lung parenchyma infection due to aspiration of oral cavity microbes (anaerobes).
Pneumonitis is caused by lung parenchyma inflammation due to aspiration of gastric contents with
subsequent acid injury.
Elevated cholesterol concentrations increase the likelihood of cholesterol precipitation and gallstone
formation. High levels of bile salts and phosphatidylcholine increase cholesterol solubility and decrease
the risk of gallstones.
Organ susceptibility to infarction after occlusion of a feeding artery is ranked from greatest to least as
follows: CNS, myocardium, kidney, spleen and liver.
Characterized by sacral agenesis causing lower extremity paralysis and urinary incontinence. This
condition is commonly associated with poorly controlled diabetes during pregnancy.
Caudate nucleus = GABA. Locus ceruleus = Norepinephrine. Nucleus basalis of Meynert = cholinergic.
Raphe nuclei = serotonin. Red nucleus = neurons that participate in motor coordination of the upper
extremities. Substantia Nigra = dopaminergic neurons.
Sodium = +60 mV. Potassium = -90 mV. Chloride = -75 mV. Calcium = +125 mV.
Intrathoracic spread of bronchogenic carcinoma may lead to compression of the superior vena cava,
causing imparied venous return from the upper part of the body. Signs and symptoms include dyspnea,
facial swelling an dilated collateral veins in the upper trunk.
Low frequency sound occuring after S2 that is commonly associated with increased left ventricular end
systolic volume, which occurs in the setting of left ventricular systolic failure.
Dobutamine is a B-adrenergic agonist with predominant activity on B1-receptors. It causes an increase in
heart rate and cardiac contractility, leading to an increase in myocardial oxygen consumption.
Used for treatment-resistant schiziphrenia and schizophrenia associated with suicidality. Adverse effects
are agranulocytosis, seizures, myocarditis and metabolic syndrome.
Occurs due to twisting of the infundibulopelvic ligament (suspensory ligament of the ovary).
Is a rare neoplasm that arises from the pleura or peritoneum. It is strongly associated with asbestos
exposure. Hemorrhagic pleural effusions and pleural thickening are characteristic. Histopathology
reveals tumors cells with numerous, long slender microvilli and abundant tonofilaments.
Are supresellar tumors arising from Rathke's pouch remnants in the antrior pituitary. They
characteristically have three components: solid, comprised of the actual tumor cells; cystic, filled with
"machinery oil" brownish-yellow liquid; and a calcified component that contains cholesterol crystals.
They present during childhood, usually, with mass effect and visual deficits.
Ovary = Simple cuboidal; Fallopian tube = simple columnar; Uterus (endometrium) = simple columnar;
Cervix: Ectocervix = stratified squamous non-keratinized, Endocervix = simple columnar; Vagina =
stratified squamous non-keratinized; Peritoneum = simple squamous.
Minimum alveolar concentration (MAC) is a measure of the POTENCY of an inhaled anesthetic. The lower
the MAC the more potent the anesthetic. The blood/gas partition coefficient corresponds to the solubility
of anesthetic in the blood. Anesthetics with high blood/gas partition coefficient are absorbed to a greater
extent by the blood and have a SLOWER onset.
Exposure to ionizing radiation induces DNA damange through DNA double strad fractures and the
formation of free radicals.

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Typically caused by hypertensive vasculopathy involving the penetrating braches of the major cerebral
arteries. The most frequently affected locations include the basal ganglia (putamen), cerebellar nuclei,
thalamus and pons. The basal ganglia are supplied by the lenticulostriate arteries, which are small
vessel branches off the middle cerebral artery.
Causes dusky discoloration of the skin (similar to cyanosis), and becaues methemoglobin is unable to
carry oxygen, a state of functional anemia is induced. However, the blooed partial pressure of oxygen
will be UNCHANGED as it is a measure of oxygen dissolved in plasma and is unrelated to hemoglobin
function.
Treatments for hepatic encephalopathy include lactulose (increase conversion of ammonia to ammonium)
and rifaximin (decreases intraluminal ammonia production).
Menopause occurs on average at age 51 and is diagnosable retrospectively after 12 months of
amenorrhea. An elevated serum FSH level confrims the diagnosis. Estradiol and progesterone levels
gradually decrease due to decreasing ovarian function.
Is characterized by the abnormal proliferation of mast cells and increased histamine release. Histamine
causes hypersecretion of gastric acid by parietal cells in the stomach as well as a variety of other
symptoms (eg, hypotension, flushing and pruritus).
An autosomal recessive disorder caused by defective transporter of cystine, ornithine, lysine and arginine
(COLA) across the intestinal and renal tubular epithelium. Recurrent nephrolitiasis is the only clinical
manifestation. Urinalysis shows pathognomonic hexagonal cystine crystals.
Blanching of a vein into which NE is being infused together with induration and pallor of the tissue
surrounding the IV site are signs of NE extravasation and resulting vasoconstriction. Tissue necrosis is
best prevented by local injection of an alpha 1 blocking drug (phentolamine).
Benzodiazepines, antihistamines and sedating antidepressants should be avoided in treatment of
insomnia in the elderly do to their adverse effects. Ramelteon, a melatonin agonist, is safe and effective
in reduing time to sleep onset in the elderly.
Benign tumor composed of blooed vessels, smooth muscle, and fat. Bilateral renal angiomyolipomas are
associated with tuberous sclerosis, an autosominal dominant condition chacterized by coritcal tubers and
subependymal hamatomas in the brain, with consequent seizures and cognitive disability. Cardiac
rhabdomyomas, facial angiofibromas and leaf-shaped patchs of skin lacking pigment (ash-leaf patches)
can also occur.
Fibronectin are large glycoproteins produced by fibroblasts and some epithelial cells. They bind to
integrins, matrix collagen and glycosaminoglycans, serving as a mediator of cell adhesion and migration.
Neuroligic symptoms of Vitamin E deficiency closely mimic Freidreich ataxia and include ataxia (due to
degeneration of spinocerebellar tracts), loss of position and vibration sense (due to degeneration of the
dorsal columns), and loss of deep tendon reflexes (due to peripheral nerve damage).
MAO-B (Selegiline) = decreaed central dopamine degradation. Direct/Indirect dopaminergic agent
(Amantadine) = Enchances the effect of endogenous dopamine. COMT (Entacapone, tolcapone) and
dopa decarboxylase inhibotors (carbidopa) = Enhances the effect of endogenous dopamine.
Anticholinergics (trihexyphenidyl, benztropine) = inhibit muscarinic receptors. Dopamine agonits
(bromocriptine (ergot), pramipexole, ropinirole (nonergot) = directly stimulate dopamine receptors.

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Results from damage to the angular gyrus of the dominant parietal lobe and is characterized by agraphia
(inablity to write), acalculia (inability to carry out mathematical calculations), finger agnosia (inability to
identify individual fingers on the hand) and left-right disorientation.
Flushed skin and mydriasis result from muscarinic receptor blockade. Drugs with antimuscarinic effects
include: atropine, tricyclic antidepressants (amitriptyline), H1 receptor antagonists (diphenhydramine),
neuroleptics and antiparkinson drugs.
In patients with hypertrophic cardiomyopathy, dyanamic left ventricular outflow tract obstruction is due
to abnormal systolic anterior motion of the anterior leaflet of the mitral valve toward a hypertrophied
interventricular septum.

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