USMLE STEP | REVIEW STUDY GUIDE 2015 EDITION DOCTORS IN TRAINING BETTER DOCTORS. BETTER WORLD. BRIAN Jenkins, MDDoctors In Training.com: USMLE Step 1 Review, 2015 elton Author: Brian Jenkins, MD. Copyright © 2015 Doctors In Training.com, LLC swortrdoctorsintraininggcom Doctors In Trainingcom, LLC 1704 River Run, Suite #750 Fort Worth. TX 76107 ahhisResaval Ts testepeatecty ony No p Inte asap se ie tone ten gr ts bon ay beeen ay ba UY aR GES eb NED evant DIscLAMER 118 AUTIEAELNSEX ANS Abe AT: Hass uy, Ang INCU AS ONL QUEICEBEC TO OIL TE Ha eee Ana) MMNICATIOH OH AY OL 188 COSICHT AND MAW RIA. CONTARAM TGC 7, ALIHGUGIL FE STOFSADE RL Peete iiAs ny He At etry VE VAD FO ORT HS THE ADT CASNET ACCT AGI RESPORGSAUTY Fo ARLES Pesipoe unisiaray HAL THE AUTHOR FIAPES PRO WARDANI LMPRISRORIFGAILD Ay TE (UE CLELE TEES. CRATES eee eee A TI CORI EIS OF IHS lace IEE BROORSATH ON ONTABI IN Te XT SUR DBIOT OCONEE AS SPU asin hose vom aba IAL PATRITS, PARA AG AG RSPRCQICA IAFCMTIATIRUARDD EAC Cte LIS SERS KE VE WA> IRaCUDINNS COE HA ATIONS, DOMAR ES AND HFCATIION FoRCUR NT NECA sos eon pzatne orang run orn mther a errr 11216FOUNDATIONS 1, Embryology. 2. Teratogencsis Cell Biology: Organeltes Cell Biology: Cytoplasm & Cytoskeleton ‘Cell Biology: Plasma Membrane Cellular Suffering and Death Taflammation Extracellular Environment (Cellular Adaptations EURO ‘Brain Embryology Nervous System Basics Cortex and*Brain Lesions Cranial Nerves part 4 (CranialiNerves part 2 Brainstem in Cross Section ‘Brainstem Lesions Limbie System and Hypothalamus CSP and ICP mo 10. Vascular Events 11. Seizures 12, Headache 13. Brain Tumors 14. Sleep 15, Anesthenies 16, Movement 47. Basal Ganglia’ 38. Spinal Cord and Lesions 19. Brachial Plexus and Upper Extremity Nerves|part 1 20. Brachial Plexus and Upper Extremity Nerves part 2 21, Lower Extremity nd Skeletal Muscle 22. Sensation 23. Bye 24, Ear 25. Delitiuim and Dementia PHARM BASICS 1. Parasympathetic Activation Parasympathetie ‘Sympathetic Activation G Protein Second Messengers Pharmacokinetics Pharmacodynamics Drug Metabotism 10. Drug 11. Drug Side Effects 12, Antidotes 10 12 16 18 20 2 28 33 36 39, 42 a7 50 52 54 7 eL 63 66 68 4 6 83 87 1 95 98 103, 106 108 110 112 us ug 123, 125 127 431 135 SLN3LNOD 40 aTevL‘TABLE OF CONTENTS v vi TABLE OF CONTENTS CARDIOVASCULAR 1. Embryology 2. Congenital Heart Defects 3. Cardiae Output 4, Heart Failure 5. Treatment of CHF 6. 7. 8. 9. : ic Heart Murmurs 9. Systolic Hare Murmurs 10. Electrophysiolo 11, Aatamuyeimie 12. Electrocardiography 13. Aerhyehimi 14. Regulation of BP 15. Hypertension 16. Antihypertensives 17, ‘Atherosclerosis 18. Antianginal Therapy and Lipid-Lowering Agents 19. Myocardial Tafaretion part 1 20. Myocardial Infarction part 2 21, Cardiomyopathies and Endocarditis 22. Other Cardiac Pathology 23, Nasculit RHEUM & DERM 1. Bone Formation and Bone Tumors 2. Bone Disorders 5. Musculoskeletal Injuries . is and Rheumatoid Arthritis 5. Other Types of Arthritis 5. Systemic Disorders Dermatology part 1 ‘Dermatology part 2 3. 4. 5 6 7 8 REPRODUCTION 1 2. 3. 4 S. 6 2. 8, Reproductive Anatomy . Genital Embryology Androgens 1. Testicular Pathok Penis and Prostate Patk@logy Female Reproductive Cycle ‘Menstruation and Menopause Vulva, Vagina and Cervix 9. Userine Pathology 10, Ovarian Pathology 11. Ovarian Neoplasms 12, Prognancy part 1 13. regaaney pare 2 14, Chromosomal Disorders 15. Genetie Disorders: AD and ‘Trinucléotide Repeats 16. Genetic Disorders: AR and X-Linked 17. Breast 139 142 aaa 146 148 150 153, 157 159 161 163, 165, 167 17 174 17% 179 182 184 187 189 191 193, 195 199 201 204 208, 210 22 24 217 221 223, 225 227 229, 232 235 238 240 242 244 2ar 249 251 255vu MICRO 1, BacterialBasics 2, Bacterial Toxins 3. Staphylococcus 4, Streptococcus 5. Other Gram-Positive Bacteria! 6. Gram-Negative Bacteria part 1 7. Gram=-Negative Bacteria part2 8. Spirochetes and Zoonoties 9, Mycobacteria 10, Nonstaining Bacteria 1. Penicillins 12. Cephalos 13. Other Cell Wall Tabibitors 14, Protein Synthesis Inhibitors 15. Other Antibiotics 16, Micro by Systems part 1 17. Mierolby Systems part 2 18, Viral Basics 19. DNA Virusesipart 2 20, DNA Viuses part 2 21, RNA Viruses part 1 22. RNA Viruses part 2 23. HIV. 24. HIV Drugs 25. Mycology part 26. Mycology part 2 27. Antifun 28. Protozoa 29, Helminths ani Betoparasites Haband eich TE Seem BA ‘Antigen Presentation ‘T Cells. B Cells and Antibodies ‘Immunization and Autoantibodies: Hypersensitivity and Complement ‘Macrophages, Granuloeytes/and Cytokines Immunosuppressants: Tmmunadefclencies 263 265 269 a7 223 275 27 279 281 283 285, 289 292 295 298 301 303 306 308 310 313, 315 318 320 322 325 328 333 335 337, 339 341 344, 345. 348, 350 SUNRINOD 40 378VL‘TABLE OF CONTENTS 1 xt cI 1. Oropharynx 2. Esophagus 3. Stomach 4. Upper GI Patholoy 5. Denise 6 Enterocytes and Absorption 7, Diseases of the Small Intestine 8. Large Intestine part 1 9. Large Latestine part 2 10, Large Intestine part 3 ML Panereat 12. Liver Basies 13. Alcoholic Liver Disease and Cirrhosi¢ 14. Liver Pathology 15, Hepatitis 16. Biliary Tract PULMONARY 1, ‘Anatomy and Physiology. Lung Volumes and Pulmonary Circulation Oxygen and Hemoglobin Osygenation tion and Perfusion Eas Ener PE, DVT and Pneumothorax COPD and Asthma Pulmonary Medications 10. Restrictive Lung Disease 2. Lung Cancer: 12, Lung Infections MEDICINE IN SOCIETY Research Study Designs Diagnostic Test Evaluation Interpretation of Study Data Study Validity Statistical Distribution and Error Biostatistics Disease Prevention and Public Health Healthcare System Ethics 357 361 64 366 368 370 372 374 376 378 380 382 384 386 388 390 395 397 400 402 404 406 409 a a3 as a8 420 425 427 429 432 434 436 438 442 448xi xi xiv BIOCHEM . DNA Basics DNA Replication, Mutation and Repair RNA Protein Synthesis Tnberitance Genetic Lab Techniques Clyeoljaia 3 Gluconeogenesis Glycogen Energy Metabolism Shunt and Other Sugars . Starvation and Malnutrition Lipids ‘Amino Acids and Nitrogen 45, Amino/Acid Disorders 46. Minerals 17, FarSolible Vitam 18, Water-Soluble Vi PSYCH 1. Psychology’ ‘Child Psych Eating Disorders Alcohol Abuse Substance Abuse Psychosis ‘Antipsychotics Bipolar Disorder ‘Depression 10. Antidepressants 1. Anxiety and Somatoform Disorders 12, Ego Defense Mechanisms and Personality Disorders RENAL 1. Renal Embryologyiand Anatomy, Glomerular Physiology ‘Nephron Physiology. Diuretics Electrolyte Disorders Acid-Base Disorders ‘Nephtitis Nephrosis Other Renal Pathology part Other Renal Pathology part 2 and Antioxidants Beene MAED 457 "460 464 465 46) 47 476 479 482 486 488 491 494 496 498 ‘502 507 509 Sut 513 516 513 522 524 525 528 530 535 537 539, 544 546 548 350 552. 554 556 SLNINOD 4O a78VLTABLE OF CONTENTS x s xv xvi PEDIATRICS 1. Pediatric Review ENDOCRINE Endocrine Overview Pituitary ‘Adrenal Steroid Synthesis Glucocorticoids and Cushing Syndrome Other Adrenal Pathology ‘Thyroid Basies and Hyperthyroidism Hyporhyfoidism and Thyroid Cancer Diabetes DKA and Diabetes Treatment 10. Obesity 11, Calcium Metabolism HEME Clotting Factors 2 icosgtant Bru RBC Basics 4. Exythropoi 5. Nonhemolytic Anemnias Hemolytic Anemias Platelet Function Platelet Disorders Lymphoma 10. Leukemia and Multiple Myeloma ONCOLOGY 1, Cancer Basics 2. Genetics of Cancer ‘Cancer Risk Factors Cancer Sercening and Prevention Cancer Drugs part 1 Cancer Drugs part 2 560 S67 69 573 576 578 580 582 S84 586 590 592 97 599 601 603 1605 607 10 612 6M 616 en 623 626 628 630 632KEY TO ABBREVIATIONS ‘This Study Guide contains page references to several medical educational resources. Below is a key to the abbreviations that accompany the various page number references appearing in this text. FAIS FAIA GG Le, T, Bhushan, V, etal. Fest id fr the USMLE Step 1 2015. New York, NY: McGraw-Flill; 2014, Le, T, Bhushan, V, etal. First Aid for the USMLE Step 1 2014. New York, NY: McGraw-Hill; 2013. Jenkins Ba al: Sop: Up te USMLE Sip 12015, Philadephia, PA: Lippincott Williams & Wilkins; 2014. Hall, JE. Guyton and Hall Texibook of Mes Philadelphia, PA: Saunders Elscvier; 20 Kumar, V, Abbas, AK, et al. Robbinsand Cotran Pathologie Bass of Disease 9th ed. Philadelphia, PA: Saunders Elsevier; 2015. Moore, KL, Dalley, AF, & Agur, AMR. Clinically Oriented Anatomy. 7th ed. Philadelphia, PA: Lippincott Williams 8 Wilkins; 2014, Longo, DL, Fauci, AS, Kasper, DL, Hauser, SL, Jameson, JL, Loscalzo, J, eds. Harrison's Principlesof Internal Medicine. 18th ed. New York, NY: McGraw-Hill 2012. Brunton LL, Chabnes BA, ¢Knollman, BC, os, Conan Gilman’ Toe Pharmacological Basis fs, 12th ed. New York, S¥eMecrw titeon wy Deven SBL0NNOTES Kara ‘Mary Beth Cox, M.D. Aaj Selzer, M.D. Jennifer Shuford, M.D. Katharina Hathaway, M.D. Hampton Richards, M.D. COURSE VIEWING OPTIONS Part 2 consists of 238 videos. Examples of 15, 18, 21, 24, and 30-day plans are provided below for maximum flexibility to meet your personal study needs. 15-day plan 18-day plan 2-day plan | 2a-day plan 30-day plan t No. of Videos/Day |Video Runtime/Day* 6 ‘Approx. 5.5hes 8B Approx. 45 hrs uo Approx. 4hies 10 | Approx. 35 hrs 8 Approx. 25 hes “Does not include study breaks oF time spent annotating and answering questions.| AXTHOUGH YOU HAVE THE FLEXOIITY TO VW THE VIDEOS IM ANY ORDER, WE STRONGLY RECOMMEND | “THAT YOU WATCH THE VIDEOS THE ORDER WHICH YOUR FERSONALIZED DASHBOAND PRESENTS THEM | RECAROAESS OF HOW MANY VIDEOS YOU VEW IN A DAY ‘WIQUO 3SYNOD G3GNIMWODIY ‘Neuro 4 ~ Cranial Nerves part 1 2B Neuro 5 - Cranial Nerves part 2 2C Neuro 6 - Brainstem in Cross Section 2D Neuro 7 - Brainstem Lesions 2E Neuro 8 - Limbic System and Hypothalamus, 2F — Neuro 9 - CSF and ICP 2G Neuro 10 - Vascular Events 2H Neuro 11 -Seizures 21 Neuro 12 - Headache 2 Neuro 13 - Brain Tumors 2K Neuro 14 -Sleep 2L__ Neuro 15 - Anesthetics A (edRECOMMENDED COURSE ORDER [x] Cardiovascular 1 - Embryology Cardiovascular2 - Congenital Heart Defects Cardiovascular3 ~ Cardiac Output Cardiovascular 4 ~ Heart Faitare Cardiovascular ~ ‘Treatment of CHF Cardiovascular 6 - Edema and Shock Cardiovascular 7 = Cardiae Cycle Cardiovascular ~ Diastolic Heart Murmurs. Cardiovascular9 - Systolic Heart Murmurs Cardiovascular 10 - Electrophysiology Cardiovascular 11 - Antiarshythmies Cardiovascular 12 - Electrocardiography oroductive Anatomy “Reptoduction 2- E Reproduction 4- Testicular Pathology. Reproduction 5- Penis and Prost Reproduction 6 - Female Reproductive Cycle Reproduction 7 - Menstruation and Menopause Reproduction 8 - Vulva, Vagina and Cervix Reproduction 9 - Uterine Pathology Reproduction 10 - Ovarian Pathology Reproduction 11 - Ovarian Neoplasms Reproduction 12 ~ Pregnancy part 1 Reproduction 13 - Pregnancy part 2 Reproduction 14 ~ Chromosomal Disorders Reproduction 15 ~ Genetic Disorders: AD and Trinucleotide Repeats Reproduction 16 - Genetic Disorders: AR and X-Linked Reproduction 17 ~ BreastWAQO 3SUNOD GEUNSHODIY 8A 8B Immunology 7 - Macrophages, Granulocytes and Cytokines 8C Immunology 8 ~ Immunosuppressants 8D Immunology 9 - Immunodeficiencies 85 SF 8G ‘Neuro 16 - Movement Neuro 17 - Basal Ganglia ‘Neuro 18 - Spinal Cord and Lesions 8H Neuro 19 - Brachial Plexus and Upper Extremity Nerves part 1 81 Neuro 20 - Brachial Plexus and Upper Extremity Nerves part 2 8} Neuro 21 - Lower Extremity and Skeletal Muscle 8K Neuro 22 - Sensation BL Neuro 23 - Eye Gli2 Cli3- Al ON Gl tx]RECOMMENDED COURSE ORDER Lx 0A, 108 GL 15 - Hepatitis G1 16- Biliary Tract Pulmonary 1 - Anatomy and Physiology Pulmonary 2~ Lung Volumes and Pulmonary Circulation Pulmonary 3 - Oxygen and Hemoglobin Palmonary 4 - Oxygenation Pulmonary 5 - Ventilation and Peefusion Pulmonary 6 Extreme Environments Palmonary 7 - PE, DVT, and Pneumothorax Pulmonary 8- COPD and Asthma Pulmonary 9 - Pulmonary Medications Pulmonary 10 - Restrictive Lung Disease Pulmonary 11 - Lung Cancer Pulmonary 12 - Lung Infections ‘Medicine in Society 4 - Seudy Validity ‘Medicine in Society 5 ~ Statistical Distribution and Error ‘Medicine in Society 6 ~ Biostatistics ‘Medicine in Society 7 ~ Disease Prevention and Public Health ‘Medicine in Society 8 - Healtheare System ‘Medicine in Society 9 - Ethies Micro 11 ~ Penicillins ‘Miceo 12 - Cephalosporins ‘Micro 13 - Other Cell Wall Inhibitors ‘Micro 14 - Protein Synthesis Inhibitors ‘Micco 15 - Other Antibiotics ‘Micro 16 - Micro by Systems par 1 Micro 17 - Micro by Systems part 2Paych 8 - Bipolar Disorder Paych 9 - Depression Paych 10 ~ Antidepressants Paych 11 - Anxiety and Somatoform Disorders Paych 12 - Ego Defense Mechanisms and Personality Disorders Renal 1- Renal Embryology and Anatomy Renal 2- Glomerular Physiology Renal 3 - Nephron Physiology Renal 4~ Diuretics Renal 5 ~ Electrolyte Disorders Renal 6~ Acid-Base Disorders Renal 7 - Nephritis Renal 8 Nephrosis YECYO 3SUNOD GIGNIKWODIYRECOMMENDED COURSE ORDER {xiv A 168 16C 16D 16E, 16F a7N 170 18B 8c 18D 18E, 18F 18G 18H 18h 19 18K 18L, 18M Biochem 17 Fat-Soluble Vitamins and Antioxidants Biochem 18 ~ Water-Soluble Vitamins Endocrine 1 = Endocrine Overview Endocrine 2 ~ Pituitary Endocrine 3 Adrenal Steroid Synthesis Endocrine 4 - Glucocorticoids and Cushing Syndrome Endocrine 5 - Other Adrenal Pathology Endocrine 6 - Thyroid Basics and Hyperthyroidism Endocrine 7 - Hypothyroidism and Thyroid Cancer Endocrine 8 - Diabetes Endocrine 9 - DKA and Diabetes Treatment Endocrine 10 - Obesity Endocrine 11 - Calcium Metabolism deme Te Micro 24- HIV Drugs ‘Micro 25 ~ Mycology part 1 sm 26 - Mycology part 2 ‘Micro 27 - Antifungals ‘Micro 28 - Protozoa Micro 29 - Helminths and Ectoparasites Oncology 1 - Cancer Basics Oncology 2 ~ Genetics of Cancer Oncology 3 ~ Cancer Risk Factors Oncology 4 ~ Cancer Sercening and Prevention Oncology 5 ~ Cancer Drugs part 1 Ontology 6 - Cancer Drugs part 2FOUNDATIONS 1 Embryology JE fel NTater | le) 2 Teratogenesis rae 3. Cell Biology: Organelles 4 Cell Biology: Cytoplasm & Cytoskeleton 5 Cell Biology: Plasma Membrane 6 Cellular Suffering and Death 7 Inflammation 8 Extracellular Environment 9 Cellular AdaptationsNeuron (FA valves (FAL ps esis (FAIA pS > Trephoblen——> spaces *tembyonte membrane 2. What neural crest structures are found in each of the following adult structures? Peripheral nervous system ‘Mouth Thyroid Heart Digestive system Adrenal gland Skin ADOTOAWENIE SNOLLVONNOdEMBRYOLOGY End of Session Quiz 3, What's the relationship between the notochord, the neural plate the neural tube, and the neural crest cells? 4. What is the embryologic origin of each the following adult structures? ‘Asmerir ploukary * Cornea, = Lens + Retina * Olfsctory epithelium = Mammary glands + Salivary glands + Swear glands 5. At what developmental age does each of the following events typically take place? + chamber heart begins to develop + Genitalia begin to take on visible sex-specific characteristics ‘+ Feral movement begins ‘+ Limb buds begin to formHlomeabeox (10%) g Genes of embyogeness (FA 3 Question Warm-Up 1. What embryonic structure (derived from the hypoblast) serves asa secondary ‘energy source? 2. What embryonie structure cerves asa reservoir of nonepecialized (undifferentiated) stem eels? 3, What are the three germ ayers that derive from the epiblast? I. Potentially teratogenic drugs: ACE inhibitors — ‘malformations Aminoglycosides Fluoroquinolones ‘Tetracyclines = ‘Cyclophosphamide ~ ear/facial anomalies, limb hypoplasia, absence of digits ‘Methotrexate ~ neural tube defects, abortion Carbamazepine ~ Valpeoic acid — - Phenytoin — fetal hydantoin syndrome Lichium = Statins — CNS and limb abnormalities ‘Warfarin ~facial/imb/CNS anomalies, spontaneous abortion Isotretinoin ~ Dicthyistlbestrol (DES) ~clear cell vaginal adenocarcinoma ‘Thalidomide - phocometia siIssNaDOLV¥aL, SNOLLWAONNOJ5, Homeobox (HOX) Genes © Blueprint for skeletal morphology ‘Code for transcription regulators © Mutation in Homeobox HOXD-13 — synpolydactyy (extra fused digit berwoen Sed and 4th finger) © Retinoic acid alters HOX gene expression End of Session Quiz 6. Which antibiotics are potentially teratogenic? 7. Which drugs have such high potential for teratogenicity that they are classified ‘5 pregnancy category X? 8 Examination of a fetus from a spontaneous abortion at 14 weeks gestation. reveals a vestigial par of legs that arse from the torso, just below the arms. A. ‘mutation in what family of genes is the mostlieely cause of this malformation? Rapip-Fire Facts ‘Most common cause of neural tube defers | ‘Most common preventable cause of | congenital malformations in the US.SaTIBNVOYO ADOTOIS THD 3 Question Warm-Up 1. Whats the embryologic origin ofthe tissue just proximal to the peetinae line? ‘What is the origin ofthe tissue just distal to the pectinate line? (FAt4 p553) (FAIS 559) (SUIS pli6) 2. What effect might each of the following teratogens have on a developing fetus? (ALA 5) (AIS p50) SUIS p37) + ACE inhibitors + Aminoglycosides © Diethylstilbestrol + Tetracyclines + Valproe ac 3. Which vitamin should not be supplemented in large amounts during pregnancy? (Al4 p55) (AIS p50) GUIS 312) 4, Nuclear localization signals © Amino acids sequences: 4-8 amino acids ich in proline, arginine, and lysine © Essential component of proteins bound for or residing in the nucleus (eg. histones) © Nuclear pores recognize these signals and transport proteins into the nucleus via ATPase * A muration ima single amino acid may prevene nuclear transportCELL BIOLOGY: ORGANELLES Cell cycle basics + Cyctins + cyclin-dependent kinases (CDK) phosphorylate target proteins to drive the eal gee © All eyelins are degraded by ——— ‘When ther cell-cycle specific jo is complete © p21, p27, and p57 bind to and inactivate cyelin-CDK complexes (p53 controls the setivation of 2) Gi-s © Cyclin D binds/activates CDK4 —> phosphorylation of Rb protein —> Rb protein is released from transcription factor E2F —+ with B2F unbound, the cel is ce to transribe/ synthesize components needed for progression through the S phase (cyclin E, DNA polymerase, thymidine kinase, dihydrofolate reductase) © Cyclin E binds/activates CDK2 —> the cells allowed to progress into S phase GM © Cyclin A~ CDK2 complex —+ mitotic prophase © Cyclin B- CDK1 complex is activated by cde25 —> breakdown of. and initiation of mitosis -cell disease + Deficiency in mannose phosphorylation No. secretion out of cel instead oF int lysosomes + Death by age 8 years + Comeal clouding, coarse faces, hepatosplenomegaly skeletal abnormalities, res joint movement + May have intellectual disability to target lysosomal proteins > cd Chaperones and heat shock proteins = Chaperones asist in the proper folding and transport of polypeptides in the ER, Gol, etc. Some chaperones ate synthesized constantly and are involved in normal intracellular protein trafficking. © Other chaperones are induced by stressors such as (heat shock proteins hsp70, and hsp), These chaperones “rescue” shock-stressed proteins from misfolding, = Ifthe folding process snot success the chaperones facitate degradation of the darraged protein. This degradative process often involves ubiquitin aso a heat shock protein), which added to the abnormal proten and marks it for degradation. 8. Peroxisomes dation of very long chain itty acids and branched chain fey acids fo portant phospholipids found "© Oridases and catalase for metabolizing ethanol (and other toxic substances)End of Session Quiz 9, What must be present on a protein inorder for that protein to gain entry into the nucleus? 10, Which cyelin-CDK complexes assist in the progression from G, phase to S phase? 11, Which cyclin-CDK complexes assist in the progression from G, phase to M phase? 412. What molecule does the Golgi spparstus add to proteins in order to direct the proteins o the lysosomes? 13. What are the different methods that a cell uses to break down protins? SATENVO¥O 2901019 THD SNOILWGNNO4‘CELL BIOLOGY: CYTOPLASM & CYTOSKELETON ‘Gytoskleton (FAM p78) (FAL AMeofiemens (FAl1 p79) (FMS pr Moot 3 Question Warm-Up 1, Which amino acids are found in nuclear localization signals? (2. What is the most common cause of intellectual disability in infants? (FAN p55) AIS p56) 3. How do Rb protein and p53 regulate the cell cycle? F414 p74) (415 p72) 4. Intermediate filament structures Intermediate Structural Stain used to Filaments ‘Component of: identify... Cytokeratin Epithelial cells (ke jn desmosomes and hemidesmosomes) Desmin ‘Muscle cells (smooth, skeletal, heart) Glial fibrillary acid Astrocytes, Schwann cells, proteins (GFAP) “other neuroglia | Neurofilaments ‘Axons within neurons (L, M, H molecular wt) Nuclear lamins(A, B,C) | Nuclear envelope and DNA within Vimentin Connective tissue + Support cellular (Fibroblasts, leukocytes, membranes endothelium) + Keep certain organelles fixed in eytopasmNOL31S¥SOAAD 8 WSVOLAD “ADOTOIE 1139. cudCELL BIOLOGY: PLASMA MEMBRANE 3 Question Warm-Up 1. Daring what weeks of fetal development does organogenesis take place? 4 152) (AIS )S58) 2. What molecules provide the structural framework: for DNA and the nuclear envelope? 3. What is deficient in I-cell disease? (414 p77) (FAIS 73) ‘Tyrosine kinase receptors © Transmembrane receptors that Bind an extracellularligand then intacelhulaly eranefora phosphate group (phosphorylate) from ATP to selected tyrosine side chains on specific cellular proteins induding self autophosphorylaion). The frst stp inthe signaling cascade thats initiated by tyrosine kinase receptcrsis autophosphoryltion. ¢ PDGF and other growth factor receptors: single-pass transmembrane protein © Insulin and IGF-1 receptors: 2.1 subunits (bound by csulide bonds) ~ bind extraelblarFgend 2B subunits— tyrosine nase actwity5. Receptor-mediated endocytosis Clathrin Dy wma A) Normal LDL receptor LDL binding site LoL clathrin coated pit, CYTOSOL 8B) Mutant LDL receptor LDL receptor protein with ‘abnormal coated pit binding site CYTOSOL, SNVUEW3N VHISYTd ADOTO!B 13D, Asmutant LDL receptor lacks the coated-pit binding site but retains a funetioning LDL- binding site. As a result, cells with ‘mutant receptors are able to bind LDL normally but are tunable to ingest it. Individuals with this mutation have @ higher risk of dying prematurely from a ‘myocardial infarction. SNOILVONNO4A a 6, List the steps outlining the derivatives of arachidonic acid. fe tUow 5 ANVUSHIH VHSV'd ADOTOIS 1139. (ayEnd of Session Quiz 7. Which arachidonic acid product causes each of the following effects? + Increased bronchial tone + Decreased bronchial tone + Tcreasd platelet aggregation * Decreased platelet aggregation + Increased uterine rove * Decreased uterine rone * Increased vascular tone + Decreased vascular tone Zz 8 = (e) vA 6 ANVEEHZN VASYId ADOION 12D 8 What are the two most abundant substances in plasma membranes? 9. What drugs act on the arachidonic acid product pathway? What enzymes do they affect?‘CELLULAR SUFFERING AND DEATH R Chapter | 15 (FAL4 220) (FAIS p22) Exenss peatray ocr (A422!) FANS 223) Reversible vz. reversible imry (FAV p22) (FAIS p224) ‘Mechanisms of cell mary Defects n membrane permet ity Real vs plenfacts (FAIS p22) (FAIS p24) 3 Question Warm-Up 1. What are the stages that an embryo goes through between conception and the development of an inner cell mass? ‘2. What drugs interfere with mieronihule fanctioniing® (FAl4 p78) (FAIS p74) 3. Which ceil types are constantly regenerating themselves due to an absence of the G, phase and a short G, phase? (FAl4 p76) (FAIS p72) 4, Intrinsic pathway of apoptosis ‘© Bul-2is the major anti-apoptotic regulator of mitochondrial permeability © DNA damage or apoptotic signal activates Bax (pro-apoptotic) ‘© Bax ereates channels in mitochondrial membrane © Cytochrome C moves from the mitochondria into the eytosol and aetirates caspases + Caspases are primary initiator of apoprosis 5S. Extrinsic pathways of apoptosis © Death receptor ~ TNF receptor and Fas receptor are located on cell membrane ~ TNF ctand Fas ligand actwate the receptors ~ Activated receptors wil lead to activation of caspases © Cytotoxic T lymphocyte (CTL) = Cytotoxic T cells recognize foreign or infected cell CTLs release perforin and granzyrne B Perforin punches hole in membrane = Granayme B enters and activates caspasesMechanisms of cel injury = ATP depletion: due to decreased oxygen/nutrients and toxin (cyan) Mitochondrial damage: impairs ATP production and can induce apoptosis + Influx of calcium: increases mitochondrial permeability and can activate phospholipases, proteases, endonucleases and ATPases © Accumulation of oxygen-derived fe radicals: cll damage through membrane lipid peroxidation, prin modification and DNA breakage. Multiple causes like radiation ‘exposure, metabolism of drugs, redox reaction, nitric oxide, transition metals, leukocyte ‘oxidative bust, iron overdose and reperfusion injury. 7. What cellular by-products might you detect in the serum when the following cell types are injured? Cardiac myocytes Hepatocytes Skeletal myocytes | Salivary gland cells Pancreatic exoerinc cells | RBCs End of Session Quiz 8. What histologic fearures are seen in apoptotic liver cells? 9, What substances do cytotoxic T cells and NK cells use to induce apoptosis in the cells infected with a virus? 30, What highly damaging events can cause ireversble cell injury? 1, What cellular enzymes are responsible for handling oxygen free radicals? Hiv ONY ONIWWINS YYTATAD SNOILVONNO4INFLAMMATION 3 Question Warm-Up 1. What are the characteristic fearutes of «cel undergoing apoprosis? (FAIA p220) AIS p222) 2. How do Bax and Bel-2 affect apoptosis? 3. What neural crest derivatives are found in each of the following adult structures? (FAl4 553) (FAIS p552) Peripheral nervous system Ear Eye ‘Adrenal gland Mouth Heart Digestive system ‘Thyroid Skin 4, Acute inflammation © Release of inflammatory mediators +» Vasodilation and increased vascular permeability —> fuid exudation Serotonin Bradykinin + Fibrosis Fiorotass lay down (equres —) + Tissue remodeling by metalloproteinases (which cortain, )6 Elevated ESR © Polymyalgia rheuratica © Temporal art © Discase activity in RA and SLE, © Infection, inflammation (e.g, osteomyelitis) © Malignancy C-reactive protein © Acute-phase eactant synthesized by the liver © Partof the innate immune response: opsonizes bacteria and activates complement © Canbe secreted from cells within atherosclerotic plaques to activate loa! endothelial calls to induce a prothrombotic state and increase the adhesiveness ofthe endothelium to Teukocytes © Elevations area strong predictor of MI, stroke, PAD, and sudden cardiac death © CRP can be lowered by smoking cessation, exercise, weightloss, and statins End of Session Quiz 7. Describe the process of leukocyte extravasation. 8, What cytokine is particuladly important in the formation of granulomas? 9. Whar cell type plays azole in inflammation by generating Aibrinogen and C-reactive protein? 410. What cell is most responsible for the acute phase of inflammation? NOWWWHYTANI on € Zz Ss Ea fe) Zz aS EXTRAC! 3 Question Warm-Up 2. What protein is involved in transporting endocytosed vesicles from the plasina ‘membrane to the endosome? (alt p77) (AIS p72) 2 Which metals are known to facilitate the generation of oxygen free radicals? 3. Which tumor suppressor proteins prevent the progression ofthe cell nto S phase? (PAIS prt) FAIS p72) |. Cutaneous wound healing 0-3 hours Hlemorshage and clotting 12-24 hours Acute inflammation (PMNs) 153 days. = Macrophage infiltration + Granulstion tissue (fibroblasts and vascular endothelial cells) «+ Epitheliaization ‘Wecks-months | Collagen production (type Tl then type)End of Session Quiz 5, What findiags are associated with Ehiler-Danlos syndrome? mn fe) eS Zz S zi fe) Zz Pa ANAWNOWANS HVT 6. What are the different types of collagen, and where can they be found? 7. Which amino acide are found in large encentrations in collagen? In elastin? 8, Whats the role of vitamin C in collagen production? Rapio-Fire FACTS. Hyperflexible joints, arachnodactyly, aortic dissection, lens dislocation Hereditary nephritis, cataracts, sensorineural hearing lostCELLULAR ADAPTATIONS “CELUULARADAPTATIONS = R: Choptor | Hiner he 3 Question Warm-Up 1. What developmental structure matches each ofthe following descriptions? The fetal placental strucrure that seretes hCG. * Maternal component ofthe placenta 2. How does having a high cholesterol content in the plasma membrane affect the function of the plasma membrane? 3. A patient presents with an agangtionic colon and other neural crest derivative deficiencies. What other findings would you expect to see? FAI4 p53) (FAIS 2559)End of Session Quiz: 4. Does the compensatnry growth of muscle fibers occur primarily as a result of hyperplasia or hypertrophy? 5. Does myometrial growth in pregnancy occur primarily as a result of hyperplasia or hypertrophy? 6. What can happento the cells ofthe lower esophagus in response to chronic acid wellux? 7. Whats actually occurring atthe cellular level during atrophy? 8, Whats a lipofuscin granule? SNOLWLAVOY WWIOT SNOLWONNO4NEUROLOGY Brain Embryology Nervous System Basics Cortex and Brain Lesions Cranial Nerves part 1 Cranial Nerves part 2 Brainstem in Cross Section Brainstem Lesions Limbic System and Hypothalamus CSF and ICP 10 Vascular Events wean aunr wre 11 Seizures 12 Headache 13 Brain Tumors 14 Sleep 15 Anesthetics 16 Movement 17 Basal Ganglia 18 Spinal Cord and Lesions 19 Brachial Plexus and UE Nerves part 1 20 Brachial Plexus and UE Nerves part 2 21 Lower Extremity and Skeletal Muscle 22 Sensation 23 Eye 24 Ear 25 Delirium and DementiaBRAIN EMBRYOLOGY {26} R: Cropter 28, Developing bran (FAIL p44) (FAIS p48) (SUIS p23) Newz tbe defects (AM fv445) (FAIS p40) (SUIS p21) (R p1256) Ferchrom anomalies FAV p445) (FAIS p14) (SUIS p24) ‘Cri malrmatins (FAL pit) (FAIS p49) (SUIS p24, Spergonyci (FAL pte) (AIS 150) (SUIS p39) (R p!258) (4 p3373) Bana Water syne (FAI4 prF85) (FAIS p49) (SUIS 924) rant apparatus (FA 9898) (FAIS p56) Branch eft dericnmes (FAI p55) (FAIS ps4) Branch pouch deities (FAI p60) (FAIS 1568) Branch ech derivates (FAI p59) (FAIS p505) (SUIS p226 227) _ 3 Question Warm-Uj : A. What adult cel arise from neural crest cells? (F 1 the Golgi apparatus? FA/47) (FlEnd of Session Quiz 4, What abnormalities are often found with a Chia malformation® 5, What are the classe presenting symptoms of syringomyelia? 6. What amniotic Hud lab abnormality might point you to a diagnosis of ancncephaly? 7. From whic’ branchial pouch are each ofthe following structures desived™ > Middle ear and eustachian tubes . ger : 1 pay oe ple won + Thymus ASO TOYS NIVES fe) [aE in|EM BASICS. NERVOUS SY (su 3 Question Warm-Up 1. What organelle becomes hypertrophied in hepatocytes with chronic phenobarbital use? (f p!2) 2. Wiatenzyme mitigates the aging effects of cellular division by maintaining chromosomal length? (8 pé7) 3. Whatis currently known as the most effective way of prolonging life span? WR p67) blocking these pathways? Major pathway 7) (FAIS ptS1 152) 5 153) (GG p76) (Phys p50) Result of blocking ‘What are the four major dopaminergic pathways, and what is the result of Mesocortical pathway ‘Mesolimbic pathway | Nigrostriatal pathway ‘Tuberoinfundibular pathway5. What disorder is thought to arise from reduced norepinephrine activity? Increased norepinephrine activity? 6. What disease is associated with the degeneration of the basal nucleus of Meynert and less CNS acetylcholine? End of Session Quiz 7. Which nervous system cell matches each of the following descriptions? + Look like fried exgs under histologic staining + Form multinucleated giant cells inthe CNS when infected with HIV. + Myslinares multiple CNS axons + Myelinates one FNS axon + Damaged in Guillain-Barré syndrome + Damaged in mukiple sclerosis + Macrophages of the CNS * Calls ofthe blood-brain barrier 8 Inwhich newological diseases is acetylcholine altered? 9. What's the main inhibitory neurotransmitter of the CNS? In which diseases are levels alrered? 10. What are the components of the blood-brain barrier ESAS SNOAYEN, OS Ya Wi fe) [aF IN|CORTEX AND BRAIN LESIONS Phys: Chapter 87 COR Chapter? Covel conto (F414 p45) (FAIS 460) (SUIS p31) muncuts (AI p55) ALS p63) Blood supply to the ban (PA pASB 459) (FAIS 162) (SUIS p28) ice of Wis CAL p58) (FAIS p482) (SUIS p26) ‘Arteria load supply othe cortex (FAIA 138) (FATS p62) (SUIS p28) ‘Apasios FAIA p57) (AIS pt60) ‘Bean Fess (AVA 158) (FAIS prt6l) (SUIS p31)NEURO. ‘CORTEX AND BRAIN LESIONS 4, Label the following diagram of the Circle ofSIONS CORTEX AND BRAIN Li 5. Dysprosody © Expresive dysprosody Inability to express emotion or election in speech 'Non-dominant cortical son corresponding o Brocas area © Receptive dysprosody = Inability to cormprehend emotion oriectionin speech "Non-dominant cortical lesion corresponding to Wernick’ area End of Session Quiz ‘6. A lesion to which area of the brain is responsible for each of the following clinical scenarios? 7. What typically isthe cause ofa lesion 16 the mamnmillary bodies? 8. What artery is damaged in each ofthe following presentations? + Brocas or Wernicke's aphasia + Unilateral lower extremity sensory and/or motor loss + Unilateral sensory and/or motor loss in the fice and arma3 Question Warm-Up 1. Whut regulates the progression of G, phase ofthe cell eyelet § phase? (FAIS p76) (FAIS p72) 2. What arachidonic acid product has actions that oppose that of prostacyclin? ANd pA) FAIS pg) 3, In what disorder is there an abnormal breakdown of elastin? (FA 4p) (FAIS p77). (Gus n296) Liiva S3MN WINES, fe}-[aF IN)CRANIAL NERVES PART I 4, Label the cranial nerves as they come off the brainstem:End of Session Quiz 5. Which cranial nerve nuclei are located in each of the following locations? © Medulla = Pons ° Midbrain 6. ‘Where isthe pathology located in each of the following scenarios? 7. When lights shone in a patients right eye, his right pupil fails to constrict but his left pupil constricts normally. When light is shone in the left eye, the left ‘pupil constricts but the right pupil does not. Where is the likely pathology? 1 Lud S3AW3N INVES, ONIN3 Question Warm-Up 2. What organelle and cytochrome are particuladly important in intrinsic apoptosis? (Als p220 (AIS $229) 2. Label the following diagram of the Circle of Willis: Fi4 p459) (FAIS p44p GUS pity 3. What prenatal testing is abnormal in a fecus with a neural tube defect? (FAIA p45) AIS 449)5. 7 ‘What conditions can result in facial nerve palsy? (Hint: Lovely Bella Had An STD) Lyme discase AIDS Sarcoidosis Tumors © Diabetes How do the symptoms of a facial nerve (or facial nerve nucleus) lesion from the symptoms of a facial motor cortex lesion? * Facial nerve/nucleus lesion ~ Paralysis of ipsilatcral side of face © Facial motor cortex lesion — Paralysis of contralateral side of face Why does a motor cortex stroke not affect the upper face? ‘© The facial motor nucleus receives motor fibers forthe lower face only from the contralateral ‘motor cortex, but it receives motor fibers forthe upper face from both left and right motor © Inaleft motor cortex stoke, ony the right lower face will be paralyzed because the right “upper fice stil receives innervation from the right motor cortex. If the right vagus nerve or nucleus is damaged, to which side will the uvula deviate? A patient's uvula deviates to the right when she says, “Ah.” What neurological structures might be damaged? Rightward deviation of uvula means that the muscles ofthe right palate arc raising the palate and the muscles of the let palate are not. This could be caused by damage to: eo Le © Left recsives input from: = Right cortcobutbar tract = Right motor cortex CAuva S3AYEN TWINYED. fo)-TaFINAL NERVES PART 2 9. Ifthe right hypoglossal nerve or nucleus is damaged, to which side will the tongue deviate when sticking out? End of Session Quiz. 10. What two nerves are tested with the gag reflex? 11. A19-year-old man presents with a furuncle on his philtrum, and the cavernous sinus becomes infected. What neurological deficits might you seein this patient? 12. How can a stroke of the ficial motor cortex he distinguished from Bell’ palsy?BRAINSTEM IN/GROSS SECTION | 3 Question Warm-Up 1. What effect might aminoglycosides have on a developing fetus? (Fas p54) (AIS p9eu) UIs 97) 2. What molecule rarges proreins inthe endoplasmic reticulum for lysosomes? EBC TIS 3, What birth defect can result from the following teratogenic agents? (A p554) (PAIS pS80) GUIS 1397) + ACE inhibitors + Folate anagonists ‘+ Tetracycline + Lid 5 Zz g z g fe)[aE IN|BRAINSTEM IN CROSS SECTION 4, Rostral midbrain ‘Scalomotor (CI nucleus Cerebral aqueduct 5. Pons | jue Abducens (CN VI) nucleus: | ‘Vestibular (CN Vit) nucleus oe Oat ee | Zs ee a ZR ~~ iS er | 5 cna “sre 1 6. Medulla Hypoglossal (XIN nucleus Dorsal motor nucleus /Muclous of solitary tract Vestibutar (CN VID nucet Inferior corebellar peduncle Spinal trigeminal tract ‘and nucleus ad ‘Nucleus ambiguus y bessrsomtnan Sy) toferor tivary nucleus oe.End of Session Quiz 7. What acterysupplics the medullary pyramids and the medial emriseus in the medulla? 8. What artery supplies the inferior cerebellar peduncle, nucleus ambiguus and lateral spincthalamic tract in the medulla? 9. Where does each ofthe following spinal tracts decussate? © Corticospinal sract + Dorsal colurnn-medial lemniscal pathway + Lateral spinothalamictract 10. What is the triad of Homer syndrome? NOILD3S SSOUD NI WBLSNIVY! OWNIANBRAINSTEM LESIONS. [2] He-chaprer 370 The rule of furs Bransiem sues (FAIS p60) (FAIS 464) (Hp 3268) tac pcm FAIA 102) AS 8H) US 8) (2 Locked in sydrome (FAIS p56) (H p22 Weber syndrome (H p3287)4, Whats the hallmark sign of a general brainctom lesion? Alternating syndromes: long tract symptoms on one side (.g., hemiparalysis) and cranial nerve symptoms on the other 5. The Rule of Fours 1. There are 4 medial/midline structures, beginning with M + Motor pathway (corticospinal tract) Deficits + Medial lemniscus Deficit: + Medial longitudinal fasccules Deficit: = Motor cranial nerve nucle Deficit 2, There are 4 “side” (lateral) structures, beginning with § © Spinocerebella tract, Deficit: = Spinothalamic tract Deficit: © Sensory nucleus of CNV Deficit + Sympathetic pathway Deficit: 3. cranial nerves o ate in the pons, 4 ori inate above the pons (2 in the midbrain). oiginat in the midbrain originate in the pos originate in the media 4, "The 4 motor cranial nerve nuclei in the midline are those that divide equally into 12 (except for CN T and CN TI) CN + CN + CNW +N te below the pons, and 4 oF SNOIS31 W31SNIVEEBRAINSTEM LESIONS ‘What are the symptoms of lateral medullary syndrome (Wallenberg. syndrome)? Loss of pain and temperature over contralateral body (spinothalamic tract damage) © Loss of pain and temperature over ipsilateral fare (spinal trigeminal nucleus damage) © Hoarseness, difficulty swallowing, loss of gag re‘icx (nucleus ambiguus: CN IX and X damage) © Ipsilateral Horner syndrome (descending sympathctic tract) = Vertigo, nystagmus, nausca/vomiting (vestibukar nuclei damage) + Ipsilateral cerebellar deficits (ic, ataxia, past pointing) (inferior cerebellar peduncle damage) ‘Which vessel is most likely occluded in a stroke of the lateral medulla? ‘What are the symptoms of medial medullary syndrome? © Contralateral spastic hemiparesis (pyramid/corticospinal tract damage) + Contralateral tactile and kinesthetic defects (medial lemniscus damage) + Tongue deviates toward side of the lesion (hypoglossal nucleus/nerve damage) ‘+ Note that pain and temperature sensation are generally preserved What are the symptoms of lateral inferior pontine syndrome? © Ipsilateral facial nerve paralysis (facil nucleus and nerve fbr damage) ‘Ipsilateral limb and gait ataxia damage to middle cercbellae peduncle) + Ipsilateral loss of pain and temperature sensation from the face (spinal trigemi 0 Eine fiecdimp) Cons genial mcs © Contralateral loss of pain and temperature sensation (damage to spinothalamic tract) © Ipsilateral Horner syndrome (amage to descending sympathetic tact) © No contralateral body paralysis or loss of ight touch/vibratory/proprioceptive sensation What are the symptoms of medial pontine syndrome! Contralateral spastic hemiparesis (ortcospinal tract damags) * Conta ln of igh touche proprioceptive sensation (med nists Ipilterlimermclea ophthalmoplegia Jamag o medal longi fuieuls) Gaze away from side oF lesion (damage to pontine gze center: PPRF) Ipsilateral paralysis of atral rectus muscle (damage to abducens nucleus) ‘Nowe that pain and temperature sensation are preserved12. What causes and what are the symptoms of Weber syndrome? Anterior midbrain infarction resulting from occlusion of the paramedian branches of the posterior cerebral artery: © Cerebral peduncle lesion = Dysphagia. dysphonia, dysarthria (cortcobulbar tract damage) Contralateral spastic hemiparess (corticobuibar tract damage) * Oculomoror nerve (CNM) palsy ~ ipsilateral ptoss, pupillary dilation, and lateral strabismus (eye looks down and out) SNOISHT W3LSNIVEE (o)-[a EINSIONS BRAINSTEM LE End of Session Quiz 13. A patient comes to the ER with double visio and left-sided weakness. On physical examination, she cannot abduct he right eye. In addition to motor ‘weakness ofthe left arm and leg she also as loss of fine touch, proprioception and vibration sense in the left arm and leg, Where isthe lesion and what vesel is most likely involved? 14, A patient presents with vertigo, nystagmus and slurred speech. Physical amination reveals right-sided ptosis and miosis, decreased gag reflex on the right, deviation of the uvula tothe lef, diminished pain/temperature sensation on the right side of his face, and diminished pain/temperature sensation on the left side of his body. Where i the lesion and what vessel is most likely involved? 15. A patient presents with double vision, slurred speech, hoarse voice and acute right-sided weakness. Physical examination shows weakness of the right arm ‘and leg, and the left eye is depressed and abducted. Where isthe lesion and. what vessel is most hikely involved?___UMBIC SYSTEMAND Pips Chapt 115 p38) 3 Question Warm-Up 1. Which cell types are derived from the neural crest? (FA/4 9553) (FAIS 1552) 2. Which amino acids are modified by the Golgi a FAH p77) (FAS 673) 3, Whatare the components of the blood brain barier® FAM p44” (FS 453 JASAS DAWN SAWYTVHLOdAH ONY Wi (o)-[aEINLIMBIC SYSTEM AND HYPOTHALAMUS 4, Hypothalamic nuclei NUCLEUS | FUNCTIONS [NOTES ANTERIOR HYPOTHALAMUS Anterior “Thermoregulation (cooling) | Damage causes Suprachiasmatic | Circadian rhythms “Master clock 1 Preopticarea | Secretes : Supraoptic | Seeretes Damage causes Secretes Paraventricular | Secretes GRA Sccretes TRH TUBERAL HYPOTHALAMUS Secretes GHRH eu Secretes dopamine Arcane —____ GnRH secretion Regulate appetite Regulates hunger Damage leads to aan Inhibited by Se Regulates satiety Damage leads Stimolatedby——__ | and savage behavior — ulation leads to obesiy Regulates hunger and savage behavior POSTERIOR HYPOTHALAMUS Posterior ‘Thermoregulation (warming) | Damage causes Mam Memory Damage causesEnd of Session Quiz 5. Which typothalamic muck fiteach ofthe following desciptions? > Savage behavior and obesity result from stimulation + Savage behavior and obesiy result from destruction + The “master clock” for setting circadian rhythms + Relesses hormones affecting the anecor pituitary + Responsible for sweating and cutaneous vasodilation in hot temperatures + Responsible for shivering and decreased cutancoas blood flow in the cold. + Produces antidiuretic hormone (ADH) to regulate water balance + Regulates the release of gonadotropic hormones (i. LH and FSH) + Destruction results in inability to say warm, + Receives input from the retina + Stimulation leads to cating and destruction leads to anorexia + Destruction results in diabetes insipidus 6. A patient is evaluated for behavior and personality changes. She used to be argumentative and aggressive, but has become fairly quiet and docile. She has also become socially disinhibited, and has been making inappropriate sexual advances toward fiends, relatives, and strangers. During the interview, you note the patient's tendency to chew on pens, her fingers, and her necklace. Damage to what neurological structure might account for these behaviors? SNWVIVHLOdAH ONV W3JSAS DIBWIT io} [a= IN}SF AND ICP 3 Question Warm-Up 1 Whiatis the main inhibitcry neurotransmitter of the CNS? In which discascs are levels alered® (14 pt) (a1s p53) 2, What conditions are associated with an clevated erythrocyte sedimentation rate (ESRY (4149379) (a p230) 3, Which cytokine is particularly important in maintaining granulomas? (AY p28 (AIS p20) ‘What are the characteristic features of idiopathic intracranial hypertension {AKA pseudotumor cerebri? Headaches —chily, pulseile, worse at night or carly AM, possible netroocular pain ‘worsened by eye movernent, possible N/V “Most worrisome sequalais vision loss CT scan: no ventricular dilstion, no rumor, no mass Intracranial pressure (ICP) — patients, > 250 mm HO in otese patients) 200mm H,Oin non-obese5. How is idiopathic intracranial hypertension managed? * Discontinue any inciting agents (eg, excess vitamin A, isotretinoin, tetracyclines, danazol) ° in obese patients . = firs-line pharmacotherapy Invasive tweatment options Serial Lumbar punctures ‘Optic nerve sheath decompression Lumboperitoneal shunting (CSF shunt) End of Session Quiz 6. Where is CSF generated? Where is CSF reabsorbed? 7. Whatis the difference between communicating and noncommunicating hydrocephalus? 8, What clinical features characterize normal pressure hydrocephalus? LNY 483) 3 re}: (aE IN|VASCULAR EVENTS. Re Chapter 28 ‘Aneuryams (FA pt (FAIS pts) (SUIS p79) Suborachnou esroreie (FAI 2) Epidral hematoma (FAM 462) (FAIS pe Seindra hematoma (FAY p62) {FAIS p66) (SUIS p2 nchymal hemorrhage (FAIS p62) PAIS p66) (Hp Ischeme stroke [FAI pt63) (AIS p17) (SUES p29) Wiarterstee ces (FAI p80) (FA frid2) SUIS p29 30) 30) (Hp3379) 3 Question Warm-Up 1. What the function ofthe lysosome? FAs (77) AIS P73} 2, A woman involved in an accident cannot turn her head to the left and has a ‘ight shoulder droop. What structure is damaged? (F'4 p474) (AS p47) (IS pl) 3. _Inwhich section of the brainstem is cach of the cranial nerve nuclei located? (PAYA pi72) (FAIS p74) 4. Intraventricular hemorrhage in the newborn © Hemorrhage into the ventricular system © Most common in premature/very low birth weight infants (« 32 wks, < 1500g) within the first 72 hours ofife © Originates from the germinal matrixin the subependymal, subventsicular zone that gives rise to neurons and glia during development © Allinfants born at younger than 30-32 ws gestational age should receive a sereening US todeteetEnd of Session Quiz ‘5, Whats the most common site of a berry aneurysm? What diseases are often associated with berry aneurysms? 6, An 85-year-old man with Alaheimer disease falls at home and presents three days later with severe hesduche and voriting. What isthe mos likely diagnosis and which strucrures were damaged? 7. Abcalthy 52 year old man presents to the ER with stoke symptoms that began two hours ago. What treatment should be considered immediately? What study must be ordered irameciately? Rapib-Fire FACTS [_ “Worst headache of my life” | Lucid interval following head trauma Bloody CSF on LP ‘Most common © subdural hematoma “Most common cause of ej jural hematoma SLNAAB BYTNDSVA lo) [aE|y|SEIZURES 4] "SEIZURES 5 : 4. Hi Chepter 389 Phys Chopra 59 ‘GG Chapter 21 Sozures (FAM p85) (FAIS p89) (SUIS pA3 Tube‘ous sderais (FAVA p187) (FANS p99) (Rp Sturge Webs syrtionne (FAL 187) (FAIS p49) fs noon (FAIA p92) (FAIS p96) (SUIS p44) (H p3261 3267) (GG p90. 606) (Phys p72) (6 p3251) ) 3 Question Warm-Up 1. What information is communicated at the nucleus solitarius? Nucleus ambiguus? Dorsal motor nucleus? (F4 p47) (AIS p76) 2. Which cranial nerve is responsible for each of the following actions? {FA14 9472) (FAIS p75) (SUIS 40°41) + Eyelid opening + Taste from anterior 23 of ngue + Head turning + Tongue movement Muscles of mastication + Balance ‘+ Monitored carotid body and sinus chemo and baroreceptors 3. What cranial nerve innervates the tongue in each of the following ways? (AIA p72 (FAIS p75) + Tasrein the aneroe 2/3 + Taste inthe posterior 13 (main innervation) + Moror + Sensation in the anterior 2/3 “+ Sensation in the posterior 1/3 Tuberous sclerosis © Autosomal dominant; 1/5,000 - 1/10,000 live Births © Incomplete penetrance and variable expressivity Most common mutations are in ehe TSC1 or TSC2 genes TSC: gene > hamartin protein = TSC2.gene ~ tuberin protein © Classic triad: setaures, mental retardation, angiofibromas| © Additional findings: hypometanotie macules (ash-leaf spots), retinal hamartomas, cortical tubers (glioncuronal hamartomas) © ‘Tumor associations: renal angiomyotipema, cardiac rhabdomyora, astrocytoma (ubependymal giant cll astrocytoma)2 Be ‘Trigeminal neuralgia (tic douloureux) «© “Lighening-like” pain, “clectreshocke," along a division of the trigeminal (usually maxillary) triggered by light touch (wind, bed sheets) © Treatment: carbamazepine or other anticonvulsant (phenytoin, gabapentin, opiramate) Drug of choice for absence seizures: Used to treat status epilepticus: Used to treat eclamp: ‘Additional SE of phenytoin: |. Which anti-epileptics are teratogens? What drugs cause Stevens-Johnson syndrome? What drugs are known to cause agranulocytosis? Hepatotoxic anti-epileptics: S3unZIBS fey [aE iN)14, What drugs induce the P450 system? SEIZURES End of Session Quiz 15. In regard to seizures, what do the tcums partial, simple, couples, and ‘generalized mean? 16. What are the most common causes of seizures in children? 17. A10-year-old child “spaces out” in class (stops talking midsentence and then Continues as ifnothing had happened). During the spells, there is slight quivering oflips, What is the diagnosis? 18, Whar drugs are known for causing Stevens-Johnson syndrome? 19, What are the tonic side effects of phenytoin Rapip-HRe FACTS ‘Treatment for absence seizures | ‘Treatment for tonic-clonic seizures3 Question Warm-Up 1. Which acca ofthe hypothalasmus regulate the autonomic nervous estem? (PAL p50 AS p59) 2. Which nucleus of the hypothalamas fits each ofthe following descriptions® TFA p50) FAS p45H) '* Considered the “master clock” for most of our circadian rhythms ‘+ Regulates the parasympathetic NS + Regulates the sympathetic NS + Produces antidiuretic hormone (ADH) to regulate water balance “+ Mediates oxytocin production + Regulates the release of gonadotropic hormones (.c., LH{ and FSH) 3. ‘What are the differences between oligodendroglia and Schwann cells? Al 447448) (AIS p51 452) BHOVOVaH 1e)- [AENHEADACH: 4 Patient Profile: Eddie's Exploding Eye Eddie is a 27-year‘old man who comes to the physician because of two weeks of recurrent headaches. The headache begins around 10:00 AM and lasts about 90 minutes before resolving spontaneously. The pins alway located bend the ight eye, ad fecls like a red hot poker is being jabbed into his eye. The headache docs nor throb During the headache, the right eye is red and watery, and the right side of his nose runs profusely. He denies any nausea or vomiting, The headache is not worsened by bright lights, loud noises, or physical activity. What therapy will treat this patient's headache most rapidly? Tension headache © Constant, non-throbbing pain (lasts 4-6 hours, up to 7 days) Occurs in the regions (most often bilateral) oF asa band around the bead = No associated symptoms such as: Migraine headache © Atleast attacks © Headache lacing 4-72 hours (2-48 hours in children) © Atleast2 ofthe flowing: location quailty ‘Moderate to severe intensity (inhitits or prohibits day activities) ‘Aggravated by routine physcal actwity © Atleast 1 of the following: ‘Nausea andor vomiting ‘Cluster headache © Strictly © Severe pietcin © Does not chrob like a migraine. No aura. © Duration of 15 minutes to 3 hours, occurs (often at the ‘same time), and continues for an interval of 4-8 wecks © Maybe associated with: ~ Partial Homer syndrome ( ) = Ipsilateral tearing, hinorthea, or nasal congestion region8. What is the most likely cause of headache based on each of the following descriptions? ‘Made worse by foods containing tyramine ‘Obese female with papilledema Jaw muscle pain when chewing Photophobia and/or phonophobia Bilateral frontal/occipital pressure Pati using topical retinoic acid for acne “Worst headache of my life” Headache + extraocular musele palsies ‘Scintllating scotomata prior to headache Headache occurring either before or after orgasm Responsive to 100% oxygen supplementation ‘Trauma to the head > headache begins days after the event, persists for over a week and does not go avay Severe headache + fever or neck stiffness 3HOVOV3H o}-[aE IN}HEADACHE [60}BRAINTUMORS | (14 pA8B) (FAIS p92) (SUIS Pechatn bin tumors (FAIA pi89) 93) (SUIS (91308) (6 93382) 3 Question Warm-Up 1. Which cranial nerve relays the following information? (Fl4 p472) (AIS 0475) + Hypoxia measured by the carotid body = Motor information for swallowing + Blood pressure from the aortic arch + Salvation from che sublingual glands + Salivation from the parotid gland + Blood pressure from the carotid 2, Which type of collagen is abnormal in Alpor« syndrome? (14 979) FA15 p75} 3. Which type of collagen is abnormal in Ehlers-Danlos syndrome? (414572) (15 975) SHOWNL Niv¥e e)-[a=lN|BRAIN TUMORS End of Session Quiz, 4. What are the three most common primary brain tumors in adults? What are ‘he three most common in children? 5. Which primary brain tumor fits each of the following descriptions? « Pscudopaisading necrosis + Polyeythemia + Neurofbromatosis type 2 + Associated with von Hippel- Lindau syndrome + Foamy cells, high vascularity + Hyperprolactinemia —> galactorthea, amenorthes, anovulation +» Psammoma bodies + Fried-egg appearance + Perivascular pseudorosetss + Bitemporal hemianopia + Worst prognosis of any primary brain tumor © Child with hydrocephalus + Homer: Weight pseudoroseresSLEEP 3 Questiun Warm-Up LA 43-year-old man presents with symptoms of dizziness and tinnitus. CT shows an enlarged intemal acoustic meatus, What is the diagnosis? 2. Which portions of the hypothalamus are inhibited by leptin? Which are stimulated by leptin? (FAl4 9/50) (FS p454) 3. What substances are utilized by natural killer cells to induce apoptosis in other ‘celle? (FA!4 p199) (IS p201) as loy-/aE ly!SLEEP 4, What medications are common in the treatment of insomnia? What makes each one unique? ‘Melatonin Non-addictive, OTC, vivid dreams, safe for < 3 months Valerian OTC herbal remedy, studies show no benefit ‘Antihistamines (Benadryl, | Commonly used by patients first-line, associated ‘Tylenol PM, doxylamine) with poor sleep quality, not for long-term use, anticholinengic side effects (avoid in the elderly) “Trazodone ‘Antidepressant, increases REM slecp, small risk ‘of priapism TCAs (amitriptyline, ‘Antidepressant, small risk of arrhythmias doxepin) (obtain EKG prior to use), anticholinergic side effects (avoid in the elderly) Longactngbenzdinspnes | Addi, soneexm only 35 dae) (emazepam, lorazepam, clonazepam, diazepam, chlordiazepoxide) Zolpidem (Ambien), zaleplon | Act at the benzo receptor, short-term only (Sonata) (< 35 days), rebound insomnia when discontinued Eszopiclone (Lunes ‘May be used long term Ramelteon (Rozerem) ‘Non-addictive because it works at melatonin receptors instead of GABA/benzo receptors; hepatic insufficiency; sm studies are lacking, 5, What is the treatment for narcolepsy? © Avoitdance of drugs that cause sleepiness * Scheduled naps (once or twice a day for 10-20 min) © Stimulants~ modafinil is first-Hine © Support group attendance © fcataplexy then use venlafaxine, fluoxetine, oF atomoxetine + Sodium oxybate (GHB) can assist in sleep and reduce caaplexyans (681ANESTHETICS Motignanthyperthe Daniolene FAM p Local anastreucs (FAI p95) (FAIS p99) 3 Question Warm-Up 1. Which intracranial tumor best fits cach of the following descriptions? (4 88-409 (a p92 499 GUIS p5D) + Polyeythemia + Newofibromatosi ype 2 « Hyperprolactinemia ~ galactonea, amenorchca, anovaltion| + Poammoma bodies + Peciascular pseudorostes + Bitemporal hemianopia + Worst prognosis of any primary bran tumor 2. What portion of the brain is supplied by the anterior cerebral artery? Middle cerebral artery? (FAl4 p458 459) (FAIS p42) SUIS p24) 3, What brain structure is responsible for extraocular moments dusing REM sleep?End of Session Quiz 4. Which anesthetic fits each ofthe following descriptions? + TV, associated with hallucinations and bad dreams + IV, most common drug used for conscious sedation + Tohaled,sde effec of hepatotoxicity + TV, used for rapid anesthesia induction and shore duration of action + IV, decreases cercbral blood flow (important in brain surgery) * Opioid tht does not induce histamine release * High tigheeride content, inreases the risk of pancreatitis with longterm use z 5. What is the mechanism of action of dantrolene? 6. Whit is the mechanism of action of local anesthetics? Which nerve fibers are blocked fist with local anesthesia? 7. What drug can be used to reverse neuromuscular blockade? for-[aEiyyMOVEMENT MOVEMENT Phys Chapters 54, 55, 56 Lote corticospinal rt (FAIA pi) (FAIS p70) (Phys ps ron sigs (FAIA 166) (FAIS p70) tum (FAIA p52) (FAIS p57) (SUIS p21) (Phys pt) pr) (FAIS p59) (H 3327) 3 Question Warm-Up 1. Whats the initial tearment for vertricular fibiltion? (AH 2) (AIS 124) 2. What organism is associated with each ofthe following clues? + Rabbit hunter » Pet prairie dog + Tavdes tick + Lymphadenopathy +a new kien + Dog bite 3. What bacterial structure has the following function? «+ Provides rigid support to the bacterial cell and protects against osmotic pressure differences + Space beoween the inner and outer cellular membranes in gram-negative bacteria + Mediates adherence of bacteria to the surface ofa cell © Protects against phagocytosis,4, Muscle spindle control Muscle spindle: monitors muscle length © Extrafusal muscle fibers: fanetional unit of muscle * Intrafusal muscle fibers: regulate length ‘Muscle stretch resuits in intrafusl stretch which stimulates la afferent ~> dorsal hom —> ‘motor neuron, causing reflex muscle contraction Hint: help you pick up a heavy suitease * Golgi tendons: monitor tension rather than length (perpendicular to intrafusal muscle fibers) Provide inhibitory Ib aflarent feedback Hint: cue you to drop a heavy suitcase Gamma loop: regulates sensitivity of reflex are © CNS the ¥ motor neuron — contracts intrafusal fiber (cntral part of spindle), increasing the sensitivity ofthe reflex are ALNIW3AOW (@)[aF ly)HOVEHENT What portions of the thalamus relay each of the following types of information: © Sensory signals from body (via medial lemniscus and spinothalamic tract) —> cortex + Trigeminothalamic and tase signals > somatosensory cortex © Retina (visual information) —> occipital bbe © Inferior colliculus (auditory information) > primary auditory cortex © Mammillochatamic tract cingulate gyrus (part of Paper ccc © Communications with prefrontal cortex; memory loss results i © Cerebdlum (dentate nucleus) and basal ganglia > motor cortex © Basal ganglia — prefrontal, premotor, and orbital cortices lestroyed Describe the general flow of information through the cerebellum. Inputs (mossy and climbing fibers) cerebellar cortex > Purkinje fiber — deep nucle! of cerebellum ~> output rargets List the deep nuclei of the cerebellum, from medial to lateral. ‘What structure provides the major output pathway from the cerebellum? ‘Superior cerebellar peduncle — contralateral ventral lateral nucleus (VL) of thalamus (On which side of the body (contralateral or ipsilateral) would motor control be affected by a lesion of the cerebellum? © Motor control ipsilateral to the side of the lesion would be affected © Output from the cerebellum > contralateral thalamus > cortex “> corticospinal tract ~ body contralateral to cortex10. What are the longitudi © Vermis * Intermediate (paravermal) zones (right and left) * Latzral hemispheres (Fight and lei) Spinocerebellum Vermis Intermediate hemisphere v co (igferal hemisphere) Dentate ucleus Tomotor Tolateral Tomedial and premotor descending descending ——‘To vestibular contices systems systems nuclel —[ - Motor Motor Balance planning execution andeye movernent ANSW3AOW @) EIN)MOVEMENT ‘What is the difference between resting tremor, intention tremor and essential tremor? © Resting tremor ‘Tremor occurs at rest, but disappears with voluntary movernents, Associated with Parkinson disease © Tntention tremor ‘Tremor appears only with voluntary movernents Associated with cerebellar damage © Essential tremor ‘Tremor occurs both with movement and at rest ‘Assodated with family history of tremor 12, What are the features of essential (AKA familial) tremor? © Ropid fine tremor of ead, hands, arms, and/or voice © Occurs both with movement and at rest + 5016 of patients have a Family history of tremor * ‘Treated with B-blocker (propranolo), primidone an anticonvulsant), clonazepam, or alcohol (patients often selfemedicate)| End of Session Quiz 13, What are the differences between the 1a afferent motor pathway and the 1b afferent motor pathway? ALNIW3AOW 4, Whatare the classic signs of an upper motor neuron lesion? What are the classic signs ofa lower motor neuron lesion? 15. What is the difference herween essential tremor, resting tremor, and intention ‘tremor? Rapip-Fire Facts “Toe extension upon stimulating the soe of the foot with a blunt instrument Hyperreflexia, increased musele tone, and __ positive Babinski sign Hyporeflexia, decreased muscle tone, znd muscle atrophyBASAL GANGLIA Phy 6 Re Chapter 28 Ht Chapter 372 4) (Phys po03) (H p3317) 3321) (6 6t4) 1) (GG porip ) (H 93230) 3 Question Warm-Up 1. What isthe inital treatment for ventricular tachycardia when there is no pulse?, 2. Whatis the function of catalase? (FA'4pi23) (FAIS pi32) 3. Whats the most common aerobic sin flora? (FAM pI70) (45 p79) Guurradsin | [ cmatatozce | lo (renee =]End of Session Quiz: 5, What are the cardinal features of Parkinson disease? 6. 28-year-old chemist presents with MPTP exposure. What neurotransmitter is Aepleed? 7, How do each of the following structures normally impact movement? = Globus pallidas interaa + Subthalamic nucleus 8, A.male patient presents with involuntary filing of one arm. Whereis te lesion? 9. What neurotransmitters are altered in Huntington disease? Rapin-Fire Facts ‘Depigmentation of the substantia nigra CChorea, dementia and atrophy of the eaudate and putamen in the cytoplasm of neurons ve WNONVO 1¥' fo} larly!SPINAL CORD AND LESIONS SPINAL CORD AND LESIONS Spun cord 3 Question Warm-Up 1, What infections are caused by Streptococrus pyogenes (group A strep)? (FA pi3)) ANS p29) (SUIS p323 2. Which Gram (¢) organism matches each of the following statements? (ats 9129-135) als p27 134) + Causes scalded skin syndrome * Gray-white membrane in the posterior pharynx ofan unvaccinated child + Pharyngitis —> glomerulonep! + Most common cause of meningitis + Most common eause of osteomyelitis + Serious newborn infections 3. What molecules are expressed on the surface of antigen presenting dendritic cells?End of Session Quiz 5. Which spinal tract conveys the following types of information? «+ Touch, vibration and pressure sensation «+ Valuntary motor command from motor cortex to body ‘+ Veuntary motor command from motor cortex to head/neck + Pain and temperature sensation (ORD AND LESIONS Importact for postural adjustments and head movements roprioceptive information forthe cerebellum SPINAL 6 What are the findings of Brown-Séquard syndrome? 7. What clinical presentation would lead you to suspect amyotrophic lateral sclerosis 1s a diagnosis? 8. Whatare some of the more classic presenting scenarios for multiple sclerosis? Rapip-Fire FACTS Conjugate at “and ipl Degeneration of the dorsal columns Demyelinating disease in a young woman Mixed upper and lower motor neuron disease| SUBRAGHIALPLEXUSAND UEN 3 Question Warm-Up 1. Which gram-positive organisin matches each of the folowing statements? (Alt p12 135) (AIS p27 13) + Tafant with poor muscle tone + Diarthea after using antibiotics « Respiratory distress ina postal worker + Otitis media in children + Collis 2, What is the classic presenting symptom in a patient with Lyme disease? {FAH pial (AIS pHO) (IS p333) 3. What is the function of macrophages in the spleen? (44 p97) (FAI5p199) RVES PART I! | 1d WIHV¥a 1 Auvd S3AW3N 3n ONY sNXx OundNTerminal Branches Cords | ig UO we 4, Label the following diagram of the brachial plexus: Divisions | Diva S3A¥3N 30 CNY SNX3Td WHOVE £80)pede ‘Session Quiz ; = & & : 2 é & a Zz a z asrrecperert | BRACHIAL PLEXUS AND UE NERVES PART | 1982) Rarib-Fire FACTS ‘Newborn with arm paralysis fellowing a diffcalthbor 7res (AM pla (F 3 Question Warm-Up 1, What patients are susceptible to Listeria monocytogenes? 2. What name is given to RBCs that have been partially digested by splenic macrophages? 3, Which nerve is being tested with each of the following reflexes? + Biceps reflex + Thiceps reflex + Patellar reflex * Achilles reflex 4, Radial nerve Motor ‘+ Triceps brachii (extends forearm) + Supinator(supinates) + Brachioradials (Rees forearm, supinates and pronstes) + Extensor earpi radials longus (extends wrist) + Extensor digitorum, extensor pollicis longus plus other extensors (extends wrist and digits) + Mnemonic: BEST Sensory + Posterior arm + Dorsal side ofthe hand Pathology + “Saturday night palsy” (wrist drop, difficulty straightening the fingers, numbness on back: of hand and posterior arm) Compression of radial nerve agains the spiral groove of the humerus + Damage associated with fracture ofthe shaft of the humerus 7 Luv S2AWBN 2/N GNY SNXa1d WIHDWYS