Micro

1. Malaria:
a. Primaquine is added for hypnozoites; chloroquine prevents detoxification of heme into
hemozoin by plasmodium and other hematophagues (Schistosoma mansoni, Rhodnius
prolixus)
b. Ring in erythrocytes: vivax; amoeboid multiple inclusions, banana-shaped gametocyte
falciparum; hypnozoite: with rings (also ovale)
c. Travel history, jaundice, splenomegaly
d. Check G6PD before starting treatment
e. Duffy factor required for infection; plasmodium can’t infect without this protein
2. Squamous cell carcinoma of bladder:
a. Schistosoma hematobium causes squamous cell carcinoma in male migrant from middle
east or Japan with mass in urinary bladder and eggs/larvae in urine, pulmonary
hypertension, terminal spine; intermediate host: cercariae, praziquantel
3. S mansoni: periportal fibrosis, inflammation and portal hypertension, intestinal bleeding;
lateral spine
4. Cholangiocarcinoma:
a. Clonorchis sinensis causes cholangiocarcinoma in people consuming seafood (Thaliand),
also causes pigmented gall stones, praziquantel
5. Neurocysticercosis:
a. Taenia solium causes neurocysticercosis. Q Mexican presenting with seizure, MRI
showing single intraventricular cyst with scolex.
6. Renal transplant:
a. Polyoma virus, BK virus, targets kidney in transplant patients under immunosuppression
presenting with gross hematuria
b. Post-transplantation lymphoproliferative disorder: EBV
c. Acute graft rejection presents with lymphocytosis, mononuclear cells; Q pt under
tacrolimus and prednisolone, Cr >3, lymphocytes in intima
7. HSV:
a. HSV II: latent phase in peripheral nervous system, sacral plexus (S2-S4); vesicles on
penile shaft and head; also causes viral meningitis
b. Treated with acyclovir but resistant on 2nd treatment due to modification in tegument of
virus; thymidine kinase present on tegument is mutated
8. Cats:
a. Cat scratch disease, Bacillary angiomatosis: Bartonella henselae infected patient
presents with h/o cat exposure and lymphadenopathy of lymph node draining affected
site ; histiocytes+?
b. Toxoplasmosis: intracranial cyst, obligate intracellular org 5 micrm, cysts ingested; t/t
sulfadiazine, pyrimethamine, AO dihydrofolate reductase inhibition
c. Microsporium canis: dandruff, dermatophytes ringworm on cheek/chin,
lymphadenopathy, hair pull positive, tenia barbae
9. HPV: act on the basal layer of epidermis; E6 p53, E7 RB; NB verrucous warts (small capillaries on
magnification); vacuolated squamous cells; child with vocal cord polyp’s most likely risk factor;
IFN alpha causes reactivation; Low-risk HPV types include types 6, 11, 42, 43, and 44.
 High-risk HPV types include types 16, 18, 31, 33, 34, 35, 39, 45, 51, 52, 56, 58, 59, 66,
68, and 70.
10. Leishmania donovani: sandfly; amastigote resides, promastigote infects; cutaneous- deforming
ulcers, more in African-Americans, face involved usually; spiking fevers, hepatosplenomegaly,
pancytopenia
11. Scabies: act on the stratum corneum of epidermis; circle of Hebra; intertriginous spaces;
12. Tenia: Branching septate hyphae visible on KOH preparation with blue fungal stain; positive pull
test, kerion- inflammatory pus filled abscess d/t fungal infection, discharge and crusting on scalp
13. Giardiasis: Q eat wild berries and drink contaminated river water containing cysts, foul-smelling
fatty diarrhea; picture
14. Roseola infantum (HHV6): <2 years, fever then rash, rash starts on trunk; enveloped ds-DNA,
post auricular lymphadenopathy; exanthema subitum
15. Leg ulcers:
a. GABH streptococci: M protein
16. Tuberculosis:
a. Isolated for 2 weeks
b. Travel history: sub-saharan, Uganda, lesion in lung in lower lobe
c. Granuloma: formation IFN gamma (Similarly, IFN-gamma increased the transcription
rate of the class I HLA-A2-encoding gene as well as that of the human invariant chain
gene.), maintenance TNF alpha
17. American lung fungi:
a. Coccidioidomycoses: California, desert bumps, spherule>>>RBC is filled with
endospores; NB barrels on top of each other blue; erythema nodosum + arthralgia;
inhalation of airborne spores
b. Blastomycosis: broad based budding; verrucous lesions; west of Mississippi; same size
as RBC
c. Histoplasmosis: east of Ohio; lower lobe pneumonia, hilar calcification; erythema
nodosum; macrophage filled with it (smaller than RBC)
18. Babesia: fever, bleeding, hemolysis; PBS RBC ring inclusion; rats/mice; Babesia microti has a
two-host life cycle involving hard-bodied ticks of the genus Ixodes as the definitive host
and a vertebrate intermediate host
19. Diphyllobothrium latum: picture, fish tapeworm, vitamin B12 deficiency; involves a definitive
host(2): humans (and other fish-eating mammals) and at least two intermediate hosts
(3): a planktonic crustacean and one or more freshwater fish.
20. Streptococcus pneu: Optochin sensitive, capsule is virulence factor, IgA protease (in
pneumonia) is also virulence factor, partial hemolysis, catalase -ve; NB lancet shaped gram +ve
diplococci; rusty sputum, chest pain; complement>myeloperoxidase suppresses
21. N gonorrhea: multiple sex partners, now presents with knee pain, pustules and tenosynovitis;
disseminated can involve palms and soles; no vaccine due to variation in pili virulence factor
(antigenic variation of organisms antigen); Q pain over suprapubic region and discharge from
urethra; NB small pink diplococci within neutrophils; Q CH50 half-classical, AH50 half-alternate,
both- terminal complement def (recurrent Neisseria infections)
22. Pneumocystis jeroveci: silver stain, HIV patsabouient; TMP-SMX; CXR: b/l ground glass opacities
23. Mucormycosis: angioinvasion; DKA/neutropenia; wide-angle non-septate hyphae; black necrotic
eschar on face causing deformity
24. Ancylostoma duodenale: serpiginous lesion on foot, walking barefoot, IDA; albendazole
25. Influenza: strain changing yearly (drift) d/t mutation in hemagglutinin/neuraminidase; fusion of
hemagglutinin with sialic acid most pathogenic phase; shift causes marked change (new disease-
H1N1), drift causes mild changes (new vaccine- for same disease); RNA virus
26. 25. Hepatitis:
a. Hep A IgG: Hep A
b. HBcAg IgG, HBsAg IgG: recovered and immunized;
c. HBsAg IgG: vaccinated
d. Female, nausea, RUQ pain, Hep B vaccine full course: Hep E IgM
e. Nurse needle prick HBV + pt., nurse has taken vaccine, acute hepatitis infection if: IgM
anti HbcAb +
f. Hep C: Presence of polyclonal igG and igM monoclonal rheumatoid antibodies; Q
palpable purpura, arthralgia, weakness, peripheral neuropathy: AO cryoglubinemia
27. Candida: vulvovaginitis with h/o OCP, tt MOA ergosterol synthesis inhibitor- azoles; NB blue
hyphae; sabouraud’s agar; Q foul smelling vaginal discharge with pic of germ tube;
disseminated t/t echinocandins
28. Cryptococcus: India ink, MOA drug, amphotericin forms pore in membrane by binding to
ergosterol in cell membrane; maintenance fluconazole; NB capsule not staining
29. Chagas: Trypanosoma cruzi, reduviid (triatomine/kissing) bug transmits, trypomastigote in
figure; dilated cardiomyopathy with apical atrophy, megacolon, megaesophagus; t/t
benznidazole (inhibits the synthesis of DNA, RNA, and proteins within the T. cruzi
parasite), nifurtimox (partial reduction to chemically reactive radicals that cause
production of toxic reduced products of oxygen)
30. HIV: Protease inhibitor (-navir- indinavir) causes Cushing; Immune reconstitution inflammatory
syndrome- paradoxical loss of immunity following initiation of antiretroviral treatment; Q
meningitis- Cryptococcus- t/t cell membrane inhibitor; Integrase inhibitor causes myolysis, ^Cr
31. EBV: mono, kissing dx, tender hepatosplenomegaly- don’t play sports, pink oropharynx;
penicillin shouldn’t be given as it causes rash; atypical lymphocytes (Downey cells)-CD8;
implicated in Burkitt lymphoma c-myc(t 8,14), Hodgkin lymphoma, nasopharyngeal carcinoma,
1° CNS lymphoma (in immunocompromised patients), oral hairy leukoplakia; colitis with mass
d/t lymphoproliferation; organism latent in b-lymphocyte
32. CMV: ds linear DNA, enveloped; Hearing loss, seizures, petechial rash, “blueberry muffin” rash,
chorioretinitis, periventricular calcifications; NB lymphocytes with eyes like nuclei, RBCs
abundant; Q colitis without mass, pneumonia and esophagitis
33. Neisseria: terminal (c5b-c9) complement deficiency; LOS-lipooligosaccharides cause
hypotension
34. Leprosy: hypoesthetic lesions, leonine facies; Th1 tuberculoid- type IV hypersensitivity; Th2
lepromatous
35. Onchocerciasis: river blindness, skin changes, black nodules; female black fly; ivermectin (binds
selectively and with high affinity to glutamate-gated chloride ion channels in invertebrate
muscle and nerve cells of the microfilaria.)
36. Clostridium botulinum: canned food, exotoxin (A, B); floppy baby syndrome- check for AO
tongue fasciculation
37. Clostridium perfringens: Q puncture wound with reddish pus, gas gangrene; alpha toxin;
clindamycin
38. Clostridium difficile: enterotoxin, watery diarrhea, leukocytosis, pseudomembranous colitis, oral
vancomycin and no s/e d/t poor oral absorption; tcdC(transcription regulator) mutation more
toxin
39. Sporothrix schenckii: gardening, thorn prick; cigar-shaped yeast; ascending lymphadenitis; most
and yeast form
40. Pseudomonas aeruginosa: non lactose fermenting, gram -ve, oxidase +ve, catalase +ve, rods;
blackish necrotic lesion over thigh; ecthyma gangrenosum, severe neutropenia; severe sepsis
and death in neutropenic cancer patients (ALL Q); MoA => exotoxin A, inactivate EF-2, mannose
binding lectin pathway can activate complement in immunocompromised cases with this
organism; Q necrotic lesion, no gas
41. Mumps: neck mass (angle of mandible), fever, nasal congestion; Q AO testes
42. Parainfluenza: Croup dx, inspiratory stridor, steeple sign +; resides in ciliated columnar
epithelium
43. Measles: paramyxo, SSPE (subacute sclerosing panencephalitis); Q neurological features in a
non-immunized child
44. Rubella: German measles; PDA, cataracts, deafness; Beginning at head and moving down with
postauricular lymphadenopathy
45. Staph aureus: staphylococcal toxic shock syndrome (STSS), tampon long time; protein A;
catalase prevents formation of hypochlorite by forming water and oxygen from hydrogen
peroxide; Q c3b defect leads to recurrent infections d/t decreased recruitment of neutrophils;
resistance caused by AO mecA gene mutation
a. SSSS: Q 65 y/p multiple blisters, no lesions in mouth, nikolsky +, sterile blisters; AO-
exfoliative toxin
46. Staph epidermidis: gram +, catalase +, coagulase -, novobiocin +; glycocalyx forms biofilm, septic
arthritis in prosthetic
47. JC virus: PML; natalizumab targets alpha4 integrin; childhood radiation, external capsule of rt
side hyperintense
48. Tuleremia: tick, rabbit, deer-fly; gram -ve coccobacilli; fever, myalgia, b/l inguinal pain
lymphadenopathy, multiple bite marks
49. S gallolyticus: MC aorta, listen to murmur and pick
50. S saprophyticus: UTI, young sexually active females, nitrite -ve
51. Viridans: partially clear, catalase -ve, gm +ve, optochin -ve; Q dental extraction
52. Klebsiella: gm -ve rods, UTI
53. Gardnerella vaginalis: bacterial vaginosis, green-gray vaginal discharge, fishy smell; clue cells,
amine whiff test (10% KOH); metron
54. Chlamydia: antibiotic without treatment: resistance; within 3 weeks: IUD; Q recovered and came
back after 6 months: reinfection; ruptured ectopic, deranged vitals; Reiters sexually active young
male; Q inconsistent condom, features of epididymitis
55. Syphilis: tertiary: sudden loss of vision, defective pupillary light reflex, h/o CAD, painless lesions-
primary is chancre; gumma argyll; Jarisch-Herxheimer reaction (due to host response to sudden
release of bacterial antigens) => fever, chills, headache, myalgia following antibiotic treatment;
secondary: wartlike white condylomata lata is secondary; Q thickening of palmar tendon of
middle and little finger of different hands
56. Campylobacter: grows at 42 degrees, oxidase + gm -ve curved rod, polar flagella, poultry
(reservoir), bloody diarrhea
57. Rocky mountain spotted fever: palms, soles involved, R ricketssiae, starts at wrist, tick
58. R prowazekii: epidemic, louse; doesn’t involve palms or soles; Q month long into the forest
59. R typhi: endemic, fleas
60. HIV: 2NRTI+1II; avoid abacavir in HLA B5701 allele carrier; CCR5 mutation in macrophage
confers immunity; Kaposi- HHV8, spindle shaped tumor cells with vessel proliferation, red
patches
61. Mycobacterium avium: T cells, Most common if CD4+ cell count < 50/mm; IFN gamma defect-
cord factor (inhibits the interferon (IFN)–induced activation of macrophages and
stimulates the production of tumor necrosis factor alpha (TNF-α))
62. Pinworm (Enterobius vermicularis): cellophane tape test, from perirectal region. You treat by
mebendazole; NB eggs
63. E coli: Gram ⊝, indole ⊕ rod. Nitrite + (gm - rods) E coli virulence factors: fimbriae—cystitis and
pyelonephritis (P pili); K capsule—pneumonia, neonatal meningitis; LPS endotoxin—septic shock
64. Leptospirosis: Gm -ve spirochete; fever, conjunctival suffusion, jaundice, travel from Uganda;
fresh water; Weil’s: ectohemorrhagic- jaundice, anemia, azotemia, hepatotoxicity and renal
failure
65. Whooping cough: Bordetella pertussis; subunit=>killed vaccine; Q heavy coughing and vomiting;
affects ciliated columnar epithelium
66. Tetanus: TT IgG production inc; synaptic vesicle associated defect, fusion of vesicles;
Human tetanus immunoglobulin contains mainly immunoglobulin G (IgG) with a specifically
high content of antibodies against the toxin produced by the bacteria
67. Chikungunya: travel history, polyarthralgia, fever, retroorbital pain, leukopenia, Aedes; Q travel
to Caribbean
68. W bancrofti: lymphatic filariasis, non-pitting edema w thickened skin of legs, pain-, tenderness-
69. Aspergillus: aflatoxin; Q kenya, maize intake
70. Zika: microcephaly, pericortical calcification
71. Trichomonas vaginalis: turnip shaped on wet mount, single nuclei, cilia; foul smelling discharge,
itchy, burning, strawberry cervix; metron
72. Echinococcus granulosum: dog tapeworm; hydatid cyst; ingestion of contaminated food;
intermediate-sheep
73. Coxsackie b: myocarditis; Q SoB, pulmonary edema, pleural effusion, cardiomegaly, fever several
weeks back; global enlargement of heart and dilation of all chambers
74. Coxsackie a: hand, foot and mouth dx
75. Vibrio cholerae: gm -, comma, oxidase +; permanently activates Gs=> ^cAMP
76. Shigella: red in color, slimy mucoid diarrhea, >10 times but less amount; tenesmus, FOBT +
77. Entamoeba: trophozoite in RBC; anchovy paste, RUQ pain, liver abscess; bloody foul smelling
blackish diarrhea, 6-8 episodes/day, copious amount; metron
78. Actinomyces: Branching gram ⊕ rods with sulfur (yellow) granules, anerobic, non-acid fast; Q
maxillary sinusitis with sinus tracts; Q oral/facial abscesses,
79. Legionella: Charcoal-yeast agar (with iron and cysteine); t/t macrolide/quinolone; Q After
initially not responding to some antibiotic, responds to azithromycin
80. Mycoplasma: ILD, 3 days inflammation, alveolar septa and
 81. Anaplasma: tick-borne; yellow fever, jaundice, weight loss, aggression, erythema migrans; gm -
ve, morula in RBC and granulocyte
82. Helminthic killing due to eosinophils and MBP (major basic protein= a helminthotoxin)

Experimental:

1. GH injection: increases cartilage activity, chondrocyte proliferation

2. Radiolabeled linoleic acid: TXA2 precursor
3. Rat on treadmill: GH
4. Gene mutation in E3 gene, defect in methylation
5. Transcription factors: Transfection is a procedure that introduces foreign nucleic acids into cells
to produce genetically modified cells. Transfection is a powerful analytical tool for study of gene
function and regulation and protein function.; stem cells differentiated after transfection
6. IGF-1 (somatomedin C promotes linear growth and muscle mass) resistance: inc GH and inc IGF-
1.Laron syndrome (also known as Laron dwarfism) is a condition wherein short stature
(height SDS between -4 to -10SD) is associated with typical facies, obesity, acromicria,
high basal GH, and low IGF-1.
7. Cats fur: co dominance
8. Knockout of tumor suppressor genes: growth in media +, contact inhibition –, growth in
immunocompromised host-
9. Upper q, inserted gene: growth -, contact inhibition +, growth in immunosuppressed mice +
10. Encoding protein x , loss of gene on tumor cell: cadherin
11. Drug X promotes collagen addition: endogenous TGF beta has similar property
12. Mice substance causing allergy, receptor: FceRI
13. 19 AA substance X t is released from vascular smooth muscle in response to wall tension. At
normal times, it Is found freely in plasma. What I the property of the substance a. binds on
receptor on plasma membrane
14. Mice injected with sheep RBC: f, IgG peaks in 20 days but on reexposure 10 days
15. Mice with defective FcERi and TLR4 if lipopolysachharide given response defective d/t TLR4
binding dec
16. Tumor given antibodies to control tumor growth against PD1 receptor, CTLA4 to be given
17. Gene insertion impossible: gene defect in promoter region
18. Mice 6 transmembrane protein and 1 unit has ATPase: helps transport solutes
19. Drug X in culture along with candida, decreased ergosterol=> fluconazole
20. Undifferentiated pluripotent stem cell=> mature fibroblast with protein addition acts on DNA
sequence
21. MELAS like disease, drug targeting mitochondrial tRNA
22. Splicing application: GU at 5’ terminal and AG at 3’; removal of introns following transcription
23. Protein beneficial in HF antagonize ill effects of aldosterone on heart= ANP; MoA= cGMP
24. Berotralstat: inhibits plasma kallikrein, prevents hereditary angioedema
 25. Undifferentiated pleuripotent stem cells=> mature fibroblasts + protein: protein acts on DNA
sequence
26. Rote ping (Ferris wheel): STAT release from neurons in brain
27. Influenza article inserted intranasally in a mouse. Radiolabeled dye will be taken up by which
leukocytes=> dendritic cells

Patho:

1. Multiple myeloma, a plasma cell dyscrasia,

a. Primary amyloidosis is seen with possible amyloid deposits in heart (restrictive CM);
congo red stain positive; Q proteinuria, b/l pitting edema
2. C3b—opsonization. C3a, C4a, C5a—anaphylaxis. C5a—neutrophil chemotaxis. C5b-9 (MAC)—
cytolysis.
3. Neutrophils
a. Rolling: Lselectin blood vessel; sialyl lewis neu
b. Tight binding: ICAM blood vessel; integrin neu
c. Diapedesis: PECAM from both
d. reach CNS by: PECAM (CD31) >CD11/18> ICAM (CD54)>Sialyl lewis> P/E selectin
e. Q following laceration: Dohle ^, Band cells ^, segmentation dec; The presence of
Döhle bodies, nuclear immaturity, "toxic" cytoplasmic granulation, and giant
platelets may indicate, at least in some measure, a general metabolic
disturbance of the hematopoietic system.
f. Bactericidal due to hydrogen peroxide halide formation
4. Apoptosis: macrophage-annexin, apoptotic cell-phosphatidylserine
5. Anaphylaxis: IL-4,5,13; inc eosinophils
6. Tcells:
a. CD4: MHC2, HLA DP DQ DR
b. CD8: MHC1, HLA A B C
c. Activation: 1st TLR (T-cell) and MHC II (APC) facilitated by CD4/8; 2nd co-stimulation by B7
(CD80/86) on APC with CD28 on T cell
d. B-cell activation: CD40L ligand on Tcell binds with CD40 on B cell, Q causes production of
specific antibodies
7. Squamous cell carcinoma:
a. Lung mass with cytokeratin +
b. Tobacco, alcohol, HPV-16, 18
c. Esophageal d/t plummer vinson, affect upper 2/3, Alcohol, hot liquids, caustic strictures,
smoking, achalasia; MC worldwide
d. Skin: actinic keratosis predisposition, MC below lower lip; keratin pearls on biopsy; NB
prevent with sunscreen, mitotic figures
8. Leiomyosarcoma: myometrium, postmenopausal, single; lesion/mass, areas of hemorrhage and
necrosis, desmin +, vimentin +; malignant and mesenchymal; undifferentiated spindle cells
9. Helix loop helix: basic helix-loop-helix (bHLH) proteins form a large superfamily of transcriptional
regulators that are found in organisms from yeast to humans and function in critical
 developmental processes, including sex determination and the development of the nervous
system and muscles. DNA-binding proteins
Proteins, such as transcription factors that bind to DNA, require specific protein domains
(structural motifs.)
These structural motifs usually use either an α-helix or a β sheet to bind to the major groove of
DNA.
Important examples of motifs are the zinc finger domains, leucine zippers, basic helix-loop-helix,
and the homeobox. AO- DNA binding
10. Chronic granulomatous disease: Abnormal dihydrorhodamine (flow cytometry) test (dec green
fluorescence), Nitroblue tetrazolium dye reduction test (obsolete) fails to turn blue; Schaumann
bodies are inclusion bodies found in granulomatous diseases, composed of two elements,
birefringent, calcium carbonate, crystals and concentric, laminated, conchoidal bodies.;
neutrophil oxidase defect
11. Lead poisoning: sideroblastic anemia, basophilic stippling; Lead lines in gingiva (brutons lines)
and metaphysis of long bones in Lead poisoning; Dense bands (green overlay) are seen at the
distal femoral and proximal tibial and fibular metaphyses as a result of lead accumulation in
these metabolically active zones; AO decreased heme synthesis
12. Cannabis intoxication: conjunctival injection, ptosis; Finally, cannabis use produced a 5.2%
reduction in pupil diameter at scotopic light levels; this change is statistically
significant when compared to the baseline condition (p < 0.001). At higher lighting levels
there was little difference in pupil size in the two conditions. AO: nasal congestion
13. Thyroid Ca
a. Psammoma bodies in papillary Ca thyroid; common in pt with radiation exposure in
childhood; powdery chromatin in nuclei, nuclear grooving
14. Polycythemia vera: activating JAK2 mutation, non-receptor tyrosine kinase, protooncogene;
generalized itching after taking a bath (aquatic pruritis), facial plethora, fluid thrill/shifting
dullness, Hb 15+; Q progressive left sided weakness resolves, HB ^^, HCT ^^, EPO N/dec; Q AO
inactivating mutation of inhibitory domain of JAK; AO constitutional activation of JAK2 at V617F
mutation in majority of patient
15. Inherited diseases:
a. XR: 50 % chance; DMD
16. NAPQI (N-Acetyl-p-benzoquinone imine) causes acetaminophen poisoning; t/t N-
acetylcysteine; hepatotoxicity- decreased hepatic complement factors
17. Mother takes valproate: neural tube defects;
18. Defect in radial migration: double cortex sign; CT with double cortex and pachygyria; band
heterotopia; DCX and LIX mutation
19. Zellweger syndrome: AR, peroxisomal disease, inc pipecolic acid, VLCFA; mutated PEX:
hypotonia, seizure, jaundice, craniofacial anomaly, early death
20. Adrenoleukodystrophy: XR; ABCD1 mutation, beta oxidation defect, VLCFA buildup in adrenals,
white matter, testes
21. Rb gene defect: acts on G1, inhibits progress to S phase; Rb phosphorylation Dna transcription
d/t free E2F; Q other symptom they would have- strabismus
22. Malnutrition:
a. Kwashi+maras: Wasted boy with protruded abdomen: fat deposition in liver
 b. Q rashes and protuberance: insulin and protein dec, ketone inc
23. Contaminated NS: cytokine release
24. Vitamin B1 deficiency: confusion, memory impairment, dec proprioception, vibration altered,
dec deep tendon reflexes; deficiency in alcoholism, vertical downbeat nystagmus; Q homeless,
alcoholic
25. Vitamin B3 deficiency: Pellagra-dermatitis, diarrhea, dementia with hallucinations; casal
necklace, sun-exposed areas; ^AST and ALT
26. Vitamin B6 deficiency: Q anemia and rashes; ^homocysteine, ^methionine
27. Vitamin A deficiency: nyctalopia, xerosis cutis, xerophthalmia, Bitot, keratomalacia;
hypervitaminosis=> hair loss
28. Vitamin B9 deficiency: ^homocysteine only
29. Vitamin B12 deficiency: Veganism, increased methylmalonic acid, inc homocysteine; pernicious
anemia, polymorphonuclear lymphocytes, vertical upbeat nystagmus, may have Ab against
parietal cell; glove and stocking pattern of loss of sensation; fish tapeworm; AO decreased
isomerization of methylmalonyl CoA to succinyl CoA
30. Vitamin E deficiency: horizontal nystagmus, h/o recurrent foul smelling fatty diarrhea, ataxia
31. Zinc deficiency: Acrodermatitis enteropathica; mental retardation, dysgeusia and rash around
mouth and diaper area
32. Vitamin K deficiency: Home delivery, carboxylation defect; complement quantity normal, quality
dec
33. Vitamin C deficiency: bleeding gums, cork-screw hair, bruising d/t defect in collagen synthesis,
decreased activity of proline hydroxylase
34. Maple syrup urine disease: AR; isoleucine, leucine, valine aren’t degraded d/t dec alpha
ketoacid dehydrogenase; sweet d/t valine; phenylalanine accumulates
35. Hypersensitivity:
a. Type 1: tryptase seen in blood; FcERi is the receptor
b. 2: hyperacute
c. 3: serum sickness: Q antisnake venom-> fever, rash, joint pain;
d. 4: acute graft rejection, kidney transplant, monocyte infiltration, host T cell against
donor HLA; GVHD; PPD
36. PPD: positive d/t CD80-CD28; IL12, macrophage; measured 48-72 hours after injection; negative
in immunocompromised patient due to decreased T helper cell count
37. GVHD: Q bone marrow transplantation under cyclosporine develops maculopapular rash,
jaundice, splenomegaly
38. Mitochondrial diseases: gomori stain; some have severe disease while others have mild because
differently inherited by different cells=heteroplasmy
a. MELAS: point mutation in mitochondrial DNA; tRNA leucine mutation; mitochondrial
encephalomyopathy with lactic acidosis and strokelike episodes; Q 3y/o developmental
delay, vision loss, hearing loss, wheelchair, tingling, numbness, ^CK; leucine
b. MERRF: myoclonic epilepsy with ragged red fibers; lysine, tRNA lysine mutation
c. Leber hereditary optic neuropathy: variable number of mitochondrial DNA
39. DiGeorge-Thymic aplasia: CATCH 22 (cardiac, abnormal facies, thymic hypoplasia, cleft palate,
hypocalcemia); 22q11 microdeletion; 3RD PHARYNGEAL POUCH, cd3
 40. Velocardiofacial: cd3; Q cleft palate, developmental delay, VSD, pulmonary stenosis, aorta
defect, AO duodenal atresia
41. Erythema nodosum: painful lesion over anterior tibial shin; OCP (also hepatic adenoma),
coccidio
42. KRAS: anti EGF antibody, non-small cell cancer of lungs; increased GTPase autophosphorylation
43. P53: Li-Fraumeni syndrome, AD, is also known as the Sarcoma, Breast, Leukemia, and
Adrenal Gland (SBLA) cancer syndrome;
44. APC: FAP, chromosomal instability + KRAS mutation=> adenoma + TP53,DCC loss => carcinoma;
can prevent with colectomy; AO negative regulator of cell cycle
45. VHL: hemangioblastoma, RCC, angiomatosis, pheochromocytoma; DNA repair defect,
chromosomal 3p deletion, usually inhibits hypoxia inducing factor; Q young male
46. GIST: CD34 positive and CD117 positive
47. Epinephrine ferris wheel: STAT1 release
48. Aspirin poisoning: NaHCO3 given promotes salicylaturia; decreased renal reabsorption
49. Cystic fibrosis: AR, deletion; Cl channel mutated, lipase def due to mucous blockade of pancreas;
NB CT bronchiectasis; after tt viscosity dec, surfactant<>, Cl transport ^; Q S aureus in children;
Q very thin, doesn’t gain weight, uncle dies of pneumonia, ask for diarrhea after every meal;
G551d open ion channel, Phe508 misfolded protein; diagnosed by pilocarpine induced sweat
test; vas deferens absent in males- infertility
50. Wilson disease: decreased hepatocyte uptake of Cu d/t mutation in copper transporting ATPase
(chr 13); dec ceruloplasmin; Kayser Fleischer rings; trientine, is a potent and selective copper
(II)-selective chelator, penicillamine, heavy metal antagonist; decreaed biliary excretion of
copper
51. Collagen:
a. Hydroxylation of proline/lysine occurs in RER, scurvy
b. Glycosylation of hydroxylysine and procollagen triple helix in RER, osteogenesis
imperfecta
c. Ehlers danlos: collagen defect, joint hypermoboility, procollagen peptidase
deficiency; COLA3 mutation=> artery defect
52. G1 phase: rapidly dividing cells uptake molecules
53. Checkpoints: G1, G2
54. Trinucleotide repeat dx:
a. Huntington: CAG; AD; dec Ach and GABA in caudate, caudate atrophy
b. Myotonic dystrophy: CTG; AD; cataracts, toupee, gonadal atrophy males, reduced
fertility in females; dmpk (myotonic protein kinase) mutation
55. Apoptosis: membrane blebbing, chromatin condensation, nuclear fragmentation; Q AO myocytes
AO nerve cell
56. MCAD: hypoketotic hypoglycemic state, Acyl CoA dehydrogenase, fatty acid oxidation defect; fatty
acyl carnitines in serum; avoid fasting; consume carbs; weakness, hypotonia, DCM;
hyperammonemia
57. Hypercholesterolemia
a. Hyperchylomicronemia: thoracic duct injury?
b. Type I: Hyperchylomicronemia; supernatant milky ppt, lipoprotein lipase, conversion of
TG to FFA (TG degradation); apolipoprotein C
c. Type II: early MI, tendon xanthoma; missense mutation of LDLR gene; AO early
childhood cholesterol deposition in intima; apolipoprotein B
 d. Clathrin recognizes cholesterol-LDL and mediates reuptake by forming pit on plasma
membrane
e. Statin, ezetimibe (Niemann-Pick C1-Like 1 (NPC1L1) is a polytopic transmembrane
protein localized at the apical membrane of enterocytes and the canalicular membrane
of hepatocytes. It functions as a sterol transporter to mediate intestinal cholesterol
absorption and counterbalances hepatobiliary cholesterol excretion. NPC1L1 is the
molecular target of ezetimibe, a potent cholesterol absorption inhibitor that is widely
used in treating hypercholesterolemia. Recent findings suggest that NPC1L1 deficiency
or ezetimibe treatment also prevents diet-induced hepatic steatosis and obesity in
addition to reducing blood cholesterol.); Secreted PCSK9 binds to the LDLR on
the surface of the hepatocyte, leading to the internalization and
degradation of the LDLR in the lysosomes, and reducing the number of
LDLRs on the cell surface.
58. Rett syndrome: XD, females; MECP2 on X de novo, trinucleotide expansion; regression of abilities,
difficult purposeful hand movements, wringing; loss of motor tone, hypotonia
59. Marfan: AD, MVP heard at cardiac apex; fibrillin (extracellular support protein for elastin); ectopia
lentis (up and out)
60. Q child changes diet from fatty to carbohydrate based but still doesn’t lose weight d/t: AO acetyl
CoA=>malonyl CoA, fatty acid synthesis
61. Homocystinuria: AR, pectus deformity, tall stature, inc arm:height ratio, dec upper:lower body
segment ratio, arachnodactyly, joint hyperlaxity, skin hyperelasticity, scoliosis; ectopia lentis (down
and in)
62. Giant cell arteritis: ESR raised d/t acute phase reactants; t/t steroids
63. Kikuchi disease, also called Kikuchi-Fujimoto disease or Kikuchi histiocytic necrotizing
lymphadenitis, was originally described in young women and is a rare, benign condition of
unknown cause usually characterized by cervical lymphadenopathy and fever.
64. Kartagener syndrome: situs inversus, tubule/axoneme defect- alpha tubulin, dynein; recurrent
infections
65. Erythema: histamine>PG>bradykinin>NO
66. Pinprick foot, redness, swelling and serous discharge within 1 hour d/t vasodilation
67. Aminoacyl tRNA synthetase matches amino acid to tRNA
68. Pyruvate kinase deficiency: Q new born with anemia, PBS with burr cells
69. Glucose storage dx
a. Von Gierke: glucose 6 phosphatase; Q tonic clonic seizure in child, low glucose, TG^, uric
acid^, lactic acid^
b. McArdle: myophosphorylase, 2nd wind phenomenon; Q h/o muscle cramping and
inability to continue playing
c. Cori: milder VG; debranching enzyme
d. Andersen: hepatosplenomegaly, cardiomyopathy; branching enzyme; hypoglycemia
late;
e. Pompe: 1,4-glucosidase, lysosomal glycogen accum; defect in lysosome, accumulation
of glycogen in lysosome
f. Hers disease: liver involvement; phosphorylase kinase; has to eat chocolate candy
occasionally
70. Lysosomal storage dx: All AR except Fabry, Hunter XR
 a. Niemann Pick: sphingomyelinase def; foam cells, sphingomyelin deposited;
hepatosplenomegaly, cherry red, progressive neurodegenration
b. Tay Sachs: AR; hexosaminidase A deficiency; GM2 ganglioside; Progressive
neurodegeneration, developmental delay, hyperreflexia, hyperacusis, “cherry-red” spot
on macula A (lipid accumulation in ganglion cell layer), lysosomes with onion skin, no
hepatosplenomegaly (vs Niemann-Pick).
c. Krabbe: AR; globoid cells, optic atrophy, oligodendrocyte destruction;
galactocerebrosidase (galactosylceramidase) def., galactocerebroside accum.; Q
wheelchair bound, hypertonia, deficient
d. Fabry: angiokeratoma, hypohidrosis; alpha galactosidase a, ceramide trihexoside
e. Metachromatic leukodystrophy: Arylsulfatase A def; ataxia, dementia; cerebroside
sulfate
i. Late infantile onset (age 6 months to 2 years): hypotonia, dec reflex
ii. Juvenile onset (age 3 to <16 years): spastic paresis (UMN sign)
iii. Adult onset (age ≥16): dementia and behavioral problems
f. Gaucher: glucocerebrosidase; glucocerebroside; gaucher cells, AVN, bone crises,
hepatosplenomegaly, pancytopenia
71. Risk factor Qs:
a. Hoarseness, dysphagia, h/o mono, alcohol, smoking, ear ache: smoking
b. Ulcer in obese smoker: smoking
c. Coal mine worker, smoked 1 pack year for 50 years, Arizona, weight loss 10kg, blood
tinged sputum for 3 weeks, mass in upper lobe: smoking
d. Temperature raised warrants antibiotic prescription: Army man from Bahrain, 8cm over
rt thigh with fluctuation
e. Risk factor of ischemic heart disease in obese patient with family h/o obesity and death:
1st risk smoking, 2nd dyslipidemia
f. BMI for PV bleeding in endometrial ca: 50 y/o, cervical dysplasia treated with
cryotherapy, family h/o colon ca, BMI 25
g. Lady with birds, respi dx with b/l crackles: birds
72. Further workup:
a. Hypokalemia in HTN with normal BP and soft S4
73. Hyper IgM syndrome: CD40L, lack of germinal center, b cell WNL
74. E3 ubiquitin ligase regulates HIF1a (hypoxia-inducible factor 1a) under conditions of normoxia,
mutation: defective proteosomal degradation pathway
75. Bruton agammaglobinemia: BTK defect=> no B cell maturation; recurrent infections after 6
months; AO normal lymphocytes mature in bone marrow
76. LAD 1: LFA-1 integrin (CD18) protein defect on phagocytes; AR; late separation of umbilical cord,
neutrophils absent at infection sites but increased in blood
77. Mushroom poisoning: alpha amanitin, inhibits RNA polymerase II
78. Lynch syndrome: HNPCC; family h/o endometrial, ovarian, breast, colon cancer; mismatch repair
(MLH1, MSH2)=> microsatellite instability; proximal colon is always involved
79. I-cell disease: N-acetylglucosaminyl-1-phosphotransferase defect; inclusion cell disease,
mucolipidoses; AR; lysosomes deficient of digestive enzymes> inclusion bodies; corneal
 clouding, gingival hyperplasia, restricted joint movements, claw hand, kyphoscoliosis, inc plasma
lysosomal enzymes
80. Blots:
a. Southern: DNA visualized
b. Northern: RNA, gene expression
c. Western: protein; right antibody or not
d. Southwestern: DNA-binding proteins
e. ELISA: titre; beta hcG beta subunit; AO IgM from control to be added to plate first; AO
vaccine titre
81. Field cancerization
82. Bee sting: mast cell and eosinophil
83. Benzene poisoning: glutathione transferase defect causes increased cancer risk
84. Free radical elimination by catalase
85. Autoimmune polyendocrine syndrome-1: AIRE mutation> dec negative selection>; candidiasis,
hypoparathyroidism, Addison
86. Polyendocrine syndrome type 2: cold/heat intolerance
87. G6PD deficiency: dec NADPH, dec reduced gulathione (GSH), inc oxidized glutathione (GSSG)
88. ADA deficiency : increased deoxyadenosine nucleotides-dATP^=> dec ribonucleotide reductase
activity=> dec DNA precursors=> dec lymphocytes
89. Acute radiation syndrome: DNA damage
90. Orotic aciduria: defect in UMP synthase; t/t-uridine supplementation
91. OTC (ornithine transcarbamylase deficiency): XR; hyperammonemia, 1st few days of life
92. Carbon monoxide poisoning: ETC, cytochrome c and water production are inhibited
93. Classic galactosemia: galactose-1-phosphate uridyltransferase deficiency; AR; galactitol
accumulates; Q several days old child vomiting after breastfeeding, scid
94. Carcinoid syndrome: histamine, serotonin releasing tumor-carcinoid tumor; MC-intestine, lung;
episodic flushing, diarrhea, wheezing, pellagra,^urinary 5-hydroxyindoleacetic acid (5-
HIAA); histo- prominent ros
95. Gene polymorphism: The cytochrome P450 (P450 or CYP) monooxygenases, CYP2D6,
CYP2C19, CYP2E1 and CYP2C9, and non-P450 monooxygenases, N-
acetyltransferase, thioprine methyltransferases and dihydropyrimidine dehydrogenase,
all display polymorphism.
96. Somatic hypermutation: Complementarity-determining regions (CDRs) are part of the
variable chains in immunoglobulins (antibodies) and T cell receptors, generated by B-
cells and T-cells respectively, where these molecules bind to their specific antigen.
97. Affinity maturation: increased antigenic binding to antibody in recurrent infection
Genetics:

1. Imprinting: Prader-willi, angelman, beckwith wiedemann

2. XR: color blindness, DMD 0% in daughters, 50% in sons;
3. XD: mother- both 50%, father-daughter 100%, son 0%; Alport, Fragile X,
Incontinentia pigmenti, Rett
4. AR: CAH, Fukuyama muscular dystrophy
5. DOMINANT
D- myotonic Dystrophy
 O- Osteogenic imperfecta
M- Marfan
I - Intermittent porphyria
N- NF
A- Achondroplasia
N- Noonan syndrome
T- Tuberous sclerosis
6. Turner syndrome: webbed neck, wide nipples, shield chest; meiotic
nondisjunction > deletion of chromosome>isochromosome >mosaicism;
Q 3/6 ejection systolic murmur at the LLSB
7. Fragile X: XD,FMR gene mutation; 50-200 CGG repeat on X, frontal
bossing, large ears, giant gonads, protruding chin; Q AO ask history
about intellectual disability in male family members
8. Klinefelter: azoospermia, defective separation of homologous
chromosomes, triple sex chromosome, dec inhibin=> inc FSH, dec
testosterone=> inc LH, ^estrogen
9. Isotretinoin exposure: HOX gene, homeobox; cranial-caudal direction,
transcription factor coding
10. Holoprosencephaly, cyclops, cleft: SHH gene (anterior-posterior axis
patterning)
11. Dorsal-ventral axis patterning, limb development: Wnt 7
12. Limb lengthening: FGF gene
13. AD disorders: Hereditary spherocytosis, Osteogenesis imperfecta
14. Hemifacial microsomia: Goldenhar syndrome
15. Down: trisomy 21; hypertelorism, moon facies, single transverse palmar
crease, single uterine artery, clinodactyly, inc sandal gap
16. Amino acid elimination: Proline replaced with lysine
17. Pedigree
18. TRMT10A mutations cause a distinct syndrome that includes abnormal
glucose homeostasis, intellectual disability, short stature and
microcephaly.
19. Primer placed at promoter region, i.e. next to 3’

Pharma:

1. Colchicine: Tubulin disruption

2. Azathioprine: metabolized by thiopurine methyltransferase (TPMT); activity increased by
xanthine oxidase inhibitor
3. Carbamazepine: euvolemic hyponatremia
4. Amoxicillin: alteration of binding site
5. Paclitaxel: hyperstabilization of tubulin
6. Rifampicin: bacterial DNA-dependent RNA polymerase; resistance common;
prophylaxis in Neisseria meningitis
7. Isoniazid: mycolic acid disruption in cell wall
8. Acyclovir: competitievely inhibits viral DNA polymerase by acting as an analog to
deoxyguanosine triphosphate (dGTP); resistance with mutated viral thymidine
kinase
9. Ganciclovir: CMV, viral kinase
10. Foscarnet: viral polymerase inhibitor, HIV RTI; doesn’t require kinase; res in mutated
DNA polymerase
11. Cidofovir: viral polymerase inhibitor; no phosphorylation required
12. Praziquantel: severe spasms and paralysis of the worms' muscles. by a rapid Ca 2+
influx inside the schistosome, inc vacuolation
13. Permethrin: AChE inhibitor, persistent depolarization
14. Alben: binds to tubulin, prevents polymerization, in inhibits malate dehydrogenase
and fumarate reductase, decrease ATP production; Meben/Pyrantel
pamoate/ivermectin: microtubule inhibition
15. Ceftriaxone
16. ACEI: cough, neck heaviness d/t bradykinin; s/e hyperkalemia, hypotension, teratogen
17. Benzocaine: decreased oxygenation of heme> methemoglobinemia; Q pt given
anesthetic during endoscopy
18. Drug induced lupus: etanercept- TNF inh, anti-histone antibodies
19. Trimethoprim: ADR hyperkalemia in high doses; thrombocytopenia in UTI male with
ecchymotic patches
20. Tesamorelin: GnRH analog used to treat HIV associated (PI, NRTI??) lipodystrophy
21. Baloxavir: endonuclease inhibitor (transfers 5’ cap from cell mRNA to viral mRNA)
22. Dexrazoxane: treats cardiotoxicity from anthracyclines
23. Niacin: used to treat dyslipidemia ^HDL, dec VLDL; increases aminotransferase activity
24. Tryptophan: tryp> niac, serotonin- melatonin
25. Tizanidine: alpha 2 agonists, acts centrally; muscle spasms, cerebral palsy, MS, ALS
26. 5 FU: addition of folinic acid produces pronounced inhibition of thymidylate synthase
27. Tacrolimus: binds FK506 bp, inhibits calcineurin, prevents IL2 transciption, nephrotoxic in high
doses; Sirolimus: mTOR inhibitor, binds FKBP, prevents response to IL2, kidney transplant
rejection prophylaxis with basiliximab
28. Ivacaftor: opens Cl channels; lumacaftor/tezacaftor: improves misfolded proteins
29. Paromomycin: clearance of intestinal pathogens, poorly absorbed; inhibits protein synthesis
by binding to 16s ribosomal RNA
30. Cimetidine, Omeprazole graph; Q Cimetidine inhibits the tubular secretion of
creatinine, without altering the glomerular filtration rate (GFR).
31. Pantoprazole (PPI): hypomagnesemia
32. Digoxin: blocks NaK ATPase directly> indirect inhibition of Na+ /Ca2+ exchanger. inc [Ca2+]i
> positive inotropy. Stimulates vagus nerve > dec HR
33. Digitoxin (ouabain): inc MCV
34. Hydrochlorothiazide: inhibits NaCl channel in DCT, decreased Ca secretion; causes AE
hypercalcemia, hyperuricemia, hyperlipidemia, hyperglycemia, sulfa
35. Cilostazol PDE3 inhibitor, dipyridamole nonspecific PDE inhibitor: intermittent claudication,
cardiac stress test, stent
36. Diphenhydramine: antimuscarinic action causes delirium, antihistaminic action causes
drowsiness
37. Infliximab: TNF alpha inhibitor
38. Stimulants: Amphetamines inh reuptake of NE and dopamine; Q party intoxicant, confused,
diaphoretic, mydriatic, ^BP=> MDMA; Ask patient taking mao b inhibitors to avoid cheese and
wine due to risk of tyrosine converting to catecholamines and decreased breakdown due to
mao b inhibition.
39. Mifepristone: progesterone antagonist; medical abortion
40. Medroxyprogesterone: works for 15 months
41. Propranolol: inh T4-T3, give before thyroid operation
42. Phenacetin (analgesic/antipyretic in vet): urothelial cancer, renal papillary necrosis
43. Beta blockers (Metoprolol)msk effect on RAAS: renin dec, aldosterone dec; dec renin secretion
(due to β1-receptor blockade on JG cells); reduced sympathetic flow
44. Trazodone: s/e painful erection, blocks 5-HT2 , α1 -adrenergic (causes painful prolonged
erection), and H1 receptors; also weakly inhibits 5-HT reuptake; s/e priapism, sedation
45. Hydroxyurea: s/e severe myelosuppression
46. SERM: Tamoxifen (anta in breast, partial agonist uterus and bone) /Raloxifene (anta breast,
uterus, agonist at bone)/Clomiphene (antagonist at hypothalamus); Q breast cancer drug which
increases endometrial hyperplasia risk- AO SERM
Tamoxifen (TAM) is known to have a dual mechanism of action: (1) to compete with
17β-estradiol (E2) at the receptor site and to block the promotional role of E2 in
breast cancer; and (2) to bind DNA after metabolic activation and to initiate
carcinogenesis.
47. Anthracycline: inhibit topoisomerase II, prevented with dexrazoxane; s/e DCM check for dec
COpr, myelosuppression
48. Fluoroquinolones: inhibit prokaryotic topo II(gyrase) and topo IV; resistance by Chromosome-
encoded mutation in DNA gyrase, plasmid-mediated resistance, efflux pumps
49. ACEI: efferent arteriolar dilatation as angiotensin is blocked=> dec glomerular pressure, GFR
dec, FF dec
50. ARB: decreased phospholipase c
51. Bismuth/sucralfate: increases bicarbonate secretion and is bactericidal
52. Echinocandin inhibit cell wall formation of fungi: beta glucan, chitin; griseofulcin- microtubule,
terbinafine- squalene epoxidase, flucytosine- DNA, RNA synthesis, azole- cell wall synthesis
cytochrome p450
53. Oseltamivir: inhibit neuraminidase dec release of progeny virus; begin within 48 hours
54. NNRTI: rash, hepatotoxicity, vivid dreams
55. NRTI: lactic acidosis, hepatotoxicity
56. NSAID: epigastric pain, bleeding, black tarry stools, young female; dec mucin prod, dec PGE2/I2
57. Prostaglandin: decrease cAMP
58. 2,4-Dinitrophenol: uncoupling agent, inc membrane permeability, dec proton gradient, inc O2
consumption, block ATP synthesis, produces heat; illicit use in weight loss
59. Terbinafine: inhibiting squalene monoxide/epoxide; tinea pedis/unguiim
60. Bethanechol: M3 muscarinic receptor agonist; Q old woman with incontinence, can’t void
completely until getting up
61. Erythromycin: motilin receptor agonist, peristaltic waves
62. PDE5 inhibitor: Sildenafil- cyanopia d/t PDE6 action; Q with 27 y/o difficulty maintaining
erection and absent morning erection; Q AO disruption of CNS transmission of signal; AO
inhibits cGMP=>GMP, ^cGMP; Q patient had orthostatic hypotension took blue pill,
nitroglycerin use history=> AO increased cGMP
63. Amiloride
64. Aspirin: inhibits COX> dec TXA2 release
65. Lactulose: forms ammonium in GIT acidifying it
66. Valproate: Na channel inactivation, inc GABA
67. Warfarin: decreased Vitamin K dependent factors; cyp2c9; protein C depletes before factors II
and X causing hypercoagulation
68. Metron: forms toxic free radicals=> DNA damage
69. Fluconazole/adenoItraconazole: QT prolongation; alteration in lanosterol-ergosterol, 14 alpha
demethylase causes resistance
70. Methadone: QT prolongation, prolonged repolarization
71. Biguanides Metformin Inhibit mitochondrial glycerol-3-phosphate dehydrogenase (mGPD) Ž
inhibition of hepatic gluconeogenesis and the action of glucagon. •inc glycolysis, peripheral
glucose uptake (•inc insulin sensitivity).
72. Ethosuximide: block thalamic t-type Ca channel; Q 3 Hz spike and wave discharged, triggered
by hyperventilation
73. Statin: HmG CoA to mevalonate; dec intrahepatic cholesterol, ^LDL receptor recycling, ^LDL
catabolism; s/e myoglobinuria> myopathy=> increased CK; best drug in dyslipidemic heart
patients
74. Beta blockers: s/e ED
75. Beta agonist: ^cAMP
76. Leukotriene antagonist:
77. Varenicline: partial nicotine agonist; Q intercostal
78. Nicotine gum: through ligand gated Ach receptors
79. Doxycycline: 30s; s/e photosensitivity; Q acne patient under doxy develops rashes after
exposure to sunlight, non-immunogenic
80. Duloxetine: SNRI; Q fibromyalgia?; Q diabetic neuropathy wants non-habit forming drug
81. Sulfonylurea: Close K+ channels in pancreatic B cell membrane => cell depolarizes =>insulin
release via ^ Ca2+ influx.
82. Buprenorphine: mu opioid agonist and antagonist; Q pregnant using oxycodone wants to
switch drug
83. Zolpidem: No active metabolites
84. Nivastatin: dec cholesterol synthesis; Ezetimibe: decreases cholesterol absorption from gut
85. Rituximab: CD20; increase b cell degradation
86. Hydralazine: causes arteriolar dilation and decreased afterload
87. Leuprolide: flare up at the start
88. Leflunomide: used with cholestyramine to reduce enterohepatic circulation
89. Insulin: Fed state: inc insulin dec cAMP dec protein kinase A dec FBPase-2, inc PFK-2, more
 glycolysis, less gluconeogenesis

1. First order elimination: steady state concentration

2. Opioid three curves graph: AO tolerance
3. Zero order elimination: Rate of elimination is independent of concentration; effect ofg loading
dose on plasma conc?; Amount of drug eliminated is independent of initial plasma
concentration; drugs- ethanol, aspirin, phenytoin
4. Decreased efficacy and same potency
5. Bioequivalence: the biochemical similarity of two (or more) drugs that share the
same active ingredient(s) and desired outcome(s) for patients

Cardio/Heme:

1. MI:
a. CK, CK-MB present due to membrane damage; lipid peroxidation of myocyte cell
membrane
b. ST ^ II, III and aVF, RCA affected, crushing chest pain, SA node
c. ST ^ I, aVL, V5, V6, LCX affected (posterior mitral leaflet is anatomical landmark)
d. >80% occlusion, oxidation of LDL, free radical in vessels, LDL deposition; anerobic
glycolysis
e. Medication prescribed on discharge: Aspirin (TXA2 inhibitor), Clopidogrel (ADP inhibitor)
f. Cardiac index dec, stroke volume dec, edv^
2. HOCM:
a. Beta myosin heavy chain
b. sarcomere defect, normal ECG; child with shortness of breath and chest pain
c. Family history of heart problems, SOB after playing sports
d. Heart murmur 2/6 systolic, left parasternal; increase LV volume on hand grip or
squatting and decreased murmur but increased murmur on Valsalva, diastolic increased
on standing
e. T/T: beta blocker, non dihydropyridine CCB
3. Murmurs: (medzcool)
a. MVP: midsystolic click at midclavicular line; inc on Valsalva; asymptomatic incidental;
episodic palpitation, Marfan
b. AS: crescendo decrescendo; pulsus parvus et tardus delayed pulse on radial palpation;
inc LV and endsystolic pressure; elastin replaced by collagen> dec aortic compliance in
old age; radiating to carotid area; younger=> bicuspid aortic valve (in Turners);
^TPR/afterload
c. VSD: Eisenmenger, L-R shunt, PAH> shunt reversal R-L which is cyanotic; holosystolic
murmur in left lower sternal border; Q post pci holosystolic d/t interventricular septal
damage; AO increased on standing/val salva
d. ASD: S2 fixed splitting
e. PDA
f. MR: holosystolic blowing murmur in mitral area; Valsalva dec murmur, ^ on hand grip
and squatting
g. MS: diastolic
h. PFO: DVT can cause stroke
i. TR: holosystolic murmur, left sided S3, left lowersternal border, increases on inspiration
4. ECG:
a. Premature ventricular excitation
5. Postcardiac injury syndrome: Dressler, autoimmune, immune complex deposition in
pericardium=> fibrinous pericarditis; Q 2 weeks after MI
6. Tetralogy of fallot: neural crest cell migration defect
7. Q Mitral valve commissural fusion no calcification in an immigrant: chronic rheumatic heart
disease
8. Acute pericarditis: sharp midsternal chest pain, slight relief on leaning forward, St concave
elevation in V5, V6; Q fibrinous pericarditis- chest pain while hiking with ST^ and deep Q; Q
widespread ST elevation, PR depression, viral infection is risk factor
9. P HTN, OSA: endothelin-1 increased (bosentan inhibits this); RV heave, P2 loud
10. Infective endocarditis: osler nodes, Janeway lesions; most common risk factor IV drug use;
female from Cambodia, childhood disease d/t GABS Strep py; vegetation includes fibrin and
platelets; Ag against bacterial wall antigen cross reacting with myosin
11. Atrial fibrillation: originates in pulmonary vein ostia: left atrial enlargement, b/l lung base
crackles, absent p wave, irregularly irregular; binge drinking causes holiday heart syndrome
12. A flutter: area between opening of IVC and tricuspid valve annulus; NB sawtooth ECG
13. Hypovolemic shock: dec CO, CVP, PCWP, PP, preload; ^ SVR, ^HR
14. Kawasaki: strawberry tongue, oral mucositis, papilla present (vs Scarlet doesn’t have), petechial
rash, fever, desquamation, conjunctivitis; mucocutaneous lymph node syndrome
15. Athlete, female: flow systolic murmur, aortic and pulmonary area; hyperdynamic circulation
16. Myxoma: left atrium, IL6, gelatinous histo with myxoma cells in glycosaminoglycans; repeated
syncopal attacks
17. Coarctation of aorta: two BP readings arm and leg, arterial disease
18. Aortic dissection: mediastinum enlarged, HTN, bicuspid aortic valve; short acting beta blockers-
decreased diastolic blood pressure, AO dec circulatory blood volume; unequal blood pressure in
 arms; Stanford classification; Q man lifting weight=> severe chest pain, radiating to tip, BP low;
MC site aortic isthmus
19. Cardiac myocyte graph: Disopyramide (lidocaine is similar)- inc AP, ERP
20. Pressure volume loops: aortic stenosis
21. Chronic HTN: 3 check ups BP decreasing; Q kidney atrophied d/t arteriosclerosis
22. Ortner’s syndrome: MS, LA enlargement, esophagus compressed=> dysphagia, RLN=>
hoarseness
23. Aplastic anemia: MCC idiopathic, low retics, fat replaces bone marrow
24. PSVT: AV node, QR without P, adenosine
25. Cardiac tamponade: pulsus paradoxus, electrical alternans; Beck: low BP, muffled heart sounds,
^ JVP; reduced systolic BP during inspiration
26. Fantoon procedure: protein losing enteropathy=> b/l pedal edema, proteinuria, pleural effusion,
pericardial effusion
27. Hypertension: Ang II dec, alpha 1 dec, beta 2 ^
28. Ventricular hypertrophy: S3, S4 heard, athletic young male
29. Torsades: hypokalemia
30. Epi-prazosin-epi: dec MAP, dec BP, ^HR
31. Epi-norepi mice experiment
32. Subclavian artery b/w anterior and middle scalene
33. Venous ulcer: Q Woman with ragged bordered ulcer from shin to medial malleolus; pulses and
pin-prick normal=> venous stasis
34. Atherosclerosis: accumulation of LDL cholesterol in macrophage

1. Heparin:
a. Heparin induced thrombocytopenia: d/t IgG antibodies against heparin-bound PF4
(platelet factor 4) which binds and activates platelets; typically 5-10 days after
administration
b. Activates antithrombin III acting on factors II and X, DVT drug
c. Difference with argatroban: no reversal agent,
d. Difference with dabigatran: doesn’t bind antithrombin III
2. Iron diseases: Transferrin, serum Fe, Ferritin, % sat
a. Iron deficiency: absorption from duodenum
b. AoCD: dec, dec, inc, TIBC dec; dec sideroblast
c. Hemochromatosis: intestinal cell
d. Pregnancy/OCP: ^, <>, <>, dec
3. Clotting:
a. Clopidogrel acts by inhibiting ADP receptor on platelets
b. Experimental drug inhibiting platelet aggregation: similar to PGI2
4. CLL: old>60 , smudge cells, autoimmune hemolytic anemia; accumulation of monoclonal
lymphocytes; AO interstitial aggregate of lymphoid
5. AML: alkylating agent> radiation>benzene, down syndrome ass, auer rods, myeloperoxidase +,
>20% blasts, APL t(15,17); t/t alltransretinoic, arsenic trioxide; bone marrow infiltration
6. ALL: flow cytometry- anti CD3, anti tDt, immature lymphocytes/thymocytes; tumor lysis
syndrome=> AKI; Down syndrome; 12;21 implies better prognosis than 9;22
7. CML: BCR ABL, receptor tyrosine kinase, imatinib resistance- mutation in kinase domain in ABL;
9;22- Philadelphia; t/t- tyrosine kinase inhibitor-ima^
8. Follicular lymphoma: bcl2, t(14;18); waxing and waning course; centroblast and ce
9. 11;14- Mantle cell:
10. 11;18-Marginal zone lymphoma
11. Thallasemia: African American microcytic anemia; hair-on-end/crew cut appearance on X-ray;
dec heme synthesis
12. Rhogam: polyclonal anti D IgG due to maximum antigenic specificity, binds to fetal D antigen in
RBC
13. Thalassemia:
14. Erythroblastosis fetalis: maternal IgG binds to Fc receptors on placenta
15. Antihemophilic factor VIII def: aPTT inc, multiple ecchymosis, tooth extraction
16. TTP: adamts13 mutation=congenital, fever, anemia, neurologic-confusion, thrombocytopenia,
inc Cr (HUS) (FATRN); schistocytes
17. Myelofibrosis: reticulin and collagen in marrow, LDH ^, retics inc, epo inc; dacrocytes (tear-
shaped cells)
18. Sickle cell anemia: glutamate=>valine- point mutation in beta globin – single amino acid sub;
hydroxyurea- ^HbF; SIckle cell Analgesics DIabetes-papillary renal necrosis- vasa recta; AVN of
femur medial circumflex artery; capsulated (pseudomonas); crisis-vasa recta
19. HbC: glutamate=> lysine
20. Downey cells: mono, non-infected atypical, reactive CD8 (NB)
21. O2 dissoc curve:
a. Left shift: (Carboxy/met)hemoglobin, hypothermia, decreased 2,3 BPG, alkalosis,
pregnancy, fetal Hb
b. Right shift: acidosis, hyperthermia, hypoxia, increased 2,3 BPG
22. Alkalosis: hypocalcemia, perioral numbness, facial twitching while stroking facial nerve a/w;
promotes binding of albumin with anions so decreased ionized Ca2+
23. COPD: HbA, HbA1 and HbA2 present; saddle embolism in pulmonary artery=> cor pulmonale; Q
lab ^RBC, ^HCT, ^Hb d/t AO tissue hypoxia
24. Emphysema: panacinar; production of elastase and collagenase
25. Alpha-1 antitrypsin deficiency: centriacinar; distal to respiratory bronchioles dilation d/t
consumption by elastase and collagenase
26. Hereditary spherocytosis: AD; microcytes with loss of central pallor
27. DIC: dec factor VII; also dec protein c and fibrinogen; Q bleeding from cannulation site
28. Protein c inactivation: family h/o acute onset of chest pain and breathing difficulties, left leg
bigger than right?
29. Factor v leiden: DNA point mutation=> factor V resistant to inactivation by protein c;
hypercoagulability, recurrent pregnancy loss; Q recurrent miscarriage and hard painful posterior
thigh veins
30. Von Willebrand disease: BT^, aPTT-/^; not activation of platelets by vWF adhesion; MC inherited
bleeding disorder; Q female what found- epistaxis
 31. Paroxysmal nocturnal hemoglobinuria: defective complement inhibition; PIGA gene prevents
the formation of glycosylphosphatidylinositol (GPI) anchors for complement inhibitors, such as
decay-accelerating factor (DAF/CD55) and membrane inhibitor of reactive lysis (MIRL/CD59)
32. PNH: CD 55/59, DAF/MIRL, PIGA mutation, complement activation defect; more than 5%
hemolysis on sucrose lysis test; dark-colored early morning urine
33. Burkitt: c-myc, t(8;14); Q jaw mass; NB starry sky appearance, tingible body macrophage; may
have only bcl-6 +
34. Langerhans cell histiocytosis: lytic bone lesions, skin rash, recurrent OM, mass in mastoid;
immature cells, express S-100 and CD1a, birbeck granules
35. DBA: triphalangeal thumb; splice site mutation
36. Fanconi anemia: absent thumb, loss of DNA crosslink repair (DNA repair mutation); café au lait,
thumb/radial defects, ^tumors/leukemia, aplastic anemia/pancytopenia
37. Essential thrombocythemia: JAK2 mutation
38. Porphyria cutanea tarda: uroporphyrinogen decarboxylase deficiency; blistering cutaneous
photosensitivity and hyperpigmentation, tea-colored urine d/t uroporphyrin
39. Heart failure:
a. HCO3 reabsorbed> hypochloremia, Na retained> hypokalemia, serum aldosterone ^,
ANP^, epinephrine^; raised JVP, b/l basal crackles, s3=> furosemide (thick asc l, NaK2Cl)
inhibits sodium reabsorption, given in acute decompensated
b. Hemosiderin-laden macrophages (HF cells) in lungs
c. Lipofuscin in heart
d. Acute decompensated: ESV^, EDV^, CO dec
e. Preserved ejection fraction: decreased LV compliance

Respi:

1. Asthma:
a. Cause of death: MCC bronchoconstriction>mucus plug
b. Normal CXR: airway inflammation
c. Early histamine, late eosinophil
d. Inc total airway resistance, inc bronchiolar resistance, normal pharynx and larynx
resistance
e. First SABA-bronchodilation, then steroids-decreased recruitment of inflammatory cells,
then anti-IL-5
f. Alveoli infiltration during expiratory phase
2. Surfactant: synthesis starts ~20 weeks, mature levels ~35 weeks; decreased surface tension
relative to water
3. Pneumocytes, cells and their function:
a. Type I: gas exchange
b. Type II: release surfactant, prevent alveolar collapse
c. Club cells
d. Goblet cells
4. AMS: high altitude: ^^ 2,3 BPG, decreased affinity of Hb to O2; Right shift dissociation curve;
^Hb and ^HCT d/t conversion of late erythroid precursor to erythroblast
5. Samter triad (aspirin-exacerbated respiratory disease): asthma, aspirin allergy, nasal polyps
6. Allergy in spring season: antihistaminics
7. Smoking:
a. Idiopathic pulmonary fibrosis: CXR- peripheral reticular opacities, honeycomb
appearance; cigarette smoke, nonproductive
b. SCC: male, smoking for 20 years, upper lobe hilar mass from bronchial cavitation, biopsy
reveals keratin pearls and intercellular bridges
c. Airway resistance inc, bronchus resistance inc, no changes in laryngopharynx
8. Pleural effusion:
a. Dec breath sounds, dec fremitus, dull on percussion, So
b. Light criteria: Malignancy P:S LDH >0.6, red color fluid
9. Spirometry:
a. Obese: FEV1 dec, fvc dec, DLCO normal/inc
b. ILD: dec, dec, ratio inc
c. Restrictive: systemic sclerosis
10. Stab wound in 5th ICS in left midclavicular line, raised JVP: left lung injured
11. Beryllium: NASA, electronics manufacturing; granuloma seen
a. lvh
12. AMP allosteric activator of phosphofructokinase as increases Vmax
13. Pneumothorax: inc percussion, dec vocal fremitus (^in pneumonia) and breath sounds;
^vascular resistance in left lung; overall dec V/P ratio; Q cause of discomfort: AO reduced
preload
14. Sarcoidosis: male, b/l hilar lymphadenopathy; non caseating granuloma, cutaneous sarcoidosis;
^ACE, ^PTH from granuloma=> hypercalcemia
15. Heerfordt-Waldenström syndrome is a rare subacute variant of sarcoidosis, characterized by
enlargement of the parotid or salivary glands, facial nerve paralysis and anterior uveitis.
Granulomas with a peripheral lymphocyte deficit are found in the anatomic pathology of
affected organ ◦ Parotitis, Uveitis, Facial palsy
16. Small cell carcinoma: oat, paraneoplastic syndrome; LEMS presynaptic Ca, ACTH; synaptophysin
+; small blue Kultchisky cells
17. Electrolyte balance:
a. Decreased ventilation: PaCO2 inc, PaO2 dec, HCO3 <>
b. Fat embolism:
c. Vomiting: RAAS> Se aldo ^, Se Na ^, Ur K ^ (exchanged), Ur Cl dec (low in body); inc
muscle glycogenolysis, inc liver glycolysis, inc lipolysis
d. Heart failure: similar but Ur Cl inc (exchanged with HCO3)
18. Aspirin exacerbated respiratory disease: Samter’s triad- asthma, aspirin allergy, nasal polyps;
 19. Drowning: pulmonary shunting
20. Mother gives birth, two days later, SoB: PCO2 dec, PO2 dec, pH^
21. Pulmonary embolism: significant physiological dead space
22. Malignant hyperthermia: AD, ryanodine receptor; family h/o is important
23. UIP (usual interstitial fibrosis): subpleural fibrosis, honeycombing
24. Hypersensitive pneumonitis: bird fancier
25. Lung transplant: dec FEV1/FVC=> smooth muscle proliferation: Bronchiolitis obliterans

Skin/MSK:

1. Mycosis fungoides: cutaneous T-cell lymphoma; skin patches/plaques, Pautrier microabscesses,

atypical lymphocytes; Sezary syndrome implies malignant lymphocytes in blood; Q boy with
recurrent h/o red rash around buttocks
2. Paint spill: stratum corneum protects
3. Impetigo: S pyogenes; honey crusted lesion; organism found in epidermis
4. Langerhans cells responsible for initial response; stratum spinosum
5. Sports injury: muscle and neural origin
6. Foot:
a. Heel: deep peroneal, toe extension; superficial, foot drop
b. Toe: Tibial , can’t tip toe
7. DDH: Ortolani in, barlow out; femur easily slips in and out; increased risk in breech presentation
8. Achondroplasia: FGFR3 mutation due to interaction of sulphydril groups; FGFR3 also causes
hypochondroplasia and thanatophoric dysplasia (TD); partial loss-of-function
 mutation of FGFR3 causes camptodactyly, tall stature, scoliosis and hearing loss
(CATSHL) syndrome
9. RA: synovial hyperplasia, morning stiffness, pannus> periarticular erosions, spares DIP;
Boutonniere deformity
10. Erlenmeyer flask deformity (osteopetrosis): bone resorption
11. Patellofemoral syndrome: overuse injury, young females, pain all around knee
12. Reactive arthritis: HLAB27; conjunctivitis, urethritis, arthritis; Shigella, salmonella,
campylobacter, yersinia, chlamydia, e coli
13. Antiphospholipid syndrome: Common with SLE, h/o spontaneous abortion; lupus anticoagulant,
anticardiolipin, anti-β2 glycoprotein I antibodies
14. Dermatomyositis: gottron papules, heliotrope rash, shawl and face rash, mechanic’s hands;
perimysial inflammation and atrophy, CD4 + T cells; QAO progressive muscle weakness; check
muscle strength; ⊕ anti-Jo-1 (histidyl-tRNA synthetase), ⊕ anti-SRP (signal recognition particle),
⊕ anti-Mi-2 (helicase)
15. Scleroderma: Triad of autoimmunity, noninflammatory vasculopathy, and collagen deposition
with fibrosis; collagen in dermis; anticentromere antibodies
16. Bullous pemphigoid: dermoepidermal junction, hemidesmosomes, tense blisters, picture shows
bulla which are ruptured and intact; oral mucosa spared; immunofluorescence: linear; collagen
17, XVII collagen, also known as 180-kDa bullous pemphigoid antigen, is a type II
transmembrane collagen; oral mucosa spared, nikolsky -ve; from derm DR: itchy and
erythematous; gliptins?
17. Epidermolysis bullosa: AD; keratin, laminin>collagen, palms and soles, heals without scarring,
intraepidermal cleavage/separation; congenital blistering disorder; T-lymphocytes are
Directly Involved in the Clinical Expression of Migratory Circinate Erythema in
Epidermolysis Bullosa Simplex Patients. Epidermolysis bullosa simplex with
migratory circinate erythema (EBS-MCE) is a rare EBS subtype characterised by
migratory blistering lesions that resolve with brownish pigmentation.
18. Pemphigus vulgaris: IgG Ab against desmoglein-1/3, flaccid blisters; immunofluorescence:
reticular; Nikolsky +, oral mucosa involved usually
19. Nickel: contact dermatitis; Q rash just below the umbilicus
20. Atopic dermatitis: child, Type I hypers, skin flexures, ^IgE, filaggrin gene mutation
21. Ichthyosis vulgaris: defective keratinocyte desquamation, leading to the accumulation of dry,
scaly skin with loss of normal barrier function
22. Runner: Marathon: inc slow fibers and mitochondria, capillary dilation inc, glycolytic dec;
sprinters opposite; glycogen low, compliance^; aerobic
23. Exercise dec SVR
24. Osteopetrosis (Erlen Meyer flask deformity): Defective CA II enzyme, defective bone resorption;
dense bones prone to fracture; pancytopenia, extramedullary hematopoiesis; lab values normal
25. Osteosarcoma: metaphysis, X-ray lytic lesion with sunburst appearance
26. Scabies: old age home woman, stratum corneum; hebra circle; mites in burrows in epidermis
27. Leriche syndrome/Meralgia parasthesia: compression of lateral cutaneous branch of femoral
nerve d/t tight clothing, pelvic surgery, obesity; triad- buttock and thigh claudication, decreased
femoral pulse, erectile dysfunction/impotence
28. Gluteus maximus: climbing
29. Piriformis: lateral rotation of hip; Q pain in the buttock, shooting pain from back radiating to
post leg and foot
30. Giant cell Arteritis with polymyalgia rheumatic: steroid- nuclear receptor, NFKB
31. Melanoma: BRAF; check braf kinase before giving vemurafenib otherwise ipilimumab (binds to
CTLA-4 antigen which results in its anti-tumor immune response. This allows the body to attack
cancerous cells while less likely to harm healthy tissues.CTLA4); b/l cannon balls on mets to
lungs; immunosuppression can lead to it, Qtacro, tmp-smx, renal transplant; s100 marker
32. Merkel cell ca: u/l full blown white lung on mets
33. Keratoacanthoma: keratinocyte lesion
34. Seborrheic keratosis
35. Polymyositis: CD8 inflitration with muscle fibre invasion; dematomyositis: CD4
36. Myositis ossificans
37. Albinism: basal layer; Normal melanocyte number with dec melanin production, due to dec
tyrosinase activity or defective tyrosine transport; Q blue eyes, curled light colored hair
38. Tumors:
a. Ewing: aggressive tumor with early metastasis, anaplastic small blue cells of
neuroectodermal origin; 11,22 translocation (EWS-FLI1), transcription factors; diaphysis;
Q young boy after trauma to the hip, periosteal reaction in diaphysis, HPE
39. Tietze syndrome, costochondritis: chondrocyte; Q no radiation, no change with change in
position
40. Xeroderma pigmentosa: nucleotide excision repair defect> DNA repair; dry skin,
photosensitivity
41. Collagenase responsible for fibrosis in stenographer case
42. DVT: deep posterior calf veins, lower leg posterior compartment
43. Injury to lateral aspect of knee: Dorsiflexion of foot; NM marked area
44. Osteomyelitis: NB FPL tendon insertion site 1st digit
45. Shoulder dislocation: NB anteroin
46. Ankylosing spondylitis: Xray SI joint nearly fusion
47. Psoriasis: papules and scales on elbows, microabscesses, auspitz sign +, nail pitting, psoriatic
arthritis
48. Normal <200; OA: <2000; Pseudogout; RA/Gout: 2000-50,000; septic arthritis>50,000
49. Pityriasis rosea: herald patch then scaly erythematous plaques; Christmas tree on trunk; HHV 6,7
ass.
50. Myasthenia gravis: postsynaptic Ach receptor Ab; reflexes spared; young- thymic hyperplasia,
old-thymoma; t/t neostigmine, pyridostigmine
51. LEMS: presynaptic Ca channel Ab; hyporeflexia; autonomic (dry mouth, con
52. Sweat: sympathetic stimulation of eccrine glands, Ach
53. HSP: type 3 hypersensitivity leukocytoclastic vasculitis; IgA vasculitis: arthralgia, abd. pain,
palpable purpura; MC childhood systemic vasculitis, follows URI
54. Hereditary hemorrhagic telangiectasia
55. Cleidocranial dysplasia: absence of clavicle, frontal bossing, supernumerary teeth,
hypertelorism, hypoplastic; CBFA1 gene mutation=>decreased osteoblastic differentiation
56. Axillary: C5-6, posterior cord
57. Radial nerve: C5-T1, posterior cord
 58. Medial Tibial Stress Syndrome (MTSS) is a common overuse injuries of the lower
extremity, often seen in athletes and military personnel.
59. Hidradenitis suppurativa: blockage of apocrine sweat glands
60. 45-120 painful arc=> subacromial bursitis; 170-180 acromioclavicular problem
61. Subscapularis: shoulder flexion and internal rotation pain
62. Weakness and pain during internal rotation of hip: gluteus medius/minimus, tensor fascia
latae
63. Supra- and infra-spinatus: external rotation, horizontal abduction
64. Erysipelas: upper dermis and superficial lymphatics
65. Paget (osteitis deformans): ^osteoclastic activity followed by ^osteoblastic activity; ^ALP;
hearing loss common; t/t inhibit osteoclastic activity
66. Compartment syndrome: myocyte necrosis, segmental neutrophils
67. Rickets: defective cartilaginous growth plates; Q Xray findings of rickets- bowing of legs, frontal
bossing?; hyperactivity of osteoblasts=> ^ALP
68. Osteomalacia: defective mineralization of osteoid
69. Ulnar nerve: abduction of interphalangeal; go through brachial plexus
70. Dupuytren contracture: superficial palmar fascia fibrosed
71. Systemic lupus erythematosus: Lupus nephritis (glomerular deposition of DNA-anti-DNA
immune complexes)

Neuro/Psych:

1. Functional hypothalamic amenorrhea: exercise-induced amenorrhea; triad of dec calorie

availability/excessive exercise, dec bone mineral density, menstrual dysfunction; dec leptin,
^ghrelin, ^CRH=> inc cortisol; dec GnRH
2. Primary auditory cortex (41, 42) in posterior temporal gyrus above Wernicke’s are (22),
connected to MGB in thalamus through the retrolenticular part of IC; inferior colliculus below
connects cochlea and MGB
3. Gross brain: circle of willis rupture of aneurysm
4. Migraine: Sumatriptan 5-HT1B/1D agonists- s/e coronary vasospasm
5. Alzheimer’s:
 a. Widespread cortical atrophy esp. hippocampus>temporal and parietal lobe, senile
plaques in gray matter, neurofibrillary tangles, Hirano (intracellular inclusion
proteinaceous rods) bodies in hippocampus; beta amyloid; visuospatial disorientation;
AO ataxia with impaired movement
b. ApoE2 dec risk, ApoE4 inc risk
c. AChE inhibitor: Donepezil, rivastigmine, galantamine
d. Aberrant proteolytic cleavage
6. Frontotemporal dementia: silver staining spherical tau proteins; frontal lobe syndrome:
impulsivity, disinhibition, aggressive, hyperorality; ubiquitinated TDP-43 deposits
7. Normal pressure hydrocephalus: ataxia, wide based gait, urinary incontinence, memory loss;
telencephalon is most likely affected
8. Creutzfeldt Jakob disease (CJD): Fatal, rapid onset dementia, prion disease, myoclonus, ataxia,
periodic sharp waves on EEG; inc 14-3-3 in CSF, beta pleated sheets; Small vacuoles in neuopil
with gliosis, PrPsc accumulation; spongiform encephalopathy; Q corneal transplantation
9. Narcolepsy: Q falls asleep while laughing, ask h/o AO day time sleepiness
10. Vagus:
a. Lateral medullary syndrome: Q uvula deviation to opposite side, hoarseness of voice,
pronator drift; loss of c/l pain and temperature sensation
b. Unable to lift posterior tongue
11. Pituitary adenoma: bitemporal hemianopsia; Q hyperglycemia, raised cortisol, ACTH, skin color
change; Q raised BP, shoe size somatotropin; Q loss of libido and fatigue d/t dec LH; Q t/t
somatostatin; Q post transsphenoidal resection, decreased lacrimation, structure damaged=
base of sphenoid bone
12. Prolactinoma: acidophils
13. Parkinson: defect in substantia nigra, alpha synuclein accumulation; affected; protein functions
for axonal transport; Q tyrosine hydroxylase activity low> decreased dopamine metabolism; Q
treatment AO precursor
14. Syringomyelia: anterior commissure
15. Ischemia
a. Temporal lobe: medial geniculate nucleus of thalamus
b. SAH: severe headache; AO check range of motion of neck; circle of willis; Q severe
headache and LOC while loading a truck
c. SDH: doesn’t cross midline d/t falx cerebri but crosses suture lines and the midline
shifts; tearing of bridging veins
d. EDH: lucid interval (episodes of loss of consciousness and regaining consciousness),
rapid deterioration d/t hematoma expansion; biconvex; doesn’t cross suture line,
middle meningeal artery; foramen spinosum
e. AICA: facial nerve palsy- dec lacrimation, salivation; lateral pontine syndrome
f. PICA: vagus nerve palsy- gag reflex, dysphagia, hoarseness, hiccups; Lateral medullary
syndrome
g. ASpinalA: hypoglossal nerve palsy- tongue deviates to same side; medial medullary
syndrome
h. ACA: motor and sensory of lower limb
i. MCA: motor and sensory of upper limb, Wernicke and broca
 j. LSA: pure motor palsy
16. Compression:
a. PCom: ipsilateral CN III palsy=> mydriasis, ptosis, down and out
17. Parinaud syndrome: dorsal midbrain compression- upward gaze palsy, convergence-retraction
nystagmus, light-near dissociation; histo similar to seminoma; pineal gland tumor; extragonadal
germ cell tumor
18. Cerebellar lesion: resting tremor, fingernose test -, dysdiadochokinesia +, heel shin -, ataxia, b/l
nystagmus; Q anterior vermis
19. Pons:
a. PPRF: Neither eye can look on affected side
b. Abducens: Ipsilateral eye lateral gaze palsy
20. Neurocutaneous:
a. Sturge-Weber syndrome: GNAQ activation, port wine stain in CN V1/2, calcifications in
brain, ipsilateral leptomeningeal angioma, episcleral hemangioma (NB infantile
hemangioma)
b. TS: TSC1-hamartin, TSC2-tuberin, angiofibroma, MR, ash leaf spots, cardiac
rhabdomyoma(ventricular wall), shagreen, renal angiomyolipoma; NB guys nose with
^^^^papules
c. NF1: NF1-neurofibromin, hyperpigmented patch, café au lait, Lisch nodules,
pheochromocytoma
d. NF2: NF2-merlin, b/l vestibular schwannomas, juvenile cataracts
21. GBS: symmetric ascending muscle weakness/paralysis and depressed/absent DTRs beginning in
lower extremities, Schwann cells injured, Campylobacter jejuni antecedent infection, plasma
exchange, IVIg; Q URTI later numbness of lower extremeties, o/e sensation lost=> AO recent
viral illness; defect in myelin
22. Tumor
a. Ependymoma: 4th ventricle, rod shaped blepharoplasts (basal ciliary bodies) eosinophilic
fibers and perivascular pseudorosettes
b. Meningioma: psammoma bodies/laminated calcifications, arachnoid cap, spindle cells,
palisading; posterior fossa; ass. W NF
c. Glioblastoma multiforme: astrocytes, highly malignant, butterfly glioma,
pseudopalisading; GFAP (glial fibrillary acidic protein)
d. Primitive neuroectodermal tumors: Medulloblastoma
23. Thalamic pain syndrome: pure sensory symptoms; pain in right upper limb, c/l thalamus,
allodynia, flexion of neck pain; Q mark thalamus in coronal section; Pain or temperature
sensations can be evoked in humans by electrical stimulation in a vaguely defined
region of the posterolateral thalamus.
24. Thalamus:
a. Following ischemic stroke, VPL, Thalamic pain, pulvinar nucleus
b. Paraventricular: oxytocin
c. Supraoptic: ADH
25. Uvula deviated to one side: c/l vagus
26. HIV PML: visual symptoms common; encephalopathy: cognition
27. HIV leukoencephalopathy: memory loss in HIV patient
28. HIV dementia: memory loss common
29. Lissencephaly: can be detected at 23 wog, pachygyria, agyria
30. Basal ganglia hemorrhage: fibriboid necrosis of lenticulostriate vessels
31. Hyphema: Source of bleeding in hyphema with blunt trauma to eye is circulus iridis
major artery; Compressive force to the globe can result in injury to the iris, ciliary
body, trabecular meshwork, and their associated vasculature; blood accumulates in
the anterior chamber
32. Coloboma iris: defect in the choroidal fissure, keyhole pupil
33. CN 12 and 5 push, CN 10 and 7 pull
34. Astrocytes: neurotransmitter clearance, macrophage of CNS; reactive gliosis
35. Ataxia telangiectasia: ATM gene mutation; ataxia, angiomas, IgA deficiency, DNA repair defect;
osler weber rendu?: AR
36. Lateral
37. Central retinal artery occlusion: painless monocular loss of vision, cloudy retina, cherry red spot;
Q with d/t AO AF
38. Huntingtons: AD, CAG-caudate, dec Ach, dec GABA
39. Multiple myeloma: hypergammaglobulinemia, amyloid alpha chain deposition neuropathy, inc
Cr; NB bone marrow, multiple plasma cells with clockface nuclei, beautiful blue cells with
bluberry like nuclei; Q carpal tunnel syndrome d/t lambda light chain accumulation
40. Age related macular degeneration (ARMD): Drusen on fundoscopy; wet type shows retinal
detachment
41. Multiple sclerosis: neck weakness, T cells; oligodendrocytes, ocular eye movement d/t MLF
damage=> no conjugate gaze=internuclear ophthalmoplegia; oligo clonal bands, periventricular
plaque; optic neuritis, painful monocular loss of vision, intention tremor, scanning speech,
dissociation of time and space; relapsing-remitting course; farther away from equator; Q MRI
with white patch at C4, AO T lymphocytes; T/t decreased migration of immune cells by
Natalizumab; Q multiple sclerosis, periventricular calcification, AO spastic quadriplegia
42. Immune reconstitution inflammatory syndrome
43. Pilocytic astrocytoma: MCC cerebellar tumor children; Rosenthal fibers (eosinophilic corkscrew
fibers), microcysts; posterior fossa
44. Medulloblastoma: MC malignant tumor in childhood, cerebellum; Homer-Wright rosette
45. Hemangioblastoma: MCC cerebellar tumor in adults; ass with VHL when found with retinal
angiomas
46. Vestibular schwannoma: S100+
47. Kallmann syndrome: dec FSH, dec LH, dec testosterone; diencephalon
48. Horner: pathway- hypothalamus-superior cervical ganglion-ciliary ganglion; Qstellate ganglion
blocked, dx confirmed by: AO right sided ptosis
49. Charcot marie: Typically autosomal dominant; Most common type, CMT1A, is caused by PMP22
gene duplication; Mutations in the gap junction gene connexin32 (Cx32) cause the X-linked form
of Charcot-Marie-Tooth disease, an inherited demyelinating neuropathy. More than 130
different mutations have been described, affecting all portions of the Cx32 protein.
50. Mamillary body: lies a lot, features of severe dementia
51. Agraphia with acalculia: dominant parietal, pie on the floor; Grestmann syndrome; also finger
agnosia and left-right dissociation
52. Retinitis pigmentosa: African-American, family history
53. Immune reconstitution inflammatory syndrome: Q cornea transplant, cmv retinitis, reduced
visual acuity
54. CMV retinitis: cotton wool exudates, floaters; Q in association with HIV not adherent to
antiretroviral therapy, CD4 <100

1. ADHD: Methylphenidate, amphetamines- NE and dopamine increased in synaptic cleft;

behavioral therapy; atomoxetine- selective NE reuptake inhibitor; guanfacine, clonidine (α2-
agonists)
2. Denial: doesn’t want to undergo necessary evaluation
3. Altruism: wants to help similar patients
4. Narcissistic personality disorder
5. OCD: Rituals block from reaching goals
6. OCPD: rituals help meet goals
7. Bipolar: grandiose, opens clothes, doesn’t sleep; lability implies shift from one to other affect
8. Borderline: splitting
9. Somatic symptom disorder: ≥ 1 bodily complaints (eg, abdominal pain, fatigue) lasting months to
years; visit the same physician
10. Preparation: calcium elderly
11. Antidepressant withdrawal syndrome: Typical symptoms of antidepressant discontinuation
syndrome include flu-like symptoms, insomnia, nausea, imbalance, sensory
disturbances, and hyperarousal. These symptoms usually are mild, last one to two
weeks, and are rapidly extinguished with reinstitution of antidepressant medication; In
AWS:
a. Gaba downregulation: cause for need for higher dosages of BZP
b. Glutamate upregulation: cause for seizure
12. Decreased reuptake of catecholamine (serotonin+dopamine): man in the street wants to fight
random person in car (PCP, cocaine), treat by antagonism of dopamine
13. Escitalopram: SSRI, causes ED; pt has problem with wife, morning erection normal
14. Alcohol withdrawal: glutamate upregulation; NMDA upregulated; receptor induction- GABA
desensitization; Q HR^, BP^, delirium tremens
15. Serotonin syndrome: akathisia, hyperreflexia, dilated pupils; decreased serotonin reuptake
16. Bupropion: Depression, smoking cessation (NE-DA reuptake inhibitor); recurrent seizures=>
hypoxia=> death
17. GAD: decreased serotonin release from raphe nucleus; >6 months
18. Adjustment: <6 months
19. Reportable cases: child abuse, elderly abuse, impaired driver/colleague
20. MDD: decreased sleep latency, increased REM sleep; >= 5 criteria; >2 weeks; dec prefrontal
cortex
21. Dependent personality disorder
22. Agoraphobia
23. Panic attack: Q sudden onset tachycardia, SoB, dizziness, ECG normal
24. Impulsivity: marijuana use, h/o required
 25. Catatonic schizophrenia: catatonic posture; Q homeless, flat affect, arm in same position
26. Old age: increased sleep latency, early morning awakening
27. SSRI: loss of facial expression, posture flexed at lumbosacral region> Parkinsons dopamine
28. Schizophrenia: dec mesocortical -negative symptoms (apathy, emotionless); inc mesolimbic -
positive symptoms (hallucinations, ad
29. Conversion disorder: inconsistent symptoms, following certain event; Q facial nerve palsy
following palsy
30. Separation anxiety: Q military man, sent to Ukranie, not able to concentrate, finish tasks
31. Fixation: surgeons thumb?
32. Depression: Prolonged Sleep Latency (Time to Fall Asleep) · Lack of Slow Wave Sleep
(Deep Sleep) · Reduced REM Sleep Latency and Increased REM Sleep Density; ^HPA
axis, amygdala, prefrontal cortex, cingulate gyrus, anterior thalamus; dec size of
hippocampus, HDL, dorsolateral
33. Short term memory- mammillary bodies (also implicated in anterograde memory loss), long-
term memory- hippocampus
34. Anorexia nervosa: low BP, lanugo hair, BMI<18, thinks she needs to lose weight
35. Bulimia: buccal erosion, Russell sign
36. Phencyclidine: NMDA (N methyl D aspartate) receptor inhibitor; cause anaesthesia and
analgesia without causing cardiorespiratory depression.
37. Normal grief response: upto 6 months
38. pin point: opioids, phencyclidine, op poisoning, heroin
39. dilated pupil: MDMA, cocaine, amphetamine, cannabis (but miosis Q AO), opioids
withdrawal, alcohol withdrawal, alcohol intoxication
40. Set a quit date for a patient who is ready for abstinence
41. Displacement: displace emotions to a third person

Endocrine:

1. Graves’ disease:
a. Lid lag
b. Antibody against TSH receptor; hand tremor, heat intolerance, palpitation,
exophthalmos, T4 inc, TSH dec
2. Pheochromocytoma: associated with MEN2, increased vanillylmandelic acid (VMA),
homovanillic acid in urine and serum, chromatophysin +, synaptophysin + NSE +; chromaffin cell
derivative, neural crest cells, metanephric blastema; episodic HTN, sweating, don’t give beta
blocker (unopposed alpha action; also in cocaine toxicity), alpha followed by beta before OT
3. Intracellular receptors: Progesterone, Estrogen, Testosterone, Cortisol, Aldosterone,
T3/T4,Vitamin D
4. Congenital hypothyroidism
5. Hypothyroidism: GAG accumulation
6. CAH: ^17hydroxyprogesterone, cortical expansion and disarray
7. Propylthiouracil: blocks TPO (organification and coupling of iodine) and 5’ deiodinase (peripheral
conversion); causes agranulocytosis=> neutropenia
8. OCP use for 6 months: T4 inc, free T3, free T4, TSH normal
9. Diabetes:
a. DKA: unconscious after exercise, hormone-insulin; 6 y/o inc PR RR dehydration DKA,
decrease glucose utilization with accumulation of beta hydroxubutyrate; ^cortisol=> dec
L-selectin=>demargination and leukocytosis
b. Dyspnea, edema, Drug to use for diuresis: NaK2Cl
c. Obese: Biguanides(metformin) inc insulin sensitivity by blocking hepatic
gluconeogenesis; GLP1 agonist(exenatide) dec glucagon release dec gastric emptying=>
satiety, glucose induced insulin secretion; SGLT2 dec glucose absorption PCT=> inc
glucose excretion, inc risk of UTI, dehydration, orthostatic hypotension, dec GFR (BiGS);
alpha glucosidase inhibitor(acarbose)
d. HbA1C >9 => insulin + GLP1 +/- metformin (metformin+ GLP1/SGLT2 for <9); GLP1 also
with cardiovascular and renal risk factors= GLP1>SGLT2
e. Check nerve functioning: vibration sense first to go, dorsal column, medial lemniscus; Q
monofilament
f. DM I: monoclonal antibodies affecting regulatory T cells; can cause s/e ED
g. DM II: hyperosmolar hyperglycemia, ^glucose uptake by muscle, gluconeogenesis
h. Charcot neuroarthropathy: swollen extremity
i. Nephropathy: diffuse increase in mesangial thickening with nodules
j. No sulfo: CKD, sulfa-allergy, occupational hazard d/t hypoglycemia (working at great
heights), obese
k. For patients without cardiovascular disease and HbA1C <9 => DPP4 inh- gliptins
l. Q leg swelling, frothy urine, type II DM under meds, microscopic finding=> nodular
sclerosis (Kimmelstein-Wilson)
m. t/t for peripheral neuropathy: SNRI- duloxetine
10. Primary polydipsia: water restriction=> ^urine osmolality(315)
11. Polyendocrine syndrome-1 (Chronic mucocutaneous candidiasis, Hypoparathyroidism, Adrenal
insufficiency, Recurrent Candida infections).
12. Autoimmune polyglandular syndrome type 2 is an autoimmune disorder that affects
many hormone-producing (endocrine) glands. It is characterized by the presence of
Addison's disease along with autoimmune thyroid disease and/or type 1 diabetes.
13. Gliptins: DPP-4 inhibitor=>inactivates GLP1=>dec glucagon release=>dec gastric emptying=>
^glucose-dependent insulin release
14. Psychogenic polydipsia: Q drinks 12L/day water, has bipolar, under lithium, cause asked
15. MODY (maturity onset diabetes of the young): glucokinase deficiency; Q LOX/FOX gene: AO
absence of autoimmune antibodies
16. Hashimoto: autoimmune, anti-TPO Ab (antimicrosomal-TPO), antithyroglobulin; periorbital
myxedema d/t GAG accumulation; Q Female around 30s, has symptoms of weight gain, brittle
hair, intermittent constipation, fatigue. On examination has BP:100/70, HR:55. What else will be
seen?: tertiary lymphoid structure (thyroid); AO lymphocytic infiltration
17. Waterhouse Friderichsen syndrome: b/l adrenal cortical hemorrhage extending to medulla,
fulminant meningococcemia (Neisseria); hypotensive, rash, meningitis; acute adrenal
insufficiency
18. Insulinoma: Recurrent lightheadedness, nausea, sweating, palpitations; manages by sugar;
insulin normal; tumor of b cell
19. Glucagonoma: tumour of alpha cell; dermatitis (necrolytic migratory erythema), diabetes, DVT,
declining weight, depression, diarrhea; t/t octreotide
20. ADH works on renal medulla
21. Primary hyperparathyroidism: inc PTH, Ca, urine cAMP, dec PO4; recurrent renal stones
22. SIADH: ^urine osmolarity, ^urine Na, dec urine K
23. Secondary hyperparathyroidism: graph, inc PTH, dec Ca
24. Chief cells secret PTH, c cells secrete calcitonin
25. Primary hyperaldosteronism: resistant HTN, metabolic acidosis?, hypokalemia; Q pt on lisinopril
26. Adrenals: just below the capsule- hyperkalemia
27. Adrenal insufficiency:
a. Primary: dec vcortisol, dec blood glucose, dec BP, skin pigmentation +=> AO ^ACTH
28. Milk alkali syndrome: hypercalcemia, alkalosis, renal failure; PTH dec; calcium deposits all over
the place; Q CaCO3 consumption
29. Amiodarone: Wolff Chaikoff hypo; Jod Basedow hyper- TSH dec, T3 inc, T4 inc
30. MEN 1: PPP; menin gene, putative tumor-suppressor gene located on human chromosome
11q13.
31. MEN 2A: PPM; Parathyroid hyperplasia, medullary thyroid carcinoma, pheochromocytoma; RET
oncogene
32. MEN2B: PMM- Pheochromocytoma, medullary thyroid carcinoma, mucosal neuromas,
marfanoid habitus
33. McCune Albright syndrome: GNAS mutation; precocious puberty; Q 3 y/o girl, vaginal bleeding,
poly- fibrosis dysplasia, hyperpigmented macules
34. Central precocious puberty:
35. APLA: multiple abortions; anticardiolipin Ab, anti beta glycoprotein antibody; sudden loss of
vision like something is covering their eye; b/l limb swelling; no improvement with mixing
studies
36. PTH therapy for hypoparathyroidism: cAMP^, serum Ca^, serum PO4 dec
37. Hormones:
a. PTH: helical dimer; ^free Ca in blood, ^ Ca2+ and PO4 3– absorption in GI system, ^Ca2+
and PO4 3– from bone resorption, ^Ca2+ reabsorption from DCT, ^PO4 3– reabsorption
in PCT, ^1,25-(OH)2D3 (calcitriol) production by activating 1α-hydroxylase in PCT;
^serum Ca, dec serum PO4, ^urine PO4, ^urine cAMP
b. Insulin: The insulin molecule contains 51 amino acids; it is made up of two
peptide chains linked by disulphide bonds. Although it is active as a
monomer, during its biosynthesis and storage it assembles to dimers and,
in the presence of zinc, to hexamers.; α chain and β chain joined by 2 disulfide bonds
forming a dimer; ^ glucose transport in skeletal muscle and adipose tissue, ^glycogen
synthesis and storage, ^triglyceride synthesis, ^Na+ retention (kidneys), ^protein
synthesis (muscles), ^cellular uptake of K+ and amino acids, dec glucagon release, dec
lipolysis in adipose tissue; The insulin receptor appears as a tetrameric glycoprotein
Renal/Repro:

1. ATN:
a. Granular casts (muddy brown): rhabdomyolysis, CK, deposition of myoglobin
b. Ischemic: secondary to decreased blood flow> death and sloughing of tubular cells; Q
hypovolemia
c. Toxic substances: aminoglycosides (clearance depends upon Cr clearance), lead,
cisplatin, radiocontrast dye, ethylene glycol; post coronary angiography with cast
d. Q homeless, h/o hepatitis, massive hematemesis, clothes dried blood, Hb 6, Cr 3, BP
70/60, urine RBC, pus cells
e. Myoglobinuria
2. Acute Glomerulonephritis: nausea, headache, high BP; Urine- RBC cast, urea 30, Cr 2.5
3. Renal artery stenosis: Elderly man with uncontrolled HTN, abdominal bruit heard on
auscultation; Q angiography shows proximal renal artery narrowing d/t AO renal artery
atherosclerosis; AO fibromuscular dysplasia
4. Q ER with burning vision, confused: methanol- fomepizole
5. Malignant HTN: arteriolar fibrinoid necrosis, intimal damage
6. ACEI: Renin, AT II, Aldo- inc, dec, dec; Cr inc, Na<>, K inc; GFR dec, FF dec, renal flow^; ACE
inhibitors reduce release of norepinephrine from sympathetic nerves by acting on
AT1 receptors at the nerve terminal. Within tissue, ACE inhibitors inhibit Ang II
 production and thus attenuate Ang II-mediated cardiomyocyte hypertrophy and fibroblast
hyperplasia.
7. CKD:
a. Serum: Inc PO4, dec Ca, inc PTHpra
b. Dec Ca due to dec absorption as 1,25 D3 not synthesized
c. High anion gap metabolic acidosis: winters; generation of organic acid
d. Oral phosphate binders inhibit PTH release
e. AS with carotid radiation on auscultation: LV
8. UTI:
a. S saprophyticus: young sexually active female
9. Hydronephrosis: parenchymal atrophy and dilated ureter; Girl with chronic renal insufficiency ->
what is the cause of that insufficiency from the picture -> Vesicoureteral reflux. (NB)
10. Pyelonephritis: tenderness at T12-L1; pain at loin is suggestive of;
11. Nephrolithiasis: pain managed with topiramate, blocks Na channels and agonizes GABA
12. Hyperactive detrusor: unable to void enough at a time, weak stream, old female
13. Aliskiren: direct renin inhibitor; blocks angiotensinogen
14. Alport: col4; can’t see, can’t pee, can’t hear a bee
15. PSGN: Q h/o sore throat 2 weeks ago with present c/o red colored urine; AO immune complex
deposition
16. Overactive detrusor: Q can’t void completely while sitting but voids on standing up; t/t AO
muscarinic antagonist-;
17. RCC: inc renin, EPO, metastasizes from renal vein, bag of worms, VHL disease, angioblastoma of
cerebellum; NB clear cell variant, vessels interspersing in clear cell ocean
18. Horse shoe kidney: inferior pole of both kidneys fused while ascending, trapped below IMA,
higher incidence of aneuploidy; fusion of the metanephric mesenchyme/blastema
19. Double ureter in CT: ureteric bud
20. Anatomical landmark for ureteric stone: posterior to ductus deferens
21. Winter’s: [1.5 × HCO3+ 8] ± 2
22. Kidney arterial: seg-loba-arcuate-lobu-afferent
23. Kidney arrangement: VAP-vein, artery, pelvis (medial to lateral)
24. AIN:
a. eosinophils after penicillin, TMP-SMX
b. Q middle aged male, isoniazid resistant mycobacterial TB, eosinophilia, eosinophiluria,
deranged RFT, fever, chills, rash
c. ^ Cr, pyuria
25. Renal angiography shoes decreased blood flow in segmental arteries of rt kidney; Swelling: Na
can’t be pumped out of cell
26. Renal tubular defects:
a. Liddle syndrome: AD; gain of function mutation NEDD4, collecting tubules inc Na
reabsorption d/t dec channel degradation; metabolic alkalosis, hypokalemia, HTN, dec
aldosterone; t/t amiloride
27. Glomerulus:
a. Diabetic: NB amyloid deposits
28. Nephrogenic DI: lithium>V2 receptors damaged?, not corrected by vasopressin, medullary
collecting duct; causes ADH receptor mutation, Vasopressin(V2) receptor abnormality
29. Potter syndrome: oligohydramnios=> coarse facies, limb defects, lung hypoplasia; NB; AO
deformation
30. ADPKD: polycystin; berry aneurysm assc.; calcium ion transport- polycystin-1 inhibited
calcium leak across the ER membrane, polycystin-1 accelerated the decay of ligand-
activated cytoplasmic calcium transients through enhanced reuptake of calcium into the
endoplasmic reticulum
31. ARPKDL: Autosomal recessive polycystic kidney disease Mutation in PKHD1 encoding fibrocystin.
32. Atheroembolism of kidney: following coronary angiogram develops bluish marks on toes, feeble
pedal pulse and ^Cr
33. Impermeable to water: early DCT, ascending loop of henle
34. Overflow incontinence
35. Instrinsic sphincter defect: Q tip >30; Q female with h/o leaking urine on coughing and carrying
heavy equipment
36. Hexagonal stones: Cysteine stones; decreased tubular reabsorption; Fanconi
37. Familial hypocalciuric hypercalcemia: Ca Sr receptor malfunction
38. Ifosfamide: equires activation by microsomal liver enzymes to active metabolites in
order to exert its cytotoxic effects. Hemorrhagic cystitis due to ifosfamide therapy is
generally worse than that caused by cyclophosphamide. Ifosfamide causes the
release of tumor necrosis factor – alpha and interleukin-1 beta, mediating the
release of nitric oxide and leading to hemorrhagic cystitis. Activation occurs by
hydroxylation at the ring carbon atom 4 to form the unstable intermediate 4-
hydroxyifosfamide; causes hemorrhagic cystitis, mesna added to decrease toxicity
39. Bladder cancer:
a. BCG●Induction of a mononuclear cell infiltrate that consists predominantly of CD4 T
cells and macrophages.
●Increased expression of interferon gamma (IFNg) in the bladder. Expression of IFNg induces
expression of class II major histocompatibility (MHC) molecules on bladder cancer cells,
including HLA-DR and intercellular adhesion molecule (ICAM)-1. IFNg can also increase the
sensitivity of bladder tumor cells to BCG by activating lymphokine-activated killer (LAK) cells and
antigen-presenting cells.
●Elevated urinary cytokine levels, including interleukin (IL)-1, IL-2, IL-6, IL-8, IL-12, IFNg, tumor
necrosis factor (TNF)-alpha, and tumor necrosis factor apoptosis inducing ligand (TRAIL).●Direct
suppression of tumor growth in a dose-dependent fashion [95].

1. Testicular torsion: Prehn -; congenital defect of tunica vaginalis; deep gonadal vein/left renal
vein hampered; orchidopexy or orchidectomy if necrosed
2. Infundibulopelvic ligament torsion: ovarian vein
3. Testes: paraaortic, retroperitoneal, paraspinal
4. Epididymitis/Epididymoorchitis: sexual history; Prehn +; C trachomatis and N gonorrhoeae
(young males), E coli and Pseudomonas (older males, associated with UTI and BPH)
5. Dermoid cyst: gross picture
6. Serous cystadenocarcinoma: psammoma bodies in ovarian mass
7. Physiological gynecomastia: Q 16 y/o boy at tanner stage 4; Pubertal gynecomastia is thought to
be a physiological phenomenon, and is most commonly seen in midpuberty with Tanner stage
3–4 pubic hair and testicular volumes of 5 to 10 mL bilaterally. In a 3-year longitudinal study of
hormonal changes during puberty, study participants with and without gynecomastia were
compared.
8. Uneven testes-5cm disparity: abnormal seminiferous tubule number
9. Paracentric inversion: recurrent abortions; inc abortion, dec aneuploidy
10. Seminoma: U/L painless, swelling; transillumination -, fried egg histo; increased seminiferous
tubule number; PLAP+; large cells with clear cytoplasm, distinct borders, squared off nuclei,
prominent nucleoli
11. Patent urachus, urine from umbilicus
12. Uterine didelphys: complete failure of fusion of Mullerian duct, ass. W vaginal septum
13. Hypospadias: failure of urethral fold to fuse, ventral opening
14. Epispadias: genital tubercle defect, dorsal opening
15. Peyroni: defect in tunica albuginea
16. Bifid scrotum: labioscrotal fold; Bifid scrotum is usually associated with scrotal and perineal
hypospadias. The penoscrotal transposition in these cases may be partial or complete. In
the incomplete or partial type, which is less severe but more common than the complete
type, the penis lies in the middle of the scrotum.
17. Leiomyosarcoma: post menopausal
18. Leiomyoma: t/t dec steroid synthesis- leuprolide; also in endometriosis
19. Breast Ca: IHC immunoperoxide stain; Trastuzumab- targets EGF RTK Her 2, nuclear receptor; Q
estrogen receptor +, progesterone receptor +; cytokeratin +
20. Breast metastasis: loss of cadherin
21. Mucinous adenocarcinoma: Pseudomyxoma peritonei: signet ring histo
22. Secretory phase: secretory endometrium with tortuous vessels
23. Complete hydatidirom mole: no fetus, paternal duplicated, NB grapes
24. Sarcoma botryoides: embryonal rhabdomyosarcoma, grapelike vesicles through vagina; IHC
desmin +, contains sarcomere
25. AIS (Androgen insensitivity syndrome): abnormal androgen receptor (nuclear receptor); Q
Female external genitalia, normal breasts, b/l inguinal testes, 14-15 years
26. Estrogen: Smooth muscle proliferation in pregnancy; Estrogen has a well-known indirect
effect on thyroid economy, increasing the thyroxine binding globulin
27. Menopause: inc FSH, dec estrogen, inc LH
28. Placenta previa: painless PV bleed
29. Abruptio placenta: painful PV bleed
30. Lymphatics: Ovaries/testes/fundus of uterus - para-aortic lymph nodes. Body of
uterus/cervix/superior part of bladder - external iliac nodes. Prostate/cervix/corpus
cavernosum/proximal vagina/inferior part of bladder - internal iliac nodes. Distal
vagina/vulva/scrotum/distal anus - superficial inguinal nodes. Clitoris/glans penis - deep inguinal
nodes
31. Prostate ca: site-peripheral zone; lumbosacral mets, osteoblastic ca, sclerotic; BPH nodular, Ca..
indurated, Prostatitis…Boggy, tender
32. Conjoined twins: monochorionic monoamniotic
33. Leydig cell tumor (sex cord stromal): releases testosterone in post menopausal woman=>
masculinization/virilization
34. Granulosa cell: estrogen
35. PCOS: ^LH/FSH ratio=> dec FSH, ^androgens, dec rate of follicular maturation
36. Fibroadenoma: MC benign tumor of breasts; Fibroadenomas grow up to 2-3 cm and then
stop growing but phyllodes tumors grow continually and sometimes are to 40 cm
big. Both these lesions have two components, epithelial and stromal. Clinically
fibroadenomas are well circumscibed, hard, oval, movable lesions.
37. Phyllode: post-menopausal, originates from breast stroma
38. BPH: MC-transitional zone; increased bowmans capsule hydrostatic pressure; diffusely enlarged
and rubbery
39. Serous carcinoma: psammoma bodies
40. Endometrial cyst:
41. Vaginal steaming: herbal steaming procedure; lactobacillus content to be check before and after
procedure to get the best results
42. Ascending infection: primigravida at 27 wog, uterine contraction every 10 mins lasting 20s
43. Post pregnancy decrease in breast size: apoptosis, dec BCL2 expression
44. Q laparoscopy for endometriosis, pain=> substance P
45. Qtip >30` d/t weak pelvic support
46. Disparity in testes size: seminiferous tubule defect/abnormality
47. Estrogen in postmenopausal woman: Transdermally administered 17β-estradiol has no
effect on lipoprotein levels, suggesting that the hepatic effects of estrogen absorbed
through the gut are important for changes in lipoprotein levels.17 The reduction in LDL
cholesterol levels is probably a result of accelerated conversion of hepatic cholesterol to
bile acids19 and increased expression of LDL receptors on cell surfaces,20 resulting in
augmented clearance of LDL from the plasma.
48. Postpartum hypothyroidism: This typically occurs 4-8 months after delivery and may last
up to 9 –12 months. Typical symptoms include fatigue, weight gain, constipation, dry
skin, depression and poor exercise tolerance. Most women will regain normal thyroid
function within 12-18 months after the onset of symptoms
49. Q Young female found unconscious in room brought to ER by friend, extremely low BP,
PV bleeding, AO- ruptured tubo-ovarian abscess if UPT -ve, AO-ruptured ectopic
pregnancy if UPT +ve, with intraperitoneal fluid accumulation
GI:

1. Acute appendicitis: gross? photo with neutrophilic infiltration of muscularis layer; red,
edematous- histamine; only swollen- leukotriene
2. Abdominal surgery shows ischemic segment, cause of acidosis is lactic acidosis due to ischemia
3. Multiple abdominal surgery: tissue growth in intestine> adhesions
4. h/o peptic ulcer, ^basal gastric acid secretion, gastrin <>, Idiopathic hyperchlorhydria
5. Gastrin increases stomach acid through histamine>direct stimulation of chief cell
6. Secretin administered in pancreatic insufficiency: no release of HCO3
7. Gas under diaphragm: peptic ulcer perforates anterior>posterior
8. Meckel diverticulum: defect of vitelline duct/yolk sac stalk/omphalomesenteric duct (doesn’t
obliterate completely), true diverticulum with all layers of intestine, may have heterotopic
gastric/pancreatic tissue; : 99mTc-pertechnetate scan (also called Meckel scan) for uptake by
heterotopic gastric mucosa
9. TIPS (transjugular intrahepatic portosystemic shunt): hepatic vein to portal vein>IVC to portal
vein>
10. TEFistula commonly presents with polyhydramnios as fetus is unable to swallow amniotic fluid;
defect in separation of lung bud and esophagus; AO pleuroperitoneal defect
11. Dysphagia and GERD MC d/t reflux; Q acid level not suppressed despite treatment d/t dec
somatostatin activity
12. Chronic pancreatitis symptoms d/t lipase: fat saponification; peripancreatic fat necrosis
13. Pancreatitis: b/l diffuse infiltration in lung d/t inc capillary permeability
14. Acute pancreatitis: fat necrosis, liquefactive necrosis
15. Pancreatic pseudocyst: Following multiple bouts of pancreatitis; Q mass in abdomen following
many episodes of pancreatitis
16. Ulcerative colitis:
a. Infliximab= TNF alpha antibody; film director with bloody diarrhea under stress Q
b. Sloughing of mucosa, no granuloma
17. Intussusception: 2 y/o stool with streaks of blood, crying; d/t IgA vasculitis, target sign on
USG/CT; MCC of obstruction in children
18. Volvulus: coffee bean sign on X-ray; rotation of sigmoid colon around its mesentery; MCC
obstruction in adults
19. Diverticulosis: false diverticulum, MCC of PR bleeding in elderly, painless; elderly, bright red
bleed resected colon with multiple diver; Q Recurrent constipation, bisacodyl, lactulose, CT-
perforated of sigmoid diverticula
20. Alcoholic CHD: esophageal varices, caput medusa, hemorrhoids, telangiectasia, hairfall in males
(estrogen effect)
21. Hemochromatosis: AR, HFE mutation, low hepcidin=> increased intestinal absorption,
sequesters iron in RES; classic triad cirrhosis, diabetes mellitus, skin bronze; cardiomyopathy
22. Cirrhosis: with splenomegaly=> red pulp congestion
23. Choledocholithiasis: RUQ pain referred to right shoulder d/t phrenic nerve; increased
cholesterol to bile acid ratio
24. Post chemotherapy vomiting: DOC: <24 hours- 5HT3 antagonist (Ondansetron, granisetron), >24
hours- NK1 antagonist (Aprepitant, fosaprepitant)
25. Sea sickness or vomiting while travelling: scopolamine, anticholinergic
26. Esophageal hiatus during endoscopy T10
27. Colon adenocarcinoma: exophytic mass, 4 cm, p53; Q IDA, near cecum
28. Celiac disease: lymphocytes; villous atrophy, crypt hyperplasia, intraepithelial lymphocytosis; Q
flatulence and steatorrhea; dermatitis herpetiformis: IgA in dermal papillae; anti
transglutaminase +/-; AO IgA deficiency (If someone has IgA deficiency and celiac disease,
the IgA deficiency can cause a false negative on a celiac disease antibody test.)
29. Vitamin D inc Ca absorption from gut
30. GI blood supply:
a. Celiac: PSNS-vagus; T12-L1; pharynx to proximal duodenum, liver, GB, pancreas, spleen
b. SMA: vagus; L1; distal duodenum to proximal 2/3 of transverse colon
c. IMA: pelvic; L3; distal ½ transverse colon to upper anal canal
31. Spleen: mesenchyme derivative, accessory spleen
32. Carcinoma below pectinate line metastasize via superior inguinal
33. cholecystectomy: tie cystic duct and CBD
34. Acute cholangitis: stone in CBD
35. Biliary atresia: increased conjugated bilirubin, hepatomegaly, dark green liver; Q 3 m/o with
yellowish discoloration and hepatomegaly
36. Sliding hernia: Q Endoscopy done, histo shows abundant neutrophils, eosinophils and
lymphocytes
37. Vitamin C is required for iron absorption; Q celiac disease patient requiring iron
supplementation
38. Physiological jaundice: decreased glucuronidation, dec UDP glucuronyl transferase
39. Duodenal atresia: double bubble sign, recanalization failure; Duodenal atresia has long been
associated with the antenatal “double bubble” sign on ultrasound. This
appearance results from a distended stomach and duodenal bulb that are
separated by a hypoechoic gastric antrum.
40. Acute mesenteric ischemia: not associated with food (unlike chronic, low perfusion), embolism
of mesenteric artery
41. CHPS NBME: olive like mass in the epigastric region
42. GIST: posterior wall of stomach and there was CD117 + , ckit gene and cd34+
43. Oral leukoplakia: EGFR mutation, painless, doesn’t bleed, Q white patch on inside of lip/rim of
tongue
44. Adenomatous polyp: NB solitary red lesion in the rugose lumen
45. Villous polyp: Qpedunculated polyp with frond like projections were seen on descending colon
on colonoscopy
46. Gastrinoma: Zollinger Ellison syndrome- esophageal webs, duodenal peptic ulcer, gastrinoma;
hypersegmented neutrophils, autoimmunity against parietal cells; NB- head of pancreas
resected; associated with celiac ganglion
47. Kernicterus: NB yellowish atrophied cortices
48. Diabetic gastroparesis: Erythromycin; dopamine antagonist metoclo
49. Acute Cholangitis: pain RUQ, yellowish discoloration, fever and chills, cachexia, counts raised,
LFT deranged
50. HCC: HBV risk, USG/CT/MRI but confirm with biopsy, aflatoxin causes
51. Tip of tongue is drained by submental LNs
52. Gi resection with loss of enterohepatic circulation> less cholesterol> ^^HmGCoA reductase;
Q50% abdominal resection following gunshot
53. Q Ileal resection present with dry skin, itchy eyes, flatulence, rash=> vitamin A def; antoher Q
AO decreased HmG CoA reductase increased activity
54. Grapefruit juice is a potent inhibitor of CYP3A4-mediated drug metabolism.
55. Crohn: fissure, transmural lesion, skip lesions; calcium oxalate stone
56. Parotid resected, taste sensation lost in ant 2/3rd of tongue and decreased salivary secretion:
Chorda tympani
57. Abdominal trauma: falciform ligament is injured
58. Polyarteritis nodosa: pain, bloody diarrhea, necrotizing vasculitis; HBV; beads on a string
appearance
Statistics:

1. ITT(intention to treat) principle aims to preserve the original randomization and to avoid
potential bias due to exclusion of patients, the aim of a per-protocol (PP) analysis is
to identify a treatment effect which would occur under optimal conditions
2. Kaplan Meyer curve
3. Cumulative incidence
4. Lineweaver burk plot
5. Skewed diagrams: - least affected by outlier= median is best
a. Right skewed: positive; mean>median>mode
b. Left skewed: negative; mode>median>mean
6. Prevalence in relation to PPV and NPV
7. Bias:
a. Selection bias
b. Observer bias: Pygmalion/rosenthal effect
c. Referral bias is a type of selection bias. People who are referred into studies are
frequently different from those who are not, meaning that the results of a trial may not
generalize well to the general population
8. Bradford Hill criteria: strength, consistency, specificity, temporality, bio
9. Most accurate test
10. Hardy Weinberg
11. Prevention
12. ROC
13. Logistic regression: correlation best test
14. Pearson correlation coefficient
15. Decreased type II error: ^ power and dec β by: ^sample size, ^ expected effect size, ^ precision
of measurement
16. Whisker plot
17. Type I error: Q decrease by adding yoghurt
18. Stratification, matching, randomization
19. Anova, t-test, fischer, chi square
20. Power=1-beta; alpha=1-CI
21. Population pyramid
22. Accuracy vs precision
23. Cohort: Exposure vs no exposure; Relative risk
a. Retrospective
 b. Prospective
24. Case control: Retrospectively compares group with and without disease for exposure; Odds ratio
25. Case series
26. Cross-sectional
27. A correlational research design investigates relationships between two variables (or more)
without the researcher controlling or manipulating any of them. It's a non-experimental type of
quantitative research.
28. Information bias is any systematic difference from the truth that arises in the collection, recall,
recording and handling of information in a study
29. Publication bias is defined as the failure to publish the results of a study on the basis of the
direction or strength of the study finding
30. ARR: risk in receiving – not receiving
65y/o female with h/o smoking for past 35 years, also k/c/o COPD and under treatment with LAMA and
steroids. She is physically inactive and obese. She is taking LMWH for her inactivity. She develops
shortness of breath, tachycardia and labs show d-dimer of 900,000 ng/mL. What is the cause of above
finding?

a. Antithrombin III
b. Steroid use
c. Inactivity
d. Obesity
e. Smoking

A patient with h/o intermittent blood in urine. Cystoscopy done and biopsy of the tissue shows: normal
size nucleolus and normal N:C ratio. What is happening?

A. Anaplasia
B. Dysplasia
C. Metaplasia
D. Neoplsia

A middle aged skier comes to you

What symptom warrants further investigation and intervention?

For hospital admitted patients, a double blinded clinical trial is about to be conducted, what should a
researcher do to get approved from IRB?

A Should inform nursing staff about the trial

B Should inform treating physician about the trial

C Should inform hospital administration about the trial

D Should inform parent and patient about the trial

Frontal eye field

Left: check gbob last few pages; Loeffler 20, 110, 112, 124; sapporo

hiv wala flow cytometry

diabetes drugs

tor

medzcool: pericardial rub

immune disorder: scid, chediak

cervical sinus cyst

lymph node drainage

released from pituitary and hypothalamus

post MI

peutz jeg

arr

582- creatinine clearance graph

298

Histone acetylation of lysine

MRRGF CLB29B7434