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Pass Program Clues

“You ain’t told me squat till you
tell me the CLUE!!!”
What are the 5 bacteria causing
Heart Block?
• Lyme Disease
• Salmonella typhii (typhoid)
• Chagas Disease (Whipple’s)
• Legionella
• Diptheria

• Lets Stop Doing Long Contractions
What bacteria cause Reiter’s
Syndrome?
• Shigella
• IBD
– Crohn’s
• Chlamydia
• Yersina

• Reiter & Crohn Saw Yersina and got
Chlamyia
What are the Low Complement
bugs causing Cryoglobuniemia?
• Influenzae
• Adenovirus
• Mycoplasma
• Hepatitis C
• EBV

• I AM HE
What are the drugs induced
SLE?
• Hydralazine
• INH
• Phenytoin
• Procainamide
• Penicillamine
• Ethosuximide

• H I PPPE
What are the drugs that Blast
the BM?
• AZT
• Benzene
• Chloramphenicol
• Vinblastine

• Vinblastine Anilate Bone Cells
What are the Comma Shaped
bugs?
• Vibrio
• Campylobacter
• Listeria
• H. pylori

• Campylobacter Has Very Long Comma
Genes
What is the cresent shaped
protozoa?
• Giardia lamblia
What bacteria looks like Chinese
letters?
• Corynebacter
What are the TB Rx?
• Rifampin
• Pyrazinamide
• INH
• Ethambutanol
• Streptomycin

• R E S P I
What are the 6 Low Complement
assocs. with Nephrotic Syndrome?
• Serum Sickness
• PSGN
• SLE
• SBE
• Cryoglobinemia
• MPGN II

What drugs Induce p450?
• BAG 4 CPR QTS
• Car Grabs Queens Tets to
Rev Up
• Alcoholic doing drugs and
stinking up car
• Barbiturates
• Alcohol
• Griseofulvin
• Carbamazapine
• Rifampin
• Quinidine
• Tetracycline
• Sulfa drugs

What drugs Inhibit p450?
• I Do SMACK
Quinolones
• INH
• Dapsone
• Spirolactones
• Macrolides
• Amiodarone
• Cimetidine
• Ketoconazole
• Quinilones
What drugs are P450
Dependent?
• Warfarin
• Estrogen
• Phenytoin
• Theophylline
• Digoxin

• Theo came from war & dig inside WDEPT taking
Estrogen & now is Phenytoin
What disease is a Neutophil
Deficiency?
• CGD

What is another name for CGD?
• Chronic Granulomatous disease
• NADPH Oxidase deficiency
What are the Side effects of
Statins?
• Myositis
• Hepatitis
• Increased liver enzymes
What are the painful genital
Lesions?
• Chancroid
• Herpes
• Lymphogranuloma inguinale
What is the painful chancroid
lesion due to?
• Hemophilus ducreyi
What are the 4 hormones with
disulfide bonds?
• Prolactin
• Insulin
• Inhibin
• GH

• I PIG on BONDS
What are the Hookworms?
• Necatur americanis
• Enterobius vermicularis
• Ankylostoma duodenale
• Trichuris trichurium
• Ascaris lumbercoides
• Strongyloides

• Hooks AS NEAT
What are the X-Linked enzyme
Deficiencies?
• G6-PD
• CGD
• Pyruvate dehydrogenase Def.
• Fabry’s
• Hunter’s
• Lesch-nyhan
• Lesch-Nyhan Hunter Puts Fabrys on G6 Clothes


What diseases do we screen for
at birth?
• Please
• Check
• Before
• Going
• Home
• PKU
• CAH(Congential
Adrenal Hyperplasia)
• Biotinidase
• Galactosemia
• Hypothyroidism
HLA-Antigens
• HLA-DR2= Narcolepsy, Allergy, Goodpasture’s,
MS
• HLA-DR3= DM, Chronic Active Hepatitis,
Sjogren’s, SLE, Celiac Sprue
• HLA-DR3 & 4= IDDM(Type I)
• HLA-DR4= Rheumatoid Arthritis, Pemphigus
Vulgaris
• HLA-DR5= JRA, Pernicious Anemia
• HLA-DR7= Nephrotic Syndrome(Steroid induced)

HLA-Antigens
• HLA-DR 3 & B8=Celiac Disease
• HLA-A3= Hemochromatosis(chromo. 6, point
mut.-cysteine>tyrosine)
• HLA-B8=MG
• HLA-B13= Psoriasis
• HLA-B27= Psoriais(only if w/arthritis) Ankylosing
Spondylitis, IBD, Reiter’s, Postgonococcal
Arthritis
• HLA-BW 47= 21 alpha Hydroxylas def.(Vit.D)

What are the actions of
Steroids?
• Kills helper T-cells & eosinophils
• Inhibits Macrophage migration
• Inhibits Mast cell degranulation
• Inhibits Phospholipase A
• Stimulates protein synthesis
• Stablizes endothelium
What are the causes of
Monocytosis?
• Salmonella (typhoid)
• TB
• EBV
• Listeria
• Syphillis
E. Coli is the most common
cause of what?
• UTI
• Spontaneous bacterial peritonitis
• Abdominal abscess
• Cholecystitis
• Ascending cholangitis
• Appendicitis

What are the one dose treatments
for Gonorrhea?
• Ceftriaxone
• Cefixime
• Cefoxine
• Ciprofloxin
• Oflaxacin
• Gatifolxacin
What is the one dose treatment for
Chlamydia?
• Azithromycin
What are the “Big Mama”
anaerobes?
• Strep bovis
• Clostridium melanogosepticus
• Bacteriodes fragilis
What are the “Big Mama” Rx?
• Clindamycin
• Metranidazole
• Cefoxitin
What “big mama” bugs are
associated with colon cancer?
• Strep. Bovis
• Clostridium melanogosepticus
What do you see in the serum with
low volume state?
• K+?
• Decreases

• Na+?
• Decreases

• Cl-?
• Decreases

• pH?
• Increases

• BP?
• Increases




What are psammoma bodies?
• Calcified CA’s
In what diseases are Psammoa
Bodies present?
• Papillary carcinoma of the Thyroid
• Serous cystadenocarcinoma of the ovary
• Meningioma
• Mesothelioma
What are the Urease (+)
Bacteria?
• Proteus
• Pseudomonas
• Ureaplasma urealyticum
• Nocardia species
• Cryptococcus neoformans
• H. pylori

What types of stones are
formed from Proteus?
• Struvite (90%)
What type of motility do Proteus
have?
• swarming
What are 5 indications of
Surgery?
• Intractable pain
• Hemorrhage (massive)
• Obstruction (from scarring)
• Perforation
What drugs cause Cardiac
Fibrosis?
• Adriamycin (Doxyrubicin)
• Phen-fen
What drug is used to tx cardiac
fibrosis?
• Dozaroxsin
What is the MCC of any
….penia?
• #1 = Virus
• #2 = Drugs

What is seen in the Salmonella
Triad?
• High Fever
• Rose spots (rash)
• Intestinal fire
What drugs cause Myositis?
• Rifampin
• INH
• Predinsone
• Statins

What are the 7 Gram -
encapsulated bacteria?
• Some
• Strange
• Killers
• Have
• Pretty
• Nice
• Capsules
• Salmonella
• Strep. Pneumo (gr+)
• Klebsiella
• H. influenza
• Pseudomonas
• Neisseria
• Cryptococcus
What is the Jones Criteria for
Rheumatic Fever?
• SubQ nodules
• Polyarthritis
• Erythema marginatum
• Carditis
• Chorea
What are the causes of
Eosinophilla?
• Neoplasms
• Allergies/Asthma
• Addison’s Dz
• Collagen Vascular Dz
• Parasites
What are the Risk Factors for
Liver CA?
• Hep B,C,D
• Aflatoxin
• Vinyl chloride
• Ethanol
• Carbon Tetrachloride
• Anyline Dyes
• Smoking
• Hemochromatosis
• Benzene
• Schistomiasis



What are the 9 Live Vaccines?
• Measles
• Mumps
• Rubella
• Oral Polio (sabin)
• Rotavirus
• Small pox
• BCG
• Yellow fever
• Varicella


What are the Killed Vaccines?
• SIR Hep A • Salk (polio)
• Influenza
• Rubella
• Hepatitis A
What are the IgA
Nephropathies?
• Henoch-Schoenlein P. (HSP)
• Alport’s
• Berger’s
What are the Drugs that cause
Autoimmune hemolytic anemia?
• PCN
• α-methyldopa
• Cephalosporins
• Sulfa
• PTU
• Anti-malarials
• Dapsone
What are the drugs that cause
Autoimmune thrombocytopenia?
• ASA
• Heparin
• Quinidine
What are the enzymes that show
after an MI?
• Troponin I
• CKMB
• LDH
What is the first MI enzyme to
appear?
• Troponin I
• Appears
• Peaks
• Gone

• 2 hrs
• 2 days
• 7 days
What is the 2
nd
MI enzyme to
appear?
• CK-MB
• Appears
• Peaks
• Gone


• 6 hrs
• 12 hrs
• 24 hrs
What is the 3
rd
MI enzyme to
appear?
• LDH
• Appears
• Peaks
• Gone


• 1 day
• 2 days
• 3 days
What bacteria have Silver Stains?
• Legionella
• Pneumocysitis carinii
• H. pylori
• Bartonella henseslae (lymph node)
• Candida (yeast)
What are the sulfa containing
drugs?
• Sulfonamides
• Sulfonylurea
• Celebrex
What is another name for celebrex?
• Celecoxib
What type of inhibitor is Celebrex?
• COX 2 specific
What COX-2 specific drug can you
give to a pt with sulfa allergy?
• Vioxx (Rofecoxib)
What drugs inhibit dihydrofolate
reductase?
• Pyremethamin/Sulfadiazine
• Trimethoprim/Sulfamethoxazole
What drugs cause Pulmonary
Fibrosis?
• Bleomycin
• Bulsufan
• Amiodarone
• Tocainide
What are the macrophage
deficiency diseases?
• Chediak-Higashi
• NADPH-oxidase deficiency
What are the SE of Loops and
Thiazides?
• Hyperglycemia
• Hyperuricemia
• Hypovolemia
• Hypokalemia
What are the SE of Loop diuretics?
• OH DANG • Ototoxicity
• Hypokalemia
• Dehydration
• Allergy
• Nephritis (interstitial)
• Gout
What are the only 3 Pansystolic
Murmurs and when are they heard?
• MR

• TR

• VSD
• Decrease on
inspiration (^exp)
• Increase on
inspiration
• Decrease on
inspiration (^exp)
Macrophages in various organs
• Brain
• Lung
• Liver
• Spleen
• Kidney
• Lymph nodes
• Skin
• Bone
• CT
• Mircoglia
• Type I pneumocyte
• Kupffer cell
• RES
• Mesangial
• Dendritic
• Langerhans
• Osteoclasts
• Histiocytes or
• Giant cells or
• Epithelioid cells
What are the 7 Rashes of the
Palms & Soles?
• TSS
• Rocky Mountain Spotted Fever
• Coxsackie A (Hand/Foot & mouth dz)
• Kawasaki
• Syphillis
• Scarlet Fever
• Staph Scalded Skin Syndrome
What is seen in every restrictive
lung dz and low volume state?
• Tachypnea
• Decrease pCO2
• Decrease pO2
• Increase pH
What are the different 2
nd

messenger systems?
• cAMP
• cGMP
• IP3/DAG
• Ca:Calmodulin
• Ca+
• Tyrosine kinase
• NO
What is the clue for cAMP?
• It is the 90%
• Sympathetic
• CRH (cortisol)
• Catabolic
What is the clue for cGMP?
• Parasympathetic
• Anabolic

What are the clues for IP3/DAG?
• Neurotransmitter
• GHRH
• All hypothalamic hormones xc cortisol
• Used by what and for what?
• Smooth muscle for contraction
What is the clue for Ca:Calmodulin?
• Used by smooth muscle for contraction by
distention
What is the clue for Ca+?
• Used by Gastrin only
What is the clue for Tyrosine
Kinase?
• Used by Insulins
• Used by ALL growth factors
What is the clue for NO?
• Nitrates
• Viagra
• ANP
• LPS
What are the T & B cell deficiencies?
• WAS
• SCID
• CVID
• HIV
• HTLV-1
What are the CLUES for WAS?
• Thrombocytopenia
• IL-4
• Infection
• Eczema
• Decrease IgM
• IgE???
What are the CLUES for SCID?
• Framshift/Nonsense mutation
• Adenosine deaminase deficiency
• T-cell>B-cell
• Bacterial infections
• Fungal infections
What are the CLUES for CVID?
• Late onset
• Frameshift/Missense mutation
• Tyrosine Kinase deficiency
What are the CLUES for HIV &
HTLV-1?
• T-cell>B-cell
• CD4 rich
• Brain
• Testicles
• Cervix
• Blood vessels
What are the inhibitors of Complex
1 of the ETC?
• Amytal
• Rotenone
What are the inhibitors of Complex
2 of the ETC?
• Malonate
What are the inhibitors of Complex
3 of the ETC?
• Antimycin D
What are the inhibitors of Complex
4 of the ETC?
• CN-
• CO
• Chloramphenicol
What are the inhibitors of Complex
5 of the ETC?
• Oligomycin
What are the ETC chemical
uncouplers?
• DNP
• Free Fatty acids
• Aspirin
What type of uncoupler is Aspirin?
• Physical uncoupler
What are the 4 sources of Renal
Acid?
• Plasma
• Urea cycle
• Collecting ducts
• Glutaminase

What is the one dose tx for
Hemophilus ducreyi?
• Azithromycin
1 gram po
• Ceftriazone
250 mg im
What is the one dose tx for
Chlaymdia?
• Azithromycin
1 gram po
What is the one dose tx for
Candidiasis?
• Ketoconazole
150mg
What is the one dose tx for Vaginal
Candidiasis?
• Difluccan
1 pill
What is the one dose tx for
Trichomonas?
• Metronidazole
2 grams
What is the one dose tx for
Gardnerella?
• Metronidazole
2 grams
What are the 3 cephalosporins & doses
used as one dose treatments for
Gonorrhea?
• Ceftriaxone
250 mg im
• Cefixime
400 mg po
• Cefoxitin
400 mg po
What are the 3 Quinolones & doses
used as one dose treatments for
Gonorrhea?
• Ciprofloxacin
500 mg po
• Ofloxacin
400 mg po
• Gatifloxacin
400 mg im
What are the 4 enzymes needed to
break down glycogen?
• Phosphorylase (Pi)
• Debranching enzyme
• Alpha-1,6 –Glucosidase
• Phosphatase
What are the 2 enzymes needed to
make glycogen?
• Glycogen synthase
• Branching enzyme

What are the branching enzymes?
• Glycogen alpha-1,4 glycosyl transferase
• Glycogen alpha-1,6 glycosyl transferase
What is the rate limiting enzyme in
the break down of glycogen?
• Phosphorylase (Pi)
What values do you see in
obstructive pulmonary dz?
• pO2?
Normal
• pCO2?
Normal or increased
• pH?
Decreased
What values do you see in
restrictive pulmonary dz?
• pO2?
Decreased
• pCO2?
Decreased
• pH?
Increased
What type of acidosis do you see
with obstructive pulmonary dz?
• Respiratory acidosis
What are the Lysosomal Storage
Disease & what is the deficiency?
• Fabry’s
• Krabbe’s
• Gaucher’s
• Niemann – Pick
• Tay-Sachs
• Metachromatic
leukodystrophy
• Hurler’s
• Hunter’s
• α – galactosidase
• Galactosylceramide
• β – glucocerebrosidase
• Sphingomyelinase
• Hexosaminidase
• Arylsulfatase
• α – L – iduronidase
• Iduronidase sulfatase
What dz’s are associated with HLA
B27?
• Psoriasis
• Ankylosing spondylitis
• IBD (Ulcerative colitis)
• Reiter’s Syndrome
What HLA is Psorisis w/RA
associated with?
• HLA-13
What are the Glycogen Storage
Diseases & the deficiency?
• Von Gierke’s

• Pompe’s

• Cori’s

• McArdle’s
• Glucose – 6 – phosphate


• α – 1 – 4 glucosidase

• Debranching enzyme


• Glycogen phosphorylase
What are 6 places of the TCA cycle where
amino acids feed in/out?
• Pyruvate?
• Glycine
• Alanine
• Serine

• Acetyl CoA ?
• Phenylalanine
• Isoleucine
• Threonine
• Tryptophan
• Lysine
• Leucine
What are 6 places of the TCA cycle where
amino acids feed in/out?
• Alpha-KG ?
• Glutamate
• Glutamine

• Succinyl CoA?
• Phenylalanine
• Tryptophan
• Tyrosine

What are 6 places of the TCA cycle where
amino acids feed in/out?
• Fumerate ?
• Proline

• Oxaloacetate?
• Aspartate
• Asparigine
What are the 4 steps of B-
oxidation?

• Oxidation – 7 NADH – 21 ATP
• Hydration
• Oxidation - 7FADH – 14 ATP
• Thiolysis – 8 AcCoA – 96ATP
131 ATP – 2 (to bring it
in)

What are the blood gases in
neuromuscular disease (= restrictive
blood gases)?
• pO2?
Decreased
• pCO2?
Decreased
• PCWP?
Decreased (b/c it’s a pressure problem)
• Respiratory Rate?
Increased
• pH?
Increased
• SZ?
Increased
What are 5 Hormones produced by
small cell (oat cell) lung CA?
• ACTH
• ADH
• PTH
• TSH
• ANP
What Autoimmune Disease has the
following Autoimmune Antibodies?

•Anti-smith
•Anti cardiolipin
•Anti-ds DNA

•SLE
What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti – histone?

• Drug induced SLE
What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-topoisomerase?

• PSS (Progressive Systemic Sclerosis)

What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti TSH receptors?

• Graves
What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-centromere?

• CREST


What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-GBM?

• Goodpasture’s
What does Goodpastures have
antibody to?
• Type IV collagen
What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-mitochondria?

• Primary biliary cirrhosis
What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-hair follicle?

• Alopecia areata
What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-IgG?

• Rheumatoid arthritis
What Autoimmune Disease has the
following Autoimmune Antibodies?

• Anti-myelin receptors?

• MS

What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-gliaden?
• Anti-gluten?

• Celiac sprue

What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-islet cell receptor?

• DM Type I

What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-melanocyte?

• Viteligo

What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-ACh receptor?

• MG

What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-ribonuclear protein?

• Mixed Connective Tissue dz (MCTD)

What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-parietal cell receptor?

• Pernicious anemia

What does Pernicious Anemia have
antibody to?
• Intrinsic factor
What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-epidermal anchoring protein
receptors?

• Pemphigus vulgaris
What does Pemphigus vulgaris
have antibody to?
• Intercelluar junctions of epidermal cells
What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-epidermal basement membrane
protein?

• Bullous pemphigoid
What do you see with bullous
pemphigoid?
• IgG sub-epidermal blisters
• Oral blisters

What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-platelet?

• ITP

What does ITP have antibody to?
• Glycoprotein IIb/IIIa


What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-thyroglobulin?
• Anti-microsomal?

• Hashimoto’s

What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-smooth muscle?
• Anti-scl-70?

• Scleroderma

What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-rho (SS-A)?
• Anti-la?

• Sjogren’s

What Autoimmune Disease has the
following Autoimmune Antibodies?
• Anti-proteinase?
• C-ANCA?

• Wegener’s

What Autoimmune Disease has the
following Autoimmune Antibodies?
• P-ANCA?

• Polyarteritis nodosa
What antigen & immunoglobulin is
Polyarteritis nodosa associated
with?
•Hepatitis B antigen
•IgM

What are the viruses that directly cause
CA and which CA do they cause?
• Papilloma virus?
Cervical CA
• EBV?
Burkitts
Nasopharyngeal CA
• HepB & C?
Liver CA
• HIV?
Kaposi’s Sarcoma
What are the 7 Nephrotic Patterns seen
with every Vasculitis?
• Clot in front of renal artery?
Renal artery stenosis
• Clot off whole renal artery?
Renal failure
• Inflamed glomeruli?
Glumerulo nephritis
• Clot in papilla?
Papillary necrosis
• Clot off medulla?
Interstitial nephritis
• Clot off pieces of nephron?
Focal segmental GN (HIV, drug use association)
• Clot off lots of nephrons?
Rapidly Progressive GN
What is the most common
nephrotic disease seen in kids and
when does it occur?
• Min. change disease

• 2 wks post URI

What is the most common
vasculitity leading to rapidly
progressive glomerulonephrosis?

• Goodpasture’s

What is the most common
malignant renal tumor in children?
• Wilm’s tumor
What is the most common
malignant renal tumor in adults?
• Adenocarcinoma
What is the most common renal
mass?
• Cyst
What is the most common renal
disease in Blacks/Hispanics?
• Focal Segmental GN
What is the most common
nephrotic disease in adults?
• Membranous GN
Thrombolytics & Inhibitors
• What does tPA, Streptokinase, Urokinase
inhibit?
• Aminocaproic acid
• What doe Warfarin inhibit?
• Vitamin K
• What does Heparin inhibit?
• Protamine Sulfate

What is the dosage of tPA?
• IV push?
• 20mg

• Drip?
• 40mg
What is the dosage for
Streptokinase?
• IV push?
• 750K

• Drip?
• 750K
What is Urokinase used for?
• Used ONLY for such things as:
• Feeding tubes
• Central lines
• Fistulas
What is Alopecia Areata?
• Loss of a patch of hair
What is Alopecia Totalis?
• Loss of ALL hair on head “bald”
What is Alopecia Universalis?
• Loss of hair on entire body “hairless”
What is Loffler syndrome?
• Pneumonitis with endocarditis =
pulmonary infiltrate with severe
eosinophilia

What is Loffler syndrome also
known as?
• PIE syndrome
What are the 5 Parasites associated
with Loffler Syndrome?
• Necator americanus
• Ankylostoma duodenale
• Shistosomiasis
• Strongyloides
• Ascaris lumbricoides
What happens when a patient is on
prednisone for > 7 days?

•Immunocompromised
What are 2 enzymes used by B12?
• Homocystine methyl transferase
• Methyl malonyl-coA mutase
What does Mitochondrial
inheritance mean?
• No male transmission
• All females pass it on
Who are 4 pt’s who would be
susceptable to pseudomonas and
staph infxns?
• Burn patients
• Cystic fibrosis
• DM
• Neutropenic patients
In a neutropenic patient, what do
you cover for?
• cover 1x for Staph aureus during 1st week
• cover 2x for Pseudo after 2nd week

What are the 3 main concepts
causing a widened S2 splitting?
• Increased pO2
• Delayed opening/closing of the pulmonary
value
• Increased volume in the right ventricle
What are causes for a widened
S2 splitting?

• Blood transfusion
• Increased Tidal Volume
• Giving O2
• Right sided heart failure
• Pregnancy due to increase volume
• IV fluids
• ASD/VSD
• Deep breathing
• Hypernateremia
• SIADH
• Pulmonary regurge
• Pulmonary stenosis
• Right bundle branch block
What are the 8 common cavities of
blood loss?
• Pericardium
• Intracranial
• Mediastinum
• Pleural cavity
• Thighs
• Retroperitoneum
• Abdominal cavity
• Pelvis
What is the special list for
Penicillin?
• Gram +
• Basement membrane suppressor
• Works on simple anaerobes
• The #1 cause of anaphylaxis
• Causes interstial nepritits
• Causes nonspecific rashes
• Acts as a hapten causing hemolytic anemia
What is the #1 cause of
anaphylaxis?
• Penicillin
What are the Chron’s Gifts?
• Granuloma
• Ileum
• Fistula
• Transmural
• Skip Lesion
What are the negative-stranded
RNA Clues?
• Prodromal period before symptoms =
1-3 weeks
• Why is there a prodromal period?
• Because must switch to positive stranded
before replication
What are the clues for positive
stranded RNA?
• Symptoms within 1 week or less
• EXCEPTIONS:
• Hanta
• Ebola
• Yellow fever
• They are -ve stranded = don’t have to switch to
positive before replicating
What are the Most common
cyanotic heart diseases?
• Transposition of the great arteries
• Tetrology of Fallot
• Truncus Arteriosus
• Tricuspid Atresia
• Total anomalous pulmunary Venous Return

• Hypoplastic Left heart syndrome
• Ebstein’s anomaly
• Aortic atresia
• Pulmonary atresia
What cyanotic heart disease is –
boot shaped?
• Tetrology of Fallot
What cyanotic heart disease is
associated with mom taking lithium
during pregnancy?
• Ebstein’s Anomaly
What things make the membrane
less likely to depolarize?
• Hypokalemia
• Hypermagnesemia
• Hypercalcemia (except atrium)
• Hypernatremia
What things make the membrane
more likely to depolarize?
• Hyperkalemia
• Hypomagnasemia
• Hypocalcemia (except atrium)
• Hyponatremia
What is Plan F?
• TPP – Thiamin – B1
• Lipoic Acid – B4
• CoA – Pantothenic acid – B5
• FAD – Riboflavin – B2
• NAD – Niacin – B3

What are the 8 x-linked inherited
diseases?
• Bruton’s Agammaglobulinemia
• CGD (NADPH def)
• DMD
• Color Blindness
• G6PD
• Hemophilia
• Lesch-Nyhan
• Vit D resist. Rickets (X-linked dominant)
• Fabrys
• Hunters

What are the 7 B-cell deficiencies?
• Bruton’s agammaglobulinemia
• CVID (Common Variant Imm. Def)
• Leukemias
• Lymphomas
• SCID
• WAS
• Job Buckley Syndrome

What is the Tyrosine kinase
deficiency?
• Bruton’s agammaglobulinemia

What are the B-cell deficiencies
with T-cell overlap?
• SCID
• WAS
• Job Buckley Syndrome

What are the 4 itchiest rashes?
• Scabies
• Lichen Planus
• Urticaria
• Dermatitis Herpetiformis
Tumor Markers/Oncongenes I
• L-myc?
• Small cell lung Ca

• C-myc?
• Promyelocytic leukemia (Burkitt’s lymphoma)

• N-myc?
• Neuroblastoma
• Small cell lung CA

• C-able?
• CML
• ALL

Tumor Markers/Oncongenes II
• C-myb?
• Colon CA
• AML

• C-sis ?
• Osteosarcoma
• Glioma
• Fibrosarcoma
Tumor Markers/Oncongenes III

• C-erb B2?
• Epidermal growth factor receptors

• CSF-1 ?
• Breast



Tumor Markers/Oncongenes IV

• Erb-B2?
• Breast CA
• Ovarian CA
• Gastric CA

• Ret?
• Medullary CA of thyroid
• Men II & III
• Papillary carcinoma

Tumor Markers/Oncongenes V
• Ki-ras?
• Lung CA
• Colon CA

• Bcl-2?
• Burkitts
• Follicular lymphoma

• Erb?
• Retinoblastoma


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


What is cancer grading?
• Severity of microscopic change
• Degree of differentiation
What is cancer staging?
• Degree of dissemination of tumor
• What the surgeon sees
What are the rashes associated
with cancer and what cancer are
they associated with?

• Urticaria/Hives?
• Any CA, especially lymphoma
• Pagets Ds (ulcers around nipples)

• Seborrheic keratosis (waxy warts)?
• Colon CA
• HIV if sudden increase in number
• Normal with aging

What are the rashes associated
with cancer and what cancer are
they associated with?


• Actinic keratosis?
– Dry scaly plaques on sun-exposed skin
• Squamous Cell CA of skin

• Dermatomyositis?
– violacious, heliotropic rash, malar area
• Colon CA


What are the rashes associated
with Cancer and the cancer they
are associated with?


• Akanthosis nigricans?
– dark lines in skin folds
• Any visceral CA
• End organ damage

• Erythema nodosum?
– ant aspect of legs, tender nodules
• Anything granulomatous
• NOT assoc. w/ bacteria

What is carried by HDL?
• Apo E
• Apo A
• Apo CII

• L-CAT
– lecithin cholesterol acetyl transferase
• Cholesterol
– from periphery to liver
What is carried by VLDL?
• Apo B-100
• Apo E
• Apo C II

• Triglcyerides (95%)
• Cholesterol (5%)

What is carried by IDL?
• Apo B-100
• Apo E
• Apo CII

• Triglycerides (< VLDL)
• Cholesterol (>VLDL)
What is carried by LDL?
• Apo B-100

• Cholesterol
– from liver to tissue

• NOT a good thing!!!!!
What do chylomicrons carry?
• Apo A
• Apo B-48
• Apo E
• Apo C II

• Triglycerides from:
• GI to liver (25% of the time)
• GI to endothelium (75% of the time)
Which lipoprotein carries the
most cholesterol?


•LDL

Where are the AVMs?
• Clue = HEAL
• Heart?
• Machinery murmur

• Elbow?
• Fistula from dialysis in renal disease

• Abdomen/Brain?
• Von Hippel-Lindau = clot off with coils
• Increase incidence of Renal cell CA on chrom 3

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

What are the phage mediated
toxins?
• Mnemonic: BEDS
• Botulinum
• Erythrogenic toxin
– from strep pyogenes
• Diptheria
• Salmonella
– Has O antigen

What is the story used to
remember the segmented RNA
viruses?
• I sprayed ORTHO on my BUNYA at the
ARENA down in REO to kill
SEGMENTED WORMS
Name the 3 major types of
adhesion molecules
• ICAMs
• Integrins
• Selectins

What does IgCam do?
• Bind proteins
What do integrins do?
• Stop the leukocytes
What do selectins do?
• Bind carbohydrates
• Mediate the rolling to slow leukocytes
down
What are the functions of adhesion
molecules?
• Homing of lymphocytes
– tells lymphocytes where to go
• Inflammation
• Cell-cell interaction

Primary allergic response is due
to what?
• Contact
What cells are present in the first 3
days?
• Neutrophils

• The next cells to show up are?
• B-cells

• What do B-cells make?
• IgM

What day does IgM show up?
• Three

• IgM peaks at what day?
• 14

• When does IgM leave?
• In 2 months
What shows up in 2 wks (14 days)?
• IgG

• When does IgG peak?
• In 2 months

• When does IgG leave?
• In 1 year
What is Secondary Allergic
response is due to?
• MEMORY


What shows up at day 3?
• IgG with 5x concentration
• Has the highest affinity

• When does IgG peak?
• In 5 years

• When does IgG leave?
• In 10 years
What Ig has the hightest affinity?
• IgG
What are the risk factors for
Esophageal/Gastric CA?
• Smoking
• Alcohol
• Nitrites
• Japanese

What are the risk factors for
bladder CA?
• Smoking
• Aniline dyes
• Benzene
• Aflatoxin
• Cyclophosphamide
• Schistosomiasis
• 2 diseases:
• Von Hippel-Lindau
• Tubular sclerosis
What is the NBT test?
• Nitro Blue Tetrazolium test
• What is it used for?
• Screening CGD
• What does a –ve test indicate?
• +ve for the disease
What disease corresponds with the
following inclusion bodies?
• Howell-Jolly?
• Sickle cell

• Heinz?
• G-6-P-D

• Zebra?
• Niemann pick
What disease corresponds with the
following inclusion bodies?
• Donovan?
• Leishmaniasis

• Mallory?
• Alcoholism

• Negri?
• Rabies
What disease corresponds with the
following inclusion bodies?
• Councilman?
• Yellow fever

• Call-exner?
• Ovarian tumors
– granulosa origin

What disease corresponds with the
following inclusion bodies?
• Lewy?
• Parkinsons

• Pick?
• Pick’s disease

• Barr body?
• Normal female

What disease corresponds with the
following inclusion bodies?
• Aschoff?
• Rheumatic fever

• Cowdry type A inclusions?
• Herpes virus

• Auer rods?
• AML




What disease corresponds with the
following inclusion bodies?
• Globoid?
• Krabbe’s lysosomal storage disease

• Russell?
• Multiple myeloma


What disease corresponds with the
following inclusion bodies?
• Schiller-Duvall?
• Yolk sac tumor

• Basal bodies?
• Only found in smooth mm

What are the 4 types of
hypersensitivities?
• Mnemonic?
• ACID

• Type I
• Anaphylaxis/Atopic

• Type II
• Cytotoxic (Humoral)

• Type III
• Immune complex mediation

• Type IV
• Delayed hypersensitivity/Cell mediated
What are the Characteristics of
Type I hypersensitivity?
• Atopic
• IgE (Asthma) binds to mast cell
• IgA activates IP3 cascade degrading mast
cells
What are the Characteristics of
Type II hypersensitivity?
• Humoral
• What are examples of type II?
• Rh disease
• Goodpastures
• Autoimmune hemolytic Anemia
• All Autoimmune diseases
– except RA and SLE

What are the Characteristics of
Type III hypersensitivity?
• Ag-Ab complement
• What are examples of Type III?
• RA
• SLE
• Vasculitides
• Some GN?

What are the Characteristics of
Type IV hypersensitivity?
• Cell mediated
• What are examples of Type IV?
• TB skin test
• Contact dermatitis
• Transplant rejection
What structures have no known
function?
• Appendix
• Epithalamus
• Palmaris longus
– muscle
• Pancreatic polypeptide
– hormones in F-cells
What diseases can progress to
RPGN?
• Goodpastures
• Wegeners
• DM
• HTN
What are causes of papillary
necrosis?
• Vasculitis
• AIDS
Cytic fibrosis Questions?
• Tx?
• Pilocarpine
• also used for glaucoma

• Test used to detect CF?
• Pilocarpine sweat test

• What ion does this test measure?
• Cl-

• Definitive presence of disease has a test value of what?
• >60
Cytic fibrosis Questions?
• What is the value in a normal person?
• <20

• What is the value in a heterozygous person?
• 30 – 60

• What chromosome is the CF gene on?
• Chrom 7

• What Second messenger is used?
• IP3/DAG
What are the gram +ve spore
formers?
• Bacillus anthracis
• Clostridium perfringens
• Clostridium tetani
• Clostridium melangosepticus

• What is the chemical in spores?
• Calcium dipocholinate
What does strep mutans
ferment?
• Lactic acid
What type of receptors do all
sphincters in the body have?
• Alpha-receptors
Strep. Salivarius ag is used for
what test?
• Cold agglutinin testing
– IgM
Types of amyloid found in various
Systemic amyloidoses:
• AA amyloid?
• Chronic active disease

• AL amyloid from Ig light chain?
• Myeloma

Types of amyloid found in various
Systemic amyloidoses:
• Beta 2 microglobulin?
• Chronic hemodialysis

• AA amyloid from SAA?
• Nephrotic hereditary forms
– eg. Mediterranean fever
Types of amyloid found in various
Systemic amyloidoses:
• Pre-albumin/transthyretin?
• Cardiomyopathic hereditary forms
– senile systemic amyloidosis
• Neuropathic hereditary syndromes
Types of amyloid found in various
Local amyloidoses:
• ANP fibrils are caused by?
• Senile cardiac amyloisosis

• Cerebral amyloid in Alzheimer’s disease/Down’s?
• Cerebral amyloidosis
Types of amyloid found in various
Local amyloidoses:
• Calcitonin precursors?
• Medullary CA of thyroid

• AL from light chains?
• Isolated, massive, nodular deposits
– lung, skin, urogenital tract
What type of dementia do you
get in Pick’s dis?
• Frontotemporal dementia
Describe Pick’s disease
• Atrophy of frontal and temporal cortex
with sparing of remaining neocortical
regions
What 3 things do Pick bodies
contain?
• Altered neurofilaments
• Tau protein
• ubiquitin
What drugs can cause a
disulfiram reaction?
• Mnemonic?
• CLAM

• Chloramphenicol
• Lactams
– Cefamandole
– Cefoperazone
• Antabuse
– disulfiram
• Metronidazole

What is the mode of action of the
Clostridium botulinum toxin?
• Prevents pre-synaptic release of Ach

• How do babies get it?
• From spores in honey or molasses

• How do adults get it?
• From canned food
What are 3 Toxins of Bacillus?
• Lethal factor – (black necrosis)
• Protective factor
• Edema factor
Who has Poly-D Glutamic acid?
• Anthracis
• Cereus
Name that B-blocker:
• B1-selective?
• A – M
• Non-selective?
• N – Z
• Exceptions?
• Carbetalol and Labetolol are non-selective
What are the 4 facts of Fanconi
Syndrome?
• Problem in proximal tubule
• Can’t reabsorb
• Low energy state causing anemia
• Can be due to old tetracycline
Where is glutaminase found?
• In the collecting duct of the kidney

• What does glutmainase help the kidney
absorb?
• Ammonia if the liver fails
Name 3 anatomical spots where
renal stones get stuck:
• Hilum
• Pelvic brim
• Entering the bladder
Renal failure is the most common
cause of death in what 3 diseases?
• SLE
• Endometrial CA
• Cervical CA
What is the rate-limiting enzyme
in the urea cycle?
• Carbamoyl synthase I

• Where is it found 90% of the time?
• Liver

• Where is it found 10% of the time?
• Collecting duct of the kidney
What type of charge does
heparin have?
•-ve charge
What type of charge does
protamine sulfate have?
•+ve charge

• What is it used for?
• Reversing the effects of heparin
What is commonly seen in all
vasculitides?
• T-cells and macrophages
• Schistocytes
• Decreased platelets
• Decreased RBCs
• Bleeding from mucosal surfaces
• Bleeding from skin and GI
• Petechiae
• Ecchymoses
What happens if you expose the
blood to the basement membrane?
• The following deveop:
• Clots
• DIC
• Pulmonary embolism
• DVT
• MI
• Stroke
Signs and symptoms in all
vasculitides
• Tachypnea and SOB

• Most common cause of death?
• Heart failure

What is the MOA of Erythromycin?
• Inhibits the translocation step of ribosomal
protein synthesis
What is the MOA of
Chloramphenicol?
• Inhibits ribosomal peptidyl transferase in
prokaryotes
What is the MOA of Puromycin?
• Inhibits elongation by binding to “A” site
and prematurely terminating chain growth
in pro and eukaryotes

What is the MOA of Streptomycin?
• Causes misreading of code during
initiation in prokaryotes
What is the MOA of Tetracycline?
• Prevents binding of aminoacyl-t-RNA to
ribosome on prokaryotes therefore
inhibiting initiation

What is the MOA of
Cyclohexamide?
• Inhibits ribosomal peptidyl transferase in
eukaryotes
– cell wall inhibitor

What is the MOA of Rifampin?
• Blocks B-subunit of RNA polymerase
• Prophylaxis for contacts of N. meningitidis
What is the MOA of Vancomycin?
• Cell wall inhibitor
• Binds irreversibly to Phopholipase carrier
• Bacteriacidal
• Covers all gram +ves
• Linezolid
What is the MOA of Warfarin?
• Blocks vitamin k dependent gamma-
carboxylation of prothrombin and factors
2, 7, 9, 10, proteins C & S

What is the MOA of Clindamycin?
• Blocks translation by binding the 50S
subunit
Hemolytic properties of
Streptococcus:
• What type of hemolysis is alpha hemolysis?
• Partial hemolysis

• What color is it’s zone?
• Green

• What type of hemolysis is beta-hemolysis?
• Complete hemolysis
Hemolytic properties of
Streptococcus:

• What color is it’s zone
• Clear
– eg. Streptokinase

• What type of hemolysis is gamma-hemolysis?
• No hemolysis

• What color is it’s zone?
• Red
What are the 5 notable things
about RTA I?
• High urine PH (??????not sure about this)
• Acidosis
• UTI s
• Stones
• Babies die < 1 yr old
What are 3 notable things about
RTA II?
• Acidosis
– urine PH = 2, normal is 5-6
• Hypokalmia
• Patients have NO carbonic anhydrase


What are 3 notable things about
RTA III?
• It is a combination of RTA I & III
• Normal urine pH
• Hypokalemia

What are 3 notable things about
RTA IV?
• Seen in diabetics
• Hyperkalemia
• NO aldosterone b/c JG apparatus has
infarcted
What are the members of
Streptococcus Group D?
• Viridans
• Mutans
• Sanguis
• Salivarius
• Bovis
What Steptococcus has green
pigment?
• Viridans
What Streptococcus causes
SBE?
• Viridans
What Streptococcus causes
cavities?
• Mutans
What do you see in Nephritic
Syndrome?
• HTN
• Hematuria
• RBC casts
What do you see in Nephrotic
Syndrome?
• Increase Edema
• Increase Lipidemia
• Increase Cholesterolemia
• Increase Coagulability
• Decrease serum Albumin
• Increase urinary Albumin
What is the #1 cause of Sinusitis,
Otitis, Bronchitis, Pneumonia?
• Strep. Pneumo

• What is the #2 cause?
• Hemophilus influenza

• What is the #3 cause?
• Neisseria meningitides

What is the #1 method to
paralyze cilia?
• Viruses

• Which are secondary to what?
• Bacterial infections

• What is the #2 method to paralyze cilia?
• Smoking

If you develop gastroenteritis
within 8hrs of eating what are the
most common likely bugs?
• Staph aureus
• Clostridium perfringens
• Bacillus cereus….from what?
• Fried rice
Gastroenteritis within 8hrs of eating
what toxin?
• Preformed
What does Clostridum tetani
inhibit?
• Release of glycine from spinal cord

• What physical finding would you see?
• Lock jaw

• What is the tx?
• Antitoxin and Toxoid

• Where is it injected?
• Injected in different areas of body
The Most common cause of UTI is?
• E. coli

• Followed by?
• Proteus

• Followed by?
• Klebsiella
The most frequent cause of UTI in
females between 5-10?
• Staph saprophyticus

• Why?
• They stick things in themselves

• 18-24 yoa?
• Staph saprophyticus
• Why?
• Because they stick things inside themselves

• Why no UTI’s after 24?
• Because women are use to penises and Staph saprophyticus lives on
penis (becomes part of normal flora).
Staph aureus is the most
common cause of what bone
disease?
• Osteomyelitis

• Because of what?
• Collagenase

What is the Most Common cause of
infections one week post burn
injury?

• Staph. aureus
What is the triad of SSSS?
• Shock
• Rash
• Hypotension
Most common cause of UTI?
• E. coli
• Then?
• Proteus
• Then?
• Klebsiella
Newborn meningitis is caused
by?
• Group B Strep (agalactiae)
• E. coli
• Listeria
What is normal rectal flora from
mom
• Group B Strep (Strep. Agalactiae)
• E. coli
• Listeria
What is associated with colon
CA?
• Clostridium melanogosepticus
• Strep bovis

• What color pigment is produced?
• Black
What Ig do you look for with
affinity?
• IgG

• What about Avidity?
• IgM
What is transduction

• Virus inject it’s DNA into bacteria

What is transformation?
• Virus injects it’s DNA into it bacteria in a
hospital or nursing home setting, then
becomes deadly.
Conjuction occurs only with
what?
• Bacteria with Pili
What causes mutiple cerebral
abscesses in newborns?
• Citrobacter
What are the 2 gram –ves that are
strict anaerobes?
• Hemophilus influenza
• Neisseria
What type of complement problem
do you have in recurrent infections
with encapsulated organisms?

• C3
What does complement fight
against?

• Gram negative bacteria
What do you see in serum with
prerenal failure and what are the
values?
• BUN
• >20

• Fractional Na+ excertion
• <1%

• Creatine
• >40
What do you see in Renal failure
and what are the values?
• BUN
• 10-15

• Fractional Na+ excretion
• >2%

• Creatinine
• <20
What is the extravasation order?
• Pavementing
• Margination
• Diapediesis
• Migration
What is the rate limiting enzyme
for Glycolysis?

• PFK-1

What is the rate limiting enzyme of
Gluconeogenesis?

• Pyruvate Carboxlyase
If treating a disease that initiates
the cell mediated response, what
are you treating first?
• Viral

• If resistant to tx, what next?
• Fungal
• Mycobacterium
• Protozoa
• Parasite
• Neoplasm

What bugs can you pick up
during birth?
• Step. Group B
– Strep agalactiae
• Strep. Pneumonia
• Herpes simplex virus
• Neisseria gonorrhea
• Chlyamydia
What is another name for
Adenoma sebaceum?

• Perivascular angiofibromata
What is another name for
Addison’s?
• Primary Adrenocoritcal Insufficiency
What is another name for
Alkaptonuria?

• Ochronosis
What is another name for
Churg-Strauss?
• Allergic Granulomatosis
• Angiitis
What is another name for
Craniopharyngioma?
• Ameloblastoma

• What is Ameloblast?
• Tooth material
What is another name for
Chrons?
• Regional enteritis
• Granulomatous ileitis
• Ileocolitis
What is another name for
DeQuervain’s?
• Subacute Granulomatous Thyroiditis
What is another name for
Intraductal Ca?
• Comedo Ca
What is another name for I-Cell
Disease?
• Mucolipidosis II
What is another name for
Kawassaki Disease?
• MLNS
• Mucocutaneous Lymph Node Syndrome
What is another name for
Leydig cells?
• Interstitial cells
What is another name for
Sertoli cells?
• Sustentacular cells
What is another name for
Temporal arteritis?
• Giant cell arteritis (granulomatous)
What is another name for
Waldenstrom’s macroglobulinemia?
• Hyperviscosity syndrome
HHV I causes?
• Oral
• Trigeminal ganglia

HHV II causes?
• Genital
• Sacral plexus

HHV III causes?
• Varicella zoster
HHV IV causes?
• EBV
• Mononucleosis
• Burkitt’s
HHV V causes?
• CMV
• Inclusion bodies
HHV VI causes?
• Roseola
• Duke Disease
• Exanthem subitum
HHV VII causes?
• Pityriasis rosea
HHV VIII causes?
• Kaposi’s sarcoma
Answer the following questions
about Coumadin/Warfarin.
• What is the MOA?
• Interferes with normal synthesis and gama
carboxylation of Vit. K dependent clotting
factors via vitamin K antagonism.

• Is it long or short acting?
• Long half-life
• 8-10 hours to act
Answer the following questions
about Coumadin/Warfarin.
• Clinical use?
• Chronic anticoagulation

• Contra-indication?
• Pregnancy because it can cross the
placenta

Answer the following questions
about Coumadin/Warfarin.
• What pathway does it affect?
• Extrinsic pathway

• What does it do to PT?
• Prolongs

• PT

Answer the following questions
about Coumadin/Warfarin.
• What are the toxicities?
• Bleeding
• Teratogenic
• Drug-drug interactions

• How is it activatied?
• Tissue activated
Answer the following questions
about Coumadin/Warfarin.
• Administration?
• po


What are the Vitamin K dependent
clotting factors?
• II
• VII
• IX
• X
• Protein C
• Protein S
Answer the following questions
about Heparin.
• What is the MOA?
• Catalyzes the activation of antithrombin III
• Decreases thrombin and Xa

• Is it long or short acting?
• Short half-life
• Acts immediately

Answer the following questions
about Heparin.
• Clinical use?
• Immediate anticoagulation of pulmonary
embolism, stroke, angina, MI, DVT.

• Contra-indication?
• Can be used during pregnancy because it
does not cross the placenta
Answer the following questions
about Heparin.
• What pathway does it affect?
• Intrinsic pathway

• What value should you follow?
• PTT


Answer the following questions
about Heparin.
• What are the toxicities?
• Bleeding
• Thrombocytopenia
• Drug-drug interactions

• How is it activatied?
• Blood activated
Answer the following questions
about Heparin.
• Administration?
• I.V.

• Drug of choice for what?
• DVT


Answer the following questions
about Heparin.
• What is good about the newer low-
molecular-weight heparins?
• They act more on Xa
• Have better bioavailability
• Have 2 to 4 times longer half life
• Can be administered subcutaneously and
without laboratory monitoring.
What do you use for rapid reversal
of heparinization?
• Protamine sulfate

How do you treat Lead Poisoning?
• Dimercaprol
How do you treat Benzodiazepine
poisoning?

• Flumazenil
How do you treat
Anticholinesterase poisoning?

• Pralidoxime
How do you treat Iron poisoning?

• Deferoxamine
How do you treat Opioid poisoning?

• Naloxene
How do you treat Barbituate
poisoning?

• Bicarbonate
• Doxapram
What does Doxapram do?
• Activates the respiratory center in the
brain
What is the treatment for
Hypercholesterolemia?
• Provostatin
• Atrovastatin
• Lovastatin
• Simvastatin
What statin is renally excreted?
• Provastatin
What statins do you have to follow
liver enzymes every 3 months?
• Atrovastatin
• Lovastatin
• Simvastatin
What do statins inhibit?
• HMG-CoA reductase

• When is it most active?
• 8:00pm on
If statins are insufficient what do
you add?
• Cholestipol
• Cholestyramine

• If nothing works what do you give?
• Probucol
• Niacin

What are the side effects of Niacin?
• Flushing
• Itching
What 2 statins bind bile salts?
• Cholestipol
• Cholestyramine

What are 4 causes of severe
pain (in order)?
1.Pancreatitis
• Due to What?
• ETOH

2.Kidney stones
• Due to What?
• Alcohol
What are 4 causes of severe
pain (in order)?

3.AAA
• How is this described?
• Ripping pain down back

4.Ischemic bowel
• What is symptom?
• Bloody diarrhea
What are 5 causes of SIADH?
• Small cell Ca of lung
• Increased intracranial pressure
• Pain (most common)
• Drugs
• Hypoxic Lung Disease/Restrictive Lung
disease
What drug causes SIADH?
• Carbamazepine
What are the cells of neural
crest origin?
• Parafollicular cells of thyroid
• Odontoblasts (predentin)
• Pseudounipolar cells
• Spiral membrane of heart
• Chromaffin cells
• All Ganglion cells (Schwann, Adrenal medulla)
• Melanocytes
• Laryngeal/Tracheal cartilage
What are the triple repeat
diseases?
• Huntington’s
• Fragile X
• Myotonic Dystrophy
• Prauder Willie
• Spinal/bulbar muscular atrophy (Fredicks
ataxia)

How do you determine the
maximum sinus rate?
• 220 - age
What are the 3 low volume states
with acidosis rather than alkalosis?
• RTA
• Diarrhea
• Diabetic ketoacidosis (DKA)
What are the causes of Croup &
Bronchiolities?
• Parainfluenza
• Adenovirus
• Influenza
• RSV

What is asthma in a child less
than 2 called?
• Bronchiolitis
What are the 4 D’s of Pellagra?
• Diarrhea
• Dermatitis
• Dementia
• Death

What are the uric acid stones?
• Cysteine
• Ornithine
• Lysine
• Arginine
What is happening in the
Atrium?
• Phase 0?
• Depolarization

• Phase 1?
• No name

• Phase 2?
• Plateau phase (A-V node)

What is happening in the
Atrium?

• Phase 3?
• Repolarization

• Phase 4?
• Automaticity (S-A node)

What do Na+ channels do to
the EKG?
• Wider QRS
What does Ca+ do to the EKG?
• Wider P-wave
• Longer PR interval
What are the types of kidney
stones?
• Calcium oxalate (phosphate) stones
• Struvite stones
• Uric acid stones
• Cysteine stones
• Oxalate stones
What percent of kidney stones are
calcium oxalate?
• 80%
If you find oxalate stones in the
following what should you think of?
• 3 y/o white male?
• CF

• 5 y/o black male?
• Celiac Sprue

If you find oxalate stones in the
following what should you think of?
• Adult male?
• Whipple’s

• Adult male or female?
• Crohn’s

If oxalate stones found in CF what
is the most common cause?
• In 0-20 y/o?
• Malabsorptin

• What age do they die?
• Young
Answer the following questions
about pseudogout?
• What type of crystals are present?
• Calcium pyrophosphate

• Where are they found?
• Joint spaces





Answer the following questions
about pseudogout?
• Who gets it?
• Older patients M=F

• Tx?
• Colchicine





What are the most common non-
cyanotic heart disease?
• VSD
• ASD
• PDA
• Coarctation
What murmur increases on
expiration?
• VSD
• Mitral

What murmur has fixed wide
splitting?
• ASD
What murmur has bounding
pulses?
• PDA
What gives you differenital
pulses?
• Coarctation
What is increased incidence in
Turners?
• Coarctation
What are 4 enzymes never seen
in glycolysis?
• Pyruvate carboxylase
• PEP carboxykinase
• F-1,6 dPhosphatase
• G-6-Phosphatase
What are 3 enzymes seen ONLY
in glycolysis?
• Hexokinase
• PFK-1
• Pyruvate kinase
What are 2 hormones that are
acidophilic?
• Prolactin
• GH
What are the partially acid fast
Gram +ve?
• Nocardia
What are the partially acid fast
Protozoa?
• Cryptosporidium
What are the septic emboli of
SBE?
• Mycotic aneurysm
• Roth spots
• Janeway lesions
• Osler’s nodes
• Splinter hemorrhages
• Endocarditis
Where are the following lesions
found?
• Janeway lesions?
• Toes

• Osler’s nodes?
• Fingers

• Roth spots?
• Retina

What is the most common cause of
endocarditis?
• Strep. viridans
What causes microsteatosis?
• Acetaminophen
• Reye Syndrome
• Pregnancy
What causes macrosteatosis?
• Alcohol
What are 2 bacteria that release
elastase?
• Staph. Aureus
• Pseudomonas
What are the 2 bacteria with toxins
that inhibit EF-2?
• Pseudomonas
• Diptheria
How does Diptheria work?
• It ADP ribosylates EF2 inhibiting protein
synthesis

• Is it Gram +/-?
• +

• Where and how does it get its exotoxin?
• From virus via transduction
How does Diptheria work?

• What does it cause?
• Heart block

• What do you give for Tx?
• Antitoxin
• Never scrape membrane
What are the different types of
Emphysema and their causes?
• Bullous?
• Staph aureus
• Pseudomonas

• Centroacinar?
• Smoking



What are the different types of
Emphysema and their causes?

• Distalacinar?
• Aging

• Panacinar?
• Alpha-1 antitrypsin def




What are the stages of
erythropoiesis?
• 4 mo gestation?
• Yolk sac

• 6 mo gestation?
• Spleen, liver, flat bones

What are the stages of
erythropoiesis?
• 8 mo gestation?
• Long bones

• 1 yr old?
• Long bones


If long bones become damaged
after 1 yr what takes over?
• Spleen can resume erythropoieses causing
splenomegaly
What ions correspond with the
following EKG?
• P-wave?
• Ca+

• QRS complex?
• Na+

• S-T?
• Ca+

What ions correspond with the
following EKG?

• T-wave?
• K+

• U-wave?
• Na+

What do Na+ channel blockers
do to the EKG?
• QRS
What do Ca+ channel blockers
do to the EKG?
• Widens P-wave
• PR interval longer
P.P. Clue 4 Bio Stat
D W
+ B A+B
_ C C+D
A+C B+D ALL
A
D
Sensitivity A/A+C
Specificity D/B+D
PPV A/A+B
NPV D/C+D
OR AD/BC
RR (A/All)/(C/All)
AR (A/All)-(C/All)
Sensitivity: Truly Diseased People
Specificity: Truly Well People
+ Predictive Value: Test +ve With DZ
- Predictive Value: Tested –ve w/o DZ
OR: Odds Ratio
RR: Relative Risk
AR: Attributed Risk




Always in the
numerator
A&D
In EKG P-wave Represents?
• Atrium contraction
• Phase zero
• Calcium
In EKG P-R Interval means?
• AV Node
• Phase 2
• Sodium
In EKG Q-Wave means?
• Septum
• Phase 2
• Sodium
In EKG R-upstoke means?
• Anterior wall
• Phase 2
• Sodium
In EKG S-down stroke means?
• Posterior wall
• Phase 2
• Sodium
In EKG S-T Interval means?
• Ventricle
• Phase 2
• Calcium
In EKG T-wave means?
• Ventricle
• Phase 3
• Potassium

In EKG U-wave means
• Ventricle
• Phase 4
• Sodium
4 DZ associated with HLA-DR 2?
• Narcolepsy
• Allergy (hay fever)
• Goodpasture
• MS
5 DZ associated with HLA-DR 3?
• DM
• Chronic active Hepititis
• Sjogrens
• SLE
• Celiac sprue
DZ associated with HLA-DR 3&4?
• IDDM (DM Type 1)
DZ associated with HLA-DR 4?
• Rheumatoid Arthritis
• Pemphigus Vulgaris
DZ associated with HLA-DR 5
• JRA (JUV RA)
• Pernicious anemia
DZ associated with HLA-DR 7?
• Nephrotic syndrome (Steroid induced)
DZ associated with HLA-DR 3
and HLA-B 8?
• Celiac Disease
DZ Associated with HLA-A3?
• Hemochromatosis
– chromosome 6
– point mutation Cystine to Tyrosine
DZ Associated with HLA-A 3?
• Myasthenia gravis
DZ Associated with HLA-B 13?
• Psoriasis
5 DZ Associated with HLA-B 27?
• Psoriasis
– only if with arthritis
• Ankylosing Spondylities
• IBD
– Ulcerative Cholitis
• Reiter’s
• Post gonococcal arthritis
DZ Associated to HLA-BW 47
• 21 alpha hydroxylase deficiency
– Vit. D
Facts about Diphtheria
• ADP ribosylates EF-2
• Stops cell synthesis
• Gr +ve
• Gets exotoxin from virus via transduction
• Heart block
• Its toxoid therefore give antitoxin
MCC of Pneumonia in 6wks to
18 yrs?
• RSV (infants only)
• Mycoplasma
• Chlamydia pneumonia
• Strep pneumonia
MCC Pneumonia in 18 yrs to 40 yrs
of age?
• Mycoplasma
• Chlamydia pneumonia
• Strep. Pneumonia

MCC of Pneumonia in 40 yrs to
65 yrs of age?
• Strep pneumonia
• H. influenza
• Anaerobes
MCC of pneumonia in the Elderly?
• Strep pneumonia
• Viruses
• Anaerobes
• H.influenza
• Gr –ve rods
What are 4 Clues for IgA?
• Monomer in blood
• Dimer in secretion
• Located on mucosal surface
• Found in secretion
What are Clues for IgD?
• Only functions as surface marker for
Mature B-Cell
What are Clues for IgE?
• Immediate hypersensitivity/anaphylaxis
• Parasite defense
• Worms
• Fc region binds to mast cells and basophils
• Allergies
• Does Not fix complement


What are Clues for IgG?
• Highest affinity
• Memory respond at day 3 five times the concentration
• Peaks in 5 years last for 10 years
• Opsonizes
• Activates complement
• 2
nd
to show up in primary response
• Only one to show up for secondary respond
• Most abundant Ig in newborn
• Antigenic differences in heavy chain and site of di-sulfide
bond
• 4 subclasses G1 to G4


What are Clues for IgG1?
• Crosses placenta due to fc portion
What are Clues for IgG2?
• Most common sub-class deficiency
• Patient susceptible to encapsulated
organisms
What are Clues for IgG3?
• Most memory antibody
What are Clues for IgG4?
• Only IgG NOT fixing complement
What are Clues for IgM?
• Responds in primary response
• Most efficient in agglutination and
complement fixation
• Defenses against bacteria and viruses
What do Macrophages release?
• MHC II
What does TH1 secrete?
• IL-2
• IF- Gamma
What does TH2 Secrete?
• IL-4
• IL-5
• IL-6
• IL-10
What does TH-0 secrete?
• TH-1
• TH-2
MHC-1 are also called what?
• CD8
• CD8 becomes T-cytotoxic cells
All T-Cells express what?
• CD-3
• For what?
• Signal transduction

• CD-2
• For what?
• Adherence
What do CD-4 cells Become?
• T helper cells
What do CD-8 cells Become?
• T cytotoxic cells
Neutrophils produce what enzymes
and what is their action?
• Myeloperoxidase
• NADPH
• Will kill ALL Gr+ve
– Ex..Hydrogen peroxide kills gr+
What do T-cells stimulate?
• Clue 4x7=28

• CD-4
• B-7
• CD-28

What are the Clues for Type-1
Hyperlipidemia?
• Increased Chylomicron
• Deficiency of Lipoprotein lipase enzyme
• Defect in liver only

What are the Clues for type-2
hyperlipedimia?
• Increased LDL
• Two types IIa and IIb
• Type IIa Receptor deficiency for LDL or missing
B-100
• Type II-b (LDL and VLDL problems) enzyme
deficiency for LDL at adipose. Receptor problem
for VLDL. Most common in General Population
What are the Clues for type-3
Hyperlipedimia?
• Increased IDL
• Receptor problem for APO-E
What are the Clues for Type-4
hyperlipedimia?
• Increased VLDL
• Lipoprotein lipase enzyme deficiency at
adipose tissue
What are the Clues for Type-5
hyperlipedimia?
• Combination of Types 1&4
• Increased Chylomicron and VLDL
• Enzyme and receptor deficiency at C-II
• Most common in diabetics
What is a Xanthoma?
• Deposition of Cholesterol on elbows
• Can cause what?
• CAD
What is a Xanthelasma?
• Deposition of Triglycerides on eyelids, face
• Can cause what?
• Pancreatitis
Description of
Rashes
ERYTHEMA MARGINATUM
• Little red spots w/ bright red margins
• Sandpapery
• RF- Jones critera
ERYTHEMIA CHRONICUM
MIGRANS
• Lymes disease
• Target lesions (bulls eye)
MEASLES
• Morbiliform rash
• Preceded by cough
• conjunctiivitis
ROSEOLA
• Fever x 2 day
• Followed by rash
• ONLY ONE WITH RASH FOLLOWING
FEVER (HHV 6)
ERYTHEMA NODOSUM
• Anterior aspect of leg
• Redness
• Tender nodules
Erythema multiforme
• Red macules, target lesions
• Causes: allergy, viruses
• Mild: MCC virus, #2 drugs (sulfas)
• Moderate: Stevens-Johnsons Syndrome
• Severe: Toxic epidermal necrolysis , skin
peels off
SEBORRHEIC DERMATITIS
• Scaly skin with oily shine on headline
SEBORRHEIC KERATOSIS
• Stuck on warts
• Due to aging
PSORIASIS
• HLA-B27
• Extensor surfaces
• Silvery white plaques
• Scaly skin
• Pitted nails
VARICELLA ZOSTER HHV 3
• STAGES
• Red macules
• Papules
• Vesicles
• Pustules then scabs
• Different stages may appear at same
time


DERMATITIS HERPATIFORMIS
• Rash and blisters on ant. thighs
• Assoc. with diarrhea
• Assoc. with flare up of celiac sprue

TYPHOID FEVER
• SEEN WITH SALMONEALLA INFXN
• Rose spots assoc. with intestinal fire
DERMATOMYOSITIS
• Heliotropic rash
ERYSIPELAS
• Reddened area on skin w/ raised borders
• DOES NOT BLANCH
TINEEA CRURIS
• Redness
• Itchy groin
PITYRIASIS ROSEA
• Herald patch= dry skin patches that follow
skin lines
• HHV 7
TINEA VERSICOLOR
• Hypopigmented macules on upper back
• Presents in a V pattern
• A.K.A. upside down christmas tree
• Tx: Griseofulvin
What do you see in SCABIES?
• Linear excoriations on belt line and finger
webs
• What is the tx?
• Lindane
• Permethrin
What is a T-CELL DEFICIENCY?
• DiGeorges
• What ion imbalance will they have?
• Hypokalemia
• What did not form?
• 3
rd
and 4
th
pharyngeal pouch
• What chromosome?
• Deletion on chromosome 22
T-CELL DEFICIENCY
• HIV
• Also B-cell but less so
What is MYCOSIS FUNGOIDES?
• NOT A FUNGUS
• Non-Hodgkins form of cutaneous T-cell
lymphoma
What is the job of
CHYLOMICRONS?
• Transport TG’s from GI to liver and
endothelium
What is the job of VLDL?
• Transports TG’s from liver to adipose
What is the job of IDL?
• Transports TG’s from adipose to tissue
What is special about LDL’s?
• ONLY ONE THAT CARRIES CHOLESTEROL
What do you develop with
HYPERTRIGLYCERIDEMA?
• XANTHELASMA

• Where are they located?
• On eyelids and eyebrows
What do you develop with
HYPERCHOLESTEROLEMIA?
• Xanthomas

• Where are they located?
• elbows
Where is VLDL made?
• ONLY ONE MADE IN THE LIVER
What are IDL AND LDL formed
from?
• ARE BREAK DOWN PRODUCTS OF VLDL
What are the clues for
HEMOPHILIUS INFLUENZA?
• Gram -/+?
• Pleomorphic gram (-) rods
• What pattern?
• “school of fish pattern”
• What type is most common?
• Type A
– 80%
What are the clues for
HEMOPHILIUS INFLUENZA?
• Capsule or no capsule?
• non-encapsulated
• Invasive or non invasive?
• non-invasive
What are the clues for
HEMOPHILIUS INFLUENZA?
• Most common cause of what?
• Sinusitis
• Otitis
• Bronchitis

What are the clues for
HEMOPHILIUS INFLUENZA?
• What is the 2
nd
most common type?
• TYPE B
– 20%
• Encapsulated or non encapsulated?
• Encapsulated
• What does it have in its capsule?
• Polyribosyl phosphate in capsule
• Contains IgA protease
What are the clues for
HEMOPHILIUS INFLUENZA?

• Invasive or non invasive?
• Invasive
• What does it cause most often?
• #1 cause of epiglottitis
• What are the signs of epiglottitis?
• Stridor
• Fever
• Thumb sign on xray
What are the most common causes
of MENINGITIS corresponding with
the following ages?
• 0-2 months?
• #1. Group B strep (agalactiae)
• #2. E. coli
• #3. Listera
What are the most common causes
of MENINGITIS corresponding with
the following ages?
• 2 Months- 10 years?
• #1. strep pneumonia
• #2. n. meningitides
• (adolescent years only)
What are the most common causes
of MENINGITIS corresponding with
the following ages?
• 10yrs- 21 yrs?
• #1. n. meningitides

What are the most common causes
of MENINGITIS corresponding with
the following ages?
• > 21 years old?
• #1 S. pneumoniae
Answer the following about the
Strep. Pneumonia vaccine.
• At what age is it given?
• Given at 2,4,6 months
• What strain does it cover?
• Covers 23 strains (98% cases)
Answer the following about the
Strep. Pneumonia vaccine.
• Indications?
• Anyone> 65y/o
• Anyone splenectomized
– Sickle cell anemia
• Anyone with end-organ damage
– CF
– RF
– Nephrotic Syndrome
STREP PYOGENES is the most
common cause of what?
• MCC of all throat infections
• #2 MCC of all what?
• Skin infections except lines
What are the STAPHYLOCOCCUS
PIGMENTS?
• St. aureus?
• Gold pigment
• St. epidermidis?
• White pigment
• St. saprophyticus?
• No pigment
What is the clue for RUSTY
COLORED SPUTUM?
• Strep. Pneumonia
– pneumococcus
Clues for GENERAL INFECTIONS
• Skin Infections?
• Say Staph. Aureus

• Throat Infections?
• Say Strep. Pyogenes

• Small Intestine Infections?
• Say E. coli
What disease is a NEUTROPHIL
DEFICIENCY & T,B cell deficiency?
• Job Syndrome:
• IL-4
• Hyper IgE
• What do they look like?
• Red hair
• Fair complexion
• Female
What are the NEUTROPHIL
DEFICIENCY?
• NADPH-OXIDASE DEF (CGD)
• NEUTROPENIA
• MYLOPEROXIDASE
• Job-Buckley Syndrome
What Hepatitis B antigen is found
with an acute/recent infection?
• HbC antigen
• HbS antigen

What Hepatitis B antigen &
antibody is found with an
acute/recent infection?

• HbC antigen
• HbS antigen
• HbC antibody
What Hepatitis B antigen is found
with Recent immunization within
the past 2wks?

• HbS antigen ONLY
What Hepatitis B antibody is found with Recent
immunization two wks after and can be due to
vaccination immunity from a long time ago?

• HbS antibody ONLY
What Hepatitis B antibody &
antigen is found with past disease
but now immune?

• HbC antibody
• HbS antibody
• HbS antigen
What Immunogloblin is found in
Hepatitis B immunity?

• IgG
What Hepatitis B antigen/antibody
is found in the chronic carrier
state?

• HbS antigen for >6months
• Can be with or without HbS antibody
What Hepatitis B antigen is found
with the infectious state?

• HbE antigen
What Hepatitis B antibody is found
with the non-infectious state?

• HbE antibody
If patient has recovered from
Hepatitis B what antigen will they
have?

• NEGATIVE HbS antigen
If patient is a chronic carrier what
antigen will they have?

• POSITIVE HbS antigen
What does the “window period”
build in Hepatitis B?

• HbE antibody
• IgM HbC antibody

• What disappears?
• HbS antigen


What is the incubation period for
Hepatitis B?

• 4 to 26 wks
• Average @ 8wks

How long is the acute disease
period in Hepatitis B?

• 4 to 12 wks
How long is the convalescence
period in Hepatitis B?

• 4 to 20 wks
How long is the recovery period for
Hepatitis B?

• YEARS
Answer the following about HIV?
• MC infection?
• CMV
• MCC of death?
• PCP
• What is p41 used for?
• Just a marker
Answer the following questions
about HIV?
• What does Gp120 do?
• Attachment to CD4
• What is Pol used for?
• Integration
• What is reverse transcriptase used for?
• Transcription
• What are p17 & p24 antigens used for?
• Assembly

Answer the following questions
about HIV?
• What is the normal CD4 count?
• 800-1200
• What can the CD4 count be up to in children?
• 1500
• When do you begin treating with 2 nucleotide
inhibitors and 1 protease inhibitor?
• <500
– (child at 750)
Answer the following questions
about HIV?
• AIDS is defined as a CD4 count of what?
• <200
• With a CD4 count of <200 what do you tx
for?
• PCP
• What do you treat for when CD count is
<100?
• Mycobacterium aviam intracellular
What are the Antioxidants?
• Vitamin E
– #1
• Vitamin A
• Vitamin C
• Betakertine
What is Vitamin A a cofactor for?
• Parathyroid

• Along with what other cofactor?
• Mg+
Too much Vitamin A will cause
what?
• Hyperparathyroid
– Increase Ca+
– Decrease Phosphate
• What will be the symptoms?
• Goans
• Moans
• Bones
• Stones
Too much Vitamin A will cause
what?
• Pseudotumor Cerebri
– Increase CSF production from Chorichoid
Plexus
What is the only cause of ICP that
does not cause herniation?
• Pseucotumor cerebri
What does Vitamin A deficiency
cause?

• Nightvision problems/nightblindness

• Hypoparathyroidism
– Decrease Ca+
– Increase Phosphate
What is Vitamin B1?
• THIAMINE

• What do you get with a decrease in thiamine?
• Beri Beri

• What is the most common cause in US?
• ETOH
What do you get with Vitamin B1
deficiency?
• Wet Berry Berry
• With heart failure

• Dry Berry Berry
• Without heart failure
What do you get with Vitamin B1
deficiency?
• Wernicke’s Encephalopathy

• Wernicke’s Korsakoff
What is Wernicke’s
Encephalopathy?

• Alcoholic thymine deficiency of the
Temporal Lobe
What is Wernicke’s Korsakoff?

What needs B1 as a Cofactor?
• 3 Dehydrogenases
• Pyruvate dehydrogenase
• Alpha ketoglutarate dehydrogenase
• Branch chain amino acid dehydrogenase

• Transketolase
What is B2
• Riboflavin

• What is a physical sign of this deficiency?
• Angular stomatitis
• Angular cheliosis
• Corneal Neurovasculazations
What is the best source of B2?
• Milk
• Also from FAD
What is B3?
• Niacin

• What is the clue?
• Diarrhea
• Dermatitis
• Dementia
• Death
What is the disease that presents
like B3 deficiency?
• Hartnup Disease

• What is deficient in this disease?
• Tyrptophan

• What is typtophan needed for?
• Needed for niacin formation
What is B4?

• Lipoic acid

• What is the deficiency caused by this
vitamin?
• Not one
What is B5?
• Pantothenic acid

• What is the deficiency caused by this
vitamin?
• You guessed it…nothing
What is B6?
• Pyridoxine

• What is the deficiency caused by this vitamin?
• Neuropathy
• Seizures

• Who do you need to give B6 to?
• Patient on INH
What type of anemia is seen with
B6 Deficiency?
• Sideroblastic
What needs B6 as a cofactor?
• ALL transaminases
What is B12?
• Cyanocobalamine

• What is the deficiency caused by this
vitamin?
• Pernicious anemia
• Neuropathy
What is the most common cause of
vitamin B12 deficiency?
• Pernicious anemia
What 2 enzymes are needed for
synthesis of B12?
• Methylmalonyl CoA Mutase
• Homocysteine Methyl Transferase
Deficiency in Methylmalonyl CoA
Mutase leads to what?

• Neuropathy

• Why?
• Because it recycles myelin
Deficiency in Homocystiene Methyl
Transferase leads to what?
• Megaloblastic anemia

• What else is this enzyme needed for?
• Nucleotide synthesis
When is ANGULARE STOMATOSIS
seen?
• VITAMIN B2- RIBOFLAVIN deficiency
What are the 4 D’S of pellegra?
• DIARRHEA
• DERMATITIS
• DEMENTIA
• DEATH
What causes a
NEUROPATHY WHEN
DEFICIENT & also needs
TRANSAMINASE?
• PYRIDOXINE B6
What vitamin is deficient
with PERNICIOUS ANEMIA
& NEUROPATHY?
• B12 CYANOCOBALAMINE
What is the first vitamin to run out
with disease of rapidly dividing
cells?

• Folate


What type of anemia is seen with
Folate deficiency?
• Megaloblastic anemia

• With neuropathy?
• NO NEUROPHATHY

• What else is Folate used for?
• Nucleotide synthase (THF)
What is another name for Vitamin
C?
• Ascorbate acid
What is Vitamin C needed for?
• Collagen synthesis
What happens with Vitamin C
deficiency?
• Scurvy

What is the CLUE for Scurvy?
• Bleeding gums
• Bleeding hair follicles
What is the most common cause of
Vitamin C deficiency?
• Diet deficient in citrus fruit
• Diet deficient in green vegetables
• Over cooked green vegetables

What does Vitamin D do with Ca+?
• Controls Ca+
• Absorbes Ca+ from GI
• Reabsorbs Ca+ in Kidneys

• Controls osteoblastic activity
What does Vitamin D deficiency
cause in Children?
• Ricketts

• What does it cause in ADULTS?
• Osteomalcia
What is the CLUE for RICKETTS?
• Lateral Bowing of the Legs
• X-linked dominant
What is Vitamin E needed for?
• Hair
• Skin
• Eyes
• Protection against free radicals
• #1 antioxidant
What does a deficiency of Vitamin
E cause in newborns?

• Retinopathy
What are the vitamins from GI that
are normal flora?
• Folate
• Vitamin K
– 90%
• Biotin
• Panothenic acid
• Helps with absorption of B12

What are the Vitamin K dependent
clotting factors?
• 1972
• Protein C
• Protein S

• Which one has the shortest half-life?
• Protein C

• Which one has the 2
nd
shortest half-life?
• 7
What are the TRACE elements?
• Chromium
• Selenium
• Manganese Molebdenum
• Tin



What is Chromium needed for?
• Insulin action
What organ needs Selenium?
• Heart
What trace element is an enzyme
in glycolsis?
• Manganese Molebdenum

What organ needs Tin?
• Hair
What does a deficiency in Zinc
cause?
• Dysguzia
• Decrease sperm
• Dry hair
• Dry skin
Cofactor for ALL Kinases?
• Mg+
Cofactor for ALL Carboxylases?
• Biotin
Cofactor for ALL Transaminases?
• Pyridoxine
– B6
What is Biotin a cofactor for?
• ALL carboxylases
What is Mg+ a cofactor for?
• ALL kinases
• Parathyroid along with Vitamin A
What is Ca+ needed for?
• Muscle contraction
• Axonal transport
• 2
nd
messengers
What tracts are affected due to
deficiency in Methyl Malonyl CoA
Mutase?

• Dorsal Columns
• Cortical Spinal Tracts

• Why are these affected?
• Because they are the longest
• Because they need the most myelin
What enzyme does Zanthein
Oxidase need?

• Maganese Molebdenum
How are drugs that are bioavailable
ALWAYS excreted?
• By the liver
• Always Hepatotoxic
How are soluble drugs ALWAYS
excreted?
• By the kidney
• Always nephrotoxic
What are the 5 P’S OF
COMPARTMENT SYNDROME?
• Pain
• Pallor
• Paresthesia
• Pulselessness
• Poikilothermia

What are 5 skin infections were
Strep. Pyogenes is the number
one cause?
• Lympangitis
• Impetigo (not bullous)
• Necrotizing fascitis
• Erysepelas
• Scarlet fever
What are 5 skin infections were
Staph. aureus is the number two
cause?
• Lympangitis
• Impetigo (not bullous)
• Necrotizing fascitis
• Erysepelas
• Scarlet fever

What is the #1 bacteria causing
infection associated in shunts and
central lines?

• Staph epidermitis
What is the #1 bacteria causing
infection in peripheral lines?
• Staph aureus
Why do we need E. COLI in the
gut?
• Absorption of Vit. B12
• Synthesis of:
• -Vitamin K
• -Biotin
• -Folate
• -Pantothenic acid
– B5
Answer the following questions
about RESTRICTION ENZYMES?
• Trypsin cuts where?
• cuts to R of
• Arg
• Lys

• Chymotrypsin cuts where?
• cuts to R of bulky aa’s (aromatics)
• Phe
• Tyr
• Trp
Answer the following questions
about RESTRICTION ENZYMES?
• Elastase cuts where?
• Cuts to R of (“SAG”)
• Ser
• Ala
• Gly

• CNBr cuts where?
• Cuts to R of
• Methionine

Answer the following questions
about RESTRICTION ENZYMES?
• Mercaptoethanol cuts where?
• Cuts to R of: disulfide bonds
– Cysteine
– methionine
Answer the following questions
about RESTRICTION ENZYMES?
• Aminopeptidase cuts where?
• Cuts to R of
• amino acid terminal

• Caboxypeptidase cuts where?
• Cuts to L of
• carboxy terminal
What is THE ONLY LIVE VACCINE
INDICATED IN AIDS PATIENTS?
• MMR
What VACCINE is NOT GIVEN IF
pt. is Allergic to EGG?
• MMR & INFLUENZA
What VACCINE is NOT GIVEN IF
patient HAS YEAST ALLERGIES?
• Hepatitis B
What 3 VACCINES DROP OUT
AFTER 6 YEARS OF AGE?
• Hib
• Diphtheria
• Pertussis

What is the MC STRAIN OF STREP
PYOGENES TO CAUSE GN?
• Strain 12
What 2 substances are in
NEUTROPHILS?
• Myeloperoxidase
• NADPH Oxidase
MACROPHAGES CONTAIN what
SUBSTANCE?
• NADPH Oxidase

• Which means they only kill what?
• Kills only G -ve
What do MACROPHAGES SECRETE?
• IL-1
• IL-6??
What DRUGS CAUSE PAINFUL
NEUROPATHY?
• DDI>DDC
• Pancreatitis
What are the MITOCHONDRIAL
DISEASES?
• Leigh’s Disease
• What is another name?
• Subacute necrotizing encephalomyelopathy
• What are the signs & symptoms?
• Progressively decreasing IQ
• Seizure
• Ataxia
• What is the deficiency?
• Cytochrome oxidase deficiency
What are the MITOCHONDRIAL
DISEASES?
• Leber’s Hereditary Optic Atrophy (LHON)
• They all die



What is the ONLY G +ve WITH
ENDOTOXIN?
•Listeria

• What part is toxic?
• Lipid A

• Does it cross the placenta?
• Yes

What does Listeria activate?


• T-cells & Macrophages, therefore, have
granulomas

What are the Associations in
contracting the Listeria bug?

• Raw cabbage
• Spoiled milk
• Migrant workers
What are the PERIODS OF RAPID
GROWTH/RAPIDLY DIVIDING
CELLS?

• Birth – 2 months
• 4 – 7 years old
• Puberty
What is THE ONLY IMMUNE
DEFICIENCY WITH LOW CALCIUM
and Increase Phosphate?
• DiGeorge’s Syndrome

What are the BASIC AMINO ACIDS?
• Lysine
• Arginine
What are the ACIDIC AMINO
ACIDS?
• Glutamate
• Aspartate
What are the Ketogenic +
Glucogenic Amino Acids?
• Phenylalanine
• Isoleucine
• Trptophan
• Threonine
What are the AROMATIC AMINO
ACIDS?
• Phenylalanin
• Tyrosine
• Tryptophan
What are the AMINO ACIDS with
DISULFIDE BONDS?
• Met
• Cyst
What are the “KINKY” AMINO
ACID?
• Proline
What are the SMALLEST AMINO
ACID?
• Gly
What are the AMINO ACIDS with
O-BONDS?
• Serine
• Threonine
• Tyrosine
What are the AMINO ACIDS with N-
BONDS?
• Asparagine
• Glutamine
What are the BRANCHED-CHAIN
AMINO ACIDS?
• Leu
• Iso
• Val
What are the KETOGENIC AMINO
ACIDS?
• Leu
• Lys
What CONDITIONS are
ASSOCIATED WITH
HLA-B27?
• Psoriasis (with arthritis)
• Ankylosing Spondylitis
• Irritable Bowel Syndrome
• Reiter’s Syndrome
What is associated with HLA-B13?
• Psoriasis with out arthritis
What are the ORGANISMS WITH
IgA PROTEASE (resistant to IgA)?
• Strep. Pneumoniae
• H. influenza
• Neisseria catarrhalis

What do EOSINOPHILS SECRETE?
• Histaminase
• Arylsulfatase
• Heparin
• Major Basic Protein
What do MAST CELLS SECRETE?
• In an Acute Reaction?
• Histamine

• In a Late Reaction ?
• SRS-A
• ECF-A
What is the MCC of ATYPICAL
PNEUMONIA?
• 0 – 2 months?
• chlamydia pneumonia


What does chlamydia pneumonia
cause?
• Intersitital pneumonia
What is the CLUE for HEART
BLOCK?
• High temperature with NORMAL pulse
rate!

(This should never be! Each degree ↑ in temp. → 10
beats/min ↑ in pulse rate)
What are the clues for IL-1?
• FEVER
• NONSPECIFIC ILLNESS
• RECRUITS TH CELLS for LINKING with
MHC II COMPLEX
• SECRETED BY MACROPHAGES
What are the clues for IL-2?
• MOST POTENT OF THE Interleukins
• RECRUITS EVERYBODY
• MOST POWERFUL CHEMO-ATTRACTANT
• MUST BE INACTIVATED
• When must you inactivate it?
• PRIOR TO TRANSPLANTATION
by cyclosporin
• SECRETED BY TH1 CELLS
What are the clues for IL-3?
• ENERGIZED MACROPHAGES
• CAUSES B-CELL PROLIFERATION
• LABELED BY THYMIDINE (USE POKEWEED
MITOGEN OR ENDOTOXIN)
• SECRETED BY ACTIVATED T CELLS
What are the clues for IL-4?
• B-CELL DIFFERENTIATION
• RESPONSIBLE FOR CLASS SWITCHING
• SECRETED BY TH2 CELLS
What are the clues for IL-5 thru
14?
• They do exactly what IL-1 thru IL4

What are the clues for IL-10?
• SUPPRESSES CELL-MEDIATED RESPONSE
(tells macrophages and fibroblasts to stay
away if bacterial)
• INHIBITS MAC ACTIVATION
What are the clues for IL-12?
• PROMOTES CELL-MEDIATED RESPONSE
(recruits macs & fibroblasts if NOT bacterial)
• ACTIVATES NK CELLS TO SECRETE IF-γ
• INHIBITS IL-4 INDUCED IgE SECRETION
• CHANGES TH CELLS to TH1 CELLS
– secretes IL-2 & IF-γ → inhib. TH2, therefore, ↑ host
defenses against delayed hypersensitivity
What are the clues for IF-α?
• Where is it from?
• LEUKOCYTES
• ↓VIRAL REPLICATION AND TUMOR GROWTH
• ↑ NK ACTVITY
– secretes perforins and granzymes to kill infected cell
• ↑MHC CLASS I & II EXPRESSION
• ↓ PROTEIN SYNTHESIS
– translation inhibited, therefore, defective protein
synthesis
Summary of clues for IF-α?
• Increase NK activity
• Increase MHC class I & II
• Decrease protein synthesis
• Decrease viral replication and growth
What are the clues for IF-B?
• Where is it from?
• FIBROBLASTS
• Increase NK activity
• Increase MHC class I & II
• Decrease protein synthesis
• Decrease viral replication and growth


What are the clues for IF-gama?
• Where is it from?
• T-CELLS & NK CELLS
• ↑ NK ACTIVITY
• ↑MHC CLASS I & II
• ↑ MACROPHAGE ACTIVITY
• CO-STIMULATES B-CELL GROWTH &
DIFFERENTIATION
• ↓ IgE SECRETION
What are the clues for TNF-alpha?
• Where is it from?
• MONOCYTES & MACROPHAGES
• What is another name for TNF-alpha?
• CACHECTIN
• INDUCES IL-1
• ↑ ADHESION MOLECULES & MHC CLASS I ON
ENDOTHELIAL CELLS
• PYROGEN
• INDUCES IF-γ SECRETION
• CYTOTOXIC/CYTOSTATIC EFFECT
What are the clues for TNF-beta?
• Where is it from?
• T-CELLS

• What is another name for it?
• LYMPHOTOXIN

• CYTOTOXIC FACTOR
What are the clues for TGF-α?
• Where is it from?
• SOLID TUMORS (CARCINOMA >
SARCOMA)
• MONOCYTES

• What is another name for it?
• TRANSFORMING GROWTH FACTORS

What are the clues for TGF-α?
• What does it INDUCE?
• ANGIOGENESIS
• KERATINOCYTE PROLIFERATION
• BONE RESORPTION
• TUMOR GROWTH

• What is it mainly for?
• MAINLY FOR TUMOR GROWTH

What are the clues for TGF-β?
• Where is it from?
• PLATELETS
• PLACENTA
• KIDNEY
• BONE
• T & B CELLS

What are the clues for TGF-β?

• What INDUCES it?
• FIBROBLAST PROLIFERATION
• COLLAGEN
• FIBRONECTIN SYNTHESIS
What are the clues for TGF-β?
• What INHIBITS it?
• NK
• LAK
• CTL
• T & B CELL PROLIFERATION
What are the clues for TGF-β?
• What ENHANCES it?
• WOUND HEALING
• ANGIOGENESIS

What are the clues for TGF-β?
• What does it suppress?
• SUPPRESSES IR AFTER INFECTION &
PROMOTES HEALING PROCESS

• What is it mainly for?
• MAINLY FOR WOUND HEALING
What does LAK stand for?
• LYMPHOKINE ACTIVATED KILLER CELLS
What does CTL stand for?
• CYTOTOXIC T-LYMPHOCYTES
What does mitochondrial
inheritance affect?
• CNS
• Heart
• Skeletal muscle

• Why does it affect these particular places?
• Due to uneven cytokinesis during meiosis
or oogenesis
Answer the following about
Mitochondrial diseases?
• Who are affected?
• All offspring

• Who passes the disease?
• MOM

• Who has no transmission?
• Dad
Answer the following about
Autosomal Recessive inheritance?
• Who does it show in?
• Not parents
• Siblings/uncles may show disease

• When is onset?
• Early in life (childhood diagnosis)

• Is it complete on incomplete penetrance?
• COMPLETE
Answer the following about
Autosomal Recessive inheritance?
• How are they acquired?
• Almost ALL are inborn error of metabolism

• When does it occur?
• Only when both alleles at a locus are
mutant

Answer the following about
Autosomal Recessive inheritance?
• How is it transmitted?
• Horizontal Tm

• Are there malformations present?
• Physical malformations are uncommon

• What type of defect?
• Enzyme defect
Answer the following about
Autosomal Dominant inheritance?
• Who does it affect the most?
• M=F

• How does it manifest?
• Heterozygote state

• Who can transmit the disease?
• Both parents
Answer the following about
Autosomal Dominant inheritance?
• Where is the new mutation?
• Often in germ cells of older fathers

• When is onset?
• Often delayed (adult diagnosis)
– Example = Huntington’s
Answer the following about
Autosomal Dominant inheritance?
• What is penetrance?
• Reduced penetrance

• How is it expressed?
• Variable expressin
– Different in each individual
Answer the following about
Autosomal Dominant inheritance?
• How is it transmitted?
• Vertical TM

• Is there malformation present?
• Physical malformation common

• What type of defect?
• Structural
Who is affected in the family with
an X-Linked disease?

• Maternal grandfather
• Maternal uncle
Immune System Time Line for viral
& cell-mediated.
• What happens <24hrs?
• Swelling

• What happens at 24 hrs?
• Neutrophils show up

• What happens at day 3?
• Neutrophils peak
Immune System Time Line for viral
& cell-mediated.
• What happens at day 4?
• T cells and Macrophages show up

• What happens at day 7?
• Fibroblasts show up

• What happens in 1 month?
• Fibroblast peak
Immune System Time Line for viral
& cell-mediated.
• What happens at 3-6 months?
• Fibroblasts are gone
What is the general CLUE for any
Lysosomal Storage Disease?

• Lysosomal Inclusion Bodies
What are the Lysosomal Storage
diseases?
• Gauchers
• Fabrys
• Krabbe
• Tay Sachs
• Sandhoffs
• Hurlers
• Hunters
• Neiman Pick
• Metachromatic Leukodystropy
What is missing in Gauchers?
• Beta-Glucocerberosidase

• What Accumulates?
• Glucocebroside

• Where?
• Brain
• Liver
• Bone Marrow
• Spleen
What are the CLUES for Gauchers?
• Ask. Jew
• Gargols
• Gaucher cells
– Macrophages looking like Crinkeled paper
• Erlin myoflask legs
• Pseudohypertrophy

What is missing in Fabrys?
• Alpha-galactosidase

• What accumulates?
• Ceramide Trihexoside
What are the CLUES for Fabrys?
• X-Linked recessive
• Presents with cataracts as a child
• Presents with renal failure as a child
What is missing in Krabbes?
• Galactosylceramide B-Galactosidase

• What accumulates?
• Galactocerebrosidase

• Where?
• Brain
What are the CLUES for Krabbes?
• Early death
• Globoid bodies
– Fat cells
What is missing in Tay Sachs?
• Hexoseaminidase A

• What accumulates?
• GM2 Ganglioside


What is the CLUE for Tay Sachs?
• Ask. Jews
• Cherry red macula
• Death by 3
What is missing in Sandhoffs?
• Hexoseaminadase A & B
What is missing in Hurlers?
• Iduronidase
What are the CLUES for Hurlers?
• Corneal Clouding
• Mental Retardation
What is missing in Hunters?
• Iduronate Sulfatase
What are the CLUES for Hunters?
• Mild mental retardation
• No corneal clouding
• Mild form of Hurlers
• X-linked recessive
What is missing in Niemann Picks?
• Spingomyelinase

• What accumulates?
• Spingomyelin
• Cholesterol
What are the CLUES for Niemann
Picks?
• Zebra bodies
• Cherrry red macula
• Die by 3
What is missing in Metachromatic
Leukodystrophy?
• Arylsulfatase A
What is the CLUE for
Metachromatic Leukodystrophy?
• Visual Disturbance
• Presents like MS in 5 to 10 years of age
What are the Glycogen Storage
Diseases?
• Von Gierkes
• Andersons
• Corys
• McCardles
• Pompes
• Hers
What is deficient in Von Gierkes?
• G-6-Pase Deficiency
What is the CLUE for Von Gierkes?
• Big Liver
• Big Kidney
• Severe hypoglycemia
• Can NEVER raise their blood sugar

What is deficient in Andersons?
• Branching enzyme deficiency
What is the CLUE for Andersons?
• Glycogen will be ALL LONG chains on liver
biopsy
What is missing in Corys?
• Debranching enzyme
What is the CLUE for Corys?
• Glycogen from liver biopsy will be ALL
SHORT branches
What is missing in McCardles?
• Muscle phosporalase
What is the CLUE for McCardles?
• Severe muscle cramps when exercising
• High CPK
What is missing in Pompes?
• Cardiac alpha-1,4 glucocydase
What is the CLUE for Pompes?
• Heart problems
• Die early
What is missing in Hers?
• Liver phosphoralase
What is the CLUE for Hers?
• Big Liver
• NO big kidney
Pagets disease is associated with
what cancer?
• Intraductal Ca
What MUST you rule out with a
decrease AVO2?

• AV Fistula
• Vasodilation
What diseases have a cherry red
macula?

• Tay Sachs
• Sandhoffs
• Niemann Pick
What is translocation 9;22?
• CML
What is translocation 11;22?
• Ewing’s sarcoma
What is translocation 8;14?
• Burketts lymphoma
What is translocation 14;18?
• Follicular lymphoma
What are the causes of restrictive
cardiomyopathy?
• Sarcoid
• Amyloid
• Hemochromatosis
• Cancer
• Fibrosis

• Thanks STAN!!
What are the CLUES for Vasulitis or
Intravascular Hemolysis?
• Shistocytes
– Burr cells
– Helmet cells
What is the CLUE for Extravascular
Hemolysis?
• Splenomagely
Where is Glucose 6-Pase present?
• Adrenal
• Liver
What is the Heinz body CLUE?
• G6PD
If you see the CLUE basophilic
stippling, what should you be
thinking?

• Lead poisoning
What are the Microcytic
Hypochromic Anemias?
• Iron deficiency
• Anemia of Chronic disease
• Lead poisoning
• Hemoglobinopathy
• Thallasemia’s
• Sideroblastic anemia




What is primary sideroblastic
anemia due to?
• Genetic
• AD
What is secondary Sideroblastic
anemia due to?
• Blood transfusions
What are the Microcytic
Hyperchromic Anemia’s?
• Hereditary Spherocytosis
What are the Normocytic
Normochromic Anemia’s?
• Acute hemorrhage
• Anemia of Chronic Disease
• Hypothyrodism
– Early
• Renal Failure


What are the Macrocytic anemia’s?
• Folate deficiency
• B12 deficiency
• Reticulocytosis
• ETOH
• Hemolytic Anemias
• Chemo Treatment
• Anticonvulsants
• Myelodysplasia
What are the anticonvulsants
causing a Macrocytic Anemia?
• Phenytoin
• Ethusuximide
• Carbamyazapine
• Valproate
What anemia is caused by blood
transfusions?
• Sideroblastic anemia
What is the problem if you see
Eliptocytes?
• Something is wrong with the RBC
membrane
– Extravascular
• Heridatary Ellitocytosis
• Increased RET count
What disease do you get if you
have an EXCESS in Cu+?
• Wilson’s Disease
What is the CLUE for Wilson’s
Disease?
• Hepato/Lenticular Degeneration
• Kayser Fleishner Rings
– Copper in eyes

• Hepato = Liver
• Lenticular = Movement problem
What is Copper needed for?
• Collagen synthesis
What disease manifest with Cu+
deficiency?
• Minky Kinky Hair Syndrome
What are the plasma
catecholamines?
• Epinephrine
• Norepinephrine
• Dopamine
What are Plasma Catecholamines
derived from?
• Tyrosine
A patient with episodic HTN leading to
headache with arrhythmias leading to
palpitations most likely is diagnosed with?

• Adrenal Pheochromocytoma
What is the MOA for
Fluroquinolones?
• Blocks DNA gyrase (topoisomerase II)
• Inhibits p450

What do Fluroquinolones cover?
• All Gram + including staph auerus
• All Gram –
• Atypicals

What are the atypicals?
• Chlamydia
• Ureoplasma
• Mycoplasma
• Legionella



What induces Gluconeogensis?
• Cortisol
• Epinephrine
• Glucagon
What is Dermatan Sulfate?
• Glycosaminoglycan chain that helps form
proteoglycans
What is Hyaluronic Acid?
• Glycosaminoglycan chain that helps form
proteoglycans
What is the MOA of Methotrexate?
• Inhibits dihydrofolate reductase
• Inhibits DNA synthesis in the S phase of
cycle.
• Prevents reduction of folic acid needed to
produce THF

What are THF derivatives used in?
• Purine nucleotide synthesis
• Methylation of dUMP to for dTMP
What happens when Dihydrofolate
Reductase is inhibited?
• Obstructs one carbon methylation which
deprives DNA polymerase of essential
substrates
What diseases present as Failure to
Thrive?

• CF
• Galactosemia
In general, what should you always
associate Hemolytic Anemia’s with?

• Defects in Glycolysis
• Defects in Hexose Monophosphate Shunt
What is required for the conversion
of Homocysteine to Methionine?

• B12
What is required for the conversion
of methylmalonyl CoA to Succinyl
CoA?

• B12
What is required for the
degradation of cystathionine?
• Vitamin B6
What does the hydroxalation of
Purines require?
• Vitamin C
When does the carboxyalation of
Glutamic acid occurs and what is
required for this carboxyalation?

• Occurs in the synthesis of Blood Clotting
factors
• Requires Vitamin K
Decarboxylation of alpha-ketoacids
requires what?

• Thiamine
Synthesis of 1,25-d-
hydroxycholecalciferol requires
what?

• Vitamin D
Synthesis of Rhodopsin requires
what?

• Vitamin A
Pyruvate Decarboxylase requires
what as a cofactor?
• Thiamine
What is CN1?
• Olfactory
• What is its function?
• Sensory for smell
• What if lesioned?
• Anosmia
• Where does it Exit/Enter the Cranium?
• Cribriform plate
• What does it innervate?
• Nasal Cavity


What is CN2?
• Optic
• What is its function?
• Sensory for sight
• What if lesioned?
• Anopsia
– Visual field defect
• Loss of light reflex with CN III
• Only nerve affected by MS
Cont. CN2
• Where does it Exit/Enter the Cranium?
• Optic Canal

• What does it innervate?
• Orbit
What is CN3?
• Occulomotor
• What are the functions?
• Motor
• Moves the eyeball in ALL directions
• Adduction Most important action (MR)
• Constricts the pupil (Spincter Pupillae)
• Accomodates (Cililary Muscle)
• Raises eyelid (Levator Palpebrae)

Cont. CN 3
• What if lesioned?
• Diplopia
• Loss of parallel gaze
• Dilated pupil
• Loss of light reflex
• Loss of near response
• Ptosis

Cont. CN 3
• Where does it Exit/Enter the Cranium?
• Superior Orbital Fissure

• What does it innervate?
• Orbit
What is CN 4?
• Trochlear
• What is its function?
• Motor
• Superior Oblique
• Depresses and abducts the eyeballs
• Intorts

Cont. CN 4
• What if lesioned?
• Weakness looking down w/ adducted eye
• Trouble going down stairs
• Head tilts away from lesioned side

• Where does it Exit/Enter the Cranium?
• Superior Orbital Fissure
Cont. CN 4
• What does it innervate?
• Orbit
What is CN 5?
• Trigeminal

What are the different branches of
CN 5?
• V1?
• Opthalmic

• V2?
• Maxillary

• V3?
• Mandibular

What is the function of CN V1?

• Mixed
• General sensation (touch, pain, temperature) of the
forehead, scalp, & cornea

• What if lesioned?
• Loss of general sensation of the forehead/scalp
• Loss of blink reflex w/ VII

• Where does it Exit/Enter the Cranium?
• Superior orbital Fissure
– Ophthalmic division
Cont. CN V1
• What does it innervate?
• Orbit
• Scalp
What is the function of CN V2?
• Mixed
• General sensation of Palat, Nasal cavity,
Maxillary face, and Maxillary teeth

• What if lesioned?
• Loss of general sensation in skin over
maxilla & maxillary teeth

Cont. CN V2
• Where does it Exit/Enter the Cranium?
• Foramen Rotundum

• What does it innervate?
• Pterygopalatine
– Leaves by openings to face, oral & nasal
cavity
What is the function of CN V3?
• What is its function?
• Mixed
• General sensation of anterior 2/3 of tongue,
mandibular face & mandibular teeth
• Motor
• Muscles of Mastication and anterior belly of
digastric, mylohyoid, tensor tympani, tensor
palati
Cont. CN V3
• What if lesioned?
• Loss of general sensation in skin over
mandible, mandibular teeth, tongue,
weakness in chewing
• Jaw deviation to weak side
• Trigeminal neuralgia
– Intractable pain in V2 or V3 territory
Cont. CN V3
• Where does it Exit/Enter the Cranium?
• Foramen Ovale

• What does it innervate?
• Infratemporal Fossa
What is CN VI?
• Abducens

• What is its function?
• Motor
• Lateral rectus
– Abducts eye
Cont. CN VI
• What if lesioned?
• Diplopia
– Internal strabismus
• Loss of parallel gaze
– Pseudoptosis

• Where does it Exit/Enter the Cranium?
• Superior orbital fissure

• What does it innervate?
• Orbit
What is CN VII?
• Facial
• What is its function?
• Mixed
• To muscles of facial expression
• Posterior belly of diagastric
• Stylohyoid & Stapedius
• Tastes anterior 2/3 of tongue/palate
• Salivates (submandibular & sublingual glands)
• Tears (Lacrimal glands)
• Makes mucous (nasal & palatine glands)
Cont. CN VII
• What if lesioned?
• Corner of mouth droops
• Can’t close eye
• Can’t wrinkle forehead
• Loss of blink reflex
• Hypeacusis
• Loss or alteration of taste (ageusia)
• Eye dry and red
• Bell Palsy
– Lesion of nerve in facial canal
Cont. CN VII
• Where does it Exit/Enter the Cranium?
• Internal Auditory meatus

• What does it innervate?
• Face
• Nasal & oral cavity
– Branches leave skull in stylomastoid foramen,
petrotympanic fissure, or Hiatus of facial canal
What is CN VIII?
• Vestibulocochlear

• What is its function?
• Sensory
• Hears
• Linear acceleration (Gravity)
• Angular acceleration (Head Turning)

Cont. CN VIII
• What if lesioned?
• Loss of Balance
• Nystagmus

• Where does it Exit/Enter the Cranium?
• Internal Auditory Meatus

• What does it innervate?
• Inner ear
What is CN IX?
• Glossopharyngeal

• What is its function?
• Mixed
• Sense Pharynx
• Carotid sinus/body
• Salivates (parotid glands)
• Tastes and senses posterior 1/3 of tongue
Cont. CN IX
• What is its function?
• To one muscle only (stylopharyngeus)

• What if lesioned?
• Loss of Gag Reflex with X

• Where does it Exit/Enter the Cranium?
• Jugular Foramen
Cont. CN IX
• What does it innervate?
• Neck
• Pharynx/Tongue
What is CN X?
• Vagus
• What is its function?
• Mixed
• To muscles of palate & pharynx for swallowing
except tensor palate (V) & Stylopharynegeus
(IX)
• To all muscles of Larynx (phonates)
• Senses Larynx & Laryngopharynx
• Senses Larynx & GI tract
• To GI tract smooth muscle & glands in forgut &
midgut
Cont. CN X
• What if lesioned?
• Nasal speech
• Nasal regurgitation
• Dysphagia
• Palate drop
• Uvula points away from pathology
• Hoarseness/fixed vocal cord
• Loss of gag reflex w/ IX
• Loss of cough reflex
Cont. CN X
• Where does it Exit/Enter the Cranium?
• Jugular Foramen

• What does it innervate?
• Neck
• Pharynx/Larynz
• Thorax/Abdo
CN X – Sympathetics to Head
• What is its function?
• Motor
• Raises eyelid (superior tarsal muscle)
• Dilates pupil
• Innervates sweat glands of face & scalp
• Constricts blood vessels in head
Cont. CN X
• What if lesioned?
• Horner syndrome
– Eyelid droop (ptosis)
– Constricted pupil (miosis)
– Loss of sweating (anhydrosis)
– Flushed face
Cont. CN X
• Where does it Exit/Enter the Cranium?
• Carotid canal on internal carotid artery

• What does it innervate?
• Orbit
• Face
• Scalp
What is CN XI?
• Accessory

• What is its function?
• Turns head to opposite side
– sternocleidomastoid
• Elevates & Rotates scapula
– Trapezius
Cont. CN XI
• What if lesioned?
• Weakness turning head to opposite side
• Shoulder droop

• Where does it Exit/Enter the Cranium?
• Jugular Foramen

• What does it innervate?
• Neck
What is CN XII?
• Hypoglossal

• What is its function?
• Moves tongue

• What if lesioned?
• Tongue points toward pathology on protrusion
What is CN XII?
• Where does it Exit/Enter the Cranium?
• Hypoglossal Canal

• What does it innervate?
• Tongue


What are the muscles of
mastication?
• Temporalis
• Masseter
• Medial Pterygoids
• Lateral Pterygoids
What part of the brain deals with
problem solving?
• Frontal Lobe
What happens if there is a lesion to
the Optic nerve?
• Unilateral Blindness

What happens if there is a lesion to
the Optic Chiasm?
• Bitemporal Hemianopia
What is a Berry Aneurysm due to in
the Circle of Willis?
• SUBARACHNOID Hemorrhage
What is a CLUE for
SUBARACHNOID Hemorrhage?
• The worse headache of my life
What effect does Pernicious
Anemia have on the nervous
system?

• Causes degeneration of the posterior
columns
• Causes degeneration of the CST
• Loss of proprioception
• Upper motor neuron defect
What does the diencephalon
originate from?
• Forebrain
What originates from the
Diencephalon?
• Thalamus
• 3
rd
Ventricle
Where does the Telencephalon
originate from?
• Forebrain
– Prosencephalon
What originates from the
Telencephalon?
• Cerebral Hemispheres
• Lateral Ventricles
What originates from the
Mesencephalon?
• Midbrain
• Aqueduct
What originates from the
Hindbrain?
• Metencephalon
• Myerencephalon
What originates from the
Metencephalon?
• Pons
• Cerebrum
What originates from the
Myerencephalon?
• Medulla
What does the Jugular Foramen
contain?
• CN IX
• CN X
• CN XI
• Internal Jugular Vein
• Spinal accessory nerves
What does the Foramen Spinosum
contain?
• Middle menningeal artery
– Branch of the maxillary artery
What does the Foramen Ovale
contain?

• CN V3
What does the Foramen Magnum
contain?
• Vertebral arteries
• Brain stem
• Spinal roots of CN XI
• Spinal cord
What does the Optic Canal contain?

• Opthalmic artery
• Central retinal vein
• CN II
What does the Hypoglossal Canal
contain?
• CN XII
• Hypoglossal nerve
What does the Carotid Canal
contain?
• Internal Carotid artery
What does the Posterior Condylar
Canal contain?

• Large Emissary Vein
What are signs of an UPPER motor
neuron damage?
• + Babinski sign
• Spastic Paralysis
• Hyperactive Deep Tendon Reflexes
What are signs of a lower motor
neuron defect?

• Atrophy
• Fasciullations
• Flaccid Paralysis
• Loss of deep tendon reflexes
What does it mean to see a physis
on radiograph?
• Means the skeleton is not fully mature
When does Physis disappear?
• Once growth is complete
What is a nonunion fracture?
• Fracture that does not heal with in 6
months
What does Malunion mean?
• A fracture that heals in an Abnorman
position
What is a characteristic feature of
cancellous (spongy) bone?
• Trabeculae
Which CN’s control eye movement?
• CN III
– Oculomotor nerve
• CN IV
– Trochlear nerve
• CN VI
– Abducens nerve
What CN is responsible for turning
the head and shrugging the
shoulders?

• CN XI
– Accessory nerve
What CN has sensory fibers for
Face and Motor fibers for muscles
of mastication?

• CN V
– Tigeminal Nerve
What CN controls tongue
movement?

• CN XII
– Hypoglossal nerve
What CN controls sensory fibers for
Vison

• CN II
– Optic nerve

What CN senses fiber for smelling?
• CN I
– Olfactory
What does the Mesenteric Artery
Supply?

• Distal 1/3 of transverse colon
• Descending colon
• Sigmoid colon
• Upper Portion of Rectum
What does the Superior Mesenteric
Artery Supply?
• Duodenum
• Jejunum
• Ileum
• Cecum
• Appendix
• Ascending colon
• Proximal 2/3 of transverse colon
What does the common Iliac artery
supply?

• Pelvis
• Perineum
• Leg
What does the Celiac trunck give
rise to?
• Left gastric artery
• Splenic artery
• Common hepatic artery
What do the Left. Gastric Artery,
Splenic Artery, & Common Hepatic
artery supply?

• Esophagusa
• Stomach
• Duodenum
• Liver
• Gallbladder
• Pancreas
If there is a lesion in the frontal
lobe will you have motor or sensory
defects?

• Motor
If patient has a visual field defect
with cognitive Distrubance, what
part of the brain will be affected?

• Temporal or Partial Lobe