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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 • Barbiturates
• Car Grabs Queens • Alcohol
Tets to Rev Up
• Alcoholic doing drugs
• Griseofulvin
and stinking up car • Carbamazapine
• Rifampin
• Quinidine
• Tetracycline
• Sulfa drugs
What drugs Inhibit p450?
• I Do SMACK • INH
Quinolones • 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 • PKU
• Check • CAH(Congential
• Before Adrenal
Hyperplasia)
• Going
• Home • 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 • Salmonella
• Strange • Strep. Pneumo
• Killers (gr+)
• Have
• Klebsiella
• Pretty
• Nice
• H. influenza
• Capsules • 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 • 2 hrs
• Peaks • 2 days
• Gone • 7 days
What is the 2
nd
MI enzyme
to appear?
• CK-MB
• Appears • 6 hrs
• Peaks • 12 hrs
• Gone • 24 hrs
What is the 3 MI enzyme to
rd

appear?
• LDH
• Appears • 1 day
• Peaks • 2 days
• Gone • 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 • Decrease on
inspiration (^exp)
• TR • Increase on
inspiration
• VSD • Decrease on
inspiration (^exp)
Macrophages in various
organs
• Brain • Mircoglia
• Lung • Type I pneumocyte
• Liver • Kupffer cell
• Spleen • RES
• Kidney • Mesangial
• Lymph nodes • Dendritic
• Skin • Langerhans
• Bone • Osteoclasts
• CT • 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 2nd
messenger systems?
• cAMP
• cGMP
• IP3/DAG
• Ca:Calmodulin
• Ca+
• Tyrosine kinase
• NO
What is the clue for cAMP?

• It is the 90%
• Sympathetic
• CRH (cortisol)
• Catabolic
What is the clue for cGMP?

• Parasympathetic
• Anabolic
What are the clues for
IP3/DAG?
• Neurotransmitter
• GHRH
• All hypothalamic hormones xc
cortisol
• Used by what and for what?
• Smooth muscle for contraction
What is the clue for
Ca:Calmodulin?
• Used by smooth muscle for
contraction by distention
What is the clue for Ca+?

• Used by Gastrin only


What is the clue for Tyrosine
Kinase?
• Used by Insulins
• Used by ALL growth factors
What is the clue for NO?

• Nitrates
• Viagra
• ANP
• LPS
What are the T & B cell
deficiencies?
• WAS
• SCID
• CVID
• HIV
• HTLV-1
What are the CLUES for
WAS?
• Thrombocytopenia
• IL-4
• Infection
• 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 • α – galactosidase
• Krabbe’s • Galactosylceramide
• Gaucher’s • β – glucocerebrosidase
• Niemann – Pick • Sphingomyelinase
• Tay-Sachs • Hexosaminidase
• Metachromatic • Arylsulfatase
leukodystrophy • α – L – iduronidase
• Hurler’s • Iduronidase sulfatase
• Hunter’s
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 • Glucose – 6 –
phosphate

• Pompe’s
• α – 1 – 4 glucosidase
• Cori’s
• Debranching enzyme

• McArdle’s
• 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


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
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
• Viral first?

• 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

+ A B A+B

_ C D C+D

A+C B+D ALL

Sensitivity A/A+C Sensitivity: Truly Diseased People Always in the


Specificity D/B+D Specificity: Truly Well People numerator
PPV A/A+B + Predictive Value: Test +ve With DZ
NPV D/C+D
OR AD/BC - Predictive Value: Tested –ve w/o DZ A&D
OR: Odds Ratio
RR (A/All)/(C/All) RR: Relative Risk
AR (A/All)-(C/All) AR: Attributed Risk
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
• 2nd to show up in primary response
• Only one to show up for secondary respond
• Most abundant Ig in newborn
• Antigenic differences in heavy chain and site of
di-sulfide bond
• 4 subclasses G1 to G4
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?
• 3rd and 4th pharyngeal pouch
• What chromosome?
• Deletion on chromosome 22
T-CELL DEFICIENCY

• HIV
• Also B-cell but less so
What is MYCOSIS
FUNGOIDES?
• NOT A FUNGUS
• Non-Hodgkins form of cutaneous T-
cell lymphoma
What is the job of
CHYLOMICRONS?
• Transport TG’s from GI to liver and
endothelium
What is the job of VLDL?

• Transports TG’s from liver to adipose


What is the job of IDL?

• Transports TG’s from adipose to


tissue
What is special about LDL’s?

• ONLY ONE THAT CARRIES


CHOLESTEROL
What do you develop with
HYPERTRIGLYCERIDEMA?
• XANTHELASMA

• Where are they located?


• On eyelids and eyebrows
What do you develop with
HYPERCHOLESTEROLEMIA?

• Xanthomas

• Where are they located?


• elbows
Where is VLDL made?

• ONLY ONE MADE IN THE LIVER


What are IDL AND LDL formed
from?
• ARE BREAK DOWN PRODUCTS OF
VLDL
What are the clues for
HEMOPHILIUS INFLUENZA?
• Gram -/+?
• Pleomorphic gram (-) rods
• What pattern?
• “school of fish pattern”
• What type is most common?
• Type A
– 80%
What are the clues for
HEMOPHILIUS INFLUENZA?
• Capsule or no capsule?
• non-encapsulated
• Invasive or non invasive?
• non-invasive
What are the clues for
HEMOPHILIUS INFLUENZA?
• Most common cause of what?
• Sinusitis
• Otitis
• Bronchitis
What are the clues for
HEMOPHILIUS INFLUENZA?
• What is the 2nd most common type?
• TYPE B
– 20%
• Encapsulated or non encapsulated?
• Encapsulated
• What does it have in its capsule?
• Polyribosyl phosphate in capsule
• Contains IgA protease
What are the clues for
HEMOPHILIUS INFLUENZA?

• Invasive or non invasive?


• Invasive
• What does it cause most often?
• #1 cause of epiglottitis
• What are the signs of epiglottitis?
• Stridor
• Fever
• Thumb sign on xray
What are the most common
causes of MENINGITIS
corresponding with the
following ages?
• 0-2 months?
• #1. 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 2nd 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
• 2nd messengers
What tracts are affected due to
deficiency in Methyl Malonyl
CoA Mutase?

• Dorsal Columns
• Cortical Spinal Tracts

• Why are these affected?


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

• 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?
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
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
• 3rd 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