Pass Program Clues

Pass Program
Clues
You aint told me squat till you tell me the CLUE!!!
What are the 5 bacteria causing Heart Block?

Lyme Disease Salmonella typhii (typhoid) Chagas Disease (Whipples) Legionella Diptheria Lets Stop Doing Long Contractions
What bacteria cause Reiters Syndrome?

Shigella IBD Chlamydia Yersina Reiter & Crohn Saw Yersina and got
Chlamyia
Crohns
What are the Low Complement bugs causing Cryoglobuniemia? Influenzae Adenovirus Mycoplasma Hepatitis C EBV
I AM HE
What are the drugs induced SLE?

Hydralazine INH Phenytoin Procainamide Penicillamine Ethosuximide H I PPPE
What are the drugs that Blast the BM?

AZT Benzene Chloramphenicol Vinblastine Vinblastine Anilate Bone Cells
What are the Comma Shaped bugs?

Vibrio Campylobacter Listeria H. pylori Campylobacter Has Very Long
Comma Genes
What is the cresent shaped protozoa?

Giardia lamblia
What bacteria looks like Chinese letters?

Corynebacter
What are the TB Rx?

Rifampin Pyrazinamide INH Ethambutanol Streptomycin R E S P I
What are the 6 Low Complement assocs. with Nephrotic Syndrome?
Serum Sickness PSGN SLE SBE Cryoglobinemia MPGN II
What drugs Induce p450?

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

I Do SMACK
Quinolones
INH Dapsone Spirolactones Macrolides Amiodarone Cimetidine Ketoconazole Quinilones
What drugs are P450 Dependent?

Warfarin Estrogen Phenytoin Theophylline Digoxin Theo came from war & dig inside WDEPT
taking Estrogen & now is Phenytoin
What disease is a Neutophil Deficiency?

CGD
What is another name for CGD?

Chronic Granulomatous disease NADPH Oxidase deficiency
What are the Side effects of Statins?

Myositis Hepatitis Increased liver enzymes
What are the painful genital Lesions?

Chancroid Herpes Lymphogranuloma inguinale
What is the painful chancroid lesion due to?

Hemophilus ducreyi
What are the 4 hormones with disulfide bonds?

Prolactin Insulin Inhibin GH I PIG on BONDS
What are the Hookworms?

Necatur americanis Enterobius vermicularis Ankylostoma duodenale Trichuris trichurium Ascaris lumbercoides Strongyloides Hooks AS NEAT
What are the X-Linked enzyme Deficiencies?

G6-PD CGD Pyruvate dehydrogenase Def. Fabrys Hunters Lesch-nyhan Lesch-Nyhan Hunter Puts Fabrys on G6
Clothes
What diseases do we screen for at birth?

Please Check Before Going Home PKU CAH(Congential
Adrenal Hyperplasia) Biotinidase Galactosemia Hypothyroidism
HLA-Antigens
HLA-DR2= Narcolepsy, Allergy,
Goodpastures, MS HLA-DR3= DM, Chronic Active Hepatitis, Sjogrens, 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, Reiters, 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 CAs
In what diseases are Psammoa Bodies present?

Papillary carcinoma of the Thyroid Serous cystadenocarcinoma of the
ovary Meningioma Mesothelioma
What are the Urease (+) Bacteria?

Proteus Pseudomonas Ureaplasma urealyticum Nocardia species Cryptococcus neoformans H. pylori
What types of stones are formed from Proteus?

Struvite (90%)
What type of motility do Proteus have?

swarming
What are 5 indications of Surgery?

Intractable pain Hemorrhage (massive) Obstruction (from scarring) Perforation
What drugs cause Cardiac Fibrosis?

Adriamycin (Doxyrubicin) Phen-fen
What drug is used to tx cardiac fibrosis?

Dozaroxsin
What is the MCC of any . penia?

#1 = Virus #2 = Drugs
What is seen in the Salmonella Triad?

High Fever Rose spots (rash) Intestinal fire
What drugs cause Myositis?

Rifampin INH Predinsone Statins
What are the 7 Gram -encapsulated bacteria?

Some Strange Killers Have Pretty Nice Capsules
Salmonella Strep. Pneumo

(gr+) Klebsiella H. influenza Pseudomonas Neisseria Cryptococcus
What is the Jones Criteria for Rheumatic Fever?

SubQ nodules Polyarthritis Erythema marginatum Carditis Chorea
What are the causes of Eosinophilla?

Neoplasms Allergies/Asthma Addisons 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) Alports Bergers
What are the Drugs that cause Autoimmune hemolytic anemia?

PCN -methyldopa Cephalosporins Sulfa PTU Anti-malarials Dapsone
What are the drugs that cause Autoimmune thrombocytopenia? ASA Heparin Quinidine
What are the enzymes that show after an MI?

Troponin I CKMB LDH
What is the first MI enzyme to appear?

Troponin I Appears Peaks Gone 2 hrs 2 days 7 days
What is the 2 to appear?

CK-MB Appears Peaks Gone
nd
MI enzyme
6 hrs 12 hrs 24 hrs
What is the 3 MI enzyme to appear?

rd
LDH Appears Peaks Gone
1 day 2 days 3 days
What bacteria have Silver Stains?

Legionella Pneumocysitis carinii H. pylori Bartonella henseslae (lymph node) Candida (yeast)
What are the sulfa containing drugs?

Sulfonamides Sulfonylurea Celebrex
What is another name for celebrex?

Celecoxib
What type of inhibitor is Celebrex?

COX 2 specific
What COX-2 specific drug can you give to a pt with sulfa allergy? Vioxx (Rofecoxib)
What drugs inhibit dihydrofolate reductase?

Pyremethamin/Sulfadiazine Trimethoprim/Sulfamethoxazole
What drugs cause Pulmonary Fibrosis?

Bleomycin Bulsufan Amiodarone Tocainide
What are the macrophage deficiency diseases?

Chediak-Higashi NADPH-oxidase deficiency
What are the SE of Loops and Thiazides?

Hyperglycemia Hyperuricemia Hypovolemia Hypokalemia
What are the SE of Loop diuretics?

OH DANG Ototoxicity Hypokalemia Dehydration Allergy Nephritis
(interstitial) Gout
What are the only 3 Pansystolic Murmurs and when are they heard?
MR TR VSD Decrease on
inspiration (^exp) Increase on inspiration Decrease on inspiration (^exp)
Macrophages in various organs

Brain Lung Liver Spleen Kidney Lymph nodes Skin Bone CT
Mircoglia Type I pneumocyte Kupffer cell RES Mesangial Dendritic Langerhans Osteoclasts Histiocytes or Giant cells or Epithelioid cells
What are the 7 Rashes of the Palms & Soles?

TSS Rocky Mountain Spotted Fever Coxsackie A (Hand/Foot & mouth dz) Kawasaki Syphillis Scarlet Fever Staph Scalded Skin Syndrome
What is seen in every restrictive lung dz and low volume state? Tachypnea Decrease pCO2 Decrease pO2 Increase pH
What are the different 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

Malonate

Antimycin D

CN CO Chloramphenicol

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?

Fabrys Krabbes Gauchers Niemann Pick Tay-Sachs Metachromatic leukodystrophy Hurlers Hunters
galactosidase Galactosylceramide glucocerebrosidase Sphingomyelinase Hexosaminidase Arylsulfatase L iduronidase Iduronidase sulfatase
What dzs are associated with HLA B27?

Psoriasis Ankylosing spondylitis IBD (Ulcerative colitis) Reiters Syndrome
What HLA is Psorisis w/RA associated with?

HLA-13
What are the Glycogen Storage Diseases & the deficiency?

Von Gierkes Pompes
1 4 glucosidase Glucose 6
phosphate
Coris McArdles
Debranching enzyme Glycogen
phosphorylase
What are 6 places of the TCA cycle where amino acids feed in/out?

Pyruvate? Glycine Alanine Serine Acetyl CoA ? Phenylalanine Isoleucine Threonine Tryptophan Lysine Leucine
Alpha-KG ? Glutamate Glutamine Succinyl CoA? Phenylalanine Tryptophan Tyrosine
Fumerate ? Proline Oxaloacetate? Aspartate Asparigine
What are the 4 steps of Boxidation?

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 its 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?

Goodpastures
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?
Hashimotos
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?
Sjogrens
What Autoimmune Disease has the following Autoimmune Antibodies? Anti-proteinase? C-ANCA?
Wegeners
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? Kaposis Sarcoma
What are the 7 Nephrotic Patterns seen with every Vasculitis?

Clot in front of renal artery? Clot off whole renal artery? Inflamed glomeruli? Clot in papilla?
Glumerulo nephritis Papillary necrosis Interstitial nephritis Renal failure Renal artery stenosis
Clot off medulla?
Clot off pieces of nephron? Clot off lots of nephrons?

Rapidly Progressive GN Focal segmental GN (HIV, drug use association)
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? Goodpastures
What is the most common malignant renal tumor in children? Wilms 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 pts 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 Chrons Gifts?

Granuloma Ileum Fistula Transmural Skip Lesion
What are the negativestranded 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 = dont 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 Ebsteins 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? Ebsteins 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?

Brutons 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?

Brutons agammaglobulinemia CVID (Common Variant Imm. Def) Leukemias Lymphomas SCID WAS Job Buckley Syndrome
What is the Tyrosine kinase deficiency?

Brutons 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 (Burkitts 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?
Dermatomyositis? Colon CA
Dry scaly plaques on sun-exposed skin
Squamous Cell CA of skin
violacious, heliotropic rash, malar area
What are the rashes associated with Cancer and the cancer they are associated with?
Akanthosis nigricans?
Any visceral CA End organ damage
dark lines in skin folds
Erythema nodosum?
Anything granulomatous NOT assoc. w/ bacteria
ant aspect of legs, tender nodules
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? Elbow?
Machinery murmur Fistula from dialysis in renal disease
Abdomen/Brain? Lungs?
Von Hippel-Lindau = clot off with coils Increase incidence of Renal cell CA on chrom 3 Osler Weber Rendu Syndrome
What is the Ransons criteria for acute pancreatitis (at admission)? Glucose > 200 Age > 55 LDH >350 AST > 250 WBC > 16,000
What is the Ransons 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

Donovan? Leishmaniasis Mallory? Alcoholism Negri? Rabies

Councilman? Yellow fever Call-exner? Ovarian tumors
granulosa origin

Lewy? Parkinsons Pick? Picks disease Barr body? Normal female

Aschoff? Rheumatic fever Cowdry type A inclusions? Herpes virus Auer rods? AML

Globoid? Krabbes lysosomal storage disease Russell? Multiple myeloma

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? Clwhat? >60
Definitive presence of disease has a test value of
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
Beta 2 microglobulin? Chronic hemodialysis AA amyloid from SAA? Nephrotic hereditary forms
eg. Mediterranean fever
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 Alzheimers
disease/Downs? 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 Picks dis?

Frontotemporal dementia
Describe Picks 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 Antabuse
Cefamandole Cefoperazone 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 nonselective
What are the 4 facts of Fanconi Syndrome?

Problem in proximal tubule Cant 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 gammacarboxylation 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 its zone? Green What type of hemolysis is beta-hemolysis? Complete hemolysis
Hemolytic properties of Streptococcus:

What color is its zone Clear
eg. Streptokinase
What type of hemolysis is gammahemolysis? No hemolysis
What color is its 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 UTIs 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 its DNA into bacteria
What is transformation?
Virus injects its DNA into it bacteria
in a hospital or nursing home setting, then becomes deadly.
Conjuction occurs only with what?

Bacteria with Pili
What causes mutiple cerebral abscesses in newborns?

Citrobacter
What are the 2 gram ves that are strict anaerobes?

Hemophilus influenza Neisseria
What type of complement problem do you have in recurrent infections with encapsulated organisms?
C3
What does complement fight against?

Gram negative bacteria
What do you see in serum with prerenal failure and what are the values?
BUN >20
Fractional Na+ excertion <1% Creatine >40
What do you see in Renal failure and what are the values?
BUN 10-15
Fractional Na+ excretion >2% Creatinine <20
What is the extravasation order?

Pavementing Margination Diapediesis Migration
What is the rate limiting enzyme for Glycolysis?

PFK-1
What is the rate limiting enzyme of Gluconeogenesis?

Pyruvate Carboxlyase
If treating a disease that initiates the cell mediated response, what are you treating first? Viral
If resistant to tx, what next? Fungal Mycobacterium Protozoa Parasite Neoplasm
What bugs can you pick up during birth?

Step. Group B
Strep agalactiae
Strep. Pneumonia Herpes simplex virus Neisseria gonorrhea Chlyamydia
What is another name for Adenoma sebaceum?

Perivascular angiofibromata
What is another name for Addisons?

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 DeQuervains?

Subacute Granulomatous Thyroiditis
What is another name for Intraductal Ca?

Comedo Ca
What is another name for ICell 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 Waldenstroms 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 Burkitts
HHV V causes?
CMV Inclusion bodies
HHV VI causes?
Roseola Duke Disease Exanthem subitum
HHV VII causes?

Pityriasis rosea
HHV VIII causes?

Kaposis 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

Clinical use? Chronic anticoagulation Contra-indication? Pregnancy because it can cross the
placenta

What pathway does it affect? Extrinsic pathway What does it do to PT? Prolongs PT

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

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

What pathway does it affect? Intrinsic pathway What value should you follow? PTT

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

What is good about the newer lowmolecular-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?

Huntingtons 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 Ds 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? Whipples
Adult male or female? Crohns
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 Oslers nodes Splinter hemorrhages Endocarditis
Where are the following lesions found?

Janeway lesions? Toes Oslers 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
A
W B
D
+ _
A+B C+D ALL

Always in the numerator
A+C B+D
Sensitivity Specificity PPV NPV OR RR AR A/A+C D/B+D A/A+B D/C+D AD/BC (A/All)/(C/All) (A/All)-(C/All)
Sensitivity: Truly Diseased People Specificity: Truly Well People
+ Predictive Value: Test +ve With DZ - Predictive Value: Tested ve w/o DZ

OR: Odds Ratio RR: Relative Risk AR: Attributed Risk
A&D
In EKG P-wave Represents?

Atrium contraction Phase zero Calcium
In EKG P-R Interval means?

AV Node Phase 2 Sodium
In EKG Q-Wave means?

Septum Phase 2 Sodium
In EKG R-upstoke means?

Anterior wall Phase 2 Sodium
In EKG S-down stroke means?

Posterior wall Phase 2 Sodium
In EKG S-T Interval means?

Ventricle Phase 2 Calcium
In EKG T-wave means?

Ventricle Phase 3 Potassium
In EKG U-wave means

Ventricle Phase 4 Sodium
4 DZ associated with HLADR 2?

Narcolepsy Allergy (hay fever) Goodpasture MS
5 DZ associated with HLADR 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
Reiters 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

Most common sub-class deficiency Patient susceptible to encapsulated
organisms

Most memory antibody

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 Tcell lymphoma
What is the job of CHYLOMICRONS?

Transport TGs from GI to liver and
endothelium
What is the job of VLDL?

Transports TGs from liver to adipose
What is the job of IDL?

Transports TGs from adipose to
tissue
What is special about LDLs?

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%

Capsule or no capsule? non-encapsulated Invasive or non invasive? non-invasive

Most common cause of what? Sinusitis Otitis Bronchitis

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

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 Anyone with end-organ damage
CF RF Nephrotic Syndrome Sickle cell anemia
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

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)

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?

Wernickes Encephalopathy Wernickes Korsakoff
What is Wernickes Encephalopathy?

Alcoholic thymine deficiency of the
Temporal Lobe
What is Wernickes 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 itnothing
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 DS 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 PS 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 aas (aromatics) Phe Tyr Trp
Elastase cuts where?

Cuts to R of (SAG)

Ser Ala Gly
CNBr cuts where? Cuts to R of Methionine

Mercaptoethanol cuts where? Cuts to R of: disulfide bonds
Cysteine methionine

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?

Leighs 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?

Lebers 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?
DiGeorges 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 BRANCHEDCHAIN 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 Reiters Syndrome
What is associated with HLAB13?

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

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

ENERGIZED MACROPHAGES CAUSES B-CELL PROLIFERATION LABELED BY THYMIDINE (USE
POKEWEED MITOGEN OR ENDOTOXIN) SECRETED BY ACTIVATED T CELLS

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 IL10?

SUPPRESSES CELL-MEDIATED
RESPONSE (tells macrophages and fibroblasts to stay away if bacterial) INHIBITS MAC ACTIVATION
What are the clues for IL12?

PROMOTES CELL-MEDIATED RESPONSE
(recruits macs & fibroblasts if NOT bacterial) ACTIVATES NK CELLS TO SECRETE IF- INHIBITS IL-4 INDUCED IgE SECRETION CHANGES TH CELLS to TH1 CELLS
secretes IL-2 & IF- inhib. TH2, therefore, host defenses against delayed hypersensitivity
What are the clues for IF-?

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-?

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 IFgama?

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 TNFalpha?

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- SECRETION CYTOTOXIC/CYTOSTATIC EFFECT
What are the clues for TNFbeta?

Where is it from? T-CELLS What is another name for it? LYMPHOTOXIN CYTOTOXIC FACTOR
What are the clues for TGF?

Where is it from? SOLID TUMORS (CARCINOMA >
SARCOMA) MONOCYTES
What is another name for it? TRANSFORMING GROWTH FACTORS

What does it INDUCE? ANGIOGENESIS KERATINOCYTE PROLIFERATION BONE RESORPTION TUMOR GROWTH What is it mainly for? MAINLY FOR TUMOR GROWTH

Where is it from? PLATELETS PLACENTA KIDNEY BONE T & B CELLS

What INDUCES it? FIBROBLAST PROLIFERATION COLLAGEN FIBRONECTIN SYNTHESIS

What INHIBITS it? NK LAK CTL T & B CELL PROLIFERATION

What ENHANCES it? WOUND HEALING ANGIOGENESIS

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 = Huntingtons
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

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

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

Ewings sarcoma

Burketts lymphoma

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 Thallasemias 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 Anemias?

Hereditary Spherocytosis
What are the Normocytic Normochromic Anemias?

Acute hemorrhage Anemia of Chronic Disease Hypothyrodism
Early
Renal Failure
What are the Macrocytic anemias?

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+?

Wilsons Disease
What is the CLUE for Wilsons 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 Anemias 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 alphaketoacids requires what?

Thiamine
Synthesis of 1,25-dhydroxycholecalciferol 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
Cranium? Superior Orbital Fissure
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

Cranium?
Cont. CN 4
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

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
Cranium? Foramen Rotundum
What does it innervate? Pterygopalatine

Leaves by openings to face, oral & nasal cavity

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
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
Pseudoptosis Internal strabismus
Loss of parallel gaze 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 Cant close eye Cant 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
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
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
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?
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 CNs 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

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