Most Common's in medical science 1 Tumor arising from bone in adults Multiple Myeloma Adrenal Medullary Tumor Adults

ts Pheochromocytoma Adrenal Medullary Tumor Children Neuroblastoma Bacterial Meningitis adults Neisseria meningitidis Bacterial Meningitis elderly Strep pneumoniae Bacterial Meningitis newborns E. coli Bacterial Meningitis toddlers Hib Bone Tumors Metasteses from Breast & Prostate Brain Tumor Child Medulloblastoma (cerebellum) Brain Tumor Adult Astrocytoma (including Glioblastoma Multiforme) then: mets, meningioma, Schwanno ma Breast Carcinoma Invasive Duct Carcinoma Breast Mass Fibrocystic Change (Carcinoma is the most common is post-menopausal women) Bug in Acute Endocarditis Staph aureus Bug in debilitated, hospitalized pneumonia pt Klebsiella Bug in Epiglottitis Hib Bug in GI Tract Bacteroides (2nd E. coli) Bug in IV drug user bacteremia / pneumonia Staph aureus Bug in PID N. Gonnorrhoeae Bug in Subacute Endocarditis Strep Viridans Cardiac 1 Tumor Adults Myxoma Ball Valve Cardiac 1 Tumor Child Rhabdomyoma Cardiac Tumor Adults Metasteses Cardiomyopathy Dilated (Congestive) Cardiomyopathy Cause of 2 HTN Renal Disease Cause of Addisons Autoimmune (2nd infection) Cause of Congenital Adrenal Hyperplasia 21-Hydroxylase Deficiency (then, 11-) Cause of Cushings Exogenous Steroid Therapy (then, 1 ACTH, Adrenal Adenoma, Ectopic ACTH) Cause of death in Alzheimer pts Pneumonia Cause of death in Diabetics MI

Cause of Death in SLE pts. Lupus Nephropathy Type IV (Diffuse Proliferative) Cause of Dementia Alzheimers Cause of Dementia (2nd most common) Multi-Infarct Dementia Cause of food poisoning Staph aureus Cause of mental retardation Downs Cause of mental retardation (2nd most common) Fragile X Cause of preventable blindness Chlamydia Cause of Pulmonary HTN COPD Cause of SIADH Small Cell Carcinoma of the Lung Chromosomal disorder Downs Congenital cardiac anomaly VSD (membranous > muscular) Congenital early cyanosis Tetralogy of Fallot Coronary Artery thrombosis LAD Demyelinating Disease Multiple Sclerosis Dietary Deficiency Iron Disseminated opportunistic infection in AIDS CMV (Pneumocystis carinii is most common overall) Esophageal cancer SCCA Fatal genetic defect in Caucasians Cystic Fibrosis Female Tumor Leimyoma Form of Amyloidosis Immunologic (Bence Jones protein in multiple myeloma is also called the Amyloid Light Chain) Form of Tularemia Ulceroglandular Gynecologic malignancy Endometrial Carcinoma Heart Murmur Mitral Valve Prolapse Heart Valve in bacterial endocarditis Mitral Heart Valve in bacterial endocarditis in IV drug users Tricuspid Heart Valve involved in Rheumatic Fever Mitral then Aortic Hereditary Bleeding Disorder Von Willebrands Disease Liver 1 Tumor Hepatoma Liver Disease Alcoholic Liver Disease Location of Adult brain tumors

 Above Tentorium Location of Childhood brain tumors Below Tentorium Lysosomal Storage Disease Gauchers Motor Neuron Disease ALS Neoplasm Child Leukemia Neoplasm Child (2nd most common) Medulloblastoma of brain (cerebellum) Nephrotic Syndrome Membranous Glomerulonephritis Opportunistic infection in AIDS PCP Ovarian Malignancy Serous Cystadenoma Ovarian Tumor Hamartoma Pancreatic Tumor Adeno (usually in the head) Patient with ALL / CLL / AML / CML ALL - Child / CLL - Adult over 60 / AML - Adult over 60 / CML - Adult 35-50 Patient with Goodpastures Young male Patient with Reiters Male Pituitary Tumor Prolactinoma (2nd Somatotropic Acidophilic Adenoma) Primary Hyperparathyroidism Adenomas (followed by: hyperplasia, then carcinoma) Pt. With Hodgkins Young Male (except Nodular Sclerosis type Female) Pt. With Minimal Change Disease Young Child Secondary Hyperparathyroidism Hypocalcemia of Chronic Renal Failure Sexually transmitted disease Chlamydia Site of Diverticula Sigmoid Colon Site of metastasis Regional Lymph Nodes Site of metastasis (2nd most common) Liver Sites of atherosclerosis Abdominal aorta > coronary > popliteal > carotid Skin Cancer Basal Cell Carcinoma Stomach cancer Adeno Testicular Tumor Seminoma Thyroid Cancer Papillary Carcinoma Tracheoesophageal Fistula Lower esophagus joins trachea / upper esophagus blind pouch Tumor of Infancy Hemangioma Type of Hodkins

 Mixed Cellularity (versus: lymphocytic predominance, lymphocytic depletion, nodu lar sclerosis) Type of Non-Hodgkins Follicular, small cleaved Vasculitis (of medium & small arteries) Temporal Arteritis Viral Encephalitis HSV

Characterstic Drug Toxicities - most commenly asked in all PG exams ,DNB, FMGE Agranulocytosis Clozapine

Atropine-like Side Effects Tricyclics Cardiotoxicity Doxorubicin Daunorubicin Cartilage Damage in children Fluoroquinolones (Ciprofloxacin & Norfloxacin) Cinchonism Quinidine Coronary Steal Phenomenon Dipyridamole Corneal micro deposits Amiodarone Cough ACE Inhibitors Diabetes Insipidus Lithium Disulfiram-like effect Metronidazole Sulfonylureas (1st generation) Extrapyramidal Side Effects Antipsychotics (Thioridazine, Haloperidol, Chlorpromazine) Fanconis Syndrome Tetracycline Fatal Hepatotoxicity (necrosis) Valproic Acid Halothane Acetaminophen Gingival Hyperplasia

... Aplastic Anemia Chloramphenicol NSAIDs

Benzene

Gray Baby Syndrome Chloramphenicol

Hand Foot Syndrome 5-Flurouracil (5-FU) Ibuprofen

Hemorrhagic Cystitis Cyclophosphamide Ifosamide (Treat by Mesna & Acetylcysteine Bladder Wash) Hepatitis Isoniazid Hot Flashes, Flushing Niacin Tamoxifen Ca++ Channel Blockers Hypertension: Postural Prazocin Hypertension: Rebound Clonidine withdrawal Tetracycline Rifampin Isoniazid (INH) [remember CEKI]

Phenytoin

Carbamazepine Ketoconazole

Furosemide

Milk Alkali Syndrome Calcium Carbonate (CaCo3) Monday Disease Nitroglycerin Industrial exposure tolerance during week loss of tolerance during weekend headache, tach, dizziness upon re-exposure Gentamycin

Orange Body Fluids Rifampin Osteoporosis Heparin Corticosteroids

Pancreatitis L-Asparginase

Glucocorticoids

Nephrotoxicity Cephaloridine

Amphotericin

Interstitial Nephritis Methicillin NSAIDs (except Aspirin)

Inhibit CP450 Cimetidine Erythromycin

Induce CP450 Barbiturates

Sulfonamides

Increased intra cranial tension ( ICT) Amiodarone Hypervitaminosis A OCPs

Hemolytic Anemia in G6PD-deficiency Sulfonamides Isoniazid Aspirin

Primaquine

Quinolones

Gynecomastia Cimetidine Azoles Spironolactone Digitalis Estrogen & testosterone mide Clomiphine Phenytoin Reserpine & Methyldopa

Phenytoin

INH & ethion

Photosensitivity Lomefloxacin Pefloxacin Positive Coombs Test Methyldopa Pulmonary Fibrosis Bleomycin Amiodarone Rabbit Syndrome (Perioral tremors) Phenothiazines Red Man Syndrome Vancomycin (rapid IV) Severe HTN with Tyramine MAOIs

Tardive Dyskinesia Antipsychotics (Thioridazine, Haloperidol, Chlorpromazine)

Torsades de Pontis Terfanadine

Tumor Suppressor Genes Genes Chrom. Associated Tumors VHL 3p Von Hippel Lindau, Renal Cell CA APC 5p Familial adenomatous polyposis, Colon CA ... WT-1 11p Wilms tumor Rb 13q Retinoblastoma, Osteosarcoma BRCA-2 13q Breast CA p53 17p Most human Cas NF-1 17q Neurofibromatosis type 1 BRCA-1 17q Breast CA, Ovarian CA DCC 18q Colon & Stomach CA DPC 18q Pancreatic CA NF-2 22q Neurofibromatosis type 2 = bilateral acoustic neuroma

Tinnitus Aspirin

Quinidine

SLE- Drug Induced[Anti Histone Antibody Characteristic of this] Chloropromazine Hydralazine Isoniazid Methyldopa Procainamide er CHIMP -Q]

Quinidine [ remem

Anatomy High yield points -Global institute of medical sciences Sure shot points for fmge 1 wrist drop (inability to extend the wrist and fingers) caused by damage to wha t nerve? radial nerve (posterior chord of BP) 2 this nerve supplies the flexors of the arm and is cutaneous in the forearm mus culocutaneous nerve 3 most intrinsic hand muscles are supplied by what nerve? ulnar nerve 4 order of structures passing behind the medial malleolus (from ant to post) (an terior) tibialis posterior, flexor digitorum longus, posterior tibial aa, flexor hallucis longus (TOM, DICK, AND HARRY) 5 CN from which chorda tympani originates CN VII 6 chorda tympani controls salivation from which glands? sublingual and submandib ular 7 parotid is innervated by which nerve? glossopharyngeal (CN IX) 8 median nerve paralysis causes ulnar deviation of the hand (unopposed flexor carp i ulnaris innervated by ulnar) 9 innervation of the interossei ulnar 10 ulnar nerve lesion causes radial deviation of the hand (unopposed flexor carpi radialis innervated by radial) 11 radial nerve paralysis causes inability to extend the hand against gravity ("wr ist drop"), loss of triceps and brachioradialis reflexes 12 what causes cleft lips? failure of maxillary and medial nasal processes to fu se during development 13 occlusion of the gastroduodenal aa would cause no change (rich supply from vari ous sources 14 nerve that causes extension of the thumb radial 15 nerve which adducts the thumb ulnar 16 nerve that abducts, rotates, opposes, and flexes the thumb median 17 nerve that runs with the spermatic cord through the inguinal canals ilioingui nal 18 direct inguinal hernias are due to what defect? breakdown of transversus abdo minalis aponeurosis and transversalis fascia 19 small bowel receives its blood supply from the superior mesenteric aa. 20 what embryological defect puts an infant at risk for inguinal hernia? patent processus vaginalis 21 testicular histology shows many Leydig cells, few Sertoli cells, and absent g

erm cells; patient presents with gynecomastia and small testes Klinefelter s (46 ,XXY) 22 what nerve runs through the parotid gland? facial nerve 23 what nerve accompanies the superior laryngeal aa? internal branch of superior laryngeal nn 24 innervation of the superior laryngeal nn mucosa above the vocal folds 25 what is the ventral white commissure? crossing fibers of the spinothalamic tr act 26 Cooper s ligaments connect mammary glands to the dermis of overlying skin 27 alternative name for inguinal ligament Poupart s ligaments 28 multiple small openings in the depressed area of the nipple are lactiferous duc ts 29 # of lobes in every breast 10 to 15 30 derivatives of the uteric bud collecting ducts, calyces, renal pelvis 31 patients with verbal difficulties most likely have a lesion in which hemisphe re? left 32 artery that supplies the distal lesser curvature of the stomach right gastric 33 movements mediated by the trapezius mm elevation of the acromion (upper fiber s) and depression of the medial scapula (lower fibers) 34 on what day of embryonic life is the notochord formed? 17 35 during what week can a fetus move? 8 weeks gestation 36 the incision for a saphenous cutdown should be located . anterior to the medial malleolus 37 the structure immediately medial to the insertion of the biceps (near the elb ow) is brachial aa 38 role of MIF in development suppression of paramesonephric ducts 39 the only mm that can elevate the eye in the abducted position is the superior r ectus 40 embyronic origin of the thyroid foramen cecum 41 the first pharyngeal pouch develops into middle ear, eustacian tube 42 the second pharyngeal arch develops into mm of face, styloid process of tempora l bone 43 the third pharyngeal pouch develops into thymus, inferior parathyroids 44 which mm lowers the jaw? lateral pterygoid 45 what CN(s) come(s) through the foramen ovale? What branch? V3 46 what CN(s) come(s) through the foramen rotundum? V2 47 what CN(s) come(s) through the superior orbital fissure? III, IV, V1, VI 48 which two CNs come through the internal acoustic meatus? VII, VIII 49 which three CNs come through the jugular foramen? XI, X, XI 50 which CN(s) come(s) through the cribriform plate? I 51 nerve that innervates all the thenar mm median 52 the medial aspects of the cerebral hemispheres are supplied by which aa? ante rior cerebral 53 location of the AV node subendocardium of the interarterial septum 54 location of SA node wall of the right atrium 55 innervation of the stapedius facial (CN VII) 56 the heart begins to beat at what week of gestation? 4th 57 the heart is fully formed by what week of gestation? 6th 58 what muscle might avulse the lesser trochanter from the femur, resulting in f racture? psoas major 59 3 mm that insert into the greater trochanter of the femur gluteus minimus and medius, piriformis 60 most common form of ASD results from failure of fusion of the septum primum and secundum 61 type of epithelium contained in the distal esophagus nonkeratinized stratifie d squamous 62 the median nerve is formed by which cords of the brachial plexus? lateral and medial 63 the medial nerve runs between which two tendons on the anterior aspect of the forearm? palmaris longus and flexor carpi radialis

64 the smooth part of the right ventricule is derived from bulbus cordis 65 the smooth part of the right atrium is derived from sinus venosus 66 the truncus arteriosis develops into the proximal pulm aa and ascending aorta 67 lesion results in inability to dorsiflex and inversion of the foot when relax ed common peroneal nerve lesion 68 A patient s tongue deviates toward the right. What mm and nerve are affected? right hypoglossal (CN XII); right genioglossus 69 what is the role of the hyoglossus mm? retracts the tongue 70 information carried by the dorsal column system of the spinal cord propriocep tion, discriminative touch, vibrat 71 pseudounipolar cells are derived from the neural crest 72 Schwann cells are derived from the neural crest 73 astrocytes and microglia are derived from the neural tube 74 path of the superior sagittal sinus along the attachment of the falx cerebri 75 how does a mast cell look on EM? "scroll" inclusions (look like lamellar bodi es), cell membrane irregularities, microvilli, evident nucleolus 76 "unhappy triad" medial meniscus, medial collateral ligament, and ACL tear 77 the sensory innervation of the posterior half of the external auditory meatus comes from . auricular branch of the vagus (CN X) 78 sensory innervation of the anterior half of the external auditory meatus auri culotemporal nerve 79 abdominal viscera protrude through the anterior abdominal wall (not covered i n skin, etc) when what fails to occur during embryogenesis? failure of fusion of the lateral body folds (4th wk) 80 failure of the yolk stalk to degenerate results in Meckel s diverticulum 81 pain from the anterior two-thirds of the tongue is carried to the CNS by V3 82 taste from the anterior 2/3 of the tongue is carried to the CNS by VII 83 what is the role of CN IX in taste and pain sensation of the tongue? posterio r 1/3 of the tongue (pain & taste) 84 the structure medial to a femoral hernia in a female patient lacunar ligament 85 indirect inguinal hernias pass just lateral to inferior gastric aa 86 direct inguinal hernias pass just medial to inferior gastric aa 87 anesthetic injected near the ischial spine will block which nerve? pudendal 88 what nerve runs just anterior to the anterior scalene mm? phrenic nn 89 brain structure involved with formation of memories hippocampus 90 the greater sciatic foramen is occupied by what mm? piriformis 91 what nn runs through the greater sciatic foramen just caudal to the piriformi s? superior gluteal nerve (along with the aa and vv) 92 what nns run through the greater sciatic foramen just below the piriformis? p udendal & sciatic 93 the remnant of the embryological umbilical vein falciform ligament 94 in which part of the small intestine does a Meckel s diverticulum arise? ileu m 95 neurons in the olfactory bulb synapse on which part of the brain? pyriform co rtex 96 name the mm that causes internal rotation of the arm at the shoulder subscapu laris 97 the inferior rectal nerve is a direct branch of the pudendal nn. 98 innervation of the abductor pollicis longus median nn. 99 innervation of the adductor pollicis ulnar nn. 100 mostly unbrached vein existing on the medial side of the leg and continuing upward to meet with the femoral vein saphenous 101 what does the ansa cervicalis innervate? geniohyoid (pulls the hyoid bone an teriorly for swallowing) 102 the inferior mesenteric aa arises from the abdominal aorta directly posterio r to what structure? third part of the duodenum 103 the superior mesenteric aa arises from the aorta directly posterior to what structure? neck of the pancreas 104 the ____ contains striated mm NOT under voluntary control esophagus 105 the foramen through which the saphenous vein passes to join the femoral vein

fossa ovalis 106 mm that flexes the thigh at the hip psoas major 107 the fasciculus cuneatus carries what kind of fibers from where? propriocepti on, discriminative touch, vibration from the arms 108 the role of the sER steroid hormone synthesis and detox 109 decreased sensation over the first 3.5 digits of the hand indicates a lesion of median nn. 110 what mm are supplied by the median nerve? opponens pollicis, abductor pollic is brevis, flexor pollicis brevis, 1st 2 lumbricals, anterior forearm flexors 111 the extensor pollicis longus is supplied by the (nn) radial nerve 112 backward movement of the jaw during chewing is due to what mm? temporalis 113 gap junctions contain connexons 114 tonofilaments are found in hemidesmosomes and desmosomes 115 what type of collagen is found in the basal lamina? Type IV (under the floor ) 116 the superior opthalamic vein drains into the cavernous sinus 117 the sigmoid sinus drains into the IJV 118 the posterior continuation of the cavernous sinus is the petrosal sinus 119 three mm that flex the arm at the elbow biceps, brachioradialis, and brachia lis 120 the median nerve passes through the two heads of what mm? pronator tere 121 the coracobrachialis is pierced by the MC nerve 122 the flexor carpi ulnaris is pierced by the ulnar nerve 123 the deep branch of the radial nerve pierces which mm? supinator mm 124 annular pancreas results from a failure in what part of normal development? failure of the ventral pancreatic bud to rotate around the second part of the du odenum 125 pain sensation from the upper part of the posterior pharynx is carred by the gl ossopharyngeal (CN IX) 126 the cells that provide myelin in the CNS oligodendrocytes 127 to which nodes is a cancer of the descending colon most likely to metastasiz e? inferior mesenteric 128 the gastroepiploic lymph nodes drain the greater curvature of the stomach 129 the superficial inguinal lymph nodes drain rectum, vagina, and perineum 130 the internal iliac nodes drain the bladder and male internal genitalia 131 the subpyloric nodes drain the distal stomach, duodenum, and pancreas 132 upward traction on the upper limb may cause what brachial plexus injury? low er trunk (interossei and thumb problems) 133 two "ligaments" that separate the greater peritoneal sac from the lesser gas trohepatic, hepatoduodenal 134 claw hand is due to ulnar nerve lesion 135 cord of the brachial plexus from which the ulnar nerve arises medial cord 136 cord of the brachial plexus from which the MC nerve arises lateral cord 137 obturator nerve innervates mm of medial compartment of the thigh (adductors an d gracilis) 138 is the lower trunk of the brachial plexus within the axillary sheath? no > f ormed in the neck and moves independently 139 hip abduction is mediated by what nerve? superior gluteal nerve 140 nn responsible for knee extension femoral nerve 151 nerves that supply sensation to the dorsal aspect of the hand radial (on the thumb side) and ulnar (on the pinkie side) 152 nerve that lies in the posterior tonsillar fossa CN IX 153 the muscles of mastication are derived from what pharyngeal arch? first 154 sensory innervation of the sole of the foot is by the . posterior tibial nerve 155 nn that supplies the medial mm of the thigh obturator 156 the femoral nerve innervates the mm of the anterior compartment of the thigh 157 the posterior compartment of the thigh is innervated by sciatic nerve 158 the uterus develops from the mesonephric ducts 159 the role of neural crest cells in the development of the heart invade the ao rticopulmonary septum

160 retroperitoneal organs descending & ascending colon, duodenum, kidneys, adre nals 161 brief pathway of auditory sensation spiral ganglion > CN VIII > dorsal/ventr al cochlear nuclei of the medulla > superior olivary nuceli > lateral lemniscus > inferior colliculus of the midbrain > medial geniculate body of thalamus > aud itory cortex 162 the superior colliculus is involved in . eye movements 163 Erb s palsy results from a lesion of the upper part of brachial plexus (C5, C6 ) 164 the facial vein drains into the cavernous sinus 165 name three structures in the hepatoduodenal ligament common bile duct and he patic vessels 166 how are the three structures of the hepatoduodenal ligament arranged? portal vein is posterior, bile duct is on right, hepatic aa on left 167 mm that elevates the soft palate levator palatini 168 innervation of the mm that elevates the soft palate CN X 169 when the uvula deviates toward the right, the most likely lesion is left CN X 170 course of the axillary nerve surgical neck of the humerous 171 innervation of the axillary nerve deltoid mm 172 a lesion of the axillary nerve would cause .. inability to raise the arm fro m the side 173 the posterior descending artery is a branch of the . RCA 174 nerve in the posterior triangle of the neck accessory 175 the pancreas gets its arterial supply from the celiac aa 176 the ductus deferens and the spermatic cord converge when they pass through the internal inguinal ring 177 inability to read (alexia), with preservation of the ability to write (agrap hia), is indicative of a lesion in the left occipital cortex and splenium of CC 178 nerve that innervates the dorsum of the foot superficial peroneal 179 anesthesia of the medial surface of the leg suggests a lesion of the saphenous nerve 180 when a female stands, where does fluid in the abdomen collect? rectouterine pouch (of Douglas 181 venous place in the body with pressure oscillations of 25/0 RA 182 venous place in the body with no pressure oscillations peripheral veins 183 cell bodies for Pacinian corpuscles reside in DRG 184 depression of the mandible is affected by what nerves? mandibular and facial (digastric) (NOTE: First Aid says that the lateral pterygoid lowers the mandibl e . You decide) 185 the cremasteric reflex is elicited via what nerve roots? L1, L2 186 a waddling (Trundelberg) gait is indicative of lesion of the gluteus medius a nd minimus or the superior gluteal nerve 187 loss of the ability to climb stairs is indicative of lesion of gluteus maximum or inferior gluteal nn 188 lesion of CN III would result in an eye that looks . down and out 189 damage to Meyer s loop results in . contralateral superior quadrantanopsia 190 the azygus vein drains the posterior thoracic wall Posts 127 191 the azygus vein empties into the SVC 192 the paramesonephric ducts give rise to the upper vagina, cervix, uterus, and fallopian tubes 193 the lower vagina develops from the . urogenital sinus 194 what cell in the liver is derived from foregut endoderm? hepatocytes 195 nerve that accompanies the superior laryngeal aa superior laryngeal nerve (i nternal branch) 196 innervation of the superior laryngeal nn (internal branch) mucosa above the vocal folds 197 nn that provides sensory innervation to the laryngeal mucosa below the vocal folds recurrent laryngeal nerve 198 motor innervation to the cricothyroid superior laryngeal nerve (external bra nch)

199 what fascia encloses the thyroid gland? pretracheal 200 what is the best place to palpate the dorsalis pedis artery? on the dorsum o f the foot, between the tendons of the extensor hallucis longus and extensor dig itorum longus 201 lymph from the medial side of the foot drains via lymphatics near the saphenou s vein into the inguinal nodes 202 lymph from the lateral side of the foot drains via lymphatics near the short s aphenous vein into the popliteal nodes 203 what is the gap between the two embryonic atria called? ostium primum 204 what fills the gap between the two embryonic atria? septum primum 205 when the septum primum meets with the ___, the ostium primum is closed endoc ardial cushions 206 failure of the septum primum to fuse with the cushions results in . ostium prim um-type ASD 207 the ostium secondum usually forms within the septum primum 208 the results of failure to form the septum secundum fetal death (no hole betw een atria means no oxygenation for most of the fetus) 209 run through the development of the foramen ovale, etc. ostium primum closed by septum primum > ostium segundum forms > septum primum fuses with endocardial cushions > septum segundum develops 210 the valve of the foramen ovale is made up of the septum ostium (the part that does not regress) 211 does the septum segundum fuse with the endocardial cushions? no - only the s eptum primum does 212 the afferent arm of the corneal reflex CN V 213 the efferent arm of the corneal reflex CN VII 214 which nerve provides taste sensation over the anterior portion of the tongue ? Facial VII 215 girl fracctures humerus through lateral epicondyle. What nerve might be dama ged? radial 216 what type of nerve fibers innervate the radial dilator mm? only sympathetic postganglionic fibers 217 what is the status of the fetal heart once the arms, legs, and extremities a re nearly fully formed? nearly fully formed, beating 218 from where does the levator veli palatini originate? petrous portion of the temporal bone 219 wrist drop is caused by damage to . radial nerve 220 the lingula belongs to what lobe of the lung? left upper lobe 221 neonate with left-sided intestinal hermiation had a structural anomaly of th e pleuroperitoneal membrane (most likely) 222 decreased sensation over with posterior portion of the side of the tongue in dicates a lesion of what nerve? CN IX 223 oocytes are derived from the yolk sac 224 winged scapula results from lesions of what cervical nerves? C5-C7 (long tho racic nerve) 225 anterior horn motor neurons of the spinal cord are derived from the basal plat e 226 sympathetic plexus that provides pain sensation from the stomach celiac plex us 227 spinal tract that carries two-point touch, vibration, and proprioception dor sal columns 228 where (if anywhere) do the dorsal white columns cross? medullary pyramids 229 spinal tract that carried pain and temperature sensation spinothalamic tract 230 where (if anywhere) does the spinothalamic tract cross? lumbar region 231 where does the corticospinal tract cross? medullary pyramids 232 the smooth part of the right ventricle is derived from bulbus cordis 233 what is located between the cells of the yolk sac and the cells of the cytot rophoblast in a 14-day blastocyst? extraembryonic mesoderm

234 the adult derivative of the ductus venosus ligamentum venosum 235 the ventromedial nucleus mediates what type of behavior? eating behavior (wi thout it, we starve) 236 the transverse cervical ligament carries what aa? uterine 237 biological methylations are mediated by SAM 238 the splenic aa is located in what ligament? splenorenal 239 what respiratory system component is derived from visceral mesoderm? endothe lial cells 240 the artery supplying the anterior aspect of the interventricular septum runs in the anterior interventricular sulcus (LAD) 241 the cystic aa is a branch of the right hepatic 242 what nerve mediates the cremasteric reflex? genitofemoral 243 Schwann cells are derived from the neural crest 244 what structure gives rise to the greater omentum? dorsal mesentery 245 from where is the spleen derived? embryonic dorsal mesentery 246 name two membranes that hold the ulna and radius together interosseous (big) and annular (small) 247 intention tremor of the ipsilateral extremity would result from a lesion of the cerebellum 248 tremor that improves with purposeful movement indicates a lesion of the basal ganglia 249 a lesion of the frontal eye field would cause deviation of the eyes toward the lesion 250 the urachus is the remnant of the allantois 251 the urachus connects apex of bladder to umbilicus 252 branch of the axillary artery that forms an anastomosis with branches of the subclavian subscapular aa 253 hypothalamic nuclei involved with circadian rhythms suprachiasmatic nucleus 254 lymph from the scrotum drains into the superficial inguinal nodes 255 the only laryngeal mm innervated by the superior laryngeal nn cricothyroid 256 most of the laryngeal mm are innervated by recurrent laryngeal nerve 257 lies between the flexor carpi radialis and flexor digitorum superficialis me dian nerve 258 role of the pupillary sphincter muscle pupillary constriction 259 innervation of the pupillary sphincter mm parasympathetic 260 what mm dilates the pupil? radial dilator mm 261 the blood vessels that supply the skin are located in the deep and superficial dermis (the epidermis does not have vessels) 262 what pores on the cell surface allow the passage of small molecules? gap jun ctions 263 muscle used to get up from a sitting position gluteus maximus Spinal cord syndromes: Result from incomplete spinal cord injuries. The Central Cord syndrome is associated with greater loss of upper limb function compared to lower limbs. The Brown-Squard syndrome results from injury to one side with the spinal cord, ca using weakness and loss of proprioception on the side of the injury and loss of pain and thermal sensation of the other side. The Anterior Spinal syndrome results from injury to the anterior part of the spi nal cord, causing weakness and loss of pain and thermal sensations below the inj ury site but preservation of proprioception that is usually carried in the poste rior part of the spinal cord. Tabes Dorsalis results from injury to the posterior part of the spinal cord, usu ally from infection diseases such as syphilis, causing loss of touch and proprio ceptive sensation.

Conus Medullaris syndrome results from injury to the tip of the spinal cord, loc ated at L1 vertebra. Cauda Equina syndrome is, strictly speaking, not really spinal cord injury but i njury to the spinal roots below the L1 vertebra.

CARBOHYDRATE CHEMISTRY:Formula:- Cn H2n On Glucose and mannose are epimers at C2 carbon Glucose galactose epimers at C4 Enantimomers are mirror images to each other. nd cyclic forms of D-glucose known s nomers C1 is nomeric c r on Benedict test reducing properties of sug rs Sodium m lg m is used s reducing gent. Reduction of mono s cch rides gives lcohols. Aldose reduct se converts ldehydes to lcohols. Fructose is converted to sor itol dehydrogen se (liver) Monos cch rides gives needle sh ped os zones. M ltose gives sunflower sh ped os zones L ctose gives powderpuff sh ped os zones M ltose (1-4) (glucose + glucose) m ltose (hydrolysed) L ctose (g l ctose glucose) (1-4) l ct se (hydrolysed) Sucrose (glucose-fructose) (1- 2) Glucosidic ond- ond etween monos cch rides. Sucrose is hydrolysed y sucr se/invert se Dextrins re re kdown product of st rch Inulin is polymer of fructose Glycogen nd st rch re polymer of glucose Inulin is need to ssess GFR Diet ry fi er is cellulose (-glycoside ond) D-glucoronic cid + N- cetyl glucos mine Hy luronic cid Ker tin sulph te keeps corne tr nsp rent LIPID CHEMISTRY:S tur ted f tty cids does not cont in dou le ond Uns tur ted f tty cids h s dou le onds Linolecic, linolenic nd r chidonic cid (PUFA)

Deficiency of EFA phyrnoderm (to d skin) Ar chidonic cid gives Eic sonoids Uns tur ted f tty cids exists in Cis form Hydrolysis of tri cyl glycerin with lk li produces so ps (s ponific tion) Vit.E is n tur lly occuring ntioxid nt, superoxide dismut se, ur se The medic l iochemistry - FMGE Glo l institute of medic l sciences www.gims-org.com Purity of f tty cid is checked y iodine num er RM num er (Reichert-Meissl) to check purity of utter Phospholipids free f tty cids + lcohol + phosph te + nitrogen B se Lecithin choline ( nitrogen se) - ( lung surf ct nt) Hormones like oxytocin nd v sopressin ction is medi ted y phosph tidyl inosit ol Sphinogophospholipid :- cere onic cid + sphingosine + phosph te + choline = sph ingomyelin. Phospholip ses A1, A2, C, D PLA2 (phospholip se A2) give r chidonic cid G nglioside GM2 ccmul tes in t ys chs dise se Cholesterol C27 H46 O Cholesterol h s ohg group t C3. Dou le ond etween C5-C6 Ergosterol is precussor for vit.D Z ks test is used to identify the qu lit tive n lysis of cholesterol Emulsified f ts in the intestine forms Micelles PROTEINS AND AMINO ACID CHEMISTRY:kjeld his method is used to find out protein in iologic l fluids. the mino cid glycine h s H s side ch in l nine h s CH3 (methyl) s side ch in. Cysteine nd methionine re sulphur cont ining mino cid. Asp rtic cid nd glut mic cid re cidic mino cid Phenyl l nine, tyrosine, tryptoph n rom tic mino cid Al nine is glucogenic mino cid. Leucine nd lysine ketogenic mino cid. Monosodium glut m te intoler nce c uses chinese rest ur nt syndrome D-penicil mine- used s chel ting gent in Wilsons dise se (Accmul tion of copper in r in) N- cetyl cysteine used in cystic fi rosis nd chronic ren l f ilure. GABA-pent ne is used s nticonvuls nt Line r sequence of mino cid seen in prim ry structure helix nd she th second ry structure.3 diminsion l rr ngement of protein terit r y 2 or more poly peptide ch ins- qu rten ry structure Peptide ond ond etween 2 mino cid. S ngers re gent used to determine mino cid sequence S ngers re gent used to determin insulin structure Biur te is compound formed y he ting ure to 180 degrees . process is iur te re ction Copper sulph te is used for he tin in iur te re ction The medic l iochemistry - FMGE Glo l institute of medic l sciences www.gims-org.com Glut thione is involved in tr nsport of mino cfid in intestine nd kidney vi glut nyl cycle/meister cycle. Aspert me rtific l sweetner. NUCLEIC ACIDS AND NUCLEOTIDES:Nucleotides nitrogen se + pentose sug r + phosph te Nucleoside nitrogen se + sug r Ri ose nd deoxyri ose differs in C2 Purine nucleotide is Adenosin mono phosph te Pyr mide nucleotide is Cyitidine MonoPhosph te, Ur dineMonoPhosph te

Alopurinol used in the tre tment of gout 5- fluorour cil used in the tre tment of c ncers Az thioprine is used to suppress immunologic l rejection during tr nspl nt tion The width of dou le helix of DNA 20 / 2 nm E ch turn of helix cont ins 10 se p irs E ch turn of helix is 34 2 str nds of dou le helixd re hold y H- onds DNA protiens re known s histones B-DNA proposed y w tson nd crick in 1953 A-DNA h s 11 se p irs per turn. A nd B- DNA re right h nded helix Z-DNA is left h nded helix Z-DNA h s 12 se p irs per turn (zigz g) Form mide dest hilses H- onds, therefore it lowers Tm Form mide used in recom in nt DNA technology The sug r in RNA kis ri ose RNA is su jected to lk li hydrolysis nd DNA c nnot RNA c n e identified l y orcinol colour re ction ec use of ri ose Nucleolus synthesis r-RNA DNA converts M-RNA converts protein M-RNA h s 7 methyl guicnosine t 5 prime end The 3 prime kend cont ins poly- A t il (MRNA) The stucture of t-RNA resem les clover le f the cceptor rm of t-RNA h s CCA c p (3prime) D- rm h s dihyrouridine (t-RNA) TC arm has T, pseudouridine and C (tRNA) The medical biochemistr - FMGE Global institute of medical sciences www.gims-org.com ENZYMES :There are 6 cclasses of enz mes The functional unit of enz me is holoenz me Holoenz me is made up of apoenz me (protein part) and co-enz me (non-protein par t). Increase in concentration of substrate increase enz me velocit Km = Vmax Km = S (substrate concentration) Km-(michaelis-menten constant) Km is defined as the substrate concentration to produce maximum velocit . Low Km denotes strong affinit between enz me and substrate When enz mes are exposed to C and above temperatures denaturation occurs. All enz mes are active at neutral PH (7) The most common aminoacid at active site is serine INHIBITORS:Xanthine oxidase allopurinol MAO (mono amino oxidase) ephedrine, auphetamine Dih drofolate reducatse aminopterin, amethopterin, methotrexate Acet lcholine esterase succin l choline Dih dropteroate s nthase sulfanilamide Vit. Kepoxide reductase dicumorol HMG co-A reducatse lorastatin, compactin. Disulfiran is the drug used in the treatment of alcoholism Transketolase requires TPP Streptokinase is used to remove blood clots Streptokinase converts plasminogen to plasmin Asperginase is used in treatment of leukemias Increase am lase acute pancreatitis Increase SGPT (serum glutamate p ruvate transaminase) liver diseases Increase alkaline phosphatase rickets and bone diseases

The medical biochemistr - FMGE Global institute of medical sciences www.gims-org.com LIPID METABOLISM:TG plasma concentration is 75-150 mg/dl Cholesterol plasma concentration is 150-200 mg/dl H percholesteremia - >250mg/dl Hormone sensitive TG lipase removes fatt acid from C1 or C3 of TAG glucagon, epinephrine, th roxine, ACTH increase cAMP increase lipol sis. Insulin decrease cAMP decrease lipol sis Gl cerol is metabolized b liver. FFA from Adipose Tissue are transported to liver b albumin. Brain, er throc tes cannot utilize FA FA activation c tosol (ATP, Co-A, mg2+) requires 2 ATP Long chain FA are metabolized in peroxisomes Tangairs disease plasma HDL particles are almost absent Bios nthesis of FA in liver starts with gl cerol and in adipose tissue with gluc ose and acet l Co-A Gl colipids act as receptors in cell membrane Absorption of cholesterol from intestine is b diffusion Cholesterol gives bile salts, vit.D, steroid hormones (sex hormone and corticoid s) Prostaglandin exhibit platelet aggregation, increase cAMP and vasodilation Obesit gene leptin -oxid tion mitochondri ctiv tion of FA in -oxid tion cytosol mel noyl Co-A inhi its CAT-I, thus inhi its -oxid tion CAT-I outer mitochondri l mem r ne CAT-II inner mitochondri l mem r ne Medium ch in ceyl Co-A dehydrogen se, r te limiting step of -oxid tion. -oxid tion of p lmit te gives 106 ATP SIDS (sudden inf nt de d syndrome) deficiency of medium ch in ceyl Co-A dehydro gen se (M-CAD.) Methyl mel noic c demi vit.B12 deficiency Methyl mel noic Co-A requires Vit. B12 Zellweger syndrome sence of peroxisomes cere rohep toren l syndrome. Zellweger syndrome defect in long ch in f tty re kdown -oxid tion Refsums dise se ccumul tion of phyt nic cid. -oxidation requires cytochrome P450 , NADPH, O2. Ketone bodies are synthesized in liver Ketone bodies are utilized by brain in prolonged starvation HMG CoA synthase rate limiting step in ketone bodies synthesis Ketone bodies cannot be utilized by liver because of deficiency of thiophorase Acetone exhaled by lungs s eetish odur.

Detection of ketone bodies Glucagon stimulates ketone Treatment of keto acidosis Fatty acid bio-synthesis

in urine rothers test bodies synthesis, insulin inhibits insulin cytosol.

The medical biochemistry - FMGE Global institute of medical sciences

.gims-org.com

Increase Increase Increase Increase Increase Increase

acid phosphatase prostate carcinoma aldolase muscle d stroph troponin I MI (first marker) CPK1 BB (brain) CPK2 MB (heart) CPK3 MM (skeletal muscle)

Acetyl Co-A for fatty acid biosynthesis (FAB) obtains from citrate lyase NADPH in FAB obtained form HMP- path ay and malic enzyme Acetyl Co-A carboxylase rate limiting step in FAB Insulin stimulates FAB glucagon inhibits Un-saturated fatty acids synthesized by fatty aceyl Co-A desaturase. Human lacks this enzyme. TAG synthesis adipose tissue Cerebronic acid + phyngosine = seramide Seramide + phosphate + choline = sphingomyelin Phospholipase A1 cleaves FFA at C1 Phospholipase A2 cleavesFFA at C2 Phospholipase C - cleaves phosphate and glycerol found in lysozomes of hepatocyt es L-CAT found in lungs L-CAT activity is associated ith apo-A1 of HDL Sphingomyelinase deficiency niemanns picks desease Deficiency of seramidase Faubers disease Deficiency of -g l ctid se kr es dise se Deficiency of -glucosid se g uchers dise se Deficiency of -g l ctid se f rys dise se Deficiency of hexos minid se A T ys chs dise se Cholesterol iosynthesis, liver- 50%, intestine- 15% Cholesterol synthesis- cytosol. HMG- CoA reduct se r te limiting step in cholesterol iosynthesis Cholesterol formul e :- C27 H46 O Gluc gon glucocorticoids decre se cholesterol iosynthesis Comp ctin, lor st tin inhi its HMG Co-A reduct se HMG-CoA reduct se lso inhi ited y ile cids 7--hydroxyl se r te limiting step in ile cid iosynthesis 95% of the ile is re sor ed nd return ck to liver Prim ry ile cids cholic cid chenodeoxycholic cid. Conju tion of ile cids done y glycine , t urine Deoxycholic cid,lithocholic cid second ry ile cids Chenodiol tre t for cholilithi siscti tn of chylomi Chylomicrons h s B48 VLDL h s B100 HDL h s poprotein-A The medic l iochemistry - FMGE Glo l institute of medic l sciences www.gims-org.com Activ tion of chylomicrons nd VLDL requires Apo-CII nd Apo-E from HDL Lipoprotein lip se deficiency hyperlipoprotenimi type I Defect in LDL receptors type IIA Excess poB type IIB A norm lity in po-E type III Over production of TG type IV Defect in HDL receptors t ngiers dise se OXIDATIVE PHOSPHORYLATION AND ETC:Phosphophenol pyruv te is 14.8 c l/mole. S- denosyl methion ne is 10 c l/mole cAMP is 12 c l/mole ATP is 7.3 c l/mole The inner mitochondri l mem r ne is imperme le to H+, K+ nd N + Co-enzyme Q is lso known s u iquione Complex-I NADH-co-encyme Q reduct se inhi ited y myt l, rotenone, pricydine-A Complex III Co-enzyme Q-cytC reduct se inhi ited y ntimycin A,

BAL ( ritish nti lewisite) Comple IV cytochrome oxid se inhi ited y cy nide, CO, N - zide. ot tion of -su unit is 12 ATP synth t se h s F0 nd F1 su units. F0 ch nnel protein C F1 centr l subunit, 3, 3 Mut tion of mitochondri l DNA oxiphos dise se AKA (le ers heredit ry optic neuro p thy) 2, A dinitrophenol uncoupler of oxiphosphoryl tion Digomycin inhi its oxid tive phosphoryl tion y inding to ATP synthet se 2 loc kes proton ch nnels Atr ctyloside inhi its oxid tive phosphoryl tion y locking the dequ te supply of ADP. The medic l iochemistry - FMGE Glo l institute of medic l sciences www.gims-org.com VITAMINS:Vit.A:Retinol is present in nim ls in the form of retinylester Retin l,retinol nd retinoic cid re vit mers of vit min A - c rotene gives l2 moles of retin l y 1 -1 di-oxygen se retinyl esters re tr nsported y chylomicrons nd stored in liver retinol is tr nsported in circul tion y RBP 9retin l inding protein) rods dim light vision cones right light vit-A required for rods rhodopsin present in rods rhodopsin = 11-cis retin l + opsin during w lds visu l cycle rhodipsin is le ched to met rhodopsin-II which incre ses C-GMP n degener tes nerve impulse Vit-A deficiency night lindness Serene deficiency of vit-A c uses xerophth lmi , ch r cterized of dryness of con junctiv nd corne , white tri ngul r pl ques, itots spots re seen Xerophth lmi le ds to ker tom l ci c using tot l lindness Vit. D Ergosterol (pl nts) ergoc lciferol vit. D2 Cholec lciferol ( nim ls)- vit.D3 Vit-D synthesis t kes pl ce in skin. 1,25- Di-hydroxycholec lcifer l is known s c lcitriol i.e., ctive form of vitD 25- -hydroxyl se nd 1--hydroxyl se requires cyt-p-450, NADPH nd O2 Vit.D is essenti l for one form tion Vit-D deficiency:- pickets owlegs children; osteom l ci Adults. Alk line phosph t se ctivity elev ted in rickets Vit-D is more toxic in over doses Vit-D is tr nsported in the circul tion y 2-glo ulin 1--hydroxyl se present in kidney nd stimul ted y PTH 25- hydroxyl se present in liver Vit-E:Anti sterility vit min Also known s tocopherols ,,, out of these -tocopherols more ctive Vit-E is tr nsporte by VLDL n LDL in the circul tion Norm l pl sm levels of tocopherols <1m / l The me ic l biochemistry - FMGE Glob l institute of me ic l sciences www. ims-or .com Vit-E n tur lly occurrin ntioxi nt n it requires selenium Vit-E prevents peroxi tion re ctions of PUFA ALA-synth se requires vit.E Vit-K:-

Vit-K lso synthesize by intestin l b cteri Bile s lts re essenti l for bsorption of vit- K Tr nsporte to liver by me ns of LDL Vit-K is responsible for post tr nsition l mo ific tion of 2,7,9,10 clottin f c tors by c rboxyl tion of lut mic ci C rboxyl tion of lut mic ci is inhibite by icum rol Deficiency of vit-K le s to l ck of cive prothrobin in circul tion Hi h oses of vit-K c uses hemolytic nemi Vit-C :Vit-C is require for coll en form tion Vit-C is co-enzyme for hy roxyl tion of proline n lysine, where protocoll en is converte to coll en Deficiency of vit-C le s to scurvy, el ye woun he lin Vit-B1 :co-enzyme TPP TPP require for PDH tr nsketol se Deficiency seen in the people who consume polishe rice s st ple foo Elev tion of pyruv te in pl sm n excrets in urine Wet-beriberi e em systolic incre se i stolic ecre se bouncin pulse. Dry-beriberi no e em neurolo ic l m nifest tions re seen Decre se tr nsketopl se ctivity Wernicks kors koff syn rome Thy mine eficiency more commonly seen in lcoholics. B2 RIBOFLAVIN:Coenzymes FMN, FAD Use in oxi tion re uction re ctions Deficiency cheilosis, losittis, erm titis Assessment of lut thione re uct se in erythrocytes will be useful in ribofl vin eficiency NIACIN:Coenzyme NAD, NADP Pell r preventive f ctor Ni cin coenzymes synthesize from tryptoph n Ni cin eficiency results pell r Pell r symptoms i rrhe , ementi , erm titis e th HD Ni cin inhibits lipolysis Ni cin is use in tre tment of hyperlipoprotenuri type_IIB. (incre se VLDL, in cre se LDL) PYRIDOXINE:- B6 Coenzyme pyri oxine, pyri ox l pyri ox mine Pyri oxine use in tr ns min tion, ec rboxyl tion, e min tion. Active form is pyri ox l phosph te (PLP) tr ns min tion It is require for the pro uction of the mono mine neurotr nsmitters serotonin, op mine, norepinephrine n epinephrine, s it is the precursor to pyri ox l ph osph te: cof ctor for the enzyme rom tic mino ci ec rboxyl se. This enzyme is responsible for convertin the precursors 5-hy roxytryptoph n (5-HTP) into se rotonin n levo op (L-DOPA) into op mine, nor ren line n ren line. As su ch it h s been implic te in the tre tment of epression n nxiety. DEFICIENCY MANIFESTATIONS:1. neurolo ic l symptoms 2. excretion of x nthurenic ci in urine 3. ru s isoni zi n penicill mine c n c use B6 eficiency. The me ic l biochemistry FMGE Glob l institute of me ic l sciences www. ims-or .com

ccessin

BIOTIN B7 It is require for c rboxyl tion re ctions E .:- 1. cetyl CoA c rboxyl se 2. propony CoA c rboxyl se 3. pyruv te c rboxyl se PANTOTHENIC ACID:lso known s coenzyme A eficiency burnin feet syn rome FOLIC ACID:it is import nt for one c rbon met bolism the ctive form if tetr hy roflo te TH4 or THF the most common vit min eficiency import nt for the synthesis of nitro enous b ses in DNA n Supplemente in pre n ncy to prevent neur l tube efects Deficiency of folic ci me lobl stic nemi . In folic ci eficiency FIGLU excrete in urine. (FIGLU- formimino lut m te) VITAMIN B12 (COBALAMIN) The bsorption of vit-B12 requires intrinsic f ctor, intrinsic f ctor pro uce b y stric p riet l cells Absorption of B12 into mucos l cells is C +2 epen ent In mucos l cells B12 converts to methyl B12 From the mucos l cells tr nsporte in the pl sm by tr nscob l mins i.e., Tc-I n Tc-II Methyl B12 (mucos l cells) 90% bin s to Tc-I n 10% bin s to Tc-II Vit-B12 stores in liver, s eoxy enosyl B12 (stor e form of vit B12) DEFICIENCY:Methyl mel noic ci emi Pernicious nemi Neurolo ic l m nifest tions (optic neurop thy) The me ic l biochemistry FMGE Glob l institute of me ic l sciences www. ims-or .com Use schillin test to etect eficiency Vit-B12 eficiency - most common c use is m l bsorption sprue . HAEMOGLOBIN AND PORPHYRINS:METABOLISM:Heme cont ins porphyrin molecule known s protoporphyrin IX Heme cont ins 4 pyrole rin s The centr l tom of heme cont ins Fe The ult hemo lobin 2,2 H A1 Fet l hemoglo in 2 2 HbF HbA2 2 2 Glycosyl te hemo lobin Hb A1 C 2 2 glucose (di etes) Fet l H h s more ffinity tow rds O2 th n dult H F 100% ; H A1 95%. In heme if Fe2+ oxidizes to form Fe3+ known methehemoglo in BIOSYNTHESIS OF HEME:-

RNA.

The medic l iochemistry FMGE Glo l institute of medic l sciences www.gims-org.com HEME METABOLISM :Biliru in ound to l umin to form iliru in l umin complex The medic l iochemistry FMGE Glo l institute of medic l sciences www.gims-org.com Enters liver for conjug tion Biliru in enters into intestine where it re cts with cteri l enzymes to form s terco ilin which enters into feces 1 gm of H gives 35 mg of iliru in Biliru in- l umin complex inds to receptor LIGANDIN which in present on hep to cytes Porphyri s :CARBOHYDRATE METABOLISM:Insulin dependent glucose tr nsport GLIT-4 skelet l muscle, dipose tissue GLUT-1 erythrocytes GLYCOLYSIS CYCLE:The medic l iochemistry FMGE Glo l institute of medic l sciences www.gims-org.com Loc tion cytosol of ll most ll the cells Glucokin se liver, hexokin se other tissues Hexokin se low Km, glucokin se- High Km (PFK-1) Phosphofructokin se-1 r te limiting step Spilitting ldol se-A . 7 ATP in ero ic glycolysis nd 2 ATP in nero ic Glycolysis in RBC is lw ys nero ic IRREVERSIBLE STEPS:Hexokin se PFK-1 Pyruv te kin se ( deficiency hemolytic nemi ) INHIBITORS:Glycerol dehyde 3 phosph te dehydrogen se iodo cet te , rsen te Enol se fluoride Phospphotriose isomer se - romohydroxy cetone phosph te End product of ero ic glycolysis pyruv te End product of n ero ic glycolysis l ct te Glycolysis in erythrocytes is lw ys n ero ic Num er of ATP under ero ic glycolysis 7 Num er of ATP under n ero ic glycolysis 2 PFK-1 is regul ted y PFK-2 A product of glycolysis 2,3 BPG com ines with hemoglo 9in nd unlo ds O2 to tiss ues. Incre se 2,3-BPG shifts O2 /H dissoci tion curve to right Decre se 2,3-BPG shifts O2/H dissoci tion curve to left. PDH COMPLEX: Loc tion mitochondri Enzyme complexes:1. E1 pyruv te dehydrogen se TPP 2. E2 dihydro lipoyl tr ns cetyl se lipo mide ,CoA 3. E3 dihydro lipoyl dehydrogen se NAD, FAD Inhi itors rsenic poisoning

Heme synthesis t ke pl ce in liver ALA synth se is r te limiting step in heme

iosynthesis

TCA CYCLE:The medic l iochemistry FMGE Glo l institute of medic l sciences www.gims-org.com Loc tion mitochondri Citr te synth se - r te limitin step NADH produce in :1. iso citr te dehydrogen se 2. -ketoglut r te dehydrogen se 3. m l te dehydrogen se FADH produced y succin te dehydrogen se GTP produced y succin te thiokin se INHIBITORS:1. Aconit se fluro cet te 2. -keto glutarate dehydrogenase arsenate 3. Succinate dehydrogenase malonate Number of TP produced from 1 cetyl Co- is 10. GLUCONEOGENESIS:Synthesis of glucose from non-carbohydrate compounds. 160 gms of glucose required per day (whole body) 120 gms of glucose is required brain Location:- initial step mitochondria ; key step cytosol Rate limiting step pyruvate carboxylase The medical biochemistry FMGE Global institute of medical sciences www.gims-org.com

lanin glucogenic aminoacid Glucagon stimulates gluconeogenesis, insulin inhibits lpha- cells secrets glucagone lcohol inhibits gluconeogenesis induces hypoglycemia GLYCOGEN MET BOLISM

Liver glycogen maintains blood glucose Muscle glycogen is used ony for muscle Glycogenesis in muscle starts with hexokinase Glycogenesis in liver starts with glucokinase Glycogen in protein produced by liver acts as initiator of glycogen synthesis The tyrosine residue of glycogenin adds glucose from UDP-G to form glycogen prim er Glycogen synthatase rate limiting step in glycogen synthesis The medical biochemistry FMGE Global institute of medical sciences www.gims-org.com Glycogen phosphorylase breaks glycogen at 1-4 resi ues. Gluc ons stimul tes lyco en bre k own in liver Epinephrine stimul tes lyco en bre k own in muscle C lcium promotes lyco en bre k own by C +2 colmo ulin complex Glucose 6 phosph t se eficiency Von Gireks ise se Lysosom l (1, 4) lucosi se eficiency Pompes ise se he rt is more commonly inv olve e th occurs ue to he rt f ilure. De-br nchin enzyme eficiency An ersons ise se Muscle lyco en phosphoryl se eficiency MC Ar les ise se Liver lyco en phosphoryl se Hers ise se Phosphofructokin se T ruris ise se erythocytes, hemolysis

HMP PATHWAY:HMP p thw y is only p thw y which synthesizes NADPH in RBC (require for ntioxi nt re ction) R te limitin step lucose 6 phosph te ehy ro en se Deficiency of lucose 6 phosph te ehy ro en se hemolytic nemi HMP p thw y synthesis of riboses Tr nsketol se epen ent on TPP ecre se TPP Wericks kors koff syn rome Glucose 6 phosph te ehy ro en se eficiency is resist nt to m l ri Deficiency of xylitol ehy ro en se essenti l pentosuri GLACTOSE METABOLISM:CLASSICAL GALACTOSEMIA Inf nts Deficiency of l ctose 1-phosph te Tr nsfer se ur yl. Incre se l ctitol by l ose re uct e c t r ct i nosis elev te hosph te uri yl tr nsfer se FRUCTOSE METABOLISM:-

NEURO ANATOMY HIGH YIELD Schw nn cells - Myelin production in cns Oligodendrocytes - Myelin production in cns The f stest conduncting fi res re TYPE-A fi res TYPE-A: Muscle spindle { Extr fus l muscle fi res } Intr fus l muscle fibres Coll terls to A Type-B:Supplies pre n lionic utonomic fibres n receives inform tion from skin,visce r ,connective tissue . TYPE-C:These re unmyelin te Sen s efferents to post n lionic utonomic fibres Jumpin of AP from one no e to other is S lt tory con unction Fibrous Astrocytes Bloo Br in B rrier {BBB} Spin l cor en s t L2 Verterbr L min e I M r in l cell L min e II Subst nti el tinos of Rol n o L min e III Chief sensory cells L min e IV Clr kes cells

Deficiency of Deficiency of Mucopolys cch Mucopolys cch Mucopolys cch - glucuronid

fructokin se essenti l fructosuri l ol se-B here it ry fructose intoler nce ri oses-I I uroni se Hurlers syn rome ri oses-II i uron te sulf t se Hunters syn rome ri oses-III s nfilippo syn rome se sly syndrome (Mucopolys cch ridoses-VII)

l ctose 1-p

 L min e IX Subst nti el tinos centr lis The occulomotor nerve emer sfrom me i l spect of crus cerebri The Trochle r nerve emer s from l ter l spect of crus cerebri A p ir of superior n inferior colliculi forms corpor qu ri emin Telenceph lon Cerebr l cortex , B s l n li Dienceph lon Th l mus , Hypoth l mus Mesenceph lon Mi br in , cerebr l pen uncles Rhombceph lon Pons , cerebellum , Me ull Spin l cor evelops from the ownw r Continu tion of Neur l Tube Anterior Spinoth l mic Tr ct Cru e touch sens tions , Chief-Sensory cell L ter l Spincoth l mic Tr ct Subst nti eltinos , P in n Temper ture Rensh w cell L min e VII L min e -IX OR Motor neurons Me ull oblon t 3cm len th , 2cm wi th Anterior surf ce of pons is m rke in the mi line by sh llow roove which cont i ns B sil r Artery Cerebello pontine n le h s F ci l Nerve , Vestibulo cochle r Nerve n Glossoph ryn e l Nerve emer s from Me i l To L ter l Spin l nucleus of tri eminus presents on the L ter l spect of me ull , More me i lly nucleus r cilis n nucleus cune tus Me i l lemniscus is forme by fibres risin from nucleus r cilis n nucleus c une tus Cerebrum n cerebellum re sep r te by Tentrioum cerebell Cerebell r nuclei Dent te , Emboli form , Globose ,F sti e l Dent te is the l r est form of cerebell r nuclei Anterior spin l rtery Anterior 2/3 of spin l cor Posterior spin l rtery Posterior 1/3 of spin l cor Gre ter Anterior se ment l me ull ry rtery A m Kiewilz Directly risin from ort M jor source of bloo to lower thir of spin l cor Spin l shock is more common in Lower Thir Of Spin l cor Anterior Lon itu in l rtery n Intr me ull ry rteries re en rteries of sp in l cor Spin l shock is seen Most common in Thor cic n Lumb r Are Lumb r spin l shock - Most common Ab omin l Aortic Aneurysm Syn ptic cleft - 20 - 40 nm Wi e Subconscious Kinesthetic sens tions from upperlimb Cuneocerebell r Tr ct Toxin in uce neuron l e ener tiob Injury to ors l columns L ter l spinoth l mic n nterior spinoth l mic scen s in the form Of spin l Lemniscus Dors l spino cerebell r tr ct Cl rkes column Ventr l spino cerebell t tr ct M r in l cell Spino cerebell r tr ct c rries Subconscious kinesthetic sens tions Syrin omyelie Dors l Column Injury Sensory Loss ARAS Conscious An Aw rness Upper motor neuron { UMN } Sp stic P r lysis Lower motor neuron { LMN } - Fl cci P r lysis B binski si n positive UMN Lesions CSF 150 Ml Globus P lli us + put men = Lentiform Nucleus Lentiform Nucleus + C u te Nucleus = Corpus Stri tum Corpus stri tum is import nt for Intelli ence n Lon term Memory n Developmen t of IQ Flow of CSF from L ter l 2/3 r ventricle For men of Monro CSF from 3r 4th ventricle Aque uct of sylvius Are 4 Prim ry Motor Are Are 6 Pre Motor Are { Associ tion Are } Are 8 Front l eye fiel { Conju te Movements of eye b ll } Are 9,10,11 Controls person lity n intellect Are 3,2,1 Prim ry sensory re

 D m e to som to sensory re c uses eficit in fine touch ,position n vibr ti on sense ( Dors l columns re more commonly involve ) Are 17,18,19 Visu l Cortex Are 17 Prim ry Visu l Are Are 18 Visu l Associ tion Are Are 19 I entific tion n An lyzin Are 41 Prim ry Au itory Are Are 42 Au itory Associ tion Are Are 22 Wernickes Are Are 44,45 Broc s Are The posterior limb of intern l c psule cont ins Cortico spin l tr ct Bloo supply of intern l c psule Mi le cerebr l rtery Specific Gr vity of CSF 1.005 Concentr tion of N cl is hi h in CSF when comp re to pl sm Pro uction of CSF 0.3 ml / min Th l mus is supplie by Posterior cerebr l Artery (75%) , Mi le Cerebr l Artery (25%) Th l mus - Stri te Vein - Venous Dri n e of th l mus L ter l Hypoth l mic Are consi ere s fee in ccentre Hypo loss l nucleus Innerv tes Stylo lossus n Genio lossus Arteri l Supply Of Me ull Anterior spin l rtery Br nch of veretebr l rtery Posterior spin l rtery Br nch of veretebr l rtery Posterior inferior cerebell r rtery Br nch of verterbr l rtery Subst nti Ni r :Dors l p rt P rs Comp ct Ventr l p rt P rs Reticul ris P rs Comp ct cont ins Dop miner ic n Choliner ic Neurons P rs Reticul ris cont ins Dop miner ic Neurons Trochle r Nerve is the only cr ni l nerve rises from Dors l spect of br in { P osteriorly } Lesion in re nucleus c uses Bene icts syn rome P r n u s syn rome Tumor t superior collicul r which compresses pine l bo y Bloo supply of pons Superior Cerebell r Artery , Posterior Inferior Cerebell r A rtery Archicerebellum Lin ul + Flocull Function : Equilibrium Tone n Posture of trunk muscles P leo cerebellum Tone n Posture of Anti r vity muscles Neop lli l cortex Skille Movements Climbin Fibers , Mossy Fibers , Gr nul r Fibers { Excit tory Neurotr nsmitters re Asp rt te , Glut m te } Purkinjie cell Neurotr nsmitter GABA BBB is bsent in Posterior Pituit ry , Me i n Eminence , Pine l Gl n Put men Anterior Cerebr l Artery Anterior Choro i l Artery Optic Tr ct , Optic Chi sm Globus p lli us Str ite Arteries Br nch of mi le cerebr l rtery T il of c u te nucleus n my loi bo y re perfor tin br nches of mi le c erebr l rtery Lesions in corpus stri tum P rkinsonism The cr ni l nerve which oes not h ve p r symp thetic component Ab ucens Nerve

Ph rm colo y - Gener l consi er tions ( every i ill post 1 ch pter from ph rm now on n si e by si e lso follow sur ery s i poste 40 till now n next 60 will be poste in 3 ys s per 20 mcqs y - h ve oo y ......

1.Which ru n me is not Atropine V lium Ipr tropium Hyoscine 2.Which of the followin Met bolism Protein-bin in Absorption Receptor-bin in

eneric n me?

is not

ph rm cokinetic property of

ru ?

3.So ium hy ro en c rbon te is sol s ru un er v rious n mes such s lk li , b kin so , ur col, n so ium bic rbon te. Which of the followin is consi e re propriet ry n me for this subst nce? Ur col So ium bic rbon te So ium hy ro en c rbon te B kin so

4.Dru s re often protein-boun in the bloo stre m. Wh t is the princip l protei n th t oes this best? Fibrino en Albumin H emo lobin G mm

lobulin

5.N tur l vit min E is usu lly iven in el tine c psules issolve in soybe n o il. Which wor woul best escribe the property of vit min E in this process? Lipophobic

Hy rophilic Lipophilic Hy roxyl tion 6.The princip l site of ru met bolism is the: ki neys stom ch colon liver 7.The most efficient s: non-ionise t bsorption of ru t kes pl ce in the ileum if the

pH of ~6

we k b se

ionise

pH of ~8

we k ci

8.Wh t is the b sic mech nism of ction of Physic l Chemic l Enzyme inhibition Receptor ctiv tion

n osmotic iuretic such

s ure ?

9.A ru ministere to person pro uce bloo concentr tion of 900 n /L ft er 3 hours. After further 5 hours the concentr tion h f llen to 300 n /L. Wh t is the pproxim te h lf-life of this ru ssumin zero kinetics? 5 hours 3 hours 4.5 hours 3.5 hours 10.Morphine n pent zocine both ct upon simil r receptors in the centr l nervo us system n pro uce n l esi . If pent zocine is iven to morphine ict it m y pro uce with r w l symptoms. Wh t kin of ction oes pent zocine h ve t o pioi receptors? A full nt onist ction A p rti l A full onist

ction

onist ction

ru i

An inhibitor

11.Which of these ru s is F moti ine Niz ti ine R niti ine Cimeti ine

12.Un er wh t con itions is it most import nt to store so ium nitroprussi e? Protecte from he t Protecte from moisture Protecte from col

Protecte from li ht 13.It is possible to refer to me ic tion usin n me is best to use in clinic l pr ctice? The me ic tion s tr e n me. ifferent n mes. Which type of

The me ic tion s propriet ry n me. The me ic tion s chemic l n me. The me ic tion s eneric n me. 14.A ru s m r in of s fety is the ose r n e which pl ces it: bove both the minimum effective concentr tion (mec) ion (msc) below the m ximum s fe concentr tion (msc) n ntr tion (mec) bove the m ximum s fe concentr tion (msc) ntr tion (mec) n m ximum s fe concentr t

bove the minimum effective conce

below the minimum effective conce n minimum effective concentr t

below both the m ximum s fe concentr tion (msc) ion (mec)

15.Bloo cell lysis is ssoci te with which type of hypersensitivity re ction? IV III II I 16.Pl cent l ru tr nsfer is ffecte by the ru

s:

ction potent enzyme inhibitor in the liver?

molecul r size only ffinity for pl sm proteins only r ient cross the pl cent only

concentr tion

ll of the bove

ffect pl cent l ru tr nsfer c te ory X ru is escr

17.In reference to the use of me icines in pre n ncy, ibe s me icine:

where nim l stu ies m y be in equ te, but there is no evi ence of foet l e th t h s no proven h rmful effects on the foetus h ve hi h risk of c usin irreversible

m e to the foetus

where the h rmful effects on the foetus m y be reversible 18.A slow cetyl tor n incre se in ru ecre se in ru ministere ru met bolise in this w y m y w rr nt:

os e

os e

no speci l consi er tions in their c re more frequent os e 19.P renter l ru bsorption in be expecte to result in: hi her bloo concentr tion n lower bloo concentr tion n person with con estive c r i c f ilure mi ht

lower concentr tion

t the injection site t the injection site

hi her concentr tion hi her concentr tion

hi her bloo concentr tion n lower bloo concentr tion n

t the injection site

lower concentr tion

t the injection site

20.Which of the followin physiolo ic l st tes woul be expecte her pl sm levels if the ru w s hy rophilic? the ru with foo

to result in hi

When t kin Diuresis

An incre se in ut perist lsis In hep tic isor ers 21.Which of the followin p e i tric client? st tements is pplic ble when ministerin

Involve the p rents in the proce ure. In or er to urt. in the chil s co-oper tion tell the chil th t injections on t h

ru to

Prep re the me ic tions in front of the chil . Avoi the or l route when ivin ru to youn chil . ose c lcul tions is:

22.Gener lly, the most reli ble in ic tor for p e i tric

bo ywei ht sex bo y surf ce

re

23.Why is it import nt to ssess the number of me ic tions n el erly client is t kin ? Solely to minimise Solely to minimise ru inter ctions verse ru re ctions

Only bec use the person m y be seein number of octors who o not communic te with e ch other bout the ru s they h ve prescribe All of the bove to contribute to compli

24.Which of the followin f ctors woul not be expecte nce with ru tre tment in the el erly? In ivi u lise me ic tion e uc tion Complic te Use of ru re imens

osette box

Thorou h ssessment of clients 25.If spirin is ministere to ether with w rf rin, wh t is the most likely ou tcome with respect to protein bin in ? There will be more unboun (free) form of the w rf rin v il ble, le in to ecre se blee in ten ency. There will be more boun blee in ten ency. form of the w rf rin v il ble, le in to

n incre se ecre se

There will be more boun form of the w rf rin v il ble, le in to blee in ten ency.

There will be more free (or unboun ) form of the w rf rin v il ble, le in to incre se blee in ten ency. 26.Which of the followin is not Remov l or ition of type of ph se I met bolism? roup on

n ctive molecule

ru .

Conju tion of cretion. Oxi tion of

ru

with

pol r molecule to ren er the pro uct soluble for ex

ru .

Re uction n hy rolysis of

27._______ me ic tions h ve l r er volume of istribution in neon tes n youn inf nts comp re with ults n therefore require l r er ose to re ch ther peutic levels. hi hly protein boun

hy rophilic n lipophilic hy rophilic lipophilic 28.In which st te Pol r Un-ionise Ch r e re ru s more likely to be well bsorbe ?

Hy rophilic

29.In c se of poisonin , ru with which pp rent volume of l be most effectively cle re from the bo y by h emo i lysis? 50 L/k

istribution wou

0.57 L/k 0.04 L/k 3 L/k

30.The p r meters th t contribute to eterminin cle r nce n pp rent volume of

the

ru h lf-life re:

istribution ru concentr tion

pp rent volume of istribution n pl sm ose n cle r nce n pl sm

lo in

frequency of

ministr tion

ru concentr tion

ANSWERS - PHARMACOLOGY ( 1- 30 ) 1. Which ru n me is not Correct Answer: V lium eneric n me?

________________________________________ 2. Which of the followin is not ph rm cokinetic property of correct Answer: Receptor-bin in

ru ?

ru .

________________________________________ 3. So ium hy ro en c rbon te is sol s ru un er v rious n mes such s lk l i, b kin so , ur col, n so ium bic rbon te. Which of the followin is consi ere propriet ry n me for this subst nce? Correct Answer: Ur col ________________________________________ 4. Dru s re often protein-boun in the bloo stre m. Wh t is the princip l prote in th t oes this best? Correct nswer - Albumin ________________________________________ 5. N tur l vit min E is usu lly iven in el tine c psules issolve in soybe n oil. Which wor woul best escribe the property of vit min E in this process? Correct nswer - lipoplilic ________________________________________ 6. The princip l site of ru met bolism is the: Correct Answer: liver ________________________________________ 7. The most efficient bsorption of ru t kes pl ce in the ileum if the ru is: Correct Answer: we k b se n osmotic iuretic such s ure ?

Correct Answer: Physic l ________________________________________ 9. A ru ministere to person pro uce bloo concentr tion of 900 n /L f ter 3 hours. After further 5 hours the concentr tion h f llen to 300 n /L. W h t is the pproxim te h lf-life of this ru ssumin zero kinetics? Correct Answer: 3.5 hours ________________________________________ 10. Morphine n pent zocine both ct upon simil r receptors in the centr l nerv ous system n pro uce n l esi . If pent zocine is iven to morphine ict i t m y pro uce with r w l symptoms. Wh t kin of ction oes pent zocine h ve t opioi receptors? Correct Answer: A p rti l onist ction

________________________________________ 11. Which of these ru s is potent enzyme inhibitor in the liver? Correct Answer: Cimeti ine ________________________________________ 12. Un er wh t con itions is it most import nt to store so ium nitroprussi e? Correct Answer: Protecte from li ht ________________________________________

________________________________________ 8. Wh t is the b sic mech nism of ction of

13. It is possible to refer to me ic tion usin n me is best to use in clinic l pr ctice? Correct Answer: The me ic tion s eneric n me.

ifferent n mes. Which type of

________________________________________ 14. A ru s m r in of s fety is the ose r n e which pl ces it: Correct Answer: below the m ximum s fe concentr tion (msc) n effective concentr tion (mec)

________________________________________ 15. Bloo cell lysis is ssoci te with which type of hypersensitivity re ction? Correct Answer: II ________________________________________ 16. Pl cent l ru tr nsfer is ffecte by the ru s: Correct Answer: ll of the bove ffect pl cent l ru tr nsfer

________________________________________ 17. In reference to the use of me icines in pre n ncy, c te ory X ru is esc ribe s me icine: Correct Answer: h ve hi h risk of c usin irreversible m e to the foetus ________________________________________ 18. A slow cetyl tor ministere ru met bolise Correct Answer: ecre se in ru os e

in this w y m y w rr nt:

________________________________________ 19. P renter l ru bsorption in person with con estive c r i c f ilure mi ht be expecte to result in: Correct Answer: lower bloo concentr tion n ction site hi her concentr tion t the inje

be expecte to result in h

Correct Answer: In hep tic isor ers ministerin

________________________________________ 22. Gener lly, the most reli ble in ic tor for p e i tric ose c lcul tions is: Correct Answer: bo y surf ce re

________________________________________

________________________________________ 21. Which of the followin st tements is pplic ble when p e i tric client? Correct Answer: Involve the p rents in the proce ure.

________________________________________ 20. Which of the followin physiolo ic l st tes woul i her pl sm levels if the ru w s hy rophilic?

ru

bove the minimum

to

23. Why is it import nt to ssess the number of me ic tions t kin ? Correct Answer: All of the bove

n el erly client is

________________________________________ 24. Which of the followin f ctors woul not be expecte to contribute to compli nce with ru tre tment in the el erly? Correct Answer: Complic te ru re imens

________________________________________ 25. If spirin is ministere to ether with w rf rin, wh t is the most likely o utcome with respect to protein bin in ? Correct Answer: There will be more free (or unboun ) form of the w rf rin v il ble, le in to incre se blee in ten ency. ________________________________________ 26. Which of the followin is not type of ph se I met bolism? Correct Answer: Conju tion of t soluble for excretion. ru with pol r molecule to ren er the pro uc

________________________________________ 27. _______ me ic tions h ve l r er volume of istribution in neon tes n you n inf nts comp re with ults n therefore require l r er ose to re ch the r peutic levels. Correct Answer: hy rophilic bsorbe ?

Correct Answer: Un-ionise

________________________________________ 29. In c se of poisonin , ru with which pp rent volume of istribution wo ul be most effectively cle re from the bo y by h emo i lysis? Correct Answer: 0.04 L/k

________________________________________ 30. The p r meters th t contribute to eterminin the ru h lf-life re: correct Answer: cle r nce n pp rent volume of istribution

________________________________________ 28. In which st te re ru s more likely to be well