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Cavernous hemangioma risk?
bleeding
Tryptophan --> what two pathways? 2 mnemonics
"tripped on his nice nads" B2, B6 cofactors ---> NAD+
and
"tripped on Sir-o-tony's Melons" B4, B6 cofactors ---> serotonin--- hydroxyindole transferase --->MELANIN
hyperosmotic volume CONTRACTION (losing water, osm up in plasma) caused by...
SWEATING OR DI
primary polydipsia results in what fluid changes?
expands both ICF ECF with decreased osmolarity
adrenal insufficiency volume changes?
ECF down ICF up!
what reaction forms PORPHYRIN? Cofactor?
Glycine --> B6 cofactor --> Porphyrin
treat P. aerug with...
cefaPime
Alkaptonuria defect and accumulation
Cannot synthesize MALEYLACETOACETIC ACID, so precursor HOMOGENISTIC acid accumulates. Urine turns BLACK on sitting.
which drug given after benzos to STOP REUCRRENCE OF tonic clonic seizures?
PHENYTOIN
glutamine metabolism yeilds?
part of BICARB and AMMONIA so useful for ALKYLIZING THINGS!
ALANINE AND ASPARTATE FUNCTION IN WHAT PATHWAY?
GLUCONEOGENESIS!
it ain't an ULCER until?
it gets to the SUBMUCOSA
Brain infarct timing and histology
1d = red dead (eosinophilic, loss of nissl)
then NEUTROPHILS
1w = MACs come clean up and start LIQUEFACTIVE NECROSIS
2w = gliosis and vascular proliferation
1 month = GLIAL SCAR
Drugs causing stephen johnson syndrome/Toxic epidermal necrosis?
"Steven Johnson has TEN funny barbie cars"

Phenytoin
Phenobarbitol
Carbamazepime
Alpha 1 =
Alpha 2 =
B1 =
B2 =
B3 =
M1 =
M2 =
M3 =
H1 =
H2 =
D1 =
D2 =
V1 =
V2 =
Alpha 1 = q, IP3/DAG = smooth m contraction, eye dilates
Alpha 2 = i, decr cAMP = smooth m contract, plate agg
B1 = s, increased CAMP, incr HR/Contractility HEART
B2 = s, increased camp, bronchodilation LUNGS
B3 = s, increased camp, detrusor relax BLADDER?
M1 = Q, IP3/DAG, smooth m contraction BRAIN
M2 = i, decr cAMP HEART
M3 = Q, IP3/DAG = smooth m contract LUNGS
H1 = q = vasodilation and bronchoconstriction
H2 = s = gastric acid secretion
D1 = s
D2 = i
V1A,B = q = V1 B in posterior pituitary
V2 = s > this is the one in the RENALs
HEPCIDIN produced...
HEPATICALLY
benzos metabolized NOT in Liver?
LOT = lorazepam, oxa, Tam
drugs causing hypothyroid? mnemonic?
Amy surfs on lithium

amiodarone
sulfas
lithium
draw glaucoma drugs chart
prostaglandins incr outflow
pilocarp & carbachol => incr outflow
alpha agonists incr out and decr prod
carb anhydrase inhib = decr production

PG = OUT
carp and chol = OUT
alpha antag = OUT and DOWN
carb anh inhib = DOWN
Lithium = "LITH"
lithium causes INSIPIDUS Db, Tremor, Hypothyroid
"Amigoglycosides"
GNATS: gentmycin, neomycin, tobramycin, streptomycin

inhibit 30s, work outside so no anaerobic coverage, and they are N.O.T. wanted here...so Nephrotoxic, Ototoxic, and Teratogenic
Arsenic/insecticides poisoning, use?
Dimercapturol to capture all the arsenic
Cyanide poisoning use?
hydroxycobalamine or NITRITES!
Osteomyelitis in kids v adults?
osteo in kids goeds to METAPHIYSIS. Adults goes to VERTEBRAL BODY
D1 agonists mnemonic?
D1 athletes say

"if-an-old-pam dope-ex-of-mine stephanie (calls) ibop her"

fenoldopam, dopexamine, ibopamine, stepholidine
Resistance Mechanisms:

penicillin
vanco
Fq
amigos
tetra
rifamycins
PBP, porin, ESBL
in/efflux, wall changes
change in topo or gyrase, influx efflux
30s ribosome change or porins
change in RNA pol
RIPE regimen

drug, MOA, S/E
Rifampin = rna pol = red fluids and cytopenia
Isoniazid = disrupt "(m)icolic acid" = neurotox GIVE B6!
Pyrazinamide = none = HEPATOTOXIC
Ethambutol screws up the WALL = OPTIC NEUROPATHY
CYP450 inhibitors mnemonic
sippin grapefruit juice is errything, 'az all the right tone (avir)...

Cipro
Gf juice
Erythromycin
azoles
ritonavir
partial seizures treatment =
"have a partial seizure in gabs funny barbie car"
phenobarbitol
gabapentin
phenytoin
carbamazepime
absence seizure treatment? MOA?
ethasuxamide, "failed the LCAT" blocks L-type calcium channels
phenytoin MOA?
puts a "TOE-in" the Na channel to stop it recovering
drugs causing gingival hyperplasia mnemonic?
it's a funny cycle-of-phosphamides
phenytoin, cyclophosphamide
rifaxamin sends a fax to...
gut flora, telling them to INCREASE RESORPTION OF AMMONIA!
what are the precurors to methoinine?
cystine, carnitine, taurine, lecithin
pyruvate PIE is cut in three pieces, what are they?
1. lactic acid (via LDH) ---> ANAEROBIC RESPIRATION
2. oxaloacetate (via pyruvate carbOXylase with B7 cofactor!) ---> GLUCONEOGENESIS
3. Acetyl-Co-A (via PDH) -- TCA
maple syrup urine disease mnemonic
maple syrup disease AKA VILe

can't break down Valine, Isoleucine, leucine

because missing ALPHA-KETO-ACID dehydrogenase
treatment of bipolar mnemonic?
valley of bipolarbears

Valproate and Lithium
side effect of olanzepine antiphychotic?
OOOOH you'll get FAT
R frontal lobe lesion =
L frontal lobe lesion =
Right gets RANDY (disinhibited)
Left goes "LEH" (apathy)
temporal lesion =
broca or wernicke language, memory, KLUVER-BUCY disinhibition too
parietal lesion =
visual, auditory, motor PROCESSING
draw double hump diagram and effect of moving R or left set point
...
which BUTT quadrant do you avoid with shots/
upper middle b/c can causs TRENDELLENBURG block of SUP GLUT N.
where do you put your RESTLESS LEGS?
in a FULL DOPAMINE D2 AGONIST "pram"-pexole or levadopa/carbidopa
what travels through...

cribiform plate =
optic chiasm =
SOF =
Rotundum =
Ovale =
Spinosum =
IAM =
Jugular =
Hypoglossal =
Magnum =
cribiform plate = CN1
optic chiasm = CN2, opthalmic artery, c ret vein
SOF = 3, 4, V1, 6
Rotundum = V2
Ovale = V3
Spinosum = MMA/MMV
IAM = 7,8
Jugular = 9, 10, 11
Hypoglossal = 12
Magnum = 11? and vertebral arteries?
what nerve gets injured during APPENDECTOMY?
iliohypogastric nerve
what gets injuried during HYSTORECTOMY?
...
cocaine OD signs/sx
nasal mucosal atrophy
nasal septum perforation
pupil still ACCOMMODATES but dilated
Heroin withdrawal sx?
YAWNING and TEARING/CRYING plus N/V abd pain
neuroleptic malignant syndrome sx? treatment?
RIGIDITY, HYPERTHERMIA, autonomic and change in mental status treatment is with DANTROLENE *who blocks ryanair channels so no rigidity, also get cooling
small cystic kidney =
large cystic kidney =
small = DIALYSIS (risk of renal carcinoma) or ESRF

large = PCKD
Nitrous oxide MOA
myosin dephosphorylation means muscle RELAXES
abdominal hemorrhage goes to...
pelvic hemorrhage goes to...
femoral artery region goes to...
R paracolic gutter
retroperitoneal space
pelvis, either GYN or PELVIC TRAUMA
what is CORONARY STEAL? how do we cause it?
dilation of coronary arteries to get blood to them actually sends blood away from heart? caused by ADENOSINE or DIPYRIDAMINE
cilostozol effects?
both PLATELET DECREASE AGGREGATION AND VASODILATION
acute rheumatic fever presents with what heart problem?
Mitral Regurg
draw a venous pressure diagram with labels
a = atrial contraction c = tricuspid bulge x = atrial relaxation v = atrium fills with V-nous blood y = atria emptY into ventricles
pemphiGUS
vs
pemphiGOID
gus = vulgar MOUTH and desmosomes

goid = hemidesmosomes in DEEP w c3 too
GVHD vs rejection of organ?
GVHD has GI SYMPTOMS and DERM SYMPTOMS!
draw eye with nerve damage locations of pupil
...
drug induced lupus is...mnemonic?
HIP

Hydralazine
Isoniazid
Procainamide
how do we treat DRUG-induced parkisonian symptoms?
ANTICHOLINERGICs "TROPINE" durgs
mnemonic for CYP INDUCERS?
gris is rifampin in his funny barbie car

griseofulvin
rifampin
phenytoin
phenobarbitol
carbamazepine
what's wrong with LITTLE ALDO B?
little aldo B is "FK'd"...can't eat SUCROSE because he doesn't have FRUCTOKINASE
yolk sac tumors present with?
ELEVATED AFP
Sertoli-leydig tumors in women present with?
increased T so hirsuitism, deep voice, etc.
Theca cell
vs
Granulosa cell
Theca makes T from cholesterol
Gran secretes ESTROGEn and INHIBIN
when you lose granulosa cell or sertoli cell you also lose?
FEEDBACK, because NO INHIBIN B being produced either...lose sertoli and you have no MIF so you'll have female internal organs too!
serous ovarian tumor has?
PSAMOMMA BODIES!
morphine MOA?
mu-agonist so INCREASES K EFFLUX TO HYPERPOLARIZE and stop pain
which drug doesn't prolong QT as much as her friends?
AMY o. darone
Achondroplasia inheritance?
AD
marfanoid habitus can be caused by?
marfan syndrome
homocysteinuria
Men2B
Ehlers-Danlos
what do you say if you have SIDEROBLASTIC ANEMIA?
ALAS, i'm screwed (no ALAS)
Roll =
Crawl/Tight =
Transmigrate =
selectins
integrins
PECAMS
Hartnup presents with what sx?
needs serotonin, melanin, niacin. presents with PELLAGRA, ataxia, nystagmus, tremor, failure to thrive. SIMILAR TO B3 deficiency, becaues that is nicotinamide?
cromolyns do what?
inhibit HISTAMINE release from mast cells
Zileuton MOA? how different from LEUKAST drugs?
puts "Ze-brakes on" 5-LIPOXYGENASE, so no ARACHADONIC acid from going down pathway, so blocks LEUKOTRIENE synthesis but cox pathway still open? beause COX isn't affected,....leukast drugs are LEUKOTRIENE RECEPTOR ANTAGONISTS, whereas zileuton blocks original formation of LTs --- both are used for ASTHMA!!!!
pharyngeal arch derivatives:

1
2
3
4
5
6
1 V
2 VII
3 IX
4 X (sup laryngeal)
5 obliterated
6 X (recurrent laryngeal)
aortic arch derivatives
1. max = maxillary a
2. = stapedial a?
3 = CARotid
4 a-4-ta, AORTA
cardioselective beta blockers
ES ACE MET AT BETAX

esmolol
acetolol
metolol
atenolol
betaxolol
insulin arches diagram mnemonic?
OUR LITTLE GIRL's REGULAR MPH DEBT LARGE

A,L,G = our little girl = aspart, g
REGular insulin
NPH
Detimir
Glargine
fibrates MOA?
increase LPL activity, decrease VLDL production via PPAR-y
so can cause CHOLESTEROL STONES!
vitamin D 1 and 25 added?
first 25 in LIVER
then 1 in kidney
if breastfed exclusively, needs?
VIT D and K
influximab
inflicts TNF-alpha by blocking it?
imatinib
i'm AT philidelphia, so good for blocking tyrosine kinase so that BCR/ABL is turned off. good for tx of 9,22 CML!
Abcixumab
blocks IIb/IIIa to decresae aggregation of plates
myeloperoxidase is used for?
OXIDATIVE BURST
diphtheria dipshits grow up in?
TELLURIDE media
what two things estimate GFR?
glucose and inulin clearance
statin S/E?
MYOPATHY
cholera calls what media?
you used to chol me, basic bitches
ehlers danlos MOA?
lost procollagen peptidase so can't cleave procollagen of its N-terminus so doesn't crosslink
hyperkinetic pulse =
slow rising pulse =
hyper = AR = hyp-AR-kinetic
slow = AS = slow AS hell
neutropenia predisposes to?
FUNGAL and VIRAL infections
draw spinal cord with tracts, and ipsi or contra
...
valproate is a pro at causing what?
neural tube defects
schizophrenia damages what loci?
mesolimbic, mesocortical
parkinsons damages what loci?
nigro-striatum
prolactin what loci in brain?
tuberoinfundibular (tits are fun!)
MDN of thalamus ====> what disease?
weirnicke korsakoss B1 thiamine deficiency also MAMMALARY BODTY
oligodendrocytes are injured in what three diseases?
1. MS
2. PMLE
3. leukodystrophy

because ALL WHITE MATTER DESTRUCTORZ
area postrema =
vomiting center POST-CHEMO
huntington's causes what to incr, decr
incr D2
decr GABA
decr AcH

incr CAG repeats!
irritability, PERSONALITY changes, aggression! APATHY

atrophy to CAUDATE NUCLEUS and PUTAMEN
lesions to these cause?

VPL
VPM
LGN
MGN
VLN
VPL = vibration, pain, light touch
VPM = very pretty makeup (facial sensation)
LGN = here's LGN at you, kid" CNII vision
MGN = MGN can't hear you
VLN = villain in his motor car (MOTOR)
what gets atrophied in alz?
hippcampus and MAYNERT?
low ACH and low ACHTRANSFERASE!
polio weakness is
ASSYMMETRIC FLOPPY BABBY
trazadone MOA/SE?
trazadone is a "TCAdone", gets a bone
PRIAPISM
epidural hemorrhage is what structure? mnemonic?
MMA is EPIc...Middle Meningeal Artery
subdural hemorrhage is what structure?
bridging veins
adult ependymomas show up?
in SPINE
kids are in CEREBELLUM histo is ROSETTES?
neuroblastoma histology is positive for what three things?
NSE (neuron specific enolase)
chromogranin & synaptophysin
S-100
hyperatremia corrected too fast
vs
hyponatremia corrected too fast
go down too fast = edema go up too fast = central pontine myelinolysis?
DM or HTN hemorrhages in brain?
cause SMALL VESSEL occlusion, lacunar and deep structures

lipohyalinosis!
zolpidem mnemonic?
get some Z's
wallerian degeneration mnemonic?
wallerian Nissl GOES TO THE WALL (periphery)

it goes away completely in IRREVERSIBLE injury
SAH findings?
"WHOL" worst HA of life, + nuchal rigidity, can turn into VASOSPASM later, and is SACCULAR/BERRY ANEURYSM burst
Tamoxiphen vs Raloxifene?
B = bone
E = endometrium
T = tits

Tam = + + - (so can cause endometrial hyperplasia)

Ralox = + - - (so better for endometrium)
what at risk for if have HYDROCELE of testicle?
this means your processus vaginalis didn't fuse, so can get INDIReCT HERNIA into testes
neimann pick disease is accumulation of? findings?
sphingomyelin
develpmental regression and CHERRY RED MACULA like tay sachs
tay sachs is collecting
GM2 ganglioside
Ipatropium does what?
PROPS open your bronchioles for COPD treatment
omalizumab MOA
blocks igE
monoleukast MOA
blocks leukotrienes at target receptors
draw NEPHRITIS CHART!!!
...
pralidoxime can be used for?
organophosphate poisoning
curare MOA vs succinylcholine
curare are NONDEPOL blockers

succinylcholine is depol blockers so desensitizes receptors 2 phase blockage
dyenin vs kinesin?
dyenin carries stuff back to the DOMICILE (cell body)

kinesin towards SYNAPESE
what two things inhibit GnRH?
somatostatin and glucose
leuprolide MOA?
GnRH agonist, so can be used to promote CONSTANT (non-pulsitile) secretion of GnRH to inhibit pituitary
leydig cells are inhibited by?
spironolactone so less T so gynecomastia!
flutamide blocks DHT where?
doug flutamide puts his footballs in the TARGET ORGAN RECEPTORS for DHT to block the touchdown
hypocalciuric hypercalcemia
defect in CAlcium receptor CASR so MORE CALCIUM IS NEEDED TO SUPPRESS PTH
finasteride moa
blocks conversion of T to DHT by blocking 5-alpha-reductase
what nerve is damaged in thyroidectomy? result?
external laryngeal n, so HOARSENESS b/c external laryngeal n innervates CRICOTHYROID m only
t3 causes what four "B" effects?
bone growth
beta adrenergic
brain dev
BMR increased
nsaids can cause what nephritic finding?
AIN, acute interstitial nephritis
if you have LOW glucose AND low ACETOACETATE?
this is a FATTY ACID OXIDATION DISORDER
highly developed sER means?
STEROID HORMONE PRODUCING
MEN 1 vs MEN2 A/B?
MEN2A = PTH hyperplasia, Medullary thyroid cancer, PHEO MEN2B: pheo and thyroid medullary + marfan and neuromas
what drives pituitary feedback for thyroid?
T3
DHT gives what GU parts?
T gives what GU parts?
DHT gives external genitalia and prostate
T gives testicles?
orotic acid buildup signals?
ammonia increase, urea cycle disorder
ornithin transcarbomylase problem => and treat with?
incraesed ammonia b/c can't make CITRULLINE so ataxia, lethargy, death

treat iwth LOW PROTEIN DIET! or liver transplant
why can't use sulfonylurea in DM1?
they stimulate beta cells, and DM1 they're GONE!
gastrinoma =>
insulinoma =>
glucagonoma =>
VIPoma =>
...
describe the process of pancreatic beta cell release of inulin stepwise
...
sirenomeilia is caused by
mermaid maternal DM
5-alpha-reductase deficiency?
feminized until puberty
galactokinase deficiency presents with what at birth?
CATARACTS
G-1-P-Uridyl transferase deficiency can present with?
jaundice and HYPERAMMONEMIA in newborn, plus-minus cataracts
pertechnate and perchlorate act where?
import of iodide blocked
what drugs block TPO?
methimazole and uracyl-propylthio...
Krabbe is missing...accumulates?**
GALC (galactosylceramidase), galactosylceramide AND galactosyl sphingosine...defect in MYELIN so shows astrocytosis, white matter degradation centrally and peripherally, and gliosis?
ewards syndrme chromosome and findings
18, rocker bottom feet, clenched overlapping fingers, LAERGE occiput
patau is what chrom and findings?
13, midline defects
which virus has predilection for VOCAL CHORDZ?
HPV
subacute thyroiditis histo?
mixed cellularity
what does carnitine do?
the carnitine car drives *******-fatty acids across membrane to MITOCHONDRIA
Biotin function? so deficiency causes?
co-factor for CARBOXYLASE reactions like succinate to oxaloacetate

so deficiency causes lack of TCA cycle, so LACTATE and LACTIC ACIDOSIS
EtOH effect on TCA?
blocks PDH so can't make oxaloacetate so NO GLUCONEOGENESIS
flozin drugs MOA?
get the glucose flowin! blocks SGLT2 in KIDNEY PCT so more glucose remains in URINE and peed out
increased lung compliance is seen in?
EMPHYSEMA
Hb curve what shifts it right?
basically think BPG and EXERCISE!

BPG, acid, CO2, exercise, HIGH TEMP
effect of foscarnet on electrolytes?
keeps Ca, trashes Mg
concentric vs eccentric hypertrophy of heart?
...
small oat cell tumor of LUNG cancause?
lamberg eaton syndrome
squamous cell lung cancer shows up where?
HILAR/CENTRAL
adenoma to carcinoma mutation sequence?
APC Meth COx2 KRAS DCC p53

A PC methhead's cock crahsed DC in '53
squamous cell carcinoma histo?
keratin whorls and INTERCELLULAR BRIDGE!
amatoxin from mushrooms MOA?
mRNA synth inhibitor
RICIN MOA?
rRNA inhibitor via cleavage at 60s
colitis that is HEREDITARY is different how?
flat
young ppl
signets
p53 EARLY not late
APC late not early
multifocal
cirrhosis and estrogen
cirrhosis normally removes estrogen from the blood, so cirrhosis can cause gynecomastia, spider angiomas, and palmar erythema from estrogen
cholesterol and estrogen
estrogen incresaes cholESTerol
Vitamin E deficiency sx?
E-PAA! low apolipoprotein B
ataxia
neuropathy of POSTERIOR COLUMNS ONLY
alpha-1-antitrypsin is what positive?
PAS+
Iga is a monomer where? dimer?
blOOOOOD
dimer in yer D-cups! breastmilk
right sided colon cancer presents with?
IRON deficiency IRON on the I-RIGHT SIDE from occult blood loss
what are the four nucleotide repeat diseases and what are the individual respective repeats?

Hunting For X MDs
Always AA Good Time

Huntingtons cAg, Freidrichs ataxia gAA

fragile x = cGg

myotonic dystrophy = CTG
...
two diseases for imprinting?
prader wili is PATERNAL is SILENT, mom is delete or mutated

AngelMOM syndrome is MATERNAL is SILENT, dad's is delete or mutated
charcot marie tooth disease presents with?
its a muscular dystrophy, so HIGH STEAPPING GAIT and HAMMER TOES. Loss of PERIPHERAL NERVE SENSATION AND PROPRIOCEPTION but PAIN usually spared
nucleotide excision repari defect --->
xeroderma pigmentosum can't fix UV dimers
mismatch repair defect --->
microsatellite insufficiency LYNCH yndrome
leish nyan has what in his diaper? what is it made of?
he's got SANDY ORANGE SAND IN HIS DIAPER!
these are sodium nitrate crystals
Renal tubular acidosis 1, 2, 4
1 = low K low ph, no H secretion
2 = low K low ph high bicarb secretion
4 = high K low ph low aldo
diphtheria toxin MOA, and is similar to?
RIBOSYLATES and inactivates EF-2 elongation factor so can't make proteins so cELL DEATH
it is similar to pseudomonas aeruginosa exotoxin A!!!!
what artery do we use to fix LAD occlusion?
use L thoracic artery

or saphenous vein
what causes asterixis?
high alcohol or high ammoniumq
carcinoid syndrome will show incresaed what excretion?
yoiu've got way too many catecholamines, so increased urine excretion of 5-HIAA
if normal pancreatic pain but also ABD pain and HYPERACTIVE BOWEL SOUNDS< think...
GALLSTONE ILEUS!
d-xylose test tells us what?
that our intestinal mucosa is intact b/c need intact mucosa for absorption of this
FRUCTOSE iS FASTER METABOLISM BC?
skips PFK1
preemies need what
term babies need
iron
vit D then iron at 4 months
wilson's disease sx
basal ganglia degeneration
anemia
dementia
dyskinesia
dysarthria
DECREASED CERULOPLASM
chromosome 13
occlusion symptoms:

PICA
AICA
Basilar
PCA
BG
PICA = pick a hoarse and swallow!
AICA = fAICAl droop
Basilar = locked in syndrome *locked in the base-ment
PCA = macular sparing contralateral hemanopsia
BG = charcot bouchard aneuryssm, chorea athytosis
neurotransmitter at each location:

raphe
caudate
locus ceruleus
meynert
red
sub nigra
raphe - serotonin
caudate - GABA
locus ceruleus - norepi
meynert - acH
red - motor!
sub nigra = dopamine
hyperpigmentation mnemonic
DARK

DM
Ach/addisons/adrenal crisis
iron overload
kidney failure
insulin-dependent tissues mnemonic?
BRICKL

brain
RBCs
intestines
cornea
kidney
liver
transplatn rejection (non-lung)
hyper acute = cyanosis and fibrinoid necrosis

acute = t cell complement and neutrophils, necrotizing vasculitis

chronic = vascular wall thickening, organ atrophy
lobar pneumonia = what two bugs?
strep pneumo or klebsiella
Abetalipoproteinemia vs dysbetalipoproteinemia
abetalipo = lack of ApoB48 & B100 so no DLs, so can't absorb and transport fats, so ADEK deficiency, failure to thrive. DYSBETA means you don't have FUNCTIONAL ApoE, so can't get cholesterol or VLDLs INTO THE LIVER, so your levels in the blood will be very high
nadph oxidase fxn
SOD fxn
MPO fxn
nadph oxidase makes O2- from O2
SOD makes hydrogen peroxide from O2-
MPO makes HOCl from hydrogen peroxide
waht five organisms are CGD patients susceptible to?
THE CAT positives.."SORRY, ASP, NOCARD, marasencs, kapeesh?"
S aureus
p. cepaciae
aspergillus
nocardia
marascens
LUNG transplant rejection
hyperacute = Antibodies to HLA or ABO (ischemia)

acute = vascular damage by CD8+ t cells

chronic = SMALL AIRWAY damage
NF1 symptoms?
cafe au lait spots, lisch nodules *melanocytes of iris and CUTANEOUS NODULES LATER IN LIFE (no nodules in NF2)
NF2 symptoms?
bilateral acoustic schwannomas neuromas and CN8 deafness with NO CUTANEOUS LESIONS
deficiency of LDH causes what?
muscle stiffness and soreness because can't do ANAEROBIC GLYCOLYSIS
G6PD deficiency presents with
oxidative damage to RBCs so hemolytic anemia
glycogen phosphorylase deficiency...
can't chop up glycogen, so present with MCARDLES! muscle intolerance
G6phosphatase deficiency...
von gierke's! no gluconeogenesis
acid maltase is also called
alpha glucosidase
deficiency of acid maltase/alpha glucosidase...
POMPE!
papillary thyroid cancer histo...
intranuclear groove, calcifications (psammoma) branching and ground glass appearance
percarditis vs tamponade?
pericarditis has PAIN

tamponade has dyspnea/tachypnea, no pain, DECREASED HEART SOUNDS, DECREASE in BP on INSPIRATION!
lamuvidine MOA?
NRTI, causes LACTIC ACIDOSIS and peripheral neuropathy
BUVIR drugts MOA?
NS5B inhibition
gancyclovir S/E?
neutropenia! especially in combo with BM suppressive agents
hunter and hurler disease....
too much heparin causes DEVELOPMENTAL DELAY, but hurler also has CLOUDY CORNEAS
location of...

GLUT1
GLUT2
GLUT3
GLUT4
GLUt5
SGLT1
SGLT2
GLUT1= RBCs, Brain, Cornea
GLUT2 = B-islet
GLUT3 = brain
GLUT4 = BRICKL tissues
GLUt5 = small intestines
SGLT1 = small intestines
SGLT2 = kidney (target of "-flozin" drugs)
what nerve is damaged in humeral surgical neck fx?
USE AXE IN SURGERY ON YOUR NECK axillary n
what nerve is injured in midshaft humerous fx?
MIDSHAFT IS RAD! radial n

but midshaft LOSES SENSORY of FOREARM
epicondylar fx = injury to...
ulnar n
what nerve is damaged in MASTECTOMY?
long thoracic n
FOOSH causes...what findings?
ulnar nerve damage
what does lunate or carpal tunnel nerve entrapment entrap
median nerve
lancet shaped organism?
STREP PNEUMO
club shaped organism?
CORYNEbacterium
Bean shaped organism?
N. men
Tennis racket shaped?
tetanus
anterior pituitary hormones + mnemonic?
flat pig

FSH, LH, TSH, PRL, GH
basophillic anterior pit = B flat
FSH, LH, ACTH, TSH
surface ectoderm becomes...mnemonic?
ROSIE

rathke's
olfactory epithelium
salivary glands
inner ear sensory organs
eye lens and cornea
what does MCARDLES show after exercise?
intolerance and NO INCREASE IN LACTIC ACID OR LACTATE
pompe disease shows as?
severe cardioMEGALY with accumulation of GLYCOGEN IN LYSOSOMES
cori disease shows as?
hepatomegaly, hypoglycemia, hypotonia
von gierke shows as?
steatosis, uricemia, lipidemia

fat in his pooop, fat in his blooood, pee in his bloooood
what conditions RAISE alpha-fetoprotein levels?
neuraltube defects
yolk sac tumors
HCC
ataxia telangiectasia
imperforate anus mnemonic?
vacteryl

Vertebral defect
anal atresia
cardiac abnormalities
Tracheoesophageal fistula
esophageal atresia
renal
LIMBS
MCcune albright has...
bone fractures
early puberty
fibrous dysplasia
Wiscott aldrich has...
bleeding
sinupulm infections
exzema
tuberous sclerosis presents with
"tubers" tumors in brain
"rabbits" rhabdomyeloma in HEART
VHL hemangiomas are located...mnemonic?
watch HEMAN with your RETINAS in the CELLAR/cerebellar

in the cerbellar retina and hemangiomas
chromosomal abnormalities on chromosome... list
3 = VHL
4 = achondroplasia (4 for the dwar)
5 = FAP for five
6 = hemochromato-6
7 = CF
9 = friedrich's
11 = w11lms
13 = wilson's
15 = prader wili, marfan, angleman
16 = alpha subunit of thalassemias
17 =
18 = edwards
21 = downs
22 = diGeorge, NF2
low na...high na symptoms
low = stupor, coma, seize

high = stupor, coma
low k, high k
low k = arrythmia, kramps, weakness

high k = QRS prolongation, arrthymia, muscle weakness
low ca, high ca
low ca = TETANY and long QT

high ca = stones, bones, thrones, moans...

renal stones, bone pain, increased urine output, psych symptoms
low Mg causes what symptoms?
torsades, low K

high mg = SLOW HEART and LUNGS, HOTN, decr ca
blots mnemonic
SNW
DRP

southern = DNA
northern = RNA
western = Protein
vit a def =
night blind, dry eyes, corneal keratomalacia
vit b1 def =
alcoholics, pain, change in HR, sensory perception changes
vit B2 def =
cheilitis on sides of mouth
b3 def =
niacin, glossitis, chelitis, conjunctivitis (like B6)
b6 def =
chelitis, glsositis, conjunctivitis
B7 def =
problems with CARBOXYLATION reactions?
pyridoxine def =
glossitis, chelitis, conunctivitis
vit E deficiency =
RBC oxidative stress, neuronal stress:
E-taxia
hE-molytic anEmia
low proprEoception

presents with ATAXIA and TVP loss like FRIEDRICH~!
four causes of NON-caseating granulomas
1. sarcoidosis
2. berryliosis
3. foreign body
4. chrons
CF mutation chart
1 = not 1 is made (only frameshift, others are missense)
2 = both destroyed -- DELTA508!

3 = not "threeted" once there...
4 = doesn't work 100%
5 = doesn't make enough to keep production alive
6 = doesn't STIX around before degraded
draw out collagen chart
1 = tendONE, bONE, and R3mode1ed collagen scar
2 = carTWOlage
3 =
4 = BM
5 = hair and placenta
collagen disorders
O1, 3-hlers and V-lehrs, alp-4-rt
what is the normal A-a gradient?
LESS THAN 10
NRTI antivirals names and S/E
ZIDOVUDINE (BM suppression) + cavir, fovir, buvir (NS5?)
bine, sine, dine
lactic acidosis and lipodystrophy
NNRTI antiviral names and S/E
virenz and virapine
rash/TEN/SJS or hepatotoxicity
PI antivirals names mnemonic? and S>e?
"NEVER USE A PI"

navir drugs, METABOLIC DYSFUNCION:
lipodystrophy, dyslipidemia, insulin resistance
INTEGRASE inhibitors names and S/E
Integrase Inhibitors are inte-GRAVIRs, and you GRAV your muscles in pain!
live vaccines
MR VZ MAPY

measles
rubella
vzv
mumps
adenovirus (attenuated)
polio
yellow fever
killed vaccines
RIPA

Rabies
Influenza
Polio (old one)
A-hepatitis
conjugate vaccines
H flu B (HiB)
meningeococcal
only one polysaccharide vaccine...
pneumovax
myasthenia gravis can also often have...
thymoma or thyroid hyperplasia
etanercept need to watch patients for...
TB reactivation becuaes you're giving them block of TNF-alpha
what vessel involved in OSTEONECROSIS of hip fracture?
medial circumflex artery
lacy rash =
parvovirus B19
linezolid has what s/e<
siezure risk, because it also has MAOI action
temporal arteritis patients have ELEVATED IL-?
IL-6!
baclofen MOA?
Gaba-B agonist
afterload is basically just...
aortic pressure that ventricle has to pump against!
what disorders use JAK-STAT pathway?
chronic myeloproliferative disorders, except CML (which uses BCR-ABL)
ruxolitimab
JAK ruxo terrier
collagen: what amino acid is in highest proportion
glycine
APL involves what mutation?
t(15,17) RARA (retinoic acid receptor) so can use ALL TRANS RETINOIC ACID treatment
t(8,14)
burkitt lymphoma, jaw in africans, abdomen in sporadic, STARRY SKY APPEARANCE
Bosentan MOA and usage?
for pulmonary htn, endothelin receptor ANTAGONIST
DNA damage repair mnemonic?
"Get Em Done, Ladies"

Glycosylation
Endonuclease
DNA pol
Ligase
AUR rods associated with...
"apple" of AUR eye!

APL
lung at midaxillary line extends to ___ rib, pleura extends to...rib, and maximally?
front to back: start with front, then midax, then posterior = 6,8,10; 8,10,12
muscle contraction steps
...
UROD deficiency?
"PCT UROD up"

heme synthesis disorder, causes sx of:
onycholysis and photosensitive BLISTERS, causes PORPHYRIA CUTANEA TARDA
PBG deaminase deficiency mnemonic?
PBG / AIP
causes AIP (acute intermittent porphyria) lack of porphylobilinogen deaminase, so porphylobilinogen accumulates, with NEURO SYMPTOMS!
dermatitis hepatiformis
itching and burning, often with papules and excoriations, intensely itchy. associated with CELIAC and northern european ancestry
C1 esterase inhibitor deficiency
causes HEREDITARY ANGIOEDEMA!
homocysteinuria patients lack ____, so they need ______ and they die from _______
HOMO SISTERS don't have CBS so they play with their PAIROFDOXINES and die from THOMBOSIS
migratory thrombophlebitis should make you suspect...
cancer.

The Trousseau sign of malignancy or Trousseau's Syndrome is a medical sign involving episodes of vessel inflammation due to blood clot (thrombophlebitis) which are recurrent or appearing in different locations over time (thrombophlebitis migrans or migratory thrombophlebitis). The location of the clot is tender and the clot can be felt as a nodule under the skin.[1] Trousseau's syndrome is a rare variant of venous thromboembolism (VTE) that is characterized by recurrent, migratory thrombosis in superficial veins and in uncommon sites, such as the chest wall and arms. This syndrome is particularly associated with pancreatic and lung cancer
head bobbing = what murmur?
AR
II, III, AvF = what artery?
RCA
V1 - V4 = what artery?
LAD
LCX artery = what leads?
I, AvL, V5, V6
sacroilitis associated with?
REACTIVE arthritis!
platelets do not aggregate in response to RISTOCIN...
vWF deficiency
erosions do not go past what layer?
muscularis mucosa
risks for CERVICAL CANCER?
STD
high risk HPV strains
IMMUNOSUPPRESSION (HIV,etc.)
Low SES
tobacco use
early SEX activity onset
vag or vulvar cancer
V/Q is highest at...
APEX
continuous murmur =
PDA~!
which arteries on LESSER and GREATER curve of stomach?
lesser = R and L gastrics,

greater = gastroepiploics
buspirone onset?
SLOW just like SSRIs but it's a NON-benzo anxiolytic
which viruses can RECOMBINE like flu?
BOAR

bunya
orthomyxo
Arena
rotavirus (reoviruses)
zidovudine MOA?
inhibits RT, so inhibits "3-5 phosphodiester bond formation"
what INCREASES with exercise?
CO2 content in VENOUS BLOOOOOD

arterial side stays within normal range, but VENOUS gets lower pH
anal squamous cell carcinoma?
ulcerative lesions and associaged with HPV!!!!
B1 def sx? B3 deficiency sx?
B1 = wernickes mammallary body destruction, B3 = dermatitis, dimentia, diarrhea
IP3 pathway
binding of ligand on extracellular domain

activation of PHOSPHOLIPASE C, which turns PIP2 into IP3/DAG

then DAG stimulates Protein Kinase C

PKC then does it's thing
cAMP pahway
activation of adenylate cyclase forms cAMP then activates Protein kinase A then PKA phosphorylates intracellular proteins
PKC associated with...
PKA associated with..

phospholipase C associated with? role?
Protein Kinase C = IP3/DAG

Protein Kinase A = cAMP pathway

PLC = what cleaves PIP2 into IP3/DAG
how do we get FRAGILE X?
METHYLATE and make a MUTE FARMER

it's a problem with HYPER METHYLATION!
methylation makes DNA mute, so this inactivates FMR1 "farmer one" preventing transcription of the Fragile X mental retardation protein, which thereby INHIBITS NEURONAL DEVELOPMENT!
fragile x protein?
FMR1 "farmer one" retardation protein
how do we make NIACIN if there is none in diet?
Nice Nads can be made via TRYPTOPHAN!

"have a NICE tryp"
right ventricular MI causes what change in CO, LA pressure, CVP?
Co and La go down, but CENTRAL VENOUS PRESSURE GOES UPPPPP UPPP b/c backup in venous side!
what causes AAA? Aortic dissection?

marfan Aorta = what change?
AAA = TRANSMURAL inflamation chronically

Aortic dissect = INTIMAL TEAR

marfan = CYSTIC MEDIAL NECROSIS
vasa vasorum endarteritis?
SYPHILIS goes VA-VOOM...this is SYPHYLITIC aortitis in THORACIC AORTA, because ABDOMINAL AORTY doesn't have a VASA VASORUM
where does syphoilis casuse aortitis?
in THORACIC AORTA ONLY!
non-bacterial endocarditis is associated with what two conditions?
CANCER! CANCER CANCER

OR

SLE ANTIPHOSPHOLIPID SYNDROME and SEPSIS/DIC
WIDE FIX SPLIT S2 -- MEANS?
ASD, so need to intervene so you don't reverse and get eisemengers and change PULMONARY VESSELS IRREVERSIBLY!
Takayasu or GCA histology?
granulomas in MEDIA of vessels
segmental fibrinoid necrosis =
PAN
thromboanggiitis obliterans =
BUERGER in smokers EARLY in life, BEFORE 35
"fibrous intimal thickening with endocardial plaques limited to RIGHT HEART"
CARCINOID SYNDOME! so you'll see increased 5-HIAA excretion

only right heart because SEROTONIN AND BRADYKININ are INACTIVATED BY pulmonary endothelial monoamine oxidase
elevated homocysteine levels cause risk of?
THOMBOTIC embolism and thrombosis
"osin" drugs MOA?
alpha-1 blockers for HTN and PBH
TCAs side effect?
URINARY RETENTION!
PAN spares what vessels?
PULMONARY
atrial myxoma on histology?
scattered cells with mucopolysaccharide stroma
hypertrophic cardiomyopathy when do we think of this?
YOUNG MAN DIES WHILE EXERCISING!
what is the change seen in HCM?
mitral valve leaflet and interventricular septum create LVOT obstruction
chest pain worse with INSPIRATION or LYING FLAT?
PULM/PLEURITIC
GI pain is usually worse...
AT NIGHT!
onion-like thickenig of artries?
HTN HTN HTN HTN
hyaline arteriosclerosis?
lower levels of HTN than huperplastic arteriosclerosis
MIGRATORY THROMBOPHLEBITIS should make you think...
CANCER usually ADENOCARCINOMA OF VISCERAL ORGANS!!!
who makes fibrous cap on atherotic plaque?
ENDOTHELIAL CELLS
milky supernatant on blood draw?
familial chylomicronemia so risk of ACUTE PANCREATITITS and skin xanthomas
tendon xanthomas =
familial HYPERCHOLESTEROLEMIA
tuboeruptive and palmar xanthomas? =
no beta-Ps, xanthelasmas on your P's (palms) Familial DYSBETALIPOPROTEINEMIA
hereditary long QT associated with...
NEUROSENSORY DEAFNESS (lange-neilsen_ problem with K channels or sodium channels!
osler-weber-rendu?
talangiectasias of skin and mucous membranes PLUS HEMORRHAGE
S. epi =use what abx?
assume methycillin resistance and use VANCO
wide pulse pressure =
AR
homocyesteinuria needs suppplement of
pyridoxine
anaphylactic reaction is mediated by?
HISTAMINE and TRYPTASE (specific to mast cells) !!!
alkylosis, need to ask check?
URINE CHLORIDE
C1 inibitor deficiency presents with INCREASE OF?
BRADYKININ!
suspected wilson's needs to be tested with
SLIT LAMP
MERRF inheritance pattern?
MITOCHONDRIAL!
Hepatitis B chronicity?
low risk of chronic disease EXCEPT IN NEONATES!~
homocystine can be turned into...
METHIONINE (via B12) or CYSTEINE
acute organ rejection is
T cell infiltrate
chronic organ rejection is
vascular damage ischemia necrosis
all presynaptic are ____ neurotransmitter
AcH
what POSTsynaptics use EPINEPHRINE?
sympathetics except ADRENALs and SWEAT ECCRINE
junctional nevus is
at junction of dermis and epidermis but DOES NOT EXTEND INTO DERMIS
compound nevus
RAISED BECAUSE extends into DERMIS
pacreatic ducts are lined with keratinization and squamous metapasia
think CF and VIT A deficiency!
mitral regurg intensity depends on
PRESENCE OF S3! MR S3 mitral stenosis depends on OPENING SNAP (MS OPENING SNAP)
hereditary spherocytosis has increased
MCHC
mean corpuscular HEMOGLOBIN concentration and OSMOTIC FRAGILITY!
what conditions make sickle cells sickle?
think EXERCISE!

acidity, low O2, dehydration or HIGH HIGH GHIG 2,3BPG
erythematous nodule by mandible...
think PAROTITIS (can be S. aureus) especially with INTUBATION or dehydration or ANTICHOLINERGICS that decrease saliva!
what if you have elevated AP? elevated AP + GGT?
AP = bone problem

AP + GGT = LIVER, not bone problem
what does the diphtheria toxin do?
inhibits RIBOSLATION of EF-2!
attributable risk formula?
(risk in exposed - risk of unexposed)/(risk in exposed) = decimal, x100 for percent
not able to raise arm ABOVE horizontal plane...what nerve?
9 trapezius and SCM
raise arm BELOW horizontal plane = what nerve?
11 - ax - deltoid
latissimus innervation?
THORCODORSAL
temporal trauma or INFERIOR ORBITAL FRACTURE = what nerve?
FACIAL 7 so loss of sensation in upper cheek, upper lip, upper gingiva OR INFERIOR RECTUS can also be stuck! so can't look up!
trauma to MIDFACE = what nerve
OLFACTORY CN1
smear results:
megaloblastic anemia:
hered sph: spherocytes
G6P: bite cells heinz bodies
thalass: target cells
sickle:
megaloblastic: OVAL cells and HYPERSEGMENTED NEURTROPHILS
megaloblastic anemia smear shows:
oval cells and HYPERSEGMENTED NEUTROPHILS!
basophils up means
CML!!!
ehler's danlos presents with?
hyperelastic skin, fragile skin, easy bruising and POOR WOUND HEALING

defect in CHOPPING N-terminal peptide from procollagen
what do we treat carcinoid/VIPoma with?
OCTREOTIDE
GCA pathophys is like
takayasu's!
male pattern baldness inheritance
polygenic
what disorders exhibit polygenic inheritance
alopecia
epilepsy
glaucoma
HTN
ischemic heart disease
schizophrenia
T2DM
HSV encephalitis findings
NECROSIS and hemorrhage of TEMPORAL LOBE

also personality changes (because temporal lobe). seizures, aphasia, etc.
what does NAGLERI FOWLERI present with?
smell and taste abnormalities in addition to meningioencephalitis symptoms
ring enhacing brain lesions?
TOXO
periventricular lesions in brtain?
CMV or LCMV
endonuclease does what
N for "NICKS DNA" ...recognizes damaged DNA and nicks it single strandedly, exonuclease REMOVES the segment
Treacher collins inheritance pattern?
AD
hCG given mimics what?
LH surge, think LHcG
temporal arteritis elevation of what diagnostic indicator?
IL-6
Which toxin inhibits Rho-regulatory proteins, leading to DISRUPTED tight junctions/cytoskeleton abnormalities?
C. difficile
what toxins cause loss of membrane integrity?
LECITHINASE from C. perfringes
what toxin interrupt sMITOCHONDRIAL
CYANIDE
what toxins inhibit 60s
shiga toxin
increased contractility =
increased EJECTION FRACTION or STROKE VOLUME
increased afterload =
caused by increased systemic blood pressure
increased preload =
increased end diastolic pressure?
what anatomical marker can be used to find appendix?
TENIA COLI
CNIV =
trochlear nerve
oculomotor nerve =
CN III
pt can't climb stairs b/c double vision, no probelm going up stairs
VERTICAL DIPLOPIA = problem with CNIV trochelar nerve
conjugate vs polysacch vaccine?
conjugate has more robust immune response through B + T cells
what is dystrophic calcification?
hallmark of CELLULAR INJURY and occurs in all types of cell NECROSIS

always in the setting of NORMAL CALCIUM LEVELS, and results in PSAMMOMA BODIES
true diverticulum example and false diverticulum example
true= meckel's

false = zenkers
describe osteoporotic bone
trebecular thinning with fewer interconnections
right sided colon adenocarcinoma presents with?
fatigue b.c occult blood loss
left sided colon cancer presents with?
constipation and nausea/vom, distension, SX OF BLOCKAGE!
rectal adenocarcinoma presents with?
SMALL CALIBER STOOLS and tenesmus (straining on defecation)
HPV E6 role? E7?
e6 = p53, E7 = rb
HPV can infect ____ vocal cords
true, because STRAT SQUAM
simple squamous is for
gas exchange
cuboidal is for
bronchioles
first pharyngeal arch produces:
CN 5. facial bones, malleus + incus
second pharyngeal arch produces
CN VII

"stapes, styloid, LESSER horn of hyoid"
"stapes, styloid, LESSER horn of hyoid" rhyme is for what pharyngeal arch? CN?
second, VII
genetic defect of FIRST and SECOND pharyngeal arches = mnemonic?
Ms. COLLINS TEACHES 1st and 2nd GRADE ...treacher collins syndrome
larynx is what pharyngeal arches?
4 & 6 sp crocoid and thyroid cartilage
germs cell tumors and HCC have elevated?
ALPHA FETOPROTEIN
CA125 marks what cancer?
ovarian
Ca19-9 marks what cancer?
pancreatic
HCG marks what cancers?
choriocarcinoma (hematogenous spread!) and germ cell
carcinoembryonic antigen marks what cancer?
GASTROINTESTINAL
what do we use for HTN CRISIS
fendoldepam D-1 AGONIST
hydralazine dsoes what?
ARTERIOLAR DILATION

not used in HTN crisis b/c causes REFLEX TACHYCARDIA
BCR-ABL
9,22 take the CAMEL to PHILIDELPHA
HCM murmur is accentuated by?
STANDING SUDDENLY to DECREASE PRELOAD
SSRI + _____ can cause SEROTONIN SYNDROME?
TCA, MAOI, meperidine, dextromethorphan
leber hereditary optic neuropathy inheritance?
MITOCHONDRIAL
rare disease assumption
approximating odds ratio and relative risk when only a few ppl to study
postprandial epigastric pain, weight loss, and FOOD AVERSION with ischemic heart diesase =
CHRONIC MESENTERIC ISCHEMIA

mesenteric arteries get atherosclerotic, called "INTESTINAL ANGINA" when postprandially hurts
TCAs MOA
block FAST SODIUM CHANNELS that are coupled with NOREPI and SEROTONIN REUPTAKe, so they're REUPTAKE INHIBITORS!

inhibit FAST SODIUM CHANNELS
leads to ARRHYTNMIAS TCAS also...
have antihistamine effects
block amine reuptake
serotonin syndrome?
hyperthermia
hyperreflexic
myoclonic
SWEATY

usually no CARDIAC changes
amphetamines MOA?
increase dopamine and norepi release in presynaptic neurons
MAO-I + ____ can cause HTN crisis
NE releasers, alpha-1 agonists, L-dopa
thalassemia is problem with ?
mRNA TRANS or postTRANSCRIPTIONAL
mutation is always transcription, processing, translation of globin RNA

presents with THAL TARGET CELLS!
elevated HBA2 =
thalassemia!
OSTEOPOROSIS calcium and pth levels?
NORMAL even if they fracturing vertebrae! if not underlying condition
order of DNA repair?
glycosylase
endonuc
lyase
DNA pol
ligase
dorsal column and Spinothalamic tract = what area of brain lesion?
Ventral posterior THalamus
hip fx = osteonecrosis from what artery?
MCX

medial circumflex
RNA pol 1 =
RNA pol 2 =
RNA pol 3 =

what do they do?
RNA POL 1 = makes RIBOSOMES

RNA POL II = mRNA, snRNA, microRNA

RNA POL III = tRNA and 60s components
C diff toxin =
cytoskeleton abnormalities
what do we treat Cdiff with?
METRO VAN
THYMIDINE SYNTHESIS DECREASES when...
B12 or FOLATE deficiency

so can't make PURINES AND PYRIMIDINES
calcineurin pathway?
TCR Ca2+ binds Calmodulin then binds Calcineurin which dephosphorylates NFAT to activate it for TRANSCRiption of IL-2
drop in pCO2 in brain causes...
VASOCONSTRICTION, so REDUCES ICP!
turn your VENT O2 too high...
INCREASE ICP and cause blindness and shit stevie wonder style
if they delerious, use...
HALOPERIDOL
tyrosne kineases are involved in...
GROWTH FACTORS often
CF causes what sodium to happen thing
increased sodium ABSORPTION so you dehydrate yer mucus even more
ROSEOLA HHV6 presenting b like?
HIGH AF FEVER CAUSING SEIZURES! with a rash afterwards too
coxsackie causes what symptom
palm and soles rash HAND AND FOOT MOUF DISEASER
GAS can cause
scarlet fever
TTP presents as?
schistocytes, HEMOLYTIC ANEMIA, AND THROMBOCYTOPENIA!

increased LDH, Decrease haptoglobin, normal PT/PTT but PROLONGED BLEEDING TIME

tx with plasma exchange
SCID look for?
diarrhea "SCID MARKS" on undies and MOUTH (oral candydiasis) and CANDIDIASIS ORALLY
PPV formula ?
TP / (TP + FP)
SN formula?
TN/(TN + FP)
double hump of drug conc in group of ppls is due to?
ACETYLATION differences in metabolism
TRANSPLANT patients think what viruses?
CMV, BK, JC
viral interference:
one virus blocks another virus from infecting same tissue
phenotypic mixing?
2 viral strains infect same tissue
combine, but get GENOME from one and STRUCTURAL (capsid, HA, etc) from another

BUT

since genome is unchanged, the progeny viruses will revert to characteristics of the ORIGINAL virus GENOME so will not acquire characteristics from second virus
viral reassortment mnemonic?
REASSORTMENT creates A NEW SORT OF VIRUS! tghis is when genetics of two viruses mix, so progeny can acquire new characteristics
transformation
uptake of DNA/RNA from outside BACTERIAL CELL
pelvic/UTERINE bleed like after delivery, need to OCCLUDE what artery?
INTERNAL ILIAX~!
hormone sensitive lipase
in starvation, uses fat to make KETONES so maintains GLUCOSE LEVELS IN BLOOD b/c doesn't use gluc
Lipoprotein lipase
found on endothelial cells, does lipolysis to create energy for tissues
amniotic fluid embolism?
can cause cardiogenic shock + DIC!
asthma and work of breathing?
not raise too much, b/c will compensate with lower breath rates?

but RAISED in PULMONARY FIBROSIS
NOCARDIOSIS
can cause RING ENHANCING LESIONS with surrounding EDEMA in brain, but also pneumonia, so think when you are also thinking TOXO!!

but NOCARDIA creates "ASTERIODS" cavitary lesions in lungs
what recognizes STOP CODONS? and can be target for drugs?
RLEASING FACTOR!
how to differentiate HIRPSCHPRUNGS and CF meconium ileus?
Hirp: down syndrome, RECTOSIGMOID OBSTRUCTION B/c IN COLON! and normal meconium -- POSITIVE "SQUIRT SIGN" if you stick finger in rectum and relieve pressure all the shite squirts out!

CF: inspissated, ILEAL obstruction.
remember that missense and nonsense are SUBSTITUTIONS, not deletions
...
hamartoma is what?
NORMAL TISSUE that should be there but it's OVERGROWN!
what causes elevated ESR?
IL=6. because it creates ACUTE PHASE PROTEINS like CRP, ferritin, fibrinogen, amyloid, etc. that fix complement and drag em down
pertussis is what kind o organism?
GNCB
which BACTERIA causes LYMPHOCYTOSIS?
pertussis (GNCB)
what molecules play roe in ASTHMA?
LEUKOTRIENES! histamine has minor role
aspiration pneumonia lying on back goes to what lung sement?
posterior UPPER RIGHT LOBE

"PURL"

or superior LOWRE LOBES
SERTOLI gives you?
sertoli gives you MIF and SPERM
which organism do we suspect if PRP positive?
say Hi to the PRP!!!H. influenzae!
CN11
trapezius and deltoid
levator scapulae innerv?
dorsal scapular n
what cancer is dermatomyositis associated with?
OVARIAN ADENOCARCINOMA
porphyria cutanea tarda sx
blistering rash in sun exposed areas
whippeli infection can have what sx?
HYPERPIGMENTED
SPOON nails =
KOILONYCHIA! iron deficiency anemia
homo's sister-uria needs?
TWO DOGS, a "PAIR-o-DOGs-ine"
how do we damage THE AXILLARY NERVE?
ANTERIOR SHOULDER DISLCATION
clavicular fx nerve damage?
no
what is the delta508 mutation in CF?
impaired POST-TRANSLATIONAL folding etc
BP age related =
AORTIC STIFFY
what drug to maintainance therapy for BIPOLAR
valley of bipolar = LITHIUM or vALPROATE
whcih type of hemorrahge has PERIOD OF LUCENCY IN BETWEEN?
EPIDURAL
blunted intestinal villi =
CELIAC SPRUE
most common cancers in women?
BLC breast, lung, colon

but lung has most deaths
adenomyosis
endometrial glandular tissue within myometrium, shows as HEAVY MENSTRUAL BLEEDING, dysmenorrhea with UNIFORMLY ENLARGED UTERUS

seen in middle aged MULTIPAROUS women
endometrial GLAND proliferation COMPARED TO STROMA =
endometrial hyperplasia

presents with IRREGULAR mentstrual bleeding
lyomeioma presents with
IRREGULAR LUMPY enlarged uterus
empendymomas present with
rosettes and hydrocephalus
dermatitis herpetiformis
pruritic skin rash, ELBOWS and KNEES, + ABD discomfort, flatulence, voluminous GREASY stools

due to IgA against GLIADIN (associated with CELIAC DISEASE!)
hypertrphy/flattened hypothenar =
ULNAR guyon's canal syndrome HOOK OF HAMATE
restricting diet to lose weight risk of?
ALAS / AIP
eczema, recurrent infections, thrombocytopenia =
wiscott aldrich
igG mediated skin eruptions?
PEMPHIGOID or PEMPHIGUS
pilocytic astrocytoma?
shows up as DARK BLOTCH WITH WHITE BLOTCH NEXT TO IT IN BRAIN
glioblastoma?
GLBS ==> GLOBES so within the HEMISPHERES!
oligodendromas present how on MRI?
40s and 50 year old

WELL CIRCUMSCRIBED GRAY MASSES with NO ASSOCIATED NECROSIS OR HEMORRHAGE
tyrosine kinase associated with what cell porocess?
GROWTH FACTORS!@
which hormones from PITUITARY ARE ENDORPHINS/OPIODS?
ACTH and MSH b/c from POMC
with what condition do we see PURE RED CELL APLASIA? what will we see on labs?
Erythroid precursors screwed up, but preserved Myeloid and Megakaryocyte...seen with thymoma
p. aeruginosa is what positive?
ox
he's the AURIGINAL moxpos!!!
motile and ox pos
causes OUTER EAR INFECTIONS/SWIMMERS EAR
Linear melanocytic pattern? cafe au lait spots?
lentigo = linear (not nested) melanocytes. cafe au lait spots are INCREASED melanocytic aggregates within melanocyte cytoplasm
tzank smear shows?
HERPES and ZOSTER
intranuclear inclusions and multinucleated giant cells?
VZV
light microscopy shows neutrophils on the tips of dermal papillae/microabscesses?
dermatitis herpetiformis SO CELIAC DISEASE! (not caused by herpes tho)
JAK2 is a
CYTOPLASMIC tyrosine kinase
thoracic outlet syndrome for PITCHERS who hurt they arm
subclavian a and v WITHIN THE SCALENE TRIANGLE
where is PAH lowest conc?
BOWMAN's
what landmark separates direct and indirect hernias?
INFERIOR EPIGASTRIC VESSELS
CN 11 innervates?
TRAPEZIUS, not deltoid
deltoid inneravation?
C5-6
when do we suspect INHERITED coagulability syndromes?
pts under 50 with hypercoagulation in absence of any other obvius reason for hypercoag
folic acid deficiency and bleeding?
can cause HYPERHOMOCYSTEINEMIA, which is PROCOAG!!! so folic deficient can be THROMBOTIC!
calcification of epigastric region =
can be ALCOHOLIC CHRONIC PANCREATITIS form ductal plugs and calcify
paraneoplastic syndromes
cushings
SIADH

Subacute CEREBELLAR degeneration (anti Yo, anti-hu antibodies)

lambert eaton
Myasthenia gravis
dermatomyositis/polymyositis
erythrocytosis
pyruvate kinase DEFICIENCY causes...
hemolysis, splenomegaly, and RED PULP HYPERPLASIA in spleen

as reticuloendothelial cells are involved in CLEANUP of RBCs that don't have neough ATP, they get hyperplastic
angiofibromas on face and ash leaf spots?
AUTO DOM = TUBEROUS SCLEROSIS!

ASH LEAF SPOTS (areas of HYPO-pigmentation)
ASTROCYTOMAS (subpendymal)
ANGIOFIBROMAS in butterfly face pattern
kidney tumors, rabbits in heart, tubers in brain, ASH LEAF SPOTS and facial angiofibromas
SUBEPENDYMAL ASTROCYTOMAS can block lead to hydrocephalus
autosomal dominant
DKA is DM___
HHS is DM ___

ph?
glucose?
1, II,

acidotic, ALKYLOTIC

high, SUPER HIGH (600+)

HHS = elderly
DKA = younger

HHS = MORE DEADLY
posterior fossa tumors in kids MNEMONIC?
BEAM

brainstem glioma
Ependymoma
astrocytomas (pilocytic, most common of all)
medulloblastoma
BYCE grows
legionella, OLD PPL AT THE BYMCA
swollen macrophages in lamina propria =
WHIPPLE's DISEASE
guillan barre actual reaction is what kind? toxin, infiltrate, etc?
GILLIAN BARRE ATTACKS THE SCHWANNS! antibody mediated SCHWANN CELL peripheral nerve damage
abetalipoproteinemia = problem with?
can't make LIPOPROTEINS so find
failure to thrive
malabsorption of FATs and FAT SOLUBLE VITS
so no vit E, so NERVE PROBLEMS (ataxia, etc.)
steatorrhea
ACANTHOCYTES! on smear and FAT GLOBULES IN TISSUES
serum CK levels in cushings?
NORMAL despite high cortisol

so if abnomal...
lactose is made up of?
galactose and glucose, so if you have lactate deficiency you can't break up GALACTYL-GLUCOSE!
which three organisms have IgA proteases?
IgA-bomb has Hi GONN PNEU-clear!
odansetron MOA?
5HT-3 antagonist
S4 level gives what reaction?
NO ANAL WINK!
area postrema is what nucleus?
nucleus solitarius
SOLITARY and throwing up after chemo located in POSTERIOR by FOURTH VENTRICLE
malignant transformation requires what two mutations?
p53 and DCC
releasing factor binds
STOP CODON
S Aureus has what toxin?
PROTEIN A for AUREUS

binds Fc on IgG
how do you cause ICP to drop?
LOWER CO2 causing vasoconstriction
LOOPS lose ___ AND _____
calcium and HEARING!

b/c inhibit Na/K channels in EAR too!
aprepitant MOA?
a-P-repitANT is ANTI- substance P
ANTERIOR PITUITARY IS WHAT LAYER?
surface ectoderm from RATHKE's POUCH
NEURAL TUBE forms
CNS + retina

(pineal, posterior pit)
RNA pol I, II, III
1 = ribosome
2 = mRNA, snRNA, microRNA
3 = tRNA + 60s subunit part
fast lactose fermenters?
Kleb and Coli
Statin two S/E
myopathy AND hepatotoxicity
Pyro Exotoxin B ?
PSGN
RPF equation? FF equation?
RPF = RBF * (1- hematocrit)

FF = GFR/RPF
medicare vs medicaid
care for OLD PEOPLE

AID for the POOR
medicare part A B C D
A = at the hospital
B = basic bills
C = companies, private
D = DRUGS
epiglottitis presents with
D's: drooling, dysphagia, distress (respiratory)
"complex atypical hyperplasia" of endometrium =
long term estrogen without progesterone
numbers for levels of:

obturator
femoral
fibular
sup glut
inf glut
24 obturator
24 femoral

42 fibular
41 sup glut
52 inf glut
dequervains is what kind of thyroiditis?
GRANULOMATOUS, with PAINFUL/tender thyroid
what prolongs CHF patient SURVIVAL?
k-sparing SPARES YOUR LIFE in CHF diuretics
thiazide diuretics
keep Ca inside, trash Na/Cl and K, Mg
atropine MOA
AnTagonizes at MUSCARINIC
G6PD acts to do what via what pathway?
acts to CREATE NADPH via PPP (pentose phosphate pathway)
Parkinsons changes in brain?
destroy SUBSTANTIA NIGRA
LOW DOPAMINE
Huntington's changes in brain
D(ogs) can still HUNT, so INCREASED DOPAMINE

but DECREASED

AcH and GABA
alzheimers degrades what part of brain?
low AcH and low serotonin

MEYNERT and HIPPOcampus
urease + and ox + mnemonics?
Every one knows the famous mnemonic for urease positive organisms = PrUNCH

P = Proteus
U = Ureaplasma
N = Nocardia
C = Cryptococcus
H = H.pylori

so it would be easy to remember the important oxidase positive organisms if we replace "U" of PUNCH by "V"

so PsVNCH for Oxidase positive organisms;

P = Pseudomonas
V = Vibrio
N = Nisseria
C = Compylobacter
H = H.pylori

(Also don't forget that most gram negatives in general are Oxidase positive minus enterobacteriacea family)
POST MI complications in order of timing:
" APP Pseu-Rupt-True Dress"

Arrhythmia
Pericarditis (fibrinous)
Papillary rupture

Pseudoaneurism 3-14d
Rupture of free wall 1-2 w
True-ventricular anaeurism 2w-mo

Dressler syndrome 1mo+ AUTOIMMUNE fibrinous pericarditis
mcConkey turns pink if...
fermenting LACTOSE
thayer martin media has...
vanco, etc.
why do we get MEDIAL necrosis that predisposes to AORTIC DISSECTION?
HTN ---> hyaline deposits block VASO VASORUM from getting blood to vessel ---> cystic medial necrosis?
Zolamide drugs are MOA?
carbonic anhydrase inhibitors, can treat GLAUCOMA angle closure by DECREASING prod

CAI - DOWN!
SHUNT =
DEAD SPACE =
shunt = PERFUSE without VENT
dead space = VENT without perfusing so PE is dead space
restrictive lung disease FEV/FCV ratio?
RESTRICTIVES RAISE RATIO!
lung toxicity causing interstitial lung disease? mnemonic
AMY BLOWS-my-son and takes METH on the BUS

amiodarone
bleumyosin
methotrexate
busulfan
bosentan used for? MOA?
PULMONARY HYPERTENSION!

ENDOTHELIN 1 BLOCK ---> DECR PULM VASC RESIST
hard supraclavicular nodule?
virchow nodules, signals INTESTINAL MALIGNANCY? metastesis?
dextromethorphan MOA?
NDMA BLOCK
PHENYLEPHRINE MOA? USE?
ALPHA ANTAGONIST, ALLERGY AND NASAL DECONGESTANT
TROPIUM DRUGS MOA?
TROPIUM - Muscarinic BLOCK
alButerol MOA?
all-B2-agonist
theophylline MOA?
"PHILLING your lugns!" inhibits PDE so more cAMP! bronchodilation!

careful with INHIBITORS of CYP450
Hypervariable pilli are virulence factor for waht two organisms?
NEISSERIA HAVE NICE PILLI...Neisseria Meningiditis
Neisseria Gonorrheae
Intracellular polyphosphate granules are virulence factor for?
DIPHTHERIA!

stain bleu on methylene blue
hypothyroidism in Mom presents how in babby?
constipation, lethargy
HYPOTONIA
MACROGLOSSIA (BIG TONGUE!)
UMBILICAL HERNIA


SO TREAT WITH LEVOTHYROXINE WITHIN FIRST TWO WEEKS and NORMALIZE DEVELOPMENT PHYSICALLY AND COGNITIVELY!

also hvave
G1P urydyltransferase deficiency causes?
GALACTOSEMIA! G1P builds up! ... "says G1PU to first feeding, gets GALACTOSEMIA!"

neonatal JAUNDICE, VOMITING, LETHARGY, and HEPATOMEGALY after BREASTFEEDING or FORMULA FEEDING
developmental delay and light pigmentation...we also should expect what finding?
MUSTY ODOR, because this is PKU
what drug to limit CALCIUM OXALATE stones?
THIAZIDES!

they keep CALCIUM INSIDE the body
what is the P50 of Hb? Myoglobin?
Hb = 26 mm Hg

Mb = 1 mm Hg
lots of OROTIC acid in urine?
hereditary orotic aciduria

"OOOOOOOORRROOOUT AHEEEERRREEE! the UMP is leaving
can't make PYRIMIDINE bases for DNA -- lack of "UMP synthetase" (uridine 5 monophosphate synthetase)
causes MEGALOBLASTIC ANEMIA
high urinary KETONES suggests?
DM1 NOT II
DMII have low ketones b/c insulin high levels suppress it
hypersegmented neutrophils means?
MEGALOBLASTIC ANEMIA!
L2 =
L 3 =
L4
L5
L2 = iliopsoas
L3 = hip adduction and knee extension
L4 kick the door (patellar)
L5 = fibularis and tibialis ant)
S1
hamstrings, ACHILLES ankle reflex, PLANTARFLEXION gastrocnemius
OVARY gets blood from?
infundibular ligament artery aka OVARIAN artery
uterus gets blood from?
uterine arteries off of INTERNAL ILIACS!
vulvar hematoma due to nicking what artery?
pudendal during vaginal delivery
meyenteric plexus degeneration leads to?
achalassia -- lack of LES relaxation
mucus retention cysts in the maxillary sinus are caused by?
chronic rhinosinusitis
how do we get Zenker diverticulum to develop>
diminished relaxation of CRICOPHARYNGEAL muscles, causing INCREASE in PRESSURE IN OROPHARYNX
what drugs should be avoided in C1 esterase inhibitor deficiency?
ACE, b/c lead to INCREASED BRADYKININ
what drug do we use in COMBINATION ABsence and tonic/clonic seizures?
that takes a VALPROate
what three drugs inhibit dihydrofolate reductase?
methotrexate, trimethoprim,
sulfamethoxizole inhibits?
dihiDROPterate synthetase

(they are PABA analogues)
d1phenh1dram1ne and ch1orphe1ramine
H1 blocker antihistamines
that cause DROWSINESS
(1orat1d1ne does not)
ranitidine MOA?
H2 blocker
RAS-MAPK pathway: draw + mnemonic?
TK SOS RAS GTP MAPK FU/JUN

take SOS in RAS' GT with a MAP of FUJUN
PI3K/mTOR pathway + mnemonic?
Take your PICK AKT motors

TK PI3K AKT mTOR
IP3 DAG pathway draw out
PLC turns PIP2 into IP3 and DAG

IP3 ----> IP3-sensitive Ca2+ channels open

DAG ---> activates PKC to phosphorylate target
retroperitoneal organs SAD PUCKER
Sadrenals
Aorta/IVC
Duodenum (except first part)

Pancreas secondarily
Ureter + bladder
Colon
Kidneys
Esophagus
Rectum
muir-torre is a subtype of
HNCPP
Mesna is used to do what?
with FOSPHAMIDes to keep PHOSPHAMIDES from MESSNAin' up yer kidney and bladder... reduce KIDNEY and BLADDER dysfunction
what kind of stones do we treat with ACETAZOLAMIDE?
Cysteine stones, b/c it alkylizes the urine?
antibodies to melanocytes?
VITILIGO
tyrosine kinase list
alky Brett jacked her 2neu BCR-ABLS

ALK
RET (receptor TK)
JAK2
HER2NEU
BCR/ABLE
cKIT is for
GIST of it GASTROINTESTINAL STROMAL TUMOR
x-MYC (mycs are always)
transcription factors!
BRCA does what in cell?
repairs BREAKS in DNA
Wilms tumor is a
NEPHROBLASTOMA
NDMA receptor normally binds?
GLUT, GLY, D-cyclo
MYCL vs MYCN
N = Neuroblastoma
L = lung tx factor
Krabbe
1. lacks
2. accumulates
3. presents with
1. Galactocerebroside ("GALC" by the C-side crabs)
2. accumulates galactoCERAMIDE
3. vision problems, peripheral neuropathy, dev delay
because can't make MYELIN!
Neimann Pick

1. lacks
2. accumulates
3. presents with
NP lacks sphingomyelinase, accumulates sphingomyelin

presents with BIG LIVER and CHERRY RED SPOT on macula, plus...FOAMY cells
Tay Sachs
Tay is HEX-A deficient
accumulates GM2 gangliosides,
presents with:
ONION-skin LYSOSOME
CHERRY spot

Tay likes CHERRIES and ONIONS
Gaucher's lacks, presents with?
OH MY Gauche gauche at the SwEET-C-SIDE... has a SWEET PURSE carrying around that glucocerebroside
lacks GlucoCEREBROSIDE
so glucocerebroside
macs look like TISSUE PAPER
Gauche for Gaucher's, hepatosplenomegaly, macrophages look like crumpled tissue paper, glucocerebroside accumulates.
Metachromatic dystrophy?
Colorful little ARYL A is clumsy and confused.

Arylsulfatase A is messed up
cerebroside sulfate accumulates, it has
ataxia and dementia.
Colorful is for metachromatic.
Hurler's disease = defect in what action?
defect HUNTER and HURLER are that they can't break down GAGs via LYSOSOMES!

gARgoyle (gargoylism, dev delay) (autosomal RECESSIVE)
Airway obstruction (can't breathe)
CLOUDY CORNEAS
hepatosplenomegaly
lacks LIDURONIDASE ---> no LID => accumulates HEPARAN and DERMAN sulfate
Hunter disease mnemonic?
HUNTER hunts angrily on the iditerod XR

aggressive behavior, x-linked recessive
lack of IDURONATE sulfase...
same heparan and dermatan sulfate accumulate like hurler but no corenas
scaphoid necrosis is due to branch of what artery?
radial artery (dorsal scaphoid branch?)
FOOSH damages what bone?
LUNATE

also implicated in CARPAL TUNNEL medial nerve
acantholysis?
A-KERATINOCYTE-LYSIS...loss of cohesion between keratinocytes, seen in PEMPHIGUS but NOT NOT NOT PEMPHIGOID!!
acanthosis is thickening of what layer?
thickening of STRATUM SPINOSUM (think acanthosis nigricans)
spongiosis skin changes see in?
increases in width between cells, seen in eczematous dermatitis
acute MI RV failure leads to death how?
profound HYPOTENSION with clear lungs
what does papillary muscle rupture lead to?
PULMONARY EDEMA and MR with flail leaflet
Free wall rupture sx?
tamponade and JVD "distant/muffled heart sounds"
budd chiari is where? portal v thrombosis is where?
BC is at HEPATIC VEINS that drain liver,,so
after live, so between liver and systemic, so LIVER BACKS UP
portal v thrombosis VERICES because distal to PV backs up
how do STATINS work?
decrease hepatic SYNTHESIS of cholesterol, so cells in periphery UPREGULATE LDL RECEPTORS to suck the available cholesterol in!
which drugs DECREASE production of VLDL?
fibrates and nicotinic acid
most common stone type?
CALCIUM usually
hyperuricosuria can be caused by
LEISH NYAN, Myeloprolif, gout
hyperOXALuria can be caused by?
Chrons, hypoCALCIUM?
which enzymes need THIAMINE?
PDH, Alpha-keto-glutarate, transketolase

so these are DEFICIENT IN ALCOHOLISM!
connexins =
claudins/occludin =
cadherins =
cadherins =
integrins =
connect GAPS
clot/occlude TIGHT jxns
adhere ADHERENS
adhere DESMOSOMES
Hem it IN with integrins
HCM always think they also have...
LVOT

so avoid NITRATES and DIURETICS! because LV volume decreased HURTS this flow
how do NITRATES relieve angina?
NOT BY INCREASED CORONARY BLOOD FLOW

instead, they DECREASE PRELOAD so heart needs LESS OXYGEN
Nystatin MOA?
AMPHO B and NYSTATIN
ampho B-ind ergosterol
drugs that block B-D-glucan synthesis?
FUNGINS
drugs that prevent MITOSIS by binding TUBULIN?
GRISeofulvin GREASING up those tubules
inhibit fungal protein synthesis what drug?
FLUCYTOSINE, turns into 5-FU and interrupts URACIL mRNA for SYSTEMIC fungal infections
"FOVIR" drugs?
FOVIRS are FOREVER active, so don't need to be phosphorylated....Nucleoside so doesn't need phosphorylation
"CLOVIR" drugs need?
NUCLEOSIDES but need phosphorylation once in cell
Chrons?
TRANSMURAL inflammation, fistulas, PERIANAL disease but NO COLON `
Intergluteal pilonidal disease?
skin condition of upper natal cleft of buttocks
Paget disease of bone phases/pathophys>
THREE PHASEs

1. osteoclast phase: incr osteoclasts that are ABNORMALLY LARGE and MANY NUCLEI so increased RESORPTION

2. mixed phase: osteoblasts start to remodel but OSTEOCLASTS still resorbing so new bone is ABNORMAL

(at this stage bone will be lamellar + woven in same area)

3. osteoblast: results in DENSE, MOSAIC pattern of LAMELLAR bone with HAPHAZARD pattern & CEMENT LINES
aminoglycosides resistance?
aminoglycoside-modifying enzymes

mutated RIBOSOMAL 30S subunit

mutated PORIN!
Tetracyclines resistance?
EFFLUX/INFLUX or mutation that allows RIBOSOME TO CONTINUE TO WORK EVEN IN PRESENCE OF TETRACYCLINES
hepatic ABSCESS in developed vs undeveloped countries!
dev: BACTERIAL infection HEMATOGENOUS SPREAD

undev: ENTAMOEBA HISTOLYTICA or ECHINOCOCCUS
graves disease watch out for risk of?
A-GRAVES-ULOCYTOSIS!
which GRAVES drug do we use in FIRST TRIMESTER?
PROPOLTIURACIL in first trimester
which graves drug do we use in LATER PREG?
METHIMAZOLE
which THYROID drugs cause agranulocytosis?
TPO inhibitors!
what GENE missing in TURNER's?
SHOX gene which creates LONG BONE GROWTH!

so SHORT STATURE!
intermediate filaments found?
keratins are IF, also CYTOSKELETON vimentins, etc.
where is RENIN produced? ATII?
renin in JUXTAGLOMERULAR APPARATUS that secretes it

ATII primarily in PULMONARY VASCULATURE b/c that's where ENDOTHELIUM-bound ACE is
loss of JUGULAR FORAMEN nerves = what sydnrome?
VERNET syndrome: dysphagia, hoarseness, loss of gag reflex on IPSILATERAL, deviation of UVULA to NORMAL side
letrozole MOA
SMELLY STARS, decrease AROMAtase for decrease in estrogen for ER+ breast cancer, also ANASTROZOLE
estrogen and testosterone in menopause?
granulosa cells GO AWAY
but T and E still produced but EXTRA-OVARIAN AROMATASE keeps low level of E in circulation..still produce E a little and PROGESTERONE EVEN LESS

FSH levels still high along with LH
amantadine MOA?
ENHANCES ENDOGENOUS DOPAMINE

increases synthesis, relase, and uptake of DOPAMINE
bromocriptine, pergolide, pramipexole, ropinerole MOA?
DOPAMINE AGONISTS at D2
selegeline MOA?
takes a SELEGE-hammer to MAO-B to incresae the amount of available CENTRAL DOPAMINE
Entecapone and tolcapone MOA?
Al CAPONE blocks COMT COMT inhibitors so block peripheral COMT so more dopa avail for brain
Carbidopa MOA?
blocks Dopa decarboxylase in periphery so that L-dopa can cross BBB (because dopamine can't cross)
if we want drug to be HEPATICALLY METABOLIZED AND AND AND excreted?
highly LIPOPHIILIC so that it CAN't GO INTO KIDNEY!

and fits well in BILE for excretion
high CNS penetration drugs have...
HIGHLY LIPOPHILIC
where do we see RINGED SIDEROBLASTS?
only in MARROw, not in peripheral smear so watch out!
lead poisoning sx?
abd pain, constipation, neuropathy, anemia!

MICROCYTIC ANEMIA with BASOPHILIC STIPPLING
mom has facial hair growth and deeper voice during pregnancy?
AROMATASE DEFICIENCY in newborn!

will have sx of HIGH T but low E in babby!
how much risk can be attributed to....formula?)
(RR-1)/RR
which diseases can you NOT use clovirs on as easily?
EBV/CMV don't have tyrosine kinases so can't convert the drug to active form
only the _____ antivirals need to be activated in cell
CLOVIRS
how does DIPhTHERIA TOXIN WORK?
enters cell bound to Heparin-EGF

then RIBOSYLATES EF-2 so that it is INACTIVE!
which form of EF-2 is INACTIVE?
RIBOSYLATED!
which other toxin acts like DIPHTHERIA TOXIN MOA?
P. aeruginosa is not so AU-riginal after all!
milrinone MOA?
PDE-3 inhibitor causes VASODILATION and CONTRACTILITY
what two drugs used for ACUTE gout?
colchicine (microtubule inhibition) or NSAIDS
when do we NOT use NSAIDS for acute gout?
PEPTIC ULCERS or RENAL FAILURE or other contraindications for NSAIDS
when do we get DIFFUSION LIMITED in lung?
always with O2, think about WHAT WOULD MAKE IT DIFFUSE LESS!...

1. emphysema (lower diffusion surface area)
2. pulmonary fibrosis (increase thickness for diffusion)
3. super high blood flow, like EXERCISE
CO2 is always _____ limited
PERFUSION
DLCO decreased in...
EMPHYSEMA b/c destroy surface area for gas exchange
FRC =
air remaining in lungs after normal exhalation
Residual volume?
air remaining after MAXIMAL exhalation
1st part of duodenum 2 STRUCTURES behind it?
1. common bile duct
2. gastroduodenal artery
3rd part of duodenum what structure lies on top of it?
SMA
behind pancreas, that can be drilled into by pancreas rupture?
AORTA
what plexus do we get most nosebleeds from?
ANTERIOR nosebleeds = Kiesselbach's
how do we treat TOXO?
pyrimethamine and sulfadiazine
what do we use AMPHO B on?
CRYPTOCOCCAL MENINGITIS
Cryptococcal meningitis traet with?
ampho B(inds ergosterol) so use with CRYPTO~!
what do we treat listeria with?
listeria LAMP (list-ampicillin)AMPICILLIN
what do we use for CMV?
gancyclovir
glioblastoma multiforme can present with?
rign enhancing lesion
how do GDM babies present at birth?
BIG HEAD
BIG HEART
LOW GLUCOSE
hypertrophic Beta cells!
diastolic heart failure presents with?
NORMAL LVEF
NORMAL EDV

but INCREASED LV FILLING PRESSURES
diastolic heart failure is due to what changes in the heart?
decreased WALL COMPLIANCE, increased stiffness, or IMPAIRED RELAXATION (like from ischemia)
systolic heart failure presents with
LOW Ejection FRACTION
increased LV volume
incresed LVEDP
T-pertechnetate
binds to PARIETAL CELLS of gastric mucosa
failure to descend hindgut =
IMPERF ANUS
hypothyroid can present with what muscle problem?
myopathy serum CK elevation
Types of CREATINE KINASE:

CK BB found in?
CK MM found in?
CK MB found in?
BB CNS
MM skeletal MMuscle
MB my boo (heart)
difference betwen somatic symptom disorder and CONVERSION?`
Conversion is C for CNS (NEUROLOGIC SYMPTOM)

Somatic can be one or more other kind of symptom
what do we treat DKA with?
insulin and saline

insulin allows cells to get glucose, saline normalize sodium conc.
loops do what to SERUM osmo?
increase it
rathke's pouth tumors?
craniopharyngiomas, present with SOLID, CYSTIC, and CALCIFIED ALL AT ONCE

and have "MACHINERY OIL" liquid

present with HYPOPITUITARISM (growth retard in child)
bulemia if have evidence of bingeing BUT THEN
fasting, throwing up, etc. TO MAKE UP TO IT COMPENSATORY
"cau-DATE TIPS hippo" draw out
...
which viruses have host **NUCLEAR membrane**, not cellular membrane!?
HSV, CMV
what is a LACUNA and what causes it?
"HAS lacuna" H.A.S cavity filled with CSF after CHRONIC HYPERTENSIVE ARTERIOLAR SCLEROSIS
internal capsule stroke?
PURE CONTRALATERAL SENSORY STROKE: FACE< ARM
granulosa cell tumor histo?
granny granulosa has PINK FATTY coffee beans
Ca-125 =
GI tumors!
Sertoli Leydig tumors present with?
SIGNS OF HIGH TESTOSTERONE so hirsuitism, cliteromegaly, deep voice
struma ovarri?
THYROID TISSUE IN OVARY! can secrete THYROXINE
asymptomatic parents =
autosomal RECESSIVE!
hemophilia B is ___ pattern of inheritance?
X-linked recessive and targets BOYS BOY BOY
Hemophilia A
factor 8 deficiency,
maple syrup disease deficiency of ____ means they can't _______
AUTO RECESSIVE...alpha-keto-acid DH, can't break down BRANCHED AAs, which are toxic to CNS
B4 supplementation for...
PKU variant without dihydropterin
What do we give for HYPER-HOMOCYSTEINURIA?
FOLATE & PYRIDOXINE (B6)
what do we give for SIDEROBLASTIC ANEMIA? Most common sideroblastic anemia cause?
sideroblastic most commonly due to ALAS defect. give pyridoxine B6
methemoglobin increases with
nitrites, dapsone, Hbopathies
"aban" drugs block?
DIRECT THROMBIN INHIBITORS BAN THROMBIN
xaban drugs
block Xa in coag
intrinsic pathway?
TTP
TISSUE FACTOR?
converts VII to VIIa (active form on PT side of coag cascade)
CMV is ____ ____ virus
dsDNA ENVELOPED with nuclear membrane!
branched and budding filamentous can be what two organsims? how do we tell apart?
can be NOCARDIA and ACTINOMYCES

nocardia = Acid FAST and AEROBIC

actinomyces: ANAEROBIC and not acid fast
big ass bilobed thing that's blue/purple?
REED STERN-bilobed
most common benign tumor in liver?
CAVERNOUS HEMANGIOMA (see blood in caverns on histo)

DO NOT BIOPSY B/c COULD BLEEEEED
HCC is associated with what other thing?
HEMOCHROMATOSIS!
how do we treat HEPATIC ADENOCARCINOMA?
DISCONTINUE OCPs
p27?
cell cycle INHIIBITOR
how do we inactivate Rb?
phosphorylate it
which organism can invade MESENTERIC LYMPH nodes and cause PSEUDO-appendicitis?
yersinia enterolitica
Shigella spreads LATERALLY to other cells in gut how?
polymerization of ACTIN
villous atrophy and crypt hyperplasia?
CELIAC!
what do we use to TEST for CGD?
nitroblue tetrazolium test. Tests for NADPH oxidase, so can diagnose defects in neutrophil respiratory burst
xanthine oxidase does what
makes URIC ACID from hypoxanthine --- final setp of PURINE degradation
COPD what two things INCREASE
"COPD...gettin TLC in the RV" RV SUPER INCREASED and TLC only milkdly increased
if confidence interval DOES NOT INCLUDE THE NULL HYPOTHESIS?
statistically significant!
collapsed lung, have to consider?
MAINSTEM BRONCHUS LESION (like central lung tumor) look for DEVIATED TRACHEUM
parietel lesions affect?
WRITING MATHS HEMINEGLECT
kid with gait instability...what part of SC affected?
probably FRIEDRICH's ataxia: both POSTERIOR COLUMNS and SPINOCEREBELLAR
area postrema is located>
posterior MEDULLA
p2 + 2pq + q2 = 1
psquared = NORMAL individuals

qsquared = DISEASED individuals

2pq = CARRIER FREQUENCY
sq root of disease prevalence (dz = qsquared) =
allele prevalence for mutant allele
autosomal recessive disorders = shorthand for probability of beign CARRIER?
2q (2x allele frequency)
hepatic encephalopathy -- consider when...
patient with LIVER DZs, like hepatatis, is OBTUNDED --- enceph from builidup of ammonia products
VIT E neuro sx?
mimic FRIEDRICH's"

loss of MOTOR/ATAXIA + POSTERIOR COLUMN
polio leads to what neuro sx?
asymmetric FLACCID paralysis

PRESERVED SENSORY!
AIP can cause what neuro sx?
just peripheral neuropathy
rapidly progressive MYOCLONUS?
Creutzfeldt-jakob disease
ataxia + ophthalmoplegia?
THIAMINE DEFICIENCY/WEIRICKE's
schizoid personality disorder
LONER DETATCHED UNEMOTIONAL
schizotypal personality disorer
schizotypal is the TYPE to live in BERKLEY....ECCENTRIC ODD THOUGHTS PERCEPTIONS and BEHVIOR
avoidance personality disorder?
avoids due to fear of criticism or rejection
borderline personality disoder?
chaotic relationships, sensitivity to abondonment, labile mood, impulsivity, inner emptiness, self hard...YOU KNOW WHO HAS THIS!
test to order if MALABSORPTION of unknown etiology for workup?
sudan II stool test to test for UNABSOBED FAT (usually stool should contain NO unabsorbed fat)
reduced intercostal muscle strength leads to?
hypoxia and TELANGIECTASIA
aspiration pneumonia organisms?
peptostrepto, bacteroides, fusobacterium, prevotella
lemierre's disease? what is it, what causes it?
"LEMIERRE LIT THE FUSE-obacterium"

caused by FUSOBACTERIUM
it is THROMBO-PHLEBITIS of IJV AFTER A TONSILLAR ABSCESS grows ANAEROBES! then bursts and they invade local tissues
heme oxygenase does what?
turns HEME to BILIVERDIN! then BILIVERDIN REDUCTASE turns to UNCONJ
so bruise turns GREEN it's because of heme oxygenase
how do we tell it's DIMENTIA?
NO change in consciousness, progerssive and DISTANT MEMORIES SPARED
alveolar growth pattern without invasion?
bronchioalveolar carcinoma (looks kinda like pneumonia)
HAMARTOMA can have what in them?
CARTILAGE/HYALINE and FAT tissue!
what activates TRYPSINOGEN to TRYPSIN and wehre?
in GUT, DUODENAL ENTEROPEPTIDASE
multiple myeloma kidney sx?
renal CASTS, excess excretion of LIGHT CHAINS precipitate with TAMM HORSFALL and cause casts that occlude TUBULES znd cause tubular destruction
GLASSY CASTS that stain EOSINOPHILICALLY in renal tubules?
MULTIPLE MYELOMA kidney symptoms

tamm horstfall + light chains = what precipiitated
think PURE RED CELL APLASIA if...
ERYTHROID PRECURSORS are LOW but PRESERVED MYELOID + MEGAKARYOCYTIC
cerebellar HEMANGIOBLASTOMA can secrete?
EPO! cause polycythemia
uterine fibroids can secrete?
EPO! cause polycythemia
aminocaproic acid puts a "CAP" on...
plasminogen activation to inhibit fibrinolysis
tamide, zamide, buride, pizide, piride are all? MOA?
sulfonylureas

stimulate insulin release via inhibition of K channels

(can cross placenta)

also reduce glucagon
fibrates MOA mnemonic>
fibrates fi-BREAK UP triglycerides

into VLDL and chylomicrons, which are removed from circulation
apolipoprotein A1 is the highway for... Apolipoprotein C2? ApoE? APoB100?
HDL transport in serum...C2 is LPL cofactor. ApoE helps chylomicrons ENTER liver). ApoB100 is in ALL DL's
vasopressin V2 receptors
secrete ADH so increase factor VIII activity
Anthracyclines
anthracyclines are RUBICINS, so they kill cancer via ROS- generation, but those same ROS- are CARDIOTOXIC, so give DEFEROXAMINE with them to limit cardiotoxicity
RUBICIN drugs do what? what do they side effect?
Rick RUBICIN is upping rick ROS-
URSADIOL MOA? usage?
is a BILE ACID. used for PBC
what do we use DACTINOMYCIN for?
intercalates between C=G in DNA to treat WILMS and EWING
PILCAMYCIN give that PIL-camycin to whom?
pilcamycin for PAGET of bone, rNA synth inhibitor
BLEOMYCIN will do what?
she was an ROS- that blew you and BLEUW UP DNA! break it double strandedly
BUSALTAN MOA and USE?
treasts CAMELS! and he is an ALKYlating ALKYHOLIC....CML because he's alkylating
6 MPs do what?
can't make them PURE so inhibit PURINE synthesis
6MPs are old white men, so
they get METABOLIZED BY GOUTY GOUT, xanthine oxidase!

so if you give ALLOPURINOL with 6MP it will increse in conc. because no longer being metabolized
5-FU MOA?
via TK and Tyrosine Phosphorylase, 5FU activates FdUMP to block THYMIDINE SYNTHASe and therefore block THYMIDINE SYNTHESIS
paclitaxel interrupts
bind to a TUBE in your Pa-CLITpaclit....TUBULIN by binding to it
hydroxyurea just wants...
some RnR, ribonucleotide reductase inhibitor

so decreased dna synthesisi
tacrolimus MOA?
IL-2crolimus
via inhibit CALCINEURIN, blocks T-cell proliferation. Remember that sirolimus does this via the mTOR pathway blockage
Sirolimus MOA
must inhibit mTOR, decreases IL-2 to decrease proliferation of T-cells
Mycophenylate Mofetil MOA?
Mycophenolate mofetil is metabolised in the liver to the active moiety mycophenolic acid. It inhibits inosine monophosphate dehydrogenase, ratelimiting step for GMP...blocking purine sythesis pathway used for T and B cells to proliferate, so they don't proliferate
little THEO-phylline loves?
to STAY at cAMP! inhibits PDE that degrades cAMP
chloremphenicol MOA?
grey babby syndrome? 50s subunit
K sparing diuretic list
Epithelial sodium channel blockers
Amiloride
Triamterene

Aldosterone antagonists (mostly spirolactones):
Spironolactone
Eplerenone
RINONE drugs?
like a PDE (pretty) RINONE cowboy loves CAMP, causing your HEART TO BEAT!
inhitid PDE3 leads to more CAMP in CARDIAC
Nesiritide
BNP
brain natriuretic pptide
fondaparineux is very fond of?
ATIII
drugs ending in ABAN and RUDIN
ban rudy THOMBIN
clopidogrel has a grill to BURN what?
ADP, which he hates
cilostazol MOA?
inhibited PDE3 and increased camp, so decreases platelet agg + vasodilation increase
abcixumab
IIb,IIa blocker, so used in heart disease to prevent clots/platelet aggregation.
TRACRINE me a river...
TACRINE me a RIVA-stigmine, i'm AcH-in and
I'm DONE-pazil being GALANT-amine
all AchESTERASE INHIBITORS for ALZheimers
M3 stimulation and aqueous humor?
leads to MORE OUTFLOW
parathion and malathion?
Organophosphates block organophosph-"AcHes" so lead to accumulation of AcH. Give ANTICHOLINERGICS like ATROPINE to block Muscarinic receptors and block the effects of too much AcH!
what two things do we give for NERVE GAS poisoning?
atropine or praladoxime
praladoxime MOA?
binds AChEsterase INHIBITORS, allowing ACHesterase to work~@
stigmines are?
ACHesterase inhibitors
mitrazepine does what?
can cause palpitations and weight gain, but it inhibits alpha-2 and SEROTONIN receptors, increasing release of NE and SEROTONIN
barbituates MOA
GABA-rbituates, potentiator at receptor, INCREASE FLOW OF Cl- ions, leading to HYPERPOLARIZATION and DECREASED CNS neuronal activity

for sedation or seizures
zolpidem full MOA?
GABA-A binder like Benzos, leads to INCREASED INFLOW OF CHLORIDE leading to HYPERPOLARIZATION and CNS block for sedation
Vigabatrin MOA? Major S/E?
Vig is a GABA-transaminase INHIBITOR so decreases breakdown of GABA to increse levels...
used for INFANTILE SPASMS in children or refractory seizures

S/E = VISION loss or field constriction in up to 30% of patients
Vigabatrin S/E?
VISION LOSS or FEILD CONSTRICTION IN 30% of patients!
GABATRINE or GABINE =
deals with GABA
Topiramate, matey?
he's a GABA-gonist pirate and blocks the SODIUM coming in ---> hyperpolAAARGHH-ize
Carbamazepine MOA?
STABILIZES THE INACTIVE state of SODIUM channels, so that nerves are LESS EXCITABLE. can cause AGRANULOCYTOSIS
"caine" drugs MOA?
Caine = block Na-in(e)
halothane causes what thaneg?
FULMINANT HEPATIC NECROSIS
how do we treat MALIGNANT HYPERTHERMIA AND NEUROLEPTIC MALIGNANT SYNDROME?
Dantroline hates RYANAIR so blocks RYANTIDINE receptors from dumping Ca2+
PROPOFOL asleep but might get?
HY-PRO-TENSION to FALL
tramadol MOA?
mu receptor AGONIST
BUTORPHANOL?
blue orphans GO BOTH WAYS AT MU RECEPTORS and AGONIZE kappa receptors!
Memantine MOA and usage?
BLOCKS NDMA for alzheimers
Sumatriptan MOA?
STIMULATES 5HT CENTRALLY to inhibit vasodilation and inflammation + VASOCONSTRICT vessels intracranially

can cause CORONARY VASOSPASM
Nitroprusside gets turned into?
NO in the blood, then ---> cGMP pathway so SMOOTH MUSCLE RELAX OF ARTERIES and MAINLY VEINS

reduces AFTER and PRELOAD

but can ONLY GIVE NITROPRUSSIDE IV!!!!!
what happens if you give NITROPRUSSIDE ORALLY?
turns into CYANIDE in gut ...treat with THIOSULFATE!
mannitol can be used to...
decrease ICP or INTRAOCULAR PRESSURE!
What two things do LOOPs retain?
Uric acid and Na+, so can precipitate/worsen GOUTY attacks
what degrades imapenam in kidney, and is blocked by CILASTIN?
Renal DIHYDROPEPTIDASE I,
when do we use NEOMYCIN?
before SURG to CLEAR OUT GUT
Clindamycin, Linezolid MOA and usage?
she's in her 50s
usually likes it ANAEROBIC and ABOVE THE WAIST (anaerobic aspiration pnemonica or lung abscess)
chloramphenicol MOA?
chloram50sicol
Clarithramycin, Azithramycin, Erythramycin MOA?
50s inhibition
tetracycline is cycling at what age?
30s

causes fanconi and teef discoloration plus PHOTOSENSITIVE

so FANS don't take PHOTOS of 4 cyclers because their TEEF look funny in the photos
TMP-SMX MOA each?
TMP = DHFR
SMX = DHPTS

can get TEN/SJS tho
MIDODRINE & PHENYLEPHRINE
A-ag I MIDO-dream of Phenylephrine both alpha agonists
clonidine MOA?
Paula dean loves ALPHA 2 agonism
FENDOLDEPAM MOA?
D1 agonist
albuteral is..
ALL BETA all agonist
TERBUTALINE?
B2 agonist in lungs and uterus

draws a a line from your LUNGs to your UTERUS and relaxes them both
ZOSINS do what?
ALPHA-1 BLOCKERS!

can get "first dose" syncope b/c of orthostatic HOTN
normal vs celiac histo? description and image
blunted villi and crypt hyperplasia
schizoaffective
major depressive critera met

and

delusions or hallucinations IN ABSENCE OF MOOD SYMPTOMS for 2+ weeks at some point
schizofreniform?
between 1 and 6 months
abetalipoproteinemia histo
will contain CLEAR FOAMY CYTOPLASMIC CELLS AT TIPS OF THE VILLI in intestines!
abetalipoproteinemia Symptoms
ABLP: A = acanthocytes, B = low Blood levels of Chol & Trig, L = lipids in stool P = PNS/CNS nerve symptoms

malabsorption (fatty smelly stools)
also LOW TRIGLYCERIDE and CHOLSTEROL and chylomicrons, etc. levels in BLOOD bc they in tissues
and ACANTHOCYTES and NEURO SX!
lewy bodies are found in ___ and are made of
PARKinsons and made of ALPHA-synuclein
Pick bodies are found __ and made of
FRONTO-TEMPORAL tau protein inclusions

PICK disease = frontotemporal dimentia
how do bacteria resist AMINOGLYCOSIDES?
STAND AT THE BORDER GATSE the the AMIGOs trying to come in and CHANGE them so they can't work onc3 i the USA can attach ACETYL, ADENYL, PHOSPHATE GROUPS TO THEM OUTSIDE THE MEMBRANE and then they can't bind to 30S
KIT mutations =
proliferation of MAST CELLS ---> histamine release ---> gastric secretion out the wazoo!
REDDISH urine THAT DARKENS after SITTING --what is the deficiency?
AIP
due to PBGD deficiency..."Pee Bloody Gets Darker"
PBG deaminase deficiency?
AIP

will show RED URINE PBG and ALA in urine
DBS for PARK movements?
GOT dibs on the GPi SUB....GPi or SUBTHALAMIC
drainage of COLON by lymph is same as BLOOD
but superior rectal also drain into?
and middle rectal -->
and DISTAL TO pectinate line -->
Sup rec ---> internal iliac too
middle rect --> int iliac
distal to Pectinate is SKIN so
--> INGUINAL nodes
celiac lymph nodes drain?
CELIAC TRUNK AREAS
hep c envelope has
ANTIGENIC VARIATION so can have antibodies that only react with some
MACROPHAGES have what CD?
CD14
do not aggregate platelets IN RESPONSE TO RISTOCETIN?
vWF deficiency
evidence of EXTRAMEDULLARY HEMOLYSIS?
skeletal abnormalities (frontal bossing, etc.)

and HYPERPLASTIC MARROW usually CHRONIC HEMOLYTIC ANEMIA causes EXTRAMED HEMATOPO
HCM think _____ and don't give them drugs that?
LVOT obstruction!

so gets worse with LESS PRELOAD, so don't give VASODILATORS or LOWER AFTERLOAD
what drugs HELP LVOT?
negative inotropic (verapimil, beta blockers) because they help FILL heart
young patient with HEART COAGULATION and CORONARY ARTERY SYMPTOMS?
think HOMOCYSTEINURIA need to give CYSTEINE

defect in CYSTATHIONE SYNTHASE so can't make CYST from HOMOCYST
who do we give tyrosine to?
PKU
chronic LYMPHADEMA can cause what cancer?
ANGIO-SARCOMA! will present with violaceous nodules on skin
collapsed lung --> atelectasis and alveolar collapse ---> trachea deviates which way?
TOWARD atelectasis/opacified lung
trachea deviates AWAY FROM?
pneumothorax
pleural effusion
trachea deviates TOWARD?
collapsed lung due to obstruction
HTN retinal changes?
dot or flame hemorrhages
cherry red spot on macula?
tay sachs, neimann pick, or CENTRAL RETINAL ARTERY OCCLUSION
bipolar II =
2-MANIC
1 is HYPONE
area postrema is where?
DORSAL MEDULLA --> posterior medulla by 4th ventricle!
colchicine use and MOA
acute gout

inhibits MICROTUBULES
milrinone 2 effects
increases CAMP by blocking PDE3 so that cAMP not degraded!

so VASODILATION and CARDIAC CONTRACTION!
transthyretin?
seen in FAMILIAL AMYLOID POLYNEUROPAHY or FAMILIAL AMYLOID CARDIOMYOPATHY
why do downs get early alzheimer's?
APP (amyloid PRECURSOR protein) gene located on CHROMOSOME 21 so they have EXTRA COPY of this
tau protein defect in Alz?
TAU TANGLE with TOO MANY PHOSPHATES
hemachromatosis
increased iron absorption, presents in 50s with bronze fatigue, CHROMOSOME 6
coughing up TONS OF PALE COLORED LIQUID
ADENOCARCINOMA in SITU in lung
damage to caudate leads to?
BEHAVIORAL changes like aggression, speech/language, and huntington's like CHOREA
loops lose what ions, how?
loops block Na/K/2cl in thick ascending limb, so lose: Na, K, Cl, also Ca, and K because of indirect reabsorption block through no K gradient established
complete contralateralsensory loss?
damage to VENTRAL POSTERIOR LATERAL nucleus or VENTRAL POSTERIOR MEDIAL

VPL or VPM
CAT+ STAPH

STAPHANIE likes CATS
...
1 g fat = how many cals
1 g protein =
1 g carbs =
carbs = 4
prot = 4

fat = 9
how do we tell if lymph node is malignant prolif?
if it is MONOCLONAL proliferation of tcells bc normal is POLYCLONAL
ALAS, you have...
sideroblastic microcytic hypochromic anemia
enhancers do what?
https://www.youtube.com/watch?v=ysxtZJUeTCE
promoters do what?
initiate transcription by binding TX factors and RNA POL II
UPSTREAM from gene!!!
rosenthol fibers and eosinophilic granules in CEREBELLUM?
Rosenthol has PINK HAIR STARS! PILOCYTIC ASTROCYTOMA!
will also have HAIR_like processes
ependymomas look like what?
pseudorosettes with GFAP processes
MedulloBlastoma looks like?
small, poorly differentiated, scant cytoplasm, HIGH MITOTIC index

homer-wright rosettes
pilocytic astrocytoma onMRI?
"starry" in the sky...white with black next to it
HLA associated with SERONEGATIVE SPONDYLOARTHROPATHIES?
B27

MHC-1
B-ALL has what CD4?

T-ALL has what CD4?
B = TdT, 10, 19

T = tdt, 2, 3, 4, 5, 7, 8
HbCORE antigen in serum?
not detectable! because it's within the envelopd!
acute hep B is most reliably marked by?
Anti-HbC
Hep B window period
between when SURFACE ANTIGEN disappears and IgG against it appears!
G6PD catalyzes the first and rate limiting step of the
PPP
VMN =
satiety
Lateral nucleus of hypothal?
LATERAL FOR LATE-NIGHT HUNGER
HUNGER
destruction -> anorexia
Anterior nuclueus?
Posterior nucleus?
A= AC cooling
Post = HEATING
arcuate nucleus secretes
DOPAMINE to inhibit PrL GnRH, etc.
pagets disease of nipple leads to what sx?
eczematous exudate over nipple and areola
two main causes of ACUTE PANCREATITIS?
alcohol and gallstones

but can also be caused DIRECTLY by super high TRIGLYCERIDES leading to lots of FFAs that damage the acinar cells directly due to TISSUE TOXICITY
diastolic HF?
you "DIE-a-stolic" because of all the LV pressure

normal EF and normal LVEDV
systolic HF?
reduced LVEF and increased LV volume and LVEDP
klebs granulomatis?
causes granuloma inguinale, extensive progressive ULCERATIVE LESIONS but

NO LYMPHADENOPATHY

tissue stains GM - intracytoplasmic donovan bodies
painful lesion at start?
rhymes: HSV or DU-CRE-YI
Chlamydia Trachomatis serotypes
L1-L3 cause LYMPHGRAN -- use DOXY

D-K cause STD

A-C OCULAR TRACHOMA in KIDS!
koilocytosis is hallmark of?
HPV!!!! eating RAISINOIDS at the HPV!
supplmentation of THYMIDINE can help...
restore dTMP production and therefore REDUCE APOPTOSIS of ERYTHROID PRECURSORS
Glutamine is source of..
major source of nitrogen for nucleotides

NITROGEN!
cysteinuria caused by? major sx?
blocks Na-independent AA transporter on proximal tubules and intestines, so DUMP "COAL" (the dibasic ones) into urine

but only CYSTEINE forms stones

ornithine
arginine
lyseine
cysteinuria pathophys? tx?
AUTO RECESSIVE
PCT transporter mutation in Cysteinuria, cysteine stones in ureter, bladder, kidney. Treatment is with citrate or acetazolamide to ALK the urine.
the chronic MYELOPROLIF disorders wha tpathway?
JAK STAT
vit E deficiency presents wtih?
ataxia
loss of TVP
loss of Deep tendon reflexes
PKA activation in liver via?
eipinephrine and glucagon --> Gs ---> camp ---> phosphorylation of PKA
Histone 1 location?
OUTSIDE CORE ball of H2 A, B H3
cyanide poisoning PaO2, SaO2, Oxygen content?
NORMAL ALL NORMAL!!!!

cyanide takes O2 for a ride. PaO2 nl, Hb nl, Sat Nl, but can't get OFF in tissues, so VENOUS O2 content is UP UP UP
CO poisoning SaO2?
NlPaO2 but low SATO2

PaO2 = dissolved in blood O2
Oxygen content = PaO2 + Hb conc + O2 bound to Hb...so because Hb bound is down, other two normal, so OXYGEN CONTENT DECREASED!
What are the three things that go into blood Oxygen content? What happens in POLYCYTHEMIA? CO? Anemia?
The three elements are 1. PaO2 dissolved in blood 2. Hb concentration 3. Hb saturation with Oxygen. In polycythemia, Hb conc. is increased to OXY CONT INCREASED. In CO, sat is down, so OXY CONT is down. Anemia Hb is down, so oxy cont is DOWN.
PANCREATITIS ---> ARDS!!! always think ARDS!!!
...
CCC is from?
KIDNEY
infection then GLOMERULONEPHRITIS, how to tell which one?
IgA Neprhopathy = LESS THAN A WEEK LATER!
PSGN = WEEKS LATER
blood cells OSMOTICALLY fragile?
hereditary SPHEREOCYTOSI!
HbA2 is what two subunits? when do we find it?
ALPHA DELTA!

BETA THALASSEMIA
HbA2 = ____ HbF = ____ HbH = _____
A2 = alpha delta, FAG = alpha gamma HbH = some Betax4 tetramers, but have some working normal alpha-gammas, so subject to problems only under HEMOLYTIC STRESS
in brain after lesion?
MYELIN DEBRIS can persist for YEARS because macs move slow and activated slowly and BBB in the way
drugs that dissolve clots via PROMOTION OF FORMATION OF PLASMIN?
kinases, urokinase, streptokinase, anistreplase, alteplase, reteplase

promote formation of PLASMIN that destroys FIBRIN
Aminocaproic acid MOA? Usage?
Inactivates PLASMINOGEN, so no plasmin can be formed, so is ANTI-fibrolytic. So can control BLEEDING. Used for ANTIDOTE for tPA or Streptokinase, and can be used before surgery to prevent bleeding when expected.
ZONE drugs MOA?
PPAR-gamma DECREASES insulin resistance
(Zone drugs)
emzitimibe MOA + S/E?
blocks cholesterol absorption at the brush border of the intestines.
MYALGIAS
abnormal LFTs
fibrates and warfarin?
warfarin competes to bind to plasma proteins, but fibrates can bind instead and INCREASE WARFARIN ACTIVATED UNBOUND LEVELS
anastrozole is...
SMELLY, inhibits AROMATASE soLESS estadiol

for breast cancer E-receptor posiitive sort
ADH causes what other thing to INCREASES?
FACTOR 8, so can treat vWF deficiency or HEMOPHILIA A~!
the DACTINO DINO for dactinomycin is for KIDS...
ewing and wilms tumors, INTERCALATES into DNA
who did Bleomycin blow?
ROS-
who is on the BUSultan?
ALKYHOLICS, so ALKYLATING agent

and he is a SULTAN so he likes CMLs
6MPs can't what?
ALL be PURe-ines

ALL tx, inhibit PURINE synthesis

6MP activated by XANTHINE OXIDASE so if taking allopurinol, levels of 6MP will go crazy
VINblastine is VIN-BINDING to what?
TUBULIN and breaking up the MITOTIC SPIND-diesel (spindle)
hydroxyurea doesn't want you to have what?
A little RnR (ribonucleotide reductase) so no DNA synth
Imatinib MOA, usage?
I'm-a-TK-inhib" inhibits all TKs, useful for BCR-ABL+ t(9,22) phil+ CML?
TACROLIMUS
must inhibit CALCINEURIN ---> no IL-2 so immunosuppression
SIROLIMUS?
mTOR inhibitor
CYCLOSPORINE
inhibits CALCINEURIN so decreased IL-2
Mycophenylate Mofetil
by inhibiting inosine monophosphate DHase so blocks PURINE SYNTHESIS
"prost" drugs are
prostaglandins
INFLIXUMAB and ADALIMUMAB inflicts damage by?
binding TNF_alpha
theophilline is "philling" what
YOUR LUNGS at CAMP --- bronchodilation!
garlic breath? Bitter almonds?
ARSENIC poisoning = garlic. Bitter Almonds is CYANIDE
dimercaprol and penicillamine can be used antidote for?
ARSENIC and (OLD) LEAD
50s inhibitors
CHLOR
MAC
CLINDA

chloramphenicol
MACrolides
CLINDAMYCIN
warm agglutinins are Ig___
Gee it's hot
cold agglutinins are Ig____
MMM cold icecream
macrolides TOXCITITY
M = motility issues
A = arrhythmia caused by prolonged QT
C = acute Cholestatic hepatitis
R = rash
O = eOsinophilia
TMP toxicity?
TREATS MARROW POORLY (leukopenia, granulocytopenia, megaloblastic anemia)
MM crab
Calcemia
Renal failure
Anemia
Bone lesions/back pain
succs to be a kid who eats lead
lead poisoning use succimer in kids
Giemsa stain mnemonic
That GEM CHAMYDIA bores ricky? Try Plasmodium

CHlamydia
BOrrelia
RICKETTSIA
Trypanosomes
Plasmodium
IgA protease hits you right in the SHIN
S. pneumo
Hinfluenzae
Neisseria
Strep "B-BRAS"
Bacitracin:

B-strep Resitant
Astrep Sensitive
viridans are not afraid of
THE CHIN, so they live in your MOUTH

optochinin
CEEKS seek what? grow on what?
CEEKS SEEK LACTOSE
grow on MC-CONK-CEEK agar

Citrobacter
Enterobacters
Ecoli
Klebsiella
Serratia
MeninGococci ferments

Gonococci ferment
MG ...maltose and glucose

Glucose
H. influenza needs what to grow?
chocolate agar, factors V and X, and NAD
legionella grows where?
BYCE + cysteine + iron (stains with silver stain(
q fever is queer why?
can survive as endosome outside host, and NO RASH
Histo on histology will be seen?
in macrophages
sporothrix is the disease of, and treat with?
garden, treat with POT (potassium iodide)
asplenics get ___ infections
SHiN

S. pneumo
H. influ
Neisseria
little wiscott loves ...
PIE
purpura
Infections
Eczema
infantile vs adult COARCTATION OF AORTA LOCATION?
infant is IN close to heart

adult is A-distal
interosseus m. mnemonic?
DAB
PAD
dorsal = abduct fingers
Palmar ADDUCT
1 slow red ox
type 1 slow fibers are red and oxidative phosphorylation
Ewings go well with
ONION RINGS! onion-appearance
PGI2 mnemonic
(platelet gathering inhibitor)
treat methb with
methylene blue
mesoderm
macrophages and microglia M for mesoderm
basal ganglia pathways
D1 is D1rect

D2 is indirect INHIBITORY
triad of symptoms in MS?
Charcot's classic triad of MS is a SIIIN
Scanning speech
Intention tremor,
Incontinence,
Internuclear opthalmoplegia (UNILATERAL nystagmus)
Nystagmus
methylation DNA ----

Acetylation DNA ---
mute

active
brown tumors?
osteitis fibrosa cystica. due to OVERACTIVE PTH leading to overactive osteoclastic activity. also called VON RECKLINGHAUS'S DISEASE OF BONE
17 letters in...for chromosome 17
von recklinghausen NF1
Cocaine MOA
inhibits Na+/K+ ATPase that reuptakes NE, so increses levels of NE in your brain
alpha agonists: Alpha 1 = ? Alpha 2 =
alpha 1 = midrodine, phenylephrine, methoxamine. Alpha 2 = "clon, guan, methyldopa"
phenoxybenzamine is an ALPHA
BLOCKER phenoxybenzamine (irreversible)
name 3 muscarinic ANTAGONISTS
pilocarpine, carbechol, atropine
benztropine MOA and how works?
PARK your BENZin the CORPUS STRIATUM and BLOCK the M1 muscarinic receptor to restore AcH-Dopamine balance in
oxybutanin MOA?
block the muscarinic receptor
mirtazine MOA
alpha-2 and 5HT blocker, so increses NE and 5HT
barbitch u hate is too?
GABA-A-gabby but we POTENTIATE HER anyway
lamotrigine blocks ______ resulting in _______. Used for _______
VOLTAGE GATED SODIUM CHANNELS AT PRE-SYNAPTIC MEMBRANE, so that EXCITATORY GLUTAMATE CANNOT BE RELEASED. THIS STOPS EXCITATORY NEURONAL signals FOR EPILEPSY.
the me-MAN-tine wont let you do what?
get your NMDA, he blocks the receptor
muranic acid lacking in what bacteria?
chlamydia
Lynch Syndrome: What three cancers? What mutations?
lynch syndrome is:
Colon
Endometrial
Ovarian
and due to mutations of MSH1,2,6 or PSM2
APC gene is for what cancers mnempnic?
APC COsBr! = colon, osteomas, brain FAP so chromosome 5, OSTEOMAS, COLON, or BRAIN!
TP53 mutation?
LI FRAUMENI
VHL shows what kind of cancers?
hemangioblastoma (retinal, cerebellar?)
CCC of renals
pheo
Postive and negative likelihood ratio FORMULAS?
PLR = SN/1-SP
NLR = SP/1-SN

PLR = chances of having the disease with a positive result. NLR = changes of having the disease with a NEGATIVE result
agonists that can bind to NMDA receptor
glutamate, asparate, D-cycloserine
DCIS histo?
DUCKS LIVE IN "NESTS and cords of cells"
Glutamate, Aspartate, Glycine, and D-cycloserine bind ____ and ______ it.
NDMA receptor and ACTIVATE IT.
uncal herniation what CN?
uncal herniation below TENTORUM CEREBELLI is CN III compression so fixed dilated pupil
TONSILLAR herniations like chiari compress what?
MEDULLA
subfalcine herniations compress what?
ACA
SCID is deficient in...
ADenosine DeAminase (ADDA)
C1 COMPLEMENT deficiency is associated with?

C1 Esterase INhibitor deficiency is associrted with?
C1 deficiency = SLE but usually not symptomatic because complement still can go by the alterate pathway

C1esterase inhib def --> complement get sactiavted all over the place so HEREDITARY ANGIOEDEMA! DON'T USE ACE INHIBITORS
what effect does blocking NICOTINIC receptors have?
paralysis during anaesthesia, but can also block AUTONOMICS so get HYPOTENSION and TACHYCARDIA
inferior gluteal nerve injury leads to what sx?
dificulty climbing stairs or rising from chair
stop codons mnemonic?
YOU ARE ANNOYING
YOU GO AWAY
YOU ARE GONE
glu-val
switch = SICKLE CELL!
TB-oid leprosy is Th___
TB is Th1! b/c TB=granulomatous!
DNA POL I vs III
III synthesizes strand, 1 moves in after to be the ONE who removes RNA promers!
Ecthyma gangrenosum?
neutropenic patients get necrotic lesions on chest

caused by P. aeruginosa -- including EXOTOXIN that stops EF-2 like DIPHTHERIA
which two factors incraes ANGIOGENESIS?
FGF and VEGF
EGF does what?
mitogen for HEF...epithelial cells, hepatocytes, and fibroblasts!
biphasic tumor growth?
SCHWANNOMA has SCHWAN tumor but
TWO PHASIC GROWTH

Spindle cells and
S-100+ too b/c NEURAL CREST CELLS
sensory of hand mnemonic?
doRsal is RADIAL n

palM is MEDIAL n
thenar atrophy weakness?
recurrent MEDIAL N. carpal tunnel?
Corocobrach which nerve is by here?
MUSCULOCUTANEOUS

forearm flexion loss and sensory loss lateral forearm
radial nerve passes through ___ canal
SUPINATOR!

SUPER RAD!
PVera shows on labs?
HIGH Hb
HIGH Hct
HIGH ERYTHROCYTES
HIGH PLATES

but normal MCV, MCHb, MCHC, distribution width

NORMAL RBCs, just a SHIT TON OF THEM
endometriosis sx?
endometriosis gets DISSED...DYSMENORRHEA, PELVIC PAIN, DYSPAREUNIA
uterine fibroids sx?
aka LEIOMYOMAS! HEAVY MENSES with CLOTS
constipation, urinary frequency
IRREGULAR LUMPY ENLARGED UTERUS
adenomyosis
tender uterus, BULKY uterus
dysmenorrhea

this is endometrial glands in MYOMETRIUM
small uterus =
endometrial hyperplasia/cancer
chrons mnemonic?
FAGS get chrons

Fistulas
All layers
Granulomas
Skip lesions
putamen involved in mnemnic?
PUTTIN EM IN MOTION (initiate movement!)
Globus Pallidus damage

internal:
external:
internal = EXCESSIVE mot9ion
external: decreased movement
salicylate toxcicity early, middle, late
early: resp alkylosis bc they stimulate the RESPIRATORY CENTER in MEDULLA

middle ANION GAP ACIDOSIS METABOLIC b/c lipolysis and inhibit TCA

late = mixed RESP ALK, MET ACID

so normal PH and low CO2 and high HCO3
Transition vs transversion?
TRANSITION = PURE to PURE or PY to PY

TRANSVERSION changes for a DIFFERENT VERSION! substitution of PURINE for a PYRIMIDINE or vice versa
degeneracy?
more than 1 codon for each amnio acid
lung rejection mnemonic?
blood and coag on the TV airways

BLOOD + COAG
T-cells VASCULAR damage
AIRWAYS
microsomal monooxygenase
P450 other name for this, so can turn PRO-carcinogens into CARCINOGENS!

so protects, but can also metabolize thigs into POISONS
prognostic factor in cirrhosis?
PT time, albumin levels, and bilirubin

so BLOOD THINGS
ANEMIA + LOW or NORMAL RETIC?
aplastic anemia

marrow is FATTY and MARROW STROMA
APL marrow/smear?
hypergranular promyelocytes with AUR RODS
Reidel's thyroiditis is what cell infiltration?
REIDEL's hard as a ROCK. infiltration of IgG4-secreting PLASMA CELLS
germinal centers and lymphocytic infiltration in thyroid?
HASHIMOTO
de quervains histo?
MACs and lymphs with MULTINUCLEATED GIANT CELLS/granulomas
esophageal SQUAMOUS CANCER risk?
SQAMOUS IS THINGS YOU PUT IN YOUR SQUAMOUTH...smoking or alcohol or ACHALASIA
Collagen structure
GLYCINE at GLY-X-Y repeats because it's small enough to fit
what makes KINKS in protein?
proline --> alpha helixes
collagen structure video
https://www.youtube.com/watch?v=kR8D33ZfJts
impetigo two organism? complication?
STAPH AUREUS

or

GAS


PSGN is complication!
DNA mismatch repair syndrome list
Lynch/HNPCC, Muirre-Torre (HNPCC + skin cancers - same MSH mutations as lynch), Turcot (HNCC + brain tumors). Lynch = CEO colon, endometrial, and ovarian
GROWTH factors are what kind of molecule?
RTKs
bone deformity + hearing loss?
PAGETS BONE skull, long bones, etc.

three stages: clast, mixed, blast
so mutations are usually NFKB (rankL)

PTH is NORMAL, Ca2+ is NORMAL, phosphate is NORMAL, Alk Phos can be elevated or normal
osteoprotegerin?
protects you from RANK-RANKL

decreasees RANK-RANKL binding, so decreases OSTEOCLASTS
LOF mutation = kids pagets
Anti mitocondrial antibodies seen in what disease?
PBC
MCSF = ? GCSF = ?
GCSF = granulocytes so PMNs. MCSF = MACROPHAGE and MONOCYTES, but also major OSTEOCLAST sitmulator. Secreted by BLASTS to stimulate CLASTS and raise Calcium levels
PPP pathway forms what?
GLUTATHIONE antioxidant AND CHOLESTEROL + FFAs
blue neoplasm under nail?
GROMANGIOMA or MELANOMA subungual
GLOMUS bodies do what
shunts blood away from skin in cold temps or toward skin in warm temps

THERMOREGULATION
HEREDITARY/FAMILIAL retinoblastoma patients have risk of?
OSTEOSARCOMA due to TWO HIT hypothesis
internal capsule stroke presents with?
motor weakness of ARM LEG FACE
"initial resistance to passive extension followed by release of resistance" what is it and what causes it?
"clasp knife" spasticity - UMN lesion
hageman factor produced where, when, and what does it do?
produced in liver and acctivated by ENDOTHELIAL INJURY -- it then activates factor ELEVEN! Factor 11 is deficient in hemophilia C.
protein C role?
degrades Va and VIIIa
transference vs displacement vs projection vs reaction formation?
transfer from past person to PRESENT

displace to a SAFER person

project YOURSELF

reaction formation you REACT in a way that is OPPOSITE to your feelings!
shrunken LIVER?
halothane toxicitity?
Friedrich's ataxia
ataxia and dysarthria, adolescents, can die of HCM
non rhythmic eye movements and myoclonus ?
opsoclonus myoclonus syndrome, NEUROBLASTOMA

due to PARANEOPLASTIC SYNDROME, because tumor is in the ADRENALS!
medulloblastoma sx?
well, in the CEREBELLUm so ATAXIA
RHEUMATIC fever and SCARLET fever both after...
GAStrep VIRIDANS
PSGN follows ______
both pharyngitis AND skin infections!
Rheumatic fever only after...
PHARYNGITIS, not skin infections

use PENICILLIN to prevent RF!
N men prophylaxis with..
RIFAMPIN
fitz hugh curtis is due to
N. gonorrheae
only GM+ with LPS
listeria and it TUMBLES!
SIckle cell watch out for
Salmonella makes you GASSY (H2 gas production, antigenic FLAGELLA variation)
ETEC and Vibrio toxins MOAa
induces ADP-RIBOSYLATION (activation) of Gs --> constitutive cAMP leads to ion loss into lumen and watery diarrhea
"sensitive skin"
S. epidermis, novobiocin sensitive
swarming appearance on blood agar
PIERCE MORGAN WAS SWARMED! Proteus, morganella
CF patients think what organism?
pseudamonas CEPACIA
chocolate NAD+ factors V and X
HI! H. influenzae
bordet genout agar
bordatella pertussis
tularemia symptoms
flue-like + ULCEROGLANDULAR lesions ---- hole in skin, black base, draining pus
Hep B histo
vs
Hep C histo
B = granular, homogenous, eosinophilic, ground glass hepatocytes --- the granules are HEP B surface antigen!

C = lymphoid within portal tracts and macrovesicular steatosis
patient presents in first few weeks of life with jaundice, vomiting, lethargy, and hepatomegaly after breastfeeding or formula feeding
galactosemia!

lack of Galactose-1-p-UrydylTxferase
Apolipoprotein E-4 allele =
late ALZHEIMERS association
familial hypercholesterolemia is due to lack of?
LDL receptors
HCM mutation familially is what kind of mutation?
AD defect in beta myosin gene leads to incorporation into TYPE II muscle fibers but not proper function
if patient has LESCH NYAN, what is the alternate purine pathway used?
Purine salvage pathway is messed up so use...PRPP amidotransferase
Increased ICP usually what focal neuro sx?
blown pupil CNIII
lateral hypothalamus = what CN finding?
abducens palsy
pons, medulla, or cerebellum damage = what sx?
NYSTAGMUS
pinpoint pupils = what area of brain damaged?
Pinpoint Pupils is PONS

(desceding sympathetic tracts)
rash, neuro, encephalitis, paralysis?
West Nile VIrus, a FLAVIVIRUS
Overdose chart of symptoms:
PCP =
LSD =
Cocaine =
Meth:
Heroin:
Overdose chart of symptoms:
PCP = hallucinations + nystagmus
LSD = hallucinations + panic/euphoria
Cocaine = Heart sx or seizures
Meth: violence, psychosis, chorioform movements
Heroin: Miosis, constipation, yawning, tearing, respiratory depression
Q fever presentation
myalgias, fever, SEVERE HEADACHES and PNEUMONIA + thrombocytopenia and LFT abnormalities
borrelia burgdorferi =
LYME disease
after SAH what can happen?
VASOSPASM! leading to neuro sx!
what is analogous to AFP in amniotic fluid, and is raised or lowered along with AFP?
Acytlcholinesterase!
after cardiogenic shock you can have...
HYPOXIC-ISCHEMIC encephalopathy!
APL is a subset of
AML
aldolase B deficiency accumulates?
F1P
high Alkaline phosphatase?
LEUKEMOID RXN
QRS = ion?
T = ion?
Na+
K+
NON DISJUNCTION happens in what stage?
MEIOSIS I
fastest to slowest, conduction velocity in heart?
Park At Ventura Ave

Purkinje, Atria, Ventricles, AV node
murmur gets louder LEANING FORWARD?
AR
prazole drugs?
PPIs
PTH inferior + ____ same arch?
PTH inferior and THYMUS!
two brain cell changes in MS?
astrocyte PROLIFERATE

oligodendrocytes DEPLETE (like in PMLE)
amy odarone can give you what reaction?
CHEST BURN and FLUSHING and BRONCHOSPASM

remmeber, we use her for PHARMACOLOGIC STRESS TESTS
what causes HCM?
defect in B-MYOSIN heavy chain!!!!!
isoniazid S/E mechanism?
peripheral neropathy, due to competing with VITAMIN B6 in synthesis of neurotransmitters like GABA and INCREASING EXCRETION OF B6 as well

so izoniazid pn = vitamin loss
methotrexate overdose, give? What other use for this drug?
FOLINIC ACID/LEUCOVORIN given with 5FU it enhances the effect of 5-fluorouracil by inhibiting thymidylate synthase.
amifostine decreses what toxcicity?
PLATINUM alkylating agents
dexrozoxane prevents toxicity from?
ANTHEM-cyline anthracyclines
RPF formula with PAH
RPF = PAH clearance = (urine PAH x urine flow rate ) / Plasma PAH

RBF = PAH clearance (GFR)/1-hct
leukoplakia presentation and cause?
not scrapable, SMOKING!
primary secondary tertiary prevention?
primary = before have it

secondary = asymptomatic but you have it

tertiary = reduce complications once symptomatic or long term effects (chemo, etc.)

quartenary = PREVENT HARM and UNNECESSARY tests/procedures, etc.
DNA pol I has ____ exonuclease

DNA pol III has ___ exonuclease
I = 3-5 exo + 5-3 exo to remove RNA primer

III = 3-5 exo

both have 5-3 synthesis
start codon
AUG
microRNA function?
post-transcriptional regulation of protein expression. bind to complementary mRNA sequence in 3' UTR
activate a zymogen how?
remove C or N terminal peptides
A, P, E site of protein elongation
A arrives tRNA, Peptide grows, Exits
Example of Each:
Variable Expressivity:
Incomplete Penetrance:
Pleiotropy:
Anticipation:
Loss of Heterozygocity:
Dominant Negative:
Example of Each:
Variable Expressivity: NF1 same geno, diff pheno
Incomplete Penetrance: BRCA1 not always mean CA
Pleiotropy: PKU one gene, multiple effects
Anticipation: Triplet expansion diseases
Loss of Heterozygocity: two hit hypoth (lynch, li frau)
Dominant negative: normal gene INACTIVATED by its other mutated gene sister, usually AD-esque and inactivate by DIMERIZATION with other gene, sometimes.
McCune albright is survivable if...
MOSAIC
Impriting, two ways to get it?
1. One allele active, other silenced
2. uniparental disomy!
Prader vs Angleman
Prader PAPA is silent/mutated
AngelMan MAMA is silent/mutated
fabry is the only sphingolipid disease that is
recessive, all others DOMINANT
XR conditions?
Ornithin transcarb
Wiscott
Hunter
G6PD
Hemophilia A+B
Leish-Nyan
DMD + Becker's
myotonic dystrophy
AD CTG repeat expansion disease, presents with MYOTONIA, MY TESTICLES ATROPHY, MY TOUPPEE NEEDED for BALDING, and MY TICKER IS ARRYTHMIC
B-hCG in first trimester screen:

DOWNS
EDWARDS
PATAU
DOWNS = UP
ED = DOWN
PATAU = DOWN
Chromosome 17 =
NF1, BRCA1, Rb
sickle and beta thal are what chromosome?
11
EtOH how changes NADH/NAD ratio?
INCREASES it, so favors KETOGENESIS over TCA
Von Gierke is missing, gets?
G-6-phosphatase, gets GOUTY and GLYCOGEN IN LIVER INCREASED
Pompe is missing?
LYSOSOMAL alpha-1,4, & 1,6 glucosidase (acid maltase)
media to grow on chart
H. flu =
Neisseria =
Pertussis =
C. DIphtheriae =
MTB =
Lactose CEEKS =
Ecoli =
Legionella =
H. flu = Chocolate, V, X, NAD+
Neisseria = Thayer-Martin
Pertussis = Bordet
C. DIphtheriae = Tellurite, Loffler
MTB = Lowestein-Jansen
Lactose CEEKS = McConkCEEK
Ecoli = Eosin-Methylene Blue
Legionella = BYCE
M protein = which organism
GAS 'eM up!
LOS vs LPS
LOS = N MEN, acts like LPS!
Kruckenberg tumor on histo?
mucin-secreting signet cells! metastesizes TO OVARY from stomach, so mucinous and signet-y like gastric tissue
CAPE and ABCDS
CAPE = cAMP toxins
cholera, anthrax, pertussis, erythro A

Astrep, Botulism, Cholera, Diphtheria, Shiga
drug induced lupus is defect in...
DRUG ACETYLATION IN LIVER
PAO2 = formula
PAO2 = 150 - PaCO2 / O.8
nondepolarizing block stimulation curve? depolarizing?
non= slope DOWN

depol = FLAT phase 1, then SLOPE DOWN in phase II
decerebrate posture =
decorticate posture =
CEREBRATE EXTENDS BELOW, so BRAINSTEM. Corticate FLEXES ABOVE, so damage to corticospinal or rubrospinal tract.
treatment resistant schizo treat with?
CLOZAPINE but watch out for AGRANULOCYTOSIS closet cartoon
all PREGANGLIONIC symp and parasymp are what ntxmitter?

which are NE?
AcH

sympathetic EXCEPT to ADRENALS and ECCRINE glands
status epilepticus tx?
BENZOS
myosin
PHOSPHORYLATED. Calcium released via ryanodine receptors, Ca binds TROPONIN, which conformational changes and exposes MYOSIN binding sites for ACTIN. Myosin DE-ATP = detatch
what supplies blood to ovary?
SUSPENSORY or INFUNDIBULOPELVIC LIGAMENT
Ki-67 assicuated wutg
BURKITT LYMPHOMA
which two conditions does HHV8 cause in HIV+?
primary effusion lymphoma and kaposi's sarcoma
Smile =
Stranger =
Separation anx =
2, 6, 9months
Words ___ by 2, ____ by 3
200, 2 word sentences by 2

1000 by 3, 3 word sentences, TRI-cycle

tell stories by 4, drawings copies, friends/imaginary
Atherosclerotic aneurysm =
Dissecting Aneurysm =
Mycotic aneurysm =
Pseudoaneurysm =
Saccular Aneurysm =
Pseudo =
Dissecting = AORTIC DISSECTION widened mediastinum,

Mycotic = FUNGAL

Saccular = circle of willis, unrelated to atherosclerosis --> SAH if rupture

Pseudo = artery gets a hole but blood leaking out is CONTAINED by ADJASCENT TISSUES
monoclonal biologicals in CHRONS and other inflammatory disease are usually...
INFLIXUMAB so TNF-alpha
alendronate / bisphosphonates MOA?
JUST INHIBIT OSTEOCLASTS, do not affect mineralization. Analogues of PYROPHOSPHATE
normochromic anemia =
hypochromic RBCs anemia?
Normo = B12/Folate, chemo, aplastic

Hypo = Thalassemia or iron deficiency anemia
friction rub =
pericarditis
Homologs M/F

gonads
swelling
urogen folds
tubercle
Homologs M F
Gonads = testes ovaries
Swelling = Scrotum labia majora
UroGen Folds = spongy ur. labia minora
Tubercle penis clitoris
order of changes at puberty = TAG
girls = THELARCHE (breasts), ADRENACHE (hair), Growth, Menarche (last)

boys = Testicular growth, Adrenarche, Growth, Spermarche (last)
B-thal point mutation -->
splice change
actinic keratosis =
KERATOSIS so lots of keratinocytes, on sun exposed areas, ROUGH grossly
merkel cell CA
usually face, old people, BLUE grossly
Heavy metals are associated with what liver diseaase?
FATTY liver disease
think ROSACEA when...
stuff on FACE and inducible FLUSHING~! caffeine, cold, etc.
rash involving NASOLABIAL FOLDS =

"stuck on" appearance, more in older ppl.. =
seborrheic dermatitis

seborrheic KERATOSIS
brown fat oxphos
UNCOUPLES Oxphos from ATP, so you're GENERATING HEAT but NO ATP
leak of PROTONS across mitochondrial membrane =>
uncoupling of O2 to ATP, so O2 gets used to create the gradient but then some H+s not used for ATP so raises ratio of O2/ATP https://www.youtube.com/watch?v=lRlTBRPv6xM&nohtml5=False
hereditary sphereocytosis tx?
SPLENECTOMY indicated
palpable mass, flank pain, hematuria? well vascularized tumor, can see VARICOCELE?
RENAL CELL CARCINOMA
after exercise, marathon, etc?
THINK RHABDO
DEXA is for
BONE MASS measurements for osteoporosis
dressler syndrome
autoimmune fibrous pericarditis
agranulocytosis drugs that can induce...
"TPOinh "tom" GANCY PTU in the CLOZet with COLCH...........GANCYCLOVIR
CLOZEPINE
TPO INHIBITORS
PTU
COLCHICINE
adenomyoma vs leiomyoma?
adenomyoma = glandular tissue in MYometrium diffusely? Leiomyoma is overgrowth of SMOOTH MUSCLE tissue neoplasm but benign.
adenomyosis:
endometriosis:
endometrial hyperplasia:
adenymyosis: lumpy/irregular uterus
lieomyoma: lumpy uterus
endometriosis: pain, dysmenorrhea, dysparunia. tissue out of place
endometrial hyperplasia: NORMAL uterus but increased glands to stroma ratio. IRREGULAR but NOT PAINFUL bleeding.
cyclophosphamide key feature?
prodrug that needs to be converted by CYP450
lichen sclerosis
paper thin itchy skin
GRANULOMATOUS DISEASES think..
HYPERCALCEMIA so HYPER 1,25 VITD. because MACROPHAGES HAVE 1-ALPHA-hydroxylase to turn 25,OHVITd to 1,25 VIT D and thereby INCREASE CALCIUM!
helix-loop-helix =
hydroxyproline =
fibrin =
TRANSCRIPTION FACTORS structure
hydroxyPROs play in COLLAGEN
DISULFIDE BRIDGES
cyclosporine MOA?
interferes with CALCINEURIN decr T cell function prolif
Odds ratio formula and table
table is a b
c d

formula= AD/BC
number needed to treat
vs
needed to harm
NNT = 1/ARR (absolute risk reduction)
NNH = 1/Attributable risk
sensitive test has low ____

specific test has low ____
SN LFN

SP LFP
RR formula
risk in exposed / risk in unexposed

RR = RE/RU
AR formula
ARR = 1 - (RE/RU)
Positive skew mnemonic
MEAN > ME > MO
t test measures
t means two!
CpG methylation ->
vs
Histone methylation ->
vs
Histone Acetylation
CpG Methylation MAKES DNA MUTE

Histone Methylation MOSTLY MAKES DNA MUTE

Histone acetylation MAKES DNA ACTIVE (relaxes coiling)
NucleoSide =
NucleoTide
SIDE = SUGAR
Tide = phosphaTe w 3-5 diester bond
ribavirin inhibits
PURINE synthesis
transversion vs transition
transVERSION changes for a different VERSION (purine to pyrimidine, vice versa)

transition just changes PURE TO PURE or PY to PY
Which two diseases are FRAMESHIFT?
Missense?
DMD and Tay Sachs
sickle is MISSICKLESENSE
nonhomologous end joining is defective in what two diseases?
ATAXIA TELANGIECTASIA and FANCONI ANEMIA
INACTIVATE Rb how?
PHOSPHORYLATE IT!
I-cell disease
failure to phosphorylate MANNOSE residues on glycoproteins, so proteins are secreted EXTRACELLULARLY instead of to lysosomes, leads to CLOUDY CORNEAS, FACIES, restircted joint movement
MICROTUBULES are for
MOVING and MITOSIS!
Huntingtons is HUNTING...
4 CAGs

chromosome 4, CAG repeats!
other name for Li-fraumeni?
SLAB!

sarcoma
breast
leukemia
adrenal
variable expression in..
NF1 TS
CF has no
VAS DEFERENS!
Fragile X symptoms
Xtra big testes, large forehead big ears, SIMILAR TO MARFAN so watch out!
what three things is DOWNS at risk for?
early ALZ, ALL, AML!
first trimester values

DOWNS
ED
PATAU
DOWNS = PAPPA is DOWN; INHIBIN A UP

ED = ALL DOWN

PATAU = PAPPA & BCG DOWN
chromosome chart
3 VHL, RCC
4 ADPCK, HUNT, ACHONDRO
5 FAP CRU-CHAT
6 HFE
7 CF
9 Friedrich says NEIN!
11 W11ms, Sickle & Beta-Thal
13 Patau, Wilson, Rb, BRCA2
15 angle, marfan, prader
17 NF1, BRCA1
18 edward
22 NF2, Di-george
Williams syndrome has
HIGH Ca2+ b/c sensitivity to Vit D
Vitamins can become:
B1
B2
B3
B5
1 = one TIP...TPP
2 = 2 FADish FMNISTS...FAD, FMN
3 NAD+ NICE NADS
5 CoA
where can we do GLUCONEOGENESIS?
LIVER, KIDNEY, EPITHELIUM OF INTESTINES
SORBITOL pathway
Gluc --> aldose reductase -> SORBITOL -> sorbitol DH -> fructose
PKU is defect of ______ AA metabolism can lead to?
AROMATIC, think MUSTY ODOR. leads to BRAIN DAMAGE and DEVELOPMENTAL DELAY~!
Chart Glycogen storage diseaese 1-5

VonGierke

Pompe

Cori

McAdrle
VG has Very(much)Glycogen in liver, Very GOUTY (high uric acid) and lacks G-6-P

Pompe lacks LYSOSOMAL alpha 1,4 AND 1,6-glucosidase (debranching enzyme)

Cori lacks alpha-1,6-glucosidase (debranching enzyme)

McArdle lacks MYOPHOSPHORYLASE...MYOGLOBINURIA, MUSCLE CRAMPS can't METABOLIZE GLCOGEN in muscle
VLDL vs IDL
VLDL from liver, delivers to TISSUES
IDL comes "I DELIVER to the LIVER"
CAT+ mnemonic
PLACESS for your CATS: p. aerug, listeria, candida, e. coli, serratia, s.aureus
M protein
MGAS
phage toxins mnemonic
ABCDS

Astrep
Botulism
Cholera
Diphtheria
Shiga
GM+

NOVOBIOCIN mnemonic?
OPTOCHIN mnemnonic?
SENSITIVE SKIN, RESISTANT SAPHYTICUS

VIRIDANS Resist the chin, STRE PNEUMO SENSITIVE CHIN --- OVRPS

B-BRAS GBSR, GASS
alpha hemolytic
PNEU DANS
hemolysis: clear/complete, partial, none?
clear = BETA, partial = ALPHA, none = GAMMA (mostBAGleast)
strep pneumo causes...
RUSTY MOPS most common cause of mops with RUSTY SPUTUM!
GMNEGS mnemonics
GNDC = Nmen, Gonor, Moraxella

GNCB = Hi, Pertussis

Salmon and Proteus = H2S
Shig and Yers NO GAS

slow lac = CITRO SERRATIA
treat NMEN with?
ceftriaxone or PCNG
curratn jelly sputum
KLEBS KAUGHS up JELLY
salmonella salmon...
SWIM flagella
Yersinia enterocolitica
PET FECES (puppies and kittens!) and Pseudo-appendicitis
Erythema migrans
LYME
Secondary syphilis
Tertiary syphilis
secondary = SYSTEMIC RASH, CONDYLOMA, LAD

tertiary = AORTITIS, ARGYL-PUPIL, ATAXIA (TABES DORSALIS TOO)
FALSE POSITIVES FOR VDRL
VIRAL INFECTION EBV, HEPATITIS
DDRUGS
RHEUMATIC FEVER
LUPUS AND LEPROSY
RICKY RICKY =
RMSF
erlichiosis vs anaplasmosis
MEGA

monocytes = erlichiosis
Granulomas = anaplasmosis

ana likes MORULAE BERRIES
neutropenic or ketoacidotic patients think what fungi?
MUCOR/RHIZOPS
maltese cross =
babesiosis ixoides tick like LYME
Ingested nemotodes =
Cutaneous infection =
EATT Enterobius, Ascaris, Toxocara, Tichinella

SANd = strongyloides, ancyclostoma, necator
circular dsDNA viruses?
circle of friends JC and BK, book a room at the CIRCULAR HPV with HEPB ...HPV, JC, BK, HEP B
REO are only
dsRNA
naked viruses part of chart?
HPV, Adeno, JC/BK. then Cali HEV Pico Reo
picornaviruses
polio, echo, rhino, coxsackie, Hep A
liver biopsy HEPATITIS viruses A, B, C, D, E
A = monocytes, councilman bodies
B = eosinophils, ground glass, T-cells
C = lympoid, focal macrovesicular steatosis
D = like B
E = patch-E necrosis
Rubella
Rub her behind the ears LAD
p186 FA
chart
avoid in pregnancy antimicrobials
SAFe Children Take Really Good Care

Sulfonamides = kernicterus
Aminoglycosides = ototoxic
FQs = cartilage damage
Clarithro = Embryotoxic
Tetracyclines = teeth colored, bones not grow
Ribavirin = teratogen
Griseo = teratogen
Chloramphenicol = grey babby
layers of SPLEEN and cells in each
Follicular B-cells
Medulla MACS & PLASMA
PCortical T cells
follicle b cells (primary follicles are DENSE DORMANT, secondary are PALE and ACTIVE
spleen where are T and B cells found, macs?
T-cells WHITE PALS *white pulp, periarteriolar lymohatic sheath

B-FOLL WHITE

MACS MARGINAL
THYMUS is ____ pharyngeal pouch
THYMUS THIRD
MHC I = one letter
MHC II = two letter
A, B, C

DP, DQ, DR
HLA B27 mnemonic?
PAIR seronegative arthropathies

psoriatic
ankylosing
IBD-related
Reactive
NK cells activity enhanced by
2,12,alpha, beta
IFN GAMMA
GAMMA GETS MACS GOING

IL-12 from macs ---> T and NK secrete GAMMA to get MACS activated and also activates NK

GAMMA gets MHC upregulated
CD16
on NK cells binds Fc of IgG
CD56
56NK specific
type III hypersentivity two examples
SERUM SICKNESS after drugs 5-10 days after drug get fever, urticaria, proteinuria, LAD

ATHUS = Antigen-Ab reaction

of putting subq injected antigen gets response due to IMMUNE COMPLEX formation
anticardiolipin =
anticentromere =
antidsDNA, smith =
antiGAD65 =
antijo,SRP,mi2 =
antiMITOCHONDRIAL =
antiA2 =
antismoothmuscle =
antiRO/La/SSA/SSB =
antiU1 =
antiIgA =
antiPR3 =
anticardiolipin = SLE
anticentromere = CREST scleroderma
antidsDNA, smith = SLE
antiGAD65 = DM1
antijo,SRP,mi2 = Polymyositis, dermatomyositis
antiMITOCHONDRIAL = PBC
antiA2 = primary MEMBRANOUS GN
antismoothmuscle = hepatitis autoimmune
antiRO/La/SSA/SSB = SJOGREN
antiU1 = MCTD
antiIgA = CELIAC
antiPR3 = GPA/Wegeners
job syndrome is deficiency of
Th17 cells ---> STAT3 mutation --> can't recruit NEUTROPHILS LOW IFN-GAMMA

FATED

facies, abscesses staph, too many teeth, hyper IgE, Derm eczema
TRANSPLANT REJECTION
Hyper THROMB
Acute VASC
Chron FIB
basilixumab and daclizumab
bloc IL-2
Micophenylate Mofetil risk of what infection?
invasive CMV
use

IFN BETA =
IFN GAMMA =
BETA MS
GAMMA CGD
bevacixumab
cetuxumab
eculiz =
natalie natalizumab =
denosumab =
pavlov pavalizumab
BEVA VEG
CETA EG TIMER (EGFR)
CULIZ COMPLEMENT C5
natalie ALPHA4INTEGRIN
denosumab = RANKL deno
pavlov = RSV F protein
ischemia danger areas

Brain
Heart
Kidney
Liver
Colon
Brain = ACA, MCA, PCA

Heart = SUBENDO LV

Kidney = PCT straight and ThickAL

Liver = ZONE III

Colon = SPLENIC FLEX RECTUM
exact nerves in brain susceptible to ischemia?
Neurons = PURKINJE and PYRAMIDAL (hippo & neocortex)
rollin with your

tight

diapedesis
rollin SELECT

IN(tegrin) tight

Pecam RIDE OR diapedesis
hypertrophic vs keloid
keloid = TONS O COLLEGEN SYNTHESIS< OUTSIDE BORDERS of ORIGINAL SCAR<, FREQUENT RECUR, BLACK PPL PREDISPOSED EARS AND CHEST
PDGF =
PDGF = platelet-derived, VASCULAR and SMOOTH MUSCLE migration (stimulates FIBROBLAST and collegen synthesis)
granulomatous diseases are associated with
HYPERCALCEMIA b/c 1,25 VIT D/CALCITRIOL PRODUCTION!!!!
low ESR =
"LOW E.S.R"

Low fibrinogen
Elevated RBCs
Sickle cell
Rt ht failure
AA amyloid associated with?

Dialysis-related Amyloidosis?
AA = INFLAMMATORY conditions

Dialysis-related = B2-microglobulin fibrils in ESRD or long term dialysis patients (can look like CARPAL TUNNEL)
age related amyloidosis?
TRANSTHYRETIN in cardiac ventricleas, slower progression than AL amyloidosis
lipofuscin =
agre lated oxidation and polymerization of phagocytosed organelle membranes
invasive cancer loses
E cadherin
tumor STAGING =
STAGE IS SPREAD

T = tumor size
M = mets
N = nodal involvement
carcinoma = ____ origin
sarcoma = ____ origin
CAR is EPITHELIAL = CARE

SAR = MESENCHYMAL = SARM
incidence of CA vs deaths
PLC, BLC

LPC, LBC lots of drama in the LBC
anti NMDA receptor encephalitis? psychiatric disturbances, etc.
ovarian teratoma
paraneoplastic CEREBELLAR degeneration cancers?
SCLC, Gyno/Breast, Hodgkins

antibodies against HU YO TR in punkinje cells
suddenly get lots of seborrheic keratoses?
sign of leser trelat, ADENOCA visceral
RTKs, CTKs, and Tfactors are all
ONCOGENES so need to GAIN OF FUNCTION

only 1 allele needs to be borked
TSC1 =
TSC2 = against?
TSC1 = hamartin
TSC2 = tuberin

1 HAM and 2 POTATOES
CCl4 liver damage is
vinyl chloride =
Cl = CENTRILOBAR
vinyl = angiosarcoma angie loves vinyl
Psamomma bodies mnemonic?
Pappy is Serously Mesothlial Men(ingioma)
P-glycoprotein =
also known as MULTIDRUGRESISTANCE PROTEIN 1

P is for PUMP OUT TOXINS and CHEMO!

leads to LESS RESPONSE TO CHEMO OVER TIME
metasteses to

Brain
Liver
Bone
brain = MEL LONG thought of BREASTS and PROSTATES

Liver = Colon STOM PANC

Bone = BLTKP t is for thyroid; breast is mixed, panc is BLASTIC
competitive inhibit graph

noncompetitve
if you compete you can ultimately GET THERE (to max effect/saturation) --- they decrease your POTENCY but not your EFFICACY

not if you can't compete
tachyphylaxis?
acute decrease in response to drug after initial/repeat administration (MDMA and LSD!)
zero order elim drugs?
Zero-APE

aspirin, pheny, EtOH
pre and post PARA and SYMP neurotransmitters?
para ALL AcH

SYMP is pre ACH ---> post NE except for D1 in RENAL SMOOTH MUSCLE VASCULATURE

*Ach = sweat glands and Adrenals
SLUDD
OP overdose cholinergic storm: salivation, lacrimation, urination, digestive, defecation/diarrhea
add D1D2 H1H2 and V1V2 to your alpha beta receoptor chart! p242 FA
...
Organophosphates sx?
SLUDD. salivation, lacrimation, urination, digestive, defectation/diarrhea
alpha 2 agonits
ALPHA METHYLDOPA and PAULA DEEN CLONIDINE
tetrodotoxin
blocks Na channels in cardiac and nerves prevent depol
massive hepatic necrosis drugs causing?
HAVAc

Halothane
Amanita
Valproic acid
Acetaminophen
Fat redistribution drugs causing?
I HAART FAT PiG

protease inhibitors and GLUCOCORTICOIDS

also HAART
Neural crest cell problems congenital?
T's

Tetrology
Truncus arteriosis
Transposition of vessels
umbilical arteries branch off of?
INTERNAL ILIACS
SV CAP
stroke volume increased by Contractility, Afterload DOWN, preload UP
preload approximated by?
EDV
ACE and ARBS effect on preload? afterload?
DECR BOTH!
WIDE split
FIXED SPLIT
wide RV
fixed ASD
PDA heard best
AT CLAVICLE LEFT SIDE KISSSES
romano ward vs jervell
romano has no hearing problems but LONG QT

jervell has DEAF and LONG QT
carotid and aortic bodies stimulated by?
LOW PO2, HIGH CO2, LOW PH

central only respond to PH and CO2 in brain so really only ARTERIAL CO2
tetrology of fallot mnemonic>
PISS RIVER ORA VSD

Pulm infundibular stenosis
RVhypertrophy
Overriding aorta
VSD
rib notching
COARCT OF AORTA
digeorge has what defect cardiac?

Lithium =?

Alcohol?

Rubella?
dig = TRUNCUS OR TETROLOGY

li = EBSTEINs

ALC = VERONICA STARTED DRINKING VSD

Rub = PDA in public rub her
hyaline arteriosclerosis 2 causes
HTN or DM
Thoracic Aorta Aneurysm due to? Abdominal Aortic Aneurism due to?
Thoracic = Syphylis.
AAA = marfan or HTN
aortic dissection related to?
HTN
MARFAN
BICUSPID VALVE AORTA
mediastinum widening DDX mnemonic?
AORTA dissection
ANTHRAX
AFFUSION (pericardiac efflusion)
Amponade (tamponade)
heart sounds for DILATED vs HYPERTROPHIC CARDIOMYOPATHY?
DILAT3D

HYP-4-TROPHIC beta myosin young anthelete dies
loffler syndrome
eosinophlic pneumonia / endomyocardial fibrosis
chart

HYPOVOL SHOCK
CARDIOGENIC/OBSTRUCTIVE
DISTRIBUTIVE
PRELOAD CO AFTERLOAD

DOWN DOWN UP
UP DOWN UP
DOWN varies DOWN
acute vs subacute bacterial endocarditis bugs?
acute AUREUS subacute VIRIDANS danced around the heart for a while
pulsus paradoxis caused by?
restricted heart or overinflated lung

systolic goes down more than 10 mgHg ith inspiration
GPA presents with
NECROTIZING...

vasculitis
glomerulonephritis
granulomas in lung and airway
palpable purpura + necrotizing vasculitis?
microscopic polyangiitis
hydralazine MOA?
incr cGMP
beta blockers decrease all other things but INCREASE what?
only EDV (maybe) or EJECTION TIME!
nitrates decrease everything BUT...
HEART RATE b/c compensatory tachy

no effect on CONTRACTILITY
which one RAISES HDL?

which one DECR Trigs the most?

which one DECR LDL most?
niacin B3

FIBRATES

STATINS HmGcoa INHIBS
ACT GFR add column for RESPONDS TO/INPUT
A G renin-ATII
C F ACTH, CRH
T R ACTH, CRH
anterior pit is
ADENOHYPOPHYSIS from RATHKE
Anterio pituitary: FLAT PIG B FLAT
FSH, LH, ACTH, TSH, PRL, GH
FSH, LH, ACTH, TSH
acidophils GH, PRL
alpha cells --->
beta cells -->
AG
Bi
CORTISOL INCREASES...decreases
BIG FIB

BP
Insulin resistance
Gluconeogenesis, lipolysis, proteolysis

Fibroblast activity (leads to striae)
Inflammation/immune system
Bone formation osteoblasts
wolff chaikoff
if you WOLFF down a bunch of iodine at once, it turns T3/T4 off
TBG and pregnancy?
INCREASES TBG so LESS FREE T3/T4

also OCPs do this
Propylthiouracil vs methimazole?
propylth inhibits BOTH TPO and 5-deiodinase so less PERIPHERAL CONVERSION of T4 to T3

methim only TPO
RTKs use what pathwa?
MAP KINASE
intracellular receptors?
PECAT TVitC

progesterone, estrogen, cortisol, aldo, T3/T4, Vit C
cGMP hormones?
BAD GraMP
BNP
ANP
EDGF
IP3 pathway used by...
GOAT HAG

GnRH
Oxytocin
ATIII
TRH
H1
ADH
Gastrin
NB vs Wilms difference/
NB can be B for BOTHSIDES

Wilms is always unilateral
primary
vs
secondary
vs
tertiary ADRENAL INSUFFICIENCY?
primary = PIGMENTED skin and mucosa (from ACTH building up and acting like MSH?)

Secondary SPARES SKIN
Tertiary from TREATMENT
EPISODIC HTN =
PHEO HTN comes and "PHEOs"
PROTRUDING TONGUE AND PROTRUDING UMBILICUS
HYPOTHYROID CONGENITALLY
jod basedow
thyrotoxic if your BASELINE DEFICIENCY is FIXED
thyroid adenoma vs thyroid carcinoma
adenoma follicular but NOT INVASIVE of capsule or vascular
carcinoma is invasive follicular: FOLL CARCINOMA invades CAPSULE
papillary thyroid cancer
orphan annie eyes
psamomma
RET BRAF
Pediatric irradiation
What two things inhibit GnRH?
octreotide/somatostatin & Glucose *treat pit adenoma with octreotide (or pegvisomant, a GH analogue constitutively)
Follicular Thyroid Mutation: Papillary Thyroid mutation: Medullary thyroid carcinoma mutation:
Foll RAS Pap BRAF RET MTC RET (congo red, c cells, calcitonin)
chart page 325 FA
...
albright hereditary osteodrystophy
kidney can't respond to PTH so HYPOCA but HIGH PTH

short stature, short fingers

defective MATERNAL DEFECT due to IMPRINTING!
familial hypocalciuric hypercalcemia
NORMAL or only slightly elevated PTH
primary hyperPTH
secondary hyperPTH
tertiary hyperPTH
primary = ALL HIGH
secondary = HYPOCA, HYPERPO4, INCR PTH, ALP
tertiary = HYPERCA, super high PTH
treatment for PIT ADENOMA?
Pit is a DAG! Dopamine AGONISTS
bromo, cabergoline
nelson syndrome
nelson's PIT gets bigger after remove his adrenals
treat acromegaly with?
octreotide/somatostatin analog

or

pegvisomant GH agonist
laron drawf has defective?
GH RECEPTORS so high GH but no response
CENTRAL vs NEPHROGENIC DI
central = LOW ADH; "central corrects" with DDVAP

nephro = HIGH ADH
DM2 HLA?
DM2, 3, 4

DR3 & DR4
necroylytic migratory erythema think?
GLUCAGONOMA

DVT, DM, DEPRESSION, DECLINING WEIGHT
SUBMUCOSA = plexus?
MUSC EXT = plexus?
secretory SUBM = MEISSNER
motility MUSCT EXT = roger AURBACH could MOVE
vomit loses ___
diarrhea loses ___
HCL
NA
Fore
Mid
Hind
arteries & nerves for each?
CSI XXP
Celiac X
SMA X
IMA PELVIC
GASTRIN stimulates
SOMATOSTATIN
SECRETIN

GDIP/GIP
GOTILITY GACID secretion
D-cells D fense
S cells GET THE DUDE SECRETIN

K cells D&J, gastric secretion H+ DECR and UP INSULIN
erythromycin can stimulate
GASTRIC/INTESTINAL MOVEMENT!
VIPOMA WDHA
watery diarrhea, hypoK, achlorhydria
GLUT1
GLUT2
GLUT 5
GLUT1 = GLUCOSE uptake Na dependent
GLUT2 = transports monosacchardies 2 blood
GLUT5 = FIVE is F FOR FRUCTOSE and FACILITATED DIFFUSION
Dude is?
JUST FEELING ILL BRO
ulcers esophagus CMV vs HSV1
CMV = linear
HSV1 = PUNCHED OUT
CELIAC PATHOPHYS
autoimmune intolerance to GLIADIN

HLADQ2,8 can't go to DQ for GLIADIN
stool PH in lactose intol?
LOW from fermentation of lactose + lactose breath test
apple core on barium?
COLO-RECTAL CANCER
TIBC in: Hemachromatosis vs iron deficiency.
opposite of iron
PSC associated with
PBC associated with
PSC = UC, pANCA, incr IgM

PBC = sjogren, hashimoto, RA, celiac, CREST and ANTI MITOCHONDRIAL AB
TIDINES are
H2 blockers
vwf binds
fibrinogen binds
von Willi Ib9, Fibrinogen 2b3A
HbF...
HbFAG = alpha gamma
t(11,14) =
t(14,18) =
t(15,17) =
MANTLE cyclinD1
FOLL BCL2
APL ATRA
EPO in PV?
LOW
CML RBCs, WBCs, Plates
DOWN UP UP
golfer elbow = epicondyle?
tennis?
MEDIAL GOLF
LATERAL TENNIS
SITS CHART DRAW
...
grip strength decr = what n?
RADIAL b/c need extensors
C56 _____ injury =
C8T1 _____ =
Thoracic outlet =
56 = erb palsy waiters tip
8T1 = lower trunk GRAB A TREE -> claw hand
Lower trunk thoracic outlet, can be pancoast tumor too
midshaft of humerus =
distal humerus =
cubital fossa =
popliteral fossa =
rad
med
med
tibial
biferingence mnemonic?
NEGOUT
PosPYROPHOS
VDRL/RPR + long PTT?
LUPUS antiphospholipid
staph scalded skin toxin VS TEN

which layers affected?
STAPH = only GRANULOSUM

TEN/SJ = EPIDERMAL/DERMAL JUNCTION...STEPHEN JOHNSON IS JUNCTIONAL
HAIRY LEUKOPLAKIA associated with?
HIV HAIRY not scrapable
ERYSIPELAS caused by?
SYP for S. PYOGENES
LIchen Planus associated with?
It's PLANE to C (hep C)
UVB vs UVA
UVB = sunBurn

UVA = photoAging and tAnning
febuxostat
inhibits XO xanthine oxidase
Chiari I associated with

Chiari II associated with?
I = seryngomyelia

II = 2 M's, MeningioMyelocele = both spinal cord (myelin) and meninges
meissner corpuscles =
pacinian =
merkel =
ruffini =
meissner light touch
pacinian pressure
merkel STABs
SLIPPIN ruffini
what INCREASES in PARK?
SEROTONIN and AcH
EEG waveforms

Beta
Alpha
Theta
Spindles/K
Delta
Beta
BATS Drink Blood at night

beta = REM or awake
Alpha = eyes closed awake
Theta = NR1
Spindles/K = NR2
Delta = slow wave NR3 -- night terrors, bedwetting, sleepwalk

Beta = REM incr brain O2 use, incr pulse and BP, lose motor tone
nondominant parietal lesion ->
dominant parietal -->
Non = NEGLECT
Dom = Writing "dom de plume"
cerebral perfusion pressure?
Cereb Perfusion pressure = MAP - ICP
Charcot-Bouchard aneurysms associated with?
Ch for CHRONIC HTN
central post stroke pain syndrome due to lesion in
THALAMUS

TH-allodynia!
SUBDural =
BRIDGING VEINS CRESCENT BRIDGE

SUB = SHB ... SHAKEN bABBY
communicating hydrocephalus?

noncommunicating?
decr ABSORPTION OF CSF

pressure bruilds up

NOT COMMUNICATING = SOMETHING'S BLOCKED!
wet wobbly wacky
NORMAL PRESSURE HYDROCEPHALUS in elderly

episodic expension of ventricles
upper border of rib space (lower edge of rib) risk of hitting?
NERVE

V & A above it, protected by rib
weakness = UMN or LMN?
BOTH

atrophy and fascic = LMN

babinski, incr tone, clasp knife/spastic = UMN
ANT. SPINAL A. occlusion spinal cord?
only POSTERIOR COLUMNS SPARED
perinaud can't...
LOOK UP at the SUPERIOR COLLICULUS that has been damaged

SUPERIOR SIGHT
INFERIOR HEAR-ior
solitarius =
ambiguous =
Dorsal motor nucleus =
solitary taSte
aMbiguous motor
DMN = autonomic/parasypathetic to organs
AFFARENT
corneal reflex =
crying reflex =
pupillary reflex =
gag reflex =
corneal CORN V1 (effarent is VII)
crying CRY V1 (effarent is VII)
Pup PUP II (eff is III)
Gag GAG 9 (eff is 10) alphabetical order A/E
uvula points ____ from side of lesion
CNXII lesion tongue points _____
uvulAWAY
TONGUE TWELVE TOWARD
p481 FA cav sinus N and As
...
aqueous flow chart
PG = out; pilocarpine and chol OUT; zosins alpha block down and out; zolamide/CAIs DOWN
marcus gunn pupil
fails flashlight test. decreased BILATERAL constriction when shone in AFFECTED EYE
draw eye with where eye deviates CN damage
...
p489 diagram
...
APOE2 =
APOE4 =
2 = DECR risk of ALZ
4 = INCR risk of ALZ
how do we treat guillain barre?
IVIG and plasmapheresis NO STEROIDS
spindle cells and psamomma bodies in BRAIN =
meningioma
frontal lobe tumor brain =
usully OLIGODENDROGLIOMA
pilocytic astocytoma = prognosis?
Pilo POSITIVE PROGNOSIS (benign)
identification in psych =
modeling after more powerful person

abused becomes abusor later in life
x-lined DOMINANT in GIRLS?
RETT syndrome: age 1-4 regression, loss of verbal, ataxia, sterotypical HAND WRINGING
somatic sx disorder vs conversion vs illness anxiety
conversion = NEURO sx, and can be INDIFFERENT to sx

whereas somatic = WORRIED ABOUT IT!

illness anxiety usually minimal ACTUAL SX but lots of worry
pseudocyesis
false, NONDELUSIONAL beleif of being pregnancy. can have SIGN OF PREGNANCY but is not pregnant
Cluster A personality disorders =
Cluster B personality disorders =
Cluster C personality disorders =
WEIRD (paranoid, schizoid, schizotypal)
WILD (antisocial/sociopath, borderline, histrionic, narcissistic)
WORRIED (avoidant, Obsessive compulsive, dependent)
treat borderline personality disoder with?
dialectical behavioral therapy
binge eating disorder
NO COMPENSATORY behaviors
during REM dreams
REMEMBERED
whereas sleep terrors in NREM N(ot)REMembered
treat Nerulptic malignant syndrome
D2 AGONISTS like bromocriptine (b/c most antipsych block d2)
or
DANTROLENE!
TYPICAL antipsychotic names?
haloperidol + AZINES
faxine drugs MOA?
SNERIs
ureteric bud origin if it...

metanephric mesenchyme if it...
ureteric if has PEE in it

met mesench BEFORE ITS URINE
fanconi syndrome


bartter syndrome =

liddle syndrome
defect in PCT ..cant resorb basically ANYTHING

bartter looks like LOOPs


looks like HYPERALDO
Denys-Drash is a...

lack of IRIS =
denys-drash is WILMS + nephrotic male pseudohermaprhodite

lack of iris = WAGR = WILMS + aniris + GU deform + Retard
embryonic dev

6days =
2 weeks =
3 weeks =
nt closes at =
4 weeks =
week 8 =
week 10 =
6 days is when the CYST STICKS
2 weeks 2 layers
3 weeks 3 layers
NT closes at 4
4 wks = 4 limbs and 4 heart chambers
8 ws = GAIT at 8 (movement)
10 wks = PENIS and VAG (1 and 0, respectively!)
agenesis =
hypoplasia =
disruption =
deformation =
malformation =
agenesis = NO PRIMORDIAL TISSUE was present
hypoplasia = didn't grow but PRIMORDIAL WAS THERE
diruption = previously normal then breakdown
deformation = EXTRINSIC force, occurs AFTER EMBRYONIC PERIOD
malformation = INTRINSIC DISRUPTION DURING EMBRYONIC PERIOD (weeks 3-8)
cytotrophoblast fxn?
syncitiotrophoblast fxn?
cyto makes cells
syncitio synthesizes hormones (lacks MHC1 so can be attacked by maternal immune system)
E --> C --> S --> mom
endothelium of babby vessel to cytotrophoblast through to syncitio to get to maternal circulation
how many umbilical artery, vein?
2A 1V
branchial pouch chart
1 ear
2 tonsils
3 INF PTHroids and THREE-THYMUS
4 SUP PTHroids