2,000 terms

USMLE

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often precedes squamous cell carcinoma
actinic keratosis
primary adrenocortical deficiency
Addison's disease
polyostotic fibrous dysplasia, precocious puberty, cafe-au-lait spots, short stature, young girls - diagnosis?
Albright's syndrome
hereditary nephritis with nerve deafness
Alport's syndrome
anti-basement membrane antibodies - diagnosis?
Goodpasture's syndrome
anticentromere antibodies - diagnosis?
scleroderma (CREST)
anti-double-stranded DNA antibodies (ANA antibodies) - diagnosis?
- what hypersensitivity type?
SLE - type III hypersensitivity
anti-epithelial cell antibodies - diagnosis?
pemphigus vulgaris
antigliadin antibodies - diagnosis?
celiac disease
antihistone antibodies - diagnosis?
drug-induced SLE
anti-IgG antibodies - diagnosis?
rheumatoid arthritis
antimitochondrial antibodies - diagnosis?
primary biliary cirrhosis
antineutrophil antibodies - diagnosis?
vasculitis
antiplatelet antibodies - diagnosis?
idiopathic thrombocytopenic purpura
arachnodactyly - diagnosis?
Marfan's syndrome
Argyll-Robertson pupil - diagnosis?
neurosyphilis
Arnold-Chiari malformation
cerebellar tonsillar herniation
Aschoff bodies - diagnosis?
rheumatic fever
atrophy of the mammillary bodies - diagnosis?
Wernicke's encephalopathy
Auer rods - diagnosis?
acute myelogenous leukemia (especially promyelocytic type)
autosplenectomy - diagnosis?
sickle cell anemia
Babinski's sign is associated with what?
UMN lesion
"bamboo spine" on x-ray
ankylosing spondylitis
basophilic stippling of RBCs - diagnosis?
lead poisoning
defective dystrophin, less severe than Duchenne's
Becker's muscular dystrophy
LMN CN VII palsy
Bell's palsy
Bence Jones proteins - possible diagnoses?
- in each case, what are the proteins?
multiple myeloma - kappa or lambda light chains
Waldenstrom's macroglobulinemia - IgM
IgA nephropathy - diagnosis?
Berger's disease
Bernard-Soulier disease - what is the defect?
defect in platelet adhesion
bilateral hilar adenopathy, uveitis - diagnosis?
sarcoidosis
Birbeck granules on EM - diagnosis?
histiocytosis X (eosinophilic granuloma)
bloody tap on LP - diagnosis?
subarachnoid hemorrhage
"blue bloater"
chronic bronchitis
blue-domed cysts - diagnosis?
fibrocystic change of the breast
blue sclera - diagnosis?
osteogenesis imperfecta
boot-shaped heart on x-ray - possible diagnoses?
tetralogy of Fallot or RVH
Bouchard's nodes - diagnosis?
- where are they located?
- why do they occur?
osteoarthritis - on PIP secondary to osteophytes
boutonniere deformity - diagnosis?
rheumatoid arthritis
branching rods in oral infection - diagnosis?
Actinomyces israelii
"brown tumor" of bone - possible diagnoses?
- what causes the brown color?
hyperparathyroidism or osteitis fibrosa cystica (von Recklinghausen's disease)
- color is due to hemorrhage in cysts
X-linked agammaglobulinemia
Bruton's disease
posthepatic venous thrombosis - diagnosis?
Budd-Chiari syndrome
Buerger's disease - what size arteries does it affect?
small or medium-artery vasculitis
Burkitt's lymphoma - what is the translocation?
- what virus is it associated with?
- appearance on histology?
8:14 translocation
EBV
starry sky appearance
Burton's lines - diagnosis?
lead poisoning
what types of ANCA are associated with Wegener's granulomatosis and microscopic polyangiitis?
Wegener's - c-ANCA
MPA - p-ANCA
cafe-au-lait spots on skin - diagnosis?
neurofibromatosis
calf pseudohypertrophy - diagnosis?
Duchenne's muscular dystrophy
Call-Exner bodies - diagnosis?
granulosa-theca cell tumor of the ovary
cardiomegaly with apical atrophy - diagnosis?
Chagas' disease
trypanosome infection - diagnosis?
Chagas' disease
painless chancre - diagnosis?
primary syphilis
painful chancroid - cause?
Haemophilus ducreyi
Charcot's triad of multiple sclerosis
nystagmus, intention tremor, scanning speech
Charcot's triad of cholangitis
jaundice, RUQ pain, fever
Charcot-Leyden crystals - diagnosis?
- what are they?
bronchial asthma - eosinophil membranes
what is the defect in Chediak-Higashi disease?
phagocyte deficiency
cherry-red spot on macula - possible diagnoses?
Tay-Sachs or Niemann-Pick disease
what are Cheyne-Stokes respirations, and in what circumstance do they occur?
central apnea in CHF and increased intracranial pressure
"chocolate cysts"
endometriosis
what does chronic atrophic gastritis predispose to?
gastric carcinoma
Chvostek's sign - what is it, and what does it indicate?
facial muscle spasm upon tapping - sign of hypocalcemia
DES exposure in utero predisposes to what?
clear cell adenocarcinoma of the vagina
clue cells - diagnosis?
Gardnerella vaginitis
Codman's triangle on x-ray - diagnosis?
osteosarcoma
cold agglutinins - possible diagnoses?
Mycoplasma pneumonia or infectious mononucleosis
cold intolerance - sign of what?
hypothyroidism
condylomata lata - diagnosis?
secondary syphilis
continuous machinery murmur - indicates what?
patent ductus arteriosus
what is the defect in Cori's disease?
debranching enzyme deficiency
cough, conjunctivitis, coryza, fever - diagnosis?
measles
Councilman bodies - diagnosis?
toxic or viral hepatitis
Cowdry type A bodies - caused by what?
herpesvirus
crescents in Bowman's capsule - diagnosis?
rapidly progressive crescentic glomerulonephritis
what is Crigler-Najjar syndrome?
congenital unconjugated hyperbilirubinemia - due to absent UDP glucuronyl transferase
acute gastric ulcer associated with severe burns
Curling's ulcer
currant-jelly sputum - diagnosis?
Klebsiella
Curschmann's spirals - diagnosis?
- what are they?
bronchial asthma - whorled mucous plugs
acute gastric ulcer associated with CNS injury
Cushing's ulcer
D-dimers - diagnosis?
DIC
depigmentation of neurons in substantia nigra - diagnosis?
- where is the defect?
- symptoms?
Parkinson's disease - basal ganglia disorder
- rigidity, resting tremor, bradykinesia
dermatitis, dementia, diarrhea - diagnosis?
pellagra (niacin/vitamin B3 deficiency)
dog or cat bite - infected with?
Pasteurella multocida
what is Dressler's syndrome?
post-MI fibrinous pericarditis
what is Dubin-Johnson syndrome?
- what is the defect?
- what is the pathologic consequence?
congenital conjugated hyperbilirubinemia - due to defective liver excretion of conjugated bilirubin, causing black liver
what is the defect in Duchenne's muscular dystrophy?
- what is the inheritance pattern?
deleted dystrophin gene - X-linked recessive
eburnation - diagnosis?
osteoarthritis
trisomy 18 associated with rocker-bottom feet, low-set ears, heart disease
Edwards' syndrome
what is Eisenmenger's complex?
late cyanosis shunt (reversal of an uncorrected L-R shunt to an R-L shunt)
elastic skin - diagnosis?
Ehlers-Danlos syndrome
where and what is Erb-Duchenne palsy?
superior trunk injury to brachial plexus (C5-6) - "waiter's tip"
erythema chronicum migrans - diagnosis?
Lyme disease
genetically inherited aplastic anemia
Fanconi's anemia
what is Fanconi's syndrome?
proximal tubular reabsorption defect (causes excretion of many things - leads to, among other things, rickets, metabolic acidosis, hypokalemia)
"fat, female, forty, and fertile" - at risk for?
acute cholecystitis
fatty liver - associated with?
alcoholism
ferruginous bodies - diagnosis?
asbestosis
colon polyps with osteomas and soft tissue tumors - diagnosis?
Gardner's syndrome
what is the defect in Gaucher's disease?
glucocerebrosidase deficiency
Ghon focus - diagnosis?
primary TB
what is Gilbert's syndrome?
- what is the deficiency?
benign congenital unconjugated hyperbilirubinemia - due to mildly decreased UDP-glucouronyl transferase or decreased bilirubin uptake by liver
what is the defect in Glanzmann's thrombasthenia?
defect in platelet aggregation (defect in GPIIb/IIIa)
autoantibodies against alveolar and glomerular basement membrane proteins - diagnosis?
Goodpasture's syndrome
Gowers' maneuver - diagnosis?
- what is the maneuver?
Duchenne's - use of patient's arms to help legs pick self off floor
idiopathic peripheral polyneuritis - diagnosis?
Guillain-Barre syndrome
"hair on end" (crew cut) appearance on x-ray - possible diagnoses?
- why does this happen?
beta-thalassemia or sickle cell anemia - due to extramedullary hematopoiesis
what is Hand-Schuller-Christian disease?
chronic progressive histiocytosis (Langerhans cell histiocytosis)
lots of HbF - diagnosis?
thalassemia major
HbS - diagnosis?
sickle cell anemia
conditions in which hCG is elevated
choriocarcinoma, hydatidiform mole
Heberden's nodes - diagnosis?
- where are they located?
- why do they occur?
osteoarthritis - DIP swelling secondary to osteophytes
Heinz bodies - diagnosis?
G6PD deficiency
hypersensitivity vasculitis associated with hemorrhagic urticaria and upper respiratory tract infections - diagnosis?
Henoch-Schonlein purpura
heterophil antibodies - diagnosis?
- caused by what?
infectious mononucleosis - caused by EBV
high-output cardiac failure (dilated cardiomyopathy) is associated with what vitamin deficiency?
- what is the disease called?
vitamin B1 (thiamine) deficiency - wet beriberi
HLA-B27 - associated with what diseases?
Reiter's syndrome, ankylosing spondylitis, psoriasis, inflammatory bowel disease
disease associated with HLA-DR3 or DR4
- what causes it?
diabetes mellitus type 1 - autoimmune destruction of beta cells
Homer Wright rosettes - diagnosis?
neuroblastoma
honeycomb lung on x-ray - diagnosis?
interstitial fibrosis
symptoms of Horner's syndrome
ptosis, miosis, anhidrosis
Howell-Jolly bodies - caused by what?
splenectomy or nonfunctional spleen
caudate degeneration - diagnosis?
- what is the inheritance pattern?
Huntington's disease - autosomal dominant
hyperphagia, hypersexuality, hyperorality, hyperdocility - diagnosis?
- what is the affected organ?
Kluver-Bucy syndrome - affects amygdala
hyperpigmentation of skin - diagnosis?
primary adrenal insufficiency (Addison's disease)
hypersegmented neutrophils - diagnosis?
macrocytic anemia
hypertension and hypokalemia - diagnosis?
Conn's syndrome (aldosterone-secreting tumor)
hypochromic microcytosis - possible diagnoses?
iron deficiency anemia, lead poisoning
increased alpha-fetoprotein in amniotic fluid/maternal serum - possible diagnoses?
neural tube defects (anencephaly, spina bifida)
increased uric acid levels - possible diagnoses?
gout, Lesch-Nyhan syndrome, myeloproliferative disorders, use of loop and thiazide diuretics
Janeway lesions - diagnosis?
endocarditis
what disease is the Jarish-Herxheimer reaction associated with, and what is it?
syphilis - overaggressive treatment of an asymptomatic patient that causes symptoms due to rapid lysis
what is the defect in Job's syndrome?
neutrophil chemotaxis abnormality - due to failure of IFN-gamma production by helper T cells
Kaposi's sarcoma - associated with?
AIDS in MSM
what is the defect in Kartagener's syndrome?
dynein defect
Kayser-Fleischer rings - diagnosis?
Wilson's disease
keratin pearls - diagnosis?
squamous cell carcinoma
Kimmelstiel-Wilson nodules - diagnosis?
diabetic nephropathy
bilateral amygdala lesions - diagnosis?
Kluver-Bucy syndrome
koilocytes - diagnosis?
HPV
Koplik spots - diagnosis?
measles
gastric adenocarcinoma with ovarian metastases
Krukenberg tumor (Puneet, this one is for you)
Kussmaul hyperpnea - diagnosis?
diabetic ketoacidosis
lens dislocation, aortic dissection, joint hyperflexibility - diagnosis?
- what is the defect?
Marfan's syndrome - defect in fibrillin
what is the defect in Lesch-Nyhan syndrome?
HGPRT deficiency
Lewy bodies - diagnosis?
Parkinson's disease
what is Libman-Sacks disease?
endocarditis associated with SLE
lines of Zahn - diagnosis?
arterial thrombus
Lisch nodules - diagnosis?
neurofibromatosis (von Recklinghausen's disease)
low serum ceruloplasmin - diagnosis?
Wilson's disease
lucid interval - associated with what head pathology?
epidural hematoma
"lumpy-bumpy" appearance of glomeruli on immunofluorescence - diagnosis?
poststreptococcal glomerulonephritis
lytic bone lesions on x-ray - diagnosis?
multiple myeloma
Mallory bodies - diagnosis?
alcoholic liver disease
esophagogastric lacerations - diagnosis?
Mallory-Weiss syndrome
what is the defect in McArdle's disease?
muscle phosphorylase deficiency
McBurney's sign - diagnosis?
appendicitis
MLF syndrome (internuclear ophthalmoplegia) - diagnosis?
multiple sclerosis
monoclonal antibody spike - possible diagnoses?
- what makes up the spike in each?
multiple myeloma (IgG or IgA)
MGUS
Waldenstrom's macroglobulinemia (IgM)
myxedema - diagnosis?
hypothyroidism
necrotizing vasculitis of the lungs (hemoptysis) and necrotizing glomerulonephritis - possible diagnoses?
Wegener's or Goodpasture's
needle-shaped, negatively birefringent crystals - diagnosis?
gout
Negri bodies - diagnosis?
rabies
nephritis, cataracts, hearing loss - diagnosis?
- what is the defect?
Alport's syndrome
- type IV collagen defect
neurofibrillary tangles - diagnosis?
Alzheimer's disease
what is the defect in Niemann-Pick disease?
sphingomyelinase deficiency
no lactation postpartum - diagnosis?
- what causes it?
Sheehan's syndrome - due to pituitary infarction
nutmeg liver - diagnosis?
CHF
occupational exposure to asbestos - associated with?
malignant mesothelioma
"Orphan Annie" nuclei - diagnosis?
papillary carcinoma of the thyroid
Osler's nodes - diagnosis?
endocarditis
owl's eye inclusion bodies - diagnosis?
CMV
eczematous dermatitis of nipple or areola - diagnosis?
- what is it a sign of?
Paget's disease of breast
- sign of underlying neoplasm
increased osteoblastic and osteoclastic activity - diagnosis?
Paget's disease of bone (osteitis deformans)
painless jaundice - diagnosis?
pancreatic cancer (of head)
palpable purpura on legs and buttocks - diagnosis?
Henoch-Schonlein purpura
bronchogenic apical tumor associated with Horner's syndrome
Pancoast's tumor
pannus - diagnosis?
rheumatoid arthritis
nigrostriatal dopamine depletion - diagnosis?
Parkinson's disease
periosteal elevation on x-ray - diagnosis?
pyogenic osteomyelitis
benign polyposis - diagnosis?
Peutz-Jeghers syndrome
penile fibrosis - diagnosis?
Peyronie's disease
Philadelphia chromosome (bcr-abl) - diagnosis?
CML
Pick bodies - diagnosis?
Pick's disease
progressive dementia, similar to Alzheimer's - diagnosis?
Pick's disease
"pink puffer" - diagnosis?
- what are the two types, and what causes them?
emphysema
- centroacinar - due to smoking
- panacinar - due to alpha1-antitrypsin deficiency
esophageal webs with iron deficiency anemia - diagnosis?
Plummer-Vinson syndrome
podagra - diagnosis?
- where is it located?
gout - MP joint of hallux
podocyte fusion - diagnosis?
minimal change disease
polyneuropathy, cardiac pathology, and edema - diagnosis?
- what causes it?
wet beriberi (vitamin B1 deficiency)
polyneuropathy preceded by GI or respiratory infection
Guillain-Barre syndrome
what is the defect in Pompe's disease?
- what significant finding is it associated with?
lysosomal glucosidase deficiency
- cardiomegaly
port-wine stain - diagnosis?
hemangioma
positive anterior "drawer sign" - diagnosis?
anterior cruciate ligament injury
what is Pott's disease?
vertebral tuberculosis
pseudopalisade tumor cell arrangement - diagnosis?
glioblastoma multiforme
pseudorosettes - diagnosis?
Ewing's sarcoma
ptosis, miosis, anhidroisis - diagnosis?
- often associated with what?
Horner's syndrome
- Pancoast's tumor
rash on palms and soles - possible diagnoses?
secondary syphilis, Rocky Mountain Spotted Fever, coxsackie A virus
recurrent vasospasm in extremities - diagnosis?
Raynaud's syndrome
RBC casts in urine - diagnosis?
acute glomerulonephritis
recurrent pulmonary Pseudomonas and S. aureus infections - associated with?
cystic fibrosis
red urine in the morning - diagnosis?
paroxysmal nocturnal hemoglobinuria
Reed-Sternberg cells - diagnosis?
Hodgkin's lymphoma
increased Reid index - diagnosis?
chronic bronchitis (gland depth/total thickness of bronchial wall)
Reinke crystals - diagnosis?
Leydig cell tumor
what are the symptoms of Reiter's syndrome?
urethritis, conjunctivitis, arthritis
renal cell carcinoma, cavernous hemangiomas, adenomas - diagnosis?
von Hippel-Lindau disease
renal epithelial casts in urine - diagnosis?
acute toxic/viral nephrosis
rhomboid crystals, positively birefringent - diagnosis?
pseudogout
rib notching - diagnosis?
coarctation of aorta
Roth's spots in retina - diagnosis?
endocarditis
what is Rotor's syndrome?
- what is the defect?
- similar to what disease?
congenital conjugated hyperbilirubinemia
- defective liver excretion of bilirubin (similar to Dubin-Johnson, but milder)
rouleaux formation of RBCs - diagnosis?
multiple myeloma
S3 - possible diagnoses?
left-to-right shunt (VSD, PDA, ASD), mitral regurgitation, CHF (LV failure)
S4 - possible diagnoses?
aortic stenosis, hypertrophic subaortic stenosis
Schiller-Duval bodies - diagnosis?
yolk sac tumor
senile plaques - diagnosis?
Alzheimer's disease
what is Sezary syndrome?
cutaneous T-cell lymphoma
what is Sheehan's syndrome?
postpartum pituitary necrosis
Schwartzman reaction - associated with?
Neisseria meningitidis
signet-ring cells - diagnosis?
gastric carcinoma
simian crease - diagnosis?
Down syndrome
Sipple's syndrome - also known as?
MEN IIa
dry eyes, dry mouth, arthritis - diagnosis?
Sjogren's syndrome
skip lesions - diagnosis?
Crohn's
slapped cheeks - diagnosis?
erythema infectiosum (fifth disease)
Smith antigen - diagnosis?
SLE
"smudge cell" - diagnosis?
CLL
soap bubble on x-ray - diagnosis?
giant cell tumor of bone
spike and dome on EM - diagnosis?
membranous glomerulonephritis
what is a Spitz nevus?
benign juvenile melanoma
splinter hemorrhages in fingernails - diagnosis?
endocarditis
starry-sky pattern - diagnosis?
Burkitt's lymphoma
"strawberry tongue" - diagnosis?
scarlet fever
streaky ovaries - diagnosis?
Turner's syndrome
string sign on x-ray - diagnosis?
Crohn's disease
subepithelial humps on EM - diagnosis?
poststreptococcal glomerulonephritis
suboccipital lymphadenopathy - diagnosis?
rubella
sulfur granules - diagnosis?
Actinomyces israelii
swollen gums, bruising, poor wound healing, anemia - diagnosis?
- what is this due to?
- why do these symptoms occur?
scury - vitamin C (ascorbic acid) deficiency
- vitamin C is needed for hydroxylation of proline and lysine in collagen synthesis
systolic ejection murmur (crescendo-decrescendo) - diagnosis?
aortic valve stenosis
t(8;14) - diagnosis?
- gene involved?
Burkitt's lymphoma
- c-myc activation
t(9;22) - diagnosis?
- gene involved?
CML
- Philadelphia chromosome - bcr-abl hybrid
t(14;18) - diagnosis?
- gene involved?
follicular lymphoma
- bcl-2 activation
tabes dorsalis - diagnosis?
tertiary syphilis
tendon xanthomas (classically Achilles) - diagnosis?
familial hypercholesterolemia
thumb sign on lateral x-ray - diagnosis?
- caused by what?
epiglottitis - due to Haemophilus influenzae
thyroidization of kidney - diagnosis?
chronic bacterial pyelonephritis
tophi - diagnosis?
gout
"tram-track" appearance on LM - diagnosis?
membranoproliferative glomerulonephritis
what is Trousseau's sign of malignancy?
- possible diagnoses?
migratory thrombophlebitis
- visceral cancer or pancreatic adenocarcinoma
what is Trousseau's sign of latent tetany?
- diagnosis?
carpal spasm
- hypocalcemia
what is Virchow's node?
- what is it a sign of?
left supraclavicular node enlargement
- from metastatic carcinoma of the stomach
what is Virchow's triad?
- predilection for what?
blood stasis, endothelial damage, hypercoagulation
- pulmonary embolism
neurofibromatosis with cafe-au-lait spots - diagnosis?
von Recklinghausen's disease
what is von Recklinghausen's disease of bone?
osteitis fibrosa cystica ("brown tumor")
adrenal hemorrhage associated with meningococcemia - diagnosis?
Waterhouse-Friderichsen syndrome
waxy casts in urine - diagnosis?
chronic end-stage renal disease
WBC casts in urine - diagnosis?
acute pyelonephritis
WBCs in urine - diagnosis?
acute cystitis
Wermer's syndrome - also known as?
MEN type I
what is Whipple's disease?
- caused by what?
malabsorption syndrome caused by Tropheryma whippelii
hepatolenticular degeneration - diagnosis?
Wilson's disease
"wire loop" appearance on LM - diagnosis?
lupus nephropathy
"worst headache of my life" - rupture of what?
- associated with what syndrome?
rupture of berry aneurysm
- associated with adult polycystic kidney disease
xanthochromia of CSF - diagnosis?
subarachnoid hemorrhage
xerostomia, arthritis, keratoconjunctivitis sicca - diagnosis?
Sjogren's syndrome
upper GI diverticulum
Zenker's diverticulum
gastrin-secreting tumor associated with ulcers - diagnosis?
Zollinger-Ellison syndrome
most common bacteremia/pneumonia among IV drug abusers
S. aureus
most common bacteria associated with cancer
H. pylori
most common bacteria found in GI tract
- 2nd most common?
Bacterioides
- E. coli
4 most common brain tumors in adults
mets > astrocytoma (including glioblastoma multiforme) > meningioma > schwannoma
most common brain tumor in kids
- location?
medulloblastoma - in cerebellum
most common supratentorial brain tumor in kids
craniopharyngioma
most common breast cancer
infiltrating ductal carcinoma
most common breast mass
- most common in post menopausal women?
fibrocystic change
- carcinoma
most common benign breast tumor
fibroadenoma
most common bug in debilitated, hospitalized pneumonia patient
Klebsiella
most common cardiac primary tumor in adults
- usual location and appearance?
myxoma
- "ball and valve" in left atrium
most common cardiac primary tumor in kids
rhabdomyoma
most common cardiac tumor in adults
mets
most common cardiomyopathy
dilated cardiomyopathy
most common chromosomal disorder
- what other disorders is it associated with?
Down syndrome
- associated with ALL, Alzheimer's dementia, endocardial cushion defects
most common chronic arrhythmia
- what is the patient at high risk for?
atrial fibrillation - high risk of emboli
most common congenital cardiac anomaly
VSD
most common cause of constrictive pericarditis
tuberculosis
most common coronary arteries involved in thrombosis
LAD > RCA > LCA
most common causes of early cyanosis
tetralogy of Fallot, transposition of great vessels, truncus arteriosus
most common causes of late cyanosis
VSD, ASD, PDA
how do you close a PDA?
- how do you keep it open?
close with indomethacin
open with misoprostol
most common demyelinating disease
multiple sclerosis
most common dietary deficit
iron
most common cause of epiglottitis
Haemophilus influenzae type B
most common esophageal cancer
squamous cell carcinoma
most common gene involved in cancer
p53 tumor suppressor gene
most common group affected by cystic fibrosis
- what dietary deficiency is associated with CF?
- what lung problems occur?
Caucasians
- fat-soluble vitamin deficiencies
- mucous plugs and lung infections
most common gynecologic malignancy
endometrial carcinoma
most common heart murmur
mitral valve prolapse
most common heart valve involved in bacterial endocarditis
mitral
most common heart valve involved in bacterial endocarditis in IV drug abusers
tricuspid
most common heart valve involved in rheumatic fever
- which is 2nd most common?
mitral valve
- aortic is 2nd
most common helminth infection in the U.S.
- 2nd most common?
Enterobius vermicularis
- Ascaris lumbricoides is 2nd most common
most common hereditary bleeding disorder
von Willebrand's
most common kidney stone
- 2nd most common?
- are they each radiopaque or radiolucent?
- how are the 2nd most common formed?
calcium - radiopaque
2nd is ammonium - radiopaque
- formed by urease-positive organisms like Proteus vulgaris or Staphylococcus
most common leukemia in adults
AML
most common liver disease
alcoholic liver disease
most common location of brain tumors in adults
supratentorial
most common location of brain tumors in kids
infratentorial
most common lysosomal storage disease
Gaucher's disease
most common male cancer
prostatic carcinoma
most common malignancy associated with noninfectious fever
Hodgkin's disease
most common malignant skin tumor
- does it metastasize?
basal cell carcinoma
- only very rarely metastasizes
most common mets to bone
breast, lung, thyroid, testes, prostate, kidney
most common mets to brain
lung, breast, skin (melanoma), kidney (renal cell carcinoma), GI
most common mets to liver
colon, gastric, pancreatic, breast, lung carcinomas
most common motor neuron disease
ALS
most common neoplasm in kids
- 2nd most common?
ALL
- cerebellar medulloblastoma is 2nd
most common nephrotic syndrome
membranous glomerulonephritis
most common obstruction of male urinary tract
BPH
most common opportunistic infection in AIDS
Pneumocystis jiroveci pneumonia
most common organ receiving mets
- why?
adrenal glands
- rich blood supply
most common organs sending mets
lung > breast, stomach
most common benign ovarian tumor
serous cystadenoma
most common malignant ovarian tumor
serous cystadenocarcinoma
most common pancreatic tumor
- which part of pancreas is affected?
adenocarcinoma of the head of the pancreas
most common age of patient with ALL
child
most common age of patient with CLL
adult >60
most common age of patient with AML
adult >60
most common age of patient with CML
adult 35-50
most common patient with Hodgkin's
- exception: nodular sclerosis type - what patient?
young male
- nodular sclerosis type - female
most common patient with minimal change disease
young child
most common patient with Reiter's
male
most common pituitary tumor
- 2nd most common? how does it stain?
prolactinoma
- somatotropic adenoma is 2nd - acidophilic
most common preventable cancer
lung cancer
most common primary bone tumor in adults
multiple myeloma
most common cause of primary hyperparathyroidism
- other causes?
adenomas
- also hyperplasia and carcinoma
most common primary liver tumor
hepatoma
most common renal tumor
- what diseases is it associated with?
- what paraneoplastic syndromes is it associated with?
renal cell carcinoma
- von Hippel-Lindau and acquired polycystic kidney disease
- erythropoietin, renin, PTH, ACTH
most common cause of secondary hyperparathyroidism
hypocalcemia of chronic renal failure
most common sexually transmitted disease
Chlamydia
most common site of diverticula
sigmoid colon
most common site of metastasis
- 2nd most common?
regional lymph nodes
- liver is 2nd
most common sites of atherosclerosis
abdominal aorta > coronary > popliteal > carotid
most common skin cancer
basal cell carcinoma
most common stomach cancer
adenocarcinoma
most common testicular tumor
seminoma
most common thyroid cancer
papillary carcinoma
most common tumor in men
prostate carcinoma
most common tumor in women
leiomyoma (estrogen dependent)
most common tumor of infancy
hemangioma
most common tumor of the adrenal medulla in adults
- benign or malignant?
pheochromocytoma - benign
most common tumor of the adrenal medulla in kids
- benign or malignant?
neuroblastoma - malignant
most common type of Hodgkin's
nodular sclerosis
most common type of non-Hodgkin's
follicular (small cleaved)
most common type of pituitary adenoma
prolactinoma
most common vasculitis
- poses risk for?
- what causes this?
temporal arteritis
- risk of ipsilateral blindness - due to thrombosis of opthalmic artery
most common cause of viral encephalitis
HSV
most common vitamin deficiency in the U.S.
- how long do body stores last?
- what patient population is most at risk?
folic acid - stores last 3-4 months
- pregnant women at high risk
most common cause of Addison's
- 2nd most common?
autoimmune
- infection is 2nd
most common cause of dissecting aneurysm
hypertension
most common cause of descending and abdominal aortic aneurysm
atherosclerosis
most common cause of ascending aortic aneurysm
tertiary syphilis
most common cause of bacterial meningitis in adults
Streptococcus pneumoniae
most common cause of bacterial meningitis in the elderly
S. pneumoniae
most common cause of bacterial meningitis in kids
S. pneumoniae or Neisseria meningitidis
most common cause of bacterial meningitis in newborns
group B streptococcus
most common cancer associated with AIDS
Kaposi's sarcoma
most common cause of congenital adrenal hyperplasia
21-hydroxylase deficiency
most common cause of cretinism
iodine deficit/hypothyroidism
most common cause of Cushing's syndrome
- 2nd most common?
corticosteroid therapy
- excess ACTH secretion by pituitary is 2nd
most common cause of death in CML
blast crisis
most common cause of death in SLE
lupus nephropathy
most common cause of dementia
- 2nd most common?
Alzheimer's
- multi-infarct is 2nd
most common causes of DIC
Gram-negative sepsis, obstetric complications, cancer, burn trauma
most common cause of ejection click
aortic/pulmonic stenosis
most common cause of food poisoning
S. aureus
most common cause of glomerulonephritis in adults
IgA nephropathy (Berger's disease)
most common cause of epidural hematoma
- is bleeding fast or slow?
rupture of middle meningeal artery - fast bleeding
most common cause of subdural hematoma
- is bleeding fast or slow?
rupture of bridging veins due to trauma - slow bleeding
most common cause of hemochromatosis
- causes risk of?
multiple blood transfusions
- can cause CHF and increased risk of hepatocellular carcinoma
most common cause of hepatic cirrhosis
alcohol
most common cause of hepatocellular carcinoma
cirrhotic liver, often due to hepatitis B and C
most common causes of holosystolic murmur
VSD, tricuspid regurgitation, mitral regurgitation
most common cause of secondary hypertension
renal disease
most common cause of hypoparathyroidism
thyroidectomy
most common cause of hypopituitarism
adenoma
most common infection in blood transfusion
hepatitis C
most common infection in burn victims
Pseudomonas
most common cause of "machine-like" murmur
PDA
most common cause of mental retardation
- 2nd most common?
Down syndrome
- fragile X is 2nd
most common cause of MI
atherosclerosis
most common cause of mitral valve stenosis
rheumatic heart disease
most common cause of myocarditis
coxsackie B
most common cause of nephrotic syndrome in adults
membranous glomerulonephritis
most common cause of nephrotic syndrome in kids
- how do you treat it?
minimal change disease
- treat with corticosteroids
most common cause of opening snap
mitral stenosis
most common cause of osteomyelitis
S. aureus
most common cause of osteomyelitis in patients with sickle cell disease
Salmonella
most common cause of osteomyelitis in IV drug abusers
Pseudomonas
most common causes of acute pancreatitis
alcohol and gallstones
most common cause of chronic pancreatitis in adults
- in kids?
alcohol in adults
cystic fibrosis in kids
most common cause of peau d'orange
carcinoma of the breast
most common cause of PID
Neisseria gonorrhoeae
most common cause of hospital-acquired pneumonia
Klebsiella
most common cause of pneumonia in cystic fibrosis or burn infection
Pseudomonas aeruginosa
most common cause of preventable blindness
Chlamydia
most common cause of primary amenorrhea
- what is the abnormality?
Turner's - XO
most common cause of primary hyperaldosteronism
adenoma of adrenal cortex
most common cause of primary hyperparathyroidism
adenoma
most common cause of pulmonary hypertension
COPD
most common cause of right heart failure due to a pulmonary cause
cor pulmonale
most common cause of right-sided heart failure
left-sided heart failure
most common cause of Sheehan's syndrome
postpartum pituitary infarction secondary to hemorrhage
most common cause of SIADH
small cell carcinoma of the lung
most common cause of UTI
E. coli
most common causes of UTI in young women
E. coli and Staphylococcus saprophyticus
heterochromatin vs. euchromatin
HeteroChromatin = Highly Condensed (transcriptionally inactive)
euchromatin = less condensed, transcriptionally active ("truly transcribed")
what nucleotides are purines?
A,G (PURines = PURe As Gold)
what nucleotides are pyrimidines?
C,U,T (PYrimidines = CUT the PY)
what functional group does thymine have?
THYmine has a meTHYl
what amino acids are needed for purine synthesis?
Glycine, Aspartate, Glutamine (A and G are purines)
hydroxyurea - mechanism of action?
inhibits ribonucleotide reductase (converts ribonucleotides to deoxyribonucleotides)
6-mercaptopurine - mechanism of action?
blocks de novo purine synthesis
5-fluorouracil - mechanism of action?
inhibits thymidylate synthase (makes dTMP from dUMP)
mechanism of action of methotrexate and trimethoprim
inhibit dihydrofolate reductase (makes THF, which is needed for dTMP synthesis)
transition vs. transversion
transition - substituting purine for purine, e.g. (transItion = Identical type)
transversion - substituting purine for pyrimidine, e.g. (transVersion = conVersion between types)
nonsense mutation
change resulting in an early stop codon (Stop the nonsense!)
fluoroquinolones - mechanism of action?
inhibit DNA gyrase
what is the defect in xeroderma pigmentosum?
mutated endonucleases (for nucleotide excision repair) - prevents repair of thymidine dimers
what is the defect in hereditary nonpolyposis colorectal cancer?
mutated mismatch repair genes
what are the 3 types of RNA, and what are their distinguishing characteristics?
rRNA - most abundant (Rampant)
mRNA - longest (Massive)
tRNA - smallest (Tiny)
mRNA start codon
AUG (inAUGurates protein synthesis)
mRNA stop codons
UGA (U Go Away)
UAA (U Are Away)
UAG (U Are Gone)
which types of RNA do the different types of RNA polymerase make?
RNA polymerase I - rRNA
RNA polymerase II - mRNA
RNA polymerase III - tRNA
(numbered in order as products are used in protein synthesis)
exons vs. introns
exons are coding segments
introns are non-coding segments that are spliced out
(INtrons stay IN the nucleus, whereas EXons EXit and are EXpressed)
tetracyclines - mechanism of action?
bind 30S subunit and prevent attachment of aminoacyl-tRNA
subunits that make up the eukaryotic vs. prokaryotic ribosome
Eukaryotes: 40S + 60S = 80S (Even)
prOkaryotes: 30S + 50S = 70S (Odd)
function of ribosome sites in protein synthesis
going APE:
A site - incoming Aminoacyl-tRNA binds here
P site - accommodates growing Peptide
E site - holds Empty tRNA as it Exits
functions of ATP and GTP in protein synthesis
ATP - for tRNA charging (Activation)
GTP - for tRNA binding to ribosome and translocation (Gripping and Going places)
aminoglycosides - mechanism of action?
inhibit formation of initiation complex in protein synthesis and cause misreading of mRNA
chloramphenicol - mechanism of action?
inhibits 50S peptidyltransferase (which catalyzes peptide bond formation)
mechanism of action of macrolides and clindamycin?
bind 50S subunit and block translocation
function of G1 and G2 phases in cell cycle
Gap or Growth (duplication of cell contents, cell growth)
function of S phase in cell cycle
DNA Synthesis
what is the defect in I-cell disease?
lysosomal storage disorder - failure of addition of mannose-6-phosphate to lysosome proteins (normally targets proteins to lysosomes)
- so enzymes are secreted from cell instead of going to lysosomes
name 5 drugs that act on microtubules (and what they're used for)
mebendazole/thiabendazole (antihelminthic)
griseofulvin (antifungal)
vincristine/vinblastine (anti-cancer)
paclitaxel (anti-breast cancer)
colchicine (anti-gout)
what is the defect in Chediak-Higashi syndrome?
- symptoms?
defect in microtubule polymerization, causing decreased phagocytosis
- symptoms: recurrent pyogenic infections, partial albinism, peripheral neuropathy
what is the defect in Kartagener's syndrome?
- symptoms?
dynein arm defect, causing cilia to be immotile
- symptoms: infertility, bronchiectasis, recurrent sinusitis, situs inversus
mechanism of action of cardiac glycosides (digoxin and digitoxin)?
inhibit Na+/K+-ATPase, causing decreased Na+/Ca2+ exchange
- more Ca2+ in cell causes increased cardiac contractility
location of the different types of collagen
Be (So Totally) Cool, Read Books
type I: Bone, Skin, Tendon (type I: bONE)
type II: Cartilage (carTWOlage)
type III (Reticulin): blood vessels, uterus, fetal tissue
type IV: Basement membrane (type IV: under the floor)
what is the defect in scurvy?
vitamin C deficiency, so can't hydroxylate proline and lysine residues in collagen
what is the defect in Ehlers-Danlos syndrome?
- which type of collagen is most affected?
- symptoms?
faulty collagen synthesis, especially type III collagen
- symptoms: hyperextensible skin, tendency to bleed, hypermobile joints
what is the defect in osteogenesis imperfecta?
- which type of collagen is most affected?
- symptoms?
abnormal type I collagen synthesis
- symptoms: multiple fractures with minimal trauma (brittle bones), blue sclerae, hearing loss, dental imperfections
what is the defect in Alport's syndrome?
- which type of collagen is most affected?
- symptoms?
abnormal type IV collagen synthesis
- symptoms: hereditary nephritis, deafness, ocular disturbances (type IV collagen found in kidney, ears, and eyes)
what is the defect in Marfan's syndrome?
mutation in fibrillin (component of elastin)
what disease can be caused by alpha1-antitrypsin deficiency?
- why does this occur?
emphysema - due to excess elastase activity (alpha1-antitrypsin normally inhibits elastase)
what blotting procedures are used to probe for DNA, RNA, and protein?
SNoW DRoP:
Southern = DNA
Northern = RNA
Western = Protein
Prader-Willi vs. Angelman's syndrome - inactivation of which parent's allele?
Prader-Willi - deletion of Paternal allele
AngelMan's - deletion of Maternal allele
what is the defect in hypophosphatemic rickets (vitamin D-resistant rickets)?
- what is the inheritance pattern?
phosphate wasting at proximal tubule
- X-linked dominant
what is the primary symptom in Leber's hereditary optic neuropathy?
- what causes this?
- what is the inheritance pattern?
loss of central vision due to degeneration of retinal ganglion cells and axons
- mitochondrial inheritance
what gene is mutated in achondroplasia?
fibroblast growth factor receptor 3
what gene is mutated in ADPKD?
- what chromosome is it on?
APKD1 gene
- on chromosome 16 (16 letters in "polycystic kidney")
what gene is mutated in familial adenomatous polyposis?
- what chromosome is it located on?
APC gene
- chromosome 5 (5 letters in "polyp")
what is the defect in familial hypercholesterolemia?
defective or absent LDL receptor
what is Osler-Weber-Rendu syndrome?
hereditary hemorrhagic telangiectasia - disorder of blood vessels
what is the defect in hereditary spherocytosis?
defect in spectrin or ankyrin
what chromosome is the mutation in Huntington's disease located on?
chromosome 4 (hunting 4 food)
what chromosome is the mutated gene in neurofibromatosis type 1 (von Recklinghausen's disease) located on?
- symptoms?
chromosome 17 (17 letters in von Recklinghausen)
- symptoms: cafe-au-lait spots, neural tumors, Lisch nodules (iris hamartomas)
what gene is mutated in neurofibromatosis type 2?
- what chromosome is it on?
- symptoms?
NF2 gene on chromosome 22 (type 2 = 22)
- symptoms: bilateral acoustic neuromas, juvenile cataracts
what are some symptoms of tuberous sclerosis?
facial lesions, hypopigmented "ash leaf spots" on skin, cortical/retinal hamartomas, renal cysts, cardiac rhabdomyomas
what are some symptoms of von Hippel-Lindau disease?
- what gene is mutated?
- what chromosome is it on?
hemangioblastomas, bilateral renal cell carcinomas
- VHL gene (tumor suppressor) on chromosome 3 (von Hippel-Lindau = 3 words)
what gene is mutated in cystic fibrosis, and how?
- treatment? how does it work?
CFTR - deletion of Phe 508
- N-acetylcysteine cleaves disulfide bonds in mucus
name 10 X-linked recessive disorders
Be Wise, Fool's GOLD Heeds False Hope:
Bruton's agammaglobulinemia
Wiskott-Aldrich syndrome
Fragile X
G6PD defiency
Ocular albinism
Lesch-Nyhan syndrome
Duchenne's/Becker's muscular dystrophy
Hemophilia A and B
Fabry's disease
Hunter's syndrome
what is the gene defect in Duchenne's muscular dystrophy?
- what is the defect in Becker's?
Duchenne's = Deleted Dystrophin (frameshift mutation)
- Becker's = mutated dystrophin
what are the symptoms of fragile X syndrome?
macro-orchidism, long face, large jaw, large everted ears (fragile X = eXtra-large testes, jaw, ears)
name 4 trinucleotide repeat expansion diseases
- what are the repeated segments for each?
Try (trinucleotide) hunting for my fried eggs (X):
Huntington's disease - CAG
myoTonic dystrophy - CTG
Friedreich's ataxia - GAA
fraGile X syndrome - CGG
name the 3 most common autosomal trisomies
- which chromosome?
- symptoms?
Down syndrome - 21 (Drinking age) - flat facies, prominent epicanthal folds, simian crease
Edward's syndrome - 18 (Election age) - micrognathia, low-set ears, clenched hands with overlapping fingers
Patau's syndrome - 13 (Puberty) - cleft lip/Palate, holoProsencephaly, Polydactyly
symptoms of 22q11 deletion syndromes
- what is the cause?
- 2 examples of syndromes?
CATCH-22:
Cleft palate
Abnormal facies
Thymic aplasia (causes T cell deficiency)
Cardiac defects
Hypocalcemia due to parathyroid aplasia
- due to aberrant development of 3rd and 4th branchial pouches
- examples: DiGeorge syndrome, velocardiofacial syndrome
vitamin A - other name?
- function?
retinol
- constituent of visual pigments (retin-A)
vitamin B1 - other name?
- what cofactor does it make?
- what types of reactions does this assist in?
- what diseases are caused by deficiency?
thiamine
- TPP - for dehydrogenase reactions
- beriberi (Ber1Ber1) and Wernicke-Korsakoff syndrome
vitamin B2 - other name?
- what cofactors does it make? how many ATP?
- symptoms of deficiency?
riboflavin
- FAD and FMN (derived from riboFlavin) - FAD makes 2 ATP (B2)
- 2 C's: Cheilosis, Corneal vascularization
vitamin B3 - other name?
- what cofactor does it make? how many ATP?
- what disease is caused by deficiency? symptoms?
niacin
- NAD (derived from Niacin) - 3 ATP (B3)
- pellagra - 3 D's: Diarrhea, Dermatitis, Dementia
vitamin B5 - other name?
- what cofactor does it make?
pantothenate
- CoA (from pantothen-A)
vitamin B6 - other name?
- what types of reactions does it participate in?
pyridoxine
- transamination and decarboxylation reactions
vitamin B12 - other name?
cobalamin
source of folate
green leaves (FOLate from FOLiage)
function of S-adenosyl-methionine
transfers methyl units (SAM the methyl donor man)
biotin - cofactor in what kind of reactions?
- cause of deficiency?
carboxylation reactions
- ingestion of raw eggs, which contain avidin (AVIDin in egg whites AVIDly binds biotin)
vitamin E - function?
antioxidant that protects erythrocytes and membranes from damage (E for Erythrocytes)
vitamin K - function?
needed for proper function of clotting factors II, VII, IX, and X and proteins C and S (K is for Koagulation)
disulfiram - mechanism of action?
inhibits acetaldehyde dehydrogenase, causing accumulation of acetaldehyde
kwashiorkor vs. marasmus - what are the causes and symptoms of each?
kwashiorkor - protein malnutrition
- results from a protein-deficient MEAL: malnutrition, edema, anemia, liver fatty change
marasmus - energy malnutrition
- Marasmus results in Muscle wasting
cell processes that take place in both mitochondria and cytoplasm
HUGs take two:
Heme synthesis
Urea cycle
Gluconeogenesis
hexokinase vs. glucokinase
- what do they do?
- where are they each located?
- high or low affinity?
- high or low Vmax?
both convert glucose to glucose-6-phosphate
- hexokinase is everywhere and has high affinity and low Vmax
- glucokinase is in liver and beta cells of pancreas - has low affinity and high Vmax
cofactors involved in pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase reactions
TPP (B1), FAD (B2), NAD (B3), CoA (B5), lipoic acid
purely ketogenic amino acids
Lysine and Leucine
substrates in TCA cycle
Citrate Is Krebs' Starting Substrate For Making Oxaloacetate:
Citrate - Isocitrate - alpha-Ketoglutarate - Succinyl-CoA - Succinate - Fumarate - Malate - Oxaloacetate
enzymes unique to gluconeogenesis (all irreversible)
Pathway Produces Fresh Glucose:
Pyruvate carboxylase
PEP carboxykinase
Fructose-1,6-bisphosphatase
Glucose-6-phosphatase
purposes of HMP shunt
produce NADPH (for fatty acid/steroid biosynthesis and glutathione reduction to prevent oxidative damage)
produce pentose sugars (for nucleotide synthesis)
what are Heinz bodies?
- what disease do they occur in?
Heinz bodies = denatured Hemoglobin that precipitates within RBCs
- occur in G6PD deficiency (oxidative damage)
what is the defect in fructose intolerance?
deficiency of aldolase B (converts fructose-1-P to DHAP and glyceraldehyde)
what is the defect in essential fructosuria?
deficiency of fructokinase (converts fructose to fructose-1-P)
what is the defect in classic galactosemia?
- symptoms?
absence of galactose-1-phosphate uridyltransferase (converts galactose-1-P to glucose-1-P)
- failure to thrive, infantile cataracts (galactitol accumulates in eye)
substrates in urea cycle
Ordinarily, Careless Crappers Are Also Frivolous About Urination:
Ornithine - Carbamoyl phosphate - Citrulline - Aspartate - Argininosuccinate - Fumarate - Arginine - Urea
what is the defect in phenylketonuria?
- symptoms?
decrease in phenylalanine hydroxylase (converts Phe to Tyr) or in THB cofactor
- mental/growth retardation, fair skin, musty body odor (disorder of aromatic aa metabolism causes musty body odor)
what is the defect in alkaptonuria?
- symptoms?
deficiency of homogentisic acid oxidase (involved in Tyr degradation)
- dark connective tissue, pigmented sclera, urine turns black on standing
what is the defect in albinism?
deficiency of tyrosinase or defective tyrosine transporters (so can't make melanin from tyrosine)
what is the defect in homocystinuria?
defect in cystathionine synthase (in pathway converting homocysteine to cysteine) or in homocysteine methyltransferase (converts homocysteine to methionine) - both cause excess homocysteine
what is the defect in cystinuria?
- what can result?
defect of renal proximal tubule transporter for cysteine
- excess cystine in urine can cause precipitation of cystine kidney stones
what is the defect in maple syrup urine disease?
- symptoms?
defect in alpha-ketoacid dehydrogenase, which degrades branched amino acids (Ile, Leu, Val - I Love Vermont maple syrup from the branches of maple trees)
- urine smells like maple syrup, CNS defects
what enzyme deficiency is a major cause of SCID?
- what patient population gets SCID?
adenosine deaminase deficiency (excess ATP imbalances nucleotide pool and prevents DNA synthesis)
- SCID happens to kids
what is the defect in Lesch-Nyhan syndrome?
- symptoms?
absence of HGPRT (He's Got Purine Recovery Trouble) - enzyme of purine salvage pathway, so block leads to excess uric acid
- retardation, self-mutilation, gout
what is the defect in orotic aciduria?
- findings?
inability to convert orotic acid to UMP (in de novo pyrimidine synthesis pathway)
- orotic acid in urine, megaloblastic anemia
function of insulin with regard to glucose
Insulin moves glucose Into cells
tissues that don't need insulin for glucose transport
BRICK L:
Brain, RBCs, Intestine, Cornea, Kidney, Liver
what are glycogen storage diseases types I-III and V?
- what enzymes are deficient in each?
- what specific organs do types II and V affect?
Very Poor Carbohydrate Metabolism:
I = Von Gierke's disease
- glucose-6-phosphatase
II = Pompe's disease
- lysosomal alpha-1,4-glucosidase
- heart (cardiomegaly) - Pompe's trashes the Pump
III = Cori's disease
- debranching enzyme
V = McArdle's disease
- skeletal muscle glycogen phosphorylase
- muscle (McArdle's = Muscle)
what is the defect in Fabry's disease?
- what substrate accumulates?
deficient alpha-galactosidase A
- ceramide trihexoside accumulates
what is the defect in Gaucher's disease?
- what substrate accumulates?
deficient beta-glucocerebrosidase
- glucocerebroside accumulates
what is the defect in Niemann-Pick disease?
- what substrate accumulates?
deficient sphingomyelinase - no man picks (Niemann-Pick) his nose with his sphinger (sphingomyelinase)
- sphingomyelin accumulates
what is the defect in Tay-Sachs disease?
- what substrate accumulates?
deficient hexosaminidase A (Tay-SaX lacks heXosaminidase)
- GM2 ganglioside accumulates
what is the defect in Krabbe's disease?
- what substrate accumulates?
deficient galactocerebrosidase
- galactocerebroside accumulates
what is the defect in metachromatic leukodystrophy?
- what substrate accumulates?
deficient arylsulfatase A
- cerebroside sulfate accumulates
what is the defect in Hurler's syndrome?
- what substrates accumulate?
deficient alpha-L-iduronidase
- heparan sulfate and dermatan sulfate accumulate
what is the defect in Hunter's syndrome?
- what substrates accumulate?
- what is the inheritance pattern?
deficient iduronate sulfatase
- heparan sulfate and dermatan sulfate accumulate
- X-linked recessive (hunters aim for the X)
Hunter's vs. Hurler's - which has corneal clouding?
Hurler's
(hunters see clearly - no corneal clouding)
citrate shuttle vs. carnitine shuttle - what metabolic pathways are they involved in?
citrate - fatty acid synthesis (SYtrate = SYnthesis)
carnitine - fatty acid degradation (CARnitine = CARnage of fatty acids)
statins - mechanism of action?
inhibit HMG-CoA reductase
functions of apolipoproteins A-I, B-100, C-II, B-48, and E
A-I - activates LCAT
B-100 - Binds LDL receptor and mediates VLDL secretion
C-II - Cofactor for lipoprotein lipase
B-48 - mediates chylomicron secretion
E - mediates remnant (Extra) uptake
direction of transport of LDL and HDL
LDL - from liver to tissues (LDL is Lousy)
HDL - from periphery to liver (HDL is Healthy)
what is the defect in hyperchylomicronemia?
lipoprotein lipase deficiency or altered apolipoprotein C-II
what is the defect in familial hypercholesterolemia?
absent or decreased LDL receptors
what is the defect in hypertriglyceridemia?
hepatic overproduction of VLDL
what is the defect in abetalipoproteinemia?
deficiencies of apoB-100 and apoB-48 - unable to synthesize lipoproteins
landmarks of 2nd week of fetal development
rule of 2's:
- 2 germ layers (epiblast, hypoblast)
- 2 cavities (amniotic cavity, yolk sac)
- 2 components to placenta (cytotrophoblast, syncytiotrophoblast)
landmark of 3rd week of fetal development
rule of 3's:
- 3 germ layers (ectoderm, mesoderm, endoderm)
landmarks of 4th week of fetal development
rule of 4's:
- 4 heart chambers
- 4 limb buds grow
what germ layer are odontoblasts derived from?
neural crest (Crest toothpaste)
symptoms of mesoderm defects
VACTERL:
Vertebral defects
Anal atresia
Cardiac defects
Tracheo-Esophageal fistula
Renal defects
Limb defects
at which days in fetal development do the amnion and chorion form?
chorion forms at day 3
amnion forms at day 8
what are the components of the umbilical cord?
2 umbilical arteries
1 umbilical vein
urachus
all surrounded by Wharton's jelly
structures that perform fetal erythropoiesis during development, in order
Young Liver Synthesizes Blood:
Yolk sac (3-8 wk)
Liver (6-30 wk)
Spleen (9-28 wk)
Bone marrow (28+ wk)
what is the adult derivative of the umbilical arteries?
umbiLical arteries become mediaL umbilical ligaments
what is the adult derivative of the allantois/urachus?
allaNtois becomes mediaN umbilical ligaments
what is the adult derivative of the 1st aortic arch?
part of the MAXillary artery (1st arch is MAXimal)
what are the adult derivatives of the 2nd aortic arch?
Stapedial artery (Second arch) and hyoid artery
what are the adult derivatives of the 3rd aortic arch?
common Carotid artery and internal Carotid artery (C is 3rd letter of alphabet)
what are the adult derivatives of the 4th aortic arch?
aortic arch and right subclavian artery (4th arch = 4 limbs = systemic circulation)
what is the defect in spina bifida occulta?
- in meningocele?
- in myelomeningocele?
bony spinal canal fails to close, but no herniation
- meninges herniate through
- meninges and spinal cord herniate through
what is Chiari type II?
cerebellar tonsils herniate through foramen magnum
what is Dandy-Walker?
large posterior fossa, absent cerebellum, enlarged 4th ventricle
what is the defect in holoprosencephaly?
cerebral hemispheres do not separate across midline
what is the defect in syringomyelia?
- symptom?
enlarged central canal of spinal cord - damages crossing fibers of spinothalamic tract
- so bilateral loss of pain and temperature sense
what germ layers are the different parts of the branchial apparatus derived from?
CAP covers outside from inside:
Clefts = ectoderm
Arches = mesoderm
Pouches = endoderm
innervations and general functions of derivatives of each branchial arch
arch 1 - CN V2 and V3 - chewing
arch 2 - CN VII - facial expression
arch 3 - CN IX - stylopharyngeus
arch 4 - CN X - swallowing
arch 6 - CN X - speaking
name some derivatives of branchial arch 1
Meckel's cartilage (Mandible, Malleus, incus, sphenoMandibular ligament)
Muscles of Mastication (temporalis, Masseter, lateral and Medial pterygoids)
Mylohyoid, anterior belly of digastric, tensor tympani, tensor veli palatini, anterior tongue
what is the defect in Treacher Collins syndrome?
- symptoms?
1st arch neural crest fails to migrate
- mandibular hypoplasia, facial abnormalities
name some derivatives of branchial arch 2
Stapes, Styloid process, lesser horn of hyoid, Stylohyoid ligament
muscles of facial expression, Stapedius, Stylohyoid, posterior belly of digastric
name some derivatives of branchial arch 3
greater horn of hyoid, stylopharyngeus (innervated by glossopharyngeal nerve)
what are the derivatives of the 3rd branchial pouch?
3rd pouch contributes to 3 structures:
thymus and inferior parathyroids
what is the defect in DiGeorge syndrome?
- symptoms?
aberrant development of 3rd and 4th branchial pouches (form thyroid and parathyroids)
- T-cell deficiency and hypocalcemia
what ear bones and muscles derive from the 1st branchial arch?
- from the 2nd?
1st: Malleus/incus, tensor tyMpani
2nd: Stapes, Stapedius
embryologic components of diaphragm
Several Parts Build Diaphragm:
Septum transversum
Pleuroperitoneal folds
Body wall
Dorsal mesentery of esophagus
innervation of diaphragm
C3,4,5 (keeps the diaphragm alive)
what is the defect in gastroschisis?
failure of lateral body folds to fuse, causes extrusion of abdominal contents
what is the defect in Potter's syndrome?
- symptoms?
bilateral renal agenesis in utero (due to malformed ureteric bud) causes oligohydramnios (babies with Potter's can't Pee in utero)
- limb deformities, face deformities, pulmonary hypoplasia
adult derivatives of the mesonephric (wolffian) ducts
SEED:
Seminal vesicles
Epididymis
Ejaculatory duct
Ductus deferens
what is the defect in hypospadias?
failure of urethral folds to close - causes abnormal opening of penile urethra on inferior side of penis (hypo is below)
what is the defect in epispadias?
- what condition is associated with epispadias?
faulty positioning of genital tubercle - causes abnormal opening of penile urethra on superior side of penis (Epispadias - you hit your Eye when you pEE)
- Extrophy of the bladder is associated with Epispadias
only bacteria with a protein capsule
Bacillus anthracis
bacteria that do not Gram stain well
These Rascals May Microscopically Lack Color:
Treponema
Rickettsia
Mycobacteria
Mycoplasma
Legionella pneumophila
Chlamydia
what does PAS stain for?
- what does it diagnose?
glycogen and mucopolysaccharides (PASs the sugar)
- Whipple's disease
name 4 obligate aerobes
Nagging Pests Must Breathe:
Nocardia
Pseudomonas aeruginosa (P. AERuginosa is an AERobe)
Mycobacterium tuberculosis
Bacillus
name 3 obligate anaerobes
anaerobes Can't Breathe Air:
Clostridium
Bacteroides
Actinomyces
what type of bacteria are aminoglycosides ineffective against?
anaerobes (aminO2glycosides require O2 to enter bacterial cell)
name 2 obligate intracellular bacteria
stay inside cells when it's Really Cold:
Rickettsia
Chlamydia
name 8 facultative intracellular bacteria
Some Nasty Bugs May Live FacultativeLY:
Salmonella
Neisseria
Brucella
Mycobacterium
Listeria
Francisella
Legionella
Yersinia
what does a positive quellung reaction indicate?
bacteria is encapsulated (quellung = capsular swellung)
name 4 encapsulated bacteria
Some Nasties Have Kapsules:
Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae
Klebsiella pneumoniae
name 4 urease-positive bacteria
Particular Kinds Have Urease:
Proteus
Klebsiella
H. pylori
Ureaplasma
what bacteria produce a yellow pigment?
S. aureus (aureus = yellow)
what bacteria produce a blue-green pigment?
Pseudomonas aeruginosa (AERUGula is green)
what bacteria produce a red pigment?
Serratia marcescens (red maraschino cherries)
function of Corynebacterium diphtheriae toxin
inactivates elongation factor (EF-2)
function of Vibrio cholerae toxin
activates Gs, stimulating adenylyl cyclase - increases Cl- in gut and decreases Na+ absorption
E. coli heat-labile toxin vs. heat-stable toxin
heat-labile stimulates Adenylate cyclase, heat-stable stimulates Guanylate cyclase
("labile like the Air, stable like the Ground")
function of Bordetella pertussis toxin
inhibits Gi, causing increased cAMP
function of C. tetani toxin
blocks release of GABA and glycine
function of C. botulinum toxin
blocks release of acetylcholine
function of Shigella toxin
Shiga toxin cleaves host rRNA and enhances cytokine release
location of endotoxin
Gram-Negative cell wall
(N-dotoxin)
name 5 bacterial toxins that are encoded in a lysogenic phage
ABCDE:
ShigA-like toxin
Botulinum toxin
Cholera toxin
Diphtheria toxin
Erythrogenic toxin of Streptococcus pyogenes
how do you distinguish between Staph. epidermidis and Staph. saprophyticus?
NOvobiocin - Saprophyticus is Resistant, Epidermidis is Sensitive (on the office's staph retreat, there was NO StRES)
how do you distinguish between Strep. pneumoniae and viridans?
Optochin - Viridans is Resistant, Pneumoniae is Sensitive (OVRPS - overpass)
how do you distinguish between group A and B strep?
Bacitracin - group B strep are resistant, group A are Sensitive (B-BRAS)
how do you distinguish between Staphylococci and Streptococci?
catalase (Staph make catalase because they have more staff)
what diseases does Streptococcus pneumoniae cause?
MOPS (Most OPtochin Sensitive):
Meningitis
Otitis media
Pneumonia
Sinusitis
what species of viridans group Strep causes subacute bacterial endocarditis?
S. sanguis (blood - there is lots of blood in the heart)
normal location of viridans Streptococci
in the mouth (not afraid of-the-chin - op-to-chin resistant)
sequelae of Strep pharyngitis
rheumatic fever (PHever), glomerulonePHritis (due to PHaryngitis)
symptoms of rheumatic fever
no rheum for SPECCulation:
Subcutaneous nodules
Polyarthritis
Erythema marginatum
Chorea
Carditis
what patients does Streptococcus agalactiae infect?
babies (group B is for Babies)
characteristics of Corynebacterium diphtheriae
ABCDEFG:
ADP ribosylation (by toxin)
Beta-prophage (encodes toxin)
Corynebacterium
Diphtheriae
Elongation Factor 2 (ribosylated by toxin)
Granules
main symptom of Clostridium tetani infection
TETanic paralysis (TETanus)
what are the sources of C. botulinum?
BOTulinum - from bad BOTtles of food and honey
what does C. perfringens infection cause?
gas gangrene (PERFringens PERForates a gangrenous leg)
what does C. difficile infection cause?
DIfficile - causes DIarrhea and pseudomembranous colitis
what is the only Gram-positive bacteria with endotoxin?
Listeria monocytogenes
what are the treatments for Actinomyces israelii and Nocardia asteroides?
SNAP:
Sulfamethoxazole for Nocardia
Actinomyces gets Penicillin
lepromatous vs. tuberculoid leprosy - which is worse?
- what causes the difference?
LEpromatous is worse (LEthal)
- due to failed cell-mediated immunity
what type of bacteria grow pink colonies on MacConkey's agar?
- name 5 examples
lactose fermenters (lactose is KEE)
- MacConKEE's agar: Citrobacter, Klebsiella, E. coli, Enterobacter, Serratia
how do you distinguish between Neisseria gonorrhoeae and meningitidis?
MeninGococci ferment Maltose and Glucose
Gonococci ferment only Glucose
what diseases does Haemophilus influenzae cause?
HaEMOPhilus causes Epiglottitis, Meningitis, Otitis media, Pneumonia
what special culture is needed to grow Haemophilus influenzae?
chocolate agar with factors V (NAD) and X (hematin)
(when a child has the "flu", mom goes to the five (V) and dime (X) to buy some chocolate)
how do you stain Legionella pneumophila?
- what special culture is needed to grow it?
silver stain
- charcoal yeast extract with iron and cysteine
(French legionnaire with silver helmet sitting around charcoal fire with an iron dagger - he is no sissy/cysteine)
what diseases does Pseudomonas aeruginosa cause?
PSEUDOmonas - Pneumonia, Sepsis, External otitis, UTI, Diabetic Osteomyelitis
antigen types found in Enterobacteriaceae
- are they glucose fermenters or nonfermenters?
COFFEe:
Capsular (K) antigen
O antigen
Flagellar (H) antigen
Ferment glucose
Enterobacteriaceae
what diseases does Klebsiella cause?
- what patients does it affect?
4 A's:
Aspiration pneumonia
Abscess in lungs
Alcoholics
di-A-betics
Salmonella vs. Shigella - which is motile?
- how are they transmitted?
Salmonella (salmon swim)
- Food, Fingers, Feces, Flies
name the spirochetes
- which is the biggest?
BLT: Borrelia, Leptospira, Treponema
- Borrelia (B is Big)
what is Weil's disease?
icterohemorrhagic leptospirosis (severe infection with Leptospira interrogans)
symptoms of Lyme disease
BAKE a Key Lyme pie:
Bell's palsy
Arthritis
Kardiac block
Erythema migrans
which stage of syphilis is characterized by systemic disease?
Secondary syphilis = Systemic
what is the Argyll Robertson pupil?
sign of tertiary syphilis - constricts with accommodation but is not reactive to light (prostitute's pupil - accommodates but doesn't react)
which treponeme test is more specific and remains positive longest: FTA-ABS or VDRL?
FTA-ABS (Find The Antibody ABSolutely)
causes of VDRL false positives
VDRL:
Viruses (mono, hepatitis)
Drugs
Rheumatic fever
Lupus/leprosy
name 6 zoonotic bacteria
Big Bad Bugs From Your Pet named Ella:
Bartonella henselae
Borrelia burgdorferi
Brucella
Francisella tularensis
Yersinia pestis
Pasteurella multocida
what is the source of Brucella, and what does it cause?
Unpasteurized dairy products - causes Undulant fever
triad of symptoms caused by rickettsiae
headache, fever, rash
what distinguishes rickettsial rash from typhus rash?
rickettsial rash starts on hands and feet and spreads inward
typhus rash starts centrally and spreads outward
(Rickettsia on the wRists, Typhus on the Trunk)
what causes Q fever, and what distinguishes it from other rickettsiae?
Coxiella burnetii
Q fever is Queer - no rash, no vector (transmitted by aerosol), negative Weil-Felix reaction, organism can survive outside for a long time
what infections cause a palm and sole rash?
drive CARS using palms and soles:
Coxsackievirus A
Rocky Mountain spotted fever
Syphilis
Chlamydia elementary body vs. reticulate body - what is the function of each?
Elementary body Enters the cell
Reticulate body Replicates in the cell
what do the different serotypes of Chlamydia trachomatis cause?
types A, B, C - in Africa, cause Blindness and Chronic infection
types L1-3 - cause Lymphogranuloma venereum
types D-K - cause everything else
treatment for C. difficile
metronidazole
treatment for leprosy
- side effects?
dapsone
- hemolysis, methemoglobinemia
treatment for H. influenzae meningitis
- prophylaxis for close contacts?
ceftriaxone
- rifampin prophylaxis
treatment for Legionella
erythromycin
treatment for Pseudomonas
aminoglycoside + extended-spectrum penicillin
treatment for H. pylori
triple therapy: bismuth, metronidazole, and tetracycline/amoxicillin
treatment for Lyme disease
doxycycline
treatment for syphilis
penicillin
treatment for Gardnerella
metronidazole
treatment for Rickettsiae
tetracycline
treatment for Chlamydia
erythromycin or tetracycline
treatment for Mycoplasma pneumoniae
tetracycline or erythromycin
histoplasmosis - where is it contracted?
- microscopic appearance?
Mississippi/Ohio river valleys
- macrophage filled with intracellular oval bodies
blastomycosis - where is it contracted?
- microscopic appearance?
- preferred form at different temperatures?
east of Mississippi river
- Blastomycosis = Big Broad-Based Budding
- cold = mold, heat = yeast
coccidioidomycosis - where is it contracted?
- microscopic appearance?
southwestern US
- spherule filled with endospores
paracoccidioidomycosis - where is it contracted?
- microscopic appearance?
Latin America
- budding yeast looks like captain's wheel
treatment for local mycotic infection
- for systemic infection?
fluconazole or ketoconazole
- amphotericin B for systemic
what causes tinea versicolor?
- treatment?
Malassezia furfur
- miconazole, selenium sulfide
treatment for superficial Candida albicans infection
- for systemic infection?
nystatin
- amphotericin B for systemic
treatment for Pneumocystis jiroveci
trimethaprim-sulfamethoxazole
treatment for Sporothrix schenckii
itraconazole or potassium iodide
symptoms of Chagas' disease
- what causes it?
- what transmits it?
- treatment?
dilated cardiomyopathy, megacolon, megaesophagus
- Trypanosoma cruzi transmitted by reduviid bug
- nifurtimox
treatment for African sleeping sickness
SURamin for blood-borne disease
MELArsoprol for CNS penetration
(it SURe is nice to go to sleep; MELAtonin helps with sleep)
how is Leishmania transmitted?
- treatment?
sandfly
- treat with sodium stibogluconate
treatment for malaria
chloroquine + primaquine to prevent relapse by dormant species in liver
what organisms does the Ixodes tick transmit?
Borrelia burgdorferi and Babesia
what is the main symptom of Entamoeba histolytica infection?
bloody diarrhea
what are three main drugs used to treat nematode (roundworm) infections?
meBENDazole (worms are BENDy), pyrantel pamoate, diethylcarbamazine
what disease does Onchocerca volvulus cause?
- treatment?
- how is it transmitted?
rIVER blindness
- IVERmectin
- blackflies
what is the main drug used to treat cestode (tapeworm) and trematode (fluke) infections?
praziquantel
Taenia solium - what are the two types of infection?
- ingestion of which form causes each?
intestinal tapeworms - caused by ingestion of larvae
cysticercosis - caused by ingestion of eggs
infection by what causes cysts in liver?
- what happens if the cysts burst?
Echinococcus granulosus
- anaphylactic reaction
what parasite is associated with squamous cell carcinoma of the bladder?
Schistosoma haematobium
what parasite is associated with cholangiocarcinoma?
Clonorchis sinensis
what nematodes are spread by ingestion?
you'll get sick if you EAT these:
Enterobius
Ascaris
Trichinella
nematodes that spread cutaneously
these get into your feet from the SANd:
Strongyloides
Ancylostoma
Necator
what parasite can cause vitamin B12 deficiency?
Diphyllobothrium latum
what parasites can cause microcytic anemia?
Ancylostoma and Necator
what parasite can cause perianal pruritis?
Enterobius
what organism causes typhoid fever?
Salmonella typhi
name 3 organisms that cause typhus (and what kind of typhus they cause)
Rickettsia prowazekii (epidemic)
Rickettsia typhi (endemic)
Rickettsia tsutsugamushi (scrub typhus)
live vs. killed vaccines - what type of immunity is induced?
live - humoral and cell-mediated immunity
killed - only humoral immunity
which viral vaccines are killed vaccines?
RIP Always:
Rabies
Influenza
Salk Polio
HAV
Sabin vs. Salk polio vaccines - which is killed, and which is live?
Sabin - live
SalK - Killed
are DNA viruses single-stranded or double-stranded?
- exception?
double-stranded
- parvovirus is exception ("part-of-a-virus")
are DNA viruses linear or circular?
- exceptions?
linear
- exceptions: papilloma, polyoma, hepadna are circular
are RNA viruses single-stranded or double-stranded?
- exception?
single-stranded
- exception: reovirus ("repeatovirus") is double-stranded
are viruses haploid or diploid?
- exception?
haploid
- exception: retroviruses are diploid
where do DNA viruses replicate?
- exception?
nucleus
- exception: poxvirus replicates in the cytoplasm
where do RNA viruses replicate?
- exceptions?
cytoplasm
- exceptions: influenza virus and retroviruses replicate in the nucleus
name the nonenveloped viruses (and whether they are DNA or RNA)
naked CPR and PAPP smear:
RNA: Calicivirus, Picornavirus, Reovirus
DNA: Parvovirus, Adenovirus, Papillomavirus, Polyomavirus
name the DNA viruses
HHAPPPPy:
Hepadna
Herpes
Adeno
Pox
Parvo
Papilloma
Polyoma
do DNA viruses have icosahedral or complex nucleocapsids?
- exception?
icosahedral
- exception: pox (complex)
name the herpesviruses
get herpes in a CHEVrolet:
CMV
HSV
EBV
VZV
what does the Tzanck test look for?
- what does it test for?
multinucleated giant cells
- HSV-1, HSV-2, VZV (Tzanck heavens I don't have herpes)
what viruses are paramyxoviruses?
PaRaMyxovirus:
Parainfluenza
RSV
Measles (rubeola)
Mumps
what is the treatment for RSV?
ribavirin
what RNA viruses are negative-stranded?
Always Bring Polymerase Or Fail Replication:
Arenavirus
Bunyavirus
Paramyxovirus
Orthomyxovirus
Filovirus
Rhabdovirus
what RNA viruses are segmented?
BOAR:
Bunyavirus
Orthomyxovirus
Arenavirus
Reovirus
what viruses are picornaviruses?
- RNA or DNA viruses?
PERCH on a peak (pico):
Poliovirus
Echovirus
Rhinovirus
Coxsackievirus
HAV
- RNA viruses (picoRNAvirus)
what disease does rhinovirus cause?
common cold (rhino has a runny nose)
what virus causes yellow fever?
flavivirus (flavi = yellow)
what disease does rotavirus cause?
infantile gastroenteritis (ROTA = RIght Out The Anus)
genetic drift vs. genetic shift - which causes epidemics and which pandemics of influenza virus?
drift - epidemics
shift - pandemics
(Sudden Shift is more deadly than graDual Drift)
what are the main symptoms of measles?
3 C's:
Cough, Coryza, Conjunctivitis + Koplik's spots
what are the main symptoms of mumps?
Parotitis, Orchitis, aseptic Meningitis
(make your parotid glands and testes as big as POM-poms)
name 3 arboviruses
- what are arboviruses?
ARBOvirus = ARthropod-BOrne virus
- Flavivirus, Togavirus, Bunyavirus (Fever Transmitted by Bites)
what type of infection does hepatitis A cause?
hep A:
usually Asymptomatic, Acute
how is hepatitis B transmitted?
hep B:
Blood-borne
what type of infection does hepatitis C cause?
- what are possible sequelae?
hep C:
Chronic infection
can cause Cirrhosis and Carcinoma
what does hepatitis D require to infect?
HBV
(hep D is Defective and Dependent on HBV)
how is hepatitis E transmitted?
- what patient population is particularly at risk?
hep E:
Enteric (can cause Epidemics)
Expectant mothers (pregnant women) have high mortality
which hepatitis viruses are transmitted by fecal-oral route?
hepatitis A and E ("the vowels hit your bowels")
what does ABcAb indicate?
IgM HBcAb - recent disease
IgG HBcAb - chronic disease
what does HBeAb indicate?
HBeAb = low transmissibility
(HBeAg = high transmissibility - Beware!)
what receptors does HIV virus bind on T cells?
- on macrophages?
T cells - CD4 and CXCR4
macrophages - CD4 and CCR5
4 stages of HIV infection
1 - Flulike (acute)
2 - Feeling fine (latent)
3 - Falling CD4 count
4 - Final crisis (AIDS)
what is Bacillus cereus contracted from?
reheated rice (food poisoning from reheated rice? Be serious/B. cereus!)
4 most common causes of pneumonia in children
Runts May Cough Sputum:
RSV
Mycoplasma
Chlamydia pneumoniae
Streptococcus pneumoniae
most common cause of pneumonia in hospitalized and immunocompromised patients
Staphylococcus
most common cause of aspiration pneumonia
anaerobes
most common cause of osteomyelitis in diabetics and drug addicts
Pseudomonas aeruginosa
most common cause of osteomyelitis in sickle cell patients
Salmonella
name 7 bacteria that cause UTIs
SSEEK PP:
Serratia marcescens
Staphylococcus saprophyticus
Escherichia coli
Enterobacter cloacae
Klebsiella pneumoniae
Proteus mirabilis
Pseudomonas aeruginosa
name 6 infections that are transmitted in utero or during birth
ToRCHeS:
Toxoplasma gondii
Rubella
CMV
HIV
HSV-2
Syphilis
what organism causes a painful genital ulcer?
Haemophilus ducreyi (it's so painful, you do cry)
what is Fitz-Hugh-Curtis syndrome a complication of?
- what are the characteristics?
PID
- infection of liver capsule with "violin string" adhesions to parietal peritoneum
what is the most common nosocomial infection caused by respiratory therapy equipment?
Pseudomonas AERuginosa (involves AIR)
name 6 bacteriostatic antibiotics
we're ECSTaTiC about bacteriostatics:
Erythromycin
Clindamycin
Sulfamethoxazole
Trimethoprim
Tetracyclines
Chloramphenicol
name 6 bactericidal antibiotics
Very Finely Proficient At Cell Murder:
Vancomycin
Fluoroquinolones
Penicillin
Aminoglycosides
Cephalosporins
Metronidazole
penicillin - mechanism of action?
- toxicity?
blocks transpeptidase cross-linking of cell wall
- hypersensitivity reaction
what class of drugs are methicillin, nafcillin, and dicloxacillin?
- what bacteria are they used for?
- side effect of methicillin?
penicillinase-resistant penicillins
- S. aureus (but not MRSA)
- interstitial nephritis
what class of drugs are ampicillin and amoxicillin?
- which has greater oral bioavailability?
- what Gram-negative rods do they kill?
aminopenicillins - extended spectrum (AMPed up penicillin)
- amOxicillin has greater Oral bioavailability
- HELPS kill enterococci: Haemophilus influenzae, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella
name 3 antipseudomonal penicillins
Ticarcillin, Carbenicillin, Piperacillin (TCP = Takes Care of Pseudomonas)
what Gram-negatives are covered by 1st generation cephalosporins?
- by 2nd generation?
1st: PEcK = Proteus mirabilis, E. coli, Klebsiella pneumoniae
2nd: HEN PEcKS = Haemophilus influenzae, Enterobacter aerogenes, Neisseria, Proteus mirabilis, E. coli, Klebsiella pneumoniae, Serratia marcescens
side effect of cephalosporins
disulfiram-like reaction with ethanol
beta-lactamase-resistant monobactam
- what does it treat?
- who is it used for?
aztreonam
- Gram-negative rods
- penicillin-allergic patients
what is imipenem always administered with?
- why?
cilastatin - inhibits renal dihydropeptidase I and decreases renal inactivation of imipenem (with imipenem, the kill is LASTIN with ciLASTATIN)
side effects of carbapenems
seizures, GI distress, rash
vancomycin - mechanism of action?
- side effects?
binds D-Ala-D-Ala on cell wall and blocks cell wall mucopeptide formation
- NOT many: Nephrotoxicity, Ototoxicity, Thrombophlebitis, red man syndrome
what antibiotics block 30S and 50S ribosomal subunits?
buy AT 30, CCELL at 50:
30S: Aminoglycosides, Tetracyclines
50S: Chloramphenicol, Clindamycin, Erythromycin, Lincomycin, Linezolid
name 5 aminoglycosides
- mechanism of action?
- anaerobe coverage?
- side effects?
mean GNATS: Gentamycin, Neomycin, Amikacin, Tobramycin, Streptomycin
- inhibit formation of 30S initiation complex
- no anaerobe coverage
- canNOT kill anaerobes: Nephrotoxicity, Ototoxicity, Teratogen
uses of demeclocycline
antibiotic
ADH antagonist (Demeclocycline = Diuretic in SIADH)
tetracyclines - mechanism of action?
- what are they used for?
- side effects?
block attachment of aminoacyl-tRNA to 30S
- VACUUM THe BedRoom: Vibro cholerae, Acne, Chlamydia, Ureaplasma Urealyticum, Mycoplasma pneumoniae, Tularemia, H. pylori, Borrelia burgdorferi, Rickettsia
- discolor teeth and inhibit bone growth, photosensitivity
which tetracycline can be used in patients with renal failure? why?
doxycycline - fecally eliminated
chloramphenicol - mechanism of action?
- use?
- side effects?
blocks 50S peptidyltransferase activity
- meningitis
- aplastic anemia, gray baby syndrome
what two drugs are mainly used to treat anaerobes, and where?
clindamycin - for anaerobes above the diaphragm
metronidazole - for anaerobes below the diaphragm
clindamycin - mechanism of action?
- use?
- side effect?
blocks 50S peptide bond formation
- anaerobes
- pseudomembranous colitis
sulfonamides - mechanism of action?
- side effects?
inhibit dihydropteroate synthetase (involved in folate synthesis)
- hemolysis in G6PD deficiency, nephrotoxicity, photosensitivity
trimethoprim - mechanism of action?
- side effect? how can it be alleviated?
inhibits dihydrofolate reductase (folate synthesis)
- bone marrow suppression (TMP = Treats Marrow Poorly) - alleviate with folinic acid
fluoroquinolones - mechanism of action?
- side effects?
inhibit DNA gyrase
- damage to cartilage, tendonitis, tendon rupture (fluoroquinoLONES hurt attachments to your BONES)
what bacteria are treated with metronidazole?
- side effects?
GET GAP on the metro:
Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes, H. Pylori
- disulfiram-like reaction with alcohol, metallic taste
polymyxins - mechanism of action?
- side effects?
act like detergents - bind and disrupt cell membranes of bacteria ('MYXins MIX up membranes)
- neurotoxicity, acute renal tubular necrosis
solo prophylaxis against M. tuberculosis
isoniazid
anti-TB drugs
- side effect for all?
- side effect of ethambutol?
INH-SPIRE: Streptomycin, Pyrazinamide, Isoniazid, Rifampin, Ethambutol
- hepatotoxicity
- ethambutol causes red-green color blindness
isoniazid - mechanism of action?
- side effects?
blocks synthesis of mycolic acids
- neurotoxicity, hepatotoxicity (INH Injures Neurons and Hepatocytes)
rifampin - mechanism of action?
- side effects?
4 R's:
RNA polymerase inhibitor
Revs up microsomal P-450
Red/orange body fluids
Rapid resistance if used alone
treatment of MRSA
vancomycin
treatment of vancomycin-resistant enterococcus
linezolid and streptogramins (quinupristin/dalfopristin)
amphotericin B - mechanism of action?
- side effects?
binds ergosterol and forms membrane pores (amphotericin "tears" holes in the membrane)
- fever/chills, nephrotoxicity, arrhythmias, anemia, IV phlebitis
nystatin - mechanism of action?
binds ergosterol and disrupts fungal membranes
azoles - mechanism of action?
- side effects?
inhibit fungal ergosterol synthesis
- gynecomastia, inhibit cytochrome P-450
what drug is used to treat cryptococcal meningitis? why?
fluconazole - can cross blood-brain barrier
flucytosine - mechanism of action?
- use?
- side effect?
blocks DNA synthesis
- systemic fungal infections
- bone marrow suppression
caspofungin - mechanism of action?
blocks synthesis of beta-glucan (part of fungal cell wall)
terbinafine - mechanism of action?
inhibits fungal squalene epoxidase (part of ergosterol synthesis)
griseofulvin - mechanism of action?
blocks mitosis by interfering with microtubule function
amantadine - mechanism of action?
- used to treat?
- side effects?
blocks viral uncoating (a man to dine takes off his coat), increases dopamine release
- Amantadine - used to treat influenza A and rubellA and Parkinson's
- ataxia, slurred speech (causes problems with the cerebellA)
zanamavir/oseltamavir - mechanism of action?
inhibit influenza neuraminidase
ribavirin - mechanism of action?
- used for?
- side effect?
inhibits IMP dehydrogenase (blocks nucleotide synthesis)
- RSV, chronic hepatitis C
- hemolytic anemia
acyclovir - mechanism of action?
- used for?
GTP analog - inhibits viral DNA polymerase
- HSV, VZV, EBV
ganciclovir - mechanism of action?
- used for?
- side effects?
GTP analog - inhibits viral DNA polymerase
- CMV
- leukopenia, neutropenia, thrombocytopenia
foscarnet - mechanism of action?
- how is it unlike acyclovir and ganciclovir?
- side effect?
pyrophosphate analog (FOScarnet = pyroFOSphate analot) - viral DNA polymerase inhibitor
- does not need to be activated by viral kinase to work
- nephrotoxic
what class of drugs are saquinavir, ritonavir, indinavir, etc.?
- side effects?
HIV protease inhibitors (NAVIR TEASE a proTEASE)
- hyperglycemia, lipodystrophy
what class of drugs are zidovudine, didanosine, zalcitabine, stavudine, etc.?
HIV nucleoside reverse transcriptase inhibitors (have you dined/vudine with my nuclear/nucleoside family?)
name 3 HIV non-nucleoside reverse transcriptase inhibitors
Never Ever Deliver nucleosides:
Nevirapine
Efavirenz
Delavirdine
side effects of HIV reverse transcriptase inhibitors
bone marrow suppression, peripheral neuropathy, lactic acidosis, rash, megaloblastic anemia
name an HIV fusion inhibitor
- mechanism of action?
enfuvirtide - binds viral gp41 and blocks conformational change necessary for fusion with CD4
antibiotics to avoid in pregnancy
SAFE Moms Take Really Good Care:
Sulfonamides
Aminoglycosides
Fluoroquinolones
Erythromycin
Metronidazole
Tetracyclines
Ribavirin
Griseofulvin
Chloramphenicol
where do T cells and B cells mature?
T cells = Thymus
B cells = Bone marrow
what HLA genes encode MHC I?
- MHC II?
MHC I - A, B, C (HLA I letter)
MHC II - DR, DP, DQ (HLA II letters)
location of MHC I vs. II
MHC I - on all nucleated cells
MHC II - only on APCs
cytotoxic vs. helper T cells - which has CD4 and which has CD8?
- which MHC class do they each bind to?
cytotoxic T cells - CD8 (binds MHC I)
helper T cells - CD4 (binds MHC II)
(product of CD and MHC = 8)
what are the 2 signals needed for Th cell activation?
1. MHC II presents antigen to TCR
2. B7 on APC binds CD28 on T cell
what are the 2 signals needed for Tc cell activation?
1. MHC I presents antigen to TCR
2. IL-2 from Th cell signals Tc cell to kill
what are the 2 signals needed for B cell class switching?
1. IL-4, IL-5, or IL-6 from Th2 cell
2. CD40 receptor on B cell binds CD40 ligand on Th cell
characteristics of Fc portion of antibody
Constant
Carboxy terminal of heavy chain
Complement-binding area
Carbohydrate side chains
3 functions of antibodies
1. opsonization
2. neutralization
3. complement activation (enhances opsonization and lysis of antigen)
which immunoglobulin is found in mucous membrane secretions?
IgA
which immunoglobulin can be a dimer?
- which a pentamer?
dimer: IgA
pentamer: IgM
which immunoglobulin mediates type I hypersensitivity?
IgE
what is an Ig allotype?
- isotype?
- idiotype?
allotype - epitope that differs among members of the same species (ALLotypes = different ALLeles)
isotype - epitope common to a single class of Ig
idiotype - epitope determined by antigen-binding site
what is a thymus-independent antigen?
- what type of Ig is secreted in response?
no peptide component
- IgM only (can't be presented on MHC to T cells, so no T cell activation of B cells for class switching)
what are the functions of IL-1-5?
hot T-Bone stEAk:
IL-1 - inflammatory response, fever (hot)
IL-2 - stimulates T cells
IL-3 - stimulates Bone marrow
IL-4 - stimulates IgE production
IL-5 - stimulates IgA production
what is the function of IL-8?
- what is it secreted by?
recruits neutrophils to clear infections (clean up on aisle 8)
- secreted by macrophages
what activates the classic complement pathway?
IgG or IgM (GM makes classic cars)
what is the function of decay-accelerating factor (DAF) and C1 esterase inhibitor?
- what does deficiency of each cause?
prevent complement activation on self-cells
- deficiency of C1 esterase inhibitor - hereditary angioedema
- deficiency of DAF - paroxysmal nocturnal hemoglobinuria (complement-mediated lysis of RBCs)
what is the function of C3b?
opsonization (C3b Binds Bacteria)
what is the function of C3a and C5a?
C3a, C5a - Anaphylaxis
what does deficiency of C5-C8 predispose to?
Neisseria bacteremia
what are the functions of interferons?
interferons interfere with virus activity in uninfected cells:
- alpha- and beta-interferons cause production of viral protein-inhibiting ribonuclease
- gamma-interferons stimulate MHC I and II expression
- also activate NK cells
with what infections are patients given preformed antibodies (passive immunity)?
given antibodies To Be Healed Rapidly:
Tetanus toxin
Botulinum toxin
HBV
Rabies virus
what cytokine plays a major role in granulomas?
- what secretes it?
- what does it do?
IFN-gamma
- secreted by Th1 cells
- stimulates macrophages
what are the 4 types of hypersensitivity reactions?
ACID:
I - Anaphylactic and Atopic
II - Cytotoxic (antibody-mediated)
III - Immune complex
IV - Delayed (cell-mediated)
what is serum sickness?
- what type of hypersensitivity reaction?
- how is the Arthus reaction different?
antibodies to foreign serum protein or drug form - immune complexes deposit in tissues and fix complement - tissue damage
- type III hypersensitivity
- Arthus reaction - local intradermal injection of antigen, so complexes formed locally in skin
what initiates type IV hypersensitivity reactions?
- give 3 examples
4 T's:
T lymphocytes
- Transplant rejections, TB skin tests, Touching (contact dermatitis)
what is the defect in Bruton's agammaglobulinemia?
- what is the major symptom?
- what is the inheritance pattern?
defect in tyrosine kinase gene - causes decreased production of B cells
- recurrent Bacterial infections after maternal IgG levels decline
- X-linked recessive (affects Boys)
what is the defect in severe combined immunodeficiency?
defect in early stem-cell differentiation - decreased production of B and T cells
what causes hyper-IgM syndrome?
defect in CD40 ligand on Th2 cells - inability to class switch
what is the defect in Wiskott-Aldrich syndrome?
- what are the main symptoms?
defect in ability to mount IgM response - low IgM, high IgE and IgA (Aldrich)
- WIPE: recurrent Infections, thrombocytopenic Purpura, Eczema
what is the defect in Job's syndrome?
- symptoms?
failure of IFN-gamma production, so no neutrophil chemotaxis
- FATED: coarse Facies, cold staphylococcal Abscesses, retained primary Teeth, increased IgE, Dermatologic problems
what is the defect in Chediak-Higashi syndrome?
defect in microtubule function and thus lysosomal emptying of phagocytic cells
what is the defect in chronic granulomatous disease?
lack of NADPH oxidase - defect in microbicidal activity of neutrophils
what is the defect in chronic mucocutaneous candidiasis?
T-cell dysfunction, specifically against Candida albicans
what is the defect in ataxia-telangiectasia?
defect in DNA repair enzymes with associated IgA deficiency
what is the defect in common variable immunodeficiency?
defect in B cell maturation - normal number of circulating B cells, but decreased plasma cells
what diseases are associated with HLA-B27?
PAIR:
Psoriasis
Ankylosing spondylitis
Inflammatory bowel disease
Reiter's syndrome
cyclosporine - mechanism of action?
- side effects?
inhibits calcineurin, preventing production of IL-2 (blocks T cell activation)
- susceptibility to infection, nephrotoxic
tacrolimus - mechanism of action?
- side effects?
binds FK-binding protein, inhibiting IL-2 secretion (blocks T cell activation)
- nephrotoxic, peripheral neuropathy
azathioprine - mechanism of action?
- side effects?
- what is the effect of simultaneous allopurinol?
blocks nucleic acid synthesis - toxic to proliferating lymphocytes
- bone marrow suppression
- increased toxicity (since drug is metabolized by xanthine oxidase)
muromonab - mechanism of action?
binds CD3 on T cell surface and blocks T cell signal transduction
sirolimus - mechanism of action?
- side effects?
binds mTOR and blocks T cell proliferation in response to IL-2
- hyperlipidemia, thrombocytopenia, leukopenia
mycophenolate mofetil - mechanism of action?
inhibits de novo guanine synthesis - blocks lymphocyte production
daclizumab - mechanism of action?
binds IL-2 receptor on activated T cells
loading dose equation
- maintenance dose equation
loading = Cp x Vd/F
maintenance = Cp x Cl/F
name 3 zero-order elimination drugs
PEA (pea is round, like 0):
Phenytoin
Ethanol
Aspirin
therapeutic index equation
TILE:
TI = LD50/ED50
(LD50 = median lethal dose, ED50 = median effective dose)
what G-protein class is associated with each receptor type?
qiss and qiq till you're siq of sqs:
qiss = alpha1, alpha2, beta1, beta2
qiq = M1, M2, M3
siq = D1, D2, H1
sqs = H2, V1, V2
bethanechol - mechanism of action?
- used for?
muscarinic agonist
- used for postoperative ileus and urinary retention - activates Bowel and Bladder smooth muscle (Beth Anne, call me if you want to activate your Bowels and Bladder)
pilocarpine - mechanism of action?
- used for?
muscarinic agonist
- stimulates sweat, tears, saliva (PILocarpine - PILE on the sweat and tears)
methacholine - mechanism of action?
- used for?
muscarinic agonist
- challenge test for diagnosing asthma (bronchoconstricts)
neostigmine and pyridostigmine - mechanism of action?
- used for?
- CNS penetration?
anticholinesterases
- myasthenia gravis
- NO CNS penetration (NEO CNS)
physostigmine - mechanism of action?
- used for?
anticholinesterase
- glaucoma (PHYS is for EYES)
echothiophate - mechanism of action?
- used for?
anticholinesterase
- glaucoma
symptoms of cholinesterase inhibitor poisoning
- what is the antidote?
DUMBBELSS:
Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating, Salivation
- antidote: atropine + pralidoxime (regenerates cholinesterase)
benztropine - mechanism of action?
- used for?
muscarinic antagonist
- PARKinson's disease (PARK my BENZ)
scopolamine - mechanism of action?
- used for?
muscarinic antagonist
- motion sickness
ipratropium - mechanism of action?
- used for?
muscarinic antagonist
- asthma, COPD (I pray/ipra- I can breathe soon)
oxybutynin, glycopyrrolate - mechanism of action?
- used for?
muscarinic antagonists
- reduce bladder urgency/spasms
methscopolamine, pirenzepine, propantheline - mechanism of action?
- used for?
muscarinic antagonists
- peptic ulcer treatment
atropine - mechanism of action?
- side effects?
muscarinic antagonist
- hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter
hexamethonium - mechanism of action?
nicotinic antagonist (put a HEX on smokers/nicotine) - ganglionic blocker
what are low doses of epinephrine selective for?
beta1 receptors (Blow - low = beta1)
what is norepinephrine selective for?
alpha > beta1 (NO beta2 activity)
what is isoproterenol selective for?
beta receptors only
dobutamine - mechanism of action?
beta1 agonist
phenylephrine - mechanism of action?
alpha1 agonist
albuterol and terbutaline - mechanism of action?
beta2 agonists
ritodrine - mechanism of action?
- used for?
beta2 agonist
- reduces premature uterine contractions
amphetamine and ephedrine - mechanism of action?
indirect sympathetic agonists - release stored catecholamines
cocaine - mechanism of action?
indirect sympathetic agonist - catecholamine uptake inhibitor
clonidine and alpha-methyldopa - mechanism of action?
- used for?
alpha2 agonists
- hypertension
name 4 selective beta2 agonists
MAST:
Metaproterenol
Albuterol
Salmeterol
Terbutaline
phenoxybenzamine and phentolamine - mechanism of action?
- used for?
- what is the difference?
nonselective alpha blockers
- pheochromocytoma
- phenoxybenzamine is irreversible, phentolamine is reversible
prazosin, terazosin, doxazosin - mechanism of action?
selective alpha1 blockers
mirtazapine - mechanism of action?
- used for?
selective alpha2 blocker
- depression
name 5 selective beta1 antagonists
A BEAM of beta1 blockers:
Acebutolol
Betaxolol
Esmolol
Atenolol
Metoprolol
name 2 non-selective alpha and beta antagonists
carvedilol, labetalol
name 2 partial beta agonists
Partial beta Agonists:
Pindolol
Acebutolol
antidote for methemoglobin toxicity
METHylene blue (for METHemoglobin), vitamin C
symptoms of lead poisoning
- treatment?
LEAD:
Lead Lines on gingivae (Burton's lines)
Encephalopathy, Erythrocyte basophilic stippling
Abdominal colic, sideroblastic Anemia
Drops (wrist and foot drop)
- treatment: dimercaprol and EDTA, succimer for kids (it sucks to be a kid with lead poisoning)
drugs that cause atropine-like side effects
tricyclics
name 2 drugs that cause coronary vasospasm
cocaine, sumatriptan
drugs that cause cutaneous flushing
niacin, calcium channel blockers, adenosine, vancomycin
name 2 drugs that cause dilated cardiomyopathy
doxorubicin, daunorubicin
drugs that cause torsades de pointes
class III (sotalol) and IA (quinidine) antiarrhythmics, cisapride
name 5 drugs that cause agranulocytosis
clozapine, carbamazepine, colchicine, propylthiouracil, methimazole
drugs that cause aplastic anemia
chloramphenicol, benzene, NSAIDs, propylthiouracil, methimazole
what drug causes a direct Coombs-positive hemolytic anemia?
methyldopa
what drug causes gray baby syndrome?
chloramphenicol
drugs that cause hemolysis in G6PD deficient patients
hemolysis IS PAIN:
Isoniazid
Sulfonamides
Primaquine
Aspirin
Ibuprofen
Nitrofurantoin
drugs that cause megaloblastic anemia
having a blast with PMS:
Phenytoin
Methotrexate
Sulfa drugs
what drugs cause thrombotic complications?
OCPs (estrogens/progestins)
what drugs cause cough?
ACE inhibitors
name 3 drugs that cause pulmonary fibrosis
bleomycin, busulfan, amiodarone
what drugs cause acute cholestatic hepatitis?
macrolides
name 3 drugs that cause hepatic necrosis
halothane, valproic acid, acetaminophen
what drug causes hepatitis?
isoniazid
name 2 drugs that cause pseudomembranous colitis
clindamycin, ampicillin
name 6 drugs that cause gynecomastia
Some Drugs Create Awesome Knockers:
Spironolactone
Digitalis
Cimetidine
Alcohol
Ketoconazole
estrogens
name 2 drugs that cause hot flashes
tamoxifen, clomiphene
what drug causes gingival hyperplasia?
phenytoin
what drugs cause gout?
furosemide, thiazides
what drugs cause osteoporosis?
corticosteroids, heparin
what drugs cause photosensitivity?
SAT for a photo:
Sulfonamides
Amiodarone
Tetracycline
what drugs cause Stevens-Johnson syndrome?
ethosuximide, lamotrigine, carbamazepine, phenobarbital, phenytoin, sulfa drugs, penicillin, allopurinol
name 4 drugs that cause SLE-like syndrome
it's not HIPP to have lupus:
Hydralazine
Isoniazid
Procainamide
Phenytoin
what drugs cause tendonitis, tendon rupture, and cartilage damage?
fluoroquinolones
what drug causes Fanconi's syndrome?
expired tetracycline
what drugs cause interstitial nephritis?
methicillin, NSAIDs, furosemide
name 2 drugs that cause hemorrhagic cystitis
- how can you prevent this?
cyclophosphamide, ifosfamide
- prevent with mesna
name 2 drugs that cause cinchonism
quinidine, quinine
name 2 drugs that cause diabetes insipidus
lithium, demeclocycline
name 4 drugs that cause a Parkinson-like syndrome
haloperidol, chlorpromazine, reserpine, metoclopramide
name 3 drugs that cause seizures
bupropion, imipenem/cilastatin, isoniazid
what drugs cause tardive dyskinesia?
antipsychotics
what drugs cause a disulfiram-like reaction?
metronidazole, 1st generation sulfonylureas, certain cephalosporins, procarbazine
what drugs are nephrotoxic and neurotoxic?
polymyxins
what drugs are nephrotoxic and ototoxic?
aminoglycosides, vancomycin, loop diuretics, cisplatin
name 7 drugs that are P-450 inducers
Queen Barb Steals Phen-phen and Refuses Greasy Carbs:
Quinidine
Barbiturates
St. John's wort
Phenytoin
Rifampin
Griseofulvin
Carbamazine
name 6 drugs that are P-450 inhibitors
inhibit yourself from drinking from a KEG because you'll get SICk:
Sulfonamides
Isoniazid
Cimetidine
Ketoconazole
Erythromycin
Grapefruit juice
transudate vs. exudate
transudate is hypocellular and protein poor
exudate is cellular and protein rich
what receptors mediate tight neutrophil binding to endothelium?
ICAM-1 on endothelium binds integrin on leukocyte
(hold on tight to your CAMera)
what is AL amyloid derived from?
- AA amyloid?
- A-CAL amyloid?
AL = Light chains (multiple myeloma)
AA = Acute-phase reactant (chronic inflammatory disease)
A-CAL = calcitonin (medullary carcinoma of the thyroid)
tumor grade vs. stage
- which is more prognostic?
grade = degree of differentiation
Stage = degree of Spread
- stage is more prognostic
what tumor type is l-myc gene associated with?
L-myc = Lung tumor
what tumor type is n-myc gene associated with?
N-myc = Neuroblastoma
what gene is associated with melanoma? what chromosome is it on?
p16 on 9p (melaNoma is on Nine)
what chromosome is NF2 on?
22q (type 2 = 22)
what cancer is DPC gene associated with?
pancreatic cancer (Deleted in Pancreatic Cancer)
what cancer is DCC gene associated with?
colon cancer (Deleted in Colon Cancer)
what tumor types are associated with elevated beta-hCG?
HCG:
Hydatidiform moles
Choriocarcinomas
Gestational trophoblastic tumors
what does TRAP stain test for?
hairy cell leukemia (TRAP the hairy animal)
name 4 tumors that have psammoma bodies
PSaMMoma:
Papillary adenocarcinoma of thyroid
Serous papillary cystadenocarcinoma of ovary
Meningioma
Mesothelioma
what primary tumors metastasize to brain?
Lots of Bad Stuff Kills Glia:
Lung, Breast, Skin, Kidney, GI
what primary tumors metastasize to liver?
Cancer Sometimes Penetrates Benign Liver:
Colon, Stomach, Pancreas, Breast, Lung
what primary tumors metastasize to bone?
- are lung, prostate, and breast tumors osteoblastic or osteolytic?
P.T. Barnum Loves Kids:
Prostate, Thyroid, Testes, Breast, Lung, Kidney
- Lung = Lytic
- prostate = blastic
- Breast = Both
case-control vs. cohort study
- do they use odds ratio or relative risk?
case-control - compare group with disease to those without (retrospective)
- odds ratio
cohort - compare group with risk factor to those without (prospective)
- relative risk
sensitivity vs. specificity
sensitivity - how well a test identifies truly ill people (SNOUT - rules OUT)
specificity - how well a test identifies truly well people (SPIN - rules IN)
positive predictive value vs. negative predictive value
PPV - proportion of positive tests that are true positives
NPV - proportion of negative tests that are true negatives
prevalence vs. incidence
prevalence = percent of people affected in a population
incidence = new incidents in a given time period/total population at risk
type I vs. type II error
type I (alpha) - saying that there is a difference when none exists (you "saw" a difference)
type II (beta) - saying there is not a difference when one exists (you did not "see" a difference)
t-test vs. ANOVA vs. chi-squared
t-test - difference between 2 means
ANOVA - difference between 3+ means
chi-squared - difference between percentages or proportions of categorical outcomes (not means)
types of disease prevention
PDR:
primary - Prevent disease occurrence
secondary - Detect disease early
tertiary - Reduce disability from disease
name some reportable diseases
Hep Hep Hep Hooray, the SSSMMART Chick is Gone:
Hep A, Hep B, Hep C
HIV
Salmonella, Shigella, Syphilis
Measles, Mumps
AIDS
Rubella
Tuberculosis
Chickenpox
Gonorrhea
4 things required for a malpractice claim to be valid
4 D's:
Duty of physician to patient
Dereliction - physician breached duty
Damage to patient
Direct - breach of duty caused harm directly
what does Apgar score evaluate?
Appearance, Pulse, Grimace, Activity, Respiration
what are the verbal milestones at age 2?
200 words and 2 word sentences at age 2
at what age does toilet training take place?
age 3 (pee at age 3)
how many blocks can be stacked at 1, 2, and 3 years?
3 at age 1, 6 at age 2, 9 at age 3 (age in years x 3)
at what age can a child ride a tricycle?
age 3 (3-cycle)
what are the Kubler-Ross grief stages?
Denial, Anger, Bargaining, Grieving, Acceptance
(Death Arrives Bringing Grave Adjustments)
what EEG waveforms are associated with the different sleep stages?
BATS Drink Blood:
Beta - awake, eyes open
Alpha - awake, eyes closed
Theta - stage 1 (light sleep)
Sleep spindles/K complexes - stage 2 (deeper)
Delta - stage 3-4 (deepest)
Beta - REM
name 5 causes of eosinophilia
NAACP:
Neoplastic
Asthma
Allergic processes
Collagen vascular diseases
Parasites
what is the defect in factor V Leiden?
mutant factor V that cannot be degraded by protein C - thrombosis
functions of von Willebrand factor
mediates linking of platelet Gp1b receptor to subendothelial collagen
carries and protects factor VIII
function of GpIIb/IIIa receptor on platelets
- what upregulates it?
platelet cohesion - binds fibrinogen and links platelets together
- ADP binding to platelet
function of protein C
with protein S, cleaves and inactivates factors V and VIII
name 4 diseases that have target cells
"HALT," said the hunter to his target:
HbC disease
Asplenia
Liver disease
Thalassemia
name 4 diseases that have basophilic stippling:
TAIL:
Thalassemias
Anemia of chronic disease
Iron deficiency
Lead poisoning
what are Howell-Jolly bodies?
- when are they seen?
nuclear remnants in RBCs
- asplenia or hyposplenia
what enzymes are affected in lead poisoning?
ferrochelatase and ALA dehydratase
what enzyme is affected in acute intermittent porphyria?
uroporphyrinogen I synthase
what enzyme is affected in porphyria cutanea tarda?
uroporphyrinogen decarboxylase
what are the symptoms of porphyria?
5 P's:
Painful abdomen, Pink urine, Polyneuropathy, Psychological disturbances, Precipitated by drugs
warm and cold agglutinins - which Ig type are they each associated with?
warm = IgG (warm weather is Great)
cold = IgM (cold ice cream - MMM)
name 7 causes of DIC
STOP Making New Thrombi:
Sepsis
Trauma
Obstetric complications
acute Pancreatitis
Malignancy
Nephrotic syndrome
Transfusion
what is the defect in ITP?
anti-GpIIb/IIIa antibodies cause platelet destruction
what is the defect in TTP?
defect in vWF-cleaving enzyme - large vWF multimers increase platelet aggregation
what is the defect in hemophilia A?
factor VIII deficiency
what is the defect in hemophilia B?
factor IX deficiency
extrinsic vs. intrinsic coagulation cascade - which bleeding time test is used to test each?
extrinsic = PT
intrinsic = PTT
what is the defect in Glanzmann's thrombasthenia?
decreased GpIIb/IIIa
what is the defect in Bernard-Soulier disease?
decreased Gp1b
which type of Hodgkin's lymphoma is associated with very high numbers of Reed-Sternberg cells?
mixed cellularity type
symptoms of multiple myeloma
CRAB:
hyperCalcemia
Renal insufficiency
Anemia
Bone/Back pain
which leukemia is TdT+?
ALL (marker of pre-T and pre-B cells)
which leukemia response to all-trans retinoic acid?
- why?
AML - induces differentiation of myeloblasts
which leukemia has smudge cells?
CLL
what distinguishes leukemoid reaction from leukemia?
leukocyte alkaline phosphatase level (only secreted by normal benign leukocytes - so only in leukemoid reaction)
what is the defect in Langerhans cell histiocytoses?
- what is a characteristic EM finding?
proliferative disorder of dendritic cells (Langerhans cells)
- Birbeck granules (look like tennis rackets)
what condition are teardrop cells found in?
myelofibrosis
heparin - mechanism of action?
- side effects?
- use what to rapidly reverse?
activates antithrombin III
- bleeding, HIT
- protamine sulfate
what tests are used to monitor heparin and warfarin?
heparin - PTT
warfarin - PT (the EX-PresidenT went to WAR)
lepirudin and bivalirudin - mechanism of action?
- used for?
directly inhibit thrombin
- HIT (heparin alternative)
warfarin - mechanism of action?
- side effects?
- use what to rapidly reverse?
inferferes with gamma-carboxylation of vitamin K-dependent clotting factors
- teratogenic, skin/tissue necrosis
- vitamin K and fresh frozen plasma
name 3 thrombolytics
- mechanism of action?
- treat toxicity with what?
streptokinase, urokinase, tPA
- aid conversion of plasminogen to plasmin
- aminocaproic acid
clopidogrel and ticlopidine - mechanism of action?
- side effect of ticlopidine?
block ADP receptors, preventing GpIIb/IIIa expression
- neutropenia
abciximab - mechanism of action?
binds and blocks GpIIb/IIIa
methotrexate - mechanism of action?
- used for?
- side effect? reverse with?
inhibits dihydrofolate reductase, blocking nucleotide synthesis
- cancer, abortion, autoimmune diseases
- myelosuppression - reverse with leucovorin
5-fluorouracil - mechanism of action?
- side effect? reverse with?
inhibits thymidylate synthase, blocking nucleotide synthesis
- myelosuppression - reverse with thymidine
6-mercaptopurine - mechanism of action?
- metabolized by?
blocks purine synthesis
- xanthine oxidase
cytarabine - mechanism of action?
inhibits DNA polymerase
cyclophosphamide and ifosfamide - mechanism of action?
- side effects? reverse with?
alkylating agents (cross-link DNA)
- myelosuppression, hemorrhagic cystitis - reverse latter with mesna
carmustine, lomustine, semustine - class?
- mechanism of action?
- used for?
nitrosoureas
- alkylate DNA
- brain tumors (cross blood-brain barrier)
cisplatin and carboplatin - mechanism of action?
- side effects?
cross-link DNA
- nephrotoxic and ototoxic
busulfan - mechanism of action?
- side effect?
alkylates DNA
- pulmonary fibrosis
doxorubicin and daunorubicin - mechanism of action?
- side effect?
intercalate in DNA
- dilated cardiomyopathy
dactinomycin - mechanism of action?
- used for?
intercalates in DNA
- childhood tumors (kids ACT out - dACTinomycin)
bleomycin - mechanism of action?
- side effect?
forms free radicals, causing DNA breaks
- pulmonary fibrosis
hydroxyurea - mechanism of action?
- used for?
inhibits ribonucleotide reductase, blocking DNA synthesis
- cancer, sickle cell anemia
etoposide - mechanism of action?
blocks topoisomerase II
prednisone - side effects?
Cushing-like symptoms
tamoxifen and raloxifene - mechanism of action?
- used for?
- side effect of tamoxifen?
estrogen receptor antagonists in breast
- estrogen-positive breast cancers
- increased risk of endometrial carcinoma (partial agonist effect)
trastuzumab - mechanism of action?
- used for?
monoclonal antibody against HER-2
- HER-2-positive breast cancer
imatinib - mechanism of action?
bcr-abl tyrosine kinase inhibitor
vincristine and vinblastine - mechanism of action?
- side effects?
block microtubule polymerization, blocking mitotic spindle
- vincristine - neurotoxic
- vinBLASTine - myelosuppression (BLASTs Bone marrow)
paclitaxel - mechanism of action?
block microtubule depolymerization (mitotic spindle can't break down)
structures in carotid sheath
internal jugular vein
common carotid artery
vagus nerve
relationship between resistance and viscosity, length and vessel radius
directly related to viscosity and length
inversely related to radius^4
what is wide S2 splitting associated with?
pulmonic stenosis (delayed RV emptying)
what is fixed S2 splitting associated with?
ASD (increased flow through pulmonic valve)
what is paradoxical S2 splitting associated with?
- what occurs on inspiration?
aortic stenosis (delayed LV emptying)
- P2 and A2 move closer together, eliminating the split
murmur increases in intensity on inspiration - which side is the defect?
right side (more blood flows into RA)
murmur increases in intensity on expiration - which side is the defect?
left side (more blood flows into LA)
what causes U wave in EKG?
hypokalemia, bradycardia
what is the characteristic EKG finding in Wolff-Parkinson-White syndrome?
- what causes it?
delta wave
- ventricles begin to depolarize early due to accessory bundle of Kent that bypasses AV node
treatment for atrial fibrillation?
warfarin
1st degree AV block
prolonged PR interval
2nd degree AV block - Mobitz type I and II
- which is Wenckebach?
type I = Wenckebach - progressive lengthening of PR interval until a QRS is dropped
type II - no lengthening of PR interval, but occasional dropped beats
3rd degree AV block
atria and ventricles beat independently of each other
(P waves have no relation to QRS waves)
Cushing triad
- what is it a sign of?
hypertension, reflex bradycardia, respiratory depression
- sign of increased intracranial pressure (constricts arterioles - cerebral hypoperfusion - sympathetic response causes HTN)
name the 5 right-to-left congenital shunts in the heart
5 T's:
Truncus arteriosus
Transposition of the great vessels
Tricuspid atresia
Tetralogy of Fallot
Total anomalous pulmonary venous return
left-to-right shunts and right-to-left shunts in the heart - which has early vs. late cyanosis?
right-to-left - early cyanosis
left-to-right - late cyanosis
what is Eisenmenger's syndrome?
reversal of a left-to-right shunt due to progressive pulmonary hypertension
what are the elements of tetralogy of Fallot?
PROVe:
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
VSD
location of infantile vs. adult coarctation of the aorta
INfantile = proximal to ductus arteriosus (IN close to heart)
aDult = Distal to Ductus arteriosus
what is Prinzmetal's angina?
angina at rest due to coronary artery spasm
what causes red infarcts?
hemorrhagic - occur in tissues with collateral circulation (liver, lungs, etc.) or due to REperfusion injury (REd)
what is the most specific and long-lasting marker of MI?
troponin
what is Dressler's syndrome?
autoimmune fibrinous pericarditis several weeks post-MI
causes of dilated cardiomyopathy
Alcohol abuse
Beriberi
Coxsackie B
Cocaine use
Chagas' disease
Doxorubicin toxicity
which type of dysfunction (systolic or diastolic) does each type of cardiomyopathy cause?
dilated - systolic
hypertrophic - diastolic
restrictive - diastolic
name 6 types of emboli
FAT BAT:
Fat
Air
Thrombus
Bacteria
Amniotic fluid
Tumor
what causes acute vs. subacute endocarditis?
- normal or previously damaged heart valves?
acute - S. aureus, affects previously normal valves
subacute - viridans strep, affects abnormal or diseased valves
symptoms of bacterial endocarditis
FROM JANE:
Fever
Roth's spots
Osler's nodes
Murmur
Janeway lesions
Anemia
Nail-bed hemorrhage
Emboli
what is Libman-Sacks endocarditis?
verrucous, sterile endocarditis associated with lupus (SLE causes LSE)
symptoms of rheumatic heart disease
FEVERSS:
Fever
Erythema marginatum
Valve damage
ESR increased
Red-hot joints (migratory polyarthritis)
Subcutaneous nodules (Aschoff bodies), St. Vitus' dance (chorea)
pulsus paradoxus (Kussmaul's pulse) - what is it, and what is it a sign of?
pulse decreases during inspiration
- due to compression of heart by cardiac tamponade, pericarditis, etc.
triad of findings in Wegener's granulomatosis
- marker of disease?
- treatment?
vasculitis, granulomas in lung, glomerulonephritis
- c-ANCA
- cyclophosphamide and corticosteroids
what are the p-ANCA vasculitides, and what are their characteristics?
microscopic polyangiitis - like Wegener's, but no granulomas
Churg-Strauss syndrome - granulomatous with eosinophilia
what are the symptoms of Sturge-Weber disease?
port-wine stain on face
leptomeningeal angiomatosis
what is the distinguishing feature of Henoch-Schonlein purpura?
- what organs are affected?
IgA
- affects skin, joints, GI
what size vessels are affected by Buerger's disease?
- what patients does it affect?
small and medium vessels
- heavy smokers
what patients are affected by Kawasaki disease?
- what is a common sequela?
kids, Asians
- coronary aneurysm
what is polyarteritis nodosa?
- what disease is it associated with?
immune complex inflammation of medium-sized muscular arteries
- hepatitis B
what is Takayasu's arteritis?
- symptoms?
granulomatous thickening of aortic arch/proximal great vessels ("pulseless disease")
- FAN MY SKIN On Wednesday: Fever, Arthritis, Night sweats, MYalgia, SKIN nodules, Ocular disturbances, Weak pulses
reserpine and guanethidine - mechanism of action?
- used for?
decrease norepinephrine release
- hypertension
losartan - mechanism of action?
angiotensin II receptor blocker
hydralazine - mechanism of action?
- affects arterioles or veins more?
- used for?
- side effects?
increases cGMP, causing smooth muscle relaxation
- arterioles
- hypertension
- lupus-like syndrome, compensatory tachycardia
minoxidil - mechanism of action?
- used for?
- side effect?
opens K+ channels, hyperpolarizing and relaxing smooth muscle
- hypertension
- hypertrichosis
name 3 calcium channel blockers
- mechanism of action?
- which has strongest effect on vasculature, and which on heart?
- side effects?
nifedipine, verapamil, diltiazem
- block voltage-dependent calcium channels of cardiac and smooth muscle
- vasculature = nifedipine, heart = verapamil
- cardiac depression, peripheral edema, constipation
nitroglycerin - mechanism of action?
- does it affect arteries or veins more?
releases NO in smooth muscle, increasing cGMP and relaxing
- veins (decreases preload)
nitroprusside - mechanism of action?
- used for?
releases NO, increasing cGMP and relaxing smooth muscle
- malignant hypertension
fenoldopam - mechanism of action?
- used for?
D1 receptor agonist - relaxes renal vascular smooth muscle
- malignant hypertension
diazoxide - mechanism of action?
- used for?
K+ channel opener - hyperpolarizes and relaxes vascular smooth muscle
- malignant hypertension
statins - mechanism of action?
- side effects?
HMG-CoA reductase inhibitors
- increased LFTs, rhabdomyolysis
niacin - mechanism of action?
- side effect?
inhibits adipose tissue lipolysis, reduces hepatic VLDL secretion
- flushing
cholestyramine, colestipol, colesevelam - mechanism of action?
- side effects?
- contraindicated in whom?
prevent intestinal reabsorption of bile acids, so liver must use cholesterol to make more
- GI discomfort, decreased absorption of fat-soluble vitamins
- patients with gallstones
ezetimibe - mechanism of action?
prevent cholesterol reabsorption in small intestine
gemfibrozil, clofibrate, fenofibrate - mechanism of action?
- side effects?
upregulate LPL, which degrades triglycerides in VLDL
- myositis, increased LFTs
digoxin - mechanism of action?
- effects increased by?
- antidote?
blocks Na+/K+-ATPase, causing increased Ca2+ in the cell (indirect inhibition of Na+/Ca2+ exchanger)
- renal failure, hypokalemia, quinidine
- normalize K+, lidocaine, anti-digoxin Fab fragments, Mg2+, cardiac pacer
class IA antiarrhythmics - name 3
- mechanism of action?
- effect on action potential duration?
- side effects?
Quinidine, Procainamide, Disopyramide (the Queen Proclaims Diso's pyramid)
- Na+ channel blockers
- increase AP duration
- quinidine - cinchonism, torsades de pointes
- procainamide - SLE-like syndrome
class IB antiarrhythmics - name 3
- mechanism of action?
- effect on action potential duration?
Lidocaine, Mexiletine, Tocainide (I'd Buy Lidy's Mexican Tacos)
- Na+ channel blockers
- decrease AP duration
class IC antiarrhythmics - name 3
- mechanism of action?
- effect on action potential duration?
flecainide, encainide, propafenone
- Na+ channel blockers
- no effect on AP duration
class II antiarrhythmics - mechanism of action?
- side effects?
beta-blockers, so block phosphorylation and activation of calcium channels
- asthma exacerbation, cardiovascular slowing, CNS sedation
class III antiarrhythmics - name 3
- mechanism of action?
- effect on action potential duration?
- side effects?
sotalol, ibutilide, amiodarone
- K+ channel blockers
- increase AP duration
- torsades de pointes; amiodarone - pulmonary fibrosis, hepatotoxicity, photodermatitis, blue corneas, hypo/hyperthyroidism (check PFTs, LFTs, and TFTs when using amiodarone)
class IV antiarrhythmics - name 2
- mechanism of action?
- side effects?
verapamil, diltiazem
- Ca2+ channel blockers
- constipation, CV slowing
adenosine - mechanism of action?
- used for?
increases K+ efflux from cells, hyperpolarizing
- AV nodal arrhythmias
spatial relationship of pulmonary artery to bronchus in each lung hilum
pulmonary artery is RALS - Right Anterior, Left Superior
spinal levels of structures perforating diaphragm
T8: IVC
T10: esophagus, vagus
T12: aorta, thoracic duct, azygous vein
(I 8 10 eggs at 12)
innervation of diaphragm
C3,4,5 (keeps the diaphragm alive) - phrenic nerve
muscles of inspiration during exercise
inSpiration = external intercostals, Scalene muscles, Sternomastoids
which form of hemoglobin has higher O2 affinity?
R (relaxed) form
(when you're Relaxed, you do your job better - carry O2)
left and right shifts in the oxygen hemoglobin curve are associated with what changes in O2 affinity?
left shift = increased affinity
right shift = decreased affinity
what gene is mutated in primary pulmonary hypertension?
- what does it normally do?
BMPR2 - normally inhibits vascular smooth muscle proliferation
in which situation does 100% O2 improve PO2 - airway obstruction or blood flow obstruction?
blood flow obstruction
what is the defect in chronic bronchitis?
increased Reid index (hypertrophy of mucus-secreting glands in bronchioles)
chronic bronchitis vs. emphysema - which has early and which has late-onset hypoxemia?
chronic bronchitis - early-onset (due to shunting because of mucus obstruction)
emphysema - late-onset (due to eventual loss of capillary beds)
obstructive vs. restrictive lung disease - high or low FEV1/FVC ratio?
obstructive - low FEV1/FVC
restrictive - high FEV1/FVC
what is the defect in neonatal respiratory distress syndrome?
surfactant deficiency
what is the defect in acute respiratory distress syndrome?
alveolar damage by many different causes leads to protein-rich leakage into air spaces
bronchial obstruction vs. tension pneumothorax - which way does the trachea deviate?
bronchial obstruction - toward lesion
tension pneumothorax - away from lesion
complications of lung cancer
SPHERE of complications:
Superior vena cava syndrome
Pancoast's tumor
Horner's syndrome
Endocrine (paraneoplastic)
Recurrent laryngeal symptoms (hoarseness)
Effusions (pleural or pericardial)
squamous cell carcinoma of lung - location?
- major risk factor?
- paraneoplastic syndrome?
central (Squamous = Sentral)
- Smoking
- PTH-related peptide
most common lung cancer in females and nonsmokers
adenocarcinoma
small cell carcinoma of lung - location?
- paraneoplastic syndromes?
central (Small = Sentral)
- ACTH or ADH, Lambert-Eaton syndrome
what do carcinoid tumors secrete?
serotonin
Pancoast's tumor - location?
- consequence?
apex of lung
- compresses cervical sympathetic plexus, causing Horner's syndrome
name 3 1st generation H1 blockers
- side effects?
diphenhydramine, dimenhydrinate, chlorpheniramine
- sedation, antimuscarinic, anti-alpha-adrenergic
name 3 2nd generation H1 blockers
- advantage over 1st generation?
loratadine, fexofenadine, cetirizine
- less sedating - decreased entry into CNS
which beta2-agonist is used in acute asthma attacks vs. long-term control?
albuterol - acute
salmeterol - long-acting
theophylline - mechanism of action?
- side effects?
inhibits phosphodiesterase, decreasing cAMP hydrolysis - so increased cAMP leads to bronchodilation
- cardiotoxic, neurotoxic
cromolyn - mechanism of action?
- used for?
prevents release of mast cell contents
- asthma prophylaxis (not acute attacks)
zileuton - mechanism of action?
- used for?
blocks conversion of arachidonic acid to leukotrienes
- asthma
zafirlukast, montelukast - mechanism of action?
- used for?
block leukotriene receptors
- asthma
guaifenesin - used for?
expectorant - removes excess sputum
what is secreted by each layer of the adrenal glands?
zona glomerulosa - aldosterone (salt)
zona fasciculata - cortisol (sugar)
zona reticularis - sex hormones (sex)
medulla - catecholamines
name the hormones secreted by the anterior pituitary
- which are secreted from basophils?
FLAT PiG - FSH, LH, ACTH, TSH, prolactin, GH
- B-flat - FSH, LH, ACTH, TSH are secreted by basophils
what hormones are secreted by the different pancreatic islet cells?
- where is each cell type located?
alpha - glucagon (peripheral)
beta - insulin (central - INSulin INSide)
delta - somatostatin (interspersed)
prolactin regulation - what upregulates it, what inhibits it, and what does it upregulate and inhibit?
upregulated by TRH
inhibited by dopamine
prolactin upregulates dopamine and inhibits GnRH
what does somatostatin do?
inhibits GH and TSH
what is secreted in 17-alpha hydroxylase deficiency?
- symptoms?
aldosterone
- hypertension, hypokalemia, pseudohermaphroditism (due to lack of testosterone)
what is secreted in 21-alpha hydroxylase deficiency?
- symptoms?
sex hormones
- masculinization, hypotension, hyperkalemia
what is secreted in 11-beta hydroxylase deficiency?
- symptoms?
sex hormones
- masculinization, hypertension (since 11-deoxycorticosterone can act like aldosterone)
what substances alter phosphate levels, and how?
PTH - increases phosphate excretion in kidney (Phosphate Trashing Hormone)
vitamin D - increases phosphate absorption in gut
what ions regulate PTH secretion, and how?
low Ca2+ - increased PTH
low Mg2+ - decreased PTH
where is calcitonin secreted from?
- function?
parafollicular (C) cells of thyroid
- decreases bone resorption (opposite of PTH) - calciTONin TONes down calcium levels
functions of T3
4 B's:
Brain maturation
Bone growth
Beta1-adrenergic effects
Basal metabolic rate increased
which endocrine hormones signal via cAMP?
FLAT CHAMP:
FSH, LH, ACTH, TSH
CRH, hCG, ADH, MSH, PTH
(+ calcitonin and glucagon)
which hormones signal via IP3?
GGOAT:
GnRH, GHRH
Oxytocin
ADH (V1 receptor)
TRH
treatment for Conn's syndrome
- why?
spironolactone - acts as an aldosterone antagonist
what is the defect in Sheehan's syndrome?
enlargement of anterior pituitary during pregnancy (increased lactotrophs) without increased blood supply - infarction of pituitary after severe bleeding of delivery
treatment for pheochromocytoma
phenoxybenzamine (irreversible alpha-antagonist)
symptoms of pheochromocytoma
5 P's:
elevated blood Pressure
Pain (headache)
Perspiration
Palpitations
Pallor
rule of 10's for pheochromocytoma
10% malignant
10% bilateral
10% extra-adrenal
10% calcify
10% kids
10% familial
tumors of MEN 1, 2A, and 2B
MEN 1: Parathyroid, Pituitary, Pancreatic (3 P's)
MEN 2A: medullary thyroid carcinoma, Pheochromocytoma, Parathyroid (2 P's)
MEN 2B: medullary thyroid carcinoma, Pheochromocytoma, oral/intestinal ganglioneuromatosis (1 P)
what gene is mutated in MEN 2A and 2B?
ret oncogene
what diseases are associated with a tender and a non-tender thyroid?
tender - subacute thyroiditis (de Quervain's)
nontender - Hashimoto's thyroiditis
what is the defect in Riedel's thyroiditis?
thyroid replaced by fibrous tissue - hypothyroidism
Jod-Basedow phenomenon
thyrotoxicosis upon iodine replenishment in a patient with an iodine deficient goiter
characteristics of papillary thyroid carcinoma
ground-glass nuclei (Orphan Annie), psammoma bodies
what cell do medullary thyroid carcinomas derive from?
- what hormone do they produce?
parafollicular (C) cells
- calcitonin
symptoms of hyperparathyroidism
stones, bones, and groans:
hypercalcemia and hypercalciuria (renal stones)
bone resorption and increased alkaline phosphatase (bones)
weakness and constipation (groans)
what is the other name for osteitis fibrosa cystica?
- defect?
von Recklinghausen's syndrome
- cystic bone spaces filled with brown fibrous tissue
renal osteodystrophy - what is the defect?
renal disease causes secondary hyperparathyroidism, which causes bone lesions
what are the signs of hypoparathyroidism?
Chvostek's sign - tapping of facial nerve causes facial spasm
Trousseau's sign - occlusion of brachial artery causes carpal spasm
what is pseudohypoparathyroidism?
kidney is unresponsive to PTH
causes of hypercalcemia
CHIMPANZEES:
Calcium ingestion, Hyperparathyroid, Hyperthyroid, Iatrogenic, Multiple myeloma, Paget's disease, Addison's disease, Neoplasms, Zollinger-Ellison syndrome, Excess vitamin D or A, Sarcoidosis
treatment for prolactinoma
bromocriptine (dopamine agonist)
which HLA genes are associated with diabetes mellitus type 1?
HLA-DR3 and DR4
what is the cause of central vs. nephrogenic diabetes insipidus?
central - lack of ADH
nephrogenic - kidney is unresponsive to ADH
treatment for SIADH
demeclocycline (ADH antagonist)
rule of 1/3s for carcinoid tumors
1/3 metastasize
1/3 present with a 2nd malignancy
1/3 multiple
treatment for carcinoid syndrome
octreotide
what is the defect in Zollinger-Ellison syndrome?
gastrin-secreting tumor - causes recurrent ulcers
name 2 sulfonylureas
- mechanism of action?
- used for?
- side effects?
glyburide, glipizide
- close K+ channel in islet beta cell, depolarizing the cell and triggering insulin secretion
- type 2 diabetes
- hypoglycemia, disulfiram-like effect (1st generation)
metformin - used for?
- side effect?
type 1 and 2 diabetes
- lactic acidosis
pioglitazone and rosiglitazone - mechanism of action?
- side effects?
increase target cell's response to insulin
- edema, hepatotoxicity, CV toxicity
acarbose and miglitol - mechanism of action?
inhibit intestinal alpha-glucosidases, decreasing glucose absorption
pramlintide - mechanism of action?
decreases glucagon
exenatide - mechanism of action?
GLP-1 mimetic - increases insulin and decreases glucagon release
orlistat - mechanism of action?
- used for?
inhibits pancreatic lipases, decreasing fat metabolism (orlistat gets rid of fat)
- obesity
sibutramine - mechanism of action?
- used for?
serotonin and norepinephrine reuptake inhibitor
- obesity
propylthiouracil and methimazole - mechanism of action?
- used for?
- side effects?
inhibit organification and coupling of thyroid hormone synthesis (propylthiouracil also decreases conversion of T4 to T3)
- hyperthyroidism
- rash, agranulocytosis, aplastic anemia
levothyroxine and triiodothyronine - used for?
thyroxine replacement in hypothyroidism
demeclocycline - mechanism of action?
- used for?
- side effects?
ADH antagonist
- SIADH
- photosensitivity, abnormalities of bone and teeth (like all tetracyclines), diabetes insipidus
what nerve plexus is in the intestinal submucosa?
- in the muscularis externa?
- what do they each control?
Submucosa = Submucosal plexus (Meissner's)
- controls Secretions
Muscularis = Myenteric plexus (Auerbach's)
- controls Motility
structures that derive from foregut
- from midgut?
- from hindgut?
stomach to proximal duodenum + liver, gallbladder, pancreas
- distal duodenum to proximal 2/3 of transverse colon
- distal 1/3 of transverse colon to upper rectum
where are varices seen in portal hypertension?
gut, butt, and caput:
esophageal, internal hemorrhoids, and caput medusae
which liver zones are affected first in viral hepatitis vs. alcoholic hepatitis?
viral - periportal zone (virus reaches here from blood first)
alcoholic - centrilobular zone (most sensitive to toxic injury)
organization of vessels in femoral region
you go from lateral to medial to find your NAVEL:
femoral Nerve - femoral Artery - femoral Vein - Empty space - Lymphatics
what patients get indirect inguinal hernias?
- why?
infants - due to failure of processus vaginalis to close
what are the boundaries of Hesselbach's triangle?
- which type of hernia protrudes through here?
inferior epigastric artery, rectus abdominis, inguinal ligament
- direct inguinal hernias
indirect vs. direct inguinal hernias - what is the spatial relationship to the inferior epigastric vessels?
MDs don't LIe:
Medial to vessels = Direct
Lateral to vessels = Indirect
where do femoral hernias protrude?
- what patients get them?
below inguinal ligament lateral to pubic tubercle
- women
what do B/plasma cells in Peyer's patches secrete?
IgA - the Intra-gut Antibody
which salivary glands secrete most serous vs. most mucinous saliva?
parotid = Serous (on the Sides)
sublingual = Mucinous (in the Middle)
what is the function of cholecystokinin?
- what cells secrete it?
increased pancreatic secretion and gallbladder contraction
- secreted by I cells in small intestine
what is the function of secretin?
- what cells secrete it?
increased bicarbonate and bile secretion, decreased gastric acid secretion
- secreted by S cells in duodenum
what is the function of somatostatin?
inhibitory - decreases secretion of all GI fluids (anti-GH)
what is the function of glucose-dependent insulinotropic peptide?
- what cells secrete it?
decreases gastric acid secretion, increases insulin release
- secreted by K cells in small intestine
what is the function of vasoactive intestinal polypeptide (VIP)?
- where is it secreted from?
increased intestinal fluid secretion, relaxation of sphincters
- secreted from parasympathetic ganglia
what is the function of motilin?
produces migrating motor complexes in the fasting state
what is the defect in achalasia?
loss of myenteric plexus leads to failure of lower esophageal sphincter to relax
what is Boerhaave syndrome?
transmural esophageal rupture due to violent retching (Boerhaave = been-heaving)
what are the symptoms of Plummer-Vinson syndrome?
triad:
- dysphagia (esophageal webs)
- glossitis
- iron-deficiency anemia
risk factors for esophageal cancer
ABCDEF:
Alcohol, Achalasia
Barrett's esophagus
Cigarettes
Diverticula
Esophageal webs, Esophagitis
Familial
causes of Curling's vs. Cushing's ulcer in stomach
Curling's - burns lead to sloughing of mucosa (burned by the Curling iron)
Cushing's - brain injury leads to increased vagal stimulation and increased H+ production (always Cushion the brain)
chronic gastritis type A vs. type B - causes and location in stomach?
type A - Autoimmune (pernicious Anemia), affects Body
type B - due to H. pylori Bacteria, affects Antrum
what is the defect in Menetrier's disease?
gastric hypertrophy with atrophy of parietal cells (rugae look like brain gyri)
gastric vs. duodenal ulcers - associated with weight gain or weight loss? why?
Gastric ulcer - pain is Greater with meals, leading to weight loss
Duodenal ulcer - pain Decreases with meals, leading to weight gain
what are the features of Crohn's that distinguish it from ulcerative colitis?
old crone and a fat granny (creeping fat, granulomas) skipping (skip lesions) down a cobblestone road (cobblestone mucosa) away from the wreck (rectal sparing)
what is intussusception?
telescoping of 1 bowel segment into a distal segment
what is the defect in Hirschsprung's disease?
failure of neural crest cell migration causes lack of enteric nerve plexuses and leads to congenital megacolon proximal to aganglionic segment
what is the defect in meconium ileus?
- what patients does it affect?
meconium plug obstructs intestine
- cystic fibrosis patients
which type of colon polyps are more likely to be malignant?
villous (so villainous)
what is Gardner's syndrome?
FAP with osseous and soft tissue tumors and retinal hyperplasia
what is Turcot's syndrome?
FAP with brain involvement (TURcot = TURban)
alcoholic vs. viral hepatitis - which has higher ALT and which AST?
alcoholic - AST (toASTed)
viral - ALT
causes of micronodular vs. macronodular cirrhosis
micronodular - toxic insult (alcohol, iron, copper)
macronodular - significant injury and necrosis (infectious or drug-induced)
symptoms of Wilson's disease
- treatment?
ABCD:
Asterixis
Basal ganglia degeneration (parkinsonian)
Ceruloplasmin decreased, Cirrhosis, Corneal deposits, Copper accumulation, Carcinoma of liver, Choreiform movements
Dementia
- treat with penicillamine
symptoms of hemochromatosis
- treatment?
- which HLA is it associated with?
Hemochromatosis Can Cause Deposits:
Cirrhosis (micronodular)
CHF
Diabetes mellitus (bronze diabetes due to skin pigmentation)
- treat with phlebotomy and deferoxamine
- HLA-A3
Charcots triad of cholangitis
jaundice, fever, RUQ pain
causes of acute pancreatitis
GET SMASHeD:
Gallstones, Ethanol, Trauma
Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia/lipidemia, Drugs
what tumors are associated with CEA and CA-19-9 markers?
CEA - colorectal cancer
CEA and CA-19-9 - pancreatic cancer
what is Trousseau's syndrome, and what is it a sign of?
migratory thrombophlebitis (redness and tenderness in extremities)
- sign of pancreatic adenocarcinoma
what is Courvoisier's sign, and what does it indicate?
obstructive jaundice with a palpable gallbladder - sign of pancreatic adenocarcinoma
cimetidine, ranitidine, famotidine, nizatidine - mechanism of action?
- side effects of cimetidine?
H2 blockers - decrease H+ secretion by parietal cells
- P-450 inhibitor, antiandrogenic, decreased renal creatinine excretion
omeprazole, lansoprazole - mechanism of action?
gastric parietal cell proton pump inhibitors
bismuth, sucralfate - mechanism of action?
bind ulcer base and allow bicarbonate to reestablish pH gradient (protection)
triple therapy of H. pylori ulcers
metronidazole, amoxicillin/tetracycline, bismuth
misoprostol - mechanism of action?
- used for?
PGE1 analog - increases secretion of gastric mucus barrier
- prevent NSAID-induced peptic ulcers, maintain patent ductus arteriosus, induce labor
name 2 muscarinic antagonists used to treat peptic ulcers
pirenzipine, propantheline
aluminum hydroxide - used for?
- side effects?
antacid
- constipation (aluminimum amount of feces), proximal muscle weakness
magnesium hydroxide - used for?
- side effects?
antacid
- diarrhea (Mg = Must go to the bathroom), hyporeflexia, cardiac arrest
sulfasalazine - mechanism of action?
- used for?
- side effects?
antibacterial and anti-inflammatory
- IBD (both forms)
- malaise, sulfonamide toxicity, oligospermia
ondansetron - mechanism of action?
serotonin antagonist - anti-emetic
metoclopramide - mechanism of action?
- used for?
- side effect?
D2 receptor antagonist - increases contractility, sphincter tone, and motility in gut
- post-surgical gastroparesis
- parkinsonian symptoms
layers of epidermis
Californians Like Girls in String Bikinis:
stratum Corneum
stratum Lucidum
stratum Granulosum
stratum Spinosum
stratum Basale
unhappy triad knee injury
damage to medial collateral ligament, medial meniscus, and anterior cruciate ligament
what does positive anterior drawer sign indicate?
damage to ACL
what does abnormal passive abduction of the knee indicate?
damage to MCL
rotator cuff muscles
- what do they each do?
SITS:
Supraspinatus - abduction
Infraspinatus - lateral rotation
Teres minor - adduction and lateral rotation
Subscapularis - medial rotation and adduction
damage to which nerve causes "Saturday night palsy"?
radial nerve (compression of axilla)
proximal median nerve lesion causes what?
ape hand (can't oppose thumb)
distal median nerve lesion causes what?
Pope's blessing (median claw) when asked to bend fingers and ulnar deviation of wrist upon flexion
proximal ulnar nerve lesion causes what?
radial deviation of wrist upon flexion
distal ulnar nerve lesion causes what?
ulnar claw hand (Pope's blessing) when asked to straighten fingers
musculocutaneous nerve lesion causes what?
inability to flex arm at elbow
axillary nerve lesion causes what?
inability to abduct arm (deltoid muscle)
what causes Erb-Duchenne palsy?
lesion to upper trunk of brachial plexus (C5,6)
what causes Klumpke's palsy?
- what is the motor deficit?
lesion to lower trunk of brachial plexus (C8,T1)
- loss of lumbrical function - total claw hand (MCP joints extended, PIP and DIP flexed)
function of radial nerve
- what muscles does it innervate?
- what is the sign of a lesion?
great extensor nerve
- BEST: Brachioradialis, Extensors of wrist and fingers, Supinator, Triceps
- wrist drop
what muscles are contained in the thenar and hypothenar eminences?
OAF:
thenar - Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis
hypothenar - Opponens digiti minimi, Abductor digiti minimi, Flexor digiti minimi
function of dorsal vs. palmar interosseous muscles
PAD DAB:
Palmars ADduct
Dorsals ABduct
motor function of obturator nerve
thigh adduction
motor function of femoral nerve
thigh flexion and leg extension
motor function of common peroneal vs. tibial nerve
- what are the signs of damage?
PED:
Peroneal Everts and Dorsiflexes foot (if damaged, foot droPED)
TIP:
Tibial Inverts and Plantarflexes foot (if damaged, can't stand on TIPtoes)
motor function of superior gluteal nerve
- what symptom occurs if damaged?
thigh abduction
- positive Trendelenburg sign
type 1 vs. type 2 muscle fibers - what are the characteristics?
type 1 - slow twitch, red fibers, oxidative phosphorylation ("one slow red ox")
type 2 - fast twitch, white fibers, anaerobic glycolysis
what is the defect in osteopetrosis?
failure of normal bone resorption (abnormal osteoclasts) due to carbonic anhydrase deficiency
what is the defect in polyostotic fibrous dysplasia?
bone replaced by fibroblasts, collagen, irregular bony trabeculae
what is McCune-Albright syndrome?
polyostotic fibrous dysplasia + endocrine abnormalities (precocious puberty) and cafe-au-lait spots
giant cell tumor of bone - what cell type?
- located where?
- appearance on x-ray?
osteoclastoma
- epiphyseal ends of long bones
- soap bubble/double bubble
Ewing's sarcoma - what is it?
- appearance?
- chromosome translocation?
small blue cell tumor of bone
- onion-skin appearance (Ewings and onion rings)
- t(11;22)
what HLA type is rheumatoid arthritis associated with?
HLA-DR4
what are the symptoms of Sjogren's syndrome?
- diagnostic autoantibodies?
- how is Sicca syndrome different?
xerophthalmia (dry eyes), xerostomia (dry mouth), arthritis
- SS-A (Ro), SS-B (La)
- Sicca syndrome - dryness, but no arthritis
symptoms of Reiter's syndrome
conjunctivitis/uveitis, urethritis, arthritis ("can't see, can't pee, can't climb a tree")
what disease is associated with "pencil-in-cup" deformity?
psoriatic arthritis
symptoms of lupus
I'M DAMN SHARP:
Immunoglobulins (anti-dsDNA, anti-Sm), Malar rash
Discoid rash, ANA, Mucositis, Neurologic disorders
Serositis, Hematologic disorders, Arthritis, Renal disorders, Photosensitivity
characteristics of sarcoidosis
GRAIN:
Gammaglobulinemia
Rheumatoid arthritis
ACE increase
Interstitial fibrosis
Noncaseating granulomas
what is the defect in polymyositis?
- dermatomyositis?
- significant findings?
CD8+ T-cell injury to myofibers - progressive symmetric proximal muscle weakness
- dermatomyositis = polymyositis + malar/heliotrope rash, Gottron's papules
- increased CK, ANA, anti-Jo-1
what is the defect in myasthenia gravis?
- Lambert-Eaton syndrome?
- for each, do symptoms improve or worsen with muscle use?
autoantibodies to postsynaptic ACh receptors - worsens with muscle use
- autoantibodies to presynaptic Ca2+ channels - improves with muscle use
what disease is associated with anti-Scl-70 antibody (anti-DNA topoisomerase)?
diffuse scleroderma
symptoms of CREST syndrome
- what marker is it associated with?
Calcinosis
Raynaud's phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia
- antiCentromere antibody
what is Auspitz sign, and what is it associated with?
psoriasis - bleeding when scales are scraped off
what is the defect in albinism?
defect in tyrosinase, so unable to make melanin (normal number of melanocytes)
what is the defect in vitiligo?
patches with decreased number of melanocytes
what is melasma?
hyperpigmentation associated with pregnancy
honey-colored crusting - diagnosis?
impetigo
white painless plaques on tongue - diagnosis?
- caused by what?
hairy leukoplakia
- EBV
what is the defect in pemphigus vulgaris?
- what sign is associated with it?
- how is it different from bullous pemphigoid?
IgG auto-antibody against desmosomes
- Nikolsky's sign - separation of epidermis upon manual stroking
- bp = auto-antibodies against hemidesmosomes (Ab's are "bullow" the epidermis), negative Nikolsky
pruritic papules with deposits of IgA at the tips of the dermal papillae - diagnosis?
- associated with what disease?
dermatitis herpetiformis
- celiac disease
symptoms of lichen planus
- what disease is it associated with?
Pruritic Purple Polygonal Papules, Wickham's striae
- hepatitis C
main symptom of pityriasis rosea
herald patch followed by "Christmas tree" distribution
what is actinic keratosis a precursor to?
squamous cell carcinoma
function of LTB4
- what do other leukotrienes do?
neutrophil chemotaxis (neutrophils arrive B4 others)
- bronchoconstriction
function of PGI2
inhibits platelet aggregation, vasodilation (all opposite TXA2)
aspirin - mechanism of action?
- side effects?
irreversible COX inhibitor
- GI upset, Reye's syndrome, renal failure
NSAIDs - mechanism of action?
- use?
reversible COX inhibitors
- antipyretic, analgesic, anti-inflammatory
celecoxib - mechanism of action?
COX2 inhibitor, so less GI toxic than other NSAIDs
acetaminophen - mechanism of action?
- side effect? why? antidote?
reversible COX inhibitor
- hepatic necrosis (metabolite depletes glutathione) - antidote is N-acetylcysteine (regenerates glutathione)
activity of aspirin and acetaminophen, as compared to NSAIDs
acetaminophen = NSAID - anti-inflammatory
aspirin = NSAID + antiplatelet
etidronate, pamidronate, alendronate, risedronate - mechanism of action?
- used for?
bisphosphonates - inhibit osteoclast activity
- osteoporosis, Paget's disease of bone
colchicine - mechanism of action?
- used for?
depolymerizes microtubules, impairing leukocyte chemotaxis
- acute/chronic gout
probenecid - mechanism of action?
- used for?
inhibits uric acid reabsorption in proximal tubule
- chronic gout
allopurinol - mechanism of action?
- used for?
inhibits xanthine oxidase
- chronic gout, tumor lysis syndrome
etanercept - mechanism of action?
recombinant TNF receptor that sequesters TNF
(etanerCEPT is a TNF decoy reCEPTor)
infliximab - mechanism of action?
anti-TNF Ab
(INFLIXimab INFLIX pain on TNF)
what structures do ureters pass under?
uterine artery, ductus deferens
fluid compartments in body
60-40-20 rule:
60% total body water
40% intracellular
20% extracellular
clearance calculation
Cx = UxV/Px
how is GFR estimated?
- effective renal plasma flow?
GFR = inulin clearance (or creatinine clearance)
EPRF = PAH clearance
free water clearance calculation
CH2O = V-Cosm
Cosm = UosmV/Posm
does angiotensin II cause acidosis or alkalosis?
alkalosis - stimulates Na+/H+ exchange in proximal tubule, so H+ is excreted
effect of aldosterone in collecting tubules
inserts more Na+ channels to increase Na+ reabsorption
which segments of the kidney does PTH act on?
proximal tubule - inhibits Na+-phosphate cotransport
distal tubule - increases Ca2+/Na+ exchange
effect of prostaglandins on kidney
vasodilate afferent arterioles - increase GFR (this is why NSAIDs can cause acute renal failure
causes of anion gap metabolic acidosis
MUD PILES:
Methanol, Uremia, Diabetic ketoacidosis
Paraldehyde/Phenformin, Iron tablets/INH, Lactic acidosis, Ethylene glycol, Salicylates
what is the defect in type 1 renal tubular acidosis?
- type 2?
- type 4?
type 1 - defect in H+/K+-ATPase of collecting tubules, so can't secrete H+
type 2 - defect in proximal tubule bicarbonate absorption
type 4 - hypoaldosteronism
nephritic vs. nephrotic syndromes
nephrItic = Inflammatory (hematuria)
nephrOtic = massive prOteinuria
diffuse proliferative glomerulonephritis - associated with what?
- appearance on microscopy?
SLE
- wire looping of capillaries
membranous glomerulonephritis - associated with what?
- appearance on EM?
SLE
- spike and dome appearance
GBM splitting is associated with what diseases?
Alport's syndrome (nephritic)
membranoproliferative glomerulonephritis (nephrotic)
what disease is associated with subendothelial deposits in glomerulus?
lupus glomerulonephritis (diffuse proliferative glomerulonephritis)
mesangial deposits - diagnosis?
IgA nephropathy (Berger's disease)
what are struvite kidney stones caused by?
infection with urease-positive bacteria
are uric acid stones radiolucent or radiopaque?
Uric acid = radiolUcent
WAGR complex
Wilms' tumor
Aniridia
Genitourinary malformation
Retardation
risk factors for transitional cell carcinoma
Pee SAC:
Phenacetin
Smoking
Aniline dyes
Cyclophosphamide
conditions that cause renal papillary necrosis
diabetes mellitus
acute pyelonephritis
chronic phenacetin use
sickle cell anemia
does renal failure cause acidosis or alkalosis?
acidosis - failure to secrete H+ and reabsorb bicarbonate
what are the EKG findings in hyper- and hypokalemia?
hyperkalemia - peaked T waves
hypokalemia - U waves, flattened T waves
mannitol - mechanism of action?
osmotic diuretic - increases tubular fluid osmolarity, causing increased urine flow
acetazolamide - mechanism of action?
- used for?
- side effects?
carbonic anhydrase inhibitor - decreases bicarbonate reabsorption in proximal tubule
- glaucoma, metabolic alkalosis, altitude sickness
- metabolic ACIDosis (ACIDazolamide), sulfa allergy
furosemide - mechanism of action?
- side effects?
loop diuretic - inhibits Na+-K+-2Cl- cotransport in thick ascending limb, increases calcium excretion (Loops Lose calcium)
- OH DANG: Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa), Nephritis, Gout
ethacrynic acid - mechanism of action?
- used for?
same as loop diuretics - inhibits Na+-K+-2Cl- reabsorption in thick ascending limb
- diuresis in patients with sulfa allergies
hydrochlorothiazide - mechanism of action?
- side effects?
thiazide diuretic - inhibits NaCl reabsorption in distal tubule, decreases calcium excretion
- hypokalemia, metabolic alkalosis, hyperGLUC (hyperGlycemia, Lipidemia, Uricemia, Calcemia)
name 3 K+-sparing diuretics
- mechanisms of action?
- side effects?
Spironolactone, Triamterene, Amiloride (K+ STAys)
- spironolactone - aldosterone receptor antagonist in collecting duct
- triamterene and amiloride - block Na+ channels in collecting duct
- hyperkalemia, antiandrogen effects (spironolactone)
captopril, enalapril, lisinopril - mechanism of action?
- side effects?
ACE inhibitors
- CAPTOPRIL: Cough, Angioedema, Proteinuria, Taste changes, hypOtension, Pregnancy problems, Rash, Increased renin, Lower angiotensin II, hyperkalemia
embryologic origins of CNS, PNS, and microglia
CNS - neuroectoderm
PNS - neural crest
Microglia - Mesoderm (like Macrophages)
function of Meissner's corpuscles, Pacinian corpuscles, and Merkel's disks
Meissner's corpuscles - dynamic fine touch (adapt quickly)
Pacinian corpuscles - vibration and pressure
Merkel's disks - static touch (adapt slowly)
functions of hypothalamus
TAN HATS:
Thirst/water balance
Adenohypophysis control
Neurohypophysis control
Hunger
Autonomic regulation
Temperature regulation
Sexual urges
what does lateral area of hypothalamus control?
hunger (if lateral area is damaged, you shrink laterally - anorexia)
what does ventromedial area of hypothalamus control?
satiety (if ventromedial area is damaged, you grow ventrally and medially - hyperphagia)
what does anterior hypothalamus control?
- posterior hypothalamus?
cooling, pArasympathetic (A/C - anterior cooling)
- heating, sympathetic
what does septal nucleus of hypothalamus control?
Septal nucleus = Sexual urges
what does suprachiasmatic nucleus of hypothalamus control?
circadian rhythm
what do LGN and MGN of thalamus control?
LGN - vision (Lateral = Light)
MGN - auditory (Medial = Music)
what do VPL and VPM of thalamus control?
VPL - body sensation
VPM - facial sensation (you put Make-up on your face)
what do VA/VL nuclei of thalamus control?
motor (anterior to sensation, just like in cortex)
functions of limbic system
5 F's:
Feeding, Fleeing, Fighting, Feeling, and sex
functions of superior, middle, and inferior cerebellar peduncles
middle - receives contralateral cortical input
inferior - receives ipsilateral proprioceptive input
superior - output to contralateral cortex
name the cerebellar deep nuclei, from lateral to medial
Don't Eat Greasy Foods:
Dentate, Emboliform, Globose, Fastigial
which pathway in basal ganglia does each type of dopamine receptor act on?
D1 receptors stimulate the excitatory pathway
D2 receptors inhibit the inhibitory pathway
what is the defect in Parkinson's disease?
- symptoms?
- characteristic pathology?
degeneration and depigmentation of the substantia nigra pars compacta (loss of dopaminergic neurons - so decreased stimulation of basal ganglia)
- TRAP: Tremor at rest, cogwheel Rigidity, Postural instability
- Lewy bodies
what is the defect in hemiballismus?
contralateral subthalamic nucleus lesion - so loss of inhibition of thalamus
what is the defect in Huntington's disease?
expansion of CAG repeats - atrophy of caudate nucleus
what is athetosis?
- what is it characteristic of?
slow writhing movements of fingers
- basal ganglia lesion (Huntington's disease)
what is the cause of intention tremor?
cerebellar dysfunction
major symptom of frontal lobe damage
Damage = Disinhibition
what is the consequence of a parietal lobe lesion?
contralateral spatial neglect
what is the consequence of a lesion to the reticular activating system?
reduced levels of arousal and wakefulness
cerebellar hemispheres vs. vermis - which affects limbs vs. trunk?
- does damage affect contralateral or ipsilateral side?
hemispheres - laterally located, so affect lateral limbs
vermis - centrally located, so affect central body
- damage affects ipsilateral side
damage to paramedian pontine reticular formation vs. frontal eye fields - what is the major symptom?
PPRF - eyes look away from side of lesion
frontal eye fields - eyes look toward side of lesion
what is the result of damage to the hippocampus?
anterograde amnesia (unable to make new memories)
what causes Wallenberg's syndrome?
- symptoms?
PICA infarct
- nystagmus, ipsilateral ataxia, Horner's syndrome
what causes locked-in syndrome?
basilar artery infarct
what disease are Charcot-Bouchard microaneurysms associated with?
- what part of circulation do they affect?
chronic hypertension
- small deep vessels (basal ganglia, thalamus, etc.)
bloody or yellow spinal tap - diagnosis?
subarachnoid hemorrhage
what connects lateral ventricles to 3rd ventricle?
foramen of Monro
relative locations of foramina of Luschka and Magendie
Luschka = Lateral
Magendie = Medial
symptoms of hydrocephalus
dementia, gait problems, urinary incontinence
lower extent of spinal cord
- lower extent of subarachnoid space
- where should lumbar puncture be performed?
L1-L2
- S2
- between L3 and L5 (to keep the spinal cord alive)
organization of spinal tracts with respect to legs and arms
corticospinal and spinothalamic - Legs are Lateral
DC-ML - legs are medial, arms are lateral (peel off as you move down spinal cord)
lower muscle mass and tone, decreased reflexes, downgoing toe - UMN or LMN lesion?
LMN - everything lowered
what is the defect in poliomyelitis and Werdnig-Hoffman disease?
destruction of anterior horns of spinal cord - lower motor neuron lesion
what part of the spinal cord is spared in occlusion of the anterior spinal artery?
dorsal columns
what part of the spinal cord is affected in tabes dorsalis?
dorsal columns
what part of the spinal cord is affected in syringomyelia?
crossing fibers of spinothalamic tract (so bilateral loss of pain and temperature sense)
symptoms of Werdnig-Hoffman disease
floppy baby, tongue fasciculations (early death)
dermatome of the neck
C3
dermatome at the nipple
T4 (teat pore)
dermatome at the umbilicus
T10 (belly butTEN)
dermatome at the inguinal ligament
L1 (IL = inguinal ligament)
dermatome of the kneecaps
L4 (down on L4s)
innervation of the penis
S2,3,4 (keeps the penis off the floor)
function of muscle spindles vs. Golgi tendon organs
muscle spindles monitor muscle length - activate motor neurons when stretched
Golgi Tendon organs monitor muscle Tension - inhibit motor neurons
spinal levels of arm and leg reflexes
ankle - S1,2
knee - L3,4
biceps - C5,6
triceps - C7,8
cranial nerves that lie medially at brain stem
III, VI, XII
function of superior and inferior colliculi
superior - vertical gaze
inferior - auditory
(eyes are above ears)
what is the defect in Parinaud syndrome?
lesion in superior colliculi - so paralysis of conjugate vertical gaze
are CN I-XII sensory, motor, or both?
I, II - Sensory (Some Say)
III, IV - Motor (Marry Money)
V - Both (But)
VI - Motor (My)
VII - Both (Brother)
VIII - Sensory (Says)
IX, X - Both (Big Brains)
XI, XII - Motor (Matter Most)
what are the functions of the three vagal nuclei?
nucleus Solitarius - visceral Sensory information
nucleus aMbiguus - Motor innervation of pharynx, larynx, and esophagus
dorsal motor nucleus - autonomics to thorax
what openings in the skull do CN V divisions exit through?
CN V must exit due to Standing Room Only:
V1 - Superior orbital fissure
V2 - foramen Rotundum
V3 - foramen Ovale
what cranial nerves exit through the superior orbital fissure?
CN III, IV, V1, VI (all eye nerves except CN II)
what cranial nerves exit through the internal auditory meatus?
CN VII, VIII (ear nerves)
what cranial nerves exit through the jugular foramen?
CN IX, X, XI
what cranial nerves pass through the cavernous sinus?
- what are the symptoms of cavernous sinus syndrome?
CN III, IV, V1, V2, VI
- opthalmoplegia, ophthalmic and maxillary sensory losses (due to nerve compression)
symptoms of UMN vs. LMN facial lesion
UMN - contralateral paralysis of lower face only (upper face gets bilateral innervation)
LMN - ipsilateral paralysis of whole face
what is Bell's palsy a complication of?
ALexander graHam Bell with STD:
AIDS
Lyme disease
Herpes zoster
Sarcoidosis
Tumors
Diabetes
what muscles close the jaw?
- what muscle opens it?
close - Masseter, teMporalis, Medial pterygoid (M's Munch)
open - Lateral pterygoid (Lowers)
perilymph vs. endolymph - what is the predominant ion in each?
perilymph = Na+ (outside cell)
endolymph = K+ (inside cell)
which parts of inner ear detect linear vs. angular acceleration?
utricle and saccule - linear (contain maculae)
semicircular canals - Angular (contain Ampullae)
open vs. closed angle glaucoma - what is the difference, and which is painful?
open - obstructed outflow through canal of Schlemm (painless)
closed - obstruction of flow between lens and iris (painful)
down and out eye - diagnosis?
CN III damage
(since lateral rectus and superior oblique still functional)
what is strabismus?
misalignment of eyes
what is amblyopia?
reduction of vision due to disuse in critical period
innervation of pupillary constriction vs. dilation
constriction - CN III (parasympathetic)
dilation - T1 sympathetics
what is the Marcus Gunn pupil?
afferent pupillary defect, so decreased bilateral constriction when light is shone in affected eye
what are the functions of the outer and inner parts of CN III, and what can damage each part?
inner - carries output to ocular muscles (affected by vascular disease)
outer - carries parasympathetic output (affected by compression)
what is the defective protein in Lewy body dementia?
- symptoms?
alpha-synuclein defect
- parkinsonism + dementia and hallucinations
what is the defect in progressive multifocal leukoencephalopathy?
- what causes it?
demyelination of CNS
- JC virus
what is the defect in Charcot-Marie-Tooth disease?
hereditary defect in production of proteins needed for peripheral nerves/myelin sheath
stain for astrocytes (and astrocytomas)
GFAP
microscopic appearance of oligodendroglioma
fried egg cells with chicken-wire capillary pattern
Rosenthal fibers - diagnosis?
pilocytic astrocytoma
latanoprost - used for?
- mechanism of action?
- side effect?
glaucoma
- increases outflow of aqueous humor
- darkens iris
butorphanol - mechanism of action?
- what distinguishes it from other drugs in its class?
partial agonist at opioid mu receptors, agonist at kappa receptors
- less respiratory depression
tramadol - mechanism of action?
weak opioid agonist, inhibits serotonin and NE reuptake (works on multiple receptors - "tram it all" in)
phenytoin - mechanism of action?
- used for?
- side effects?
Na+ channel inactivation
- tonic-clonic seizures, prophylaxis of status epilepticus
- ataxia, gingival hyperplasia, hirsutism, teratogenic, megaloblastic anemia, SLE-like syndrome, P-450 induction
carbamazepine - mechanism of action?
- used for?
- side effects?
Na+ channel inactivation
- tonic-clonic seizures, partial seizures, trigeminal neuralgia
- agranulocytosis, aplastic anemia, liver toxicity, teratogenic, P-450 induction
lamotrigine - mechanism of action?
- side effect?
blocks voltage-gated Na+ channels
- Stevens-Johnson syndrome
gabapentin - mechanism of action?
- used for?
- side effects?
increases GABA release
- seizures, peripheral neuropathy
- sedation, ataxia
topiramate - mechanism of action?
- side effects?
blocks Na+ channels, increases GABA action
- sedation, kidney stones
phenobarbital - mechanism of action?
- what patients is it used for?
- side effects?
increases GABA action by increasing DURATion of Cl- channel opening (barbiDURATe)
- pregnant women, children
- sedation, P-450 induction
valproic acid - mechanism of action?
- used for?
- side effects?
Na+ channel inactivation, increases GABA concentration
- tonic-clonic seizures, myoclonic seizures
- hepatotoxicity, neural tube defects
ethosuximide - mechanism of action?
- used for?
- side effects?
blocks thalamic T-type Ca2+ channels
- absence seizures
- EFGH: Ethosuximide - Fatigue, GI distress, Headache, Stevens-Johnson syndrome
benzodiazepines - mechanism of action?
- used for?
- side effects?
- treat overdose with?
increase GABA action by increasing FREquency of Cl- channel opening (FREnzodiazepines)
- acute status epilepticus, seizures of eclampsia
- sedation, dependence
- flumazenil
name the short-acting benzodiazepines
- what is the problem with them?
TOM thumb: Triazolam, Oxazepam, Midazolam
- highest addictive potential
side effects of inhaled anesthetics
hepatotoxicity, nephrotoxicity, malignant hyperthermia
what drugs are used as intravenous anesthetics?
B.B. King on OPIATES PROPoses FOOLishly:
Barbiturates
Benzodiazepines
Ketamine
Opiates
Propofol
ketamine - mechanism of action?
- used for?
- side effects?
blocks NMDA receptors
- IV anesthetic
- hallucinations, bad dreams
what IV anesthetics are used for short surgical procedures?
thiopental, propofol
with anesthetics, what qualities do solubility in blood and lipids determine?
low blood solubility - rapid induction and recovery
high lipid solubility - high potency
name 3 ester-type and 3 amide-type local anesthetics
- mechanism of action?
- side effects?
esters - procaine, cocaine, tetracaine
amides - lIdocaIne, mepIvicaIne, bupIvacaIne (amIdes have 2 I's)
- block Na+ channels
- CNS excitation, CV toxicity, arrhythmias
order of loss of sensation types with local anesthetics
pain > temperature > touch > pressure
name 1 depolarizing neuromuscular blocker and 2 nondepolarizing neuromuscular blockers
depolarizing: succinylcholine
nondepolarizing: tubocurarine, pancuronium
dantrolene - used for?
- mechanism of action?
malignant hyperthermia, neuroleptic malignant syndrome
- prevents Ca2+ release from sarcoplasmic reticulum
name 3 dopamine agonists used in Parkinson's
bromocriptine, pramipexole, ropinirole
amantadine and L-dopa - mechanism of action?
- used for?
- side effect of L-dopa? what drug is given to reduce this?
increase dopamine in CNS
- Parkinson's
- arrhythmias from peripheral conversion to dopamine
- carbidopa inhibits peripheral conversion of L-dopa to dopamine
selegiline - mechanism of action?
- used for?
MAO-B inhibitor, preventing dopamine breakdown
- Parkinson's
entacapone, tolcapone - mechanism of action?
- used for?
COMT inhibitors, preventing dopamine breakdown
- Parkinson's
benztropine - mechanism of action?
- used for?
antimuscarinic
- Parkinson's - curbs excess cholinergic activity, improving tremor and rigidity
sumatriptan - mechanism of action?
- used for?
- side effect?
serotonin agonist - inhibits trigeminal activation and vasoactive peptide release
- migraines, cluster headaches
- coronary vasospasm
memantine - mechanism of action?
- used for?
NMDA receptor antagonist
- Alzheimer's
donepezil - mechanism of action?
- used for?
acetylcholinesterase inhibitor
- Alzheimer's
mature defense mechanisms
mature women wear a SASH:
Sublimation
Altruism
Suppression
Humor
what is conduct disorder?
- difference from oppositional defiant disorder?
repetitive behavior violating social norms in a child <18
- defiance toward authority, but no serious violations of social norms
autistic disorder vs. Asperger's disorder
autism - language and social impairment, below-normal intelligence
Asperger's - milder, no language impairment, normal intelligence
characteristics of Rett's disorder
loss of development, mental retardation, stereotyped hand-wringing
major characteristic of childhood disintegrative disorder
regression in multiple areas of functioning after at least 2 years of normal development
hypnagogic vs. hypnopompic hallucinations
hypnaGOgic - occur while GOing to sleep
hypnopompic - occur while waking from sleep
progression of schizophrenic diseases
<1 month - brief psychotic disorder
1-6 months - schizophreniform disorder
>6 months - schizophrenia
what is dissociative identity disorder?
2+ distinct identities or personalities (multiple personality disorder)
what is depersonalization disorder?
feelings of detachment from self
what is a dissociative fugue?
abrupt change in geographic location with inability to recall past, confusion about identity, or assumption of a new identity
characteristics of manic episode
maniacs DIG FAST:
Distractibility, Irresponsibility, Grandiosity
Flight of ideas, goal-directed Activity, Agitation, decreased need for Sleep, Talkativeness
mood stabilizers used in bipolar disorder
lithium, valproic acid, carbamazepine
symptoms of major depressive episode
SIG E CAPS:
Sleep disturbance, loss of Interest, Guilt
loss of Energy
loss of Concentration, Appetite changes, Psychomotor retardation or agitation, Suicidal ideations
depressed mood
symptoms of panic disorders
PANICS:
Palpitations, Paresthesias
Abdominal distress
Nausea
Intense fear of dying or losing control, lIghtheadedness
Chest pain, Chills, Choking, disConnectedness
Sweating, Shaking, Shortness of breath
what is malingering?
consciously faking a disorder in order to attain a specific gain
what is factitious disorder?
- 2 examples?
consciously creating symptoms in order to assume "sick role" and get medical attention
- Munchausen's syndrome and Munchausen's syndrome by proxy
what is conversion?
motor or sensory symptoms following an acute stressor
name the cluster A personality disorders
paranoid
schizoid
schizotypal
schizoid vs. schizotypal personality disorder?
schizoid - voluntary social withdrawal, limited emotional expression
schizotypal - eccentric appearance, magical thinking, interpersonal awkwardness
name the cluster B personality disorders
antisocial
borderline
histrionic
narcissistic
name the cluster C personality disorders
avoidant
obsessive-compulsive
dependent
name 4 types of depressant
alcohol, opioids, barbiturates, benzodiazepines
treatment for delirium tremens
benzodiazepines
name 4 stimulants
amphetamines, cocaine, caffeine, nicotine
name 3 hallucinogens
PCP, LSD, marijuana