586 terms

USMLE

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Urease (+) Organisms
P-CHUNKSS
P - proteus
C - cryptococcus
H - h. pylori
U - ureaplasma
N - Nocardia
K - Klebsiella
S - S. saprophyticus
S - S. epidermidis
Lactose Fermenting Organisms
CKEES
C - citrobacter
K - klebsiella
E - enterobacter
E - e. coli
S - serratia (weak)
#1 causes of meningitis in neonates
GBS
E. coli
Listeria
Causes of blood diarrhea
EHEC
EIEC
Campylobacter
Shigella
Salmonella
Y. enterolytica
E. histolytica
Causes of water diarrhea
Cholera
ETEC
C. difficile
C. perfringens
Giardia, Cryptosporidium
Rotavirus, Norovirus, Adenovirus
Toxoplasmosis Triad
1. chorioretinitis
2. hydrocephalus
3. intracranial calcifications
Rubella Triad
1. cataracts
2. deafness
3. PDA

Eyes, ears, congenital heart
Fitz-Hugh-Curtis syndrome
Perihepatic inflammation & fibrosis;
Complication of Chlamydia infection; violin strings
Retroperitoneal Organs
SAD PUCKER
S - suprarenal (adrenal) glands
A - aorta and IVC
D - duodenum (except 1st part)

P - pancreas (except tail)
U - ureters
C - colon (ascending and descending)
K - kidneys
E - esophagus
R - rectum
Kussmaul Sign
Increase in jugular venous pressure on inspiration (instead of normal decrease)
- constrictive pericarditis, restrictive cardiomyopathy, RA or ventricular tumors
ACE Inhibitor on the Arterioles
Vasodilates the efferent arteriole

Can be an issue with renal stenosis - lowers intraglomerular pressure which makes it hard to maintain GFR in reduced perfusion setting
Thayer Martin Agar
Selective agar for Neisseria
Contains vancomycin, nystatin, colistin and trimethoprim
Cutaneous Nematodes
Strongyloides
Necator
Ancyclostoma
Nematode bites
Loa loa
Onchocerca volvulus
Wuchereira bancrofti
Ingested nematodes
EATTT
E - enterobius (pinworm)
A - ascaris (giant roundworm, ileocecal valve obstruction)
T - toxocara
T - trichinella (muscles, mean)
T -trichuris (whipworm)
Naked Viruses
DNA
Papillomavirus (HPV)
Polyomavirus (JC virus)
Parvovirus (B19)
Adenovirus (conjunctivitis)

RNA
Picornavirus (PERC,HAV viruses)
Calciviruses (norovirus)
Reovirus (rotavirus)
Hepevirus (HEV)
DNA Viruses
Hepadnaviruses (partial ds + circular, HBV)
Herpesvirus
Poxvirus (ds linear smallpox, molluscum contagiosum)
Parvovirus (ss linear B19)

Adenovirus (ds linear)
Papillomavirus (ds circular HPV)
Polyomavirus (ds circular JC virus)
Paramyxovirus
-ssRNA, enveloped
Parainfluenza - croup
RSV - bronchiolitis
Measles
Mumps
Picornavirus
+ssRNA, small, naked
P - polio
E - echo (aseptic meningitis)
R - rhino (common cold)
C - coxsacie (herpangina, hand-foot-mouth, myo/pericarditis)
H - HAV (acute viral)
RNA viruses that don't replicate in the cytoplasm
Retrovirus, influenza virus
Culture Negative Endocarditis
Coxiella burnetti
Bartonella spp.
HACEK
T. whipplei
False Positive VDRL
Pregnancy
Viruses (EBV)
Drugs
Rheumatic fever
Leprosy, SLE
Bacterial with low infective dose
Shigella
Campylobacter
EIEC
Entameoba histolytica
Giardia
Pseudomonas Properties
Oxidase (+)
Motile
Non-lactose fermenter
Aerobic
Mucoid polysaccharide capsule
Grape-like odor
Pigments (proverdine, pyocyanin)
causes Ecthyma gangrenosum
Biofilm production
Exotoxin A - inactivates EF2
Gonorrhea Treatment
Ceftriaxone
(+ azithromycin or doxycycline for chlamydia)
Chlamydia Treatment
Azithromycin or Doxycycline
(+ ceftriazone for gonorrhea)
Actinomyces
Gram (+) anaerobe
- not acid fast
- normal to oral, repro and GI flora
- causes oral/facial abscesses that drain sinus tracts
- forms sulfur granules - yellow
Tx: penicillin
Avascular Necrosis causes
*CAST Bent LeGS"
Corticosteroids
Alcoholism
Sickle cell
Trauma
the Bends (Caisson disease)
Legg-Calvés-Perthes (idiopathic)
Gaucher disease
Slipped capital femoral epiphysis
Rheumatoid Factor
IgM antibody to Fc portion of IgG
Reactive Arthritis
Can't see, can't pee, can't climba tree
- conjunctivitis
- ureteritis
- arthritis

Causes by ShY ChiCS
Shigella
Yersina
Chlamydia
Campylobacter
Salmonella
Minute Ventilation
= TV x RR
Alveolar Ventilation
= (TV - dead space) x RR
Physiological Dead Space
Vd = Tidal Volume (Vt) x (PaCO - PeCO / PaCO)
Rett Syndrome
Female toddler who is normal, then regresses in speech and motor skills
- deceleration of head circumference
- purposeless hand movements
- MECP2 gene mutation
Lower Motor Neuron Signs
Fasciculations
Flaccid paralysis
Hypotonia
Hyporeflexia
Atrophy
Upper Motor Neuron Signs
(+) Babinski
Spastic paralysis
Hypertonia
Hyperreflexia
Clasp knife spasticity
(+) Babinski Sign
sign of UMN lesion
aka extensor sign
Lateral Medullary Syndrome
PICA affected
Nucleus ambiguous: dysphagia, hoarseness, ⬇️gag reflex
Vestibular nucleus: vomiting, vertigo, nystagmus
Lateral Spinothalamic tract: ⬇️P&T contralateral body
Spinal Trigeminal nucleus: ⬇️P&T ipsilateral face
SNS fibres: ipsilateral Horner Syndrome
Inferior Cerebellar Peduncle: ispilateral ataxia, dysmetria
Lateral Pontine Syndrome
AICA affected
Facial Nucleus: facial droop, ⬇️lacrimation, salivation, taste from anterior 2/3
Vestibular nucleus: vomiting, vertigo, nystagmus
Lateral Spinothalamic tract: ⬇️P&T contralateral body
Spinal Trigeminal nucleus: ⬇️P&T ipsilateral face
SNS fibres: ipsilateral Horner Syndrome
Middle & Inferior Cerebellar Peduncle: ispilateral ataxia, dysmetria
Labyrinthine artery: ipsilateral sensorineural deafness, vertigo
Neuroblastoma
Kids <2 years old
- adrenal medulla tumor (NCC origin)
- can occur anywhere along sympathetic chain
- opsoclonus-myoclonus syndrome (dancing eyes, dancing feet)
- increase in HVA, VMA
- homer-wright rosettes
- NSE (+)
- n-myc
- APUD tumor
Psoriasis Skin Changes
Hyperkeratosis (⬆️thickness of corneum)
Parakeratosis (retention of nu. in corneum)
Acathosis (epidermal hyperplasia, ⬆️ spinosum)
Polymyositis/Dermatomysitis
anti-Jo (histidyl tRNA synthetase)
anti-SSRP
anti-M1-2
P - endomysial inflammation with CD8+ T cells
D - perimysial inflammation with CD4+ T cells
H. Pylori Triple Therapy
Amoxicillin (or metronidazole)
+
PPI
+
Clarithromycin
Nocardia
Gram (+) anaerobe with long branching filaments
- weakly acid fast
- soil
- immunocompromised
- mimic TB with (-) PPD
Tx: TMP-SMX
Mixed Connective Tissue Disease
Anti-U1 RNP (speckled ANA)
Causes of Acute Pancreatitis
I GET SMASHED
I - idiopathic

G - gallstones
E - EtOH
T - trauma

S - steroids
M - mumps
A - autoimmune
S - scorpion sting
H - hypertriglyceridemia
H - hypercalcemia
E - ERCP
D - drugs
Tuberous Sclerosis
H - hamartomas of CNS, skin
A - angiofibroma (nodules on nose)
M - mitral regurgitation
A - angiomyolipoma (kidney)
R - rhabdomyoma
T - tuberous sclerosis
autOsomal dominant
M - mental retardation
M - mTOR mutation
A - ash leaf spots
S - Shagreen patches
S - seizures
Oseltamivir
Neuraminidase inhibitor
- Inhibition of virus maturation aka inhibits virion progeny release
Amantadine
Inhibition of viral uncoating (no longer used)
Sturge-Weber Syndrome
S - sporadic/somatic mutation
S - stain (port-wine stain, unliateral, V1/V2 region)
T - tram track calcifications (
U - unilateral stain/angioma (capillary venous malformation)
R - retardation
G - glaucoma
G - GNAQ gene (somatic mutation)
E - epilepsy
von Hippel Lindau Disease
VHL is a tumor suppressor gene - ubiquinates hypoxia inducible factor 1a
- chromosome 3
- both benign and malignant tumors
H - hemangioblastomas in retina, brain stem, cerebellum, spine
A - angiomatosis (cavernous hemangiomas)
R - renal cell carcinoma (bilateral)
P - pheochromocytomas
Neurofibromatosis
autosomal dominant, 100% penetrance, variable expressivity, tumor suppression gene that regulates RAS

NF1 - cafe-au-lait spots, neurofibromas, lisch nodules, optic gliomas, pheochromocytomas

NF2 (chromo 22) - bilateral schwannomas, cataracts, meningioma/ependymoma

Cx: malignancy, HTN
Sodium Hypochlorite
Active ingredient in household bleach
Inactivates naked viruses by denaturing proteins capsid
Norovirus
+ssRNA, naked virus, calcivirus
Cruise ships
Inactivated by Sodium Hypochlorite
Urogenital folds (labioscrotal folds)
Gives rise to ventral shaft of penis in men; and labia minora in women
Labioscrotal swelling
Gives rise to scrotum in men; and labia majora in women
Tay Sachs
Lysosomal enzyme missing: hexosaminidase A
Accumulation of: GM2 ganglioside
Symptoms:
Cherry red macular spot
Blindness
Mental retardation
Death <2
NO HSM
Onion skin lyosomes
Neimann Pick
Lysosomal enzyme missing: sphingomyelinase
Accumulation of: sphingomyelin
Symptoms:
Cherry red macular spot
HSM
Foam cells (lipid laden mø)
microcephaly
Gaucher
Lysosomal enzyme missing: Glucocerebrosidase
Accumulation of: glucocerebrosides
Symptoms:
Avascular necrosis of femur
Bone pain
HSM (adult onset)
pancytopenia
Tissue paper macrophages
Eaton agar
Enriched with cholesterol to grow mycoplasma pneumonia
COD for Infants
1. congenital
2. preterm birth
3. SIDS
COD for kids 1-4
1. unintended injury
2. cancer
3. congenital malformations
COD for young adults 15-34
1. Unintentional injury
2. suicide
3. homicide
COD for adults 35-44
1. unintentional injury
2. cancer
3. heart disease
COD for 45-65
1. cancer
2. heart disease
3. unintentional injury
COD for 65+
1. heart disease
2. cancer
3. chronic respiratory disease
Digoxin Toxicity
Predisposing factors:
- hypokalemia
- drugs - verapamil, quinidine, amiodarone (displace digoxin, and decrease clearance)
- renal failure
Pilocytic Astrocytoma
Most common brain tumor in kids
- benign
- most often found in posterior fossa (cerebellum)
- cystic and solid on imaging
- histo: rosenthal fibres (eosinophilic, corkscrew fibres)
Median Umbilical Ligament
Remnant of the allantois (btw bladder and umbilicus)
Medial Umbilical Ligament
Remnant of the umbilical arteries
Ejection Fraction
SV/EDV

DECREASED in systolic HF
Measurement of Plasma Volume
Use radiolabeled albumin
Measurement of ECF
Use mannitol or inulin
Eccrine Sweat Glands
Found everywhere
- post-ganglionic SNS cholinergic (ACh)
Apocrine Sweat Glands
Armpit, areola, perianal, ear canal
- post-ganglionic SNS adrenergic (E, NE)
Chromosome 3
- VHL
- RCC
Chromosome 4
- achondroplasia
- Huntington disease
- ADPKD(2)
Chromosome 5
- Cri-du-chat
- Familial adenomatous polyposis
Chromosome 6
Hemochromatosis
Chromosome 7
- Williams syndrome
- Cystic Fibrosis
Chromosome 9
- Friedreich ataxia
- Tuberous sclerosis (1)
Chromosome 11
- B-globin gene
- Wilm's tumor
- MEN1
Chromosome 13
- Patau Syndrome
- Wilson Disease
- Retinoblastoma (1)
- BRCA (2)
Chromosome 15
- Marfan Syndrome
- Angelman Syndrome
- Prader Willi Syndrome
Chromosome 16
- alpha globin genes
- ADPKD (1)
- Tuberous sclerosis (2)
Chromosome 17
- NF1
- BRCA (1)
- p53
Chromosome 18
Edward Syndrome
Chromosome 21
Down Syndrome
Chromosome 22
- NF2
- DiGeroge Syndrome
X Chromosome
- Fragile X syndrome
- X-linked agammaglobinemia
- Klinefelter
Fanconi Syndrome
General defect in reabsorption in proximal tubule
- metabolic acidosis (proximal RTA)
- hereditary defects (Wilson disease, tyrosinemia, glycogen storage disease), ischemia, multiple myeloma, drugs (ifosfamide, cisplatin, expired tetracycline), lead poisoning
Barter Syndrome
Defect in NKCC of thick ascending limb
- metabolic alkalosis
- hypokalemia, hypercalciuria
- presents similar to chronic loop diuretic use
Gitelman
Defect in NaCL channel in DCt
- metabolic alkalosis
- hypokalemia
- hypocalciuria, hypomagnesemia
- presents similar to chronic thiazide diuretic use
Liddle Syndrome
Gain of function in ENaC in collecting tubules
- aldosterone undetectable
- presents like excess aldosterone
- metabolic alkalosis
- hypokalemia
- HTN (decreased aldosterone)
Tx: amiloride (blocks ENaC)
Syndrome of Apparent Mineralocorticoid Excess
Cortisol tries to be the SAME as aldosterone
- metabolic alkalosis
- hypokalemia
- decreased serum aldosterone
Tx: K+ sparing diuretics
Winter's formula
predicted PCO2 = 1.5 (HCO3-) +/- 2

PCO2 = predicted = appropriate compensation
PCO2 > predicted: respiratory acidosis
PCO2 < predicted: respiratory alkalosis
Anion Gap Metabolic Acidosis
MUDPILES
M - methanol
U - uricemia
D - diabetic ketoacidosis
P - propylene glycol
I - isoniazid, iron tablets
L - lactic acidosis (shock, metformin)
E - ethylene glycol
S - salicylates (later, after resp alkalosis)
Anion Gap Equation
Na+ - (Cl- + HCO3-)
> 12 = anion gap
Distal Renal Tubular Acidosis (Type I)
- hypokalemia
- alpha-intercalated cells in collecting tubule can't secrete H+
- urine pH > 5.5 (high) - you should see low urine pH in setting of metabolic acidosis
- HCO3- really low
Causes: amphotericin B toxicity, analgesic nephropathy, obstruction of urinary tract, autoimmune disease (SLE, Sjogren's, RA)
⬆️risk for bilateralral* calcium phosphate kidney stones (due to high urine pH and bone turnover)
Proximal Renal Tubular Acidosis (Type II)
- hypokalemia
- defect in PCT HCO3- reabsorption
- urine pH <5.5
Causes: fanconi syndrome, multiple myeloma, CA inhibitors
⬆️risk for hypophosphatemic rickets
Hyperkalemic Tubular Acidosis (Type IV)
- hyperkalemia
- hypoaldosteronism or aldosterone resistance
- decreased NH3 synthesis in PCT
- ⬇️NH4 excretion (impaired ammonium excretion)
Causes: diabetics, renal failure, adrenal insufficiency, K+ sparing diuretic, TMP-SMX, ACEI/ARB, NSAIDs
WAGR
W - wilm's tumor WT1 mutation
A - aniridia (absence of iris)
G - GU malfomations
R - mental retardation
Denys-Drash Syndrome
Wilm's Tumor WT1 mutation
Diffuse mesangial sclerosis
Dysgenesis of gonads (male pseudohermaphrodism)
Beckwith-Wiedemann Syndrome
Wilm's tumor WT2 mutation
- macroglossia (big tongue)
- organomegaly (enlarged organs)
- hemihyperplasia
Ethacrynic Acid
Basically a loop diuretic, but for people who are allergic to sulfonamides
Kiesselbach Plexus
Located in anterior nostril, composed of:
- ant. & post. ethmoidal a.
- superior labial a.
- greater palatine a.
- sphenopalatine a. (branch of maxillary that can be life threatening)
2 Cell types that can't use ketones
1. red blood cells (no mitochondria)
2. hepatocytes (lack enzyme succinyl-CoA-acetoacetate transferase)
Blast Crisis
Transformation of CML -> ALL or AML
Richter Transformation
Transformation of CLL/SLL -> DLBCL
Direct Thrombin Inhibitors
- bivalirudin
- argratraban
- dabigatran
Sodium Bicarbonate
Anecdote to TCA overdose causing widened QRS or ventricular arrhythmias
MOA: increases sodium to overcome sodium channel block by TCA; also increases serum pH so TCA isn't in active form

In theory you would give ammonium chloride for TCA OD because it's a weak base and you want to make the urine acidic to excrete it, but more important to deal with sodium channels on heart
Osteoblastic Bones Mets
aka sclerotic bone lesions
- prostate cancer
- small cell lung cancer
- Hodgkin lymphoma
Osteolytic Bone Mets
aka lucent bone lesions
- multiple myeloma
- non-small cell lung cancer
- non-Hodgkins lymphoma
- renal cell carcinoma
- melanoma
Poor prognosis MR
S3 heart sound due to quick cessation of blood flow in a compliant LV
Malaria Tx
Chloroquine (if not in Africa, or resistant)
Atovaquone-proguanil
Artemisinins

+ Primaquine for P. oval or P. vivax
Neonatal Tetanus Prevention
- hygenic umbilical cord care
- maternal vaccination (passive IgG immunity)
- neonatal vaccination around 2 months
Anticholinergic Activity
- hot as a hare: increased body temp
- mad as a hatter: altered mental status
- dry as a bone: no sweating
- red as a beet: flushing
- full as a flask: urine retention, constipation
- fast as a fiddle: tachycardia
- blind as a bat: cycloplegia, mydriasis

i.e. diphenhydramine (1st gen antihistamine, with anti-cholinergic activity)
Cyanide Toxicity Antidote
1. sodium nitrite: induce methemoglobin
2. sodium thiosulfate: donate sulfur group to form thiocyanate (soluble)
3. hydroxycobalamin: direct binding of cyanide
Dorsal Midbrain Syndrome (Parinaud)
Due to pinealoma compressing pretectal midbrain (superior colliculus), presents with:
1. upward gaze palsy
2. lid retraction
3. convergence-retraction nystagmus
4. pupillary light near dissociation (pupil constricts with accommodation, but not with light)
Cyanide Toxicity
Reddish-brown skin discolouration
Burned almonds smell
Migratory Thrombophlebitis (Trousseau sign)
Think malignancy
- superficial venous thrombosis that show up in one area, disappear, and pop up in another area
- hypercoagulability state
- pancreas, colon, lung adenocarcinomas
Hematogenous osteomyelitis
Occurs in kids in the metaphysis due to slow blood flow and capillary fenestra
DOC Toxoplasmosis
Pyrimethamine + sulfadiazine
Ioxdes tick
- lyme disease
- babeosis

coinfection common
Renal Cell Carcinoma
Most common subtype is clear cell carcinoma - arise from Proximal renal tubules - clear cells (with lipid and glycogen) with eccentric nuclei
GROSS: round, yellow, necrotic, hemorrhage
Attributable Risk Percent (exposed)
ARP = 100 x RR-1/RR

represents the excess risk in the exposed population that can be attributed to the risk factor
GS for detecting a microdeletion
FISH
Causes of increased tactile fremitus
Consolidation
- lobar pneumonia
- pulmonary edema
Anti-ACh receptor Ab
Myasthenia Gravis
Anti-presynaptic VG calcium channel Ab
Lambert Eaton
Anti-B2 glycoprotein Ab;
Antiphospholipid syndrome
Antinuclear Ab
Nonspecific - possible SLE
Anticardiolipin & lupus anticoagulant
SLE, antiphospholipid syndrome
anticardiolipin antibody gives syphilis false positive
lupus anticoagulant gives prolonged aPTT
Anti-dsDNA, Anti-Smith
SLE
Anti-histone Ab
Drug-induced lupus
Anti-U1 RNP (ribonucleoprotein)
Mixed connective tissue disease
Rheumatoid factor (IgM Ab to IgG Fc region) + anti-citrullinated protein (more specific)
Rheumatoid arthritis
Anti-Ro (SSA) + Anti-La (SSB)
Sjögren Syndrome
Anti-Scl-70 (anti-DNa topoisomerase I)
Scleroderma (diffuse)
Anticentromere
Limited Scleroderma (CREST syndrome)
Antisynthetase (anti-Jo-1), anti-SRP, anti-helicase (anti-Mi-2)
Polymyositis, dermatomyositis
Antimitochondrial Ab
1° biliary cholangitis
Anti-smooth muscle
Autoimmune hepatitis type I
MPO-ANCA/P-ANCA
- Churg Strauss (eosinophilic granulomatosis with polyangitis)
- Microscopic polyangitis
- ulcerative colitis
PR3-ANCA/c-ANCA
Wegener's granulomatosis (granulomatosis with polyangitis)
Anti-phospholipase A2 receptor
1° membranous nephropathy
Anti-hemidesmosome
Bullous pemphigoid
Anti-desmoglein
Pemphigus vulgaris
Anti-microsomal, anti-thyroglobulin, antithyroid peroxidase
Hashimoto thyroiditis
Anti-TSH
Graves disease
IgA anti-endomysial, IgA anti-tissue transglutaminase, IgA and IgG deamidated gliadin peptide
Celiac disease
Anti-glutamic acid decarboxylase, islet cell cytoplasmic antibodies
DM I
Antiparietal cell, anti-intrinsic factor
Pernicious anemia
Anti-glomerular basement membrane
Goodpasture Syndrome
Citrate accumulation
Occurs in RBC transfusion of more than 5/6L
- due to accumulation of citrate anticoagulant in stored blood
P bodies
In the cytoplasm and act as quality control of mRNA
- translation repression and mRNA decay
- also storage
- contain exonucleases, miRNA, decapping enzymes
Haptoglobin
Intravascular hemolysis results in increase of serum unconjugated bilirubin. Also release of free hemoglobin in serum and urine, and increase LDH. Haptoglobin binds free hemoglobin. Haptoglobin levels ⬇️ when there is free hemoglobin aka intravascular hemolysis.
Parotitis
Caused by S. aureus
RF: entubation, dental cleaning, etc
Preauricular swelling to mandible
+
isolated ⬆️amylase
Mediastinal Mass
- t-cell acute lymphoblastic leukemia (T-ALL)
- nodular sclerosis
Pseudogout
P - positive birefringence
P - parallel shows blue
P - pyrophosphate (calcium pyrophosphate rhomboid crystals)

Usually idiopathic, maybe hemochromatosis, hyperparathyroidism, or joint trauma

Knee joint
Synpatophysin
Tumor marker for neuroendocrine tumors:
- small cell carcinoma of lung
- carcinoid tumor
protein of neuron
Pasteurella multocida
- gram negative coccobacilli
- dog bites
- mousy odor
Bortezomib
Proteosome inhibitors
- used in multiple myeloma, mantle cell lymphpoma
- cause cell apoptosis of malignant plasma cells
RALS
Right anterior
Left superior
relationship of pulmonary artery to bronchus
LAMP
Lateral femoral condyle - Anterior Cruciate
Medial femoral condyle - Posterior Cruciate
relationship of cruciate ligaments to condyles of the femur
Rituximab
Monoclonal Ab to CD20
Hyoglossus
XII innveration
- retracts and depresses tongue
Genioglossus
XII innervation
- protrudes tongue
genie sticks out his tongue
Styloglossus
XII innervation
- draws sides of tongue upward to create a trough for swallowing
Palatoglossus
X innervation
- elevates posterior tongue during swallowing
Reactive Gliosis
Response to neuronal injury by astrocytes
Cachexia Mediators
TNF-alpha (decrease appetite + increase BMR), INF-gamma, IL-1, IL-6
When are vocal cords closed?
Speaking, swallowing
When are vocal cords open?
Breathing, coughing
Sarcoidosis Labs
⬆️Ca2+
⬆️Vit D
⬆️ACE
⬇️PTH
VIT D production is independent of PTH, instead it is upregulated by ACTIVATED MØ with 1-alpha-hydroxylase activity
Where is Meyer's Loop?
Temporal loop
Injury = "pie in sky"
Osmotic demyelination syndrome
Occurs 2° to rapid correction of hyponatremia
- dysphagia, dysarthria, diplopia, acute paralysis, LOC
"From low to high..."
"your pons will die"
"From high to low..."
"your brains will blow (edema)"
ALS Treatment
Riluzole - decreases neuron glutamate excitotocity
*riLOUzole for Lou Gherig's"
Type II Error
AKA (b)
- probability of concluding that there is NO DIFFERENCE when there actually is one
Power
=1-B
- ability of study to detect difference between groups when a difference DOES exist
Acute hemolytic transfusion
Type II antibody mediate HS
- acute reaction to blood transfusion
- fever, chills, hypotension, SOB
- complement mediated cell lysis - classical pathway of complement is initiated by Ag-Ab complexes
Breast Milk
Deficient in Vitamin D and K
- vit K given at birth
- vit D should be supplemented to all newborns exclusively breast fed
Low in iron (supplement after >4 months)
Pulsus Paradoxus
Decrease in systolic blood pressure greater than 10mmHg upon inspiration
- cardaic tamponade, asthma, COPD, constrictive pericarditis

You candetect in with BP cuff when you hear the korotkoff sounds on expiration only then on both exsp. and insp e.g. you hear them at 120 on exsp. and then hear them at 100 on insp and exsp.
APC
almost 100% guarantee of colon cancer
- encodes for protein that degrades for B-catenin
- loss of APC means higher levels of B-catenin
- increased transcription and intestinal crypt formation = polyps
MEN1
- parathyroid
- pancreatic
- pituitary
MEN2A
- pheochromocytoma
- medullary thyroid
- parathyroid
(RET gain of function)
MEN2B
- pheochromocytoma
- medullary thyroid
- marfinoid habitus/mucosal neuromas
(RET gain of function)
Klinefelter Labs
⬆️FSH, LH (loss of feedback inhibition)
⬆️estradiol
⬇️testosterone
⬇️inhibin
Vitamin A
FUNCTION:
- epithelial cell differentiation (to pancreatic cells, or mucus secreting cells, conjunctiva of eye)
- metaplasia with deficiency
DEFICIENCY:
- night blindness (metaplasia thickening = keratomalacia)
- nausea, vomiting, vertigo
- alopecia, pseudotumor cerebri, hepatic toxicity
USED AS TREATMENT FOR:
- measles
- acute promyelocytic leukemia
- severe cystic acne
- psoriasis
Trastuzumab
HER-2 neu receptor monoclonal antibody
AE: cardiotoxicity (decrease in myocardial contractility, with no destruction or cardiac fibrosis)
Dystonia
Sudden, involuntary muscle contractions
- spasmotic torticollis (SCM)
- blepharospasm (eyelid closure)
- writer's cramp
Phentolamine
- tx for pheochromocytoma
- anecdote to NE extravasation
- anecdote to HTN crisis (cheese rxn)
AFP Tumor Marker
⬆️ in:
- HCC
- Endodermal sinus tumor (yolk sac)
- Mixed Germ cell tumor
- ataxia-telangiectasia
- neural tube defects
⬇️in: Down Syndrome
3rd and 4th gen cephalosporins for pseudomonas
3rd - ceftazidime
4th - cefepime
Subsequent reaction after flu vaccine
Hemagglutinin is recognized and bound by antibodies; so hemagglutinin can't bind sialic acid and gaint entry into cells
JAK/STAT pathway (non-receptor tyrosine kinase pathway)
PIGGlET
P - prlactin
I - immunomodulators (IL-2,IL-6, IFN)
G - growth hormone
G - granulocyte - CSF
E - EPO
T - TPO
Neurons most vulnerable to hypoxia
- purkinje cells of cerebellum
- pyramidal cells of hippocampus, and neocortex (layers 3,5,6)
Chemotactic Agents
- C5a
- kallikrein
- LTB4
- IL-8
- platelet-activating factor
Vinyl chloride
Used to make PVC pipes
- RF for angiosarcoma
Radon
By-product of uranium decay, accumulated in basements
- RF for lung cancer
Vimentin
Mesenchyme immunohistochemical stain
- sarcoma
- RCC
- meningioma
- endometrial carcinoma
Desmin
Muscle immunohistochemical stain
- rhabdomyosarcoma
S-100
Neural crest cell immunohistochemical stain
- melanoma
- schwannoma
- langerhans histiocytosis
- EWING sarcoma
P-glycoprotein
aka multi-drug resistant protein
- seen in adrenocortical carcinoma
- ATP dependent efflux pump
- pumps out toxins and chemo drugs
- gives tumors resistance to chemo drugs
Brain Mets
Lung>breat>colon, kidney, melanoma
Liver Mets
Colon>>stomach>pancreas
Bone Mets
Prostate, Breast>Kidney,Thyroid, Lung
PB KeTtLe
Anti-Rh (D)
IgG anti-D antibodies that BIND FETAL ERYTHROCYTES preventing their interaction with maternal immune system; therefore no antibodies are made.

Give to all Rh(-) moms at 28 weeks and immediate post-partum
Hyperammoniemia
When increased NH3 in blood, it crosses BBB, grabs onto glutamine and astrocytes swell - impairing glutamine release.

Therefore, decrease in glutamine release available to become glutamate = impaired excitatory transmission
Methadone
Potent, long acting, good bioavailability, full mu-agonist - with long half-life
- good for opioid maintenance treatment
- suppress withdrawal sxs and cravings
- once-daily dosing
Cholesterol Gallstones Labs
⬆️cholesterol
⬇️bile acids
⬇️phosphatidylcholine
+ GB hypomotility, calcium salts, etc
= gallstones
Epiphyseal Plate closure
Excess steroids (estrogen, testosterone) at a young age will initially cause tremendous growth in a young person, but will also prematurely fuse the epiphyseal plate with the metaphysis -stopping growth. The child will be tall as a kid, and short as an adult.
3 Stages of Paget's Disease
1. Osteolytic (clasts)
2. Mixed
3. Osteosclerotic (blasts)
Mu (opioid receptors)
Opioids on mu receptors:
- inhibits calcium influx presynaptically (⬇️neurotransmitter release)
- upregulated potassium efflux postsynaptically (hyperpolarizing cell)
ApoE
- on everything except LDL
- mediates chylomicron and VLDL remnant uptake
- defective in dysbetalipoproteinemia (III) (palmar xanthomas)
ApoCII
- activates LPL
- on chylomicrons, VLDL, HDL
- can be defective in hyperchylomicronemia (I)(pruritic xanthomas)
ApoA1
- activates LCAT (catalyzes esterification of cholesterol)
Macular Sparing
due to collateral MCA supply of occipital lobe during PCA stroke (occipital lobe processes central vision)
Urine pH for Struvite stones
high pH (alkaline)
- alkalinization is usually due to urease splitting into ammonia
- Proteus , Klebsiella
Multiple Myeloma Labs
HIGH calcium
LOW PTH
LOW Vitamin D
Erythema infectiosum (fifth disease)
Childhood disease due to parvovirus B19 (ssDNA virus)
1. malaise, congestion, headache, fever
2. slapped cheek appearance
3. lacy, reticular rash

virus replicates in erythrocytes in BM (they have the P globoside receptor)
- complications in IC or asplenic
Where is ACh produced?
Nucleus basalis of Meynert (basal forebrain)
Androgenic Steroid Abuse
- acne
- testicular atrophy
- erythrocytosis (⬆️hematocrit)
- virillization in women (deep voice, hirsutism)
Procalcitonin
A unique acute phase reactant that increases with bacterial infection, and decreases with viral infection
APR that decrease
Albumin
Transferrin
Tranthyretin (prealbumin)
APR that increase
- Ferritin
- Fibrinogen
- Serum amyloid A
- Hepcidin
- CRP
Autosplenectomy
Seen in SCC patients due to trapping of sickled cells in rigid splenic cords
- leads to scarring, fibrosis and atrophy
Zero order drugs
Phenytoin
High dose aspirin
Ethanol
constant amount
Gq GPCR
A-1
M-1
H-1
V-1
M-3
Gi GPCR
A-2
M-2
D-2
Mirtazapine
A2 antagonist used for depression
Tetrodotoxin
Found in pufferfish
- binds fast VG Na+ channels in cardiac/nerve tissue
prevents depolarization
Tx: supportive
Scombroid
Found in eel, barracuda, snapper
- opens VG Na+ channels
causes depolarization
Tx: supportive
Arsenic or Mercury Toxicity Tx
Dimercaprol, succimer
Causes of Interstitial Nephritis
- penicillin
- furosemide
- NSAIDs
- PPIs
- sulfa drugs
Causes of Pulmonary Fibrosis
- methotrexate
- amiodarone
- busulfan
- bleomycin
- carmustine
- nitrofurantoin
Retroperitoneal Structures
SAD PUCKER
S - suprarenal glands (adrenals)
A - aorta, IVC
D - duodenum (not 1st part)

P - pancreas (except tail)
U - ureters
C - colol (ascending and descending)
K - kidneys
E - esophagus
R - rectum

have adventitia, not serosa
GI mucosa layers
- epithelium
- lamina propria
- muscularis mucosa
Esophageal Anastomosis
- portal HTN causes esophageal varices
- by left gastric-azygous
Umbilical Anastomosis
- portal HTN causes caput medusa
- by paraumbilical-small epigastric veins
Rectal Anastomosis
- portal HTN causes hemorrhoids
- by superior rectal-inferior and middle rectal
Anal fissure
Tear in anal mucosa below pectinate line
- pain while pooping
- blood on toilet paper
- located posteriorly because that area is poorly perfused
- associated with low fibre diets and constipation
Zone I liver
Periportal zone
- affected 1st by viral hepatitis
- ingested toxins (e.g. cocaine)
Zone II liver
Affected by yellow fever
Zone III liver
Peri-central vein
- affected 1st by ischemia
- high concentration of CYP P450
- most sensitive to metabolic toxins
- site of alcoholic hepatitis (fat accumulation)
Rat Poison
Acts similar to warfarin toxicity - with bleeding symptoms
Tx: FFP and vitamin K
Trouble with Stairs
- polymyositis
- inferior gluteal n. damage
- CN IV damage
Lecithinase
Main toxin of C. perfringens (aka alpha toxin)
- acts by splitting phospholipids molecules
- results in cell lysis, tissue edema, necrosis and gas gangrene
Livedo Reticularis
Lacy skin finding caused by:
- atheroembolic disease (microemboli in circulation)
- amantadine (flu drug used for Parkinson's)
- SLE
Schizoaffective disorder
- when someone has delusions or hallucinations for >2 weeks in the absence of major depressive or bipolar symptoms.
Succinylcholine
Depolarizing muscular blocker
Best solution for dehydration
Hypotonic, equimolar sodium-glucose solution
- sodium transport with glucose will maximize absorption
Biggest RF for dissection
Hypertension
Biggest RF for aneurysm
Atherosclerosis
Most common Shoulder dislocation
Anterior humeral dislocation
- affects axillary nerve (deltoid paralysis and patch on upper arm)
- happens with blow to externally rotated arm (i.e. throwing a football)
TB Pathogenesis
1. inhibits phagolysosome
2. intracellular proliferation
3. migration to lymph node
...mø activation and granuloma formation
Cinacalcet
Calcium-mimic that stimulates CaSR's, decreasing PTH release
Tx of Post-op hypoparathyroidism
- calcium supplement
- vitamin D
H. pylori Location
Antrum = duodenal ulcers due to ⬇️ D cells (⬇️somatostatin) so ⬆️in gatric acid + duodenum destruction and ⬇️HCO3- = increased acid, underprotected duodenum

Body = gatric ulcers due to destruction of parietal cells, ⬇️gastric acid secretion, less protection of stomach from bacterial invasion
Li Fraumenia
B-BALS (tp53 mutation)
B - brain
B - breast
A - adrenal
L - leukemia
S - sarcomas
Delayed Peripheral Edema
High hydrostatic pressure for chronic HF or other, can be offset initially with increased lymph drainage delaying edema
Location of Pancoast Tumor
Superior sulcus (groove formed by subclavian vessels)
Myocardial Hybernation
In a state of chronic ischemia, the myocardial metabolism and function are reduced to match a reduction in coronary blood flow = ⬇️contractility and impaired LV systolic function
S. agalactiae
- Group B strep
- colonizes vaginal area
- B-hemolysis
- CAMP Factor produced, and will enhances area of hemolysis when exposed to S. aureus
- hippurate (+)
- PYR (-)
- screen at 35-37 weeks gestation
Flutamide
Androgen receptor blocker
USES: prostate carcinoma (with goserelin to counteract androgen surge)
Finasteride
5-alpha reductase inhibitor
USES: BPH, male-pattern baldness
Cushing Ulcer
Increase in ICP leading to increased ACh and vagal stimulation = ⬆️gastric secretionion* = ulcer
Curling Ulcer
Due to shock/burns = hypovolemia = local ischemia = ⬇️ mucosal protection
EGFR Mutations
- Glioblastoma multiforme
- prostate ca
- non-small cell lung cancer
- breast ca.
Tx: -inib tyrosine kinase inhibitor
Heart Conduction Velocities
Purkinje > Atria > Ventricles > AV node
Part At VENTure AVenue
Heart Pacemaker Paces
SA>AV>Bundle of His/Purkinje/Ventricles
Globus Sensation (Globus hystericus)
Feeling of tightness or foreign object in throat
- feeling of lump in throat
- endoscopy normal, barium swallow normal
- alleviated with food
- often associated with anxiety
Germline mosaicism
Suspect this when parents and relatives don't have disease, but a child does.
- the gonadal cells (oocytes/spermatocytes) of a parent have a mutation, and that is passed onto the child
Molluscum Contagiosum
- poxvirus
- flesh coloured, umbilicated spots, slightly pruritic
- large, eosinophilic inclusion bodies
High Pancreatic flow rate
⬆️HCO3-
⬇️Cl-
via secretin up-regulation of the Cl-/HCO3- exchanger on the apical surface of ductal cells
(Na+ and K+ remain same)
Myasthenia gravis
Associated with thymoma/thymic hyperplasia
- autoantibodies against AChR
DKA Labs
Serum:
⬆️K+ (although actually depleted)
⬆️Glucose
⬇️Na+ (glucose osmotic pull, diuresis free water pull)
⬇️insulin
⬆️Ketones
Metabolic acidosis
Hypovolemia
Cisplatin
Cancer drug
AE: ototoxicity
Carboplatin
Cancer drug
AE: ototoxicity
Pseudohypoparathyroidism
⬆️PTH, but low calcium, and high phosporous
- because the Gs protein is defective (kidney/end organ resistance to PTH)
- short 4th/5th digits
- short stature
- obesity
- developmental delay
- inherited from mom due to imprinting
Pseudopseudohypoparathyroidism
NORMAL PTH,
- because of Gs protein is defective
- short 4th/5th digits
- short status
- obesity
- developmental delay
- defective GPCR inherited from father
Unmyelinated Nerves
C-fibres are unmyelinated, responsible for afferent:
- slow pain
- heat sensation
- olfaction

efferent:
- postganglionic autonomic nerves
Hyperkeratosis
Thickening of the stratum corneum
- psoriasis
- callus
Transcription Factors
Collection of proteins that mediate the binding of RNA polymerase on DNA and the initiation of transcription.
- responsible for differentiation/de-differentiation of human cells
Acanthosis nigricans
- gastric adenocarcinoma
- insulin resistance
- obesity
- Cushing syndrome
Hyper IgM
XLR Deficiency CD40L, defective isotype class switching
- ⬆️IgM
- ⬇️IgG, IgA, IgE
- normal T and B cells
- recurrent sinopulmonary, GI, opportunistic infections
Treatment for Pneumothroax
- needle decompression
- chest tube placement
Subacute Granulomatous Thyroiditis
aka Quervain thyroiditis
- painful/tender thyroid
- ⬆️ESR, jaw pain
- histo: granulomatous inflammation
- follows viral illness
- initial hyperthyroidism, then hypo
RLS glycolysis
...
Garlic breath
Arsenic poisoning, inhibits lipoic acid, cofactor for PDH
Glucogenic AAs
MET HIS VALentine
Methionine
Histidine
Valine
Ketogenic AAs
Lysine, leucine
Glucogenic and ketogenic AAs
Threonine
Tyrosine
Isoleucine
Phenylalanine
Treatment of PDH deficiency
KETOGENIC DIET
- lysine, leucine
- high fat
Fibrates MOA
- activates PPAR = up-regulate HDL
- up-regulate LPL = clearance of TG (⬇️VLDL prod)
- blocks 7-alpha-hydroxylase = gallstones
Aldosterone Escape
In Conn syndrome hypernatremia and pedal edema is rare because the re-absorbed Na+ triggers increased renal blood flow, with a resulting pressure naturiesis and release of ANP
Pseudotumor Cerebri
- young, obese woman
- daily headaches, bilateral papilledema, transient visual disturbances
- worse with valsalva/bending over
- impaired axoplasmic flow within optic nerves = bilateral optic disc papilledema
Goodpasture Syndrome
Anti-GBM syndrome
I - type I RPGN (crescentic)
II - type II HS
III - alpha-3 subunit
IV - type IV collagen
Radial Nerve Injuries
Axilla - saturday night palsy
- no forearm/hand/wrist extension
- absent triceps reflex
- sensory loss of arm, forearm, back of hand

Midshaft of humerus
- radial/spiral groove with deep brachial artery
- no hand/wrist/finger extension
- sensory loss of forearm, back of hand
- triceps reflex intact

Supinator Canal
- no finger/thumb extension
- sensory and reflex intact
S. pneumonia
- optochin sensitive
- Quellung reaction +
- Catalase (-)
- bile soluble
- alpha-hemolytic (partial hemolysis)
Red Pulp
Of the spleen compsosed of sinusoids, and splenic cords
- functions to remove damaged RBCs - can result in hyperplasia
RAA System
Renin -> Angiotensin II -> Aldosterone -> Endothelin
Primary Amebic Meningoencephalitis
- caused by Naegleria fowleri
- recreational water exposure
- olfactory mucosa -> cribiform plate -> invades olfactory bulb
- almost always fatal; tx with amphotericin B
- acute onset photophobia, high fever, confusion and meningitis sxs
motile trophozoites in CSF lumbar puncture
CoNS
Coagulase Negative Staphylococci
- >80% are methicillin resistant
Squatting
Squat ⬇️
preload, afterload and venous return ⬆️
⬆️ intensity of most murmurs
⬇️ intensity of HOCM
Valsalva
⬇️preload
⬇️ intensity of most murmurs
⬆️ intensity of HOCM
Clostridium septicum
- spore forming
- exotoxin producing
- gram (+)
- normal colonic/GI bacteria
- can cause spontaneous gas gangrene
- RF is colonic malignancy
AAs in Histones
Basic: lysine, arginine
Why Acetyl-Coa isn't glucogenic
Acetyl-Coa can become ketone bodies, or be fed into TCA, but in TCA it's 2 carbons are USED and therefore, do not contribute to gluconeogenesis like all other TCA intermediates
Odd Chain FAs
Can be glucogenic via propionyl CoA -> methyl malonyl CoA -> succinyl CoA -> TCA ... gluconeogenesis
PKU
Onset: babies
⛔️phenylalanine dehydrogenase OR BH4 (dihydropteroine reductase)
⬆️phenylalanine
⬆️phenyl ketones
⬇️tyrosine
⬇️neurotransmitters in BH4 type
Sx: fair skin, light hair,
Tx: restrict phenylalanine, no aspartame (contains phe), tyrosine becomes essential
SCREEN: 2-3 days after birth
Albinism
Onset: infancy
⛔️tyrosinase
⬇️melanin
Sxs: pale, blue eyes, skin cancer risk
Alkkaptonuria
Onset: infancy (urine), joints (older)
⛔️homogentisate oxidase
⬆️homogentisic acid
⬇️fumarate
Sxs: black pigment on cartilage/joints, dark urine, arthralgias
Tx: no Phe or Tyr
Maple Syrup Urine Disease
Onset: infancy
⛔️alpha-KG-dehydrogenase
⬆️branched chain amino acids (val, leu, isoleu)
⬆️alpha-ketoacids
Sxs: urine sweet smell, neurotoxicity
Tx: restrict BCAAs, supplement thiamine (cofactor)
Homocystinuria
Onset:
⛔️cystathione beta-synathase (methionine synthase, methylene THF reductase)
⬆️homocysteine
⬇️cysteine (becomes essential)
Sxs: lens dislocation, long limbs, chest deformities,
Tx: supplement B6, increase cysteine, ostoporosis, mafanoid habitus, cardiovascular (thrombosis, stroke)
Vitamin C functions
- reduced Fe3+ -> Fe2+ for gut absorption
- dopamine synthesis
- hydroxylation of collagen
Vitamin E Deficiency
- hemolytic anemia
- gait ataxia (post. column and spinocerebellar tract demyelination)
- muscle weakness
XLR Enzyme Deficiencies
- Fabry's disease
- Hunter syndrome
- OTC deficiency
- G6PD Deficiency
Mechanism of Insulin Resistance
Phosphorylation of Serine/Threonine residues on insulin receptor/insulin receptor substrates
- can be induced by TNF-alpha, glucagon, catecholamines and glucocorticoids
Diphtheria
Diphtheria antitoxin
Antibiotics
PTHrP (parathyroid related protein)
Most common cause of humoral hypercalcemia of malignancy
- increased bone resorption of Ca2+
- decreased renal excretion of Ca2+
- squamous cell carcinoma, renal cell carcinoma, bladder, breast, ovarian
- NOT MULTIPLE MYELOMA
⬇️PTH
⬆️⬆️Ca2+
Hyperchylomicronemia (I)
⛔️LPL or Apo-CII
⬆️cholesterol
⬆️TG
⬆️chylomicrons
Sx: acute pancreatitis, HSM, *eruptive/pruritic xanthomas
- increased risk of atherosclerosis
- creamy supernatant
Familial Hypercholesteremia (II)
Autosomal Dominant
⛔️LDL receptor or ApoB-100
⬆️LDL, cholesterol
⬆️VLDL
Sx: tendonous xanthomas, corneal arcus, accelerated atherosclerosis MI by age 20
Dysbetalipoproteinemia (III)
⛔️ApoE (defective clearance of chylomicron remnants)
⬆️chylomicrons
⬆️VLDL
Sx: tuberoeruptive or palmar xanthomas, preamture atherosclerosis
Hypertriglyceridemia (IV)
Autosomal Dominant
➕➕production of VLDL
⬆️VLDL
⬆️TG
Sx: possible pancreatitis, insulin resistance
Abetalipoproteinemia
⛔️missing B-48 (chylomicron marker), B-100 (VLDL)
⬇️chylomicrons, VLDL, LDL
Sx: fat malabsorption, steatorrhea, failure to thrive, vitamin E deficiency (spinocerebellar degeneration), ataxia, acanthocytosis, retinitis pigmentosa
Tx: restrict long chain FAs, give vitamin E
Titin Gene
Defect leads to idiopathic dilated cardiomyopathy
- auto dominant inheritance
PCOS
⬆️LH:FSH, androgens
⬇️progesterone
Sxs: amenorrhea (anovulatory cycles), hirsutism, acne, obesity
Cx: endometrial carcinoma (due to decreased progesterone, so unopposed estrogen)
Class I Antiarrhythmic Dissociation Speed
fast 1B > 1A > 1C slow dissociation (sodium channel binding strength)
Fibrocystic Change
A type of metaplasia in the breast (apocrine metaplasia) that does not progress to dysplasia
Budd Chiari
Thrombosis of the hepatic vein
- polycythemia vera
- SLE
Negative Selection
AFTER positive selection
- do you bind self antigen too strongly?
yes -> FAS/FAS-L apoptosis pathway
no -> survival
Familial Mediterranean Fever
Neutrophils dysfunction, presents with fever, involves serosal inflammation - amyloidosis
Kozak Sequence
GCC-GCC-(x)CC-AUG on mRNA
(x) either A or G
- eukaryotic sequence to initiate translation
Pancreatic Adenocarcinoma
- painless obstructive jaundice
- weight loss
- cigarette smoking big RF
Lung Hamartoma
Disorganized tissue growth in lung
- composed of cartilage, adipose and fibrous tissue
Chikungunya
RNA virus transmitted by aedes mosquito
- self-limited fever, polyarthralgia, rash
- >50% of people develop chronic arthralgias, polyarthritis or tenosynovitis
CD14
On * a co-receptor for TLR
- recognizes LPS (PAMPs) on outer membrane of gram (-) bacteria
- part of acute inflammation
- results in NF-kB activation
Mast Cells
Activated by:
- tissue trauma
- C3a and C5a
- IgE cross-linking

Stage 1 - immediate - preformed histamine granules - vasodilation, vascular permeability
Stage 2 - delayed - leukotrienes
Fever Modulation
Mø produce IL-1, TNF
- increase COX activity in perivascular cells of hypothalamus
- increased PGE2
- raise temperature set point
Tone down Inflammation
- IL-10
- TGF-B
IL8
Produced by mø, chemotaxis for PMNs
Regulatory T-cells
CD4+
CD25+ (polymorphism can = autoimmunity)
FOXP3 (mutations can lead to immune dysregulation [IPEX syndrome])
Pericarditis ECG Changes
- ST segment elevation
+/- PR depression
steep y wave on JVP
CD34
BM hematopoietic stem cell marker
Type II Pneumocytes
- stem cell of lung
- fibrosis, repair
- secrete surfactant
Segmented Viruses
BOAR (all RNA)
B - bunyavirus
O -orthomyxovirus (influenza)
A - arenavirus
R - reovirus (rotavirus)
Dihydrorhodamine Flow Cytometry Test
Similar to the tetrazolium blue test for CGD
- tests for NAPDH function
- normal is fluorescent green
CGD will lack colour change
3rd Pharyngeal Pouch Derivatives
- thymus
- inferior parathyroid glands
Opioid GIT AE
Opioids can triggers the smooth muscle cells of the Sphincter of Oddi leading to increased pressures in the common bile duct and gallbladder
Internal Iliac Branches
I Love Going Places In My Very Own Underwear
Iliolumbar
Lateral Sacral
Gluteal (superior, inferior)
Pudendal
Inferior Vesicle
Middle Rectal
Vaginal
Obturator
Uterine
Umbilical
Sleep Waves
BATS Drink Blood
B-waves: awake
A-waves: closed eyes
T-theta waves: N1
S-spindles and K-complexes: N2 (teeth grinding)
D-delta waves: N3 (night terrors)
B-waves: REM (nightmares)
Influenza Virus
(-)ssRNA, segmented, with lipid bilayer, enveloped
- neuraminidase, hemagglutinin
- droplet precautions (gown and mask)
- hand hygiene for close contacts
Osgoode Schlatter
Ligament that attached tibia to patella is separated at tibial tuberosity
- from chronic use
- boys, growth spurt, athletes
- healing can lead to callous formation on tibia
Alcohol disinfectant
- membrane damage
- denatures proteins
- destroys everything except spores
D-glutamate capsule
B. anthracis main virulence factor
Tryptase
Released from mast cells along with histamine
- high levels are fairly specific for anaphylaxis reaction
Medistinal/Thymic Mass
- Myasthenia gravis (thymoma)
- T-cell ALL (kids)
-
95% Confidence Interval
CI = mean +/- 1.96 x SE

SE = SD / sq root of (n)

replace 1.96 with 2.58 when 99% CI
Fibrinoid necrosis
Think type III HS
- Polyarteritis Nodosa
- Serum sickness (blood transfusion or monoclonal Ab tx)
- Pre-eclampsia (vessels of placenta)
- malignant HTN
Free ribosomes
Synthesize cytosolic/organelle proteins
Attached ribosomes
Synthesize nuclear and cell membrane proteins
PDH Deficiency Diet
Ketogenic (lysine, leucine, fats)
Angiosarcoma
Malignancy of blood vessels
- vinyl chloride
- arsenic
- chronic lymphedema (LN dissection, from breast mastectomy)
Lowest pH in kidney
DCT/Collecting Ducts
- predisposed to have precipitation of uric acid
Calretinin
A cytokeratin present in mesotheliomas (along with spindle cells)
Adenomyosis
Presence of endometrial tissue in the myometrium
- middle aged parous women
- heavy & painful bleeding
- uniformly enlarged uterus (as opposed to leiomyomas)
- normal appearing endometrial biopsy
Fractured Clavicle
Medial part is pulled up with SCM
Lateral part is pulled down with pec major/arm weight
Leukocyte Adhesion
Margination - vasodilation
Rolling - sialyl lewis; p-selectins, e-selectins
Adhesion - CD18 integrins (MAC, LFA); ICAM
Transmigration - PECAM-1
Small Cell Lung Cancer Paraneoplastic Syndromes
- SIADH
- Cushing
- MG Lambert Eaton
- Cerebellar degeneration (autoimmune)
- can be associated with membranous nephropathy (nephrotic syndrome + hilar mass)
Hyperammonemia Treatment
Lactulose GIT conversion of NH3 -> NH4
Rifaximin alters GIT flora to decrease NH3 production and absorption
DNA Pol III
5' -> 3' endonuclease (produce DNA)
3' -> 5' exonuclease (proofreading)
DNA Pol I
5' -> 3' endonulease (produce DNA)
3' -> 5' exonuclease (proofreading)
5' -> 3' exonuclease (nick recognition, DNA repair)
removes RNA and replaces it with DNA
DNA Ligase
Joins Okazaki fragments, seals (after DNA repair)
Parvovirus
Fifth disease in kids
Arthritis (self-resolving) in adults
DISEASE IN SICKLE CELL/ANEMIAS
ssDNA, non-enveloped
Tumor Invasion
1. downregulate e-cadherin
2. attach to laminin
3. destroy collagen type IV via collagenases
4. attach to fibronectin
5. gain access to BV or LN
SPREAD
Immune Thrombocytopenic Purpura (ITP)
Antibodies to gpIIb/IIIa
- megakaryocytes on PBS
Thrombotic Thrombocytopenic Purpura
ADAMSTS13 deficiency (genetic or antibody)
- can't cleave vWF
- schistocytes
Bernard Soulier
GpIb deficiency
- big platelets on PBS
- fail to aggregate with ristocetin + won't correct with plasma (unline vWF disease)
Aminocaproic Acid
Blocks the activation of plasminogen to plasmin (used in disorder of fibrinolysis)
Thrombis
- lines of Zahn
- attached to wall
Field Defect
When something goes wrong via a combination of alcohol or gene defects that leads to multiple malformations, and disrupting many tissues/organs.
e.g. holoprosencephaly (alcohol, SHH)
Vertebral Malalignment (subluxation)
Occurs in RA involvement of the cervical spine commonly the C1 atlantoaxial joint
- neck pain, neurological symptoms and stiffness
- exacerbated by endotracheal intubation
PD-1 (programmed death-1)
Binds to receptor on CD8+ t-cells and inhibits their ability to induce apoptosis
- upregulated in cancer
- there is a monoclonal antibody that binds it which restores the cytotoxic T-cell response to tumor cells
Rebound Rhinorrhea
Nasal congestion with no other sxs after 3+ days of using a decongestant (like phenylephrine)
- no other symptoms
Red Nucleus
- rostral midbrain
- received afferents from motor cortex and cerebellum
- facilitates flexor activity
- inhibits extensor activity in anti-gravity muscles

INJURY ABOVE = decorticate (flexor)
- loss of inhibition of nucleus
- predominant excitatory flexor response

INJURY BELOW = decerebrate (extensor)
- loss of descending excitation to flexors
- uninhibited extensors (vestibulospinal tract predominates)
HbC
Hemoglobin with substitution glu->lysine
- lysine is polar
- causes mild anemia
- b/c of polarity of lysine, there is no hydrophobic interaction of hemoglobin, and no polymerization/sickling as opposed to Sickle Cell Anemia (valine, non-polar)
False Negative Urea Breath Test
Due to treatment with PPIs, bismuth or antibiotics. These medications suppress H. pylori, but don't eradicate it.
Liposarcoma
Malignant tumor of fat
- common in adults
- slow growing mass in deep connective tissue
- trunk or lower extremities
- histo: lipoblasts: cells that non-membrane bound cytoplasmic liquid; scalloping of nuclear membrane
Prolonged Alcohol Use
Direct toxicity + thiamine deficiency,results in damage to:
Mamillary bodies: encephalopathy, occulomotor & ataxia
Cerebellar degeneration: wide based gait, truncal instability
Thalamus: confabulation, amnesia
Calcineurin Inhibitors
⬇️IL-2 transcription via cyclophilin or F506
AE: increase BUN, Cr = glomerular scarring, bliterative vasculopathy, tubular vacuolization
(likely due to vasoconstriction of afferent/efferent)
Screening Test for Fetal Lung Maturity
- Lecithin:sphingomyelin ratio in amniotic fluid
- foam stability index (ethanol + phospholipids = foam)
- surfactant:albumin ratio
Female Athlete Triad
- low calorie intake
- amenorrhea (chronic energy deficit = ⬇️GnRH = ⬇️LH, FSH and ESTROGEN)
- osteoporosis (⬇️ estrogen, loss of bone mass, accelerated bone loss)
Pancreatic Pseudocyst
Collection of enzymes, fluid and blood lined by granulation tissue
Cx: may resolve, become infected or expand
Recombination
Exchange of genes between 2 chromosomes by crossing over within regions of significant base sequence homology
Reassortment
When viruses with segmented genomes (e.g. influenza virus) exchange genetic material. H1N1 influenza A emerged via complex viral reassortment of genes from human, swine and avian viruses. Antigenic shift
Complementation
When 1 of 2 viruses that infect the cell has a mutations that results in a nonfunctional protein, the nonmutated virus "complements" the mutated one by making a functional protein that serves both viruses. E.g. hep D requiring Hep B for HbsAg, the envelope protein for Hep D.
Phenotypic Mixing
Occurs with simultaneous infection of one cell with 2 viruses. Genome A can be partially or completely coated (forming pseudovirion) with the surface proteins of virus B. Type B protein coats determines the tropism (infectivity) of the hybrid virus. However, the progeny from this infection have a type A coat that is encoded by its type A genetic material.
Change in coat, but not change in viral genome
Hyperkalemia (ECG)
- peaked T waves (earliest change)
- loss of P wave
- prolonged PR
- widened QRS
- slowed HR
Crypts of Lieberkühn
New intestinal epithelium regenerates from GI stem cells, located here
Lactose Intolerance
- very rarely congenital
- can occur after illness
- lactase activity declines with age - due to decreased gene expression
Down-regulation of production of lactase by intestinal enterocytes
Kluver Bucy Syndrome
Damage to amygdala
- hyperphagia
- hyperorality
- hypersexuality
- hyperdocility
Associated with herpes encephalitis (because it likes the temporal lobe)
Central Venous Pressure
Analogous to preload
- high CVP would be seen in pulmonary embolism, due to lack of forward flow
Contact Inhibition
Mediated by cadherins and catenins - cells grow just enough to cover a petri dish. Mitosis halts when it hits the edge.
- malignant cells lacks this
Psoriasis Treatment
- vitamin D
- corticosteroids
- vitamin A (retinoids)
Xerosis
Winter itch
- elderly
- heaters lower humidity
- moisturize
- defects in stratum corneum permeability barrier
Hydrophobic (nonpolar) AAs
- alanine
- glycine
- proline
- valine
- leucine
- isoleucine
- tryptophan
- phenylephrine
- methionine
Diarrhea MSM
- entameoba histolytica
- shigella flexneri
Probenecid
Used in renal proximal tubule for:
GOUT - block URAT (stops uric acid reabsorption)
PENICILLIN - block OAT (stops penicillin secretion)
Cough Syncope
During a coughing fit, there is increased interthoracic pressure, leading to decreased venous return to the heart, then decreased CO, decreased cerebral perfusion and syncope
Neurofibromas
Loose, proliferative disorganizations of Schwann cells, fibroblasts and neurites
RNA viruses that replicates in the nucleus
- influenza
- retrovirus
DNA virus that replicates outside nucleus
- poxvirus
VHL
VHL gene mutation on chromosome 3, manifests with:
- cerebellar & retinal hemangioblastomas
- renal cell carcinoma (clear cell)
- pheochromocytoma
autosomal dominant
Kayser-Fleischer rings
Wilson disease
- deposits in decemet membrane of cornea
Fibroadenoma
"breast mouse"
- firm, mobile, non tender
- epithelial component is estrogen sensitive
- young women
Dysplastic Nevus Syndrome
- more than 3 relatives with melanoma
- numerous dysplastic nevi
- CDKN2A mutation chromosome 9
Flumazenil
- anecdote for benzodiazepines: competitively inhibits GABA binding site for benzos
- not for barbiturates because it's a different location on GABA receptor
Leucine Zipper
Eukaryotic transcription factor
- 2 alpha helical proteins that form a dimer
- leucine every 7th position
- DNA binding region has arginine and lysine (basic to bind negative DNA)
p57
Stain for molar pregnancy
- complete moles are (-)
- partial moles are (+)
Biggest RF for MI
- hyperlipidemia
- smoking (stopping smoking, and within a year, risk drops significantly, regardless of how long pt smoked)
Smoking Changes
- induces prothrombic state
- accelerating atherosclerosis
- vasoconstriction
Hiatuses of Diaphragm
T8 - IVC
T10 - esophagus & vagal trunks
T12 - aorta & thoracic duct & azygous vein
Cytotoxic Edema
Cellular swelling of the brain following ischemia
- Na+/K+ pump failure
Vasogenic Edema
Disruption of BBB resulting in leaky endothelial cells - edema from trauma/tumor
Yersinia pestis
- safety pin on staining
- buboes - painful LAD
- rodents - reservoir
- fleas - transmisson
- gram (-) coccobaccilli
Inhalant Use
- short lived effects
- rash around nose/mouth
- kids, youth
- euphoria, lethargy, ataxia
Residue
another name for fiber
Peripartum Cardiomyopathy
- in last month of pregnancy or 5 months post-partum
- presents as dilated cardiomyopathy
- maybe due to impaired angiogenic factors
- eccentric hypertrophy
- ⬇️EF
- ⬆️compliance
V. vulnificus
Can cause watery diarrhea, but more commonly, wound infections
- think water source
- RF: chronic liver disease
Alpha-amantin
- binds DNA-dependent-RNA-polymerase (i.e. RNA Pol II)
- stops mRNA synthesis
= apoptosis
- from mushrooms
Carotid Sinus Massage
Massage carotid
⬆️IX afferent
⬆️baroreceptor firing
⬆️VAGAL TONE (X)
⬆️PSNS
⬇️SNS
= decreased conduction through AV node (increasing refractory), decrease systemic vascular resistance, slowing of HR

Useful for paroxysmal SVT
Ixodes Tick
- babeosis
- lyme disease
Anopheles mosquito
Malaria transmission
Aedes mosquito
Chikungunya transmission
Small Intestine Bacterial Overgrowth
- patients with gastric bypass
- due to excessive proliferation of bacteria in blind pouch
- overgrowth of vitamin K and folate
- deficiency of vitamin A,D,E and B12, iron
Bordetella Pertussis
Gram (-) coccobacilli
- whooping cough
- cough until vomit
- catarrhal phase: URI
- paroxysmal phase: bad cough
- convalescent phase: recovery

MOA is excessive adenylate cyclase activity, disables Gi
Hyper IgE
F - facies coarse
A - abscess cold
T - teeth retainted
E - IgE
D - diffuse eczema
Th17 deficiency, impaired neutrophil recruitment
Catalase Positive Organisms
NAPSS
N - nocardia
A - aspergillus
P - pseudomonas
S - S. aureus
S - serratioj
Mycophenolate
⛔️IMP dehydrogenase
⬇️purine synthesis = ⬇️B and T cell synthesis
Immunosuppressant
AE: pancytopenia, HTN, hyperglycemia, CMV infection
Councilman bodies
Cytotoxic T-cell apoptosis causes accumulation of hepatocytes that stain eosinophilic in viral hepatitis
- shrunken apoptotic hepatocytes
Chlordiazepoxide
A long acting benzo
Hashimoto thyroiditis
Active germinal centers in thyroid, with lymphocytic infiltrate
Anti-Sm Antibody
- specific for lupus
- antibody to small nuclear ribonuclearproteins
Felty Syndrome
Triad in someone with long term, severe RA:
- rheumatoid arthritis
- neutropenia
- splenomegaly
Usually improves with RA treatment
Lymphocytic sialadenitis
Associated with Sjogren's syndrome
- seen on biopsy of labial salivary gland
Henoch-Schoenlein Purpura (HSP)
- child
- recent URI
- triad: GI (intussusception, melena), skin (purpura) and antrhalgias
May involve kidney as IgA nephropathy
Vasculitis 2° to IgA immune complex deposition
Prostaglandins
Vasodilate the afferent
Ang II
Vasoconstrict the efferent
Ezetimibe
Prevents cholesterol absorption at intestinal brush border
Methamphetamines
Increase catecholamines in the synaptic cleft - especially NE and D
- for ADHD and narcolepsy
Fibromuscular Dysplasia
A cause of HTN (10% of the time), that appears like a string of beads (alternating areas of aneurysmal dilation, and stenosis)
Dissecting Aneurysm
When the wall of an artery rips; common in thoracic aorta; common in marfan's
Loratidine
Second generation anti-H1
- far less sedating than first generation (no entry to CNS)
- used for allergies
Ranitidine
H2 blocker (gastric acid inhibitor)
Sulfasalazine
Combination of anti-bacterial & anti-inflammatory
USE: UC, Crohn's
AE: malaise, nausea, reversible oligospermia, sulfonamide toxicity
hCG same alpha subunit as
- LH
- FSH
- TSH
Hyperplastic polyp
Generally benign
- small, rectosigmoid region
Fibrinous Pericarditis
Occurs 1-3 days post-MI, with friction rub
- can occur 2 weeks + as Dressler Syndrome, autoimmune pathophysiology resulting in fibrinous pericarditis
Aspirin (salicylate) Overdose
1° respiratory alkalosis
2° metabolic acidosis
>12 hour post OD, pH will be normal, with ⬇️PCO2 & ⬇️HCO3-

+ tinnitus, nausea, fatigue

Tx: sodium bicarb (to alkaliniza urine), dialysis
Lichen Sclerosis
Paper-thin vulva/anal region
- benign, slight increase risk SCC
Lichen Simplex Chronicus
Leathery, thick, vulvar skin
- benign, no risk SCC
Gynecomastia
Increase in estrogen, comapred to androgens in males
Some Hormones Create Funny Knockers
- spironolactone
- hormones
- cimetidine
- finasteride
- ketoconazole
0.9% Saline (isotonic)
For sepsis, trauma treatment to increase BP
- initial hypovolemic efforts
Carcinoid Syndrome
- flushing
- watery diarrhea
- bronchospasm
- right sided valvular lesions
Nonbacterial Thrombotic Endocarditis (marantic endocarditis)
- sterile platelet thrombi on heart valve (commonly line of closure of MV)
- may thrombose to Internal Carotid/MCA
- associated with adenocarcinomas (mucinous, pancreatic)
- SLE (Libman Sacks)
- anti-phospholipid syndrome, DIC, extensive burns
Underlying hypercoagulable state
Long acting Sulfonylureas
- Glyburide, glimepiride
- higher incidence of hypoglycemia, especially in elderly
Glipizide
Short acting sulfonylurea, that carries less risk of hyperglycemia
Enfurvitide
Fusion inhibitor, inhibits gp41
- HIV retroviral therapy
Cold Water Immersion Changes
Cold water
- vasoconstriction leading to ⬆️CENTRAL blood volume
- now body thinks high blood volume, so ⬇️ADH, ⬆️ANP
Contraindications for Rotavirus Vaccine
- intussusception
- SCID
Acceptor Stem
5' CCA - 3' OH
- accepts the correct amino acid on tRNA
D-arm
Detects the correct AA for acceptor stem on tRNA
T-arm
Tethers tRNA to ribosome
Composed of special bases:
- ribothymidine
- pseudouridine
- cytidine
Aminoacyl-tRNA synthetase
Enzyme responsible for binding the correct AA to tRNA
Zencker diverticulum
A false diverticulum in the esophagus
- due to cricopharyngeal motor dysfunction
- leads to increased intraluminal pressure in the oropharynx
- leads to mucosa herniation through posterio hypopharynx (Killian triangle)
- halitosis, difficulty swallowing, painful swallowing
- thumb sign on barium swallow
Dematomyositis
- muscle weakness
- skin findings
- paraneoplastic syndrome for ovarian, lung, colorectal cancers, lymphoma
- Grottton's papules over joints/bony prominences
Thrombolytic therapy (alteplase)
Drug given for MI, fibrinolytic therapy, major AE is hemorrhage (GI, intracerebral)
Glucagonoma
Necrolytic migratory erythema + DM/hyperglycemia
Acute Tubular Necrosis
1. insult/injury
2. oliguria, rising creatinine
3. normalizing urine output with risk of: polyuria, electrolyte wasting (tubular resorptive capacity isn't fully intact)
Pure Red Cell Aplasia
- low RBCs, RBC precursors
- normal granulopoiesis, thrombopoiesis
Due to:
- thymoma
- lymphocytic leukemia
- parvovirus B19
Hypocitrateuria
When urinary citrate is low, it can't bind to calcium, so calcium-oxalate crystals are formed, leading to calcium oxalate stones
PNH
Uncontrolled complement mediated hemolysis
- hemolytic anemia
- hemoglobinuria
- atypical thrombosis
- pancytopenia
- chronic hemolysis = hemosiderin deposits in kidney
Carpal Tunnel Syndrome
Causes:
- pregnancy (fluid buildup)
- hypothyroidism (GAG buildup)
- DM (connective thickening)
- RA (tendon inflammation)
- Chronic Renal Failure (amyloid buildup)
Bohr Effect
In the tissues, a high CO2 or H+ content allows for more offloading of O2 from hemoglobin
- curve shifted to right (more offloading)
Haldane Effect
In the lungs, a high O2 content allows for more offloading of CO2 and H+ from hemoglobin
- dissociation of H+ from Hb
Leukocyte Alkaline Phosphatase (LAP)
Enzyme produced by PMNs
- ⬆️leukomoid rxn (sepsis)
- ⬇️CML
Dhole Bodies
Light blue peripheral granules in PMNs
- blue probably from ribosomes bound to RER
- seen in systemic illness
- myelodysplasia & burns
Biliary Atresia
Presents in first 2 months of life
- due to immune or viral
- block of extrahepatic bile ducts
- bile duct proliferation, portal tract edema, fibrosis
- high bilirubin, high direct
- hepatomegaly
- jaundice, icteric
- dark urine, pale stools
Cx: death due to cirrhosis
Tx: surgery
Meconium Ileus
- specific finding in babies with CF
- thick stool (inspissated)
- obstructs ileum
- within 1st days of life
HIV prophylaxis
TMP-SMX - P. jiroveci, toxoplasmosis
Azithromycin - MAC
Monospot test
Tests to see if serum agglutinated horse erythrocytes
- if yes, EBV
- if no, CMV
Flu vaccine
- given annually
- humoral immunity
- prevents viral entry into cells by binding hemagglutinin before it can bind sialic acid on cells
Accessory Nipple
Failure of involution of the mammary line
Age-related Macular Degeneration (AMD)
- leading cause of blindness in developed world
- smoking
- dry and wet types
Dry: gradual vision loss, difficulty driving and reading; drusen deposits with pigment abnormalities
Wet: acute vision loss; metamorphopsia (distortion of straight lines); grayish-green subretinal discolouration with adjacent hemorrhage

Tx: stop smoking; VEGF inhibitors
#1 COD for DM
Coronary heart disease
Vitamin A toxicity
Vomiting, vertigo, blurred vision, dry skin, hepatotoxicity
- papilledema (pseudotumor cerebri)
Call-Exner Bodies
Cuboidal cells in microfollicular pattern around pink cytoplasm, and coffee bean nuclei found in Granulosa cell tumor, secretes estrogen
Glomus Tumor
Tumor of thermoregulatory cells (modified smooth muscle cells) in the skin;
- tender, small, red-blue papule under nail
HOCM (Hypertrophic Obstructive Cardiomyopathy)
- increased LV mass
- LA enlargement
- decreased LV cavity size
- thickened interventricular septum
- normal or increased EF
Cerebral Amyloid Angiopathy
Most common cause of spontaneous lobar hemorrhage, particularly in elderly
- occipital and parietal lobes
Ground Glass Hepatocytes
Specific to Hep B infection
tdt
A surface maker for ALL
- DNA polymerase
MPO
Characterizes AML
- aggregates = auer rod = increases risk for DIC
- from PMN
Mycosis Fungoides
Neoplastic proliferation of CD4+ T-cell that infiltrate the skin
- rash, papules, nodules
- pautrier microabscesses (aggregates of neoplastic cells in the epidermis)
- blood involvement = Sezary syndrome
Sezary Syndrome
When CD4+ T-Cells that cause mycosis fungoides spreads to the blood
- sezary cells lymphocytes with cerebriform nuclei
IL-6
Plasma cell growth stimulator
- increased in multiple myeloma
Langerhans Cell Histiocytosis
A neoplastic proliferation of specialized dendritic cells of the skin (derived from bone marrow, antigen presenting cells)
- birbeck granules
- CD1A +
- S-100 +
Letterer Siwe Disease
- malignant langerhans histiocytosis
- skin rash + skeletal defects
- children <2 years
Eosinophilic Granuloma
- benign langerhans histiocytosis
- bone fractures
- mixed inflammatory cells, including eosinophils
Hand-Schuller-Christian Disease
- malignant langerhans histiocytosis
- scalp rash + lytic skull defects
- diabetes insipidus
- exophthalmos
- child > 3 years
Myopia
Nearsightedness (image focusses in front of retina)
Presbyopia
Changes in the eye with age - image focusses behind retina giving a farsightedness
- can correct nearsightedness (myopia)
Club Cells
Found mostly in terminal bronchioles
- secrete CC
- fights toxins, inflammation
- secretes surfactant components
- reserve cells
- non ciliated
M protein
Virulence of S. pyogenes
- studded alone cell
- resists phagocytosis
- the molecular mimicry protein responsible for rheumatic fever
- structurally analogous to tropomyosin, myosin alpha helical coiled protein
Pancreatic adenocarcinoma
Painless, obstructive jaundice + weight loss
Hypoxic-ischemic encephalopathy
bilateral wedge shaped strips of necrosis
- few centimeters lateral to longitudinal fissues
Hyaline Arteriolosclerosis
A result of 2 things:
- diabetes (NEG)
- benign HTN (leak proteins)
Malignant Nephrosclerosis
Isschemia of the kidney due to malignant HTN, leading to flea bitten kidney appearance
Thoracic Aneurysm Complication
- aortic insufficiency (due to aortic root dilatation)
Location of AAA
- above carotid bifurcation
- below renal arteries
Hypertensive Encephalopathy
Sudden increase in BP -> Sudden headache and coma/convulsions
Extramedullary Hematopoiesis
When the spleen has large islands of hematopoietic stem cells so it is the primary producer of hematopoiesis due to BM fibrosis
- dacrocytes are commone
- massive splenomegaly
- cytopenias are common
Zollinger Ellison Syndrome
⬆️Gastrin resulting in:
- increased HCl
- parietal cell hyperplasia (visible enlargement of gastric folds)
Vitiligo
Complete loss of melanocytes in epidermis
Nimodipine
Calcium channel blocker that can prevent vasospasm in SAH
cerebral selective drug
Diabetic Polyneuropathy
Affects distal axons of large sensory fibres
- glove and stocking distribution
- numbness & paresthesias
- accumulation of AGEs, sorbitol
Perforated Abdominal Viscus
Causes pneuoperitoneum - often due to rupture of duodenal ulcer
- rebound tenderness
- acute, painful
- possible referred shoulder pain with diaphragm involvement
Dexrazoxane
Give with chemo anthracyclines (daunorubicin, doxorubicin) to prevent dilated cardiomyopathy
- prevents free radical formation
- derivative of EDTA
Giardia Pathogenicity
Has a ventral sucking disc that adheres to SI mucosa = foul smelling, greasy stools
RPGN
Marked proliferation of cells in the urinary space of most of the glomeruli
- rapid onset of hematuria, HTN, renal failure
Glucokinase
In the pancreas this enzyme is linked to glucose sensing mechanism triggering insulin release
- defective in maturity onset diabetes of the young (MODY)
Low potency Antipsychotics
- chlorpromazine
- thioidazine
Have more anticholinergic, antihistamine and alpha-1 blocking effects that their high potency counterparts
Alexia without Agraphia
Inability to read, but able to write
- damage to occipital lobe/splenium of corpus callosum
- likely due to PCA issue
Basic Amino Acids
- arginine
- lysine
- histidine
EDTA
Anecdote to lead poisoning - IV or IM
Succimer
Anecdote to lead poisoning - oral
Lead Toxicity Tx
- Dimercaprol
- Succimer
- EDTA
- Penicillamine
Psoas Abscess
A cold abscess on the psoas muscle associatied with TB osteomyelitis
- cold meaning relative lack of inflammation
Trendelenberg Sign
Injury to superior gluteal nerve makes it so that the opposite side hip drops, when you stand on the injured nerve side.
- innervates the gluteus medius, gluteus minimus, tensor fasciae latae
Ischial Spine
Landmark for pudendal nerve block/episiotomy
Adrenal Insufficiency
Sx: weakness, weight loss, skin pigmentation
Causes: autoimmune, TB, metastatic cancer
Linked to autoimmune disease (thyroiditis, gastritis, etc.)
Plasma Cell
Large, ovoid cells, with eccentric nuclear and chromatin at nuclear periphery
Multipotent
Stem cells in the BM with limited differentiation
Totipotent
Stem cells that have the ability to transform to any cell line (only in fetus); they become multipotent at birth
Middle Meatus
Drains the maxillary sinus
Lyme Disease & HIV Diagnosis
- ELISA first
- Western blot to detect antibodies (to confirm)
Hyponatremia
Hypothyroidism can cause this due to decreased free water clearance
Blood Volume Calculation
BV = plasma volume / (1-Hct)
Plasma volume Estimates
5% of ECF
- radiolabeled albumin
- evans blue
ECF estimates
20% of blood volume
- thiosulfate
- radioactive salt
- inulin
- mannitol
Blood volume Estimates
60% of total body water
- D2O
- Antipyrine
- Titrated water
b-hCG
Maintains corpus luteum for first 8-10 weeks, by mimicking LH and allowed for production of progesterone
- replaced by placenta
Elbow flexors
1. biceps
2. brachialis
3. brachioradialis
Cremasteric Reflex
Tests L1, L2
- stroke inside of upper thigh
Anal Wink
Tests S3, S4
Achilles Reflex
Tests S1,S2
Patellar Reflex
Tests L3,L4
Pulmonary Vascular Resistance
= delta P / Q
= P(pulm a.) - P (left atrium) / CO
REM & Awake waves
Beta waves with low amplitude, but fast frequency
Lipid-laden Macrophages
Found in:
Gaucher: tissue paper (+pancytopenia, avascular necrosis of bone)
Niemann Pick: foam cells (+macular spot)
both have HSM
Paget Disease Complications
- myelophthisic anemia (destruction of BM)
- high output cardiac failure (AV shunts in bone)
- osteosarcoma
- pain secondary to nerve compression
Delta waves
High amplitude, low frequency
- seen in N3
- decrease in BP, HR, temp, RR and oxygen consumption (mild acidosis)
HLA-A3
Hemochromatosis
Prussian Blue
Stains irons, like in hemochromatosis
Behcet Syndrome
VOGU
- vasculitis associated
- oral ulcers
- genital lesions
- uveitis
Hairy Leukoplakia
Lateral tongue
- white plaque
- EBV associated
Subcutaneous Emphysema
Caused by air in mediastinum (like from mallory weiss tear)
Pyloric Stenosis
2 weeks after birth
- projectile vomiting
- nonbilious vomit
- olive like mass
- visible peristalsis
Intestinal Type Gastric Adenocarcinoma
Heaped up, irregular, large ulcer in antrum
RF: chronic gastritis (autoimmune or H. pylori), blood type A or nitrosamines (Japan)
- Sister Mary Joseph Node (spread to periumbilical region)
Diffuse Type Gastric Adenocarcinoma
Diffuse desmoplasia with thickening of stomach wall
- linitis plastic
- signet ring cells
- Kruckenberg tumor (bilateral seeding to ovaries)
Duodenal Atresia
Blind ending duodenum
- bilious vomiting
- Down Syndrome
- Double bubble sign on x-ray
UC Cancer Risk
When you have inflammatory bowel disease, risk of cancer is based on:
- extend of colon involvement
- duration of disease
Asherman Syndrome
Loss of basalis (stem cells) layer in endometrium
- lack of 2° amenorrhea
RF: overaggressive D&C
Cellular Atypia
The most important predictor for progression of endometrial hyperplasia to carcinoma
BRCA1 Mutation
- breast cancer
- serous ovarian ca.
- serous fallopian ca.
Schiller Duval Bodies
Glomerulus like structures
- seen on endodermal sinus tumor (yolk sac tumor)
- AFP
- kids
Reinke Crystals
From Leydig cells
- seen on sertoli-leydig ovarian sex cord stromal tumor
- hirsutism
Meigs Syndrome
1. Ovarian fibroma
2. Ascites
3. Hydrothorax (pleural effusion)
Pseudomyxoma Peritonei
Mucinous tumor of the appendix that is commonly mets to ovary
JELLY BELLY
Smoking
Risk Factor for:
- oropharyngeal ca.
- esophageal ca.
- lung car.
- renal/urothelial ca.
- pancreatic ca.
- cervical ca.
PCLuB
Tumors with CEA marker:
- Pancreas
- Colon
- Lung
- Breast
- Stomach

P-CLUB are common to mets to liver
Dysgerminoma
A germ cell tumor in teens
- fried egg appearance; resembles oocytes
- ⬆️LDH
- analogous to seminoma in males
- good prognosis, responds to radiation (just like seminoma)
Psammoma Bodies
Concentric calcifications seen in:
P - papillary thyroid
P - papillary RCC
S - serous ovarian
S - serous endometrial
M - meningioma
M - mesothelioma