USMLE Step 1 clues 2- 800 slides

Pass ProgramPass Program CluesClues

““You ain’t told me squat till You ain’t told me squat till you tell me the CLUE!!!”you tell me the CLUE!!!”

What are the 5 bacteria What are the 5 bacteria causing Heart Block?causing Heart Block?

• Lyme DiseaseLyme Disease

• Salmonella typhii (typhoid)Salmonella typhii (typhoid)

• Chagas Disease (Whipple’s)Chagas Disease (Whipple’s)

• LegionellaLegionella

• DiptheriaDiptheria

• Lets Stop Doing Long ContractionsLets Stop Doing Long Contractions

What bacteria cause What bacteria cause Reiter’s Syndrome?Reiter’s Syndrome?• ShigellaShigella• IBDIBD

– Crohn’sCrohn’s

• ChlamydiaChlamydia• YersinaYersina

• Reiter & Crohn Saw Yersina and got Reiter & Crohn Saw Yersina and got Chlamyia Chlamyia

What are the Low Complement What are the Low Complement bugs causing bugs causing Cryoglobuniemia?Cryoglobuniemia?• InfluenzaeInfluenzae

• AdenovirusAdenovirus

• MycoplasmaMycoplasma

• Hepatitis CHepatitis C

• EBVEBV

• I AM HEI AM HE

What are the drugs induced What are the drugs induced SLE?SLE?• HydralazineHydralazine

• INHINH

• PhenytoinPhenytoin

• ProcainamideProcainamide

• PenicillaminePenicillamine

• EthosuximideEthosuximide

• H I PPPEH I PPPE

What are the drugs that What are the drugs that Blast the BM?Blast the BM?

• AZTAZT

• BenzeneBenzene

• ChloramphenicolChloramphenicol

• VinblastineVinblastine

• Vinblastine Anilate Bone CellsVinblastine Anilate Bone Cells

What are the Comma What are the Comma Shaped bugs?Shaped bugs?

• VibrioVibrio

• CampylobacterCampylobacter

• ListeriaListeria

• H. pyloriH. pylori

• Campylobacter Has Very Long Campylobacter Has Very Long Comma GenesComma Genes

What is the cresent shaped What is the cresent shaped protozoa?protozoa?

• Giardia lambliaGiardia lamblia

What bacteria looks like What bacteria looks like Chinese letters?Chinese letters?

• CorynebacterCorynebacter

What are the TB Rx?What are the TB Rx?

• RifampinRifampin

• PyrazinamidePyrazinamide

• INHINH

• EthambutanolEthambutanol

• StreptomycinStreptomycin

• R E S P IR E S P I

What are the 6 Low Complement What are the 6 Low Complement assocs. with Nephrotic Syndrome?assocs. with Nephrotic Syndrome?

• Serum SicknessSerum Sickness

• PSGNPSGN

• SLESLE

• SBESBE

• CryoglobinemiaCryoglobinemia

• MPGN IIMPGN II

What drugs Induce p450?What drugs Induce p450?

• BAG 4 CPR QTSBAG 4 CPR QTS

• Car Grabs Queens Car Grabs Queens Tets to Rev Up Tets to Rev Up

• Alcoholic doing drugs Alcoholic doing drugs and stinking up carand stinking up car

• BarbituratesBarbiturates

• AlcoholAlcohol

• GriseofulvinGriseofulvin

• CarbamazapineCarbamazapine

• QuinidineQuinidine

• TetracyclineTetracycline

• Sulfa drugsSulfa drugs

What drugs Inhibit p450?What drugs Inhibit p450?

• I Do SMACK I Do SMACK QuinolonesQuinolones

• INHINH

• DapsoneDapsone

• SpirolactonesSpirolactones

• MacrolidesMacrolides

• AmiodaroneAmiodarone

• CimetidineCimetidine

• KetoconazoleKetoconazole

• QuinilonesQuinilones

What drugs are P450 What drugs are P450 Dependent?Dependent?• WarfarinWarfarin

• EstrogenEstrogen

• TheophyllineTheophylline

• DigoxinDigoxin

• Theo came from war & dig inside WDEPT Theo came from war & dig inside WDEPT taking Estrogen & now is Phenytointaking Estrogen & now is Phenytoin

What disease is a Neutophil What disease is a Neutophil Deficiency?Deficiency?

• CGDCGD

What is another name for What is another name for CGD?CGD?

• Chronic Granulomatous diseaseChronic Granulomatous disease

• NADPH Oxidase deficiency NADPH Oxidase deficiency

What are the Side effects of What are the Side effects of Statins?Statins?

• MyositisMyositis

• HepatitisHepatitis

• Increased liver enzymesIncreased liver enzymes

What are the painful genital What are the painful genital Lesions?Lesions?

• ChancroidChancroid

• HerpesHerpes

• Lymphogranuloma inguinaleLymphogranuloma inguinale

What is the painful What is the painful chancroid lesion due to?chancroid lesion due to?

• Hemophilus ducreyiHemophilus ducreyi

What are the 4 hormones with What are the 4 hormones with disulfide bonds?disulfide bonds?

• Prolactin Prolactin

• InsulinInsulin

• InhibinInhibin

• GHGH

• I PIG on BONDSI PIG on BONDS

What are the Hookworms?What are the Hookworms?

• Necatur americanisNecatur americanis

• Enterobius vermicularisEnterobius vermicularis

• Ankylostoma duodenaleAnkylostoma duodenale

• Trichuris trichuriumTrichuris trichurium

• Ascaris lumbercoidesAscaris lumbercoides

• StrongyloidesStrongyloides

• Hooks AS NEATHooks AS NEAT

What are the X-Linked What are the X-Linked enzyme Deficiencies?enzyme Deficiencies?• G6-PDG6-PD

• CGD CGD

• Pyruvate dehydrogenase Def.Pyruvate dehydrogenase Def.

• Fabry’sFabry’s

• Hunter’sHunter’s

• Lesch-nyhanLesch-nyhan

• Lesch-Nyhan Hunter Puts Fabrys on G6 Lesch-Nyhan Hunter Puts Fabrys on G6 ClothesClothes

What diseases do we screen What diseases do we screen for at birth? for at birth? • PleasePlease

• CheckCheck

• BeforeBefore

• GoingGoing

• HomeHome

• PKUPKU

• CAH(Congential CAH(Congential Adrenal Adrenal Hyperplasia)Hyperplasia)

• BiotinidaseBiotinidase

• GalactosemiaGalactosemia

• HypothyroidismHypothyroidism

HLA-AntigensHLA-Antigens

• HLA-DR2HLA-DR2= = Narcolepsy, Allergy, Narcolepsy, Allergy, Goodpasture’s, MSGoodpasture’s, MS

• HLA-DR3HLA-DR3= = DM, Chronic Active Hepatitis, DM, Chronic Active Hepatitis, Sjogren’s, SLE, Celiac SprueSjogren’s, SLE, Celiac Sprue

• HLA-DR3 & 4HLA-DR3 & 4= = IDDM(Type I)IDDM(Type I)• HLA-DR4HLA-DR4= = Rheumatoid Arthritis, Pemphigus Rheumatoid Arthritis, Pemphigus

VulgarisVulgaris• HLA-DR5HLA-DR5= = JRA, Pernicious AnemiaJRA, Pernicious Anemia• HLA-DR7HLA-DR7= Nephrotic Syndrome(Steroid = Nephrotic Syndrome(Steroid

induced)induced)

HLA-AntigensHLA-Antigens

• HLA-DR 3 & B8=HLA-DR 3 & B8=Celiac DiseaseCeliac Disease• HLA-A3= HLA-A3= Hemochromatosis(chromo. 6, Hemochromatosis(chromo. 6,

point mut.-cysteine>tyrosine)point mut.-cysteine>tyrosine)• HLA-B8=HLA-B8=MGMG• HLA-B13= PsoriasisHLA-B13= Psoriasis• HLA-B27= Psoriais(only if w/arthritis) HLA-B27= Psoriais(only if w/arthritis)

Ankylosing Spondylitis, IBD, Reiter’s, Ankylosing Spondylitis, IBD, Reiter’s, Postgonococcal ArthritisPostgonococcal Arthritis

• HLA-BW 47= 21 alpha Hydroxylas def.HLA-BW 47= 21 alpha Hydroxylas def.(Vit.D)(Vit.D)

What are the actions of What are the actions of Steroids?Steroids?

• Kills helper T-cells & eosinophilsKills helper T-cells & eosinophils

• Inhibits Macrophage migrationInhibits Macrophage migration

• Inhibits Mast cell degranulationInhibits Mast cell degranulation

• Inhibits Phospholipase AInhibits Phospholipase A

• Stimulates protein synthesisStimulates protein synthesis

• Stablizes endotheliumStablizes endothelium

What are the causes of What are the causes of Monocytosis? Monocytosis?

• Salmonella (typhoid)Salmonella (typhoid)

• TBTB

• EBVEBV

• SyphillisSyphillis

E. Coli is the most common E. Coli is the most common cause of what?cause of what?

• UTIUTI

• Spontaneous bacterial peritonitis Spontaneous bacterial peritonitis

• Abdominal abscessAbdominal abscess

• CholecystitisCholecystitis

• Ascending cholangitisAscending cholangitis

• AppendicitisAppendicitis

What are the one dose What are the one dose treatments for Gonorrhea?treatments for Gonorrhea?

• CeftriaxoneCeftriaxone

• CefiximeCefixime

• CefoxineCefoxine

• CiprofloxinCiprofloxin

• OflaxacinOflaxacin

• GatifolxacinGatifolxacin

What is the one dose What is the one dose treatment for Chlamydia?treatment for Chlamydia?

• AzithromycinAzithromycin

What are the “Big Mama” What are the “Big Mama” anaerobes?anaerobes?

• Strep bovisStrep bovis

• Clostridium melanogosepticusClostridium melanogosepticus

• Bacteriodes fragilisBacteriodes fragilis

What are the “Big Mama” What are the “Big Mama” Rx?Rx?

• ClindamycinClindamycin

• MetranidazoleMetranidazole

• CefoxitinCefoxitin

What “big mama” bugs are What “big mama” bugs are associated with colon cancer?associated with colon cancer?

• Strep. BovisStrep. Bovis

What do you see in the serum What do you see in the serum with low volume state?with low volume state?• K+?K+?• DecreasesDecreases

• Na+?Na+?• DecreasesDecreases

• Cl-?Cl-?

• DecreasesDecreases

• pH?pH?• IncreasesIncreases

• BP?BP?• IncreasesIncreases

What are psammoma What are psammoma bodies?bodies?

• Calcified CA’sCalcified CA’s

In what diseases are In what diseases are Psammoa Bodies present?Psammoa Bodies present?

• Papillary carcinoma of the ThyroidPapillary carcinoma of the Thyroid

• Serous cystadenocarcinoma of the Serous cystadenocarcinoma of the ovaryovary

• MeningiomaMeningioma

• MesotheliomaMesothelioma

What are the Urease (+) What are the Urease (+) Bacteria?Bacteria?

• ProteusProteus

• PseudomonasPseudomonas

• Ureaplasma urealyticumUreaplasma urealyticum

• Nocardia speciesNocardia species

• Cryptococcus neoformansCryptococcus neoformans

What types of stones are What types of stones are formed from Proteus?formed from Proteus?

• Struvite (90%)Struvite (90%)

What type of motility do What type of motility do Proteus have?Proteus have?

• swarmingswarming

What are 5 indications of What are 5 indications of Surgery?Surgery?

• Intractable painIntractable pain

• Hemorrhage (massive)Hemorrhage (massive)

• Obstruction (from scarring)Obstruction (from scarring)

• PerforationPerforation

What drugs cause Cardiac What drugs cause Cardiac Fibrosis?Fibrosis?

• Adriamycin (Doxyrubicin)Adriamycin (Doxyrubicin)

• Phen-fenPhen-fen

What drug is used to tx What drug is used to tx cardiac fibrosis?cardiac fibrosis?

• DozaroxsinDozaroxsin

What is the MCC of any What is the MCC of any ….penia?….penia?

• #1 = Virus#1 = Virus

• #2 = Drugs#2 = Drugs

What is seen in the What is seen in the Salmonella Triad?Salmonella Triad?

• High FeverHigh Fever

• Rose spots (rash)Rose spots (rash)

• Intestinal fireIntestinal fire

What drugs cause Myositis?What drugs cause Myositis?

• INHINH

• PredinsonePredinsone

• StatinsStatins

What are the 7 Gram -What are the 7 Gram -encapsulated bacteria?encapsulated bacteria?• SomeSome

• StrangeStrange

• KillersKillers

• HaveHave

• Pretty Pretty

• NiceNice

• CapsulesCapsules

• SalmonellaSalmonella

• Strep. Pneumo Strep. Pneumo (gr+)(gr+)

• KlebsiellaKlebsiella

• H. influenzaH. influenza

• NeisseriaNeisseria

• CryptococcusCryptococcus

What is the Jones Criteria for What is the Jones Criteria for Rheumatic Fever?Rheumatic Fever?

• SubQ nodulesSubQ nodules

• PolyarthritisPolyarthritis

• Erythema marginatumErythema marginatum

• CarditisCarditis

• ChoreaChorea

What are the causes of What are the causes of Eosinophilla? Eosinophilla?

• NeoplasmsNeoplasms

• Allergies/AsthmaAllergies/Asthma

• Addison’s DzAddison’s Dz

• Collagen Vascular DzCollagen Vascular Dz

• ParasitesParasites

What are the Risk Factors What are the Risk Factors for Liver CA?for Liver CA?• Hep B,C,DHep B,C,D• AflatoxinAflatoxin• Vinyl chlorideVinyl chloride• EthanolEthanol• Carbon TetrachlorideCarbon Tetrachloride• Anyline DyesAnyline Dyes• SmokingSmoking• HemochromatosisHemochromatosis• BenzeneBenzene• SchistomiasisSchistomiasis

What are the 9 Live What are the 9 Live Vaccines?Vaccines?• MeaslesMeasles• MumpsMumps• RubellaRubella• Oral Polio (sabin)Oral Polio (sabin)• RotavirusRotavirus• Small poxSmall pox• BCGBCG• Yellow feverYellow fever• VaricellaVaricella

What are the Killed What are the Killed Vaccines?Vaccines?• SIR Hep ASIR Hep A • Salk (polio)Salk (polio)

• InfluenzaInfluenza

• RubellaRubella

• Hepatitis AHepatitis A

What are the IgA What are the IgA Nephropathies?Nephropathies?

• Henoch-Schoenlein P. (HSP)Henoch-Schoenlein P. (HSP)

• Alport’sAlport’s

• Berger’sBerger’s

What are the Drugs that cause What are the Drugs that cause Autoimmune hemolytic anemia?Autoimmune hemolytic anemia?

• PCNPCN

• αα-methyldopa-methyldopa

• CephalosporinsCephalosporins

• SulfaSulfa

• PTUPTU

• Anti-malarialsAnti-malarials

• DapsoneDapsone

What are the drugs that cause What are the drugs that cause Autoimmune Autoimmune thrombocytopenia?thrombocytopenia?• ASAASA

• HeparinHeparin

• QuinidineQuinidine

What are the enzymes that What are the enzymes that show after an MI?show after an MI?

• Troponin ITroponin I

• CKMBCKMB

• LDHLDH

What is the first MI enzyme What is the first MI enzyme to appear?to appear?• Troponin ITroponin I

• AppearsAppears

• PeaksPeaks

• GoneGone

• 2 hrs2 hrs

• 2 days2 days

• 7 days7 days

What is the 2What is the 2ndnd MI enzyme MI enzyme to appear?to appear?• CK-MBCK-MB

• AppearsAppears

• PeaksPeaks

• GoneGone

• 6 hrs6 hrs

• 12 hrs12 hrs

• 24 hrs24 hrs

What is the 3What is the 3rdrd MI enzyme to MI enzyme to appear?appear?• LDHLDH

• AppearsAppears

• PeaksPeaks

• GoneGone

• 1 day1 day

• 2 days2 days

• 3 days3 days

What bacteria have Silver What bacteria have Silver Stains?Stains?

• Pneumocysitis cariniiPneumocysitis carinii

• Bartonella henseslae (lymph node)Bartonella henseslae (lymph node)

• Candida (yeast)Candida (yeast)

What are the sulfa containing What are the sulfa containing drugs?drugs?

• SulfonamidesSulfonamides

• SulfonylureaSulfonylurea

• CelebrexCelebrex

What is another name for What is another name for celebrex?celebrex?

• CelecoxibCelecoxib

What type of inhibitor is What type of inhibitor is Celebrex?Celebrex?

• COX 2 specificCOX 2 specific

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

What drugs inhibit What drugs inhibit dihydrofolate reductase?dihydrofolate reductase?

• Pyremethamin/SulfadiazinePyremethamin/Sulfadiazine

• Trimethoprim/SulfamethoxazoleTrimethoprim/Sulfamethoxazole

What drugs cause Pulmonary What drugs cause Pulmonary Fibrosis?Fibrosis?

• BleomycinBleomycin

• BulsufanBulsufan

• AmiodaroneAmiodarone

• TocainideTocainide

What are the macrophage What are the macrophage deficiency diseases?deficiency diseases?

• Chediak-HigashiChediak-Higashi

• NADPH-oxidase deficiencyNADPH-oxidase deficiency

What are the SE of Loops and What are the SE of Loops and Thiazides?Thiazides?

• HyperglycemiaHyperglycemia

• HyperuricemiaHyperuricemia

• HypovolemiaHypovolemia

• HypokalemiaHypokalemia

What are the SE of Loop What are the SE of Loop diuretics?diuretics?

• OH DANGOH DANG • OtotoxicityOtotoxicity

• DehydrationDehydration

• AllergyAllergy

• Nephritis Nephritis (interstitial)(interstitial)

• GoutGout

What are the only 3 Pansystolic What are the only 3 Pansystolic Murmurs and when are they Murmurs and when are they heard?heard?• MRMR

• TRTR

• VSDVSD

• Decrease on Decrease on inspiration (^exp)inspiration (^exp)

• Increase on Increase on inspirationinspiration

• Decrease on Decrease on inspiration (^exp)inspiration (^exp)

Macrophages in various Macrophages in various organsorgans• BrainBrain• LungLung• LiverLiver• SpleenSpleen• KidneyKidney• Lymph nodesLymph nodes• SkinSkin• BoneBone• CTCT

• MircogliaMircoglia• Type I pneumocyteType I pneumocyte• Kupffer cellKupffer cell• RESRES• MesangialMesangial• DendriticDendritic• LangerhansLangerhans• OsteoclastsOsteoclasts• Histiocytes orHistiocytes or• Giant cells or Giant cells or • Epithelioid cellsEpithelioid cells

What are the 7 Rashes of the What are the 7 Rashes of the Palms & Soles?Palms & Soles?

• TSSTSS

• Rocky Mountain Spotted FeverRocky Mountain Spotted Fever

• Coxsackie A (Hand/Foot & mouth dz)Coxsackie A (Hand/Foot & mouth dz)

• KawasakiKawasaki

• SyphillisSyphillis

• Scarlet FeverScarlet Fever

• Staph Scalded Skin Syndrome Staph Scalded Skin Syndrome

What is seen in every What is seen in every restrictive lung dz and low restrictive lung dz and low volume state?volume state?• TachypneaTachypnea

• Decrease pCO2Decrease pCO2

• Decrease pO2Decrease pO2

• Increase pHIncrease pH

What are the different 2What are the different 2ndnd messenger systems?messenger systems?

• cAMPcAMP

• cGMPcGMP

• IP3/DAGIP3/DAG

• Ca:CalmodulinCa:Calmodulin

• Ca+Ca+

• Tyrosine kinaseTyrosine kinase

• NO NO

What is the clue for cAMP?What is the clue for cAMP?

• It is the 90%It is the 90%

• SympatheticSympathetic

• CRH (cortisol)CRH (cortisol)

• CatabolicCatabolic

What is the clue for cGMP?What is the clue for cGMP?

• ParasympatheticParasympathetic

• AnabolicAnabolic

What are the clues for What are the clues for IP3/DAG?IP3/DAG?

• NeurotransmitterNeurotransmitter

• GHRHGHRH

• All hypothalamic hormones xc All hypothalamic hormones xc cortisolcortisol

• Used by what and for what?Used by what and for what?

• Smooth muscle for contractionSmooth muscle for contraction

What is the clue for What is the clue for Ca:Calmodulin?Ca:Calmodulin?

• Used by smooth muscle for Used by smooth muscle for contraction by distentioncontraction by distention

What is the clue for Ca+?What is the clue for Ca+?

• Used by Gastrin onlyUsed by Gastrin only

What is the clue for Tyrosine What is the clue for Tyrosine Kinase?Kinase?

• Used by InsulinsUsed by Insulins

• Used by ALL growth factorsUsed by ALL growth factors

What is the clue for NO?What is the clue for NO?

• NitratesNitrates

• ViagraViagra

• ANPANP

• LPSLPS

What are the T & B cell What are the T & B cell deficiencies?deficiencies?

• WAS WAS

• SCIDSCID

• CVIDCVID

• HIVHIV

• HTLV-1HTLV-1

What are the CLUES for What are the CLUES for WAS?WAS?

• ThrombocytopeniaThrombocytopenia

• IL-4IL-4

• InfectionInfection

• EczemaEczema

• Decrease IgMDecrease IgM

• IgE???IgE???

What are the CLUES for What are the CLUES for SCID?SCID?

• Framshift/Nonsense mutationFramshift/Nonsense mutation

• Adenosine deaminase deficiencyAdenosine deaminase deficiency

• T-cell>B-cellT-cell>B-cell

• Bacterial infectionsBacterial infections

• Fungal infectionsFungal infections

What are the CLUES for What are the CLUES for CVID?CVID?

• Late onsetLate onset

• Frameshift/Missense mutationFrameshift/Missense mutation

• Tyrosine Kinase deficiencyTyrosine Kinase deficiency

What are the CLUES for HIV & What are the CLUES for HIV & HTLV-1?HTLV-1?

• T-cell>B-cellT-cell>B-cell

• CD4 richCD4 rich

• BrainBrain

• TesticlesTesticles

• CervixCervix

• Blood vesselsBlood vessels

What are the inhibitors of What are the inhibitors of Complex 1 of the ETC?Complex 1 of the ETC?

• AmytalAmytal

• RotenoneRotenone

• MalonateMalonate

• Antimycin DAntimycin D

• CN-CN-

• COCO

• ChloramphenicolChloramphenicol

• OligomycinOligomycin

What are the ETC chemical What are the ETC chemical uncouplers?uncouplers?

• DNPDNP

• Free Fatty acidsFree Fatty acids

• AspirinAspirin

What type of uncoupler is What type of uncoupler is Aspirin?Aspirin?

• Physical uncouplerPhysical uncoupler

What are the 4 sources of What are the 4 sources of Renal Acid?Renal Acid?

• PlasmaPlasma

• Urea cycleUrea cycle

• Collecting ductsCollecting ducts

• GlutaminaseGlutaminase

What is the one dose tx for What is the one dose tx for Hemophilus ducreyi?Hemophilus ducreyi?

1 gram po1 gram po

• CeftriazoneCeftriazone

250 mg im250 mg im

What is the one dose tx for What is the one dose tx for Chlaymdia?Chlaymdia?

1 gram po1 gram po

What is the one dose tx for What is the one dose tx for Candidiasis?Candidiasis?

• KetoconazoleKetoconazole

150mg150mg

What is the one dose tx for What is the one dose tx for Vaginal Candidiasis?Vaginal Candidiasis?

• DifluccanDifluccan

1 pill1 pill

What is the one dose tx for What is the one dose tx for Trichomonas?Trichomonas?

• MetronidazoleMetronidazole

2 grams2 grams

What is the one dose tx for What is the one dose tx for Gardnerella?Gardnerella?

2 grams2 grams

What are the 3 cephalosporins & What are the 3 cephalosporins & doses used as one dose doses used as one dose treatments for Gonorrhea?treatments for Gonorrhea?• CeftriaxoneCeftriaxone

250 mg im250 mg im

• CefiximeCefixime

400 mg po400 mg po

• CefoxitinCefoxitin

400 mg po400 mg po

What are the 3 Quinolones & What are the 3 Quinolones & doses used as one dose doses used as one dose treatments for Gonorrhea?treatments for Gonorrhea?• CiprofloxacinCiprofloxacin

500 mg po500 mg po

• OfloxacinOfloxacin

400 mg po400 mg po

• GatifloxacinGatifloxacin

400 mg im400 mg im

What are the 4 enzymes needed What are the 4 enzymes needed to break down glycogen?to break down glycogen?

• Phosphorylase (Pi)Phosphorylase (Pi)

• Debranching enzymeDebranching enzyme

• Alpha-1,6 –GlucosidaseAlpha-1,6 –Glucosidase

• PhosphatasePhosphatase

What are the 2 enzymes What are the 2 enzymes needed to make glycogen?needed to make glycogen?

• Glycogen synthaseGlycogen synthase

• Branching enzymeBranching enzyme

What are the branching What are the branching enzymes?enzymes?

• Glycogen alpha-1,4 glycosyl Glycogen alpha-1,4 glycosyl transferasetransferase

• Glycogen alpha-1,6 glycosyl Glycogen alpha-1,6 glycosyl transferasetransferase

What is the rate limiting What is the rate limiting enzyme in the break down of enzyme in the break down of glycogen?glycogen?• Phosphorylase (Pi)Phosphorylase (Pi)

What values do you see in What values do you see in obstructive pulmonary dz?obstructive pulmonary dz?

• pO2?pO2?

NormalNormal

• pCO2?pCO2?

Normal or increasedNormal or increased

• pH?pH?

DecreasedDecreased

What values do you see in What values do you see in restrictive pulmonary dz?restrictive pulmonary dz?

• pO2?pO2?

Decreased Decreased

• pCO2?pCO2?

Decreased Decreased

• pH?pH?

IncreasedIncreased

What type of acidosis do you What type of acidosis do you see with obstructive pulmonary see with obstructive pulmonary dz?dz?• Respiratory acidosisRespiratory acidosis

What are the Lysosomal Storage What are the Lysosomal Storage Disease & what is the deficiency?Disease & what is the deficiency?

• Fabry’sFabry’s

• Krabbe’sKrabbe’s

• Gaucher’sGaucher’s

• Niemann – PickNiemann – Pick

• Tay-SachsTay-Sachs

• Metachromatic Metachromatic leukodystrophyleukodystrophy

• Hurler’sHurler’s

• Hunter’sHunter’s

• αα – galactosidase – galactosidase

• GalactosylceramideGalactosylceramide

• ββ – glucocerebrosidase – glucocerebrosidase

• SphingomyelinaseSphingomyelinase

• HexosaminidaseHexosaminidase

• ArylsulfataseArylsulfatase

• αα – L – iduronidase – L – iduronidase

• Iduronidase sulfataseIduronidase sulfatase

What dz’s are associated with What dz’s are associated with HLA B27?HLA B27?

• PsoriasisPsoriasis

• Ankylosing spondylitisAnkylosing spondylitis

• IBD (Ulcerative colitis)IBD (Ulcerative colitis)

• Reiter’s SyndromeReiter’s Syndrome

What HLA is Psorisis w/RA What HLA is Psorisis w/RA associated with?associated with?

• HLA-13HLA-13

What are the Glycogen Storage What are the Glycogen Storage Diseases & the deficiency?Diseases & the deficiency?

• Von Gierke’sVon Gierke’s

• Pompe’sPompe’s

• Cori’sCori’s

• McArdle’sMcArdle’s

• Glucose – 6 – phosphateGlucose – 6 – phosphate

• αα – 1 – 4 glucosidase – 1 – 4 glucosidase

• Glycogen phosphorylaseGlycogen phosphorylase

What are 6 places of the TCA cycle What are 6 places of the TCA cycle where amino acids feed in/out?where amino acids feed in/out?

• Pyruvate?Pyruvate?• GlycineGlycine• AlanineAlanine• SerineSerine

• Acetyl CoAAcetyl CoA ? ? • PhenylalaninePhenylalanine• IsoleucineIsoleucine• ThreonineThreonine• TryptophanTryptophan• LysineLysine• LeucineLeucine

• Alpha-KGAlpha-KG ? ?

• GlutamateGlutamate

• GlutamineGlutamine

• Succinyl CoA?Succinyl CoA?

• PhenylalaninePhenylalanine

• TryptophanTryptophan

• TyrosineTyrosine

• FumerateFumerate ? ?

• ProlineProline

• Oxaloacetate?Oxaloacetate?

• AspartateAspartate

• AsparigineAsparigine

What are the 4 steps of B-What are the 4 steps of B-oxidation?oxidation?

• Oxidation – 7 NADH – 21 ATPOxidation – 7 NADH – 21 ATP

• HydrationHydration

• Oxidation - 7FADH – 14 ATPOxidation - 7FADH – 14 ATP

• Thiolysis – 8 AcCoA –Thiolysis – 8 AcCoA – 96ATP 96ATP 131 ATP – 2 (to bring it 131 ATP – 2 (to bring it

in)in)

What are the blood gases in What are the blood gases in neuromuscular disease (= neuromuscular disease (= restrictive blood gases)?restrictive blood gases)?• pO2?pO2?

DecreasedDecreased• pCO2?pCO2?

DecreasedDecreased• PCWP?PCWP?

Decreased Decreased (b/c it’s a pressure problem)(b/c it’s a pressure problem)

• Respiratory Rate?Respiratory Rate?IncreasedIncreased

• pH?pH?IncreasedIncreased

• SZ?SZ?IncreasedIncreased

What are 5 Hormones produced by What are 5 Hormones produced by small cell (oat cell) lung CA?small cell (oat cell) lung CA?

• ACTHACTH

• ADHADH

• PTHPTH

• TSHTSH

• ANPANP

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?

•Anti-smith Anti-smith •Anti cardiolipin Anti cardiolipin •Anti-ds DNAAnti-ds DNA •SLESLE

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti – histone?Anti – histone?

• Drug induced SLEDrug induced SLE

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-topoisomerase?Anti-topoisomerase?

• PSS (Progressive Systemic Sclerosis)PSS (Progressive Systemic Sclerosis)

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti TSH receptors?Anti TSH receptors?

• GravesGraves

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-centromere?Anti-centromere?

• CRESTCREST

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-GBM?Anti-GBM?

• Goodpasture’sGoodpasture’s

What does Goodpastures have What does Goodpastures have antibody to?antibody to?

• Type IV collagenType IV collagen

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-mitochondria?Anti-mitochondria?

• Primary biliary cirrhosisPrimary biliary cirrhosis

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-hair follicle?Anti-hair follicle?

• Alopecia areataAlopecia areata

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-IgG?Anti-IgG?

• Rheumatoid arthritisRheumatoid arthritis

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies? Antibodies?

• Anti-myelin receptors?Anti-myelin receptors?

• MSMS

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-gliaden?Anti-gliaden?

• Anti-gluten?Anti-gluten?

• Celiac sprueCeliac sprue

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-islet cell receptor?Anti-islet cell receptor?

• DM Type IDM Type I

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-melanocyte?Anti-melanocyte?

• ViteligoViteligo

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-ACh receptor?Anti-ACh receptor?

• MGMG

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-ribonuclear protein?Anti-ribonuclear protein?

• Mixed Connective Tissue dz (MCTD)Mixed Connective Tissue dz (MCTD)

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-parietal cell receptor?Anti-parietal cell receptor?

• Pernicious anemiaPernicious anemia

What does Pernicious Anemia What does Pernicious Anemia have antibody to?have antibody to?

• Intrinsic factorIntrinsic factor

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-epidermal anchoring protein Anti-epidermal anchoring protein

receptors?receptors?

• Pemphigus vulgarisPemphigus vulgaris

What does Pemphigus vulgaris What does Pemphigus vulgaris have antibody to?have antibody to?

• Intercelluar junctions of epidermal Intercelluar junctions of epidermal cellscells

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-epidermal basement membrane Anti-epidermal basement membrane

protein?protein?

• Bullous pemphigoidBullous pemphigoid

What do you see with bullous What do you see with bullous pemphigoid?pemphigoid?

• IgG sub-epidermal blistersIgG sub-epidermal blisters

•Oral blistersOral blisters

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-platelet?Anti-platelet?

• ITPITP

What does ITP have antibody What does ITP have antibody to?to?

• Glycoprotein IIb/IIIaGlycoprotein IIb/IIIa

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-thyroglobulin?Anti-thyroglobulin?

• Anti-microsomal?Anti-microsomal?

• Hashimoto’sHashimoto’s

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-smooth muscle?Anti-smooth muscle?

• Anti-scl-70?Anti-scl-70?

• SclerodermaScleroderma

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-rho (SS-A)?Anti-rho (SS-A)?

• Anti-la?Anti-la?

• Sjogren’sSjogren’s

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• Anti-proteinase?Anti-proteinase?

• C-ANCA?C-ANCA?

• Wegener’sWegener’s

What Autoimmune Disease has What Autoimmune Disease has the following Autoimmune the following Autoimmune Antibodies?Antibodies?• P-ANCA?P-ANCA?

• Polyarteritis nodosaPolyarteritis nodosa

What antigen & What antigen & immunoglobulin is Polyarteritis immunoglobulin is Polyarteritis nodosa associated with?nodosa associated with?•Hepatitis B antigenHepatitis B antigen

•IgMIgM

What are the viruses that directly What are the viruses that directly cause CA and which CA do they cause CA and which CA do they cause?cause?• Papilloma virusPapilloma virus??

Cervical CACervical CA• EBVEBV??

BurkittsBurkittsNasopharyngeal CANasopharyngeal CA

• HepB & CHepB & C??Liver CALiver CA

• HIVHIV? ? Kaposi’s SarcomaKaposi’s Sarcoma

What are the 7 Nephrotic Patterns What are the 7 Nephrotic Patterns seen with every Vasculitis?seen with every Vasculitis?

• Clot in front of renal artery?Clot in front of renal artery?

Renal artery stenosis Renal artery stenosis • Clot off whole renal artery?Clot off whole renal artery?

Renal failureRenal failure• Inflamed glomeruli?Inflamed glomeruli?

Glumerulo nephritisGlumerulo nephritis• Clot in papilla?Clot in papilla?

Papillary necrosis Papillary necrosis • Clot off medulla?Clot off medulla?

Interstitial nephritis Interstitial nephritis • Clot off pieces of nephron?Clot off pieces of nephron?

Focal segmental GN (HIV, drug use association)Focal segmental GN (HIV, drug use association)• Clot off lots of nephrons?Clot off lots of nephrons?

Rapidly Progressive GN Rapidly Progressive GN

What is the most common What is the most common nephrotic disease seen in kids nephrotic disease seen in kids and when does it occur?and when does it occur?•Min. change diseaseMin. change disease

•2 wks post URI2 wks post URI

What is the most common What is the most common vasculitity leading to rapidly vasculitity leading to rapidly progressive progressive glomerulonephrosis?glomerulonephrosis?• Goodpasture’s Goodpasture’s

What is the most common What is the most common malignant renal tumor in malignant renal tumor in children?children?• Wilm’s tumorWilm’s tumor

What is the most common What is the most common malignant renal tumor in malignant renal tumor in adults?adults?• AdenocarcinomaAdenocarcinoma

What is the most common What is the most common renal mass?renal mass?

• CystCyst

What is the most common What is the most common renal disease in renal disease in Blacks/Hispanics?Blacks/Hispanics?• Focal Segmental GNFocal Segmental GN

What is the most common What is the most common nephrotic disease in adults?nephrotic disease in adults?

• Membranous GNMembranous GN

Thrombolytics & InhibitorsThrombolytics & Inhibitors

• What does tPA, Streptokinase, What does tPA, Streptokinase, Urokinase inhibit?Urokinase inhibit?

• Aminocaproic acidAminocaproic acid

• What doe Warfarin inhibit? What doe Warfarin inhibit?

• Vitamin KVitamin K

• What does Heparin inhibit? What does Heparin inhibit?

• Protamine SulfateProtamine Sulfate

What is the dosage of tPA?What is the dosage of tPA?

• IV push?IV push?

• 20mg20mg

• Drip?Drip?

• 40mg40mg

What is the dosage for What is the dosage for Streptokinase?Streptokinase?

• IV push?IV push?

• 750K750K

• Drip?Drip?

• 750K750K

What is Urokinase used for?What is Urokinase used for?

• Used ONLY for such things as:Used ONLY for such things as:

• Feeding tubesFeeding tubes

• Central linesCentral lines

• Fistulas Fistulas

What is Alopecia Areata?What is Alopecia Areata?

• Loss of a patch of hairLoss of a patch of hair

What is Alopecia Totalis?What is Alopecia Totalis?

• Loss of ALL hair on head “bald”Loss of ALL hair on head “bald”

What is Alopecia What is Alopecia Universalis?Universalis?

• Loss of hair on entire body “hairless”Loss of hair on entire body “hairless”

What is Loffler syndrome?What is Loffler syndrome?

• Pneumonitis with endocarditis = Pneumonitis with endocarditis = pulmonary infiltrate with severe pulmonary infiltrate with severe eosinophiliaeosinophilia

What is Loffler syndrome also What is Loffler syndrome also known as?known as?

• PIE syndromePIE syndrome

What are the 5 Parasites What are the 5 Parasites associated with associated with Loffler Loffler Syndrome?Syndrome?•Necator americanusNecator americanus

•Ankylostoma duodenaleAnkylostoma duodenale

•ShistosomiasisShistosomiasis

•StrongyloidesStrongyloides

•Ascaris lumbricoidesAscaris lumbricoides

What happens when a patient What happens when a patient is on prednisone for > 7 days?is on prednisone for > 7 days?

•ImmunocompromisedImmunocompromised

What are 2 enzymes used by What are 2 enzymes used by B12?B12?

• Homocystine methyl transferaseHomocystine methyl transferase

• Methyl malonyl-coA mutaseMethyl malonyl-coA mutase

What does Mitochondrial What does Mitochondrial inheritance mean?inheritance mean?

• No male transmissionNo male transmission

• All females pass it onAll females pass it on

Who are 4 pt’s who would be Who are 4 pt’s who would be susceptable to pseudomonas susceptable to pseudomonas and staph infxns?and staph infxns?•Burn patientsBurn patients

•Cystic fibrosisCystic fibrosis

•DMDM

•Neutropenic patientsNeutropenic patients

In a neutropenic patient, what In a neutropenic patient, what do you cover for?do you cover for?

• cover 1x for Staph aureus during 1st cover 1x for Staph aureus during 1st weekweek

• cover 2x for Pseudo after 2nd weekcover 2x for Pseudo after 2nd week

What are the 3 main concepts What are the 3 main concepts causing a widened S2 splitting?causing a widened S2 splitting?

• Increased pO2 Increased pO2

• Delayed opening/closing of the Delayed opening/closing of the pulmonary valuepulmonary value

• Increased volume in the right Increased volume in the right ventricleventricle

What are causes for a What are causes for a widened S2 splitting?widened S2 splitting?

• Blood transfusionBlood transfusion• Increased Tidal VolumeIncreased Tidal Volume• Giving O2Giving O2• Right sided heart failureRight sided heart failure• Pregnancy due to increase volumePregnancy due to increase volume• IV fluidsIV fluids• ASD/VSDASD/VSD• Deep breathingDeep breathing• HypernateremiaHypernateremia• SIADHSIADH• Pulmonary regurgePulmonary regurge• Pulmonary stenosisPulmonary stenosis• Right bundle branch blockRight bundle branch block

What are the 8 common What are the 8 common cavities of blood loss?cavities of blood loss?

• PPericardiumericardium• IIntracranial ntracranial • MMediastinumediastinum• PPleural cavityleural cavity• TThighshighs• RRetroperitoneumetroperitoneum• AAbdominal cavitybdominal cavity• PPelviselvis

What is the special list for What is the special list for Penicillin?Penicillin?

• Gram +Gram +

• Basement membrane suppressorBasement membrane suppressor

• Works on simple anaerobesWorks on simple anaerobes

• The #1 cause of anaphylaxisThe #1 cause of anaphylaxis

• Causes interstial neprititsCauses interstial nepritits

• Causes nonspecific rashesCauses nonspecific rashes

• Acts as a hapten causing hemolytic Acts as a hapten causing hemolytic anemia anemia

What is the #1 cause of What is the #1 cause of anaphylaxis?anaphylaxis?

• Penicillin Penicillin

What are the Chron’s Gifts?What are the Chron’s Gifts?

• GranulomaGranuloma

• IleumIleum

• FistulaFistula

• TransmuralTransmural

• Skip LesionSkip Lesion

What are the negative-What are the negative-stranded RNA Clues?stranded RNA Clues?

• Prodromal periodProdromal period before before symptoms = 1-3 weekssymptoms = 1-3 weeks

• Why is there a prodromal period?Why is there a prodromal period?

• Because must switch to positive Because must switch to positive stranded before replicationstranded before replication

What are the clues for positive What are the clues for positive stranded RNA?stranded RNA?

• Symptoms within 1 week or less Symptoms within 1 week or less • EXCEPTIONSEXCEPTIONS: : • HantaHanta• EbolaEbola• Yellow feverYellow fever• They are -ve stranded = don’t have to They are -ve stranded = don’t have to

switch to positive before replicatingswitch to positive before replicating

What are the Most common What are the Most common cyanotic heart diseases?cyanotic heart diseases?• Transposition of the great arteriesTransposition of the great arteries• Tetrology of FallotTetrology of Fallot• Truncus ArteriosusTruncus Arteriosus• Tricuspid AtresiaTricuspid Atresia• Total anomalous pulmunary Venous Return Total anomalous pulmunary Venous Return

• Hypoplastic Left heart syndromeHypoplastic Left heart syndrome• Ebstein’s anomalyEbstein’s anomaly• Aortic atresiaAortic atresia• Pulmonary atresiaPulmonary atresia

What cyanotic heart disease is What cyanotic heart disease is – boot shaped?– boot shaped?

• Tetrology of FallotTetrology of Fallot

What cyanotic heart disease is What cyanotic heart disease is associated with mom taking associated with mom taking lithium during pregnancy?lithium during pregnancy?• Ebstein’s Anomaly Ebstein’s Anomaly

What things make the What things make the membrane less likely to membrane less likely to depolarize?depolarize?• HypokalemiaHypokalemia

• HypermagnesemiaHypermagnesemia

• Hypercalcemia (except atrium)Hypercalcemia (except atrium)

• HypernatremiaHypernatremia

What things make the What things make the membrane more likely to membrane more likely to depolarize?depolarize?• HyperkalemiaHyperkalemia

• HypomagnasemiaHypomagnasemia

• Hypocalcemia (except atrium)Hypocalcemia (except atrium)

• HyponatremiaHyponatremia

What is Plan F?What is Plan F?

• TTPPP – Thiamin – B1P – Thiamin – B1

• LLipoic Acid – B4ipoic Acid – B4

• CoCoAA – Pantothenic acid – B5 – Pantothenic acid – B5

• FFAD – Riboflavin – B2AD – Riboflavin – B2

•NAD – Niacin – B3AD – Niacin – B3

What are the 8 x-linked What are the 8 x-linked inherited diseases?inherited diseases?• Bruton’s AgammaglobulinemiaBruton’s Agammaglobulinemia• CGD (NADPH def)CGD (NADPH def)• DMDDMD• Color BlindnessColor Blindness• G6PDG6PD• HemophiliaHemophilia• Lesch-NyhanLesch-Nyhan• Vit D resist. Rickets (X-linked dominant)Vit D resist. Rickets (X-linked dominant)• FabrysFabrys• HuntersHunters

What are the 7 B-cell What are the 7 B-cell deficiencies?deficiencies?

• Bruton’s agammaglobulinemiaBruton’s agammaglobulinemia• CVID (Common Variant Imm. Def)CVID (Common Variant Imm. Def)• LeukemiasLeukemias• LymphomasLymphomas• SCIDSCID• WASWAS• Job Buckley SyndromeJob Buckley Syndrome

What is the Tyrosine kinase What is the Tyrosine kinase deficiency?deficiency?

• Bruton’s agammaglobulinemiaBruton’s agammaglobulinemia

What are the B-cell What are the B-cell deficiencies with T-cell deficiencies with T-cell overlap?overlap?• SCIDSCID

• WASWAS

• Job Buckley SyndromeJob Buckley Syndrome

What are the 4 itchiest What are the 4 itchiest rashes?rashes?

• ScabiesScabies

• Lichen PlanusLichen Planus

• UrticariaUrticaria

• Dermatitis HerpetiformisDermatitis Herpetiformis

Tumor Markers/Oncongenes Tumor Markers/Oncongenes II• L-myc?L-myc? • Small cell lung CaSmall cell lung Ca

• C-myc?C-myc?• Promyelocytic leukemia (Burkitt’s lymphoma)Promyelocytic leukemia (Burkitt’s lymphoma)

• N-myc?N-myc?• Neuroblastoma Neuroblastoma • Small cell lung CASmall cell lung CA

• C-able?C-able?• CML CML • ALLALL

Tumor Markers/Oncongenes Tumor Markers/Oncongenes IIII• C-myb?C-myb?• Colon CAColon CA• AMLAML

• C-sis ?C-sis ?• OsteosarcomaOsteosarcoma• Glioma Glioma • FibrosarcomaFibrosarcoma

Tumor Markers/Oncongenes Tumor Markers/Oncongenes IIIIII

• C-erb B2?C-erb B2?• Epidermal growth factor receptorsEpidermal growth factor receptors

• CSF-1 ?CSF-1 ?• BreastBreast

Tumor Markers/Oncongenes Tumor Markers/Oncongenes IVIV

• Erb-B2?Erb-B2?• Breast CABreast CA• Ovarian CAOvarian CA• Gastric CAGastric CA

• Ret?Ret?• Medullary CA of thyroidMedullary CA of thyroid• Men II & IIIMen II & III• Papillary carcinomaPapillary carcinoma

Tumor Markers/Oncongenes Tumor Markers/Oncongenes VV• Ki-ras?Ki-ras?• Lung CALung CA• Colon CAColon CA

• Bcl-2?Bcl-2?• BurkittsBurkitts• Follicular lymphomaFollicular lymphoma

• Erb?Erb?• RetinoblastomaRetinoblastoma

What are 6 Hormones What are 6 Hormones produced by the placenta?produced by the placenta?• hCGhCG• InhibinInhibin• Human placental lactogen (HPL)Human placental lactogen (HPL)• Oxytocin (drug lactation, pit gland Oxytocin (drug lactation, pit gland

prod it also)prod it also)• ProgesteroneProgesterone• EstrogenEstrogen• RelaxinRelaxin

What is cancer grading?What is cancer grading?

• Severity of microscopic changeSeverity of microscopic change

• Degree of differentiationDegree of differentiation

What is cancer staging?What is cancer staging?

• Degree of dissemination of tumorDegree of dissemination of tumor

• What the surgeon seesWhat the surgeon sees

What are the rashes associated What are the rashes associated with cancer and what cancer with cancer and what cancer are they associated with?are they associated with?

• Urticaria/Hives?Urticaria/Hives?• Any CA, especially lymphomaAny CA, especially lymphoma• Pagets Ds (ulcers around nipples)Pagets Ds (ulcers around nipples)

• Seborrheic keratosis (waxy warts)?Seborrheic keratosis (waxy warts)?• Colon CA Colon CA • HIV if sudden increase in number HIV if sudden increase in number • Normal with agingNormal with aging

What are the rashes associated What are the rashes associated with cancer and what cancer with cancer and what cancer are they associated with?are they associated with?

• Actinic keratosis?Actinic keratosis? – Dry scaly plaques on sun-exposed skinDry scaly plaques on sun-exposed skin

• Squamous Cell CA of skinSquamous Cell CA of skin

• Dermatomyositis?Dermatomyositis? – violacious, heliotropic rash, malar areaviolacious, heliotropic rash, malar area

• Colon CAColon CA

What are the rashes associated What are the rashes associated with Cancer and the cancer with Cancer and the cancer they are associated with?they are associated with?

• Akanthosis nigricans?Akanthosis nigricans? – dark lines in skin foldsdark lines in skin folds

• Any visceral CAAny visceral CA• End organ damageEnd organ damage

• Erythema nodosum?Erythema nodosum? – ant aspect of legs, tender nodulesant aspect of legs, tender nodules

• Anything granulomatousAnything granulomatous• NOT assoc. w/ bacteriaNOT assoc. w/ bacteria

What is carried by HDL?What is carried by HDL?

• Apo EApo E

• Apo AApo A

• Apo CIIApo CII

• L-CAT L-CAT – lecithin cholesterol acetyl transferaselecithin cholesterol acetyl transferase

• CholesterolCholesterol– from periphery to liverfrom periphery to liver

What is carried by VLDL?What is carried by VLDL?

• Apo B-100Apo B-100

• Apo EApo E

• Apo C IIApo C II

• Triglcyerides (95%)Triglcyerides (95%)

• Cholesterol (5%)Cholesterol (5%)

What is carried by IDL?What is carried by IDL?

• Apo EApo E

• Apo CIIApo CII

• Triglycerides (< VLDL)Triglycerides (< VLDL)

• Cholesterol (>VLDL)Cholesterol (>VLDL)

What is carried by LDL?What is carried by LDL?

• CholesterolCholesterol– from liver to tissuefrom liver to tissue

• NOT a good thing!!!!! NOT a good thing!!!!!

What do chylomicrons What do chylomicrons carry?carry?• Apo AApo A• Apo B-48Apo B-48• Apo EApo E• Apo C IIApo C II

• Triglycerides from:Triglycerides from:• GI to liver (25% of the time)GI to liver (25% of the time)• GI to endothelium (75% of the time)GI to endothelium (75% of the time)

Which lipoprotein carries Which lipoprotein carries the most cholesterol?the most cholesterol?

•LDLLDL

Where are the AVMs?Where are the AVMs?

• Clue = HEALClue = HEAL• Heart?Heart?• Machinery murmurMachinery murmur

• Elbow?Elbow?• Fistula from dialysis in renal diseaseFistula from dialysis in renal disease

• Abdomen/Brain?Abdomen/Brain?• Von Hippel-Lindau = clot off with coilsVon Hippel-Lindau = clot off with coils• Increase incidence of Renal cell CA on chrom 3Increase incidence of Renal cell CA on chrom 3

• Lungs?Lungs?• Osler Weber Rendu SyndromeOsler Weber Rendu Syndrome

What is the Ranson’s criteria What is the Ranson’s criteria for acute pancreatitis (for acute pancreatitis (at at admissionadmission)?)?• Glucose > 200Glucose > 200

• Age > 55Age > 55

• LDH >350LDH >350

• AST > 250AST > 250

• WBC > 16,000WBC > 16,000

What is the Ranson’s criteria What is the Ranson’s criteria for acute pancreatitis (for acute pancreatitis (at less at less than 48 hrs)?than 48 hrs)?• Calcium <8 mg/dlCalcium <8 mg/dl

• HCT drop > 10%HCT drop > 10%

• O2 < 60 (PaO2)O2 < 60 (PaO2)

• Base deficit > 4Base deficit > 4

• BUN > 5 mg/dlBUN > 5 mg/dl

• Sequestration > 6LSequestration > 6L

What 2 diseases is What 2 diseases is pilocarpine used for?pilocarpine used for?

• CFCF

• Glaucoma Glaucoma – Painful, red, teary eyePainful, red, teary eye

What is dysguzia?What is dysguzia?

• Problem with sense of tasteProblem with sense of taste

What are 3 causes of What are 3 causes of dysgusia?dysgusia?

• ClarithromycinClarithromycin

• Zinc deficiencyZinc deficiency

What is the triad of Carcinoid What is the triad of Carcinoid syndrome?syndrome?

• FlushingFlushing

• Wheezing Wheezing

• diarrheadiarrhea

What do you measure for What do you measure for carcinoid syndrome?carcinoid syndrome?

• Serotonin Serotonin – 5-HIAA5-HIAA

Where are the 2 most Where are the 2 most common places a carcinoid common places a carcinoid tumor is found?tumor is found?• PancreasPancreas

• IleumIleum

What are the phage What are the phage mediated toxins?mediated toxins?

• MnemonicMnemonic: BEDS: BEDS

• BotulinumBotulinum

• Erythrogenic toxinErythrogenic toxin– from strep pyogenesfrom strep pyogenes

• SalmonellaSalmonella– Has O antigenHas O antigen

What is the story used to What is the story used to remember the segmented RNA remember the segmented RNA viruses?viruses?• I sprayed I sprayed ORTHOORTHO on my on my BUNYABUNYA at at

the the ARENAARENA down in down in REOREO to kill to kill SEGMENTED WORMSSEGMENTED WORMS

Name the 3 major types of Name the 3 major types of adhesion moleculesadhesion molecules

• ICAMsICAMs

• IntegrinsIntegrins

• SelectinsSelectins

What does IgCam do?What does IgCam do?

• Bind proteinsBind proteins

What do integrins do?What do integrins do?

• Stop the leukocytesStop the leukocytes

What do selectins do?What do selectins do?

• Bind carbohydratesBind carbohydrates

• Mediate the rolling to slow Mediate the rolling to slow leukocytes downleukocytes down

What are the functions of What are the functions of adhesion molecules?adhesion molecules?

• Homing of lymphocytesHoming of lymphocytes– tells lymphocytes where to gotells lymphocytes where to go

• InflammationInflammation

• Cell-cell interactionCell-cell interaction

Primary allergic response is Primary allergic response is due to what?due to what?•Contact Contact

What cells are present in the What cells are present in the first 3 days?first 3 days?

• NeutrophilsNeutrophils

• The next cells to show up are?The next cells to show up are?

• B-cellsB-cells

• What do B-cells make?What do B-cells make?

• IgMIgM

What day does IgM show What day does IgM show up? up?

• ThreeThree

• IgM peaks at what day?IgM peaks at what day?

• 1414

• When does IgM leave?When does IgM leave?

• In 2 monthsIn 2 months

What shows up in 2 wks (14 What shows up in 2 wks (14 days)?days)?

• IgGIgG

• When does IgG peak?When does IgG peak?

• In 2 monthsIn 2 months

• When does IgG leave?When does IgG leave?

• In 1 yearIn 1 year

What is Secondary Allergic What is Secondary Allergic response is due to?response is due to?• MEMORYMEMORY

What shows up at day 3?What shows up at day 3?

• IgG with 5x concentrationIgG with 5x concentration

• Has the highest affinityHas the highest affinity

• When does IgG peak?When does IgG peak?

• In 5 yearsIn 5 years

• When does IgG leave?When does IgG leave?

• In 10 yearsIn 10 years

What Ig has the hightest What Ig has the hightest affinity?affinity?

• IgGIgG

What are the risk factors for What are the risk factors for Esophageal/Gastric CA?Esophageal/Gastric CA?

• SmokingSmoking

• AlcoholAlcohol

• NitritesNitrites

• JapaneseJapanese

What are the risk factors for What are the risk factors for bladder CA?bladder CA?• Smoking Smoking • Aniline dyesAniline dyes• BenzeneBenzene• AflatoxinAflatoxin• CyclophosphamideCyclophosphamide• SchistosomiasisSchistosomiasis• 2 diseases:2 diseases:• Von Hippel-LindauVon Hippel-Lindau• Tubular sclerosisTubular sclerosis

What is the NBT test?What is the NBT test?

• Nitro Blue Tetrazolium testNitro Blue Tetrazolium test

• What is it used for?What is it used for?

• Screening CGDScreening CGD

• What does a –ve test indicate?What does a –ve test indicate?

• +ve for the disease+ve for the disease

What disease corresponds with What disease corresponds with the following inclusion bodies?the following inclusion bodies?• Howell-Jolly?Howell-Jolly?• Sickle cellSickle cell

• Heinz?Heinz?• G-6-P-DG-6-P-D

• Zebra?Zebra?• Niemann pickNiemann pick

What disease corresponds with What disease corresponds with the following inclusion bodies?the following inclusion bodies?• Donovan? Donovan? • LeishmaniasisLeishmaniasis

• Mallory?Mallory?• AlcoholismAlcoholism

• Negri?Negri?• RabiesRabies

What disease corresponds with What disease corresponds with the following inclusion bodies?the following inclusion bodies?

• Councilman?Councilman?

• Yellow feverYellow fever

• Call-exner?Call-exner?

• Ovarian tumors Ovarian tumors – granulosa origingranulosa origin

• Lewy?Lewy?• ParkinsonsParkinsons

• Pick?Pick?

• Pick’s diseasePick’s disease

• Barr body?Barr body?

• Normal femaleNormal female

• Aschoff?Aschoff?

• Rheumatic feverRheumatic fever

• Cowdry type A inclusions?Cowdry type A inclusions?

• Herpes virusHerpes virus

• Auer rods?Auer rods?

• AMLAML

• Globoid?Globoid?

• Krabbe’s lysosomal storage diseaseKrabbe’s lysosomal storage disease

• Russell? Russell?

• Multiple myelomaMultiple myeloma

• Schiller-Duvall?Schiller-Duvall?

• Yolk sac tumorYolk sac tumor

• Basal bodies?Basal bodies?

• Only found in smooth mmOnly found in smooth mm

What are the 4 types of What are the 4 types of hypersensitivities?hypersensitivities?• Mnemonic?Mnemonic?• ACIDACID

• Type IType I• Anaphylaxis/AtopicAnaphylaxis/Atopic

• Type IIType II• Cytotoxic (Humoral)Cytotoxic (Humoral)

• Type IIIType III• Immune complex mediationImmune complex mediation

• Type IVType IV• Delayed hypersensitivity/Cell mediatedDelayed hypersensitivity/Cell mediated

What are the Characteristics What are the Characteristics of Type I hypersensitivity?of Type I hypersensitivity?

• AtopicAtopic

• IgE (Asthma) binds to mast cellIgE (Asthma) binds to mast cell

• IgA activates IP3 cascade degrading IgA activates IP3 cascade degrading mast cellsmast cells

What are the Characteristics What are the Characteristics of Type II hypersensitivity?of Type II hypersensitivity?

• HumoralHumoral

• What are examples of type II?What are examples of type II?

• Rh diseaseRh disease

• GoodpasturesGoodpastures

• Autoimmune hemolytic AnemiaAutoimmune hemolytic Anemia

• All Autoimmune diseases All Autoimmune diseases – except RA and SLEexcept RA and SLE

What are the Characteristics What are the Characteristics of Type III hypersensitivity?of Type III hypersensitivity?

• Ag-Ab complementAg-Ab complement

• What are examples of Type III?What are examples of Type III?

• RARA

• SLESLE

• VasculitidesVasculitides

• Some GN?Some GN?

What are the Characteristics What are the Characteristics of Type IV hypersensitivity?of Type IV hypersensitivity?

• Cell mediatedCell mediated

• What are examples of Type IV?What are examples of Type IV?

• TB skin testTB skin test

• Contact dermatitisContact dermatitis

• Transplant rejectionTransplant rejection

What structures have no What structures have no known function?known function?

• AppendixAppendix

• EpithalamusEpithalamus

• Palmaris longus Palmaris longus – musclemuscle

• Pancreatic polypeptide Pancreatic polypeptide – hormones in F-cellshormones in F-cells

What diseases can progress What diseases can progress to RPGN?to RPGN?

• GoodpasturesGoodpastures

• WegenersWegeners

• DMDM

• HTNHTN

What are causes of papillary What are causes of papillary necrosis?necrosis?

• VasculitisVasculitis

• AIDSAIDS

Cytic fibrosis Questions?Cytic fibrosis Questions?

• Tx?Tx?• Pilocarpine Pilocarpine • also used for glaucomaalso used for glaucoma

• Test used to detect CF?Test used to detect CF?• Pilocarpine sweat testPilocarpine sweat test

• What ion does this test measure?What ion does this test measure?• Cl-Cl-

• Definitive presence of disease has a test value of what?Definitive presence of disease has a test value of what?• >60>60

Cytic fibrosis Questions?Cytic fibrosis Questions?

• What is the value in a normal person?What is the value in a normal person?• <20<20

• What is the value in a heterozygous person?What is the value in a heterozygous person?• 30 – 6030 – 60

• What chromosome is the CF gene on?What chromosome is the CF gene on?• Chrom 7Chrom 7

• What Second messenger is used?What Second messenger is used?• IP3/DAGIP3/DAG

What are the gram +ve spore What are the gram +ve spore formers?formers?

• Bacillus anthracisBacillus anthracis

• Clostridium perfringensClostridium perfringens

• Clostridium tetaniClostridium tetani

• Clostridium melangosepticusClostridium melangosepticus

• What is the chemical in spores?What is the chemical in spores?

• Calcium dipocholinateCalcium dipocholinate

What does strep mutans What does strep mutans ferment?ferment?

• Lactic acidLactic acid

What type of receptors do all What type of receptors do all sphincters in the body have?sphincters in the body have?

• Alpha-receptorsAlpha-receptors

Strep. Salivarius ag is used Strep. Salivarius ag is used for what test?for what test?

• Cold agglutinin testing Cold agglutinin testing – IgMIgM

Types of amyloid found in various Types of amyloid found in various SystemicSystemic amyloidoses: amyloidoses:

• AA amyloid?AA amyloid?

• Chronic active diseaseChronic active disease

• AL amyloid from Ig light chain?AL amyloid from Ig light chain?

• MyelomaMyeloma

• Beta 2 microglobulin?Beta 2 microglobulin?

• Chronic hemodialysisChronic hemodialysis

• AA amyloid from SAA?AA amyloid from SAA?

• Nephrotic hereditary forms Nephrotic hereditary forms – eg. Mediterranean fevereg. Mediterranean fever

• Pre-albumin/transthyretin?Pre-albumin/transthyretin?

• Cardiomyopathic hereditary formsCardiomyopathic hereditary forms– senile systemic amyloidosissenile systemic amyloidosis

• Neuropathic hereditary syndromesNeuropathic hereditary syndromes

Types of amyloid found in Types of amyloid found in various various Local Local amyloidoses:amyloidoses:

• ANP fibrils are caused by?ANP fibrils are caused by?• Senile cardiac amyloisosisSenile cardiac amyloisosis

• Cerebral amyloid in Alzheimer’s Cerebral amyloid in Alzheimer’s disease/Down’s?disease/Down’s?

• Cerebral amyloidosisCerebral amyloidosis

Types of amyloid found in Types of amyloid found in various various Local Local amyloidoses:amyloidoses:

• Calcitonin precursors?Calcitonin precursors?• Medullary CA of thyroidMedullary CA of thyroid

• AL from light chains?AL from light chains?• Isolated, massive, nodular depositsIsolated, massive, nodular deposits

– lung, skin, urogenital tractlung, skin, urogenital tract

What type of dementia do What type of dementia do you get in Pick’s dis?you get in Pick’s dis?

• Frontotemporal dementiaFrontotemporal dementia

Describe Pick’s diseaseDescribe Pick’s disease

• Atrophy of frontal and temporal Atrophy of frontal and temporal cortex with sparing of remaining cortex with sparing of remaining neocortical regionsneocortical regions

What 3 things do Pick What 3 things do Pick bodies contain?bodies contain?

• Altered neurofilamentsAltered neurofilaments

• Tau proteinTau protein

• ubiquitinubiquitin

What drugs can cause a What drugs can cause a disulfiram reaction?disulfiram reaction?• Mnemonic?Mnemonic?• CLAMCLAM

• ChloramphenicolChloramphenicol• Lactams Lactams

– CefamandoleCefamandole– CefoperazoneCefoperazone

• AntabuseAntabuse– disulfiram disulfiram

What is the mode of action of the What is the mode of action of the Clostridium botulinum toxin?Clostridium botulinum toxin?

• Prevents pre-synaptic release of AchPrevents pre-synaptic release of Ach

• How do babies get it?How do babies get it?

• From spores in honey or molassesFrom spores in honey or molasses

• How do adults get it?How do adults get it?

• From canned foodFrom canned food

What are 3 Toxins of What are 3 Toxins of Bacillus?Bacillus?

• Lethal factor – (black necrosis)Lethal factor – (black necrosis)

• Protective factorProtective factor

• Edema factorEdema factor

Who has Poly-D Glutamic Who has Poly-D Glutamic acid?acid?

• AnthracisAnthracis

• CereusCereus

Name that B-blocker:Name that B-blocker:

• B1-selective?B1-selective?• A – MA – M• Non-selective?Non-selective?• N – ZN – Z• Exceptions?Exceptions?• Carbetalol and Labetolol are non-Carbetalol and Labetolol are non-

selectiveselective

What are the 4 facts of Fanconi What are the 4 facts of Fanconi Syndrome?Syndrome?

• Problem in proximal tubuleProblem in proximal tubule

• Can’t reabsorbCan’t reabsorb

• Low energy state causing anemiaLow energy state causing anemia

• Can be due to old tetracyclineCan be due to old tetracycline

Where is glutaminase Where is glutaminase found?found?

• In the collecting duct of the kidneyIn the collecting duct of the kidney

• What does glutmainase help the What does glutmainase help the kidney absorb?kidney absorb?

• Ammonia if the liver failsAmmonia if the liver fails

Name 3 anatomical spots Name 3 anatomical spots where renal stones get stuck:where renal stones get stuck:

• HilumHilum

• Pelvic brimPelvic brim

• Entering the bladderEntering the bladder

Renal failure is the most Renal failure is the most common cause of death in common cause of death in what 3 diseases?what 3 diseases?• SLESLE

• Endometrial CAEndometrial CA

• Cervical CACervical CA

What is the rate-limiting What is the rate-limiting enzyme in the urea cycle?enzyme in the urea cycle?

• Carbamoyl synthase ICarbamoyl synthase I

• Where is it found 90% of the time?Where is it found 90% of the time?

• LiverLiver

• Where is it found 10% of the time?Where is it found 10% of the time?

• Collecting duct of the kidneyCollecting duct of the kidney

What type of charge does What type of charge does heparin have?heparin have?

•-ve charge-ve charge

What type of charge does What type of charge does protamine sulfate have?protamine sulfate have?

•+ve charge+ve charge

• What is it used for?What is it used for?

• Reversing the effects of heparinReversing the effects of heparin

What is commonly seen in What is commonly seen in all vasculitides?all vasculitides?• T-cells and macrophagesT-cells and macrophages• SchistocytesSchistocytes• Decreased plateletsDecreased platelets• Decreased RBCsDecreased RBCs• Bleeding from mucosal surfacesBleeding from mucosal surfaces• Bleeding from skin and GIBleeding from skin and GI• PetechiaePetechiae• EcchymosesEcchymoses

What happens if you expose What happens if you expose the blood to the basement the blood to the basement membrane?membrane?• The following deveop:The following deveop:

• ClotsClots

• DICDIC

• Pulmonary embolismPulmonary embolism

• DVTDVT

• MIMI

• StrokeStroke

Signs and symptoms in all Signs and symptoms in all vasculitidesvasculitides

• Tachypnea and SOBTachypnea and SOB

• Most common cause of death?Most common cause of death?

• Heart failureHeart failure

What is the MOA of What is the MOA of Erythromycin?Erythromycin?

• Inhibits the translocation step of Inhibits the translocation step of ribosomal protein synthesisribosomal protein synthesis

What is the MOA of What is the MOA of Chloramphenicol?Chloramphenicol?

• Inhibits ribosomal peptidyl Inhibits ribosomal peptidyl transferase in prokaryotestransferase in prokaryotes

What is the MOA of What is the MOA of Puromycin?Puromycin?

• Inhibits elongation by binding to “A” Inhibits elongation by binding to “A” site and prematurely terminating site and prematurely terminating chain growth in pro and eukaryoteschain growth in pro and eukaryotes

What is the MOA of What is the MOA of Streptomycin?Streptomycin?

• Causes misreading of code during Causes misreading of code during initiation in prokaryotesinitiation in prokaryotes

What is the MOA of What is the MOA of Tetracycline?Tetracycline?

• Prevents binding of aminoacyl-t-RNA Prevents binding of aminoacyl-t-RNA to ribosome on prokaryotes therefore to ribosome on prokaryotes therefore inhibiting initiationinhibiting initiation

What is the MOA of What is the MOA of Cyclohexamide?Cyclohexamide?

• Inhibits ribosomal peptidyl Inhibits ribosomal peptidyl transferase in eukaryotes transferase in eukaryotes – cell wall inhibitorcell wall inhibitor

What is the MOA of What is the MOA of Rifampin?Rifampin?

• Blocks B-subunit of RNA polymeraseBlocks B-subunit of RNA polymerase

• Prophylaxis for contacts of N. Prophylaxis for contacts of N. meningitidismeningitidis

What is the MOA of What is the MOA of Vancomycin?Vancomycin?

• Cell wall inhibitorCell wall inhibitor

• Binds irreversibly to Phopholipase Binds irreversibly to Phopholipase carriercarrier

• BacteriacidalBacteriacidal

• Covers all gram +vesCovers all gram +ves

• LinezolidLinezolid

What is the MOA of What is the MOA of Warfarin?Warfarin?

• Blocks vitamin k dependent gamma-Blocks vitamin k dependent gamma-carboxylation of prothrombin and carboxylation of prothrombin and factors 2, 7, 9, 10, proteins C & Sfactors 2, 7, 9, 10, proteins C & S

What is the MOA of What is the MOA of Clindamycin?Clindamycin?

• Blocks translation by binding the 50S Blocks translation by binding the 50S subunitsubunit

Hemolytic properties of Hemolytic properties of Streptococcus:Streptococcus:• What type of hemolysis is alpha What type of hemolysis is alpha

hemolysis?hemolysis?• Partial hemolysisPartial hemolysis

• What color is it’s zone?What color is it’s zone?• GreenGreen

• What type of hemolysis is beta-hemolysis?What type of hemolysis is beta-hemolysis?• Complete hemolysisComplete hemolysis

Hemolytic properties of Hemolytic properties of Streptococcus:Streptococcus:

• What color is it’s zoneWhat color is it’s zone• Clear Clear

– eg. Streptokinaseeg. Streptokinase

• What type of hemolysis is gamma-hemolysis?What type of hemolysis is gamma-hemolysis?• No hemolysisNo hemolysis

• What color is it’s zone?What color is it’s zone?• RedRed

What are the 5 notable What are the 5 notable things about RTA I?things about RTA I?

• High urine PH (??????not sure about High urine PH (??????not sure about this)this)

• AcidosisAcidosis

• UTI sUTI s

• StonesStones

• Babies die < 1 yr oldBabies die < 1 yr old

What are 3 notable things What are 3 notable things about RTA II?about RTA II?

• Acidosis Acidosis – urine PH = 2, normal is 5-6urine PH = 2, normal is 5-6

• HypokalmiaHypokalmia

• Patients have NO carbonic anhydrasePatients have NO carbonic anhydrase

What are 3 notable things What are 3 notable things about RTA III?about RTA III?

• It is a combination of RTA I & IIIIt is a combination of RTA I & III

• Normal urine pHNormal urine pH

What are 3 notable things What are 3 notable things about RTA IV?about RTA IV?

• Seen in diabeticsSeen in diabetics

• HyperkalemiaHyperkalemia

• NO aldosterone b/c JG apparatus has NO aldosterone b/c JG apparatus has infarctedinfarcted

What are the members of What are the members of Streptococcus Group D?Streptococcus Group D?

• ViridansViridans

• MutansMutans

• SanguisSanguis

• SalivariusSalivarius

• BovisBovis

What Steptococcus has What Steptococcus has green pigment?green pigment?

What Streptococcus causes What Streptococcus causes SBE?SBE?

What Streptococcus causes What Streptococcus causes cavities?cavities?

• MutansMutans

What do you see in What do you see in Nephritic Syndrome?Nephritic Syndrome?

• HTNHTN

• HematuriaHematuria

• RBC castsRBC casts

What do you see in What do you see in Nephrotic Syndrome?Nephrotic Syndrome?

• Increase EdemaIncrease Edema

• Increase LipidemiaIncrease Lipidemia

• Increase CholesterolemiaIncrease Cholesterolemia

• Increase CoagulabilityIncrease Coagulability

• Decrease serum AlbuminDecrease serum Albumin

• Increase urinary AlbuminIncrease urinary Albumin

What is the #1 cause of What is the #1 cause of Sinusitis, Otitis, Bronchitis, Sinusitis, Otitis, Bronchitis, Pneumonia?Pneumonia?• Strep. PneumoStrep. Pneumo

• What is the #2 cause?What is the #2 cause?

• Hemophilus influenzaHemophilus influenza

• What is the #3 cause?What is the #3 cause?

• Neisseria meningitidesNeisseria meningitides

What is the #1 method to What is the #1 method to paralyze cilia?paralyze cilia?• VirusesViruses

• Which are secondary to what?Which are secondary to what?

• Bacterial infectionsBacterial infections

• What is the #2 method to paralyze cilia?What is the #2 method to paralyze cilia?

• SmokingSmoking

If you develop gastroenteritis If you develop gastroenteritis within 8hrs of eating what are within 8hrs of eating what are the most common likely bugs? the most common likely bugs? • Staph aureusStaph aureus

• Clostridium perfringensClostridium perfringens

• Bacillus cereus….from what?Bacillus cereus….from what?

• Fried riceFried rice

Gastroenteritis within 8hrs of Gastroenteritis within 8hrs of eating what toxin?eating what toxin?

• PreformedPreformed

What does Clostridum tetani What does Clostridum tetani inhibit? inhibit? • Release of glycine from spinal cordRelease of glycine from spinal cord

• What physical finding would you see?What physical finding would you see?• Lock jawLock jaw

• What is the tx?What is the tx?• Antitoxin and ToxoidAntitoxin and Toxoid

• Where is it injected?Where is it injected?• Injected in different areas of bodyInjected in different areas of body

The Most common cause of UTI The Most common cause of UTI is?is?

• E. coliE. coli

• Followed by?Followed by?

• ProteusProteus

• Followed by?Followed by?

The most frequent cause of UTI The most frequent cause of UTI in females between 5-10?in females between 5-10?• Staph saprophyticusStaph saprophyticus

• Why?Why?• They stick things in themselvesThey stick things in themselves

• 18-24 yoa?18-24 yoa?• Staph saprophyticusStaph saprophyticus• Why?Why?• Because they stick things inside themselvesBecause they stick things inside themselves

• Why no UTI’s after 24?Why no UTI’s after 24?• Because women are use to penises and Staph Because women are use to penises and Staph

saprophyticus lives on penis (becomes part of normal flora).saprophyticus lives on penis (becomes part of normal flora).

Staph aureus is the most Staph aureus is the most common cause of what common cause of what bone disease?bone disease?• OsteomyelitisOsteomyelitis

• Because of what?Because of what?

• CollagenaseCollagenase

What is the Most Common What is the Most Common cause of infections one week cause of infections one week post burn injury?post burn injury?

• Staph. aureusStaph. aureus

What is the triad of SSSS?What is the triad of SSSS?

• ShockShock

• RashRash

• HypotensionHypotension

Most common cause of UTI?Most common cause of UTI?

• E. coliE. coli

• Then?Then?

• ProteusProteus

• Then?Then?

Newborn meningitis is Newborn meningitis is caused by?caused by?

• Group B Strep (agalactiae)Group B Strep (agalactiae)

• E. coliE. coli

What is normal rectal flora What is normal rectal flora from momfrom mom

• Group B Strep (Strep. Agalactiae)Group B Strep (Strep. Agalactiae)

• E. coliE. coli

What is associated with What is associated with colon CA?colon CA?

• Strep bovisStrep bovis

• What color pigment is produced?What color pigment is produced?

• BlackBlack

What Ig do you look for with What Ig do you look for with affinity?affinity?

• IgGIgG

• What about Avidity?What about Avidity?

• IgMIgM

What is transductionWhat is transduction

• Virus inject it’s DNA into bacteriaVirus inject it’s DNA into bacteria

What is transformation?What is transformation?

• Virus injects it’s DNA into it bacteria Virus injects it’s DNA into it bacteria in a hospital or nursing home setting, in a hospital or nursing home setting, then becomes deadly.then becomes deadly.

Conjuction occurs only with Conjuction occurs only with what?what?

• Bacteria with PiliBacteria with Pili

What causes mutiple cerebral What causes mutiple cerebral abscesses in newborns?abscesses in newborns?

• CitrobacterCitrobacter

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

• Hemophilus influenzaHemophilus influenza

• NeisseriaNeisseria

What type of complement What type of complement problem do you have in problem do you have in recurrent infections with recurrent infections with encapsulated organisms?encapsulated organisms?

• C3C3

What does complement What does complement fight against?fight against?

• Gram negative bacteriaGram negative bacteria

What do you see in serum with What do you see in serum with prerenal failure and what are prerenal failure and what are the values?the values?• BUN BUN

• >20>20

• Fractional Na+ excertionFractional Na+ excertion

• <1%<1%

• CreatineCreatine

• >40>40

What do you see in Renal What do you see in Renal failure and what are the failure and what are the values?values?• BUNBUN

• 10-1510-15

• Fractional Na+ excretionFractional Na+ excretion

• >2%>2%

• CreatinineCreatinine

• <20<20

What is the extravasation What is the extravasation order?order?

• PavementingPavementing

• MarginationMargination

• DiapediesisDiapediesis

• MigrationMigration

What is the rate limiting What is the rate limiting enzyme for Glycolysis?enzyme for Glycolysis?

• PFK-1PFK-1

What is the rate limiting What is the rate limiting enzyme of Gluconeogenesis?enzyme of Gluconeogenesis?

• Pyruvate CarboxlyasePyruvate Carboxlyase

If treating a disease that If treating a disease that initiates the cell mediated initiates the cell mediated response, what are you response, what are you treating first?treating first?• ViralViral

• If resistant to tx, what next?If resistant to tx, what next?

• FungalFungal

• MycobacteriumMycobacterium

• ProtozoaProtozoa

• ParasiteParasite

• NeoplasmNeoplasm

What bugs can you pick up What bugs can you pick up during birth?during birth?

• Step. Group BStep. Group B– Strep agalactiaeStrep agalactiae

• Strep. PneumoniaStrep. Pneumonia

• Herpes simplex virusHerpes simplex virus

• Neisseria gonorrheaNeisseria gonorrhea

• ChlyamydiaChlyamydia

What is another name for What is another name for Adenoma sebaceum?Adenoma sebaceum?

• Perivascular angiofibromataPerivascular angiofibromata

What is another name for What is another name for Addison’s?Addison’s?

• Primary Adrenocoritcal InsufficiencyPrimary Adrenocoritcal Insufficiency

What is another name for What is another name for Alkaptonuria?Alkaptonuria?

• OchronosisOchronosis

What is another name for What is another name for Churg-Strauss?Churg-Strauss?

• Allergic GranulomatosisAllergic Granulomatosis

• AngiitisAngiitis

What is another name for What is another name for Craniopharyngioma?Craniopharyngioma?

• AmeloblastomaAmeloblastoma

• What is Ameloblast?What is Ameloblast?

• Tooth materialTooth material

What is another name for What is another name for Chrons?Chrons?

• Regional enteritisRegional enteritis

• Granulomatous ileitisGranulomatous ileitis

• IleocolitisIleocolitis

What is another name for What is another name for DeQuervain’s?DeQuervain’s?

• Subacute Granulomatous ThyroiditisSubacute Granulomatous Thyroiditis

What is another name for What is another name for Intraductal Ca?Intraductal Ca?

• Comedo CaComedo Ca

What is another name for I-What is another name for I-Cell Disease?Cell Disease?

• Mucolipidosis IIMucolipidosis II

What is another name for What is another name for Kawassaki Disease?Kawassaki Disease?

• MLNSMLNS

• Mucocutaneous Lymph Node Mucocutaneous Lymph Node SyndromeSyndrome

What is another name for What is another name for Leydig cells?Leydig cells?

• Interstitial cellsInterstitial cells

What is another name for What is another name for Sertoli cells?Sertoli cells?

• Sustentacular cellsSustentacular cells

What is another name for What is another name for Temporal arteritis?Temporal arteritis?

• Giant cell arteritis (granulomatous)Giant cell arteritis (granulomatous)

What is another name for What is another name for Waldenstrom’s Waldenstrom’s macroglobulinemia?macroglobulinemia?• Hyperviscosity syndromeHyperviscosity syndrome

HHV I causes?HHV I causes?

• Oral Oral

• Trigeminal gangliaTrigeminal ganglia

HHV II causes?HHV II causes?

• GenitalGenital

• Sacral plexusSacral plexus

HHV III causes?HHV III causes?

• Varicella zosterVaricella zoster

HHV IV causes? HHV IV causes?

• EBVEBV

• MononucleosisMononucleosis

• Burkitt’sBurkitt’s

HHV V causes?HHV V causes?

• CMVCMV

• Inclusion bodiesInclusion bodies

HHV VI causes?HHV VI causes?

• RoseolaRoseola

• Duke DiseaseDuke Disease

• Exanthem subitumExanthem subitum

HHV VII causes?HHV VII causes?

• Pityriasis roseaPityriasis rosea

HHV VIII causes?HHV VIII causes?

• Kaposi’s sarcomaKaposi’s sarcoma

Answer the following questions Answer the following questions about Coumadin/Warfarin.about Coumadin/Warfarin.

• What is the MOA?What is the MOA?• Interferes with normal synthesis and Interferes with normal synthesis and

gama carboxylation of Vit. K dependent gama carboxylation of Vit. K dependent clotting factors via vitamin K antagonism.clotting factors via vitamin K antagonism.

• Is it long or short acting?Is it long or short acting?• Long half-lifeLong half-life• 8-10 hours to act8-10 hours to act

• Clinical use?Clinical use?

• Chronic anticoagulationChronic anticoagulation

• Contra-indication?Contra-indication?

• Pregnancy because it can cross the Pregnancy because it can cross the placentaplacenta

• What pathway does it affect?What pathway does it affect?

• Extrinsic pathwayExtrinsic pathway

• What does it do to PT?What does it do to PT?

• ProlongsProlongs

• PTPT

• What are the toxicities?What are the toxicities?

• BleedingBleeding

• TeratogenicTeratogenic

• Drug-drug interactionsDrug-drug interactions

• How is it activatied?How is it activatied?

• Tissue activatedTissue activated

• Administration?Administration?

• popo

What are the Vitamin K What are the Vitamin K dependent clotting factors?dependent clotting factors?

• IIII

• VIIVII

• IXIX

• XX

• Protein CProtein C

• Protein SProtein S

Answer the following questions Answer the following questions about Heparin.about Heparin.

• What is the MOA?What is the MOA?

• Catalyzes the activation of antithrombin IIICatalyzes the activation of antithrombin III

• Decreases thrombin and XaDecreases thrombin and Xa

• Is it long or short acting?Is it long or short acting?

• Short half-lifeShort half-life

• Acts immediatelyActs immediately

• Clinical use?Clinical use?

• Immediate anticoagulation of Immediate anticoagulation of pulmonary embolism, stroke, angina, pulmonary embolism, stroke, angina, MI, DVT.MI, DVT.

• Contra-indication?Contra-indication?

• Can be used during pregnancy because Can be used during pregnancy because it does not cross the placentait does not cross the placenta

• What pathway does it affect?What pathway does it affect?

• Intrinsic pathwayIntrinsic pathway

• What value should you follow?What value should you follow?

• PTTPTT

• What are the toxicities?What are the toxicities?

• BleedingBleeding

• ThrombocytopeniaThrombocytopenia

• Drug-drug interactionsDrug-drug interactions

• How is it activatied?How is it activatied?

• Blood activatedBlood activated

• Administration?Administration?

• I.V.I.V.

• Drug of choice for what?Drug of choice for what?

• DVTDVT

• What is good about the newer low-What is good about the newer low-molecular-weight heparins?molecular-weight heparins?

• They act more on XaThey act more on Xa

• Have better bioavailability Have better bioavailability

• Have 2 to 4 times longer half lifeHave 2 to 4 times longer half life

• Can be administered subcutaneously Can be administered subcutaneously and without laboratory monitoring.and without laboratory monitoring.

What do you use for rapid What do you use for rapid reversal of heparinization?reversal of heparinization?

• Protamine sulfateProtamine sulfate

How do you treat Lead How do you treat Lead Poisoning?Poisoning?

• DimercaprolDimercaprol

How do you treat How do you treat Benzodiazepine poisoning?Benzodiazepine poisoning?

• FlumazenilFlumazenil

How do you treat How do you treat Anticholinesterase poisoning?Anticholinesterase poisoning?

• PralidoximePralidoxime

How do you treat Iron How do you treat Iron poisoning?poisoning?

• DeferoxamineDeferoxamine

How do you treat Opioid How do you treat Opioid poisoning?poisoning?

• NaloxeneNaloxene

How do you treat Barbituate How do you treat Barbituate poisoning?poisoning?

• BicarbonateBicarbonate

• Doxapram Doxapram

What does Doxapram do?What does Doxapram do?

• Activates the respiratory center in Activates the respiratory center in the brainthe brain

What is the treatment for What is the treatment for Hypercholesterolemia?Hypercholesterolemia?

• ProvostatinProvostatin

• AtrovastatinAtrovastatin

• LovastatinLovastatin

• SimvastatinSimvastatin

What statin is renally What statin is renally excreted?excreted?

• ProvastatinProvastatin

What statins do you have to What statins do you have to follow liver enzymes every 3 follow liver enzymes every 3 months?months?• AtrovastatinAtrovastatin

• LovastatinLovastatin

• SimvastatinSimvastatin

What do statins inhibit?What do statins inhibit?

• HMG-CoA reductaseHMG-CoA reductase

• When is it most active?When is it most active?

• 8:00pm on8:00pm on

If statins are insufficient what If statins are insufficient what do you add?do you add?

• CholestipolCholestipol

• CholestyramineCholestyramine

• If nothing works what do you give?If nothing works what do you give?

• ProbucolProbucol

• NiacinNiacin

What are the side effects of What are the side effects of Niacin?Niacin?

• FlushingFlushing

• ItchingItching

What 2 statins bind bile What 2 statins bind bile salts?salts?

• CholestipolCholestipol

• CholestyramineCholestyramine

What are 4 causes of severe What are 4 causes of severe pain (in order)?pain (in order)?1.Pancreatitis1.Pancreatitis• Due to What?Due to What?• ETOHETOH

2.Kidney stones2.Kidney stones • Due to What?Due to What?• AlcoholAlcohol

What are 4 causes of severe What are 4 causes of severe pain (in order)?pain (in order)?

3.AAA3.AAA• How is this described?How is this described?• Ripping pain down backRipping pain down back

4.Ischemic bowel4.Ischemic bowel• What is symptom?What is symptom?• Bloody diarrheaBloody diarrhea

What are 5 causes of What are 5 causes of SIADH?SIADH?

• Small cell Ca of lungSmall cell Ca of lung

• Increased intracranial pressureIncreased intracranial pressure

• Pain (most common)Pain (most common)

• DrugsDrugs

• Hypoxic Lung Disease/Restrictive Hypoxic Lung Disease/Restrictive Lung diseaseLung disease

What drug causes SIADH?What drug causes SIADH?

• CarbamazepineCarbamazepine

What are the cells of neural What are the cells of neural crest origin?crest origin?• Parafollicular cells of thyroidParafollicular cells of thyroid• Odontoblasts (predentin)Odontoblasts (predentin)• Pseudounipolar cellsPseudounipolar cells• Spiral membrane of heartSpiral membrane of heart• Chromaffin cellsChromaffin cells• All Ganglion cells (Schwann, Adrenal All Ganglion cells (Schwann, Adrenal

medulla)medulla)• MelanocytesMelanocytes• Laryngeal/Tracheal cartilageLaryngeal/Tracheal cartilage

What are the triple repeat What are the triple repeat diseases?diseases?

• Huntington’sHuntington’s

• Fragile XFragile X

• Myotonic DystrophyMyotonic Dystrophy

• Prauder WilliePrauder Willie

• Spinal/bulbar muscular atrophy Spinal/bulbar muscular atrophy (Fredicks ataxia)(Fredicks ataxia)

How do you determine the How do you determine the maximum sinus rate?maximum sinus rate?

• 220 - age220 - age

What are the 3 low volume What are the 3 low volume states with acidosis rather than states with acidosis rather than alkalosis?alkalosis?• RTA RTA

• DiarrheaDiarrhea

• Diabetic ketoacidosis (DKA)Diabetic ketoacidosis (DKA)

What are the causes of What are the causes of Croup & Bronchiolities?Croup & Bronchiolities?

• ParainfluenzaParainfluenza

• AdenovirusAdenovirus

• InfluenzaInfluenza

• RSVRSV

What is asthma in a child What is asthma in a child less than 2 called?less than 2 called?

• BronchiolitisBronchiolitis

What are the 4 D’s of What are the 4 D’s of Pellagra?Pellagra?

• DermatitisDermatitis

• DementiaDementia

• DeathDeath

What are the uric acid What are the uric acid stones?stones?

• CysteineCysteine

• OrnithineOrnithine

• LysineLysine

• Arginine Arginine

What is happening in the What is happening in the Atrium?Atrium?• Phase 0?Phase 0?• DepolarizationDepolarization

• Phase 1?Phase 1?

• No nameNo name

• Plateau phase (A-V node)Plateau phase (A-V node)

What is happening in the What is happening in the Atrium?Atrium?

• RepolarizationRepolarization

• Automaticity (S-A node)Automaticity (S-A node)

What do Na+ channels do What do Na+ channels do to the EKG?to the EKG?

• Wider QRSWider QRS

What does Ca+ do to the What does Ca+ do to the EKG?EKG?

• Wider P-waveWider P-wave

• Longer PR intervalLonger PR interval

What are the types of What are the types of kidney stones?kidney stones?

• Calcium oxalate (phosphate) stonesCalcium oxalate (phosphate) stones

• Struvite stonesStruvite stones

• Uric acid stonesUric acid stones

• Cysteine stonesCysteine stones

• Oxalate stones Oxalate stones

What percent of kidney stones What percent of kidney stones are calcium oxalate?are calcium oxalate?

• 80%80%

If you find oxalate stones in the If you find oxalate stones in the following what should you following what should you think of?think of?• 3 y/o white male?3 y/o white male?• CFCF

• 5 y/o black male?5 y/o black male?• Celiac SprueCeliac Sprue

If you find oxalate stones in the If you find oxalate stones in the following what should you following what should you think of?think of?• Adult male?Adult male?

• Whipple’sWhipple’s

• Adult male or female?Adult male or female?

• Crohn’sCrohn’s

If oxalate stones found in CF If oxalate stones found in CF what is the most common what is the most common cause?cause?• In 0-20 y/o?In 0-20 y/o?

• MalabsorptinMalabsorptin

• What age do they die?What age do they die?

• YoungYoung

Answer the following questions Answer the following questions about pseudogout?about pseudogout?

•What type of crystals are What type of crystals are present?present?

•Calcium pyrophosphateCalcium pyrophosphate •Where are they found?Where are they found?• Joint spacesJoint spaces

Answer the following questions Answer the following questions about pseudogout?about pseudogout?

•Who gets it?Who gets it?•Older patients M=FOlder patients M=F

•Tx?Tx?•Colchicine Colchicine

What are the most common What are the most common non-cyanotic heart disease?non-cyanotic heart disease?

• VSDVSD

• ASDASD

• PDAPDA

• CoarctationCoarctation

What murmur increases on What murmur increases on expiration?expiration?

• VSDVSD

• Mitral Mitral

What murmur has fixed What murmur has fixed wide splitting?wide splitting?

• ASDASD

What murmur has bounding What murmur has bounding pulses?pulses?

• PDAPDA

What gives you differenital What gives you differenital pulses?pulses?

• CoarctationCoarctation

What is increased incidence What is increased incidence in Turners?in Turners?

• Coarctation Coarctation

What are 4 enzymes never What are 4 enzymes never seen in glycolysis?seen in glycolysis?

• Pyruvate carboxylasePyruvate carboxylase

• PEP carboxykinasePEP carboxykinase

• F-1,6 dPhosphataseF-1,6 dPhosphatase

• G-6-PhosphataseG-6-Phosphatase

What are 3 enzymes seen What are 3 enzymes seen ONLY in glycolysis?ONLY in glycolysis?

• HexokinaseHexokinase

• PFK-1PFK-1

• Pyruvate kinasePyruvate kinase

What are 2 hormones that What are 2 hormones that are acidophilic?are acidophilic?

• ProlactinProlactin

• GHGH

What are the partially acid What are the partially acid fast Gram +ve?fast Gram +ve?

• NocardiaNocardia

What are the partially acid What are the partially acid fast Protozoa?fast Protozoa?

• CryptosporidiumCryptosporidium

What are the septic emboli What are the septic emboli of SBE?of SBE?

• Mycotic aneurysmMycotic aneurysm

• Roth spotsRoth spots

• Janeway lesionsJaneway lesions

• Osler’s nodesOsler’s nodes

• Splinter hemorrhagesSplinter hemorrhages

• EndocarditisEndocarditis

Where are the following Where are the following lesions found?lesions found?• Janeway lesions?Janeway lesions?

• ToesToes

• Osler’s nodes?Osler’s nodes?

• FingersFingers

• Roth spots?Roth spots?

• RetinaRetina

What is the most common What is the most common cause of endocarditis?cause of endocarditis?

• Strep. viridansStrep. viridans

What causes What causes microsteatosis?microsteatosis?

• AcetaminophenAcetaminophen

• Reye SyndromeReye Syndrome

• PregnancyPregnancy

What causes What causes macrosteatosis?macrosteatosis?

• AlcoholAlcohol

What are 2 bacteria that What are 2 bacteria that release elastase?release elastase?

• Staph. AureusStaph. Aureus

What are the 2 bacteria with What are the 2 bacteria with toxins that inhibit EF-2?toxins that inhibit EF-2?

How does Diptheria work?How does Diptheria work?

• It ADP ribosylates EF2 inhibiting protein It ADP ribosylates EF2 inhibiting protein synthesissynthesis

• Is it Gram +/-?Is it Gram +/-?

• ++

• Where and how does it get its exotoxin?Where and how does it get its exotoxin?

• From virus via transductionFrom virus via transduction

How does Diptheria work?How does Diptheria work?

• What does it cause?What does it cause?

• Heart blockHeart block

• What do you give for Tx?What do you give for Tx?

• AntitoxinAntitoxin

• Never scrape membraneNever scrape membrane

What are the different types of What are the different types of Emphysema and their causes?Emphysema and their causes?

• Bullous?Bullous?

• Staph aureusStaph aureus

• Centroacinar?Centroacinar?

• Smoking Smoking

What are the different types of What are the different types of Emphysema and their causes?Emphysema and their causes?

• Distalacinar?Distalacinar?

• AgingAging

• Panacinar?Panacinar?

• Alpha-1 antitrypsin defAlpha-1 antitrypsin def

What are the stages of What are the stages of erythropoiesis?erythropoiesis?• 4 mo gestation?4 mo gestation?• Yolk sacYolk sac

• 6 mo gestation?6 mo gestation?• Spleen, liver, flat bonesSpleen, liver, flat bones

What are the stages of What are the stages of erythropoiesis?erythropoiesis?• 8 mo gestation?8 mo gestation?

• Long bonesLong bones

• 1 yr old?1 yr old?

• Long bonesLong bones

If long bones become damaged If long bones become damaged after 1 yr what takes over?after 1 yr what takes over?

• Spleen can resume erythropoieses Spleen can resume erythropoieses causing splenomegalycausing splenomegaly

What ions correspond with What ions correspond with the following EKG?the following EKG?•P-wave?P-wave?•Ca+Ca+

•QRS complex?QRS complex?•Na+Na+

•S-T?S-T?•Ca+Ca+

What ions correspond with What ions correspond with the following EKG?the following EKG?

•T-wave?T-wave?

•K+K+

•U-wave?U-wave?

•Na+Na+

What do Na+ channel What do Na+ channel blockers do to the EKG?blockers do to the EKG?

• QRSQRS

What do Ca+ channel What do Ca+ channel blockers do to the EKG?blockers do to the EKG?

• Widens P-waveWidens P-wave

• PR interval longerPR interval longer

P.P. Clue 4 Bio Stat P.P. Clue 4 Bio Stat DD WW

++ BB A+BA+B

__ CC C+DC+D

A+CA+C B+DB+D ALLALL

Sensitivity A/A+CSpecificity D/B+DPPV A/A+BNPV D/C+DOR AD/BC

RR (A/All)/(C/All)

AR (A/All)-(C/All)

Sensitivity: Truly Diseased PeopleSpecificity: Truly Well People

+ Predictive Value: Test +ve With DZ

- Predictive Value: Tested –ve w/o DZOR: Odds RatioRR: Relative RiskAR: Attributed Risk

Always in the numerator

In EKG P-wave Represents?In EKG P-wave Represents?

• Atrium contractionAtrium contraction

• Phase zeroPhase zero

• CalciumCalcium

In EKG P-R Interval means?In EKG P-R Interval means?

• AV NodeAV Node

• Phase 2Phase 2

• SodiumSodium

In EKG Q-Wave means?In EKG Q-Wave means?

• SeptumSeptum

• Phase 2Phase 2

• SodiumSodium

In EKG R-upstoke means?In EKG R-upstoke means?

• Anterior wallAnterior wall

• Phase 2Phase 2

• SodiumSodium

In EKG S-down stroke In EKG S-down stroke means?means?

• Posterior wallPosterior wall

• Phase 2Phase 2

• SodiumSodium

In EKG S-T Interval means?In EKG S-T Interval means?

• VentricleVentricle

• Phase 2Phase 2

• CalciumCalcium

In EKG T-wave means?In EKG T-wave means?

• Phase 3Phase 3

• PotassiumPotassium

In EKG U-wave meansIn EKG U-wave means

• Phase 4Phase 4

• SodiumSodium

4 DZ associated with HLA-4 DZ associated with HLA-DR 2?DR 2?

• NarcolepsyNarcolepsy

• Allergy (hay fever)Allergy (hay fever)

• GoodpastureGoodpasture

• MSMS

5 DZ associated with HLA-5 DZ associated with HLA-DR 3?DR 3?

• DMDM

• Chronic active HepititisChronic active Hepititis

• SjogrensSjogrens

• SLESLE

• Celiac sprueCeliac sprue

DZ associated with HLA-DR DZ associated with HLA-DR 3&4?3&4?

• IDDM (DM Type 1)IDDM (DM Type 1)

DZ associated with HLA-DR DZ associated with HLA-DR 4?4?

• Rheumatoid ArthritisRheumatoid Arthritis

• Pemphigus Vulgaris Pemphigus Vulgaris

DZ associated with HLA-DR DZ associated with HLA-DR 55

• JRA (JUV RA)JRA (JUV RA)

DZ associated with HLA-DR DZ associated with HLA-DR 7?7?

• Nephrotic syndrome (Steroid Nephrotic syndrome (Steroid induced) induced)

DZ associated with HLA-DR DZ associated with HLA-DR 3 and HLA-B 8?3 and HLA-B 8?

• Celiac DiseaseCeliac Disease

DZ Associated with HLA-A3?DZ Associated with HLA-A3?

• HemochromatosisHemochromatosis– chromosome 6chromosome 6– point mutation Cystine to Tyrosinepoint mutation Cystine to Tyrosine

DZ Associated with HLA-A DZ Associated with HLA-A 3?3?

• Myasthenia gravis Myasthenia gravis

DZ Associated with HLA-B DZ Associated with HLA-B 13?13?

• PsoriasisPsoriasis

5 DZ Associated with HLA-B 5 DZ Associated with HLA-B 27?27?

• Psoriasis Psoriasis – only if with arthritisonly if with arthritis

• Ankylosing SpondylitiesAnkylosing Spondylities

• IBDIBD– Ulcerative CholitisUlcerative Cholitis

• Reiter’sReiter’s

• Post gonococcal arthritisPost gonococcal arthritis

DZ Associated to HLA-BW DZ Associated to HLA-BW 4747

• 21 alpha hydroxylase deficiency21 alpha hydroxylase deficiency– Vit. DVit. D

Facts about Diphtheria Facts about Diphtheria

• ADP ribosylates EF-2ADP ribosylates EF-2• Stops cell synthesisStops cell synthesis• Gr +ve Gr +ve • Gets exotoxin from virus via Gets exotoxin from virus via

transductiontransduction• Heart blockHeart block• Its toxoid therefore give antitoxinIts toxoid therefore give antitoxin

MCC of Pneumonia in 6wks MCC of Pneumonia in 6wks to 18 yrs?to 18 yrs?

• RSV (infants only)RSV (infants only)

• Chlamydia pneumoniaChlamydia pneumonia

• Strep pneumoniaStrep pneumonia

MCC Pneumonia in 18 yrs to 40 MCC Pneumonia in 18 yrs to 40 yrs of age?yrs of age?

• Chlamydia pneumoniaChlamydia pneumonia

• Strep. PneumoniaStrep. Pneumonia

MCC of Pneumonia in 40 yrs MCC of Pneumonia in 40 yrs to 65 yrs of age?to 65 yrs of age?

• Strep pneumoniaStrep pneumonia

• Anaerobes Anaerobes

MCC of pneumonia in the MCC of pneumonia in the Elderly? Elderly?

• Strep pneumonia Strep pneumonia

• VirusesViruses

• AnaerobesAnaerobes

• H.influenzaH.influenza

• Gr –ve rodsGr –ve rods

What are 4 Clues for IgA?What are 4 Clues for IgA?

• Monomer in bloodMonomer in blood

• Dimer in secretionDimer in secretion

• Located on mucosal surfaceLocated on mucosal surface

• Found in secretionFound in secretion

What are Clues for IgD?What are Clues for IgD?

• Only functions as surface marker for Only functions as surface marker for Mature B-CellMature B-Cell

What are Clues for IgE?What are Clues for IgE?

• Immediate Immediate hypersensitivity/anaphylaxishypersensitivity/anaphylaxis

• Parasite defenseParasite defense• WormsWorms• Fc region binds to mast cells and Fc region binds to mast cells and

basophilsbasophils• AllergiesAllergies• Does Not fix complementDoes Not fix complement

What are Clues for IgG?What are Clues for IgG?

• Highest affinityHighest affinity• Memory respond at Memory respond at day 3day 3 five times the five times the

concentrationconcentration• Peaks in 5 years last for 10 yearsPeaks in 5 years last for 10 years• OpsonizesOpsonizes• Activates complementActivates complement• 22ndnd to show up in primary response to show up in primary response• Only one to show up for secondary respondOnly one to show up for secondary respond• Most abundant Ig in newbornMost abundant Ig in newborn• Antigenic differences in heavy chain and site of di-Antigenic differences in heavy chain and site of di-

sulfide bondsulfide bond• 4 subclasses G1 to G44 subclasses G1 to G4

What are Clues for IgG1?What are Clues for IgG1?

• Crosses placenta due to fc portionCrosses placenta due to fc portion

• Most common sub-class deficiencyMost common sub-class deficiency

• Patient susceptible to encapsulated Patient susceptible to encapsulated organismsorganisms

• Most Most memorymemory antibody antibody

• Only IgG NOT fixing complementOnly IgG NOT fixing complement

What are Clues for IgM?What are Clues for IgM?

• Responds in primary responseResponds in primary response

• Most efficient in agglutination and Most efficient in agglutination and complement fixationcomplement fixation

• Defenses against bacteria and Defenses against bacteria and virusesviruses

What do Macrophages What do Macrophages release?release?

• MHC IIMHC II

What does TH1 secrete? What does TH1 secrete?

• IL-2IL-2

• IF- GammaIF- Gamma

What does TH2 Secrete?What does TH2 Secrete?

• IL-4IL-4

• IL-5IL-5

• IL-6IL-6

• IL-10IL-10

What does TH-0 secrete?What does TH-0 secrete?

• TH-1TH-1

• TH-2TH-2

MHC-1 are also called what? MHC-1 are also called what?

• CD8CD8

• CD8 becomes T-cytotoxic cellsCD8 becomes T-cytotoxic cells

All T-Cells express what?All T-Cells express what?

• CD-3CD-3

• For what?For what?

• Signal transductionSignal transduction

• CD-2 CD-2

• For what?For what?

• AdherenceAdherence

What do CD-4 cells What do CD-4 cells Become?Become?

• T helper cellsT helper cells

What do CD-8 cells What do CD-8 cells Become?Become?

• T cytotoxic cellsT cytotoxic cells

Neutrophils produce what Neutrophils produce what enzymes and what is their enzymes and what is their action?action?• MyeloperoxidaseMyeloperoxidase

• NADPHNADPH

• Will kill ALL Gr+veWill kill ALL Gr+ve– Ex..Hydrogen peroxide kills gr+Ex..Hydrogen peroxide kills gr+

What do T-cells stimulate?What do T-cells stimulate?

• Clue 4x7=28Clue 4x7=28

• CD-4CD-4

• B-7B-7

• CD-28CD-28

What are the Clues for Type-1 What are the Clues for Type-1 Hyperlipidemia?Hyperlipidemia?

• Increased ChylomicronIncreased Chylomicron

• Deficiency of Lipoprotein lipase Deficiency of Lipoprotein lipase enzymeenzyme

• Defect in liver onlyDefect in liver only

What are the Clues for type-2 What are the Clues for type-2 hyperlipedimia?hyperlipedimia?

• Increased LDLIncreased LDL• Two types IIa and IIbTwo types IIa and IIb• Type IIa Receptor deficiency for LDL or Type IIa Receptor deficiency for LDL or

missing B-100missing B-100• Type II-b (LDL and VLDL problems) enzyme Type II-b (LDL and VLDL problems) enzyme

deficiency for LDL at adipose. Receptor deficiency for LDL at adipose. Receptor problem for VLDL. Most common in problem for VLDL. Most common in General PopulationGeneral Population

What are the Clues for type-3 What are the Clues for type-3 Hyperlipedimia?Hyperlipedimia?

• Increased IDLIncreased IDL

• Receptor problem for APO-EReceptor problem for APO-E

What are the Clues for Type-4 What are the Clues for Type-4 hyperlipedimia?hyperlipedimia?

• Increased VLDLIncreased VLDL

• Lipoprotein lipase enzyme deficiency Lipoprotein lipase enzyme deficiency at adipose tissue at adipose tissue

What are the Clues for Type-5 What are the Clues for Type-5 hyperlipedimia?hyperlipedimia?

• Combination of Types 1&4Combination of Types 1&4

• Increased Chylomicron and VLDLIncreased Chylomicron and VLDL

• Enzyme and receptor deficiency at Enzyme and receptor deficiency at C-IIC-II

• Most common in diabeticsMost common in diabetics

What is a Xanthoma?What is a Xanthoma?

• Deposition of Cholesterol on elbowsDeposition of Cholesterol on elbows

• Can cause what?Can cause what?

• CADCAD

What is a Xanthelasma?What is a Xanthelasma?

• Deposition of Triglycerides on Deposition of Triglycerides on eyelids, faceeyelids, face

• Can cause what?Can cause what?

• PancreatitisPancreatitis

Description of Description of RashesRashes

ERYTHEMA MARGINATUMERYTHEMA MARGINATUM

• Little red spots w/ bright red marginsLittle red spots w/ bright red margins

• SandpaperySandpapery

• RF- Jones criteraRF- Jones critera

ERYTHEMIA CHRONICUM ERYTHEMIA CHRONICUM MIGRANSMIGRANS

• Lymes diseaseLymes disease

• Target lesions (bulls eye)Target lesions (bulls eye)

MEASLESMEASLES

• Morbiliform rashMorbiliform rash

• Preceded by coughPreceded by cough

• conjunctiivitisconjunctiivitis

ROSEOLAROSEOLA

• Fever x 2 dayFever x 2 day

• Followed by rashFollowed by rash

• ONLY ONE WITH RASH FOLLOWING ONLY ONE WITH RASH FOLLOWING FEVER (HHV 6)FEVER (HHV 6)

ERYTHEMA NODOSUMERYTHEMA NODOSUM

• Anterior aspect of legAnterior aspect of leg

• RednessRedness

• Tender nodulesTender nodules

Erythema multiformeErythema multiforme

• Red macules, target lesionsRed macules, target lesions• Causes: allergy, virusesCauses: allergy, viruses• Mild:Mild: MCC virus, #2 drugs (sulfas) MCC virus, #2 drugs (sulfas)• Moderate:Moderate: Stevens-Johnsons Stevens-Johnsons

SyndromeSyndrome• Severe:Severe: Toxic epidermal necrolysis , Toxic epidermal necrolysis ,

skin peels offskin peels off

SEBORRHEIC DERMATITISSEBORRHEIC DERMATITIS

• Scaly skin with oily shine on headlineScaly skin with oily shine on headline

SEBORRHEIC KERATOSISSEBORRHEIC KERATOSIS

• Stuck on wartsStuck on warts

• Due to agingDue to aging

PSORIASISPSORIASIS

• HLA-B27HLA-B27

• Extensor surfacesExtensor surfaces

• Silvery white plaquesSilvery white plaques

• Scaly skinScaly skin

• Pitted nailsPitted nails

VARICELLA ZOSTER HHV 3VARICELLA ZOSTER HHV 3

• STAGESSTAGES• Red maculesRed macules• PapulesPapules• VesiclesVesicles• Pustules then scabsPustules then scabs• Different stages may appear at Different stages may appear at

same timesame time

DERMATITIS DERMATITIS HERPATIFORMISHERPATIFORMIS

• Rash and blisters on ant. thighsRash and blisters on ant. thighs

• Assoc. with diarrheaAssoc. with diarrhea

• Assoc. with flare up of celiac sprueAssoc. with flare up of celiac sprue

TYPHOID FEVERTYPHOID FEVER

• SEEN WITH SALMONEALLA INFXNSEEN WITH SALMONEALLA INFXN

• Rose spots assoc. with intestinal fireRose spots assoc. with intestinal fire

DERMATOMYOSITISDERMATOMYOSITIS

• Heliotropic rashHeliotropic rash

ERYSIPELASERYSIPELAS

• Reddened area on skin w/ raised Reddened area on skin w/ raised bordersborders

• DOES NOT BLANCHDOES NOT BLANCH

TINEEA CRURISTINEEA CRURIS

• RednessRedness

• Itchy groinItchy groin

PITYRIASIS ROSEAPITYRIASIS ROSEA

• Herald patch= dry skin patches that Herald patch= dry skin patches that follow skin linesfollow skin lines

• HHV 7HHV 7

TINEA VERSICOLORTINEA VERSICOLOR

• Hypopigmented macules on upper Hypopigmented macules on upper back back

• Presents in a V patternPresents in a V pattern

• A.K.A. upside down christmas treeA.K.A. upside down christmas tree

• Tx: GriseofulvinTx: Griseofulvin

What do you see in What do you see in SCABIES?SCABIES?

• Linear excoriations on belt line and Linear excoriations on belt line and finger websfinger webs

• What is the tx?What is the tx?

• LindaneLindane

• PermethrinPermethrin

What is a T-CELL DEFICIENCY?What is a T-CELL DEFICIENCY?

• DiGeorges DiGeorges

• What ion imbalance will they have?What ion imbalance will they have?

• What did not form?What did not form?

• 33rdrd and 4 and 4thth pharyngeal pouch pharyngeal pouch

• What chromosome?What chromosome?

• Deletion on chromosome 22Deletion on chromosome 22

T-CELL DEFICIENCYT-CELL DEFICIENCY

• HIVHIV

• Also B-cell but less soAlso B-cell but less so

What is MYCOSIS What is MYCOSIS FUNGOIDES?FUNGOIDES?

• NOT A FUNGUSNOT A FUNGUS

• Non-Hodgkins form of cutaneous T-Non-Hodgkins form of cutaneous T-cell lymphomacell lymphoma

What is the job of What is the job of CHYLOMICRONS? CHYLOMICRONS?

• Transport TG’s from GI to liver and Transport TG’s from GI to liver and endotheliumendothelium

What is the job of VLDL?What is the job of VLDL?

• Transports TG’s from liver to adiposeTransports TG’s from liver to adipose

What is the job of IDL?What is the job of IDL?

• Transports TG’s from adipose to Transports TG’s from adipose to tissuetissue

What is special about LDL’s?What is special about LDL’s?

• ONLY ONE THAT CARRIES ONLY ONE THAT CARRIES CHOLESTEROLCHOLESTEROL

What do you develop with What do you develop with HYPERTRIGLYCERIDEMA?HYPERTRIGLYCERIDEMA?

• XANTHELASMAXANTHELASMA

• Where are they located?Where are they located?

• On eyelids and eyebrowsOn eyelids and eyebrows

What do you develop with What do you develop with HYPERCHOLESTEROLEMIA?HYPERCHOLESTEROLEMIA?

• Xanthomas Xanthomas

• Where are they located?Where are they located?

• elbowselbows

Where is VLDL made?Where is VLDL made?

• ONLY ONE MADE IN THE LIVERONLY ONE MADE IN THE LIVER

What are IDL AND LDL formed What are IDL AND LDL formed from?from?

• ARE BREAK DOWN PRODUCTS OF ARE BREAK DOWN PRODUCTS OF VLDLVLDL

What are the clues for What are the clues for HEMOPHILIUS INFLUENZA?HEMOPHILIUS INFLUENZA?

• Gram -/+?Gram -/+?• Pleomorphic gram (-) rodsPleomorphic gram (-) rods• What pattern?What pattern?• ““school of fish pattern”school of fish pattern”• What type is most common?What type is most common?• Type AType A

– 80%80%

• Capsule or no capsule?Capsule or no capsule?• non-encapsulatednon-encapsulated• Invasive or non invasive?Invasive or non invasive?• non-invasivenon-invasive

• Most common cause of what?Most common cause of what?• SinusitisSinusitis• OtitisOtitis• BronchitisBronchitis

What are the clues for What are the clues for HEMOPHILIUS INFLUENZA? HEMOPHILIUS INFLUENZA? • What is the 2What is the 2ndnd most common type? most common type?• TYPE BTYPE B

– 20%20%• Encapsulated or non encapsulated?Encapsulated or non encapsulated?• EncapsulatedEncapsulated• What does it have in its capsule?What does it have in its capsule?• Polyribosyl phosphate in capsulePolyribosyl phosphate in capsule• Contains IgA proteaseContains IgA protease

What are the clues for What are the clues for HEMOPHILIUS INFLUENZA? HEMOPHILIUS INFLUENZA?

• Invasive or non invasive?Invasive or non invasive?• Invasive Invasive • What does it cause most often? What does it cause most often? • #1 cause of epiglottitis #1 cause of epiglottitis • What are the signs of epiglottitis?What are the signs of epiglottitis?• StridorStridor• FeverFever• Thumb sign on xrayThumb sign on xray

What are the most common What are the most common causes of MENINGITIS causes of MENINGITIS corresponding with the corresponding with the following ages?following ages?• 0-2 months?0-2 months?

• #1. Group B strep (agalactiae)#1. Group B strep (agalactiae)

• #2. E. coli#2. E. coli

• #3. Listera#3. Listera

What are the most common What are the most common causes of MENINGITIS causes of MENINGITIS corresponding with the corresponding with the following ages?following ages?• 2 Months- 10 years?2 Months- 10 years?

• #1. strep pneumonia #1. strep pneumonia

• #2. n. meningitides#2. n. meningitides

• (adolescent years only)(adolescent years only)

What are the most common What are the most common causes of MENINGITIS causes of MENINGITIS corresponding with the corresponding with the following ages?following ages?• 10yrs- 21 yrs?10yrs- 21 yrs?

• #1. n. meningitides#1. n. meningitides

What are the most common What are the most common causes of MENINGITIS causes of MENINGITIS corresponding with the corresponding with the following ages?following ages?• > 21 years old?> 21 years old?

• #1 S. pneumoniae#1 S. pneumoniae

Answer the following about the Answer the following about the Strep. Pneumonia vaccine.Strep. Pneumonia vaccine.

• At what age is it given?At what age is it given?• Given at 2,4,6 monthsGiven at 2,4,6 months• What strain does it cover?What strain does it cover?• Covers 23 strains (98% cases)Covers 23 strains (98% cases)

Answer the following about the Answer the following about the Strep. Pneumonia vaccine.Strep. Pneumonia vaccine.

• Indications?Indications?• Anyone> 65y/oAnyone> 65y/o• Anyone splenectomized Anyone splenectomized

– Sickle cell anemiaSickle cell anemia

• Anyone with end-organ damageAnyone with end-organ damage– CFCF– RF RF – Nephrotic SyndromeNephrotic Syndrome

STREP PYOGENES is the most STREP PYOGENES is the most common cause of what?common cause of what?

• MCC of all throat infectionsMCC of all throat infections

• #2 MCC of all what?#2 MCC of all what?

• Skin infections except linesSkin infections except lines

What are the What are the STAPHYLOCOCCUS PIGMENTS?STAPHYLOCOCCUS PIGMENTS?

• St. aureus?St. aureus?

• Gold pigmentGold pigment

• St. epidermidis?St. epidermidis?

• White pigmentWhite pigment

• St. saprophyticus?St. saprophyticus?

• No pigmentNo pigment

What is the clue for RUSTY What is the clue for RUSTY COLORED SPUTUM?COLORED SPUTUM?

• Strep. Pneumonia Strep. Pneumonia – pneumococcuspneumococcus

Clues for GENERAL Clues for GENERAL INFECTIONSINFECTIONS• Skin Infections?Skin Infections?

• Say Staph. AureusSay Staph. Aureus

• Throat Infections? Throat Infections?

• Say Strep. PyogenesSay Strep. Pyogenes

• Small Intestine Infections?Small Intestine Infections?

• Say E. coliSay E. coli

What disease is a NEUTROPHIL What disease is a NEUTROPHIL DEFICIENCY & T,B cell DEFICIENCY & T,B cell deficiency?deficiency?• Job Syndrome:Job Syndrome:

• IL-4IL-4

• Hyper IgEHyper IgE

• What do they look like?What do they look like?

• Red hairRed hair

• Fair complexionFair complexion

• FemaleFemale

What are the NEUTROPHIL What are the NEUTROPHIL DEFICIENCY?DEFICIENCY?

• NADPH-OXIDASE DEF (CGD)NADPH-OXIDASE DEF (CGD)

• NEUTROPENIANEUTROPENIA

• MYLOPEROXIDASEMYLOPEROXIDASE

• Job-Buckley SyndromeJob-Buckley Syndrome

What Hepatitis B antigen is What Hepatitis B antigen is found with an acute/recent found with an acute/recent infection?infection?• HbC antigenHbC antigen

• HbS antigenHbS antigen

What Hepatitis B antigen & What Hepatitis B antigen & antibody is found with an antibody is found with an acute/recent infection?acute/recent infection?

• HbC antigenHbC antigen

• HbC antibodyHbC antibody

What Hepatitis B antigen is What Hepatitis B antigen is found with Recent found with Recent immunization within the past immunization within the past 2wks?2wks?

• HbS antigen ONLYHbS antigen ONLY

What Hepatitis B antibody is found with What Hepatitis B antibody is found with Recent immunization two wks after and can Recent immunization two wks after and can be due to vaccination immunity from a long be due to vaccination immunity from a long time ago?time ago?

• HbS antibody ONLYHbS antibody ONLY

What Hepatitis B antibody & What Hepatitis B antibody & antigen is found with past antigen is found with past disease but now immune?disease but now immune?

• HbC antibodyHbC antibody

• HbS antibodyHbS antibody

What Immunogloblin is found What Immunogloblin is found in Hepatitis B immunity?in Hepatitis B immunity?

• IgGIgG

What Hepatitis B What Hepatitis B antigen/antibody is found in antigen/antibody is found in the chronic carrier state? the chronic carrier state?

• HbS antigen for >6monthsHbS antigen for >6months

• Can be with or without HbS antibodyCan be with or without HbS antibody

What Hepatitis B antigen is What Hepatitis B antigen is found with the infectious state?found with the infectious state?

• HbE antigenHbE antigen

What Hepatitis B antibody is What Hepatitis B antibody is found with the non-infectious found with the non-infectious state?state?

• HbE antibodyHbE antibody

If patient has recovered from If patient has recovered from Hepatitis B what antigen will Hepatitis B what antigen will they have?they have?

• NEGATIVE HbS antigen NEGATIVE HbS antigen

If patient is a chronic carrier If patient is a chronic carrier what antigen will they have?what antigen will they have?

• POSITIVE HbS antigenPOSITIVE HbS antigen

What does the “window What does the “window period” build in Hepatitis B?period” build in Hepatitis B?

• HbE antibodyHbE antibody

• IgM HbC antibodyIgM HbC antibody

• What disappears?What disappears?

What is the incubation period What is the incubation period for Hepatitis B?for Hepatitis B?

• 4 to 26 wks4 to 26 wks

• Average @ 8wksAverage @ 8wks

How long is the acute disease How long is the acute disease period in Hepatitis B?period in Hepatitis B?

How long is the convalescence How long is the convalescence period in Hepatitis B?period in Hepatitis B?

How long is the recovery How long is the recovery period for Hepatitis B?period for Hepatitis B?

• YEARSYEARS

Answer the following about Answer the following about HIV? HIV?

• MC infection?MC infection?

• CMVCMV

• MCC of death?MCC of death?

• PCPPCP

• What is p41 used for?What is p41 used for?

• Just a markerJust a marker

Answer the following questions Answer the following questions about HIV? about HIV?

• What does Gp120 do? What does Gp120 do?

• Attachment to CD4Attachment to CD4

• What is Pol used for?What is Pol used for?

• IntegrationIntegration

• What is reverse transcriptase used for?What is reverse transcriptase used for?

• TranscriptionTranscription

• What are p17 & p24 antigens used for?What are p17 & p24 antigens used for?

• AssemblyAssembly

• What is the normal CD4 count?What is the normal CD4 count?

• 800-1200800-1200

• What can the CD4 count be up to in children?What can the CD4 count be up to in children?

• 15001500

• When do you begin treating with 2 nucleotide When do you begin treating with 2 nucleotide inhibitors and 1 protease inhibitor?inhibitors and 1 protease inhibitor?

• <500 <500 – (child at 750)(child at 750)

• AIDS is defined as a CD4 count of what?AIDS is defined as a CD4 count of what?• <200 <200 • With a CD4 count of <200 what do you With a CD4 count of <200 what do you

tx for?tx for?• PCPPCP• What do you treat for when CD count is What do you treat for when CD count is

<100?<100?• Mycobacterium aviam intracellularMycobacterium aviam intracellular

What are the Antioxidants?What are the Antioxidants?

• Vitamin EVitamin E– #1#1

• Vitamin AVitamin A

• Vitamin CVitamin C

• BetakertineBetakertine

What is Vitamin A a cofactor What is Vitamin A a cofactor for?for?

• ParathyroidParathyroid

• Along with what other cofactor?Along with what other cofactor?

• Mg+Mg+

Too much Vitamin A will cause Too much Vitamin A will cause what?what?

• HyperparathyroidHyperparathyroid– Increase Ca+Increase Ca+– Decrease PhosphateDecrease Phosphate

• What will be the symptoms?What will be the symptoms?

• GoansGoans

• MoansMoans

• BonesBones

• StonesStones

Too much Vitamin A will cause Too much Vitamin A will cause what?what?

• Pseudotumor CerebriPseudotumor Cerebri– Increase CSF production from Chorichoid Increase CSF production from Chorichoid

PlexusPlexus

What is the only cause of ICP What is the only cause of ICP that does not cause that does not cause herniation?herniation?• Pseucotumor cerebriPseucotumor cerebri

What does Vitamin A What does Vitamin A deficiency cause?deficiency cause?

• Nightvision problems/nightblindnessNightvision problems/nightblindness

• HypoparathyroidismHypoparathyroidism– Decrease Ca+Decrease Ca+– Increase PhosphateIncrease Phosphate

What is Vitamin B1?What is Vitamin B1?

• THIAMINETHIAMINE

• What do you get with a decrease in What do you get with a decrease in thiamine?thiamine?

• Beri BeriBeri Beri

• What is the most common cause in US?What is the most common cause in US?

• ETOHETOH

What do you get with Vitamin What do you get with Vitamin B1 deficiency?B1 deficiency?

• Wet Berry BerryWet Berry Berry

• With heart failureWith heart failure

• Dry Berry BerryDry Berry Berry

• Without heart failureWithout heart failure

What do you get with Vitamin What do you get with Vitamin B1 deficiency?B1 deficiency?

• Wernicke’s EncephalopathyWernicke’s Encephalopathy

• Wernicke’s KorsakoffWernicke’s Korsakoff

What is Wernicke’s What is Wernicke’s Encephalopathy?Encephalopathy?

• Alcoholic thymine deficiency of the Alcoholic thymine deficiency of the Temporal LobeTemporal Lobe

What is Wernicke’s What is Wernicke’s Korsakoff?Korsakoff?

What needs B1 as a What needs B1 as a Cofactor?Cofactor?

• 3 Dehydrogenases3 Dehydrogenases

• Pyruvate dehydrogenasePyruvate dehydrogenase

• Alpha ketoglutarate dehydrogenaseAlpha ketoglutarate dehydrogenase

• Branch chain amino acid Branch chain amino acid dehydrogenasedehydrogenase

• TransketolaseTransketolase

What is B2What is B2

• RiboflavinRiboflavin

• What is a physical sign of this What is a physical sign of this deficiency?deficiency?

• Angular stomatitisAngular stomatitis

• Angular cheliosisAngular cheliosis

• Corneal NeurovasculazationsCorneal Neurovasculazations

What is the best source of What is the best source of B2?B2?

• MilkMilk

• Also from FADAlso from FAD

What is B3?What is B3?

• NiacinNiacin

• What is the clue?What is the clue?

• DermatitisDermatitis

• DementiaDementia

• DeathDeath

What is the disease that What is the disease that presents like B3 deficiency?presents like B3 deficiency?

• Hartnup DiseaseHartnup Disease

• What is deficient in this disease?What is deficient in this disease?

• Tyrptophan Tyrptophan

• What is typtophan needed for?What is typtophan needed for?

• Needed for niacin formationNeeded for niacin formation

• Lipoic acidLipoic acid

• What is the deficiency caused by this What is the deficiency caused by this vitamin?vitamin?

• Not oneNot one

• Pantothenic acidPantothenic acid

• You guessed it…nothingYou guessed it…nothing

• PyridoxinePyridoxine

• What is the deficiency caused by this vitamin?What is the deficiency caused by this vitamin?

• NeuropathyNeuropathy

• Seizures Seizures

• Who do you need to give B6 to?Who do you need to give B6 to?

• Patient on INHPatient on INH

What type of anemia is seen What type of anemia is seen with B6 Deficiency?with B6 Deficiency?

• SideroblasticSideroblastic

What needs B6 as a What needs B6 as a cofactor?cofactor?

• ALL transaminasesALL transaminases

• CyanocobalamineCyanocobalamine

• Neuropathy Neuropathy

What is the most common What is the most common cause of vitamin B12 cause of vitamin B12 deficiency?deficiency?• Pernicious anemiaPernicious anemia

What 2 enzymes are needed What 2 enzymes are needed for synthesis of B12?for synthesis of B12?

• Methylmalonyl CoA MutaseMethylmalonyl CoA Mutase

• Homocysteine Methyl TransferaseHomocysteine Methyl Transferase

Deficiency in Methylmalonyl Deficiency in Methylmalonyl CoA Mutase leads to what?CoA Mutase leads to what?

• NeuropathyNeuropathy

• Why?Why?

• Because it recycles myelin Because it recycles myelin

Deficiency in Homocystiene Deficiency in Homocystiene Methyl Transferase leads to Methyl Transferase leads to what?what?• Megaloblastic anemiaMegaloblastic anemia

• What else is this enzyme needed for?What else is this enzyme needed for?

• Nucleotide synthesisNucleotide synthesis

When is ANGULARE When is ANGULARE STOMATOSIS seen?STOMATOSIS seen?

• VITAMIN B2- RIBOFLAVIN deficiency VITAMIN B2- RIBOFLAVIN deficiency

What are the 4 D’S of What are the 4 D’S of pellegra?pellegra?

• DIARRHEADIARRHEA

• DERMATITISDERMATITIS

• DEMENTIA DEMENTIA

• DEATHDEATH

What causes a What causes a NEUROPATHY WHEN NEUROPATHY WHEN DEFICIENT & also DEFICIENT & also needs TRANSAMINASE?needs TRANSAMINASE?

• PYRIDOXINE B6PYRIDOXINE B6

What vitamin is What vitamin is deficient with deficient with PERNICIOUS ANEMIA & PERNICIOUS ANEMIA & NEUROPATHY?NEUROPATHY?

• B12 CYANOCOBALAMINEB12 CYANOCOBALAMINE

What is the first vitamin to run What is the first vitamin to run out with disease of rapidly out with disease of rapidly dividing cells?dividing cells?

• FolateFolate

What type of anemia is seen What type of anemia is seen with Folate deficiency?with Folate deficiency?

• Megaloblastic anemiaMegaloblastic anemia

• With neuropathy?With neuropathy?

• NO NEUROPHATHYNO NEUROPHATHY

• What else is Folate used for?What else is Folate used for?

• Nucleotide synthase (THF)Nucleotide synthase (THF)

What is another name for What is another name for Vitamin C?Vitamin C?

• Ascorbate acidAscorbate acid

What is Vitamin C needed What is Vitamin C needed for?for?

• Collagen synthesisCollagen synthesis

What happens with Vitamin C What happens with Vitamin C deficiency?deficiency?

• ScurvyScurvy

What is the CLUE for What is the CLUE for Scurvy?Scurvy?

• Bleeding gums Bleeding gums

• Bleeding hair folliclesBleeding hair follicles

What is the most common What is the most common cause of Vitamin C deficiency?cause of Vitamin C deficiency?

• Diet deficient in citrus fruit Diet deficient in citrus fruit

• Diet deficient in green vegetablesDiet deficient in green vegetables

• Over cooked green vegetablesOver cooked green vegetables

What does Vitamin D do with What does Vitamin D do with Ca+?Ca+?

• Controls Ca+Controls Ca+

• Absorbes Ca+ from GIAbsorbes Ca+ from GI

• Reabsorbs Ca+ in KidneysReabsorbs Ca+ in Kidneys

• Controls osteoblastic activity Controls osteoblastic activity

What does Vitamin D What does Vitamin D deficiency cause in Children?deficiency cause in Children?

• RickettsRicketts

• What does it cause in ADULTS?What does it cause in ADULTS?

• OsteomalciaOsteomalcia

What is the CLUE for What is the CLUE for RICKETTS?RICKETTS?

• Lateral Bowing of the LegsLateral Bowing of the Legs

• X-linked dominantX-linked dominant

What is Vitamin E needed What is Vitamin E needed for?for?

• HairHair

• SkinSkin

• EyesEyes

• Protection against free radicalsProtection against free radicals

• #1 antioxidant#1 antioxidant

What does a deficiency of What does a deficiency of Vitamin E cause in newborns?Vitamin E cause in newborns?

• RetinopathyRetinopathy

What are the vitamins from GI What are the vitamins from GI that are normal flora?that are normal flora?

• FolateFolate

• Vitamin KVitamin K– 90%90%

• BiotinBiotin

• Panothenic acidPanothenic acid

• Helps with absorption of B12Helps with absorption of B12

What are the Vitamin K What are the Vitamin K dependent clotting factors?dependent clotting factors?• 19721972• Protein CProtein C• Protein SProtein S

• Which one has the shortest half-life?Which one has the shortest half-life?• Protein CProtein C

• Which one has the 2Which one has the 2ndnd shortest half-life? shortest half-life?• 77

What are the TRACE What are the TRACE elements?elements?

• ChromiumChromium

• SeleniumSelenium

• Manganese MolebdenumManganese Molebdenum

• TinTin

What is Chromium needed What is Chromium needed for?for?

• Insulin actionInsulin action

What organ needs What organ needs Selenium?Selenium?

• HeartHeart

What trace element is an What trace element is an enzyme in glycolsis?enzyme in glycolsis?

• Manganese MolebdenumManganese Molebdenum

What organ needs Tin?What organ needs Tin?

• HairHair

What does a deficiency in Zinc What does a deficiency in Zinc cause?cause?

• DysguziaDysguzia

• Decrease spermDecrease sperm

• Dry hairDry hair

• Dry skinDry skin

Cofactor for ALL Kinases?Cofactor for ALL Kinases?

• Mg+Mg+

Cofactor for ALL Cofactor for ALL Carboxylases?Carboxylases?

• BiotinBiotin

Cofactor for ALL Cofactor for ALL Transaminases?Transaminases?

• PyridoxinePyridoxine– B6B6

What is Biotin a cofactor What is Biotin a cofactor for?for?

• ALL carboxylases ALL carboxylases

What is Mg+ a cofactor for?What is Mg+ a cofactor for?

• ALL kinasesALL kinases

• Parathyroid along with Vitamin AParathyroid along with Vitamin A

What is Ca+ needed for?What is Ca+ needed for?

• Muscle contractionMuscle contraction

• Axonal transportAxonal transport

• 22ndnd messengers messengers

What tracts are affected due to What tracts are affected due to deficiency in Methyl Malonyl deficiency in Methyl Malonyl CoA Mutase?CoA Mutase?

• Dorsal ColumnsDorsal Columns

• Cortical Spinal TractsCortical Spinal Tracts

• Why are these affected?Why are these affected?

• Because they are the longest Because they are the longest

• Because they need the most myelin Because they need the most myelin

What enzyme does Zanthein What enzyme does Zanthein Oxidase need?Oxidase need?

• Maganese MolebdenumMaganese Molebdenum

How are drugs that are How are drugs that are bioavailable ALWAYS excreted?bioavailable ALWAYS excreted?

• By the liverBy the liver

• Always HepatotoxicAlways Hepatotoxic

How are soluble drugs ALWAYS How are soluble drugs ALWAYS excreted?excreted?

• By the kidneyBy the kidney

• Always nephrotoxicAlways nephrotoxic

What are the 5 P’S OF What are the 5 P’S OF COMPARTMENT SYNDROME?COMPARTMENT SYNDROME?

• PainPain

• PallorPallor

• ParesthesiaParesthesia

• PulselessnessPulselessness

• PoikilothermiaPoikilothermia

What are 5 skin infections What are 5 skin infections were Strep. Pyogenes is the were Strep. Pyogenes is the number one cause?number one cause?• LympangitisLympangitis

• Impetigo (not bullous)Impetigo (not bullous)

• Necrotizing fascitisNecrotizing fascitis

• ErysepelasErysepelas

• Scarlet feverScarlet fever

What are 5 skin infections were What are 5 skin infections were Staph. aureus is the number Staph. aureus is the number two cause?two cause?• LympangitisLympangitis

• Impetigo (not bullous)Impetigo (not bullous)

• Necrotizing fascitisNecrotizing fascitis

• ErysepelasErysepelas

• Scarlet feverScarlet fever

What is the #1 bacteria What is the #1 bacteria causing infection associated in causing infection associated in shunts and central lines?shunts and central lines?

• Staph epidermitisStaph epidermitis

What is the #1 bacteria What is the #1 bacteria causing infection in peripheral causing infection in peripheral lines?lines?• Staph aureusStaph aureus

Why do we need E. COLI in the Why do we need E. COLI in the gut?gut?

• Absorption ofAbsorption of Vit. B12 Vit. B12

• Synthesis ofSynthesis of::

• -Vitamin K-Vitamin K

• -Biotin-Biotin

• -Folate-Folate

• -Pantothenic acid -Pantothenic acid – B5B5

Answer the following questions Answer the following questions about RESTRICTION ENZYMES?about RESTRICTION ENZYMES?• Trypsin cuts where?Trypsin cuts where?• cuts to R of cuts to R of • ArgArg• LysLys

• Chymotrypsin cuts where?Chymotrypsin cuts where?• cuts to R of bulky aa’s cuts to R of bulky aa’s (aromatics)(aromatics)• PhePhe• TyrTyr• TrpTrp

Answer the following questions Answer the following questions about RESTRICTION ENZYMES?about RESTRICTION ENZYMES?

•Elastase cuts where?Elastase cuts where?• Cuts to R of (“SAG”)Cuts to R of (“SAG”)• SSerer• AAlala• GGlyly

• CNBr cuts where?CNBr cuts where?• Cuts to R ofCuts to R of• MethionineMethionine

• Mercaptoethanol cuts where?Mercaptoethanol cuts where?

• Cuts to R of: disulfide bonds Cuts to R of: disulfide bonds – CysteineCysteine– methioninemethionine

• Aminopeptidase cuts where?Aminopeptidase cuts where?• Cuts to R ofCuts to R of• amino acid terminalamino acid terminal

• Caboxypeptidase cuts where?Caboxypeptidase cuts where?

• Cuts to L ofCuts to L of

• carboxy terminal carboxy terminal

What is THE What is THE ONLY LIVE ONLY LIVE VACCINE INDICATED IN VACCINE INDICATED IN AIDS AIDS PATIENTS?PATIENTS?• MMRMMR

What VACCINE is What VACCINE is NOTNOT GIVEN IF GIVEN IF pt. is Allergic to EGG?pt. is Allergic to EGG?

• MMR & INFLUENZAMMR & INFLUENZA

What VACCINE is What VACCINE is NOT NOT GIVEN GIVEN IF patient HAS YEAST IF patient HAS YEAST ALLERGIES?ALLERGIES?• Hepatitis BHepatitis B

What 3 VACCINES DROP OUT What 3 VACCINES DROP OUT AFTER 6 YEARS OF AGE?AFTER 6 YEARS OF AGE?

• HibHib

• DiphtheriaDiphtheria

• PertussisPertussis

What is the MC STRAIN OF What is the MC STRAIN OF STREP PYOGENES TO CAUSE STREP PYOGENES TO CAUSE GN?GN?• Strain 12Strain 12

What 2 substances are in What 2 substances are in NEUTROPHILS?NEUTROPHILS?

• MyeloperoxidaseMyeloperoxidase

• NADPH OxidaseNADPH Oxidase

MACROPHAGES CONTAIN what MACROPHAGES CONTAIN what SUBSTANCE?SUBSTANCE?

• NADPH OxidaseNADPH Oxidase

• Which means they only kill what?Which means they only kill what?

• Kills only G -veKills only G -ve

What do MACROPHAGES What do MACROPHAGES SECRETE?SECRETE?

• IL-1IL-1

• IL-6??IL-6??

What DRUGS CAUSE PAINFUL What DRUGS CAUSE PAINFUL NEUROPATHY?NEUROPATHY?

• DDI>DDCDDI>DDC

• PancreatitisPancreatitis

What are the MITOCHONDRIAL What are the MITOCHONDRIAL DISEASES?DISEASES?• Leigh’s DiseaseLeigh’s Disease• What is another name?What is another name?• Subacute necrotizing encephalomyelopathySubacute necrotizing encephalomyelopathy• What are the signs & symptoms?What are the signs & symptoms?• Progressively decreasing IQ Progressively decreasing IQ • SeizureSeizure• AtaxiaAtaxia• What is the deficiency?What is the deficiency?• Cytochrome oxidase deficiencyCytochrome oxidase deficiency

What are the MITOCHONDRIAL What are the MITOCHONDRIAL DISEASES?DISEASES?• Leber’s Hereditary Optic Atrophy (LHON)Leber’s Hereditary Optic Atrophy (LHON)• They all dieThey all die

What is the What is the ONLYONLY G +ve WITH G +ve WITH ENDOTOXIN?ENDOTOXIN?

•ListeriaListeria

• What part is toxic?What part is toxic?• Lipid ALipid A

• Does it cross the placenta?Does it cross the placenta?• YesYes

What does Listeria What does Listeria activate?activate?

• T-cells & Macrophages, T-cells & Macrophages, therefore, therefore, have granulomashave granulomas

What are the Associations in What are the Associations in contracting the Listeria bug?contracting the Listeria bug?

• Raw cabbageRaw cabbage

• Spoiled milkSpoiled milk

• Migrant workersMigrant workers

What are the PERIODS OF What are the PERIODS OF RAPID GROWTH/RAPIDLY RAPID GROWTH/RAPIDLY DIVIDING CELLS?DIVIDING CELLS?

• Birth – 2 monthsBirth – 2 months

• 4 – 7 years old4 – 7 years old

• PubertyPuberty

What is THE What is THE ONLY ONLY IMMUNE IMMUNE DEFICIENCY WITH DEFICIENCY WITH LOW CALCIUM LOW CALCIUM and Increase Phosphate?and Increase Phosphate?• DiGeorge’s SyndromeDiGeorge’s Syndrome

What are the BASIC AMINO What are the BASIC AMINO ACIDS?ACIDS?

• LysineLysine

• ArginineArginine

What are the ACIDIC AMINO What are the ACIDIC AMINO ACIDS?ACIDS?

• GlutamateGlutamate

• AspartateAspartate

What are the Ketogenic + What are the Ketogenic + Glucogenic Amino Acids?Glucogenic Amino Acids?

• PhenylalaninePhenylalanine

• IsoleucineIsoleucine

• TrptophanTrptophan

• ThreonineThreonine

What are the AROMATIC What are the AROMATIC AMINO ACIDS?AMINO ACIDS?

• PhenylalaninPhenylalanin

• TryptophanTryptophan

What are the AMINO ACIDS What are the AMINO ACIDS with DISULFIDE BONDS?with DISULFIDE BONDS?

• MetMet

• CystCyst

What are the “KINKY” AMINO What are the “KINKY” AMINO ACID?ACID?

• ProlineProline

What are the SMALLEST AMINO What are the SMALLEST AMINO ACID?ACID?

• GlyGly

What are the AMINO ACIDS What are the AMINO ACIDS with O-BONDS?with O-BONDS?

• SerineSerine

• ThreonineThreonine

What are the AMINO ACIDS What are the AMINO ACIDS with N-BONDS?with N-BONDS?

• AsparagineAsparagine

• GlutamineGlutamine

What are the BRANCHED-What are the BRANCHED-CHAIN AMINO ACIDS?CHAIN AMINO ACIDS?

• LeuLeu

• IsoIso

• ValVal

What are the KETOGENIC What are the KETOGENIC AMINO ACIDS?AMINO ACIDS?

• LeuLeu

• LysLys

What CONDITIONS are What CONDITIONS are ASSOCIATED WITH ASSOCIATED WITH HLA-B27?HLA-B27?• Psoriasis (with arthritis)Psoriasis (with arthritis)

• Ankylosing SpondylitisAnkylosing Spondylitis

• Irritable Bowel SyndromeIrritable Bowel Syndrome

• Reiter’s SyndromeReiter’s Syndrome

What is associated with HLA-What is associated with HLA-B13?B13?

• Psoriasis with out arthritisPsoriasis with out arthritis

What are the ORGANISMS What are the ORGANISMS WITH IgA PROTEASE WITH IgA PROTEASE (resistant to (resistant to

IgA)IgA)??• Strep. PneumoniaeStrep. Pneumoniae

• Neisseria catarrhalisNeisseria catarrhalis

What do EOSINOPHILS What do EOSINOPHILS SECRETE?SECRETE?

• HistaminaseHistaminase

• ArylsulfataseArylsulfatase

• HeparinHeparin

• Major Basic ProteinMajor Basic Protein

What do MAST CELLS What do MAST CELLS SECRETE?SECRETE?

• In an Acute Reaction?In an Acute Reaction?

• HistamineHistamine

• In a Late ReactionIn a Late Reaction ??

• SRS-ASRS-A

• ECF-AECF-A

What is the MCC of ATYPICAL What is the MCC of ATYPICAL PNEUMONIA?PNEUMONIA?

• 0 – 2 months?0 – 2 months?

• chlamydia pneumoniachlamydia pneumonia

What does chlamydia What does chlamydia pneumonia cause?pneumonia cause?

• Intersitital pneumoniaIntersitital pneumonia

What is the CLUE for HEART What is the CLUE for HEART BLOCK?BLOCK?

• High temperature with High temperature with NORMAL NORMAL pulse rate!pulse rate!

((This should never be!This should never be! Each degree Each degree ↑ in temp. → ↑ in temp. → 10 beats/min ↑ in pulse rate)10 beats/min ↑ in pulse rate)

What are the clues for IL-1?What are the clues for IL-1?

• FEVERFEVER

• NONSPECIFIC ILLNESSNONSPECIFIC ILLNESS

• RECRUITS TH CELLS for LINKING with RECRUITS TH CELLS for LINKING with MHC II COMPLEXMHC II COMPLEX

• SECRETED BY MACROPHAGESSECRETED BY MACROPHAGES

• MOST POTENT OF THE InterleukinsMOST POTENT OF THE Interleukins

• RECRUITS EVERYBODYRECRUITS EVERYBODY

• MOST POWERFUL MOST POWERFUL CHEMO-ATTRACTANTCHEMO-ATTRACTANT

• MUST MUST BE INACTIVATEDBE INACTIVATED

• When must you inactivate it?When must you inactivate it?

• PRIOR TO TRANSPLANTATIONPRIOR TO TRANSPLANTATIONby cyclosporinby cyclosporin

• SECRETED BY TH1 CELLSSECRETED BY TH1 CELLS

• ENERGIZED MACROPHAGESENERGIZED MACROPHAGES

• CAUSES B-CELL PROLIFERATIONCAUSES B-CELL PROLIFERATION

• LABELED BY THYMIDINE (USE LABELED BY THYMIDINE (USE POKEWEED MITOGEN OR POKEWEED MITOGEN OR ENDOTOXIN)ENDOTOXIN)

• SECRETED BY ACTIVATED T CELLSSECRETED BY ACTIVATED T CELLS

• B-CELL DIFFERENTIATIONB-CELL DIFFERENTIATION

• RESPONSIBLE FOR CLASS SWITCHINGRESPONSIBLE FOR CLASS SWITCHING

• SECRETED BY TH2 CELLSSECRETED BY TH2 CELLS

What are the clues for IL-5 thru What are the clues for IL-5 thru 14?14?

• They do exactly what IL-1 thru IL4 They do exactly what IL-1 thru IL4

What are the clues for IL-What are the clues for IL-10?10?

• SUPPRESSES CELL-MEDIATED SUPPRESSES CELL-MEDIATED RESPONSE (tells macrophages and RESPONSE (tells macrophages and fibroblasts to stay away if bacterial)fibroblasts to stay away if bacterial)

• INHIBITS INHIBITS MACMAC ACTIVATION ACTIVATION

What are the clues for IL-What are the clues for IL-12?12?• PROMOTES CELL-MEDIATED RESPONSE PROMOTES CELL-MEDIATED RESPONSE

(recruits macs & fibroblasts if NOT (recruits macs & fibroblasts if NOT bacterial)bacterial)

• ACTIVATES ACTIVATES NKNK CELLS TO SECRETE IF- CELLS TO SECRETE IF-γγ

• INHIBITS IL-4 INDUCED IgE SECRETIONINHIBITS IL-4 INDUCED IgE SECRETION

• CHANGES TH CELLS to TH1 CELLS CHANGES TH CELLS to TH1 CELLS – secretes IL-2 & IF-secretes IL-2 & IF-γγ → inhib. TH2, therefore, ↑ → inhib. TH2, therefore, ↑

host defenses against delayed hypersensitivityhost defenses against delayed hypersensitivity

What are the clues for IF-What are the clues for IF-αα??

• Where is it from?Where is it from?• LEUKOCYTESLEUKOCYTES• ↓↓VIRAL REPLICATION AND TUMOR GROWTHVIRAL REPLICATION AND TUMOR GROWTH• ↑ ↑ NK NK ACTVITY ACTVITY

– secretes perforins and granzymes to kill infected secretes perforins and granzymes to kill infected cellcell

• ↑↑MHC CLASS I & II EXPRESSIONMHC CLASS I & II EXPRESSION• ↓ ↓ PROTEIN SYNTHESISPROTEIN SYNTHESIS

– translation inhibited, therefore, defective protein translation inhibited, therefore, defective protein synthesissynthesis

Summary of clues for IF-Summary of clues for IF-αα??

• Increase NK activityIncrease NK activity

• Increase MHC class I & IIIncrease MHC class I & II

• Decrease protein synthesisDecrease protein synthesis

• Decrease viral replication and growthDecrease viral replication and growth

What are the clues for IF-B?What are the clues for IF-B?

• Where is it from?Where is it from?

• FIBROBLASTSFIBROBLASTS

• Increase NK activityIncrease NK activity

• Increase MHC class I & IIIncrease MHC class I & II

• Decrease protein synthesisDecrease protein synthesis

• Decrease viral replication and growthDecrease viral replication and growth

What are the clues for IF-What are the clues for IF-gama?gama?• Where is it from?Where is it from?

• T-CELLS & NK CELLST-CELLS & NK CELLS

• ↑ ↑ NK NK ACTIVITYACTIVITY

• ↑↑MHC MHC CLASS I & IICLASS I & II

• ↑ ↑ MACROPHAGE ACTIVITYMACROPHAGE ACTIVITY

• CO-STIMULATES B-CELL GROWTH & CO-STIMULATES B-CELL GROWTH & DIFFERENTIATIONDIFFERENTIATION

• ↓ ↓ IgE SECRETIONIgE SECRETION

What are the clues for TNF-What are the clues for TNF-alpha?alpha?• Where is it from?Where is it from?• MONOCYTES & MONOCYTES & MACROPHAGESMACROPHAGES• What is another name for TNF-alpha?What is another name for TNF-alpha?• CACHECTINCACHECTIN• INDUCES INDUCES IL-1IL-1• ↑ ↑ ADHESION MOLECULES & MHC CLASS I ON ADHESION MOLECULES & MHC CLASS I ON

ENDOTHELIAL CELLSENDOTHELIAL CELLS• PYROGENPYROGEN• INDUCES IF-INDUCES IF-γγ SECRETION SECRETION• CYTOTOXICCYTOTOXIC/CYTOSTATIC EFFECT/CYTOSTATIC EFFECT

What are the clues for TNF-What are the clues for TNF-beta?beta?

• T-CELLST-CELLS

• What is another name for it?What is another name for it?

• LYMPHOTOXINLYMPHOTOXIN

• CYTOTOXIC FACTOR CYTOTOXIC FACTOR

What are the clues for TGF-What are the clues for TGF-αα??

• SOLID TUMORS SOLID TUMORS (CARCINOMA > (CARCINOMA > SARCOMA)SARCOMA)

• MONOCYTESMONOCYTES

• What is another name for it?What is another name for it?

• TRANSFORMING GROWTH FACTORSTRANSFORMING GROWTH FACTORS

What are the clues for TGF-What are the clues for TGF-αα??• What does it INDUCE?What does it INDUCE?

• ANGIOGENESISANGIOGENESIS

• KERATINOCYTE PROLIFERATIONKERATINOCYTE PROLIFERATION

• BONE RESORPTIONBONE RESORPTION

• TUMOR GROWTHTUMOR GROWTH

• What is it mainly for?What is it mainly for?

• MAINLY FOR TUMOR GROWTHMAINLY FOR TUMOR GROWTH

What are the clues for TGF-What are the clues for TGF-ββ??

• PLATELETSPLATELETS

• PLACENTAPLACENTA

• KIDNEYKIDNEY

• BONEBONE

• T & B CELLST & B CELLS

• What What INDUCES it?INDUCES it?

• FIBROBLAST PROLIFERATIONFIBROBLAST PROLIFERATION

• COLLAGENCOLLAGEN

• FIBRONECTIN SYNTHESISFIBRONECTIN SYNTHESIS

• What INHIBITS it?What INHIBITS it?

• NKNK

• LAKLAK

• CTLCTL

• T & B CELL PROLIFERATIONT & B CELL PROLIFERATION

• What ENHANCES it?What ENHANCES it?

• WOUND HEALING WOUND HEALING

• ANGIOGENESISANGIOGENESIS

• What does it suppress?What does it suppress?

• SUPPRESSES IR AFTER INFECTION & SUPPRESSES IR AFTER INFECTION & PROMOTES HEALING PROCESSPROMOTES HEALING PROCESS

• What is it mainly for?What is it mainly for?

• MAINLY FOR WOUND HEALINGMAINLY FOR WOUND HEALING

What does LAK stand for?What does LAK stand for?

• LYMPHOKINE ACTIVATED KILLER LYMPHOKINE ACTIVATED KILLER CELLSCELLS

What does CTL stand for?What does CTL stand for?

• CYTOTOXIC T-LYMPHOCYTESCYTOTOXIC T-LYMPHOCYTES

What does mitochondrial What does mitochondrial inheritance affect?inheritance affect?

• CNSCNS

• HeartHeart

• Skeletal muscleSkeletal muscle

• Why does it affect these particular Why does it affect these particular places?places?

• Due to uneven cytokinesis during Due to uneven cytokinesis during meiosis or oogenesismeiosis or oogenesis

Answer the following about Answer the following about Mitochondrial diseases?Mitochondrial diseases?

• Who are affected?Who are affected?

• All offspringAll offspring

• Who passes the disease?Who passes the disease?

• MOMMOM

• Who has no transmission?Who has no transmission?

• DadDad

Answer the following about Answer the following about Autosomal Recessive Autosomal Recessive inheritance?inheritance?• Who does it show in?Who does it show in?• Not parentsNot parents• Siblings/uncles may show diseaseSiblings/uncles may show disease

• When is onset?When is onset?• Early in life (childhood diagnosis)Early in life (childhood diagnosis)

• Is it complete on incomplete penetrance?Is it complete on incomplete penetrance?• COMPLETECOMPLETE

Answer the following about Answer the following about Autosomal Recessive Autosomal Recessive inheritance?inheritance?• How are they acquired?How are they acquired?

• Almost ALL are inborn error of Almost ALL are inborn error of metabolismmetabolism

• When does it occur?When does it occur?

• Only when both alleles at a locus are Only when both alleles at a locus are mutantmutant

Answer the following about Answer the following about Autosomal Recessive Autosomal Recessive inheritance?inheritance?• How is it transmitted?How is it transmitted?

• Horizontal TmHorizontal Tm

• Are there malformations present?Are there malformations present?

• Physical malformations are uncommonPhysical malformations are uncommon

• What type of defect?What type of defect?

• Enzyme defectEnzyme defect

Answer the following about Answer the following about Autosomal Dominant Autosomal Dominant inheritance?inheritance?• Who does it affect the most?Who does it affect the most?

• M=FM=F

• How does it manifest?How does it manifest?

• Heterozygote stateHeterozygote state

• Who can transmit the disease?Who can transmit the disease?

• Both parentsBoth parents

Answer the following about Answer the following about Autosomal Dominant Autosomal Dominant inheritance?inheritance?• Where is the new mutation?Where is the new mutation?

• Often in germ cells of older fathersOften in germ cells of older fathers

• When is onset?When is onset?

• Often delayed (adult diagnosis)Often delayed (adult diagnosis)– Example = Huntington’sExample = Huntington’s

Answer the following about Answer the following about Autosomal Dominant Autosomal Dominant inheritance?inheritance?• What is penetrance?What is penetrance?

• Reduced penetranceReduced penetrance

• How is it expressed?How is it expressed?

• Variable expressinVariable expressin– Different in each individualDifferent in each individual

Answer the following about Answer the following about Autosomal Dominant Autosomal Dominant inheritance?inheritance?• How is it transmitted?How is it transmitted?

• Vertical TMVertical TM

• Is there malformation present?Is there malformation present?

• Physical malformation commonPhysical malformation common

• What type of defect?What type of defect?

• Structural Structural

Who is affected in the family Who is affected in the family with an X-Linked disease?with an X-Linked disease?

• Maternal grandfatherMaternal grandfather

• Maternal uncleMaternal uncle

Immune System Time Line for Immune System Time Line for viral & cell-mediated.viral & cell-mediated.

• What happens <24hrs?What happens <24hrs?

• SwellingSwelling

• What happens at 24 hrs?What happens at 24 hrs?

• Neutrophils show upNeutrophils show up

• What happens at day 3?What happens at day 3?

• Neutrophils peakNeutrophils peak

• T cells and Macrophages show upT cells and Macrophages show up

• Fibroblasts show upFibroblasts show up

• What happens in 1 month?What happens in 1 month?

• Fibroblast peakFibroblast peak

• What happens at 3-6 months?What happens at 3-6 months?

• Fibroblasts are goneFibroblasts are gone

What is the general CLUE for What is the general CLUE for any Lysosomal Storage any Lysosomal Storage Disease?Disease?

• Lysosomal Inclusion BodiesLysosomal Inclusion Bodies

What are the Lysosomal What are the Lysosomal Storage diseases?Storage diseases?• GauchersGauchers• FabrysFabrys• KrabbeKrabbe• Tay SachsTay Sachs• SandhoffsSandhoffs• HurlersHurlers• HuntersHunters• Neiman PickNeiman Pick• Metachromatic LeukodystropyMetachromatic Leukodystropy

What is missing in What is missing in Gauchers?Gauchers?• Beta-GlucocerberosidaseBeta-Glucocerberosidase

• What Accumulates?What Accumulates?• GlucocebrosideGlucocebroside

• Where?Where?• BrainBrain• LiverLiver• Bone MarrowBone Marrow• Spleen Spleen

What are the CLUES for What are the CLUES for Gauchers?Gauchers?

• Ask. JewAsk. Jew

• GargolsGargols

• Gaucher cellsGaucher cells– Macrophages looking like Crinkeled Macrophages looking like Crinkeled

paperpaper

• Erlin myoflask legsErlin myoflask legs

• PseudohypertrophyPseudohypertrophy

What is missing in Fabrys?What is missing in Fabrys?

• Alpha-galactosidaseAlpha-galactosidase

• What accumulates?What accumulates?

• Ceramide TrihexosideCeramide Trihexoside

What are the CLUES for What are the CLUES for Fabrys?Fabrys?

• X-Linked recessiveX-Linked recessive

• Presents with cataracts as a childPresents with cataracts as a child

• Presents with renal failure as a childPresents with renal failure as a child

What is missing in Krabbes?What is missing in Krabbes?

• Galactosylceramide B-GalactosidaseGalactosylceramide B-Galactosidase

• GalactocerebrosidaseGalactocerebrosidase

• Where?Where?

• BrainBrain

What are the CLUES for What are the CLUES for Krabbes?Krabbes?

• Early deathEarly death

• Globoid bodiesGloboid bodies– Fat cellsFat cells

What is missing in Tay What is missing in Tay Sachs?Sachs?

• Hexoseaminidase AHexoseaminidase A

• GM2 GangliosideGM2 Ganglioside

What is the CLUE for Tay What is the CLUE for Tay Sachs?Sachs?

• Ask. JewsAsk. Jews

• Cherry red maculaCherry red macula

• Death by 3Death by 3

What is missing in What is missing in Sandhoffs?Sandhoffs?

• Hexoseaminadase A & BHexoseaminadase A & B

What is missing in Hurlers?What is missing in Hurlers?

• IduronidaseIduronidase

What are the CLUES for What are the CLUES for Hurlers?Hurlers?

• Corneal CloudingCorneal Clouding

• Mental RetardationMental Retardation

What is missing in Hunters?What is missing in Hunters?

• Iduronate SulfataseIduronate Sulfatase

What are the CLUES for What are the CLUES for Hunters?Hunters?

• Mild mental retardationMild mental retardation

• No corneal cloudingNo corneal clouding

• Mild form of HurlersMild form of Hurlers

• X-linked recessiveX-linked recessive

What is missing in Niemann What is missing in Niemann Picks?Picks?

• SpingomyelinaseSpingomyelinase

• Spingomyelin Spingomyelin

• CholesterolCholesterol

What are the CLUES for What are the CLUES for Niemann Picks?Niemann Picks?

• Zebra bodiesZebra bodies

• Cherrry red maculaCherrry red macula

• Die by 3Die by 3

What is missing in What is missing in Metachromatic Metachromatic Leukodystrophy?Leukodystrophy?• Arylsulfatase AArylsulfatase A

What is the CLUE for What is the CLUE for Metachromatic Metachromatic Leukodystrophy?Leukodystrophy?• Visual DisturbanceVisual Disturbance

• Presents like MS in 5 to 10 years of Presents like MS in 5 to 10 years of ageage

What are the Glycogen Storage What are the Glycogen Storage Diseases?Diseases?

• Von GierkesVon Gierkes

• AndersonsAndersons

• CorysCorys

• McCardlesMcCardles

• PompesPompes

• HersHers

What is deficient in Von What is deficient in Von Gierkes?Gierkes?

• G-6-Pase Deficiency G-6-Pase Deficiency

What is the CLUE for Von What is the CLUE for Von Gierkes?Gierkes?

• Big LiverBig Liver

• Big KidneyBig Kidney

• Severe hypoglycemiaSevere hypoglycemia

• Can NEVER raise their blood sugarCan NEVER raise their blood sugar

What is deficient in What is deficient in Andersons?Andersons?

• Branching enzyme deficiency Branching enzyme deficiency

What is the CLUE for What is the CLUE for Andersons?Andersons?

• Glycogen will be ALL LONG chains on Glycogen will be ALL LONG chains on liver biopsyliver biopsy

What is missing in Corys?What is missing in Corys?

What is the CLUE for Corys?What is the CLUE for Corys?

• Glycogen from liver biopsy will be Glycogen from liver biopsy will be ALL SHORT branchesALL SHORT branches

What is missing in What is missing in McCardles?McCardles?

• Muscle phosporalase Muscle phosporalase

What is the CLUE for What is the CLUE for McCardles?McCardles?

• Severe muscle cramps when Severe muscle cramps when exercisingexercising

• High CPKHigh CPK

What is missing in Pompes?What is missing in Pompes?

• Cardiac alpha-1,4 glucocydaseCardiac alpha-1,4 glucocydase

What is the CLUE for What is the CLUE for Pompes?Pompes?

• Heart problemsHeart problems

• Die earlyDie early

What is missing in Hers?What is missing in Hers?

• Liver phosphoralaseLiver phosphoralase

What is the CLUE for Hers?What is the CLUE for Hers?

• Big LiverBig Liver

• NO big kidneyNO big kidney

Pagets disease is associated Pagets disease is associated with what cancer?with what cancer?

• Intraductal CaIntraductal Ca

What MUST you rule out with a What MUST you rule out with a decrease AVO2?decrease AVO2?

• AV FistulaAV Fistula

• VasodilationVasodilation

What diseases have a cherry What diseases have a cherry red macula?red macula?

• Tay SachsTay Sachs

• SandhoffsSandhoffs

• Niemann PickNiemann Pick

What is translocation 9;22?What is translocation 9;22?

• CMLCML

• Ewing’s sarcomaEwing’s sarcoma

• Burketts lymphomaBurketts lymphoma

• Follicular lymphomaFollicular lymphoma

What are the causes of What are the causes of restrictive cardiomyopathy?restrictive cardiomyopathy?

• SarcoidSarcoid

• AmyloidAmyloid

• HemochromatosisHemochromatosis

• CancerCancer

• FibrosisFibrosis

• Thanks STAN!!Thanks STAN!!

What are the CLUES for What are the CLUES for Vasulitis or Intravascular Vasulitis or Intravascular Hemolysis?Hemolysis?• ShistocytesShistocytes

– Burr cellsBurr cells– Helmet cellsHelmet cells

What is the CLUE for What is the CLUE for Extravascular Hemolysis?Extravascular Hemolysis?

• Splenomagely Splenomagely

Where is Glucose 6-Pase Where is Glucose 6-Pase present?present?

• AdrenalAdrenal

• LiverLiver

What is the Heinz body What is the Heinz body CLUE?CLUE?

• G6PDG6PD

If you see the CLUE basophilic If you see the CLUE basophilic stippling, what should you be stippling, what should you be thinking?thinking?

• Lead poisoningLead poisoning

What are the Microcytic What are the Microcytic Hypochromic Anemias?Hypochromic Anemias?

• Iron deficiencyIron deficiency

• Anemia of Chronic diseaseAnemia of Chronic disease

• Lead poisoningLead poisoning

• HemoglobinopathyHemoglobinopathy

• Thallasemia’sThallasemia’s

• Sideroblastic anemiaSideroblastic anemia

What is primary sideroblastic What is primary sideroblastic anemia due to?anemia due to?

• GeneticGenetic

• ADAD

What is secondary What is secondary Sideroblastic anemia due to?Sideroblastic anemia due to?

• Blood transfusionsBlood transfusions

What are the Microcytic What are the Microcytic Hyperchromic Anemia’s?Hyperchromic Anemia’s?

• Hereditary SpherocytosisHereditary Spherocytosis

What are the Normocytic What are the Normocytic Normochromic Anemia’s?Normochromic Anemia’s?

• Acute hemorrhageAcute hemorrhage

• Anemia of Chronic DiseaseAnemia of Chronic Disease

• Hypothyrodism Hypothyrodism – EarlyEarly

• Renal FailureRenal Failure

What are the Macrocytic What are the Macrocytic anemia’s?anemia’s?

• Folate deficiencyFolate deficiency

• B12 deficiencyB12 deficiency

• ReticulocytosisReticulocytosis

• ETOHETOH

• Hemolytic AnemiasHemolytic Anemias

• Chemo TreatmentChemo Treatment

• AnticonvulsantsAnticonvulsants

• MyelodysplasiaMyelodysplasia

What are the anticonvulsants What are the anticonvulsants causing a Macrocytic Anemia?causing a Macrocytic Anemia?

• EthusuximideEthusuximide

• CarbamyazapineCarbamyazapine

• ValproateValproate

What anemia is caused by What anemia is caused by blood transfusions?blood transfusions?

• Sideroblastic anemiaSideroblastic anemia

What is the problem if you see What is the problem if you see Eliptocytes?Eliptocytes?

• Something is wrong with the RBC Something is wrong with the RBC membranemembrane– ExtravascularExtravascular

• Heridatary EllitocytosisHeridatary Ellitocytosis

• Increased RET countIncreased RET count

What disease do you get if you What disease do you get if you have an EXCESS in Cu+?have an EXCESS in Cu+?

• Wilson’s DiseaseWilson’s Disease

What is the CLUE for Wilson’s What is the CLUE for Wilson’s Disease?Disease?

• Hepato/Lenticular DegenerationHepato/Lenticular Degeneration

• Kayser Fleishner RingsKayser Fleishner Rings– Copper in eyesCopper in eyes

• Hepato = LiverHepato = Liver

• Lenticular = Movement problemLenticular = Movement problem

What is Copper needed for?What is Copper needed for?

• Collagen synthesisCollagen synthesis

What disease manifest with What disease manifest with Cu+ deficiency?Cu+ deficiency?

• Minky Kinky Hair SyndromeMinky Kinky Hair Syndrome

What are the plasma What are the plasma catecholamines?catecholamines?

• EpinephrineEpinephrine

• NorepinephrineNorepinephrine

• DopamineDopamine

What are Plasma What are Plasma Catecholamines derived from?Catecholamines derived from?

A patient with episodic HTN leading to A patient with episodic HTN leading to headache with arrhythmias leading to headache with arrhythmias leading to palpitations most likely is diagnosed palpitations most likely is diagnosed with?with?

• Adrenal PheochromocytomaAdrenal Pheochromocytoma

What is the MOA for What is the MOA for Fluroquinolones?Fluroquinolones?

• Blocks DNA gyrase (topoisomerase II)Blocks DNA gyrase (topoisomerase II)

• Inhibits p450Inhibits p450

What do Fluroquinolones What do Fluroquinolones cover?cover?

• All Gram + including staph auerusAll Gram + including staph auerus

• All Gram –All Gram –

• AtypicalsAtypicals

What are the atypicals?What are the atypicals?

• ChlamydiaChlamydia

• UreoplasmaUreoplasma

What induces What induces Gluconeogensis?Gluconeogensis?

• CortisolCortisol

• EpinephrineEpinephrine

• GlucagonGlucagon

What is Dermatan Sulfate?What is Dermatan Sulfate?

• Glycosaminoglycan chain that helps Glycosaminoglycan chain that helps form proteoglycansform proteoglycans

What is Hyaluronic Acid?What is Hyaluronic Acid?

• Glycosaminoglycan chain that helps Glycosaminoglycan chain that helps form proteoglycansform proteoglycans

What is the MOA of What is the MOA of Methotrexate?Methotrexate?

• Inhibits dihydrofolate reductaseInhibits dihydrofolate reductase

• Inhibits DNA synthesis in the S phase Inhibits DNA synthesis in the S phase of cycle.of cycle.

• Prevents reduction of folic acid Prevents reduction of folic acid needed to produce THFneeded to produce THF

What are THF derivatives used What are THF derivatives used in?in?

• Purine nucleotide synthesisPurine nucleotide synthesis

• Methylation of dUMP to for dTMPMethylation of dUMP to for dTMP

What happens when What happens when Dihydrofolate Reductase is Dihydrofolate Reductase is inhibited?inhibited?• Obstructs one carbon methylation Obstructs one carbon methylation

which deprives DNA polymerase of which deprives DNA polymerase of essential substratesessential substrates

What diseases present as What diseases present as Failure to Thrive?Failure to Thrive?

• CFCF

• GalactosemiaGalactosemia

In general, what should you In general, what should you always associate Hemolytic always associate Hemolytic Anemia’s with?Anemia’s with?

• Defects in GlycolysisDefects in Glycolysis

• Defects in Hexose Monophosphate Defects in Hexose Monophosphate ShuntShunt

What is required for the What is required for the conversion of Homocysteine to conversion of Homocysteine to Methionine?Methionine?

• B12B12

What is required for the What is required for the conversion of methylmalonyl conversion of methylmalonyl CoA to Succinyl CoA?CoA to Succinyl CoA?

• B12B12

What is required for the What is required for the degradation of cystathionine?degradation of cystathionine?

• Vitamin B6Vitamin B6

What does the hydroxalation of What does the hydroxalation of Purines require?Purines require?

• Vitamin CVitamin C

When does the carboxyalation When does the carboxyalation of Glutamic acid occurs and of Glutamic acid occurs and what is required for this what is required for this carboxyalation?carboxyalation?

• Occurs in the synthesis of Blood Occurs in the synthesis of Blood Clotting factorsClotting factors

• Requires Vitamin KRequires Vitamin K

Decarboxylation of alpha-Decarboxylation of alpha-ketoacids requires what?ketoacids requires what?

• ThiamineThiamine

Synthesis of 1,25-d-Synthesis of 1,25-d-hydroxycholecalciferol requires hydroxycholecalciferol requires what?what?

• Vitamin DVitamin D

Synthesis of Rhodopsin Synthesis of Rhodopsin requires what?requires what?

• Vitamin AVitamin A

Pyruvate Decarboxylase Pyruvate Decarboxylase requires what as a cofactor?requires what as a cofactor?

• ThiamineThiamine

What is CN1?What is CN1?

• OlfactoryOlfactory• What is its function?What is its function?• Sensory for smellSensory for smell• What if lesioned?What if lesioned?• AnosmiaAnosmia• Where does it Exit/Enter the Cranium?Where does it Exit/Enter the Cranium?• Cribriform plateCribriform plate• What does it innervate?What does it innervate?• Nasal Cavity Nasal Cavity

• OpticOptic

• What is its function?What is its function?

• Sensory for sightSensory for sight

• What if lesioned?What if lesioned?

• Anopsia Anopsia – Visual field defectVisual field defect

• Loss of light reflex with CN IIILoss of light reflex with CN III

• Only nerve affected by MSOnly nerve affected by MS

Cont. CN2Cont. CN2

• Where does it Exit/Enter the Where does it Exit/Enter the Cranium?Cranium?

• Optic CanalOptic Canal

• What does it innervate?What does it innervate?

• OrbitOrbit

• OcculomotorOcculomotor

• What are the functions?What are the functions?

• MotorMotor

• Moves the eyeball in ALL directionsMoves the eyeball in ALL directions

• Adduction Most important action (MR)Adduction Most important action (MR)

• Constricts the pupil (Spincter Pupillae)Constricts the pupil (Spincter Pupillae)

• Accomodates (Cililary Muscle)Accomodates (Cililary Muscle)

• Raises eyelid (Levator Palpebrae)Raises eyelid (Levator Palpebrae)

Cont. CN 3Cont. CN 3

• DiplopiaDiplopia

• Loss of parallel gazeLoss of parallel gaze

• Dilated pupilDilated pupil

• Loss of light reflexLoss of light reflex

• Loss of near responseLoss of near response

• PtosisPtosis

• Superior Orbital FissureSuperior Orbital Fissure

• OrbitOrbit

What is CN 4?What is CN 4?

• TrochlearTrochlear

• MotorMotor

• Superior ObliqueSuperior Oblique

• Depresses and abducts the eyeballsDepresses and abducts the eyeballs

• IntortsIntorts

• Weakness looking down w/ adducted eyeWeakness looking down w/ adducted eye

• Trouble going down stairsTrouble going down stairs

• Head tilts away from lesioned sideHead tilts away from lesioned side

• Where does it Exit/Enter the Cranium?Where does it Exit/Enter the Cranium?

• Superior Orbital FissureSuperior Orbital Fissure

• OrbitOrbit

What is CN 5?What is CN 5?

• TrigeminalTrigeminal

What are the different What are the different branches of CN 5?branches of CN 5?

• V1?V1?

• OpthalmicOpthalmic

• V2?V2?

• MaxillaryMaxillary

• V3?V3?

• MandibularMandibular

What is the function of CN V1?What is the function of CN V1?

• MixedMixed• General sensation (touch, pain, temperature) of General sensation (touch, pain, temperature) of

the forehead, scalp, & corneathe forehead, scalp, & cornea

• What if lesioned?What if lesioned?• Loss of general sensation of the forehead/scalpLoss of general sensation of the forehead/scalp• Loss of blink reflex w/ VIILoss of blink reflex w/ VII

• Where does it Exit/Enter the Cranium?Where does it Exit/Enter the Cranium?• Superior orbital FissureSuperior orbital Fissure

– Ophthalmic divisionOphthalmic division

Cont. CN V1Cont. CN V1

• OrbitOrbit

• ScalpScalp

What is the function of CN What is the function of CN V2?V2?• MixedMixed

• General sensation of Palat, Nasal General sensation of Palat, Nasal cavity, Maxillary face, and Maxillary cavity, Maxillary face, and Maxillary teethteeth

• Loss of general sensation in skin over Loss of general sensation in skin over maxilla & maxillary teethmaxilla & maxillary teeth

• Foramen RotundumForamen Rotundum

• PterygopalatinePterygopalatine– Leaves by openings to face, oral & nasal Leaves by openings to face, oral & nasal

cavitycavity

What is the function of CN What is the function of CN V3?V3?• What is its function?What is its function?

• MixedMixed

• General sensation of anterior 2/3 of tongue, General sensation of anterior 2/3 of tongue, mandibular face & mandibular teethmandibular face & mandibular teeth

• MotorMotor

• Muscles of Mastication and anterior belly of Muscles of Mastication and anterior belly of digastric, mylohyoid, tensor tympani, digastric, mylohyoid, tensor tympani, tensor palatitensor palati

• Loss of general sensation in skin over Loss of general sensation in skin over mandible, mandibular teeth, tongue, mandible, mandibular teeth, tongue, weakness in chewingweakness in chewing

• Jaw deviation to weak sideJaw deviation to weak side

• Trigeminal neuralgiaTrigeminal neuralgia– Intractable pain in V2 or V3 territoryIntractable pain in V2 or V3 territory

• Foramen Ovale Foramen Ovale

• Infratemporal FossaInfratemporal Fossa

What is CN VI?What is CN VI?

• AbducensAbducens

• MotorMotor

• Lateral rectusLateral rectus– Abducts eyeAbducts eye

Cont. CN VICont. CN VI

• What if lesioned?What if lesioned?• DiplopiaDiplopia

– Internal strabismusInternal strabismus• Loss of parallel gazeLoss of parallel gaze

– PseudoptosisPseudoptosis

• Where does it Exit/Enter the Cranium?Where does it Exit/Enter the Cranium?• Superior orbital fissureSuperior orbital fissure

• What does it innervate?What does it innervate?• OrbitOrbit

What is CN VII?What is CN VII?

• FacialFacial• What is its function?What is its function?• MixedMixed• To muscles of facial expressionTo muscles of facial expression• Posterior belly of diagastricPosterior belly of diagastric• Stylohyoid & StapediusStylohyoid & Stapedius• Tastes anterior 2/3 of tongue/palateTastes anterior 2/3 of tongue/palate• Salivates (submandibular & sublingual glands)Salivates (submandibular & sublingual glands)• Tears (Lacrimal glands)Tears (Lacrimal glands)• Makes mucous (nasal & palatine glands)Makes mucous (nasal & palatine glands)

Cont. CN VIICont. CN VII

• What if lesioned?What if lesioned?• Corner of mouth droopsCorner of mouth droops• Can’t close eyeCan’t close eye• Can’t wrinkle foreheadCan’t wrinkle forehead• Loss of blink reflexLoss of blink reflex• HypeacusisHypeacusis• Loss or alteration of taste (ageusia)Loss or alteration of taste (ageusia)• Eye dry and redEye dry and red• Bell PalsyBell Palsy

– Lesion of nerve in facial canalLesion of nerve in facial canal

Cont. CN VIICont. CN VII

• Where does it Exit/Enter the Cranium?Where does it Exit/Enter the Cranium?• Internal Auditory meatusInternal Auditory meatus

• What does it innervate?What does it innervate?• FaceFace• Nasal & oral cavity Nasal & oral cavity

– Branches leave skull in stylomastoid Branches leave skull in stylomastoid foramen, petrotympanic fissure, or Hiatus of foramen, petrotympanic fissure, or Hiatus of facial canalfacial canal

What is CN VIII?What is CN VIII?

• VestibulocochlearVestibulocochlear

• SensorySensory

• HearsHears

• Linear acceleration (Gravity)Linear acceleration (Gravity)

• Angular acceleration (Head Turning)Angular acceleration (Head Turning)

Cont. CN VIIICont. CN VIII

• What if lesioned?What if lesioned?• Loss of BalanceLoss of Balance• NystagmusNystagmus

• Where does it Exit/Enter the Cranium?Where does it Exit/Enter the Cranium?• Internal Auditory MeatusInternal Auditory Meatus

• What does it innervate?What does it innervate?• Inner earInner ear

What is CN IX?What is CN IX?

• GlossopharyngealGlossopharyngeal

• MixedMixed

• Sense PharynxSense Pharynx

• Carotid sinus/bodyCarotid sinus/body

• Salivates (parotid glands)Salivates (parotid glands)

• Tastes and senses posterior 1/3 of tongueTastes and senses posterior 1/3 of tongue

Cont. CN IXCont. CN IX

• To one muscle only (stylopharyngeus)To one muscle only (stylopharyngeus)

• Loss of Gag Reflex with XLoss of Gag Reflex with X

• Jugular ForamenJugular Foramen

Cont. CN IXCont. CN IX

• NeckNeck

• Pharynx/TonguePharynx/Tongue

What is CN X?What is CN X?

• VagusVagus• What is its function?What is its function?• MixedMixed• To muscles of palate & pharynx for swallowing To muscles of palate & pharynx for swallowing

except tensor palate (V) & Stylopharynegeus (IX)except tensor palate (V) & Stylopharynegeus (IX)• To all muscles of Larynx (phonates)To all muscles of Larynx (phonates)• Senses Larynx & LaryngopharynxSenses Larynx & Laryngopharynx• Senses Larynx & GI tractSenses Larynx & GI tract• To GI tract smooth muscle & glands in forgut & To GI tract smooth muscle & glands in forgut &

midgutmidgut

Cont. CN XCont. CN X

• What if lesioned?What if lesioned?• Nasal speechNasal speech• Nasal regurgitationNasal regurgitation• DysphagiaDysphagia• Palate dropPalate drop• Uvula points away from pathologyUvula points away from pathology• Hoarseness/fixed vocal cordHoarseness/fixed vocal cord• Loss of gag reflex w/ IXLoss of gag reflex w/ IX• Loss of cough reflexLoss of cough reflex

• Jugular ForamenJugular Foramen

• NeckNeck

• Pharynx/LarynzPharynx/Larynz

• Thorax/AbdoThorax/Abdo

CN X – Sympathetics to CN X – Sympathetics to HeadHead

• MotorMotor

• Raises eyelid (superior tarsal muscle)Raises eyelid (superior tarsal muscle)

• Dilates pupilDilates pupil

• Innervates sweat glands of face & Innervates sweat glands of face & scalpscalp

• Constricts blood vessels in headConstricts blood vessels in head

• Horner syndromeHorner syndrome– Eyelid droop (ptosis)Eyelid droop (ptosis)– Constricted pupil (miosis)Constricted pupil (miosis)– Loss of sweating (anhydrosis)Loss of sweating (anhydrosis)– Flushed faceFlushed face

• Carotid canal on internal carotid arteryCarotid canal on internal carotid artery

• OrbitOrbit

• Face Face

• ScalpScalp

What is CN XI?What is CN XI?

• AccessoryAccessory

• Turns head to opposite sideTurns head to opposite side– sternocleidomastoidsternocleidomastoid

• Elevates & Rotates scapulaElevates & Rotates scapula– TrapeziusTrapezius

Cont. CN XICont. CN XI

• What if lesioned?What if lesioned?• Weakness turning head to opposite sideWeakness turning head to opposite side• Shoulder droopShoulder droop

• Where does it Exit/Enter the Cranium?Where does it Exit/Enter the Cranium?• Jugular ForamenJugular Foramen

• What does it innervate?What does it innervate?• NeckNeck

What is CN XII?What is CN XII?

• HypoglossalHypoglossal

• Moves tongueMoves tongue

• Tongue points toward pathology on Tongue points toward pathology on protrusionprotrusion

What is CN XII?What is CN XII?

• Hypoglossal CanalHypoglossal Canal

• TongueTongue

What are the muscles of What are the muscles of mastication?mastication?

• TemporalisTemporalis

• MasseterMasseter

• Medial PterygoidsMedial Pterygoids

• Lateral PterygoidsLateral Pterygoids

What part of the brain deals What part of the brain deals with problem solving?with problem solving?

• Frontal LobeFrontal Lobe

What happens if there is a What happens if there is a lesion to the Optic nerve?lesion to the Optic nerve?

• Unilateral BlindnessUnilateral Blindness

What happens if there is a What happens if there is a lesion to the Optic Chiasm?lesion to the Optic Chiasm?

• Bitemporal HemianopiaBitemporal Hemianopia

What is a Berry Aneurysm due What is a Berry Aneurysm due to in the Circle of Willis?to in the Circle of Willis?

• SUBARACHNOID Hemorrhage SUBARACHNOID Hemorrhage

What is a CLUE for What is a CLUE for SUBARACHNOID Hemorrhage?SUBARACHNOID Hemorrhage?

• The worse headache of my lifeThe worse headache of my life

What effect does Pernicious What effect does Pernicious Anemia have on the nervous Anemia have on the nervous system?system?

• Causes degeneration of the posterior Causes degeneration of the posterior columnscolumns

• Causes degeneration of the CSTCauses degeneration of the CST

• Loss of proprioceptionLoss of proprioception

• Upper motor neuron defectUpper motor neuron defect

What does the diencephalon What does the diencephalon originate from?originate from?

• ForebrainForebrain

What originates from the What originates from the Diencephalon?Diencephalon?

• ThalamusThalamus

• 33rdrd Ventricle Ventricle

Where does the Telencephalon Where does the Telencephalon originate from?originate from?

• Forebrain Forebrain – ProsencephalonProsencephalon

What originates from the What originates from the Telencephalon?Telencephalon?

• Cerebral HemispheresCerebral Hemispheres

• Lateral VentriclesLateral Ventricles

What originates from the What originates from the Mesencephalon?Mesencephalon?

• MidbrainMidbrain

• AqueductAqueduct

What originates from the What originates from the Hindbrain?Hindbrain?

• MetencephalonMetencephalon

• MyerencephalonMyerencephalon

What originates from the What originates from the Metencephalon?Metencephalon?

• PonsPons

• CerebrumCerebrum

What originates from the What originates from the Myerencephalon?Myerencephalon?

• MedullaMedulla

What does the Jugular Foramen What does the Jugular Foramen contain?contain?

• CN IXCN IX

• CN XCN X

• CN XICN XI

• Internal Jugular VeinInternal Jugular Vein

• Spinal accessory nervesSpinal accessory nerves

What does the Foramen What does the Foramen Spinosum contain?Spinosum contain?

• Middle menningeal arteryMiddle menningeal artery– Branch of the maxillary arteryBranch of the maxillary artery

What does the Foramen Ovale What does the Foramen Ovale contain?contain?

• CN V3CN V3

What does the Foramen What does the Foramen Magnum contain?Magnum contain?

• Vertebral arteriesVertebral arteries

• Brain stemBrain stem

• Spinal roots of CN XISpinal roots of CN XI

• Spinal cordSpinal cord

What does the Optic Canal What does the Optic Canal contain?contain?

• Opthalmic arteryOpthalmic artery

• Central retinal veinCentral retinal vein

• CN IICN II

What does the Hypoglossal What does the Hypoglossal Canal contain?Canal contain?

• CN XIICN XII

• Hypoglossal nerveHypoglossal nerve

What does the Carotid Canal What does the Carotid Canal contain?contain?

• Internal Carotid arteryInternal Carotid artery

What does the Posterior What does the Posterior Condylar Canal contain?Condylar Canal contain?

• Large Emissary VeinLarge Emissary Vein

What are signs of an UPPER What are signs of an UPPER motor neuron damage?motor neuron damage?

• + Babinski sign+ Babinski sign

• Spastic ParalysisSpastic Paralysis

• Hyperactive Deep Tendon ReflexesHyperactive Deep Tendon Reflexes

What are signs of a lower What are signs of a lower motor neuron defect?motor neuron defect?

• AtrophyAtrophy

• FasciullationsFasciullations

• Flaccid ParalysisFlaccid Paralysis

• Loss of deep tendon reflexesLoss of deep tendon reflexes

What does it mean to see a What does it mean to see a physis on radiograph?physis on radiograph?

• Means the skeleton is not fully Means the skeleton is not fully maturemature

When does Physis When does Physis disappear?disappear?

• Once growth is completeOnce growth is complete

What is a nonunion What is a nonunion fracture?fracture?

• Fracture that does not heal with in 6 Fracture that does not heal with in 6 monthsmonths

What does Malunion mean?What does Malunion mean?

• A fracture that heals in an Abnorman A fracture that heals in an Abnorman position position

What is a characteristic feature What is a characteristic feature of cancellous (spongy) bone?of cancellous (spongy) bone?

• TrabeculaeTrabeculae

Which CN’s control eye Which CN’s control eye movement?movement?

• CN IIICN III– Oculomotor nerveOculomotor nerve

• CN IVCN IV– Trochlear nerveTrochlear nerve

• CN VICN VI– Abducens nerveAbducens nerve

What CN is responsible for What CN is responsible for turning the head and turning the head and shrugging the shoulders?shrugging the shoulders?

• CN XICN XI– Accessory nerveAccessory nerve

What CN has sensory fibers for What CN has sensory fibers for Face and Motor fibers for Face and Motor fibers for muscles of mastication? muscles of mastication?

• CN VCN V– Tigeminal NerveTigeminal Nerve

What CN controls tongue What CN controls tongue movement?movement?

• CN XIICN XII– Hypoglossal nerveHypoglossal nerve

What CN controls sensory What CN controls sensory fibers for Visonfibers for Vison

• CN IICN II– Optic nerveOptic nerve

What CN senses fiber for What CN senses fiber for smelling?smelling?

• CN ICN I– OlfactoryOlfactory

What does the Mesenteric What does the Mesenteric Artery Supply?Artery Supply?

• Distal 1/3 of transverse colonDistal 1/3 of transverse colon

• Descending colonDescending colon

• Sigmoid colonSigmoid colon

• Upper Portion of RectumUpper Portion of Rectum

What does the Superior What does the Superior Mesenteric Artery Supply?Mesenteric Artery Supply?

• DuodenumDuodenum

• JejunumJejunum

• IleumIleum

• CecumCecum

• AppendixAppendix

• Ascending colonAscending colon

• Proximal 2/3 of transverse colonProximal 2/3 of transverse colon

What does the common Iliac What does the common Iliac artery supply?artery supply?

• PelvisPelvis

• PerineumPerineum

• LegLeg

What does the Celiac trunck What does the Celiac trunck give rise to?give rise to?

• Left gastric arteryLeft gastric artery

• Splenic arterySplenic artery

• Common hepatic arteryCommon hepatic artery

What do the Left. Gastric What do the Left. Gastric Artery, Splenic Artery, & Artery, Splenic Artery, & Common Hepatic artery Common Hepatic artery supply?supply?

• EsophagusaEsophagusa

• StomachStomach

• DuodenumDuodenum

• LiverLiver

• GallbladderGallbladder

• PancreasPancreas

If there is a lesion in the frontal If there is a lesion in the frontal lobe will you have motor or lobe will you have motor or sensory defects?sensory defects?

• MotorMotor

If patient has a visual field If patient has a visual field defect with cognitive defect with cognitive Distrubance, what part of the Distrubance, what part of the brain will be affected?brain will be affected?

• Temporal or Partial LobeTemporal or Partial Lobe

USMLE Step 1 clues 2- 800 slides

Health & Medicine

Transcript of USMLE Step 1 clues 2- 800 slides

Schedule Ahead your USMLE Step 2 CS Exam with Target USMLE

Notes on USMLE

USMLE biostats guide

USMLE - Viruses

David Usmle

USMLE 2020 DIRECTORY

Usmle Images

usmle Study Guide

Usmle Medical Biochemistry

Usmle fisiologia

Schedule of 2017 USMLE Step 2 CS Program CS Schedules.pdf · Step 2 CS Live + Practice Exam* Step 2 CS Practice Exam MEDICAL 1-800-KAP-TEST I kaplanmedical.com *USMLE is a joint program

Usmle Fast Facts

USMLE SOS Prep Night...Outline Prep Night USMLE examination (why, who and how) USMLE S.O.S. course (5- 7 July 2017) USMLE Step 1 examination USMLE Step 1 examination content High-yield

Farmacologia usmle

Patient Safety USMLE

wbc usmle questions

USMLE Stats

USMLE Bulletin

Usmle Ppt Hemato

CONTEXT CLUES CONTEXT CLUES Concept map WHAT ARE CONTEXT CLUES? Context Clues.