PASS PROGRAM CLUES - Webs · 6/21/2012 1 PASS PROGRAM CLUES “You ain’t told me squat till you...
Transcript of PASS PROGRAM CLUES - Webs · 6/21/2012 1 PASS PROGRAM CLUES “You ain’t told me squat till you...
www.karanja-githua.kbo.co.ke 6/21/2012
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PASS PROGRAMCLUES
“You ain’t told me squat till you tell me the CLUE!!!”
What are the 5 bacteria causing Heart Block?• Lyme Disease• Salmonella typhii (typhoid)• Chagas Disease (Whipple’s)• Legionella• Diptheria
• Lets Stop Doing Long Contractions
What bacteria cause Reiter’s Syndrome?
• Shigella• IBD
• Crohn’s
• Chlamydia• Yersina
• Reiter & Crohn Saw Yersina and got Chlamyia
What are the Low Complement bugs causing Cryoglobuniemia?• Influenzae• Adenovirus• Mycoplasma• Hepatitis C• EBV
• I AM HE
What are the drugs induced SLE?
• Hydralazine
• INH
• Phenytoin
• Procainamide
• Penicillamine
• Ethosuximide
• H I PPPE
What are the drugs that Blast the BM?
• AZT• Benzene• Chloramphenicol• Vinblastine
• Vinblastine Anilate Bone Cells
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What are the Comma Shaped bugs?• Vibrio• Campylobacter• Listeria• H. pylori
• Campylobacter Has Very Long Comma Genes
What is the cresent shaped protozoa?
• Giardia lamblia
What bacteria looks like Chinese letters?
• Corynebacter
What are the TB Rx?• Rifampin• Pyrazinamide• INH• Ethambutanol• Streptomycin
• R E S P I
What are the 6 Low Complement assocs. with Nephrotic Syndrome?• Serum Sickness• PSGN• SLE• SBE• Cryoglobinemia• MPGN II
What drugs Induce p450?
• BAG 4 CPR QTS• Car Grabs Queens Tets to
Rev Up • Alcoholic doing drugs and
stinking up car
• Barbiturates
• Alcohol
• Griseofulvin
• Carbamazapine
• Rifampin
• Quinidine
• Tetracycline
• Sulfa drugs
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What drugs Inhibit p450?
• I Do SMACK Quinolones
• INH
• Dapsone
• Spirolactones
• Macrolides
• Amiodarone
• Cimetidine
• Ketoconazole
• Quinilones
What drugs are P450 Dependent?
• Warfarin
• Estrogen
• Phenytoin
• Theophylline
• Digoxin
• Theo came from war & dig inside WDEPT taking Estrogen & now is Phenytoin
What disease is a Neutophil Deficiency?
• CGD
What is another name for CGD?• Chronic Granulomatous disease• NADPH Oxidase deficiency
What are the Side effects of Statins?• Myositis• Hepatitis• Increased liver enzymes
What are the painful genital Lesions?• Chancroid• Herpes• Lymphogranuloma inguinale
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What is the painful chancroid lesion due to?• Hemophilus ducreyi
What are the 4 hormones with disulfide bonds?• Prolactin • Insulin• Inhibin• GH
• I PIG on BONDS
What are the Hookworms?
• Necatur americanis
• Enterobius vermicularis
• Ankylostoma duodenale
• Trichuris trichurium
• Ascaris lumbercoides
• Strongyloides
• Hooks AS NEAT
What are the X-Linked enzyme Deficiencies?• G6-PD
• CGD
• Pyruvate dehydrogenase Def.
• Fabry’s
• Hunter’s
• Lesch-nyhan
• Lesch-Nyhan Hunter Puts Fabrys on G6 Clothes
What diseases do we screen for at birth?
• Please
• Check
• Before
• Going
• Home
• PKU
• CAH(Congential Adrenal Hyperplasia)
• Biotinidase
• Galactosemia
• Hypothyroidism
HLA-Antigens• HLA-DR2= Narcolepsy, Allergy, Goodpasture’s, MS
• HLA-DR3= DM, Chronic Active Hepatitis, Sjogren’s, SLE, Celiac Sprue
• HLA-DR3 & 4= IDDM(Type I)• HLA-DR4= Rheumatoid Arthritis, Pemphigus Vulgaris
• HLA-DR5= JRA, Pernicious Anemia• HLA-DR7= Nephrotic Syndrome(Steroid induced)
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HLA-Antigens• HLA-DR 3 & B8=Celiac Disease• HLA-A3= Hemochromatosis(chromo. 6, point mut.-cysteine>tyrosine)
• HLA-B8=MG• HLA-B13= Psoriasis• HLA-B27= Psoriais(only if w/arthritis) Ankylosing Spondylitis, IBD, Reiter’s, Postgonococcal Arthritis
• HLA-BW 47= 21 alpha Hydroxylas def.(Vit.D)
What are the actions of Steroids?• Kills helper T-cells & eosinophils• Inhibits Macrophage migration• Inhibits Mast cell degranulation• Inhibits Phospholipase A• Stimulates protein synthesis• Stablizes endothelium
What are the causes of Monocytosis? • Salmonella (typhoid)• TB• EBV• Listeria• Syphillis
E. Coli is the most common cause of what?• UTI• Spontaneous bacterial peritonitis • Abdominal abscess• Cholecystitis• Ascending cholangitis• Appendicitis
What are the one dose treatments for Gonorrhea?• Ceftriaxone• Cefixime• Cefoxine• Ciprofloxin• Oflaxacin• Gatifolxacin
What is the one dose treatment for Chlamydia?• Azithromycin
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What are the “Big Mama” anaerobes?
• Strep bovis• Clostridium melanogosepticus• Bacteriodes fragilis
What are the “Big Mama” Rx?• Clindamycin• Metranidazole• Cefoxitin
What “big mama” bugs are associated with colon cancer?• Strep. Bovis• Clostridium melanogosepticus
What do you see in the serum with low volume state?• K+?• Decreases
• Na+?• Decreases
• Cl-?• Decreases
• pH?• Increases
• BP?• Increases
What are psammoma bodies?• Calcified CA’s
In what diseases are Psammoa Bodies present?• Papillary carcinoma of the Thyroid• Serous cystadenocarcinoma of the ovary• Meningioma• Mesothelioma
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What are the Urease (+) Bacteria?• Proteus• Pseudomonas• Ureaplasma urealyticum• Nocardia species• Cryptococcus neoformans• H. pylori
What types of stones are formed from Proteus?• Struvite (90%)
What type of motility do Proteus have?
• swarming
What are 5 indications of Surgery?• Intractable pain• Hemorrhage (massive)• Obstruction (from scarring)• Perforation
What drugs cause Cardiac Fibrosis?• Adriamycin (Doxyrubicin)• Phen-fen
What drug is used to tx cardiac fibrosis?
• Dozaroxsin
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What is the MCC of any ….penia?• #1 = Virus• #2 = Drugs
What is seen in the Salmonella Triad?
• High Fever• Rose spots (rash)• Intestinal fire
What drugs cause Myositis?• Rifampin• INH• Predinsone• Statins
What are the 7 Gram -encapsulated bacteria?• Some• Strange• Killers• Have• Pretty • Nice• Capsules
• Salmonella
• Strep. Pneumo (gr+)
• Klebsiella
• H. influenza
• Pseudomonas
• Neisseria
• Cryptococcus
What is the Jones Criteria for Rheumatic Fever?• SubQ nodules• Polyarthritis• Erythema marginatum• Carditis• Chorea
What are the causes of Eosinophilla? • Neoplasms• Allergies/Asthma• Addison’s Dz• Collagen Vascular Dz• Parasites
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What are the Risk Factors for Liver CA?
• Hep B,C,D• Aflatoxin• Vinyl chloride• Ethanol• Carbon Tetrachloride• Anyline Dyes• Smoking• Hemochromatosis• Benzene• Schistomiasis
What are the 9 Live Vaccines?• Measles• Mumps• Rubella• Oral Polio (sabin)• Rotavirus• Small pox• BCG• Yellow fever• Varicella
What are the Killed Vaccines?
• SIR Hep A • Salk (polio)
• Influenza
• Rubella
• Hepatitis A
What are the IgA Nephropathies?• Henoch-Schoenlein P. (HSP)• Alport’s• Berger’s
What are the Drugs that cause Autoimmune hemolytic anemia?• PCN
• α-methyldopa
• Cephalosporins
• Sulfa
• PTU
• Anti-malarials
• Dapsone
What are the drugs that cause Autoimmune thrombocytopenia?• ASA• Heparin• Quinidine
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What are the enzymes that show after an MI?• Troponin I• CKMB• LDH
What is the first MI enzyme to appear?
• Troponin I
• Appears
• Peaks
• Gone
• 2 hrs
• 2 days
• 7 days
What is the 2nd MI enzyme to appear?
• CK-MB
• Appears
• Peaks
• Gone
• 6 hrs
• 12 hrs
• 24 hrs
What is the 3rd MI enzyme to appear?
• LDH
• Appears
• Peaks
• Gone
• 1 day
• 2 days
• 3 days
What bacteria have Silver Stains?• Legionella• Pneumocysitis carinii• H. pylori• Bartonella henseslae (lymph node)• Candida (yeast)
What are the sulfa containing drugs?• Sulfonamides• Sulfonylurea• Celebrex
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What is another name for celebrex?• Celecoxib
What type of inhibitor is Celebrex?• COX 2 specific
What COX-2 specific drug can you give to a pt with sulfa allergy?• Vioxx (Rofecoxib)
What drugs inhibit dihydrofolate reductase?• Pyremethamin/Sulfadiazine• Trimethoprim/Sulfamethoxazole
What drugs cause Pulmonary Fibrosis?
• Bleomycin• Bulsufan• Amiodarone• Tocainide
What are the macrophage deficiency diseases?• Chediak-Higashi• NADPH-oxidase deficiency
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What are the SE of Loops and Thiazides?
• Hyperglycemia• Hyperuricemia• Hypovolemia• Hypokalemia
What are the SE of Loop diuretics?
• OH DANG • Ototoxicity
• Hypokalemia
• Dehydration
• Allergy
• Nephritis (interstitial)
• Gout
What are the only 3 Pansystolic Murmurs and when are they heard?• MR
• TR
• VSD
• Decrease on inspiration (^exp)
• Increase on inspiration
• Decrease on inspiration (^exp)
Macrophages in various organs• Brain• Lung• Liver• Spleen• Kidney• Lymph nodes• Skin• Bone• CT
• Mircoglia• Type I pneumocyte• Kupffer cell• RES• Mesangial• Dendritic• Langerhans• Osteoclasts• Histiocytes or• Giant cells or • Epithelioid cells
What are the 7 Rashes of the Palms & Soles?• TSS• Rocky Mountain Spotted Fever• Coxsackie A (Hand/Foot & mouth dz)• Kawasaki• Syphillis• Scarlet Fever• Staph Scalded Skin Syndrome
What is seen in every restrictive lung dz and low volume state?• Tachypnea• Decrease pCO2• Decrease pO2• Increase pH
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What are the different 2nd messenger systems?• cAMP• cGMP• IP3/DAG• Ca:Calmodulin• Ca+• Tyrosine kinase• NO
What is the clue for cAMP?• It is the 90%• Sympathetic• CRH (cortisol)• Catabolic
What is the clue for cGMP?• Parasympathetic• Anabolic
What are the clues for IP3/DAG?• Neurotransmitter• GHRH• All hypothalamic hormones xc cortisol• Used by what and for what?• Smooth muscle for contraction
What is the clue for Ca:Calmodulin?• Used by smooth muscle for contraction by distention
What is the clue for Ca+?• Used by Gastrin only
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What is the clue for Tyrosine Kinase?• Used by Insulins• Used by ALL growth factors
What is the clue for NO?• Nitrates• Viagra• ANP• LPS
What are the T & B cell deficiencies?
• WAS • SCID• CVID• HIV• HTLV-1
What are the CLUES for WAS?• Thrombocytopenia• IL-4• Infection• Eczema• Decrease IgM• IgE???
What are the CLUES for SCID?• Framshift/Nonsense mutation• Adenosine deaminase deficiency• T-cell>B-cell• Bacterial infections• Fungal infections
What are the CLUES for CVID?• Late onset• Frameshift/Missense mutation• Tyrosine Kinase deficiency
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What are the CLUES for HIV & HTLV-1?
• T-cell>B-cell• CD4 rich• Brain• Testicles• Cervix• Blood vessels
What are the inhibitors of Complex 1 of the ETC?• Amytal• Rotenone
What are the inhibitors of Complex 2 of the ETC?• Malonate
What are the inhibitors of Complex 3 of the ETC?• Antimycin D
What are the inhibitors of Complex 4 of the ETC?• CN-• CO• Chloramphenicol
What are the inhibitors of Complex 5 of the ETC?• Oligomycin
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What are the ETC chemical uncouplers?
• DNP• Free Fatty acids• Aspirin
What type of uncoupler is Aspirin?• Physical uncoupler
What are the 4 sources of Renal Acid?
• Plasma• Urea cycle• Collecting ducts• Glutaminase
What is the one dose tx for Hemophilus ducreyi?• Azithromycin
1 gram po• Ceftriazone
250 mg im
What is the one dose tx for Chlaymdia?
• Azithromycin1 gram po
What is the one dose tx for Candidiasis?
• Ketoconazole150mg
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What is the one dose tx for Vaginal Candidiasis?• Difluccan
1 pill
What is the one dose tx for Trichomonas?
• Metronidazole2 grams
What is the one dose tx for Gardnerella?
• Metronidazole2 grams
What are the 3 cephalosporins & doses used as one dose treatments for Gonorrhea?• Ceftriaxone
250 mg im• Cefixime
400 mg po• Cefoxitin
400 mg po
What are the 3 Quinolones & doses used as one dose treatments for Gonorrhea?• Ciprofloxacin
500 mg po• Ofloxacin
400 mg po• Gatifloxacin
400 mg im
What are the 4 enzymes needed to break down glycogen?• Phosphorylase (Pi)• Debranching enzyme• Alpha-1,6 –Glucosidase• Phosphatase
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What are the 2 enzymes needed to make glycogen?• Glycogen synthase• Branching enzyme
What are the branching enzymes?• Glycogen alpha-1,4 glycosyl transferase• Glycogen alpha-1,6 glycosyl transferase
What is the rate limiting enzyme in the break down of glycogen?• Phosphorylase (Pi)
What values do you see in obstructive pulmonary dz?• pO2?
Normal• pCO2?
Normal or increased• pH?
Decreased
What values do you see in restrictive pulmonary dz?• pO2?
Decreased • pCO2?
Decreased • pH?
Increased
What type of acidosis do you see with obstructive pulmonary dz?• Respiratory acidosis
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What are the Lysosomal Storage Disease & what is the deficiency?
• Fabry’s• Krabbe’s• Gaucher’s• Niemann – Pick• Tay-Sachs• Metachromatic
leukodystrophy• Hurler’s• Hunter’s
• α – galactosidase• Galactosylceramide• β – glucocerebrosidase• Sphingomyelinase• Hexosaminidase• Arylsulfatase• α – L – iduronidase• Iduronidase sulfatase
What dz’s are associated with HLA B27?
• Psoriasis• Ankylosing spondylitis• IBD (Ulcerative colitis)• Reiter’s Syndrome
What HLA is Psorisis w/RA associated with?• HLA-13
What are the Glycogen Storage Diseases & the deficiency?
• Von Gierke’s
• Pompe’s
• Cori’s
• McArdle’s
• Glucose – 6 – phosphate
• α – 1 – 4 glucosidase
• Debranching enzyme
• Glycogen phosphorylase
What are 6 places of the TCA cycle where amino acids feed in/out?• Pyruvate?• Glycine• Alanine• Serine
• Acetyl CoA ? • Phenylalanine• Isoleucine• Threonine• Tryptophan• Lysine• Leucine
What are 6 places of the TCA cycle where amino acids feed in/out?
• Alpha-KG ?
• Glutamate
• Glutamine
• Succinyl CoA?• Phenylalanine
• Tryptophan
• Tyrosine
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What are 6 places of the TCA cycle where amino acids feed in/out?
• Fumerate ?• Proline
• Oxaloacetate?• Aspartate• Asparigine
What are the 4 steps of B-oxidation?
• Oxidation – 7 NADH – 21 ATP• Hydration• Oxidation - 7FADH – 14 ATP• Thiolysis – 8 AcCoA – 96ATP
131 ATP – 2 (to bring it in)
What are the blood gases in neuromuscular disease (= restrictive blood gases)?• pO2?
Decreased• pCO2?
Decreased• PCWP?
Decreased (b/c it’s a pressure problem)
• Respiratory Rate?Increased
• pH?Increased
• SZ?Increased
What are 5 Hormones produced by small cell (oat cell) lung CA?• ACTH• ADH• PTH• TSH• ANP
What Autoimmune Disease has the following Autoimmune Antibodies?
•Anti-smith •Anti cardiolipin •Anti-ds DNA
•SLE
What Autoimmune Disease has the following Autoimmune Antibodies?• Anti – histone?
• Drug induced SLE
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What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-topoisomerase?
• PSS (Progressive Systemic Sclerosis)
What Autoimmune Disease has the following Autoimmune Antibodies?• Anti TSH receptors?
• Graves
What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-centromere?
• CREST
What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-GBM?
• Goodpasture’s
What does Goodpastures have antibody to?• Type IV collagen
What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-mitochondria?
• Primary biliary cirrhosis
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What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-hair follicle?
• Alopecia areata
What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-IgG?
• Rheumatoid arthritis
What Autoimmune Disease has the following Autoimmune Antibodies?
• Anti-myelin receptors?
• MS
What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-gliaden?• Anti-gluten?
• Celiac sprue
What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-islet cell receptor?
• DM Type I
What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-melanocyte?
• Viteligo
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What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-ACh receptor?
• MG
What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-ribonuclear protein?
• Mixed Connective Tissue dz (MCTD)
What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-parietal cell receptor?
• Pernicious anemia
What does Pernicious Anemia have antibody to?• Intrinsic factor
What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-epidermal anchoring protein receptors?
• Pemphigus vulgaris
What does Pemphigus vulgaris have antibody to?• Intercelluar junctions of epidermal cells
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What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-epidermal basement membrane protein?
• Bullous pemphigoid
What do you see with bullous pemphigoid?• IgG sub-epidermal blisters•Oral blisters
What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-platelet?
• ITP
What does ITP have antibody to?• Glycoprotein IIb/IIIa
What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-thyroglobulin?• Anti-microsomal?
• Hashimoto’s
What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-smooth muscle?• Anti-scl-70?
• Scleroderma
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What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-rho (SS-A)?• Anti-la?
• Sjogren’s
What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-proteinase?• C-ANCA?
• Wegener’s
What Autoimmune Disease has the following Autoimmune Antibodies?• P-ANCA?
• Polyarteritis nodosa
What antigen & immunoglobulin is Polyarteritis nodosa associated with?
•Hepatitis B antigen•IgM
What are the viruses that directly cause CA and which CA do they cause?• Papilloma virus ?Cervical CA
• EBV?BurkittsNasopharyngeal CA
• HepB & C ?Liver CA
• HIV? Kaposi’s Sarcoma
What are the 7 Nephrotic Patterns seen with every Vasculitis?• Clot in front of renal artery?
Renal artery stenosis • Clot off whole renal artery?
Renal failure• Inflamed glomeruli?
Glumerulo nephritis• Clot in papilla?
Papillary necrosis • Clot off medulla?
Interstitial nephritis • Clot off pieces of nephron?
Focal segmental GN (HIV, drug use association)• Clot off lots of nephrons?
Rapidly Progressive GN
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What is the most common nephrotic disease seen in kids and when does it occur?•Min. change disease
•2 wks post URI
What is the most common vasculitity leading to rapidly progressive glomerulonephrosis?• Goodpasture’s
What is the most common malignant renal tumor in children?• Wilm’s tumor
What is the most common malignant renal tumor in adults?• Adenocarcinoma
What is the most common renal mass?
• Cyst
What is the most common renal disease in Blacks/Hispanics?• Focal Segmental GN
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What is the most common nephrotic disease in adults?• Membranous GN
Thrombolytics & Inhibitors• What does tPA, Streptokinase, Urokinase inhibit?• Aminocaproic acid• What doe Warfarin inhibit? • Vitamin K• What does Heparin inhibit? • Protamine Sulfate
What is the dosage of tPA?• IV push?• 20mg
• Drip?• 40mg
What is the dosage for Streptokinase?
• IV push?• 750K
• Drip?• 750K
What is Urokinase used for?• Used ONLY for such things as:• Feeding tubes• Central lines• Fistulas
What is Alopecia Areata?• Loss of a patch of hair
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What is Alopecia Totalis?• Loss of ALL hair on head “bald”
What is Alopecia Universalis?• Loss of hair on entire body “hairless”
What is Loffler syndrome?• Pneumonitis with endocarditis = pulmonary infiltrate with
severe eosinophilia
What is Loffler syndrome also known as?
• PIE syndrome
What are the 5 Parasites associated with Loffler Syndrome?•Necator americanus•Ankylostoma duodenale
•Shistosomiasis•Strongyloides
•Ascaris lumbricoides
What happens when a patient is on prednisone for > 7 days?
•Immunocompromised
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What are 2 enzymes used by B12?• Homocystine methyl transferase• Methyl malonyl-coA mutase
What does Mitochondrial inheritance mean?• No male transmission• All females pass it on
Who are 4 pt’s who would be susceptable to pseudomonas and staph infxns?•Burn patients•Cystic fibrosis
•DM•Neutropenic patients
In a neutropenic patient, what do you cover for?• cover 1x for Staph aureus during 1st week• cover 2x for Pseudo after 2nd week
What are the 3 main concepts causing a widened S2 splitting?• Increased pO2 • Delayed opening/closing of the pulmonary value• Increased volume in the right ventricle
What are causes for a widened S2 splitting?
• Blood transfusion• Increased Tidal Volume• Giving O2• Right sided heart failure• Pregnancy due to increase volume• IV fluids• ASD/VSD• Deep breathing• Hypernateremia• SIADH• Pulmonary regurge• Pulmonary stenosis• Right bundle branch block
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What are the 8 common cavities of blood loss?• Pericardium• Intracranial • Mediastinum• Pleural cavity• Thighs• Retroperitoneum• Abdominal cavity• Pelvis
What is the special list for Penicillin?
• Gram +
• Basement membrane suppressor
• Works on simple anaerobes
• The #1 cause of anaphylaxis
• Causes interstial nepritits
• Causes nonspecific rashes
• Acts as a hapten causing hemolytic anemia
What is the #1 cause of anaphylaxis?• Penicillin
What are the Chron’s Gifts?• Granuloma• Ileum• Fistula• Transmural• Skip Lesion
What are the negative-stranded RNA Clues?• Prodromal period before symptoms = 1-3 weeks• Why is there a prodromal period?• Because must switch to positive stranded before
replication
What are the clues for positive stranded RNA?• Symptoms within 1 week or less • EXCEPTIONS: • Hanta• Ebola• Yellow fever• They are -ve stranded = don’t have to switch to positive before replicating
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What are the Most common cyanotic heart diseases?• Transposition of the great arteries• Tetrology of Fallot• Truncus Arteriosus• Tricuspid Atresia• Total anomalous pulmunary Venous Return
• Hypoplastic Left heart syndrome• Ebstein’s anomaly• Aortic atresia• Pulmonary atresia
What cyanotic heart disease is – boot shaped?• Tetrology of Fallot
What cyanotic heart disease is associated with mom taking lithium during pregnancy?• Ebstein’s Anomaly
What things make the membrane less likely to depolarize?• Hypokalemia• Hypermagnesemia• Hypercalcemia (except atrium)• Hypernatremia
What things make the membrane more likely to depolarize?• Hyperkalemia• Hypomagnasemia• Hypocalcemia (except atrium)• Hyponatremia
What is Plan F?• TPP – Thiamin – B1• Lipoic Acid – B4• CoA – Pantothenic acid – B5• FAD – Riboflavin – B2• NAD – Niacin – B3
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What are the 8 x-linked inherited diseases?• Bruton’s Agammaglobulinemia• CGD (NADPH def)• DMD• Color Blindness• G6PD• Hemophilia• Lesch-Nyhan• Vit D resist. Rickets (X-linked dominant)• Fabrys• Hunters
What are the 7 B-cell deficiencies?• Bruton’s agammaglobulinemia• CVID (Common Variant Imm. Def)• Leukemias• Lymphomas• SCID• WAS• Job Buckley Syndrome
What is the Tyrosine kinase deficiency?
• Bruton’s agammaglobulinemia
What are the B-cell deficiencies with T-cell overlap?• SCID• WAS• Job Buckley Syndrome
What are the 4 itchiest rashes?• Scabies• Lichen Planus• Urticaria• Dermatitis Herpetiformis
Tumor Markers/Oncongenes I• L-myc?• Small cell lung Ca
• C-myc?• Promyelocytic leukemia (Burkitt’s lymphoma)
• N-myc?• Neuroblastoma • Small cell lung CA
• C-able?• CML • ALL
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Tumor Markers/Oncongenes II• C-myb?• Colon CA• AML
• C-sis ?• Osteosarcoma• Glioma • Fibrosarcoma
Tumor Markers/Oncongenes III
• C-erb B2?• Epidermal growth factor receptors
• CSF-1 ?• Breast
Tumor Markers/Oncongenes IV
• Erb-B2?• Breast CA• Ovarian CA• Gastric CA
• Ret?• Medullary CA of thyroid• Men II & III• Papillary carcinoma
Tumor Markers/Oncongenes V• Ki-ras?• Lung CA• Colon CA
• Bcl-2?• Burkitts• Follicular lymphoma
• Erb?• Retinoblastoma
What are 6 Hormones produced by the placenta?• hCG• Inhibin• Human placental lactogen (HPL)• Oxytocin (drug lactation, pit gland prod it also)• Progesterone• Estrogen• Relaxin
What is cancer grading?• Severity of microscopic change• Degree of differentiation
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What is cancer staging?• Degree of dissemination of tumor• What the surgeon sees
What are the rashes associated with cancer and what cancer are they associated with?• Urticaria/Hives?• Any CA, especially lymphoma• Pagets Ds (ulcers around nipples)
• Seborrheic keratosis (waxy warts)?• Colon CA • HIV if sudden increase in number • Normal with aging
What are the rashes associated with cancer and what cancer are they associated with?
• Actinic keratosis?• Dry scaly plaques on sun-exposed skin
• Squamous Cell CA of skin
• Dermatomyositis?• violacious, heliotropic rash, malar area
• Colon CA
What are the rashes associated with Cancer and the cancer they are associated with?• Akanthosis nigricans?
• dark lines in skin folds• Any visceral CA• End organ damage
• Erythema nodosum?• ant aspect of legs, tender nodules
• Anything granulomatous• NOT assoc. w/ bacteria
What is carried by HDL?• Apo E• Apo A• Apo CII
• L-CAT • lecithin cholesterol acetyl transferase
• Cholesterol• from periphery to liver
What is carried by VLDL?
• Apo B-100
• Apo E
• Apo C II
• Triglcyerides (95%)
• Cholesterol (5%)
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What is carried by IDL?• Apo B-100• Apo E• Apo CII
• Triglycerides (< VLDL)• Cholesterol (>VLDL)
What is carried by LDL?• Apo B-100
• Cholesterol• from liver to tissue
• NOT a good thing!!!!!
What do chylomicrons carry?• Apo A• Apo B-48• Apo E• Apo C II
• Triglycerides from:• GI to liver (25% of the time)• GI to endothelium (75% of the time)
Which lipoprotein carries the most cholesterol?
•LDL
Where are the AVMs?• Clue = HEAL• Heart?• Machinery murmur
• Elbow?• Fistula from dialysis in renal disease
• Abdomen/Brain?• Von Hippel-Lindau = clot off with coils• Increase incidence of Renal cell CA on chrom 3
• Lungs?• Osler Weber Rendu Syndrome
What is the Ranson’s criteria for acute pancreatitis (at admission )?• Glucose > 200• Age > 55• LDH >350• AST > 250• WBC > 16,000
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What is the Ranson’s criteria for acute pancreatitis (at less than 48 hrs)?• Calcium <8 mg/dl• HCT drop > 10%• O2 < 60 (PaO2)• Base deficit > 4• BUN > 5 mg/dl• Sequestration > 6L
What 2 diseases is pilocarpine used for?• CF• Glaucoma
• Painful, red, teary eye
What is dysguzia?• Problem with sense of taste
What are 3 causes of dysgusia?• Metronidazole• Clarithromycin• Zinc deficiency
What is the triad of Carcinoid syndrome?• Flushing• Wheezing • diarrhea
What do you measure for carcinoid syndrome?• Serotonin
• 5-HIAA
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Where are the 2 most common places a carcinoid tumor is found?• Pancreas• Ileum
What are the phage mediated toxins?• Mnemonic : BEDS• Botulinum• Erythrogenic toxin
• from strep pyogenes
• Diptheria• Salmonella
• Has O antigen
What is the story used to remember the segmented RNA viruses?• I sprayed ORTHO on my BUNYA at the ARENA down in
REO to kill SEGMENTED WORMS
Name the 3 major types of adhesion molecules• ICAMs• Integrins• Selectins
What does IgCam do?• Bind proteins
What do integrins do?• Stop the leukocytes
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What do selectins do?• Bind carbohydrates• Mediate the rolling to slow leukocytes down
What are the functions of adhesion molecules?• Homing of lymphocytes
• tells lymphocytes where to go
• Inflammation• Cell-cell interaction
Primary allergic response is due to what?•Contact
What cells are present in the first 3 days?• Neutrophils
• The next cells to show up are?• B-cells
• What do B-cells make?• IgM
What day does IgM show up? • Three
• IgM peaks at what day?• 14
• When does IgM leave?• In 2 months
What shows up in 2 wks (14 days)?• IgG
• When does IgG peak?• In 2 months
• When does IgG leave?• In 1 year
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What is Secondary Allergic response is due to?• MEMORY
What shows up at day 3?
• IgG with 5x concentration
• Has the highest affinity
• When does IgG peak?
• In 5 years
• When does IgG leave?
• In 10 years
What Ig has the hightest affinity?• IgG
What are the risk factors for Esophageal/Gastric CA?• Smoking• Alcohol• Nitrites• Japanese
What are the risk factors for bladder CA?• Smoking • Aniline dyes• Benzene• Aflatoxin• Cyclophosphamide• Schistosomiasis• 2 diseases:• Von Hippel-Lindau• Tubular sclerosis
What is the NBT test?• Nitro Blue Tetrazolium test• What is it used for?• Screening CGD• What does a –ve test indicate?• +ve for the disease
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What disease corresponds with the following inclusion bodies?• Howell-Jolly?• Sickle cell
• Heinz?• G-6-P-D
• Zebra?• Niemann pick
What disease corresponds with the following inclusion bodies?• Donovan? • Leishmaniasis
• Mallory?• Alcoholism
• Negri?• Rabies
What disease corresponds with the following inclusion bodies?• Councilman?• Yellow fever
• Call-exner?• Ovarian tumors
• granulosa origin
What disease corresponds with the following inclusion bodies?• Lewy?• Parkinsons
• Pick?
• Pick’s disease
• Barr body?
• Normal female
What disease corresponds with the following inclusion bodies?• Aschoff?
• Rheumatic fever
• Cowdry type A inclusions?
• Herpes virus
• Auer rods?
• AML
What disease corresponds with the following inclusion bodies?• Globoid?• Krabbe’s lysosomal storage disease
• Russell? • Multiple myeloma
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What disease corresponds with the following inclusion bodies?• Schiller-Duvall?• Yolk sac tumor
• Basal bodies?• Only found in smooth mm
What are the 4 types of hypersensitivities?• Mnemonic?• ACID
• Type I• Anaphylaxis/Atopic
• Type II• Cytotoxic (Humoral)
• Type III• Immune complex mediation
• Type IV• Delayed hypersensitivity/Cell mediated
What are the Characteristics of Type I hypersensitivity?• Atopic• IgE (Asthma) binds to mast cell• IgA activates IP3 cascade degrading mast cells
What are the Characteristics of Type II hypersensitivity?• Humoral• What are examples of type II?• Rh disease• Goodpastures• Autoimmune hemolytic Anemia• All Autoimmune diseases
• except RA and SLE
What are the Characteristics of Type III hypersensitivity?• Ag-Ab complement• What are examples of Type III?• RA• SLE• Vasculitides• Some GN?
What are the Characteristics of Type IV hypersensitivity?• Cell mediated• What are examples of Type IV?• TB skin test• Contact dermatitis• Transplant rejection
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What structures have no known function?• Appendix• Epithalamus• Palmaris longus
• muscle
• Pancreatic polypeptide • hormones in F-cells
What diseases can progress to RPGN?• Goodpastures• Wegeners• DM• HTN
What are causes of papillary necrosis?• Vasculitis• AIDS
Cytic fibrosis Questions?• Tx?• Pilocarpine • also used for glaucoma
• Test used to detect CF?• Pilocarpine sweat test
• What ion does this test measure?• Cl-
• Definitive presence of disease has a test value of what?• >60
Cytic fibrosis Questions?• What is the value in a normal person?• <20
• What is the value in a heterozygous person?• 30 – 60
• What chromosome is the CF gene on?• Chrom 7
• What Second messenger is used?• IP3/DAG
What are the gram +ve spore formers?• Bacillus anthracis• Clostridium perfringens• Clostridium tetani• Clostridium melangosepticus
• What is the chemical in spores?• Calcium dipocholinate
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What does strep mutans ferment?• Lactic acid
What type of receptors do all sphincters in the body have?• Alpha-receptors
Strep. Salivarius ag is used for what test?• Cold agglutinin testing
• IgM
Types of amyloid found in various Systemic amyloidoses:• AA amyloid?• Chronic active disease
• AL amyloid from Ig light chain?• Myeloma
Types of amyloid found in various Systemic amyloidoses:• Beta 2 microglobulin?• Chronic hemodialysis
• AA amyloid from SAA?• Nephrotic hereditary forms
• eg. Mediterranean fever
Types of amyloid found in various Systemic amyloidoses:• Pre-albumin/transthyretin?• Cardiomyopathic hereditary forms
• senile systemic amyloidosis
• Neuropathic hereditary syndromes
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Types of amyloid found in various Local amyloidoses:• ANP fibrils are caused by?• Senile cardiac amyloisosis
• Cerebral amyloid in Alzheimer’s disease/Down’s?• Cerebral amyloidosis
Types of amyloid found in various Local amyloidoses:• Calcitonin precursors?• Medullary CA of thyroid
• AL from light chains?• Isolated, massive, nodular deposits
• lung, skin, urogenital tract
What type of dementia do you get in Pick’s dis?• Frontotemporal dementia
Describe Pick’s disease• Atrophy of frontal and temporal cortex with sparing of
remaining neocortical regions
What 3 things do Pick bodies contain?• Altered neurofilaments• Tau protein• ubiquitin
What drugs can cause a disulfiram reaction?• Mnemonic?• CLAM
• Chloramphenicol• Lactams
• Cefamandole• Cefoperazone
• Antabuse• disulfiram
• Metronidazole
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What is the mode of action of the Clostridium botulinum toxin?• Prevents pre-synaptic release of Ach
• How do babies get it?• From spores in honey or molasses
• How do adults get it?• From canned food
What are 3 Toxins of Bacillus?• Lethal factor – (black necrosis)• Protective factor• Edema factor
Who has Poly-D Glutamic acid?• Anthracis• Cereus
Name that B-blocker:• B1-selective?• A – M• Non-selective?• N – Z• Exceptions?• Carbetalol and Labetolol are non-selective
What are the 4 facts of Fanconi Syndrome?• Problem in proximal tubule• Can’t reabsorb• Low energy state causing anemia• Can be due to old tetracycline
Where is glutaminase found?• In the collecting duct of the kidney
• What does glutmainase help the kidney absorb?• Ammonia if the liver fails
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Name 3 anatomical spots where renal stones get stuck:• Hilum• Pelvic brim• Entering the bladder
Renal failure is the most common cause of death in what 3 diseases?• SLE• Endometrial CA• Cervical CA
What is the rate-limiting enzyme in the urea cycle?• Carbamoyl synthase I
• Where is it found 90% of the time?• Liver
• Where is it found 10% of the time?• Collecting duct of the kidney
What type of charge does heparin have?
•-ve charge
What type of charge does protamine sulfate have?
•+ve charge
• What is it used for?
• Reversing the effects of heparin
What is commonly seen in all vasculitides?• T-cells and macrophages• Schistocytes• Decreased platelets• Decreased RBCs• Bleeding from mucosal surfaces• Bleeding from skin and GI• Petechiae• Ecchymoses
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What happens if you expose the blood to the basement membrane?• The following deveop:
• Clots
• DIC
• Pulmonary embolism
• DVT
• MI
• Stroke
Signs and symptoms in all vasculitides• Tachypnea and SOB
• Most common cause of death?• Heart failure
What is the MOA of Erythromycin?• Inhibits the translocation step of ribosomal protein
synthesis
What is the MOA of Chloramphenicol?• Inhibits ribosomal peptidyl transferase in prokaryotes
What is the MOA of Puromycin?• Inhibits elongation by binding to “A” site and prematurely
terminating chain growth in pro and eukaryotes
What is the MOA of Streptomycin?• Causes misreading of code during initiation in prokaryotes
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What is the MOA of Tetracycline?• Prevents binding of aminoacyl-t-RNA to ribosome on
prokaryotes therefore inhibiting initiation
What is the MOA of Cyclohexamide?• Inhibits ribosomal peptidyl transferase in eukaryotes
• cell wall inhibitor
What is the MOA of Rifampin?• Blocks B-subunit of RNA polymerase• Prophylaxis for contacts of N. meningitidis
What is the MOA of Vancomycin?• Cell wall inhibitor• Binds irreversibly to Phopholipase carrier• Bacteriacidal• Covers all gram +ves• Linezolid
What is the MOA of Warfarin?• Blocks vitamin k dependent gamma-carboxylation of
prothrombin and factors 2, 7, 9, 10, proteins C & S
What is the MOA of Clindamycin?• Blocks translation by binding the 50S subunit
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Hemolytic properties of Streptococcus:• What type of hemolysis is alpha hemolysis?• Partial hemolysis
• What color is it’s zone?• Green
• What type of hemolysis is beta-hemolysis?• Complete hemolysis
Hemolytic properties of Streptococcus:• What color is it’s zone• Clear
• eg. Streptokinase
• What type of hemolysis is gamma-hemolysis?• No hemolysis
• What color is it’s zone?• Red
What are the 5 notable things about RTA I?• High urine PH (??????not sure about this)• Acidosis• UTI s• Stones• Babies die < 1 yr old
What are 3 notable things about RTA II?• Acidosis
• urine PH = 2, normal is 5-6
• Hypokalmia• Patients have NO carbonic anhydrase
What are 3 notable things about RTA III?• It is a combination of RTA I & III• Normal urine pH• Hypokalemia
What are 3 notable things about RTA IV?• Seen in diabetics• Hyperkalemia• NO aldosterone b/c JG apparatus has infarcted
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What are the members of Streptococcus Group D?• Viridans• Mutans• Sanguis• Salivarius• Bovis
What Steptococcus has green pigment?• Viridans
What Streptococcus causes SBE?• Viridans
What Streptococcus causes cavities?• Mutans
What do you see in Nephritic Syndrome?• HTN• Hematuria• RBC casts
What do you see in Nephrotic Syndrome?• Increase Edema• Increase Lipidemia• Increase Cholesterolemia• Increase Coagulability• Decrease serum Albumin• Increase urinary Albumin
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What is the #1 cause of Sinusitis, Otitis, Bronchitis, Pneumonia?• Strep. Pneumo
• What is the #2 cause?• Hemophilus influenza
• What is the #3 cause?• Neisseria meningitides
What is the #1 method to paralyze cilia?• Viruses
• Which are secondary to what?• Bacterial infections
• What is the #2 method to paralyze cilia?• Smoking
If you develop gastroenteritis within 8hrs of eating what are the most common likely bugs? • Staph aureus• Clostridium perfringens• Bacillus cereus….from what?• Fried rice
Gastroenteritis within 8hrs of eating what toxin?• Preformed
What does Clostridum tetani inhibit? • Release of glycine from spinal cord
• What physical finding would you see?• Lock jaw
• What is the tx?• Antitoxin and Toxoid
• Where is it injected?• Injected in different areas of body
The Most common cause of UTI is?• E. coli
• Followed by?• Proteus
• Followed by?• Klebsiella
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The most frequent cause of UTI in females between 5-10?• Staph saprophyticus
• Why?• They stick things in themselves
• 18-24 yoa?• Staph saprophyticus• Why?• Because they stick things inside themselves
• Why no UTI’s after 24?• Because women are use to penises and Staph saprophyticus lives on
penis (becomes part of normal flora).
Staph aureus is the most common cause of what bone disease?• Osteomyelitis
• Because of what?• Collagenase
What is the Most Common cause of infections one week post burn injury?
• Staph. aureus
What is the triad of SSSS?• Shock• Rash• Hypotension
Most common cause of UTI?• E. coli• Then?• Proteus• Then?• Klebsiella
Newborn meningitis is caused by?• Group B Strep (agalactiae)• E. coli• Listeria
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What is normal rectal flora from mom• Group B Strep (Strep. Agalactiae)• E. coli• Listeria
What is associated with colon CA?• Clostridium melanogosepticus• Strep bovis
• What color pigment is produced?• Black
What Ig do you look for with affinity?• IgG
• What about Avidity?• IgM
What is transduction
• Virus inject it’s DNA into bacteria
What is transformation?• Virus injects it’s DNA into it bacteria in a hospital or
nursing home setting, then becomes deadly.
Conjuction occurs only with what?• Bacteria with Pili
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What causes mutiple cerebral abscesses in newborns?• Citrobacter
What are the 2 gram –ves that are strict anaerobes?• Hemophilus influenza• Neisseria
What type of complement problem do you have in recurrent infections with encapsulated organisms?• C3
What does complement fight against?
• Gram negative bacteria
What do you see in serum with prerenal failure and what are the values?• BUN
• >20
• Fractional Na+ excertion
• <1%
• Creatine
• >40
What do you see in Renal failure and what are the values?• BUN
• 10-15
• Fractional Na+ excretion
• >2%
• Creatinine
• <20
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What is the extravasation order?• Pavementing• Margination• Diapediesis• Migration
What is the rate limiting enzyme for Glycolysis?
• PFK-1
What is the rate limiting enzyme of Gluconeogenesis?
• Pyruvate Carboxlyase
If treating a disease that initiates the cell mediated response, what are you treating first?• Viral
• If resistant to tx, what next?
• Fungal
• Mycobacterium
• Protozoa
• Parasite
• Neoplasm
What bugs can you pick up during birth?• Step. Group B
• Strep agalactiae
• Strep. Pneumonia• Herpes simplex virus• Neisseria gonorrhea• Chlyamydia
What is another name for Adenoma sebaceum?
• Perivascular angiofibromata
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What is another name for Addison’s?• Primary Adrenocoritcal Insufficiency
What is another name for Alkaptonuria?• Ochronosis
What is another name for Churg-Strauss?• Allergic Granulomatosis• Angiitis
What is another name for Craniopharyngioma?• Ameloblastoma
• What is Ameloblast?• Tooth material
What is another name for Chrons?• Regional enteritis• Granulomatous ileitis• Ileocolitis
What is another name for DeQuervain’s?• Subacute Granulomatous Thyroiditis
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What is another name for Intraductal Ca?• Comedo Ca
What is another name for I-Cell Disease?• Mucolipidosis II
What is another name for Kawassaki Disease?• MLNS• Mucocutaneous Lymph Node Syndrome
What is another name for Leydig cells?• Interstitial cells
What is another name for Sertoli cells?• Sustentacular cells
What is another name for Temporal arteritis?• Giant cell arteritis (granulomatous)
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What is another name for Waldenstrom’s macroglobulinemia?• Hyperviscosity syndrome
HHV I causes?• Oral • Trigeminal ganglia
HHV II causes?• Genital• Sacral plexus
HHV III causes?• Varicella zoster
HHV IV causes? • EBV• Mononucleosis• Burkitt’s
HHV V causes?• CMV• Inclusion bodies
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HHV VI causes?• Roseola• Duke Disease• Exanthem subitum
HHV VII causes?• Pityriasis rosea
HHV VIII causes?• Kaposi’s sarcoma
Answer the following questions about Coumadin/Warfarin.• What is the MOA?• Interferes with normal synthesis and gama carboxylation
of Vit. K dependent clotting factors via vitamin K antagonism.
• Is it long or short acting?• Long half-life• 8-10 hours to act
Answer the following questions about Coumadin/Warfarin.• Clinical use?• Chronic anticoagulation
• Contra-indication?• Pregnancy because it can cross the placenta
Answer the following questions about Coumadin/Warfarin.• What pathway does it affect?• Extrinsic pathway
• What does it do to PT?• Prolongs
• PT
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Answer the following questions about Coumadin/Warfarin.• What are the toxicities?• Bleeding• Teratogenic• Drug-drug interactions
• How is it activatied?• Tissue activated
Answer the following questions about Coumadin/Warfarin.• Administration?• po
What are the Vitamin K dependent clotting factors?• II• VII• IX• X• Protein C• Protein S
Answer the following questions about Heparin.• What is the MOA?
• Catalyzes the activation of antithrombin III
• Decreases thrombin and Xa
• Is it long or short acting?
• Short half-life
• Acts immediately
Answer the following questions about Heparin.• Clinical use?• Immediate anticoagulation of pulmonary embolism,
stroke, angina, MI, DVT.
• Contra-indication?• Can be used during pregnancy because it does not cross
the placenta
Answer the following questions about Heparin.• What pathway does it affect?• Intrinsic pathway
• What value should you follow?• PTT
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Answer the following questions about Heparin.• What are the toxicities?• Bleeding• Thrombocytopenia• Drug-drug interactions
• How is it activatied?• Blood activated
Answer the following questions about Heparin.• Administration?• I.V.
• Drug of choice for what?• DVT
Answer the following questions about Heparin.• What is good about the newer low-molecular-weight
heparins?• They act more on Xa• Have better bioavailability • Have 2 to 4 times longer half life• Can be administered subcutaneously and without
laboratory monitoring.
What do you use for rapid reversal of heparinization?• Protamine sulfate
How do you treat Lead Poisoning?• Dimercaprol
How do you treat Benzodiazepine poisoning?
• Flumazenil
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How do you treat Anticholinesterase poisoning?
• Pralidoxime
How do you treat Iron poisoning?
• Deferoxamine
How do you treat Opioid poisoning?
• Naloxene
How do you treat Barbituate poisoning?
• Bicarbonate• Doxapram
What does Doxapram do?• Activates the respiratory center in the brain
What is the treatment for Hypercholesterolemia?• Provostatin• Atrovastatin• Lovastatin• Simvastatin
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What statin is renally excreted?• Provastatin
What statins do you have to follow liver enzymes every 3 months?• Atrovastatin• Lovastatin• Simvastatin
What do statins inhibit?• HMG-CoA reductase
• When is it most active?• 8:00pm on
If statins are insufficient what do you add?• Cholestipol• Cholestyramine
• If nothing works what do you give?• Probucol• Niacin
What are the side effects of Niacin?• Flushing• Itching
What 2 statins bind bile salts?• Cholestipol• Cholestyramine
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What are 4 causes of severe pain (in order)?1.Pancreatitis• Due to What?• ETOH
2.Kidney stones• Due to What?• Alcohol
What are 4 causes of severe pain (in order)?3.AAA• How is this described?• Ripping pain down back
4.Ischemic bowel• What is symptom?• Bloody diarrhea
What are 5 causes of SIADH?• Small cell Ca of lung• Increased intracranial pressure• Pain (most common)• Drugs• Hypoxic Lung Disease/Restrictive Lung disease
What drug causes SIADH?• Carbamazepine
What are the cells of neural crest origin?• Parafollicular cells of thyroid• Odontoblasts (predentin)• Pseudounipolar cells• Spiral membrane of heart• Chromaffin cells• All Ganglion cells (Schwann, Adrenal medulla)• Melanocytes• Laryngeal/Tracheal cartilage
What are the triple repeat diseases?• Huntington’s• Fragile X• Myotonic Dystrophy• Prauder Willie• Spinal/bulbar muscular atrophy (Fredicks ataxia)
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How do you determine the maximum sinus rate?• 220 - age
What are the 3 low volume states with acidosis rather than alkalosis?• RTA • Diarrhea• Diabetic ketoacidosis (DKA)
What are the causes of Croup & Bronchiolities?• Parainfluenza• Adenovirus• Influenza• RSV
What is asthma in a child less than 2 called?• Bronchiolitis
What are the 4 D’s of Pellagra?• Diarrhea• Dermatitis• Dementia• Death
What are the uric acid stones?• Cysteine• Ornithine• Lysine• Arginine
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What is happening in the Atrium?• Phase 0?• Depolarization
• Phase 1?• No name
• Phase 2?• Plateau phase (A-V node)
What is happening in the Atrium?
• Phase 3?• Repolarization
• Phase 4?• Automaticity (S-A node)
What do Na+ channels do to the EKG?• Wider QRS
What does Ca+ do to the EKG?• Wider P-wave• Longer PR interval
What are the types of kidney stones?• Calcium oxalate (phosphate) stones• Struvite stones• Uric acid stones• Cysteine stones• Oxalate stones
What percent of kidney stones are calcium oxalate?• 80%
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If you find oxalate stones in the following what should you think of?• 3 y/o white male?• CF
• 5 y/o black male?• Celiac Sprue
If you find oxalate stones in the following what should you think of?• Adult male?• Whipple’s
• Adult male or female?• Crohn’s
If oxalate stones found in CF what is the most common cause?• In 0-20 y/o?• Malabsorptin
• What age do they die?• Young
Answer the following questions about pseudogout?•What type of crystals are present?•Calcium pyrophosphate
•Where are they found?•Joint spaces
Answer the following questions about pseudogout?•Who gets it?•Older patients M=F
•Tx?•Colchicine
What are the most common non-cyanotic heart disease?• VSD• ASD• PDA• Coarctation
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What murmur increases on expiration?• VSD• Mitral
What murmur has fixed wide splitting?• ASD
What murmur has bounding pulses?• PDA
What gives you differenital pulses?• Coarctation
What is increased incidence in Turners?• Coarctation
What are 4 enzymes never seen in glycolysis?• Pyruvate carboxylase• PEP carboxykinase• F-1,6 dPhosphatase• G-6-Phosphatase
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What are 3 enzymes seen ONLY in glycolysis?• Hexokinase• PFK-1• Pyruvate kinase
What are 2 hormones that are acidophilic?• Prolactin• GH
What are the partially acid fast Gram +ve?• Nocardia
What are the partially acid fast Protozoa?• Cryptosporidium
What are the septic emboli of SBE?• Mycotic aneurysm• Roth spots• Janeway lesions• Osler’s nodes• Splinter hemorrhages• Endocarditis
Where are the following lesions found?• Janeway lesions?
• Toes
• Osler’s nodes?
• Fingers
• Roth spots?
• Retina
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What is the most common cause of endocarditis?• Strep. viridans
What causes microsteatosis?• Acetaminophen• Reye Syndrome• Pregnancy
What causes macrosteatosis?• Alcohol
What are 2 bacteria that release elastase?• Staph. Aureus• Pseudomonas
What are the 2 bacteria with toxins that inhibit EF-2?• Pseudomonas• Diptheria
How does Diptheria work?
• It ADP ribosylates EF2 inhibiting protein synthesis
• Is it Gram +/-?
• +
• Where and how does it get its exotoxin?
• From virus via transduction
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How does Diptheria work?
• What does it cause?• Heart block
• What do you give for Tx?• Antitoxin• Never scrape membrane
What are the different types of Emphysema and their causes?• Bullous?• Staph aureus• Pseudomonas
• Centroacinar?• Smoking
What are the different types of Emphysema and their causes?
• Distalacinar?• Aging
• Panacinar?• Alpha-1 antitrypsin def
What are the stages of erythropoiesis?• 4 mo gestation?• Yolk sac
• 6 mo gestation?• Spleen, liver, flat bones
What are the stages of erythropoiesis?• 8 mo gestation?• Long bones
• 1 yr old?• Long bones
If long bones become damaged after 1 yr what takes over?• Spleen can resume erythropoieses causing splenomegaly
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What ions correspond with the following EKG?•P-wave?•Ca+
•QRS complex?•Na+
•S-T?•Ca+
What ions correspond with the following EKG?
•T-wave?•K+
•U-wave?
•Na+
What do Na+ channel blockers do to the EKG?• QRS
What do Ca+ channel blockers do to the EKG?• Widens P-wave• PR interval longer
P.P. CLUE 4 BIO STAT D W
+ B A+B
_ C C+D
A+C B+D ALL
A
D
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
A&D
In EKG P-wave Represents?• Atrium contraction• Phase zero• Calcium
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In EKG P-R Interval means?• AV Node• Phase 2• Sodium
In EKG Q-Wave means?• Septum• Phase 2• Sodium
In EKG R-upstoke means?• Anterior wall• Phase 2• Sodium
In EKG S-down stroke means?• Posterior wall• Phase 2• Sodium
In EKG S-T Interval means?• Ventricle• Phase 2• Calcium
In EKG T-wave means?• Ventricle• Phase 3• Potassium
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In EKG U-wave means• Ventricle• Phase 4• Sodium
4 DZ associated with HLA-DR 2?• Narcolepsy• Allergy (hay fever)• Goodpasture• MS
5 DZ associated with HLA-DR 3?• DM• Chronic active Hepititis• Sjogrens• SLE• Celiac sprue
DZ associated with HLA-DR 3&4?• IDDM (DM Type 1)
DZ associated with HLA-DR 4?• Rheumatoid Arthritis• Pemphigus Vulgaris
DZ associated with HLA-DR 5• JRA (JUV RA)• Pernicious anemia
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DZ associated with HLA-DR 7?• Nephrotic syndrome (Steroid induced)
DZ associated with HLA-DR 3 and HLA-B 8?• Celiac Disease
DZ Associated with HLA-A3?• Hemochromatosis
• chromosome 6• point mutation Cystine to Tyrosine
DZ Associated with HLA-A 3?• Myasthenia gravis
DZ Associated with HLA-B 13?• Psoriasis
5 DZ Associated with HLA-B 27?• Psoriasis
• only if with arthritis
• Ankylosing Spondylities• IBD
• Ulcerative Cholitis
• Reiter’s• Post gonococcal arthritis
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DZ Associated to HLA-BW 47• 21 alpha hydroxylase deficiency
• Vit. D
Facts about Diphtheria • ADP ribosylates EF-2• Stops cell synthesis• Gr +ve • Gets exotoxin from virus via transduction• Heart block• Its toxoid therefore give antitoxin
MCC of Pneumonia in 6wks to 18 yrs?• RSV (infants only)• Mycoplasma• Chlamydia pneumonia• Strep pneumonia
MCC Pneumonia in 18 yrs to 40 yrs of age?• Mycoplasma• Chlamydia pneumonia• Strep. Pneumonia
MCC of Pneumonia in 40 yrs to 65 yrs of age?• Strep pneumonia• H. influenza• Anaerobes
MCC of pneumonia in the Elderly? • Strep pneumonia • Viruses• Anaerobes• H.influenza• Gr –ve rods
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What are 4 Clues for IgA?• Monomer in blood• Dimer in secretion• Located on mucosal surface• Found in secretion
What are Clues for IgD?• Only functions as surface marker for Mature B-Cell
What are Clues for IgE?• Immediate hypersensitivity/anaphylaxis• Parasite defense• Worms• Fc region binds to mast cells and basophils• Allergies• Does Not fix complement
What are Clues for IgG?• Highest affinity• Memory respond at day 3 five times the concentration• Peaks in 5 years last for 10 years• Opsonizes• Activates complement• 2nd to show up in primary response• Only one to show up for secondary respond• Most abundant Ig in newborn• Antigenic differences in heavy chain and site of di-sulfide
bond• 4 subclasses G1 to G4
What are Clues for IgG1?• Crosses placenta due to fc portion
What are Clues for IgG2?• Most common sub-class deficiency• Patient susceptible to encapsulated organisms
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What are Clues for IgG3?• Most memory antibody
What are Clues for IgG4?• Only IgG NOT fixing complement
What are Clues for IgM?• Responds in primary response• Most efficient in agglutination and complement fixation• Defenses against bacteria and viruses
What do Macrophages release?• MHC II
What does TH1 secrete? • IL-2• IF- Gamma
What does TH2 Secrete?• IL-4• IL-5• IL-6• IL-10
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What does TH-0 secrete?• TH-1• TH-2
MHC-1 are also called what? • CD8• CD8 becomes T-cytotoxic cells
All T-Cells express what?• CD-3• For what?• Signal transduction
• CD-2 • For what?• Adherence
What do CD-4 cells Become?• T helper cells
What do CD-8 cells Become?• T cytotoxic cells
Neutrophils produce what enzymes and what is their action?• Myeloperoxidase• NADPH• Will kill ALL Gr+ve
• Ex..Hydrogen peroxide kills gr+
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What do T-cells stimulate?• Clue 4x7=28
• CD-4• B-7• CD-28
What are the Clues for Type-1 Hyperlipidemia?• Increased Chylomicron• Deficiency of Lipoprotein lipase enzyme• Defect in liver only
What are the Clues for type-2 hyperlipedimia?• Increased LDL• Two types IIa and IIb• Type IIa Receptor deficiency for LDL or missing B-100
• Type II-b (LDL and VLDL problems) enzyme deficiency for LDL at adipose. Receptor problem for VLDL. Most common in General Population
What are the Clues for type-3 Hyperlipedimia?• Increased IDL• Receptor problem for APO-E
What are the Clues for Type-4 hyperlipedimia?• Increased VLDL• Lipoprotein lipase enzyme deficiency at adipose tissue
What are the Clues for Type-5 hyperlipedimia?• Combination of Types 1&4• Increased Chylomicron and VLDL• Enzyme and receptor deficiency at C-II• Most common in diabetics
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What is a Xanthoma?• Deposition of Cholesterol on elbows• Can cause what?• CAD
What is a Xanthelasma?• Deposition of Triglycerides on eyelids, face• Can cause what?• Pancreatitis
Description of Rashes
ERYTHEMA MARGINATUM• Little red spots w/ bright red margins• Sandpapery• RF- Jones critera
ERYTHEMIA CHRONICUM MIGRANS• Lymes disease• Target lesions (bulls eye)
MEASLES• Morbiliform rash• Preceded by cough• conjunctiivitis
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ROSEOLA• Fever x 2 day• Followed by rash• ONLY ONE WITH RASH FOLLOWING FEVER (HHV 6)
ERYTHEMA NODOSUM• Anterior aspect of leg• Redness• Tender nodules
Erythema multiforme• Red macules, target lesions• Causes: allergy, viruses• Mild: MCC virus, #2 drugs (sulfas)• Moderate: Stevens-Johnsons Syndrome• Severe: Toxic epidermal necrolysis , skin peels off
SEBORRHEIC DERMATITIS• Scaly skin with oily shine on headline
SEBORRHEIC KERATOSIS• Stuck on warts• Due to aging
PSORIASIS• HLA-B27• Extensor surfaces• Silvery white plaques• Scaly skin• Pitted nails
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VARICELLA ZOSTER HHV 3• STAGES• Red macules• Papules• Vesicles• Pustules then scabs• Different stages may appear at same time
DERMATITIS HERPATIFORMIS• Rash and blisters on ant. thighs• Assoc. with diarrhea• Assoc. with flare up of celiac sprue
TYPHOID FEVER• SEEN WITH SALMONEALLA INFXN• Rose spots assoc. with intestinal fire
DERMATOMYOSITIS• Heliotropic rash
ERYSIPELAS• Reddened area on skin w/ raised borders• DOES NOT BLANCH
TINEEA CRURIS• Redness• Itchy groin
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PITYRIASIS ROSEA• Herald patch= dry skin patches that follow skin lines• HHV 7
TINEA VERSICOLOR• Hypopigmented macules on upper back • Presents in a V pattern• A.K.A. upside down christmas tree• Tx: Griseofulvin
What do you see in SCABIES?• Linear excoriations on belt line and finger webs• What is the tx?• Lindane• Permethrin
What is a T-CELL DEFICIENCY?• DiGeorges • What ion imbalance will they have?• Hypokalemia• What did not form?• 3rd and 4th pharyngeal pouch• What chromosome?• Deletion on chromosome 22
T-CELL DEFICIENCY• HIV• Also B-cell but less so
What is MYCOSIS FUNGOIDES?• NOT A FUNGUS• Non-Hodgkins form of cutaneous T-cell lymphoma
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What is the job of CHYLOMICRONS? • Transport TG’s from GI to liver and endothelium
What is the job of VLDL?• Transports TG’s from liver to adipose
What is the job of IDL?• Transports TG’s from adipose to tissue
What is special about LDL’s?• ONLY ONE THAT CARRIES CHOLESTEROL
What do you develop with HYPERTRIGLYCERIDEMA?• XANTHELASMA
• Where are they located?• On eyelids and eyebrows
What do you develop with HYPERCHOLESTEROLEMIA?• Xanthomas
• Where are they located?• elbows
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Where is VLDL made?• ONLY ONE MADE IN THE LIVER
What are IDL AND LDL formed from?• ARE BREAK DOWN PRODUCTS OF VLDL
What are the clues for HEMOPHILIUS INFLUENZA?• Gram -/+?• Pleomorphic gram (-) rods• What pattern?• “school of fish pattern”• What type is most common?• Type A
• 80%
What are the clues for HEMOPHILIUS INFLUENZA?• Capsule or no capsule?• non-encapsulated• Invasive or non invasive?• non-invasive
What are the clues for HEMOPHILIUS INFLUENZA?• Most common cause of what?• Sinusitis• Otitis• Bronchitis
What are the clues for HEMOPHILIUS INFLUENZA? • What is the 2nd most common type?• TYPE B
• 20%• Encapsulated or non encapsulated?• Encapsulated• What does it have in its capsule?• Polyribosyl phosphate in capsule• Contains IgA protease
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What are the clues for HEMOPHILIUS INFLUENZA?
• Invasive or non invasive?• Invasive • What does it cause most often? • #1 cause of epiglottitis • What are the signs of epiglottitis?• Stridor• Fever• Thumb sign on xray
What are the most common causes of MENINGITIS corresponding with the following ages?• 0-2 months?• #1. Group B strep (agalactiae)• #2. E. coli• #3. Listera
What are the most common causes of MENINGITIS corresponding with the following ages?• 2 Months- 10 years?• #1. strep pneumonia • #2. n. meningitides• (adolescent years only)
What are the most common causes of MENINGITIS corresponding with the following ages?• 10yrs- 21 yrs?• #1. n. meningitides
What are the most common causes of MENINGITIS corresponding with the following ages?• > 21 years old?• #1 S. pneumoniae
Answer the following about the Strep. Pneumonia vaccine.• At what age is it given?• Given at 2,4,6 months• What strain does it cover?• Covers 23 strains (98% cases)
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Answer the following about the Strep. Pneumonia vaccine.• Indications?• Anyone> 65y/o• Anyone splenectomized
• Sickle cell anemia
• Anyone with end-organ damage• CF• RF • Nephrotic Syndrome
STREP PYOGENES is the most common cause of what?• MCC of all throat infections• #2 MCC of all what?• Skin infections except lines
What are the STAPHYLOCOCCUS PIGMENTS?• St. aureus?• Gold pigment• St. epidermidis?• White pigment• St. saprophyticus?• No pigment
What is the clue for RUSTY COLORED SPUTUM?• Strep. Pneumonia
• pneumococcus
Clues for GENERAL INFECTIONS
• Skin Infections?
• Say Staph. Aureus
• Throat Infections?
• Say Strep. Pyogenes
• Small Intestine Infections?
• Say E. coli
What disease is a NEUTROPHIL DEFICIENCY & T,B cell deficiency?• Job Syndrome:• IL-4• Hyper IgE• What do they look like?• Red hair• Fair complexion• Female
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What are the NEUTROPHIL DEFICIENCY?• NADPH-OXIDASE DEF (CGD)• NEUTROPENIA• MYLOPEROXIDASE• Job-Buckley Syndrome
What Hepatitis B antigen is found with an acute/recent infection?• HbC antigen• HbS antigen
What Hepatitis B antigen & antibody is found with an acute/recent infection?• HbC antigen• HbS antigen• HbC antibody
What Hepatitis B antigen is found with Recent immunization within the past 2wks?• HbS antigen ONLY
What Hepatitis B antibody is found with Recent immunization two wks after and can be due to vaccination immunity from a long time ago?
• HbS antibody ONLY
What Hepatitis B antibody & antigen is found with past disease but now immune?• HbC antibody• HbS antibody• HbS antigen
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What Immunogloblin is found in Hepatitis B immunity?
• IgG
What Hepatitis B antigen/antibody is found in the chronic carrier state?
• HbS antigen for >6months• Can be with or without HbS antibody
What Hepatitis B antigen is found with the infectious state?
• HbE antigen
What Hepatitis B antibody is found with the non-infectious state?
• HbE antibody
If patient has recovered from Hepatitis B what antigen will they have?• NEGATIVE HbS antigen
If patient is a chronic carrier what antigen will they have?
• POSITIVE HbS antigen
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What does the “window period” build in Hepatitis B?
• HbE antibody• IgM HbC antibody
• What disappears?• HbS antigen
What is the incubation period for Hepatitis B?
• 4 to 26 wks• Average @ 8wks
How long is the acute disease period in Hepatitis B?
• 4 to 12 wks
How long is the convalescence period in Hepatitis B?
• 4 to 20 wks
How long is the recovery period for Hepatitis B?
• YEARS
Answer the following about HIV?
• MC infection?
• CMV
• MCC of death?
• PCP
• What is p41 used for?
• Just a marker
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Answer the following questions about HIV? • What does Gp120 do?
• Attachment to CD4
• What is Pol used for?
• Integration
• What is reverse transcriptase used for?
• Transcription
• What are p17 & p24 antigens used for?
• Assembly
Answer the following questions about HIV? • What is the normal CD4 count?
• 800-1200
• What can the CD4 count be up to in children?
• 1500
• When do you begin treating with 2 nucleotide inhibitors and 1 protease inhibitor?
• <500 • (child at 750)
Answer the following questions about HIV? • AIDS is defined as a CD4 count of what?• <200 • With a CD4 count of <200 what do you tx for?• PCP• What do you treat for when CD count is <100?• Mycobacterium aviam intracellular
What are the Antioxidants?• Vitamin E
• #1
• Vitamin A• Vitamin C• Betakertine
What is Vitamin A a cofactor for?• Parathyroid
• Along with what other cofactor?• Mg+
Too much Vitamin A will cause what?
• Hyperparathyroid• Increase Ca+• Decrease Phosphate
• What will be the symptoms?
• Goans• Moans
• Bones
• Stones
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Too much Vitamin A will cause what?• Pseudotumor Cerebri
• Increase CSF production from Chorichoid Plexus
What is the only cause of ICP that does not cause herniation?• Pseucotumor cerebri
What does Vitamin A deficiency cause?
• Nightvision problems/nightblindness
• Hypoparathyroidism• Decrease Ca+• Increase Phosphate
What is Vitamin B1?
• THIAMINE
• What do you get with a decrease in thiamine?
• Beri Beri
• What is the most common cause in US?
• ETOH
What do you get with Vitamin B1 deficiency?• Wet Berry Berry• With heart failure
• Dry Berry Berry• Without heart failure
What do you get with Vitamin B1 deficiency?• Wernicke’s Encephalopathy
• Wernicke’s Korsakoff
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What is Wernicke’s Encephalopathy?
• Alcoholic thymine deficiency of the Temporal Lobe
What is Wernicke’s Korsakoff?
What needs B1 as a Cofactor?• 3 Dehydrogenases• Pyruvate dehydrogenase• Alpha ketoglutarate dehydrogenase• Branch chain amino acid dehydrogenase
• Transketolase
What is B2• Riboflavin
• What is a physical sign of this deficiency?• Angular stomatitis• Angular cheliosis• Corneal Neurovasculazations
What is the best source of B2?• Milk• Also from FAD
What is B3?• Niacin
• What is the clue?• Diarrhea• Dermatitis• Dementia• Death
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What is the disease that presents like B3 deficiency?• Hartnup Disease
• What is deficient in this disease?• Tyrptophan
• What is typtophan needed for?• Needed for niacin formation
What is B4?
• Lipoic acid
• What is the deficiency caused by this vitamin?• Not one
What is B5?• Pantothenic acid
• What is the deficiency caused by this vitamin?• You guessed it…nothing
What is B6?
• Pyridoxine
• What is the deficiency caused by this vitamin?
• Neuropathy
• Seizures
• Who do you need to give B6 to?
• Patient on INH
What type of anemia is seen with B6 Deficiency?• Sideroblastic
What needs B6 as a cofactor?• ALL transaminases
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What is B12?• Cyanocobalamine
• What is the deficiency caused by this vitamin?• Pernicious anemia• Neuropathy
What is the most common cause of vitamin B12 deficiency?• Pernicious anemia
What 2 enzymes are needed for synthesis of B12?• Methylmalonyl CoA Mutase• Homocysteine Methyl Transferase
Deficiency in Methylmalonyl CoA Mutase leads to what?
• Neuropathy
• Why?• Because it recycles myelin
Deficiency in Homocystiene Methyl Transferase leads to what?• Megaloblastic anemia
• What else is this enzyme needed for?• Nucleotide synthesis
When is ANGULARE STOMATOSIS seen?• VITAMIN B2- RIBOFLAVIN deficiency
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What are the 4 D’S of pellegra?• DIARRHEA• DERMATITIS• DEMENTIA • DEATH
What causes a NEUROPATHY WHEN DEFICIENT & also needs TRANSAMINASE?
• PYRIDOXINE B6
What vitamin is deficient with PERNICIOUS ANEMIA & NEUROPATHY?
• B12 CYANOCOBALAMINE
What is the first vitamin to run out with disease of rapidly dividing cells?
• Folate
What type of anemia is seen with Folate deficiency?• Megaloblastic anemia
• With neuropathy?• NO NEUROPHATHY
• What else is Folate used for?• Nucleotide synthase (THF)
What is another name for Vitamin C?• Ascorbate acid
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What is Vitamin C needed for?• Collagen synthesis
What happens with Vitamin C deficiency?• Scurvy
What is the CLUE for Scurvy?• Bleeding gums • Bleeding hair follicles
What is the most common cause of Vitamin C deficiency?• Diet deficient in citrus fruit • Diet deficient in green vegetables• Over cooked green vegetables
What does Vitamin D do with Ca+?• Controls Ca+• Absorbes Ca+ from GI• Reabsorbs Ca+ in Kidneys
• Controls osteoblastic activity
What does Vitamin D deficiency cause in Children?• Ricketts
• What does it cause in ADULTS?• Osteomalcia
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What is the CLUE for RICKETTS?• Lateral Bowing of the Legs• X-linked dominant
What is Vitamin E needed for?• Hair• Skin• Eyes• Protection against free radicals• #1 antioxidant
What does a deficiency of Vitamin E cause in newborns?
• Retinopathy
What are the vitamins from GI that are normal flora?• Folate• Vitamin K
• 90%
• Biotin• Panothenic acid• Helps with absorption of B12
What are the Vitamin K dependent clotting factors?• 1972• Protein C• Protein S
• Which one has the shortest half-life?• Protein C
• Which one has the 2nd shortest half-life?• 7
What are the TRACE elements?• Chromium• Selenium• Manganese Molebdenum• Tin
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What is Chromium needed for?• Insulin action
What organ needs Selenium?• Heart
What trace element is an enzyme in glycolsis?• Manganese Molebdenum
What organ needs Tin?• Hair
What does a deficiency in Zinc cause?• Dysguzia• Decrease sperm• Dry hair• Dry skin
Cofactor for ALL Kinases?• Mg+
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Cofactor for ALL Carboxylases?• Biotin
Cofactor for ALL Transaminases?• Pyridoxine
• B6
What is Biotin a cofactor for?• ALL carboxylases
What is Mg+ a cofactor for?• ALL kinases• Parathyroid along with Vitamin A
What is Ca+ needed for?• Muscle contraction• Axonal transport• 2nd messengers
What tracts are affected due to deficiency in Methyl Malonyl CoA Mutase?• Dorsal Columns• Cortical Spinal Tracts
• Why are these affected?• Because they are the longest • Because they need the most myelin
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What enzyme does Zanthein Oxidase need?
• Maganese Molebdenum
How are drugs that are bioavailable ALWAYS excreted?• By the liver• Always Hepatotoxic
How are soluble drugs ALWAYS excreted?• By the kidney• Always nephrotoxic
What are the 5 P’S OF COMPARTMENT SYNDROME?• Pain• Pallor• Paresthesia• Pulselessness• Poikilothermia
What are 5 skin infections were Strep. Pyogenes is the number one cause?• Lympangitis• Impetigo (not bullous)• Necrotizing fascitis• Erysepelas• Scarlet fever
What are 5 skin infections were Staph. aureus is the number two cause?• Lympangitis• Impetigo (not bullous)• Necrotizing fascitis• Erysepelas• Scarlet fever
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What is the #1 bacteria causing infection associated in shunts and central lines?• Staph epidermitis
What is the #1 bacteria causing infection in peripheral lines?• Staph aureus
Why do we need E. COLI in the gut?• Absorption of Vit. B12• Synthesis of :• -Vitamin K• -Biotin• -Folate• -Pantothenic acid
• B5
Answer the following questions about RESTRICTION ENZYMES?• Trypsin cuts where?• cuts to R of • Arg• Lys
• Chymotrypsin cuts where?• cuts to R of bulky aa’s (aromatics)• Phe• Tyr• Trp
Answer the following questions about RESTRICTION ENZYMES?•Elastase cuts where?• Cuts to R of (“SAG”)• Ser• Ala• Gly
• CNBr cuts where?• Cuts to R of• Methionine
Answer the following questions about RESTRICTION ENZYMES?• Mercaptoethanol cuts where?• Cuts to R of: disulfide bonds
• Cysteine• methionine
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Answer the following questions about RESTRICTION ENZYMES?• Aminopeptidase cuts where?• Cuts to R of• amino acid terminal
• Caboxypeptidase cuts where?• Cuts to L of• carboxy terminal
What is THE ONLY LIVE VACCINE INDICATED IN AIDS PATIENTS?• MMR
What VACCINE is NOT GIVEN IF pt. is Allergic to EGG?• MMR & INFLUENZA
What VACCINE is NOT GIVEN IF patient HAS YEAST ALLERGIES?• Hepatitis B
What 3 VACCINES DROP OUT AFTER 6 YEARS OF AGE?• Hib• Diphtheria• Pertussis
What is the MC STRAIN OF STREP PYOGENES TO CAUSE GN?• Strain 12
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What 2 substances are in NEUTROPHILS?• Myeloperoxidase• NADPH Oxidase
MACROPHAGES CONTAIN what SUBSTANCE?• NADPH Oxidase
• Which means they only kill what?• Kills only G -ve
What do MACROPHAGES SECRETE?• IL-1• IL-6??
What DRUGS CAUSE PAINFUL NEUROPATHY?• DDI>DDC• Pancreatitis
What are the MITOCHONDRIAL DISEASES?• Leigh’s Disease• What is another name?• Subacute necrotizing encephalomyelopathy• What are the signs & symptoms?• Progressively decreasing IQ • Seizure• Ataxia• What is the deficiency?• Cytochrome oxidase deficiency
What are the MITOCHONDRIAL DISEASES?• Leber’s Hereditary Optic Atrophy (LHON)• They all die
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What is the ONLY G +ve WITH ENDOTOXIN?•Listeria
• What part is toxic?• Lipid A
• Does it cross the placenta?• Yes
What does Listeria activate?
• T-cells & Macrophages, therefore, have granulomas
What are the Associations in contracting the Listeria bug?• Raw cabbage• Spoiled milk• Migrant workers
What are the PERIODS OF RAPID GROWTH/RAPIDLY DIVIDING CELLS?• Birth – 2 months• 4 – 7 years old• Puberty
What is THE ONLY IMMUNE DEFICIENCY WITH LOW CALCIUM and Increase Phosphate?• DiGeorge’s Syndrome
What are the BASIC AMINO ACIDS?• Lysine• Arginine
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What are the ACIDIC AMINO ACIDS?• Glutamate• Aspartate
What are the Ketogenic + Glucogenic Amino Acids?• Phenylalanine• Isoleucine• Trptophan• Threonine
What are the AROMATIC AMINO ACIDS?• Phenylalanin• Tyrosine• Tryptophan
What are the AMINO ACIDS with DISULFIDE BONDS?• Met• Cyst
What are the “KINKY” AMINO ACID?• Proline
What are the SMALLEST AMINO ACID?• Gly
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What are the AMINO ACIDS with O-BONDS?• Serine• Threonine• Tyrosine
What are the AMINO ACIDS with N-BONDS?• Asparagine• Glutamine
What are the BRANCHED-CHAIN AMINO ACIDS?• Leu• Iso• Val
What are the KETOGENIC AMINO ACIDS?• Leu• Lys
What CONDITIONS are ASSOCIATED WITH HLA-B27?• Psoriasis (with arthritis)• Ankylosing Spondylitis• Irritable Bowel Syndrome• Reiter’s Syndrome
What is associated with HLA-B13?• Psoriasis with out arthritis
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What are the ORGANISMS WITH IgA PROTEASE (resistant to IgA)?• Strep. Pneumoniae• H. influenza• Neisseria catarrhalis
What do EOSINOPHILS SECRETE?• Histaminase• Arylsulfatase• Heparin• Major Basic Protein
What do MAST CELLS SECRETE?• In an Acute Reaction?• Histamine
• In a Late Reaction ?• SRS-A• ECF-A
What is the MCC of ATYPICAL PNEUMONIA?• 0 – 2 months?• chlamydia pneumonia
What does chlamydia pneumonia cause?• Intersitital pneumonia
What is the CLUE for HEART BLOCK?• High temperature with NORMAL pulse rate!
(This should never be! Each degree ↑ in temp. → 10 beats/min ↑ in pulse rate)
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What are the clues for IL-1?• FEVER• NONSPECIFIC ILLNESS• RECRUITS TH CELLS for LINKING with MHC II
COMPLEX• SECRETED BY MACROPHAGES
What are the clues for IL-2?
• MOST POTENT OF THE Interleukins
• RECRUITS EVERYBODY
• MOST POWERFUL CHEMO-ATTRACTANT• MUST BE INACTIVATED
• When must you inactivate it?
• PRIOR TO TRANSPLANTATIONby cyclosporin
• SECRETED BY TH1 CELLS
What are the clues for IL-3?• ENERGIZED MACROPHAGES• CAUSES B-CELL PROLIFERATION• LABELED BY THYMIDINE (USE POKEWEED MITOGEN
OR ENDOTOXIN)• SECRETED BY ACTIVATED T CELLS
What are the clues for IL-4?• B-CELL DIFFERENTIATION• RESPONSIBLE FOR CLASS SWITCHING• SECRETED BY TH2 CELLS
What are the clues for IL-5 thru 14?• They do exactly what IL-1 thru IL4
What are the clues for IL-10?• SUPPRESSES CELL-MEDIATED RESPONSE (tells
macrophages and fibroblasts to stay away if bacterial)• INHIBITS MAC ACTIVATION
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What are the clues for IL-12?
• PROMOTES CELL-MEDIATED RESPONSE (recruits macs & fibroblasts if NOT bacterial)
• ACTIVATES NK CELLS TO SECRETE IF-γ
• INHIBITS IL-4 INDUCED IgE SECRETION
• CHANGES TH CELLS to TH1 CELLS • secretes IL-2 & IF-γ → inhib. TH2, therefore, ↑ host
defenses against delayed hypersensitivity
What are the clues for IF-α?• Where is it from?• LEUKOCYTES• ↓VIRAL REPLICATION AND TUMOR GROWTH• ↑ NK ACTVITY
• secretes perforins and granzymes to kill infected cell
• ↑MHC CLASS I & II EXPRESSION• ↓ PROTEIN SYNTHESIS
• translation inhibited, therefore, defective protein synthesis
Summary of clues for IF-α?• Increase NK activity• Increase MHC class I & II• Decrease protein synthesis• Decrease viral replication and growth
What are the clues for IF-B?• Where is it from?• FIBROBLASTS• Increase NK activity• Increase MHC class I & II• Decrease protein synthesis• Decrease viral replication and growth
What are the clues for IF-gama?
• Where is it from?• T-CELLS & NK CELLS• ↑ NK ACTIVITY
• ↑MHC CLASS I & II
• ↑ MACROPHAGE ACTIVITY
• CO-STIMULATES B-CELL GROWTH & DIFFERENTIATION
• ↓ IgE SECRETION
What are the clues for TNF-alpha?• Where is it from?• MONOCYTES & MACROPHAGES• What is another name for TNF-alpha?• CACHECTIN• INDUCES IL-1• ↑ ADHESION MOLECULES & MHC CLASS I ON
ENDOTHELIAL CELLS• PYROGEN• INDUCES IF-γ SECRETION• CYTOTOXIC/CYTOSTATIC EFFECT
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What are the clues for TNF-beta?• Where is it from?• T-CELLS
• What is another name for it?• LYMPHOTOXIN
• CYTOTOXIC FACTOR
What are the clues for TGF-α?• Where is it from?• SOLID TUMORS (CARCINOMA > SARCOMA)• MONOCYTES
• What is another name for it?• TRANSFORMING GROWTH FACTORS
What are the clues for TGF-α?
• What does it INDUCE?• ANGIOGENESIS
• KERATINOCYTE PROLIFERATION
• BONE RESORPTION
• TUMOR GROWTH
• What is it mainly for?• MAINLY FOR TUMOR GROWTH
What are the clues for TGF-β?• Where is it from?• PLATELETS• PLACENTA• KIDNEY• BONE• T & B CELLS
What are the clues for TGF-β?
• What INDUCES it?• FIBROBLAST PROLIFERATION• COLLAGEN• FIBRONECTIN SYNTHESIS
What are the clues for TGF-β?• What INHIBITS it?• NK• LAK• CTL• T & B CELL PROLIFERATION
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What are the clues for TGF-β?• What ENHANCES it?• WOUND HEALING • ANGIOGENESIS
What are the clues for TGF-β?• What does it suppress?• SUPPRESSES IR AFTER INFECTION & PROMOTES
HEALING PROCESS
• What is it mainly for?• MAINLY FOR WOUND HEALING
What does LAK stand for?• LYMPHOKINE ACTIVATED KILLER CELLS
What does CTL stand for?• CYTOTOXIC T-LYMPHOCYTES
What does mitochondrial inheritance affect?• CNS• Heart• Skeletal muscle
• Why does it affect these particular places?• Due to uneven cytokinesis during meiosis or oogenesis
Answer the following about Mitochondrial diseases?• Who are affected?
• All offspring
• Who passes the disease?
• MOM
• Who has no transmission?
• Dad
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Answer the following about Autosomal Recessive inheritance?• Who does it show in?• Not parents• Siblings/uncles may show disease
• When is onset?• Early in life (childhood diagnosis)
• Is it complete on incomplete penetrance?• COMPLETE
Answer the following about Autosomal Recessive inheritance?• How are they acquired?• Almost ALL are inborn error of metabolism
• When does it occur?• Only when both alleles at a locus are mutant
Answer the following about Autosomal Recessive inheritance?• How is it transmitted?
• Horizontal Tm
• Are there malformations present?
• Physical malformations are uncommon
• What type of defect?
• Enzyme defect
Answer the following about Autosomal Dominant inheritance?• Who does it affect the most?
• M=F
• How does it manifest?
• Heterozygote state
• Who can transmit the disease?
• Both parents
Answer the following about Autosomal Dominant inheritance?• Where is the new mutation?• Often in germ cells of older fathers
• When is onset?• Often delayed (adult diagnosis)
• Example = Huntington’s
Answer the following about Autosomal Dominant inheritance?• What is penetrance?• Reduced penetrance
• How is it expressed?• Variable expressin
• Different in each individual
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Answer the following about Autosomal Dominant inheritance?• How is it transmitted?
• Vertical TM
• Is there malformation present?
• Physical malformation common
• What type of defect?
• Structural
Who is affected in the family with an X-Linked disease?
• Maternal grandfather• Maternal uncle
Immune System Time Line for viral & cell-mediated.• What happens <24hrs?
• Swelling
• What happens at 24 hrs?
• Neutrophils show up
• What happens at day 3?
• Neutrophils peak
Immune System Time Line for viral & cell-mediated.• What happens at day 4?
• T cells and Macrophages show up
• What happens at day 7?
• Fibroblasts show up
• What happens in 1 month?
• Fibroblast peak
Immune System Time Line for viral & cell-mediated.• What happens at 3-6 months?• Fibroblasts are gone
What is the general CLUE for any Lysosomal Storage Disease?
• Lysosomal Inclusion Bodies
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What are the Lysosomal Storage diseases?• Gauchers• Fabrys• Krabbe• Tay Sachs• Sandhoffs• Hurlers• Hunters• Neiman Pick• Metachromatic Leukodystropy
What is missing in Gauchers?• Beta-Glucocerberosidase
• What Accumulates?• Glucocebroside
• Where?• Brain• Liver• Bone Marrow• Spleen
What are the CLUES for Gauchers?• Ask. Jew• Gargols• Gaucher cells
• Macrophages looking like Crinkeled paper
• Erlin myoflask legs• Pseudohypertrophy
What is missing in Fabrys?• Alpha-galactosidase
• What accumulates?• Ceramide Trihexoside
What are the CLUES for Fabrys?• X-Linked recessive• Presents with cataracts as a child• Presents with renal failure as a child
What is missing in Krabbes?• Galactosylceramide B-Galactosidase
• What accumulates?• Galactocerebrosidase
• Where?• Brain
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What are the CLUES for Krabbes?• Early death• Globoid bodies
• Fat cells
What is missing in Tay Sachs?• Hexoseaminidase A
• What accumulates?• GM2 Ganglioside
What is the CLUE for Tay Sachs?• Ask. Jews• Cherry red macula• Death by 3
What is missing in Sandhoffs?• Hexoseaminadase A & B
What is missing in Hurlers?• Iduronidase
What are the CLUES for Hurlers?• Corneal Clouding• Mental Retardation
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What is missing in Hunters?• Iduronate Sulfatase
What are the CLUES for Hunters?• Mild mental retardation• No corneal clouding• Mild form of Hurlers• X-linked recessive
What is missing in Niemann Picks?• Spingomyelinase
• What accumulates?• Spingomyelin • Cholesterol
What are the CLUES for Niemann Picks?• Zebra bodies• Cherrry red macula• Die by 3
What is missing in Metachromatic Leukodystrophy?• Arylsulfatase A
What is the CLUE for Metachromatic Leukodystrophy?• Visual Disturbance• Presents like MS in 5 to 10 years of age
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What are the Glycogen Storage Diseases?• Von Gierkes• Andersons• Corys• McCardles• Pompes• Hers
What is deficient in Von Gierkes?• G-6-Pase Deficiency
What is the CLUE for Von Gierkes?• Big Liver• Big Kidney• Severe hypoglycemia• Can NEVER raise their blood sugar
What is deficient in Andersons?• Branching enzyme deficiency
What is the CLUE for Andersons?• Glycogen will be ALL LONG chains on liver biopsy
What is missing in Corys?• Debranching enzyme
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What is the CLUE for Corys?• Glycogen from liver biopsy will be ALL SHORT branches
What is missing in McCardles?• Muscle phosporalase
What is the CLUE for McCardles?• Severe muscle cramps when exercising• High CPK
What is missing in Pompes?• Cardiac alpha-1,4 glucocydase
What is the CLUE for Pompes?• Heart problems• Die early
What is missing in Hers?• Liver phosphoralase
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What is the CLUE for Hers?• Big Liver• NO big kidney
Pagets disease is associated with what cancer?• Intraductal Ca
What MUST you rule out with a decrease AVO2?
• AV Fistula• Vasodilation
What diseases have a cherry red macula?
• Tay Sachs• Sandhoffs• Niemann Pick
What is translocation 9;22?• CML
What is translocation 11;22?• Ewing’s sarcoma
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What is translocation 8;14?• Burketts lymphoma
What is translocation 14;18?• Follicular lymphoma
What are the causes of restrictive cardiomyopathy?• Sarcoid• Amyloid• Hemochromatosis• Cancer• Fibrosis
• Thanks STAN!!
What are the CLUES for Vasulitis or Intravascular Hemolysis?• Shistocytes
• Burr cells• Helmet cells
What is the CLUE for Extravascular Hemolysis?• Splenomagely
Where is Glucose 6-Pase present?• Adrenal• Liver
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What is the Heinz body CLUE?• G6PD
If you see the CLUE basophilic stippling, what should you be thinking?• Lead poisoning
What are the Microcytic Hypochromic Anemias?• Iron deficiency• Anemia of Chronic disease• Lead poisoning• Hemoglobinopathy• Thallasemia’s• Sideroblastic anemia
What is primary sideroblastic anemia due to?• Genetic• AD
What is secondary Sideroblastic anemia due to?• Blood transfusions
What are the Microcytic Hyperchromic Anemia’s?• Hereditary Spherocytosis
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What are the Normocytic Normochromic Anemia’s?• Acute hemorrhage• Anemia of Chronic Disease• Hypothyrodism
• Early
• Renal Failure
What are the Macrocytic anemia’s?
• Folate deficiency
• B12 deficiency
• Reticulocytosis
• ETOH
• Hemolytic Anemias
• Chemo Treatment
• Anticonvulsants
• Myelodysplasia
What are the anticonvulsants causing a Macrocytic Anemia?• Phenytoin• Ethusuximide• Carbamyazapine• Valproate
What anemia is caused by blood transfusions?• Sideroblastic anemia
What is the problem if you see Eliptocytes?• Something is wrong with the RBC membrane
• Extravascular
• Heridatary Ellitocytosis• Increased RET count
What disease do you get if you have an EXCESS in Cu+?• Wilson’s Disease
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What is the CLUE for Wilson’s Disease?• Hepato/Lenticular Degeneration• Kayser Fleishner Rings
• Copper in eyes
• Hepato = Liver• Lenticular = Movement problem
What is Copper needed for?• Collagen synthesis
What disease manifest with Cu+ deficiency?• Minky Kinky Hair Syndrome
What are the plasma catecholamines?• Epinephrine• Norepinephrine• Dopamine
What are Plasma Catecholamines derived from?• Tyrosine
A patient with episodic HTN leading to headache with arrhythmias leading to palpitations most likely is diagnosed with?
• Adrenal Pheochromocytoma
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What is the MOA for Fluroquinolones?• Blocks DNA gyrase (topoisomerase II)• Inhibits p450
What do Fluroquinolones cover?• All Gram + including staph auerus• All Gram –• Atypicals
What are the atypicals?• Chlamydia• Ureoplasma• Mycoplasma• Legionella
What induces Gluconeogensis?• Cortisol• Epinephrine• Glucagon
What is Dermatan Sulfate?• Glycosaminoglycan chain that helps form proteoglycans
What is Hyaluronic Acid?• Glycosaminoglycan chain that helps form proteoglycans
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What is the MOA of Methotrexate?• Inhibits dihydrofolate reductase• Inhibits DNA synthesis in the S phase of cycle.• Prevents reduction of folic acid needed to produce THF
What are THF derivatives used in?• Purine nucleotide synthesis• Methylation of dUMP to for dTMP
What happens when Dihydrofolate Reductase is inhibited?• Obstructs one carbon methylation which deprives DNA
polymerase of essential substrates
What diseases present as Failure to Thrive?
• CF• Galactosemia
In general, what should you always associate Hemolytic Anemia’s with?
• Defects in Glycolysis• Defects in Hexose Monophosphate Shunt
What is required for the conversion of Homocysteine to Methionine?
• B12
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What is required for the conversion of methylmalonyl CoA to Succinyl CoA?
• B12
What is required for the degradation of cystathionine?• Vitamin B6
What does the hydroxalation of Purines require?• Vitamin C
When does the carboxyalation of Glutamic acid occurs and what is required for this carboxyalation?• Occurs in the synthesis of Blood Clotting factors• Requires Vitamin K
Decarboxylation of alpha-ketoacids requires what?
• Thiamine
Synthesis of 1,25-d-hydroxycholecalciferol requires what?
• Vitamin D
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Synthesis of Rhodopsin requires what?
• Vitamin A
Pyruvate Decarboxylase requires what as a cofactor?• Thiamine
What is CN1?• Olfactory• What is its function?• Sensory for smell• What if lesioned?• Anosmia• Where does it Exit/Enter the Cranium?• Cribriform plate• What does it innervate?• Nasal Cavity
What is CN2?
• Optic
• What is its function?
• Sensory for sight
• What if lesioned?
• Anopsia • Visual field defect
• Loss of light reflex with CN III
• Only nerve affected by MS
Cont. CN2• Where does it Exit/Enter the Cranium?• Optic Canal
• What does it innervate?• Orbit
What is CN3?
• Occulomotor
• What are the functions?
• Motor
• Moves the eyeball in ALL directions
• Adduction Most important action (MR)
• Constricts the pupil (Spincter Pupillae)
• Accomodates (Cililary Muscle)
• Raises eyelid (Levator Palpebrae)
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Cont. CN 3• What if lesioned?• Diplopia• Loss of parallel gaze• Dilated pupil• Loss of light reflex• Loss of near response• Ptosis
Cont. CN 3• Where does it Exit/Enter the Cranium?• Superior Orbital Fissure
• What does it innervate?• Orbit
What is CN 4?• Trochlear• What is its function?• Motor• Superior Oblique• Depresses and abducts the eyeballs• Intorts
Cont. CN 4• What if lesioned?• Weakness looking down w/ adducted eye• Trouble going down stairs• Head tilts away from lesioned side
• Where does it Exit/Enter the Cranium?• Superior Orbital Fissure
Cont. CN 4• What does it innervate?• Orbit
What is CN 5?• Trigeminal
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What are the different branches of CN 5?• V1?
• Opthalmic
• V2?
• Maxillary
• V3?
• Mandibular
What is the function of CN V1?
• Mixed• General sensation (touch, pain, temperature) of the
forehead, scalp, & cornea
• What if lesioned?• Loss of general sensation of the forehead/scalp• Loss of blink reflex w/ VII
• Where does it Exit/Enter the Cranium?• Superior orbital Fissure
• Ophthalmic division
Cont. CN V1• What does it innervate?• Orbit• Scalp
What is the function of CN V2?• Mixed• General sensation of Palat, Nasal cavity, Maxillary face,
and Maxillary teeth
• What if lesioned?• Loss of general sensation in skin over maxilla & maxillary
teeth
Cont. CN V2• Where does it Exit/Enter the Cranium?• Foramen Rotundum
• What does it innervate?• Pterygopalatine
• Leaves by openings to face, oral & nasal cavity
What is the function of CN V3?
• What is its function?
• Mixed
• General sensation of anterior 2/3 of tongue, mandibular face & mandibular teeth
• Motor
• Muscles of Mastication and anterior belly of digastric, mylohyoid, tensor tympani, tensor palati
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Cont. CN V3• What if lesioned?• Loss of general sensation in skin over mandible,
mandibular teeth, tongue, weakness in chewing• Jaw deviation to weak side• Trigeminal neuralgia
• Intractable pain in V2 or V3 territory
Cont. CN V3• Where does it Exit/Enter the Cranium?• Foramen Ovale
• What does it innervate?• Infratemporal Fossa
What is CN VI?• Abducens
• What is its function?• Motor• Lateral rectus
• Abducts eye
Cont. CN VI• What if lesioned?• Diplopia
• Internal strabismus• Loss of parallel gaze
• Pseudoptosis
• Where does it Exit/Enter the Cranium?• Superior orbital fissure
• What does it innervate?• Orbit
What is CN VII?• Facial• What is its function?• Mixed• To muscles of facial expression• Posterior belly of diagastric• Stylohyoid & Stapedius• Tastes anterior 2/3 of tongue/palate• Salivates (submandibular & sublingual glands)• Tears (Lacrimal glands)• Makes mucous (nasal & palatine glands)
Cont. CN VII• What if lesioned?• Corner of mouth droops• Can’t close eye• Can’t wrinkle forehead• Loss of blink reflex• Hypeacusis• Loss or alteration of taste (ageusia)• Eye dry and red• Bell Palsy
• Lesion of nerve in facial canal
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Cont. CN VII• Where does it Exit/Enter the Cranium?• Internal Auditory meatus
• What does it innervate?• Face• Nasal & oral cavity
• Branches leave skull in stylomastoid foramen, petrotympanic fissure, or Hiatus of facial canal
What is CN VIII?• Vestibulocochlear
• What is its function?• Sensory• Hears• Linear acceleration (Gravity)• Angular acceleration (Head Turning)
Cont. CN VIII• What if lesioned?• Loss of Balance• Nystagmus
• Where does it Exit/Enter the Cranium?• Internal Auditory Meatus
• What does it innervate?• Inner ear
What is CN IX?
• Glossopharyngeal
• What is its function?
• Mixed
• Sense Pharynx
• Carotid sinus/body
• Salivates (parotid glands)
• Tastes and senses posterior 1/3 of tongue
Cont. CN IX
• What is its function?
• To one muscle only (stylopharyngeus)
• What if lesioned?
• Loss of Gag Reflex with X
• Where does it Exit/Enter the Cranium?
• Jugular Foramen
Cont. CN IX• What does it innervate?• Neck• Pharynx/Tongue
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What is CN X?• Vagus• What is its function?• Mixed• To muscles of palate & pharynx for swallowing except tensor palate (V) & Stylopharynegeus (IX)
• To all muscles of Larynx (phonates)• Senses Larynx & Laryngopharynx• Senses Larynx & GI tract• To GI tract smooth muscle & glands in forgut & midgut
Cont. CN X• What if lesioned?• Nasal speech• Nasal regurgitation• Dysphagia• Palate drop• Uvula points away from pathology• Hoarseness/fixed vocal cord• Loss of gag reflex w/ IX• Loss of cough reflex
Cont. CN X• Where does it Exit/Enter the Cranium?• Jugular Foramen
• What does it innervate?• Neck• Pharynx/Larynz• Thorax/Abdo
CN X – Sympathetics to Head• What is its function?• Motor• Raises eyelid (superior tarsal muscle)• Dilates pupil• Innervates sweat glands of face & scalp• Constricts blood vessels in head
Cont. CN X• What if lesioned?• Horner syndrome
• Eyelid droop (ptosis)
• Constricted pupil (miosis)• Loss of sweating (anhydrosis)
• Flushed face
Cont. CN X• Where does it Exit/Enter the Cranium?• Carotid canal on internal carotid artery
• What does it innervate?• Orbit• Face • Scalp
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What is CN XI?• Accessory
• What is its function?• Turns head to opposite side
• sternocleidomastoid
• Elevates & Rotates scapula• Trapezius
Cont. CN XI• What if lesioned?• Weakness turning head to opposite side• Shoulder droop
• Where does it Exit/Enter the Cranium?• Jugular Foramen
• What does it innervate?• Neck
What is CN XII?
• Hypoglossal
• What is its function?
• Moves tongue
• What if lesioned?
• Tongue points toward pathology on protrusion
What is CN XII?• Where does it Exit/Enter the Cranium?• Hypoglossal Canal
• What does it innervate?• Tongue
What are the muscles of mastication?• Temporalis• Masseter• Medial Pterygoids• Lateral Pterygoids
What part of the brain deals with problem solving?• Frontal Lobe
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What happens if there is a lesion to the Optic nerve?• Unilateral Blindness
What happens if there is a lesion to the Optic Chiasm?• Bitemporal Hemianopia
What is a Berry Aneurysm due to in the Circle of Willis?• SUBARACHNOID Hemorrhage
What is a CLUE for SUBARACHNOID Hemorrhage?• The worse headache of my life
What effect does Pernicious Anemia have on the nervous system?
• Causes degeneration of the posterior columns• Causes degeneration of the CST• Loss of proprioception• Upper motor neuron defect
What does the diencephalon originate from?• Forebrain
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What originates from the Diencephalon?• Thalamus• 3rd Ventricle
Where does the Telencephalon originate from?• Forebrain
• Prosencephalon
What originates from the Telencephalon?• Cerebral Hemispheres• Lateral Ventricles
What originates from the Mesencephalon?• Midbrain• Aqueduct
What originates from the Hindbrain?• Metencephalon• Myerencephalon
What originates from the Metencephalon?• Pons• Cerebrum
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What originates from the Myerencephalon?• Medulla
What does the Jugular Foramen contain?• CN IX• CN X• CN XI• Internal Jugular Vein• Spinal accessory nerves
What does the Foramen Spinosum contain?• Middle menningeal artery
• Branch of the maxillary artery
What does the Foramen Ovale contain?
• CN V3
What does the Foramen Magnum contain?• Vertebral arteries• Brain stem• Spinal roots of CN XI• Spinal cord
What does the Optic Canal contain?
• Opthalmic artery• Central retinal vein• CN II
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What does the Hypoglossal Canal contain?• CN XII• Hypoglossal nerve
What does the Carotid Canal contain?• Internal Carotid artery
What does the Posterior Condylar Canal contain?
• Large Emissary Vein
What are signs of an UPPER motor neuron damage?• + Babinski sign• Spastic Paralysis• Hyperactive Deep Tendon Reflexes
What are signs of a lower motor neuron defect?
• Atrophy• Fasciullations• Flaccid Paralysis• Loss of deep tendon reflexes
What does it mean to see a physis on radiograph?• Means the skeleton is not fully mature
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When does Physis disappear?• Once growth is complete
What is a nonunion fracture?• Fracture that does not heal with in 6 months
What does Malunion mean?• A fracture that heals in an Abnorman position
What is a characteristic feature of cancellous (spongy) bone?• Trabeculae
Which CN’s control eye movement?• CN III
• Oculomotor nerve
• CN IV• Trochlear nerve
• CN VI• Abducens nerve
What CN is responsible for turning the head and shrugging the shoulders?• CN XI
• Accessory nerve
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What CN has sensory fibers for Face and Motor fibers for muscles of mastication? • CN V
• Tigeminal Nerve
What CN controls tongue movement?
• CN XII• Hypoglossal nerve
What CN controls sensory fibers for Vison
• CN II• Optic nerve
What CN senses fiber for smelling?• CN I
• Olfactory
What does the Mesenteric Artery Supply?
• Distal 1/3 of transverse colon• Descending colon• Sigmoid colon• Upper Portion of Rectum
What does the Superior Mesenteric Artery Supply?• Duodenum• Jejunum• Ileum• Cecum• Appendix• Ascending colon• Proximal 2/3 of transverse colon
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What does the common Iliac artery supply?
• Pelvis• Perineum• Leg
What does the Celiac trunck give rise to?• Left gastric artery• Splenic artery• Common hepatic artery
What do the Left. Gastric Artery, Splenic Artery, & Common Hepatic artery supply?• Esophagusa• Stomach• Duodenum• Liver• Gallbladder• Pancreas
If there is a lesion in the frontal lobe will you have motor or sensory defects?• Motor
If patient has a visual field defect with cognitive Distrubance, what part of the brain will be affected?• Temporal or Partial Lobe