Pass Program Clues
“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
What are the Comma Shaped bugs? • Vibrio • Campylobacter • Listeria • H. pylori 1 2 3 4 5 6 7 752 753 754 755 756 757 758 759 760 761 762 763 764 765 766 767 768 769 770 771 772 773 774 775 776 777 778 779 780 781 782 783 784 785 786 787 788 789 790 791 792 793 794 795 796 797 798 799 800 801 802 803 804 805 806 807 808 809 810 811 812 813 814 815 816 817 818 819 820 821 822 823 824 825 826 827 828 829 830 831 832 833 834 835 836 837 838 839 840 841 842 843 844 845 846 847 848 849 850 851
•
• 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 •
What drugs Inhibit p450? • I Do SMACK Quinolones • INH • Dapsone • Spirolactones • Macrolides • Amiodarone • Cimetidine • Ketoconazole • Quinilones
What drugs are P450 Dependent? • Warfarin 8 9 10 11 12 1 2 13 1 2 14
• 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
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
15 16 17 18 19 20 21 22
• •
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) •
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 23 1 2 24 25 26 27 28
• 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
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?
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• Papillary carcinoma of the Thyroid • Serous cystadenocarcinoma of the ovary • Meningioma
• Mesothelioma
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
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 37 38 39 40 41 42 43 44 45 46 1
• 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
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 • 2 47 48 49 1 2 50 1 2
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
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 2ndMI enzyme to appear?
• CK-MB • Appears • Peaks • Gone • • 6 hrs • 12 hrs • 24 hrs
What is the 3rdMI enzyme to appear?
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• 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
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
What are the SE of Loops and Thiazides? • Hyperglycemia
• Hyperuricemia • Hypovolemia • Hypokalemia
What are the SE of Loop diuretics? • OH DANG • Ototoxicity • Hypokalemia 1 2 59 60 61 62 63 64 65 66 67 68 1 2
• 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 69 1 2 70 1 2 71 72
What are the different 2ndmessenger 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
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 73 74 75 76 77 78 79 80 81 82
• 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
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
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 83 84 85 86 87 88 89 90 91 92 93
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? • Azithromycin
1 gram po
What is the one dose tx for Candidiasis? • Ketoconazole
150mg
What is the one dose tx for Vaginal Candidiasis? • Difluccan
1 pill
What is the one dose tx for Trichomonas? • Metronidazole
2 grams
What is the one dose tx for Gardnerella? • Metronidazole
2 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
What are the 2 enzymes needed to make glycogen? • Glycogen synthase
• Branching enzyme
What are the branching enzymes? • Glycogen alpha-1,4 glycosyl transferase
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• 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
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 105 106 107 108 109 1 2 110 111 112 1
• 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 •
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 2 113 114 115 116
• 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
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 117 118 119 120 121 122 123
• •
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
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 •
What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-ACh receptor? 124 125 126 127 128 129 130 131 132 133
• 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
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? 134 135 136 137 138 139 140 141 142 143 144
• Anti-scl-70? • Scleroderma •
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? Burkitts Nasopharyngeal 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)
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• Clot off lots of nephrons? Rapidly Progressive GN
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
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 151 152 153 154 155 156 157 158 159 160 161
• Central lines • Fistulas
What is Alopecia Areata? • Loss of a patch of hair 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
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 162 163 164 165 166 167 168 169 170 171 172 173 174
• 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
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 175 176 177 178 179 180
• They are -ve stranded = don’t have to switch to positive before replicating 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 •
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?
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• 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 Tumor Markers/Oncongenes II • C-myb? • Colon CA • AML • C-sis ? • Osteosarcoma • Glioma • Fibrosarcoma
Tumor Markers/Oncongenes III
189 190 191 192 193 194
• 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 What is cancer staging?
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196
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• 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
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201
202
What is carried by VLDL? • Apo B-100 • Apo E • Apo C II • • Triglcyerides (95%) • Cholesterol (5%) 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
204 205 206 207 208 209
• 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
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
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 • 210 211 212 213 214 215 216 217 218
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 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 • 219 220 221 222 223 224 225 226 227 228
• When does IgG leave? • In 1 year
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
What disease corresponds with the following inclusion bodies? • Howell-Jolly? • Sickle cell • Heinz? • G-6-P-D • Zebra? 229 230 231 232 233 234 235
• 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 236 237 238 239 240
•
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 241 242 243 244 245 246
• What are examples of Type IV? • TB skin test
• Contact dermatitis • Transplant rejection
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 247 248 249 250 251 252
• Clostridium tetani
• Clostridium melangosepticus • What is the chemical in spores? • Calcium dipocholinate
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
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 253 254 255 256 257 258 259 260 261
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 •
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?
262 263 264 265 266 267 268 269 270
• In the collecting duct of the kidney •
• What does glutmainase help the kidney absorb? • Ammonia if the liver fails
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
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
271 272 273 274 275 276 277 278
•
• 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 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 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 279 280 281 282 283 284 285 286 287 288 289
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
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 290 291 292 293 294 295 296 297 298
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
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? 299 300 301 302 303 304 305
• Injected in different areas of body The Most common cause of UTI is? • E. coli
• Followed by? • Proteus • Followed by? • Klebsiella
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 306 307 308 309 310 311 312
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
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 • >40 313 314 315 316 317 318 319 320 321 322 323
What do you see in Renal failure and what are the values? • BUN
• 10-15
• Fractional Na+ excretion • >2%
• Creatinine • <20
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
What is another name for Addison’s? • Primary Adrenocoritcal Insufficiency
What is another name for Alkaptonuria?
324 325 326 327 328 329 330 331 332
• 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
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)
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 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347
• Burkitt’s HHV V causes? • CMV • Inclusion bodies 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 •
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? 348 349 350 351 352 353 354 355 356
• 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
•
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 357 358 359 360 361 362
•
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
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
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 363 364 365 366 367 368 369 370 371 372 373 374 375
• 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 •
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) 376 377 378 379 380 381 382 383
• 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)
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
What is happening in the Atrium? • Phase 0? • Depolarization • Phase 1? • No name • Phase 2? 384 385 386 387 388 389 390 391
• 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%
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 392 393 394 395 396 397 398 399 400 1
• 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
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
What are 3 enzymes seen ONLY in glycolysis? • Hexokinase • PFK-1 • Pyruvate kinase 2 401 1 2 402 403 404 405 406 407 408 409
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
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?
410 411 412 413 414 1 2 415 416 417 418 419 420
• From virus via transduction 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
421 422 1 2 423 1 2 424 425 426
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
In EKG P-wave Represents? • Atrium contraction
• Phase zero • Calcium
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?
427 428 429 430 431 432 433 434 435 436 437
• Ventricle • Phase 2 • Calcium
In EKG T-wave means? • Ventricle
• Phase 3 • Potassium •
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
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?
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• Psoriasis
– only if with arthritis • Ankylosing Spondylities • IBD
– Ulcerative Cholitis • Reiter’s
• Post gonococcal arthritis 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
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 451 452 453 454 455 456 457 458 459
• 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
• 2ndto 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 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
What does TH-0 secrete? • TH-1 460 461 462 463 464 465 466 467 468 469
• 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+ 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
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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
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 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 480 481 482 483 484 485 486 487 488 489 490 491
PSORIASIS • HLA-B27
• Extensor surfaces • Silvery white plaques • Scaly skin • Pitted nails 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
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?
492 493 494 495 496 497 498 499 500 501 502
• DiGeorges
• What ion imbalance will they have? • Hypokalemia
• What did not form?
• 3rdand 4thpharyngeal 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 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
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?
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• 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 2ndmost common type?
• TYPE B – 20%
• Encapsulated or non encapsulated? • Encapsulated
• What does it have in its capsule? • Polyribosyl phosphate in capsule • Contains IgA protease
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
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