Transcript
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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
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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.
Fabrys
Hunters
Lesch-nyhan
Lesch-Nyhan Hunter Puts Fabrys on G6 Clothes
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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, Goodpastures, MS
HLA-DR3= DM, Chronic Active Hepatitis, Sjogrens, 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, Reiters, PostgonococcalArthritis
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
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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 fragilisWhat 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 CAs
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
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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
Addisons 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
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What are the Killed Vaccines?
SIR Hep A
Salk (polio)
Influenza
Rubella
Hepatitis A
What are the IgA Nephropathies?
Henoch-Schoenlein P. (HSP)
Alports
Bergers
What are the Drugs that cause Autoimmune hemolytic anemia?
PCN
-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 2nd MI enzyme to appear?
CK-MB
Appears
Peaks
Gone
6 hrs
12 hrs
24 hrs
What is the 3rd MI 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
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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
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
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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
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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?
Metronidazole2 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?
IncreasedWhat type of acidosis do you see with obstructive pulmonary dz?
Respiratory acidosis
What are the Lysosomal Storage Disease & what is the deficiency?
Fabrys
Krabbes
Gauchers
Niemann Pick
Tay-Sachs
Metachromatic leukodystrophy
Hurlers
Hunters galactosidase
Galactosylceramide
glucocerebrosidase
Sphingomyelinase
Hexosaminidase
Arylsulfatase
L iduronidase
Iduronidase sulfatase
What dzs are associated with HLA B27?
Psoriasis
Ankylosing spondylitis IBD (Ulcerative colitis)
Reiters Syndrome
What HLA is Psorisis w/RA associated with?
HLA-13
What are the Glycogen Storage Diseases & the deficiency?
Von Gierkes
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Pompes
Coris
McArdles
Glucose 6 phosphate
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
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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 its 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
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What Autoimmune Disease has the following Autoimmune Antibodies?
Anti-GBM?
Goodpastures
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?
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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?
Hashimotos
What Autoimmune Disease has the following Autoimmune Antibodies?
Anti-smooth muscle?
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Anti-scl-70?
Scleroderma
What Autoimmune Disease has the following Autoimmune Antibodies?
Anti-rho (SS-A)?
Anti-la?
Sjogrens
What Autoimmune Disease has the following Autoimmune Antibodies?
Anti-proteinase?
C-ANCA?
Wegeners
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?
Kaposis 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 progressiveglomerulonephrosis?
Goodpastures
What is the most common malignant renal tumor in children?
Wilms 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
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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 pts 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
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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 anemiaWhat is the #1 cause of anaphylaxis?
Penicillin
What are the Chrons 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
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They are -ve stranded = dont 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
Ebsteins 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?
Ebsteins 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?
Brutons 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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Brutons agammaglobulinemia
CVID (Common Variant Imm. Def)
Leukemias
Lymphomas
SCID
WAS
Job Buckley Syndrome
What is the Tyrosine kinase deficiency?
Brutons 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 (Burkitts 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
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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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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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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
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Lungs?
Osler Weber Rendu Syndrome
What is the Ransons criteria for acute pancreatitis (at admission)?
Glucose > 200
Age > 55
LDH >350
AST > 250
WBC > 16,000
What is the Ransons criteria for acute pancreatitis (at less than 48 hrs)?
Calcium 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
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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
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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?
IgGWhat 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 diseaseWhat disease corresponds with the following inclusion bodies?
Howell-Jolly?
Sickle cell
Heinz?
G-6-P-D
Zebra?
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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?
Picks 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?
Krabbes 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
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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?
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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 Alzheimers disease/Downs?
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 Picks dis?
Frontotemporal dementia
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Describe Picks 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
Cant reabsorb
Low energy state causing anemia
Can be due to old tetracycline
Where is glutaminase found?
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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
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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 andeukaryotes
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, proteinsC & 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 its zone?
Green
What type of hemolysis is beta-hemolysis?
Complete hemolysis
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Hemolytic properties of Streptococcus:
What color is its zone
Clear
eg. Streptokinase
What type of hemolysis is gamma-hemolysis?
No hemolysis
What color is its 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
BovisWhat Steptococcus has green pigment?
Viridans
What Streptococcus causes SBE?
Viridans
What Streptococcus causes cavities?
Mutans
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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 likelybugs?
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?
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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 UTIs after 24?
Because women are use to penises and Staph saprophyticus lives on penis (becomes part ofnormal 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 its DNA into bacteria
What is transformation?
Virus injects its 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 withencapsulated 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
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What do you see in Renal failure and what are the values?
BUN
10-15
Fractional Na+ excretion
>2%
Creatinine
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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 DeQuervains?
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 cellsWhat is another name for Temporal arteritis?
Giant cell arteritis (granulomatous)
What is another name for Waldenstroms 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
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Burkitts
HHV V causes?
CMV
Inclusion bodies
HHV VI causes?
Roseola Duke Disease
Exanthem subitum
HHV VII causes?
Pityriasis rosea
HHV VIII causes?
Kaposis 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 viavitamin 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?
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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
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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
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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)
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Pseudounipolar cells
Spiral membrane of heart
Chromaffin cells
All Ganglion cells (Schwann, Adrenal medulla)
Melanocytes
Laryngeal/Tracheal cartilage
What are the triple repeat diseases?
Huntingtons
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 Ds 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?
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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?
Whipples
Adult male or female?
Crohns
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
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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
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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
Oslers nodes
Splinter hemorrhages
Endocarditis
Where are the following lesions found?
Janeway lesions? Toes
Oslers 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?
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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
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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
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?
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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
MS5 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
Reiters
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
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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
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- GammaWhat does TH2 Secrete?
IL-4
IL-5
IL-6
IL-10
What does TH-0 secrete?
TH-1
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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 forVLDL. 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
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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?
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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
What is the job of CHYLOMICRONS?
Transport TGs from GI to liver and endothelium
What is the job of VLDL?
Transports TGs from liver to adipose
What is the job of IDL?
Transports TGs from adipose to tissue
What is special about LDLs?
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 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
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 followingages?
0-2 months?
#1. Group B strep (agalactiae)
#2. E. coli
#3. Listera
What are the most common causes of MENINGITIS corresponding with the followingages?
2 Months- 10 years?
#1. strep pneumonia
#2. n. meningitides (adolescent years only)
What are the most common causes of MENINGITIS corresponding with the followingages?
10yrs- 21 yrs?
#1. n. meningitides
What are the most common causes of MENINGITIS corresponding with the following
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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)
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
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Female
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 bedue 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
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?
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POSITIVE HbS antigen
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
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?
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1500
When do you begin treating with 2 nucleotide inhibitors and 1 protease inhibitor?
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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?
Wernickes Encephalopathy
Wernickes Korsakoff
What is Wernickes Encephalopathy?
Alcoholic thymine deficiency of the Temporal Lobe
What is Wernickes 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
What is the disease that presents like B3 deficiency?
Hartnup Disease
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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 itnothing
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
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?
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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
What are the 4 DS 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
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
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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
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
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Tin
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+
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
What enzyme does Zanthein Oxidase need?
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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 PS 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
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
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Chymotrypsin cuts where?
cuts to R of bulky aas (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
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
What 2 substances are in NEUTROPHILS?
Myeloperoxidase
NADPH Oxidase
617
618
619
620
621
622
623
624
625
7/31/2019 Usmle Clues
73/86
3/29
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?
Leighs Disease
What is another name?
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