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346 Cards in this Set
- Front
- Back
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Rhinovirus belongs to the picornavirus family. It is a non-enveloped RNA virus where the genome acts directly as mRNA.
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C
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Koplick's spots are virtually diagnostic of the measles. Fatal encephalitis is a possible complication of measles infection.
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C
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Acute post-streptococcal glomerulonephritis can occur several weeks after a skin infection caused by Streptococcus pyogenes.
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c
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Giardia lamblia is a protozoan that causes profuse watery diarrhea in people that recently went on a camping trip and drank stream water. The cysts are in water and are ingested, causing foul-smelling diarrhea.
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c
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Creutzfeldt-Jacob disease is caused by prions. Clinically, it causes a rapidly progressive dementia, myoclonus and death usually within the first year. The associated pathology is spongiform encephalopathy in which the brain becomes vacuolated.
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c
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Organophosphate poisoning can be tested for rapidly using atropine to determine the correct treatment.
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Baclofen is a spasmolytic commonly used for cerebral palsy. It binds GABA-b receptors and reduces the release of excitatory neurotransmitters.
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Loratadine is a second generation antihistamine which doesn’t cause as much sedation as the first generation drugs.
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Probenecid is used to treat chronic gout when the cause is under-secretion of uric acid as shown by low levels in the urine. High levels of uric acid in the urine indicate that allopurinol is the appropriate drug.
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Buspirone is an anxiolytic that is not a benzodiazepine thus it doesn’t cause sedation, CNS depression or dependence.
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This man has acute bacterial prostatitis. The initial treatment is antibiotics that are active against the most common bacterial agent, E-coli
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The most common bacterial cause of prostatitis is E-coli which can be treated with doxycycline, ciprofloxacin or trimethoprim-sulfamethoxazole
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Metoclopramide is a prokinetic drug that stimulates peristalsis. It works by blocking dopamine receptors and can have extrapyramidal side-effects
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Diphenhydramine is a H1-blocker used for allergies. It causes sedation and has strong antimuscarinic effects.
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This woman is experiencing serotonin syndrome due to the fact that she is currently on both sertraline, an SSRI, and isocarboxazid, a MAO inhibitor. The treatment is cyproheptadine which is a 5-HT2 receptor antagonist.
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Defense against pyogenic bacteria with polysaccharide capsules (the 3 major ones are S. pneumoniae, H. influenzae and N. meningitidis) depends mostly on antibody-mediated (humoral) immunity.
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Plasma cells are derived from B-cells and secrete antibodies, which are the most important defense against bacteria with polysaccharide capsules.
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. Gardnerella vaginalis is a pleomorphic, gram-variable rod that demonstrates squamous cells studded with bacteria, or “clue cells,” upon on microscopic examination and is thought to be the cause of bacterial vaginosis (BV) (A). BV doesn't demonstrate severe cervical inflammation, the discharge is more watery and gray and it is not thought to be sexually transmitted
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A sexually active female with a frothy, foul-smelling greenish discharge should be suspected of having a Trichomonas vaginalis infection. The organism is a motile protozoan.
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Metronidazole is the drug of choice in treating infections caused by Trichomonas vaginalis, a motile protozoan causing itching, burning, and a greenish, frothy discharge.
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Fluconazole is the prophylactic drug of choice for Cryptococcal meningitis in AIDS patients when the CD4 drops below 100/uL.
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CEA is the tumor marker for colorectal cancer. On barium enema this lesion looks like an “apple-core” and is very characteristic. The typical case is in someone over 50-years-of age, has blood in his or her stool and has caused iron deficiency anemia.
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CA-125 is a tumor marker for ovarian carcinoma.
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Scaled-skin syndrome is a toxin-mediated disease caused by Staphylococcus aureus. It causes painful blistering due to splitting the epidermis at the stratum granulosum.
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2/3 of patients with hematochromatosis have the human leukocyte antigen A3
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Ondansetron works well for nausea caused by chemotherapy and/or surgery. 5-HT3 blocker
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Streptococcus pyogenes is catalase-negative with clear beta-hemolysis and bacitracin sensitive.
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Negri bodies are intracytoplasmic neuronal inclusions characteristic of rabies virus infection.
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The rabies virus is a bullet-shaped virion containing a single-stranded RNA genome.
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Meningitis with a petechial rash and shock is caused by Neisseria meningitidis.
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Bottom line:
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Sander's loves the wang
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Waterhouse-Friderichsen syndrome is characterized by DIC and hemorrhagic necrosis of the adrenal glands caused by meningococcemia.
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The viscero-somatic reflex for the adrenal gland is T10-T12.
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he first line medication for cholinesterase inhibitor poisoning includes atropine and the second medication that is used is pralidoxime.
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Terbinafine is the most effective pharmacotherapy for onychomycosis.
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Candida albicans causes vulvovaginitis in women and diaper rash in babies.
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A common cause of urinary tract infections in sexually active women is due to S. saprophyticus, which is a catalase positive, coagulase negative, gram-positive cocci in clusters.
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Those diabetics with recurrent history of ketoacidosis are at a high risk for mucur and rhizopus frontal lobe absesses
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Patients with C1 esterase inhibitor deficiency (also known as hereditary angioedema) present with episodes of angioedema and severe laryngeal edema that could be life-threatening
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Microtubule dysfunction is associated with Chediak-Higashi syndrome, which increases the risk of a variety of infections, not particular for Neisseria The classic clue for Chediak-Higashi is immunodeficiency associated with albinism
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Chronic hepatitis B increases the risk for polyarteritis nodosa.
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The two most common organisms that cause PID are N. gonorrhoeae and C.trachomatis. Empirical therapy should provide coverage against both.
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Goodpasture syndrome can cause a rapidly progressive glomerulonephritis (RPGN) also known as cresentic glomerulonephritis.
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CRP is an anti-inflammatory protein produced in the liver during an acute inflammatory process. Cirrhosis of the liver would complicate the production and release of CRP.
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The presence of a delta wave on ECG is a sign of Wolff-Parkinson-White syndrome. It is caused by an accessory pathway in the heart that can cause a re-entry circuit and result in palpitations tachycardia.
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The anteroseptal region of the heart is supplied by the left anterior descending artery, a branch off the left main coronary artery, which supplies majority of the left side of the heart.
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Sinus tachycardia is defined as a ventricular rate greater then the upper limit of normal for the age of the patient and the presence of a P before every QRS with a normal P-R interval.
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First degree AV block is a uniformly prolonged PR interval on ECG (greater than 200-msec or one large square).
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Long-standing chronic hypertension leads to left-sided heart failure and the back-up of blood to the lungs results in hemosiderin-laden macrophages.
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IV drug users are at risk for infective endocarditis of the right-sided valves. The most common organism for the acute form is Staphylococcus aureus.
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Two thirds of the cardiac cycle is spent in diastole. As the heart rate increases the time spent in diastole falls more rapidly than systole.
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ACE-inhibitors, such as captopril, have been shown to improve survival in post-MI patients.
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ST-elevations in leads V1-V5 represent ischemia to the anterior heart due to a ruptured plaque in left anterior descending artery (E).
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Lidocaine blocks sodium channels and slows depolarization in ischemic tissue only. The most common adverse effects involve the CNS.
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Amiodarone is the anti-arrhythmic drug for ventricular arrhythmias that prolongs the action potential
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Metabolic acidosis is expected when there is adrenal insufficiency
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Aldosterone deficiency leads to hyperkalemia which can manifest as peaked T waves on the EKG.
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Pt with CML has a 70% chance of progressing to AML
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Familial Rb related to Rb gene (13q14). They are at increased risk of developing osteosarcoma
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Atopic dermatitis characterized by chronic/relapsing course. Lesions described as red, papulovesicular, and exudative. Infants and kids present with it on the face and extensor surfaces
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Prior mediastinal radiation, esophogeal cancer, are likely to have constrictive pericarditis. sxs pulsus paradoxus, JVD. dx with transthoracic echo
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Viscerosomatic reflex of the kidney = T9-L1
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Long-term memory consolidation occurs in delta sleep
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Bed wetting occurs in delta sleep
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Night terrors occur in stage 4 sleep
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Verapamil is a calcium channel blocker that decreases cardiac output and could lead to AV block and exacerbate congestive heart failure.
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Finasteride is a 5-alpha reductase inhibitor that decreases dihydrotestosterone levels by decreasing its conversion from testosterone. Gynecomastia is a side effec
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Gastric acid production is most directly and effectively inhibited by proton pump inhibitors. These agents inhibit the release of hydrogen ions from the H+/K+ATPase pump.
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Morphine is contraindicated for the pain associated with biliary colic.
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A large Vd indicates that the drug is distributed widely throughout the body thus a smaller percent remains in the plasma. The minimum Vd is the plasma volume.
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The spinal level of the triceps reflex is C7 and the biceps is C5.
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Methylprednisone, given within 8-hours of an acute spinal cord injury, reduces the risk of permanent damage
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Syringomyelia causes central cord syndrome, usually at the cervical levels, which presents as loss of pain and temperature sensation in upper extremities.
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Allopurinol interferes with the metabolism mercaptopurines thus greatly increasing their toxicity.
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Bethanechol is a selective muscarinic receptor agonist that can cause diarrhea and urinary incontinence.
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Leucovorin, a folinic acid analog, is used to reverse the adverse effects of methotrexate therapy.
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Valprioc acid is the first line treatment for tonic-clonic seizures, but its use is contraindicated in pregnancy due to its potential to cause neural tube defects including spina bifida.
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Statins inhibit HMG-CoA reductase, the rate-limiting step in cholesterol biosynthesis.
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econd-generation antihistamines such as loratadine (Claritin) have less sedating effects than first-generation antihistamines such as diphenhydramine (Benadryl).
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The anti-tuberculosis drug that can cause optic neuritis is ethambutol.
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Niacin inhibits lipolysis in adipose tissue and reduces VLDL that is released into the circulation by the liver.
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onstipation, miosis, nausea and decreased respiration rate are common side-effects of opioids.
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The effect on the unborn is a key factor regarding which drugs to use in pregnant women. Pregnancy category D means that there is evidence of fetal risk, but potential benefits may outweigh these risks
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Methimazole inhibits the addition of iodine to tyrosine residues and the coupling reactions to form T3 and T4.
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Hydroxyurea can prevent painful occlusive crises in sickle cell disease. It is an anti-neoplastic agent which causes an increase in fetal hemoglobin.
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Methotrexate slows the progress of joint destruction in rheumatoid arthritis but it can be hepatotoxic.
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Osteopenia/osteoporosis treatments are not benign, and key side effects of the main medicinal therapies are DVT/PE. An alternative to SERMs and bisphosphonates is calcitonin.
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Phenytoin taken during pregnancy can cause microcephaly, midfacial abnormalities and hypoplasia of the finger and toe nails.
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The drug of choice for ADHD is methylphenidate which increases norepinephrine release.
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Chronic alcohol consumption induces P450s while acute intoxication inhibits P450s.
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Benzene exposure can cause aplastic anemia
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ACE-inhibitors slow the progression of diabetic nephropathy and thus are the initial drug of choice for diabetics with hypertension
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Here are more "must know" things about ACE-inhibitors. 1) cough and angioedema are possible side-effects 2) they cause hyperkalemia 3) they increase survival in congestive heart failure 4) they are contraindicated in bilateral renal artery stenosis
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Lovastatin inhibits cholesterol synthesis in the liver thus stimulating LDL receptor expression to uptake cholesterol from the periphery.
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The benzodiazepines lorazepam and oxazepam are safe to use in liver dysfunction because they are metabolized outside the liver.
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Phenelzine is in the class of antidepressants known as monoamine oxidase inhibitors (MAOIs).
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Patients taking MAOIs must avoid foods high in tyramine, such as aged cheese, red wine, and cured meats.
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Muscarinic receptors on blood vessels relax smooth muscle by stimulating NO. There is no nerve synapse for these receptors thus acetylcholinesterase inhibitors cannot produce the same effect.
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Acetazolamide causes a non-anion gap hyperchloric metabolic acidosis. It can worsen or precipitate hepatic encephalopathy in patients with impaired liver function.
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Amitriptyline is a strong muscarinic blocking agent that can lead to urinary retention.
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: Beta-blockers may affect insulin-dependent diabetics by masking the symptoms of hypoglycemia.
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In first few days of warfarin therapy the patient is in a state of hypercoagulation, thus heparin should be started simultaneously.
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Acute alcohol intoxication can lead to hypoglycemia due to reduction of the metabolites involved in gluconeogenesis.
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Trimethoprim/sulfamethoxazole is a sulfonamide derivative that prevents the synthesis of dihydrofolic acid.
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Ciprofloxacin and other fluoroquinolones function by inhibiting bacterial DNA topoisomerase II.
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Tophi are chalky white uric acid deposits under the skin found in patients with gout.
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Indomethacin is the drug of choice for acute gout attacks.
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Allopurinol inhibits the enzyme xanthine oxidase which is needed to breakdown purines into uric acid.
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Sildenafil, the drug of choice for erectile dysfunction, inhibits phosphodiesterase-5 thus increasing cGMP and promoting erection.
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Sildenafil and erectile dysfunction have been heavily tested on the COMLEX. Thus, even though the COMLEX rarely tests on the details of molecular mechanisms, this one is worth studying.
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The most common adverse effect of lithium is tremor.
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Fetal hydantoin syndrome is caused by the teratogen phenytoin
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Lithium is the first line drug for bipolar disorder. Valproic acid and Carbamazepine may also be used, but are not first-line. Antidepressants can cause a manic phase if bipolar disorder is misdiagnosed as depression.
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Drug potency is related to the amount needed to achieve 50% maximum response. Efficacy is the strength of the maximum response.
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For acetaminophen overdose, N-acetylcysteine can replenish glutathione stores preventing severe liver damage.
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Acetaminophen overdose causes the generation of free radicals which damage hepatic tissue causing hepatic necrosis and subsequent liver failure and death.
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Acetaminophen is a pain reliever and fever reducer. It does NOT have anti-inflammatory or anti-platelet effects.
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Acetaminophen is a pain reliever and fever reducer. It does NOT have anti-inflammatory or anti-platelet effects.
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Leuprolide is a GnRH analog used to shrink fibroid tumors
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Common side effects for furosemide include: hypokalemic metabolic alkalosis, ototoxicity, hyperuricemia, hypomagnesemia, allergic reactions, and hypercalciuria.
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Acyclovir is a purine analog used in the treatment of herpes. It functions by inhibiting viral DNA polymerase.
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For inhaled anesthetics a low MAC value indicates high potency and low blood solubility indicates rapid onset.
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Thiopental is a short-acting barbiturate that can exacerbate acute intermittent porphyria.
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Organophosphates inhibit acetylcholinesterase activating muscarinic and nicotinic receptors at the post-synapse. Toxic levels can cause respiratory failure.
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Gastric acid production is most directly and effectively inhibited by proton pump inhibitors. These agents inhibit the release of hydrogen ions from the H+/K+ATPase pump.
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Benzodiazepines bind to the GABA receptor and increase the frequency of chloride channel opening.
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Furosemide is a sulfonamide loop diuretic indicated for acute exacerbations of congestive heart failure. Patients with sulfa allergies should be given ethacrynic acid which has a similar mechanism of action but is not a sulfonamide.
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Rimantadine, an antiviral for influenza A, is eliminated by the liver.
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Macrolides have extensive side effects which include increasing the QT interval
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The thiazide diuretics may rarely, but significantly decrease renal calcium excretion and cause hypercalcemia.
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Selective alpha1-blockers induce less reflexive tachycardia than non-selective blockers because alpha-2 receptors downregulate the sympathetic response.
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The extended-spectrum penicillins, including ticarcillin, are susceptible to B-lactamase.
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Amoxicillin has better oral absorption than ampicillin.
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Bleomycin is an anti-cancer drug known to cause pulmonary fibrosis.
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Most anti-caner drugs cause GI distress, hair loss and bone marrow suppression. If the COMLEX is going to ask you about anti-cancer drugs, it will likely be a question concerning unique or dose-limiting side-effects.
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Finasteride is a 5-alpha reductase inhibitor that decreases dihydrotestosterone levels by decreasing its conversion from testosterone. Gynecomastia is a side effect.
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Phenytoin not only blocks sodium channels to increase the refractory period of neurons, the drug also inhibits glutamate release from excitatory presynaptic neurons.
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Diphenhydramine is a H1-blocker used for allergies. It causes sedation and has strong antimuscarinic effects.
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Ethosuximide is the drug of choice for absence seizures. It blocks calcium channels and GI distress is the most common adverse effect.
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Potassium channel blockers prolong the QT interval by blocking the repolarization phase of the action potential.
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Warfarin is absolutely contraindicated in pregnancy. It is listed under pregnancy category X.
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Pioglitazone increases the sensitivity of tissues to insulin by increasing the transcription of insulin responsive genes.
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Propranolol is a non-selective beta-blocker that can cause hyperlipidemia.
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First generation anti-histamines (diphenhydramine, dimenhydrinate, chlopheniramine, and hydroxyzine) are more sedating than 2nd generation anti-histamines (loratadine, fexofenadine, desloratadine, cetirizine)
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Maple syrup urine disease
X α-ketoacid DH ↑BCAA in urine Brain damage and MR |
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Homocystinuria
X cystathionine synthase ↑ homocysteine MR, lens dislocation, CAD tx decrease methionine diet, B6 supplement |
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Cystinuria
X membrane transporter of cysteine, ornithine, arginine, and lysine (dibasic aa) in collecting ducts cystiene renal stones |
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Hartnup disease
X membrane transporter of tryptophan ↓ serum tryptophan niacin deficient -->pellagra |
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Fructosuria
X fructokinase ↑ fructose serum Benign |
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Fructose intolerance
X aldose B ↑ fructose-1-P ↑ fructose-1,6-P Fructose-1-P builds up in kidney and liver resulting in organ failure GNG is shut down-->hypoglycemia |
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Galactosuria
X galactose-1-P uridylyl transferase ↑ galactose MR, failure to thrive, liver failure |
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(Von's SIX three letters each)
Von Gierke Type 1 glycogen storage disease X G-6-P phosphatase ↑G-6-P + G-1-P Stimulation of Glycogenosis even if hypoglycemic, hepatomegaly, large kidneys |
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(Pompe's lysosomal depot)
Pompe's Type II GSD X α glucosidase (lysosomal) ↑ glycogen Hepatomegaly, cardiomegaly with heart failure, muscle hypotonia, damage to all organs, all d/t reduced access to glucose (G-1-P impairs glycogenolysis) |
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(Cori Mathias with branch cutters)
Type III GSD Cori's X debranching enzyme deficient ↑ branch points of glucogen hepatomegaly |
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Type 4 GSD McArdle
X skeletal mm phosphorylase ↑ glycogen in muscle McArdle = muscle Excersice induced mm pain and cramps with no rise in lactate, mm are starved for glucose from no glycolysis |
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Hurler's mucopolysaccharidoses
X lysosomal α-L-idoronidase ↑ heparan and dermatan SO4 Corneal clouding, MR!!, gargoyle facies, dwarf |
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Scheie mucopolysaccharidoses
X α-L-iduronidase ↑ heparan and dermatan SO4 Corneal clouding, S for SMART (NO MR!!!), aortic valve disease, stiff joints |
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Hunter's mucopolysaccharidoses
X iduronate sulfatase ↑ heparan and dermatan SO4 NO CORNEAL CLOUDING MR |
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What is the reason for the difference in presentations of Hurler's, Scheie's and Hunter's mucopolysaccharidoses when the accumulation of GAG is the same for all (heparan and dermatan SO4)?
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Different ratios of accumulation
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Porphyrias
X hemin ↑ succinyl CoA + glycine |
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Porphyrias
Lead poison ↑ Delta ALA |
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Acute intermittent porphyria
Barbs and neuropsych Porphobilinogen-->hydroxymethylbilinogen ↑ Porphobilinogen |
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Congenital erythropoietic porphyria
Hydroxymethylbilinogen (↑↑)-->uroporphyrinogen III |
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Cutanea tarda porphyria
Uroporphyrinogen(↑↑)-->coporporphyrinogen Most common and AR |
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Coproporphyria
Coproporphyrinogen (↑↑)-->protoporphyrinogen |
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Photosensitivity in chronic
mircocytic anemia abdominal pain oxidation damage tissues 2nd to oxidation of excess heme precursors tx IV hemin (to slow the heme synthesis process) avoid sunlight (unless acute) Beta-carotene - free radical scavenger |
Porphyrias in general
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Lithium is a mood stabilizer used in the treatment of bipolar disorder. It can cause nephrogenic diabetes insipidus where the kidneys fail to respond to ADH and patient experiences polydipsia and polyuria.
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Verapamil is a calcium channel blocker that decreases cardiac output and could lead to AV block and exacerbate congestive heart failure.
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Side-effects associated with the long-term use of phenytoin include hirsutism, gingival hyperplasia, peripheral neuropathies and osteomalacia.
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Clopidogrel inhibits platelet aggregation by blocking ADP receptors. TTP is a rare but serious side-effect.
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The major side effects of oral retinoids include suicidal ideations, teratogenicity, hypertriglyceridemia, hypercholesterolemia and elevated liver enzymes.
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In zero-order kinetics the rate of elimination is constant regardless of the plasma concentration. In first-order kinetics the half-life is constant and the rate of elimination increases with plasma concentration.
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Lovastatin may cause skeletal muscle damage which can lead to rhabdomyolysis and elevated creatinine kinase.
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The first line agent for strep throat is penicillin
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Treatment for serotonin syndrome includes cyproheptadine which is a 5-HT2 receptor antagonist
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Sulfonamides displace warfarin from plasma proteins thus increasing the anticoagulation effects.
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The most common bacterial cause of prostatitis is E-coli which can be treated with doxycycline, ciprofloxacin or trimethoprim-sulfamethoxazole
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haloperidol is a typical anti-psychotic. Hyperprolactinemia causing lactation is a common side-effect due to its dopamine antagonist effects
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Demeclocycline is the drug of choice for SIADH that cannot be managed with water deprivation alone. It causes nephrogenic diabetes insipidus.
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Odansetron (Zofran) is 5-HT3 receptor antagonist anti-emetic shown best to stave nausea after chemotherapy and surgery.
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Irreversible inhibition decreases Vmax, while competitive inhibition increases Km.
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If beta-blocker therapy is necessary, patients with asthma should use a selective beta-1 blocker in order to avoid respiratory complications.
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Treat absence seizures with either ethosuximide or valproic acid
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Epilepsy drug usage and their toxicities are high-yield on the COMLEX
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: The gold standard treatment for sinusitis is a beta-lactam antibiotic, ie) Augmentin.
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Treat pseudomembranous colitis by giving oral vancomycin or metronidazole.
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Baclofen is a spasmolytic commonly used for cerebral palsy. It binds GABA-b receptors and reduces the release of excitatory neurotransmitters.
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Didanosine is a nucleotide reverse transcriptase inhibitor (NRTI) with the dose-limiting adverse effect of pancreatitis.
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Indinavir is a protease inhibitor that can cause kidney stones, especially if the patient is not well hydrated.
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Trimethoprim-sulfamethoxazole is used for prophylaxis for Pneumocystis carinii pneumonia in AIDS patients with a CD4 count less than 200/uL.
Fluconazole is used for treatment and prophylaxis against Cryptococcal meningitis commonly seen in AIDS patients CD4 <100 |
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Low intracellular pH and high extracellular pH increase the effectiveness of local anesthetics.
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: Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenase-2 thus preventing the synthesis of prostaglandins and thromboxanes.
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A large Vd indicates that the drug is distributed widely throughout the body thus a smaller percent remains in the plasma. The minimum Vd is the plasma volume.
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Nandrolone is an anabolic steroid that when abused can lead to gynecomastia, decreased testicular size and liver damage.
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Theophylline is used for COPD control and causes dry mouth.
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Mucinous cystadenocarcinomas are malignant ovarian tumors of epithelial origin that secrete mucous material
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The anti-cancer drug paxclitaxel disrupts microtubule thus arresting cells in the M phase
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A disulfiram-like reaction is characterized by nausea, vomiting, headaches and hypotension after consuming alcohol. This is a potential side-effect of metronidazole.
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Probenecid is used to treat chronic gout when the cause is under-secretion of uric acid as shown by low levels in the urine. High levels of uric acid in the urine indicate that allopurinol is the appropriate drug.
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Sildenafil, the drug of choice for erectile dysfunction, acts by inhibiting cGMP phosphodiesterase thus increasing cGMP.
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Sporothrix schenkii is a dimorphic fungus that lives on vegetation. It produces a local infection of pustules and ulcers with nodules along a draining lymphatic chain (ascending lymphangitis). The drug of choice is itraconazole.
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Pseudomonas aeruginosa is found ubiquitously in water. Common associations include hot tub folliculitis, otitis externa, eye infections in contact lens users, cellulitis in burm victims and pneumonia in cystic fibrosis.
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Piperacillin and ticarcillin are the wider spectrum penicillins with activity against Pseudomonas aeruginosa.
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Aminoglycosides bind the 30S ribosomal unit thus interfering with protein synthesis. The two most common side-effects are ototoxicty and nephrotoxicity.
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Alzheimer’s disease is associated with generalized cerebral atrophy.
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Alzheimer’s disease is associated with generalized cerebral atrophy
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Donepezil is an acetylcholinesterase inhibitor used particularly for Alzheimer’s disease. It blocks the metabolism of acetylcholine at the synapse.
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By the age of 40 virtually all Down syndrome patients will develop Alzheimer’s disease.
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Metoclopramide is a prokinetic drug that stimulates peristalsis. It works by blocking dopamine receptors and can have extrapyramidal side-effects.
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Understand that ganglion blockers only block reflexive, not direct, autonomic effects.
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The major side effect of alpha 1inhibitos including prazosin is first dose hypotension.
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Allopurinol interferes with the metabolism mercaptopurines thus greatly increasing their toxicity.
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Succinylcholine is a depolarizing acetylcholine agonist at the neuromuscular junction. It initially causes fasciculations before paralysis.
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hort-acting benzodiazepines are the drug of choice for panic attacks. Overdose of benzodiazepines can be managed with flumazenil. Chronic use can cause tolerance and dependence.
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Treat organophosphate poisoning with both atropine and Pralidoxime (2-PAM). Pralidoxime is a cholinesterase reactivating agent that will treat neuromuscular dysfunction.
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Efavirenz is a non-nucleoside reverse transcriptase inhibitor (NNRTI). It does not incorporate itself into viral DNA
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Hypotension stimulates baroreceptors causing tachycardia and activation of the renin-angiotensin system leading to salt and water retention
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The spinal level of the triceps reflex is C7 and the biceps is C5.
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Methylprednisone, given within 8-hours of an acute spinal cord injury, reduces the risk of permanent damage
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Syringomyelia causes central cord syndrome, usually at the cervical levels, which presents as loss of pain and temperature sensation in upper extremities.
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Zidovudine is a nucleoside reverse transcriptase inhibitor (NRTI), which inhibits HIV reverse transcriptase and incorporates itself into the growing DNA chain.
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Aspirin toxicity presents as GI distress, tinnitus and hyperthermia. It also causes elevated leukotrienes which could lead to bronchospasms.
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Organophosphate poisoning can be tested for rapidly to determine the correct treatment.
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Doxepin is a first generation tricyclic antidepressant which blocks the re-uptake of norepinephrine and serotonin.
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Buspirone is an anxiolytic that is not a benzodiazepine thus it doesn’t cause sedation, CNS depression or dependence.
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Cilostazol is a phosphodiesterase inhibitor used for intermittent claudication.
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SNS/PNS effects and receptors:
Coronary aa: dilated ß2 constricted α1/dilated M3 Apocrine glands: thick, odor α1/none Lung blood vessels: constricted α1/dilated M3 |
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Micotic emboli (septic emboli) usually occur in the vertebral-basilar or internal carotid-cerebral system
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Hemorrhagic CVA normally d/t arteriosclerotic artery or aneurysm
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Hemorrhagic CVA-->lenticulate branch of MCA-->hemorrhage into the basal ganglia and internal capsule
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Amphotericin B binds to ergosterol and forms pores in fungal cell membranes.
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The main effect of lithium is to block second messenger function. It is the drug of choice for bipolar disorder.
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Lovastatin is a HMG-CoA reductase inhibitor. Serious side effects include rhabdomyolysis and myositis.
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The first line medication for cholinesterase inhibitor poisoning includes atropine and the second medication that is used is pralidoxime
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Digoxin inhibits the Na+/K+ ATPase and allows the heart to beat stronger.
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Cefoperazone treatment can result in a disulfiram-like alcohol intolerance
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Haloperidol is a dopamine blocker. Excess dopamine is associated with psychosis and hyperkinetic movement disorders such as Huntington disease
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Ketamine is a short-duration intravenous anesthetic that can cause hallucinations post-operatively
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Doxycycline may be used for treating cat and dog bite wounds when the patient is allergic to firstline therapies.
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Metformin is an oral hypoglycemic medication that can lead to lactic acidosis
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Mesna is added to cyclophosphamide to prevent hemorrhagic cystitis. Cyclophosphamide is used to treat ovarian and breast cancers, as well as non-Hodgkin’s lymphoma.
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The mechanism of action of vancomycin is to bind the D-Ala terminus of peptidoglycan thus preventing elongation of the chain in cell wall synthesis.
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Vancomycin, niacin, calcium channel blockers, and adenosine may cause cutaneous flushing.
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he diabetic drugs most likely to cause hypoglycemia are the sulfonylureas
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Valproic acid, a drug of choice for general tonic-clonic seizures, can also useful for bipolar disorder.
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Myasthenia gravis is associated with thymomas or hyperplasia of the thymus.
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The drug of choice to treat Myasthenia gravis is pyridostigmine which inhibits the breakdown of acetylcholine at the neuromuscular junction.
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The initial drug of choice to control hypertension in pheochromocytoma is phentolamine which is a non-selective alpha-blocker
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The two times to remember not to give a beta-blocker before an alpha-blocker are cocaine toxicity and pheochromocytoma. The beta-blocker will prevent the beta-2 mediated vasodilation thus worsening hypertension
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: Citralopram is a serotonin selective reuptake inhibitor and side effects such as sexual dysfunction and GI distress may occur.
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Sodium bicarbonate is the antidote in TCA overdose with cardiac involvement.
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Mifepristone is both a glucocorticoid and progesterone antagonist.
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Organophosphate poisoning can be tested for rapidly using atropine to determine the correct treatment.
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rugs that can cause SJS are ethosuximide, lamotrigine, phenobarbital, phenytoin, sulfa drugs and allopurinol.
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Insight: Know the most common and life-threatening side effects of drugs, they are extremely high yield and are always asked. These are 5 big side effects that were seen on this years exam and will most likely be asked again.
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Elevated α-fetoprotein indicates an open neural tube defect. Pregnant woman with seizure disorder taking valporate. If she were on phenytoin, risk for fetal hydantoin syndrome
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von Willebrand disease is the most common autosomal bleeding disorder. It causes prolonged bleeding time and prolonged aPTT.
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he classic pentad for TTP is fever, neurological symptoms, kidney failure, anemia and thrombocytopenia.
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von Willebrand disease is the most common inherited coagulopathy that the common physician will see in practice.
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Whipple disease presents with malabsorption syndrome, joint pain, and CNS symptoms. Small intestinal biopsy shows PAS positive staining.
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: DiGeorge syndrome presents with the triad of conotruncal cardiac anomalies, hypoplastic thymus, and hypocalcemia due to parathyroid hypoplasia due to a defective development of the 3rd and 4th pharyngeal pouches, most commonly due to a chromosome 22q11.2 deletion.
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With impaired kidneys, 25-hydroxycholecalciferol (calcidiol) will accumulate in the blood.
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Wilson’s disease is an autosomal recessive disease that results in inadequate copper excretion from the body. Copper then accumulates in the body, most notably in the liver and brain causing encephalopathy, basal ganglia degeneration, dementia, hemolytic anemia, and Kayser-Fleischer rings in the cornea
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Graves’ Disease is a hyperthyroid autoimmune disease noted to have antibodies against its TSH receptors.
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DIC is a complicated disorder that involves both excess bleeding and widespread thrombosis. Fibrinogen is decreased while fibrin split products are elevated. Bleeding time, PT and PTT are prolonged.
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The gynecomastia and spider telangectasia of chronic liver failure are due to excess estrogen.
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Reiter’s syndrome is an acute onset of arthritis, urethritis, and conjunctivitis due to the presence of an infection, most commonly Chlamydia, seen in young, sexually active men
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Huntington disease and osteogenesis imperfecta have autosomal dominant inheritance.
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The more villous the polyp the higher the malignant potential
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C-ANCA is used for monitoring disease activity in Wegener's granulomatosis. P-ANCA (A), or Perinuclear Antineutrophil Cytoplasmic Antibodies is used to monitor disease activity of polyarteritis nodasa, an autoimmune vasculitis of small and medium-sized arteries
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Know the classic description of fibroadenoma and that it is the most common breast tumor in women under 25-years-old.
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Membranoproliferative glomerulonephritis is characterized by mesangial proliferation on light microscopy and splitting of the basement membrane on electron microscopy.
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Factor V Leiden is the most common hereditary hypercoagulable disease. It is caused by a mutation in factor V rendering it unable to be inactivated by protein C.
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: Angioedema is a sudden swelling of the dermis, subcutaneous tissue, musoca, and submucosa. If severe, it may lead to airway obstruction.
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G6PD deficiency is an X-linked disease that is characterized by episodes of hemolysis triggered by oxidative stress induced by drugs and fava beans.
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When a male patient is noted to have evidence of an abdominal aortic aneurysm with an outer diameter equal to or greater than 5.5cm, surgical repair is recommended.
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Gout is classically manifested by the painful MTP joint in the great toe (podagra). Synovial fluid analysis reveals negatively birefringent needle-shaped crystals made of uric acid.
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Adverse effects of niacin include cutaneous flushing, reactivation of dyspepsia, and increased uric acid levels. It can precipitate a gouty attack in suseptable individuals
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Guillain-Barré syndrome is an autoimmune demyelination that causes rapidly ascending paralysis. It typically occurs after an infection with Mycoplasma pneumoniae or Campylobacter jejuni.
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APKD is an autosomal dominant disease in which the kidneys develop numerous cysts causing complications such as hypertension and berry aneurysms.
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Temporal arteritis presents in elderly patients with headaches, jaw claudication and visual impairment. Labs show high ESR. Biopsy shows granulomas with giant cells.
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Bell's palsy is a paralysis of the facial nerve resulting in an inability to move the facial muscles on the affected side.
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Nothing by mouth protocol is helpful in preventing complications to conditions of inflammation and infection of the GI tract that may require surgery or acute care.
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Tuberous sclerosis:
AD multi-nodular growth of multi-nucleated astrocytes White nodules in cortex and periventricular area Seizures, MR, rhabdo |
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Saddle nose deformity
Otalgia Lung nodules + cytoplasmic antineutrophil antibodies -->Wergner's |
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All larnyx is innervated
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Hyperparathyroidism can lead to cystic fibrotic changes in bone known as osteitis fibrosa cystica.
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Paget’s is an eczematous disease of the breast that requires investigation for ductal carcinoma.
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: Iron deficiency anemia is a microcytic anemia that is very common, especially with any blood loss.
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Hereditary hemochromatosis is characterized by diabetes, skin pigmentation and cirrhosis of the liver. It is caused by iron accumulation.
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Multiple myeloma is a plasma cell dyscrasia in which activated B-cells (plasma cells) produce excessive monoclonal immunoglobulin. Dark blue, elderly person with back pain
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Ankylosis, fibrosis and involvement of the proximal interphalangeal joints is characteristic of RA but not OA.
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Corticosteroids inhibit phospholipase A2 which normally synthesizes arachidonic acid from membrane lipids.
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Rheumatoid arthritis is an autoimmune destruction of the joints with a symmetric distribution involving the MCP and PIP joints, ulnar deviation, morning stiffness (improving with use), systemic symptoms, and majority have a positive rheumatoid factor.
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Androgen Insensitivity Syndrome is a defect in the androgen receptor. They are genotypically male, but phenotypically female that present with primary amenorrhea, have no internal female sex organs, and have undescended testes that may cause cancer if not removed. They are infertile and have no pubic hair.
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Ischemia to the CNS can result in liquefactive necrosis which destroys tissue structure
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Seminoma is the most common form of testicular cancer. A history of cryptorchidism is a risk factor. Never a rise in α-FP, rarely a rise in ß-HCG
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lassic Multiple Sclerosis presents with white plaques on imaging after several episodes of vision changes and leg or arm weakness
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: Acute post-streptococcal glomerulonephritis display enlarged glomeruli that is hypercellular with neutrophils displaying a “lumpy bumpy” appearance on light microscopy, and subepithelial immune complex humps on electron microscopy.
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Osteophytes (C) and cartilage degeneration (D) are associated with osteoarthritis which is considered a non-inflammatory arthritis
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Prostaglandins mediate pain, fever, and inflammation.
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CFTR mutations prevent chloride transmission and create a disease state called Cystic Fibrosis.
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Pemphigus vulgaris is an autoimmune skin disease that presents with superficial blisters and is caused by antibodies against desmosomes.
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Autoimmune arthritis of the fingers is associated with psoriasis which may also show pitting and discoloration of the nails
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Malabsorption syndrome (celiac disease) is associated with dermatitis herpetiformis which presents with extremely pruritic uticaria (hives)
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Antibodies against the basement membrane describe bullous pemphigoid which presents with tense subepidermal bullae (or bullae form at the dermal-epidermal junction) that do not easily rupture
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Unrelenting wrist pain one week after immobilization with a soft splint requires a further evaluation for scaphoid fracture.
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Alendronate can increase bone density in women with post-menopausal osteoporosis.
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Alendronate can increase bone density in women with post-menopausal osteoporosis.
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: ACE inhibitor therapy is contraindicated in patients with hereditary angioedema.
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Dermatomyositis is an autoimmune disorder that typically presents with proximal muscle weakness and skin discolorations.The exhibit shows the characteristic heliotrope rash of the eyelids which is highly associated. A history of cancer is also associated.
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denocarcinoma of the head of the pancreas is associated with Courvoiser 's sign which is an enlarged and palpable, but painless, gallbladder.
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Adenocarcinoma of the head of the pancreas is associated with Courvoiser 's sign which is an enlarged and palpable, but painless, gallbladder.
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CA 19-9 and CT are very useful in the confirmation of diagnosis of pancreatic adenocarcinoma.
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Paget disease of the bone presents in adulthood as enlarged bones with lytic and sclerotic lesions. Defective bone remodeling is the cause.
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Paget disease is characterized by highly elevated alkaline phosphatase with otherwise normal lab values.
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Paget disease of the bone increases the risk of osteosarcoma.
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Endometriosis is due to functioning glands and stroma outside of the uterus and causes an increased risk for infertility. Rupturing choclate cysts.
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Acute mountain sickness is the most common form of altitude disease, and symptoms occur most commonly in individuals accustomed to lower altitudes.
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The drug of choice to reduce inflammation in ulcerative colitis is sulfasalazine.
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If Chlamydia trachomatis goes untreated it can cause Pelvic Inflammatory Disease (B) in a woman. This presents with cervical motion tenderness (Chandelier sign) and a purulent cervical discharge. This may cause salpingitis, endometritis and a tubo-ovarian abscess. May cause infertility later in life, chronic pelvic pain and adhesions known as “violin string"
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Chlamydia and Gonorrhea can both cause pelvic inflammatory disease in a female if not treated properly.
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Type II diabetes mellitus is due to insulin resistance of target tissues. When the liver doesn’t respond to insulin it releases excess glucose.
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Osteoporosis is a commonly asymptomatic until the first fracture. It is characterized by low bone mass and skeletal fragility
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Chronic lymphocytic leukemia most commonly presents in men over the age of 60 with lymphadenopathy and an unexplained elevated white cell count.
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Chronic lymphocytic leukemia most commonly presents in men over the age of 60 with lymphadenopathy and an unexplained elevated white cell count.
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B-lymphocytes are the malignant cells in acute and chronic lymphocytic leukemia.
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Chronic lymphocytic leukemia is associated with autoimmune hemolytic anemia which is characterized by spherocytes, elevated reticulocytes and a positive Coombs test
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Drug-induced SLE is associated with hydralazine. Anti-histone antibodies is the serum marker
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Depth is the most important prognostic indicator for malignant melanoma.
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Dysplastic nevi are the precursor lesions for malignant melanoma
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Actinic keratoses are rough papules that are the precursor lesions for squamous cell carcinoma
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Periventricular plaques are most likely diagnostic of Multiple Sclerosis on MRI. These are areas of demyelination of white matter surrounding the lateral ventricles. Demyelination in the CNS is caused by damage to oligodendrocytes. Schwann cells myelinate the peripheral nervous system and are not affected in MS.
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Myotonic dystrophy is often recognized by its sustained muscular contractions. It exhibits anticipation through a CTG tri-nucleotide repeat expansion that mis linked to instability during maternal meiosis.
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Black widow spider bites manifest with gastrointestinal complaints and muscle twitching.
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The Brown recluse spider (D) is poisonous and is responsible for necrotic bites. Its venom is both cytotoxic and hemolytic
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Each vagal nucleus located in the medulla of the brainstem corresponds to each type of vagal innervation. The nucleus solitarius provides visceral sensory innervation, the nucleus ambiguus provides motor innervation, and the dorsal motor nucleus functions in autonomic innervation.
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Agnosia the inability to recognize objects, via tactile sensory information.
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Aprosodia is a neurological deficit where a person cannot portray or understand emotional context of language.
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The cranial nerves, CN III, IV, V1, V2, and VI course through the cavernous sinuses.
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Bottom line: CJD is a rapidly progressive dementia caused by a mutation in prion protein from alpha helices to beta sheets, which are resistant to protease breakdown. This disease progresses to death in weeks to months and should be distinguished from other forms of dementia.
COMLEX Insight: Dementia is a big topic on COMLEX. Know each type listed, their underlying mechanism and time frame of progression. These are important aspects and should be mastered. COMLEX likes to ask neurological disease presentations and were very common on the most recent exam. |
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Classic multiple sclerosis presents with several episodes of vision changes (optic neuritis) and leg or arm weakness. Multiple white plaques are often visible on MRI.
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Syringomyelia is associated with bilateral loss of pain and temperature sensation in the upper extremities due to the expansion of the central canal of the spinal cord with fluid. Often there is an associated Arnold-Chiari malformation.
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Multiple sclerosis is associated with damage to the MLF. This manifests as the inability to adduct the ipsilateral eye and nystagmus of the abducting eye during contralateral gaze.
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Huntington’s disease is an autosomal dominant disease that presents with chorea, muscle rigidity, and dementia with a delayed onset of symptoms between ages 35-40.
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The lingual nerve is a branch of the mandibular nerve (V3) that provides sensation to the anterior tongue. Chorda tympani = taste to the anterior tongue
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Horner's syndrome is caused by damage to the sympathetic nerves which travel with the internal carotid artery.
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A type I collagen defect as seen in osteogenesis imperfecta may manifest as multiple fractures, dental problems, hearing loss, and characteristic blue sclerae due to the visibility of the choroid plexus.
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An upper motor neuron lesion of the face will manifest as contralateral facial droop with sparing of the forehead.
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