Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/434

Click to flip

434 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
what adverse effect is associated with bleomycin?
pulmonary fibrosis
Name 4 antineoplastic agents which are cell-cycle specific
Methotrexate
5-Fluorouracil (5-FU)
Cytarabine (Ara-C)
6-Mercaptopurine
What enzyme activates 6-Mercaptopurine?
Hypoxanthine-guanine phosphoribosyltransferase (HGPRT)
Name the antineoplastic alkylating agents
Busulfan
Cyclophosphamide
Nitrosoureas (lomustine, carmustine)
Cisplastin, Carboplatin, Procarbazine
Which alkylating agent crosses the BBB?
Nitrosoureas (lomustine, carmustine)
Which antibiotics are antineoplastics?
Bleomycin, doxorubicin
Which antineoplastic is associated with nephrotoxicity?
cisplastin, carboplastin
Which antineoplastic is associated with cardiotoxicity?
Doxorubicin
Which antineoplastic is associated with pulmonary fibrosis?
Bleomycin
What's the mechanism of action of Doxorubicin?
Intercalates DNA
Tamoxifen increases the risk of which cancer?
Endometrial carcinoma
Name the antineoplastic plant alkaloids
Vinblastine
Vincristin
Paclitaxel
Etoposide
Which antineoplastics are M-phase specific?
vinblastine, vincristine, paclitaxel
What's the mechanism of action of the plant alkaloids?
Prevent the assembly of microtubules
What's the mechanism of action of etoposide?
Inhibits topoisomerase II
What is the metabolite from cyclophosphamide responsible for the hemorrhagic cystitis?
Acrolein
What's the chromosomal translocation in Burkitt's lymphoma?
t(8;14)
What two genes are translocated in Burkitt's lymphoma?
c-myc proto-oncogene (chromosome 8)
Antibody heavy chain (chromosome 14)
Which colon cancer is associated with napkin-like lesion and marked thickening of the mucosa layer of the rectum?
Adenocarcinoma in the distal colon
What's the Duke's classification used for?
Used for stagin colorectal cancer
Duke's classification B1 of colorectal cancer
B1: Invasion into the muscularis propria but no metastases or lymph node involvement, 70-85% 5 year survival
Muscularis, metastases, and lymph node involvement. Survival rate?
Duke's classification A
A: Tumor is limited to the mucosa with no lymph node or metastatic disease. 5 year survival is more than 90%
Mucosal, metastases, and lymph node involvement. Survival rate?
Duke's classification B2
Invasion of the muscularis through the propria with no metastases or lymph node involvement. 55-65% 5 year survival
Duke's classification C1 of colorectal cancer
Invasion into the muscularis propria and lymph node but no metastases. 45-55% 5 year survival
Duke's classification C2
Invasion through the muscularis propria and lymph node but no distant metastases. 20-30% 5 year survival
Muscularis propria, lymph node, and metastases involvement. Survival rate?
Duke's classification D
Distant metastatic disease of colon cancer. 5 year survival is less than 1%
What's the normal function of the BRCA proteins?
DNA repair
Acquired and inherited colon cancer is associated with which genetic mutations?
Loss of APC gene on 5q
Activation of k-ras on 12q
Loss of DCC on 18q
Loss of p53 on 17p
Which cancers are associated with mutation of VHL tumor suppressor gene on chromosome 3?
von Hippel-Lindau
Hemangioblastoma (CNS and retina)
Renal cell carcinoma
What's the Pickwickian syndrome?
Obesity-Hypoventilation syndrome:
Patient is obese
Daytime sleepiness
Obstructive sleep apnea
Awake hypoventilation (high pCO2)
Sleep apnea
What's the mechanism of action of acetazolamide in central sleep apnea?
It causes metabolic acidosis, which stimulate a central compensatory response to increase ventilatory effort.
What is the only nematode capable of increasing its numbers in the a host?
Strongyloides stercoralis
Which is the only worm capable of causing intestinal obstruction?
Ascaris lumbricoides
Large oval eggs with a lateral spine found in the stool
Schistosoma
Large round to oval eggs, with a thick mammillated shells found in the stool
Ascaris lumbricoides
Lemon-shaped eggs, with bipolar plugs found in the stool
Trichuris trichiura
Round eggs and proglottids filled with eggs found in the stool
Taenia solium/saginata
Small larvae found in the stool
Strongyloides stercoralis
Which region of the US will a patient most likely acquire an Ascaris lumbricoides infection?
Southeast
What is the pharmacologic treatment for Fasciola hepatica?
Bethionol
What's the pharmacologic treatment for Giardia lamblia, and Entamoeba histolytica
Metronidazole
Proliferating ducts and stromal cells are microscopic characteristic of which breast tumor?
Fibroadenoma
Cribiform pattern with neoplastic epithelial cells are histological characteristic of which breast cancer?
Intraductal carcinoma of the breast
What's the histological characteristic of intraductal carcinoma of the breast?
Cribiform pattern with neoplastic epithelial cell
What would a histological specime of fibrocystic change of the breast reveal?
Cystically dilated ducts and stromal fibrosis
What changes in ducts and stroma?
What histological characteristics present in a phyllodes tumor differentiate it from a fibroadenoma?
Increased cellularity
Enhanced mitotic rate
Stromal overgrowth
Nuclear pleomorphism
Infiltrative borders
What percentage of congenital heart defects is made up of patent ductus arteriosus?
10%
HLA B27
Begins at the rectum and descending colon.
Crypt abscesses
Pseudopolyps
Lead pipe colon
High risk of colon cancer
Toxic megacolon.
Characteristics associated with?
Ulcerative colitis
Mechanism of action of infliximab
TNF-alpha inhibitor
What are the most common type of brain tumors?
Astrocytomas
What type of granuloma in sarcoidosis?
Noncaseating
What is Lofgren syndrome?
A subtype of acute sarcoidosis
Hilar adenopathy on x-ray
Erythema nodosum (tender red nodules, usually on the shins)
Albright’s Syndrome
Polyostotic fibrous dysplasia
Precocious puberty
Café au lait spots
Short stature
Young girls
Alport’s Syndrome
Hereditary nephritis
Nerve deafness
Type 4 collagen defect (basement membranes)
Alzheimer’s
Progressive dementia
Tau proteins
Neurofibrillary tangles, Apolipoprotein E4 allele
Narrow gyri
Wide sulci (atrophy)
Occipital sparing
Hydrocephalus ex vacuo
Plaques in hippocampus and cortex,
Acetylcholine
Hiramo bodies (inrtacellular inclusion bodies in hippocampal cells)
Arnold-Chiari Malformation
Cerebellar tonsil herniation
Barrett’s
Columnar metaplasia of lower esophagus (* risk of adenocarcinoma)
Bartter’s Syndrome
hyperreninemia
Bernard-Soulier Disease
Defect in platelet adhesion (abnormally large platelets & lack of von willenbrand factor receptor GP 1b platelet-surface glycoprotein)
Berger’s Disease
IgA nephropathy
Bowen’s Disease
carcinoma in situ on shaft of penis (* risk of visceral ca)
Bronchiolitis
RSV
Bruton’s Disease
X-linked agammaglobinemia
Budd-Chiari
Post-hepatic venous thrombosis
Buerger’s Disease
Acute inflammation of small, medium arteries * painful ischemia * gangrene * Japan * smoking
Burkitt’s Lymphoma
Small noncleaved cell lymphoma
EBV
8:14 translocation
Chediak-Higashi Disease
Phagocyte Deficiency: Neutropenia
Albinism
Cranial & peripheral neuropathy
Repeated infections
Congenital adrenal hyperplasia
21-hydroxylase deficiency: virilism, no cortisol, salt loss, hypotension 11-hydroxylase deficiency: virilism, no cortisol, salt retention, hypertension
Conn’s Syndrome
Primary aldosteronism
Cori’s Disease
Glycogen storage disease (debranching enzyme deficiency)
Crigler-Najjar Syndrome
Congenital hyperbilirubinemia (unconjugated) • glucuronyl transferase deficiency
Crohn’s Disease
IBD; ileocecum, transmural, skip lesions, lymphocytic infiltrate, granulomas (contrast to UC: limited to colon, mucosa & submucosa, crypt abscesses, pseudopolyps, * colon cancer risk)
Croup: What virus?
Parainfluenza
Curling’s Ulcer
Acute gastric ulcer associated with severe burns
Cushing’s Disease/Syndrome
Disease: hypercorticism 2* to * ACTH from pituitary (basophilic adenoma) • Syndrome: hypercorticism of all other causes (1* adrenal or ectopic)
Cushing’s Ulcer
Acute gastric ulcer associated with CNS trauma
de Quervain’s Thyroiditis
Self-limiting focal destruction (subacute thyroiditis)
DiGeorge’s Syndrome
Thymic hypoplasia
T-cell deficiency
Hypoparathyroidism
Doll's Eyes Maneuver
Patient comatose with intact brain stem
Eyes remain fixed and seem to move opposite the movement of the head
Dressler’s Syndrome
Post-MI Fibrinous Pericarditis autoimmune
Dubin-Johnson Syndrome
Congenital hyperbilirubinemia (conjugated)
Striking brown-to-black discoloration of the liver
Edwards’ Syndrome
Trisomy 18
Rocker-bottom feet
Low ears
Heart disease
Ehler’s-Danlos
Defective collagen
Eisenmenger’s Complex
Late cyanotic shunt (R-->L)
Pulmonary HTN & RVH 2 to long-standing VSD, ASD, or PDA
Ewing Sarcoma
Undifferentiated round cell tumor of bone
Fanconi’s Syndrome
Impaired proximal tubular reabsorption 2* to lead poisoning or Tetracycline
Diagnosis of Rheumatic Fever
2 major or 1 major and 2 minor
Major manifestations (mnemonic = CHANCE) Also try mnemonic "JONES"

Carditis J= Joints

PolyArthritis O = Carditis

Chorea N= Nodules

Erythema marginatum E = erythema

Subcutaneous Nodules S = Syndenham's Chorea
MEN I
3 P's (pituitary, parathyroid, and pancreas) plus adrenal cortex
MEN II
2 C's(carcinoma of thyroid and catacholamines [pheochromocytoma]) plus parathyroid for MEN IIa or mucocutaneous neuromas for MEN IIB(aka MEN III)
INNERVATION OF PENIS
* Parasympathetic causes erection. Sympathetic causes ejaculation. "Point and Shoot."
* "S2, 3, 4 keep the penis off the floor"
* Innervation of the penis by branches of the pudendal nerve, derived from spinal cord levels S2-4
HYPERSENSITIVITY REACTIONS
* Type I Anaphylaxis
* Type II Cytotoxic-mediated
* Type III Immune-complex
* Type IV Delayed hypersensitivity
WBC Count
"Never Let Mom Eat Beans" and "60, 30, 6, 3, 1"

"Nice Ladies Make Easter Bread" and "60, 30, 6, 3, 1"

* Neutrophils 60%
* Lymphocytes 30%
* Monocytes 6%
* Eosinophils 3%
* Basophils 1%
5 SIGNS OF INFLAMMATION
* Redness/Erythema Italic text(Rubor)
* Raised temperature Italic text(Calor)
* Swelling Italic text(Tumor)
* Pain Italic text(Dolor)
* Loss of Function Italic text(Functio Laesa)
Presentation of HYPO-kalemia:
EKG S-T wave depression (sometimes with T and U waves)

Arrythmias

Heart block

Muscle weakness

Hypo-reflexia
Presentation of HYPER-kalemia:
Widened QRS interval

Ventricular tachycardia

Asystole

Muscle weakness (paralysis)

Hypo-reflexia

Mental confusion

Irritability
Causes of Hyper-Calcemia
PAM SCHMIDT OR MISHAP


Paget's Disease Malignancy

Amyloid Intoxication (hypervitaminosis)

Multiple Myeloma Sarcoidosis

Sarcoid Hyperparathyroidism

Cancer Alkali ( Milk ) syndrome

Hormonal (para-thyroid) Paget's Disease bone

Milk-alkali Syndrome

Immobilization

D-vitamin overdose

Thyrotoxicosis

also consider Addison's Disease, thiazide diuretics and simple lab error
Causes of Metabolic Acidosis
M U D P I L E S

Methanol poisoning

Uremia

Diabetic Keto-acidosis

Para-aldehyde ingestion

Ischemia

Lactic Acidosis

Ethanol poisoning

Salicylate ingestion
MUDPILES
Deep Reflexes
Biceps (C5-6) elbow flexion

Barchio-radialis (C5-6) elbow flexion & supination

Triceps (C7) elbow extension

Patellar (L3-4) knee extension = kneee jerk

Achilles (S1) plantar flexion = ankle jerk
BRANCHES OF FACIAL NERVE
Temporal, Zygomatic, Buccal, Mandibular, Cervical

* Two Zebras Bought My Car
* Two Zebras Bit My Cookie
* To Zanzibar By Motor Car
* Ten Zulus Buggered My Cat
CERVICAL SPINAL NERVES
* c345 keeps the phrenic alive (innervation of phrenic nerve)
* c345 keep the diaphragm alive (innervation of diaphragm)
* c5-6-7 raise your arms to heaven (nerve roots of long thoracic nerve innervate serratus anterior and if severed you see "winging" of the scapula)
Order of things in the Femoral Triangle
* "N(AVEL)"
* Nerve, Artery, Vein, Empty space, Lymphatics

NOTE: Parenthesis includes things contained in the femoral sheath.
Nucleotides
purines vs. pyrimidines "Guardian Angels are Pure, with two Wings": G and A are Purines, with two Rings.
What's the genetic defect in Cri-du-chat syndrome?
Chromosomal deletion of 5p
Marfan syndrome features
MARFAN:
Mitral valve prolapse
Aortic Aneurysm
Retinal detachment
Fibrillin
Arachnodactyly
Negative Nitroprusside test (differentiates from homocystinuria)
Cell cycle stages
"Go Sally Go! Make Children!": G1 phase (Growth phase 1) S phase (DNA Synthesis) G2 phase (Growth phase 2) M phase (Mitosis) C phase (Cytokinesis)
Tay Sach's features
SACHS:
Spot in macula
Ashkenazic Jews
CNS degeneration
Hex A deficiency
Storage disease
Extra details with TAY:
Testing recommended
Autosomal recessive/ Amaurosis Young death (<4 yrs)
Carnitine shuttle: function
The carnitine shuttle transports the acyl group from cytosolic fatty acyl CoA molecules across the inner mitochondrial membrane, which is impermeable to CoA, returning it to mitochondrial CoA molecules. The newly formed mitochondrial fatty acyl CoA molecules can then undergo -oxidation.
A-P-G-A-R:
* A - appearance (color)
* P - pulse (heart rate)
* G - grimmace (reflex, irritability)
* A - activity (muscle tone)
* R - respiratory effort
Takayasu's diz
Pulseless diz, therefore when you have Takayasu's, I can't Tak'a yu pulse.
CAGE--alcohol use screening
* Have you ever felt it necessary to CUT DOWN on your drinking?
* Has anyone ever told you they were ANNOYED by your drinking?
* Have you ever felt GUILTY about your drinking?
* Have you ever felt the need to have a drink in the morning for an EYE OPENER?
P-Q-R-S-T--eliciting and HPI and exploring symptoms
* P--palliative or provocative factors for the pain
* Q--quality of pain(burning, stabbing, aching, etc.)
* R--region of body affected
* S--severity of pain(usually 1-10 scale)
* T--timing of pain(eg.-after meals, in the morning, etc.)
Huntington’s brain changes
Progressive degeneration of caudate nucleus, putamen & frontal cortex;
AD Hunter’s
enzyme deficiency?
Decreased iduronosulfate sulfatase
Hurler’s
Decreased alpha-L-iduronidase
Niemann-Pick
Lysosomal Storage Disease sphingomyelinase deficiency • “foamy histiocytes”
Angiomatosis
Little knots of capillaries in the retina and various organs
What are the features of von-Hippel Lindau
Abnormal growth of tumors in parts of the body which are rich in blood supply.
1) Angiomatosis
2) Hemangioblastoma
3) Pheochromocytoma
4) Renal cell carcinoma
5) Pancreas
What's the MoA and site of action of acetazolamide?
It inhibits carbonic anhydrase, which mediates reabsorption of NaHCO3 in the PCT
Thiazide effect on Ca2+ excretion
It reduces Ca2+ excretion
Site of action of thiazide diurectics
Distal convoluted tubule
MoA of thiazides
Inhibit NaCl reabsorption
Acetazolamide toxicity
Hyperchloremic metabolic acidosis
Neuropathy
Mannitol MoA
Osmotic diuretic, incr tubular fluid osmolarity ---> incr urine flow
Mannitol toxicities
Toxicities:
Pulmonary edema
Dehydration
Contraindications:
Anuria
CHF
Furosemide MoA and site of action
Inhibits cotransport system (Na+, K+, 2Cl-)
Abolishes hypertonicity of medulla, preventing concentration of urine
Furosemide site of action
Thick ascending loop of Henle
K+ sparing diuretics
Spironolactone
Triamterene
Amiloride
Eplereone
Spironolactone MoA
Competitive aldosterone receptor antagonist
Spironolactone SoA
Cortical collecting tubule
Triamterene and amiloride MoA
Block Na+ channels
Triamterene and amiloride SoA
Cortical collecting tubule
Spironolactone toxicity
Gynecomastia
Antiandrogen effects
Which diuretics decr pH?
Carbonic anhydrase inhibitors
K+ sparing diuretics
Which diuretics incr pH?
Loop diuretics
Thiazides
Loop diuretics effect on urine Ca+
Increase Ca+ urine
List of ACE inhibitors
Captopril
Enalapril
Lisinopril
ACE inhibitors toxicities
CAPTOPRIL:
Cough
Angioedema
Proteinuria
Taste changes
hypOtension
Pregnancy problems (fetal renal damage)
Rash
Increased renin
Lower angiotensin II
--Hyperkalemia--
Losartan MoA
Not an ACE inhibitor
Angiotensin II receptor antagonist
Positive Predictive Value (PPV)
Number of true positives divided by the number of people who tested positive for the disease

The probability of having a condition given a positive test
Negative Predictive Value (NPV)
Number of true negatives divided by the number of people who tested negative for the disease

The probability of not having the condition given a negative test
Odds ratio
Odds of having disease in exposed divided by odds of having disease in unexposed
Type I error (alpha)
Stating that there is an effect or difference when none exists (to mistakenly accept the experimental hypothesis and reject the null hypothesis)
p is judged against alpha, a preset level of significance (usually <.05)
p = probability of making a type I error

False Positive
p<.05
There is less than a 5% chance that the data will show something that is not really there.

alpha = you "saw" a difference that did not exist
Type II error (beta)
Stating that there is not an effect or difference when one exist (to fail to reject the null hypothesis when in fact Ho is false).
Beta is the probability of making a type II error
Type II error (beta)
You did not "see" a difference that does exist
Kimmelstiel-Wilson
Increase in mesangial matrix by marked nodular accumulations

Seen in:
Diabetic Nephropathy
Rapidly progressive (crescentic) glomerulonephritis

Pathological findings?
Extensive capillary damage ---> accumulation of cells and fibrinous changes in Bowman's space
Membranoproliferative glomerulonephritis
Mesangial proliferation
Thickening of the peripheral capillary walls by immune deposits
Mesangial interposition into the capillary wall ---> tram-track appearance on light microscopy
Focal segmental glomerulosclerosis
Nephrotic syndrome
Young
Hypertensive
African-American
Glomerular sclerosis (Obliteration of capillary lumen)
Focal (some glomeruli affected)
Segmental (only parts of the glomerulus)
NephrItic Syndrome
Diseases
1) Acute poststreptococcal glomerulonephritis
2) Rapidly progressive (crescentic) glomerulonephritis
3) Goodpasture's syndrome (type II hypersenstivity)
4) Membranoproliferative glomerulonephritis
5) IgA nephropathy (Berger's disease)
6) Alport's syndrome
NephrOtic syndrome
O = prOteinuria
Massive proteinuria (frothy urine)
Hypoalbuminemia
Peripheral and periorbital edema
Hyperlipidemia
NeprhOtic syndrome diseases
1) Membranous glomerulonephritis
2) Minimal change disease (lipoid neprhosis)
3) Focal segmental glomerular sclerosis
4) Diabetic nephropathy
5) SLE
6) Amyloidosis-IF
NephrItic Syndrome
I = Inflammation
Hematuria
Hypertension
Oliguria
Azotemia
Anti-D agglutination
Indicates Rh-positive
CREST syndrome
C: Calcinosis
R: Raynaud's
E: Esophageal dysmotility
S: Sclerodactyly
T: Telangiectasia

Anticentromere antibody positive
Reiter's syndrome
Urethritis
Conjunctivitis/Anterior uveitis
Arthritis
anti-Scl-70
Diffuse slceroderma
Anti-mitochondrial antibody
Primary biliary cirrhosis
Anti-dsDNA, and-Smith
Specific for SLE
Antihistone
Drug-induced lupus
Antineutrophil (C-ANCA, P-ANCA)
Vasculitis
Stop codons
UAA
UGA
UAG
Primary transcript RNA
pre-mRNA (hnRNA)
Termination of transcription in prokaryotes
Stem and loop + UUUUU
Stem and loop + rho factor
Initiation of transcription in prokaryotes
Promoter (-10) TATAAT and (-35) sequence
Sigma initiation subunit(s) required to recognize promoter
Initiation of transcription in eukaryotes
Promoter (-25) TATA and (-70) CAAT
Transcription factors (TFIID) bind promoter
Turner's syndrome genotype
XO
Turner's syndrome phenotype
Women
Short
Webbed neck
Poorly developed secondary sexual characteristics
Ovarian dysgenesis (streak ovaries)

"Hugs and kisses"(XO) from Tina Turner (female)
Aorta in Turner's syndrome
Aorta in Marfan's syndrome
Turner's: Coarctation of the aorta
Marfan's: Aortic dissection
Klinefelter's syndrome genotype
XXY genotype
Testicular feminization syndrome defect
Dihydrotestosterone receptor defect
Testicular feminization syndrome phenotype
Normal appearing female
Amenorrheic
Klinefelter's syndrome phenotype
Male
Testicular atrophy
Eunichoid body shape
Tall (long extremities)
Gynecomastia
Female hair body distribution
Klinefelter's syndrome testicular pathology
Dysgenesis of seminererous tubules ---> Decr inhibin ---> Incr FSH

Abnormal Leydig cell function ---> Decr testosterone ---> Incr LH ---> Incr estrogen
Alternative Splicing of Eukaryotic mRNA
Primary transcript:
Is spliced differently in different cell types to produce two or more variants of a protein from the same gene
Silent mutation
What effect on codon and protein?
New codon specifies same amino acid

No effect on protein
Missense mutation
New codon specifies different amino acid

Possible decrease in function; variable effects on protein
Nonsense mutation
Effect on codon and protein
New codon is stop codon

Shorter than normal; usually nonfunctional protein
Frameshift mutation
Deletion or addition of a base

Usually nonfunctional protein; often shorter than normal
Large segment deletion (unequal crossover in meiosis) mutation
Loss of function; shorter than normal or entirely missing protein
Splice donor or acceptor mutation
Variable effects on protein; ranging from addition or deletion of a few amino acids to deletion of an entire exon
Triplet repeat expansion mutation
Expansions in coding regions cause protein product to be longer than normal and unstable

Disease shows anticipation in pedigree.
Sickle cell anemia type of mutation
Missense point mutation
a-Thalassemia type of mutation
Unequal crossover has deleted one or more a-chain hemoglobin genes from chromosome 16
Mutations in Splice Sites
Mutations in splice sites affect the accuracy of intron removal from hnRNA during posttranscriptional processing

* If a splice site is lost through mutation, spliceosomes may:
1. Delete nucleotides from the adjacent exon.
2. Leave nucleotides of the intron in the processed mRNA.
3. Use the next normal upstream or downstream splice site, deleting an exon from the processed mRNA.
b-thalassemia, Gaucher’s disease, and Tay-Sachs type of muatiion
Mutations in splice sites
Huntington’s disease
Fragile X syndrome
Spinobulbar muscular atrophy
Myotonic dystrophy
What type of mutation?
Trinucleotide Repeat Expansion
aminoacyl-tRNA synthetases
Amino acids are “charged” onto tRNA by aminoacyl-tRNA synthetases
The Wobble Hypothesis
The wobble hypothesis states that the third position (3' end) of the codon on mRNA and the first position (5' end) of the anticodon on tRNA are bound less tightly than the other base pairs, and, therefore, allow unusual base pairings to occur.
Bone marrow appearance in aplastic anemia
Hypocellular
RBC appearance in thalassemia
Hypochromic that may have a target appearance
What's the chemical most commonly associated as the cause of aplastic anemia?
Benzine
What lung disorders are usually caused by asbestos?
Pulmonary fibrosis
Mesothelioma
Lung cancer
RBC appearance in lead poison anemia
Hypochromic Microcytic
What drugs are usually associated as the cause of aplastic anemia?
Chloramphenicol
Phenylbutazone
Gold
What's the multidrug treatment for Mycobacterium leprae?
Rifampin
Clofazimine
Dapson
What's the MoA of dapson?
Inhibits bacterial synthesis of dihydrofolic acid
Tricky T's
Chlamydia trachomatis -- bacteria , STD
Trichomonas vaginalis -- protozoan, STD
Trichinella spiralis -- worm in undercooked meat
Trypanosoma -- causes Chaga's diesease (T. cruzi) or African sleeping sickness
Treponema -- spirochete; causes syphilis (T. pallidum) or yaws (T. pertenue)
Trichomoniasis
Vaginitis
Strawberry-colored mucosa
Vaginitis
Foul-smelling
Greenish discharge
Itching
Burning
Common organisms which cause vaginal infections
Itchiness Discharge
C.
Albicans: yes white
T.
Vaginalis: yes yellow
Gardenerella
vaginalis: white/gray
Giardiasis
Bloating
Flatulence
Foul-smelling diarrhea
Transmxn: Cysts in water
Dx: Trophozoites or cysts in stool
Giardiasis treatment
Metronidazole
3 Protozoans usually transmitted by cysts in water
Entamoeba histolytica
Giardia lamblia
Cryptosporidium
Metronidazole MoA
Forms toxic metabolites in the bacterial cell
Metronidazole clinical use
Giardia
Entamoeba
Trichomonas
(GET on the METRO)
Gardnerella vaginalis
Anaerobs (bacteroides, clostridium)
Triple therapy against H. pylori
Bismuth
Amoxicillin
Metronidazole
(BAM)
Anti-TB drugs
Streptomycin
Pyrazinamide
Isoniazid (INH)
Rifampin
Ethambutol
(INH-SPIRE [inspire])
Cycloserine (2nd-line therapy)
What drug is used for TB prophylaxis?
Isoniazid (INH)
Isoniazide (INH):
MoA
Decreases the synthesis of mycolic acids
Isoniazide (INH):
Toxicity
Hemolysis if G6PD deficient
Neurotoxicity
Hepatotoxicity
SLE-like syndrome
Pyridoxine (vit B6) can prevent neurotoxicity

INH: Injures Neurons and Hepatocytes
Bacterial vaginitis causative agent
Gardnerella vaginalis
Dangerous infections during pregnacy
ToRCHeS:
Toxoplasma
Rubella
CMV
HSV/HIV
Syphilis
Coxsackie B virus causes what heart condition?
Myocarditis
5 major rheumatic fever criteria
Carditis
Migratory polyarthritis
Subcutaneous nodules
Sydenham chorea
Erythema marginatum
Ebstein's anomaly
Anomalous attachment of the tricuspid leaflets
Downward displacement of the tricuspid valve into the right ventricle
Tricuspid regurgitation
Aschoff body
Rheumatic fever
Focal interstitial myocardial inflammation
Large cells (Anitschkow myocytes)
Aschoff cells (multinucleated giant cells)
Libman-Sacks lesions
Small vegetations that occur on valvular heart tissue
Associated with endocarditis in SLE
Calcium channel blocker agents and MoA
Diltiazem
Nifedipine
Verapamil

Block voltage-dependent L-type calcium channels
X-ray findings in sarcoidosis
Bilateral hilar lymphadenopathy
Sarcoidosis findings
GRAIN
Gammaglobulinemia
Rheumatoid arthritis
ACE increase
Interstitial fibrosis
Noncaseating granuloma
Lung disease in sarcoidosis
Restrictive lung disease
ANCA positive vasculitidies
Polyarteritis nodosa
Wegener's granulomatosis
Microscopic polyangiitis
1o pauci-immune crescentic glomerulonephritis
Churg-Strauss syndrome
Cafe-au-lait spots
Neurofibromatosis
Cerebriborm nuclei
Mycosis fungoides (cutaneous T-cell lymphoma)
Charcot's triad - Multiple sclerosis
Multiple sclerosis
* Nystagmus
* Intention tremor
* Scanning speech
Charcot's triad - Cholangitis
Cholangitis
* Jaundice
* RUQ pain
* Fever
Charcot-Leyden crystals
Bronchial asthma (eosinophil membranes)
Cotton-Wool spots
Chronic hypertension
Curling's ulcer
Acute gastric ulcer associated with severe burns
Currant jelly sputum - What organism?
Klebsiella
Ghon focus is an indication of?
Primary TB
Glanzmann's thrombasthenia
Defect in platelet aggregation
Hand-Schuller-Disease
Chronic progressive hitiocytosis
Heterophil antibodies
Infectious mononucleosis (EBV)
High-output cardiac failure (dilated cardiomyopathy)
Wet beriberi (thiamine, vit B1 deficiency)
Homer Wright rosettes
Neuroblastoma
Honeycomb lung on x-ray
Interstitial fibrosis
Howell-Jolly bodies
Splenectomy (or nonfunctional spleen)
Increased uric acid levels
Gout
Lesch-Nyhan syndrome
Myeloproliferative disorders
Loop and thiazide diuretics
Kartagener's syndrome
Dynein defect
Krukenberg tumor
Gastric adenocarcinoma with ovarian metastases
Lesch-Nyhan syndrome what enzyme deficiency
HGPRT deficiency
Libman-Sacks disease
Endocarditis associated with SLE
Lisch nodules
Neurofibromatosis (von Recklinghausen's diease)
Lumpy-bumpy appearance of glomeruli on immunofluorescence
Poststreptococcal glomerulonephritis
Monoclonal antibody spike
Multiple myeloma (called the M protein; IgG or IgA)
MGUS
Waldenstrom's (M protein = IgM) macroglobulinemia
Needle-shaped, negative birefringent crystals
Gout
Nephritis
Cataracts
Hearing loss
Alport's syndrome
Malignant mesothelioma
Occupational exposure to asbestos
"orphan annie" nuclei
Papillary carcinoma of the thyroid
Osler's nodes
Endocarditis
Painless jaundice
Pancreatic cancer (head)
Palpable purpura on legs and buttocks
Henoch-Schonlein purpura
Pancoast's tumor
Bronchogenic apical tumor associated with Horner's syndrome
Periosteal elevation on x-ray
Pyogenic osteomyelitis
Peutz-Jeghers syndrome
Benign polyposis
Peyronie's diasease
Penile fibrosis
Pink puffer
Emphysema (centroacinar [smoking], panacinar [a1-antitrypsin deficiency)
Podagra
Gout (MP joint of hallux)
Plummer-Vinson syndrome
Esophageal webs with iron deficiency anemia
Positive anterior "drawer sign"
Anterior cruciate ligament injury
Pseudorosettes
Ewing's sarcoma
Rash on palms and soles
2o syphilis
Rocky mountain spotted fever
RBC casts in urine
Acute glomerulonephritis
Red urine in the morning
Paroxysmal nocturnal hemoglobinuria
Increased Reid index
Chronic bronchitis
Reinke crystals
Leydig cell tumor
Renal cell carcinoma + cavernous hemangiomas + adenomas
von Hippel-Lindau disease
Renal epithelial casts in urine
Acute toxic/viral nephrosis
Rhomboid crystals, positively birefringent
Pseudogout
Rib notching
Coarctation of the aorta
Roth's spots in retina
Endocarditis
Rotor's syndrome
Congenital conjugated hyperbilirubinemia
Rouleaux formation (RBCs)
Multiple myeloma
Russell bodies
Multiple myeloma
S3
Left to right shunt (VSD, PDA, ASD)
Mitral regurgitation
LV failure (CHF)
S4
Aortic stenosis
Hypertrophic subaortic stenosis
Schiller-Duval bodies
Yolk sac tumor
Sezary syndrome
Cutaneous T-Cell lymphoma
Shwartzman reaction
Neisseria meningitidis
Signet-ring cells
Gastric carcinoma
Simian crease
Down syndrome
Sipple's syndrome
MEN type IIa
Smudge cell
CLL
Smith antigen
SLE
Soap bubble on x-ray
Giant cell tumor of bone
Spike and dome on EM
Membranous glomerulonephritis
Spitz nevus
Benign juvenile melanoma
Splinter hemorrhages in fingernails
Endocarditis
Starry-sky pattern
Burkitt's lymphoma
Strawberry tounge
Scarlet fever
String sign on x-ray
Crohn's disease
Subepithelial humps on EM
Poststreptococcal glomerulonephritis
Suboccipital lymphadenopathy
Rubella
Sulfur granules
Actinomyces israelii
Systolic ejection murmur (crescendo-decrescendo)
Aortic valve stenosis
t(14;18)
Follicular lymphomas (bcl-2 activation)
Tendon xanthomas
Familial hypercholesterolemia
Thumb sign on lateral x-ray
Epiglottitis (Haemophilus influezae)
Thyroidization of kidney
Chronic bacterial pyelonephritis
Tram-track appearance on LM
Membranoproliferative glomerulonephritis
Trousseau's sign
Visceral cancer
Pancreatic adenocarcinoma (migratory thrombophlebitis)
Hypcalcemia (carpal)
Virchow's node
Left supraclavicular node enlargement from metastic carcinoma of the stomach
Virchow's triad
Pulmonary embolism:
1) Blood stasis
2) Endothelial damage
3) Hypercoagulation
von Recklinghausen's disease of bone
Osteitis fibrosa cystica (brown tumor)
Wallenberg's syndrome
PICA thrombosis
Waxy casts
Chronic end-stage renal disease
WBC casts in urine
Acute pyelonephritis
WBCs in urine
Acute cystitis
Wermer's syndrome
MEN type I
Whipple's disease
Malaborption syndrome caused by Tropheryma whippelii
Wire loop appearance on LM
Lupus nephropathy
Xanthochromia (CSF)
Subarachnoid hemorrhage
Xerostomia + arthritis + keratoconjunctivitis sicca
Sjogren's syndrome
Zenker's diverticulum
Upper GI diverticulum
Zollinger-Ellison syndrome
Gastrin-secreting tumor associated with ulcers
Death in CML
Blast crisis
Death in SLE
Lupus nephropathy
Ejection click
Aortic/pulmonic stenosis
Glomerulonephritis (adults)
IgA nephropathy (Berger's disease)
Which hepatitis viruses lead to Hepatocellular carcinoma?
Cirrhotic liver (often associated with hepatitis B and C)
Holosystolic murmur
VSD
Tricuspid regurgitation
Mitral regurgitation
Infection in burn victims
Pseudomonas
Leukemia (adults)
AML
MI
Atherosclerosis
Mitral valve stenosis
Rheumatic heart disease
Nephrotic syndrome (adults)
Membranous glomerulonephritis
Nephrotic syndrome (kids)
Minimal change disease (associated with infections/vaccinations; treat with corticosteroids)
Opening snap
Mitral stenosis
Osteomyelitis with IVDA: causative agent
Pseudomonas
Causes of pancreatitis (acute)
EtOH and gallstones
Glutamate inhibitors
Topiramate
Felbamate
Genetic d/o of two or more chromosomes in men
Klinefelter's syndrome
Genetic defects of SCID
1) Recombinase-activating gene (RAG-1 and RAG-2) on chr. 11
2) ADA deficiency on chr. 20
3) Interleukin 2 receptor gama-chain (IL-2Rg)deficiency on chr. X
4) Janus-associated kinase 3 (JAK3) chr. 19
5) DNA-dependent protein kinase (PK) deficiency on chr. 8
X-linked recessive d/o
1) Fragile X
2) Duchenne's
3) Hemophelia A and B
4) Fabry's
5) G6PD
6) Hunter's syndrome
7) Ocular albanism
8) Lesch-Nyhan syndrome
9) Bruton's agammaglobulinemia
10) Wiskott-Aldrich syndrome
Loss of gene for Wiskott-Aldrich syndrome protein (WASP)
Causes disturbance in actin in the cytoskeleton
Only d/o with smaller than normal platelets
Impaired CD43 gp
Triad: eczema, recurrent infections, and thrombocytopenia
Increased lymphoreticular malignancy
Wiskott-Aldrich syndrome
Media to grow cryptococcosis
Sabourd's medium
or
Niger seed agar
Buddding of Cryptococcus
Narrow-based unequal budding
Flucytosine MoA
Inhibits DNA synthesis by:
conversion to fluorouracil which competes with uracil
Requires:
Telurite medium
Loffler's medium
Blood agar
C. diphtheriae
Inactivates elongation factor (EF-2)
Diphtheria toxin
8 y/o girl with congenital duplicate thumb, cafe-au-lait spots, and anemia
Most likely diagnosis?
Fanconi's anemia
Gram + spore formers
Bacillus anthracis
Clostridium perfringens
Clostridium tetani
Ursoldiol
Prevents formation of cholesterol gallstones through three mechanisms:
1) Decr hepatic secretion of cholesterol bile
2) Decr cholesterol synthesis by inhibiting HMG-CoA reductase
3) Decr reabsorption of cholesterol by the intestine
Elliptocytosis Treatment
Splenectomy
Pantothenic acid
B vitamin
Combines with cysteine and ATP to form CoA
Zanamivir (Relenza)
Reversible inhibits neuraminidase (NA) of influenze A and B
Oseltamivir (Tamiflu)
prodrug that is converted into an active neuraminidase inhibitor
Schistosomiasis treatment
Praziquantel
Slow-reacting substance of anaphylaxis
LTB4
LTC4
LTD4
Warfarin (Coumadin) MoA
Inhibits epoxide reductase
Shigellosis (Bacillary dysentery)
Affected bowel area
Diarrhea
Treatment
Colon
Profuse, initially nonbloody turning to bloody
Tetracyclines, ciprofloxacin
Vancomycin (Vancocin) MoA
Binds to D-alanyl-D-alanine portion of the cell wall precursors and prevents polymerization of peptidoglycans
Vancomycin (Vanconin) side effect
Red man syndrome:
flushing and pruritis of torso, neck, and face when used too rapidly
Bacitracin
Inhibits cell wall synthesis by blocking the transport of peptidoglycan precursors across the cell membrane

Too toxic to use systemically

Only used topically
Vancomycin resistance
Amino acid change of D-ala D-ala to D-ala D-lac
Rash in smallpox
1) Macular to vesicular and pustular

2) 1-2 week course

3) First appears on face, in mouth, and on arms before spreading to the rest of the body

4) Some have bleeding into vesicles (hemorrhagic smallpox)
DNA viruses families
Hepadnavirus: HBV
Herpesvirus: HSV-1, HSV-2, VZV, EBV, CMV, HHV-6, HHV-8
Adenovirus: (febrile pharyngitis, pneumonia, conjuctivitis)
Parvovirus: B19 virus
Papovavirus: HPV, JC
Poxvirus: Smallpox, Molluscum contagiosum
Double enveloped viruses
Herpes
HBV
Smallpox
Osteomyelitis
Causative agents:
Most people:
Sexually active:
Diabetics and drug addicts:
Sickle cell:
Prosthetic replacement:
Vertebral:
Most people: S. aureus
Sexually active: N. gonorrhoeae
Diabetics and drug addicts: P. aeruginosa
Sickle cell: Salmonella
Prosthetic replacement: S. aureus and S. epidermidis
Vertebral: Mycobacterium tuberculosis (Pott's disease)
Salmonella enterocolitis treatment
Supportive treatment only, if there is no systemic sequelae like osteomyelitis or meningitis
Gram -
Rods
Lactose nonfermenter
Oxidase -
Shigella
Salmonella
Proteus
Gram -
Rods
Lactose nonfermenters
Oxidase +
Pseudomonas
Gram -
Rods
Lactose fermenters
Fast fermenters
Klebsiella
E. coli
Enterobacter
Gram -
Rods
Lactose fermenters
Slow fermenters
Citrobacter
Serratia
Others
Chaga's disease treatment
Nifurtimox
Benznidazole
Causes of eosinophilia
NAACP:
Neoplastic
Asthma
Allergic processes
Collagen vascular disease
Parasites
RBC appearance in beta-thalassemia
Hypochromic microcytic anemia
Target cell
Tear-drop shaped
Hair on end skull on radiograpph
Beta-thalassemia
Cat scratch disease
Organism
Baronella henselae
Small pleomorphic
Gram - bacilli
Warthin-Starry stain positive
Granulomatous inflammation with stellate necrosis in lymph nodes
Bartonella henselae
Aspergillosis laboratory technique?
Silver stain
Babesiosis laboratory tech?
Giemsa blood smear
Cat scratch disease lab tech?
Warthin-Starry stain
Cryptococcus lab tech?
Sabouraud's medium or Niger seed agar
Gonorrhea lab tech?
Thayer-Martin media culture
Legionnaire's disease lab tech?
Charcoal yeast extract with silver stain
Leprosy lab tech?
Modified Fite-Franco stain (also acid fast)
Lyme lab tech?
Darkfield technique
Ribaviring clinical use
RSV
Chronic hepatitis C
Beta-hemolytic bacteria
Organisms?
S. aureus (catalase + and coagulase +)
S. pyogenes (catalase - and bacitracin sensitive)
S. agalactiae (catalase - and bacitracin resistant)
L. monocytogenes (tumbling motility, meningitis in newborns, unpasteurized milk)
Gram +
Bacilli
Non-spore forming
Tumbling motility
L. monocytogenes
Only gram + with endotoxin
Listeria
Intracellular bugs:
Obligate intracellular
Rickettsia
Chlamydia

*can't make own ATP
Intracellular bugs:
Facultative intracellular
Salmonella
Neisseria
Brucella
Mycobacterium
Listeria
Francisella
Legionella
Yersinia
Trifluridine (Viroptic)
Thymidine analog
Phosphorylated by both cellular and viral thymidine kinases
The triphosphate derivative is incorporated into viral and to a lesser extent mammalian DNA
Theophylline (Theo-Dur, Slo-bid)
Methylxanthine prototypical

Phosphodiesterase inhibitor
Blocks adenosine rcptrs

Results in incr cAMP levels -->
Bronchodilation and tachycardia
What's the treatment of choice for most rickettsial infections
Tetracycline
Ehrlichiosis:

Intracellular infection of monocytes. What agent?

Intracellular infection of granulocytes
Monocytes: Ehrlichia chaffeensis (HME)

Granulocytes: Ehrlichia phagocytophilia (HGE)
Rickettsial diseases and vectors:

Rocky mountain spotted fever

Endemic typhus

Epidemic typhus

Q fever
RMSF: tick__Rickettsia ricketsii

Endemic typhus: fleas__R. typhi

Epidemic typhus: human body louse__R. prowazekii

Q fever (no vector...inhaled aerosols): Coxiella burnetii
Diseases transmitted by Ixodes tick
Lyme
Ehrlichiosis
Bartonella
Babesiosis
Parasites enter RBC
Ring-like structure in RBCs on Giemsa blood smear
Sometimes tetrad daughter organisms are seen inside RBCs owing to asexual reproduction
Babesiosis
Babesiosis treatment
Oral Malarone and azithromycin for 30 days
Mepron (atovaquone) and azithromycin for 30 days
What's the most appropriate diagnostic tool to demonstrate gallbladder stones?
Real-time ultrasonography

98% sensitivity
95% specificity
How do gallstones form?
Form when solubulizing bile acid and lecithin are overwhelmed by high cholesterol and/or bilirubin
Causes of acute pancreatitis?
EtOH
Gallstones
Guarnieri's bodies
Smallpox
What arteries anastomose if occlusion of the celiac artery occurs?
Pancreaticoduodenal branches of both the superior mesenteric and gastroduodenal arteries
What is the name of the space between the stomach, hepatoduodenal ligament, and hepatogastric ligament?
Omental bursa

Can be entered through the epiploic foramen of Winslow
Portacaval anastomoses:
Sites of anastomoses
Clinical signs
1) Left gastric --> azygous (esophageal varices)

2) Superior --> inferior rectal (internal hemorrhoids)

3) Paraumbilical --> inferior epigastric ( caput medusae)

4) Retroperitoneal --> renal

5) Retroperitoneal --> paravertebral
Gallstones appearance:
Cholesterol
Bilirubin
Mixed
Cholesterol: yellow, radiolucent

Bilirubin: pigmented, small, black, multiple, and radiolucent, hemolytic disease

Mixed: chronic cholecystitis, cholesterol and calcium bilirubinate
"Fibrates"
Agents
Lipid profile
Side effects
Gemfibrozil, clofibrate, bezafibrate, fenofibrate

Lower LDL, Increase HDL, Decrease triglycerides

Myositis
Increase LFTs
Gallstones
Causes of hypercalcemia
CHIPANZEES

Calcium ingestion (milk-alkali syndrome)
Hyperthyroid
Hyperparathyroid
Iatrogenic (thiazides)
Multiple myeloma
Paget's disease
Addison's disease
Zollinger-Ellison syndrome
Excess vit. D
Excess vit. A
Sarcoidosis
CHIPANZEES
Stellate giant-cell cytoplasmic inclusions (bodies)
Asteroid bodies (not specific) found in sarcoidosis
Laminated calcifications found in sarcoidosis (bodies)
Schaumann bodies
Anitschkow cells
Large histiocytes found in aschoff bodies
Aschoff bodies
Focal collections of perivascular fibrinoid necrosis surrounded by inflammatory cells including large histiocytes (Anitschkow cells)
Paget's cells
Individual adenocarcinoma cells found within the squamous epithelium of the skin
Grocott silver stain use
Used to identify fungal organisms
Naproxen MoA
NSAID
Inhibits cyclooxygenase
Coarctation of the arota:
Associated conditions
1) Turner's
2) Congenital bicuspid valve
3) Gonodal dysgenesis
4) Cerebral aneurysms
5) Infective endocarditis
6) Cerebral hemorrhage
7) Early arteriosclerosis
Acyanotic congenital heart defects
No communication between circulations
1) Right-sided aorta
2) Ebstein's anomaly
3) Coarctation of the aorta
4) Tricuspid atresia
Cyanotic congenital heart defects
Permanent right-to-left shunt
1) Tetralogy of Fallot
2) Truncus arteriosus
3) Transposition of the great vessels
Cyanose tardive congenital heart defects
Initially left-to-right shunt then right-to-left shunt of Eisenmenger's
1) VSD
2) ASD
3) PDA
4) Persistent truncus arteriosus
5) Anomalous pulmonary venous drainage
Eisenmenger's syndrome
Cyanosis
Clubbing
Pulmonary HTN
Heart failure
Thickening of pulmonary artery walls
VSD
Infective endocarditis
Failure to thrive
Paradoxical emboli
ASD
Early fatigability
Dyspnea of exertion
Paradoxical emboli
Truncus arteriosus
Heart failure
Recurrent pulmonary infections
Cyanotic shunts at birth
Causes
5 T's
1) Truncus arteriosus
2) Transposition of great vessels
3) Tetralogy of Fallot
4) Tricuspid atresia
5) Total anomalous pulmonary venous congestion
Most common type of VSD defect
Defect in the membranous septum (usually superior part)
Most common type of ASD defect
Ostium secundum
Classic triad predisposing to DVT
1) Endothelial injury
2) Stasis
3) Hypercoagulable state
QRS appearance in ventricular arrhythmia
Widened
Class 1B sodium channels blockers
Lidocaine/Mexiletine/Tocainide

Depress the action potential
Stabilize the cell membrane
Class 1B sodium channel blockers use
Acute ventricular arrhythmias
Digitalis-induced arrhythmias
Class 1C sodium channel blockers
Flecainide/Encainide/Propafenone

Depress action potential at phase 0
Stabilize cell membranes
Rb gene function
Tumor suppressor gene inhibit cell proliferation

Rb protein binds to and sequesters the specific transcription factor E2F, inactivating E2F
E2F
Increases transcription of a variety of proteins that move the cell from G1 to S phase of the cell cycle
Proteins that promote cell cycle progression and cell proliferation are cellular?
Oncogenes
Ewing sarcoma
1) Adolescents and young adults
2) Long limbs
3) Malignant neoplasm
4) Small blue cell tumors
5) Aggressive course
Small blue cell tumors
1) Ewing sarcoma
2) Small cell carcinoma of the lung
3) Lymphoma
4) Neuroblastoma
3 types of ovarian tumors that produce high level of steroid hormone
1) Sertoli-Leydig cell tumors
2) Fibroma-thecomas
3) Granulosa cell tumors