Step Facts

Front 1

Lamivudine

Back 1

Tx- HIV via NRTI

Tx- Hep B

SA- Lactic Acidosis; Peripheral Neuropathy

Front 2

Indinavir

Back 2

tx- HIV via Protease Inhibitor

SA- stones; thrombocytopenia; (PI common SA are Hyper- glu, lipodystrophy, GI issues).

Front 3

Tuberculoid leprosy

Back 3

STRONG CD4+ Rxn; like tuberculosis bc walled off the ds;
Pos skin test

Front 4

3 Golgi actions w oligosaccharides (and associated aa's)

Back 4

Modifies N-oligosaccharides (of ER) at Arginine;
Adds O-oligosaccharides at Serine and Threonine
Adds Mannose-6-Pi into Lysosomes, guides enzymes to here.

Front 5

I-Cell ds

Back 5

No Mannose phosphorylation

CP- clouded Cornea; joint pains; coarse face

Front 6

Gallbladder Pain tx

Back 6

Meperidine- Opiod agonist, that doesn't really contract the sphicinter of Oddi (avoid THIS drug in MOA-I tx of anti-depressed pts)
-Dicyclomine- anti musc; relaxes SM, dec pain

-NSAIDs- Diclofenac or Ketorolac

Front 7

Estrogen and Progesterone on Gallstones

Back 7

Estrogen:
-Inc HMG-CoA Reductase (inc cholesterol, and HDL) (rate limiting step in Cholesterol Syn, block by Statins.
-Suppresses 7alpha-hydroxylase (n'lly converted cholesterol into Bile, now lost; Fibrates also adversely suppress, SA).

Progesterone:
-Dec bile acid secretion, slows emptying.

Other cholesterol stone risk- fat, rapid wt loss, fasting, malabsorption of bile acids;

Front 8

Cytochrome P450 Monooxygenase

Back 8

Metabolizes steroids, EtOH, toxins, etc making them easier to excrete; Bad news- also turns Proto-carcinogens into Carcinogens.
-Phase I (w HOR); Liver Zone III (EtoH, ischemia; Zone I is viral)

Front 9

Primary HSV-1 infection

Back 9

Herpetic gingivostomatitis; ulcerative gingivitis; fever; vesiculoulcerative lesions; lymphadenopathy; Usually 1-3yo child.

Front 10

Cornea-

Retina-
CN 2-
Choroid, sclera-
Lens-

Back 10

Cornea- Surface ectoderm

Retina- Neuroectoderm (as is Posterior Pit)
CN 2- NCC (as are all CNs)
Choroid, sclera- NCC
Lens- Surface Ectoderm (as is Anterior Pit)

Front 11

C. difficile toxins

vs

C. Perfringens toxins

Back 11

Toxin A- enterotoxin- recruits Neutrophils; edema- diarrhea!

Toxin B- Cytotoxin- Actin Depolymerizationl mucosal necrosis!

C. perfringens- lecithinase and Phospholypase C, hydrolyze lecithin and sphingomyelin; disrupt membrane and mito membrane. Lyse leukocytes, few WBCs.
tx- Penicillin

Front 12

Phentolamine

Back 12

alpha 1 blocker; essientially used to counter NE that has leaked from the vein of an IV tx (CP- cold hard pale tissue, need to reverse these a1).
-causes vasodilation

Front 13

cal per item:

Protein-
EtOH-
Fat-

Back 13

Protein (or Carbs)- 4 cal ("PC is a 4 yr president")

EtOH- 7 cal ("lucky to drink")

Fat- 9 cal (''dressed to the 9s!")

Front 14

Tx of urinary urgency

Back 14

Anti-Musc (M3)
-Glycopyrrolate, Oxybutynin, Trospium; Solifenacin, Tolterodine, Darifenacin,

Front 15

Tx of Peptic Ulcer

Back 15

Anti-Musc (M1 on ECL cells; M3 on Parietal cells)

- Methscopolamine; pirenzepine; propantheline

Front 16

What "sexually" does the Urogenital Sinus become in each gender? (maybe >1 thing in each)

Back 16

Male- Bulbourethral Gland (of Cowper); makes pre-ejaculate fluid
Female- Greater Vestibular Glands (of Batholin); moistens vagina

Male- Prostate gland
Female- Urethral and Paraurethral glands (of Skene)

Front 17

Bronchopneumonia

Secondary pneumonia (following virus)

Back 17

-S. aureus; H influenz, Kelbsiella, S. pneumoniae

-2nd: S. aureus (also #1 abscess in lung), then Klebsiella

Front 18

Reoviridae is

Back 18

dsRNA, non-env, icosahedral, segmented.

Front 19

The four beta-hemolytic bugs

Back 19

(beta= completely clear plate): Staph aureus, Strep pyogenes, Strep agalactiae (CAMP test), Listeria monocytogenes.
Reverse CAMP test is different, and if + then the bug is Clostridium perfringens.

Front 20

Cisterna chyli

Back 20

It forms the primary lymph vessel transporting lymph and chyle from the abdomen via the aortic opening to the junction of LEFT subclavian vein and internal jugular veins.

Dilated sac at the lower end of the thoracic duct into which lymph from the intestinal trunk and two lumbar lymphatic trunks flow.

Front 21

Niacin- (lipid drug)

Back 21

Inhibit LOPOLYSIS of ADIPOSE tissue, less ffa to liver = reduce Hepatic VLDL, and less VLDL secretion into circulation (IN Liver). DEC Cholesterol into VLDL (which eventually becomes LDL; bc less VLDL made, you instead make HDL)!

SA- DUH- DM, Uric acid, HTN:
Flushing (Red Face - that decreases with Aspirin or chronic use), Hyperglycemia (Acanthosis Nigricans), Hyperuricemia (Makes Gout worse)

Front 22

"Fibrate"

Back 22

Upregulate LPL (LPLase enzyme, not receptor; in circulation, not liver) to increase Triglyceride clearance-

SA- Myositis, Hepatotoxicity (Increase LFTs), Cholesterol Gallstones (bile action of Fibbing).

Front 23

MI Time Line:
0-4hrs- (die of _________ and tx for this is 3 ___)
4-12hrs-
12-24hrs-
2d(48hr)-5d- _______; Risk- _________ (3-5d)
5d-10d- (Comps w blood vessel and ECG marker- ___ heard area), ___ (heard at ___ area in ___ ) if ____.

10-14d-
7 wk-
Most die bc _____, tx w- 1 ______

Back 23

MI Time Line:
0-4hrs- nothing (BEFORE ER die of V. Fib, tx- AMLODIPINE, Stalo, Procainamide)
4-12hrs- Wavy lines; Edema; Early Coag necrosis!
12-24hrs- Contraction BANDS
2d(48hr)-5d- Neutrophiles; Pericadritis (3-5d; tx- Aspirin, leaning fwd)
5d-10d- Macrophages; Rupture (tamponade, VSD (LAD supplied, V1-V2; heard pan-systole at TRICUSPID area), MR (heard at Mitral area in systole) if Posterior medial papillary m of LV, PIVA supplied via RCA II III aVF).
10-14d- Granulation
7 wk- scar (Dressler w fever, 6-8 wks; Type II HSN)
MOST total die bc Cardio Shock, tx w- Dobutamine (B1>>>>a1,a2,b2)

Front 24

Becaizumab-

Cetuximab-

Rituximab-

Back 24

Becaizumab- anti VEGF; Colon, lung renal, recurring glioblastoma multiforme. (Beca is a VAG F'er, large colon, good kids and messed up brain).

Cetuximab- anti EGFR (Endodermal GF Receptor); head and neck squamous cx, colon, lung, pancrease, (in a tux u can only see your head and neck, etoh hurts your Panc)

Rituximab- Ab against CD20 on all B cell neoplasms. Tx- NHL, RA (w MTX).

Front 25

Apos:
A-I -
B-48 -
B-100 -
C-II -
E -

ds a/w
Equation=

Back 25

A-I - activates LCAT for HDLs; (randomly also on Chylomicrons, but not the remnants).

B-48 - Mediates Chylomicron secretion (Chylomicrons, and the remnants).

B-100 - binds LDL RECEPTOR for IDLs and LDLs (>50% cholesterol), and ALSO mediates VLDL Secretion from Liver; (lost LDL recepor in Type IIa, >600 cholesterol is HOMO, n'l is <200; MI and Achilles); (a/w Type IV bc VLDL inc, which are 65%TG n'l <150); but Type IV from in VLDL, not defect in B-100.

C-II - cofactor for LPL (enzyme; inc by Fibrates) for Chylomicrons (>90% TG), IDLs and VLDLs; Lost in Type I (inc TG); (on the ones that act in the blood w cells, Chylomicrons, VLDL; also on HDL bc HDL is a RESERVE for Apo C and Apo E).

E - Mediates Extra Remnant Uptake (Chylomicron Remnants; which n'lly become LDL); (chrm 19, ApoE4- bad for Az pts, ApoE2- good); On all types Except LDL, whom just has the ApoB-100.

Total Cholesterol = LDL + HDL + (1/5 TG); nl <200 total. Must fast to get n'l TG level in test, but no change in HDL or cholesterol level if pt cheats. TG is whats milky.

Front 26

Leishmania donovani
CP-
CP-

Diagnosis:

Due to-
Treatment:

Back 26

-Fever (Hyperpigmentation of Skin, Splenomegaly, Dec Bone Marrow Activity

CP- Visceral Leishmaniasis (Kala-Azar) - with Spiking Fevers, Hepatosplenomegaly, Pancytopenia
CP- Cutaneous Leishmaniasis with possible Granulomas

Diagnosis: Amastigotes (form without flagella) seen Intracellular inside Macrophages (spotted, like the pt!) in bone marrow, liver and spleen

Due to- Phlebotomus Sandfly bite, Reservoirs in Dogs and Rodents
Treatment: Sodium Stibogluconate (an antimony compound; stops PFK rxn); (maybe Miltefosine, melts PM)

Front 27

Amino Acids (D vs L):
Essential Gulcogenic-
Essential Mixed-
Essential Ketogenic-
3 for the NLS-
3 Basic-
2 Acidic- (also, pyrimidine and Purines)
2 on Histones-
2 that are Methylated-

Back 27

Amino Acids: Essential- PVT TIM HALL (Phen, Val, Thre, Tryp, Isolu, Meth, Hist, Leucine, Lysine). Only L-form are found in proteins (D for carbohydrates).
Essential Gulcogenic- Met Val Arguing Hysterically.
Essential Mixed- Iso (I so) Pheen (phenylalanine) for a mixed Three some on this Tryp, that is essential.
Essential Ketogenic- The Key is to Lye to Lue.

3 for the NLS- Pro at Lying about ENTERING Argentina. (Needed to enter nucleus).

3 Basic- Basically His Lys about Argentina were positively. (note- Histine, is actually neutral at body pH).
2 Acidic- Aspartic Acid, Gultamic Acid. (note- these two plus Glycine make Purines). (note- Pyrimidine is of Aspartate and Carbamoyl Pi)

2 on Histones- Negatively charged DNA (from Phosphates) wraps twice around positive charged histones to form a nucleosome; Histone made of lysine and arginine (both +); His tone showed he was positively Lyin' about Arginina', twice, but the Lyin got him Ace (ass- Acetylation-> lysine).

2 that are Methylated- Cytosine and Adenine

Front 28

Smell, color discharge; What ds looks like, histo or gross-
Trichomoniasis Vaginitis-

Gardnerella Vaginalis-

Back 28

Trichomoniasis Vaginitis - foul smelling (esp after menses), frothy green/yellow purulent discharge, itching and burning and Strawberry Mucosa (Strawberry Cervix)


Gardnerella Vaginalis- Pleomorphic, Gram-Variable Bacillus (Bacteria with Unusual Cell Walls or Membranes)
Diseases: Bacterial Vaginosis (Gray Vaginal Discharge with Fishy Smell, nonpainful), associated with sexual activity and STD due to overgrowth of bacteria in Vagina

Diagnosis:Clue Cells (Stippled Vaginal Epithelial Cells covered with Bacteria).

Front 29

Praziquantel

Back 29

Schistosomiasis
Mechanism: unk; inc Ca+2 into pathogen, causes contraction.
SA- Toxicity and Undesired Effects: Mild and short lived
N/V
Abdominal Pain

Front 30

heavy chain-
c-myc-
abl-
Cyclin D-
BCL-
Retinoic receptor-

Back 30

chrom 14 being HEAVY CHAIN-heavy chain like the drenched tampon girls have once they turn 14

c-myc being chrm 8- 8 = late = late because riding a camyl (camel)

abl = able, chrm 9 (Mike Modano) is able to do what he wants, even 22 yos! (9;22 in CML).

Cyclin D being chrm 11- 11 is like a bicycle with each "1" being a wheel

BCL being chrm 18- before age 18 you refuse to call it "Before Christ Lives"

Retinoic receptor- chrm 25, rick is a DIC, had Vit A to tx his acne and his number was 15; (AML 15;17).

Front 31

Ogilvie's Syndrome

Back 31

• Ogilvie's Syndrome: acute pseudo-obstruction of the colon without any real mechanical obstruction, seen in men over 60 with associated underlying condition. Likely autonomic impairment.
○ May occur after surgery, especially following coronary artery bypass surgery and total joint replacement.
○ Also seen with neurologic disorders, serious infections, cardiorespiratory insufficiency, and metabolic disturbances.
○ Drugs that disturb colonic motility (e.g., anticholinergics or opioid analgesics) contribute to the development.
"Olivia has an obstruction of her butt (colon) even though there is not anything physically blocking it! She has bad knees and a bad heart!".

Front 32

-Reassortment


-Recombination

Back 32

Reassortment- Segmented Viruses (exchange Homologous Segments); Stable Genetic Change (do 1-for-1 swap that lasts many generations)
-When Segmented Genome Viruses (ex. Influenza Virus) exchange segments - resulting in high frequency Recombination
Reason for world-wide influenza pandemics.


Recombination- Exchange of genes between 2 chromosomes by Crossing Over within regions of significant base sequence homology

Types: Homologous Crossing Over - one-to-one exchange of linear extrachromosomal DNA for Homologous Alleles within the chromosome - uses Recombinase A.
Site-Specific Crossing Over - incorporation of extrachromosomal circles of DNA into another molecule of DNA using restriction Endonucleases.

Pathology:
Inversion - Take part broken off to cross over and flip its direction
a. Paracentric Inversion - does NOT involve Centromere (Centromere will not be moved in final created chromosome) - forms acentric fragment and dicentric bridge, cell WON'T complete meiosis
b. Pericentric Inversion - involves Centromere (Chromosome will have centromere moved so that SISTER chromosomes don't match up) - needs to do recombination loop to pair up (only uses 1 arm to duplicate stuff)

Front 33

Anesthetic Principles

Inc blood solubility-

Inc AV Concentration Gradient-

Back 33

Lung - Inc rate and depth of Ventilation resulting in Inc Gas Tension.
Blood - INC blood solubility means INC Blood/Gas Partition Coefficient, so Inc solubility and INC gas required to saturate blood that results in SLOWER onset of action!
----Anesthetics with LOW blood:gas partition coefficients are advantageous, because they act rapidly and the time to recover from their effects is short!
Tissue (ex. Brain)- INC AV Concentration Gradient = results in INC solubility and INC gas required to saturate tissue and SLOWER onset of action. (think- >in arteries and low in veins, bc gas is getting lost in tissues, not getting to brain!)

Drugs with DEC solubility in the blood = RAPID induction and recovery times.
Drugs with Inc solubility in lipids have Inc Potency = 1/MAC (where MAC is Minimal Alveolar Concentration at which 50% of the population is anesthetized - and can vary with age)

-Inhaled type will INC Cerebral Blood Flow

Front 34

Clopidogrel-

Abciximab-

Enoxaparin-

Ticlopidine-

Eptifibatide-

Tirofiban-

Back 34

Clopidogrel- Binds ADP RECEPTORS

Abciximab- Binds Gp II/III receptors

Enoxaparin- activates AT III to selectively bind Factor X

Ticlopidine- Binds ADP RECEPTORS

Eptifibatide- Binds Gp II/III receptors

Tirofiban- bind GpII/III receptor

Front 35

Yersinia Enterocolitica

Back 35

Yersinia Enterocolitica- Coagulase Positive (like S. Aureus) Ox neg, Cat +; Transmitted from Pet Feces (ex. Puppies), Contaminated Milk or Pork
Can grow at low temperatures (4 degrees Celsius - like Listeria Monocytogenes)
Outbreaks/Mini-epidemics common in Day-Care Centers; Also from Pork and Blood Transfusions.
Heat Stable Toxins (cGMP); Bipolar staining.
CP- Diarrhea that may Mimic Crohn's Disease or Appendicitis (Pseudoappendicitis) - esp in Teens
tx- Quinolone; 2rd gen Cephalosporin; Trimethoprim/Sulfamethoxazole (DOC)

Front 36

Infections buzz words:

-Pneumonia in immunocompromised-

-Fungal Lung in Texas/Gulf Coast-

-Pneumonia in pts w other health issues-

-Bacterial COPD exacerbation-

-Endogenous flora in 20% of adults- Strep pneumonia

Back 36

Infections buzz words:

-Pneumonia in immunocompromised- PCP

-Fungal Lung in Texas/Gulf Coast- Histoplasma (Caves, Bats); vs West Tx of Coccidio

-Pneumonia in pts w other health issues- Kelbsiella

-Bacterial COPD exacerbation- H. influenza

-Endogenous flora in 20% of adults- Strep pneumonia

Front 37

HPV
Papillomavirus virus-

ID-
virulence strands and proteins-
Tx-
Tx-

Back 37

HPV
Papillomavirus virus- (PAPP = naked), dsDNA, non-env, circular DNA (so is Polyomoa virus family w JC and BK).
ID- Koilocytic Cells (Koilocytes) on Pap Smear - are Epi cells with large nuclei and perinuclear vacuolization
virulence strands and proteins- HPV 16 w E6 binds p53; HPV 18 w E7 binds Rb.

Tx- HPV Vaccine (Guardasil) - Recombinant Vaccine for most dangerous types 6, 11, 16, 18
Tx- IFN-alpha

Front 38

Elastin differs from Collagen via:
-aa's: PG (rich in Proline, Glycine; vs in Collagen: Proline, Lysine, and esp Glycine (every 3rd aa); PL, collagen is a G PLaya; Elastin is more PG, less L).
-Fewer hydroxy groups in Elastin, and not glycosylated (in collagen, add OH to Proline and Lysine, add SUGAR to Lysine-OH)
-No triple helix due to the lack of Glycosylation (and so no Disulfide Bridge, bc Elastin is PG, not PL and its the L, LYSINE, that does triple helix and bridge)!
-Elastin, Instead of Triple Helix, uses a fibrillin scaffolding (marfan's).
-Cross-links: (in collagen due to *Lysine-OH* and copper); Relies on DESMOSINE Cross-links for elasticity between the limited Lysine that is in Elastin.
-Dec via enzyme: Elastase of Neutrophiles, n'lly we have alpha-1-anti-tripsin to turn this off (panacinar emphysema, cirrhosis).

Back 38

move here

Front 39

Optic canal transmits:
-______nerve, _________artery, and the -_________ vein.

Superior Orbital Fissure:

Both in ________ Bone (CN's 2-6)

Back 39

Optic canal transmits:
-Optic nerve, ophthalmic artery (note, a branch of this is the central retinal artery), and the central Vein of the Retina.

Superior Orbital Fissure: (SOF3,4,5,6)
Sympathetics, Ophthalmic Vein (V bc CN V), Four nerves: CN III (ophthalmic n), CN IV, CN V1, CN VI

Both in Sphenoid Bone (CN's 2-6)

Front 40

Acute Rejection-

Hypersensitivity Myocarditis-

Patchy Necrosis w granulation tissue-

Scant inflammatory cells and interstitial fibrosis-

Back 40

Acute Rejection- Dense infiltrate of mononuclear cells composed of T-lymphocytes (against the forgein MHC Ags).

Hypersensitivity Myocarditis- Perivascular infiltrate w abundant eosiniphils. Can be following new drug tx.

Patchy Necrosis w granulation tissue- ischemic damage from donor tissue.

Scant inflammatory cells and interstitial fibrosis- Chronic rejection; B and T cells and Abs.

Front 41

Metoclopromide-

Domperidone-

Odansetron-

Summatriptan-

Back 41

.Metoclopromide- Antagonist of the D2 Receptor resulting in Increased Resting Tone, Contractility, Lower Esophageal Sphincter (LES) Tone, and Motility of GI tract; also Antagonist of 5-HT3 (dec N/V); crosses BBB.
tx- Used for Gastroparesis (will inc mvt via freeing once dopamine blocked ACh) in Diabetes and Post-OP; SA- inc risk of Sz; bc block dopamine, can cause Tardive Dyskinesia (lip smacking).

Domperidone- suppress nausea and vomiting (antagnoist of 5-HT3), and as a prokinetic agent (antagonist of Dopmine, frees ACh in GI) and for promoting lactation (so will NOT cross BBB, also good in PD pts w N/V or lack of GI mvt (From dopamine tx) bc can use this drug and will not mess w central Dopamine).

Odansetron- 5-HT3 antagonist, so dec's N/V, esp in Chemo pts. (On da ser tron receptor it blocks, good for O'l dan w chemo). (SA- HA (bc 5-HT3 agonist will tx HA (summatriptan); constipation (bc serotonin syndrome has diarrhea)). Use w Dexamethasone for better tx.

Summatriptan- serotonin agonist, ergot, causes vaso constriction to dec HAs, esp migraine. (risk in CAD, pinzmental, and raynauds).

Front 42

Anesthesia is given at-

CSF is found at-

Back 42

anesthesia- in Epidural, which goes to L3-L5; cord ends at L2

CSF- sub arachnoid space, ends at S2

Front 43

Hashimoto’s Thyroiditis:
-antibodies are against
CP- hypothyroidism;
most prevalent in: ___; age group ____.

Histo-

Back 43

autoimmune disease in which antibodies are against thyroglobulin protein and thyroperoxidase enzyme in the thyroid cell -> hypothyroidism; most prevalent in: women; age group 45-65.

Undulating T3 and T4 levels; painless goiter. § Thyroid storm- Fever, Tachycardia; medical emergency;


○ [Histo: diffuse mononuclear infiltrate w formation of germinal centers usually of Plasma cells (hints risk of B cell), lymphocytic thyroiditis; atropic thyroid follicles lined by eosinophilic granular epithelial cells (Hurthle cells)].

Front 44

Graves’ disease
-HSN-
ID test-
Histo-

Back 44

○ CP: 2 unique Grave's features: 1- Exophthalmos; 2- Pretibial Myxedema (non-pitting edema, orange peel texture(also in myxedema); bruit over gland.

○ ID: increased T3, T4; decreased TSH; Increased radioactive iodine uptake with a diffuse pattern (bc entire gland!).


○ [Histo: diffuse hyperplasia; follicles are lined by tall, columnar epithelium; scalloped appearance at edges of colloid].

Front 45

Medulloblastoma-
histo:

Ependymoma-
Histo:

Back 45

Medulloblastoma-
histo: PNET, so small blue cells; Homer-wright Rosettes. Radiosensitive bc MDs see MD, and speak latin like Homer, and get small blue balls bc never dull sex.

Ependymoma-
Histo: Perivascular pseudorosettes, as in the PE of Epen..; Rod-shaped blepharoplasts like a pen in Epen...

Front 46

Butorphanol-
Pentazocine-
Tramadol-

Back 46

Butorphanol- partial mu agonist
Pentazocine- partial mu agonist
Tramadol- Very weak opioid (mu) agonist, also in NE and Serotonin by DEC their re-uptake

Front 47

Anti-Glutamate Decarboxylase

Back 47

Type 1 DM
(Anti-glutamic acid)