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1000 Cards in this Set

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  • Back
Describe the pathway of an upper motor neuron.
1) Origination: primary motor cortex
2) Pass through posterior limb of the internal capsule, midbrain cerebral peduncles, ventral pons, & medullary pyramids
3) Majority decussate @ the caudal medulla
4) Run in the lateral white matter tracts in the spinal cord
5) Synapse on the lower motor neuron @ he ventral horn, in the gray matter
What is the ABVD regimen?
- Adriamycin (aka doxorubicin: DNA intercalator; cardiotoxic)
- Bleomycin (DNA strand breaker )
- Vinblastine
- Dacarbazine

Rx: Hodgkin's lymphoma
What change in gram + structure results in vancomycin resistance?
D-ala D-ala to D-ala D-lac amino-acid change for the cell wall inhibitor that vancomycin targets
What does a right or left shift in the O2 dissociation curve indicate?
Right: decreased affinity for O2 (lower % of bound O2 @ a given partial pressure)

Left: increased affininity for O2 (greater % of bound O2 @ a given partial pressure)
What drug is used both as an antitumor agent and for sickle cell?
Hydroxyurea: antitumor (Rx: CML) & also raised fetal hemoglobin levels
What is 2.3-BPG's relationship with O2 affinity?
Inverse: high levels decreases O2 affinity
What are the classic symptoms of Prader-Willi?
- Mental retardation
- Short stature
- Hypotonia
- Hyperphagia
- Obesity
- Small hands & feet
- Hypogonadism

Deletion of q12 on paternally derived chromosome 15
What are the classical symptoms of AngleMan's syndrome?
- Mental Retardation
- Seizures
- Ataxia
- Inappropriate Laughter

"Happy Puppets"
- Deletion of q12 on the maternally derived chromosome 15
What characterizes Paget's disease of bone & what lab values go along with it?
- Extensive remodeling of bone that drastically incrases bone mass (yet, with increased fracture risk).
- Up risk for sarcomas
- LAB: elevated/normal Ca, normal phosphate, elevated alk phosphate
How does class V "lupus" nephritis present histologically?
- Membranous nephropathy: diffuse thickening of the glomerular basement membrane due to immune complex deposition
- Nephrotic: edema, proteinuria, hyperlipidemia
- EM: sup epithelial deposits (spike & dome"
- Immuno: granular
What type of nephritis results in eosinophilia of the kidney interstitium?
drug-induced interstitial nephritis
How does class 1 lupus nephritis present on light microscopy? clinically
no apparent pathology on LM; nephrotic syndrome
What disease presents with proliferation of the mesangial cells in the glomerulus?
membranoproliferative glomerulonephritis or (slight proliferation) in class II lupus nephritis
What kidney disease is characterized by subepithelial humps on EM?
subepithelial humps
What are smudge cells and what do they indicate?
- Fragile lymphocytes (arrested between between pre-B & mature B cells) that are destroyed during slide prep
- CLL: chronic lymphocytic leukemia
What are the kidney-targeted drugs used to treat gout? What is their MOA?
Probenecid & sulfinpyrazone: compete with uric acid for reaborbtion in the kidney
What is the MOA of Allopurinol?
- Blocks xanthine oxidase & prevents formation of uric acid from purines
- Rx: chronic gout or tumor lysis syndrome
What OTC drug is contraindicated in gout patients?
ASPIRIN
- b/c, at low doses it competes with uric acid for excretion
What drug is used to treat acute gout?
Colchine: depolymerizes microtules to limit the inflammatory response to urate crystals
What is the 1st line DOC for acute gout?
Indomethacin (NSAID): blocks prostaglandin synthesis
What diuretic is counter indicated in gout patients?
Furosemide (sulfonamide loop) b/c it raises serum uric acid levels
- Inhibits Na-K-2Cl cotransporter to increase Na, K, & Cl excretion
- Ototoxic
What other cancers are kids with retinoblastoma at risk for?
Osteosarcomas in their teens:
- Rb gene mutation on ch. 13: no E2F regulation and cells easily move into S phase
What causes metabolic acidosis?
Increase in acid:
- Ion gap
- Hypovolemic shock via lactic acid
Decrease in base:
- Diarrhea
- Kidney failures
What is non ion gap vs. ion gap acidosis?
Ion gap acidosis: caused by an increase of anions (such as lacate)

Non ion gap: caused by a loss of bicarb with an increase in Cl

Anion Gap = [Na+] - [Cl-] - [HCO3-]
Normal anion Gap = 10-16 mEq/L
Unpack the mneumoic "MUDPILES" in regards to anion gap metabolic acidosis?
Methanol
Uremia
Diabetic/ethanol ketocaidosis
Paraldehyde
Isoniazid/Iron toxicity
Lactic acidosis
Ethylene glycol
Salicylates

(& Rhabdomyolysis)
What are the 2 causes of respiratory acidosis?
1) Inadequate ventilation (drugs or neurologic injury)
2) Impaired gas exchange (e.g. pulmonary edema)
What is metabolic alkalosis?
High pH + increased plasma bicarbonate

Cause: addition of alkaline compounds (antacid) or loss of acid (vomiting)
What causes respiratory alkalosis?
Increase in ventialtion leading to a decrease in serum CO2 & excess bicarb. Causes:
- Increased drive (drugs or CNS disorders)
- Anxiety/Fear
What are fibrates used to treat?
hypertriglyceridemia

E.G. Genfibrozil
What does Niacin do to cholesterol levels?
@ high doses:
- Raises HDL
- Reduces VLDL
What is the MOA of phytosterols?
- Inhibit the incorporation of cholesterol into micelles in the GI tract
- Decreases the overall amount of cholesterol absorbed.
What is the chromosomal source of von Hippel-Lindau disease?
Defect in the VHL gene on Chromosome 3
Where is the Rb gene?
Ch. 13
Where is the NF-1 gene?
Ch. 17
Where is the NF-2 gene?
Ch. 22: merlin tumor suppressor gene is mutated
Where is the APC gene?
Ch. 5
What can hypersecretion of ectopic thyroid tissue cause?
menstrual abnormalities: amenorrhea & oligomenorrhea

Location of (congenital) ectopic thyroid tissue: anywhere along the course of the throglossal duct beginning beneath the the tongue @ the foramen cecum
How does Addison's result in diffuse integumentary hyperpigmentation?
- NO ACTH secretion feedback inhibition from cortisol
- T/F the POMC gene (which codes for ACTH & melanocyte-stimulating hormone) is upregulated
What is the DOC for B-blocker overdose?
Glugagon:
- positive inotropic agent: increases intracellular cAMP independently of adrenergic receptor signaling (thus, it bypasses any adrenergic blockage)
Unpack the mneumonic "B-FLAT Major" for the cells of the pituitary gland cells.
Basophilic:
FSH
LH
ACTH
TSH
MSH
What is the MOA of exemestane?
Inhibits aromatase: no conversion of testosterone to estradiol & androstenedione to estrone
- forms an irreversible bon with aromatase
What is the difference between the site of estrogen production in pre & postmenopausal women?
Pre: produced in ovaries
Post: adrenal gland via aromatase
What 2 drugs inhibit aromatase via reversible competition?
anastrozole & letrozole
What is the MOA of finasteride when used to treat BPH, prostate cancer, & male pattern baldness?
inhibits 5alpha reductase (in prostate, epididymis, seminal vesicles, & skin) from converting testosterone to dihydrotestosterone
- Can increase levels of estradiol
- Dutasteride has the same MOA
How do GnRH agnonists like Leuprolide act to reduce FSH & LH release in hormone-responsive prostate or breast cancer?
B/C the drug is not giving the physiological GnRH pulses, FSH & LH are downregulated after an initial burst.
What cell population defect causes Hirschsprung's disease?
craniocaudal neural crest cell migration failure to distal colon: no parasympathetic ganglion cells & no coordinated peristalsis (functional obstruction of the colon)

Symptoms: constipation, distended abdomen, bilious vomiting

Rx: resecetion of the aganglionic segment of the colon
What types of drug can cause hyperprolactinemia?
Drugs that suppress dopamine's effects (& its inhibitory effect on prolactin): e.g. Haloperidol, a typical antipsychotic
What face nervous modalities pass through the VPN of the thalamus?
- All sensory: light touch, proprioception, vibration, pain & temperature
- Blood to this structure is supplied by the posterior cerebral artery
What information does the lateral geniculate nucleus of the thalamus receive?
optic tract
What information does the medial geniculate nucleus of the thalamus receive?
auditory info from the inferior colliculi
Through what nucleus of the thalamus do all sensory modalities of the body (including dorsal column & spinothalamic tract) pass through?
Ventral posterolateral nucleus
What result on Hektoen enteric agar will show that the infection is Salmonella and not Shigella?
- Green with black centers = a colony of Salmonella (produces hydrogen sulfate) & are flagellated
- Both will appear clear or white on MacConkey agar
What are the symptoms & history that indicate an infection iwth Entamoeba histolytica?
- Bloody mucoid diarrhea
- Hepatic abscess (up alk phos with normal AST, ALT & bilirubin)
- Recent travel to a developing country

Rx: metronidazole
For what infection would triple therapy with Ampicillin, gentamicin, & clindamycin be prescribed?
Gram-negative GI infection
Why do injection drug users have a higher risk for hepatocellular carcinoma (HCC)?
Concomitant increased risk for Hep B & C, which are the direct cancer risk factors
What is deficient in Pompe's?
Lysosomal alpha-1,4-glucosidase: necessary for the hydrolysis of the outer branches of glycogen
- glycogen is deposited in the myocardium & thus, "Pompe's trashes the Pump" by the 6th month of life
What defect results in Fabry's?
lysosomal alpha-galactosidase A: T/F ceramide trihexoside accumulates, resulting in:
- peripheral neuropathies of the hands & feet
- angiokeratomas, heart, & renal disease

- X-linked recessive
What is defective in Gaucher's
Lysosomal beta-glucocerebrosidase:
- Hepatosplenomegaly
- Aseptic necrosis of the femus, bone crises
- Gaucher's cells
What is the defect in VonGierke's?
glucose-6-phosphate deficiency:
- severe fasting hypoglycemia with large stores of glycogen in the liver
- hepatomegaly
- increased blood lactate levels
What deficiency results in McArdle's?
gycogen phosphorylase: glycogen in skeletal muscle cannot be broken down
- cramping
- myoglobinuria with strenuous exercise
What is the MOA of trimethoprim-sulfamethoxazole?
blocks the synthesis of folate:
- Trimethoprim inhibits bacterial dkhydrofolate reductatase
- Sulfamethoxazole inhibits dihydropteroate synthase
What is the #1 & #2 cause of UTIs in young women?
1) E. coli
2) Staph saprophyticus
What are the symptoms of HSV-1 encephalitis?
- Amnesia
- Behavior changes (e.g. hypomania)
- Kluver-Bucy syndrome (loss of anger/fear response + hypersexuality
- Late: coma & death
How do patients with HIV meningoencephalitis present?
Gradual onset of slowly worsening dementia
How does progressive multifocal leukoencephalopathy present?
- Cause: JC virus
- Altered mental status, motor deficits (hemiparesis or limb ataxia)
- Visual symptoms: e.g. hemianopia
What is characteristic of dermatomyositis & what does it indicate?
- Immune-mediated disorder of skin & skeletal muscles: rash is violet discoloration of the upper eyelids with periorbital edema; gradual, symmetric muscle weakness of proximal muscles, sometimes dysphagia
- Gottron's lesions: erythematous patches over knuckles, elbows, & knees

- 6-45% of patients have underlying visceral cancer
What is Zenker's diverticulum?
Pharyngeoesophageal diverticulum:
- Outpouching of the esophageal wall above the level of the upper esophageal sphincter
- Pathogenesis: herniation of mucosa though defective muscular layer
What will a physician find upon physical exam of a spontaneous pneumothorax?
- Lung sound: decreased sound
- Percussion: Hyperresonance b/c the space is filled with air instead of tissue.
- Tactile fremitus: absent
- Tracheal deviation: toward side of lesion (opposite for tension pneumothorax)
What is the MOA of Norwalk virus infection?
- Direct, noninvasive toxin-mediated damage of the microvilli of enterocytes
- Disease course: gasteroenteritis (nausea, vomiting, diarrhead) that resolves within 12-24 hrs.
What is the MOA of Shigella toxin?
Induces cytokine release & causes hemolytic uremic syndrome:
bloody & mucus-rich diarrhea
What is lacking in Krabbe's disease & how does it present?
galactosylceramide B-galactosidase deficiency: galactocerebroside
- optic atrophy
- spasticity
- Early death via deposition in intermediary of the brain
What is deficient in Niemann-Pick disease & how does it progress?
- Sphingomyelinase: sphingomyelin & cholesterol buildup in reticuloendothelial & parenchymal cells/tissue
- Patients die by age 3
Which 5 kidney diseases are nephrItic (hematuria, azotemia, RBC casts in urine, oliguria, hypertension, proteinuria)?
- Acute proststrep
- Rapidly progressive (crescentic)
- Diffuse proliferative (due to SLE)
- Berger's (IgA glomerulopathy)
- Alport's
What type of cells are found in the liver's space of Disse?
Hepatic stellate cells (Ito/lipocytes):
- filled with lipid droplets containing vitamin A
- produce collagen in response to liver injury
What is the ingested form of vit. D called?
ergosterol
What type of murmur is heard with a classic case of acute bacterial endocarditis?
Diastolic: dues to large vegetations on the ricuspid valve that impede flow through the valve
What is the difference between the action of Ca in smooth & skeletal muscle?
1) Smooth: Ca signals through myosin light chain kinase
- Ca binds/activates calmodulin that activates MLCK
- MLCK phosphorylates myosin to allow cross-bridges
2) Skeletal: Ca binds troponin to allow actin-myosin interaction
How does skeletal muscle respond to depolarization?
- Dihydropyridine receptor directly allows extracellular Ca influx & activates the ryanodine receptor
- Ryanodine receptor mediates release of Ca from intracellular stores in the sarcoplasmic reticulum
What is the MOA of Class IA antiarrhythmics?
Rx: atrial or ventricular arrhythmia
MOA:
- block Na channels and slow conduction velocity -> this slows phase 0 & t/f increases QRS duration
- block potassium channels -> increases AP duration & ERP (effective refractory period
What results from combining an ACE inhibitor with a potassium-sparing diuretic?
A possible dangerous level of hyperkalemia:
- ACE reduces angiotension II production and aldosterone is reduced (increases Na excretion & potassium retention)
What GI side effects do typical antipsychotics like Haloperidol causes?
antimuscarinic: constipation
What Bp effects can typcial antipsychotics have?
hypotension (anti-alpha receptor action)
What histamine-related effects can typical antipsychotics have?
anti: sedation
What causes the extrapyramidal adverse effects of antipsychotics?
An imbalance in dopamin & muscarinic receptor antagonism:
- Dystonia (abnormal postures due to sustained & prolonged contraction of agonist/antagonist muscles)
- Akinesia: absence of movement
- Akathisia: restlessness that is relieved by movement
- Tardive dyskinesia: involuntary choreiform movements of the lower face (e.g. rhythmic protrusion of the tongue, lip smaking, chewing)
What musculoskeletal problem can be due to lithium use?
Ataxia: incoordination
What culture is used to grow Corynebacterium diptheriae?
Loeffler's medium, blood agar, tellurite plate
What type of goiter do Grave's patients have?
- Diffuse on palpation
- High radionuclide uptake on thyroid scan
What type of goiter does a patient with a TSH-secreting pituitary tumor have?
- Diffuse on palpation
- Low radionuclide uptake on thyroid scan
What type of goiter do patients with toxic hyperthyroidism present with?
- Multinodular on palpation
- High radionuclide uptake on thyroid scan
How does a goiter on a patient with primary hyperthyroidism due to destructive throiditis, iodine excess or excess thyroid hormone appear?
- Nodular on palpation
- Low radionuclide uptake
How does Bell's palsy present clinically?
Inability to close the eye or seal the corner of the mouth on the affected (ipsilateral) side
How does stage 2 Lyme disease present?
- Bell's palsy (LMN lesion of facial nerve)
- New Heart block
What drugs cause ototoxicity?
aminoglycosides & vancomycin
What drugs are notorious for their nephrotoxicity?
Aminoglycosides
Vancomycin
What drug can result in PED teeth discoloration?
doxycycline
What drug class can cause acute cholestatic hepatitis?
macrolides
What is the 1st treatment for acute ICP (increased intracranial pressure)?
1) Intubate
2) Hyperventilate: CO2 is a powerful vasodilator of the cerebral vessels; thus, "blow it off" to cause vasoconstriction & decrease intracrainal blood
Why is a lumbar puncture dangerous in patients with an increased ICP?
ICP drops too much and this can depress the entire ventricular system and allow for further herniation of the brain.
The patient is a smoker and X-ray revelas a large hilar mass with signs of cavitation. What's the Dx?
Squamous cell carcinoma: also can present with paraneoplastic production of parathyroid hormone-related peptide (PTHrP) that causes HYPERcalcemia (-> urolithiasis)
What is tumor lysis syndrome?
Uric acid stone formation due to excessive cell turnover after chemo (esp. with lymphoma)
What paraneoplastic syndromes are associated with renal cell carcinoma?
- Parathyroid hormone-related peptide
- Erythropoietin
What paraneoplastic syndrome is associated with small cell lung carcinoma?
- ADH (SIADH)
- ACTH (Cushing-like)
What infections can cause urolithiasis with ammonium magnesium phosphate (aka struvite) stones?
Urease-producing orgs:
- Proteus vulgaris
- Staphylococcus
- Klebsiella
What is the MOA of Tacrolimus & for what is it usually prescribed?
1) Immunosuppressive: transplant recepients
2) MOA:
- Binds FK-binding protein & this complex inhibits the secretion of cytokines that activate lymphocytes (e.g. IL-2)
- SE: nephrotox, CNS effects, hyperglycemia
To which class of drug do busulfan, nitrosoureas, & cyclophosphamide belong?
Alkylating agents that bind to & disrupt DNA = antineoplastic
What drug classes inhibit microtubules?
- Vinca Alkaloids (Vincristine & vinblastine)
- Rx: cancer (testicular & lymphomas)
What type of virus is Hep A?
Picornavirus: Linear ssRNA
What embryologic abnormality results in cleft lip?
Failure of the maxillary processes or the medial nasal processes to fuse
What embyrologic abnormality results in cleft palate?
- Failure of the fusion of the lateral palatine processes: difficult to create suction needed for proper feeding
- Result: choking/coughing/aspiration + poor weight gain
What lab values indicate an intrarenal type of renal failure?
- Decline in GFR
- BUN & Cr increase in proportion (RATIO REMAINS BELOW 15:1)
- Faction of excreted Na >2% b/c the kidney is not effectively reaborbing Na = LOW URINE OUTPUT
What lab values indicate postrenal causes of renal failure (e.g. prostatic disease, urethral stones)?
- BUN:Cr ration of 15-20:1
- Low urine output
What lab values indicate a prerenal cause of renal failure?
- BUN:Cr ration of >20:1
- Fractional excretion of Na <1%
- LOW URINE OUTPUT

Cause: decreased blood flow to the kidneys -> Na conservation, increase in urea reaborbtion increases BUN
What vitamin is necessary for NADPH production?
B3 (niacin): used to make fatty acids & steroids & respiratory burst in WBCs (recycling of glutathione in RBCs)
- Glucose 6-phosphate dehydrogenase requires B3 & it is the rate-limiting step in the O2 portion of the pentose phosphate pathway
What is FAD used for?
It is an oxidizing agent used to make double bonds:
e.g. production of fumarate from succinate in the TCA cycle
Which vitamin is FADH2 derived from?
B2 (riboflavin): participates in the electron transport chain
- FADH2 is generated when succinate is oxidized to fumarate
What does increased NADH result in?
- Pyruvate conversion to lactate
- Stimulates fatty acid synthesis
- Inhibits gluconeogensis

- NB: this is part of the pathophysiology of ALCOHOLISM
How is transferrin saturation calculated?
Serum iron / TIBC

TIBC = 1.4 x serum transferrin
What genetic defect results in hereditary hemochromatosis?
- Defect in the gene that encodes the protein HFE (MHC locus on chromosome 6)
- Result: increased dietary iron absoption & inability to excrete iron -> hepatic storage & liver makes more ferritin, which in turn saturates serum transferrin
- Dx: increase in transferrin saturation
What antiviral is also prescribed for Parkinson's? What is its MOA?
Amantadine (Rx: influenza & rubella):
- Dopamine agonist: Promotes the synthesis, release, or reuptake of dopamine
- SE: ataxia, dizziness, & slurred speech
- Overdose: TOXIC PSYCHOSIS
What antimuscarinics are used to treat Parkinsonian tremor?
- Benztropine
- Biperiden
- Orphenadrine
- Procyclidine
- Trihexyphenidyl
List the SSRIs.
- Citalopram
- Fluoxetine
- Fluoxamine
- Paroxetine
- Sertraline
What monoamine oxidase-B drug is used to increase the availability of dopamine in Parkinson's treatment?
Selegiline
What is the MOA of bile acid resins like Cholestyramine & Colestipol?
- Promote binding & excretion of dietary fats that are bile-soluable
- T/F the fats don't enter the blood stream effectively
- Decrease serum LDL & total cholesterol levels
What type of structures result when a fertilized oocyte divides between days 4 & 8?
- Monozygotic twins
- Monochorinoic placenta
- Diamniontic
What type of structures result when a fertilized oocyte divides between days 8 & 12?
1 of everything:
- Monozygotic twins
- Monoamniotic
- Monochorinoic placenta
What type of structures result when a fertilized oocyte divides within 3 days postfertiziation?
2 of everything:
- Mono or dizygotic twins
- Diamniotic
- Dichorionic
- 2 placentas
What does an elevated AFP in amniotic fluid possibly indicate?
- Neural tube defects (spina bifida, meningocele, menigomyelocele) & AFP is leaking out into the amniotic fluid
- Folate Deficiency in 1st 4 weeks of pregnancy or drugs such as valproate & carbamazepine
What is another name for Potter's syndrome?
Bilateral renal agenesis:
- disruption in the interaction between the ureteric bud & the metanephrogenic tissue
- fetus does not produce urine & t/f there is a lower amount of amniotic fluid (oligohydramnios) ->
- Hypoplasia
- Fetal compression with altered facies
- Positioning defects of hands & feet
What is the ductus arteriosus & what is its function?
- Connection between the pulmonary artery & the aorta
- Allows O2 blood from the placenta to bypass the fetal lungs & enter the systemic circulation
- Open during gestation & closes with O2 increase @ birth & subsequent decrease in prostaglandins
What is the MOA of Phenytoin?
Blocks Na channels & inhibits the generation of action potentials

Rx: partial & generalized seizures
SE: nystagmus, diplopia, lethargy, ataxia, tubulointerstitial nephritis (Up Cr), Up tox with anything that inhibits microsomal enzymes in the liver (e.g. cimetidine)
What defective transporter is missing in Hartnup's disease?
for Neutral amino acids (all except proline) @ the renal & GI tracts
- Result: aminoacidurias
- can manifest as Pellagra b/c tryptophan is used to make niacin with B6 as a cofactor
Where is the potential space in the pericardium?
Between the visceral & parietal layers
How does Kartagener's result in female infertility?
Loss of fimbrae & tubal cilia "sweeping" leads to immobile eggs that do not advance through the fallopian tubes @ normal rates
- microtubule dysfunction
What enzyme defect results in albinism?
- Melanocyte lack of tyrosinase: no conversion of tyrosine to melanin
- Increased risk of squamous, basal cell, & malignant melanoma
What cells/tissues are derived from neural crest cells (part of the neuroectoderm)?
- Melanocytes
- Odontoblasts
- Pia & arachnoid mater
- Schwann cells
- Cells of the gangila
- Parafollicular C cells of the thyroid
- Chromaffin cells
- Aorticopulmonary septum
- Pharyngeal arch skeletal components
- Neurocranium
What conversion do statins inhibit?
HMG CoA to mevalonic acid

Side effect: muscle pain or injury similar to myositis (MOI unknown)
Where is the horizontal fissure of the right lung on the anterior chest?
fourth rib anteriorly: separates superior from middle lobe
What does the oblique fissure of the right lung separate?
Middle from inferior lobe
What are the symptoms of vitamin E deficiency?
- Absent tendon reflexes
- Ataxia
- Loss of position & vibration sense
- Loss of pain sensations
What are the symptoms of vitamin B2 (riboflavin) deficiency?
- Cheilosis
- Glossitis
- Corneal vascularization
- Seborrheic dermatitis
Where are water-soluable vitamins absorbed?
small intestine
What are Brenner tumors?
- Benign ovarian tumors composed of cells that resemble bladder transitional epithelium
- Adenofibroma with epithelial component of nests of transitional cells
In what tumor are Call-Exner bodies seen?
Graunulosa cell tumors (sex cord stromal tumor): ovarian follicles filled with eosinophilic material
- secrete estrogen -> precocious puberty, endometrial hyperplasai, endometrial carcinoma
What is Meigs' syndrome?
TRIAD:
- overian fibromas
- ascities
- hydrothorax
What is struma ovarii?
Ectopic thyroid tissue in the ovaries:
- a benign functional cystic teratoma
- Result: throtoxicosis &/or hyperthyroidism
How does primary sclerosing cholangitis present?
- Progressive fatigue
- Pruritis
- Icteric Sclera
How is primary sclerosing cholangitis characterized?
A disease associated with Ulcerative Colitis resulting in:
- Inflammation
- Obliterative fibrosis
- Segmental constriction of intrahepatic & extrahepatic bile ducts (visualized as alternating strictures & dilations, or "beading"

- Dx: PANCA (majority)
- Rx: liver transplant
- Proctocolectomy to eliminate the GI problems with UC & risk of colon cancer
What is an ERCP "double-duct" sign?
- Pancreatic tumor obstruction of both the common bile duct & main pancreatic duct
- Seen on a radiographic visualization of the pancreatic duct & bilary tree
What is the pathology of primary biliary cirrhosis?
Granulomatous destruction of the medium-sized intrahepatic bile ducts
How does HPV cause carcinoma?
inactivates tummor suppressor genes such as p53 (viral protein E6) & Rb (viral protein E7)
What 2 types of cancer is EBV associated with?
- t(8:14) = Burkett's (b-cell) lymphoma
- Nasopharyngeal carcinoma
What cancer does the Human T-cell lymphotropic virus cause?
Adult T-cell leukemia
What is the treatment for Hep B?
- lamivudine (reverse transcriptase inhibitor to inhibit viral repication)
- interferon alpha (blocks viral replication)
What is the treatment for Hep C?
Ribavirin + pegylated interferon alpha
What triptan is a DOC for the acute treatment of migraine?
Sumatriptan (serotonin agonist @ the 5-HT1d recetpr): reduces migraine severity
What type of drugs are used as prophylactic against migraines?
- TCAs (e.g. Amitriptyline)
- Ergot Alkalodi derivative (e.g. Methysergide)
- B-blocker (e.g. Nadolol or propanolol)
What is the MOA of diazepam?
- Increases the opening frequency of the Cl channel assocated with the y-aminobuteric acid (GABA) receptor: this inhibits further neuronal firing
- Immediate onset of action when given IV
What is the MOA of Carbamazepine?
Blocks repetitive activation of Na-channels
What is the MOA of ethosuximide?
- Blocks low-threshold T-type Ca channels
- Rx: absence seizures
What is the MOA of Gabapentin?
It is a GABA analog & blocks H-current modulators
What is the MOA of Phenobarbital?
Increases the duration of Cl channel opening
What lab values indicate ALL in a child 3-7 years old?
- Greatly elevated ABC count (>20% blasts)
- Neutropenia
What is a serum marker of cell lysis?
Elevated uric acid level (from purine breakdown)
What clotting/bleeding problem can be indicated by petechiae?
insufficient platelets
What is "rose gardener's disease"?
Sporothrix schenckii fungal infection:
- necrotizing granulomatous lymphocutaneous skin infection
- S/S: local pustule with nodules in the distribution of draining lymph nodes
What is a common kidney complication of DIC & what is the Tx?
- Diffuse cortical necrosis due to generalized infarction of the cortices of both kidneys
- Dialysis when the patient presents with AEIOU:
A = Acidosis refractory to bicarb
E = severe Electrolyte abnormalities (esp. K) refractory to meds
I = intoxication with some drugs
O = volume Overload refractory to diuretics
U = Uremic symptoms (e.g. cardiac friction rub & altered mental status)
What personality disorder presents with violent swings in affect, recurrent suicidal ideation, impulsivity, self-mutilation, & strained interpersonal relationships?
Boarderline
What personality disorder presents with a complete disregard for the rights of others & criminal behavior?
Antisocial
What personality disorder presents with clingy behavior & constantly need to be taken care of?
Dependent
What personality disorder presents with the inherent belief that the world is a dangerous & threatening place, distrust everyone, & believe various conspiracy theories?
Paranoid
What personality disorder is characterized by interpersonal awkwardness, a tendency not to relate well to others, & an inability to understand why others don't find the same things interesting as they do? (also, they tend to have odd beliefs & eccentric appearance)
Schizotypal
What is the difference between Wernicke's encephalopathy & Korsakoff's pscyhosis
BOTH: B1 deficiency
Wernicke's is reversible:
- ataxia
- confusion
- nystagmus
Korsakoff's is permanent (lesion in the mamillary bodies):
- anterograde amnesia
- confabulation
- personality changes
What results from bilateral lesions of the amygdala?
Kluver-Bucy syndrome:
- hyperorality
- hypersexuality
- disinhibition
What happens when there is a lesion in the inferior frontal gyrus (Broca's area)?
motor/nonfluent/expressive aphasia:
- Can understand
- Cannot produce ("no boca")
What happens when there is a lesion in the superior temporal gyrus (Wernicke's area)?
sensory/fluent/receptive aphasia:
- can speak fluently
- cannot understand others or what they say themselves
What is the most common cause of neonatal sepsis & meningitis
Group B Strep (GBS)
- prophylaxis to mom = Penicillin G prebirth
What types of food can precipitate a gouty attack?
Foods rich in purine: meats (organ meats, e.g. kidneys)

Rx:
- NSAIDS (ibuprofen, naproxen, indomethaicn)
- Colchicine if NSAID-allergic: SE = diarrhea, GI upset... (inhibits microtubule polyermization by binding to tubulin -> inhibits immune cell motility/activity)
What is the treatment for gonococcal arthritis?
Ceftriaxone
What is a common side effect of an overose of corticosteroids?
Iatrogenic Cushing's syndrome (moon facies & buffalo hump)
What are the clinical hallmarks of NF1 (aka von Recklinghausen's disease)?
AD defect on long arm of Ch. 17: 1/4000 births
- Cafe au lait spots
- Neurofibromas
- Lisch nodules (pigmented iris hamartomas)

NB: NF1 is a risk factor for menigiomas
What syndrome presents with Brushfield's spots?
Down's: white spots in the periphery of the iris
How can protaglandins be used to induce labor?
- In general, they activate dissolution of collagen bundles & increase the submucosal H2O content of the cervix
- PGE = potentiates endogenous oxytocin (increases labor induction)
What causes Kartagener's syndrome?
- Lack of dynein arms in the microtubles in cilia = immotile
- immotile sperm
- defective muco-ciliar ladder
- situs invertus (reversed/mirrored major organs)
Why are CF males infertile?
Cystic fibrosis causes a bilateral absence of the vas deferens
What male-specific problem can arise due to familial hypercholesterolemia?
Atherosclerosis of the vessels of the male genitalia can cause erectile dysfunction
What are brown granular deposits in the cornea?
Kayser-Fleischer rings: copper deposits
What is the ABCD's of Wilson's
- Asterixis
- Basal ganglia degeneration (parkinsonian symptoms)
- Decreased Ceruloplasmin level
- Cirrhosis, Corenal deposits in Descernet's membrane, Copper accumulation, hepatocellular Carcinoma, Choreaform movements
- Dementia
What is the treatment for Wilson's?
D-penicillamine: promotes urinary copper excretion

2nd choice: copper chelators (e.g. Deferoxamine)

Plasmapheresis if Px has fulminant hepatic failure
What is Dimercaprol used to treat?
Chelator of arsenic, mercury, gold, or lead
What is Succimer used to treat?
Chelator of arsenic, mercury, gold, or lead
What is EDTA used to treat
It is a Ca chelator used to treat LEAD poisoning
What causes replacement of throid & surrounding tissue with fibrous tissue?
Riedel's thyroiditis
- presentation: dysphagia, stridor, dyspnea, hypothroidism or euthyroid
- DDx: thyroid carcinoma
What is the etiology of renal insufficiency in Multiple myeloma patients?
Bence Jones proteins (antiboy light chains) result in renal damage by forming large, tubular casts that obstruct the renal tubular lumina & induce inflammation.
What is Rheumatoid factor?
IgM antibody directed against the Fc portion of IgG
How does renal cell carcinoma or prostate carcinoma damage the kidneys?
obstructive damage by a neoplastic mass
What is Strep pyogen's major virulence factor?
Protein M: inhibits complement system & protects from phagocytosis
How does a cerebrovascular event of the vertebral artery present?
Vertebrobasilar system: ipsilateral cranial nerve defects & contralateral motor weakness
- diplopia
- dysarthria
- vertigo
- ataxia
How does a cerebrovascular event of the anterior cerebral artery present?
contralateral motor weakness, greater in leg than in arm, & mild sensory deficits
How does a cerebrovascular event of the anterior choroidal artery present?
- contralateral homonymous hemianopsia
- hemiparesis
- hemisensory loss
How does a lacunar ischemia present?
If long-term: dementia

If acute: (basal ganglia & pons)
- pure motor deficits (face, arm, & leg paralysis)
- sensory deficits (sensory loss in face, arm, & leg)
How does a cerebrovascular event of the middle cerebral artery (MCA) present?
Contralateral motor & sensory deficits that are greater in the face & arms than the leg
What 2 signals are needed to activate T-lymphocytes?
Provided by APCs (macs, dendritic cells, B lymphocytes):
1) Major histocompatibility complex/peptide
2) CD28-B7 interaction
What cells are the main effectors that mediated acute allograft rejection?
CD8+ T lymphocytes
Name 3 anti-VEGF (vascular endothelial growth factor) antibodies that are used to inhibit tumor angiogenesis.
1) Bevacizumab
2) Sorafenib
3) Sunitinib
What 4 glycoprotein hormones share the same alpha subunit?
- beta-hCG (fertilized egg during 1st trimester & then placenta)
- TSH (anterior pituitary)
- LH (anterior pituitary)
- FSH (anterior pituitary)
What results from taking an MAO with a tyramine food (aged cheese, liver, red wine)?
the tyramine will not be metabolized and, as a vasoactive compound, can cause a drastic increase in Bp & hypertensive crisis & "serotonin syndrome"

- MAO example: Phenelzine
What antidepressance can cause the 3 "C"s (Coma, Convulsions, Cardiotoxicity)?
Amitriptyline (TCA)
- can also cause sedation, confusion, memory loss, & mania
What symptoms/signs characterize serotonin syndrome?
- Anxiety
- Diaphoresis
- Tachycardia
- Hypertension
- Hyperthermia
- Vomiting
- Tremor
- Hyperreflexia
- Muscle rigidity
What type of drug is Venlafaxine?
Heterocyclic antidepressant

SE: anxiety, agitation, headache, weight loss, insomina
What drug causes hallucination, delusions, dilated pupils, and potentially marked anxiety or depression, nausea, weakness, & parethesias?
LSD: lysergic acid diethylamide
What extraintestinal manifestions are there for Crohn's patients?
- Uveitis
- Migratory polyarthritis
- Erythema nodosum
What type of renal calculi are Crohn's patients at risk for?
Calcium oxalate: B12 absorption is compromised & oxalate absorption is enhanced.
How does primary biliary cholangitis present? What is seen histologically?
- 40-50 year old female patient with pruritus with or without jaundice
- Histo: granulomatous degeneration of the intrahepatic bile ducts
- LAB: antimitochondiral antibodies are positive in >90% of Px
What liver disease is strongly associated with UC?
primary sclerosing cholangitis
- inflammatory fibrosis of the intra & extrahepatic bile ducts
- hyperbilirubinemia, jaundice, ultimately cirrhosis
- Dx: endoscopic retrograde cholangiopancreatography ("beading" along the biliary tree)
- Up risk for cholangiocarcinoma
What is a rare but serious side effect of metformin?
lactic acidosis due to over suppression of hepatic gluconeogenesis & promotion of glycolysis
What trinucleotide repeat results in Jacobsen's syndrome?
Expansion of CCG on Chromosome 11:
- Mental retardation
- Facial Dysmophisms
- Cardiac defects
- Thrombocytopenia
- Trigonocephaly
What trinucleotide repeat results in fragile X syndrome?
- CGG on the X chromosome = FMR1 RNA-binding protein gene
- is the 2nd most common cause of inherited mental retardation (Down's is 1st)
What trinucleotide repeat results in myotonic dystrophy?
- CTG on Chromosome 19
- Autosomal dominate disorder that presents late in childhood
- Gait abnormalities, weakness of upper extremities (intrinsic hand & wrist extensors)
- Atrophy of facial muscles resulting in characteristic facies
What trinucleotide expansion results in Friedreich's ataxia?
GAA on Chromosome 9:
- AR: pyramidal, dorsal, & spinocerebellar tracts are affected:
- Progressive ataxia & neurologic delince
- RIP: cardiomyopathy
What left-shifts the O2 dissociation curve?
Hemoglobin will have a higher affeinity for O2:
- Fetal hemoglobin
- Increased pH
- decreased temperature
- decreased 2,3-DPG levels
- decreased arterial CO2 pressure
When is tamoxifen prophylaxis indicated?
- When the patient has had a hysterectomy (i.e. no more risk of endometrial carcinoma) & the endrometrial estrogen receptors will no longer be stimulated.
- It is an antagonist for DNA in breast tissue & an agonist in endometrial, bone & hepatic tissue
What drugs are analogues of gonadotropin-releasing hormone?
- Leuprolide
- Goserelin

MOA: decrease in FSH & LH -> decreased androgen & estrogen synthesis
What drug is a recombinant cytokine used to augment recovery of bone marrow?
Filgratim (granulocyte colony-stimulating factor)
What is the MOA of Flutamide?
Blocks androgen receptors & prevents the body from usng sex steroids
What is the MOA of Imatinib mesylate?
Blocks the ATP-binding site on the bcr-abl tyrosine kinase domain & is used to treat CML.
What is the MOA of Tacrolimus?
Suppresses cellular immunity by binding to the intracellular protein FKBP-12 & inhibits the activation of T lymphocytes
What drug is a monoclonal antibody against HER-2 that can kill breast cancer cells over expressing HER-2?
Trastuzumab
What is the MOA of Paclitaxel & other taxanes?
- Inhibit depolymerization of microtubles
- Cell cycle arrest in mitosis

Rx: breast cancer
What type of breast cancer is Tamoxifen useful for?
ONLY estrogen receptor-positive beast cancer:
- blocks estrogen receptors to impeded the production of estrogen-responsive genes
What drug binds to the glycoprotein receptor IIb/IIIa on activated platelets & prevents fibrinogen from binding & therefore interfers with platelet aggegation?
Abciximab

Rx: acute corinary syndrome & angioplasty
What can leuprolide be used for?
GRH analogue:
- Pulsation: infertility
- Continuous: prostate cancer & uterine fibroids
What 2 drugs prevent fibrinogen from binding to platelets during aggregation by irreversibly blocking the ADP receptors?
- Clopidogrel
- Ticlopidine

Rx: aucte coronary syndrome or prophylaxis after coronary stenting
What is the most common cause of community-acquired, lobar pneumonia?
Streptococcus pneumoniae
How does atypical pneumonia present on chest exam?
Diffuse, patchy inflammation localized to interstitial areas at alveolar walls
What are the physical exam signs of Streptococcus pneumoniae pneumonia?
Lung consolidation resulting in:
- Bronchial breath sounds
- Dull resonance
- Increased tactile fremitus
What test confirms autoimmune hemolytic anemia?
Positive direct Coombs test after lab values indicate hemolytic anemia:
- Elevated LDH
- Increased indirect bilirubin
- Low haptoglobin levels
What is the DDx for the etiology of autoimmune hemolytic anemia?
- Idiopathic
- Viral induced
- SLE-induced
- Lymphoma
What causes microangiopathic hemolytic anemia?
any mechanical trauma to RBCs:
- Defective prosthetic cardiac valves
- TTP
- Hemolytic uremic syndrome
- DIC
What are neuroleptics?
Dopamine receptor-blocking agents (e.g. haloperidol: central receptor blocker)

- Used to treat positive symptoms of schizophrenia: illusions/hallucinations, delusions & ideas of reference, agitation, talkativeness
What are the negative symptoms of schizophrenia?
- Cognitive disturbance (memory, orientation, consciousness)
- Flat affect
- Poor grooming & appetite
- Social Withdrawel

Rx: nontraditional/atypical antipsychotics to modulate central serotonergic activity & dopamine receptors.
What is the MOA of nondihydroperidines?
- Ca-channel blocker that prolongs the PR interval
- Prolongs phase 0 & 2--slows the recovery of Ca-channels--especially in the AV nodal cells

Rx: nodal arrhythmias
How can dihydroperidine Ca-channel blockers (e.g. nifedipine) help to reduce hypertension?
- Inhibit Ca influx in the vascular smooth muscle cells
- Decrease vascular tone
How does GH act on tissue (i.e. via what kind of receptor)?
- Binds a tyrosine kinase associated receptor that then associates with a tyrosine kinase to add phosphates & increases intracellular signaling via the JAK/STAT pathway
- Causes transcriptional modification of the progrowth pathways
What hormones work via the Gq receptor pathway via phospholipase C & IP3/DAG pathway?
- Thyroid-releasing hormone
- Growth hormone-releasing hormone
- Gonadotropin-releasing hormone oxytocin
- Angiotensin II
- Bradykinin
What hormones work via the Gs protien receptor pathway to increase adenylate cyclase activity to increase intracellular cAMP & protein kinase A levels?
- TSH
- LH
- FSH
- ACTH
- Glucagon
- ADH
- PTH
What compounds work via a receptor tyrosine kinase (receptor has intrinsic tyrosine kinase activity that autophosphorylates tyrosine & progresses down the Ras/MAP kinase pathway)?
- Insulin
- Growth factors: Endothelial growth factor, platelet-derived growth factor
What is the action of Bcl-2 & bcl-x?
Antiapoptotic: prevents the release of cytochrome c & stops it from binding to APAF-1 & activating the caspase cascade
What are the 2 actions of p53
- stops the cell cycle & activates DNA repair proteins
- initiates apoptosis if repair cannot be made
What does c-myc do?
- Upregulates the cell cycle (drives cell proliferation)
- e.g. Burkitt's lymphoma
What type of proteins are bax and bak?
proapoptotic: trigger release of caspase-activating proteins to trigger cell death
In what cancers is the constitutive ras G protein activated?
neurofibromatosis
What is the most common presentation of von Willebrand diseases?
Mucocutaneous bleeding (e.g. after a dental extraction)
What do schistocytes indicated?
intravascular hemolysis
What is overproduced in Waldenstrom's macroglobulinemia?
Neoplastic plasma cells produce monoclonal imunoglobulin M heavy chains:
- leads to hyperviscosity syndrome & often to Raynaud's
What genetic disorders increase the risk of a saccular or berry aneurysm?
- Polycystic kidney disease
- Connective tissue disorders
- Coarctation of the aorta
What UTI-causing organisms often result in struvite stones?
Urease-positive (alkalize the pH of the urine):
- Proteus
- Klebsiella
What bacteria causes hospital-acquired or drug-resistant UTIs and produces a blue/green pigment & fruity odor?
Psuedomonas aeruginosa (gram -, anaerobic bacillus)
What organism can cause hospital-acquired, drug-resistant UTIs & produce a red pigment & discoloration of the urine?
Serratia marcescens
What is the second leading cuase of community-acquired UTIs?
Staphylococcus saprophyticus (gram +)
What causes Microscopic Polyarteritis (MPA)?
White individual
- Activation of neutrophils & monocytes by perinuclear antineutrophil cytoplasmic antibodies (p-ANCAs) leads to inflammation & vasculitis in small arteries (esp glomerulous & pulmonary capillaries):
- S/S: dark brown stools, palpable purpura along extremities, reddish sputum
What is the DOC (& 2nd choice) for Absence seizures?
1st: Ethosuximide
2nd: Valproic acid
What is Carbamazepine used to treat?
tonic-clonic (grand mal) & partial (focal) seizures
What is the DOC for status epilepticus?
Diazepam
What analogue of y-aminobuteric acid is not approved for use with absent seizures?
Gabapentin
What anti-seizure medication is effective in all seizure types except absence seizures?
Phenytoin

SE: sedation, ataxia, nystagmus, hirsutism, gingival hyperplasia
What is the cellular failure in I-cell disease?
- Failure of the addition of mannose-6-phosphate by GIcNAc phosphotransferase on the GOLGI apparatus = no direction of enzymes to lysosomes & are excreted (e.g. hexoaminidase iduronate sulfatase, arylsufatase A)
- S/S: skeletal abnormalities, restricted joint movement, coarse facial features, severe psychomotor impairment, death in 1st decade of life.
Eating what puts immunocompromised patients or pregnant women at risk for listeriosis?
Poorly pasteurized milk
Soft cheeses
Coleslaw
Ready-to-eat turkey & pork
What section of the GI absorbs the largest net amount of water?
jejunum (colon only absorbs 400 mL/day out of 9L/day total)
At what pH is it advisable to administer bicarb to correct an acidosis?
pH < 6.9
What enzyme is lacking in phenylketonuria (PKU)?
phenylalanin hydroxylase: usually converts phenylalanine to tyrosine using tetrahydrobiopterin as a cofactor
What causes "fith disease" of childhood with a bilateral, red, maculopapular cheek rash with a "slapped cheek" appearance (erythema infectiosum)?
Parvovirus B19 (ssDNA virus)
What are the only pathogenic gram - diplococci?
Neisseria
How does a disseminated N. gonorrhoeae infection present?
- Acute onset of fever
- Swelling of 2 joints
- 75% of Px also have skin lesions on the extremities
What lab value is the hallmark of obstructive lung disease?
Decreased FEV1:FVC ration (to < 80%)
- also increased FRC & TLC

(FEV1:FVC is normal or increased with restrictive lung disease b/c FVC is reduced along with TLV)
What genetic translocation results in mucosa-associated lyphoid tissue lymphoma?
t(11:18)
What genetic translocation results in follicular (B-lymphocyte) lymphoma?
bcl-2 (antiapoptotic) from 18 to 14 (Ig heavy chain locus)
What protein is formed when a patient has CML?
Protein tyrosine kinase bcr-abl: due to the Philadelphia chromosome translocation (9:22)
What is Mesna disulfide used to prevent?
- Hemorrhagic cystitis associated with cyclophosphamide usage
- MOA: reduced to mensa (a free thiol compound) that reacts with urotoxic products
What drug is used to prevent &/or treat tumor lysis syndrome associated with chemo for rapidly growing leukemia/lymphoma cells?
Allopurionol:
- inhibits xanthine oxidase to decrease hyperuricemia when DNA synthesis is inhibited
What drug is used as prophylaxis against doxorubicin-associated cardiomyopathy?
Dexrazoxane
What drug can be used to reduce the megaloblastic anemia caused by methotrexate therapy?
Leucovorin (5-formyltetrahydrofolic acid):
- bypasses dihydrofolate reductase (blocked by methotrexate) to replenish the folate pool
What accumulates in galactosemia?
galactose-1-phosphate & galactitol

- Galactokinase phosphorylates galactose to galactose-1-phosphate & G1PUR converts this to glucose-1-phosphate.
- G1PUR is lacking in galactosemia
What causes Sjogren-Larsson syndrome & how is this disease characterized?
1) AR: Mutation in the fatty aldehyde dehydrogenase gene on chromosome 17p
2) Congenital ichthyosis (dry & scaly fishlike skin); mental retardation; spastic paraplegia
What causes the neurological problems associated with B12 deficiency?
- B12 is a cofactor for the conversion of methymalonyl coenzyme A to succinyl coenzyme A for the breakdown of odd-chained fatty acid.
- Without B12, toxic byproducts damage Schwann cells in the PNS
- Dx: methylmalonic acid (MMA) levels rise (even before B12 levels decrease) + megaloblastic anemia
What vitamin is needed as a cofactor for the conversion of propionyl coenzyme A to methylmalonyl coenzyme A?
Biotin
What drug is used to revive bone marrow in order to prevent infection & decrease the duration of neutropenia associated with myelosuppressive chemo?
Filgrastim (G-CSF):
- recombinate cytokine
- stimulates production, maturation, & activation of neutrophils
What drug is used to treat acute tumor lysis syndrome?
Allopurinol
What is Oprelvekin & what is it used for?
- Interleukin-11: throbopoietic growth factor
- Combats thrombocytopenia
What results from prolonged oligohydramnios (<0.5 L of amniotic fluid)?
Potter's (lethal): hypoplastic lungs, flattened facies, & clubbed feet
What is the MOA of Clomiphene when used as a drug to combat infertility?
- Selective estrogen receptor antagonist in the hypothalamus & anterior pituitary
- Shields negative feedback of estrogen & increases GnRH release
- GnRH stimulates release of FSH & LH to stimulate the ovary
What is a common side effect of bisphosphonates?
Esophagitis
What is a common side effect of Cabergoline?
- psychosis, nasal congestion, orthostasis, nausea/vomiting, headache
- MOA: Inhibits prolactin secretion by dopamine receptor agonist action
What is the MOA of gonadotropins when used to treat female infertility?
Increase overian follicular maturation

SE: weight gain & fluid retention
What is the DOC for CNS stimulate street drugs?
Labetalol: nonselective alpha & beta antagonist that blocks hypertension & cardiac stimulation

&/or

Neurolepics: to control agitation & psychotic symptoms

&/or

Diazepam: to control possible seizures
What is the antidote for acetylcholinesterase inhibitor overdose?
Atropine (muscarinic antagonist)
What is the antidote for benzo overdose?
Flumazenil (benzo receptor antagonist)
What is the antidote for a CNS stimulate overdose?
Fluoxetine (SSRI)
What is the antidote for opiate (heroine/morphine) overdose (sleepy, lethargic, comatose with miotic pupils, low Bp & depressed respiration)?
Naloxone (opiod-receptor antagonist)
What is the antidote for antimuscarinic drug (atropine, scopolamine, Jimson weed) overdose (hot & dry skin + CNS stimulation)?
Physostigmine (acetylcholinesterase inhibitor)
What organelle is the sperm's acrosome a development from?
- Golgi apparatus
- Acrosome covers the anterior 2/3 of the nucleus & contains enzymes (e.g. hyaluronidase) that permit the sperm to penetrate the zona pellucida of the egg @ fertilization)
What are the chemical markers of bone formation & bone resorption?
Formation: Alkaline phosphatase
Resorption: hydroxyproline
What are the 3 stages of Paget's disease of the bone
Primary abnormality: overproduction & overactivity of osteoclast
1) Osteolytic lesion of marked bone resorption
2) Disorganized bone formation
- Bone-specific alkaline phosphatase = up to 10x normal
- Phosphate = normal
- Ca = slightly elevated or normal
3) Sclerotic or Burned-out phase
How does hemophilia A present?
- Bleeding into a joint or retroperitoneal space
- Lab: Elevated PTT (b/c of factor VIII deficiency)
Which is more common, hemophilia A or B?
A = factor VIII deficiency (more common)

B = factor IX deficiency
What vessel supplies Wernicke's area?
Inferior division of the left MCA: to the posterosuperior portion of the superior temporal lobe
What vessel supplies Broca's area?
Superior division of the left MCA: to the posterior-inferior frontal lobe
What is transcortical motor aphasia?
- Caused by damage to the watershed region between the anterior & middle cerebral arteries
- Like Broca's aphasia, but with better repetition
What is transcoritcal sensory aphasia?
- Caused by damage to the watershed region between the middle & posterior cerebral arteries
- Sounds like Wernicke's, but the Patient's repetition is better than spontaneous speech
How do patients with agromegaly present?
1) Glucose intolerance
2) Coarsening of facial features
3) Thickened fingers
4) Macroglossia -> obstructive sleep apnea

Cause: GH-secreting adenoma
What is the DOC for agromegaly?
Octreotide (somatostatin analog that suppresses GH secretion @ the anterior pituitary)
What is the MOA of Somatrem?
Somatotropin (GH analog) that stimulates the release of insulin-like growth factor-1 (aka somatomedin) from the liver

Rx: GH deficiency
What are the derivatives of the 6th aortic arch?
- Proximal pulmonary arteries
- Ductus arteriosus: connects the pulmonary trunk to the aorta (lung bypass)
What are the derivatives of the 2nd aortic arch?
stapedial & hyoid artery
What are the derivatives of the 3rd aortic arch?
Common carotid artery
Proximal part of the internal carotid
What are the derivatives of the 4th aortic arch?
Aortic arch on the left
Proximal right subclavian
What is a SE of magnesium treatment for preeclampsia?
Depressed tendon reflex
What neuroexam finding can indicate hypomagnesemia?
Babinski's sign
What does Chvostek's sign (ipsilateral contraction of the facial muscles when the facila nerve @ the angle of the jaw is tapped) indicate?
hypocalcemia
What is an ELISA test?
- Antigen-antibody hybridization: used to detect antigenic match in a patient's blood sample
- Has a Patient's blood encountered a particular antigen? If positive: Px has a vaccination or exposure
What test is used to detect single-point mutations?
Ligase chain reaction (LCR): used to diagnose carriers of disease genes
What muscles abduct & medially rotate the thig to keep the pelvis level? (hint: damage results in Trendelenburg gait)
Gluteus medius & minimus (supplied by the superior gluteal nerve)
Describe the Trendelenburg gait.
- Standing still: pelvis sinks away from the affected muscles
- Walking: trunk lurches to the lesioned side
What muscle(s) extends and laterally rotates the thigh & assists in standing from a sitting position?
gluteus maximus (inferior gluteal nerve)
What do the branches of S1 & L5 innervate?
- Quadratus femoris: laterally rotates the thigh
- Oburator internus: laterally rotates when the leg is extended & abducts when the thigh is flexed
What innervates the obturator externus>
- Obturator nerve
- Laterally rotates the thigh
What is the action of the piriformis & what innervates this muscle?
- When leg is extended: laterally rotates the leg
- When the leg is flexed: abducts the leg
What is the vector for Borrelia recurrentis?
- Human louse: causes relapsing fever
- Changes cell surface proteins (antigenic variation) to evade humoral immunity
What organisms are capable of antigenic variation?
1) Salmonella species
2) Trypanosomes
3) Neisseria gonorrhoeae
4) Influenza virus
What filarial nematode causes river blindness?
Onchocera volvulus
What drug can reverse an isoniazid overdose induced seizure?
Pyridoxine b/c isoniazid is a competitive antagonist of pyridoxal kinase that helps to synthesize GABA from vit B6 (pyridoxine).
What 3 channels can be defective in Brtter's syndrome?
Channel dysfunction causes hypokalemia & metabolic acidosis:
1) Na+/K+/2Cl- (NKCC)
2) K+ channel
3) Cl- channel

All in the thick ascending limb (where loop diuretics act)
What causes NRDS (neonatal respiratory distress syndrome)?
Inflammatory cell-mediated endothelial injury & t/f disruption of alveolar or capillary integrity with leakage of protein-rich fluid exudate into alveoli
What is seen in pulmonary alveolar proteinosis?
Alveolar filling with proteinaceous material
How is ARDs (Acute respiratory distress syndrome) characterized?
Severe lung injury with acute hypoxemia & pulmonary edema resulting from increased pulmonary capillary permeability
What immunological mediated disease results in deposits at the alveolocapillary membrane?
Goodpasteur's
What cause an intense inflammatory response in the bronchi & alveoli (pneumonitis) within hours in a neonate?
Meconium aspiration syndrome
What is the MOA of metoclopramide & what are it's main SE?
MOA: antiemetic that also relaxes the pylorus (Rx: gastroparesis)

SE: parkinsonism-type extrapyramidal effects
What is sodium thosulfate used for?
- Convert cyanide into into thiocyanate via Rhodenase
- Cyanide is a a metabolite of nitroprusside & can inhibit cytochrome oxidase
What is the MOA of DNP (2,4-dinitrophenol)?
Uncoupler: destroys the mitochondrial membrane's proton gradient
What substance is formed in CO poisoning?
Carbon monoxyhemoglobin
What is a common complication of CLL (chronic lymphocytic leukemia)?
Autoimmune hemolytic anemia with warm antibodes
How many eggs must one eat to become biotin deficient?
> 20
What vitamin found in green leafy veggies is heat sensitive & can be destroyed by cooking?
Folic acid: methyl group transferer to form amino acids, purines, & thymidine

Deficiency: megaloblastic anemia or neural tube defects
What is the symptomatic difference between folic acid & B12 deficiency?
B12 has neuro in addition to megaloblastic anemia
What are the symptoms of vitamin E deficiency?
Defective lipid absorption

Premature infants: RBC membrane deposits
What artery supplies the LV, the RV?
LV: left (or obtuse) marginal (follows the left border of the heart)

RV: Right marginal (follows the right border of the heart)
What is the most treatable form of dementia?
Hypothyroidism
What causes a well-circumscribed granuloma in the liver?
Echinococcus infection
What typically causes an irregular mass lesion in the liver?
Hepatocellular carcinoma
What viral illness predisposes to subsequent bacterial pneumonia in an otherwise helathy individual?
influenza via damage of the epithelium of the upper respiratory tract
What infection causes profuse, frothy discharge that is associated with vulvovaginal pruritis, tenderness, & burning?
Trichomonas vaginalis:
- Histo: small pear-shaped flagellate orgs on web mount
- Can cause small, red, punctuate leasions on the cervix & vagina
What does bloody, foul-smelling vaginal discharge suggest?
Vaginal foreign body
What is indicated with pelvic or lower abdominal pain with an abnormal, foul-smelling vaginal discharge?
PID:
- Can involve endometrium, fallopian tubes, ovaries, peritoneum
- Orgs: Neisseria & Chylamydia
What causes intense pruritis with a thick, odorless, white, cottage cheese-like vaginal discharge?
Candida: buddy yeasts & hyphae on wet mount
What presents with an unpleasant, fishy-smelling vaginal discharge that is thin, gray-white & homogenous?
Bacterial vaginOSIS

Dx: clue cells (bacteria coating epithelial cells)
What tricyclic antidepressant can reduce night terrors & enuresis?
Imipramine: decreases stage 4 sleep
What infection causes HUS (hemolytic-uremic syndrome)?
E. coli

Result: Thrombocytopenia, Acute Renal Failure & DIC
What can be used to treat moderate cases of von Willebrand disease or hemophilia A?
Desmopressin (ADH analog): improves platelet function and promotes the release of vonWillebrand factor & factor VIII
What is a jaw-related complication of chronic bisphosphonate therapy?
Osteonecrosis of the jaw (avascular necrosis of the jaw)
What differentiates Osteomalacia from osteoporosis?
Osteomalacia: new matrix can be synthesized, but it cannot be mineralized (usually due to vitamin D deficiency)

Osteoporosis: reduced synthesis of new bone matrix
How does osteomyelitis show up histologically?
Neutrophils & bone necrosis on micrscopic exam

Cause: S. aureus or M. tuberculosos (macrocytic predominance if M. tub...)
Where is osteosarcoma usually found?
Metaphysis of long bones:
- Characterized by formation of new bone matrix
- Most common primary malignancy of bone
When can neuroendocrine tumors cause carcinoid syndrome?
When they met to the liver and serotonin is no longer metabolized by 1st-pass hepatic metabolism:
- diarrhea, cutaneous flushing, asthmatic wheezing, Rt-sided heart disease
Besides the skin, in what organs is Kaposi's sarcoma also found?
- Lungs
- GI
- Biliary tree
How does Kaposi's infiltration of the GI present?
Mucosal bleeding:
- Hematochezia
- Hematemesis
- Melena (black-colored stools)
How is Crigler-Najjar syndrome type 1 characterized?
AR: UGT-1 deficiency (Uridine diphosphate-glucuronoxyltransferase)
- unconjugated hyperbilirubinemia b/c no conjugation of bilirubin with glucuronic acid
- fatal within 18 months due to kernicterus
What is the most commonly diagnosed porphyria?
Porphyria cutanea tarda
- Deficiency of uroporphyrinogen decarboxylase
- Can result in 2ndary hemochromatosis
What is primary gain?
When an individual subconsciously expresses an internal conflict as a symptom of a physical or mental illness, leading to a relief of their anxiety
What is La belle indifference?
When a person has a strikingly cavalier attitude about something very serious
What is secondary gain?
Willful invention of symptoms in order to obtain something desired or avoid something unpleasant
What is tertiary gain?
Benefit that the care provider derives from treating the sick individual
What pathway is monitored when treating a patient with Heparin?
PTT (intrinsic coagulation pathway)
- Heparin activates antithrombin III -> decreases thrombin & inhibits factor Xa
When do you monitor INR (international normalized ratio)?
Standarizes prothrombin (extrinsic pathway) time: warfarin
- INR should be between 2 & 3
What is an Arnold-Chiari malformation?
Displacement of the hindbrain through the foramen magnum
- causes syringomyelia: damage to the crossing fibers of the spinothalamic tract & bilateral loss of pain/temp sensation in the upper extremities
How does Cushing's syndrome cause poor wound healing?
Inhibition of collagen synthesis by glucocoritcoids
Does smoking increase or decrease the risk of endometrial cancer?
Decreases
What is the classic triad of acute graft-versus-host disease (GVHD)?
1) Dermatitis
2) Hepatitis
3) Gastroenteritis
Are isolation, acting out, sissocation, denial, fixation, identification, isolation of affect, projection, rationalization, reaction formation, splitting, repression, or displacement mature or immature defense mechanisms?
Immature
What is the mechanism of primary graft rejection?
- When neutrophil & platelet recover does not occur after transplation
- Due to recipient immune system attack on alloantigens expressed on donor stem cells
Is humor (appreciating the amusing nature of an anxiety-provoking or adverse situation) a mature or immature defense mechanism?
Mature
How do (some) bacteria use IgA protease?
To cleave secretory IgA & colonize mucosal areas
What are the mature defense mechanisms?
SASH:

Altruism
Humor
sublimation
supression
What does Clostridium perfringens produce which causes gas gangrene, cellulitis, & diarrhea?
Lecithinase
What is the pathogenesis of communicating hydrocephalus secondary to meningitis?
- Arachnoid granulations may become scarred & fail to resorb adequate CSF
- CSF builds up in subarachnoid space & ventricles
What are 3 examples of acute-phase proteins?
C-reactive protein
Mannose-binding Lectin
Pulmonary surfactant proteins

- All produced by the liver
- All are opsonins & activate complement
What is hydrocephalus ex vacuo?
When brain mass is progressively lost, cerebrospinal fluid accumulates to fill the void.
What do the following symptoms indicate?
- Anxiety & irritability
- Neuromuscular excitability
- Tetany
- Intracranial calcifications
- Dental abnormalities
- Cardiac conduction abnormalities
Hypoparathyroidism

Causes: thyroidectomy, metastatic cancer, DiGeorge's syndrome
What can cause hydrocephalus via CSF overproduction?
Choroid plexus papilloma
What gram-negative, nonmotile facilitative anaerobe causes abdominal pain, high fever & bloody diarrhea in the developing world?
Shigella flexneri
What infection is associated with 30% of polyarteritis nodosa patients?
Hepatitis B
What urine values are characteristic of Nephrogenic or Central DI?
- Low urine specific gravity
- High serum osmolality
What are the x-ray signs of a transposition of the great vessels?
1) Enlarged heart
2) Dome-shaped heart (fried egg yoke seen from the side)
3) Pulmonary vascular markings are increased
What is the most common invastive tumor of the breast?
- Ductal carcinoma
- Histo: anastomosing sheets of pleomorphic cells
- Most aggressive tumors overexpress HER2/neu
What reflex action happens with norepinephrine?
Reflex bradycardia due to an increased in SV.
What nerve is damaged when the eye appears "down & out"?
CNIII (occular motor):
- Loss of superior & inferior rectus, inferior oblique muscles
- Dominance of superior oblique & lateral rectus
- Ptosis: loss of levator palpebrae superioris
- Dilated pupils due to loss of parasympathetic fibers (unless the damage is an infarction)
What are "pressor" drugs?
drugs used to increase Bp
What are the endocrine hormones of the pancreas?
Alpha Cells: glucagon
Beta islet Cells: insulin
Delta islet cells: somatostain
What is the formula for MAP?
2/3 diastolic + 1/3 systolic Bp
What are the exocrine hormones of the pancreas?
Digestive enzyme: amylase, lipase, trypsin, chymotripsin

- Acinar cells (large, eosinophilic cytoplasm, pyramidal-shaped, polar)
How does a patient with an L5-S1 disc herniation present?
S1 nerve root damage:
- Pain & paresthesia & sensory loss over: back of thigh, lateral posterior calf, & lateral foot; loss of motor of gastrocnemius w/ or w/o deficit in foot eversion
- LOSS of Achilles relfex
What cells of the Gi secrete CCK (cholecystokinin)?
mucosal neuroendocrine cells
- primarily in the dudenum
- pyramidal, extend from the BM to the lumen with microvilli & secretory granules
When is the patellar reflex lost?
Herniation affecting the L4 nerve root:
- pain & sensory loss over anterior thigh & interior shin, + motor deficits of the quadriceps
What does a deficiency of the CD40 ligand on activated CD4+ lymphocytes cause?
X-linked, hyper-IgM syndrome:
- Deficiency of IgG
- Normal/Elevated IgM
- Recurrent pyogenic infections (no IgG opsinization) & P. jiroveci pneumonia b/c of the defect in cell-mediated immunity
What results in an abnormal plantar reflex or Babinski's sign?
UMN injury with the lesion to the corticospinal tract above S1
What does a patient with chronic, intermittent abdominal pain, diarrhea, fever, & megoblastic anemia likely have?
Crohn's
What is the Conus medullaris syndrome?
Damage to the distal part of the spinal cord that presents with:
- lax anal tone
- Urinary retension
- incontinence
- impotence
- Bilateral saddle anesthesia (S3-5) may be present
What causes neurogenic claudation?
Lumbar spiral stenosis
- back or buttocks pain induced by walking or prolonged standing.
- Pain relieved by rest or forward flexing of the vertebral column.
What does an increase in hemoglobin A2 indicate?
B-thalassemia minor = hypochromatic, microcytic anemia
What is the triad for parathyroid adenomas?
Stones, bones, abdominal groans, & psychic moans:
1) Nephrolithiasis
2) Osteoporosis or osteitis fibrosa cystica
3) Constipation, nausea, vomiting, ulcers, pancreatitis, gallstones
4) Depression, lethargy, & eventual seizures
What neurological symptoms are seen with vitamin B12 deficiency?
Increased methylmalonic acid levels impairs myelin synthesis:
- Primary impact: posterior & lateral spinal columns
- Paresthesias & impaired proprioception

+ megaloblastic anemia
What are signs of vitamin D deficiency in the elderly due to poor nutrition/feeding?
Poor Dentition
Loss of appetite
Creeping dementia
What type of sputum is indicative of hosptial-acquired or alcoholic pneumonia?
Bloody sputum resembling dark jelly; caused by gram - rods:
- Klebsiella pneumoniae
- Psuedomonas
- Enterobacter
What lab values indicate Paget's disease of the bone?
- Normal Ca & PO4-
- Elevated Alk Phos (significantly elevated)
What are the only endogenous agents that allow dilation of the afferent arteriole of the kidney?
Prostaglandins

- Their production blocked by NSAIDs and COX-2 inhibitors = increased vascular tone & constriction
What 3 endogenous systems/agents constrict the efferent arteriole of the kidney?
1) Sympathetic nervous sytem
2) Angiotensin II
3) Vasopressin
What lab values indicate parathyroid carcinoma?
1) Hypercalcemia
2) Hypophosphatemia
3) Elevated PTH
What is the action of COX-2 inhibitors?
- Modulate vascular & bronchial tone

- DO NOT modify vascular permeability or platelet aggregation (NSAIDs change platelet aggregation)
What is the physical sign of LMN lesions?
- Fasciculations: twitching of the muscle as it loses innervation
- Cause (in ALS: amylotrophic lateral sclerosis): release of acetylcholinesterase from the degenerating nerve terminal at the neuromuscular junction
What is the cutaneous innervation of the median nerve?
1) Palmar hand: lateral portion up to the lateral 1/2 of the 4th digit
2) Dorsal hand:
- distal to the proximal interphalangeal joints of the 1-3 digints
- the dorsal aspect of the radial 1/2 of the 4th digit distal to the proximal interphalangeal joint
- THENAL muscles ("Oaf"): Opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
WHat causes hypogonadism due to hypogonadotropic cuases?
- Cause: Impaired secretion of LH & FSH do to congenital GnRH deficiency
- Characterized by low testosterone in the setting of low LH & FSH
Where is warfarin metabolized?
p450 system
What connection caus increase the rist of testicular torsion?
When the tunica vaginalis is attached high on the spermatic cord
What drugs for GERD inhibit the CYP450 system?
- PPIs (e.g. omeprazole)
- Cimentidine (antihistamine)
What reverses heparinization?
Protamine sulfate: it is + charged and binds - charged heparin decrease antithrombin III activation (& thereby reinstating levels of thrombin & factor Xa)
What type of seizures is Phenytoin used for?
Gran mal (generalized tonic-clonic)
Complex partial
What is Aminocaproic acid used for?
Reverse the thrombolytic effects of:
- Streptokinase
- Urokinase
- Tissue plasminogen activator

MOA: inhibits fibrinolysis
What drug is used prophylactically to prevent blood loss in cardiothoracic surgery? What is its MOA?
Aprotinin: slows bleeding by blocking plasmin

- Also inhibits streptokinase
What type of seizures is Carbamazepine used to treat?
Partial complex
What results from a loss of function of the NF2 gene on chromosome 22q?
NF2 gene no longer produces a protein that interacts with the cell membrane & cytoskeleton:
- AD Neurofibromatosis type 2 with bilater vestibular (CNVIII) schwannomas & meningiomas

Mneumonic: NF type 2 = Ch. 22
What 3 seizure meds induce the CYP450 system?
Penytoin
Carbamazepine
Phenobarbital
What ECG finding indicate hypOkalemia? hyPERkalemia?
- Hypo: Flattened T wave & U wave
- Hyper: Peak T waves & prolonged PR interval
What are the side effects of Quinidine?
- Diarrhea
- Cinchonism: tinnitus, vertigo, vision problems, & delirium
What is DOC in a penicillin-allergic patient with a pseudomonal infection?
Aztreonam: inhibits cell wall synthesis
What antimalarial med can also be used to covert atrial fibrillation or suppress ventricular arrhythmias?
Quinidine
What is Tinea unguium?
Fungal infection of the nail with Trichophyton

Rx: Griseofulvin (CYP450 inducer)
What is Beck's triad?
Indicates hemopericardiua:
1) Hypotension
2) Increased JVP
3) Distant heart sounds
What are the drugs used to treat trigeminal neuralgia?
1st: carbamazepine
2nd: Phenytoin

Both induce CYP450
What type of degenerative dementia presents with visual hallucinations, problems with executive & visuospatial functions, & trouble driving?
Lewy body Dementia:
Dementia + 2 of these
1) Cogntivie fluctuations
2) Visual hallucinations
3) Parkinsonism

Lewy bodies are eosinophilic & involve the entire cerebral cortex (stained by alpha-synuclein)
What is the clinical triad for renal cell carcinoma?
1) Flank pain
2) Palpable abdominal mass
3) Hematuria

+ polycythemia (ectopic epo), fever, & weight loss

If genetic, associated with von Hippel-Lindau syndrome (Ch. 3 mutation)
What histopathology is seen in Alzheimer's disease?
1) Amyloid proteins
2) Apo-E
3) Taupathy
4) Synaptic loss
5) Senile plaques
6) Neurofibrillary tangles
7) Granulovascular degeneration
What symtom is present with Creutzfeild-Jakob disease & missing in dementia with Lewy bodies?
- CJD is must rarer & presents with myoclonus
- Electroencephalography shows burst suppression & periodic complexes
What conditions go along with APKD?
- Polycycstic liver disease
- Berry Aneurysms
- Mitral valve prolapse

Cause: APKD1 mutated gene on Ch. 16
What protease inhibitor is associated with crystal-induced nephropathy?
Indinavir: precipitates in the urine & obstructs its flow

Rx: HIV/AIDS
What organism causes a chest X-ray picture of diffuse infiltrates bilaterally along with a cough & shortness of breath in an HIV patient?
Pneumocystis jiroveci
What the does the allantoic duct eventually become?
Median umbilical ligament

"allaNtosis" has an "N", as does "mediaN"
What organism presents on X-ray with consolidations that are typically noted in the apical or posterior portions of the upper lobe or superior portions of the lower lobe?
Mycobacterium tuberculosis
What is the ligamentum teres hepatis a remnant of?
Umbilical vein (carries O2 blood from mother to baby)
What type of colonic polyp is a risk factor for colorectal cancer?
Villus adenoma
What is the ligamentum arteriosum a remnant of?
Ductus arteriosum (shunts blood from the pulmonary artery to the aorta in the normal fetal circulation)
What are the medial umbilical ligaments a remnant of?
Fetal umbilical arteries (carry blood from the baby to the mother)
How is prolactin endogenously regulated?
Dopamine secreted by the neuroendocrine cell nuclei of the hypothalamus suppress prolactin secretion from trophic hormone-secreting cells of the anterior pituitary.
- Bromocriptine (drug) can stimulate this loop to inhibit prolactin
What drug, used to treat gastric ulcers induced by NSAID use, is an abortofactant?
Misoprostol (Prostaglandin E1 analog)
What enables working muscle to have a greater blood supply during exercise?
Selective vasodilation via metabolic factors: lactate, potassium, & adenosine
- Overcomes sympathetic effect that exercise also induces to vasocontrict via alpha receptors
What drugs are H2-receptor antagonists?
Ranitidine
Cimetidine
Famotidine

Rx: inhibit acid secretion at the histamine receptor
What happens in the lungs during exercise?
- Pulmonary resistance decreases to accommodate greater pulmonary blood flow
- Decreased resistance improves gas exchange & allows an even distribution of blood throughout the lungs.
What diuretic is the DOC for a patient with a sulfa allergy?
Ethacrynic acid
Mannitol (but not for CHF or anuric patient)
What is reactive arthritis?
- a seronegative spondyloarthopathy with HLA B27
- an arthritis that follows a GI or GU infection by 2-4 weeks
- "can't SEE, can't PEE, can't CLIMB A TREE"
- Extra-articular manifestations include:
1) conjunctivitis
2) keratoderma blennorrhagia (papulosquamous skin rash on palms/soles)
3) Urethritis
4) Circinate balanitis (lesion on the penile shaft)
5) Aortitis (occasionally seen)
What drug causes gray baby syndrome?
Chloramphenicol (also causes aplastic anemia)
What are Heberden's nodes on distal interphalangeal joins of fingers manifestations of?
Osteoarthritis: destruction of articular cartilage
What drug group has a disulfiram-like reaction with alcohol use?
Cephalosporins (cefamandole, cefotetan, cefoperazone, cefmetazole)
What is Ulnar deviation of the fingers a late manifestation of?
Rheumatoid arthritis
What chronic autoimmune liver disorder can present with sever itching, hepatomegaly, & xanthomas?
Primary biliary cirrhosis

LAB: antimitochondrial antibodies
HISTO: Granulomatous destuction of medium-sized intrahepatic bile ducts
What drug group can cause Kernicterus?
Sulfonamides: they displace bilirubin from protein, resulting in excess free bilirubin
What do elevated levels of anticentromere antibodies indicate?
CREST variant of scleroderma
What antibiotic drug groups are known to cause ototoxicity?
Aminoglycosides
Vancomycin
What does antihistone antibodies indicate?
Drug-induced lupus syndromes
What do antinuclear antibodies often indicated?
Connective tissue diseases like SLE
What antibiotic is associated with teeth discoloration?
Tetracyclines
What does uvula deviation indicate?
LMN lesion contralateral to the side to which the uvula is deviating

OR

UMN vagus nerve (CNX) lesion will cause the uvula to deviate toward the side of the lesion
What heart sound is present in sickle cell patients?
Systolic ejection murmur due to increased SV & velocity to compensate for anemia
- Heard when Hb falls below 6 mg/dL & blood viscosity decreases (increased turbulence)
- Over mitral or aortic valve
What nerve innervates the palatal archers & uvula?
Vagus (CNX)
What class of diuretics can worsen osteoporosis?
Furosemide & other loops (decrease Ca2+ absorption)
What does tongue deviation indicate?
Injury to the LMN of the hypoglossal nerve (CNXII) on the opposite side due to unopposed action of the opposite genioglossus muscle
What are the signs of pulmonary edema?
1) Orthopnea
2) Dyspnea
3) Pulmonary rales
4) Systemic edema of extremities ("backward failure")
What components of the CNS are derived from mesoderm?
- Microglia (like all macrophages)
- Dura mater
- Connective tissues: endo, peri, & epineuria
What are the signs of "forward failure"?
Fatigue due to insufficient CO to meet matabolic demands
What tissues of the nervous system are derived from neural crest cells?
- Peripheral ganglia
- Afferent sensory nerves (dorsal root)
- Schwann cells
What heart sound indicates volume overload?
3rd heart sound on auscultation
What are the derivatives of the neuroectoderm?
- Posterior pituitary
- CNS neurons
- Oligodendrocytes
- Astrocytes
- Ependymal cells
- Pineal gland
What are the 2 main indications for carbonic anhydrase inhibitors like Acetazolamide?
1) Metabolic alkalosis
2) Alkalize the urine to remove a toxic drug
What are the lends of the eye, epidermis, & anterior pituitary derived from?
Surface ectoderm
What are the major actions of Captopril?
ACE inhibitor:
1) Arteriolar vasodiation (decreases afterload)
2) Venous vasodilation (decreases preload)
3) Decreased aldosterone (decreases preload)
What hormones act through nuclear steroid hormone receptors?
1) Thyroid hormones
2) Cortisol
3) Aldosterone
4) Vitamin D
5) Testosterone
6) Estrogen
7) Progesterone
What is the order of items within the common carotid sheath?
1) Artery is medial
2) Internal jugular is lateral
3) Vagus is posterior
How does Glucagon act on target cells?
G-protein receptors in the plasma membrane, an alpha subunit activates adenylate cyclase
How do Histamine & vasopressin act on target cells?
Activate phospholipase C, resulting in cleavage of phosphatidylinositol diphosphate to inositol triphosphate & diacyglycerol
Describe the embryo origins of the ear structures.
- 1st branchial arch: incus & malleus
- 1st branchial cleft: external auditory meatus
- 1st branchial pouch: iddle ear cavity, Eustachian tubes, mastoid air cells
- 2nd branchial arch: stapes
- 2nd branchial cleft: temporary cervical sinus
How does intracellular insulin act?
Via a tyrosine kinase cascade
What is the pathogenesis of Alport's syndrome?
X-linked genetic disorder with absent or mutated type IV collagen:
- Renal disease
- Nerve disorders (deafness)
- Ocular disorders

EM: split basement membrane due to the collagen IV mutation (kidneys & ears)
How does norepinephrine act on target cells?
Binding to & activating adrenergic receptors
What kidney problem shows up as wire-loop appearance under EM?
SLE (systemic lupus erythematosus) due to subendothelial basement membrane deposits
What is acute coronary syndrome?
Either unstable angina or acute MI
- T wave inversion of ECG indicates myocardial ischemia
What causes dysentery?
Mucosal destruction leading to purulent (epithelial cells) & bloody stools:
- Persists with fasting
- Cause: Shigella (verotoxin inactivates 60S subunit & kills epithelial cells) & some E. coli species
Why are ACE inhibitors prescribed after a patient recovers from an MI?
Maintenance therapy to reduce ventricular remodeling
Is osmotic diarrhea relieved by fasting?
Yes:
- Osmotic gap (290 - 2(Na(stool) + K(stool)) > 50 mOsm
- No increase in fecal fat
- Classic Causes: celia disease, lactose or fructose intolerance
What disease presents with high fever with uniform renal impairment & mild hepatitis after a recreational freshwater exposure?
Leptospirosis
What is secretory diarrhea?
- Isotonic with plasma
- Net intestinal fluid secretion
- No abatement with fasting
- Causes: viral or bacteria (Cholera)
What does a radiologic study showing soft tissue swelling, bone destruction, & periosteal reaction indicate?
Hematogenous osteomyelitis

- Usually due to Staphylococcus aureus
What drug is most effective med to increase HDL?
Niacin
What is the MOA of tentus toxin?
Blocks release of glycine from Renshaw cells in the spinal cord & results in "lockjaw"
- Early symptoms: risus sardonicus (muscle spasm-induced grimace), poor prognosis, and opisthotones (severe hyperextension of the head, neck, & back)
What organism is part of the normal oral flora & can be responsible for abscesses in the mouth, pharynx, brain, & lung?
Prevotella melaninogenica
What causes rose-gardener's disease?
Sporothrix schenckii (fungus)

- Pustule or ulcer at entry point with ascending lymphangitis (rarely causes a systemic effect)
What 4 components develop into the diaphragm?
"Several Parts Build the Diaphragm":
- Septum transversum
- Pleuroperitoneal folds
- Body wall
- Dorsal mesentery of the esophagus
What is the MOA of unmetabolized tyramine?
- Loaded with beer, red wine, cheese, sausage & pickles, the TYRE of AMINE is squeezing out biogenic amines from a presynaptic vesicle of the adrenergic terminal
- Sympathomimetic: NE release stimulant
What is fetal hydantoin syndrome?
Due to maternal use of anti-epileptics like phenytoin during pregnancy:
- Abnormal skull & facies
- Growth deficiency
- Underdeveloped nails of fingers & toes
- Mild developmental delay
What patients should avoid Tyramine?
In patients taking MAOs b/c this will block liver MAO A & cuase the high-pressure TYRE of AMINE crisis
What is the MOA of polymyxins?
disrupts the cell membrane's osmotic properties
What is the MOA of phyenlephrine?
- Selective alpha-1 agonist
- This PHENomEnaL ElePHant tightens the alpha-1 RINg on a segment of arteriole
- Mydriasis dues to alpha-1 activation of the radial muscle of the iris
What is the MOA of rifampin? What is it used for?
Inhibits DNA-dependent RNA polymerase encoded by the rpo gene

Rx:
- Antimycobacteria
- Leprosy (to delay dapsone resistance)
- Chemoprophylaxis for N. meningitidis exposure & also for kids exposed to H. influenzae
What is the clinical use of PHENylephrine?
- Priaprism (alpha-1 on the corpora cavernosa to decrease blood flow)
- Hypotension or shock (with low PVR)
- Eye disorders or exams (mydriatic)
- Nasal & sinus congestant (decongestant or vasoconstriction in sinus surgery)
What is the MOA of ethambutol?
Inhibits the arabinosyl transferase-mediated synthesis of arabinogalactin for mycobacterial cell walls
What is the MOA of dapsone?
Inhibition of folic acid synthesis
What are the major side effects of PHEnyleprine?
P = prostatic hyperplasia symptoms
H = hyperemia (rebound) due to chronic use with nasal/sinus congestion
E = elevated Bp in Px with hypertension

HYPERtensive crisis with MOAIs
What is prescribed prophylactically in asymptomatic patients with a positive PPD?
Isoniazid & B6 (the latter to prevent neurotox)
What is the MOA of Epinephrine?
- Equally gives everybody a shot of adrenaline (alpha1, apha2, beta1, beta2 agonist):
- vasoconstriction (a1)
- vasodilation (b2)
- cardiac stimulation (b1)
- bronchoconstriction (b2)
- decreased IOP (increased aqueous humor outflow: E for Efflux)
What is the most poten antituberculous med?
Rifampin (blocks DNA-dependent RNA polymerase)

SE: liver toxicity
What are the 6 clinical uses of Epinephrine?
1) Anaphylaxis
2) Bleeding (superficial)
3) Cardiac arrest
4) (local) Anesthesia
5) Bronchospasm (rarely used)
6) Coup induced by intubation or infation

7) Open-angle glaucoma
What is the clinical presentation of Steven-Johnson's
Prodrome: fever & fatigue, then skin & mucocutaneous lesions that begin as erythematous macules, progress to form bullae, & then slough
What drug interacts with Epinephrine to cause severe hypertension or even cerebral hemorrhage?
nonselective Beta-blocker
What 3 drugs often cause cutaneous flushing?
Niacin
Adenosine
Vancomycin
What are the major side effects of Epinephrine?
HAT on the head & heart:
- Headache, restlessness, cerebral Hemorrhage
- Angina and cardiac Arrhythmias
- Tachycardia & palpitations
What characterizes erythema nodosum?
Painful erythematous nodules on the lower legs (+ fever & malaise)

Diverse etiology: drugs, infections, inflammatory diseases
What is the MOA of Norepinephrine
I'm NO Epinephrine because I can't activate B2 receptors:
- A1 = A2; B1 > B2
With what underlying disease is pyoderma gangrenosum associated?
Pyoderma gangrenosum: boggy, red ulcers with purulent, necrotic bases (painful to the touch)
What are the TPR, CO, HR, & MAP values for phenylephrine?
alpha1 >> apha2:

TPR = increased
CO = reduced (reflex)
HR = reduced (reflex)
MAP = increased
What are the lab results for stage I & II of Lyme disease?
I: elevated IgM for B. burgdorferi (for 2 weeks)

II: elevated IgG (6 wks later)
What are the TPR, CO, HR, & MAP values for NOrEpinephrine?
alpha1 = alpha 2 = Beta1 >>> Beta2:
TPR = Increased
CO = NA or decreased (reflex)
HR = decreased (reflex)
MAP = Increased
What are the Dx criteria for rheumatic fever?
Pancarditis
Polyarthritis
Sydenham's chorea
Subcutaneous nodules
Erythema marginatum

Lab: Leukocytosis with neutrophilia
What are the TPR, CO, HR, & MAP values for Epinephrine?
TPR = decreased
CO = increased
HR = increased
MAP = NA or increased
How does Q fever present?
Sudden onset of 1(+):
- High fevers
- Chills
- Severe headache
- Malaise
- Myalgia
- Confusion
- Soar throat
- Nonproductive cough
- Nausea/vomiting
- Abdominal pain
- Chest pain

Dx: serologic testing for antibodies to Coxiella burnetii antigens
What are the TPR, CO, HR, & MAP values for Isoproterenol?
beta1 = beta2 >>> alpha 1
TPR = decreased
CO = increased
HR = increased
MAP = decreased
Why are benzos prefered over barbiturates in the treatment of anxiety?
Less likely to lead to respiratory depression and central cardiac depression
What is the MOA of Isoproterenol?
- I am SO PRO for the beta TERRItory of PROpraNOLol a nonselective beta-blocker, although we are opposite in actions
- Cardiac stimulation (B1 via Gs)
- Vasodialtion (B2 via Gs in skeletal muscle)
- Bronchodilation (B2 via Gs in broncial smooth muscle)
What are the signs of a long thoracic nerve injury?
1) Difficulty raising the arm above horizontal
2) Winged scapula
What are the 3 clinical uses of Isoproterenol?
1) Bradycardia
2) heart Block
3) Asthma (rarely)
What are the major side effects of isoproterenol?
HAT on the head & heart:
H = headache
A = Angina & cardiac Arrhythmias
T = Tachycardia & palpitations
What is the receptor MOA of PTH on the kidney?
Binds to basolateral hormone receptor in the proximal tubule cells that is coupled to adenylate cyclase via a Gs protein
- Increased renal Ca reabsorption
- Increased urinary cAMP
- Phosphaturia
What G proteins are alpha1 & alpha2 receptors linked with?
Gq, Gi

"AA flight 12 flies on the qi" (chi = air in chinese)
What is the MOA of PTH on the kidney to make acitve vitamin D?
Stimulates 1-alpha hydroxylase to produce 1,25-OH vitamin D from 25-OH vitamin D
What G proteins are beta1 & beta2 receptors linked with?
Gs, Gs

"BaBy goes to SS (sunday school)"
Why do emphysema patients often breathe through pursed lips?
- Upon expiration, larger airways collapse more (due to loss of elastic fibers & recoil) and lead to air trapping.
- Pursed lips causes increased resistance & increases pressure to keep the airways open.
What G proteins are D1 & D2 receptors linked with?
Gs, Gi

"2D grades makes everybody SIgh"
What is the function of G6PD?
- To generate reduced nicotinamide adenine dinucleotid phosphate from oxidized NADH, which is then used to reduce glutathione
- Glutathione detoxifies oxidizing agents
What G proteins are M1, M2, & M3 receptors linked with?
Gq, Gi, Gq

"3M is quick (qiq) for posting"
What enzyme generates Glucose-6-phosphate?
From glucose via hexokinase
What channels are Nn & Nm receptors linked with?
Na channel, Na channel

"Both Nn & Nm contain the N of Na+"
What is NADPH used for?
- Maintain a reduced pool of glutathione
- Fatty acid & steroid synthesis
- Cytochrome P450 system
- Phagocytosis
What G proteins are H1, H2 receptors linked with?
Gq, Gs

"Double-Hit is q.s. (L quantum sufficit [enough]"
What is the classical pattern of sensorineural hearing loss in older patients?
Loss of hair cells at the organ of Corit in the proximal portion of the basilar membrane (loss of hearing high-pitched sounds)
What G proteins or channels are 5-HT1, 5-HT2, 5-HT3, 5-HT4 receptors linked with?
Gi, Gq, Na+ channel, Gs

"Albeit with a 5-feet HeighT, his IQ is Not Significant (IQNS)"
What are the utricle and saccule for?
Part of the vestibular apparatus in the ear & responsible for seansing changes in head position with respect to linear acceleration
What G proteins or channels are GABAa & GABAb receptors linked with?
Cl- channel, Gi

"ABCi"
What is rheumatoid factor?
an IgM autoantibody that is directed against the Fc region of the patient's IgG antibody: immune complexes form
What G proteins are NMDA receptors linked with?
Na+, Ca2+, K+ channel

"Nmda also contains the N of Na+"
What is the sensitive & specific serological diagnostic test for Rheumatoid arthritis?
Anti-CCP (citrulline-containing protein) antibodies
What is the MOA of Dobutamine?
- DOes the BUTA of MINE excite the BeTA1 receptor of the heart? definately yes!
- Selective B1-agonist
- Cardiac stimulation (Gs-coupled = rise in cAMP)
- Weak alpha1 & beta2 receptor agonism = vasoconstriction & vasodilation
Where is ACh synthesized in the brain?
basal nucleus of Meynert
What is the clinical use of Dobutamine?
Refractory or severe CHF
Where is NE synthesized?
locus ceruleus in the brain
What are the major SE of Dobutamine?
HAT on the heart:
- Hypertension
- Angina & cardiac Arrhythmias
- Tachycardia
Where is serotonin synthesized?
Raphe nucleus
What is the MOA of Terbutaline & Ritodrine?
Tow 2 BeTA LINES, the RIghT sTRINgs used to Relax uTeRINE muscle
- Selective B2 agonists
- Uterine relaxation (Gs coupled B2 receptors)
- Bronchodilation (Gs coupled B2 receptors)
Where is Dopamine synthesized?
Ventral tegmentum & substantia nigra
What are the 2 clinical uses of Terbutaline & Ritodrine?
1) Premature labor (delays labor)
2) Asthma (Terbutaline, not ritodrine)
What are the 1st symptoms of botulism in adults?
Diplopia & dysphatiga

Cause: contaminated canned goods & smoked fish
What are the major SE of Terbutaline & Ritodrine?
RAT in the brain, HAT on the heart, & PET in the Lungs:

R = restless
A = anxiety
T = tremor

H = hyerglycemia & hypokalemia
A = angina & Arrhythmias
T = Tachycardia

P = low PO2 (early in Rx for severe asthma)
E = edema (pulmonary, rare)
T = tolerance
How is Follicular lymphoma recognized histologically?
- Cellular attempt to recapitulate lymph node architecture by forming follicles
- t(14:18) & over expression of antiapoptotic bcl-2 gene
What is the MOA of Ephedrine?
- Activates alpha and beta receptors and stimulates CA release
- A non-catecholamine (CA) agent
What is overexpressed in Mantle cell lymphoma?
Cyclin D1 (proto-oncogene)
What selective B2-agonists end in -buterol?
Al, Leva, Pir

Rx: Asthma
What gives Pseudomonas aeruginosa its blue-green color?
- It produces procyanin
- Gram -, oxidase positive, lactose-fermenting
- Virulence factor: exotoxin A (ADP riboxylates & inhibits eF2 in the host cell)
What selective B2-agonists end in -terenol?
Metaproterenol
What is the leading cause of death in cystic fibrosis patients?
Pulmonary infection by alginate-producing P. aeruginosa
What selective B2-agonists end in -terol?
Bitolterol
Formoterol (long-acting)
Salmeterol (long-acting)

Rx: asthma
What is the MOA of superantigens (like TSST-1 by S. aureus)?
Directly bind to & activates MHC-II & T-lymphocyte receptors
What selective B2-agonists are used to stop premature labor?
terbutaline & ritodrine
What vessel supplies the region of external hemorrhoids?
- External hemorrhoids are below the pectinate line
- Supplied by the inferior rectal artery (branch from the internal pudendal) & drained by the inferior rectal vein
What type of drug is Dopamine?
Direct sympathomimetic, non-selective D-agonist
What vessel supplies the external genitalia & a portion of the thigh?
External pudendal
What are the dose-dependent effects of dopamine?
"DOPeDOse-dePendent Awards of MINE:
- bronze (D1) at low doses = increased renal Perfusion
- silver (B1) at intermediate = Positive inotropy
- gold (Alpha1) at high doses = increased Peripheral resistance
What does the inferior mesenteric artery become?
- In the rectum: superior rectal artery
- Site of internal (painless) hemorrhoids)
What are the 3 MOAs of dopamine?
1) Low dose: Gs-coupled vascular D1 activation = up in blood flow to renal, mesenteric, & coronary vascular beds
2) Medium dose: Gs-coupled cardiac B1-receptors = positive inotropic
3) High dose: Gq-coupled vascular alpha-1 receptors to increase intracellular IP3/Ca2+ to vasoconstrict, increase PVR & Bp
What is the main step in melanin production?
Oxidation of tyrosine via tyrosinase in melanocytes
What are the 2 clinical uses of dopamine?
1) Refractory or severe CHF, especially for patients with decreased renal blood flow & low Bp
2) Cardiogenic or septic SHOCK
What is the most effective medical therapy for a uterine leiomyoma?
GnRH agonists like leuprolide
- leads to a desensitization and downregulation of these receptors resulting in a hypogonadal state resembling menopause)
- decreases both tumor & uterus size
What are the major side effects of Dopamine?
HAT on the heart:
- Hypertension
- Angina, Arrhythmias
- Tachycardia
What is the main feature of myasthenia gravis (MG)?
- Fluctuating weakness of certain voluntary muscles, particularly those innervated by the motor nuclei of the brain stem
- Manifest during continued activity, quick restoration of power with rest & dramatic improvement in stregnth following admin of neostigmine
What does the activation of an adrenergic alpha-1 receptor elicit?
- Gq --> increased DAG/IP3/Ca2+
- Increased TPR & BP (vasoconstriction in A & V of superficial tissues)
- Decreased Urination (Urinary SM contraction)
- Mydriasis without cycloplegia (contraction of the Radial m. of the iris)
- Ejaculation (Ductus deferens contraction)
What defect often results in myelin sheath malformation?
Defective long-chain fatty acid metabolism:
- Peroxisome disfunction (long-chain fatty acid catabolism, detox, & microbial killing)
What does the activation of an adrenergic alpha-2 receptor elicit?
Gi = decreased cAMP
- Reduced central sympathetic outflow (decrease presynaptic NE release)
- Decreased intraocular pressure (decreased aqueous humor secretion)
What is the dominant component of pulmonary surfactant?
Phosphatidylcholine (aka lecithin)
- Produced in adequate amounts by the 36th week of gestation
What does the activation of an adrenergic beta-1 receptor elicit?
Gs = increased cAMP
- increase HR, CO, & systolic BP (heart stimulation)
- Increased ATII (increased renin release)
What measurement is used to estimate lung maturity?
- Lecithin:Sphingomyelin ratio
- <2 = high rist for neonatal respiratory distress
What does the activation of an adrenergic beta-2 receptor elicit?
Gs = increased cAMP
- Reduced TPR & BP (skeletal muscle vasodilation)
- Increased Airflow (Bronchodilation)
- Delay of labor (Uterine relaxation)
- Increased plasma glucose & decreased K+ (Glycogenolysis/Gluconeogensis)
What is the genetic basis of Duchenne's muscular dystrophy?
- X-linked disorder due to frameshift mutation
- Progressive muscle weakness & early death due to accelerated rate of muscle breakdown
What does the activation of an dopaminergic D1 receptor elicit?
Gs = increase in cAMP
- Increased renal perfusion (Arterial dilation in the renal, mesenteric & coronary beds)
- Decreased TPR & Bp
What is the genetic root of Becker's muscular dystrophy?
Point mutation in the dystrophin gene
What does the activation of an dopaminergic D2 receptor elicit?
Gi = decrease in cAMP
- Extrapyramidal motor activity
What drug can be used to treat IBS?
loperamide (an opioid antidiarrheal)
What adreneric receptor is the only one to result in decreased cAMP?
Alpha-2: Gi = decreased cAMP
What is Bactrim?
Trimethoprim-sulfamethoxazole
What causes a greenish vaginal discharge, friable cervix, & motile cells on wet prep?
Trichomonas vaginalis

Rx: metronidazole
How does Haemophilus ducreyi present?
- Gram -
- Chancroid: painful genital ulcer & inguinal lymphadenopathy
What does Staphylococcus saprophyticus cause in young adults?
UTIs
What is the histological presentation of papillary thyroid carcinoma?
- Fingerlike projections of epithelium surrounded by a centeral fibrovascular core
- Psammoma bodies (calcified spheres)
- "Orphan Annie" nuclei & nuclei molding

- Risk factor: prior history of radiation to the head & neck
What HLA is found in patients with Hashimoto's?
HLA-DR5
What is the histological presentation of Hashimoto's?
- Substantial lymphocyte infiltration & germinal central formation
- Characteristic = Hurthle cells (epithelial cells with eosinophilic granular cytoplasm)
How is interstitial (or idiopathic) pulmonary fibrosis (IPF) characterized?
- Abnormal proliferation of mesenchymal cells, disruption of collagen structures, & impaired gas exchange
- RIP within 5 years without lung transplant
- X-ray: white lines in a netlike pattern at the lower part of the lungs
What is Lethal Factor?
- Released by Bacillus anthracic
- Zinc metalloprotease
- Inactivates protein kinase that stimulates macrophages to release tumor necrosis factor alpha
What organism causes Q fever?
Coxiella burnetti (a rickettsial org)
- transmitted by aerosolized endospores
- Q fever: high fever, headache, shaking malaise, myalgia
- Can cause a life-threatening endocarditis (esp, if Px has abnormal heart valves)
What causes hand, foot, & mouth disease?
Coxsackie A (RNA virus)
How is endemic typhus (caused by Rickettsia typhi) spread?
- Fleas (oftn on rodents)
- Sign: Centrifugal rash
What is the MOA of Albendazole?
- Interrupts microtubule function
- Rx: parasitic worms (e.g. hook & pin)
What is the pathophysiology of BPH (Benign Prostatic hyperplasia)
- Estradiol level increases with age
- Sensitization of the prostate to the effects of dihydrotestosterone (DHT)
- Porstatic cells grow
What drug for BPH also promotes hair growth?
Finasteride: 5-alpha-reductase inhibitor that prevents further cellular growth
What commonly-used antifungal also has antiandrogen effects?
Ketoconazole - used in polycycstic ovarian syndrome to prevent hirsutism
What K+ sparing diuretic also has antiandrogen effects?
Spironolactone - used to prevent hirsutism in polycystic ovarian syndrome
What are the clinical signs of a splenic infarct due to an embolism?
- Left upper quadrant abdominal pain
- Left shoulder pain (Kehr's sign)
- Nausea
- Vomiting
- History of embolic disorder
Describe the source of blood to the stomach.
- Left Gastric (branch of the celiac)
- Left gastroepiploic artery (branch of the splenic)
- Right Gastric (branch of the common hepatic)
- Right gastroepiploic (branch of gastroduodenal, a branch of celiac)
What anastomosis in cirrhosis results in hemorrhoids?
- Superior rectal & Middle Rectal
- Sign: bright red blood after a bowel moment
What anastomosis results in esophageal varices?
- Left gastric & Esophageal
- Painless hematemesis
What type of surgery predisposes patients to vitamin A deficiency?
Intestinal (esp. if ileum is involved) - absorbtion requires micelles formed with bile salts
What is required for normal iron absorption?
Ferrous iron requires apoferrin
Where in the GI tract is vitamin B12 absorbed?
Terminal ileum via binding to intrinsic factor (secreted by gastric parietal cells)
What enzyme is most essential in activation of pancreatic enzymes in the duodenum?
- Enterokinase: activates trypsinogen to trypsin
- This enzyme is normally embedded in the intestinal mucosa
What are premalignant, hyperkeratoic areas with surrounding erythema that often preceded the development of squamous cell carcinoma?
Actinic keratoses
What is acral lentiginous?
Melanoma that often appears on the palms & soles of dark-skinned individuals
What skin cancer is described as "pearly papules with overlying telangiectasias"?
Basal cell carcinoma
What lifestyle factor doubles the risk of peptic ulcers?
Tobacco use
What is a left shift in the hemoglobin curve?
- An increase in hemoglobin's affinity for oxygen = less O2 unloading to tissue
What is a good way to remember what activity decreases O2 affinity to hemoglobin?
Exercise
- Increase in temperature
- Decrease in pH
- Increase in CO2
What does 2,3-DPG do to the hemoglobin curve?
Decreases its affinity for O2 = right shift
What does methemoglobin do to the hemoglobin curve?
Has a decreased affinity for O2 = right shift
Why are nitrates used to treat cyanide poisoning?
- Nitrates can increase the amount of Methemoglobin
- Methemoglobin: the iron in hemoglobin is oxidized to Fe3+ & has an increased affinity for cyanide.
- Then this can be treated with methylene blue
What is the normal vaginal pH?
- 3.8 - 4.5
- This is maintained by Lactobacilli species that secrete lactic acid & hydrogen peroxide
At what pH is vulvovaginal candidiasis found?
- Normal vaginal pH range (<4.5)
- On Gram Stain: Hyphe & bastospores
At what pH is bacterial vaginosis found?
- 5.0-6.0 (moderately elevated)
- Dx: Add KOH to vaginal discharge = strong fishy or amine odor = WHIFF TEST
At what pH is a Trichomanos vaginalis infection found?
- 5.0-7.0
What is the pH of cervical mucus or sperm?
8.0
What is Waterhouse-Friderichesen syndrome?
Sepsis with adrenal insufficiency
What tumor can cause paroxysmal hypertension, palpitations, anxiety, & drenching sweats?
pheochromocytoma: tumor of the adrenal medulla that leads to the overproduction of epinephrine
What presents with Thrombocytopenia, hemolytic anemia with schistocytes, & uremia... & is a sequelae of a bacterial infection?
- Hemolytic-uremic syndrome
- Shigella or Escherichia coli O157:H7 infection
What type of drug is omeprazole?
PPI
What type of drug is Loratadine?
- 2nd generation, H1-receptor antagonist
- Rx: relieves allergy symptoms
What type of drug is Diphenhydramine?
- 1st generation H1-receptor antagonist
- Rx: symptomatic relief of allergy symptoms or as a sleep aid
How do NSAIDS cause GI problems?
- They are nonspecific inhibitors of cycloxygenase enzymes
- T/F they reduces the production of prostaglandin & thromboxane from arachidonic acid
- Prostaglandins play an important role in preserving mucosal integrity
What V/Q scan value indicates a physiologic dead space?
- Approaches infinity
- There is a obstruction to perfusion (like a spontaneous pulmonary embolism) and perfusion is decreased
What value is found in a V/Q scan when there is a ventilatory obstuction to the lung?
- Approaches 0
- Airway obstruction leads to some perfusion, but no ventilation
What is teh V/Q ratio at the apex of the lung?
- High
- Low blood flow & only a slight decrease in ventilation
What is the classical presentation for CML?
Middle-aged person
- Weakness
- Weight Loss
- Left Upper Quadrant Pain

LAB: increased # of cells of myeloid lineage + t(9:22)
What is CML?
Stem cell disorder that results in the overproduction of myeloid cells (mature forms)
What is the DOC for CML?
- Imatinib mesylate: inhibits the abnormal bcr-abl tyrosine kinase found in >90% of CML
- Not a cure but restores normal blood cell counts & prevents progression to bast phase for several years
What is infliximab?
- Chimeric monoclonal antibody to tumor necrosis factor alpha
- Rx: refractory Crohn's disease
What is the MOA of Propylthiouracil?
- Blocks thyroid hormone synthesis by partially inhibiting peripheral deiodination of thyroxine to triiodothyronine
- Rx: hyperthyroidism or thyroid storm
What is subacute sclerosing panencephalitis (SSPE)?
- A sequela of rubeola (measles virus)
- Presents 7-10 years after initial infection
- Demyelination of the CNS
- 1st stage: dementia & personality changes (1 yr. duration)
- 2nd stage: Severe myoclonus (3-12 months)
- 3rd & 4th stage: Worsening dementia & deterioration of the ANS + decorticate rigidity or flaccidity
- FATAL
What causes mutifocal leukoencephalopathy & typically affects only immunosuppressed people though reactivation of latent infection?
JC virus:
- altered mental status
- motor deficits (hemiparesis or limb ataxia)
- hemianopia
What is the symtomatic course of Rabies virus infection?
- Months after infection: convulsions, parasthesias, & difficulty swallowing solids/liquids due to spasticity of pharynx muscles
- Cognitive effects: manic episodes & altered mental status
- Death after flaccid paralysis sets in
What is the major problem with Rubella (or German measles) infection?
antenatal infection = CRS (congenital rubella syndrome)
- High degree of fetal mortality
- Cardia & ophthalmologic defects
- RARE: SSPE-like syndrome
What symptoms indicate a manic phase?
3 of the following:
1) inflated self-esteem/grandiosity
2) Decreased need for sleep
3) Increased rate of speech/talkativeness (pressured speech)
4) Flight of ideas/racing thoughts
5) Distractibility
6) Increased goal-directed activity/psychomotor agitation
7) Increase in pleasurable activities without regard for consequences
What is unique about Bacteroides fragilis?
- Gram - but without lipid A = NO ENDOTOXIN
- anaerobic, Rx: metronidazole or clindamycin or surgical drainage for abscesses
What causes wollsorters' disease?
Bacillus anthracis (Gram +, aerobic, spore-forming rods) inhalation
How does Candida albicans infections of the vagina present?
- Vaginal itching
- Cheese-like discharge
- Dx: 10% KOH prep = pseudohyphae
What anaerobe is a major colonizer of the colon?
Bacteroides
How does a Trichomonas (protozoa) infection of the vagina present?
- Frothy, foul-smelling discharge
- Itching & burning on urination

- Dx: Motile parasites on wet mount
What is Protamine sulfate used for?
Heparin OD
- heparin is negatively charged and this positively charged molecule binds to it to reverse its effects
Where is Alanine aminotransferases (ALT) found?
Liver = marks hepatocyte damage
Where is Aspartate aminotransferase (AST) found?
Heart, liver, skeletal muscle
Where is creatinine kinase (CK) found?
Inner mitochondrial membrane, on myofibrils, & in the muscle cytoplasm
- Catalyzes the production of ATP
- Types: MM (skeletal muscle), MB (cardiac muscle), BB (brain)
Where is Lactate dehydrogenase (LDH) found?
- Many tissues
- Used as a marker for liver disease, MI, & hemolysis, but is not specific
Laceration of what region can lead to post-vaginal delivery incontinence in the mother?
Perineal body: convergence of several muscles of the urogenital diaphragm (anterior to the anus)
- Bublospongiosus
- External anal sphincter
- Perineal muscles
Damage to what muscle can lead to postpartum urinary incontinence?
Coccygeus or levator ani (together = pelvic diaphragm)
What CSF finding points to JC virus?
1) Myelin pasic protein = due to demyelination
2) Dx: CSF PCR for JC virus or Stereotactic biopsy
How does PML (Ptrogressive mutifocal leukoencephalopathy) present?
- Multiple nonenhancing T2-hyperintense lesions
- Histology: nuclear inclusions in oligodendrocytes
How does CMV encephalitis show on a scan?
- Enhancing periventricular white matter lesions in cortical & subependymal regions
- Histo: Giant cells with eosinophilic inclusions in cytoplasm & nucleus
How does CNS lymphoma present on a scan
- 1(+) enhancing lesions surounded by enema = mass effect
- PCR CSF for EBV
What is the most common cause of multiple cerebral mass lesions in HIV-infected patients?
- Space occupying lesions due to toxoplasmosis infection
- Usually at corticomedullary junction
- Surrounded by edeam = mass effect
What is the treatment for Toxoplasma infection?
- Sulfadiazine & Pyrimethamine
- Trimethoprim/Sulfamethoxazole
What is Hydrochlorothiazide used to treat?
Diuretic: inhibits NaCL reabsorption @ distal tubule (blocks the Na-Cl symporter on lumina) & reduces Ca excretion (Increases Na gradient = upregulates Na/Ca antiporter & sends more Ca to interstitium & more Na into the cell)
1) Hypertension
2) Chronic kidney stones (due to hypercalciuria)
How does Acetazolamide work to treat altitude sickness?
1) Can cause a hyperchloremic metabolic acidosis
2) The drop in pH results in increased breathing drive and higher O2 in the body
3) Result: Reverses the effects of hypoxemia
What is the MOA of Amiloride?
Potassium-Sparing Diuretic:
- Inhibits Na reabsorption transportion @ the cortical collecting duct
- T/F reduces K secretion at the same time
What is the MOA of Furosemide?
Loop diuretic:
- Inhibits co-transport of Na, K, & Cl in the thick ascending loop of Henle
- This reduces the medullary concentration gradient & the lumen gains a positive potential
- T/F divalent cations are not absorbed as much (including Ca)
What is the MOA of both cyclosporine & tacrolimus?
Immunosuppressants:
- Bind to intracellular proteins called immunophilins (Cyclosporine = cyclophilins; Tacrolimus = FK-binding proteins (FKBP-12))
- These protein-drug complexes then interfere with intracellular signaling events that occur after T-lymphocyte receptor ligation
- T/F prevent T lymphocyte activation

Rx: Transplant recepients to prevent rejections
SE: nephrotoxicity
What is the MOA of Azathioprine?
Antimetabolite derivative of 6-mercapopurine
- Interferes with the metabolism & synthesis of nucleic acids
- Toxic to proliferating lymphocytes

Rx: immunosuppression for autoimmune disorders (e.g. glomerulonepritis, hemolytic anemia) or with kidney transplants
SE: Hyperglycemia
What is Abruptio placentae?
Premature separation of the placenta from the uterus (despite normal location of implantation) due to rupture of defective maternal vessels in the decidua basalis
- Risk factors: hypertension, cocaine use, short umbilical cord, trama, cigarette smoking, uterine fiboids, advanced age, sudden uterine decompression, premature membrane rupture, bleeding diathesis
How does Abruptio placentae present?
Bleeding with uterine contractions
What is a concealed abruption (of the placenta)?
- An abruptio placentae that occurs near the center of the placenta
- Hematoma is hidden behind the placenta & there is no external bleeding
What is Placenta accretia?
An abnormally strong adherence of the placenta to uterine weall
- Placental villi attach directly to the myometrium due to a defect in the decidua basalis layer
How does Placenta accretia present & what are the risk factors??
- Incomplete separation of the placenta after delivery -> severe postpartum hemorrhage
- RF: placenta previa, prior cesarean, prior intrauterine manipulation or surgery
What is Placenta previa?
- When the placenta overlies the internal cervical os
- This condition is painless
What is the action of NA+K+ATPase pump inhibitors (like Digoxin) on vascular smooth muscle & the kidney?
1) SM: increase of intracellular [Na] = blocked Na+Ca2+ exchange & an increase in vascular resistance & Bp
2) Kidney: impairment of tubular Na resorption
What happens if a fetus in homozygous for an SOX9 mutation and the male gonade does not form testes?
The individual will have no Sertoli cells (no MIS & no 17b-estradiol) & no Leydig cells (no testosterone):
- female internal genitalia: persistence of the paramesonephric ducts b/c no mesonephric duct stimulation via testosterone & no MIS
- female external genitalia: no DHT production
What do plasma cells look like?
- Off-center nuclei
- Clock-face chromatin distribution
What are the clinical signs of epiglottis?
High fever
dysphagia
drooling
inspiratory stridor
respiratory distress

X-ray: thumbprint sign (epiglottis thickening & aryepiglotic folds

Cause: Hemophilus influenzae
What virus causes croup?
Parainfluenze

X-ray: steeple sign: narrowing of the upper trachea
What presents with an inspiratory stridor, seal-like barking cough, retractions, & coryza?
Parainfluenza virus = CROUP
What does RSV cause?
Bronchiolitis: gradually developing respiratory distress & paroxysmal wheezing
What is the formula for Clearance of Inulin (aka: GFR)?
Cl = (Urine inulin)(Urine volume) / (Plasma inulin)
What is the DOC for Entaerobius vermicularis infection
- Pinworm: transmitted in food contaminated with eggs -> intetinal infection & anal pruritus
- Dx: tape on anus to catch noctural worms
- DOC: mebendazole
What are Benznidazole & nifurtimox used to treat?
- Trypanosoma cruzi (Chaga's disease)
- South/Central America
What is ivermectin used to treat?
Onchocerca volvulus infection (causes River blindness)
What is Niridazole used to treat?
Dracunculus medinensis (causes skin ulceration & inflammation)
What is measure in the urease breath test?
- 13C-labeled CO2
- Px ingests 13C-labeled urea, which is hydrolyzed into 2 ammonia molecules & 1 CO2 by H. pylori
What is the DOC class for costochondritis or pericarditis?
NSAIDs
What are condyloma acuminata?
- Multiple, white, hyperkeratoic peduculated verrucase clusterd in the perianal region
- Caused by HPV type 6&11
What causes chancroid?
- Haemophilus ducreyi
- Painful genital ulcers
What 4 problems can HSV-1 cause?
- gingivostomatitis
- keratoconjunctivitis
- temporal lobe encephalitis
- herpes labialis
What does HSV-2 cause?
Herpes genitalis & neonatal herpes
- 1st lesion appears as ULCERS
What HPV causes genital flat warts & is associated with cervical dysplasia & carcinoma?
HPV types 16 & 18
In what age group are fibroids found?
- <40 years old & can regress after menopaus
- ~75% of these are asymptomatic
What is the function of vonWillebrand factor?
- It is a protein that binds platelets to the endothelium during clot formation
- Carries factor VIII
How do symptomatic vWD patients present?
- Easy bruising or bleeding
- Prolonged bleeding
- Menorrhagia (heavy menses)
What are the most common fungal causes of pneumonia?
Blastomyces
Coccidioides
Histoplasma
How is Crytococcus neoformans visualized?
India ink stain

Reservoir: pigeons
What conditions show Mallory bodies on histological exam of liver tissue?
Intracytoplasmic hyaline inclusions derived from cytokeratin intermediate filaments:
- Primary biliary cirrhosis
- Wilson's
- Chronic cholestatic syndromes
- Hepatocellular tumors
- Alcoholic Cirrhosis
How does Cocaine-induced hepatitis present?
Clinical: Acute subfulminant hepatitis

Histo: necrosis & microvesicular steatosis
What enzyme is deficient in Tay-Sachs & how does the disease present?
- Hexosaminidase A
- Loss of motor skills, increased startle reaction, macular pallor, CHERRY-RED spot on Macula
- Dx: quantify hexosamidase level in isolated WBCs from flood
- 1/25 carrier rate of this AR disease in Ashkenazi Jewish population
What does a deficiency in Arylsulfatase A result in?
Metachromatic leukodystrophy (AR):
- Central & peripheral demyelination
- Ataxia
- Dementia
What is the pathogenesis of Ehlers-Danlos syndrome?
- Reduced hydroxylysine in collagen
- T/F the content of collagen cross-links
- Results in decreased tensile strength of collagen
In what 2 syndromes is Wilms' Tumor a member?
- WAGR
- Beckwith-Wiedemann
List the components of the WAGR syndrome?
- Wilms' Tumor
- Aniridia (partial or complete lack of the iris)
- Genital anomalies (gonadal dysgenesis, hypospadias, crytochidism...)
- Mental Retardation
What are the typical findings in VHL (Von Hippel-Lindau) syndrome?
- hemangioblastomas (when in brain: primary brain tumor with foamy cells & high vascularity) in cerebellum/retina/medulla
- Increase in epo -> 2ndary polycythemia
- 59% of Px develop bilateral renal cell carcinoma
- Mean age of diagnosis = 29 years old (Very rare genetic disorder)
What 2 neurotransmitters does Monoamine oxidase (MAO) decrage?
Norepinephrine
Serotonin
What 4 diseases are associated with an imbalance of ACh & Dopamine?
Decreased Ach:
- Alzheimers
- Huntington's
Increased Dopamine:
- Schizophrenia
Decreased Dopamine:
- Parkinson's
Which T cells (type 1 or 2) are involved in a type IV hypersensitivity reaction?
Type 1 (Th1)
What type of T-helper cells (type 1 or 2) are involved in mediating an antibody response?
Type 2 (Th2)
What diagnostic test results indicated multiple sclerosis?
1) MRI: multiple white matter plaques
2) CSF: IgG oligoclonal bands

Rx: beta-interferon (from connective tissue fibroblasts)
What diseases is alpha-interferon used to treat?
- Hep B&C
- Kaposi's sarcoma
- Malignant melanoma
- Certain leukemias
What is y-interferon used to treat?
- Chronic graulomatous disease
- Produced by T lymphocytes & activated tumoricidal macrophages
What is interleukin-11 (aka oprelvekin) used to treat?
Thrombocytopenia: stimulates megakaryocyte & platelet growth
Why is Sildenafil contraindicated in patients taking nitrates?
Increased risk of priapism & hypotensive shock
- Phosphodiesterase inhibitiors promote higher levels of cGMP & smooth muscle relaxation
- Nitrates vasodilated by releasing nitric oxide in smooth muscle, which also raises cGMP levels
Why are ACE inhibitors and NSAIDs a bad idea for the kidney?
ACE = decreased efferent arteriolar tone & decreased glomerular capillary perfusion pressuer
NSAIDS = similar mechanism

Potential for ARF (due to ATN) if there is a drop in blood volume for any reason
What loops are used to treat congestive heart failure?
Loops like furosemide to treat the edema
What neuro exam finding indicates sensorineural hearing loss?
Equal bone and air conduction

Cause: acoustic neuroma (schwannoma) compressing CNVIII where it enters the internal auditory meatus
What neuro exam finding indicates a conductive hearing loss?
Bone is more effective than air conduction through the blocked ear canal (e.g. cerumen) or sclerosis of the ear ossicles or perforated membrane
What causes TTP (thrombocytopenic purpura)?
- Defect in ADAMTS 13, metalloprotease respoonsible for cleaving high-molecular-weight, large vonWillebrand factor multimers
- T/F platelets aggregate in the microcirculation & schistocytes are produced
- Rx: plasma exchange
What causes PNH (paroxysmal nocturnal hemoglobinuria)?
- Mutated PIG-A gene
- Abnormal synthesis of surface phospholipids that anchor inhibitors of complement activation on all cell lines (WBCs, RBCs, platelets)
- Deficiency of DAF (decay-accelerating factor) in the compliment cascade
What enzyme in heme synthesis can be inhibited by heavy metal poisoning?
Aminolevulinic acid dehydratase
- Elevated aminolevulinic acid & anemia
What is the action on heme synthesis in lead poisoning?
1) inhibition of aminolevulinic acid dehydratase
2) Denatures ferrochelatase
3) Denatures ribonuclease in RBCs (basophilic stippline due to ribosomes NOT breaking down)
What is the initial DOC for generalized anxiety disorder?
Benxodiazepines
What causes the bradykinesia in Parkinson's
There is excessive inhibition of the ventral lateral nucleus of the thalamus
- Loss of dopaminergic neurons in the substantia nigra leads to a lack of inhibition of the globus pallidus, which would lift the inhibition of the thalamus.

Rx: levadopa or ablation of the internal segment of the globus pallidus (pallidotomy) in refractory cases
What does a positive leukocyte esterase & nitrite on urine dipstick, + fever, indicate?
UTI
What structures are the remnants of the umbilical arteries?
Medical umbilical ligaments
What causes a urachal fistula?
When the allantois fails to regress; predisposes to a UTI
What embryological structure is the nucleus puposus a remnant of?
notochord
In what phase of the cell cycle does Bleomycin act?
G2: causes stand breaks in DNA via intercalation & free radical damage
In what phase of the cell cycle does Etoposide act?
late S & G2: inhibits topoisomerase II (normally this enzyme untangles chromosomes and separates replicated DNA strands as well as DNA repair)
What is the MOA of 5-Fluorouracil?
S-phase-specific antimetabolite:
- Inhibits thymidylate synthase
- T/F blocks the production of thymidine (no pyrimidines)
When are beta waves seen on EEG?
When someone is awake & concentrating
When are theta waves seen on an EEG?
- Stage 1 sleep: transition from awake to sleep
- 4-7 cycles per second
When are sleep spindles and K-complexes seen on EEG
- Stage 2 sleep: physiologic sleep
- 45% of sleep
What results in delta waves of EEG
- Stage 3 or deep sleep
- Slow waves that are < 3 Hz
- 12% of total sleep
What 2 sleep stages have been merged?
- 3 & 4 = N3
- 13% of total sleep
What problems occur in stage 4 (delta wave) sleep?
enuresis
sleepwalking
night terrors
What are the branches of the RCA in a "right-dominate" person?
SA nodal branch
Acute marginal artery
AV nodal branch
Posterior descending artery
What does the LAD artery (a branch of the left main coronary artery) supply?
- Anterior wall of both ventricles
- Anterior 2/3 of the interventricular septum
- AV bundle
In 80% of people, what artery supplies the AV node?
a branch of the RCA

20% = branch of the left main coronary artery
What arteries supply the RV?
2 branches of the RCA:
- Acute marginal
- Posterior descending
What organisms are most often associated with Guillain-Barre Syndrome (GBS)?
1) Campylobacter jejuni
2) Haemophilus influenzae
3) Cytomegalovirus
4) EBV
5) Mycoplasma pneumoniae
6) Varicella--zoster Virus
What is albuminocytologic dissociation?
CSF: increased protein concentration with normal cell count in the setting of normal glucose

- Indicates GBS (Guillain-Barre Syndrome)
What type of inheritance pattern does Leber's hereditary optic neuropathy have?
Mitochondrial:
- mother to child only, but not all children of an affected mother will be affected.
- Ratio of normal to abnormal mitochondria inherited will determine whether the disease manifests itself phenotypically.
What is familial hypophosphatemic rickets?
X-linked dominant bone disease:
- Defect in the resorption of phosphate by the proximal renal tubule
- Abnormal regulation of 25-(OH) vitamin D activation
What 2 lysosomal storage diseases are X-linked recessive (all others are autosomal recessive)?
1) Fabry's
2) Hunter's
What causes a child to present with anorexia, hyperirritability, altered sleep patterns, & decreased play?
LEAD poisoning
What are the 1st signs of lead poisoning? How do these symptoms then progress?
LEAD-induced porphyria:
1) Loss of developmental milestones (esp. speech), abdominal complains (intermittent vomiting, pain, & constipation)
2) Ataxia, altered state of consciousness, coma, seizures, encephalopathy
3) Permanent consequences: learning & cognitive deficits, aggressive behavior
From a clinical perspective, what 3 substances do lysosomes contain that are deficient in certain genetic diseases?
Enzymes for destruction of:
1) Cellular Mucopolysaccharides
2) Sphingolipids
3) Mucopolysaccharides

Lack of these enzymes: lysosomal storage diseases
How do Gaucher's patients present?
beta-glucocerebrosidase lacking (AR):
1) Organomegaly (esp. spleen & reticuloendothelial organs)
2) Bone pain, Anemia, Thrombocytopenia (bone marrow infiltration)
3) fatigue

Dx: Radiograph changes: 50% have abnormal cortex of distal femur = "Erlenmeyer flask"
What is the mechanism of acetaminophen toxicity?
Glutathione stores are depleted & toxic metabolites accumulate in the liver
What does a patient deficient in Glucose-6-phosphatase (final step in bluconeogenesis to produce glucose from glucose-6-phosphate) have?
vonGierke's disease
- Abnormal accumulation of glycogen within liver cells
What does a young child with decreased eye contact, increased startle, macrocephaly, seizures, ataxia, & cherry-red spots on the macula have?
Tay-Sachs: deficiency of hexosaminidase A & subsequent accumulation of ganglioside within cells
What type of virus is EBV?
Herpes: double-straded, linear, DNA genome
What viruses have double-stranded, circular DNA?
Papillomaviruses
Polyomaviruses
What type of genome do the following viruses have?
Picornaviruses
Calciviruses
Flaviviruses
Togaviruses
Coronaviruses
Retroviruses
Single-stranded (+), linear, RNA
What 4 virus families are single-stranded (-), linear RNA?
1) Orthomyxoviruses
2) Paramyxoviruses
3) Rhabdoviruses
4) Filviruses
What viral families have single-stranded, circular RNA?
Arenaviruses
Bunyaviruses
Deltaviruses
What causes a newborn to present 2-7 days after birth with GI, intracranial, umbilical, mucosal, circumcisional, &/or cutaneous bleeding?
Hemorrhagic disease of the newborn caused by vitamin K deficiency

Lab: elevated PT & PTT with normal platelet count & bleeding time
What is the hallmark of hemophilia?
Spontaneous hemarthrosis (bleeding into joints) caused by
- Deficiency of factor VIII (hemophilia A) or factor IX (hemophilia B)
What are 2 qualitative platelet disorders that present with petechiae & purpura shortly after birth?
- Bernard-Soulier
- Glanzmann's throbasthenia
What do Pheochromacytomas produce?
Norepinephrine & Epinephrine
- These are tumors of neural crest-derived tissue

Rx: alpha-blockage (DOC: phenoxybenzamine, long-lasting, noncompetitive, irreversible alpha-blockers)
What testicular cells secrete mullerian-inhibiting factor, & thus causes mullerian ducts to regress?
Sertori cells
Where are Leydig cells located?
in the interstitial spaces between the seminiferous tubules?
What viral infection presents after a fever with a facial rash (bright red, blanchable, on the cheeks with perioral pallor) followed by a diffuse trunk & extremities rash that waxes and wanes with temperature over 3 weeks
Parvovirus B19 (5th disease)

Rx: nothing, self-limiting
What is the triad for Meigs' syndrome?
1) Benign ovarian tumor (fibroma)
2) Ascites: hypoactive bowel sounds & some abdominal guarding on deep palpation, fluid wave
3) hydrothorax (pleural effusion): decreased breath sounds
What is another name for a benign cystic teratoma of the ovary?
dermoid cyst (3 germ cell layers)
What is a Struma ovarii?
A teratoma in which thyroid tissue has overgrown
- presents with symptoms of hyperthyroidism
What is the 1st line treatment for pyoderma gangrenosum (PG)?
Extraintestinal manifestations of IBD (inflammatory bowel disease)
- Rx: Oral corticosteroids
What is the DOC to treat cellulitis?
Ampicillin (beta-lactam antibiotic)
What type of drug is Bacitracin?
Topical antibiotic: prevents isoprenyl dephosphorylation & t/f bacterial wall synthesis
What are the stage 1 & stage 2 symptoms of Reye's syndrome of aspirin tox?
1) vomiting, confusion, lethargy
2) stupor, hyperventilation, microvesicular fatty liver
What causes type 1 dyslipidemia?
Deficiency of lipoprotein lipase (in capillary walls of adipose & muscle tissues)
- Normally this enzyme cleaves triglycerides into free fatty acids & glycerol
- No activation of this enzyme by VLDL cholesterol (apolipoprotein C-II) or chylomicrons
What results from an apolipoprotein E receptor deficiency?
dysbetalipoproteinemia: VLDL cholesterol remnants are not removed from the circulation:
- Elevated VLDL cholesterol, triglyceride, & cholesterol
- Xanthomas
What is familiarl hyperbetalipoproteinemia?
Type II hyperlipidemia (LDL cholesterol receptor dysfunction):
- Elevated plasma LDL & t/f increased in plasma cholesterol
What results in extremely high triglyceride levels & visibly foamy plasma?
Type V: mixed hypertriglyceridemia
- Elevated VLDL cholesterol levels
How does bronchiectasis present on CT?
1) "tram track" appearance of bronchi
2) Enlarged bronchiole with thickened wall
3) "Signet-ring" sign: diameter of the airway lumen greater than adjacent vessel

Clinical: large amounts of purulent sputeum due to repeated infection
How does TB present on CT?
1) Primary: Ghon complex = hilar lymph nodes & subpleural parenchymal lesion
2) Secondary: lesions in the apical or posterior segments of the upper lobe +/- cavitary lesion
How does pneumonia present on CT?
1) Diffuse opacities of the lung parenchyma
2) Dense consolidations
3) Ground glass opacities
What causes Meckel's diverticulum?
A persistence of part of the omphalomesenteric duct (vitelline duct or yok stalk)

Dx: 99mTc pertechnetate radionuclide imaging b/c the diverticulum can contain gastric or pancreatic tissue & it will absorb this dye.
What differs in presentation between an infant with intussusception & Meckel's diverticulum?
Meckel's = mild (blood in stool, & mild tenderness)

Intussusception = abrupt & severe presentation (paroxysmal bouts of screaming, vomiting, diarrhea, & bloody bowel movements w/in 24 hours of onset)
What is the term for abnormal or incomplete rotation of the intestine?
volvulus = twisting of loops of bowel

Presentation: bile-containing vomit or bowel obstruction
What does PT measure? PTT?
PTT: VIII, IX, XI, XII
PT: VII

Both: X, V, prothrombin, & fibriniogen
What are the most common paraneoplastic syndromes of a thymoma?
1) MG = myasthenia gravis
2) pure RBC aplasia
3) Hypogammaglobulinemia
What 5HT(1B/1D) receptor agnoist is used to treat acute migraine & cluster headaches?
Sumatriptan: MOA = vasoconstriction of cerebral & meningeal vessels

SE: (rare) coronary vasoconstriction
What 5HT3 receptor antagonist is used to treat the nausea & vomiting associated with chemo?
Ondansetron
How does exercise cause an increase in SV? Is there an increase in EDV or ESV?
- Exercise increases preload (EDV)
- So,ESV is decreased to increase the cardiac ejection fraction (EDV-ESV)
What are the clinical signs of Eisenmenger's syndrome?
- Late cyonosis (reversal of initial LtoR shunt)
- Polycythemia
- Clubbing
- Pulmonary regurgitation (sometimes)
- Holosystolic murmur
What causes a self-limited localized infection consisting of nonerythematous, pearly, dome-shaped papules on the skin of children or immunosuppressed patients?
Molluscum contagiosum (a poxvirus)
What is the appearance of Papillomavirus warts?
Either: flat, raised or resemble a cauliflower
What happens when a polyomavirus is reactivated?
Progressive multifocal leukoencephalopathy (in immunosuppressed patients)
How does Cushing's result in proximal limb weakness?
Selective atrophy of fast-twitch (type 2) myofibers
What is the only adrenergic receptor that acts through a Gq mechanism (& increased DAG/IP3/Ca2+)
Alpha-1
What type of drug is Fenaldopam?
direct sympathomimetic, selective D1-agonist
What is the MOA of Fenoldopam?
"one FELLOW of DOPAMine fires the D1-receptor"

Gs -> increased cAMP -> PKA -> MLCK-Pi -> smooth muscle relaxation

Vasodilation:
- Renal, mesenteric, & coronary vascular beds
- decreases arterial Bp
- reflex sympathetic activation
What are the 2 clinical uses of Fenoldopam?
1) Hypertensive emergencies = IV, short-term Tx
2) Postoperative hypertension
What are the major side effects of Fenoldopam?
The FELLOW has FAITH in D1-receptors:
1) Flushing
2) Angina (rare)
3) Increased IOP (FENOLdopam may FILL the eye)
4) Tachycardia (reflex)
5) Hypotension/Headache
What drugs are used in hypertensive emergencies?
NFL ENAbled for a fast touchdown:
1) Nitroprusside & Nitroglycerin (NO providers)
2) Nicardipine (CCB)
3) Fenoldopam (D1-agonist)
4) Labetalol (apha-1, B-agonist)
5) ENAlaprilat (ACE inhibitor)
What sympatholytic drug is a synthesis inhibitor?
Metyrosine
What sympatholytic drug is a false trasmitter?
Guanadrel
Guanethidine
What sympatholytic drug is a storage blocker?
Reserpine
What sympatholytic drug is a release inhibitor?
Guanethidine
What sympatholytic drugs are selective alpha-2 agonists?
Clonidine
alpha-Methyldopa
Guanabenz
Guanfacine
Apraclonine
Brimonidine
What sympatholytic drug is a selective alpha-1 blocker?
- azosin

Prazosine, Doxzaosin, Terazosin

- osin

Tamsulosin
What sympatholytic drug is a nonselective alpha blocker?
Phen__amine:
Phentolamine
Phenoxybenzamine
What sympatholytic drug is a selective beta-blocker?
A-M + olol: (A BEAM)
1) Acebutolol (also has intrinsic sympathomimetic activity)
2) Atenolol
3) Betaxolol
4) Bisoprolol
5) Esmolol
6) Metoprolol
What sympatholytic drug is a nonselective beta-blocker?
M-Z + olol:
1) Nadolol
2) Propranolol
3) Penbutolol (also has intrinsic sympathomimetic activity)
4) Pindolol (also has intrinsic sympathomimetic activity)
5) Timolol
What sympatholytic drug is a mixed alpha1, beta blocker??
1) Labetalol (also has intrinsic sympathomimetic activity)
2) Carvedilol
What type of drug is reserpine?
indirect sympatholytic, storage blocker
What is the MOA of Reserpine?
this SERPENT lets CA RESERve PINE away by blocking vesicular uptake pumps:

CA depletion:
- irreversibly inhibits Mg2+, ATP-dependent CA uptake pumps on storage vesicles, then MAO breaks down extravesicular CA
- depletes CA store in central/peripheral nerve terminals & in the Adrenal Medulla

- Lowers Bp: decreased CO & PVR
- Striatum: Dopamine depletion suppresses extrapyramidal motor activity
What are the 2 clinical uses of Reserpine?
1) Hypertension (3rd line choice for mild/moderate cases)
2) Huntington's (relieves dyskinesia)
What are the major side effects of Reserpine?
Such a RESERVE depletion makes me 2SAD:

CNS: Sedation, pArkinsonism, Depression

GI: Secretion of gastric acid, Abdominal pain, Diarrhea
What type of drug is Clonidine?
Indirect sympatholytic, selective alpha2 agonist
What is the MOA of Clonidine?
this CLOWN's CLONe ID is INE: Inhibiting NE exocytosis by igniting presynaptic alpha2-receptor

Gi -> decrease in cAMP -> decrease PKA -> decrease Ca2+ influx

Central depressor: decreases CO & PVR to lower Bp (DOES NOT reduced renal blood flood), initially vasoconstriction due to possynaptic alpha2 activation

Reduces GI motility / Increases fluid absorption / decreases secretion
What are the 4 clinical uses of Clonidine?
the CLOWN needs to HOLD the lighter:
1) Hypertension (2nd choice) & hot flashes (due to menopause)
2) Opiod & Alcohol withdrawal
3) Loss of behavioral control (ADHD)
4) Diabetic Diarrhea due to sympathetic neuropathy
What are the major side effects of Clonidine?
SAD:
Sedation
Allergic dermatitis
Dry mouth & Depression

WITHDRAWEL syndrome: hypertensive crisis
What drug name ending indicates a selective alpha2 agnoists
-onidine:

Clonidine
Apraclonidine
Brimonidine
What selective alpha2 agonists are used to treat open-angle glaucoma?
Apraclonidine & Brimonidine
What selective alpha2 agonist is used as a central acting skeletal muscle relaxant?
Tizanidine
What drugs are preferred for treating hypertension in pregnancy?
About the ABC of Water. Yes, the fetus needs water to survive:
- Alpha-methyldopa (methyldopa for materal use!)
- Beta blockers, especially labetalol
- CCBs
- Hydralazine (IV for eclampsia)
What drugs are contraindicated for treating hypertension in pregnancy?
Can't be ADded due to the risk of endangering fetus by losing water:
ACEIs (fetopathy risk)
ARBS (fetopathy risk)
Diuretics (use with caution)
What type of drug is Pazosin?
adrenergic blocker, selective alpha1 blocker
What is the MOA of Prazosin?
PRessured Alpha 1 ZOne Selectively INcised:
- Vasodilation (blocks Gq -> decreased IP3/Ca2+) in veins & arterioles. NO significant sympathetic activation
- Urinary sm. relaxation @ base of the bladder, prostate, & urethra
- Reduces plasma lipids
What are the 2 clinical uses of Prazosin?
1) Hypertension (2nd choice or 1st if patient has BPH)
2) BPH: symptomatic relief
What are the major side effects of Prazosin?
prazoSIN:
- Syncopy (1st dose) due to marked orthostatic hypotension
- Increased retention of Na & H2O
- Nonspecific dizziness & headache
What drug ending indicates a selective alpha1 blocker?
-azosin:
Prazosin
Deoxazosin
Terazosin

-uz(l)osin: BPH drugs (Urinary alpha1 ZOne Selectively Incised
Alfuzosin
Tamsulosin
What is the clinical use of AlfUzosin?
BPH: preferentially acts on the lower Urinary tract, Alpha1 blocker
What is the clinical use of TamsUlosin?
BPH

"FLow of urine will reach its MAX once TAM (Tight, Alpha1A dominat Muscle in the lower UI) is SO LOOSe IN tone"
- blocks alpha1A receptors in the prostate
- SE: Ejaculation disorders
What type of drug are Pentolamine & phenoxybenzamine?
bleh
Are hyperuricemia kidney stones radiolucent or radio-opaque?
Radiolucent: not seen on X-ray
Are struvite calculi (ammonium, magnesium, & phosphate) radiolucent or radiopaque?
80% radiopaque

Cause: Proteus vulgaris or Staphylococcus saprophyticus
Where is lactate dehydrogenase located within the cell?
Cytoplasm
What are the main functions of rough endoplasmic reticulum?
- Synthesis of secretory proteins
- N-linked oligosaccharide addition to proteins
What amino acids are modified in the Golgi?
1) Asparagine: N-oligosaccharide modification
2) Serine & Threonine: addition of O-oligosaccharides
What can happen to sugars, proteins, & lysosomal proteins in the golgi?
1) Sulfonation of sugars in proteoglycans & tyrosine residues on proteins
2) Addition of mannose-6-phosphate to specific lysosomal proteins to target them to the lysosome
Which develops quickly, vitamen B12 or folate deficiency?
Folate: deficient intake (diet), increased need (e.g. pregnancy), or impaired use (antimetabolate drugs)
Why do vitamin B12 & folate deficiency cause megaloblastic anemia?
DNA synthesis is impaired & with fewer cell divisions & more cytoplasm is present = increase MCV & hypersegmented neutrophils
What causes hypochromic, microcytic RBCs?
iron deficient anemia: low MCV
+ low serum iron & ferritin & high TIBC
What type of molecule is "ras"?
G protein that cycle between 2 conformations:
1) Activated ras-GTP
2) Inactivated ras-GDP

Mutation = oncogenic GTP binding with a loss of GTPase activity ( = permanently turned on)
What type of molecules are the oncogenes "erb" & "HER2"?
Epidermal growth factor receptor encoding genes
What type of proto-oncogene is "abl"?
Tyrosine kinase activity.
- In CML, is translocated from Ch. 9 to 22 & fuses with bcr
What type of molecule is "myc"?
Protein transcriptional activator that binds DNA & activates many growth-related genes
What is the progression of CMV retinitis (usually only found in AIDS patients)?
1) Rapidly diminishing sight (loss of central vision with floaters & blind sptos)
2) Funduscopic exam: cotton-wool exudates -> necrotizing retinitis -> perivascular hemorrhages -> (lastly) retinal detachment

Rx: ganciclovir & foscarnet
What is the mechanism of the cherry0red spot on the macula in Tay-Sachs & Niemann-Pick disease?
1) Ganglion cells filled with gangliosides (Tay-Sachs) or spingolipids (Niemann-Pick) are located outside the fovea & block the orange-red color of the choroid
2) Absence of ganglion cells within the fovea allow the choroid's normal color to be seen in this area (CHERRY-RED)
How do microaneurysms show up on fundoscopic examination?
- Tiny, round, red spots arougd the macular area
- Cause: diabetic retinopathy
Why does diabetic retinopathy result in neovascularization?
Abnormal proliferation is due to impaired autoregulation of retinal blood flow
What is papilledema?
Edema of the optic disc (often due to increased intracranial pressure)
What shunts blood from the left pulmonary artery to the aorta?
Ductus arteriosus: allows blood to avoid the high-resistance lungs & deliver more O2 blood to the rest of the body
What are the 2 most common cause of a failed closure of the ductus arteriosus?
1) Prematurity
2) Maternal rubella infection during pregnancy

Rx: indomethacin (blocks PGE1 & can be used to close a PDA)
What is the most common cause of Conn's Syndrome?
Adrenal adenoma: increased aldosterone

Histo: lipid-laden clear cells in a well-circumscribed adenoma
What is the drainage of the adrenal glands?
- RIGHT: right adrenal vein into the IVC
- LEFT: left adreanl vein into the right adrenal vein into the IVC
What are "B symptoms"?
Night sweats, fever, & weight loss

Hodgkin's lymphoma symptoms with enlarged mediastinal lymphadenopathy
- 50% of patients have EBV
What is 1st line treatment for prostatitis & UTI?
TMP-SMX: inhibits dihydrofolate reductase (TMP) & dihydropteroate synthases (SMX)

2nd choice: fluroquinolones
What does a midshaft fracture of the humerus cause injury to?
Radial groove structures: radial nerve & deep brachial artery
- "Great Extensor Nerve": wrist drop (inability to extend wrist & matacarpophalangeal joints of all digits)
What are the liver enzyme levels in alcoholic hepatitis?
AST:ALT ratio >1.5 & normal alkaline phosphatase
What is bacterial TRANSFORMATION?
Gene TRANSFER resulting from the uptake of DNA from a doner, often when a bacteria dies & surviving bac pick up the residual DNA.
What is bacterial CONJUGATION?
Gene transfer from a donor to a recipient by direct PHYSICAL contact between cells
What is bacterial TRANSDUCTION?
Gene TRANSFER from a donor to a recipient by way of a bacteriophage
What are "transposable elements"?
Segments of DNA that are able to move from 1 location to another
What is the Lab Value hallmark of PCOS?
LH hypersecretion:
- Obesity
- Hirsutism
- Oligo or amenorrhea
- Acanthosis nigricans (velvety hyperpigmentation)

- Hyperglycemia, hyperlipidemia, insulin resistance
Why do Mg levels rise with renal failure?
The only regulatory method of Mg is through renal exretion

Mg levels of 2-4 mEq/L = vomiting, nausea, lightheadedness

Mg levels greater than 4 = depressed consciousness, respiratory depression & cardiac arrest
What are negatively birefringent crystals?
- yellow & parallel
- monosodium urate

In aspirated joint fluid of a patient with gout
What are symptoms of Reye's syndrome?
Abrupt onset of nausea & vomiting
Followed by encephalopathy & jaundice

Cause: fatty infiltration of liver b/c of impaired mitochondrial metabolism of fatty acids due to ASPRIN administration to a CHILD
How is Dubin-Johnson syndrome characterized?
AR: defective hepatobiliary transport of certain organic anions
- Conjugated hyperbilirubinemia
- BENIGN
What H2-blocker is associated with antiandrogenic effects? Which is NOT?
Cimetidine: gynecomastia & impotence
Ranitidine: no such SE
Which antacid can buffer gastric acid?
Magnesium oxide
What 3 conditions can Omeprazole be used to treat?
PPI:
- GERD
- Zollinger-Ellison syndrome
- Peptic Ulcer disease
What are the 2 problems that Spironolactone is used to treat?
MOA: aldosterone receptor antagonist
- Hyperaldosteronism
- Edematous states (heart/liver/kidney failure)
What fractional excretion of Na indicates intrarenal renal failure?
Between 2 & 4%
What 3 drug classes are associated with allergic reactions?
1) Penicillins (esp: Methicillin & Nafcillin)
2) Cephalosporins
3) Sulfonamides

S/S: fever, rash, eosinophilia
What is the pathological process of interstitial nephritis?
Allergic/Infective/Immunological disorder: inflammatory process that results in infiltration of the interstitum of the kidney with polymorphonuclear leukocytes & lymphocytes
What drug directly inhibits testosterone biosynthesis?
Ketoconzaole (antifungal)
What are the main causes of aplastic anemia?
1) Carbamazepine (antiseizure drug)
2) EBV, HEP C, Parvovirus B19
3) Toxins (benzene & insecticides)
4) Cancer chemotherapeutics

Hypocellular bone marow W/O abnormal cells
What are the 3 causes of Eisenmenger's syndrome?
VSD
ASD
PDA

S/S: late cyanosis & digital clubbing after the L to R shunt shifts to R to L & becomes cyanotic
How do steroids block the production of cytokines?
Inactivate NF-kB, a transcription factor that induces proinflammatory cytokine production
What does Cromyolyn do?
Mass cell mediator release inhibitor

Rx: asthma prophylaxis
What causes hyperlipidemia in nephrotic syndrome?
Hepatic overproduction of lipids + a defect in lipoprotein lipase
What are the different defects that cause the familial dyslipidemias (I, III, IIa, IV, V)?
I: lipoprotein lipase defect
III: altered lipoprotein E
IIa: decrease in LDL receptors
IV: hepatic overproduction of VLDL
V: increased heaptic production & decreased clearance of VLDL
What is the main reservoir of Borrelia burgdorferi?
White-footed mouse
Which diuretic groups act on the luminal surface by inhibiting transporters, which do not?
1) Thiazides, Loops, K-sparing all act on the luminal surface
2) Carbonic anhydrase inhibitors inhibit a cytoplasmic enzyme
3) Spironolactone inhibitis steroid receptor function
What are the S/S of intussusception?
1) Vomiting (due to partial obstruction)
2) Bloody diarrhea
3) Hyperactive bowel sounds
4) Palpable mass (usually at the ileocecal junction)
What is the histology of polymyositis?
An infiltrate of CD8+ T-lymphocytes & macrophages surround & destroy healthy muscle fibers
- SPARES the extraocular & facial expression muscles
- Progressive symmetric muscle weakness that is often subacute
What 3 diseases are associated with HLA-DR4?
1) Rheumatoid arthritis
2) Diabetes mellitus
3) SLE
What 2 diseases are associated with HLA-B8?
Celiac disease
Dermatitis herpetiformis
What disease is associated with HLA-BW22?
Kawasaki's
What 3 diseases are associated with HLA-DR3?
Chronic active hepatitis
Sjogren's syndrome
Type 1 diabetes mellitus
What ECG picture is a sign of Digoxin toxicity?
Severe bradycardia (36 bpm) with complete heart block
- Often precipitated by an increase in FUROSEMIDE (increases K-secretion & thus, this hypokalemic state potentiates the effects of digoxin)

Rx: Digoxin immune FAB
In what type of heart problem can Adenosine be used?
Re-entrant supraventricular tachycardia: binds to A1 receptors & induces a heart block within the AV node
What type of arrhythmia is Amiodarone used to manage?
- Recurrent ventricular fibrillation
- Hemodynamically-unstale ventricular tachycardia
What 4 types of arrhythmia is cardioversion used to treat?
- Atrial flutter
- Atrial fib
- Ventricular tachycardia
- Ventricular fib
How is Osteoarthritis characterized?
- Loss of cartilage elasticity
- Eburnation: polished ivory-like appearance of bone
- Cystic changes in the subchondral bone
- Osteophyte formation at the perimeter of the articular surface
What disease can present with Heberden's or Bouchard's nodes?
Osteoarthritis:
- Heberden's: osteophytes @ the distal interphalangeal joints
- Bouchard's: ostephytes @ the proximal interphalageal joints
What are the possible causes of microcytic anemia?
1) Iron deficiency: decreased intake or increased loss through bleeding
2) Chronic inflammatory disease (e.g. rheumatoid arthritis)
3) Thalassemia
4) Sideroblastic anemia
What are the possible causes of normocytic anemia?
1) Acute blood loss
2) Aplastic anemia
3) Chronic renal failure
4) Hemolytic anemia
5) Hereditary spherocytosis
6) Sickle cell anemia
7) G6PD deficiency
8) Paroxysmal nocturnal hemoglobinuria
What are the 3 possible causes of macrocytic anemia?
1) Vitamin B12 deficiency
2) Folate deficiency
3) Pernicious anemia
What are the 5 actions of PTH?
1) Increases Ca absorption in the small intestine
2) Promoting Ca reabsorption in the renal tubules
3) INHIBITING phosphate reabsorption in the reanl tubules
4) Inhibiting further PTH release (negative feedback)
5) Stimulating 1,25-dihydroxyvitamin D
What are the 3 causes of microcytic, hypochromic RBCs (anemias)?
- Iron-deficiency anemia
- Thalassemias
- Lead poisoning
What are the lab values for anemia of chronic disease?
Decreased serum iron
Decreased TIBC
Normal % saturation
What lab values indicated hemosiderosis?
Increased serum iron
Normal TIBC
Increased % saturation
What is the radiographic picture of Pneumocystis jiroveci pneumonia?
- Ground Glass = Diffuse Bilateral infiltrates
- Absence of air bronchograms
- No obliteration of the pulmonary vessels
What is the radiographic picture of Mycoplasma pneumoiae infection?
Peribronchial pneumonia pattern with STREAKS of infiltrates
What is the radiographic picture of Staphlococcus aureus pneumonia (rare)?
Cavitations &/or abscesses within the lung fields
What is the radiographic picture of Streptococcus pneumoniae infection?
Lobar consolidation
What is seen in pathologica preparations of herpes zoster skin rashes?
Cowdry A inclusion bodies: eosinophilic inclusions surrounded by a clear halo
What are Auer rods?
Rod-shaped bodies in myeloid cells = fused lysosomes
- found in APL (acute, promyelocytic leukemia; M3)
What are Call-Exner bodies?
Spaces between granulosa cells in ovarian follicles & in granulosa cell tumors
How does hereditary spherocytosis result in anemia?
Shortened life span & increased destruction of unstable RBCs:
- Disease results in decreased elastic deformability of RBC cell membranes
What cells maintain the BBB?
Astrocytes
What cells produce CSF?
ependymal cells that line the ventricles
What 3 conditions must be met to diagnose delirium?
1) Acute & usually fluctuating (hours to days) disturbance of consciousness (reduced ability to focus, sutain, or shift attention)
2) A change in cognition (e.g. memory disturbance, hallucination, or other perceptual disturbances)
3) Evidence of a direct physiologic cause (e.g. infection)
How is a brief psychotic disorder characterized?
1) One of the following: hallucinations, delusions, disorganized speech or grossly disorganized behavior
2) Duration: lasts @ least 1 day, but less than a month
3) Patient returns to full functionality
4) State NOT attributable to a general medial condition or other psychiatric disorder
What is necessary for a diagnosis of delusional disorder?
1) Nonbizarre delusions (i.e. plausibel situations in reality), which are not attributable to another psychiatric disorder
2) Duration: @ least 1 month
3) Does NOT markedly impair the person's life: ramifications are limited to the delusional content
How is dementia characterized?
Chronic condition of cognitive decline with an INTACT level of consciousness
What are the acute phase symptoms of schizophrenia?
@ least 2 of the following for a 1-month period:
1) Delusions
2) Hallucinations
3) Disorganized speech
4) Grossly disorganized or catatonic behavior

& Negative symptoms: flat affect, lack of motivation, or poverty of speech
What are the major toxins associated with TCC of the bladder?
"associated problems in your Pee SAC":
- Phenacetin (painkiller)
- Smoking
- Aniline dyes
- Cyclophosphamide

S/S: painless hematuria (post 40 age patient)
How are bile ductules identified histologically?
Lined by simple cuboidal epithelium & each luminal cell has a single centrally-located nucleus
What does the portal vein carry?
Blood from the alimentary canal, spleen, & pancreas to hepatic cells
How does surfactant reduce surface tension?
Disrupts intermolecular forces (hydrogen bonds) between molecules of water
What is the MOA of Lidocaine as an anesthetic?
Blocks Na channels on neuronal membranes to reduce sensory impulse conduction from the periphery to the CNS
- Nerve Sensitivity:
1) small > large
2) myelinated > unmyelinated
What causes atypical pneumonia in those recently exposed to a bird?
Chylamydia psittaci (intracellular parasite w/o cell wall)

Rx: 10-day course of doxycycline or tetracycline
How does HSV move in the peripheral nervous system?
Retrograde axonal transport to the neuronal cell body to remain latent in the dorsal root ganglia
What is the treatment for Wilms' tumor?
MOPP regimen:
Mechlorethamine
Oncovin (vincristine = neurotoxic)
Procarbazine
Prednisone
What 2 chemotherapeutic agents can cause pulmonary fibrosis?
- Busulfan (CML Rx)
- Bleomycin (testicular cancer & lymphoma Rx)
What are the FEV1 & FVC values for an interstital lung disease?
FEV1 & FVC are both reduced & the ratio between the 2 remains the same
Where does pain occur in intermittent obstruction of the gall bladder?
referred pain near the right scapula & pain after eating (due to gallbladder contraction)
Where do Naegleri fowleri live?
In fresh water
What causes secondary Achalasia?
Chagas' diseases (T. cruzi): destruction of the myenteric plexus of the esophagus
- Dx: bird's beak on barium swallow (proximal constriction of the esophagus)
Where is ADH (vasopressin) & oxytocin synthesized
ADH (aquaporins): supraoptic nuclei of the hypothalamus

Oxytocin (milk "let down"): paraventricular nuclei of the hypothalamus
What hormone stimulates spermatogenesis?
FSH from the anterior pituitary gland
What is the most common cause of vaginal discharge worldwide?
Trichomonas (motile, flagellated parasite) -> symptomatic vaginitis

Rx: Metronidazole
Does Candida vaginitis present with a discharge?
Yes, white & odorless

Rx: Fluconazole
Which of the following are radiopaque? Calcium, Ammonium, Magnesium, NaCl, Uric Acid
Calcium
Besides generalized decrease in bone mass (osteopenia), what other abnormalities is Osteogenesis associated with?
- Blue Sclerae
- Dental abnormalities
- Progressive hearing loss
What is chondrodysplasia?
A group of inherited skeletal disorders characterized by defects in type II collagen
What is achondroplasia?
AD dwarfism:
- Mutation in the fibroblast growth factor receptor 3 gene
- Short limbs with normal trunk & skull size
- IF they have a narrow foramen magnum, this can impinge on the brain stem & cause neurologic dysfunction or death
Along what nerve do baroreceptors from the carotid sinus send signals to the medulla regarding vaso-tension?
blossopharyngeal
Which bareoreceptor (in the carotid sinur or aortic arch) only responds to an INCREASE in Bp?
Aortic arch
Why is Alendronate a DOC to treat multiple myeloma?
It is an ornal bisphosphonate:
- Lowers serum Ca2+
- Helps to decrease pain & fractures by inhibiting bone resorption through the reduction of the # & activity of osteoclasts
What type of diuretics should be avoided in a patient with multiple myeloma?
Thiazides: worsen hypercalcemia by increasing reaborption of Ca2+
What common GI problem makes a patient a bad candidate for bisphosphonates like Alendronate?
GERD: bisphosphonates can cause erosions of the esophagus
Which interlukin is secreted by helper T lymphocytes that stimulates the growth of helper & cytotoxic (CD8) T lymphocytes to fight VIRAL infections?
IL 2
What interleukin is secreted by activated T lymphocytes & functions similarly to granulocyte macrophage colony-stimulating factor?
IL3
What interleukin is secreted by helper T lymphocytes and promotes the growth of B lymphocytes to fight bacterial infections?
IL4
What interleukin is a major chemotactic factor for neutrophils?
IL8
What is the Schilling test?
An infusion of exogenous Intrinsic factor (usually produced by gastric parietal cells) that will enable vitamin B12 absorption and then radiolabelled B12 will be found in the urine:
- Confirms a diagnosis of pernicious anemia
Where is B12 absorbed?
Terminal ileum (in the presence of intrinsic factor)
What are the S/S of tuberous sclerosis (TS)?
- Sagreen patch: rough, raised lesions that has the consistency of an organg peel (in the lumbosacral area)
- Seizures
- CT/MRI showing TUBERS (calcified hamartomas in the periventricular region = nodular proliferation of multinucleated atypical astrocytes)
- Adenoma sebaceum: facial angiofibromas
What is characterized by small, firm, umbilicated, skin-colored, pearly-white papules?
Contangious molluscum contagiosus virus skin manifestation
What do cafe au lait macules look like?
Hyperpigmented, sharply=bordered, ovoid macules:
- >5mm pre-puberty & >15 mm post-puberty
- 6+ are needed to consider a diagnosis of NFT1
What are tender, violaceous, subcutaneous nodules of the palms & soles indicated of?
Osler's ndoes of bacterial endocarditis
What is thickened & hyperpigmented skin on the back of the neck & axillae?
Acanthosis nigricans: can be found in patients with diabetes, obesity, & GI malignancies
What is the typical profile of a patient that suffers from Prizmetal's (variant) angina?
- Patient is young
- Pain is NOT prompted by activity
- Pain relieved by sublingual nitroglycerin
- Normal ECG

Cause: coronary vasospasm
What is Budd-Chiari syndrome (BCS)?
Nearly complete obstruction to the blood flow by an acute clot in the hepatic veins or the IVC

Predisposing disorders:
- Hematologic (polycytemia veria, essential thrombocytosis)
- Thrombotic diatheses (antiphospholipid antibody syndrome, factor V Leiden)
- Pregnancy
- OC use
- Intra-abdominal neoplasms (hepatocellular carcinoma, renal cell)
What are predisposing disorders for Budd-Chiari?
Nearly complete obstruction to the blood flow by an acute clot in the hepatic veins or the IVC

Predisposing disorders:
- Hematologic (polycytemia veria, essential thrombocytosis)
- Thrombotic diatheses (antiphospholipid antibody syndrome, factor V Leiden)
- Pregnancy
- OC use
- Intra-abdominal neoplasms (hepatocellular carcinoma, renal cell)
What glut transporter allows glucose to enter pancreatic beta cells?
GLUT 2
What glut transporter allows glucose to enter RBCs & brain?
GLUT 1
What glut transporter allows glucose to enter adipose & skeletal muscle cells?
GLUT 4
What syndrome is associated with bilateral obliteration of the amygdala?
Kluver-Bucy syndrome: hyper (orality, sexuality, & disinhibited behavior)
What area of the brain shows a decreased number of neurons in Alzheimer's disease?
Nucleus basalis of Mynert
What is pica?
eating nonnutritive substances

- can indicated Lead poisoning
Describe the time bomb of acetaminophen tox?
- Initially: asymptomatic
- 1st 24 hrs: nausea, vomiting, & malaise
- 24-48 hrs: Right upper quadrant pain only
- Day 3-4: jaundice & hepatic failure
What is Asprin tox at low & high doses?
LOW: tinnitus, abdominal pain, vomiting, & tachypnea
HIGH: respiratory alkalosis, metabolic acidosis, hypotension, coma, & DEATH
What accidental overdose presents with hallucinations, dry mouth, flushing, urinary retension, & mydriasis?
Tricyclic antidepressants (excess anticholinergic activity)
What is the MOA of zileuton?
- Blocks the conversion of arachidonic acid to leukotrienes by inhibiting 5-lipoxygenase
- Rx: asthma
- SE: elevation of liver enzyme levels, sinusitis, nausea
What is asthma characterized by?
- Airway hyperresponsiveness
- Smooth muscel hypertrophy
- Mucous plugging
What chronic condition can prednisone induce?
- Steroid-induced diabetes
- Monitor blood glucose if the patient is on long-term therapy
What syndrome is associated with montelukast (Asthma med)?
Churg-Strauss (autoimmune vasculitis)
How does T1 radiculopathy present?
- Pain & numbness of the medial forearm
- Weakness to thumb flexion/abduction & finger abduction/adduction
How does C8 radiculopathy present?
- Pain & numbness of the medial forearm & hand (4th & 5th digits)
- Weakness to wrist extension & finger extension/abduction/adduction
How does C6 radiculopathy present?
- Pain & numbness of the lateral arm, forearm & hand (1st & 2nd digits)
- Weakness to shoulder abduction/external rotation & elbow flexion/supination
- Diminished biceps reflex
How does C5 radiculopathy present?
- Neck & shoulder pain
- Numbness of the skin on the lateral arm
- Weakness to shoulder abduction/external rotation & elbow flexion/supination
- Diminished biceps reflex
How does C7 radiculopathy present?
- Pain & numbness extending to the hand & index & middle finger
- Weakness to elbow & wrist extension
- Diminished triceps relex
Define relative risk.
- The incidence rate of some outcome in those exposed to a risk factor divided by the incidence rate of those not exposed
- RR = probability (exposed) / probability (control)
- for COHORT studies
What is the target organelle for chloramphenicol & erythromycin?
mitochondira: has 30S50S robosomal system (a reminent of its prokaryotic origin)
Which cells in the skin are already dead?
Keratinized epithelial cells (e.g. stratum corneum layer of the skin)
What are ribozymes?
RNA molecules with catalytic activity:
- bind target RNA & cleave the phosphodiester backbone @ specific cutting sites
What builds up in the urine when a patient has lead poisoning
Aminolevuline & coproporphrin III b/c of the inhibition of aminolevulinate dehydratase & ferrochelatase enzymes of the heme synthesis pathway
What builds up iwn 3-beta-hydroxysteroid dehydrogenase deficiency?
DHEA (Dehydroepiandrosterone) & pregnenolone due to this form of congenital adreanl hyperplasia
What builds up in the urine of patients with acute intermittent porphyria?
Porphobilinogen: due to a deficiency in urophorphyrinogen I synthases
What is found in the urine of patients with the most common porphyria?
Uroporhyrin due to a deficiency in uroporphyrinogen decarboxylase in patients with porphyria cutanea tarda
How do patients with AIP (acute intermittent porphyria) present?
- Hyponatremia & recurrent episode of abdominal pain
- RARELY: neuropsychiatric problems
- attacks can be precipitated with barbiturates & starvations diets
- NO Photoensitivity
What is Fanconi's Anemia?
AR: DNA repair is defective
- aplastic anemia & defective DNA
- increased risk of malignancy
What are the common symptoms of porphyria cutanea tarda?
- Cutaneous fragility of hands & forearms after SUN exposure
- Hypertrichosis
- Scleroderma-like plaques
- Redish urine (due to increased levels of uroporphyrin)
What is the most likely causitive organism in IV drug user osteomyelitis?
Candida albicans