6135075-USMLE-Pass-Program-Clue.pdf

Pass ProgramClues “You ain’t told me squat till you tell me the CLUE!!!” What are the 5 bacteria causing Heart Block? • Lyme Disease • Salmonella typhii (typhoid) • Chagas Disease (Whipple’s) • Legionella • Diptheria • Lets Stop Doing Long Contractions What bacteria cause Reiter’s Syndrome? • Shigella • IBD – Crohn’s • Chlamydia • Yersina • Reiter & Crohn Saw Yersina and got Chlamyia What are the Low Complement bugs causing Cryoglobuniemia? • Influenzae • Adenovirus • Mycoplasma • Hepatitis C • EBV • I AM HE What are the drugs induced SLE? • Hydralazine • INH • Phenytoin • Procainamide • Penicillamine • Ethosuximide • H I PPPE What are the drugs that Blast the BM? • AZT • Benzene • Chloramphenicol • Vinblastine • Vinblastine Anilate Bone Cells What are the Comma Shaped bugs? • Vibrio • Campylobacter • Listeria • H. pylori • Campylobacter Has Very Long Comma Genes What is the cresent shaped protozoa? • Giardia lamblia What bacteria looks like Chinese letters? • Corynebacter What are the TB Rx? • Rifampin • Pyrazinamide • INH • Ethambutanol • Streptomycin •R E S P I What are the 6 Low Complement assocs. with Nephrotic Syndrome? • Serum Sickness • PSGN • SLE • SBE • Cryoglobinemia • MPGN II What drugs Induce p450? • BAG 4 CPR QTS • Car Grabs Queens • Tets to Rev Up Alcoholic doing drugs and stinking up car • Barbiturates • Alcohol • Griseofulvin • Carbamazapine • Rifampin • Quinidine • Tetracycline • Sulfa drugs What drugs Inhibit p450? • I Do SMACK Quinolones • INH • Dapsone • Spirolactones • Macrolides • Amiodarone • Cimetidine • Ketoconazole • Quinilones What drugs are P450 Dependent? • Warfarin • Estrogen • Phenytoin • Theophylline • Digoxin • Theo came from war & dig inside WDEPT taking Estrogen & now is Phenytoin What disease is a Neutophil Deficiency? • CGD What is another name for CGD? • Chronic Granulomatous disease • NADPH Oxidase deficiency What are the Side effects of Statins? • Myositis • Hepatitis • Increased liver enzymes What are the painful genital Lesions? • Chancroid • Herpes • Lymphogranuloma inguinale . What is the painful chancroid lesion due to? • Hemophilus ducreyi . What are the 4 hormones with disulfide bonds? • Prolactin • Insulin • Inhibin • GH • I PIG on BONDS . What are the Hookworms? • Necatur americanis • Enterobius vermicularis • Ankylostoma duodenale • Trichuris trichurium • Ascaris lumbercoides • Strongyloides • Hooks AS NEAT . What are the X-Linked enzyme Deficiencies? • G6-PD • CGD • Pyruvate dehydrogenase Def. • Fabry’s • Hunter’s • Lesch-nyhan • Lesch-Nyhan Hunter Puts Fabrys on G6 Clothes . What diseases do we screen for at birth? • Please • Check • Before • Going • Home • PKU • CAH(Congential Adrenal Hyperplasia) • Biotinidase • Galactosemia • Hypothyroidism . Goodpasture’s. Pemphigus Vulgaris • HLA-DR5= JRA.HLA-Antigens • HLA-DR2= Narcolepsy. SLE. Allergy. MS • HLA-DR3= DM. Celiac Sprue • HLA-DR3 & 4= IDDM(Type I) • HLA-DR4= Rheumatoid Arthritis. Sjogren’s. Pernicious Anemia • HLA-DR7= Nephrotic Syndrome(Steroid induced) . Chronic Active Hepatitis. (Vit. IBD.D) . 6. Reiter’s. Postgonococcal Arthritis • HLA-BW 47= 21 alpha Hydroxylas def.-cysteine>tyrosine) • HLA-B8=MG • HLA-B13= Psoriasis • HLA-B27= Psoriais(only if w/arthritis) Ankylosing Spondylitis. point mut.HLA-Antigens • HLA-DR 3 & B8=Celiac Disease • HLA-A3= Hemochromatosis(chromo. What are the actions of Steroids? • Kills helper T-cells & eosinophils • Inhibits Macrophage migration • Inhibits Mast cell degranulation • Inhibits Phospholipase A • Stimulates protein synthesis • Stablizes endothelium . What are the causes of Monocytosis? • Salmonella (typhoid) • TB • EBV • Listeria • Syphillis . E. Coli is the most common cause of what? • UTI • Spontaneous bacterial peritonitis • Abdominal abscess • Cholecystitis • Ascending cholangitis • Appendicitis . What are the one dose treatments for Gonorrhea? • Ceftriaxone • Cefixime • Cefoxine • Ciprofloxin • Oflaxacin • Gatifolxacin . What is the one dose treatment for Chlamydia? • Azithromycin . What are the “Big Mama” anaerobes? • Strep bovis • Clostridium melanogosepticus • Bacteriodes fragilis . What are the “Big Mama” Rx? • Clindamycin • Metranidazole • Cefoxitin . What “big mama” bugs are associated with colon cancer? • Strep. Bovis • Clostridium melanogosepticus . What do you see in the serum with low volume state? • K+? • Decreases • Na+? • Decreases • Cl-? • Decreases • pH? • Increases • BP? • Increases . What are psammoma bodies? • Calcified CA’s . In what diseases are Psammoa Bodies present? • Papillary carcinoma of the Thyroid • Serous cystadenocarcinoma of the ovary • Meningioma • Mesothelioma . What are the Urease (+) Bacteria? • Proteus • Pseudomonas • Ureaplasma urealyticum • Nocardia species • Cryptococcus neoformans • H. pylori . What types of stones are formed from Proteus? • Struvite (90%) . What type of motility do Proteus have? • swarming . What are 5 indications of Surgery? • Intractable pain • Hemorrhage (massive) • Obstruction (from scarring) • Perforation . What drugs cause Cardiac Fibrosis? • Adriamycin (Doxyrubicin) • Phen-fen . What drug is used to tx cardiac fibrosis? • Dozaroxsin . What is the MCC of any …. penia? • #1 = Virus • #2 = Drugs . What is seen in the Salmonella Triad? • High Fever • Rose spots (rash) • Intestinal fire . What drugs cause Myositis? • Rifampin • INH • Predinsone • Statins . influenza • Pseudomonas • Neisseria • Cryptococcus . Pneumo (gr+) • Klebsiella • H.What are the 7 Gram -encapsulated bacteria? • • • • • • • Some Strange Killers Have Pretty Nice Capsules • Salmonella • Strep. What is the Jones Criteria for Rheumatic Fever? • SubQ nodules • Polyarthritis • Erythema marginatum • Carditis • Chorea . What are the causes of Eosinophilla? • Neoplasms • Allergies/Asthma • Addison’s Dz • Collagen Vascular Dz • Parasites . D Aflatoxin Vinyl chloride Ethanol Carbon Tetrachloride Anyline Dyes Smoking Hemochromatosis Benzene Schistomiasis .What are the Risk Factors for Liver CA? • • • • • • • • • • Hep B.C. What are the 9 Live Vaccines? • Measles • Mumps • Rubella • Oral Polio (sabin) • Rotavirus • Small pox • BCG • Yellow fever • Varicella . What are the Killed Vaccines? • SIR Hep A • Salk (polio) • Influenza • Rubella • Hepatitis A . What are the IgA Nephropathies? • Henoch-Schoenlein P. (HSP) • Alport’s • Berger’s . What are the Drugs that cause Autoimmune hemolytic anemia? • PCN • α-methyldopa • Cephalosporins • Sulfa • PTU • Anti-malarials • Dapsone . What are the drugs that cause Autoimmune thrombocytopenia? • ASA • Heparin • Quinidine . What are the enzymes that show after an MI? • Troponin I • CKMB • LDH . What is the first MI enzyme to appear? • Troponin I • Appears • Peaks • Gone • 2 hrs • 2 days • 7 days . What is the 2 to appear? nd • CK-MB • Appears • Peaks • Gone MI enzyme • 6 hrs • 12 hrs • 24 hrs . What is the 3 MI enzyme to appear? rd • LDH • Appears • Peaks • Gone • 1 day • 2 days • 3 days . pylori • Bartonella henseslae (lymph node) • Candida (yeast) .What bacteria have Silver Stains? • Legionella • Pneumocysitis carinii • H. What are the sulfa containing drugs? • Sulfonamides • Sulfonylurea • Celebrex . What is another name for celebrex? • Celecoxib . What type of inhibitor is Celebrex? • COX 2 specific . What COX-2 specific drug can you give to a pt with sulfa allergy? • Vioxx (Rofecoxib) . What drugs inhibit dihydrofolate reductase? • Pyremethamin/Sulfadiazine • Trimethoprim/Sulfamethoxazole . What drugs cause Pulmonary Fibrosis? • Bleomycin • Bulsufan • Amiodarone • Tocainide . What are the macrophage deficiency diseases? • Chediak-Higashi • NADPH-oxidase deficiency . What are the SE of Loops and Thiazides? • Hyperglycemia • Hyperuricemia • Hypovolemia • Hypokalemia . What are the SE of Loop diuretics? • OH DANG • Ototoxicity • Hypokalemia • Dehydration • Allergy • Nephritis (interstitial) • Gout . What are the only 3 Pansystolic Murmurs and when are they heard? • MR • TR • VSD • Decrease on inspiration (^exp) • Increase on inspiration • Decrease on inspiration (^exp) . Macrophages in various organs • • • • • • • • • Brain Lung Liver Spleen Kidney Lymph nodes Skin Bone CT • • • • • • • • • • • Mircoglia Type I pneumocyte Kupffer cell RES Mesangial Dendritic Langerhans Osteoclasts Histiocytes or Giant cells or Epithelioid cells . What are the 7 Rashes of the Palms & Soles? • TSS • Rocky Mountain Spotted Fever • Coxsackie A (Hand/Foot & mouth dz) • Kawasaki • Syphillis • Scarlet Fever • Staph Scalded Skin Syndrome . What is seen in every restrictive lung dz and low volume state? • Tachypnea • Decrease pCO2 • Decrease pO2 • Increase pH . What are the different 2nd messenger systems? • cAMP • cGMP • IP3/DAG • Ca:Calmodulin • Ca+ • Tyrosine kinase • NO . What is the clue for cAMP? • It is the 90% • Sympathetic • CRH (cortisol) • Catabolic . What is the clue for cGMP? • Parasympathetic • Anabolic . What are the clues for IP3/DAG? • Neurotransmitter • GHRH • All hypothalamic hormones xc cortisol • Used by what and for what? • Smooth muscle for contraction . What is the clue for Ca:Calmodulin? • Used by smooth muscle for contraction by distention . What is the clue for Ca+? • Used by Gastrin only . What is the clue for Tyrosine Kinase? • Used by Insulins • Used by ALL growth factors . What is the clue for NO? • Nitrates • Viagra • ANP • LPS . What are the T & B cell deficiencies? • WAS • SCID • CVID • HIV • HTLV-1 . What are the CLUES for WAS? • Thrombocytopenia • IL-4 • Infection • Eczema • Decrease IgM • IgE??? . What are the CLUES for SCID? • Framshift/Nonsense mutation • Adenosine deaminase deficiency • T-cell>B-cell • Bacterial infections • Fungal infections . What are the CLUES for CVID? • Late onset • Frameshift/Missense mutation • Tyrosine Kinase deficiency . What are the CLUES for HIV & HTLV-1? • T-cell>B-cell • CD4 rich • Brain • Testicles • Cervix • Blood vessels . What are the inhibitors of Complex 1 of the ETC? • Amytal • Rotenone . What are the inhibitors of Complex 2 of the ETC? • Malonate . What are the inhibitors of Complex 3 of the ETC? • Antimycin D . What are the inhibitors of Complex 4 of the ETC? • CN• CO • Chloramphenicol . What are the inhibitors of Complex 5 of the ETC? • Oligomycin . What are the ETC chemical uncouplers? • DNP • Free Fatty acids • Aspirin . What type of uncoupler is Aspirin? • Physical uncoupler . What are the 4 sources of Renal Acid? • Plasma • Urea cycle • Collecting ducts • Glutaminase . What is the one dose tx for Hemophilus ducreyi? • Azithromycin 1 gram po • Ceftriazone 250 mg im . What is the one dose tx for Chlaymdia? • Azithromycin 1 gram po . What is the one dose tx for Candidiasis? • Ketoconazole 150mg . What is the one dose tx for Vaginal Candidiasis? • Difluccan 1 pill . What is the one dose tx for Trichomonas? • Metronidazole 2 grams . What is the one dose tx for Gardnerella? • Metronidazole 2 grams . What are the 3 cephalosporins & doses used as one dose treatments for Gonorrhea? • Ceftriaxone 250 mg im • Cefixime 400 mg po • Cefoxitin 400 mg po . What are the 3 Quinolones & doses used as one dose treatments for Gonorrhea? • Ciprofloxacin 500 mg po • Ofloxacin 400 mg po • Gatifloxacin 400 mg im . 6 –Glucosidase • Phosphatase .What are the 4 enzymes needed to break down glycogen? • Phosphorylase (Pi) • Debranching enzyme • Alpha-1. What are the 2 enzymes needed to make glycogen? • Glycogen synthase • Branching enzyme . What are the branching enzymes? • Glycogen alpha-1.4 glycosyl transferase • Glycogen alpha-1.6 glycosyl transferase . What is the rate limiting enzyme in the break down of glycogen? • Phosphorylase (Pi) . What values do you see in obstructive pulmonary dz? • pO2? Normal • pCO2? Normal or increased • pH? Decreased . What values do you see in restrictive pulmonary dz? • pO2? Decreased • pCO2? Decreased • pH? Increased . What type of acidosis do you see with obstructive pulmonary dz? • Respiratory acidosis . What are the Lysosomal Storage Disease & what is the deficiency? • • • • • • • • Fabry’s Krabbe’s Gaucher’s Niemann – Pick Tay-Sachs Metachromatic leukodystrophy Hurler’s Hunter’s • • • • • • • • α – galactosidase Galactosylceramide β – glucocerebrosidase Sphingomyelinase Hexosaminidase Arylsulfatase α – L – iduronidase Iduronidase sulfatase . What dz’s are associated with HLA B27? • Psoriasis • Ankylosing spondylitis • IBD (Ulcerative colitis) • Reiter’s Syndrome . What HLA is Psorisis w/RA associated with? • HLA-13 . What are the Glycogen Storage Diseases & the deficiency? • Von Gierke’s • Glucose – 6 – phosphate • Pompe’s • α – 1 – 4 glucosidase • Cori’s • McArdle’s • Debranching enzyme • Glycogen phosphorylase . What are 6 places of the TCA cycle where amino acids feed in/out? • • • • Pyruvate? Glycine Alanine Serine • • • • • • • Acetyl CoA ? Phenylalanine Isoleucine Threonine Tryptophan Lysine Leucine . What are 6 places of the TCA cycle where amino acids feed in/out? • Alpha-KG ? • Glutamate • Glutamine • Succinyl CoA? • Phenylalanine • Tryptophan • Tyrosine . What are 6 places of the TCA cycle where amino acids feed in/out? • Fumerate ? • Proline • Oxaloacetate? • Aspartate • Asparigine . What are the 4 steps of Boxidation? • Oxidation – 7 NADH – 21 ATP • Hydration • Oxidation .7FADH – 14 ATP • Thiolysis – 8 AcCoA – 96ATP 131 ATP – 2 (to bring it in) . What are the blood gases in neuromuscular disease (= restrictive blood gases)? • pO2? • • • • • Decreased pCO2? Decreased PCWP? Decreased (b/c it’s a pressure problem) Respiratory Rate? Increased pH? Increased SZ? Increased . What are 5 Hormones produced by small cell (oat cell) lung CA? • ACTH • ADH • PTH • TSH • ANP . What Autoimmune Disease has the following Autoimmune Antibodies? •Anti-smith •Anti cardiolipin •Anti-ds DNA •SLE . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti – histone? • Drug induced SLE . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-topoisomerase? • PSS (Progressive Systemic Sclerosis) . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti TSH receptors? • Graves . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-centromere? • CREST . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-GBM? • Goodpasture’s . What does Goodpastures have antibody to? • Type IV collagen . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-mitochondria? • Primary biliary cirrhosis . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-hair follicle? • Alopecia areata . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-IgG? • Rheumatoid arthritis . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-myelin receptors? • MS . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-gliaden? • Anti-gluten? • Celiac sprue . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-islet cell receptor? • DM Type I . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-melanocyte? • Viteligo . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-ACh receptor? • MG . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-ribonuclear protein? • Mixed Connective Tissue dz (MCTD) . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-parietal cell receptor? • Pernicious anemia . What does Pernicious Anemia have antibody to? • Intrinsic factor . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-epidermal anchoring protein receptors? • Pemphigus vulgaris . What does Pemphigus vulgaris have antibody to? • Intercelluar junctions of epidermal cells . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-epidermal basement membrane protein? • Bullous pemphigoid . What do you see with bullous pemphigoid? • IgG sub-epidermal blisters • Oral blisters . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-platelet? • ITP . What does ITP have antibody to? • Glycoprotein IIb/IIIa . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-thyroglobulin? • Anti-microsomal? • Hashimoto’s . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-smooth muscle? • Anti-scl-70? • Scleroderma . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-rho (SS-A)? • Anti-la? • Sjogren’s . What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-proteinase? • C-ANCA? • Wegener’s . What Autoimmune Disease has the following Autoimmune Antibodies? • P-ANCA? • Polyarteritis nodosa . What antigen & immunoglobulin is Polyarteritis nodosa associated with? •Hepatitis B antigen •IgM . What are the viruses that directly cause CA and which CA do they cause? • Papilloma virus? Cervical CA • EBV? Burkitts Nasopharyngeal CA • HepB & C? Liver CA • HIV? Kaposi’s Sarcoma . What are the 7 Nephrotic Patterns seen with every Vasculitis? • Clot in front of renal artery? Renal artery stenosis • Clot off whole renal artery? Renal failure • Inflamed glomeruli? Glumerulo nephritis • Clot in papilla? Papillary necrosis • Clot off medulla? Interstitial nephritis • Clot off pieces of nephron? Focal segmental GN (HIV. drug use association) • Clot off lots of nephrons? Rapidly Progressive GN . change disease • 2 wks post URI .What is the most common nephrotic disease seen in kids and when does it occur? • Min. vasculitity leading to rapidly progressive glomerulonephrosis? • Goodpasture’s . What is the most common malignant renal tumor in children? • Wilm’s tumor . What is the most common malignant renal tumor in adults? • Adenocarcinoma . What is the most common renal mass? • Cyst . What is the most common renal disease in Blacks/Hispanics? • Focal Segmental GN . What is the most common nephrotic disease in adults? • Membranous GN . Urokinase inhibit? • Aminocaproic acid • What doe Warfarin inhibit? • Vitamin K • What does Heparin inhibit? • Protamine Sulfate .Thrombolytics & Inhibitors • What does tPA. Streptokinase. What is the dosage of tPA? • IV push? • 20mg • Drip? • 40mg . What is the dosage for Streptokinase? • IV push? • 750K • Drip? • 750K . What is Urokinase used for? • Used ONLY for such things as: • Feeding tubes • Central lines • Fistulas . What is Alopecia Areata? • Loss of a patch of hair . What is Alopecia Totalis? • Loss of ALL hair on head “bald” . What is Alopecia Universalis? • Loss of hair on entire body “hairless” . What is Loffler syndrome? • Pneumonitis with endocarditis = pulmonary infiltrate with severe eosinophilia . What is Loffler syndrome also known as? • PIE syndrome . What are the 5 Parasites associated with Loffler Syndrome? • Necator americanus • Ankylostoma duodenale • Shistosomiasis • Strongyloides • Ascaris lumbricoides . What happens when a patient is on prednisone for > 7 days? •Immunocompromised . What are 2 enzymes used by B12? • Homocystine methyl transferase • Methyl malonyl-coA mutase . What does Mitochondrial inheritance mean? • No male transmission • All females pass it on . Who are 4 pt’s who would be susceptable to pseudomonas and staph infxns? • Burn patients • Cystic fibrosis • DM • Neutropenic patients . In a neutropenic patient. what do you cover for? • cover 1x for Staph aureus during 1st week • cover 2x for Pseudo after 2nd week . What are the 3 main concepts causing a widened S2 splitting? • Increased pO2 • Delayed opening/closing of the pulmonary value • Increased volume in the right ventricle . What are causes for a widened S2 splitting? • • • • • • • • • • • • • Blood transfusion Increased Tidal Volume Giving O2 Right sided heart failure Pregnancy due to increase volume IV fluids ASD/VSD Deep breathing Hypernateremia SIADH Pulmonary regurge Pulmonary stenosis Right bundle branch block . What are the 8 common cavities of blood loss? • Pericardium • Intracranial • Mediastinum • Pleural cavity • Thighs • Retroperitoneum • Abdominal cavity • Pelvis . What is the special list for Penicillin? • Gram + • Basement membrane suppressor • Works on simple anaerobes • The #1 cause of anaphylaxis • Causes interstial nepritits • Causes nonspecific rashes • Acts as a hapten causing hemolytic anemia . What is the #1 cause of anaphylaxis? • Penicillin . What are the Chron’s Gifts? • Granuloma • Ileum • Fistula • Transmural • Skip Lesion . What are the negativestranded RNA Clues? • Prodromal period before symptoms = 1-3 weeks • Why is there a prodromal period? • Because must switch to positive stranded before replication . What are the clues for positive stranded RNA? • Symptoms within 1 week or less • EXCEPTIONS: • Hanta • Ebola • Yellow fever • They are -ve stranded = don’t have to switch to positive before replicating . What are the Most common cyanotic heart diseases? • Transposition of the great arteries • Tetrology of Fallot • Truncus Arteriosus • Tricuspid Atresia • Total anomalous pulmunary Venous Return • Hypoplastic Left heart syndrome • Ebstein’s anomaly • Aortic atresia • Pulmonary atresia . What cyanotic heart disease is – boot shaped? • Tetrology of Fallot . What cyanotic heart disease is associated with mom taking lithium during pregnancy? • Ebstein’s Anomaly . What things make the membrane less likely to depolarize? • Hypokalemia • Hypermagnesemia • Hypercalcemia (except atrium) • Hypernatremia . What things make the membrane more likely to depolarize? • Hyperkalemia • Hypomagnasemia • Hypocalcemia (except atrium) • Hyponatremia . What is Plan F? • TPP – Thiamin – B1 • Lipoic Acid – B4 • CoA – Pantothenic acid – B5 • FAD – Riboflavin – B2 • NAD – Niacin – B3 . What are the 8 x-linked inherited diseases? • Bruton’s Agammaglobulinemia • CGD (NADPH def) • DMD • Color Blindness • G6PD • Hemophilia • Lesch-Nyhan • Vit D resist. Rickets (X-linked dominant) • Fabrys • Hunters . Def) • Leukemias • Lymphomas • SCID • WAS • Job Buckley Syndrome .What are the 7 B-cell deficiencies? • Bruton’s agammaglobulinemia • CVID (Common Variant Imm. What is the Tyrosine kinase deficiency? • Bruton’s agammaglobulinemia . What are the B-cell deficiencies with T-cell overlap? • SCID • WAS • Job Buckley Syndrome . What are the 4 itchiest rashes? • Scabies • Lichen Planus • Urticaria • Dermatitis Herpetiformis . Tumor Markers/Oncongenes I • L-myc? • Small cell lung Ca • • C-myc? Promyelocytic leukemia (Burkitt’s lymphoma) • • • N-myc? Neuroblastoma Small cell lung CA • • • C-able? CML ALL . Tumor Markers/Oncongenes II • C-myb? • Colon CA • AML • C-sis ? • Osteosarcoma • Glioma • Fibrosarcoma . Tumor Markers/Oncongenes III • C-erb B2? • Epidermal growth factor receptors • CSF-1 ? • Breast . Tumor Markers/Oncongenes IV • • • • Erb-B2? Breast CA Ovarian CA Gastric CA • • • • Ret? Medullary CA of thyroid Men II & III Papillary carcinoma . Tumor Markers/Oncongenes V • Ki-ras? • Lung CA • Colon CA • Bcl-2? • Burkitts • Follicular lymphoma • Erb? • Retinoblastoma . pit gland prod it also) • Progesterone • Estrogen • Relaxin .What are 6 Hormones produced by the placenta? • hCG • Inhibin • Human placental lactogen (HPL) • Oxytocin (drug lactation. What is cancer grading? • Severity of microscopic change • Degree of differentiation . What is cancer staging? • Degree of dissemination of tumor • What the surgeon sees . What are the rashes associated with cancer and what cancer are they associated with? • Urticaria/Hives? • Any CA. especially lymphoma • Pagets Ds (ulcers around nipples) • Seborrheic keratosis (waxy warts)? • • • Colon CA HIV if sudden increase in number Normal with aging . heliotropic rash.What are the rashes associated with cancer and what cancer are they associated with? • Actinic keratosis? – Dry scaly plaques on sun-exposed skin • Squamous Cell CA of skin • Dermatomyositis? – violacious. malar area • Colon CA . w/ bacteria .What are the rashes associated with Cancer and the cancer they are associated with? • Akanthosis nigricans? – dark lines in skin folds • Any visceral CA • End organ damage • Erythema nodosum? – ant aspect of legs. tender nodules • Anything granulomatous • NOT assoc. What is carried by HDL? • Apo E • Apo A • Apo CII • L-CAT – lecithin cholesterol acetyl transferase • Cholesterol – from periphery to liver . What is carried by VLDL? • Apo B-100 • Apo E • Apo C II • Triglcyerides (95%) • Cholesterol (5%) . What is carried by IDL? • Apo B-100 • Apo E • Apo CII • Triglycerides (< VLDL) • Cholesterol (>VLDL) . What is carried by LDL? • Apo B-100 • Cholesterol – from liver to tissue • NOT a good thing!!!!! . What do chylomicrons carry? • Apo A • Apo B-48 • Apo E • Apo C II • Triglycerides from: • GI to liver (25% of the time) • GI to endothelium (75% of the time) . Which lipoprotein carries the most cholesterol? •LDL . Where are the AVMs? • Clue = HEAL • Heart? • Machinery murmur • Elbow? • Fistula from dialysis in renal disease • Abdomen/Brain? • Von Hippel-Lindau = clot off with coils • Increase incidence of Renal cell CA on chrom 3 • Lungs? • Osler Weber Rendu Syndrome . 000 .What is the Ranson’s criteria for acute pancreatitis (at admission)? • Glucose > 200 • Age > 55 • LDH >350 • AST > 250 • WBC > 16. What is the Ranson’s criteria for acute pancreatitis (at less than 48 hrs)? • Calcium <8 mg/dl • HCT drop > 10% • O2 < 60 (PaO2) • Base deficit > 4 • BUN > 5 mg/dl • Sequestration > 6L . red.What 2 diseases is pilocarpine used for? • CF • Glaucoma – Painful. teary eye . What is dysguzia? • Problem with sense of taste . What are 3 causes of dysgusia? • Metronidazole • Clarithromycin • Zinc deficiency . What is the triad of Carcinoid syndrome? • Flushing • Wheezing • diarrhea . What do you measure for carcinoid syndrome? • Serotonin – 5-HIAA . Where are the 2 most common places a carcinoid tumor is found? • Pancreas • Ileum . What are the phage mediated toxins? • Mnemonic: BEDS • Botulinum • Erythrogenic toxin – from strep pyogenes • Diptheria • Salmonella – Has O antigen . What is the story used to remember the segmented RNA viruses? • I sprayed ORTHO on my BUNYA at the ARENA down in REO to kill SEGMENTED WORMS . Name the 3 major types of adhesion molecules • ICAMs • Integrins • Selectins . What does IgCam do? • Bind proteins . What do integrins do? • Stop the leukocytes . What do selectins do? • Bind carbohydrates • Mediate the rolling to slow leukocytes down . What are the functions of adhesion molecules? • Homing of lymphocytes – tells lymphocytes where to go • Inflammation • Cell-cell interaction . Primary allergic response is due to what? • Contact . What cells are present in the first 3 days? • Neutrophils • The next cells to show up are? • B-cells • What do B-cells make? • IgM . What day does IgM show up? • Three • IgM peaks at what day? • 14 • When does IgM leave? • In 2 months . What shows up in 2 wks (14 days)? • IgG • When does IgG peak? • In 2 months • When does IgG leave? • In 1 year . What is Secondary Allergic response is due to? • MEMORY . What shows up at day 3? • IgG with 5x concentration • Has the highest affinity • When does IgG peak? • In 5 years • When does IgG leave? • In 10 years . What Ig has the hightest affinity? • IgG . What are the risk factors for Esophageal/Gastric CA? • Smoking • Alcohol • Nitrites • Japanese . What are the risk factors for bladder CA? • • • • • • • • • Smoking Aniline dyes Benzene Aflatoxin Cyclophosphamide Schistosomiasis 2 diseases: Von Hippel-Lindau Tubular sclerosis . What is the NBT test? • Nitro Blue Tetrazolium test • What is it used for? • Screening CGD • What does a –ve test indicate? • +ve for the disease . What disease corresponds with the following inclusion bodies? • Howell-Jolly? • Sickle cell • Heinz? • G-6-P-D • Zebra? • Niemann pick . What disease corresponds with the following inclusion bodies? • Donovan? • Leishmaniasis • Mallory? • Alcoholism • Negri? • Rabies . What disease corresponds with the following inclusion bodies? • Councilman? • Yellow fever • Call-exner? • Ovarian tumors – granulosa origin . What disease corresponds with the following inclusion bodies? • Lewy? • Parkinsons • Pick? • Pick’s disease • Barr body? • Normal female . What disease corresponds with the following inclusion bodies? • Aschoff? • Rheumatic fever • Cowdry type A inclusions? • Herpes virus • Auer rods? • AML . What disease corresponds with the following inclusion bodies? • Globoid? • Krabbe’s lysosomal storage disease • Russell? • Multiple myeloma . What disease corresponds with the following inclusion bodies? • Schiller-Duvall? • Yolk sac tumor • Basal bodies? • Only found in smooth mm . What are the 4 types of hypersensitivities? • Mnemonic? • ACID • Type I • Anaphylaxis/Atopic • Type II • Cytotoxic (Humoral) • Type III • Immune complex mediation • Type IV • Delayed hypersensitivity/Cell mediated . What are the Characteristics of Type I hypersensitivity? • Atopic • IgE (Asthma) binds to mast cell • IgA activates IP3 cascade degrading mast cells . What are the Characteristics of Type II hypersensitivity? • Humoral • What are examples of type II? • Rh disease • Goodpastures • Autoimmune hemolytic Anemia • All Autoimmune diseases – except RA and SLE . What are the Characteristics of Type III hypersensitivity? • Ag-Ab complement • What are examples of Type III? • RA • SLE • Vasculitides • Some GN? . What are the Characteristics of Type IV hypersensitivity? • Cell mediated • What are examples of Type IV? • TB skin test • Contact dermatitis • Transplant rejection . What structures have no known function? • Appendix • Epithalamus • Palmaris longus – muscle • Pancreatic polypeptide – hormones in F-cells . What diseases can progress to RPGN? • Goodpastures • Wegeners • DM • HTN . What are causes of papillary necrosis? • Vasculitis • AIDS . Cytic fibrosis Questions? • • • Tx? Pilocarpine also used for glaucoma • Test used to detect CF? • Pilocarpine sweat test • • What ion does this test measure? Cl- • Definitive presence of disease has a test value of • what? >60 . Cytic fibrosis Questions? • What is the value in a normal person? • <20 • • What is the value in a heterozygous person? 30 – 60 • What chromosome is the CF gene on? • Chrom 7 • What Second messenger is used? • IP3/DAG . What are the gram +ve spore formers? • Bacillus anthracis • Clostridium perfringens • Clostridium tetani • Clostridium melangosepticus • What is the chemical in spores? • Calcium dipocholinate . What does strep mutans ferment? • Lactic acid . What type of receptors do all sphincters in the body have? • Alpha-receptors . Strep. Salivarius ag is used for what test? • Cold agglutinin testing – IgM . Types of amyloid found in various Systemic amyloidoses: • AA amyloid? • Chronic active disease • AL amyloid from Ig light chain? • Myeloma . Mediterranean fever .Types of amyloid found in various Systemic amyloidoses: • Beta 2 microglobulin? • Chronic hemodialysis • AA amyloid from SAA? • Nephrotic hereditary forms – eg. Types of amyloid found in various Systemic amyloidoses: • Pre-albumin/transthyretin? • Cardiomyopathic hereditary forms – senile systemic amyloidosis • Neuropathic hereditary syndromes . Types of amyloid found in various Local amyloidoses: • ANP fibrils are caused by? • Senile cardiac amyloisosis • Cerebral amyloid in Alzheimer’s disease/Down’s? • Cerebral amyloidosis . massive.Types of amyloid found in various Local amyloidoses: • Calcitonin precursors? • Medullary CA of thyroid • AL from light chains? • Isolated. nodular deposits – lung. skin. urogenital tract . What type of dementia do you get in Pick’s dis? • Frontotemporal dementia . Describe Pick’s disease • Atrophy of frontal and temporal cortex with sparing of remaining neocortical regions What 3 things do Pick bodies contain? • Altered neurofilaments • Tau protein • ubiquitin What drugs can cause a disulfiram reaction? • Mnemonic? • CLAM • Chloramphenicol • Lactams – Cefamandole – Cefoperazone • Antabuse – disulfiram What is the mode of action of the Clostridium botulinum toxin? • Prevents pre-synaptic release of Ach • How do babies get it? • From spores in honey or molasses • How do adults get it? • From canned food What are 3 Toxins of Bacillus? • Lethal factor – (black necrosis) • Protective factor • Edema factor Who has Poly-D Glutamic acid? • Anthracis • Cereus Name that B-blocker: • B1-selective? •A – M • Non-selective? •N – Z • Exceptions? • Carbetalol and Labetolol are nonselective What are the 4 facts of Fanconi Syndrome? • Problem in proximal tubule • Can’t reabsorb • Low energy state causing anemia • Can be due to old tetracycline Where is glutaminase found? • In the collecting duct of the kidney • What does glutmainase help the kidney absorb? • Ammonia if the liver fails Name 3 anatomical spots where renal stones get stuck: • Hilum • Pelvic brim • Entering the bladder Renal failure is the most common cause of death in what 3 diseases? • SLE • Endometrial CA • Cervical CA What is the rate-limiting enzyme in the urea cycle? • Carbamoyl synthase I • Where is it found 90% of the time? • Liver • Where is it found 10% of the time? • Collecting duct of the kidney What type of charge does heparin have? •-ve charge What type of charge does protamine sulfate have? •+ve charge • What is it used for? • Reversing the effects of heparin What is commonly seen in all vasculitides? • T-cells and macrophages • Schistocytes • Decreased platelets • Decreased RBCs • Bleeding from mucosal surfaces • Bleeding from skin and GI • Petechiae • Ecchymoses What happens if you expose the blood to the basement membrane? • The following deveop: • Clots • DIC • Pulmonary embolism • DVT • MI • Stroke Signs and symptoms in all vasculitides • Tachypnea and SOB • Most common cause of death? • Heart failure What is the MOA of Erythromycin? • Inhibits the translocation step of ribosomal protein synthesis . What is the MOA of Chloramphenicol? • Inhibits ribosomal peptidyl transferase in prokaryotes . What is the MOA of Puromycin? • Inhibits elongation by binding to “A” site and prematurely terminating chain growth in pro and eukaryotes . What is the MOA of Streptomycin? • Causes misreading of code during initiation in prokaryotes . What is the MOA of Tetracycline? • Prevents binding of aminoacyl-t-RNA to ribosome on prokaryotes therefore inhibiting initiation What is the MOA of Cyclohexamide? • Inhibits ribosomal peptidyl transferase in eukaryotes – cell wall inhibitor What is the MOA of Rifampin? • Blocks B-subunit of RNA polymerase • Prophylaxis for contacts of N. meningitidis What is the MOA of Vancomycin? • Cell wall inhibitor • Binds irreversibly to Phopholipase carrier • Bacteriacidal • Covers all gram +ves • Linezolid What is the MOA of Warfarin? • Blocks vitamin k dependent gammacarboxylation of prothrombin and factors 2, 7, 9, 10, proteins C & S What is the MOA of Clindamycin? • Blocks translation by binding the 50S subunit Hemolytic properties of Streptococcus: • What type of hemolysis is alpha hemolysis? • Partial hemolysis • What color is it’s zone? • Green • What type of hemolysis is beta-hemolysis? • Complete hemolysis Hemolytic properties of Streptococcus: • What color is it’s zone • Clear – eg. Streptokinase • What type of hemolysis is gammahemolysis? • No hemolysis • What color is it’s zone? • Red What are the 5 notable things about RTA I? • High urine PH (??????not sure about this) • Acidosis • UTI s • Stones • Babies die < 1 yr old What are 3 notable things about RTA II? • Acidosis – urine PH = 2, normal is 5-6 • Hypokalmia • Patients have NO carbonic anhydrase What are 3 notable things about RTA III? • It is a combination of RTA I & III • Normal urine pH • Hypokalemia What are 3 notable things about RTA IV? • Seen in diabetics • Hyperkalemia • NO aldosterone b/c JG apparatus has infarcted What are the members of Streptococcus Group D? • Viridans • Mutans • Sanguis • Salivarius • Bovis What Steptococcus has green pigment? • Viridans What Streptococcus causes SBE? • Viridans What Streptococcus causes cavities? • Mutans What do you see in Nephritic Syndrome? • HTN • Hematuria • RBC casts What do you see in Nephrotic Syndrome? • Increase Edema • Increase Lipidemia • Increase Cholesterolemia • Increase Coagulability • Decrease serum Albumin • Increase urinary Albumin . Bronchitis. Pneumonia? • Strep.What is the #1 cause of Sinusitis. Otitis. Pneumo • What is the #2 cause? • Hemophilus influenza • What is the #3 cause? • Neisseria meningitides . What is the #1 method to paralyze cilia? • Viruses • Which are secondary to what? • Bacterial infections • What is the #2 method to paralyze cilia? • Smoking . from what? • Fried rice .If you develop gastroenteritis within 8hrs of eating what are the most common likely bugs? • Staph aureus • Clostridium perfringens • Bacillus cereus…. Gastroenteritis within 8hrs of eating what toxin? • Preformed . What does Clostridum tetani inhibit? • Release of glycine from spinal cord • What physical finding would you see? • Lock jaw • What is the tx? • Antitoxin and Toxoid • Where is it injected? • Injected in different areas of body . coli • Followed by? • Proteus • Followed by? • Klebsiella .The Most common cause of UTI is? • E. The most frequent cause of UTI in females between 5-10? • Staph saprophyticus • Why? • They stick things in themselves • • • • 18-24 yoa? Staph saprophyticus Why? Because they stick things inside themselves • Why no UTI’s after 24? • Because women are use to penises and Staph saprophyticus lives on penis (becomes part of normal flora). . Staph aureus is the most common cause of what bone disease? • Osteomyelitis • Because of what? • Collagenase . aureus .What is the Most Common cause of infections one week post burn injury? • Staph. What is the triad of SSSS? • Shock • Rash • Hypotension . Most common cause of UTI? • E. coli • Then? • Proteus • Then? • Klebsiella . coli • Listeria .Newborn meningitis is caused by? • Group B Strep (agalactiae) • E. coli • Listeria .What is normal rectal flora from mom • Group B Strep (Strep. Agalactiae) • E. What is associated with colon CA? • Clostridium melanogosepticus • Strep bovis • What color pigment is produced? • Black . What Ig do you look for with affinity? • IgG • What about Avidity? • IgM . What is transduction • Virus inject it’s DNA into bacteria . What is transformation? • Virus injects it’s DNA into it bacteria in a hospital or nursing home setting. then becomes deadly. . Conjuction occurs only with what? • Bacteria with Pili . What causes mutiple cerebral abscesses in newborns? • Citrobacter . What are the 2 gram –ves that are strict anaerobes? • Hemophilus influenza • Neisseria . What type of complement problem do you have in recurrent infections with encapsulated organisms? • C3 . What does complement fight against? • Gram negative bacteria . What do you see in serum with prerenal failure and what are the values? • BUN • >20 • Fractional Na+ excertion • <1% • Creatine • >40 . What do you see in Renal failure and what are the values? • BUN • 10-15 • Fractional Na+ excretion • >2% • Creatinine • <20 . What is the extravasation order? • Pavementing • Margination • Diapediesis • Migration . What is the rate limiting enzyme for Glycolysis? • PFK-1 . What is the rate limiting enzyme of Gluconeogenesis? • Pyruvate Carboxlyase . what are you treating first? • Viral • If resistant to tx. what next? • Fungal • Mycobacterium • Protozoa • Parasite • Neoplasm .If treating a disease that initiates the cell mediated response. Pneumonia • Herpes simplex virus • Neisseria gonorrhea • Chlyamydia . Group B – Strep agalactiae • Strep.What bugs can you pick up during birth? • Step. What is another name for Adenoma sebaceum? • Perivascular angiofibromata . What is another name for Addison’s? • Primary Adrenocoritcal Insufficiency . What is another name for Alkaptonuria? • Ochronosis . What is another name for Churg-Strauss? • Allergic Granulomatosis • Angiitis . What is another name for Craniopharyngioma? • Ameloblastoma • What is Ameloblast? • Tooth material . What is another name for Chrons? • Regional enteritis • Granulomatous ileitis • Ileocolitis . What is another name for DeQuervain’s? • Subacute Granulomatous Thyroiditis . What is another name for Intraductal Ca? • Comedo Ca . What is another name for ICell Disease? • Mucolipidosis II . What is another name for Kawassaki Disease? • MLNS • Mucocutaneous Lymph Node Syndrome . What is another name for Leydig cells? • Interstitial cells . What is another name for Sertoli cells? • Sustentacular cells . What is another name for Temporal arteritis? • Giant cell arteritis (granulomatous) . What is another name for Waldenstrom’s macroglobulinemia? • Hyperviscosity syndrome . HHV I causes? • Oral • Trigeminal ganglia . HHV II causes? • Genital • Sacral plexus . HHV III causes? • Varicella zoster . HHV IV causes? • EBV • Mononucleosis • Burkitt’s . HHV V causes? • CMV • Inclusion bodies . HHV VI causes? • Roseola • Duke Disease • Exanthem subitum . HHV VII causes? • Pityriasis rosea . HHV VIII causes? • Kaposi’s sarcoma . • What is the MOA? • Interferes with normal synthesis and gama carboxylation of Vit. • Is it long or short acting? • Long half-life • 8-10 hours to act . K dependent clotting factors via vitamin K antagonism.Answer the following questions about Coumadin/Warfarin. • Clinical use? • Chronic anticoagulation • Contra-indication? • Pregnancy because it can cross the placenta .Answer the following questions about Coumadin/Warfarin. Answer the following questions about Coumadin/Warfarin. • What pathway does it affect? • Extrinsic pathway • What does it do to PT? • Prolongs • PT . Answer the following questions about Coumadin/Warfarin. • What are the toxicities? • Bleeding • Teratogenic • Drug-drug interactions • How is it activatied? • Tissue activated . • Administration? • po .Answer the following questions about Coumadin/Warfarin. What are the Vitamin K dependent clotting factors? • II • VII • IX •X • Protein C • Protein S . • What is the MOA? • Catalyzes the activation of antithrombin III • Decreases thrombin and Xa • Is it long or short acting? • Short half-life • Acts immediately .Answer the following questions about Heparin. • Contra-indication? • Can be used during pregnancy because it does not cross the placenta . DVT. stroke. angina. MI. • Clinical use? • Immediate anticoagulation of pulmonary embolism.Answer the following questions about Heparin. Answer the following questions about Heparin. • What pathway does it affect? • Intrinsic pathway • What value should you follow? • PTT . • What are the toxicities? • Bleeding • Thrombocytopenia • Drug-drug interactions • How is it activatied? • Blood activated .Answer the following questions about Heparin. • Administration? • I.V.Answer the following questions about Heparin. • Drug of choice for what? • DVT . • What is good about the newer low- molecular-weight heparins? • They act more on Xa • Have better bioavailability • Have 2 to 4 times longer half life • Can be administered subcutaneously and without laboratory monitoring. .Answer the following questions about Heparin. What do you use for rapid reversal of heparinization? • Protamine sulfate . How do you treat Lead Poisoning? • Dimercaprol . How do you treat Benzodiazepine poisoning? • Flumazenil . How do you treat Anticholinesterase poisoning? • Pralidoxime . How do you treat Iron poisoning? • Deferoxamine . How do you treat Opioid poisoning? • Naloxene . How do you treat Barbituate poisoning? • Bicarbonate • Doxapram . What does Doxapram do? • Activates the respiratory center in the brain . What is the treatment for Hypercholesterolemia? • Provostatin • Atrovastatin • Lovastatin • Simvastatin . What statin is renally excreted? • Provastatin . What statins do you have to follow liver enzymes every 3 months? • Atrovastatin • Lovastatin • Simvastatin . What do statins inhibit? • HMG-CoA reductase • When is it most active? • 8:00pm on . If statins are insufficient what do you add? • Cholestipol • Cholestyramine • If nothing works what do you give? • Probucol • Niacin . What are the side effects of Niacin? • Flushing • Itching . What 2 statins bind bile salts? • Cholestipol • Cholestyramine . Kidney stones • Due to What? • Alcohol .Pancreatitis • Due to What? • ETOH 2.What are 4 causes of severe pain (in order)? 1. What are 4 causes of severe pain (in order)? 3.AAA • How is this described? • Ripping pain down back 4.Ischemic bowel • What is symptom? • Bloody diarrhea . What are 5 causes of SIADH? • Small cell Ca of lung • Increased intracranial pressure • Pain (most common) • Drugs • Hypoxic Lung Disease/Restrictive Lung disease . What drug causes SIADH? • Carbamazepine . What are the cells of neural crest origin? • Parafollicular cells of thyroid • Odontoblasts (predentin) • Pseudounipolar cells • Spiral membrane of heart • Chromaffin cells • All Ganglion cells (Schwann. Adrenal medulla) • Melanocytes • Laryngeal/Tracheal cartilage . What are the triple repeat diseases? • Huntington’s • Fragile X • Myotonic Dystrophy • Prauder Willie • Spinal/bulbar muscular atrophy (Fredicks ataxia) . How do you determine the maximum sinus rate? • 220 .age . What are the 3 low volume states with acidosis rather than alkalosis? • RTA • Diarrhea • Diabetic ketoacidosis (DKA) . What are the causes of Croup & Bronchiolities? • Parainfluenza • Adenovirus • Influenza • RSV . What is asthma in a child less than 2 called? • Bronchiolitis . What are the 4 D’s of Pellagra? • Diarrhea • Dermatitis • Dementia • Death . What are the uric acid stones? • Cysteine • Ornithine • Lysine • Arginine . What is happening in the Atrium? • Phase 0? • Depolarization • Phase 1? • No name • Phase 2? • Plateau phase (A-V node) . What is happening in the Atrium? • Phase 3? • Repolarization • Phase 4? • Automaticity (S-A node) . What do Na+ channels do to the EKG? • Wider QRS . What does Ca+ do to the EKG? • Wider P-wave • Longer PR interval . What are the types of kidney stones? • Calcium oxalate (phosphate) stones • Struvite stones • Uric acid stones • Cysteine stones • Oxalate stones . What percent of kidney stones are calcium oxalate? • 80% . If you find oxalate stones in the following what should you think of? • 3 y/o white male? • CF • 5 y/o black male? • Celiac Sprue . If you find oxalate stones in the following what should you think of? • Adult male? • Whipple’s • Adult male or female? • Crohn’s . If oxalate stones found in CF what is the most common cause? • In 0-20 y/o? • Malabsorptin • What age do they die? • Young . Answer the following questions about pseudogout? • What type of crystals are present? • Calcium pyrophosphate • Where are they found? • Joint spaces . Answer the following questions about pseudogout? • Who gets it? • Older patients M=F • Tx? • Colchicine . What are the most common non-cyanotic heart disease? • VSD • ASD • PDA • Coarctation . What murmur increases on expiration? • VSD • Mitral . What murmur has fixed wide splitting? • ASD . What murmur has bounding pulses? • PDA . What gives you differenital pulses? • Coarctation . What is increased incidence in Turners? • Coarctation . 6 dPhosphatase • G-6-Phosphatase .What are 4 enzymes never seen in glycolysis? • Pyruvate carboxylase • PEP carboxykinase • F-1. What are 3 enzymes seen ONLY in glycolysis? • Hexokinase • PFK-1 • Pyruvate kinase . What are 2 hormones that are acidophilic? • Prolactin • GH . What are the partially acid fast Gram +ve? • Nocardia . What are the partially acid fast Protozoa? • Cryptosporidium . What are the septic emboli of SBE? • Mycotic aneurysm • Roth spots • Janeway lesions • Osler’s nodes • Splinter hemorrhages • Endocarditis . Where are the following lesions found? • Janeway lesions? • Toes • Osler’s nodes? • Fingers • Roth spots? • Retina . What is the most common cause of endocarditis? • Strep. viridans . What causes microsteatosis? • Acetaminophen • Reye Syndrome • Pregnancy . What causes macrosteatosis? • Alcohol . Aureus • Pseudomonas .What are 2 bacteria that release elastase? • Staph. What are the 2 bacteria with toxins that inhibit EF-2? • Pseudomonas • Diptheria . How does Diptheria work? • It ADP ribosylates EF2 inhibiting protein synthesis • Is it Gram +/-? •+ • Where and how does it get its exotoxin? • From virus via transduction . How does Diptheria work? • What does it cause? • Heart block • What do you give for Tx? • Antitoxin • Never scrape membrane . What are the different types of Emphysema and their causes? • Bullous? • Staph aureus • Pseudomonas • Centroacinar? • Smoking . What are the different types of Emphysema and their causes? • Distalacinar? • Aging • Panacinar? • Alpha-1 antitrypsin def . What are the stages of erythropoiesis? • 4 mo gestation? • Yolk sac • 6 mo gestation? • Spleen. liver. flat bones . What are the stages of erythropoiesis? • 8 mo gestation? • Long bones • 1 yr old? • Long bones . If long bones become damaged after 1 yr what takes over? • Spleen can resume erythropoieses causing splenomegaly . What ions correspond with the following EKG? • P-wave? • Ca+ • QRS complex? • Na+ • S-T? • Ca+ . What ions correspond with the following EKG? • T-wave? • K+ • U-wave? • Na+ . What do Na+ channel blockers do to the EKG? • QRS . What do Ca+ channel blockers do to the EKG? • Widens P-wave • PR interval longer . P. Clue 4 Bio Stat D W + A B A+B _ C D C+D A+C B+D Sensitivity Specificity PPV NPV OR A/A+C D/B+D A/A+B D/C+D AD/BC RR (A/All)/(C/All) AR (A/All)-(C/All) ALL Sensitivity: Truly Diseased People Specificity: Truly Well People + Predictive Value: Test +ve With DZ .P.Predictive Value: Tested –ve w/o DZ OR: Odds Ratio RR: Relative Risk AR: Attributed Risk Always in the numerator A&D . In EKG P-wave Represents? • Atrium contraction • Phase zero • Calcium . In EKG P-R Interval means? • AV Node • Phase 2 • Sodium . In EKG Q-Wave means? • Septum • Phase 2 • Sodium . In EKG R-upstoke means? • Anterior wall • Phase 2 • Sodium . In EKG S-down stroke means? • Posterior wall • Phase 2 • Sodium . In EKG S-T Interval means? • Ventricle • Phase 2 • Calcium . In EKG T-wave means? • Ventricle • Phase 3 • Potassium . In EKG U-wave means • Ventricle • Phase 4 • Sodium . 4 DZ associated with HLADR 2? • Narcolepsy • Allergy (hay fever) • Goodpasture • MS . 5 DZ associated with HLADR 3? • DM • Chronic active Hepititis • Sjogrens • SLE • Celiac sprue . DZ associated with HLA-DR 3&4? • IDDM (DM Type 1) . DZ associated with HLA-DR 4? • Rheumatoid Arthritis • Pemphigus Vulgaris . DZ associated with HLA-DR 5 • JRA (JUV RA) • Pernicious anemia . DZ associated with HLA-DR 7? • Nephrotic syndrome (Steroid induced) . DZ associated with HLA-DR 3 and HLA-B 8? • Celiac Disease . DZ Associated with HLA-A3? • Hemochromatosis – – chromosome 6 point mutation Cystine to Tyrosine . DZ Associated with HLA-A 3? • Myasthenia gravis . DZ Associated with HLA-B 13? • Psoriasis . 5 DZ Associated with HLA-B 27? • Psoriasis – only if with arthritis • Ankylosing Spondylities • IBD – Ulcerative Cholitis • Reiter’s • Post gonococcal arthritis . DZ Associated to HLA-BW 47 • 21 alpha hydroxylase deficiency – Vit. D . Facts about Diphtheria • ADP ribosylates EF-2 • Stops cell synthesis • Gr +ve • Gets exotoxin from virus via transduction • Heart block • Its toxoid therefore give antitoxin . MCC of Pneumonia in 6wks to 18 yrs? • RSV (infants only) • Mycoplasma • Chlamydia pneumonia • Strep pneumonia . MCC Pneumonia in 18 yrs to 40 yrs of age? • Mycoplasma • Chlamydia pneumonia • Strep. Pneumonia . MCC of Pneumonia in 40 yrs to 65 yrs of age? • Strep pneumonia • H. influenza • Anaerobes . influenza • Gr –ve rods .MCC of pneumonia in the Elderly? • Strep pneumonia • Viruses • Anaerobes • H. What are 4 Clues for IgA? • Monomer in blood • Dimer in secretion • Located on mucosal surface • Found in secretion . What are Clues for IgD? • Only functions as surface marker for Mature B-Cell . What are Clues for IgE? • Immediate hypersensitivity/anaphylaxis • Parasite defense • Worms • Fc region binds to mast cells and basophils • Allergies • Does Not fix complement . What are Clues for IgG? • Highest affinity • Memory respond at day 3 five times the • • • • • • • • concentration Peaks in 5 years last for 10 years Opsonizes Activates complement 2nd to show up in primary response Only one to show up for secondary respond Most abundant Ig in newborn Antigenic differences in heavy chain and site of di-sulfide bond 4 subclasses G1 to G4 . What are Clues for IgG1? • Crosses placenta due to fc portion . What are Clues for IgG2? • Most common sub-class deficiency • Patient susceptible to encapsulated organisms . What are Clues for IgG3? • Most memory antibody . What are Clues for IgG4? • Only IgG NOT fixing complement . What are Clues for IgM? • Responds in primary response • Most efficient in agglutination and complement fixation • Defenses against bacteria and viruses . What do Macrophages release? • MHC II . What does TH1 secrete? • IL-2 • IF.Gamma . What does TH2 Secrete? • IL-4 • IL-5 • IL-6 • IL-10 . What does TH-0 secrete? • TH-1 • TH-2 . MHC-1 are also called what? • CD8 • CD8 becomes T-cytotoxic cells . All T-Cells express what? • CD-3 • For what? • Signal transduction • CD-2 • For what? • Adherence . What do CD-4 cells Become? • T helper cells . What do CD-8 cells Become? • T cytotoxic cells . .Neutrophils produce what enzymes and what is their action? • Myeloperoxidase • NADPH • Will kill ALL Gr+ve – Ex.Hydrogen peroxide kills gr+ . What do T-cells stimulate? • Clue 4x7=28 • CD-4 • B-7 • CD-28 . What are the Clues for Type-1 Hyperlipidemia? • Increased Chylomicron • Deficiency of Lipoprotein lipase enzyme • Defect in liver only . What are the Clues for type-2 hyperlipedimia? • Increased LDL • Two types IIa and IIb • Type IIa Receptor deficiency for LDL or missing B-100 • Type II-b (LDL and VLDL problems) enzyme deficiency for LDL at adipose. Most common in General Population . Receptor problem for VLDL. What are the Clues for type-3 Hyperlipedimia? • Increased IDL • Receptor problem for APO-E . What are the Clues for Type-4 hyperlipedimia? • Increased VLDL • Lipoprotein lipase enzyme deficiency at adipose tissue . What are the Clues for Type-5 hyperlipedimia? • Combination of Types 1&4 • Increased Chylomicron and VLDL • Enzyme and receptor deficiency at C-II • Most common in diabetics . What is a Xanthoma? • Deposition of Cholesterol on elbows • Can cause what? • CAD . What is a Xanthelasma? • Deposition of Triglycerides on eyelids. face • Can cause what? • Pancreatitis . Description of Rashes . ERYTHEMA MARGINATUM • • • Little red spots w/ bright red margins Sandpapery RF.Jones critera . ERYTHEMIA CHRONICUM MIGRANS • Lymes disease • Target lesions (bulls eye) . MEASLES • Morbiliform rash • Preceded by cough • conjunctiivitis . ROSEOLA • Fever x 2 day • Followed by rash • ONLY ONE WITH RASH FOLLOWING FEVER (HHV 6) . ERYTHEMA NODOSUM • Anterior aspect of leg • Redness • Tender nodules . #2 drugs (sulfas) • Moderate: Stevens-Johnsons Syndrome • Severe: Toxic epidermal necrolysis .Erythema multiforme • Red macules. skin peels off . target lesions • Causes: allergy. viruses • Mild: MCC virus. SEBORRHEIC DERMATITIS • Scaly skin with oily shine on headline . SEBORRHEIC KERATOSIS • Stuck on warts • Due to aging . PSORIASIS • HLA-B27 • Extensor surfaces • Silvery white plaques • Scaly skin • Pitted nails . VARICELLA ZOSTER HHV 3 • • • • • • STAGES Red macules Papules Vesicles Pustules then scabs Different stages may appear at same time . with diarrhea • Assoc. thighs • Assoc.DERMATITIS HERPATIFORMIS • Rash and blisters on ant. with flare up of celiac sprue . TYPHOID FEVER • SEEN WITH SALMONEALLA INFXN • Rose spots assoc. with intestinal fire . DERMATOMYOSITIS • Heliotropic rash . ERYSIPELAS • Reddened area on skin w/ raised borders • DOES NOT BLANCH . TINEEA CRURIS • Redness • Itchy groin . PITYRIASIS ROSEA • Herald patch= dry skin patches that follow skin lines • HHV 7 . K.A. upside down christmas tree • Tx: Griseofulvin .TINEA VERSICOLOR • Hypopigmented macules on upper back • Presents in a V pattern • A. What do you see in SCABIES? • Linear excoriations on belt line and finger webs • What is the tx? • Lindane • Permethrin . What is a T-CELL DEFICIENCY? • DiGeorges • What ion imbalance will they have? • Hypokalemia • What did not form? • 3rd and 4th pharyngeal pouch • What chromosome? • Deletion on chromosome 22 . T-CELL DEFICIENCY • HIV • Also B-cell but less so . What is MYCOSIS FUNGOIDES? • NOT A FUNGUS • Non-Hodgkins form of cutaneous Tcell lymphoma . What is the job of CHYLOMICRONS? • Transport TG’s from GI to liver and endothelium . What is the job of VLDL? • Transports TG’s from liver to adipose . What is the job of IDL? • Transports TG’s from adipose to tissue . What is special about LDL’s? • ONLY ONE THAT CARRIES CHOLESTEROL . What do you develop with HYPERTRIGLYCERIDEMA? • XANTHELASMA • Where are they located? • On eyelids and eyebrows . What do you develop with HYPERCHOLESTEROLEMIA? • Xanthomas • Where are they located? • elbows . Where is VLDL made? • ONLY ONE MADE IN THE LIVER . What are IDL AND LDL formed from? • ARE BREAK DOWN PRODUCTS OF VLDL . What are the clues for HEMOPHILIUS INFLUENZA? • Gram -/+? • Pleomorphic gram (-) rods • What pattern? • “school of fish pattern” • What type is most common? • Type A – 80% . What are the clues for HEMOPHILIUS INFLUENZA? • Capsule or no capsule? • non-encapsulated • Invasive or non invasive? • non-invasive . What are the clues for HEMOPHILIUS INFLUENZA? • Most common cause of what? • Sinusitis • Otitis • Bronchitis . What are the clues for HEMOPHILIUS INFLUENZA? • What is the 2nd most common type? • TYPE B – 20% • Encapsulated or non encapsulated? • Encapsulated • What does it have in its capsule? • Polyribosyl phosphate in capsule • Contains IgA protease . What are the clues for HEMOPHILIUS INFLUENZA? • Invasive or non invasive? • Invasive • What does it cause most often? • #1 cause of epiglottitis • What are the signs of epiglottitis? • Stridor • Fever • Thumb sign on xray . What are the most common causes of MENINGITIS corresponding with the following ages? • 0-2 months? • #1. Group B strep (agalactiae) • #2. coli • #3. Listera . E. What are the most common causes of MENINGITIS corresponding with the following ages? • 2 Months.10 years? • #1. strep pneumonia • #2. meningitides • (adolescent years only) . n. meningitides . n.21 yrs? • #1.What are the most common causes of MENINGITIS corresponding with the following ages? • 10yrs. What are the most common causes of MENINGITIS corresponding with the following ages? • > 21 years old? • #1 S. pneumoniae . Answer the following about the Strep.6 months • What strain does it cover? • Covers 23 strains (98% cases) .4. Pneumonia vaccine. • At what age is it given? • Given at 2. Answer the following about the Strep. Pneumonia vaccine. • Indications? • Anyone> 65y/o • Anyone splenectomized – Sickle cell anemia • Anyone with end-organ damage – – – CF RF Nephrotic Syndrome . STREP PYOGENES is the most common cause of what? • MCC of all throat infections • #2 MCC of all what? • Skin infections except lines . saprophyticus? • No pigment . aureus? • Gold pigment • St. epidermidis? • White pigment • St.What are the STAPHYLOCOCCUS PIGMENTS? • St. What is the clue for RUSTY COLORED SPUTUM? • Strep. Pneumonia – pneumococcus . Pyogenes • Small Intestine Infections? • Say E. Aureus • Throat Infections? • Say Strep. coli .Clues for GENERAL INFECTIONS • Skin Infections? • Say Staph. What disease is a NEUTROPHIL DEFICIENCY & T.B cell deficiency? • Job Syndrome: • IL-4 • Hyper IgE • What do they look like? • Red hair • Fair complexion • Female . What are the NEUTROPHIL DEFICIENCY? • NADPH-OXIDASE DEF (CGD) • NEUTROPENIA • MYLOPEROXIDASE • Job-Buckley Syndrome . What Hepatitis B antigen is found with an acute/recent infection? • HbC antigen • HbS antigen . What Hepatitis B antigen & antibody is found with an acute/recent infection? • HbC antigen • HbS antigen • HbC antibody . What Hepatitis B antigen is found with Recent immunization within the past 2wks? • HbS antigen ONLY . What Hepatitis B antibody is found with Recent immunization two wks after and can be due to vaccination immunity from a long time ago? • HbS antibody ONLY . What Hepatitis B antibody & antigen is found with past disease but now immune? • HbC antibody • HbS antibody • HbS antigen . What Immunogloblin is found in Hepatitis B immunity? • IgG . What Hepatitis B antigen/antibody is found in the chronic carrier state? • HbS antigen for >6months • Can be with or without HbS antibody . What Hepatitis B antigen is found with the infectious state? • HbE antigen . What Hepatitis B antibody is found with the non-infectious state? • HbE antibody . If patient has recovered from Hepatitis B what antigen will they have? • NEGATIVE HbS antigen . If patient is a chronic carrier what antigen will they have? • POSITIVE HbS antigen . What does the “window period” build in Hepatitis B? • HbE antibody • IgM HbC antibody • What disappears? • HbS antigen . What is the incubation period for Hepatitis B? • 4 to 26 wks • Average @ 8wks . How long is the acute disease period in Hepatitis B? • 4 to 12 wks . How long is the convalescence period in Hepatitis B? • 4 to 20 wks . How long is the recovery period for Hepatitis B? • YEARS . Answer the following about HIV? • MC infection? • CMV • MCC of death? • PCP • What is p41 used for? • Just a marker . Answer the following questions about HIV? • What does Gp120 do? • Attachment to CD4 • What is Pol used for? • Integration • What is reverse transcriptase used for? • Transcription • What are p17 & p24 antigens used for? • Assembly . Answer the following questions about HIV? • What is the normal CD4 count? • 800-1200 • What can the CD4 count be up to in children? • 1500 • When do you begin treating with 2 nucleotide inhibitors and 1 protease inhibitor? • <500 – (child at 750) . Answer the following questions about HIV? • AIDS is defined as a CD4 count of what? • <200 • With a CD4 count of <200 what do you tx for? • PCP • What do you treat for when CD count is <100? • Mycobacterium aviam intracellular . What are the Antioxidants? • Vitamin E – #1 • Vitamin A • Vitamin C • Betakertine . What is Vitamin A a cofactor for? • Parathyroid • Along with what other cofactor? • Mg+ . Too much Vitamin A will cause what? • Hyperparathyroid – Increase Ca+ – Decrease Phosphate • What will be the symptoms? • Goans • Moans • Bones • Stones . Too much Vitamin A will cause what? • Pseudotumor Cerebri – Increase CSF production from Chorichoid Plexus . What is the only cause of ICP that does not cause herniation? • Pseucotumor cerebri . What does Vitamin A deficiency cause? • Nightvision problems/nightblindness • Hypoparathyroidism – Decrease Ca+ – Increase Phosphate . What is Vitamin B1? • THIAMINE • What do you get with a decrease in thiamine? • Beri Beri • What is the most common cause in US? • ETOH . What do you get with Vitamin B1 deficiency? • Wet Berry Berry • With heart failure • Dry Berry Berry • Without heart failure . What do you get with Vitamin B1 deficiency? • Wernicke’s Encephalopathy • Wernicke’s Korsakoff . What is Wernicke’s Encephalopathy? • Alcoholic thymine deficiency of the Temporal Lobe . What is Wernicke’s Korsakoff? . What needs B1 as a Cofactor? • 3 Dehydrogenases • Pyruvate dehydrogenase • Alpha ketoglutarate dehydrogenase • Branch chain amino acid dehydrogenase • Transketolase . What is B2 • Riboflavin • What is a physical sign of this deficiency? • Angular stomatitis • Angular cheliosis • Corneal Neurovasculazations . What is the best source of B2? • Milk • Also from FAD . What is B3? • Niacin • What is the clue? • Diarrhea • Dermatitis • Dementia • Death . What is the disease that presents like B3 deficiency? • Hartnup Disease • What is deficient in this disease? • Tyrptophan • What is typtophan needed for? • Needed for niacin formation . What is B4? • Lipoic acid • What is the deficiency caused by this vitamin? • Not one . What is B5? • Pantothenic acid • What is the deficiency caused by this vitamin? • You guessed it…nothing . What is B6? • Pyridoxine • What is the deficiency caused by this vitamin? • Neuropathy • Seizures • Who do you need to give B6 to? • Patient on INH . What type of anemia is seen with B6 Deficiency? • Sideroblastic . What needs B6 as a cofactor? • ALL transaminases . What is B12? • Cyanocobalamine • What is the deficiency caused by this vitamin? • Pernicious anemia • Neuropathy . What is the most common cause of vitamin B12 deficiency? • Pernicious anemia . What 2 enzymes are needed for synthesis of B12? • Methylmalonyl CoA Mutase • Homocysteine Methyl Transferase . Deficiency in Methylmalonyl CoA Mutase leads to what? • Neuropathy • Why? • Because it recycles myelin . Deficiency in Homocystiene Methyl Transferase leads to what? • Megaloblastic anemia • What else is this enzyme needed for? • Nucleotide synthesis . RIBOFLAVIN deficiency .When is ANGULARE STOMATOSIS seen? • VITAMIN B2. What are the 4 D’S of pellegra? • DIARRHEA • DERMATITIS • DEMENTIA • DEATH . What causes a NEUROPATHY WHEN DEFICIENT & also needs TRANSAMINASE? • PYRIDOXINE B6 . What vitamin is deficient with PERNICIOUS ANEMIA & NEUROPATHY? • B12 CYANOCOBALAMINE . What is the first vitamin to run out with disease of rapidly dividing cells? • Folate . What type of anemia is seen with Folate deficiency? • Megaloblastic anemia • With neuropathy? • NO NEUROPHATHY • What else is Folate used for? • Nucleotide synthase (THF) . What is another name for Vitamin C? • Ascorbate acid . What is Vitamin C needed for? • Collagen synthesis . What happens with Vitamin C deficiency? • Scurvy . What is the CLUE for Scurvy? • Bleeding gums • Bleeding hair follicles . What is the most common cause of Vitamin C deficiency? • Diet deficient in citrus fruit • Diet deficient in green vegetables • Over cooked green vegetables . What does Vitamin D do with Ca+? • Controls Ca+ • Absorbes Ca+ from GI • Reabsorbs Ca+ in Kidneys • Controls osteoblastic activity . What does Vitamin D deficiency cause in Children? • Ricketts • What does it cause in ADULTS? • Osteomalcia . What is the CLUE for RICKETTS? • Lateral Bowing of the Legs • X-linked dominant . What is Vitamin E needed for? • Hair • Skin • Eyes • Protection against free radicals • #1 antioxidant . What does a deficiency of Vitamin E cause in newborns? • Retinopathy . What are the vitamins from GI that are normal flora? • Folate • Vitamin K – 90% • Biotin • Panothenic acid • Helps with absorption of B12 . What are the Vitamin K dependent clotting factors? • 1972 • Protein C • Protein S • Which one has the shortest half-life? • Protein C • Which one has the 2nd shortest half-life? •7 . What are the TRACE elements? • Chromium • Selenium • Manganese Molebdenum • Tin . What is Chromium needed for? • Insulin action . What organ needs Selenium? • Heart . What trace element is an enzyme in glycolsis? • Manganese Molebdenum . What organ needs Tin? • Hair . What does a deficiency in Zinc cause? • Dysguzia • Decrease sperm • Dry hair • Dry skin . Cofactor for ALL Kinases? • Mg+ . Cofactor for ALL Carboxylases? • Biotin . Cofactor for ALL Transaminases? • Pyridoxine – B6 . What is Biotin a cofactor for? • ALL carboxylases . What is Mg+ a cofactor for? • ALL kinases • Parathyroid along with Vitamin A . What is Ca+ needed for? • Muscle contraction • Axonal transport • 2nd messengers . What tracts are affected due to deficiency in Methyl Malonyl CoA Mutase? • Dorsal Columns • Cortical Spinal Tracts • Why are these affected? • Because they are the longest • Because they need the most myelin . What enzyme does Zanthein Oxidase need? • Maganese Molebdenum . How are drugs that are bioavailable ALWAYS excreted? • By the liver • Always Hepatotoxic . How are soluble drugs ALWAYS excreted? • By the kidney • Always nephrotoxic . What are the 5 P’S OF COMPARTMENT SYNDROME? • Pain • Pallor • Paresthesia • Pulselessness • Poikilothermia . Pyogenes is the number one cause? • Lympangitis • Impetigo (not bullous) • Necrotizing fascitis • Erysepelas • Scarlet fever .What are 5 skin infections were Strep. aureus is the number two cause? • Lympangitis • Impetigo (not bullous) • Necrotizing fascitis • Erysepelas • Scarlet fever .What are 5 skin infections were Staph. What is the #1 bacteria causing infection associated in shunts and central lines? • Staph epidermitis . What is the #1 bacteria causing infection in peripheral lines? • Staph aureus . COLI in the gut? • Absorption of Vit.Why do we need E. B12 • Synthesis of: • -Vitamin K • -Biotin • -Folate • -Pantothenic acid – B5 . Answer the following questions about RESTRICTION ENZYMES? • Trypsin cuts where? • cuts to R of • Arg • Lys • Chymotrypsin cuts where? • cuts to R of bulky aa’s (aromatics) • Phe • Tyr • Trp . Answer the following questions about RESTRICTION ENZYMES? • Elastase cuts where? • Cuts to R of (“SAG”) • • • Ser Ala Gly • CNBr cuts where? • Cuts to R of • Methionine . Answer the following questions about RESTRICTION ENZYMES? • Mercaptoethanol cuts where? • Cuts to R of: disulfide bonds – Cysteine – methionine . Answer the following questions about RESTRICTION ENZYMES? • Aminopeptidase cuts where? • Cuts to R of • amino acid terminal • Caboxypeptidase cuts where? • Cuts to L of • carboxy terminal . What is THE ONLY LIVE VACCINE INDICATED IN AIDS PATIENTS? • MMR . is Allergic to EGG? • MMR & INFLUENZA .What VACCINE is NOT GIVEN IF pt. What VACCINE is NOT GIVEN IF patient HAS YEAST ALLERGIES? • Hepatitis B . What 3 VACCINES DROP OUT AFTER 6 YEARS OF AGE? • Hib • Diphtheria • Pertussis . What is the MC STRAIN OF STREP PYOGENES TO CAUSE GN? • Strain 12 . What 2 substances are in NEUTROPHILS? • Myeloperoxidase • NADPH Oxidase . MACROPHAGES CONTAIN what SUBSTANCE? • NADPH Oxidase • Which means they only kill what? • Kills only G -ve . What do MACROPHAGES SECRETE? • IL-1 • IL-6?? . What DRUGS CAUSE PAINFUL NEUROPATHY? • DDI>DDC • Pancreatitis . What are the MITOCHONDRIAL DISEASES? • • • • • • • • • Leigh’s Disease What is another name? Subacute necrotizing encephalomyelopathy What are the signs & symptoms? Progressively decreasing IQ Seizure Ataxia What is the deficiency? Cytochrome oxidase deficiency What are the MITOCHONDRIAL DISEASES? • Leber’s Hereditary Optic Atrophy (LHON) • They all die What is the ONLY G +ve WITH ENDOTOXIN? •Listeria • What part is toxic? • Lipid A • Does it cross the placenta? • Yes What does Listeria activate? • T-cells & Macrophages, therefore, have granulomas What are the Associations in contracting the Listeria bug? • Raw cabbage • Spoiled milk • Migrant workers What are the PERIODS OF RAPID GROWTH/RAPIDLY DIVIDING CELLS? • Birth – 2 months • 4 – 7 years old • Puberty What is THE ONLY IMMUNE DEFICIENCY WITH LOW CALCIUM and Increase Phosphate? • DiGeorge’s Syndrome What are the BASIC AMINO ACIDS? • Lysine • Arginine What are the ACIDIC AMINO ACIDS? • Glutamate • Aspartate What are the Ketogenic + Glucogenic Amino Acids? • Phenylalanine • Isoleucine • Trptophan • Threonine What are the AROMATIC AMINO ACIDS? • Phenylalanin • Tyrosine • Tryptophan What are the AMINO ACIDS with DISULFIDE BONDS? • Met • Cyst What are the “KINKY” AMINO ACID? • Proline What are the SMALLEST AMINO ACID? • Gly What are the AMINO ACIDS with O-BONDS? • Serine • Threonine • Tyrosine What are the AMINO ACIDS with N-BONDS? • Asparagine • Glutamine What are the BRANCHEDCHAIN AMINO ACIDS? • Leu • Iso • Val What are the KETOGENIC AMINO ACIDS? • Leu • Lys . What CONDITIONS are ASSOCIATED WITH HLA-B27? • Psoriasis (with arthritis) • Ankylosing Spondylitis • Irritable Bowel Syndrome • Reiter’s Syndrome . What is associated with HLAB13? • Psoriasis with out arthritis . What are the ORGANISMS WITH IgA PROTEASE (resistant to IgA)? • Strep. influenza • Neisseria catarrhalis . Pneumoniae • H. What do EOSINOPHILS SECRETE? • Histaminase • Arylsulfatase • Heparin • Major Basic Protein . What do MAST CELLS SECRETE? • In an Acute Reaction? • Histamine • In a Late Reaction • SRS-A • ECF-A ? . What is the MCC of ATYPICAL PNEUMONIA? • 0 – 2 months? • chlamydia pneumonia . What does chlamydia pneumonia cause? • Intersitital pneumonia . → 10 beats/min ↑ in pulse rate) .What is the CLUE for HEART BLOCK? • High temperature with NORMAL pulse rate! (This should never be! Each degree ↑ in temp. What are the clues for IL-1? • FEVER • NONSPECIFIC ILLNESS • RECRUITS TH CELLS for LINKING with MHC II COMPLEX • SECRETED BY MACROPHAGES . What are the clues for IL-2? • MOST POTENT OF THE Interleukins • RECRUITS EVERYBODY • MOST POWERFUL CHEMO-ATTRACTANT • MUST BE INACTIVATED • When must you inactivate it? • PRIOR TO TRANSPLANTATION by cyclosporin • SECRETED BY TH1 CELLS . What are the clues for IL-3? • ENERGIZED MACROPHAGES • CAUSES B-CELL PROLIFERATION • LABELED BY THYMIDINE (USE POKEWEED MITOGEN OR ENDOTOXIN) • SECRETED BY ACTIVATED T CELLS . What are the clues for IL-4? • B-CELL DIFFERENTIATION • RESPONSIBLE FOR CLASS SWITCHING • SECRETED BY TH2 CELLS . What are the clues for IL-5 thru 14? • They do exactly what IL-1 thru IL4 . What are the clues for IL10? • SUPPRESSES CELL-MEDIATED RESPONSE (tells macrophages and fibroblasts to stay away if bacterial) • INHIBITS MAC ACTIVATION . therefore. TH2. ↑ host defenses against delayed hypersensitivity .What are the clues for IL12? • PROMOTES CELL-MEDIATED RESPONSE (recruits macs & fibroblasts if NOT bacterial) • ACTIVATES NK CELLS TO SECRETE IF-γ • INHIBITS IL-4 INDUCED IgE SECRETION • CHANGES TH CELLS to TH1 CELLS – secretes IL-2 & IF-γ → inhib. What are the clues for IF-α? • Where is it from? • LEUKOCYTES • ↓VIRAL REPLICATION AND TUMOR GROWTH • ↑ NK ACTVITY – secretes perforins and granzymes to kill infected cell • ↑MHC CLASS I & II EXPRESSION • ↓ PROTEIN SYNTHESIS – translation inhibited. therefore. defective protein synthesis . Summary of clues for IF-α? • Increase NK activity • Increase MHC class I & II • Decrease protein synthesis • Decrease viral replication and growth . What are the clues for IF-B? • Where is it from? • FIBROBLASTS • Increase NK activity • Increase MHC class I & II • Decrease protein synthesis • Decrease viral replication and growth . What are the clues for IFgama? • Where is it from? • T-CELLS & NK CELLS • ↑ NK ACTIVITY • ↑MHC CLASS I & II • ↑ MACROPHAGE ACTIVITY • CO-STIMULATES B-CELL GROWTH & DIFFERENTIATION • ↓ IgE SECRETION . What are the clues for TNFalpha? • • • • • • • • • Where is it from? MONOCYTES & MACROPHAGES What is another name for TNF-alpha? CACHECTIN INDUCES IL-1 ↑ ADHESION MOLECULES & MHC CLASS I ON ENDOTHELIAL CELLS PYROGEN INDUCES IF-γ SECRETION CYTOTOXIC/CYTOSTATIC EFFECT . What are the clues for TNFbeta? • Where is it from? • T-CELLS • What is another name for it? • LYMPHOTOXIN • CYTOTOXIC FACTOR . What are the clues for TGFα? • Where is it from? • SOLID TUMORS (CARCINOMA > SARCOMA) • MONOCYTES • What is another name for it? • TRANSFORMING GROWTH FACTORS . What are the clues for TGFα? • What does it INDUCE? • ANGIOGENESIS • KERATINOCYTE PROLIFERATION • BONE RESORPTION • TUMOR GROWTH • What is it mainly for? • MAINLY FOR TUMOR GROWTH . What are the clues for TGFβ? • Where is it from? • PLATELETS • PLACENTA • KIDNEY • BONE • T & B CELLS . What are the clues for TGFβ? • What INDUCES it? • FIBROBLAST PROLIFERATION • COLLAGEN • FIBRONECTIN SYNTHESIS . What are the clues for TGFβ? • What INHIBITS it? • NK • LAK • CTL • T & B CELL PROLIFERATION . What are the clues for TGFβ? • What ENHANCES it? • WOUND HEALING • ANGIOGENESIS . What are the clues for TGFβ? • What does it suppress? • SUPPRESSES IR AFTER INFECTION & PROMOTES HEALING PROCESS • What is it mainly for? • MAINLY FOR WOUND HEALING . What does LAK stand for? • LYMPHOKINE ACTIVATED KILLER CELLS . What does CTL stand for? • CYTOTOXIC T-LYMPHOCYTES . What does mitochondrial inheritance affect? • CNS • Heart • Skeletal muscle • Why does it affect these particular places? • Due to uneven cytokinesis during meiosis or oogenesis . Answer the following about Mitochondrial diseases? • Who are affected? • All offspring • Who passes the disease? • MOM • Who has no transmission? • Dad . Answer the following about Autosomal Recessive inheritance? • Who does it show in? • Not parents • Siblings/uncles may show disease • When is onset? • Early in life (childhood diagnosis) • Is it complete on incomplete penetrance? • COMPLETE . Answer the following about Autosomal Recessive inheritance? • How are they acquired? • Almost ALL are inborn error of metabolism • When does it occur? • Only when both alleles at a locus are mutant . Answer the following about Autosomal Recessive inheritance? • How is it transmitted? • Horizontal Tm • Are there malformations present? • Physical malformations are uncommon • What type of defect? • Enzyme defect . Answer the following about Autosomal Dominant inheritance? • Who does it affect the most? • M=F • How does it manifest? • Heterozygote state • Who can transmit the disease? • Both parents . Answer the following about Autosomal Dominant inheritance? • Where is the new mutation? • Often in germ cells of older fathers • When is onset? • Often delayed (adult diagnosis) – Example = Huntington’s . Answer the following about Autosomal Dominant inheritance? • What is penetrance? • Reduced penetrance • How is it expressed? • Variable expressin – Different in each individual . Answer the following about Autosomal Dominant inheritance? • How is it transmitted? • Vertical TM • Is there malformation present? • Physical malformation common • What type of defect? • Structural . Who is affected in the family with an X-Linked disease? • Maternal grandfather • Maternal uncle . Immune System Time Line for viral & cell-mediated. • What happens <24hrs? • Swelling • What happens at 24 hrs? • Neutrophils show up • What happens at day 3? • Neutrophils peak . Immune System Time Line for viral & cell-mediated. • What happens at day 4? • T cells and Macrophages show up • What happens at day 7? • Fibroblasts show up • What happens in 1 month? • Fibroblast peak . Immune System Time Line for viral & cell-mediated. • What happens at 3-6 months? • Fibroblasts are gone . What is the general CLUE for any Lysosomal Storage Disease? • Lysosomal Inclusion Bodies . What are the Lysosomal Storage diseases? • Gauchers • Fabrys • Krabbe • Tay Sachs • Sandhoffs • Hurlers • Hunters • Neiman Pick • Metachromatic Leukodystropy . What is missing in Gauchers? • Beta-Glucocerberosidase • What Accumulates? • Glucocebroside • • • • • Where? Brain Liver Bone Marrow Spleen . What are the CLUES for Gauchers? • Ask. Jew • Gargols • Gaucher cells – Macrophages looking like Crinkeled paper • Erlin myoflask legs • Pseudohypertrophy . What is missing in Fabrys? • Alpha-galactosidase • What accumulates? • Ceramide Trihexoside . What are the CLUES for Fabrys? • X-Linked recessive • Presents with cataracts as a child • Presents with renal failure as a child . What is missing in Krabbes? • Galactosylceramide B-Galactosidase • What accumulates? • Galactocerebrosidase • Where? • Brain What are the CLUES for Krabbes? • Early death • Globoid bodies – Fat cells What is missing in Tay Sachs? • Hexoseaminidase A • What accumulates? • GM2 Ganglioside What is the CLUE for Tay Sachs? • Ask. Jews • Cherry red macula • Death by 3 What is missing in Sandhoffs? • Hexoseaminadase A & B What is missing in Hurlers? • Iduronidase What are the CLUES for Hurlers? • Corneal Clouding • Mental Retardation What is missing in Hunters? • Iduronate Sulfatase What are the CLUES for Hunters? • Mild mental retardation • No corneal clouding • Mild form of Hurlers • X-linked recessive What is missing in Niemann Picks? • Spingomyelinase • What accumulates? • Spingomyelin • Cholesterol What are the CLUES for Niemann Picks? • Zebra bodies • Cherrry red macula • Die by 3 What is missing in Metachromatic Leukodystrophy? • Arylsulfatase A What is the CLUE for Metachromatic Leukodystrophy? • Visual Disturbance • Presents like MS in 5 to 10 years of age What are the Glycogen Storage Diseases? • Von Gierkes • Andersons • Corys • McCardles • Pompes • Hers What is deficient in Von Gierkes? • G-6-Pase Deficiency What is the CLUE for Von Gierkes? • Big Liver • Big Kidney • Severe hypoglycemia • Can NEVER raise their blood sugar What is deficient in Andersons? • Branching enzyme deficiency What is the CLUE for Andersons? • Glycogen will be ALL LONG chains on liver biopsy . What is missing in Corys? • Debranching enzyme . What is the CLUE for Corys? • Glycogen from liver biopsy will be ALL SHORT branches . What is missing in McCardles? • Muscle phosporalase . What is the CLUE for McCardles? • Severe muscle cramps when exercising • High CPK . 4 glucocydase .What is missing in Pompes? • Cardiac alpha-1. What is the CLUE for Pompes? • Heart problems • Die early . What is missing in Hers? • Liver phosphoralase . What is the CLUE for Hers? • Big Liver • NO big kidney . Pagets disease is associated with what cancer? • Intraductal Ca . What MUST you rule out with a decrease AVO2? • AV Fistula • Vasodilation . What diseases have a cherry red macula? • Tay Sachs • Sandhoffs • Niemann Pick . What is translocation 9.22? • CML . 22? • Ewing’s sarcoma .What is translocation 11. 14? • Burketts lymphoma .What is translocation 8. 18? • Follicular lymphoma .What is translocation 14. What are the causes of restrictive cardiomyopathy? • Sarcoid • Amyloid • Hemochromatosis • Cancer • Fibrosis • Thanks STAN!! . What are the CLUES for Vasulitis or Intravascular Hemolysis? • Shistocytes – – Burr cells Helmet cells . What is the CLUE for Extravascular Hemolysis? • Splenomagely . Where is Glucose 6-Pase present? • Adrenal • Liver . What is the Heinz body CLUE? • G6PD . what should you be thinking? • Lead poisoning .If you see the CLUE basophilic stippling. What are the Microcytic Hypochromic Anemias? • Iron deficiency • Anemia of Chronic disease • Lead poisoning • Hemoglobinopathy • Thallasemia’s • Sideroblastic anemia . What is primary sideroblastic anemia due to? • Genetic • AD . What is secondary Sideroblastic anemia due to? • Blood transfusions . What are the Microcytic Hyperchromic Anemia’s? • Hereditary Spherocytosis . What are the Normocytic Normochromic Anemia’s? • Acute hemorrhage • Anemia of Chronic Disease • Hypothyrodism – Early • Renal Failure . What are the Macrocytic anemia’s? • Folate deficiency • B12 deficiency • Reticulocytosis • ETOH • Hemolytic Anemias • Chemo Treatment • Anticonvulsants • Myelodysplasia . What are the anticonvulsants causing a Macrocytic Anemia? • Phenytoin • Ethusuximide • Carbamyazapine • Valproate . What anemia is caused by blood transfusions? • Sideroblastic anemia . What is the problem if you see Eliptocytes? • Something is wrong with the RBC membrane – Extravascular • Heridatary Ellitocytosis • Increased RET count . What disease do you get if you have an EXCESS in Cu+? • Wilson’s Disease . What is the CLUE for Wilson’s Disease? • Hepato/Lenticular Degeneration • Kayser Fleishner Rings – Copper in eyes • Hepato = Liver • Lenticular = Movement problem . What is Copper needed for? • Collagen synthesis . What disease manifest with Cu+ deficiency? • Minky Kinky Hair Syndrome . What are the plasma catecholamines? • Epinephrine • Norepinephrine • Dopamine . What are Plasma Catecholamines derived from? • Tyrosine . A patient with episodic HTN leading to headache with arrhythmias leading to palpitations most likely is diagnosed with? • Adrenal Pheochromocytoma . What is the MOA for Fluroquinolones? • Blocks DNA gyrase (topoisomerase II) • Inhibits p450 . What do Fluroquinolones cover? • All Gram + including staph auerus • All Gram – • Atypicals . What are the atypicals? • Chlamydia • Ureoplasma • Mycoplasma • Legionella . What induces Gluconeogensis? • Cortisol • Epinephrine • Glucagon . What is Dermatan Sulfate? • Glycosaminoglycan chain that helps form proteoglycans . What is Hyaluronic Acid? • Glycosaminoglycan chain that helps form proteoglycans . What is the MOA of Methotrexate? • Inhibits dihydrofolate reductase • Inhibits DNA synthesis in the S phase of cycle. • Prevents reduction of folic acid needed to produce THF . What are THF derivatives used in? • Purine nucleotide synthesis • Methylation of dUMP to for dTMP . What happens when Dihydrofolate Reductase is inhibited? • Obstructs one carbon methylation which deprives DNA polymerase of essential substrates . What diseases present as Failure to Thrive? • CF • Galactosemia . In general. what should you always associate Hemolytic Anemia’s with? • Defects in Glycolysis • Defects in Hexose Monophosphate Shunt . What is required for the conversion of Homocysteine to Methionine? • B12 . What is required for the conversion of methylmalonyl CoA to Succinyl CoA? • B12 . What is required for the degradation of cystathionine? • Vitamin B6 . What does the hydroxalation of Purines require? • Vitamin C . When does the carboxyalation of Glutamic acid occurs and what is required for this carboxyalation? • Occurs in the synthesis of Blood Clotting factors • Requires Vitamin K . Decarboxylation of alphaketoacids requires what? • Thiamine . Synthesis of 1.25-dhydroxycholecalciferol requires what? • Vitamin D . Synthesis of Rhodopsin requires what? • Vitamin A . Pyruvate Decarboxylase requires what as a cofactor? • Thiamine . What is CN1? • Olfactory • What is its function? • Sensory for smell • What if lesioned? • Anosmia • Where does it Exit/Enter the Cranium? • Cribriform plate • What does it innervate? • Nasal Cavity . What is CN2? • Optic • What is its function? • Sensory for sight • What if lesioned? • Anopsia – Visual field defect • Loss of light reflex with CN III • Only nerve affected by MS . CN2 • Where does it Exit/Enter the Cranium? • Optic Canal • What does it innervate? • Orbit .Cont. What is CN3? • Occulomotor • What are the functions? • Motor • Moves the eyeball in ALL directions • Adduction Most important action (MR) • Constricts the pupil (Spincter Pupillae) • Accomodates (Cililary Muscle) • Raises eyelid (Levator Palpebrae) . Cont. CN 3 • What if lesioned? • Diplopia • Loss of parallel gaze • Dilated pupil • Loss of light reflex • Loss of near response • Ptosis . CN 3 • Where does it Exit/Enter the Cranium? • Superior Orbital Fissure • What does it innervate? • Orbit .Cont. What is CN 4? • Trochlear • What is its function? • Motor • Superior Oblique • Depresses and abducts the eyeballs • Intorts . CN 4 • What if lesioned? • Weakness looking down w/ adducted eye • Trouble going down stairs • Head tilts away from lesioned side • Where does it Exit/Enter the Cranium? .Cont. Cont. CN 4 • What does it innervate? • Orbit . What is CN 5? • Trigeminal . What are the different branches of CN 5? • V1? • Opthalmic • V2? • Maxillary • V3? • Mandibular . pain. & cornea • • • What if lesioned? Loss of general sensation of the forehead/scalp Loss of blink reflex w/ VII • Where does it Exit/Enter the Cranium? • Superior orbital Fissure – Ophthalmic division .What is the function of CN V1? • Mixed • General sensation (touch. temperature) of the forehead. scalp. CN V1 • What does it innervate? • Orbit • Scalp .Cont. Maxillary face. Nasal cavity.What is the function of CN V2? • Mixed • General sensation of Palat. and Maxillary teeth • What if lesioned? • Loss of general sensation in skin over maxilla & maxillary teeth . CN V2 • Where does it Exit/Enter the Cranium? • Foramen Rotundum • What does it innervate? • Pterygopalatine – Leaves by openings to face. oral & nasal cavity .Cont. mandibular face & mandibular teeth • Motor • Muscles of Mastication and anterior belly of digastric. mylohyoid. tensor tympani.What is the function of CN V3? • What is its function? • Mixed • General sensation of anterior 2/3 of tongue. tensor palati . tongue. weakness in chewing • Jaw deviation to weak side • Trigeminal neuralgia – Intractable pain in V2 or V3 territory .Cont. mandibular teeth. CN V3 • What if lesioned? • Loss of general sensation in skin over mandible. Cont. CN V3 • Where does it Exit/Enter the Cranium? • Foramen Ovale • What does it innervate? • Infratemporal Fossa . What is CN VI? • Abducens • What is its function? • Motor • Lateral rectus – Abducts eye . Cont. CN VI • What if lesioned? • Diplopia – Internal strabismus • Loss of parallel gaze – Pseudoptosis • Where does it Exit/Enter the Cranium? • Superior orbital fissure • What does it innervate? • Orbit . What is CN VII? • • • • • • • • • • Facial What is its function? Mixed To muscles of facial expression Posterior belly of diagastric Stylohyoid & Stapedius Tastes anterior 2/3 of tongue/palate Salivates (submandibular & sublingual glands) Tears (Lacrimal glands) Makes mucous (nasal & palatine glands) . Cont. CN VII • • • • • • • • • What if lesioned? Corner of mouth droops Can’t close eye Can’t wrinkle forehead Loss of blink reflex Hypeacusis Loss or alteration of taste (ageusia) Eye dry and red Bell Palsy – Lesion of nerve in facial canal . Cont. or Hiatus of facial canal . petrotympanic fissure. CN VII • Where does it Exit/Enter the Cranium? • Internal Auditory meatus • What does it innervate? • Face • Nasal & oral cavity – Branches leave skull in stylomastoid foramen. What is CN VIII? • Vestibulocochlear • What is its function? • Sensory • Hears • Linear acceleration (Gravity) • Angular acceleration (Head Turning) . CN VIII • What if lesioned? • Loss of Balance • Nystagmus • Where does it Exit/Enter the Cranium? • Internal Auditory Meatus • What does it innervate? • Inner ear .Cont. What is CN IX? • Glossopharyngeal • What is its function? • Mixed • Sense Pharynx • Carotid sinus/body • Salivates (parotid glands) • Tastes and senses posterior 1/3 of tongue . CN IX • What is its function? • To one muscle only (stylopharyngeus) • What if lesioned? • Loss of Gag Reflex with X • Where does it Exit/Enter the Cranium? • Jugular Foramen .Cont. CN IX • What does it innervate? • Neck • Pharynx/Tongue .Cont. What is CN X? • Vagus • What is its function? • Mixed • To muscles of palate & pharynx for swallowing except tensor palate (V) & Stylopharynegeus (IX) • To all muscles of Larynx (phonates) • Senses Larynx & Laryngopharynx • Senses Larynx & GI tract • To GI tract smooth muscle & glands in forgut & midgut . Cont. CN X • What if lesioned? • Nasal speech • Nasal regurgitation • Dysphagia • Palate drop • Uvula points away from pathology • Hoarseness/fixed vocal cord • Loss of gag reflex w/ IX • Loss of cough reflex . CN X • Where does it Exit/Enter the Cranium? • Jugular Foramen • What does it innervate? • Neck • Pharynx/Larynz • Thorax/Abdo .Cont. CN X – Sympathetics to Head • What is its function? • Motor • Raises eyelid (superior tarsal muscle) • Dilates pupil • Innervates sweat glands of face & scalp • Constricts blood vessels in head . CN X • What if lesioned? • Horner syndrome – – – – Eyelid droop (ptosis) Constricted pupil (miosis) Loss of sweating (anhydrosis) Flushed face .Cont. CN X • Where does it Exit/Enter the Cranium? • Carotid canal on internal carotid artery • What does it innervate? • Orbit • Face .Cont. What is CN XI? • Accessory • What is its function? • Turns head to opposite side – sternocleidomastoid • Elevates & Rotates scapula – Trapezius . CN XI • What if lesioned? • Weakness turning head to opposite side • Shoulder droop • Where does it Exit/Enter the Cranium? • Jugular Foramen • What does it innervate? • Neck .Cont. What is CN XII? • Hypoglossal • What is its function? • Moves tongue • What if lesioned? • Tongue points toward pathology on protrusion . What is CN XII? • Where does it Exit/Enter the Cranium? • Hypoglossal Canal • What does it innervate? • Tongue . What are the muscles of mastication? • Temporalis • Masseter • Medial Pterygoids • Lateral Pterygoids . What part of the brain deals with problem solving? • Frontal Lobe . What happens if there is a lesion to the Optic nerve? • Unilateral Blindness . What happens if there is a lesion to the Optic Chiasm? • Bitemporal Hemianopia . What is a Berry Aneurysm due to in the Circle of Willis? • SUBARACHNOID Hemorrhage . What is a CLUE for SUBARACHNOID Hemorrhage? • The worse headache of my life . What effect does Pernicious Anemia have on the nervous system? • Causes degeneration of the posterior columns • Causes degeneration of the CST • Loss of proprioception • Upper motor neuron defect . What does the diencephalon originate from? • Forebrain . What originates from the Diencephalon? • Thalamus • 3rd Ventricle . Where does the Telencephalon originate from? • Forebrain – Prosencephalon . What originates from the Telencephalon? • Cerebral Hemispheres • Lateral Ventricles . What originates from the Mesencephalon? • Midbrain • Aqueduct . What originates from the Hindbrain? • Metencephalon • Myerencephalon . What originates from the Metencephalon? • Pons • Cerebrum . What originates from the Myerencephalon? • Medulla . What does the Jugular Foramen contain? • CN IX • CN X • CN XI • Internal Jugular Vein • Spinal accessory nerves . What does the Foramen Spinosum contain? • Middle menningeal artery – Branch of the maxillary artery . What does the Foramen Ovale contain? • CN V3 . What does the Foramen Magnum contain? • Vertebral arteries • Brain stem • Spinal roots of CN XI • Spinal cord . What does the Optic Canal contain? • Opthalmic artery • Central retinal vein • CN II . What does the Hypoglossal Canal contain? • CN XII • Hypoglossal nerve . What does the Carotid Canal contain? • Internal Carotid artery . What does the Posterior Condylar Canal contain? • Large Emissary Vein . What are signs of an UPPER motor neuron damage? • + Babinski sign • Spastic Paralysis • Hyperactive Deep Tendon Reflexes . What are signs of a lower motor neuron defect? • Atrophy • Fasciullations • Flaccid Paralysis • Loss of deep tendon reflexes . What does it mean to see a physis on radiograph? • Means the skeleton is not fully mature . When does Physis disappear? • Once growth is complete . What is a nonunion fracture? • Fracture that does not heal with in 6 months . What does Malunion mean? • A fracture that heals in an Abnorman position . What is a characteristic feature of cancellous (spongy) bone? • Trabeculae . Which CN’s control eye movement? • CN III – Oculomotor nerve • CN IV – Trochlear nerve • CN VI – Abducens nerve . What CN is responsible for turning the head and shrugging the shoulders? • CN XI – Accessory nerve . What CN has sensory fibers for Face and Motor fibers for muscles of mastication? • CN V – Tigeminal Nerve . What CN controls tongue movement? • CN XII – Hypoglossal nerve . What CN controls sensory fibers for Vison • CN II – Optic nerve . What CN senses fiber for smelling? • CN I – Olfactory . What does the Mesenteric Artery Supply? • Distal 1/3 of transverse colon • Descending colon • Sigmoid colon • Upper Portion of Rectum . What does the Superior Mesenteric Artery Supply? • Duodenum • Jejunum • Ileum • Cecum • Appendix • Ascending colon • Proximal 2/3 of transverse colon . What does the common Iliac artery supply? • Pelvis • Perineum • Leg . What does the Celiac trunck give rise to? • Left gastric artery • Splenic artery • Common hepatic artery . Gastric Artery.What do the Left. & Common Hepatic artery supply? • Esophagusa • Stomach • Duodenum • Liver • Gallbladder • Pancreas . Splenic Artery. If there is a lesion in the frontal lobe will you have motor or sensory defects? • Motor . If patient has a visual field defect with cognitive Distrubance. what part of the brain will be affected? • Temporal or Partial Lobe .