1st Aid Q and A book:Chapter 17 RespiratoryQID: 8260ObstructiveRestrictive

Increased Air Flow ResistanceIncreased elastic resistance

Decreased RR respiratory rateIncreased RR respiratory rate

Tidal volume increasedStiff Lung

Slow deep breath, exhale rate is slowRapid shallow breathing

Asthma, COPD, alpha1 trypsin deficiency Pulmonary Fibrosis, PE, ARD

FEV/FVC > 80

Air trapping in lungs

Hard to exhale, easy to inhale (air trap) -> like plastic bagHard to inhale, easy to exhale (like a balloon)

Chapter 16 ReproductionBladder incontinence pharmacologyMale/Guy BPH Use alpha 1 blocker: ie doxazosin/prazosin/terazosin for both BPH and HTN. Relaxation of smooth muscle in arterial and venous walls - decrease in peripheral vascaular resistance BPH: induce relaxation of smooth muscle in bladder neck and prostate decrease in urine obstructionWomen/Female with Urge Incontinence = overactive bladder syndrome: Caused by inhibited bladder contractions (detrusor instability) sudden sensation of urency and involuntary leakage of urine.

Chapter 15 Renal 1. Statins cause renal failure.2. Loop diuretics and thiazides cause metabolic acidosis.3. In nephrotic syndrome: you lose the anti-coagulants-> antithrombin III, protein C and S. Therefore u are in a hypercoagulable state. When u have a hypercogulable state, u suffer a stroke. hyperlipidemia, Edema (generalized), hypoAlbuminemia, and Proteinuria.4. Nephritic syndrome Mnemonic: LEAP: LipiduriaGlomerulonephritisAcute post-streptococcal glomerulonephritisLumpy bumpy due to circulating anti-streptococcal Ab-Ag complexes depositing in glomerular BM. happens several wks after URTI.

Bergers IgAhappens days within infection. Non-linear IgA deposition in mesangium.

Cresenteric Glomeruloneprhitis:1) Goodpastures : commonly presents with Crescent-shaped1) Linear subendothelial deposition of antibodies against glomerular basement membrane on IF

Alport sydndromeSplintering of lamina densa

Nephrotic syndromeMembranous glomerulonephritisSpike and dome

Diabetic glomerulonephritisEosinophilic Nodoular glomerulosclerosis accumulations = Kimmelsteil-Wilson nodules, diffuse glomerulosclerosis

Focal segmental glomerulosclerosisYoung, hypertensive African American males. Glomerular sclerosis (obliterated capillary lumen) w focal patterns, and segmental patterns

Amyloidosis

Minimal change diseaseFoot process effacement of the visceral epithelial cells on EM.

BothMembranous proliferative glomerulon.ephritisType 1: Tram tracks, due to GBM splitting. 8-30yo youngsters on light mesangial microscopy.a/w HBV, HCV.Type II: intramembranous IC deposits dense deposits. a/w C3 neprhitic factor

Diffuse Proliferative glomerulonephritis (DPGN)Due to SLE or MPGNWire loop. Granular subendothelial deposits -> C3 deposition. Widespread and pronounced thickening and splitting of the glomerular basement membrane on EM electron microscopy.

5. V2 receptors are located in the principal cells of ate distal tubule and collecting duct, a Gs protein mechanism inserts the aquaporins into the luminal wall. Activation of V1 receptor found in vascular smooth muscles results in activation of Gq protein 2nd-messenger cascade and contraction of vascular smooth muscle, leading to increase in TPR. 6. Gentamicin side effects is ototoxicity.7. Thiazides limit ca2+ loss. Works in early distal tubule.8. Pt with dilated pupils and tactile hallucination is amphetamine overdose. Treat using ion trapping: acidify urine to ionize drug and get excreted in urine. 9. Chronic renal failure results in osteomalacia due to decreased vit. D production.10. Hyperuricemia is due to tumor lysis syndrome, leukemia, myeloproflierative disorders. They are radiolucent and not seen on xray.11. 12.

FeNa (Fractional excretion of Na)Osmolarity (Osm)Bun:Cr

Pre-renal350>20:1

Renal>2%>350Acute tubular necrosis: 10-1:1 + hyaline casts and cellular debris

Post-renal>4% returned to cell in the process of HCO3- resorption as H_ and HCO-3 to form water and CO2 after catalysis by brush border enzyme carbonic anhydrase diffuse back again, liberated as H+ and HCO-3. HCO-3 transported into blood stream, H_ recycled again.Net result: increased Na+/H+ exchange is increase in HCO-3 resoprtion, no net change in H+s secretion. 14. Acute interstitial nephritis causes fever, rash, loss of urine concentration ability low specific gravity of urine. Commonly caused by drugs, antibiotics ie. beta-lactams, sulfonamides, quinolones, and rifampin, anti-convulsant drugs. 15. Ca2+ reabsorbed in 3 areas:a. Proximal tubule: coupled to Na reabsorptionb. Thick ascending limb: sodium-potassium-chloride co-transporter NKCC.c. Distal tubule: controlled by PTH16. HCTZ and furosemide causes metabolic alkalosis. Common causes of high anion-gap metabolic acidosis = MUDPILES. Methanol, uremia, DKA, Paraldehyde, Iron toxicity, Lactic acidosis, Ethanol, Salicylates.17. D18. F19. Chart p.523 of fa2013Chapter 14: Psychiatry1. Adjustement disorder is depression and anxiety in the setting of a psychosocial stressor in the past 6mths. 2. Carbamazepine is anticonvulsant/mood stabilizer for mania patients, poor anger management, and lack of impulse control. Valproate acid: anticonvulsant/mood stabilization. Both have wider therapeutic range than Lithium: 1st line for maintenance therapy in bipolard disorder.Buproprion: SSRi for bipolar disorder txt, but monitor for cycling into manic state.Fluoxetine: SSRI to elevate mood.Olanzepine: atypical antipsychotic for mania with sever agitation and psychosisResperine: depletes central cathecholamines3. Schizoid: voluntary social withdrawal, limited emotional expressions/Schizotypal: interpersonal awkwardness, odd thought patterns, eccentric appearance.4. Schizophrenia:a. Disorganized type: poor prognosis, child-like, incapabable of complete delusions, disorganized speech, inappropriate affect.5. Isolation: separation of feelings from ideas and events is an IMMATURE defense.6. Humor: mature defense.7. SSRI is choice for social phobia disorders because they lack abuse potential.8. Busiprone: for generalized anxiety disorder GAD, anxiolytic.9. TCA side effects: 3Cs: Cardiotoxicity conduction defects and arrhythmias, Convulsions, Coma, anticholinergic adverse effects ie dry mouth, mydriasis, constipation, urinary retention. (sympathetic)10. Mirtazapine: anti-depressant 5HT2 receptor antagonist, alpha-adrenoceptor antagonist. Common side effects: weight gain, sedation.11. Setraline SSRI a/w insomnia, tremor, anxiety. Leads to serotonin syndrome: headache/dizziness, coma, vomiting, death if used with MAOI.12. Trazodone: hetrocyclic a/w sedation, nausea, priaprism, postural hypotension.13. Buproprion is contra-indicated in anorexia nervosa because it increases risk of seizure.14. Benztropine and anticholinergics rapidly relieve symptons of acute dystonia.13 Neurology1. Neonates 0-6mth olds: most common causes of meningitis: grp B strep, E. coli, Listeria. HIB no longer is common due to vaccines.2. Neisseria meningitides is most common cause of meningitis from 6-60ys old.3. Enterovirus is cause for viral meningitis from 6mo-60ys old.4. In central diabetes insipidus, ADH is not produced such that kidneys fail to produce concentrated urine. In central DI patients, low urine specific gravity with a high serum osmolality. After desmopressin administration, increase in urine specific gravity.5. Worst headache in her life + blood cannot be scraped from surface of brain when dura mater is removed = Subarachanoid hemorrhage due to ruptured aneurysm. 6. Neuroblastoma: most common tumor of adrenal gland in children, wide mets and elevated urinary catecholamines. Usually demonstrate necrosis, hemorrhage, calcification. Microscope revelas small cells in pesudorosette pattern around nerve fibirls. Amplify with n-myc oncogene.7. Bcl-2 oncogene a/w follicular and undifferentiated lymphomas.8. C-myc oncogene a/w burkitts lymphoma9. Erb-B2 oncogene a/w breast, ovarian, gastric CA.10. RAS a/w colon cancer.11. Alzheimers is pgoressive memory loss and cognitive impairement. A/w deposition of neuritic plaques (abnormally cleaved amyloid) and neurofibrillary tnagles (tau) in cerebral cortex. Txt with donepezil/vit E12. 13. 14. http://what-when-how.com/neuroscience/the-reticular-formation-integrative-systems-part-1/15. 16. 17. Wilsonss due to lack of ceruloplasmin to bind to Cu to enter the circulation. 18. Depression is significant comoribidity of Alzheimers.19. Bells palsy must wear eye patch on ipsilateral eye to close it to prevent eye dryness. 20. Spina bifida occulta: failure of posterior vertebral arch to close in utero; tuft of hair21. Anencephaly: cephalic end of neural tube fails to close. Born wo forebrain and cerebrum.22. Meningocele: herniation of meninges, no nerve tissues through bony defect at bony sacrum.23. Meningomyelocele: herniation of meninges and spinal cord through spinal canal defect24. Spina bifida cystica: failure of posterior vertebral arches to close with saclike protusion.25. SJS manifestations: mucocutaneous lesions, blisters, epidermal detachment. Usually caused by anticonvulsants ie. phenytoin, carbamazepine.26. Carbamazepine: a/w osteoporosis side effects, SJS27. Cluster headache recur repetivetively for wks to mths at a time with intervening remission. Men>women, 25-50ys old, no prodromal symptons around eye or temple, are excruciating. Unilateral, last fro mins-hrs with mean duration of 45mins. 28. GBS will lead to hypoventilation leading to respiratory acidosis. 29. Humerus fractures or #:a. Midshaft: radial nerve and deep brachial arteryb. Surgical neck: anterior and posterior circumflex humeral artery, axilliary nervec. Distal end: median nerved. Medial epicondyle of humerus: ulnar nerve30. Arnold-Chiari malformation:a. I: cerebellar tonsils downward herniation into the foramen magnum a/w syringomyeliab. II: a/w spina bifida31. Syringomyelia: enlargement of central canal of spinal cord C8-T1, where crossing fibers of spinothalamic tract are damaged (loss pain and temperature sensation) with preserved dorsal column function (intact position and vibration sense).32. Communicating hydrocephalus = ventricular enlargement seen on MRI.33. Non-commmunicating hydrocephalus: abnormal formation of cerebellar vermis, due to obstruction of outlet foramina of Luschka and Magendie.34. Wallenbergs syndrome or Lateral Medullary Syndrome: loss of pain and temperature over contralateral side of body, and ipsilateral face due to occlusion of a posterior inferior cerebellar arteries.12 Musculoskeletal1. Boxers fracture: blow with closed fist, so the 1st and 2nd metacarpals are injured for experienced boxers. For inexperienced boxers, the 5th is the most common site of injury. There is good blood supply and heals rapidly. 2. Colles fracture: complete transverse fracture of distal radius, commonly in elderly falling on outstretched hand following forced dorsiflexion.3. Hamate fracture: complicated, due to ulnar nerve. There are healing difficulties. 4. Fracture of phalanges: due to crush or hyperextension injuries.5. Fracture of scaphoid: common due to falling on abducted hand.6. Ankylosing spondylitis: chronic inflammatory disease of spine and sacroiliac joints leading to stiffening or consolidation of bones making up the joints. Common findings are low back pain, stiffness for > 3mths, pain and stiffness in the thoracic region, limited movement in the lumbar area, and limited chest expansion. HLA B27 positive, other complications is uveitis and aortic regurgitation.7. Psoraitic arthritis: joint pain and HLA B27 positivie also, with psoriasis presence. Nonpruiritic scaly or silvery erythematous plaques with well-defined borders. 8. Reiters syndrome: urethritis, cervicitis, arthritis, conjunctivitis for 1 mth. Autoimmune reaction within several wks after GI or GU infection caused by Campylobacter jejuni. 9. Rheumatoid arthritis are a type III Hypersensitivity reaction where Ab-Ag complexes form to activate the complement. The rheumatoid factor is a IgM Ab directed against the Fc region of patients IgG Ab leading to immune complex formation and deposition. AntipCCP (citrullinepcontaining protein) antibodies are good indicators of RA. Rhuematoid factors are anti-IgG antibody causing marked influx of inflammatory celsl in joint synovium, results in destructive change, apannus formation, joint deformity. Develops clascially in the proximal interphalangeal joints.

10. Arthus reaction: local, subacute, antibody mediated hypersensitivity reaction from thermophilic actinomycetes, its a hypersensitivity pneumonitis11. Hypersensitivity reactions:a. Type I: antibody mediated: Ag cross-link IgE antibodies present on pre-sensitized mast cells and basophils. Cross-linking results in vasoactive amine release like histalysis mine.b. Type ii: Cytotoxic mediated, Ab binds to host antigen on a cell phagocytosisc. Type III: Immune complex: Ab-Ag complexes form to activate the complement. The rheumatoid factor is a IgM Ab directed against the Fc region of patients IgG Ab leading to immune complex formation and depositiond. Type IV: delayed cell-mediated hypersensitivity: sensizied T lymphocytes encounter Ag releasing lymphokines activate macrophages. Ie. + PPD. 12. Polyarteritis nodosa: inflamed small to medium sized arteries in the renal, cardiac, GI tract vessels, not pulmonary vessels, 30% of pts have had hep B infection.13. Buergers disease: htromboangiitis obliterans: vasculitis that affects arteries and veins of extremities. Intermittent claudication and Raynauds phenomenon. Heavy smokers, show hypersensitivity when tobacco injected into skin.14. Giant cell temporal arterits, affects arteries. Mnemonic JOE: Jaw pain, Ocular distrubances from ischemia, elevated ESR. presence of polymyalgia rheumatic15. Kawasakis disease: A/w conjunctivital and oral erythema, fever, erythema and edema of palms and soles, generalized rash, cervical LN swelling. 20% develops coronary artery inflammation and or aneurysm.16. Takayasus arteritis: fibrotic thickening of aortic arch (affect pulmonary artery, branches of aortic arch, rest of aorta). 17. Pemphigus vulagris: autoimmune disorder, attack cell-cell adhesion protein, desmoglein-3 expressed by keratinocytes of the epidermis. Destruction leads to intraepidermal acantholysis with sparing of basal layer. PE: flaccid epidermal bullae Nikolskys sign +, prone to secondary infection. Rx: steroids18. White footed mouse is main reservoir for borrelia burgdorferi. Bacterium is spread to humans by the Ixodes tick. Diagnosed via serology. Characteristic rash = Erythema chronicum migrans thats circular, macular rash with clear center. Rx: Doxycycline or any other penicillin antibiotic.3 stages of Lyme disease:a. Stage I: erythema chornicum migrans (ECM), arthralgias, nonspecific flu-like symptons.b. Stage 2: marked by multiple small ECM rashes, cardiac and neurologic involvement, ie. asceptic mengingitis and cranial neuropathies ie. Bells palsy. c. Stage 3: arthritis of large joints, chornic, progressive central nervous system disease, migratory polyarthritis. 19. CREST syndrome is a/w anti-centromere disease of scleroderma (progressive systemic sclerosis). Calcinosis, Renal, Esophageal dysmotility, Sclerodactyl, Telangiectasia.20. Actinomyces israelii infection presents as mandibular mass slow progressing, evlolving into sinus tract. Characteristic sulfur granules in the thick yellow exudate.21. Nocardiosis: nocardia asteroids: respy infection followed by abscess and sinus tract formation. No sulfur granules but is acid-fast 22. Trichinella spiralis infected person p/w fever, periorbital.facial edema, myalgia, eosinophilia.23. Gout = negatively bifringent and needle-shaped in joint aspiration fluid. 24. Rheumatoid arthiritis: bilateral symmetric joint involvement, leading to ulnar deviation of wrist, swan-neck and butonniere deformities.25. Pseudogout: calcium pyrophosphate dehydrate deposition in connective tissues which are weakly bifringent and rhomboidal.w low-grade fevers. 26. Pain and swelling in femur of child with no history of truma. Pain worse at night, No erythema on PE but firm, immobile tender mass on palpation. Fine needle aspiration reveals anaplastic small blue cells. Associated with t(11,22) Ewings sarcoma translocation.27. Yersinia pestis Black death plaque bacterium that is spread by fleas. Trip to SE. Asia c/ o fevers, chills, general weakness, painful ulcer surrounded by dark, hemorrhagic purpura on arm where flea bite. Requires 2-8 days of tender LN called buboes. Painful skin ulcers unlike painless ulcers for Bacillus antrhacis.28. Bacillus anthracis: cutaneous anthrax with painless ulcer with black scab.29. Babesia microti: tick bite to humans, similar to malaria with fever and anemia.30. Leishmania donovani: sandfly bite. A/w abd pain, distention, anorexia and weight loss.31. Trichinella spiralis: p/w fever, periorbital/facial edema, myalgia, eosinophilia.32. Tennis elbow: lateral epicondylitis from overusue of superficial extensor muscles of forearm and wrist --> extensor carpi radialis muscle. 33. Deltoid is C5-6 innervated by axilliary nerve. C6-7 found in lateral pectoral nerve and median nerve.

34. Rickets signs are unusual widening of childs wrists and ankles, marked enlargement of costcochonrdral junctions leading to increased intact PTH hormone levels due to decreased or absent minieralization of osteoid bone matrix 2ndary to decreased serum Ca or phosphorus levels. Vit D promotes absorption of Ca and phosphorus. In Vit D deficiency, bone growth areas contain patches of unminieralized, soft osteoid. When severe deficiency, lab studies demonstrate decrease serum Ca, decrease serum phosphorus, decreased serum 1, 25-dihydroxycholecalcifero. l, increased serum ALP and intact pth hormone levels. 35. Pasturella multiocida a/w cat and dog bites where cellulitis appears and can lead to osteomyelitis36. Francisella tularensis transmitted by rabbits, deer, ticks. Symptoms can be sudden onset of flu-like syndrome to prolonged course fo fever and adenopathy.37. Rabies virus: prodrome of fever and anorexia, confusion lethargy38. Sporothrix schenckii, fungus causes necrotizing, granulomatous lymphocutaneous skin infections in distribution of draining lymph nodes following trauma by taunted vegetation. Rose garderners disease. 39. Sjorgen syndrome: typ-ically women 35-45ys old, dry eyes keratoconjunctivitis sicca, dry mouth xerostomia, and one other connective tissue or autoimmune disease ie. RA. 40. Sicca syndrome: dry eyes and dry mouth41. SjorenpLarsson syndrome: AR syndrome characterized by congenital ichthyosis *dry and fishlike skin) a/w mental retardation and spastic paraplegia. Casued by mutation in fatty aldehyde dehydrogenase gene on chr 17 p. 42. Long bones form via endochondrala ossification where mesoderm si first converted to a cartilaginous model by hypertrophic chondrocytes. Forms at the primary ossiciation center at the diaphysis as cells diefferentiate into osteoblasts. 43. Sickle cell disease patients have Salmonella as the most comoon organism responsible for osteomyelitis. Staphylococcus aureus is common for general population for osteomyelitis.44. Scarlet fever is caused by Strep pyogenes characterized by typical sandpaper rash, strawberry tongues, beefy-red pharynx, and circumoral pallor. As rash heals, skin peels off in fine scales.

Chapter 11: Hematology Oncology1. Courvvesiers sign: a. Jaundiceb. Non tender enlarged, palpable gall bladderSign of cancer of the head of pancreas, obstruct gall bladder from emptying2. Glucocorticoid psychosis due to long term exposure to prednisone therapy.3. Chloramphenicol is effective against bacterial meningitis and a/w aplastic anemia and gray baby syndrome.4. Clindamycin is a/w pseudomembranous colitis due to Clostridium difficile overgrowth.5. Erythromycin is a macrolide a/w cholestatic hepatitis.6. Gatifloxacin is a fluoroquinolone a/w tendinitis. 7. Trimethoprim is a/w megaloblastic anemia, leuokopenia and granulocytopneia, so supplement with folic acid.8. Plasma cells are recognized with off-center nuclei and clock face chromatin distribution. Blood smear stacked in RBCs, rouleaux formation.9. Hereditary Spherocytosis caused by mutations in genes coding for ankyrin or spectrin that contribute to erythrocyte cytoskeleton. Often a/w jaundice and pigmented gallstones. RBC with no central pallor.10. Paroxosymal nocturnal hemoglobinuria due to RBC susceptibility to completement-mediated cell lysis. Insufficient synthesis of GPI anchors that protects RBCs. Clinically its manifested as intravascular hemolysis with Hg release into blood and subsequent hemoglobinuria, thrombotic complications such as Budd-Chiari syndrome and aplastic anemia. 11. Wilms tumor come from embryonal renal cells of the metanephors, most common solid tumor of the childhood. 12. Clear cell carcinoma is malignancy derived from renal tubular cells. p/w hematuria, palpable mass, polycythemia, flank pain and fever.13. TCCL malignancy from uroepithelial cells of the urinary tract. Occurs in renal calyx, renal pelvis, ureters and bladder. Painless hematuria an durinary outflow obstruction are common symptoms.14. Malignancy from primitive neural crest cells would be neuroblastoma. Comes from paraspinal sympathetic ganglia, so would not distort kidney infrastructure.15. In pernicious anemia, its caused by deficiency of intrinsic factor produced by gastric parietal cells. Once vit B12 is released from Rproteins and complexes with IF. IF-B12 complex binds to ileum receptors and endocytosed by enterocytes. This is due to limmune-mediated destruction of gastric mucosa. Schilling test reveals if vit B12 labelled is being absorbed and eliminated in the urine as normal or its the lack of IF or malabsoprtion thats preventing the radiolabelled compound from appearing int eh urine. 16. Small cell lung cancer notorious for producing ACTH and ADH. Cushings syndrome classical presentation of weight gain and restirubtion of body fact nad moon facies. Poor wound healing due to inhibition of collagen synthesis by glucocorticoids and hirsutism also part of it. 17. Cisplatin causes kidney damage and acoustic nerve damage so must vigorously hydrate18. Cytarabine causes leukopenia, thrombocytopenia, megaloblastic anemia19. Cyclosporine works by binding to cyclophilins and blcoks differnetaittion and activation of T lypmhocytes, inhibiting IL2 production. 20. Amoxicillin and erythromycin have same effectiveness in treating bacterial sinusitis. 21. Erythromycin inihibits the p-450 system. So itll increase the cyclosporine in the liver.22. Leishmania donovani infection: middle eastern exposure, fever, general malaise, fever, weight loss. PE: hepatomegaly, splenomegaly with edema. Macrophage contains amastigotes on histology and is transmitted via sandfly. 23. Babesia presents with malaria-like syndrome transmitted by the Ixodes tick found in same region as Lyme disease. Transmitted by deer ticks carrying Lyme dz. Sx are mild except for immunocompromised and splenectomized individuals. In fatal cases, find jaundice, hepatic necoriss, ATN, ARDS, hemolysis and hemorrhages. Maltese cross appearing parasite is observed, Rx: Quinine.24. Entamoeba histolytica: p/w intestinal amebiasis of bloody diarrhea and abd pain, less commonly liver abscesses. Cysts pass through small tintestine forming trophozoites, treat with metronidazole.25. Medulloblastoma: found exclusively in cerebellum so pt has nystagmus and truncal ataxia. A/w cerelbellar vermis lesion and dilatation of third and lateral ventricles. On histology, deeply staining nuclei with scant cytoplasm arranged in pseuodrosettes are seen.Cellular tumor with sheets of anaplastic cells, with little cytoplasm and crescent-shaped, deeply staining ncueli due to high mitotic activity. Frequently radiosensitive.26. Glioblastoma mutliforme: most common primary brain tumor in adults occurring in cerebral hemispheres with extremely poor prognosis. Histology: regular round cells aligned smoothly with spherical nuclei surrounded by clear cytoplasm and finely granular chromatin a/w calcifications. 27. Craniopharyngioma: most common supratentorial tumor in children embryologically derived from remnats of Rathkes pouch. P/w severe headaches, visual changes, and pituitary dysfunction with bimodal distribution of affected ages. Histology shows stratified squamous epithelial cells embedded in spongy reticular stroma with predominant peripheral gliosis. 28. Meningioma: benign primary intracranial neoplasm from arachanoid granulations. Histology: whorls of meningothelial cells with ovalpshaped nuclei with indistinct cytoplasm and psammoma bodies.29.

30. 1. 45. 46. Polio sufferers due to injury to nerve root supplying superior gluteal nerve that innervates gluteus medius and minimus that abduct and medially rotate thigh to keep it level. Trendelenburg gait, where hip is tilted in order to swing the affected foot to walk, and keep the pelvis level. 47. Inferior gluteal nerve innervates the gluteus maximus that extends and laterally rotates the thigh, assists in standing from sitting position.

Chapter 10 : Gastrointestinal 1. Entameoba histolytica: p/w bloody diarrhea, abd cramps with tenesmus and pus in stool. RUQ pain and liver abscesses, transmitted via cysts in water. Rx: metronidazole and iodoquinol.2. Cryptosporidium spceices p/w severe HIV+ pts with mild watery diarrhea in HIV neg patients. Tramitte dvia cysts in water (fecal-oral transmission). Acid-fast cysts can be found, no treatment.3. Giardia lambia p/w bloating, flatulence, foul-semlling diarrhea, light colored fatty stools. Transmitted via cysts in water, teardrop shaped trophozoidtes with ventral sucking disc or cysts. Rx: metrodinazole.4. Naegleria fowleri: headache, fever, nausea, vomiting, miningismus can progress to CN 3, 4, 6 palsies, siezures and coma. Transmitted through inhalation of of contaminated dust or water. Poor prognosis, rx: amphotericin B and rifampin.5. Toxoplasma gondii p/w brain abscess in HIV+ pts and birth defects if infection occurs during pregnancy. Transmitted via cysts in raw meat or cat feces. 6. GBS Guillian-Barre Syndrome: autoimmune mediated illness that is also a/w Campylobacter jejuni, , finding comma-shaped organisms with a single polar flagellum. Other enteric pathogens of the same morphology is Vibrio cholera nand parahemolyticus. 7. HUS is characterized by. Its a complication of infection cuased by E coli O157:H7 but NOT Campylobacter jejuni. Its a gram negative rod.a. Acute renal failureb. Thrombocytopeniac. Hemolytic anemia8. Waterhouse-Friderichsen symndrome is characterized by high fever, shock, purpura, adrenal insufficiency ie Neisseria meningitidies septicemia. 9. Woman with jaundice, hypercholesterolemia-xanthomas, pruritis with +antimitochondrial Ab and elevated ALP = primary biliary cirrhosis. PBC is chronic, progressive and leads to fatal liver injury characterized by destruction of medium-sized intrahepatic bile ducts. Rx: liver transplantation.10. Primary sclerosing cholangitis: stenosis of extrahepatic and intrahepatic bile ducts. 11. Child with weight loss, multiple purpuric lesions, with bulky, greasy yellow stools a/w abd pain and flatulence occurring most after meals is due to celiac disease. Celiac disease = diffuse severe atrophy and blunting of villi. Nonblanching purpuric lesions located on upper and lower extremities is dermatitis herpetiformis. Celiac disease gluten-sensitive enteropathy. There are lymphocytic infiltrates due to the gliadin fraction in wheat, discontinuation will result in complete remission. 12. Foamy macrophages in the lamina propria = Whipples disease confirmed by rdo-shaped bacilli on EM. Tropheryma whippelii is causative organism residing in macrophages, distention and lead to lymphatic blockage and lipid despoistion without neutrophil inflammation. Epidemeology: Pts in 30p-40ps men exposed to rural regions, p/w arthropathy, diarrhea, weight loss.13. Crohns disease is usually no bloody diarrhea.14. Hepatitis C treatment:a. IV immunoglobulin: engineered Ab used to clear aserum of protein products for use in txt of autoimmune diseasesb. Peglated interferon: cytokine derivative improving bodys antiviral rresponse. Adverse effects INF therapy include flu-like rxn as episodic fever and chills and ocassional profound depression.c. Lamivudine: nucleotide reverse transcriptase inhibitor used in HIV and hep B txt. Adverse SE is hepatotoxicity.d. Ribavirin: antiviral used in Hep C, RSV treatment. Not a/w dep-ression or flu-like reaction.e. TNF-alpha cytokine involved in antiviral dna anti-tumor response.15. Shigella is a non lactose fermenter and does not produce gas or Hydrogen sulfide. Usually affects preschool age children and populatiosn in nursing homes. Transmission by fecal-to-oral route via fecally contaiminated water.16. Ecoli is a lactose fermenter17. CA19-9 used for colon and pancreatic cancer. Also elevated in different GI cancers.18. CEA carcinoembryonic Ag is a glycoprotein involved in cell adhesion. Its a GPI cell surface anchored glycoprotein serving as L-selectin and E-selectin ligand. Raised in CLR CA, gastric CA, pancreatic CA, lung CA, breast CA and medullary thyroid CA. Elevated CEA found in IBD, PUD, pancreatitis, biliary dz.19. GERD give you esophageal mucosal metaplasia called Barretts esophagus with increased risk of developing adenocarcinoma of esophagus.20. Squamous cell cancer is a/w tobacco and alcohol use.21. Luekotriene (LT B4) is neutrophil chemotactic agent and is abudndant udring an acute inflammatory process produced via the 5-lipoxygenase pathway parimarily by neutrophils and macrophages. Found in elevated concentrations for inflammatory and allergic conditions such as asthma, psoriasis, RA, IBD.22. Prtostaglandin I2 synthesized by vascular endotheliuma dn smooth muscle. Inhibition of platelet aggregation, relaxation of smooth muscle, reduction of systemic and pulmonary vascular resistance by direct vasodilation and natriuresis in kidney produced by the cyclooxygenase pathway.23. Thromboxane A2 is potent inducer of platelet aggregation and vasoconstriction.24. vWF bind glycoprotein Ib and facilitates platelet adhesion at site of injury. 25. Crigler-Najjar syndrome type I, hereditary hyperbilirubinemai ecause of the abscnece of bilirubin uridine diphosphate-glucoronsyltransferase (UGT1). Much less severe is slight deficient Gilberts syndrome.26. Dubin Johnson is defective liver excretion cuasing gross black liver but is benign.27. Rotors syndrome: similar but even milder and dont cauase black liver.28. Contaminated seafood is a common source of vibrio parahemolyticus and V. vulnificus. 29. Staph aureus is found in the mayonnaise portion of tuna salad and is charactereized by more vomiting than diarrhea, since enrotoxin is preformed in food, incubation time is short (1-8hrs).30. Wilsons disease causes parkinsonian symptons due to death of neurons in basal ganglia. Wilsons disease is an AR in mutation in ATP7B, a gnee in chr 13 encoding for a Copper transporting ATPase. a. Also called hepatolenticular dengeneration, AR disorderb. Liver: fatty change with vacuolated nucleus, focal hepatocyte necrosis, and in chronic hepatitis, Mallory bodies might develop. Stain for rhodamine. KayserpFleisher rings.c. EM: mnicrovesicular steatosis: glycogen nuclei, copper deposits, mitochondrial enlargements. 31. Mallory bodies are found in Alcoholic liver disease. In hepatitis and cirrhosis.

Twisted rope appearance, an inclusion in the cytoplasm of liver cells.

32. Idiopathic transmural inflammation of distal colon ulcerative colitis. Pts would present at younger age and have other extraintestinal symptons. 33. Diverticulosis is common conidition in Western countires due to low-fiber diest and high fat. Leading to low bulk stools and increased straining during defecationl. Inflammation and microperforation in the diverticula.34. Upper one third of esophagus is made up of striated muscle. Middle one third is both striated and smooth muscle. Lower one third is smooth muscle. Pts with scleroderma develop dysphagia usually to solids 2ndary to atrophy of smooth muscle o fhte lower two thirds of the esophagus and incompetence of the LES. Esophagus becomes thina dn atrophic and have regions of fibrosis. 35. The pleomorphic adenoma or mixed tumor is the most common tumor of the parotid gland. Its benign, well-differentiated, well circumscribed mass growing slowly over the months or years. Its present with multiple cell types. 36. Warthins tumor is a beign mass of lymphoid cells. A well-circumscribed mass of lymphoid cells in a salivary gland. 37. Alpha1 trypsin deficiency affecting the liver.

Multiple large hyaline globules inside hepataocyte. 38. Brucella melitensis enters body after ingestion of contaminated milk, (ie Goat milk), and or direct contact with contaminated lifestock. Its an intracellular bacterium causing undulating fever, weakness, and LOA. On PE: theres hepatosplenomegaly and generalized lymphadenopathy. 39. Bartonella hensale is cat scratch disease. Which might also lead to Bacillary angiomatosis leading to lymphadenopathy and fever40. Pasteurella due to dog or cat bite wounds and causes cellulitis. 41. Plasmodium malaria is a protozoan characterized by episodic fever and chills every 72hrs. Spread through the Anopheles mosquitos, while lymphadenopathy but splenomegaly is present.42. Crohns disease: RLQ abd pain with diarrhea, fevers, and weight loss and sometimes bloody diarrhea. They result from chornic transmural inflammation of bowel occurring in the terminal ileum involving from mouth to anus. Rx: anti-inflammatory agents or immunosuppressants. 43. Ulcerative colitis have contiguous superficial ulcerative lesions.44. 45. 46.

Chapter 9 Endocrine1. PTU causes agranulocytosis.Rx for hyperthyroidism. PTU inhibits thyroperoxidase which ;

Chapter 8 Cardiovascular1. Post MI scenarios: 3-10 days after:a. Ruptured papillary muscle = severe actue mitral valve regurgitationb. Mitral valve regurg: HSM blowing loudest at apex and radiates to axilla.c. Rupture of LV free wall cardiac tamponade where heart cant pump severely decreased stroke volume, systemic hypotension with pulsus paradoxus, JVD, decreased heart sounds.d. Rupture of interventricular septum: Murmur is loudest at L sternal border.e. L ventricular failure occurs in 60% of people who suffer from MI and present as CHF or cardiogenic shock. Rupture can happen also.2. Dresslers syndrome is autoimmune phenomenon resulting in fibrinous pericarditis that develops 2-10 dwks post MI and clinically presents as chest pain and pericardial friction rub. 3. Dilated cardiomyopathy is characterized by dilataion and impioared contraction of one or both ventricles. Can present with arrhythmias or SCD.4. Babeosia is spread by Ixodes scapularis tick who is in Massachusetts. Bike in woods, with expanding rash on calf and fluplike symptons resolving spontaneously. Then there was dizziness, syncope, dyspnea, chest pain, palpitations and see vector of ECG. LYME disease can cost cardiac symptons and heart blocks and require pacing. Its in the northeastern corener of USA.5. Epidemic typohus is transmitted by Rickettsia prowazekii.6. Malaria is responsible for parasitiz protozoan disease by Anopheles mosquito. 7. Plague is by Yersinia pestis8. Cardiac Troponin I, CK-MB, AST, LDHEnzymeElevates

Troponin I7-10 days

CK-MB24hrsEnzyme of choice to monitor reinfarction.

AST2days

LDH2days post MI

9. Fish mouth of mitral stenosis due to fusion of valve leaflets.earlypanlate

systolicAS/PSMR/TR, Mid: HOCM, VSDMitral valve prolapse

diastolicAR/PR, Aortic/pulmonic insuffficiencyCONTINUOUSPDAMDMMS, TS

10. Carotid sinus baroreceptor sends an afferent signal via glossopharyngeal n to medulla which responds with a sympathetic efferent signal causing vasoconstriction, increased HR, increased contractility, and increased BP.11. Baroreceptor in the aortic arch responds only to an increase in BP.12. Hydralazine can be toxic at high levels resulting in body compensating with severe reflex tachycardia with salt and water retention. This resulting in patient experiencing angina due to increased oxygen demand secondary to increased cardiac output or increased HR. Hydralazine works by increasing cyclic guanosine monophosphate inducing smooth muscle relaxation that occurs more in arterioles than in veins reducing the afterload in the heart. 13. Heart blocksTypeDescriptionCause

Mobitz Type ILengthened PR intervalAV nodal abnormalities

Mobitz Type II 1st degree

Mobitz Type II 2nd degreeDefect in His-Purkinjie system

Complete Heart blockIndepednetly contracting atria and ventriclesComplete absence or ablation of the His-Purkinjie system

14. Young person with previous dental procedure contributing to 3 day history of malaise, chills fatigue also has complete visual loss in R eye thats painless. Opthalmologic exam: gray-white retina with cherry-red spot, 2 blot hemorrhaes, several segmented vessels with optic edema most likely due to endocarditis. Sceptic embolism orginiatng in the heart lodgin in the central retinal artery. 15. Cardiac glycosides increases cardiac output by increasing intracellular ca concentration via the sodium-ca exchange caqrreir mechanism.

Chapter 6 Pathology16. Smoking is the single most important cancer risk facter for Transitional cell carcinoma of the bladder.17. MSH2 is a mismatch repair enzyme mutation for certain forms of colon cancer. In its absence, DNA mutations accumulate. 18. APC is a tumor suppressor gene mutated in colon cancer. Normally the APC protein degrades transcription factor bta-catenin involved in colonic epithelial cell proliferation. 19. Histology:TumorHistologyLocation

MedullablastomaPoorly d(x) neuroectodermal tumorCerebellum midline

20. Cadmium is carcinogen a/w prostate cancer.21. Long term exposure to high levels of benzene can lead to leukemia and Hodgkins lymphoma. Benzene is exposure to light oil, gasoline and other fuels. 22. Exposure to silica occurs in glass, cermaics and electronics. Slowly progressive Silicosis characterized by bilateral fine nodularity in upper lung lobes.23. Abestos is present in gun-wielding, explosives factory which are fire-resistant materials in the building materials. Exposure to risk of mesothelioma. 24. Cardiac tamponade: post MI 4-10days, sudden shock, hypotension, distant heart sounds, elevated JVP. Requires immediate pericardiocentesis or surgery.25. HPV can cause anorectal cancer26. In cirrhosis, progressive iron deposition in liver parenchyma of patients with hemochromatosis, seen as granular brown cytoplasmic pigment. Microscopic evidence includes increased quantity of connective tissue extending from portal areas. Result of past chronic destruction. 27. CMV = large, round intranuclear inclusion with perinuclear halo, Cowdry type A as owls eyes due to microscopic appearance. Infection presents as retinitis, pneumonitis, inflammation along GI tract, polyradiculopathy, transverse myelitis, focal encephalitis. Happens when CD4+ count