usmle clues

7/31/2019 Usmle Clues

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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

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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.

Fabrys

Hunters

Lesch-nyhan

Lesch-Nyhan Hunter Puts Fabrys on G6 Clothes

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What diseases do we screen for at birth?

Please

Check

Before

Going

Home

PKU

CAH(Congential Adrenal Hyperplasia)

Biotinidase

Galactosemia

Hypothyroidism

HLA-Antigens

HLA-DR2= Narcolepsy, Allergy, Goodpastures, MS

HLA-DR3= DM, Chronic Active Hepatitis, Sjogrens, SLE, Celiac Sprue

HLA-DR3 & 4= IDDM(Type I)

HLA-DR4= Rheumatoid Arthritis, Pemphigus Vulgaris

HLA-DR5= JRA, Pernicious Anemia

HLA-DR7= Nephrotic Syndrome(Steroid induced)

HLA-Antigens

HLA-DR 3 & B8=Celiac Disease

HLA-A3= Hemochromatosis(chromo. 6, point mut.-cysteine>tyrosine)

HLA-B8=MG

HLA-B13= Psoriasis

HLA-B27= Psoriais(only if w/arthritis) Ankylosing Spondylitis, IBD, Reiters, PostgonococcalArthritis

HLA-BW 47= 21 alpha Hydroxylas def.(Vit.D)

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

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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 fragilisWhat 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 CAs

In what diseases are Psammoa Bodies present?

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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

What are the 7 Gram -encapsulated bacteria?

Some

Strange

Killers

Have

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Pretty

Nice

Capsules

Salmonella

Strep. Pneumo (gr+)

Klebsiella

H. influenza Pseudomonas

Neisseria

Cryptococcus

What is the Jones Criteria for Rheumatic Fever?

SubQ nodules

Polyarthritis

Erythema marginatum

Carditis

Chorea

What are the causes of Eosinophilla?

Neoplasms

Allergies/Asthma

Addisons Dz

Collagen Vascular Dz

Parasites

What are the Risk Factors for Liver CA?

Hep B,C,D

Aflatoxin

Vinyl chloride

Ethanol

Carbon Tetrachloride

Anyline Dyes Smoking

Hemochromatosis

Benzene

Schistomiasis

What are the 9 Live Vaccines?

Measles

Mumps

Rubella Oral Polio (sabin)

Rotavirus

Small pox

BCG

Yellow fever

Varicella

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What are the Killed Vaccines?

SIR Hep A

Salk (polio)

Influenza

Rubella

Hepatitis A

What are the IgA Nephropathies?

Henoch-Schoenlein P. (HSP)

Alports

Bergers

What are the Drugs that cause Autoimmune hemolytic anemia?

PCN

-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 2nd MI enzyme to appear?

CK-MB

Appears

Peaks

Gone

6 hrs

12 hrs

24 hrs

What is the 3rd MI enzyme to appear?

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LDH

Appears

Peaks

Gone

1 day 2 days

3 days

What bacteria have Silver Stains?

Legionella

Pneumocysitis carinii

H. pylori

Bartonella henseslae (lymph node)

Candida (yeast)

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

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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

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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

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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


Malonate


Antimycin D


CN-

CO

Chloramphenicol


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

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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?

Metronidazole2 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

What are the 4 enzymes needed to break down glycogen?

Phosphorylase (Pi)

Debranching enzyme

Alpha-1,6 Glucosidase Phosphatase

What are the 2 enzymes needed to make glycogen?

Glycogen synthase

Branching enzyme

What are the branching enzymes?

Glycogen alpha-1,4 glycosyl transferase

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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?

IncreasedWhat type of acidosis do you see with obstructive pulmonary dz?

Respiratory acidosis

What are the Lysosomal Storage Disease & what is the deficiency?

Fabrys

Krabbes

Gauchers

Niemann Pick

Tay-Sachs

Metachromatic leukodystrophy

Hurlers

Hunters galactosidase

Galactosylceramide

glucocerebrosidase

Sphingomyelinase

Hexosaminidase

Arylsulfatase

L iduronidase

Iduronidase sulfatase

What dzs are associated with HLA B27?

Psoriasis

Ankylosing spondylitis IBD (Ulcerative colitis)

Reiters Syndrome

What HLA is Psorisis w/RA associated with?

HLA-13

What are the Glycogen Storage Diseases & the deficiency?

Von Gierkes

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Pompes

Coris

McArdles

Glucose 6 phosphate

1 4 glucosidase

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


Alpha-KG ? Glutamate

Glutamine

Succinyl CoA?

Phenylalanine

Tryptophan

Tyrosine


Fumerate ?

Proline

Oxaloacetate?

Aspartate

Asparigine

What are the 4 steps of B-oxidation?

Oxidation 7 NADH 21 ATP

Hydration

2

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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 its 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


Anti histone?

Drug induced SLE


Anti-topoisomerase?

PSS (Progressive Systemic Sclerosis)


Anti TSH receptors?

Graves


Anti-centromere?

CREST

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Anti-GBM?

Goodpastures

What does Goodpastures have antibody to?

Type IV collagen


Anti-mitochondria?

Primary biliary cirrhosis


Anti-hair follicle?

Alopecia areata


Anti-IgG?

Rheumatoid arthritis


Anti-myelin receptors?

MS

What Autoimmune Disease has the following Autoimmune Antibodies? Anti-gliaden?

Anti-gluten?

Celiac sprue


Anti-islet cell receptor?

DM Type I

What Autoimmune Disease has the following Autoimmune Antibodies? Anti-melanocyte?

Viteligo


Anti-ACh receptor?

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MG


Anti-ribonuclear protein?

Mixed Connective Tissue dz (MCTD)


Anti-parietal cell receptor?

Pernicious anemia

What does Pernicious Anemia have antibody to?

Intrinsic factor


Anti-epidermal anchoring protein receptors?

Pemphigus vulgaris

What does Pemphigus vulgaris have antibody to?

Intercelluar junctions of epidermal cells


Anti-epidermal basement membrane protein?

Bullous pemphigoid

What do you see with bullous pemphigoid?

IgG sub-epidermal blisters

Oral blisters


Anti-platelet?

ITP

What does ITP have antibody to?

Glycoprotein IIb/IIIa


Anti-thyroglobulin?

Anti-microsomal?

Hashimotos


Anti-smooth muscle?

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Anti-scl-70?

Scleroderma


Anti-rho (SS-A)?

Anti-la?

Sjogrens


Anti-proteinase?

C-ANCA?

Wegeners

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?

Kaposis 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)

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Clot off lots of nephrons?

Rapidly Progressive GN

What is the most common nephrotic disease seen in kids and when does it occur?

Min. change disease

2 wks post URI

What is the most common vasculitity leading to rapidly progressiveglomerulonephrosis?

Goodpastures

What is the most common malignant renal tumor in children?

Wilms 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

Thrombolytics & Inhibitors

What does tPA, Streptokinase, Urokinase inhibit?

Aminocaproic acid

What doe Warfarin inhibit?

Vitamin K What does Heparin inhibit?

Protamine Sulfate

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

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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 pts 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

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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 anemiaWhat is the #1 cause of anaphylaxis?

Penicillin

What are the Chrons Gifts?

Granuloma

Ileum

Fistula

Transmural

Skip Lesion

What are the negative-stranded 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

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They are -ve stranded = dont 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

Ebsteins 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?

Ebsteins 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?

Brutons Agammaglobulinemia

CGD (NADPH def)

DMD

Color Blindness

G6PD

Hemophilia

Lesch-Nyhan

Vit D resist. Rickets (X-linked dominant)

Fabrys

Hunters

What are the 7 B-cell deficiencies?

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Brutons agammaglobulinemia

CVID (Common Variant Imm. Def)

Leukemias

Lymphomas

SCID

WAS

Job Buckley Syndrome

What is the Tyrosine kinase deficiency?

Brutons 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 (Burkitts 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

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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

What are 6 Hormones produced by the placenta?

hCG

Inhibin

Human placental lactogen (HPL)

Oxytocin (drug lactation, pit gland prod it also)

Progesterone

Estrogen

Relaxin

What is cancer grading?

Severity of microscopic change

Degree of differentiation

What is cancer staging?

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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

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, heliotropic rash, malar area

Colon CA

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. w/ bacteria

What is carried by HDL?

Apo E Apo A

Apo CII

L-CAT

lecithin cholesterol acetyl transferase

Cholesterol

from periphery to liver

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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

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Lungs?

Osler Weber Rendu Syndrome

What is the Ransons criteria for acute pancreatitis (at admission)?

Glucose > 200

Age > 55

LDH >350

AST > 250

WBC > 16,000

What is the Ransons criteria for acute pancreatitis (at less than 48 hrs)?

Calcium 10%

O2 < 60 (PaO2)

Base deficit > 4

BUN > 5 mg/dl

Sequestration > 6L

What 2 diseases is pilocarpine used for? CF

Glaucoma

Painful, red, 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

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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

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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?

IgGWhat 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 diseaseWhat disease corresponds with the following inclusion bodies?

Howell-Jolly?

Sickle cell

Heinz?

G-6-P-D

Zebra?

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Niemann pick

What disease corresponds with the following inclusion bodies?

Donovan?

Leishmaniasis

Mallory?

Alcoholism

Negri?

Rabies


Councilman?

Yellow fever

Call-exner?

Ovarian tumors

granulosa origin


Lewy?

Parkinsons

Pick?

Picks disease

Barr body?

Normal female


Aschoff?

Rheumatic fever

Cowdry type A inclusions?

Herpes virus

Auer rods?

AML


Globoid?

Krabbes lysosomal storage disease

Russell?

Multiple myeloma

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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

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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?


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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


Beta 2 microglobulin?

Chronic hemodialysis

AA amyloid from SAA?

Nephrotic hereditary forms

eg. Mediterranean fever


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 Alzheimers disease/Downs?

Cerebral amyloidosis

Types of amyloid found in various Local amyloidoses: Calcitonin precursors?

Medullary CA of thyroid

AL from light chains?

Isolated, massive, nodular deposits

lung, skin, urogenital tract

What type of dementia do you get in Picks dis?

Frontotemporal dementia

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Describe Picks 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

Metronidazole

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 non-selective

What are the 4 facts of Fanconi Syndrome?

Problem in proximal tubule

Cant reabsorb

Low energy state causing anemia

Can be due to old tetracycline

Where is glutaminase found?

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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

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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 andeukaryotes

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 gamma-carboxylation of prothrombin and factors 2, 7, 9, 10, proteinsC & 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 its zone?

Green

What type of hemolysis is beta-hemolysis?

Complete hemolysis

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Hemolytic properties of Streptococcus:

What color is its zone

Clear

eg. Streptokinase

What type of hemolysis is gamma-hemolysis?

No hemolysis

What color is its 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

BovisWhat Steptococcus has green pigment?

Viridans

What Streptococcus causes SBE?

Viridans

What Streptococcus causes cavities?

Mutans

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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

What is the #1 cause of Sinusitis, Otitis, Bronchitis, Pneumonia?

Strep. 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

If you develop gastroenteritis within 8hrs of eating what are the most common likelybugs?

Staph aureus

Clostridium perfringens

Bacillus cereus.from what?

Fried rice

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?

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Injected in different areas of body

The Most common cause of UTI is?

E. coli

Followed by?

Proteus

Followed by?

Klebsiella

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 UTIs after 24?

Because women are use to penises and Staph saprophyticus lives on penis (becomes part ofnormal flora).

Staph aureus is the most common cause of what bone disease?

Osteomyelitis

Because of what?

Collagenase

What is the Most Common cause of infections one week post burn injury?

Staph. aureus

What is the triad of SSSS?

Shock

Rash

Hypotension

Most common cause of UTI?

E. coli

Then? Proteus

Then?

Klebsiella

Newborn meningitis is caused by?

Group B Strep (agalactiae)

E. coli

Listeria

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What is normal rectal flora from mom

Group B Strep (Strep. Agalactiae)

E. coli

Listeria

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 its DNA into bacteria

What is transformation?

Virus injects its 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 withencapsulated 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

40

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What do you see in Renal failure and what are the values?

BUN

10-15

Fractional Na+ excretion

>2%

Creatinine


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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 DeQuervains?

Subacute Granulomatous Thyroiditis

What is another name for Intraductal Ca?

Comedo Ca

What is another name for I-Cell 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 cellsWhat is another name for Temporal arteritis?

Giant cell arteritis (granulomatous)

What is another name for Waldenstroms 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

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Burkitts

HHV V causes?

CMV

Inclusion bodies

HHV VI causes?

Roseola Duke Disease

Exanthem subitum

HHV VII causes?

Pityriasis rosea

HHV VIII causes?

Kaposis sarcoma

Answer the following questions about Coumadin/Warfarin.

What is the MOA?

Interferes with normal synthesis and gama carboxylation of Vit. K dependent clotting factors viavitamin K antagonism.

Is it long or short acting?

Long half-life

8-10 hours to act


Clinical use?

Chronic anticoagulation

Contra-indication?

Pregnancy because it can cross the placenta


What pathway does it affect?

Extrinsic pathway

What does it do to PT?

Prolongs

PT


What are the toxicities? Bleeding

Teratogenic

Drug-drug interactions

How is it activatied?

Tissue activated


Administration?

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po

What are the Vitamin K dependent clotting factors?

II

VII

IX

X

Protein C

Protein S

Answer the following questions about Heparin.

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


Clinical use?

Immediate anticoagulation of pulmonary embolism, stroke, angina, MI, DVT.

Contra-indication?

Can be used during pregnancy because it does not cross the placenta


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


Administration?

I.V.

Drug of choice for what?

DVT

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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.

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

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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

What are 4 causes of severe pain (in order)?

1.Pancreatitis

Due to What?

ETOH

2.Kidney stones

Due to What?

Alcohol

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)

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Pseudounipolar cells

Spiral membrane of heart

Chromaffin cells

All Ganglion cells (Schwann, Adrenal medulla)

Melanocytes

Laryngeal/Tracheal cartilage

What are the triple repeat diseases?

Huntingtons

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 Ds 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?

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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?

Whipples

Adult male or female?

Crohns

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

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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

What are 4 enzymes never seen in glycolysis?

Pyruvate carboxylase PEP carboxykinase

F-1,6 dPhosphatase

G-6-Phosphatase

What are 3 enzymes seen ONLY in glycolysis?

Hexokinase

PFK-1

Pyruvate kinase

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2

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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

Oslers nodes

Splinter hemorrhages

Endocarditis

Where are the following lesions found?

Janeway lesions? Toes

Oslers 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

What are 2 bacteria that release elastase?

Staph. Aureus

Pseudomonas

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?

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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

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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.P. Clue 4 Bio Stat

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?

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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 HLA-DR 2?

Narcolepsy

Allergy (hay fever)

Goodpasture

MS5 DZ associated with HLA-DR 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?

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Psoriasis

only if with arthritis

Ankylosing Spondylities

IBD

Ulcerative Cholitis

Reiters

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

MCC of pneumonia in the Elderly?

Strep pneumonia

Viruses

Anaerobes

H.influenza

Gr ve rods

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

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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


Most common sub-class deficiency

Patient susceptible to encapsulated organisms


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- GammaWhat does TH2 Secrete?

IL-4

IL-5

IL-6

IL-10

What does TH-0 secrete?

TH-1

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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. Receptor problem forVLDL. Most common in General Population

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

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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

Erythema multiforme

Red macules, target lesions

Causes: allergy, viruses

Mild: MCC virus, #2 drugs (sulfas) Moderate: Stevens-Johnsons Syndrome

Severe: Toxic epidermal necrolysis , skin peels off

SEBORRHEIC DERMATITIS

Scaly skin with oily shine on headline

SEBORRHEIC KERATOSIS

Stuck on warts

Due to aging

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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

DERMATITIS HERPATIFORMIS

Rash and blisters on ant. thighs Assoc. with diarrhea

Assoc. 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

TINEA VERSICOLOR

Hypopigmented macules on upper back

Presents in a V pattern

A.K.A. upside down christmas tree Tx: Griseofulvin

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?

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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 T-cell lymphoma

What is the job of CHYLOMICRONS?

Transport TGs from GI to liver and endothelium

What is the job of VLDL?

Transports TGs from liver to adipose

What is the job of IDL?

Transports TGs from adipose to tissue

What is special about LDLs?

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%


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Capsule or no capsule?

non-encapsulated

Invasive or non invasive?

non-invasive


Most common cause of what?

Sinusitis

Otitis

Bronchitis


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


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 followingages?

0-2 months?

#1. Group B strep (agalactiae)

#2. E. coli

#3. Listera


2 Months- 10 years?

#1. strep pneumonia

#2. n. meningitides (adolescent years only)


10yrs- 21 yrs?

#1. n. meningitides

What are the most common causes of MENINGITIS corresponding with the following

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ages?

> 21 years old?

#1 S. pneumoniae

Answer the following about the Strep. Pneumonia vaccine.

At what age is it given?

Given at 2,4,6 months

What strain does it cover?

Covers 23 strains (98% cases)

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

What are the STAPHYLOCOCCUS PIGMENTS?

St. aureus?

Gold pigment

St. epidermidis?

White pigment

St. saprophyticus?

No pigment

What is the clue for RUSTY COLORED SPUTUM?

Strep. Pneumonia

pneumococcus

Clues for GENERAL INFECTIONS

Skin Infections?

Say Staph. Aureus

Throat Infections?

Say Strep. Pyogenes

Small Intestine Infections? Say E. coli

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

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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 bedue 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?

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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?

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1500

When do you begin treating with 2 nucleotide inhibitors and 1 protease inhibitor?


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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?

Wernickes Encephalopathy

Wernickes Korsakoff

What is Wernickes Encephalopathy?

Alcoholic thymine deficiency of the Temporal Lobe

What is Wernickes 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

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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


You guessed itnothing

What is B6?

Pyridoxine


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


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?

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Because it recycles myelin

Deficiency in Homocystiene Methyl Transferase leads to what?

Megaloblastic anemia

What else is this enzyme needed for?

Nucleotide synthesis

When is ANGULARE STOMATOSIS seen?

VITAMIN B2- RIBOFLAVIN deficiency

What are the 4 DS 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

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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

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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?

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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 PS OF COMPARTMENT SYNDROME?

Pain

Pallor

Paresthesia

Pulselessness

Poikilothermia

What are 5 skin infections were Strep. Pyogenes is the number one cause?

Lympangitis

Impetigo (not bullous) Necrotizing fascitis

Erysepelas

Scarlet fever

What are 5 skin infections were Staph. aureus is the number two cause?

Lympangitis

Impetigo (not bullous)

Necrotizing fascitis

Erysepelas

Scarlet fever

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

Why do we need E. COLI in the gut?

Absorption of Vit. 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

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Chymotrypsin cuts where?

cuts to R of bulky aas (aromatics)

Phe

Tyr

Trp


Elastase cuts where?

Cuts to R of (SAG)

Ser

Ala

Gly

CNBr cuts where?

Cuts to R of

Methionine


Mercaptoethanol cuts where?

Cuts to R of: disulfide bonds

Cysteine

methionine


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

What VACCINE is NOT GIVEN IF pt. is Allergic to EGG?

MMR & INFLUENZA

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

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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?

Leighs Disease

What is another name?

usmle clues

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