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Pass Program Clues You aint told me squat till you tell me the CLUE!!! What are the 5 bacteria causing Heart Block? Lyme Disease Salmonella typhii (typhoid) Chagas Disease (Whipples) Legionella Diptheria Lets Stop Doing Long Contractions What bacteria cause Reiters Syndrome? Shigella IBD Crohns Chlamydia Yersina Reiter & Crohn Saw Yersina and got Chlamyia What are the Low Complement bugs causing Cryoglobuniemia? Influenzae Adenovirus Mycoplasma Hepatitis C EBV I AM HE What are the drugs induced SLE? Hydralazine INH Phenytoin Procainamide Penicillamine Ethosuximide H I PPPE What are the drugs that Blast the BM? AZT Benzene Chloramphenicol Vinblastine Vinblastine Anilate Bone Cells What are the Comma Shaped bugs? Vibrio Campylobacter Listeria H. pylori

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Campylobacter Has Very Long Comma Genes

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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 RESPI What are the 6 Low Complement assocs. with Nephrotic Syndrome? Serum Sickness PSGN SLE SBE Cryoglobinemia MPGN II
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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, Postgonococcal Arthritis 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

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What are the one dose treatments for Gonorrhea? Ceftriaxone Cefixime Cefoxine Ciprofloxin Oflaxacin Gatifolxacin What is the one dose treatment for Chlamydia? Azithromycin What are the Big Mama anaerobes? Strep bovis Clostridium melanogosepticus Bacteriodes fragilis What are the Big Mama Rx? Clindamycin Metranidazole Cefoxitin What big mama bugs are associated with colon cancer? Strep. Bovis Clostridium melanogosepticus
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What do you see in the serum with low volume state? K+? Decreases Na+? Decreases What are psammoma bodies? Calcified CAs In what diseases are Psammoa Bodies present? Cl-? Decreases pH? Increases BP? Increases

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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

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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
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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

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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

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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)

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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???

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What are the CLUES for SCID? Framshift/Nonsense mutation Adenosine deaminase deficiency T-cell>B-cell Bacterial infections Fungal infections What are the CLUES for CVID? Late onset Frameshift/Missense mutation Tyrosine Kinase deficiency What are the CLUES for HIV & HTLV-1? T-cell>B-cell CD4 rich Brain Testicles Cervix Blood vessels What are the inhibitors of Complex 1 of the ETC? Amytal Rotenone What are the inhibitors of Complex 2 of the ETC? Malonate What are the inhibitors of Complex 3 of the ETC? Antimycin D What are the inhibitors of Complex 4 of the ETC? CN CO Chloramphenicol What are the inhibitors of Complex 5 of the ETC? Oligomycin What are the ETC chemical uncouplers? DNP Free Fatty acids Aspirin What type of uncoupler is Aspirin? Physical uncoupler What are the 4 sources of Renal Acid? Plasma Urea cycle Collecting ducts Glutaminase

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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? Metronidazole 2 grams What is the one dose tx for Gardnerella? Metronidazole 2 grams What are the 3 cephalosporins & doses used as one dose treatments for Gonorrhea? Ceftriaxone 250 mg im Cefixime 400 mg po Cefoxitin 400 mg po What are the 3 Quinolones & doses used as one dose treatments for Gonorrhea? Ciprofloxacin 500 mg po Ofloxacin 400 mg po Gatifloxacin 400 mg im 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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What is the rate limiting enzyme in the break down of glycogen? Phosphorylase (Pi) What values do you see in obstructive pulmonary dz? pO2? Normal pCO2? Normal or increased pH? Decreased What values do you see in restrictive pulmonary dz? pO2? Decreased pCO2? Decreased pH? Increased What type of acidosis do you see with obstructive pulmonary dz? Respiratory acidosis
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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

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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

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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

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What are 6 places of the TCA cycle where amino acids feed in/out? Alpha-KG ? Glutamate Glutamine Succinyl CoA? Phenylalanine Tryptophan Tyrosine

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What are 6 places of the TCA cycle where amino acids feed in/out? Fumerate ? Proline Oxaloacetate? Aspartate Asparigine

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What are the 4 steps of B-oxidation? Oxidation 7 NADH 21 ATP Hydration

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Oxidation - 7FADH 14 ATP Thiolysis 8 AcCoA 96ATP 131 ATP 2 (to bring it
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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

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What Autoimmune Disease has the following Autoimmune Antibodies? Anti histone? Drug induced SLE

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What Autoimmune Disease has the following Autoimmune Antibodies? Anti-topoisomerase? PSS (Progressive Systemic Sclerosis)

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What Autoimmune Disease has the following Autoimmune Antibodies? Anti TSH receptors? Graves What Autoimmune Disease has the following Autoimmune Antibodies? Anti-centromere? CREST

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What Autoimmune Disease has the following Autoimmune Antibodies? Anti-GBM? Goodpastures What does Goodpastures have antibody to? Type IV collagen What Autoimmune Disease has the following Autoimmune Antibodies? Anti-mitochondria? Primary biliary cirrhosis What Autoimmune Disease has the following Autoimmune Antibodies? Anti-hair follicle? Alopecia areata What Autoimmune Disease has the following Autoimmune Antibodies? Anti-IgG? Rheumatoid arthritis What Autoimmune Disease has the following Autoimmune Antibodies? Anti-myelin receptors? MS

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What Autoimmune Disease has the following Autoimmune Antibodies? Anti-gliaden? Anti-gluten? Celiac sprue

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What Autoimmune Disease has the following Autoimmune Antibodies? Anti-islet cell receptor? DM Type I

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

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What Autoimmune Disease has the following Autoimmune Antibodies? Anti-ACh receptor?

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What Autoimmune Disease has the following Autoimmune Antibodies? Anti-ribonuclear protein? Mixed Connective Tissue dz (MCTD)

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What Autoimmune Disease has the following Autoimmune Antibodies? Anti-parietal cell receptor? Pernicious anemia

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What does Pernicious Anemia have antibody to? Intrinsic factor What Autoimmune Disease has the following Autoimmune Antibodies? Anti-epidermal anchoring protein receptors? Pemphigus vulgaris What does Pemphigus vulgaris have antibody to? Intercelluar junctions of epidermal cells What Autoimmune Disease has the following Autoimmune Antibodies? Anti-epidermal basement membrane protein? Bullous pemphigoid

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What do you see with bullous pemphigoid? IgG sub-epidermal blisters Oral blisters What Autoimmune Disease has the following Autoimmune Antibodies? Anti-platelet? ITP

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What does ITP have antibody to? Glycoprotein IIb/IIIa

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What Autoimmune Disease has the following Autoimmune Antibodies? Anti-thyroglobulin? Anti-microsomal? Hashimotos

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What Autoimmune Disease has the following Autoimmune Antibodies? Anti-smooth muscle?

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Anti-scl-70? Scleroderma
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What Autoimmune Disease has the following Autoimmune Antibodies? Anti-rho (SS-A)? Anti-la? Sjogrens

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What Autoimmune Disease has the following Autoimmune Antibodies? Anti-proteinase? C-ANCA? Wegeners

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What Autoimmune Disease has the following Autoimmune Antibodies? P-ANCA? Polyarteritis nodosa

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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

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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 progressive glomerulonephrosis? Goodpastures

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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

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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 anemia What 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
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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

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Tumor Markers/Oncongenes II C-myb? Colon CA AML C-sis ? Osteosarcoma Glioma Fibrosarcoma

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Tumor Markers/Oncongenes III

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C-erb B2? Epidermal growth factor receptors CSF-1 ? Breast

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Tumor Markers/Oncongenes IV Erb-B2? Breast CA Ovarian CA Gastric CA Ret? Medullary CA of thyroid Men II & III Papillary carcinoma

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Tumor Markers/Oncongenes V Ki-ras? Lung CA Colon CA Bcl-2? Burkitts Follicular lymphoma Erb? Retinoblastoma

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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

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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

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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?

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Actinic keratosis? Dry scaly plaques on sun-exposed skin Squamous Cell CA of skin Dermatomyositis? violacious, heliotropic rash, malar area Colon CA
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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)

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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

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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 <8 mg/dl HCT drop > 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

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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

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What is Secondary Allergic response is due to? MEMORY What shows up at day 3? IgG with 5x concentration Has the highest affinity When does IgG peak? In 5 years When does IgG leave? In 10 years What Ig has the hightest affinity? IgG What are the risk factors for Esophageal/Gastric CA? Smoking Alcohol Nitrites Japanese What are the risk factors for bladder CA? Smoking Aniline dyes Benzene Aflatoxin Cyclophosphamide Schistosomiasis 2 diseases: Von Hippel-Lindau Tubular sclerosis What is the NBT test? Nitro Blue Tetrazolium test What is it used for? Screening CGD What does a ve test indicate? +ve for the disease What disease corresponds with the following inclusion bodies? Howell-Jolly? Sickle cell Heinz? G-6-P-D Zebra?

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Niemann pick
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What disease corresponds with the following inclusion bodies? Donovan? Leishmaniasis Mallory? Alcoholism Negri? Rabies

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What disease corresponds with the following inclusion bodies? Councilman? Yellow fever Call-exner? Ovarian tumors granulosa origin

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What disease corresponds with the following inclusion bodies? Lewy? Parkinsons Pick? Picks disease Barr body? Normal female What disease corresponds with the following inclusion bodies? Aschoff? Rheumatic fever Cowdry type A inclusions? Herpes virus Auer rods? AML What disease corresponds with the following inclusion bodies? Globoid? Krabbes lysosomal storage disease Russell? Multiple myeloma

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What disease corresponds with the following inclusion bodies? Schiller-Duvall? Yolk sac tumor Basal bodies? Only found in smooth mm What are the 4 types of hypersensitivities? Mnemonic? ACID Type I Anaphylaxis/Atopic Type II Cytotoxic (Humoral) Type III Immune complex mediation Type IV Delayed hypersensitivity/Cell mediated

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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

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Cytic fibrosis Questions? What is the value in a normal person? <20 What is the value in a heterozygous person? 30 60 What chromosome is the CF gene on? Chrom 7 What Second messenger is used? IP3/DAG

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What are the gram +ve spore formers? Bacillus anthracis Clostridium perfringens

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Clostridium tetani Clostridium melangosepticus What is the chemical in spores? Calcium dipocholinate
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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

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Types of amyloid found in various Systemic amyloidoses: Beta 2 microglobulin? Chronic hemodialysis AA amyloid from SAA? Nephrotic hereditary forms eg. Mediterranean fever

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Types of amyloid found in various Systemic amyloidoses: Pre-albumin/transthyretin? Cardiomyopathic hereditary forms senile systemic amyloidosis Neuropathic hereditary syndromes Types of amyloid found in various Local amyloidoses: ANP fibrils are caused by? Senile cardiac amyloisosis Cerebral amyloid in Alzheimers disease/Downs? Cerebral amyloidosis

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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

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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

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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

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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? AM Non-selective? NZ 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
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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

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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

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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

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What is the MOA of Erythromycin? Inhibits the translocation step of ribosomal protein synthesis What is the MOA of Chloramphenicol? Inhibits ribosomal peptidyl transferase in prokaryotes What is the MOA of Puromycin? Inhibits elongation by binding to A site and prematurely terminating chain growth in pro and eukaryotes What is the MOA of Streptomycin? Causes misreading of code during initiation in prokaryotes What is the MOA of Tetracycline? Prevents binding of aminoacyl-t-RNA to ribosome on prokaryotes therefore inhibiting initiation What is the MOA of Cyclohexamide? Inhibits ribosomal peptidyl transferase in eukaryotes cell wall inhibitor What is the MOA of Rifampin? Blocks B-subunit of RNA polymerase Prophylaxis for contacts of N. meningitidis What is the MOA of Vancomycin? Cell wall inhibitor Binds irreversibly to Phopholipase carrier Bacteriacidal Covers all gram +ves Linezolid What is the MOA of Warfarin? Blocks vitamin k dependent gamma-carboxylation of prothrombin and factors 2, 7, 9, 10, proteins C&S What is the MOA of Clindamycin? Blocks translation by binding the 50S subunit Hemolytic properties of Streptococcus: What type of hemolysis is alpha hemolysis? Partial hemolysis What color is 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

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What are the 5 notable things about RTA I? High urine PH (??????not sure about this) Acidosis UTI s Stones Babies die < 1 yr old What are 3 notable things about RTA II? Acidosis urine PH = 2, normal is 5-6 Hypokalmia Patients have NO carbonic anhydrase What are 3 notable things about RTA III? It is a combination of RTA I & III Normal urine pH Hypokalemia What are 3 notable things about RTA IV? Seen in diabetics Hyperkalemia NO aldosterone b/c JG apparatus has infarcted What are the members of Streptococcus Group D? Viridans Mutans Sanguis Salivarius Bovis What Steptococcus has green pigment? Viridans What Streptococcus causes SBE? Viridans What Streptococcus causes cavities? Mutans

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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

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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

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

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The Most common cause of UTI is? E. coli Followed by? Proteus Followed by? Klebsiella

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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 of normal flora).
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Staph aureus is the most common cause of what bone disease? Osteomyelitis Because of what? Collagenase

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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

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What Ig do you look for with affinity? IgG What about Avidity? IgM

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What is transduction Virus inject its DNA into bacteria

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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 with encapsulated organisms? C3 What does complement fight against? Gram negative bacteria What do you see in serum with prerenal failure and what are the values? BUN >20 Fractional Na+ excertion <1% Creatine >40

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What do you see in Renal failure and what are the values? BUN 10-15 Fractional Na+ excretion >2% Creatinine <20

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What is the extravasation order? Pavementing Margination Diapediesis Migration What is the rate limiting enzyme for Glycolysis? PFK-1 What is the rate limiting enzyme of Gluconeogenesis? Pyruvate Carboxlyase If treating a disease that initiates the cell mediated response, what are you treating first? Viral If resistant to tx, what next? Fungal Mycobacterium Protozoa Parasite Neoplasm

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What bugs can you pick up during birth? Step. Group B Strep agalactiae Strep. Pneumonia Herpes simplex virus Neisseria gonorrhea Chlyamydia What is another name for Adenoma sebaceum? Perivascular angiofibromata What is another name for Addisons? Primary Adrenocoritcal Insufficiency What is another name for Alkaptonuria?

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Ochronosis
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What is another name for Churg-Strauss? Allergic Granulomatosis Angiitis What is another name for Craniopharyngioma? Ameloblastoma What is Ameloblast? Tooth material

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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 cells What 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
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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 via vitamin K antagonism. Is it long or short acting? Long half-life 8-10 hours to act Answer the following questions about Coumadin/Warfarin. Clinical use? Chronic anticoagulation Contra-indication? Pregnancy because it can cross the placenta Answer the following questions about Coumadin/Warfarin. What pathway does it affect? Extrinsic pathway What does it do to PT? Prolongs PT Answer the following questions about Coumadin/Warfarin. What are the toxicities? Bleeding Teratogenic Drug-drug interactions How is it activatied? Tissue activated Answer the following questions about Coumadin/Warfarin. Administration?

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po
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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 Answer the following questions about Heparin. 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 Answer the following questions about Heparin. What pathway does it affect? Intrinsic pathway What value should you follow? PTT Answer the following questions about Heparin. What are the toxicities? Bleeding Thrombocytopenia Drug-drug interactions How is it activatied? Blood activated Answer the following questions about Heparin. Administration? I.V. Drug of choice for what? DVT

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Answer the following questions about Heparin. 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

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If statins are insufficient what do you add? Cholestipol Cholestyramine If nothing works what do you give? Probucol Niacin

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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

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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

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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)

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What is happening in the Atrium? Phase 3? Repolarization Phase 4? Automaticity (S-A node)

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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

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If oxalate stones found in CF what is the most common cause? In 0-20 y/o? Malabsorptin What age do they die? Young
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Answer the following questions about pseudogout? What type of crystals are present? Calcium pyrophosphate

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Where are they found? Joint spaces

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Answer the following questions about pseudogout? Who gets it? Older patients M=F Tx? Colchicine

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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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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
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Where are the following lesions found? Janeway lesions? Toes Oslers nodes? Fingers Roth spots? Retina

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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

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How does Diptheria work? What does it cause? Heart block What do you give for Tx? Antitoxin Never scrape membrane

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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?

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Distalacinar? Aging Panacinar? Alpha-1 antitrypsin def

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What are the stages of erythropoiesis? 4 mo gestation? Yolk sac 6 mo gestation? Spleen, liver, flat bones

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What are the stages of erythropoiesis? 8 mo gestation? Long bones 1 yr old? Long bones

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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+

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What ions correspond with the following EKG? T-wave? K+ U-wave? Na+

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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

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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 MS 5 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
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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

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What are Clues for IgG1? Crosses placenta due to fc portion What are Clues for IgG2? Most common sub-class deficiency Patient susceptible to encapsulated organisms What are Clues for IgG3? Most memory antibody What are Clues for IgG4? Only IgG NOT fixing complement What are Clues for IgM? Responds in primary response Most efficient in agglutination and complement fixation Defenses against bacteria and viruses What do Macrophages release? MHC II What does TH1 secrete? IL-2 IF- Gamma What does TH2 Secrete? IL-4 IL-5 IL-6 IL-10 What does TH-0 secrete? TH-1

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TH-2
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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

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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

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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 for VLDL. 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% What are the clues for HEMOPHILIUS INFLUENZA?

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Capsule or no capsule? non-encapsulated Invasive or non invasive? non-invasive

What are the clues for HEMOPHILIUS INFLUENZA? Most common cause of what? Sinusitis Otitis Bronchitis What are the clues for HEMOPHILIUS INFLUENZA? What is the 2nd most common type? TYPE B 20% Encapsulated or non encapsulated? Encapsulated What does it have in its capsule? Polyribosyl phosphate in capsule Contains IgA protease What are the clues for HEMOPHILIUS INFLUENZA? Invasive or non invasive? Invasive What does it cause most often? #1 cause of epiglottitis What are the signs of epiglottitis? Stridor Fever Thumb sign on xray What are the most common causes of MENINGITIS corresponding with the following ages? 0-2 months? #1. Group B strep (agalactiae) #2. E. coli #3. Listera What are the most common causes of MENINGITIS corresponding with the following ages? 2 Months- 10 years? #1. strep pneumonia #2. n. meningitides (adolescent years only) What are the most common causes of MENINGITIS corresponding with the following ages? 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

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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

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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
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What are the NEUTROPHIL DEFICIENCY? NADPH-OXIDASE DEF (CGD) NEUTROPENIA MYLOPEROXIDASE Job-Buckley Syndrome What Hepatitis B antigen is found with an acute/recent infection? HbC antigen HbS antigen What Hepatitis B antigen & antibody is found with an acute/recent infection? HbC antigen HbS antigen HbC antibody What Hepatitis B antigen is found with Recent immunization within the past 2wks? HbS antigen ONLY What Hepatitis B antibody is found with Recent immunization two wks after and can be due to vaccination immunity from a long time ago? HbS antibody ONLY What Hepatitis B antibody & antigen is found with past disease but now immune? HbC antibody HbS antibody HbS antigen What Immunogloblin is found in Hepatitis B immunity? IgG What Hepatitis B antigen/antibody is found in the chronic carrier state? HbS antigen for >6months Can be with or without HbS antibody What Hepatitis B antigen is found with the infectious state? HbE antigen What Hepatitis B antibody is found with the non-infectious state? HbE antibody If patient has recovered from Hepatitis B what antigen will they have? NEGATIVE HbS antigen If patient is a chronic carrier what antigen will they have?

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POSITIVE HbS antigen

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What does the window period build in Hepatitis B? HbE antibody IgM HbC antibody What disappears? HbS antigen

542

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? <500 (child at 750)
549

Answer the following questions about HIV? AIDS is defined as a CD4 count of what? <200 With a CD4 count of <200 what do you tx for? PCP What do you treat for when CD count is <100? Mycobacterium aviam intracellular What are the Antioxidants? Vitamin E #1 Vitamin A Vitamin C Betakertine What is Vitamin A a cofactor for? Parathyroid Along with what other cofactor? Mg+ Too much Vitamin A will cause what? Hyperparathyroid Increase Ca+ Decrease Phosphate What will be the symptoms? Goans Moans Bones Stones Too much Vitamin A will cause what? Pseudotumor Cerebri Increase CSF production from Chorichoid Plexus What is the only cause of ICP that does not cause herniation? Pseucotumor cerebri What does Vitamin A deficiency cause? Nightvision problems/nightblindness Hypoparathyroidism Decrease Ca+ Increase Phosphate What is Vitamin B1? THIAMINE

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557

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

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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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566

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

567

What is B5? Pantothenic acid What is the deficiency caused by this vitamin? You guessed itnothing What is B6? Pyridoxine What is the deficiency caused by this vitamin? Neuropathy Seizures Who do you need to give B6 to? Patient on INH

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What type of anemia is seen with B6 Deficiency? Sideroblastic What needs B6 as a cofactor? ALL transaminases What is B12? Cyanocobalamine What is the deficiency caused by this vitamin? Pernicious anemia Neuropathy What is the most common cause of vitamin B12 deficiency? Pernicious anemia What 2 enzymes are needed for synthesis of B12? Methylmalonyl CoA Mutase Homocysteine Methyl Transferase Deficiency in Methylmalonyl CoA Mutase leads to what? Neuropathy Why?

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Because it recycles myelin

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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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587

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
595

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
608

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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617

Chymotrypsin cuts where? cuts to R of bulky aas (aromatics) Phe Tyr Trp

Answer the following questions about RESTRICTION ENZYMES? Elastase cuts where? Cuts to R of (SAG) Ser Ala Gly CNBr cuts where? Cuts to R of Methionine

618

Answer the following questions about RESTRICTION ENZYMES? Mercaptoethanol cuts where? Cuts to R of: disulfide bonds Cysteine methionine Answer the following questions about RESTRICTION ENZYMES? Aminopeptidase cuts where? Cuts to R of amino acid terminal Caboxypeptidase cuts where? Cuts to L of carboxy terminal

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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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626

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? Subacute necrotizing encephalomyelopathy What are the signs & symptoms? Progressively decreasing IQ Seizure Ataxia What is the deficiency? Cytochrome oxidase deficiency What are the MITOCHONDRIAL DISEASES? Lebers Hereditary Optic Atrophy (LHON) They all die

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What is the ONLY G +ve WITH ENDOTOXIN? Listeria What part is toxic? Lipid A Does it cross the placenta? Yes

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What does Listeria activate?

T-cells & Macrophages, therefore, have granulomas

633

What are the Associations in contracting the Listeria bug? Raw cabbage Spoiled milk Migrant workers

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634

What are the PERIODS OF RAPID GROWTH/RAPIDLY DIVIDING CELLS? Birth 2 months 4 7 years old Puberty What is THE ONLY IMMUNE DEFICIENCY WITH LOW CALCIUM and Increase Phosphate? DiGeorges Syndrome What are the BASIC AMINO ACIDS? Lysine Arginine What are the ACIDIC AMINO ACIDS? Glutamate Aspartate What are the Ketogenic + Glucogenic Amino Acids? Phenylalanine Isoleucine Trptophan Threonine What are the AROMATIC AMINO ACIDS? Phenylalanin Tyrosine Tryptophan What are the AMINO ACIDS with DISULFIDE BONDS? Met Cyst What are the KINKY AMINO ACID? Proline What are the SMALLEST AMINO ACID? Gly What are the AMINO ACIDS with O-BONDS? Serine Threonine Tyrosine What are the AMINO ACIDS with N-BONDS? Asparagine Glutamine What are the BRANCHED-CHAIN AMINO ACIDS? Leu Iso Val What are the KETOGENIC AMINO ACIDS? Leu

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Lys
647

What CONDITIONS are ASSOCIATED WITH HLA-B27? Psoriasis (with arthritis) Ankylosing Spondylitis Irritable Bowel Syndrome Reiters Syndrome What is associated with HLA-B13? Psoriasis with out arthritis What are the ORGANISMS WITH IgA PROTEASE (resistant to IgA)? Strep. Pneumoniae H. influenza Neisseria catarrhalis What do EOSINOPHILS SECRETE? Histaminase Arylsulfatase Heparin Major Basic Protein What do MAST CELLS SECRETE? In an Acute Reaction? Histamine In a Late Reaction ? SRS-A ECF-A What is the MCC of ATYPICAL PNEUMONIA? 0 2 months? chlamydia pneumonia What does chlamydia pneumonia cause? Intersitital pneumonia What is the CLUE for HEART BLOCK? High temperature with NORMAL pulse rate! (This should never be! Each degree in temp. 10 beats/min in pulse rate) What are the clues for IL-1? FEVER NONSPECIFIC ILLNESS RECRUITS TH CELLS for LINKING with MHC II COMPLEX SECRETED BY MACROPHAGES What are the clues for IL-2? MOST POTENT OF THE Interleukins RECRUITS EVERYBODY

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MOST POWERFUL CHEMO-ATTRACTANT MUST BE INACTIVATED When must you inactivate it? PRIOR TO TRANSPLANTATION by cyclosporin SECRETED BY TH1 CELLS
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What are the clues for IL-3? ENERGIZED MACROPHAGES CAUSES B-CELL PROLIFERATION LABELED BY THYMIDINE (USE POKEWEED MITOGEN OR ENDOTOXIN) SECRETED BY ACTIVATED T CELLS What are the clues for IL-4? B-CELL DIFFERENTIATION RESPONSIBLE FOR CLASS SWITCHING SECRETED BY TH2 CELLS What are the clues for IL-5 thru 14? They do exactly what IL-1 thru IL4 What are the clues for IL-10? SUPPRESSES CELL-MEDIATED RESPONSE (tells macrophages and fibroblasts to stay away if bacterial) INHIBITS MAC ACTIVATION What are the clues for IL-12? PROMOTES CELL-MEDIATED RESPONSE (recruits macs & fibroblasts if NOT bacterial) ACTIVATES NK CELLS TO SECRETE IF- INHIBITS IL-4 INDUCED IgE SECRETION CHANGES TH CELLS to TH1 CELLS secretes IL-2 & IF- inhib. TH2, therefore, host defenses against delayed hypersensitivity What are the clues for IF-? Where is it from? LEUKOCYTES VIRAL REPLICATION AND TUMOR GROWTH NK ACTVITY secretes perforins and granzymes to kill infected cell MHC CLASS I & II EXPRESSION PROTEIN SYNTHESIS translation inhibited, therefore, defective protein synthesis Summary of clues for IF-? Increase NK activity Increase MHC class I & II Decrease protein synthesis Decrease viral replication and growth What are the clues for IF-B? Where is it from? FIBROBLASTS Increase NK activity

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Increase MHC class I & II Decrease protein synthesis Decrease viral replication and growth

665

What are the clues for IF-gama? Where is it from? T-CELLS & NK CELLS NK ACTIVITY MHC CLASS I & II MACROPHAGE ACTIVITY CO-STIMULATES B-CELL GROWTH & DIFFERENTIATION IgE SECRETION What are the clues for TNF-alpha? Where is it from? MONOCYTES & MACROPHAGES What is another name for TNF-alpha? CACHECTIN INDUCES IL-1 ADHESION MOLECULES & MHC CLASS I ON ENDOTHELIAL CELLS PYROGEN INDUCES IF- SECRETION CYTOTOXIC/CYTOSTATIC EFFECT What are the clues for TNF-beta? Where is it from? T-CELLS What is another name for it? LYMPHOTOXIN CYTOTOXIC FACTOR

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What are the clues for TGF-? Where is it from? SOLID TUMORS (CARCINOMA > SARCOMA) MONOCYTES What is another name for it? TRANSFORMING GROWTH FACTORS

669

What are the clues for TGF-? What does it INDUCE? ANGIOGENESIS KERATINOCYTE PROLIFERATION BONE RESORPTION TUMOR GROWTH What is it mainly for?

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MAINLY FOR TUMOR GROWTH

670

What are the clues for TGF-? Where is it from? PLATELETS PLACENTA KIDNEY BONE T & B CELLS What are the clues for TGF-? What INDUCES it? FIBROBLAST PROLIFERATION COLLAGEN FIBRONECTIN SYNTHESIS

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What are the clues for TGF-? What INHIBITS it? NK LAK CTL T & B CELL PROLIFERATION What are the clues for TGF-? What ENHANCES it? WOUND HEALING ANGIOGENESIS What are the clues for TGF-? What does it suppress? SUPPRESSES IR AFTER INFECTION & PROMOTES HEALING PROCESS What is it mainly for? MAINLY FOR WOUND HEALING

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What does LAK stand for? LYMPHOKINE ACTIVATED KILLER CELLS What does CTL stand for? CYTOTOXIC T-LYMPHOCYTES What does mitochondrial inheritance affect? CNS Heart Skeletal muscle Why does it affect these particular places? Due to uneven cytokinesis during meiosis or oogenesis Answer the following about Mitochondrial diseases? Who are affected?

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679

All offspring Who passes the disease? MOM Who has no transmission? Dad

Answer the following about Autosomal Recessive inheritance? Who does it show in? Not parents Siblings/uncles may show disease When is onset? Early in life (childhood diagnosis) Is it complete on incomplete penetrance? COMPLETE Answer the following about Autosomal Recessive inheritance? How are they acquired? Almost ALL are inborn error of metabolism When does it occur? Only when both alleles at a locus are mutant Answer the following about Autosomal Recessive inheritance? How is it transmitted? Horizontal Tm Are there malformations present? Physical malformations are uncommon What type of defect? Enzyme defect Answer the following about Autosomal Dominant inheritance? Who does it affect the most? M=F How does it manifest? Heterozygote state Who can transmit the disease? Both parents Answer the following about Autosomal Dominant inheritance? Where is the new mutation? Often in germ cells of older fathers When is onset?

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Often delayed (adult diagnosis) Example = Huntingtons

684

Answer the following about Autosomal Dominant inheritance? What is penetrance? Reduced penetrance How is it expressed? Variable expressin Different in each individual Answer the following about Autosomal Dominant inheritance? How is it transmitted? Vertical TM Is there malformation present? Physical malformation common What type of defect? Structural Who is affected in the family with an X-Linked disease? Maternal grandfather Maternal uncle Immune System Time Line for viral & cell-mediated. What happens <24hrs? Swelling What happens at 24 hrs? Neutrophils show up What happens at day 3? Neutrophils peak Immune System Time Line for viral & cell-mediated. What happens at day 4? T cells and Macrophages show up What happens at day 7? Fibroblasts show up What happens in 1 month? Fibroblast peak Immune System Time Line for viral & cell-mediated. What happens at 3-6 months? Fibroblasts are gone What is the general CLUE for any Lysosomal Storage Disease? Lysosomal Inclusion Bodies

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691

What are the Lysosomal Storage diseases? Gauchers Fabrys Krabbe Tay Sachs Sandhoffs Hurlers Hunters Neiman Pick Metachromatic Leukodystropy What is missing in Gauchers? Beta-Glucocerberosidase What Accumulates? Glucocebroside Where? Brain Liver Bone Marrow Spleen

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What are the CLUES for Gauchers? Ask. Jew Gargols Gaucher cells Macrophages looking like Crinkeled paper Erlin myoflask legs Pseudohypertrophy What is missing in Fabrys? Alpha-galactosidase What accumulates? Ceramide Trihexoside What are the CLUES for Fabrys? X-Linked recessive Presents with cataracts as a child Presents with renal failure as a child What is missing in Krabbes? Galactosylceramide B-Galactosidase What accumulates? Galactocerebrosidase Where? Brain

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What are the CLUES for Krabbes?

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Early death Globoid bodies Fat cells

698

What is missing in Tay Sachs? Hexoseaminidase A What accumulates? GM2 Ganglioside What is the CLUE for Tay Sachs? Ask. Jews Cherry red macula Death by 3 What is missing in Sandhoffs? Hexoseaminadase A & B What is missing in Hurlers? Iduronidase What are the CLUES for Hurlers? Corneal Clouding Mental Retardation What is missing in Hunters? Iduronate Sulfatase What are the CLUES for Hunters? Mild mental retardation No corneal clouding Mild form of Hurlers X-linked recessive What is missing in Niemann Picks? Spingomyelinase What accumulates? Spingomyelin Cholesterol What are the CLUES for Niemann Picks? Zebra bodies Cherrry red macula Die by 3 What is missing in Metachromatic Leukodystrophy? Arylsulfatase A What is the CLUE for Metachromatic Leukodystrophy? Visual Disturbance Presents like MS in 5 to 10 years of age What are the Glycogen Storage Diseases?

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710

Von Gierkes Andersons Corys McCardles Pompes Hers

What is deficient in Von Gierkes? G-6-Pase Deficiency What is the CLUE for Von Gierkes? Big Liver Big Kidney Severe hypoglycemia Can NEVER raise their blood sugar What is deficient in Andersons? Branching enzyme deficiency What is the CLUE for Andersons? Glycogen will be ALL LONG chains on liver biopsy What is missing in Corys? Debranching enzyme What is the CLUE for Corys? Glycogen from liver biopsy will be ALL SHORT branches What is missing in McCardles? Muscle phosporalase What is the CLUE for McCardles? Severe muscle cramps when exercising High CPK What is missing in Pompes? Cardiac alpha-1,4 glucocydase What is the CLUE for Pompes? Heart problems Die early What is missing in Hers? Liver phosphoralase What is the CLUE for Hers? Big Liver NO big kidney Pagets disease is associated with what cancer? Intraductal Ca What MUST you rule out with a decrease AVO2? AV Fistula Vasodilation

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724

What diseases have a cherry red macula? Tay Sachs Sandhoffs Niemann Pick What is translocation 9;22? CML What is translocation 11;22? Ewings sarcoma What is translocation 8;14? Burketts lymphoma What is translocation 14;18? Follicular lymphoma What are the causes of restrictive cardiomyopathy? Sarcoid Amyloid Hemochromatosis Cancer Fibrosis Thanks STAN!! What are the CLUES for Vasulitis or Intravascular Hemolysis? Shistocytes Burr cells Helmet cells What is the CLUE for Extravascular Hemolysis? Splenomagely Where is Glucose 6-Pase present? Adrenal Liver What is the Heinz body CLUE? G6PD If you see the CLUE basophilic stippling, what should you be thinking? Lead poisoning What are the Microcytic Hypochromic Anemias? Iron deficiency Anemia of Chronic disease Lead poisoning Hemoglobinopathy Thallasemias Sideroblastic anemia TAIL

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736

What is primary sideroblastic anemia due to? Genetic AD What is secondary Sideroblastic anemia due to? Blood transfusions What are the Microcytic Hyperchromic Anemias? Hereditary Spherocytosis What are the Normocytic Normochromic Anemias? Acute hemorrhage Anemia of Chronic Disease Hypothyrodism Early Renal Failure What are the Macrocytic anemias? Folate deficiency B12 deficiency Reticulocytosis ETOH Hemolytic Anemias Chemo Treatment Anticonvulsants Myelodysplasia What are the anticonvulsants causing a Macrocytic Anemia? Phenytoin Ethusuximide Carbamyazapine Valproate What anemia is caused by blood transfusions? Sideroblastic anemia What is the problem if you see Eliptocytes? Something is wrong with the RBC membrane Extravascular Heridatary Ellitocytosis Increased RET count What disease do you get if you have an EXCESS in Cu+? Wilsons Disease What is the CLUE for Wilsons Disease? Hepato/Lenticular Degeneration Kayser Fleishner Rings Copper in eyes

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Hepato = Liver

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