1st Aid Q and A book: Chapter 17 Respiratory QID: 8260 Obstructive Increased Air Flow Resistance Decreased RR respiratory

rate Tidal volume increased Slow deep breath, exhale rate is slow Asthma, COPD, alpha1 trypsin deficiency FEV/FVC > 80 Air trapping in lungs Hard to exhale, easy to inhale (air trap) -> like plastic bag Restrictive Increased elastic resistance Increased RR respiratory rate Stiff Lung Rapid shallow breathing Pulmonary Fibrosis, PE, ARD

Hard to inhale, easy to exhale (like a balloon)

Chapter 16 Reproduction Bladder incontinence pharmacology Male/Guy BPH

Use alpha 1 blocker: ie doxazosin/prazosin/terazosin for both BPH and HTN. Relaxation of smooth muscle in arterial and venous walls - decrease in peripheral vascaular resistance BPH: induce relaxation of smooth muscle in bladder neck and prostate decrease in urine obstruction

Women/Female with Urge Incontinence = overactive bladder syndrome: Caused by inhibited bladder contractions (detrusor instability) sudden sensation of urency and involuntary leakage of urine.

Chapter 15 Renal 1. Statins cause renal failure. 2. Loop diuretics and thiazides cause metabolic acidosis. 3. In nephrotic syndrome: you lose the anti-coagulants-> antithrombin III, protein C and S. Therefore u are in a hypercoagulable state. When u have a hypercogulable state, u suffer a stroke. hyperlipidemia, Edema (generalized), hypoAlbuminemia, and Proteinuria. 4. Nephritic syndrome Mnemonic: LEAP: Lipiduria Glomerulonephritis Acute post-streptococcal glomerulonephritis Lumpy bumpy due to circulating antistreptococcal Ab-Ag complexes depositing in glomerular BM. happens several wks after URTI. Bergers IgA happens days within infection. Non-linear IgA deposition in mesangium. Cresenteric Glomeruloneprhitis: Crescent-shaped 1) Goodpastures : commonly presents with 1) Linear subendothelial deposition of antibodies against glomerular basement membrane on IF Rapidly progressive glomeruloscloeris Destruction of glomeruli with crescents of proliferating cells adherent to Bowmans capsule. Alport sydndrome Splintering of lamina densa Nephrotic syndrome Membranous glomerulonephritis Diabetic glomerulonephritis Spike and dome Eosinophilic Nodoular glomerulosclerosis accumulations = Kimmelsteil-Wilson nodules, diffuse glomerulosclerosis. Ovoid hyaline masses located in periphery of glomerulus, with prominent wire looping.

Focal segmental glomerulosclerosis

Young, hypertensive African American males. Glomerular sclerosis (obliterated capillary lumen) w focal patterns, and segmental patterns. Focal lesions involving collapse of basement membrane, increase in matrix and deposition of hyaline masses wit detachment of the epithelial cells from the basement membrane happen in HIV, heroin, sickle cell. Foot process effacement of the visceral epithelial cells on EM.

Amyloidosis Minimal change disease

Both Membranous proliferative glomerulon.ephritis Type 1: Tram tracks, due to GBM splitting. 830yo youngsters on light mesangial microscopy. a/w HBV, HCV. Type II: intramembranous IC deposits dense deposits. a/w C3 neprhitic factor Wire loop. Granular subendothelial deposits -> C3 deposition. Widespread and pronounced thickening and splitting of the glomerular basement membrane on EM electron microscopy.

Diffuse Proliferative glomerulonephritis (DPGN) Due to SLE or MPGN

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

FeNa (Fractional excretion of Na)

Osmolarity (Osm)

Bun:Cr

Pre-renal Renal

<1% >2%

>350 >350

>20:1 Acute tubular necrosis: 10-1:1 + hyaline casts and cellular debris

Post-renal >4% <350 13. Angiotensin II increases activity of the Na/H exchanger in the proximal tubule to facilitate salt and water resorption. Increased H+ is pumped into the tubular lumen -> returned to cell in the process of HCO3- resorption as H_ and HCO-3 to form water and CO2 after catalysis by brush border enzyme carbonic anhydrase diffuse back again, liberated as H+ and HCO-3. HCO-3 transported into blood stream, H_ recycled again. Net result: increased Na+/H+ exchange is increase in HCO-3 resoprtion, no net change in H+s secretion. 14. Acute interstitial nephritis causes fever, rash, loss of urine concentration ability low specific gravity of urine. Commonly caused by drugs, antibiotics ie. beta-lactams, sulfonamides, quinolones, and rifampin, anti-convulsant drugs. 15. Ca2+ reabsorbed in 3 areas: a. Proximal tubule: coupled to Na reabsorption b. Thick ascending limb: sodium-potassium-chloride co-transporter NKCC. c. Distal tubule: controlled by PTH 16. HCTZ and furosemide causes metabolic alkalosis. Common causes of high anion-gap metabolic acidosis = MUDPILES. Methanol, uremia, DKA, Paraldehyde, Iron toxicity, Lactic acidosis, Ethanol, Salicylates. 17. D 18. F

19. Chart p.523 of fa2013

Chapter 14: Psychiatry 1. Adjustement disorder is depression and anxiety in the setting of a psychosocial stressor in the past 6mths. 2. Carbamazepine is anticonvulsant/mood stabilizer for mania patients, poor anger management, and lack of impulse control. Valproate acid: anticonvulsant/mood stabilization. Both have wider therapeutic range than Lithium: 1st line for maintenance therapy in bipolard disorder. Buproprion: SSRi for bipolar disorder txt, but monitor for cycling into manic state. Fluoxetine: SSRI to elevate mood. Olanzepine: atypical antipsychotic for mania with sever agitation and psychosis Resperine: depletes central cathecholamines 3. Schizoid: voluntary social withdrawal, limited emotional expressions/ Schizotypal: interpersonal awkwardness, odd thought patterns, eccentric appearance. 4. Schizophrenia:

5. 6. 7. 8. 9.

10. 11. 12. 13. 14.

a. Disorganized type: poor prognosis, child-like, incapabable of complete delusions, disorganized speech, inappropriate affect. Isolation: separation of feelings from ideas and events is an IMMATURE defense. Humor: mature defense. SSRI is choice for social phobia disorders because they lack abuse potential. Busiprone: for generalized anxiety disorder GAD, anxiolytic. TCA side effects: 3Cs: Cardiotoxicity conduction defects and arrhythmias, Convulsions, Coma, anticholinergic adverse effects ie dry mouth, mydriasis, constipation, urinary retention. (sympathetic) Mirtazapine: anti-depressant 5HT2 receptor antagonist, alpha-adrenoceptor antagonist. Common side effects: weight gain, sedation. Setraline SSRI a/w insomnia, tremor, anxiety. Leads to serotonin syndrome: headache/dizziness, coma, vomiting, death if used with MAOI. Trazodone: hetrocyclic a/w sedation, nausea, priaprism, postural hypotension. Buproprion is contra-indicated in anorexia nervosa because it increases risk of seizure. Benztropine and anticholinergics rapidly relieve symptons of acute dystonia.

13 Neurology 1. Neonates 0-6mth olds: most common causes of meningitis: grp B strep, E. coli, Listeria. HIB no longer is common due to vaccines. 2. Neisseria meningitides is most common cause of meningitis from 6-60ys old. 3. Enterovirus is cause for viral meningitis from 6mo-60ys old. 4. In central diabetes insipidus, ADH is not produced such that kidneys fail to produce concentrated urine. In central DI patients, low urine specific gravity with a high serum osmolality. After desmopressin administration, increase in urine specific gravity. 5. Worst headache in her life + blood cannot be scraped from surface of brain when dura mater is removed = Subarachanoid hemorrhage due to ruptured aneurysm. 6. Neuroblastoma: most common tumor of adrenal gland in children, wide mets and elevated urinary catecholamines. Usually demonstrate necrosis, hemorrhage, calcification. Microscope revelas small cells in pesudorosette pattern around nerve fibirls. Amplify with n-myc oncogene. 7. Bcl-2 oncogene a/w follicular and undifferentiated lymphomas. 8. C-myc oncogene a/w burkitts lymphoma 9. Erb-B2 oncogene a/w breast, ovarian, gastric CA. 10. RAS a/w colon cancer. 11. Alzheimers is pgoressive memory loss and cognitive impairement. A/w deposition of neuritic plaques (abnormally cleaved amyloid) and neurofibrillary tnagles (tau) in cerebral cortex. Txt with donepezil/vit E

12.

13. 14. http://what-when-how.com/neuroscience/the-reticular-formation-integrative-systems-part-1/

15.

16. 17. Wilsonss due to lack of ceruloplasmin to bind to Cu to enter the circulation. 18. Depression is significant comoribidity of Alzheimers. 19. Bells palsy must wear eye patch on ipsilateral eye to close it to prevent eye dryness.

20. 21. 22. 23. 24. 25. 26. 27.

28. 29.

30.

31.

32. 33. 34.

Spina bifida occulta: failure of posterior vertebral arch to close in utero; tuft of hair Anencephaly: cephalic end of neural tube fails to close. Born wo forebrain and cerebrum. Meningocele: herniation of meninges, no nerve tissues through bony defect at bony sacrum. Meningomyelocele: herniation of meninges and spinal cord through spinal canal defect Spina bifida cystica: failure of posterior vertebral arches to close with saclike protusion. SJS manifestations: mucocutaneous lesions, blisters, epidermal detachment. Usually caused by anticonvulsants ie. phenytoin, carbamazepine. Carbamazepine: a/w osteoporosis side effects, SJS Cluster headache recur repetivetively for wks to mths at a time with intervening remission. Men>women, 25-50ys old, no prodromal symptons around eye or temple, are excruciating. Unilateral, last fro mins-hrs with mean duration of 45mins. GBS will lead to hypoventilation leading to respiratory acidosis. Humerus fractures or #: a. Midshaft: radial nerve and deep brachial artery b. Surgical neck: anterior and posterior circumflex humeral artery, axilliary nerve c. Distal end: median nerve d. Medial epicondyle of humerus: ulnar nerve Arnold-Chiari malformation: a. I: cerebellar tonsils downward herniation into the foramen magnum a/w syringomyelia b. II: a/w spina bifida Syringomyelia: enlargement of central canal of spinal cord C8-T1, where crossing fibers of spinothalamic tract are damaged (loss pain and temperature sensation) with preserved dorsal column function (intact position and vibration sense). Communicating hydrocephalus = ventricular enlargement seen on MRI. Non-commmunicating hydrocephalus: abnormal formation of cerebellar vermis, due to obstruction of outlet foramina of Luschka and Magendie. Wallenbergs syndrome or Lateral Medullary Syndrome: loss of pain and temperature over contralateral side of body, and ipsilateral face due to occlusion of a posterior inferior cerebellar arteries.

12 Musculoskeletal 1. Boxers fracture: blow with closed fist, so the 1st and 2nd metacarpals are injured for experienced boxers. For inexperienced boxers, the 5th is the most common site of injury. There is good blood supply and heals rapidly. 2. Colles fracture: complete transverse fracture of distal radius, commonly in elderly falling on outstretched hand following forced dorsiflexion.

3. Hamate fracture: complicated, due to ulnar nerve. There are healing difficulties.

4. Fracture of phalanges: due to crush or hyperextension injuries. 5. Fracture of scaphoid: common due to falling on abducted hand. 6. Ankylosing spondylitis: chronic inflammatory disease of spine and sacroiliac joints leading to stiffening or consolidation of bones making up the joints. Common findings are low back pain, stiffness for > 3mths, pain and stiffness in the thoracic region, limited movement in the lumbar area, and limited chest expansion. HLA B27 positive, other complications is uveitis and aortic regurgitation. 7. Psoraitic arthritis: joint pain and HLA B27 positivie also, with psoriasis presence. Nonpruiritic scaly or silvery erythematous plaques with well-defined borders. 8. Reiters syndrome: urethritis, cervicitis, arthritis, conjunctivitis for 1 mth. Autoimmune reaction within several wks after GI or GU infection caused by Campylobacter jejuni. 9. Rheumatoid arthritis are a type III Hypersensitivity reaction where Ab-Ag complexes form to activate the complement. The rheumatoid factor is a IgM Ab directed against the Fc region of patients IgG Ab leading to immune complex formation and deposition. AntipCCP (citrullinepcontaining protein) antibodies are good indicators of RA. Rhuematoid factors are anti-IgG antibody causing marked influx of inflammatory celsl in joint synovium, results in destructive change, apannus formation, joint deformity. Develops clascially in the proximal interphalangeal joints.

10. Arthus reaction: local, subacute, antibody mediated hypersensitivity reaction from thermophilic actinomycetes, its a hypersensitivity pneumonitis 11. Hypersensitivity reactions: a. Type I: antibody mediated: Ag cross-link IgE antibodies present on pre-sensitized mast cells and basophils. Cross-linking results in vasoactive amine release like histalysis mine. b. Type ii: Cytotoxic mediated, Ab binds to host antigen on a cell phagocytosis c. Type III: Immune complex: Ab-Ag complexes form to activate the complement. The rheumatoid factor is a IgM Ab directed against the Fc region of patients IgG Ab leading to immune complex formation and deposition d. Type IV: delayed cell-mediated hypersensitivity: sensizied T lymphocytes encounter Ag releasing lymphokines activate macrophages. Ie. + PPD. 12. Polyarteritis nodosa: inflamed small to medium sized arteries in the renal, cardiac, GI tract vessels, not pulmonary vessels, 30% of pts have had hep B infection. 13. Buergers disease: htromboangiitis obliterans: vasculitis that affects arteries and veins of extremities. Intermittent claudication and Raynauds phenomenon. Heavy smokers, show hypersensitivity when tobacco injected into skin. 14. Giant cell temporal arterits, affects arteries. Mnemonic JOE: Jaw pain, Ocular distrubances from ischemia, elevated ESR. presence of polymyalgia rheumatic 15. Kawasakis disease: A/w conjunctivital and oral erythema, fever, erythema and edema of palms and soles, generalized rash, cervical LN swelling. 20% develops coronary artery inflammation and or aneurysm. 16. Takayasus arteritis: fibrotic thickening of aortic arch (affect pulmonary artery, branches of aortic arch, rest of aorta). 17. Pemphigus vulagris: autoimmune disorder, attack cell-cell adhesion protein, desmoglein-3 expressed by keratinocytes of the epidermis. Destruction leads to intraepidermal acantholysis with sparing of basal layer. PE: flaccid epidermal bullae Nikolskys sign +, prone to secondary infection. Rx: steroids

18. White footed mouse is main reservoir for borrelia burgdorferi. Bacterium is spread to humans by the Ixodes tick. Diagnosed via serology. Characteristic rash = Erythema chronicum migrans thats circular, macular rash with clear

19. 20. 21. 22. 23. 24. 25. 26.

27.

28. 29. 30. 31.

center. Rx: Doxycycline or any other penicillin antibiotic. 3 stages of Lyme disease: a. Stage I: erythema chornicum migrans (ECM), arthralgias, nonspecific flu-like symptons. b. Stage 2: marked by multiple small ECM rashes, cardiac and neurologic involvement, ie. asceptic mengingitis and cranial neuropathies ie. Bells palsy. c. Stage 3: arthritis of large joints, chornic, progressive central nervous system disease, migratory polyarthritis. CREST syndrome is a/w anti-centromere disease of scleroderma (progressive systemic sclerosis). Calcinosis, Renal, Esophageal dysmotility, Sclerodactyl, Telangiectasia. Actinomyces israelii infection presents as mandibular mass slow progressing, evlolving into sinus tract. Characteristic sulfur granules in the thick yellow exudate. Nocardiosis: nocardia asteroids: respy infection followed by abscess and sinus tract formation. No sulfur granules but is acid-fast Trichinella spiralis infected person p/w fever, periorbital.facial edema, myalgia, eosinophilia. Gout = negatively bifringent and needle-shaped in joint aspiration fluid. Rheumatoid arthiritis: bilateral symmetric joint involvement, leading to ulnar deviation of wrist, swan-neck and butonniere deformities. Pseudogout: calcium pyrophosphate dehydrate deposition in connective tissues which are weakly bifringent and rhomboidal.w low-grade fevers. Pain and swelling in femur of child with no history of truma. Pain worse at night, No erythema on PE but firm, immobile tender mass on palpation. Fine needle aspiration reveals anaplastic small blue cells. Associated with t(11,22) Ewings sarcoma translocation. Yersinia pestis Black death plaque bacterium that is spread by fleas. Trip to SE. Asia c/ o fevers, chills, general weakness, painful ulcer surrounded by dark, hemorrhagic purpura on arm where flea bite. Requires 2-8 days of tender LN called buboes. Painful skin ulcers unlike painless ulcers for Bacillus antrhacis. Bacillus anthracis: cutaneous anthrax with painless ulcer with black scab. Babesia microti: tick bite to humans, similar to malaria with fever and anemia. Leishmania donovani: sandfly bite. A/w abd pain, distention, anorexia and weight loss. Trichinella spiralis: p/w fever, periorbital/facial edema, myalgia, eosinophilia.

32. Tennis elbow: lateral epicondylitis from overusue of superficial extensor muscles of forearm and wrist --> extensor carpi radialis muscle. 33. Deltoid is C5-6 innervated by axilliary nerve. C6-7 found in lateral pectoral nerve and median nerve.

34. Rickets signs are unusual widening of childs wrists and ankles, marked enlargement of costcochonrdral junctions leading to increased intact PTH hormone levels due to decreased or absent minieralization of osteoid bone matrix 2ndary to decreased serum Ca or phosphorus levels. Vit D promotes absorption of Ca and phosphorus. In Vit D deficiency, bone growth areas contain patches of unminieralized, soft osteoid. When severe deficiency, lab studies demonstrate decrease serum Ca, decrease serum phosphorus, decreased serum 1, 25dihydroxycholecalcifero. l, increased serum ALP and intact pth hormone levels. 35. Pasturella multiocida a/w cat and dog bites where cellulitis appears and can lead to osteomyelitis 36. Francisella tularensis transmitted by rabbits, deer, ticks. Symptoms can be sudden onset of flulike syndrome to prolonged course fo fever and adenopathy. 37. Rabies virus: prodrome of fever and anorexia, confusion lethargy 38. Sporothrix schenckii, fungus causes necrotizing, granulomatous lymphocutaneous skin infections in distribution of draining lymph nodes following trauma by taunted vegetation. Rose garderners disease.

39. Sjorgen syndrome: typ-ically women 35-45ys old, dry eyes keratoconjunctivitis sicca, dry mouth xerostomia, and one other connective tissue or autoimmune disease ie. RA. 40. Sicca syndrome: dry eyes and dry mouth 41. SjorenpLarsson syndrome: AR syndrome characterized by congenital ichthyosis *dry and fishlike skin) a/w mental retardation and spastic paraplegia. Casued by mutation in fatty aldehyde dehydrogenase gene on chr 17 p. 42. Long bones form via endochondrala ossification where mesoderm si first converted to a cartilaginous model by hypertrophic chondrocytes. Forms at the primary ossiciation center at the diaphysis as cells diefferentiate into osteoblasts. 43. Sickle cell disease patients have Salmonella as the most comoon organism responsible for osteomyelitis. Staphylococcus aureus is common for general population for osteomyelitis. 44. Scarlet fever is caused by Strep pyogenes characterized by typical sandpaper rash, strawberry tongues, beefy-red pharynx, and circumoral pallor. As rash heals, skin peels off in fine scales.

Chapter 11: Hematology Oncology 1. Courvvesiers sign: a. Jaundice b. Non tender enlarged, palpable gall bladder Sign of cancer of the head of pancreas, obstruct gall bladder from emptying 2. Glucocorticoid psychosis due to long term exposure to prednisone therapy. 3. Chloramphenicol is effective against bacterial meningitis and a/w aplastic anemia and gray baby syndrome. 4. Clindamycin is a/w pseudomembranous colitis due to Clostridium difficile overgrowth. 5. Erythromycin is a macrolide a/w cholestatic hepatitis. 6. Gatifloxacin is a fluoroquinolone a/w tendinitis. 7. Trimethoprim is a/w megaloblastic anemia, leuokopenia and granulocytopneia, so supplement with folic acid. 8. Plasma cells are recognized with off-center nuclei and clock face chromatin distribution. Blood smear stacked in RBCs, rouleaux formation. 9. Hereditary Spherocytosis caused by mutations in genes coding for ankyrin or spectrin that contribute to erythrocyte cytoskeleton. Often a/w jaundice and pigmented gallstones. RBC with no central pallor. 10. Paroxosymal nocturnal hemoglobinuria due to RBC susceptibility to completement-mediated cell lysis. Insufficient synthesis of GPI anchors that protects RBCs. Clinically its manifested as

11. 12. 13.

14. 15.

16.

17. 18. 19. 20. 21. 22.

23.

24.

25.

intravascular hemolysis with Hg release into blood and subsequent hemoglobinuria, thrombotic complications such as Budd-Chiari syndrome and aplastic anemia. Wilms tumor come from embryonal renal cells of the metanephors, most common solid tumor of the childhood. Clear cell carcinoma is malignancy derived from renal tubular cells. p/w hematuria, palpable mass, polycythemia, flank pain and fever. TCCL malignancy from uroepithelial cells of the urinary tract. Occurs in renal calyx, renal pelvis, ureters and bladder. Painless hematuria an durinary outflow obstruction are common symptoms. Malignancy from primitive neural crest cells would be neuroblastoma. Comes from paraspinal sympathetic ganglia, so would not distort kidney infrastructure. In pernicious anemia, its caused by deficiency of intrinsic factor produced by gastric parietal cells. Once vit B12 is released from Rproteins and complexes with IF. IF-B12 complex binds to ileum receptors and endocytosed by enterocytes. This is due to limmune-mediated destruction of gastric mucosa. Schilling test reveals if vit B12 labelled is being absorbed and eliminated in the urine as normal or its the lack of IF or malabsoprtion thats preventing the radiolabelled compound from appearing int eh urine. Small cell lung cancer notorious for producing ACTH and ADH. Cushings syndrome classical presentation of weight gain and restirubtion of body fact nad moon facies. Poor wound healing due to inhibition of collagen synthesis by glucocorticoids and hirsutism also part of it. Cisplatin causes kidney damage and acoustic nerve damage so must vigorously hydrate Cytarabine causes leukopenia, thrombocytopenia, megaloblastic anemia Cyclosporine works by binding to cyclophilins and blcoks differnetaittion and activation of T lypmhocytes, inhibiting IL2 production. Amoxicillin and erythromycin have same effectiveness in treating bacterial sinusitis. Erythromycin inihibits the p-450 system. So itll increase the cyclosporine in the liver. Leishmania donovani infection: middle eastern exposure, fever, general malaise, fever, weight loss. PE: hepatomegaly, splenomegaly with edema. Macrophage contains amastigotes on histology and is transmitted via sandfly. Babesia presents with malaria-like syndrome transmitted by the Ixodes tick found in same region as Lyme disease. Transmitted by deer ticks carrying Lyme dz. Sx are mild except for immunocompromised and splenectomized individuals. In fatal cases, find jaundice, hepatic necoriss, ATN, ARDS, hemolysis and hemorrhages. Maltese cross appearing parasite is observed, Rx: Quinine. Entamoeba histolytica: p/w intestinal amebiasis of bloody diarrhea and abd pain, less commonly liver abscesses. Cysts pass through small tintestine forming trophozoites, treat with metronidazole. Medulloblastoma: found exclusively in cerebellum so pt has nystagmus and truncal ataxia. A/w cerelbellar vermis lesion and dilatation of third and lateral ventricles. On histology, deeply staining nuclei with scant cytoplasm arranged in pseuodrosettes are seen.Cellular tumor with sheets of anaplastic cells, with little cytoplasm and crescent-shaped, deeply staining ncueli due to high mitotic activity. Frequently radiosensitive.

26. Glioblastoma mutliforme: most common primary brain tumor in adults occurring in cerebral hemispheres with extremely poor prognosis. Histology: regular round cells aligned smoothly with spherical nuclei surrounded by clear cytoplasm and finely granular chromatin a/w calcifications. 27. Craniopharyngioma: most common supratentorial tumor in children embryologically derived from remnats of Rathkes pouch. P/w severe headaches, visual changes, and pituitary dysfunction with bimodal distribution of affected ages. Histology shows stratified squamous epithelial cells embedded in spongy reticular stroma with predominant peripheral gliosis. 28. Meningioma: benign primary intracranial neoplasm from arachanoid granulations. Histology: whorls of meningothelial cells with ovalpshaped nuclei with indistinct cytoplasm and psammoma bodies. 29. 30. 1.

45.

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

Chapter 10 : Gastrointestinal 1. Entameoba histolytica: p/w bloody diarrhea, abd cramps with tenesmus and pus in stool. RUQ pain and liver abscesses, transmitted via cysts in water. Rx: metronidazole and iodoquinol. 2. Cryptosporidium spceices p/w severe HIV+ pts with mild watery diarrhea in HIV neg patients. Tramitte dvia cysts in water (fecal-oral transmission). Acid-fast cysts can be found, no treatment. 3. Giardia lambia p/w bloating, flatulence, foul-semlling diarrhea, light colored fatty stools. Transmitted via cysts in water, teardrop shaped trophozoidtes with ventral sucking disc or cysts. Rx: metrodinazole. 4. Naegleria fowleri: headache, fever, nausea, vomiting, miningismus can progress to CN 3, 4, 6 palsies, siezures and coma. Transmitted through inhalation of of contaminated dust or water. Poor prognosis, rx: amphotericin B and rifampin. 5. Toxoplasma gondii p/w brain abscess in HIV+ pts and birth defects if infection occurs during pregnancy. Transmitted via cysts in raw meat or cat feces. 6. GBS Guillian-Barre Syndrome: autoimmune mediated illness that is also a/w Campylobacter jejuni, , finding comma-shaped organisms with a single polar flagellum. Other enteric pathogens of the same morphology is Vibrio cholera nand parahemolyticus. 7. HUS is characterized by. Its a complication of infection cuased by E coli O157:H7 but NOT Campylobacter jejuni. Its a gram negative rod. a. Acute renal failure b. Thrombocytopenia c. Hemolytic anemia 8. Waterhouse-Friderichsen symndrome is characterized by high fever, shock, purpura, adrenal insufficiency ie Neisseria meningitidies septicemia. 9. Woman with jaundice, hypercholesterolemia-xanthomas, pruritis with +antimitochondrial Ab and elevated ALP = primary biliary cirrhosis. PBC is chronic, progressive and leads to fatal liver injury characterized by destruction of medium-sized intrahepatic bile ducts. Rx: liver transplantation. 10. Primary sclerosing cholangitis: stenosis of extrahepatic and intrahepatic bile ducts. 11. Child with weight loss, multiple purpuric lesions, with bulky, greasy yellow stools a/w abd pain and flatulence occurring most after meals is due to celiac disease. Celiac disease = diffuse severe atrophy and blunting of villi. Nonblanching purpuric lesions located on upper and lower extremities is dermatitis herpetiformis. Celiac disease gluten-sensitive enteropathy. There are

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15.

16. 17. 18.

19. 20. 21.

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23. 24.

lymphocytic infiltrates due to the gliadin fraction in wheat, discontinuation will result in complete remission. Foamy macrophages in the lamina propria = Whipples disease confirmed by rdo-shaped bacilli on EM. Tropheryma whippelii is causative organism residing in macrophages, distention and lead to lymphatic blockage and lipid despoistion without neutrophil inflammation. Epidemeology: Pts in 30p-40ps men exposed to rural regions, p/w arthropathy, diarrhea, weight loss. Crohns disease is usually no bloody diarrhea. Hepatitis C treatment: a. IV immunoglobulin: engineered Ab used to clear aserum of protein products for use in txt of autoimmune diseases b. Peglated interferon: cytokine derivative improving bodys antiviral rresponse. Adverse effects INF therapy include flu-like rxn as episodic fever and chills and ocassional profound depression. c. Lamivudine: nucleotide reverse transcriptase inhibitor used in HIV and hep B txt. Adverse SE is hepatotoxicity. d. Ribavirin: antiviral used in Hep C, RSV treatment. Not a/w dep-ression or flu-like reaction. e. TNF-alpha cytokine involved in antiviral dna anti-tumor response. Shigella is a non lactose fermenter and does not produce gas or Hydrogen sulfide. Usually affects preschool age children and populatiosn in nursing homes. Transmission by fecal-to-oral route via fecally contaiminated water. Ecoli is a lactose fermenter CA19-9 used for colon and pancreatic cancer. Also elevated in different GI cancers. CEA carcinoembryonic Ag is a glycoprotein involved in cell adhesion. Its a GPI cell surface anchored glycoprotein serving as L-selectin and E-selectin ligand. Raised in CLR CA, gastric CA, pancreatic CA, lung CA, breast CA and medullary thyroid CA. Elevated CEA found in IBD, PUD, pancreatitis, biliary dz. GERD give you esophageal mucosal metaplasia called Barretts esophagus with increased risk of developing adenocarcinoma of esophagus. Squamous cell cancer is a/w tobacco and alcohol use. Luekotriene (LT B4) is neutrophil chemotactic agent and is abudndant udring an acute inflammatory process produced via the 5-lipoxygenase pathway parimarily by neutrophils and macrophages. Found in elevated concentrations for inflammatory and allergic conditions such as asthma, psoriasis, RA, IBD. Prtostaglandin I2 synthesized by vascular endotheliuma dn smooth muscle. Inhibition of platelet aggregation, relaxation of smooth muscle, reduction of systemic and pulmonary vascular resistance by direct vasodilation and natriuresis in kidney produced by the cyclooxygenase pathway. Thromboxane A2 is potent inducer of platelet aggregation and vasoconstriction. vWF bind glycoprotein Ib and facilitates platelet adhesion at site of injury.

25. Crigler-Najjar syndrome type I, hereditary hyperbilirubinemai ecause of the abscnece of bilirubin uridine diphosphate-glucoronsyltransferase (UGT1). Much less severe is slight deficient Gilberts syndrome. 26. Dubin Johnson is defective liver excretion cuasing gross black liver but is benign. 27. Rotors syndrome: similar but even milder and dont cauase black liver. 28. Contaminated seafood is a common source of vibrio parahemolyticus and V. vulnificus. 29. Staph aureus is found in the mayonnaise portion of tuna salad and is charactereized by more vomiting than diarrhea, since enrotoxin is preformed in food, incubation time is short (1-8hrs). 30. Wilsons disease causes parkinsonian symptons due to death of neurons in basal ganglia. Wilsons disease is an AR in mutation in ATP7B, a gnee in chr 13 encoding for a Copper transporting ATPase. a. Also called hepatolenticular dengeneration, AR disorder b. Liver: fatty change with vacuolated nucleus, focal hepatocyte necrosis, and in chronic hepatitis, Mallory bodies might develop. Stain for rhodamine. KayserpFleisher rings. c. EM: mnicrovesicular steatosis: glycogen nuclei, copper deposits, mitochondrial enlargements.

31. Mallory bodies are found in Alcoholic liver disease. In hepatitis and cirrhosis.

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

38.

39. 40. 41. 42.

43. 44. 45. 46.

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

Chapter 9 Endocrine 1. PTU causes agranulocytosis.Rx for hyperthyroidism. PTU inhibits thyroperoxidase which ;

Chapter 8 Cardiovascular 1. Post MI scenarios: 3-10 days after: a. Ruptured papillary muscle = severe actue mitral valve regurgitation

2. 3. 4.

5. 6. 7. 8.

b. Mitral valve regurg: HSM blowing loudest at apex and radiates to axilla. c. Rupture of LV free wall cardiac tamponade where heart cant pump severely decreased stroke volume, systemic hypotension with pulsus paradoxus, JVD, decreased heart sounds. d. Rupture of interventricular septum: Murmur is loudest at L sternal border. e. L ventricular failure occurs in 60% of people who suffer from MI and present as CHF or cardiogenic shock. Rupture can happen also. Dresslers syndrome is autoimmune phenomenon resulting in fibrinous pericarditis that develops 2-10 dwks post MI and clinically presents as chest pain and pericardial friction rub. Dilated cardiomyopathy is characterized by dilataion and impioared contraction of one or both ventricles. Can present with arrhythmias or SCD. Babeosia is spread by Ixodes scapularis tick who is in Massachusetts. Bike in woods, with expanding rash on calf and fluplike symptons resolving spontaneously. Then there was dizziness, syncope, dyspnea, chest pain, palpitations and see vector of ECG. LYME disease can cost cardiac symptons and heart blocks and require pacing. Its in the northeastern corener of USA. Epidemic typohus is transmitted by Rickettsia prowazekii. Malaria is responsible for parasitiz protozoan disease by Anopheles mosquito. Plague is by Yersinia pestis Cardiac Troponin I, CK-MB, AST, LDH Enzyme Elevates Troponin I 7-10 days CK-MB 24hrs Enzyme of choice to monitor reinfarction. AST 2days LDH 2days post MI

9. Fish mouth of mitral stenosis due to fusion of valve leaflets. early pan systolic AS/PS MR/TR, Mid: HOCM, VSD diastolic AR/PR, CONTINUOUS Aortic/pulmonic PDA insuffficiency

late Mitral valve prolapse MDM MS, TS

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

13. Heart blocks Type Mobitz Type I Mobitz Type II 1st degree Mobitz Type II 2nd degree Complete Heart block

Description Lengthened PR interval

Cause AV nodal abnormalities Defect in His-Purkinjie system Complete absence or ablation of the His-Purkinjie system

Indepednetly contracting atria and ventricles

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

Chapter 6 Pathology 16. Smoking is the single most important cancer risk facter for Transitional cell carcinoma of the bladder. 17. MSH2 is a mismatch repair enzyme mutation for certain forms of colon cancer. In its absence, DNA mutations accumulate. 18. APC is a tumor suppressor gene mutated in colon cancer. Normally the APC protein degrades transcription factor bta-catenin involved in colonic epithelial cell proliferation. 19. Histology: Tumor Histology Location Medullablastoma Poorly d(x) neuroectodermal tumor Cerebellum midline

20. Cadmium is carcinogen a/w prostate cancer. 21. Long term exposure to high levels of benzene can lead to leukemia and Hodgkins lymphoma. Benzene is exposure to light oil, gasoline and other fuels. 22. Exposure to silica occurs in glass, cermaics and electronics. Slowly progressive Silicosis characterized by bilateral fine nodularity in upper lung lobes. 23. Abestos is present in gun-wielding, explosives factory which are fire-resistant materials in the building materials. Exposure to risk of mesothelioma. 24. Cardiac tamponade: post MI 4-10days, sudden shock, hypotension, distant heart sounds, elevated JVP. Requires immediate pericardiocentesis or surgery.

25. HPV can cause anorectal cancer 26. In cirrhosis, progressive iron deposition in liver parenchyma of patients with hemochromatosis, seen as granular brown cytoplasmic pigment. Microscopic evidence includes increased quantity of connective tissue extending from portal areas. Result of past chronic destruction. 27. CMV = large, round intranuclear inclusion with perinuclear halo, Cowdry type A as owls eyes due to microscopic appearance. Infection presents as retinitis, pneumonitis, inflammation along GI tract, polyradiculopathy, transverse myelitis, focal encephalitis. Happens when CD4+ count

<100/mm3. 28. Cryptococcus neoformans causes meningitis and meningocencpehalitis in AIDS pts. Easier to observe with methenamine silver o PAS stains to identify narrow-based buds and round-to 0oval yeast surrounded by polysaccharide capsule.

29. 30. Squamous cell cancer of the bladder is caused by Schistosoma hematobium. 31. Aniline dyes are a/w bladder transitional cell cancer. 32. Heteroplasmy is presence of both normal and mutated mitochondrial DNA, responsible for variable expression of mitochondrila inherited disease. 33. Mosaicism: cells in body have different genetic makeup. Occurs in turners syndrome only. 34. Locus heterozygosity: mutation at different loci resulting in the same result phenotype. An example is albinism. 35. Anticipation: severity of disease porgbresses in succeeding generations. 36. Angelman syndrome: individual with phenotype characteristic facies of microcephaly, maxillary hypoplasia, deep set eyes, large mouth with tongue protusion. Gait jerky and puppet-like. severe mental retardation, speech impairment.

37. Adult Polycystic Kidney disease mutation of chr 16. Von Hippel-Lindau disease is chromosome 3. Chromosome 6 recessive polycystic kidney disease. Chromosome 9 tuberous sclerosis, presents with adenoma sebaceum and CNS harmatomas. 38.

Chapter 5 1. Severe combined immunodeficiency: defect in early stem cell differentiation leading to total lack of cellular immune system. Infected with bacterial, viral, protozoal, fungal ainfections. 2. Ataxia-telaniectasia: defect in DNA repair enzymes a/w IgA deficiency includes ataxia and telangiectasia. 3. Chediak-Higashi is AR disease p/w recurrent streptococcal and staphylocococcal infections. Defect in lysomomal emptying of phagocytic cells due to microtubular dysfunction. Partial albinism might be present, as melanosomes are derivatives of lysosomes. 4. Chronic granulomatous disease presents with increased susceptibility to infections by microbes that produce their own catalase ie Staph and Candida. Results from defective neutrophil and phagocytosis due to lack fo NADPH oxidase activity. Negative nitroblue tetrazolium dye reduction test confirms diagnosis of chornic granulomatous disease. 5. Common variable immunodeficiency low IgM, igG, igA levels but normal B and T lymphocyte levels. 6. Jobs syndrome: failure of helper T lymphocytes to produce INF gamma that is a potent activator of phagocytic cells. Decrease in production leads to failure of neutrophils to respond to chemotactice stimuli. 7. Wiskott-Aldrich syndrome: X-linked defect a/w elevated IgA, IgE and low IgM levels. Defect in bodys ability to mount IgM response. Recurrent pyogenic infections, eczema, thrombocytopenia are triad. 8. X-linked agamma globulinemia: decreased igM, IgG, IgA, and B lymphocyte levels with normal T lymphocyte levels. 9. Chapter 4 Microbiology 1. Tzanck smear look for multinucleated giant cells. Lesion Causative Description organism CHancroid Hemophilius Deep multiple ulcers ducreyi Gray, yellow base school of fihs Genital herpes HSV1 & 2 Multiple small group ulcers, shallow etythematous ulcer. Multinodular

Pain Treatment Yes ceftriaxone

acyclovir

Granuloma inguinale

KLebsiella inguinale

Syphilis

Treponoma Pallidum

Lymphogranlum Chlamydia venerum trachomatis

granulomas, Cowdry A inclusions Exclusive and progressive No granulation-like tissue. G neg deep stain. Donovan bodies Single indurated wellNo circumscribed clean base. Thin delicate corkscrew-shape. Small shallow ulcer, heals No rapidly, intracytoplasmic inclusion in epithelial bodies, no leukocytosis

2. Foscarnet inhibits viral DNA polymerase without activating thymidine kin ase. Used for CMV retinitis treatment. 3. Riabvirin treats RSV. Inhibits IMP inosine monophosphate dehydrogenase, blocks synthesis of guanine nucelotides. 4. HBSAg=surface antigen = carrier state. IgG antibody to HBcAb = recovery. HBcAb=chronic. 5. Chagas disease infection by Trypanosoma cruzi include small ermal granulomas (chagomas), myocarditis, CHF, arrhythmias, dilated cardiomyotphaty, megacolon, megaesophagus. Found in S. America, central Mexico, Rx: swymptomatic. 6. Ixodes tick transmits Borrelia burgdorferi (lyme) and Babesia. 7. Sandfly transmits Leishmania donovani, kalazaar or visceral leishmaniasis includes hepatosplenomegaly, anemia, leukopenia. Light skinned pt become dark skinned. 8. Tsetse fly carries Trypanosoma brucei gambiense and T brucei rhodesiense, African sleeping sickness, recurrent fever, dizziness, lymphadenopathy. 9. Klebsiella pneumonia ferments lactose. Has mucoid capsule. Bronchopenumonias have acute inflammatory infiltrates from bronchioles into adjacent alveoli. Usualy caused by aspiration. 10. Lobar penumoniae mcc due to Strep pneumonia goes through 4 stages: causes rust colored sputum. a. Congestion b. Red heaptization c. Gray hepatization d. Resolution 11. Interstitial pneumonia ie mycoplasma and virus: diffuse patchy inflammation 12. CD4+ count <50 presents with radpily progressive focal neurologic deficits without signs of increased ICP. LP yields mild elevations in protein and wbc. CSF reveals presence of myelin basic protein due to demyelination cuased by JC virus. PML presents as multiple nonenhancing T2 hyperintense lesions. Use + CSF.

13. CMV encephalitis has enhancing periventricular white matter lesions in cortical and subependymal regions. CMV encephalitis a//w systemic signs and symptons. 14. CNS lymphoma affects CD4+ under 50 also. MRI shows 1+ enhancing lesions surrounded by edema and produces mass effect. Can present as EBV+ in CSF findings. 15. Toxoplasmosis infection are SOL space occupying. MCC cerebral mass laesions, p/w muylitple enhancing lesion on MRI. Located around corticomedullary junction surrounded by edema, and distinguishes appearance from PML. Rx: Sulfadizaine and pyrimethamine, or Bactrim. 16. Muscullom contagiosum is caused by pox virus.
o

Rubeola + RNA enveloped virus causes measles, Kolpiks spots on oral mucosa and progresses to maculopapular rash. a PARA Ruby weasles caught SSPEcial measles = Paramyxo, Rubeola, SSPE complication, Measles

17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35.

EBV is herpes viral family member. Linear dsDNA, enveloped DNA. Plasmodium malariea 72hr cyclic fever. Plasmodium ovale 48hr cyclic fever. P. ovale also form hypnozoites remaining dormant in liver. Acanthamoeba presents with meningoencephalitis in immunocompromised pts. Cause keratitis in contaminated contact lens solutions. Leishmania donovani infection p/w hepatosplenomegaly, malaise, anemia, weight loss. Transmitted via sandfly. Contain amastigotes. Rx: Sodium stibogluconae. Naegleria fowleri infection p/w meningoencephalitis progress to coma/death in 6 days. N/V, irrational behavior. Transmission through freshwater lakes and see amoebas in spinal fluid. Trypansoma curzi transmitted via reduviid bug revealing flagellated trypomastigotes in blood and non-motile amastigoites in blood. HPV human papilloma virus causes cervical cancer by iinactivating tumor suppressor genes p53 and Rb thorough E6 and E7 Antigenic shift: when RNA is changed either HA or NA, either influenza virus infect same cell and exchanging RNA. Antigenic drift: mutations occurring in hemagglutinin and neuramindase leads to different strain but not global epidemic. Hemagglutinin attaches to salici acid receptors activating fusion of virus to cell. Neuraminidase destroys neuraminic acid, a component of mucin, breaking down airsways upper and aids in infectivity. Bordatella pertussis = flu-like symptons with whooping cough. B. pertussis can be cultured on Bordet-Cengou medium. Charcoal yeast extract when buffered with increased levels of Fe and cysteine cultures Legionella penumophilia. Lofflers medium needed to culture Crynebacterium diphtheria. Coccidomycosis: cough and bumps

36. 37. Chapter 2 : Biochemistry 1. Argininosuccinate lyase : result in elevated citrullline 2. 9mth old seizures, delay in developmental milestones, poor muscle tone, enlarged liver. Urinary orotic acid level is increased. Pt suffering for ornithine transcarbamoylase deficiency exhibit low blood urea nitrogen level. Exhibit a very low BUN. 3. Carbamoyl phosphate synthetase I:

4. Types of dyslipidemia: a. Type 1: dyslipidemia lipoprotein lipase. Cleave triglycerides into free fatty acids and glycerol. b. c. 5. 6. 7. 8. Test Block 2

1. In pregnant woman, give heparain, not warfarin. Warfarin can corss placenta and cause nasal hypoplasia nad skeletal abnormalities in the 1st trimester. Also optic atrophy. 2. Overriding aorta doesnt cause emergency hypoxia. 3. Owl eyes = Reed-Stenberg cell. Hodgkins lymphoma, use ABVD regimen: Adriamycin, Belomycin, Vinblastine, Dacarabazine. 4. Vinblastine: inhibits microtubule formation to build mitotic spindle, so cells stuck in metaphase. Used to treat Hodgkins and non-Hodgkins lymphoma. SE: alopecia, constipation, myelosuppresion, neurotoxicity. 5. Cyclosporin: inhibits the production and release of IL-2 used to induce cytotoxic T lymphocytes. SE: GI upset, headache, tremor. 6. Hydroxyurea: sickle cell anemia, suppress high WBC in acute leukemia and CML. Believed to work in S phase of cell cyle. 7. Orphan annie nuclei:

8. Acute promyelocytic leukemia: t(15, 17) containing ton of Auer rods. Risk of DIC when the promeylocytes lyse. Can give all-trans retinoic acid ATRA for the maglinant promeylocytes to mature first, then use regular chemo.

Auers rods indicate AML.

9. Imantinib = CML, chronic myeloid leukemia also for gastrointestinal stromal tumors. 10. McArdles glycogen storage disorder where glycogen phosphrylase is deficient in muscle. 11. Homocystinuria: defect in cystathionine synthase that prevents homocysteine conversion to cystathionine. Get kyphosis, Marfan-like features, with mental retardation, and risk of vardiovascular disease due to increased atherosclerosis, premature vascular disease, lens subluxation and early death. 12. Glucose-6-phosphatase converts glucose-6-phosphate to glucose. Deficiency causes Von Gierkes disease with severe fasting hypoglycemia, increased glycogen in liver, hepatomegaly and increased blood lactate. 13. Milder form of Von Gierkes disease: alpha-1,6-glucosidase for debranching glycogen. Mild form normal blood lactate levels. 14. Lysosomal alpha-1,4-glucosidase defective in Pompes dz. Gycosgen storage disorder, respiratory difficulties and cardiomegaly, progressive loss of muscle tone. 15. Osteitis fibrosa cystica: due to PTH elevation leading to bone abnormalities of osteitis fibrosa cystica due to excess bone resorption and fibrous replacement of marrow cystic spaces and reas of hemorrhage. Clinically pt has bone pain nad #s. Primary hyperparthyroid causes increased Ca2+, dec phosphate, increased ALP and increased serum PTH. Pt experienced bone pain, confusion, lethargy, recurrent renal stones, duodenal ulcer, small nodule on anterior neck. 16. Hypertrophic osteoarthropathy: various patients with luncg cancer, sepsis, endocarditis, IBD. Present with digital clubbing and painful swelling of wrists, fingers, elbows and other joints. New bone formation present at ends of the bones. 17. Ostepetrosis: brittle, dense, thickened bones that # easily. It is autosomal dominant and recessive mode of inheritance.

18. Pagets dz of bone: due to excessive bone resorption. Resorbed bone replaced by soft, disorganized bone matrix with a mosaic, instead of trabecular pattern. ALP activity increased. Pts p/w bone pain, #, deformity, sensory deficits due to nerve impingement. 19. Rheumatic fever: fever, migratory polyarthritis, carditis, subcutaneous nodules (back of wrists, outside elbow, front of knees), erythema marginatum that are trunk and spread outward and clear in middle to form rings uliamtely take on snake like appearance and worse with heat. SYndehams chorea are aalso major criteria. Minor: fever, arthralgia, ESR inc, leukocytosis, ECG. Maybe caused by Grp A streptococcal pharyngitis. 20. Bacterial endocarditis: fever, new murmur, janeway lesions, splinter hemorrhages caused by Staphylococcus aureus and subacute infection by Streptococcus vridians. 21. PGI2 inhibits platelet aggregration and is selectively decreased by COX-2 inhibitors. TXA2 action is decreased by aspirin. Aspirin also decreases PGI2. If only COX-2 inhibitor is administered, there could be unopposed TXA2 action increasing platelet aggregation. 22. Anemia of chronic disease: ACD presents with low serum iron levels, elevated ferritin levels, decreased total iron-binding capacity, and microcytic/normocytic RBCs on blood smear. 23. Craniopharyngiomas are MCC supratentorial tumor of childhood originating from Rathkes pouch squamous rest cells between adenohypophysis and neurohypophysis. 24. Ependymomas most commonly found in the 4th ventricle and causes hydrocephalus. 25. Hemangioblastomas a/w VHL syndrome with retinoblastomas. 26. Chest pain can be felt down the left arm becaue afferent pain fibers of the heart enter the posterior horn of the spinal cord at the same level as the brachial plexus. 27. For HIV pts who are immune ocompromised, for diseases causing fever and headache are Cryptococcus, toxoplasmosis, CNS lymphoma. Cryptococcus treatment is using amphoterin B: toxicity can cause fever chills, hypotension, nephrotoxicity, arrhythmias. Arrythmias due to QT prolongation. 28. Flucanzaole can cause gynecomastia. It is an azole inhibiting ergosterol synthesis used to treat systemic mycoses. Other SE include liver dysfunction and fever. 29. Flushing can be caused by Caspofungin, thats used to treat aspergillosis by interfering with synthesis of an essential component of the fungal cell wall. SE: GI upset. 30. Flucytosine: Nausea and vomiting seen, used to treat systemic fungal infection. Inhibits DNA synthesis because its converted to fluorouracil in vivo. 31. Tolbutamide is a sulfonylurea that can cause disulfiram=like adverse effects when cominbed with alcohol use. Effect sof flushing, tachycardia, headaches, and vomiting. 32. Prolactin prevents ovulation by several mechanisms. It inhibits the secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus and inhibits the action of GnRH at the anterior pituitary, thus decreasing the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Finally, it inhibits the actions of LH and FSH on the ovaries. 33. Hirschprung disease is disorder of neural crest cells failing to migrate to distal portions of colon leading to congenital lack of parasympathetic ganglion cells. Lack in Meissners and Auerbachs plexuses and nerve fiber hypertrophy. 34. Desmopressin is ADH analog. 35. Demeclocycline treats SIADH by inhibiting ADH action.

36. Arteriosclerosis is a general term for vascular disease characterized by rigidity caused by calcifcation and often thickening of blood vessels. The most common places for arteriosclerosis are the radial and ulnar arteries 37. Medial calcic sclerosis, also known as Mnckebergs arteriosclerosis, involves the media of medium-sized muscular arteries characterized by ringlike calci cations that do not cause obstruction to arterial ow because the intima is not involved. 38. Melanocytes, odontoblasts, pia and arachnoid mater, Schwann cells, cells of the ganglia, parafollicular C cells of the thyroid, chromaf n cells, the aorticopulmonary septum, pharyngeal arch skeletal components, and the neurocranium are all derived from neural crest cells, a speci c portion of the neuroectoderm. 39. 40. 41. 42. 43. 44. 45.

Test Block 3: 1. Childhood respiratory infections Disease Caused by Croup: barking cough Parainfluenza virus Epiglottitis HIB (now less due to vaccines)

Treatment supportive

2. Treating hyponatremia too aggressively by infusing too much sodium, will prompt osmotic demyelination -> central pontine myelinolysis due to oeragressive treatment of hyponatremia. 3. GABA us a NT actuvated ion channel linked receptor. 4. Serotonin is a ion-linked receptor. 5. One consequence of MM multiple myeloma is systemic amyloidosis where plasma cells secrete misfolded aggregates of amyloid secondary to immunoglobulin light chain overproduction. Deposited in kidney in mesangium and subendothelial space in the mesangium and subendothelial space. They stain + with Congo red, with apple green befringerence in polarized light, and will later obliterate the glomerulus. Pts p/w heavy proteinuria progressing to renal insufficiency and uremia. 6. Pts with cirrhosis, at risk for hepatic encephalopathy reversible delirium. HCTZ is known for causing hypoK+ metabolic alkalosis. 7. Pseudomonas aeruginosa is an aerobic gram negative bacteria. Major virulence factor is its alginate exopolysachhardie capsule forming a slime layer to mediate adherence. Cystic fibrosis patients with lung infection is Pseudomonas.

8. Cord factor = mycobacterium tuberculosis TB. Inhibits neutrophil migration, damages mitochondria, leads to cachexia. 9. F protein released by the RSV causes formation of multinucleated giant cells (syncytial cells) causing atypical pneumonia. 10. Protein P1 adhesin virulence factor used for attachment to respiratory cells by Mycoplasma pneumonia. 11. Pellagra has 3 symptoms D: Dermatitis, Diarrhea, Dementia, beefy glossitis due to Niacin deficiency. Isoniazid impairs conversion of tryptophan to niacin. 12. Deficiency of biotin causes dermatitis 13. Deficeincy of folic acid causes amcrocytic, megaloblastic anemia. 14. Deficiency of b2 riboflavin causes angular stomatitis, cheilosis, corneal vascularization. 15. Anti-CD3 Ab bind to CD3 and trigger destruction of T lymphocytes (via phagocytes or complement mediated lysis). 16. CD8+ T lymphocytes are main effector mediating acute allograft rejection. 17. Cytotoxic T lymphocytes express CD8 while helper T lymphocytes express CD4. CD14 Macrophage cell surface marker CD 16 NK cell surface marker CD19 B lymphocyte surface marker

18. Ectopic pregnancy most commonly occurs when blastocyst implants in ampulla of uterine tube. RF: PID gonorrhea, prior appendicitis/endometriosis/prvs abd surgery. 19. Fructokinase converts fructose to fructose-1-phosphate. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32.