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1

P450 inducers

Inducible Momma Barb Steals Phen-phen and refuses Greasy Carbs Chronically

Modafinil
Barbiturates
St John's Wort
Phenytoin
Rifampin
Griseofulvin
Carbamazepine
Chronic alcohol

2

P450 inhibitiors

MAGIC RACKS in GQ
Macrolides
Amiodarone
GFJ
INH
Cimetidine
Ritonavir
Acute Alcohol
Ciprofloxacin
Ketoconazole
Sulfonamides (TMP/SMX)
Gemfibrozil
Quinidine

3

Sulfa Drugs

Popular FACTSSS
Probenecid
Furosemide
Acetazolamide
Celecoxib
Thiazides
Sulfonamide
Sulfasalazine
Sulfonylureas

Allergy = fever, UTI, pruritic rash, SJS, hemolysis, thrombocytopenia, agranulocytosis, urticaria

4

cAMP hormones

FLAT ChAMP
FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2), MSH, PTH

5

cGMP hormones

vasodilators: ANP, NO

6

IP3 hormones

GGGOAT
GnRH, GHRH, Gastrin, Oxytocin, ADH (V1), TRH

7

Steroid hormones

Vitamin D, EStrogen, Testosterone, T3/T4, Cortisol, Aldosterone, Progesterone

8

Intrinsic Tyrosine kinase hormones

MAP kinase --> Ras
Growth factors: Insulin, IGF-1, FGF, PDGF, EGF

9

Receptor -associated tyrosine kinase

JAK/STAT pathway
PIG: Prolactin, Immunomodulators (cytokines, IL-2,6,8, IFN), GH

10

Path vit D def

osteomalacia
failure to mineralize (Ca) osteoid matrix (made by osteoblasts)
increased deposition of unmineralized osteoid matrix around trabeculae

11

Path Paget dz

disorganized lamellar bone in mosaic pattern with cement lines

12

Path osteopetrosis (marble bone dz)

persistence of primary spongiosa in medullary cavity with no mature trabeculae. Osteoclastic dysfunction→ accumulation of woven bone and diffuse bone thickening

13

Bones in CKD


osteitis fibrosa cystica (from PTH)
osteomalacia (from lack of Vit D)
osteoporosis (from hypoCa)

14

path osteoporosis


leaching of calcium from bones slowly over time
trabecullar thinning with fewer interconnections

15


path hyperPTH

osteitis fibrosa cystica
Resorption of bone Ca → “burn out” → fibrosis and cysts
subperiosteal thinning → erosions and salt and pepper skull

16

Efficacy

Emax

17

Potency

dose requirement (ED50)

18

Drug-induced lupus

slow acetylators
Hydral
Procainamide
INH

19

Effect of competitive antagonist on dose-response curve

shifts curve to right (ED50 incr), without affecting Emax

20

effect of noncompetitive or irreversible antagonist on dose-response curbe

does not shift curve, reduces Emax

21

MEN syndromes

Men 1 -- 3Ps. parathyroid, Pancreatic (ZES), pituitary adenoma (PRL, ACTH)
Men 2a 1M, 2 Ps: Medullary thyroid (calcitonin), pheo, parathyroid
Men 2b: 3Ms, 1 P: Medullary, Marfanoid, Mucosal neuromas, pheo

22

actions of TGFb

1. arrest of cell cycle (tumor suppressor)
2. promotes angiogenesis (allows mets to survive once they become resistant to it)
3. stimulates fibroblasts to lay down ECM proteins (role in atherosclerosis and fibrosis

23

action of bradykinin

secreted by kidney when RAAS activated. constricts veins and dilates arterioles locally to incr renal perfusion

24

BNP and ANP pathways

increase cGMP --> vasodilation. Also cause natruresis

25

skeletal muscle excitation- contraction coupling

depolarization --> opening of L-type Ca Channels --> direct opening through physical interaction of RyR1 Ca channels on SR --> release of Ca --> Troponin C
NO extracellular Ca flux. no effect of CCBs

26

cardiac muscle E-C coupling

L type channel --> Calcium influx --> binding to RyR2 (Ca-dependent Ca release) --> troponin C

27

Smooth muscle E-C coupling

L type channel --> Ca influx --> RyR (Ca-dependent Ca release) --> calmodulin --> Myosin LC kinase --> myosin phosphorylation --> actin binding --> muscle contraction

28


pemphigus vulgaris vs bulous pemphigoid

PV -- desmosome Abs (desmoglein 1). flaccid bullae, mucosal membranes, +sloughing and new bullae nikolsky. Analogous to SSSS!

BP -- hemidesmosome Abs. intact bullae, no mucosal involvement. "Bullow" epidermis! (basement membrane)

29

anorexia vs bulimia

BN: binging and compensatory behaviors (don’t have to be purging per se)
self-worth influenced by weight
maintain BMI, don’t get malnutrition

Anorexia can have purging behaviors, difference is that they lose weight and have malnutrition.***

30

grehlin

"hunger hormone"
secreted when stomach is empty --> arcuate nuc of hypothal --> incr hunger
also incr gastric acid, motility to prepare for a meal

31

leptin

"satiety hormone"
secreted by adipose --> arcuate nuc of hypothal --> decr hunger
decr sensitivity in obesity

32

UC vs Crohn's

UC -- mucosa and Submucosa, crypt abscess, pseudopolyps, loss of haustra (lead pipe sign on imaging). Toxic megacolon, carcinoma after >10 years. PSC, p-ANCA. smoking protective
Crohn’s -- full thickness, fissures, lymphoid aggregates and granulomas, skip lesions, cobblestone mucosa, creeping fat, strictures (string sign), malabsorption, Ca oxalate nephrolithiasis, fistula, carcinoma (if colonic dz), ankylosing spondylitis, sacroiliitis, migratory polyarthritis, erythema nodosum, uveitis, incr risk with smoking.

33

alpha subunit hormones

FSH, hCG, LH, TSH

34

17 deficiency

incr mineralcorticoids, decr cortisol and sex hormones

35

21 deficiency

decr mineralcorticoids (may not show), decr cortisol, incr sex hormones. INCR 17-hydroxyprogesterone

36

11 deficiency

decr aldo but incr 11-deoxycorticosterone can --> hypermineralism
decr cortisol and incr sex hormones

37

puberty order girls

telarche --> pubarche --> menarche

38

porphyria cutanea tarda

uroporphyrinogen decarboxylase def
accumulate uroporphyrin (tea colored urine)
Blistering cutaneous photosensitivity

39

AIP

def in porphobilinogen deaminase
accumulate porphobilinogen, d-ALA, urophorphyrin (urine)
Abd pain, port wine colored urine, polyneuropathy, psych, precipitated by drugs
Tx: glucose, heme, inhibit d-ALA synthase

40

Lead poisoning

inhibit ferrochelatase and ALA dehydratase (containe Zn). Accumulate protophorphyrin, d-ALA.
Microcytic anemia, GI/renal dz, headache, memory loss, demyelination

41

Cavernous sinus nerves

III, IV, V1, V2, VI, and postaganglionic sympathetics in route to orbit

42

action of PGs on kidney

dilate afferent arteriole
(FF constant but RPF, GFR up)

43

action of ATII on kidney

constrict efferent arteriole (RPF, GFR down but FF incr)

44

retroperitoneal organs

SAD PUCKER
Suprarenal (adrenals)
Aorta/IVC
Duodenum (second and third segments)
Pancrease (head, neck, body)
Ureters
Colon (ascending and descending)
Kidneys
Esophagus (lower 2/3s)
Rectum (upper 2/3s)

45

Meniere's

defective absorption of endolymph
Triad: vertigo, tinnitus, hearing loss

46

path temporal and takayasu's

granulomatous inflammation
Takayasu's: younger asian women
Temporal: older women

47

PAN

Young adults
HBV positive in 30%
Segmental, transmural fibrinoid necrosis
spares lungs (PAs)
Tx steroids, cyclophosphamide

48

Path buerger's

segmental thrombosing vasculitis extending into vessels/nerves

49

microscopic polyangiitis

necrotizing vasculitis.
pauci-immune RPGN
Type III hypersensitivity. Abx.
p-ANCA
cyclophosphamide, corticosteroids.

50

calcium oxalate/calcium phosphate

most common.
Radiopaque
Colorless octahedron
crohn's -> bile acid malabsorption --> calcium binds to lipids instead of oxalate --> incr oxalate absorption --> stones
Also ethylene glycol or Vit C abuse
Tx: thiazides and citrate

51

Struvite stones

(Mag ammonium sulfate or triple phosphate)
radiopaque
Rectangular prism (coffin lids)
urease forming organisms (Proteus, staph, klebsiella)
Staghorn
Alkaline environments

52

Urate stones

RAdiolucent**
Yellow or red-brown, diamond or rhombus
high protein, low fluid, Lesch-Nyhan, leukemia
Tx: alkalinization of urine

53

Cystine stones

Radiopaque
Flat, yellow, hexagonal
Cystinuria (AR)
form in acidic pH
tx: alkalinization of urine

54

VIPomas

WDHA
watery diarrhea, hypokalemia, achlorhydria

55

stool findings watery diarrhea

no fecal leuks, no RBCs

56

stool findings inflammatory diarrhea

PMNs +/- RBCs

57

Stool findings in salmonella Typhi

Monos

58

live attenuated vaccines

Live! one night only! see small yellow chickens get vaccinated with Sabin's and MMR! it's incredible
Smallpox, yellow fever, chickenpox, Sabin's polio, MMR, Influenza (inhaled

59

Killed vaccines

SalK = Killed
RIP Always
Rabies, Influenza (injected), Polio (Salk), HAV

60

drugs causing incr lithium levels

ACEi, HCTZ, NSAIDS
not loops

61

Clinical trial phases

Preclinical -- Testing of drug in non-human subjects
Phase 0 -- small doses; pharmacodynamic and pharmacokinetics (often skipped)
Phase I -- healthy volunteers, dose-ranging. 20-100 pt
Phase II -- patients. efficacy/safety (100-300pt) does it have an effect?
Phase III -- 1000-2000 pts. quantify efficacy, effectiveness, safety
Phase IV -- postmarket surveillance

62

congenital parvo

hydrops fetalis

63

congenital GBS, lysteria, E coli

meningitis

64

Congenital rubella

PDA (or PA hypoplasia), cataracts, excephalopathy, deafness, +/- "blueberry muffin" rash

65

Congenital CMV

Chorioretinitis, petechial "blueberry muffin" rash, HSM, jaundice

66

Congenital HIV

recurrent infections, diarrhea

67

Congenintal HSV-2

encephalitis, herpetic lesions

68

congenital syphillis

usually stillbirth, hydrops. Saddle nose, short maxilla, notched teeth, saver shins, CN 8 deafness.