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1
Q

What are the five GI associations with Down syndrome?

A

Hirschsprungs, TE fistula, annular pancreas, celiacs disease, duodenal atresia

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2
Q

What would a quad screen for down syndrome show?

A

increased beta hCG, increased inhibin A, decr alpha FP, decr estriol

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3
Q

What are unique findings for edwards syndrome?

A

Hands (clenched), jaw (small), ears (low set), head (large posterior)

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4
Q

What are the GI associations in edwards syndrome?

A

Malrotation, meckels

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5
Q

What are the unique side effects of patau’s syndrome?

A

holoProsenchephaly (can actually also be seen in edwards), cleft liP/Palate, polydactyly, decrease PAPPA

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6
Q

What are the GI associations with patau’s?

A

umbilical hernia, omphalocele, pyloric stenosis

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7
Q

What is CATCH22?

A 
for 22q11 deletion syndrome
Cleft palate
Abnormal facies
thymic aplasia
Cardiac defects (the trunc falls from 22 to 11)
Hypocalcemia (parathyroid aplasia)
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8
Q

Important things about vitamin A

A

Deficiency-> night blindness and dry skin
Excess -> HSM, skin, neuro (incl incr intracranial pressure), arthralgia, vision problems
Teratogen
Treats MEASLES and AML (APL 15:17)
Nuclear receptor

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9
Q

What four enzymes use B1 (thiamine)

A 
Maple syrup give me ATP
alpha ketoacid dehydrogenase
alpha ketogluterate dehydrogenase
transketolase
pyruvate dehydrogenase
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10
Q

What happens in riboflavin (B2) deficiency?

What enzyme need B2

A

2 Cs of B2
Cheilosis and corneal vascularization
Succinate dehydrogenase (succinate -> fumarate)

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11
Q

What cholesterol drug is best at increasing HDL?

A

Niacin

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12
Q

What is the precursor to niacin and what cofactor is needed?

A

Tryptophan and B6

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13
Q

What are they symptoms of niacin deficiency?

A

The 3 D’s of B3

Diarrhea, Dermatitis, Dementia (ataxia), +/- death

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14
Q

What can vitamin E deficiency cause?

A

E is for erythrocytes -> anemia (hemolytic d/t incr fragility)

Friedrich’s like neuro problems: demyelination of the posterior columns and spinocerebellar tracts

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15
Q

What are the functions of zinc/ things are absent with zinc deficiency?

A 
2 senses, 3 H's
Smell 
Taste
Hypogonadism
Hair
Healing of wounds
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16
Q

what are the ketogenic aminoacids?

A

Leucine, lysine (used for PDH deficiency)

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17
Q

What are the essential amino acids

A

PVT TIM HALL

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18
Q

What are hydrophobic amino acids

A

GAV LIP TMP

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19
Q

What cofacto are needed for transamination reactions (transfer of NH3)?

A

B6

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20
Q

What cofactor is needed for lactic acid dehydrogenase?

A

B3

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21
Q

What are the symptoms of PKU

A 
Musty or mousy smell
seizures
eczema
fair skin
mental retardation if not caught earlyq
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22
Q

What enzyme controls conversion of NE to E and what regulates it?

A

PNMT, positively regulated by cortisol.

SAM is a necessary cofactor

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23
Q

Whats the saying for homocystinuria?

A

Is kinda RETARDED to be a TALL, HOMO with AKO- osis and lens subluxation.

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24
Q

What is the saying for fabrys disease?

A

Alpha gal’s always look FAB break hearts on their TRIcycles until they crash because of their painful neuropathy and get a kidney shot.

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25
What are the essential fatty acids?
Linoleic, linolenic
26
What is the function of apoE
remnant uptake via remnant receptors (on everything except LDL)
27
What is the function of apoA1
Activates LCAT (put A1 steak sauce on a cat)
28
What is the function of apoCII?
LPL cofactor
29
What is the function of apoCIII?
Inhibits LPL
30
What is the function of apoB48?
Chylomicron secretion from intestinal epithelial cells
31
What is the function of apoB100?
Binds LDL receptor
32
What is deficient in Type1 dyslipidemia and what are symptoms?
Deficient LPL or CII So you get build of chylomicrons Causes pancreatitis HSM, HSM, and pruritic xanthomas but no atherosclerosis
33
What is deficient in type IIa dislipidemia? symptoms?
Familial hypercholesterolemia LDL receptor is deficient Excess LDL/ cholesterol Xanthomas (tendon, eyes), atherosclerosis, heart disease
34
What is deficient in type III dislipidemia? symptoms?
ApoE is type threeeeee Deficient apoE3/4 Chylomicron remnants build up, these are cholesterol rich so similar presentation to type IIa Xanthomas (tendon, eyes), atherosclerosis, heart disease
35
What is the problem in type IV dyslipidemia? symptoms?
Familial hypertriglyceridemia Hepatic over secretion of VLDL Pancreatitis
36
What is the problem in abetalipoproteinemia? Symptoms?
MTP mutation causes decreased B48 and B100 so you get less chylomicron and VLDL secretion. **Lipid accumulation in enterocytes** Presents within a few months: failure to thrive, steatorrhea, acanthocytosis (spiky RBCs), ataxia, night blindness Vit E helps restore lipoproteins
37
What is the ABCDEFG of Corynebacterium diphtheriae
``` ADP ribosylating Beta phage Cysteine-tellurite agar, Cardiac problems Dont scrape EF2/ Elek's toxin test F- pharyngitis with pseudomembranes Granules (red/ blue) ```
38
What is the most important treatment to give immediately when someone has diphtheria?
Antitoxin antibody!! then also give penicillin and toxoid vaccine
39
How do you diagnose tetanus vs botulism vs difficile?
``` Tetanus= history and physical Botulism= assays for toxin or organism Difficile = stool toxin assay (via PCR) ```
40
What drugs can treat Pseudoinfections?
``` Ticarcillin, piperacillin Ceftazidime (3rd gen), cefepime (4th gen) Aminoglycosides (only GAT of GNATS) Ciprofloxacin or levofloxacin Aztreonam Imipenem, Meropenem ```
41
What is the virulence factor of E. coli that causes cystitis/ pyelonephritis?
Fimbrae
42
What is the virulence factor of E. coli that causes pneumonia/ neonatal meningitis?
K capsule
43
What is the virulence factor of E. coli that causes septic shock?
LPS
44
Whats the difference between EHEC and EIEC
EIEC is invase + shiga like toxin EHEC is not invasive but has shiga like toxin Shiga like toxins cleaves 60s EHEC causes HUS -> acute renal failure, anemia, thrombocytopenia
45
How can EHEC be differentiated from the rest of the E. coli
Does NOT ferment sorbitol. Does NOT produce glucoronidase
46
E. coli Tx?
TMP-SMX or fluoroquinilones
47
VDRL detects Ab's that react to beef cardiolipin. What things give false positive VDRLs?
``` VDRL Viruses (mono, hepatitis) Drugs Rheumatic fever Lupus/ leprosy ```
48
Treponema pertenue
Causes Yaws -> many keloids that cause disfigurement, VDRL positive but not an STD
49
Brucellosis
Brucella species in unpasteurized cheeses
50
Campylobacter
Bloody diarrhea from pets/ livestock
51
Severe interstitial pneumonia after parrot/ bird contact
Psittacosis -> chlamydia psittaci
52
Q fever
Coxiella burnetti from cattle amniotic fluid
53
Tularemia
Francisella tularensis from rabbits
54
Leptospira
animal urine
55
Pasteurella mutocida
Animal bites (dog, cat) -> cellulitis and osteomyelitis
56
Bartonella
Cat scratch fever -> self resolving. can lead to bacillary angiomatosis in immunocompromised
57
Rickettsia rickettsii
Rocky mountain spotted fever. Dermacentor tick bite -> causes Rash on Derma center of palms and soles
58
Yersinia enterocolitica
Pet feces. common outbreaks in day cares. Mimic crohns or appendicitis
59
Yersinia pestis
From fleas/ prairie dogs -> bubonic plague/ black death. Painful lymphadenitis, sepsis, DIC, PAINFUL ulcer surrounded by black hemorrhagic purpura
60
Spirillum minus
Rat bites
61
Raw oyster consumption
Vibrio parahaemolyticus -> cholera like watery diarrhea | Vibrio vulnificus -> sepsis w/ 50% mortality
62
What are the treatments for PCP?
1) TMP-SMX 2) Pentamidine 3) Dapsone
63
What are the treatments for sporothrix?
Itraconazole or potassium iodide | You must plant the rose InTRA POT.
64
What are the live, attenuated vaccines? How do they help the immune system? Drawbacks?
``` Live for one night only! See SMALLL YELLOW CHICKENs get vaccinated with Sabins and MMR! It's INcredible Small pox Yellow fever Chickenpox (VZV) Sabin's polio MMR Influenza intranasal ``` Provide humoral and cell mediated immunity Possible to revert to virulent form.
65
What are the killed vaccines? How do they help the immune system? Drawbacks?
``` RIP Always Rabies Influenza (injected) Polio (SalK = Killed) A -> HAV ``` Provide humoral response, but no cell mediated response.
66
What DNA virus is ssDNA?
Parvoviridae = part of a virus
67
What RNA virus is dsRNA?
Reoviridae = repeatovirus
68
What is the only diploid virus?
Retroviruses -> have 2 exact copies of ssRNA molecules
69
Where do DNA viruses replicate? Exceptions?
Nucleus. Except poxvirus -> cytoplasmic factory!
70
Where do RNA viruses replicate? Exceptions?
Cytoplasm. Except retroviruses and influenza viruses.
71
What are the naked viruses (no envelope)?
``` Give PAPP smears and CPR to a naked Hepe. PAPP= DNA Polyomavirus Adenovirus Parvovirus Papillomavirus ``` ``` CPR = RNA Calicivirus Picronavirus Reovirus Hepevirus (also RNA) = Hep E ```
72
Of enveloped viruses, herpesvirus is the only one to do what?
Bud from the nuclear membrane (most bud from plasma membrane) -> they will have an envelope with phospholipid composition similar to the nuclear membrane.
73
What can adenovirus cause?
``` #1 cause of hemorrhagic cystitis in kids febrile pharyngitis conjunctivits pneumonia Gastroenteritis ``` Common in military barracks and college campuses
74
What family does HBV belong to?
Hepadnavirus- DS partial circular DNA
75
Other than Hepadnavirus, what other DNA viruses are DS circular?
Papovaviridae -> Polyomavirus (JC and BK viruses) and Papillomavirus (HPV)
76
What viruses are in the poxvirus family?
Smallpox Vaccinia- milkmaids blisters Molluscum contagiosum- flesh dome lesions with central dimple.
77
What are the negative stranded RNA viruses?
In the orthopedics arena, it is paramount to file down bunyans rabidly Orthomyxovirus (influenza- segmented) Arenaviruses Paramyxoviruses (Parainfluenza, RSV, Measles, Mumps) Filoviruses (Fucked with Filo -> ebola and shit) Bunyaviruses Rhabdoviruses
78
What are the segmented RNA Viruses?
BOAR Bunyaviruses, Orthomyxoviruses, Arenaviruses, Reoviruses Only these can undergo REASSORTMENT because reassortment involves transfer of entire segments
79
What viruses are picornaviruses?
PERCH on a peak (pico) Enteroviruses -> fecal oral transmission and cause GI disease: Polio, Echovirus, Coxsackievirus, HAV Coxsackievirus and Echoviruses are common causes of aseptic meningitis -> fever, photophobia, painful extra-ocular movements Rhinovirus, not fecal oral b/c acid labile -> common cold (>100 serotypes).
80
What are the findings of yellow fever (a flavivirus)?
Transmitted by Aedes mosquito 1) Liver disease- jaundice (flavi means yellow) 2) Hemorrhagic disease: epistaxis, menorrhagia, hematuria, easy bruising, GI bleeding (black vomitus -> "coffee ground emesis") 3) High fever 4) Renal disease 5) Unique tongue- red on tip and sides, but whited coated center
81
Important points about rotavirus
A reovirus (dsRNA) Major cause of infantile diarrhea worldwide Daycare centers and kindergartens Villous destruction/ atrophy -> lose Na+ and K+ -> diarrhea ROTA = right out the anus WINTER MONTHS, GREENISH DIARRHEA
82
What are findings in Rubella infection in children and in congenital rubella?
Rubella is a togavirus Children- arthralgias, postauricular adenopathy, fever, fine truncal rash that starts on head and moves down to trunk but spares hands and feet. Congenital- blue berry muffin appearance (extramedullary hematopoiesis), blindness, deafness, Cardiac (PDA or pulmonary artery stenosis)
83
Paramyxovirus
PaRaMyxovirus -> NONSEGMENTED (different than orthomyxoviruses) Parainfluenza- croup. Barking, brassy, seal like cough. RSV- resp. tract infection in infants Measles, mumps All contain F (fusion protein)- causes epithelial cells to fuse into multinucleated giant cells. Palivizumab is monoclonal Ab against F protien -> prevents pneumonia from RSV in premature infants
84
Measles
NONSEGMENTED 3 C's- cough, coryza, conjunctivitis Maculopapular rash that starts on head and spreads downward (INCLUDES HANDS AND FEET) Koplik spots on buccal mucosa (red w/ white center) SSPE (subacute sclerosing panencephalitis) is rare sequellae. No Ab to M-component of virus (caused by a verison of measles without M-component). Thought virus is not completely killed and several years later will get SSPE. Fatal.
85
Mumps
``` No rash POM-poms Parotitis = mump Orchitis -> swollen testes Meningitis (tropism for empendymal cells lining ventricles) ```
86
Rabies
Bullet shaped. Negri bodies (cytoplasmic inclusions in purkinje cells). Binds to nicotinic ACh receptors and travels retrograde up nerves to CNS. Distance of innoculation site determines length of incubation (asymptomatic phase where it replicates in muscle first) Symptomatic phase: agitation, photophobia, hydrophobia (fear of water, foamy mouth, hypersalivation) -> paralysis, coma, death. Bat, raccoon, skunk, coyotes > dog bites.
87
What is the mechanism of resistance for MRSA?
Altered PBP
88
What is the only cephalosporin that can treat MRSA?
Ceftaroline is terrible news for MRSA
89
What drugs do aminopenicillins (amoxicillin, ampicillin) cover that penicillin does not?
``` HELPSS kill enterocytes Haemophilus E. coli Listeria Proteus Salmonella Shigella ```
90
What can the carboxypenicillins be used for (ticarcillin, piperacillin, carbenicillin)?
Pseudomonas! and G. neg rods
91
Both carboxypenicillins and aminopenicillins need to be given with what?
Beta lactamase inhibitor -> Clavulanate, tazobactam, sulbactam
92
What are first gen cephalosporins used for?
G+ plus PEcK Proteus E. coli Klebsiella
93
What are second gen cephalosporins used for?
``` HEN PEcKS and G+ Haemophilus Enterobacter Nisseria Proteus E. coli Klebsiella Serratia ```
94
What does aztreonam (a monobactam) treat?
Gram negatives rods only -> E. colli, Klebsiella, PSEUDO, Serratia These are synergistic with aminoglycosides No cross reactivity to penicillins
95
What is the biggest toxicity of carbapenem (imipenem, meropenem)
SEIZURES!
96
Vanco important facts
blocks D-ala D-ala precursor. Gram + only! Drug of choice for empiric endocarditis tx C. diff Diffuse flushing (Red man)- caused by histamine! NOT many other problems: Nephrotoxicity, ototoxicity, thrombophlebitis D-ala D-lac is mechanism or resistance
97
What is the only protein synthesis inhibitor that is bacteriocidal?
Aminoglycosides
98
What are the two drugs that affect the initiation complex of bacterial ribosomes
Aminoglycosides- bind 30s | Linezolid- binds 50s (23s)
99
What drugs are aminoglycosides? Which can be used to treat pseudo?
``` Ami02glycosides GNATS Gentamycin Neomycin Amikacin Tobramycin Streptomycin ``` Only GAT can treat pseudo
100
What are the side effects of aminoglycosides?
``` caNNOT treat anaerobes Nephrotoxicity Neuromuscular blockade Ototoxicity Teratogen ```
101
What is the mechanism of resistance for aminoglycosides?
Acetylation, phosphorylation, adenylation
102
What four drugs are ototoxic and nephrotoxic?
Vanco, aminoglycosides, Loops, Cisplatin
103
Mechanism of action of tetracycline
Blocks incoming tRNA (t for t) on 30s
104
What dietary supplements can limit effect of the tetracyclines?
Divalent cations (milk, antacids, iron supplements) b/c they inhibit gut absorption of tetracyclines
105
What are the uses for tetracyclines?
``` VACUUM THe BedRoom V. cholera Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Tularemia H. pylori Borrelia Rickettsia ```
106
What is the mechanism of resistance to tetracyclines
Efflux pumps
107
What is the mechanism of action for macrolides and mechanism of resistance?
MacroSLIDES like MJ Binds 23s and block translocation Methylation of 23s = resistance
108
Uses of macrolides?
Mac CAPS Chlamydiae Atypical Pneumonias Strep (pen allergy)
109
Side effects of macrolides?
``` MACRO Motility issues (diarrhea!) Arrhythmia (prolonged QT) Cholestatic hepatitis (acute) Rash eOsinophilia ```
110
What cephalosporins cover pseudo?
Ceftazidime (3rd gen) and Cefepime (4th gen)
111
What is the saying for chloramPHENicol?
ChoramPHENicol defends against SHiN meningitis by blocking 50s peptidyltansferase but can cause APLASTIC anemia and GREY baby syndrome
112
What is the mechanism of action of clindamycin and what does it treat?
Blocks 50s translocation Anaerobes above the diaphragm TREATMENT OF CHOICE FOR ASPIRATION PNEUMONIA OR LUNG ABSCESS
113
What is the mechanism of action of Sulfonamides?
PABA analogs that block dihydropteroate synthase which is a precursor reaction to make tetrahydrofolate. Synergistic with the DHFR inhibitors.
114
What are the side effects of sulfonamides?
Hypersensitivity rxns, photosensitivity, hemolysis in G6PD, nephrotoxicity
115
What are the uses for TMP-SMX?
A bunch of abbreviations: UTIs Salmonella/ Shigella (S/S) PCP MRSA
116
What does metronidazole treat
GET GAP on the metro | Giardia, entamoeba, trichamonas, Gardnerella, Anaerobes, H. Pylori
117
What is the unique side effect for metronidazole
Disulfiram like reaction!!!
118
What is the mechanism of action of isoniazid?
Decreased synthesis of mycolic acids. First needs to be activated by KatG (bacterial catalase-peroxidase)
119
Side effects of isonizid?
INH injures neurons and hepatocytes (INH INH) and drug induced lupus! Give vit. B6 to prevent neurotoxicity
120
What is unique about isoniazid metabolism?
Acetylation!!! Fast vs slow acetylators
121
What are the 4 R's of rifampin?
RNA polymerase inhibitor, Revs up P450, red orange body fluids, rapid resistant when solo treatment
122
What can Rifampin be used for as a prophylactic agent?
H. flu and N. meningitis (Rifampin prophylaxis against SHiN!!!!)
123
What is needed for pyrazinamide to be effective?
Acidic environment! | Works inside macrophage phagolysosome
124
What are the side effects of pyrazinamide?
Gout and hepatotoxicity
125
What is the mechanism of ethambutol?
Decreased carbohydrate metabolism by blocking arabinosyltransferase
126
Side effects of ethambutol?
Optic neuropathy (decr visual acuity and red green color blindness) Also peripheral neuropathy
127
What is the drug of choice for prophylaxis against meningococcal infection?
Cipro
128
what eye drops or given to newborns to treat gonococcal or chlamydial eye infection?
Erythromycin
129
What is the prophylaxis for PCP and Toxo in HIV patients?
TMP-SMX
130
What is the prophylaxis for Histo in HIV patient?
Itraconazole
131
what is the prophylaxis for MAC in HIV patients and at what CD4 count?
Azithromycin at <50
132
What are the treatments for MRSA?
Vanco > Ceftaroline or Linezolid
133
What are the treatments for VRE?
Linezolid and streptogramins (pristin drugs)
134
What drugs are resistant to ESBL?
Imipenem and meropenem
135
Where do the "fungin" drugs work?
Fungins (caspofungin) work the farthest out. Inhibit beta glucan synthesis of the cell wall. Good for invasive ASPergillus (cASPofungin) SE: histamine induced flushing (Fungins flushing)
136
MOA of amphotericin and nystatin
Bind ergosterol and TEAR holes STAT!
137
SE of amphotericin
Has some effect on cholesterol (even tho relatively ergosterol specific) NEPHROTOXICITY -> leads to loss of Mg+/K+ -> arrhythmias Others: fevers/ chills, acute infusion reactions (phlebitis, hypotension, anemia) Limit toxicity by supplementing K+/Mg2+ and lots of hydration
138
MOA and SE of Azoles
Blocks ergosterol synthesis (from lanosterol) by inhibiting P450. Miconazole and Clotrimazole are topical agents. SE: gynecomastia (inhibits testosterone synthesis, esp ketoconazole) and inhibition of P450 system
139
MOA of Terbinafine and Naftifine
Ihibit squalene epoxidase (thereby blocking production of squalene from cholesterol)
140
Use of Terbinafine and Naftifine
Topical for Fungal nail infections (onychomycosis)
141
MOA/ use/ SE for Griseofulvan
Interferes with MICROTUBLES of fungi thereby inhibiting mitosis Deposits in nails -> oral treatment for nails, superficial infections, ringworm Teratogen, carcinogen, hepatotoxicity INDUCES P450 system
142
What is the mechanism of action of Chlorquine?
Blocks heme detoxification (heme polymerase). Widespread falciparum resistance, must use other drug.
143
What is the mechanism of action of ribavirin? toxicity? use?
Tyrion (teratogen) is an IMP (blocks IMP dehydrogenase) likes Ribs (ribavirin) Used for RSV and Hep C Teratogen and hemolytic anemia
144
What is the MOA of oseltamivir and zanamivir?
Block neuraminidase (release of progeny virus)
145
What is the mechanism of amantidine even tho widespread resistance? Toxicity?
Block hemagglutinin (viral fusion). Also cause Dopamine release so can be used for parkinsons. Cause livedo reticularis
146
Acyclovir, valcyclovir, famciclovir MOA, use, toxicity
Phosphorylated by viral thymidine kinase Block DNA polymerase Used for HSV and VZV (no effect on CMV) Only block active replication, not latent virus Crystaline nephropathy (aggressive hydration)
147
Ganciclovir, valganciclovir
Use for CMV, phosphorylated by CMV kinase blocks DNA polymerase SE: Neutropenia and thrombocytopenia, RENAL TOXICITY
148
Foscarnet
Pyrophosphate analog Inhibits DNA polymerase at different site, no viral activation is needed CMV retinitis for failed ganciclovir or HSV with failed acyclovir Nephrotoxic, Seizures (foscarnet is a Ca++ chelator and causes nephro Mg++ wasting)
149
Cidofovir
Inhibits viral DNA polymerase Does not need to be activated CMV retinitis for failed ganciclovir or HSV with failed acyclovir Nephrotoxic (saline + probenacid limits)
150
What are the side effects of protease inhibitors (-navir)
GI disturbance, hypergylcemia, hyperlipidemia, and cushinglike fat redistribution
151
What protease inhibitors have special side effects?
Rotinavir- pancreatitis, cyp3A4 inhibition "Rotinavir rocks the pancreas and CYP450s" Idinavir- nephropathy, hematuria, nephrolithiasis "Idinavir invades the urinary tract and causes problems"
152
What is the only NRTI that doesnt need to be phosphorylated?
Tenofovir | Tenofovir has enof to be active
153
What NRTIs have additional action against hep B
TEL them it also works against hep B Tenofovir Emtricitabine Lamivudine
154
What are the general side effects of NRTIs
Lactic acidosis
155
What is the unique SE of Abacavir
A for allergy (hypersensitivity) but no lactic acidosis
156
What SE is unique for Zidovudine?
Dives into the bone marrow and GI
157
What SE are seen with Didanosine, Stavudine and Zalcitabine?
Did Stav and Zal cite the pacreatitis and peripheral neuropathy they caused? Didanosine and Stavudine also cause hepatic steatosis
158
What are the NNRTIs
Nevir Efa Dela Nevirapine Efavirenz Delavirdine
159
What are the SE of the NNRTIs
Norths NED lacts a head and got a rash Lactic acidosis and rash Efavirenz also efs your head and efs you on a drug test
160
What drug is an HIV integrase inhibitor?
Raltegravir
161
Maraviroc MOA, SE
CCR5 inhibitor- blocks binding and gp120 conformational change. Only works on early virus (R5) ``` SE: CCR and 5 shits in the liver Cough CV events Rash Hepatotoxicity ```
162
Enfuvirtide MOA, SE
enFuvirtide, Fusion inhibitor, gpFortyone Hypersensativity, severe injection site rxns, bacterial pneumonia
163
What are IFN alpha, gamma, and beta used for? SE
IFN alpha- Hep B/C, Kaposi's IFN beta- MS IFN gamma NAPDH oxidase deficiency SE: neutropenia, myopathy
164
Antibiotics to avoid in pregnancy
``` SAFe Children Take Really Good Care Sulfonamides- kernicterus Aminoglycosides- ototoxicity Fluoroquinilones- cartilage damage Clarithromycin- embryotoxic Tetracycline- teeth, bones Ribavirin Griseofulvin Chloramphenicol- grey baby ```
165
What is MHC I pared with? MHC II?
I- beta 2 microglobulin II- invariant chain that needs an acidified endosome to be released. Without release -> no MHC II on APC's`
166
What are the two primary opsonins against bacteria?
IgG and C3b
167
What causes happens in C1 esterase inhibitor deficiency and what is contraindicated?
This is hereditary angioedema. Build up of bradykinin. ACE inhibitors are contraindicated.
168
What are the examples of the type 4 hypersensitivity?
Hashimoto's Minnesota Sweathearts PP'D like DM1 after Contact Vs Host GB packers b/c (Hep) they had IBD and Sarcoidosis. ``` Hashimotos Minnesota Sweethearts= multiple sclerosis PPD= PPD TB skin test DM1 Contact dermatitis Graft vs host disease GB= Guillain Barre b/c = Hep B and C IBD Sarcoidosis ```
169
What are the examples of type 3 hypersensitivity?
``` Arthus Serum helps me SLEePPP in my Rheum Arthus reaction Serum sickness SLE Poststreptococcal glomerulonephritis Polyarteritis nodosa hypersensitivity Pneumonitis Rheumatoid Arthritis ```
170
What is the MOA of cyclosporine and SE?
Binds cyclophilins, blocks calcineurin, no IL2 or IL2R production Nephrotoxicity (prevent with mannitol) Gingival hyperplasia, Hirsutism HyperTLG (triglyceride, glycemia, lipidemia)
171
MOA and SE of Tacrolimus
Binds FK-binding protein and inhibits calcineurin blocks IL2 and cytokine secretion Nephrotoxicity and peripheral neuropathy
172
MOA and SE of Sirolimus
Inhibits MTOR -> Inhibits T cell response to IL2 (inhibits T cell proliferation) SE: Thrombocytopenia, leukopenia
173
What is the MOA of Daclizumab?
Monoclonal Ab against IL2 receptor (CD25) on activated T-cells
174
MOA and SE of Muromonab?
Ab against CD3 blocking signal transduction in T cells SE cytokine release syndrome and hypersensitivity
175
Muromonab
Ab against CD3 Transplants
176
Daclizumab
Ab against IL-2 receptor (CD25) Kidney transplants
177
Basiliximab
Ab that blocks IL-2 receptor Kidney transplants
178
Bevacizumab
Ab against VEGF Used for CRC and RCC
179
Oprelvekin
IL-11 used for thrombocytopenia
180
Filgastrim
GCSF
181
Sargramostim
CMCSF
182
Aldesleukin
recombinant IL2 RCC and metastatic melanoma
183
Cetuximab
Ab against EGFR Stage 4 CRC, Head and neck cancer
184
Natalizumab
Ab against alpha 4 integrin MS, Crohns
185
Denosumab
Ab against RANK-L Osteoporosis
186
Omalizumab
Ab against IgE Fc Allergic asthma
187
Alemtuzumab
Ab against CD52 CLL
188
Pavalizumab
Ab against RSV F protein RSV prophylaxis in premature infants (esp winter months)
189
What does vinyl chloride, thorotrast, or arsenic exposure cause?
Angiosarcoma Arsenic can also cause Sq. cell cancer in the skin
190
What does carbon tetrachloride exposure cause?
Centrilobular necrosis and fatty change via lipid peroxidation
191
Nitrosamine exposure can cause.....
Gastric cancer
192
Naphthaline (analine) dyes and mothballs can cause....
Transition cell carcinoma
193
Radon can cause....
Lung cancer
194
What characteristics give a drug a low volume of distribution?
Large, charged, hydrophilic, or protein bound
195
What is a low volume of distribution?
Blood volume (4-8 liters)
196
What is a medium volume of distribution?
Extracellular fluid volume (14-16 liters) b/c 70 kg man x 20% (60:40:20 rule) = 14 liters
197
What characteristics give a drug a medium volume of distribution?
Small hydrophilic
198
What is a large volume of distribution?
All tissues (around 40L)
199
What characteristics give a drug a high volume of distribution?
Small LIPOPHILIC molecules, esp if bound to TISSUE protein
200
What are the direct cholinergic agonists?
Bethanechol, carbechol, methacholine, Pilocarpine
201
What are the acetlycholinesterase inhibitors?
Neostigmine, pyridostigmine, physostigmine, edrophonium, donepezil, galantamine, rivastigmine
202
What is the treatment for cholinesterase poisoning?
Atropine and pralidoxime (regenerates active AChE)
203
Fetal erythropoiesis:
``` Young liver synthesizes blood Yolk sack- 3-10 wk Liver- 6wk- birth Spleen- 15-30 wk Bone marrow: 22wk - adult (occurs the the ribs, sternum, pelvis, skull, vertebrae) ``` Up to age 25, also have erythropoiesis occurring in the tibia and femur
204
What does AFIB look like on ECG?
Irregularly irregular (talking about the RR interval) with no discernible P waves
205
What does atrial flutter look like on ECG?
Lots of P waves with regular RR intervals. | Sawtooth waves, flutter waves
206
What is seen on ECG with 1st degree heart block?
Consistently prolonged PR interval | Generally asymptomatic
207
What is seen on ECG with 2nd degree, Mobitz type 1 AV block?
Wenckebach. Warning Progressively lengthening PR until beat is dropped (P wave not followed by QRS.) Generally asymptomatic
208
How do you determine heart rain on ECG?
300/ # of big boxes
209
What defines sinus bradycardia?
Less than 60 bpm (RR > 5 big boxes on ECG)
210
What is seen on ECG with 2nd degree, Mobitz type 2 AV block?
Nonconducted P waves. No lengthening of PR interval. Simply dropped beats. Often 2:1 ratio (P waves to QRS complexes). Often treated with a pacemaker
211
What is seen on ECG with 3rd degree heart block?
Atria and ventricles beat independently of one another. No relation to P wave and QRS complexes on ECG. Tx= pacemaker
212
What are the 5 causes of early cyanosis (blue babies)?
``` 5 T's (R-> L shunts) Transposition of the great arteries Truncus arteriosus Tetralogy of Fallot Tricuspid atresia Total anomalous pulmonary venous return ```
213
What are the causes of late cyanosis? Blue kids
VSD> ASD > PDA Since these are initially L-R until pulmonary resistance become too high. Then Eisenmengers syndrome and cyanosis in kids (ie blue lower extremities for PDA in a child)
214
What is seen in tetralogy of Fallot?
``` Improper neural crest migration PROV Pulmonary stenosis RVH -> boot shaped heart Overriding aorta VSD ``` Cyanotic spells improved with squatting (incr vasc resistance)
215
What is heart condition is maternal diabetes associated with? What is necessary for life with with this condition?
D-Transposition of the great vessels D for diaebetes (maternal) One of the aorticopulmonary septum problems (not the Trunc falls from 22 to 11), therefore all thats left is transposition. Failure of the AP septum to spiral Neural crest migration failure VSD necessary for life Death within months w/o surgical correction
216
Infantile coarctation
Preductal A/w Turners syndrome Disparity between pulses in UE and LE No cyanosis
217
Adult coarcation
Distal to ductus a/w bicuspid valve Upper extremity HTN with LE HOTN and weak pulses Notching of the ribs Coarctation is a/w berry aneurysms that are prone to rupture due to the high pressure
218
What is the treatment for isolated systemic hypertension? ie 170/70 -> common in elderly
Diabetic: ACEI/ARB | Non-diabetic: DHP CCB or Thiazide
219
When do you see hyaline arteriolosclerosis?
Essential HTN or diabetes Homogenous deposition of eosinophilic deposition in media
220
When do you see hyperplastic arteriolosclerosis?
Malignant HTN Onion skinning d/t concentric layers of media smooth muscle
221
What cells directly respond to intimal (endothelial) injury?
Smooth muscle cells proliferate to make a neointima
222
What substances causes smooth muscle cell migration in the formation of atherosclerotic plaque? What cells release these substances?
PDGF and FGF | Released by macrophages, endothelial cells and platelets
223
What is the most common cause of abdominal aortic aneurysm?
Atherosclerosis Abdominal aorta is the most common place for atherosclerotic involvement, followed by carotids. Most abd. aortic aneurysms occur in male smokers > 50 y/o
224
What are the main causes of thoracic aortic aneurysm and aortic dissection?
HTN and Marfans
225
What is the intiating factor in aortic dissection?
Intimal tear
226
What is the initiating factor in atherosclerosis and what is the earliest lesion?
Initiating factor = Endothelial dysfunction | First lesion = intimal fatty streak
227
What is the presentation of aortic dissection?
Sudden onset severe chest pain radiating to the back High blood pressure CXR shows mediastinal widening and abnormal aortic contour
228
What is the presentation for cardiac tamponade?
Low blood pressure, fast heart rate (makes sense), muffled heart sounds, incr JVP, pulsus paradoxus (incr of greater than 10mmHg on inspiration) EKG- electrical alternans- beat to beat variations of QRS amplitude
229
What are the 3 highest risk factors for coronary artery disease?
non coronary atherosclerotic disease CKD Diabetes
230
What is the most common cause of death in diabetes patients?
Coronary heart disease!!
231
In a STEMI, how long does it take to lose contractility in affected area?
60 sec! even tho ATP will appear high Need to repurfuse within 30 min to gain some contractility back in this area
232
What is the presentation of acute pericarditis?
Sharp pain worsened by inspiration ***Relieved by sitting up and sitting forward!!*** Widespread ST segment elevation Friction rub on heart auscultation
233
What is the cause of raynauds syndrome? Tx?
Arteriolar vasospasm worsened by cold temperature or emotional stress Tx- aspirin, DHP CCB, sildenafil
234
What are similarities of the Large vessel vasculitis diseases (temporal arteritis and Takayasu's)?
Elevated ESR, Granulomatous thickening, Tx = corticosteroids
235
Polyarteritis nodosa
Spares the lungs! Hep B Abd. pain, peripheral neuropathy Cutaneous eruptions- livedo reticularis TRANSMURAL inflammation and fibrinoid necrosis Aneurysms and constrictions on arteriorgram Tx- corticosteroids and cyclophosphamide
236
Kawasakis
Coronary anuerysms Asian children Motorcycles use hands and feet -> erythema, peeling skin Lips/ oral mucosa/ strawberry tongue Cervical lymphadenitis Tx IV immunoglobulin and ASPIRIN (to prevent MI's even though Reye's is possible)
237
Lung kidney and skin vasculitis, no granulomas, p-ANCA
Microscopic polyangitis
238
Upper and lower airway disease, granulomas, glomerulonephritis, c-ANCA
Wegener's
239
Churg strauss
IgE, eosinophilia, asthma Peripheral neuropathy p-ANCA granulomas
240
Henloch schonlein
1) kids 2) palpable purpura on legs/ buttocks 3) recent URI 4) IGA and C3 COMPLEX deposition 5) IgA nephropathy -> renal disease 6) Arthralgia (knee classically) 7) Abd. pain
241
Where does angiosarcoma occur and due to what exposures?
Head neck breast and liver Radiation, thorotrast arsenic, vinyl chloride
242
What does sturge weber disease present like?
Port wine stain, ophthalmic division distribution on face | AVM, seizures, glaucoma, MR, hemiplegia
243
What is the mechanism of DHP CCBs
Dilate arteriolar sm. muscle (decr afterload) and dilate coronaries
244
What cholesterol drug has the best effect on LDL?
Statins
245
What is the mechanism and side effects of statins?
Inhibit HMG CoA reductase. SE: hepatotoxicity Myalgias, mypathies, rhabdomyolisis
246
What are the mechanisms of action of niacin? SE?
Inhibits lipolysis and VLDL secretion SE: Flushing (reduced with aspirin) Hyperglycemia (acanthosis nigricans) and hyperuricemia ``` Myositis (but not as bad as statins or fibrates) Cholesterol gallstones (but not as bad as fibrates or bile acid resins) ```
247
What is the unique effect of bile acid resins (cholestyramine)?
slightly increase triglycerides
248
Bile acid resins SE
Tastes bad GI discomfort Cholesterol gallstones**
249
What is the main use for fibrates?
Decrease triglycerides!!!
250
What is the MOA of fibrates and what are the SE?
Upregulate LPL Myositis, Hepatoxicity (similar to statins, can be bad when combined) ** Gallstones: fibrates block 7 alpha hydroxylase conversion of cholesterol into bile acids. This causes cholesterol excess in gallbladder
251
Whats unique about class IC antiarrhythmics?
Dissociate from sodium channel the slowest due to strongest binding. Makes them the most USE DEPENDENT
252
What are the main side effects of quinidine?
Prolonged QT -> Torsades. Thrombocytopenia Cinchonism: headache, tinnitus
253
What is the main use and side effect of procainamide?
Use- WPW | SE: Drug induced lupus (anti histone Ab)
254
What antiarrhythmics are reverse use dependent?
``` Class III- K+ blocker (AIDS) Amiodarone Ibutilide Dofetilide Sotalol ```
255
What is the drug of choice for abolishing SVT?
Adenosine | SE= flushing, hypotension, chest pain
256
Mg++
Effective in torsades, digoxin toxicity and eclampsia seizures
257
Thyroid gland is derived from what tissue?
Endoderm
258
What can get damaged in a superior artery ligation?
Ext. branch of the superior laryngeal nerve -> cricothyroid muscle
259
What can get damaged in a inferior artery ligation?
Recurrent laryngeal nerve (innervates all laryngeal muscles other than cricothyroid -> can cause horseness. Also innervates sensation below the vocal cords)
260
Where are the adrenal cortex and medulla derived from?
Cortex- mesoderm | Medulla- neural crest
261
What is responsible for fetal lung production and surfactant production?
Cortisol from the placental and fetal thyroid (inner active zone)
262
What factors cause HYPERPLASIA of the cortex?
AngII-> Glomerulosa ACTH -> fasciculata and reticularis
263
What is well developed in adrenal cells?
Smooth ER -> needed for steroid synthesis! Liver (detoxification) and gonads (steroids) also have well developed smooth ER
264
What shares alpha units with beta hCG?
beta hCG causes a Terrible Fucking Life TSH FSH LH
265
Where is the posterior pit derived from?
Neuroectoderm
266
What is stored in the posterior pit?
ADH (AVP) and Oxytocin These are made in the hypothalamus and carried to the posterior pit via neurophysins
267
Where is the anterior pit derived from?
Rathkes pouch-> oral ectoderm (surface ectoderm)
268
Hormones of the anterior pit. Which are basophils, which are acidophils
FLAT PiG Basophils = FLAT Acidophils = PiG
269
What types of cells are in Islets of langerhans and where is each located?
``` Alpha cells (glucagon)- outer rim Beta cells (insulin)- central Delta cells- somatostatin (interspersed) ```
270
What tissues have insulin independent glucose uptake?
BRICKL BR- brain, RBCs- GLUT1 ICKL- intestine, cornea, Kidney, Liver- GLUT2
271
What tissues have insulin dependent glucose uptake? What transporter?
Adipose and skeletal muscle | GLUT4
272
What do beta 2 agonists and alpha 2 agonists do to insuline levels?
Beta 2- raise | Alpha 2- lower
273
What is the MOA and uses of diazoxide?
Opens K+ channels which relaxes vasc. sm. muscle -Can be used in malignant HTN Opening K+ channels in beta pancreatic cells also decreases insulin release. Can be used in insulinoma
274
What hypothalamic hormones regulare prolactin secretion from the anterior pit? What are the effects of prolactin?
Dopamine is a negative inhibitor TRH increased prolactin release Estrogens also stimulate prolactin secretion Prolactin stimulates mil production and inhibits GnRH
275
What are the functions of cortisol?
``` BBIIG Blood pressure- upregulates alpha1 Bone- decreases formation Inflammatory- inhibits PLA2, neutrophilia (inhib adhesion) decr histamine, eosinophils, decr IL2 Insulin resistance Gluconeogenesis (stimulates) ```
276
How does PTH stimulate osteoclasts?
Increased M-CSF and RANK-L by osteoblasts
277
What is the derivative of parafollicular cells (C cells) of the thyroid?
Neural crest
278
What endocrine hormones use cAMP
anything that ends in H (except GnA1Tr) and hCG hCG calcitonin glucagon
279
What hormones use IP3
``` GOAT HAG which includes GnA1Tr GnRH oxytocin ADH V1 TRH Histamine (H1) Ang II Gastrin ```
280
What hormone use cGMP
NO, ANP
281
What hormones use a steroid receptor?
``` VETTT CAP Vit D Estrogen Testoterone T3/T4 (nuclear receptor!!) Cortisol Aldosterone Progesterone ```
282
What endocrine hormones use an intrinsic tyrosine kinase (receptor tyrosine kinase)?
``` Growth hormones Insulin IGF-1 FGF PDGF EGF ``` This uses the MAP kinase pathway
283
Insulin signaling leads to what
activation of protein phosphatase 1 activation of serine kinases which phosphorylate IRS-1
284
What are the endocrine hormones that use receptor associated tyrosine kinase (non receptor)
PIG Prolactin Immunomodulators (cytokines) GH JAK/STAT pathway
285
What blocks iodine entry into follicular thyroid cells via competitive inhibition?
Perchlorate, pertechnetate
286
How would a patient in Primary hyperaldosteronism (Conn syndrome) present
Hypertension (but not hypernatremia d/t escape from aldo) Hypokalemia -> muscle weakness Hypokalmeic alkalosis -> parasthesias LOW plasma renin
287
What are the causes of primary adrenal insufficiency?
Addison needed to stop at the ATM Autoimmune TB Metastasis (esp lungs)
288
How would primary adrenal insufficiency present?
Hypotension, hypocholremia, metabolic acidosis, hyperkalemia Weakness, fatigue, anorexia, weigh loss, ***skin hyperpigmentation****
289
Adrenal neuroblastoma
``` N-myc Occurs in adrenal medulla of children Less likely for episodic HTN HVA in urine (dopamine breakdown product) Tumor marker = bombesin IHC stain: neurofilament stain Homer wright pseudorosettes ```
290
Whats not revved up in hyperthyroidism?
Cholesterol -> hypocholesterolemia! Opposite is true for hypothyroidism -> hypercholesterolemia
291
What is a unique possibility in hypothyroidism?
Hypothyroid myopathy | incr'd CK, muscle pain, proximal muscle weakness, cramping
292
What is the presentation of cretinism? THINK! you always miss this one
``` 6 P's and jaundice Potbellied Pale Puffy face Protruding umbilicus (umbilical hernia****) Protuberant tongue (macroglossia****) Poor feeding Jaundice Constipation ```
293
De Quervain's subacute granulomatous thyroiditis
``` After a flu like illness Granulomatous inflammation Incr ESR Jaw pain Very painful thyroid "Mixed cellular infiltration with multinucleated giant cells" ```
294
Riedel's thyroiditis
Rock hard thyroid, painless Can extend into local structures IgG4 related Macrophages and eosinophils
295
What would the thyroid follicles look like histologically in Graves
Abnormal shape with scalloping
296
What causes the proptosis in Graves
Fibroblasts responding to the cytokines secreted by TH1 cells
297
Whats unique about hyperparathyroidism caused by kidney disease
The kidneys cant activate Vit. D or trash phosphate | Hyperphosphatemia
298
Albright's hereditary osteodystrophy
``` PseudohypOparathyroidism Auto Dom kidney unresponsiveness to PTH Shortened 4th/5th digits Hypocalcemia Elevated PTH causes osteitis fibrosa cystica ```
299
What is the most common cause of death in acromegaly?
Heart failure (GH causes growth of internal organs)
300
How does the body respond to SIADH
The body will be retaining a bunch of water so the body decreases aldosterone to maintain near normal volume status (HYPONATREMIA)
301
What is found in the Hepatoduodenal ligament?
I can the portal triad in HD
302
What is found in the Falciform ligament?
Ligamentum teres
303
What is found in the Gastrohepatic ligament?
It is on the lesser curve of the stomach and contains the gastric arteries
304
What is found in the Gastrocolic ligament?
Found on the greater curvature/ transverse colon and contains the gastroepiploic arteries
305
What is found in the Gastrosplenic ligament?
Short gastrics, gastroepiploic vessels
306
What is found in the splenorenal ligament?
Splenic artery and vein
307
What are the signs of kernicterus?
Billirubin deposits in the basal ganglia and causes: Athetoid writhing cerebral palsy (uncontrolled limb movements) Hearing loss
308
Focal nodular hyperplasia
Central stellate scar
309
Cavernous hemangionma
Most common benign liver tumor | Cavernous blood filled cavities lined by single layer of epithelium
310
Hepatic adenoma
Benign | ORAL CONTRACEPTIVES OR STEROIDS
311
Angiosarcoma
Malignant. Arsenic, polyvinyl chloride, thorotrast
312
What are the unique features of primary biliary cirrhosis?
AMA (anti mitochondrial antibodies) Middle aged females with new onset PRURITIS Xanthelasma (d/t incr cholesterol) -> cutaneous eye lid lesion with foam cells Lymphocytic infiltrate + GRANULOMAS
313
What are the unique features of Primary sclerosing cholangintis?
``` Onion Skinning bile duct fibrosis Deading of the bile ducts on ERCP Commonly men in 40s Hyper IgM a/w ulcerative cholitis Incr cholangiocarcinoma risk ```
314
What is a unique complication of pancreatitis?
Pseudocyst formation- lined by granulation tissue, not epithelium. Can rupture and hemorrhage
315
What is the mechanism of ondansetron (also granisetron)? | SE?
5HT3 antagonist -> antiemetic SE: Constipation (opposite of serotonin syndrome) Headache (opposite of sumatriptan)
316
What is the mechanism of action of metoclopramide?
D2 antagonist. 5HT4 agonist Helps you shit (esp post surgery or diabetic gastroparesis), antiemetic Increases parkinsonism effects. Contraindicated in small bowel obstruction patients, Parkinsons disease, or seizure history -> lower seizure threshold)
317
What are races are more prone to the thalassemias?
Asian- cis alpha gene deletion Africans- trans alpha gene deletion Mediterranean- Beta thalassemia
318
What is the major finding in beta thal minor?
Increased HbA2 > 3.5%
319
What is the major finding in beta thal major?
No HbA! Mainly HbF
320
What enzymes does iron inhibit? What else does it inhibit?
Ferrochelatase and ALAD -> impaired heme synthesis | Also inhibits rRNA degradation -> basophilic stippling
321
What does LEAD stand for in lead poisoning?
Lead lines, Encephalopathy, Erythrocyte basophilic stippling Abdominal pain, anemia (sideroblastic -> ferochelatase is in the mitochondria) Drops (foot and wrist), eDta, Dimercaperol
322
What are the causes of sideroblastic anemia?
Alcohol, lead, isoniazid, ALAS enzyme defect
323
What is the side effect of doxorubicin and danorubicin? How is it prevented?
Cadiotoxicity (dilated cardiomyopathy) Dexrazoxane
324
What are the MOAs of bleomycin and busulfan? SE?
Bleeeeeeeomycin makes freeeeee radicals Busulfan alkalates DNA Pulmonary fibrosis
325
What cancer drugs cause hemorrhagic cystitis? How would you prevent?
Cylcophosphamide, ifosfamide (prodrugs; alkylating agent) Prevent with mesna
326
Putting nitro on your mustang will rock your brain
Nitrosureas -mustines Cross BBB, treat brain tumors, CNS toxicity
327
Vincristine, Vinblastine
M phase Inhibit microtubule formation Vincristine- neurotoxicity Vinblastine blasts the bone marrow
328
Paclitaxol
M phase "Its taxing to stay polymerized" Hyperstabilize microtubules, preventing breakdown
329
What are the side effects of cisplatin and carboplatin? Prevention?
Nephrotoxicity and ototoxicity | Prevent nephro with amifostine and chloride diuresis
330
What is the mechanism of etoposide and teniposide?
Inhibit topoisomerase II -> double strand breaks**
331
What is the mechanism of action of Trinotecan and tropotecan?
inhibit topoisomerase I -> single strand breaks**
332
How des prednisone and prednisolone work as anti cancer agents?
Induce apoptosis
333
What are the side effects of glucocorticoids?
``` CHIPA CHIPO Cushing like symptoms Hypertension Immunosuppression Peptic ulcers Acne ``` ``` Cataracts Hyperglycemia Insomnia Psychosis Osteoporosis ```
334
Rotator cuff tendons and actions
``` SITS Supraspinatus- abducts initial 10 degrees Infraspinatus- laterally rotates Teres minor- laterally rotates, adducts Subscapularis- medially rotates, adducts ```
335
What is the saying for the wrist bones?
``` So Long To Pinky Here Comes The Thumb Scaphoid Lunate Triqetrium Pisiform Hamate Capitate Trapezoid Trapezium ```
336
What is the most common fractured carpal bone? Leads to what injury?
Scaphoid | Avascular necrosis
337
Dislocation of what bone may cause carpal tunnel syndrome?
Lunate
338
What can cause avascular necrosis of the femoral head?
Sickle cell, steroids, SLE, alcoholism Femoral neck fraction (fall on hip w/ osteoporosis) -> can injure medial femoral circumflex
339
What muscle provides the brachial plexus protection?
Subclavius
340
What things can cause autoimmune hemolytic anemia?
Warm (IgG)- alpha methyldopa, CLL, SLE | Cold (IgM)- CLL, Mycoplasma pneumonia, infectious mononucleosis
341
Lichen planus
Saw tooth lymphocytic infiltrate at dermal epidermal junction Purple and Pruitic Hep C
342
Pityriasis rosea
Hearld patch on head/ neck that then spreads down the body. Plaques with collarette scale. Self resolving
343
As a sunscreen, avobenzene blocks...
UVAI and UVAII
344
As a sunscreen PABA esters block....
UVB
345
As a sunscreen zinc oxide blocks...
UVAI, UVAI, UVB
346
What levels of skin are affected by SSSS and SJS/TEN?
SSSS affects the stratum granulosum only and sluffing off of only the upper layers of the epidermis occurs SJS/TEN affects the epidermal dermal junction
347
Basal cell carcinoma
``` Most common, least likely to metastasize Shiny/ pearly ulcer with rolled borders Upper lip Locally invasive Palisading nuclei in dermal nests ```
348
Squamous cell carcinoma (of skin)
Lower lip Ulcerative red lesions with FREQUENT SCALE KERATIN PEARLS
349
Melanoma
Least common but most likely to metastasize S100+ Neural crest origin Loves to metastasize to the brain Activating mutation of BRAF kinase (BRAF V600E) Excision. If metastatic Vemurafenib Dysplastic nevus syndrome- nest of nevomelanocytees at the dermoepidermal junction. 9p21 mutation
350
Never give a patient with gout ______?
Aspirin (decreases renal clearance of uric acid)
351
The Prosencephalon yields what
Telencephalon-> cerebral hemispheres (other stuff) | Diencephalon-> Thalamus (second brain)
352
Mesencephalon yields what?
Midbrain
353
The Rhombencephalon yields what?
Metencephalon -> Pons and Cerebellum | Myelencephalon -> Medulla (very myelinated)
354
What is associated with anencephaly?
Maternal diabetes type 1
355
What are the medications for essential tremor?
Essential tremor is a rapid tremor of the head, hands, arms or voice that occurs during movement and at rest. ``` Family history. Often self medicate with ETOH BETA BLOCKERS (drug of choice) or PRIMIDONE (anticonvulsant) ```
356
Medial medullary syndrome
Ant. Spinal Artery Tongue towards Contralateral proprioception Contralateral weakness
357
What do both Lateral medullary and Later pontine syndromes have in common?
Vertigo, nausea and vomiting Ataxia Ipsilateral horners Ipsilateral face pain and temp
358
Lateral medullary syndrome (Wallenburg's)
PICA Dont PICA horse that cant eat (hoarseness and dysphagia) Contralateral body pain and temp (checker board)
359
Lateral Pontine syndrome
AICA Facial droop means your AICA's pooped Ipsilateral deafness/ tinnitus Ipsilateral face paralysis Ipsilateral lacrimation and salivation defects Ipsilateral loss of taste from anterior 2/3 of tongue Ipsilateral loss of corneal reflex
360
Webers syndrome (midbrain)
contralateral hemiparesis Ipsilateral CNIII palsy
361
What is pseudotumor cerebri and is it treated?
Headaches in a young obese female. No ventricular dilation on CT, but elevated CSF pressure Tx- acetazolamide is first line
362
What is the jingle for the reflexes?
``` S1,2 buckle my shoe L3,4 kick the door C5,6 pick up sticks C7,8 lay them straight L1,2 picks your nuts up for you S3,4 anal winks galore ```
363
Increased CSF protein with normal cell count
Guillain Barre (acute inflammatory demyelinating polyradiculopathy)
364
What can trigger Guillain Barre?
CMV and campylobacter jejuni
365
What is the presentation of fanconi's syndrome
Metabolic acidosis with hypokalemia and Rickets
366
What are the four causes of renal papillary necrosis (hematuria and proteinuria)?
Diabetes Chronic NSAIDs or aspirin or acetaminophen Acute pyelonephritis Sickle cell anemia AND TRAIT!
367
What are the values for prerenal azotemia?
Urine osmolality > 500 Urine Na < 40 Fe Na < 1% Serum BUN/Creatinine >20% This happens when the kidneys arent getting enough blood flow. They are still able to concentrate the urine. Extra BUN is getting reabsorbed with the water increasing the ratio (normally 15%). Fractional excretion of sodium is also very low.
368
What are the side effects of loop diuretics?
``` OH DANG Ototoxicity Hypokalemia Dehydration Allergy (sulfa) Nephrotoxic (interstitial nephritis) Gout ```
369
What is the main side effect of mannitol?
Pulmonary edema
370
What are the side effects of Thiazides?
Hypokalemic metabolic acidosis, hyponatremia, sulfa allergy ``` hyperGLUC hyperglycemia hyperlipidemia hyperuricemia hypercalcemia ```
371
What is the triad for preeclampsia?
HTN, proteinuria, edema (esp hands and face) If seizures are also present = ecclampsia
372
What 4 things is abrubtio placenta associated with?
Smoking HTN Cocaine DIC
373
Whats the main clinical difference between placenta previa and abrubtio placenta?
Abruptio placenta is usually seen in the third trimester and is PAINFUL. +/- bleeding Placenta previa is PAINLESS BLEEDING during any trimester (a painless preview)
374
What ovarian germ cell tumor is a/w Turner syndrome?
Dysgerminoma
375
Key features of Yolk sac tumor
Elevated AFP Yellow, friable mass Most common in young children Schiller Duval bodies (resemble glomeruli)
376
Sarcoma botryoides
Cluster of grapes mass that hangs out of the vagina of girls < 4. Spindle shaped tumor cells that are desmin and myogenin positive.
377
Breast mass with yellow or bloody nipple discharge
Intraductal papilloma Fibrovascular projections lined with both layers of epithelium (columnar epithelial cells and myopeithelial cells) Benign
378
Phyllodes tumore
``` Large mass of CONNECTIVE TISSUE Leaf like projections Late (postmenopausal) Latino Can have necrosis and hemorrhage Benign ```
379
Seminoma testicular tumor
``` Fried egg appearance By far most common testicular tumor Transillumination test positive (cannot be transilluminated) Incr Placental Alk phos (PLAP) Good prognosis ```
380
Embrynal carcinoma (of testicle)
``` Glandular/ papillary Hemorrhage and necrosis Aggressive primitive cells Hematogenous spread Painful Usually mixed with other tumor types ```
381
Most common testicular tumor > 60 y/o
Metatstatic lymphoma. Aggressive. often bilateral
382
What causes primary pulmonary HTN?
Inactivating mutation in BMPR2. Normally limits smooth muscle proliferation
383
What is the key feature of a fat embolus
bone breaks and petechial rash!! also can result from liposuction
384
Silicosis
Upper lobes **Egg shell calcifications of hilar lymph nodes** Disrupts Macrophage phagolysosomes -> incr TB risk Incr risk of bronchogenic carcinoma Birefringent silica particles Foundries, sandblasting, mines
385
Abestosis
Worsk best at the BOTTOM of the lung Ivory white calcified pleural plaques (pathognomonic) Asbestos bodies (golden brown ferruginous dumbells) Bronchogenic > mesothelioma Shipbuilding, roofing, plumbing
386
Lung adenocarcinoma
Peripheral (large adeno's peripheral) Not related to smoking k-ras mutations (activating) ***hypertrophic osteoarthropathy -> clubbing and arthritis***
387
Squamous cell carcinoma of the lung
Central (S- cells are central) Cavitation, neCrosis, Cigarettes, hyperCalcemia (PTHrp) Keratin pearls
388
Small cell carcinoma of the lung
``` Central (S- cells are central) Many paraneoplastic syndromes L-myc amplification Small blue neuroendocrine cells (NEUROFILAMENTS) Inoperable, tx with chemo ```
389
Large cell carcinoma of the lung
Peripheral (large adenos peripheral) Large, undifferentiated cells, poor prognosis Remove surgically larGe -> gynecomastia and galactorrea, pleomorphic Giant cells with leukocyte fragments in cytoplasm
390
Carcinoid
Not a/w smoking Good prognosis BFDR Neuroendocrine stains (chromogranin positive)
391
What childhood rash spares the hands and feet?
Rubella
392
What childhood rash spares the face?
Scarlet fever from strep pyogenes
393
Drugs that cause agranulocytosis
Agranulocytosis could certainly cause pretty major damage ``` Carbamazepine Clozapine Colchicine PTU Methimazole Dapsone ```
394
Drugs that cause aplastic anemia
Cholaramphenicol, benzene, NSAIDS, PTU, methimazole
395
Drugs that cause hemolysis with G6PD
``` Hemolysis IS PAIN Isoniazid Sulfonamides Primaquine Aspirin Ibuprofen Nitrofurantoin ``` Also dapsone, napthalene, fava beans
396
Drugs that cause megaloblastic anemia
Having a BLAST with PMS Phenytoin Methotrexate Sulfa drugs
397
Drugs that cause acute cholestatic hepatitis/ jaundice
Erythromycin
398
Drugs that cause hypothyroidism
Lithium, amiodarone, sulfonamides
399
Drugs that cause gingival hyperplasia
Phenytoin, cyclosporine, verapamil
400
Drugs that can cause gout
Furosemide, thiazides, niacin, cyclosporine
401
Drugs that cause myopathies
``` Fish N CHIPS Give you myopathies Fibrates Niacin Colchicine Hydroxychloroquine Interferon alpha Penicillamine Statins Glucocorticoids ```
402
Drugs that can cause Stephens Johnson syndrome
``` Steven Johnson gave me a PEC SLAPP Penicillin Ethosuximide Carbamazepine Sulfa drugs Lamotrigine Allopurinol Phenytoin Phenobarbital ```
403
What can give you acquired fanconi's syndrome?
Expired tetracycline
404
What drugs can give you acute interstitial nephritis
Methicillin NSAIDS Furosemide
405
What drugs can cause SIADH
Carbamazepine and cyclophosphamide
406
What drugs are likely to cause seizures
``` With seizures, I BITE My tongue Isoniazid Bupropion Imipenem/ Cilastin Tramadol Enflurane Metoclopramide ```
407
What drugs can cause disulfiram like reaction
Metronidazole Certain cephalosporins 1st gen sulfonylureas (tolbutamide, chlorpropamide)
408
What drugs are nephrotoxic and ototoxic?
Vancomycin, aminoglycosides, loops, cisplatin
409
What drugs can cause massive hepatic necrosis
``` HAVAc Halothane Amanita phalloides Valproic acid Acetaminophen ```
410
What drugs are sulfa drugs
``` Popular FACTSSS Probenacid Furosemide Celecoxib Thiazides Sulfonamide antibiotics Sulfasalazine Sulfonylureas ```
411
What are two tocolytic drugs (reduce uterine contractions)?
Ritrodrine, Terbutaline (Beta 2 agonists)

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