Usmle Clues

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Pass Program Clues “You ain’t told me squat till you tell me the CLUE!!!”

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What are the 5 bacteria causing Heart Block? • Lyme Disease • Salmonella typhii (typhoid) • Chagas Disease (Whipple’s) • Legionella • Diptheria • • Lets Stop Doing Long Contractions

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What bacteria cause Reiter’s Syndrome? • Shigella • IBD – Crohn’s • Chlamydia • Yersina • • Reiter & Crohn Saw Yersina and got Chlamyia

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What are the Low Complement bugs causing Cryoglobuniemia? • Influenzae • Adenovirus • Mycoplasma • Hepatitis C • EBV • • I AM HE

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What are the drugs induced SLE? • Hydralazine • INH • Phenytoin • Procainamide • Penicillamine • Ethosuximide • • H I PPPE

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What are the drugs that Blast the BM? • AZT • Benzene • Chloramphenicol • Vinblastine • • Vinblastine Anilate Bone Cells

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What are the Comma Shaped bugs? • Vibrio • Campylobacter • Listeria • H. pylori

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• • Campylobacter Has Very Long Comma Genes 8

What is the cresent shaped protozoa? • Giardia lamblia

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What bacteria looks like Chinese letters? • Corynebacter

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What are the TB Rx? • Rifampin • Pyrazinamide • INH • Ethambutanol • Streptomycin • • RESPI

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

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What drugs Induce p450? • BAG 4 CPR QTS • Car Grabs Queens Tets to Rev Up • Alcoholic doing drugs and stinking up car • Barbiturates • Alcohol • Griseofulvin • Carbamazapine • Rifampin • Quinidine • Tetracycline • Sulfa drugs • What drugs Inhibit p450? • I Do SMACK Quinolones • INH • Dapsone • Spirolactones • Macrolides • Amiodarone • Cimetidine • Ketoconazole • Quinilones What drugs are P450 Dependent? • Warfarin

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Estrogen Phenytoin Theophylline Digoxin Theo came from war & dig inside WDEPT taking Estrogen & now is Phenytoin

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What disease is a Neutophil Deficiency? • CGD

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What is another name for CGD? • Chronic Granulomatous disease • NADPH Oxidase deficiency

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What are the Side effects of Statins? • Myositis • Hepatitis • Increased liver enzymes

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What are the painful genital Lesions? • Chancroid • Herpes • Lymphogranuloma inguinale

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What is the painful chancroid lesion due to? • Hemophilus ducreyi

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What are the 4 hormones with disulfide bonds? • Prolactin • Insulin • Inhibin • GH • • I PIG on BONDS

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What are the Hookworms? • Necatur americanis • Enterobius vermicularis • Ankylostoma duodenale • Trichuris trichurium • Ascaris lumbercoides • Strongyloides • • Hooks AS NEAT

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What are the X-Linked enzyme Deficiencies? • G6-PD • CGD • Pyruvate dehydrogenase Def. • Fabry’s • Hunter’s • Lesch-nyhan • Lesch-Nyhan Hunter Puts Fabrys on G6 Clothes

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What diseases do we screen for at birth? • Please • Check • Before • Going • Home • PKU • CAH(Congential Adrenal Hyperplasia) • Biotinidase • Galactosemia • Hypothyroidism

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HLA-Antigens • HLA-DR2= Narcolepsy, Allergy, Goodpasture’s, MS • HLA-DR3= DM, Chronic Active Hepatitis, Sjogren’s, SLE, Celiac Sprue • HLA-DR3 & 4= IDDM(Type I) • HLA-DR4= Rheumatoid Arthritis, Pemphigus Vulgaris • HLA-DR5= JRA, Pernicious Anemia • HLA-DR7= Nephrotic Syndrome(Steroid induced) •

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HLA-Antigens • HLA-DR 3 & B8=Celiac Disease • HLA-A3= Hemochromatosis(chromo. 6, point mut.-cysteine>tyrosine) • HLA-B8=MG • HLA-B13= Psoriasis • HLA-B27= Psoriais(only if w/arthritis) Ankylosing Spondylitis, IBD, Reiter’s, Postgonococcal Arthritis • HLA-BW 47= 21 alpha Hydroxylas def.(Vit.D) •

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What are the actions of Steroids? • Kills helper T-cells & eosinophils • Inhibits Macrophage migration • Inhibits Mast cell degranulation • Inhibits Phospholipase A • Stimulates protein synthesis • Stablizes endothelium

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What are the causes of Monocytosis? • Salmonella (typhoid) • TB • EBV • Listeria • Syphillis

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E. Coli is the most common cause of what? • UTI • Spontaneous bacterial peritonitis • Abdominal abscess

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• Cholecystitis • Ascending cholangitis • Appendicitis 29

What are the one dose treatments for Gonorrhea? • Ceftriaxone • Cefixime • Cefoxine • Ciprofloxin • Oflaxacin • Gatifolxacin

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What is the one dose treatment for Chlamydia? • Azithromycin

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What are the “Big Mama” anaerobes? • Strep bovis • Clostridium melanogosepticus • Bacteriodes fragilis

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What are the “Big Mama” Rx? • Clindamycin • Metranidazole • Cefoxitin

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What “big mama” bugs are associated with colon cancer? • Strep. Bovis • Clostridium melanogosepticus

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What do you see in the serum with low volume state? • K+? • Decreases • Na+? • Decreases • • • • • • • •

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Cl-? Decreases pH? Increases BP? Increases

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What are psammoma bodies? • Calcified CA’s

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In what diseases are Psammoa Bodies present?

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Papillary carcinoma of the Thyroid Serous cystadenocarcinoma of the ovary Meningioma Mesothelioma

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What are the Urease (+) Bacteria? • Proteus • Pseudomonas • Ureaplasma urealyticum • Nocardia species • Cryptococcus neoformans • H. pylori

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What types of stones are formed from Proteus? • Struvite (90%)

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What type of motility do Proteus have? • swarming

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What are 5 indications of Surgery? • Intractable pain • Hemorrhage (massive) • Obstruction (from scarring) • Perforation

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What drugs cause Cardiac Fibrosis? • Adriamycin (Doxyrubicin) • Phen-fen

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What drug is used to tx cardiac fibrosis? • Dozaroxsin

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What is the MCC of any ….penia? • #1 = Virus • #2 = Drugs

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What is seen in the Salmonella Triad? • High Fever • Rose spots (rash) • Intestinal fire

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What drugs cause Myositis? • Rifampin • INH • Predinsone • Statins

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What are the 7 Gram -encapsulated bacteria? • Some • Strange • Killers • Have

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Pretty Nice Capsules Salmonella Strep. Pneumo (gr+) Klebsiella H. influenza Pseudomonas Neisseria Cryptococcus

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What is the Jones Criteria for Rheumatic Fever? • SubQ nodules • Polyarthritis • Erythema marginatum • Carditis • Chorea

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What are the causes of Eosinophilla? • Neoplasms • Allergies/Asthma • Addison’s Dz • Collagen Vascular Dz • Parasites

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What are the Risk Factors for Liver CA? • Hep B,C,D • Aflatoxin • Vinyl chloride • Ethanol • Carbon Tetrachloride • Anyline Dyes • Smoking • Hemochromatosis • Benzene • Schistomiasis • • • What are the 9 Live Vaccines? • Measles • Mumps • Rubella • Oral Polio (sabin) • Rotavirus • Small pox • BCG • Yellow fever • Varicella •

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What are the Killed Vaccines? • SIR Hep A • Salk (polio) • Influenza • Rubella • Hepatitis A

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What are the IgA Nephropathies? • Henoch-Schoenlein P. (HSP) • Alport’s • Berger’s

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What are the Drugs that cause Autoimmune hemolytic anemia? • PCN • α-methyldopa • Cephalosporins • Sulfa • PTU • Anti-malarials • Dapsone

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What are the drugs that cause Autoimmune thrombocytopenia? • ASA • Heparin • Quinidine

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What are the enzymes that show after an MI? • Troponin I • CKMB • LDH

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What is the first MI enzyme to appear? • Troponin I • Appears • Peaks • Gone • • 2 hrs • 2 days • 7 days What is the 2nd MI enzyme to appear? • CK-MB • Appears • Peaks • Gone • • 6 hrs • 12 hrs • 24 hrs What is the 3rd MI enzyme to appear?

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LDH Appears Peaks Gone

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• • 1 day • 2 days • 3 days

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What bacteria have Silver Stains? • Legionella • Pneumocysitis carinii • H. pylori • Bartonella henseslae (lymph node) • Candida (yeast)

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What are the sulfa containing drugs? • Sulfonamides • Sulfonylurea • Celebrex

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What is another name for celebrex? • Celecoxib

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What type of inhibitor is Celebrex? • COX 2 specific

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What COX-2 specific drug can you give to a pt with sulfa allergy? • Vioxx (Rofecoxib)

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What drugs inhibit dihydrofolate reductase? • Pyremethamin/Sulfadiazine • Trimethoprim/Sulfamethoxazole

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What drugs cause Pulmonary Fibrosis? • Bleomycin • Bulsufan • Amiodarone • Tocainide

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What are the macrophage deficiency diseases? • Chediak-Higashi • NADPH-oxidase deficiency

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What are the SE of Loops and Thiazides? • Hyperglycemia • Hyperuricemia • Hypovolemia • Hypokalemia

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What are the SE of Loop diuretics? • OH DANG • Ototoxicity • Hypokalemia

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Dehydration Allergy Nephritis (interstitial) Gout

What are the only 3 Pansystolic Murmurs and when are they heard? • MR • TR

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VSD Decrease on inspiration (^exp) Increase on inspiration Decrease on inspiration (^exp)

Macrophages in various organs • Brain • Lung • Liver • Spleen • Kidney • Lymph nodes • Skin • Bone • CT • Mircoglia • Type I pneumocyte • Kupffer cell • RES • Mesangial • Dendritic • Langerhans • Osteoclasts • Histiocytes or • Giant cells or • Epithelioid cells

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What are the 7 Rashes of the Palms & Soles? • TSS • Rocky Mountain Spotted Fever • Coxsackie A (Hand/Foot & mouth dz) • Kawasaki • Syphillis • Scarlet Fever • Staph Scalded Skin Syndrome

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What is seen in every restrictive lung dz and low volume state? • Tachypnea • Decrease pCO2 • Decrease pO2 • Increase pH

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What are the different 2nd messenger systems? • cAMP • cGMP • IP3/DAG • Ca:Calmodulin • Ca+ • Tyrosine kinase • NO

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What is the clue for cAMP? • It is the 90% • Sympathetic • CRH (cortisol) • Catabolic

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What is the clue for cGMP? • Parasympathetic • Anabolic •

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What are the clues for IP3/DAG? • Neurotransmitter • GHRH • All hypothalamic hormones xc cortisol • Used by what and for what? • Smooth muscle for contraction

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What is the clue for Ca:Calmodulin? • Used by smooth muscle for contraction by distention

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What is the clue for Ca+? • Used by Gastrin only

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What is the clue for Tyrosine Kinase? • Used by Insulins • Used by ALL growth factors

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What is the clue for NO? • Nitrates • Viagra • ANP • LPS

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What are the T & B cell deficiencies? • WAS • SCID • CVID • HIV • HTLV-1

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What are the CLUES for WAS? • Thrombocytopenia • IL-4 • Infection

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• Eczema • Decrease IgM • IgE??? 83

What are the CLUES for SCID? • Framshift/Nonsense mutation • Adenosine deaminase deficiency • T-cell>B-cell • Bacterial infections • Fungal infections

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What are the CLUES for CVID? • Late onset • Frameshift/Missense mutation • Tyrosine Kinase deficiency

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What are the CLUES for HIV & HTLV-1? • T-cell>B-cell • CD4 rich • Brain • Testicles • Cervix • Blood vessels

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What are the inhibitors of Complex 1 of the ETC? • Amytal • Rotenone

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What are the inhibitors of Complex 2 of the ETC? • Malonate

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What are the inhibitors of Complex 3 of the ETC? • Antimycin D

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What are the inhibitors of Complex 4 of the ETC? • CN• CO • Chloramphenicol

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What are the inhibitors of Complex 5 of the ETC? • Oligomycin

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What are the ETC chemical uncouplers? • DNP • Free Fatty acids • Aspirin

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What type of uncoupler is Aspirin? • Physical uncoupler

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What are the 4 sources of Renal Acid? • Plasma • Urea cycle • Collecting ducts • Glutaminase

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What is the one dose tx for Hemophilus ducreyi? • Azithromycin 1 gram po • Ceftriazone 250 mg im

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What is the one dose tx for Chlaymdia? • Azithromycin 1 gram po

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What is the one dose tx for Candidiasis? • Ketoconazole 150mg

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What is the one dose tx for Vaginal Candidiasis? • Difluccan 1 pill

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What is the one dose tx for Trichomonas? • Metronidazole 2 grams

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What is the one dose tx for Gardnerella? • Metronidazole 2 grams

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What are the 3 cephalosporins & doses used as one dose treatments for Gonorrhea? • Ceftriaxone 250 mg im • Cefixime 400 mg po • Cefoxitin 400 mg po

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What are the 3 Quinolones & doses used as one dose treatments for Gonorrhea? • Ciprofloxacin 500 mg po • Ofloxacin 400 mg po • Gatifloxacin 400 mg im

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What are the 4 enzymes needed to break down glycogen? • Phosphorylase (Pi) • Debranching enzyme • Alpha-1,6 –Glucosidase • Phosphatase

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What are the 2 enzymes needed to make glycogen? • Glycogen synthase • Branching enzyme

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What are the branching enzymes? • Glycogen alpha-1,4 glycosyl transferase

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• Glycogen alpha-1,6 glycosyl transferase 105

What is the rate limiting enzyme in the break down of glycogen? • Phosphorylase (Pi)

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What values do you see in obstructive pulmonary dz? • pO2? Normal • pCO2? Normal or increased • pH? Decreased

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What values do you see in restrictive pulmonary dz? • pO2? Decreased • pCO2? Decreased • pH? Increased

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What type of acidosis do you see with obstructive pulmonary dz? • Respiratory acidosis

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What are the Lysosomal Storage Disease & what is the deficiency? • Fabry’s • Krabbe’s • Gaucher’s • Niemann – Pick • Tay-Sachs • Metachromatic leukodystrophy • Hurler’s • Hunter’s • α – galactosidase • Galactosylceramide • β – glucocerebrosidase • Sphingomyelinase • Hexosaminidase • Arylsulfatase • α – L – iduronidase • Iduronidase sulfatase

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What dz’s are associated with HLA B27? • Psoriasis • Ankylosing spondylitis • IBD (Ulcerative colitis) • Reiter’s Syndrome

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What HLA is Psorisis w/RA associated with? • HLA-13

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What are the Glycogen Storage Diseases & the deficiency? • Von Gierke’s

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• Pompe’s • Cori’s

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• McArdle’s • Glucose – 6 – phosphate

• α – 1 – 4 glucosidase • Debranching enzyme • • Glycogen phosphorylase 113

What are 6 places of the TCA cycle where amino acids feed in/out? • Pyruvate? • Glycine • Alanine • Serine • • • • • • •

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What are 6 places of the TCA cycle where amino acids feed in/out? • Alpha-KG ? • Glutamate • Glutamine • • • • •

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Acetyl CoA ? Phenylalanine Isoleucine Threonine Tryptophan Lysine Leucine

Succinyl CoA? Phenylalanine Tryptophan Tyrosine

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

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

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

in)

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What are the blood gases in neuromuscular disease (= restrictive blood gases)? • pO2? Decreased • pCO2? Decreased • PCWP? Decreased (b/c it’s a pressure problem) • Respiratory Rate? Increased • pH? Increased • SZ? Increased

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What are 5 Hormones produced by small cell (oat cell) lung CA? • ACTH • ADH • PTH • TSH • ANP

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What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-smith • Anti cardiolipin • Anti-ds DNA • SLE

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

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

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What Autoimmune Disease has the following Autoimmune Antibodies? • Anti TSH receptors? • • Graves

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What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-centromere? • • CREST

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What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-GBM? • • Goodpasture’s

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What does Goodpastures have antibody to? • Type IV collagen

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What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-mitochondria? • • Primary biliary cirrhosis

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What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-hair follicle? • • Alopecia areata

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What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-IgG? • • Rheumatoid arthritis

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What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-myelin receptors? • MS •

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

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

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

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

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• MG • 134

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

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

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What does Pernicious Anemia have antibody to? • Intrinsic factor

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What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-epidermal anchoring protein receptors? • • Pemphigus vulgaris

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What does Pemphigus vulgaris have antibody to? • Intercelluar junctions of epidermal cells

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What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-epidermal basement membrane protein? • Bullous pemphigoid

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What do you see with bullous pemphigoid? • IgG sub-epidermal blisters • Oral blisters •

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What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-platelet? • ITP •

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What does ITP have antibody to? • Glycoprotein IIb/IIIa •

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What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-thyroglobulin? • Anti-microsomal? • Hashimoto’s •

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

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• Anti-scl-70? • Scleroderma • 145

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-rho (SS-A)? • Anti-la? • Sjogren’s •

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What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-proteinase? • C-ANCA? • Wegener’s

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

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What antigen & immunoglobulin is Polyarteritis nodosa associated with? • Hepatitis B antigen • IgM •

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What are the viruses that directly cause CA and which CA do they cause? • Papilloma virus? Cervical CA • EBV? Burkitts Nasopharyngeal CA • HepB & C? Liver CA • HIV? Kaposi’s Sarcoma

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What are the 7 Nephrotic Patterns seen with every Vasculitis? • Clot in front of renal artery? Renal artery stenosis • Clot off whole renal artery? Renal failure • Inflamed glomeruli? Glumerulo nephritis • Clot in papilla? Papillary necrosis • Clot off medulla? Interstitial nephritis • Clot off pieces of nephron? Focal segmental GN (HIV, drug use association)

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• Clot off lots of nephrons? Rapidly Progressive GN 151

What is the most common nephrotic disease seen in kids and when does it occur? • Min. change disease • • 2 wks post URI

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What is the most common vasculitity leading to rapidly progressive glomerulonephrosis? • Goodpasture’s •

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What is the most common malignant renal tumor in children? • Wilm’s tumor

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What is the most common malignant renal tumor in adults? • Adenocarcinoma

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What is the most common renal mass? • Cyst

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What is the most common renal disease in Blacks/Hispanics? • Focal Segmental GN

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What is the most common nephrotic disease in adults? • Membranous GN

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Thrombolytics & Inhibitors • What does tPA, Streptokinase, Urokinase inhibit? • Aminocaproic acid • What doe Warfarin inhibit? • Vitamin K • What does Heparin inhibit? • Protamine Sulfate •

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What is the dosage of tPA? • IV push? • 20mg • • Drip? • 40mg

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What is the dosage for Streptokinase? • IV push? • 750K • • Drip? • 750K

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What is Urokinase used for? • Used ONLY for such things as: • Feeding tubes

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• Central lines • Fistulas 162

What is Alopecia Areata? • Loss of a patch of hair

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What is Alopecia Totalis? • Loss of ALL hair on head “bald”

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What is Alopecia Universalis? • Loss of hair on entire body “hairless”

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What is Loffler syndrome? • Pneumonitis with endocarditis = pulmonary infiltrate with severe eosinophilia

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What is Loffler syndrome also known as? • PIE syndrome

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What are the 5 Parasites associated with Loffler Syndrome? • Necator americanus • Ankylostoma duodenale • Shistosomiasis • Strongyloides • Ascaris lumbricoides

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What happens when a patient is on prednisone for > 7 days? • • Immunocompromised

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What are 2 enzymes used by B12? • Homocystine methyl transferase • Methyl malonyl-coA mutase

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What does Mitochondrial inheritance mean? • No male transmission • All females pass it on

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Who are 4 pt’s who would be susceptable to pseudomonas and staph infxns? • Burn patients • Cystic fibrosis • DM • Neutropenic patients

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In a neutropenic patient, what do you cover for? • cover 1x for Staph aureus during 1st week • cover 2x for Pseudo after 2nd week

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What are the 3 main concepts causing a widened S2 splitting? • Increased pO2 • Delayed opening/closing of the pulmonary value • Increased volume in the right ventricle

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What are causes for a widened S2 splitting? • Blood transfusion

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Increased Tidal Volume Giving O2 Right sided heart failure Pregnancy due to increase volume IV fluids ASD/VSD Deep breathing Hypernateremia SIADH Pulmonary regurge Pulmonary stenosis Right bundle branch block

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What are the 8 common cavities of blood loss? • Pericardium • Intracranial • Mediastinum • Pleural cavity • Thighs • Retroperitoneum • Abdominal cavity • Pelvis

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What is the special list for Penicillin? • Gram + • Basement membrane suppressor • Works on simple anaerobes • The #1 cause of anaphylaxis • Causes interstial nepritits • Causes nonspecific rashes • Acts as a hapten causing hemolytic anemia

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What is the #1 cause of anaphylaxis? • Penicillin

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What are the Chron’s Gifts? • Granuloma • Ileum • Fistula • Transmural • Skip Lesion

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What are the negative-stranded RNA Clues? • Prodromal period before symptoms = 1-3 weeks • Why is there a prodromal period? • Because must switch to positive stranded before replication

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What are the clues for positive stranded RNA? • Symptoms within 1 week or less • EXCEPTIONS: • Hanta • Ebola • Yellow fever

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• They are -ve stranded = don’t have to switch to positive before replicating 181

What are the Most common cyanotic heart diseases? • Transposition of the great arteries • Tetrology of Fallot • Truncus Arteriosus • Tricuspid Atresia • Total anomalous pulmunary Venous Return • • Hypoplastic Left heart syndrome • Ebstein’s anomaly • Aortic atresia • Pulmonary atresia

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What cyanotic heart disease is – boot shaped? • Tetrology of Fallot

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What cyanotic heart disease is associated with mom taking lithium during pregnancy? • Ebstein’s Anomaly

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What things make the membrane less likely to depolarize? • Hypokalemia • Hypermagnesemia • Hypercalcemia (except atrium) • Hypernatremia

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What things make the membrane more likely to depolarize? • Hyperkalemia • Hypomagnasemia • Hypocalcemia (except atrium) • Hyponatremia

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What is Plan F? • TPP – Thiamin – B1 • Lipoic Acid – B4 • CoA – Pantothenic acid – B5 • FAD – Riboflavin – B2 • NAD – Niacin – B3 •

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What are the 8 x-linked inherited diseases? • Bruton’s Agammaglobulinemia • CGD (NADPH def) • DMD • Color Blindness • G6PD • Hemophilia • Lesch-Nyhan • Vit D resist. Rickets (X-linked dominant) • Fabrys • Hunters

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What are the 7 B-cell deficiencies?

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Bruton’s agammaglobulinemia CVID (Common Variant Imm. Def) Leukemias Lymphomas SCID WAS Job Buckley Syndrome

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What is the Tyrosine kinase deficiency? • Bruton’s agammaglobulinemia

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What are the B-cell deficiencies with T-cell overlap? • SCID • WAS • Job Buckley Syndrome

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What are the 4 itchiest rashes? • Scabies • Lichen Planus • Urticaria • Dermatitis Herpetiformis

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Tumor Markers/Oncongenes I • L-myc? • Small cell lung Ca • • • • • • • • • •

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N-myc? Neuroblastoma Small cell lung CA C-able? CML ALL

Tumor Markers/Oncongenes II • C-myb? • Colon CA • AML • • • •

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C-myc? Promyelocytic leukemia (Burkitt’s lymphoma)

C-sis ? Osteosarcoma Glioma Fibrosarcoma

Tumor Markers/Oncongenes III

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• • • • •

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

Tumor Markers/Oncongenes IV • • • •

Erb-B2? Breast CA Ovarian CA Gastric CA

• • • •

Ret? Medullary CA of thyroid Men II & III Papillary carcinoma

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

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What are 6 Hormones produced by the placenta? • hCG • Inhibin • Human placental lactogen (HPL) • Oxytocin (drug lactation, pit gland prod it also) • Progesterone • Estrogen • Relaxin •

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What is cancer grading? • Severity of microscopic change • Degree of differentiation

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What is cancer staging?

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• Degree of dissemination of tumor • What the surgeon sees 200

What are the rashes associated with cancer and what cancer are they associated with? • • Urticaria/Hives? • Any CA, especially lymphoma • Pagets Ds (ulcers around nipples) • • Seborrheic keratosis (waxy warts)? • Colon CA • HIV if sudden increase in number • Normal with aging

201

What are the rashes associated with cancer and what cancer are they associated with?

• Actinic keratosis? – Dry scaly plaques on sun-exposed skin • Squamous Cell CA of skin • • Dermatomyositis? – violacious, heliotropic rash, malar area • Colon CA • 202

What are the rashes associated with Cancer and the cancer they are associated with? • • • Akanthosis nigricans? – dark lines in skin folds • Any visceral CA • End organ damage • • Erythema nodosum? – ant aspect of legs, tender nodules • Anything granulomatous • NOT assoc. w/ bacteria •

203

What is carried by HDL? • Apo E • Apo A • Apo CII • L-CAT – lecithin cholesterol acetyl transferase • Cholesterol – from periphery to liver

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204

What is carried by VLDL? • Apo B-100 • Apo E • Apo C II • • Triglcyerides (95%) • Cholesterol (5%)

205

What is carried by IDL? • Apo B-100 • Apo E • Apo CII • Triglycerides (< VLDL) • Cholesterol (>VLDL)

206

What is carried by LDL? • Apo B-100 • • Cholesterol – from liver to tissue • • NOT a good thing!!!!!

207

What do chylomicrons carry? • Apo A • Apo B-48 • Apo E • Apo C II • • Triglycerides from: • GI to liver (25% of the time) • GI to endothelium (75% of the time)

208

Which lipoprotein carries the most cholesterol? • • • LDL •

209

Where are the AVMs? • Clue = HEAL • Heart? • Machinery murmur • Elbow? • Fistula from dialysis in renal disease • Abdomen/Brain? • Von Hippel-Lindau = clot off with coils • Increase incidence of Renal cell CA on chrom 3

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• Lungs? • Osler Weber Rendu Syndrome 210

What is the Ranson’s criteria for acute pancreatitis (at admission)? • Glucose > 200 • Age > 55 • LDH >350 • AST > 250 • WBC > 16,000

211

What is the Ranson’s criteria for acute pancreatitis (at less than 48 hrs)? • Calcium <8 mg/dl • HCT drop > 10% • O2 < 60 (PaO2) • Base deficit > 4 • BUN > 5 mg/dl • Sequestration > 6L

212

What 2 diseases is pilocarpine used for? • CF • Glaucoma – Painful, red, teary eye

213

What is dysguzia? • Problem with sense of taste

214

What are 3 causes of dysgusia? • Metronidazole • Clarithromycin • Zinc deficiency

215

What is the triad of Carcinoid syndrome? • Flushing • Wheezing • diarrhea

216

What do you measure for carcinoid syndrome? • Serotonin – 5-HIAA

217

Where are the 2 most common places a carcinoid tumor is found? • Pancreas • Ileum •

218

What are the phage mediated toxins? • Mnemonic: BEDS • Botulinum • Erythrogenic toxin – from strep pyogenes • Diptheria • Salmonella – Has O antigen •

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219

What is the story used to remember the segmented RNA viruses? • I sprayed ORTHO on my BUNYA at the ARENA down in REO to kill SEGMENTED WORMS

220

Name the 3 major types of adhesion molecules • ICAMs • Integrins • Selectins •

221

What does IgCam do? • Bind proteins

222

What do integrins do? • Stop the leukocytes

223

What do selectins do? • Bind carbohydrates • Mediate the rolling to slow leukocytes down

224

What are the functions of adhesion molecules? • Homing of lymphocytes – tells lymphocytes where to go • Inflammation • Cell-cell interaction •

225

Primary allergic response is due to what? • Contact

226

What cells are present in the first 3 days? • Neutrophils • The next cells to show up are? • B-cells • What do B-cells make? • IgM

227

What day does IgM show up? • Three • • IgM peaks at what day? • 14 • • When does IgM leave? • In 2 months

228

What shows up in 2 wks (14 days)? • IgG • • When does IgG peak? • In 2 months •

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• When does IgG leave? • In 1 year 229

What is Secondary Allergic response is due to? • MEMORY •

230

What shows up at day 3? • IgG with 5x concentration • Has the highest affinity • • When does IgG peak? • In 5 years • • When does IgG leave? • In 10 years

231

What Ig has the hightest affinity? • IgG

232

What are the risk factors for Esophageal/Gastric CA? • Smoking • Alcohol • Nitrites • Japanese •

233

What are the risk factors for bladder CA? • Smoking • Aniline dyes • Benzene • Aflatoxin • Cyclophosphamide • Schistosomiasis • 2 diseases: • Von Hippel-Lindau • Tubular sclerosis

234

What is the NBT test? • Nitro Blue Tetrazolium test • What is it used for? • Screening CGD • What does a –ve test indicate? • +ve for the disease

235

What disease corresponds with the following inclusion bodies? • Howell-Jolly? • Sickle cell • Heinz? • G-6-P-D • Zebra?

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• Niemann pick 236

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

237

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

238

What disease corresponds with the following inclusion bodies? • Lewy? • Parkinsons • • Pick? • Pick’s disease • • Barr body? • Normal female •

239

What disease corresponds with the following inclusion bodies? • Aschoff? • Rheumatic fever • • Cowdry type A inclusions? • Herpes virus • • Auer rods? • AML • • • •

240

What disease corresponds with the following inclusion bodies? • Globoid? • Krabbe’s lysosomal storage disease • • Russell? • Multiple myeloma

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• 241

What disease corresponds with the following inclusion bodies? • Schiller-Duvall? • Yolk sac tumor • • Basal bodies? • Only found in smooth mm

242

What are the 4 types of hypersensitivities? • Mnemonic? • ACID • Type I • Anaphylaxis/Atopic • Type II • Cytotoxic (Humoral) • Type III • Immune complex mediation • Type IV • Delayed hypersensitivity/Cell mediated

243

What are the Characteristics of Type I hypersensitivity? • Atopic • IgE (Asthma) binds to mast cell • IgA activates IP3 cascade degrading mast cells

244

What are the Characteristics of Type II hypersensitivity? • Humoral • What are examples of type II? • Rh disease • Goodpastures • Autoimmune hemolytic Anemia • All Autoimmune diseases – except RA and SLE •

245

What are the Characteristics of Type III hypersensitivity? • Ag-Ab complement • What are examples of Type III? • RA • SLE • Vasculitides • Some GN? •

246

What are the Characteristics of Type IV hypersensitivity? • Cell mediated

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• • • •

What are examples of Type IV? TB skin test Contact dermatitis Transplant rejection

247

What structures have no known function? • Appendix • Epithalamus • Palmaris longus – muscle • Pancreatic polypeptide – hormones in F-cells

248

What diseases can progress to RPGN? • Goodpastures • Wegeners • DM • HTN

249

What are causes of papillary necrosis? • Vasculitis • AIDS

250

Cytic fibrosis Questions? • Tx? • Pilocarpine • also used for glaucoma • Test used to detect CF? • Pilocarpine sweat test • What ion does this test measure? • Cl• Definitive presence of disease has a test value of what? • >60

251

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

252

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

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• Clostridium tetani • Clostridium melangosepticus • What is the chemical in spores? • Calcium dipocholinate 253

What does strep mutans ferment? • Lactic acid

254

What type of receptors do all sphincters in the body have? • Alpha-receptors

255

Strep. Salivarius ag is used for what test? • Cold agglutinin testing – IgM

256

Types of amyloid found in various Systemic amyloidoses: • AA amyloid? • Chronic active disease • AL amyloid from Ig light chain? • Myeloma

257

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

258

Types of amyloid found in various Systemic amyloidoses: • Pre-albumin/transthyretin? • Cardiomyopathic hereditary forms – senile systemic amyloidosis • Neuropathic hereditary syndromes

259

Types of amyloid found in various Local amyloidoses: • ANP fibrils are caused by? • Senile cardiac amyloisosis • Cerebral amyloid in Alzheimer’s disease/Down’s? • Cerebral amyloidosis

260

Types of amyloid found in various Local amyloidoses: • Calcitonin precursors? • Medullary CA of thyroid • AL from light chains? • Isolated, massive, nodular deposits – lung, skin, urogenital tract

261

What type of dementia do you get in Pick’s dis? • Frontotemporal dementia

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262

Describe Pick’s disease • Atrophy of frontal and temporal cortex with sparing of remaining neocortical regions

263

What 3 things do Pick bodies contain? • Altered neurofilaments • Tau protein • ubiquitin

264

What drugs can cause a disulfiram reaction? • Mnemonic? • CLAM • Chloramphenicol • Lactams – Cefamandole – Cefoperazone • Antabuse – disulfiram • Metronidazole •

265

What is the mode of action of the Clostridium botulinum toxin? • Prevents pre-synaptic release of Ach • How do babies get it? • From spores in honey or molasses • How do adults get it? • From canned food

266

What are 3 Toxins of Bacillus? • Lethal factor – (black necrosis) • Protective factor • Edema factor

267

Who has Poly-D Glutamic acid? • Anthracis • Cereus

268

Name that B-blocker: • B1-selective? • A–M • Non-selective? • N–Z • Exceptions? • Carbetalol and Labetolol are non-selective

269

What are the 4 facts of Fanconi Syndrome? • Problem in proximal tubule • Can’t reabsorb • Low energy state causing anemia • Can be due to old tetracycline

270

Where is glutaminase found?

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• In the collecting duct of the kidney • • What does glutmainase help the kidney absorb? • Ammonia if the liver fails 271

Name 3 anatomical spots where renal stones get stuck: • Hilum • Pelvic brim • Entering the bladder

272

Renal failure is the most common cause of death in what 3 diseases? • SLE • Endometrial CA • Cervical CA

273

What is the rate-limiting enzyme in the urea cycle? • Carbamoyl synthase I • • Where is it found 90% of the time? • Liver • Where is it found 10% of the time? • Collecting duct of the kidney

274

What type of charge does heparin have? • -ve charge

275

What type of charge does protamine sulfate have? • +ve charge • What is it used for? • Reversing the effects of heparin

276

What is commonly seen in all vasculitides? • T-cells and macrophages • Schistocytes • Decreased platelets • Decreased RBCs • Bleeding from mucosal surfaces • Bleeding from skin and GI • Petechiae • Ecchymoses

277

What happens if you expose the blood to the basement membrane? • The following deveop: • Clots • DIC • Pulmonary embolism • DVT • MI • Stroke

278

Signs and symptoms in all vasculitides • Tachypnea and SOB

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• • Most common cause of death? • Heart failure 279

What is the MOA of Erythromycin? • Inhibits the translocation step of ribosomal protein synthesis

280

What is the MOA of Chloramphenicol? • Inhibits ribosomal peptidyl transferase in prokaryotes

281

What is the MOA of Puromycin? • Inhibits elongation by binding to “A” site and prematurely terminating chain growth in pro and eukaryotes •

282

What is the MOA of Streptomycin? • Causes misreading of code during initiation in prokaryotes

283

What is the MOA of Tetracycline? • Prevents binding of aminoacyl-t-RNA to ribosome on prokaryotes therefore inhibiting initiation •

284

What is the MOA of Cyclohexamide? • Inhibits ribosomal peptidyl transferase in eukaryotes – cell wall inhibitor •

285

What is the MOA of Rifampin? • Blocks B-subunit of RNA polymerase • Prophylaxis for contacts of N. meningitidis

286

What is the MOA of Vancomycin? • Cell wall inhibitor • Binds irreversibly to Phopholipase carrier • Bacteriacidal • Covers all gram +ves • Linezolid

287

What is the MOA of Warfarin? • Blocks vitamin k dependent gamma-carboxylation of prothrombin and factors 2, 7, 9, 10, proteins C&S •

288

What is the MOA of Clindamycin? • Blocks translation by binding the 50S subunit

289

Hemolytic properties of Streptococcus: • What type of hemolysis is alpha hemolysis? • Partial hemolysis • What color is it’s zone? • Green • What type of hemolysis is beta-hemolysis? • Complete hemolysis

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290

Hemolytic properties of Streptococcus: • What color is it’s zone • Clear – eg. Streptokinase • What type of hemolysis is gamma-hemolysis? • No hemolysis • What color is it’s zone? • Red

291

What are the 5 notable things about RTA I? • High urine PH (??????not sure about this) • Acidosis • UTI s • Stones • Babies die < 1 yr old

292

What are 3 notable things about RTA II? • Acidosis – urine PH = 2, normal is 5-6 • Hypokalmia • Patients have NO carbonic anhydrase • •

293

What are 3 notable things about RTA III? • It is a combination of RTA I & III • Normal urine pH • Hypokalemia

294

What are 3 notable things about RTA IV? • Seen in diabetics • Hyperkalemia • NO aldosterone b/c JG apparatus has infarcted

295

What are the members of Streptococcus Group D? • Viridans • Mutans • Sanguis • Salivarius • Bovis

296

What Steptococcus has green pigment? • Viridans

297

What Streptococcus causes SBE? • Viridans

298

What Streptococcus causes cavities? • Mutans

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299

What do you see in Nephritic Syndrome? • HTN • Hematuria • RBC casts

300

What do you see in Nephrotic Syndrome? • Increase Edema • Increase Lipidemia • Increase Cholesterolemia • Increase Coagulability • Decrease serum Albumin • Increase urinary Albumin

301

What is the #1 cause of Sinusitis, Otitis, Bronchitis, Pneumonia? • Strep. Pneumo • What is the #2 cause? • Hemophilus influenza • What is the #3 cause? • Neisseria meningitides •

302

What is the #1 method to paralyze cilia? • Viruses • Which are secondary to what? • Bacterial infections • What is the #2 method to paralyze cilia? • Smoking

303

If you develop gastroenteritis within 8hrs of eating what are the most common likely bugs? • Staph aureus • Clostridium perfringens • Bacillus cereus….from what? • Fried rice

304

Gastroenteritis within 8hrs of eating what toxin? • Preformed

305

What does Clostridum tetani inhibit? • Release of glycine from spinal cord • What physical finding would you see? • Lock jaw • What is the tx? • Antitoxin and Toxoid • Where is it injected?

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• Injected in different areas of body 306

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

307

The most frequent cause of UTI in females between 5-10? • Staph saprophyticus • Why? • They stick things in themselves • • • •

18-24 yoa? Staph saprophyticus Why? Because they stick things inside themselves

• Why no UTI’s after 24? • Because women are use to penises and Staph saprophyticus lives on penis (becomes part of normal flora). 308

Staph aureus is the most common cause of what bone disease? • Osteomyelitis • Because of what? • Collagenase •

309

What is the Most Common cause of infections one week post burn injury? • • Staph. aureus

310

What is the triad of SSSS? • Shock • Rash • Hypotension

311

Most common cause of UTI? • E. coli • Then? • Proteus • Then? • Klebsiella

312

Newborn meningitis is caused by? • Group B Strep (agalactiae) • E. coli • Listeria

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313

What is normal rectal flora from mom • Group B Strep (Strep. Agalactiae) • E. coli • Listeria

314

What is associated with colon CA? • Clostridium melanogosepticus • Strep bovis • What color pigment is produced? • Black

315

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

316

What is transduction • Virus inject it’s DNA into bacteria

317

What is transformation? • Virus injects it’s DNA into it bacteria in a hospital or nursing home setting, then becomes deadly.

318

Conjuction occurs only with what? • Bacteria with Pili

319

What causes mutiple cerebral abscesses in newborns? • Citrobacter

320

What are the 2 gram –ves that are strict anaerobes? • Hemophilus influenza • Neisseria

321

What type of complement problem do you have in recurrent infections with encapsulated organisms? • • C3

322

What does complement fight against? • • Gram negative bacteria

323

What do you see in serum with prerenal failure and what are the values? • BUN • >20 • Fractional Na+ excertion • <1% • Creatine • >40

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324

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

325

What is the extravasation order? • Pavementing • Margination • Diapediesis • Migration

326

What is the rate limiting enzyme for Glycolysis? • • PFK-1

327

What is the rate limiting enzyme of Gluconeogenesis? • • Pyruvate Carboxlyase

328

If treating a disease that initiates the cell mediated response, what are you treating first? • Viral • • • • • • •

If resistant to tx, what next? Fungal Mycobacterium Protozoa Parasite Neoplasm

329

What bugs can you pick up during birth? • Step. Group B – Strep agalactiae • Strep. Pneumonia • Herpes simplex virus • Neisseria gonorrhea • Chlyamydia

330

What is another name for Adenoma sebaceum? • • Perivascular angiofibromata

331

What is another name for Addison’s? • Primary Adrenocoritcal Insufficiency

332

What is another name for Alkaptonuria?

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• Ochronosis 333

What is another name for Churg-Strauss? • Allergic Granulomatosis • Angiitis

334

What is another name for Craniopharyngioma? • Ameloblastoma • What is Ameloblast? • Tooth material

335

What is another name for Chrons? • Regional enteritis • Granulomatous ileitis • Ileocolitis

336

What is another name for DeQuervain’s? • Subacute Granulomatous Thyroiditis

337

What is another name for Intraductal Ca? • Comedo Ca

338

What is another name for I-Cell Disease? • Mucolipidosis II

339

What is another name for Kawassaki Disease? • MLNS • Mucocutaneous Lymph Node Syndrome

340

What is another name for Leydig cells? • Interstitial cells

341

What is another name for Sertoli cells? • Sustentacular cells

342

What is another name for Temporal arteritis? • Giant cell arteritis (granulomatous)

343

What is another name for Waldenstrom’s macroglobulinemia? • Hyperviscosity syndrome

344

HHV I causes? • Oral • Trigeminal ganglia

345

HHV II causes? • Genital • Sacral plexus

346

HHV III causes? • Varicella zoster

347

HHV IV causes? • EBV • Mononucleosis

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• Burkitt’s 348

HHV V causes? • CMV • Inclusion bodies

349

HHV VI causes? • Roseola • Duke Disease • Exanthem subitum

350

HHV VII causes? • Pityriasis rosea

351

HHV VIII causes? • Kaposi’s sarcoma

352

Answer the following questions about Coumadin/Warfarin. • What is the MOA? • Interferes with normal synthesis and gama carboxylation of Vit. K dependent clotting factors via vitamin K antagonism. • • Is it long or short acting? • Long half-life • 8-10 hours to act

353

Answer the following questions about Coumadin/Warfarin. • Clinical use? • Chronic anticoagulation • • Contra-indication? • Pregnancy because it can cross the placenta

354

Answer the following questions about Coumadin/Warfarin. • What pathway does it affect? • Extrinsic pathway • • What does it do to PT? • Prolongs • • PT •

355

Answer the following questions about Coumadin/Warfarin. • What are the toxicities? • Bleeding • Teratogenic • Drug-drug interactions • • How is it activatied? • Tissue activated

356

Answer the following questions about Coumadin/Warfarin. • Administration?

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• po • • 357

What are the Vitamin K dependent clotting factors? • II • VII • IX • X • Protein C • Protein S

358

Answer the following questions about Heparin. • What is the MOA? • Catalyzes the activation of antithrombin III • Decreases thrombin and Xa • • Is it long or short acting? • Short half-life • Acts immediately

359

Answer the following questions about Heparin. • Clinical use? • Immediate anticoagulation of pulmonary embolism, stroke, angina, MI, DVT. • • Contra-indication? • Can be used during pregnancy because it does not cross the placenta

360

Answer the following questions about Heparin. • What pathway does it affect? • Intrinsic pathway • • What value should you follow? • PTT •

361

Answer the following questions about Heparin. • What are the toxicities? • Bleeding • Thrombocytopenia • Drug-drug interactions • • How is it activatied? • Blood activated

362

Answer the following questions about Heparin. • Administration? • I.V. • • Drug of choice for what? • DVT

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• 363

Answer the following questions about Heparin. • What is good about the newer low-molecular-weight heparins? • They act more on Xa • Have better bioavailability • Have 2 to 4 times longer half life • Can be administered subcutaneously and without laboratory monitoring.

364

What do you use for rapid reversal of heparinization? • Protamine sulfate

365

How do you treat Lead Poisoning? • Dimercaprol

366

How do you treat Benzodiazepine poisoning? • • Flumazenil

367

How do you treat Anticholinesterase poisoning? • • Pralidoxime

368

How do you treat Iron poisoning? • • Deferoxamine

369

How do you treat Opioid poisoning? • • Naloxene

370

How do you treat Barbituate poisoning? • • Bicarbonate • Doxapram

371

What does Doxapram do? • Activates the respiratory center in the brain

372

What is the treatment for Hypercholesterolemia? • Provostatin • Atrovastatin • Lovastatin • Simvastatin

373

What statin is renally excreted? • Provastatin

374

What statins do you have to follow liver enzymes every 3 months? • Atrovastatin • Lovastatin • Simvastatin

375

What do statins inhibit? • HMG-CoA reductase

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• When is it most active? • 8:00pm on 376

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

377

What are the side effects of Niacin? • Flushing • Itching

378

What 2 statins bind bile salts? • Cholestipol • Cholestyramine •

379

What are 4 causes of severe pain (in order)? 1.Pancreatitis • Due to What? • ETOH 2.Kidney stones • Due to What? • Alcohol

380

What are 4 causes of severe pain (in order)? • 3.AAA • How is this described? • Ripping pain down back 4.Ischemic bowel • What is symptom? • Bloody diarrhea

381

What are 5 causes of SIADH? • Small cell Ca of lung • Increased intracranial pressure • Pain (most common) • Drugs • Hypoxic Lung Disease/Restrictive Lung disease

382

What drug causes SIADH? • Carbamazepine

383

What are the cells of neural crest origin? • Parafollicular cells of thyroid • Odontoblasts (predentin)

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• • • • • •

Pseudounipolar cells Spiral membrane of heart Chromaffin cells All Ganglion cells (Schwann, Adrenal medulla) Melanocytes Laryngeal/Tracheal cartilage

384

What are the triple repeat diseases? • Huntington’s • Fragile X • Myotonic Dystrophy • Prauder Willie • Spinal/bulbar muscular atrophy (Fredicks ataxia)

385

How do you determine the maximum sinus rate? • 220 - age

386

What are the 3 low volume states with acidosis rather than alkalosis? • RTA • Diarrhea • Diabetic ketoacidosis (DKA)

387

What are the causes of Croup & Bronchiolities? • Parainfluenza • Adenovirus • Influenza • RSV

388

What is asthma in a child less than 2 called? • Bronchiolitis

389

What are the 4 D’s of Pellagra? • Diarrhea • Dermatitis • Dementia • Death

390

What are the uric acid stones? • Cysteine • Ornithine • Lysine • Arginine

391

What is happening in the Atrium? • Phase 0? • Depolarization • Phase 1? • No name • Phase 2?

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• Plateau phase (A-V node) • What is happening in the Atrium?

392

• • • • • •

Phase 3? Repolarization Phase 4? Automaticity (S-A node)

393

What do Na+ channels do to the EKG? • Wider QRS

394

What does Ca+ do to the EKG? • Wider P-wave • Longer PR interval

395

What are the types of kidney stones? • Calcium oxalate (phosphate) stones • Struvite stones • Uric acid stones • Cysteine stones • Oxalate stones

396

What percent of kidney stones are calcium oxalate? • 80%

397

If you find oxalate stones in the following what should you think of? • 3 y/o white male? • CF • • 5 y/o black male? • Celiac Sprue

398

If you find oxalate stones in the following what should you think of? • Adult male? • Whipple’s • Adult male or female? • Crohn’s • If oxalate stones found in CF what is the most common cause? • In 0-20 y/o? • Malabsorptin • • What age do they die? • Young

399

400 1

Answer the following questions about pseudogout? • What type of crystals are present? • Calcium pyrophosphate

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• Where are they found? • Joint spaces 2

401 1

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

2

• • • •

402

What are the most common non-cyanotic heart disease? • VSD • ASD • PDA • Coarctation

403

What murmur increases on expiration? • VSD • Mitral

404

What murmur has fixed wide splitting? • ASD

405

What murmur has bounding pulses? • PDA

406

What gives you differenital pulses? • Coarctation

407

What is increased incidence in Turners? • Coarctation

408

What are 4 enzymes never seen in glycolysis? • Pyruvate carboxylase • PEP carboxykinase • F-1,6 dPhosphatase • G-6-Phosphatase

409

What are 3 enzymes seen ONLY in glycolysis? • Hexokinase • PFK-1 • Pyruvate kinase

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410

What are 2 hormones that are acidophilic? • Prolactin • GH

411

What are the partially acid fast Gram +ve? • Nocardia

412

What are the partially acid fast Protozoa? • Cryptosporidium

413

What are the septic emboli of SBE? • Mycotic aneurysm • Roth spots • Janeway lesions • Osler’s nodes • Splinter hemorrhages • Endocarditis

414 1

Where are the following lesions found? • Janeway lesions? • Toes • Osler’s nodes? • Fingers • Roth spots? • Retina

2

415

What is the most common cause of endocarditis? • Strep. viridans

416

What causes microsteatosis? • Acetaminophen • Reye Syndrome • Pregnancy

417

What causes macrosteatosis? • Alcohol

418

What are 2 bacteria that release elastase? • Staph. Aureus • Pseudomonas

419

What are the 2 bacteria with toxins that inhibit EF-2? • Pseudomonas • Diptheria

420

How does Diptheria work? • It ADP ribosylates EF2 inhibiting protein synthesis • Is it Gram +/-? • + • Where and how does it get its exotoxin?

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• From virus via transduction How does Diptheria work?

421

• What does it cause? • Heart block • What do you give for Tx? • Antitoxin • Never scrape membrane 422 1

2

What are the different types of Emphysema and their causes? • Bullous? • Staph aureus • Pseudomonas • Centroacinar? • Smoking • • What are the different types of Emphysema and their causes?

423 1

• Distalacinar? • Aging • Panacinar? • Alpha-1 antitrypsin def 2

424

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

425

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

426

If long bones become damaged after 1 yr what takes over? • Spleen can resume erythropoieses causing splenomegaly

52

3/29/2012

427

What ions correspond with the following EKG? • P-wave? • Ca+ • QRS complex? • Na+ • S-T? • Ca+

428

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

429

What do Na+ channel blockers do to the EKG? • QRS

430

What do Ca+ channel blockers do to the EKG? • Widens P-wave • PR interval longer

431

P.P. Clue 4 Bio Stat

432

In EKG P-wave Represents? • Atrium contraction • Phase zero • Calcium

433

In EKG P-R Interval means? • AV Node • Phase 2 • Sodium

434

In EKG Q-Wave means? • Septum • Phase 2 • Sodium

435

In EKG R-upstoke means? • Anterior wall • Phase 2 • Sodium

436

In EKG S-down stroke means? • Posterior wall • Phase 2 • Sodium

437

In EKG S-T Interval means?

53

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• Ventricle • Phase 2 • Calcium 438

In EKG T-wave means? • Ventricle • Phase 3 • Potassium •

439

In EKG U-wave means • Ventricle • Phase 4 • Sodium

440

4 DZ associated with HLA-DR 2? • Narcolepsy • Allergy (hay fever) • Goodpasture • MS

441

5 DZ associated with HLA-DR 3? • DM • Chronic active Hepititis • Sjogrens • SLE • Celiac sprue

442

DZ associated with HLA-DR 3&4? • IDDM (DM Type 1)

443

DZ associated with HLA-DR 4? • Rheumatoid Arthritis • Pemphigus Vulgaris

444

DZ associated with HLA-DR 5 • JRA (JUV RA) • Pernicious anemia

445

DZ associated with HLA-DR 7? • Nephrotic syndrome (Steroid induced)

446

DZ associated with HLA-DR 3 and HLA-B 8? • Celiac Disease

447

DZ Associated with HLA-A3? • Hemochromatosis – chromosome 6 – point mutation Cystine to Tyrosine

448

DZ Associated with HLA-A 3? • Myasthenia gravis

449

DZ Associated with HLA-B 13? • Psoriasis

450

5 DZ Associated with HLA-B 27?

54

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• Psoriasis – only if with arthritis • Ankylosing Spondylities • IBD – Ulcerative Cholitis • Reiter’s • Post gonococcal arthritis 451

DZ Associated to HLA-BW 47 • 21 alpha hydroxylase deficiency – Vit. D

452

Facts about Diphtheria • ADP ribosylates EF-2 • Stops cell synthesis • Gr +ve • Gets exotoxin from virus via transduction • Heart block • Its toxoid therefore give antitoxin

453

MCC of Pneumonia in 6wks to 18 yrs? • RSV (infants only) • Mycoplasma • Chlamydia pneumonia • Strep pneumonia

454

MCC Pneumonia in 18 yrs to 40 yrs of age? • Mycoplasma • Chlamydia pneumonia • Strep. Pneumonia •

455

MCC of Pneumonia in 40 yrs to 65 yrs of age? • Strep pneumonia • H. influenza • Anaerobes

456

MCC of pneumonia in the Elderly? • Strep pneumonia • Viruses • Anaerobes • H.influenza • Gr –ve rods

457

What are 4 Clues for IgA? • Monomer in blood • Dimer in secretion • Located on mucosal surface • Found in secretion

458

What are Clues for IgD? • Only functions as surface marker for Mature B-Cell

459

What are Clues for IgE? • Immediate hypersensitivity/anaphylaxis

55

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• • • • • • • 460

Parasite defense Worms Fc region binds to mast cells and basophils Allergies Does Not fix complement

What are Clues for IgG? • Highest affinity • Memory respond at day 3 five times the concentration • Peaks in 5 years last for 10 years • Opsonizes • Activates complement • 2nd to show up in primary response • Only one to show up for secondary respond • Most abundant Ig in newborn • Antigenic differences in heavy chain and site of di-sulfide bond • 4 subclasses G1 to G4 •

461

What are Clues for IgG1? • Crosses placenta due to fc portion

462

What are Clues for IgG2? • Most common sub-class deficiency • Patient susceptible to encapsulated organisms

463

What are Clues for IgG3? • Most memory antibody

464

What are Clues for IgG4? • Only IgG NOT fixing complement

465

What are Clues for IgM? • Responds in primary response • Most efficient in agglutination and complement fixation • Defenses against bacteria and viruses

466

What do Macrophages release? • MHC II

467

What does TH1 secrete? • IL-2 • IF- Gamma

468

What does TH2 Secrete? • IL-4 • IL-5 • IL-6 • IL-10

469

What does TH-0 secrete? • TH-1

56

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• TH-2 470

MHC-1 are also called what? • CD8 • CD8 becomes T-cytotoxic cells

471

All T-Cells express what? • CD-3 • For what? • Signal transduction • CD-2 • For what? • Adherence

472

What do CD-4 cells Become? • T helper cells

473

What do CD-8 cells Become? • T cytotoxic cells

474

Neutrophils produce what enzymes and what is their action? • Myeloperoxidase • NADPH • Will kill ALL Gr+ve – Ex..Hydrogen peroxide kills gr+

475

What do T-cells stimulate? • Clue 4x7=28 • CD-4 • B-7 • CD-28 •

476

What are the Clues for Type-1 Hyperlipidemia? • Increased Chylomicron • Deficiency of Lipoprotein lipase enzyme • Defect in liver only

477

What are the Clues for type-2 hyperlipedimia? • Increased LDL • Two types IIa and IIb • Type IIa Receptor deficiency for LDL or missing B-100 • Type II-b (LDL and VLDL problems) enzyme deficiency for LDL at adipose. Receptor problem for VLDL. Most common in General Population

478

What are the Clues for type-3 Hyperlipedimia? • Increased IDL • Receptor problem for APO-E

479

What are the Clues for Type-4 hyperlipedimia? • Increased VLDL • Lipoprotein lipase enzyme deficiency at adipose tissue

57

3/29/2012

480

What are the Clues for Type-5 hyperlipedimia? • Combination of Types 1&4 • Increased Chylomicron and VLDL • Enzyme and receptor deficiency at C-II • Most common in diabetics

481

What is a Xanthoma? • Deposition of Cholesterol on elbows • Can cause what? • CAD

482

What is a Xanthelasma? • Deposition of Triglycerides on eyelids, face • Can cause what? • Pancreatitis

483

Description of Rashes

484

ERYTHEMA MARGINATUM • Little red spots w/ bright red margins • Sandpapery • RF- Jones critera

485

ERYTHEMIA CHRONICUM MIGRANS • Lymes disease • Target lesions (bulls eye)

486

MEASLES • Morbiliform rash • Preceded by cough • conjunctiivitis

487

ROSEOLA • Fever x 2 day • Followed by rash • ONLY ONE WITH RASH FOLLOWING FEVER (HHV 6)

488

ERYTHEMA NODOSUM • Anterior aspect of leg • Redness • Tender nodules

489

Erythema multiforme • Red macules, target lesions • Causes: allergy, viruses • Mild: MCC virus, #2 drugs (sulfas) • Moderate: Stevens-Johnsons Syndrome • Severe: Toxic epidermal necrolysis , skin peels off

490

SEBORRHEIC DERMATITIS • Scaly skin with oily shine on headline

491

SEBORRHEIC KERATOSIS • Stuck on warts • Due to aging

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492

PSORIASIS • HLA-B27 • Extensor surfaces • Silvery white plaques • Scaly skin • Pitted nails

493

VARICELLA ZOSTER HHV 3 • STAGES • Red macules • Papules • Vesicles • Pustules then scabs • Different stages may appear at same time •

494

DERMATITIS HERPATIFORMIS • Rash and blisters on ant. thighs • Assoc. with diarrhea • Assoc. with flare up of celiac sprue •

495

TYPHOID FEVER • SEEN WITH SALMONEALLA INFXN • Rose spots assoc. with intestinal fire

496

DERMATOMYOSITIS • Heliotropic rash

497

ERYSIPELAS • Reddened area on skin w/ raised borders • DOES NOT BLANCH

498

TINEEA CRURIS • Redness • Itchy groin

499

PITYRIASIS ROSEA • Herald patch= dry skin patches that follow skin lines • HHV 7

500

TINEA VERSICOLOR • Hypopigmented macules on upper back • Presents in a V pattern • A.K.A. upside down christmas tree • Tx: Griseofulvin

501

What do you see in SCABIES? • Linear excoriations on belt line and finger webs • What is the tx? • Lindane • Permethrin

502

What is a T-CELL DEFICIENCY?

59

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• • • • • • •

DiGeorges What ion imbalance will they have? Hypokalemia What did not form? 3rd and 4th pharyngeal pouch What chromosome? Deletion on chromosome 22

503

T-CELL DEFICIENCY • HIV • Also B-cell but less so

504

What is MYCOSIS FUNGOIDES? • NOT A FUNGUS • Non-Hodgkins form of cutaneous T-cell lymphoma

505

What is the job of CHYLOMICRONS? • Transport TG’s from GI to liver and endothelium

506

What is the job of VLDL? • Transports TG’s from liver to adipose

507

What is the job of IDL? • Transports TG’s from adipose to tissue

508

What is special about LDL’s? • ONLY ONE THAT CARRIES CHOLESTEROL

509

What do you develop with HYPERTRIGLYCERIDEMA? • XANTHELASMA • • Where are they located? • On eyelids and eyebrows

510

What do you develop with HYPERCHOLESTEROLEMIA? • Xanthomas • • Where are they located? • elbows

511

Where is VLDL made? • ONLY ONE MADE IN THE LIVER

512

What are IDL AND LDL formed from? • ARE BREAK DOWN PRODUCTS OF VLDL

513

What are the clues for HEMOPHILIUS INFLUENZA? • Gram -/+? • Pleomorphic gram (-) rods • What pattern? • “school of fish pattern” • What type is most common? • Type A – 80%

514

What are the clues for HEMOPHILIUS INFLUENZA?

60

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• • • •

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

515

What are the clues for HEMOPHILIUS INFLUENZA? • Most common cause of what? • Sinusitis • Otitis • Bronchitis

516

What are the clues for HEMOPHILIUS INFLUENZA? • What is the 2nd most common type? • TYPE B – 20% • Encapsulated or non encapsulated? • Encapsulated • What does it have in its capsule? • Polyribosyl phosphate in capsule • Contains IgA protease

517

What are the clues for HEMOPHILIUS INFLUENZA? • • Invasive or non invasive? • Invasive • What does it cause most often? • #1 cause of epiglottitis • What are the signs of epiglottitis? • Stridor • Fever • Thumb sign on xray

518

What are the most common causes of MENINGITIS corresponding with the following ages? • 0-2 months? • #1. Group B strep (agalactiae) • #2. E. coli • #3. Listera

519

What are the most common causes of MENINGITIS corresponding with the following ages? • 2 Months- 10 years? • #1. strep pneumonia • #2. n. meningitides • (adolescent years only)

520

What are the most common causes of MENINGITIS corresponding with the following ages? • 10yrs- 21 yrs? • #1. n. meningitides

521

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

61

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ages? • > 21 years old? • #1 S. pneumoniae 522

Answer the following about the Strep. Pneumonia vaccine. • At what age is it given? • Given at 2,4,6 months • What strain does it cover? • Covers 23 strains (98% cases)

523

Answer the following about the Strep. Pneumonia vaccine. • Indications? • Anyone> 65y/o • Anyone splenectomized – Sickle cell anemia • Anyone with end-organ damage – CF – RF – Nephrotic Syndrome

524

STREP PYOGENES is the most common cause of what? • MCC of all throat infections • #2 MCC of all what? • Skin infections except lines

525

What are the STAPHYLOCOCCUS PIGMENTS? • St. aureus? • Gold pigment • St. epidermidis? • White pigment • St. saprophyticus? • No pigment

526

What is the clue for RUSTY COLORED SPUTUM? • Strep. Pneumonia – pneumococcus

527

Clues for GENERAL INFECTIONS • Skin Infections? • Say Staph. Aureus • Throat Infections? • Say Strep. Pyogenes • Small Intestine Infections? • Say E. coli

528

What disease is a NEUTROPHIL DEFICIENCY & T,B cell deficiency? • Job Syndrome: • IL-4 • Hyper IgE • What do they look like? • Red hair • Fair complexion

62

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• Female 529

What are the NEUTROPHIL DEFICIENCY? • NADPH-OXIDASE DEF (CGD) • NEUTROPENIA • MYLOPEROXIDASE • Job-Buckley Syndrome

530

What Hepatitis B antigen is found with an acute/recent infection? • HbC antigen • HbS antigen

531

What Hepatitis B antigen & antibody is found with an acute/recent infection? • • HbC antigen • HbS antigen • HbC antibody

532

What Hepatitis B antigen is found with Recent immunization within the past 2wks? • • HbS antigen ONLY

533

What Hepatitis B antibody is found with Recent immunization two wks after and can be due to vaccination immunity from a long time ago? • • HbS antibody ONLY

534

What Hepatitis B antibody & antigen is found with past disease but now immune? • • HbC antibody • HbS antibody • HbS antigen

535

What Immunogloblin is found in Hepatitis B immunity? • • IgG

536

What Hepatitis B antigen/antibody is found in the chronic carrier state? • • HbS antigen for >6months • Can be with or without HbS antibody

537

What Hepatitis B antigen is found with the infectious state? • • HbE antigen

538

What Hepatitis B antibody is found with the non-infectious state? • • HbE antibody

539

If patient has recovered from Hepatitis B what antigen will they have? • • NEGATIVE HbS antigen

540

If patient is a chronic carrier what antigen will they have?

63

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• • POSITIVE HbS antigen 541

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

542

What is the incubation period for Hepatitis B? • • 4 to 26 wks • Average @ 8wks •

543

How long is the acute disease period in Hepatitis B? • • 4 to 12 wks

544

How long is the convalescence period in Hepatitis B? • • 4 to 20 wks

545

How long is the recovery period for Hepatitis B? • • YEARS

546

Answer the following about HIV? • MC infection? • CMV • MCC of death? • PCP • What is p41 used for? • Just a marker

547

Answer the following questions about HIV? • What does Gp120 do? • Attachment to CD4 • What is Pol used for? • Integration • What is reverse transcriptase used for? • Transcription • What are p17 & p24 antigens used for? • Assembly •

548

Answer the following questions about HIV? • What is the normal CD4 count? • 800-1200 • What can the CD4 count be up to in children?

64

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• 1500 • When do you begin treating with 2 nucleotide inhibitors and 1 protease inhibitor? • <500 – (child at 750) 549

Answer the following questions about HIV? • AIDS is defined as a CD4 count of what? • <200 • With a CD4 count of <200 what do you tx for? • PCP • What do you treat for when CD count is <100? • Mycobacterium aviam intracellular

550

What are the Antioxidants? • Vitamin E – #1 • Vitamin A • Vitamin C • Betakertine

551

What is Vitamin A a cofactor for? • Parathyroid • • Along with what other cofactor? • Mg+

552

Too much Vitamin A will cause what? • Hyperparathyroid – Increase Ca+ – Decrease Phosphate • What will be the symptoms? • Goans • Moans • Bones • Stones

553

Too much Vitamin A will cause what? • Pseudotumor Cerebri – Increase CSF production from Chorichoid Plexus

554

What is the only cause of ICP that does not cause herniation? • Pseucotumor cerebri

555

What does Vitamin A deficiency cause? • • Nightvision problems/nightblindness • • Hypoparathyroidism – Decrease Ca+ – Increase Phosphate

556

What is Vitamin B1? • THIAMINE •

65

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• • • • •

What do you get with a decrease in thiamine? Beri Beri What is the most common cause in US? ETOH

557

What do you get with Vitamin B1 deficiency? • Wet Berry Berry • With heart failure • • Dry Berry Berry • Without heart failure

558

What do you get with Vitamin B1 deficiency? • Wernicke’s Encephalopathy • Wernicke’s Korsakoff

559

What is Wernicke’s Encephalopathy? • • Alcoholic thymine deficiency of the Temporal Lobe

560

What is Wernicke’s Korsakoff?

561

What needs B1 as a Cofactor? • 3 Dehydrogenases • Pyruvate dehydrogenase • Alpha ketoglutarate dehydrogenase • Branch chain amino acid dehydrogenase • • Transketolase

562

What is B2 • Riboflavin • • What is a physical sign of this deficiency? • Angular stomatitis • Angular cheliosis • Corneal Neurovasculazations

563

What is the best source of B2? • Milk • Also from FAD

564

What is B3? • Niacin • • What is the clue? • Diarrhea • Dermatitis • Dementia • Death

565

What is the disease that presents like B3 deficiency? • Hartnup Disease

66

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• • • • • • 566

What is deficient in this disease? Tyrptophan What is typtophan needed for? Needed for niacin formation

What is B4? • Lipoic acid • • What is the deficiency caused by this vitamin? • Not one

567

What is B5? • Pantothenic acid • • What is the deficiency caused by this vitamin? • You guessed it…nothing

568

What is B6? • Pyridoxine • • • • • •

What is the deficiency caused by this vitamin? Neuropathy Seizures Who do you need to give B6 to? Patient on INH

569

What type of anemia is seen with B6 Deficiency? • Sideroblastic

570

What needs B6 as a cofactor? • ALL transaminases

571

What is B12? • Cyanocobalamine • • What is the deficiency caused by this vitamin? • Pernicious anemia • Neuropathy

572

What is the most common cause of vitamin B12 deficiency? • Pernicious anemia

573

What 2 enzymes are needed for synthesis of B12? • Methylmalonyl CoA Mutase • Homocysteine Methyl Transferase

574

Deficiency in Methylmalonyl CoA Mutase leads to what? • • Neuropathy • • Why?

67

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• Because it recycles myelin 575

Deficiency in Homocystiene Methyl Transferase leads to what? • Megaloblastic anemia • • What else is this enzyme needed for? • Nucleotide synthesis

576

When is ANGULARE STOMATOSIS seen? • VITAMIN B2- RIBOFLAVIN deficiency

577

What are the 4 D’S of pellegra? • DIARRHEA • DERMATITIS • DEMENTIA • DEATH

578

What causes a NEUROPATHY WHEN DEFICIENT & also needs TRANSAMINASE? • PYRIDOXINE B6

579

What vitamin is deficient with PERNICIOUS ANEMIA & NEUROPATHY? • B12 CYANOCOBALAMINE

580

What is the first vitamin to run out with disease of rapidly dividing cells? • • Folate • •

581

What type of anemia is seen with Folate deficiency? • Megaloblastic anemia • • With neuropathy? • NO NEUROPHATHY • • What else is Folate used for? • Nucleotide synthase (THF)

582

What is another name for Vitamin C? • Ascorbate acid

583

What is Vitamin C needed for? • Collagen synthesis

584

What happens with Vitamin C deficiency? • Scurvy

585

What is the CLUE for Scurvy? • Bleeding gums • Bleeding hair follicles

586

What is the most common cause of Vitamin C deficiency? • Diet deficient in citrus fruit • Diet deficient in green vegetables • Over cooked green vegetables

68

3/29/2012

587

What does Vitamin D do with Ca+? • Controls Ca+ • Absorbes Ca+ from GI • Reabsorbs Ca+ in Kidneys • • Controls osteoblastic activity

588

What does Vitamin D deficiency cause in Children? • Ricketts • • What does it cause in ADULTS? • Osteomalcia

589

What is the CLUE for RICKETTS? • Lateral Bowing of the Legs • X-linked dominant

590

What is Vitamin E needed for? • Hair • Skin • Eyes • Protection against free radicals • #1 antioxidant

591

What does a deficiency of Vitamin E cause in newborns? • • Retinopathy

592

What are the vitamins from GI that are normal flora? • Folate • Vitamin K – 90% • Biotin • Panothenic acid • Helps with absorption of B12 •

593

What are the Vitamin K dependent clotting factors? • 1972 • Protein C • Protein S • • Which one has the shortest half-life? • Protein C • • Which one has the 2nd shortest half-life? • 7

594

What are the TRACE elements? • Chromium • Selenium • Manganese Molebdenum

69

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• Tin • • • 595

What is Chromium needed for? • Insulin action

596

What organ needs Selenium? • Heart

597

What trace element is an enzyme in glycolsis? • Manganese Molebdenum

598

What organ needs Tin? • Hair

599

What does a deficiency in Zinc cause? • Dysguzia • Decrease sperm • Dry hair • Dry skin

600

Cofactor for ALL Kinases? • Mg+

601

Cofactor for ALL Carboxylases? • Biotin

602

Cofactor for ALL Transaminases? • Pyridoxine – B6

603

What is Biotin a cofactor for? • ALL carboxylases

604

What is Mg+ a cofactor for? • ALL kinases • Parathyroid along with Vitamin A

605

What is Ca+ needed for? • Muscle contraction • Axonal transport • 2nd messengers

606

What tracts are affected due to deficiency in Methyl Malonyl CoA Mutase? • • Dorsal Columns • Cortical Spinal Tracts • • Why are these affected? • Because they are the longest • Because they need the most myelin

607

What enzyme does Zanthein Oxidase need? •

70

3/29/2012

• Maganese Molebdenum 608

How are drugs that are bioavailable ALWAYS excreted? • By the liver • Always Hepatotoxic

609

How are soluble drugs ALWAYS excreted? • By the kidney • Always nephrotoxic

610

What are the 5 P’S OF COMPARTMENT SYNDROME? • Pain • Pallor • Paresthesia • Pulselessness • Poikilothermia •

611

What are 5 skin infections were Strep. Pyogenes is the number one cause? • Lympangitis • Impetigo (not bullous) • Necrotizing fascitis • Erysepelas • Scarlet fever

612

What are 5 skin infections were Staph. aureus is the number two cause? • Lympangitis • Impetigo (not bullous) • Necrotizing fascitis • Erysepelas • Scarlet fever •

613

What is the #1 bacteria causing infection associated in shunts and central lines? • • Staph epidermitis

614

What is the #1 bacteria causing infection in peripheral lines? • Staph aureus

615

Why do we need E. COLI in the gut? • Absorption of Vit. B12 • Synthesis of: • -Vitamin K • -Biotin • -Folate • -Pantothenic acid –B5

616

Answer the following questions about RESTRICTION ENZYMES? • Trypsin cuts where? • cuts to R of • Arg • Lys

71

3/29/2012

• • • • • 617

Chymotrypsin cuts where? cuts to R of bulky aa’s (aromatics) Phe Tyr Trp

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

618

Answer the following questions about RESTRICTION ENZYMES? • Mercaptoethanol cuts where? • Cuts to R of: disulfide bonds – Cysteine – methionine

619

Answer the following questions about RESTRICTION ENZYMES? • Aminopeptidase cuts where? • Cuts to R of • amino acid terminal • Caboxypeptidase cuts where? • Cuts to L of • carboxy terminal

620

What is THE ONLY LIVE VACCINE INDICATED IN AIDS PATIENTS? • MMR

621

What VACCINE is NOT GIVEN IF pt. is Allergic to EGG? • MMR & INFLUENZA

622

What VACCINE is NOT GIVEN IF patient HAS YEAST ALLERGIES? • Hepatitis B

623

What 3 VACCINES DROP OUT AFTER 6 YEARS OF AGE? • Hib • Diphtheria • Pertussis

624

What is the MC STRAIN OF STREP PYOGENES TO CAUSE GN? • Strain 12

625

What 2 substances are in NEUTROPHILS? • Myeloperoxidase • NADPH Oxidase

72

3/29/2012

626

MACROPHAGES CONTAIN what SUBSTANCE? • NADPH Oxidase • • Which means they only kill what? • Kills only G -ve

627

What do MACROPHAGES SECRETE? • IL-1 • IL-6??

628

What DRUGS CAUSE PAINFUL NEUROPATHY? • DDI>DDC • Pancreatitis

629

What are the MITOCHONDRIAL DISEASES? • Leigh’s Disease • What is another name? • Subacute necrotizing encephalomyelopathy • What are the signs & symptoms? • Progressively decreasing IQ • Seizure • Ataxia • What is the deficiency? • Cytochrome oxidase deficiency

630

What are the MITOCHONDRIAL DISEASES? • Leber’s Hereditary Optic Atrophy (LHON) • They all die

631

What is the ONLY G +ve WITH ENDOTOXIN? • Listeria • • • • •

632

What part is toxic? Lipid A Does it cross the placenta? Yes

What does Listeria activate?

• T-cells & Macrophages, therefore, have granulomas 633

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

73

3/29/2012

634

What are the PERIODS OF RAPID GROWTH/RAPIDLY DIVIDING CELLS? • • Birth – 2 months • 4 – 7 years old • Puberty

635

What is THE ONLY IMMUNE DEFICIENCY WITH LOW CALCIUM and Increase Phosphate? • DiGeorge’s Syndrome

636

What are the BASIC AMINO ACIDS? • Lysine • Arginine

637

What are the ACIDIC AMINO ACIDS? • Glutamate • Aspartate

638

What are the Ketogenic + Glucogenic Amino Acids? • Phenylalanine • Isoleucine • Trptophan • Threonine

639

What are the AROMATIC AMINO ACIDS? • Phenylalanin • Tyrosine • Tryptophan

640

What are the AMINO ACIDS with DISULFIDE BONDS? • Met • Cyst

641

What are the “KINKY” AMINO ACID? • Proline

642

What are the SMALLEST AMINO ACID? • Gly

643

What are the AMINO ACIDS with O-BONDS? • Serine • Threonine • Tyrosine

644

What are the AMINO ACIDS with N-BONDS? • Asparagine • Glutamine

645

What are the BRANCHED-CHAIN AMINO ACIDS? • Leu • Iso • Val

646

What are the KETOGENIC AMINO ACIDS? • Leu

74

3/29/2012

• Lys 647

What CONDITIONS are ASSOCIATED WITH HLA-B27? • Psoriasis (with arthritis) • Ankylosing Spondylitis • Irritable Bowel Syndrome • Reiter’s Syndrome

648

What is associated with HLA-B13? • Psoriasis with out arthritis

649

What are the ORGANISMS WITH IgA PROTEASE (resistant to IgA)? • Strep. Pneumoniae • H. influenza • Neisseria catarrhalis

650

What do EOSINOPHILS SECRETE? • Histaminase • Arylsulfatase • Heparin • Major Basic Protein

651

What do MAST CELLS SECRETE? • In an Acute Reaction? • Histamine • • In a Late Reaction ? • SRS-A • ECF-A

652

What is the MCC of ATYPICAL PNEUMONIA? • 0 – 2 months? • chlamydia pneumonia • •

653

What does chlamydia pneumonia cause? • Intersitital pneumonia

654

What is the CLUE for HEART BLOCK? • High temperature with NORMAL pulse rate! • (This should never be! Each degree ↑ in temp. → 10 beats/min ↑ in pulse rate)

655

What are the clues for IL-1? • FEVER • NONSPECIFIC ILLNESS • RECRUITS TH CELLS for LINKING with MHC II COMPLEX • SECRETED BY MACROPHAGES

656

What are the clues for IL-2? • MOST POTENT OF THE Interleukins • RECRUITS EVERYBODY

75

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• • • •

MOST POWERFUL CHEMO-ATTRACTANT MUST BE INACTIVATED When must you inactivate it? PRIOR TO TRANSPLANTATION by cyclosporin • SECRETED BY TH1 CELLS 657

What are the clues for IL-3? • ENERGIZED MACROPHAGES • CAUSES B-CELL PROLIFERATION • LABELED BY THYMIDINE (USE POKEWEED MITOGEN OR ENDOTOXIN) • SECRETED BY ACTIVATED T CELLS

658

What are the clues for IL-4? • B-CELL DIFFERENTIATION • RESPONSIBLE FOR CLASS SWITCHING • SECRETED BY TH2 CELLS

659

What are the clues for IL-5 thru 14? • They do exactly what IL-1 thru IL4

660

What are the clues for IL-10? • SUPPRESSES CELL-MEDIATED RESPONSE (tells macrophages and fibroblasts to stay away if bacterial) • INHIBITS MAC ACTIVATION

661

What are the clues for IL-12? • PROMOTES CELL-MEDIATED RESPONSE (recruits macs & fibroblasts if NOT bacterial) • ACTIVATES NK CELLS TO SECRETE IF-γ • INHIBITS IL-4 INDUCED IgE SECRETION • CHANGES TH CELLS to TH1 CELLS – secretes IL-2 & IF-γ → inhib. TH2, therefore, ↑ host defenses against delayed hypersensitivity

662

What are the clues for IF-α? • Where is it from? • LEUKOCYTES • ↓VIRAL REPLICATION AND TUMOR GROWTH • ↑ NK ACTVITY – secretes perforins and granzymes to kill infected cell • ↑MHC CLASS I & II EXPRESSION • ↓ PROTEIN SYNTHESIS – translation inhibited, therefore, defective protein synthesis

663

Summary of clues for IF-α? • Increase NK activity • Increase MHC class I & II • Decrease protein synthesis • Decrease viral replication and growth

664

What are the clues for IF-B? • Where is it from? • FIBROBLASTS • Increase NK activity

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

665

What are the clues for IF-gama? • Where is it from? • T-CELLS & NK CELLS • ↑ NK ACTIVITY • ↑MHC CLASS I & II • ↑ MACROPHAGE ACTIVITY • CO-STIMULATES B-CELL GROWTH & DIFFERENTIATION • ↓ IgE SECRETION

666

What are the clues for TNF-alpha? • Where is it from? • MONOCYTES & MACROPHAGES • What is another name for TNF-alpha? • CACHECTIN • INDUCES IL-1 • ↑ ADHESION MOLECULES & MHC CLASS I ON ENDOTHELIAL CELLS • PYROGEN • INDUCES IF-γ SECRETION • CYTOTOXIC/CYTOSTATIC EFFECT

667

What are the clues for TNF-beta? • Where is it from? • T-CELLS • What is another name for it? • LYMPHOTOXIN • • CYTOTOXIC FACTOR

668

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

669

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

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• MAINLY FOR TUMOR GROWTH • 670

What are the clues for TGF-β? • Where is it from? • PLATELETS • PLACENTA • KIDNEY • BONE • T & B CELLS

671

What are the clues for TGF-β? • • • •

What INDUCES it? FIBROBLAST PROLIFERATION COLLAGEN FIBRONECTIN SYNTHESIS

672

What are the clues for TGF-β? • What INHIBITS it? • NK • LAK • CTL • T & B CELL PROLIFERATION

673

What are the clues for TGF-β? • What ENHANCES it? • WOUND HEALING • ANGIOGENESIS

674

What are the clues for TGF-β? • What does it suppress? • SUPPRESSES IR AFTER INFECTION & PROMOTES HEALING PROCESS • What is it mainly for? • MAINLY FOR WOUND HEALING

675

What does LAK stand for? • LYMPHOKINE ACTIVATED KILLER CELLS

676

What does CTL stand for? • CYTOTOXIC T-LYMPHOCYTES

677

What does mitochondrial inheritance affect? • CNS • Heart • Skeletal muscle • • Why does it affect these particular places? • Due to uneven cytokinesis during meiosis or oogenesis

678

Answer the following about Mitochondrial diseases? • Who are affected?

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• • • • • • •

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

679

Answer the following about Autosomal Recessive inheritance? • Who does it show in? • Not parents • Siblings/uncles may show disease • • When is onset? • Early in life (childhood diagnosis) • • Is it complete on incomplete penetrance? • COMPLETE

680

Answer the following about Autosomal Recessive inheritance? • How are they acquired? • Almost ALL are inborn error of metabolism • • When does it occur? • Only when both alleles at a locus are mutant

681

Answer the following about Autosomal Recessive inheritance? • How is it transmitted? • Horizontal Tm • • Are there malformations present? • Physical malformations are uncommon • • What type of defect? • Enzyme defect

682

Answer the following about Autosomal Dominant inheritance? • Who does it affect the most? • M=F • • How does it manifest? • Heterozygote state • • Who can transmit the disease? • Both parents

683

Answer the following about Autosomal Dominant inheritance? • Where is the new mutation? • Often in germ cells of older fathers • • When is onset?

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• Often delayed (adult diagnosis) – Example = Huntington’s 684

Answer the following about Autosomal Dominant inheritance? • What is penetrance? • Reduced penetrance • • How is it expressed? • Variable expressin – Different in each individual

685

Answer the following about Autosomal Dominant inheritance? • How is it transmitted? • Vertical TM • • Is there malformation present? • Physical malformation common • • What type of defect? • Structural

686

Who is affected in the family with an X-Linked disease? • • Maternal grandfather • Maternal uncle

687

Immune System Time Line for viral & cell-mediated. • What happens <24hrs? • Swelling • • What happens at 24 hrs? • Neutrophils show up • • What happens at day 3? • Neutrophils peak

688

Immune System Time Line for viral & cell-mediated. • What happens at day 4? • T cells and Macrophages show up • • What happens at day 7? • Fibroblasts show up • • What happens in 1 month? • Fibroblast peak

689

Immune System Time Line for viral & cell-mediated. • What happens at 3-6 months? • Fibroblasts are gone

690

What is the general CLUE for any Lysosomal Storage Disease? • • Lysosomal Inclusion Bodies

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691

What are the Lysosomal Storage diseases? • Gauchers • Fabrys • Krabbe • Tay Sachs • Sandhoffs • Hurlers • Hunters • Neiman Pick • Metachromatic Leukodystropy

692

What is missing in Gauchers? • Beta-Glucocerberosidase • • What Accumulates? • Glucocebroside • • • • •

Where? Brain Liver Bone Marrow Spleen

693

What are the CLUES for Gauchers? • Ask. Jew • Gargols • Gaucher cells – Macrophages looking like Crinkeled paper • Erlin myoflask legs • Pseudohypertrophy •

694

What is missing in Fabrys? • Alpha-galactosidase • • What accumulates? • Ceramide Trihexoside

695

What are the CLUES for Fabrys? • X-Linked recessive • Presents with cataracts as a child • Presents with renal failure as a child

696

What is missing in Krabbes? • Galactosylceramide B-Galactosidase • • What accumulates? • Galactocerebrosidase • Where? • Brain

697

What are the CLUES for Krabbes?

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• Early death • Globoid bodies – Fat cells 698

What is missing in Tay Sachs? • Hexoseaminidase A • • What accumulates? • GM2 Ganglioside •

699

What is the CLUE for Tay Sachs? • Ask. Jews • Cherry red macula • Death by 3

700

What is missing in Sandhoffs? • Hexoseaminadase A & B

701

What is missing in Hurlers? • Iduronidase

702

What are the CLUES for Hurlers? • Corneal Clouding • Mental Retardation

703

What is missing in Hunters? • Iduronate Sulfatase

704

What are the CLUES for Hunters? • Mild mental retardation • No corneal clouding • Mild form of Hurlers • X-linked recessive

705

What is missing in Niemann Picks? • Spingomyelinase • • What accumulates? • Spingomyelin • Cholesterol

706

What are the CLUES for Niemann Picks? • Zebra bodies • Cherrry red macula • Die by 3

707

What is missing in Metachromatic Leukodystrophy? • Arylsulfatase A

708

What is the CLUE for Metachromatic Leukodystrophy? • Visual Disturbance • Presents like MS in 5 to 10 years of age

709

What are the Glycogen Storage Diseases?

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• • • • • •

Von Gierkes Andersons Corys McCardles Pompes Hers

710

What is deficient in Von Gierkes? • G-6-Pase Deficiency

711

What is the CLUE for Von Gierkes? • Big Liver • Big Kidney • Severe hypoglycemia • Can NEVER raise their blood sugar •

712

What is deficient in Andersons? • Branching enzyme deficiency

713

What is the CLUE for Andersons? • Glycogen will be ALL LONG chains on liver biopsy

714

What is missing in Corys? • Debranching enzyme

715

What is the CLUE for Corys? • Glycogen from liver biopsy will be ALL SHORT branches

716

What is missing in McCardles? • Muscle phosporalase

717

What is the CLUE for McCardles? • Severe muscle cramps when exercising • High CPK

718

What is missing in Pompes? • Cardiac alpha-1,4 glucocydase

719

What is the CLUE for Pompes? • Heart problems • Die early

720

What is missing in Hers? • Liver phosphoralase

721

What is the CLUE for Hers? • Big Liver • NO big kidney

722

Pagets disease is associated with what cancer? • Intraductal Ca

723

What MUST you rule out with a decrease AVO2? • • AV Fistula • Vasodilation

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724

What diseases have a cherry red macula? • • Tay Sachs • Sandhoffs • Niemann Pick

725

What is translocation 9;22? • CML

726

What is translocation 11;22? • Ewing’s sarcoma

727

What is translocation 8;14? • Burketts lymphoma

728

What is translocation 14;18? • Follicular lymphoma

729

What are the causes of restrictive cardiomyopathy? • Sarcoid • Amyloid • Hemochromatosis • Cancer • Fibrosis • • Thanks STAN!!

730

What are the CLUES for Vasulitis or Intravascular Hemolysis? • Shistocytes – Burr cells – Helmet cells

731

What is the CLUE for Extravascular Hemolysis? • Splenomagely

732

Where is Glucose 6-Pase present? • Adrenal • Liver

733

What is the Heinz body CLUE? • G6PD

734

If you see the CLUE basophilic stippling, what should you be thinking? • • Lead poisoning

735

What are the Microcytic Hypochromic Anemias? • Iron deficiency • Anemia of Chronic disease • Lead poisoning • Hemoglobinopathy • Thallasemia’s • Sideroblastic anemia • • TAIL

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• • 736

What is primary sideroblastic anemia due to? • Genetic • AD

737

What is secondary Sideroblastic anemia due to? • Blood transfusions

738

What are the Microcytic Hyperchromic Anemia’s? • Hereditary Spherocytosis

739

What are the Normocytic Normochromic Anemia’s? • Acute hemorrhage • Anemia of Chronic Disease • Hypothyrodism – Early • Renal Failure • •

740

What are the Macrocytic anemia’s? • Folate deficiency • B12 deficiency • Reticulocytosis • ETOH • Hemolytic Anemias • Chemo Treatment • Anticonvulsants • Myelodysplasia

741

What are the anticonvulsants causing a Macrocytic Anemia? • Phenytoin • Ethusuximide • Carbamyazapine • Valproate

742

What anemia is caused by blood transfusions? • Sideroblastic anemia

743

What is the problem if you see Eliptocytes? • Something is wrong with the RBC membrane – Extravascular • Heridatary Ellitocytosis • Increased RET count

744

What disease do you get if you have an EXCESS in Cu+? • Wilson’s Disease

745

What is the CLUE for Wilson’s Disease? • Hepato/Lenticular Degeneration • Kayser Fleishner Rings – Copper in eyes

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• Hepato = Liver

86