Pass Program Clue
Transcript of Pass Program Clue
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Pass ProgramPass Program CluesClues““ You ain’t told me squat till You ain’t told me squat till
you tell me the CLUE!!!”you tell me the CLUE!!!”
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What are the 5 bacteriaWhat are the 5 bacteria
causing Heart Block?causing Heart Block?• Lyme DiseaseLyme Disease• Salmonella typhii (typhoid)Salmonella typhii (typhoid)• Chagas Disease (Whipple’s)Chagas Disease (Whipple’s)• LegionellaLegionella
• DiptheriaDiptheria
• Lets Stop Doing Long ContractionsLets Stop Doing Long Contractions
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What bacteria causeWhat bacteria cause
Reiter’s Syndrome?Reiter’s Syndrome?• ShigellaShigella• IBDIBD
– Crohn’sCrohn’s• ChlamydiaChlamydia• Yersina Yersina
• Reiter & Crohn Saw Yersina and gotReiter & Crohn Saw Yersina and gotChlamyiaChlamyia
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What are the Low ComplementWhat are the Low Complementbugs causingbugs causingCryoglobuniemia?Cryoglobuniemia?• InfluenzaeInfluenzae• AdenovirusAdenovirus• MycoplasmaMycoplasma• Hepatitis CHepatitis C
• EBVEBV
• I AM HEI AM HE
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What are the drugs inducedWhat are the drugs induced
SLE?SLE?• HydralazineHydralazine• INHINH
• PhenytoinPhenytoin• ProcainamideProcainamide• PenicillaminePenicillamine
• EthosuximideEthosuximide
• H I PPPEH I PPPE
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What are the drugs thatWhat are the drugs that
Blast the BM?Blast the BM?• AZTAZT• BenzeneBenzene• ChloramphenicolChloramphenicol• VinblastineVinblastine
• Vinblastine Anilate Bone CellsVinblastine Anilate Bone Cells
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What are the CommaWhat are the Comma
Shaped bugs?Shaped bugs?• VibrioVibrio• CampylobacterCampylobacter• ListeriaListeria• H. pyloriH. pylori
• Campylobacter Has Very LongCampylobacter Has Very LongComma GenesComma Genes
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What is the cresent shapedWhat is the cresent shaped
protozoa?protozoa?• Giardia lambliaGiardia lamblia
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What bacteria looks likeWhat bacteria looks like
Chinese letters?Chinese letters?• CorynebacterCorynebacter
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What are the TB Rx?What are the TB Rx?
• RifampinRifampin• PyrazinamidePyrazinamide
• INHINH• EthambutanolEthambutanol
•StreptomycinStreptomycin
• R E S P IR E S P I
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What are the 6 Low ComplementWhat are the 6 Low Complementassocs. with Nephrotic Syndrome?assocs. with Nephrotic Syndrome?
• Serum SicknessSerum Sickness• PSGNPSGN
• SLESLE• SBESBE
•CryoglobinemiaCryoglobinemia
• MPGN IIMPGN II
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What drugs are P450What drugs are P450
Dependent?Dependent?• WarfarinWarfarin• EstrogenEstrogen
• PhenytoinPhenytoin• Theophylline Theophylline• DigoxinDigoxin
• Theo came from war & dig inside WDEPT Theo came from war & dig inside WDEPTtaking Estrogen & now is Phenytointaking Estrogen & now is Phenytoin
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What disease is a NeutophilWhat disease is a Neutophil
Deficiency?Deficiency?• CGDCGD
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What are the Side effects of What are the Side effects of
Statins?Statins?• MyositisMyositis• HepatitisHepatitis
• Increased liver enzymesIncreased liver enzymes
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What are the painful genitalWhat are the painful genital
Lesions?Lesions?• ChancroidChancroid• HerpesHerpes
• Lymphogranuloma inguinaleLymphogranuloma inguinale
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What is the painfulWhat is the painful
chancroid lesion due to?chancroid lesion due to?• Hemophilus ducreyiHemophilus ducreyi
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What are the 4 hormones withWhat are the 4 hormones withdisulfide bonds?disulfide bonds?
• ProlactinProlactin• InsulinInsulin
• InhibinInhibin• GHGH
• I PIG on BONDSI PIG on BONDS
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What are the Hookworms?What are the Hookworms?
• Necatur americanisNecatur americanis• Enterobius vermicularisEnterobius vermicularis
• Ankylostoma duodenaleAnkylostoma duodenale• Trichuris trichurium Trichuris trichurium• Ascaris lumbercoidesAscaris lumbercoides
• StrongyloidesStrongyloides
• Hooks AS NEATHooks AS NEAT
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What are the X-LinkedWhat are the X-Linked
enzyme Deficiencies?enzyme Deficiencies?• G6-PDG6-PD• CGDCGD
• Pyruvate dehydrogenase Def.Pyruvate dehydrogenase Def.• Fabry’sFabry’s• Hunter’sHunter’s
• Lesch-nyhanLesch-nyhan• Lesch-Nyhan Hunter Puts Fabrys on G6Lesch-Nyhan Hunter Puts Fabrys on G6
ClothesClothes
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What diseases do we screenWhat diseases do we screen
for at birth?for at birth?• PleasePlease• CheckCheck
• BeforeBefore• GoingGoing• HomeHome
• PKUPKU• CAH(CongentialCAH(Congential
AdrenalAdrenalHyperplasia)Hyperplasia)• BiotinidaseBiotinidase• GalactosemiaGalactosemia• HypothyroidismHypothyroidism
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HLA-AntigensHLA-Antigens
• HLA-DR2HLA-DR2 == Narcolepsy, Allergy,Narcolepsy, Allergy,Goodpasture’s, MSGoodpasture’s, MS
• HLA-DR3HLA-DR3 == DM, Chronic Active Hepatitis,DM, Chronic Active Hepatitis,Sjogren’s, SLE, Celiac SprueSjogren’s, SLE, Celiac Sprue
• HLA-DR3 & 4HLA-DR3 & 4 == IDDM(Type I)IDDM(Type I)• HLA-DR4HLA-DR4 == Rheumatoid Arthritis,Rheumatoid Arthritis,
Pemphigus VulgarisPemphigus Vulgaris• HLA-DR5HLA-DR5 == JRA, Pernicious Anemia JRA, Pernicious Anemia• HLA-DR7HLA-DR7 = Nephrotic Syndrome(Steroid= Nephrotic Syndrome(Steroid
induced)induced)
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HLA-AntigensHLA-Antigens
• HLA-DR 3 & B8=HLA-DR 3 & B8= Celiac DiseaseCeliac Disease• HLA-A3=HLA-A3= Hemochromatosis(chromo. 6,Hemochromatosis(chromo. 6,
point mut.-cysteine>tyrosine)point mut.-cysteine>tyrosine)• HLA-B8=HLA-B8= MGMG• HLA-B13= PsoriasisHLA-B13= Psoriasis• HLA-B27= Psoriais(only if w/arthritis)HLA-B27= Psoriais(only if w/arthritis)
Ankylosing Spondylitis, IBD, Reiter’s,Ankylosing Spondylitis, IBD, Reiter’s,Postgonococcal ArthritisPostgonococcal Arthritis• HLA-BW 47= 21 alpha HydroxylasHLA-BW 47= 21 alpha Hydroxylas
def.(Vit.D)def.(Vit.D)
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What are the actions of What are the actions of
Steroids?Steroids?• Kills helper T-cells & eosinophilsKills helper T-cells & eosinophils• Inhibits Macrophage migrationInhibits Macrophage migration
• Inhibits Mast cell degranulationInhibits Mast cell degranulation• Inhibits Phospholipase AInhibits Phospholipase A• Stimulates protein synthesisStimulates protein synthesis• Stablizes endotheliumStablizes endothelium
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What are the causes of What are the causes of
Monocytosis?Monocytosis?• Salmonella (typhoid)Salmonella (typhoid)• TB TB
• EBVEBV• ListeriaListeria• SyphillisSyphillis
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E. Coli is the most commonE. Coli is the most common
cause of what?cause of what?• UTIUTI• Spontaneous bacterial peritonitisSpontaneous bacterial peritonitis
• Abdominal abscessAbdominal abscess• CholecystitisCholecystitis• Ascending cholangitisAscending cholangitis• AppendicitisAppendicitis
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What are the one doseWhat are the one dosetreatments for Gonorrhea?treatments for Gonorrhea?
• CeftriaxoneCeftriaxone• CefiximeCefixime
• CefoxineCefoxine• CiprofloxinCiprofloxin• OflaxacinOflaxacin• GatifolxacinGatifolxacin
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What is the one doseWhat is the one dosetreatment for Chlamydia?treatment for Chlamydia?
• AzithromycinAzithromycin
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What are the “Big Mama”What are the “Big Mama”
anaerobes?anaerobes?• Strep bovisStrep bovis• Clostridium melanogosepticusClostridium melanogosepticus
• Bacteriodes fragilisBacteriodes fragilis
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What are the “Big Mama”What are the “Big Mama”
Rx?Rx?• ClindamycinClindamycin• MetranidazoleMetranidazole
• CefoxitinCefoxitin
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What “big mama” bugs areWhat “big mama” bugs areassociated with colon cancer?associated with colon cancer?
• Strep. BovisStrep. Bovis• Clostridium melanogosepticusClostridium melanogosepticus
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What do you see in the serumWhat do you see in the serumwith low volume state?with low volume state?• K+?K+?• DecreasesDecreases
• Na+?Na+?
• DecreasesDecreases• Cl-?Cl-?• DecreasesDecreases
• pH?pH?
• IncreasesIncreases
• BP?BP?• IncreasesIncreases
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What are psammomaWhat are psammoma
bodies?bodies?• Calcified CA’sCalcified CA’s
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In what diseases areIn what diseases are
Psammoa Bodies present?Psammoa Bodies present?• Papillary carcinoma of the ThyroidPapillary carcinoma of the Thyroid• Serous cystadenocarcinoma of theSerous cystadenocarcinoma of the
ovaryovary• MeningiomaMeningioma• MesotheliomaMesothelioma
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What are the Urease (+)What are the Urease (+)
Bacteria?Bacteria?• ProteusProteus• PseudomonasPseudomonas
• Ureaplasma urealyticumUreaplasma urealyticum• Nocardia speciesNocardia species• Cryptococcus neoformansCryptococcus neoformans• H. pyloriH. pylori
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What types of stones areWhat types of stones are
formed from Proteus?formed from Proteus?• Struvite (90%)Struvite (90%)
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What type of motility doWhat type of motility do
Proteus have?Proteus have?• swarmingswarming
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What are 5 indications of What are 5 indications of
Surgery?Surgery?• Intractable painIntractable pain• Hemorrhage (massive)Hemorrhage (massive)
• Obstruction (from scarring)Obstruction (from scarring)• PerforationPerforation
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What drugs cause CardiacWhat drugs cause Cardiac
Fibrosis?Fibrosis?• Adriamycin (Doxyrubicin)Adriamycin (Doxyrubicin)• Phen-fenPhen-fen
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What drug is used to txWhat drug is used to tx
cardiac fibrosis?cardiac fibrosis?• DozaroxsinDozaroxsin
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What is the MCC of any ….What is the MCC of any ….
penia?penia?• #1 = Virus#1 = Virus• #2 = Drugs#2 = Drugs
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What is seen in theWhat is seen in the
Salmonella Triad?Salmonella Triad?• High FeverHigh Fever• Rose spots (rash)Rose spots (rash)
• Intestinal fireIntestinal fire
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What drugs cause Myositis?What drugs cause Myositis?
• RifampinRifampin• INHINH
• PredinsonePredinsone• StatinsStatins
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What are the 7 GramWhat are the 7 Gram
-encapsulated bacteria?-encapsulated bacteria?• SomeSome• StrangeStrange• KillersKillers• HaveHave• PrettyPretty• NiceNice
• CapsulesCapsules
• SalmonellaSalmonella• Strep. PneumoStrep. Pneumo
(gr+)(gr+)• KlebsiellaKlebsiella• H. influenzaH. influenza• PseudomonasPseudomonas• NeisseriaNeisseria• CryptococcusCryptococcus
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What is the Jones Criteria forWhat is the Jones Criteria forRheumatic Fever?Rheumatic Fever?
• SubQ nodulesSubQ nodules• PolyarthritisPolyarthritis
• Erythema marginatumErythema marginatum• CarditisCarditis• ChoreaChorea
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What are the Risk FactorsWhat are the Risk Factors
for Liver CA?for Liver CA?• Hep B,C,DHep B,C,D• AflatoxinAflatoxin• Vinyl chlorideVinyl chloride
• EthanolEthanol• Carbon TetrachlorideCarbon Tetrachloride• Anyline DyesAnyline Dyes• SmokingSmoking
• HemochromatosisHemochromatosis• BenzeneBenzene• SchistomiasisSchistomiasis
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What are the 9 LiveWhat are the 9 LiveVaccines?Vaccines?• MeaslesMeasles• MumpsMumps• RubellaRubella• Oral Polio (sabin)Oral Polio (sabin)• RotavirusRotavirus• Small poxSmall pox• BCGBCG• Yellow fever Yellow fever• VaricellaVaricella
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What are the KilledWhat are the KilledVaccines?Vaccines?• SIR Hep ASIR Hep A • Salk (polio)Salk (polio)
• InfluenzaInfluenza
• RubellaRubella• Hepatitis AHepatitis A
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What are the IgAWhat are the IgANephropathies?Nephropathies?• Henoch-Schoenlein P. (HSP)Henoch-Schoenlein P. (HSP)• Alport’sAlport’s
• Berger’sBerger’s
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What are the Drugs that causeWhat are the Drugs that causeAutoimmune hemolytic anemia?Autoimmune hemolytic anemia?
• PCNPCN• αα -methyldopa-methyldopa
• CephalosporinsCephalosporins• SulfaSulfa• PTUPTU
• Anti-malarialsAnti-malarials• DapsoneDapsone
What are the drugs that causeWhat are the drugs that cause
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What are the drugs that causeWhat are the drugs that causeAutoimmuneAutoimmune
thrombocytopenia?thrombocytopenia?• ASAASA• HeparinHeparin
• QuinidineQuinidine
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What are the enzymes thatWhat are the enzymes thatshow after an MI?show after an MI?
• Troponin I Troponin I• CKMBCKMB
• LDHLDH
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What is the 2What is the 2 ndnd MI enzymeMI enzymeto appear?to appear?• CK-MBCK-MB• AppearsAppears
• PeaksPeaks• GoneGone
• 6 hrs6 hrs
• 12 hrs12 hrs• 24 hrs24 hrs
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What is the 3What is the 3 rdrd MI enzyme toMI enzyme toappear?appear?• LDHLDH• AppearsAppears
• PeaksPeaks• GoneGone
• 1 day1 day
• 2 days2 days• 3 days3 days
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What bacteria have SilverWhat bacteria have SilverStains?Stains?
• LegionellaLegionella• Pneumocysitis cariniiPneumocysitis carinii
• H. pyloriH. pylori• Bartonella henseslae (lymph node)Bartonella henseslae (lymph node)• Candida (yeast)Candida (yeast)
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What are the sulfa containingWhat are the sulfa containingdrugs?drugs?
• SulfonamidesSulfonamides• SulfonylureaSulfonylurea
• CelebrexCelebrex
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What is another name forWhat is another name forcelebrex?celebrex?
• CelecoxibCelecoxib
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What type of inhibitor isWhat type of inhibitor isCelebrex?Celebrex?
• COX 2 specificCOX 2 specific
What COX-2 specific drug canWhat COX-2 specific drug can
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What COX-2 specific drug canWhat COX 2 specific drug canyou give to a pt with sulfayou give to a pt with sulfa
allergy?allergy?• Vioxx (Rofecoxib)Vioxx (Rofecoxib)
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What drugs inhibitWhat drugs inhibitdihydrofolate reductase?dihydrofolate reductase?
• Pyremethamin/SulfadiazinePyremethamin/Sulfadiazine• Trimethoprim/Sulfamethoxazole Trimethoprim/Sulfamethoxazole
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What drugs cause PulmonaryWhat drugs cause PulmonaryFibrosis?Fibrosis?
• BleomycinBleomycin• BulsufanBulsufan
• AmiodaroneAmiodarone• Tocainide Tocainide
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What are the macrophageWhat are the macrophagedeficiency diseases?deficiency diseases?
• Chediak-HigashiChediak-Higashi• NADPH-oxidase deficiencyNADPH-oxidase deficiency
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What are the SE of Loops andWhat are the SE of Loops and Thiazides? Thiazides?
• HyperglycemiaHyperglycemia• HyperuricemiaHyperuricemia
• HypovolemiaHypovolemia• HypokalemiaHypokalemia
f
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What are the SE of LoopWhat are the SE of Loopdiuretics?diuretics?• OH DANGOH DANG • OtotoxicityOtotoxicity
• HypokalemiaHypokalemia
• DehydrationDehydration• AllergyAllergy• NephritisNephritis
(interstitial)(interstitial)• GoutGout
What are the only 3 PansystolicWhat are the only 3 Pansystolic
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What are the only 3 PansystolicWhat are the only 3 PansystolicMurmurs and when are theyMurmurs and when are they
heard?heard?• MRMR
• TR TR
• VSDVSD
• Decrease onDecrease oninspiration (^exp)inspiration (^exp)
• Increase onIncrease oninspirationinspiration
• Decrease onDecrease oninspiration (^exp)inspiration (^exp)
M h i iM h i i
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Macrophages in variousMacrophages in variousorgansorgans• BrainBrain• LungLung• LiverLiver• SpleenSpleen• KidneyKidney• Lymph nodesLymph nodes• SkinSkin• BoneBone• CTCT
• MircogliaMircoglia• Type I pneumocyte Type I pneumocyte• Kupffer cellKupffer cell• RESRES
• MesangialMesangial• DendriticDendritic• LangerhansLangerhans• OsteoclastsOsteoclasts• Histiocytes orHistiocytes or• Giant cells orGiant cells or• Epithelioid cellsEpithelioid cells
h h h f hWh h 7 R h f h
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What are the 7 Rashes of theWhat are the 7 Rashes of thePalms & Soles?Palms & Soles?
• TSS TSS• Rocky Mountain Spotted FeverRocky Mountain Spotted Fever
• Coxsackie A (Hand/Foot & mouth dz)Coxsackie A (Hand/Foot & mouth dz)• KawasakiKawasaki• SyphillisSyphillis• Scarlet FeverScarlet Fever• Staph Scalded Skin SyndromeStaph Scalded Skin Syndrome
What is seen in everyWhat is seen in every
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What is seen in everyWhat is seen in everyrestrictive lung dz and lowrestrictive lung dz and low
volume state?volume state?• Tachypnea Tachypnea• Decrease pCO2Decrease pCO2
• Decrease pO2Decrease pO2• Increase pHIncrease pH
h h diff 2Wh h diff 2 dd
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What are the different 2What are the different 2 ndnd messenger systems?messenger systems?
• cAMPcAMP• cGMPcGMP
• IP3/DAGIP3/DAG• Ca:CalmodulinCa:Calmodulin• Ca+Ca+• Tyrosine kinase Tyrosine kinase• NONO
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What is the clue for cAMP?What is the clue for cAMP?
• It is the 90%It is the 90%• SympatheticSympathetic
• CRH (cortisol)CRH (cortisol)• CatabolicCatabolic
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What is the clue for cGMP?What is the clue for cGMP?
• ParasympatheticParasympathetic• AnabolicAnabolic
Wh h l fWh t th l f
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What are the clues forWhat are the clues forIP3/DAG?IP3/DAG?
• NeurotransmitterNeurotransmitter• GHRHGHRH
• All hypothalamic hormones xcAll hypothalamic hormones xccortisolcortisol
• Used by what and for what?Used by what and for what?
• Smooth muscle for contractionSmooth muscle for contraction
Wh i h l fWh t i th l f
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What is the clue forWhat is the clue forCa:Calmodulin?Ca:Calmodulin?
• Used by smooth muscle forUsed by smooth muscle forcontraction by distentioncontraction by distention
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What is the clue for Ca+?What is the clue for Ca+?
• Used by Gastrin onlyUsed by Gastrin only
Wh t i th l f T iWh t i th l f T i
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What is the clue for TyrosineWhat is the clue for TyrosineKinase?Kinase?
• Used by InsulinsUsed by Insulins• Used by ALL growth factorsUsed by ALL growth factors
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What is the clue for NO?What is the clue for NO?
• NitratesNitrates• ViagraViagra
• ANPANP• LPSLPS
Wh t th T & B llWh t th T & B ll
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What are the T & B cellWhat are the T & B celldeficiencies?deficiencies?
• WASWAS• SCIDSCID
• CVIDCVID• HIVHIV• HTLV-1HTLV-1
What are the CLUES forWhat are the CLUES for
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What are the CLUES forWhat are the CLUES forWAS?WAS?• Thrombocytopenia Thrombocytopenia• IL-4IL-4
• InfectionInfection• EczemaEczema• Decrease IgMDecrease IgM• IgE???IgE???
What are the CLUES forWhat are the CLUES for
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What are the CLUES forWhat are the CLUES forSCID?SCID?• Framshift/Nonsense mutationFramshift/Nonsense mutation• Adenosine deaminase deficiencyAdenosine deaminase deficiency
• T-cell>B-cell T-cell>B-cell• Bacterial infectionsBacterial infections• Fungal infectionsFungal infections
What are the CLUES forWhat are the CLUES for
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What are the CLUES forWhat are the CLUES forCVID?CVID?• Late onsetLate onset• Frameshift/Missense mutationFrameshift/Missense mutation
• Tyrosine Kinase deficiency Tyrosine Kinase deficiency
What are the CLUES for HIV &What are the CLUES for HIV &
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What are the CLUES for HIV &What are the CLUES for HIV &HTLV-1?HTLV-1?
• T-cell>B-cell T-cell>B-cell• CD4 richCD4 rich
• BrainBrain• Testicles Testicles• CervixCervix• Blood vesselsBlood vessels
What are the inhibitors ofWhat are the inhibitors of
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What are the inhibitors of What are the inhibitors of Complex 1 of the ETC?Complex 1 of the ETC?
• AmytalAmytal• RotenoneRotenone
What are the inhibitors ofWhat are the inhibitors of
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What are the inhibitors of What are the inhibitors of Complex 2 of the ETC?Complex 2 of the ETC?
• MalonateMalonate
What are the inhibitors ofWhat are the inhibitors of
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What are the inhibitors of What are the inhibitors of Complex 3 of the ETC?Complex 3 of the ETC?
• Antimycin DAntimycin D
What are the inhibitors ofWhat are the inhibitors of
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What are the inhibitors of What are the inhibitors of Complex 4 of the ETC?Complex 4 of the ETC?
• CN-CN-• COCO
• ChloramphenicolChloramphenicol
What are the inhibitors ofWhat are the inhibitors of
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What are the inhibitors of What are the inhibitors of Complex 5 of the ETC?Complex 5 of the ETC?
• OligomycinOligomycin
What are the ETC chemicalWhat are the ETC chemical
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What are the ETC chemicalWhat are the ETC chemicaluncouplers?uncouplers?
• DNPDNP• Free Fatty acidsFree Fatty acids
• AspirinAspirin
What type of uncoupler isWhat type of uncoupler is
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What type of uncoupler isWhat type of uncoupler isAspirin?Aspirin?
• Physical uncouplerPhysical uncoupler
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What is the one dose tx forWhat is the one dose tx for
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What is the one dose tx forWhat is the one dose tx forHemophilus ducreyi?Hemophilus ducreyi?
• AzithromycinAzithromycin1 gram po1 gram po
• CeftriazoneCeftriazone250 mg im250 mg im
What is the one dose tx forWhat is the one dose tx for
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What is the one dose tx forWhat is the one dose tx forChlaymdia?Chlaymdia?
• AzithromycinAzithromycin1 gram po1 gram po
What is the one dose tx forWhat is the one dose tx for
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What is the one dose tx forWhat is the one dose tx forCandidiasis?Candidiasis?
• KetoconazoleKetoconazole150mg150mg
What is the one dose tx forWhat is the one dose tx for
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What is the one dose tx forWhat is the one dose tx forVaginal Candidiasis?Vaginal Candidiasis?
• DifluccanDifluccan1 pill1 pill
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What is the one dose tx forWhat is the one dose tx for
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What is the one dose tx forWhat is the one dose tx forGardnerella?Gardnerella?
• MetronidazoleMetronidazole2 grams2 grams
What are the 3 cephalosporins &What are the 3 cephalosporins &
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doses used as one dosedoses used as one dose
treatments for Gonorrhea?treatments for Gonorrhea?• CeftriaxoneCeftriaxone250 mg im250 mg im
• CefiximeCefixime400 mg po400 mg po
• CefoxitinCefoxitin400 mg po400 mg po
What are the 3 Quinolones &What are the 3 Quinolones &
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doses used as one dosedoses used as one dose
treatments for Gonorrhea?treatments for Gonorrhea?• CiprofloxacinCiprofloxacin500 mg po500 mg po
• OfloxacinOfloxacin400 mg po400 mg po
• GatifloxacinGatifloxacin400 mg im400 mg im
What are the 4 enzymes neededWhat are the 4 enzymes needed
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What are the 4 enzymes neededWhat are the 4 enzymes neededto break down glycogen?to break down glycogen?
• Phosphorylase (Pi)Phosphorylase (Pi)• Debranching enzymeDebranching enzyme
• Alpha-1,6 –GlucosidaseAlpha-1,6 –Glucosidase• PhosphatasePhosphatase
What are the 2 enzymesWhat are the 2 enzymes
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What are the 2 enzymesWhat are the 2 enzymesneeded to make glycogen?needed to make glycogen?
• Glycogen synthaseGlycogen synthase• Branching enzymeBranching enzyme
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What values do you see inWhat values do you see in
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What values do you see inWhat values do you see inobstructive pulmonary dz?obstructive pulmonary dz?
• pO2?pO2?NormalNormal
• pCO2?pCO2?Normal or increasedNormal or increased
• pH?pH?DecreasedDecreased
What values do you see inWhat values do you see in
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What values do you see inWhat values do you see inrestrictive pulmonary dz?restrictive pulmonary dz?
• pO2?pO2?DecreasedDecreased
• pCO2?pCO2?DecreasedDecreased
• pH?pH?IncreasedIncreased
What type of acidosis do youWhat type of acidosis do youh b li h b i l
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see with obstructive pulmonarysee with obstructive pulmonary
dz?dz?• Respiratory acidosisRespiratory acidosis
What are the Lysosomal StorageWhat are the Lysosomal Storage
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What are the Lysosomal StorageWhat are the Lysosomal StorageDisease & what is the deficiency?Disease & what is the deficiency?
• Fabry’sFabry’s• Krabbe’sKrabbe’s• Gaucher’sGaucher’s
• Niemann – PickNiemann – Pick• Tay-Sachs Tay-Sachs• MetachromaticMetachromatic
leukodystrophyleukodystrophy• Hurler’sHurler’s• Hunter’sHunter’s
• αα – galactosidase– galactosidase• GalactosylceramideGalactosylceramide• ββ – glucocerebrosidase– glucocerebrosidase
• SphingomyelinaseSphingomyelinase• HexosaminidaseHexosaminidase• ArylsulfataseArylsulfatase• αα – L – iduronidase– L – iduronidase• Iduronidase sulfataseIduronidase sulfatase
What dz’s are associated withWhat dz’s are associated with
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What dz s are associated withHLA B27?HLA B27?
• PsoriasisPsoriasis• Ankylosing spondylitisAnkylosing spondylitis
• IBD (Ulcerative colitis)IBD (Ulcerative colitis)• Reiter’s SyndromeReiter’s Syndrome
What HLA is Psorisis w/RAWhat HLA is Psorisis w/RA
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What HLA is Psorisis w/RAassociated with?associated with?
• HLA-13HLA-13
What are the Glycogen StorageWhat are the Glycogen Storage
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What are the Glycogen Storagey g gDiseases & the deficiency?Diseases & the deficiency?
• Von Gierke’sVon Gierke’s
• Pompe’sPompe’s
• Cori’sCori’s
• McArdle’sMcArdle’s
• Glucose – 6 –Glucose – 6 –phosphatephosphate
• αα – 1 – 4 glucosidase– 1 – 4 glucosidase
• Debranching enzymeDebranching enzyme
• GlycogenGlycogenphosphorylasephosphorylase
What are 6 places of the TCA cycleWhat are 6 places of the TCA cycle
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W at a e 6 p aces o t e C cyc ep ywhere amino acids feed in/out?where amino acids feed in/out?
• Pyruvate?Pyruvate?• GlycineGlycine• AlanineAlanine• SerineSerine
• Acetyl CoAAcetyl CoA ??• PhenylalaninePhenylalanine• IsoleucineIsoleucine• Threonine Threonine• Tryptophan Tryptophan• LysineLysine• LeucineLeucine
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What are 6 places of the TCA cycleWhat are 6 places of the TCA cycle
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p yp ywhere amino acids feed in/out?where amino acids feed in/out?
• FumerateFumerate ??• ProlineProline
• Oxaloacetate?Oxaloacetate?• AspartateAspartate
• AsparigineAsparigine
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What are the blood gases inWhat are the blood gases inl di (neuromuscular disease (=
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neuromuscular disease (=neuromuscular disease (=
restrictive blood gases)?restrictive blood gases)?• pO2?pO2?
DecreasedDecreased• pCO2?pCO2?
DecreasedDecreased
• PCWP?PCWP?DecreasedDecreased (b/c it’s a pressure problem)(b/c it’s a pressure problem)
• Respiratory Rate?Respiratory Rate?IncreasedIncreased
• pH?pH?IncreasedIncreased
• SZ?SZ?IncreasedIncreased
What are 5 Hormones produced byWhat are 5 Hormones produced by
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p yp ysmall cell (oat cell) lung CA?small cell (oat cell) lung CA?
• ACTHACTH• ADHADH
• PTHPTH• TSH TSH• ANPANP
What Autoimmune Disease hasWhat Autoimmune Disease hasth f ll i g A t ithe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti-smithAnti-smith
• Anti cardiolipinAnti cardiolipin• Anti-ds DNAAnti-ds DNA • SLESLE
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What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti-topoisomerase?Anti-topoisomerase?
• PSS (Progressive Systemic Sclerosis)PSS (Progressive Systemic Sclerosis)
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti TSH receptors?Anti TSH receptors?
• GravesGraves
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti-centromere?Anti-centromere?
• CRESTCREST
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti-GBM?Anti-GBM?
• Goodpasture’sGoodpasture’s
What does Goodpastures haveWhat does Goodpastures have
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antibody to?antibody to?
• Type IV collagen Type IV collagen
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti-mitochondria?Anti-mitochondria?
• Primary biliary cirrhosisPrimary biliary cirrhosis
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti-hair follicle?Anti-hair follicle?
• Alopecia areataAlopecia areata
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti-IgG?Anti-IgG?
• Rheumatoid arthritisRheumatoid arthritis
a u o mmune sease asthe following Autoimmunethe following Autoimmune
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Antibodies?Antibodies?
• Anti-myelin receptors?Anti-myelin receptors?
• MSMS
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti-gliaden?Anti-gliaden?• Anti-gluten?Anti-gluten?
• Celiac sprueCeliac sprue
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti-islet cell receptor?Anti-islet cell receptor?
• DM Type IDM Type I
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti-melanocyte?Anti-melanocyte?
• ViteligoViteligo
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti-ACh receptor?Anti-ACh receptor?
• MGMG
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti-ribonuclear protein?Anti-ribonuclear protein?
• Mixed Connective Tissue dz (MCTD)Mixed Connective Tissue dz (MCTD)
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti-parietal cell receptor?Anti-parietal cell receptor?
• Pernicious anemiaPernicious anemia
What does Pernicious AnemiaWhat does Pernicious Anemia
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have antibody to?have antibody to?
• Intrinsic factorIntrinsic factor
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti-epidermal anchoring proteinAnti-epidermal anchoring proteinreceptors?receptors?
• Pemphigus vulgarisPemphigus vulgaris
What does Pemphigus vulgarisWhat does Pemphigus vulgaris
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have antibody to?have antibody to?
• Intercelluar junctions of epidermalIntercelluar junctions of epidermalcellscells
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti-epidermal basement membraneAnti-epidermal basement membraneprotein?protein?
• Bullous pemphigoidBullous pemphigoid
What do you see with bullousWhat do you see with bulloush d
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pemphigoid?pemphigoid?
• IgG sub-epidermal blistersIgG sub-epidermal blisters• Oral blistersOral blisters
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti-platelet?Anti-platelet?
• ITPITP
What does ITP have antibodyWhat does ITP have antibody?
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to?to?
• Glycoprotein IIb/IIIaGlycoprotein IIb/IIIa
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti-thyroglobulin?Anti-thyroglobulin?• Anti-microsomal?Anti-microsomal?
• Hashimoto’sHashimoto’s
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmunethe following Autoimmune
Antibodies?Antibodies?• Anti-smooth muscle?Anti-smooth muscle?• Anti-scl-70?Anti-scl-70?
• SclerodermaScleroderma
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmuneg
Antibodies?Antibodies?• Anti-rho (SS-A)?Anti-rho (SS-A)?• Anti-la?Anti-la?
• Sjogren’sSjogren’s
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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the following Autoimmuneg
Antibodies?Antibodies?• Anti-proteinase?Anti-proteinase?• C-ANCA?C-ANCA?
• Wegener’sWegener’s
What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune
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t e o ow g uto u eg
Antibodies?Antibodies?• P-ANCA?P-ANCA?
• Polyarteritis nodosaPolyarteritis nodosa
What antigen &What antigen &immunoglobulin is Polyarteritisimmunoglobulin is Polyarteritis
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g yg y
nodosa associated with?nodosa associated with?• Hepatitis B antigenHepatitis B antigen• IgMIgM
What are the viruses that directlyWhat are the viruses that directlycause CA and which CA do theycause CA and which CA do they
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yycause?cause?• Papilloma virusPapilloma virus ??
Cervical CACervical CA• EBVEBV ??
BurkittsBurkittsNasopharyngeal CANasopharyngeal CA• HepB & CHepB & C ??
Liver CALiver CA
• HIVHIV ??Kaposi’s SarcomaKaposi’s Sarcoma
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What is the most commonWhat is the most commonnephrotic disease seen in kidsnephrotic disease seen in kids
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pp
and when does it occur?and when does it occur?• Min. change diseaseMin. change disease
• 2 wks post URI2 wks post URI
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What is the most commonWhat is the most commonmalignant renal tumor inmalignant renal tumor in
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gg
children?children?• Wilm’s tumorWilm’s tumor
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What is the most commonWhat is the most commonrenal mass?renal mass?
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renal mass?renal mass?
• CystCyst
What is the most commonWhat is the most commonrenal disease inrenal disease in
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Blacks/Hispanics?Blacks/Hispanics?• Focal Segmental GNFocal Segmental GN
What is the most commonWhat is the most commonnephrotic disease in adults?nephrotic disease in adults?
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nephrotic disease in adults?nephrotic disease in adults?
• Membranous GNMembranous GN
Thrombolytics & Inhibitors Thrombolytics & Inhibitors
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yy
• What does tPA, Streptokinase,What does tPA, Streptokinase,Urokinase inhibit?Urokinase inhibit?
• Aminocaproic acidAminocaproic acid• What doe Warfarin inhibit?What doe Warfarin inhibit?• Vitamin K Vitamin K
• What does Heparin inhibit?What does Heparin inhibit?• Protamine SulfateProtamine Sulfate
What is the dosage of tPA?What is the dosage of tPA?
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gg
• IV push?IV push?• 20mg20mg
• Drip?Drip?• 40mg40mg
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What is Urokinase used for?What is Urokinase used for?
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• Used ONLY for such things as:Used ONLY for such things as:• Feeding tubesFeeding tubes
• Central linesCentral lines• FistulasFistulas
What is Alopecia Areata?What is Alopecia Areata?
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p
• Loss of a patch of hairLoss of a patch of hair
What is Alopecia Totalis?What is Alopecia Totalis?
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p
• Loss of ALL hair on head “bald”Loss of ALL hair on head “bald”
What is AlopeciaWhat is AlopeciaUniversalis?Universalis?
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Universalis?Universalis?• Loss of hair on entire body “hairless”Loss of hair on entire body “hairless”
What is Loffler syndrome?What is Loffler syndrome?
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• Pneumonitis with endocarditis =Pneumonitis with endocarditis =pulmonary infiltrate with severepulmonary infiltrate with severeeosinophiliaeosinophilia
What is Loffler syndrome alsoWhat is Loffler syndrome alsoknown as?known as?
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known as?known as?
• PIE syndromePIE syndrome
What are the 5 ParasitesWhat are the 5 Parasitesassociated withassociated with LofflerLoffler
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Syndrome?Syndrome?• Necator americanusNecator americanus• Ankylostoma duodenaleAnkylostoma duodenale
• ShistosomiasisShistosomiasis• StrongyloidesStrongyloides
• Ascaris lumbricoidesAscaris lumbricoides
What happens when a patientWhat happens when a patientis on prednisone for > 7 days?is on prednisone for > 7 days?
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is on prednisone for > 7 days?is on prednisone for > 7 days?
• ImmunocompromisedImmunocompromised
What are 2 enzymes used byWhat are 2 enzymes used byB12?B12?
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B12?B12?
• Homocystine methyl transferaseHomocystine methyl transferase• Methyl malonyl-coA mutaseMethyl malonyl-coA mutase
What does MitochondrialWhat does Mitochondrialinheritance mean?inheritance mean?
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inheritance mean?inheritance mean?• No male transmissionNo male transmission• All females pass it onAll females pass it on
Who are 4 pt’s who would beWho are 4 pt’s who would besusceptable to pseudomonassusceptable to pseudomonas
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and staph infxns?and staph infxns?• Burn patientsBurn patients• Cystic fibrosisCystic fibrosis
• DMDM• Neutropenic patientsNeutropenic patients
In a neutropenic patient, whatIn a neutropenic patient, whatdo you cover for?do you cover for?
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do you cover for?do you cover for?
• cover 1x for Staph aureus during 1stcover 1x for Staph aureus during 1stweekweek
• cover 2x for Pseudo after 2nd weekcover 2x for Pseudo after 2nd week
What are the 3 main conceptsWhat are the 3 main conceptscausing a widened S2 splitting?causing a widened S2 splitting?
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causing a widened S2 splitting?causing a widened S2 splitting?
• Increased pO2Increased pO2• Delayed opening/closing of theDelayed opening/closing of the
pulmonary valuepulmonary value• Increased volume in the rightIncreased volume in the right
ventricleventricle
What are causes for aWhat are causes for awidened S2 splitting?widened S2 splitting?
• Blood transfusionBlood transfusion
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• Blood transfusionBlood transfusion
• Increased Tidal VolumeIncreased Tidal Volume• Giving O2Giving O2• Right sided heart failureRight sided heart failure• Pregnancy due to increase volumePregnancy due to increase volume• IV fluidsIV fluids• ASD/VSDASD/VSD• Deep breathingDeep breathing• HypernateremiaHypernateremia• SIADHSIADH
• Pulmonary regurgePulmonary regurge• Pulmonary stenosisPulmonary stenosis• Right bundle branch blockRight bundle branch block
What are the 8 commonWhat are the 8 commoncavities of blood loss?cavities of blood loss?
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cavities of blood loss?cavities of blood loss?
• PP ericardiumericardium• IIntracranialntracranial• MM ediastinumediastinum
• PP leural cavityleural cavity• TT highshighs• RR etroperitoneumetroperitoneum• AAbdominal cavitybdominal cavity
• PP elviselvis
What is the special list forWhat is the special list forPenicillin?Penicillin?
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Penicillin?Penicillin?• Gram +Gram +• Basement membrane suppressorBasement membrane suppressor• Works on simple anaerobesWorks on simple anaerobes• The #1 cause of anaphylaxis The #1 cause of anaphylaxis• Causes interstial neprititsCauses interstial nepritits• Causes nonspecific rashesCauses nonspecific rashes
• Acts as a hapten causing hemolyticActs as a hapten causing hemolyticanemiaanemia
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What are the Chron’s Gifts?What are the Chron’s Gifts?
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• GranulomaGranuloma• IleumIleum
• FistulaFistula• Transmural Transmural• Skip LesionSkip Lesion
What are the negative-What are the negative-stranded RNA Clues?stranded RNA Clues?
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stranded RNA Clues?stranded RNA Clues?• Prodromal periodProdromal period before symptomsbefore symptoms
= 1-3 weeks= 1-3 weeks• Why is there a prodromal period?Why is there a prodromal period?• Because must switch to positiveBecause must switch to positive
stranded before replicationstranded before replication
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What are the Most commonWhat are the Most commoncyanotic heart diseases?cyanotic heart diseases?
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cyanotic heart diseases?y• Transposition of the great arteries Transposition of the great arteries• Tetrology of Fallot Tetrology of Fallot• Truncus Arteriosus Truncus Arteriosus
• Tricuspid Atresia Tricuspid Atresia• Total anomalous pulmunary Venous Total anomalous pulmunary VenousReturnReturn
• Hypoplastic Left heart syndromeHypoplastic Left heart syndrome• Ebstein’s anomalyEbstein’s anomaly• Aortic atresiaAortic atresia• Pulmonary atresiaPulmonary atresia
What cyanotic heart disease isWhat cyanotic heart disease is– boot shaped?– boot shaped?
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boot s aped?p
• Tetrology of Fallot Tetrology of Fallot
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What things make theWhat things make themembrane less likely tomembrane less likely tod l i ?d l i ?
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depolarize?depolarize?• HypokalemiaHypokalemia• HypermagnesemiaHypermagnesemia
• Hypercalcemia (except atrium)Hypercalcemia (except atrium)• HypernatremiaHypernatremia
What things make theWhat things make themembrane more likely tomembrane more likely tod l i ?d l i ?
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depolarize?depolarize?• HyperkalemiaHyperkalemia• HypomagnasemiaHypomagnasemia
• Hypocalcemia (except atrium)Hypocalcemia (except atrium)• HyponatremiaHyponatremia
What is Plan F?What is Plan F?
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• T TPP P – Thiamin – B1P – Thiamin – B1• LL ipoic Acid – B4ipoic Acid – B4
• CoCo AA – Pantothenic acid – B5– Pantothenic acid – B5• FF AD – Riboflavin – B2AD – Riboflavin – B2• N AD – Niacin – B3AD – Niacin – B3
What are the 8 x-linkedWhat are the 8 x-linkedinherited diseases?inherited diseases?
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• Bruton’s AgammaglobulinemiaBruton’s Agammaglobulinemia• CGD (NADPH def)CGD (NADPH def)• DMDDMD
• Color BlindnessColor Blindness• G6PDG6PD• HemophiliaHemophilia• Lesch-NyhanLesch-Nyhan
• Vit D resist. Rickets (X-linked dominant)Vit D resist. Rickets (X-linked dominant)• FabrysFabrys• HuntersHunters
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What is the Tyrosine kinaseWhat is the Tyrosine kinasedeficiency?deficiency?
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yy
• Bruton’s agammaglobulinemiaBruton’s agammaglobulinemia
What are the B-cellWhat are the B-celldeficiencies with T-celldeficiencies with T-cello erlap?overlap?
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overlap?overlap?• SCIDSCID• WASWAS
• Job Buckley Syndrome Job Buckley Syndrome
What are the 4 itchiestWhat are the 4 itchiestrashes?rashes?
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• ScabiesScabies• Lichen PlanusLichen Planus
• UrticariaUrticaria• Dermatitis HerpetiformisDermatitis Herpetiformis
Tumor Markers/Oncongenes Tumor Markers/OncongenesII
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• L-myc?L-myc? • Small cell lung CaSmall cell lung Ca
• C-myc?C-myc?
• Promyelocytic leukemia (Burkitt’s lymphoma)Promyelocytic leukemia (Burkitt’s lymphoma)
• N-myc?N-myc?• NeuroblastomaNeuroblastoma
• Small cell lung CASmall cell lung CA
• C-able?C-able?• CMLCML• ALLALL
Tumor Markers/Oncongenes Tumor Markers/OncongenesIIII
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• C-myb?C-myb?• Colon CAColon CA• AMLAML
• C-sis ?C-sis ?• OsteosarcomaOsteosarcoma
• GliomaGlioma• FibrosarcomaFibrosarcoma
Tumor Markers/Oncongenes Tumor Markers/OncongenesIIIIII
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• C-erb B2?C-erb B2?• Epidermal growth factor receptorsEpidermal growth factor receptors
• CSF-1 ?CSF-1 ?• BreastBreast
Tumor Markers/Oncongenes Tumor Markers/OncongenesIVIV
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• Erb-B2?Erb-B2?• Breast CABreast CA• Ovarian CAOvarian CA• Gastric CAGastric CA
• Ret?Ret?• Medullary CA of thyroidMedullary CA of thyroid• Men II & IIIMen II & III• Papillary carcinomaPapillary carcinoma
Tumor Markers/Oncongenes Tumor Markers/OncongenesVV
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• Ki-ras?Ki-ras?• Lung CALung CA• Colon CAColon CA
• Bcl-2?Bcl-2?• BurkittsBurkitts• Follicular lymphomaFollicular lymphoma
• Erb?Erb?• RetinoblastomaRetinoblastoma
What are 6 HormonesWhat are 6 Hormonesproduced by the placenta?produced by the placenta?
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p y pp y p• hCGhCG• InhibinInhibin• Human placental lactogen (HPL)Human placental lactogen (HPL)
• Oxytocin (drug lactation, pit glandOxytocin (drug lactation, pit glandprod it also)prod it also)• ProgesteroneProgesterone
• EstrogenEstrogen
• RelaxinRelaxin
What is cancer grading?What is cancer grading?
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• Severity of microscopic changeSeverity of microscopic change• Degree of differentiationDegree of differentiation
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What are the rashes associatedWhat are the rashes associatedwith cancer and what cancerwith cancer and what cancerare they associated with?are they associated with?
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are they associated with?are they associated with?
• Urticaria/Hives?Urticaria/Hives?• Any CA, especially lymphomaAny CA, especially lymphoma• Pagets Ds (ulcers around nipples)Pagets Ds (ulcers around nipples)
• Seborrheic keratosis (waxy warts)?Seborrheic keratosis (waxy warts)?• Colon CAColon CA• HIV if sudden increase in numberHIV if sudden increase in number
• Normal with agingNormal with aging
What are the rashes associatedWhat are the rashes associatedwith cancer and what cancerwith cancer and what cancerare they associated with?are they associated with?
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are they associated with?are they associated with?
• Actinic keratosis?Actinic keratosis? – Dry scaly plaques on sun-exposed skinDry scaly plaques on sun-exposed skin
• Squamous Cell CA of skinSquamous Cell CA of skin
• Dermatomyositis?Dermatomyositis? – violacious, heliotropic rash, malar areaviolacious, heliotropic rash, malar area
• Colon CAColon CA
What are the rashes associatedWhat are the rashes associatedwith Cancer and the cancerwith Cancer and the cancerthey are associated with?they are associated with?
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they are associated with?they are associated with?
• Akanthosis nigricans?Akanthosis nigricans? – dark lines in skin foldsdark lines in skin folds
• Any visceral CAAny visceral CA
• End organ damageEnd organ damage
• Erythema nodosum?Erythema nodosum? – ant aspect of legs, tender nodulesant aspect of legs, tender nodules
• Anything granulomatousAnything granulomatous
• NOT assoc. w/ bacteriaNOT assoc. w/ bacteria
What is carried by HDL?What is carried by HDL?
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• Apo EApo E• Apo AApo A
• Apo CIIApo CII
• L-CATL-CAT
– lecithin cholesterol acetyl transferaselecithin cholesterol acetyl transferase• CholesterolCholesterol– from periphery to liverfrom periphery to liver
What is carried by VLDL?What is carried by VLDL?
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• Apo B-100Apo B-100• Apo EApo E• Apo C IIApo C II
• Triglcyerides (95%) Triglcyerides (95%)• Cholesterol (5%)Cholesterol (5%)
What is carried by IDL?What is carried by IDL?
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• Apo B-100Apo B-100• Apo EApo E
• Apo CIIApo CII
• Triglycerides (< VLDL) Triglycerides (< VLDL)
• Cholesterol (>VLDL)Cholesterol (>VLDL)
What is carried by LDL?What is carried by LDL?
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• Apo B-100Apo B-100
• CholesterolCholesterol– from liver to tissuefrom liver to tissue
• NOT a good thing!!!!!NOT a good thing!!!!!
What do chylomicronsWhat do chylomicronscarry?carry?
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• Apo AApo A• Apo B-48Apo B-48• Apo EApo E
• Apo C IIApo C II
• Triglycerides from: Triglycerides from:• GI to liver (25% of the time)GI to liver (25% of the time)
• GI to endothelium (75% of the time)GI to endothelium (75% of the time)
Which lipoprotein carriesWhich lipoprotein carriesthe most cholesterol?the most cholesterol?
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• LDLLDL
Where are the AVMs?Where are the AVMs?
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• Clue = HEALClue = HEAL• Heart?Heart?• Machinery murmurMachinery murmur
• Elbow?Elbow?• Fistula from dialysis in renal diseaseFistula from dialysis in renal disease
• Abdomen/Brain?Abdomen/Brain?• Von Hippel-Lindau = clot off with coilsVon Hippel-Lindau = clot off with coils• Increase incidence of Renal cell CA on chrom 3Increase incidence of Renal cell CA on chrom 3
• Lungs?Lungs?• Osler Weber Rendu SyndromeOsler Weber Rendu Syndrome
What is the Ranson’s criteriaWhat is the Ranson’s criteriafor acute pancreatitis (for acute pancreatitis ( atatadmissionadmission )?)?
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admissionadmission )?)?• Glucose > 200Glucose > 200• Age > 55Age > 55
• LDH >350LDH >350• AST > 250AST > 250• WBC > 16,000WBC > 16,000
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What is dysguzia?What is dysguzia?
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• Problem with sense of tasteProblem with sense of taste
What are 3 causes of What are 3 causes of dysgusia?dysgusia?
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• MetronidazoleMetronidazole• ClarithromycinClarithromycin
• Zinc deficiencyZinc deficiency
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What do you measure forWhat do you measure forcarcinoid syndrome?carcinoid syndrome?
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• SerotoninSerotonin– 5-HIAA5-HIAA
Where are the 2 mostWhere are the 2 mostcommon places a carcinoidcommon places a carcinoidtumor is found?tumor is found?
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tumor is found?tumor is found?• PancreasPancreas• IleumIleum
What are the phageWhat are the phagemediated toxins?mediated toxins?
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• MnemonicMnemonic : BEDS: BEDS• BotulinumBotulinum
• Erythrogenic toxinErythrogenic toxin– from strep pyogenesfrom strep pyogenes
• DiptheriaDiptheria
• SalmonellaSalmonella– Has O antigenHas O antigen
What is the story used toWhat is the story used toremember the segmented RNAremember the segmented RNAviruses?viruses?
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• I sprayedI sprayed ORTHOORTHO on myon my BUNYABUNYA atatthethe ARENAARENA down indown in REOREO to killto killSEGMENTED WORMSSEGMENTED WORMS
Name the 3 major types of Name the 3 major types of adhesion moleculesadhesion molecules
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• ICAMsICAMs• IntegrinsIntegrins
•SelectinsSelectins
What does IgCam do?What does IgCam do?
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• Bind proteinsBind proteins
What do integrins do?What do integrins do?
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• Stop the leukocytesStop the leukocytes
What do selectins do?What do selectins do?
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• Bind carbohydratesBind carbohydrates• Mediate the rolling to slowMediate the rolling to slow
leukocytes downleukocytes down
What are the functions of What are the functions of adhesion molecules?adhesion molecules?
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• Homing of lymphocytesHoming of lymphocytes– tells lymphocytes where to gotells lymphocytes where to go
• InflammationInflammation• Cell-cell interactionCell-cell interaction
Primary allergic response isPrimary allergic response isdue to what?due to what?
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• ContactContact
What cells are present in theWhat cells are present in thefirst 3 days?first 3 days?
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• NeutrophilsNeutrophils
• The next cells to show up are? The next cells to show up are?• B-cellsB-cells
• What do B-cells make?What do B-cells make?• IgMIgM
What day does IgM showWhat day does IgM showup?up?
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• Three Three
• IgM peaks at what day?IgM peaks at what day?• 1414
• When does IgM leave?When does IgM leave?• In 2 monthsIn 2 months
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What is Secondary AllergicWhat is Secondary Allergicresponse is due to?response is due to?
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• MEMORY MEMORY
What shows up at day 3?What shows up at day 3?
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• IgG with 5x concentrationIgG with 5x concentration• Has the highest affinityHas the highest affinity
• When does IgG peak?When does IgG peak?• In 5 yearsIn 5 years
• When does IgG leave?When does IgG leave?• In 10 yearsIn 10 years
What Ig has the hightestWhat Ig has the hightestaffinity?affinity?
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• IgGIgG
What are the risk factors forWhat are the risk factors forEsophageal/Gastric CA?Esophageal/Gastric CA?
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• SmokingSmoking• AlcoholAlcohol• NitritesNitrites• Japanese Japanese
What are the risk factors forWhat are the risk factors forbladder CA?bladder CA?
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• SmokingSmoking• Aniline dyesAniline dyes• BenzeneBenzene• AflatoxinAflatoxin
• CyclophosphamideCyclophosphamide• SchistosomiasisSchistosomiasis• 2 diseases:2 diseases:• Von Hippel-LindauVon Hippel-Lindau
• Tubular sclerosis Tubular sclerosis
What is the NBT test?What is the NBT test?
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• Nitro Blue Tetrazolium testNitro Blue Tetrazolium test• What is it used for?What is it used for?• Screening CGDScreening CGD• What does a –ve test indicate?What does a –ve test indicate?• +ve for the disease+ve for the disease
What disease corresponds withWhat disease corresponds withthe following inclusion bodies?the following inclusion bodies?
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• Howell-Jolly?Howell-Jolly?• Sickle cellSickle cell
• Heinz?Heinz?
• G-6-P-DG-6-P-D
• Zebra?Zebra?• Niemann pickNiemann pick
What disease corresponds withWhat disease corresponds withthe following inclusion bodies?the following inclusion bodies?
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• Donovan?Donovan?• LeishmaniasisLeishmaniasis
• Mallory?Mallory?• AlcoholismAlcoholism
• Negri?Negri?
• RabiesRabies
What disease corresponds withWhat disease corresponds withthe following inclusion bodies?the following inclusion bodies?
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• Councilman?Councilman?• Yellow fever Yellow fever
• Call-exner?Call-exner?• Ovarian tumorsOvarian tumors
– granulosa origingranulosa origin
What disease corresponds withWhat disease corresponds withthe following inclusion bodies?the following inclusion bodies?
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• Lewy?Lewy?• ParkinsonsParkinsons
• Pick?Pick?• Pick’s diseasePick’s disease
• Barr body?Barr body?• Normal femaleNormal female
What disease corresponds withWhat disease corresponds withthe following inclusion bodies?the following inclusion bodies?
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• Aschoff?Aschoff?• Rheumatic feverRheumatic fever
• Cowdry type A inclusions?Cowdry type A inclusions?• Herpes virusHerpes virus
• Auer rods?Auer rods?• AMLAML
What disease corresponds withWhat disease corresponds withthe following inclusion bodies?the following inclusion bodies?
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• Globoid?Globoid?• Krabbe’s lysosomal storage diseaseKrabbe’s lysosomal storage disease
• Russell?Russell?• Multiple myelomaMultiple myeloma
What disease corresponds withWhat disease corresponds withthe following inclusion bodies?the following inclusion bodies?
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• Schiller-Duvall?Schiller-Duvall?• Yolk sac tumor Yolk sac tumor
• Basal bodies?Basal bodies?• Only found in smooth mmOnly found in smooth mm
What are the 4 types of What are the 4 types of hypersensitivities?hypersensitivities?
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• Mnemonic?Mnemonic?• ACIDACID
• Type I Type I• Anaphylaxis/AtopicAnaphylaxis/Atopic
• Type II Type II• Cytotoxic (Humoral)Cytotoxic (Humoral)
• Type III Type III• Immune complex mediationImmune complex mediation
• Type IV Type IV• Delayed hypersensitivity/Cell mediatedDelayed hypersensitivity/Cell mediated
What are the CharacteristicsWhat are the Characteristicsof Type I hypersensitivity?of Type I hypersensitivity?
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• AtopicAtopic• IgE (Asthma) binds to mast cellIgE (Asthma) binds to mast cell• IgA activates IP3 cascade degradingIgA activates IP3 cascade degrading
mast cellsmast cells
What are the CharacteristicsWhat are the Characteristicsof Type II hypersensitivity?of Type II hypersensitivity?
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• HumoralHumoral• What are examples of type II?What are examples of type II?• Rh diseaseRh disease• GoodpasturesGoodpastures• Autoimmune hemolytic AnemiaAutoimmune hemolytic Anemia
• All Autoimmune diseasesAll Autoimmune diseases– except RA and SLEexcept RA and SLE
What are the CharacteristicsWhat are the Characteristicsof Type III hypersensitivity?of Type III hypersensitivity?
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• Ag-Ab complementAg-Ab complement• What are examples of Type III?What are examples of Type III?• RARA• SLESLE• VasculitidesVasculitides
• Some GN?Some GN?
What are the CharacteristicsWhat are the Characteristicsof Type IV hypersensitivity?of Type IV hypersensitivity?
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• Cell mediatedCell mediated• What are examples of Type IV?What are examples of Type IV?• TB skin test TB skin test• Contact dermatitisContact dermatitis• Transplant rejection Transplant rejection
What structures have noWhat structures have noknown function?known function?
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• AppendixAppendix• EpithalamusEpithalamus• Palmaris longusPalmaris longus
– musclemuscle
• Pancreatic polypeptidePancreatic polypeptide– hormones in F-cellshormones in F-cells
What diseases can progressWhat diseases can progressto RPGN?to RPGN?
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• GoodpasturesGoodpastures• WegenersWegeners• DMDM• HTNHTN
What are causes of papillaryWhat are causes of papillarynecrosis?necrosis?
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• VasculitisVasculitis• AIDSAIDS
Cytic fibrosis Questions?Cytic fibrosis Questions?
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• Tx? Tx?• PilocarpinePilocarpine• also used for glaucomaalso used for glaucoma
• Test used to detect CF? Test used to detect CF?• Pilocarpine sweat testPilocarpine sweat test
• What ion does this test measure?What ion does this test measure?• Cl-Cl-
• Definitive presence of disease has a test value of Definitive presence of disease has a test value of what?what?
• >60>60
Cytic fibrosis Questions?Cytic fibrosis Questions?
h h l lh h l l
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• What is the value in a normal person?What is the value in a normal person?• <20<20
• What is the value in a heterozygous person?What is the value in a heterozygous person?
• 30 – 6030 – 60• What chromosome is the CF gene on?What chromosome is the CF gene on?• Chrom 7Chrom 7
• What Second messenger is used?What Second messenger is used?• IP3/DAGIP3/DAG
What are the gram +ve sporeWhat are the gram +ve sporeformers?formers?
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• Bacillus anthracisBacillus anthracis• Clostridium perfringensClostridium perfringens• Clostridium tetaniClostridium tetani• Clostridium melangosepticusClostridium melangosepticus
• What is the chemical in spores?What is the chemical in spores?• Calcium dipocholinateCalcium dipocholinate
What does strep mutansWhat does strep mutansferment?ferment?
dd
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• Lactic acidLactic acid
What type of receptors do allWhat type of receptors do allsphincters in the body have?sphincters in the body have?
l hl h
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• Alpha-receptorsAlpha-receptors
Strep. Salivarius ag is usedStrep. Salivarius ag is usedfor what test?for what test?
C ld l i i iC ld l i i i
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• Cold agglutinin testingCold agglutinin testing– IgMIgM
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Types of amyloid found in various Types of amyloid found in variousSystemicSystemic amyloidoses:amyloidoses:
P lb i / h i ?P lb i / h i ?
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• Pre-albumin/transthyretin?Pre-albumin/transthyretin?• Cardiomyopathic hereditary formsCardiomyopathic hereditary forms
– senile systemic amyloidosissenile systemic amyloidosis
• Neuropathic hereditary syndromesNeuropathic hereditary syndromes
Types of amyloid found in Types of amyloid found invariousvarious LocalLocal amyloidoses:amyloidoses:
ANP fib il d b ?ANP fib il d b ?
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• ANP fibrils are caused by?ANP fibrils are caused by?• Senile cardiac amyloisosisSenile cardiac amyloisosis
• Cerebral amyloid in Alzheimer’sCerebral amyloid in Alzheimer’sdisease/Down’s?disease/Down’s?• Cerebral amyloidosisCerebral amyloidosis
Types of amyloid found in Types of amyloid found invariousvarious LocalLocal amyloidoses:amyloidoses:
C l it i ?C l it i ?
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• Calcitonin precursors?Calcitonin precursors?• Medullary CA of thyroidMedullary CA of thyroid
• AL from light chains?AL from light chains?• Isolated, massive, nodular depositsIsolated, massive, nodular deposits– lung, skin, urogenital tractlung, skin, urogenital tract
What type of dementia doWhat type of dementia doyou get in Pick’s dis?you get in Pick’s dis?
F t t l d tiF t t l d ti
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• Frontotemporal dementiaFrontotemporal dementia
Describe Pick’s diseaseDescribe Pick’s disease
At h f f t l d t lAt h f f t l d t l
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• Atrophy of frontal and temporalAtrophy of frontal and temporalcortex with sparing of remainingcortex with sparing of remainingneocortical regionsneocortical regions
What 3 things do PickWhat 3 things do Pickbodies contain?bodies contain?
Alt d fil tAlt d fil t
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• Altered neurofilamentsAltered neurofilaments• Tau protein Tau protein• ubiquitinubiquitin
What drugs can cause aWhat drugs can cause adisulfiram reaction?disulfiram reaction?
M i ?M i ?
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• Mnemonic?Mnemonic?• CLAMCLAM
• ChloramphenicolChloramphenicol• LactamsLactams
– CefamandoleCefamandole
– CefoperazoneCefoperazone• AntabuseAntabuse
– disulfiramdisulfiram
What is the mode of action of theWhat is the mode of action of theClostridium botulinum toxin?Clostridium botulinum toxin?
P t ti l f A hP t ti l f A h
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• Prevents pre-synaptic release of AchPrevents pre-synaptic release of Ach
• How do babies get it?How do babies get it?• From spores in honey or molassesFrom spores in honey or molasses
• How do adults get it?How do adults get it?• From canned foodFrom canned food
What are 3 Toxins of What are 3 Toxins of Bacillus?Bacillus?
L th l f t (bl k i )L th l f t (bl k i )
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• Lethal factor – (black necrosis)Lethal factor – (black necrosis)• Protective factorProtective factor• Edema factorEdema factor
Who has Poly-D GlutamicWho has Poly-D Glutamicacid?acid?
AnthracisAnthracis
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• AnthracisAnthracis• CereusCereus
Name that B-blocker:Name that B-blocker:
B1 selective?B1 selective?
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• B1-selective?B1-selective?• A – MA – M• Non-selective?Non-selective?
• N – ZN – Z• Exceptions?Exceptions?• Carbetalol and Labetolol are non-Carbetalol and Labetolol are non-
selectiveselective
What are the 4 facts of FanconiWhat are the 4 facts of FanconiSyndrome?Syndrome?
Problem in proximal tubuleProblem in proximal tubule
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• Problem in proximal tubuleProblem in proximal tubule• Can’t reabsorbCan’t reabsorb• Low energy state causing anemiaLow energy state causing anemia• Can be due to old tetracyclineCan be due to old tetracycline
Where is glutaminaseWhere is glutaminasefound?found?
In the collecting duct of the kidneyIn the collecting duct of the kidney
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• In the collecting duct of the kidneyIn the collecting duct of the kidney
• What does glutmainase help theWhat does glutmainase help thekidney absorb?kidney absorb?
• Ammonia if the liver failsAmmonia if the liver fails
Name 3 anatomical spotsName 3 anatomical spotswhere renal stones get stuck:where renal stones get stuck:
HilumHilum
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• HilumHilum• Pelvic brimPelvic brim• Entering the bladderEntering the bladder
Renal failure is the mostRenal failure is the mostcommon cause of death incommon cause of death inwhat 3 diseases?what 3 diseases?
SLESLE
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• SLESLE• Endometrial CAEndometrial CA• Cervical CACervical CA
What is the rate-limitingWhat is the rate-limitingenzyme in the urea cycle?enzyme in the urea cycle?
• Carbamoyl synthase ICarbamoyl synthase I
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• Carbamoyl synthase ICarbamoyl synthase I
• Where is it found 90% of the time?Where is it found 90% of the time?• LiverLiver
• Where is it found 10% of the time?Where is it found 10% of the time?• Collecting duct of the kidneyCollecting duct of the kidney
What type of charge doesWhat type of charge doesheparin have?heparin have?
hh
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• -ve charge-ve charge
What type of charge doesWhat type of charge doesprotamine sulfate have?protamine sulfate have?
hh
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• +ve charge+ve charge
• What is it used for?What is it used for?• Reversing the effects of heparinReversing the effects of heparin
What is commonly seen inWhat is commonly seen inall vasculitides?all vasculitides?
• T-cells and macrophagesT-cells and macrophages
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• T-cells and macrophages T-cells and macrophages• SchistocytesSchistocytes• Decreased plateletsDecreased platelets• Decreased RBCsDecreased RBCs
• Bleeding from mucosal surfacesBleeding from mucosal surfaces• Bleeding from skin and GIBleeding from skin and GI• PetechiaePetechiae• EcchymosesEcchymoses
What happens if you exposeWhat happens if you exposethe blood to the basementthe blood to the basementmembrane?membrane?• The following deveop:The following deveop:
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• The following deveop: The following deveop:• ClotsClots• DICDIC
• Pulmonary embolismPulmonary embolism• DVTDVT• MIMI
• StrokeStroke
Signs and symptoms in allSigns and symptoms in allvasculitidesvasculitides
• Tachypnea and SOBTachypnea and SOB
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• Tachypnea and SOB Tachypnea and SOB
• Most common cause of death?Most common cause of death?• Heart failureHeart failure
What is the MOA of What is the MOA of Erythromycin?Erythromycin?
• Inhibits the translocation step ofInhibits the translocation step ofb l h
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• Inhibits the translocation step of Inhibits the translocation step of ribosomal protein synthesisribosomal protein synthesis
What is the MOA of What is the MOA of Chloramphenicol?Chloramphenicol?
• Inhibits ribosomal peptidylInhibits ribosomal peptidyl
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• Inhibits ribosomal peptidylInhibits ribosomal peptidyltransferase in prokaryotestransferase in prokaryotes
What is the MOA of What is the MOA of Puromycin?Puromycin?
• Inhibits elongation by binding to “A”Inhibits elongation by binding to “A”
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• Inhibits elongation by binding to AInhibits elongation by binding to Asite and prematurely terminatingsite and prematurely terminatingchain growth in pro and eukaryoteschain growth in pro and eukaryotes
What is the MOA of What is the MOA of Streptomycin?Streptomycin?
• Causes misreading of code duringCauses misreading of code during
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• Causes misreading of code duringCauses misreading of code duringinitiation in prokaryotesinitiation in prokaryotes
What is the MOA of What is the MOA of Tetracycline? Tetracycline?
• Prevents binding of aminoacyl-t-RNAPrevents binding of aminoacyl-t-RNA
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• Prevents binding of aminoacyl-t-RNAPrevents binding of aminoacyl-t-RNAto ribosome on prokaryotes thereforeto ribosome on prokaryotes thereforeinhibiting initiationinhibiting initiation
What is the MOA of What is the MOA of Cyclohexamide?Cyclohexamide?
• Inhibits ribosomal peptidylInhibits ribosomal peptidyl
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• Inhibits ribosomal peptidylInhibits ribosomal peptidyltransferase in eukaryotestransferase in eukaryotes– cell wall inhibitorcell wall inhibitor
What is the MOA of What is the MOA of Rifampin?Rifampin?
• Blocks B-subunit of RNA polymeraseBlocks B-subunit of RNA polymerase
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• Blocks B subunit of RNA polymeraseBlocks B subunit of RNA polymerase• Prophylaxis for contacts of N.Prophylaxis for contacts of N.
meningitidismeningitidis
What is the MOA of What is the MOA of Vancomycin?Vancomycin?
• Cell wall inhibitorCell wall inhibitor
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• Cell wall inhibitorCell wall inhibitor• Binds irreversibly to PhopholipaseBinds irreversibly to Phopholipase
carriercarrier
• BacteriacidalBacteriacidal• Covers all gram +vesCovers all gram +ves• LinezolidLinezolid
What is the MOA of What is the MOA of Warfarin?Warfarin?
• Blocks vitamin k dependent gamma-Blocks vitamin k dependent gamma-
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• Blocks vitamin k dependent gammaBlocks vitamin k dependent gammacarboxylation of prothrombin andcarboxylation of prothrombin andfactors 2, 7, 9, 10, proteins C & Sfactors 2, 7, 9, 10, proteins C & S
What is the MOA of What is the MOA of Clindamycin?Clindamycin?
• Blocks translation by binding the 50SBlocks translation by binding the 50S
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• Blocks translation by binding the 50SBlocks translation by binding the 50Ssubunitsubunit
Hemolytic properties of Hemolytic properties of Streptococcus:Streptococcus:
• What type of hemolysis is alphaWhat type of hemolysis is alphahemolysis?hemolysis?
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W at type o e o ys s s a p aW at type o e o ys s s a p ahemolysis?hemolysis?• Partial hemolysisPartial hemolysis
• What color is it’s zone?What color is it’s zone?• GreenGreen
• What type of hemolysis is beta-hemolysis?What type of hemolysis is beta-hemolysis?
• Complete hemolysisComplete hemolysis
Hemolytic properties of Hemolytic properties of Streptococcus:Streptococcus:
• What color is it’s zoneWhat color is it’s zone
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What color is it s zoneWhat color is it s zone• ClearClear
– eg. Streptokinaseeg. Streptokinase
• What type of hemolysis is gamma-What type of hemolysis is gamma-hemolysis?hemolysis?
• No hemolysisNo hemolysis
• What color is it’s zone?What color is it’s zone?• RedRed
What are the 5 notableWhat are the 5 notablethings about RTA I?things about RTA I?
• High urine PH (??????not sure aboutHigh urine PH (??????not sure about
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High urine PH (??????not sure aboutHigh urine PH (??????not sure aboutthis)this)
• AcidosisAcidosis
• UTI sUTI s• StonesStones• Babies die < 1 yr oldBabies die < 1 yr old
What are 3 notable thingsWhat are 3 notable thingsabout RTA II?about RTA II?
• AcidosisAcidosis
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AcidosisAcidosis– urine PH = 2, normal is 5-6urine PH = 2, normal is 5-6
• HypokalmiaHypokalmia
• Patients have NO carbonic anhydrasePatients have NO carbonic anhydrase
What are 3 notable thingsWhat are 3 notable thingsabout RTA III?about RTA III?
• It is a combination of RTA I & IIIIt is a combination of RTA I & III
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It is a combination of RTA I & IIIIt is a combination of RTA I & III• Normal urine pHNormal urine pH• HypokalemiaHypokalemia
What are 3 notable thingsWhat are 3 notable thingsabout RTA IV?about RTA IV?
• Seen in diabeticsSeen in diabetics
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Seen in diabeticsSeen in diabetics• HyperkalemiaHyperkalemia• NO aldosterone b/c JG apparatus hasNO aldosterone b/c JG apparatus has
infarctedinfarcted
What are the members of What are the members of Streptococcus Group D?Streptococcus Group D?
• ViridansViridans
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ViridansViridans• MutansMutans• SanguisSanguis• SalivariusSalivarius• BovisBovis
What Steptococcus hasWhat Steptococcus hasgreen pigment?green pigment?
• ViridansViridans
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V da sV da s
What Streptococcus causesWhat Streptococcus causesSBE?SBE?
• ViridansViridans
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What Streptococcus causesWhat Streptococcus causescavities?cavities?
• MutansMutans
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What do you see inWhat do you see inNephritic Syndrome?Nephritic Syndrome?
• HTNHTN
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• HematuriaHematuria• RBC castsRBC casts
What do you see inWhat do you see inNephrotic Syndrome?Nephrotic Syndrome?
• Increase EdemaIncrease Edema
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• Increase LipidemiaIncrease Lipidemia• Increase CholesterolemiaIncrease Cholesterolemia
• Increase CoagulabilityIncrease Coagulability• Decrease serum AlbuminDecrease serum Albumin
•Increase urinary AlbuminIncrease urinary Albumin
What is the #1 cause of What is the #1 cause of Sinusitis, Otitis, Bronchitis,Sinusitis, Otitis, Bronchitis,Pneumonia?Pneumonia?• Strep. PneumoStrep. Pneumo
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pp
• What is the #2 cause?What is the #2 cause?
• Hemophilus influenzaHemophilus influenza
•What is the #3 cause?What is the #3 cause?
• Neisseria meningitidesNeisseria meningitides
What is the #1 method toWhat is the #1 method toparalyze cilia?paralyze cilia?
• VirusesViruses
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• Which are secondary to what?Which are secondary to what?
• Bacterial infectionsBacterial infections
• What is the #2 method to paralyzeWhat is the #2 method to paralyzecilia?cilia?
• SmokingSmoking
If you develop gastroenteritisIf you develop gastroenteritiswithin 8hrs of eating what arewithin 8hrs of eating what arethe most common likely bugs?the most common likely bugs?• Staph aureusStaph aureus
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pp• Clostridium perfringensClostridium perfringens• Bacillus cereus….from what?Bacillus cereus….from what?
• Fried riceFried rice
Gastroenteritis within 8hrs of Gastroenteritis within 8hrs of eating what toxin?eating what toxin?
• PreformedPreformed
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What does Clostridum tetaniWhat does Clostridum tetaniinhibit?inhibit?
• Release of glycine from spinal cordRelease of glycine from spinal cord
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• What physical finding would you see?What physical finding would you see?• Lock jawLock jaw
• What is the tx?What is the tx?• Antitoxin and ToxoidAntitoxin and Toxoid
• Where is it injected?Where is it injected?• Injected in different areas of bodyInjected in different areas of body
The Most common cause of UTI The Most common cause of UTIis?is?
• E. coliE. coli
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• Followed by?Followed by?
• ProteusProteus
• Followed by?Followed by?• KlebsiellaKlebsiella
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Staph aureus is the mostStaph aureus is the mostcommon cause of whatcommon cause of whatbone disease?bone disease?• OsteomyelitisOsteomyelitis
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yy
• Because of what?Because of what?
• CollagenaseCollagenase
What is the Most CommonWhat is the Most Commoncause of infections one weekcause of infections one weekpost burn injury?post burn injury?
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• Staph. aureusStaph. aureus
What is the triad of SSSS?What is the triad of SSSS?
• ShockShock
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• RashRash• HypotensionHypotension
Most common cause of UTI?Most common cause of UTI?
• E. coliE. coli
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• Then? Then?• ProteusProteus
• Then? Then?• KlebsiellaKlebsiella
Newborn meningitis isNewborn meningitis iscaused by?caused by?
• Group B Strep (agalactiae)Group B Strep (agalactiae)
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• E. coliE. coli• ListeriaListeria
What is normal rectal floraWhat is normal rectal florafrom momfrom mom
• Group B Strep (Strep. Agalactiae)Group B Strep (Strep. Agalactiae)
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• E. coliE. coli• ListeriaListeria
What is associated withWhat is associated withcolon CA?colon CA?
• Clostridium melanogosepticusClostridium melanogosepticusb
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• Strep bovisStrep bovis
• What color pigment is produced?What color pigment is produced?• BlackBlack
What Ig do you look for withWhat Ig do you look for withaffinity?affinity?
• IgGIgG
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• What about Avidity?What about Avidity?
• IgMIgM
What is transductionWhat is transduction
• Virus inject it’s DNA into bacteriaVirus inject it’s DNA into bacteria
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What is transformation?What is transformation?
• Virus injects it’s DNA into it bacteriaVirus injects it’s DNA into it bacteriain a hospital or nursing home settingin a hospital or nursing home setting
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in a hospital or nursing home setting,in a hospital or nursing home setting,then becomes deadly.then becomes deadly.
Conjuction occurs only withConjuction occurs only withwhat?what?
• Bacteria with PiliBacteria with Pili
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What causes mutiple cerebralWhat causes mutiple cerebralabscesses in newborns?abscesses in newborns?
• CitrobacterCitrobacter
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What are the 2 gram –ves thatWhat are the 2 gram –ves thatare strict anaerobes?are strict anaerobes?
• Hemophilus influenzaHemophilus influenzaN i iN i i
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• NeisseriaNeisseria
a ype o comp emenproblem do you have inproblem do you have inrecurrent infections withrecurrent infections withencapsulated organisms?encapsulated organisms?
C3C3
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• C3C3
What does complementWhat does complementfight against?fight against?
• G ti b t iG g ti b t i
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• Gram negative bacteriaGram negative bacteria
What do you see in serum withWhat do you see in serum withprerenal failure and what areprerenal failure and what arethe values?the values?• BUNBUN• >20>20
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>20>20
• Fractional Na+ excertionFractional Na+ excertion• <1%<1%
• CreatineCreatine• >40>40
What do you see in RenalWhat do you see in Renalfailure and what are thefailure and what are thevalues?values?• BUNBUN• 10-1510-15
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10-1510 15
• Fractional Na+ excretionFractional Na+ excretion• >2%>2%
• CreatinineCreatinine• <20<20
What is the extravasationWhat is the extravasationorder?order?
• PavementingPavementing• M gi tiMargination
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• MarginationMargination• DiapediesisDiapediesis
• MigrationMigration
What is the rate limitingWhat is the rate limitingenzyme for Glycolysis?enzyme for Glycolysis?
• PFK 1PFK 1
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• PFK-1PFK-1
What is the rate limitingWhat is the rate limitingenzyme of Gluconeogenesis?enzyme of Gluconeogenesis?
• Pyruvate CarboxlyasePyruvate Carboxlyase
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• Pyruvate CarboxlyasePyruvate Carboxlyase
rea ng a sease ainitiates the cell mediatedinitiates the cell mediatedresponse, what are youresponse, what are youtreating first?treating first?• ViralViral
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• If resistant to tx, what next?If resistant to tx, what next?
• FungalFungal• MycobacteriumMycobacterium• ProtozoaProtozoa
• ParasiteParasite• NeoplasmNeoplasm
What bugs can you pick upWhat bugs can you pick upduring birth?during birth?
• Step. Group BStep. Group B– Strep agalactiaeStrep agalactiae
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Strep agalactiaeStrep agalactiae
• Strep. PneumoniaStrep. Pneumonia
• Herpes simplex virusHerpes simplex virus• Neisseria gonorrheaNeisseria gonorrhea• ChlyamydiaChlyamydia
What is another name forWhat is another name forAdenoma sebaceum?Adenoma sebaceum?
• Perivascular angiofibromataPerivascular angiofibromata
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• Perivascular angiofibromataPerivascular angiofibromata
What is another name forWhat is another name forAddison’s?Addison’s?
• Primary Adrenocoritcal InsufficiencyPrimary Adrenocoritcal Insufficiency
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What is another name forWhat is another name forAlkaptonuria?Alkaptonuria?
• OchronosisOchronosis
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What is another name forWhat is another name forChurg-Strauss?Churg-Strauss?
• Allergic GranulomatosisAllergic Granulomatosis• AngiitisAngiitis
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• AngiitisAngiitis
What is another name forWhat is another name forCraniopharyngioma?Craniopharyngioma?
• AmeloblastomaAmeloblastoma
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• What is Ameloblast?What is Ameloblast?
• Tooth material Tooth material
What is another name forWhat is another name forChrons?Chrons?
• Regional enteritisRegional enteritis• Granulomatous ileitisGranulomatous ileitis
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• Granulomatous ileitisGranulomatous ileitis• IleocolitisIleocolitis
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What is another name forWhat is another name forIntraductal Ca?Intraductal Ca?
• Comedo CaComedo Ca
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What is another name for I-What is another name for I-Cell Disease?Cell Disease?
• Mucolipidosis IIMucolipidosis II
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What is another name forWhat is another name forKawassaki Disease?Kawassaki Disease?
• MLNSMLNS• Mucocutaneous Lymph NodeMucocutaneous Lymph Node
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Mucocutaneous Lymph NodeMucocutaneous Lymph NodeSyndromeSyndrome
What is another name forWhat is another name forLeydig cells?Leydig cells?
• Interstitial cellsInterstitial cells
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What is another name forWhat is another name forSertoli cells?Sertoli cells?
• Sustentacular cellsSustentacular cells
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What is another name forWhat is another name forWaldenstrom’sWaldenstrom’smacroglobulinemia?macroglobulinemia?
• Hyperviscosity syndromeHyperviscosity syndrome
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HHV I causes?HHV I causes?
• OralOral• Trigeminal gangliaTrigeminal ganglia
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Trigeminal ganglia Trigeminal ganglia
HHV II causes?HHV II causes?
• GenitalGenital• Sacral plexusSacral plexus
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Sacral plexusSacral plexus
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HHV IV causes?HHV IV causes?
• EBVEBV• MononucleosisMononucleosis
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Mononucleosis• Burkitt’sBurkitt’s
HHV V causes?HHV V causes?
• CMVCMV• Inclusion bodiesInclusion bodies
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c us o bod es
HHV VI causes?HHV VI causes?
• RoseolaRoseola• Duke DiseaseDuke Disease
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• Exanthem subitumExanthem subitum
HHV VII causes?HHV VII causes?
• Pityriasis roseaPityriasis rosea
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HHV VIII causes?HHV VIII causes?
• Kaposi’s sarcomaKaposi’s sarcoma
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Answer the following questionsAnswer the following questionsabout Coumadin/Warfarin.about Coumadin/Warfarin.
• What is the MOA?What is the MOA?• Interferes with normal synthesis andInterferes with normal synthesis andf
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gama carboxylation of Vit. K gama carboxylation of Vit. K dependent clotting factors viadependent clotting factors viavitamin K antagonism.vitamin K antagonism.
• Is it long or short acting?Is it long or short acting?
• Long half-lifeLong half-life• 8-10 hours to act8-10 hours to act
Answer the following questionsAnswer the following questionsabout Coumadin/Warfarin.about Coumadin/Warfarin.
• Clinical use?Clinical use?• Chronic anticoagulationChronic anticoagulation
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gg
• Contra-indication?Contra-indication?• Pregnancy because it can cross thePregnancy because it can cross the
placentaplacenta
Answer the following questionsAnswer the following questionsabout Coumadin/Warfarin.about Coumadin/Warfarin.
• What pathway does it affect?What pathway does it affect?• Extrinsic pathwayExtrinsic pathway
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p yp y
• What does it do to PT?What does it do to PT?• ProlongsProlongs
• PTPT
Answer the following questionsAnswer the following questionsabout Coumadin/Warfarin.about Coumadin/Warfarin.
• What are the toxicities?What are the toxicities?• BleedingBleeding
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gg• Teratogenic Teratogenic
• Drug-drug interactionsDrug-drug interactions
• How is it activatied?How is it activatied?• Tissue activated Tissue activated
Answer the following questionsAnswer the following questionsabout Coumadin/Warfarin.about Coumadin/Warfarin.
• Administration?Administration?• popo
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What are the Vitamin K What are the Vitamin K dependent clotting factors?dependent clotting factors?
• IIII• VIIVII
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• IXIX
• XX• Protein CProtein C• Protein SProtein S
Answer the following questionsAnswer the following questionsabout Heparin.about Heparin.
• What is the MOA?What is the MOA?• Catalyzes the activation of antithrombin IIICatalyzes the activation of antithrombin III
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• Decreases thrombin and XaDecreases thrombin and Xa
• Is it long or short acting?Is it long or short acting?• Short half-lifeShort half-life• Acts immediatelyActs immediately
Answer the following questionsAnswer the following questionsabout Heparin.about Heparin.
• Clinical use?Clinical use?• Immediate anticoagulation of Immediate anticoagulation of
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pulmonary embolism, stroke, angina,pulmonary embolism, stroke, angina,
MI, DVT.MI, DVT.
• Contra-indication?Contra-indication?
• Can be used during pregnancyCan be used during pregnancybecause it does not cross thebecause it does not cross theplacentaplacenta
Answer the following questionsAnswer the following questionsabout Heparin.about Heparin.
• What pathway does it affect?What pathway does it affect?• Intrinsic pathwayIntrinsic pathway
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• What value should you follow?What value should you follow?• PTTPTT
Answer the following questionsAnswer the following questionsabout Heparin.about Heparin.
• What are the toxicities?What are the toxicities?• BleedingBleeding
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• Thrombocytopenia Thrombocytopenia
• Drug-drug interactionsDrug-drug interactions
• How is it activatied?How is it activatied?• Blood activatedBlood activated
Answer the following questionsAnswer the following questionsabout Heparin.about Heparin.
• Administration?Administration?• I.V.I.V.
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• Drug of choice for what?Drug of choice for what?• DVTDVT
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What do you use for rapidWhat do you use for rapidreversal of heparinization?reversal of heparinization?
• Protamine sulfateProtamine sulfate
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How do you treatHow do you treatBenzodiazepine poisoning?Benzodiazepine poisoning?
• FlumazenilFlumazenil
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How do you treatHow do you treatAnticholinesterase poisoning?Anticholinesterase poisoning?
• PralidoximePralidoxime
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How do you treat IronHow do you treat Ironpoisoning?poisoning?
• DeferoxamineDeferoxamine
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How do you treat OpioidHow do you treat Opioidpoisoning?poisoning?
• NaloxeneNaloxene
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How do you treat BarbituateHow do you treat Barbituatepoisoning?poisoning?
• BicarbonateBicarbonate
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• DoxapramDoxapram
What does Doxapram do?What does Doxapram do?
• Activates the respiratory center inActivates the respiratory center inthe brainthe brain
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What is the treatment forWhat is the treatment forHypercholesterolemia?Hypercholesterolemia?
• ProvostatinProvostatin• AtrovastatinAtrovastatin
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• LovastatinLovastatin
• SimvastatinSimvastatin
What statin is renallyWhat statin is renallyexcreted?excreted?
• ProvastatinProvastatin
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What statins do you have toWhat statins do you have tofollow liver enzymes every 3follow liver enzymes every 3months?months?
• AtrovastatinAtrovastatin• LovastatinLovastatin
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• SimvastatinSimvastatin
What do statins inhibit?What do statins inhibit?
• HMG-CoA reductaseHMG-CoA reductase
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• When is it most active?When is it most active?
• 8:00pm on8:00pm on
If statins are insufficient whatIf statins are insufficient whatdo you add?do you add?
• CholestipolCholestipol• CholestyramineCholestyramine
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• If nothing works what do you give?If nothing works what do you give?• ProbucolProbucol• NiacinNiacin
What are the side effects of What are the side effects of Niacin?Niacin?
• FlushingFlushing• ItchingItching
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What 2 statins bind bileWhat 2 statins bind bilesalts?salts?
• CholestipolCholestipol• CholestyramineCholestyramine
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What are 4 causes of severeWhat are 4 causes of severepain (in order)?pain (in order)?
1.Pancreatitis1.Pancreatitis• Due to What?Due to What?• ETOHETOH
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ETOHETOH
2.Kidney stones2.Kid ney stones • Due to What?Due to What?• AlcoholAlcohol
What are 4 causes of severeWhat are 4 causes of severepain (in order)?pain (in order)?
3.AAA3.AAA• How is this described?How is this described?
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• Ripping pain down backRipping pain down back
4.Ischemic bowel4.Ischemic bowel• What is symptom?What is symptom?
• Bloody diarrheaBloody diarrhea
What are 5 causes of What are 5 causes of SIADH?SIADH?
• Small cell Ca of lungSmall cell Ca of lung• Increased intracranial pressureIncreased intracranial pressure( )
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• Pain (most common)Pain (most common)
• DrugsDrugs• Hypoxic Lung Disease/RestrictiveHypoxic Lung Disease/Restrictive
Lung diseaseLung disease
What drug causes SIADH?What drug causes SIADH?
• CarbamazepineCarbamazepine
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What are the cells of neuralWhat are the cells of neuralcrest origin?crest origin?• Parafollicular cells of thyroidParafollicular cells of thyroid• Odontoblasts (predentin)Odontoblasts (predentin)• Pseudounipolar cellsPseudounipolar cells
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pp• Spiral membrane of heartSpiral membrane of heart
• Chromaffin cellsChromaffin cells• All Ganglion cells (Schwann, AdrenalAll Ganglion cells (Schwann, Adrenal
medulla)medulla)
•MelanocytesMelanocytes
• Laryngeal/Tracheal cartilageLaryngeal/Tracheal cartilage
What are the triple repeatWhat are the triple repeatdiseases?diseases?
• Huntington’sHuntington’s• Fragile XFragile XhM i D h
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• Myotonic DystrophyMyotonic Dystrophy
• Prauder WilliePrauder Willie• Spinal/bulbar muscular atrophySpinal/bulbar muscular atrophy
(Fredicks ataxia)(Fredicks ataxia)
How do you determine theHow do you determine themaximum sinus rate?maximum sinus rate?
• 220 - age220 - age
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What are the 3 low volumeWhat are the 3 low volumestates with acidosis rather thanstates with acidosis rather thanalkalosis?alkalosis?
• RTARTA• DiarrheaDiarrheaDi b i k id i (DKA)Di b i k id i (DKA)
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• Diabetic ketoacidosis (DKA)Diabetic ketoacidosis (DKA)
What are the causes of What are the causes of Croup & Bronchiolities?Croup & Bronchiolities?
• ParainfluenzaParainfluenza• AdenovirusAdenovirusI flI fl
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• InfluenzaInfluenza
• RSVRSV
What is asthma in a childWhat is asthma in a childless than 2 called?less than 2 called?
• BronchiolitisBronchiolitis
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What are the 4 D’s of What are the 4 D’s of Pellagra?Pellagra?
• DiarrheaDiarrhea• DermatitisDermatitisD iD ti
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• DementiaDementia
• DeathDeath
What are the uric acidWhat are the uric acidstones?stones?
• CysteineCysteine• OrnithineOrnithine• L iL i
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• LysineLysine
• ArginineArginine
What is happening in theWhat is happening in theAtrium?Atrium?• Phase 0?Phase 0?• DepolarizationDepolarization
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• Phase 1?Phase 1?• No nameNo name
• Phase 2?Phase 2?
• Plateau phase (A-V node)Plateau phase (A-V node)
What is happening in theWhat is happening in theAtrium?Atrium?
• Phase 3?Phase 3?• RepolarizationRepolarization
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Repolarizationp
• Phase 4?Phase 4?• Automaticity (S-A node)Automaticity (S-A node)
What do Na+ channels doWhat do Na+ channels doto the EKG?to the EKG?
• Wider QRSWider QRS
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What does Ca+ do to theWhat does Ca+ do to theEKG?EKG?
• Wider P-waveWider P-wave• Longer PR intervalLonger PR interval
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What are the types of What are the types of kidney stones?kidney stones?
• Calcium oxalate (phosphate) stonesCalcium oxalate (phosphate) stones• Struvite stonesStruvite stones• Uric acid stonesUric acid stones
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• Uric acid stonesUric acid stones
• Cysteine stonesCysteine stones• Oxalate stonesOxalate stones
What percent of kidney stonesWhat percent of kidney stonesare calcium oxalate?are calcium oxalate?
• 80%80%
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If you find oxalate stones in theIf you find oxalate stones in thefollowing what should youfollowing what should youthink of?think of?• 3 y/o white male?3 y/o white male?• CFCF
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• 5 y/o black male?5 y/o black male?• Celiac SprueCeliac Sprue
If you find oxalate stones in theIf you find oxalate stones in thefollowing what should youfollowing what should youthink of?think of?• Adult male?Adult male?• Whipple’sWhipple’s
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• Adult male or female?Adult male or female?• Crohn’sCrohn’s
If oxalate stones found in CFIf oxalate stones found in CFwhat is the most commonwhat is the most commoncause?cause?
• In 0-20 y/o?In 0-20 y/o?• MalabsorptinMalabsorptin
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• What age do they die?What age do they die?• Young Young
Answer the following questionsAnswer the following questionsabout pseudogout?about pseudogout?
• What type of crystals areWhat type of crystals arepresent?present?
• Calcium pyrophosphateCalcium pyrophosphate
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• Where are they found?Where are they found?• Joint spaces Joint spaces
Answer the following questionsAnswer the following questionsabout pseudogout?about pseudogout?
• Who gets it?Who gets it?
• Older patients M=FOlder patients M=F
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• Tx? Tx?• ColchicineColchicine
What are the most commonWhat are the most commonnon-cyanotic heart disease?non-cyanotic heart disease?
• VSDVSD• ASDASD• PDAPDA
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• PDAPDA
• CoarctationCoarctation
What murmur increases onWhat murmur increases onexpiration?expiration?
• VSDVSD• MitralMitral
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What murmur has fixedWhat murmur has fixedwide splitting?wide splitting?
• ASDASD
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What murmur has boundingWhat murmur has boundingpulses?pulses?
• PDAPDA
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What gives you differenitalWhat gives you differenitalpulses?pulses?
• CoarctationCoarctation
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What is increased incidenceWhat is increased incidencein Turners?in Turners?
• CoarctationCoarctation
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What are 4 enzymes neverWhat are 4 enzymes neverseen in glycolysis?seen in glycolysis?
• Pyruvate carboxylasePyruvate carboxylase• PEP carboxykinasePEP carboxykinase• F-1 6 dPhosphataseF-1 6 dPhosphatase
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F 1,6 dPhosphataseF 1,6 dPhosphatase
• G-6-PhosphataseG-6-Phosphatase
What are 3 enzymes seenWhat are 3 enzymes seenONLY in glycolysis?ONLY in glycolysis?
• HexokinaseHexokinase• PFK-1PFK-1• Pyruvate kinasePyruvate kinase
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Pyruvate kinasePyruvate kinase
What are 2 hormones thatWhat are 2 hormones thatare acidophilic?are acidophilic?
• ProlactinProlactin• GHGH
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What are the partially acidWhat are the partially acidfast Gram +ve?fast Gram +ve?
• NocardiaNocardia
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What are the partially acidWhat are the partially acidfast Protozoa?fast Protozoa?
• CryptosporidiumCryptosporidium
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What are the septic emboliWhat are the septic emboliof SBE?of SBE?
• Mycotic aneurysmMycotic aneurysm• Roth spotsRoth spots• Janeway lesionsJaneway lesions
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Janeway lesions Janeway lesions
• Osler’s nodesOsler’s nodes• Splinter hemorrhagesSplinter hemorrhages• EndocarditisEndocarditis
Where are the followingWhere are the followinglesions found?lesions found?• Janeway lesions? Janeway lesions?• Toes Toes
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• Osler’s nodes?Osler’s nodes?• FingersFingers
• Roth spots?Roth spots?
• RetinaRetina
What is the most commonWhat is the most commoncause of endocarditis?cause of endocarditis?
• Strep. viridansStrep. viridans
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What causesWhat causesmicrosteatosis?microsteatosis?
• AcetaminophenAcetaminophen• Reye SyndromeReye Syndrome• PregnancyPregnancy
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eg a cyg y
What causesWhat causesmacrosteatosis?macrosteatosis?
• AlcoholAlcohol
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What are 2 bacteria thatWhat are 2 bacteria thatrelease elastase?release elastase?
• Staph. AureusStaph. Aureus• PseudomonasPseudomonas
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What are the 2 bacteria withWhat are the 2 bacteria withtoxins that inhibit EF-2?toxins that inhibit EF-2?
• PseudomonasPseudomonas• DiptheriaDiptheria
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How does Diptheria work?How does Diptheria work?
• It ADP ribosylates EF2 inhibiting proteinIt ADP ribosylates EF2 inhibiting proteinsynthesissynthesis
• I it G +/ ?Is it Gram +/ ?
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• Is it Gram +/-?Is it Gram +/-?
• ++
• Where and how does it get its exotoxin?Where and how does it get its exotoxin?
• From virus via transductionFrom virus via transduction
How does Diptheria work?How does Diptheria work?
• What does it cause?What does it cause?• Heart blockHeart block
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• What do you give for Tx?What do you give for Tx?• AntitoxinAntitoxin
• Never scrape membraneNever scrape membrane
What are the different types of What are the different types of Emphysema and their causes?Emphysema and their causes?
• Bullous?Bullous?
• Staph aureusStaph aureus• PseudomonasPseudomonas
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• Centroacinar?Centroacinar?
• SmokingSmoking
What are the different types of What are the different types of Emphysema and their causes?Emphysema and their causes?
• Distalacinar?Distalacinar?• AgingAging
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• Panacinar?Panacinar?• Alpha-1 antitrypsin def Alpha-1 antitrypsin def
What are the stages of What are the stages of erythropoiesis?erythropoiesis?• 4 mo gestation?4 mo gestation?• Yolk sac Yolk sac
• 6 mo gestation?6 mo gestation?
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• 6 mo gestation?6 mo gestation?
• Spleen, liver, flat bonesSpleen, liver, flat bones
What are the stages of What are the stages of erythropoiesis?erythropoiesis?• 8 mo gestation?8 mo gestation?• Long bonesLong bones
• 1 ld?1 ld?
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• 1 yr old?1 yr old?• Long bonesLong bones
If long bones become damagedIf long bones become damagedafter 1 yr what takes over?after 1 yr what takes over?
• Spleen can resume erythropoiesesSpleen can resume erythropoiesescausing splenomegalycausing splenomegaly
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What ions correspond withWhat ions correspond withthe following EKG?the following EKG?• P-wave?P-wave?• Ca+Ca+
l
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• QRS complex?QRS complex?
• Na+Na+
• S-T?S-T?• Ca+Ca+
What ions correspond withWhat ions correspond withthe following EKG?the following EKG?
• T-wave? T-wave?• K+K+
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• U-wave?U-wave?• Na+Na+
What do Na+ channelWhat do Na+ channelblockers do to the EKG?blockers do to the EKG?
• QRSQRS
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What do Ca+ channelWhat do Ca+ channelblockers do to the EKG?blockers do to the EKG?
• Widens P-waveWidens P-wave
• PR interval longerPR interval longer
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P.P. Clue 4 Bio StatP.P. Clue 4 Bio Stat
C+DC _
A+BB+
WD
A
D
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ALLB+DA+CSensitivity A/A+CSpecificity D/B+DPPV A/A+BNPV D/C+DOR AD/BC
RR (A/All) / (C/All)
AR (A/All)- (C/All)
Sensitivity: Truly D iseased PeopleSpecificity: Truly W ell People+ Predictive Value: Test + ve With DZ
- Predictive Value: Tested – ve w/o DZOR: Odds RatioRR: Relative RiskAR: Attributed Risk
Always in thenumerator
A&D
In EKG P-wave Represents?In EKG P-wave Represents?
•Atrium contractionAtrium contraction
• Phase zeroPhase zero• CalciumCalcium
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In EKG P-R Interval means?In EKG P-R Interval means?
•AV NodeAV Node
• Phase 2Phase 2• SodiumSodium
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In EKG R-upstoke means?In EKG R-upstoke means?
• Anterior wallAnterior wall• Phase 2Phase 2• SodiumSodium
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In EKG S-down strokeIn EKG S-down strokemeans?means?• Posterior wallPosterior wall• Phase 2Phase 2• SodiumSodium
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In EKG S-T Interval means?In EKG S-T Interval means?
• VentricleVentricle• Phase 2Phase 2• CalciumCalcium
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In EKG T-wave means?In EKG T-wave means?
• VentricleVentricle• Phase 3Phase 3• PotassiumPotassium
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In EKG U-wave meansIn EKG U-wave means
• VentricleVentricle• Phase 4Phase 4• SodiumSodium
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4 DZ associated with HLA-4 DZ associated with HLA-DR 2?DR 2?• NarcolepsyNarcolepsy• Allergy (hay fever)Allergy (hay fever)• GoodpastureGoodpasture
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• MSMS
5 DZ associated with HLA-5 DZ associated with HLA-DR 3?DR 3?• DMDM• Chronic active HepititisChronic active Hepititis• SjogrensSjogrens
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• SLESLE• Celiac sprueCeliac sprue
DZ associated with HLA-DRDZ associated with HLA-DR3&4?3&4?
• IDDM (DM Type 1)IDDM (DM Type 1)
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DZ associated with HLA-DRDZ associated with HLA-DR4?4?• Rheumatoid ArthritisRheumatoid Arthritis• Pemphigus VulgarisPemphigus Vulgaris
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DZ associated with HLA-DRDZ associated with HLA-DR55• JRA (JUV RA) JRA (JUV RA)• Pernicious anemiaPernicious anemia
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DZ associated with HLA-DRDZ associated with HLA-DR7?7?• Nephrotic syndrome (SteroidNephrotic syndrome (Steroid
induced)induced)
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DZ associated with HLA-DRDZ associated with HLA-DR3 and HLA-B 8?3 and HLA-B 8?• Celiac DiseaseCeliac Disease
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DZ Associated with HLA-A3?DZ Associated with HLA-A3?
• HemochromatosisHemochromatosis– chromosome 6chromosome 6– point mutation Cystine to Tyrosinepoint mutation Cystine to Tyrosine
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DZ Associated with HLA-ADZ Associated with HLA-A3?3?• Myasthenia gravisMyasthenia gravis
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DZ Associated with HLA-BDZ Associated with HLA-B13?13?• PsoriasisPsoriasis
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5 DZ Associated with HLA-B5 DZ Associated with HLA-B27?27?
• PsoriasisPsoriasis– only if with arthritisonly if with arthritis
• Ankylosing SpondylitiesAnkylosing Spondylities
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• IBDIBD– Ulcerative CholitisUlcerative Cholitis
• Reiter’sReiter’s
• Post gonococcal arthritisPost gonococcal arthritis
DZ Associated to HLA-BWDZ Associated to HLA-BW4747• 21 alpha hydroxylase deficiency21 alpha hydroxylase deficiency
– Vit. DVit. D
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Facts about DiphtheriaFacts about Diphtheria
• ADP ribosylates EF-2ADP ribosylates EF-2• Stops cell synthesisStops cell synthesis• Gr +veGr +ve• Gets exotoxin from virus viaGets exotoxin from virus via
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Gets exotoxin from virus viaGets exotoxin from virus viatransductiontransduction
• Heart blockHeart block• Its toxoid therefore give antitoxinIts toxoid therefore give antitoxin
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MCC Pneumonia in 18 yrs to 40MCC Pneumonia in 18 yrs to 40yrs of age?yrs of age?
• MycoplasmaMycoplasma• Chlamydia pneumoniaChlamydia pneumonia• Strep. PneumoniaStrep. Pneumonia
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MCC of Pneumonia in 40 yrsMCC of Pneumonia in 40 yrsto 65 yrs of age?to 65 yrs of age?• Strep pneumoniaStrep pneumonia• H. influenzaH. influenza• AnaerobesAnaerobes
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MCC of pneumonia in theMCC of pneumonia in theElderly?Elderly?
• Strep pneumoniaStrep pneumonia• VirusesViruses• AnaerobesAnaerobes
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• H.influenzaH.influenza• Gr –ve rodsGr –ve rods
What are 4 Clues for IgA?What are 4 Clues for IgA?
• Monomer in bloodMonomer in blood• Dimer in secretionDimer in secretion• Located on mucosal surfaceLocated on mucosal surface
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• Found in secretionFound in secretion
What are Clues for IgD?What are Clues for IgD?
• Only functions as surface marker forOnly functions as surface marker forMature B-CellMature B-Cell
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What are Clues for IgE?What are Clues for IgE?
• ImmediateImmediatehypersensitivity/anaphylaxishypersensitivity/anaphylaxis
• Parasite defenseParasite defense• WormsWorms
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• Fc region binds to mast cells andFc region binds to mast cells andbasophilsbasophils
• AllergiesAllergies
• Does Not fix complementDoes Not fix complement
What are Clues for IgG?What are Clues for IgG?• Highest affinityHighest affinity
• Memory respond atMemory respond at day 3
day 3 five times thefive times theconcentrationconcentration• Peaks in 5 years last for 10 yearsPeaks in 5 years last for 10 years• OpsonizesOpsonizes• Activates complementActivates complement
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Activates complementct vates co p e e t• 22 ndnd to show up in primary responseto show up in primary response• Only one to show up for secondary respondOnly one to show up for secondary respond• Most abundant Ig in newbornMost abundant Ig in newborn• Antigenic differences in heavy chain and site of Antigenic differences in heavy chain and site of
di-sulfide bonddi-sulfide bond• 4 subclasses G1 to G44 subclasses G1 to G4
What are Clues for IgG1?What are Clues for IgG1?
• Crosses placenta due to fc portionCrosses placenta due to fc portion
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What are Clues for IgG2?What are Clues for IgG2?
• Most common sub-class deficiencyMost common sub-class deficiency• Patient susceptible to encapsulatedPatient susceptible to encapsulated
organismsorganisms
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What are Clues for IgG3?What are Clues for IgG3?
• MostMost memorymemory antibodyantibody
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What are Clues for IgG4?What are Clues for IgG4?
• Only IgG NOT fixing complementOnly IgG NOT fixing complement
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What are Clues for IgM?What are Clues for IgM?
• Responds in primary responseResponds in primary response• Most efficient in agglutination andMost efficient in agglutination and
complement fixationcomplement fixation• Defenses against bacteria andDefenses against bacteria and
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Defenses against bacteria andDefenses against bacteria andvirusesviruses
What do MacrophagesWhat do Macrophagesrelease?release?• MHC IIMHC II
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What does TH1 secrete?What does TH1 secrete?
• IL-2IL-2• IF- GammaIF- Gamma
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What does TH2 Secrete?What does TH2 Secrete?
• IL-4IL-4• IL-5IL-5• IL-6IL-6
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• IL-10IL-10
What does TH-0 secrete?What does TH-0 secrete?
• TH-1 TH-1• TH-2 TH-2
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MHC-1 are also called what?MHC-1 are also called what?
• CD8CD8• CD8 becomes T-cytotoxic cellsCD8 becomes T-cytotoxic cells
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All T-Cells express what?All T-Cells express what?
• CD-3CD-3• For what?For what?• Signal transductionSignal transduction
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• CD-2CD-2• For what?For what?
• AdherenceAdherence
What do CD-4 cellsWhat do CD-4 cellsBecome?Become?• T helper cells T helper cells
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What do CD-8 cellsWhat do CD-8 cellsBecome?Become?• T cytotoxic cells T cytotoxic cells
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Neutrophils produce whatNeutrophils produce whatenzymes and what is theirenzymes and what is theiraction?action?• MyeloperoxidaseMyeloperoxidase• NADPHNADPH• Will kill ALL Gr+veWill kill ALL Gr+ve
– Ex..Hydrogen peroxide kills gr+Ex..Hydrogen peroxide kills gr+
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Ex..Hydrogen peroxide kills gry g p g
What do T-cells stimulate?What do T-cells stimulate?
• Clue 4x7=28Clue 4x7=28
• CD-4CD-4
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• B-7B-7• CD-28CD-28
What are the Clues for Type-1What are the Clues for Type-1Hyperlipidemia?Hyperlipidemia?
• Increased ChylomicronIncreased Chylomicron• Deficiency of Lipoprotein lipaseDeficiency of Lipoprotein lipase
enzymeenzyme• Defect in liver onlyDefect in liver only
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yy
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What are the Clues for Type-5What are the Clues for Type-5hyperlipedimia?hyperlipedimia?
• Combination of Types 1&4Combination of Types 1&4• Increased Chylomicron and VLDLIncreased Chylomicron and VLDL• Enzyme and receptor deficiency atEnzyme and receptor deficiency at
C-IIC-II
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• Most common in diabeticsMost common in diabetics
What is a Xanthoma?What is a Xanthoma?
• Deposition of Cholesterol on elbowsDeposition of Cholesterol on elbows• Can cause what?Can cause what?• CADCAD
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What is a Xanthelasma?What is a Xanthelasma?
• Deposition of Triglycerides onDeposition of Triglycerides oneyelids, faceeyelids, face
• Can cause what?Can cause what?• PancreatitisPancreatitis
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ERYTHEMA MARGINATUMERYTHEMA MARGINATUM• Little red spots w/ bright red marginsLittle red spots w/ bright red margins
• SandpaperySandpapery• RF- Jones criteraRF- Jones critera
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ERYTHEMIA CHRONICUMERYTHEMIA CHRONICUMMIGRANSMIGRANS• Lymes diseaseLymes disease• Target lesions (bulls eye) Target lesions (bulls eye)
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MEASLESMEASLES
• Morbiliform rashMorbiliform rash• Preceded by coughPreceded by cough• conjunctiivitisconjunctiivitis
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ROSEOLAROSEOLA
• Fever x 2 dayFever x 2 day• Followed by rashFollowed by rash• ONLY ONE WITH RASH FOLLOWINGONLY ONE WITH RASH FOLLOWING
FEVER (HHV 6)FEVER (HHV 6)
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ERYTHEMA NODOSUMERYTHEMA NODOSUM
• Anterior aspect of legAnterior aspect of leg• RednessRedness• Tender nodules Tender nodules
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Erythema multiformeErythema multiforme• Red macules, target lesionsRed macules, target lesions
• Causes: allergy, virusesCauses: allergy, viruses• Mild:Mild: MCC virus, #2 drugs (sulfas)MCC virus, #2 drugs (sulfas)• Moderate:Moderate: Stevens-JohnsonsStevens-Johnsons
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SyndromeSyndrome• Severe:Severe: Toxic epidermal necrolysis , Toxic epidermal necrolysis ,
skin peels off skin peels off
SEBORRHEIC DERMATITISSEBORRHEIC DERMATITIS
• Scaly skin with oily shine on headlineScaly skin with oily shine on headline
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SEBORRHEIC KERATOSISSEBORRHEIC KERATOSIS
• Stuck on wartsStuck on warts• Due to agingDue to aging
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PSORIASISPSORIASIS
• HLA-B27HLA-B27• Extensor surfacesExtensor surfaces• Silvery white plaquesSilvery white plaques
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• Scaly skinScaly skin• Pitted nailsPitted nails
VARICELLA ZOSTER HHV 3VARICELLA ZOSTER HHV 3• STAGESSTAGES
• Red maculesRed macules• PapulesPapules• VesiclesVesicles
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• Pustules then scabsPustules then scabs• Different stages may appear atDifferent stages may appear at
same timesame time
DERMATITISDERMATITISHERPATIFORMISHERPATIFORMIS• Rash and blisters on ant. thighsRash and blisters on ant. thighs• Assoc. with diarrheaAssoc. with diarrhea• Assoc. with flare up of celiac sprueAssoc. with flare up of celiac sprue
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TYPHOID FEVER TYPHOID FEVER
• SEEN WITH SALMONEALLA INFXNSEEN WITH SALMONEALLA INFXN• Rose spots assoc. with intestinal fireRose spots assoc. with intestinal fire
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DERMATOMYOSITISDERMATOMYOSITIS
• Heliotropic rashHeliotropic rash
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ERYSIPELASERYSIPELAS
• Reddened area on skin w/ raisedReddened area on skin w/ raisedbordersborders
• DOES NOT BLANCHDOES NOT BLANCH
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TINEEA CRURIS TINEEA CRURIS
• RednessRedness• Itchy groinItchy groin
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PITYRIASIS ROSEAPITYRIASIS ROSEA
• Herald patch= dry skin patches thatHerald patch= dry skin patches thatfollow skin linesfollow skin lines
• HHV 7HHV 7
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TINEA VERSICOLOR TINEA VERSICOLOR
• Hypopigmented macules on upperHypopigmented macules on upperbackback
• Presents in a V patternPresents in a V pattern• A.K.A. upside down christmas treeA.K.A. upside down christmas tree
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• Tx: Griseofulvin Tx: Griseofulvin
What do you see inWhat do you see inSCABIES?SCABIES?• Linear excoriations on belt line andLinear excoriations on belt line and
finger websfinger webs• What is the tx?What is the tx?• LindaneLindane
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• PermethrinPermethrin
What is a T-CELL DEFICIENCY?What is a T-CELL DEFICIENCY?
• DiGeorgesDiGeorges• What ion imbalance will they have?What ion imbalance will they have?• HypokalemiaHypokalemia
Wh did f ?What did not form?
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• What did not form?• 33 rdrd and 4and 4 thth pharyngeal pouchpharyngeal pouch• What chromosome?What chromosome?
• Deletion on chromosome 22Deletion on chromosome 22
T-CELL DEFICIENCY T-CELL DEFICIENCY
• HIVHIV• Also B-cell but less soAlso B-cell but less so
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What is MYCOSISWhat is MYCOSISFUNGOIDES?FUNGOIDES?• NOT A FUNGUSNOT A FUNGUS• Non-Hodgkins form of cutaneous T-Non-Hodgkins form of cutaneous T-
cell lymphomacell lymphoma
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What is the job of What is the job of CHYLOMICRONS?CHYLOMICRONS?
• Transport TG’s from GI to liver and Transport TG’s from GI to liver andendotheliumendothelium
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What is the job of VLDL?What is the job of VLDL?
• Transports TG’s from liver to adipose Transports TG’s from liver to adipose
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What is the job of IDL?What is the job of IDL?
• Transports TG’s from adipose to Transports TG’s from adipose totissuetissue
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What is special about LDL’s?What is special about LDL’s?
• ONLY ONE THAT CARRIESONLY ONE THAT CARRIESCHOLESTEROLCHOLESTEROL
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What do you develop withWhat do you develop withHYPERTRIGLYCERIDEMA?HYPERTRIGLYCERIDEMA?
• XANTHELASMAXANTHELASMA
• Where are they located?Where are they located?
On eyelids and eyebrowsOn eyelids and eyebrows
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• On eyelids and eyebrows
What do you develop withWhat do you develop withHYPERCHOLESTEROLEMIA?HYPERCHOLESTEROLEMIA?
• XanthomasXanthomas
• Where are they located?Where are they located?
elbowselbows
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• elbows
Where is VLDL made?Where is VLDL made?• ONLY ONE MADE IN THE LIVERONLY ONE MADE IN THE LIVER
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What are the clues forWhat are the clues forHEMOPHILIUS INFLUENZA?HEMOPHILIUS INFLUENZA?
• Gram -/+?Gram -/+?
• Pleomorphic gram (-) rodsPleomorphic gram (-) rods• What pattern?What pattern?• ““school of fish pattern”school of fish pattern”
What type is most common?What type is most common?
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• What type is most common?What type is most common?• Type A Type A
– 80%80%
What are the clues forWhat are the clues forHEMOPHILIUS INFLUENZA?HEMOPHILIUS INFLUENZA?
• Capsule or no capsule?Capsule or no capsule?
• non-encapsulatednon-encapsulated• Invasive or non invasive?Invasive or non invasive?• non-invasivenon-invasive
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What are the clues forWhat are the clues forHEMOPHILIUS INFLUENZA?HEMOPHILIUS INFLUENZA?
• Most common cause of what?Most common cause of what?
• SinusitisSinusitis• OtitisOtitis• BronchitisBronchitis
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What are the clues forWhat are the clues forHEMOPHILIUS INFLUENZA?HEMOPHILIUS INFLUENZA?• What is the 2What is the 2 ndnd most common type?most common type?
• TYPE B TYPE B– 20%20%• Encapsulated or non encapsulated?Encapsulated or non encapsulated?• EncapsulatedEncapsulated
• What does it have in its capsule?What does it have in its capsule?
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• What does it have in its capsule?What does it have in its capsule?• Polyribosyl phosphate in capsulePolyribosyl phosphate in capsule• Contains IgA proteaseContains IgA protease
What are the clues forWhat are the clues forHEMOPHILIUS INFLUENZA?HEMOPHILIUS INFLUENZA?
• Invasive or non invasive?Invasive or non invasive?• InvasiveInvasive• What does it cause most often?What does it cause most often?• #1 cause of epiglottitis#1 cause of epiglottitis
• What are the signs of epiglottitis?What are the signs of epiglottitis?
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• What are the signs of epiglottitis?What are the signs of epiglottitis?• StridorStridor• FeverFever• Thumb sign on xray Thumb sign on xray
a are e mos commoncauses of MENINGITIScauses of MENINGITIScorresponding with thecorresponding with thefollowing ages?following ages?• 0-2 months?0-2 months?
• #1. Group B strep (agalactiae)#1. Group B strep (agalactiae)• #2. E. coli#2. E. coli• #3. Listera#3. Listera
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a are e mos common
causes of MENINGITIScauses of MENINGITIScorresponding with thecorresponding with thefollowing ages?following ages?• 2 Months- 10 years?2 Months- 10 years?
• #1. strep pneumonia#1. strep pneumonia• #2. n. meningitides#2. n. meningitides• (adolescent years only)(adolescent years only)
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a are e mos common
causes of MENINGITIScauses of MENINGITIScorresponding with thecorresponding with thefollowing ages?following ages?• 10yrs- 21 yrs?10yrs- 21 yrs?
• #1. n. meningitides#1. n. meningitides
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a are e mos common
causes of MENINGITIScauses of MENINGITIScorresponding with thecorresponding with thefollowing ages?following ages?• > 21 years old?> 21 years old?
• #1 S. pneumoniae#1 S. pneumoniae
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Answer the following about theAnswer the following about theStrep. Pneumonia vaccine.Strep. Pneumonia vaccine.
• At what age is it given?At what age is it given?
• Given at 2,4,6 monthsGiven at 2,4,6 months• What strain does it cover?What strain does it cover?• Covers 23 strains (98% cases)Covers 23 strains (98% cases)
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Answer the following about theAnswer the following about theStrep. Pneumonia vaccine.Strep. Pneumonia vaccine.
• Indications?Indications?
• Anyone> 65y/oAnyone> 65y/o• Anyone splenectomizedAnyone splenectomized
– Sickle cell anemiaSickle cell anemia
• Anyone with end-organ damageAnyone with end-organ damage
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• Anyone with end-organ damageAnyone with end-organ damage– CFCF– RFRF
– Nephrotic SyndromeNephrotic Syndrome
STREP PYOGENES is the mostSTREP PYOGENES is the mostcommon cause of what?common cause of what?
• MCC of all throat infectionsMCC of all throat infections
• #2 MCC of all what?#2 MCC of all what?• Skin infections except linesSkin infections except lines
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What are theWhat are theSTAPHYLOCOCCUS PIGMENTS?STAPHYLOCOCCUS PIGMENTS?
• St. aureus?St. aureus?
• Gold pigmentGold pigment• St. epidermidis?St. epidermidis?• White pigmentWhite pigment
St h ti ?St h ti ?
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• St. saprophyticus?St. saprophyticus?• No pigmentNo pigment
What is the clue for RUSTYWhat is the clue for RUSTYCOLORED SPUTUM?COLORED SPUTUM?
• Strep. PneumoniaStrep. Pneumonia– pneumococcuspneumococcus
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Clues for GENERALClues for GENERALINFECTIONSINFECTIONS• Skin Infections?Skin Infections?
• Say Staph. AureusSay Staph. Aureus
• Throat Infections? Throat Infections?
• Say Strep. PyogenesSay Strep. Pyogenes
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Say Strep. PyogenesSay Strep. Pyogenes
• Small Intestine Infections?Small Intestine Infections?
• Say E. coliSay E. coli
What disease is a NEUTROPHILWhat disease is a NEUTROPHIL
DEFICIENCY & T,B cellDEFICIENCY & T,B celldeficiency?deficiency?• Job Syndrome: Job Syndrome:
• IL-4IL-4• Hyper IgEHyper IgE• What do they look like?What do they look like?• R d h iRed hair
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• Red hairRed hair• Fair complexionFair complexion
• FemaleFemale
What are the NEUTROPHILWhat are the NEUTROPHILDEFICIENCY?DEFICIENCY?
• NADPH-OXIDASE DEF (CGD)NADPH-OXIDASE DEF (CGD)
• NEUTROPENIANEUTROPENIA• MYLOPEROXIDASEMYLOPEROXIDASE• Job-Buckley Syndrome Job-Buckley Syndrome
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What Hepatitis B antigen isWhat Hepatitis B antigen is
found with an acute/recentfound with an acute/recentinfection?infection?• HbC antigenHbC antigen
• HbS antigenHbS antigen
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What Hepatitis B antigen &What Hepatitis B antigen &
antibody is found with anantibody is found with anacute/recent infection?acute/recent infection?
• HbC antigenHbC antigen• HbS antigenHbS antigen• HbC antibodyHbC antibody
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a epa s an gen s
found with Recentfound with Recentimmunization within the pastimmunization within the past2wks?2wks?
• HbS antigen ONLYHbS antigen ONLY
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What Hepatitis B antibody is found withWhat Hepatitis B antibody is found withRecent immunization two wks after and canRecent immunization two wks after and canbe due to vaccination immunity from a longbe due to vaccination immunity from a longtime ago?time ago?
• HbS antibody ONLYHbS antibody ONLY
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What Immunogloblin is foundWhat Immunogloblin is foundin Hepatitis B immunity?in Hepatitis B immunity?
• IgGIgG
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What Hepatitis BWhat Hepatitis B
antigen/antibody is found inantigen/antibody is found inthe chronic carrier state?the chronic carrier state?
• HbS antigen for >6monthsHbS antigen for >6months• Can be with or without HbS antibodyCan be with or without HbS antibody
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What Hepatitis B antigen isWhat Hepatitis B antigen isfound with the infectious state?found with the infectious state?
• HbE antigenHbE antigen
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What Hepatitis B antibody isWhat Hepatitis B antibody is
found with the non-infectiousfound with the non-infectiousstate?state?
• HbE antibodyHbE antibody
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If patient has recovered fromIf patient has recovered from
Hepatitis B what antigen willHepatitis B what antigen willthey have?they have?
• NEGATIVE HbS antigenNEGATIVE HbS antigen
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If patient is a chronic carrierIf patient is a chronic carrierwhat antigen will they have?what antigen will they have?
• POSITIVE HbS antigenPOSITIVE HbS antigen
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What does the “windowWhat does the “windowperiod” build in Hepatitis B?period” build in Hepatitis B?
• HbE antibodyHbE antibody• IgM HbC antibodyIgM HbC antibody
• What disappears?What disappears?
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What disappears?What disappears?• HbS antigenHbS antigen
What is the incubation periodWhat is the incubation periodfor Hepatitis B?for Hepatitis B?
• 4 to 26 wks4 to 26 wks• Average @ 8wksAverage @ 8wks
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How long is the convalescenceHow long is the convalescenceperiod in Hepatitis B?period in Hepatitis B?
• 4 to 20 wks4 to 20 wks
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Answer the following aboutAnswer the following aboutHIV?HIV?• MC infection?MC infection?
• CMVCMV• MCC of death?MCC of death?• PCPPCP
• What is p41 used for?What is p41 used for?J kJ t k
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• Just a marker Just a marker
Answer the following questionsAnswer the following questionsabout HIV?about HIV?• What does Gp120 do?What does Gp120 do?
• Attachment to CD4Attachment to CD4• What is Pol used for?What is Pol used for?• IntegrationIntegration
• What is reverse transcriptase used for?What is reverse transcriptase used for?• T i tiT i ti
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• Transcription Transcription• What are p17 & p24 antigens used for?What are p17 & p24 antigens used for?
• AssemblyAssembly
Answer the following questionsAnswer the following questionsabout HIV?about HIV?• What is the normal CD4 count?What is the normal CD4 count?
• 800-1200800-1200• What can the CD4 count be up to inWhat can the CD4 count be up to in
children?children?
• 15001500• When do you begin treating with 2When do you begin treating with 2
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• When do you begin treating with 2When do you begin treating with 2nucleotide inhibitors and 1 proteasenucleotide inhibitors and 1 proteaseinhibitor?inhibitor?
• <500<500– (child at 750)(child at 750)
Answer the following questionsAnswer the following questionsabout HIV?about HIV?• AIDS is defined as a CD4 count of AIDS is defined as a CD4 count of
what?what?• <200<200• With a CD4 count of <200 what doWith a CD4 count of <200 what do
you tx for?you tx for?• PCPPCP
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yy• PCPPCP• What do you treat for when CD countWhat do you treat for when CD count
is <100?is <100?• Mycobacterium aviam intracellularMycobacterium aviam intracellular
What are the Antioxidants?What are the Antioxidants?• Vitamin EVitamin E
– #1#1• Vitamin AVitamin A• Vitamin CVitamin C• BetakertineBetakertine
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What is Vitamin A a cofactorWhat is Vitamin A a cofactorfor?for?
• ParathyroidParathyroid
• Along with what other cofactor?Along with what other cofactor?• Mg+Mg+
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Too much Vitamin A will cause Too much Vitamin A will causewhat?what?• HyperparathyroidHyperparathyroid
– Increase Ca+Increase Ca+– Decrease PhosphateDecrease Phosphate
• What will be the symptoms?What will be the symptoms?
•GoansGoans
• MoansMoans
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Moans• BonesBones• StonesStones
Too much Vitamin A will cause Too much Vitamin A will causewhat?what?
• Pseudotumor CerebriPseudotumor Cerebri– Increase CSF production from ChorichoidIncrease CSF production from Chorichoid
PlexusPlexus
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What is the only cause of ICPWhat is the only cause of ICP
that does not causethat does not causeherniation?herniation?• Pseucotumor cerebriPseucotumor cerebri
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What does Vitamin AWhat does Vitamin Adeficiency cause?deficiency cause?
• Nightvision problems/nightblindnessNightvision problems/nightblindness
• HypoparathyroidismHypoparathyroidism– Decrease Ca+Decrease Ca+
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– Increase PhosphateIncrease Phosphate
What is Vitamin B1?What is Vitamin B1?• THIAMINE THIAMINE
• What do you get with a decrease inWhat do you get with a decrease inthiamine?thiamine?
• Beri BeriBeri Beri
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• What is the most common cause in US?What is the most common cause in US?• ETOHETOH
What do you get with VitaminWhat do you get with VitaminB1 deficiency?B1 deficiency?
• Wet Berry BerryWet Berry Berry
• With heart failureWith heart failure
• Dry Berry BerryDry Berry Berry• Without heart failureWithout heart failure
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What do you get with VitaminWhat do you get with VitaminB1 deficiency?B1 deficiency?
• Wernicke’s EncephalopathyWernicke’s Encephalopathy
• Wernicke’s Korsakoff Wernicke’s Korsakoff
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What is Wernicke’sWhat is Wernicke’sEncephalopathy?Encephalopathy?
• Alcoholic thymine deficiency of theAlcoholic thymine deficiency of the Temporal Lobe Temporal Lobe
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What is Wernicke’sWhat is Wernicke’sKorsakoff?Korsakoff?
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What needs B1 as aWhat needs B1 as aCofactor?Cofactor?• 3 Dehydrogenases3 Dehydrogenases
• Pyruvate dehydrogenasePyruvate dehydrogenase• Alpha ketoglutarate dehydrogenaseAlpha ketoglutarate dehydrogenase• Branch chain amino acidBranch chain amino acid
dehydrogenasedehydrogenase
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• Transketolase Transketolase
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What is the best source of What is the best source of B2?B2?• MilkMilk
• Also from FADAlso from FAD
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What is the disease thatWhat is the disease thatpresents like B3 deficiency?presents like B3 deficiency?
• Hartnup DiseaseHartnup Disease
• What is deficient in this disease?What is deficient in this disease?• Tyrptophan Tyrptophan
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• What is typtophan needed for?What is typtophan needed for?
• Needed for niacin formationNeeded for niacin formation
What is B4?What is B4?
• Lipoic acidLipoic acid
• What is the deficiency caused by thisWhat is the deficiency caused by thisvitamin?vitamin?
• Not oneNot one
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What is B5?What is B5?• Pantothenic acidPantothenic acid
• What is the deficiency caused by thisWhat is the deficiency caused by thisvitamin?vitamin?
• You guessed it…nothing You guessed it…nothing
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What is B6?What is B6?• PyridoxinePyridoxine
• What is the deficiency caused by thisWhat is the deficiency caused by thisvitamin?vitamin?
• NeuropathyNeuropathy• SeizuresSeizures
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• Who do you need to give B6 to?Who do you need to give B6 to?• Patient on INHPatient on INH
What type of anemia is seenWhat type of anemia is seenwith B6 Deficiency?with B6 Deficiency?
• SideroblasticSideroblastic
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What needs B6 as aWhat needs B6 as acofactor?cofactor?• ALL transaminasesALL transaminases
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What is B12?What is B12?• CyanocobalamineCyanocobalamine
• What is the deficiency caused by thisWhat is the deficiency caused by thisvitamin?vitamin?
• Pernicious anemiaPernicious anemia
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• NeuropathyNeuropathy
What is the most commonWhat is the most common
cause of vitamin B12cause of vitamin B12deficiency?deficiency?• Pernicious anemiaPernicious anemia
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What 2 enzymes are neededWhat 2 enzymes are neededfor synthesis of B12?for synthesis of B12?• Methylmalonyl CoA MutaseMethylmalonyl CoA Mutase
• Homocysteine Methyl TransferaseHomocysteine Methyl Transferase
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Deficiency in MethylmalonylDeficiency in MethylmalonylCoA Mutase leads to what?CoA Mutase leads to what?
• NeuropathyNeuropathy
• Why?Why?• Because it recycles myelinBecause it recycles myelin
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Deficiency in HomocystieneDeficiency in Homocystiene
Methyl Transferase leads toMethyl Transferase leads towhat?what?• Megaloblastic anemiaMegaloblastic anemia
• What else is this enzyme needed for?What else is this enzyme needed for?• Nucleotide synthesisNucleotide synthesis
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When is ANGULAREWhen is ANGULARESTOMATOSIS seen?STOMATOSIS seen?• VITAMIN B2- RIBOFLAVIN deficiencyVITAMIN B2- RIBOFLAVIN deficiency
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What are the 4 D’S of What are the 4 D’S of pellegra?pellegra?• DIARRHEADIARRHEA
• DERMATITISDERMATITIS• DEMENTIADEMENTIA• DEATHDEATH
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What causes aWhat causes aNEUROPATHY WHENNEUROPATHY WHENDEFICIENT & alsoDEFICIENT & alsoneeds TRANSAMINASE?needs TRANSAMINASE?
• PYRIDOXINE B6PYRIDOXINE B6
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What vitamin isWhat vitamin is
deficient withdeficient withPERNICIOUS ANEMIA &PERNICIOUS ANEMIA &NEUROPATHY?NEUROPATHY?
• B12 CYANOCOBALAMINEB12 CYANOCOBALAMINE
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What is the first vitamin to runWhat is the first vitamin to run
out with disease of rapidlyout with disease of rapidlydividing cells?dividing cells?
• FolateFolate
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What type of anemia is seenWhat type of anemia is seenwith Folate deficiency?with Folate deficiency?• Megaloblastic anemiaMegaloblastic anemia
• With neuropathy?With neuropathy?• NO NEUROPHATHYNO NEUROPHATHY
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• What else is Folate used for?What else is Folate used for?
• Nucleotide synthase (THF)Nucleotide synthase (THF)
What is another name forWhat is another name forVitamin C?Vitamin C?• Ascorbate acidAscorbate acid
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What is Vitamin C neededWhat is Vitamin C neededfor?for?• Collagen synthesisCollagen synthesis
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What happens with Vitamin CWhat happens with Vitamin Cdeficiency?deficiency?• ScurvyScurvy
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What is the CLUE forWhat is the CLUE forScurvy?Scurvy?• Bleeding gumsBleeding gums
• Bleeding hair folliclesBleeding hair follicles
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What is the most commonWhat is the most commoncause of Vitamin C deficiency?cause of Vitamin C deficiency?• Diet deficient in citrus fruitDiet deficient in citrus fruit
• Diet deficient in green vegetablesDiet deficient in green vegetables• Over cooked green vegetablesOver cooked green vegetables
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What does Vitamin D do withWhat does Vitamin D do withCa+?Ca+?• Controls Ca+Controls Ca+
• Absorbes Ca+ from GIAbsorbes Ca+ from GI• Reabsorbs Ca+ in KidneysReabsorbs Ca+ in Kidneys
• Controls osteoblastic activityControls osteoblastic activity
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What does Vitamin DWhat does Vitamin Ddeficiency cause in Children?deficiency cause in Children?• RickettsRicketts
• What does it cause in ADULTS?What does it cause in ADULTS?• OsteomalciaOsteomalcia
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What is the CLUE forWhat is the CLUE forRICKETTS?RICKETTS?• Lateral Bowing of the LegsLateral Bowing of the Legs
• X-linked dominantX-linked dominant
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What is Vitamin E neededWhat is Vitamin E neededfor?for?• HairHair
• SkinSkin• EyesEyes• Protection against free radicalsProtection against free radicals
• #1 antioxidant#1 antioxidant
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What does a deficiency of What does a deficiency of Vitamin E cause in newborns?Vitamin E cause in newborns?
• RetinopathyRetinopathy
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What are the vitamins from GIWhat are the vitamins from GIthat are normal flora?that are normal flora?• FolateFolate
• Vitamin K Vitamin K – 90%90%
• BiotinBiotin
• Panothenic acidPanothenic acid• Helps with absorption of B12Helps with absorption of B12
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• Helps with absorption of B12Helps with absorption of B12
What are the Vitamin K What are the Vitamin K dependent clotting factors?dependent clotting factors?• 19721972• Protein CProtein C• Protein SProtein S
• Which one has the shortest half-life?Which one has the shortest half-life?
• Protein CProtein C• Which one has the 2Which one has the 2 ndnd shortest half life?shortest half life?
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• Which one has the 2Which one has the 2 ndnd shortest half-life?shortest half-life?• 77
What are the TRACEWhat are the TRACEelements?elements?• ChromiumChromium
• SeleniumSelenium• Manganese MolebdenumManganese Molebdenum• Tin Tin
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What is Chromium neededWhat is Chromium neededfor?for?• Insulin actionInsulin action
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What organ needsWhat organ needsSelenium?Selenium?• HeartHeart
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What trace element is anWhat trace element is anenzyme in glycolsis?enzyme in glycolsis?• Manganese MolebdenumManganese Molebdenum
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What organ needs Tin?What organ needs Tin?• HairHair
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What does a deficiency in ZincWhat does a deficiency in Zinccause?cause?• DysguziaDysguzia
• Decrease spermDecrease sperm• Dry hairDry hair• Dry skinDry skin
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Cofactor for ALL Kinases?Cofactor for ALL Kinases?• Mg+Mg+
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Cofactor for ALLCofactor for ALLCarboxylases?Carboxylases?• BiotinBiotin
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Cofactor for ALLCofactor for ALL Transaminases? Transaminases?• PyridoxinePyridoxine
– B6B6
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What is Biotin a cofactorWhat is Biotin a cofactorfor?for?• ALL carboxylasesALL carboxylases
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What is Mg+ a cofactor for?What is Mg+ a cofactor for?• ALL kinasesALL kinases
• Parathyroid along with Vitamin AParathyroid along with Vitamin A
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What is Ca+ needed for?What is Ca+ needed for?• Muscle contractionMuscle contraction
• Axonal transportAxonal transport• 22 ndnd messengersmessengers
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What tracts are affected due toWhat tracts are affected due to
deficiency in Methyl Malonyldeficiency in Methyl MalonylCoA Mutase?CoA Mutase?
• Dorsal ColumnsDorsal Columns• Cortical Spinal TractsCortical Spinal Tracts
• Why are these affected?Why are these affected?• Because they are the longestBecause they are the longest
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• Because they are the longestBecause they are the longest• Because they need the most myelinBecause they need the most myelin
What enzyme does ZantheinWhat enzyme does ZantheinOxidase need?Oxidase need?
• Maganese MolebdenumMaganese Molebdenum
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How are drugs that areHow are drugs that arebioavailable ALWAYS excreted?bioavailable ALWAYS excreted?• By the liverBy the liver
• Always HepatotoxicAlways Hepatotoxic
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How are soluble drugs ALWAYSHow are soluble drugs ALWAYSexcreted?excreted?• By the kidneyBy the kidney
• Always nephrotoxicAlways nephrotoxic
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What are the 5 P’S OFWhat are the 5 P’S OFCOMPARTMENT SYNDROME?COMPARTMENT SYNDROME?• PainPain
• PallorPallor• ParesthesiaParesthesia• PulselessnessPulselessness
• PoikilothermiaPoikilothermia
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What are 5 skin infectionsWhat are 5 skin infections
were Strep. Pyogenes is thewere Strep. Pyogenes is thenumber one cause?number one cause?• LympangitisLympangitis
• Impetigo (not bullous)Impetigo (not bullous)• Necrotizing fascitisNecrotizing fascitis• ErysepelasErysepelas
• Scarlet feverScarlet fever
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What are 5 skin infections wereWhat are 5 skin infections were
Staph. aureus is the numberStaph. aureus is the numbertwo cause?two cause?• LympangitisLympangitis
• Impetigo (not bullous)Impetigo (not bullous)• Necrotizing fascitisNecrotizing fascitis• ErysepelasErysepelas
• Scarlet feverScarlet fever
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What is the #1 bacteriaWhat is the #1 bacteria
causing infection associated incausing infection associated inshunts and central lines?shunts and central lines?
• Staph epidermitisStaph epidermitis
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What is the #1 bacteriaWhat is the #1 bacteria
causing infection in peripheralcausing infection in peripherallines?lines?• Staph aureusStaph aureus
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Why do we need E. COLI in theWhy do we need E. COLI in thegut?gut?• Absorption of Absorption of Vit. B12Vit. B12
• Synthesis of Synthesis of ::• -Vitamin K -Vitamin K • -Biotin-Biotin
• -Folate-Folate• -Pantothenic acid-Pantothenic acid
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Pantothenic acidPantothenic acid– B5B5
Answer the following questionsAnswer the following questionsabout RESTRICTION ENZYMES?about RESTRICTION ENZYMES?• Trypsin cuts where? Trypsin cuts where?• cuts to R of cuts to R of • ArgArg• LysLys
• Chymotrypsin cuts where?Chymotrypsin cuts where?
• cuts to R of bulky aa’scuts to R of bulky aa’s (aromatics)(aromatics)• PhePhe• TyrTyr
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Tyr Tyr• Trp Trp
Answer the following questionsAnswer the following questionsabout RESTRICTION ENZYMES?about RESTRICTION ENZYMES?• Elastase cuts where?Elastase cuts where?
• Cuts to R of (“SAG”)Cuts to R of (“SAG”)• SS erer• AA lala• GG lyly
• CNBr cuts where?CNBr cuts where?• Cuts to R of Cuts to R of
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• MethionineMethionine
Answer the following questionsAnswer the following questionsabout RESTRICTION ENZYMES?about RESTRICTION ENZYMES?• Mercaptoethanol cuts where?Mercaptoethanol cuts where?
• Cuts to R of: disulfide bondsCuts to R of: disulfide bonds– CysteineCysteine– methioninemethionine
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Answer the following questionsAnswer the following questionsabout RESTRICTION ENZYMES?about RESTRICTION ENZYMES?• Aminopeptidase cuts where?Aminopeptidase cuts where?
• Cuts to R of Cuts to R of • amino acid terminalamino acid terminal
• Caboxypeptidase cuts where?Caboxypeptidase cuts where?• Cuts to L of Cuts to L of b l
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• carboxy terminalcarboxy terminal
What is THEWhat is THE ONLY LIVEONLY LIVE
VACCINE INDICATED INVACCINE INDICATED IN AIDSAIDSPATIENTS?PATIENTS?• MMRMMR
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What VACCINE isWhat VACCINE is NOTNOT GIVEN IFGIVEN IFpt. is Allergic to EGG?pt. is Allergic to EGG?• MMR & INFLUENZAMMR & INFLUENZA
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What VACCINE isWhat VACCINE is NOTNOT GIVENGIVEN
IF patient HAS YEASTIF patient HAS YEASTALLERGIES?ALLERGIES?• Hepatitis BHepatitis B
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What 3 VACCINES DROP OUTWhat 3 VACCINES DROP OUTAFTER 6 YEARS OF AGE?AFTER 6 YEARS OF AGE?• HibHib
• DiphtheriaDiphtheria• PertussisPertussis
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What is the MC STRAIN OFWhat is the MC STRAIN OF
STREP PYOGENES TO CAUSESTREP PYOGENES TO CAUSEGN?GN?• Strain 12Strain 12
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What 2 substances are inWhat 2 substances are inNEUTROPHILS?NEUTROPHILS?• MyeloperoxidaseMyeloperoxidase
• NADPH OxidaseNADPH Oxidase
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MACROPHAGES CONTAIN whatMACROPHAGES CONTAIN whatSUBSTANCE?SUBSTANCE?• NADPH OxidaseNADPH Oxidase
• Which means they only kill what?Which means they only kill what?• Kills only G -veKills only G -ve
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What do MACROPHAGESWhat do MACROPHAGESSECRETE?SECRETE?• IL-1IL-1
• IL-6??IL-6??
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What DRUGS CAUSE PAINFULWhat DRUGS CAUSE PAINFULNEUROPATHY?NEUROPATHY?• DDI>DDCDDI>DDC
• PancreatitisPancreatitis
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What are the MITOCHONDRIALWhat are the MITOCHONDRIALDISEASES?DISEASES?• Leigh’s DiseaseLeigh’s Disease• What is another name?What is another name?
• Subacute necrotizing encephalomyelopathySubacute necrotizing encephalomyelopathy• What are the signs & symptoms?What are the signs & symptoms?• Progressively decreasing IQProgressively decreasing IQ• SeizureSeizure
•AtaxiaAtaxia
• What is the deficiency?What is the deficiency?• Cytochrome oxidase deficiencyCytochrome oxidase deficiency
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What are the MITOCHONDRIALWhat are the MITOCHONDRIALDISEASES?DISEASES?• Leber’s Hereditary Optic Atrophy (LHON)Leber’s Hereditary Optic Atrophy (LHON)• They all die They all die
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What is theWhat is the ONLY ONLY G +ve WITHG +ve WITHENDOTOXIN?ENDOTOXIN?• ListeriaListeria
• What part is toxic?What part is toxic?• Lipid ALipid A
• Does it cross the placenta?Does it cross the placenta?
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pp• Yes Yes
What does ListeriaWhat does Listeria
activate?activate?
• T-cells & Macrophages, T-cells & Macrophages, therefore,therefore,have granulomashave granulomas
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What are the Associations inWhat are the Associations in
contracting the Listeria bug?contracting the Listeria bug?• Raw cabbageRaw cabbage
• Spoiled milkSpoiled milk• Migrant workersMigrant workers
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What are the PERIODS OFWhat are the PERIODS OF
RAPID GROWTH/RAPIDLYRAPID GROWTH/RAPIDLYDIVIDING CELLS?DIVIDING CELLS?
• Birth – 2 monthsBirth – 2 months• 4 – 7 years old4 – 7 years old• PubertyPuberty
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What is THEWhat is THE ONLY ONLY IMMUNEIMMUNE
DEFICIENCY WITHDEFICIENCY WITH
LOW CALCIUMLOW CALCIUM
and Increase Phosphate?and Increase Phosphate?• DiGeorge’s SyndromeDiGeorge’s Syndrome
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What are the BASIC AMINOWhat are the BASIC AMINOACIDS?ACIDS?• LysineLysine
• ArginineArginine
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What are the ACIDIC AMINOWhat are the ACIDIC AMINOACIDS?ACIDS?• GlutamateGlutamate
• AspartateAspartate
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What are the Ketogenic +What are the Ketogenic +Glucogenic Amino Acids?Glucogenic Amino Acids?• PhenylalaninePhenylalanine
• IsoleucineIsoleucine• Trptophan Trptophan• Threonine Threonine
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What are the AROMATICWhat are the AROMATICAMINO ACIDS?AMINO ACIDS?• PhenylalaninPhenylalanin
• Tyrosine Tyrosine• Tryptophan Tryptophan
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What are the AMINO ACIDSWhat are the AMINO ACIDSwith DISULFIDE BONDS?with DISULFIDE BONDS?• MetMet
• CystCyst
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What are the “KINKY” AMINOWhat are the “KINKY” AMINOACID?ACID?• ProlineProline
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What are the AMINO ACIDSWhat are the AMINO ACIDSwith O-BONDS?with O-BONDS?• SerineSerine
• Threonine Threonine• Tyrosine Tyrosine
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What are the AMINO ACIDSWhat are the AMINO ACIDSwith N-BONDS?with N-BONDS?• AsparagineAsparagine
• GlutamineGlutamine
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What are the BRANCHED-What are the BRANCHED-CHAIN AMINO ACIDS?CHAIN AMINO ACIDS?• LeuLeu
• IsoIso• ValVal
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What are the KETOGENICWhat are the KETOGENICAMINO ACIDS?AMINO ACIDS?• LeuLeu
• LysLys
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What CONDITIONS areWhat CONDITIONS are
ASSOCIATED WITHASSOCIATED WITHHLA-B27?HLA-B27?• Psoriasis (with arthritis)Psoriasis (with arthritis)
• Ankylosing SpondylitisAnkylosing Spondylitis• Irritable Bowel SyndromeIrritable Bowel Syndrome• Reiter’s SyndromeReiter’s Syndrome
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What are the ORGANISMSWhat are the ORGANISMS
WITH IgA PROTEASEWITH IgA PROTEASE (resistant to(resistant to
IgA)IgA) ??• Strep. PneumoniaeStrep. Pneumoniae
• H. influenzaH. influenza• Neisseria catarrhalisNeisseria catarrhalis
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What do EOSINOPHILSWhat do EOSINOPHILSSECRETE?SECRETE?• HistaminaseHistaminase
• ArylsulfataseArylsulfatase• HeparinHeparin• Major Basic ProteinMajor Basic Protein
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What do MAST CELLSWhat do MAST CELLS
SECRETE?SECRETE?• In an Acute Reaction?In an Acute Reaction?
• HistamineHistamine
• In a Late ReactionIn a Late Reaction ??
• SRS-ASRS-A• ECF-AECF-A
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What is the MCC of ATYPICALWhat is the MCC of ATYPICAL
PNEUMONIA?PNEUMONIA?• 0 – 2 months?0 – 2 months?
• chlamydia pneumoniachlamydia pneumonia
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What does chlamydiaWhat does chlamydia
pneumonia cause?pneumonia cause?• Intersitital pneumoniaIntersitital pneumonia
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What is the CLUE for HEARTWhat is the CLUE for HEART
BLOCK?BLOCK?• High temperature withHigh temperature with NORMALNORMAL
pulse rate!pulse rate!
((This should never be!This should never be! Each degreeEach degree ↑ in temp. →↑ in temp. →10 beats/min ↑ in pulse rate)10 beats/min ↑ in pulse rate)
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What are the clues for IL-1?What are the clues for IL-1?• FEVERFEVER
• NONSPECIFIC ILLNESSNONSPECIFIC ILLNESS• RECRUITS TH CELLS for LINKING withRECRUITS TH CELLS for LINKING withMHC II COMPLEXMHC II COMPLEX
• SECRETED BY MACROPHAGESSECRETED BY MACROPHAGES
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What are the clues for IL-2?What are the clues for IL-2?• MOST POTENT OF THE InterleukinsMOST POTENT OF THE Interleukins• RECRUITS EVERYBODYRECRUITS EVERYBODY• MOST POWERFULMOST POWERFUL CHEMO-ATTRACTANTCHEMO-ATTRACTANT• MUSTMUST BE INACTIVATEDBE INACTIVATED• When must you inactivate it?When must you inactivate it?• PRIOR TO TRANSPLANTATIONPRIOR TO TRANSPLANTATION
by cyclosporinby cyclosporin• SECRETED BY TH1 CELLSSECRETED BY TH1 CELLS
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• SECRETED BY TH1 CELLSSECRETED BY TH1 CELLS
What are the clues for IL-3?What are the clues for IL-3?• ENERGIZED MACROPHAGESENERGIZED MACROPHAGES
• CAUSES B-CELL PROLIFERATIONCAUSES B-CELL PROLIFERATION• LABELED BY THYMIDINE (USELABELED BY THYMIDINE (USEPOKEWEED MITOGEN ORPOKEWEED MITOGEN OR
ENDOTOXIN)ENDOTOXIN)• SECRETED BY ACTIVATED T CELLSSECRETED BY ACTIVATED T CELLS
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What are the clues for IL-4?What are the clues for IL-4?• B-CELL DIFFERENTIATIONB-CELL DIFFERENTIATION
• RESPONSIBLE FOR CLASS SWITCHINGRESPONSIBLE FOR CLASS SWITCHING• SECRETED BY TH2 CELLSSECRETED BY TH2 CELLS
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What are the clues for IL-5 thruWhat are the clues for IL-5 thru
14?14?• They do exactly what IL-1 thru IL4 They do exactly what IL-1 thru IL4
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What are the clues for IL-What are the clues for IL-10?10?• SUPPRESSES CELL-MEDIATEDSUPPRESSES CELL-MEDIATED
RESPONSE (tells macrophages andRESPONSE (tells macrophages andfibroblasts to stay away if bacterial)fibroblasts to stay away if bacterial)• INHIBITSINHIBITS MACMAC ACTIVATIONACTIVATION
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What are the clues for IL-What are the clues for IL-12?12?• PROMOTES CELL-MEDIATED RESPONSEPROMOTES CELL-MEDIATED RESPONSE
(recruits macs & fibroblasts if NOT(recruits macs & fibroblasts if NOTbacterial)bacterial)
• ACTIVATESACTIVATES NK NK CELLS TO SECRETE IF-CELLS TO SECRETE IF- γγ• INHIBITS IL-4 INDUCED IgE SECRETIONINHIBITS IL-4 INDUCED IgE SECRETION
• CHANGES TH CELLS to TH1 CELLSCHANGES TH CELLS to TH1 CELLS– secretes IL-2 & IF-secretes IL-2 & IF- γγ → inhib. TH2, therefore, ↑→ inhib. TH2, therefore, ↑
host defenses against delayed hypersensitivityhost defenses against delayed hypersensitivity
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What are the clues for IF-What are the clues for IF- αα ??• Where is it from?Where is it from?• LEUKOCYTESLEUKOCYTES• ↓↓ VIRAL REPLICATION AND TUMORVIRAL REPLICATION AND TUMOR
GROWTHGROWTH• ↑↑ NK NK ACTVITYACTVITY
–secretes perforins and granzymes to killsecretes perforins and granzymes to killinfected cellinfected cell
• ↑↑ MHC CLASS I & II EXPRESSIONMHC CLASS I & II EXPRESSION• ↓↓ PROTEIN SYNTHESISPROTEIN SYNTHESIS
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↓↓ PROTEIN SYNTHESISPROTEIN SYNTHESIS
– translation inhibited, therefore, defectivetranslation inhibited, therefore, defectiveprotein synthesisprotein synthesis
Summary of clues for IF-Summary of clues for IF- αα ??• Increase NK activityIncrease NK activity
• Increase MHC class I & IIIncrease MHC class I & II• Decrease protein synthesisDecrease protein synthesis• Decrease viral replication and growthDecrease viral replication and growth
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What are the clues for IF-B?What are the clues for IF-B?
• Where is it from?Where is it from?
• FIBROBLASTSFIBROBLASTS• Increase NK activityIncrease NK activity• Increase MHC class I & IIIncrease MHC class I & II
• Decrease protein synthesisDecrease protein synthesis• Decrease viral replication and growthDecrease viral replication and growth
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What are the clues for IF-What are the clues for IF-gama?gama?• Where is it from?Where is it from?• T-CELLS & NK CELLST-CELLS & NK CELLS• ↑↑ NK NK ACTIVITYACTIVITY• ↑↑ MHCMHC CLASS I & IICLASS I & II• ↑↑ MACROPHAGE ACTIVITYMACROPHAGE ACTIVITY• CO-STIMULATES B-CELL GROWTH &CO-STIMULATES B-CELL GROWTH &
DIFFERENTIATIONDIFFERENTIATION• ↓↓ IgE SECRETIONIgE SECRETION
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• ↓↓ IgE SECRETIONIgE SECRETION
What are the clues for TNF-What are the clues for TNF-
alpha?alpha?• Where is it from?Where is it from?• MONOCYTES &MONOCYTES & MACROPHAGESMACROPHAGES
• What is another name for TNF-alpha?What is another name for TNF-alpha?• CACHECTINCACHECTIN• INDUCESINDUCES IL-1IL-1• ↑↑ ADHESION MOLECULES & MHC CLASS I ONADHESION MOLECULES & MHC CLASS I ON
ENDOTHELIAL CELLSENDOTHELIAL CELLS• PYROGENPYROGEN• INDUCES IF-INDUCES IF- γγ SECRETIONSECRETION• CYTOTOXICCYTOTOXIC /CYTOSTATIC EFFECT/CYTOSTATIC EFFECT
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CYTOTOXICCYTOTOXIC /CYTOSTATIC EFFECT/CYTOSTATIC EFFECT
What are the clues for TNF-What are the clues for TNF-
beta?beta?• Where is it from?Where is it from?
• T-CELLST-CELLS
• What is another name for it?What is another name for it?
• LYMPHOTOXINLYMPHOTOXIN
• CYTOTOXIC FACTORCYTOTOXIC FACTOR
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• CYTOTOXIC FACTORCYTOTOXIC FACTOR
What are the clues for TGF-What are the clues for TGF-
αα ??• Where is it from?Where is it from?
• SOLID TUMORSSOLID TUMORS (CARCINOMA >(CARCINOMA >SARCOMA)SARCOMA)• MONOCYTESMONOCYTES
• What is another name for it?What is another name for it?• TRANSFORMING GROWTH FACTORSTRANSFORMING GROWTH FACTORS
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TRANSFORMING GROWTH FACTORS TRANSFORMING GROWTH FACTORS
What are the clues for TGF-What are the clues for TGF-
αα ??• What does it INDUCE?What does it INDUCE?• ANGIOGENESISANGIOGENESIS• KERATINOCYTE PROLIFERATIONKERATINOCYTE PROLIFERATION• BONE RESORPTIONBONE RESORPTION• TUMOR GROWTH TUMOR GROWTH
• What is it mainly for?What is it mainly for?• MAINLY FOR TUMOR GROWTHMAINLY FOR TUMOR GROWTH
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• MAINLY FOR TUMOR GROWTHMAINLY FOR TUMOR GROWTH
What are the clues for TGF-What are the clues for TGF-
ββ ??• Where is it from?Where is it from?
• PLATELETSPLATELETS• PLACENTAPLACENTA• KIDNEY KIDNEY
• BONEBONE• T & B CELLST & B CELLS
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What are the clues for TGF-What are the clues for TGF-
ββ ??
• WhatWhat INDUCES it?INDUCES it?• FIBROBLAST PROLIFERATIONFIBROBLAST PROLIFERATION• COLLAGENCOLLAGEN
• FIBRONECTIN SYNTHESISFIBRONECTIN SYNTHESIS
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What are the clues for TGF-What are the clues for TGF-
ββ ??• What INHIBITS it?What INHIBITS it?
• NK NK • LAK LAK • CTLCTL
• T & B CELL PROLIFERATION T & B CELL PROLIFERATION
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What are the clues for TGF-What are the clues for TGF-
ββ ??• What ENHANCES it?What ENHANCES it?
• WOUND HEALINGWOUND HEALING• ANGIOGENESISANGIOGENESIS
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What are the clues for TGF-What are the clues for TGF-
ββ ??• What does it suppress?What does it suppress?
• SUPPRESSES IR AFTER INFECTION &SUPPRESSES IR AFTER INFECTION &PROMOTES HEALING PROCESSPROMOTES HEALING PROCESS
• What is it mainly for?What is it mainly for?• MAINLY FOR WOUND HEALINGMAINLY FOR WOUND HEALING
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What does LAK stand for?What does LAK stand for?
• LYMPHOKINE ACTIVATED KILLERLYMPHOKINE ACTIVATED KILLERCELLSCELLS
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What does CTL stand for?What does CTL stand for?
• CYTOTOXIC T-LYMPHOCYTESCYTOTOXIC T-LYMPHOCYTES
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What does mitochondrialWhat does mitochondrial
inheritance affect?inheritance affect?• CNSCNS
• HeartHeart• Skeletal muscleSkeletal muscle
• Why does it affect these particularWhy does it affect these particularplaces?places?
• Due to uneven cytokinesis duringDue to uneven cytokinesis during
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y gy g
meiosis or oogenesismeiosis or oogenesis
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Answer the following aboutAnswer the following aboutAutosomal RecessiveAutosomal Recessiveinheritance?inheritance?• Who does it show in?Who does it show in?• Not parentsNot parents
• Siblings/uncles may show diseaseSiblings/uncles may show disease
• When is onset?When is onset?• Early in life (childhood diagnosis)Early in life (childhood diagnosis)
• Is it complete on incomplete penetrance?Is it complete on incomplete penetrance?• COMPLETECOMPLETE
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Answer the following aboutAnswer the following aboutAutosomal RecessiveAutosomal Recessiveinheritance?inheritance?• How are they acquired?How are they acquired?
• Almost ALL are inborn error of Almost ALL are inborn error of metabolismmetabolism
• When does it occur?When does it occur?• Only when both alleles at a locus areOnly when both alleles at a locus are
mutantmutant
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Answer the following aboutAnswer the following aboutAutosomal RecessiveAutosomal Recessiveinheritance?inheritance?• How is it transmitted?How is it transmitted?• Horizontal TmHorizontal Tm
• Are there malformations present?Are there malformations present?• Physical malformations are uncommonPhysical malformations are uncommon
• What type of defect?What type of defect?• Enzyme defectEnzyme defect
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Enzyme defectEnzyme defect
Answer the following aboutAnswer the following aboutAutosomal DominantAutosomal Dominantinheritance?inheritance?• Who does it affect the most?Who does it affect the most?• M=FM=F
• How does it manifest?How does it manifest?• Heterozygote stateHeterozygote state
• Who can transmit the disease?Who can transmit the disease?• Both parentsBoth parents
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Both parentsBoth parents
Answer the following aboutAnswer the following aboutAutosomal DominantAutosomal Dominantinheritance?inheritance?• Where is the new mutation?Where is the new mutation?
• Often in germ cells of older fathersOften in germ cells of older fathers
• When is onset?When is onset?
• Often delayed (adult diagnosis)Often delayed (adult diagnosis)– Example = Huntington’sExample = Huntington’s
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Answer the following aboutAnswer the following aboutAutosomal DominantAutosomal Dominantinheritance?inheritance?• What is penetrance?What is penetrance?
• Reduced penetranceReduced penetrance
• How is it expressed?How is it expressed?
• Variable expressinVariable expressin– Different in each individualDifferent in each individual
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Answer the following aboutAnswer the following aboutAutosomal DominantAutosomal Dominantinheritance?inheritance?• How is it transmitted?How is it transmitted?• Vertical TMVertical TM
• Is there malformation present?Is there malformation present?• Physical malformation commonPhysical malformation common
• What type of defect?What type of defect?• StructuralStructural
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StructuralStructural
Who is affected in the familyWho is affected in the family
with an X-Linked disease?with an X-Linked disease?
• Maternal grandfatherMaternal grandfather• Maternal uncleMaternal uncle
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Immune System Time Line forImmune System Time Line for
viral & cell-mediated.viral & cell-mediated.• What happens <24hrs?What happens <24hrs?• SwellingSwelling
• What happens at 24 hrs?What happens at 24 hrs?• Neutrophils show upNeutrophils show up
• What happens at day 3?What happens at day 3?• Neutrophils peakNeutrophils peak
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Neutrophils peakp p
Immune System Time Line forImmune System Time Line for
viral & cell-mediated.viral & cell-mediated.• What happens at day 4?What happens at day 4?• T cells and Macrophages show up T cells and Macrophages show up
• What happens at day 7?What happens at day 7?• Fibroblasts show upFibroblasts show up
• What happens in 1 month?What happens in 1 month?• Fibroblast peakFibroblast peak
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Fibroblast peakp
Immune System Time Line forImmune System Time Line for
viral & cell-mediated.viral & cell-mediated.• What happens at 3-6 months?What happens at 3-6 months?
• Fibroblasts are goneFibroblasts are gone
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What is the general CLUE forWhat is the general CLUE forany Lysosomal Storageany Lysosomal StorageDisease?Disease?
• Lysosomal Inclusion BodiesLysosomal Inclusion Bodies
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What are the LysosomalWhat are the Lysosomal
Storage diseases?Storage diseases?• GauchersGauchers• FabrysFabrys
• KrabbeKrabbe• Tay Sachs Tay Sachs• SandhoffsSandhoffs• HurlersHurlers• HuntersHunters• Neiman PickNeiman Pick• Metachromatic LeukodystropyMetachromatic Leukodystropy
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What is missing inWhat is missing in
Gauchers?Gauchers?• Beta-GlucocerberosidaseBeta-Glucocerberosidase
• What Accumulates?What Accumulates?• GlucocebrosideGlucocebroside
• Where?Where?
• BrainBrain• LiverLiver• Bone MarrowBone Marrow• SpleenSpleen
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What are the CLUES forWhat are the CLUES for
Gauchers?Gauchers?• Ask. JewAsk. Jew
• GargolsGargols• Gaucher cellsGaucher cells– Macrophages looking like CrinkeledMacrophages looking like Crinkeled
paperpaper
• Erlin myoflask legsErlin myoflask legs• PseudohypertrophyPseudohypertrophy
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What is missing in Fabrys?What is missing in Fabrys?
• Alpha-galactosidaseAlpha-galactosidase
• What accumulates?What accumulates?• Ceramide TrihexosideCeramide Trihexoside
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What are the CLUES forWhat are the CLUES for
Fabrys?Fabrys?• X-Linked recessiveX-Linked recessive
• Presents with cataracts as a childPresents with cataracts as a child• Presents with renal failure as a childPresents with renal failure as a child
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What is missing in Krabbes?What is missing in Krabbes?
• Galactosylceramide B-GalactosidaseGalactosylceramide B-Galactosidase
• What accumulates?What accumulates?• GalactocerebrosidaseGalactocerebrosidase
• Where?Where?• BrainBrain
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What are the CLUES forWhat are the CLUES for
Krabbes?Krabbes?• Early deathEarly death
• Globoid bodiesGloboid bodies– Fat cellsFat cells
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What is missing in TayWhat is missing in Tay
Sachs?Sachs?• Hexoseaminidase AHexoseaminidase A
• What accumulates?What accumulates?• GM2 GangliosideGM2 Ganglioside
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What is the CLUE for TayWhat is the CLUE for Tay
Sachs?Sachs?• Ask. JewsAsk. Jews
• Cherry red maculaCherry red macula• Death by 3Death by 3
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What is missing inWhat is missing in
Sandhoffs?Sandhoffs?• Hexoseaminadase A & BHexoseaminadase A & B
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What is missing in Hurlers?What is missing in Hurlers?
• IduronidaseIduronidase
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What are the CLUES forWhat are the CLUES for
Hurlers?Hurlers?• Corneal CloudingCorneal Clouding
• Mental RetardationMental Retardation
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What is missing in Hunters?What is missing in Hunters?
• Iduronate SulfataseIduronate Sulfatase
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What are the CLUES forWhat are the CLUES for
Hunters?Hunters?• Mild mental retardationMild mental retardation
• No corneal cloudingNo corneal clouding• Mild form of HurlersMild form of Hurlers• X-linked recessiveX-linked recessive
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What is missing in NiemannWhat is missing in Niemann
Picks?Picks?• SpingomyelinaseSpingomyelinase
• What accumulates?What accumulates?• SpingomyelinSpingomyelin
• CholesterolCholesterol
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What are the CLUES forWhat are the CLUES for
Niemann Picks?Niemann Picks?• Zebra bodiesZebra bodies
• Cherrry red maculaCherrry red macula• Die by 3Die by 3
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What is missing inWhat is missing inMetachromaticMetachromaticLeukodystrophy?Leukodystrophy?• Arylsulfatase AArylsulfatase A
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What is the CLUE forWhat is the CLUE forMetachromaticMetachromaticLeukodystrophy?Leukodystrophy?• Visual DisturbanceVisual Disturbance
• Presents like MS in 5 to 10 years of Presents like MS in 5 to 10 years of ageage
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What are the Glycogen StorageWhat are the Glycogen Storage
Diseases?Diseases?• Von GierkesVon Gierkes
• AndersonsAndersons• CorysCorys• McCardlesMcCardles
• PompesPompes• HersHers
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What is deficient in VonWhat is deficient in Von
Gierkes?Gierkes?• G-6-Pase DeficiencyG-6-Pase Deficiency
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What is the CLUE for VonWhat is the CLUE for Von
Gierkes?Gierkes?• Big LiverBig Liver
• Big KidneyBig Kidney• Severe hypoglycemiaSevere hypoglycemia• Can NEVER raise their blood sugarCan NEVER raise their blood sugar
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What is deficient inWhat is deficient in
Andersons?Andersons?• Branching enzyme deficiencyBranching enzyme deficiency
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What is the CLUE forWhat is the CLUE for
Andersons?Andersons?• Glycogen will be ALL LONG chains onGlycogen will be ALL LONG chains on
liver biopsyliver biopsy
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What is missing in Corys?What is missing in Corys?
• Debranching enzymeDebranching enzyme
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What is the CLUE for Corys?What is the CLUE for Corys?
• Glycogen from liver biopsy will beGlycogen from liver biopsy will beALL SHORT branchesALL SHORT branches
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What is missing inWhat is missing in
McCardles?McCardles?• Muscle phosporalaseMuscle phosporalase
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What is the CLUE forWhat is the CLUE for
McCardles?McCardles?• Severe muscle cramps whenSevere muscle cramps when
exercisingexercising• High CPK High CPK
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What is missing in Pompes?What is missing in Pompes?
• Cardiac alpha-1,4 glucocydaseCardiac alpha-1,4 glucocydase
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What is the CLUE forWhat is the CLUE for
Pompes?Pompes?• Heart problemsHeart problems
• Die earlyDie early
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What is missing in Hers?What is missing in Hers?
• Liver phosphoralaseLiver phosphoralase
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What is the CLUE for Hers?What is the CLUE for Hers?
• Big LiverBig Liver
• NO big kidneyNO big kidney
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What MUST you rule out with aWhat MUST you rule out with a
decrease AVO2?decrease AVO2?
•AV FistulaAV Fistula
• VasodilationVasodilation
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What diseases have a cherryWhat diseases have a cherry
red macula?red macula?
• Tay Sachs Tay Sachs• SandhoffsSandhoffs• Niemann PickNiemann Pick
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What is translocation 9;22?What is translocation 9;22?
• CMLCML
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What is translocation 11;22?What is translocation 11;22?
• Ewing’s sarcomaEwing’s sarcoma
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What is translocation 8;14?What is translocation 8;14?
• Burketts lymphomaBurketts lymphoma
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What is translocation 14;18?What is translocation 14;18?
• Follicular lymphomaFollicular lymphoma
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What are the causes of What are the causes of
restrictive cardiomyopathy?restrictive cardiomyopathy?• SarcoidSarcoid• AmyloidAmyloid• HemochromatosisHemochromatosis• CancerCancer
• FibrosisFibrosis
• Thanks STAN!! Thanks STAN!!
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What are the CLUES forWhat are the CLUES forVasulitis or IntravascularVasulitis or IntravascularHemolysis?Hemolysis?• ShistocytesShistocytes
– Burr cellsBurr cells– Helmet cellsHelmet cells
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What is the CLUE forWhat is the CLUE for
Extravascular Hemolysis?Extravascular Hemolysis?• SplenomagelySplenomagely
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Where is Glucose 6-PaseWhere is Glucose 6-Pase
present?present?• AdrenalAdrenal• LiverLiver
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What is the Heinz bodyWhat is the Heinz body
CLUE?CLUE?• G6PDG6PD
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If you see the CLUE basophilicIf you see the CLUE basophilicstippling, what should you bestippling, what should you bethinking?thinking?
• Lead poisoningLead poisoning
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What are the MicrocyticWhat are the Microcytic
Hypochromic Anemias?Hypochromic Anemias?• Iron deficiencyIron deficiency• Anemia of Chronic diseaseAnemia of Chronic disease• Lead poisoningLead poisoning• HemoglobinopathyHemoglobinopathy
• Thallasemia’s Thallasemia’s• Sideroblastic anemiaSideroblastic anemia
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What is primary sideroblasticWhat is primary sideroblastic
anemia due to?anemia due to?• GeneticGenetic• ADAD
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What is secondaryWhat is secondary
Sideroblastic anemia due to?Sideroblastic anemia due to?• Blood transfusionsBlood transfusions
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What are the MicrocyticWhat are the Microcytic
Hyperchromic Anemia’s?Hyperchromic Anemia’s?• Hereditary SpherocytosisHereditary Spherocytosis
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What are the NormocyticWhat are the Normocytic
Normochromic Anemia’s?Normochromic Anemia’s?• Acute hemorrhageAcute hemorrhage• Anemia of Chronic DiseaseAnemia of Chronic Disease• HypothyrodismHypothyrodism
– EarlyEarly
• Renal FailureRenal Failure
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What are the MacrocyticWhat are the Macrocytic
anemia’s?anemia’s?• Folate deficiencyFolate deficiency• B12 deficiencyB12 deficiency
• ReticulocytosisReticulocytosis• ETOHETOH• Hemolytic AnemiasHemolytic Anemias
• Chemo TreatmentChemo Treatment• AnticonvulsantsAnticonvulsants• MyelodysplasiaMyelodysplasia
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What are the anticonvulsantsWhat are the anticonvulsants
causing a Macrocytic Anemia?causing a Macrocytic Anemia?• PhenytoinPhenytoin• EthusuximideEthusuximide• CarbamyazapineCarbamyazapine• ValproateValproate
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What anemia is caused byWhat anemia is caused by
blood transfusions?blood transfusions?• Sideroblastic anemiaSideroblastic anemia
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What is the problem if you seeWhat is the problem if you see
Eliptocytes?Eliptocytes?• Something is wrong with the RBCSomething is wrong with the RBC
membranemembrane– ExtravascularExtravascular
• Heridatary EllitocytosisHeridatary Ellitocytosis• Increased RET countIncreased RET count
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What disease do you get if youWhat disease do you get if you
have an EXCESS in Cu+?have an EXCESS in Cu+?• Wilson’s DiseaseWilson’s Disease
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What is the CLUE for Wilson’sWhat is the CLUE for Wilson’s
Disease?Disease?• Hepato/Lenticular DegenerationHepato/Lenticular Degeneration• Kayser Fleishner RingsKayser Fleishner Rings
– Copper in eyesCopper in eyes
• Hepato = LiverHepato = Liver• Lenticular = Movement problemLenticular = Movement problem
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What is Copper needed for?What is Copper needed for?
• Collagen synthesisCollagen synthesis
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What disease manifest withWhat disease manifest with
Cu+ deficiency?Cu+ deficiency?• Minky Kinky Hair SyndromeMinky Kinky Hair Syndrome
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What are the plasmaWhat are the plasma
catecholamines?catecholamines?• EpinephrineEpinephrine• NorepinephrineNorepinephrine• DopamineDopamine
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What are PlasmaWhat are Plasma
Catecholamines derived from?Catecholamines derived from?• Tyrosine Tyrosine
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A patient with episodic HTN leading toA patient with episodic HTN leading toheadache with arrhythmias leading toheadache with arrhythmias leading topalpitations most likely is diagnosedpalpitations most likely is diagnosedwith?with?
• Adrenal PheochromocytomaAdrenal Pheochromocytoma
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What is the MOA forWhat is the MOA for
Fluroquinolones?Fluroquinolones?• Blocks DNA gyrase (topoisomerase II)Blocks DNA gyrase (topoisomerase II)• Inhibits p450Inhibits p450
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What do FluroquinolonesWhat do Fluroquinolones
cover?cover?• All Gram + including staph auerusAll Gram + including staph auerus• All Gram –All Gram –• AtypicalsAtypicals
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What are the atypicals?What are the atypicals?
• ChlamydiaChlamydia• UreoplasmaUreoplasma• MycoplasmaMycoplasma• LegionellaLegionella
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8/6/2019 Pass Program Clue
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What is Dermatan Sulfate?What is Dermatan Sulfate?
• Glycosaminoglycan chain that helpsGlycosaminoglycan chain that helpsform proteoglycansform proteoglycans
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What is the MOA of What is the MOA of
Methotrexate?Methotrexate?• Inhibits dihydrofolate reductaseInhibits dihydrofolate reductase• Inhibits DNA synthesis in the S phaseInhibits DNA synthesis in the S phase
of cycle.of cycle.• Prevents reduction of folic acidPrevents reduction of folic acid
needed to produce THFneeded to produce THF
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What are THF derivatives usedWhat are THF derivatives used
in?in?• Purine nucleotide synthesisPurine nucleotide synthesis• Methylation of dUMP to for dTMPMethylation of dUMP to for dTMP
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What happens whenWhat happens whenDihydrofolate Reductase isDihydrofolate Reductase isinhibited?inhibited?• Obstructs one carbon methylationObstructs one carbon methylation
which deprives DNA polymerase of which deprives DNA polymerase of essential substratesessential substrates
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What diseases present asWhat diseases present as
Failure to Thrive?Failure to Thrive?
• CFCF• GalactosemiaGalactosemia
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In general, what should youIn general, what should youalways associate Hemolyticalways associate HemolyticAnemia’s with?Anemia’s with?
• Defects in GlycolysisDefects in Glycolysis• Defects in Hexose MonophosphateDefects in Hexose Monophosphate
ShuntShunt
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What is required for theWhat is required for theconversion of Homocysteine toconversion of Homocysteine toMethionine?Methionine?
• B12B12
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What is required for theWhat is required for theconversion of methylmalonylconversion of methylmalonylCoA to Succinyl CoA?CoA to Succinyl CoA?
• B12B12
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What is required for theWhat is required for the
degradation of cystathionine?degradation of cystathionine?• Vitamin B6Vitamin B6
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What does the hydroxalation of What does the hydroxalation of
Purines require?Purines require?• Vitamin CVitamin C
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en oes e car oxya a onof Glutamic acid occurs andof Glutamic acid occurs and
what is required for thiswhat is required for thiscarboxyalation?carboxyalation?
• Occurs in the synthesis of BloodOccurs in the synthesis of BloodClotting factorsClotting factors
• Requires Vitamin K Requires Vitamin K
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Decarboxylation of alpha-Decarboxylation of alpha-
ketoacids requires what?ketoacids requires what?
• Thiamine Thiamine
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Synthesis of 1,25-d-Synthesis of 1,25-d-hydroxycholecalciferol requireshydroxycholecalciferol requireswhat?what?
• Vitamin DVitamin D
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Synthesis of RhodopsinSynthesis of Rhodopsin
requires what?requires what?
• Vitamin AVitamin A
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Pyruvate DecarboxylasePyruvate Decarboxylase
requires what as a cofactor?requires what as a cofactor?• Thiamine Thiamine
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What is CN1?What is CN1?
• OlfactoryOlfactory• What is its function?What is its function?
• Sensory for smellSensory for smell• What if lesioned?What if lesioned?• AnosmiaAnosmia• Where does it Exit/Enter the Cranium?Where does it Exit/Enter the Cranium?
• Cribriform plateCribriform plate• What does it innervate?What does it innervate?• Nasal CavityNasal Cavity
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What is CN2?What is CN2?
• OpticOptic• What is its function?What is its function?
• Sensory for sightSensory for sight• What if lesioned?What if lesioned?• AnopsiaAnopsia
– Visual field defectVisual field defect• Loss of light reflex with CN IIILoss of light reflex with CN III• Only nerve affected by MSOnly nerve affected by MS
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Cont. CN2Cont. CN2
• Where does it Exit/Enter theWhere does it Exit/Enter theCranium?Cranium?
• Optic CanalOptic Canal
• What does it innervate?What does it innervate?• OrbitOrbit
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What is CN3?What is CN3?
• OcculomotorOcculomotor• What are the functions?What are the functions?
• MotorMotor• Moves the eyeball in ALL directionsMoves the eyeball in ALL directions• Adduction Most important action (MR)Adduction Most important action (MR)
• Constricts the pupil (Spincter Pupillae)Constricts the pupil (Spincter Pupillae)• Accomodates (Cililary Muscle)Accomodates (Cililary Muscle)• Raises eyelid (Levator Palpebrae)Raises eyelid (Levator Palpebrae)
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Cont. CN 3Cont. CN 3
• What if lesioned?What if lesioned?• DiplopiaDiplopia• Loss of parallel gazeLoss of parallel gaze• Dilated pupilDilated pupil
• Loss of light reflexLoss of light reflex• Loss of near responseLoss of near response• PtosisPtosis
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Cont. CN 3Cont. CN 3
• Where does it Exit/Enter theWhere does it Exit/Enter theCranium?Cranium?
• Superior Orbital FissureSuperior Orbital Fissure
• What does it innervate?What does it innervate?• OrbitOrbit
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Cont. CN 4Cont. CN 4
• What if lesioned?What if lesioned?• Weakness looking down w/ adductedWeakness looking down w/ adducted
eyeeye• Trouble going down stairs Trouble going down stairs• Head tilts away from lesioned sideHead tilts away from lesioned side
• Where does it Exit/Enter theWhere does it Exit/Enter the
Cranium?Cranium?
•
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C a u ?•
Cont. CN 4Cont. CN 4
• What does it innervate?What does it innervate?• OrbitOrbit
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What is CN 5?What is CN 5?
• Trigeminal Trigeminal
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What are the differentWhat are the different
branches of CN 5?branches of CN 5?• V1?V1?• OpthalmicOpthalmic
• V2?V2?• MaxillaryMaxillary
• V3?V3?• MandibularMandibular
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What is the function of CN V1?What is the function of CN V1?
• MixedMixed• General sensation (touch, pain, temperature) of General sensation (touch, pain, temperature) of
the forehead, scalp, & corneathe forehead, scalp, & cornea
• What if lesioned?What if lesioned?• Loss of general sensation of the forehead/scalpLoss of general sensation of the forehead/scalp• Loss of blink reflex w/ VIILoss of blink reflex w/ VII
• Where does it Exit/Enter the Cranium?Where does it Exit/Enter the Cranium?• Superior orbital FissureSuperior orbital Fissure
– Ophthalmic divisionOphthalmic division
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Cont. CN V1Cont. CN V1
• What does it innervate?What does it innervate?• OrbitOrbit• ScalpScalp
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What is the function of CNWhat is the function of CN
V2?V2?• MixedMixed• General sensation of Palat, NasalGeneral sensation of Palat, Nasal
cavity, Maxillary face, and Maxillarycavity, Maxillary face, and Maxillaryteethteeth
• What if lesioned?What if lesioned?• Loss of general sensation in skin overLoss of general sensation in skin over
maxilla & maxillary teethmaxilla & maxillary teeth
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Cont. CN V2Cont. CN V2
• Where does it Exit/Enter theWhere does it Exit/Enter theCranium?Cranium?
• Foramen RotundumForamen Rotundum
• What does it innervate?What does it innervate?• PterygopalatinePterygopalatine
– Leaves by openings to face, oral & nasalLeaves by openings to face, oral & nasalcavitycavity
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What is the function of CNWhat is the function of CN
V3?V3?• What is its function?What is its function?• MixedMixed
• General sensation of anterior 2/3 of General sensation of anterior 2/3 of tongue, mandibular face & mandibulartongue, mandibular face & mandibularteethteeth
• MotorMotor
• Muscles of Mastication and anterior bellyMuscles of Mastication and anterior bellyof digastric, mylohyoid, tensor tympani,of digastric, mylohyoid, tensor tympani,tensor palatitensor palati
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Cont. CN V3Cont. CN V3
• What if lesioned?What if lesioned?• Loss of general sensation in skin overLoss of general sensation in skin over
mandible, mandibular teeth, tongue,mandible, mandibular teeth, tongue,weakness in chewingweakness in chewing
• Jaw deviation to weak side Jaw deviation to weak side
• Trigeminal neuralgia Trigeminal neuralgia– Intractable pain in V2 or V3 territoryIntractable pain in V2 or V3 territory
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Cont. CN V3Cont. CN V3
• Where does it Exit/Enter theWhere does it Exit/Enter theCranium?Cranium?
• Foramen OvaleForamen Ovale
• What does it innervate?What does it innervate?• Infratemporal FossaInfratemporal Fossa
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What is CN VI?What is CN VI?
• AbducensAbducens
• What is its function?What is its function?• MotorMotor
• Lateral rectusLateral rectus– Abducts eyeAbducts eye
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What is CN VII?What is CN VII?
• FacialFacial• What is its function?What is its function?• MixedMixed• To muscles of facial expression To muscles of facial expression• Posterior belly of diagastricPosterior belly of diagastric• Stylohyoid & StapediusStylohyoid & Stapedius• Tastes anterior 2/3 of tongue/palate Tastes anterior 2/3 of tongue/palate• Salivates (submandibular & sublingual glands)Salivates (submandibular & sublingual glands)• Tears (Lacrimal glands) Tears (Lacrimal glands)• Makes mucous (nasal & palatine glands)Makes mucous (nasal & palatine glands)
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Cont. CN VIICont. CN VII
• What if lesioned?What if lesioned?• Corner of mouth droopsCorner of mouth droops• Can’t close eyeCan’t close eye• Can’t wrinkle foreheadCan’t wrinkle forehead• Loss of blink reflexLoss of blink reflex• HypeacusisHypeacusis• Loss or alteration of taste (ageusia)Loss or alteration of taste (ageusia)• Eye dry and redEye dry and red• Bell PalsyBell Palsy
– Lesion of nerve in facial canalLesion of nerve in facial canal
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Cont. CN VIICont. CN VII
• Where does it Exit/Enter theWhere does it Exit/Enter theCranium?Cranium?
• Internal Auditory meatusInternal Auditory meatus
• What does it innervate?What does it innervate?
• FaceFace• Nasal & oral cavityNasal & oral cavity
– Branches leave skull in stylomastoidBranches leave skull in stylomastoidforamen, petrotympanic fissure, orforamen, petrotympanic fissure, orHiatus of facial canalHiatus of facial canal
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What is CN VIII?What is CN VIII?
• VestibulocochlearVestibulocochlear
• What is its function?What is its function?• SensorySensory
• HearsHears
• Linear acceleration (Gravity)Linear acceleration (Gravity)• Angular acceleration (Head Turning)Angular acceleration (Head Turning)
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Cont. CN VIIICont. CN VIII
• What if lesioned?What if lesioned?• Loss of BalanceLoss of Balance• NystagmusNystagmus
• Where does it Exit/Enter the Cranium?Where does it Exit/Enter the Cranium?• Internal Auditory MeatusInternal Auditory Meatus
• What does it innervate?What does it innervate?• Inner earInner ear
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What is CN IX?What is CN IX?
• GlossopharyngealGlossopharyngeal
• What is its function?What is its function?• MixedMixed• Sense PharynxSense Pharynx
• Carotid sinus/bodyCarotid sinus/body• Salivates (parotid glands)Salivates (parotid glands)• Tastes and senses posterior 1/3 of tongue Tastes and senses posterior 1/3 of tongue
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Cont. CN IXCont. CN IX
• What is its function?What is its function?• To one muscle only (stylopharyngeus) To one muscle only (stylopharyngeus)
• What if lesioned?What if lesioned?• Loss of Gag Reflex with XLoss of Gag Reflex with X
• Where does it Exit/Enter the Cranium?Where does it Exit/Enter the Cranium?• Jugular Foramen Jugular Foramen
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Cont. CN IXCont. CN IX
• What does it innervate?What does it innervate?• NeckNeck• Pharynx/TonguePharynx/Tongue
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What is CN X?What is CN X?
• VagusVagus• What is its function?What is its function?
• MixedMixed• To muscles of palate & pharynx for To muscles of palate & pharynx forswallowing except tensor palate (V) &swallowing except tensor palate (V) &Stylopharynegeus (IX)Stylopharynegeus (IX)
• To all muscles of Larynx (phonates) To all muscles of Larynx (phonates)• Senses Larynx & LaryngopharynxSenses Larynx & Laryngopharynx• Senses Larynx & GI tractSenses Larynx & GI tract
• To GI tract smooth muscle & glands in To GI tract smooth muscle & glands inforgut & midgutforgut & midgut
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Cont. CN XCont. CN X
• What if lesioned?What if lesioned?• Nasal speechNasal speech• Nasal regurgitationNasal regurgitation• DysphagiaDysphagia• Palate dropPalate drop• Uvula points away from pathologyUvula points away from pathology
• Hoarseness/fixed vocal cordHoarseness/fixed vocal cord• Loss of gag reflex w/ IXLoss of gag reflex w/ IX• Loss of cough reflexLoss of cough reflex
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Cont. CN XCont. CN X
• Where does it Exit/Enter theWhere does it Exit/Enter theCranium?Cranium?
• Jugular Foramen Jugular Foramen
• What does it innervate?What does it innervate?• NeckNeck• Pharynx/LarynzPharynx/Larynz
• Thorax/Abdo Thorax/Abdo
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Cont. CN XCont. CN X
• What if lesioned?What if lesioned?• Horner syndromeHorner syndrome
– Eyelid droop (ptosis)Eyelid droop (ptosis)– Constricted pupil (miosis)Constricted pupil (miosis)– Loss of sweating (anhydrosis)Loss of sweating (anhydrosis)
– Flushed faceFlushed face
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Cont. CN XCont. CN X
• Where does it Exit/Enter theWhere does it Exit/Enter theCranium?Cranium?
• Carotid canal on internal carotidCarotid canal on internal carotidarteryartery
• What does it innervate?What does it innervate?• OrbitOrbit• FaceFace•
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What is CN XI?What is CN XI?
• AccessoryAccessory
• What is its function?What is its function?• Turns head to opposite side Turns head to opposite side
– sternocleidomastoidsternocleidomastoid
• Elevates & Rotates scapulaElevates & Rotates scapula– Trapezius Trapezius
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Cont. CN XICont. CN XI
• What if lesioned?What if lesioned?• Weakness turning head to opposite sideWeakness turning head to opposite side• Shoulder droopShoulder droop
• Where does it Exit/Enter the Cranium?Where does it Exit/Enter the Cranium?• Jugular Foramen Jugular Foramen
• What does it innervate?What does it innervate?• NeckNeck
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What is CN XII?What is CN XII?
• HypoglossalHypoglossal
• What is its function?What is its function?• Moves tongueMoves tongue
• What if lesioned?What if lesioned?• Tongue points toward pathology on Tongue points toward pathology on
protrusionprotrusion
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What is CN XII?What is CN XII?
• Where does it Exit/Enter theWhere does it Exit/Enter theCranium?Cranium?
• Hypoglossal CanalHypoglossal Canal
• What does it innervate?What does it innervate?• Tongue Tongue
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What are the muscles of What are the muscles of
mastication?mastication?
• Temporalis Temporalis• MasseterMasseter
• Medial PterygoidsMedial Pterygoids• Lateral PterygoidsLateral Pterygoids
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What part of the brain dealsWhat part of the brain dealswith problem solving?with problem solving?
• Frontal LobeFrontal Lobe
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What happens if there is aWhat happens if there is alesion to the Optic nerve?lesion to the Optic nerve?
• Unilateral BlindnessUnilateral Blindness
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What happens if there is aWhat happens if there is alesion to the Optic Chiasm?lesion to the Optic Chiasm?
• Bitemporal HemianopiaBitemporal Hemianopia
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What is a Berry Aneurysm dueWhat is a Berry Aneurysm dueto in the Circle of Willis?to in the Circle of Willis?
• SUBARACHNOID HemorrhageSUBARACHNOID Hemorrhage
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What is a CLUE forWhat is a CLUE forSUBARACHNOID Hemorrhage?SUBARACHNOID Hemorrhage?
• The worse headache of my life The worse headache of my life
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What does the diencephalonWhat does the diencephalonoriginate from?originate from?
• ForebrainForebrain
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What originates from theWhat originates from theDiencephalon?Diencephalon?
• Thalamus Thalamus• 33 rdrd VentricleVentricle
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Where does the TelencephalonWhere does the Telencephalonoriginate from?originate from?
• ForebrainForebrain– ProsencephalonProsencephalon
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What originates from theWhat originates from the Telencephalon? Telencephalon?
• Cerebral HemispheresCerebral Hemispheres• Lateral VentriclesLateral Ventricles
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What originates from theWhat originates from theMesencephalon?Mesencephalon?
• MidbrainMidbrain• AqueductAqueduct
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What originates from theWhat originates from theHindbrain?Hindbrain?
• MetencephalonMetencephalon• MyerencephalonMyerencephalon
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What originates from theWhat originates from theMetencephalon?Metencephalon?
• PonsPons• CerebrumCerebrum
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What originates from theWhat originates from theMyerencephalon?Myerencephalon?
• MedullaMedulla
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What does the Jugular ForamenWhat does the Jugular Foramencontain?contain?
• CN IXCN IX• CN XCN X
• CN XICN XI• Internal Jugular VeinInternal Jugular Vein• Spinal accessory nervesSpinal accessory nerves
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What does the Foramen OvaleWhat does the Foramen Ovalecontain?contain?
• CN V3CN V3
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What does the ForamenWhat does the ForamenMagnum contain?Magnum contain?
• Vertebral arteriesVertebral arteries• Brain stemBrain stem
• Spinal roots of CN XISpinal roots of CN XI• Spinal cordSpinal cord
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What does the Optic CanalWhat does the Optic Canalcontain?contain?
• Opthalmic arteryOpthalmic artery
• Central retinal veinCentral retinal vein• CN IICN II
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What does the HypoglossalWhat does the HypoglossalCanal contain?Canal contain?
• CN XIICN XII• Hypoglossal nerveHypoglossal nerve
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What does the Carotid CanalWhat does the Carotid Canalcontain?contain?
• Internal Carotid arteryInternal Carotid artery
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What does the PosteriorWhat does the PosteriorCondylar Canal contain?Condylar Canal contain?
• Large Emissary VeinLarge Emissary Vein
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What are signs of an UPPERWhat are signs of an UPPERmotor neuron damage?motor neuron damage?
• + Babinski sign+ Babinski sign• Spastic ParalysisSpastic Paralysis
• Hyperactive Deep Tendon ReflexesHyperactive Deep Tendon Reflexes
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What are signs of a lowerWhat are signs of a lowermotor neuron defect?motor neuron defect?
• AtrophyAtrophy
• FasciullationsFasciullations• Flaccid ParalysisFlaccid Paralysis• Loss of deep tendon reflexesLoss of deep tendon reflexes
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What does it mean to see aWhat does it mean to see aphysis on radiograph?physis on radiograph?
• Means the skeleton is not fullyMeans the skeleton is not fullymaturemature
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When does PhysisWhen does Physis
disappear?disappear?• Once growth is completeOnce growth is complete
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What is a nonunionWhat is a nonunion
fracture?fracture?• Fracture that does not heal with in 6Fracture that does not heal with in 6
monthsmonths
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What does Malunion mean?What does Malunion mean?
• A fracture that heals in an AbnormanA fracture that heals in an Abnormanpositionposition
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What is a characteristic featureWhat is a characteristic featureof cancellous (spongy) bone?of cancellous (spongy) bone?
• Trabeculae Trabeculae
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Which CN’s control eyeWhich CN’s control eyemovement?movement?
• CN IIICN III– Oculomotor nerveOculomotor nerve
• CN IVCN IV– Trochlear nerve Trochlear nerve
• CN VICN VI– Abducens nerveAbducens nerve
Wh t CN i ibl fWhat CN is responsible for
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What CN is responsible forWhat CN is responsible forturning the head andturning the head and
shrugging the shoulders?shrugging the shoulders?
• CN XICN XI– Accessory nerveAccessory nerve
Wh t CN h fib fWhat CN has sensory fibers for
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What CN has sensory fibers forWhat CN has sensory fibers forFace and Motor fibers forFace and Motor fibers for
muscles of mastication?muscles of mastication?
• CN VCN V– Tigeminal Nerve Tigeminal Nerve
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What CN controls sensoryWhat CN controls sensoryfibers for Visonfibers for Vison
• CN IICN II– Optic nerveOptic nerve
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What CN senses fiber forWhat CN senses fiber forsmelling?smelling?
• CN ICN I– OlfactoryOlfactory
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What does the MesentericWhat does the MesentericArtery Supply?Artery Supply?
• Distal 1/3 of transverse colonDistal 1/3 of transverse colon
• Descending colonDescending colon• Sigmoid colonSigmoid colon• Upper Portion of RectumUpper Portion of Rectum
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What does the SuperiorWhat does the SuperiorMesenteric Artery Supply?Mesenteric Artery Supply?
• DuodenumDuodenum• Jejunum Jejunum
• IleumIleum• CecumCecum• AppendixAppendix• Ascending colonAscending colon• Proximal 2/3 of transverse colonProximal 2/3 of transverse colon
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What does the common IliacWhat does the common Iliacartery supply?artery supply?
• PelvisPelvis
• PerineumPerineum• LegLeg
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What does the Celiac trunckWhat does the Celiac trunckgive rise to?give rise to?
• Left gastric arteryLeft gastric artery• Splenic arterySplenic artery
• Common hepatic arteryCommon hepatic artery
a o e e as r c
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a o e e . as r c.Artery, Splenic Artery, &Artery, Splenic Artery, &Common Hepatic arteryCommon Hepatic arterysupply?supply?
• EsophagusaEsophagusa
• StomachStomach• DuodenumDuodenum• LiverLiver• GallbladderGallbladder• PancreasPancreas
If there is a lesion in the frontalIf there is a lesion in the frontal
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If there is a lesion in the frontalIf there is a lesion in the frontallobe will you have motor orlobe will you have motor or
sensory defects?sensory defects?
• MotorMotor