Must Knows and Reminders Flashcards
1
Q
AB exotoxin bacteria
ABCDES
A
Pseudomonas Aeruginosa Bordetella pertussis Cholera, Clostridia Diphtheria E. coli Shigella
2
Q
P. aeruginosa
[Exotoxin, MOA]
A
Exotoxin A.
>Inhibits EF-2 (elongation factor) – inhibits protein synthesis – host cell death, necrosis
3
Q
B. pertussis
[Exotoxin, MOA]
A
Pertussis toxin.
>Inhibits Gi – overactivates adenylyl cyclase – inc. cAMP – phagocyte dysfxn
4
Q
V. cholera
[Exotoxin, MOA]
A
Cholera toxin.
>Overactivates adenylate cyclase – inc. cAMP – activates CFTR – inc. Cl- secretion, H20 secretion – “Rice water” diarrhea
5
Q
C. botulinum
[Exotoxin, MOA]
A
Botulinum toxin.
>Protease that cleaves SNAREs – prevents ACh release into NMJ – flaccid paralysis
6
Q
C. tetani
[Exotoxin, MOA]
A
Tetanospasmin.
>Protease that cleaves SNAREs – prevents GABA/glycine release into spinal cord – spastic paralysis
7
Q
C. diphtheriae
[Exotoxin, MOA]
A
Diphtheria toxin.
>Inhibits EF-2 (elongation factor) – inhibits protein synthesis – pseudomembranous pharyngitis
8
Q
Enterotoxic E. coli (ETEC)
[Exotoxin, MOA]
A
Labile toxin.
>Overactivates adenylyl cyclase – inc. cAMP – activates CFTR – inc. Cl- secretion, H2O secretion – watery diarrhea.
>Similar to cholera
9
Q
Enterohemorrhagic E. coli (EHEC)
[Exotoxin, MOA]
A
Shigella-like toxin (SLT; verotoxin).
>Inhibits 60s ribosomal subunit – inhibits protein synthesis, inc. cytokine release – bloody diarrhea (HUS).
>Similar to Shigella, but doesn’t invade host cell
10
Q
Shigella
[Exotoxin, MOA]
A
Shigella toxin.
>Inhibits 60s ribosomal subunit – inhibits protein synthesis, inc. cytokine release – damages gut epithelium – bloody diarrhea (HUS)
11
Q
ABC carboxylase (3)
A
ATP, Biotin, CO2.
>Pyruvate carboxylase (gluconeogenesis).
>Acetyl-CoA carboxylase (FA synthesis).
>Propionyl-CoA carboxylase.
12
Q
TLCFN dehydrogenase (3)
A
Thiamine, Lipoic acid, CoA, FAD+, NAD+.
>Pyruvate dehydrogenase.
>a-ketoglutarate dehydrogenase.
>Branched chain ketoacid dehydrogenase.
13
Q
Intracellular organisms
A
Rickettsia, Chlamydia
Listeria, Legionella, Mycobacteria, Salmonella, Neisseria
14
Q
Catalase (+)
Cats Need PLACESS
A
Nocardia, Pseudomonas, Listeria, Aspergillus, Candida, E. coli, Staphylococcus, Serratia
15
Q
Encapsulated organisms (polysaccharide capsule)
A
S. pneumonia, H. influenzae type B, N. meningitidis, E. coli, Salmonella, Klebsiella pneumoniae, GBS
16
Q
Aerobic bacteria
A
Mycobacteria
Pseudomonas
Nocardia
(have superoxide dismutase)
17
Q
Anaerobic bacteria
A
Actinomyces
Bacteroides
Clostridium
Fusobacterium
18
Q
Chocolate agar.
Selective for what organism?
A
H. influenzae type B
Has Factor V (NAD+) and X (hematin)
19
Q
Sabouraud agar.
Selective for what organism?
A
Fungi
20
Q
Thayer-Martin agar.
Selective for what organism?
A
Neisseria
Vancomycin, Trimethoprim, Colistin, Nystatin
21
Q
Charcoal yeast extract (w/ Cysteine + iron).
For what organism?
A
Legionella
needs Cysteine
22
Q
Loffler agar.
For what organism?
A
C. diphtheriae
23
Q
Regan-Lowe agar.
For what organism?
A
B. pertussis
Charcoal, blood, antibiotics
24
Q
Lowenstein-Jensen agar.
For what organism?
A
Mycobacteria
25
Eaton agar.
| For what organism?
Mycoplasma
26
Tellurite agar.
| For what organism?
C. diphtheriae
27
Bordet-Gengou agar.
| For what organism?
B. pertussis
| Potato
28
MacConkey agar.
| For what organisms?
```
Lactose fermenters (pink)
E. coli, Klebsiella
```
29
Poor gram staining bugs
```
Treponemia
Mycobactera
Mycoplasma
Legionella
Rickettsia
Chlamydia
```
30
Biofilm producers
S. epidermidis -- prosthetic devices, IV catheters
Viridans strep -- dental carries, endocarditis
P. aeruginosa -- Pneumonia, CF, contacts
H. influenzae -- otitis media, other mucosal infxns
31
DNA viruses
| HHAPPPPy
```
Hepadna
Herpes
Adeno
Pox
Parvo
Papilloma
Polyoma
```
32
DNA virus properties
>dsDNA (except Parvo -- ssDNA).
>Linear (except Papilloma, Polyoma, hepadna -- circular).
>Icosahedral (except Pox).
>Replicates in nucleus (except Pox).
33
Naked viruses
>DNA: Parvo, Adeno, Papilloma, Polyoma
| >RNA: Calici, Picorna, Reovirus, Hepevirus
34
(+) RNA viruses
Calici, Corona
Retro, Toga
Flavi, Hepe, Picorna
35
(-) RNA viruses
| Always Bring Polymerase Or Fail Replication
Arena, Bunya
Paramyxo, Orthomyxo
Filo, Rhabdo
36
Segmented RNA viruses
| ROBA parts
Reovirus
Orthomyxo
Bunya
Arena
37
Reoviruses
Rotavirus (fatal diarrhea in kids)
| Coltivirus
38
Picornaviruses
```
>Poliovirus (Sabin, Salk)
>Echovirus - aseptic meningitis
>Rhinovirus - common cold
>Coxsackievirus - hand-foot-mouth dse, aseptic meningitis.
>HAV
```
39
Hepevirus
HEV
40
Calicivirus
Norovirus - viral gastroenteritis
41
Flaviviruses
```
HCV
Yellow fever
Dengue
West nile virus
St. Louis encephalitis
```
42
Togavirus
Rubella
| Easter/Western equine encephalitis
43
Retroviruses
HIV - AIDs (lentivirus)
HTLV - T cell leukemia (oncovirus)
Have reverse transcriptase
44
Coronavirus
Coronavirus - common cold
| SARS
45
Orthomyxoviruses
Influenza virus
46
Paramyxoviruses
>Parainfluenza - croup
>RSV - bronchiolitis in babies
>Measles, Mumps
47
Rhabdovirus
Rabies
48
Filoviruses
Ebola/Marburg hemorrhagic fever
49
Arenaviruses
>LCMV - lymphocytic choriomeningitis virus
| >Lassa fever encephalitis
50
Bunyavirus
>California encephalitis
>Sandfly/Rift Valley fevers
>Crimean-Congo hemorrhagic fever
>Hantavirus - hemorrhagic fever, pneumonia
51
Delta virus
Defective virus -- needs HBV to replicate
52
IL-1
Secreted by macrophages.
Acute inflammation.
Fever.
Recruits WBCs.
53
IL-6
Secreted by macrophages.
| Acute phase reactant prodn.
54
IL-8
Secreted by macrophages.
| Neutrophil chemotactic.
55
IL-12
Secreted by macrophages.
Th1 differentiation.
Activated NK cells.
56
TNF-alpha
Secreted by macrophages.
Mediates septic shock.
WBC recruitment, vascular leak.
57
IL-2
Secreted by T cells.
| T cell growth.
58
IL-3
Secreted by T cells.
| Growth and differentiation of BM stem cells.
59
IFN-gamma
Secreted by Th1 cells.
Stimulates macrophages to kill.
Activated NK cells to kill.
60
IL-4
Secreted by Th2 cells.
Th2 differentiation.
B cell growth -- IgE, IgG.
61
IL-5
Secreted by Th2 cells.
B cell diff -- IgA.
Eosinophils.
62
IL-10
Secreted by Th2 cells.
Attenuates immune response, inflammation.
Inhibits macrophages and dendritic cells.
63
TCR.
| What cells? Binds to?
T cells.
| Binds Ag-MHC complex
64
CD28.
| What cell? Binds to?
T cells.
| Binds to B7 on APCs
65
CD40L.
| What cell? Binds to?
Helper T cells.
| Binds to CD40 of B cells
66
CD21.
| What cell? Binds to?
B cells.
| Receptor for EBV
67
CD40.
| What cell? Binds to?
B cells.
| Binds to CD40L of Helper T cells
68
MHC II.
| What cell? Binds to?
APCs (B cells, macrophages).
| Binds to TCR of CD4+ T cells
69
B7.
| What cell? Binds to?
APCs.
| Binds to CD28 on T cells
70
Fc and C3b receptors.
| What cell? Function?
Macrophages.
| To enhance phagocytosis
71
CD4.
| What cell?
Helper T cells
72
CD8.
| What cell?
Cytotoxic T cells
73
CD16.
| What cell? Binds to?
NK cells.
| Binds to Fc of IgG, for antibody-dependent cell-mediated cytotoxicity.
74
CD56.
| What cell?
Unique marker for NK cells
75
BCR-ABL.
| Tumor?
CML, ALL
76
BCL-2.
| Tumor?
Follicullar lymphoma, undifferentiated lymphoma
77
BRAF.
| Tumor?
Melanoma
| Non-hodgkin lymphoma
78
C-myc.
| Tumor?
Burkitt lymphoma
79
HER2/neu (c-erbB2).
| Tumors?
Breast, ovarian, gastric CA
80
L-myc.
| Tumor?
Lung tumor
81
N-myc.
| Tumor?
Neuroblastoma
82
RAS.
| Tumors?
Colon, lung, pancreatic cancer
83
RET.
| Tumors?
MEN 2a, 2b
| Medullary thyroid cancer
84
APC.
| Tumor?
Colorectal cancer (FAP)
85
BRCA1/BRCA2.
| Tumor?
Breast, ovarian cancer
86
NF1, NF2.
| Tumors?
Neurofibromatosis type 1 (neurofibromin)
| Neurofibromatosis type 2 (Merlin/schwannomin)
87
p16.
| Tumor?
Melanoma
88
p53.
| Tumors?
Most human cancers, Li-Fraumeni
89
PTEN.
| Tumors?
Breast, prostate, endometrial cancers
90
Rb.
| Tumor?
Retinoblastoma, osteocarcinoma
91
VHL.
| Tumor?
Von Hippel-Lindau dse
| Renal cell carinoma
92
TSC1, 2.
| Tumor?
Tuberous sclerosis (hamartin; tuberin)
93
DCC.
| Tumor?
Colon cancer
94
DPC4/SMAD4.
| Tumor?
Pancreatic cancer
95
Cancer screening.
| How many cell divisions for early ssx? Purpose of screening? Examples?
At least 30 divisions of a single mutated cell will result in early ssx. Each division has inc. mutations, so poor prognosis if cancer detected late.
>Purpose: 1) detect dysplasia before CA, 2) detect CA before clinical sx arise.
>Examples: pap smear, mammogram, colonoscopy
96
Psammoma bodies.
| Found in what diseases?
```
>Laminated, concentric spherules w/ dystrophic calcification.
>Papillary CA of thyroid.
>Serous papillary cystadenoCA of ovary.
>Meningioma.
>Malignant mesothelioma.
```
97
Cholinesterase inhibitor poisoning. (organophosphates: Echothiophate, Malathion, Parathion; Nerve gas Sarin)
DUMBBEELSS
>Irreversibly inhibit AChE.
>Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle/CNS, Lacrimation, Sweating, Salivation.
>Tx: Atropine + Pralidoxime (regenerates AChE if given early).
98
Atropine
| [Action, SE, Tx]
Muscarinic antagonist; Blocks DUMBBEELSS
>Mydriasis, cycloplegia; Dec. airway secretions; Dec. gastric acid secretion, Dec. peristalsis; Dec. urinary urgency
>SE: inc. body temp (dec. sweating), dry mouth, flushed skin, cycloplegia, disorientation
>Tx: Physostigmine (Neostigmine, Edrophonium)
99
CYP450 Inducers
| Chronic alcohol and Gritty Carbs NevR Stop Phen-Phen
```
Chronic alcohol use
St. John's wort
Phenytoin
Phenobarbital
Rifampin
Griseofulvin
Carbamazepine
Nevirapine
```
100
CYP450 Inhibitors
| Alcohol abuse and Grapefruit juice RACK QuIMs
```
Acute alcohol abuse
Ritonavir (-avirs)
Amiodarone
Cimetidine
Ketoconazole
Sulfonamides
INH
Grapefruit juice
Quinidine
Macrolide's (except azithromycin)
```
101
CYP450 substrates
Anti-epileptics
Warfarin
Theophylline
OCPs
102
Sulfa drugs
| [Drug names, ssx of sulfa allergies]
Probenecid, Furosemide, Acetazolamide, Celecoxib, Thiazides, Sulfonamides, Sulfasalazine, Sulfonylureas
Sulfa allergies: fever, UTI, SJS, hemolytic anemia, thrombocytopenia, agranulocytosis, urticaria
103
CAMP factor.
| Which bacteria? Function?
>Produced by S. agalactiae (GBS). Enlarges the area of hemolysis formed by S. aureus.
>Arrowhead clearing at junction of the 2 organisms)
104
Culture tests for C. perfringens
>"Stormy fermentation" on milk media.
>Double zone of hemolysis.
>Nagler reaction on egg yolk agar (opalescence around colonies)
105
Whipple Triad (of insulinoma)
>Low Blood glucose
>Ssx of Hypoglycemia
>Ssx disappear w/ normalization of glucose levels
106
Cushing reflex is the body's way of maintaining cerebral perfusion in the setting of inc. ICP (brain injury). What are the roles of the chemoreceptors and baroreceptors in this reflex?
>Inc ICP compresses cerebral arteries -- cerebral ischemia, inc. PCO2 -- chemoreceptors send signals to vasomotor center to inc. peripheral vasoconstriction -- inc. CO, inc. MAP (HTN) -- more blood to brain, better cerebral perfusion
>Reflex Bradycardia due to stimulation of peripheral baroreceptors from increased stretch -- signals sent to VMC to dec. HR
107
What is the cause of decreased, irregular respiration (respiratory depression) in Cushing reflex?
>Reduced perfusion of brainstem from swelling or possible brain herniation (due to inc. ICP) -- occurs if condition is not caught early enough. (Central chemoreceptors in medulla oblongata detect pCO2 in brain CSF).
>Cushing triad: HTN, bradycardia, respiratory depression
108
Diagnostic tests for MI
>Gold standard for first 6 hrs: ECG.
>Troponin I: rises after 4 hrs, elevated for 7-10 days, specific.
>CK-MB: rises after 6-12 hrs, normal after 48 hrs; diagnose reinfarction, nonspecific (skeletal muscle).
109
Duke's criteria for Bacterial endocarditis
B.E.F.E.V.R (2 major / 1 major, 3 minor/ 5 minor)
>Major: (+) Blood culture, (+) Endocardial involvement on Echo.
>Minor: Fever > 38C, Vascular phenomenon (Janeway lesions, emboli, infarct), Evidence of micro/immuno findings (Osler nodes, Roth spots), Risk factors.
110
Jones criteria for Rheumatic Fever
```
J.O.N.E.S (2 major / 1 major, 2 minor)
Joints (migratory polyarthritis)
❤️ (pancarditis)
Nodules (Subcutaneous)
Erythema marginatum
Sydenham chorea
>Minor: Fever, arthralgia, inc. acute phase reactants
```
111
Aortic stenosis murmur
>Systolic murmur, Crescendo-decrescendo w/ peak mid-systole.
>Inc. LV pressure >> aortic pressure
>"Pluses parvus et trades": pulses weak w/ delayed peak.
>Syncope, Angina, Dyspnea (SAD).
>Due to age-related calcification or early-onset calcification of bicuspid aortic valve
112
Mitral/Tricuspid regurgitation murmur
>Holosystolic, high-pitched "blowing" murmur.
>Mitral - apex radiating to axilla, IHD (post-MI), doesn't usually intensify w/ inspiration.
>Tricuspid - tricuspid area radiating to right sternal border, intensifies w/ inspiration
>Assctd w/ RF and infective endocarditis.
113
Mitral valve prolapse murmur
>Late systole; crescendo w/ midsystolic click.
>Most frequent valve lesion.
>Loudest just before S2, apex.
>Predisposes to infective endocarditis.
>Caused by myxomatous degeneration, RF, chord rupture.
114
VSD murmur
Holosystolic, harsh-sounding.
| Loudest at tricuspid area.
115
Aortic regurgitation murmur
>Early diastolic murmur, high-pitched "blowing" murmur.
>Hyper dynamic pulse when severe and chronic (head bobbing, bounding pulses).
>Due to aortic root dilation, bicuspid aortic valve, endocarditis, RF.
>Can progress to left HF
116
Mitral stenosis murmur
>Diastolic murmur; opening snap ff. by rumbling.
>Inc. LA pressure >> LV pressure.
>Due to RF; Can lead to LA dilatation.
117
PDA murmur
>Continuous, machine-like.
>Loudest at S2, left infraclavicular area.
>Due to congenital rubella, prematurity.
118
High anion gap metabolic acidosis (MUDPILES)
```
Methanol (formic acid)
Uremia
DKA
Propylene glycol
Iron tablets, Isoniazid
Lactic acid
Ethylene glycol (antifreeze)
Salicylates
```
119
Normal anion gap metabolic acidosis (HARD-ASS)
```
Hyperalimentation
Addison disease (dec. aldosterone)
Renal tubular acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline infusion
```
120
Acute PSGN (LM, IF, EM)
>LM: enlarged, hypercellular glomeruli.
>IF: "starry sky" granular appearance (Ig, IgM, C3).
>EM: sub epithelial IC humps
121
RPGN (LM, IF)
>LM, IF: crescentic moon shape filled w/ fibrin and plasma proteins
122
DPGN (LM, EM, IF)
>LM: "wire looping" of capillaries.
>EM: subendothelial IgG-based IC deposits.
>IF: granular.
123
IgA nephropathy (LM, EM, IF)
>LM: mesangial proliferation.
>EM: mesangial IC deposits.
>IF: IgA-based IC deposits in mesangium
124
Alport syndrome (LM, EM)
LM, EM: thinning and splitting of GBM
125
MPGN type I (EM, IF, PAS, H and E)
>EM: subendothelial deposits.
>IF: granular.
>PAS, H and E stains: "tram-track" due to GBM splitting caused by mesangial ingrowth.
126
MPGN type II (EM findings)
EM: intramembranous deposits, "dense deposits"
127
FSGS (LM, IF, EM)
>LM: segmental sclerosis, hyalinosis
>IF: nonspecific for focal deposits of IgM, C3, C1.
>EM: effaced foot processes
128
MCD (LM, IF, EM)
>LM: normal glomeruli (maybe lipid in PCT cells).
>IF: nonspecific deposits.
>EM: effaced foot processes
129
Membranous nephropathy (LM, IF, EM)
>LM: diffuse capillary and GBM thickening.
>IF: granular.
>EM: "spike and dome" w/ sub epithelial deposits
130
Amyloidosis nephrotic syndrome (LM findings)
LM: Apple-green birefringence under polarized light w/ congo red stain
131
Diabetic glomerulonephropathy (LM findings)
LM: GBM thickening, mesangial expansion, Kimmelstiel-Wilson lesions (eosinophilic nodular glomerulosclerosis)
132
External carotid branches (SALFOPMS, from bottom up)
```
Superior thyroid artery
Ascending pharyngeal artery
Lingual artery
Facial artery
Occipital artery
Posterior auricular artery
Maxillary artery (terminating branch)
Superficial temporal artery (terminating branch)
```
133
Process of Ammoniagenesis in PCT cells
>Site for RECLAIMING HCO3 that's been filtered.
>Intracellular CA combines CO2 and H20 into H2CO3 --> dissolves into H+ and HCO3 --> HCO3- reabsorbed while H+ secreted into urine (Na/H antiporter) --> H+ combines w/ urine HCO3 to become H2CO3 --> CA dissolves H2CO3 into CO2 and Water, w/c diffuse back into cell to continue cycle.
134
HCO3- regenerated and reabsorbed in Collecting ducts
CO2 from renal interstitium diffuses into cell and combines w/ H2O via CA to become H2CO3 --> dissolves into H+ and HCO3- --> HCO3 reabsorbed while H+ secreted (H-ATPase) --> H+ combines w/ acid buffers to be secreted (NH3, PO4).
135
Renal collecting duct is the primary sign for K+ excretion (Na/K-ATPase) and excretion of excess H+ (H/K-ATPase). How are these channels affected by Aldosterone?
>In principal cells, aldosterone enhances action of ENaC (Na reabsorbed), epithelial K channels (K loss), and N/K pump --> K+ excretion.
>In alpha-intercalated cells, aldosterone enhances H/K pump to secrete H+ in exchange for K+. H+ is excreted w/ HPO3 and NH3 as H2PO4 and NH4+.
136
Pathogenesis of RTA type 1 (distal)
>Inability to regenerate HCO3- due to dysfunctional H/K-ATPase (H out, K in) in collecting tubules -- Severe Hypokalemia.
>Urine pH > 5.5 (alkaline, dec. titratable acid in urine).
>Dec. HCO3, H+ combines w/ Cl- in blood --> Normal anion gab metabolic acidosis.
Causes: amphora, lithium, Sickle cell trait/dse
137
Pathogenesis of RTA type 2 (proximal)
>Inability of PCT to reclaim HCO3.
>Urine is initially at pH > 5.5 (alkaline), but when serum HCO3 finally equals the lowered renal threshold for HCO3 reclamation, the PCT can go back to reclaiming HCO3 and urine pH
138
Pathogenesis of RTA type 4 (Hyperkalemic)
MC RTA in adults.
>No aldosterone -- Na loss, K retention -- Hyperkalemia, w/c inhibits ammoniagenesis in PCT -- transcellular switch b/w H+ and K+, so K+ enters cell while H+ exits -- intracellular alkalosis inhibits ammonia synthesis from glutamine, no generation of HCO3.
>Normal anion gap Metabolic Acidosis.
>Causes: dec. Aldosterone prod (ACEi, ARBs), aldosterone resistance (K-sparing diuretics, nephropathy due to obstruction)
139
Structures found at vertebral levels T4, T8, T10, T12
>T4: sternal angle of Louis, begin and end of aortic arch, end of superior mediastinum, trachea bifurcates.
>T8: IVC.
>T10: esophagus, CN X.
>T12: aorta, thoracic duct, azygous vein.
140
What is the mechanism of gastric H+ secretion by gastric parietal cells?
After a meal, CO2 is extracted from the blood and converted, w/ H20, by CA into H+ and HCO3. Activation of parietal cell by Histamine, Gastrin, and ACh stimulates the H/K-pump to secrete the H+ in exchange for K+. The HCO3 is absorbed into bloodstream ("alkaline tide" of venous blood) in exchange for Cl-. Cl- maintains (-) potential of stomach lumen, and Cl- is also secreted w/ H+ to form HCl.
141
Only monosaccharides are absorbed by enterocytes. What is the transporter for Glucose and Galactose? For Fructose? What transports all monosaccharides in the blood?
>Glucose, Galactose: SGLT1 (Na dependent).
>Fructose: GLUT5.
>Blood transporter: GLUT2.
142
What is the D-xylose absorption test? Where is it useful?
D-xylose is a monosaccharide that doesn't need pancreatic enzymes for digestion before absorption, but requires only intact mucosa. Differentiates GI musoca damage from other causes of malabsorption.
In pancreatic insufficiency, the test has normal absorption w/ normal urinary excretion. If there is an intestinal mucosal defect or bacterial overgrowth, there is dec. excretion due to a problem w/ absorption.
143
Opioid intoxication ssx
```
Respi/CNS depression
Pupillary constriction (pinpoint pupils)
Seizures (overdose)
```
144
Opioid withdrawal ssx
Sweating
Dilated pupils
Piloerection
Flu-like ssx (diarrhea, nausea, rhinorrhea, fever)
145
Amphetamine intoxication ssx
```
Euphoria, grandiosity
Pipillary dilation
Prolonged wakefulness and attention
HTN, tachycardia
Severe: cardiac arrest, seizure
```
146
Amphetamine withdrawal ssx
Anhedonia
Hypersomnolence
Existential crisis
147
Cocaine intoxication ssx
```
Impaired judgment
Pupillary dilation
Hallucinations (tactile)
Combative, uncooperative
Sudden cardiac death (potent vasoconstrictor)
```
148
Cociaine withdrawal ssx
Hypersomnolence
Psychological craving
Depression/suicidality
149
Barbiturate intoxication ssx
Low safety margin
| Marked respi depression
150
Barbiturate withdrawal ssx
Life-threatening cardiovascular collapse
| Delirium
151
BZD intoxication ssx
Greater safety margin vs Barbs
Minor respi depression
Ataxia
152
BZD withdrawal ssx
Rebound anxiety
Depression
Sleep disturbance
153
PCP intoxication ssx
```
Belligerence
Impulsivity
Homocidality (violent behavior)
Psychosis
Delirium
Nystagmus
```
154
LSD intoxication ssx
Perceptual distortion (visual, auditory)
Depersonalization
Possible flashbacks
155
Marijuana (cannabinoid) intoxication ssx
Euphoria, Paranoid delusions
Perception of slowed time
Conjunctival injection
Hallucinations
156
Marijuana withdrawal ssx
| [peak, detectability]
Depression, Insomnia, Nausea, Anorexia.
Peaks in 48 hours, lasts 5-7 days.
Detectable in urine up to 1 month (stored in lipophilic tissues, slowly released).
157
What is the antibiotic of choice for treating Lung abscesses?
Clindamycin can cover a combination of anaerobic oral flora (Bacteroides, Fusobacterium, Peptostreptococcus) and aerobic bacteria.
158
C.R.A.B. of Multiple myeloma
>C: Hypercalcemia (GI ssx).
>R: Renal involvement (thirst).
>A: Anemia (fatigue, pallor), thrombocytopenia.
>B: Bone lytic lesions, Back pain (fractures).
159
Chromosomal translocations: Burkitt lymphoma, CML, Mantle cell lymphoma, Follicular lymphoma, AML-M3
>Burkitt lymphoma: t(8;14), c-myc activation.
>CML: t(9;22) Philadelphia chromosome, BCR-ABL hybrid.
>Mantle cell lymphoma: t(11;14), cyclin D1 activation.
>Follicular lymphoma: t(14;18), Bcl-2 activation.
>AML-M3: t(15;17)
160
Dermatomes: C2, C3, C4, T4, T7, T10, L1, L4
```
>C2: posterior skull
>C3: neck (turtleneck)
>C4: low collar
>T4: nipple line
>T7: xiphoid
>T10: umbilicus
>L1: inguinal ligament
>L4: kneecap
```
161
Clinical reflexes: biceps, triceps, patella, achilles, anal wink, cremaster
```
>Achilles: S1, S2
>Patella: L3, L4
>Biceps: C5, C6
>Triceps: C7, C8
>Anal wink: S3, S4
>Cremaster: L1, L2
```
162
Describe the regulation of iron absorption.
>Dec. iron stores: upregulate DMT, ferroportin; dec. liver hepcidin secretion -- DMT absorbs Fe from gut lumen, ferroportin releases Fe into blood -- transferrin transports Fe to liver and marrow.
>Inc. iron stores: DMT downregulated, liver releases hepcidin w/c degrades ferroportin.
