MUST MEMORIZE Flashcards
What are the five GI associations with Down syndrome?
Hirschsprungs, TE fistula, annular pancreas, celiacs disease, duodenal atresia
What would a quad screen for down syndrome show?
increased beta hCG, increased inhibin A, decr alpha FP, decr estriol
What are unique findings for edwards syndrome?
Hands (clenched), jaw (small), ears (low set), head (large posterior)
What are the GI associations in edwards syndrome?
Malrotation, meckels
What are the unique side effects of patau’s syndrome?
holoProsenchephaly (can actually also be seen in edwards), cleft liP/Palate, polydactyly, decrease PAPPA
What are the GI associations with patau’s?
umbilical hernia, omphalocele, pyloric stenosis
What is CATCH22?
for 22q11 deletion syndrome Cleft palate Abnormal facies thymic aplasia Cardiac defects (the trunc falls from 22 to 11) Hypocalcemia (parathyroid aplasia)
Important things about vitamin A
Deficiency-> night blindness and dry skin
Excess -> HSM, skin, neuro (incl incr intracranial pressure), arthralgia, vision problems
Teratogen
Treats MEASLES and AML (APL 15:17)
Nuclear receptor
What four enzymes use B1 (thiamine)
Maple syrup give me ATP alpha ketoacid dehydrogenase alpha ketogluterate dehydrogenase transketolase pyruvate dehydrogenase
What happens in riboflavin (B2) deficiency?
What enzyme need B2
2 Cs of B2
Cheilosis and corneal vascularization
Succinate dehydrogenase (succinate -> fumarate)
What cholesterol drug is best at increasing HDL?
Niacin
What is the precursor to niacin and what cofactor is needed?
Tryptophan and B6
What are they symptoms of niacin deficiency?
The 3 D’s of B3
Diarrhea, Dermatitis, Dementia (ataxia), +/- death
What can vitamin E deficiency cause?
E is for erythrocytes -> anemia (hemolytic d/t incr fragility)
Friedrich’s like neuro problems: demyelination of the posterior columns and spinocerebellar tracts
What are the functions of zinc/ things are absent with zinc deficiency?
2 senses, 3 H's Smell Taste Hypogonadism Hair Healing of wounds
what are the ketogenic aminoacids?
Leucine, lysine (used for PDH deficiency)
What are the essential amino acids
PVT TIM HALL
What are hydrophobic amino acids
GAV LIP TMP
What cofacto are needed for transamination reactions (transfer of NH3)?
B6
What cofactor is needed for lactic acid dehydrogenase?
B3
What are the symptoms of PKU
Musty or mousy smell seizures eczema fair skin mental retardation if not caught earlyq
What enzyme controls conversion of NE to E and what regulates it?
PNMT, positively regulated by cortisol.
SAM is a necessary cofactor
Whats the saying for homocystinuria?
Is kinda RETARDED to be a TALL, HOMO with AKO- osis and lens subluxation.
What is the saying for fabrys disease?
Alpha gal’s always look FAB break hearts on their TRIcycles until they crash because of their painful neuropathy and get a kidney shot.
What are the essential fatty acids?
Linoleic, linolenic
What is the function of apoE
remnant uptake via remnant receptors (on everything except LDL)
What is the function of apoA1
Activates LCAT (put A1 steak sauce on a cat)
What is the function of apoCII?
LPL cofactor
What is the function of apoCIII?
Inhibits LPL
What is the function of apoB48?
Chylomicron secretion from intestinal epithelial cells
What is the function of apoB100?
Binds LDL receptor
What is deficient in Type1 dyslipidemia and what are symptoms?
Deficient LPL or CII
So you get build of chylomicrons
Causes pancreatitis HSM, HSM, and pruritic xanthomas but no atherosclerosis
What is deficient in type IIa dislipidemia? symptoms?
Familial hypercholesterolemia
LDL receptor is deficient
Excess LDL/ cholesterol
Xanthomas (tendon, eyes), atherosclerosis, heart disease
What is deficient in type III dislipidemia? symptoms?
ApoE is type threeeeee
Deficient apoE3/4
Chylomicron remnants build up, these are cholesterol rich so similar presentation to type IIa
Xanthomas (tendon, eyes), atherosclerosis, heart disease
What is the problem in type IV dyslipidemia? symptoms?
Familial hypertriglyceridemia
Hepatic over secretion of VLDL
Pancreatitis
What is the problem in abetalipoproteinemia? Symptoms?
MTP mutation causes decreased B48 and B100 so you get less chylomicron and VLDL secretion.
Lipid accumulation in enterocytes
Presents within a few months: failure to thrive, steatorrhea, acanthocytosis (spiky RBCs), ataxia, night blindness
Vit E helps restore lipoproteins
What is the ABCDEFG of Corynebacterium diphtheriae
ADP ribosylating Beta phage Cysteine-tellurite agar, Cardiac problems Dont scrape EF2/ Elek's toxin test F- pharyngitis with pseudomembranes Granules (red/ blue)
What is the most important treatment to give immediately when someone has diphtheria?
Antitoxin antibody!! then also give penicillin and toxoid vaccine
How do you diagnose tetanus vs botulism vs difficile?
Tetanus= history and physical Botulism= assays for toxin or organism Difficile = stool toxin assay (via PCR)
What drugs can treat Pseudoinfections?
Ticarcillin, piperacillin Ceftazidime (3rd gen), cefepime (4th gen) Aminoglycosides (only GAT of GNATS) Ciprofloxacin or levofloxacin Aztreonam Imipenem, Meropenem
What is the virulence factor of E. coli that causes cystitis/ pyelonephritis?
Fimbrae
What is the virulence factor of E. coli that causes pneumonia/ neonatal meningitis?
K capsule
What is the virulence factor of E. coli that causes septic shock?
LPS
Whats the difference between EHEC and EIEC
EIEC is invase + shiga like toxin
EHEC is not invasive but has shiga like toxin
Shiga like toxins cleaves 60s
EHEC causes HUS -> acute renal failure, anemia, thrombocytopenia
How can EHEC be differentiated from the rest of the E. coli
Does NOT ferment sorbitol. Does NOT produce glucoronidase
E. coli Tx?
TMP-SMX or fluoroquinilones
VDRL detects Ab’s that react to beef cardiolipin. What things give false positive VDRLs?
VDRL Viruses (mono, hepatitis) Drugs Rheumatic fever Lupus/ leprosy
Treponema pertenue
Causes Yaws -> many keloids that cause disfigurement, VDRL positive but not an STD
Brucellosis
Brucella species in unpasteurized cheeses
Campylobacter
Bloody diarrhea from pets/ livestock
Severe interstitial pneumonia after parrot/ bird contact
Psittacosis -> chlamydia psittaci
Q fever
Coxiella burnetti from cattle amniotic fluid
Tularemia
Francisella tularensis from rabbits
Leptospira
animal urine
Pasteurella mutocida
Animal bites (dog, cat) -> cellulitis and osteomyelitis
Bartonella
Cat scratch fever -> self resolving. can lead to bacillary angiomatosis in immunocompromised
Rickettsia rickettsii
Rocky mountain spotted fever. Dermacentor tick bite -> causes Rash on Derma center of palms and soles
Yersinia enterocolitica
Pet feces. common outbreaks in day cares. Mimic crohns or appendicitis
Yersinia pestis
From fleas/ prairie dogs -> bubonic plague/ black death. Painful lymphadenitis, sepsis, DIC, PAINFUL ulcer surrounded by black hemorrhagic purpura
Spirillum minus
Rat bites
Raw oyster consumption
Vibrio parahaemolyticus -> cholera like watery diarrhea
Vibrio vulnificus -> sepsis w/ 50% mortality
What are the treatments for PCP?
1) TMP-SMX
2) Pentamidine
3) Dapsone
What are the treatments for sporothrix?
Itraconazole or potassium iodide
You must plant the rose InTRA POT.
What are the live, attenuated vaccines? How do they help the immune system? Drawbacks?
Live for one night only! See SMALLL YELLOW CHICKENs get vaccinated with Sabins and MMR! It's INcredible Small pox Yellow fever Chickenpox (VZV) Sabin's polio MMR Influenza intranasal
Provide humoral and cell mediated immunity
Possible to revert to virulent form.
What are the killed vaccines? How do they help the immune system? Drawbacks?
RIP Always Rabies Influenza (injected) Polio (SalK = Killed) A -> HAV
Provide humoral response, but no cell mediated response.
What DNA virus is ssDNA?
Parvoviridae = part of a virus
What RNA virus is dsRNA?
Reoviridae = repeatovirus
What is the only diploid virus?
Retroviruses -> have 2 exact copies of ssRNA molecules
Where do DNA viruses replicate? Exceptions?
Nucleus. Except poxvirus -> cytoplasmic factory!
Where do RNA viruses replicate? Exceptions?
Cytoplasm. Except retroviruses and influenza viruses.
What are the naked viruses (no envelope)?
Give PAPP smears and CPR to a naked Hepe. PAPP= DNA Polyomavirus Adenovirus Parvovirus Papillomavirus
CPR = RNA Calicivirus Picronavirus Reovirus Hepevirus (also RNA) = Hep E
Of enveloped viruses, herpesvirus is the only one to do what?
Bud from the nuclear membrane (most bud from plasma membrane) -> they will have an envelope with phospholipid composition similar to the nuclear membrane.
What can adenovirus cause?
#1 cause of hemorrhagic cystitis in kids febrile pharyngitis conjunctivits pneumonia Gastroenteritis
Common in military barracks and college campuses
What family does HBV belong to?
Hepadnavirus- DS partial circular DNA
Other than Hepadnavirus, what other DNA viruses are DS circular?
Papovaviridae -> Polyomavirus (JC and BK viruses) and Papillomavirus (HPV)
What viruses are in the poxvirus family?
Smallpox
Vaccinia- milkmaids blisters
Molluscum contagiosum- flesh dome lesions with central dimple.
What are the negative stranded RNA viruses?
In the orthopedics arena, it is paramount to file down bunyans rabidly
Orthomyxovirus (influenza- segmented)
Arenaviruses
Paramyxoviruses (Parainfluenza, RSV, Measles, Mumps)
Filoviruses (Fucked with Filo -> ebola and shit)
Bunyaviruses
Rhabdoviruses
What are the segmented RNA Viruses?
BOAR
Bunyaviruses, Orthomyxoviruses, Arenaviruses, Reoviruses
Only these can undergo REASSORTMENT because reassortment involves transfer of entire segments
What viruses are picornaviruses?
PERCH on a peak (pico)
Enteroviruses -> fecal oral transmission and cause GI disease: Polio, Echovirus, Coxsackievirus, HAV
Coxsackievirus and Echoviruses are common causes of aseptic meningitis -> fever, photophobia, painful extra-ocular movements
Rhinovirus, not fecal oral b/c acid labile -> common cold (>100 serotypes).
What are the findings of yellow fever (a flavivirus)?
Transmitted by Aedes mosquito
1) Liver disease- jaundice (flavi means yellow)
2) Hemorrhagic disease: epistaxis, menorrhagia, hematuria, easy bruising, GI bleeding (black vomitus -> “coffee ground emesis”)
3) High fever
4) Renal disease
5) Unique tongue- red on tip and sides, but whited coated center
Important points about rotavirus
A reovirus (dsRNA)
Major cause of infantile diarrhea worldwide
Daycare centers and kindergartens
Villous destruction/ atrophy -> lose Na+ and K+ -> diarrhea
ROTA = right out the anus
WINTER MONTHS, GREENISH DIARRHEA
What are findings in Rubella infection in children and in congenital rubella?
Rubella is a togavirus
Children- arthralgias, postauricular adenopathy, fever, fine truncal rash that starts on head and moves down to trunk but spares hands and feet.
Congenital- blue berry muffin appearance (extramedullary hematopoiesis), blindness, deafness, Cardiac (PDA or pulmonary artery stenosis)
Paramyxovirus
PaRaMyxovirus -> NONSEGMENTED (different than orthomyxoviruses)
Parainfluenza- croup. Barking, brassy, seal like cough.
RSV- resp. tract infection in infants
Measles, mumps
All contain F (fusion protein)- causes epithelial cells to fuse into multinucleated giant cells.
Palivizumab is monoclonal Ab against F protien -> prevents pneumonia from RSV in premature infants
Measles
NONSEGMENTED
3 C’s- cough, coryza, conjunctivitis
Maculopapular rash that starts on head and spreads downward (INCLUDES HANDS AND FEET)
Koplik spots on buccal mucosa (red w/ white center)
SSPE (subacute sclerosing panencephalitis) is rare sequellae. No Ab to M-component of virus (caused by a verison of measles without M-component). Thought virus is not completely killed and several years later will get SSPE. Fatal.
Mumps
No rash POM-poms Parotitis = mump Orchitis -> swollen testes Meningitis (tropism for empendymal cells lining ventricles)
Rabies
Bullet shaped.
Negri bodies (cytoplasmic inclusions in purkinje cells). Binds to nicotinic ACh receptors and travels retrograde up nerves to CNS.
Distance of innoculation site determines length of incubation (asymptomatic phase where it replicates in muscle first)
Symptomatic phase: agitation, photophobia, hydrophobia (fear of water, foamy mouth, hypersalivation) -> paralysis, coma, death.
Bat, raccoon, skunk, coyotes > dog bites.
What is the mechanism of resistance for MRSA?
Altered PBP
What is the only cephalosporin that can treat MRSA?
Ceftaroline is terrible news for MRSA
What drugs do aminopenicillins (amoxicillin, ampicillin) cover that penicillin does not?
HELPSS kill enterocytes Haemophilus E. coli Listeria Proteus Salmonella Shigella
What can the carboxypenicillins be used for (ticarcillin, piperacillin, carbenicillin)?
Pseudomonas! and G. neg rods
Both carboxypenicillins and aminopenicillins need to be given with what?
Beta lactamase inhibitor -> Clavulanate, tazobactam, sulbactam
What are first gen cephalosporins used for?
G+ plus PEcK
Proteus
E. coli
Klebsiella
What are second gen cephalosporins used for?
HEN PEcKS and G+ Haemophilus Enterobacter Nisseria Proteus E. coli Klebsiella Serratia
What does aztreonam (a monobactam) treat?
Gram negatives rods only -> E. colli, Klebsiella, PSEUDO, Serratia
These are synergistic with aminoglycosides
No cross reactivity to penicillins
What is the biggest toxicity of carbapenem (imipenem, meropenem)
SEIZURES!
Vanco important facts
blocks D-ala D-ala precursor.
Gram + only!
Drug of choice for empiric endocarditis tx
C. diff
Diffuse flushing (Red man)- caused by histamine!
NOT many other problems:
Nephrotoxicity, ototoxicity, thrombophlebitis
D-ala D-lac is mechanism or resistance
What is the only protein synthesis inhibitor that is bacteriocidal?
Aminoglycosides
What are the two drugs that affect the initiation complex of bacterial ribosomes
Aminoglycosides- bind 30s
Linezolid- binds 50s (23s)
What drugs are aminoglycosides? Which can be used to treat pseudo?
Ami02glycosides GNATS Gentamycin Neomycin Amikacin Tobramycin Streptomycin
Only GAT can treat pseudo
What are the side effects of aminoglycosides?
caNNOT treat anaerobes Nephrotoxicity Neuromuscular blockade Ototoxicity Teratogen
What is the mechanism of resistance for aminoglycosides?
Acetylation, phosphorylation, adenylation
What four drugs are ototoxic and nephrotoxic?
Vanco, aminoglycosides, Loops, Cisplatin
Mechanism of action of tetracycline
Blocks incoming tRNA (t for t) on 30s
What dietary supplements can limit effect of the tetracyclines?
Divalent cations (milk, antacids, iron supplements) b/c they inhibit gut absorption of tetracyclines
What are the uses for tetracyclines?
VACUUM THe BedRoom V. cholera Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Tularemia H. pylori Borrelia Rickettsia
What is the mechanism of resistance to tetracyclines
Efflux pumps
What is the mechanism of action for macrolides and mechanism of resistance?
MacroSLIDES like MJ
Binds 23s and block translocation
Methylation of 23s = resistance
Uses of macrolides?
Mac CAPS
Chlamydiae
Atypical Pneumonias
Strep (pen allergy)
Side effects of macrolides?
MACRO Motility issues (diarrhea!) Arrhythmia (prolonged QT) Cholestatic hepatitis (acute) Rash eOsinophilia
What cephalosporins cover pseudo?
Ceftazidime (3rd gen) and Cefepime (4th gen)
What is the saying for chloramPHENicol?
ChoramPHENicol defends against SHiN meningitis by blocking 50s peptidyltansferase but can cause APLASTIC anemia and GREY baby syndrome
What is the mechanism of action of clindamycin and what does it treat?
Blocks 50s translocation
Anaerobes above the diaphragm
TREATMENT OF CHOICE FOR ASPIRATION PNEUMONIA OR LUNG ABSCESS
What is the mechanism of action of Sulfonamides?
PABA analogs that block dihydropteroate synthase which is a precursor reaction to make tetrahydrofolate. Synergistic with the DHFR inhibitors.
What are the side effects of sulfonamides?
Hypersensitivity rxns, photosensitivity, hemolysis in G6PD, nephrotoxicity
What are the uses for TMP-SMX?
A bunch of abbreviations:
UTIs
Salmonella/ Shigella (S/S)
PCP
MRSA
What does metronidazole treat
GET GAP on the metro
Giardia, entamoeba, trichamonas, Gardnerella, Anaerobes, H. Pylori
What is the unique side effect for metronidazole
Disulfiram like reaction!!!
What is the mechanism of action of isoniazid?
Decreased synthesis of mycolic acids. First needs to be activated by KatG (bacterial catalase-peroxidase)
Side effects of isonizid?
INH injures neurons and hepatocytes (INH INH) and drug induced lupus! Give vit. B6 to prevent neurotoxicity
What is unique about isoniazid metabolism?
Acetylation!!! Fast vs slow acetylators
What are the 4 R’s of rifampin?
RNA polymerase inhibitor, Revs up P450, red orange body fluids, rapid resistant when solo treatment
What can Rifampin be used for as a prophylactic agent?
H. flu and N. meningitis (Rifampin prophylaxis against SHiN!!!!)
What is needed for pyrazinamide to be effective?
Acidic environment!
Works inside macrophage phagolysosome
What are the side effects of pyrazinamide?
Gout and hepatotoxicity
What is the mechanism of ethambutol?
Decreased carbohydrate metabolism by blocking arabinosyltransferase
Side effects of ethambutol?
Optic neuropathy (decr visual acuity and red green color blindness)
Also peripheral neuropathy
What is the drug of choice for prophylaxis against meningococcal infection?
Cipro
what eye drops or given to newborns to treat gonococcal or chlamydial eye infection?
Erythromycin
What is the prophylaxis for PCP and Toxo in HIV patients?
TMP-SMX
What is the prophylaxis for Histo in HIV patient?
Itraconazole
what is the prophylaxis for MAC in HIV patients and at what CD4 count?
Azithromycin at <50
What are the treatments for MRSA?
Vanco > Ceftaroline or Linezolid
What are the treatments for VRE?
Linezolid and streptogramins (pristin drugs)
What drugs are resistant to ESBL?
Imipenem and meropenem
Where do the “fungin” drugs work?
Fungins (caspofungin) work the farthest out. Inhibit beta glucan synthesis of the cell wall.
Good for invasive ASPergillus (cASPofungin)
SE: histamine induced flushing (Fungins flushing)
MOA of amphotericin and nystatin
Bind ergosterol and TEAR holes STAT!
SE of amphotericin
Has some effect on cholesterol (even tho relatively ergosterol specific)
NEPHROTOXICITY -> leads to loss of Mg+/K+ -> arrhythmias
Others: fevers/ chills, acute infusion reactions (phlebitis, hypotension, anemia)
Limit toxicity by supplementing K+/Mg2+ and lots of hydration
MOA and SE of Azoles
Blocks ergosterol synthesis (from lanosterol) by inhibiting P450.
Miconazole and Clotrimazole are topical agents.
SE: gynecomastia (inhibits testosterone synthesis, esp ketoconazole) and inhibition of P450 system
MOA of Terbinafine and Naftifine
Ihibit squalene epoxidase (thereby blocking production of squalene from cholesterol)
Use of Terbinafine and Naftifine
Topical for Fungal nail infections (onychomycosis)
MOA/ use/ SE for Griseofulvan
Interferes with MICROTUBLES of fungi thereby inhibiting mitosis
Deposits in nails -> oral treatment for nails, superficial infections, ringworm
Teratogen, carcinogen, hepatotoxicity
INDUCES P450 system
What is the mechanism of action of Chlorquine?
Blocks heme detoxification (heme polymerase). Widespread falciparum resistance, must use other drug.
What is the mechanism of action of ribavirin? toxicity? use?
Tyrion (teratogen) is an IMP (blocks IMP dehydrogenase) likes Ribs (ribavirin)
Used for RSV and Hep C
Teratogen and hemolytic anemia
What is the MOA of oseltamivir and zanamivir?
Block neuraminidase (release of progeny virus)
What is the mechanism of amantidine even tho widespread resistance? Toxicity?
Block hemagglutinin (viral fusion). Also cause Dopamine release so can be used for parkinsons. Cause livedo reticularis
Acyclovir, valcyclovir, famciclovir MOA, use, toxicity
Phosphorylated by viral thymidine kinase
Block DNA polymerase
Used for HSV and VZV (no effect on CMV)
Only block active replication, not latent virus
Crystaline nephropathy (aggressive hydration)
Ganciclovir, valganciclovir
Use for CMV, phosphorylated by CMV kinase
blocks DNA polymerase
SE: Neutropenia and thrombocytopenia, RENAL TOXICITY
Foscarnet
Pyrophosphate analog
Inhibits DNA polymerase at different site, no viral activation is needed
CMV retinitis for failed ganciclovir or HSV with failed acyclovir
Nephrotoxic, Seizures (foscarnet is a Ca++ chelator and causes nephro Mg++ wasting)
Cidofovir
Inhibits viral DNA polymerase
Does not need to be activated
CMV retinitis for failed ganciclovir or HSV with failed acyclovir
Nephrotoxic (saline + probenacid limits)
What are the side effects of protease inhibitors (-navir)
GI disturbance, hypergylcemia, hyperlipidemia, and cushinglike fat redistribution
What protease inhibitors have special side effects?
Rotinavir- pancreatitis, cyp3A4 inhibition
“Rotinavir rocks the pancreas and CYP450s”
Idinavir- nephropathy, hematuria, nephrolithiasis
“Idinavir invades the urinary tract and causes problems”
What is the only NRTI that doesnt need to be phosphorylated?
Tenofovir
Tenofovir has enof to be active
What NRTIs have additional action against hep B
TEL them it also works against hep B
Tenofovir
Emtricitabine
Lamivudine
What are the general side effects of NRTIs
Lactic acidosis
What is the unique SE of Abacavir
A for allergy (hypersensitivity) but no lactic acidosis
What SE is unique for Zidovudine?
Dives into the bone marrow and GI
What SE are seen with Didanosine, Stavudine and Zalcitabine?
Did Stav and Zal cite the pacreatitis and peripheral neuropathy they caused?
Didanosine and Stavudine also cause hepatic steatosis
What are the NNRTIs
Nevir Efa Dela
Nevirapine
Efavirenz
Delavirdine
What are the SE of the NNRTIs
Norths NED lacts a head and got a rash
Lactic acidosis and rash
Efavirenz also efs your head and efs you on a drug test
What drug is an HIV integrase inhibitor?
Raltegravir
Maraviroc MOA, SE
CCR5 inhibitor- blocks binding and gp120 conformational change. Only works on early virus (R5)
SE: CCR and 5 shits in the liver Cough CV events Rash Hepatotoxicity
Enfuvirtide MOA, SE
enFuvirtide, Fusion inhibitor, gpFortyone
Hypersensativity, severe injection site rxns, bacterial pneumonia
What are IFN alpha, gamma, and beta used for? SE
IFN alpha- Hep B/C, Kaposi’s
IFN beta- MS
IFN gamma NAPDH oxidase deficiency
SE: neutropenia, myopathy
Antibiotics to avoid in pregnancy
SAFe Children Take Really Good Care Sulfonamides- kernicterus Aminoglycosides- ototoxicity Fluoroquinilones- cartilage damage Clarithromycin- embryotoxic Tetracycline- teeth, bones Ribavirin Griseofulvin Chloramphenicol- grey baby
What is MHC I pared with? MHC II?
I- beta 2 microglobulin
II- invariant chain that needs an acidified endosome to be released. Without release -> no MHC II on APC’s`
What are the two primary opsonins against bacteria?
IgG and C3b
What causes happens in C1 esterase inhibitor deficiency and what is contraindicated?
This is hereditary angioedema. Build up of bradykinin. ACE inhibitors are contraindicated.
What are the examples of the type 4 hypersensitivity?
Hashimoto’s Minnesota Sweathearts PP’D like DM1 after Contact Vs Host GB packers b/c (Hep) they had IBD and Sarcoidosis.
Hashimotos Minnesota Sweethearts= multiple sclerosis PPD= PPD TB skin test DM1 Contact dermatitis Graft vs host disease GB= Guillain Barre b/c = Hep B and C IBD Sarcoidosis
What are the examples of type 3 hypersensitivity?
Arthus Serum helps me SLEePPP in my Rheum Arthus reaction Serum sickness SLE Poststreptococcal glomerulonephritis Polyarteritis nodosa hypersensitivity Pneumonitis Rheumatoid Arthritis
What is the MOA of cyclosporine and SE?
Binds cyclophilins, blocks calcineurin, no IL2 or IL2R production
Nephrotoxicity (prevent with mannitol)
Gingival hyperplasia, Hirsutism
HyperTLG (triglyceride, glycemia, lipidemia)
MOA and SE of Tacrolimus
Binds FK-binding protein and inhibits calcineurin
blocks IL2 and cytokine secretion
Nephrotoxicity and peripheral neuropathy
MOA and SE of Sirolimus
Inhibits MTOR -> Inhibits T cell response to IL2 (inhibits T cell proliferation)
SE: Thrombocytopenia, leukopenia
What is the MOA of Daclizumab?
Monoclonal Ab against IL2 receptor (CD25) on activated T-cells
MOA and SE of Muromonab?
Ab against CD3 blocking signal transduction in T cells
SE cytokine release syndrome and hypersensitivity
Muromonab
Ab against CD3
Transplants
Daclizumab
Ab against IL-2 receptor (CD25)
Kidney transplants
Basiliximab
Ab that blocks IL-2 receptor
Kidney transplants
Bevacizumab
Ab against VEGF
Used for CRC and RCC
Oprelvekin
IL-11 used for thrombocytopenia
Filgastrim
GCSF
Sargramostim
CMCSF
Aldesleukin
recombinant IL2
RCC and metastatic melanoma
Cetuximab
Ab against EGFR
Stage 4 CRC, Head and neck cancer
Natalizumab
Ab against alpha 4 integrin
MS, Crohns
Denosumab
Ab against RANK-L
Osteoporosis
Omalizumab
Ab against IgE Fc
Allergic asthma
Alemtuzumab
Ab against CD52
CLL
Pavalizumab
Ab against RSV F protein
RSV prophylaxis in premature infants (esp winter months)
What does vinyl chloride, thorotrast, or arsenic exposure cause?
Angiosarcoma
Arsenic can also cause Sq. cell cancer in the skin
What does carbon tetrachloride exposure cause?
Centrilobular necrosis and fatty change via lipid peroxidation
Nitrosamine exposure can cause…..
Gastric cancer
Naphthaline (analine) dyes and mothballs can cause….
Transition cell carcinoma
Radon can cause….
Lung cancer
What characteristics give a drug a low volume of distribution?
Large, charged, hydrophilic, or protein bound
What is a low volume of distribution?
Blood volume (4-8 liters)
What is a medium volume of distribution?
Extracellular fluid volume (14-16 liters) b/c 70 kg man x 20% (60:40:20 rule) = 14 liters
What characteristics give a drug a medium volume of distribution?
Small hydrophilic
What is a large volume of distribution?
All tissues (around 40L)
What characteristics give a drug a high volume of distribution?
Small LIPOPHILIC molecules, esp if bound to TISSUE protein
What are the direct cholinergic agonists?
Bethanechol, carbechol, methacholine, Pilocarpine
What are the acetlycholinesterase inhibitors?
Neostigmine, pyridostigmine, physostigmine, edrophonium, donepezil, galantamine, rivastigmine
What is the treatment for cholinesterase poisoning?
Atropine and pralidoxime (regenerates active AChE)
Fetal erythropoiesis:
Young liver synthesizes blood Yolk sack- 3-10 wk Liver- 6wk- birth Spleen- 15-30 wk Bone marrow: 22wk - adult (occurs the the ribs, sternum, pelvis, skull, vertebrae)
Up to age 25, also have erythropoiesis occurring in the tibia and femur
What does AFIB look like on ECG?
Irregularly irregular (talking about the RR interval) with no discernible P waves
What does atrial flutter look like on ECG?
Lots of P waves with regular RR intervals.
Sawtooth waves, flutter waves
What is seen on ECG with 1st degree heart block?
Consistently prolonged PR interval
Generally asymptomatic
What is seen on ECG with 2nd degree, Mobitz type 1 AV block?
Wenckebach. Warning
Progressively lengthening PR until beat is dropped (P wave not followed by QRS.)
Generally asymptomatic
How do you determine heart rain on ECG?
300/ # of big boxes
What defines sinus bradycardia?
Less than 60 bpm (RR > 5 big boxes on ECG)
What is seen on ECG with 2nd degree, Mobitz type 2 AV block?
Nonconducted P waves. No lengthening of PR interval. Simply dropped beats. Often 2:1 ratio (P waves to QRS complexes).
Often treated with a pacemaker
What is seen on ECG with 3rd degree heart block?
Atria and ventricles beat independently of one another. No relation to P wave and QRS complexes on ECG.
Tx= pacemaker
What are the 5 causes of early cyanosis (blue babies)?
5 T's (R-> L shunts) Transposition of the great arteries Truncus arteriosus Tetralogy of Fallot Tricuspid atresia Total anomalous pulmonary venous return
What are the causes of late cyanosis? Blue kids
VSD> ASD > PDA
Since these are initially L-R until pulmonary resistance become too high. Then Eisenmengers syndrome and cyanosis in kids (ie blue lower extremities for PDA in a child)
What is seen in tetralogy of Fallot?
Improper neural crest migration PROV Pulmonary stenosis RVH -> boot shaped heart Overriding aorta VSD
Cyanotic spells improved with squatting (incr vasc resistance)
What is heart condition is maternal diabetes associated with? What is necessary for life with with this condition?
D-Transposition of the great vessels
D for diaebetes (maternal)
One of the aorticopulmonary septum problems (not the Trunc falls from 22 to 11), therefore all thats left is transposition.
Failure of the AP septum to spiral
Neural crest migration failure
VSD necessary for life
Death within months w/o surgical correction
Infantile coarctation
Preductal
A/w Turners syndrome
Disparity between pulses in UE and LE
No cyanosis
Adult coarcation
Distal to ductus
a/w bicuspid valve
Upper extremity HTN with LE HOTN and weak pulses
Notching of the ribs
Coarctation is a/w berry aneurysms that are prone to rupture due to the high pressure
What is the treatment for isolated systemic hypertension? ie 170/70 -> common in elderly
Diabetic: ACEI/ARB
Non-diabetic: DHP CCB or Thiazide
When do you see hyaline arteriolosclerosis?
Essential HTN or diabetes
Homogenous deposition of eosinophilic deposition in media
When do you see hyperplastic arteriolosclerosis?
Malignant HTN
Onion skinning d/t concentric layers of media smooth muscle
What cells directly respond to intimal (endothelial) injury?
Smooth muscle cells proliferate to make a neointima
What substances causes smooth muscle cell migration in the formation of atherosclerotic plaque? What cells release these substances?
PDGF and FGF
Released by macrophages, endothelial cells and platelets
What is the most common cause of abdominal aortic aneurysm?
Atherosclerosis
Abdominal aorta is the most common place for atherosclerotic involvement, followed by carotids.
Most abd. aortic aneurysms occur in male smokers > 50 y/o
What are the main causes of thoracic aortic aneurysm and aortic dissection?
HTN and Marfans
What is the intiating factor in aortic dissection?
Intimal tear
What is the initiating factor in atherosclerosis and what is the earliest lesion?
Initiating factor = Endothelial dysfunction
First lesion = intimal fatty streak
What is the presentation of aortic dissection?
Sudden onset severe chest pain radiating to the back
High blood pressure
CXR shows mediastinal widening and abnormal aortic contour
What is the presentation for cardiac tamponade?
Low blood pressure, fast heart rate (makes sense), muffled heart sounds, incr JVP, pulsus paradoxus (incr of greater than 10mmHg on inspiration)
EKG- electrical alternans- beat to beat variations of QRS amplitude
What are the 3 highest risk factors for coronary artery disease?
non coronary atherosclerotic disease
CKD
Diabetes
What is the most common cause of death in diabetes patients?
Coronary heart disease!!
In a STEMI, how long does it take to lose contractility in affected area?
60 sec! even tho ATP will appear high
Need to repurfuse within 30 min to gain some contractility back in this area
What is the presentation of acute pericarditis?
Sharp pain worsened by inspiration
Relieved by sitting up and sitting forward!!
Widespread ST segment elevation
Friction rub on heart auscultation
What is the cause of raynauds syndrome? Tx?
Arteriolar vasospasm worsened by cold temperature or emotional stress
Tx- aspirin, DHP CCB, sildenafil
What are similarities of the Large vessel vasculitis diseases (temporal arteritis and Takayasu’s)?
Elevated ESR, Granulomatous thickening, Tx = corticosteroids
Polyarteritis nodosa
Spares the lungs!
Hep B
Abd. pain, peripheral neuropathy
Cutaneous eruptions- livedo reticularis
TRANSMURAL inflammation and fibrinoid necrosis
Aneurysms and constrictions on arteriorgram
Tx- corticosteroids and cyclophosphamide
Kawasakis
Coronary anuerysms
Asian children
Motorcycles use hands and feet -> erythema, peeling skin
Lips/ oral mucosa/ strawberry tongue
Cervical lymphadenitis
Tx IV immunoglobulin and ASPIRIN (to prevent MI’s even though Reye’s is possible)
Lung kidney and skin vasculitis, no granulomas, p-ANCA
Microscopic polyangitis
Upper and lower airway disease, granulomas, glomerulonephritis, c-ANCA
Wegener’s
Churg strauss
IgE, eosinophilia, asthma
Peripheral neuropathy
p-ANCA
granulomas
Henloch schonlein
1) kids
2) palpable purpura on legs/ buttocks
3) recent URI
4) IGA and C3 COMPLEX deposition
5) IgA nephropathy -> renal disease
6) Arthralgia (knee classically)
7) Abd. pain
Where does angiosarcoma occur and due to what exposures?
Head neck breast and liver
Radiation, thorotrast
arsenic, vinyl chloride
What does sturge weber disease present like?
Port wine stain, ophthalmic division distribution on face
AVM, seizures, glaucoma, MR, hemiplegia
What is the mechanism of DHP CCBs
Dilate arteriolar sm. muscle (decr afterload) and dilate coronaries
What cholesterol drug has the best effect on LDL?
Statins
What is the mechanism and side effects of statins?
Inhibit HMG CoA reductase.
SE: hepatotoxicity
Myalgias, mypathies, rhabdomyolisis
What are the mechanisms of action of niacin? SE?
Inhibits lipolysis and VLDL secretion
SE: Flushing (reduced with aspirin)
Hyperglycemia (acanthosis nigricans) and hyperuricemia
Myositis (but not as bad as statins or fibrates) Cholesterol gallstones (but not as bad as fibrates or bile acid resins)
What is the unique effect of bile acid resins (cholestyramine)?
slightly increase triglycerides
Bile acid resins SE
Tastes bad
GI discomfort
Cholesterol gallstones**
What is the main use for fibrates?
Decrease triglycerides!!!
What is the MOA of fibrates and what are the SE?
Upregulate LPL
Myositis, Hepatoxicity (similar to statins, can be bad when combined)
** Gallstones: fibrates block 7 alpha hydroxylase conversion of cholesterol into bile acids. This causes cholesterol excess in gallbladder
Whats unique about class IC antiarrhythmics?
Dissociate from sodium channel the slowest due to strongest binding. Makes them the most USE DEPENDENT
What are the main side effects of quinidine?
Prolonged QT -> Torsades.
Thrombocytopenia
Cinchonism: headache, tinnitus
What is the main use and side effect of procainamide?
Use- WPW
SE: Drug induced lupus (anti histone Ab)
What antiarrhythmics are reverse use dependent?
Class III- K+ blocker (AIDS) Amiodarone Ibutilide Dofetilide Sotalol
What is the drug of choice for abolishing SVT?
Adenosine
SE= flushing, hypotension, chest pain
Mg++
Effective in torsades, digoxin toxicity and eclampsia seizures
Thyroid gland is derived from what tissue?
Endoderm
What can get damaged in a superior artery ligation?
Ext. branch of the superior laryngeal nerve -> cricothyroid muscle
What can get damaged in a inferior artery ligation?
Recurrent laryngeal nerve (innervates all laryngeal muscles other than cricothyroid -> can cause horseness. Also innervates sensation below the vocal cords)
Where are the adrenal cortex and medulla derived from?
Cortex- mesoderm
Medulla- neural crest
What is responsible for fetal lung production and surfactant production?
Cortisol from the placental and fetal thyroid (inner active zone)
What factors cause HYPERPLASIA of the cortex?
AngII-> Glomerulosa
ACTH -> fasciculata and reticularis
What is well developed in adrenal cells?
Smooth ER -> needed for steroid synthesis!
Liver (detoxification) and gonads (steroids) also have well developed smooth ER
What shares alpha units with beta hCG?
beta hCG causes a Terrible Fucking Life
TSH
FSH
LH
Where is the posterior pit derived from?
Neuroectoderm
What is stored in the posterior pit?
ADH (AVP) and Oxytocin
These are made in the hypothalamus and carried to the posterior pit via neurophysins
Where is the anterior pit derived from?
Rathkes pouch-> oral ectoderm (surface ectoderm)
Hormones of the anterior pit. Which are basophils, which are acidophils
FLAT PiG
Basophils = FLAT
Acidophils = PiG
What types of cells are in Islets of langerhans and where is each located?
Alpha cells (glucagon)- outer rim Beta cells (insulin)- central Delta cells- somatostatin (interspersed)
What tissues have insulin independent glucose uptake?
BRICKL
BR- brain, RBCs- GLUT1
ICKL- intestine, cornea, Kidney, Liver- GLUT2
What tissues have insulin dependent glucose uptake? What transporter?
Adipose and skeletal muscle
GLUT4
What do beta 2 agonists and alpha 2 agonists do to insuline levels?
Beta 2- raise
Alpha 2- lower
What is the MOA and uses of diazoxide?
Opens K+ channels which relaxes vasc. sm. muscle
-Can be used in malignant HTN
Opening K+ channels in beta pancreatic cells also decreases insulin release. Can be used in insulinoma
What hypothalamic hormones regulare prolactin secretion from the anterior pit? What are the effects of prolactin?
Dopamine is a negative inhibitor
TRH increased prolactin release
Estrogens also stimulate prolactin secretion
Prolactin stimulates mil production and inhibits GnRH
What are the functions of cortisol?
BBIIG Blood pressure- upregulates alpha1 Bone- decreases formation Inflammatory- inhibits PLA2, neutrophilia (inhib adhesion) decr histamine, eosinophils, decr IL2 Insulin resistance Gluconeogenesis (stimulates)
How does PTH stimulate osteoclasts?
Increased M-CSF and RANK-L by osteoblasts
What is the derivative of parafollicular cells (C cells) of the thyroid?
Neural crest
What endocrine hormones use cAMP
anything that ends in H (except GnA1Tr) and hCG
hCG
calcitonin
glucagon
What hormones use IP3
GOAT HAG which includes GnA1Tr GnRH oxytocin ADH V1 TRH Histamine (H1) Ang II Gastrin
What hormone use cGMP
NO, ANP
What hormones use a steroid receptor?
VETTT CAP Vit D Estrogen Testoterone T3/T4 (nuclear receptor!!) Cortisol Aldosterone Progesterone
What endocrine hormones use an intrinsic tyrosine kinase (receptor tyrosine kinase)?
Growth hormones Insulin IGF-1 FGF PDGF EGF
This uses the MAP kinase pathway
Insulin signaling leads to what
activation of protein phosphatase 1
activation of serine kinases which phosphorylate IRS-1
What are the endocrine hormones that use receptor associated tyrosine kinase (non receptor)
PIG
Prolactin
Immunomodulators (cytokines)
GH
JAK/STAT pathway
What blocks iodine entry into follicular thyroid cells via competitive inhibition?
Perchlorate, pertechnetate
How would a patient in Primary hyperaldosteronism (Conn syndrome) present
Hypertension (but not hypernatremia d/t escape from aldo)
Hypokalemia -> muscle weakness
Hypokalmeic alkalosis -> parasthesias
LOW plasma renin
What are the causes of primary adrenal insufficiency?
Addison needed to stop at the ATM
Autoimmune
TB
Metastasis (esp lungs)
How would primary adrenal insufficiency present?
Hypotension, hypocholremia, metabolic acidosis, hyperkalemia
Weakness, fatigue, anorexia, weigh loss, skin hyperpigmentation*
Adrenal neuroblastoma
N-myc Occurs in adrenal medulla of children Less likely for episodic HTN HVA in urine (dopamine breakdown product) Tumor marker = bombesin IHC stain: neurofilament stain Homer wright pseudorosettes
Whats not revved up in hyperthyroidism?
Cholesterol -> hypocholesterolemia!
Opposite is true for hypothyroidism -> hypercholesterolemia
What is a unique possibility in hypothyroidism?
Hypothyroid myopathy
incr’d CK, muscle pain, proximal muscle weakness, cramping
What is the presentation of cretinism? THINK! you always miss this one
6 P's and jaundice Potbellied Pale Puffy face Protruding umbilicus (umbilical hernia****) Protuberant tongue (macroglossia****) Poor feeding Jaundice Constipation
De Quervain’s subacute granulomatous thyroiditis
After a flu like illness Granulomatous inflammation Incr ESR Jaw pain Very painful thyroid "Mixed cellular infiltration with multinucleated giant cells"
Riedel’s thyroiditis
Rock hard thyroid, painless
Can extend into local structures
IgG4 related
Macrophages and eosinophils
What would the thyroid follicles look like histologically in Graves
Abnormal shape with scalloping
What causes the proptosis in Graves
Fibroblasts responding to the cytokines secreted by TH1 cells
Whats unique about hyperparathyroidism caused by kidney disease
The kidneys cant activate Vit. D or trash phosphate
Hyperphosphatemia
Albright’s hereditary osteodystrophy
PseudohypOparathyroidism Auto Dom kidney unresponsiveness to PTH Shortened 4th/5th digits Hypocalcemia Elevated PTH causes osteitis fibrosa cystica
What is the most common cause of death in acromegaly?
Heart failure (GH causes growth of internal organs)
How does the body respond to SIADH
The body will be retaining a bunch of water so the body decreases aldosterone to maintain near normal volume status (HYPONATREMIA)
What is found in the Hepatoduodenal ligament?
I can the portal triad in HD
What is found in the Falciform ligament?
Ligamentum teres
What is found in the Gastrohepatic ligament?
It is on the lesser curve of the stomach and contains the gastric arteries
What is found in the Gastrocolic ligament?
Found on the greater curvature/ transverse colon and contains the gastroepiploic arteries
What is found in the Gastrosplenic ligament?
Short gastrics, gastroepiploic vessels
What is found in the splenorenal ligament?
Splenic artery and vein
What are the signs of kernicterus?
Billirubin deposits in the basal ganglia and causes:
Athetoid writhing cerebral palsy (uncontrolled limb movements)
Hearing loss
Focal nodular hyperplasia
Central stellate scar
Cavernous hemangionma
Most common benign liver tumor
Cavernous blood filled cavities lined by single layer of epithelium
Hepatic adenoma
Benign
ORAL CONTRACEPTIVES OR STEROIDS
Angiosarcoma
Malignant. Arsenic, polyvinyl chloride, thorotrast
What are the unique features of primary biliary cirrhosis?
AMA (anti mitochondrial antibodies)
Middle aged females with new onset PRURITIS
Xanthelasma (d/t incr cholesterol) -> cutaneous eye lid lesion with foam cells
Lymphocytic infiltrate + GRANULOMAS
What are the unique features of Primary sclerosing cholangintis?
Onion Skinning bile duct fibrosis Deading of the bile ducts on ERCP Commonly men in 40s Hyper IgM a/w ulcerative cholitis Incr cholangiocarcinoma risk
What is a unique complication of pancreatitis?
Pseudocyst formation- lined by granulation tissue, not epithelium. Can rupture and hemorrhage
What is the mechanism of ondansetron (also granisetron)?
SE?
5HT3 antagonist -> antiemetic
SE:
Constipation (opposite of serotonin syndrome)
Headache (opposite of sumatriptan)
What is the mechanism of action of metoclopramide?
D2 antagonist. 5HT4 agonist
Helps you shit (esp post surgery or diabetic gastroparesis), antiemetic
Increases parkinsonism effects.
Contraindicated in small bowel obstruction patients, Parkinsons disease, or seizure history -> lower seizure threshold)
What are races are more prone to the thalassemias?
Asian- cis alpha gene deletion
Africans- trans alpha gene deletion
Mediterranean- Beta thalassemia
What is the major finding in beta thal minor?
Increased HbA2 > 3.5%
What is the major finding in beta thal major?
No HbA! Mainly HbF
What enzymes does iron inhibit? What else does it inhibit?
Ferrochelatase and ALAD -> impaired heme synthesis
Also inhibits rRNA degradation -> basophilic stippling
What does LEAD stand for in lead poisoning?
Lead lines,
Encephalopathy, Erythrocyte basophilic stippling
Abdominal pain, anemia (sideroblastic -> ferochelatase is in the mitochondria)
Drops (foot and wrist), eDta, Dimercaperol
What are the causes of sideroblastic anemia?
Alcohol, lead, isoniazid, ALAS enzyme defect
What is the side effect of doxorubicin and danorubicin? How is it prevented?
Cadiotoxicity (dilated cardiomyopathy)
Dexrazoxane
What are the MOAs of bleomycin and busulfan? SE?
Bleeeeeeeomycin makes freeeeee radicals
Busulfan alkalates DNA
Pulmonary fibrosis
What cancer drugs cause hemorrhagic cystitis? How would you prevent?
Cylcophosphamide, ifosfamide (prodrugs; alkylating agent)
Prevent with mesna
Putting nitro on your mustang will rock your brain
Nitrosureas
-mustines
Cross BBB, treat brain tumors, CNS toxicity
Vincristine, Vinblastine
M phase
Inhibit microtubule formation
Vincristine- neurotoxicity
Vinblastine blasts the bone marrow
Paclitaxol
M phase
“Its taxing to stay polymerized”
Hyperstabilize microtubules, preventing breakdown
What are the side effects of cisplatin and carboplatin? Prevention?
Nephrotoxicity and ototoxicity
Prevent nephro with amifostine and chloride diuresis
What is the mechanism of etoposide and teniposide?
Inhibit topoisomerase II -> double strand breaks**
What is the mechanism of action of Trinotecan and tropotecan?
inhibit topoisomerase I -> single strand breaks**
How des prednisone and prednisolone work as anti cancer agents?
Induce apoptosis
What are the side effects of glucocorticoids?
CHIPA CHIPO Cushing like symptoms Hypertension Immunosuppression Peptic ulcers Acne
Cataracts Hyperglycemia Insomnia Psychosis Osteoporosis
Rotator cuff tendons and actions
SITS Supraspinatus- abducts initial 10 degrees Infraspinatus- laterally rotates Teres minor- laterally rotates, adducts Subscapularis- medially rotates, adducts
What is the saying for the wrist bones?
So Long To Pinky Here Comes The Thumb Scaphoid Lunate Triqetrium Pisiform Hamate Capitate Trapezoid Trapezium
What is the most common fractured carpal bone? Leads to what injury?
Scaphoid
Avascular necrosis
Dislocation of what bone may cause carpal tunnel syndrome?
Lunate
What can cause avascular necrosis of the femoral head?
Sickle cell, steroids, SLE, alcoholism
Femoral neck fraction (fall on hip w/ osteoporosis) -> can injure medial femoral circumflex
What muscle provides the brachial plexus protection?
Subclavius
What things can cause autoimmune hemolytic anemia?
Warm (IgG)- alpha methyldopa, CLL, SLE
Cold (IgM)- CLL, Mycoplasma pneumonia, infectious mononucleosis
Lichen planus
Saw tooth lymphocytic infiltrate at dermal epidermal junction
Purple and Pruitic
Hep C
Pityriasis rosea
Hearld patch on head/ neck that then spreads down the body. Plaques with collarette scale. Self resolving
As a sunscreen, avobenzene blocks…
UVAI and UVAII
As a sunscreen PABA esters block….
UVB
As a sunscreen zinc oxide blocks…
UVAI, UVAI, UVB
What levels of skin are affected by SSSS and SJS/TEN?
SSSS affects the stratum granulosum only and sluffing off of only the upper layers of the epidermis occurs
SJS/TEN affects the epidermal dermal junction
Basal cell carcinoma
Most common, least likely to metastasize Shiny/ pearly ulcer with rolled borders Upper lip Locally invasive Palisading nuclei in dermal nests
Squamous cell carcinoma (of skin)
Lower lip
Ulcerative red lesions with FREQUENT SCALE
KERATIN PEARLS
Melanoma
Least common but most likely to metastasize
S100+
Neural crest origin
Loves to metastasize to the brain
Activating mutation of BRAF kinase (BRAF V600E)
Excision. If metastatic Vemurafenib
Dysplastic nevus syndrome- nest of nevomelanocytees at the dermoepidermal junction. 9p21 mutation
Never give a patient with gout ______?
Aspirin (decreases renal clearance of uric acid)
The Prosencephalon yields what
Telencephalon-> cerebral hemispheres (other stuff)
Diencephalon-> Thalamus (second brain)
Mesencephalon yields what?
Midbrain
The Rhombencephalon yields what?
Metencephalon -> Pons and Cerebellum
Myelencephalon -> Medulla (very myelinated)
What is associated with anencephaly?
Maternal diabetes type 1
What are the medications for essential tremor?
Essential tremor is a rapid tremor of the head, hands, arms or voice that occurs during movement and at rest.
Family history. Often self medicate with ETOH BETA BLOCKERS (drug of choice) or PRIMIDONE (anticonvulsant)
Medial medullary syndrome
Ant. Spinal Artery
Tongue towards
Contralateral proprioception
Contralateral weakness
What do both Lateral medullary and Later pontine syndromes have in common?
Vertigo, nausea and vomiting
Ataxia
Ipsilateral horners
Ipsilateral face pain and temp
Lateral medullary syndrome (Wallenburg’s)
PICA
Dont PICA horse that cant eat (hoarseness and dysphagia)
Contralateral body pain and temp (checker board)
Lateral Pontine syndrome
AICA
Facial droop means your AICA’s pooped
Ipsilateral deafness/ tinnitus
Ipsilateral face paralysis
Ipsilateral lacrimation and salivation defects
Ipsilateral loss of taste from anterior 2/3 of tongue
Ipsilateral loss of corneal reflex
Webers syndrome (midbrain)
contralateral hemiparesis
Ipsilateral CNIII palsy
What is pseudotumor cerebri and is it treated?
Headaches in a young obese female.
No ventricular dilation on CT, but elevated CSF pressure
Tx- acetazolamide is first line
What is the jingle for the reflexes?
S1,2 buckle my shoe L3,4 kick the door C5,6 pick up sticks C7,8 lay them straight L1,2 picks your nuts up for you S3,4 anal winks galore
Increased CSF protein with normal cell count
Guillain Barre (acute inflammatory demyelinating polyradiculopathy)
What can trigger Guillain Barre?
CMV and campylobacter jejuni
What is the presentation of fanconi’s syndrome
Metabolic acidosis with hypokalemia and Rickets
What are the four causes of renal papillary necrosis (hematuria and proteinuria)?
Diabetes
Chronic NSAIDs or aspirin or acetaminophen
Acute pyelonephritis
Sickle cell anemia AND TRAIT!
What are the values for prerenal azotemia?
Urine osmolality > 500
Urine Na < 40
Fe Na < 1%
Serum BUN/Creatinine >20%
This happens when the kidneys arent getting enough blood flow. They are still able to concentrate the urine. Extra BUN is getting reabsorbed with the water increasing the ratio (normally 15%). Fractional excretion of sodium is also very low.
What are the side effects of loop diuretics?
OH DANG Ototoxicity Hypokalemia Dehydration Allergy (sulfa) Nephrotoxic (interstitial nephritis) Gout
What is the main side effect of mannitol?
Pulmonary edema
What are the side effects of Thiazides?
Hypokalemic metabolic acidosis, hyponatremia, sulfa allergy
hyperGLUC hyperglycemia hyperlipidemia hyperuricemia hypercalcemia
What is the triad for preeclampsia?
HTN, proteinuria, edema (esp hands and face)
If seizures are also present = ecclampsia
What 4 things is abrubtio placenta associated with?
Smoking
HTN
Cocaine
DIC
Whats the main clinical difference between placenta previa and abrubtio placenta?
Abruptio placenta is usually seen in the third trimester and is PAINFUL. +/- bleeding
Placenta previa is PAINLESS BLEEDING during any trimester (a painless preview)
What ovarian germ cell tumor is a/w Turner syndrome?
Dysgerminoma
Key features of Yolk sac tumor
Elevated AFP
Yellow, friable mass
Most common in young children
Schiller Duval bodies (resemble glomeruli)
Sarcoma botryoides
Cluster of grapes mass that hangs out of the vagina of girls < 4.
Spindle shaped tumor cells that are desmin and myogenin positive.
Breast mass with yellow or bloody nipple discharge
Intraductal papilloma
Fibrovascular projections lined with both layers of epithelium (columnar epithelial cells and myopeithelial cells)
Benign
Phyllodes tumore
Large mass of CONNECTIVE TISSUE Leaf like projections Late (postmenopausal) Latino Can have necrosis and hemorrhage Benign
Seminoma testicular tumor
Fried egg appearance By far most common testicular tumor Transillumination test positive (cannot be transilluminated) Incr Placental Alk phos (PLAP) Good prognosis
Embrynal carcinoma (of testicle)
Glandular/ papillary Hemorrhage and necrosis Aggressive primitive cells Hematogenous spread Painful Usually mixed with other tumor types
Most common testicular tumor > 60 y/o
Metatstatic lymphoma. Aggressive. often bilateral
What causes primary pulmonary HTN?
Inactivating mutation in BMPR2. Normally limits smooth muscle proliferation
What is the key feature of a fat embolus
bone breaks and petechial rash!! also can result from liposuction
Silicosis
Upper lobes
Egg shell calcifications of hilar lymph nodes
Disrupts Macrophage phagolysosomes -> incr TB risk
Incr risk of bronchogenic carcinoma
Birefringent silica particles
Foundries, sandblasting, mines
Abestosis
Worsk best at the BOTTOM of the lung
Ivory white calcified pleural plaques (pathognomonic)
Asbestos bodies (golden brown ferruginous dumbells)
Bronchogenic > mesothelioma
Shipbuilding, roofing, plumbing
Lung adenocarcinoma
Peripheral (large adeno’s peripheral)
Not related to smoking
k-ras mutations (activating)
hypertrophic osteoarthropathy -> clubbing and arthritis
Squamous cell carcinoma of the lung
Central (S- cells are central)
Cavitation, neCrosis, Cigarettes, hyperCalcemia (PTHrp)
Keratin pearls
Small cell carcinoma of the lung
Central (S- cells are central) Many paraneoplastic syndromes L-myc amplification Small blue neuroendocrine cells (NEUROFILAMENTS) Inoperable, tx with chemo
Large cell carcinoma of the lung
Peripheral (large adenos peripheral)
Large, undifferentiated cells, poor prognosis
Remove surgically
larGe -> gynecomastia and galactorrea, pleomorphic Giant cells with leukocyte fragments in cytoplasm
Carcinoid
Not a/w smoking
Good prognosis
BFDR
Neuroendocrine stains (chromogranin positive)
What childhood rash spares the hands and feet?
Rubella
What childhood rash spares the face?
Scarlet fever from strep pyogenes
Drugs that cause agranulocytosis
Agranulocytosis could certainly cause pretty major damage
Carbamazepine Clozapine Colchicine PTU Methimazole Dapsone
Drugs that cause aplastic anemia
Cholaramphenicol, benzene, NSAIDS, PTU, methimazole
Drugs that cause hemolysis with G6PD
Hemolysis IS PAIN Isoniazid Sulfonamides Primaquine Aspirin Ibuprofen Nitrofurantoin
Also dapsone, napthalene, fava beans
Drugs that cause megaloblastic anemia
Having a BLAST with PMS
Phenytoin
Methotrexate
Sulfa drugs
Drugs that cause acute cholestatic hepatitis/ jaundice
Erythromycin
Drugs that cause hypothyroidism
Lithium, amiodarone, sulfonamides
Drugs that cause gingival hyperplasia
Phenytoin, cyclosporine, verapamil
Drugs that can cause gout
Furosemide, thiazides, niacin, cyclosporine
Drugs that cause myopathies
Fish N CHIPS Give you myopathies Fibrates Niacin Colchicine Hydroxychloroquine Interferon alpha Penicillamine Statins Glucocorticoids
Drugs that can cause Stephens Johnson syndrome
Steven Johnson gave me a PEC SLAPP Penicillin Ethosuximide Carbamazepine Sulfa drugs Lamotrigine Allopurinol Phenytoin Phenobarbital
What can give you acquired fanconi’s syndrome?
Expired tetracycline
What drugs can give you acute interstitial nephritis
Methicillin
NSAIDS
Furosemide
What drugs can cause SIADH
Carbamazepine and cyclophosphamide
What drugs are likely to cause seizures
With seizures, I BITE My tongue Isoniazid Bupropion Imipenem/ Cilastin Tramadol Enflurane Metoclopramide
What drugs can cause disulfiram like reaction
Metronidazole
Certain cephalosporins
1st gen sulfonylureas (tolbutamide, chlorpropamide)
What drugs are nephrotoxic and ototoxic?
Vancomycin, aminoglycosides, loops, cisplatin
What drugs can cause massive hepatic necrosis
HAVAc Halothane Amanita phalloides Valproic acid Acetaminophen
What drugs are sulfa drugs
Popular FACTSSS Probenacid Furosemide Celecoxib Thiazides Sulfonamide antibiotics Sulfasalazine Sulfonylureas
What are two tocolytic drugs (reduce uterine contractions)?
Ritrodrine, Terbutaline (Beta 2 agonists)
