Our PP Clues 1 Flashcards
Test to detect point mutations within a gene?
PCR
Only anabolic steroid used in medicine?
Megestrol
(Uses and increase appetite in cancer patients)
What steroid takes place of aldosterone in adrenal insufficiency?
Fludrocortisone
MCC of adrenal insufficiency
- children: congenital adrenal hyperplasia, 21-hydroxylase deficiency
- adult: forgot to take steroids
Steroid DOC to induce surfactant
Dexamethasone
(Crosses membranes fastest)
Steroids for pediatrics
“B’s for babies”
Budesonide
Beclomethasone (incr surfactant)
Betamethasone (incr surfactant)
Dexamethasone is DOC for surfactant b/c it crosses membrane fastest
Best steroid to take the place of cortisol in adrenal insufficiency
Hydrocortisone
(Topical or injectable)
Main inhaled steroid
Triamcinolone
Actions of steroids
“IKISS”
I -> inhibit PLP-A (= cannot make arachidonic acid)
K -> kills T cells and eosinophils (= decr immune system)
I -> inhibit macrophage migration
S -> stabilizes mast cells
S -> stabilizes endothelium
Receptors of vessels
- Arteries
- Arterioles
- Veins
Arteries -> alpha-1 (IP3/DAG) -> vasoconstriction
Arterioles -> beta-2 (cAMP) -> Epi -> vasodilation & decr TPR
Veins -> alpha-1 (IP3/DAG) -> venoconstriction
Nervous controls of vessels and their resting state
- Veins
- Arteries
Veins -> parasympathetic -> usually dilated
Arteries -> sympathetic -> usually constricted
What vessel(s) respond to hypovolemia first?
Venoconstriction (veins) are 1st
Then vasoconstriction (arteries) to get volume back into circulation since veins hold 60% of blood
What is the underlying skin disease w/ warfarin-induced skin necrosis?
Protein C Deficiency
(Protein C = thrombolytic)
Therefore, less likely to break up clots
Anticoagulation meds timeline
1st clot, known cause
2nd clot, known cause
3rd clot, known cause
Unknown cause
3 months
1 year
Lifelong
Lifelong
What is the MCC of bleeding into tissues?
Hypertension
(Lots of diseases cause HTN but HTN is always the MCC)
What are the clues for left coronary infarct?
Sudden death
Congested heart failure (lost >40% or EF<45%)
Recurrent ventricular arrhythmias
What is the clue for right coronary infarct?
Heart Block
Slow HR with heavy chest pain
“Hippo on chest”
What is the 2nd messenger of anabolic processes?
Sympathetic or parasympathetic?
cGMP
Parasympathetic
Active when dephosphorylated
NSAID with morphine strength
Ketorolac
NSAID with GABA effect
Baclofen
(Uses = back spasm)
Most potent NSAID
Indomethacin
(Uses = gout, close PDA)
What is the only irreversible COX inhibitor?
Aspirin
Indications?
- anti-inflammatory
- analgesic
- anti-platelet
- anti-pyretic
Dx of macrophages w/ sugar
(Hint: globoid cells)
Krabbe’s
Enzyme deficiency:
- Beta-galactocerebrosidase or galactosyl-ceramidase
Inheritance:
- autosomal recessive
Presents how?
- low energy state
- CN II atrophy globoid cells
Disease due to alpha-galactosidase deficiency
Fabry’s
Inheritance:
- X-linked recessive
Presents how?
- low energy state
- cataracts
- early renal failure
Dx of macrophages that look like crinkled paper and Erlenmeyer flask legs
Gaucher disease
AR
Enzyme: glucocerebrosidase
Demographic: Ashkenazi Jews
Gargoyle features
What transporter transports triglyceride to endothelium and liver?
What are they made?
Carries what triglycerides?
What is the surface tag?
Chylomicrons
In GI tract
Short and long chain
C2 (E1, E4 for liver)
What transporter transports triglycerides from adipose to everywhere else?
What is the surface tag?
IDL
ApoE
What transporter transports triglycerides to adipose tissue for storage?
Where are they made?
Carries what triglycerides?
What is the surface tag?
VLDL
In liver
LCFA (90%), cholesterol
B100
What are the symptoms of cinchonism?
Drug causes?
Tinnitus, hearing/vision loss, psychosis, and cognitive impairment
Quinidine, quinine, aspirin
Dx of red “currant jelly” sputum in patients w/ alcohol overuse or diabetes
Klebsiella pneumoniae => pneumonia
What is the only electrolyte that is at Nernst #?
Chloride
Dx of calf pseudohypertrophy
Muscular dystrophy
Most commonly: Duchenne
Due to X-linked recessive frameshift mutation
Dx of microcytic hyperchromic anemia
Hereditary spherocytosis
Amino acids required to make a purine ring
Which AA is most important?
Glycine (Lord Farquad) -> most important
Aspartate
Glutamine
Amino Acids
(N-bonds)
Asparagine
Glutamine
What amino acids are associated with various substrates in Kreb’s cycle (6)?
Pyruvate -> Ala, Ser, Gly
Acetyl CoA -> Lys, Leu, Phe, Ile, Thr, Trp
Alpha-ketoglutarate -> glutamate, glutamine
Succinyl CoA -> Phe, Trp, Tyr
Fumarate -> Proline
OAA -> Aspartate, asparagine
What infection attacks the temporal lobes of the brain?
Herpes simplex virus
(Temporal lobe encephalitis is more common with HSV1 over HSV2.)
(Viral meningitis is more common with HSV2.)
Where is Wernicke’s area of the brain?
What enzymes does it need?
What is the necessary cofactor?
Posterior temporal lobe
Transketolase
Thiamine (B1)
Top 3 bacteria for respiratory
1) S pneumo
2) H influenza
3) M catarrhalis
Drug that inhibits HMG-CoA reductase
Statins
- decr cholesterol synthesis
- decr intrahepatic cholesterol
- incr LDL receptor recycling
- incr LDL catabolism
“Pulseless disease”
Granuloma in arch of aorta
Takayasu’s arteritis
= Giant cell arteritis
When do macrophages and T cells arrive at the site of inflammation?
Show up at day 4
Peak at day 7
Describe characteristics of fat soluble compounds
Uncharged
Small
Base
Vd high
Long 1/2 life (> 12 hours)
Eliminated via liver
(Hepatitis, myositis, pancreatitis)
(C/I in liver failure)
List all Live vaccines
“Pick MMR B/c it VaRYS”
Polio (oral)
Measles
Mumps
Rubella
BCG
Varicella
Rotavirus
Yellow fever
Smallpox
Need to know isomer
Glucose <-> Fructose
(Same chemical makeup but different structure)
Disorders associated with:
HLA-B27
“PAIR”
(All involve sacroiliac joint & uveitis)
Psoriatic arthritis (silver oral plaques on extensor surfaces, sausage digits)
Ankylosing spondylitis (middle age, chronic back pain, bamboo spine, pos schober test)
Inflammatory bowel disease
Rheumatoid arthritis
Specifics for IL-1
Fever
Osteoclast activating factor
Specifics for IL-2
Stimulates T cells, NK cells
Specifics for IL-3
Stimulates bone marrow
Specifics for IL-4
Stimulates IgE production and IgG from B cells
Specifics for IL-5
Stimulates IgA production from B cells
Specifics for IL-6
Stimulates aKute phase reactants
General specifics for Interleukins
“Hot T-BONE stEAK”
Made by macrophages -> IL-1 and IL-6
Secreted by T cells -> IL-2 and IL-3
Secreted by Th2 cells (and B cells) -> IL-4 and IL-5
Drugs that cause Hemolytic Anemia
Penicillins
Cephalosporins
Sulfa drugs
Alpha-methyldopa
PTU
Antimalarials
Dapsone
Name an enzyme that uses magnesium
Kinases
Amino Acid
(Causing kinks & bends)
Proline
Dx of grey exudates/membranes
Diphtheria
Signs => lymphadenopathy (Bull’s neck), myocarditis
A - ADP ribosylation
B - B prophage
C - Corynebacterium
D - Diphtheriae
E - EF2
G - Granules
MOA of Hydroxyurea
Inhibits ribonucleotide reductase
(Used in sickle cell patients to increase HbF levels)
Where is alpha-1,4-glucosidase found?
If deficient?
Only in the heart
Pompe’s -> heart failure shortly after birth
How would you silence DNA?
Methylation
Deacetylation
Add more G’s and C’s
What are the drugs that affect PGE?
(Extra function)
PGE 1
- Misoprostal: treatment of ASA/NSAID-induced ulcers; abortifacent
- Alprostadil: keeps PDA open
PGE 2
- Dinoprostone: labor induction
Drugs that cause disulfiram-like reaction
Metronidazole (#1)
Cefotetan
Cefamandole
Etoperidone
Moxalactam
Chlorpropamide
Dx for:
Basophilic stippling
Elevated FEP
Heme synthesis is completely blocked
Lead poisoning
(Lead inhibits delta-ALA dehydratase or ferrochetolase)
What are the anaerobic bacteria?
“Can’t Breathe Fresh Air”
Clostridium
Bacterioides
Fusobacterium
Actinomyces
The only protein completely modified in the rER
Collagen
3 MCC of Jarisch-Herxheimer Reaction
CMV
EBV
Syphilis
Most common gram pos bacteria with a capsule
Strep pneumo
High cell turnover, what vitamin should be added?
Folate (B9)
What nucleotide is most susceptible to UV damage?
Thymidine
(Forms thymidine dimers)
DOC to lower triglycerides
Fibrates
- fenofibrate
- gemfibrozil
What are the essential fatty acids?
Linolenic acid
Linoleic acid
(Used to make arachidonic acid)
What cells make thromboxane?
How long do they function?
Platelets
2 hours
Vasoconstrict, promote platelet aggregation
MCC of retroperitoneal bleeding in pancreatitis (anatomy)
Splenic artery
Dx of early cataracts in child
Galactosemia
Enzyme: galactose-1-phosphate uridyl transferase deficiency
Results in: osmotic burst
S&Sx: seizures, N/V following meals
Dx of microcephaly, high-pitched cry, and intellectual disability
Cri-du-chat syndrome
Amino acids
(O-bonds)
Serine
Threonine
Tyrosine
Need to know epimer
Glucose <-> Galactose
(Some chemical makeup and structure, but differ around one chiral carbon)
Humoral Immune System
- Protects what?
- Cell type?
- Stimulates cell type?
- Kills what?
- protects blood
- B cells
- neutrophils
- kill bacteria
What are the lactose-fermenting bacteria?
“CEEK”
Citrobacter
Enterobacter
E.coli
Klebsiella
MOA: Probenacid
Promotes uric acid excretion
What are the cofactors of Pyruvate dehydrogenase?
“PLAN F” = “Tender Loving Care For Nancy”
P: TPP - Decarboxylates
L: Lipoic acid - Accepts C
A: CoA - Accept from lipoic acid
N: NAD - oxidizes FADH2
F: FAD - oxidizes lipoic acid
Retinal Detachment:
- from top
- from bottom
- homocystinuria (“looking down at a child”)
- Marfan’s (“looking up at Mars”)
MOA: Colchicine
Blocks microtubules
Interferes w/ cell division
Interferes w/ inflammatory cell mobility
Dx of extra white teeth and bone
Fluoride poisoning
MCC of death: heart failure
Dx of elevated PTT and elevated Bleeding Time
Von Willebrand Disease
(Only one that effects intrinsic pathway and platelets)
Dx of white crystals in urine
Orotic aciduria
(First ringed structure in pyramidine synthesis)
What amino acid increases during acidosis?
Alanine
List all encapsulated organisms
- gram pos
- gram neg
Gram pos
- strep pneumo
Gram neg
- pseudomonas aeruginosa
- H influenzae B
- Neisseria meningitidis
- E. coli
- Salmonella
- Klebsiella pneumoniae
What are the segmented viruses?
“BOAR”
Bunya (3 segments)
Orthomyxo (8 segments)
Arena (2 segments)
Reo (10-12 segments)
Drug causes of nephrogenic diabetic insipidus
Lithium
Demeclocycline
Why are galactosuria and fructosuria milder form?
The alternative enzyme hexokinase is able to fill in
Most common collagen disease
Marfan’s
- fibrillin defect
- long wingspan
- arachnodactyly
- retinal detachment “fans out”
What is the main anapleurotic enzyme?
(Can fill in any of the intermediates of the Kreb cycle)
Pyruvate carboxylase
What is the only X-linked dominant enzyme deficiency?
Pyruvate dehydrogenase
Markers for SLE
One of the Markers’ 4 important effects
Markers: anti-dsDNA, anti-Smith, cardiolipid
1) Stimulates intrinsic clotting factors
2) causes false elevated VDRL
3) blocks vWF
4) multiple spontaneous abortions
DOC for gonorrhea
Ceftriaxone
Doxycycline
Dx of vasculitis attacking medium-sized arteries recovering Hep B
Polyarteritis nodosa (PAN)
Never attacks pulmonary vessels or other large vessels
(Hint: by blood in stool or blood in urine)
What is Autonomic Dysfunction?
Causes (most common)?
- Overall?
- Newborns?
- Parkinsonism?
- Elderly?
A dysfunction in CN IX and CN X to regulate HR and BP
MCC (overall) - Diabetes Mellitus
In Newborns: Riley-Day Syndrome
In Parkinsonism: Shy-Dragger syndrome
In Elderly: Sick sinus syndrome
Dx of IgA nephropathy after URI
Berger’s
MC nephropathy
50% resolve
50% progress to renal failure
Dx of IgA in the kidney
Berger’s -> 2 weeks after URI
Henoch-Schonlein Purpura -> 2 weeks after gastroenteritis
Alport’s -> deafness, cataracts
Dx of most common cause of crescent formation in kidney
Goodpasture’s
Dx of vasculitis, involving sinus, lungs, and kidneys
(Extra hint: saddle nose in adults)
2 cause of crescents in kidneys
Wegener’s
= Granulomatosis with polyangiitis
c-ANCA positive
Dx of vasculitis leading to renal failure after eating raw hamburgers
Hemolytic uremic syndrome
- MCC renal failure in kids
- E. coli infection
- Endemic = EHEC
- Epidemic = O157:H7
What direction should these parameters go in relation to each other?
- venous return
- CO
- EDV
- SV
- CN IX
- CN X
- carotid sinus stretch
- HR
Venous return, EDV, CO, SV, carotid sinus stretch, CNIX firing, and CNX firing ALWAYS go in the SAME direction.
(All go up or all go down)
HR always goes in the opposite direction
Congenital defect if spiral membrane:
- never developed
- rotated too far to the right
- did not migrate all the way down
- Transposition of great arteries
- tetralogy of Fallot
- truncus arteriosus
Dx of atrialization of right ventricle
Epstein anomaly
- large right atrium, causes tricuspid regurgitation
- drug causes lithium and valproate
Dx of vasculitis involving lungs and kidneys w/o sinus involvement
Goodpasture’s
- anti-glomerular basement membrane
- type IV collagen
- linear Immunofluorescence on EM
Carcinoid syndrome is emitting what neurotransmitter?
Leads to what heart sound pathology?
Serotonin
Tricuspid stenosis
Dx of pulmonary infiltrates w/ eosinophilia
PIE syndromes
- Churg-Strauss (= sudden, severe asthma in young adult)
- Aspergillosis (= sudden, severe asthma in adult; moldy hay or basement)
- Loeffler’s syndrome (= due to parasites)
Dx of vasculitis with sudden severe asthma in young adult
Churg-Strauss Syndrome
- p-ANCA positive
- IgE w/ pulmonary infiltrates (PIE)
Aortic arches derivatives
1st: M structures -> maxillary artery
2nd: S structures -> stapedial artery
3rd: C is 3rd letter -> carotid artery (common & internal)
4th: on left -> aortic arch; on right -> subclavian
5th: adios
6th: pulmonary arteries and PDA
Trinucleotide repeats (4)
Huntington Disease (CAG; caudate has decr ACh and GABA)
Myotonic Dystrophy (CTG; cataracts, toupee, gonadal atrophy)
Fragile X Syndrome (CGG; chin (protruding), giant gonads)
Friedrich Ataxia (GAA; ataxic GAAit)
Dx of nephrotic syndrome 2 weeks after sore throat
PSGN
- subendothelial humps on histology
(Also seen in SLE)
- strain 12 (90%)
- low complement
Dx of anhedonia or failure to function for 2 weeks
Major Depressive Disorder
- Sleep disturbance
- Interest loss
- Guilt or feelings of worthlessness
- Energy loss
- Concentration difficulties
- Appetite or weight gain/loss
- Psychomotor agitation
- Suicidal thoughts
Dx of collagen vascular diseases with low complement, 2 weeks after vaccination
Serum sickness
(High incidence with MMR)
What antiarrhythmics block Na and Ca together?
For what do we need to give it?
Quinidines
Procainamide
Phenytoin
Wolff-Parkinson-White
Dx of subacute endocarditis
Attacks what valve?
Strep viridans
Attacks mitral valve => mitral regurgitation
Signs:
- mycotic aneurysm (brain)
- Roth spots (retina)
- splinter hemorrhages (nail beds)
- Osler’s nodes (painful)
- Janeway lesions (painless)
Dx with rash on palms and soles
TRiCKSSSSS
- toxic shock syndrome
- Rocky Mountain spotted fever
i
- Coxsackie A
- Kawasaki disease
- Strep pyogenes
- scarlet fever
- scalded skin syndrome
- syphilis (secondary)
- streptobacillus moniliformus (rat bite fever)
Dx of vasculitis with auto-amputation of digits and history of smoking
Buerger’s disease
- necrotizing vasculitis
- increased incidence in smokers and Jews
- repeated intermittent claudication of medium vessels
Dx of vasculitis with high platelet count
Kawasaki disease
Tx: Aspirin daily for 2 years minimum, flu shot yearly
Dx of only vasculitis with normal platelet count
Henoch-Schonlein Purpura (HSP)
Dx of IgA nephropathy after gastroenteritis
Henoch-Schonlein Purpura (HSP)
- only vasculitis with normal platelet count
- Purpura from buttocks down
- high incidence of intussusception
Which factor does the most to regulate flow?
Radius
Dx of multiple AVMs in abdomen and brain
Von Hippel-Lindau
- defect of VHL gene on short arm of chromosome 3
- high risk of renal cell carcinoma
Dx of multiple AVMs in lungs
Older-Weber-Rendu
- continuous murmur
- machinery
- to-and-fro
- multiple AVMs in lung
- MCC of death is pulmonary hemorrhage
What is the diagnosis if A-V oxygen is almost zero?
A-V shunt
- PDA (MCC in newborns)
- ASD
- VSD
- AVM (death from massive hemorrhage)
List tissues and/or organs where blood flow resistance is in series
Liver (portal to hepatic vein)
Kidney (afferent to efferent artery)
Spleen (filtration)
Lung (oxygenation)
Placenta (nutrition)
What are the function of the spleen? (5)
Remove old RBCs
Remove damaged cells
Remove encapsulated organisms
Remove nuclear material
Secondary erythropoiesis, if you lose bone marrow
Pancreatic enzymes secreted into GI of this type of endocrine secretion
Exocrine (secreted into a cavity)
Sweat glands of armpits and groin have this type of endocrine secretion
Holocrine
- entire cell is secreted with the substance
- 10% of sweat glands
Sweat glands of skin, breast, eyelids, and ear are this type of endocrine secretion
Apocrine
- tip of cell is secreted with the substance
- 90% of sweat glands
Thymosin & thymopoietin are secreted by the thymus, and only works on thymus are this type of endocrine secretion
Autocrine
- secreted by the cell it works on
GI somatostatin that only works on GI hormones are an example of this endocrine secretion
Paracrine
- secreted then only works in the vicinity
Dx of low volume state with high Na
Diabetes Insipidus
Elderly neglect
Dx of low volume state with acidosis
Diarrhea (normal AG)
DKA (elev AG)
Renal tubular acidosis type 2 (normal AG)
Characteristics of low volume state
Decr Na serum (dilutional)
Decr Cl serum (dilutional)
Decr K serum (renal + dilution)
Decr pH urine (aldosterone)
Incr pH serum (metabolic alkalosis)
Incr TPR
Actions of angiotensin 2
(5)
1) Vasoconstrict arteries (incr TPR d/t NE)
2) Constricts efferent arteriole more than afferent arteriole in kidney
(Creates backpressure; re-establishes GFR)
3) stimulates aldosterone
(Reabsorbs Na; excretes K, H)
4) stimulates ADH
5) stimulates thirst center in brain
Post MI (day 4-7) Complications and their symptoms
1) cardiac tamponade
(Die suddenly, distant heart tones)
2) ventricular aneurysm
(Double knock, pericardial knock)
3) VSD
(Murmur louder w/ exhale, does not radiate to axilla)
4) Peri-infarct Pericarditis
(Triphasic rub, pericardial rub)
5) mitral regurgitation
(Murmur radiates to axilla)
4 ways that acidosis can kill/harm you
1) denatures proteins
2) causes hyperkalemia
3) kussmaul breathing
4) elevated GABA (inhibitory)
Organs/tissues that do not require insulin
“BRICKLE”
Brain
RBC
Intestine
Cardiac muscle/cornea
Kidney
Liver
Exercising muscle
What are the tissues with resistance in series?
Liver
Kidney
Spleen
Lung
Placenta
“Series wants to slow you down for a little to perform its function”
Heart sounds: opening snap during diastole
TS
MS
Heart sounds: ejection click during systole
AS
PS
Heart sounds: midsystolic click
Mitral valve prolapse
- common in women
- faster S1 -> standing
- slower S2 -> lying down
Heart sounds: soft S1
TR
MR
Tricuspid atresia
Mitral atresia
Atresia due to lack of apoptosis, leads to cyanosis at birth
Heart sounds: loud S1
Stiff valves bangs shut or one ventricle contracting harder
TS
MS
Heart sounds: soft S2
AR
PR
Aortic atresia
Pulmonary atresia
DOC for atrial fibrillation or atrial tachycardia
Verapamil
Diltiazem
Ca channel blockers b/c atrium and thalamus use Ca to depolarize
Heart sounds: paradoxical S2 splitting
Aortic stenosis
or
Pulmonary HTN
What are the fat soluble anesthetics?
What are the water soluble anesthetics?
All anesthetics end in -caine
Fat soluble -> amides -> Two “I”s in name = Lidocaine
Water soluble -> esters = tetracaine
DOC for absence seizures (thalamic seizures)
Ethosuximide
- blocks Ca type T channels
(Thalamus and atrium use Ca to depolarize)
DOC for:
- generalized seizure
- temporal lobe seizure
- status epilepticus
Phenytoin
- blocks Na channels
- prevents depolarization
- SE: gingival hyperplasia, hirsutism
Carbamazepine
- blocks Na channels
- prevents depolarization
- SE: SIADH, aplastic anemia
Diazepam
- facilitates GABA to increase frequency
- only rectal suppositories
What controls HR?
What receptors does it have?
SA node
Beta-1 receptors
Left coronary infarct clues
Sudden death
Congested HF
- lost >40%
- EF <45%
Recurrent ventricular arrhythmias
Right coronary infarct clue
Heart block
Slow HR with chest pain described as hippo on chest
1 cause of venous clots
Stasis
- promotes aggregation
- Tx: heparin
Endothelial injury
- high velocity blood flow
- injury promotes aggregation
- Tx: aspirin
Virchow’s triad
Hypercoagulablity
Stasis
Endothelial injury
What is the control (nervous) of veins?
- resting condition
Parasympathetic control
(Usually dilated)
What is the control (nervous) of arteries?
(Resting condition)
Sympathetic control
(Usually constricted)
Why do plasma proteins not leak out of the blood vessel?
Heparin sulfate is a negative charge in the basement membrane that repels negatively charged plasma proteins
Dx of IgA Nephropathy with cataracts + deafness
Alport’s
- X-linked recessive
- involves type IV collagen
- late onset renal failure
Important lab markers for iron deficiency anemia
Ferritin is low
TIBC is high
Clue of Dx: nasal polyps
In children
- asthma
- cystic fibrosis
Top 3 causes of pancreatitis
- children
- adults
Children
- trauma
- infections (coxsackie B, mumps)
- hypertriglyceridemia
Adults
- gallstones
- alcohol
- hypertriglyceridemia
Causes of macrosteatosis
1) obesity
2) alcohol
What lab findings is most indicative of a poor heart failure prognosis?
Hyponatremia
(Yes: K too, but Na is the more serious of the two)
Anti-smooth muscle antibody
Scleroderma
Autoimmune diabetes
Dx of dead birds in the area with the symptoms of meningitis
West Nile virus
What is acanthocytes?
Causes?
RBCs coated with lipids
MCC hyperlipidemia
- obesity
- nephrotic syndrome
- renal failure
- pregnancy
What is the most common bone cancer?
Metastasis
Multiple myeloma
Dx of slapped cheek appearance
Parvovirus B19
(Slapped cheek = 5 fingers = 5th disease d/t parvo B19)
Describe characteristics of water soluble compounds
Charged
Large
Acid
Vd low
Short half life (<12 hours)
Excreted in kidney
- nephrotoxic
- check renal labs
- C/I in renal failure
No CNS toxicity
What are the bacteria that are curved rods?
Helicobacter
Vibrio vulnificus
Campylobacter
List drugs that cause pulmonary fibrosis
“My Nose Cannot Breathe Bad Air”
Methotrexate
Nitrofurantoin
Carmustine
Bleomycin
Busulfan
Amiodarone
Apoptosis
- What is the gene?
- What is the protein?
- What is the label?
- What is the enzyme?
- p53
- Cyclin D
- phosphatidylserine
- caspase
How would you determine if it’s fulminant hepatitis?
Hepatic encephalopathy
Evidence of GABA
What’s caused by Sodium Nitroprusside?
Cyanide poisoning
(Side note: best drug for HTN crises except for pregnancy or aortic dissection)
What is the screening tests for cystic fibrosis?
Immunoreactive trypsin
Then: Chloride sweat test (use pilocarpine)
Top 3 bacteria for GU tract
What if nitrite neg?
What if post-coital?
1) E. coli
2) Proteus
3) Klebsiella
Enterococcus
Staph saprophyticus
Drug-Induced Lupus serum marker
Anti-histone antibody
Amino acids
(Ketogenic only)
Lysine
Leucine
Amino acids
(Both glucogenic and ketogenic)
Phenylalanine
Isoleucine
Threonine
Tryptophan
Causes of microsteatosis
Sign of uncoupling
1) pregnancy
2) Tylenol poisoning
3) Reye’s syndrome
What is the rate limiting enzyme of glycolysis?
Phosphofructokinase 1 (PFK-1)
If susceptible to encapsulated organisms, vaccinate against what?
Susceptible due to asplenia
“No spleens here”
- Neisseria meningitidis
- Strep pneumo
- H influenzae
What two membranes depolarize w/ Ca?
Atrium and thalamus
(Everything else use Na to depolarize)
What 2nd messenger do the following use?
- estrogen
- progesterone
- testosterone
- cortisol
NONE!
All steroid hormones are fat soluble hormones
Do not use 2nd messenger b/c they are able to freely cross membrane
Which 2nd messenger systems are affected by calcium?
IP3/DAG, Calcium, Calcium-Calmodulin
(Sx consistent with smooth muscle contraction, gastric, hypothalamic hormones)
DOC for venous clots
Heparin
(Heparin before warfarin w/ 2 day bridge)
- periosteal erosion
- only arthritis to attack C1 and C2
- only arthritis to attack pannus or synovium
Rheumatoid arthritis
Anti-centromere antibody
CREST syndrome
- mildest form of scleroderma
- calcinosis cutis
- Reynaud’s phenomenon
- esophageal dysmotility
- sclerodactyly
- telangiectasias
Anticoagulants used that do not require bridge therapy
Rivaroxaban
Apixaban
Dx of elevated C-peptide and elevated insulin in:
- newborns
- mass in pancreas
- drug
- nesidioblastosis
- insulinoma
- sulfonylureas
What is the antibody for autoimmune T1 DM?
Anti-glutamic acid decarboxylase (anti-GAD)
What are the X-linked recessive enzymes?
“A GOLF PATCH”
Adenosine deaminase (SCID)
G6PD
OTC
Lesch-Nyhan (HGPRT)
Fabry’s (alpha-galactosidase)
PRPP synthetase
Adrenal leukodystrophy (CAT-1)
Tyrosine kinase
CGD (NADPH oxidase)
Hunter’s (Iduronidase)
“Ragged red fiber”
“Wavy red fiber”
Mitochondrial diseases
Chaperone HSP-70
guides proteins where?
Mitochondria
DOC to raise HDL
Niacin
Infections that cause heart block
Legionella
Lyme disease
Chaga’s disease
Diphtheria
Typhoid fever
What is the rate limiting enzyme of gluconeogenesis?
Pyruvate carboxylase
Most immunogenic bacteria
Shigella
(MCC of diarrhea in daycare)
Amino acids
(Aromatic)
Phenylalanine
Tryptophan
Tyrosine
Amino acids
(Sulfur)
Hormones with lots of disulfide bonds
Methionine & Cysteine
“PIGI”
- prolactin
- insulin
- growth hormone
- inhibin
What is the 2nd messenger of smooth muscle?
Contraction by hormone or neurotransmitter
- IP3/DAG
Contraction by distention:
- calcium-calmodulin
Dx of painless erythematous lesions on palms and soles
Janeway lesions
- infective endocarditis
- septic emboli/microabscesses
How would you promote DNA transcription?
Loosen DNA
Acetylation
Add more A’s & T’s
Rules for fatty acid synthesis in the body
1) Cannot synthesize beyond 16 carbons
2) can only create double bonds at least 3 carbon aparts
3) cannot create any double bonds after C-10
Crescent formation in kidney
Rapid progressive glomerulonephritis
What is the only hormone to control lipolysis & ketogenesis?
Glucagon
(In DKA -> answer is STILL glucagon. There is just no insulin to shut it off)
Drugs that induce Lupus
“HIPPPE”
Hydralazine
INH
Procainamide
Penicillamine
Phenytoin
Ethosuximide
Dx of AST:ALT::1:1
Dx of AST:ALT::2:1
1:1 ratio is seen in:
- liver disease
- muscle disease
- trauma
- infection
(Broad doesn’t mean a lot)
2:1 is only seen in alcoholic hepatitis b/c only alcohol can destroy mitochondrial membrane
Increased plasma hydrolases
I cell disease
“Empty lysosome”
Cause if increased Ca and increased phosphate
Cause if increased Ca and decreased phosphate
Vitamin D
PTH
Heart sounds: S2 splitting
S2 -> aortic or pulmonary
Widens when inhaling
- increased O2
- increased RV volume
- delayed closure of pulmonic valve
Narrows when exhaling
- decreased O2
- decreased RV volume
- early closure of pulmonic valve
Heart sounds: fixed S2 splitting
ASD
(MCC in general: septum primum)
Do ACE inhibitors or ARBs contain sulfur?
ACE inhibitors
- avoid w/ sulfur allergies
(ARBs do not contain sulfur)
Which ARB does not cause any angioedema?
Candesartan
“Candy is so sweet to not cause swelling”
(ARBs end in “-sartan”)
Dx of dinucleotide repeats
Lynch Syndrome
(HNPCC)
- mismatch repair
- family hx of colon cancer w/o polyps
What are the strong chemoattractant for neutrophils?
LTB 4 and IL-8
(Minorly: C3a and C5a, but almost never the answer)
List the non-immune hemolytic anemias (4)
Paroxysmal nocturnal hemoglobinuria (PNH)
Glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency)
Microangiopathic hemolytic anemia
Malaria
What organ cannot use ketones?
What cell cannot use ketones?
Liver
RBCs
Treatment for neuropathic pain
- 1st line
- w/ heart failure
- shooting, stabbing
- amitriptyline (TCA)
- Gabapentin
- Carbamazepine
What is the 2nd messenger of catabolic processes?
Sympathetic or parasympathetic?
cAMP
sympathetic
Active when phosphorylated
Dx of Achilles tendon xanthoma
Familial hypercholesterolemia
(Decreased LDL receptor signaling)
What is the 2nd messenger of gastrin?
Calcium
Dx of chorioretinitis, hydrocephalus, intracranial calcifications in children
Congenital toxoplasmosis
RA-related diseases
- RA w/ leukopenia and splenomegaly
- RA w/ GI ulcers
- RA w/ xerostomia, xerophthalmia
- Felty’s syndrome
- Behçet’s syndrome
- Sjögren’s syndrome (Ro, La, SSA, SSB antibodies)
When do neutrophils arrive at the site of inflammation?
Show up at 4.5 hours
Predominate 24 hours
Peak at day 3
What pump or exchange resets membrane potential?
Na/Ca exchange
(Phase 4)
What brain herniations cause pupil dilation?
(Which one has no effect?)
Tonsillar & Uncal
Subfalcine
What are the non-lactose fermenting bacteria?
“ShYPS”
- Shigella
- Yersinia
- Proteus
- Salmonella
Dx of cherry-red spots on macula
Due to central retinal artery occlusion
Tay-Sach’s
- ganglioside accumulation
- NO hepatosplenomegaly
Niemann-Pick
- sphingomyelin accumulation
- YES hepatosplenomegaly
Chaperone HSP-90
guides proteins where?
Golgi apparatus
Endothelin produces what? (3)
Factor V
Factor VIII
vWF
4 syndromes associated with chromosome 22
Digeorge syndrome
CML (t 9;22)
Neurofibromatosis (t 17;22)
Ewing sarcoma (t 11;22)
Retroperitoneal organs
“SAD PUCKER”
Suprarenal (adrenal) glands
Aorta and IVC
Duodenum (2nd-4th parts)
Pancreas
Ureters
Colon (ascending & descending)
Kidney
Esophagus
Rectum
When do fibroblasts arrive at the site of inflammation?
Show up at 7 days
Peak at 1 month
Take 6 months to complete fibrosis
What are the 6 actions of TCAs?
1) Blocks reuptake of catecholamines
2) strongly anticholinergic
3) blocks alpha-1 receptors
4) blocks Na channels in the ventricle
5) blocks AV conduction
6) antihistaminic
What is the 2nd messenger of all hypothalamic hormones?
Except?
IP3/DAG
(Except CRH which is cAMP)
Dx of strawberry tongue (2)
Scarlet fever
- w/ sandpaper rash
Kawasaki disease
- w/ lymphadenopathy & high fever for 5 days
Gray baby syndrome drug
Chloramphenicol
What drugs are strong acids and need to be taken on empty stomach?
Tetracyclines
Quinolones
Short amino acid sequences are added where?
rER
What electrolyte drive the concentration gradient?
Sodium
(Biggest gradient)
Name the enzyme that is most active at 8PM
HMG CoA Reductase
Dx of splinter hemorrhages in fingernails
Infective endocarditis
- acute = staph aureus
- subacute = strep viridans
Short amino acid sequences guides proteins where?
Mitochondria
List sympathetic effects
Incr HR
Incr BP
Incr contractility
Incr EF
Incr SV
Vasoconstriction
Pupils dilation
What is the most common leukemia?
ALL
Pro-sequence guides proteins where?
Golgi
Gout treatments
- Acute = most effective
- Acute = drug of choice
- w/ renal failure
- chronic or recurrent
- to break up crystals
- colchicine
- indomethacin
- steroids
- allopurinol, febuxostate, probenecid
- rasburicase
MOA:
Allopurinol
Febuxostat
Blocks xanthine oxidase
Dx of self-mutilation and always running De Novo pathway
Lesch-Nyhan syndrome
- complete HGPRT deficiency
- severe gout
Cell-mediated immunity
- protects what?
- cell type?
- stimulates what cell type?
- kill what?
Patrols your tissue
T cells
Macrophages
Kills everything except bacteria (= virus, fungi, parasite)
Dx of male child with recurrent infections, no mature B cells
Bruton disease
= X-linked agammaglobulinemia
Cause of loose or spasmodic stools
Osmotic diarrhea
Inflammatory
Dx of CD55 and CD59 detected on surface
Paroxysmal Nocturnal Hemoglobinuria (PNH)
(Tx: makes susceptible to encapsulated organisms)
Name an enzyme that uses Molybdenum
Xanthine oxidase
MCC cause of malabsorption
- in children
- in adults
Children:
- cystic fibrosis
- celiac sprue
Adult:
- Crohn’s disease
Name an enzyme group that uses Biotin (B7)
Carboxylases
MCC of vasculitis:
- in children
- in adults
Children: Henoch Schönlein Purpura
Adults: HTN and DM
List the causes of acyanotic heart lesions in neonates (3)
Coarctation of aorta
Critical aortic stenosis
Single ventricle
What are the 6 causes of complement deposition in kidney?
“PMS in Salt Lake City”
Post-streptococcal GN
Membranous GN
Serum sickness
SBE (subacute bacterial endocarditis d/t strep viridans)
Lupus
Cryoglobulinemia
MCC of nephrotic syndrome
- in children
- in adults
Children: minimal change disease
Adults: focal segmental GN (d/t HTN and DM)
Main antioxidants
- in GI
- in blood
Vitamin A
Beta-carotene
Vitamin C - GI
Vitamin E - blood
Name an enzyme that uses vitamin B6
Transaminases
MCC of aplastic anemia (5)
Parvovirus B19
Drugs: chloramphenicol, benzene, AZT, vinblastine
Myelofibrosis
Fanconi
Diamond-Blackfan
List all killed vaccines
“RIP-A”
Rabies
Influenza
Polio (IV)
What is Ki-67?
Communicates cell-to-cell to inform the rapid cellular division
(TNF is similar to alpha-macrophage 2/T cells)
Mitochondrial diseases (2)
Leber’s
- optic
- blind shortly after birth
Leigh’s
- chronically fatigued
- “Leigh’s wants to lay down”
Pre-sequence guides proteins where?
rER
Mannose-6-phosphate tag assets are sent where?
Lysosome
Stretchy skin
Velvety skin
Ehler’s Danlos
Cause of rice water or watery stool
Dx
(Name the only hormone one)
Secretory diarrhea
1) Vibrio cholera
2) ETEC
3) cryptosporidium
4) VIPoma (only hormone)
What is the first sign of diabetic nephropathy?
(Treatment?)
Microalbuminuria
ACE inhibitors or Ca channel blockers
Important lab markers for anemia of chronic diseases (3)
Hepicidin
- interferes w/ transferrin ability to absorb iron
Ferritin
- normal or increased
TIBC
- decreased
Free Radicals
- most common cause
- made by
- pathway
- MOA
- viral
- neutrophils
- NADPH oxidase
- perforates membranes
Cofactors of ribonucleotide reductase
(Shut off by what?)
NADPH
Thioredoxin
Shut off by: dATP
What is the treatment DOC for metastasis to brain or spinal cord (CNS)?
1) Pain medication
2) Dexamethasone
What pump or exchange resets the concentration gradient?
Na/K pump
(Phase 3)
Dx of fixed wide splitting S2
ASD
Blue sclera
Multiple fractures at birth
Osteogenesis imperfecta
Location of COX types
COX 1 - GI tract
COX 2 - Joints (and some 1)
COX 3 - vascular endothelium
What is the 2nd messenger of insulin and all growth factors?
Tyrosine kinase
(Interleukins can act as growth factors specifically IL3, IL4, IL5)
How does nitrous oxide decrease BP?
NO -> incr guanylate Cyclase -> incr cGMP -> dilates veins first -> dilates arteries later
What electrolyte has the most conductance at rest?
(Hint: who always has channels open)
Potassium (K)
X-linked dominant diseases (3)
Vitamin D resistant rickets
Pyruvate dehydrogenase deficiency
Pseudohypoparathyroid
Name an enzyme that uses 5 B vitamins
Dehydrogenase
B1 - TPP
B2 - FADH2
B3 - NADH
B4 - Lipoic acid
B5 - Acetyl CoA
Only pro-sequence not destroyed
(What hormone?)
C-peptide
Insulin
How many CCs/kg make up 1 unit of blood for a child?
20 cc/kg = 1 unit
What cofactor do kinases use?
Magnesium
What are the gain of function (enhancer) genes? (4)
BRAF
BCL2
Jun
KRAS
List all cyanotic heart disease in neonates
(hint: the 5 t’s)
Truncus arteriosus
Tricuspid atresia
Tetralogy of Fallot (most common)
Transposition of great arteries (most common)
Total anomalous pulmonary venous return (TAPVR)
Dx of Tri-phalangeal thumb/clover-leaf thumb (2)
Diamond-Blackfan syndrome
Edward’s syndrome (trisomy 18)
IL-1 is produced by (cell type)?
IL-1 causes what?
Produced by macrophages
Causes fever, nonspecific symptoms of illness, recruits T-helpers
Dx bilirubin attaches to basal ganglia
Kernicterus
Name 2 enzyme that use vitamin B12
Homocysteine methyl-transferase
Methylmalonyl CoA mutase
What is the underlying disease associated with sclerosing cholangitis?
Ulcerative colitis
Drugs to give in setting of an acute MI
1) morphine (Na channels -> decr pain)
2) Nitrates (stimulate NO -> vasodilates)
3) ASA (blocks COX 1 and COX 2)
4) Clopidogrel (blocks ADP receptor)
5) beta blockers (carvedilol, metoprolol, bisprolol-> decr mortality)
6) oxygen
7) heparin
8) tPA (= alteplase, plasminogen activator)
9) ACEi/ARBs
10) statins
Stop metformin
Stop CCBs
What are the encapsulated bugs that have IgA protease?
Strep pneumo
H influenzae
Neisseria catarrhalis
DOC for post-op urinary retention
Carbachol (= stimulate bladder emptying)
Bethanechol
DOC to challenge for diagnosis of asthma
Methacholine
What is first line antiemetic for children?
Promethazine
(Metoclopromide is 2nd)
What is first line antiemetic for adults?
Perchlorparazine
(Metoclopramide is 2nd.)
Key finding to differentiate anticholinergic from sympathetic
Anticholinergic -> NO sweating
Sympathetic -> sweating
How does the liver remove drugs?
Acetylation
What is the U wave on an EKG?
- what phase of action potential?
- What ion is moving and where?
- automaticity
- phase 4
- Na/Ca exchange
EKG findings for ventricular repolarization
- what part of EKG?
- What phase of action potential?
- What ion is moving and where?
- T wave
- phase 3
- potassium is moving out
EKG findings for ventricular contraction
- what part of EKG?
- What phase of action potential?
- What ion is moving and where?
- ST segment
- phase 2
- Calcium moving in
EKG findings for ventricular depolarization
- what part of EKG? Q? R? S?
- what phase of action potential?
- What ion is moving and where?
- QRS complex
Q -> septum
R -> anterior wall
S -> posterior wall - phase 0
- sodium moving in
EKG findings for atrial depolarization
- what part?
- what phase of action potential?
- What ion is moving and where?
- P wave
- phase 0
- calcium moving in
Dx (MCC) of paroxysmal supraventricular tachycardia in teenagers
Wolff-Parkinson-White
EKG finding = delta wave
d/t accessory pathway around the AV node
Drug contraindicated = Digitalis
- stimulates vagus -> slowing SA/AV conduction
What are the top antibiotics for babies?
1) Ampicillin/Gentamicin
2) Ampicillin/Ceftriaxone
What are the top 3 bacteria for babies?
1) Group B strep
2) E. coli
3) Listeria
Only antibiotic that cover staph epidermidis
Vancomycin
What is the PR interval?
Atrial conduction time
What is the PR segment of EKG?
AV nodal pause
or
Sustained atrial contraction
What controls the development of male genitalia?
- inner half
- outer half
- Müllerian Inhibiting Factor
- Testosterone
What is the main form of testosterone in women?
DHEA-S
(Dehydroepiandrosterone-sulfate)
DOC for prostate cancer
- MOA
Flutamide
- Blocks DHT receptors
Most common causes of sinusitis (5)
1) Allergies
2) Virus
3) S pneumo
4) H influenzae
5) N catarrhalis
DM -> Mucor, Rizor
What cancer can present with depression?
Pancreatic
Dx of cracked corneal lacerations
(Linear, branched)
Herpes
Keratitis
Avoid steroids
Dendrites
What is stress jaundice?
- unconjugated levels?
- conjugated levels?
Gilbert’s syndrome
- decreased conjugation
What brain changes are seen in schizophrenia?
Frontal Lobe changes
- loss of asymmetry
- enlargement in ventricles
What brain region should you suspect if deficiencies in hearing and balance?
Temporal lobe
(CNVII & CNVIII are found running through here)
DOC for temporal lobe seizures
Carbamazepine
(Na channel blocker)
- hallucinations precede seizures
Broad category of drugs that cause vertical or rotary nystagmus
- MOA
Amphetamines
- MOA: Taken up presynaptically causing release of catecholamines. Increase neurotransmitters specifically NE and DA
In the thalamus, all information labeled “medial” controls what?
Legs
Common causes of renal cell carcinoma
1) VHL
2) Tuberous sclerosis
3) Li Fraumeni
Changes due to chronic hypoxia
1) Mitochondrial density increases in muscles
2) angiogenesis
3) erythropoiesis
In the thalamus, all information labeled “lateral” controls what?
Arms
DOC for male patterned baldness
- MOA
Finasteride
- blocks 5-alpha reductase
What neurotransmitter causes hallucinations?
Dopamine
What neurotransmitter controls hallucinations?
Serotonin
What sensory information does not cross through the thalamus?
Olfactory nerve
What drug could take place of cortisol?
Hydrocortisone
What drug could take place of aldosterone?
Fludrocortisone
Dx of scaphoid abdomen and no bowel sounds on the left
Diaphragmatic hernia
(Will hear bowel sounds on chest exam)
What vitamin would you want to put polycythemia patients on?
Folate
(b/c they are making rapidly dividing cells)
Immunosuppressive actions of cortisol (5)
1) Kills T cells and eosinophils
2) inhibits phospholipase A
3) inhibits macrophage migration so body cannot process antigens
4) stabilizes endothelium, macrophages cannot enter tissues
5) stabilizes mast cells, so they cannot degranulate
Testosterone
- Made by:
- Stimulus:
- What it does:
- Where it goes:
- 2nd messenger:
- Misc syndromes:
- Made in: zona reticularis
- Stimulus: ACTH, GnRH -> LH -> testosterone
- What it does:
1) controls male external genitalia in utero
2) incr appetite, aggression, violence
3) incr libido
4) incr RBC count - Where it goes: testes, bone, muscle
- 2nd messenger: none
- Misc syndromes:
Adrenal insufficiency: too little
Hirsutism: too much
Physiological actions of cortisol
1) proteolysis: turning proteins into glucose (catabolic action)
2) gluconeogenesis
3) upregulates all receptors (permissive in stress)
Cortisol
- Made by:
- Stimulus:
- Inhibitor:
- What it does:
- Where it goes:
- 2nd messenger:
- Misc syndromes:
- Made by: zona fasciculata
- Stimulus: stress/hypoglycemia
- inhibitor: hyperglycemia
- What it does: upregulates ALL receptor during stress
- Where it goes: everywhere
- 2nd messenger: none
- Misc syndromes:
Adrenal insufficiency - too little
Cushing syndrome - too much
Aldosterone
- Made by:
- Stimulus:
- Inhibition:
- What it does:
- Where it goes:
- 2nd messenger:
- Made by: zona glomerulosa
- Stimulus: 1) hyperkalemia, 2) hypovolemia, 3) hyponatremia
- Inhibition: hypervolemia
- What it does: stimulate Na/K pumps & increase activity, 1) Na in with 3x H20, 2) K out, 3) H out
- Where it goes: late DCT, early collecting duct, ascending colon
- 2nd messenger: none
Erythropoietin
- Made by:
- Stimulus:
- Inhibition:
- What it does:
- Where it goes:
- 2nd messenger:
- Misc syndromes:
- Made by: renal parenchymal cells
- Stimulus: hypoxia
- Inhibition: increased O2
- What it does: stimulate erythropoiesis
- Where it goes: bone marrow
- 2nd messenger: tyrosine kinase
- Misc syndromes:
Gaisbock -> elderly
Stress & spurious polycythemia
Cancer associated with HPV
Squamous cell carcinoma of the cervix
Cancer associated with EBV
B cell lymphoma
Nasopharyngeal carcinoma
Cancer associated with schistosoma haematobium
Squamous cell carcinoma of the bladder
Cancer associated with aflatoxin
Hepatocellular carcinoma
Cancer associated with myasthenia gravis
Thymoma
t(15;17)
AML
t(11;22)
Ewing’s sarcoma
t(14;18)
Follicular lymphoma
t(8;14)
Burkitt’s lymphoma
t(9;22)
CML
Which duodenal hormone activates trypsinogen to trypsin?
Enterokinase
(Trypsin activates all other pancreatic enzymes)
Which duodenal hormones are purely inhibitory?
VIP
- released from Auerbach plexus
Somatostatin
- released from D cells
Which duodenal hormone decreases secretion of stomach acid?
GIP
- released from K cells
- enhances insulin release
Which duodenal hormone stimulates peristalsis?
CCK
- released from I cells
- increases gallbladder contraction
- increases release of digestive enzymes
- in pancreas, via IP3/DAG
Which duodenal hormone inhibits gastric and gastric emptying?
Secretin
- released from S cells
- increases bicarb
- in pancreas, via cAMP
4 causes of edema
- incr hydrostatic pressure
- decr oncotic pressure
- lymph obstruction
- endothelial damage
Dx of edema but liver and kidneys intact
(Classic clue of low albuminemia)
Menetrier’s disease
(Rare disease characterized by thick rugal folds.)
(Goblet cell hyperplasia d/t protein leaking out from GI tract.)
Gastritis: Location
- body & fundus?
- Antrum & duodenum?
- Type A
- Type B
Most common type of Gastritis
Type B
(~90% of cases)
Causes of Gastritis
- antibodies?
- breakdown in barrier?
Type A
- parietal cells -> gastric atrophy -> B12 deficiency
Type B
- breakdown in barrier production
- H pylori
Gastritis: cancer association
- adenocarcinoma
- MALToma
Type A
- associated with adenocarcinoma
Type B
- associated with MALToma
Gastritis: autoimmune cause
Antiparietal cell antibody
3 ways to protect the stomach
- mucus production from goblet cells protect from acid erosion of GI
- prostaglandin E secretion promotes mucus production
- HCO3 production from alkaline tide
Diseases that cause Heart Block
“LSD Loves Company”
- Legionella
- Salmonella
- Diphtheria
- Lyme disease
- Chagas’ disease
What is the most potent vasodilator in the lungs?
Oxygen
Flow (Q) is greater to the ___ (top/bottom) of the lungs because…
Increase at bottom b/c:
1) gravity
2) less resistance
3) more oxygen goes to the bottom of the lung with each breath
Dx of bag of worms in testicles
Epididymitis
-> pain improves with lifting
Varicocele
-> acute & recurrent
-> pain does not improve with lifting
Blood supply effected in medial medullary syndrome and symptoms
Occlusion of vertebral artery
Pyramid -> C/L spastic hemiparesis
CNXII -> tongue deviates towards the lesion
Blood supply effected in lateral medullary syndrome and symptoms
Occlusion of posterior inferior cerebellar artery (PICA)
Cerebellar peduncle -> ipsilateral limb ataxic
Descending hypothalamic -> ipsilateral Horner’s
Nucleus ambiguus -> dysphagia, CNIX & CNX
Blood supply effected in lateral pontine syndrome and symptoms
Occlusion of anterior inferior cerebellar artery (AICA)
CN VII -> ipsilateral facial paralysis
CN VIII -> hearing loss
Blood supply effected in medial midbrain syndrome and symptoms
(Weber)
Occlusion of posterior cerebral artery
Corticospinal tract -> C/L spastic hemiparesis of upper limb
CN III -> eye down and out
Corticobulbar tract -> lower face (C/L)
What cranial nerves cross the midline?
VIII (Facial)
- UMN innervations ONLY lower half of face on C/L side
- LMN innervates ENTIRE same side face
XII (hypoglossal)
- Tongue deviates towards the lesion if above nucleus
- If below nucleus, tongue deviates away
- IF intranuclear, tongue same side
Both sensory and motor cranial nerves
some say marry money But my Brother says Big Brains matter most
V (trigeminal)
- V1 (ophthalmic)
- V2 (maxillary)
- V3 (mandibular)
VII (Facial)
IX (Glossopharyngeal)
X (Vagus)
Only Motor cranial nerves
some say Marry Money but My brother says big brains Matter Most
III (oculomotor)
IV (trochlear)
VI (abducens)
XI (spinal accessory)
XII (hypoglossal)
Only Sensory cranial nerves
Some Say marry money but my brother Says big brains matter more
I (Olfactory)
II (Optic)
VIII (Vestibulo-cochlear)
Cranial nerves in medulla
IX (Glossopharyngeal)
X (Vagus)
XI (Spinal Accessory)
XII (Hypoglossal)
Cranial nerves in pons
V (Trigeminal)
VI (Abducens)
VII (Facial)
VIII (Vestibulo-cochlear)
Cranial nerves in midbrain
III (Oculomotor)
IV (Trochlear)
MOA of Plan B and Drug Name
Levonorgestrel
Large dose of progesterone
Followed by sudden withdrawal mimics end of cycle
Endometrial lining will slough off
What abortifacent blocks the progesterone receptor?
Mifepristone
Which hormone is responsible for a thick endometrial stripe?
Progesterone
How can you differentiate Androgen Insensitivity Syndrome (AIS) from 5-alpha reductase deficiency?
AIS has small breast
5-alpha reductase deficiency has more testosterone
-> thus complete suppression of breast development
What hormone inhibits ovulation?
Progesterone
(Incr progesterone inhibits LH via negative feedback)
What cancer frequency decreases with OCP use?
Ovarian cancers most common
-> serous cyst adenocarcinoma
(This stops ovary from cycling.)
Most common ovarian mass…
- mass
- tumor
- cancer
- mass: follicular cyst
- tumor: serous cystadenoma
- cancer: serous cystadenocarcinoma
During ovulation, what levels rise?
Which one first?
Why?
GnRH, FSH, and LH
LH because there is no feedback inhibition for first 10 days
Feedback inhibition by FSH inhibited by estrogen in first 10 days
These changes in Graafian follicle make which stage?
- cell division, no antrum
- small antrum
- large antrum
- primary
- secondary
- tertiary -> egg is off to one side, ready for ovulation
Dx of large soft boggy uterus on PE
Adenomyosis
Risk factor -> pt’s mother on diethylstilbestrol (DES)
Most common causes of heavy menstrual bleeding
(Anatomical)
Leiomyoma
Endometriosis
Adenomyosis
Most common causes of heavy menstrual bleeding?
(Overall)
Obesity (Adipose)
Fibroids = Leiomyoma
Endometriosis
Adenomyosis
What is the most common cause of painful pelvic pain in female of childbearing age?
Endometriosis
(Dx w/ laparoscopy showing -> chocolate cyst, powder-burn appearance)
Sequence of pubic staging
T (Thelarche)
A (Adrenarche)
P (Pubarche)
M (Menarche)
What bacterial membrane component is the most immunogenic?
Core antigen
- more variable
- different for every gram neg family member
If you want to add sugar, who is the carrier?
- one?
- couple?
- for one: UDP
- for a couple: Dolechol
What membrane component of bacteria causes toxicity?
Lipid A
What is the only gram pos but with an endotoxin?
None
(Used to be thought that Listeria monocytogenes but found to be wrong)
Describe the peptidoglycan walls of bacteria
- Gram Positive
- Thicker than gram neg walls
- minimum of 40 layers
- more likely to have an exotoxin
- has techoic acid
Describe the peptidoglycan walls of bacteria
- Gram negative
- thinner than gram pos walls
- only have 1 layer
- more likely to have endotoxin
- has a periplasmic space
- has Lipid A
Drugs that blast the bone marrow?
(Causing aplastic anemia)
Vinblastine (chemo for cancer)
AZT (old HIV drug)
Chloramphenicol (antibiotic at 50S)
Benzene (working in factory)
Dx of HCT >60%
Polycythemia Rubra Vera
- all cell lines increase but RBCs increase the most
- itching after hot bath
- uric acid stones
- splenomegaly
- elev LAP
Most common lymphoma
Follicular lymphoma
- Bcl-2 marker (enhancer)
- t(14;18)
What are the most malignant lymph nodes?
1) supraclavicular (Virchow)
2) Epitrochlear
3) Inguinal nodes
Dx of lymphoma with CD30 and CD is positive
Hodgkin lymphoma
Which lymphoma is equally present in men and women?
Hodgkin lymphoma
- Reed-Sternberg cells -> CD30, CD15 pos
- commonly begins as swollen lymph node
Dx of leukemia associated with DIC
Promyelobalst leukemia
- most common form is M3
- treat with vitamin A
Dx of TRAP pos
Hairy Cell Leukemia
- hair-like projections on the cell membrane
Drugs used on rapidly dividing cells
Anti-metabolites
Drugs used on slow-growing cells
Alkylating agents
Dx of: (only ask one)
- elev levels of neutrophils
- elev levels of monocytes
- elev levels of macrophages
CML
- t(9;22)
- BCR-abl
- age b/w 30-50y
- more common in women
Dx of Auer rods pos
(Stain pos w/ Sudan black)
AML
- t(15;17)
- age 15-30y
- more in boys
Dx of:
PAS pos
TdT pos
CALLA pos
ALL
- most common from 0-15y
- more in boys
What leukemia has the worst prognosis and why?
AML
- acts on both arms of the immune system
- myeloblasts give rise to:
- neutrophils -> B cells -> humoral response
- macrophages -> T cells -> cell-mediated
Most common symptomatic virus?
Adenovirus
MCC
- pulmonary
- UTI
- conjunctivitis
What cytokines causes weight loss?
TNF
Dx of leukocytosis w/ <5% blasts?
Leukemoid reaction
- trauma
- painful
Ex: MCV, burns, extreme stress
Dx of leukocytosis w/ >5% blasts?
Acute leukemia
What is indicated by a high procalcitonin?
Bacterial infection
Drugs that cause agranulocytosis?
Carbamazepine (temporal lobe seizures)
Ticlopidine (anti-platelet)
Clozapine
Most common cause of “-penia”?
1) viral
2) drugs
What is the main methyl donor?
SAM
Where are leukocytes found?
90% of leukocytes are marginated which means they are stuck along the sides of blood vessels (subendothelial)
Dx of:
1) fundus growing higher than predicted
2) hCG rising faster than predicted
3) HTN in 1st trimester
1) molar pregnancy
2) complete (46,XX) -> no fetal parts
3) incomplete (69,XXY) -> fetal parts
Human placental lactogen (HPL) effects
- elev most in 3rd trimester
- blocks mom’s insulin receptors
- creates insulin resistance
- gestational diabetes
Inhibin effects
- inhibits FSH
- prevents another menstrual cycle from beginning
Estrogen effects
- smooth muscle relaxation
- stimulates protein synthesis
- elev ESR, elev TBG (T4, T3)
- elev clotting factors
- elev angiotensinogen
- hyperlipidemia -> keep baby warm
- suppresses immune system
- autoimmune diseases will improve
Progesterone effects
- elev RR from pons
- incr appetite
- Pica
- incr RBC mass by 30%
- causes acne
- hyperpigmentation
- incr plasma volume via aldosterone
What controls the delivery of the placenta during stage 3 of delivery?
Prostaglandin F
- clamps down on vessels and responsible for separating the placenta
After implantation, what “-blast” belongs to:
- the baby
- the mother
- both (= placenta)
- baby = trophoblast
- mother = cytotrophoblast
- both = syncytiotrophoblast
Cell stages of fertilization and where in female?
- 2 cell
- 16 cell
- 256 to 512 cell
Zygote -> 2 cell stage
- 90% fertilizations occur in ampulla
- migrate into fallopian tubes
Morula -> 16 cell stage
- enters the uterus
Blastula -> 256 to 512 cell
- this is the stage that implants
Before sperm can leave, where does it stop and why?
1) seminal vesicles
- semen
- fructose
2) bulbourethral (Cowper) gland
- HCO3
3) prostate
- Zn (capacitation reaction)
- acid phosphatase
- hyaluronidase
Most common causes of PID
1) Chlamydia
2) Gonorrhea
- purulent
- Tx: ceftriaxone 500 mg
Dx of snowstorm appearance in uterus on U/S?
Molar pregnancy
After removal, there is a ball of grapes appearance:
- incr risk of choriocarcinoma
- concern for uterine invasion, if not removed
What is responsible for maintaining the blood-testes barrier?
- produces what?
Sertoli cells
- produces inhibin
- protect and nourish sperm to maturity
- protects sperm from lymphatic flow
Urease pos bugs
PPUNCH SB
- proteus
- pseudomonas
- ureaplasma
- nocardia
- cryptococcus
- H pylori
- staph saprophyticus
- brucellosis
Acute bacterial endocarditis
- organism?
- valve?
- Staph aureus
- tricuspid regurgitation
Subacute bacterial endocarditis (SBE)
- organism?
- valve?
- strep viridans
- mitral valve prolapse
What are the filamentus organism?
How to differentiate?
Actinomyces
- gram pos
- lumpy jaw
Nocardia
- partially acid fast
What is the drug of choice for vancomycin resistance?
MOA?
Linezolid
MOA: binds to 50S subunit
Type of bacterial adaption using a…
- phage?
- plasmid?
- pili?
Phage -> transduction (90%)
Plasmid -> transformation (healthcare setting)
Pili -> conjugation (close proximity)
Most common cause of skin infections?
- gram stain?
- oxygen?
1) Staph aureus
2) strep pyogenes (except its #1 in UNES)
- lymphangitis
- impetigo
- necrotizing fasciitis
- erysipelas
- scarlet fever
Gram pos aerobic except propionibacterium acne which is gram pos anaerobe
What type of rejection would you see an inflammatory response that involves only T suppressor cells?
Graft vs Host
- very rare
- occurs almost exclusively
- after a bone marrow transplant
- presents w/ painful rash
With what type of rejection would you see fibrosis?
Treatment?
Chronic rejection
- irreversible, therefore you have to remove and start over
With what type of rejection would you see T lymphocytes and macrophages?
Treatment?
Acute rejection
Prednisone, cyclosporine, anti-lymphocytic antibodies, or tyrosine kinase inhibitors
What type of rejection is due to preformed antibodies?
Test to prevent?
Timeframe?
Hyperacute rejection
Cross match test
Occurs w/in 12 hours
(1st change is swelling)
Function of the complement system
Responsible for coating and destroying encapsulated organisms
Gram pos: strep pneumo
Gram neg: pseudomonas, salmonella, Klebsiella, H influenzae, citrobacter, neisseria meningitidis
You can only have Rh incompatibility disease if mom is what?
ONLY if mom is negative and dad is positive
Which complement member can cause angioedema?
C5a
(Can produce a localized anaphylaxis called angioedema)
- Due to C1-esterase inhibitor deficiency
- recurrent facial swelling
What are the most important opsins?
IgG
IgM
C3b - only one in complement system
What is an opsin?
Which is the only member of the complement system that acts as an opsin?
Opsins can coat the capsule so that the macrophages can phagocytize the capsule easily
C3b
Which antibody can fix the most complement?
IgM
Fixing 2 complement molecules on each of 5 arms
Examples of T1 HSR
Anaphylaxis
Urticaria
Steven Johnson syndrome
Erythema multiforme
What hypersensitivity has no complement involved?
Type 1
IgE does not fix complement
What drug can destroy CD3?
Muronamab
Used in T cell lymphomas
What cells are CD16 and CD56 pos?
NK cells
- do not go through clonal deletion
- responsible for immunosurveillance
- can detect cancer at the one cell stage
How do CD4 cells communicate with B cells?
With macrophages?
- CD40 ligand
- B7/CD28 molecule
What are the immunoprivileged sites?
(No lymphatics running through them)
Brain
Thymus
Cornea
Testicle
What antibody targets the Fc portion of IgG?
Disease?
New Marker?
Rheumatoid factor
Rheumatoid arthritis
Anti-citrullinated antibody
Why are alcoholics considered immunocompromised?
Alcohol breaks down disulfide bonds.
There are a lot of disulfide bonds in antibodies, meaning no antibodies.
What are the amino acids that make an active site?
Glutamate
Histidine
Serine
What antibodies have memory?
IgA in secretions/mucosal surfaces
IgE in allergies
IgG in blood (memory)
- highest affinity
- arrives in 3 days
- peaks at 5 years
- lasts for 10 years
Timeline
- first antibody made?
- class switching time?
- 2nd antibody made?
- memory response start?
- fully developed?
IgM
6 months
IgG
12 months
15 months
What antibody can start being made at:
- 6 months?
- arrives in?
- peaks in?
- lasts for?
Primary IgG
- class switching starts at 6 months
- arrives in 2 weeks
- peaks in 2 months
- lasts for 1 year
What is the first antibody made?
- arrives when?
- peaks in?
- lasts for?
IgM
- arrives in 3 days
- peaks in 2 weeks
- lasts for 2 months
ONLY antibody produced in a newborn until 6 months
What is needed to stimulate B cells?
Endotoxin
Pokeweed mitogen
Add labeled thymidine
What B cell stage of development is it if you see IgM and IgD on their surface?
Mature B cell
(You need your MD to go to work.)
Now a plasma cell can produce antibodies.
What B cell stage of development is it if you see IgM on the surface as a monomer?
Immature B cells
Interleukin responsible for class switching?
Exception? (And it’s IL)
IL-4
(2nd messenger is tyrosine kinase b/c it is a growth factor)
IL-5
(Class switching of IgA only)
What is the most potent interleukin?
Function?
Drug?
IL-2 -> recruits everybody
Daclizumab -> antibody against IL-2
(Used in transplants to prevent rejection)
What cells are involved in germinal cell hyperplasia?
What immune response?
What infections?
B cells (this where they differentiate)
Humoral immune (patrols blood)
Protects against bacteria
What B cell stage of development is it if you see Mu chains?
In cytoplasm?
Pre-B
What cells are involved in lymphoid tissue hyperplasia?
What immune response?
What infections?
T cells (this where they differentiate)
Cell-mediated (patrols tissues)
Protects against viruses, fungi (everything except bacteria)
Causes of eosinophilia
NAACP
- neoplasias, especially lymphoma
- allergies
- addison’s disease
- collagen vascular diseases
- parasites
Which H2 blocker is associated with colon cancer?
Ranitidine
Which H2 blocker blocks p450 ?
Cimetidine
(Incr estrogen causing gynecomastia)
What enzyme is needed to make any fluid in body?
(And what is the drug that blocks it?)
Carbonic anhydrase
Acetazolamide
What is most severe bronchoconstrictor?
(What is drug to stop?)
(What is enzyme to stop?)
SRS-A = slow-reacting substance of anaphylaxis
Most potent bronchoconstrictor and vasoconstrictor
Drug to stop? Steroids
Enzyme to stop? Arylsulfatase
What is the 1st antibody made by B cells?
In allergies?
IgM
Can only get IgE from IgM from class switching
Most common cause of monocytosis
Monocytosis >15%
- salmonella
- tuberculosis
- EBV (anti-heterophile pos)
- CMV (anti-heterophile neg)
- listeria
- syphilis
What does a CD14 marker indicate?
Macrophages
(Which are monocytes that have now entered into tissues)
(Mediated by interferon gamma)
What does a CD4 marker indicate?
Monocytes
(Which are in circulation)
Clues to anaerobic infections
Malodorous smell
Gas formation
-> on imaging: “fluid-gas levels” or “air-fluid levels”
What is the antibiotic of choice…
- above the diaphragm?
- below the diaphragm?
- clindamycin
- metronidazole
Abscess culture bacteria?
Day 1-3
Day 3-7
After day 7
Staph aureus
Strep pyogenes
Anaerobes
What is the most abundant granulocyte?
Neutrophils
- arrive: 4.5 hours
- predominate: 24 hours
- peak at: 3 days
Contains myeloperoxidase and NADPH oxidase
What bacteria stain with Ziehl-Neilson (acid-fast)?
Completely acid fast:
- mycobacterium
Partially acid fast:
- gram pos -> Nocardia
- Protozoa -> cryptosporidium
What are the important catalase positive bacteria?
Staph aureus
Pseudomonas
Neisseria
Listeria
In what phase of the bacterial life cycle is the most endotoxin released?
Except?
Decline phase
Except Neisseria meningitidis
- endotoxin released in log phase
What is the only bacteria that releases endotoxin while dividing?
What phase?
Neisseria meningitidis
Log phase
(B/c it has the largest capsule)
“Neisseria is not so nice”
What is a gram pos anaerobe?
Propioniobacterium acne
What constipation meds promote peristalsis?
Bisacodyl
Dulcolax
What diseases affect the apex of the heart?
Takotsubo cardiomyopathy
Chagas’ disease
Dx of only Gram neg pleomorphic rods
Hemophilus
(Also described as a school of fish)
What are the encapsulated bugs that have IgA protease?
Strep pneumo
H influenzae
Neisseria (Moraxella) catarrhalis
Influenza (virus)
Dx of gas gangrene
Clostridium perfringens
(Associated with holiday ham or turkey)
(Increased risk in diabetics)
Dx of GI upset within 8 hours of eating fried rice
Bacillus cereus
- self-limiting
- hydration
Dx of Wool Sorters’ Disease
- membrane component?
- contains what toxins?
Bacillus anthracis (anthrax)
- membrane -> poly D-Glu
- toxins
1) lethal factor
2) edema factor
3) protective factor
How do you remove spores?
Autoclave
(121 C vaporized heat for at least 15 minutes)
What bacteria are spore farmers?
“Be Careful of spores”
- Bacillus
- Clostridium
Dx of bacteria that has a toxin the ADP ribosylates EF2
- Corynebacterium diphtheriae
- Pseudomonas aeruginosa
What bacteria looks like Chinese letters?
Corynebacterium Diphtheriae
What is the only Gram pos cocci in clusters?
Staphylococcus family
- Aureus -> coag pos, gold pigment
- Epidermitis -> white pigment
- Saprophyticus -> no pigment
Enzymes
- Catalase -> separates strep
DA-CEP
What are the bacteria that are ADP-ribosylators?
EF 2
- Diphtheria
- Aeruginosa
G subunit
- Cholera (Gs)
- E. coli = ETEC (Gs)
- Pertussis (Gi)
Which hepatitis B serum marker shows up first?
Abbreviation?
Core antigen (HBc)
Rises & falls before any symptoms arrive
Which hepatitis B serum marker is indicative of vaccination?
Abbreviation?
Surface antibody (anti-HBs)
Which hepatitis B serum marker(s) indicate immunity?
Abbreviation?
Surface antiBODY (anti-HBs)
Core antiBODY (anti-HBc)
Which hepatitis B serum marker(s) indicate a previous infection?
Abbreviation?
Core anti-BODY (anti-HBc)
Does it go away?
Once positive, it’s present for life, so it alone does NOT indicate a current infection, only previous infection
Which hepatitis B serum marker(s) indicate a current infection?
Abbreviation?
Surface antiGEN (HBsAg)
- infective antigen
Core antiBODY (anti-HBc)
Which hepatitis B serum marker(s) indicate the window period?
Abbreviations?
Core antiBODY (anti-HBc)
Which hepatitis B serum marker(s) indicate infectivity?
Abbreviations?
Hepatitis envelope antigen (HBeAg)
What stage of hepatitis B?
- pos HBsAg >6mo
- neg active inflammation
- neg fibrosis
Transmission risk?
Chronic carrier state
Yes, still pose a threat to others b/c pos HBsAg, which is the infective antigen
What stage of hepatitis B?
- pos anti-HBs
- pos HBsAg
- pos anti-HBc
- pos HBeAg
- pos symptoms >6 mo
- pos active inflammation
- pos fibrosis
Transmission risk?
Chronic Active Hepatitis
Transmission: yes, has both
HBeAg and HBsAg
Incr risk of cancer & cirrhosis
Treatment: interferon & lamivudine
What stage of hepatitis B?
- neg HBeAg
- pos anti-HBc
- neg active inflammation
- neg fibrosis
- pos elevated liver enzymes >6 mo
Transmission risk?
Chronic persistent hepatitis
Transmission: No, b/c no HBsAg or HBeAg
How would you differentiate chronic hepatitis C from active vs persistent?
Treatment?
Chronic Active Hep C
- pos inflammation
- pos fibrosis
- incr risk cirrhosis & cancer
Treat: Ledipsavir/sofosbuvir combo
Chronic Persistent Hep C
- elevated liver enzymes or persistent symptoms >6 mo
- neg inflammation
- neg fibrosis
Why does hepatitis D require coinfection with hepatitis B?
Hep D uses Hep B surface antigen
Which hepatitis is associated with shellfish?
Hepatitis A
- RNA picornavirus
- Councilman bodies on liver biopsy
Which hepatitis is associated with high mortality in pregnant women?
Hepatitis E
- RNA HepEvirus
Which hepatitis is the only DNA virus?
Hepatitis B
- DNA hepadnavirus
Most common viral cause of myocarditis and pericarditis?
Coxsackie B
Myo
- leads to loss of contractility (S3 murmur)
- diffuse ST depression
Peri
- causes friction or triphasic rub
- may lead to cardiac tamponade
- diffuse ST elevation
Most common viral cause of gastroenteritis
- adults
- children
- recent travel
Adenovirus
Rotavirus (not immunized)
Norovirus (immunized)
Norwalk agent
Most common causes of cystitis
Adenovirus
- virus always #1
E. coli
Proteus
Klebsiella
Most common viral cause of bronchiolitis/croup
Most severe viral cause of bronchiolitis/croup
Other viral causes
Parainfluenza (80%) - mild
RSV (15%) - severe, hospitalized
Adenovirus and influenza
What are the infections that cause cold agglutination?
(Elev IgM titers)
Cryoglobulinemia
“I AM HE”
- Influenza
- Adenovirus
- Mycoplasma
- Hepatitis B & C
- EBV
Viral causes of encephalitis
Arboviruses
- Birds -> Mosquito -> Human
- St Louis encephalitis
- Equine Eastern Encephalitis
*More E’s = more fatal
Herpesvirus
- prefers temporal lobe
Identify the meningitis
1) pos proteins, neutrophils, decr glucose
2) pos proteins, T cells and macrophages, decr glucose
3) pos proteins, T cells and macrophages, norm or elev glucose
1) Bacterial
- strep pneumo
- strep agalactiae
- N meningitidis
2) TB/Fungal
- coccidiodomycosis
- cryptococcus neoformans
3) Viral (aseptic)
- enterovirus
- picorna
Common cold causes and how to differentiate
Rhinovirus -> nose only
Coronavirus -> spring/summer
Adenovirus -> fall/winter
- conjunctivitis
- swimming pool
Herpesvirus -> attacks cornea and gums
Influenza virus -> Nov-Feb Cryoglobulinemia
Parainfluenza -> barking cough
MCC of bacterial meningitis
- 0-2 months
- 2 months - 10 years
- 10-21 years
- >21 years
- immunocompromised
- strep agalactiae
- strep pneumo
- strep meningitis
- strep pneumo
- cryptococcus neoformans (presence of lymphocytes)
Dx of painful ulcers in back of mouth, soles of feet, and palms
Coxsackie A
Hand-Foot-Mouth disease
Dx associated with a rash that presents as a red macule THEN clear vesicles THEN pustules and THEN scarring
Varicella
Chicken pox
Very itchy
Incr risk of skin infection
-> d/t scratching
1) staph aureus
2) strep pyogenes
Dx that presents as RA but resolves 2 weeks later
Parvovirus B19
- Fifth disease
- Aplastic anemia
- red lacy rash appearance on cheeks (= slapped cheeks)
Rubella
(3d measles)
- lymphadenopathy behind ears and neck
- morbilliform rash
Dx of morbilliform rash
(Flat, red/pink spots that merge and become raised)
Rubeola
(2w measles)
- 3 C’s: cough, coryza, conjunctivitis
- Koplik spots
- SSPE
Rubella
(3d measles)
- lymphadenopathy behind ears and neck
Dx of a collection of melanocytes in sacral area
Mongolian spots
- normal in people of color
- typically self resolve after a couple months
- or persists without complications
Dx of Café au lait spots
Can be normal and resolve shortly after birth
Or rule out:
- neurofibromatosis type 1
(Chr 17, AD)
(Pigmented iris hamartomas, optic glioma, pheochromocytoma, seizures)
- McCune Albright Syndrome
(Gs protein activating mutation)
(Unilateral café au lait spots & at least one endocrinopathy)
Dx of a Port Wine stain
Can be normal and resolve shortly after birth
Or
Sturge-Weber
- congenital anomaly of neural crest derivatives
=> capillary vascular malformations in CN V1/V2 distribution
- angiomas in retina and brain
Dx of childhood infection if the rash comes AFTER fever
What type?
Roseola
HHV6
Exanthem subitum -> asymptomatic rose-colored macules on body
Dx associated with dermatitis herpetiformis?
Antibody?
Celiac sprue
Tissue transglutaminase (anti-TTG)
Dx of stridor and barking cough
AND/OR
Steeple sign on neck film
Parainfluenza (80% - mild)
RSV (15% - severe)
- hospitalized
Adenovirus
Influenza virus
Bacteria causing bloody diarrhea (3)
Shigella (inflammatory)
Yersinia (inflammatory)
EHEC (non-inflammatory)
(Inflammatory = pos leukocytes in stool)
