pass program clues - webs · 6/21/2012 1 pass program clues “you ain’t told me squat till you...

www.karanja-githua.kbo.co.ke 6/21/2012

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PASS PROGRAMCLUES

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

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

• Lets Stop Doing Long Contractions

What bacteria cause Reiter’s Syndrome?

• Shigella• IBD

• Crohn’s

• Chlamydia• Yersina

• Reiter & Crohn Saw Yersina and got Chlamyia

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

• I AM HE

What are the drugs induced SLE?

• Hydralazine

• INH

• Phenytoin

• Procainamide

• Penicillamine

• Ethosuximide

• H I PPPE

What are the drugs that Blast the BM?

• AZT• Benzene• Chloramphenicol• Vinblastine

• Vinblastine Anilate Bone Cells


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

• Campylobacter Has Very Long Comma Genes

What is the cresent shaped protozoa?

• Giardia lamblia

What bacteria looks like Chinese letters?

• Corynebacter

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

• R E S P I

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

What drugs Induce p450?

• BAG 4 CPR QTS• Car Grabs Queens Tets to

Rev Up • Alcoholic doing drugs and

stinking up car

• Barbiturates

• Alcohol

• Griseofulvin

• Carbamazapine

• Rifampin

• Quinidine

• Tetracycline

• Sulfa drugs


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What drugs Inhibit p450?

• I Do SMACK Quinolones

• INH

• Dapsone

• Spirolactones

• Macrolides

• Amiodarone

• Cimetidine

• Ketoconazole

• Quinilones

What drugs are P450 Dependent?

• Warfarin

• Estrogen

• Phenytoin

• Theophylline

• Digoxin

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

What disease is a Neutophil Deficiency?

• CGD

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

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

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


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

What are the 4 hormones with disulfide bonds?• Prolactin • Insulin• Inhibin• GH

• I PIG on BONDS

What are the Hookworms?

• Necatur americanis

• Enterobius vermicularis

• Ankylostoma duodenale

• Trichuris trichurium

• Ascaris lumbercoides

• Strongyloides

• Hooks AS NEAT

What are the X-Linked enzyme Deficiencies?• G6-PD

• CGD

• Pyruvate dehydrogenase Def.

• Fabry’s

• Hunter’s

• Lesch-nyhan

• Lesch-Nyhan Hunter Puts Fabrys on G6 Clothes

What diseases do we screen for at birth?

• Please

• Check

• Before

• Going

• Home

• PKU

• CAH(Congential Adrenal Hyperplasia)

• Biotinidase

• Galactosemia

• Hypothyroidism

HLA-Antigens• HLA-DR2= Narcolepsy, Allergy, Goodpasture’s, MS

• HLA-DR3= DM, Chronic Active Hepatitis, Sjogren’s, SLE, Celiac Sprue

• HLA-DR3 & 4= IDDM(Type I)• HLA-DR4= Rheumatoid Arthritis, Pemphigus Vulgaris

• HLA-DR5= JRA, Pernicious Anemia• HLA-DR7= Nephrotic Syndrome(Steroid induced)


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HLA-Antigens• HLA-DR 3 & B8=Celiac Disease• HLA-A3= Hemochromatosis(chromo. 6, point mut.-cysteine>tyrosine)

• HLA-B8=MG• HLA-B13= Psoriasis• HLA-B27= Psoriais(only if w/arthritis) Ankylosing Spondylitis, IBD, Reiter’s, Postgonococcal Arthritis

• HLA-BW 47= 21 alpha Hydroxylas def.(Vit.D)

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

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

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

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

What is the one dose treatment for Chlamydia?• Azithromycin


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What are the “Big Mama” anaerobes?

• Strep bovis• Clostridium melanogosepticus• Bacteriodes fragilis

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

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

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

• Na+?• Decreases

• Cl-?• Decreases

• pH?• Increases

• BP?• Increases

What are psammoma bodies?• Calcified CA’s

In what diseases are Psammoa Bodies present?• Papillary carcinoma of the Thyroid• Serous cystadenocarcinoma of the ovary• Meningioma• Mesothelioma


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

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

What type of motility do Proteus have?

• swarming

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

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

What drug is used to tx cardiac fibrosis?

• Dozaroxsin


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

What is seen in the Salmonella Triad?

• High Fever• Rose spots (rash)• Intestinal fire

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

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

• Salmonella

• Strep. Pneumo (gr+)

• Klebsiella

• H. influenza

• Pseudomonas

• Neisseria

• Cryptococcus

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

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


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What are the Risk Factors for Liver CA?

• Hep B,C,D• Aflatoxin• Vinyl chloride• Ethanol• Carbon Tetrachloride• Anyline Dyes• Smoking• Hemochromatosis• Benzene• Schistomiasis

What are the 9 Live Vaccines?• Measles• Mumps• Rubella• Oral Polio (sabin)• Rotavirus• Small pox• BCG• Yellow fever• Varicella

What are the Killed Vaccines?

• SIR Hep A • Salk (polio)

• Influenza

• Rubella

• Hepatitis A

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

What are the Drugs that cause Autoimmune hemolytic anemia?• PCN

• α-methyldopa

• Cephalosporins

• Sulfa

• PTU

• Anti-malarials

• Dapsone

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


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

What is the first MI enzyme to appear?

• Troponin I

• Appears

• Peaks

• Gone

• 2 hrs

• 2 days

• 7 days

What is the 2nd MI enzyme to appear?

• CK-MB

• Appears

• Peaks

• Gone

• 6 hrs

• 12 hrs

• 24 hrs

What is the 3rd MI enzyme to appear?

• LDH

• Appears

• Peaks

• Gone

• 1 day

• 2 days

• 3 days

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

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


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What is another name for celebrex?• Celecoxib

What type of inhibitor is Celebrex?• COX 2 specific

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

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

What drugs cause Pulmonary Fibrosis?

• Bleomycin• Bulsufan• Amiodarone• Tocainide

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


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What are the SE of Loops and Thiazides?

• Hyperglycemia• Hyperuricemia• Hypovolemia• Hypokalemia

What are the SE of Loop diuretics?

• OH DANG • Ototoxicity

• Hypokalemia

• Dehydration

• Allergy

• Nephritis (interstitial)

• Gout

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

• TR

• VSD

• Decrease on inspiration (^exp)

• Increase on inspiration

• Decrease on inspiration (^exp)

Macrophages in various organs• Brain• Lung• Liver• Spleen• Kidney• Lymph nodes• Skin• Bone• CT

• Mircoglia• Type I pneumocyte• Kupffer cell• RES• Mesangial• Dendritic• Langerhans• Osteoclasts• Histiocytes or• Giant cells or • Epithelioid cells

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

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


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

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

What is the clue for cGMP?• Parasympathetic• Anabolic

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

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

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


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

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

What are the T & B cell deficiencies?

• WAS • SCID• CVID• HIV• HTLV-1

What are the CLUES for WAS?• Thrombocytopenia• IL-4• Infection• Eczema• Decrease IgM• IgE???

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

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


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What are the CLUES for HIV & HTLV-1?

• T-cell>B-cell• CD4 rich• Brain• Testicles• Cervix• Blood vessels

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

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

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

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

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


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What are the ETC chemical uncouplers?

• DNP• Free Fatty acids• Aspirin

What type of uncoupler is Aspirin?• Physical uncoupler

What are the 4 sources of Renal Acid?

• Plasma• Urea cycle• Collecting ducts• Glutaminase

What is the one dose tx for Hemophilus ducreyi?• Azithromycin

1 gram po• Ceftriazone

250 mg im

What is the one dose tx for Chlaymdia?

• Azithromycin1 gram po

What is the one dose tx for Candidiasis?

• Ketoconazole150mg


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

1 pill

What is the one dose tx for Trichomonas?

• Metronidazole2 grams

What is the one dose tx for Gardnerella?

• Metronidazole2 grams

What are the 3 cephalosporins & doses used as one dose treatments for Gonorrhea?• Ceftriaxone

250 mg im• Cefixime

400 mg po• Cefoxitin

400 mg po

What are the 3 Quinolones & doses used as one dose treatments for Gonorrhea?• Ciprofloxacin

500 mg po• Ofloxacin

400 mg po• Gatifloxacin

400 mg im

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


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

What are the branching enzymes?• Glycogen alpha-1,4 glycosyl transferase• Glycogen alpha-1,6 glycosyl transferase

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

What values do you see in obstructive pulmonary dz?• pO2?

Normal• pCO2?

Normal or increased• pH?

Decreased

What values do you see in restrictive pulmonary dz?• pO2?

Decreased • pCO2?

Decreased • pH?

Increased

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


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What are the Lysosomal Storage Disease & what is the deficiency?

• Fabry’s• Krabbe’s• Gaucher’s• Niemann – Pick• Tay-Sachs• Metachromatic

leukodystrophy• Hurler’s• Hunter’s

• α – galactosidase• Galactosylceramide• β – glucocerebrosidase• Sphingomyelinase• Hexosaminidase• Arylsulfatase• α – L – iduronidase• Iduronidase sulfatase

What dz’s are associated with HLA B27?

• Psoriasis• Ankylosing spondylitis• IBD (Ulcerative colitis)• Reiter’s Syndrome

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

What are the Glycogen Storage Diseases & the deficiency?

• Von Gierke’s

• Pompe’s

• Cori’s

• McArdle’s

• Glucose – 6 – phosphate

• α – 1 – 4 glucosidase

• Debranching enzyme

• Glycogen phosphorylase

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

• Acetyl CoA ? • Phenylalanine• Isoleucine• Threonine• Tryptophan• Lysine• Leucine

What are 6 places of the TCA cycle where amino acids feed in/out?

• Alpha-KG ?

• Glutamate

• Glutamine

• Succinyl CoA?• Phenylalanine

• Tryptophan

• Tyrosine


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What are 6 places of the TCA cycle where amino acids feed in/out?

• Fumerate ?• Proline

• Oxaloacetate?• Aspartate• Asparigine

What are the 4 steps of B-oxidation?

• Oxidation – 7 NADH – 21 ATP• Hydration• Oxidation - 7FADH – 14 ATP• Thiolysis – 8 AcCoA – 96ATP

131 ATP – 2 (to bring it in)

What are the blood gases in neuromuscular disease (= restrictive blood gases)?• pO2?

Decreased• pCO2?

Decreased• PCWP?

Decreased (b/c it’s a pressure problem)

• Respiratory Rate?Increased

• pH?Increased

• SZ?Increased

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

What Autoimmune Disease has the following Autoimmune Antibodies?

•Anti-smith •Anti cardiolipin •Anti-ds DNA

•SLE

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

• Drug induced SLE


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What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-topoisomerase?

• PSS (Progressive Systemic Sclerosis)

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

• Graves

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

• CREST

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

• Goodpasture’s

What does Goodpastures have antibody to?• Type IV collagen

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

• Primary biliary cirrhosis


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

• Alopecia areata

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

• Rheumatoid arthritis

What Autoimmune Disease has the following Autoimmune Antibodies?

• Anti-myelin receptors?

• MS

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

• Celiac sprue

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

• DM Type I

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

• Viteligo


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

• MG

What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-ribonuclear protein?

• Mixed Connective Tissue dz (MCTD)

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

• Pernicious anemia

What does Pernicious Anemia have antibody to?• Intrinsic factor

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

• Pemphigus vulgaris

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


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

• Bullous pemphigoid

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

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

• ITP

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

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

• Hashimoto’s

What Autoimmune Disease has the following Autoimmune Antibodies?• Anti-smooth muscle?• Anti-scl-70?

• Scleroderma


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

• Sjogren’s

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

• Wegener’s

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

• Polyarteritis nodosa

What antigen & immunoglobulin is Polyarteritis nodosa associated with?

•Hepatitis B antigen•IgM

What are the viruses that directly cause CA and which CA do they cause?• Papilloma virus ?Cervical CA

• EBV?BurkittsNasopharyngeal CA

• HepB & C ?Liver CA

• HIV? Kaposi’s Sarcoma

What are the 7 Nephrotic Patterns seen with every Vasculitis?• Clot in front of renal artery?

Renal artery stenosis • Clot off whole renal artery?

Renal failure• Inflamed glomeruli?

Glumerulo nephritis• Clot in papilla?

Papillary necrosis • Clot off medulla?

Interstitial nephritis • Clot off pieces of nephron?

Focal segmental GN (HIV, drug use association)• Clot off lots of nephrons?

Rapidly Progressive GN


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

•2 wks post URI

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

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

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

What is the most common renal mass?

• Cyst

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


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

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

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

• Drip?• 40mg

What is the dosage for Streptokinase?

• IV push?• 750K

• Drip?• 750K

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

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


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

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

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

severe eosinophilia

What is Loffler syndrome also known as?

• PIE syndrome

What are the 5 Parasites associated with Loffler Syndrome?•Necator americanus•Ankylostoma duodenale

•Shistosomiasis•Strongyloides

•Ascaris lumbricoides

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

•Immunocompromised


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

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

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

•DM•Neutropenic patients

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

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

What are causes for a widened S2 splitting?

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


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

What is the special list for Penicillin?

• Gram +

• Basement membrane suppressor

• Works on simple anaerobes

• The #1 cause of anaphylaxis

• Causes interstial nepritits

• Causes nonspecific rashes

• Acts as a hapten causing hemolytic anemia

What is the #1 cause of anaphylaxis?• Penicillin

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

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

replication

What are the clues for positive stranded RNA?• Symptoms within 1 week or less • EXCEPTIONS: • Hanta• Ebola• Yellow fever• They are -ve stranded = don’t have to switch to positive before replicating


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What are the Most common cyanotic heart diseases?• Transposition of the great arteries• Tetrology of Fallot• Truncus Arteriosus• Tricuspid Atresia• Total anomalous pulmunary Venous Return

• Hypoplastic Left heart syndrome• Ebstein’s anomaly• Aortic atresia• Pulmonary atresia

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

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

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

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

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


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

What are the 7 B-cell deficiencies?• Bruton’s agammaglobulinemia• CVID (Common Variant Imm. Def)• Leukemias• Lymphomas• SCID• WAS• Job Buckley Syndrome

What is the Tyrosine kinase deficiency?

• Bruton’s agammaglobulinemia

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

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

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

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

• N-myc?• Neuroblastoma • Small cell lung CA

• C-able?• CML • ALL


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

• C-sis ?• Osteosarcoma• Glioma • Fibrosarcoma

Tumor Markers/Oncongenes III

• C-erb B2?• Epidermal growth factor receptors

• CSF-1 ?• Breast

Tumor Markers/Oncongenes IV

• Erb-B2?• Breast CA• Ovarian CA• Gastric CA

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

Tumor Markers/Oncongenes V• Ki-ras?• Lung CA• Colon CA

• Bcl-2?• Burkitts• Follicular lymphoma

• Erb?• Retinoblastoma

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

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


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What is cancer staging?• Degree of dissemination of tumor• What the surgeon sees

What are the rashes associated with cancer and what cancer are they associated with?• Urticaria/Hives?• Any CA, especially lymphoma• Pagets Ds (ulcers around nipples)

• Seborrheic keratosis (waxy warts)?• Colon CA • HIV if sudden increase in number • Normal with aging

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

• Actinic keratosis?• Dry scaly plaques on sun-exposed skin

• Squamous Cell CA of skin

• Dermatomyositis?• violacious, heliotropic rash, malar area

• Colon CA

What are the rashes associated with Cancer and the cancer they are associated with?• Akanthosis nigricans?

• dark lines in skin folds• Any visceral CA• End organ damage

• Erythema nodosum?• ant aspect of legs, tender nodules

• Anything granulomatous• NOT assoc. w/ bacteria

What is carried by HDL?• Apo E• Apo A• Apo CII

• L-CAT • lecithin cholesterol acetyl transferase

• Cholesterol• from periphery to liver

What is carried by VLDL?

• Apo B-100

• Apo E

• Apo C II

• Triglcyerides (95%)

• Cholesterol (5%)


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What is carried by IDL?• Apo B-100• Apo E• Apo CII

• Triglycerides (< VLDL)• Cholesterol (>VLDL)

What is carried by LDL?• Apo B-100

• Cholesterol• from liver to tissue

• NOT a good thing!!!!!

What do chylomicrons carry?• Apo A• Apo B-48• Apo E• Apo C II

• Triglycerides from:• GI to liver (25% of the time)• GI to endothelium (75% of the time)

Which lipoprotein carries the most cholesterol?

•LDL

Where are the AVMs?• Clue = HEAL• Heart?• Machinery murmur

• Elbow?• Fistula from dialysis in renal disease

• Abdomen/Brain?• Von Hippel-Lindau = clot off with coils• Increase incidence of Renal cell CA on chrom 3

• Lungs?• Osler Weber Rendu Syndrome

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


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

What 2 diseases is pilocarpine used for?• CF• Glaucoma

• Painful, red, teary eye

What is dysguzia?• Problem with sense of taste

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

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

What do you measure for carcinoid syndrome?• Serotonin

• 5-HIAA


37

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

What are the phage mediated toxins?• Mnemonic : BEDS• Botulinum• Erythrogenic toxin

• from strep pyogenes

• Diptheria• Salmonella

• Has O antigen

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

REO to kill SEGMENTED WORMS

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

What does IgCam do?• Bind proteins

What do integrins do?• Stop the leukocytes


38

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

What are the functions of adhesion molecules?• Homing of lymphocytes

• tells lymphocytes where to go

• Inflammation• Cell-cell interaction

Primary allergic response is due to what?•Contact

What cells are present in the first 3 days?• Neutrophils

• The next cells to show up are?• B-cells

• What do B-cells make?• IgM

What day does IgM show up? • Three

• IgM peaks at what day?• 14

• When does IgM leave?• In 2 months

What shows up in 2 wks (14 days)?• IgG

• When does IgG peak?• In 2 months

• When does IgG leave?• In 1 year


39

What is Secondary Allergic response is due to?• MEMORY

What shows up at day 3?

• IgG with 5x concentration

• Has the highest affinity

• When does IgG peak?

• In 5 years

• When does IgG leave?

• In 10 years

What Ig has the hightest affinity?• IgG

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

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

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


40

What disease corresponds with the following inclusion bodies?• Howell-Jolly?• Sickle cell

• Heinz?• G-6-P-D

• Zebra?• Niemann pick

What disease corresponds with the following inclusion bodies?• Donovan? • Leishmaniasis

• Mallory?• Alcoholism

• Negri?• Rabies

What disease corresponds with the following inclusion bodies?• Councilman?• Yellow fever

• Call-exner?• Ovarian tumors

• granulosa origin

What disease corresponds with the following inclusion bodies?• Lewy?• Parkinsons

• Pick?

• Pick’s disease

• Barr body?

• Normal female

What disease corresponds with the following inclusion bodies?• Aschoff?

• Rheumatic fever

• Cowdry type A inclusions?

• Herpes virus

• Auer rods?

• AML

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

• Russell? • Multiple myeloma


41

What disease corresponds with the following inclusion bodies?• Schiller-Duvall?• Yolk sac tumor

• Basal bodies?• Only found in smooth mm

What are the 4 types of hypersensitivities?• Mnemonic?• ACID

• Type I• Anaphylaxis/Atopic

• Type II• Cytotoxic (Humoral)

• Type III• Immune complex mediation

• Type IV• Delayed hypersensitivity/Cell mediated

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

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

• except RA and SLE

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

What are the Characteristics of Type IV hypersensitivity?• Cell mediated• What are examples of Type IV?• TB skin test• Contact dermatitis• Transplant rejection


42

What structures have no known function?• Appendix• Epithalamus• Palmaris longus

• muscle

• Pancreatic polypeptide • hormones in F-cells

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

What are causes of papillary necrosis?• Vasculitis• AIDS

Cytic fibrosis Questions?• Tx?• Pilocarpine • also used for glaucoma

• Test used to detect CF?• Pilocarpine sweat test

• What ion does this test measure?• Cl-

• Definitive presence of disease has a test value of what?• >60

Cytic fibrosis Questions?• What is the value in a normal person?• <20

• What is the value in a heterozygous person?• 30 – 60

• What chromosome is the CF gene on?• Chrom 7

• What Second messenger is used?• IP3/DAG

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

• What is the chemical in spores?• Calcium dipocholinate


43

What does strep mutans ferment?• Lactic acid

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

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

• IgM

Types of amyloid found in various Systemic amyloidoses:• AA amyloid?• Chronic active disease

• AL amyloid from Ig light chain?• Myeloma

Types of amyloid found in various Systemic amyloidoses:• Beta 2 microglobulin?• Chronic hemodialysis

• AA amyloid from SAA?• Nephrotic hereditary forms

• eg. Mediterranean fever

Types of amyloid found in various Systemic amyloidoses:• Pre-albumin/transthyretin?• Cardiomyopathic hereditary forms

• senile systemic amyloidosis

• Neuropathic hereditary syndromes


44

Types of amyloid found in various Local amyloidoses:• ANP fibrils are caused by?• Senile cardiac amyloisosis

• Cerebral amyloid in Alzheimer’s disease/Down’s?• Cerebral amyloidosis

Types of amyloid found in various Local amyloidoses:• Calcitonin precursors?• Medullary CA of thyroid

• AL from light chains?• Isolated, massive, nodular deposits

• lung, skin, urogenital tract

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

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

remaining neocortical regions

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

What drugs can cause a disulfiram reaction?• Mnemonic?• CLAM

• Chloramphenicol• Lactams

• Cefamandole• Cefoperazone

• Antabuse• disulfiram

• Metronidazole


45

What is the mode of action of the Clostridium botulinum toxin?• Prevents pre-synaptic release of Ach

• How do babies get it?• From spores in honey or molasses

• How do adults get it?• From canned food

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

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

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

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

Where is glutaminase found?• In the collecting duct of the kidney

• What does glutmainase help the kidney absorb?• Ammonia if the liver fails


46

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

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

What is the rate-limiting enzyme in the urea cycle?• Carbamoyl synthase I

• Where is it found 90% of the time?• Liver

• Where is it found 10% of the time?• Collecting duct of the kidney

What type of charge does heparin have?

•-ve charge

What type of charge does protamine sulfate have?

•+ve charge

• What is it used for?

• Reversing the effects of heparin

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


47

What happens if you expose the blood to the basement membrane?• The following deveop:

• Clots

• DIC

• Pulmonary embolism

• DVT

• MI

• Stroke

Signs and symptoms in all vasculitides• Tachypnea and SOB

• Most common cause of death?• Heart failure

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

synthesis

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

What is the MOA of Puromycin?• Inhibits elongation by binding to “A” site and prematurely

terminating chain growth in pro and eukaryotes

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


48

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

prokaryotes therefore inhibiting initiation

What is the MOA of Cyclohexamide?• Inhibits ribosomal peptidyl transferase in eukaryotes

• cell wall inhibitor

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

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

What is the MOA of Warfarin?• Blocks vitamin k dependent gamma-carboxylation of

prothrombin and factors 2, 7, 9, 10, proteins C & S

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


49

Hemolytic properties of Streptococcus:• What type of hemolysis is alpha hemolysis?• Partial hemolysis

• What color is it’s zone?• Green

• What type of hemolysis is beta-hemolysis?• Complete hemolysis

Hemolytic properties of Streptococcus:• What color is it’s zone• Clear

• eg. Streptokinase

• What type of hemolysis is gamma-hemolysis?• No hemolysis

• What color is it’s zone?• Red

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

What are 3 notable things about RTA II?• Acidosis

• urine PH = 2, normal is 5-6

• Hypokalmia• Patients have NO carbonic anhydrase

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

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


50

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

What Steptococcus has green pigment?• Viridans

What Streptococcus causes SBE?• Viridans

What Streptococcus causes cavities?• Mutans

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

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


51

What is the #1 cause of Sinusitis, Otitis, Bronchitis, Pneumonia?• Strep. Pneumo

• What is the #2 cause?• Hemophilus influenza

• What is the #3 cause?• Neisseria meningitides

What is the #1 method to paralyze cilia?• Viruses

• Which are secondary to what?• Bacterial infections

• What is the #2 method to paralyze cilia?• Smoking

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

Gastroenteritis within 8hrs of eating what toxin?• Preformed

What does Clostridum tetani inhibit? • Release of glycine from spinal cord

• What physical finding would you see?• Lock jaw

• What is the tx?• Antitoxin and Toxoid

• Where is it injected?• Injected in different areas of body

The Most common cause of UTI is?• E. coli

• Followed by?• Proteus

• Followed by?• Klebsiella


52

The most frequent cause of UTI in females between 5-10?• Staph saprophyticus

• Why?• They stick things in themselves

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

• Why no UTI’s after 24?• Because women are use to penises and Staph saprophyticus lives on

penis (becomes part of normal flora).

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

• Because of what?• Collagenase

What is the Most Common cause of infections one week post burn injury?

• Staph. aureus

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

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

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


53

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

What is associated with colon CA?• Clostridium melanogosepticus• Strep bovis

• What color pigment is produced?• Black

What Ig do you look for with affinity?• IgG

• What about Avidity?• IgM

What is transduction

• Virus inject it’s DNA into bacteria

What is transformation?• Virus injects it’s DNA into it bacteria in a hospital or

nursing home setting, then becomes deadly.

Conjuction occurs only with what?• Bacteria with Pili


54

What causes mutiple cerebral abscesses in newborns?• Citrobacter

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

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

What does complement fight against?

• Gram negative bacteria

What do you see in serum with prerenal failure and what are the values?• BUN

• >20

• Fractional Na+ excertion

• <1%

• Creatine

• >40

What do you see in Renal failure and what are the values?• BUN

• 10-15

• Fractional Na+ excretion

• >2%

• Creatinine

• <20


55

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

What is the rate limiting enzyme for Glycolysis?

• PFK-1

What is the rate limiting enzyme of Gluconeogenesis?

• Pyruvate Carboxlyase

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

• If resistant to tx, what next?

• Fungal

• Mycobacterium

• Protozoa

• Parasite

• Neoplasm

What bugs can you pick up during birth?• Step. Group B

• Strep agalactiae

• Strep. Pneumonia• Herpes simplex virus• Neisseria gonorrhea• Chlyamydia

What is another name for Adenoma sebaceum?

• Perivascular angiofibromata


56

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

What is another name for Alkaptonuria?• Ochronosis

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

What is another name for Craniopharyngioma?• Ameloblastoma

• What is Ameloblast?• Tooth material

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

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


57

What is another name for Intraductal Ca?• Comedo Ca

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

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

What is another name for Leydig cells?• Interstitial cells

What is another name for Sertoli cells?• Sustentacular cells

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


58

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

HHV I causes?• Oral • Trigeminal ganglia

HHV II causes?• Genital• Sacral plexus

HHV III causes?• Varicella zoster

HHV IV causes? • EBV• Mononucleosis• Burkitt’s

HHV V causes?• CMV• Inclusion bodies


59

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

HHV VII causes?• Pityriasis rosea

HHV VIII causes?• Kaposi’s sarcoma

Answer the following questions about Coumadin/Warfarin.• What is the MOA?• Interferes with normal synthesis and gama carboxylation

of Vit. K dependent clotting factors via vitamin K antagonism.

• Is it long or short acting?• Long half-life• 8-10 hours to act

Answer the following questions about Coumadin/Warfarin.• Clinical use?• Chronic anticoagulation

• Contra-indication?• Pregnancy because it can cross the placenta

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

• What does it do to PT?• Prolongs

• PT


60

Answer the following questions about Coumadin/Warfarin.• What are the toxicities?• Bleeding• Teratogenic• Drug-drug interactions

• How is it activatied?• Tissue activated

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

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

Answer the following questions about Heparin.• What is the MOA?

• Catalyzes the activation of antithrombin III

• Decreases thrombin and Xa

• Is it long or short acting?

• Short half-life

• Acts immediately

Answer the following questions about Heparin.• Clinical use?• Immediate anticoagulation of pulmonary embolism,

stroke, angina, MI, DVT.

• Contra-indication?• Can be used during pregnancy because it does not cross

the placenta

Answer the following questions about Heparin.• What pathway does it affect?• Intrinsic pathway

• What value should you follow?• PTT


61

Answer the following questions about Heparin.• What are the toxicities?• Bleeding• Thrombocytopenia• Drug-drug interactions

• How is it activatied?• Blood activated

Answer the following questions about Heparin.• Administration?• I.V.

• Drug of choice for what?• DVT

Answer the following questions about Heparin.• What is good about the newer low-molecular-weight

heparins?• They act more on Xa• Have better bioavailability • Have 2 to 4 times longer half life• Can be administered subcutaneously and without

laboratory monitoring.

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

How do you treat Lead Poisoning?• Dimercaprol

How do you treat Benzodiazepine poisoning?

• Flumazenil


62

How do you treat Anticholinesterase poisoning?

• Pralidoxime

How do you treat Iron poisoning?

• Deferoxamine

How do you treat Opioid poisoning?

• Naloxene

How do you treat Barbituate poisoning?

• Bicarbonate• Doxapram

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

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


63

What statin is renally excreted?• Provastatin

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

What do statins inhibit?• HMG-CoA reductase

• When is it most active?• 8:00pm on

If statins are insufficient what do you add?• Cholestipol• Cholestyramine

• If nothing works what do you give?• Probucol• Niacin

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

What 2 statins bind bile salts?• Cholestipol• Cholestyramine


64

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

2.Kidney stones• Due to What?• Alcohol

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

4.Ischemic bowel• What is symptom?• Bloody diarrhea

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

What drug causes SIADH?• Carbamazepine

What are the cells of neural crest origin?• Parafollicular cells of thyroid• Odontoblasts (predentin)• Pseudounipolar cells• Spiral membrane of heart• Chromaffin cells• All Ganglion cells (Schwann, Adrenal medulla)• Melanocytes• Laryngeal/Tracheal cartilage

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


65

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

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

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

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

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

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


66

What is happening in the Atrium?• Phase 0?• Depolarization

• Phase 1?• No name

• Phase 2?• Plateau phase (A-V node)

What is happening in the Atrium?

• Phase 3?• Repolarization

• Phase 4?• Automaticity (S-A node)

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

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

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

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


67

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

• 5 y/o black male?• Celiac Sprue

If you find oxalate stones in the following what should you think of?• Adult male?• Whipple’s

• Adult male or female?• Crohn’s

If oxalate stones found in CF what is the most common cause?• In 0-20 y/o?• Malabsorptin

• What age do they die?• Young

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

•Where are they found?•Joint spaces

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

•Tx?•Colchicine

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


68

What murmur increases on expiration?• VSD• Mitral

What murmur has fixed wide splitting?• ASD

What murmur has bounding pulses?• PDA

What gives you differenital pulses?• Coarctation

What is increased incidence in Turners?• Coarctation

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


69

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

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

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

What are the partially acid fast Protozoa?• Cryptosporidium

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

Where are the following lesions found?• Janeway lesions?

• Toes

• Osler’s nodes?

• Fingers

• Roth spots?

• Retina


70

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

What causes microsteatosis?• Acetaminophen• Reye Syndrome• Pregnancy

What causes macrosteatosis?• Alcohol

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

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

How does Diptheria work?

• It ADP ribosylates EF2 inhibiting protein synthesis

• Is it Gram +/-?

• +

• Where and how does it get its exotoxin?

• From virus via transduction


71

How does Diptheria work?

• What does it cause?• Heart block

• What do you give for Tx?• Antitoxin• Never scrape membrane

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

• Centroacinar?• Smoking

What are the different types of Emphysema and their causes?

• Distalacinar?• Aging

• Panacinar?• Alpha-1 antitrypsin def

What are the stages of erythropoiesis?• 4 mo gestation?• Yolk sac

• 6 mo gestation?• Spleen, liver, flat bones

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

• 1 yr old?• Long bones

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


72

What ions correspond with the following EKG?•P-wave?•Ca+

•QRS complex?•Na+

•S-T?•Ca+

What ions correspond with the following EKG?

•T-wave?•K+

•U-wave?

•Na+

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

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

P.P. CLUE 4 BIO STAT D W

+ B A+B

_ C C+D

A+C B+D ALL

A

D

Sensitivity A/A+CSpecificity D/B+DPPV A/A+BNPV D/C+DOR AD/BC

RR (A/All)/(C/All)

AR (A/All)-(C/All)

Sensitivity: Truly Diseased PeopleSpecificity: Truly Well People

+ Predictive Value: Test +ve With DZ

- Predictive Value: Tested –ve w/o DZOR: Odds RatioRR: Relative RiskAR: Attributed Risk

Always in the numerator

A&D

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


73

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

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

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

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

In EKG S-T Interval means?• Ventricle• Phase 2• Calcium

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


74

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

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

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

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

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

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


75

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

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

DZ Associated with HLA-A3?• Hemochromatosis

• chromosome 6• point mutation Cystine to Tyrosine

DZ Associated with HLA-A 3?• Myasthenia gravis

DZ Associated with HLA-B 13?• Psoriasis

5 DZ Associated with HLA-B 27?• Psoriasis

• only if with arthritis

• Ankylosing Spondylities• IBD

• Ulcerative Cholitis

• Reiter’s• Post gonococcal arthritis


76

DZ Associated to HLA-BW 47• 21 alpha hydroxylase deficiency

• Vit. D

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

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

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

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

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


77

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

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

What are Clues for IgE?• Immediate hypersensitivity/anaphylaxis• Parasite defense• Worms• Fc region binds to mast cells and basophils• Allergies• Does Not fix complement

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

bond• 4 subclasses G1 to G4

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

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


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What are Clues for IgG3?• Most memory antibody

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

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

What do Macrophages release?• MHC II

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

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


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What does TH-0 secrete?• TH-1• TH-2

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

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

• CD-2 • For what?• Adherence

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

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

Neutrophils produce what enzymes and what is their action?• Myeloperoxidase• NADPH• Will kill ALL Gr+ve

• Ex..Hydrogen peroxide kills gr+


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

• CD-4• B-7• CD-28

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

What are the Clues for type-2 hyperlipedimia?• Increased LDL• Two types IIa and IIb• Type IIa Receptor deficiency for LDL or missing B-100

• Type II-b (LDL and VLDL problems) enzyme deficiency for LDL at adipose. Receptor problem for VLDL. Most common in General Population

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

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

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


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

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

Description of Rashes

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

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

MEASLES• Morbiliform rash• Preceded by cough• conjunctiivitis


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

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

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

SEBORRHEIC DERMATITIS• Scaly skin with oily shine on headline

SEBORRHEIC KERATOSIS• Stuck on warts• Due to aging

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


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

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

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

DERMATOMYOSITIS• Heliotropic rash

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

TINEEA CRURIS• Redness• Itchy groin


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

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

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

What is a T-CELL DEFICIENCY?• DiGeorges • What ion imbalance will they have?• Hypokalemia• What did not form?• 3rd and 4th pharyngeal pouch• What chromosome?• Deletion on chromosome 22

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

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


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

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

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

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

What do you develop with HYPERTRIGLYCERIDEMA?• XANTHELASMA

• Where are they located?• On eyelids and eyebrows

What do you develop with HYPERCHOLESTEROLEMIA?• Xanthomas

• Where are they located?• elbows


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

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

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

• 80%

What are the clues for HEMOPHILIUS INFLUENZA?• Capsule or no capsule?• non-encapsulated• Invasive or non invasive?• non-invasive

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

What are the clues for HEMOPHILIUS INFLUENZA? • What is the 2nd most common type?• TYPE B

• 20%• Encapsulated or non encapsulated?• Encapsulated• What does it have in its capsule?• Polyribosyl phosphate in capsule• Contains IgA protease


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What are the clues for HEMOPHILIUS INFLUENZA?

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

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

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

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

What are the most common causes of MENINGITIS corresponding with the following ages?• > 21 years old?• #1 S. pneumoniae

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


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Answer the following about the Strep. Pneumonia vaccine.• Indications?• Anyone> 65y/o• Anyone splenectomized

• Sickle cell anemia

• Anyone with end-organ damage• CF• RF • Nephrotic Syndrome

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

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

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

• pneumococcus

Clues for GENERAL INFECTIONS

• Skin Infections?

• Say Staph. Aureus

• Throat Infections?

• Say Strep. Pyogenes

• Small Intestine Infections?

• Say E. coli

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


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

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

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

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

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

• HbS antibody ONLY

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


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What Immunogloblin is found in Hepatitis B immunity?

• IgG

What Hepatitis B antigen/antibody is found in the chronic carrier state?

• HbS antigen for >6months• Can be with or without HbS antibody

What Hepatitis B antigen is found with the infectious state?

• HbE antigen

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

• HbE antibody

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

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

• POSITIVE HbS antigen


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What does the “window period” build in Hepatitis B?

• HbE antibody• IgM HbC antibody

• What disappears?• HbS antigen

What is the incubation period for Hepatitis B?

• 4 to 26 wks• Average @ 8wks

How long is the acute disease period in Hepatitis B?

• 4 to 12 wks

How long is the convalescence period in Hepatitis B?

• 4 to 20 wks

How long is the recovery period for Hepatitis B?

• YEARS

Answer the following about HIV?

• MC infection?

• CMV

• MCC of death?

• PCP

• What is p41 used for?

• Just a marker


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Answer the following questions about HIV? • What does Gp120 do?

• Attachment to CD4

• What is Pol used for?

• Integration

• What is reverse transcriptase used for?

• Transcription

• What are p17 & p24 antigens used for?

• Assembly

Answer the following questions about HIV? • What is the normal CD4 count?

• 800-1200

• What can the CD4 count be up to in children?

• 1500

• When do you begin treating with 2 nucleotide inhibitors and 1 protease inhibitor?

• <500 • (child at 750)

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

What are the Antioxidants?• Vitamin E

• #1

• Vitamin A• Vitamin C• Betakertine

What is Vitamin A a cofactor for?• Parathyroid

• Along with what other cofactor?• Mg+

Too much Vitamin A will cause what?

• Hyperparathyroid• Increase Ca+• Decrease Phosphate

• What will be the symptoms?

• Goans• Moans

• Bones

• Stones


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Too much Vitamin A will cause what?• Pseudotumor Cerebri

• Increase CSF production from Chorichoid Plexus

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

What does Vitamin A deficiency cause?

• Nightvision problems/nightblindness

• Hypoparathyroidism• Decrease Ca+• Increase Phosphate

What is Vitamin B1?

• THIAMINE

• What do you get with a decrease in thiamine?

• Beri Beri

• What is the most common cause in US?

• ETOH

What do you get with Vitamin B1 deficiency?• Wet Berry Berry• With heart failure

• Dry Berry Berry• Without heart failure

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

• Wernicke’s Korsakoff


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What is Wernicke’s Encephalopathy?

• Alcoholic thymine deficiency of the Temporal Lobe

What is Wernicke’s Korsakoff?

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

• Transketolase

What is B2• Riboflavin

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

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

What is B3?• Niacin

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


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

• What is deficient in this disease?• Tyrptophan

• What is typtophan needed for?• Needed for niacin formation

What is B4?

• Lipoic acid

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

What is B5?• Pantothenic acid

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

What is B6?

• Pyridoxine

• What is the deficiency caused by this vitamin?

• Neuropathy

• Seizures

• Who do you need to give B6 to?

• Patient on INH

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

What needs B6 as a cofactor?• ALL transaminases


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What is B12?• Cyanocobalamine

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

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

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

Deficiency in Methylmalonyl CoA Mutase leads to what?

• Neuropathy

• Why?• Because it recycles myelin

Deficiency in Homocystiene Methyl Transferase leads to what?• Megaloblastic anemia

• What else is this enzyme needed for?• Nucleotide synthesis

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


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

What causes a NEUROPATHY WHEN DEFICIENT & also needs TRANSAMINASE?

• PYRIDOXINE B6

What vitamin is deficient with PERNICIOUS ANEMIA & NEUROPATHY?

• B12 CYANOCOBALAMINE

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

• Folate

What type of anemia is seen with Folate deficiency?• Megaloblastic anemia

• With neuropathy?• NO NEUROPHATHY

• What else is Folate used for?• Nucleotide synthase (THF)

What is another name for Vitamin C?• Ascorbate acid


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What is Vitamin C needed for?• Collagen synthesis

What happens with Vitamin C deficiency?• Scurvy

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

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

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

• Controls osteoblastic activity

What does Vitamin D deficiency cause in Children?• Ricketts

• What does it cause in ADULTS?• Osteomalcia


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

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

What does a deficiency of Vitamin E cause in newborns?

• Retinopathy

What are the vitamins from GI that are normal flora?• Folate• Vitamin K

• 90%

• Biotin• Panothenic acid• Helps with absorption of B12

What are the Vitamin K dependent clotting factors?• 1972• Protein C• Protein S

• Which one has the shortest half-life?• Protein C

• Which one has the 2nd shortest half-life?• 7

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


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What is Chromium needed for?• Insulin action

What organ needs Selenium?• Heart

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

What organ needs Tin?• Hair

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

Cofactor for ALL Kinases?• Mg+


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Cofactor for ALL Carboxylases?• Biotin

Cofactor for ALL Transaminases?• Pyridoxine

• B6

What is Biotin a cofactor for?• ALL carboxylases

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

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

What tracts are affected due to deficiency in Methyl Malonyl CoA Mutase?• Dorsal Columns• Cortical Spinal Tracts

• Why are these affected?• Because they are the longest • Because they need the most myelin


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What enzyme does Zanthein Oxidase need?

• Maganese Molebdenum

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

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

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

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

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


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

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

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

• B5

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

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

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

• CNBr cuts where?• Cuts to R of• Methionine

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

• Cysteine• methionine


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

• Caboxypeptidase cuts where?• Cuts to L of• carboxy terminal

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

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

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

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

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


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

MACROPHAGES CONTAIN what SUBSTANCE?• NADPH Oxidase

• Which means they only kill what?• Kills only G -ve

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

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

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

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


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

• What part is toxic?• Lipid A

• Does it cross the placenta?• Yes

What does Listeria activate?

• T-cells & Macrophages, therefore, have granulomas

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

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

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

What are the BASIC AMINO ACIDS?• Lysine• Arginine


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What are the ACIDIC AMINO ACIDS?• Glutamate• Aspartate

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

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

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

What are the “KINKY” AMINO ACID?• Proline

What are the SMALLEST AMINO ACID?• Gly


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

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

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

What are the KETOGENIC AMINO ACIDS?• Leu• Lys

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

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


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

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

What do MAST CELLS SECRETE?• In an Acute Reaction?• Histamine

• In a Late Reaction ?• SRS-A• ECF-A

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

What does chlamydia pneumonia cause?• Intersitital pneumonia

What is the CLUE for HEART BLOCK?• High temperature with NORMAL pulse rate!

(This should never be! Each degree ↑ in temp. → 10 beats/min ↑ in pulse rate)


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

COMPLEX• SECRETED BY MACROPHAGES

What are the clues for IL-2?

• MOST POTENT OF THE Interleukins

• RECRUITS EVERYBODY

• MOST POWERFUL CHEMO-ATTRACTANT• MUST BE INACTIVATED

• When must you inactivate it?

• PRIOR TO TRANSPLANTATIONby cyclosporin

• SECRETED BY TH1 CELLS

What are the clues for IL-3?• ENERGIZED MACROPHAGES• CAUSES B-CELL PROLIFERATION• LABELED BY THYMIDINE (USE POKEWEED MITOGEN

OR ENDOTOXIN)• SECRETED BY ACTIVATED T CELLS

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

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

What are the clues for IL-10?• SUPPRESSES CELL-MEDIATED RESPONSE (tells

macrophages and fibroblasts to stay away if bacterial)• INHIBITS MAC ACTIVATION


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What are the clues for IL-12?

• PROMOTES CELL-MEDIATED RESPONSE (recruits macs & fibroblasts if NOT bacterial)

• ACTIVATES NK CELLS TO SECRETE IF-γ

• INHIBITS IL-4 INDUCED IgE SECRETION

• CHANGES TH CELLS to TH1 CELLS • secretes IL-2 & IF-γ → inhib. TH2, therefore, ↑ host

defenses against delayed hypersensitivity

What are the clues for IF-α?• Where is it from?• LEUKOCYTES• ↓VIRAL REPLICATION AND TUMOR GROWTH• ↑ NK ACTVITY

• secretes perforins and granzymes to kill infected cell

• ↑MHC CLASS I & II EXPRESSION• ↓ PROTEIN SYNTHESIS

• translation inhibited, therefore, defective protein synthesis

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

What are the clues for IF-B?• Where is it from?• FIBROBLASTS• Increase NK activity• Increase MHC class I & II• Decrease protein synthesis• Decrease viral replication and growth

What are the clues for IF-gama?

• Where is it from?• T-CELLS & NK CELLS• ↑ NK ACTIVITY

• ↑MHC CLASS I & II

• ↑ MACROPHAGE ACTIVITY

• CO-STIMULATES B-CELL GROWTH & DIFFERENTIATION

• ↓ IgE SECRETION

What are the clues for TNF-alpha?• Where is it from?• MONOCYTES & MACROPHAGES• What is another name for TNF-alpha?• CACHECTIN• INDUCES IL-1• ↑ ADHESION MOLECULES & MHC CLASS I ON

ENDOTHELIAL CELLS• PYROGEN• INDUCES IF-γ SECRETION• CYTOTOXIC/CYTOSTATIC EFFECT


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What are the clues for TNF-beta?• Where is it from?• T-CELLS

• What is another name for it?• LYMPHOTOXIN

• CYTOTOXIC FACTOR

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

• What is another name for it?• TRANSFORMING GROWTH FACTORS

What are the clues for TGF-α?

• What does it INDUCE?• ANGIOGENESIS

• KERATINOCYTE PROLIFERATION

• BONE RESORPTION

• TUMOR GROWTH

• What is it mainly for?• MAINLY FOR TUMOR GROWTH

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

What are the clues for TGF-β?

• What INDUCES it?• FIBROBLAST PROLIFERATION• COLLAGEN• FIBRONECTIN SYNTHESIS

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


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

What are the clues for TGF-β?• What does it suppress?• SUPPRESSES IR AFTER INFECTION & PROMOTES

HEALING PROCESS

• What is it mainly for?• MAINLY FOR WOUND HEALING

What does LAK stand for?• LYMPHOKINE ACTIVATED KILLER CELLS

What does CTL stand for?• CYTOTOXIC T-LYMPHOCYTES

What does mitochondrial inheritance affect?• CNS• Heart• Skeletal muscle

• Why does it affect these particular places?• Due to uneven cytokinesis during meiosis or oogenesis

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

• All offspring

• Who passes the disease?

• MOM

• Who has no transmission?

• Dad


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Answer the following about Autosomal Recessive inheritance?• Who does it show in?• Not parents• Siblings/uncles may show disease

• When is onset?• Early in life (childhood diagnosis)

• Is it complete on incomplete penetrance?• COMPLETE

Answer the following about Autosomal Recessive inheritance?• How are they acquired?• Almost ALL are inborn error of metabolism

• When does it occur?• Only when both alleles at a locus are mutant

Answer the following about Autosomal Recessive inheritance?• How is it transmitted?

• Horizontal Tm

• Are there malformations present?

• Physical malformations are uncommon

• What type of defect?

• Enzyme defect

Answer the following about Autosomal Dominant inheritance?• Who does it affect the most?

• M=F

• How does it manifest?

• Heterozygote state

• Who can transmit the disease?

• Both parents

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

• When is onset?• Often delayed (adult diagnosis)

• Example = Huntington’s

Answer the following about Autosomal Dominant inheritance?• What is penetrance?• Reduced penetrance

• How is it expressed?• Variable expressin

• Different in each individual


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Answer the following about Autosomal Dominant inheritance?• How is it transmitted?

• Vertical TM

• Is there malformation present?

• Physical malformation common

• What type of defect?

• Structural

Who is affected in the family with an X-Linked disease?

• Maternal grandfather• Maternal uncle

Immune System Time Line for viral & cell-mediated.• What happens <24hrs?

• Swelling

• What happens at 24 hrs?

• Neutrophils show up

• What happens at day 3?

• Neutrophils peak

Immune System Time Line for viral & cell-mediated.• What happens at day 4?

• T cells and Macrophages show up

• What happens at day 7?

• Fibroblasts show up

• What happens in 1 month?

• Fibroblast peak

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

What is the general CLUE for any Lysosomal Storage Disease?

• Lysosomal Inclusion Bodies


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

What is missing in Gauchers?• Beta-Glucocerberosidase

• What Accumulates?• Glucocebroside

• Where?• Brain• Liver• Bone Marrow• Spleen

What are the CLUES for Gauchers?• Ask. Jew• Gargols• Gaucher cells

• Macrophages looking like Crinkeled paper

• Erlin myoflask legs• Pseudohypertrophy

What is missing in Fabrys?• Alpha-galactosidase

• What accumulates?• Ceramide Trihexoside

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

What is missing in Krabbes?• Galactosylceramide B-Galactosidase

• What accumulates?• Galactocerebrosidase

• Where?• Brain


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What are the CLUES for Krabbes?• Early death• Globoid bodies

• Fat cells

What is missing in Tay Sachs?• Hexoseaminidase A

• What accumulates?• GM2 Ganglioside

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

What is missing in Sandhoffs?• Hexoseaminadase A & B

What is missing in Hurlers?• Iduronidase

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


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What is missing in Hunters?• Iduronate Sulfatase

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

What is missing in Niemann Picks?• Spingomyelinase

• What accumulates?• Spingomyelin • Cholesterol

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

What is missing in Metachromatic Leukodystrophy?• Arylsulfatase A

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


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What are the Glycogen Storage Diseases?• Von Gierkes• Andersons• Corys• McCardles• Pompes• Hers

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

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

What is deficient in Andersons?• Branching enzyme deficiency

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

What is missing in Corys?• Debranching enzyme


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

What is missing in McCardles?• Muscle phosporalase

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

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

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

What is missing in Hers?• Liver phosphoralase


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

Pagets disease is associated with what cancer?• Intraductal Ca

What MUST you rule out with a decrease AVO2?

• AV Fistula• Vasodilation

What diseases have a cherry red macula?

• Tay Sachs• Sandhoffs• Niemann Pick

What is translocation 9;22?• CML

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


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What is translocation 8;14?• Burketts lymphoma

What is translocation 14;18?• Follicular lymphoma

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

• Thanks STAN!!

What are the CLUES for Vasulitis or Intravascular Hemolysis?• Shistocytes

• Burr cells• Helmet cells

What is the CLUE for Extravascular Hemolysis?• Splenomagely

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


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What is the Heinz body CLUE?• G6PD

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

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

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

What is secondary Sideroblastic anemia due to?• Blood transfusions

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


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

• Early

• Renal Failure

What are the Macrocytic anemia’s?

• Folate deficiency

• B12 deficiency

• Reticulocytosis

• ETOH

• Hemolytic Anemias

• Chemo Treatment

• Anticonvulsants

• Myelodysplasia

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

What anemia is caused by blood transfusions?• Sideroblastic anemia

What is the problem if you see Eliptocytes?• Something is wrong with the RBC membrane

• Extravascular

• Heridatary Ellitocytosis• Increased RET count

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


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

• Copper in eyes

• Hepato = Liver• Lenticular = Movement problem

What is Copper needed for?• Collagen synthesis

What disease manifest with Cu+ deficiency?• Minky Kinky Hair Syndrome

What are the plasma catecholamines?• Epinephrine• Norepinephrine• Dopamine

What are Plasma Catecholamines derived from?• Tyrosine

A patient with episodic HTN leading to headache with arrhythmias leading to palpitations most likely is diagnosed with?

• Adrenal Pheochromocytoma


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What is the MOA for Fluroquinolones?• Blocks DNA gyrase (topoisomerase II)• Inhibits p450

What do Fluroquinolones cover?• All Gram + including staph auerus• All Gram –• Atypicals

What are the atypicals?• Chlamydia• Ureoplasma• Mycoplasma• Legionella

What induces Gluconeogensis?• Cortisol• Epinephrine• Glucagon

What is Dermatan Sulfate?• Glycosaminoglycan chain that helps form proteoglycans

What is Hyaluronic Acid?• Glycosaminoglycan chain that helps form proteoglycans


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What is the MOA of Methotrexate?• Inhibits dihydrofolate reductase• Inhibits DNA synthesis in the S phase of cycle.• Prevents reduction of folic acid needed to produce THF

What are THF derivatives used in?• Purine nucleotide synthesis• Methylation of dUMP to for dTMP

What happens when Dihydrofolate Reductase is inhibited?• Obstructs one carbon methylation which deprives DNA

polymerase of essential substrates

What diseases present as Failure to Thrive?

• CF• Galactosemia

In general, what should you always associate Hemolytic Anemia’s with?

• Defects in Glycolysis• Defects in Hexose Monophosphate Shunt

What is required for the conversion of Homocysteine to Methionine?

• B12


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What is required for the conversion of methylmalonyl CoA to Succinyl CoA?

• B12

What is required for the degradation of cystathionine?• Vitamin B6

What does the hydroxalation of Purines require?• Vitamin C

When does the carboxyalation of Glutamic acid occurs and what is required for this carboxyalation?• Occurs in the synthesis of Blood Clotting factors• Requires Vitamin K

Decarboxylation of alpha-ketoacids requires what?

• Thiamine

Synthesis of 1,25-d-hydroxycholecalciferol requires what?

• Vitamin D


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Synthesis of Rhodopsin requires what?

• Vitamin A

Pyruvate Decarboxylase requires what as a cofactor?• Thiamine

What is CN1?• Olfactory• What is its function?• Sensory for smell• What if lesioned?• Anosmia• Where does it Exit/Enter the Cranium?• Cribriform plate• What does it innervate?• Nasal Cavity

What is CN2?

• Optic

• What is its function?

• Sensory for sight

• What if lesioned?

• Anopsia • Visual field defect

• Loss of light reflex with CN III

• Only nerve affected by MS

Cont. CN2• Where does it Exit/Enter the Cranium?• Optic Canal

• What does it innervate?• Orbit

What is CN3?

• Occulomotor

• What are the functions?

• Motor

• Moves the eyeball in ALL directions

• Adduction Most important action (MR)

• Constricts the pupil (Spincter Pupillae)

• Accomodates (Cililary Muscle)

• Raises eyelid (Levator Palpebrae)


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Cont. CN 3• What if lesioned?• Diplopia• Loss of parallel gaze• Dilated pupil• Loss of light reflex• Loss of near response• Ptosis

Cont. CN 3• Where does it Exit/Enter the Cranium?• Superior Orbital Fissure


What is CN 4?• Trochlear• What is its function?• Motor• Superior Oblique• Depresses and abducts the eyeballs• Intorts

Cont. CN 4• What if lesioned?• Weakness looking down w/ adducted eye• Trouble going down stairs• Head tilts away from lesioned side

• Where does it Exit/Enter the Cranium?• Superior Orbital Fissure

Cont. CN 4• What does it innervate?• Orbit

What is CN 5?• Trigeminal


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What are the different branches of CN 5?• V1?

• Opthalmic

• V2?

• Maxillary

• V3?

• Mandibular

What is the function of CN V1?

• Mixed• General sensation (touch, pain, temperature) of the

forehead, scalp, & cornea

• What if lesioned?• Loss of general sensation of the forehead/scalp• Loss of blink reflex w/ VII

• Where does it Exit/Enter the Cranium?• Superior orbital Fissure

• Ophthalmic division

Cont. CN V1• What does it innervate?• Orbit• Scalp

What is the function of CN V2?• Mixed• General sensation of Palat, Nasal cavity, Maxillary face,

and Maxillary teeth

• What if lesioned?• Loss of general sensation in skin over maxilla & maxillary

teeth

Cont. CN V2• Where does it Exit/Enter the Cranium?• Foramen Rotundum

• What does it innervate?• Pterygopalatine

• Leaves by openings to face, oral & nasal cavity

What is the function of CN V3?


• Mixed

• General sensation of anterior 2/3 of tongue, mandibular face & mandibular teeth

• Motor

• Muscles of Mastication and anterior belly of digastric, mylohyoid, tensor tympani, tensor palati


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Cont. CN V3• What if lesioned?• Loss of general sensation in skin over mandible,

mandibular teeth, tongue, weakness in chewing• Jaw deviation to weak side• Trigeminal neuralgia

• Intractable pain in V2 or V3 territory

Cont. CN V3• Where does it Exit/Enter the Cranium?• Foramen Ovale

• What does it innervate?• Infratemporal Fossa

What is CN VI?• Abducens

• What is its function?• Motor• Lateral rectus

• Abducts eye

Cont. CN VI• What if lesioned?• Diplopia

• Internal strabismus• Loss of parallel gaze

• Pseudoptosis

• Where does it Exit/Enter the Cranium?• Superior orbital fissure


What is CN VII?• Facial• What is its function?• Mixed• To muscles of facial expression• Posterior belly of diagastric• Stylohyoid & Stapedius• Tastes anterior 2/3 of tongue/palate• Salivates (submandibular & sublingual glands)• Tears (Lacrimal glands)• Makes mucous (nasal & palatine glands)

Cont. CN VII• What if lesioned?• Corner of mouth droops• Can’t close eye• Can’t wrinkle forehead• Loss of blink reflex• Hypeacusis• Loss or alteration of taste (ageusia)• Eye dry and red• Bell Palsy

• Lesion of nerve in facial canal


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Cont. CN VII• Where does it Exit/Enter the Cranium?• Internal Auditory meatus

• What does it innervate?• Face• Nasal & oral cavity

• Branches leave skull in stylomastoid foramen, petrotympanic fissure, or Hiatus of facial canal

What is CN VIII?• Vestibulocochlear

• What is its function?• Sensory• Hears• Linear acceleration (Gravity)• Angular acceleration (Head Turning)

Cont. CN VIII• What if lesioned?• Loss of Balance• Nystagmus

• Where does it Exit/Enter the Cranium?• Internal Auditory Meatus

• What does it innervate?• Inner ear

What is CN IX?

• Glossopharyngeal


• Mixed

• Sense Pharynx

• Carotid sinus/body

• Salivates (parotid glands)

• Tastes and senses posterior 1/3 of tongue

Cont. CN IX


• To one muscle only (stylopharyngeus)


• Loss of Gag Reflex with X

• Where does it Exit/Enter the Cranium?

• Jugular Foramen

Cont. CN IX• What does it innervate?• Neck• Pharynx/Tongue


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What is CN X?• Vagus• What is its function?• Mixed• To muscles of palate & pharynx for swallowing except tensor palate (V) & Stylopharynegeus (IX)

• To all muscles of Larynx (phonates)• Senses Larynx & Laryngopharynx• Senses Larynx & GI tract• To GI tract smooth muscle & glands in forgut & midgut

Cont. CN X• What if lesioned?• Nasal speech• Nasal regurgitation• Dysphagia• Palate drop• Uvula points away from pathology• Hoarseness/fixed vocal cord• Loss of gag reflex w/ IX• Loss of cough reflex

Cont. CN X• Where does it Exit/Enter the Cranium?• Jugular Foramen

• What does it innervate?• Neck• Pharynx/Larynz• Thorax/Abdo

CN X – Sympathetics to Head• What is its function?• Motor• Raises eyelid (superior tarsal muscle)• Dilates pupil• Innervates sweat glands of face & scalp• Constricts blood vessels in head

Cont. CN X• What if lesioned?• Horner syndrome

• Eyelid droop (ptosis)

• Constricted pupil (miosis)• Loss of sweating (anhydrosis)

• Flushed face

Cont. CN X• Where does it Exit/Enter the Cranium?• Carotid canal on internal carotid artery

• What does it innervate?• Orbit• Face • Scalp


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What is CN XI?• Accessory

• What is its function?• Turns head to opposite side

• sternocleidomastoid

• Elevates & Rotates scapula• Trapezius

Cont. CN XI• What if lesioned?• Weakness turning head to opposite side• Shoulder droop

• Where does it Exit/Enter the Cranium?• Jugular Foramen

• What does it innervate?• Neck

What is CN XII?

• Hypoglossal


• Moves tongue


• Tongue points toward pathology on protrusion

What is CN XII?• Where does it Exit/Enter the Cranium?• Hypoglossal Canal

• What does it innervate?• Tongue

What are the muscles of mastication?• Temporalis• Masseter• Medial Pterygoids• Lateral Pterygoids

What part of the brain deals with problem solving?• Frontal Lobe


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What happens if there is a lesion to the Optic nerve?• Unilateral Blindness

What happens if there is a lesion to the Optic Chiasm?• Bitemporal Hemianopia

What is a Berry Aneurysm due to in the Circle of Willis?• SUBARACHNOID Hemorrhage

What is a CLUE for SUBARACHNOID Hemorrhage?• The worse headache of my life

What effect does Pernicious Anemia have on the nervous system?

• Causes degeneration of the posterior columns• Causes degeneration of the CST• Loss of proprioception• Upper motor neuron defect

What does the diencephalon originate from?• Forebrain


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What originates from the Diencephalon?• Thalamus• 3rd Ventricle

Where does the Telencephalon originate from?• Forebrain

• Prosencephalon

What originates from the Telencephalon?• Cerebral Hemispheres• Lateral Ventricles

What originates from the Mesencephalon?• Midbrain• Aqueduct

What originates from the Hindbrain?• Metencephalon• Myerencephalon

What originates from the Metencephalon?• Pons• Cerebrum


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What originates from the Myerencephalon?• Medulla

What does the Jugular Foramen contain?• CN IX• CN X• CN XI• Internal Jugular Vein• Spinal accessory nerves

What does the Foramen Spinosum contain?• Middle menningeal artery

• Branch of the maxillary artery

What does the Foramen Ovale contain?

• CN V3

What does the Foramen Magnum contain?• Vertebral arteries• Brain stem• Spinal roots of CN XI• Spinal cord

What does the Optic Canal contain?

• Opthalmic artery• Central retinal vein• CN II


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What does the Hypoglossal Canal contain?• CN XII• Hypoglossal nerve

What does the Carotid Canal contain?• Internal Carotid artery

What does the Posterior Condylar Canal contain?

• Large Emissary Vein

What are signs of an UPPER motor neuron damage?• + Babinski sign• Spastic Paralysis• Hyperactive Deep Tendon Reflexes

What are signs of a lower motor neuron defect?

• Atrophy• Fasciullations• Flaccid Paralysis• Loss of deep tendon reflexes

What does it mean to see a physis on radiograph?• Means the skeleton is not fully mature


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When does Physis disappear?• Once growth is complete

What is a nonunion fracture?• Fracture that does not heal with in 6 months

What does Malunion mean?• A fracture that heals in an Abnorman position

What is a characteristic feature of cancellous (spongy) bone?• Trabeculae

Which CN’s control eye movement?• CN III

• Oculomotor nerve

• CN IV• Trochlear nerve

• CN VI• Abducens nerve

What CN is responsible for turning the head and shrugging the shoulders?• CN XI

• Accessory nerve


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What CN has sensory fibers for Face and Motor fibers for muscles of mastication? • CN V

• Tigeminal Nerve

What CN controls tongue movement?

• CN XII• Hypoglossal nerve

What CN controls sensory fibers for Vison

• CN II• Optic nerve

What CN senses fiber for smelling?• CN I

• Olfactory

What does the Mesenteric Artery Supply?

• Distal 1/3 of transverse colon• Descending colon• Sigmoid colon• Upper Portion of Rectum

What does the Superior Mesenteric Artery Supply?• Duodenum• Jejunum• Ileum• Cecum• Appendix• Ascending colon• Proximal 2/3 of transverse colon


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What does the common Iliac artery supply?

• Pelvis• Perineum• Leg

What does the Celiac trunck give rise to?• Left gastric artery• Splenic artery• Common hepatic artery

What do the Left. Gastric Artery, Splenic Artery, & Common Hepatic artery supply?• Esophagusa• Stomach• Duodenum• Liver• Gallbladder• Pancreas

If there is a lesion in the frontal lobe will you have motor or sensory defects?• Motor

If patient has a visual field defect with cognitive Distrubance, what part of the brain will be affected?• Temporal or Partial Lobe

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