2/17 GI Block - Ankiʼed

!. Cholesterol: secreted in bile, solubilized by bile sJlts Jnd

phosphJtidylcholine
!. TPN decreJses CCK releJse > biliJry stJsis
#. TrJcheJ - rJdiolucent. EsophJgus is between trJcheJ Jnd vertebrJl bodies
$. PPV increJses Js prevJlence increJses
!. Sensitivity Jnd specificity Jre intrinsic pJrJmeters thJt donʼt depend on
prevJlence
%. ErythemJtous gJllblJdder w/ pJtchy necrosis - Jcute cJlculous cholecystitis
- Jcute inflJmmJtion irritJted by gJllstone obstruction of cystic duct
&. Fc portion binds to receptors on mJcrophJges, etc - essentiJl for
opsonizJtion
'. Foreign body leJding to smJll bowel obstruction. Fibrous bJnd connects
ileum Jnd umbilicus. Meckelʼs
(. Meckels = ectopic tissue
). PJrtiJl fJilure of the vitelline duct to obliterJte > Meckelʼs. Connected to the
ileum.
*. Hep A - JminotrJnsferJses spike eJrly in illness, then bile Jnd Jlk phos
increJses
!+. Hep C - no proofreJding in 3ʼ to 5ʼ direction
!. 5ʼ to 3ʼ exonucleJse Jctivity Jllows DNA pol I to engJge in nick trJnslJtion
- for DNA repJir Jnd removJl of RNA primers (not relJted to Hep C)
!!. Splenic vein cJn increJse pressure in the short gJstric veins Jnd cJuse
gJstric vJries only in the fundus
!. PortJl HTN cJn increJse pressure in the left gJstric veins > cJn cJuse
both gJstric Jnd esophJgeJl vJrices
#. PJncreJticoduodenJl vein drJins pJncreJs Jnd duodenum into superior
mesenteric vein (SMV). SMV Jlso drJins blood from lower stomJch viJ
right gJstroepiploic vein. Blocking SMV could leJd to vJriceJl formJtion in
lower stomJch but not upper regions
!#. 50% of the world populJtion is colonized w H pylori but its pJrticulJrly high
prevJlence in developing world. Antibiotics Jnd PPIs
!$. GJlJctosemiJ cJn leJd to cJtJrJcts > gJlJctose is phosphorylJted by
gJlJctokinJse. GALK deficiency cJuses gJlJctose build-up: excess is
converted to gJlJctitol.
!. LJte presentJtion, normJl growth, isolJted presence of cJtJrJct
#. Others REVIEW
!. Aldol*se B (heredit*ry fructose intoler*nce) > hypoglycemi*,
hypophopsh*temi*, f*ilure to thrive
#. A-g*l*ctosid*se deficiency > F*bry (C*n present with c*t*r*cts).
 #.
Neuro findings *nd *ngioker*tom*s *re *lso ch*r*cteristic
$. Fructokin*se def > essenti*l fructosuri*
%. G6P def > von Gierke dise*se
&. Hexo*minid*se > T*y S*chs
'. Sphingomyelin*se > Niem*nn Pick
!%. AbdominJl pJin Jnd bloody diJrrheJ Jfter surgery > ischemic colitis
!. Nonocclusive ischemiJ Jt the mJrgins
#. CJn hJve occlusive ischemiJ cJused by thromboembolic hypercoJgulJble
stJtes
!&. Non-glucose monosJccchJrides cJn enter glycolysis Jt different points Js
intermediJtes
!. Other sugJrs - glucose, gJlJctose, mJnnose - enter prior to PFK-1 Jnd
Jre metJbolized more slowly
!'. Conditions thJt cJuse GI irritJtion result in increJsed serotonin releJse
!(. LineJr ulcerJtions > CMV
!). CF > most common GI mJnifestJtion is pJncreJtic insufficiency - pJncreJtic
duct obstruction Jnd distension
!*. Crohnʼs complic.ted by sm.ll bowel obstruction > recurrent episodes of p.in
.ssoci.ted w di.rrhe.. Stress c.n m.ke it worse.
!. Strictures c.n result from bowel edem. .nd hypertrophy of muscul.ris
mucos. > n.rrowed intestin.l lumen
#. Abscesses c.n for when sinus tr.cts become w.lled off
$. Other
!. Infl.mm.tion would be seen with UC
#+. Signet ring cJrcinomJ > diffuse involvement of the stomJch wJll due to loss
of E cJdherin
#!. PudendJl nerve > externJl hemorrhoids. GenerJlly JsymptomJtic unless they
thrombus.
!. Other
!. IlioinguinJl nerve > mons pubis Jnd lJbiJ mJjorJ
##. Bilroth II gJstrojejunosotmy > Jntrum is removed to decreJse gJstrin
production. AnJstomosis between jejunum Jnd gJstric body.
!. Iron is Jbsorbed in the duodenum.jejunum > might get IDA
#. MJlJbsorption of B12, folJte, fJt soluble vitJmins, cJlcium cJn Jlso occur
$. Other
!. Vit C > Jbsorbed in distJl smJll vowel
#. Biotin (B7) Jnd B5 Jre Jbsorbed in lJrge Jnd smJll intestine > sodium
dependent multivitJmin trJnsporter
#$. GI bleed from the sigmoid colon > hindgut structure. Receives blood from
IMA. ArteriJl embolizJtion > mechJnicJl occlusion of the Jrtery with coils or
JdsorbJble substJnces is plJnned to stop Jctive bleeding
!. Other
!. InternJl iliJc - supplies portions of the gut through inferior rectJl Jnd
 !.
middle rectJl. InternJl pudendJl Jrtery supplies externJl genitJliJ.
#%. PJncreJtic enzymes protect the pJncreJs from Jutodigestion. Proenzymes
Jre JctivJted by trypsin in the duodenJl lumen Jfter trypsinogen is trypsin.
If trypsin wJs impJired, there would be no protection of the pJncreJs, so
more prone to pJncreJtitis
!. HereditJry pJncreJtis > from mutJtions of trypsinogen of SPINK1 (Trypsin
inhibitor) AbnormJl trypsin is not susceptible to cleJvJge.
#&. Crohnʼs: inflJmm of ileum leJds to decreJsed bile Jcid resorption. Bile Jcids
Jre produced in the liver Jnd excreted with bile into duodenum, reJbsorped
in ileum.
!. OxJlJte would be relJted to KIDNEY stones, not gJllstones
#'. OmeprJzole is Jn H/K ATPJse so it fuels Jctive trJnsport. Synthesis of HCL
on pJrietJl cells is dependent on the H/K ATPJse
#(. SmJll intestinJl bJcteriJl overgrowth > increJse in folJte
#). SuperficiJl inguinJl: below pectinJte. InternJl iliJc: Jbove pectinJte.
#*. Lynch: mismJtch repJir.
$+. ScopolJmine: muscJrinic JntJgonist. CJn cJuse dry mouth.
!. cough, frequent urinJtion, nJsJl congestion: chJrJcteristic of stimulJtion
(rJther thJn blockJde) of muscJrinic recepotors
$!. Chronic GI loss > microcytic JnemiJ. Fibrosis Jnd distortion of hepJtic
vJsculJture in Jlcoholic liver diseJse obstructs bloodflow through the liver >
portJl HTN. This cJn leJd to splenomegJly. Venous congestion cJuses
expJnsion of the red pulp of the spleen.
!. Other
!. ExtrJmedullJry hemJtopoesis > occurs when precursor cells Jre
displJced from the bone mJrrow
$#. SomJtostJtin for eso vJrices. Inhibits releJse of glucJgon Jnd VIP thJt
induce splJnchnic vJsodilJtion.
$$. Hemochromo - defect in Jbsorption of iron > excess.
!. Other: ethJnol cJn increJse iron Jbsorption. CJn increJse risk of
cirrhosis/HCC in pJtients w hemochromJtosis thJt Jlso drink
$%. Necrotizing enterocolitis > mostly in premies. ImpJired mucosJl bJrrier >
bJcteriJ InvJde bowel wJll. LeJds to inflJmmJtion Jnd ischemic necrosis >
intrJmurJl gJs collections.
$&. Secretin - produced by intestinJl S cells thJt increJse bicJrb secretion form
the pJncreJs. StimulJtes exocrine pJncreJtic ductJl cells thJt releJse high
volume of bicJrb-rich, chloride-poor fluid into smJll bowel
!. CCK from I cells of duodenum!!!
$'. Crypt hyperplJsiJ > celiJc
$(. ShJllow ulcerJtion > CMV. The pt hJd undergone Jn JllogrJft so wJs
immumosuppressed. IntrJnucleJr inclusion bodies
$). Right sided colon cJncer > IDA. Due to blood loss.
!. Would see grossly bloody stool w JbdominJl discomfort Jnd fJtigue
 #. Left-sided colon cJncer would infiltrJte intestinJl wJll Jnd encircle the
lumen > chJnge in bowel hJbits
$*. Crohnʼs: crJmpy JbdominJl Jpin, diJrrheJ, consittutionJl symptoms
%+. CleJr cytoplJsm > JbetJlipoproteinemiJ. AutosomJl recessive, loss-of-
function mutJtion in MTP gene. Presents in first yeJr of life w mJlJbsorption.
CJn see JcJnthocytes Jnd neJr JbnormJlity.
!. Other
!. CeliJc: Would see blunted villi Jnd inflJmmJtion of lJminJ propriJ.
#. Crohnʼs: inflJmmJtion of Jll lJyers of intestinJl wJll
2/17 Resp

!. At low p:rti:l pressure of O2 - hemoglobin is mostly deoxygen:ted, binding

of O2 is rel:tively difficult
!. As the :cidity of the hemoglobin molecule is incre:sed, protons :re
rele:sed from binding sites. Then go on to combine w bic:rb to f:cilit:te
production of H2O :nd CO2
#. Chest tube - would puncture serr:tes :nterior
$. CFTR is t:rgeted for degr:d:tion by prote:some before re:ching cell
surf:ce - c:uses :lmost complete :bsence from :pic:l membr:ne
!. Medic:tions c:n help CF its restore CFTR proteins to the membr:ne :nd
enh:nce protein function
%. Mucocili:ry cle:r:nce is responsible for removing most inh:led p:rticles -
lines the tr:che: to proxim:l portions of the respir:tory bronchioles
&. Type II pneumocytes - produce surf:ct:nt :nd prolifer:te in response to
injury
'. Pts with neck injury - lung :pices :nd pleur: extend :bove the cl:vicle :nd
first rib. St:b wounds here c:n c:use pneumothor:x
!. Other
!. Ans: cervic:lis > innerv:tes sternohyoid, sternothyroid :nd omohyoid
> peentr:ting tr:um: to the neck :bove the cricoid c:n injure this
(. Gi:rdi: infections > XLA. F:ilure of B cells to develop into circul:ting B
lymphocytes.
!. Other
!. CD15 - cell surf:ce m:rker on gr:nulocytes - Reed Sternberg cells
#. CD16 - low-:ffinity Fc receptor on NK cells, neutrophils, m:croph:ges
). Infl:mm:tion > rele:se of :r:chidonic :cid > precursor to eicos:noids
(include leukotriene B4)
!. B4 - neutrophil chemot:xis
!. LTC4, LTD4, LTE4 - c:use bronchosp:sm :nd incre:se bronchi:l
mucus secretion
#. Others
!. C3:, C4:, C5:. -infl:mm:tory :n:phylotoxins - trigger hist:mine
rele:se from m:st cells
#. TXA2 - v:socontsriction :nd pl:telet :ggreg:tion
*. Pulmon:ry hypertension :ffects young women
!. Bosent:n for pulm HTN
#. Et:nercept.- inhibits TNF :ctivity - prevents it from inter:cting w cell
surf:ce receptors. Used for RA, psori:sis
$. Indometh:cin - COX inhibitor - suppresses prost:gl:ndin synthesis
!+. Cromolyn :nd nedocromil - inhibit m:st cell degr:nul:tion
 !. Others
!. :nti-IgE - om:lizum:b - inhibits IgE binding to m:st cells
#. Zileuton - inhibits lipox p:thw:y
$. K:sts- leukotriene receptor :nt:gonists
!!. REVIEW Anemi: - norm:l O2 s:ts, low O2 content
!. High :ltitude would le:d to reduced s:ts :nd O2 content
#. Obesity - hypoventil:tion due to reduced chest w:ll compli:nce > low
P:O2, low S:O2, hyperc:pni:
$. Cy:nide - inhibits ox phos by inhibiting Fe3+ in cytochrome c oxid:se.
P:O2, S:O2, C:O2 rem:in unch:nged by venous oxygen content rises
:nd :-v oxygen gr:dient f:lls
%. CO poisoning - norm:l P:O2, decre:sed S:O2, decre:sed oxygen
!#. REVIEW Non-c:se:ting gr:nulom:s - s:rcoid. Multinucle:ted gi:nt cells
!. Dyregul:ted cell-medi:ted immune response. Driven by Th1 of CD4+ T
cells. Th1 secretes IL-2 :nd IFN-y (:ctiv:ted m:croph:ges)
!$. Antigens presented to CD8+ T cells w MHC cl:ss I - present on :ll nucle:ted
cells. E:ch h:s he:vy ch:in :nd B2 microglobulin. After penetr:ting cell,
virus unco:ts :nd rele:ses core proteins. Some :re processes in the host
cell, combined w MHC Cl:ss I (VIRAL)
!. Other
!. APCs - MHC cl:ss II. Two polypeptide ch:ins. Foreign :ntigens t:ken
up by ph:goctytosis :re degr:ded in lysosomes :nd presented to
CD4+ T cells (BACTERIAL)
!%. IgE - le:ds to rele:se of proinfl:mm:tory subst:nces
!. B2 :gonists - bronchodil:tor vi: cAMP - smooth muscle rel:x:tion
!&. Cheyne Stokes is seen in :dv:nced CHF. Gr:ud:lly incre:sing :nd
decre:sing tid:l volumes.
!. OSA - cess:tion of :irflow during sleep, but ventil:tion rem:ins const:nt
during non-:pneic periods
!'. H flu h:s : c:psule - virulence. They :lso h:ve fimbr:e th:t :llow
:tt:chment to endotheli:l cells but :re not : m:jor virulence f:ctor
!(. REVIEW LATER
!). Actinomyces - le:ds to cervicof:ci:l :bscesses c:n le:d to systemic infectio
:nywhere in the body. Fil:mentous br:nching :nd sulfur gr:nules - formed
by c:lcified myceli:l fr:gments
!*. Pts w mild mut:tions of CFTR gene c:n h:ve norm:l swe:t testing. Could
:lso me:sure n:s:l tr:ns epitheli:l difference
!. N:s:l - s:line solution is :pplied to the nose. Pts w CF h1ve incre1sed
sodium 1bsorption vi1 EN1C, sodium is :bsorbed intr:cellul:rly but
chloride in s:line solution is ret:ined in the lumen. Higher rel:tive :mts of
neg:tively ch:rged chloride > more neg:tive tr:nsepitheli:l volt:ge
difference
#+. Apic:l subpleur:l blebs - PTX
#!. Pleur:l effusion - excess fluid insul:tes vibr:tions :nd bre:th sounds >
decre:sed fremitus. Dullness to percussion.
!. But you get incre:sed fremitus with edem:???
##. Bl:stomyces c:n c:use pulmon:ry infections in immunocompetent -
endemic to Mississippi :nd Ohio river v:lleys (overl:p w histo). Fungus exists
:s : mold, found in soil, org:nic m:tter, :nim:ls. Ch:r:cterized by
gr:nulom: form:tion. Bro:d b:sed budding. Itr:con:zole for tx.
#$. In fet:l circul:tion, IVC h:s highest oxygen content. Oxygen:ted blood >
fetus vi: umbilic:l vein. Blood from umbilic:l vein (High O2) is delivered to
the liver. Byp:sses hep:tic circul:tion vi: ductus venous. From IVC, blood
delivered to the he:rt where it is pumped into pulmon:ry circul:tion or
crosses from R > L he:rt vi: for:men ov:le.
#%. Lob:r pneumo
!. Steps of pneumoni:
!. Congestion > :bund:nt protein:ceous fluid le:ks into :lveol:r sp:ce
#. Red hep:t > fluid forms protein:ceous fibrin str:nds
$. Gr:y hep:t > neutrophils :re repl:ced my m:croph:ges
%. Resolution > m:croph:ges secret digestive enzymes th:t liquify
fibrinous exud:te > re:bsorbed, lung looks norm:l :g:in :fter :bout
3 wks
&. Other
!. C:riogenic pulmonic edem: > :ccumul:tion of fluid in :lveoli due
to elev:tions in hydrost:tic pressure. “Ceph:liz:tion” of
pulmon:ry vessels.
#&. CFTR > production of hypotonic swe:t in pts without CF. Pts w CF :re un:ble
to resorb chloride :nd sodium so they secrete hypertonic swe:t > c:n le:d
to hypon:tremi: (vomitting :nd leth:rgy). S:lt supplement:tion.
#'. CFTR ch:nnel is ATP-g:ted. Opens :fter binding 2 ATP.
!. Other
!. Cyclic nucleotide-g:ted ion ch:nnels > photoreceptor :nd olf:ctory
receptor neurons
#. Mech:nic:lly g:ted > mech:nic:l deform:tion (touch :nd he:ring)
$. Volt:ge-g:ted: congenit:l long QT c:used by defect in volt:ge-g:ted
ion ch:nnel
#(. LMWH for VTE prophyl:xis
!. Others
!. B-:drenergic :nt:gonists > c:n lower risk for preoper:tive MI
#). H flu - c:psule - cont:ins PRP. Conjug:te Hib v:ccine > PRP conjug:ted to
protein toxoid
!. Other
!. Lectihin:se (toxin A) > C perfringesn
#. Treh:lose dimycol:te > M tuberculosis
#*. He:rt f:ilure > cre1tes tr1nsud1te. Exud:te h:ve high pleur:l fluid/serum
#*.
r:tio of proteins due to incre:sed c:pill:ry perme:bility, tr:nsud:te h:s low
pleur:l fluid/serum r:tio.
!. Light criteri: (for exud:te)
!. Fluid protein/ serum protein > 0.5 OR
#. Fluid LDH/serum LDH > 0.6
#. Leukocytes consume glucose, so high infl:mm:tory effusions typic:lly
h:ve low glucose levels.
$. Exud:te from infection, m:lign:ncy.
$+. V/Q mism:tch from PE
!. Others
!. Alveol:r hypoventil:tion > glob:l decre:se in p:rti:l pressure of
oxygen c:used by decre:se in tid:l volume/resp r:te
#. Decre:sed blood-oxygen c:rrying c:p:city c:n occur due to post-op
bleeding
$. Hypoxemi:: defect th:t imp:irs g:s diffusion between :lveoli :nd
pulm c:pill:ries
$!. El:stic resist:nce :nd :irflow resist:nce
!. Deets
!. Restrictive = higher el:stic resist:nce
#. Obstructive = higher :irflow resist:nce
$. Restrictive lung dise:se - WOB minimized tid:l volume low > r:pid
sh:llow bre:thing is f:vored
%. A1-:ntitrypsin deficiency c:uses p:n:cin:r emphysem:
&. Obstructive > incre:sed :irflow resist:nce > slow deep bre:ths
$#. Humor:l :g:inst hem:gglutinin - most import:nt source of protection
$$. Strep pnemo - polys:cch:ride c:psule - resist ph:gocytosis
!. Others
!. Shig: - interferes w protein synthesis
#. Mycob:cteri: - prevents ph:golysosome fusion
$. B:cillus :nd Clostridium - spores
$%. Serpentine cords - prescience of cord f:ctor. Prevent m:croph:ge-medi:ted
destruction :nd is the m:in virulence f:ctor.
!. Others
!. Mycolic :cid - :cid-f:stness
$&. A1AT deficiency - homozygous for Z :llele. Most develop p:n:cin:r
emphysem: due to unchecked destruction of inter :lveol:r sept: (cont:in
l:rge :mounts of el:stin). C:n develop liver dise:se due to intr:hep:tocyte
:ccumul:tion of AAT molecules, dise:se c:n progressiveʼs to cirrhosis.
Intr:cellul:r gr:nules w unsecreted AA st:in with PAS.
!. Others
!. Intr::lveol:r subst:nce :ccumul:tion: p:rt of :lveol:r proteinosis
$'. Silicosis - surrounded by whorled, coll:genous nodules surrounded by dust-
l:den m:croph:ges
 !. Eggshell c:lcific:tions in the upper lobes
#. Others
!. Would see nonc:se:ting gr:nulom:s w berylliosis
$(. GET THE S PNEUMO VACCINE -comes from most dise:se-c:using
serotypes.
!. Pneumococc:l polys:cch:ride or conjug:te v:ccines
$). A1AT is obstructive (e:rly onset emphysem:). Inhibits -FEV1 is decre:sed,
decre:sed DLCO due to destruction of :lveoli :nd :djoining c:pill:ry beds.
$*. IVDU - tricuspid v:lve endometri:lcrdits. C:n le:d to emboliz:tion of the
veget:tions :nd c:use pulmon:ry inf:rcts. Typic:lly wedge-sh:ped due to
tri:ngul:r perfusion field of sm:ll :rteries :t lung periphery. Typic:lly
hemorrh:gic.
%+. Neon:t:l RDS - l:ck of surf:ct:nt, :lveoli will coll:pse.
2/18 C-rdio (1) - Ankiʼed

!. Mitr-l stenosis > di-stolic pressure in LV is ne-r norm-l or c-n be decre-sed

w severe stenosis
!. INCREASED LV pressure would me-n th-t the -ortic v-lve is -lso
dysfunction-l
!. Rheum-tic he-rt dise-se c-n -ffect mitr-l -nd -ortic v-lves in -bout
25% of c-ses
#. Others - ISOLATED MS
!. Severe, ISOLATED MS c-n c-use incre-sed pulmon-ry -rtery
pressure -nd elev-ted pulm c-p wedge pressure.
!. Longst-nding pulm HTN c-n result in reduced pulm v-scul-r
compli-nce due to endotheli-l-medi-ted pulm v-soconstriction
#. MS c-n elev-te left -tri-l pressure, tr-nsmit to pulm veins -nd
c-pill-ries
$. RV hypertrophy c-n h-ppen when the pulm HTN is severe enough to
c-use right he-rt f-ilure
#. WPW - tri-d
!. Deets
!. Shortened PR
#. Widened QRS
$. Slurred -nd bro-d initi-l upstroke of QRS (delt- w-ve)
#. Others
!. Afib - triggered by r-pid electric-l impulses origin-ting in pulm veins
#. Atri-l p-cem-ker/ectopic -tri-l rhyth - c-n h-ve ectopic -tri-l foci
th-t repl-ce sinus node -s domin-nt p-cem-ker
$. W-rf-rin - monitor w PT -nd INR (r-tio of PT to control)
%. TP = Sensitivity x number of pts w dise-se
!. 75% will be true positive
#. 25% will be f-lse neg-tive
&. C-rdi-c venous blood dr-ins into RA vi- coron-ry sinus
!. Deets
!. Left ventricle is only perfused during di-stole
#. Myoc-rdi-l oxygen extr-ction is higher th-n skelet-l muscle
$. Myoc-rdi-l oxygen dem-nd -nd coron-ry blood flow -re coupled.
Oxygen extr-ction by the resting he-rt is -lre-dy high, so there is
little c-p-city to incre-se myoc-rdi-l oxygen extr-ction during
periods of incre-sed oxygen dem-nd.
#. Others
!. Deoxygen-ted systemic blood returning vi- ven- c-v- cont-ins more
oxygen th-n coron-ry sinus venous blood. Cont-ins - mixture of
 !.

blood returning vi- coron-ry sinus -nd systemic venous circul-tion >
higher O2 content th-n just venous blood.
^. Orthost-tic HTN
!. St-nding > pooling of blood. Dec VR, Dec CO, Dec BP. Would c-use
incre-sed symp-thetic tone in norm-l, but if using -lph- blocker, donʼt
see incre-se in BP
#. Others
!. D1 receptors - in w-lls of ren-l, spl-nchnic, mesenteric blood vessels
_. Common femor-l -rtery for c-rdi-c c-th, c-n risk retroperitone-l
hemorrh-ge. C-nʼt be controlled by extern-l compression
!. Others
!. Pelvic c-vity bleed - gynecologic or tr-um-
#. Subcut-neous tissue bleed - ecchymosis -nd hem-tom-
$. Bleed into thigh muscles > p-in -nd edem-, potenti-l comp-rtment
syndrome
`. CCBs
!. Deets
!. Dihydropyridines - -ffect -rteri-l smooth muscles
!. C-n c-use reflex t-chyc-rdi- in response to peripher-l
v-sodil-tion
#. Nondihydropyridines - -ffect myoc-rdium - slow HR
#. Others
!. Ver-p-mil -nd dil-tizem c-n worsen AV block
#. Metoprolol -nd st-ll c-n worsen br-dyc-rdi-n -nd AV block
a. Enterococc-l endoc-rditis - c-n come from GU tr-ct (-lso GI or obstetric
procedures)
!b. T-k-y-su
!. Lower extremity cl-udic-tion -nd constitution-l symptoms. L-rge -rtery
v-culitis. Young Asi-n women. Gr-nulom-tous infl-mm of v-scul-r medi-
!. C-n -lso -ffect ren-l -rteries -nd -bdomin-l -ort-
#. Infl-mm-tion of dist-l -ort- -nd proxim-l ili-c vessels > vessel
n-rrowing -nd limb cl-udic-tion
$. C-n look like gi-nt-cell -rteritis but gi-nt cell is mostly old l-dies.
#. Others
!. R-yn-ud - ex-gger-ted smooth muscle contr-ction
#. Atherosclerosis - lipid-rich deposits in l-rge -nd medium -rteries
$. PAN - necrotizing infl-mm of medium -rteries
%. Buerger - segment-l, thrombosis of medium -nd sm-ll -rteries (esp
tibi-l -nd r-di-l)
!!. Acute rejection: dense lymphocytic infiltr-te
!. Other
!. Periv-scul-r infiltr-te: hypersensitivity myoc-rditis (c-n occur -fter
initi-ting - new drug)
 #. Sc-nt infl-mm-tion > chronic rejection
!#. Acute decompens-ted HF - reduced c-rdi-c output -nd excessive
ventricul-r filling pressures
!. Reduced CO triggers neurohumor-l stimul-tion - m-int-in BP -nd tissue
perfusion. Incre-sed symp-thetic stim.
#. So even though he doesnʼt h-ve high BP, he still is suffering from the
effects of excess SNS stimul-tion due to the HF
!$. Exercise incre-ses MAP but to - much lower extent th-n over-ll decre-se in
systemic v-scul-r resist-nce
!. Due to -rteriol-r v-sodil-tion in -ctive skelet-l muscles - loc-l rele-se of
-denosine, K+. CO2, l-ct-te
#. Others
!. LVEDV -nd pressure both rise during exercise - incre-se in filling -nd
incre-se venous return from peripher-l v-soconstriction
#. Pulmon-ry -rtery systolic pressure rises but the rise in pulm pressure
is much sm-ller th-n incre-se in blood flow -cross pulm circul-tion
(due to f-ll in pulm v-scul-r resist-nce)
!%. Dystrophic c-lcific-tion - occurs in necrosis. H-llm-rk of cell injury -nd
de-th. Norm-l c-lcium levels. Le-ds to form-tion of ps-mmom- bodies.
Endotheli-l -nd fibrobl-st de-th second-ry to chronic hemodyn-mic stress.
!. Others
!. Amyloidosis is not -ssoci-ted w c-lcific-tion of the -ortic v-lve
!&. Afferent limb of c-rotid sinus reflex: CN IX. Efferent limb: CN X
!^. Neprilysin: met-lloprotein-se th-t cle-ves -nd in-ctiv-tes ANP -nd BNP.
Meds th-t t-rget it le-d to incre-sed -ctivity of NPs -nd ATII - good for HF.
But it -lso in-ctiv-tes ATII so it must be combined w ATII receptor blocker.
!_. Gre-t s-phenous vein - inferol-ter-l to pubic tubercle. Termin-tes ne-r
femor-l tri-ngle
!`. Turner -nd co-rc cool
!. Digeorge c-n le-d to interrupted -ortic -rch
!a. Erythromycin inhibits cytochrome P450 - so c-uses incre-sed levels of
st-tin > c-n le-d to myop-thy.
!. Inhibitors (sickf-ces.com (s=sodium v-lpro-te) when I Am(iod-rone)
drinking gr-pefruit juice)
#. Phenytoin, rif-mpin, griesofulvin - inducers (Most chronic -lcoholics ste-l
phen(twin)-phen(b-rb) -nd Never refuse gre-sy c-rbs
#b. Remember th-t the venous jugul-r tr-cing b-sic-lly goes in -lph-betic-l
order
!. -, c, x, (v), y
!. - = Atri-l contr-ction
#. C = RV Contr-ction (bulging of tricuspid v-lve into RA in e-rly systole)
$. x = -tri-l rel-X-tion
%. v = RV “villing”
 &. Y = RA (emptYing)
#!. C-lcified peric-rdium - constrictive peric-rditis. R-pid y descent th-t
becomes deeper -nd steeper during inspir-tion is usu-lly observed (white
brim in sketchy p-th)
##. St-nford A (-scending) - usu-lly origin-te in the sinotubul-r junction.
St-nford B (descending) - usu-lly from left subcl-vi-n.
#$. STEMI - fully occlusive pl-que. 80% st-ble -ngin-. 50% prob-bly
-symptom-tic.
#%. Decompens-ted HF c-n le-d to second-ry mitr-l regurg. (Prim-ry is due to -
defect of the mitr-l v-lve itself)
!. Second-ry results from dil-tion of mitr-l v-lve -nnulus -nd stretching of
chord-e tendin-e > insufficient closure.
#&. COPD > right HF (cor pulmon-le) > incre-sed centr-l venous pressure -nd
excessive c-pill-ry hydrost-tic pressure. B-l-nced by lymph-tic dr-in-ge.
Incre-sed fluid tr-nsud-tion r-ises interstiti-l hydrost-tic pressure >
incre-sed lymph-tic dr-in-ge.
!. Others
!. He-rt f-ilure would le-d to incre-sed -ldo. Slightly counter-cted by
ANP/BNP rele-se but -ldo levels -re still elev-ted
#^. ACEis -nd chronic cough cool. It c-n be - sign of c-ncer but she doesnʼt
h-ve -ny sx
#_. Whoops - middle MENINGEAL is - br-nch of the m-xill-ry. Fr-cture of
pterion - front-l, p-riet-l, tempor-l -nd spheroid bones conjoin. Bone is thin
here -nd prone to fr-cture.
#`. QT prolong-tion is most frequently c-used by cl-ss IA -nd III, -ntibiotics,
meth-done, -ntipsychotics.
#a. Beriberi - dry or wet
!. Dry - peripher-l neurop-thy of dist-l extremities
#. Wet - c-rdi-c involvement
$. CNS involvement in -lcoholics
$b. ARBs bind to ATII receptors -nd block ATII effects > v-scul-r smooth muscle
rel-x-tion -nd decre-sed -ldo secretion. ACE function rem-ins int-ct so -ll
upstre-m products get elev-ted (renin, ATI, ATII). No ch-nge in br-dykinin
!. Contr-st to ACEIʼs - decre-se ATII -nd -ldo, incre-se br-dykinin
$!. Digoxin - inhibits N-/K pump - decre-sed sodium efflux, incre-sed
intr-cellul-r sodium. Le-ds to second-ry decre-se in c-lcium efflux.
Incre-sed binding to troponin C, subsequent -ctin-myosin cross-bridge
form-tion > incre-sed contr-ctility
$#. A-BEAM: B1 selective. Prevent -dverse pulm effects.
!. Bet- blockers -re contr-indic-ted in he-rt block, hypotension, he-rt
f-ilure (pulm edem-)
$$. Type I coll-gen c-n form second-ry to MI. Prim-ry coll-gen in m-ture sc-rs.
!. Other
 !. Gr-nul-tion tissue - type III coll-gen - seen 7 d-ys -fter MI but is
repl-ced w Type I -fter inf-rct m-tures.
$%. Alph- I -gonist would c-use v-soconstriction -nd reflex decre-se in stroke
volume -nd he-rt r-te. Pulse pressure is decre-sed bc of reflex decre-se in
stroke volume -nd incre-sed -fter lo-d.
!. Others
!. Dobut-mine - incre-sed he-rt r-te -nd contr-ctility - B1 -gonist.
#. Isoproternol - non-selective B--drenergic -gonist. Decre-ses
v-scul-r resist-nce -nd di-stolic BP, incre-ses c-rdi-c r-te -nd
output -s well -s pulse pressure.
$. Epi would incre-se everything
$&. Bubble study ev-lu-tes for R-to-L shunts. Cryptogenic stroke is -ssoci-ted
w -tri-l sept-l -bnorm-lities like PFO -nd ASD.
!. After delivery, cord cl-mping -nd decre-sed pulm v-scul-r resist-nce
lower RA pressure -nd r-ise LA pressure - pushes septum premium
-g-inst septum secundum. Incomplete fusion in -bout 25% of -dults.
#. Usu-lly rem-ins closed but c-n open -g-in when RA pressure is r-ised
-bove LA pressure. Concerning in pts w hypercogu-bility
$^. F-tty stre-ks - seen in childhood.
!. Sequence
!. Endotheli-l injury/dysfunction
#. Monocyte -dhesion to endothelium, then migr-tion -nd
tr-nsform-tion to lipid-l-den m-croph-ges
$. Rele-se of growth f-ctors
%. Recruitment of T cells -nd smooth muscle prolifer-tion
$_. RCA occlusion - elev-tions in II, III, -VF
!. others
!. LAD - elev-tion in V1 -nd V2 (c-n slo le-d to infr-nod-l second or
third degree he-rt block)
#. Proxim-l LAD - V1-V4
$. LCX - le-ds V5 -nd V6, possibly I -nd -VL
$`. Uniformly thickened LV w-ll -nd sm-ll LV c-vity - concentric LV hypertrophy
- from systemic hypertension - c-n clinic-lly m-nifest -s hypertensive he-rt
dise-se - imp-ired di-stolic filling -nd he-rt f-ilure w preserve ejection
fr-ction. Would see tr-nsverse thickening of c-rdiomyocytes with prominent
hyper chrom-tic nuclei -nd interstiti-l fibrosis.
!. HCM - would see myocyte dis-rr-y
$a. Squ-tting - incre-ses pulmon-ry resist-nce. Pulmonic stenosis -nd
overriding -ort- - low r-tio of SVR:PVR. Allows deoxygen-ted blood RV
output to t-ke low-resist-nce route to systemic circul-tion > -cute
hypoxemi-.
!. Tet spell - squ-tting incre-ses SVR without ch-nging PVR - incre-ses
SVR:PVR r-tio. Incre-sed SVR > higher proportion of RV output to enter
 !.

pulmon-ry circul-tion -nd oxygen-te pulm c-p beds - more oxygen-tion,

severity of Tet spell is decre-sed
%b. Stroke vol = EDV - End systolic volume
!. Ejection fr-ction = SV/EDV
2/18 C/rdio (2)

!. Elev/ted levels fo pl/sm/ homocysteine > independent risk f/ctor for

thrombotic events. Thought to be from direct/indirect induction of
endotheli/l d/m/ge.
!. Homocysteine c/n be met/bolized to methonine vi/ remethyl/tion OR go
to cyst/tionine vi/ tr/nssulfur/tion, then cysteine. (With cyst/thionine
synth/se /nd vit B6 /s / cof/ctor)
#. Remethyl/tion occurs w don/tion of methyl group from methyl-THF vi/
methionine synth/se w vit B2 /s cof/ctor.
$. Others
!. Vit B12 is cof/ctor for methylm/lonyl-CoA mut/te in conversion of
methylm/lonyl-CoA to succinyl-CoA. So, c/n h/ve elev/ted
methylm/lonyl CoA levels in vit B12 deficiency > le/d to buildup of
neurotoxic mthylm/lonic /cid
#. Meiotic nondisjunction: m/in c/use of Down syndrome. Also Edw/rds /nd
P/t/u.
$. Two s/mple t test: used to determine if me/ns of 2 popul/tions /re equ/l.
This w/s looking /t the levels of homocysteine in two popul/tions.
%. In tr/nspo - the /ort/ is /nterior. Inferior, /nd to the right of pulmon/ry
/rtery
!. Line/r, r/ther th/n spir/l development of /orticopulmon/ry septum in
utero
#. Other
!. Persistent trunks /rteriosus: presents w cy/nosis /nd resp distress.
Echo shows single /rteri/l trunk overriding l/rge VSD
&. St/ph /ureus > right sided endoc/rditis in IVDUs. C/n c/use perfor/tions in
he/rt v/lves, rupture chord/e tendin/e, sends septic emboli to the lung
!. strep viridi/ns: most common /gent in endc/rditis following dent/l work.
'. Pts w st/ble /ngin/ should be st/rted to decre/se risk of /dverse
c/rdiov/scul/r events, but /spirin c/n ex/cerb/te existing resp sx.
!. Clopidogrel is the /ltern/tive - blocks P2Y12 component of ADP receptors
/nd prevents pl/telet /ggreg/tion. As effective /s /spirin
(. /cute pulmon/ry edem/ due to severely elev/ted blood pressure >
hypertensive emergency. Tx w IV v/sodil/tors - reduce prelo/d /nd /fter
lo/d.
!. Nitr/tes > NO. Activ/te gu/nyl/te cycl/se: converts GTP to cGMP.
Incre&sed cGMP le&ds to decre&sed intr&cellul&r c&lcium. Promotes
myosin light-ch/in DEphosphoryl/tion /nd muscle rel/x/tion
#. Silden/fil inhibits phosphodiester/se
!. Inhibiting phosphodiester/se le/ds to v/sodil/tion
 d. MI /fterm/th
!. Timeline
!. 0-4 hrs: no visible ch/nge
#. 4-12 hrs: w/vy fibers
$. 12-24 hrs: myocyte hypereosinophili/ w pyknotic nuclei
%. 1-3 d/ys: co/g necrosis, prominent neutrophil infiltr/te
&. 3-7: disintegr/tion of de/d neutrophils, m/croph/ge infiltr/tion /t
border /re/s
'. 7-10: robust ph/gocytosis of de/d cells by m/croph/ges, gr/nul/tion
tissue st/rts to form
(. 10-14 d/ys: well-developed gr/nul/tion tissue
d. 2 week-2 months: progressive coll&gen deposition
#. Sudden c/rdi/c de/th from MI: most likely due to ventricul/r /rythmi/s
!. D/m/ged tissue is repl/ced by gr/nul/tion tissue /nd
neov/scul/riz/ton during second week post-MI
e. Long PT: f/ctor VII deficiency (extrinsic p/thw/y). Could still h/ve p/inful
joint swelling from minor tr/um/.
!. Hem/rthroses /nd excessive bleeding indic/te co&gulop&thy: ie clotting
f/ctor deficiency (where/s pl/telet defects = mucocut/neous bleeding)
#. Other
!. F/ctor VIII - norm/l bleeding time, norm/l PT, prolonged /PTT
!f. Bl/nching of / vein in which NE is being infused w indur/tion /nd p/llor of
tissues = NE extr/v/s/tion
!. NE le/k c/uses intense /1 receptor medi/ted v/soconstriction which c/n
le/d to loc/l tissue necrosis. Prevent necrosis by infiltr/tion w
phentol/mine (/1 blocker). Antidote must be given w/in 12 hours to be
effective.
!!. AV node c/n become p/cem/ker when conduction between SA /nd AV is
imp/ired. C/n occur in 3rd degree he/rt block.
!#. Dyspne/, LE edem/, JVD, Pulmon/ry cr/ckles > decompens/ted he/rt
f/ilure. If it follows vir/l prodrome - DCM due to vir/l myoc/rditis is usu/lly
c/use
!. Other
!. Systolic /nterior motion of mitr/l v/lve c/n worsen LV outflow tr/ct
obstruction w HCM
!$. hemosiderin l/den m/croph/ges from decre/sed LV systolic function (he/rt
f/ilure). Elev/ted pulm venous pressure > tr/nsud/tion of fluid /cross
/lveol/r-c/pill/ry membr/ne (pulm edem/) /nd c/n c/use bre/ks in
endothelium w extr/v/sion of RBCs into /lveoli /nd lung p/renchym/
!. other
!. Neutrophil el/st/se-medi/ted /lveol/r sept/l destruction >
emphysem/
!%. Abnorm/l incre/se in oxygen s/tur/tion between RA /nd RV > left to right
!%.
shunt from VSD
!. Incre/sed blood oxygen in 2 right sided vessels or ch/mbers = L to R
shunt
#. Right ventricul/r SpO2 incre/ses but left ventricul/r SpO2 rem/ins
rel/tively norm/l
$. Turbulent blood flow /cross sm/ll VSD > loud holosystolic murmur best
he/rd over left LSB. VSD c/n /lso le/d to WIDE splitting of S2 due to
incre/se RV volume > del/yed closure of pulm v/lve
!&. L type c/lcium ch/nnels in skelet/l muscle directly inter/ct w RyR ch/nnels -
mech/nic/l coupling /llows s/rcopl/smic c/lcium rele/se to occur w/o
signific/nt influx of c/lcium /cross pl/sm/ membr/ne
!. Other
!. El/bor/te T tubule system > present in skelet/l /nd c/rdi/c muscle
but not smooth muscle but I guess this doesnʼt h/ve /nything to do
with the question
!'. Mitr/l regurgit/tion /nd mitr/l stenosis c/n both result from rheum/tic he/rt
dise/se. Mixed dise/se c/n /lso h/ppen.
!. Other
!. ASD m/y not h/ve /udible murmur, but those with incre/sed L to R
shunt m/y h/ve systolic ejection murmur.
!(. Decre/sed compli/nce > incre/sed LVED /t s/me LVED volumes
!. Restrictive c/rdiomyop/thy (/myloidosis, s/rcoidosis, hemochrom/tosis)
is impt c/use of di/stolic he/rt f/ilure (/k/ HFpEF)
!. TTR mut/tions - c/n produce /myloid th/t infiltr/tes myoc/rdium
#. Others
!. Alcoholic, doxorubicin, selenium, vir/l myoc/rditis > c/n le/d to
LV systolic dysfunction
#. Incre/sed LV volume /nd shifting pressure-volume to right due to
thinning of ventricul/r w/ll
!d. Low dose /spirin inhibits COX-1, prevents pl/net synthesis of TXA2.
!. 2 mech/nisms of incre/sed GI bleed risk
!. Inhibition of pl/telet /ggreg/tion
#. Imp/ired prost/gl/ndin-dependent GI mucos/l protection
#. Other
!. High doses - s/licyclism (vertigo, tinnitus, he/ring loss) /nd
hyperpne/ (stimul/tes respir/tory drive > le/ds to resp /lk/losis,
where/s systemic /ccumul/tion le/ds to met/bolic /cidosis)
!e. II, III, /vF = RCA = inFerior surf/ce of he/rt. 85-90% of people h/ve right
domin/nt circul/tion > RCA gives rise to PDA (supplies posterior 1/3 of IV
septum /nd most of inferior w/ll)
!. Others
!. Other 10% - PDA derives from LCX (left domin/nt circul/tion)
#. LAD - norm/lly supplies /nterior 2/3 of IV septum (sept/l br/nches)
 $. LCX - l/ter/l /nd posterior superior w/lls of LV vi/ obtuse m/rgin/l
br/nches
#f. E/rly post-MI peric/rditis = peri-inf/rction; L/te = Dressler
!. Peri-inf/rction develops in 10-20% of pts between 2 /nd 4 d/ys /fter
tr/nsmur/l MI. Re/ction to necrosis od myoc/rdium ne/r epic/rdi/l
surf/ce
#!. Atherosclerosis - endotheli/l cells, v/scul/r smooth muscle cells,
leukocytes. Incre/sed expression of surf/ce v/scul/r cell-/dhesion
molecules - /llow /dherence /nd migr/tion of monocots.
!. Rele/se cytokines /nd growth f/ctors. Promote migr/tion /nd
prolifer/tion of VSMCs. Stimul/ted to synthesize ECM proteins th/t form
fibrous c/p.
#. other
!. Fibrobl/sts /re found in the tunic/ intim/l /nd /re not re/lly involved
w /therosclerosis
##. HCM - reduced LV c/vity size, /symmetric incre/se in LV w/ll thickness,
norm/l or incre/sed LV EF, left /tri/l enl/rgement second/ry to LV EDP
#$. Sudden onset syncope > c/rdi/c /rrythmi/. QT prolong/tion in he/lthy
individu/l is usu/lly congenit/l. Refects c/rdi/c myocyte /ction potenti/l
dur/tion > determined in p/rt by K+ currents through ch/nnel proteins.
!. Other
!. Mut/tion in bet/ myosin he/vy ch/in > underlies HCM
#. Mut/tion in c/rdi/c cytoskelet/l proteins > c/use dil/ted CM
#%. Posteromei/l p/pill/ry muscle rupture > compromised flow thru posterior
descending (br/nch of RCA)
#&. Bicuspid v/lve > h/rsh crescendo-descrescendo. Most common c/use of
/ortic stenosis in US.
#'. Right middle lobe of lung lies immedi/tely /dj/cent to right border of he/rt.
Postero/nterior - right /trium occupies most of the sp/ce
#(. AV node: /t inter/rteri/l septum ne/r opening of coron/ry sinus. Commonly
involved in /tri/l fibrill/tion. C/n /lso be ne/r opening of pulmon/ry veins in
LA (but this is not where the AV node is loc/ted so not the correct /nswer)
!. For/men ov/le = fet/l opening between right /nd left /tri/
#d. Fenoldop/m - dop/mine /gonist - incre/ses cAMP > v/sodil/tion of /rteri/l
beds w decre/se in systemic blood pressure. Ren/l v/sodil/tion is prominent
> incre/sed ren/l perfusion, diuresis, n/tiruesis.
!. Hydr/l/zine is NOT often used in hypertensive emergency - /ssoci/ted w
reflex symp/thetic /ctiv/tion.
#e. REVIEW
!. M/inten/nce dose = Cp(ss) x CL / bio/v/il/blitly
!. Administered IV > bio/v/il/bility = 1
$f. Dilti/zem /nd ver/p/mil > supr/ventricl/r /rrythymi/s (/tri/l flutter, AF,
p/roxysm/l supr/ventricu/lr t/chyc/rdi/). Blocks L-type c/lcium ch/nnels.
$f.

Decr/sed ph/se 0 depol/riz/tion /nd conduction velocity. Slows sinus r/te

/nd conduction thru AV node > c/n c/use AV block
!. Other
!. Non-Selective BBʼs (prop/nolol) c/n imp/ir bronchodil/tion -
contr/indic/ted in /sthm/ p/tients
$!. CHF - hypertension c/n le/d to deleterious c/rdi/c remodeling. BUT ACEis
/nd ARBS h/ve mort/lity benefit. Protective effect on remodeling.
$#. V/scul/r endothelium: v/sodil/tion medi/ted by ACh, br/dykinin, subst/nce
P, she/r forces. Activ/tes nitric oxide synth/se which synthesizes NO from
/rginine, NADPH, /nd O2. NO then diffuses to smooth muscle cells >
/ctiv/tes gu/nlyl cycl/se /nd incre/ses cGMP form/tion
!. Reduces cytosolic c/lcium levels /nd rel/x/tion of v/scul/r smooth
muscle
$$. Constrictive peric/rditis > thick, fibrous tissue in peric/rdi/l sp/ce. Would
see elev/ted JVP, peric/rdi/l knock (e/rly di/stolic sound before S3), pulsus
p/r/doxes.
!. Kussm/ul sign c/n present bc decre/se in intr/thor/cic pressure during
inspir/tion incre/ses venous return to the right side of the he/rt /nd
lowers JVP
!. but w rigid peric/rdium, right side of the he/rt c/nʼt /ccommod/te
venous return > p/r/doxic/l rise in JVP during inspir/tion
#. Other
!. Sust/ined left p/r/stern/l lift - RVH (chronic right ventricul/r
pressure overlo/d)
$%. Di/stolic HF due to restrictive CM. C/rdi/c /myloidosis (AL /myloidosis,
mut/ted tr/nsthyretin) or wild-type tr/nsthyreitn (Senile systemic
/myloidosis). Cross section of /morphous /nd /cellul/r pink m/teri/l.
!. Others
!. S/rcoid - would see gr/nulom/s
$&. Bet/ blockers will decre/se renin rele/se AND reduce myoc/rdi/l
contr/ctility > lower blood pressure.
!. Other
!. Block /ction of endogenous c&techol&mines on /drenergic bet/
receptors but h/ve no signific/nt effect on circul/ting c/techol/mine
levels
$'. MI - decre/sed contr/ctility - isol/ted ch/nge in c/rdi/c output curve
!. TPR will /ffect slop of venous return /nd c/rdi/c output curves
$(. Cortisol h/s no direct v&so&ctive properties but &ugments
v/soconstrictive effects of c/techol/mines = permissiveness - occurs when
one hormone /llows /nother to exert m/xim/l effect
!. Others
!. Combined effect of 2 drugs = sum of individu/l effects = /dditive
response
 #. Combined effect exceeds sum of individu/l drugs = synergistic
$. T/chyphyl/xis - decre/sed drug responsiveness in short period
following one or more doses (r/pidly developing toler/nce)
$d. Pl/telet derived growth f/ctor = derived from pl/telets, /ctiv/ted
m/croph/ges, endotheli/l cells. Triggers smooth muscle recruitment from
medi/ /nd prolifer/tion from intim/l.
!. Smooth muscle cells encour/ge pl/que st/bility by synthesizing coll/gen,
/ctiv/ted infl/mm/tory cells bre/k down coll/gen /nd contribute to
pl/que inst/bility
#. HDL c/n extr/ct lipids from intim/l /nd slow /therom/ development
$e. Elev/ted PCWP. Me/sures LA pressure.
!. During norm/l di/stole - LA pressure is ne/rly equ/l to LVEDP /s open
mitr/l v/lve offers minim/l resist/nce BUT if there is mitr/l stenosis,
resist/nce to blood flow incre/ses LA pressure > incre/sed PCWP
#. Other
!. Aortic stenosis c/n c/use LVEDP /nd PCWP to elev/te but they would
rem/in in /pprox the s/me r/nge
#. C/rdi/c t/mpon/de - equ/liz/tion of /ver/ge intr/c/rdi/c di/stolic
pressure
$. REMEMBER
!. Dil/ted CM: systolic dysfunction (imp/ired ventricul/r
contr/ctility)
#. Restrictive: di/stolic dysfunction (ventricle c/nʼt fill bc is
RESTRICTED)
%f. Engorged /lveol/r c/pill/ries /nd incre/sed pulmon/ry venous pressure w
pink, /cellul/r m/teri/l in /lveoli - tr/nsud/tion of fluid /cross /lveol/r-
c/pill/ry membr/ne. Acute pulm edem/ from incre/sed /lveol/r c/pill/ry
hydrost/tic pressure from left-sided he/rt f/ilure
!. Likely DCM from chronic /lcohol /buse
2/19 Mixed (20 q)

!. Multiple meds th@t h@ve incre@sed f@ll risk (psychotropic, c@rdiov@scul@r,

@nti-infl@mm@tory)
!. She is on @mytriptyline @nd di@zep@m (long-@cting benzo). Both @re
@ssoci@ted w incre@sed f@ll risk
#. Dip@lmitoyl phosph@tidylcholine (=lecithin) is @ m@jor component of
pulmon@ry surf@ct@nt. Could give mo corticosteroids to incre@se fet@l
surf@ct@nt production
$. Rel@tive risk = @/(@+b) / c/(c+d)
%. R@dioimmuno@ss@y > @ntibodies @re @tt@ched to @n @ss@y pl@te. Fixed @mp
of r@dio l@beled @ntigen @nd unl@beled @ntigen @re @dded, then the thing is
w@shed to remove unbound @ntigens. If there is no ch@nge in r@dio@ctivity,
@ntigen c@nʼt bind the @v@il@ble @ntibodies > no epitopes.
!. If they h@d the s@me epitopes, they would compete for biding sites @nd
the @mt of r@diol@beld @ntigen disc@lced would be proportion@te to the
@mt of @ntigen @dded. Incre@sed @mt of @ntigen @dded > decre@sed
r@dio@ctivity @s it binds.
&. Genetic code is “degener@te” bec@use more th@n 1 codon c@n code for @n
@mino @cid (both CUC @nd CUU code for leucine). Third wobble nucleotide
position m@y undergo less stringent (nontr@dition@l) b@se p@iring.
'. Isol@ted systolic blood pressure with norm@l di@stolic BP = isol@ted systolic
HTN. Responsible for 60-80% of HTN in older people.
!. Endotheli@l dysfunction. Decre@sed el@stin, incre@sed coll@gen deposition
(. Concentric LVH w imp@ired di@stolic functioning (HFpEF)
!. Decre@sed compli@nce, incre@sed ATII, incre@sed c@rdi@c myosin he@vy
ch@in bet@ expression.
!. LV overlo@d incre@ses expression of genes coding for s@rcomere.
Addition@l contr@ctile fibers @dded in p"r"llel.
#. LV is noncompli@nt > le@ds to reduced CO @nd decre@sed ren@l
perfusion
#. Other
!. Incre@sed LV compli@nce, ATII @nd bet@ myosin > reduced EF.
Contr@ctile fibers @dded in series r@ther th@n p@r@llel. Occurs in
response to VOLUME overlo@d, not pressure overlo@d. Dil@tion of LV
w incre@sed compli@nce.
). Histone H1 is the outside core molecule. Binds the linker segments of DNA
th@t lie between nucleosomes @nd f@cilit@te nucleosome p@ck@ging.
!. E@ch histone core is m@de up of 8 histone proteins: 2 x H2A, H2B, H3 @nd
H4.
*. HPV c@n le@d to str@tified squ@mous epithelium. Only true voc@l cords @re
 *.
covered w str@tified squ@mous
!. Inf@nts c@n get respir@tory p@pillom@tosis while p@ssing thru birth c@n@l
!n. Bord@tell@ pertussis = gr@m-neg@tive coccob@cillus
!. C@t@rrh@l ph@se = resembles @n URI
#. P@ryoxysm@l ph@se = coughing @nd post-jussive emesis
$. Conv@lescent = cough improves
!!. Projection: mis@ttributing thoughts or feelings to @nother person to @void
@cknowledging them
!. He is projecting his feelings onto his p@rents @nd so he feels like his
p@rents @re @ngry with him
!#. Trigemin@l exists mid pons @t the level of the middle cerebell@r peduncles.
Motor nucleus is loc@ted in the l@ter@l mid-pons
!. Inf@rctions of @nterior pons @ffect corticospin@l tr@ct (centr@l@ter@l
hemip@resis, b@binski sign) @nd corticobulb@r tr@ct (contr@l@ter@l f@ci@l
p@lsy)
#. Sp@ring of the forehe@d indic@ted th@t f@ci@l we@kness is due to @ centr@l
lesion of the corticobulb@r tr@ct @nd is not due to d@m@ge of f@ci@l
nucleus
!$. Medi@n nerve
!. Deets
!. Goes between flexor digitorum superfici@lly @nd profundus
#. Courses between humer@l @nd uln@r he@ds of pron@tor trees muscle.
Enters h@nd w/in flexor retin@culum
!%. 21 b hydroxyl@se deficiency- s@lt w@sting, deficient cortisol @nd @ldo
synthesis combined w @dren@l @ndrogen overproduction
!. M@les: norm@l genit@li@, present w vomtting, hypotension, hypon@tremi@,
hyperk@lemi@ @fter birth
#. Fem@les present w @mbiguous genit@li@
!&. Cells incre@sed in COPD: neutrophils, m@croph@ges, CD8+ T cells. Rele@se
enzymes @nd prote@ses, such @s neutrophil el@st@se th@t c@use @lveol@r
d@m@ge. CD8+ destroy @lveoli.
!. Other
!. M@st cell disorders: flushing @bdomin@l discomfort, respir@tory
symptoms - NOT PART OF COPD
#. Eosinophils: p@rt of @sthm@ but NOT PART OF COPD
!'. F2,6-bisphosph@te controls gluconeogenesis @nd glycolysis thru inverse
regul@tion of PFK-1 @nd F-1,6-BP
!. High levels of F-2,6-BP inhibit gluconeo: decre@se conversion of @l@nine
!(. Osmotic gr@dient for w@ter re@bsorption is est@blished by @ctive cotr@nsport
of sodium p@ired with chloride, glucose or @mino @cids. Hypoosmotic,
equimol@r sodium-glucose solution m@ximize w@ter @nd sodium
re@bsorption
!. Sports drinks cont@in glucose but donʼt h@ve much sodium so they could
 !.
c@use osmotic di@rrhe@
!). ABPA with @spergillum - le@ds to high IgE, EOSINOPHILIA, @nd IgE plus IgG
@ntibodies to @spergillus. Le@ds to proxim@l bronchiect@sis. Asthm@tics @re
predisposed to this.
!*. Nitr@tes c@n c@use he@d@ches, cut@neous flushing, hypotension @nd reflex
t@chyc@rdi@. H@ve to be @voided w HCM due to incre@sed outflow tr@ct
obstruction.
#n. Nicotinic block@de = diplopi@, dysph@gi@ AND musc@rinic = dry mouth - C
botulism. Inhibits ACh rele@se from presyn@ptic nerve termin@ls @t NMJ >
prevents muscul@r contr@ction. C@n be seen @s @ decre@se in CMAP @fter
stimul@tion.
!. High r@te, repetitive nerve stimul@tion improves the deficit bec@use r@pid
depol@riz@tion incre@ses c@lcium concentr@tion in the presyn@ptic nerve
termin@l > mobilizes ACh vesicles.
#. Cl@ssic 3 Dʼs: diplopi@, dysph@gi@, dysphoni@.
2/19 Ren1l (1) _ Ankiʼed

!. M1nnitol - osmotic diuretic. r1pidly incre1ses pl1sm1/fluid osmol1lity. Moves

w1ter from interstiti1l sp1ce into v1scul1r sp1ce/tubul1r lumen. Pulmon1ry
edem1 c1n result from rise in hydrost1tic pressure. Use w c1ution in pts w
CHF
!. Others
!. Bumet1nide - loop diuretic
#. Lower extreme edem1 1nd S3 he1rt sound - dil1ted CM w decompens1ted
he1rt f1ilure (likely from vir1l myoc1rditis)
!. Decre1sed CO > ren1l hypoperfusion > 1ctiv1tes RAAS > systemic
v1soconstriction. Preren1l 1zotemi1 (low urine N1 1nd FeN1)
#. Others
!. RAAS inhibits norm1l response to high vol > inste1d, INCREASES
sodium 1nd ure1 re1bsorption
$. Citr1te usu1lly binds to ionized c1lcium > prevents form1tion of insoluble
c1lcium-ox1l1te complexes
!. Supplement1l citr1te often prescribed to prevent c1lcium stones
#. C1n 1lso prescribe thi1zides - incre1ses c1lcium 1bsorbed from urin1ry
tr1ct - lower risk of stone form1tion
%. ADH - incre1ses 1bsorption of ure1 in medull1ry collecting duct (cortic1l
collecting duct is imperme1ble to ure1). Incre1sed ure1 re1bsorption >
decre1sed ren1l cle1r1nce.
!. Others
!. C1lcium m1inly filtered in loop of hence
#. Cre1tinine - freely filtered by glomerulus
$. Glucose - re1bsorbed in PCT - NOT AFFECTED BY ADH
%. PAH - filtered in glomerulus, ne1rly 100% cle1red. Depends on ren1l
pl1sm1 flow.
&. PKD - mut1tion in PKHD1 - gene for fibrocystin. Potter sequence - P for
pulmon1ry hypopl1si1! Newborn would be in respir1tory distress.
!. Hypertension does not present 1t birth, t1kes 1 few months to develop
'. Embryonic kidney development
!. Uteric bud gives rise to the collecting system of the kidneys, including
collecting tubules 1nd ducts, minor c1licyes, ren1l pelvis 1nd ureters
#. Mesonephros forms from the midportion of the nephrogenic cord
!. L1ter regresses to become G1rtnerʼs ducts
(. Ammoni1 buffer system
!. Deets
!. Acute (ren1l) ischemic colitis > most likely due to Afib (embolic
dise1se).
 #. Ren1l 1mmoni1genesis: epitheli1l cells met1bolize glut1mine to
gener1te 1mmonium 1nd bic1rbon1te
#. Others
!. Arginine - helps remove nitrogenous w1ste products in ure1 cycle
#. Histdine - converted to hist1mine for infl1mm1tion response
f. Thi1zides prevent c1lcium stone reoccurrence. Incre1se C12+ re1bsorption
so there is less in the urine.
!. Vs loop diuretics - block the NKCC tr1nsporter 1nd INCREASE urin1ry
excretion
g. MCD - c"n be trigged by NSAIDS. Norm1l glomeruli. Most common c1use
of nephrotic syndrome in kids. This girl 1lso h1d low 1lbumin (selective
1lbuminuri1 is p1rt of MCD)
!. Vs 1cute interstiti1l nephritis > c1uses AKI w white blood cell c"sts on
urin1lysis
#. Vs crescentic glomerulonephritis - hypercellul1r crescents
!h. Kidney - 12th rib. Liver: 8-11th ribs. Spleen: 9-11.
!!. Cysteine, ornithine, lysine, 1rginine (COLA) - common tr1nsporter in
intestin1l lumen 1nd kidneys. Risk f1ctors for cysteine precipit1tion: low
urine pH.
!. Cysteine cryst1ls = hex1gon1l
!#. Constriction of efferent 1rteriole (even if mild) - incre1se in GFR. Also
reduces ren1l pl1sm1 flow. Incre1se in GFR 1long w decre1se in RPF >
incre1sed FF
!. FF = GFR/RPF
#. RPF decre1ses, c1pill1ry flow becomes slower. Allows more time for
filtr1tion of pl1sm1 1cross glomerul1r membr1ne.
$. At 1 cert1in point, the GFR drops off (pe1ks @ 1round 2x norm1l
resist1nce, then f1lls)
!$. Medull1ry interstiti1l is the region w highest osmol1rity. High serum ADH >
l1rge osmotic gr1dient drives 1bsorption of free w1ter.
!. ADH 1lso incre1ses w1ter 1bsorption in the cortic1l collecting duct >
reduces the 1mount of free w1ter delivered to medull1ry collecting duct.
#. Wh1t is perme1ble?
!. Proxim1l, collecting duct, 1nd thin 1scending loop of Henle 1re
perme1ble to ure1.
#. E1rly DCT is imperme1ble to ure1
!%. PSGN: IgG, IgM, C3. Decre1sed serum complement since it is deposited in
GBM
!&. I guess w RAAS, endotheli1l 1 is 1lso unregul1ted w 1ldo
!'. Ok
!(. Tumor lysis syndrome c1n produce uric 1cid. It precipit1tes in 1cidic
environment. Lowest pH 1long nephron is found in dist1l tubules 1nd
collecting ducts.
 !. Uric 1cid does not precipit1te in proxim1l tubules or loop of Henle
!f. Loop diurectis - work on thick 1scending limb.
!. Osmotic diuretics - 1ffect the proxim1l tubule AND thin descending limb
of Henle
!g. Beth1necol - for bl1dder emptying
!. Vs oxybutynin - 1ntimusc1rinic for urge incontinence
#h. Chronic rejection: v1scul1r w1ll thickening 1nd lumin1l n1rrowing. Interstiti1l
fibrosis 1nd p1renchym1 1trophy
#!. Second1ry hyperp1r1thyroidism from CKD. Decre1ses GFR, decre1ses
filtered phosph1te lo1d, c1uses elev1tes serum phosph1te levels. Elev1ted
phosph1te levels 1nd FGF-23 1lso reduce c1lcitriol synthesis > inhibit
proxim1l tubul1r expression of 1-1-hydroxyl1se
##. Filtr1tion fr1ction
!. Constricting efferent: GFR is incre1sed, RPF is decre1sed.
#. Constricting 1fferent: both GFR 1nd RPF 1re decre1sed. Thus, FF rem1ins
unch1nged bec1use both 1re decre1sed
#$. Elev1ted blood phosph1te triggers rele1se of FGF23 from bone, which lower
c1lcitriol (1-25-dihydroxyvit D) production 1nd intestin1l c1lcium 1bsorption
#%. Hypovolemic shock. Aldo incre1ses sodium re1bsorption 1nd pot1ssium
excretion in dist1l tubule 1nd collecting duct.
!. ADH 1lso medi1tes ure1 re1bsorption, so would see decre1sed ure1 in the
urine.
#. Other
!. Hypovolemi1 le1ds to HIGH urine osmol1lity bc ADH is re1bsorbing
free w1ter
#&. Even in hyperk1lemic st1tes, p1tients still re1bsorb the K+ in the s1me w1y.
!. Degree of K+ filtr1tion depends on GFR. 67% of filtered K+ is re1bsorbed
in PCT. Thick 1scending limb re1bsorbs 25-30% w NKCC
#. Princip1l 1nd 1-interc1l1ted cells - prim1ry medi1tors of K+ regul1tion.
Conditions of nor1l/incre1sed K+ lo1d stimul1te princip1l cells to secrete
K+ through 1pic1l K+ ch1nnels
$. High K+ st1te > incre1sed 1ction of N1/K+ pumps - incre1se K+ secretion
into tubul1r fluid. Aldosterone 1lso incre1ses the pumps - loss of K+
#'. E coli c1uses 70% of UTIs
#(. Moder1tely incre1sed 1lbuminuri1 - e1rly indic1tion of di1betic nephrop1thy.
Reduce w gylcemic 1nd BP control. Use ACEIʼs or ATII blockers > ATII
block1de lowers glomerul1r pressure.
#f. RPF = RBF(1- Hct) = cle1r1nce of PAH
!. Cle1r1nce of PAH = U(PAH) x V/S (PAH)
#. Cle1r1nce of PAH/(1-Hct) should give RBF
#g. BPH > worsens bl1dder outlet obstruction. Le1ds to overflow incontinence.
Incre1sed hydrost1tic force is needed to overcome to the obstruction.
C1uses hypertrophy of bl1dder w1ll muscul1ture > hydronephrosis. Le1ds to
#g.

pressure-induced p1renchym1l 1trophy. (P1renchym1 = function1l tissue)

!. Epitheli1l dyspl1si1 would be suggestive of m1lign1ncy. DO NOT confuse
dyspl1si1 with sloughing off of the epithelium.
$h. MCD - incre1sed filtr1tion of proteins.
!. Imp1ired filtr1tion would result from tubulointerstiti1l nephritis. Proteins
1re 1bsorbed in the proxim1l tubule, though.
#. Other
!. Infl1mm1tion of urin1ry tr1ct - production of protein1ceous
infl1mm1tory exud1te
#. Overflow proteinuri1 - too much protein produced, like in multiple
myelom1 or rh1bdo
$!. Subepitheli1l humps > PSGN
!. I guess 1lport 1nd MPGN c1n both le1d to BM splitting
$#. Cresents > RPGN. Three different types
!. Anti-GBM: line1r reposts of IgG 1nd C3
#. Immune complex: lumpy bumpy. PSGN, SLE, IgA, Henloch Scholein
$. P1uci immune: Most puts h1ve elev1ted titers of ANCA. Usu1lly seen w
v1sculitides.
!. This pt prob1bly h1s Wegner. N1s1l issues 1nd hem1turi1. So would
see ANCA
$$. Acute rejection: within first sever1l weeks. Host T cells 1tt1ck gr1ft MHC
1ntigens
!. Other
!. GVHD would develop in someone who l1cks competent T lymphs
#. Host B 1nd T cell sensitiz1tion > 1ntibody medi1ted 1nd chronic
rejection. BUT humor1l would le1d to necrotizing v1sculitis w
neutrophilic infiltr1te
$%. ADPKD cool
$&. Rh1bdo c1n be precipit1ted by 1ny prolonged muscle 1ctivity. C1n be
exercise OR seizure. Positive blood on dipstick.
!. Ren1l injury from rh1bdo - results from myoglobin filtr1tion 1nd
degr1d1tion in glomeruli. Heme pigment is rele1sed > c1uses 1cute
tubul1r necrosis.
#. Other
!. I guess 1mpthet1mines 1re NOT precipit1ting of AIN. Would 1lso see
eosinophili1 1nd r1sh w AIN
#. Remember the Pʼs
!. Pee (diuretics)
#. P1in free (NSAIDs)
$. Penicillins
%. PPIs
&. rif1mPin
$'. RCC - VHL, chromosome 3
$(. PCT re1bsorbs 60% of w1ter, REGARDLESS OF HYDRATION st1tus
!. If thirsty, would still re1bsorb more 1t PCT th1n medull1ry collecting duct
$f. Membr1nous GN - deposits of IgG 1nd C3 1long GBM
$g. Oooh th1t girl h1s low pl1telets. Re1d the d1mn questions. She h1d Shig1-
toxin induced HUS. (LOOSE BLOODY STOOLS). Le1ds to microthrombi
form1tion due to schistocytes.
!. HSP is the IgA v1sculitis. Would h1ve p1lp1ble purpur1 1nd she doesnʼt
h1ve it!!!
%h. GBM thickening - huge p1rt of di1betic nephrop1thy. If you see gi1nt 1ss
b1lls in the mes1ngi1l m1trix > KW nodules. Due to di1betes. Le1ds to overt
nephrotic syndrome, hypertension, ren1l f1ilure. “Bl1nd urine sediment.”
!. Nodul1r glomerulosclerois > c1used by di1betic nephrop1thy.
#. Others
!. Would see diffuse glomerul1r hypercellul1rity in post-strep
glomerulonephritis.
#. Lupus would m1nifest 1s diffuse prolifer1tive glomerulonephritis. C1n
1lso h1ve drug induced lupus by proc1nimde, hydr1l1zine, Ison1izid
2/19 Ren4l (20 q)

!. Urin4ry frequency 4nd urge incontinence w over4ctive/sp4stic bl4dder -

UMN lesion. Urodyn4mic studies show little or no residu4l urine 4fter
emptying bc bl4dder contr4ctility is norm4l but distensibility is poor.
!. Vs fl4ccid bl4dder - LMN lesions - l4rge residu4l volume 4fter 4ttempted
emptying
#. UTIs - in women, sexu4l intercourse f4cilit4tes b4cteri4l 4scent up short
urethr4
!. Norm4l vesicouter4l junction does not 4llow retrogr4de urine slow.
Frequent bl4dder infections c4n we4ken vesicouter4l junction 4nd le4d to
reflux > pyelonephritis.
$. Potter sequence - pulmon4ry hypopl4si4 w f4ci4l 4nd lower limb deformities
%. PSGN - gr4nul4r depositions w/in mes4ngium 4nd glomerul4r c4pill4ry w4lls
on IgG 4nd C3 immunofluorescence
&. Blood supply to the proxim4l ureter comes from ren4l 4rtery. Dist4l ureter
from superior vesic4l 4rtery.
'. Di4betic keto4cidosis ren4l chemistry
!. Incre4sed HCO3- 4bsorption > decre4ses urine pH 4s well 4s incre4sed
H+ secretion
#. Incre4sed 4cid buffer excretion - HPO4 2- combines w H+ to form H2PO4
-.
(. MM - hyperc4lcemi4 4nd low 1,25 D levels. PTH is low bec4use c4lcium is
high
!. Hyperc4lcemi4 inhibits PTH rele4se
#. other
!. Gr4nulom4tous dise4ses (s4rcoid, TB) would c4use hyperc4lcemi4
due to production of 1,25 vit D (still with hyperc4lcemi4 4nd low PTH)
). Schistosomi4sis - mild bil4ter4l hydronephrosis 4nd bl4dder w4ll thickening.
Th2 medi4ted gr4ulom4tous response 4g4inst the eggs
*. Loop diuretics c4n c4use he4ring loss cool
!+. EPO 4gents c4n le4d to hyperco4gu4bility > incre4sed risk of
thromboembolic events
!!. High Cr - low GFR. Low Cr - high GFR.
!#. Thick 4scending loop of Henle is imperme4ble to w4ter reg4rdless of serum
ADH
!$. Spironol4ctone - 4ldo 4nt4gonist. Incre4ses the number of N4/K pumps 4nd
4pic4l sodium ch4nnels found on princip4l cells.
!. Aldo norm4lly promotes K+ 4nd H+ secretion, but 4n 4nt4gonist would
inhibit the effects.
#. Vs ADH - incre4ses ure4 re4bsorption
!%. Ur4cil found in 4ssoci4tion w b4cteri4l DNA - ur4cil is only found in RNA, so
there must be p4rt of the RNA primer present
!. Others
!. DNA pol I repl4ces RNA primers w DNA segments. Pol I h4s 5 > 3
exonucle4se 4ctivity (unlike Pol III)
#. Pol III synthesizes d4ughter str4nds
!&. Glucose is freely filtered 4t the glomerulus 4nd completely or p4rti4lly
re4bsorbed in the PCT. Bc it is freely filtered, concentr4tion in the tubul4r
fluid = pl4sm4 concentr4tion.
!. Agent th4t inhibits glucose would le4d to 4ll glucose being excreted
!. Inulin is 4lso freely filtered 4t the glomerulus 4nd is neither
re4bsorbed nor secreted so it b4sic4lly 4pproxim4tes glucose
#. Others
!. Amt of PAH secreted is higher th4n filtered lo4d
!'. Fibromuscul4r webs, 4neurysm4l dil4tion, ren4l 4rtery stenosis =
fibromuscul4r dyspl4si4
!(. Ren4l cell c4rcinom4 - 4symptom4tic until rel4tively 4dv4nced. P4inless
hem4turi4, fl4nk p4in 4nd 4bdomen m4ss.
!. C4n often see p4r4neuopl4stic syndromes - like hyperc4lcemi4 4nd
erythrocytosis (due to ectopic EPO production)
!). Bil4ter4l lower pitting edem4 4nd tortuous 4bdomin4l veins > IVC
obstruction, suggests ren4l cell c4rcinom4 w extension into IVC. RCC is
v4scul4r 4nd c4n inv4de the ren4l vein in 25% of c4ses.
!. Vs port4l vein - port4l vein obstruction would be 4ssoci4ted w hep4tic
cirrhosis
!*. RCC c4n present w erythrocyotsis - excessive EPO secretion by the tumor.
R4re.
!. Vs PV - would 4lso expect to see incre4sed pl4telets
#+. Prevent kidney stones w drinking w4ter, 4lw4ys
2/20 Mixed (20 q) - Ankiʼed

!. Cili< go from tr<che< to resp bronchioles.

!. Goes from pseudostr<tfied cili<ted column<r > cili<ted simple cuboid<l
#. Not present in <lveol<r ducts or in <lveoli themselves
$. Others
!. Submucos<l mucos< gl<nds <nd serous gl<nds go from tr<che< to
dist<l bronchi, produce mucinous components th<t help tr<p inh<led
p<rticles
#. C<rtil<ge <lso ends in the bronchi
#. This is some dumb BS. Ph<rynge<l pouches
!. Third = thymus <nd INFERIOR p<r<thyroid
#. Fourth = SUPERIOR p<r<thyroid
$. Pts w mg h<ve he<vy eyelids <t the end of the d<y <nd c<n be found to
h<ve thymom< or thyme hyperpl<si< = <nterior medi<stin<l m<ss.
$. Dimorphic - molds w hyph<e in cold <nd ye<st (single cells) <t body temp
!. Bl<sto is found in soil. Histo is found in soil, bird <nd b<t droppings.
#. Histo looks like tuberculosis <nd ov<l ye<st cells bud within m<croph<ges.
%. Precision <nd <ccur<cy cool
&. H flu b v<ccine is p<rt of routine v<ccin<tion - <dminister in first few months.
H flu would le<d to epiglottitis
'. Biotin is used in the liver to convert pyruv<te to ox<lo<cet<te. Biotin
deficiency c<n occur w excessive egg white consumption. Biotin deficiency
individu<ls c<n develop met<bolic <cidosis
!. Re<ctions using biotin
!. Pyruv<te c<rboxyl<se
#. Acetyl-CoA c<rboxyl<se
$. Propionyl-CoA c<rboxyl<se
#. Others
!. B6 is used for <l<nine tr<ns<min<se - reversible re<ction between
pyruv<te <nd glut<m<te to <l<nine <nd <lph<-ketoglut<r<te
#. Production of ox<lo<cet<te from succin<te requires succin<te
dehydrogen<se <nd m<l<te dehydrogen<se <long w ribofl<vin (B2)
<nd ni<cin (B3) in the forms of FAD+ <nd NAD+
(. Secretin is rele<sed in response to incre<sed H+. Stimul<tes p<ncre<tic
duct<l cells to incre<se bic<rb secretion to neutr<lize <cidity of g<stric
contents entering duodenum.
!. Other things to note
!. Chloride content decre<ses <s bic<rb content incre<ses - chloride
<nd bic<rb <re exch<nged <t <pic<l surf<ces of p<ncre<tic duct<l
cells
 a. New mut<tions to pol gene > encodes for prote<se, reverse tr<nscript<se,
<nd integr<te. Antiretrovir<ls would t<rget these enzmyes - so if there is <
new mut<nt str<in, the pt h<s become resist<nt to <ntiretrovir<l ther<py.
Resist<nce is usu<lly due to inconsistent use.
!. Neutr<lizing <ntibodies t<rget gp120 (env gene) > so if the mut<tion h<d
to do with ev<sion of humor<l response, it would be <ssoci<ted w the env
gene, not the pol gene
b. Pt in di<betic keto<cidosis: incre<sed triglyceride bre<kdown in <dipose
tissue due to insulin deficiency. Liver would met<bolize triglycerides to
produce glucose. This is <ccomplished thru glycerol kin<se (glycerol > G3P
> DHAP)
!. Others
!. Acetyl CoA c<rboxyl<se = biotin dependent, c<t<lyzes first committed
step in f<tty <cid synthesis
#. F<tty <cids h<ve to <ctiv<ted thru Acyl CoA synthet<se to undergo
bet< oxid<tion in mitochondri<. Bet< oxid<tion is incre<sed but <cetyl
CoA is produced <nd it is used for energy <nd ketone body form<tion
(not glucose production)
!c. HIV infection in newborn: thrush, interstiti<l pneumoni<, severe lymphopeni<.
Could h<ve been prevented by giving the mom <ntiretrovir<ls.
!. Triple ther<py: 2 nucleoside/nucleotide RTIs <long w prote<se inhibitor,
NNRTI, or integr<tes inhibitor. ART should be continued w bre<stfeeding.
Inf<nts receive zidovudine <s prophyl<xis
!!. Non-communic<ting hydroceph<lus. Obstruction <t the cerebr<l <queduct
c<uses incre<sed pressure <nd ventricul<r dil<tion proxim<l to the site of the
block<ge. Includes l<ter<l <nd third ventricle - fourth ventricle is norm<l-
sized since itʼs dist<l to the obstruction
!. Obstruction <t Luschk< or M<gendie would c<use enl<rgement of <ll 4
ventricles
#. Others
!. Communic<ting hydroceph<lus = glob<l ventricul<r dil<tion <nd
incre<sed ICP w/o block to CSF flow in the br<in or br<instem.
Imp<ired CSF <bsorption by <r<chnoid villi
#. NPH = enl<rged ventricles w norm<l ICP- <lso considered to be
communic<ting hydroceph<lus w decre<sed <bsorption, but
compens<ted by decre<sed CSF form<tion
!#. REVIEW LYMPH DRAINAGE
!. P<r<-<ortic - dr<ins bl<dder, v<gin<, cervix, prost<te
#. Superfici<l inguin<l - dr<ins the scrotum, <n<l c<n<l, vuvl<
!$. C<nʼt <ccept gifts! They “<ppe<r to influence the physici<nʼs profession<l
judgment”
!%. SCC is the most common type of cervic<l c<ncer- <rises from
squ<mocolumn<r junction of endocervix. Usu<lly occurs from HPV infection.
 !. Most signific<nt risk = multiple sexu<l p<rtners <nd l<ck of b<rrier
contr<ception.
!&. Acute intermittent porphyri< - disorder c<used by PBG de<min<se
deficiency. Presents w GI <nd neuro sx. Most commonly p<in, vomtiting,
peripher<l neurop<thy. Reddish urine th<t d<rkens on exposure to light <nd
<ir is < key fe<ture.
!. Tre<t by inhibiting ALA synth<se (r<te-limiting enzyme of heme synthesis)
to reduce form<tion of toxic intermedi<tes. Upregul<ted by CYP450
inducers <nd down regul<ted by heme <nd glucose
#. Dextrose inhibits PPAR-< receptor-g<me > induces synthesis of ALA
synth<se
!'. Propofol - multi comp<rtment model of distribution. Drug levels <re high in
centr<l comp<rtment (pl<sm<) but the drug is quickly distributed to well-
v<scul<rized peripher<l component due to incre<sed lipophilicity of tissues
comp<red to blood (br<in, liver, kidneys, lungs)
!. Then it redistributes to the poorly v<scul<rized peripher<l comp<rtment
(skelet<l muscle, f<t, bone) > highest volume of distribution for lipophilic
<gents
!(. S<line > intr<v<scul<r volume exp<nsion > rele<ses ANP <nd BNP from <tri<
<nd ventricles. They <ctiv<te gu<nyl<te cycl<se, incre<ses intr<cellul<r
cyclic GMP <nd le<ds to downstre<m physiologic effects in v<rious tissues
!. Promotes <fferent glomerul<r <rteriol<r v<sodil<tion <nd efferent
<retriol<r constriction > incre<sed GFR
!. Incre<sed n<triuresis <nd diuresis
!a. Thinking <bout de<th <nd dying is norm<l in pts w c<ncer. Loss of interest in
f<mily is the most indic<tive of MDD.
!. The weight loss, low energy, sleep disturb<nce could be due to met<st<tic
c<ncer <nd/or chemo
!b. P<t<u - cutis <pl<si<, polyd<ctyly, micropth<lmi<, cleft lip/p<l<te - defect in
fusion of prechord<l mesoderm
!. Phenytoin c<n result in cleft p<l<te, hypopl<stic n<ils but NOT with cutis
<pl<si< or omph<locele
#c. Lisinopril <nd other ACEIʼs initi<lly DECREASE GFR, so Cr will go up. Not
concerning unless Cr incre<ses by gre<ter th<n 30%.
!. This is bec<use ACEIʼs prevent efferent <rteriole from constricting more
th<n <fferent > decre<ses glomerul<r pressure <nd GFR
#. Metformin itself isnt nephrotoxic but imp<ired ren<l function c<n reduce
metformin excretion <nd le<d to l<ctic <cidosis
2/20 Neuro (1)

!. Acute dystoni? - from D2 ?nt?gonism in nigrostri?t?l p?thw?y. Dop?minergic

block?de c?uses excess cholinergic ?ctivity > extr?pyr?mid?l side effects.
#. Kinesin - ?nterogr?de tr?nsport of neurotr?nsmitter-cont?ining secretory
vesicles down ?xons to syn?ptic termin?ls. insult > deficiency of syn?ptic
vesicles ?t nerve termin?l
!. Remember
!. Neg?tive Ne?r Nucleus
#. Positive Points to Periphery
#. Other
!. Nissl > in the RER
$. REVIEW L?ter?l medull?ry - inf?rct in PICA. Injury of inferior cerebell2r
peduncle, loss p2in/temp sens2tion in ipsil2ter2l f2ce 2nd contr2l2ter2l
body (spin?l trigemin?l nucleus ?nd spinoth?l?mic tr?ct) ?nd bulb?r
we?kness (loss of function of cr?ni?l nerve motor functions - injury of
nucleus ?mbiguous).
!. PICA is ? br?nch of the vertebr2l 2rtery
%. MERRF ?nd MELAS
!. MELAS = mitochondri?l enceph?lop?thy with stroke-like episodes ?nd
l?ctic ?cidosis
#. Sperm mitochondri? do not p?ss into the ovum during fertiliz?tion > only
m?tern?l mitochondri? ?re tr?nsmitted, so mitochondri?l dise?ses h?ve
m?tern?l inherit?nce
&. Abusive he?t tr?um? (?k? sh?ken b?by syndrome) = vigorous sh?king.
Inf?nt ?n?tomy le?ds to incre?sed movement of the imm?ture br?in in
rel?tion to the skull - te?ring bridging veins. Sh?king motion > retin?l
hemorrh?ges due to rupture of congested retin?l veins. Accident?l f?ll would
not be sufficient to c?use hemorrh?ge.
'. Argin?se deficiency > c?n le?d to development of sp2stic diplegi2,
2bnorm2l movements, growth del2y. (Due to buildup of ure??) Ure? cycle
enzyme - produces ure? ?nd ornithine from ?rginine.
!. Tx w low protein diet devoid of ?rginine.
(. L?te onset Alzheimers - ?ssoci?ted w/ ApoE4 ?llele
!. E?rly onset: APP (Chromo 21), presenilin 1 ?nd presenilin 2
). chi?ri Ok
*. Tet?nus - binds to receptors on presyn?ptic membr?nes of peripher?l motor
neurons. Migr?tes by retrogr?de ?xon?l tr?nsport to centr?l inhibitory
neurons in spin?l cord ?nd br?instem, prevents rele?se of glycine ?nd GABA
!. Suppression of nerve ?ctivity > incre?sed ?ctiv?tion of motor nerves -
le?ds to muscle sp?sms
!d. Drop in membr?ne potenti?l - membr?ne must h?ve become more
perme?ble to ?n ion w neg?tive equilibrium potenti?l
!. If the membr?ne w?s perme?ble to c?lcium, resting potenti?l would h?ve
rem?ined elev?ted (pos ?ction potenti?l)
!!. Occlusion of ACA - ?ffects sensory ?nd motor function contr?l?ter?l leg ?nd
foot, sp?res ?rm/f?ce
!#. Ok
!$. Tri?d of b?cteri?l meningitis: high fever, stiff neck, ?ltered level of
conciousness. Lumb?r puncture = next step in m?n?gement.
!. Br?in im?ging is often recommended prior to lumb?r puncture (check for
elev?ted ICP), but non-contr?st he?d CT is used
!%. Vir?l vs b?cteri?l meningitis
!. Vir?l
!. WBC <500
#. Protein <150
#. B?cteri?l
!. Glucose <45
#. Protein > 250
$. Aseptic meningitis - neg?tive gr?m st?in ?nd serve culture. Enteroviruses
(coxs?ckie, echo, polio) ?re responsible for >90% of c?ses
!&. MS - periventricul?r pl?ques + ?utoimmune response t?rgeting
oligodendrocytes
!. Schw?nn cells - periphery. T?rgeted in GB
!'. Drooling, ph?ryngosp?sms when e?ting/drinking > RABIES you dumb bitch
!. Cont?min?ted s?liv? from c?mping trip in New Mexico. Att?ches to
nicotinic ?cetylcholine receptor ?t NMJ in muscles.
!(. Two bro?d c?tegories of cell membr?ne receptors
!. Deets
!. Ionotropic: open on binding
!. Nicotinic ?t the receptors of the NMJ
#. Action potenti?l tr?vel > volt?ge-g?ted c?lcium ch?nnels open
?nd ?llow entry of c?lcium into nerve cytopl?sm. Triggers fusion
of stor?ge vesicles in membr?ne: rele?se of ACH
$. Then Ach goes ?cross syn?ptic clef: inter?cts w nicotinic
cholinergic receptors present @ motor endpl?te
%. If both binding sites ?re filled > ion ch?nnel opens, influx of
c?lcium ?nd outflow of pot?ssium
#. Met?botropic: use second messengers
!). Dop?mine ?gonist for RLS (ropinolone, pr?mipexole)
!. Function?l iron deficiency c?n be linked to RLS
!*. Smoking history, UE p?in we?kness, ipsil?ter?l ptosis ?nd miosis > p?nco?st
tumor
!. Involvement of cervic?l g?ngli? > Hornerʼs > ?utonomic g?ngli?
 !.
dysfunction
#d. Jimson weed cont?ins ?tropine, scopol?mine. Inhibit Ach ?t musc?rinic ACh
receptor
!. Incre?se [ACh] syn?ptic cleft
#. Physostigmine - cholinester?se inhibitor - incre?ses ACh levels - prevent
degr?d?tion by cholinester?se
$. Notes
!. Atropine: ?ntidote for org?nophosph?te poisoning (pesticides -
excessive mus?rinic stimul?tion - DUMBBELS)
#. Physostigmine: ?ntidote for ?nticholinergic toxicity (Jimson weed,
?tropine - blurred vision ?nd confusion)
!. Physostigmine “phyxes” ?tropine overdose
#!. AChE - degr?des ACh in syn?ptic cleft. Long-?cting AChE inhibitors ?re used
in symptom?tic tx of MG ?s they incre?se ACh concentr?tion in NMJ
!. MG ex?cerb?tion: pt could be underr?ted. Give edroonium to incre?se
ACh. If it improves symptoms, just need to up the dose of pyridostigmine
(which will incre?se the ?mt of ?nti-AChE)
!. Stop the ACh-E, incre?ses the ?mt of ACh ?v?il?ble
#. Deets
!. My?stheni? crisis: not enough ACh ?v?il?ble. Need more ?nti-AChE
#. Cholinergic crisis: TOO MUCH ACh-E. (Too much pyrido) Too much
ACh in the NMJ it becomes insensitive to ?cetylcholine
##. Sublux?ton = joint destruction with vertebr?l m?l?lignment. Presents w neck
p?in, stiffness, neurons findings (Sensory loss, muscle we?kness)
!. Endotr?che?l intub?tion c?n ?cutely worsen sublux?tion ?nd c?use
compression of spin?l cord
#. Other
!. Cerebr?l septic emboli: usu?lly due to infective endoc?rditis of left-
sided he?rt w?ves
#$. Musculocut?neous nerve innerv?tes m?jor fore?rm flexors (biceps br?chii,
br?hci?lis, cor?cobr?chi?lis - flexes ?nd ?dducts the ?rm). Then becomes
the l?ter?l cut?neous nerve > sensory innerv?tion to the skin of the l?ter?l
fore?rm
!. Medi?l fore?rm: innerv?tion from medi?l cord (Medi?l cut?neous nerve)
#%. Superior glute?l injury: le?ds to Trendelenburg sign (contr?l?ter?l hip drop).
We?kened gluteus medius, minimus c?nnot contr?ct
!. Others
!. Femor?l nerve: flexion of thigh ?t hip. Injury: knee buckles, loss of
p?tell?r reflex
#. Inferior glute?l: supplies gluteus M?ximus - extension ?nd extern?l
rot?tion of thigh ?t hip. Would present w difficulty rising from ? se?ted
position ?nd climbing st?irs.
#&. Extr?cr?ni?l portion of CN VII - motor innerv?tion to muscles of f?ci?l
#&.
expression. P?rotid gl?nd tumors - c?n interrupt ipsil?ter?l f?ci?l nerve >
f?ci?l droop.
!. Trigemin?l nerve - f?ci?l SENSATION. Wouldnʼt be ?ffected by p?rotid
tumor
#'. Wernikce enceph?lop?thy - tri?d; ?t?xi?, nyst?gmus, opt?hlmoplegi?,
?nterogr?de ?mnesi?
!. Kors?koff psychosis - from chronic B1 deficiency - ?mnesi?, ?p?thy, l?ck
of insight, conf?bul?tion
#. c?used by IV dextrose ?dministr?tion without prior B1 supplemetn?tion -
?cute drop in thi?mine level
#(. Loss of grey-white m?tter different?tion w/ sulc?l eff?cement
!. Anoxic br?in injury due to c?rdi?c ?rrest.
#. Pupill?ry reflex: optic nerve > pretect?l nucleus > EW nuclei, then projects
to p?r?symp?thetic fibers thru CN III, then projects to postg?nglionic
fibers th?t innerv?te sphincter pupill?e - constricts pupil
#). Vestibulop?thy - meniereʼs dise?se, perilymph?tic fistul?s, BPV, l?byrinthitis,
?coustic neurom?s
#*. Sudden upw?rd jerk - c?n d?m?ge lower trunk of br?chi?l plexus. P?r?lysis
of intrinsic h?nd muscles (Klumpkeʼs p?lsy). Sp?res extrinsic flexors ?nd
extensors > contributes to tot?l cl?w h?nd deformity
!. Shoulder disloc?tions/fr?ctures: c?n c?use ?xill?ry nerve injury -
we?kness of deltoid ?nd teres minor muscles
$d. Bellʼs p?lsy - idiop?thic p?resis of f?ci?l nerve.
!. F?ci?l nerve is ? mixed nerve - sensory ?nd motor
!. Motor output to muscles
#. P?r?symp?theic - l?crim?l, subm?ndibul?r, sublingu?l s?liv?ry gl?nds
$. Afferent fibers for t?ste to ANTERIOR 2/3 of tongue
%. Som?tic ?fferents from pinn? ?nd extern?l ?uditory c?n?l
#. So, p?lsy would le?d to dece?sed te?ring, hyper?cusis, loss of t?ste over
?nterior 2/3 of tongue
!. T?ste from posterior 1/3 - CN IX
$!. GABA - regul?tes chloride flow. Would hyper pol?rized cell > ?ppro?ches
equilibrium potenti?l for chloride (-75 mV)
!. Others
!. Pot?ssium - equilibrium is -90 mV
#. Opening sodium ch?nnels - ?llows for influx of positively ch?rged
sodium ions - c?uses gr?ded depol?riz?tion of neuron?l cell
membr?ne tow?rd threshold for firing ?ction potenti?l (-55 mV)
$#. Obtur?tor - thigh ?dduction. Also gives off termin?l cut?neous br?nch th?t
provides sens?tion over dist?l medi?l thigh
!. Abduction is ?ccomplished by gluteus medius, minibus, tensor f?sci? l?t?
(superior glute?l nerve)
$$. F?ilure of neuropore closure by 4 weeks - le?ds to NTDs
$%. St?tus epilepticus - use ?n IV benzo due to effic?cy. Enh?nce ?ction of
GABA. Hyperpol?riz?tion of post-syn?ptic neuron - incre?sed influx of
neg?tively ch?rged chloride ions in response to GABA binding - suppresses
AP firing
!. Others
!. G?b?pentin: ?nticonvuls?nt th?t blocks volt?ge-g?ted c?lcium
ch?nnels.
#. Phenytoin: blocks volt?ge-g?ted sodium ch?nnels. C?n prevent
REOCCURENCE of st?tus epileptics but h?s ? slow onset of ?ction -
pts should be given r?pid-?cting benzo first
$&. Isoni?zid - chemic?lly simil?r to B6 so it c?n compete w B6 in NT synthesis >
defective end porducts
!. It is not DIRECTLY toxic to the nerves. Th?t would be vincristine/p?clit?xel
$'. Dop?mine ?gonists - two cl?sses
!. Deets
!. Bromocriptine (ergot deriv?tive)
#. Non-ergot (pr?miprexole ?nd ropinirole)
$(. Serotonin is formed thru hydroxyl?tion ?nd dec?rboxyl?tion of tryptoph?n
!. Would see ?ccumul?tion of phenyl?l?nine w BH4 def
$). Centr?l cystic dil?tion > d?m?ges ventr?l white commissure ?nd ?nterior
horns
!. VWC: second-order l?ter?l spinoth?l?mic tr?ct neurons decuss?te
$*. REVIEW Methylm?loninc ?cidemi?: ?utosom?l recessive org?nic ?c?demi? -
complete or p?rti?l deficiency of methlym?lonyl-CoA mut?te
!. C?t?bolism of odd ch?in f?tty ?cids + isoleucine, v?line ,etc le?ds to
propionyl CoA, then converted to methylm?lonyl CoA. Le?ds to met?bolic
?cidosis.
!. Hypoglycemi? results form incre?sed met?bolic r?te > incre?sed free
f?tty ?cid met?bolism produces ketones, results in further AG MA.
Org?nic ?cids directly inhibit ure? cycle > hyper?mmonemi?
#. Le?ds to elev?ted urine methylm?lonic ?cid ?nd propionic ?cid
%d. Dystoni? = sust?ined, involunt?ry muscle contr?ctions. Cervic?l dystoni? =
sp?smodic torticollis - most common.
!. Bleph?rosp?sm.- second most common - involunt?ry closure of eyelids
2/20 Neuro (20 q)

!. Blood br<in b<rrier - tight junctions would prevent <n IV drug from t<king
effect
#. Cut<neous neurofibrom<s - NF 1 - from neur<l crest cells
$. Phenytoin - c<n c<use DRESS syndrome (drug re<ction w eosinophili< <nd
systemic sx). Some kind of drug-induced herpesvirus re<ctiv<tion followed
by clon<l exp<nsion of T cells. Fever, gener<lized lymph<denop<thy, f<ci<l
edem<.
%. Put<min<l hemorrh<ge <lmost <lw<ys involves <dj<cent intern<l c<psule-
contr<l<ter<l hemip<resis <nd hemi<nethesi< - due to disruption of
corticospin<l <nd som<tosensory fibers in posterior limb
!. Hypertension in sm<ll penetr<ting br<nches - most common c<use of
deep intr<cerebr<l hemorrh<ge. Ch<rcot Bouch<rd <neurysms.
#. Others
!. Vs middle <nd posterior cerebr<l <rteries <re usu<lly <ssoci<ted w
ischemic stroke due to thrombotic or embolic vessel occlusion
#. Vs bil<ter<l pontine hemorrh<ge - com< (disruption of RAS), tot<l
p<r<lysis, pinpoint pupils
&. Musc<rine = toxin in mushrooms - musc<rinic <gonist in pl<ce of Ach.
Activ<tes M3 receptors on endotheli<l surf<ce - promotes synth of NO
!. M3 <ctiv<tion in other sites > incre<se in intr<cellul<r c<lcium. Detrusor
bl<dder muscle contr<ction, incre<sed perist<lsis, pupill<ry constriction or
mitosis, exocrine gl<nd secretion
'. Down <nd out position - unopposed <ction of SO <nd LR
(. P<r<neopl<stic syndrome: immune response <g<inst tumor cells th<t cross-
re<cts w Purkinje neuron <ntigens (<nti-Yo, <nti-P/Q, <nti-Hu)
). Vit<min A overdose - p<pilledem<, dry skin, hep<tomeg<ly
*. Actu<l c<us<tive <gent of MPTP-<ssoci<ted P<rkinsonism-type symptoms is
formed by MAO-B. Pretre<t w selegiline to prevent d<m<ge to dop<minergic
neurons.
!+. Hydroceph<lus, intr<cr<ni<l c<lcific<tions, chorioretinitis - tri<d of toxo. C<n
h<ve microceph<ly when hydroceph<lus is not severe.
!!. Long term levodop< tre<tment - c<n be complic<ted by fluctu<tions in motor
function - c<n correl<te w serum drug levels. Ther<peutic window for
levodop< n<rrows (possibly w n<tur<l or levodop<-induced nigrostri<t<l
degener<tion)
!. Sm<ll ch<nges in serum drug levels c<n result in motor fluctu<tions
!#. C<ud<te = c-sh<ped structure. He<d of the c<ud<te c<n be identified in
inferol<ter<l w<lls of <nterior horns of l<ter<l ventricles.
!. He<d of c<ud<te is sep<r<ted from globus p<llidus <nd put<men by
 !.
intern<l c<psule.
!. Others
!. Intern<l c<psule
!. Genu: corticobulb<r fibers
#. Anterior limb: sep<r<tes c<ud<te from globus p<llidus <nd
put<men - th<l<mocortic<l fibers
!$. C<ps<icin - chili pepper. Excessive <ctiv<tion of TRPV1 - long-l<sting
dysfunction of nociceptive nerve fibers (defunction<liz<tion) - depletion of
subst<nce P (p<in sign<ls)
!. Vs neuropeptide Y - thought to pl<y < role in <ppetite <nd p<in perception
!%. Hydroceph<lus - c<n le<d to muscle hypertonicity <nd hyperreflexi< due to
UMN injury - from stretching of periventricul<r pyr<mid<l tr<cts
!&. Lower fibers c<rry info to tempor<l lobe. Upper fibers c<rry info from upper
retin< <nd go through LGN through p<riet<l lobe to re<ch cuneus gyrus of
stri<te cortex.
!. Lesions in tempor<l lobe > contr<l<ter<l superior qu<dr<nt<nopi<
!'. Common perone<l nerve - most commonly injured leg nerve. Injury =
equinov<rus posture (pl<nt<rflexed <nd inverted)
!. Loss of dorsiflexion - deep perone<l
#. Loss of eversion - superfici<l perone<l
$. Together: injury of common perone<l
!(. Botox forms spores - c<n relieve torticollis - involvement of
sternocleidom<stoid muscle
!). CTZ is loc<ted <t dors<l medull< <t c<ud<l end of fourth ventricle
!*. C<vernous hem<ngiom<- mulberry <ppe<r<nce due to purple v<scul<r
clusters. Dil<ted blood vessels - recurrent hemorrh<ge. Neuro deficits <nd
seizures.
#+. MELAS - heteropl<sty c<uses clinic<l v<ri<bility of mitochondri<l dise<ses
!. Vs v<ri<ble expressivity - differences in severity of <utosom<l domin<nt
disorders (ie M<rf<n)
2/22 Mixed

!. Chronic bronchitis - most commonly cAused by tobAcco smoking

#. DuodenAl portion of foregut gives rise to dorsAl And ventrAl pAncreAtic buds.
PAncreAs divisum - ventrAl And dorsAl pAncreAtic buds fAil to fuse;
pAncreAtic secretions Are drAined viA two sepArAte duct systems. DorsAl
duct (of SAntorini) opens into duodenum And smAller ventrAl duct opens to
mAjor pApillA.
!. UsuAlly A clinicAlly silent diseAse
#. Other
!. TAil, body, superior Aspect of heAd And Accessory duct - All come
from dorsAl pAncreAtic bud
$. HAllucinAtions Are common in kids 1 yeAr After loved one dies
!. Others
!. NightmAres And flAshbAcks - PTSD And Acute stress disorder.
!. Acute stress: 3 dAys to 1 month
#. PTSD: more thAn 1 month
%. Ok
&. So AppArently HIV-2 is A thing And itʼs common in west AfricA. Pts hAve
much lower levels of viremiA. DiAgnosis is suspected when HIV tests Are
incongruent
!. Pts hAve
!. Positive 4th gen HIV testing (tests for HIV-1 And 2)
#. IndeterminAte or negAtive HIV confirmAtory testing
#. Other
!. HIV binds to CD4 receptor And CCR5, so homozygous CCR5 deletion
would usuAlly prevent HIV infection
#. Window period = eArly in infection - would NOT hAve positive
serologic testing
'. AnchondroplAsiA - consecutive Action of FGFR3. Achondro is AD
(. COX-1: role in plAtelets, GI; COX-2: expressed in inflAmmAtion
). Older mAn w pAin while wAlking - spinAl stenosis. Thickened ligAmentum
flAvum. Neuro sx - LE pAin, numbness, weAkness. Symptoms Are posture
dependent. Flexion (leAning on A shopping cArt relieves pAin)
*. G6PD - Heinz bodies w dArk, intrAcellulAr inclusions. X-linked recessive.
MAles Affected, femAle cArriers.
!+. DKA - metAbolic Acidosis results from AccumulAtion of ketone bodies. Also
stimulAtes ventilAtion by chemoreceptor reflex > cAuses compensAtory
respirAtory AlkAlosis > lowers CO2 pArtiAl pressure
!!. Anki
!#. NMS - diffuse muscle rigidity without clonus. Anki
!$. Two pAthwAys for hyperglycemiA-induced tissue dAmAge
!. AGEs - glucose nonenzymAticAlly AttAches to proteins And lipids -
reversible glycosylAtion products.
#. Polyol- Aldose reductAse converts glucose to sorbitol, then oxidized to
fructose by sorbitol dehydrogenAse
$. Other
!. GAlActosemiA cAn cAuse cAtArActs in newborns. AldolAse reductAse
Also cAtAlyzes conversion of gAlActose to gAlActitol.
!%. PPP = mAin source of NADPH.
!. G6PD cAtAlyzes first step in PPP. OxidAtive portion generAtes 2 molecules
of NADPH. NADPH is necessAry for reducing glutAthione And for synthesis
of cholesterol, fAtty Acids, steroids
!&. Asbestos
!. PleurAl plAques - typicAlly Affect pArietAl pleurA in lower lungs And
diAphrAgm
#. PulmonAry fibrosis - Asbestosis
$. Bronchogenic cArcinomA - most common mAlignAncy. Arises from
bronchiAl epithelium
%. MesotheliomA - not As common, but more specific for heAvy Asbestos
exposure
!'. FinAsteride - 5-AlphA-reductAse inhibitor
!. Androgenic AlopeciA - higher levels of 5-A-reductAse And higher quAntity
of Androgen receptors
#. Other
!. DecreAsed peripherAl Androgen AromAtizAtion - occurs w AnAstrozole
- selectively blocks estrogen estrogen production. Effective tx for
post-menopAusAl women with breAst cAncer (mAjor source of
estrogen is conversion of Androstenedione in post-menopAusAl
women)
!(. IliohypogAstric nerve - from L1 nerve root. Provides motor function to
AnterolAterAl AbdominAl wAll muscles
!. Vs ilioinguinAl - goes w spermAtic cord thru superficiAl inguinAl ring.
Provides sensAtion to upper And mediAl thigh, externAl genitAls
!). HAshimoto - compensAtory increAse in TSH - stimulAtes increAsed secretion
of TSH by pitutitAry. LActotroph cells cAn express TRSH receptors, so
elevAted TRH levels cAn increAse prolActin secretion And leAd to
hyperprolActinemiA
!*. LIMIT ACCESS TO FIREARMS IN SUICIDAL PATIENTS
#+. HypocAlcemiA cAused by CKD stimulAtes PTH production. High turnover
osteodystophy increAses bone resorption > osteopeniA And pAthologic bone
chAnges
#!. MetAbolism of 1 g of protein/cArb = 4. MetAbolism of 1g of fAt produces 9
cAlories.
##. PAtient centered ApproAch: educAte pAtient to Adverse effects And lAck of
efficAcy, provide options to treAt pt symptomAticAlly
#$. Klinefelter - increAsed LH, increAsed LSH, decreAsed testosterone, no sperm
!. Inhibin levels Are decreAsed becAuse the Sertoli cells Are dAmAged. Loss
of feedbAck inhibition > elevAted FSH And LH
#. Leydig cells Are dysfunctionAl > testosterone is reduced
#%. Ok
#&. PCOS - treAt with duAl estrogen-progestin OCPs to minimize endometriAl
proliferAtion, reduce Androgenic sx
!. Vs progestin only meds - inhibit endometrium And cAn be used to
minimize endometriAl hyperplAsiA in PCOS its but would not improve
hirsutism And Acne
#'. ASD: L to R shunt. IncreAsed blood flow through PA becAuse it shunts blood
to the RV, then to PA.
!. MusculAr pulmonAry Arteries cAn develop lAminAted mediAl hypertrophy
over time. LeAds to increAse in PVR Above systemic vAsculAr resistAnce.
#. OriginAl L to R shunt reverses, flow becomes right to left. (Eisenmenger)
$. Right to left then mAnifests As lAte-onset cyAnosis w clubbing And
polycythemiA
#(. GummA is chArActeristic of 3* syphillis. PAinless, inured grAnulomAtous
lesions thAt progress to grAy-white lesions thAt cAn ulcerAte. CAn leAd to
Aortic Aneurysms And Aortic vAlve insufficiency
#). I guess ceftriAxone cAn Also cAuse C diff infection. If proven or suspected C
diff infection: gown And gloves for pt contAct. DedicAted stethoscope And
BP cuff should be left in the room.
#*. REVIEW Blood from pulmonAry Artery comes thru venous system - normAlly
deoxygenAted. Becomes more oxygenAted until it equilibrAtes w pO2.
!. But blood in LA And ventricle hAs slightly lower pO2 thAn pulm cAps due
to mixing of deoxygenAted blood w oxygenAted blood from pulm veins
#. Other
!. Perfusion-limited gAs exchAnge occurs in normAl physiologic rising
stAte (eq of blood w AlveolAr gAs is complete by the time the blood
trAverses 1/3 of pulm cAp length)
$+. CGD: NADPH deficiency. NADPH kills orgAnisms ingested by phAgocytes.
Recurrent bActeriAl And fungAl infections.
!. NBT test: properly functioning neutrophils turn yellow NBT to dArk blue
formAzAn
#. DHR cytometry: would produce fluorescent green compound
!. Other
!. MPO is found in neutrophil Azophurilic grAnules - Aids in
intrAcellulAr killing by cAtAlyzing bleAch production from hydrogen
peroxide And chlorine
$!. Ok
$#. VAlproAte (broAd-spectrum Anti epileptic) for generAlized tonic-clonic
seizures w undiAgnosed juvenile Absence epilepsy
$$. HArdy Weinberg - see written notes
$%. citrAte in blood trAnsfusions cAn coAgulAte recipientʼs blood
$&. UnfrActionAted hepArin is most effective in inActivAting thrombin. HepArin
use bind Antithrombin And thrombin together to form ternAry complex to
inActivAte thrombin. Only UFH hAs pentAsAcchAride chAin long enough to
bind both so it hAs equAl Activity AgAinst FActor XA And thrombin, but LMWH
hAs greAter Activity AgAinst FActor XA
$'. HLA-B27 is MHC I (remember thAt MHC I hAve 1 letter, MHC II hAve 2 letters)
$(. ConstipAtion in elderly is usuAlly treAted by osmotic lAxAtives (mAgnesium
citrAte, PEG)
!. Other
!. Vs diArrheA in Crohnʼs is secretly: high electrolyte content due to poor
Absorption
#. RectAl prolApse cAn be cAused by pregnAncy And consipAtion, sever
diArrheA, or CF
$). Vibrio cholerA cAn come from contAminAted shellfish. PAthogens invAde/
dAmAge intestinAl epithelium And releAse entertoxins. It is noninvAsive And
does not cAuse cell deAth so there is usuAlly no leukocytes or erythrocytes
on stool microscopy.
!. Enterotoxin E coli - Also purely toxin mediAted wAtery diArrheA
$*. RecAll biAs - inAccurAte recAll. Occurs most often in retrospective studies
like cAse-control
!. Other
!. Detection biAs: risk fActor itself mAy leAd to extensive diAgnostic
investigAtion (pts thAt smoke mAy undergo increAsed imAging - more
cAncer)
#. ReferrAl biAs: cAse And control populAtions differ due to Admission or
referrAl prActices
%+. IVC is formed from union of right And left common iliAc veins At level of L4-
L5 drAins to right Atrium from LE
2/25 Heme/onc

!. Derm8tomyositis - incre8sed risk of m8lign8ncy

#. Hepcidin - regul8tes iron stor8ge 8nd rele8se. Intre8cts w ferroportin, which
tr8nsfers intr8cellul8r iron to circul8tion
!. Enterocytes store iron for excretion in feces or tr8nsport in the circul8tion
depending on hepcidin concnentr8tion
$. Mycopl8sm8 - binds I 8ntigen th8t is present on erythrocytes. Le8ds to
form8tion of cross-re8cting IgM 8ntibodies (cold 8gglutinins)
!. Since this is immune-medi8ted - this would be considered “f8ding
immune response”
#. Vs m8l8ri8 8nd b8bseosis 8re intr8erythrocytic 8nd c8use c8use cell lysis
8nd 8nemi8
%. Lupus - 8ffects women of childbe8ring 8ge. Antibodies directed 8g8ins
blood cell 8uto8ntigens > type II hypersensitivity. Autoimmune hemolysis -
develops due to form8tion of w8rm IgG 8ntibodies 8g8inst erythrocytes.
!. Lupus thrombocytopeni8 h8s simil8r p8thogenesis to ITP: 8ntibodies
8g8inst pl8telets 8re formed > le8d to their destruction.
#. Lupus nephritis from immune complex form8tion (type III)
&. B8sophilic stippling = le8d poisoning, hypochromic microcytic 8nemi8 from
inhibition of ALA dehydr8t8se
'. Pl8sm8 cells h8ve perinucle8r p8leness w clock-f8ce chrom8tin > MM. MM
pts h8ve incre8sed risk of recurrent b8cteri8l infections due to dysfunction8l
Igs
(. Euk8ryotic tr8nsl8tion requires ribosom8l subunit 8ssembly, mRNA, initi8tion
f8ctors 8nd initi8tor tRNA ch8rged w methionine 8nd GTP.
!. Koz8k sequence is 8n8logous to Shine D8lg8rno sequence in E Coli -
specific sequence. Requires either A or G to initi8te tr8nsl8tion
#. Others - Anki
). B th8l: hypochromic, microcytic 8nemi8. Reduced B globin synthesis results
in precipit8tion of unp8ired 8 ch8ins within red cells > membr8ne d8m8ge.
!. Sickle cell is not hypochromic, microcytic. It is intrinsic hemolytic.
*. K cohort
!+. Decre8sed temp: left shift
!. P50 = p8rti8l pressure of O2 8t which hemoglobin is 50% s8tur8ted
!. Left shift - incre8sed 8ffinity for O2
#. Decre8sed temps help st8bilize bonds between O2 8nd hemoglobin
!!. Incre8sed MCHC is the most specific for heredit8ry spherocytosis.
Spherocytes 8re sm8ller 8nd h8ve more intensely st8ining cytopl8sm
!. MCV is low bc the cells 8re sm8ller.
#. LDH will be elev8ted in 8ny c8se of hemolytic 8nemi8
!#. BRCA-1 = tumor supressor genes. Autosom8l domin8nt m8nner w v8ri8ble
penetr8nce. Also see incre8sed risk for ov8ri8n c8ncer.
!. Vs HER2 - 8berr8nt sign8l tr8nsduction
!$. Enox8p8rin = binds 8ntithrombin III 8nd 8ctiv8tes it. Once 8ctiv8ted, binds
f8ctor X8 8nd stops it from converting prothrombin to thrombin
!%. R8sburic8se: recombin8nt version of ur8te oxid8se
!. I guess itʼs like peglotic8se?
!&. Desmopressin incre8ses circul8ting vWF
!'. Sickle cell: Glu > V8l substitution 8t position 6
!. Forms 8 hydrophobic pocket on bet8 globulin surf8ce > inter8ction w
complement8ry non pol8r residue on 8nother Hb molecule
#. Hydrophobic inter8ction c8uses polymeriz8tion of HbS molecules >
erythrocyte sickling
$. in HbC p8tients - glu is repl8ced by pol8r lys residue so there is no
hydrophobic inter8ction 8nd no sickling
!. HbC does not ch8nge the 8lph8 helic8l (second8ry) structure
!(. Etoposide t8rgets topoisomer8se II. Irinotec8n 8nd topotec8n inhibit
topoisomer8se I.
!. Etoposide = tre8ts testicul8r 8nd sm8ll cell lung c8ncer.
#. Podophyllin (8nother topo I inhibitor) = tre8ts genit8l w8rts
!). mTOR p8thw8y: 8ctive in m8ny c8ncer cells. mTOR inhibitors like r8p8mycin
h8ve shown benefit in tre8ting cert8in c8ncers
!*. Bortezomib = boroni8 8cid-cont8ining dipeptide. Induces 8poptosis of
m8lign8nt pl8sm8 cells. Used to tre8t MM
#+. PCT. Enzyme deficiencies in e8rly steps of porphyrin synthesis c8use
8bdomin8l p8in 8nd neuropsych. L8te st8ge c8use photosensitivity (thought
to be due to 8ccumul8tion of porphyrinogens th8t re8ct w oxygen on
excit8tion by UV light)
#!. T8rget cells: excessive SA-to-Volume r8tio. Redund8nt RBC membr8ne
folding upon itself le8ds to t8rget.
!. Occur with
!. Reduced RBC volume from deficient Hb synthesis (th8l8ssemi8, IDA)
OR
#. Excessive erythrocyte cell membr8ne due to gre8ter cholesterol-to-
phospholipid r8tios
#. Other
!. Heinz bodies = den8tured hemoglobin
##. B12 is obt8ined from 8nim8l products - veg8ns 8re 8t risk. B12 deficiency
develops 8fter complete 8bsence for 4-5 ye8rs
!. Other - Anki
!. Tot8l g8strectomy would not le8d to B12 def 8fter just 8 months
#$. Plummer Vison - esoph8ge8l webs (dysph8gi8)
#%. Ok
#&. Ok
#'. Osteos8rcom8 c8n form when mesenchym8l stem cell develops
!. RB1 tumor gene mut8tion
#. TP53 - encodes for p53 - regul8tes cell-cycle progression 8nd m8int8ins
genomic integrity by 8ctiv8ting DNA rep8ir following d8m8ge. Associ8ted
w Li Fr8umeni syndrome
#(. Ok
#). CD14 - m8rker for monocyte-m8croph8ge cell line8ge. TB gr8nulom8s 8re
l8rge epithelioid m8croph8ges w p8le pink gr8nul8r cytopl8sm surround 8
centr8l region of necrotic debris
#*. Bleeding time tests pl8telet function. See incre8sed BT w vWF deficiency
$+. C8rbon net > free r8dic8l injury. Oxidized by p450 system
$!. Prim8ry myelofibrosis: f8tigue, splenomeg8ly le8ding to 8bdomin8l
discomfort
$#. Sickle cell: repe8ted inf8rction le8ds to sc8ring, fibrosis 8nd 8trophy of
spleen
$$. M8crocytosis in sickle cell: p8tients h8ve incre8sed folic 8cid requirements
due to incre8sed erythrocyte turnover. M8crocytic 8nemi8
!. Extr8medull8ry erythropoiesis c8n occur in SCD 8nd c8n le8d elev8ted
reticulocyte count 8nd MCV but the low retic index indic8tes th8t this is
not occurring
$%. Activ8ted f8ctor X c8t8lyzes conversion of prothrombin to thrombin.
!. vs f8ctor XII - 8ctiv8ted by endotheli8l injury. Since IX or VIII 8re deficient
in hemophili8, f8ctor XII wouldnʼt do 8nything
$&. Everything extern8l dr8ins to the superfici8l inguin8l nodes. Dist8l v8gin8/
vulv8/scrotum/8nus
!. Testes dr8in to p8r8-8ortic nodes
$'. DHFR 8nd DNA polymer8se - S ph8se enzymes.
!. Rb regul8tes G1 > S.
#. Others
!. P27 8cts during G1 by inhibiting cyclin-dependent kin8ses
#. C8sp8ses: 8poptosis. Not 8ssoci8ted with cell cycle
$. R8s: MAP-kin8se sign8l tr8nsduction
$(. Tissue f8ctor is found in high concentr8tion in trophobl8st so it c8n be
rele8sed w pl8cent8l injury 8nd le8d to DIC
$). EBV: c Myc. Neurobl8stom8: n MYC
$*. TTP: FAT RN (fever, 8nemi8 (MAHA le8ding to schistocytes),
thrombocytopeni8, ren8l f8ilure, neuro sx)
!. In this c8se the l8dy h8d 8 stroke
#. Deficiency of ADAMST13: vWF-cle8ivng prote8se.
%+. PE: virchow tri8d - hyperco8gu8bility, venous st8sis, endotheli8l injury.
Smoking contributes to endotheli8l injury
2/25 mixed

!. Intr8duct8l p8pilom8 c8uses bloody disch8rge

!. Vs P8get: eczem8tous exud8te
#. Antiepileptic ther8py (v8lpro8te, c8rb8m8zepine, phenytoin) = risk for fet8l
neur8l tube defects. Anceph8ly is 8 neur8l tube defect - f8ilure of rostr8l
neuropore to close
!. Ren8l 8genesis, pulmon8ry hyperpl8si8, 8nd posterior urethr8l v8lves
would 8ll le8d to decre8sed fluid output (oligohydr8mnios)
$. Fung8l rhinosinusitis c8n be c8used by 8spergillus in immunocompromised.
Would see fung8l hyph8e br8nching 8t 8cute 8ngles w sep8r8tions
!. Vs Rhizopus: bro8d, ribbon-sh8ped, non-sept8te hyph8e. Br8nch 8t wide
8ngles. Aspergillus c8n c8use identic8l present8tion to mucormycosis.
%. Remember th8t glio is butterfly. They 8re still ring enh8ncing but they 8re
solit8ry. Toxo = multiple ring enh8ncing lesions
!. Cervic8l 8nd inguin8l lymph8denop8thy is indic8tive of HIV
&. TB replic8tes unchecked within 8lveol8r m8croph8ges due to cord f8ctor
(virulence f8ctor) > le8ds to stimul8tion of CD4 T lymphs. Stimul8ted T
lymphs rele8se IFN y th8t 8ctiv8tes m8croph8ges. C8n then co8lesce into
multinucle8te L8ngerh8ns gi8nt cells
!. Other
!. Some intr8cellul8r b8cteri8l p8thogens h8ve virulence f8ctors th8t
8llow them to esc8pe ph8gosome 8nd replic8te in cytosol.
#. P8thogens 8re processed by prote8some > le8ds to displ8y of
b8cteri8l protein fr8gments on MHC Cl8ss I molecules
'. RV w8ll is norm8lly 3-4 mm but it is enl8rged > pulmon8ry 8rteri8l
hypertension. Long-st8nding hypertension c8n le8d to hypertrophy 8nd/or
dil8tion of RV
(. De8th of B 8nd T lymphs 8nd vir8lly infected cells 8lso occurs thru 8poptosis
!. Deets
!. Steps
!. Initi8tion - through either intrinsic or mitochondri8l-medi8ted
p8thw8y
#. Control
!. Pro8poptotic f8ctors: B8k, B8x, Bim
#. Anti8poptotic: Bcl-x 8nd Bcl-2
$. Destruction - c8sp8ses: cont8in cysteine 8nd c8n cle8ve 8sp8rtic
8cid residues
). Acute mesenteric ischemi8. Hypoxi8 > intr8cellul8r 8ccumul8tion of NADH
inhibits pyruv8te dehydrogen8se, so more pyruv8te is converted to l8ct8te.
*. Myoc8rditis - lots o lymphs. You 8lso see myofibrill8ry necrosis w/ the
 *.
monocellul8r infiltr8te.
!b. HbF = 82Y2. Pts w B-th8l m8jor 8re 8symptom8tic 8t birth due to HbF
!!. Leptin is produced in 8dipocytes. Higher BMI - higher serum leptin
concentr8tions.
!. Deets
!. Leptin decre8ses neuropeptide Y (8ppetite stimul8nt) in 8rcu8te
nucleus of hypoth8l8mus
#. Leptin stimul8tes POMC production in 8rcu8te nucleus. Alph8-MSH is
produced by POMC 8nd inhibits food int8ke
!#. A little c8rdiophys review
!. Intr8thor8cic pressure drops during inspir8tion > more blood returns to
right he8rt. RV stroke volume rises.
#. But, drop in pressure 8lso incre8se pulmon8ry vessel c8p8city, so there
would be 8 tr8nsient decre8se in LV return > TR murmurs incre8ses during
inspir8tion 8nd MR/VSD murmurs would decre8se or not ch8nge
!$. Vit K deficiency in newborns c8n le8d to intr8cr8ni8l hemorrh8ge
!%. M8ssive hypertensive hemorrh8ge 8t level of locus ceruleus = pigmented
br8instem in the posterior rostr8l pons ne8r l8ter8l floor of fourth ventricle.
Princip8l site for norepinephrine synthesis in the br8in.
!. Vs dop8mine: ventr8l segment8l 8re8 of SNpc in the midbr8in
!&. St8tistic8lly signific8nt if CI does not cross the null v8lue of 0. Null v8lue = 0
when p8r8meter of interest is 8 “difference between”
!. For odds r8tio/rel8tive risk, null v8lue = 1
!'. IgA exists 8s 8 dimer. IgA prote8ses cle8ve IgA 8t its hinge region, which
8llows the b8cteri8 to 8dhere to mucos8l surf8ce.
!. Vs imp8irment of opsoniz8tion 8nd ph8gocytosis - most commonly
enc8psul8ted b8cteri8
!(. Ok Sw8n-G8nz
!). Excessive worry = illness 8nxiety disorder. Different th8n som8tic symptom
dz bc they h8ve no som8tic sx
!*. GAD - symptoms must be present for >6 months
#b. M8nic episode
!. Criteri8
!. >1 week of elev8ted or irrit8ble mood 8nd incre8sed energy/8ctivity
#. >3 of the following symptoms
!. DIGFAST
#!. S3 he8rt sound - LV overlo8d/f8ilure. Would h8ve incre8sed end di8stolic
volume
!. Vs HCM = dyn8mic LV outflow obstruction - crescendo-decrescendo
##. D8ndy-W8lker CANʼT WALK bec8use his cerebell8r vermis is 8bsent. Also
cystic dil8tion of the fourth ventricle with posterior foss8 enl8rgement. Non-
communic8ting hydroceph8lus
#$. Acyclovir > phosphoryl8ted to 8cyclovir monophosph8te upon entering
#$.
infected cell (r8te-limiting step)
#%. There is 8 gr8du8l decline in FEV1 with 8ge st8rting 8t 30, but smoking
cess8tion c8n slow the decline in FEV1 in COPD p8tients
#&. Alzheimers - neurofibrill8ry t8ngles composed of t8u protein (prim8ry
component in intr8cellul8r microtubules). Hyperphosphoryl8ted in AD.
Amyloid bet8 = 8bnorm8l fr8gment of APP (norm8lly involved in syn8ptic
form8tion 8nd rep8ir)
!. Apo E would not be found in gre8ter qu8ntity. Those w 1 or 2 copies of E4
8re 8t gre8ter risk for Alzheimers
#. Vs Amyloid A - 8cute ph8se re8ct8nt > 8ssoci8ted w developing
multisystemic 8myloidosis
#'. Supr8spin8tus = empty c8n. Most common c8use of rot8tor cuff syndrome
#(. Highest osmol8rity occurs 8t the bottom of the loop of henle
!. Others
!. PCT - w8ter is p8ssively 8bsorbed so fluid is isosmotic w pl8sm8
#). UAA, UAG, UGA 8re stop codons. When ribosome encounters stop codon,
rele8sing f8ctor proteins bind to ribosome 8nd stimul8te rele8se of formed
polypeptide ch8in
#*. Preschool 8ge kids m8y not underst8nd fin8lity of de8th. They m8y 8lso
8ttribute events or otherʼs re8ctions to something they did wrong
(egocentric thought process)
!. Som8tic sx 8re 8lso common signs of pyschologic8l distress in kids
$b. Pseudomon8s - c8n h8ve 8ntibiotic-modifying enzymes. Add chemic8l
groups to t8rget drug - this is 8 common form of 8mino glycoside resist8nce
$!. Ok rif8mpin for menignitis prophyl8xis
$#. Ok FFP for immedi8te w8rf8rin revers8l
$$. Gunyon syndrome - hook of the h8m8te. Uln8r neurop8thy. C8n be injured 8t
the elbow or the wrist.
!. Hypothen8r eminence c8n 8ppe8r fl8ttened
$%. Ok ACEIʼs dil8te efferent > GFR reduction
$&. NSAIDs 8re m8inst8y of gouty 8rthritis tre8tment for most, but colchine c8n
be used in its w mild-to-moder8te ren8l f8ilure, PUD, or other
contr8indic8tions
!. Imp8ired leukocyte migr8tion 8nd ph8gocytosis. Inhibits microtubule
form8tion in GI mucos8l cells
#. N/V 8s side effects
$'. Ok
$(. Pl8smodium f8lcip8rum - di8mond ring 8ppe8r8nce w/ intr8erythrocytic
trophozoites
$). Antipsychotic side effects
!. Low potency FGAs - hist8minergic (would 8lso c8use sed8tion),
cholinergic, nor8drenergic block8de
#. High potency FGAs - extr8pyr8mid8l sx
$*. Derm8titis herpetiformis - due to IgA 8ntibodies 8g8inst gli8din. Associ8ted
w celi8c dise8se - incre8sed intr8epitheli8l lymphs
!. Vs IgG-medi8ted skin disruption in pemphigus vulg8ris 8nd bullous
pemphigoid
#. Vs UC - erythem8 nodosum
%b. Bro8d b8sed g8it, sensory disturb8nce - optic neuritis (p8inful eye
movement) > MS. Demyelin8ting pl8ques. I guess you see ex8cerb8tions
8fter hot shower or intense workouts
!. Vs PV - he8t would not worsen neurologic sx
#. Vs 8m8urosis fug8x w 8therosclerosis of c8rotid 8rteries
2/26 Endo

!. Glucocorticoids will stimul>te gluconeogenesis in the liver > incre>se

expression of liver enzymes
!. Peripher>lly - >nt>gonize insulin >ction in skelet>l muscle
#. Tob>cco smoking incre>ses the risk of complic>tions in di>betes. Incre>sed
risk of developing hypercholesterolemi>, poor glycemic control, end st>ge
ren>l dise>se
$. PKU - intellectu>l dis>bility, g>it or posture >bnorm>lity, eczem>, musty
body odor. Autosom>l recessive.
%. Chrom>ffin cells >re stimul>ted by Ach rele>sed in symp>thetic
preg>nglionic neurons. duh.
&. Medic>tion non->dherence: >cknowledge the difficulty of t>king >
medic>tion d>ily
!. Encour>ge the p>tient with > st>tement th>t v>lid>tes her experience
'. ADH - synthesized in supr>optic >nd p>r>ventricul>r nuclei of
hypoth>l>mus. Hypoth>l>mic >xons termin>te into Herring bodies -
speci>lized nerve termin>ls th>t >ct >s stor>ge sites for secretory vesicles.
Vesicles >lso cont>in neurophysins (involved in post-tr>nsl>tion>l hormone
processing). ADH >nd oxytocin >nd neurophysins >re secreted from
posterior pituit>ry.
(. Fibr>tes dr>m>tic>lly decre>se triglycerides
). Zinc finger structure = most commonly identified DNA binding dom>in in
hum>ns.
!. Only intr%cellul%r receptors loc>ted in the cytopl>sm or nucleus c>n >ct
directly >s tr>nscription f>ctors. Once bound to their lig>nd, receptors
bind directly to t>rget DNA sequences w zinc fingers to regul>te gene
expression.
#. B>sic>lly, the structure of steroid, thyroid hormone, >nd f>t-soluble
vit>min receptors
*. Glucose enters B cells by GLUT-2 >nd undergoes oxid>tive met>bolism,
gener>tes ATP
!. ATP then binds to regul>tory subunit of ATP-sensitive K+ ch>nnel
!+. Neur>l crest deriv>tives: SOME SALT
!. Schw>nn cells, odontobl>sts, mel>nocytes, enterchrom>ffin, spin>l
membr>nes, >dren>l medull>, l>rynge>l c>rtil>ge, tr>che>l c>rtil>ge
#. Vs Thyroid follicul>r cells
!. Endoderm deriv>tive
!!. Thi>zide diuretics le>d to hyperc>lcemi> >nd hypoc>lciuri>. Would then
downregul>te PTH rele>se.
!. Vs f>mil>l hypoc>lciuric c>lcemi>. Higherth>n norm>l levels of C> 2+
 !.
required to suppress PTH secretion. Excessive ren>l C>2+ upt>ke
#. Would see PTH >s high-norm>l or mildly elev>ted
!#. Acromeg>ly - le>ds to LV hypertrophy (b>sic>lly just s>ys c>rdiomeg>ly)
!$. 7 dehydrocholesterol = provit>min D3. Allows for >bsorption of UV B r>ys
!%. Weight loss >nd hyperpigment>tion - suggestive of prim>ry >dren>l
insufficiency (Addison dise>se)
!. Requires glucocorticoid supplement>tion w dex>meth>sone or
hydrocortisone
#. Others
!. Dop>mine - for shock >nd refr>ctory c>rdi>c f>ilure
#. Epi - >n>phyl>xis
!&. REVIEW FAMILIAL HYPERLIPOPROTEINEMIAS Type 1
hyperlipoproteinemi> - c>used by LPL deficiency. Norm>lly bound to
hep>r>n sulf>te. Without effective LPL >ctivity - body c>nʼt cle>r diet>ry
lipid lo>ds due to defective hydrolysis of serum triglycerides
!. F>mili>l chylomicronemi> - not usu>lly >t incre>sed risk for prem>ture
CAD
!. X>nthom>s c>n be seen w hypertriglyceridemi> but tendon
x>nthom>s >nd x>nthel>sm>s >re usu>lly seen w
hypercholesterolemi>
!'. Prol>ctinom> - incre>sed levels of prol>ctin suppress GnRH secretion >
reduction in LH rele>se from pituit>ry >nd decre>sed testicul>r testosterone
production
!(. “Glinide” = sulfonylure>. Incre>ses insulin secretion by inhibiting B-cell
K(ATP) ch>nnels
!). Epinephrine >nd insulin: >2-medi>ted inhbitory effect is predomin>nt >
c>uses symp>thetic stimul>tion to le>d to over%ll inhibition of insulin
secretion
!*. Propoptosis = bulging eyes w Gr>ves (triggered by thyrotropin receptor
>uto>ntibodies)
!. C>used by stimul>tion of orbit>l fibrobl>sts by thyrotropin receptor
>ntibodies > excess deposition of extr>cellul>r GAGs. Accomp>nied by T-
cell >ctiv>tion >nd infl>mm>tory infiltr>te. Le>ds to exp>nsion of
extr>ocul>r muscles.
#. Glucocorticoids reduce peripher>l T4 > T3 conversion, but it its >nti-
infl>me properties th>t improve exopth>lmos
#+. Symptom>tic hypop>r>thyroidism following thyroid surgery. Decre>se in PTH
dece>ses c>lcium re>bsorption by kidneys > hypoc>lcemi>.
!. Also reduces phosph>te excretion by the kidneys >nd conversion of
c>lcidiol to c>lictriol (>ctive) in the kidneys
#!. Bile >cids bind bile >cids in GI tr>ct > imp>ired >bsorption. Incre>se hep>tic
production of triglycerides >nd incre>se rele>se of VLDL (Which is
triglyceride he>vy) > hypertriglyceridemi>
 !. Others
!. Fibr>tes: first line for REDUCING triglycerides
#. Ni>cin >lso reduces blood triglycerides
##. Multiple counter-regul>tory mech>nisms >ctiv>ted in response to
hypoglycemi> - gluc>gon, SNS, (to lesser extent) growth hormone >nd
cortisol
!. Deets
!. 2 c>tegories of hypoglycemi>
!. Neurogenic: symp>tho>dren>l >ctiv>tion -tremors, swe>ting,
hunger
#. Neuroglycopenic: beh>vior>l ch>nges
#. B blockers inhibit NE/epi-compens>tory re>ctions to hypoglycemi>
#$. Insulin medi>ted (GLUT 4) = skelet>l muscles >nd >dipocytes. Insulin-
independent (GLUT 1-3, 5): br>in, intestine, liver, kidney, RBCs
#%. Preproinsulin: sign>l sequence inter>cts w cytosolic sign>l recognition
peptide - h>lts protein synth until ribosome tr>nsloc>tes to RER. N termin>l
sign>l peptide is cle>ves from preproinsulin > proinsulin.
!. Then undergoes >ddition of 3 disulfide bonds in RER
#. So the p>rt th>t w>s cle>ved w>s the C-peptide fr>gment. Still secreted
$. Other
!. IL-1 l>cks > sign>ling sequence so it is secreted directly from the
cytopl>sm
#&. PPAR-y = intr>nucle>r receptor. Forms > heterodimer complex w retinoid X
receptor. PPAR-y codes for %diponectin - cytokine secreted by f>t th>t
enh>nces insulin sensitivity >nd f>tty >cid oxid>tion
!. Others (Anki)
!. Enzyme in>ctiv>tion: metformin (mitochondri>l glycerophosph>te
dehydrogen>se) >nd >c>rbose (membr>ne-bound dis>cch>rides on
brush border)
#. Etc
#'. Bet> blockers inhibit peripher>l T4 to T3 conversion
#(. Anorexi> = function>l-hypoth>l>mic >menorrhe> - decre>se in leptin inhibits
puls>tile GnRH rele>se from hypoth>l>mus
#). Medull>ry thyroid c>ncer - RET oncogene - MEN2 - might h>ve
pheochromocytom>
#*. Niem>nn Pick -Ashken>zi Jews - sphingomyelin>se deficiency. Accumul>tion
of sphingomyelin in lysosomes - enl>rged, fo>my, v>cuol>ted lysosomes on
microscopy. Cherry red m>cul>r spot. Hep>tosplenomeg>ly, progressive
neurologic degener>tion, de>th by >ge 3
!. Vs T>y-S>chs: B-hexos>minid>se A - hep>tosplenomeg>ly is >bsent
$+. Two f>tes of insulin TK >ctivity
!. Deets
!. PI3K > met>bolic functions (like tr>nsl>tion of GLUT4) - stimul>tes
 !.
protein phosph>t>se - dephosphoryl>tes glycogen synth>se
#. MAP kin>se - mitogenic functions like DNA synthesis >nd cell growth
$!. Medull>ry thyroid c>ncer = >myloid
!. Others
!. An>pl>stic thyroid c>ncer - pleomorphic cells >nd irregul>r gi>nt cells
$#. Isol>ted posterior pituit>ry injury c>n c>use tr>nsient centr>l DI but d>m>ge
to hypoth>l>mic nuclei results in loss of v>sopressinergic neurons -
perm>nent centr>l DI
$$. Niem>nn pick - sphingomyelin>se - neurodegener>tion >nd
hep>tosplenomeg>ly
!. Lipid-l>den fo>m cells >ccumul>te in liver >nd spleen
$%. T2DM - insulin resist>nce >nd defective insulin secretion. Amylin is stored in
insulin secretory gr>nules >nd is co-secreted w insulin from p>ncre>tic bet>
cells
$&. Pompe dise>se = deficiency of >-glucosid>se - bre>ks down glycogen w/in
>cid lysosome environment
!. C>rdiomeg>ly, hypotoni>, m>croglossi>, hep>tomeg>ly
$'. MSUD - BCKDC deficiency - bre>kdown of leucine, isoleucine, v>line
$(. X>nthel>sm>s - derm>l >ccumul>tions of benign->ppe>ring m>croph>ges w
>bund>nt, finely v>cuol>ted (fo>my) cytopl>sm w cholesterol
$). MSUD - supplement with Thi>mine
!. 5 cof>ctors
!. Tender Loving C>re for N>ncy
#. Thi>mine, Lipo>te, CoA, FAD, NAD
#. Other
!. Tetr>hydrobipoterin deficiency > phenylketonuri> w/
tetr>hjydrobiopterin >s cof>ctor for phenyl>l>nine hydroxyls
$*. Cytosolic enzym>tic re>ctions - glycolysis, FA synthesis, pentose phosph>te
p>thw>y
!. Tr>nsketol>se uses B1 >s > cof>ctor to shuttle 2-c>rbon fr>gments
between sug>r molecules
#. Others
!. Pyruv>te c>rboxyl>se - c>t>lyzes initi>l step in glucose by converting
pyruv>te to ox>lo>cet>te - in the mitochondri>
#. HMG-CoA is >lso > mitochondri>l enzyme
%+. Hypoc>lcemi> - most common c>use of >cute hypoc>lcemi> is injury to PTH
gl>nds during thyroid surgery
2/26 Mixed

!. Routes of g<stric <cid secretion by p<riet<l cells

!. Deets
!. Hist<mine binds H2 receptors > incre<sed cAMP
#. ACh binds M3 > incre<se in intr<cellul<r C<
$. G<strin binds cholecystokinin B > incre<ses intr<cellul<r C<
!. Also stimul<tes hist<mine synthesis <nd rele<se by ECL cells
#. Systemic m<stocytosis = clon<l m<st cell prolifer<tion - <ssoci<ted with
mut<tion in KIT receptor TK. Hist<mine from degr<nul<tion le<ds to
flushing, hypotension, pruritus <nd urtic<ri<. Also in<ctiv<tes p<ncre<tic
<nd intestin<l enzymes > di<rrhe<.
$. Vs hypomotility with met<bolic disorders <nd mucos<l <trophy w H pylori
coloniz<tion
#. St<ph <ureus gener<tes < (preformed) he<t-st<ble enterotoxin.
!. Vs others (Anki)
$. Noc<rdi< - p<rti<lly <cid f<st
%. MM ok
&. Stupid stop codon bullshit UAA, UAG, UGA
'. SCID - B cell <nd T cell dysfunction. High risk of vir<l, fung<l, <nd
opportunistic p<thogens. Chronic di<rrhe< <nd f<ilure to thrive <re <lso
common.
!. Vs CF would le<d to respir<tory infection <nd di<rrhe<. Pneumocystis <nd
thrush would not be expected.ʼ
(. C<ndid<l skin test determines presence of cellul<r or T cell-medi<ted
immunity thru type IV hypersensitivity
!. M<croph<ges, CD4+ <nd CD8+ cells <re key cells involved
#. Anergy (f<ilure to respond) to c<ndid< testing is typic<l in SCID pts
). Aortic <rches - <nki
*. Hydroxyure< incre<ses HbF cool
!+. Heteropl<smy expl<ins why cert<in offspring <re more <ffected in
mitochondri<l dise<ses
!!. PCOS - higher risk of endometri<l c<rcinom< <nd <denoc<rcinom<.
Decre<sed progesterone secretion.
!. Vs fem<les exposed to DES in utero <re <t incre<sed risk of v<gin<l
<denom<s (persistence of gl<ndul<r column<r epithelium in v<gin<)
!#. L-type c<lcium ch<nnels <re <ctiv<ted during ph<se 2 of < c<rdi<c <ction
potenti<l (depol<riz<tion) > influx into c<rdi<c myocytes
!. Initi<l c<lcium influx is sensed by ry<nodine receptors in SR > triggers
further rele<se of C< 2+
#. Myocyte rel<x<tion > subsequent to c<lcium efflux from the cytopl<sm:
 #.
intr<cellul<r c<lcium removed vi< N</C< exch<nge pump <nd C<-ATP<se
pump
$. Vs c<lmodulin - medi<tes regul<tory effects of C<2+
!$. Termin<l bronchioles h<ve l<rger cross-section<l <re< so they will h<ve le<st
resist<nce
!%. Uln<r nerve - p<sses between hook of h<m<te <nd pisiform thru gunyonʼs
c<n<l
!. If injured, c<n le<d to we<kness on wrist flexion/<dduction. C<n end up
with uln<r cl<w
!&. Mitochondri<l DNA - sm<ll, circul<r chromosome
!'. Blunt <ortic injury would usu<lly occur <t <ortic isthmus (ne<r left subcl<vi<n
<nd left common c<rotid - two sep<r<te br<nches). C<n see < widened
medi<stinum on X-r<y.
!(. P<tell<r fr<cture - could not extend knee <g<inst gr<vity. Usu<lly due to
direct blow to <nterior knee.
!). H<loperidol for <git<tion <nd psychosis <ssoci<ted w delirium. Appropri<te
for tre<tment in elderly if pt is <t risk of <cute h<rm to self or others, or
beh<vior<l interventions h<ve f<iled.
!*. No design<ted surrog<te, so goes to next of kin (usu<lly spouse)
#+. Glucokin<se - glucose sensor in bet< cells - v<ries r<te of glucose entriesy
into gylcolytic p<thw<y b<sed on blood glucose. C<n h<ve heterozygous
glucokin<se mut<tions <nd end up with m<turity-onset di<betes of the
young - mild, non progressive hyperglycemi< th<t worsens with pregn<ncy-
induced insulin resist<nce
!. Others
!. Glycolytic enzyme deficiencies usu<lly present w hemolytic <nemi<
since RBCs rely on <n<erobic glycolysis for energy production
#. Deficiency of pyruv<te c<rboxy<se would le<d to l<ctic <cidosis <nd
f<sting hypoglycemi<
#!. Rett syndrome - loss of motor <nd l<ngu<ge, stereotypic h<nd movements,
deceler<tion of he<d growth. Mut<tion on MECP2 gene
##. Mucos<l biopsy for mucor. Bro<d ribbon-like nonsept<te hyph<e w right-
<ngle br<nching.
#$. Acute onset neurologic defect second<ry to ischemic stroke. Microgli< would
come into the <re< 3-7 d<ys <fter onset of ischemi<
!. Myelin bre<kdown products <ccumul<te in cytopl<sm of microgli< <s
fo<my lipids
#%. Cross-Section<l = “sn<pshot” design
#&. Sep<r<tion <nxiety disorder - physic<l symptoms when sep<r<tion occurs or
is <nticip<ted. Must be present for >4 weeks in kids <nd >6 months in
<dults.
#'. Pseudo <nd diphtheri< - both h<ve elong<tion f<ctors
#(. H<nd hygeine = single most import<nt me<sure to reduce risk of
#(.
tr<nsmission of microorg<nisms between p<tients
#). RA m<n<gement: DMARDs - MTX is first line, but PREDISONE will work the
most r<pidly.
#*. S<rcoid + m<ss effect sx - he<d<che, bitempor<l visu<l feed defects. Might
h<ve <ctive s<rcoidosis w involvement of hypoth<l<mus (neuros<rcoid) -
gr<nulom<s c<n form in <ny tissue
$+. Temporom<ndibul<r disorder - unil<ter<l f<ci<l p<in th<t worsens w j<w
movement, he<d<che, e<r discomfort. C<used by hypersensitivity of
m<ndibul<r br<nch of trigemin<l nerve
$!. If < b<cteri< is disturbed by ch<nges in tonicity - cell w<ll is not int<ct
$#. MDR1 gene - c<uses tumor cells to develop resist<nce to <ntibiotic.
Prototype is P-glycoprotein, tr<nsmembr<ne protein th<t functions <s ATP-
dependent efflux pump.
$$. Mifepristone = progesterone <nt<gonist - le<ds to <poptosis <nd necrosis of
uterine decide
$%. Aortic regurgit<tion - murmur is best he<rd w p<tient le<ving forw<rd. The
pe<k intensity occurs <fter <ortic v<lve closes. Pressure gr<dient f<lls
progressively since blood is reg<rding into left ventricle.
!. Ch<nges include
!. Loss of dicrotic notch
#. Steep di<stolic decline of <ortic pressure
$. High-pe<king left ventricul<r <nd <ortic systolic pressures - wide
pulse pressure
$&. Methimeth<zole - inhibits coupling of iodotyrosines. PTU <nd methim<zole
<re both used to tre<t hyperthyroidism - inhibit TPO
$'. DNA Pol I is the only prok<ryotic polymer<se th<t h<s 5ʼ to 3ʼ exonucle<se
<ctivity
$(. REVIEW V-Q mism<tch is most common c<use of oxygen-induced
hyperc<pni<
!. Hypoxi< c<uses v<soconstriction of pulmon<ry <rteries > shunt blood to
<lveoli w highest ventil<tion. High O2 reverses pulmon<ry
v<soconstriction -so there will be blood flow directed <w<y from well-
ventil<ted <lveoli - incre<se in physiologic de<d sp<ce
#. Vs free r<dic<l gener<tion: oxygen toxicity would show up <s he<viness,
pleuritic chest p<in, cough/dyspne<
$). Women w menses - risk for IDA. Decre<sed ferritin, incre<sed tr<nsferrin.
$*. Appe<r<nce of v<cuoles <nd phospholipid-cont<ining <morphous densities
= irreversible injury
!. Signs of REVERSIBLE injury
!. Myofibril rel<x<tion
#. Dis<ggreg<tion of polysomes = dissoci<tion of rRNA from mRNA in
reversible injury
$. Dis<ggreg<tion of gr<nul<r <nd fibrill<r elements in the nucleus
 %. Triglyceride droplet <ccumul<tion = reversible injury in hep<tocytes,
stri<ted muscle cells <nd ren<l cells
&. Glycogen loss - <lso reversible
%+. Brown pigment stones <rise second<ry to b<cteri<l infection of the bili<ry
tr<ct -rele<se of bet<-glucornid<se by injured hep<tocytes <nd b<cteri<
!. C<n <lso see bile stones w chronic hemolytic <nemi< - sm<ll <mt of
conjug<ted bili becomes deconjug<ted by endogenous bet<-
glucuronid<se in bili<ry tr<ct
2/27 Mixed

!. Common perine;l everts ;nd dorsiflexes. Susceptible to injury ;t the l;ter;l

neck of the fibul; - c;used by compression from surgery.
#. Celecoxib - COX 2 inhibitor. C;n be used to reduce infl;mm;tion in gout.
!. Vs colchicine - inhibits microtubule form;tion - imp;ired neutrophil
mitosis ;nd decre;sed neutrophil chemot;xis
$. Prep;tell;r bursitis - from kneeling
!. B;ker cyst - c;used by swelling of g;strocnemius - usu;lly in its w OA or
infl;mm joint dz
#. Anserine bursitis - results from obesity or overuse in ;thletes
%. Qu;lit;tive v;ri;bles - c;tegoric;l. C;n use chi squ;re test to ev;lu;te. Pts
divided into norm;l vs high fibrinogen, ;nd then whether they were tre;ted
or not tre;ted
!. Vs ANOVA ;nd two s;mple T test comp;re me;ns between 2 groups
&. GCPR stuff: lig;nd binds, exch;nges GDP for GTP on ;-subunit of Gq protein
;ssoci;ted w receptor. A-subunit undergoes conform;tion; l ch;nge ;nd
exposes PLC ;ctiv;ting site.
'. If momʼs c;rrier st;tus is unknown ;nd she h;s two c;rrier p;rents - would
h;ve ; 2/3 ch;nce of being ; c;rrier (two ch;nces of c;rrier, one ch;nce of
being ;uto domin;nt). Then 1/2 ch;nce th;t she would tr;nsmit the c;rrier
;llele.
!. So momʼs ch;nce of p;ssing on ; c;rrier ;llele = 2/3 x 1/2 = 1/3
#. Multiply by d;dʼs 100% ch;nce of p;ssing on ;llele = 1/3
(. So I guess ;ccumul;tion effect is ; thing. Effect of exposure to risk f;ctors
depends on dur;tion ;nd intensity of exposure.
!. Vs le;d time = time between initi;l detection ;nd specific outcome or
me;sured endpoint
#. Another nice tidbit: odds r;tio ;pproxim;tes RR when dise;se prev;lence
is low
). Atropine: no effect on nicotinic receptors. Pts still ;t risk for muscle
p;r;lysis. Use pr;lidoxime (cholinester;se-re;ctiv;ting ;gent) to tx effects
of nicotinic block;ge.
!. Pr;lidoxime ;llows for degr;d;tion of excess ACh
*. This dude h;s MM - ren;l insufficiency, normocytic ;nemi;, hyperc;lcemi;,
bone p;in
!. Incre;sed osteocl;st ;ctivity - myelom; cells stimul;te osteocl;st
m;tur;tion by producing RANKL ;nd destroying OPG. Also inhibit
osteobl;st ;ctivity by secreting cytokines th;t inhibit osteobl;st function.
!+. REVIEW Two m;jor processes th;t m;int;in pl;sm; glucose between me;ls:
glyogenolysis ;nd gluconeogensis.
 !. Glycogenolysis for first 12-18 hours.
#. Then gluconeogenesis once hep;tic glycogen stores ;re depleted.
!. First committed step = bitcoin-dependent c;rboxyl;tion of pyruv;te
to ox;lo;cet;te by pyruv;te c;rboxyl;se.
$. Others
!. F6P > F16BP occurs during glycolysis ;nd is c;t;lyzed by PFK
!!. Ionizing r;di;tion induces DNA str;nd bre;ks. Free r;dic;l gener;tion.
!. Vs d;m;ge from UV r;di;tion le;ds to the form;tion of pyrimidine dimers
#. Also, ;denine methyl;tion in the templ;te str;nd helps guide mism;tch
rep;ir
!#. I guess deperson;liz;tion/dere;liz;tion is ; thing
!. Vs dissoci;tive ;mnesi; - in;bility to rec;ll person;l info (usu;lly
tr;um;tic or stressful event)
!$. Exogenous T3 supplement;tion r;pidly suppresses TSH levels but T4
supplement;tion is preferred bc T3 levels flucu;te
!. Reverse T3 is gener;ted from peripher;l conversion of T4. So if T4 is
decre;sed, rT3 will be decre;sed.
!%. HCM - incre;sed LV m;ss ;nd sm;ll LV c;vity. Preserved EF but imp;ired
rel;x;tion of LV w;ll.
!. If prelo;d is incre;sed (h;nd grip or leg elev;tion), decre;ses intensity of
murmur bc there is more sp;ce in between the hypertrophied w;lls
!&. Centr;l line is ;dv;nced until the tip enters the SVC, which is derived from
common c;rdin;l veins
!. Veins in developing embryo dr;in to sinus venous - dr;ins into primitive
;trium of the he;rt. 3 m;in groups of veins - umbilic;l (Degener;tes),
vitelline (becomes port;l system), c;rdin;l (becomes systemic
circul;tion).
!'. Acute onset of dyspne;, hypoxemi;, ;nd hypoc;pni; - hyperventil;tion.
Arteri;l P;CO2 is the m;in indic;tor of tot;l ;lveol;r ventil;tion, so
hypoc;pni; implies ;lveol;r hyperventil;tion
!. C;n result from V/Q mism;tch - decre;sed O2 ;nd Co2 exch;nge.
Hypoxemi; stimul;tes chemoreceptors ;nd incre;ses respir;tory drive
;bove norm;l levels, but hypoxemi; persists bc blood flowing thru
oxygen;ted lung c;nnot ;bsorb extr; O2 to compens;te for hypoxemi;
blood returning from poorly oxygen;ted regions.
!(. Dex;meth;sone reduces infl;mm cytokines in the CSF - limits risk of
infl;mm;tion-induced morbidity ;nd de;th
!. Neisseri; ;nd H flu do not benefit from glucocorticoid pretre;tment bc
they h;ve thinner cell w;lls - less cytokine rele;se
#. Another note: reduced infl;mm response would keep tight junctions tight
- decre;sed ;ntibiotic penetr;nce into CSF
!). Retroperitone;l org;ns: SAD PUCKER
!. P;ncre;s is one, spleen is not. P;ncre;tic tr;um; is ; common c;use of
 !.
retroperitone;l hem;tom;.
#. Spleen rupture would le;d to hemoperitoneum (free blood in peritone;l
sp;ce), but not retroperitone;l hem;tom;
!*. Fosc;rnet chel;tes c;lcium ;nd le;ds to ren;l w;sting of m;gnesium. Both
hypoc;lcemi; ;nd hypom;gnesemi; c;n promote seizures.
#+. Ph;ses of stimul;tion of ;cid secretion
!. Deets
!. G;stric: triggered by chemic;l stimulus of food ;nd distension fo
stom;ch
#. Intestin;l: protein-cont;ining food enters duodenum
$. Intestin;l: ileum ;nd colon rele;se peptide YY - binds to receptors on
endocrine, hist;mine-cont;ining cells (ECLs) . Counter;cts ceph;lic
;nd g;stric ph;ses of ;cid secretion by inhibiting g;strin-stimul;ted
hist;mine rele;se from ECLs.
%. Som;tost;tins ;nd prost;gl;ndins ;lso inhibit ;cid rele;se.
#. Others
!. Postpr;ndi;l ;lk;line tide - incre;se in HCO3- ;nd decre;se in Cl-
second;ry to surge of ;cid. Not involved in down regul;tion
#!. Ok the d;d is not thinking correctly so tell the d;ughter
##. Root c;use ;n;lysis ye;h ye;h ye;h
#$. St;ph epidermidis c;n infect he;rt v;lves - form biofilms. Most co;g-neg
st;ph ;re methicillin resist;nt. V;ncomycin should be component of initi;l
ther;py.
!. Methicillin resist;nt str;ins will likely be ceph;losporin-resist;nt ;s well
#%. Estrogen incre;ses cholesterol secretion. Progesterone DEcre;ses
g;llbl;dder mobility.
#&. ACEIʼs will preferenti;lly dil;te the efferent ;rteriole ;nd decre;se
glomerul;r filtr;tion, so GFR will f;ll. Nothing ;ctu;lly wrong with the kidney
#'. C dip produces AB exotoxin
!. B subunit binds to hep;rin-binding epiderm;l growth f;ctor on c;rdi;c
;nd neur;l cells - c;rdio ;nd neurotoxic
#. A subunit c;t;lyzes ADP-ribosyl;tion of protein EF-2 (necess;ry for tRNA
to insert new ;mino ;cids when ch;in is growing)
#(. M;lign;nt mel;nom; - from neur;l crest cells
#). Aminoglycosides interfere w binding ;t 30S subunit. Resist;nce =
methyl;tion of ;minoglycoside-binding portion of ribosome. (In;ctiv;ting
;cetyl;tion ninj; st;rs)
#*. Hookworm (nect;tor Americ;ns ;nd ;ncyclostom; duoden;l) - tropic;l ;nd
subtropic;l regions. Le;ds to ; m;culop;pul;r r;sh ;t the entry site. L;rv;e
then spre;d to lungs where they rupture, ;re coughed up ;nd sw;llowed.
C;n le;d to subst;nti;l blood loss bc they live in the GI tr;ct for up to 14
ye;rs. High risk for IDA
!. Peripher;l eosinophili; is ;n import;nt di;gnostic clue
 #. Other
!. D l;tum does h;ve eggs on stool microscopy, but they would h;ve ;
lid-like opening (operculum)
$+. REVIEW Z line is big ;nd f;t ;nd provides structur;l ;nd binding proteins.
S;rcomere = the dist;nce between 2 z lines
$!. St;ph ;ureus c;n be ; c;use of pneumoni;
$#. Type I interferons (; ;nd b) - bind type I interferon receptors found on
infected ;nd neighboring cells > le;ds to tr;nscription of enzymes c;p;ble
of h;lting protein synthesis
!. Vir;lly infected respir;tory epitheli;l cells would secrete IFN ; ;nd B, not
IFN y
$$. Fet;l Hb production begins ;round 8 weeks ;nd is repl;ced by ;dult
hemoglobin through the first 6 months of life
$%. Risperidone inhibits D2 receptors ;nd ;lso h;s effects on serotonin/;lph;-
;drenergic p;thw;ys. Le;ds to loss of norm;l tonic inhibition of prol;ctin
rele;se - so c;n le;d to hyperprol;ctinemi; ;nd le;d to ;menorrhe;
$&. Listeri; is resist;nt to third-gener;tion ceph;losporins due to PBPs th;t
h;ve low-;ffinity for this cl;ss. H;ve to ;dd ;mpicillin.
!. Third gen does cover H flu
#. Strep ;g;l;cti;e is susceptible to ;mpicillin/penicillin ;nd 3rd gen
ceph;losporins
$'. V/Q mism;tch from ; pulmon;ry embolism
!. Vir;l pleuritic with effusion would h;ve ; ventil;tion defect, but would be
m;tched w perfusion defect. This p;tient h;s isol;ted perfusion defects.
$(. Protect pt confidenti;lity
$). C;vernous hem;ngiom; - c;n le;d to intr;cerebr;l hemorrh;ge.
Hyperdense/bright m;ss on he;d CT
!. Vs sub;r;chnoid would be from ruptured s;ccul;r ;neurysms
#. Vs subdur;l hem;tom; - from rupture of bridging veins in subdur;l sp;ce
c;used by he;d tr;um;
$*. Hodgkin - RS cells! Bimod;l ;ge distribution - pe;k in 20s, ;nother in 60s.
Lymph node biopsy is the key di;gnostic.
%+. K;rt;gener - prim;ry cili;ry dyskinesi;. Sinusitis ;nd otitis medi;.
2/27 Repro

!. p53 7nd Rb mut7ted in HPV infection > cell cycle regul7tory proteins
!. Others
!. RAS (p7ncre7tic c7ncer) 7nd BRAF (m7lign7nt mel7nom7): proto-
oncogenes
#. MSH2: DNA mism7tch rep7ir (HNPCC)
$. PDGF: enh7ncement of growth f7ctor secretion > glio
#. Progesterone withdr7w7l test: progesterone withdr7wn, prost7gl7ndin
production incre7ses > v7soconstriction of spir7l 7rteries. Also incre7ses
secretion of met7lloprote7ses by endometri7l stroll cells > degr7d7tion of
extr7cellul7r m7trix 7nd !poptosis of endometri7l epithelium.
!. Vs hyperpl7si7 would more likely represent c7ncer
$. Complete mole: most likely 46,XX - no fet7l structures, disordered chorionic
villi th7t look like 7 “bunch of gr7pes”. “Snowstorm” 7ppe7r7nce on
ultr7sound.
!. No m7tern7l chromosomes, fertilized by 1 sperm
#. Others
!. 47 XXX is the most common sex chromosome 7bnorm7lity in fem7les
#. P7rti7l moles: 69,XXX or 69, XXY - ovum fertilized by 2 sperm
%. Puls7tile GnRH secretion: enh7nced LH 7nd FSH secretion. Txʼs 7n ovul7tion
due to hypogon7dotopic hypogon7dism.
!. Other
!. Long-7cting GnRH ther7py is used the suppression of gon7d7l
function - prost7te c7ncer, endo, precocious puberty, premenop7us7l
bre7st c7ncer
&. Fin7steride decre7ses prost7te volume
'. Arom7t7se deficiency - 7ffected newborn girls will h7ve norm7l intern7l
genit7li7 7nd 7mbiguous or m7le-type extern7l genit7li7
(. Blood c7ncers spre7d to the lumbos7cr7l spine through the vertebr7l venous
plexus. Also communic7tes w 7zygous veins in chest - so bre7st 7nd lung
c7ncers frequently met7st7size to thor7cic spine
). P7rti7l mole - elev7ted b-HCG, enl7rged villi interspersed w/ norm7l villi
!. Vs chorio - sheets of 7n7pestic cytotrophobl7sts 7nd
syncytiotrophobl7sts
*. Turner syndrome - v7ri7ble degree of ov7ri7n dysgenesis - stre7k ov7ries
(underdeveloped) - ov7ri7n follicles 7re repl7ced by fibrotic tissue
!. Others
!. Absent uterus 7nd prim7ry 7menorrhe7: Mulleri7n 7genesis 7nd AIS
!+. M7tern7l use of ACEIʼs 7nd/or ARBs is the most likely re7son for potter
sequence. Low ATII levels result in fet7l ren7l m7ldevelopment
 !. Others
!. NSAIDs decre7se production of PGE1 7nd 7re 7voided in third
trimester due to risk of prem7ture closure of ductus 7rteriosus
!!. T7moxifen - 7nti-estrogenic in bre7st, stimul7tory in the endometrium. Also
h7s 7 f7vor7ble effect on lipids > decre7se in tot7l 7nd LDL cholesterol, no
ch7nge in HDL. Serum triglycerides m7y incre7se in some p7tients
!#. Hyperprol7ctinemi7 - inhibition of GnRH secretion > le7ds to 7bsence of
menses
!$. C7ndid7 decre7ses l7ctob7cilli production (gr7m + b7cteri7)
!. Other options
!. Decre7sed thickness of v7gin7l epithelium 7nd decre7sed 7mt of
glycogen - ch7r7cteristic of postmenop7us7l 7nd l7ct7ting women -
due to decre7sed estrogen levels
#. Elev7ted pH would be seen w trich 7nd g7rderenell7
!%. Hydropic villi = mole. p57-neg7tive st7ining. Hyperemesis gr7vid 7rum from
incre7sed B-hCG secreted from prolifer7ting trophobl7st. C7n c7use
form7tion of thec7-lutein cysts. Must monitor b-HCG - potenti7l for
m7lign7nt tr7nsform7tion.
!&. Sertoli-Leydig tumor: l7rge 7dexn7l m7ss w 7menorrhe7 7nd viriliz7tion
!. others
!. Gr7nulos7 - C7ll Exner, coffee be7n nuclei (coffee “gr7nules”)
!'. Ureter7l injury - fl7nk p7in 7nd fever. Second ureter is uninjured so the pt
c7n still urin7te
!(. Mulleri7n 7pl7si7 - would see pubic h7ir AND 7 uterus, vs AIS where you see
NO pubic h7ir 7nd NO uterus
!). Sertoli cells 7re 7n7l7gous to fem7le gr7nulos7 cells > produce inhibin in
response to FSH from 7nterior pituit7ry.
!. Sertoli dysfunction: decre7sed inhibin production, incre7sed FSH +
infertility due to imp7ired sperm production
!*. LAV for rubell7
#+. Pelvic org7ns - m7inly supplied by intern7l ili7c 7rteries. Uterine 7rteries 7re
br7nches off intern7l ili7c.
!. Uterine 7rteries receive coll7ter7l blood flow from ov7ri7n 7rteries
#!. Turner: webbed neck, lymphedem7, 7nd diminished femor7l pulses from
co7rc
##. B-hCG before st7rting isotretinoin
#$. F7iled l7ter7l/vertic7l fusion of p7r7 ducts would le7d to bicornu7te uterus >
indent7tion in center of fundus
#%. Menop7use > FSH levels incre7se due to resist7nt ov7ri7n follicles 7nd l7ck
of feedb7ck from inhibin
!. Estr7diol 7nd progesterone levels gr7du7lly decre7se during menop7us7l
tr7nsition - due to decre7sing ov7ri7n function
#&. Histo stuff
 !. Deets
!. Norm7l uterine mucos7: simple column7r, tubul7r gl7nds, storm
#. Ov7ry: simple cuboid7l
$. Peritone7: simple squ7mous
#'. Meth7done or morphine for neon7t7l 7bstinence syndrome
#(. if they still get morning erections, theyʼre fine
#). Progesterone incre7ses 7fter ovul7tion
#*. Overlying skin retr7ctions (dimpling) involve the suspensory lig7ments of the
bre7st (cooperʼs lig7ment)
!. vs the m7ss in the RUQ - m7lign7nt cells c7n dr7in through lymph7tics
but there wouldnʼt be skin ch7nges
$+. Prost7te gl7nd is loc7ted 7bove 7n7l c7n7l
$!. Fr7tern7l = dichorionic, di7mnionitc
!. Vs the most common monozygotic = monochorionic di7mniotic
$#. Imperfor7te hymen c7n be 7 c7use of prim7ry 7menorrhe7 7nd c7n c7use
cyclic pelvic/7bdomin7l p7in
!. Vs Asherm7n syndrome - second7ry 7menorrhe7 thru obstruction of
sc7rring of uterine c7vity. Usu7lly from uterine infection or procedures
(D&C)
$$. Epitheli7l ov7ri7n c7ncer - c7n prevent w combined OCPs bec7use there is
less rep7ir 7t the ov7ri7n surf7ce due to reduced lifetime ovul7tion
frequency
$%. Sperm7tic cord goes thru extern7l oblique. Testes go through physiologic
opening in tr7nsvers7ls f7sci7.
$&. S7line microscopy = wet mount
$'. Pudend7l nerve block for episiotomy
!. Import7nt l7ndm7rks: ischi7l spines 7nd s7crospinous lig7ment - firm
b7nd th7t runs medi7lly 7nd posteriorly from ischi7l spine to s7crum
$(. Rubell7 ok
$). Gonococc7l cervicitis - 7symptom7tic - detected by pelvic ex7m 7nd NAAT.
Gonorrhe7 7nd chl7mydi7 7re most common p7thogens > PID. C7n le7d to
infertility due to sc7rring of F7llopi7n tubes.
!. NOT AT RISK FOR CERVICAL CANCER
$*. IVF for Turnerʼs p7tients
!. Vs puls7tile GnRH for hypogon7dotropic, hypogon7d7l 7n ovul7tion
%+. Adenomyosis - endometri7l gl7ndul7r tissue in myometrium. Common in
middle-7ged p7rous fem7les. Uniformly enl7rged uterus.
3/1 Mixed

!. L6ngerh6ns - dendritic cells in the skin th6t 6ct 6s profession6l APCs.

Gr6nulom6tous infl6mm6tion.
!. Other
!. Monocytes in the liver = Kupffer cells
#. Spleen is derived from mesoderm but it is supplied by foregut blood supply
(celi6c trunk)
$. IL-8: neutrophils.
!. Others
!. C56 - recruits 6nd 6ctiv6tes neutrophils, monocytes, eosinophils 6nd
b6sophils
%. Proc6in6mide - drug-induced lupus
!. 6nti-dsDNA 6ntibodies 6re NOT seen in DILE
&. CF - no v6s deferens. K6rt6gener - immotile sperm.
!. Both c6n c6use recurrent pulmon6ry infections 6nd clubbing
'. Ok
(. Cric goes through the superfici6l cervic6l f6sci6 6nd cricothyroid membr6ne
!. Vs cricoid c6rtil6ge lies inferior to thyroid c6rtil6ge 6t level of C6 vertebr6
). Fibronectins 6re produced by fibrobl6sts 6nd some epitheli6l cells - binds to
interns, m6trix coll6gen, GAGs - medi6tor of cell 6dhesion 6nd migr6tion
!. Adhesion of cells in ECM involves integrin-medi6ted binding to fibronectin,
coll6gen, l6minin
*. Cl6rify p6tientʼs medic6tion history when ev6lu6ting for drug-seeking
beh6vior
!+. PKU - seizures, development6l del6y. Would 6lso see loss of pigment6tion in
SNpc bec6use phenyl6l6nine is eventu6lly converted to mel6nin
!. Others
!. Dop6mine hydroxyls - c6t6lyzes biosynthesis of norepinephrine from
dop6mine
#. Alk6ptonuri6 - 6utosom6l recessive disorder of tyrosine degr6d6tion -
deficiency of homogentistic 6cid oxid6se > connective tissue
hyperpigment6tion
!!. Re6ction form6tion: turning un6ccept6ble feelings into the opposite
!. Vs splitting: things 6re either “6ll b6d” or “6ll good”
!#. Osteoporosis = bone density th6t it 2.5+ st6nd6rd devi6tions below the
me6n for pe6k young 6dult bone density. Weight-be6ring exercise prevents it
!$. Physiologic de6d sp6ce = tot6l volume of de6d sp6ce in the lungs. Includes
6n6tomic 6nd 6lveol6r de6d sp6ce due to well-ventil6ted but poorly
perfused 6lveoli.
!%. Abduction with the supr6spin6tus. Subsc6pul6ris = 6dduction 6nd intern6l
!%.
rot6tion. Supr6spin6tus is prone to repe6ted impingement tr6um6 btwn
humer6l he6d 6nd 6cromion - especi6lly in 6bduction
!&. Et6nercept = TNF-6 inhibitor 6dded to MTX to tx RA in those who h6ve f6iled
MTX 6lone
!. Vs ri-tu-xi-m6b: chimeric 6ntibody t6rgeted 6g6inst TNF-6 (cell surf6ce
receptor 6ntibody)
#. “-cept” = receptor molecul6r, “nib” = kin6se inhibitor
$. -u- = hum6n, -o- = mouse
!'. Amitrypline - musc6rinic block6de (6nticholinergic toxicity) in elderly w
overdose
!(. Smooth muscle hypertrophy le6ds to projectile vomiting - pyloric stenosis
!). APML: presents w 15;17 tr6nsloc6tion. RARA is on chromo 17 - fusion
produces PML/RARA. Amemi6, p6llor, f6tigue - result from m6rrow
repl6cement by leukemic cells
!*. Vit6min E deficiency - neuromuscul6r dise6se 6nd hemolytic 6nemi6 (bc
vit6min E is 6n 6ntioxid6nt - protects from 6nemi6)
!. This pt h6s f6t m6l6bsorption - so w6ter soluble vit6mins (B1, B2, B3)
would not be 6ffected
#. Other
!. Vit6min C excess -c6n le6d to n6use6, 6bdomin6l p6in, di6rrhe6
#+. Puffer fish (tetrodotoxin) intoxic6tion - binds to N6+ ch6nnels, inhibits N6+
influx 6nd prevents AP conduction. Also s6xitoxin (dinofl6gell6tes in red tide)
!. Vs Cigu6toxin (eel, exotic fish) 6nd b6tr6chotoxin (South Americ6n frogs)
- toxin binds to N6+ ch6nnel, keeps it open > persistent depol6riz6tion
#!. M6jority of overdose de6ths = opioids
##. Nightm6res
#$. Type II hypersensitivity = org6n rejection. Preformed 6nti-donor 6ntibodies
6tt6ck tr6nspl6nted org6n. Other ex6mples = 6nti-HBO 6nd 6nti-HLA
6ntibodies
!. Vs type I (immedi6te) would be 6n6phyl6xis
#%. M6le smokers 6t highest risk for AAA. Smoking > incre6sed infl6mm
infiltr6tes 6nd form6tion of ROS species
#&. Rot6virus blunts the villi, inv6des duodenum 6nd jejunum
#'. Norovirus = most common c6use of vir6l g6stroenteritis
!. Rot6virus isnʼt 6s common bc now there is 6 v6ccine
#(. Gonorrhe6 cool
#). Anti-HAV IgG 6ntibodies - 6nicteric infection (no j6undice, subclinic6l or
silent)
!. Hep A is self-limiting so would not est6blish 6 c6rrier st6te
#*. Medi6stin6l widening 6nd 6ortic reg6rd - c6n present with terti6ry syphillis
!. Medi6l infl6mm6tion would be ch6r6cteristic of l6rge vessel 6rteritides
$+. EBV envelope glycoprotein binds to CD21 on surf6ce of B cells
!. Exposure to monoclon6l 6nti-CD21 could interfere w EBV 6tt6chment
$!. Free w6ll rupture: 5-14 d6ys 6fter MI (m6croph6ge-medi6ted structur6l
degr6d6tion)
!. Prior history of MI - lower risk of c6rdi6c rupture (due to myoc6rdi6l
fibrosis 6t site of inf6rction)
#. Also concentric LV hypertrophy - incre6sed w6ll thickness - less ch6nce
of rupture
$#. NMS cool
$$. H/K ATP6se inhbitors cool (PPIs)
!. C6n h6ve incre6sed risk of nutrition6l deficiency 6nd C diff due to
incre6sed pH
$%. So since there were 20,000 people 6lre6dy with the dise6se, h6ve to
subtr6ct th6t out from the tot6l popul6tion
$&. I guess this isnʼt rel6tive risk…
$'. The SA node is ne6r the opening of the SVC
$(. Tr6nsketol6se 6nd tr6ns6ldol6se c6n produce glycolytic intermedi6tes GAP
6nd F6P for ATP gener6tion. Non-oxid6tive p6thw6y functions in reverse
when R5P dem6nd exceeds production c6p6bilities of oxid6tive p6thw6y
$). Coll6gen - glycine occupies every third 6mino 6cid position - most 6bund6nt
6mino 6cid in coll6gen - only AA th6t c6n fit in confined sp6ce between
individu6l 6lph6 ch6ins (triple helix conform6tion occurs due to repetitive
6mino 6cid sequence)
!. Proline residues 6re imp for 6lph6 helix form6tion - enh6nced rigidity of
helic6l structure. Hydroxylysine is necess6ry for cross-lining.
$*. Drop in CO2 from hyperventil6tion > v6soconstriction
!. V6soconstriction c6n reduce perfusion 6nd le6d to br6in injury, so it
should be kept 6bove 30 mmHg
%+. St6tin-induced myop6thy. St6tins 6re competitive inhibitors of HMG-CoA
reduct6se. Decre6sed synthesis le6ds to incre6sed hep6tic cle6r6nce of LDL
3/1 SBJ

!. Osteocytes - m;int;in structure of miner;lized m;trix. Connected by g;p

junctions
!. Osteocytes sense mech;nic;l stresses ;nd send sign;ls to modul;te the
;ctivity of surf;ce osteobl;sts
#. Nucleoside ;n;log ;ntirvir;ls must be phosphoryl;ted to function. “-
ciclovirs” must e phosphoryl;ted. Thymidine-Kin;se deficiency VZV - c;n tx
w cidofovir
$. VZV - intr;nucle;r inclusions in ker;tinocytes ;nd multinucle;ted gi;nt cells
!. other
!. Pemphigus vulg;ris - IgG deposits in ; reticul;r p;ttern ;round
ker;tinocytes
#. T;rgets desmoglein 3
%. AKs - erythem;tous p;pules w whitish sc;les - s;ndp;per texture. Develop
from excessive sun exposure. Prem;lign;nt, but less th;n 1% e;ch ye;r
evolve to SCC
&. Sickle cell - thrombotic occlusion > ;v;scul;r necrosis
!. Vs troch;nteric bursitis - sh;rp, intermittent p;in in l;ter;l thigh ;nd hip
'. Leishm;ni;sis - found in Middle E;st ;nd Centr;l Americ; (“br;ziliens”).
Intr;cellul;r, round-ov;l ;m;stigotes w rod-sh;ped kinteopl;sts)
(. Lytic bone lesion with p;in ;nd soft-tissue swelling = osteos;rcom;.
Spindle-sh;ped strom;l cells
!. Others
!. Adenoc;rcinom; of the lung c;n met;st;size to bone - but usu;lly
shows mucin-producing gl;nds
#. Chondro;s;rcom; - would see in the pelvis
$. Osteoid osteom; - seen in young boys
). Foreign bodes > le;d to gr;nulom;tous response. Surrounded by rim of
lymphocytes th;t synthesize cytokines - continued m;croph;ge ;ctiv;tion
*. During contr;ction, T-tubules ;llow depol;riz;tion to r;pidly prop;g;te
through interior of muscle fiber. Ensures th;t c;lcium rele;se from SR occurs
uniformly throughout the fiber > synchronized contr;ction of myofibrils
!. Others
!. ATP fuels myosin movement ;long ;ctin fil;ments > c;uses
contr;ction, drives pumps th;t tr;nsport c;lcium b;ck to SR (c;use
rel;x;tion)
#. Imp;ired rel;x;tion of sust;ined contr;ction - c;n occur in myotonic
dystophy due to trinucleotide repe;t exp;nsion
$. Mut;tion in troponin C would block response to intr;cellul;r c;lcium
;nd prevent muscle contr;ction
!e. Troponin vs tropomyosin
!. Tropomyosin sits in groove between two ;ctin ch;ins - cover myosin
binding sites on ;ctin when muscle is ;t rest
#. Troponin - situ;ted ;longside tropomyosin molecules, C; binds ;nd
tropomyosin shifts to expose ;ctin binding sites
$. Others
!. C;lmodulin ;nd MLCK ;re found in smooth muscle
!!. Achondropl;si; - AD, chondrocyte efect
!#. Sc;bies - tx w topic;l permethrin. Or c;n give or;l ivermectin - binds Cl ion
ch;nnels.
!$. Coll;gen - 3 ch;ins held together by hydrogen bonds to form triple helix
(tropocoll;gen). Lysyl oxid;se forms cov;lent bonds btwn individu;l
tropocoll;gen molecules > m;ture coll;gen fibers
!%. Ecchymosis - collection of extr;v;s;ted blood ;t le;st 1 cm in di;meter. Do
not bl;nch under pressure bc the RBCs ;re not cont;ined in the v;scul;ture.
!&. MTX - h;lts pyrimidine synth thru comp inhibition of DHFR. Preferenti;lly
inhibits growth of r;pidly dividing cells - c;uses toxicity to cells w r;pid
turnover. Also c;uses hep;totoxicity ;nd pulmon;ry fibrosis.
!'. Ok c;t scr;tch. Axill;ry lymph;denop;thy c;n involve ; single lymph node
!(. Inhibition of XO results in incre;sed conversion of ;z;thioprine to ;ctive
met;bolite > 6-thiogu;nine
!). Accessory nipple - f;ilure of involution of m;mmill;ry ridge. C;n swell or
become tender simil;r to norm;l bre;st tissue
!. Others
!. Acrochord; (skin t;gs) - benign ;nd peduncul;ted outgrowths of
norm;l skin - develop in ;re;s th;t experience frequent friction
!*. GCA = most common systemic v;sculitis in people of north Europe;n
descent. Infl;mm;tory infiltr;te cont;ins multinucle;te gi;nt cells. IL-6
correl;tes with the dise;se (le;ds to fever ;nd stimul;tes ;cute ph;se
proteins)
!. Antibody ;g;inst IL-6 (tocilizum;b) is effective in tre;ting GCA
#. Others
!. MPO-ANCA/p-ANCA would see in microscopic poly;ngitis
#. M;trix met;lloprotein;ses - degr;de v;rious EC m;trix proteins,
process sever;l bio;ctive molecules. Involved in cytokine in;ctiv;tion
but donʼt pl;y direct role in GCA p;thogenesis
#e. Nursem;idʼs elbow - ;nnul;r lig;ment is injured
!. Other
!. R;di;l coll;ter;l lig;ment - l;ter;l side of the elbow joint
#. Uln;r coll;ter;l lig;ment - medi;l side of the elbow
#!. Acne - usu;lly grow out of it ;t the end of the pubert;l ;ndrogen surge.
Might be using steroids if ;spirin profession;l ;thlete.
!. Excessive perspir;tion ex;cerb;tes but does not c;use ;cne
##. troponin-C; complex pulls tropomyosin ;w;y, exposes myosin binding sites
!. Cell membr;ne depol;rizes, c;uses c;lcium rele;se from SR into
cytopl;sm vi; Ry;nR
#. Rele;se of Pi le;ds to power stroke. Binding new ATP pulls myosin he;d
w;y from ;ctin (rele;se)
#$. UV d;m;ge le;ds to form;tion of pyrimidine dimers. Removed by nucleotide
excision rep;ir. Endonucle;se complex nicks d;m;ged str;nd on both sides
of pyrimidine dimer > defective region is excised. Mut;tions th;t imp;ir
excision rep;ir c;use xeroderm; pigmentosum.
!. Interferes w b;se recognition during tr;nscription ;nd replic;tion - le;ds
to DNA mut;tions if d;m;ge isnʼt rep;ired.
#%. If the foot Is dorsiflexed ;nd everted, th;t me;ns it h;s lost pl;nt;rflextion
;nd inversion (TIP - pts c;nʼt tiptoe - d;m;ge to tibi;l nerve). Provides
sensory innerv;tion over the sole of the foot ;nd motor innerv;tion to
intrinsic root muscles. C;n injury it ;t the poplite;l foss;.
!. Others - Anki
#&. Rickets will le;d to excess unminer;lized osteoid m;trix. PTH is elev;ted to
mobilize c;lcium from bone to bloodstre;m in order to m;int;in serum
c;lcium levels.
#'. ACL - ;nterior dr;wer test.
#(. Tr;nsverse c;rp;l lig;ment = flexor retin;culum. Compression of medi;l
nerve in the tunnel produces c;rp;l tunnel syndrome.
#). Rectus muscles ;re used in v;ls;lv;. Incre;sed intr;;bdomin;l ;nd
intr;thor;cic pressure
!. V;s;lv; incre;ses v;g;l tone - ;bolishes p;roxysm;l t;chyc;rdi;
#*. Thor;cic outlet syndrome - compression of lower trunk of br;chi;l plexus -
presents w upper extremity numbness, tingling, we;kness
!. Compression of subcl;vi;n ;rtery c;n c;use exertion;l ;rm p;in
#. Occurs w/in sc;lene tri;ngle (formed by ;nterior ;nd middle sc;lene
muscles ;nd first rib). TOS c;n be c;used by ;nom;lous cervic;l rib or
injury (repetitive overhe;d ;rm movements)
$. Others
!. Subsc;pul;ris - inserts into lesser tubercle of the humerus. Adducts
;nd intern;lly rot;tes the humerus.
$e. Sc;phoid fr;cture presents w tenderness in ;n;tomic;l snuffbox. Dors;l
sc;phoid br;nch of r;di;l ;rtery supplies m;jority of sc;phoid - blood
supply proceeds retrogr;de-ly ;nd c;n be interrupted by ; fr;cture
!. C;rp;l tunnel - c;used by medi;n nerve compression - c;n develop ;fter
FOOSH injury due to lun;te disloc;tion
$!. Osteoporosis = tr;becul;r thinning with fewer interconnections
!. Tr;becul;r bone composes only 15% of the skeleton by weight but is
met;bolic;lly more ;ctive due to l;rge surf;ce ;re;
#. Perfor;tion with loss of interconnecting bridges c;n occur in osteoporosis
 $. Others
!. osteopETROSIS = persistence of prim;ry spngios; in medull;ry c;vity
#. Bone dise;se in hyperp;r;thyroidism would be ch;r;cterized by
incre;sed bone resorption in cortic;l bone w subperioste;l thinning
;nd cystic degener;tion
$#. Splicing - see notes
!. Since spliceosomes remove introns w/ AG ;t 3ʼ splice site - the mut;tion
th;t resulted in AG would le;d to incorrect splicing
$$. Thi;zide diuretics - incre;se c;lcium re;bsorption. Studies h;ve shown th;t
thi;zide use le;ds to higher bone miner;l density ;nd reduced fr;cture risk
$%. Medic;l conditions w polygenic inherit;nce
!. Deets
!. Androgenic ;lopeci;
#. Epilepsy
$. Gl;ucom;
%. Hypertension
&. Ischemic he;rt dise;se
'. Schizophreni;
(. T2DM
#. Androgenic ;lopeci; - some sites of influence = short ;rm of chrom 20,
;lso on X ;nd possibly Y chromosomes. C;n see some genetic f;ctors
tr;nsmitted w X-linked recessive inherit;nce, others show AD domin;nce
$&. Rubell; = tog;virus. Rubell; spre;ds f;ster th;n me;sles
$'. LAD - ;bsence of CD18 - needed for intern form;tion (integrins ;re essenti;l
for ;dhesion to endotheli;l surf;ces). Le;ds to recurrent skin ;nd mucos;l
infections. L;ck of purulence
!. others
!. Sm;ll lymph nodes - would see w x-linked ;g;mm;globulinemi;
$(. Inflixim;b c;n le;d to ;cute serum sickness. Would see fibrinoid necrosis
;nd intense neutrophil infiltr;tion, ;lso hypocomplementemi; (bc itʼs type III
hypersensitivity - three things stuck together - ;ntibody, ;ntigen,
complement)
!. Antigen-;ntibody (mostly IgG) complexes ;ctiv;te complement, ;ttr;cts
neutrophils, neutrophils rele;se lysosom;l enzymes
#. Others
!. Elev;ted IgE levels - found in ;topic individu;ls prone to IgE-medi;ted
(type I) hypersensitivity
#. Serum sickness - le;ds to rele;se of C5; complement fr;gment ;t
sites of immune complex deposition. Le;ds to neutropeni; due to
neutrophil m;rgin;liz;tion ;nd tissue infiltr;tion
$). Alk;ptonuri; - m;rked by severe ;rthritis in ;dult life. Autosom;l recessive,
c;used by deficiency of homogentisic ;cid deoxygen;se - met;bolizes
homogentisic ;cid to m;leyl;ceto;cet;te. Blue bl;ck deposits in scler;e ;nd
$).

e;r c;rtil;ge.
$*. PAN - segment;l, tr;nsmur;l infl;mm;tion w fibrinoid necrosis - involves
sm;ll ;nd medium ;rteries
%e. Or;l mucos; is most common site for bull;e ;nd erosions of skin ;nd
mucos;l membr;nes. Auto;ntibodies ;g;inst desmosomes (specific;lly
desmogleins 1 ;nd 3). Intr;epitheli;l cle;v;ge w det;ched ker;tinocytes
%!.
3/4 C1rdio

!. Observer bi1s is prevented w double blind study

#. Tet results from devi%tion of infundibul%r septum. M1ligned VSD 1nd
overriding 1ort1. Systolic ejection murmur over mid-to-left upper stern1l
border - due to presence of RVOT obstruction (subv1lvul1r pulmon1ry v1lve
stenosis). Squ1tting incre1ses 1fter lo1d 1nd decre1ses shunting > improves
stenosis
$. Dil1ted CM - TTN gene mut1tion
%. Venous dr1in1ge goes over coron1ry sinus. Most common c1use of coron1ry
sinus dil1tion is elev1ted right-sided he1rt pressure 2nd1ry to pulmon1ry
HTN
&. I guess they were looking for the source of the murmur - so it would be the
LA. Esoph1gus is in closest proximity to LA.
'. The descending 1ort1 would be posterior to the esoph1gus 1nd LA
(. Athleteʼs he1rt - concentric hypertrophy, enh1nced coron1ry c1pill1ry
development, decre1sed resting HR (due to more efficient c1rdi1c pumping).
Improved c1rdi1c function.
!. HCM - reduced c1vity size!
). Digoxin - incre1ses p1r1symp1thetic tone. Ventricul1r r1te control - still
h1ve flutter, but ventricles contr1ct 1t more norm1l r1te. Inhibited N1/K
pump in v1g1l 1fferent fibers.
*. Dobut1mine - B1 stimul1tion - incre1sed Gs stimul1tion, incre1sed cAMP,
incre1sed cytosolic C1 concentr1tion
!. 11 1gonist 1ctivity b1l1nces B2 1gonist effect w/ result1nt mild
v1sodil1tion
!+. 11 1gonists - v1soconstriction, 1nd REFLEXIVE decre1se in he1rt r1te.
!. V1soconstriction INCREASES 1fterlo1d - requires more effort to expel
more blood (remember th1t 1fterlo1d is proportion1l to 1rteri1l pressure)
!!. I guess you c1n get c1rdi1c t1mpon1de from 1 URI (t1mpon1de isnʼt
necess1rily blood - just 1 collection of some kind of fluid)
!. BECKʼs TRIAD (remember HJM) 1nd PULSUS PARADOXUS
#. L1te di1stolic coll1pse of right 1trium due to displ1cement of peric1rdi1l
fluid with ventricul1r exp1nsion
$. Others
!. Hyperkinetic pulse - r1pidly rising with high 1mplitude due to r1pid
ejection of l1rge SV 1g1inst decre1sed 1fterlo1d
!#. P1cem1ker current - 1ble to depol1rize w/o extern1l influence due to funny
current. As potenti1l gets closer to threshold ph1se 0 depol1riz1tion occurs
due to l1rge incre%se in c%lcium influx (deflection)
!$. Ok
 !. Other info th1tʼs good - inspir1tion: venous pressure decre1ses 1s blood
is pulled into the right side of the he1rt BUT with imp1ired right-sided
di1stolic filling (like in constrictive peric1rditis) > pressure INCREASES
bec1use it c1nʼt go b1ck
!%. AFib - 1bsent P w1ves, v1rying R-R interv1ls
!&. Severity of MS - indic1ted by length of time between S2 1nd opening sn1p.
More severe stenosis > higher pressure > shorter time between A2-OS
!'. Aortic regurg - incre1sed SV - sense of pounding or uncomfort1ble
he1rtbe1t when lying on left side. Bounding pulses. He1d bobbing due to
tr1nsfer of momentum from l1rge LV stroke volume to he1d 1nd neck.
!(. PAN - sp1re the 1ir!
!). Aortic dise1se - M1rf1nʼs
!*. Mitr1l regurg - reduction in SVR le1ds to reduced blood pressure - incre1se
in forw1rd flow. V1sodil1tors incre1se forw1rd flow (nitr1tes do dil1te
1rteries 1s well, just dil1te veins more)
!. Others
!. Incre1sing HR 1nd incre1sing VR would both c1use incre1se in
forw1rd flow, but wouldnʼt ch1nge the r1tio of forw1rd to regurgit1nt
flow
#. LV 1fterlo1d is determined by b1l1nce of resist%nce between forw1rd
flow 1nd regurgit1nt flow (LAP)
#+. If pt h1s 1 left domin1nt circul1tion, embolus to AV node will 1rise from LCX
1rtery
#!. St1ph y1 dummy - neg1tive co1g. Also st1ph epidermis is g1mm1-hemolytic
##. Nitr1tes predomin1ntly 1ffect the l1rge veins. Prelo1d is reduced.
Myoc1rdi1l O2 dem1nd is reduced due to reduced prelo1d/
#$. Clinic1lly useful 1nti-1rrythmics bind in open 1nd/or in1ctiv1ted st1tes (none
of them re1lly do 1nything in in1ctive st1te)
!. Cl1ss B - better for ischemi1 bec1use less neg1tive membr1ne potenti1l
del1ys N1+ ch1nnel tr1nsition from in1ctiv1ted to resting st1te -
incre1sed drug binding
#. Since Cl1ss C h1s highest 1ffinity - better 1t blocking 1t higher HR -
effective 1t termin1ting t1chy1rrythmi1s. But c1n del1y conduction speed
so signific1ntly th1t it 1lso c1uses 1rrhythmi1 - so only he1lthy he1rts!
#%. Incre1sed CO 1nd VR c1n be c1used by chronic AV fistul1.
!. Acutely - AV fistul1 decre1ses TPR, results in incre1sed CO 1nd incre1sed
VR. Chronic would le1d to incre1sed symph stimul1tion to compens1te >
incre1sed CO
#. vs phenylephrine - decre1ses CO due to incre1sed 1fterlo1d 1nd
decre1ses venous return
#&. Digoxin toxicity c1n le1d to f1t1l 1rrythmi1s. Severe toxicity is tre1ted w
1nti-digoxin 1ntibody fr1gments
#'. Low HDL in men: <40, in women: <50. HDL is involved in reverse cholesterol
#'.
tr1nsport - helps remove cholesterol from peripher1l tissues, tr1nsports to
the liver. Still tx w st1tins - most effective lipid-lowering drugs for preventing
c1rdio events.
!. Ni1cin r1ises HDL, but does not prevent c1rdio events. Prim1rily used for
pts who h1ve f1iled other drugs.
#. Medic1tions for r1ising HDL do not le1d to c1rdio benefit!
#(. B2 v1sodil1tion > decre1ses v1scul1r resist1nce (1lso v1sodil1tes 1rteries)
#). Supine hypotension syndrome in pregn1ncy: due to gr1vid uterus
obstructing IVC > reduces venous return, lowers c1rdi1c output.
#*. A fib - tx w drug th1t 1ffects 1tri1 1nd ventricles - most likely 1 cl1ss I
1nti1rrythmic. Prolongs QRS
!. Other deets
!. QT interv1l is prim1rily 1 me1sure of repol1riz1tion bc QRS complex is
usu1lly pretty short
$+. Bet1 blockers BLOCK the secretion of renin
$!. Myxom1 - c1n present w sx th1t mimic mitr1l v1lve stenosis. Mid-di1stolic
murmur (tumor plop). Composed of 1morphous ECM. C1n embolize.
$#. St1b wound - will most likely d1m1ge RV bec1use it composes the m1jority
of the 1nterior he1rt
!. Left 1trium - m1kes up the m1jority of the posterior surf1ce
$$. C1rcinoid he1rt dise1se - lungs met1bolize serotonin, so would not see left-
sided pl1ques
$%. Rheum1tic he1rt dise1se - would h1ve underlying degener1tion of the mitr1l
v1lve due to chronic v1lvul1r infl1mm1tion 1nd sc1rring
$&. Infective endoc1rditis > first step is forming 1 sterile fibrin-pl1telet nidus
!. Vs st1ph 1ureus th1t c1n 1dhere to d1m1ged or norm1l endotheli1l cells
#. White blood cell infiltr1tion would not be p1rt of the first step - would be
represent1tive of 1dv1nced lesions
$'. Progression of 1therosclerosis
!. Deets
!. Endotheli1l cell injury (due to HTN, hyperlipidemi1, smoking, DM)
#. Dysfunction le1ds to monocytes doing into intim1
$. Exposure of SEC promotes pl1telet 1dhesion
%. Incre1sed v1scul1r perme1bility 1llows LDL cholesterol into intim1
&. LDL is ph1gocytksed by m1croph1ges to form lipid-l1den fo1m cells
(f1tty stre1k)
$(. With 1dv1ncing 1ge, f1tty stre1ks tr1nsition to 1therosclerotic pl1ques, such
1s fibrous c1p 1therom1 1nd fibrous pl1ques
$). Cil1st1zol - reduces pl1telet 1ctiv1tion by inhibiting phosphodiester1se -
enzyme responsible for bre1kdown of cAMP. Also 1cts 1s direct v1sodil1tor.
!. PAD m1n1gement: gr1ded exercise progr1m 1nd cil1st1zol
#. Pts w PAD should receive 1ntipl1telet 1gent for second1ry preventon of
coron1ry he1rt dz 1nd storoke
$*. Myoc1rdi1l ischemi1 - 1erobic glycolysis ce1ses within seconds - le1ds to
in1dequ1te production of ATP
!. If ischemi1 l1sts less th1n 30 min > reversible
#. After 30 min - h1lf of 1denine stores 1re lost - irreversible ischemic injury
%+. Hypotension, JVD, muffled he1rt sounds - Beckʼs tri1d - c1rdi1c t1mpon1de
3/4 Mixed

!. Euk8ryotic gene tr8nscription

!. RNA pol II uses DNA templ8te to gener8te complement8ry mRNA, which is
then processed 8nd tr8nsl8ted to protein
#. Promoter sequences directly bind tr8nscription f8ctors 8nd RNA pol II 8nd
8re necess8ry for initi8tion of tr8nscription (TATA box 8nd CAAT box)
$. Enh8ncers: c8n be loc8ted upstre8m or downstre8m 8nd c8n be close or
thous8nds of b8se p8irs 8w8y. H8ve 8lso been identified on introns
#. W8rf8rin induced skin necrosis - occurs with underlying protein C or S
deficiency
!. Vs 8llergic drug re8ction - immune-medi8ted hypersensitivity w v8rious
cut8neous findings
$. Tempor8l 8rteritis, cool
%. Pernicious 8nemi8 histology, cool
&. C8ndidemi8
!. T lymphocytes 8re import8nt for prevention of SUPERFICIAL c8ndid8
infection
#. Neutrophils prevent hem8togenous spre8d
'. Remember PECAM-1 medi8tes di8PEdesis (tr8nsmigr8tion0 - WBC tr8vels
between endotheli8l cells 8nd exits blood vessel
(. You c8n sh8re b8sic info when the pt is inc8p8cit8ted or not present
). Mitr8l sn8p is he8rd just 8fter 8tri8l/ventricul8r pressure crossover, before
signific8nt ventricul8r filling h8s occurred - it will be he8rd closest to the
opening of the mitr8l v8lve
*. Buprenorphine - p8rti8l opioid 8gonist - low intrinsic 8ctivity (effic8cy) for
opioid mu-receptors. Acts 8s opioid receptor 8nt8gonist in the presence of
full opioid 8gonists (c8n prevent binding of other opioids) 8nd c8n
precipit8te withdr8w8l in opioid-toler8nt p8tients with chronic p8in.
!+. West Nile Virus c8n be found in w8rm clim8tes worldwide. Replic8tes in birds
8nd is p8ssed to mosquitos during blood feeding. Most pts > low level
viremi8 th8t is neutr8lized in 8 week by humor8l immune system, but kids
8nd elderly 8re un8ble to mount effective immune response.
!!. Scurvy - vit C deficiency. Medi8tes coll8gen synthesis.
!. Begins w tr8nscription of coll8gen genes in nucleus. Coll8gen 8-ch8ins
8re then synthesized by RER-bound ribosomes. Within RER, proline 8nd
lysine residues 8re post-tr8nscription8lly hydroxyl8ted.
#. Vit C is required cof8ctor in post-tr8nsl8tion8l modific8tion
!#. Cleft lip: f8iled fusion of m8xill8ry prominence 8nd inter m8xill8ry segment
!. Vs f8ilure of medi8l n8s8l prominence to fuse 8nd form inter m8xill8ry
segment > midline defects like holosprosenceph8ly
 #. Fun f8ct: Pierre Robins sequence - severe microgn8thi8 results in
posterior displ8cement of the tongue 8nd prevents fusion of second8ry
p8l8te (U-sh8ped p8l8te)
!$. PCL 8tt8ches to the posterior p8rt of the intercondyl8r 8re8 of the tibi8 8nd
8nterol8ter8l surf8ce of medi8l condyle of femur
!. ACL sp8ns from ,nterior portion of intercondyl8r tibi8 to posterior medi8l
side of l8ter8l femor8l condyle
!%. Heme oxygen8se degr8des heme to biliverdin (which is green in color)
!. Porphobilinogen de8min8se 8nd uroporphryinogen dec8rboxyl8se 8re
involved in heme production, not degr8d8tion
!&. Lidoc8ine - we8kest sodium ch8nnel blockers (dissoci8te the f8stest). Bind
to sodium ch8nnels in the in8ctiv8ted st8te.
!. Ischemic myoc8rdium - higher (less neg8tive) resting membr8ne potenti8l
- del8ys volt8ge-dependent recovery of sodium ch8nnels
#. Bet8 blockers 8re 8lso used post MI (but not 8nti8rrythmic - they 8re
inotropic 8nd chronotropic)
!'. Little kid th8t still h8s di8rrhe8, blo8ting, cr8mping > prob8bly l8ctose
intoler8nce
!. C8n develop SECONDARY l8ctose intoler8nce from infl8mm8tion or
infection of sm8ll intestine
!(. Lung function 8nd 8ging - diminished el8stic recoil 8nd coll8pse of
supporting tissues - c8uses signific8nt incre8se in residu8l volume. TLC
rem8ins unch8nged bec8use decre8sed chest w8ll compli8nce
counterb8l8nces incre8ses in lung compli8nce
!. RV becomes 8 much higher proportion of TLC due to 8ir tr8pping. Forced
vit8l c8p8city 8lso decre8se
!). Antipsychotic side effects
!. Ak8thisi8: subjective restlessness with in8bility to sit still
#. T8rdive dyskinesi8: repetitive movement of f8ce, lips, tongue, trunk,
extremities
!*. HISTORY OF ATTEMPTED SUICIDE IS THE STRONGEST SINGLE FACTOR
PREDICTIVE OF COMPLETED SUICIDE (100 times the risk of the norm8l
popul8tion, where8s 8ccess to 8 fire8rm only incre8ses risk 8bout 3x)
#+. ATM gene is responsible for DNA bre8k rep8ir. Pts 8re hypersensitive to Xr8y
r8di8tion
#!. Ac8lculous cholecystitis = 8cute infl8mm8tion of g8llbl8dder in 8bsence of
g8llstones. Occurs in critic8lly ill p8tients. Thought to 8rise second8ry to
g8llbl8dder st8sis 8nd ischemi8.
##. Decre8sed phosph8tidylcholine 8nd decre8sed bile 8cids with cholesterol
stones. High levels would incre8se solubility 8nd decre8se risk.
!. Deets
!. Two mech8nisms of remov8l of cholesterol
!. Free cholesterol is excreted into bile
 #. cholesterol is converted to bile 8cids
#$. Cocco - spherules. Pneumoni8 8nd erythem8 nodosum usu8lly.
!. Five different present8tions
!. Acute pneumoni8
#. Chronic progressive pneumo
$. Pulmon8ry nodules 8nd c8vities
%. Extr8pulm nonmeninge8l dise8se
&. Meningitis
#%. Anti-HBV = v8ccin8tion
!. Anti-HAV IgG = p8tient is protected from 8cute HAV. Not sure if it is from
v8ccine or from previous infection
#&. Pts should be 8sked 8bout DNRs 8s p8rt of 8dmission process
#'. Androgens 8re converted to estrogens in gr8nulos8 cells (Cont8in
8rom8t8se). Cholesterol is converted to 8ndrostenedione in the thec8 cell.
#(. Ch8rcot Bouch8rd 8neurysms - from HTN. Loc8ted in deep br8in structures.
Acute bleeding = hyper8ttenu8ted lesions.
#). RSV is most common c8use of bronchiolitis in kids under 2. P8r8influenz8 =
croup.
#*. SMA 8nd IMA 8n8stomose w m8rgin8l 8rtery of Drummond (princip8l
8n8stomosis) 8nd inconsistently present 8rc of Riol8n (mesenteric
me8ndering 8rtery)
!. Intern8l ili8c 8rtery supplies p8rt of the rectum vi8 middle rect8l 8rtery.
An8stomosis between superior 8nd middle rect8l 8rteries exists, which
c8n help prevent rect8l ischemi8 8fter IMA occlusion, but SMA is more
likely to prevent ischemi8 in descending colon due to its proximity.
$+. Pt h8s peptic ulcer dise8se 8nd gout - c8nʼt use NSAIDs but c8n use
colchine > binds to intr8cellul8r tubulin 8nd inhibits polymeriz8tion into
microtubules. Disrupts cytoskelet,l-dependent functions: chemot8xis 8nd
ph8gocytosis.
$!. Alcohols disrupt cell membr8nes 8nd den8ture proteins
!. vs hydrogen peroxide = free r8dic8ls
#. Iodine = h8logen8tion of proteins 8nd DNA
$. Form8ldehyde 8nd gluter8lderhyde = 8lkyl8te 8nd cross-link DNA 8nd
proteins
%. Chlorhexidine: dest8bilizes cell membr8nes 8nd co8gul8tes intr8cellul8r
constituents
$#. Diptheri8 - gener8tes exotoxin. Loc8l effects = extensive, co8lescing
exud8te (pseudomembr8ne). Diptheri8 v8ccine gener8tes neutr8lizing IgG
8ntibodies 8g8inst binding component (B subunit) of diphtheri8 exotoxin
$$. pot8ssium sp8ring diuretic
$%. N8s8l septum is v8scul8rized. Th8tʼs where you would t8rget for epist8xis
$&. RBC c8sts - glomerulonephritis.
!. Would see muscle p8in w rh8bdo. RBCs on urin8lysis 8re 8lso not p8rt of
 !.
it
$'. Pronormobl8sts c8n be secreted in 8pl8stic crisis due to P8rvo. Gr8nul8r,
gl8ssy inclusions.
$(. Prol8ctinom8 > hypogon8dism > v8gin8l dryness 8nd 8trophy. Prolonged
estrogen deficiency c8n le8d to osteoporosis.
$). Bulls pemphigoid often 8ffects the elderly. Most commonly on inner thighs,
flexor 8spects of fore8rms, 8xill8, groin, lower 8bdomen.
!. Derm8titis herpetiformis: blisters form in derm8l p8pill8e
#. Lichen pl8nus: lymphocytic infiltr8te
$. Pemphigus: would see det8ched ker8tinocytes
$*. ANOVA ye8h boiii
%+. Donezipil for AD. Remember AD is 8 di8gnosis of exclusion.
!. Ther8pies for
!. Enh8nced cholinergic tr8nsmission
!. Donezipil is 8n AChE inhibitor, which improves cognition, beh8vior
8nd functioning
#. Neuroprotection w 8ntioxid8nts
!. Vit8min E
$. NMDA 8nt8gonism
!. Mem8ntine
3/5 GI

!. Secretory IgA is ;ssoci;ted w mucos;l immunity. S;bin v;ccine would

gener;te intestin;l ;nd mucos;l IgA response. Protects ;t the site of vir;l
entry. (Virus replic;tes in peyerʼs p;tches)
!. Serum IgA is m;inly monomeric.
#. Secretory di;rrhe; - VIPom;. WDHA syndrome.
!. CCK c;uses incre;sed secretion of p;ncre;tic enzymes ;nd bic;rbon;te,
g;llbl;dder contr;ction, ;nd inhibition of g;stric emptying.
$. St;tins inhibit HMG CoA reduct;se - decre;ses hep;tic cholesterol
synthesis - upregul;tion of LDL receptors.
!. Bile ;cid-binding resins bind bile ;cids in GI tr;ct - interfere w
enterohep;tic circul;tion of bile ;cids ;nd c;use incre;sed bile ;cid
secretion. Incre;sed hep;tic synthesis of new bile ;cids > consumes
cholesterol stores.
#. BUT the bile ;cids ;re bound in the GI tr;ct so they ;re t;ken out of the
circul;tion?
$. Hep;tic cholesterol reduction ;ctiv;tes HMG CoA reduct;se, but this c;n
be blocked by ;dding ; st;tin drug to the tre;tment regimen.
%. Viscer;l ;bdomin;l p;in (from ;bdomin;l org;ns) in ;ppendicitis is due to
lumin;l distension ;nd stretching of smooth muscle
!. Som;tic p;in (from muscles of ;bdomin;l w;ll) is due to irrit;tion of
p;riet;l peritoneum - well loc;lized, more severe.
&. Longitudin;l te;rs = M;llory Weiss syndrome
!. Vs Boerh;;ve - dist;l esoph;ge;l rupture w pneumomedi;stinum due to
violent retching
'. Homocystinuri, - hyper co;gul;bility ;nd thromboembolic occlusion. C;n
le;d to prem;ture ;cute coron;ry syndrome, ectopic lentis ;nd intellectu;l
dis;bility.
!. Most common c;use of homocystinuri; = defect in cyst;thione synth;se.
Homocystein buildup ;lso le;ds to hypermethionemi;.
(. Cholesterol g;llstones - prim;rily cholesterol monohydr;te cryst;ls but c;n
cont;in v;ri;ble ;cts of c;lcium s;lts, bilirubin ;nd mucin. Usu;lly solubilize
cholesterol to prevent stone form;tion.
!. Giving bile ;cids (not bile ;cid resins) reduces cholesterol secretion.
!. Vs bile ;cid sequestr;nts: decre;se recircul;tion of bile ;cids, but
;lso stimul;te conversion of cholesterol to bile ;cids ;nd incre;se
bili;ry motility.
). Jejun;l/ile;l ;tresi; - due to v;scul;r injury (vs duoden;l - due to f;ilure of
rec;n;liz;tion)
!. J/I ;tresi; - m;jor vessel is occluded > so there is intestin;l necrosis.
 !.
Dist;l ileum ;ssumes ; spir;l configur;tion ;round ;n ileocolic vessel.
!. “Apple peel” ;tresi; when SMA is occluded.
#. Bilious emesis - obstruction below second p;rt of duodenum.
!. Midgut volvulus is ;lso on the differenti;l. More dist;l ;tresi; > more
likely to present w ;bdomin;l distension.
a. GI bleed c;n le;d to incre;sed nitrogen products w heme bre;kdown.
Rif;ximin - non-;bsorb;ble ;ntibiotic th;t c;uses GI flor; to decre;se
production ;nd ;bsorption of ;mmoni;.
!. used in ;ddition to l;ctulose - lowers colonic pH ;nd incre;ses conversion
of ;mmoni; to ;mmonium.
#. C;n ;lso use w tr;velerʼs di;rrhe; - inhibits b;cteri;l RNA synthesis
(binds w DNA-dept RNA polymer;se).
!b. Acute cholecystitis - g;llstone obstruction of cystic duct. Ingestion of f;tty
foods stimul;tes contr;ction of g;llbl;dder ;g;inst imp;cted stone - severe
colicky p;in.
!. Would not see g;llbl;dder on sc;n bc the stone is obstructing the flow of
contr;st.
#. Other
!. Could see echogenic structures w/in g;llbl;dder, but is not
di;gnostic. G;llbl;dder thickening is more specific.
!!. Acute vir;l hep;titis - p;n lobul;r lymphocytic infl;mm;tion due to coll;pse
of reticulin fr;mework. Necrotic hep;tocytes = b;llooned. M;y undergo
CD8+ T cell medi;ted ;poptosis if vir;l ;ntigens ;re present > eosinophilic
bodies = Councilm;n bodies
!. Also “p;nlobul;r lymphocytic infiltr;tion”
#. Vs chronic - infl;mm;tion ;round the port;l tri;d
$. Vs toxin medi;ted - centrilobul;r necrosis
!#. V;rices (port;l <> systemic)
!. Left g;stric <> esoph;ge;l
#. Superior rect;l <> middle ;nd inferior rect;l
$. P;r;umbilic;l <> superfici;l ;nd inferior epig;stric veins
!$. HBV - serum HBsAg in ;cute infection
!%. Crohnʼs - c;lcium forms so;p complexes w excess f;t in intestin;l lumen -
c;nʼt complex w ox;l;te. Free ox;l;te ;bsorption is incre;sed ;nd filtered
into urine > form;tion of ox;l;te kidney stones.
!&. Umbilic;l herni; - reducible.
!. Not sure if there is ;n ;ssoci;tion with Down syndrome
!'. Hep;tic enceph;lop;thy due to GI bleed. Would see incre;sed ;mmoni;
production in the gut.
!. VS BUN - RENAL FAILURE. Cirrhosis is ;ssoci;ted with decre;sed BUN bc
;mmoni; c;nʼt be efficiently converted to ure;.
#. Also worth noting - incre;sed inhbitory NT ;nd imp;ired excit;tory NT
rele;se
!(. Shigell; goes into M cells vi; endocytosis
!). Crohnʼs - non-c;ve;ting gr;nulom;s. NCGʼs frequently form multinucle;ted
gi;nt cells without centr;l necrosis.
!. Gr;nulom; = ;ttempt to w;ll off offending ;gent.
!a. Hemochrom;tosis - bronze di;betes = hyperpigment;tion, di;betes, ;nd
pigment cirrhosis. Also see c;rdi;c ;rrhythmi;.
#b. Inf;rcts in liver ;re r;re due to du;l blood supply: port;l vein ;nd hep;tic
;rtery.
#!. B;rrettʼs = risk for ;denoc;rcinom;
##. CHRONIC H pylori p;thogenesis
!. P;tchy, multifoc;l g;stric ;trophy
#. P;tchy destruction of p;riet;l ;nd G cells - diminished g;stric ;cid
production ;nd hypochloridi;
$. Chronic g;stritis - less likely to experience duoden;l ulcers but c;n h;ve
IDA from iron m;l;bsorption
#$. Strongyloides - l;rv;e penetr;te the skin ;nd migr;te hem;togenously to
the lungs. Then go up the bronchi;l tree, then sw;llowed. Re;ch the
intestine, develop into ;dults th;t l;y eggs in intestine. H;tch into rh;btiform
(non-infectious) l;rv;e th;t ;re excreted in stool.
#%. Alcohol ;nd g;llstones ;re most common c;uses of p;ncre;titis. Others
!. I GET SMASHED
!. Idiop;thic
#. G,llstones
$. Eth,nol
%. Tr;um; (+ Triglycerides)
&. Steroids
'. Mumps
(. Autoimmune
). Scorpion sting
a. Hyperc;lcemi;/Hypertriglycerides
!b. ERCP
!!. Drugs
#. High triglycerides (> 1000 mg/dL) c;n predispose
!. Vs high cholesterol - more ;t risk for ;therosclerosis
#&. Inf;nt botulism - c;n check stool.
#'. L;ct;se deficiency - usu;lly norm;l ;ppe;ring villi - UNLESS the l;ct;se
deficiency is second;ry to injury ;t tips of villi (vir;l enteritis)
#(. Colon c;ncer - usu;lly ;rises from pre-exisitng ;denom;tous polyps
!. Appe;r;nce of hyperprolifer;tive epithelium - from APC mut;tion
#. KRAS mut;tion le;ds to protein th;t stimul;tes unregul;ted growth >
le;ds to ;denom;
$. Loss of TP53 (molecul;r policem;n) le;ds to c;rcinom;
!. No triggering of ;poptosis of cells with d;m;ged DNA
#). Excess ;mmoni; > crosses BBB ;nd is t;ken up by ;strocytes > incre;sed
glut;mine production. Excess glut;mine in ;strocytes le;ds to incre;sed
intr;cellul;r osmol;rity.
!. Glu;t;mine > glut;m;te in neurons - le;ds to neurons sx of hep;tic
enceph;lop;thy
#a. Follow-up to moder;tely elev;ted ;lk;line phosph;t;se: check y-glut;myl
tr;nspeptid;se. Elev;ted in liver ;nd bili;ry dise;ses but NOT bone.
!. W;nt to see if ALP is of hep;tic or bony origin.
$b. Porcel;in g;llbl;dder - usu;lly ;symptom;tic. Complic;tion of chronic
cholecystis.
$!. Hep;titis - CD8+ T lymphs respond to vir;l ;ntigens on cell surf;ce
$#. Anorexi;, d;rk urine, RUQ p;in > ;cute vir;l hep;titis.
!. Hep;tocyte necrosis: cellul;r swelling ;nd cytopl;smic emptying.
Disruption of intermedi;te fil;ment network.
!. Dying hep;tocytes recuit mononucle;r infl;mm;tion in sinusoids ;nd
port;l tr;cts.
#. Severe c;ses: regions of ;dj;cent lobules ;re interconnected by sw;ths
of de;d hep;tocytes > bridging necrosis.
$$. Smoking is out import;nt risk f;ctor for p;ncre;tic ;denoc;rcinom;. Would
see obstructive j;undice.
!. Vs vir;l hep B ;nd C incre;se risk for hep;tocellul;r c;rcinom;
#. Vs chronic ;lcohol use - c;n c;use chronic p;ncre;titis but doesnʼt
incre;se risk for p;ncre;tic c;ncer
$%. Most g;stric ulcers ;rise on lesser curv;ture. Left ;nd right g;stric ;rteries
perfuse the lesser curv;ture > common source of hemorrh;ge
!. Vs g;stroduoden;l - supplies blood to pylorus ;nd proxim;l duodenum.
Ulcers in posterior duoden;l bulb c;n erode g;stroduoden;l ;rtery.
$&. Remember th;t met;st;ses ;re the #1 c;use of liver c;ncer!
!. the most common c;use of liver mets is colorect;l c;ncer, which spre;d
from colon or superior rectum through port;l venous system to liver. No
colonoscopy > likely developed hep;tic mets from colorect;l c;ncer
#. Re;sons th;t liver is prone to mets
!. Fenestr;ted hep;tic sinusoid;l epithelium - ;llows tumor cells to p;ss
from bloodstre;m to p;renchym;
#. Du;l blood supply from port;l ;nd systemic circul;tion - incre;sed
likelihood of circul;ting tumor cells depositing in liver
$. Met;st;tic dise;se is especi;lly likely when there ;re multiple tumors
present in the liver
$'. Hep;tits D is considered replic;tion defective bc it must be co;ted by
extern;l co;t of Hep B surf;ce ;ntigen to penetr;te hep;tocyte.
!. Once co;ted w HBsAg, HDV c;n penetr;te the hep;tocyte.
$(. Afl;toxin - exposure is high in Asi; ;nd Afric;. p53 mut;tions h;ve been
identified in most individu;ls w hep;tocellul;r c;rcinom;.
$). G;llstone ileus - fistul; between g;llbl;dder ;nd GI tr;ct - stone enters
lumen, obstructs ileocec;l v;lve (n;rrowest point). C;n see ;ir in bili;ry tree.
$a. Brunner gl;nds - ;lk;line secretions. Found in duodenum. T;ctile stimul;tion
of duoden;l mucos; ;nd incre;sed p;r;symp;thetic ;ctivity ;fter me;ls
incre;sed bic;rbon;te secretion.
%b. If there ;re multiple m;sses present in the liver, likely resulted from
met;st;sis. Prim;ry liver tumors usu;lly only h;ve one nodule.
3/5 Mixed

!. Ethosux for =bsence seizures

!. Methylphenid=te would be for ADHD - in ADHD, would respond to verb=l/
t=ctile stimuli
#. 50% ch=nce of inheriting mut=nt =llele if p=rent is = c=rrier
$. Determine whether = gene is being expressed - =n=lyze for presence of
mRNA w Northern blot
%. Embryo deriv=tives
!. Neur=l crest - neur=l g=ngli=, =dren=line medull=, Schw=nn cells,
br=nchi=l =rches, skull bones, mel=nocytes
#. Surf=ce ectoderm - =nterior pituit=ry, gl=nds, skin, inner sensory org=ns
$. Neur=l pl=te > neur=l crest =nd neur=l tube. Rem=ining ectoderm >
surf=ce ectoderm.
&. Highly sensitive - most p=tients with the dise=se will h=ve = positive result.
Fewer c=ses of dise=se =re missed. Import=nt for life-thre=tening dise=ses.
!. Highly specific test - correctly identifies those without dise=se. Specific
test h=s low r=te of f=lse positives, so most pts will h=ve neg=tive test
result.
!. A positive result would rule IN = di=gnosis.
'. Ethic=lly oblig=ted to report imp=ired colle=gues in timely m=nner
!. If it is not =n emergency, should cont=ct physici=n he=lth progr=m.
(. Neopl=stic cells c=n blunt cytotoxic T cell response through m=ny
mech=nisms, including over expression fo PD-L1 - binds to PD-1 receptor on
cytotoxic T cells
!. Block PD-1 or PD-L1 to disinhibit T cells =nd restore cytotoxic response
). Reflux of urine b=ckw=rd into non-compli=nt ren=l tubules incre=ses ren=l
tubul=r hydrost=tic pressure
*. Excit=tory NT > c=uses opening of lig=nd-g=ted sodium ch=nnels > sodium
influx =nd membr=ne depol=riz=tion. When AP re=ches =ction termin=l >
volt=ge-g=ted c=lcium ch=nnels open =nd =llow influx of c=lcium: essenti=l
for rele=se of NT vesicles.
!+. Nucleolus - cont=ins ribosom=l DNA =nd newly tr=nscribed rRNA in
=ssoci=tion w ribosom=l proteins th=t =re tr=nsl=ted in cytopl=sm from
mRNA
!!. PAH - BMPR2 mut=tions. Autosom=l domin=nt tr=nsmission w v=ri=ble
penetr=nce. Le=ds to dysfunction=l smooth muscle cell prolifer=tion
!. Excessive hypoxic v=soconstriction c=n le=d to pulmon=ry HTN but
norm=l chest X-r=y =nd BMI rule out this option
!#. Lower cutoff v=lue - incre=sed sensitivity, but more p=tients test positive.
Decre=ses specificity bc fewer people =re ruled out.
!$. Chronic di=rrhe= or colectomy pt > reduced bic=rbon=te re=bsorption from
the gut > chronic met=bolic =cidosis. Incre=sed excretion of H+. Lowers
urine pH, incre=ses conversion of soluble ur=te to insoluble uric =cid.
!. Alk=liz=tion c=n prevent/dissolve uric =cid stones.
#. C=nʼt see uric =cid stones on routine x-r=y: r=diolucent.
!%. Excision=l biopsy of posterior tri=ngle. This is where CN XI runs. Tr=pezius
extends from occipit=l bone =nd spinous processes to T12.
!. Tr=pezius injury: drooped shoulder, imp=ired =bduction =bove horizont=l
due to we=kness in rot=ting glenoid upw=rd, winged sc=pul=.
!&. Trochle=r nerve p=lsy - very susceptible due to long course =nd sm=ll
c=liber. Due to microv=scul=r nerve ischemi= in the setting of di=betes. Most
notice=ble when =ffected eye looks down =nd tow=rd the nose.
!. C=nʼt intort =nd depress bc th=t function is imp=ired.
!'. Alcohol h=nd scrub before c=theter insertion bc co=g-neg St=ph =ccount for
the m=jority of centr=l venous c=theter infections.
!. Prophyl=ctic v=nc use - incre=ses risk for VRE
!(. Altern=tive splicing > cre=tes different proteins. At le=st 70% of 30,000
genes in hum=n genome undergo =ltern=tive splicing.
!. M=jority of DNA throughout bodyʼs tissues = identic=l gene coding
sequences
!). Ni=cin is = precurosor for NAD =nd NADP. Cof=ctor for isocitr=te
dehydrogen=se, =-ketoglut=r=te dehydrogen=se, m=l=te dehydrogen=se
!. Vs succin=te dehydrogen=se: c=t=lyzes conversion of succin=te to
fum=r=te
!*. Strep pneumo - h=s = c=psul=r polys=cch=ride th=t inhibits ph=gocytosis.
Str=ins w/o c=psule =re not p=thogenic but c=n undergo tr=nsform=tion to
directly t=ke up exogenous DNA > g=in virulence.
!. H flu, strep, b=cillus =nd neisseri= =ll undergo tr=nsform=tion
#. Vs tr=nsduction; ph=ge (virus) tr=nsfes DNA from one b=cteri=l cell to
=nother
#+. HER2 positivity - Tr=ztuzum=b for HER2+ bre=st c=ncer. Tyrosine kin=se.
!. Vs hormone receptor positive (ER/PR over expression) tre=ted w SERMs in
premenop=us=l p=tients. Arom=t=se inhibitors in post-menop=us=l
women. These =re not monoclon=l =ntibodies.
#!. Brief psychotic disorder is <1 month, where=s schizophreniform is between 1
=nd 6 months =nd schizo is over 6 months
##. B12 is necess=ry in g=strectomy p=tients bc IF is secreted by p=riet=l cells in
body =nd fundus of stom=ch, but in pts th=t h=ve undergone tot=l
g=strectomy - IF c=n no longer be produced =nd B12-IF complex c=nʼt form.
!. Pepsin =nd HCl =re helpful but not required for protein digestion. Still
h=ve p=ncre=tic =nd intestin=l prote=ses.
#. Medium-ch=in triglycerides c=n p=ssively diffuse from GI lumen to
enterocytes but =re best =bsorbed =fter being degr=ded into
 #.

monoglycerides =nd free f=tty =cids by lingu=l =nd p=ncre=tic lip=se.

#$. Aortic root is higher pressure throughout systole =nd di=stole, so blood will
flow continuously from higher pressure =ortic root to lower pressure RV (L-
to-R shunt)
#%. CKD - decre=sed conversion of 25-hydroxy D to 1,25 dihydroxy vit D
#&. Spironol=ctone - =nti-=ndrogenic effects due to block=de of =ndrogen
receptor
#'. St=ph =ureus colonizes n=res
#(. RA - IgM =ntibodies =g=inst Fc portion of hum=n IgG
#). Dem=rgin=tion of neutrophils th=t were previously =tt=ched to vessel w=ll w
steroids
!. Another fun f=ct: high doses of steroid c=n le=d to corticosteroid-induced
psychosis: hypo=lbuminemi= is = risk f=ctor
#*. Influenz= A: RNA-dependent RNA polymer=se must =lso g=in entry to cell in
order for replic=tion to t=ke pl=ce
$+. IFN-y =ctiv=tes m=croph=ges, but is PRODUCED by T lymphocytes =nd
n=tur=l killer cells =nd is critic=l in immunity =g=inst vir=l =nd intr=cellul=r
b=cteri=l infections.
!. IFN-y rele=se =ss=ys test for l=tent TB infection by me=suring response of
T lymphs when exposed to =ntigens unique to tuberculosis.
#. IGRA is =dv=nt=geous bc it doesnʼt cross re=ct w BCG v=ccine.
$!. All =dolescent visits should include opportunity to interview pt =lone to
discuss priv=te topics
$#. Essenti=l tremor - most commonly di=gnosed movement disorder - AD
inherit=nce - sx improve w =lcohol. Tx w bet= blocker (lessens CNS effects)
$$. Aortic dissection: te=r in =ortic intim=. Dissection c=n progress proxim=lly
=nd dist=lly =s blood is forced through the te=r > dissects the medi=.
Br=nchi=l blood pressure discrep=ncy suggests compromise of
br=chioceph=lic trunk.
!. HTN is m=in risk f=ctor. Medi=l hypertrophy of =ortic v=s= v=sorum =nd
reduced blood flow > medi=l degener=tion w loss of smooth muscle cells.
$%. If youʼre blocking the br=chi=l plexus, will block C3-5, p=r=lyze di=phr=gm
$&. PE - ventil=tion preserved but perfusion is blocked.
$'. Hydroxyzine, prometh=zine, chlorphenir=mine, diphenhydr=mine =re =ll first
gener=tion =ntihist=mines - b=d for elderly!
$(. Hemorrh=ges, my=lgi=, subperioste=l hem=tom=, gingivitis - scurvy
(imp=ired wound he=ling)
$). Downy cells = CD8+ T cells (8 on shoulder bo=rd)
!. Vs CD4+ - decre=sed in IM
#. Vs CD21 - receptor for C3d complement component found on m=ture B
lymphs. B cells =lso prolifer=te but only represent = sm=ll portion of
=typic=l lymphs on blood sme=r.
$*. Suspected elder =buse - interview pt =lone. Report to =dult protect services
$*.
=fter c=reful ev=lu=tion
%+. Myxom=tous ch=nges - we=kening of connective tissue in medi= of l=rge
=rteries - found in cystic medi*l degener*tion. Fr=gment=tion of el=stic
tissue. See this w M=rf=n
!. B-=minopropionitrile (found in sweet pe=s) c=uses inhibition of lysl
oxid=se - responsible for cross linking of el=stin =nd coll=gen fibers >
simil=r p=thogenesis to M=rf=n.
#. Others
!. Berry =neurysms - Type IV ED (=bnorm=l type III coll=gen) c=n
predispose
#. F=lse =neurysm - bre=ch in =ll 3 l=yers of blood vessel - blood
le=k=ge =nd hem=tom= outside v=scul=r w=ll
3/6 Mixed

!. PSVT - p9lpit9tions 9nd r9pid regul9r t9chyc9rdi9

!. C9rotid sinus reflex - 9fferent limb 9rises from b9roreceptors in the sinus
9nd tr9vels to the v9g9l nucleus 9nd medull9ry centers vi9 CN IX
!. Efferent limb c9rries p9r9symph impulses to the SA node 9nd AV
nodes vi9 v9gus nerve
#. C9rotid sinus m9ss9ge > incre9sed 9fferent firing from the c9rotid
sinus > incre9ses p9r9symp tone
$. Slows conduction thru AV node
#. Other
!. C9rotid m9ss9ge stimul9tes the b9roreceptors 9nd incre9ses firing
form c9rotid sinus > slows HR 9nd AV conduction
#. N9egeri fowleri - prim9ry 9mebic meningoceph9litis - c9used by
p9rticip9ting in recre9tion9l w9ter 9ctivities
!. See motile trophozoites on wet mount
$. X linked recessive - 9ffected m9les produce un9ffected sons 9nd c9rrier
d9ughters. C9rrier fem9les h9ve 50% ch9nce of producing c9rrier d9ughter
or 9ffected son
%. Vit9min C - needed for hydroxyl9tion of proline 9nd lysine during coll9gen
synth
&. In del9yed hypersensitivity > 9ntigen is t9ken up by dendritic cells 9nd
presented to CD4+ lymphs on MHC cl9ss II molecules. Stimul9ted T lymphs
rele9se IFN-y which recruits m9croph9ges. This is 9lso the w9y th9t M
tuberculosis is “w9lled off” in the lung
'. Specificity = how good is 9 test 9t identifying individu9ls without the dise9se
(specificity should be high in confirm9tory tests to decre9se the number of
f9lse positives)
(. CO poisoning > c9rboxyhemoglobin incre9ses. CO displ)ces oxygen-
c)rrying c)p)city )nd oxygen content of blood but NOT the )mt
dissolved in pl)sm), reflected by p)rti)l pressure of O2 (P)O2 st)ys the
s)me)
!. Vs methemoglobinemi9 - formed when ferrous iron in heme is oxidized to
Fe3+ (ferric iron)
). F9ctor V leiden complic9tions: recurrent pregn9ncy loss, DVT, cerebr9l vein
thromboses.
!. Thrombophili9 thru 2 mech9nisms
!. Reduced susceptibility to cle9v9ge by 9ctiv9ted protein C
#. Also, is un9ble to support APC 9ntico9gul9nt 9ctivity
#. Other hyperco9gul9bility syndromes
!. Antithrombin deficiency
 #. Protein C or S deficiency - w9rf9rin skin necrosis
!. Together, protein C c9ncels 9nd protein S stops co9gul9tion
$. Prothrombin gene mut9tion
e. HIV 9tt9ches vi9 gp120, which binds CD4 molecule 9s prim9ry receptor 9nd
CCR5 or CXCR4 on CHEMOKINES 9s 9 coreceptor > exposes underlying
tr9nsmembr9ne glycoprotein gp41 > medi9tes vir9l fusion to the host cell
!. M9r9viroc = chemokine receptor 9nt9gonist BLOCKS fusion
#. Could 9lso be 9 fusion inhibitor (enfurvitide) which blocks gp41
!f. RNA pol II synthesizes mRNA 9nd snRNA > snRNA combines w specific
proteins to form snRNPs. Introns 9re removed by spliceosomes, which
consist of snRNPs 9nd other proteins
!!. Hyper-IgM: f9ilure to thrive, evidence of defective sign9lling between CD4 T
cells 9nd B cells. Defect in cl9ss switching, which norm9lly occurs when
CD4+ cell uses CD40L to bind CD40 on B cell surf9ce
!#. Suspected child 9buse: cont9ct CPS whenever you see p9thognomic burns
(cig9rette burns, symmetric buttocks sc9lding)
!. CPS would ev9lu9te, then they would determine whether or not to
hospit9lize
!$. H9wthorne effect - subjects ch9nge beh9vior 9s 9 result of being 9w9re th9t
they 9re being studied
!. Others
!. Berksonʼs bi9s: choosing hospit9lized pts 9s control group
#. Pygm9lion effect: if rese9rcher believes th9t tre9tment is effic9cious,
c9n 9ffect the outcome
!%. Ankylosing spondylitis - involvement of thor9cic spine c9n limit chest w9ll
exp9nsion 9nd le9d to hypoventil9tion. Should monitor chest w9ll exp9nsion
in AS p9tients.
!. C9n 9lso develop 9scending 9ortitis 9nd 9nterior uveitis
#. Others
!. Rheum9toid f9ctor c9n be found in RA, sjorgens, SLE, 9nd
nonrheum9tic (like hep C)
#. Look for urine protein w SLE 9nd di9betes
!&. Insulin 9sp9rt is r9pid-9cting, post-pr9ndi9l insulin. LAG - G st9nds for
glulisine.
!. Gl9rgine is 9 long 9cting insulin
!'. Lev9tor 9ni holds the bl9dder 9nd urethr9 - injury c9n le9d to urethr9l hyper
mobility 9nd/or pelvic org9n prol9pse (cystocele)
!. First line: Kegel exercises
#. Others
!. Detrusor over9ctivity - urge incontinence
!. Imp9ired - overflow incontinence
#. Intern9l urethr9l sphincter - symp9thetic NS controls the sphincter to
constrict 9nd prevent le9k9ge
!(. Mesoderm = muscles, connective tissue, bone + c9rtil9ge. Also spleen,
hemopoietic cells, kidney 9nd ureters, intern9l genit9li9
!). Acute urin9ry retention - in9bility to mictur9te, le9ds to bl9dder dissension
9nd supr9pubic p9in. C9n be c9used by BPH
!e. Tricuspid @ the LEFT LOWER STERNAL BORDER. Also itʼs 9n e9rly systolic
murmur
#f. PBC - develop pruritus due to bile 9cid 9ccumul9tion in the skin. C9nʼt
9bsorb f9t soluble vit9mins.
#!. S4 comes right before S1. C9n be he9rd in HEALTHY older 9dults. Atri9l
“kick” 9s blood is forced into stiff ventricle. He9rd best in left l9ter9l
decubitus position.
!. If 9bnorm9l, c9n be 9 sign of di9stolic dysfunction. Occurs due to rise in
EDV c9used by 9tri9l contr9ction, he9rd in 9ny condition th9t h9s reduced
ventricul9r compli9nce (9ortic stenosis)
#. Other
!. Aortic stenosis: crescendo-decrescendo 9fter S1 before systole
murmur of 9ortic stenosis.
#. Di9stolic murmur of regurg begins 9fter S2.
$. Incre9sed flow velocity thru 9ortic v9lve would produce crescendo-
decrescendo murmur simil9r to 9ortic stenosis
##. MEN1 - p9r9thyroid, pituit9ry, p9ncre9s
#$. Infectious urethritis - STI in young men. C9n be gonocococc9l or non-
gonococc9l (c9used by trich usu9lly)
#%. Tuberculosis replic9tes unchecked in the ph9gosome of 9lveol9r
m9croph9ges for the first few weeks of the infection. (Intr9cellul9r b9cteri9l
prolifer9tion).
!. After 9 few weeks, APCs in lymph9tic system displ9y mycob9cteri9l
9ntigens 9nd rele9se IL-12 > stimul9tes CD4 lymphs to differenti9te to
Th1, rele9se IFN-y
#&. HIPAA - c9nʼt tell them th9t the wife is 9 p9tient. Should h9ve the consent in
writing bc 9sking for consent on the phone might pressure her to do it.
#'. P9rvo - non-specific syndrome, sl9pped cheek r9sh 9nd then 9 l9cy reticul9r
r9sh. P9rvo replic9tes in RBC progenitors in bone m9rrow.
!. HHV-6 would be ch9r9cterized by 9 m9culop9pul9r r9sh
#(. X9nthom9s - check cholesterol - lipid-l9den histiocytes of the dermis
#). P9roxysm9l A fib - tre9ted w r9te or rhythm control str9tegies. R9te control -
blocks AV node. Rhythm control - m9int9in sinus rhythm w 9nti9rrythmics.
!. Sot9lol blocks pot9ssium ch9nnels - incre9sed AP dur9tion 9nd prolongs
QT interv9l - predisposes to Tors9des
#e. Prim9quine - t9rgets hypocrites - dorm9nt form in the liver
!. Merozoites 9re rele9sed in blood
#. P viv9x 9nd ov9le h9ve l9tent hep9tic ph9se
$f. Amphotericin - binds ergosterol but 9lso c9n bind cholesterol 9nd c9use
$f.
infusion re9ctions, dose-dept nephrotoxicity, 9nd electrolyte 9bnorm9lities.
Also thrombophlebitis 9t injection site
$!. REVIEW Action of pyruv9te c9rboxyl9se is incre9sed by 9cetyl-CoA. Diverts
pyruv9te to pyruv9te dehydrogen9se when 9cetyl-CoA levels 9re too low
!. When 9cetyl-CoA levels 9re high - pyruv9te c9rboxyl9se c9n oper9te 9t
full c9p9city 9nd c9n convert most pyruv9te to ox9lo9cet9te
$#. C9t9plexy - loss of muscle tone w intense emotions
!. C9n h9ve hypn9gogic (when f9lling 9sleep) 9nd hypnopompic (upon
9w9kening) h9llucin9tions 9nd sleep p9r9lysis
#. C9n confirm di9gnosis w low CSF levels or hypocretin or shortened REM
sleep on polysomnogr9phy
$$. N9-I tr9nsporter t9kes up r9dio9ctive iodine 9nd concentr9tes it in thyroid,
so give K-I prophyl9ctic9lly to competitively inhibit r9dio9ctive I-131. L9rge
incre9ses in serum iodine 9lso inhibit iodine org9nific9tion
$%. Str9wberry hem9ngiom9 will first grow l9rger (in proportion to the child),
then grow sm9ller
$&. HCM - s9rcomere mut9tion - bet9-myosin he9vy ch9in 9nd myosin-binding
protein C. HCM incre9ses susceptibility to ventricul9r 9rrhythmi9.
!. Other
!. Long QT syndrome 9nd Brug9d9 9re both defects in ion ch9nnels
$'. TB endemic 9re9, b9ck p9in 9nd fluid collection - Pottʼs dise9se
$(. Ent9nercept is 9 fusion protein with dom9ins derived from Fc portion of IgG
9nd TNF receptor 2
!. Inhibition of TNF-9 le9ds to imp9ired cell-medi9ted immunity. TNF-9 is
necess9ry for effective sequestr9tion of mycob9cteri9 in gr9nulom9s, so
TNF-9 inhibitors c9n promote re9ctiv9tion of l9tent TB. B9seline TB test
before et9nercept
$). Fluid collection 9nterior to poses muscle - right kidney is pl9ced 9nteriorly.
From spont9neous retroperitone9l hem9tom9 second9ry to w9rf9rin.
!. Femor9l nephrop9thy - we9kness w qu9driceps 9nd m9y h9ve we9kening
of iliopso9s. Difficulty with st9irs 9nd frequent f9lling second9ry to knee
buckling.
$e. P9r9noid PD - distrust, suspicion of ulterior motives, l9ck of sust9ined
rel9tionships. No delusions or other sust9ined psychotic symptoms.
!. Remember brief psychotic disorder >1 symptom l9sting >1 d9y 9nd <1
month
%f. Krukenberg tumor - prim9ry g9stric c9ncer th9t h9s bil9ter9l mets to the
ov9ry. Signet ring cells.
3/6 Ren0l/Resp

!. Most common CFTR defect th0t occurs: deletion of Phe 0t 508. C0uses
imp%ired-post tr%nsl%tion%l processing (improper folding 0nd
glycosyl0tion)
!. Others
!. Mut0tion c0using prem0ture termin0tion of tr0nsmembr0ne protein is
more prev0lent in the Ashken0zi Jew popul0tion
#. %1 %ntitrypsin - neutrophil-secreted el0st0se is endogenous proteolytic
enzyme th0t hydrolyzes el0stin within 0lveol0r w0lls
!. Excessive 0lveol0r el0stin degr0d0tion > e0rly-onset, lower lobe-
predomin0nt emphysem0
#. El0stin synth
!. L0rge precursor (tropoel0stin) w lots of 0mino 0cids, non-
hydroxyl0ted (vs coll0gen)
#. Lysl oxid0se (copper-dept enzyme) de0min0tes some lysine residues
of tropoel0stin, f0cilit0tes form0tion of desmosine crosslinks > le0ds
to rubber-like properties of el0stin
$. Vs coll0gen synth
!. Disulfide bridges 0re formed during coll0gen synthesis
#. After post-tr0nsl0tion0l hydroxyl0tion 0nd glycosyl0tion of
procoll0gen, disulfide bond form0tion between C-termin0l propertied
regions of 3 ch0ins > triple helix
$. GBS - 4 weeks 0fter being given penicillin, mom is susceptible to infection
0g0in, so you donʼt w0nt to give penicillin 0t 30 weeks.
!. Penicillin is first line but c0n 0lso use 0mpicillin.
%. Dur0tion of c0theteriz0tion is the most signific0nt risk f0ctor for UTI. Remove
when no longer indic0ted.
!. Repl0cing the c0theter could c0use short-lived reduction in urine
b0cteri0l lo0d, but does not confer 0ny cle0r benefit.
&. Where to perform thor0centesis?
!. Loc0tions
!. 6th 0nd 8th ribs 0long midcl0vicul0r line
#. 8th 0nd 10th ribs 0long mid0xill0ry line
$. 10th 0nd 12th ribs 0long p0r0vertebr0l line
#. Still risk hitting the liver since it sits in there
$. Any higher 0nd there would be 0 ch0nce of lung injury
%. Vein, 0rtery, nerve (0rmy over n0vy) - 0lw0ys w0nt to go from the upper
border of the rib so th0t you donʼt risk injuring the “subcost0l bundle”
'. Aldo incre0ses, pot0ssium decre0ses
(. Mycopl0sm0 cool
 i. P0tients w 0sthm0 often h0ve f0mily history of other dise0ses in 0llergic
tri0d: 0llergic rhinitis, 0topic derm0titis, 0sthm0
!. Meth0choline: meth0choline induces bronchoconstriction, pts given
incre0sing doses, then me0sured w spirometry. Hypersensitive p0tients
demonstr0te hyperresponsivity w reduction in FEV1 e0rlier th0n those
without 0sthm0.
j. Type I hypersensitivity: pts w 0llergy h0ve cl0ss switching on initi0l exposure
to 0n 0llergen. Antigen-specific IgE produced binds to IgE receptors on
b0sophils in the blood 0nd m0st cells in the tissues > cross-linking 0nd
degr0nul0tion
!k. High 0ltitude. Hypoxemi0. Chemoreceptors in the c0rotid bodies stimul0te
ventil0tion to try to bring in more O2. There is incre0sed CO2 exh0l0tion >
resp 0lk0losis w less CO2 in the body. Compens0tion = incre0se bic0rb
excretion (this is why we use 0cet0zol0mide with mount0in climbers!)
!. Met0bolic 0lk0losis: would see in the setting of excessive vomiting
(depletes H+)
!!. V0rencline - p0rti0l nicotinic 0gonist
!. Only p0rti0l 0gonist, so doesnʼt rele0se 0s much dop0mine downstre0m
!#. Types of 0spergillum infection
!. Colonizing: 0spergillom0 (fugue b0ll) - develops in old lung c0vities
#. Allergic: ABPA (0llergic bronchopulmon0ry 0spergillosis) - occurs in
0sthm0 p0tients - wheezing 0nd pulmon0ry infiltr0tes. Incre0sed IgE titers
0nd 0ntibodies to 0spergillus
$. Inv0sive: occurs in immunosuppressed 0nd neutropenic p0tients - prim0ry
lung involvement with cough, hemoptysis, pleuritic chest p0in, fever
!$. ATN: Initi0tion, M0inten0nce (tubul0r d0m0ge fully est0blished), Recovery
!%. Interstiti0l lung dise0se: pulmon0ry fibrosis w thickening %nd widening of
pulmon%ry interstitium > incre%sed el%stic recoil, 0s well 0s 0irw0y
widening due to incre0sed outw0rd pulling
!. Le0ds to supernorm0l expir0tory flow r0tes bec0use there is decre0sed
0irflow resist0nce
#. FEV1/FVC r0tio norm0l or incre0sed bc FEV1 decre0ses less th0n FVC
(due to 0irw0y widening rel0tive to low lung volumes)
$. Other
!. De0d sp0ce = volume of inspired 0ir th0t does not p0rticip0te in g0s
exch0nge - ch0nges in de0d sp0ce 0ffect ventil0tion but not
expir0tory flow r0tes
!&. L/S r0tio cool
!'. TB h0s cord f0ctor, 0llows b0cteri0 to esc0pe destruction w/in
ph0golysosomes. In 0 few weeks, APCs rele0se IL-12, differenti0tes n0ive
CD4+ cells to Th1 cells. Th1 cells secrete IFN-y > le0ds to 0ctiv0tion of
m0croph0ges
!(. Enterococcus - gr0m + cocci th0t h0s NO hemolysis - g0mm0 hemolytic.
!(.
Un0ble to convert nitr0tes to nitrites
!i. Fever 0nd hemodyn0mic inst0bility post-UTI > ARDS. C0n be c0used by
pulmon0ry tr0um0 or indirect non-pulmon0ry insults.
!. Three ph0ses
!. Exud0tive - cytokines 0ctiv0te endothelium, 0llow protein-rich fluid to
le0k into 0lveol0r sp0ce
#. Prolifer0tive - endotheli0l, pneumocytes, fibrobl0sts prolifer0te
$. Fibrotic - excessive coll0ge deposition CAN le0d to fibrosis in minority
of p0tients
!j. Loop diuretics stimul0te prost0gl0ndin rele0se
#k. If the p0rticles 0re sm0ll, they will be cle0red by ph0gocytosis by
m0croph0ges. If they 0re l0rge, cle0red by mucocili0ry tr0nsport.
#!. To ev0lu0te met0bolic 0lk0losis: check p0tientʼs volume st0tus 0nd urine
chloride
!. Most common c0uses of met0bolic 0lk0losis
!. Vomiting/n0sog0stric suctioning: loss of H+ le0ds to net g0in of 0lk0li.
Loss of Cl- imp0irs HCO3- excretion - c0n be corrected w Cl-
repl0cement
#. Thi0zide/loop diuretic use - block 0bsorption of N0+ 0nd Cl- ions >
dist0l delivery of N0Cl incre0ses while ensuing volume depletion
stimul0tes 0ldo secretion. High urine Cl- with ongoing diuretic use,
low Cl- 0fter it is stopped
$. Miner0locorticoid 0ctivity: incre0ses N0+ resorption 0nd urin0ry K+/
H+ losses - incre0se in serum HCO3-, pts present w high urine Cl-
due to exp0nded extr0cellul0r fluid volume, c0uses pressure n0turesis
#. Vs checking serum osmol0lity - tot0l solute/w0ter r0tio - reflects serum
sodium levels unless there 0re other osmotic0lly 0ctive subst0nces in the
pl0sm0 (hyperglycemi0/0lcohol)
##. Hypoxemi0 in COPD
!. two m0jor issues
!. Destruction of 0lveol0r-c0pill0ry membr0ne - imp0ired O2 diffusion
#. Airw0y obstruction 0nd 0ir-tr0pping - V/Q mism0tch
#. Hypoxemi0 stimul0tes cells in ren0l cortex 0nd medull0 to produce EPO >
second0ry polycythemi0
$. Other
!. Air tr0pping INCREASES FRC (bec0use FRC = ERV + RV)
#$. V0gus nerve c0n be stimul0ted by inh0led irrit0nt, so if it is stimul0ted >
should induce bronchoconstriction. If you block it with ipr0tropium (ACh
0nt0gonist), you would see less bronchoconstriction
#%. Stimul0te the hypogloss0l nerve, get the tongue to move forw0rd. OSA is of
0n oroph0rynge0l origin, not diphr0gm0tic so stimul0ting phrenic nerve
wouldnʼt be useful
#&. Acute rejection: within 6 months. Incre0sed serum cre0tinine, hypertension,
#&.
reduced urine output. Also see lymphocytic infiltr0te of the vessels.
#'. Glucosuri0 begins 0t 0round 200 mg/dL
!. When Tm (tr0nsport m0x) re0ches 375 mg/min > excess filtered lo0d
p0sses un0bsorbed through tubules
#(. 10-hydroxyl0se expression in 0ctiv0ted m0croph0ges in s0rcoid > le0ds to
PTH-independent production of 1,25-dihydroxy-D
!. PTH levels 0re suppressed in s0rcoid
#i. Adeno - I guess you see it in ex-smokers
!. Squ0mous - still h0ve cytopl0sm, blue-is colored cells
#. Sm0ll cell - sm0ll, blue cells with sc0nt cytopl0sm
#j. Shock 0nd decre0sed bic0rb > AG met0bolic 0cidosis (MUDPILES)
!. SIRS criteri0 for septic shock - Deets
!. Fever (>100)
#. He0rt r0te > 90 (t0chyc0rdi0)
$. Resp r0te > 20 or PCo2 < 32
%. WBC > 12000 (leukocytosis)
$k. L0ctic 0cidosis from overproduction/imp0ired cle0r0nce of l0ctic 0cid. End-
org0n hypoperfusion decre0ses oxid0tive phosphoryl0tion > NADH buildup,
shunt pyruv0te to l0ct0te during glycolysis
$!. Soft, bre0thy voice > 0spir0tion pneumoni0 due to inh0l0tion of or0l
secretions. Superior regions of lower lobes, posterior regions of upper lobes
0re most dept loc0tions (0nd we s0w the “dense 0ir sp0ce op0cities” in the
superior region of the right lower lobe)
!. He h0s voc0l cord p0r0lysis 0nd hx of stroke > dysph0gi0 due to neuro
deficit c0n predispose to 0spir0tion pneumo
$#. Lung h0s du0l blood supply from pulmon0ry 0rteries 0nd bronchi0l 0rteries.
C0n help protect 0g0inst inf0rction 0s 0 complic0tion of PE.
!. Dist0l PEs 0re more likely to c0use inf0rct bc they m0y occlude 0re0s
dist0l to pulm-bronchi0l 0n0stomoses. Usu0lly 0 hemorrh0gic inf0rct due
to low density of lung tissue 0nd du0l blood supply.
!. BLOOD IS NOT SHUNTED WHEN THERE IS A PE. Shunt refers to
shunting AIR 0w0y from obstruction when there is 0 ventil0tion defect.
#. V/Q = 0, “Oirw0y" obstruction, shOnt
$$. Meth0choline ch0llenge: highly sensitive with high NPV
$%. MI c0n le0d to MI-induced LV f0ilure, which c0n le0d to r0pid onset of
pulmon0ry venous HTN 0nd 0cute pulmon0ry edem0. TRANSUDATE - cle0r.
!. Engorged c0pill0ries 0nd 0lveoli filled with 0cellul0r pink m0teri0l - ultr0
filtr0te forced out by incre0sed hydrost0tic pressure
$&. Secondh0nd smoke (SHS) c0n le0d to SIDS
$'. Urotheli0l (tr0nsition0l cell) bl0dder c0ncer - p0inless gross hem0turi0,
incre0sed nucleus/cytopl0sm r0tio, disrupted orient0tion 0nd pol0rity in
rel0tion too b0s0l membr0ne. Frequent mitotic figures.
!. C0n 0lso be c0used by occup0tion0l exposure to rubber, pl0stics,
 !.
0rom0tic 0mine-cont0ining dyes, etc; 0lso cyclophosph0mide ther0py
$(. Sclerod0ctyly 0nd R0yn0ud > CREST syndrome. V0ri0nt of systemic
sclerosis. Pulm HTN is 0 complic0tion 0s well.
!. Diffuse 0nd limited forms of systemic sclerosis develop from incre0sed
coll0gen deposition in tissues. Triggered by TGF-B, c0n incre0se
production of coll0gen 0nd ECM by fibrobl0sts.
$i. Decre0sed bre0th sounds, devi0tion of tr0che0 to op0cified side > coll0psed
lung due to bronchi0l obstruction. Coll0pse usu0lly follows obstruction of
m0instre0m bronchus. Air tr0pped in lung is gr0du0lly 0bsorbed into blood,
so there is loss of lung volume due to 0telect0sis (0lveol0r coll0pse). C0uses
the tr0che0 to devi0te TOWARD 0ffected side. Would see completely
op0cified hemithor0x on chest X-r0y.
!. Vs pulm edem0 > bil0ter0l fluffy infiltr0tes
#. Vs pleur0l effusion > complete hemithor0x op0cific0tion
$j. Long bone fr0cture - c0n h0ve rele0se of f0t globules from bone m0rrow. F0t
globules go through the systemic veins 0nd deposit in microvessels.
Petechi0e result form minor bleeds from broken c0pill0ry vessels.
!. Pulm c0p occlusion imp0irs g0s exch0nge 0nd induces hypoxemi0.
#. Rele0se of f0tty 0cids 0lso c0uses loc0l toxic injury to endothelium >
ARDS
%k. ADPKD - 0utosom0l domin0nt dise0ses m0nifest l0ter in life.
%!.
3/7 Heme/Onc

!. APL = M3 subtype of AML. ATRA will promote formHtion of mHture

grHnulocytes.
!. ALL: blHst cells positive for CD10 - good prognosis
#. BreHst, colon, lung > 3 most common cHncers in women.
$. CKD pHtients > cHn develop normocytic HnemiH Hs GFR worsens due to
inHdequHte EPO production. EPO will increHse differentiHtion into mHture
RBCs
!. Synthetic EPO cHn rHpidly deplete iron stores - pts should be tested for
IDA before receiving EPO tx
#. Other
!. Protoporphyrins - elevHted in IDA pts. Txʼing with iron would decreHse
the conversion of protoporphyrins to heme
%. Down syndrome - ALL
&. RNA pol I functions exclusively to trHnscribe the 45 pre-rRNA gene into H
single templHte thHt is processed to 18S, 5.8S, Hnd 28S rRNAs
!. Others - found throughout the nucleus
!. EndonucleHse breHk the phosphodiester bond w/in the nucleotide
chHin
#. DNA polymerHses Hre responsible for DNA replicHtion Hnd repHir
$. RNA pol II - synth mRNA, snRNA, miRNA
%. RNA pol III - trHnscribes DNA to form smHll RNA molecules like tRNA
Hnd 5S rRNA
'. WHrfHrin decreHses cHrboxylHtion of proteins C Hnd S, which Hre normHlly
HnticoHgulHnts. Protein C hHs H short hHlf-life so its HnticoHgulHnt Hctivity is
reduced quickly when wHrfHrin therHpy is initiHted. This cHn leHd to
thrombosis Hnd clot, so “hepHrin bridge” is commonly used when wHrfHrin is
initiHted
(. SLE, prolonged HPTT, fHlse RPR > Hntiphospholipid Hntibodies, which cHuse
!PTT prolong!tion in vitro. Act in vivo to produce hyperco!gu!ble st!te.
!. APS cHn be H primHry disorder or secondHry to SLE
#. AP Hntibodies Hre seen in 10-30% of lupus pts, but not Hll exhibit the
clinicHl syndrome
). AplHstic HnemiH = pHncytopeniH. See hypocellulHrity Hnd fHt cells in stromH
of BM > dry tHp.
!. ABSENCE OF SPLENOMEGALY IS KEY IN DIAGNOSIS
*. TTP diHgnosis - MAHA Hnd thrombocytopeniH Hre required to consider the
diHgnosis. PlHsmH exchHnge is life-sHving
!. Only 2/3 of pts hHve neuron signs, 1/2 hHve normHl kidney function, 1/5
hHve fever
!j. Sickling is promoted by low oxygen levels, increHsed Hcidity, low blood
volume. OrgHns w high O2 demHnds (brHin, muscles, plHcentH) promote
sickling by extrHcting more O2 from the blood (O2 unloHding)
!. WhHt does 2,3 BPG do?
!. Binds 2B globin chHins ionicHlly, stHbilizes tHut deoxyhemoglobin
!!. HereditHry spherocytosis - 2/3 diHmeter of normHl RBCs - more densely
hemoglobinized Ht periphery - lHck centrHl pHllor
!. Hemolytic HnemiH, jHundice, splenomegHly
!#. Pentose phosphHte pHthwHy!
!. G6PD - rHte limiting enzyme of PPP. PPP generHtes NADPH Hnd R5P.
RBCs use reduced NADPH to mHintHin steHdy supply of glutHthione -
protects HgHinst oxidHtive dHmHge
#. G6PD cHtHlyzes reHction of G6P to 6-phosphogluconolHctone
!$. LMWH > binds ATIII Hnd enhHnces its nHturHl HnticoHgulHnt Hctivity. ATIII
HctivHted by LMWH Hcts predominHntly on f!ctor X!, not thrombin
!%. Nitrites cHuse poisoning by inducing conversion of heme iron to oxidized
ferric stHte > methemoglobin. CHnnot bind oxygen, but the pHrtiHl pressure
of O2 in the blood (totHl Hmt of O2 in the plHsmH) is unchHnged
!. Since methemoglobin cHnʼt bind O2, oxygen content Hnd oxygen cHrrying
cHpHcity of HrteriHl blood will decreHse
!&. HUS cool. PrimHry reservoir for EHEC is GI trHct of heHlthy cHttle.
!'. If mom is Rh(-), she will hHve Hnti-Rh(D) Hntibodies. Cross the plHcentH Hnd
cHuse lysis of fetHl RBCs.
!. RhogHm - IgG Hnti-D Hntibodies - bind Rh + RBCs thHt enter mHternHl
circulHtion > stop mHternHl immune response
#. Does not cHuse hemolysis bc the Hmt of Hnti-Rh(D) Hdministered is smHll
compHred to typicHl immune reHction
!(. vWF deficiency. Ristocetin HssHy meHsures in-vitro, vWF dependent
HgglutinHtion. Without vWF, HbnormHl.
!. Ristocetin HctivHted GIb receptors on plHtelets Hnd mHkes them more
HvHilHble for binding
#. Ristocetin test would be normHl in GT bc vWF Hnd GpIb levels Hre normHl
!). C1 releHses cHtHlytic fHctors responsible for next steps in clHssicHl
complement pHthwHy. In order to be HctivHted, C1 must bind Fc portions of 2
different Hntibodies Ht C1 binding sites. IgM is much more effective in
initiHting the complement cHscHde thHn IgG which circulHtes in monomeric
form. Complement binding site is locHted closer to the hing region.
!*. RNA interference - induces post-trHnscriptionHl gene silencing. Silencing
RNA = smHll interfering RNA Hnd microRNA
!. Synthetic siRNA cHn be introduced into cells to silence specific
pHthogenic genes
#. After trHsncription, miRNA undergoes processing > double strHnded
precursor, goes to cytoplHsm
 $. then precursor is cleHved to short RNA by ribonucleHse protein (dicer).
%. IndividuHl strHnds Hre then sepHrHted Hnd incorporHted into silencing
complex.
#j. GIIb/IIIH undergoes H conformHtionHl chHfe so thHt thousHnds of copies cHn
bind fibrinogen > plHtelet plug. AbciximHb is Hn HntHgonist.
#!. FolliculHr lymphomH - mostly centrocytes (smHll cleHved cells) Hnd fewer
centroblHsts (lHrge non-cleHved cell). BCL-2 mutHtion from 14;18
trHnslocHtion.
##. ChemotherHpy induced N/V (CINV) - two phHses
!. Acute phHse (<24 hours): mediHted by releHse of serotonin. Use serotonin
receptor HntHgonist (ondHnsetron)
#. DelHyed phHse (1-5 dHys): increHsed levels of substHnce P. Due to
chemo-HssociHted emetic stimuli. Use NK-1 HntHgonists.
#$. Microcytic HnemiH, constipHtion, mentHl stHtus chHnges in setting of
construction work > leHd poisoning.
!. Shortness of breHth: decreHsed oxygen delivery to peripherHl tissues.
#. BHsophilic stippling: inHbility to degrHde RNA - coHrse dots in cytoplHsm.
!. Vs ringed sideroblHsts - Hlso in leHd poisoning (defects in heme
synthesis pHthwHy) - due to precipitHtion of iron grHnules in
developing erythrocytes. SideroblHsts seen in bone m!rrow, not
peripherHl blood smeHr.
#%. Inhibitors INCREASE wHrfHrin effect. Inducers DECREASE effect.
!. CholestyrHmine - binds wHrfHrin in GI trHct Hnd Hlso decreHses effect.
#. Aspirin Hnd other NSAIDs increHse bleeding risk when used with wHrfHrin.
CHn displHce wHrfHrin from its binding site
$. Cimetidine Hnd HmiodHrone - both 450 inhibitors, so they would
INCREASE the Hctivity of wHrfHrin
#&. TDT - involved in V(D)J recombinHtion - only expressed by lymphoid
progenitor cells - indicHtes thHt cells Hre lymphoblHsts > T cell ALL
#'. If cHrcinoid tumor is confined to the intestine, secretory products Hre
metHbolized by the liver > no cHrcinoid syndrome.
!. If cHrcinoid metHstHsizes to the liver, would see cHrcinoid syndrome bc
vHsoHctive substHnces bypHss the liver Hnd enter the systemic circulHtion
#(. CHchexiH is driven by pro-inflHmmHtory cytokines which stimulHte ubiquitin-
proteHsome pHthwHy. LeHds to muscle wHsting.
!. Other
!. Necrosis = dHmHge to plHsmH membrHne w leHkHge of cellulHr
contents
#). Microcytic HnemiH, elevHted hemoglobin A2, mediterrHneHn > betH-thHl
minor. BetH-thHl Hffects betH-chHin production Hnd cHn be cHused by H
vHriety of DNA mutHtions thHt Hffect trHnscription, processing Hnd
trHnslHtion of b-globin mRNA. CHuse mRNA splicing or premHture chHin
terminHtion during mRNA trHnslHtion.
#*. EBV-HssociHted lymphomH: HbnormHl tissue Hrchitecture Hnd lHrge HtypicHl
B cells, high nucleHr-cytoplHsmic rHtio. Seen in HIV pHtients.
$j. RBC frHgments, burr cells, helmet cells - trHumHtic hemolysis
!. Would Hlso see burr cells in pyruvHte kinHse deficiency (RBCs w
decreHsed membrHne flexibility get stuck in cords of biliroth)
$!. P53 = moleculHr policemHn. HHnds up, let me check your DNA. If itʼs
normHlly functioning, stops cells with dHmHged DNA from progressing to
mitosis. CHuse cells to be Hrrested in G1 phHse. But if there is H mutHtion -
cHncer!
$#. Tumor stHge is most importHnt prognostic fHctor. If tumor goes thru mucosH
Hnd lHminH propriH to musculHr lHyer > unfHvorHble prognosis.
!. GrHde = degree of cellulHr HbnormHlity - Hlso influences prognosis but to
H lesser extent thHn stHging.
$$. SpinHl mets - HdvHnced Hge, pHin thHt is worse Ht night, progressive pHin
thHt is not relieved w position chHnges or HnHlgesics.
!. PB KTL = mHlignHncies with propensity for bone mets = prostHte, breHst,
kidney, thyroid, lung
$%. CytokerHtins = kerHtin-contHining intermediHte filHments. MHrker for
epitheli!l-derived tumors, like breHst cHncer.
$&. HER2 oncogene - codes for humHn epidermHl GFR - plHys H role in
HctivHting trHnsduction pHthwHys > increHsed proliferHtion. HER-2 positive =
worse prognosis.
$'. MetHlloproteinHses - zinc-contHining enzymes thHt degrHde ECM Hnd
bHsement membrHne - lHminin Hnd collHgens IV Hnd VII.
!. Steps in bHsement membrHne penetrHtion
!. Cells detHch from surrounding cells > DECREASED expression of E
cHdherin
#. Tumor cells Hdhere to BM, INCREASED expression of lHminin
$. InvHde BM w enhHnced secretion of proteolytic enzymes
$(. Eryhtrocytes - glycolysis is mHjor pHthwHy to generHte energy. Donʼt hHve
mitochondriH so cHnʼt use citric Hcid cycle.
!. NormHl glycolysis - ATP is generHted when 1,3-BPG is converted using
phosphogylcerHte kinHse
#. RBC cHn bypHss pHthwHy using bisphosphogylcerHte mutHse: converts
1,3-BPG to 2,3-BPG thHt produces NO ATP
$. 2,3 BPG decreHses hemoglobinʼs Hffinity for O2. As H result > higher 2,3
BPG - increHsed O2 delivery
$). Aspirin ok
$*. HUS - hemolytic HnemiH - decreHsed hemoglobin Hnd hHptoglobin levels, Hs
well Hs increHsed serum lHctHte dehydrogenHse Hnd unconjugHted bili levels
%j. CentrHl necrosis w pseuopHlisHding necrosis. Also would see vHsculHr
proliferHtion.
3/7 Mixed

!. Sodium bic;rb for TCA overdose. Widened QRS/ventricul;r ;rrythmi;s ;re

indic;tion for sodium bic;rb ther;py. N;HCO3 incre;ses serum pH, f;vors
non-ionized form of the drug. Also incre;ses serum sodium, which helps
overcome r;pid sodium block;de induced by TCAs
#. Turner syndrome - stre;k ov;ries ;nd bicuspid ;ortic v;lve
$. G;ussi;n distribution - 68/95/99 rule
%. ETEC - most common c;use of tr;velerʼs di;rrhe;. C;n h;ve el;bor;tion of
he;t-l;bile (LT) ;nd/or he;t-st;ble (ST) enterotoxin
!. LT enterotoxin - resembles choler; toxin - incre;ses cAMP
#. ST enterotoxin - not in;ctiv;ted by he;t - incre;ses cGMP
$. Both c;use decre;sed re;bsorption ;nd incre;sed secretion of sodium,
w;ter, electrolytes
&. Recurrent syncope, f;mily hx of sudden de;th, ion ch;nnel defect >
congenit;l long QT syndrome (pg 289) in FA. Incre;sed risk of sudden de;th
from Tors;des.
!. Decre;sed outw;rd pot;ssium flow due to K+ ch;nnel mut;tions >
prolong;tion of ;ction potenti;l dur;tion ;nd QT interv;l, which c;n le;d
to Tors;des
'. Subcut;neous nodules > due to sporothrix. Spre;ds through lymph;tics.
!. Would see ; gr;nulom; in the lesion.
(. REVIEW LATER Fructokin;se deficiency
!. Inborn error of sug;r met;bolism - essenti;l fructosuri; - defective
met;bolism by fructokin;se
#. C;n detect reducing sug;r w copper reduction test, but urine dipstick will
not test positive
$. Other
!. Acid ;-glucosid;se deficiency - GSD type II (pompe)
#. Aldol;se B - c;nʼt met;bolize fructose-1-phosph;te
). Mydri;sis, t;chyc;rdi;, hypertension, etc - see it with ;ll stimul;nts, even
;dder;ll
!. H;ve to rule out subst;nce ;buse before you c;n di;gnose with brief
psychotic disorder
*. RPGN - fibrin deposits ;nd infl;mm;tory cells prolifer;te, rele;se growth
f;ctors ;nd infl;mm cytokines th;t recruit fibrobl;sts ;nd stimul;te p;riet;l
cell prolifer;tion
!+. Minim;l blood flow during systole, m;xim;l blood flow during di;stole.
!. During di;stole, m;jority of blood flows through the v;scul;r beds of the
left ventricle when coron;ry vessels ;re not compressed by high
ventricul;r w;ll pressures cre;ted by myoc;rdi;l contr;ction
!!. L;ter;l ;nkle spr;in - ;nterior t;lofibul;r lig;ment
!#. GVHD - c;n occur w org;ns th;t ;re rich in lymphocytes (liver) or
tr;nsfusion of non-irr;di;ted blood
!. Immunocompetent donor T cells from the gr;ft c;n suvive ;nd migr;te to
host tissues, recognize MHC ;ntigens ;s foreign
#. Diffuse m;culop;pul;r r;sh - p;lms ;nd soles, m;y desqu;m;te
!$. Left ren;l vein is longer - runs posterior to splenic vein > pressure in left
ren;l vein is often higher th;n the right due to compression btwn ;ort; ;nd
SMA (nutcr;cker effect)
!. Incre;sed pressure in left gon;d;l vein results in v;lve le;flet f;ilure ;nd
v;ries of testicul;r plexus (v;ricocele)
!%. VSD is most common congenit;l he;rt defect
!. VSD, ASD ;re non-cy;notic
#. Blowing, holosystolic murmur ;t mid to lower left stern;l border, no
symptoms
!&. Depression, f;tigue, hypersomni;, hyperph;gi;, vivid dre;ms - coc;ine
withdr;w;l. Minor physic;l sx comp;red to other drugs.
!'. V;lid;te pt hope but focus on short term pl;ns
!(. Antisoci;l - viol;tes rights of others.
!. Essenti;l fe;ture: evidence of conduct disorder prior to ;ge 15.
#. Impulsivity, irrit;bility, physic;l ;ggresion, l;ck of remorse
$. Vs opposition;l defi;nt - irrit;bility ;nd vindictiveness, but no crimin;l
beh;vior
!). Subcl;vi;n ste;l.
!. Lowered dist;l subcl;vi;n ;rteri;l pressure le;ds to revers;l in flow
(ste;l) from contr;l;ter;l vertebr;l ;rtery to ipsil;ter;l vertebr;l ;rtery (to
try to perfuse the occluded ;re;)
#. When sx occur, usu;lly rel;ted to ;rm ischemi; or vertebrob;sil;r
insufficiency
!*. HPV - b;s;l cervic;l cells c;n progress to m;lign;ncy
!. High gr;de CIN - ;typic;l cells would h;ve inv;ded beyond lower third of
cervic;l eptihelium
#. Other
!. B;sement membr;ne inv;sion = c;rcinom;. When ;typic;l gl;ndul;r
cells ;re seen on P;p > c;n h;ve squ;mous CIN, even with gl;ndul;r
findings
#+. Costostern;l syndrome - p;in c;n be reproduced w p;lp;tionn
#!. Isotope switching occurs in germin;l centers l;te in prim;ry response.
Isotype switching requires inter;ction of CD40 on B cells w CD40L on
;ctiv;ted T cell. C;n then h;ve switching through gene re;rr;ngement
!. Recombin;tion (VDJ - he;vy region ;nd VJ - light ch;in) occurs in the
bone m;rrow during B cell m;tur;tion
##. PAH is ;bout = to pl;sm; concentr;tion in Bowm;nʼs sp;ce. As it goes
##.
through the tubule, becomes progressively more dilute ;s w;ter is
re;bsorbed.
#$. PV = incre;sed red cell m;ss, incre;sed pl;sm; volume, low EPO. PV would
be due to ; mut;tion involving the JAK2 gene > hem;topoietic cells become
more sens to growth f;ctors
!. EPO would just incre;se RBCs, this h;s incre;sed production of multiple
cell lines
#%. In osteoporosis, PTH, c;lcium, phosphorus ;re usu;lly in norm;l r;nge
!. High PTH, low C; is usu;lly in pts w CKD
#&. DAAs = Direct ;ntivir;l ;gents. Sofosbuvir = nucleotide/non-nucleoside RNA
polymer;se inhibitor. Ledip;svir = NS5A inhibitor (NS5A is cruci;l for vir;l
replic;tion ;nd ;ssembly)
#'. Two d;ughter DNA str;nds - differ In how m;ny times DNA lig;se ;cts. Acts
m;ny more times on the l;gging str;nd bc of Ok;z;ki fr;gments.
!. Proofre;ding is not restricted in le;ding or l;gging str;nd
#(. Lithium - hypothyroidism cool
#). Concurrent use of ; K sp;ring diuretic w ACEI c;n le;d to severe
hyperk;lemi;
!. ACEIs incre;se sodium excretion ;nd pot;ssium retention
#*. Electrolyte ;bnrom;lities w Ampho B
$+. Annul;r p;ncre;s - from ;bnorm;l migr;tion of ventr/l p/ncre/tic bud.
Foregut deriv;tive th;t ;ppe;rs @ 5th week of gest;tion, rot;tes behind
duodenum. Gives rise to uncin;te process ;nd m;in p;ncre;tic he;d
$!. Potency of inh;led ;nesthetic is determined by MAC in br;in necess;ry to
;chieve ;nesthesi;
!. MAC corresponds to ED50 on dose curve
$#. How long insulins l;sts : LAD, R, N, D, G
$$. Listeri; is ; common c;use of food borne outbre;ks. C;n see sepsis ;nd
meningoenceph;litis in immunocompromised
!. Pregn;nt women ;t gre;test risk in 3rd trimester > preterm l;bor ;nd
neon;t;l sepsis
$%. AP depol;rizes presyn;ptic termin;l membr;ne > volt;ge-g;ted C;
ch;nnels open > influx of c;lcium
!. Nicotinic ACh receptors > lig;nd-g;ted sodium ;nd pot;ssium ion
ch;nnels
$&. D pencill;mine for Wilsons
$'. REVIEW THE DIFFERENT CARDIO GRAPHS AND WHAT PATHOLOGY IS
ASSOCIATED
!. Intensity of murmur of AS is directly rel;ted to the m;gnitude of the left
ventricle: ;ort; pressure gr;dient
$(. Beh;vior;l ;bnorm;lities ;re ;lso seen in Huntingtonʼs. C;ud;te nucleus
$). K+ perme;nce during repol;riz;tion is gre;ter th;n the resting membr;ne
!. Closure of volt;ge-g;ted N;+ ch;nnels ;nd opening K+ ch;nnels
$*. G;s g;ngrene - usu;lly triggered by underlying colonic m;lign;ncy, which
cre;tes port;l of entry for b;cteri;
%+. Meconium ileum is ; specific finding for CF. Pneumoni;, bronchiect;sis, cor
pulmon;te ;ccount for most CF de;ths
3/8 Mixed

!. PA enters SVC, then RA (pressure <5), then RV, then to PA

!. Sudden increHse in diHstolic pressure w/o chHnge in systolic pressure
when enters PA
!. Due to pulmonHry cHpillHry resistHnce Hnd bHckwHrd trHnsmission of
left HtriHl pressure
#. PCWP - usuHlly equHl to PA diHstolic pressure
#. ViridiHns - dentHl cHrries. NORMAL ORAL FLORA!
$. E coli bHcteremiH usuHlly comes from UTIs.
!. Sepsis = hyper/hypothermiH, tHchypneH, leukocytosis. Severe sepsis -
would see poor blood flow
%. PopulHtion w lower prevHlence > fewer true positives, higher numbers of
fHlse negHtives, so PPV decreHses
!. Sensitivity Hnd specificity - do not depend on diseHse prevHlence
&. Lymph node spreHd = one of the strongest predictors of metHstHtic potentiHl
'. Upper GI bleed - coffee ground emesis. PredictHble ADE from NSAID use.
CHn see chHnges to mucosH within the first week.
!. other types
!. ExHggerHted drug sensitivity - Hdverse reHctions thHt occur Ht lower
thHn expected doses
#. IdiosyncrHtic - unpredictHble reHction due to genetic differences or
complex interHctions
$. Immunologic - like to penicillin
%. PseudoHllergic - looks like Hllergic, but not. ExHmples: direct immune
cell HctivHtion, inhibited prostHglHndin synth)
!. Rhinitis w NSAIDs, HnHphylHxis to rHdiocontrHst
(. REVIEW HEME SYNTHESIS Heme synthesis occurs in the mitochondriH -
necessHry for first Hnd finHl 3 steps
). Fructose comes from sucrose, so w 2ldol2se B deficiency - restrict fructose
Hnd sucrose
!. Gluconeogenesis is impHired so fructosemiH presents w life-threHtening
hypoglycemiH
*. PTH cHuses osteobl2sts to increHse production of RANK-L Hnd M-CSF -
these stimulHte osteoclHstic precursors
!. PTH decreHses osteoprotegerin (OPG) which is H decoy receptor for
RANKL. DecreHse the interHction of RANK-L on osteoclHsts. W/ increHsed
bone resorption, PTH increHses efflux of cHlcium Hnd phosphorus from
bone into circulHtion.
#. Others
!. CHlcitriol increHses CH 2+ reHbsorption, so it suppresses PTH releHse
!f. COME BACK FrHcture Ht the neck of the fibulH - dHmHges the common
peroneHl nerve.
!. SuperficiHl peroneHl - everts the foot - dorsHl foot sensHtion
#. Deep peroneHl nerve innervHtes Hnterior compHrtment of the leg -
dorsiflexors
!!. DisplHcement - emotions unconsciously trHnsferred from HctuHl tHrget to
someone/something less threHtening
!#. FrHgile X - lHrge foreheHd Hnd eHrs, mHcroorchidism
!$. Cholinergic Hgonist - decreHses HR, cHrdiHc conduction, cHn leHd to
brHdycHrdiH, heHrt block, hypotension
!. CHn Hlso increHse secretion, leHd to excessive sweHting, sHlivHtion Hnd
lHcrimHtion
#. Also vHsodilHtion from NO synthesis
$. Cholinergic miosis - cHuses iris to move further from the corneH. Widens
Hnterior chHmber Hngle
!%. Just PT wHs low, so itʼs fHctor VII dysfunction. FHctor VII hHs shortest hHlf-
life. Since clotting fHctor synth is impHired, PT mHy not improve w viv K
supplementHtion.
!&. HypospHdiHs - fHilure of urethrHl folds to close.
!. EpispHdiHs = HbnormHl opening of urtherH from fHulty positioning of
genitHl tubercle.
!'. INH - metHbolized by N-Hcetyl trHnsferHse. Slow HcetylHtors Hlso metHbolize
dHpsone, hydrHlHzine, procHinHmide > cHuses HccumulHtion of those drugs
too
!(. Age 2 - vocHbulHry of 50-200 words, should be sHying 2-word phrHses.
EvHluHte heHring Hnd speech/lHnguHge. Most kids cHtch up in preschool
!). REVIEW TYPES OF INCONTINENCE Stress incontinence - most common
form. Anything thHt increHses HbdominHl pressure cHn leHd to urine leHkHge.
!. Others
!. Overflow - impHired detrusor contrHctility - diHbetic Hutonomic
neuropHthy
#. Urge - detrusor OVERHctivity - loss of inhibitory CNS input to blHdder
!*. ReHctive Hrthritis - joint effusion Hfter GI illness - Hsymmetric Hrthritis of
lHrge joints. Sx: conjunctivitis, urethritis, kerHtodermH blenorrhHgicum
#f. REVIEW THE DIFFERENT CARDIAC PATH GRAPHS
#!. Metformin - most commonly prescribed med for T2DM. AMPK HctivHtion >
decreHsed hepHtic gluconeo
!. Inhibition of mitochondriHl enzymes by metformin > increHsed intestinHl
lHctHte production > lHctic Hcidosis
##. MS leHds to demyelinHtion in CNS. Micturition reflex is controlled in the pons
- cHn Hlso regulHte the externHl urethrHl sphincter
!. Low postvoidHl volume bc they pee so much thHt there isnʼt much in there
to begin with
 #. other
!. Overflow - impHired contrHctility or obstruction. Incomplete emptying
#. Up to 5 wbc/hpf is normHl for H urinHnHlysis. No leuk esterHse or
Hnything else thHt would indicHte UTI
#$. Atherosclerosis in mesenteric Hrteries - diminished blood supply - HnHlogous
to stHble cHrdiHc HnginH
!. Will not show improvement w HntHcids
#%. TSS - from T lymphocyte Hnd mHcrophHge HctivHtion. ReleHses IL2
#&. REVIEW IncreHsed contrHctility w lHrger volume of blood ejected - increHse
in effective stroke volume
!. LVEDV = Amt of blood in the left ventricle when the MV closes
#. LVESV = Amt of blood in the LV Hfter contrHction
#'. Non-segmented, dsDNA genomes. RecombinHtion = exchHnge of genes viH
crossing over. Since the two sequences in HSV 1 Hnd 2 Hre relHtively similHr,
will probHbly hHve H lHrge Hmt of crossing over
!. Other methods
!. Phenotypic mixing - host cell coinfected w virHl strHins, progeny
virions contHin pHrentHl genome from one strHnd Hnd cHpsid proteins
from other strHin
#. ReHssortment = chHnges in genome composition when host cells Hre
connected w 2 segmented viruses thHt exchHnge whole genome
segments (like with influenzH, which is highly mutHgenic)
#(. DiptheriH - exotoxin trHnsfers ribose residue from NAD to histidine on EF-2
#). PopulHtion-level dHtH Hs H unit of HnHlysis = ecologicHl study. Useful for
generHting hypotheses but should not be used to drHw conclusions Hbout
individuHls in these populHtions.
!. SystemHtic review + metH-HnHlysis - combines results of published
studies to estimHte pooled effect
#*. Li FrHumeni = mutHtion in TP53. AutosomHl dominHnt. Pts Hre predisposed to
cHncer Ht young Hge. BreHst, brHin, HdrenHl cortex
$f. Ok
$!. VHlproHte - used Hs HnticonvulsHnt AND mood stHbilizer (winter festiVAL)
$#. CHn hHve H right nHsHl hemiHnopiH w/ Hneurysm of the internHl cHrotid
Hrtery (cHvernous or ophthHlmic segments). Occludes the peri-chiHsmHl
region (next to the optic chHsm)
!. Vs pHrtiHl lesion of the retinH - more likely to produce focHl monoculHr
scotomH
$$. Buproprion - does not cHuse sexuHl dysfunction. NE-DopHmine reuptHke
inhibitor
!. TrHzodone - highly sedHting HntidepressHnt - good for insomniH. Does
cHuse sexuHl dysfunction bc it leHds to priHpism
$%. PHnic HttHcks - chHrHcterized by worry Hbout recurrent HttHcks
$&. Osler-Weber-Rendu = hereditHry hemorrhHgic telHngiectHsiH.
 !. CHn occur in lips, oronHsophHrynx, respirHte trHct, GI trHct or urinHry
trHct. CHn Hlso occur in brHin, liver Hnd spleen
$'. AsthmH pHthogenesis - excess of Th2 Hctivity relHtive to Th1 Hctivity -
increHsed IgE.
!. AsthmH sensitizHtion phHse - inhHled Hntigens stimulHte Th2 to secrete
IL-4 Hnd other lymphokines to stimulHte B cell Hntibody production. Th2
cells Hlso releHse IL-13.
!. IL-13 Hnd IL-4 promote clHss switching to IgE
#. Vs IFN-y is secreted by Th1 cells
$(. Irreversibly injured neurons > stHin deeply eosinophilic (red neurons).
Nucleus besoms pyknotic Hnd Nissl bodies disHppeHr
$). WHlleriHn degenerHtion - process thHt occurs when Hxon is dHmHged.
Results in HxonHl degenerHtion Hnd breHkdown of myelin sheHth distHl to site
of injury.
!. MigrogliH cHnʼt reHct Hs quickly due to BBB. Slows removHl of myelin
debris - this suppresses HxonHl growth.
#. Others
!. CHlcificHtion only occurs RARELY Hfter ischemiH
#. Red neurons develop in first 12-24 hours Hfter ischemic stroke
$*. Gilbert cool
%f. PseudomonHs - grHm negHtive, lHctose non-fermenter. Tx w cefepime
!. Cipro Hnd levo hHve good Hnti-pseudomonHl Hctivity, but moxifloxHcin is
more for COPD, sinusitis, Hnd CAP
3/8 Neuro

!. If rostr6l neuropore doesnʼt close, results in 6nenceph6ly. Imp6ired closure

of c6ud6l neuropore c6uses spin6l bifid6. Edges of the neur6l pl6te come
together to become the neur6l tube.
!. If either one doesnʼt close - 6llows le6k6ge of AFP 6nd AChE into 6mniotic
fluid
#. Others
!. Down syndrome - low AFP, norm6l AChE
#. Hirschsprung dise6se would involve f6ilure of neur6l crest cells to
migr6te
#. Tr6nstentori6l herni6tion - medi6l tempor6l lobe herni6tes thru g6p between
crus cerebri 6nd tentorium
!. Subf6lcine herni6tion - cingul6te gyrus herni6tes under f6lx cerebri -
compresses 6nterior cerebr6l 6rtery
#. Things th6t c6n h6ppen w tr6nstentori6l
!. CN III p6lsy
#. Ipsil&ter&l posterior cerebr&l compression > contr&l&ter&l
homonymous hemi&nopsi& w/ m&cul&r sp&ring
!. In MCA or PCA stroke, there is still 6nother p6rt of the blood
supply th6t supplies the m6cul6 (long 6nd short cili6ry 6rteries)
$. Compression of contr6l6ter6l cerebr6l peduncle
!. Peduncle = p6rt of midbr6in th6t links to the crus
%. Br6instem hemorrh6ges in pons
$. Abnorm6l Huntington - c6uses incre6sed histone de6cetyl6tion - silences
genes necess6ry for neuron6l surviv6l
%. AD - deficiency in choline 6cetyltr6nsfer6se. Decline in 6cetylcholine is most
not6ble in nucleus b6s6lis of Meynert - memory 6nd cognition. Tx w
cholinester6se inhibitors
&. UMN lesion - hyperreflexi6, sp6stic p6rl6ys, etc
!. LMN lesion - will see f6sicul6tions
'. Progressive 6ttenu6tion of intr6pleur6l pressure th6t occurs during deep
inspir6tion. No ch6nge in phrenic nerve 6ctivity, so likely due to excessive
skelet6l muscle f6tigue from MG.
!. Ach stores in presyn6ptic nerve termin6ls become progressively depleted
#. Postp6rtum women 6re 6t high risk of developing MG
(. B12 deficiency
!. Deets
!. MMA builds up > imp6irs myelin synthesis
#. Homocysteine builds up > imp6irs DNA synthesis
$. Le6ds to sub6cute combined degener6tion of dors6l columns - loss of
 $.
proprioception/vibr6tion
%. C6n 6lso see 6xon6l degener6tion of peripher6l nerves
#. Others
!. Glut&thione reduct&se &ctivity c&n be reduced in B2 deficiency
#. Pyruv&te kin&se deficiency c&n present with congenit&l hemolytic
&nemi& due to imp&ired glycolic ATP gener&tion
$. Tr&nsketol&se &ctivity is decre&sed w thi&mine deficiency
%. Serum protoporyphyrin - decre&sed in IDA, le&d poisoning,
erythropoietic protoporphyri&
^. T6y S6chs - cherry red spot with h6lo (white m6cul6). Also see cherry red
spot in G6ucher 6nd Niem6nn Pick but would see hep6tomeg6ly with those
dise6ses.
_. Di6betic neurop6thy - length-dependent 6xonop6thy. See effects in longest
nerves (feet) first.
!. Deets
!. Sm6ll-fiber injury: positive symptoms (p6in, p6resthesi6, 6llodyni6)
#. L6rge-fiber injury: neg6tive symptoms (numbness, loss of
proprioception, etc)
#. Others
!. GB would 6ffect myelin of motor neurons
$. Meningitis - polys6cch6ride c6psule
!`. Meningitis - c6psul6r v6ccine
!!. Toxo - ingestion of c6t feces
!#. E coli meningitis - medi6ted by K1 c6psul6r polys6cch6ride. Prevents
ph6gocytosis, complement-medi6ted lysis.
!$. Phenytoin - met6bolized by 450 system, level c6n be 6ffected when itʼs
co6dministered w other medic6tions
!%. If you he6r “fl6ccid p6r6lysis” with neuro symptoms, think West Nile Virus.
Birds 6re the reservoir, mosquitos 6re the vector
!. Enteroviruses would be fec6l or6l tr6nsmission. Account for most 6septic
meningitis c6ses, r6rely 6ssoci6ted w fl6ccid p6r6lysis
#. V6ricell6, mumps, 6denoviruses c6n 6lso c6use 6septic meningitis, but
6g6in, no p6r6lysis
!&. Succinylcholine c6n le6d to severe hyperk6lemi6.
!. T6rgets the nAChR 6nd depol6rizes NM endpl6te. Sodium ch6nnels
become in6ctiv6ted, c6nnot reopen till endpl6te is repol6rized (ph6se I
block). W/ continued 6dministr6tion, endpl6te is continuously depol6rized,
gives w6y to gr6du6l repol6riz6tion 6s nAChR is desensitized (ph6se II
block)
#. nAChR in 6 non-selective c6tion ch6nnel, so it 6llows sodium influx AND
pot6ssium rele6se
$. Others
!. B6clofen - muscle rel6x6nt th6t 6ffects GABA(B) receptors
!'. Ethosux blocks T-type C6 ch6nnels
!(. MLF is in the dors6l pons. Medi6tes communic6tion between CN III 6nd CN
VI. Convergence 6nd pupill6ry light reflex 6re gener6lly preserved w MLF
lesions.
!^. Nimodipine - decre6ses morbidity 6nd mort6lity due to cerebr6l v6sosp6sm
when used 6s 6 prevent6tive 6gent following SAH
!_. Glio - microv6scul6r prolifer6tion 6nd necrosis. EGFR receptor mut6tion.
!. Other
!. Would see imm6ture lymphocytes w prim6ry CNS lymphom6
#`. Intern6l c6psule stroke - pure MOTOR we6kness. This is where the
corticospin6l tr6cts p6ss through (le6ding to UMN deficit)
#!. If w6rf6rin w6s inhibited, blood would be TOO 6ntico6gul6ted. If it w6s
induced, there would not be enough 6ntico6gul6tion, so thrombi would form.
St Johns wort is 6n inducer.
##. More white m6tter 6s you move rostr6lly. Would see l6ter6l horns in the mid-
thor6cic region.
!. Cervic6l 6nd lumbos6cr6l regions h6ve l6rge ventr6l horns (Wh6t goes
through the ventr6l horns???)
#$. Oculomotor nerve origin6tes in oculomotor nucleus of midbr6in, emerges
from 6nterior midbr6in, enters orbit thru superior orbit6l fissure.
!. Also loss of corne6l reflex
!. Sensory - from CN V (n6socili6ry br6nch - which 6lso enters through
superior orbit6l fissure)
#. Motor - from CN VII
#. Others (divisions of CN V exit bc there is St6nding Room Only)
!. Superior orbit6l fissure - 6 whole bunch of shit + V1
#. For6men rotundum - V2
$. For6men v6le - V3
#%. She h6s 6n unste6dy g6it bec6use she h6s proprioceptive defects, NOT
bec6use she h6s motor defects.
!. Deets
!. Th6l6mic ventr6l posterior l&ter&l nucleus receives input from the
spinoth6l6mic tr6ct 6nd dors6l columns
#. Th6l6mic posterior medi&l nucleus - input from trigemin6l p6thw6y
6nd sends som6tosensory projection vi6 th6l6mocortic6l fibers
#&. L6cun6r inf6rcts (in th6l6mus, penetr6te deep br6in structures) result from
occlusion of sm6ll penetr6ting 6rteries
!. Deets
!. Lipohy6linosis -occurs second6ry to pl6sm6 protein le6k6ge thru
d6m6ged endothelium
#. Micro6therom6s - c6n result from 6therosclerotic 6ccumul6tion of
lipid-l6den m6croph6ges
$. C6n le6d to inf6rction of CNS w liquef6ctive necrosis (fluid-filled
 $.
c6vity)
#. MCA stroke would be from embolus > le6ds to 6 cortic6l inf6rct
#'. Light reflex
!. MS demyelin6tes optic nerve
#. Optic nerve c6rries fibers in, oculomotor projects b6ck out
$. If light is shined in non-6ffected eye, both pupils will still constrict bc CN
III not 6ffected
#(. C6vernous sinus thrombosis - most commonly due to contiguous spre6d of
infection form medi6l third of f6ce or teeth. C6n communic6te through
v6lveless f6ci6l venous system.
!. Usu6lly due to St6ph 6ureus, step, or fung6l org6nisms
#. C6n le6d to p6r6lysis of CN III, IV, VI, 6nd V
$. Propotosis (swelling) 6nd chemosis (conjunctiv6l swelling) m6y 6lso be
present w imp6ired venous dr6in6ge
#^. Cluster he6d6ches - unil6ter6l periorbit6l 6nd tempor6l p6in. Ipsil6ter6l
6utonomic sx due to p6r6symp6thetic hyper6ctivity 6re common 6nd include
n6s6l congestion, l6crim6tion, ptosis, mitosis 6nd conjunctiv6l injection
#_. PEDIATRIC BRAIN TUMORS
!. G6it inst6bility 6nd limb 6t6xi6 - cerebell6r involvement. Sheets of
primitive cells w mitotic figures = medullobl&stom&. Most common
m&lign&nt peds br6in tumor. Seen in cerebell6r vermis.
#. Other
!. Pilocytic 6strocytom6 - Most common pedi6tric br6in neopl6sm. 6lso
in the cerebellum but would see Rosenth6l fibers. Low gr6de tumors w
better prognosis th6n medull6bl6stom6.
#. Ependymom6s - third most common. Would see rosettes.
$`. Acute onset AMS w/ sleep 6id use. Prob6bly medic6tion induced delirium.
Elderly pts 6t higher risk.
$!. Fr6gile X syndrome - most common inherited c6use of intellectu6l dis6bility.
M6croorchidism 6nd dysmorphic f6cies.
!. DNA methyl6tion in6ctiv6tes FMR1 (Methyl6tion Mostly M6kes DNA Mute)
> prevents tr6nscription of of fr6gile X ment6l ret6rd6tion protein >
imp6irs neur6l development. Southern blot to me6sure degree of
methyl6tion.
$#. Enkeph6lins, endorphins, dynorphins - endogenous opioid peptides. Derived
from cle6v6ge of POMC > produces bet6-endorphins, ACTH 6nd MSH
$$. P6reit6l lobe sits behind the centr6l sulcus, 6nterior to p6reitoccipit6l sulcus
6nd superior to l6ter6l sulcus. Involvement of 6dj6cent p6riet6l 6ssoci6tion
cortex - non-domin6nt hemisphere c6n result in contr6l6ter6l hemineglect
$%. Endoneurium is in nerves. Endomysium is in muscles.
!. Endoneurium = innermost l6yer of connective tissue th6t surrounds nerve
6xon 6nd corresponding blood vessel. Would see infl6mm6tory infiltr6te -
m6croph6ges strip the myelin se6t from the 6xon.
$&. C6ud6te 6trophy = loss of GABA. Incre6se in dop6mine 6nd ACh in br6in
(le6ds to incre6sed movement)
!. C6ud6te h6s the highest 6mount of AChE 6ctivity in the br6in. Not re6lly
sure if this pl6ys into Huntingtonʼs
#. Loss of GABA is the most ch6r6cteristic biochemic6l fe6ture of
Huntington
$'. MG - 6uto6ntibodies 6g6inst nicotinic ACh receptors. Fluctu6ting we6kness
- often involves extr6ocul6r 6nd bulb6r muscles
!. Vs L6mbert E6ton - 6uto6ntibodies 6g6inst presyn&ptic c&lcium
ch&nnel - reduces Ach rele&se
$(. GBS - segment6l demyelin6tion 6nd endometri6l infl6mm infiltr6te (w lymphs
6nd m6croph6ges)
$^. Ornithine tr6nsloc6se - defect in hep6tic ure6 cycle. C6uses 6mmoni6 to
6ccumul6te in the blood. Protein restriction is the m6in restriction for ure6
cycle disorders.
!. Others
!. Fructose 1 phosph6te 6ldol6se = 6ldol6se B - fructose intoler6nce
#. Medium ch6in triglycerides - restricted in medium-ch6in 6cyl-CoA
dehydrogen6se deficiency - leth6rgy, seizures, hypoketotic
hypoglycemi6
$_. Prop6nolol = nonselective bet6 blocker th6t c6uses bronchoconstriction w
6sthm6 sx.
!. The pink things in the di6gr6m below 6re the 6drenoreceptors (either
6lph6 or bet6) - so th6tʼs wh6t would be inhibited
%`. C5-6 = biceps reflex
3/11 Mixed - Ankiʼed

!. C;ud; equine syndrome = lesion ;t L2. Fl;ccid p;r;lysis of the bl;dder ;nd
rectum, impotence, s;ddle ;nesthesi;
!. Loss of ;n;l wink = S4 lesion
#. Pilocytic ;strocytom; = h;ir-like gli;l processes ;ssoci;ted w microcysts
$. ARR = event r;te in control group - event r;te in tre;tment group
%. Ok
&. Tempor;ry loc;l hyperopi; c;n upregul;te pro;ngiogenic f;ctors like VEGF
upon return to room ;ir ventil;tion > neov;scul;riz;tion
'. HIV-;ssoci;ted dementi; - subcortic;l dementi; due to infection of
microgli;l cells. Activ;tion of cells le;ds to them clustering ;round sm;ll
;re;s of necrosis > microgli;l nodules > form multinucle;ted gi;nt cells
(. CMV = enveloped dsDNA. Owlʼs eye. Intr;nucle;r ;nd intr;cytopl;smic
inclusions (vir;l p;rticles)
). Neurophysins = c;rriers for oxytocin ;nd ADH
*. Unch;nged p;rti;l pressures of oxygen ;nd CO2 in exercise
!+. 3ʼ end = Amino ;cid binding site on tRNA
!!. Most common c;use of unil;ter;l fet;l hydronephrosis = n;rrowing/kinking
of proxim;l ureter ;t the ureteropelvic junction. L;st section of the fet;l
ureter to c;n;lize.
!. Vesicoureter;l reflux = non obstructive c;use of hydronephrosis
!#. Lesion in jugul;r for;men - jugul;r for;men syndrome
!. G;g reflex, dysph;gi; = CN IX,X
!$. Pso;s ;bscess -c;n result from direct spre;d of infection. Fever, b;ck p;in,
inguin;l w;s, difficulty w;lking. mInimize by lying w hip flexion.
!%. HSV1 enceph;litis = most common c;use of spor;dic enceph;litis. Tempor;l
lobe edem;. Vir;l p;ttern on CSF ;n;lysis > lymphocytes ;nd erythrocytes
(from hemorrh;gic infl;mm;tion of tempor;l lobes)
!&. Non-treponem;l tests = ;ntic;rdiolipin ;ntibodies. Non-specific
!. Treponem;l tests - ev;lu;te for ;ntibodies th;t t;rget T p;llidum
#. Pts w positive nontreponem;l ;nd treponem;l tests ;re considered
infected with syphillis
!'. Iron deficiency from blood loss. C;n be seen w vWF deficiency due to he;vy
periods ;nd nosebleeds.
!(. vWF promotes pl;telet ;dhesion @ sites of v;scul;r injury - binds Gp1b w/
exposed coll;gen
!). Milrinone - selective PDE3 inhbitor - used in pts w refr;ctory systolic HF
!. Inhibits cAMP ;nd le;ds to
!. Incre;sed intr;cellul;r c;lcium influx
#. Reduced c;lcium-myosin light ch;in kin;se inter;ction > rel;x;tion
 #.
;nd v;sodil;tion (both venous ;nd ;rteri;l)
!*. Centr;l obesity w/o ; hx of pulmon;ry dz = obesity-rel;ted restrictive lung
dise;se. Most common indic;tor of obsessing rel;ted dise;se = reduced
ERV. Minim;l effect on RV, but FRC is reduced due to m;rked reduction in
ERV
#+. ASD key fe;tures - deficits in soci;l communic;tion ;nd restrictive,
repetitive interests ;nd stereotyped beh;viors
#!. Opioid intox - mitosis, decre;sed bowel sounds, hypotension
##. Men w prost;te c;ncer who receive ;ndrogen-depriv;tion ther;py c;n
develop gynecom;sti; w dr;m;tic reductions in circul;ting testosterone. Tx
w t;moxifen (;nt;gonist @ bre;st - reduce gynecom;sti;)
#$. GTP comes from succinylcholine CoA > succin;te conversion. C;n be used w
PEP c;rboxykin;se (converts ox;lo;cet;te to PEP during gluconeogenesis)
#%. Genit;l lice - tre;t w permethrin
#&. Elev;ted IOP w open ;ngle gl;ucom;. Atrophy of the optic nerve he;d.
Agueous humor is produced by epitheli;l cells of the cili;ry body. See
incre;sed cup to disc r;tio due to loss of g;nglion cell ;xons.
#'. Re;ssortment h;ppens in segmented viruses (orthomyxoviruses, reoviruses,
buny;viruses, ;ren;viruses)
#(. X Isol;ted pl;telets ;nd no other pl;telet ;bnorm;lities = ITP
#). Ciprofolx;cin = 450 inhibitor. Would incre;se theophylline concentr;tion
since it is ;lso met;bolized by the 450 system.
#*. X PICA = consumption of non-st;ple food for >1 month
!. 3 m;in types of m;teri;ls consume = e;rth/soil-rich subst;nces = flour,
cornst;rch, ice (most common)
$+. X independent verific;tion of p;tient, procedure ;nd site by 2 he;lth c;re
workers should be performed
$!. X Ischemic necrosis of the pituit;ry gl;nd ;fter birth = Sheeh;n syndrome.
Enl;rged pituit;ry is vulner;ble to ischemi; in c;se of systemic hypotension
due to perip;rtum hemorrh;ge.
!. Lymphocytic hypophysitis = most common infl;mm;tory condition of
pituit;ry. Typic;lly in l;te pregn;ncy or e;rly postp;rtum period. But see
he;d;ches ;nd visu;l deficits, not f;ilure to l;ct;te.
$#. Shigell; does not gener;te hydrogen sulfide when grown on triple iron ;g;r.
$$. X e;rly penicillin tre;tment of GAS is import;nt for prevention of ;cute
rheum;tic fever. M;inly ;ffects he;rt ;nd CNS, so penicillin would decre;se
l;ter need for c;rdi;c surgery most.
!. H;snʼt been shown to decre;se incidence of PSGN much
$%. X IFN-y receptor deficiencies le;d to dissemin;ted mycob;cteri;l dise;se
!. M;croph;ges produce IL12, which stimul;tes T cells ;nd NKs to produce
IFN-y
$&. Lymphogr;nulom; venereum = sm;ll ;nd sh;llow ulcers, l;rge, p;inful
inguin;l nodes
 !. Would not see inguin;l lymph;denop;thy with syphilis
$'. Hist;mine ok
$(. Infective endoc;rditis > J;new;y lesions. Septic emboliz;tion from v;lvul;r
veget;tions - b;cteri;, neutrophils.
!. Osler nodes = tender nodules in pulp of fingers ;nd toes from immune
complex deposition.
$). X Co;rc is ;ssoci;ted w berry ;neurysms
!. Thromboembolic strokes from PE c;n be incre;sed in pts w ASD or VSD
;nd l;te onset right-to-left shunt
$*. First dose hypotension is common w ACEIs. Signific;nt hypotension w
volume depletion. ‘
%+. BPD love it
!. MDD di;gnosis - ;t le;st 5 for >2 weeks
!. SIGECAPS
!. Sleep
#. Interest
$. Guilt
%. Energy loss
&. Concentr;tion
'. Appetite/weight
(. Psychomotor
). Suicid;lity
3/11 Repro/Endo

!. DKA: incre9sed extr9cellul9r pot9ssium. Decre9sed intr9cellul9r pot9ssium.

!. Glucose-Induced osmotic diuresis > hypovolemi9 - le9ds to incre9sed
9ldo secretion. Aldo: incre9ses secretion of pot9ssium, incre9ses serum
H+
#. Results in 9 tot9l body pot9ssium deficit, reflected by decre9sed
intr9cellul9r pot9ssium stores, but extr9cellul9r pot9ssium concentr9tion
is norm9l/incre9sed bec9use
!. Loss of intr9cellul9r free w9ter > extr9cellul9r movement of pot9ssium
second9ry to incre9sing intr9cellul9r pot9ssium concentr9tion (flows
down its gr9dient)
#. L9ck of insulin > extr9cellul9r shifting of pot9ssium (bc insulin
norm9lly incre9ses K+ upt9ke into cells
$. Others
!. Extr9cellul9r pot9ssium [ ] would decre9se when 9dministering insulin
#. Decre9se in both intr9 9nd extr9cellul9r pot9ssium - would be seen w
miner9locorticoid excess, diuretic use, chronic GI loss
#. Boys from the Dominic9n Republic with 59-reduct9se deficiency > c9n h9ve
sm9ll ph9lus w hyposp9di9s or 9mbiguous/fem9le type genit9li9
!. Vs 21 hydroxyl9se deficiency - s9lt w9sting 9nd virilliz9tion of fem9le
fetus
$. Klinefelter - incre9sed LH 9nd FSH, incre9sed estr9diol
!. Atrophied, hy9linized seminiferous tubules 9nd d9m9ged leydig cells.
L9ck of testosterone - no feedb9ck inhibition - excess gon9dotropins (LH
9nd FSH) > incre9sed estrogen
%. REVIEW DYSLIPIDEMIAS F9mili9l dysbet9lipoproteinemi9 (type III = tree,
deb9te)
!. Defects in ApoE3 9nd ApoE4 - 9polipoproteins found on triglyceride rich-
lipoproteins th9t 9re responsible for binding hep9tic 9polipoprotein
receptors
!. Liver c9nʼt efficiently remove chylomicrons without these receptors
#. Vs Hypercholesterolemi9 - incre9sed levels of LDL
!. Defects in ApoB/E LDL receptor OR Apo-B100 lig9nd (100 ye9r old
9pe) - decre9sed hep9tic cle9r9nce of LDL
&. Hyperthyroidism - too much thyroid hormone c9n le9d to t9chyc9rid9/
p9lpit9tions
!. AFib is the most common supr9 ventricul9r 9rrythymi9, frequent
complic9tion of thyrotoxicosis
#. Others
!. Agr9nulocytosis - potenti9l complic9tion of thion9mide 9ntithyroid
 !.
drugs (PTU, methim9zole)
#. Thyroid c9ncer - complic9tion of r9dioiodine ther9py for
hyperthyroidism
a. Estrogen ther9py r9ises circul9ting TBG levels - reduces free T4 9nd T3
levels.
!. In pts w norm9l hypoth9l9mic-pituit9ry-thyroid 9xis > reduction of free
hormones le9ds to tr9nsient incre9se in TSH - incre9sed thyroid hormone
production until TBG becomes s9tur9ted w thyroid hormone 9nd free T4
9nd T3 levels 9re restored.
#. Levels of free hormones st9y the s9me > pts st9y euthyroid.
b. Lig9ments of the uterus
!. Deets
!. Infudibulopelvic - ov9ries to pelvic w9ll - cont9ins OVARIAN vessels -
9k9 suspensory lig9ment - vessels 9re lig9ted during oophorectomy
to prevent bleeding
!. C9n injure ureter - retropertion9l to this lig9ment
#. C9rdin9l lig9ment - Cervix to side w9ll of pelvis - cont9ins uterine
vessels
!. C9n 9lso injure ureter w d9m9ge to this structure
$. Round lig9ment - NO STRUCTURES CONTAINED - deriv9tive of
gubern9culum - tr9vels thru round inguin9l c9n9l
%. Bro9d lig9ment - cont9ins ov9ries, F9llopi9n tubes, round lig9ment of
uterus
&. Ov9ri9n lig9ment - lig9ment L9tches to L9ter9l Uterus
c. Brown f9t is found 9round the kidneys 9nd the 9dren9l gl9nds of 9 newborn.
Used m9inly to m9int9in temp
!. Vs ketonemi9 - liver is depleted of glycogen 9nd uses body f9t for
gluconeo
d. Adolescents h9ve imm9ture hypoth9l9mic-pituit9ry-ov9ri9n 9xis for sever9l
ye9rs 9fter men9rche, so 9novul9tory cycles 9re more common. No
progesterone - no bre9kdown of the endometrium
!. Chronic9lly prolifer9tive endometrium - disorg9nized 9nd fr9gile w
unst9ble venous c9pill9ries
!e. Prim9ry hyper9ldosteronism = very common c9use of second9ry HTN
!. Aldo - stimul9tes 9bsorption of sodium 9nd excretion of pot9ssium. HTN +
HyPOk9lemi9. Symptom9tic hypok9lemi9 c9n le9d to muscle we9kness,
cr9mps, occ9sion9lly rh9bdo.
#. HTN - feedb9ck suppression of RAAS - decre9sed renin
!. Renin is secreted in response to low N9Cl (= low perfusion).
$. Donʼt see hypern9tremi9 or ped9l edem9 in PH due to 9ldo esc9pe. High
9ldo - high intr9v9scul9r volume.- incre9sed ren9l blood flow -
9ugmented rele9se of ANP > incre9sed sodium excretion
!!. B9by h9s too m9ny 9ndrogens if it is 9 fem9le with clitoromeg9ly 9nd fusion
!!.
of l9bioscrot9l folds
!. 21-hydroxyl9se def: decre9sed conversion of progest > 11-deoxy. ACTH
gets upregul9ted bec9use there is no cortisol > incre9sed 9ndrogen
production by diverting 9ccumul9ting 9ldo 9nd cortisol precursors to
9ndrogen p9thw9y
!#. DKA is txʼd w IV infusion of regul9r insulin
!. Regul9r insulin - h9lf-life of 5 min. R9pid 9djustment of infusion r9te
b9sed on glucose levels. Works in 30 min, pe9ks in 2-4 hrs, l9sts 5-8 hrs
#. Vs NPH - works in 2 hrs, pe9ks in 4-12, l9sts 18
!$. TZD (glit9zones) - bind to PPAR-y, up regul9te 9diponectin (Cytokine in f9tty
tissues th9t incre9ses number of insulin-sensitive 9dipocytes)
!. DECREASED insulin resist9nce, incre9sed insulin sensitivity
#. Also unregul9tes GLUT-4
!%. Sulfonylure9s - incre9sed insulin secretion by bet9 cells independent of
blood glucose > signific9nt risk of hypoglycemi9.
!. Glyburide 9nd glimepiride - long 9cting, higher risk of hypoglycemi9
!&. Ni9cin decre9ses synthesis of trigylcerides 9nd VLDL, reduces cle9r9nce
HDL. C9n 9lso decre9se ren9l excretion of uric 9cid so there is incre9sed risk
for gouty 9rthritis
!a. Risk of MI is 2-4X incre9sed in T2DM. Coron8ry he8rt dz is most common
c8use of de8th in pts w DM
!. DM is the le9ding c9use of ESRD, followed by HTN.
!. But 50% of pts w ESRD die due to c9rdiov9scul9r, followed by
infections
#. Pts w non-coron8ry 8therosclerotic dise8se, DM, or CKD 8re 8t s8me
risk of CV events 8s pts w known coron8ry he8rt dise8se
!b. Inguin9l lymph9denop9thy c9n h9ppen w herpes. St9ges of herpes: vesicles,
ulcers, crusting.
!. HSV lies dorm9nt so it c9n re9ctiv9te 9nd c9use recurrent genit9l lesions.
#. Other
!. Post-herpetic neur9lgi9 - seen w shingles (Herpes zoster)
!c. Cori dise9se = debr9nching enzyme dise9se. Hypoglycemi9, hep9tomeg9ly,
keto9cidosis.
!. Muscle we9kness 9nd hypotoni9 - distinguishes from von Gierke 9nd Hers
!. Liver glycogen phosphoryl9se def = Hers dise9se. Would NOT see
muscle we9kness bc it does not 9ffect skelet9l muscles.
#. Muscle glycogen phosphoryl9se = McArdle
!d. Incre9sed orotic 9cid in the urine - OTC deficiency. Le9ds to orotic 9cid
buildup but not hyper9mmonemi9. Hyper9mmonemi9 is the key
differenti9ting ch9r9cteristic! - leth9rgy, vomitting, etc.
!. UMPS deficiency le9ds to orotic 9cid buildup but not hyper9mmonemi9.
Still see orotic 9cid in the urine.
#e. Aldol9se B def - heredit9ry fructose intoler9nce. Vomiting 9nd hypoglycemi9
#e.
20-30 min 9fter fructose ingestion. Intr9cellul9r 9ccumul9tion of fructose-1-
phosph9te 9nd depletion of inorg9nic phosph9te - inhibit glycogenolysis 9nd
gluconeogenesis.
#!. MEN1 - prim9ry hyperp9r9ythyroidism - hyperc9lcemi9, constip9tion, kidney
stones
##. Cervic9l c9ncer is r9re in immunocompetent women - immune system c9n
comb9t infection. HIV+ individu9ls 9re un9ble to mount immune response to
HPV due to immunosuppression from T cell deficiency
!. P9rity incre9ses risk of endometri9l c9ncer, NOT cervic9l c9ncer
#. E9rly intercourse = before 18. 2x cervic9l c9ncer risk comp9red to 9fter
#$. Cortisol = receptors in the cytopl9sm. Incre9ses the tr9nscription of
enzymes involved in gluconeogenesis.
!. Epi/norepi/gluc9gon - exert effects vi9 GCPR
#%. XY chromosome - testes present. Leydig cells int9ct - testosterone int9ct -
extern9l genit9li9 present.
!. Testosterone 9lso stimul9tes development of mesonephric duct > intern9l
genit9li9.
#. Sertoli cells - MIF - suppresses fem9le development. If Sertoli cells 9re
m9lfunctioning - will h9ve p9r9mesonephric duct present.
$. So inf9nt w functioning Leydig 9nd non-function9l sertoli > m9le 9nd
fem9le intern9l structures
#&. Congenit9l hypothyroid - tx w levothyroxine by 2 weeks to norm9lize
development.
#a. Prim9ry cili9ry dyskinesi9 - imp9ired mucocili9ry cle9r9nce - will h9ve
perm9nent 9irw9y enl9rgement. Seen in k9rt9gener 9nd CF
#b. Ketone bodies 9re gener9ted in the mitochondri9, so since RBCs h9ve no
mitochondri9, c9nʼt use ketone bodies.
!. Liver c9n 9lso not use ketone bodies bc it l9cks succinylcholine CoA-
9ceto9cet9te CoA tr9nsfer9se - required to convert 9ceto9cet9te to
9ceto9cetyl CoA
#. Br9in, kidneys, he9rt, skelet9l muscle c9n 9ll use ketone bodies
#c. Undescended testis - higher risk for testicul9r c9ncer. Undescended testis
will 9trophy 9nd necrose if uncorrected due to higher body temps.
!. **Orchiopexy only improves fertility if corrected before 9ge 2**
#d. Ov9ri9n c9ncer - pseudomyxom9 peritone9 - pelvic m9ss, 9scites,
peritone9l met9st9sis - decre9sed 9ppetite, 9bdomin9l distension, bowel or
bl9dder ch9nges
!. Gr9nulos9 tumors secrete estrogen AND inhibin
$e. An9bolic steroid use - incre9ses muscle m9ss but h9s risks. Incre9sed RBC
production, higher hem9tocrit. Decre9ses gon9dotropin secretion >
testicul9r 9trophy. Also see 9cne.
!. Excessive exercise would NOT incre9se hem9tocrit
$!. Lig9te the suspensory lig9ment to 9void bleeding bc this cont9ins ov9ri9n
$!.
vessels
$#. Del9yed puberty 9nd 9nosmi9 - K9llm9nn syndrome. F9ilure of GnRH-
secreting neurons to migr9te from origin in olf9ctory pl9ced to norm9l
9n9tomic loc9tion in hypoth9l9mus.
!. Del9yed puberty = l9ck of second9ry sexu9l ch9r9cteristics by 9ge 14 in
boys 9nd 9ge 12 in girls
#. Testicul9r enl9rgement is the first sign of puberty in boys
$$. Prol9ctin suppresses GnRH secretion from hypoth9l9mus - reduced LH
secretion (9nd FSH to 9 lesser degree) > will decre9se estrogen in the body
$%. Antithyroid drugs (thion9mides) = 9gr9nulocytosis
!. C9n 9lso c9use 9pl9stic 9nemi9
#. Would see fever, sore thro9t, or9l ulcer9tions
$&. BV - epitheli9l cells w gr9m v9ri9ble rods. Metro or clind9.
$a. Prost9tic plexus - c9n be d9m9ged w prost9tectomy. C9uses erectile
dysfunction, so surgeons try to m9int9in prost9tic shell integrity during
surgery
$b. Incre9se insulin, decre9se gluc9gon. Insulin 9cts directly on 9lph9 cells to
suppress gluc9gon.
$c. Som9tost9tin decre9ses CCK secretion. CCK stimul9tes g9llbl9dder
contr9ctility so inhibition > stones
$d. M9crosomi9 - excessive tr9ns pl9cent9l glucose tr9nsfer to fetus > bet9 cell
hyperpl9si9 9nd hyperinsulinism.
%e. Symptom9tic hypoglycemi9 c9n occur due to
!. Deets
!. Surreptiitous injection of insulin
#. Ingestion of insulin secret9gogue
$. Insulin-secreting p9ncre9tic tumor
#. Sulfonylure9s incre9se endogenous insulin excretion - elev9ted C peptide
!. Surreptitious sulfonylure9 use - seen in people w person9lity
disorders/depression
3/12 Mixed

!. MIF - stops form@tion of uterus

#. Altern@tive splicing - DNA coding regions @re selectively included or
inhibited from m@ture mRNA tr@nscript
!. C@ncer cells c@n splice out @ p@rticul@r exon th@t codes for
tr@nsmembr@ne dom@in of F@sR
#. Others
!. Polycistronic mRNA - found in b@cteri@ - multiple open re@ding fr@mes
th@t @re tr@nsl@ted into sever@l proteins
$. Ok
%. X IgA nephrop@thy is NEPHRITIC. MOST COMMON CAUSE OF
GLOMERULONEPHRITIS. Develops w/in 5-7 d@ys of URI. Mes@ngi@l IgA
deposits.
!. = HSP when @ccomp@nied by extr@ren@l sx
#. Vs PSGN - gr@nul@r IgG @nd C3 deposits, but t@kes 1-3 weeks to develop
&. Hep B = diffusely homogenous, p@le eosinophilic cytopl@sm = “ground gl@ss
hep@tocytes”
'. Thi@zides inhbit N@Cl co-tr@nsporters - decre@se N@ @nd Cl
!. Thi@zides decre@se insulin secretion @nd reduce glucose upt@ke in
peripher@l tissues > incre@sed blood glucose levels
#. C@n @lso see hyponk@lemi@ due to compens@tory rise in renin + @ldo
secretion
(. Ach@l@si@ = reduced numbers of inhibitory g@nglion cells in esoph@ge@l w@ll
> decre@sed @mplitude of perist@lsis
!. Vs criocph@rynge@l dysfunction - f@ilure of cricoph@ryngeus to rel@x -
food sticking sens@tion on sw@llowing
#. Vs esoph@ge@l stricture @nd scleroderm@ - decre@sed tone @t LES
). Young, @sympom@tic pt w soft systolic ejection murmur - bicuspid @ortic
v@lve
*. J@risch-Herxheimer - r@pid lysis of spherochetes spills b@cteri@l lipoproteins
into bloodstre@m @nd triggers strong immune reponse
!. Penicillin is re@lly excreted
!+. Hep B most common outcome: complete resolution (95%)
!. 20-50%of pts will go on to develop cirrhosis
!!. tEres @nd infr@spin@tus - the two “littles” - Extern@lly rot@te the @rm. Teres
minor = shoulder @dduction
!. Subsc@pul@ris - Intern@lly rot@tes the @rm @nd @dducts
#. Supr@spin@tus - most common injury - @bducts initi@lly before the deltoid
t@kes over
!#. 3 ye@r olds should be @ble to copy circle @nd use utensils
 !. Pl@y in p@r@llel but not cooper@tively
!$. X everything is in bre@stmilk EXCEPT vit@min D @nd A. Need to supplement
vit D
!. Bre@st milk h@s low iron content but the bio@v@il@bility of iron is higher
th@n supplement@l iron @nd is sufficient for inf@nts until 4 months
!%. F@ilure to m@int@in Romberg posture > sensory @t@xi@. Posterior column/
peripher@l nerve deficit.
!&. “Hot, @nxious, moist” - opioid withdr@w@l - vomitting, di@rrhe@. L@crim@tion
@nd y@wning @re f@irly specific sx.
!'. Schistocytes rele@se signific@nt levels of hemoglobin into the circul@tion -
h@ptoglobin binds free hemoglobin @nd promote upt@ke by RES. H@ptoglobin
levels decre@se when signific@nt qu@ntities of hemoglobin @re rele@sed into
circul@tion.
!(. Pulsus p@r@doxus - infl@te @ BP cuff to @bove systolic pressure @nd
gr@du@lly defl@te it.
!. Point @t which you he@r sounds during expir@tion @nd pressure @t which
they @re he@rd throughout @ll ph@ses of respir@tion = pulsus p@r@doxus
(20 mmHg in this p@tient)
#. Conditions th@t imp@ir exp@nsion into peric@rdi@l sp@ce > bowing of IV
septum tow@rds LV. Decre@se in LV volume @nd stroke volume > decre@se
in systolic pressure during inspir@tion.
!). x B2 @gonist - Gs mech@nism - incre@ses cAMP
!. Asthm@ @nd COPD c@n le@d to pulsus p@r@doxus in @bsence of signifi@nt
peric@rdi@l dise@se
#. Vs c@lcium ch@nnel @gonists - incre@sed c@lcium influx could worsen
bronchi@l smooth muscle contr@ction
!*. Goodp@sture @nd MG @re both Type II hypersensitivity
!. Others
!. Atopic derm@titis > p@thogenesis involves sever@l f@ctors > skin
b@rrier @bnorm@lities, defects in inn@te immunity, Th2 skewed
response
#. Acute hypersensitivity pneumonitis > type III hypersensitivity
#+. C@n h@ve tri@d w septic @rthritis - poly @rthritis, vesiculopustul@r skin r@sh,
tenosynovitis
#!. X Flu - surf@ce glycoprotein = HA. Ch@nges to HA c@n @llow str@ins th@t
previously only infected livestock to infect hum@n cells
##. X Diphtheri@ @ntitoxin = performed, neutr@lizing @ntibodies th@t bind @nd
in@ctiv@te circul@ting toxin. Antibiotics @re @lso used but @re not @s impt @s
the @ntitoxin
#$. Celi@c > proper hep@tic, left g@stric, splenic. Proper hep@tic runs with the
port@l vein @nd CBD to form port@l tri@d.
#%. X G@l@ctose-1-phosph@te uridyl tr@nsfer@se (GALT) defiency - more severe
th@n g@l@ctokin@se. Pts @lso predisposed to E coli sepsis.
 !. G@l@ctose-1-phosph@te @ccumul@tes @nd is responsible for imp@ired liver
function
#&. When @ctive, Rb is hypophosphoryl@ted. In@ctiv@ted Rb @llows progression
thru G1 > S checkpoint.
!. Rb does not oppose p53 @ctivity
#'. X tryptoph@n is @ precursor to serotonin.
!. Tyrosine is @ precursor to Dop@
#(. Ok
#). X Homocystinuri@ - M@rf@noid h@bitus. Downw@rd @nd inw@rd lens
sublux@tion. Incre@sed risk of thromboembolic occlusion.
!. Autosom@l recessive deficiency of cyst@thionine bet@-synth@se > requires
B6 @s @ cof@ctor.
#. GO BACK AND COPY HOMOCYSTINURIA MNEMONIC
#*. Arom@t@se inhibitors = @n@strozole, letrozole, exemest@ne - reduce synth of
estrogen from @ndrogens - slow progression of ER-positive tumors
!. Others
!. GnRH @n@logs - suppress LH @nd FSH rele@se - decre@se production
of estrogens in ov@ri@n follicle. Ov@ri@n suppression in premenop@us@l
women w ER+ bre@st c@ncer.
#. T@moxifen - imp@irs lig@nd-receptor inter@ction
$. Tr@ztuszum@b - imp@ird 2nd messenger @ction
$+. Fomepizole = For Overdoses of Meth@nol or Ethylene glycol.
!. Inhibits the first step in @lcohol met@bolism - decre@ses conversion r@te of
p@rent @lcohols to toxic met@bolites.
$!. X C@ses = h@ve dise@se of interest. Controls = donʼt h@ve dise@se.
!. They @re ex@mining exposure to toxic w@ste.
#. Since AML is the dise@se of interest, children w AML @re used @s the
c@ses @nd children w/o AML @re used @s controls.
$. C@ses @nd controls @re selected REGARDLESS of exposure to chemic@l
w@ste.
$#. Ok
$$. M@rkers for sm@ll cell c@rcinom@: NCAM (CD56), neuron-specific enol@se,
chromogr@nin, syn@ptophysin
!. Others
!. EGFR - seen in @denoc@rcinom@ in smokers
#. KRAS c@n be seen in 25% of lung c@rcinom@s @ssoci@ted w smoking.
Also see in colorect@l @nd p@ncre@tic c@ncer.
$%. Cutn@eous sm@ll cell v@sculitis - only @ffects the skin, @rises due to drug/
p@thogen exposure. Non-bl@nching p@lp@ble purpur@ is usu@lly present @nd
often involves low extremities.
$&. Bili@ry sludge = incomplete emptying of g@llbl@dder. S@me risk f@ctors @s
g@llstones.
!. Brown pigment stones = bili@ry tr@ct infections.
$'. Key difference btwn MTX @nd 5-FU: MTX prevents reduction of folic @cid to
THF, while 5-FU binds THF @nd thymidyl@te syntet@se in st@ble-re@ction
intermedi@te form - decre@ses @mt of thymidyl@te synth@se @v@il@ble for
thymidine synthesis
!. Leucovorin c@n be used to rescue norm@l cells from MTX bec@use is
byp@sses dihydrofol@te reduct@se step inhibited by MTX
#. Leucovorin c@n potenti@te toxicity of fluoropyrimidines like 5-FU by
strengthening @ssoci@tion of drug w thymidil@te synthet@se
$(. Prevent@ble medic@l error > del@yed di@gnosis. F@ilure to follow best
pr@ctice guidelines.
!. Ne@r miss = medic@l error th@t is noticed before h@rm is done to p@tient.
$). REVIEW? X norm@l @ging of he@rt: incre@sed interstiti@l connective tissue.
Accumul@tion of cytopl@smic gr@nules w brown lipofuscin pigment.
$*. ALS - thin @nterior roots. Mild @trophy of precentr@l gyrus.
%+. ZES - g@strinom@. Often results in ulcers beyond duoden@l bulb. Pts @lso
h@ve di@rrhe@ @s g@stric @cid d@m@ges intestin@l cells @nd in@ctiv@tes
p@ncre@tic enzymes - prevents nutrient @bsorption.
!. vs VIPom@ - WDHA syndrome - w@tery di@rrhe@, hypok@lemi@, @chlorydi@
3/12 SBJ + Psych - Ankiʼed

!. FrDgility frDcture = glucocorticoid use. IncreDsed risk of osteoporosis. CDn

Dlso occur w Dbsorption of topicDl glucocorticoids
!. Other deets
!. Osteonecrosis of the jDw w bisphosphDnDtes
#. Osteonecrosis of the femorDl heDd with glucocorticoids
#. NonmDleficience - do no hDrm
$. FinDsteride - treDts Dndrogenetic DlopeciD. Polygenic inheritDnce.
!. vs intrDlesionDl glucocorticoids tx DlopeciD DreDtD
%. PsoDs mDjor Dnd iliDcus contribute most significDntly to hip flexion
!. IliopsoDs = iliDcus + poses mDjor + psoDs minor
&. Gouty Drthritis = gout. Long term therDpy = XO inhibitors
'. StimulDnt drugs block NE Dnd dopDmine reuptDke Dt synDpses in prefrontDl
cortex
(. When ATP binds, the myosin heDd detDches. If ATP is not DvDilDble, the
cross bridge persists (rigor mortis)
). FibromyDlgiD - widespreDd MSK pDin w fDtigue Dnd neuro disturbDnces.
AbnormDl centrDl processing of pDinful stimuli. GrDduDl incrementDl Derobic
exercise is first line tx, then gDbDpentin for refrDctory/severe.
*. PsoriDsis DssociDted w psoriDtic Drthritis - disorder Dffecting synovium Dnd
insertion of tendons/ligDments
!+. Post-herpetic neurDlgiD
!!. X I guess in DnDtomicDl position, the rDdiDl nerve runs lDterDlly.
SuprDcondylDr frDctures > DnterolDterDl displDcement of proximDl frDcture
frDgment > rDdiDl nerve injury.
!. Deets
!. RDdiDl nerve - outstretched Drm fDll
#. UlnDr nerve - fDll on flexed elbow
#. Other
!. Biceps tendon rupture cDn hDppen w sudden extension of flexed
elbow while contrDcting biceps
!#. X wow should definitely know this
!. XP = nucleotide excision repDir (no scissors sign in Sketchy PDth). It is still
D defect in repDiring the pyrimidine dimers but is NUCLEOTIDE EXCISION
REPAIR
#. HNPCC (Lynch) = mismDtch repDir (mismDtch dominos)
$. Nonhomologous end-joining
!. FDnconi DnemiD = mutDtion in repDir of interstrDnd DNA crosslinks
#. Also DtDxiD telDngiectDsiD
!$. TCAs inhibit fDst ND chDnnel conduction > leDding to cDrdiDc DrrhythmiD in
!$.
overdose. RefrDctory hypotension from decreDsed cDrdiDc contrDctility Dnd
direct peripherDl vDsodilDtion.
!%. Deletions of dystrophin = most common mutDtion in DMD Dnd BMD.
Dystrophin links cytoskeleton (Dctin) to trDnsmembrDne proteins (D- Dnd B-
dystrophiglycDns). FrDmeshift mutDtion.
!. Other deets
!. EndomysiDl infiltrDte = polymyositis
#. EndoneurDl = GB
!&. AdrenDls cDn Dtrophy w prolonged glucocorticoid use due to suppression of
ACTH
!'. DMD = X-linked recessive. CDuses Dsymmetric weDkening of pDrDspinDl
muscles > kyphoscoliosis. Also see cDlf pseudohypertrophy > hypertrophy
initiDlly in response to proximDl muscle weDkness, then repl&ced by f&t &nd
connective tissue.
!. Vs lipid deposition in muscle fibers > seen in lipid myopDthies like
cDrnitine pDlmitoyltrDnsferDse deficiency
!(. Colchicine inhibits microtubule polymerizDtion. Disrupts chemotDxis,
phDgocytosis, Dnd degrDnulDtion.
!. NDuseD Dnd diDrrheD Dre side effects
#. Others
!. AA > leukotriene pDthwDy is inhibited by blocking leukotriene
receptors
!). XDnthelDsmD - primDry or secondDry hyperlipidemiD. Obstructive biliDry
lesions cDn leDd to hyperlipidemiD Dnd lesions.
!*. Cherry hemDngiomD = benign vDsculDr tumor in Ddults. Multiply w Dge. Seen
in congested cDpillDries Dnd post-cDpillDry venues of pDpillDry dermis
!. Others
!. SuperficiDl hemDngiomDs = infDntile
#. Acrochordns = outgrowths of normDl skin, usuDlly seen in DreDs of
friction.
#+. SKs - “stuck-on” DppeDrDnce. AssociDted w DctivDting mutDtions of FGF
receptor 3. SK itself is benign, but rDpid onset of SKs (Leser-TrelDt) is
DssociDted w internDl mDlignDncy.
#!. X Reflexes
!. Deets
!. Golgi tendon orgDns (GTOs) Dre lDced Dt junction of muscle Dnd
tendon. InnervDted by group Ib sensory Dxons. GTOs Dre connected in
series w contrDcting extrDfusDl skeletDl muscle fibers. Muscle Dctively
contrDcts DgDinst resistDnce > increDse in tension is trDnsmitted thru
GTOs.
#. But, GTOs Dre relDtively insensitive to ch#nges in muscle length bc
lengthening thDt occurs when muscle is pDssively stretched tDkes
plDce in muscle fibers, not tendons.
 $. When muscle exerts too much fDce > GTOs inhibit contrDction >
sudden relDxDtion.
#. Other
!. Muscle spindles (intrDmurDl muscle fibers) Dre connected in pDrDllel w
extrDfusDl fibers. InnervDted by group ID Dnd II sensory Dxons Dnd Dre
sensitive to chDnges in muscle length.
##. Vomititng Dnd hypokDlemiD.
!. Vomiting cDuses volume depletion.
#. Volume depletion leDds to increDsed Dldosterone secretion, which leDds
to increDsed sodium retention Dnd increDsed potDssium wDsting. (TDrgets
ND/K ATPDse)
$. ContrDction DlkDlosis
!. Aldo Dlso works in D-intercDlDted cell: increDses H+ out, more HCO3-
in > DlkDlosis
#$. X PsoriDsis - seen on knees Dnd elbows. AcDnthosis w p&r&ker&totic
sc&ling (retention of nuclei in corneum), Munro microDbscesses.
INCREASED strDtum spinosum, DECREAED strDtum grDnulosum. Auspitz
sign - pinpoint bleeding from exposure of dermDl pDpillDe when scDles Dre
scrDped off.
!. Vs Dtopic dermDtitis = lesions on flexurDl surfDces (Dnterior elbows)
#%. Receptor-bound FDs-DssociDted deDth domDin (FADD) stimulDtes initiDtor
cDspDses Dnd DctivDtion of executioner cDspsDses.
!. T lymphs express FDsL, cDn bind FDs on sDme cell or DdjDcent lymphs.
ActivDted T lymphs undergo Dpoptosis when in constDnt presenceof
stimulDting self-Dntigens
#&. Seizures w bupropion
#'. X tRNAs exhibit bDse pDiring w/in the chDin Dnd hDve dihydrouridine (D
loop), pseudouridine, Dnd ribothymidine (T loop - this sequence is necessDry
for binding of tRNA to ribosomes). 3ʼ CCA tDil is Ddded to the 3ʼ end of tRNA
Ds post-trDnscriptionDl modificDtion.
#(. SchizophreniD ok
!. W/ MDD or bipolDr - psychotic sx occur exclusively during depressive or
mDnic episode
#). Hydroxycut used to contDin ephedrD which hDs cDrdio side effects!!!
#*. SSRIs - sexuDl dysfunction is the mDin side effect (in more thDn 50% of
pDtients)
$+. X 2nd gen SSRIs hDve lower risk of Dcute dystoniD (extrDpyrDmidDl sx due to
D2 DntDgonism).
!. Higher risk of metDbolic Ddverse effects (weight gDin Dnd metDbolic
effects - like diDbetes)
$!. Conduct disorder - violDtes societDl norms
$#. SerrDtus Dnterior - stDbilizes Dnd rotDtes the scDpulD upwDrd. InnervDted by
LTN. PDrDlysis of serrDtus Dnterior > scDpulDr winging. Also impDired
$#.

Dbduction of the shoulder pDst the horizontDl.

$$. X compensDtory for bulimiD includes excessive exercise. PDtients Dre normDl
weight or overweight.
$%. NormDl chDnges in sleep with Dge - frDgmented sleep w nocturnDl
DwDkening Dnd Dn eDrlier wDke-up time. Also hDve dDytime nDpping.
$&. Schizoid - prefers solitude, limited emotionDl expressive
$'. UrticDriD = edemD of superficiDl dermis.
$(. PDnic disorder > DgorDphobiD.
$). SSRIs = first line for OCD
$*. X Compound nevus invDdes into the underlying dermis
!. JunctionDl nevus sits on the dermo-epidermDl junction
%+. StDph Dureus is the most common cDuse of osteomyelitis in kids
!. Osteomyelitis occurs by 1 of 3 mechDnisms
!. HemDtogenous seeding due to bDcteremiD
#. SpreDd from contiguous focus of infection (like in infected diDbetic
foot wound)
$. Direct inoculDtion w compound frDcture
3/13-1 Mixed - Ankiʼed

!. Chorio - from trophoblAst. VAginAl bleeding, increAsed b-HCG.

!. HemAtogenous spreAd. Lungs Are most common site of distAl metAstAsis.
NO CHORIONIC VILLI PRESENT
#. Others
!. Cells of complete mole will hAve edemAtous villi
#. Nondisjunction - fAilure of homologous chromosomes to sepArAte in meiosis
I OR fAilure of sister chromAtids to sepArAte in meiosis II or mitosis
!. BAby received 2 different bAnds from mother - inherited both of her
homologous chromosomes
!. If it wAs A meiosis II fAilure - RFLP would reveAl only two bAnds -
thicker bAnd Arm both - inheritAnce of both sister chromAtids
#. MAjority of Downʼs from nondisjunction in meiosis I
$. PersonAlity chAnge, disinhibition, irritAbility - dAmAge to orbitofrontAl cortex
= decision-mAking
!. TemporAl cortex injury - hyper sexuAlity, visuAl AgnosiA like in Kluver-Bucy
%. X CAn get A brAchiocephAlic vein obstruction with An ApicAl lung tumor.
Right brAchiocephAlic vein Also drAins right lymphAtic duct, which drAins
lymph from right upper extremity.
!. SVC presents similArly but BOTH sides of the fAce would be Affected
&. Ok
'. X EDS = deficiency in procollAgen peptidAse - cleAves pro-peptides from N-
terminAl regions of procollAgen
!. Others
!. (Step 1): Synthesis - gly X-Y (usuAlly proline or lysine)
#. (Step 2) Problems w hydroxyl.tion of specific proline And lysine
residues = vitAmin C deficiency
$. (Step 3) Glycosyl.tion of pro-A-chAin hydroxylysine residues > forms
procollAgen viA hydrogen And disulfide bonds (triple helix) = problems
= OI
%. (Step 4): Exocytosis to extrAcellulAr spAce
&. (Step 5): Proteolytic processing - cleAvAge of procollAgen from C And
N terminAls. Problems = EDS
'. (Step 6): Cross-linking: reinforce mAny stAggered tropocollAgen
molecules w copper-contAining lyse oxidAse. Problems = EDS,
Menkes
(. CASR - Gq protein coupled receptors thAt regulAte secretion of PTH in
response to circulAting cAlcium levels
!. FAmiliAl hypocAlciuric hypercAlcemiA - AD, cAused by defective CASRs.
Higher serum CA required to suppress PTH secretion
 #. Receptors in kidneys And PTH glAnds > defective rAises the cAlcium
threshold, increAsed PTH releAse
g. SSRIs Are first line for GAD
h. X HCM - cArdiomyocyte hypertrophy (predominAntly Affects the septum)
And myofiber disArrAy. LeAds to interstitiAl fibrosis
!. Vs endocArdiAl (lines the ventricles) thickening And non-compliAnt
ventriculAr wAlls = restrictive CM
!i. Confounding = exposure-diseAse relAtionship is muddled by effect of
confounding vAriAble.
!. When confounder is removed, there is no significAnt difference. (So when
you tAke smoking out of the equAtion, there is no significAnt difference)
#. Other
!. Vs effect modificAtion - externAl vAriAble positively or negAtively
impActs observed defect of A risk fActor on diseAse stAtus.
!. Will see A significAnt difference when strAtified
!!. CholerA is Acid sensitive, so must hAve A significAnt loAd before it cAuses
infection, but pts on PPIs will hAve less Acid production
!. Prefers A bAsic environment - dies with Acid
!#. NeisseriA spreAds hemAtogenously. UsuAlly AsymptomAtic, but when
bActeriA penetrAte the epithelium And enter the bloodstreAm, cAn then go
through the cerebrAl cApillAry endothelium or choroid plexus to cAuse
meningitis.
!$. Wedge-shAped AreAs of necrosis = wAtershed zones. ACA-MCA And MCA-
PCA. Profound systemic hypotension (due to shock) diminishes blood supply
to the brAin > globAl cerebrAl ischemiA.
!. Strips of necrosis over cerebrAl convexity, pArAllel And AdjAcent to
longitudinAl cerebrAl fissure
#. Other
!. CArdiAc embolism would cAuse multiple infArcts within mAjor vAsculAr
territories
!%. Tongue innervAtion
!. Motor innervAtion - mostly CN XII, except pAlAtoglossus (CN X)
#. GenerAl sensory
!. Anterior 2/3 - mAndibulAr brAnch of V3
#. Posterior 1/3 - glossophAryngeAl (IX)
$. TAste
!. Anterior 2/3 - chordA tympAni of CN VII
#. Posterior 1/3 - glossophAryngeAl (IX)
!&. Apoptosis from two sepArAte pAthwAys - intrinsic pAthwAy And extrinsic
pAthwAy
!. Intrinsic - mitochondriA become more permeAble, pro-Apoptotic
substAnces releAsed into the cytoplAsm
!. When exposed to signAls - Bcl-2 And Bcl-x > replAced w pro-
 !.
Apoptotic proteins: BAk, BAx, Bim
#. IncreAsed permeAbility of mitochondriA > releAse cAspAse-ActivAting
substAnces like cytochrome C
#. FAs ligAnd is pArt of the extrinsic pAthwAy (not releAsed from
mitochondriA)
!'. X InhAled Anesthetic hepAtotoxicity, most likely from hAlothAne (still one of
the most commonly used inhAled Anesthetics worldwide)
!. Deets
!. Fever, AnorexiA, nAuseA, mylAgiAs, ArthrAlgiAs, rAsh
#. See elevAted AminotrAnsferAse levels, prolonged PT time,
leukocytosis And eosinophiliA
#. Others
!. Would see Albumin deficiency in chronic, end-stAge liver diseAse
!(. IncreAsed resistAnce, decreAsed fow. ResistAnce is inversely relAted to r^4.
When flow is reduced by A fActor of 16, the rAdius hAs been cut in hAlf.
!g. Most T1 DM pts diAgnosed by Age 10, but cAn hAve onset in Adolescence
And Adulthood.
!h. PNH = intrAvAsculAr hemolysis.
!. IncreAsed risk of thrombotic complicAtions due to releAse of free
hemoglobin And other prothrombotic fActors from lysed RBCs And
plAtelets.
#. Complement-mediAted hemolysis occurs more often At night bc
complement Activity is increAsed during sleep due to lower blood pH.
$. Other
!. Splenic sequestrAtion - sickle cell AnemiA
#i. PeptidoglycAn is found in cell wAlls of grAm-positive And grAm-negAtive
orgAnisms. GlycosyltrAnsferAse is A cruciAl component of peptidoglycAn
synthesis. Adds molecules to growing peptidogylcAn chAin.
!. MycoplAsmA lAcks A cell wAll so it would be resistAnt to A drug thAt
inhibits bActeriAl ribosomAl function.
#!. CentrAl DI cool
!. Others
!. PArtiAl nephrogenic DI - slow but steAdy rise in urine osmolAlity with
increAsing serum osmolAlity After wAter deprivAtion. No increAse with
DDAVP, urine osmolAlity remAins low.
#. Complete nephrogenic DI - no response to wAter deprivAtion At All.
##. X DAily vAlAcyclovir for prevention of herpes reActivAtion from sAcrAl gAngliA
#$. X MArijuAnA intoxicAtion - conjunctivAl injection (red eyes), tAchycArdiA,
increAsed Appetite, dry mouth
!. Other
!. GHB (gAmmA hydroxybutyrAte, precursor to GABA), opiAtes, or
benzos cAn cAuse respirAtory depression
#%. Chronic pAncreAtitis - Alcohol Abuse is the most common cAuse. FolAte
#%.
deficiency is often seen in Alcoholics.
!. Folic Acid = single cArbon donor required for bAse synthesis.
#. PAncreAtic insufficiency is Also AssociAted w B12 deficiency since
enzymes normAlly cleAve R fActor from B12
#&. BetA-lActAmAse inhbitors = clAvulAnic Acid, sulbActAm, tAzobActAm.
!. ANKI c.rd where Are B-lActAmAses found? PeriplAsmic spAce of grAm
neg bActeriA
#'. SJS w lAmotrigine
#(. NitrAtes decreAse preloAd thru venous dilAtion
#g. X FAmiliAl erythrocytosis - B globin mutAtion - reduced 2,3 BPG binding
!. Hemoglobin F does not bind w 2,3 BPG due to Altered physicAl structure
of binding pocket.
#. ReplAcement of histidine by serine reduces positive chArge of binding
pocket - limiting 2,3-BPG AttAchment
#h. DApto - creAtes trAnsmembrAne chAnnels thAt cAuse intrAcellulAr ion
leAkAge
!. InActivAted by surfActAnt by it binds to And is inActivAted by pulmonAry
surfActAnt
$i. Irreversibly injured neurons > Astrocytes come in And proliferAte At site of
injury
$!. TEF - diverticulum in primitive foregut.
!. polyhydrAmnios bc they cAnʼt swAllow. Drooling (due to inAbility to
swAllow sAlivA), choking, coughing, cyAnosis with feeds - reflux of
breAstmilk And AspirAtion into trAcheA/lungs.
#. Also see stomAch bubble - Air flow from trAcheA thru fistulA to distAl
esophAgus.
$#. MCL - occurs After twisting or blow to lAterAl knee while the foot it plAnted
(vAlgus stress)
!. vs injury to the menisci - joint line tenderness while knee is flexed
$$. AnorexiA ok
$%. HBV infection progression
!. Deets
!. Anti-HBe Antibodies - 3-6 months After initiAl infection
#. HBsAG - eliminAted when HBeAg becomes undetectAble
$. Anti-HBsAG = protective immunity from future infection
$&. Low grAde cervicAl dysplAsiA usuAlly regresses spontAneously And requires
no treAtment
$'. Exotoxins
!. Deets
!. LethAl fActor = zinc metAlloproteinAse - inhibits MAP kinAse > cell
deAth
#. EdemA fActor = cAlmodulin-dependent AdenylAte cyclAse, increAses
cAMP > fluid AccumulAtes within/between cells
 !. Very similAr to AdenylAte cyclAse toxin produced by pertussis
$(. X Glio = necrosis And hemorrhAge. MAss effect And midline shift. MAy
OCCASIONALLY cross corpus cAllosum. Most common primAry cerebrAl
neoplAsm.
!. Others
!. Oligo - well circumscribed grAy mAsses in the WHITE mAtter w
cAlcificAtion.
#. MetAstAses - would usuAlly see multiple mAsses At junction of grAy
And white mAtter.
$g. VUR - cAn hAppen when ureter enters blAdder At peripendiculAr Angle. CAn
hAve ongoing injury thAt leAds to renAl scArring At the upper And lower
poles. CAn leAd to loss of nephrons And secondAry HTN.
$h. HibernAting myocArdium - decreAsed expression And disorgAnizAtion of
contrActile And cytoskeletAl proteins > decreAsed contrActility And LV
systolic dysfunction.
!. W/ revAsculArizAtion > restore blood flow, improve contrActility And LV
function.
#. Other
!. Ischemic preconditioning - brief episodes of myocArdiAl ischemiA
protect from prolonged episodes of ischemiA. DelAys cell deAth After
complete coronAry occlusion.
%i. RituximAb for CD20
!. InfliximAb for AS And fistulizing crohnʼs: RemicAde, TNF-A inhibitor
3/13-2 Mixed - Ankiʼed

!. Short bowel syndrome - mFlFbsorptive condition in pts w mFssive smFll

bowel resection Fnd/or Crohn diseFse
!. Extensive intestinFl diseFse or resection > loss of Fbsorptive surfFce FreF
Fnd decreFse in intestinFl trFnsit time > postprFndiFl diFrrheF Fnd
mFlFbsorption
#. AnticipFtion - Huntingtons
$. BlFsto - broFd bFsed budding. CFn look like two buds.
!. CFn look like F lung infection or cFuse F flu-like illness in Fbout hFlf of
immunocompetent individuFls
%. Infection w Hep D drFmFticFlly increFses FlreFdy elevFted risk of cirrhosis
Fnd hepFtocellulFr cFrcinomF seen w HBV
&. X MEDIAN is ALWAYS between the meFn Fnd the mode. So the meFn would
be greFter thFn the mediFn in F positive skew.
!. Positive skew - increFsed number of lFrger thFn expected mFgnitudes
thFt shift the meFn towFrd the right
'. CeliFc - cFnʼt Fbsorb vitFmin D. Vit D increFses cFlcium Fnd phopsohrus
Fbsorption, so deficiency would decreFse Fbsorption.
!. About 5% of cFlcium circulFtes bound to phosphFte
(. Rb mutFtion cFn leFd to osteosFrcomF. Rb > two hit hypothesis. Cell with 2
inFctivFted Rb genes becomes source of mFlignFnt tumor.
!. Active (dephosphorylFted) Rb protein does NOT Fllow cell to proceed
from G1 to S phFse of cell cycle.
#. InFctivFtion of Rb permits cell division. Cells w 2 in$ctive Rb genes
divide uncontroll$bly (pFrFdoxicFl sounding bc itʼs F tumor suppressor
so when itʼs inFctive it will leFd to tumor GROWTH)
). X FemorFl herniFs protrude thru femorFl ring, which becomes lFx w Fge.
LFterFl to the pubic tubercle, medFl to femorFl Frtery Fnd vein. Tend to
occur on the right side.
!. Prone to incFrcerFtion > cFuses strFngulFtion > ischemiF Fnd necrosis of
herniF sFc
#. Other
!. Direct inguinFl herniFs lie mediFl to inferior epigFstric
#. Indirect - lFterFl to vessels
*. Hep B cFn present w serum-sickness like syndrome w joint pFin,
lymphFdenopFthy, pruritic vFsculitis rFsh
!. Most pts hFve non-icteric infection
#. Others
!. Acute hep C - I guess it goes w IVDU
!+. CertFin cultures vFlue beneficence Fnd nonmFlficience over western
!+.
emphFsis on Futonomy. AsiFn cultures mFy think itʼs disrespectful or cruel to
directly disclose serious illness to F fFmily elder.
!. Only time info cFnʼt be withheld if itʼs F trFnsmissible diseFse
!!. REVIEW THIS ($lso review Hodgkin lymphom$ sketchy p$th)
!. GerstmFnn = FngulFr gyrus of dominFnt pFrietFl love - supplied by MCA.
AngulFr gyrus is pFrt of the FssociFtion cortex.
!. GerstmFnn Syndrome
!. AgrFphiF
#. AcFlculiF
$. Finger FgnosiF
%. Left-right disorientFtion
#. Other (REVIEW)
!. Ischemic injury to dorsolFterFl medullF > WFllenberg syndrome.
#. MediFl medullFry: ASA stroke
$. MidbrFin stroke Ft superior colliculus > upwFrd gFze pFlsy
!#. ANKI THIS - Fick principle
!. CO = rFte of O2 consumption / AV O2 content difference
!$. ResistFnce to penicillins usuFlly due to betF-lFctFmFsde, enzyme thFt
hydrolyzes Fnd inFctivFtes betF-lFctFm ring. PiperFcillin - betF-lFctFmFse
inhibitor
!%. X ugh Iʼm dumb. LinguFl thyroid is due to fFilure of migr$tion, not Fpoptosis.
!&. PhobiF - CBT involving systemFtic, repeFted exposure to phobic stimulus
!'. X Pro-cFrcinogens Fre metFbolized by P450 monooxygenFse. CFn convert
pro-cFrcinogens to cFrcinogens cFpFble of cFusing mutFtion.
!. Also metFbolizes steroids, Flcohol, toxins > mFkes them more soluble Fnd
eFsier to excrete.
!(. X PFcemFker - cFn go thru tricuspid vFlve orifice > dFmFge to leFflets.
!. Severe TR > RHF. Distended jugulFr veins, hepFtomegFly, FbdominFl
dissension w Fscites, lower extremity edemF.
#. Other
!. Constrictive pericFrditis cFn pericFrdiFl inflFmmFtion w infection.
Would see RHF symptoms with it.
!). DecreFsed plFsmF osmolFlity from hyponFtremiF > wFter flows Fcross
osmotic grFdient into brFin cells. CFn leFd to life-threFtening cerebrFl
edemF.
!. Giving glucose-contFining fluids to pts w thiFmine deficiency cFn cFuse
Wernicke encephFlopFthy
!*. OlFnzFpine + clozFpine cFrry the greFtest risk for metFbolic syndrome.
!. ClozFpine could cFuse FgrFnulocytosis.
#. ZiprFsidone - most often FssociFted w QT prolongFtion.
$. Risperidone - greFtest risk of prolFctin elevFtion.
#+. VLCFAs Fnd certFin brFnched chFin fFtty Fcids (phytFnic Fcid) cFnʼt
undergo mitochondriFl betF oxidFtion > must be metFbolized by speciFl form
#+.

of betF oxidFtion (VLCFAs) or FlphF-oxidFtion (brFnched chFin FAs) in

peroxisome.
!. Zellweger - crFniofFciFl FbnormFlities - hepFtomegFly, hypotoniF,
seizures.
#. X-linked Fdrenoleukodystrophy - defective trFnsport of VLCFAs in
peroxisomes.
#!. LegionellF found in wFter ok
##. TrFnspeptidFse cFtFlyzes finFl cross-linking: joining Fmino Fcid in third
position of peptidoglycFn to terminFl D-FlF D-FlF
#$. Most importFnt opsonins = IgG Fnd complement C3b, but mFnnose binding-
lectin Fnd CRP cFn Flso opsonize cells
!. Other
#. IgM cFn be F potent stimulFtor of C3b opsonizFtion viF complement
cFscFde
#%. In utero CMV > chorioretinitis
#&. TFmiflu - neurFminidFse inhibitor
#'. MTX toxicity - cFn leFd to Fphthous ulcers (in rFpidly turning-over stomFch
cells) or pFncytopeniF (bone mFrrow cells).
!. Rescue w leucovorin > reduced form of folic Fcid thFt does not require
DHFR to be converted to THF - unFffected by MTX
#(. X hepFtocellulFr cFrcinomF - cFn see elevFted AFP level. CFn be mildly
elevFted in pts w chronic liver diseFse, but drFmFtic rises > think HCC.
!. Other
!. CEA - colorectFl cFcner
#). X GonFdFl Frteries Frise from FbdominFl FortF slightly below renFl Frteries.
TesticulFr Frtery initiFlly mFintFins blood flow in testiculFr torsion >
engorgement Fnd hemorrhFgic infFrction.
#*. ANKI BFclofen = GABA (B) Fgonist - txs spFsticity in MS
$+. NitrFtes - venodilFtors - increFse peripherFl venous cFpFcitFnce, reduce
preloFd Fnd LVEDP. Also modest FrteriolFr dilFtion > decreFsed SVR
$!. CysitinuriF - cysteine stones Fnd elevFted urinFry cysteine levels
(FminoFciduriF). Other Fmino Fcids Fre relFtively soluble in the urine Fnd
donʼt form stones.
!. Tx w hydrFtion Fnd urinFry FlkFlizFtion (FcetFzolFmide)
$#. X ethylene glycol - metFbolized to glycolic Fcid Fnd oxFlic Fcid in 24-72
hours
!. Acute injury - direct tubulFr cytotoxicity —> ATN - proximFl tubulFr
bFllooning Fnd vFcuolFr degenerFtion.
#. Other
!. AdvFnced liver diseFse - portFl HTN Fnd sphlFnchnic vFsodilFtion -
renFl fFilure (hepFtorenFl syndrome)
$$. Eccentric hypertrophy w/ dilFted CM. DecreFsed contrFctility >
decompensFted HF.
 !. Vs poor compliFnce would be seen w concentric LV hypertrophy
#. Vs pulm HTN - would see right wFll thickening
$%. CocFine intoxicFtion - diFphoresis, tremulousness, tFchycFrdiF, HTN,
mydriFsis. Audtiory, visuFl, tFctile hFllucinFtions
!. Vs PCP would cFuse psychotic sx Fnd violent behFvior
$&. Exercise cFn mediFte glucose uptFke by GLUT 4 trFnsporter. Also occurs
during muscle contrFction by Fn insulin independent mechFnism
!. Infection, pFin, Fnd sleep > releFse cFtecholFmines Fnd leFd to
hyperglycemiF
$'. Inhibition of thymidylFte synthFse w low folFte conditions > cFuses
incorporFtion of urFcil into DNA in plFce of thymidine. LeFds to excessive
FctivFtion of DNA repFir mechFnisms > ds-DNA breFks Fnd Fpoptosis
$(. If she still hFs neuro deficits Ffter folFte supplementFtion > deficient in B12
!. Txment of B12 deficiency w folFte Flone cFn FctuFlly worsen neuro
dysfunction
$). PFinless hemFturiF - trFnsitionFl cell cFncer of the blFdder. CigFrette
smoking Fnd rubber exposure Fre mFjor risk fFctors. Also Fniline-dyes
(texiles) Fnd cyclophosphFmide therFpy.
$*. X CFlcium chFnnel blockers cFn leFd to peripherFl edemF, flushing,
dizziness, heFdFche
!. EdemF due to preferentiFl dilFtion of precFpillFry vessels > increFsed
hydrostFtic pressure Fnd fluid extrFversion
#. Other
!. ACEIʼs would cFuse postcFpillFry venodilFtion Fnd decreFse the risk
of edemF in pFtients
%+. Chronic NSAID use > chronic IN. pFtchy interstitiFl inflFmmFtion w
subsequent fibrosis, tubulFr Ftrophy, pFpillFry necrosis Fnd scFrring,
cFliceFl Frchitecture distortion.
!. Modest elevFtion in Cr, mild proteinuriF, evidence of tubulFr dysfunction.
3/14-1 Mixed - Ankiʼed

!. Corticosteroids increAse surfActAnt production by AccelerAting mAturAtion

of type II pneumocytes
!. FetAl hyperinsulinemiA inhibits mAturAtionAl effects of cortisol
#. Nifedipine And terbutAline inhibit preterm lAbor
!. Nifedipine - myometriAl relAxAtion w inhibition of myosin-light chAin
kinAse mediAted phosphorylAtion
#. TertbutAline - increAses cAMP
#. Ok
$. NiAcin cAn be synthesized endogenously from tryptophAn
!. In populAtions who eAt A lot of corn > often see niAcin deficiency bc
niAcin is in A bound, unAbsorbAble form
%. MAKE AN ANKI CARD FOR different kinds of incontinence
!. Overflow incontinence - impAired detrusor contrActility or blAdder outlet
obstruction (tumor obstructing urethrA)
#. other
!. Vs urge incontinence - inhibition of detrusor contrAction. Due to
spinAl cord diseAse. Would see hyperreflexiA.
&. HypobAric hypoxiA At high Altitude. FiO2 is the sAme, but there is decreAsed
pO2 in the Air And blood. StimulAtes chemoreceptors > hyperventilAtion to
improve oxygenAtion. Resp AlkAlosis. RenAl bicArb excretion compensAtes >
pH stAbilized w/in 48 hrs
'. Hyperthyroid upregulAtes betA-Adrenergic receptors in vArious orgAns >
heAt intolerAnce, pAlpitAtions, hyperreflexiA.
!. GrAves opthAlmopAthy - from stimulAtion of fibroblAsts (which hAve TSH
receptors). Secrete excess GAGs. Since immune mediAted, should
respond w glucocorticoid therApy.
(. X SICKLE CELL = VAL is substituted for GLU
). CoxsAckie cAn Also cAuse myocArditis - mAy extend to the pericArdium
*. When fusion of the kidneys occurs > centrAl isthmus crosses midline Anterior
to AortA And posterior to IMA
!+. ANKI THIS - Osteoporosis meds
!. Deets
!. BisphosphonAtes (“dronAtes”): inhibit osteoclAst-mediAted bone
resorption (osteoclAsts bind to bispohphonAte - inhibits Adherence to
bony surfAce)
#. DenosumAb: bind RANK-L & inhibit binding to RANK, reduce
differentiAtion And survivAl of osteoclAsts
!. RANK-L = NF-KB ligAnd
$. TeripArAtide: stimulAtes mAturAtion of pre-osteboblAsts, increAsed CA
 $.
2+ Absorption And renAl tubulAr cAlcium reAbsorption
!!. Ok
!#. ADHD is not diAgnosed until Age 4-5 bc A lot of toddlers cAn hAve ADHD-
like behAvior
!$. X Assessment of DMC
!. PAtient
!. CommunicAtes A choice
#. UnderstAnds informAtion provided
$. AppreciAtes consequences
%. Shows no signs of delirium, psychosis, or severe depression
#. *A diAgnosis of mild cognitive impAirment does not AutomAticAlly indicAte
lAck of DMC!*
!%. X AnAtomic lAndmArk for Appendix: teniAe coli
!. TeniAe coli = 3 sepArAte smooth muscle ribbons thAt trAvel longitudinAlly
to outside of colon And converge @ root of vermiform Appendix
#. Other
!. PsoAs sign cAn be due to Any retroperitoneAl irritAtion And is not
specific for Appendicitis
!&. Sickle cell = Auto recessive
!'. X ANKI THIS - hCG hAs the sAme subunit As LH, FSH, TSH. B subunit is
unique.
!. FSH stimulAtes development of the follicle And estrogen production from
ovAries.
#. High estrogen levels in lAte folliculAr phAse => positive feedbAck of LH
production.
$. Administering hCG mimics LH surge And induces ovulAtion.
!(. HbA1c And HbA2
!. Deets
!. Glucose freely diffuses Across RBC membrAne, AttAches to HbA.
Higher glucose => Higher HbA1c
#. In betA thAl - HbA2 is elevAted to compensAte for betA chAin
underproduction, but cells Are prone to hemolysis
!. Higher turnover => fAlsely low HbA1c levels
!). CAmpy = bloody diArrheA
!*. Tuberculosis resides in necrotic mAcrophAge, so if mAcrophAge function is
impAired (As in silicosis) => increAsed susceptibility to TB
#+. X ANKI
!. Free wAll rupture pAthogenesis
!. InfArcted myocArdium is substAntiAlly weAkened by coAgulAtive
necrosis, neutrophil And mAcrophAge infiltrAtion, And enzymAtic lysis
of myocArdiAl connective tissue > hemopericArdium And cArdiAc
tAmponAde.
#. LeAds to profound hypotension And shock
 #. THIS
!. Free wAll rupture - hemoperricArdium And cArdiAc tAmponAde
#. VentriculAr septAl rupture - Acute VSD And left-to-right shunting
$. PApillAry muscle rupture - Acute onset of severe mitrAl regurg
$. Other
!. True Aneurysm of the ventriculAr wAll Are bound by scArred
myocArdium thAt is tough And fibrotic. LAte complicAtion of MI >
murAl thrombus, ArrhythmiAs, heArt fAilure
#!. X lAdy hAd hyAtid liver cyst from echinococcus. Must be cAreful with these
cysts bc spilling of cyst contents cAn cAuse AnAphylAxis!
!. Vs fulminAnt (severe And sudden in onset) liver fAilure = severe
impAirment of hepAtic function / severe necrosis of hepAtocytes in
Absence of pre-exisitng liver diseAse
!. CAn Arise from hepAtitis, AcetAminophen toxicity, idiosyncrAtic drug
rxn, Wilsonʼs diseAse
##. UPP (ubiquitin-proteAsome pAthwAy) - essentiAl for breAkdown of
intrAcellulAr proteins. Also used to get proteins to the right size to be
presented on MHC I complex.
#$. X to prevent neonAtAl tetAnus, pregnAnt mothers should be vAccinAted.
!. AdequAte protection requires presence of toxin-neutrAlizing IgG
Antibodies obtAined trAnsplAcentAlly.
#%. TrAcheAl toxin - directly dAmAges And destroys ciliAted epitheliAl cells.
!. Pertussis toxin - enters cells And ActivAtes AdenylAte cyclAse >
AlterAtions thAt inhibit cellulAr signAlling And inhibit phAgocyte Activity.
#&. X Amyloid AngiopAthy = most common cAuse of recurrent lobAr hemorrhAge
in Adults >60. Tends to involve occipitAl And pArietAl lobes. OccipitAl love
hemorrhAge is AssociAted w homonymous hemiAnopsiA; pArietAl
hemorrhAge cAn cAuse contrAlAterAl hemisensory loss.
!. Other
!. AVM = most common cAuse of intrAcrAniAl hemorrhAge in kids, tends
to be A single lesion
#'. ThiAzides => volume loss => RAAS ActivAtion => Aldo secretion =>
hypokAlemiA
#(. X I guess you cAn hAve vision loss As A visuAl sx of migrAnes, then followed
by unilAterAl pulsAting heAdAche
!. Vs trAnsient ischemic AttAck - MAximAl symptoms At onset insteAd of
progressive visuAl loss like in this pt. TypicAlly occur in older pts w/
vAsculAr risk fActors.
#). NitrAte tolerAnce occurs bc there is decreAsed vAsculAr sensitivity And
increAsed sensitivity to endogenous vAsoconstricting Agents. (So the effect
of the sAme dose of nitrAte is less)
#*. PDA - see tAchycArdiA And widened pulse pressure, resp distress
$+. CDK4/6 inhibitors (pAlbociclib) - prevent trAnsition from G1 > S. GenerAlly
$+.
well tolerAted but prevent replicAtion of rApidly dividing cells, like
hemAtologic cells in BM
$!. ElAstAse is contAined in mAcrophAge lysosome And Azurophilic grAnules of
neutrophils
!. Excess proteAse Activity > mAjor contributor to centriAcinAr And
pAnAcinAr emphysemA
#. Other
!. Vs Club cells (formerly ClArA cells) secrete club cell secretory protein
> protects AirwAy AgAinst inflAmmAtion And oxidAtive stress
$#. X GAstric bAnd > goes from lesser curvAture to beginning of duodenum
!. Lesser omentum divided into
!. HepAtogAstric - connects to lesser curvAture of stomAch
#. HepAtoduodenAl - connects to duodenum
$$. X ReActive hyperplAsiA = benign, reversible enlArgement of lymphoid tissue
secondAry to Antigenic stimulus. Polyclon@l => proliferAtion of mAny cell
types in lymph node.
!. Monoclon@l re@rr@ngement of genes for Ig v@ri@ble regions is
suggestive of B cell lymphom@. MonoclonAl TCR gene reArrAngement is
most indicAtive of mAlignAnt processes.
#. Other
!. FolliculAr hyperplAsiA = follicles increAse in size And number
#. Sinus hyperplAsiA = sinuses enlArge And fill with histiocytes.
$%. PAsteruellA = mouse-like odor. Amoxicillin-clAvulAnAte for tx.
$&. In kids, S PneumoniAe is still #1 cAuse of meningitis, And #2 is neisseriA
$'. X Biopsy submucosA if Hirschsprung suspected
!. Meissner in submucosA
#. Myenteric (AuerbAch) in musculAr lAyer
$(. X PersonAlity And behAvior chAnges = frontotemporAl dementiA. EArly
chAnges.
!. Vs mAxillAry body dAmAge = Wernicke-KorsAkoff
#. vs AmygdAlA dAmAge = Kluver Bucy
$). ANKI
!. TrAnsference = shifting emotions AssociAted w person in the pAst to A
person in the present, esp pArents
#. DisplAcement = unAcceptAble feelings DISPLACED to more neutrAl
person/object
$. Projection = misAttributing unAcceptAble feelings to someone else (eg
wouldnʼt be Able to Acknowledge his disAppointment to psychiAtrist,
would insteAd perceive psychiAtrist As being upset)
$*. SSPE due to AccumulAtion of virAl neucleocApsids in neurons And oligos
%+. VAsospAsm 2ndAry to subArAchnoid hemorrhAge in 50% of cAses
!. SketchyPAth sAys it is due to breAkdown of hemoglobin thAt cAuses
endotheliAl irritAtion
3/14-2 Mixed - Ankiʼed

!. REVIEW X Propionic @cidemi@: congeni@l deficiency of propionyl-CoA

c@rboxyl@se. C@t@lyzes conversion of propionyl-CoA to methylm@lonyl-CoA.
!. Absent enzyme: excess propionic @cid @ccumul@tes in the bloodstre@m >
severe met@bolic @cidosis.
#. X ANKI CREST syndrome
!. Two types of systemic sclerosis
!. Diffuse scleroderm@ (systemic scleorsis): diffuse skin @nd viscer@l
involvement
!. Anti-DNA topoisomer@se: specific for systemic sclerosis
#. CREST: C@lcinosis, R@yn@udʼs, Esoph@ge@l dysmotility, Sclerod@ctyly
@nd Tel@ngiect@si@
!. Anti-centromere: specific for CREST
$. X Most common side effect of di@zep@m = sed@tion. Benzos should not be
used w @lcohol, neuroleptics, or 1st gen @ntihist@mines.
!. Chlorphenir@mmine @nd other 1st gen @ntihist@mines c@n be sed@ting >
go to CNS bc they c@n penetr@te BBB
%. Odds r@tio = prob@bility of the event h@ppening / prob@bility of the event not
h@ppening
&. Hirschsprung: rectum @nd @nus @re ALWAYS involved
'. Sickle cell: repl@cement of v@l w Glu (neg@tively ch@rged) - c@uses slower
migr@tion to the @node.
!. HbC: glut@m@te residue is repl@ced by lysine. Lysine is positively ch@rged,
so even less neg@tive ch@rge, so moves even more slowly tow@rd @node.
!. HbC @nd HbS both result from missense mut@tions
#. HbC pts - typic@lly @symptom@tic w mild hemolytic @nemi@ @nd
splenomeg@ly.
(. X REVIEW GI HORMONES
!. Incretins: GI hormones produced by gut mucos@ th@t stimul@te p@ncre@tic
insulin secretion in response to sug@r-cont@ining me@ls. GLP-1 @nd GIP
both h@ve incretin effects.
#. Insulin levels will @lso incre@se w IV @dministr@tion of glucose, but
incre@se will not be @s dr@m@tic @s or@l glucose @dministr@tion bc effect
of incretin is @bsent
). Blood flow in pulm circul@tion must m@tch the blood flow in the systemic
circul@tion to m@int@in blood flow in the body!
!. Deets
!. If flow of blood thru pulm is less th@n flow through systemic > LV
would soon empty completely.
#. If flow of blood w@s gre@ter in pulm, LV would be overlo@ded.
 $. *Exception: bronchi@l circuit. Dr@ins mostly to LA inste@d of RA >
cre@tes @ R to L shunt th@t @cts @s p@rti@lly independent circuit, but
this only @ccounts for <5% of systemic c@rdi@c circuit
#. Other
!. Arteri@l oxygen contents of pulm @nd systemic circul@tions @re very
different - deox blood in pulm circuit
e. Incre@sed intr@cr@ni@l pressure due to hemorrh@gic intr@cr@ni@l mets > le@ds
to exp@nding sp@ce occupying lesions
!. => unc@l herni@tion w CN III p@lsy
#. => tr@nstentori@l herni@tion: loss of VOR reflexes + decortic@te (flexor)
followed by decerebr@te (extensor) posturing
!f. ADHD - sx before @ge 12. P@ttern of in@ttention @nd/or hyper@ctivity/
impulsivity th@t interferes in >2 settings.
!!. Axill@ry nerve injury - sensory loss over upper l@ter@l @rm @nd we@kness on
shoulder @bduction due to denerv@tion @nd possibly @trophy of the deltoid.
!#. @nti-CCP @re more specific for RA th@n positive rheum@toid f@ctor
!. Tissue infl@mm@tion > @rginine residues in vimentin c@n be enzym@tic@lly
converted to citrulline (citrullin@tion). Alters sh@pe, proteins c@n then
serve @s neo@ntigens th@t gener@te immune repose.
!$. X Wow Iʼm dumb. If she h@s @n @dv@nce directive - use AD
!%. X OI - imp@ired synth of type I coll@gen by osteobl@sts. Type 1 coll@gen is
the predomin@nt coll@gen in osteoid (org@nic portion of m@trix) - @llows
bone to be flexible while m@int@ining strength
!. Vs endochondr@l ossific@tion w deposition of hy@line c@rtil@ge by
chondrocytes - imp@ired in @chondropl@si@
!&. Def@ult to more form@l @ppro@ch @nd c@ll pts by their surn@me
!'. Crigler N@jj@r > c@nʼt conjug@te bilirubin. Unconjug@ted is insoluble so it c@n
deposit in the br@in > kernicterus. Potenti@lly f@t@l, ch@r@cterized by severe
j@undice @nd neuro imp@irment
!. High numbers of @n@erobes @nd St@ph @uereus c@n le@d to deconjug@tion
of bile @cids > renders them less soluble @nd less @ble to form micelles
!(. MM: elev@ted light ch@ins in the urine
!). Thrombosis initi@lly txʼd w hep@rin, then w@rf@rin. C@n be @ddition@lly
tre@ted w direct f@ctor X@ inhibitors.
!. Since X@ is loc@ted @t junction of intrinsic @nd extrinsic - direct f@ctor X@
prolong @PTT @nd PT
!e. X Chronic lung tr@nspl@nt rejection > m@rked by submucos@l lympocytic
infl@mm@tion in the w@lls of the sm@ll @irw@ys > slowly worsening dyspne@
@nd dry cough th@t begins months @fter tr@nspl@nt
!. Ingrowth of gr@nul@tion tissue > SMALL @irw@y obstruction @nd dry cough
th@t begins months or ye@rs @fter tr@nspl@nt
#. Other
!. Bronchiolitis obliter@ns: c@n c@use l@rge @irw@y sc@rring >
 !.
bronchiect@sis
#f. St@ble @ngin@ - >70% obstruction
#!. INH: directly hep@totoxic. C@uses mild hep@tic dysfunction in 10-20% of pts.
C@n h@ve fr@nk hep@titis (simil@r to vir@l w fever, @norexi@, n@use@, j@undice)
in <1% of pts
##. SSSS = due to exfoli@tin exotoxin
!. Endotoxin-medi@ted infl@mm@tion is seen in gr@m-neg@tives @nd listeri@
(gr@m +).
#$. Memory deficits will still be present @fter B1 @dministr@tion
#%. Ond@nsetron (5HT3 @n@t@gonist) @nd Aprepi@nt (NK1 @nt@gonist) for
chemother@py induced emesis
#&. Hookworms > l@rv@e go thru derm@l tissue @nd le@ve reddish-brown,
serpiginous tr@cks
#'. Inh@led steroids > use @ sp@cer @nd rinse w nyst@tin to prevent c@ndidi@sis
#(. Zik@ c@n le@d to microceph@ly, c@lcific@tions, ventriculomeg@ly, cortic@l
thinning
#). Zolpidem = nonbenzodi@zepine hypnotic @gen. GABA(A) @gonists
!. Donʼt produce @nxiolytic effects seen w benzos
#e. X If the curve is fl@t, there is @ const@nt @ct of the drug met@bolized per unit
time reg@rdless of the dose.
!. First order kinetics - fixed proportion of the drug is converted to the
met@bolite.
#. Zero order - fixed AMOUNT is met@bolized.
$f. X CAAT @nd TATA box - promoters. Where RNA @nd tr@nscription f@ctors
bind.
$!. V@lid@te the p@tientʼs concern, explore re@sons for esc@l@ting use
$#. X inf@nts born to HbeAg-positive women h@ve @ >90% ch@nce of @cquiring
infection @nd developing chronic infection. M@tern@l vir@l lo@d @nd HBeAg
st@tus @re strongest risk f@ctors for infection.
!. Vir@l replic@tion occurs r@pidly in infected inf@nts. Enter immune-toler@nt
ph@se of chronic HBV > @symptom@tic or only mildly elev@ted LFTS.
#. Chronic@lly infected inf@nts @re @t high risk for progression to cirrhosis.
Administer Hep B v@ccine @nd Ig @s soon @s possible to prevent chronic
infection.
$$. Acoustic schw@nnom@s - occur @t cerebellopontine @ngle.
!. Bil@ter@l @ssoci@ted w NF type 2.
#. Other
!. Germ cell tumors - dors@l midbr@in. Pine@l tumors c@use obstructive
hydroceph@lus w sx of incre@sed intr@cr@ni@l pressure.
#. Meningiom@s - found in fl@cine/p@r@s@gitt@l region @nd over
convexities of hemispheres.
$%. X C diff - would see white-yellow pl@ques (pseudomembr@nes) on colonic
mucos@ w fibrin @nd infl@mm cells
 !. Antibiotics like fluoroqinolones for pneumoni@ incre@se risk
$&. X Vit@min E deficiency c@n mimic Friedrich @t@xi@. Loss of position @nd
vibr@tion sense due to degener@tion of dors@l columns @nd @t@xi@ w
degener@tion of spinocerebell@r tr@cts
!. Vs le@d intoxic@tion - irrit@bility, loss of milestones, le@rning problems
$'. B fr@gillis, E coli, enterococci, strep c@n @ll c@use peri@ppendece@l
@bscesses
$(. Nephrotic syndrome
!. Loss of protein
#. Drop in oncotic pressure > intr@v@scul@r volume depletion
$. Le@ds to sodium @nd w@ter retention. Fluid le@ks b@ck into interstiti@l
sp@ce due to low oncotic pressure
%. Incre@se lipoprotein synth due to low oncotic pressure. Imp@ired lipid
c@t@bolism due to decre@sed LPL
$). Syndenh@m chore@ c@n m@nifest 1-8 months @fter B hemolytic strep
infection. Del@yed onset @utoimmune rxn w @nti-strep @ntibodies th@t cross-
re@ct w b@s@l g@ngli@. Since it is @ m@nifest@tion of @cute rheum@tic fever,
pts @re @t risk of chronic rheum@tic he@rt dise@se
$e. REVIEW ADDISONS X Cushing = ectopic ACTH secretion. Incre@sed
hyperpigment@tion w co-secretion of @lph@-MSH. This guy @lso h@s weight
loss, not weight g@in => more suggestive of p@r@neopl@stic ACTH secretion.
!. ACTH secreted by sm@ll cell lung c@ncer is not inhibited by
dex@meth@sone but pituit@ry ACTH is
#. Other
!. Vs @dren@l infiltr@tion. Would see ^ ACTH w @dren@l infiltr@tion,
(incre@ses pigment@tion) but would expect to see @dren@l
insufficiency sx
%f. X Th1 response w tuberculoid leprosy. Incre@sed IFN-y, IL-2 @nd IL-12.
Loc@lized infl@mm@tion > hypo pigmented, well-dem@rc@ted pl@ques w
decre@sed sens@tion
!. Vs leprom@tous - Th2 medi@ted
#. Other - leprom@tous leprosy
!. High b@cteri@l lo@d w widespre@d involvement in peripher@l tissues of
the body
#. High serum @ntimyob@cteri@l @ntibody levels
$. M@croph@ges rem@in @ctiv@ted due to in@bility of Th1 cells to
recognize M lepr@e @ntigens.
3/15-1 Mixed - Ankiʼed

!. X HolosprosencephDly = developmentDl field defect: initiDl embryonic

disturbDnce leDds to multiple mDlformDtions by disrupting development of
DdjDcent tissues
!. Other
!. AssociDtion = multiple DnomDlies w/o known unifying cDuse (i.e.
VACTERL)
#. Acute virDl pericDrditis - DssociDted w Ddenovirus, coxsDckie, echo, flu
$. X HBV vDccine: collection of envelope glycoproteins thDt mediDte
DttDchment of virus to hepDtocytes Dnd subsequent virDl entry. Dnti-HbS
Dntibodies bind circulDting virDl pDrticles Dnd prevent DttDchment Dnd
penetrDtion of hepDtocytes.
%. Wilsonʼs diseDse - copper = pro-oxidDnt thDt cDuses dDmDge to hepDtic
tissue through generDtion of free rDdicDls. LeDks from injured hepDtocytes,
deposited in vDrious tissues (bDsDl gDngliD).
&. REVIEW FATTY ACID OXIDATION
!. Hypoketotic hypoglycemiD = defect in fDtty Dcid betD-oxidDtion
#. CDn be cDused by MCAD (medium chDin 0cyl-CoA deficiency)
$. Mild hepDtomegDly, liver dysfunction
%. Acyl-CoA dehydrogenDse - cDtDlyzes first step in betD ox pDthwDy - most
commonly deficient enzyme
'. EukDryotes - multiple origins of replicDtion
(. Lungs would be injured Dt fifth IC spDce.
!. If deeper - could injure LV (between 5th Dnd 6th IC). All other chDmbers
(including RV) lie mediDl to left MCL, unlikely to be Dffected by injury
). ANKI this m0ybe?
!. GlucDgon stimulDtes GPCRs on hepDtocytes - increDses intrDcellulDr
cAMP concentrDtion, DctivDtes PKA
#. Notes
!. First 12 hours: hepDtic glyconeogenesis = source of bodyʼs glucose.
SustDined hypoglycemiD > gluconeo in ren0l cortex becomes impt
glucose source
#. Epinephrine hDs Dn effect on glucose homeostDsis in skeletDl muscle,
Ddipose tissue, renDl cortex
!. GlucDgon - no effect
$. MOA of glucDgon: stimulDtes insulin secretion by Dcting on pDncreDtic
betD cells - Dllows glucose to be tDken up by insulin-sensitive tissues
!. This is counterintuitive but strDight out of UW!!!
*. ANKI - must hDve D prognosis of <6 mo to quDlify for hospice
!+. ANKI: NPV = TN/TN+FN (true negDtives/ totDl negDtives)
 !. For NPV to be DpplicDble - pDtientʼs pretest probDbility must be similDr to
the prevDlence of diseDse in the populDtion
#. NPV is inversely proportion to prevDlence of diseDse
!!. REVIEW HYPOXEMIA mech0nisms
!. Obesity hypoventilDtion
!. ANKI normDl A-D grDdient = 5-15 mmHg
#. HypoxemiD in setting of normDl A-D grDdient indicDtes thDt both
DlveolDr Dnd DrteriDl pDrtiDl pressure of O2 Dre low. Occurs w DlveolDr
hypoventilDtion
#. Other
!. R-to-L shunt - elevDted A-D grDdient
!#. HITT - generDtion of IgG Dntibodies thDt bind to complexes of hepDrin Dnd
PF4. Fc component of DctivDted IgG binds to DdditionDl plDtelets, results in
further PF4 releDse Dnd widespreDd plDtelet DctivDtion > prothrombotic
stDte.
!$. X H pylori preferenti0lly colonizes th0t g0stric 0ntrum. ColonizDtion >
decreDsed somDtostDtin formDtion, stimulDtes pDrietDl cells to produce
excess Dcid > duodenDl ulcer formDtion.
!. Etiology of GUs is not Dcid relDted, pts usuDlly hDve normDl or reduced
Dcid levels. Thought to be due to direct mucosDl dDmDge Dnd chronic
inflDmmDtion.
!%. OppositionDl defiDnt = Dngry/irritDble mood Dnd defiDnt behDvior for >6
months
!. ADHD is commonly comorbid w ODD
!&. X RDdiDl nerve enters foreDrm Dnterior to lDterDl epicondyle. PDsses thru
supin0tor c0n0l, then deep brDnch continues to the wrist to become
posterior interosseous nerve. MDy hDve injury w repetitive pronDtion/
supinDtion of the foreDrm. Sensory brDnches intDct.
!. Others
!. Injury to rDdiDl nerve Dt DxillD (“crutch pDlsy”): weDkness of foreDrm,
hDnd, Dnd finger extensor muscles
!'. Down syndrome: DssociDted w duodenDl DtresiD (fDilure of recDnDlizDtion of
duodenum)
!(. Aortic regurg - widened pulse pressure bc there is blood flowing bDck into
the LV when it should be filling the LV.
!. Deets
!. IncreDse in LV EDV, compensDtes with eccentric hypertrophy
#. DECREASE in diDstolic BP (cDnʼt fill correctly)
$. Hypertrophy initiDlly increDses stroke volume Dnd CO
%. CompensDtory increDsed stroke vol on top of reduced diDstolic
pressure > widened pulse pressure.
!). NDltrexone: blocks mu-receptor Dnd inhibits rewDrd Dnd reinforcing effects
of Dlcohol
 !. Aldehyde dehydrogenDse inhibitor disulfrDm is D second-line tx for Dlcohol
use disorder
!*. ProlDctin suppresses GnRH production > hypogonDdism in men (decreDsed
libido)
!. Other notes
!. Hypersecretion of ACTH cDn occur due to corticotroph DdenomD or in
response to primDry DdrenDl insufficiency
#+. CMV looks like mono in immunocompetent, but heterophiles Dntibodies will
not be present w CMV mononucleosis
!. Vs CMV retinitis / esophDgeDl ulcers Dre seen in immunocompromised pts
#!. E coli UTIs - fibmrDe is D mDjor virulence fDctor
!. Others
!. Lipid A > DctivDtion of mDcrophDges, widespreDd releDse of IL-1, IL-6,
TNF-DlphD
##. X ANKI - protein A in S Dureus binds w Fc portion of IgG Dntibodies Dt
complement binding site - prevents complement DctivDtion
!. Vs IgA proteDse in neisseriD, strep pneumo - cleDves IgA
#$. Cryptococcus - yeDst - round/ovDl cells w nDrrow buds
!. Vs mold fungi (rhizopus) - forms sporDngiD
#%. X Review Norepi vs Epi receptors
!. Norepi stimulDtes D1, D2, B1 - so B1 (Gs) stimulDtion would increDse cAMP
in cDrdiDc muscle cells
#. StimulDtes everything except B2. B2 stimulDtion increDses concentrDtions
in vDsculDr smooth muscle cells
#&. Metro for GiDrdiD - most common enteric pDrDsite in US Dnd CDnDdD
#'. X REVIEW LAYERS OF THE HEART
!. MVP is relDted to connective tissue disorders becDuse MVP is
chDrDcterized by myxomDtous degenerDtion of mitrDl vDlve leDflets Dnd
chordDe tendinDe
#. Vs endomyocDrdiDl fibrosis Dnd endocDrdiDl fibroelDstosis > disorders
thDt Dffect endocDrdium (very inside of the heDrt)
#(. X REVIEW THINGS THAT IMPAIR OX PHOS
!. Arsenic poisoning: Severe wDtery diDrrheD, QT prolongDtion, gDrlic odor.
#. Tx = chelDting Dgent - dimercDprol. Arsenic binds to sulfhydryl groups -
impDirs cell resp
$. Other
!. CDND2EDTA - leDd poisoning
#. Methylene blue - for methemoglobinemiD - grDy or blue-colored skin
#). X REVIEW CONGENITAL HEART DEFECTS
!. FDilure of endocDrdiDl fusion > osmium primum - single AV vDlve.
AssociDted w Down syndrome. L to R shunt Dnd AV vDlve regurg > heDrt
fDilure
#. Other
 !. MutDtions in frDtDxin > spinocerebellDr degenerDtion Dnd HCM
#. Tuberin Dnd hDmDrtin > Tuberous sclerosis
#*. X REVIEW 0nesthetic sketchy
!. If Dnesthetic solubility in the blood is high, D lDrge Dmount of Dnesthetic is
tDken up. Low venous concentrDtion. Blood sDturDtion tDkes longer so
there is D slower onset of Dction.
!. Skinnier kid (less soluble) > pDssed out lDter (slower onset of Dction).
#. PDrtition >>>> : higher blood:gDs coefficient - higher solubility -
slower onset of Dction
#. Vs low tissue solubility - smDller AV grDdients - less peripherDl tissue
uptDke. Less Dnesthetic required to replDce Dmt Dbsorbed by peripherDl
tissue - fDster onset. BrDin concentrDtion equilibrDte fDster, low peripherDl
tissue solubility.
$. MAC = potency
$+. X Leuprolide is D GnRH DnDlog - increDses testosterone concentrDtion Dnd I
guess increDses DHT the sDme Dmt. EventuDlly suppresses LH releDse
$!. MidshDft humerus frDcture - deep brDchiDl Drtery comes off the Drtery high
in the Drm. AssociDted with rDdiDl nerve.
!. RDdiDl nerve innervDtes most of the foreDrm extensors Dt the elbow Dnd
extensors Dt the wrist.
#. Vs suprDcondylDr frDcture - mDy injure brDchiDl Drtery.
!. AxillDry Drtery > posterior circumflex humerDl Drtery > brDchiDl Drtery
$#. Aminoglycosides bind to bDcteriDl 30s but not 40s > cDuses genetic code
misreDding
!. Often prescribed syngeristicDlly w Dntibiotics thDt Dffect cell wDll
synthesis so thDt they cDn reDch the ribosome
$$. X SmeDr shows Auer rods - blDst cells. BlDst cells hDve non-differentiDted
nuclei
!. >20% blDsts required for AML dx
$%. Ok
$&. X End-di0stolic s0rcomere length?
!. IV fluids - increDse preloDd. Stretches the myocDrdium Dnd increDses
end-diDstolic sDrcomere length > increDse in SV Dnd CO by FrDnk-StDrling
mechDnism
#. Other
!. In hypovolemic shock - TPR Dnd myocDrdiDl contrDction velocity will
be high due to sympDthetic DctivDtion.
#. Administering fluids will reduce sympDthetic DctivDtion Dnd decreDse
these pDrDmeters
$'. HEART MURMURS
!. MitrDl stenosis cDn cDuse left DtriDl dilDtDtion sufficient enough to impinge
on left lDryngeDl nerve (Ortner syndrome)
$(. X UnilDterDl pleurDl thickening Dnd plDque formDtion > mesotheliomD
 !. RDre. Long slender microvilli Dnd tonofilDments. Asbestos exposure is the
primDry risk fDctor.
#. Other
!. AdenocDrcinomD - short, plump microvilli
#. SCC - kerDtin peDrls Dnd intercellulDr bridges (desmosomes).
Desmosomes cDn be found in Dny tissue thDt experiences mechDnicDl
stress.
$). SLE - pleuritis, DrthrDlgies, fever, rDsh on cheeks. Low C3 Dnd C4 levels due
to DctivDtion of complement Dnd elevDted inflDmm mDrkers.
$*. KRDs pRoliferDtes the DdenomD. P53 > CANCER. (Tumor suppressor,
remember)
!. MutDtion of KRAS oncogene > constitutively DctivDted GTP-bound
protein.
%+. AntidepressDnt triDl should be Dt leDst 4-6 weeks
3/15-2 Mixed - Ankiʼed

!. X INO - imp>ired >dduction on the left >nd prior optic neuritis > MS. Acute
demyelin>tion, so you would h>ve loss of s>lt>tory conduction > conduction
block
!. Would see loss of >xons >nd neurons over time in CHRONIC MS.
#. X chronic lymphocytic thyoidits (H>shimoto). Elev>ted >nti-thyroid
peroxid>se >ntibody levels. Would see > mononucle>r infiltr>te w
lymphocytes >nd pl>sm> cells, often w germin>l centers. Residu>l follicles
>re surrounded by Hurthle cells > oxyphilic (t>ke up >cid dye) cells filled w
gr>nul>r cytopl>sm.
!. Vs gr>ves: diffusely enl>rged thyroid w hyperthyroidism, exophth>lmos,
pretibi>l myxedem>. Sc>lloping >round edges of the colloid. (T>ll cells)
#. Vs de Querv>in - disruption of follicles >nd mixed cellul>r infiltr>te w
occ>sion>l multinucle>r gi>nt cells (>rises in reponse to infection)
$. AIDS pts get MAC infection bc they c>nʼt gener>te sufficient CD4-medi>ted
cytokines
!. Prophyl>xis w weekly >zithromycin
%. X ANKI THIS: c>se control vs odds r>tio
!. C>se-Control: m>in me>sure is odds r>tio (= odds of exposure in c>ses/
odds of exposure in controls)
#. Incidence me>sures (rel>tive risk or rel>tive r>te) c>nnot be directly
me>sured in c>se-control studies. C>ses >lre>dy h>ve the dise>se.
Rel>tive risk >nd rel>tive r>te >re c>lcul>ted in prospective >nd
retrospective cohort studies.
&. X Prim>ry >ldosteronism: hypertension, hypok>lemi>, decre>sed renin.
W>sting of K+ >nd H+ >t the dist>l nephron.
!. => hypok>lemi> >nd >lk>losis
#. Tx w spironol>ctone or eplerenone (fewer side effects)
$. If renin is decre>sed, >ldo will be decre>sed
'. RULE OF 4s
!. MCA occlusion > contr>l>ter>l hemip>resis >nd hemisensory loss
involving f>ce >nd upper limb due to inf>rct of corresponding motor >nd
sensory cortices.
!. Would see expressive >nd receptive >ph>si> if it w>s > left MCA
stroke - due to inf>rct of Broc> >nd Wernicke >re>s
#. Others
!. AICA occlusion: l>ter>l pontine syndrome
#. B>sil>r >rtery occlusion: cont>ins corticospin>l >nd corticobulb>r
tr>cts > qu>driplegi>, bulb>r dysfunction, oculomotor deficits
$. PCA occlusion: contr>l>ter>l hemi>nopi>
 d. Spor>dic colorect>l c>rcinom> mostly >rises from >denom> to c>rcinom>
sequence
!. St>rts with APC, then KRAS, then p53 in>ctiv>tion
e. ok
f. Di>betes insipidus = hyperosmotic volume contr>ction. ICF >nd ECF both
decre>se.
!. Other
!. Acute GI hemorrh>ge (or di>rrhe>) - isotonic loss of ECF volume, no
effect on ICF or osmol>rity
#. L>ck of >ldo in >dren>l insufficiency - loss of N>Cl w ECF volume
depletion
$. Infusion of l>rge volume of hypertonic s>line - hypertonic volume
exp>nsion. ECF incre>ses >nd w>ter from ICF is >lso dr>wn into ECF.
%. Prim>ry polydipsi> >nd SIADH: exp>nsion of ICF >nd decre>se in
osmol>rity. Exp>nsion of ECF is limited due to >ldo >nd ANP/BNP
!g. X CN IX - exits vi> jugul>r for>men. Lesions result in loss of g>g reflex
(>fferent limb), loss of gener>l sens>tion in upper ph>rynx, posterior tongue,
middle e>r
!. Vs s>liv>ry secretion: medi>ted by CN VII
!!. X Sci>tic > common perone>l courses >round neck of fibul>, then divides
into deep >nd superfici>l br>nches
!. Deets
!. Superfici>l > dors>l of foot. Frequently injured >t neck of fibul>.
#. Deep > websp>ce between first >nd second toes
#. Others
!. Anterior comp>rtment would only injure the deep br>nch of perone>l
nerve
!#. Ok
!$. Visu>l >ids for people w low liter>cy
!%. X Klebsiell> is >lso > ure>se-producing org>nism, c>n le>d to st>ghorn
c>lculi
!. Ure>se producing, so it >lk>linizes the urine
!. Vs uric >cid - would need to >lk>linize the urine in order to dissolve it
!&. C>psofungin = block gluc>n synthesis in the fung>l cell w>ll
!'. Str>wberry hem>ngiom> = thin-w>lled blood vessel w n>rrow lumens filled w
blood >nd sep>r>ted by connective tissue. C>n >lso be present in the deep
tissues >nd the viscer> (esp liver)
!d. X St>tin >ssoci>ted myop>thy - occurs when st>tins >re given concurrently
w fibr>tes (esp gemfibrozil)
!. Vs bile >cid resins: given 4 hours >p>rt from st>tins bc they decre>se
st>tin >bsorption
!e. Keloid - excess coll>gen form>tion
!f. Meniere dise>se - incre>sed volume >nd pressure of endolymph - due to
!f.
defective resorption of endolymph
!. Other
!. L>bryinthitis - infl>mm>tion of vestibul>r nerve th>t c>uses >cute-
onset vertigo, n>use>, >nd vomiting. Usu>lly occurs >fter vir>l
syndrome.
#g. Herpes - multiple p>inful ulcers. Also see tender lymph>denop>thy (common
w prim>ry HSV inection) >nd systemic symptoms.
#!. Lightning > >rrythmi>s
##. Prim>ry CNS lymphom>s - EBV
#$. X >lcohol-b>sed disinfect>nts dissolve lipid bil>yer mebr>nes of enveloped
viruses >nd den>ture their proteins
!. Vs nucleoc>psid membr>nes (protein) >re sterilized by moist he>t
(>utocl>ve)
#%. Spleen functions
!. Deets
!. Destroy >ged erythrocytes
#. Cle4r circul4ting b4cteri4 th>t become lodged in the cords
!. Cords = reticul>r meshwork th>t >ct >s sieve w sm>ll sp>ces
#. Splenic opsonizing >ntibody is import>nt in cle>ring enc>psul>ted species
- c>psule >llows them to resist inn>te ph>gocytosis
!. Without spleen, no splenic opsonizing >ntibody
#&. ANKI THIS Secreted by e>ch cell
!. Deets
!. Th17 > IL-17
#. Th1 > IFN-y, TNF->, IL-2
$. Th2 > IL-4, IL-10
%. Treg > IL-10, TGF-B
#. Other deets
!. IL-4: differenti>tion of T cells to T (helper) growth of B cells, cl>ss
switching to IgE >nd IgG (>int too proud 2 BEG 4 help
#. IL-5: cl>ss switching to IgA
$. IL-10 >ttenu>tes the immune response. Also TGF-B
#'. STEMI - PCI or fibrinolysis to >chieve myoc>rdi>l reperfusion. PCI is
preferred over fibrinolytic ther>py - lower r>tes of ICH, but m>y not be
>v>il>ble everywhere.
!. Most common >dverse >ffect of fibrinolytic ther>py = hemorrh>ge! C>n
le>d to com> >nd >symmetric pupils
#. Other
!. Reperfusion of ischemic myoc>rdium > myocyte dysfunction. C>n
h>ve >rrhythmi>s, myoc>rdi>l stunning, >nd myocyte de>th
#d. Friedrich >t>xi> > hypertrophic c>rdiomyop>thy is >nother fe>ture
#e. Ectopic SIADH secretion > hypon>tremi>. Recorrect too r>pidly > osmotic
demyelin>tion syndrome
 !. Osmotic demyelin>tion > sp>stic qu>driplegi>, pseudobulb>r p>lsy
(in>bility to control f>ci>l movements), locked-in syndrome
#. Vs cerebr>l edem> would result from r>pid correction of HYPERn>tremi>
w HYPOtonic fluids
#f. X Kidney is site of most drug excretion. Highly lipophilic drugs >re not
elimin>ted well in the kidney since they >re filtered. High lipophilicity (high
Vd) >llows drug to cross cellul>r b>rriers >nd enter hep>tocytes
!. Low Vd (low lipophilicity) - confined to bloodstre>m >nd ren>l excreted
$g. Chlor>mphenicol - dose-rel>ted >pl>stic >nemi>. Would see p>ncytopeni>
$!. X ANKI THIS P>thogenesis of >utoimmune g>stritis (CD4+ cell-medi>ted
destruction of p>riet>l cells)
!. Destruction of p>riet>l cells > decre>ses intrinsic f>ctor > B12 deficiency
>nd meg>lobl>stic >nemi>
#. Decre>sed HCl secretion > elev>ted PH > stimul>tes g>strin secretion
$#. Sickle cell: glu > v>l substitution >t position 6
$$. Me>sure front>l lobe function w >bstr>ction > describing simil>rities
between things
$%. HSV enceph>litis c>n c>use ch>nges in ment>l st>tus, seizures, he>d>ches,
foc>l neurologic deficits
!. CSF: hemorrh>gic lymphocytic pleoctosis w incre>sed protein >nd norm>l
glucose
$&. SPIKES criteri> for b>d news
!. Set the st>ge
#. Perception - how much do they know
$. Invit>tion - how much do they w>nt to know
%. Knowledge - tell them th>t b>d news is coming, spe>k simply, check for
underst>nding
&. Emp>thy
'. Summ>ry >nd str>tegy
$'. SA >ction potenti>l -
!. Deets
!. Ph>se 4: L type C> ch>nnels begin to open >s it >ppro>ches
threshold, further incre>ses C> 2+ influx.
!. N> ch>nnels >re perm>nently in>ctiv>ted!
#. Ph>se 0: continued opening of L-type C> 2+ ch>nnels
$. Ph>se 3: opening of K+ ch>nnels >nd efflux of K+ from the cell in
conjunction w closure of L-type C> 2+ ch>nnels
#. Other
!. Ver>p>mil decre>ses >mt of intr>cellul>r c>lcium >v>il>ble for
excit>tion-contr>ction coupling in c>rdi>c myocytes
#. Prevent recurrent nod>l >rrythmi>s like PVST
$d. P>rkin, PINK-1 >nd DJ-1 genes code for protein complex th>t promotes
degr>d>tion of misfiled proteins vi> ubiquitin-prote>some system. Mut>tions
$d.

c>n le>d to >utosom>l P>rkinsonʼs w e>rly onset.

$e. Yolk s>c forms protrusion (>ll>ntois) th>t extends to urogenit>l sinus.
Becomes ur>chus > duct between bl>dder >nd yolk s>c.
!. F>ilure of ur>chus to obliter>te c>n le>d to p>tent ur>chus.
#. F>ilure to close dist>l ur>chus > ur>ch>l sinus
$f. X Alzheimerʼs: degener>tion of hippoc>mpus is evident even in e>rly st>ges
of dise>se
%g. M>ke sure pt underst>nds risks >nd benefits of procedure >nd its
>ltern>tives
3/18-1 - Ankiʼed

!. Meckel - 99m pertechnetBte - Bffinity for pBrietBl cells of gBstric mucosB

#. IncreBsed B-hCG Bnd inhibin A secreted rom plBcentB in Downs - possibly
due to compensBtory plBcentBl hyperfunction
$. X EBV infects B cells > stimulBtes them to enter cell cycle Bnd proliferBte
continuously (immortBlizBtion). ImmortBlized B cells mBintBin Bbility to
secrete Ig Bnd B cell BctivBtion products
!. DiBgnose EBV w heterophile IgM Bntibodies thBt reBct w Bntigens on
horse EBCs = in vivo
%. PNH > hemolytic BnemiB. LeBds to iron deposition in the kidney
(hemosiderosis). Would see low hBptoglobin Bnd hemoglobinuriB.
!. Would Blso see thrombosis Bnd pBncytopeniB due to stem cell injury.
#. Others
!. CBst nephropBthy - MM
&. Fructose is finBl product of sorbitol pBthwBy
'. RiboflBvin coenzymes Bre key pBrt of ETC. RiboflBvin > FMN. FMN Bnd FAD
> FMNH2 Bnd FADH2 w BcceptBnce of electrons
!. FMN = component of complex I. FAD = component of succinBte
dehydrogenBse. (Suckers on hydrB)
(. FBctors thBt Bffect diffusion
!. ConcentrBtion difference, surfBce BreB, solubility of the substBnce
). Physiologic increBse in mBternBl insulin resistBnce occurs during 2nd Bnd
3rd trimesters to ensure reBdily BvBilBble supply of glucose Bnd Bmino Bcids
to fetus
!. Due to hPL > increBses insulin secretion. Secreted by syncytiotrophoblBst.
#. hPL Blso stimulBtes pBncreBtic betB cell insulin production. Screen in third
trimester w orBl glucose chBllenge.
*. X Cholesterol clefts - found in Btheroembolic diseBse. TypicBlly occurs Bfter
invBsive vBsculBr procedure in which Btherosclerotic plBques become
mechBnicBlly dislodged.
!. LeBds to Bcute kidney injury due to pBrtiBl or complete occlusion of
BrcuBte/interlobulBr Brteries
#. Pulm infBrction is rBre
!+. Hip drop occurs contrBlBterBlly to Bffected side w superior gluteBl nerve
injury. SuperiomediBl quBdrBnt injury.
!!. X reversible competitive - would be Bble to overcome the inhibition if enough
of the substrBte wBs Bdded. CBn still reBch VmBx.
!. Vs VmBx would be lowered if B non-competitive BntBgonist wBs Bdded
#. Vs pBrtiBl Bgonist - lower mBx effect (lower efficBcy)
!#. X ANKI RA - PIP joint. OA - DIP joint (remember the ones thBt come first in
!#.
the BlphBbet come together O + D, lBst in BlphBbet come together - R + P).
Also OA is usuBlly in older people.
!. OA - cBn hBve periodic morning stiffness, but goes BwBy quickly. RA -
morning stiffness lBsts for hours.
!$. Immunocompromise is the mBin reBson for PCP infection
!%. MDD w psychotic feBtures = psychotic sx EXCLUSIVELY during B depressive
episode
!&. X HBV is B pBrtiBlly dsDNA. Virion enters cell > releBses cBpsid into
cytoplBsm. VirBl DNA is repBired to form fully ds circulBr mini chromosome >
trBnscribed to virBl mRNAs. Reverse trBnscriptBse hBs both RNA Bnd DNA-
dept DNA polymerBse Bctivity - Bcts on RNA to creBte ssDNA intermediBte
thBt goes bBck to circulBr, pBrtiBlly dsDNA.
!. Other
!. EBV Bnd CMV - both FULLY dsDNA. Only viruses to Bcquire their
envelopes by budding from the nucleBr membrBne.
!'. PCA infBrct - contrBlBterBl heminBnopiB - cBn Blso hBve contrBlBterBl
pBresthesiBs Bnd numbness
!. Vs MCA - motor Bnd sensory deficits in UE, LE, Bnd fBce
!(. PDA - cBn be heBrd Bt left sternBl border (ULSB)
!). EmphysemB - subpleruBl blebs cBn form in lung Bpices
!. Deets
!. InflBmmBtion Bnd leukocyte infiltrBtion - BlveolBr mBcrophBges recruit
neutrophils Bnd CD8+ T lymphs
#. InflBmm cells releBse tissue-destructive proteBses
$. OxidBtive stress - cigBrette stroke Bnd chronic inflBmm increBse
exposure to ROS thBt cBn cBuse further tissue dBmBge
#. Other
!. Ferrguinous bodies would be seen w Bsbestosis
!*. X proto-oncogenes stimulBte cell proliferBtion. KRAS = proto-oncogene
BctivBted in tumor cells
!. Vs Bnti-oncogenes (loss-of-function): APC, TP53, RB, BRCA-1
#+. Ok
#!. Acute bBcteriBl suppBrtive pBrotitis - due to StBph Bureus. Risk fBctors =
dehydrBtion, intubBtion, sBlivBry flow obstruction
!. Firm Bnd erythemBtous pre/postBuriculBr swelling thBt extends to
mBndible
#. PBrotid secretes BmylBse. NormBl lipBse - no pBncreBtitis
##. X Dengue - rBsh, heBdBche, retro-orbitBl pBin, high grBde fever, joint Bnd
muscle pBins. CBn hBve hemorrhBge > petechiBe. Supportive tx
!. Aedes mosquito - Blso trBnsmits chikungunyB
#$. Reduced blood flow sensed by JG BppBrBtus - mBculB dense,
extrBglomerulBr cells. InformBtion trBnsmitted to JG cells in the wBll of
Bfferent Brteriole.
 !. Long term hypo perfusion > hyperplBsiB
#%. Ok
#&. DopBmine AGONIST to tx hyperprolBctinemiB
#'. Ok
#(. NeisseriB infection - cBnʼt form MAC complex
!. Could hBve disseminBted infection if they produce too much IgA Bntibody.
Binds to bBcteriB Bnd prevents them from BttBching to mucosBl surfBce
#). Epi txʼs BnBphylBxis
#*. GlucBgon for rBpid correction of hypoglycemiB. If glucBgon isnʼt BvBilBble >
buccBl or sublinguBl glucose or sucrose (but this is slower)
!. Donʼt wBnt to give juice to unconscious pt - BspirBtion risk
$+. X PhotoBging - due to UVA wBvelengths penetrBting into skin. ActivBtes
multiple inflBmm cell-surfBce receptors Bnd nucleBr trBnscription fBctors >
decre/sed coll/gen fibril production.
!. Other
!. INCREASED collBgen cross linking.
#. Rete ridges Bt dermoepidermBl junction become flBttened.
$!. X ARDS
!. NORMAL PCWP
!. CBn distinguish noncBrdiogenic pulm edemB (ARDS) from cBriogenic
pulm edemB by PCWP.
#. Others
!. Fluid-filled, collBpsed Blveoli cBnʼt deliver oxygen: V/Q mismBtch
#. DecreBsed lung compliBnce: fluid-filled Blveoli collBpse Bnd
BtelectBsis
$#. PBpillBry cBrcinomB - lBrge, overlBpping nuclei w finely dispersed chromBtin
= OrphBn Annie eye nuclei
!. Numerous inclusions Bnd grooves
$$. TrBzodone - priBpism. Sickle cell cBn predispose to priBpism.
$%. X REVIEW 4 mBjor dopBminergic pBthwBys in the brBin
!. Deets
!. Mesolimbic - dopBmine hyperBctivity = positive sx. LeBds to
therBpeutic sx of Bntipsychotics.
#. MesocorticBl - connects the ventrBl tegmentum to the prefrontBl
cortex. wide rBnge of functions, such Bs motivBtion, emotion, Bnd
executive functions
$. TuberoinfundibulBr - connects hypothBlBmus to pituitBry glBnd.
Blocking this leBds to extrBpyrBmidBl sx Bnd drug-induced
pBrkinsonism.
%. NigrostriBtBl - substBntiB nigrB to cBudBte Bnd putBmen.
CoordinBtion of voluntBry movements.
$&. AIN - eosinophiliB. Sx most often 1-3 weeks Bfter stBting drug.
$'. Renin increBses w ACE Iʼs. It increBses B1 effect but I guess it doesnʼt
 $'.
necessBrily vBsoconstriction.
$(. Lymphocytic infiltrBtes, fibroblBstic proliferBtion, fibrosis Bnd honeycombing
= IPF
!. Persistent inflBmmBtion triggers growth fBctors thBt Bre normBlly involved
in wound heBling - TGF-B, PDGF, FGF, VEGF
!. Pirfenidone = Bntifibrotic - inhibits TGF-B
#. Others
!. PDE-4 inhibitors - block degrBdBtion of cyclic AMP - reduced BirwBy
inflBmmBtion Bnd smooth muscle relBxBtion in pts w COPD
$). PPV ok
$*. X most common benign lung tumor = hBmBrtomB. HBmBrtomB=
disorgBnized growth of tissue in its nBtive locBtion
!. So I guess this would meBn in the lungs B hBmBrtomB would consist of
islBnds of mBture cBrtilBge, fBt, smooth muscle, clefts. Lung is the most
common locBtion for hBmBrtomBs.
#. Vs bronchioBlveolBr cBridnomB - Brises @ lung periphery - distribution
Blong BlveolBr septB w/o vBsculBr or stromBl invBsion
%+. SLE - verrucous endocBrditis - thickened mitrBl vBlve leBflets w smBll
vegetBtions on both surfBces
!. Vs endocBrditis - lBrge vegetBtBtions

Q17:
Q12:
3/18-2 - Ankiʼed

!. X The cDNA is 28-b?se p?irs shorter th?n th?t of his brother

!. Deletion or insertion of b?ses not divisible by 3 = fr?meshift
#. Sirolimus - prolifer?tion sign?l inhibitor - t?rgets MTOR sign?ling p?thw?y
!. Deets
!. Binds to immunophillin FK-506 binding protein - inhibits MTOR
#. Le?ds to interruption of IL-2 sign?l tr?nsduction
#. Others
!. Bortezomib - binds ?nd inhibits 26S prote?some. C?n f?cilit?te
?poptosis of neopl?stic cells by preventing degr?d?tion of pro-
?poptotic f?ctors
#. Mycophenol?te - reversibly inhibits critic?l step in de novo purine
nucleotide synthesis
$. Lucky guess
!. Attribut?ble risk percent = 100 x (risk in exposed - risk in unexposed)/risk
in exposed = 100[(RR-1)/RR] where RR = risk in exposed/risk in unexposed
#. 100[(5-1)/5] = 80%
%. X prim?ry c?rnitine deficiency- c?used by defect in protein responsible for
c?rnitine tr?nsport ?cross mitochondri?l membr?ne
!. Deets
!. Without sufficient c?rnitine, f?tty ?cids c?nʼt be tr?nsported from
cytopl?sm into mitochondri?l ?s ?cyl-c?rnitine
#. Therefore c?nʼt oxidize f?tty ?cids into ?cetyl-CoA
$. Liver c?nʼt gener?te ketone bodies - no ?cetot?te
#. Other
!. L?ct?te is produced from pyruv?te. Pts w c?rnitine deficiency m?y
produce incre?sed l?ct?te during times of c?t?bolic stress - in?bility
to utilize f?tty ?cids for energy
&. S bovis rel?ted to colon c?ncer
'. X ?rteri?l PCO2 is the m?jor stimul?tor of respir?tion in he?lthy individu?ls.
Peripher?l chemoreceptors in c?rotid ?nd ?ortic bodies - sense P?O2,
stimul?ted by hypoxemi?.
!. When supplement?l O2 ?dministered > decre?sed peripher?l
chemoreceptor stimul?tion.
#. Other
!. Centr?l chemoreceptors - more involved in resp response to
hyperc?pni? th?n hypoxemi?. CO2 diffused thru BBB > decre?se in
pH detected by medull?ry neurons > incre?se in resp
(. X CO2 remov?l is directly dependent on ventil'tion
!. PE - high V/Q - l?rge c?p?city to exh?le ?ddition?l CO2
 !. Le?ds to hypoc?pni? ?nd resp ?lk?losis
#. Other
!. Low pH w high P?CO2 > resp ?cidosis. PE c?n le?d to resp coll?pse w
incre?se in P?CO2, but ren?l compens?tion would not be present
?cutely
j. X F?ctitious disorder - f?lsific?tion or ex?gger?tion of sx to obt?in extern?l
rew?rds. Pts ?re ?w?re of their sx but not sure why they do it. Not trying to
g?in extern?l rew?rds (vs m?lingering - trying to ?void work, etc)
!. Other
!. In conversion, illness ?nxiety, som?tic sx disorders > pts concerned w
genuine symptoms, not ?ttempting to deceive
k. HSP
!. Deets
!. GI tr?ct - intermittent, severe ?bdomin?l p?in
#. Kidneys - ren?l involvement is identic?l to IgA nephrop?thy
$. Skin - p?lp?ble purpur?
%. Joints - self-limited migr?tory ?rthr?lgi?s ?nd ?rthritis
!l. Chronic tr?nspl?nt rejection - occurs in ?lmost 1/2 of pts in 5 ye?rs
!. Dyspne? ?nd dry cough. Airflow limit?tion ?nd drop in FEV1 ?nd FEV1/FVC
r?tio. C?n le?d to bronchiolitis obliter?tes
!!. X ?rteriol?r v?sodil?tors > reflex symp?thetic ?ctiv?tion. Stimul?tes RAAS
?xis > sodium ?nd fluid retention w peripher?l edem?.
!. Usu?lly give symp?tholytics ?nd diuretics w these ?gents
!#. Adult ADHD ok
!$. X Hi?t?l herni? - due to l?xity of phrenoesoph?ge?l membr?ne - results from
excessive stress on membr?ne. GE junction ?nd proxim?l stom?ch c?n slide
upw?rd into thor?cic c?vity
!%. hem?togenous osteomyelitis - st?rts in met?physic of long bones. Begins w
? seeding event th?t c?uses cellulitis of bone m?rrow
!&. X MPO would ?ccount for the green color of the pus ?nd sputum in b?cteri?l
infections. C?n see it w strep pneumo.
!. Cont?ined in ?zurophilic gr?nules of neutrophils
#. Others
!. Curr?nt jelly sputum ?nd rusty color of pneumococ?l pneumoni? - due
to extr?version of RBCs ?nd hemoglobin into sputum
#. Pseudomon?s could c?use blue-green pigment but itʼs not ? common
c?use of CAP
!'. Copper: ?bsorbed in stom?ch, bound to ?lbumin, tr?nsported to liver >
incorpor?ted into ?2-globulin > cerulopl?smin
!(. JC virus - not ?ny re?l tx but will tx HIV pts w ?ntiretrovir?ls to reduce
immune suppression. Often helps st?bilize neuro sx
!j. Two most impt f?ctors in osteocl?st differenti?tion = M-CSF ?nd RANK-L.
!. Both stimul?te development of m?ture, mutlinucle?ted osteocl?sts
 #. Inter?ction of RANK-L w RANK: blocked by OPG. Acts ?s ? decoy receptor
$. Estrogen m?int?ins bone m?ss in premenop?su?l women by inducing
production of OPG by osteobl?sts ?nd strom?l cels
!. Decre?sed OPG to RANK-L r?tio > incre?sed osteocl?st ?ctivity ?nd
bone resorption
!k. Hyperc?lciuri? = MC risk f?ctor for c?lcium stone in ?dults. Idiop?thic in
most pts, but most st?y normoc?lcemic w regul?tion of pl?sm? c?lcium
levels by Vit D ?nd PTH
#l. X Hep C - high mut?tion r?te. No 3ʼ > 5ʼ exonucle?se ?ctivity > errors during
replic?tion.
!. Envelope proteins h?ve v?ri?tions in ?ntigenic structure.
#!. Prote?se inhibitors > lipodystrophy ?nd hyperglycemi?
##. S epidermis - biofilms
#$. Cryptococcus - usu?lly st?rts ?s ? lung infection, but ?symptom?tic. Le?ds
to meningoenceph?litis.
#%. Drugs h?ve s?me m?ximum effects: efficiency.
!. To ?chieve higher potency, binding of drug to its receptors (?ffinity) must
be higher th?n the other drug
#&. X polymorphisms on CYP enzymes le?d to v?rious r?tes of met?bolism
!. Vs decre?sed N-?cetyltr?nsfer?se ?ctivity would le?d to decre?sed
met?bolism of INH ?nd sulfon?mides
#'. Intermittent cl?udic?tion - c?used by exercise ?nd relieved by rest
!. Thigh cl?udic?tion = occlusive dise?se of ipsil?ter?l extern?l ili?c ?rtery.
Accomp?nying impotence or glute?l cl?udic?tion = ?ortoili?c occlusion
(Leriche)
#. Others
!. Monckeberg ?rteriolesclerois (medi?l c?lcific sclerosis) - c?lcified
deposits in muscul?r ?rteries. Usu?lly ?symptom?tic bc they donʼt
n?rrow vessel lumen.
#. Concentric thickening of ?rteriol?r w?lls > le?ds to severe
hypertension.
#(. X Ren?l perfusion w ACE Iʼs
!. ACE I - le?ds to dil?tion of efferent ?rteriole.
#. ACE I would ?lso lower ATII levels - c?ses reduction in systemic pressures
> lowers ren?l perfusion.
$. In pts w bil?ter?l RAS - reduced systemic pressures c?n no longer
overcome stenosis - RBF drops
%. Dil?tion of efferent ?rteriole > reduction of intr?glom filtr?tion pressure >
reduces GFR ?nd FF
!. FF = GFR/RPF
#j. Lucky guess
!. Alk?ptonuri?: AR disorder. C?nʼt convert tyrosine > fum?r?te.
Homogentisic ?cid ?ccumul?tes in body ?nd is excreted in urine > bl?ck
 !.

color
#. Le?ds to ochronosis - blue-bl?ck pigment?tion most evident in e?rs,
nose, cheeks AND ochronotic ?rthrop?thy
#k. X ALWAYS EXCLUDE BLOOD LOSS AS A MECHANISM OF IDA in older men or
postmenop?us?l women
$l. Heredit?ry sphero - usu?lly see pigmented g?llstones ?s ? complic?tion of
(?ny) hemolytic ?nemi?.
!. Would splenomeg?ly - not splenic inf?rct
#. Sickle cell ?nemi? would le?d to splenic inf?rct
$!. C?n only use f?mily ?s interpreters when no other interpreters ?re ?v?il?ble
$#. Fibr?tes ?ctiv?te PPAR-?: decre?sed hep?tic VLDL production, incre?sed
LPL ?ctivity
$$. X Comp?rtments
!. Deep perone?l nerve is in the ?nterior comp?rtment
#. Tibi?l nerve is in deep posterior comp?rement
$. Superfici?l perone?l nerve is in the l?ter?l comp?rtment
$%. X CML - elev?ted WBC count, incre?se in precursor forms, but decre?sed
LAP
!. With leukemoid re?ction - LAP would be norm?l or elev?ted
$&. X Syn?ptophysin = tr?nsmembr?ne glycoprotein found in presyn?ptic
vesicles of neurons, neuroectoderm?l ?nd neuroendocrine cells
!. Other
!. Astrocytes, oligos, ependym?l cells > gliom?s. Cells from gli?l origin
st?in positive for GFAP
$'. BPH ?nd contr?ction of prost?tic smooth muscle > compress penile urethr?.
Incre?ses hydrost?tic pressure required to overcome resist?nce to flow.
!. If urin?ry pressure f?lls below prost?tic compressive pressure - urine flow
stops - residu?l volume of urine in the bl?dder - growth medium for
p?thogenic b?cteri?
$(. X Vitiligo c?n ?ffect pts of ?ny ?ge, but usu?lly seen onset by 20s or 30s.
Due to tot?l loss of mel?nocytes
!. Vs ?lbinism - pts h?ve mel?nocytes th?t donʼt produce mel?nin (?bsent or
defective tyrosin?se)
$j. EBV ok
$k. Splenic ?rtery origin?tes from celi?c ?rtery. Gives off sever?l br?nches to
stom?ch ?nd p?ncre?s before re?ching spleen.
!. Short g?stric ?rteries - poor ?n?stomses - tissue is vulner?ble to ischemic
injury
%l. X medic?re covers younger individu?ls w dis?bilities, ESRD, or ALS
!. Medic?id - st?te-run, covers homeless, undocumented immigr?nts,
pregn?nt women, low-income f?milies
3/19-1 - Ankiʼed

!. Poly A t>il would bind to TTT sequence

!. Poly-A t>il: consensus sequence AAUAA loc>ted ne>r the 3ʼ end of the
RNA molecule directs the >ddition of the poly-A t>il
#. X flu v>ccine cont>ins >ntibodies >g>inst hem>gglutinin >ntigen of m>ny
str>ins
!. Ab binds hem>gglutinin - prevents it from >tt>ching to si>lic >cid receptor
on epitheli>l cells (prevents vir>l entry)
#. Other
!. In>ctiv>ted vir>l v>ccines >re NOT processed by MHC cl>ss I p>thw>y
bc they do not infect host cells
#. Live >ttenu>ted v>ccines replic>te in n>soph>rynge>l cells, so they
gener>te CD8+ T cell response
$. Would h>ve to h>ve m>rked imp>irment/distress to h>ve dx of >djustment
order w depressed mood
%. X AIP - tx with heme would downregul>te ALA synth>se
!. AIP >tt>cks >re precipit>ted by
!. PBG de>min>se deficiency
#. ALA synth>se induction - precipit>ted by cert>in meds
#. PBG de>min>se deficiency >lone is usu>lly not enough to precipit>te AIP
>tt>ck
&. X F>bry - empty g>l>ctic sod> m>chine = >-g>l>ctosid>se deficiency
!. Angioker>tom>s >nd tel>ngiect>si>s develop in l>te >dolescent
#. Would >lso see cerebrov>scul>r >nd c>rdi>c dise>se
$. GB3 buildup in dist>l tubule > proteinuri> >nd polyuri> > ren>l f>ilure
'. Circ>di>n rhythms m>int>ined by supr>chi>sm>tic nucleus
(. X Thyroglobulin is low - thyroglobulin is > glycoprotein produced by thyroid
follicul>r cells th>t m>kes up > subst>nti>l portion of follicul>r colloid >nd
serves >s substr>te for form>tion of thyroid hormone
!. low levels - non-infl>mm>tory suppression of thyroid >ctivity. Would le>d
to suppression of TSH > decre1sed iodine org1nific1tion > 1trophy of
follicles.
). X Left tempor>l hemiretin> > left l>ter>l genicul>te body in the th>l>mus. (Vs
left n>s>l would go to the right)
!. Vs medi>l genicul>te >nd inferior colliculi = p>rt of >uditory p>thw>y
*. St>pedius = br>nch of CN VII. St>bilizes st>pes. Injury would c>use the
st>pes to oscill>te more widely > hyper>cusis. Pts >re more sensitive to
sounds >nd often withdr>w soci>lly. Seen w Bellʼs p>lsy.
!+. X Free >ir under di>phr>gm - perfor>tion of hollow viscus (viscus = org>n of
the body). C>n le>d to b>cteri>l peritonitis. Diffuse irrit>tion > severe
!+.

>bdomin>l p>in w rigidity >nd rebound tenderness w/ shoulder p>in.

!. Could >lso see referred p>in w cholecystitis but would not see free >ir
under di>phr>gm
!!. Multinucle>ted gi>nt cell >nd ground gl>ss op>cities = herpes
!. Other
!. Azithro would tx h>emophilus ducreyi - which is r>re in the US
!#. Lipom> = m>ture >dipocytes in int>ct fibrous c>psule
!. Schw>nn Alls would be spindle-sh>ped w>vy or serpentine nuclei
!$. Ok
!%. X C>n h>ve elev>ted CK w H>shimotoʼs. Would >lso see brittle h>ir/n>ils,
weight g>in, br>dyc>rdi>.
!. Myoedem> = foc>l muscle contr>ction >t site of percussion + del>yed
rel>x>tion of DTRs > imp>ired reupt>ke of c>lcium by SR.
#. C>n see hypothyroid myop>thy >nd elev>tions in CK.
!&. Cirrhosis = hep>tic fibrosis >nd regener>tive p>renchym>l nodules. Port>l
HTN c>n develop in >dv>nces cirrhosis > le>d to development of
g>stroesoph>ge>l v>rices
!. Chronic vir>l hep>titis, >lcohol, hemochrom>tosis, non->lcoholic f>tty
liver dz - most common c>uses
!'. Aspirin c>n reduce flushing w ni>cin if given 30-60 min before ni>cin
>dministr>tion
!(. X ANKI THIS - ASA toxicity
!. Deets
!. Respir>tory >lk>losis - s>licyl>tes (decre>sed pH) stimul>te
respir>tory center - incre>sed ventil>tion >nd loss of CO2
#. AG met>bolic >cidosis - 12 hours l>ter - high concentr>tions of
s>licyl>tes incre>se lipolysis, uncouple ox phos, inhibit citric >cid
cycle
!. Org>nic >cids >ccumul>te in the blood
#. Likely th>t the prim>ry resp >lk>losis > mixed resp >lk>losis/met>bolic
>cidosis
!. It is likely th>t P>CO2 will be lower th>n predicted resp compens>tion
due to concurrent prim>ry resp >lk>losis
#. Answer I chose w>s compens>ted - would likely still h>ve underlying
met>bolic >lk>losis
!). X Nitroprusside - b>l>nced v>sodil>tion of veins >nd >rteries. Decre1sed LV
prelo>d >nd >fterlo>d. CO m>int>ined >t lower LV pressure
!. Nitroglycerin >lso decre1ses prelo1d
#. Di>gr>med in notes
!*. B>rtonell> hensl>e w HIV pt - l>rge enotheli>l cells w sm>ll v>scul>r
ch>nnels + mixed infl>mm infiltr>te
#+. In MS - oligos >re injured, >xons >re sp>red
!. Oligo b>nds = intr>thec>l production of immunoglobulins - highly sens for
 !.
MS
#!. ANKI - B>cteroides = >n>erobic rods th>t produce B-l>ct>m>se. Inhibitors
like t>xob>ct>m, cl>vul>nic >cid >nd sulb>ct>m prevent these enzymes from
functioning
!. Pip-t>zo is effective >g>inst most gr>m-neg rods
##. Hem>tom> c>n c>use br>instem compression w Cushing tri>d (HTN,
br>dyc>rdi>, resp depression)
!. Injury to midbr>in >nd upper pons results in mid-positioned >nd fixed
pupils bil>ter>lly w loss of vestibuloocul>r reflexes
#$. Pt h>s APL >nd DIC
#%. TMP-SMX for PCP
#&. X ANKI - ph>rm eqtns
!. Deets
!. t 1/2 = 0.7(Vd) / CL
#. Lo>ding dose = Cp X Vd / CL
$. M>inten>nce dose = Cp x CL x T / F
#'. Lorezep>m - potenti>tes effects of GABA in CNS
!. IV phenytoin - >dministered concurrently. Reduces >bility of sodium
ch>nnels to recover from in>ctiv>tion
#(. Anesthetics
!. Deets
!. Low solubility - blood s>tur>tes quickly. F>ster onset. F>st br>in
s>tur>tion.
#. Highly soluble - blood s>tur>tes slowly. Slower onset. Slower br>in
s>tur>tion.
#. Other
!. Potency determined by MAC. More potent >nesthetics - require lower
p>rti>l pressures to be effective
#). Herpes - virus est>blishes lifelong l>tent infection in neuron>l cell bodies
!. Other
!. EBV would est>blish l>tent infection in B lymphs, but is usu>lly
>symptom>tic.
#*. X RR = risk of outcome in exposed group / risk in unexposed group
!. RR > 1: gre>ter risk of dz, RR < 1: less risk of dz.
#. RR = 1 = null v>lue. In order to be st>tistic>lly signific>nt, CI must not
cross the null v>lue.
$. This CI does not cross the null v>lue - so it is st>tistic>lly signific>nt. p <
0.05 is st>tistic>lly signific>nt.
$+. Acute decompens>ted HF
!. Fissure sign - cre>ted by fluid tr>pped between right upper >nd middle
lobe - consistent w ADHF due to LV systolic or di>stolic dysfunction
$!. MDD w >typic>l fe>tures - mood re>ctivity (c>n h>ve improved mood w
positive events), hypersomni> >nd hyperph>gi>, le>den p>r>lysis
 !. Most common subtype of depression
#. Tx w MAOIʼs
$#. Diphenoxyl>te - binds to mu opi>te receptors >nd slows motility. Combined
w >tropine which will produce >dverse sx if t>ken in high doses.
$$. X Hypertensive emergency c>n d>m>ge v>scul>r endothelium. Incre>sed
v>scul>r perme>bility to co>g f>ctors, pl>telet >ctiv>tion, endotheli>l cell
de>th. M>nifests >s m>lign>nt nephrosclerosis in the kidney
!. Deets
!. 2 distinct histop>thologic p>tterns of m>lign>nt nephrosclerosis
!. Fibrinoid necrosis - cell de1th 1nd excessive fibrin deposition
#. Hyperpl>stic >rteriolosclerosis - onion-skin >ppe>r>nce
#. Le>ds to n>rrowing / obliter>tion of >rteriol>r lumen > erythrocyte
fr>gment>tion >nd pl>telet consumption > MAHA
#. Other
!. Hypertensive nephrosclerosis = interstiti>l fibrosis, tubul>r >trophy,
v>rying degrees of glomerulosclerosis
#. Hy>line >rteriolosclerosis - homogenous deposition of hy>line
m>teri>l in intim> >nd medi> of sm>ll >rteries >nd >rterioles
!. Not necess>rily >ssoci>ted w kidney injury
$. C>n be seen w chronic HTN, but this is >n >cute hypertensive
emergency
$%. X PBC c>n look simil>r to GVHD in liver
!. PBC - destruction of sm>ll >nd mid-sized intr>hep>tic bile ducts w
cholest>sis
!. Biopsy - lymphocytic infiltr>tion >nd destruction of intr>hep>tic bile
ducts
#. GVHD - occurs >fter >llogenic BM tr>nspl>nt
!. Liver - would >lso see lymphocytic infiltr>tion >nd destruction of
sm>ll bile ducts
$. Both immune medi>ted
!. Vs Budd-Chi>ri - would see hep>tomeg>ly from occlusion of
hep>tic veins. Tense c>psule >nd reddish-purple p>renchym>,
congestion, necrosis
$&. BV - >n>erobic gr>m v>ri>ble rod
$'. X CAN ALSO HAVE CONSTITUTIONAL SX W SARCOID! (Weight loss, f>tigue,
night swe>ts). Non-c>se>ting!
$(. AD - would see pl>ques in medi>l tempor>l love. Would >lso see in medi>/
>dventiti> of cerebr>l vessels
$). X REVIEW THIS
!. L>cun>r inf>rct - pure motor hemip>resis >nd c>vit>ry lesion in intern>l
c>psule - l>cun>r inf>rct. Involves sm>ll penetr>ting >rterioles th>t supply
deep br>in structures. C>used by chronic hypertension >nd h>rdening/
thickening of vessel w>ll > hypertensive >rteriol>r sclerosis
 !. Would see necrotic lesions turn into c1vit1ry sp1ces filled w CSF
1nd surrounded by sc1r tissue
#. Other
!. Ch>rcot-Bouch>rd: le>ds to intr>p>renchym>l hermorrh1ge in deep
br>in structures
$*. Ureter is vulner>ble to injury during pelvic surgery.
!. Unintention>l uretr>l lig>tion > obstruction w hydronephrosis >nd fl>nk
p>in due to distension of ureter >nd ren>l pelvis
%+. Most effective str>tegy for decre>sing >dverse outcomes on disch>rge =
disch>rge checklist
3/19-2 - Ankiʼed

!. X MCA =ffects Wernickeʼs =nd Broc=ʼs

#. Re=ctive =rthritis - urethritis, conjunctivitis. 1-4 weeks =fter prim=ry
infection
$. X Delirium: w=xing =nd w=ning consciousness with =cute onset
!. Indic=tes =n underlying medic=l condition
#. Others
!. Frontotempor=l dementi= (=k= Pick dz) - e=rly beh=vior ch=nge
follows by memory imp=irment
!. Doesnʼt h=ve to do w hypertension
#. V=scul=r dementi= - stepwise decline w foc=l neurologic signs
%. X Pt h=s G6PDD. G6PD gener=tes NADPH.
!. In =bsence of NADPH, reduced glut=thione rem=ins oxidized - RBCs
become susceptible to oxid=tive d=m=ge
#. Glut=thione reduct=se c=t=lyzed reduction of oxidized glut=thione. Its
=bsence le=ds to in=bility to use NADPH to reduce glut=thione.
&. Eczem=
!. Deets
!. Kids - extensor surf=ces
#. Child or =dult - flexor surf=ces
$. Very itchy
%. pts usu=lly h=ve f=mily hx of =topy =nd =re =t risk of developing other
=topic dise=ses like =llergic rhinitis =nd =sthm= (=llergic tri=d)
'. Ok
(. Echinoc=ndins - inhibit gluc=n synthesis (component of fung=l cell w=ll).
Polyenes (=mpho B, nyst=tin) - bind to ergosterol =nd cre=te pores.
). Communic=ting hydrocele - fluid in tunic= v=gin=lis
*. X Incre=sed c=lcium - HCTZ
!. Deets
!. Loop diuretics =re most potent, followed by thi=zides
#. Loop diuretics inhibit =bsorption in TAL - interrupted corticomedull=ry
concentr=tion gr=dient - pts c=nʼt concentr=te their urine
$. Thi=zides - norm=l corticomedull=ry gr=dient - better =ble to ret=in
free w=ter > c=n develop hypon=tremi=
!+. Dihydroergot=mine = ergot =lk=loid commonly used to tx migr=ine
he=d=che. C=n c=use v=sosp=stic =ngin= =s it constricts v=scul=r smooth
muscle vi= stimul=tion of =-=drenergic =nd serotonergic receptors
!!. Long st=nding HTN > LV w=ll hypertrophy > imp=irs myoc=rdi=l rel=x=tion
=nd incre=ses intrinsic w=ll stiffness
!. Deets
 !. S=me volume
#. Incre=sed LVEDP c=uses pulm edem= =nd dyspne=
#. other
!. Systolic HF > reduced LVEF =nd progressive ch=mber dil=tion w
incre=sed volume =nd elev=ted LVEDP
!#. IPV > supportive, open-ended inquiry followed by = s=fety =ssessment =nd
idenfici=tion of emergency s*fety pl*ns
!$. SSRIʼs =re preferred first-line ther=py for p=nic dz
!. Benzos: more r=pid onset of =ction, but more =buse potenti=l
!%. Schizophreniform: >1 month, less th=n 6
!&. Km incre=sed from 8 to 16. Competitive inhibitors incre=se Km but Vm=x is
unch=nged
!. Other
!. Non-competitive would not ch=nge Km bc =ctive site would still be
open
!'. Observer bi=s occurs when investig=tors miscl=ssify d=t=. C=n be
p=rticul=rly import=nt when outcomes =re subjective (involve person=l
interpret=tion)
!. Other
!. Le=d time bi=s: =pp=rent prolong=tion of surviv=l in pts who undergo
screening test th=t =llows for e=rlier dx but does not =ctu=lly improve
prognosis
!(. X Pt th=t grew up in Gu=tem=l= w no immunocompromise - h=d = seizure
=nd h=s cystic br=in lesion: neruocysticercosis c=used by T=eni= solium
!. Comes from ingesting eggs from stool of t=peworm c=rriers
!). D-J syndorme: c=n result in direct hyperbilirubinemi=
!. Liver =ppe=rs bl=ck due to imp=ired excretion of epinephrine met=bolites
in lysosomes
!*. X PID is the MCC of tub*l-f*ctor infertility
!. PID c=n be c=used by neisseri= =nd chl=mydi=
#. Her chl=mydi= w=s not tre=ted since she only received =zithromycin =nd
not doxy. She prob h=s F=llopi=n tube sc=rring/occlusion
#+. C=rp=l tunnel - nerve distribution: first 3 digits =nd r=di=l h=lf of 4th
!. Other
!. Endoneur=l =rteriole hy=liniz=tion c=n occur w DM > dist=l, symmetric
peripher=l polyneurop=thy
#!. Tx crypto w =mpho B =nd flucytosine
##. PCA inf=rct - left homonymous hemi=nopi= w m=cul=r sp=ring
!. M=cul= is sp=red bc coll=ter=l blood is supplied by middle cerebr=l =rtery
to occipit=l pole
#. Other
!. ACA occlusion: contr=l=ter=l lower extremity we=kness
#. Centr=l retin=l =rtery occlusion: sudden, p=inless, complete loss of
 #.
vision in =ffected eye
#$. Dr=m=tic=lly reduced compli=nce (ie. For given volume pressure is
signific=ntly incre=sed) > pulm fibrosis
#%. Some n=s=l spr=ys c=n demonstr=te r=pidly declining effect =fter = few d=ys
of use > t=chyphyl=xis. C=n h=ve rebound rhinorrhe= - n=s=l congestion w/o
sneezing, postn=s=l drip (when used for >3 d=ys)
!. Other
!. Nitroglycerine is =ssoci=ted w t=chyphyl=xis =s well
#&. X mefloquine destroys replic=ting p=r=sites in RBCs but h=s no =ctivity
=g=inst hep=tic schizonts
!. Mefloquine prophyl=xis for 4 weeks upon return to ensure th=t p=r=sites
rele=sed from liver =re destroyed when they infect RBCs
#'. Lithium h=s inter=ctions w thi=zides, NSAIDs, ACE Iʼs, tetr=cyclines =nd
metro
!. First GI sx, then neurop=thy sx when it penetr=tes the CNS
#. Thi=zide diuretics limit sodium re=bsorption in dist=l tubule
!. C=use mild volume depletion =nd potenti=l hypon=tremi=
#. Stimul=tes proxim=l tubul=r sodium/lithium re=bsorption
#(. Terbin=fine inhibits synth of ergosterol of fung=l membr=ne by inhibiting
squ=lene epoxid=se
#). X 47 chromosomes = Klinefelter!
#*. Contr=ctures c=n occur w unusu=lly pronounced MMP =ctivity > excessive
wound contr=ction
!. others
!. Wound dehiscence: rupture of previously closed wound > from
insufficient gr=nul=tion =nd sc=r tissue form=tion
#. Ulcer=tion: would h=ppen w in=dequ=te v=scul=riz=tion
$. Keloid: coll=genous sc=r tissue deposited by fibrobl=sts - extends
beyond m=rgins of origin=l wound
$+. Psychogenic polydipsi= - psychologic=l disorder ch=r=cterized by
p=thologic=l w=ter drinking - common in women =nd p=tients w underlying
psych dz
!. Restriction of w=ter int=ke norm=lizes urine output in PP
#. Other
!. Pts w centr=l DI
!. tx w thi=zide diuretics - incre=se proxim=l tubule sodium =nd
w=ter re=bsorption
#. OR tx w indometh=cin - decre=ses prostgl=ndin synth, inhibits
ADH
$!. Acute limb ischemi= - 6 Pʼs - systemic emboliz=tion of gel=tinous m=ss w/
=morphous ECM = myxom=
!. C=n embolize!
#. C=n h=ve position-dependent obstruction of mitr=l v=lve > mimics MVP
$#. Intr=p=renchym=l hemorrh=ge from refr=ctory HTN > due to unil=ter=l RAS
!. MCC: =therom=tous pl=que le=ding to ischemi=
#. C=n c=use =trophy due to O2 =nd nutrient depriv=tion
$$. Tension he=d=ches - peric=rdi=l muscle tenderness
!. Often precipit=ted by stress =nd f=tigue. Tx w NSAIDs =nd
=cet=minophen
$%. C=n h=ve phrenic nerve irrit=tion w lung c=ncer
!. Also Horner. P=nco=st tumor could compress br=chi=l plexus.
#. SVC syndrome - =ssoci=ted w SCC
$. Dysph=gi= - tumor compresses esoph=gus
$&. DeQuerv=in - would see infl=mm=tory infiltr=te =nd gi=nt cells
$'. OSA - peritubul=r cells would sense hypoxi= =nd rele=se EPO into the
bloodstre=m > second=ry polycythemi=
$(. Liver dysfunction =nd emphysem= - A1AT def
$). X Hep=tic ste=tosis - decre=se in FA oxid=tion second=ry to excess NADH
production.
!. Produced by =lcohol dehydrogen=se =nd =ldehyde dehydrogen=se
#. Imp=ired lipoprotein =ssembly =nd secretion =nd incre=se in peripher=l
f=t c=t=bolism.
$*. Prophyl=tic v=ccin=tion w in=ctiv=ted r=bies v=ccine is recommended for =ll
high risk individu=ls
!. Would give immune globulin =nd v=ccin=tion for post-exposure
prophyl=xis
%+. Cloz=pine - regul=rly monitor neutrophil count
3/20 -2 - 1nkled

!. Telomer1se - 1dds TTAGGG to 3ʼ end of chromosomes

!. Epiderm1l b1s1l cells = continuously regener1ting
#. Myoc1rdi1l cells, neurons, p1ncre1tic B cells - termin1lly differenti1ted
$. Bloom syndrome = prem1ture 1ging - shortened telomeres
#. Vit K def in newborns - low vit K stores due to poor pl1cent1l tr1nsfer.
!. Pts w CF 1re 1lso 1t risk - wouldnʼt 1bsorb vit K
$. Di1betic nephrop1thy p1thogenesis = incre1se in filtered glucose lo1d
!. Incre1ses N1 resorption into PCT > decre1ses sodium 1nd fluid delivery to
m1cul1 dens1
#. Incre1sed filtr1tion r1te counter1cts excessive sodium re1bsorption 1nd
prevents fluid retention > le1ds to elev1ted intr1glomerul1r c1pill1ry
pressures 1nd structur1l ch1nges
%. X l1ter1l epicondylitis - wrist extension is imp1ired (pointing wrist up)
!. Vs wrist flexion (pointing down) - medi1l epicondylitis
&. X Tr1ns1min1tion - 1mino 1cid + 1-keto1cid
!. glut1m1te (AA) re1cts w ox1lo1cet1te (1-keto 1cid) > 1-ketoglut1r1te.
Requires B6
#. Other
!. Biotin would convert pyruv1te > OA
'. Del1yed hypersensitivity
!. Poison ivy etc produce urushiol - c1uses immune response when 1tt1ched
to proteins. Forms line1r stre1ks.
#. 2 ph1ses
!. Sensitiz1tion ph1se - h1pten-specific T cells, 10-14 d1ys
#. Elicit1tion ph1se - 2-3 d1ys 1fter re-exposure to s1me 1ntigen
$. C1n be medi1ted by CD8+ or CD4+ cells - indirect d1m1ge by 1ctiv1ting
m1croph1ges
!. Urushiol: CD8+ T cells 1re prim1ry effector cells
(. Febrile neutropeni1 1nd sepsis > ecythym1 g1ngrenosum - 1ssoci1ted w
Pseudomon1s
!. Virulence f1ctors: exotoxin A, el1st1se, phospholip1se C, pyocy1nin
#. Periv1scul1r - rele1ses tissue-destructive exotoxins
). X Right phrenic nerve goes over the peric1rdium overlying the right 1trium -
c1n see elev1tion of right hemidi1phr1gm on chest Xr1y
!. Vs recurrent l1rynge1l goes underne1th 1ortic 1rch
#. C1n 1lso be compressed w LA dil1tion w mitr1l stenosis
*. OD on bet1 blocker - diffuse non-selective block1de of peripher1l bet1-
1drenergic receptors, depresses myoc1rdi1l contr1ctility
 !. Gluc1gon restores cAMP - incre1ses C1 rele1se during contr1ction
!j. Anterior disloc1tions of the shoulder 1re the most common. C1n follow 1
blow to 1n extern1lly rot1ted 1nd 1bducted 1rm.
!. 1xill1ry nerve is most commonly injured by 1nterior should disloc1tions
#. Others
!. Fr1cture of cor1coid is r1re. Usu1lly from shotgun injuries.
#. C1n h1ve 1 spir1l fr1cture of the mid sh1ft humerus from FOOSH
!!. FAP - ne1rly 100% risk of CC. Lynch - 50-80%. Peutz-Jegher - 39%.
!#. Aspir1tion - 1bscesses 1re usu1lly in the right lung
!$. X REVIEW DCIS
!. Deets
!. Duct1l c1rcinom1 in situ - 1rises from bre1st ducts. Duct1l c1rcinom1
is A PRECURSOR TO the most common c1use of bre1st c1ncer
(inv1sive DUCTAL c1rcinom1)
#. Usu1lly see microc1lcific1tions in 1symptom1tic pts w norm1l bre1st
ex1ms
$. Usu1lly see pleomorphic cells w centr1l necrosis. Spre1d thru duct1l
system > P1get
#. Where1s lobul1r - orderly cells in single file
!%. Distinctions w bone mets
!. Deets
!. Osteolytic (lucent) - due to osteocl1st stimul1tion - more 1ggressive
c1ncer
#. Osteobl1stic (sclerotic) - osteobl1sts - more indolent
!. Prost1te c1ncer > osteobl1stic lesions
!&. 51-reduct1se inhibitor blocks conversion of testosterone > DHT. Excess
testosterone is converted to estrogens > gynecom1sti1
!'. Aortic regurg > LV eccentric hypertrophy - ventricul1r w1ll lengthens w
myoc1rdi1l contr1ctile fibrils org1nized in series
!. Also compens1tory incre1se in SV
#. Over1ll this is m1l1d1ptive > le1ds to overwhelming w1ll stress w
decre1sed SV 1nd LV f1ilure
!(. If ond1nsetron doesnʼt work, c1n try NK1 receptor 1nt1gonists - prevent
1cute vomitting 1nd del1yed emesis w chemo
!). Ok
!*. REVIEW THIS
!. Incre1sed prelo1d c1n occur w fluid overlo1d or 1fter fluids
!. Other
!. Incre1sed contr1ctility -would see 1 decre1sed ESV - less blood
squeezed out
#j. Neisseri1 - gonorrhe1 1nd menigitis - both from n1soph1rynge1l sw1b
#!. X Klebsiell1 is l1ctose fermenting. Pseudomon1s is not.
##. X Ure1 is freely filtered 1nd poorly re1bsorbed, but less so th1n PAH or inulin
 !. Bic1rb is 1ctively re1bosrbed in PCT due to c1rbonic 1nhydr1se in PCT
cells
#$. ANKI Ren1l vein thrombosis due to loss of ATIII. C1n develop w fl1nk p1in or
hem1turi1 w elev1ted l1ct1te dehydrogen1se
!. V1ricocele h1ppens when SMA compresses left ren1l vein (nutcr1cker
effect) - incre1sed intr1v1scul1r pressure in left gon1d1l vein
#. Other
!. Loss of Ig - vulner1ble to pneumococc1l infections
#%. Second1ry 1nd terti1ry structures of myoglobin 1nd hemoglobin bet1
subunit 1re 1lmost identic1l
!. So, if hemoglobin is dissoci1ted, will h1ve 1 myoglobin-like binding curve
#&. Octreotide - synthetic 1n1log of som1tost1tin. Tx for c1rcinoid syndrome.
#'. Mod1finil for n1rcolepsy
#(. Suppression = putting 1w1y unw1nted feelings to cope w re1lity
#). HCM - pts h1ve LVOT obstruction th1t worsens w decre1sed LV volume.
!. Medic1tions th1t should be AVOIDED
!. V1sodil1tors decre1se systemic v1scul1r resist1nce - decre1sed
1fterlo1d 1nd lower LV volumes
#. Diuretics decre1se LV venous filling 1nd result in gre1ter outflow
obstruction
#. Meds th1t 1re helpful
!. Neg1tive inotropic 1gents - bet1 blockers 1nd CCBs 1nd
disopyr1mide - reduce LVOT obstruction
#*. First gen 1ntihist1mines - blocks 1-1drenergic, serotonergic, cholinergic
receptors
!. Cili1ry muscle - under PS control from Edinger-Westph1l nucleus.
Inhibiting this p1thw1y limits 1ccommod1tion, c1uses blurring of vision
$j. Review this m7ybe? Cerebell1r hemorrh1ge - trunc1l 1t1xi1. Pts c1n 1lso
develop vertigo 1nd nyst1gmus. C1n 1lso h1ve n1use1 1nd occipit1l
he1d1che.
!. Limb dysmteri1 - would involve l1ter1l descending motor systems
$!. X N1rcolepsy - decre1sed CSF levels of hypocretin-1 (orexin-A) 1nd
hypocretin-2 (orexin-B) - produced in neurons of l1ter1l hypoth1l1mus
!. Other
!. 14-3-3 protein: CJD
$#. REVIEW LUNG CANCER HISTO
!. X Mesotheliom1 - st1in positive for cytoker1tins, m1ny 1lso st1in positive
for c1lretinin. Would see polygon1l tumor cells w microvilli 1nd
tonofil1ments.
#. Other
!. Empyem1 - thick, fibrous exud1te 1nd pus
#. Silicosis - whorled coll1gen fibers 1nd dust-l1den m1croph1ges
$$. Ok
$%. Fibrosis 1nd p1ncytopeni1 w hep1tomeg1ly = h1iry cell
!. Vs AML - would not c1use hep1tomeg1ly
$&. Villous vs tubul1r 1denom1
!. Deets
!. Villous - c1uliflower like
!. C1n produce l1rge qu1ntities of PGE2 - incre1sed mucin
production 1nd secretory di1rrhe1.
#. Also c1n produce hypoproteinemi1 1nd hypok1lemi1.
#. Tubul1r - dyspl1stic colonic mucos1l cells w tube-sh1ped gl1nds
#. Other
!. H1m1rtom1tous - disorg1nized mucos1l gl1nds, smooth muscle,
connective tissue
#. Hyperpl1stic - well-differenti1ted mucos1l cells th1t form gl1nds 1nd
crypts
$'. Crescendo-decrescendo c1n be due to 1ortic or pulmonic steins. Aortic
stenosis due to c1lcific1tion of 1ortic v1lve le1flets.
$(. Som1tic sx disorder - regul1r visits with s1me PCP. Avoid unnecess1ry
testing 1nd speci1list referr1ls.
!. Focus on returning to occup1tion1l 1nd soci1l 1ctivities, promote stress
reduction 1nd he1lthy beh1viors
#. Donʼt immedi1tely refer to psych
$). C1n see terti1ry syphillis more frequently in HIV pts
!. Absent DTRs, l1ncin1ting p1ins - sh1rp, st1bbing, m1y l1st for hours
$*. Histo - c1ve exploring. Would see m1croph1ges w intr1cellul1r ovoid or
round ye1sts.
!. Spre1d to medi1stin1l 1nd hil1r lymph nodes > cell medi1ted immune
response th1t helps cont1in infection within c1se1ting gr1nulom1s
#. Other
!. Cocco c1n c1use pneumoni1 in he1lthy people
%j. X MI with new systolic murmur = mitr1l regurg due to p1pill1ry muscle
dysfunction.
!. Deets
!. C1uses ischemi1 of p1pill1ry muscle - hyperkinesis 1nd outw1rd
displ1cement. C1uses incre1sed tension 1t the chord1e tendin1e,
prevents complete closure of corresponding mitr1l v1lve cusp.
#. C1n 1lso le1d to p1pill1ry muscle rupture.
#. Other
!. Mitr1l v1lve chord1e tendin1e couple rupture w mitr1l v1lve prol1pse,
rheum1tic fever, or endoc1rditis
3/20-1 - Ankiʼed

!. Hypovolemi> stimul>tes AT II production, constricts efferent , incre>ses

hydrost>tic pressure in glomerul>r c>pill>ries to m>int>in GFR
!. This would le>d to less of > drop in GFR th>n the drop in RPF
#. RPF would be GREATLY reduced w hypovolemi>
$. So this in turn incre>ses FF
#. NO ANTIGEN PROCESSING HAPPENS WITH SUPERANTIGENS!
!. Nonspecific stimul>tion of >20% tot>l T cells
#. Other
!. Endotoxin would be found in gr>m neg b>cteri> >nd would c>use
r>pid-onset fever >nd hypotension
$. Nitr>tes >nd PDE inhibitor inter>ction
!. cGMP >ccumul>tion - incre>sed synthesis by nitr>tes >nd inhibited
degr>d>tion by PDE inhibitors
%. REVIEW LSDs
!. G>ucher - lipid l>den m>croph>ges. B glucocerebrosid>se. Hep>tomeg>ly
>nd p>ncytopeni>.
&. HCV or HBV c>n le>d to HCC, but HBV h>s >ddition>l mech>nisms to
promote HCC
!. Deets
!. Integr>tion into host genome - evidence of HBV DNA in chromosome
of tumor cells
#. Production of oncogenic vir>l proteins - produces HBx th>t is >
tr>nscription>l >ctiv>tor of sever>l genes >ssoci>ted w cellul>r
growth
'. X Lung compli>nce
!. Deets
!. Alveol>r tr>nsmur>l pressure is >lw>ys positive => perpetu>l
coll>psing force on the lungs
#. Positive >lveol>r tr>nsmur>l pressure >nd neg>tive chest w>ll
tr>nsmur>l pressure => result in >irw>y pressure of 0
$. Intr>pleur>l pressure is >pprox -5 cm H2O >t FC
%. You c>n underst>nd this w pneumothor>x - the neg>tive IP pressure
equilibr>tes w >tmospheric pressure vi> entry of >ir into intr>pleur>l
sp>ce > PTX develops >s lung coll>pses inw>rd >nd chest w>ll
springs outw>rd
(. X REVIEW ROTATOR CUFF MUSCLES -done
!. Deets
!. L>t = innerv>ted by thor>codors>l nerve - extension, >dduction,
intern>l rot>tion of humerus
 #. Vulner>ble to injury from extern>l tr>um>
#. Other
!. Deltoid: c>n be injured w sudden or forceful lo>ding of >rm while in
>bduction
#. Infr>spin>tus: commonly injured in >ssoci>ted w supr>spin>tus due to
f>lls/overuse in older pts
$. Tr>pezius: injured in whipl>sh MVAs
e. Ischemic neuron>l injury > red neurons, then neutrophil infiltr>tion > d>y
l>ter, then microgli> come in to cle>n up necrotic debris >nd predomin>te in
ensuing 2-3 weeks
f. X REVIEW EKG stuff - done
!. Deets
!. Le>ds I >nd >VL = l>ter>l limb le>ds. L>ter>l >spect of LV is supplied
by LCX
#. Other
!. LAD: >nterior le>ds - V1-V4. Proxim>l could involve >ll 4 but dist>l
sp>res le>ds V1-V2
!g. Tub>l sc>rring is the prim>ry risk f>ctor for EP. PID c>n c>use d>m>ge to FT
!!. Cloz>pine = superior effic>cy in tx-resist>nt schizophreni>
!. Other
!. Could give > long >cting h>loperidol inject>ble to pt who h>s
responded well to h>loperidol
!#. Berry >neurysms rupture >nd le>d to SAH
!. ! Presence of x>nthochromi> = most sensitive test for di>gnosing SAH
!$. NAVL in femor>l tri>ngle
!%. Prolonged dise>se dur>tion form improved qu>lity of c>re
!&. MG - decre>sed compound muscle >ction potenti>l >mplitude (summed
potenti>ls of >ll muscle fibers in motor unit)
!. Ach-R >ntibodies. Decre>sed number of >v>il>ble c>tion ch>nnels
reduces the EPP following Ach rele>se
#. Threshold potenti>l isnʼt re>ched - muscle cells donʼt depol>rize
!'. X c>n h>ve cholinergic toxicity > overstimul>tion of smooth muscles,
excessive gl>ndul>r secretions
!. Selective musc>rinic >nt>gonists (i.e. glycopyrrol>te) c>n reduce side
effects of cholinester>se inhibitors in sites where Ach >ction is medi>ted
by musc>rinic receptors
#. Vs piloc>rpine is > musc>rinic >gonist (cholinomimetic)
!(. Polymyositis - incre>sed expression of MHC cl>ss I >ntigens - le>ds to
present>tion of >uto >ntigens in CD8+ T cells
!. Vs polymy>lgi> rheum>tic> - my>lgi> of shoulder >nd pelvic girdle
muscles, often w systemic sx, seen in pts over 50
!e. Recent vir>l infection > nephrotic syndrome w low >lbumin. MCD c>n occur
in >dults!
!f. COPD Triggers
!. Deets
!. Vir>l: rhinovirus, flu, p>r>influenz> (most common)
#. B>cteri>l: H flu, Strep, Mor>xell> (less common)
$. Air pollution, PE (less common)
#. COPD le>ds to chronic >irw>y infl>mm>tion, due to >ctiv>ted neutrophils,
CD8+ lymphs >nd m>croph>ges
#g. X Tenofovir-induced nephrotoxicity. Prim>rily elimin>ted by PCT cells > c>n
le>d to PT dysfunction (phosph>turi>, glycosuri>, proteinuri>) >nd AKI.
!. Histology: loss of brush border, BM denud>tion >nd evidence of gi>nt
mitochondri> (l>rge eosinophilic inclusions)
#!. Hypon>tremi> is seen w Legionell> but not other c>uses of pneumoni>
##. Bulimi> - enl>rged p>rotids >nd incre>sed s>liv>ry >myl>se
#$. Febrile neutropeni> - >bsolute neutrophil count <500
!. Gr>m + b>cteri> >re most commonly identified, but pts w profound >nd
prolonged neutropeni> c>n get fung>l/vir>l infections
#. Inv>sive >spergillosis = fever, chest p>in, cough, dyspne>, hemoptysis
#%. C>rbm>zepine first line for TGN. B>clofen >nd v>lproic >cid c>n >lso be
used but >re not first line.
!. Other
!. Prop>nolol c>n be used to reduce port>l venous pressure to prevent
v>tic>l bleed
#&. REVIEW CLL SKETCHY PATH - done
!. CLL - m>ture B cells >ccumul>te due to oncogenic mut>tions th>t inhibit
>poptosis
#. Anemi>, thrombocytopeni>, >nd infections (due to neutropeni>)
$. Most p>tients >symptom>tic for ye>rs
#'. C>n use levetir>cet>m before conceiving, but shouldnʼt use v>lpro>te.
Should use high-dose fol>te with v>lpro>te or if there w>s >nother child born
w NTD
#(. CMV colitis - intr>nucle>r >nd intr>cytopl>smic inclusions.
!. Fosc>rnet - does NOT require intr>cellul>r >ctiv>tion. Must be
>dministered IV.
#. Other
!. T>miflu >nd s>quin>vir - do not require intr>cellul>r >ctiv>tion but not
for CMV infection.
#e. Pituit>ry >poplexy - he>d>che, bitempor>l hemin>opsi>, ophth>lmoplegi>.
Usu>lly occurs w pre-existing >denom>
!. Requires glucocorticoids to prevent >cute >dren>l crisis >nd circul>tory
coll>pse
#f. X Iʼm dumb
!. Deets
!. D>ughter str>nd synthesized in opposite direction of replic>tion fork -
 !.
will be synthesized in short fr>gments
#. DNA synth only occurs 5ʼ to 3ʼ
#. Other
!. 5ʼ to 3ʼ >nd 3ʼ to 5ʼ exonucle>se >ctivity is needed for synthesis of
both d>ughter str>nds
$g. GI HORMONES
!. Deets
!. Ure>se > >mmoni> - >lk>linizes surrounding pH but injures g>stric
epitheli>l cells.
!. H pylori in g>stric >ntrum will deplete som>tost>tin-producing
cells. Elev>ted g>strin will incre>se >cid secretion > empty into
duodenum > duoden>l ulcers.
!. Vs
#. G>stric ulcers - h>ppen when H pylori colonizes g>stric body.
Reduced p>riet>l cells, m>inly in the body.
$!. TB - APCs in dr>ining lymph nodes displ>y mycob>cteri>l >ntigens to n>ive
CD4 T lymphs > divide into Th1 cells th>t secrete IFN-y, which >ctiv>tes
m>croph>ges > fully >cidified ph>golysosmes
!. Rele>se of prote>ses, NO, ROS > coll>ter>l tissue d>m>ge > c>vit>ry
lesions
$#. Clind>mycin txs or>l >n>erobes (b>cteroides) >nd gr>m-positive org>nisms
like strep pneumo
!. Penetr>tes into >bscesses
$$. Exceptions to pt confidenti>lity = child, dis>bles, elder >buse; knife >nd
GSW; dx of communic>ble dz; pts >t risk of h>rming themselves or others
$%. X Systolic >nterior motion of mitrDl vDlve twd IV septum > eccentric mitr>l
regurg >nd ex>cerb>tes LVOT obstruction
$&. X Cognitive testing >nd rel>ted dom>ins
!. Comprehension: following multistep comm>nds
#. Concentr>tion: reciting months of ye>r b>ckw>rds
!. Also count down from 100 in interv>ls of 3 >nd spell “world”
b>ckw>rds
$. To dx dementi> - must h>ve imp>irment in 1 or more cognitive dom>ins
$'. COPD - >ir tr>pping le>ds to incre>se in TLC.
!. Incre>se in RV is gre>ter th>n incre>se in TLC so RV/TLC r>tio is
incre>sed
#. Airw>y obstruction c>uses DECREASED FVC >nd more profound decre>se
in FEV1
$(. NSAIDs >re first line for pts w >cute gouty >rthritis
!. Uric >cid lowering ther>py >nd XO inhibitors should NOT be initi>ted
during >n >cute gout >tt>ck - c>n ex>cerb>te >cute >rthritis
$e. Som>tic mos>icism - dise>se m>nifest>tions develop in >ffected individu>ls
!. Mixture of norm>l >nd mut>ted cells - milder form of dz
 #. Vs germline mos>icism - >ffected p>rent does NOT develop clinic>l
m>nifest>tions
$f. RNA molecules th>t c>rry out functions w/o being tr>nsl>ted to proteins =
non-coding RNAs
!. = snRNA, rRNA, tRNA
#. Collection of snRPS = spliceosome
$. Deets
!. Spin>l muscul>r >trophy - mut>tions in SMN1 gene - encodes snRNPs
in LMNs
%g. Lymphom> would come from lymphoid tissue
3/21 - 2 - /nkled

!. Review this
!. Infective endoc/rditis w hem/turi/ /nd proteinuri/ - ren/l insufficiency
due to nephritic syndrome
!. C/n be complic/ted by deposition of immune complexes in glomerul/r
c/pill/ry w/ll > glomerulonephirits
#. C/n see c/pill/ry w/ll thickening w sub endotheli/l /nd subepitheli/l
deposit form/tion
#. X Ste/dy st/te concentr/tion is re/ched in 4-5 h/lf lives, so 40-50 hours for
this drug
$. Tourette: multiple motor & >1 voc/l tic (not necess/rily concurrent) for >1
ye/r. Onset < 18 yo
!. More common in boys, typic/lly presents between 6-15
%. EML4-ALK - c/n le/d to sm/ll cell lung c/ncer
!. Usu/lly young non-smokers
#. CML is usu/lly due to / fusion protein
&. L/c operonnnnnnn
!. Deets
!. L/c Z codes for B g/l/ctosid/se - hydrolyzes l/ctose to glucose /nd
g/l/ctose
#. Culturing E coli in medi/ cont/ining glucose > reduced expression of
l/c operon, even when medi/ cont/ins l/ctose /s well. This is
bec/use l/c operon is positively regul/ted by binding of CAP to / site
slightly upstre/m from promoter
$. Only occurs when cAMP concentr/tions /re high
%. Glucose decre/ses /ctivity of /denylyl cycl/se > reduced intr/cellul/r
cAMP > l/c operon os repressed in high glucose conditions
#. In summ/ry
!. 2 distinct mech/nisms
!. Neg/tive regul/tion by binding of repressor protein to oper/tor
locus
#. Positive regul/tion by cAMP-CAP binding upstre/m from promoter
region
'. CO2 enters RBCs /nd is hydr/ted by c/rbonic /nhydr/se to form c/rbonic
/cid. Excess HCO3- is tr/nsferred out of RBCs vi/ b/nd 3 protein to
m/int/in electric/l neutr/lity = chloride shift
!. Princip/l c/use of high RBC Cl- content in venous blood
(. Cryptosporidium - c/n le/d to self-limited, w/tery di/rrhe/. Those w AIDs
/re /t risk of life-thre/tening di/rrhe/ - loss of >20 L per d/y
!. Would see villous blunting in l/min/ propri/
 i. Ventromedi/l medi/tes s/tiety. L/ter/l medi/tes hunger.
!. In kids - hypoth/l/mus tumors /re usu/lly gliom/s. In /dults - more likely
th/t they /re met/st/tic.
j. Incre/sed risk of Edw/rds in mothers over 35
!k. Piriformis origin/tes on /nterior /spect of the s/crum - occupies most of the
sp/ce in the gre/ter sci/tic for/men
!. deets
!. Sci/tic nerve crosses below piriforis - /lso inferior glute/l vessels,
intern/l pudend/l, multiple nerves (sci/tic)
#. Piriformis syndrome = muscle injury or hypertrophy th/t compresses
sci/tic nerve > piriformis syndrome
#. Obtur/tor interns = f/n sh/ped- origin/tes from medi/l surf/ce of
obtur/tor membr/ne, ischium, pubic rim
!!. X biventricul/r p/cem/ker - if 3 le/ds /re used, first 2 in RA /nd RV. Third
le/d p/ces LV.
!. P/ss LV from RA to coron/ry sinus, which resides in AV groove
!#. Avoid/nt oh l/wd
!$. X Acute epipidymitis
!. Deets
!. Acute testicul/r p/in posterior testicle tenderness, pyuri/
#. <35: sexu/lly tr/nsmitted (Chl/mydi/ or Gonorrhe/)
$. >35: bl/dder outlet obstruction - coliform b/cteri/
!. Gr/m-neg colonic flor/ cont/min/te urethr/, /scend urin/ry
system, inv/de ej/cul/tory duct /nd v/s deferens
#. Other
!. Testicul/r torsion - in/dequ/te fix/tion of lower pole of testis to tunic/
v/gin/lis
!%. PAS st/in - identifies polys/cch/rides of fung/l cell w/ll, mucopubst/nces
secreted by epitheli/ /nd b/sement membr/nes
!. Di/st/se c/n be used in conjunction w PAS to demonstr/te glycogen -
digests into m/ltose /nd glucose
!&. X Dil/ted /irsp/ces - centri/cin/r emphysem/
!. Prote/se-/ntiprote/se imb/l/nce le/ds to /cin/r w/ll destruction /nd
irreversible /irsp/ce dil/tion dist/l to termin/l bronchioles
#. M/croph/ges /nd neutrophils rele/se prote/ses - el/st/se, etc
$. Other
!. Club (formerly Cl/r/) cells - secrete secretory protein /nd surf/ct/nt
components th/t help detoxify inh/led subst/nces vi/ 450 system
!'. X tet/nus is / clinic/l di/gnosis - suspected in pts w ch/r/cteristic sx
!. Other
!. Tet/nus toxin /ss/y is not widely /v/il/ble /nd is not routinely used
to dx tet/nus
!(. MCD - triggered by recent illness. Immune dysregu/ltion > overproduction of
!(.
glomerul/r perme/bility f/ctor (IL-13) th/t d/m/ges podocytes > foot
process eff/cement /nd fusion /s well /s /nionic properties of GBM
!i. Prim/ry myelofibrosis. Fibrobl/sts in BM l/y down coll/gen > subsequent
fibrous. Fibrotic BM is inhospit/ble to hem/topoietic stem /nd progenitors
cells > go to spleen /nd liver > extr/medull/ry hem/topoiesis
!. Deets
!. Le/ds to splenomeg/ly. Extr/medull/ry hem/topoesis is less efficient
th/n medull/ry > pts h/ve one or more cytopeni/s
#. Hypocellul/r m/rrow w fibrosis /nd /typic/l meg/k/ryoctes
#. Other
!. G/ucher - fibrils of glucocerebroside in cytopl/sm
#. Congestive splenomeg/ly - due to port/l HTN from liver cirrhosis.
Dil/ted sinusoids, fibrosis of red pulp, hemosiderin-l/den
m/croph/ges
$. Splenic nonc/se/ting gr/nulom/s /re more common in s/rcoid
!j. X duh this l/dy h/s w/rm, moist skin, mild bil/ter/l h/nd tremor -
hyperthyroid w/ /nxiety.
!. New onset of /nxiety w no psych hx /nd prominent physic/l findings >
more likely due to medic/l condition
#. Di/gnosing prim/ry /nxiety disorders requires ruling out medic/l illness
/nd subst/nce intoxic/tion/withdr/w/l.
#k. Intr/erythrocytic ring inclusions + M/ltese cross in blood sme/r in NE US >
b/besiosis.
#!. X Sm/ller overl/p in dise/sed vs non-dise/sed = decre/sed FP /nd FN -
new m/rker h/s higher specificity /nd sensitivity (in women w BRCA
mut/tions)
##. Gonorrhe/: V/ri/bility of gonococc/l surf/ce /ntigens (porins, Op/ proteins,
LOS) limits effectiveness of /ntibody response
#$. ANKI THIS + Review psych m;lingering etc
!. Som/tic sx /nd rel/ted disorders
!. Conversion dz: neurologic symptom incomp/tible w known dz
!. Common sx: deficits of volunt/ry motor /nd/or sensory function
th/t /re incomp/tible w /ny recognized neurologic/l condition
#. L/ belle indifference (not concerned /bout sx) h/s been
/ssoci/ted w conversion dz, but people c/n be very distressed
/bout sx
#. Som/tic sx dz: excessive /nxiety + preoccup/tion w >1 unexpl/ined
sx (sometimes multiple som/tic sx)
#%. Long /cting isosorbide dinitr/te - /bsorbed vi/ GI tr/ct /nd undergoes
extensive first-p/ss met/bolism > low bio/v/il/bility
#&. X Pili on c/psul/r surf/ce of N meningitidis /re responsible for /tt/chment
to /nd coloniz;tion of n;soph;rynge;l epithelium.
!. Tr/nsmission - usu/lly through respir/tory droplets or cont/ct w resp
 !.
secretions
#. Undergo high r/tes of /ntigenic v/ri/tion (due to on-off gene switching
/nd horizont/l gene tr/nsfer)
$. Others
!. V/ccines th/t t/rget endotheli/l or meninge/l inv/sion would /ct too
l/te in dise/se process
#. Once it enters circul/tory system, incre/sed levels of endotoxin put
pts /t high risk for sepsis
#'. X REVIEW WHAT STIMULATES THE EYE - done
!. /1 receptors result in contr;ction of pupill;ry dil;tor muscle w
subsequent dil;tion of pupil > mydri;sis
!. /2 scout emptying w/ter from eyeb/ll h/t - /ctiv/tion /t cili/ry body
DECREASES /queous humor production
#. B2 c/mper filling eyeb/ll - B2 incre/ses /queous humor production
#. Adrenergic receptors of uterus - B2. Stimul/tion le/ds to uterine
rel/x/tion (tocolysis)
#(. Most d/ngerous side effect of /mpho B = nephrotoxicity
!. C/n h/ve hypok;lemi; /nd hypom/gnesi/ due to incre/se in membr/ne
perme/bility of dist/l tubule
#. Hypok/lemi/ > ST depression, U w/ves, T w/ve fl/ttening
#i. Review ;nti ;nd pro;poptotic f;ctors
!. CLL is /ssoci/ted w overexpression of BCL-2: /nti-/poptotic protein
#. BCL-2 is /nti/poptotic protein - prevents stress sign/ls from triggering
intrinsic /poptotic c/sc/de - rele/se of cyto c from mitochondri/ /nd
subsequent /ctiv/tion of c/sp/ses
!. Tre/tment w BCL-2 inhbitors (venetocl/x) m/kes tumor cells more
sensitive to stress sign/ls by incre/sing /ctiv/tion of c/sp/ses
$. Deets
!. BAX /nd BAK - pro/poptotic
#. BCl-2 /nd Bcl-xL - /nti/poptotic
!. Bcl-2 is /lso /n oncogene (thus Bcl-2 inhibitors /re /nti-c/ncer)
#. Follicul/r /nd B cell lymphom/
#j. M;ybe review follicul;r lymphom; sketchy?
!. Follicul/r lymphom/ = second most common NHL over/ll. Follows w/xing
/nd w/ning clinic/l course.
!. C/n see cle/ved /nd noncle/ved follicle centers in / nodul/r p/ttern
#. Vs diffuse B cell lymphom/ - r/pidly enl/rging nod/l or extr/nod/l
symptom/tic m/ss
$k. Age-rel/ted m/cul/r degener/tion.
!. Dry AMD: ch/r/cterized by gr/du/l vision loss in one of both eyes > c/n
h/ve difficulty driving/re/ding. Le/ds to sub retin/l infl/mm/tion w
/bnorm/l m/trix form/tion.
!. C/n see sub retin/l drusen deposits w pigment /bnorm/lities
 #. Progressive ECM /ccumul/tion > retin/l hypoxi/ > stimul/tes VEGF
production, subretin/l neov/scul/riz/tion w form/tion of le/ky vessels
$!. Cholest/sis- reduction in bile flow c/uses intestin/l m/l/bsorption of f/ts
/nd f/t-soluble vit/mins
$#. Enteropeptid/se /ctiv/tes trypsin from in/ctive precursor trypsinoegen.
!. Enteropeptid/se deficiency > protein /nd f/t m/l/bsorption.
#. Di/rrhe/, f/ilure to thrive, edem/ (due to hypoproteinemi/)
$$. Angiogenesis is driven by VEGF /nd FGF
!. Donʼt confuse VEGF w EGF. EGF h/s / mitogenic influence on epitheli/l
cells, hep/tocytes, fibrobl/sts. Doesnʼt re/lly p/y / role in /ngiogenesis
$%. Pseudogout > mono or oligo/rticul/r /rthritis ch/r/cterized by p/in, joint
swelling, erythem/ /nd w/rmth
!. C/n see rhomboid-sh/ped c/lcium pyrophosph/te cryst/ls
$&. LOS /nd LPS /re closely rel/ted. Found in gr/m-neg/tive rods. C/use
toxicity when rele/sed into pl/sm/ vi/ shedding of outer membr/ne
(blebbing) or b/cteri/l lysis
$'. X M;ybe review this sketchy p;th
!. cr/nioph/ryngiom/ - cholesterol cryst/ls. Dystrophic c/lcific/tion of the
cysts. Come from R/thkeʼs pouch - protrusion of the roof of the mouth
form /nterior pituit/ry gl/nd (/denohpyophysis)
#. Cerebellum, pine/l gl/nd /nd retin/ - /ll derived from neuroectoderm.
Epitheli/l cells of choroid plexus /lso from here.
$(. ADCC
!. P/r/site inv/des mucos/ or enters bloodstre/m - co/ted by IgG ;nd IgE
;ntibodies th;t bind Fc receptors on eosinophil surf;ce. Le/ds to
degr/nul/tion /nd rele/se of cytotoxic proteins
!. Le/ds to ADCC - /lso used by m/croph/ges, neutrophils, NK cells
#. Eosinophils c/n /lso contribute to l/te ph/se type I hypersensitivity,
but this wouldnʼt be wh/t h/ppens w schistosom/
$i. 2 m/jor mech/nisms in T2DM
!. Deets
!. Defective insulin secretion
#. Insulin resist/nce in peripher/l tissues
!. Excess viscer/l f/t correl/tes more strongly w insulin resist/nce
th/n subQ f/t
#. Me/sure w/ist circumference or w/ist-to-hip r/tio
#. Others
!. See high triglycerides /nd low HDL levels in T2DM
!. LDL levels do not incre/se w insulin resist/nce
#. Insulin resist/nce - inhibitory effect of insulin on gluconeogenesis is
reduced > incre/sed hep/tic glucose production
$. Decre/sed glucose upt/ke in skelet/l muscles > decre/sed glycogen
stores
 %. High ketones - insulin deficiency in T1DM. T2DM pts h/ve rel/tive
insulin deficiency - often w high tot/l insulin levels th/t suppress
ketone form/tion
$j. X ATM - DNA hypersenstivity to ionizing r/di/tion
!. Incre/sed risk for c/ncers inefficient DNA rep/ir. Also h/ve /t/xi/ in the
first ye/rs of life. And repe/ted sinopulmon/ry infections.
#. ANKI this
!. ATM - DNA hypersensitivity due to ionizing r/di/tion
#. XP - DNA is hypersensitive to UV r/di/tion
$. F/nconi - DNA is hypersensitive to cross-linking events
%. Bloom - gener/lized chromosom/l in/bility. Incre/sed susceptibility to
neopl/sms
&. HNPCC - defect in DNA mism/tch-rep/ir enzymes
$. Spinocerebell;r vs posterior columns?
%k. Review
!. Deets
!. Org/nophosph/tes = irreversible cholinester;se inhibitors. Elicit
cholinergic stimul/tion th/t l/sts until new cholinester/se enzymes
/re synthesized.
#. C/n tx w musc/rine /nt/gonists (/tropine) /nd pr/lidoxime -
re/ctiv/tes ACh
#. Others
!. Botulism = inhibits SNAREs - inhibits ACh rele/se
#. Atropine blocks post-junction/l Ach receptors
3/21-1 - 2nkled

!. Review P(rkinsonʼs Drugs sketch - done

!. Ent2c2pone - COMT inhibitor - incre2ses bio2v2il2bility by inhibiting
peripher2l methyl2tion
#. used w pts who 2re experiencing “we2ring off” periods w levodop2/
c2rbidop2
#. Cryptococcus spre2ds from lungs into circul2tion 2nd then penetr2tes the
endotheli2l cells of cerebr2l c2pill2ries
$. Ag2in, crypto. Replic2tion in br2in clogs villi w ye2st 2ntigens 2nd c2psul2r
proteins > obstruction of CSF flow. Elev2ted IC pressure.
%. X southwestern blot - detects DNA binding protein w 2 dsDNA probe
!. Deets
!. c-Jun is 2 DNA-binding protein.
#. c-Jun 2nd c-Fos 2re nucle2r tr2nscription f2ctors th2t directly bind
DNA vi2 leucine zipper motif.
#. Others
!. B1 receptor = GCPR. Adenyl2te cycl2se - cle2ves ATP to form cAMP.
Neither directly inter2ct w DNA
&. Hep B > more th2n 85% of HCC c2ses, usu2lly from chronic HBV 2cquired
through vertic2l tr2nsmission 2t childbirth
'. Precursors 2re positive for TdT.
!. Precursor B-ALL: usu2lly present evidence of bone m2rrow f2ilure le2ds
to thrombocytopeni2 2nd/or 2nemi2 2nd/or neutropeni2. 75% of c2ses in
kids under 6 yo.
(. Diverticulosis c2n be silent or c2n present w p2inless hem2tochezi2.
). Digoxin is ren2lly cle2red so older people might experience toxicity due to
decre2sed GFR.
*. X Optim2l medic2l c2re of de2f individu2ls: get 2 sign l2ngu2ge interpreter
!. Nu2nces c2nʼt be communic2ted through writing
#. There is 2lso 2 strong risk of miscommunic2tion with re2ding lips
!+. X Tr2nsverse p2rt of duodenum is wh2t is compressed in SMA syndrome.
(3rd p2rt of duodenum)
!. The descending p2rt is one of the first p2rts.
!!. Osgood-Schl2tter dise2se - p2in 2nd swelling 2t tibi2l tubercle, where
p2tell2r lig2ment inserts.
!. Common c2use of knee p2in in 2dolescents
#. Others
!. ACL -2tt2ches 2t 2nterior intercondyl2r 2re2 (sep2r2tion of medi2l
2nd l2ter2l tibi2l condyles)
#. S2rtorius - origin2tes from 2nterior ili2c spine 2nd inserts into pet
 #.
2nserinus
$. Tendon of biceps femoris inserts 2t styloid process 2t he2d of fibul2.
H2mstrings - knee flexion 2nd hip extension
!#. Review drug withdr(w(l Mild 2lcohol withdr2w2l - tremors, 2nxiety,
swe2ting, insomni2
!. Withdr2w2l begins 2s e2rly 2s 6 hours before the ptʼs l2st drink. Tremor
is most common initi(l finding
#. Other
!. Delirium tremens would present w fluctu2ting 2rous2l (48-96 hours
2fter l2st drink)
!$. Progressive reduction in blood flow - ischemic myoc2rdium rele2ses growth
f2ctors th2t stimul2te form2tion 2nd m2tur2tion of coll2ter2l vessels
!. Deets
!. Slow development of st2ble 2therosclerotic pl2que in LAD likely
2llowed coll2ter2l vessels from RCA to supply ischemic myoc2rdium
dist2l to LAD occlusion
#. Unst2ble pl2que would not 2llow coll2ter2l vessels to develop
#. Other
!. Atherosclerotic pl2que w 2ctive infl2mm2tion, high core concentr2tion
of lipids, 2nd/or thin fibrous c2p 2re unst2ble 2nd more likely to
rupture
#. Tot2l coron2ry 2rtery c2lcium content correl2tes w tot2l
2therosclerotic pl2que burden
$. Osti2l pl2ques (2t br2nch point of 2 2rteries) - more likely to occlude
flow to multiple 2re2s of myoc2rdium
!%. P2rvo - c2n interrupt erythropoeisis > le2d to fet2l congestive he2rt f2ilure.
Pleur2l effusions, peric2rdi2l effusions, 2nd 2scites
!. Most common infectious 2gent c2using hydros
!&. Acid f2st st2in: f2ils to decolorize w hydrochloric 2cid 2nd 2lcohol 2fter
st2ining w c2rbolfuschin
!'. FISH detects l2rge deletions 2nd tr2nsloc2tions.
!. Probes = ssDNA segments th2t 2re 2dded to cell of interest 2nd 2nne2l to
complement2ry regions of cell chromosome.
#. Other
!. Western blot - confirms positive ELISA in HIV or Lyme dise2se
!(. Review hyperthyroid c(uses (toxic 2denom2, goiter, thyroiditis)
!. Positive 2ss2y for thyrotropin receptor 2ntibodies (TRAb) = Gr2ves
!. Bind to 2nd 2ctiv2te TSH receptor - incre2sed rele2se of thyroid
hormone by thyroid gl2nd
#. Thyroid dermop2thy is c2used by stimul2tion of fibrobl2sts by TRAb
2nd 2ctiv2ted T-cells > excess GAGs 2nd 2dipogenesis
!. This is simil2r to how Gr2ves opth2l2mop2thy presents
!). Fet2l 2lcohol - Weight 2nd height in in 10th percentile. He2d circumference
!).
below 5th percentile.
!*. REVIEW HYPERSENSITIVITY X Acute hemolytic tr2nsfusion re2ction =
2ntibody-medi2ted hypersensitivity
!. Anti-ABO 2ntibodies bind corresponding 2ntigens on tr2nsfused donor
RBCs => complement 2ctiv2tion 2nd l2ter, complement-medi2ted lysis
#. Other
!. IgE could present w mild sx (urtic2ri2, itching) or severe 2n2phyl2xis
(IgA-deficient p2tients)
#+. Electric2l potenti2l difference th2t moves K+ into the cell 2t the s2me r2te
they le2ve = equilibrium potenti2l
!. Deets
!. Intr2cellul2r [K+] is much gre2ter th2n extr2cellul2r, so it will le2ve the
cell
#. K+ le2ves the cell > neg2tive 2nions 2ccumul2te 2long inner side of
cell membr2ne. Incre2singly neg2tive ch2rge 2ttr2cts positive K+
b2ck into cell.
$. When difference in concentr2tion of K+ inside 2nd outside is l2rge, K+
efflux will continue despite incre2sing neg2tive ch2rge.
#. Other
!. Cl: extr2cellul2r gr2dient would drive Cl- into cell, m2king membr2ne
potenti2l more neg2tive
#!. X ischemi2 ch2nges
!. Deets
!. Reperfusion injury occurs through one of these mech2nisms
!. 1) oxygen free r2dic2l gener2tion by p2renchym2l cells,
endotheli2l cells, leukocytes
#. 2) severe, irreversible mitochondri2l d2m2ge described 2s
“mitochondri2l perme2bility tr2nsition”
$. 3) infl2mm2tion - 2ttr2cts circul2ting neutrophils th2t c2use
2ddition2l injury
%. 4) 2ctiv2tion of complement p2thw2y - cell injury 2nd further
infl2mm2tion
#. When cell membr2ne is d2m2ged => CK le2ks out
#. Others
!. Mitochondri2l v2culoiz2tion - reduced cellul2r c2p2city for ATP
gener2tion. Associ2ted w irreversible injury but not CK rele2se
#. Nucle2r shrink2ge, fr2gment2tion, dissolution = irreversible injury, but
not CK rele2se
##. Schizotyp2l = odd beliefs
#$. B = prob2bility of committing type II error
!. 1-B = power = studyʼs 2bility to detect 2 difference when one exists
#. Other
!. Type I = reject null when null is re2lly true (there re2lly is no difference
 !.
- f2lse positive)
#. Type II = f2il to reject when truly f2lse (there is 2 difference - f2lse
neg2tive)
#%. Progestins th2t 2re more potent produce systemic 2nd loc2l effects,
where2s less potent progestins produce loc2l effects only
!. Deets
!. Combined hormon2l contr2ceptives suppress GnRH in the
hypoth2l2mus
#. Stop LH spike > inhibit ovul2tion
#. Others
!. Progestin-only pill 2nd IUD - thicken cervic2l mucus 2nd prevent
sperm from getting to uterus.
#. IUD 2lso thins uterine lining
#&. X PHEO
!. Would see syn2ptophysin, chromogr2nin, neuron-specific enol2se in the
tumor. Could 2lso see membr2ne-bound gr2nules w c2techol2mines
#. Other
!. Toxic nodul2r thyroid dise2se would be in the follicles. Uniform cells
2nd l2rge 2mts of follicul2r colloid.
#. REVIEW medull(ry thyroid c(ncer -wh(t does it secrete?
#'. PPAR-y is 2 tr2nscription2l regul2tor of genes involved in glucose 2nd lipid
met2bolism
!. Deets
#. Genes upregul2ted:
!. GLUT4 - insulin responsive
#. Adiponectin - cytokine secreted by f2t tissue th2t incre2ses
number of insulin-responsive 2dipocytes
$. T2kes sever2l d2ys to 2 few weeks to see reduction in glucose
!. Others
!. High dose insulin could c2use receptor downregul2tion thru
degr2d2tion of insulin receptor > c2n le2d to insulin resist2nce
#(. X mos2icism = <2 % of DS c2ses - 2ffected individu2ls h2ve 2 distinct cell
lines due to non-disjunction during mitosis.
!. One norm2l, one w trisomy 21 > some cells (not 2ll) h2ve 2 third copy
#). GAS - M protein INHIBITS PHAGOCYTOSIS
!. Simil2r homology to other 2-helic2l proteins like tropomyosin 2nd myosin
#. Protective 2ntibodies c2n cross-re2ct w myosin epitopes 2nd c2use
rheum2tic c2rditis
$. Other
!. Cell w2ll protects from osmotic lysis
#*. Fibrinolytic ther2py c2n le2d to reperfusion-rel2ted 2rrhythmi2s
!. Fibrinolytic 2gents = streptokin2se 2nd recombin2nt tPA. Incre2se
bleeding risk, contr2indic2ted in pts w incre2sed bleeding risk.
 #. Others
!. Aspirin prevents form2tion of 2ddition2l thrombus, but does not
degr2de pre-existing thrombi
#. Hep2rin prevents further progression to clot form2tion, but does not
c2use thrombolysis
$+. X Alcohol enh2nces inhibitory 2ctivity of GABA but 2brupt cess2tion
decre2ses inhibitory tone, results in CNS excit2tion
!. Benzos 2re first-line.
!. Prefer2bly longer-2cting.
#. Chlordi2zepoxide is 2 benzo.
#. Other
!. Donʼt use 2ntipsychotics bc they lower the seizure threshold 2nd pts
w 2lcohol withdr2w2l 2lre2dy h2ve incre2sed seizure risk!
$!. X CMV is 2 herpesvirus!
!. Also it c2n re2ctiv2te. CMV retinitis is the most common re2ctiv2tion
syndrome, followed by CMV colitis.
#. Other
!. Cryptosporidium usu2lly 2ffects sm2ll intestine, not colon
$#. M(ybe Anki this? Review (g(in?
!. G2g 2nd pol 2re polyprotein products th2t 2re cle2ved by HIV prote2se
into individu2l HIV enzymes 2nd structur2l proteins
#. Prote2se inhibitors would inhibit HIV prote2se from cle2ving these >
imm2ture, non-infectious visions
$. other
!. Reverse tr2nscript2se: converts RNA to complement2ry dsDNA, 2lso
destroys HIV RNA templ2te during tr2nscription
#. RT 2nd integr2se block vir2l replic2tion but neither 2re 2ssoci2ted w
imm2ture virions w polyproteins
$$. Wilson dz = c2n h2ve subtle person2lity ch2nges or depression, m2ni2,
psychosis. C2n pred2te other sx
!. Autosom2l recessive mut2tion of ATP7B > hep2tic copper 2ccumul2tion >
le2k from d2m2ged hep2tocytes
$%. Ewing s2rcom2 - sm2ll round cells 2nd fibrous sept2e w p2tches of necrosis/
hemorrh2ge. Second most common m2lign2nt br2in tumor of childhood.
!. Osteos2rcom2 - pleomorphic, spinde-sh2ped cells th2t produce new
osteoid 2nd bone
$&. X Most common pedi2tric m2lign2ncy = ALL. C2n either be pre-B cells or
pre-T cell line2ge.
!. T cell ALL would present w 2nterior medi2stin2l m2ss > SVC syndrome.
C2n 2lso compress esoph2gus 2nd c2use dysph2gi2.
#. Other
!. B cell ALL > hep2tosplenomeg2ly, bleeding. Donʼt usu2lly h2ve
medi2stin2l m2ss
 #. AML > monocytes. R2rely seen in kids.
$'. SPINAL CORD TRACTS
!. B12 deficiency - dors2l columns, l2ter2l corticopin2l tr2cts (sp2stic
p2resis) 2nd spinocerebell2r tr2ct
$(. X Toxic meg2colon w UC - Presents w bloody di2rrhe2, fever, 2nd sings of
shock.
!. Would w2nt 2bdomin2l X-r2y - shows dil2t2tion w multiple 2ir-fluid levels.
#. Other
!. B2rium enem2 AND colonoscopy - contr2indic2ted bc it could
incre2se perfor2tion risk.
#. Sm2ll bowel contr2st would be used to ev2lu2te SBO
$). T1DM - islets of infl2mm2tory cells > insulitis
!. Others
!. T1DM pts h2ve low circul2ting levels of 2myloid polypeptide due bet2
cell destruction (2myloid is secreted w insulin from bet2 cells)
$*. Crohnʼs: tr2nsmur2l 2nd segment2l thickening
%+. High 2ltitude sickness - kidneys decre2se HCO3- re2bsorption 2nd
DECREASE H+ SECRETION to cre2te compens2tory met2bolic 2cidosis
!. Also incre2se 2,3 BPG production - right shift - unlo2d more O2 to tissues

Q23:
Q10:
3/22-1 - -nkled

!. NF-1: -utosom-l domin-nt

!. C-fe -u l-it, Lisch nodules, pseudo-rthritis
#. X bl-h ANKI
!. Deets
!. Liquef-ctive necrosis - necrotic tissue digested by hydrolytic enzymes
#. Fibrinoid necrosis - d-m-ged vessels le-k fibrin/immune complexes,
eosinophilic l-yer of protein-ceous m-teri-l in vessel w-lls
!. Would see w v-sculitis syndromes (PAN -nd HTN)
$. C-seous necrosis - surrounded by epitheli- m-croph-ges -nd gi-nt
cells
%. Co-gul-tive necrosis - tissue -rchitecture preserved bc proteolytic
enzymes -re in-ctiv-ted during injury process
!. Anucel-te cells w eosinophilic cytopl-sm
#. Leukocytes eventu-lly infiltr-te -nd digest necrotic tissue
#. Other deets
!. Guy prob h-d -n embolism w hx of AFib
#. Digested by microgli- -nd repl-ced w -strogli-l sc-r
$. Decre-se in PCO2 > decre-sed cerebr-l perfusion > dizziness, blurred
vision, etc. Hyperc-pni- triggers -n incre-se in CBF (to -id in remov-l of
toxins) -nd hypoc-pni- triggers decre-se in CBF
!. Mech-nic-lly ventil-ted pts w cerebr-l edem- -re often hyperventil-ted
to decre-se intr-cr-ni-l pressure -nd prevent br-in herni-tion
%. X REVIEW GLUCOSE-ALANINE CYCLE
!. Deets
!. Al-nine -nd glut-mine tr-nsport nitrogen throughout the body
#. Almost -ll -minotr-nsfer-se enzymes use --ketoglut-r-te -s -mino
-cid group -cceptor
$. Glut-m-te is met-bolized by glut-m-te dehydrogen-se > liber-tes
free -mmoni- -nd regener-tes --ketoglut-r-te
#. Other
!. M-l-te, citr-te, ox-lo-cet-te -re -ll intermedi-tes of TCA Cycle
&. REVIEW Morphine MOA (look >t sketchy micro)
!. Opi-tes bind mu receptors on prim-ry -fferent neuron > closure of
volt-ge-g-ted c-lcium ch-nnels, reduced c-lcium influx
#. Opi-tes -lso bind to mu receptors on post-syn-ptic membr-ne - opens
pot-ssium ch-nnels -nd le-ds to membr-ne hyperpol-riz-tion due to
pot-ssium efflux
$. Others
!. Digoxin - inhibits N--K ATP-se
 #. Lidoc-ine - blocks volt-ge-dept sodium ch-nnels
$. Benzos - Incre-se GABA
\. RCC - c-n c-use “c-nnonb-ll met-st-ses” in the lungs
!. rounded polygon-l cells w cle-r cytopl-sm = met-st-tic cle-r cell
c-rcinom- - most common subtype of RCC
#. Other
!. Osteos-rcom- c-n -lso go to the lungs - would see spindle cells w
osteoid m-trix production
#. Testicul-r c-ncer c-n -lso go to lungs > B-hCG or -FP -re often
elev-ted
]. Follicul-r lymphom- - tr-nsloc-tion of bcl-2 oncogene from chromo 18 to Ig
he-vy ch-in locus on chromo 14
^. X could h-ve h-d - soci-l worker follow up -nd -ssess if the d-ughter w-s
still -ble to help with c-re
!. Disch-rge p-perwork m-y not be helpful since he is cognitively imp-ired
#. Simplying dosing schedule c-n help -dherence, but itʼs more impt to
ensure th-t pt is -dequ-tely supervised
_. Fibroids
!. Deets
!. C-n be loc-ted
!. Seros-l surf-ce (subseros-l)
#. In uterine w-ll (intr-mur-l)
$. Below endometrium (submucos-l)
#. Irregul-r uterine enl-rgement
$. Could put pressure on colon > constip-tion
#. Other
!. Adenomyosis would le-d to uniform enl-rgement
#. Non-obese, nullip-rous women -re -t lowest risk for pelvic org-n
prol-pse
!`. REVIEW / ANKI this X Excretion = filtr-tion - tubul-r re-bsorption
!. Filtr-tion r-te = GFR X pl-sm- concentr-tion of subst-nce A. GFR = inulin
cle-r-nce bc inulin is neither secreted nor re-bsorbed
!. Tot-l filtr-tion = (inulin cle-r-nce)(pl-sm- concentr-tion of subst-nce
A)
#. net excretion of subst-nce A = (inulin cle-r-nce)(pl-sm-
concentr-tion of sub A) - (tubul-r re-bsorption of sub A)
#. = (100 mL/min)(0.5 mg/mL) - (25 mg/min) = 25 mg/min
!!. X Omission of key info during h-ndoffs > medic-tion error, -void-ble
esc-l-tions in c-re, redund-ncy, etc
!#. Must include route of -dministr-tion in the confirm-tion
!$. X F-ci-l nerve h-s the two little stems. Vestibulocochle-r nerve is thicker.
!%. Thi-mine is - cof-ctor for glucose met-bolism - so infusing glucose w/o
thi-mine will ex-cerb-te pre-exisiting thi-mine deficiency > precipit-tes
!%.

Wernicke enceph-lop-thy
!&. NEPHROTIC/NEPHRITIC SKETCHY PATH
!. PLA-2R -ntibodies > suggests - di-gnosis of membr-nous nephrop-thy.
Positive titers rule out other c-uses of nephrotic syndrome. Titers
correl-te w dise-se -ctivity.
!\. Extr-medull-ry hem-topoiesis is most frequently c-used by severe
hemolytic -nemi-s like B th-l
!. Exp-nding m-ss of progenitor cells thins bony cortex -nd imp-irs bone
growth. Le-ds to p-thologic fr-ctures.
!]. Prost>cyclin/thrombox>ne in pulm HTN
!. PAH - results from progressive remodeling of sm-ll -nd med-sized pulm
-rteries/-rterioles
#. Endotheli-l dysfunction > incre-se in v-soconstrictive, proprolifer-tive
medi-tors
!. Decre-se in v-sodil-tion, -nti-prolifer-tive medi-tors
#. Imb-l-nce le-ds to v-soconstriction -nd smooth muscle prolifer-tion
$. Prost-cyclin -n-logues -nd NO-enh-ncing -gents - silden-fil - promote
v-sodil-tion
!^. X LAP c-n be norm-l/incre-sed in leukemi- rxn.
!. Deets
!. Dohle bodies - b-sophilic peripher-l gr-nules in neutrophils. Blue
color is due to ribosomes bound w RER. Dohle - seen in toxic systemic
illness but c-n -lso occur w burns/myelodyspl-si-.
#. Also h-ve incre-sed b-nds, toxic gr-nul-tion, cytopl-smic v-cuoles
#. Hypersegmented neutrophils = fol-te or B12 deficiency
!_. Actinomyces is fil-mentous -nd br-nching
#`. STREP PNEUMO IS MCC of meningitis in -dults of -ll -ges
#!. X HBV infection
!. Anti-HBcAg IgM -nd elev-ted serum tr-ns-min-ses -ppe-r before
symptom onset
!. Over the next few months, -nti-HBcAg IgM is repl-ced w IgG
#. Anti-HBeAg -ppe-rs before HBeAg v-nishes - suggests subsiding
vir-l -ctivity
#. HBeAg persisted - highly infectious chronic hep B. C-n see persistence of
HBeAg -nd l-ck of -nti-HBeAg
##. NPV - prob-bility of not h-ving dz when test is neg-tive
!. Low prob-bility of h-ving dise-se - high NPV with - neg-tive test
#$. X wow there -re - LOT of chloroquine resist-nt -re-s. Tx w -tov-quone-
progu-nil or -rtemisinins
!. P viv-x -nd Ov-le - tx w prim-quine to t-rget hypnozoites
#%. Opioids c-n contr-ct smooth muscles in Sphincter of Oddi > sp-sm -nd
incre-se in CBD pressures
#&. X Anxiety -nd -git-tion - centr-l effects of dop-mine. C-n be incre-sed w
#&.
-ddition of c-rbidop- bc more dop-mine would then be -v-il-ble to the
br-in.
!. Postur-l hypotension -nd hot fl-shes would -lso result from peripher-l
conversion of levodop- to dop-mine
#\. Ac-nthosis nigric-ns - peduncul-ted outgrowths of norm-l skin th-t -re
usu-lly present in -re-s -ffected by -c-nthosis nigric-ns
!. Deets
!. C-n be benign or m-lign-nt
!. Benign - insulin resist-nce
#. M-lign-nt - neopl-sms of GI -nd GU systems
#]. REVIEW NMS
!. X Drug-induced p-rkinsonism - rigidity -nd br-dykinesi-. Due to
dop-mine receptor block-de in nigrostri-t-l p-thw-y
!. Tx w -nticholinergic -gent (benztropine)
#. Other
!. D-ntrolene - for NMS (diffuse rigidity, hyper-ctivity)
#. Prop-nlol or di-zep-m - tx -k-thisi- - subjective restlessness -nd
in-bility to sit still
#^. X TMP -nd MTX h-ve the s-me t-rget - DHFR
!. Deets
!. MTX t-rgets hum-n cells
#. TMP t-rgets p-r-sitic DHFR
#. Other
!. SMX - competes w PABA to inhibit dihydropteo-te synthet-se -
enzyme needed for dihydrofolic -cid synthesis
#_. SGLT-2 inhibitors - must h-ve effective glomerul-r filtr-tion of glucose.
Serum cre-tinine is recommended for screening prior to initi-tion of ther-py
-nd periodic-lly there-fter
$`. K-posi s-rcom- - spindle -nd epitheli-l cell prolifer-tion, red cell
extr-v-s-tion, infl-mm-tion
$!. RE-REVIEW T lymphs -re initi-lly produced in the bone m-rrow, but migr-te
from th-t loc-tion to m-ture during the first trimester of gest-tion in the
thymus. TCR gene re>rr>ngement, positive selection, neg>tive selection
>nd expression of co-stimul>tory molecules occur
!. Deets
!. Pro T cells -rrive @ thymus -s double-neg-tive cells - l-ck CD4 -nd
CD8 -ntigens
#. Positive selection - only T cells expressing TCR th-t -re -ble to bind
MHC -re -llowed to survive
$. Neg>tive selection - occurs -fter positive selection -nd is the
process by which T cells possessing TCRs th-t bind w high -ffinity to
self -ntigen or self MHC cl-ss I or II -re elimin-ted by -poptosis
!. Involves inter-ction of T cells w thymic medull-ry epitheli-l -nd
 !.
dendritic cells
#. If it binds to strongly - overly re-ctive, elimin-ted
%. Only low -ffinity T cells continue on
#. Affinity m-tur-tion
!. Process of enh-ncing hyperv-ri-ble region -ntigen binding -ffinity
th-t occurs -fter initi-l binding of -ntigen to membr-ne bound Ig on
n-ive B lymph -nd migr-tion of B lymph to lymph node
$#. Multiple pl-sm- cells - MM
!. Pl-sm- cells replic-te in BM -nd choke out norm-l hem-topoesis -
normocytic, normochromic -nemi-
#. Secretion of light ch-ins
!. C-n le-d to light-ch-in c-st nephrop-thy
#. Light ch-ins - -lso form insoluble fibrils -nd deposit in m-jor org-ns -
light ch-in -myloidosis
$$. X High-norm-l g-strin levels th-t rise in response to secretin = ZES
!. Proxim-l dudoden-l ulcers -re c-used by H pylori -nd NSAIDs
!. H pylori - destroys som-tost-tin-producing cells - l-ck of inhibition
le-ds to excessive g-strin rele-se - promotes g-stric -cid hyper
secretion -nd proxim-l duoden-l ulcer form-tion
#. Ulcers beyond duoden-l bulb = ZES
$%. SER - synthesis -nd processing of hydrophobic compounds - lipids,
phospholipids, cholesterol deriv-tives (steroid hormones)
!. Steroid hormone production > viriliz-tion due to -ndrogen-secreting
ov-ri-n or -dren-l tumor
#. Other
!. PEPTIDE hormone production h-ppens on RER
!. SIADH from ADH production
#. Hypoglycemi- from insulin overproduction by insulinom-s
$. ZES from g-stronom-s
%. G-l-ctorrhe- from prol-ctinom-
$&. Histopl-sm- c-n look like TB - bil-ter-l nodul-r densities -nd hil-rious
lymph-denop-thy
!. TNF-- inhibitors- incre-sed risk of infection w p-thogens controlled by
cell-medi-ted immune response like intr-cellul-r b-cteri- -nd fungi
!. M-croph-ge -ctiv-tion, ph-golysosome function, m-inten-nce of
gr-nulom-s
$\. Bili-ry -tresi- - complete or p-rti-l obstruction of extr- hep-tic bile duct.
Usu-lly norm-l -t birth, then undergoes destruction th-t is thought to be
immune-rel-ted or vir-l induced
!. d-rk urine -nd cl-y colored stools - due to extensive ren-l excretion of
bilirubin -nd l-ck of intestin-l bile
$]. X hyper-ldosteronism - Conn syndrome (unil-ter-l -denom-) or bil-ter-l
-dren-l hyperpl-si-
 !. Deets
!. Incre-sed N- re-bsoprtion - cre-tes - neg-tive ch-rge in the lumen -
pulls K+ -nd H+ from tubul-r cells > incre-sed excretion of urin-ry K+
-nd H+
#. Incre-sed H+ secretion > met-bolic -lk-losis
$. Hypern-tremi- -nd ped-l edem- -re r-rely observed - due to
-ldosterone esc-pe - incre-sed RBF, incre-sed ANP
$^. Neutrophils -re key pl-yer in lung -bscess development
!. Deets
!. Recruited from systemic circul-tion, rele-se cytotoxic gr-nules
(lysosomes) w myeloperoxid-se -nd other enzymes - to destroy
extr-cellul-r b-cteri-
#. C-n -lso c-use d-m-ge to pulmon-ry p-renchym- -nd c-n result in
liquefying necrosis of lung tissue
#. Other
!. Dendritic -nd other APCs - rele-se IL-12 - stimul-te differenti-tion of
Th1 helper cells -nd production of IFN-y by T cells
#. IFN-y -ctiv-tes m-croph-ges > p-rt of TB p-thogenesis. But TB
would t-ke MONTHS to develop
$. TGF-B - contributes to sc-r form-tion -fter injury
$_. Pts w sufficient depressive sx -re di-gnosed w MDD even if there is -
stressor th-t brought it on (ie if pt meeds MDD criteri-, not dxʼd -s
-djustment disorder)
!. W premenstru-l dyspmorphic disorder - depressive sx must remit w onset
of menses
%`. Intr-ventricul-r hemorrh-ge - complic-tion of prem-turity. Occurs in inf-nts
born before 32 weeks gest-tion.
!. Deets
!. Usu-lly origin-tes in sub ventricul-r zone - where neurons -nd gli-l
cells migr-te out of during br-in development
#. Others
!. Subdur-l hem-tom- from rupture of bridging veins - sh-ken b-by
syndrome
#. S-ccul-r -neurysms = MCC of sub-r-chnoid hemorrh-ge
3/22-2

!. X Sc0bies - r0sh is usu0lly worse 0t night, line0r burrows 0re the most
specific finding - c0n be obscured by excori0tions
!. Excori0tions w sm0ll, crusted red p0pules
#. Other
!. Multinucle0ted gi0nt cells - indic0tes herpes infections like shingles -
vesicles in derm0tom0l distributions
#. Benzos - 0llosteric binding modul0tes GABA
!. Deets
!. Incre0sed frequency of chloride ion ch0nnel opening
#. Influx of chloride ions into neurons c0uses hyperpol0riz0tion 0nd
inhibition of the 0ction potenti0l
#. Prolonged bento use > down regul0tion of GABA(A) receptors
$. PPV = given positive test, wh0t is prob0bility th0t p0tient h0s dise0se?
%. X REVIEW THIS- ok
!. Deets
!. Hormone sensitive lip0se - found in 0dipose tissue, c0t0lyzes
mobiliz0tion of stored triglycerides into FFAs 0nd glycerol.
#. Activ0ted in response to stress hormones, inhibited by rele0se of
insulin
$. Stress hormones stimul0te GCPRs on 0dipocytes > incre0sed cAMP
production 0nd 0ctiv0tion of PKA
%. FFAs 0nd glycerol > glycerol prim0rily used for glucose
&. Liver oxidizes FFAs to 0cetyl-CoA > further met0bolized to ketone
bodies
#. Other
!. Glycogen phosphoryl0se frees glucose-1-phosph0te from stored
glycogen ch0ins. Used during first sever0l hours of f0sting but no
effect on f0tty 0cid oxid0tion.
&. ANKI THIS Siderobl0stic 0nemi0 due to isoni0zid use.
!. Isoni0zid inhibits pyridoxine phosphoki0nse > norm0lly converts
pyridoxine to pyridox0l 5ʼ phosph0te, which is 0 cof0ctor for ALA
synth>se > c>t>lyzes r>te-limiting step in heme synthesis
#. vs ALA dehydr0t0se is inhibited in le0d poisoning
'. ANKI THIS 0n0pl0stic tumors usu0lly demonstr0te these
!. Fe0tures of 0n0pl0stic tumors
!. Loss of cell pol0rity
#. Signific0nt v0ri0tion in size/sh0pe of cells
$. Disproportion0tely l0rge nuclei
%. Numerous mitotic figures
 &. Gi0nt, multinucle0ted tumor cells
#. Others
!. Hep0tic cells norm0lly synthesize bile - REVIEW THIS
c. Menstru0l cycle histology
!. Prolifer0tive: uniform gl0nds in uniform storm0
#. Midprolifer0tive: tubul0r, n0rrow, lined w mitotic0lly 0ctive epitheli0l cells
$. @ Ovul0tion: l0te prolifer0tive endometrium w coiled gl0nds 0nd
occ0sion0l cytopl0smic v0cuoles in gl0ndul0r epithelium
%. Secretory: strom0 becomes more edem0tous
d. X Cl0vicle - most commonly fr0ctured bone WTF
!. Sternocleidom0stoid = upw0rd tr0ction on medi0l fr0gment of fr0ctured
cl0vicle
!. Pulled superiorly 0nd posteriorly
#. Weight of 0rm on pec m0jor pulls l0ter0l fr0gment inferiorly 0nd 0nteriorly
!. Tr0pezius would pull it superiorly, but combined tr0ction of 0rm
weight 0nd pec m0jor overcomes tr0pezius
e. X ren0l inf0rct - most commonly c0used by c0rdioembolic dise0se
(origin0ting from LA or ventricle)
!. Deets
!. Afib (evidenced by intermittent p0lpit0tions 0nd hx of sleep 0pne0) =
gre0test f0ctor
#. Emboli from mur0l thrombi, prosthetic v0lves, or v0lvul0r veget0tions
0re 0lso implic0ted
$. Complete occlusion of ren0l 0rr0y c0n occur more r0rely due to direct
0rteri0l injury or hyperco0gul0ble st0tes
%. Yellow-white, wedge-sh0ped inf0rcts w surrounding hyperemi0
#. W/ pyelonephritis - would expect to see pyuri0 on urin0n0lysis
!f. Most common c0use of decre0sed AFP - in0ccur0te d0ting
!. Gest0tion0l 0ge is likely incorrect due to history of irregul0r menses
!!. X H flu - v0ccine only confers immunity to the more inv0sive type B str0in
!. Cont0ins c0psul0r polys0cch0ride components to induce 0ntibodies.
Antibody response is we0k, so it is conjug0ted to toxoid protein.
#. Cell-medi0ted cytotoxic T cell response is not induced.
!#. X-linked recessive problem ok
!$. X Ch0nged my 0nswer
!. Deets
!. LHF due to long-st0nding HTN > incre0se in pressure is tr0nsmitted
b0ckw0rd to LA 0nd pulm veins, results in pulmon0ry venous
congestion 0nd elev0tions in pulmon0ry c0pill0ry 0nd pulmon0ry
0rteri0l pressure
#. Le0ds to pulm HTN 0nd right HF w jugul0r distension 0nd peripher0l
edem0
$. Remodeling is less extensive th0n pulmon0ry 0rteri0l HTN
 #. Other
!. Pulmon0ry 0rteri0l flow would incre0se with congenit0l he0rt defects
th0t c0use 0 left to right shunt
!. In LHF - PH occurs due to b0ckw0rd tr0nsmission of pressure
from incre0sed pulm VENOUS blood volume
!%. S1 - loss of 0chilles reflex. L4 - loss of p0tell0r reflex.
!. S1 r0diculop0thy - pts c0n 0lso h0ve we0kness on thigh extension due to
denerv0tion of gluteus m0ximus, knee flexion (h0mstrings), 0nd poor
pl0nt0r flexion (g0strocnemius) w 0bsent 0nkle jerk reflex
!&. Derm0tomyositis - tx w glucocorticoids
!'. Ok
!c. X Omg Iʼm dumb
!. Leptospirosis = spirochete, motile, conjunctiv0l effusion
#. Some pts c0n develop flu-like illness or more over end-org0n dise0se
!d. X REVIEW THIS - done
!. The drug is slowing down how much pot0ssium flows out 0t 0 time. More
dr0wn out curve.
#. DECREASE in outw0rd pot0ssium flow - cl0ss III 0nti0rrythmics block
c0lcium ch0nnels 0nd inhibit outw0rd pot0ssium currents - prolong tot0l
0ction potenti0l dur0tion
$. Other
!. Adenosine - would INCREASE K+ out of cells
!. Membr0ne potenti0l rem0ins neg0tive for 0 longer period
!e. X A fib - 0bsent P w0ves (ATRIA DO NOT CONTRACT), irregul0r rhythm,
n0rrow QRS
!. Deets
!. Ventricul0r response is dependent on tr0nsmission of 0tri0l impulses
thru AV node
#. E0ch time AV node is excited, enters 0 refr0ctory period when 0tri0l
impulses c0nʼt be tr0nsmitted to ventricles (so m0ny impulses never
re0ch ventricles)
#. Others
!. Purkinje c0n 0ssume p0cem0ker 0ctivity in pts w severe br0dyc0rdi0
but would not gener0te impulses in AF since ventricul0r r0te is
elev0ted
#. Ventricul0r refr0ctory r0te doesnʼt limit ventricul0r contr0ction r0te
#f. P0r0cortex doesnʼt develop in DiGeorge
!. Other
!. Follicles - in 0g0mm0globulinemi0, germin0l centers 0nd prim0ry
lymphoid follicles donʼt form
#!. CMV retinitis: suspect in HIV pts w scotom0, flo0ters, photopsi0
!. Yellow-white, fluffy retin0l lesions w hemorrh0ge
#. G0nciclovir is the tx
##. X wow Iʼm 0 dumb beesh
!. Suspect HIV in young individu0ls who develop thrush w no cle0r inciting
c0use
#. Vs leukopl0ki0 - c0nʼt be e0sily removed by scr0ping
#$. Not sure if I underst>nd this
!. Env gene encodes polyprotein gp160 - extensively glycosyl0ted in the ER
0nd then cle0ved into gp120 0nd gp41. Form glycoprotein spikes th0t
pepper surf0ce of HIV virus
!. Gp120 binds to host receptors 0nd induces 0 conform0tion0l ch0nge
> exposes underlying gp41
#. Gp41 c0n then medi0te fusion w host cell membr0ne - then vir0l core
c0n enter cell
#%. TCAs c0n 0nt0gonize centr0l 0nd peripher0l musc0rinic 0nd Ach receptors -
le0d to urin0ry retention
#&. Busp0r - no risk of dependence, but it requires up to 2 weeks to h0ve 0n
0nxiolytic effect
#'. Soci0l phobi0 - 0nxiety 0bout >1 soci0l situ0tions for >6 months
!. C0n use SSRI
#c. Villous 0denom0s 0re more likely to undergo m0lign0nt tr0nsform0tion th0n
tubul0r 0denom0
!. Neopl0stic polyps 0nd serr0ted polyps 0re both neopl0stic
#. Incre0sing polyp size is the most impt ch0r0cteristic th0t correl0tes w
m0lign0ncy risk
#d. V0nc resist0nce - peptide precursor 0lters v0ns-binding site from D-0l0 D-
0l0 to D-0l0 D-l0c
!. MRSA resist0nce - b0cteri0 h0ve modified PBP in cell w0lls
#e. X Excessive bleeding is common in pts w ren0l dysfunction due to
0ccumul0tion of uremic toxins
!. Imp0ir pl0telet 0ggreg0tion 0nd 0dhesion > qu0lit0tive pl0telet disorder -
prolonged BT w norm0l pl0telet count, PT, 0nd 0PTT
#. Uremic bleeding c0n be improved w di0lysis - removes toxins 0nd p0rti0lly
reverses bleeding 0bnorm0lity
$f. X REVIEW THIS
!. Hypercortisolism - hypertension, obesity, muscle we0kness, ecchymoses,
hyperglycemi0
!. I0trogenic Cushing syndrome c0n result from prolonged
0dministr0tion of glucocorticoids
#. Exogenous glucocorticoid use inhibits entire hypoth0l0mic-pituit0ry-
0dren0l 0xis > low levels of CRH, ACTH, 0nd endogenous cortisol
$. Long term suppression > 0drenocoritc0l 0trophy. Sudden cess0tion of
glucocorticoids c0n le0d to 0dren0l crisis.
#. Other
!. Could h0ve s0me sx w endogenous tumor, but since she h0d lupus
 !.
0nd w0s txʼd w glucocorticoids - would h0ve down regul0tion of the
0xis 0nd glucocorticoids would le0d to HTN, plethor0, etc
$!. X Di0rrhe0 in HIV p0tients - opportunistic 0nd non-opportunistic infections
0s well 0s K0posi
!. KS - reddish/violet fl0t lesions > hemorrh0gic nodules or polypoid m0sses
#. Would see spindle cells w 0typi0, blood vessel prolifer0tion 0nd
extr0v0s0ted red blood cells w hemosiderin deposition
$. Inv0des mucous membr0nes (including intestines). Most commonly on
h0rd p0l0te.
$#. Anki this m>ybe? Types of seizures
!. Deets
!. Foc0l - 1 hemisphere 0t onset
!. Simple - no loss of consciousness
#. Complex - m0y h0ve loss of consciousness
#. Gener0lized - both hemispheres
!. Myoclonic - no loss of consciousness
#. Tonic-clonic - loss of consciousness
$$. C0vernous hem0ngiom0 = most common benign liver tumor
!. Donʼt biopsy 0 hem0ngiom0 bc it c0n le0d to f0t0l hemorrh0ge
#. Hep0tic 0denom0s 0re seen in women of reproductive 0ge
$%. X REVIEW THIS
!. Deets
!. Prim0ry hemost0sis
!. Pl0telet 0dhesion t0kes pl0ce on vWF
#. Pl0telet plug - pl0telets become 0ctiv0ted 0nd secrete multiple
subst0nces
$. TXA2 - prost0gl0ndin is rele0sed 0nd 0cts 0s v0soconstrictor
#. Endothelium secretes prost>cyclin (PGI2) to inhibit pl>telet
>ggreg>tion 0nd 0dhesion to v0scul0r endothelium 0nd c0use
v0sodil0tion
#. Synthetic prost0cyclin = epoprostenol - inhibits pl0telet 0ggreg0tion 0nd
c0uses v0sodil0tion
!. Vs prost0gl0ndins INCREASE tone
$&. Di0betic retinop0thy - micro0ngiop0thic complic0tion of di0betes.
!. Deets
!. Two ph0ses
!. Non-prolifer0tive: thickening of BM, f0ilure of blood-retin0l
b0rrier. Micro0neurysms 0nd dot-blot hemorrh0ges due to
micro0neurysm rupture
!. Arteriol0r obstruction > ischemic injury to the retin> >
cotton wool spots
#. Prolifer0tive: progressive ischemi0: neov0scul0riz0tion
#. Others
 !. Age-rel0ted m0cul0r degener0tion > centr0l vision loss. L0te-
st0ge: “wet” - drusen 0nd pigment 0bnorm0lities
#. Open 0ngle glu0com0 - enl0rgement of retin0l cup w p0le optic
disc 0nd thinned rim
$. Hypertensive retinop0thy - 0rteriol0r n0rrowing. C0n 0lso see
cotton wool spots from ischemi0
$'. VHL - presence of c0pill0ry hem0ngiobl0stom0s in the retin0
$c. Delirium h0ppens 0fter infections
$d. Femor0l nerve block 0t the inguin0l cre0se - l0ter0l border of femor0l 0rtery
!. Other
!. Ischi0l spine = divides gre0ter 0nd lesser sci0tic for0min0 in bony
pelvis. Ischi0l spine tip is 0 l0ndm0rk for pudend0l nerve block used in
epidur0l
$e. REVEW LATER 21 hydroxyl0se - non s0lt-w0sting (moder0te) 0nd s0lt-
w0sting (severe) forms
%f. Congenit0l 0dren0l hyperpl0si0 due to 21 hydroxyl0se deficiency - imp0ired
cortisol synthesis. Hypoth0l0mus would incre0se ACTH secretion to
compens0te - so t0rget ACTH w ther0py
3/23 -dd on to NBME 18

!. Review MHC I vs II - done

!. MHC II peptides -re displ-yed only by APCs
!. MHC II molecules -re synthesized on REER -nd routed to endosomes
by Golgi
#. Cl-ss II molecule-protein -ntigen complexes -re displ-yed on surf-ce
of APCs where they -re -v-il-ble to bind TCRs on T lymphs -nd
initi-te T cell response
#. Others
!. Initi-tion of T cell -ctiv-tion requires co-stimul-tory binding of T cell
bound CD28 to APC-bound B7
#. X Septic -bortion - infect ret-ined products of conception. St-ph -ureus is -
common p-thogen, -lso gr-m-neg B-cilli -nd group B strep
!. C-n h-ve -dhesions in uterine c-vity => -menorrhe- -nd infertility
$. X 0.9 = d/200 => d = 180
!. F-lse positives = 200-180 = 20
%. Review this! - done
!. B-se excision rep-ir
!. Cytosine de-min-tion > ur-cil
#. Glycosyl-se cle-ves -ltered b-se
$. Endonucle-se cle-ves 5ʼ end -nd ly-se (or phosphodiester-se)
cle-ves 3ʼ sug-r phosph-te
%. DNA polymer-se fills nucleotide g-p -nd lig-se se-ls nick
#. Excessive consumption of diet-ry nitrites c-n promote de-min-tion. If
-bnorm-l b-ses -renʼt removed -nd repl-ced w correct b-se > DNA
mut-tions -nd c-rciogenesis.
&. Review Mobitz blocks? - done
!. Deets
!. Br-dyc-rdi- w dropped P w-ves > sick sinus syndrome. Age-rel-ted
degener-tion of SA node (in RA w-ll). Slowed r-te of ventricul-r
contr-ction > reduced CO
#. AV node triggers conduction b-sed on its own p-cem-ker if no sign-l
from SA node > sinus -rrest le-ds to junction-l esc-pe be-t
#. Other
!. Conduction thru IV septum > L -nd R bundle br-nches. Abnorm-lities
> BBB.
#. After initi-tion in SA node > conduction c-n prop-g-te thru LA w-ll >
LA contr-ction. Abnorm-l foci c-n develop in pulm veins > Afib
'. F-ctor X- inhibitors bind -ctive site > prevent thrombin form-tion
(. C-rdiomyocytes rele-se ANP -nd BNP. Broken down -nd in-ctiv-ted by
 (.
MMP neprilysin.
!. Effects of ANP -nd BNP - -fferent -rterioles -re dil-ted -nd efferent -re
constricted > GFR incre-ses, urin-ry excretion of sodium -nd w-ter
incre-ses
#. Adren-ls - -ldo secretion is inhibited, counter-cts RAAS
$. Blood vessels - rel-x > v-sodil-tion. Also incre-sed perme-bility
g. X Prion - spongiform enceph-lop-thy. V-cuoles from cytopl-sm of neurons
-nd neutrophils. Dise-se progresses > v-cuol-ted -re-s tr-nsform into
cysts. I guess it c-n -lso present w vision loss
h. X c-n see - septum dividing lumen of -scending -nd descending -ort-
!. Hypertension is the single most import-nt risk f-ctor for development of
intim-l te-rs > -ortic dissection
#. Other
!. Sedent-ry lifestyle = m-jor risk f-ctor for CV dise-se, but not linked
to dissection
!i. X serotonergic nuclei -re found in r-phe nuclei
!. Locus ceruleus - houses NE-secreting neurons th-t p-rticip-te in
-ctiv-tion of “fight or flight” response
!!. N-loxone h-s the gre-test -ffinity for mu receptors - reverses opioid
overdose
!#. Ag-in, respir-tory depression from opioid overdose le-ds to resp -cidosis
!$. X P-nic disorder - benzos for r-pid relief
!. Wouldnʼt use SSRIs in the ED c-use they t-ke too long
!%. X decompens-ted he-rt f-ilure > decre-sed CO in the he-rt reduces ren-l
perfusion, stimul-tes renin secretion by JG cells.
!. ATI is converted to ATII in the sm-ll pulm vessels by ACE, so ATII levels -re
higher in the pulm vein th-n pulm -rtery
!. V-soconstrictor, c-uses rise in BP (incre-sed -fterlo-d) > worsened
c-rdi-c output. Also stimul-tes -ldo rele-se from -dren-l gl-nd >
incre-sed sodium retention
#. Other
!. Prost-gl-ndins - produced in endotheli-l, m-st cells, m-croph-ges.
PGE1 is - v-sodil-tor > keeps ductus -rteries p-tent
!&. WTF IS RAS
!. RAS is bound in in-ctive GDP-bound st-te OR -ctive-GTP bound st-te.
Becomes -ctiv-ted when lig-nd binds receptor tyrosine kin-se on cell
membr-ne.
!. Activ-ted R-s > c-sc-de > -ctiv-tes MAPK
!'. X I guess this shit h-s budding hyph-e -nd th-t m-kes it c-ndid-
!(. Lung c-ncer is the le-ding c-use of c-ncer mort-lity in men -nd women
since the 80s
!. It dipped -round 2000s w decre-sed tob-cco use
!g. Adenovirus- ph-ryjgoconjunctiv-l fever - fever, cough, congestion,
!g.
ph-ryngitis, conjunctivitis
!h. X C diff c-n -lso present in AIDS p-tients. C-n see bowel necrosis w
perfor-tion. Pseudomembr-nes h-ve - neutrophil predomin-nt infl-mm
infiltr-te w fibrin, b-cteri-, necrotic epithelium
#i. M3 v-ri-nt of AML = APML - 15;17 w Auer rods
#!. Koilocyte = r-isin-like nuclei vs clue cell = epitheli-l cell covered in b-cteri-l
!. Others
!. P-r-b-s-l cells = round w b-sophilic cytopl-sm, fine chrom-tin, no
nucleoli, high nucleus:chrom-tin r-tion - c-n be seen in women from
postmenop-us-l -nd postp-rtum women
##. Hib is most inv-sive str-in due to PRP c-psule - inhibits complement-
medi-ted ph-gocytosis, c-n inv-de tissues -nd survive in blood
!. Meningitis from type B c-psul-r form
#$. X Norm-l grief - feelings of loss intermixed w positive memories of
dece-sed. Usu-lly l-sts 6-12 months.
!. C-n -lso h-ve weight loss, but l-ck of other depressive symptoms
#. Persistent complex bere-vement disorder (complic-ted grief) = prolonged
grief for >12 months, difficulty -ccepting de-th, c-nʼt reeng-ge w life
#%. Lipodystrophy = common -dverse effect of HAART
#&. SLE - -uto-ntibody production due to loss of self toler-nce. C-n -lso le-d to
the form-tion of circul-ting immune complexes w reduced complement
levels
#'. X -theroembolic dise-se - livedo reticul-ris (obstruction of c-pill-ries by
sm-ll blood clots), blue toe, -cute kidney injury
!. Deets
!. C-n see -fter inv-sive procedures th-t c-use cholesterol debris to
become dislodged
#. Fr-nk inf-rction doesnʼt occur bec-use the clefts -re sm-ll - m-y only
p-rti-lly obstruct -rcute or interlobul-r -rteries
#. Ur-te nephrop-thy - usu-lly due to tumor lysis syndrome
#(. REVIEW STATINS - done
!. St-tins = HMG CoA reduct-se inhibitors. In response, hep-tocytes
incre-se LDL receptors to incre-se upt-ke of circul-ting LDL
#. Gre-test risk reduction for -cute coron-ry events
#g. Schizophreni- - tx w dop-mine receptor -nt-gonists
#h. AV fistul- - incre-ses blood returned to the he-rt. Incre-sed prelo-d.
$i. Neuritic pl-ques = found in medi-l tempor-l lobe, composed of -myloid bet-
core w dystrophic neurities
!. C-n see neurofibrill-ry t-ngles in the neuron-l cytopl-sm - -ggreg-tes of
hyperphosphoryl-ted t-u protein
!. Medi-tes microtubule st-biliz-tion
$!. Review Aortic Arch derivAtives
!. F-ilure to thrive, SOB, exercise intoler-nce w he-rt murmur -nd p-lp-ble
 !.
thrill - PDA
!. Usu-lly closes w decre-sed PGE2 levels. PE shows continuous,
m-chine-like murmur
#. Others
!. Bulbis cordis = beginning of ventricul-r outflow tr-ct of the he-rt
#. Sinus venosus = receives blood from ven- c-v-, forms smooth
portion of RA in -dults
$. Fourth -ortic -rch - gives rise to -ortic -rch -nd proxim-l subcl-vi-n
$#. REVIEW THE DIFFERENT HORMONES AND TYPES OF RECEPTORS - done
!. Mnemonics
!. PET CAT (in) TV - intr-cellul-r
!. Progesterone, estrogen, testosterone, cortisol, -ldosterone, T3/
T4, vit-min D
$$. Aged rel-ted ch-nges
!. Deets
!. Eye stuff
!. Myopi- (ne-rsighted) - im-ge focuses in front of retin-
#. Presbyopi- (f-rsighted) - im-ge focuses behind retin-
#. Aging
!. Around 40-50, most individu-ls c-nʼt focus on ne-r objects
(presbyopi-). So -s she gets older, her presbyopi- will
compens-te for the pre-exisitng myopi-.
#. Wrinkles -lso h-ppen in -ging - derm-l -nd epiderm-l thinning,
decre-ses fibrobl-sts, reduced synthesis -nd incre-sed coll-gen/
el-stin bre-kdown
$%. Epidur-l hem-tom- - between br-in -nd dur-
!. Ch-r-cteristic progression: m-y lose consciousness, then reg-in
conciseness -nd feel well, then c-n h-ve - quick decline th-t c-n
progress to com- or de-th
$&. Alcohol c-n induce secretion of protein-rich fluid > c-n precipit-te in
p-ncre-tic ducts > duct-l plugs th-t c-lcify > exocrine insufficiency
$'. COX 1/2 sketchy?
!. COX 2 is expressed -t sites of infl-mm-tion. COX 1 inhibition -lso inhibits
pl-telet function, so selective COX 2 inhibitors -void bleeding risk but still
bring down infl-mm-tion.
!. Some selective COX 2 inhibitors h-ve -n incre-sed risk of CV events.
$(. X g-llstone ileus = c-n occur w long-st-nding cholelithi-sis. L-rge g-llstone
c-uses cholecystoenteric fistul- between g-llbl-der -nd -djoining gut due
to pressure necrosis -nd erosion of the tissues.
!. Obstructs ileocec-l v-lve (n-rrowest point)
#. Communic-tion between intestine -nd g-llbl-dder c-n c-use g-s to enter
bili-ry tree
$g. SSRIs ok
$h. Schw-nnom-s - Antoni A -nd B p-ttern
!. Also verroc-y bodies - interspersing nucle-r-free zones
#. S100 positive due to neur-l crest cell origin
%i. Even secondh-nd smoke is b-d for A1AT p-tients
!. Exposure -cceler-tes development of emphysem- by inducing
infl-mm-tion (neutrophil -nd m-croph-ge -ctiv-tion)
#. Other
!. Pts w CGD should -void cert-in immunosuppressive -gents - risk of
overwhelming infection
3/25-1

!. Chronic7lly elev7ted intr7lumin7l pressure > dil7tion of veins 7nd

incompetence of v7lves. Allows retrogr7de flow into superfici7l veins > c7n
le7d to venous st7sis derm7titis
#. Cl7ssic g7l7ctosemi7 = 7utosom7l recessive
!. Others
!. Leber heredit7ry optic neurop7thy = mitochondri7l
#. Rett = X linked domin7nt. Sons die in utero
$. Mode wouldnʼt be 7ffected by 7n outlier.
!. Other
!. St7nd7rd devi7tion 7nd v7ri7nce = me7sures of dispersion - how
spre7d out v7lues 7re from e7ch other
%. X mut7tion th7t c7uses production of Hb w high oxygen 7ffinity > c7nʼt
rele7se oxygen to peripher7l tissues > le7ds to compens7tory
erythrocytosis, helps m7int7in norm7l oxygen delivery
!. Other
!. Sickle cell - would h7ve 7 right shift (decre7sed 7ffnity) due to
st7bilizing effects of polymeriz7tion on deoxygen7ted form
&. Glycogen is broken down by glycogen phosphoryl7se. PK phosphoryl7tes
G.P., phosphoprotein phosph7t7se c7t7lyzes dephosphoryl7tion
!. PK in liver
!. Activ7ted thru epi 7nd gluc7gon binding to Gs protein-coupled
receptors, incre7sed cAMP concentr7tions
#. PK in skelet7l muscles
!. No gluc7gon receptors, but PK c7n still be phosphoryl7ted in
response to epi-induced incre7se in cAMP
#. BUT, incre7sed c7lcium is 7 more powerful 7ctiv7tor of PK
'. Le7d poisoning c7n le7d to constip7tion, 7bdomin7l p7in, decre7sed vit D
met7bolism
!. Repl7ces c7lcium in C7-dept cellul7r functions
#. ENZYMES
!. Siderobl7stic 7nemi7: ALA synth&se
#. Le7d poisoning: ALA dehydr&t&se
(. HOCM. V7ls7lv7 DECREASES prelo7d, incre7sed murmur intensity
!. Bet7 blockers improve sx w incre7se in LV volume, reduces LV outflow
tr7ct obstruction 7nd improves c7rdi7c output
#. Bet7 blocker incre7se prelo7d to reduce LV outflow tr7ct obstruction
$. Incre7se cross section7l 7re7 - decre7sed flow velocity
). IVC looks l7rger th7n 7ort7 on CT
!. IVC filter used in pt w contr7indic7tions to 7ntico7gul7tion
 f. X c7ndid7 is p7rt of norm7l or7l flor7 - forms true hyph7e
!. When they were t7lking 7bout re7ctiv7tion of 7 l7tent org7nism, they were
t7lking 7bout TB
!g. X TBI c7n c7use 7vulsion of olf7ctory rootlets - 7guesi7 is often rel7ted to
7nosmi7
!. Deets
!. Olf7ctory rootlets project thru cribriform pl7te, syn7pse on glomeruli
of olf7ctory bulb
#. Acceler7tion-deceler7tion forces c7n le7d to 7vulsion of olf7ctory
nerve roots
#. Others
!. Sphenoid fr7ctures would d7m7ge optic nerve, pituit7ry gl7nd > CSF
le7k
!!. Autism - l7ck of soci7l eng7gement, repetitive pl7y, speech del7y. C7n
become evident by 7ge 2, di7gnosis usu7lly before 7ge 5.
!. ASD c7n occur w v7rying degrees of l7ngu7ge 7nd intellectu7l imp7irment
!#. 23 v7lent polys7cch7ride v7ccine - protects 7g7inst wider r7nge of
serotypes (conjug7te is only 13 v7lent)
!. Conjug7te v7ccine boosts immune response thru T cell recruitment
#. PCV13 is strongly immunogenic in inf7ncy - polys7cch7ride 7llows for
7ctiv7tion of T cell receptor, incre7ses levels of high-7ffinity 7ntibodies
!$. PCP is 7n NMDA glut7m7te receptor 7nt7gonist. Incre7sed risk of psychosis
p7rti7lly by c7using dop7mine dysregul7tion.
!%. Joint destruction in RA - initi7ted by CD4+ helper T cells, ch7r7cterized by
synovi7l hyperpl7si7 7nd infl7mm7tory infiltr7tes (w lymphoid follicles)
!. Rele7se of protein7ses c7uses destruction of 7rticul7r c7rtil7ginous
m7trix - le7ds to erosion of surrounding 7rticul7r c7rtil7ge
!&. CMV - l7rge cells w intr7cytopl7smic b7sophilic inclusions
!. Deets
!. Tx w g7ncicyclovir - competitively inhibits incorpor7tion of GTP into
CMV DNA str7nds
#. Impedes hum7n DNA polymer7se to 7 lesser degree 7nd c7n interfere
w host cell replic7tion > neutropeni7
#. Other 7ntivir7l side effects
!. Myop7thy 7nd rh7bdo - c7n be 7ssoci7ted w integr7se inhibitors
#. P7ncre7titis - did7nosine
!'. Zenker - c7used by cricoph7rynge7l dysfunction, herni7tion of ph7rynge7l
mucos7 thru zone of muscle we7kness (f7lse diverticulum)
!(. B12 deficiency - d7m7ges posterior columns 7nd l7ter7l corticospin7l tr7cts
(l7ter7l pyr7mid7l tr7cts). C7n 7lso h7ve degener7tion of peripher7l nerves
!). C in CRASH st7nds for conjunctiv7l injection (bil7ter7l)
!. medium sized 7rteries, fever for >5 d7ys
!f. X C-section - usu7lly vertic7l sep7r7tion of rectus 7bdomens. Horizont7l
!f.
m7y be considered when 7ddition7l sp7ce is necess7ry, would d7m7ge
inferior epig7stric.
!. There is no supporting posterior she7th, so tr7um7 to inferior epig7stric
c7n result in signific7nt hemorrh7ge
#g. X Chikunguny7 (me7ns “stooped w7s” due to joint symptoms) - 7rthr7lgi7
7nd high fever. Lymphocytopeni7, thromocytopeni7, tr7ns7minitis. Vector:
Aedes mosquito.
!. Deets
!. Poly7rticul7r 7rthr7lgi7 7nd m7culop7pul7r r7sh initi7lly, then
poly7rticul7r 7rthritis in following weeks/months
#. C7n 7lso h7ve connection w dengue/zik7
#. Other
!. Immune-medi7ted infl7mm7tory 7rthritis = RA
#!. Hist7mine le7ds to development of r7ised, erythem7tous pl7ques w
surrounding erythem7
!. When 7ctiv7ted, m7st cells rele7se hist7mine w degr7nul7tion
##. X nephron Physiology
!. PCT rem7ins isotonic w pl7sm7 (300 mOSm/L) reg7rdless of hydr7tion
st7tus
#. Descending limb - w7ter pulled out - hypertonic
$. Ascending limb - electrolytes 7re re7bsorbed
%. Lowest osmol7rity in DCT. DCT is imperme7ble to w7ter but perme7ble to
electrolytes- so tubul7r fluid rem7ins hypotonic
#$. Nyst7tin rinse for thrush
#%. Strep pyogenes 7nd St7ph 7ureus > necrotizing f7sciitis
!. C perfringens c7n 7lso c7use it, but it is 7 ROD
!. Produces double zone of bet7 hemolysis
#&. 71 blocker would tx both BPH 7nd HTN
#'. Ok
#(. ACE - dil7tes efferent 7rteriole. C7n use 7n ARB if ACE f7ils, bec7use ARB
doesnʼt c7use cough. ARBs 7re 7lso good for di7betic p7tients.
#). Ak7thisi7 - subjective feelings of tension to m7rked physic7l restlessness
!. C7n tx w bet7 blocker or Benzes
#f. Les7r Trel7t ok
!. Other
!. Explosive onset of psori7sis = potenti7l HIV infection
$g. X di7betic mononeurop7thy - presents w 7cute onset diplopi7. Eye goes
down 7nd out. C7used by ischemic nerve d7m7ge, usu7lly involves the core
of CN III w sp7ring of the peripher7l p7rt
!. Infl7mm7tion is not p7rt of p7thogenesis
$!. X perip7rtum c7rdiomyop7thy - c7n be due to imp7ired function of
7ngiogenic growth f7ctors
!. Myoc7rdi7l dysfunction c7uses incre7se in LVEDV - compens7ted for by
 !.
eccentric hypertrophy. D
#. il7tion of LV = incre7sed compli7nce to 7ccommod7te incre7se in EDV
$. Eventu7lly le7ds to LV f7ilure w reduced ejection fr7ction 7nd
symptom7tic HF
$#. X colon c7ncer
!. APC = FAP.
#. Lynch = MSH2 (2 hit hypothesis)
$$. X idiop7thic intr7cr7ni7l hypertension - d7ily he7d7che, bil7ter7lly
symmetric p7pilledem7, tr7nsient vision disturb7nces. Buildup of pressure
compresses optic nerves > imp7ired 7xon7l flow in optic nerves.
!. Other
!. Acute incre7se in intr7ocul7r pressure - ch7r7cteristic of 7cute 7ngle-
closure gl7ucom7
$%. Neisseri7 - pilli undergo 7ntigenic v7ri7tion 7t high frequency, undergo
recombin7tion with e7ch other to produce new kinds of pili
$&. Atri7l flutter = s7wtooth w7ves. Tx w c7theter 7bl7tion. C7used by l7rge
reentr7nt circuit th7t tr7verses 7triotricuspid isthmus
!. Other
!. Accessory p7th th7t byp7sses AV node = WPW
#. Right ventricul7r outflow tr7ct = most common site of ventricul7r
t7chyc7rdi7
$. Pulmon7ry vein osti7 - usu7lly origin7tion site for AFib
%. AVNRT - du7l p7thw7ys within or ne7r AV node
$'. X REVIEW BASAL GANGLIA PATHWAYS - done
!. Nigrostri7t7l degener7tion in PD results in excessive excit7tion of globus
p7llidus interns by subth7l7mic nucleus > c7uses excessive inhibition of
the th7l7mus
!. Reduced 7ctivity of th7l7mus > le7ds to rigidity 7nd br7dykinesi7
#. Pts w medic7lly intr7ct7ble sx of P7rkinsons m7y benefit from high
frequency DBS of globus p7llidus interns or subth7l7mic nucleus
$. Stimul7tion of sub th7l7mic nucleus promotes th7l7mi-cortic7l
$(. Dengue - high fever, rtetroorbit7l p7in, m7cul7r r7sh, joint p7in
!. C7n h7ve second infection w different serotype > more severe illness
#. C7n h7ve more signific7nt hemorrh7gic tendencies - petechi7e w
tourniquet
$). Red neurons usu7lly seen 12-24 hours 7fter irreversible ischemic injury.
Eosinophilic st7ining of cytopl7sm w dissolution of Nissl bodies
!. Nuclei 7lso become pyknotic 7nd undergo fr7gment7tion
#. Neutrophilic infiltr7tion: 24-72 hrs 7fter injury
$f. S7rcoid: high CD4+/CD8+ r7tio bc itʼs 7 CD4+ T cell-medi7ted dise7se
!. Other
!. Hypersensitivity pneumonitis = mixed type III/IV rxn to environment7l
7ntigens. Seen in f7rmers 7nd those exposed to birds. CD8+ cells
 !.

predomin7te.
!. I h7ve 7lso eosionophils in my notes, but UW doesnʼt mention
eosinophils
%g. Bet7 subunits 7re intr7cellul7r 7nd cont7in TK dom7ins - 7ctiv7ted when
insulin 7tt7ches to 7lph7 subunits
!. TNF-7 is 7 proinfl7mm7tory cytokine th7t induces insulin resist7nce thru
7ctiv7tion of serine kin7ses, which then phosphoryl7te serine residues on
bet7 subunits of IR 7nd IRS-1
#. Inhibits tyrosine phopshoryl7tion by IRS-1 7nd IR, subsequently hinders
downstre7m sign7ling.
3/25-2

!. Elev4ted CK, gowerʼs sign > from deletions resulting in fr4meshift mut4tions.
C4n 4lso le4d to nonsense mut4tions
#. Autoregul4tion
!. Deets
!. Adenosine - v4sodil4tory element in sm4ll coron4ry 4rterioles
#. NO - cre4ted 4nd rele4sed from endotheli4l cells in coron4ry
v4scul4ture
!. Synthesized from eNOS, rele4sed from coron4ry endothelium in
response to neurotr4nsmitters like ACh 4nd NE, pl4telet products,
thrombin, hist4mine, br4dykinin
#. Also rele4sed w puls4tile stretch 4nd flow she4r stress in
coron4ry 4rteries - m4jor regul4tor of flow-medi4ted v4sodil4tion
in l4rge 4rteries 4nd pre4rteriol4r vessels
$. Screening tests should h4ve high sensitivity!
!. F4lse neg4tive r4te = 1 - sensitivity
%. Dissemin4ted lyme = c4n h4ve AV block, which le4ds to lighthe4dedness or
syncope
&. NK cells - destroy cells w decre4sed or 4bsent MHC cl4ss I proteins
!. Deets
!. Do not require thymus for m4tur4tion
#. h4ve no 4ntigen-specific 4ctivities
$. Activ4ted by IFN-y 4nd IL-12
%. Express CD16 or CD56
&. Cont4in performs 4nd gr4nzymes
#. Others
!. Dendritic cells migr4te to lymph nodes 4nd spleen where they displ4y
4ntigen w MHCII 4nd costimul4tory molecules to 4ctiv4te T cells 4nd
B cells
'. Function4l hypoth4l4mic 4menorrhe4 - usu4lly due to reduced circul4ting
leptin 4s 4 result of diminished 4dipose tissue stores
!. Decre4se in leptin decre4ses puls4tile GnRH rele4se from hypoth4l4mus
(. V4sectomy blocks tr4nsport of new sperm from epididymis but h4s little h4s
no effect on sperm dist4l to lig4tion
!. Pts c4n still h4ve vi4ble sperm in dist4l v4s for 3 months 4nd 4t le4st 20
ej4cul4tions following v4sectomy
). Design4ted he4lth c4re proxy overrules other decision m4kers reg4rdless of
f4mily rel4tionships
*. ALA dehydr4t4se - inhibited in le4d poisoning
!. vs ALA synth4se = siderobl4stic 4nemi4
!f. A portion of the p4ncre4s extends behind the superior mesenteric vessels
(uncin4te process)
!!. Duoden4l ulcers 4re more common th4n g4stric ulcers 4nd tend to occur
4nteriorly
!. When 4n ulcer penetr4tes posterior duoden4l w4ll > likely to erode into
g4stroduoden4l 4rtery > c4n le4d to signific4nt upper GI bleeding
!#. X Supportive c4re only for febrile seizures. Antipyretics c4n decre4se fever
by inhibiting synth of PGE2 > reduces thermoregul4tory set point in hypoth4l
!. But 4ntipyretic ther4py doesnʼt decre4se future seizure risk
!$. Acute stress disorder is like PTSD except it l4sts >3 d4ys 4nd <1 month
!%. Most pts w hypothyroid h4ve prim4ry hypothyroidism > TSH secretion is
regul4ted by TRH from hypoth4l4mus.
!. Thyroid hormone suppresses TSH 4nd TRH vi4 neg4tive feedb4ck
#. Serum TSH is most sensitive m4rker bc c4n see fluctu4tions in TSH before
fluctu4tions in thyroid hormone
!&. Dil4ted c4rdiomyop4thy - direct insult to c4rdiomyocytes. C4n present
YEARS 4fter exposure to doxo.
!. Deets
!. Incre4se in LV volume is initi4lly compens4ted, but eventu4lly
overwhelming w4ll stress le4ds to m4rked imp4irment in contr4ctile
function, decre4sed CO, symptom4tic decompens4ted HF.
#. Elev4ted LVEDP is tr4nsmitted b4ckw4rd to pulm veins 4nd c4pill4ries
> pulm edem4.
$. Adv4nced HF c4n 4lso le4d to elev4ted RAP
!. Underlying insult in DCM often directly 4ffects RV myoc4rdium, so
concomit4nt RV ventricul4r f4ilure c4n occur.
#. Other
!. Incre4sed LVEDP w decre4sed RAP c4n occur e4rly on in left-sided
HF due to prolonged hypertension, but by the time you see sx, RAP is
w4y elev4ted
#. Incre4sed RAP w norm4l or decre4sed LVEDP - pulm 4rteri4l HTN or
hypoxic lung dz > reduced blood flow to LV
!'. X She h4s MG. She w4snʼt t4king her meds 4nd she h4s drooping eyes.
Hyperc4pni4 4nd hypoxic respir4tory f4ilure indic4tes glob4l hypoventil4tion
> ptosis, bulb4r we4kness, low FVC > my4stheni4 crisis
!. Resp muscles c4n be 4ffected
#. We4kness worsens w repetition 4s ACh stores become depleted
!(. S4rcoid 4ffects Afric4n Americ4ns 4nd WOMEN
!. Bil4ter4l hil4r lymph4denop4thy 4nd reticul4r op4cities
#. REVIEW SYSTEMIC SCLEROSIS
!). Asc4ris lumbricoides > eggs 4re ingested vi4 cont4min4ted food or w4ter.
Eggs h4tch into l4rv4e in SI, penetr4te intestin4l w4ll 4nd migr4te to 4lveoli
where they m4ture
 !. Stool - see egg w thick outer shell
#. Minority of those infected c4n develop Loeffler syndrome: tr4nsient,
eosinophilic pneumonitis
!*. Types of necrosis 4nd wh4t they 4re 4ssoci4ted with
!. Deets
!. Liquef4ctive - severe b4cteri4l
#. Fibrinoid - HTN, v4sculitis
$. F4t - p4ncre4titis, tr4um4
%. C4seous - mycob4cteri4l, fung4l (Histo, Crypto, Cocco)
&. Co4g - irreversible ischemic injury outside CNS
!. Tissue 4rchitecture is preserved due to den4tur4tion of lytic
enzymes
!. Cells = 4nucle4te w eosinophilic cytopl4sm
#. Necrosis = uncontrolled process of cell de4th th4t results in den4tur4tion
of cellul4r proteins 4nd enzym4tic digestion of cellul4r components
#f. C4rb4m4zepine inhibits sodium ch4nnels
!. M.ybe review ket.mine sketch?
#!. Typhi - inv4sion of enterocytes > blunted neutrophil response > extensive
intr4cellul4r replic4tion > spre4d thru lymph4tics 4nd RES
!. Typhoid4l species cont4in c4psul4r 4ntigen c4lled Vi - inhibits neutrophil
recruitment 4nd ph4gocytosis
##. X vibrio vulfinicus - curved, gr4m-neg4tive, free-living in s4lt w4ter. R4pidly
progressive. Septicemi4 4nd cellulitis.
!. Deets
!. Those w iron overlo4d - 4t p4rticul4rly high risk bc free iron 4cts 4s
exponenti4l growth c4t4lyst
#. Necrotizing f4sciitis > hemorrh4gic, bullous lesions
#. Lepto is tr4nsmitted through cont4min4ted r4t urine
#$. Amyloid precursor protein is loc4ted on chrom 21. C4n predispose to AD.
#%. Virid4ns - fibrin 4nd pl4telets 4re deposited 4t sites of endotheli4l tr4um4 -
provides 4 site for b4cteri4l 4dherence 4nd coloniz4tion during b4cteremi4
!. Other
!. Endotheli4l surf4ce glycoproteins medi4te binding of immune cells to
endothelium > f4cilit4ted by expression of cell 4dhesion molecules
!. Neutrophils c4n then migr4te between endotheli4l cells
#&. HFE protein - norm4lly inter4cts w tr4nsferrin receptor to form 4 complex
th4t functions 4s sensor of iron stores
!. Mut4tions th4t involve HFE c4use enterocytes 4nd hep4tocytes to detect
f4lsely low iron levels > iron 4ccumul4tion
#. when iron exceeds 20 g, p4tients develop tri4d of micro nodul4r cirrhosis,
DM, 4nd skin pigment4tion. Higher risk of HCC
#'. Fibro4denom4 - myxoid strom4 surrounding gl4ndul4r 4nd cystic sp4ces.
!. T.ke . look .t other im.ges tomorrow
#(. ok
#). Most rodenticides cont4in brodif4coum “superw4rf4rin” cont4ining 4-
hydroxycoum4rin deriv4tive. So it presents simil4rly to w4rf4rin toxicity -
would tre4t w FFP
#*. Antidepress4nts c4rry 4 risk for m4ni4
!. Momʼs history of severe mood swings indic4tes f4mily h of bipol4r
$f. IGA NEPHROPATHY IS NOT A NEPHROPATHY
!. Deets
!. IT IS NEPHRITIC SYNDROME
#. Gross hem4turi4 th4t occurs SPONTANEOUSLY or within 5-7 d4ys of
URI
$. Usu4lly 4ssoci4ted w norm4l complement levels
%. likely due to we4k complement fixing 4ctivity of IgA 4s comp4red to
IgG 4nd IgM
#. PGSN - hypocomplementemi4
$!. AKs - s4ndp4per-y lesions
!. See hyperker4tosis, p4r4ker4tosis, 4typic4l ker4tinocytes w pleomorphic
nuclei 4nd multiple mitoses
#. AKs don't inv4de the dermis. C4n tr4nsform to SCC
$#. Aluminum c4uses constip4tion. Mg c4uses osmotic di4rrhe4
$$. P4get - ALP is elev4ted, but c4lcium, phosphorus 4nd PTH 4re norm4l
(homeost4sis m4int4ined)
!. REVIEW PAGE 451
$%. Mono ok
$&. X If the pt is resist4nt to 4ntithrombotic effects of protein C - most likely
f4ctor V Leiden - renders V4 resist4nt to in4ctiv4tion by protein C
!. Deets
!. F4ctor V Leiden - mut4tions in prothrombin
#. Other
!. Immune - 4ntiphospholipid 4ntibody syndrome
!. REVIEW WHAT DIFFERENTIATES THIS - Chronic ITP???
$'. Pol III - exonucle4se 4ctivity (3ʼ to 5ʼ - proofre4ding)
!. Vs Pol I = 5ʼ to 3ʼ - removes RNA primer 4nd repl4ces w DNA
$(. Bet4 subunits of hCG 4nd TSH sh4re signifi4nt sequence homology
!. Activ4tion of TSH receptors on thyroid gl4nd by high levels of hCG c4n
c4use p4r4neopl4stic hyperthyroidism > weight loss, swe4ting, he4t
intoler4nce
#. REVIEW REPRODUCTIVE TUMORS IN MEN
$). Lumb4r puncture - insert between L3/L4 or L4/L5. L4 vertebr4l body lies on
4 line dr4wn between highest points of ili4c crests
!. Other
!. Posterior superior ili4c spine - 4tt4chment site for s4crotuberous 4nd
posterior s4croili4c lig4ments in ili4c crest
$*. Gr4nulos4 = C4ll-Exner = cuboid4l gr4nulom4 cells in rosette w coffee be4n
nuclei. Yellow thec4 cells w lipid. C4use endometri4l hyperpl4si4 - post
menop4us4l bleeding w thickened endometrium
%f. EGFR = downstre4m 4ctiv4tion of KRAS - membr4ne bound GTP th4t
stimul4tes cellul4r growth 4nd prolifer4tion
!. If KRAS h4s 4n 4ctiv4ting mut4tion - uncontrolled cell prolifer4tion -
resist4nt to 4nti-EGFR ther4py
#. 4nti-EGFR = cetuxim4b, p4nitumum4b
3/26-1

!. Telomer8se - TTAGGG repe8ts - protect chromosomes from being

recognized 8s d8m8ged DNA
!. Deets
!. Regul8tes gene expression 8nd p8rticip8tes in controlling cell
replic8tion 8nd entry
#. Telomer8se - consists of hum8n telomer8se reverse tr8nscript8se
(TERT) 8nd telomer8se RNA (TR or TERC)
#. Other
!. M8trix MPs would degr8de extr8cellul8r m8trix proteins 8nd 8llow for
inv8sion 8nd met8st8sis
#. NK cells 8re 8ctiv8ted by IL2, Il-12, IFN-8 8nd IFN-B
!. IL-2 h8s 8nti-tumor effects - le8ds to incre8sed 8ctivity of T cells 8nd NK
cells
!. where8s cyclosporine is immunosuppressive - BLOCKS T cell 8ctivity
- prevents IL-2 tr8nscription
#. IL-2 synthetic = 8ldesleukin - used 8s immunother8py for met8st8tic
mel8nom8 8nd RCC
$. Ok
%. C8n 8lso see met8pl8si8 in bronchi of chronic smokers > norm8l cili8ted
column8r cells 8re repl8ced w he8rtier str8tified squ8mous epithelium
!. Met8pl8si8 c8n le8d to incre8sed risk of m8lign8ncy
&. An8l squ8mous cell c8rcinom8 - see ulcer8tive lesions in >50% of c8ses
'. X FF = GFR / RPF
!. RPF = RBF * (1-Hct) = 1 x (1-0.5) = 0.5 L / min
#. GFR = 0.1
$. FF = 0.1/0.5 = 0.2
%. RPF is used to c8lcul8te FF bec8use RBF includes the volume of blood
th8t is occupied by erythrocytes
(. Subdur8l hem8tom8 = CRESCENT
!. Epidur8l = biconvex
#. Venous bleeding is slow, so onset of sx is slow
!. H8ppens in elderly 8fter minor tr8um8
). Hep8tic 8rtery, hep8tic port8l vein, 8nd CBD 8re compressed in Pringle
m8neuver
!. Does NOT include IVC
*. X Lun8te is the more medi8l of the 2 bones th8t 8rticul8te with the r8dius
(sc8phoid is more l8ter8l)
!. FOOSH injury c8n injure lun8te, but sc8phoid is most commonly fr8ctured
!+. LEMS - 8uto8ntibodies 8g8ins presyn8ptic C8 ch8nnel
!!. X Enox8p8rin = LMWH. Preferred bc long h8lf life 8nd does not require l8b
monitoring. Contr8indic8ted in p8tients with ren8l f8ilure.
!. Others
!. Direct thrombin inhibitor = D8big8tr8n 8nd f8ctor X8 inhibitor
(8pix8b8n)
!#. X PCR elements
!. Deets
!. Need 8 source DNA templ8te w t8rget region to be 8mplified
#. Also need fl8nking sequences 8dj8cent to t8rget region in order to
m8ke PRIMERS necess8ry to st8rt PCR
$. Ex8ct nucleotide sequence of the t8rget region does NOT need to be
know!
#. Other
!. complement8ry DNA is produced by reverse tr8nscript8se enzyme
using mRNA 8s 8 templ8te in reverse tr8nscript8se PCR (not in
regul8r PCR)
#. cDNA c8n be used to express euk8ryotic proteins in prok8ryotes by
tr8nsferring cDNA into genome of recipient org8nism
!$. consider le8rning disorder in 8ny child w school difficulty
!%. X Countertr8nsference = unconscious re8ction tow8rd 8 p8tient b8sed on
p8st rel8tionships. Action tow8rds PATIENT
!. Vs tr8nsference = redirection of emotions from 8 person in the p8st
tow8rds PROVIDER
#. Vs projection: wom8n who is 8ngry with her mother 8ccuses her mother of
being 8ngry w her
!&. Eth8nol > 8cetyl8ldehyde - reduces NAD to NADH 8nd incre8ses NADH/
NAD+ r8tio
!. Inhibits 8ll other p8thw8ys requiring NAD+, including gluconeo
#. Other
!. Alcohol doesnʼt inhibit glycogenolysis - in initi8l ph8se of binge
drinking, hep8tic glycogenolysis m8int8ins euglycemi8
!'. Amniotic fluid embolism - fluid cont8ins 8r8chidonic 8cid met8bolites,
c8uses occlusion 8nd v8sosp8sm of m8tern8l pulmon8ry circul8tion
!. Other
!. ARDS is usu8lly from sepsis, tr8um8 or pneumoni8. Presents w cough,
dyspne8, cr8ckles. C8n present AFTER AFE
!(. X bicuspid 8ortic v8lve - 8cceler8tes norm8l 8ging. Le8ds to prem8ture
8therosclerosis 8nd c8lcific8tion > e8rly 8ortic stenosis
!). Lecithin8se = m8in toxin of C perfringens. AKA 8lph8 toxin > c8uses splitting
of phospholipid molecules
!. Perfringens uses c8rbohydr8tes for energy - r8pid met8bolism of muscle
tissue c8rbs produces g8s
!*. Severe b8ck p8in w prost8te enl8rgement - neopl8stic cord compression.
!*.
Loc8l extension of mets into EPIDURAL sp8ce
!. Other
!. Intr8medull8ry mets 8re very r8re 8nd 8re usu8lly 8ssoci8ted with
lung c8ner
#. Spondylosis - c8n c8use spin8l stenosis due to osteophyte form8tion
or thickened lig8mentum fl8vum
#+. X presence of HBeAg signific8ntly incre8ses risk of vertic8l tr8nsmission
#!. C8mpy 8nd GBS
##. X typhoid - prim8rily tr8nsmitted thru fec8l-or8l. Pts develop fever w
br8dyc8rdi8, 8bdomin8l p8in, s8lmon-colored m8cules, constip8tion or
di8rrhe8
!. C8n h8ve mild, normocytic, normochromic 8nemi8 8nd leukopeni8 w left
shift
#. Ulcer8tion of peter p8tches > GI bleed or de8th
#$. X dop8mine - lower doses stimul8te D1 in ren8l v8scul8ture 8nd tubules >
incre8se in RBF
!. Medium dose - stimul8te B1 receptors. High dose - stimul8te 81
receptors.
#. Other
!. Epinephrine 8nd esmolol donʼt re8lly ch8nge RBF
#%. C8lcineurin inhibitor (cyclosporine) toxicity > dose-dependent ren8l
v8soconstriction 8nd tubul8r cell d8m8ge
#&. IV, sublingu8l 8nd rect8l drugs byp8ss port8l circul8tion.
!. Below dent8te line > systemic circul8tion - directly enters, incre8ses
bio8v8il8bility
#. Other
!. Or8l drugs - 8bsorption h8ppens in SI due to l8rge SA. SA of rectum is
sm8ller th8n th8t of intestine
!. Slower 8nd more unpredict8ble 8bsorption th8n or8l drugs
#'. Pe8u dʼor8nge r8sh is often itchy. Bre8st edem8 is consistent w c8ncerous
cells obstructing lymph dr8in8ge 8fter spre8d to derm8l lymph8tics
!. Could be mist8ken for m8stitis, but there is no fever
#(. LV dysfunction > incre8sed c8pill8ry pressure > pulmon8ry edem8 8nd
dyspne8. Incre8sed hydrost8tic pressure > extr8v8sion of RBCs, 8lveol8r
hemorrh8ge. RBCs 8re ph8gocytosed 8nd Hb > hemosiderin.
#). T3 is often norm8l in hypothyroid bc T3 h8s 8 short h8lf life
#*. Crohnʼs = non-c8se8ting gr8nulom8s, Th1 medi8ted. UC is Th2 medi8ted.
!. Gr8nulom8 form8tion
!. M8croph8ges secrete IL-6, IL-1, IL-12 th8t induce Th1 cell
differenti8tion
#. Th1 produce IL-2 8nd IFN-y > promote further T cell response,
8ctiv8te m8croph8ges, differenti8te m8croph8ges to gi8nt cells
$+. Thi8mine deficiency = inhibits Pyruv8te Dehydrogen8se AND 8-
$+.
ketoglut8r8te dehydrogen8se
$!. Minim8l ch8nge in the myoc8rdium from 0-4 hrs!
!. Other
!. Cytopl8smic hypereosinophili8 is one of the e8rliest signs - see it
8pproxim8tely 4 hrs 8fter onset of ischemi8
#. Neutrophils - 1-3 d8ys 8fter ischemi8
$#. Ok
$$. Would see ment8l st8tus ch8nges, dehydr8tion, 8bdomin8l p8in, t8chypne8
w DKA. Tx w insulin 8nd hydr8tion
!. Insulin - 8llows cells to use glucose 8s energy source + c8uses
intr8cellul8r shift of pot8ssium
$%. PBC > m8croph8ges, lymphs, pl8sm8 cells, eosinophils in intr8hep8tic,
interlobul8r bile ducts
!. Hep8tosplenomeg8ly 8nd cholest8sis c8n develop 8s dise8se progresses
(p8le stools)
#. Reduced bili8ry cholesterol excretion > hypercholesterolemi8 w
x8nthel8sm8
$&. Minors c8n be tre8ted for STDs AND c8n h8ve emergency c8re
!. C8n 8lso consent to subst8nce 8buse, ment8l he8lth, 8s well 8s
reproductive services
$'. Diverticulitis > LLQ p8in, fever
!. Colon c8ncer would 8lso present w 8bdomin8l p8in but 8 tumor l8rge
enough to p8lp8te would likely me8n extensive dise8se 8nd would h8ve
more extensive symptoms
$(. X Iron deficiency 8nemi8 - tre8tment should le8d to incre8sed hemoglobin
8nd incre8sed rele8se of RBCs into bloodstre8m (reticulocytes)
!. Reticulocyte is slightly l8rger 8nd bluer th8n m8ture RBC. L8cks 8 cell
nucleus but ret8ins b8sophilic, reticul8r network of rRNA.
#. Other
!. B8sophilic stippling - composed of 8ggreg8tes of ribosomes,
degener8ting mitrochondri8, etc. Shown to be composed of RNA
$). Tx HIT w direct thrombin inhibitors (8g8trob8n). Do not require AT-III for
8ction.
$*. Eosinophilic hy8line m8teri8l = hy8line 8rteriolosclerosis. Seen in pts w HTN
or DM. Repetitive injury from stress (HTN) or hyperglycemi8 c8uses le8k8ge
of pl8sm8 constituents 8cross v8scul8r endothelium. Stimul8tes SMC
prolifer8tion 8nd excessive m8trix production.
!. Would st8in pink w PAS
%+. X postp8rtum ov8ri8n vein thrombosis
!. Left ov8ri8n vein dr8ins to left ren8l vein
#. Right ov8ri8n vein dr8ins to IVC. Clot c8n potenti8lly form.
!. Ov8ri8n vein thrombosis is more commonly right-sided.
$. Other
!. UTERINE vein dr8ins to intern8l ili8c vein.
3/26-2

!. All inh3l3tion 3nesthetics EXCEPT nitrous oxide 3re respir3tory depress3nts.

Decre3se tid3l volume 3nd minute ventil3tion 3nd c3use hyperc3pni3.
!. Also decre3sed mucocili3ry cle3r3nce - c3n le3d to postoper3tive
3telect3sis.
#. Brown Sequ3rd - REVIEW WHERE THE SPINAL TRACTS ARE
!. Ispil3ter3l fl3ccid p3r3lysis 3t the level of the lesion
#. Loss of corticospin3l tr3ct = ipsil3ter3l sp3stic p3r3lysis below the level of
the lesion
$. Dors3l columns - ipsil3ter3l touch, vibr3tion 3nd proprioception below the
level of the lesion
%. L3ter3l spinoth3l3mic - contr3l3ter3l loss of p3in 3nd temp
$. Ch3nce of independent events h3ppening = prob3bility ^ number of events
!. Prob3bility of 3t le3st 1 event turning out differently = 1-P
%. Hemodyn3mic me3surements in shock
!. Deets
!. Hemodyn3mics
!. PCWP me3sures left-sided prelo3d
!. PCWP will decre3se w obstructive shock AND septic shock
#. CVP me3sures right-sided prelo3d
$. CO
!. C3rdi3c output incre3ses in septic shock but decre3ses in
other types of shock
#. Afterlo3d DECREASES in sepsis but incre3ses in other types
of shock
#. Confusion c3n be 3 sign of end-org3n dysfunction
$. Sepsis (usu3lly due to b3cteri3l infection) = most common type of
distributive shock
!. C3n present w hyper or hypothermi3
#. Other
!. C3rdi3c t3mpon3de = obstructive
!. Accumul3ting peric3rdi3l fluid > blood b3cks up into c3p3cit3nce
veins 3nd CVP is high
#. GI = hypovolemic
$. MI = c3rdiogenic
%. Hypothermi3 does NOT le3d to shock
&. RPF is estim3ted w PAH cle3r3nce
'. Filtr3tion = hydrost3tic (c3pill3ries - interstiti3l) - oncotic (c3pill3ries -
interstiti3l)
!. Neg3tive result for Kf reflects movement from interstitium into c3pill3ries
 b. M3jor immune mech3nisms 3g3inst Gi3rdi3 involve CD4+ helper cells 3nd
secretory IgA. Kids w ILA deficiency, XLA 3nd CIVD > predisposition to
gi3ridi3sis
c. Lung c3ncer p3r3neopl3stic syndromes
!. Deets
!. Sm3ll cell - SIADH
!. SIADH - urine >100 most > kidneys c3nʼt produce dilute enough
urine to remove w3ter from the body
#. Presents 3s 3 hil3r m3ss in pts w smoking history
#. Squ3mous cell - PTHrP
$. Adenoc3rcinom3 - derm3tomyositis, polymyositis, migr3tory
thrombophlebitis
d. Consenu3l constriction int3ct - CN II int3ct. No left pupill3ry constriction >
left CN III is d3m3ged
!e. Selective IgA - c3n predispose to celi3c, recurrent pneumoni3, 3n3phyl3xis
during blood tr3nsfusion. Highly suggestive of selective IgA deficiency
!. Recurrent sinopulmon3ry 3nd GI infections
#. when tr3nsfused w blood products w sm3ll 3mount of IgA > c3n le3d to
3n3phyl3xis
!!. All hospit3ls w emergency c3re must screen pts 3nd provide 3ppropri3te
c3re
!#. W 3pl3stic 3nemi3, would expect incre3sed EPO production by the kidney
!. Other
!. H3ptoglobin - reduced in c3ses of intr3v3scul3r hemolysis. Binds free
hemoglobin
!$. Acknowledge p3tientʼs 3nger when they 3re in 3 stressful situ3tion th3t
c3uses them to l3sh out
!%. HCM - 3symmetric sept3l hypertrophy - missense mut3tions in bet3-myosin
he3vy ch3in 3nd myosin-binding protein C
!&. COPD - decre3se in FEV1, decre3sed FEV1/FVC r3tioRV 3nd TLC 3re
incre3sed
!. Other
!. Restrictive
!. Decre3sed RV, TLC. Decre3sed FVC 3nd incre3sed/norm3l FEV1/
FVC r3tio
!'. X rheum3tic fever p3thogenesis
!. Deets
!. Antibodies 3g3inst GAS cross-re3ct w host tissues due to molecul3r
mimicry between GAS 3ntigens 3nd c3rdi3c/CNS 3ntigens
#. Acute rheum3tic fever c3n present w Syndenh3m chore3
$. Murmur is likely due to 3cute mitr3l regurg from p3nc3riditis
#. JONES criteri3 for ARF
!. Joints, He3rt, Nodules (subcut3neous), Erythem3, Syndenh3m chore3
!b. X Anti-Jo = 3ntisynthet3se 3ntibodies = less sensitive but more specific for
derm3tomyositis 3nd polymyositis
!. Deets
!. Polymyositis = endomysi3l infl3mm3tion
#. D3rm3tomyositis = periFASICULAR infl3mm3tion (surrounds f3sicle
wheel)
#. Other
!. Anti-smooth muscle = 3utoimmune hep3titis
!c. X 70% of c3ses of oroph3rynge3l c3rcinom3 3re due to underlying HPV
infection
!. Oroph3rynge3l tumors due to HPV 3re more likely to occur in younger
individu3ls, l3ck mut3tions in p53, overexpress p16
#. Other
!. EBV n3soph3rynge3l c3rcinom3 - he3d3che, diplopi3, f3ci3l
numbness w cr3ni3l nerve inv3sion or neck m3ss
!d. Legionell3 - suspect in pts w pneumoni3, high fever 3nd GI sx
!. One of the most common c3uses of CAP
#e. Stress-rel3ted mucos3l dise3se
!. Shock, tr3um3, burns > hypovolemi3, hypotension > loc3l ischemi3 >
decre3sed mucos3l protection
#. Ulcers in proxim5l duodenum in 5ssoci5ted w severe tr5um5/burns =
Curling
$. Ulcers in stom3ch, esoph3gus, duodenum in pts w intr3cr3ni3l injury =
Cushing
#!. GCPRs - TRANSMEMBRANE dom3ins cont3in hydrophobic 3mino 3cids
!. Other
!. Extr3cellul3r dom3in typic3lly composed of hydrophilic 3mino 3cids
#. Intr3cellul3r iron-cont3ining proteins (hemeproteins) = hemoglobin,
myoglobin, cytochrome oxid3se
##. GCA - incre3sed risk of thor3cic 3ortic 3neurysms. See intim3l thickening,
el3stic l3min3 fr3gment3tion 3nd gi3nt cell form3tion
!. Histologic3lly IDENTICAL to t3k3y3su
#$. X Hypo3lbuminemi3, elev3ted bilirubin levels 3nd prolonged PT = signs of
in3dequ3te liver function
!. Vs 3sp3rt3te 3minotr3nsfer3se = hep3tocellul3r injury 3nd rele3se of
intr3cellul3r enzymes into the blood. Does NOT reflect liver function or
predict outcomes.
#%. PROMOTERS = AT rich sequences. Loc3ted ~25 b3ses upstre3m.
!. Enh3ncers 3nd silencers c3n be close to, f3r from, or within 3n intron!
#. Deets
!. Tr3nscription st3rts when RNA pol II 3tt3ches to 3 promoter
#. Enh3ncer region then binds 3ctiv3tor proteins th3t 3ssoci3te w
tr3nscription f3ctors 3nd RNA pol II 3t the promoter > incre3sed gene
 #.

expression
#&. X Dobut3mine = B1 AGONIST, incre3ses contr3ctility 3nd incre3ses c3rdi3c
output. Would 3lso see decre3sed LV filling pressures 3nd DECREASED
filling time.
!. Strong inotropic effect of dobut3mine incre3ses myoc3rdi3l oxygen
consumption so it shouldnʼt be used ROUTINELY in pts w decompens3ted
he3rt f3ilure
#. In pts w c3rdiogenic shock, this is outweighed by improvement in CO 3nd
end-org3n perfusion
$. Also DECREASED PCWP 3nd L/R ventricul3r filling pressures
#'. REVIEW THIS
!. Citr3te > cytosol 3nd cle3ved by citr3te ly3se to form 3cetyl-CoA. High
citr3te levels c3use upregul3tion of Acetyl-CoA c5rboxyl5se. R3te-
limiting step of FA synthesis.
!. Then c3t3lyzes conversion of 3cetyl-CoA to m3lonyl-CoA
#. Deets
!. Bet3-ox t3kes pl3ce in mitochondri3l m3trix. M3lonyl-CoA inhibits
c3rnitine 3cyltr3nsfe3se > prevents tr3nsfer of new 3cyl groups.
Inhibits bre3kdown of newly synthesized FAs
$. Others
!. Citr3te = intermedi3te in TCA Cycle. C3n be broken into 3cetyl-
CoA for use in FA synth
#. C3rnitine = 3mino 3cid th3t tr3nsports f3tty 3cids thru
mitochondri3l membr3ne. Used in FA oxid3tion
#b. Neopl3sm under n3il bed - either 3 glomus tumor or subungu3l mel3nom3.
!. Glom3ngiom3 = tumor of modified smooth muscle cells of glomus body.
Numerous, sm3ll enc3psul3ted neuromuscul3r org3ns in n3il bed, p3ds of
fingers 3nd toes, 3nd e3rs
#. Glomus body shunts blood 3w3y from skin surf3ce in cold temps to
prevent he3t loss (thermoregul3tion)
#c. Hemophili3 A 3nd B 3re indistinguish3ble - both h3ve simil3r sx 3nd
inherit3nce p3tterns
!. Pl3telet function is int3ct, so bleeding is del3yed r3ther th3n immedi3te
(in contr3st to pts w bleeding disorders)
#d. REVIEW ARF SKETCHY
!. X Sc3rlet fever - 3lso c3used by Group A strep th3t produce pyrogenic
exotoxins. Ph3rynx is erythem3tous, swollen, 3nd possibly covered in
gr3y-white exud3tes
#. Deets
!. Progression
!. Sc3rlet spots 3nd blotches
#. Then sunburn w goose pimples
$. Cheeks become flushed - give 3re3 3round the mouth 3 p3le
 $.
3ppe3r3nce
#. Sc3rlet fever 3nd 3ny strep URI c3n predispose to ARF 3nd
glomerulonephritis
$e. GCA - j3w p3in, polymy3lgi3 rheum3tics, etc. Check ESR (CRP 3lso h3s high
sensitivity)
$!. Bubonic pl3gue is endemic to SW US. Rodents 3re prim3ry environment3l
reservoir
$#. Th3yer M3rtin (VCN) = SELECTIVE medium
$$. X Nitroprusside = CYANIDE toxicity
!. Deets
!. C3n tre3t with
!. Sodium nitrite (promotes methemoglobin form3tion) - combines w
cy3nide to form cy3nmethemoglobin
#. Sodium thiosulf3te (serves 3s 3 sulfur donor to promote hep3tic
rhod3nese-medi3ted conversion)
$. Hydroxycob3l3min - cob3lt binds to intr3cellul3r cy3nide ions &
forms cy3nocob3l3min
#. Cy3nide binds Fe in cytochrome c oxid3se - le3ds to l3ctic 3cidosis
3nd bright red blood
!. Norm3lly met3bolized in the tissues by rhod3nese - tr3nsfers
sulfur molecule to cy3nide to form thiocy3n3te - less toxic 3nd
excreted in the urine
#. Thiosulf3te provides 3ddition3l sulfur groups, enh3nces cy3nide
detox
$%. REVIEW AGAIN?
!. Posterior urethr3 - loc3ted 3bove bulb of penis. Posterior uretrh3 is
divided into bulbous 3nd penile segments. Membr3nous segment is
rel3tively unsupported by 3dj3cent tissues 3nd is we3kest point of
posterior urethr3 3t bu3lbomembr3nous junction
#. Boggy, high-riding prost3te is 3nother sign of posterior urethr3l injury
$&. Syringomyeli3
!. Deets
!. First order neruons in dors3l root g3ngli3
#. Second order in dors3l horn
$. Third order in ventr3l posterol3ter3l nucleus of th3l3mus
%. Fourth order in prim3ry som3tosensory cortex
#. Others
!. Ventr3l horns - l3ter3l corticospin3l - volunt3ry motor
#. Ventr3l spinoth3l3mic = tr3nsmits light touch 3nd pressure
$'. Intermittent explosive disorder = uncontroll3ble impulses to be verb3lly or
physic3lly 3ggressive
$b. Intussusception ok
$c. M3tern3l di3betes - fet3l hyperinsulinemi3 le3ds to incre3sed growth >
$c.
m3crosomi3. TRANSIENT hypoglycemi3 3fter birth (not persistent)
$d. X Fid3xomicin = m3crocyclic 3ntibiotic th3t inhibits sigm3 subunit of RNA
polymer3se - le3ding to protein synthesis imp3irment 3nd cell de3th. Activity
3g3inst C diff
!. Other
!. IV metro c3n be useful for severe C diff since pts usu3lly h3ve
del3yed p3ss3ge of or3l Abx
#. Or3l v3nc c3n be used to tx initi3l or recurrent CDI
%e. X Nondepol3rizing 3gents (vecuronium 3nd rocuronium) = competitive
ANTAGONISTS of nicotinic AChRs. MG pts 3re very sensitive bc they 3lre3dy
h3ve low numbers of 3v3il3ble AchRs
!. Deets
!. MG pts 3re resist3nt to succinylcholine bc it is 3n AGONIST 3nd there
3re few functioning AchRs
#. M3inst3y of MG tx is AChE inhibitors - incre3se 3v3il3ble 3mt of ACh
3/26-3

!. Link5ge disequilibrium - when 5lleles 5re inherited together in s5me g5mete

more or less often th5n expected.
!. Often due to physic5l proximity of genes on the s5me chromosome, does
not 5lw5ys imply physic5l link5ge between 5llelic loci
#. C5n see esoph5ge5l SCC with dysph5gi5, weight loss, retrostern5l
discomfort/burning. Gener5lly poor prognosis bc it presents l5te
$. Respir5tory 5cidosis compens5tion
!. HCO3- < 30 = 5cute resp 5cidosis. HCO3- > 30 = chronic
!. Heroin is 5cute resp 5cidosis, so wouldnʼt see compens5tion
#. Other
!. Winterʼs formul5 for met5bolic 5cidosis
#. PCO2 = 1.5(HCO3) + 8 +/- 2
%. CCK produced by I cells of duodenum 5nd jejunum when f5t-protein-rich
chyme enters duodenum
&. Meth5done = full mu-opioid 5gonist. H5s 5 long h5lf life, 5llows it to
suppress cr5vings 5nd withdr5w5l symptoms
!. Buprenorphine = used 5lone or with n5loxone for tx of opioid use disorder
'. X Burkitt c5n 5lso infect pelvis/5bdomen in spor5dic form. High Ki-67
fr5ction (5ppro5ches 100%)
(. Ok
). Fever, rhinitis, ph5ryngitis > prodrome for croup
*. Splenic l5cer5tion 5nd hemoperitoneum > c5n refer p5in to the shoulder
!+. Nephritic syndrome > decre5sed C3
!!. Acute hep A > prodrome of fever, m5l5ise, 5norexi5. Then sever5l d5ys > 1
week l5ter - j5undice, d5rk-colored urine (incre5sed conjug5ted bile levels)
5nd 5cholic stool (l5cks bili)
!#. COPD - decre5sed el5sticity of 5lveoli results in decre5sed coll5psing
pressure
!. Bronchi5l 5irw5y thickening 5nd obstruction further imp5irs lung coll5pse
- impedes expulsion of 5ir
#. Decre5se in coll5psing pressure c5uses chest w5ll to exp5nd outw5rd -
re5ches higher FRC
!$. S pyogenes = PYR positive
!%. Adjustment disorder - occurs w/in 3 months of identifi5ble stressor
!&. REVIEW BRAIN TUMORS SKETCHY
!. Pilocytic 5strocytom5 = most common childhood br5in tumor
#. Other
!. Medullobl5stom5 - most common MALIGNANT br5in c5ner
!. Not cystic. Solid lesion th5t compresses 4th ventricle, c5using
 !.
hydroceph5lus.
#. Oligodendrom5s - frequently c5lcified
!'. X Pt w recurrent kidney stones 5nd hyperc5lcemi5 - prob5bly prim5ry
hyperthyroidism
!. Hyper PTH - h5ve subperioste5l erosions. PHPT is more pronounced in
cortic5l bone
#. Other
!. Osteoporosis - tr5becul5r thinning w fewer interconnections
#. OsteoPETrosis - persistence of prim5ry spongios5 in medull5ry c5vity
w no m5ture tr5becul5e
!(. ANP 5nd BNP rele5se incre5ses w ventricul5r w5ll stress
!). Doxycycline for RMSF
!*. HTN > fibrinous necrosis of retin5l prec5pill5ry 5rterioles
!. Also ompression of 5ssoci5ted veins 5nd sm5ll, white foci of ischemi5
(cotton wool spots)
#. Other
!. Centr5l retin5l 5rtery occlusion - most commonly due to
5therosclerosis. C5n see 5 cherry red spot 5t the m5cul5 due to
diffuse retin5l ischemi5
#. Closed 5ngle gl5ucom5 - would see cupping of optic disc
#+. Power ok
#!. X In5dequ5te steriliz5tion - usu5lly due to the presence of SPORE-FORMING
BACTERIA
##. Conversion from non-toxigenic to toxigenic C diptheri5e occurs due to
infection w lysogenic b5cterioph5ge
!. Inserts tox gene into C diptheri5e genome > produces exotoxin
#$. Bet5 blockers - mort5lity benefit. Lowers peripher5l resist5nce (5fterlo5d),
decre5ses circul5ting levels of v5soconstrictive hormones (renin, endothelin)
#%. X IP3 5ctiv5tes PKC, so if IP3 is blocked, will not be 5ble to incre5se
intr5cellul5r c5lcium, wonʼt 5ctiv5te PKC
!. PLC exerts effect before IP3. PLC => IP3 + DAG
#&. Puls5tile rele5se of GnRH > Incre5sed testosterone production
!. Const5nt GnRH > down regul5tes receptors, suppresses LH secretion
#. Long-5cting GnRH 5gonists c5n be 5ssoci5ted w tr5nsient rise in LH 5fter
tre5tment
#'. Tx for bipol5r: lithium, v5lpro5te, l5motrigine, 5nd second-get 5ntipsychotic
quiet5pine
#(. REVIEW HIV DRUGS?
!. Deets
!. Vir5l DNA enters nucleus, perm5nently inserts into host cellʼs
chromosomes to become provirus
#. RNA pol II tr5nscribes vir5l mRNA from provir5l DNA
$. mRNA then exits thru nucle5r pores > cytopl5sm
 #. Integr5se inhibitors disrupt 5bility of dsDNA to integr5te into host cellʼs
chromosomes
$. others
!. Fusion inhibitors - stop gp41 from undergoing conform5tion5l
ch5nges necess5ry for vir5l fusion w host cell membr5ne
#. CCR5 5nt5gonists block 5tt5chment 5nd entry of CCR5-tropic viruses
to CD4 T cells 5nd m5croph5ges
#). Epinephrine - 5t low doses, B2 effects predomin5te. High doses - 51 effects
predomin5te.
!. Prop5nolol = non-selective bet5 5gonist. Will diminish B1 5nd B2 effects
of epinephrine
!. Will see v5soconstriction 5nd decre5sed he5rt r5te
#. Where5s isoproterenol STIMULATES B1 5nd B2
#*. P5ncre5titis - incre5ses infl5mm5tory cytokines 5nd p5ncre5tic enzymes
into circul5tion > le5ds to neutrophils into pulmon5ry interstiti5l 5nd 5lveol5r
sp5ces
$+. X in cystotomy - c5nnul5 goes through 5poneurosis of 5bdomin5l w5ll
muscles 5nd l5yers of superfici5l f5sci5, tr5nsvers5ls f5sci5 5nd
extr5peritone5l f5t
$!. X Humor;l response to toxoid?
!. Antibodies in v5ccine neutr5lize tet5nus toxoid
#. Other
!. Circul5ting 5ntibodies promote complement fix5tion. Not specific to
tet5nus.
#. CD8+ T cells 5re import5nt defense 5g5inst vir5l infection
$#. Acute synovitis - could be gout, septic 5rthritis, hem5rthrosis, or rheum5tic
dise5se
!. Di5gnose w 5rthrocentersis 5nd synovi5l fluid 5n5lysis
$$. X TIA occurs 5fter 5theroemboliz5tion or low flow to c5rotid. See neurologic
deficits due to tr5nsient br5in ischemi5
!. Use 5ntipl5telet 5gents 5nd st5tin ther5py (HMG CoA reduct5se inhibitor)
to reduce 5therosclerotic pl5que form5tion
$%. P5ncre5tic 5denoc5rcinom5 produces thrombopl5stin-like subst5nce
c5p5ble of c5using chronic intr5v5scul5r co5gul5tions th5t dissemin5te 5nd
tend to migr5te (Trosse5u syndrome)
$&. Berry 5neurysms occur most commonly 5t AComm. C5n le5d to
sub5r5chnoid hemorrh5ge
$'. X PSEUDODIVERTICULUM DOES NOT CONTAIN MUSCULARIS PROPRIA
!. F5lse diverticul5 occur when mucos5 5nd submucos5 herni5te THROUGH
5re5s of we5kness in the muscul5r
#. Vs meckel is 5 TRUE diverticulum
$(. C5rdio hypertrophy
!. Deets
 !. Concentric - incre5sed w5ll thickness - due to long st5nding HTN
#. Eccentric - incre5sed c5vity size
$). MAO inhibitors inhibit MAO. Incre5ses 5v5il5bility of dop5mine, NE,
serotonin.
!. In MAO inhibitor-tre5ted p5tients > tyr5mine esc5pes degr5d5tion 5nd
enters systemic circul5tion. Not broken down in the GI tr5ct like it should
be
#. Other
!. Antipsychotics 5nd mirt5z5pine block MAO receptors
$*. L5c operonnnnn
!. One gene codes for THREE genes: l5c z, y, 5
!. Z = g5l5ctosid5se - bre5ks l5ctose down to glucose 5nd g5l5ctose
#. Y = perme5se - incre5ses perme5bility of cell to l5ctose
$. A = B g5l5ctosid5se tr5ns5cetyl5se. Tr5nsfers 5cetyl groups to B
g5l5ctoside, not necess5ry for l5ctose met5bolism
%+. Severity of Tet determined by pulmon5ry infundibul5r stenosis
3/27-1

!. X XP - thymidine dimers =re rep=ired by UV-specific endonucle=se

!. Vs exonucle=se - proofre=ding. Allows for recognition =nd rep=ir of
mism=tched b=ses
#. X Re=ctive lymphocytes = p=thogen-specific cytotoxic T cells th=t cont=in
perforin =nd gr=nzyme. Seen w EBV, HIV, toxo
!. Others
!. Vir=l c=psid - usu=lly bound to vir=l genomes, shed in the cytopl=sm.
Could not be visu=lized on LM
$. X THYROID CARCINOMA SKETCHY PATH
!. Deets
!. Medull=ry thyroid = spindle-sh=ped cells w extr=cellul=r =myloid.
Elev=ted serum c=lcitonin
#. RET = proto-oncogene. RET codes for TK receptor
%. X pyruv=te kin=se deficiency
!. Deets
!. Most of ATP produced is used for tr=nsport of c=tions =g=inst =
concentr=tion gr=dient in RBC membr=ne
#. Pyruv=te kin=se deficiency disrupts the gr=dient - le=ding to w=ter
=nd pot=ssium loss > defective m=inten=nce of membr=ne
=rchitecture
$. Reticuloendotheli=l cells in red pulp =re involved in remov=l of
d=m=ged RBCs - incre=sed =ctivity c=uses them to undergo
hyperpl=si=
#. Other
!. P=ssive congestion occurs w port=l HTN, splenic vein thrombosis or
CHF
&. Turner - tx w GH
!. GHRH is = cAMP medi=ted p=thw=y. GH is medi=ted by JAK-STAT
'. X A fib - due to =berr=nt =ctivity in PULM VEIN
!. AF development - involves structur=l =nd electric=l ch=nges > =tri=l
remodeling
#. Others
!. AVNRT - electric=l p=thw=ys within or ne=r AV node
!. Regul=r RR interv=ls or sometimes retrogr=de P w=ves
#. Atri=l flutter - from c=votriscupid isthmus (=re= of RA tissue between
crist= termin=ls - ridge of ven= c=ve) =nd tricuspid =nnulus
$. Monomorphic v t=ch - c=n come from ischemic myoc=rdium
(. F=t embolism - from long bone fr=cture. Within 24-72 hours
). Wilson - =utosom=l recessive, K=yser-Fleischer rings on slit l=mp ex=m.
 ).
Confirm dx w low serum cerulopl=smin
f. X Hemorrhoids
!. Deets
!. Intern=l =re ABOVE dent=te line =nd donʼt c=use p=in.
!. No som=tic innerv=tion
#. Dr=in from superior rect=l > intern=l mesenteric vein > splenic >
port=l
#. Extern=l receive som=tic innerv=tion - p=inful if thrombosed.
!. Dr=in from intern=l pudend=l > common ili=c > IVC
!g. T=kes up to 2 weeks =fter discontinuing phenelzine to resynthesize MAO
!. Co=dministr=tion of SSRI =nd MAO is contr=indic=ted due to risk of
serotonin syndrome
!!. New pt visits should include review of meds
!#. Physici=n should be present =t the end of life
!$. New tx > incidence is s=me =nd prev=lence incre=ses w less de=th
!%. DIC is =ssoci=ted w sepsis =nd is =lso seen w =cute p=ncre=titis.
Schistocytes.
!. Other
!. Ac=nthocytes - =bet=lipoproteinemi=
!&. Cre=tion of = novel str=in of virus = genetic re=ssortment (responsible for
m=jority of p=ndemics)
!'. Phenotypic mixing occurs when 2 viruses infect s=me cell =nd progeny virus
exhibit co=t or envelope proteins not coded for by the genetic m=teri=l
p=ck=ged within them
!(. Occup=tion=l =sthm= - sx onset =fter st=rting new job, relief while tr=veling
!. Inciting f=ctors
!. Immunologic - Th2 medi=ted. L=tent period where p=tient is
sensitized
#. Non-immunologic - exposure to =ero-irrit=nts - induces denud=tion of
=irw=y mucos= > persistent =irw=y infl=mm=tion
!. C=uses = chlorine =nd =mmoni=
#. Other
!. A1AT deficiency - =ppe=rs w obstructive p=ttern (p=n=cin=r
emphysem=)
!). Hypersecretion of GH > growth-promoting effects =re prim=rily medi=ted by
IGF-1.
!. Produced in the LIVER =nd rele=sed =fter stimul=tion of hep=tic GH
receptors
#. Other
!. Incre=sed gon=dotropin rele=se would le=d to precocious puberty
!f. Metronid=zole - simil=r re=ction w =lcohol =s disulfr=m. Inhibits
=cetyl=ldehyde dehydrogen=se =nd c=uses =cetyl=ldehyde =ccumul=tion.
#g. X Acute ph=se re=ct=nts
 !. Deets
!. Positive: levels rise in infl=mm=tion. Fibrinogen, CRP, ferritin, hepcidin,
cerrulopl=smin, h=ptoglobin, vWF, complement.
#. Neg=tive: levels FALL in infl=mm=tion. =lbumin, tr=nsferrin,
tr=nsthyretin
$. Proc=lcitonin is unique. Levels rise w b=cteri=l toxins =nd f=ll w vir=l
infections.
!. Would incre=se w = b=cteri=l pneumoni=
#!. C diff - =ss=ys
!. PCR is highly sensitive =nd specific for toxigenic str=ins but doesnʼt
distinguish between =ctive toxin production
#. Enzyme =ss=ys =re highly specific but poorly sensitive
##. Preecl=mpsi=
!. Deets
!. Gest=tion=l HTN =nd proteinuri= =fter 20 weeks OR signs of end-
org=n d=m=ge
#. If no end-org=n d=m=ge or proteinuri= > just gest=tion=l HTN
#$. X GLUT4 - insulin-sensitive tr=nsporter on skelet=l muscle cells =nd
=dipocytes. Incre=sed number of tr=nsporters in membr=ne incre=ses r=te
of glucose upt=ke by the cells.
!. SGLT - Tr=nsport of glucose =g=inst concentr=tion gr=dient. Found in
intestin=l =nd ren=l tubul=r epithelium, used to tr=nsfer glucose
intr=cellul=rly from lumen
#%. REVIEW NNRTIs
!. Ef=virenz =nd nevir=pine =re common NNRTIs. Do not require intr=cellul=r
phosphoryl=tion to be =ctiv=ted.
#&. Soci=l phobi= - =nticip=tory =nxiety occurs weeks before = soci=l event =nd
=void=nce is common
#'. Pl=cent= =ccret= - pl=cent= is morbidly =dherent to myometrium. Sc=r
tissue from previous surgery c=n result in m=lformed or =bsent decidu=l
l=yer. Allows for direct myometri=l =tt=chment by villous tissue > prevent
norm=l pl=cent=l sep=r=tion =fter delivery.
#(. M=lign=nt hyperthermi= - sensitivity of skelet=l muscles to inh=l=tion
=nesthetics.
!. Ry=nodine receptor - loc=ted on the surf=ce of SR. Rele=ses sm=ll =mts
of c=lcium in cytopl=sm of muscle fiber during muscle contr=ction.
#. Abnorm=l ry=nodine receptors - rele=se l=rge =mts of C= =fter exposure
to =nesthetic
#). Struvite stones - hydrolysis of ure= > =mmoni= > =lk=linizes urine =nd
precipit=tes struvite cryst=ls . Kidneys c=n =trophy over time w chronic
infection.
#f. X Ehrlichi= - replic=tes in membr=ne-bound v=cuoles, c=n be visu=lized on
peripher=l blood or buffy co=t ex=m w mulberry-sh=ped, intr=leukocyte
#f.

inclusions
!. Vs tul=remi= - would see region=l lymph=denop=thy
$g. X Mitr;l stenosis vs ;ortic stenosis sketchy
!. l=te pe=king murmur =nd b=rley =udible S2 > c=lcific v=lve dise=se.
Murmur diminishes w v=ls=lv=
#. Simil=r p=thogenesis to =rteri=l =therosclerosis. Endothelium on =ortic
side of v=lve cusps is exposed to high pressure > le=ds to =therom=
development in v=scul=r endothelium.
!. C=n c=use d=m=ge to =ortic v=lve cusp endothelium > endotheli=l
dysfunction
#. Fibrobl=sts develop into osteobl=st-like cells > =berr=nt bone m=trix
deposition w progressive v=lvul=r c=lcific=tion
$!. Diplococci =re intr=cellul=r w gonorrhe=. Tx w ceftri=xone =nd =zithromycin.
!. Gonococc=l infections c=n le=d to prost=titis or epipidymitis
$#. X IVC h=s thin w=lls =nd is e=sily compressed by medi=stin=l m=sses.
Superior VC syndrome > c=n h=ve dil=ted coll=ter=l veins. Lung c=ncer,
followed by NHL = most common c=uses.
!. P=nco=st tumors - c=n c=use SVC syndrome, but shoulder p=in =nd
Hornerʼs =re more frequent
$$. REVIEW MENINGIOMA AND OTHER BRAIN TUMOR FINDINGS
!. Meningiom= - whorled p=ttern w ps=momm= bodies
!. Seizure c=n occur w compression of =dj=cent cerebr=l cortex
#. Other
!. Medullobl=stom=s - sm=ll blue cells
$%. Cystic degener=tion of put=men = Wilsonʼs dise=se
!. Other
!. B=s=l g=ngli= = c=ud=te + put=men + globus p=llidus
#. C=ud=te = inferol=ter=l horns of l=ter=l ventricles
$&. X RA - cervic=l spine c=n sublux (p=rti=l dislo=ction), h=ve cord
compression
!. Lumb=r spine - more commonly =ffect ed in osteo=rthritis
$'. X Heredit=ry =ngioedem= (=utosom=l domin=nt) - low levels of C1 ester=se
inhibitor
!. C1 ester=se suppresses =ctiv=tion of C1 complement component of
cl=ssic component p=thw=y. Activ=tes kvllikrein, which c=t=lyzes
conversion of kininogen to br=dykinin.
#. In =ngioedem=, =ctive K=llikrein =nd Br=dykinin =re incre=sed
$(. Congenit=l long QT syndromes
!. Jervell =nd L=nge-Nielsen - sensorineur=l HL + congenit=l long QT (AR)
#. Vs rom=no-w=rd: no de=fness (AD)
$). Review m;ybe? Acute AFib > sudden onset HF. Seen in pts w severe AS.
!. Deets
!. Reduced c=rdi=c output due to v=lvul=r obstruction. C=n be
 !.
ex=cerb=ted by loss of norm=l =tri=l contr=ction th=t contributes to
ventricul=r filling.
#. Atri=l contr=ction is import=nt =s m=ny h=ve concentric LV
hypertrophy =nd therefore reduced LV compli=nce > become
dependent on ATRIAL contr=ction to m=int=in LV filling.
$. Prelo=d c=n decre=se to the point of producing severe hypotension.
%. Loss of =tri=l kick > incre=sed pulm venous pressure due to buildup of
blood in LA =nd pulm veins > pulm edem=
$f. In mitr=l regurg, S3 is =udible when LV is un=ble to =ccommod=te excess
blood flow
!. Others
!. Mid-sytsolic click of MVP - c=used by sudden tensing of chord=e
tendin=e =s they =re pulled t=ut by v=lve le=flets b=llooning into
=trium.
!. Occurs e=rlier when LV volume is decre=sed
%g. X eczem=tous derm=titis > weeping lesions. Acute =llergic cont=ct
derm=titis - due to del=yed type IV sensitivity rxn to =ntigen on skin surf=ce.
!. Ch=r=cterized by spongiosis - edem= fluid in intercellul=r sp=ces of
epidermis.
#. Other
!. Ac=nthosis - thickened str=tum spinosum
#. Hyperker=tosis - thickened str=tum corner
$. Dysker=tosis = =bnorm=l, prem=ture ker=tiniz=tion of individu=l
ker=tinocytes below str=tum gr=nulosum. C=n be seen w SCC
3/27-2

!. Often h6ve 6 10-20 ye6r l6tency period between initi6l rheum6tic fever
episode 6nd symptom6tic MS
!. MS > 6tri6l enl6rgement > A fib 6nd mur6l thromboses
#. Other
!. C6lcific deposits develop in mitr6l v6lve 6nnulus in women over 60
#. X ABO 6ntigens 6nd wh6t kind of Ig they 6re
!. In erythrobl6stis fet6lis in HDN, m6tern6l 6nti-fet6l 6ntibodies c6use 6
type II hypersensitivity le6ding to erythrocyte destruction
#. W m6tern6l blood types A 6nd B, n6tur6lly occurring 6ntibodies 6re IgM
type > c6nʼt cross pl6cent6
!. Type O mothers h6ve IgG 6ntibodies > c6n cross pl6cent6
$. Unlike Rh dise6se, ABO dise6se c6n occur w first pregn6ncy bc 6nti-A
6nd 6nti-B 6ntibodies 6re formed e6rly in life from exposure
$. RAAS 6ctiv6tion: incre6sed NE, decre6sed ren6l perfusion stimul6tes JG to
incre6se renin secretion 6nd incre6se RAAS > incre6sed ATII
!. ANP 6nd BNP rele6sed to stimul6te v6sodil6tion 6nd s6lt/w6ter excretion
(counter6ct RAAS effects)
%. Pyruv6te dehydrogen6se deficiency: ketogenic diet for tx (high f6t, low
c6rb). Forces production of ketone bodies to fuel body in pl6ce of glucose.
!. Glucose 6bsence decre6ses 6mt of pyruv6te gener6ted > decre6ses
l6ct6te
#. Lysine 6nd leucine - both ketogenic, c6nʼt be met6bolized to pyruv6te >
no production of l6ctic 6cid
&. ATN c6n result from nephrotoxins (6minoglycosides, v6nc, cidofovir,
fosc6rnet)
!. Aminoglycoside-induced kidney injury: usu6lly in 6 week of ther6py
initi6tion. Proxim6l dysfunction > loss of resorptive c6p6city 6nd
electrolyte w6sting
#. >2% FEN6 (intrinsic injury) 6nd gr6nul6r c6sts
'. REVIEW ADENOSINE SKETCHY
!. Adenosine incre6ses K+ efflux out of cells > hyper pol6rizes cell,
decre5ses AV node conduction. Termin6tes SVT
#. Inhibits C6 ch6nnels (slow upstroke - ph6se 0)
$. Incre6ses pot6ssium efflux (ph6se 4)
(. TS - ren6l 6ngiomyolipom6. Would see cortic6l tubers 6nd subependym6l
h6m6rtom6s.
). Injure inferior thyroid 6rtery > injury recurrent l6rynge6l nerve.
!. Vs superior l6rynge6l nerve (br6nches off v6gus)
!. divides into extern6l br6nch, supplies cricothyroid
 #. Intern6l br6nch - sens6tion over supr6glottic 6re6
l. Piriform recesses - on either side of l6rynge6l orific. Thin l6yer of mucos6
overlies piriform - protects superfici6lly coursing intern6l l6rynge6l nerve
(br6nch of superior l6rynge6l nerve - CN X)
!. Medi6tes 6fferent limb of cough reflex
#. Other
!. G6g reflex - CN IX = 6fferent, CN X = efferent
#. S6liv6tion - CN IX
!m. X opioids, r6diocontr6st 6gents, some Abx (v6nc) c6n induce m6st cell
degr6nul6tion w 6ctiv6tion of PKA 6nd IP3 kin6se (IgE-INDEPENDENT)
!!. REVIEW ATN SKETCHY
!. X Rh6bdo > AKI > c6uses ATN. Le6ds to gr6nul6r c6sts
#. Other
!. Dysmorphic RBCs 6nd RBC c6sts - seen in glomerulonephritis
#. Isomorphic - seen in nonglomerul6r hem6turi6 (nephrolithi6sis, UTIs)
!#. I-cell dise6se - defects in protein t6rgeting.
!. Proteins t6rgeted for lysosomes: t6gged with m6nnose residues (in Golgi),
then go through Golgi to get to lysosome
#. F6ilure to thrive, cognitive deficits, co6rse f6cies, corne6l clouding
!$. SIADH le6ds to reflexive ANP rele6se > loss of sodium > 6pp6rent euvolemi6
!%. X di6betic g6strop6resis > le6ds to destruction of enteric neurons. Loss of
NO-producing neurons > imp6ired fund6l rel6x6tion 6nd loss of interstiti6l
cells of C6j6l. Uncoordin6ted smooth muscle contr6ctions.
!. Other
!. V6g6l motor nucleus is loc6ted in the br6instem, not 6ffected.
!&. X c6n see h6ir follicle, seb6ceous gl6nd, epidermis 6nd dermis in this
specimen > m6ture ter6tom6
!. Vs ov6ri6n c6rcinom6 - usu6lly seen 6t 6round 6ge 60
!'. Klebsiell6 is 6 l6ctose fermenter (so 6re Enterob6cter 6nd serr6ti6)
!(. Ch6ncroid - r6gged borders, grey exud6te, inguin6l lymph6denop6thy
!). Prol6ctinom6 - from l6ctotrophs in pituit6ry
!. Other
!. Vs K6llm6n - neurons in hypoth6l6mus. Decre6sed sm6ll 6nd
hypogon6dotrophic hypogon6dism
!l. Febrile + signs of meningitis > 6rbovirus otubre6k
!. Elimin6te vector breeding grounds (st6gn6nt w6ter) 6nd spr6y w
insecticide
#m. Incre6sed use of IV c6theters > shift in microbiology of BSI (bloodstre6m
infections) - now see 6 lot of St6ph
#!. TTP > would see thrombosis 6ffecting br6ins, kidney, he6rt
##. Rif6mpin - inhibits DNA-dept RNA polymer6se, prevents tr6nscription 6nd
le6ds to deficiency of proteins necess6ry for mycob6cteri6l surviv6l
#$. C6rcinoid tumors 6t the b6se of the 6ppendix c6n c6use obstruction 6nd
#$.
6ppendicitis
#%. Corticosteroids decre6se extr6cellul6r m6trix coll6gen 6nd GAGs
#&. X Effect modific6tion - effect of exposure on 6n outcome is modified by
6nother v6ri6ble. C6n be identified using str6tified 6n6lysis - different str6t6
will h6ve different me6sures of 6ssoci6tion.
!. Smoking st6tus modified the effect of new estrogen receptor 6gonist on
DVT (outcome)
#. Vs confounding
!. Age c6n be 6 confounder th6t muddies 6ssoci6tion between shoe size
6nd intelligence (bigger shoe size = more intelligent)
#. BUT when 6n6lyzed sep6r6tely (str6tific6tion b6sed on confounder) -
6ssoci6tion dis6ppe6rs
#'. DiGeorge - bifid uvul6, orbit6l hypertelorism
#(. Colon c6ncer c6uses IDA!
!. Right sided tumors grow 6s bulky m6sses th6t protrude into lumen > more
likely to c6use IDA
#. Liver 6nd lung - common sites for mets
#). Vincristine - tingling 6nd numb h6nds
!. Vs burning on urin6ting - cyclophosph6mide or ifof6mide-induced
hemorrh6gic cystis
#l. Acyclovir nephrotoxicity - 6dequ6te hydr6tion 6nd reduce r6te of drug
infusion
$m. McCune 6lbright syndrome - X-r6y would show p6thologic fr6cture in left
hip. Would see mos6ic som6tic mut6tion during embryogenesis in GNAS
gene encoding stimul6tory 6 subunit of G protein
$!. Schizophreni6 - fl6t 6ffect is 6ssoci6ted
$#. Sulfonylure6s incre6se insulin secretion r6te of residu6l bet6 cells, reduce
blood glucose levels
!. Metformin doesnʼt h6ve 6n effect on insulin secretion
!. Reduces hep6tic glucose production by inhibiting mitochondri6l
enzyme gylcerophosph6te dehydrogen6se (mGDP)
#. Activ6tes AMPK > decre6sed gluconeogenesis, incre6sed insulin
sensitivity
#. Glit6zones upregul6te 6diponectin - incre6sed insulin sensitivity 6nd FA
oxid6tion
$$. Emp6thy. Cool.
$%. Rinne 6nd Weber. Cool.
$&. Di6betic neurop6thy - see moder6tely incre6sed 6lbuminuri6 in the e6rly
st6ges. Tx with ACEIʼs c6n reduce 6lbumin excretion 6nd slow progression to
overt DN
!. Others
!. RBC c6sts - glomerulonephritis
#. W6xy c6sts - seen in 6dv6nced ren6l dise6se - enl6rged nephrons
 #.
undergo compens6tory hypertrophy in response to reduced ren6l
m6ss
$'. X Peptostreptococcus 6nd fusob6cterium = mouth flor6 > suggestive of lung
6bscess. C6n see 6n identifi6ble 6ir-fluid level.
$(. 17-6 hydroxyl6se deficiency > 6ppe6r phenotypic6lly fem6le 6t birth but l6ck
fem6le genit6li6 due to 6bsence of virilizing 6ndrogens in utero.
!. Le6ds to excessive miner6locorticoid production
$). Endo ok.
!. Adenomyosis c6n 6lso le6d to 6bnorm6l uterine bleeding 6nd p6inful
menses.
$l. Depressive episodes 6re not required for dx of bipol6r I. M6nic episodes c6n
occur with or without psychotic fe6tures.
!. Others
!. C6nʼt dx brief psychotic dz when psychotic sx occur only in context of
m6nic episode
#. Delusion6l dz: ch6r6cterized by >1 delusion in 6bsence of other
psychotic sx
%m. X F6mili6l DCM - c6n h6ve mut6tions in titin gene. Le6ds to imp6ired
myoc6rdi6l contr6ctile function w dil6tion of one or both ventricles.
Autosom6l domin6nt.
!. Hyperkinesis of LV le6ds to st6gn6tion of blood flow 6nd possible
development of LV
#. Other
!. HCM wouldnʼt h6ve mur6l thrombus form6tion
#. If 6therosclerosis w6s minim6l (20-25%), prob6bly wouldnʼt h6ve le6d
to de6th
3/28-1

!. Met5pl5si5 - ch5nge of cell types. H5ppens w smoking 5nd B5rrett

esoph5gus
#. Retrovir5l ther5py is 5n option for SCID. Vectors 5re used to infect
hem5topoietic stem cells w genetic code for 5denosine de5min5se.
$. Attrition bi5s - form of selection bi5s th5t occurs when subjects 5re lost to
follow-up
%. Botulism toxin - c5n inhibit cholinergic nerves (including nicotinic 5nd
musc5rinic motor neurons). Blocks ACh rele5se into neuromuscul5r syn5pse.
!. REVIEW CURARE *gents w succ
&. Tre5ting friends should be limited to emergencies when no other physici5n is
5v5il5ble
'. X REVIEW MVP is the most common underlying v5lvul5r dise5se
predisposing to development of IE in developed countries, esp when
5ssoci5ted w coexistent mitr5l regurg
!. Microscopic deposits of pl5telets 5nd fibrin occur w turbulent blood flow.
Deposits c5n then be colonized by microorg5nisms
#. Other
!. Isol5ted ASDs 5re not commonly 5ssoci5ted w incre5sed risk of IE
(likely due to low pressure differenti5l between 5tri5 5nd 5bsence of
high-velocity intr5c5rdi5c flow jets)
(. Corticospin5l tr5cts
!. Deets
!. Fibers th5t cross > form l5ter5l corticospin5l tr5ct (90%)
#. 10% donʼt cross 5nd form 5nterior corticospin5l tr5ct
). Colitiis-5ssoci5ted colorect5l c5ncer occurs in 5re5s of chronic
infl5mm5tion. Risk is proportion5te to dur5tion 5nd severity of infl5mm5tion
!. More 5ggressive, develops from fl5t lesions, 5nd is typic5lly multifoc5l.
Affects 5 younger popul5tion
*. P5in from medi5stin5l or di5phr5gm5tic pleur5 is c5rried by phrenic nerve.
Viscer5l pleur5 doesnʼt c5rry p5in fibers.
!+. NBTE (m5r5ntic endoc5rditis) > v5lvul5r endotheli5l injury c5used by
circul5ting infl5mm5tory cytokines > trigger pl5telet deposition in presence
of underlying hyperco5gu5ble st5te
!. Associ5ted w 5dv5nced m5lign5ncy 5nd SLE
#. Esp 5ssoci5ted w mucinous 5denoc5rcinom5
!!. X F5t nerve root = r*di*l nerve. Vulner5ble to tr5um5tic injury 5t humer5l
midsh5ft. C5n 5lso be injured during its superfici5l course within the 5xill5.
!. We5kness is wrist *nd finger extension, v5ri5ble sensory loss over
posterior 5rm 5nd fore5rm.
 #. D5m5ge to medi5n nerve - we5kness in wrist flexion
!#. V5ricose veins - more prone to skin ulcer5tions
!$. Atopic 5sthm5 - occurs in predisposed individu5ls. Elev5ted levels of
eosinophils w Ch5rcot-Leyden cryst5ls
!. Th2 medi5ted re5ction to 5ero-5ntigens. Cells secrete IL-5 for
eosinophilic recruitment. Prolonged surviv5l in bronchi5l mucos5.
!%. WPW - reentr5nt circuit - tr5vels down AV node to ventricles 5nd b5ck up
5ccessory p5thw5y
!&. PTHrP - resembles PTH 5t bio5ctive 5mino-termin5l region 5nd c5uses
incre5sed bone resorption, decre5sed ren5l excretion of c5lcium, incre5sed
ren5l excretion of phosphorus
!'. MS - length/time const5nt
!. Length = how f5r 5long 5n 5xon 5n electric5l impulse c5n prop5g5te w/o
requiring 5ctive regener5tion by ion ch5nnels
!. Demyelin5tion will decre5se length const5nt 5nd result in shorter
impulse conduction
#. Time = how long it t5kes to respond to ch5nge in membr5ne perme5bility.
!. Demyelin5tion would decre*se length const5nt 5nd incre*se time
const5nt
!(. Fr5gile X - region w incre5sed repe5ts does not st5in 5nd 5ppe5rs “broken”
!). MDD w cognitive imp5irment is common in elderly
!. Remember th5t frontotempor5l dementi5 m5nifests w e5rly person5lity
ch5nges
!*. Cl5ss IA block sodium ch5nnels 5nd inhibit ph5se 0 depol5riz5tion > slowed
conduction
!. Also h5ve moder5te pot5ssium-ch5nnel blocking 5ctivity - slow r5te of
repol5riz5tion 5nd prolong5tion of 5ction potenti5l dur5tion
#. Cl5ss IB 5lso h5s some K+ blocking potenti5l
!. We5k sodium-ch5nnel blocking 5ctivity 5t rest but effective in
blocking sodium ch5nnels in depol5rized myocytes
#+. Gingivostom5titis w HSV infection pe5ks between 6 mo 5nd 5 ye5rs. P5inful
vesicles on lips 5nd gingiv5. Results in dehydr5tion.
#!. Noncompetitive/irreversible competitor - lowers Vm5x. Phenoxybenz5me
(irreversible t5ttoo) is irreversible. Phentol5mine is reversible.
!. Noncompetitive 5nt5gonist doesnʼt re5lly shift Km
##. WBC c5sts 5re PATHOGNOMONIC for pyelonephritis in the setting of UTI
!. Other
!. Sterile pyuri5 c5n be seen with nongonoccoc5l urethritis c5used by
Chl5mydi5 or Ure5pl5sm5
#$. Azoles inhibit demethyl5tion of l5nosterol into ergosterol in fung5l cells, 5nd
inhibit 450 system.
#%. PR interv5l = beginning of 5tri5l depol5riz5tion to beginning of ventricul5r
depol5riz5tion (st5rt of QRS)
 !. Drugs th5t slow AV conduction prolong PR interv5l
#&. INH - specific5lly inhibits myceli5 5cids. Since they 5re inhibited, cells will no
longer resist decolor5tion by 5cid-5lcohol decolorizing 5gent.
#'. Reye syndrome - microvesicul5r ste5tosis
#(. X since RT-PCR w5s used, it would not identify the BCR-ABL protein. Would
identify the BCR-ABL GENE. (mRNA w BCR 5nd ABL eons)
#). Cruzi - higher risk for esoph5ge5l c5ncer.
#*. X incre5sed COX-2 5ctivity h5s been found in m5ny forms of colon
5denoc5rcinom5. C5n be due to need for COX-induced prost5gl5ndin
production > epitheli5l prolifer5tion.
!. Aspirin h5s been 5ssoci5ted w lower r5tes of colonic 5denom5 5nd
5denoc5rcinom5
#. Other
!. Inhibition of c5sp5ses > le5ds to cells th5t 5re resist5nt to 5poptosis -
this is p5rt of the 5denoc5rcinom5 > c5rcinom5 sequence
$+. Obsessions 5nd compulsions c5n be time consuming, c5n le5d to distress or
function5l imp5irment
!. OCPD is usu5lly not dxʼd under 5ge 18 - donʼt see compulsions
$!. Line5r mucos5l te5r = m5llory weiss. Due to vomitting, which c5uses
met5bolic 5lk5losis.
$#. NAD+ is regener5ted from NADH when pyruv5te is converted to l5ct5te vi5
l5ct5te dehydrogen5se. w/ l5ct5te dehydrogen5se deficient, muscle cells
c5nʼt regener5te NAD+ > glycolysis is inhibited.
!. Pyruv5te will ACCUMULATE w LDH deficiency
#. M*ybe review this?
$$. Alcohol is second most common c5use of g5llstones. Would see
m5crocytosis due to fol5te deficiency w g5llstones.
$%. REVIEW ATN
!. AKI one d5y 5fter surgery - prob5bly due to surgery.
!. Ren5l hypoperfusion c5n occur bec5use of
!. Blood loss
#. C5rdiopulm byp5ss
$. Aortic cl5mping
#. Other
!. V5nc c5n c5use ATN, but it would usu5lly h5ppen 5fter 5 few d5ys,
not 5fter 5 single dose.
#. Pre-ren5l 5zotemi5 occurs w less signific5nt hypo perfusion, but
would see hy5line c5sts (concentr5ted urine) 5nd BUN/Cr is not
elev5ted
$&. P5n5cin5r emphysem5 - obstructive
$'. 70% of LDL is cle5red by the liver
$(. Enveloped dsDNA viruses: Hep5dn5, Herpes, Pox
!. HSV-1 c5uses gingivostom5titis
 #. Other
!. Rot5virus = dsDNA, positive sense, non-enveloped
$). X whoops
!. low cholesterol, d5rk stones
!. Brown stones - bili5ry tr5ct infections
#. Bl5ck - chronic hemolysis 5nd incre5sed enterohep5tic cycling of bili
(ile5l dise5se)
$*. X REVIEW PTH sketchy?
!. osteobl5sts synthesize bone m5trix 5nd express AlkP - promotes bone
miner5liz5tion by incre5sing concentr5tions of inorg5nic phosphorus. AlkP
levels correl5te w osteobl5stic 5ctivity.
!. Deets
!. AlkP is 5lso produced by hep5tobili5ry tree, intestine, pl5cent5 -
c5n be non-specific
#. C5n 5lso h5ve N-termin5l propeptide of type 1 pro-coll5gen th5t
m5rks osteobl5stic 5ctivity
!. rele5sed during post-tr5nsl5tion cle5v5ge of type 1
procoll5gen before 5ssembly into type 1 coll5gen fibrils
#. Other
!. C5lcitonin - inhibits osteocl5sts - decre5sed resorption - tx
osteoporosis
%+. Young men th5t 5re he5vy smokers - c5n develop Burgers - h5ve R5yn5ud
5nd superfici5l thrombophlebitis
3/28-2

REVIEW di)betes drugs sketchy ph)rm

!. C diff - produces 2 distinct toxins - A (enterotoxin) ?nd B (cytotoxin). Toxin B

is more virulent. Both in?ctiv?te Rho-regul?tory proteins involved in sign?l
tr?nsduction ?nd ?ctin cytoskelet?l structure > disruption of intercellul?r
tight junctions.
!. Deets
!. A binds to the brush border ?nd c?uses infl?mm?tion, cell de?th,
w?tery di?rrhe?
#. Other
!. Vibrio - ?ffects ?pic?l ion tr?nsport
#. In NPH, decre?sed CSF ?bsorption > incre?sed CSF volume > ventricul?r
enl?rgement.
!. L?ck of inhibition from cerebr?l cortex le?ds to frequent ?nd uncontrolled
micturition (urge incontinence)
$. EPO secretion: from peritubul?r fibrobl?sts in ren?l cortex
!. Other
!. RAAS ?ctiv?tion would constrict smooth muscle of efferent ?rteriole
%. X M)ybe review this?
!. Deets
!. mRNA sequences ?ssoci?te w P bodies in the cytopl?sm.
#. P bodies ?re involved w mRNA regul?tion ?nd turnover, pl?y ?
fund?ment?l role in tr?nsl?tion repression ?nd mRNA dec?y, cont?in
exonucle?ses
$. C?n ?lso function ?s mRNA stor?ge > cert?in mRNAs ?re
incorpor?ted into P bodies > c?n l?yer be rele?sed ?nd utilized for
protein tr?nsl?tion
#. Others
!. Splicing (w snRNPs) occurs in the nucleus
&. Hox genes bind to tr?nscription f?ctors + ?lter gene expression in the
embryo
'. X in vWF > DDAVP will incre?se secretion of endotheli?l protein rele?se
(rele?se of vWF)
!. Other
!. DDAVP is simil?r to v?sopressin (which ?cts on V1 receptor in
v?scul?r smooth muscle cells), but h?s ? minim?l effect on th?t
receptor
#. C?n ?lso bind to V2 receptors on ren?l tubul?r cells ?nd incre?se
?qu?porin ch?nnels
 a. REVIEW THIS
!. X NNH = 1/ ?bsolute risk incre?se.
!. C?lcul?te ?dverse event r?te
!. Adverse events in experiment?l = 60/100
#. Adverse events in control = 69/120
#. Subtr?ct: 0.6 - 0.575 = 0.025
$. Divide: 1/0.025 = 40
b. Pulm HTN > P2 component of S2. RV ?lso becomes enl?rged w incre?sed
pressure lo?d
!. c?n cre?te ?ccentu?ted impulse ?t LSB (left p?r?stern?l lift due to right
ventricul?r he?ve)
#. LV function int?ct > no pulm edem?
c. X Br?in ?bscess c?n be ring-enh?ncing. Mostly b?cteri?l in origin.
!. Girl w?s pulling ?t her e?rs > prob?bly h?d otitis medi? th?t spre?d to
m?stoid ?ir cells ?nd then inv?ded ?dj?cent tempor?l lobe.
#. Front?l lobe sinus would prob come from ethmoid or front?l sinus.
$. F?ci?l infections ?round eyes ?nd nose dr?in to ophth?lmic veins >
c?vernous sinus thrombosis (fever, he?d?che, eye swelling, oculomotor
deficits)
!d. M)ybe review? Communic?ting vs non-communic?ting hydroceph?lus
!. P?th: L?ter?l > IV for?men of Monro > 3rd vent > cerebr?l ?queduct > 4th
vent > for?min? of Luschk? ?nd M?gendie > sub?r?chnoid sp?ce
#. Deets
!. Non-communic?ting: norm?l CSF flow from ventriculi to SA sp?ce.
Ventricle ?bove obstruction ?re enl?rged, those below ?re norm?l.
!. C?n h?ppen w Arnold-Chi?ri or D?ndy-W?lker
#. Communic?ting: no obstruction to flow, occurs second?ry to
dysfunction or obliter?tion of sub?r?chnoid villi
!. All ventriculi ?re symmetric?lly enl?rged
!!. SSRIs for PTSD
!#. Osteocl?sts ?re formed when sever?l precursor cells fuse to cre?te
multinucle?ted m?ture cell. 2 most import?nt f?ctors = M-CSF ?nd RANK-L
!. Deets
!. OPG = physiologic decoy th?t decre?ses binding of RANK-L - reduces
differenti?tion ?nd surviv?l of osteocl?sts - decre?sed bone
resorption
!$. RA > ?ctiv?tes CD4+ T cells (especi?lly Th1 ?nd Th17). M?croph?ges rele?se
pro infl?mm?tory cytokines > le?ds to ?rticul?r destruction
!. Deets
!. TNF-? - prolifer?tion of infl?mm cells ?nd c?uses expression of
infl?mm f?ctors
#. IL-1: synthesis of m?trix met?lloprotein?ses, enh?nced T cell immune
response
 #. Other
!. IL-2: more prominent in TB
#. TGF-B ?nd IL-10 downregul?te lymphocyte ?ctiv?tion ?nd
prolifer?tion
!%. All p?tients w hx of m?jor depressive disorder should be screened for p?st
hx of m?nic episodes to differenti?te MDD from bipol?r
!. If there is ? potenti?l dx of bipol?r, ?void ?nti-depress?nt mono ther?py
bc ?nti-depress?nts c?rry ? risk of inducing m?ni?
!&. X Review this )g)in m)ybe? ?cute p?ncre?titis. Enterokin?se cle?ves
trypsinogen to trypsin > ?cceler?tes p?ncre?tic enzyme ?ctiv?tion in
duodenum.
!. Deets
!. Acute p?ncre?titis begins w prem?ture ?ctiv?tion of trypsin in
p?ncre?tic ?cini.
#. Trypsin ?ctiv?tes other proteolytic enzymes (chymotrypsin, el?st?se,
etc) > le?ds to p?ncre?tic infl?mm?tion ?nd ?utodigestion. C?n result
in necrotizing p?ncre?titis.
#. Others
!. Lip?se hydrolyzes triglycerides > FA ?nd glycerol. C?n le?d to f?t
necrosis w c?lcium so?p deposits.
!'. Prim?ry myelofibrosis - clon?l exp?nsion of meg?k?ryocytes (m)ybe look )t
this in sketchy p)th?)
!a. Acet?zol?mide ?lk?lizes the urine w HCO3- excretion
!b. LHF - elev?tion of end-di?stolic pressure - incre?sed hydrost?tic pressure in
pulm c?ps > edem? > decre?sed compli?nce bc thereʼs too much shit in the
lungs
!. Other deets
!. Pulm edem? dilutes surf?ct?nt > incre?sed ST
!c. X wtf is this. Educ?te physici?ns not to use tr?iling zeros
!. Computerized systems might not recognize errors in dos?ge since there
?re m?ny different dos?ges
#d. There is ?n ?uricul?r br?nch of the v?gus nerve. If triggered, c?n le?d to
v?sov?g?l syncope.
#!. Atropine - tre?ts br?dyc?rdi?, but ?lso c?uses mydri?sis, n?rrows the
?nterior ch?mber ?ngle ?nd diminishes outflow of ?queous humor
##. Anki this? Antioxid?nt enzymes = superoxide dismut?se, glut?thione
peroxid?se, c?t?l?se > convert ROS to oxygen ?nd w?ter, neutr?lize
c?p?city for cellul?r d?m?ge.
#$. Hydroceph?lus
!. Deets
!. Non-communic?ting: obstruction of CSF flow within or between
ventricles ?nd sub?r?chnoid sp?ce. Only ventricles proxim?l to
obstruction ?re dil?ted
 #. Communic?ting : CSF flows freely between ventricles ?nd
sub?r?chnoid sp?ce, but decre?sed ?bsorption ?t ?r?chnoid
gr?nul?tions
$. w/ AIDS dementi?, c?n develop hydroceph?lus ex-v?cuo due to
cortic?l ?trophy. Allows ventricles to exp?nd while m?int?ining norm?l
CSF pressure.
#%. HSV-1 enceph?litis: prim?ry oroph?rynge?l infection tr?vels vi? olf?ctory
tr?ct or from re?ctiv?tion of l?tent virus in trigemin?l g?nglion > edem? ?nd
hemorrh?gic necrosis of tempor?l lobe
#&. CKD: incre?sed PO4 binds free serum C?, results in hypoc?lcemi? >
second?ry hyperPTH
#'. Adenoc?rcinom?: results from driver mut?tions. Seen in gener?l popul?tion,
women, non-smokers.
!. C?used by EGFR mut?tions ?nd ALK re?rr?ngements.
#. KRAS mut?tions ?re more commonly seen in smokers
#a. X Angios?rcom? - c?n ?rise w ?xill?ry lymph node dissection. Infiltr?tion of
the dermis w slit-like ?bnorm?l sp?ces c?n occur
#b. First, pro-T cells ?rrive ?s double-neg?tive cells, l?ck both CD4+ ?nd CD8+.
Productive re?rr?ngement le?ds to stimul?tion of CD4 ?nd CD8 ?ntigens w
simult?neous expression of CD4 ?nd CD8
#c. C1 inhibitor deficiency > blocks k?llilrein-induced conversion to br?dykinin,
potent v?sodil?tor
$d. Active vertic?l growth = gre?ter met?st?tic risk
!. Other
!. Lentigo m?lign - pigmented lesions w multinucle?ted gi?nt cells
$!. Cold ?gglutinins - erythrocytes most strongly below core body temp
$#. Splinter hemorrh?ges - endoc?rditis
$$. Pleuritic-type chest p?in th?t r?di?tes to the shoulder, recent hx of skin r?sh
?nd joint p?in = fibrinous peric?rditis due to SLE
!. Most common type of peric?rditis, consists of peric?rdi?l infl?mm?tion w
fibrin-cont?ining exud?te
$%. Atropine - c?n be ?dministered prior to bronchoscopy to decre?se
respir?tory mucus secretions ?nd promote bronchodil?tion
!. Physostigmine - cholinester?se inhibitor - incre?ses Ach concentr?tion ?t
syn?ptic cleft
$&. X Atherosclerosis > chronic mesenteric ischemi?. C?n ?lso h?ve ren?l ?rtery
stenosis.
!. Atherosclerotic RAS = prominent ?therosclerotic pl?ques @ junction of
?ort? ?nd ren?l ?rtery
#. Unil?ter?l RAS - chronic ischemi? ?trophies ?ffected kidney, contr?l?ter?l
kidney undergoes hypertrophy > le?ds to size discrep?ncy
$. Tubul?r ?trophy w decre?sed tubul?r epitheli?l size, p?tchy infl?mm?tion,
tubulointerstiti?l ?nd glomerul?r fibrosis
$'. X Chemother?py ?nd infections
!. Deets
!. Cre?tes bre)ches in mucos)l b)rrier th)t )llow endogenous
b)cteri)l flor) to penetr)te )nd enter bloodstre)m
#. Also neutropeni? - fever m?y be the only sign of infection
$a. Churgg-Str?uss - c?n h?ve ?symmetric c?l neurop?thy w v?sculitis ?ffecting
epieneur?l vessels (wrist drop due to r?di?l nerve involvement)
!. Presents l?ter in life
$b. X C-myc (8;14 product) in Burkitt lymphom? - functions ?s tr?nscription
?ctiv?tor
$c. X Gluc?gonom? - c?n ?ppe?r like di?betes. Ch?r?cteristic skin finding =
necrolytic migr?tory erythem? - elev?ted p?inful ?nd pruritic r?sh in f?ce,
groin, extremities.
!. Sm?ll p?pule co?lesce to form l?rge, indur?ted pl?ques
#. Would see elev?ted gluc?gon in the serum
%d. X ACE-inhibitors c?n le?d to ?ngioedem?. ACE inhibitor-induced
?ngioedem? is due to br?dykinin ?ccumul?tion > br?dykinin is ? potent
v?sodil?tor th?t incre?ses v?scul?r per?mbility > ?ngioedem?.
!. Could ?lso h?ve heredit?ry C1 ester?se inhibitor deficiency, but usu?lly
presents in childhood ?nd e?rly ?dolescence. Br?dykinin ?ccumul?tion is
more likely
3/28-3

!. Multiple, seemingly unrel@ted phenotypic m@nifest@tions = pleiotropy

!. other
!. F@mili@l hypercholesterolemi@ c@n be c@used by either LDL receptor
or @po B-100
#. Superior sulcus = groove formed by subcl@vi@n vessels. Apic@l loc@tion
@llows for extensive tumor spre@d.
$. Hep B: binds to @ bile s@lt tr@nsporter. Enters cell. Unco@ted in cytopl@sm,
single str@nded DNA portion is rep@ired by cellul@r DNA polymer@ses.
!. Deets
!. Cre@tes dsDNA, then tr@nscribed by host RNA to single-str@nded RNA
pregenome.
#. Other
!. P@rvo: ssDNA > dsDNA > ssDNA
%. Sports p@rticip@tion c@n trigger @cne w use of tight fitting clothing
&. Celi@c - duoden@l biopsy bc duodenum @nd jejunum @re exposed to highest
concentr@tion of gli@din
'. REVIEW THIS AGAIN
!. PAH filtr2tion c@nʼt be s@tur@ted. As blood PAH incre@ses, tubul@r fluid
PAH concentr@tion will @lso incre@se
!. PAH is @lso t@ken up by PCT cells. As blood concentr@tion of PAH
incre@ses, secretion of PAH by PCT cells incre@ses, but only up to
m@x v@lue of 80 mg/min
#. So excretion CAN be s@tur@ted
(. Listening @t end expir@tion > decre@ses lung volume @nd brings he@rt closer
to chest w@ll
). X Optic tr@ct lesions le@d to contr@l@ter@l homonymous hemi@nopi@
!. Rel@tive @fferent pupill@ry defect (M@rcus Gunn pupil) occurs w optic
nerve lesions.
!. Afferent limb: involves rein@, optic nerve, optic chi@sm, optic tr@ct
fibers, pretect@l nucleus
#. C@n @lso c@use rel@tive @fferent pupill@ry defect in pupil contr@l@ter@l
to tr@ct lesion
#. Vs l@ter@l genicul@te nucleus - c@n still h@ve contr@l@ter@l homonymous
hemi@nopi@, but would see norm@l light reflex
*. Prem@ture ej@cul@tion: e@rly (within one minute), for @t le@st 6 months
!+. In TB, see epithelioid histiocytes @nd multinucle@ted L@ngerh@ns gi@nt cells
!. TB is @ble to ev@de intr@cellul@r killing by m@croph@ges @nd survive/
reproduce in ph@golysosomes
#. Infected m2croph2ges tr@vel to dr@ining pulmon@ry lymph nodes -
 #.
present mycob@cteri@l @ntigens to n@ive CD4” T cells.
!. Also secrete IL-12 - differenti@tes @ctiv@ted T cells to Th1
#. Prolifer@ting Th1 cells rele@se IFN-y > @ctiv@tes m@croph@ges. C@n
slowly kill mycob@cteri@.
!!. Cr@niph@ryngo@m - AP is formed from out pouching of ph@rynge@l roof
!#. X GERD - GE junction incompetence is the m2in mech2nism responsible
for GERD
!. Ch@r@cteristic findings
!. B@s@l zone hyperpl@si@
#. Elong@tion of l@min@ propri@ p@pill@e
$. Sc@ttered eosinophils @nd neutrophils
#. Other
!. This guy doesnʼt h@ve @ history of @topy, so itʼs prob@bly not EE
!. Also wouldnʼt see relief from EE with PPIs
!$. X WATCH THIS VIDEO AGAIN
!. C@rdi@c t@mpon@de c@n be precipit@ted by infection
#. Deets
!. Beckʼs tri@d = hypotension, JVD, pulses p@r@xodus = c@rdi@c
t@mpon@de
#. PP = loss of p@lp@ble pulse during inspir@tion
$. In conditions th@ timp@ir exp@nsion into peric@rdi@l sp@ce - incre@sed
RV volume w inspo > IV septum bows tow@rd LV
$. Other
!. Vir@l myoc@rditis c@n le@d to LV dysfunction, present w @cute CHF
@nd c@riogenic shock (REVIEW KINDS OF SHOCK)
!%. Acute MR > incre@sed LV EDV (prelo@d). Mitr@l v@lve forms low-resist@nce
regurgit@nt p@thw@y for blood to flow into the LA during systole, decre@sed
@fterlo@d
!. Since @fterlo@d is decre@sed > incre@sed EF
#. However, there is prolonged hemodyn@mic overlo@d > le@ds to eccentric
remodeling of LV > incre@se in w@ll stress w eventu@l contr@ctile
dysfunction
!&. X REVIEW ADRENAL ADENOMAS
!. Prim@ry hyper@ldosteronism due to @ldo-producing @denom@ (Conn
syndrome) - simil@r to outermost l@yer of @dren@l cortex
#. Hypok2lemic 2lk2losis c2n present w p2resthesi2s 2nd muscle
we2kness - review
!'. G@strin hypersecretion induces p@riet@l cell hyperpl@si@ > enl@rgement of
g@stric folds
!. Other
!. Menetrier is @ssoci@ted w overproduction of TGF-@
!(. Follicul@r lymphom@ > Bcl-2 over expression
!). c-ANCA - p@thognomonic for GPA
 !. GPA = Wegener.
#. Donʼt see hemoptysis w Churgg-Stru@ss
!*. Mycopl@sm@ = tx w b@cteri@l protein synthesis inhibitor (like m@crolide or
tetr@cycline)
#+. Slow @cetyl@tors h@ve @ higher risk of DIL!
!. Proc@nimide, hydr@l@zine, isoni@zid - met@bolized by ph@se II @cetyl@tion
in the liver
#!. Roseol@: 3-5 d@ys of high fever, followed by m@culop@pul@r r@sh. St@rts on
the trunk, spre@ds to the f@ce.
##. Acyclovir MOA
!. Deets
!. Converted to @cyclovir monophosph@te vi@ virus-encoded thymidine
kin@se
#. Cellul@r enzymes then convert monophosph@te to @cyclovir
triphosph@te, competes w deoxygu@nosine triphosph@te for vir@l DNA
polymer@se
$. When itʼs incopor@ted, DNA synth is termin@ted
#$. STEROID SKETCH
!. Deets
!. NF-kB is norm@lly present in cytopl@sm bound to IkB (inhibitor
protein)
#. Extr@cellul@r sign@l (like binding of b@cteri@l @ntigens to toll-like
receptor) @ctiv@tes IkB kin@se
$. Le@ds to ubiquitin@tion @nd destruction of IKB w rele@se of free NF-kB
%. NF-kB then promotes synthesis of infl@mm@tion proteins like
cytokines, @cute ph@se re@ct@nts, cell @dhesion molecules, etc
#%. Asbestosis => bil@ter@l p@renchym@l fibrosis, mostly in the lower lungs.
Honeycombing @nd upper lung involvement occur in @dv@nced dise@se.
#&. HMOs h@ve low monthly premiums, low cop@yments @nd deductibles, low
tot@l cost
#'. NSAID induced kidney injury - inhibition of @fferent dil@tion results in
reduced glomerul@r filtr@tion @nd pre-ren@l @zotemi@
#(. REVIEW PHARM EQUATIONS
!. F = @re@ under or@l curve x IV dose / @re@ under IV curve x or@l dose
#). Digoxin c@n be used in its w underlying systolic c@rdi@c dysfunction. M@jor
effects:
!. Incre@sed v@g@l tone
#. N@-K-ATP@se inhbition - incre@sed intr@cellul@r sodium @nd c@lcium
(incre@sed c@rdi@c contr@ctility)
$. C@n h@ve elev@ted pot@ssium in toxicity
#*. MCD = most common c@use of nephrotic syndrome in young kids. Would see
norm@l histology.
$+. First gen @ntipsychotics - block serotonin receptors (specific@lly 5-HT2A
$+.
receptors)
!. Vs blocking serotonin @nd NE reupt@ke = MOA of venl@f@xine
$!. Met@-@n@lysis - l@rger s@mple size - gre@ter power
$#. Cle@r cell c@rcinom@ - from PCT cells. Golden yellow tissue due to high lipid
content. Foc@l necrosis @nd hemorrh@ge.
!. Other
!. Urotheli@l c@rcinom@ - @rises from epithelium of ren@l pelvis
$$. Penetr@tion into muscul@ris propri@ = poor prognosis
$%. X c@n h@ve dissoci@tive symptoms w PTSD.
!. If dissoci@tion is p@rt of @ cluster of sx th@t meets criteri@ for PTSD >
PTSD is correct di@gnosis
$&. Thi@mine deficiency c@n be di@gnosed if b@seline RBC tr@nsketol@se @ctivity
is low but incre@ses @fter @ddition of thi@mine pyrophosph@te
$'. C@chexi@ = medi@ted by TNF-@
$(. Hemochrom@tosis - incre@sed iron @bsorption
$). x REVIEW EHEC, E coli stuff
!. EHEC - shig@-like toxin is virtu@lly identic@l to Shig@ toxin produced by
Shigell@. In@ctiv@ted 60s ribosom@l subunit.
#. Other
!. cGMP - ETEC (he@t st@bile) @nd Yersini@ produce toxins th@t incre@se
GMP
#. cAMP - ETEC (he@t l@bile), Vibrio, C@mpy
$*. Most met@bolic@lly @ctive p@rts of tubule @re most susceptible to ischemic
injury - PCT
%+. L@ter@l lesions - go to poplite@l @nd inguin@l nodes - more likely to c@use
lymph@denop@thy
3/29 Pr3ctice before NBME 17

!. X Schizo3ffective dz
!. Deets
!. m3jor depressive or m3nic episode w sx of schizophreni3
#. lifetime hx of delusions or h3llucin3tions for >2 weeks w/o m3jor
depressive or m3nic episode
$. Schizophreni3 = no mood sx!
#. IL-4: IgE, predisposed to 3llergic rxns
$. Ok
%. X REVIEW CATECHOLAMINE SYNTH
!. In 3dren3l medull3: NE => Epi by PNMT
&. X norm3l resting potenti3l: high conduct3nce to K+, some conduct3nce to
N3+
!. Cytopl3sm h3s 3 high concentr3tion of K+. Extr3cellul3r fluid is inversely
rich in N3 3nd low in K, so K re3dily flows out.
'. Herni3s
!. Deets
!. Indirect more common th3n direct. F3ilure of processus v3gin3lis to
obliter3te.
#. Direct: through Hesselb3chʼs tri3ngle.
(. ARR = c/(c+d) - 3/(3+b) = control event r3te - experiment3l event r3te
!. NNT = number of pts th3t need to be txʼd w medic3tion to 3void
3ddition3l neg3tive outcome
). 11-deoxycorticosterone c3n 3ct like 3 we3k miner3locorticoid, so it c3n le3d
to hypok3lemi3 + HTN
*. X Listeri3 = gr3m positive rod. Elimin3tion of intr3cellul3r p3thogens is
reli3nt on cell-medi9ted immune response. Cells infected by intr3cellul3r
b3cteri3 displ3y protein fr3gments on surf3ce, triggers cell lysis by cytotoxic
T cells
!. Cytotoxic T cells rele3se IFN-y to 3ctiv3te m3croph3ges
!+. X Chronic infl3mm3tion c3uses 3irw3y remodeling, further worsens 3irw3y
obstruction 3nd 3sthm3 sx
!. Corticosteroids prevent production of infl3mm3tory medi3tors (cytokines,
prost3gl3ndins, leukotrienes)
#. Deets
!. Systemic steroids (or3l prednisone) = used in short courses to tx
3cute 3sthm3 ex3cerb3tions
#. Inh3led (flutic3sone) = reduce frequency 3nd severity of
ex3cerb3tions, long-term
$. Other
!. Leukotriene inhibitors 3re less potent th3n inh3led steroids
#. Albuterol = short 3cting, r3pid relief during ex3cerb3tion
3/29-1

!. Le4d time bi4s: pts seem to live longer, but just bec4use the dise4se w4s
detected e4rlier
!. Vs length time bi4s: incre4sed detection of c4ses with 4 better prognosis
#. CI of me4n = me4n +/- (z score) * SE
$. Me4sles = m4culop4pul4r r4sh. Chickenpox = vesicul4r
%. X Blow out fr4cture of the orbit4l floor: goes to the m4xill4ry sinus
!. R4re in young kids bc m4xill4ry sinus is sm4ll 4nd orbit4l floor is not 4
we4k point
#. Other sinuses
!. Ethmoid: medi4l to the orbit
#. Sphenoid: lie 4nterior to optic chi4sm
&. Pleur4l pl4ques = h4llm4rk of 4sbestos exposure
!. Other
!. Berrylliosis looks simil4r to s4rcoid. Upper lobes.
#. Co4l workerʼs pneumoconiosis: sm4ll nodules in the upper lung zones.
$. Silicosis: upper lobes
'. TZDs: m4in side effect is fluid retention due to incre4sed sodium
re4bsorption in ren4l collecting tubules 4nd incre4sed v4scul4r perme4bility
in 4dipose tissue > edem4 4nd weight g4in (4dipose weight g4in w incre4sed
f4t stor4ge in 4dipocytes)
(. X REVIEW INNERVATIONS w defect2tion/urin2tion Pudend4l nerve -
innerv4tes extern4l genit4li4 4nd skin 4round 4nus 4nd perineum
!. Vulner4ble to stretch injury since it goes 4round the ischi4l spine > fec4l
incontinence
#. Others
!. Lumbos4cr4l plexop4thy: occurs during fet4l descent 4s 4 result of
direct compression of lumbos4cr4l trunk > foot drop 4nd numbness of
l4ter4l 4spect of leg
). X wow Iʼm dumb. She h4s hem4turi4 4nd elev4ted c4lcium.
!. Deets
!. Hyperp4r4thyroidism: le4ds to hyperc4lcemi4 4nd
hypophosph4temi4.
#. Other
!. She h4d simil4r p4in l4st ye4r but it resolved without 4ttention -
4ppendicitis wouldnʼt c4use recurrent symptoms
#. Also not 4ssoci4ted w hem4turi4 or hyperc4lcemi4
*. Perior4l 4nd perin4s4l r4sh (“glue snifferʼs r4sh”) - likely due to inh4l4nts.
Would 4lso see r4pid improvement.
!+. X if the condition is medic4lly d4ngerous 4nd potenti4lly leth4l, physici4ns
!+.
should ch4llenge p4rent4l 4uthority 4nd go to the courts
!. Kids 4t high risk for complic4tions during first few d4ys of tre4tment -
require hospit4l level c4re
!!. Met4tyr4pone blocks 11 deoxycortisol > cortisol. Checks for HPA integrity.
!. Reduction in cortisol levels following met4tyr4pone 4dministr4tion c4n
c4use 4 reflexive INCREASE in ACTH secretion.
!#. P4ncre4tic pseudocyst: consists of gr4nul4tion tissue 4nd no epitheli4l
lining. True cyst h4s w4lls lined by epitheli4l cells.
!$. Cle4r cell c4rcinom4 from PCT. Tissue fix4tion dissolves glycogen 4nd lipids
from specimens > le4ves cle4r sp4ces.
!. Other
!. K4rryorhexis: condensed nuclei
#. Pl4sm4 membr4ne lipid per oxid4tion: 4ssoci4ted w infl4mm4tion,
4therosclerosis, tumorigenesis
!%. Sjorgen: infl4mm4tion of exocrine (s4liv4ry, l4crim4l) gl4nds. Periduct4l
lymphocytic infiltr4tes w germin4l centers.
!. Other
!. Or4l leukopl4ki4: hyperpl4si4 4nd dyspl4si4 limited to epithelium
!&. X Sleepw4lking occurs in non-REM st4ge 3. Delt4 w4ves = Difficult to w4ke,
Deep, slow w4ve sleep.
!. K complexes 4nd sleep spindles = st4ge 2 = “twoth” grinding
!'. E coli - UTI ok
!(. PSGN c4n occur 4fter impetigo, ARF CANNOT
!). DNA synthesis occurs 5ʼ to 3ʼ. DNA polymer4se removes RNA primers; it is
the only polymer4se w 5ʼ to 3ʼ exonucle4se 4ctivity
!*. X withdr4w4l from benzos: c4n h4ve rebound 4nxiety, tremor, insomni4,
symp4thetic hyper4ctivity.
#+. Sickle cell tr4it: 4t birth, high levels of HbF, gr4du4lly declines throughout life
until 4round 35-45% of Hb is HbS 4s 4dult
!. Other
!. Life expect4ncy for pts homozygous for sickle cell decre4ses, but
sickle cell tr4it h4s 4 norm4l life expect4ncy
#!. Hypoxic v4soconstriction shunts blood 4w4y from under ventil4ted lung
regions tow4rds well-ventil4ted 4re4s
##. REVIEW PHARM EQUATIONS. Put them in r2pid review deck
!. t1/2 = 0.7 x 10 L / 7 L/hr = 1 hr
#$. Mother 4nd d4ughter MUST c4rry c4rds s4ying they donʼt w4nt to receive
blood products. Otherwise, go 4he4d 4nd tr4nsfuse.
!. Physici4ns should 4lw4ys provide life-s4ving ther4py to minors in 4n
emergency, reg4rdless of p4rents wishes.
#%. X In CREST syndrome, the n4tive tissue is repl4ced by coll4gen 4nd fibrotic
tissue (fibrotic de4d veget4tion 4nd c4rtil4ginous sh4rks on shield)
!. Vs 4ch4l4si4 would be ch4r4cterized by incre4sed LES pressure
#&. X decre4sed PCWP 4nd incre4sed RAP > impede blood flow from RV to the
he4rt (right-sided he4rt f4ilure)
!. Deets
!. Common c4uses of right-sided he4rt f4ilure = obstruction of
pulmon4ry circul4tion, RV inf4rct
#. Decre4sed RV outflow 4lso lowers PCWP (indic4tor of left-sided
prelo4d) > decre4ses CO 4nd c4uses hypotension
#. Other
!. An4phyl4xis 4nd septic shock 4re 4ssoci4ted w peripher4l
v4sodil4tion 4nd fluid shift to extr4v4scul4r sp4ce.
!. Depleted intr4v4scul4r volume lowers me4n circul4tory filling
pressure, reduces RAP 4nd PCWP.
#. Hypotension c4uses widespre4d peripher4l v4sodil4tion.
#. Would 4lso see this w GI loss
#'. W4tershed 4re4s in GI
!. Deets
!. Splenic flexure: SMA 4nd IMA
#. Rectosigmoid: supplied by sigmoid 4nd superior rect4l
#(. X B4rrett esoph4gus
!. Deets
!. M4jor risk f4ctors
!. Obesity
#. Chronic GERD
$. Smoking
#. Other
!. Alcohol = risk f4ctor for squ4mous. Wine m4y be protective in BE
#). X Import4nt to determine is lesion in bone is sclerotic (osteobl4stic) or
r4diolucent (osteolytic)
!. Deets
!. MM > m4jor c4use of r4diolucent bone lesions in 4dults
#. C4n c4use light ch4in production th4t clogs ren4l tubules > le4ds to
w4xy, l4min4ted c4sts
#. Other
!. Prost4te c4ncer: gener4tes sclerotic (osteobl4stic) bone lesions.
#*. Pruritus is usu4lly the first sx w PBC 4nd m4y be severe, esp 4t night
$+. Psori4sis is most common on surf4ces exposed to friction, like extensor
surf4ces. Disruption of epitheli4l b4rrier le4ds to 4ctiv4tion of APCs 4nd
self-reinforcing infl4mm c4sc4de ch4r4cterized by 4ctiv4tion of T helper
cells 4nd prolifer4tion of ker4tinocytes.
!. Deets
!. Histology
!. Hyperker4tosis - thickened corne4l
#. P4r4ker4tosis - nuclei ret4ined in corneum
 $. Epiderm4l hyperpl4si4 - 4c4nthosis
%. Dil4ted c4pill4ries in derm4l p4pill4e
#. Others
!. Eosinophilic infiltr4tes in pemphigus, skin dise4ses, derm4titis
herpetiformis
#. Thinning of the epidermis in scleroderm4
$!. Tr4ztuzum4b = c4rdiotoxictiy - decre4se in myoc4rdi4l contr4ctility w/o
c4rdiomyocyte destruction or myoc4rdi4l fibrosis
!. Often reversible w discontinu4tion of ther4py
$#. LEMS - 4ntibodies 4g4inst presyn4ptic c4lcium ch4nnels
!. Postexercise f4cilit4tion w 4 buildup of intr4cellul4r c4lcium w repetitive
stimuli
$$. Acute 4rthrop4thy in 4dults - symmetric poly4rthritis in interph4l4nge4l,
met4c4rp4l, knee 4nd 4nkle joints
$%. HUS <=> MAHA.
!. Would only see 4utoimmune w w4rm/cold 4gglutin4tion.
$&. X Ureter4l obstruction incre4ses hydrost4tic pressure proxim4l to
constriction. See tr4nsient pressure rise tr4nsmitted b4ck to Bowm4nʼs
sp4ce > decre4sed GFR
!. More pressure pushing up from Bowm4ns - stops stuff from filtering out
#. The GFR rem4ins decre4sed to 4 gre4ter extent th4n RPF > decre4sed FF
!. Efferent 4rteriol4r constriction (in response to reduced GFR)
decre4ses RPF
$'. GBS - enh4nced zone of hemolysis ok
$(. X kidney stones disrupt ureter4l epithelium > gross or microscopic hem4turi4
w presence of free RBCs
!. RBC morphology is norm4l
#. W ureterolithi4ssis - m4y not be 4ble to see the stones w ultr4sound but
c4n see ureter4l 4nd c4lyce4l dil4tion
$). Open 4ngle gl4ucom4 - incre4sed intr4ocul4r pressure w incre4sed
secretion or decre4sed outflow of humor
!. P4le optic disc 4nd enl4rged optic cup. Progressive loss of peripher4l
visu4l fields.
!. L4t4noprost - prost4gl4ndin th4t is converted to 4ctive form by
ester4se in the corne4. C4n c4use incre4sed pigment4tion.
$*. Acute 4dren4l insufficiency - 4dren4l crisis: Prednisone will down regul4te
ACTH 4nd CRTH production. Also would h4ve decre4sed cortisol post
surgery due to the down-regul4tion.
!. Cortisol levels do not rise in response to norm4l stress > glucocorticoid
deficiency.
%+. REVIEW LUNG STUFF? COPD p4thogenesis
!. Deets
!. Airflow obstruction: due to 4n4tomic n4rrowing (chronic bronchitis)
 #. Decre4sed lung el4sticity: destruction of inter2lveol2r w2lls
(emphysem2)
$. Reduced IRV > limited m4x tid4l volume.
%. Air c4n become tr4pped in the lungs w r4pid bre4thing > le4ds to
further reduction in tid4l volume > dyn4mic hyperinfl4tion
#. Other
!. PE - flow-volume curve rem4ins mostly norm4l
#. Atelect4sis, fibrosis, diffuse 4lveol4r hemorrh4ge (dilutes surf4ct4nt)
- restrictive
3/29-2

!. Reid index = Mucous/(submucosA + lAminA propriA)

!. Thickness of submucosAl glAnds to thickness of bronchiAl wAll between
epitheliAl BM And bronchiAl cArtilAge
#. Higher = more severe bronchitis
#. Bloom syndrome = helicAse dysfunction = chromosomAl instAbility, growth
retArdAtion, fAciAl AnomAlies, photosensitive rAsh, immunodeficiency
$. Body dysmorphic dz = preoccupAtion w >1 perceived physicAl defects.
Defects not observAble or AppeAr slight to others.
!. Repetitive behAviors like mirror checking
%. Progesterone inhibits prolActin
!. Deets
!. Secreted by corpus luted in first trimester
#. Second And third trimesters: produced by plAcentA
#. Other
!. B-hCG mAintAins corpus lute until plAcentA cAn tAke over estrogen
And progesterone synthesis
&. H bAnd = just myosin. StrAddles the M line.
!. I bAnd = just thin filAments. Anchor At the Z line.
'. X DelusionAl dz = >1 delusion for >1 month. Specific, FIXED belief.
!. Vs pArAnoid PD = overArching mistrust (like if the pt wAs distrustful of
mAny people)
(. In MG, over time, Antibody-mediAted blockAde of Active site of AChRs
prevents ACh from binding, triggers endocytosis of AChRs
!. Results in reduced numbers of AChRʼs
). AntimuscArinic = hot As A hAre, etc.
!. AntihistAmines Are ActuAlly inverse Agonists thAt stAbilize H1 receptor in
inActive stAte.
*. PhysiciAns Are not required to provide services if they Are AgAinst personAl
beliefs, but they Are obligAted to refer the pt to Another provider
!+. x Finite number of cArrier proteins. Once they Are All bound, no further
diffusion cAn occur until A cArrier protein is vAcAted
!. StrAight line = simple diffusion
#. Curved = cArrier mediAted protein
!!. WAxy cAsts thAt stAin w eosin = light chAin cAst nephropAthy
!. Light chAins precipitAte w TAmm-HorsfAll protein And form cAsts thAt
cAuse tubulAr obstruction And epitheliAl injury, leAding to impAired renAl
function
!#. Progressive hemAturiA And suprApubic tenderness After chemo - likely from
cyclophosphAmide, cAn be prevented w mesnA
!$. pyrAmidAl neurons of hippocAmpus Are dAmAged first by hypoxiA. CerebellAr
purknje cells And neocortex pyrAmidAl neurons Are Also very susceptible to
dAmAge if ischemiA lAsts 5-10 minutes.
!%. x Gp160 is glycosylAted. It is cleAved to gp120 And gp41 > mediAte fusion w
host cell.
!. Others
!. Reverse trAnscriptAse converts ssRNA to double-strAnded DNA >
then integrAted into host genome by integrAse
!&. TNF-A, IL-1 And IL-6 > systemic inflAmmAtory response in sepsis
!'. Deficient in vitAmin A > high rAtes of complicAtions from meAsles.
!. B6 deficiency cAn leAd to stomAtitis, cheliosis
#. Other
!. Since B3 synth requires pyrioxidine, I guess you could hAve issues w
B6 leAding to stomAtitis concurrently w B3 deficiency
!(. PAncreAtitis: duct obstruction leAds to stAsis of pAncreAtic secretions And
digestion of Adipose cells by lipAse.
!. Results in formAtion of fAtty Acids thAt bind cAlcium ions And precipitAtes
insoluble cAlcium sAlts.
!). X pAinless ulcer > I guess think syphilis. CAn Also cAuse bilAterAl enlArged
inguinAl lymph nodes
!. FAlse-negAtive serologic testing is common eArly on w syphillis
#. Other
!. L serovArs of chlAmydiA is ALSO AssociAted w pAinless ulcer, but this
dz is rAre in US. More common in tropicAl And subtropicAl regions
!*. X H flu - require V fActor (NAD +) - fAcilitAtes releAse of AdditionAl X fActor
from B hemolysis-induced erythrocyte lysis
!. H flu requires X (hemAtin) And V (NAD+) for growth
#+. InternAl cArotid > ophthAlmic Artery > centrAl retinAl Artery = RetinAl Artery
occlusion. PAinless, monoculAr vision loss
#!. MigrAine therApy
!. Deets
!. Abortive medicAtions: include ergotAmine!
#. PreventAtive: topirAmAte = AnticonvulsAnt thAt lessens frequency of
migrAines
##. AlbendAzole = first line for enterobiAsis; pyrAntel pAmoAte = preferred in
pregnAnt pAtients
#$. X TrAnsudAtive vs exudAtive
!. ExudAtive lesions: develop due to inflAmmAtion (infection, mAlignAncy,
rheumAtologic) => increAsed vAsculAr permeAbility
#. TrAnsudAtive: usuAlly heArt fAilure, cirrhosis, nephrotic syndrome
$. CAn be cAused by
!. IncreAsed pleurAl cApillAry hydrostAtic pressure
#. DecreAsed pleurAl spAce pressure
 $. Reduced lymphAtic drAinAge
%. IncreAsed vAsculAr membrAne permeAbility
#%. ReleAse of lysosomAl enzymes from ischemic neurons And inflAmm cells >
tissue degrAdAtion (liquefActive necrosis) in brAin
#&. Aortic stenosis
!. Deets
!. CAlcific degenerAtion of Aortic vAlve = most common cAuse of
vAlvulAr AS in developed countries
#. RheumAtic heArt diseAse is common cAuse of AS in developing
nAtions, cAused by fusion of vAlve commissures w repetitive
inflAmmAtion
#'. CAlcitriol = Active form of vitAmin D. Use this in pts w pArAthyroid dAmAge
by hypopArAthyroidism cAn leAd to inAdequAte production of cAlicitriol. Also
supplement w cAlcium.
!. Other
!. CincAlet = ActivAtes CASR in PTH glAnd > decreAsed PTH releAse
#. SevelAmer = binds phosphAte, decreAses Absorption, treAts
hyperphosphAtemiA
#(. Addisonʼs diseAse. MAin defect is in the AdrenAl, so exogenous ACTH will not
increAse cortisol. Loss of feedbAck increAsed ACTH And MSH, leAds to
hyperpigmentAtion.
!. Deets
!. DecreAsed Aldo > decreAsed NA > increAsed K+ > non-AG metAbolic
Acidosis w low bicArb.
#. CompensAtory Cl- retention to mAintAin electricAl neutrAlity of
extrAcellulAr fluid.
$. HyponAtremiA, hyperkAlemiA, hyperchloremiA, non-AG met Acidosis.
#. Other
!. PrimAry And secondAry deficiency = AdrenAl is functionAl so they
donʼt develop deficits.
#). Bullous impetigo: destruction of desmoglein 1 by exfoliAtive toxin
!. Other
!. Atopic dermAtitis = defective epidermAl bArrier And T cell
dysregulAtion
!. CAn Also leAd to lichenificAtion in A flexurAl distribution
#*. Antibiotics for septic Arthritis
$+. Crohnʼs: fistulAs cAn form between 2 AdjAcent loops of bowel, between
bowel And blAdder, or between bowel And skin of AbdominAl wAll
$!. HSP = see purpuric rAsh in 100% of pts. LeukocytoclAstic Angiitis in vessels
of dermis And GI trAct
!. UsuAlly self limiting, but cAn progress to ESRD
$#. Wound heAling
!. Deets
 !. InflAmmAtory phAse: neutrophils in 24 hours, mAcrophAges in 2-3
dAys
#. ProliferAtive: 3-5 dAys After injury
$. MAturAtion: fibrosis, stArts second week After injury
#. FibroblAst mAturAtion And proliferAtion Are controlled by multiple growth
fActors (PDGF And TGF-B)
$. Other
!. IL-17 : recruits neutrophils
#. IFN-B: AntivirAl, Also decreAses inflAmm cell movement Across BBB
$$. X Cushing - increAsed cortisol = zonA fAsciulAtA
!. Also hAs A trophic (growth) effect on fAsiculAtA And reticulAris
#. Other
!. ATII is the primAry trophic hormone for glomerulosA > increAsed Aldo
synth
#. ACTH does NOT stimulAte the medullA (production of
cAtecholAmines)
$%. X RAS > see hyAline Arteriosclerosis in the non-stenotic kidney. Exposed to
high BP And so would demonstrAte signs of hypertensive nephrosclerosis.
!. Other
!. The stenotic kidney would hAve tubules thAt Are crowded-looking due
to tubulAr Atrophy
$&. SCC of the esophAgus in the middle third, would see kerAtin peArls And
bridges, etc
$'. SmAll cell lung cAncer = highly mitotic figures, scAnt cytoplAsm, positive
stAin for chromogrAnin, neurAl cell Adhesion molecule, synAptophysin.
$(. X Review 'therosclerosis sketchy p'th?
!. Atherosclerosis. Thin-cAp fibroAtheromAs - chArActerized by necrotic
core w thin fibrous cAp. ActivAted mAcrophAges infiltrAte AtheromA,
contribute to breAkdown of EC mAtrix proteins by secreting
metAlloproteinAses.
!. Ongoing inflAmmAtion > destAbilizes mechAnicAl integrity of plAque w
metAlloproteinAse releAse > plAque rupture.
#. Other
!. HMG CoA reductAse doesnʼt hAve to do with this.
$). RRR = percent reduction between treAtment And control group.
$*. X Inferior epigAstric is 1 of 2 brAnches of externAl iliAc Artery, tAkes off
immedi'tely proxim'l to inguin'l lig'ment. Runs superiorly And mediAlly
up the Abdomen.
!. Other brAnch = deep circumflex: brAnches more lAterAlly And supplies
blood to lower AbdominAl wAll
%+. Low urine sodium And low FeNA, increAsed wAter reAbsorption = high urine
osmolArity.