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Id
174 Pharmacology Allergy & Immunology Loratidine is 2nd gen antihistamine and safe in elderly coz no fall problems
Hep B itself is not hepatotoxic but CD8+ repsonse to HBsAg and HBcAg will cause
375 Pathophysiology Allergy & Immunology
damage
Protein M is the main virulence of strep pyogenous as it inactivates phagocytosis,
723 Microbiology Allergy & Immunology complement activation and permit bacterial adherence. It is also the target of
humoral response to the infection Streptolysin O will lyse RBCs amd PMNs
Calcineurin activate IL2 which permit T cell proliferation. Hence the use of
1155 Immunology Allergy & Immunology
Calcineurin inhibitors in transplants
If a child has diphteria give antitoxin (passive immunization; most efficient), penicilin
1388 Microbiology Allergy & Immunology
or erythromycin and vaccine. Otherwise prevent with vaccine (active immunization)
Not all diphteria will cause pseudomembranous pharyngitis but need Tox gene to
1389 Microbiology Allergy & Immunology
produce its exptoxin AB
2068 Immunology Allergy & Immunology Tryptase is a specific marker for mast cells amd is useful in anaphylaxis
After IgE bind to receptors on Basophils and Mast cells these aggregate and cause
2069 Immunology Allergy & Immunology
degranulation of substances.
1175 Biostatistics Biostatistics & Epidemiology Absolute Risk Reduction= Event Rate % (A) - Event Rate % (B)
1183 Biostatistics Biostatistics & Epidemiology Mode is the most frequent value on statistics, it the least affected by outliers
When choosing two groups of same age and sex and race you are reducing the
1189 Biostatistics Biostatistics & Epidemiology chance of confounding bias. While selection bias occurs when you don't choose a
representative sample of the population
P value is called type I error: Probability that the difference ovserve is due to chance
alone. Type II error is measured with the power: Beta (probabiity of concluding that
1204 Biostatistics Biostatistics & Epidemiology
there is no difference when there is actually one) The power is 1 - Beta; meaning
that is the pobability of concluding that there is a difference when there is actually one
1274 Biostatistics Biostatistics & Epidemiology A result is considered legit if the 95% CI does not cross 0, so p value is less than 0.05
Validity (accuracy) is when a test gives very similar results than gold standard
Reliability refers to reproducibility of test (similar values all the time)
Effect modification is when smoking increases HRT risks of DVT compared to just
smoker, while HRT alone do not increase the risk of DVT
1282 Biostatistics Biostatistics & Epidemiology In skewed graphs the hill is the Mean, then the Median and uphill is the Mode
1286 Biostatistics Biostatistics & Epidemiology Lung cancer has been increasing a lot recently in women
95% CI that value is between X+/- Y Y is 1.96 (SD/rootsquare N) aka (SE) if it is as
99% CI it becomes 2.58 SE
Berkson's bias: The bias of choosing hospitalized patient in the study Hathorne effect
(observer effect): The tendency of subject to change their behavior as a result of
awareness that they are being studied Pygmalion effect: the effect of researcher's
belief on outcome
Ecological study are like cross sectional study, but in ecological study you want to
10570 Biostatistics Biostatistics & Epidemiology measure a certain geographical population habits or whatever. Used to make
hypotheses about populations
Transposition of Great Arteries is failite of Aorticoopulmonary spiral septum to
35 Embryology Cardiovascular System
undergo septation.
0-4 hr post mi the myocardium is normal on histology. 4-12: coagulation necrosis,
40 Pathology Cardiovascular System edema hemorrhage, wavy fibers 1-5 days neutrophils 5-10 macrophae 10-14
granulation tissue then scar with collagen
42 Pathophysiology Cardiovascular System Myocyte will stop contracting 1 min after total ischemia but it reversible until 30 mins
Hibernating myocardium refers to the presence of ledt ventricular systolic dysfunction
43 Pathology Cardiovascular System due to reduced coronary blood flow at rest that is partially or completely reversible by
coronary revascularisation
In dilated Myopathy (also in ischemic myopathy): Contractile function is decrease but
92 Pathology Cardiovascular System normal diastolic funciton (normal compliance) it is the opposite in HTN and
hypertrophic cardiomyopathy
96 Pathophysiology Cardiovascular System Constrictive pericarditis is chronic
136 Pharmacology Cardiovascular System NO will induce high cGMP which put myosin light chain in their inactive conformation
141 Pharmacology Cardiovascular System In HOCM we use bb ccb disopyramide and diuretics or dilators
142 Pharmacology Cardiovascular System Patients taking nitrates shld have a nitrate free period daily to avoid tolerance
Both cardiac and smooth muscles are activated starting with extracellular Ca2+,
144 Physiology Cardiovascular System
therefore CCB's work on them, unlike in skeletal muscles
Digoxin: AV block (parasympathetik) so helpful in Afib while in CAD its effect is helful
155 Pharmacology Cardiovascular System
coz of increase co tractolity ( DI goxi. So two functions)
160 Pharmacology Cardiovascular System Prevent NIACIN FLushing BY NSAIDS
LHF will cause RHF by congestion pulmonary veins leading to vasoconstriction of
198 Pathophysiology Cardiovascular System
pulmonary artey and intimal thickening with media hypertrophy
S3 is caused by increased preload and it can lead to functional mitral regurg that is
eliminted by preload reduction
Pulmonary HTN cause irreversible damage to pulmonary arteries while RV
hypertrophy can be reversible with correcting the HTN
PFO (failure of septum primum and secundum to fuse) and ASD (aplasia of either
202 Embryology Cardiovascular System septum secundum most commonly or septum primum) can both cause stroke from
venous clot but the difference is that PFO does not cause murmur.
IE: vegetations on valve cups along with degeneration Rhemuatic fever: fibrous
232 Pathology Cardiovascular System
thickening and distortion of mitral valve with commissural fusion at leaflet edges
240 Histology Cardiovascular System Aschoff bodies are seen in heart rheumatic fever
In tubes velocities: V1A1=V2A2=Cte (considering incompressible tubes, assuming
vessels are not compressible we can apply this rule)
296 Pathophysiology Cardiovascular System Metastatic calcification occurs in cell necrosis (like in old aortic valve)
Atheros plaques involve platelets (PDGF) macrophages that will promote migration
of smooth muscels
In mild HTN u get hyaline arteriosclerosis ( deposition in intima and media of vessels)
449 Pathology Cardiovascular System
In severe HTN u get onion like concentric thickening of the wall
474 Pathology Cardiovascular System In Varicose vein we morry most about skin ulceratio not DVT and stuff
Permissive effect of cortisol: (it permits others to work at their best) On its own it
551 Physiology Cardiovascular System doesnt do anything But increase sensitivity of vessels and bronchial tissues to
catecholamines and increase glucose response to Glucagon
679 Microbiology Cardiovascular System only Aureus is coagulase + among the Staphes
ACE inhibitor can cause hypotension in first doses therefore started gradually
(dosage)
778 Pharmacology Cardiovascular System Statins and fibrates have fucked up effects on muscles
898 Pharmacology Cardiovascular System In PSVT adenosine will cause chest burning and flushing
Amiodarone (class III K+ channel blocker of cardiac pacemaker cells so decrease
repolarization and increase AP so imcrease depo and repo time hence increase QT
899 Pharmacology Cardiovascular System but less associated with Torsades maybe coz of more homogeneous repolarization.
So eventhough Amiodarone is BAD it has a GOod Side of the Force. Adenosine
increase K+ conductance in AV and cause delay
Lidocine (IB) bind rapidly depolarizing cells (like cocaine is rapid). Ischemic heart is
depolarized, so Lidocaine likes it. SO LIDOCAINE IS GOOD IN MI
944 Pathophysiology Cardiovascular System MR is severed with volume overload so when have S3 u know MR is at its max
In exercise, tachycardia will reduce Diastolic time, so this is the limiting factor in Heart
perfusion
Viridans are acquired after dental procedure if have cardiac structural
abdnormaloties, and take glucose from out of cells and transform it into dextran to
1003 Microbiology Cardiovascular System integrate it into its polysaccharide cell wall, and also permits it to adhere to fibrin. So
Viridans adhere to fibrin and platelets that are deposited at site of endothelial trauma
in the valves and cause infection there.
Doxorubicin cause dose related dilated cardiomyopathy by creating free radicals..
Radiation cause myopathies by perocardial fibrosis (viral and surgery.)
1080 Pharmacology Cardiovascular System Cilostazol is used in PAD, reduce,atelt activation and cause vasodilation
Diphteria toxin (AB exotoxin) ribosylate and therefore inhibit EF-2, so will inhibit
1094 Microbiology Cardiovascular System
protein synthesis causing cell death
1118 Pharmacology Cardiovascular System ANP, BNP, NO --> increase cGMP --> relaxation of smooth muscle
1166 Pharmacology Cardiovascular System if have cough with ACE go for ARBs
When comparing the efficiency of a new drug mortality benifit over another standard
drug, the NNT (number to treat), represents the ammount of people needed to be
1174 Biostatistics Cardiovascular System
treated to prevent on event compared to standard drug: 1/ARR(2.5%(risk of deaths
of old drug)-1% (risk of death of new drug))
Arteriolar vasodilator like hydralazine and minoxidil will cause reflex tachycardia and
fluid retention
Dobutamine affects B1 and lesser B2 and A1. So increase HR and Contractility
hence increase Demand of O2
1444 Pharmacology Cardiovascular System FLAT CHAMP INCREASE cAMP
In fluid loss even if BP is low TPR is high due to Sympathetic activation. But Fluid
infusion will increase preload and increase End-Diastolic sarcomere length and will
1512 Physiology Cardiovascular System increase Volume status decreasing Sympathetik stimulation and decrease TPR
Remember SBP= CO.TPR, so in Hypovolemia CO is super low and even with
sympathtic compensation to increase TPR, SBP stays LOW
Cardiac electrical transmission speed: PAVA: Fastest --> Slowest: Purkinje fibers -->
Atrial muscles --> Ventricular muscles --> AV node
PSVT: Do Carotid massage (XI -> X), Valsalva or Adenosine and this will prolong AV
node refractory period
In mitral valve stenosis we have a snap (indicating that the stenosed valve is trying to
1517 Physiology Cardiovascular System open but is finding difficulties) then a dyastolic rumbling murmur because of turbulent
flow across this damaged valve.
At rest or exercise both systemic and pulmonary circulations have similar blood flows
since both systems are continuous and same amount of blood going from the LV is
going from the RV ( both systems differ in r and l of the equation but end up equal in
Q since they are continuous)
1529 Physiology Cardiovascular System CO= O2 consumption/ AV O2 difference
S3 sounds in people >40 is abnormal and indicate LV enlargement (MR, AR, Dilated
or Ischemic Cardiomyopathy). It is Increased in End of Expiration (LV fills more), Left
lateral Decubitus (Higher Flow in LV), and Heard with the Bell of Steth in Cardiac
Apex in Early Diastole. Amyl Nitrite (Vasodilation, Decrease Bp, Decrease Venous
return), Furosemide (Diuresis, lower LV Volume),Valsalva or Standing (lower V
return) all Decrease S3
In exercise PaO2 and PaCO2 do not change but CO and HR increase to
accomodate for tissue's demand PE --> Hyperventilation = Lower PaCO2
Flow (Q)= dP/R Remember U=R.I R= v.L/r4 Q=r4.(dP/v.L) So if flow decrease by X in
1621 Physiology Cardiovascular System a medium of same property this means that the radius is decreased by X root 4 But
Velocity relation is A1V1=A2V2 and has a r2 relatioship change with velocity
In the Cardiac output, Venous return curve its easy. If an event decreases venous
return like anaphylaxis for example lower the venous return curve. MI will lower the
Cardiac output curve maximum and slope. Anemia would higher it since we will have
tachycardia
In Heart PV curve, the lowest horizontal curve where heart receives blood, the slight
increase in P is preload whereas in the upper horizontal line which demonstrates
heart emptying, the slight increase in P is Afterload. Nitroprosside will decrease both
Preload and Afterload by Vasodilating Both Veins And Arteries.
Pulsus Paradoxus usually happens in Tamponade but can also happen in
Constrictive Pericarditis, Asthma COPD, or Hypovolemic Shock. In Tamponade,
1782 Physiology Cardiovascular System increased pericardial fluid will compress LV, and during Inspiration increased venous
return in RV will move InterVentricular Septum towards LV, making it even smaller,
thus a >10% decrease in SBP.
The Inferior wall of left Ventricle lies on the Diaphragm and is supplied by the
1871 Anatomy Cardiovascular System
Posterior descending artery (from RCA)
Prior to myochte relaxation Ca2+ leave cells through Ca2+ ATPases and Na+/Ca2+
exchange (3 to 1, and does not require ATP) Besides its action in Smooth Muscle
contraction, Calmodulin plays a role in Cardiac Ca2+ efflux, by binding Ca2+
ATPases and activating it.
Phentolamine is competetive alha blocker wheras phenoxybenzamine is a non
competitive irreversible antagonist
CCB's slow Diastolic depolarization of Pacemaker cells. (phase 0) they also decrease
intracellular Ca2+, affecting excitation-contraction of these cells, therefore
decreasing Contractility. But when question is about antiarrythmitic studies choose
the Antiarrythmic action of CCB's.
ACh and Adenosine reduce phase 4 of spontaneous depolarisation, in cardiac
pacemaker cells.
Desynchronization between P and QRS means 3rd degree AV Block. This means
Atria contract from SA node but the impulse does not make it to AV node on time
1976 Physiology Cardiovascular System most probably due to circuit abnormality, so AV node will take over to contract
ventricles and will get narrow QRS (since it supraventricular firing, so AV node will
filter the impulse sent)
Holosystolic murmur, that increase during inspiration is only tricuspid regurgitation
since the right heart will fill on inspiration. Left sided holosystolic murmurs and VSD
are not affected by inspiration since it does not increase left V load. Tricuspid
murmur: left sternal border, 3rd and 4th intercostal space Mitral murmur: Apex of
heart Aortic stenosis: Diamond shape (since aorta is most important and every old
person has diamonds)
2002 Pharmacology Cardiovascular System Thiazide increase GLUC Glucose, LDL, Uric Acid, Ca
The heart has the highest oxygen extraction rate. (6075%) During exercise only
increasing coronary flow by Vasodilation which is mediated by Adenosine and NO will
accommodate for the increase oxygen demand since extraction is already almost
maximal. A
Afib can be induce systemic illness (HTN, Geart failure, Hyperthyroid), Increased
Sympathetic tone and Excessive alcohol consumption. Get irregularly irregular fast
rythm with absent P waves and often Narrow QRS. on EKG. High QRS amplitude is
due to ventricular hypertrophy often due to HTN. Prolonged QT can be congenital
and associated with Torsades De Pointes and can also be dure to chronic alcohol
use (not one episode of bunge drinking, which can cause Afib)
Most common cause of aortic rupture in MVC is at the Aortic Isthmus; the site of
ligamentum arteriosum just dital to right subclavian
7640 Pharmacology Cardiovascular System Class III will increase QT, while digoxin will cause AV block
8711 Histology Cardiovascular System Thpe I Collagen is the most abundant overall and is the one we find in scars.
BNP (natriuretic peptide) is released in response to atrial and ventricular stretching
--> Natriuresis, Diuresis, Vasodilatory (antagonize vasoconstriction action of RAAS)
effect and protects against heart remodeling. BNP then inhibits RAAS system and
renin levels. Neprisylin metalloproteases, degrades BNP, bradykinins, oxytocin and
bradykinin. Neprisylin inhibitors are then good in Heart failure --> increase BNP and
in turn decrease Renin
In cardiac cath, when trying to reach the femoral artery, if cannulation is done above
11764 Anatomy Cardiovascular System the inguinal ligament you can induce RETROPERITONEAL HEMORRHAGE
(CARDIOLOGIST ARE SCARED OF THIS)
In right MI have stiffness of RV so increase CVP (backup of blood) but low RV output
so Low PCWP
In Afib clots form in left atrial appendage its a motionless part of the atria (ma ela
3aze)
876 Pathology Dermatology Dermatitis herpetiform usually appear at 40-50 Eczema can occur after some food
1061 Biochemistry Dermatology Zinc deficiency causes acrodermatitis enteropathica, infertility and Growth retardation
Apocrine glands secrete by cel lysis and content exretion like pimple glands
(sebacious and meibomian) Apocrine secrete membrane bound vesicles (breast)
1106 Anatomy Dermatology while Merocrine secrete via exocytosis like salivry, eccrine and apocrine sweat
glands (named this way coz thought to be apocrine in nature ) DA FUCK bass CV u
wont be confused
Vitiligo: loss of melanocyte (autoimmune pooly understood) in albinism have
1110 Pathology Dermatology melanocyte but cannot produce melanin (unlike vitiligo where melanocytes are
fucked up)
Leprosy is attacked by CD4+ Th1 cell mediated response (like other Mycobacterium)
1314 Pathology Dermatology
so skin lesions are due to IL2 and IFN Gamma
In Hartnup disease you have decrease Tryptophan absorption in guts and
1334 Biochemistry Dermatology
reabsorption in kidneys. So you will eventually have decreased niacin and pallegra
GVHD occur also with liver transplant because it is rich in lymphocytes and occurs a
1613 Immunology Dermatology week later (around), Acute and chronic rejection are usually Host vs Graft (also T cell
mediated)
Acyclovir valcyclovir gancyclovir and those are nucleoside analogues that require
both cellular and herpes kinases for conversion to their active nucleotide
1641 Pharmacology Dermatology
triphosphate form Cidofovir is a nucleoside monophosphate only require host cellular
kinase
Post auricular lymphadenopathy makes us more suspicious towards rubella rather
1669 Microbiology Dermatology
than measle
1725 Genetics Dermatology Androgenic alopecia have Polygenic Inheritance patterns
1937 Pathology Dermatology Lymhedema (like post mastectomy) increase risk of Angiosarcoma
2037 Biochemistry Dermatology In tRNA we have a CCA site where amino acids bind
Psoriasis is often treated with with topical vit D analogs; calcipotrieme that bind
8569 Pharmacology Dermatology
vitamin D recptor, inhibits keratinocytes proliferation and stimulate their differentiation
Accessory nipples are the most common congenital anomaly and fluctuate with
menstrual cycle, unlike nevi. On the other hand Neurofibroma are composed of
8904 Pathophysiology Dermatology
Shwann cells and neural fibroblasts and can sometimes retract to subcutaneous
tissue when pushed down.
11738 Pathology Dermatology TGF beta is responsible for fibroblast migration proliferation and CT synthesis
11852 Pathology Dermatology opioids, contrast, and vanco.. can trigger mast cell degranulation
Cleft lip: maxillary prominence fail to fuse with intermaxillary segment(below nasal
septum) Cleft palate: Failure of palatine shelves to fuse with one another or with
1740 Embryology Ear, Nose & Throat (ENT)
primary palate Occur in 5-6 week of embryo development. Cam occur together or in
isolation.
Cholesteatoas are collection of squamous cell debris that form behind tempanic
11628 Pathophysiology Ear, Nose & Throat (ENT) membrane, can be congenital or acquired following infection, trauma.. cause hearing
loss due to ossicle erosion
Psterior bleeding with sphenopalatine bleed is usually uncontrollable with bleed and
11783 Anatomy Ear, Nose & Throat (ENT)
occur with HTN
Fibric acids (gemfibrozil..) decrease triglyceride production while Cholestyramine
Endocrine, Diabetes &
163 Pharmacology (bile acid sequestrant) cause hypertriglyceride and gallstones ( cause decrease bile
Metabolism
acid reuptake so new cholesterol is put in bile u know..)
Endocrine, Diabetes & Gemfibrozil are the most efficient for triglyceride so the best in pancreatitis induced
166 Pharmacology
Metabolism by triglycerides
Endocrine, Diabetes & In addition to DERMATITIS of NIACIN Add GOUT (hyperuricemia; part of dermatitis
167 Pharmacology
Metabolism ;) )
209 Pharmacology GnRH agonist: at first act as GnRH but then in contrary coz not pulsatile
Metabolism
Sertoli cells secrete Inhibin B to feedback inhibit FSH. Leydig cells secrete Testos
that feedback inhibit LH. Sertoli cells also secrete Androgen binding proteins to bind
216 Physiology Testosterone and trap it there since it needs it for spermatogenesis. This is different
Metabolism
from Sex binding protein which let testosterone circulate in the blood and is produced
by liver
Acute hemorrhage into the pituitary (pituitary apoplexy) is usually aassociated with
Endocrine, Diabetes & Pituitary Adenoma Severe Headache, Cranial Nerve Involvement (bitemporal
225 Pathology
Metabolism hemianospia, ophtalmoplegia) and meningeal irritation. Cardiac Collapse is due to
adrenal insuficiency
Endocrine, Diabetes & Increase AFP (Dating error most commonly) Patau Gastroschisis, Omphalocele,
342 Embryology
Metabolism Neural tube defect, and Multiple gestation. Decreased levels in Trisomy 21, 18.
Endocrine, Diabetes & Pioglitazone and stuff work on PPAR gamma in fat so make u FAT not only by fat but
599 Pharmacology
Metabolism also by increasing Na absorption in Collecting Tubules
Cortisol produced in the cortex will pass through the veins that will go the medulla
602 Biochemistry and enhance the PNMT (phenylethanolamine N methytransferase) enzyme that
Metabolism
converts Norepi to Epi (Makes sense right)
603 Pharmacology Pioglitazone affect transcription factor and gene involvement so takes time
Metabolism
Gliflozin are SGLT2 inhibitors (sodium glucose cotransporter in PCT) cause
Endocrine, Diabetes & glucosuria so possible UTI and genital mycotic infection. Also cause osmotic diuresis.
604 Pharmacology
Metabolism In Pple with renal impairement, the meds will not work well and can have increase
adverse effects
605 Pharmacology PPAR gamma is a nuclear receptor affected by Pioglitazone and Rioglitazone ..
Metabolism
Endocrine, Diabetes & hyperPTH leads to Osteitis Fibrosa Cystica where we have subperiosteal eiosions
631 Pathophysiology
Metabolism affecting phallanges of hand, "salt and pepper" skull, and brown tumor bone cysts.
Endocrine, Diabetes & High dose of Iodine will inhibit iodine uptake by follicular cells (used if have
767 Pathophysiology
Metabolism radioactive iodine intoxication, T4 is not efficient coz it takes days to work)
du quervain: mixed cellular infiltrate with occasional multinuclear giant cells (post
769 Pathology URI) Hashimoto: lymphocytic infilitrate with germinal centers and Hurthle cells
Metabolism
surrounding residual follicles (large oxyphilic cells filled with granular cytoplasm)
TSH stimulate I-(Iodide) absorption (Na+I- symporter) in Follicular cells and is
competitively inhibited by Perchlorate and Pertechnetate, then goes in the colloid. I-
Endocrine, Diabetes & is converted to I2 (Iodine) in the colloid (catalysed by Peroxidase). Thyroglobulin is
770 Physiology
Metabolism synthesized in Follicules then go to colloid too, where its tyrosine residues bind to I2
(Peroxidase). MIT and DIT are phagocytosed in follicular cells then those who are
not deiodinated join and T3, T4 form and are released
Endocrine, Diabetes & Neural crest: PNS, Adrenal Medulla and Parafollicular pf thyroids (both are
771 Embryology
Metabolism chromaffin cells)
920 Pharmacology Glitazones PPAR GAMMA STUFF reduce insulin resistance
Metabolism
980 Biochemistry Remember Thiazide and HyperGLUC
Metabolism
Endocrine, Diabetes & 7-dehydrocholesterol -(UV)-> CholeCalciferol (D3) (1st step) then 25-OH in Liver
990 Physiology
Metabolism then 1-OH in Kidney
Steroid, Thyroid hormones, VitD: Intrareceptor with DNA domain (to alter DNA
expression when go in nucleus) Ligand-gated ion channels (Na+,K+,Ca2+,Cl-)
Endocrine, Diabetes & across membrane for membrane potential etc. Intrinsic Phosphorylation: Insulin and
992 Physiology
Metabolism Insulin like GF JAK STAT: GH, Prolactin, EPO Hypercalcemia Hypocalciuria (AD
since all family has it): Defective Ca2+ sensing G (THINK C, G LOOK ALIKE) proteins
coupled receptors in PT gland and kidney that regulate circulating Ca2+ levels.
Endocrine, Diabetes & Glucagon, beta adrenergic, PTH and TSH receptors work through Protein Kinase A
994 Biochemistry
Metabolism responsible for the G protein/ Adenylate cyclase secondary messenger system
Beta cells: Glucose enters pancreas through GLUT 2 transporter undergoes
glycolysis and produces ATP which will bind ATP-sensitive K+ channels (opened at
Endocrine, Diabetes & rest and maintains K+ efflux keeping cell hyperpolarized) and close them. This will
1009 Physiology
Metabolism depolarize cell, which will open Voltage-dependent Ca2+ channels, increasing Ca2+
intracellularly and inducing insulin release. If KATP channels do not respond to ATP
we will have DM. Sulfonylurea bind KATP, close them irrespectively of ATP
Endocrine, Diabetes & Glucokinase will control glucose entry in Glycolysis in pancreas and liver and hence
1010 Biochemistry
Metabolism stimulate insulin release. If non functional you can have DM predisposition
1012 Pathology DM I : Islet leukocytic infiltration DM II: Islet amyloid deposition
Metabolism
Endocrine, Diabetes & Smoking cessation is by far the most effective preventive intervention to avoid
1013 Biostatistics
Metabolism Cardiac events
gluconeogenesis requiring conversion of oxaloacetate to PEP uses GTP as a source
1022 Biochemistry of energy and this GTP comes from the conversion of Succinyl CoA to Succinate in
Metabolism
the Krab Cycle. COOL Hein
Endocrine, Diabetes & Fructose 2,6 biphosphate favors Insulin effect and decreasing conversion of
1031 Biochemistry
Metabolism pyruvate to Glucose ( decrease cAMP) in contrary to Glucagon
Endocrine, Diabetes & High Acetyl CoA level is the main Allosteric Actiator of Gluconeogenesis Increasing
1034 Biochemistry
Metabolism the activity of Pyruvate Carboxylase, Converting Pyruvate into Oxaloacetate
Endocrine, Diabetes & Panthothenic acid is B5 and is used to synthesize CoA used in TCA cycle especialy
1044 Biochemistry
Metabolism in first step reaction
Pentose phosphate reactions are all in Cytoplasm (coz only 5 carbona WTF) First
1119 Biochemistry step of Gluconeogenesis consisting of Puruvate to Pxaloacetate requires B1 and is in
Metabolism
Mitochondria
Endocrine, Diabetes & In Cushing we HyperPlasia of Zona Fasciculata (Not Hypertrophy) ... think that ure
1163 Pathophysiology
Metabolism producing an adenoma NON SENSE BUT STILL
1324 Pharmacology Alpha stimulation is dominant over beta thats why epinephrine decrease insulin
Metabolism
Endocrine, Diabetes & In DM, Infection, Pain and Sleep Deprivation can cause Hyperglycemia, while
1325 Physiology
Metabolism Exercise can induce Hypoglycemia.
Endocrine, Diabetes & Serine and threonine phosphorylation of insulin receptor lead to insulin resistanec
Metabolism (mediated by TNF alpha, catechols, steroids and glucagon)
Elevated free fatty acid levels contribute to insuline resistance (impair insulin
1328 Pathophysiology dependant glucose uptake and increase hepatic gluconeogenesis and insulin
Metabolism
secretion) and DM II
Glucose is transported in the D-Glucose form. Glut 4 is insulin mediated and
Endocrine, Diabetes & transports it into fat and muscle tissues whereas Glut 2 tranports Glucose from Liver,
1355 Physiology
Metabolism SI and Kidneys into blood circulation and helps regulates insulin secretion from
pancreas. Glut transport Glucose via Carrier-mediated transport (Active transport)
Insulin has no effect in Glucose reabsorption in kidneys, but Increase Na+ Renal
Absorption increasing blood volume and BP. Insulin also inhibits glucose release
1540 Physiology from liver, and Inhibits Glucagon secretion by directly acting on Alpha cells. It is
Metabolism
Anabolic (Glycogen, Protein Synthesis) and inhibits Glycogenolysis, Lipolysis and
other Catabolic reactions.
1615 Physiology Thyroid produce mainly T4, which is converted to T3 (active hormone) rT3 (inactive)
Metabolism
1660 Pathology RAT (activating mutation) in Men RAS is follicular thyroid
Metabolism
Insulin synthesis: Insulin translation starts in ribosomes to yield PreProInsulin. Then
translation continues in RER Ribosomes (the same ribosome translocates). In the
Endocrine, Diabetes & RER first the N terminal is cleaved giving Proinsulin then 3 disulfides bonds in the
1768 Physiology
Metabolism Insulin parts form. The ProInsulin is sent to the Golgi Apparatus and is cleaved by
endopeptidases, but both Insulin and C peptides are stored in granules and secreted
from Beta cells. But C peptide's half life is only 35 mins
Endocrine, Diabetes & In metabolic acidosis (E.g DKA) u hyperventilat but in DKA u have lung edema so u
Metabolism go in respiratory failure not only because of exhaustion
Endocrine, Diabetes & Severe hypoglycemia (patient not conscious so cannot swallow) so give Glucagon (if
1984 Pharmacology
Metabolism outsode hospital) and Sugar per IV (in Hospital)
Orotic acid converts to UMP, UDP --> TMP, CTP (pyrimidine). If the enzyme Orotate
2066 Biochemistry phosphorybosyl transferase is missing, you won't be able to convert orotic acid. But if
Metabolism
you supplement patient with Uridine you negatively feedback the reaction
2081 Pathology In CAH give Steroids to supress ACTH
Metabolism
8531 Pathology Sulfonylurea can cause Severe Hypoglycemia
Metabolism
11565 Pharmacology Sulfonylurea can cause Hypoglycemia
Metabolism
11634 Pharmacology Ezetemibe is like fenofibrate but decrease absorption of cholesterol, not bile acids
Metabolism
For ovulation induction you can use Menotropin (mimics FSH) then HCG (mimics LH,
Female Reproductive
207 Physiology same alpha subunit. Similar subunit with FSH too but not that much, and not the
System & Breast
point here)
Female Reproductive
258 Pathology PCOS have increased risk of endometrial ca and DM II
System & Breast
Female Reproductive Upon withdrawal of Progesterone, Endometrial cells undergo Apoptosis around 5
299 Physiology
System & Breast days later, causing Menses
Female Reproductive Koilocyte seen in HPV are cells with dense nucleus (pyknotic: dense DNA, as part of
1015 Histology
System & Breast apoptosis first step) and perinuclear halo clearing
Female Reproductive Comedocarcinoma (DCIS): solid sheet of pleomorphic, high grade cells with central
1057 Pathology
System & Breast necrosis
Granuloas cell tumor of ovary: Call Exner (cuboidal cells in rosette pattern with bean
Female Reproductive
1158 Pathology nuclei) and yellow theca cells with lipids Large unilateral adnexal mass with increase
System & Breast
Estrogen and inhibin
Herpes facial palsy is HSV 1 (oral not genital) HSV 2 resides in dorsal root ganglia in
Female Reproductive
1549 Pathophysiology sacral ganglia and be reactivated and give recurrent genital ulcer VZV also goes in
System & Breast
dosal root but in trigerminal ganglia
Theca interna: Cholesterol -(LH)-> progesterone + Androgen --> Granulosa
Female Reproductive (Aromatase): Androgen -(FSH)-> Estrogen. This actually explains why LH and
1560 Physiology
System & Breast Progesterone are not null during Follicular phase. Theca externa serve as supportive
connective structure.
Ovary is innervated by Ovarian artery, vein, lymphatic and nerves which are
Female Reproductive
1632 Anatomy contained in suspensory ligament as the suspensory ligament hold the ovaries in
System & Breast
suspension in the abdomen
Pudendal block is sometimes use if epidural was not used. It is intravaginal medial to
Female Reproductive
1739 Anatomy ischial spine and will num the perineum the genitals, and motor og urthra sphincter
System & Breast
and external anal sphincter (S2-S4)
Female Reproductive In contrast to Androgen insensitive patient those with Vagina agenesis (upper vagina
1809 Embryology
System & Breast and sometimes uterus, it's Mullerian defect) ave Pubic hair etc.
Female Reproductive
1831 Embryology Bicornuate nucleus: Incomplete lateral fusion of paramesonephroc duct
System & Breast
Anovulation is common in first years of menarche (Immature axis, so follicle does not
become corpus luteum) and last years before menopause, it manifests with
Female Reproductive menstrual variability, spots Complex atypical endometrial hyperplasia occurs with
1899 Physiology
System & Breast prolonged unopposed estrogen, it can happen with chronic anovulatory cycles
(where you only have estrogen without progesterone), HRT without progesterone or
Obese old women. Atrophic endometrium occurs in menopause (also get spotting
Female Reproductive
2056 Pathology Ovary is cuboidal cells
System & Breast
Female Reproductive Turner's have abnormal ovary but normal Uterus so can get pregnant with donation
8556 Genetics
System & Breast etc.
Female Reproductive Ureter injury will cause leakage of urine irritating the bowel causing ileus, flank pain
11781 Anatomy
System & Breast and fever but no urinary incontinence
Female Reproductive KOH is used to diagnose gardenella While trichonoma protozoa with flagella are
11802 Microbiology
System & Breast seen on wet mount
Internal urinary sphincter are parasympathetic innervation while external one ( distal)
Female Reproductive
11820 Anatomy is pudendal voluntary Kegel exercice target levator ani ( think of how u contract ur
System & Breast
perineum)
47 Microbiology Gastrointestinal & Nutrition hep B give hep D a capsule giving it its virulence and ability to invade hepatocyte
Aflatoxin G->T mutation in p53, increasing risk of HCC. Found in grains corns
57 Pathology Gastrointestinal & Nutrition
soybeans peanuts where fungi are grown
62 Microbiology Gastrointestinal & Nutrition Liver abscess can be caused by Staph throgh hematogenous route MESH GHALAT
In infections Beta glucoronidase are released by hepatocytes and unconjugate
70 Biochemistry Gastrointestinal & Nutrition
conjugated bilirubin causing it to precipitate and causing brown stones
cholesterol makes bile less soluble while bile salts and phosphatidylcholine makes it
78 Pathophysiology Gastrointestinal & Nutrition
more soluble
Acid secretion: 3 phases Cephalic: Vagal and cholinergic: stimulated by thought,
sight, smell and taste of food Gastric phase: Chemicals in food and gastric distention;
Gastrin-->Histamine (Enterochromafin like cells; ECL) --> Acid secretion Intestinal
126 Physiology Gastrointestinal & Nutrition
phase: proteins in Ileum and Colon will produce Peptide YY which will bind to ECL
and inhibit gastrin stimulated histamine release from these cells When acid is
secreted Bicarb and Cl- decrease in circulation (predictable)
133 Pathophysiology Gastrointestinal & Nutrition Can diagnose Lactase deficiency by decreased pH of stool
Statins decrese cholesterol formation SURE, BUT BUTTT cholestyramine will bind
165 Pharmacology Gastrointestinal & Nutrition bile acids and cause increase excretion so liver will produce more cholesterol to
throw in bile
280 Pathology Gastrointestinal & Nutrition Esophageal spasm is due to imparied neural inhibition within the myenteric plexus
290 Pathology Gastrointestinal & Nutrition Erosion does not cross Muscularis Mucosa While Ulcer Do Cross it
Mastocytosis will increase Histamine and cause Gastric Hypersecretion (EZ)
(Associated with KIT receptor Tyrosine Kinase Mutation)
Duodenal atresia is due to recanalization failure while Jejunal/Ileal atresia is due to
319 Embryology Gastrointestinal & Nutrition
vascular injuries
Imperforate anus, is most commonly associated with urogenital abnormalities
320 Embryology Gastrointestinal & Nutrition (fistulas and stuff). Then you think of VACTREL Vertebral, Anus, Cardiac, TE,
Eosophageal atresia, Renal, Limbs
Meckels diverticulum is part of vitelline (omphalocele) duct remnant (in embryo
connects midgut to yolk sac but obliterated in 7th week) If not obliterate it can cause
vitelline diverticulum where meconium passe through it into the umilibcal cord, or we
can just have a band or a cyst.
Meckels diverticulum is a true one and is composed of all layers; mucosa,
submucosa and muscular layers
Inhaled halothane can cause fulminant hepatitis (looks like viral hep) and will have
369 Pathophysiology Gastrointestinal & Nutrition high ALT AST, and decrease hepatic function so failure so prolonged PT and stuff
but no hepatic HTN
Alcohol inhibits Free FA Oxidation and Gluconeogenesis coz have INCREASED
NADH
Children <6 yrs usually get asymptomatic Hep A. They don't get anti IgM antibody
373 Immunology Gastrointestinal & Nutrition
since no disease
374 Microbiology Gastrointestinal & Nutrition Hel B is a ds DNA but replicate via reverse transcription (+RNA template)
406 Pathology Gastrointestinal & Nutrition Crohn Th1 (terminal ileum) UC Th2
407 Pathology Gastrointestinal & Nutrition in UC the rectum is always involved
410 Pathology Gastrointestinal & Nutrition Toxic megacolon is UC is diagnosed by Xray
Crohn, ileum involvement, bile acid will not be reabsorbed so bile will have less bile
acids and will be more cholesterolous hence gallstones
Traction Diverticula is True Diverticula and due to inflammation and stuff While
415 Pathology Gastrointestinal & Nutrition pulsion Diverticula is False (like sigmoidal Diverticula) Outpouching of the mucosa
and submucosa through the muscularis
431 Pathology Gastrointestinal & Nutrition Polyp were shown to be involved with COX2, thats why we give aspirin for colon CA
Tenesmus is seen in rectal adenoCA not colon righ colon: occult bleed iron
deficiency Left colon: obstruction and often hematochezia
Pancreatic pseudocyst wall is not lined by epithelium but by granulation and fibrous
tissues Serous cyst have glycogen rich cuboidal cells epithelium Mucinous cysts
habe columnar mucinous epithelium Atypical papillary projections are seen in
AdenoCa
Pancreas Embryology: Dorsal bud Tail, Neck most of Body, Accessory Duct Ventral
bud: Uncinate, Inferior Posterior Moreover, Inferoposterior aspect of Head and Major
Duct In Pancreatic Divisum (5% of population) the two buds fail to fuse fiving two
seperate ducts with independant drainage. Ventral duct (will be smaller) drain into
major papillae, Dorsal duct (major) drain into smaller papillae. Cery rarely this can
cause chronic Pancreatitis
Ig's attach Phagocytic cells through Fc portions and attach Complements through
hinge portion
589 Immunology Gastrointestinal & Nutrition Secretory IgA come in a dimer form where both Fc portions are attached by a J chain
Cells with decreased MHC1 expression like virus infected cells and tumor cells, are
targeted by NK cells to kills them
755 Biochemistry Gastrointestinal & Nutrition 1g of Proteins and Carbs produces 4 Calories while 1 g of Fat produces 9 Calories
The MAP kimase pathway (including Growth hormone) uses Ras protein and GTP
(active) and GDP (inactove)
Arsenic is found in insecticides, contaminated water and cause abd pain,vomiting,
841 Pharmacology Gastrointestinal & Nutrition
diarrhea, hypotension and garlic odor breath. Treat with DIMERCARPOL
1018 Physiology Gastrointestinal & Nutrition Fat is absorbed in Jejunem, While B12 and Bile salts are absorbed in Ileum
Shiga toxin (shiga like also) inactivates 60s ribosome by removing adenine from
rRNA, and inhibit protein synthesis in colon mucosa and renal endothelial (EHEC:
1100 Microbiology Gastrointestinal & Nutrition only e coli that does not produce glucuronidase and does not ferment sorbitol) While
ETEC and Yersinia enterotoxin increase cellular cGMP leading to diarrhea Only
enteroinvasive EIEC invade mucosa hence the I
1136 Microbiology Gastrointestinal & Nutrition Shigella need 10-500 bacteria to infect Very BadAss
1156 Pharmacology Gastrointestinal & Nutrition Iron poisoning will cause diarrhea while lead will cause constipation
NPV and PPV depend on disease prevalence irrespectively of test sensitivity and
1169 Biostatistics Gastrointestinal & Nutrition
specifictiy
Trypsinogen is converted to Trypsin in duodenal of epithelium and in turn activates
other digestion proteins
1258 Pharmacology Gastrointestinal & Nutrition Morphine cause smooth muscle contraction in sphincter of Oddi
Diphenoxylate (opioid and act on mu receptors ) given with diarrhea, but is given with
1290 Pharmacology Gastrointestinal & Nutrition
atropine to produce bad effects and discourage abuse and tolerance
Pseudomembranous colitis (C diff): White/yellow plaques membrane like on colono
1396 Pathology Gastrointestinal & Nutrition composed of fibrin and inflamatorry Undercooked meat: cysticercosis : Seizures, SC
nodules, IM calcifications
C diff toxins A: intestinal inflamation and fluid secretion B: Cytotoxic (affect actin
1397 Microbiology Gastrointestinal & Nutrition
cytoskeletal structures an intracellular signaling)
1398 Microbiology Gastrointestinal & Nutrition Clostridium mostly attack people with disturbed GI microbiome
Sabin (oral polio vaccine) has better IgA activity than Salk doing a better job at
mucosal entries
1525 Anatomy Gastrointestinal & Nutrition Air in Biliary tree means GB, SB fistula for STEP 1
Unlike other parasites, Giardia is all about IgA defense and not eosinophils (involved
in Helminthic infections)
Riboflavin B2 is used in TCA cycle by transforming Succinate to ketoglutarate
1807 Biochemistry Gastrointestinal & Nutrition forming FADH2 while the reaction before of Succinyl CoA to Succinate forms 1 GTP
used in Gluconeogenesis
Viral Hepatitis: hepatocyte necrosis (cellular swelling and cytoplasmic emptying
cused by loss of ATP and loss filament in the meshwork) and apoptosis ( in
apoptosis there cellular shrinking with nuclear fragmentation and esoniphilia
(Councilman body)with moninuclear infiltration
Atrophic Gastritis Affect the Body of stomach while H pylori zffects the Antrum first
then the Body
Viral Hepatitis cause Apoptotic Hepatocytites so get round acidophilic Councilman
BODIES (eosinophilic ) also seen in Yellow fever
Motilin is produced by Duodenal mucosa ans stimulates Smooth Muscle contraction
in Upper GI. erythromycin acts as a Motilin Agonist, causing Diarrhea. Ghrelin
(Hunger): Increase in Fasting, Decrease after Eating. Glucagonoma: DM, NEC
1938 Physiology Gastrointestinal & Nutrition
VIPoma (Pancreatic Islet Gumor): increase Cl- loss in stools, and excess H2O, Na+
and K+ follow, leading to Diarrhea. It also inhibits Gastric acid secretion. treated with
Somatostatin Gastrin: acid secretion and growth of gastric mucosa
Secretin, secreted by Duodenal S-cells in response to H+ in the duodenum, will
1971 Physiology Gastrointestinal & Nutrition stimulate Bicarb secretion from pancreas. On the other ither hand, pancretic
enzymes are secreted following Vagal and CCK stimulus (like Gallbladder)
Linkage disequilibrium is when the frequency of alleles independently do not match
8283 Genetics Gastrointestinal & Nutrition
the frequency of having both alleles at the same time
In hepatic encephalopathy, excess ammonia will deplete alpha ketoglutarate, and
glutamate to convnert them into glutamine. Glutamine is bad for the cells and
accumulated, glutamate which is excitatory is no longer here, and alpha keto which is
needed for respiration is depleted too. Do the math.
10401 Microbiology Gastrointestinal & Nutrition Fidaxomicin is used in resistant C diff
The portal triad (Hepatic artery, portal vein and CBD ) run through the
10583 Anatomy Gastrointestinal & Nutrition hepatoduodenal ligament so if there is bleeding we clamp the ligament to rule in or
rule out any other cause of bleed
In gerd Dysphagia is more consistent with ulceration while dysphagia and obsturction
goes more with strictures
Behavioral As a physician be RADICALLY AGAINST Herbal products especially if you are sure
11629 Gastrointestinal & Nutrition
science they are bad
Pudendal nerve which (S2-S4) which numbs the perineumand genitals also numbs
area when want to do external Hemorrhoids removal (Gives inferior rectal nerve).
11771 Anatomy Gastrointestinal & Nutrition
Internal Hemorrhoids are innervated by Autonomic Inferior Hypogastric Plexus and
do not sense pain or temperature.
11782 Anatomy Gastrointestinal & Nutrition The appendix is best identified by the converence of the 3 Taeniae Coli of the colon
Chronic pancreatitis can cause splenic vein thrombosis causing short gastric vein
11795 Anatomy Gastrointestinal & Nutrition
varicoses (Dr levi style)
11860 Pathophysiology Gastrointestinal & Nutrition Bacteria in guts produce not only Vit K but also Folate
Free ribosome translation destination: Cytosol, Nucleosol, Mitochondria ( nuclear
proteins) and Peroxisome ( involve in anabolism and catabolism of fat (very long
757 Physiology General Principles
chain FA) and also produce bile) RER destination: Membrane (cell membrane,
nuclear membrane), ER, Golgi, Lysosome --> Prepare to go out of cells
During exercice the Ca2+ release in muscles will also activate glycogen pathway and
1028 Biochemistry General Principles glycogenolysis hence the parallel association between muscle contraction and
gycogenolysis
Rota and influenza like genetic shift through reassortment thats why they are
1469 Genetics General Principles common and need to vaccinate many times (more efficient virulence than genetic
drift: pt mutation) Shift is Sudden wheras Drift is graDual (less killer machine)
B6 is involved in transamination reaction where an amino group from an amino acid
1482 Biochemistry General Principles goes to an alpha ketoacid making it an amino acid. B6 is involved in decaboxylation
reaction
Circuit in Parallel: 1/Rt = 1/R1 + 1/R2 + 1/R3 (Think how circulation in the body which
1616 Physiology General Principles
is mainly in Parallel wants to be efficient) In series: Rt = R1 + R2 + R3
1712 Pharmacology General Principles Isoniazid metabolism by acetylation so we have fast and slow acetylators.
1714 Pharmacology General Principles T1/2:0.7xVd/Cl
1715 Pharmacology General Principles Lipophilic deug prefer liver exretion Mante2
1728 Genetics General Principles Lesh nyhan is X linked recessive while Galactosemia is AR
Thayer and Martin are selective and only ahve sex together but culture neisseria
1912 Microbiology General Principles
BADDEEE
1970 Genetics General Principles Pleiotropy = One mutation and many many consequences
Enhancers/Repressors can be anywhere in relation to the gene involved, while
2025 Genetics General Principles
promoter are 25-70 base pair upstream to start of gene
2029 Genetics General Principles Stop codon UAA UAG UGA are recognised by Realeasing Factor 1
TATA box is a promotor (25 bases upstream) that bind to transcription factor and
2030 Genetics General Principles RNA polymerase II (in Eukaryote, binding RNA polymerase alone is not enough) for
transcription initiation.CAAt box is also a promotor but 85 bases upstream
2031 Genetics General Principles N myc is a transcription factor and bind DNA
Postranscriptional modification: (occur in nucleus) 5' capping Poly A tail (3' end):
when AAUUAAA (transcribed from DNA) is detected the cap is added (cap is not
transcribed from DNA), protects mRNA from degradation in chtoplasm Splicing:
Introns removal
Methylation of Cytosine in DNA is implicated in gene silencing and hence in
Imprinting of disease ( why silent in mom not in kids for ex)
11514 Pathology General Principles Hand Hygiene is best way to prevent hospital infections
Ubiquitin proteasome pathway: ubiquitin tag bad particles (like viral particles),
11674 Immunology General Principles proteasomes come degrade them then they a presented on cell surface bound to
MHCI for presentation to cytotoxic CD8 cells
Behavioral Preventable adverse event is defined as injury to a patient due to failure to follow
11847 General Principles
science evidence based test practice guidelines
Hep C (RNA virus) lacks reverse transcriptase and does not integrate into genome
58 Pathology Hematology & Oncology
ulnike DNA Hep B that do integrate
VWF --> GP Ib (Bernard) --> GP IIb-IIIa (Glanzman). If you add ristocetin you will
activate GP Ib receptors on platelets and make it available for vWF binding. If still no
346 Biochemistry Hematology & Oncology
response then vWF vs GP Ib. If normal plasma is added and still no reponse to
ristocetin it is Bernard (coz vWF is contained in normal plasma)
465 Pathology Hematology & Oncology Factor V is when factor V is resistent to protein C deactivation
Wiskott Aldrich is triad of Eczema, Thrombocytopenia (both appear early) and B, T
537 Immunology Hematology & Oncology
cells immunodeficiency appearing at 6-12 months.
C1 binds to IgG and IgM (Pentameric, so binds better) to activate complement
system, at the hinge point of the heavy chain
559 Immunology Hematology & Oncology Immature T lymphocytes in Thymus cortex, express both CD4 and CD8
614 Pathology Hematology & Oncology Glioblastoma: Necrosis and vascular proliferation
Hpecidin, secreted by liver will decrease intestinal Iron rate absorption. It is increased
787 Physiology Hematology & Oncology in Inflammation, and high iron levels. It is decreased in hypoxia and erythropoeisis.
Low Hepcidin, increase intestinal absorption and release from Macrophage.
RBC dont do oxidative phosphorylation since they dont have ATP, and they dont
even produce enough ATP in Glycolysis coz they sacrifice 1,3 BPG (which usually
gives ATP by turning into 3-phosphoglycerate), by turning it into 2,3 BPG (LOGICAL
YA?)
NADPH can be synthesised through the oxidative pathway of HMP shunt but can
1035 Biochemistry Hematology & Oncology also be formed from the non oxidative pathway through Transketolase and
Transaldolase from Fructose6P instead of G6P
1039 Pathology Hematology & Oncology TNF alpha cause cachexia
Heparin attaches on AT III and and enhances its activity by inhibiting Xa and
1077 Pharmacology Hematology & Oncology
thrombin, LMWH IS MORE SPECIFIC FOR Xa
In HbS valine take the place of glutamate in 6th position of the beta chain causing
new hydrophobic interactions hence sickling
Opioids has many sode effects like constipation nausea vomiting.. But build
1257 Pharmacology Hematology & Oncology to,erance to all and dont get side ffects anymore except for CONSTIPATION AND
MIOSIS
In acute porphyria, you can give heme which will inhibit ALAminuvic acid synthetase
and decrease accumulation of D ALA and porphorynohenc
1403 Genetics Hematology & Oncology AML M3 (15:17), and Retinoic acid receptor are malfounctional
1405 Pathology Hematology & Oncology AML (15-17t): Auer rods
In CN poisoining: (bind cytochrome a-a3) Nitrites bind Fe2+ --> Fe3+ (higher affinity
to CN and prevent its release to mitochondria) Another Antidote is Sodium
Thiosulfate which combines with CN forming Thiocyanate which is less toxic and
excreted in urine
In RBC, Heme is produced in Mitochondria firs 3 reactions, then cytosol. So when
RBC mature and lose their mitochondria, u cannot synthesize anymore heme
RBC cannot produce heme coz they dnt have Mitonchondria responsible for first and
last step of production
Radiation therapy works through breaking Double Strand DNA, and creating free
1474 Genetics Hematology & Oncology
radicals too
1476 Biochemistry Hematology & Oncology Thymidine dimers are usually corrected by endonucleases
I know its weird but Aplastic Crisis affect only RBC while Aplastic Anemia affects all
1496 Microbiology Hematology & Oncology
lines
CO poising will increase Carboxyhemoglobin (CO bound Hemoglobin) but does not
affect PaO2 since it competes with O2 in Hemoglobin not in plasma. It will not affect
1545 Physiology Hematology & Oncology Methemoglobin (Iron oxidized to Fe3+ due to Dapsone, Nitrite, Enzyme deficiencies
or Hemoglobinopathies) . CO poisoning will cause a Left Shift (Decreased O2
tendency to unload)
1614 Immunology Hematology & Oncology Isotype sworching occurs in germinal centers of LN
Ganciclovir can cause NEUTROPENIA. its effect increase with TMP SMX or
ZiDoVuDine coz also can cause BM supression
Patients who receive more than 5L/24 hrs of PRBC will have high levels of Citrate
1654 Physiology Hematology & Oncology (used to store blood), which in turn chelates Ca2+ and Mg2+, lowering their blood
level, causing parastheisa
1683 Immunology Hematology & Oncology Rhogam is an IgG antibody
Rb is active HypoPhosphorylated (its in kidss so we dont like much phosphorylation,,,
)
In Dysplasia there is reversible change in epithelial. Once the dysplastic cells have
breached the basement membrane it os no longer reversible
Lymphocyte bnign vs malignant: Monoclona T cell vs Polyclonal in infection (makes
sense)
bcl2 (oncogene on chromo 18) It inhibits apoptosis of tumor cells and facilitates
neoplastic growth.. In follicular lymphoma (B cell tumor) bcl-2 goes to ch 14 and is
1758 Pathology Hematology & Oncology over4 expressed RAS: component of MAP kinase path, transmits signals from cell
surface to nucleus (pancreatic, GB, colon, endometrium, thyroid ,lung cancers) DNA
mismatch repair: in Lynch syndrome (colon and stuff)
Pure red Cell aplasia is seen in : Thymoma, Lymphocytic Leukemia, and Parvovirus
B19 infection
1788 Genetics Hematology & Oncology Hemophilia is X-recessive
Erythropetein have bluish cytoplasm reticular precipitates of rRNA and is larger (also
lacks a nucleus)
Mosto Carcinogens enter body as inactive but P450 (monooxygenase) make them
so, and it depends on this system to determine succeptibility of individual
MDD1 code for a P glycoprotein a transmembrane ATP dependant efflux pump that
1819 Pharmacology Hematology & Oncology increase efflux of drugs and decrease influx of these chemo agents making the cells
resistant to chemo
1847 Biochemistry Hematology & Oncology Folate i s needed for Thymidine formation
Aplastic anemia (Thrombocytopenia, Anemia, and absent hematopoietic cell in
marrow) will have BM with fat infiltrate
Integrin bind cells to basement membrane by attaching it to FIBRONECTIN,
COLLAGEN, And LAMININin Extracelullar matrix
VEGF and Fibroblast Growth factor cause angiogenesis while epidermal growth
factor affect mitogenesis of hepatocytes and fibroblasts
1877 Pathology Hematology & Oncology Peau dorange is due to lymphatic obstruction
6-MP -(HGPRT)-> Active Metabolites 6-MP -(Xanthine Oxidase)-> Inactive
Metabolites (that why allopurinol will increase dose of 6-MP)
1911 Genetics Hematology & Oncology Follicular lymphoma 14:18 translocation causes Bcl2 overexpression
2018 Pharmacology Hematology & Oncology ETOPOS(second)ide block TOPOisomerase Second (II)
Thalassemia intermedia is associated with a muation three bases upstream from the
start codon (AUG) exchanging a puring with a pyrimidine
Thrombin II inhibtors will affect TT (throbin time) also PT PTT Xa inhibitor will affect
2133 Pathophysiology Hematology & Oncology both in theory (in practice PT is barely affected coz of heparin neutralizer in the PT
reagent)
In EBV you get atypical CD8 T cells in circulation (large with eccentric nucleus) to
attack B cells infected (you also get atypical B cells but in much smaller proportion)
8276 Biochemistry Hematology & Oncology In Alternative Splicing, same gene will give different mRNA in different tissues
8371 Pharmacology Hematology & Oncology ralTEGRAvir: Inhibits HIV inTEGRAse, so that its DNA will no be well incorporated
11728 Pharmacology Hematology & Oncology In chemo induced nausea inhibiting Neurokunin is good too (Tfayli's talk)
11750 Pathology Hematology & Oncology Hairy cell leukemia will cause marrow fibrosis
11754 Pathology Hematology & Oncology Sclerotic means osteoblastic
11816 Biochemistry Hematology & Oncology Lead: ALA D, Ferrochelatase are affected B6: ALA S is affected
Hep C envelope changes a lot coz its RNa dependant RNA polymerase has no
44 Microbiology Infectious Diseases
proofreading 3"-->5" exonuclease activity
Hep B acquired by the fetus (transplacentally) or at birth (more commonly) is very
common if mom is HbeAg positive. They have very high replication rate and higher
rate of progression to chronic disease (the younger the higher the risk). On the other
hand they are rarely symptomatik and have mildly elevated LFTs
Local Candida is controlled by T cell (seen in HIV) wheras disseminated Candida is
112 Immunology Infectious Diseases
controlled by neutrophils (seen in neutropenic)
376 Microbiology Infectious Diseases Atypical lymphocytes can be seen in Hep B, EBV and CMV and are non specific..
390 Pathology Infectious Diseases in 95% of pple hem B will resolve after acute attack
Aspiration pneumonitis is like aspiration pneumonia but resolves on its own and
532 Microbiology Infectious Diseases occur few hours after aspiration not days like pneumonia. Occurs by aspiration of
oral anaerobes not gastric!!!!
676 Immunology Infectious Diseases In TSST-1, the toxins which are superantigens activate T cells and Macrophage
819 Pharmacology Infectious Diseases Protease inhibitors navir cause metabolic stuff
822 Pathophysiology Infectious Diseases Hep B are associated with HCC coz of the integration of DNA into host genome
H. flu are blood loving, but needs factor X and NAD+ for growth. So wont grow on
sheep blood agar unless cultured with Staph that will povide her with NAD+
Oxidase + comma shaped bacteria: cholera: grow in alkaline (so PPI or decrease
977 Microbiology Infectious Diseases acidity will promote its proliferation) pylori: In acidic coz produce urease Campylo: in
42 degree They are all special
1091 Pharmacology Infectious Diseases In Tazocin, Tazobactam role is to decrease Piperacilin destruction (like Carbidopa)
Hib, in young children cause: MEningitis, pneumonia, bacteremia and epiglotitis (BIG
SHIT) While Sinusitis and OM are caused By NON TYPABLE H. flu
Salmonella Vi antigen (its virulence factor) makes it resistant to opsonization and
phagocytosis
Mycolic acid in Mycobacterium cell wall, is part of its virulence will make it acid fast as
in when then dye is given the bacteria will stain red on carbolfushin and is resistant to
decoloration when acid-alcohol decolorizing agent are given because of proper cell
wall. When Isoniazid is given it inhibits mycolic acid synthesis, so the bacteria will
lose its acid fast property and decolorize KatG (bacterial peroxidase) will tranform
INH to its active element.
Listeria (food borne) frows well on cold tpragure and can contaminate refregirated
food. It is a gram + with tumbling motility
1393 Pharmacology Infectious Diseases Losteria is nod responsive to ceftriaxone so also give ampicillin
the Herepsviruses family get their membrane from nuclear membrane of cells (unlike
the rest, get it for cell membrane.. NICE StufF)
IFN alpha and beta are secreted in response to viral particles and decrease their
protein synthesis capacity and replication, promoting apoptosis
In primary herpes, a week course of acyclovir will reduce the disease but not prevent
1550 Microbiology Infectious Diseases recurrence (latent in sacral ganglia S2 S3 S4). On the other hand prophylaxis daily
valacyclovir will do the job
1551 Pharmacology Infectious Diseases Acyclovir (nucleoside analogs) coz like Adenosine
1593 Microbiology Infectious Diseases CMV is EBV with (-) heterophile test (as in fail to agglutinate horse erythrocyte)
1645 Pharmacology Infectious Diseases Acyclovir and ovirs are to be phosphorylated to become in their active forms
In Influenza it is Antibodies against Hemaglutinin that primary protects against
infection
1670 Microbiology Infectious Diseases The 3 C's of measle + fever are prodromal to the rash
Primaquine is given to kill liver stage malaria hypnozoite and thus preventing relapse.
1965 Pharmacology Infectious Diseases
Malaria consists of fever and sweating in a 48 h cycle
2110 Pharmacology Infectious Diseases Penicilln and Ceohalosporins bind to cell membrane proteins such as transpeptidase
Cephalosporins resitance mechanis, by changing in penicilin binding protein
structure ( some of the protein remain normal so still have some binding) whereas in
2111 Pharmacology Infectious Diseases
beta lactamase in case of penicillin there is no binding at all coz antibiotics will all be
disabeled)
Daptomycin (cover gram + and MRSA) work by depolarizing bacteria Ceels and
8288 Pharmacology Infectious Diseases therefore inhibits DNA RNA fprmation and protein synthesis, but cause myopathy
and increase CPK
8593 Microbiology Infectious Diseases Alcohols are antisceptic coz they disrupt cell membranes..
Dengue fever has 4 serotypes. Chill infections vs Bad ones are due to diferrent
serotypes
IFN Gamma are produced by NK (T cells, stimulated IL12 from macrophage) and
again activate macrophage to kill phagocytosed pathogens
Cat bite: barto, pasteurella Dog: pasteur, strep, staph aureus Human: anaerobes,
strep, eikenella
11590 Pharmacology Infectious Diseases Abacavir (nrti) is associated with hypersensitivity in 10% of pple with HLA B57
Parotitis can occur in elederly (weird presentation: pre/postauricular swelling that
11596 Microbiology Infectious Diseases extends to mandible) which are dehydrated and intubated. But here it caused by
Staph most commonly and diagnosed by imaging and amylase levels
11670 Microbiology Infectious Diseases Neurocysticercosis (taenia solium) cystic brain lesion in Central america
11729 Pharmacology Infectious Diseases Acyclovir: viral inhibition of DNA polymerase
11766 Microbiology Infectious Diseases E coli is lactose fermenting, INDOLE (+) (coz they are indolent)
11822 Microbiology Infectious Diseases Roseola (HHV6): 3-5 days of fever (often have febrile seizures) than truncal rash
343 Genetics Male Reproductive System Klienfelter 46 XXY, tall male with boobs aazospermia and mild mental retardation
CF patient are Infertile due to absent Vas Deferens bilaterally. In Kartegner sperm
807 Genetics Male Reproductive System
are immotile but we have Vas
SRY --> TDF --> Testes develop --> Sertoli (Secrete MIF --> Paramesonephric duct
PMD involute) Leydig cells (Produce Testosterone --> Transform Wolffian duct into
Male internal Genitalia; Epididymis, Vas Deferens) Testosterone --> DHT -->
1449 Embryology Male Reproductive System Transform Genital Tubercle and Urogenital Sinus into Male external Genitalia (Penis,
Prostate) IN XY, IF NO SERTOLI CELLS YOU WOULD HAVE BOTH FEMALE AND
MALE INTERNAL GENITALIA BUT MALE EXTERNAL GENITALIA (coz MIG is not
here to involute PMD
11747 Anatomy Male Reproductive System Prostate Ca spreads to bone through prostatic venous plexus first
Deep ring: Internal Spermatic Fascia (coming from transversalis fascia) Superficial
ring: External Spermatic Fascia (External Oblique) COZ Deep Internal So in Crypto
11762 Anatomy Male Reproductive System
need to bring testicle from superficial ring which its opining is mainly External
spermatic fascia (coming from external oblique)
Miscellaneous Bilateral renal angiomyolipoma associated with Tuberous Sclerosi (AD, with Brain
6 Pathology
(Multisystem) Hamartoma and Ash leave spots)
Miscellaneous
701 Genetics Achondroplasia is AD
(Multisystem)
Miscellaneous In Homocyteinuria, homocysteine is not metabolised to cysteine due to cystathione
1332 Biochemistry
(Multisystem) reductase problem
Alkaptonuria is a problem in converting Tyrosine to Fumarate (its TCA intermediate
Miscellaneous equivalent) so its like the next step after Phenylketonuria. Homogentisic acid
1502 Biochemistry
(Multisystem) dioxygenase deficiency so homogentisate (next step after tyrosine) accumulate. Get
Black urine, pigmentated face and other organs, arthropathy.
Miscellaneous Many patients with Homocytinuria benefit from B6 as it will drive the reaction forward
1504 Biochemistry
(Multisystem) to Cysthathione
Behavioral Miscellaneous
11531 Always get a translator when it is not very clear
science (Multisystem)
11532 Physician's burnout (emotional stress) while Physician fatigue refers to lack of sleep
11533 Cane and walker do not decrease the risk of fall according to studies. Just assist
Behavioral Miscellaneous For a nurse to show that she has understood the order she should repeat everything
11549
science (Multisystem) and even the route of administration
Behavioral Miscellaneous An elderly for discharge is best instructed with a checklist discharge list in case he
11550
science (Multisystem) has no family members living with him
11602 Medicare cover people above 65 or younger with disabilities
Miscellaneous Most common site of compartment syndrome is Anterior compartment innervated by
11635 Anatomy
(Multisystem) Deep peroneal nerve
Miscellaneous
11678 Pharmacology [Drug]=mg given/Vd
(Multisystem)
Behavioral Miscellaneous Communication problem during patient patient handoff (teslime) is a major cause of
11757
science (Multisystem) stupid errors
in Hypoxic ischemic encephalopathy (in arrest) hippocampus is first damaged, then
18 Pathology Nervous System
neocortex and Purkinje of cerebellum
In brain infarcts, neutrophils come in the first 24-48 hrs, do not phagocytose
20 Histology Nervous System anything. Microglia (3-5 days later they deposit), then Astrocyte will cause peripheral
glial scar and get central cyst instead of necrosis
if HTN and lacunar stroke and dont appear directly on CT but later it is due to HTN
arteriosclerosis and not Charcoud bouchard rupture that wld appear directly on CT
In abscence followed up by generalised tonic clonic ethosuximide wont help. Use
249 Pharmacology Nervous System
Valproic acid
Carbidopa is given with levodopa to inhibits levodopa conversion into dopamine
262 Pharmacology Nervous System outside CNS (by being itself metabolised) but with carbidopa we will have more
dopamin in CNS and more SE like agitation and anxiety..
subdural hemorrhage in babies is sign of abuse (shaken baby syndrome) and have
retinal hemorrhage
348 Pharmacology Nervous System Ramelteon, a melatonin agonist is used for insomnia in elderly.
Blotchy red muscles fibers on Gomori trichome stain = Mitochondrial Myopathies
(Maternal Inheritance) --> Abnormal Mitochondria (increased in number, enlarged,
abnormally shaped) accumulate in the fibers making them look irregular in size and
357 Genetics Nervous System
shape. "Red Fagged Fiber" Examples: Myoclonic epilepsy with red ragged fibers
(MERRF), Leber optic neuropathy (Blindness), Mitochondrial encephalopathy
(stroke-like episodes) and lactic acidosis (MELAS)
397 Pathology Nervous System Slit lamp exam to Diagnose Kayser Fleisher
The most common cause of spontaneous lobar hemorrhage in the elderly is
499 Pathology Nervous System Cerebral Amyloid Angiopathy (same amyloid seen in Alzhemer) and most commonly
occurs in occipital and parietal lobes
If acetylcholinesterase is found in amniotic fluid (shld be contained in neural tissues)
502 Embryology Nervous System it means that there is neural tube defect with failure of fusion and hence this enzyme
is spilled in sac
ETHosuximide block T type calcium cahnnels in THalamus. Used for Abscence
seizure
Pancoast cause ipsi Horner and ipsi shoulder and arm weakness and areflexia due
566 Anatomy Nervous System
to brachial plexus involvement
Alzheimer: Neurofibrillary tangles and A-Beta amyloid plaques. In Down syndrome
there is 3 copies of The Amyloid precursor protein gene.
Stuff involved in Alzheimer: APP on chr21 Prenisilin 1 on chr14 Prenisllin 2 on chr1
ApopE4 involved in late onset familial Alzheimer
In alzheimer, decrease acetylcholine in Meynert nucleus in hipoccampus (decreased
activity of acetyltransferase)
595 Pathology Nervous System Paraneoplastic process is autoimmune
In thiamine deficiency u can get necrosis and hemorrhage of mamillary bodies, B1
598 Biochemistry Nervous System will affect the activity of transketolase (main prob) and Pyruvate and Ketoglutarate
dehydrogenase
In anesthetic if have high venoarterial difference then drug will directly go to muscle
and adipocytes then slower effect on brain Whereas potency is determined by MAC
Ataxia telengiectasia: (AR), defect in DNA repair genes Cerebellar ataxis,
673 Immunology Nervous System Oculicutaneous telengiectasia, repeated sinopulmonary infection and increased
incidemce of malignancy
Neisseia: Bean Shaped Gram - cocci in pairs(<60 especially in camps, dorms..) VS.
735 Microbiology Nervous System
Strep pneumo: Lancet shaped, Gram + cocci in paiars (more common in pple >60)
775 Physiology Nervous System POMC is a polypeptide that give rise to ADH, MSH and Beta Endorphins.
When Morphine binds to mu receptors it can will cwuse hyperpolarisation of the cell
in two ways: First and most importantly it will cause G coupled activation of K+
776 Physiology Nervous System
channel, increasing K+ efflux out of the cell, hyperpolarizing the cell. Secondly it will
decrease Ca+ influx into the cell (Think morphine acts like K(C)arl)
794 Pathology Nervous System Hippocampus atrophy is seen in Alzheimer
840 Genetics Nervous System Huntingtin proteins prevents acetylation of DNA making it more mute
Potency of Anasthetic is related to MAC (minimal alveolar concentration)
(concentration at which 50% of people pass out) High blood/air partition coefficient
851 Pharmacology Nervous System means high solubility so slower onset of action (coz stay in blood dont go to brain)
Potency: drugs needed to achieve a certain effect related to km Efficacy: maximal
effect
852 Pharmacology Nervous System Inhaled anesthetic will directly redistribute in muscles skeletal and fat
IV anesthetic effect wean off after a short time because of redistribution of drug in
body
Dantrolene is only used to treat heat stroke and malignant hyperthermia, not high
fever
871 Pathology Nervous System Liquefactive Necrosis: Lysosmal digestion of the tissue
913 Pathology Nervous System PMR: fatigue, fever, wight loss + Proximal muscle stifness
969 Pathology Nervous System Tetanus is diagnosed clinically
In Neisseria CApsular Polysaccharide resist phagocytosis and stuff, but Outer
1006 Microbiology Nervous System membrane Lipooligosaccaride (LOS or LPS) is the endotoxin associated with fucked
up disease
1048 Biochemistry Nervous System Vit A OD: Pseudotumor Cerebri, skin changes and Hepatosplenomegaly
1058 Pathology Nervous System Endomysial Inflammation: Poliomyositis Endoneural Inflammation: Guillain Barre
1149 Anatomy Nervous System Superficial peroneal: Eversion Deep Peroneal: Dorsiflexion
Meningioma often occur in dural reflection. In falx cerebri patient can have leg
symtoms (beco it is in the medial homunculus)
Craniopharyngoma arising from anterior pituitary are calcified cysts containing
cholesterols crystals
Posterior fossa tumor in kids Medullo: Sheets of primitive cells(basophilic nuclei and
scant; small round blue cell, cystoplasm) with many mitotic figures Pilocytic
1259 Pathology Nervous System astrocytoma: Most common, Rosenthal fibers (are low grade and have better
prognosis) Ependymoma: walls of venticles and can cause hydrocephalus, they form
gland like structures called rosettes
Neuronal properties: Time constant: time it takes for membrane to achieve 63% of
new membrane potential Length constant: time it takes for impulse to go a certain
distance. Demyelination will decrease both, by Increasing axon Conductance and
having less Saltatory Conduction
1320 Pharmacology Nervous System In mysathemia crisis we shld increase dose of neostigmine
Organophosphate irreversibly inhibit cholinesterase in musc and nicot synapses so if
give atropine (only musc) u wont be helping muscular effects
In Maple syrup, avoid branched chain amino acid leucine Isolucine and Valine
(defect in alpha ketoacid dehydrogenase with deficient conversion of Leucine to
1335 Biochemistry Nervous System
Acetyl CoA or Valine and Isoleucine to Propionyl CoA then Methylmalonyl then
Succinyl CoA)
1368 Pharmacology Nervous System Uterine relaxation is by B2 like in lungs..
Listeria which is a B hemolytic gram + that moves and reproduce well in low
1391 Microbiology Nervous System temperatures is common in children less than 3 months coz of their immature cell
mediated immunity
1399 Microbiology Nervous System TCA affect muscarinic not nicotinic
Rabies virus goes in skin, then motor axon (and retrograde to cNS) then salivary
gland (thats why transmitted through bites)
Fragile X: CGG repeat --> Hypermethylation of Cytosine amd inactivation of
subsequent genes
1428 Biochemistry Nervous System In tRNA, the 3 ' part is responsible for amino acid attachement site (since t and 3)
Behavioral Conversion disorder is experiencing neurological symptoms that are not explained by
1433 Nervous System
science tests or exam, and is due to a stressor
1442 Pharmacology Nervous System Donepezil Cholinesterase inhibitor is used in Alzheimer
1443 Pharmacology Nervous System Benzo increase FREQuENCY of Cl channels not DURATION
1534 Embryology Nervous System NF is a neural crest tumor since it is a Schwann cells tumor. Like in Melanoma
1536 Histology Nervous System Thight junction is responsible of the nonfenestrated endothelial in BBB (cest logique)
Musculucutaneous innervates biceps and suppinator (like when I do Dumbels) and
supply sensory lateral Forearm
Ulnar nerve functions: Wrist flexion/adduction, fingers adduction/abduction and
sensation in 1.5 last fingers and flexion of 4th/5th digit
Median nerve is sandwiched between Flexor digitorum superficialis and Flexor
Digitorum Profundus (easy since Median innervates digits)
Holding a branch like a monkey can cause lower trunk of brachial plexus injury
affecting radial and ulnar nerves and muscles of hands
immunity agaisnt neisseria mengitidis is antibodies against their polysaccaride
capsule
1966 Microbiology Nervous System enterovirus is most common cause of asceptic meningitis
Botulinsm toxin inhibit Ach release wheras rabies bind on the recptors (toxin is killed
by heat)
2082 Microbiology Nervous System Treat toxo with pyrimethamine and sulfadiazine (clinda if sulfa allergy)
2083 Microbiology Nervous System Cns lymphoma are B cells
CYPROHEPATADINE, is an antihistamine with anti serotonergic, so used in excess
serotonin syndrome
Behavioral
2123 Nervous System Acute stress disorder happen 3 days to 1 month from a bad event
science
Rabies G(accumulate in open wound) lycoprotein spikes bind nicotine acetylcholine
receptors, activate them. And go to CNS in retrograde
8385 Biochemistry Nervous System Impairement of Ubiquitin proteasome system is involved in Parkinson and Alzheimer
8476 Pharmacology Nervous System Tryptans are serotonic agonist
Staph epidedermis virulence is synthesis of an extracellular polysaccharide matric,
(adherent biofilms) when foreign bodies are inserted through skin (skin flora)
8564 Anatomy Nervous System IVH is bleed in germinal matrix
Behavioral In Narcolepsy or Cataplexy Hypocretin (1 or 2) which are secreted by the lateeral
8878 Nervous System
science Hypothlamus and usually promote wakefulness and inhibit REM sleep, are usually low
11458 Pharmacology Nervous System Baclofen, GABA B receptor agonist used for spasticity even of central cause like MS
Parkinson pple benefit from deep brain stimulation inhibiting Subthalamus eventually
increasing Thalamus inout
HIV associated dementia is suspected in AIDS patients with progressive cognitive
11568 Pathology Nervous System decline. Microglial nodules and groupd of activated macrophages/microglial cells
around necrosis that may fuse to form multinucleated giant cells
11574 Pathology Nervous System Damage to brainstem below or at level of red nucleus will cause decerebrate position
11576 Pathology Nervous System In brain calcification do not happen afer infarcts but in TUMORS
Overshooting is when lateral cerebellar is affected, when vermis (central) is affected
u get truncal ataxia
11665 Pharmacology Nervous System Treat status (even if febrile seizure) with lorazepam
Infraiebital nerve runs along the orbital floor so in such a fracture causing
11742 Anatomy Nervous System parasthesia in upper cheek, upper lip and upper gingiva and inferior rectus muscle
gets entrapped causing vertical nystagmus
GABa activation cause Chloride channel to open and causing a chloride flux inside
(passive down normal gradient)the cell hyper-polarizing its resting potential
XI injury: Trapezius injury: Droopin gof shoulder, impaired abduction above
horizontal and Winging of Scapula (weird things)
Femoral nerve passes through the Inguinal crease not the Femoral rin and canal
which contains lymphatic, vessels and lymph nodes
During intubation, beware of atlantoaxial instability that can cause subluxation of the
vertebra and compression of SC and Vertebral arteries--> Paralysis
1646 Pharmacology Ophthalmology AIDS CD4<50 CMV Retinitis
11551 Microbiology Ophthalmology CMV cause chorioretinitis when in congenital infection
11841 Pharmacology Ophthalmology In glaucoma, prostaglandin will increase outflow of humor..
Aspirin OD Fever, Tinnitus, Tachypnes): Mixed Resp Alkalosis (Stimulates medullary
centers, leading do Hyperventilation) with Anion Gap Met Acidosis (begin shortly
Poisoning & Environmental Afterward, as Aspirin Increase Lipolysis, Uncouples Oxidative Phosphorylation, and
1544 Physiology
Exposure Inhibits Citric Acid Cycle --> Ketoacid, Lactate and Phruvate Accumulation). So you
get Normal pH with low pCO2 and low HCO3-. in compensation, pH will not return to
Normal but gets close to Normal Range.
Unlike what seems intuitive Complete mole (46, XX or XY only paternal DNA) does
not contain fetal tissues and has a HONEY COMB or SNOWTORM appeance,
Pregnancy, Childbirth &
792 Pathophysiology associated with preeclampsia, before 20 weeks, Hyperemesis, Hyperthyroid Partial
Puerperium
Mole are XXY or XXX but has mom and 2 papa sets so have fetal tissuesand only
presents with vaginal bleed and lower risk of malignancy
In Aromatase deficiency female will have ambiguous genitalia and the excess of
955 Genetics Androgen that cannot be converted, will go to mom's circulation causing her
Puerperium
deepening of voice etc. unlike 21 hydroxylase deficiency that does not affect mommy
Pregnancy, Childbirth & Live vaccines: Smallpox, chickenpox, yellow fever, Rota, Intanasal Influenza, Sabin
1464 Microbiology
Puerperium for polio, MMR,
1772 Embryology In fertilization, BHCG is detectable in serum 8 days later but 14 days later in urine
Puerperium
Pregnancy, Childbirth & Patau: cleft lip,palate, omphalocele, holoprosencephaly, polydactyly, rocker bottom
1822 Genetics
Puerperium feet
Patau 13: Cleft palate, Poly/Syndactyly, Omphalocele Edwards 18: Small brain
1823 Genetics (prominent occipit), Small ears, Small mandible, Small sternum, Small clenched
Puerperium
hands + Eyes, Cardiac, GI defects (HE is small, so low HCG and Estriol)
Pregnancy, Childbirth & Complete hydatiform mole is 46 XX or XY only from father while partial is triploidy 2/3
1830 Genetics
Puerperium from father
During pregnancy, prolactin steadily increase along pregnancy but Progesterone and
1987 Physiology Estrogen do not permit lactogenesis and promote Breast Growth and Development
Puerperium
with minor help of Peolactin
Pregnancy, Childbirth & Congenital torticolis is 2-4 week after bitch it is due to malposition of head of abby in
8325 Pathology
Puerperium utero or birth trauma. they resolve with stretching
Maternal diabetes is due to HPL which increases proteolysis, lipolysis, insulin
8330 Physiology resistance and decrease gluconeogenesis. Estrogen, progesterone and cortisone
Puerperium
also play a role in maternal diabetes.
Pregnancy, Childbirth & False twins are always Di Di in indentical twins land,arks are: 0-4: Di C Di A 4-8:
8406 Embryology
Puerperium Mono C Di A 8-12: Mono Mono >12: Conjoined (4-8-12 landmarks)
Behavioral Psychiatric/Behavioral & Buspirone has a slow onset of action and is not a muscle relaxant, hence not
247
science Substance Abuse addictive
Behavioral Psychiatric/Behavioral & Tardive dyskinesia occur with lip smacking and many ticks due to antipsychotic
511
science Substance Abuse medications
Psychiatric/Behavioral & Lithium toxicity (ataxia, confusion, neuromuscular exitability) can be precipitated by
519 Pharmacology
Substance Abuse volume depletion, like with thiazide, ACE and with NSAIDS too
Psychiatric/Behavioral &
706 Pharmacology Trazodone is gd in patient with insomnia (think of erection while sleeping)
Substance Abuse
Behavioral Psychiatric/Behavioral &
1046 Bulimia patients, remain with their normal wights and do not have medical problems.
science Substance Abuse
Behavioral Psychiatric/Behavioral & PCP abuse will most likely result to trauma (fight etc.) more than seizure or cardiac
1165
science Substance Abuse event
Behavioral Psychiatric/Behavioral & Displacement: I am getting a divorce and am angry, so I shout at my daughter who
1234
science Substance Abuse fogot to throw the garbage
Behavioral Psychiatric/Behavioral & Reaction formation is when you act oppositely than what you feel. Splitting is when
1350
science Substance Abuse you perceive people as either good or bad
Supression is a mature defense mechanism involving a conscious choice not to dwell
Behavioral Psychiatric/Behavioral & on a particular thought or feeling. Rationalisation involve making excuses for
1351
science Substance Abuse unacceptable feelings ; like a student explaining that poor performance was due to
trickiness of the exam
Behavioral Psychiatric/Behavioral & Triazolam is a short acting benzo best used for sleep, Lorazepam is intermediate the
1352
science Substance Abuse other DFC are long acting
A boy whose parents are having a divorce and thinks that his dad is angry at him is
Behavioral Psychiatric/Behavioral & experiencing Projection, since he is likely angry at his parents he will think they are
1429
science Substance Abuse angry at him too. This is common in peple who lack insight or their emotions,
motivations and feelings
Behavioral Psychiatric/Behavioral & PPtm blues last maximum 10 days otherwise it is PPtm depression and require
1430
science Substance Abuse treamtent (antidepressant, psychotherapy)
Psychiatric/Behavioral &
2001 Pharmacology Cocaine inhibit reuptake of dopamine
Substance Abuse
Behavioral Psychiatric/Behavioral & Delusional disorder is one step worse than Paranoid disorder, its like a paranoid man
2046
science Substance Abuse who constantly think people are poisoning him
Behavioral Psychiatric/Behavioral & Transference is when ur transfer your emotions associated with a significant person
2053
science Substance Abuse to the person in the present
Psychiatric/Behavioral & drugs with Serotonin Syndrome: antidepressant with serotonin stuff, Tramadol
8327 Pharmacology
Substance Abuse Ondansetron Linezolid (DA FUCK) Triptans (SURE)
8954 Most cases of OD's are due to prescribed Opioids
A patient requiring antibiotic for viral infection, don't tell them that it will cause
10458 resistance, be sensitive and tell about the side effects and that other treatment are
better
Behavioral Psychiatric/Behavioral & Children under the age of 6 do not understand death, so it is normal for them to hae
10465
science Substance Abuse psychotic symptoms like seeing their grandma
11587 Bipolar I means only one criteria needed which is MANIA
11603 Phobia is treated with Exposure-based behavioral therapy
11618 Previous suicide attempt is the worse prognosis for people attempting suicide
Behavioral Psychiatric/Behavioral & Persistent depressive disorder is when Major depressive disorder and Dysthemia
11622
science Substance Abuse happen for more than 2 years
Behavioral Psychiatric/Behavioral & Adjustment disorder is applicable for only 3 months following the stressor, beyond
11737
science Substance Abuse that find another explanation
Behavioral Psychiatric/Behavioral & In treatment-resistant schizophrenia use Clozapine. Beware of agranulocytosis so
11743
science Substance Abuse monitor neutrophil count
11746 Cocaine withdrawal can cause psychosis, hyperphagia, hypersomnia
Behavioral Psychiatric/Behavioral & With adolescence non compliant to insulin, finding a peer that need to take insulin
11785
science Substance Abuse would increase compliance
Stages of change (stopping alcohol) Precontemplation (denial) -> Contemplation
11787 (realising the problem but not ready to act) -> Preparation (planning behavior
modification) -> Action -> Maintenance (maintening new behaviors)
Behavioral Psychiatric/Behavioral & Factitious is inducing sickness to assume sick role, while malingering is pretending to
11792
science Substance Abuse be sick or exaggerating symptoms to get drugs or whatever
11807 Bulimia nervosa is treated by Fluoxetine, nutritional changes and psychotherapy
Behavioral Psychiatric/Behavioral & If someone tells u he wants Tramal and that Drs used to give him, first of all make
11829
science Substance Abuse sure of the old prescriptions and stuff
11846 PTSD: SSRI + CBT
11848 OLANZAPINE CLOZAPINE (2nd generation): METABOLIC SYNDROME
When aspergillus cause fungus ball in a cavity in lung it is colonizing and can be
108 Microbiology Pulmonary & Critical Care
asymptomatik
114 Microbiology Pulmonary & Critical Care Cryptococcus most commonly cause meningoencephelitis
Cryptococcus capsule is the only fungus capsule made of polysaccharide and stains
117 Microbiology Pulmonary & Critical Care red on Muciramine and show a clear zone on silver stain Usually use india ink for
cryptococcus
abscess formation is due to lysosomal ensyme release from neutrophils and
macrophage IFN gamma secreted by T helper after IL 12 (from neutrophils) is
302 Pathology Pulmonary & Critical Care
secreted: make phagolysozome formation, NO release and granuloma and caseous
necrosis formation
According to Laplace law, small elastic spheres are more likely to collapse than
bigger ones with same surface tension. Think of distal small alveoli who receive the
least amount of air who are most prone to collapse. But Surfactant are most
477 Physiology Pulmonary & Critical Care
concentrated in small alveoli coz of smaller areas and protect them from collapse by
increasing surface tension, this will establish equilibrium between alveoli of different
radius.
Submucosal serous and mucous glands (and Goblet cells) are present where there
is cartilage therefore end where at the smallest bronchi are absent in bronchiole and
480 Histology Pulmonary & Critical Care further. And at this level epithelial will be completely changed from pseudostratified
columnar to simple cuboidal.on the other hand we can still find cilia until the level of
alveoli where they disappear and macrophage usually takes care of foreign bodies
Airway Resistance: 50% of resistance is in nares trachea etc. This Resistance
Increase in Medium sized Bronchi due to Turbulence of flow, but then decreased
significantly (lower than upper tract too) in Small Terminal Bronchiole <2mm due to
massive increase in summated surface area that will slow the flow and permit a more
laminar one. (Bronchitis patients seem more in respiratory distress than Pneumonia
patients, since there already high resistence in upper bronchi)
Upper airways Pseudostratified columnar mucus secreting cells: nose, nasopharynx,
sinuses, tracheobronchial tree, Vestibular folds (false vocal cords) and laryngeal
483 Histology Pulmonary & Critical Care vestibule are the lower half of posterior epiglottis and are columnar too Stratified
squamous: Mouth, oropharynx, laryngopharyns, anterior epiglottis, upper posterior
epiglottis, true vocal cords
In lungs Elastases are secreted by neutrophils and alveolar Macrophages. These
484 Histology Pulmonary & Critical Care can cause terminal lung parenchyma (emphysema) if very high or left unchecked by
antiproteases activity (in alpha antitripsin deficiency)
486 Pathology Pulmonary & Critical Care PCWP increase reviel Cardio problem and exlude Lungs NICEEE
488 Histology Pulmonary & Critical Care In COPD we have Neutrophils and Alveolar Macrophages, releasing proteinases
CO2 level in ABG indicated ventilation status (if have upper obstruction no ventilation
528 Pathophysiology Pulmonary & Critical Care
so hypercapnia)
Peptistreptococcus, pervotella, bacteroides and fusobacterium are the aneprbes pf
the mouth that cause aspiration pneumonia
Lung tranplant: Hyperacute rejection: graft blood vessel spasm, diffuse intravascular
coagulation and ischemia Acute:1-2 weeks later, Cell mediated CD8 with
macrophage. Vascular damage, perivascular and peribronchial lymphocytic
infiltrates. Dyspnea, cough, fever, Perihilar and lobar opacities (CXR) Chronic:
bronchiolitis obliterans (small ones) Inflammation fibrosis of bronchiolar wall (in
Chronic renal transplant it is vascular unlike here)
Bronchiolitis Obliterans: Chronic lung rejection (obstructive pattern) Lymphocytic
infiltrate, fibrosis and bronchiole destruction
Lung Hamartomas: most common benign tumor is 50-60s and are peripheral coin
lesion. Disorganised cartilage, fibrous andd adipose tissue
565 Pathology Pulmonary & Critical Care Mediastinal tumor cause IVC syndrome not superior sulcus (pancoast)
NZT blue test in CGD is also called Dihydrodamine and can be positive by inducating
571 Immunology Pulmonary & Critical Care
abscence green color in neutrophils
650 Pathology Pulmonary & Critical Care Small cell of lung is thought to have a neuroendocrine origin
In Silicosis there is ineffective Macrophage Phagolysosomes, making those patients
more susceptible to TB
746 Immunology Pulmonary & Critical Care MHCI is composed of MHCI and Beta2 microglobulin
In order for naive T cells to turn into TH1 cells they need IL12. In turn, TH1 secrete
762 Immunology Pulmonary & Critical Care IgN Gamma to activate macrophage. So if you domt have Il12 you are susceptible to
TB so give IFN Gamma
796 Immunology Pulmonary & Critical Care In Sarcoid it is mainly CD4 T cells involvement
Sarcoidosis is Th1 response where IL2 and IFN gamma play a role in granuloma
797 Immunology Pulmonary & Critical Care formation while Th2 involve IL4 (Activate B cells and secrete IgE) and IL5
(Eosinophils and IgA formation)
Complications of ob stuff: O2 use for ARDS in fetus: can cause upregulation of VEGF
and retinal vessel proliferation (neovascularixzation) potentially causing retinal
799 Pathology Pulmonary & Critical Care detachment and blindness Surfactant treatment complications: Hypoxia, HypoTN,
blockage of ET tube and pulmonary hemorrhage Terbutaline (tocolisis) to delay
labor: IVH, Hypoglycemia, Hypocalcemia and ileus
800 Embryology Pulmonary & Critical Care By week 35 L/S ratio becomes 2:1 (lecithin is also known as phosphatidylcholine)
In CF disfunctional protein do not undergo Post translational modification and we get
802 Genetics Pulmonary & Critical Care
no CFTR and it is sent to proteasome
In CF (CFTR) gene, Lungs GI: (normally) have high content of Cl- and
804 Pathophysiology Pulmonary & Critical Care Na+(decreased absorption) Sweat gland: (normally) low content so if have CF u
have high salts in glands bu the contrary in resp and GI (fun haa)
Bosentan: Antagonist of endothelial receptors, used for idiopathic pulmonary
903 Pharmacology Pulmonary & Critical Care
hypertension
Clumping of RBC at low Temperature means there is cold Agglutinins formation
(Mycoplasma, EBV..)
Legionella (pneumonia, diarrhea, high fever) cannot be detected on gram stain (think
of that syrian guy in Bassile, but need urine IgM) and is common in COPDers
Hib vaccine contains PRP and diphteria toxoid to produce AB against RPR, a
component of its capsule (think that when u say PRP u move ur epiglottis LoLllllll)
964 Microbiology Pulmonary & Critical Care Nontypable H flu dont have capsule MMAKES SENSE
1195 Pharmacology Pulmonary & Critical Care Oropharyngeal candidiasis: Nystatin
Rhinovirus is (+) SS RNA so directly produce toxin (even if only RNA is injected)
1373 Microbiology Pulmonary & Critical Care whereas RSV and Influenaza are (-) SS RNA so need a specific Viral RNA
Polymerase to produce its (+) counterpart
Envolope voruses have bilayer lipid outer membranes and destroyed by ether or
organic solvents
When CO2 enters RBC it produce HCO3- that is released again in Plasma. In order
1414 Physiology Pulmonary & Critical Care to maintain neutrality of Plasma, Cl- enter RBC, which explains higher Cl- content in
Arteries than in Veins.
In obstructive sleep apnea (obesity, tonsillar hypertrophy, hypothyroid), ABG during
the day are normal, can have erythrocytosis, can lead to Pulm HTN and RHF
Hyperventilation will cause Hypocapnea, that will constrict Cerebral Blood Vessels,
decreasing cerebral blood flow (hence the symptoms of dizziness, blurred vision),
since the brain is tricked and thinks its having good circulation getting rid of CO2.
Cerebral Blood Flow is Dependent on both O2 and CO2 contents.
1514 Physiology Pulmonary & Critical Care CFTFR (chromosome 7) is a transmembrane ATP gated chloride channel
Lung physiology. After regular expiration FRV is left in the lungs and the pleural
pressure is at its lowest (absolute value) of -5, due to chest wall position creating a
negative pressure and alveolar elasticity causing a positive alveoli transmural
pressures (remember lungs tends to collapse) OUT - IN is pleural pressure, at this
instance alveolar pressure is null hence no air movement. Only in case of
pneumothorax when pleura is in contact with atmosphere, its pressure i
In Obstructive pattern Residual Volume is increased (look at them, they barreled
chest)
In PE (poor alveolar perfusion) the alveolar composition is close to that of the
trachea since no exchange is happening. Usually O2 should decrease and CO2
increase when going down the tree due to exchange. Exchange is perfusion limited,
since exchange is easily established across membrane except in fibrosis and
emphysema where wall is damaged and diffusion is difficult. In this case O2 in alveoli
is high since it is not going to the blood, but CO2 is not affected (high DC)
To induce asthmatic change in PFT's Exercice, histamine, cold air inhalation and
Metacholine (metacholine, cholinergic agonist) will cause airway constriction and
1523 Pharmacology Pulmonary & Critical Care
increase secretion. A decrease of >20% of FEV1 is diagnostic of asthma after
metacholine test.
PAO2 is derived from an equation and does not exactly accurately represents O2
1526 Physiology Pulmonary & Critical Care content in all alveoli, therefore we get a normal PAO2 in Obstructive patients, with a
high PAO2-PaO2 value.
Pain from diaphragmatic and mediastinal pleura are carried out by phrenic nerve; so
1535 Anatomy Pulmonary & Critical Care get neck and choulder referred pain ( think of the map; like an inverted T) the rest is
carried out by intercostal nerves
Interstitial lung disease (restrictive): both FEV1 and FVC are decreased, but FVC
decrease much more which explains the increase in FEV1/FVC ration. FEV1 is not
1543 Physiology Pulmonary & Critical Care decreased that much coz interstitial fibrosis will cause traction of alveolar wall
(increased lung elastic recoil) causing supernormal expiratory flow when correcting
for lung volume.
Respiratory particles in bronchioles are cleared by mucociliary system. Beyond
terminal bronchioles, Macrophage do the job. Mucus-Secreting cells (Goblet cells)
are all along the respiratory trat but not in terminal bronchiole and farther where
surfactant line the walls.
1563 Physiology Pulmonary & Critical Care Minute ventilation = TV . RR Alveolar ventilation = (TV - Dead space) . RR
In transplant patients, ds DNA CMV (Intracellular and ctyplasmic incusion bodies)
pneumonia can happen
Hypoxemia: Normally pAO2: 104, paO2: 100 (we have complete diffusion but
difference is due to bronchial deoxygenated vein that drain in pulmonary veins)
Normal Alveolar-arterial gradient (10-15, since both are low, so alveolar problem):
hypoventilation, high altitudes (low O2 content) or decrease inspiratory capacity
(MGravis, Obesity) High A-a gradient (only arterial O2 is low): limited diffusion, R to L
shunt (cyanotic heart), V/Q mismatch (PE, pneumonia, Obstructive diseas
In COPD it js O2 that conteols Respiratory Drive and unlike what I Thought it is
Peripheral Chemoreceptors that controls that (carotid and aortic arch) Central
chemoreceptors are regulated by decrease pH not (but still low effect coz brain is
barely permeable to H+)
In LV heart failure, fluid accumulate in Lungs and decrease their Compliance.
Nothing to do with Alveolar Surface Tension and Surfactants.
Kartagener syndrome (ciliary dyskenesia due to Dynein arms defect) Is triad of
Chronic Sinusitis, Bronchitis and Situs Inversus
Pulmonary vascular resistance is lowest at FRC and it's also at FRC that alveolar
pressure is 0. Alveolar - pressure (inspiration) will narrow the vessels and lengthen
them causing pressure, while expiration will increase intrathoracic pressure also
increasing pressure in vessels.
1666 Microbiology Pulmonary & Critical Care In patients > 65, post flu pneumonia is common and cause by Strep, Staph and Hib
M. Pneumonia require cholesterol to grow on artificial media coz have no cell wall or
capsule so cholesterol to integrate in their cell membrane
Hib vaccine is conjugated with diphteria protein to switch immune reaction to T cell
independant to T cell dependant
1779 Microbiology Pulmonary & Critical Care Spore forming bacteria resist heat
IL 1,6 and TNF alpha are the mediator of sytemic inflattion and stimulate liver
secretion of fibrinogen which increase ESR
In pneumonia, green sputum is due to myeloperoxidase, a blue-green heme-based
1910 Pathophysiology Pulmonary & Critical Care enzyme that is released from neutrophil azurophilic granules and forms
hypocholorous acid
1925 Pathology Pulmonary & Critical Care Allergens are stronger than cold air to induce an asthma ttack
High altitude AB: First low FiO2 will cause hypoxemia, which will result in
Hyperventilation subsequently Respiratory Alkalosis. Within 48 hours, kidneys will
1980 Physiology Pulmonary & Critical Care respond causing Compensatory Metabolic Alkalosis. Therefore pH will be high
(Hyperventilation Respiratory Acidosis), pO2 low (Hypoxemia), pCo2 high
(Hyperventilation) and Bicarb low(metabolic acidosis)
1981 Physiology Pulmonary & Critical Care PE: Hypoxemia + Respiratory Alkalosis (Hyperventilation Reaction)
1985 Pathophysiology Pulmonary & Critical Care OSA can lead to pulmonary hypertension
RNA polym I: rRNA II: mRNA, microRNA (silencor, think of it like methylation)
2039 Genetics Pulmonary & Critical Care
smallRNA (involve in regulation and splicing) III: tRNA
8257 Microbiology Pulmonary & Critical Care Legionella does not stain well on Gram stain and cause hyponatremia
Air flow resistance: COPD, asthma, emphysema, or goiter obstruction: in these
patient the frequency of breathing will increase work of breathing, so they breathe
8260 Pathophysiology Pulmonary & Critical Care long and slowly to adjust While alveolar and elastic problems: the work of breathing
increase with increase TV so they breathe shallow and fast This is manifested by the
trough work of breathing on RR curve that is either lower or higher than 15
8519 Biostatistics Pulmonary & Critical Care Analysis of variance is ANOVA
When someone swallows a bone it can get lodged in piriform recess just behind the
epiglottis. Behinf the recess there is the Internal Branch of the Superior Laryngeal
8703 Anatomy Pulmonary & Critical Care Nerve and mediates the afferent of The cough Reflex. THINK OF SOMEONE
TRYING TO COUGH SO MUCH TO REMOVE THE BONE BUT THEN COULDNT
COUGH ANYMORE
Nocadia (Lungs, CNS, Cutaneous) occurs also in uper lobes like TB, and are
11638 Microbiology Pulmonary & Critical Care branching Gram (+) confusing with fungi Contracted by spore inhalation or traumatic
inoculation on skin
Renal, Urinary Systems & In post strep glomerulonephritis we see Granular deposit in mesangium of basement
8 Histology
Electrolytes membrane with IgG, IgM and C3 deposition "Starry sky appearance"
Renal, Urinary Systems & Goodpasture is part of RPG ( pasteur, with a RPG) so expect Crescent changes and
9 Histology
Electrolytes IgG and C3 in basement membrane
Renal, Urinary Systems & Post strep Glomerulonephritis: Hugh ASO, anti DNase B titers, Low C3 and total
12 Pathology
Electrolytes complement levels (normal C4) and presence of cryoglobulin
Renal, Urinary Systems & In nephrotoc u lose a lot of albumin so liver increase albumin production. U retain a
28 Pathology
Electrolytes lot of spdium coz of increase aldosterone
Renal, Urinary Systems & Partial Vs Complete Nephrogenic DI: In partial Urine osm with ADH urine OSM
211 Pathology
Electrolytes recovers till 500, but in complete it does not recover at all
Renal, Urinary Systems &
229 Pathology In IE glomerulonephritis can happen and it is an Immune complex mediated injury
Electrolytes
Amphotericin is nephrotoxic so can cause anemia (low EPO) and will cause increase
275 Pharmacology permeability of distal tubules so will have HYPOKALEMIA AND HYPOMG and
Electrolytes
possible heart problems
Furosemide works on Na-K-2Cl channels in TAL and also work by stimulating Renal
Renal, Urinary Systems & Prostaglandin Release (which normally dilate Afferent arteriole--> Increase RBP and
684 Physiology
Electrolytes GFR and enhance drug Delivery). If you give NSAID you will constrict Afferents and
decrease delivery, resuming ascites or pleural effusion
685 Pharmacology Autotoxic: Furosemide, Aspirin, Aminoglycoside, cisplatin, Vanco
Electrolytes
Renal, Urinary Systems & In chronic renal graft rejection you see vascular changes, tubular atrophy and
744 Immunology
Electrolytes fibrosis, but neutrophils are not involved
Renal, Urinary Systems & In parasitic infection IgE will bind to parasite then their Fc portions bind eosinophils
750 Immunology
Electrolytes that will in turn degranulate This is called Antibody-dependent- cell mediated toxicity
Renal, Urinary Systems & Idiopathic hypercalciuria is the most common cause of calcium kidney stones (NL
813 Pathophysiology
Electrolytes serum Ca2+)
Renal, Urinary Systems & Vit B6 decrease Oxalate production and decrease chance of CAlcium Oxalate
816 Pathology
Electrolytes formation
835 Pathology Beta lactam can cause acute interstitial nephritis
Electrolytes
Renal, Urinary Systems & In recovery of ATN all electrolytes are low du to slowly recovering despite increase
886 Pathology
Electrolytes UO
Renal, Urinary Systems & Ethylene glycol: tubular necrosis with balooning and vacuolisation of PCT + Ca
887 Pathology
Electrolytes Oxalate stones
1049 Pathology Chronic NSAIDS wil cause CHronic Interstitial Nephrtis
Electrolytes
1053 Pathology In recovery of ATN we get reepithelization of tubules
Electrolytes
Renal, Urinary Systems & Bence jones are large eosinophilic casts While in Hypersensitivity interstitial nephritis
1054 Pathology
Electrolytes we see eosinophils in blood
ADH works on Cortical and Medullary portions of Collecting ducts but Cortical
1161 Physiology segment is not involve in urea reabsorption but Medullary segment reabsorbs both
Electrolytes
H2O and Urea
1211 Pharmacology Bethanecol given for post op ileus (cholinergic): BEDNA NEKOL POST OP
Electrolytes
1524 Anatomy Regardless of a patient's status, reabsorption occur in proximal tubule.
Electrolytes
Liver: Angiotensinogen -(Renin produced in Juxtaglomerular cells in Kidneys)-> ATI
1532 Physiology Lungs: ATI -(ACE)-> ATII (cause vasoconstriction in systemic arterioles) Adrenal
Electrolytes
Glands: ATII Stimulates Aldosterone Production and Secretion
Hypokalemia cause K+ reabsorption by a-intercalated discs in cortical portion of
collecting tubules, through K+/H+ ATPases (K+ in, H+ out; stimulated by Aldo in
Renal, Urinary Systems & HypoK; the reason why HypoK causes Alkalosis)(Apical), while Normal to High K+
1554 Physiology
Electrolytes level will permit K+ excretion through K+ channels (Apical) in Principal cells, with help
of Na+/K+ pump basolaterally which is activated with high K+ levels and Aldosterone
(also enhance Na+(in) and K+(out) channels permeabilities)
Clearance=UrineConcentration.UrineFlowRate/PlasmaConcentration ClearanceCr(or
1555 Physiology Inulin)=GFR ClearancePAH=RPF FF=GFR/RPF UrineFlowRate is the same so it
Electrolytes
cancels in the Nominator and Denominator
Renal, Urinary Systems & RPF (PAH clearance) reprensents plasma flow, but since plasma represents one
1556 Physiology
Electrolytes pprtion of blood, to get RBF, we divide RPF/(1-HCT), and here we get the Actual RBF
Renal Excreation: Inulin and Mannitol: only Filteres, not secreted or reabsorbed
Glucose, Amino Acids, Na+, Urea: Filtered then most of it reabsorbed PAH, Creatine:
1559 Physiology Filtered and Secreted (Cr is not exactly all secreted) FF (20%)= GFR/RPF with GFR:
Electrolytes
Inulin clearance and RPF: PAH clearance (not very accurate coz Adipose tissues in
kidney do not filter or secrete RPH so this will underestimate RPF by 10%)
Renal, Urinary Systems & Glomerulus filters a substance into Bowman's capsule which is the start of the
1588 Physiology
Electrolytes journey of filtered substance (filtration does not occur there)
Proximal tubules substance concentration depends on wether water is reabsorbed
faster than them. So we have an increase by growing order of Na, K, Cl, Urea, Inulin,
1617 Physiology Cr and PAH (The last 3 are almost not absorbed) While HCO3 (Actively reabsorbed
Electrolytes
due to Carbonic Anhydrase), AA and Glucose (These 2 are vividly actively
reabsorbed) decrease significantly
PAH is freely filtered in the glomerulus but it also secreted from peritubular capillaries
(proximal tubule) through a carrier transport (reabsorption is carrier mediated too
Renal, Urinary Systems & and can be saturated) and this process can be saturated, but filtration will remain.
1619 Physiology
Electrolytes Since PAH is usually fully filtered and secreted its clearance is used to calculate
Renal Plasma Flow (RPH: that usually decrease with afferent or efferent constriction;
Epi, Norepi, ATII)
Foscarnet (pyrrophosphate analogue) chelates calcium and cause magnesium
1643 Pharmacology wasting in kidneys, hence decrease PTH and further decrease in Ca. Low Ca and
Electrolytes
and Mg can cause seizures
1651 Physiology Filtration Fraction = GFR / Renal Plasma Flow
Electrolytes
Kidney development: Intermediate mesoderm will form: Pronephros (disappear),
Mesonephros (give Wolffian ducts in male and Vestibular Gartner's ducts in
females), Metanephros duct (Collecting ducts, Minor and Majors Calyces, Renal
1736 Embryology pelvis, Ureters) arising from caudal Mesonephros. Mentanephros duct (ureteric bud)
Electrolytes
will induce formation of Metanephros Blastema in sacrum (Metanephros mesoderm:
Glomeruli, Bowmans's space, Proximal tubule, Loopf of Henle, Distal collecting
tubules)
Fabri, deficiency in alpha galactosidase A and globoside ceramde trihexoside will
1989 Biochemistry accumulate in tissues. First get angiokeratomas, hypohidrosis and acroparesthesia.
Electrolytes
In late phase if enzyme is not replaced GET RENAL FAILURE COZ FABRENAL
Urea is reabsorbed in the collecting duct through ADH effect on V2 receptors
2012 Physiology (increase water and urea permeability). Urea will go in the medulla and permit the
Electrolytes
concentration ability of kidneys.
Membranous nephropathy is associated with IgG4 antibodies to phospholipases A2
Renal, Urinary Systems & receptor, which play a role in dvlpmnt of the disease (it the class V lupus nephritis) In
2131 Pathology
Electrolytes cryoglobulinemia: there is IgM deposits in glomerulus leading to basement mmbrane
thickening and cellular proliferation
8530 Immunology T helper produce IL2 which activates CD4, CD8 T cells, NK cells and monocytes
Electrolytes
8541 Microbiology Shistozoma are contracted by Snails (makes sense)
Electrolytes
8881 Physiology Serum Cr and GFR have an negative log function.
Electrolytes
Renal, Urinary Systems & In diabetic urinary incontinence bladder ant sense full bladder and u wont void all
Electrolytes content, so have a large post void residue
Renal, Urinary Systems & Clacineurin inhibitors mediated toxicity: see vacuolization (yea NOT BAD) If Acute
Electrolytes rejection: See lymphocytic infiltrations
Renal, Urinary Systems & Sirolimus bind to FKBP and this complex inhibits mTOR (signaling transduction)
11786 Immunology
Electrolytes hence inhibiting IL2 production
Rheumatology/Orthopedics
239 Pathology Rheumatic Fever kills by Pancarditis not MS
& Sports
457 Pathology PAN and hep B BIG DEAL
& Sports
Genetic Factors are the Strongest Prognostic factors for Osteoporosis (Being black is
627 Physiology the best protective factors, as it will give you better bone density than if you take
& Sports
extra Ca2+ or Exercice)
Black women have higher Bone Density and have lower risks of Fractures (Of
628 Physiology course). Lower BMI have lower Bone Density and higher risk of fracture (not what I
& Sports
thought)
634 Pathology Hemiballism involves extremties
& Sports
Indicators of: Osteoblastic activity: Bone-specific Alkaline Phosphatase Osteoclastic
638 Physiology activity: Tartrate-resistant acid phosphatase, Urinary Hydroxyproline and Urinary
& Sports
Deoxypyridinoline (most accurate one)
Paget disease: increased numbers of abnormal osteoclasts, excessive bone turnover
and abnormal bone remodeling (osteoblast here plays its role, but the initial problem
Rheumatology/Orthopedics is in osteoclast) Osteoclast are multinucleated (2-5 but 100's in Paget) cells arising
639 Physiology
& Sports from the fusion of many mononuclear phagocytic cells due to Macrophage
colony-stimulating factors (M-CSF) and Receptor for Activated Nuclear Factor
kappa-B Ligand (RANK-L) which are produced by Osteoblasts and BM stemal cels
646 Microbiology Kids get osteomylitis with staph
& Sports
Rheumatology/Orthopedics Churg Strauss also cause Mononeuritis due to involvement of the epineural vessels
667 Pathology
& Sports of peripheral nerves
699 Pharmacology Bisphosphonate are pyrophosphate analogues and inhibits oscteoclasts
& Sports
719 Pharmacology In RA DMARDs take a lot to work whereas Steroid and NSAIDs are about rapid relief
& Sports
721 Pathology Osteomylitis affect metaphysis of long bones (in children hematogenous osteo)
& Sports
Serum sickness is a type III hypersensitivity associated with monoclonal antibodies or
non-human Immunoglobulin (e.g: antitoxin) and sometimes with non-protein drugs
741 Immunology (penicillin, cefaclor, TMP-SMX). It is complement induced and get
& Sports
Hypocomplemtemia, and C5a will induce neutrophil chemotaxis, marginalization,
hence neutropenia.
752 Immunology HLA associated in diseases and stuf autoimmune are of class I. (HLA=MHC)
& Sports
Rheumatology/Orthopedics Monitor Ankylosing spondilitis by chest wall expansion (that is limited with advanced
753 Pathophysiology
& Sports disease leading to hypoventilation)
Rheumatology/Orthopedics Rheumatoid factor: Secreted IgM from plasma cells, against Fc receptors of IgG.
754 Immunology
& Sports Immune complex will deposit then
858 Pharmacology Colchicine inhibit tubulin polymerization hence inhibit lymphocyte migration
& Sports
982 Pathophysiology In Osteoporosis: Calcium, PO4 and PTH are Normal
& Sports
Rheumatology/Orthopedics Paget disease (increase osteoclast activity): bone pain, Increased ALKPhosph with
987 Physiology
& Sports mosaic pattern of lamellar bone.
1159 Histology Osteocyte connect together through Gap Junctions
& Sports
1168 Pharmacology Colchicine will cause GI symptoms (coz like chemo, inhibits microtubules)
& Sports
Rheumatology/Orthopedics Resting membrane potential is established by the high K+ Efflux and minimal Na+
1382 Physiology
& Sports influx. (Through non-gated channels)
Rheumatology/Orthopedics When have gas gangrene, its clostridiu perfringens and also can cause food
1394 Microbiology
& Sports poisonong (reheated meat) reheated rice: B. cerus
1450 Pathophysiology Gout is associated with Myeloproliferative disorders (e.g: polycythemia vera..)
& Sports
On electron micrograph the Z line appears much darker than the M line. And only the
Rheumatology/Orthopedics H band contains purely thich filament. And only the A band (corresponds to the
1664 Physiology
& Sports whole length of thick filament) is not variable in size and does not change during
muscle contraction
Rheumatology/Orthopedics In Oustretched hand fall u can have Scaphoid fracture or Lunate dislocation
1682 Anatomy
& Sports compressing Median nerve causing Numbness of hand
Rheumatology/Orthopedics Caudal agenesis (sacral agenesis): lower extremety paralysis (are smaller), Urinary
1684 Embryology
& Sports incontinence SEEN IN DM MOTHERS
Muscle: Type I fibers: Slow twitch, Require low level sustained force, have high
Myoglobin and Mitochondria so look red (rely on aerobic respiration); Postural
1858 Physiology muscles like Soleus, Paraspinal, Type II: Rapid Forceful movements. IIb: Anaerobic
& Sports
Glycogenolysis then Glycolysis (High Glycogen content). IIa: Fast twitch but with
Aerobic Respiration (Intermediate between Type I and Type IIb)
1874 Pathology Contracture: Fibroblasts with increase metalloproteinase
& Sports
1896 Pathology Parvo can imitate RA but is self limiting
& Sports
1956 Anatomy Femoral head is supplied by Medial Circumflex femoral Artery
& Sports
1969 Anatomy the fibula is lateral, and ACL goes towards inside (out to in)
& Sports
In Myastemia Gravis, the antibodies (act like Curare) will bind the Acholine receptors
and preventing ACh of opening cation channels (Na+, K+; they are within the ACh
Rheumatology/Orthopedics receptor), therefore we have a reduced motor-end plate potential. Unlike
2061 Physiology
& Sports Eaton-Lambert or Botulism (Block release. Of ACh from presynaptic terminal) the
synaptic ACh concentration is normal. Hemicholinium: block reuptake of choline into
presynapse depleting ACh stores in presynapse
In Mysthemia Gravis, the use of Cholinesterase Inhibitors is non selective therefore
increase the activity of ACh in muscarinic receptors too (Unwanted side effect).
2062 Physiology Therefore Scopalamine (so is Hyosciamine) is given which is a selective Muscarinic
& Sports
ACh receptor Antagonist (such as the gut, cramp, nausea, diarrhea, sweating).
Pilocarpine is a non selective ACh receptor agonist and reduces the side effects.
Rheumatology/Orthopedics If someone has increased PRPP production he will have increased purines and then
2090 Biochemistry
& Sports uric acid and gout
Skeletal muscle contraction: ACh will bind post synaptic receptors, opens
post-synaptic ligand-gated ion channels causing depolarization of muscle cells. Then
Rheumatology/Orthopedics Ca2+ is released from SR. Ca2+ will bind to Troponin on the C site (Troponin C:
7592 Physiology
& Sports Ca2+ binding site, Troponin T: attaches Troponin to Tropomyosin, Troponin I:
attaches Troponin-Tropomyosin complex to Actin) When bound to Ca2+, it will rotate
tropomyosin exposing Actin's myosin binding site allow Actin-Myosin interaction
Golgi tendons system (at muscle-tendon junction) are sensitive for Active stretch in
Rheumatology/Orthopedics Muscles , and is a feedback system that monitor and maintains muscle force. (not
8266 Physiology
& Sports passive ones).they are responsible for the involuntary release of weights when hitting
the gym, to prevent muscular injury.
8523 Pharmacology mab: Monoclonal AB cept: reCEPTor molecule nih: kinase INHbitor
& Sports
Annular ligament is fucked up when a childs arm is being stretched in extended
8579 Anatomy pronated position like i used to do to Karim. Patient will be in extended pronated arm
& Sports
position, wont be able to move it again. Reduce it by flexing and supinating
Rheumatology/Orthopedics Scaphoid fracture in outstrectched hand can lead to avascular necrosis and it is the
8670 Anatomy
& Sports most common complication
10930 Pharmacology Calcium bicarb when given need acidic invironment for Ca to be absorbed
& Sports
Dronate inhibit osteoclast mediated resorption (similar to pyrrophosphate and bind to
11564 Pharmacology hydroxyapatite) so osteoclast that is eating bone takes dronates andd dont adhere
& Sports
on more bone for resorption
Rheumatology/Orthopedics in polymyositis: have ANA ANTI JO-1 (aka anti histidyl tRNA synthestase DAA
& Sports FUCKKKKKKK)
Rheumatology/Orthopedics MC cune albright: mutatuin in GNAS gene CAfe au lait, precocious puberty and
11653 Pathology
& Sports fibrous dysplasisa
11684 Anatomy Extensor muscle of the wrist attach on lateral epicondyle it is a bit intuitive
& Sports
In sciatica there is compression of the sciatic nerve in the Greater sciatic foramen
11727 Anatomy often due to HYPERTROPHY OF PIRIFORMIS MUSCLE (passes in the canal;
& Sports
involved in extrnal hip rotation)
11749 Pharmacology Azathiprine-> 6MP-> purine metabolism so if give ALLopurinolu inhibit this
& Sports
11770 Pathophysiology Temporal arteritis is cell mediated with production of cytokines (IL6..)
& Sports
11799 Anatomy Injury of ankle (inversion) think only of talofibular
& Sports
Rheumatology/Orthopedics Penis drains in superficial inguinal nodes excpet for gland which drain into deep (coz
11830 Anatomy
& Sports very sensitive and goes deeeep)
Behavioral Social Sciences
1125 A woman having tubal ligation is not required to have her partner's consent
science (Ethics/Legal/Professional)
Behavioral Social Sciences PCP should educate about exercice, smoking cessation etc. while the attending at
1235
science (Ethics/Legal/Professional) hospital should DNR DNI objectives to very sick patients
Behavioral Social Sciences When a patient refuses to know his diagnosis before directly accepting dig further
1237
science (Ethics/Legal/Professional) and ask why
Behavioral Social Sciences Eventhough people have full authorities on themselves you are to report suicidal
1238
science (Ethics/Legal/Professional) plans, or someone with EBV willing to play rugby (risk of splenic rupture)
Behavioral Social Sciences Eventhough pregnancy stuff are not be adressed to parents in minor, abortions
2057
science (Ethics/Legal/Professional) should be adressed to parents.
2058 Drunk people who want to leave the ER are not allowed to do so until they get sober
2059 Patient has the right not to know informations
Behavioral Social Sciences If Dr. is not comfortable with patient's decision he has the right to refer to another Dr.
7767
science (Ethics/Legal/Professional) who is comfortable with doing what the patient wants. (like Abortions)
10290 Hospice care is for people with life expectancy of less than 6 months from now
10463 Drs. should not receive gifts, unless of token values (less than 10$; cookies etc.)
Behavioral Social Sciences Romantic relationships with patient is inapropriate and it is even inapropriate to ask
10464
science (Ethics/Legal/Professional) the patient to change Dr. then date her.
10488 Dont rely on a translator if hes not professional when it comes to consents and stuff
If a colleague asks you about a patient in the elevator, tell him that you'll discuss it
10509 later with him, but don't demean him by telling him that you cannot discuss it and that
it is against policy
Behavioral Social Sciences In minors Call Ethic Commity if it is really not clear what to do, but if it's clear get a
10533
science (Ethics/Legal/Professional) court mandate to go for treatment
Behavioral Social Sciences A health care proxy (signed on paper) beats any relative or person when taking
10534
science (Ethics/Legal/Professional) decision to unconscious patient
If someone passed out and his friend said that the patient doesn't want resuscitation
10542 don't believe him unless he has an official note from him or he is designated the
health proxy
Unlike real life, consent forms should be obtained by the physician performing the
10545 procedure as he is most qualified to describe the procedure, its complications and to
answer the patient's questions
Behavioral Social Sciences If you can't educate an illeterate (or low education level) patient about his disease
11518
science (Ethics/Legal/Professional) use alternative learning methods like visual recources

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