Day 1 Quiz 1

Cushing’s syndrome elevation cortisol

Conn’s syndrome elevation of aldosterone

Addision’s decrease in aldosterone and cortisol

Grave’s disease increase in thyroid hormone

Function of Mackonkey’s: have crystal violet and bile salts, both inhibit growth of gram positive so only gram negative will be able to grow in Mackonkey’s agar. Lactose is the only carbohydrate found here. It has neutral red stain. Combination of these two from pink colonies on Mackonkey’s agar by fermenters. While non-fermenters form other color, or white color colonies.

Pink colony – lactose fermentors – gram negative

Medication to treat Glaucoma: alpha agaonist, beta blockers, diuretics – carbonic anhydrase inhibitors or manitol, cholino mimetics, and prostaglandin F2 alpha.

Facial angiofibroma, ash leaf spots-skin depigmentation, history of seizure, MR. What condition this patient have? And what neoplasm the patient at risk of developing?

- Tuberouscleorsis- Neoplasm: cardiac rhabdomyoma, astrocytoma, and angiomyolipoma

Cause of achalasia?

- It is where you lose your myenteric auer baux pleux, therefore, lower esophageal sphincter is unable to relax.

- How is it diagnosed: “bird peak” appearance with barium swallow

Leading causes of death:

- Ages 15 - 24: injury, homicide, suicide, cancer and heart disease - Ages 25 to 64: cancer, heart disease, injury, suicide, and stroke

Which glomerular disease would you expect to see in the following changes:

- Anti GBM [glomerular basement membrane] antibodies on immune florescence Good pasture syndrome

- Hemyto Wilson lesion on light microscopy diabetic nephropathy- Spike and dump appearance on EM membranous glomerulonephritis- Trum tracks of sub endothelial humps on EM membrano proliferative glomerulonephritis- Subendothelial humps on EM acute post streptococcal glomerulonephritis

Clinical use of metronitrozole:

- GET GAP ON THE METRO- GET: Giardia, Enteromeba, Trachamonoas- GAP: Gardinella Vaginalis (cause bacteria vaginalis), Anarobes, H. pylori

Two most common complications after an MI:

- (1) cardiac arrhythmia -- ventricular fibrillation- (2) left ventricular failure – pulmonary edema – CHF symptoms

What is Tressour syndrome

- It is an autoimmune disease- It occurs weeks after an MI- Result in fibrinous pericarditis

Cause of granulomatitis disease:

- Lack of NADPH oxidase activity which is critical for phagocytosis. Therefore neutrophil cannot phagocytosis things

- Consequences: these individuals are susceptible to opportunistic infections like staph. Aureus, e.coli, and aspergillous

What is WAGR complex?

- Seen with the Wilm’s tumor- Wilm’s tumor - Aniridia - congenital lack of iris, have huge pupil for an eye- Genito urinary malformation- Retardation – both mental and motor

Wilm’s tumor:

- Most common tumor of early childhood, ages 2 -4- May or may not have WAGR complex

5 classes of drug to treat glaucoma:

- Alpha agonist- Beta blockers- Cholino memetics- Diuretics : manitol and carbonic anhydrase inhibitors- Prostaglandin F2 alpha

How does blood pressure response to administration of phenylephrine:

- Have alpha blockers administered before hand and phenylephrine is an alpha one agonist. Therefore no change in blood pressure. When epinephrine is administered, you get rid of alpha 1 vasoconstriction, un mask the beta 2 dilation, therefore drop in bp when epinephrine and phenylephrine are on board.

Common side effects of beta blockers:

- Amphetanes, asthma exacerbation, bradycardia, AV block, worsening of heart failure, sedation, sleep alteration,

- Asthma/diabetic/low bp/ bradycardia/on CCB – mirapamil more likely to get heart bloc, not CI but cautioned. Also cocaine users shouldn’t go on it

- Dopamine: shock- Quinidine: hypertension, induce sleep on pediatric patients who are on amphetamines for

ADHD- Amphetamines: obesity, ADHD, narcolepsy, major depressive disorder (sometimes)- Terbutaline – asthma, also turcolysis - to stop uterine contraction- Epinephrine – anaphylaxis, also for injection during a procedure, for example with lidocaine

– vasoconstrict the vessels in the area so lidocaine doesn’t disperse fast.

Drugs:

- Losartan – angiotensin 2 receptor blocker (ARB)- Vecuronium – non-depolarizing neuro muscular blocking agents- Tegirocillin – penicillin- Resepiramine – TCA, anti depressant- Alopril – ACE inhibitors- Lorazepam – benzodiazepine- Trozyquisidone – increases cellular response to insulin

Argo Robertson pupil:

- Neurosyphilis- Doesn’t Constrict to light but constrict to accomadation

Antimitochondrial Antibody: Seen in primary biliary cirrohosis

Bloody tap on LP – sub arachnoid hemmorrhage

Babinzki sign: UMN lesion

Atrophy of mamillary bodies: cause Wernicke’s encephalopathy, associated with alcohol use

Basophilic stippling of RBC seen with lead poisoning

Benz Johns protein – Multiple myeloma, immunoglobulin in urine. Also seen in Walder strong macroglobular anemia

Cherkov’s triad:

- Seen with multiple sclerosis: Nysthagmus, intention tremor, and cant speak- For choliangitis: jaundice, right upper quandrant pain, and fever- 0steogenesis imperfects – blue sclera

Nerve damage :

- Claw hand – ulnar nerve- Wrist drop – radial nerve- Winged scapula - long thoracic nerve- Loss of abduction or adduction of fingers: ulnar nerve- Systemic Dorsai – thoraco dorsai nerve- Loss of pronation - median nerve- Weak lateral rotation of the arm – super scapular/axillary nerve- Loss of abduction beyond 10 degress – axillary nerves (innervates deltoid)- Loss of arm flexion – musculocutaneous- Loss of arm extension – radial- Unable to raise arm above and horizontal - long thoracic or spinal accessory (because long

thoracic and trapezius is involved)

Day 2 Quiz

Direct cholinergic agonist: carbacol, bethanacol, and pilocarpine

Indirect cholinergic agonist: neostigmine, edrophonium, epithiophate, tacrine , dinapizole

Cholinergic antagonist: atropine, epitropium, scolapamine, and binztropine, oxybutrine, and glyobutrelate

Nicotinic antagonist - Hexymethonium

Cholinesterase regenerator – pradoxine

Alpha 1 and 2, beta 1 and 2 agonist: epinephrine, norepinephine, dopamine, isoprotenelol

Beta 2 trebutaline

Primarily alpha 2 phelyephrine

Alpha blockers – tarazosine, prasazosine, phenoxy benzamine, and phentolamine

Beta 1 blockers – non selective: N-Z propanolol, timolol, and etc

Beta 1 selective: A-M esmolol, metoprolol

Agents that release norepinephrine from the pre synaptic neuron: amphetamine, tyromine

Potentiate norepinephrine by inhibiting its reuptake: cocaine, and TCA

Bamboo sign on xray: ankolysing spondylytis

P-ANCA – microscopic polyangitis, Chrugg Struav syndrome, not seen in polyarthirits nodosa

Ashkoff bodies – rheumatic fever

Auer rods – AML

Autosplenectomy – sickle cell patients, infarction crisis

Bushach nods – proximal interpharyngeal joint swelling due to osteophites in osteo arthirits

Day 3 Quiz

x-ray: pass on both side of the corona: sarcoidosis bilateral hilar lymphadenopathy

antiplatelet antibody : idiopathic thrombocytopenia purpura (ITP)

new born with chronic diarrhoea, failure to thrive, and chronic candida - SCID

child with eczema, coarse facial features, cold abcesses – hyper immunoglobulin E syndomre, also known as Job’s syndrome

child with partial albinism, peripheral neuropathy, and recurrent infection is Chedaki Kaussi disease

alpha agonist used for pheochromocytoma? Phenoxybenzamine and phentolamine

clinical use for the following Antimuscarnic:

- ipitorpium: COPD, asthma- Atropine, atropicamide- induce mydriasis and cycloplegia- Benztropine – Parkinson- Scolapine – motion sickness

Linear decrease: zero order elimination

Obligate intracellular bacteria: chlymydia and ricketsia stay inside because of cold, they cant replicate extracelluarly because they cant make their own ATP. Other intracellular bug is Legionella.

Spore forming bacteria: clostridium and bacillus species, and Coxellia

Day 4 Quiz

Encapsulated bacteria: strep. Pneumonia, bacterial meningitis, hemophillus influenza, and klebsiella influenza. Have Quellung reaction to detect these, capsular swelling.

Shock:

- Anaphylactic shock - Epinephrine - cardiogenic shock - Dobutamine - septic shock – norepinephrine (vasoconstriction)

organ transplant rejection:

- hyperacute rejection preformed antidonor antibodies (times frame: within minutes, seen in OR)

- acute rejection T cell mediated (occur within weeks)- chronic rejection antibody mediated vascular damage, taking place over months to years

Which antibiotics are used in narrow spectrum anaerobic coverage? Metronitrozole and quindoniacine

Alpha adrenergic to treat pheochromocytoma? Phenoxybenzamine and pentolamine

Brachial plexus is injured:

- C5 – C6 nerve root / the superior trunk- symptoms: loss of abductor, fixed adduction, lose your lateral rotators, and biceps,

therefore consequently in adduction, medial rotation and pronated

epinephrine and norepinephrine bind to adrenergic receptors:

- vascular smooth muscle: alpha 1 and beta 2- renal vasculature: D1 receptors for vasodialtion- heart – beta 1- pulmonary bronchioles – beta 2- pre synaptic neuron – alpha 2- papillary sphincter – alpha 1 which causes mydriasis- kidney – beta 1 rennin release, which elevate the blood pressure- beta cell of the pancreas – alpha 2, inhibit insulin release- alpha cells of the pancreas - beta 2 increase glucagon release- presence of E and NE, increase glucagon and decrease insulin, which make sense for flight or

fight response increase glyconeogenesis and gluconeogenesis

eythmya migrans expanding bull’s eye B. Bourdergilli or Lyme disease

hepatic steatosis -- Fatty liver – alcohol use, metabolic syndrome- NAH, HIV drugs – didanozine, stavudine

HLA B-27 – psoriac arthirits, ankolysing spondylitis, inflammatory bowl disease arthirits, and Writer;s syndrome

Isenmenker complex

- late cyanosis- uncorrected L to R shunt becomes a R to L shunt bypass pulmonary circulation

Lung disease with glomerular pathology Good pasture and Wegner

Elevated hCG:

- h for hydatiform mole- C for choriocarcinoma- G for germ cell tumor – testiculochoriocarcinoma- Also in pregnancy

TH1 IL1, and IN gamma

TH2 IL4, 5, and 10

G proteins:

- Gq activated phospholipase C p.227- Gs activate protein kinase A- Gi inhibit adenlyl cyclise

“ain” inhaled anesthetic

“zine” phenothiazine neuroleptic

“tidine” H2 antagonist

Tropine pitutitary hormone

Pindozole anti parasitic drugs used for worm infection

Azepam benzo drug

Azole anti fungal, conozole

Tryptilline CCA

Stigmine anticholine esterases

Endipine dihydro puridine CCB, ex. Nifidipine

Day 5 quiz

Antidepressants:

- SSRI: fluoxitine, sertiline, fluoximine,- TCA: nipiramine, amotryptilline, disipriline, nortyrptoline, chomiprine, and docipine- MAOI: phenothin, tranozipine, telegyline- NDRI: bupropione- SNRI: deloxitine, menosiprine, nefosipine

Drugs dissociative curve: how does it change compare to competitive vs. Non competitive antagonist:

- Non competitive antagonist decrease V max, shift the max velocity down which decrease the efficacy

- Competitive inhibitor increase your Km, shifting the curve to the right, need larger amount of substrate which decrease the potency

Chocolate cyst endometriosis

Increase protein in CSF and modest increase in cell count albumin cytologic dissociation

Brush field spot small white spots in the periphery of the eye lids in down syndrome patients

Kaychser flexor ring yellow – gray pigments in cornea margin Wilson’s disease

Lysh nodules or pigmented iris hematomas neurofibromatosis

Hemoster Wilson nodules glomerular diabetic nephropathy

Ashoff bodies theccal myocardial cell inflammation you see in Rheumatic fever

Nerve:

- Shaft to the femor – radial nerve- Neck of the femor – axillary nerve- Supracondylor of femor – median nerve- Medial epicondyle – ulnar nerve- Anterior shoulder dislocation – axiallry nerve- Injury to carpal tunnal – medial nerve

Phagocyte immunodeficiency

- Chronic granulomatosis disease - Chedake – Kashe disease- Job’s syndrome – hyper immunoglobin E syndrome- Leukocyte adhesion deficiency syndrome

X linked deficiency:

- WBC- Wiscott Aldrich- Burton- Chronic granulomatosis disease- Another one: hyper IgM syndrome

Personality disorder:

- Grandiosity and lack of empathy Narcissitc- Suicide attempt with 15% mortality, unstable mood and behaviour - borderline- Odd appearance, thoughts and behaviour, no psychosis, social awkwardness is SCHIZOTYPAL- Controlling, perfectionist, orderly stubborn, criminality, unable to confide in social norms

anti social

Mode is the value of greatest frequency

Median divide the frequency of distribution into half

Mean is the average

Mean>Median>mode positively skewed curve

CD4 helper T cell

CD14 macrophages

CD16 macrophages or NK cells

CD19, 20, 21 B cells

CD3 seen on all T cells except on NK cells

CD8 cytotoxic T cell

Autistic disorder

- Below normal intelligence- Poor communication, social skills and repetitive behaviour

Asperger syndrome

- Similar to autistic but more social skills problem

Rett disorder

- Primarily affect female/ female are the only one to survive it. Also similar to autisim- Loss of developmental characteristic hand wringing

Day 6 Quiz

Heart defect:

- Chromosome 22 q 11 deletion H22 syndrome associated with Digeorge syndrome (p.259)

- Down syndrome endocardial cushion defect can lead to ASD and VAD or abnormal communication between atria and ventricle

- Congenital rubella causes PDA or pulmonary artery stenosis- Turner syndrome coarction of the arota- Marfan syndrome aortic insuffiency

CN innervations the tongue:

- Ant 2/3 facial nerve- Post 1/3 glossopharnygeal nerve- Motor hypoglossal nerve- Sensation ant 2/3 V3 – mandibular division of trigerminal nerve

Post 1.3 glossopharyngeal nerve

Rapid debreathing and dehydration patients with crusmall respiration

Rash, lower abdominal pain, and pain urination henoschuff purpura

Fat, female, forty, and fertile risk factor for actute cholecystitis

Optically clear nuclei / ground glass nuclei papillary carcninoma of the thyroid

Lumpy – bumpy glomeruli in IF post streptococcal glomerulonephritis

Painless jaundice pancreatic cancer in the head of the pancreas

ESR:

- ESR to rule out osteomyelitis (negative)- Poly niasal phrumatics and temporal arthirits ESR used clinically- Rheumatoid arthiritis clinical measurement of the disease

Toxic side effects of TCA:

- Cardiotoxic: tachycardia, conduction abnormality- CNS toxic: convulsion, sedation and coma - Confusion: result of anticholinergic SE

Antiseizure drugs that treat bipolar disorder:

- Valporic acid, lamorzipine, carbamazepine

Tetreacycline: VACUM YOUR BEDROOM [Vibriocholera, Acne, chylmydia, uroplasma urolecticum, mycoplasma pneumonia, tularaemia, H.pylori, B. Borgetti, rickettsia]

Macrolides: PUS Pneumonia, URI (Gram positive cocci – eg. Strep pyogenes), STD (Neisseria Gonnorrhea)

Second generation cephalosporin: HEN PEKS H.influenza, Enterobacter, Niesseria, Protease mirablius, E.Coli, Klebsiella pneumonia, and Serasus marsesnus. Also don’t forget gram positive cocci.

Symptoms of organophosphate poisoning: DUMB BELLS Diarrhea, Urination, Miosis, Bronchospasm, Brachycardia, Excitation of CNS and skeletal muscle, Lacrimation, salivation, Sweating, abdominal cramping, get leaky everywhere

Extra ocular movement during REM sleep PPRF

Day 7 Quiz

SE of ACE inhibitors:

- Hyperkalemia- Cough- Angioedema- Taste changes- Hypotension (too much)- In preganacy: renal damage to fetus- Can cause rash and elevate your rennin

What protozoal:

- Undercooked fish and inflammation of biliary tract: cholarnic sinosis- MC proteazol infection in US: Giardia lamdia, if its a helmet, then it would be pinworm- Chaga’s disease – T. Cruzii- Common helminth infection in US E. Vermiculis/pinworm- Snail host/swimmer itch cystosoma mansoni- Diarrhea in campers and hikers Giardia lambdia- Transmitted in draw meat, cat feces toxoplasma gondii

Pathology:

- Chronic atropic gastritis cause pernicious anemai, predispose you to gastric carcinoma- Cold intolerance hypothyroidism which can cause myxedema- Branching rods and oral infection actinomyces isralii- Eczema, recurrent infection, thrombocytopenia Wiskott Aldrich syndrome- Hemecytinuria and thrombosis Paraxysomal Nocturnal Hemosidurinia (PNH)- Dermatitis, dementia, diarhhea, death pellagra, Vit D3/ninacin deficiency

Medications for Parasitic infections of most malarias sulfadoxcine + purmethimine, methyliquine, quinine + doxycycline, vivaxine ovale chlroquine + primaquine . Pinworm/round worm: mepindizole or pyrantle pymoid

Positive symptoms of schizophrenia (adding something):

- Hallucination, delusion, strange behaviour, lose association

Negative symptoms of schizophrenia (taking something away):

- Social withdrawal, flat affect, thought blocking, poor motivation, poor grooming, alogia (poverty of speech)

Different immunodeficiency

- Neutrophils fail to respond to chemotactic stimuli both Job’s syndrome (hyperimmunoglobulin E) and leukocyte adhesion deficiency syndrome

- Adenosine deaminase deficiency causes SCID- Failure of endodermal development is diGeorge syndrome- Defected tyrosine kinase A – Burton A gamma globulinimia - Assc. With high level of IgE and eosinophils Job’s syndrome

Bacterias associated with following statement:

- Cat scratches – Bordenella kensiella- Dog/Cat bite – pasturella multocida- Cat feces – toxoplasma- Dog feces (?)- yersinia enterocolitica- Animal urine – lepto splera

Seven....(p.122)

(1) Alcohol(2) ACE inhibitors(3) Diethyl diesterol(4) Vitamin A(5) Pheletamide(6) X-ray, anticonvulsants, warfarin, tetracycline(7) Alkylating agents, anticancer drugs, aminoglycoside, folate antagonist – methotrexate, lithium,

floroquinilones are all example of teratogons

Lipid lowering agents:

- Facial fleshing niacin- Elevated LST and myocytes fibroids, HMH CoA reductase inhibitors- GI discomfort, bad taste bile acid binding resins- HDL niacin- Effect TG and VLDL fibrioid- LDL and cholesterol HMG CoA reductase inhibitors statin, cholestyramine-