   Huntington’s
   Fragile X
   Myotonic Dystrophy
   Prader Willie
   Spinal/bulbar muscular atrophy (Fredicks ataxi...
   Aortic Arch
   Upper Esophagus
   True Vocal Cords
   Cilia
•Myositis
    •1 muscle hurts
•Polymyocytis
    •Bunch of muscles Hurt
•Dermatomyositis
    •HELIOTROPIC RASH + muscle pai...
   RIPS

   Rifampin
   INH
   Predinsone
   -Statins
   Hypothyroidism (Hashimoto)
   Cushing disease
   T. Spiralis
   Arylsulfatase deficiency
     Metachromatic leukodystoryphy
   G6-PD
   CGD
   Pyruvate dehydrogenase Def.
   Fabry’s
   Hunter’s
   Lesch-nyhan
   Decreased Protein
     WHY?
     ▪   Decreased intake
     ▪   Cirrhosis
     ▪   Nephrotic Syndrome
     ▪   Merrent...
   Kidneys ( at all times )
   Diabetes Mellitus
   Riley-Day Syndrome
   Shy-Dragger Syndrome
       CLUES?
        ▪ Pt. gets up and passes out
   Sick Sinus Syndrome
   Pituitary adenoma
     White nipple discharge = most likely milk due to
     increased prolactin
   Ileum
   Sigmoid Colon
   Choanal atrasia
     Turning blue on breast feeding
   C-Type Esophageal Atresia
   Duodenal Atresia
     Down syn...
   Pyloric stenosis
   Achalasia
   Intussuseption
     CLUES
      ▪ Knees in chest
      ▪ Sausage shaped mass
      ▪ Current jelly Stool
   Adhesions
   Internal Hernias
   Hirschsprung’s Disease
   Adhesions
   Adhesions
   Obstruction
       Cannot move stool

   Diverticulitis
   Cancer
   Mesonephrons
   Reticulonodular appearance
   May progress to Honey comb lung
   Gradual onset dyspnea, first evident only on
    ex...
   OA
   Septic Artheritis
   Crystal induced(GOUT)
   RA
   Viral
   SLE
   Ankylosing spondylitis
   Gonoccal Artheritis
   Rheumatic Fever
   Lyme Disease
   LH
   FSH
   TSH
   DM type 2
   Niacin
   HPL ( Human Placental Lactogen )
   Acanthosis Nigracan
   Because of the LIVER
   Polyhydramnios
   Reily Day Syndrome
     Baby cries but no tears
   Werdnig Hoffmann disease
     Fasciculation is a newborn
   Oligohydramnios
   CC LL S

   Chagas Disease (Whipple’s)
   C. Diptheria
   Lyme Disease
   Legionella
   Salmonella typhii (typhoi...
   CC S Y

   Crohn’s
   Chlamydia
   Shigella
   Yersina
   I AM HE

   Influenzae
   Adenovirus
   Mycoplasma
   Hepatitis C
   EBV
   H I PPPE

   Hydralazine
   INH
   Phenytoin
   Procainamide
   Penicillamine
   Ethosuximide
   ABC V

   AZT
   Benzene
   Chloramphenicol
   Vinblastine

   Vinblastine Anilate Bone Cells
   Vibrio
   Campylobacter
   Listeria
   H. pylori

   Campylobacter Has Very Long Comma Genes
   Giardia lamblia
   Corynebacterium Diptheria
     CLUES
     ▪ Grey membrane
     ▪ Inhibits EF-2
   RESPI

   Rifampin
   Ethambutanol
   Streptomycin
   Pyrazinamide
   INH
   C SSS PM
   Cryoglobinemia (I AM HE)
   Serum Sickness (Type III hypersen.)
   SLE ( ANA, Anti-ds-DNA, Anti-Smith)
...
   C (SEE) ! QT(CUTIE) BRAGS because she can induce p450

   Carbamazapine

 Quinidine
 Tetracycline

   Barbiturates...
   I Do SMACK      INH
    Quinolones      Dapsone
                    Spirolactones
                    Macrolides
 ...
   WET DumP

   Warfarin
   Estrogen
   Theophylline

   Digoxin
   u
   m
   Phenytoin
   CGD
   Chronic Granulomatous disease
   NADPH Oxidase deficiency
   Myositis
   Hepatitis
   Increased liver enzymes
   Chancroid
   Herpes
   Lymphogranuloma inguinale
   Haemophilus ducreyi
   Cystine
   Methionine
   Mercaptoethanol
   PI IG (pig)

   Prolactin
   Insulin
   Inhibin
   GH
   PI IG (pig)

   Prolactin
   Insulin
   Inhibin
   GH

   Because Cystine makes disulfide bonds
   Mercaptoethanol cuts where?
   Cuts to R of: disulfide bonds
     Cysteine
     methionine
CLAM

   Chloramphenicol
   Lactams
     Cefamandole
     Cefoperazone
   Antabuse
     disulfiram
   Metronidazole
   When do you see elevated ESR?
     Non-specific inflammation
   When do you see Falsely high ESR?
     Anemia
   W...
   Amyloidosis
   AA
     Acute inflammatory Disease
   AB
     Alzhiemer’s Disease
   AB-2
     Chronic Renal Failure
   AE and A...
   Fibroblasts
     Simple scarring
   Myofibroblasts
     Wound contraction
   NEAT ASs Hooks

   Necatur americanis
   Enterobius vermicularis
   Ankylostoma duodenale
   Trichuris trichurium
...
   Please      PKU
   Check       CAH(Congential Adrenal Hyperplasia)
   Before      Biotinidase
   Going       Ga...
   HLA-DR2
      ▪ Narcolepsy
      ▪ Allergy
      ▪ Goodpasture’s
      ▪ MS
   HLA-DR3 ( CC D SS )
      ▪ Celiac Spr...
 HLA-DR4
   Rheumatoid Arthritis,
   Pemphigus Vulgaris
 HLA-DR5
   JRA
   Pernicious Anemia
 HLA-DR7
   Nephrotic...
   HLA-DR 3 & B8
     Celiac Disease
   HLA-A3
     Hemochromatosis
      ▪ (ch 6, point mut.- cysteine > tyrosine)
 ...
   HLA-B27= (PAIR)
       Psoriais(only if w/arthritis)
       Postgonococcal Arthritis
       Ankylosing Spondylitis,...
   Kills helper T-cells & eosinophils
   Inhibits Macrophage migration
   Inhibits Mast cell degranulation
   Inhibits...
   STELS

   Salmonella (typhoid)
   TB
   EBV
   Listeria
   Syphillis
   UTI
   Spontaneous bacterial peritonitis
   Abdominal abscess
   Cholecystitis
   Ascending cholangitis
   Append...
   Ceftriaxone
   Cefixime
   Cefoxine
   Ciprofloxin
   Oflaxacin
   Gatifolxacin
   Azithromycin
   Strep bovis
   Clostridium melanogosepticus
   Bacteriodes fragilis
   Clindamycin
   Metranidazole
   Cefoxitin
   Strep. Bovis
   Clostridium melanogosepticus
   K+?
   Decreases
   Na+?
   Decreases
 Cl-?
 Decreases

   pH?
   Increases
   BP?
   Increases
   Calcified CA’s
   PSAMMoma bodies

   Papillary carcinoma of the Thyroid
   Serous cyst Adenocarcinoma of the ovary
   Meningioma
  ...
   P PUNCH

   Proteus
   Pseudomonas
   Ureaplasma urealyticum
   Nocardia species
   Cryptococcus neoformans
   H...
   Struvite (90%)
   swarming
   Brain
     Microglia
   Lungs
     Type I Pneumocytes
   Liver
     Kuffler cells
   Spleen
     Reticuloendoth...
   Kidney
     Mesangal Cells
   Bone
     Osteoclast
   Lymph Node
     Dendritic Cells
   Skin
     Langerhan Ce...
   Intractable pain
   Hemorrhage (massive)
   Obstruction (from scarring)
   Perforation
   Adriamycin (Doxyrubicin)
   Phen-fen
   Dozaroxsin
   #1 = Virus
   #2 = Drugs
   High Fever
   Rose spots (rash)
   Intestinal fire
 Some          *Strep. Pneumo (gr+) MC
 Strange       Salmonella
 Killers
                Klebsiella
 Have
 Pretty...
   Spleen
     Think!!! splenectomy pt. with infections
   SubQ nodules
   Polyarthritis
   Erythema marginatum
   Carditis
   Chorea
   Neoplasms
   Allergies/Asthma
   Addison’s Dz
   Collagen Vascular Dz
   Parasites
B.S HAVE CASH

   Benzene
   Schistomiasis

   Hep B,C,D
   Aflatoxin
   Vinyl chloride
   Ethanol

   Carbon Tetra...
   MMR OR SBYV
   Measles
   Mumps
   Rubella
   Oral Polio (sabin)
   Rotavirus
   Small pox
   BCG
   Yellow fe...
   RIP Always    Rubella
                  Influenza
                  Polio ( salK ) [Killed]
                  HAV
   Henoch-Schoenlein P. (HSP)
   Alport’s
   Berger’s
   PCN
   α-methyldopa
   Cephalosporins
   Sulfa
   PTU
   Anti-malarials
   Dapsone
   ASA
   Heparin
   Quinidine
   T CAL

   Troponin I
   CKMB
   AST
   LDH flip
   T CAL

   Troponin I
     Appears     2 hrs
     Peaks       2 days
     Gone        7 days
   T CAL

   CK-MB
     Appears    6 hrs     6 x 1 =6
     Peaks      12 hrs    6 x 2 = 12

     Gone       24 h...
   T CAL

   LDH1
     Appears    1 day
     Peaks      2 days
     Gone       3 days
   HUMORAL                        CELL MEDIATED
     Blood sample                   Tissue sample ( BIOPSY)
     B-Ce...
   Brain
     Microglia
   Lungs
     Type I Pneumocytes
   Liver
     Kuffler cells
   Spleen
     Reticuloendoth...
   Kidney
     Mesangal Cells
   Bone
     Osteoclast
   Lymph Node
     Dendritic Cells
   Skin
     Langerhan Ce...
Cell
 mediated




Humoral
immunity
   Legionella
   Pneumocysitis carinii
   H. pylori
   Bartonella henseslae (lymph node)
   Candida (yeast)
   Sulfonamides
   Sulfonylurea
   Celebrex
   *Celecoxib
   COX 2 specific
   Vioxx (Rofecoxib)
   Pyremethamin/Sulfadiazine
   Trimethoprim/Sulfamethoxazole
   Bleomycin
   Bulsufan
   Amiodarone
   Tocainide
   Chediak-Higashi
   NADPH-oxidase deficiency
   Hyperglycemia
   Hyperuricemia
   Hypovolemia
   Hypokalemia
   OH DANG      Ototoxicity
                 Hypokalemia

                 Dehydration
                 Allergy
     ...
   MR       Decrease on inspiration (^exp)

   TR       Increase on inspiration

   VSD      Decrease on inspiration...
   Brain            Mircoglia
   Lung             Type I pneumocyte
   Liver            Kupffer cell
   Spleen     ...
   RC KT SSS
   Rocky Mountain Spotted Fever
   Coxsackie A (Hand/Foot & mouth dz)
   Kawasaki
   TSS
   Syphillis
...
   Tachypnea
   Decrease pCO2
   Decrease pO2
   Increase pH
   cAMP
   cGMP
   IP3/DAG
   Ca:Calmodulin
   Ca+
   Tyrosine kinase
   NO
   It is the 90%
   Sympathetic
   CRH (cortisol)
   Catabolic
   Parasympathetic
   Anabolic
   Neurotransmitter
   GHRH
   All hypothalamic hormones xc cortisol
   Used by what and for what?
      ▪ Smooth musc...
   Used by smooth muscle for contraction by
    distention
   Used by Gastrin only
   Used by Insulins
   Used by ALL growth factors
   Nitrates
   Viagra
   ANP
   LPS
   AR
   Defect in LFA-1 integrin proteins on phagocytes
   Absent pus formation
   Delayed separation of umbilicus
 ...
   WAS
   SCID
   CVID
   HIV
   HTLV-1
   X-linked defect in the ability to mount an IgM response to capsular
    polysaccharides
   (Aldrich = ↑ IgA)
   norm...
   Framshift/Nonsense mutation
   Adenosine deaminase deficiency
   T-cell>B-cell
   Bacterial infections
   Fungal i...
   Late onset
   Frameshift/Missense mutation
   Normal numbers of circulating B cells
   Tyrosine Kinase deficiency
   T-cell>B-cell
   CD4 rich
   Brain
   Testicles
   Cervix
   Blood vessels
   Amytal
   Rotenone
   Malonate
   Antimycin D
   CN-
   CO
   Chloramphenicol
   Oligomycin
   DNP
   Free Fatty acids
   Aspirin
   Physical uncoupler
   Plasma
   Urea cycle
   Collecting ducts
   Glutaminase
 Azithromycin
  1 gram po
 Ceftriazone
  250 mg im
   Azithromycin
    1 gram po
   Ketoconazole
    150mg
   Difluccan
    1 pill
   Metronidazole
    2 grams
   Metronidazole
    2 grams
 Ceftriaxone
  250 mg im
 Cefixime
  400 mg po
 Cefoxitin
  400 mg po
 Ciprofloxacin
  500 mg po
 Ofloxacin
  400 mg po
 Gatifloxacin
  400 mg im
   Phosphorylase (Pi)
   Debranching enzyme
   Alpha-1,6 –Glucosidase
   Phosphatase
   Glycogen synthase
   Branching enzyme
   Glycogen alpha-1,4 glycosyl transferase
   Glycogen alpha-1,6 glycosyl transferase
   Phosphorylase (Pi)
   pO2?
     Normal
   pCO2?
     Normal or increased
   pH?
     Decreased
   pO2?
     Decreased
   pCO2?
     Decreased
   pH?
     Increased
   Respiratory acidosis
 Fabry’s                       α – galactosidase
 Krabbe’s                      Galactosylceramide
 Gaucher’s        ...
   PAIR

   Psoriasis
   Ankylosing spondylitis
   IBD (Ulcerative colitis)
   Reiter’s Syndrome
   HLA-13
   Von Gierke’s      Glucose – 6 – phosphate

   Pompe’s
                      α – 1 – 4 glucosidase

   Cori’s      ...
   Pyruvate?
     Glycine
     Alanine
     Serine

   Acetyl CoA ?
     Phenylalanine
     Isoleucine
     Threon...
   Alpha-KG ?
   Glutamate
   Glutamine

   Succinyl CoA?
   Phenylalanine
   Tryptophan
   Tyrosine
   Fumerate ?
   Proline

   Oxaloacetate?
   Aspartate
   Asparigine
   Oxidation – 7 NADH – 21 ATP
   Hydration
   Oxidation - 7FADH – 14 ATP
   Thiolysis – 8 AcCoA – 96ATP
             ...
   pO2?
    Decreased
   pCO2?
    Decreased
   PCWP?
    Decreased (b/c it’s a pressure problem)
   Respiratory Rate?...
   ACTH
   ADH
   PTH
   TSH
   ANP
   Anti-smith
   Anti cardiolipin
   Anti-ds DNA

     SLE
   Anti – histone?

   Drug induced SLE
   Anti-topoisomerase?

   PSS (Progressive Systemic Sclerosis)
   Anti TSH receptors?

   Graves
   Anti-centromere?

   CREST
   Anti-GBM?

   Goodpasture’s
   Type IV collagen
   Anti-mitochondria?

   Primary biliary cirrhosis
   Anti-hair follicle?

   Alopecia areata
   Anti-IgG?

   Rheumatoid arthritis
   Anti-myelin receptors?

   MS
   Anti-gliaden?
   Anti-gluten?

   Celiac sprue
   Anti-islet cell receptor?

   DM Type I
   Anti-melanocyte?

   Viteligo
   Anti-ACh receptor?

   MG
   Anti-ribonuclear protein?

   Mixed Connective Tissue dz (MCTD)
   Anti-parietal cell receptor?

   Pernicious anemia
   Intrinsic factor
   Anti-epidermal anchoring protein receptors?

   Pemphigus vulgaris
   Intercelluar junctions of epidermal cells
   Anti-epidermal basement membrane protein?

   Bullous pemphigoid
 IgG sub-epidermal blisters
 Oral blisters
   Anti-platelet?

   ITP
   Glycoprotein IIb/IIIa
   Anti-thyroglobulin?
   Anti-microsomal?

   Hashimoto’s
   Anti-smooth muscle?
   Anti-scl-70?

   Scleroderma
   Anti-rho (SS-A)?
   Anti-la?

   Sjogren’s
   Anti-proteinase?
   C-ANCA?

   Wegener’s
   P-ANCA?

   Polyarteritis nodosa
 Hepatitis   B antigen
 IgM
 Papilloma virus?
          Cervical CA
 EBV?
          Burkitts
          Nasopharyngeal CA
 HepB & C?
          Liver...
   Clot in front of renal artery?
     Renal artery stenosis
   Clot off whole renal artery?
     Renal failure
   In...
   Min. change disease

   2 wks post URI
   Goodpasture’s
   Wilm’s tumor
   Adenocarcinoma
   Cyst
   Focal Segmental GN
   Membranous GN
   What does tPA, Streptokinase, Urokinase inhibit?
     Aminocaproic acid

   What doe Warfarin inhibit?
     Vitamin...
   IV push?
   20mg

   Drip?
   40mg
   IV push?
   750K

   Drip?
   750K
   Used ONLY for such things as:
      ▪ Feeding tubes
      ▪ Central lines
      ▪ Fistulas
   Loss of a patch of hair
   Loss of ALL hair on head “bald”
   Loss of hair on entire body “hairless”
   Pneumonitis with endocarditis = pulmonary
    infiltrate with severe eosinophilia
   PIE syndrome
 Necator americanus
 Ankylostoma duodenale
 Shistosomiasis
 Strongyloides
 Ascaris lumbricoides
 Immunocompromised
   Homocystine methyl transferase
   Methyl malonyl-coA mutase
   No male transmission
   All females pass it on
 Burn patients
 Cystic fibrosis
 DM
 Neutropenic patients
   cover 1x for Staph aureus during 1st week
   cover 2x for Pseudo after 2nd week
   Increased pO2
   Delayed opening/closing of the pulmonary value
   Increased volume in the right ventricle
   Blood transfusion
   Increased Tidal Volume
   Giving O2
   Right sided heart failure
   Pregnancy due to increase...
   PIMP TRAP
   Pericardium
   Intracranial
   Mediastinum
   Pleural cavity
   Thighs
   Retroperitoneum
   Abdom...
   Gram +
   Basement membrane suppressor
   Works on simple anaerobes
   The #1 cause of anaphylaxis
   Causes inter...
   Penicillin
   GIFTS

   Granuloma
   Ileum
   Fistula
   Transmural
   Skip Lesion
 Prodromal period before symptoms = 1-3
  weeks
 Why is there a prodromal period?
 Because must switch to positive stra...
   Symptoms within 1 week or less
   EXCEPTIONS:
       Hanta
       Ebola
       Yellow fever
       They are -ve s...
   Transposition of the great arteries
   Tetrology of Fallot
   Truncus Arteriosus
   Tricuspid Atresia
   Total ano...
   Tetrology of Fallot
   Ebstein’s Anomaly
   Hypokalemia
   Hypermagnesemia
   Hypercalcemia (except atrium)
   Hypernatremia
   Hyperkalemia
   Hypomagnasemia
   Hypocalcemia (except atrium)
   Hyponatremia
   TLCFN (Tender Loving Care For Nancy)

   TPP –         Thiamin –             B1
   Lipoic Acid –                    ...
   Bruton’s Agammaglobulinemia
   CGD (NADPH def)
   DMD
   G6PD
   Hemophilia
   Lesch-Nyhan
   Vit D resist. Rick...
   Bruton’s agammaglobulinemia
   CVID (Common Variant Imm. Def)
   Leukemias
   Lymphomas
   SCID
   WAS
   Job Bu...
   Bruton’s agammaglobulinemia
   SCID
   WAS
   Job Buckley Syndrome
   Scabies
   Lichen Planus
   Urticaria
   Dermatitis Herpetiformis
   L-myc?
     Small cell lung Ca

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

   N-myc?
     Neurob...
   C-myb?
     Colon CA
     AML

   C-sis ?
     Osteosarcoma
     Glioma
     Fibrosarcoma
   C-erb B2?
     Epidermal growth factor receptors

   CSF-1 ?
     Breast
   Erb-B2?
     Breast CA
     Ovarian CA
     Gastric CA

   Ret?
     Medullary CA of thyroid
     Men II & III
 ...
   Ki-ras?
     Lung CA
     Colon CA

   Bcl-2?
     Burkitts
     Follicular lymphoma

   Erb?
     Retinoblasto...
   Relax hCG Is HOPE
   Relaxin
   hCG
   Inhibin
   Human placental lactogen (HPL)
   Oxytocin (drug lactation, pit...
   Severity of microscopic change
   Degree of differentiation
   Degree of dissemination of tumor
   What the surgeon sees
   Urticaria/Hives?
     Any CA, especially lymphoma
     Pagets Ds (ulcers around nipples)

   Seborrheic keratosis (...
   Actinic keratosis?
     Dry scaly plaques on sun-exposed skin
     Squamous Cell CA of skin

   Dermatomyositis?
  ...
   Akanthosis nigricans?
     dark lines in skin folds
     Any visceral CA
     End organ damage

   Erythema nodosu...
   Apo E
   Apo A
   Apo CII

   L-CAT
     lecithin cholesterol acetyl transferase
   Cholesterol
     from periph...
   Apo B-100
   Apo E
   Apo C II

   Triglcyerides (95%)
   Cholesterol (5%)
   Apo B-100
   Apo E
   Apo CII

   Triglycerides (< VLDL)
   Cholesterol (>VLDL)
   Apo B-100

   Cholesterol
     from liver to tissue


   NOT a good thing!!!!!
   Apo   A
   Apo   B-48
   Apo   E
   Apo   C II
   Triglycerides from:
   GI to liver (25% of the time)
   GI to ...
 LDL
   Clue = HEAL
   Heart?
   Machinery murmur
   Elbow?
   Fistula from dialysis in renal disease

   Abdomen/Brain?
...
   Glucose > 200
   Age > 55
   LDH >350
   AST > 250
   WBC > 16,000
   Calcium <8 mg/dl
   HCT drop > 10%
   O2 < 60 (PaO2)
   Base deficit > 4
   BUN > 5 mg/dl
   Sequestration > 6L
   CF
   Glaucoma
     Painful, red, teary eye
   Problem with sense of taste
   Metronidazole
   Clarithromycin
   Zinc deficiency
   Flushing
   Wheezing
   diarrhea
   Serotonin
     5-HIAA
   Pancreas
   Ileum
   Mnemonic: BEDS

   Botulinum
   Erythrogenic toxin
     from strep pyogenes
   Diptheria
   Salmonella/shiga like...
   I sprayed ORTHO on my BUNYA at the
    ARENA down in REO to kill SEGMENTED
    WORMS
   ICAMs
   Integrins
   Selectins
   Bind proteins
   Stop the leukocytes
   Bind carbohydrates
   Mediate the rolling to slow leukocytes down
   Homing of lymphocytes
     tells lymphocytes where to go
   Inflammation
   Cell-cell interaction
   Contact
   Neutrophils

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

   What do B-cells make?
   IgM
M
           Σ
               Three

   IgM peaks at what day?
   14

   When does IgM leave?
   In 2 months
   IgG

   When does IgG peak?
   In 2 months

   When does IgG leave?
   In 1 year
   MEMORY
   IgG with 5x concentration
   Has the highest affinity

   When does IgG peak?
   In 5 years

   When does IgG leav...
   IgG
   IgG
   IgG
   IgE

     Uh huh! You thought all of them were IgG…
   Smoking
   Alcohol
   Nitrites
   Japanese
   Smoking
   Aniline dyes
   Benzene
   Aflatoxin
   Cyclophosphamide
   Schistosomiasis
   2 diseases:
     Von ...
   Nitro Blue Tetrazolium test
   What is it used for?
     Screening CGD


   What does a –ve test indicate?
     +v...
   Howell-Jolly?
     Sickle cell

   Heinz?
     G-6-P-D

   Zebra?
     Niemann pick
   Donovan?
     Leishmaniasis

   Mallory?
     Alcoholism

   Negri?
     Rabies
   Councilman?
     Yellow fever


   Call-exner?
     Ovarian tumors
      ▪ granulosa origin
   Lewy?
     Parkinsons

   Pick?
     Pick’s disease


   Barr body?
     Normal female
   Aschoff?
     Rheumatic fever


   Cowdry type A inclusions?
     Herpes virus


   Auer rods?
     AML
   Globoid?
     Krabbe’s lysosomal storage disease


   Russell?
     Multiple myeloma
   Schiller-Duvall?
     Yolk sac tumor


   Basal bodies?
     Only found in smooth mm
   Mnemonic?      ACID
   Type I
     Anaphylaxis/Atopic

   Type II
     Cytotoxic (Humoral)

   Type III
     Imm...
   Atopic
   IgE (Asthma) binds to mast cell
   IgA activates IP3 cascade degrading mast cells
   Humoral
   What are examples of type II?
   Rh disease
   Goodpastures
   Autoimmune hemolytic Anemia
   All Auto...
   Ag-Ab complement
   What are examples of Type III?
   RA
   SLE
   Vasculitides
   Some GN?
   Cell mediated
   What are examples of Type IV?
   TB skin test
   Contact dermatitis
   Transplant rejection
   Appendix
   Epithalamus
   Palmaris longus
     muscle
   Pancreatic polypeptide
     hormones in F-cells
   Goodpastures
   Wegeners
   DM
   HTN
   Vasculitis
   AIDS
   Tx?
     N-acetylcysteine

   Test used to detect CF?
     Pilocarpine sweat test

   What ion does this test meas...
   What is the value in a normal person?
     <20

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

   Wh...
   Bacillus anthracis
   Clostridium perfringens
   Clostridium tetani
   Clostridium melangosepticus

   What is the...
   Lactic acid
   Alpha-receptors
   Cold agglutinin testing
     IgM
   AA amyloid?
     Chronic active disease


   AL amyloid from Ig light chain?
     Myeloma
   Beta 2 microglobulin?
     Chronic hemodialysis


   AA amyloid from SAA?
     Nephrotic hereditary forms
      ▪ e...
   Pre-albumin/transthyretin?
     Cardiomyopathic hereditary forms
      ▪ senile systemic amyloidosis
   Neuropathic ...
   ANP fibrils are caused by?
     Senile cardiac amyloisosis

   Cerebral amyloid in Alzheimer’s disease/Down’s?
    ...
   Calcitonin precursors?
     Medullary CA of thyroid

   AL from light chains?
     Isolated, massive, nodular depos...
   Frontotemporal dementia
   Atrophy of frontal and temporal cortex with
    sparing of remaining neocortical regions
   Altered neurofilaments
   Tau protein
   ubiquitin
   Prevents pre-synaptic release of Ach

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

   How do adult...
   Lethal factor – (black necrosis)
   Protective factor
   Edema factor
   Anthracis
   Cereus
   B1-selective?
     A–M
   Non-selective?
     N–Z
   Exceptions?
     Carbetalol and Labetolol are non-selective
   Problem in proximal tubule
   Can’t reabsorb
   Low energy state causing anemia
   Can be due to old tetracycline
   In the collecting duct of the kidney

   What does glutmainase help the kidney absorb?
     Ammonia if the liver fai...
   Hilum
   Pelvic brim
   Entering the bladder
   SLE
   Endometrial CA
   Cervical CA
   Carbamoyl synthase I

   Where is it found 90% of the time?
     Liver


   Where is it found 10% of the time?
    ...
-ve   charge
+ve           charge
   What is it used for?
     Reversing the effects of heparin
   T-cells and macrophages
   Schistocytes
   Decreased platelets
   Decreased RBCs
   Bleeding from mucosal surfaces...
   The following deveop:
     Clots
     DIC
     Pulmonary embolism
     DVT
     MI
     Stroke
   Tachypnea and SOB

   Most common cause of death?
     Heart failure
   Inhibits the translocation step of ribosomal
    protein synthesis
   Inhibits ribosomal peptidyl transferase in
    prokaryotes
   Inhibits elongation by binding to “A” site and
    prematurely terminating chain growth in pro
    and eukaryotes
   Causes misreading of code during initiation in
    prokaryotes
   Prevents binding of aminoacyl-t-RNA to
    ribosome on prokaryotes therefore inhibiting
    initiation
   Inhibits ribosomal peptidyl transferase in
    eukaryotes
     cell wall inhibitor
   Blocks B-subunit of RNA polymerase
   Prophylaxis for contacts of N. meningitidis
   Cell wall inhibitor
   Binds irreversibly to Phopholipase carrier
   Bacteriacidal
   Covers all gram +ves
   Line...
   Blocks vitamin k dependent gamma-
    carboxylation of prothrombin and factors
    2, 7, 9, 10, proteins C & S
   Blocks translation by binding the 50S subunit
   What type of hemolysis is alpha hemolysis?
   Partial hemolysis
   What color is it’s zone?
   Green
   What type ...
   What color is it’s zone
   Clear
     eg. Streptokinase

   What type of hemolysis is gamma-hemolysis?
   No hemol...
   High urine PH (??????not sure about this)
   Acidosis
   UTI s
   Stones
   Babies die < 1 yr old
   Acidosis
     urine PH = 2, normal is 5-6
   Hypokalmia
   Patients have NO carbonic anhydrase
   It is a combination of RTA I & III
   Normal urine pH
   Hypokalemia
   Seen in diabetics
   Hyperkalemia
   NO aldosterone b/c JG apparatus has infarcted
   Viridans
   Mutans
   Sanguis
   Salivarius
   Bovis
   Viridans
   Viridans
   Mutans
   HTN
   Hematuria
   RBC casts
   Increase Edema
   Increase Lipidemia
   Increase Cholesterolemia
   Increase Coagulability
   Decrease serum Album...
   Strep. Pneumo

   What is the #2 cause?
   Hemophilus influenza

   What is the #3 cause?
   Neisseria meningitides
   Viruses

   Which are secondary to what?
   Bacterial infections

   What is the #2 method to paralyze cilia?
   S...
   Staph aureus
   Clostridium perfringens
   Bacillus cereus….from what?
   Fried rice
   Preformed
   Release of glycine from spinal cord

   What physical finding would you see?
   Lock jaw

   What is the tx?
   An...
   E. coli

   Followed by?
   Proteus

   Followed by?
   Klebsiella
   Staph saprophyticus
   Why?
   They stick things in themselves
   18-24 yoa?
   Staph saprophyticus
   Why?
   B...
   Osteomyelitis

   Because of what?
   Collagenase
   Staph. aureus
   Shock
   Rash
   Hypotension
   E. coli
   Then?
   Proteus
   Then?
   Klebsiella
   Group B Strep (agalactiae)
   E. coli
   Listeria
   Group B Strep (Strep. Agalactiae)
   E. coli
   Listeria
   Clostridium melanogosepticus
   Strep bovis

   What color pigment is produced?
   Black
   IgG

   What about Avidity?
   IgM
   Virus inject it’s DNA into bacteria
   Virus injects it’s DNA into it bacteria in a hospital
    or nursing home setting, then becomes deadly.
   Bacteria with Pili
   Citrobacter
   Hemophilus influenza
   Neisseria
   C3
   Gram negative bacteria
   BUN
   >20

   Fractional Na+ excertion
   <1%

   Creatine
   >40
   BUN
   10-15

   Fractional Na+ excretion
   >2%

   Creatinine
   <20
   Pavementing
   Margination
   Diapediesis
   Migration
   PFK-1
   fructose-1,6-bisphosphatase

     NOT   Pyruvate Carboxlyase
   Viral

   If resistant to tx, what next?
   Fungal
   Mycobacterium
   Protozoa
   Parasite
   Neoplasm
   Step. Group B
     Strep agalactiae
   Strep. Pneumonia
   Herpes simplex virus
   Neisseria gonorrhea
   Chlyamy...
   Perivascular angiofibromata
   Primary Adrenocoritcal Insufficiency
   Ochronosis
   Allergic Granulomatosis
   Angiitis
   Ameloblastoma

   What is Ameloblast?
   Tooth material
   Regional enteritis
   Granulomatous ileitis
   Ileocolitis
   Subacute Granulomatous Thyroiditis
   Comedo Ca
   Mucolipidosis II
   MLNS
   Mucocutaneous Lymph Node Syndrome
   Interstitial cells
   Sustentacular cells
   Giant cell arteritis (granulomatous)
   Hyperviscosity syndrome
   Oral
   Trigeminal ganglia
   Genital
   Sacral plexus
   Varicella zoster
   EBV
   Mononucleosis
   Burkitt’s
   CMV
   Inclusion bodies
   Roseola
   Duke Disease
   Exanthem subitum
   Pityriasis rosea
   Kaposi’s sarcoma
   What is the MOA?
   Interferes with normal synthesis and gama
    carboxylation of Vit. K dependent clotting
    fact...
   Clinical use?
   Chronic anticoagulation

   Contra-indication?
   Pregnancy because it can cross the placenta
   What pathway does it affect?
   Extrinsic pathway

   What does it do to PT?
   Prolongs

   PT
   What are the toxicities?
   Bleeding
   Teratogenic
   Drug-drug interactions

   How is it activatied?
   Tissue...
   Administration?
   po
   II
   VII
   IX
   X
   Protein C
   Protein S
   What is the MOA?
   Catalyzes the activation of antithrombin III
   Decreases thrombin and Xa

   Is it long or sho...
   Clinical use?
   Immediate anticoagulation of pulmonary
    embolism, stroke, angina, MI, DVT.

   Contra-indication...
   What pathway does it affect?
   Intrinsic pathway

   What value should you follow?
   PTT
   What are the toxicities?
   Bleeding
   Thrombocytopenia
   Drug-drug interactions

   How is it activatied?
   B...
   Administration?
   I.V.

   Drug of choice for what?
   DVT
   What is good about the newer low-molecular-
    weight heparins?
   They act more on Xa
   Have better bioavailabili...
   Protamine sulfate
   Dimercaprol
   Flumazenil
   Pralidoxime
   Deferoxamine
   Naloxene
   Bicarbonate
   Doxapram
   Activates the respiratory center in the brain
   Provostatin
   Atrovastatin
   Lovastatin
   Simvastatin
   Provastatin
   Atrovastatin
   Lovastatin
   Simvastatin
   HMG-CoA reductase

   When is it most active?
   8:00pm on
   Cholestipol
   Cholestyramine

   If nothing works what do you give?
   Probucol
   Niacin
   Flushing
   Itching
   Cholestipol
   Cholestyramine
1.Pancreatitis
 Due to What?
 ETOH

2.Kidney stones
 Due to What?
 Alcohol
3.AAA
 How is this described?
 Ripping pain down back

4.Ischemic bowel
 What is symptom?
 Bloody diarrhea
   Small cell Ca of lung
   Increased intracranial pressure
   Pain (most common)
   Drugs
   Hypoxic Lung Disease/Re...
   Carbamazepine
 Melanocytes
 Odontoblasts (predentin)
 Tracheal Cartilage
 EnteroCHROMOFIN Cells
 Laryngeal/Tracheal cartilage
 Par...
   220 - age
   RTA
   Diarrhea
   Diabetic ketoacidosis (DKA)
   Parainfluenza
   Adenovirus
   Influenza
   RSV
   Bronchiolitis
   Diarrhea
   Dermatitis
   Dementia
   Death
   Cysteine
   Ornithine
   Lysine
   Arginine
   Phase 0?
   Depolarization
   Phase 1?
   No name
   Phase 2?
   Plateau phase (A-V node)
   Phase 3?
   Repolarization
   Phase 4?
   Automaticity (S-A node)
   Wider QRS
   Wider P-wave
   Longer PR interval
   Calcium oxalate (phosphate) stones
   Struvite stones
   Uric acid stones
   Cysteine stones
   Oxalate stones
   80%
   3 y/o white male?
   CF
   5 y/o black male?
   Celiac Sprue
   Adult male?
   Whipple’s
   Adult male or female?
   Crohn’s
   In 0-20 y/o?
   Malabsorptin

   What age do they die?
   Young
   What type of crystals are present?
   Calcium pyrophosphate
   Where are they found?
   Joint spaces
   Who gets it?
   Older patients M=F
   Tx?
   Colchicine
   VSD
   ASD
   PDA
   Coarctation
   VSD
   Mitral
   ASD
   PDA
   Coarctation
   Coarctation
   Pyruvate carboxylase
   PEP carboxykinase
   F-1,6 dPhosphatase
   G-6-Phosphatase
   Hexokinase
   PFK-1
   Pyruvate kinase
   Prolactin
   GH
   Nocardia
   Cryptosporidium
   Mycotic aneurysm
   Roth spots
   Janeway lesions
   Osler’s nodes
   Splinter hemorrhages
   Endocarditis
   Janeway lesions?
   Toes

   Osler’s nodes?
   Fingers

   Roth spots?
   Retina
   Strep. viridans
   Acetaminophen
   Reye Syndrome
   Pregnancy
   Alcohol
   Staph. Aureus
   Pseudomonas
   Pseudomonas
   Diptheria
   It ADP ribosylates EF2 inhibiting protein
    synthesis

   Is it Gram +/-?
   +

   Where and how does it get its ...
   What does it cause?
   Heart block

   What do you give for Tx?
   Antitoxin
   Never scrape membrane
   Bullous?
   Staph aureus
   Pseudomonas

   Centroacinar?
   Smoking
   Distalacinar?
   Aging

   Panacinar?
   Alpha-1 antitrypsin def
   4 mo gestation?
   Yolk sac
   6 mo gestation?
   Spleen, liver, flat bones
   8 mo gestation?
   Long bones
   1 yr old?
   Long bones
   Spleen can resume erythropoieses causing
    splenomegaly
   P-wave?
   Ca+
   QRS complex?
   Na+
   S-T?
   Ca+
   T-wave?
   K+
 U-wave?
 Na+
   QRS
   Widens P-wave
   PR interval longer
D         W

                                +          A          B        A+B

                                _        ...
   Atrium contraction
   Phase zero
   Calcium
   AV Node
   Phase 2
   Sodium
   Septum
   Phase 2
   Sodium
   Anterior wall
   Phase 2
   Sodium
   Posterior wall
   Phase 2
   Sodium
   Ventricle
   Phase 2
   Calcium
   Ventricle
   Phase 3
   Potassium
   Ventricle
   Phase 4
   Sodium
   Narcolepsy
   Allergy (hay fever)
   Goodpasture
   MS
   DM
   Chronic active Hepititis
   Sjogrens
   SLE
   Celiac sprue
   IDDM (DM Type 1)
   Rheumatoid Arthritis
   Pemphigus Vulgaris
   JRA (JUV RA)
   Pernicious anemia
   Nephrotic syndrome (Steroid induced)
   Celiac Disease
   Hemochromatosis
     chromosome 6
     point mutation Cystine to Tyrosine
   Myasthenia gravis
   Psoriasis
   Psoriasis
     only if with arthritis
   Ankylosing Spondylities
   IBD
     Ulcerative Cholitis
   Reiter’s
   ...
   21 alpha hydroxylase deficiency
     Vit. D
   ADP ribosylates EF-2
   Stops cell synthesis
   Gr +ve
   Gets exotoxin from virus via transduction
   Heart block...
   RSV (infants only)
   Mycoplasma
   Chlamydia pneumonia
   Strep pneumonia
   Mycoplasma
   Chlamydia pneumonia
   Strep. Pneumonia
   Strep pneumonia
   H. influenza
   Anaerobes
   Strep pneumonia
   Viruses
   Anaerobes
   H.influenza
   Gr –ve rods
   Monomer in blood
   Dimer in secretion
   Located on mucosal surface
   Found in secretion
   Only functions as surface marker for Mature B-
    Cell
   Immediate hypersensitivity/anaphylaxis
   Parasite defense
   Worms
   Fc region binds to mast cells and basophils
...
   Highest affinity
   Memory respond at day 3 five times the concentration
   Peaks in 5 years last for 10 years
   O...
   Crosses placenta due to fc portion
   Most common sub-class deficiency
   Patient susceptible to encapsulated organisms
   Most memory antibody
   Only IgG NOT fixing complement
 Responds in primary response
 Most efficient in agglutination and complement
  fixation
 Defenses against bacteria and...
   MHC II
   IL-2
   IF- Gamma
   IL-4
   IL-5
   IL-6
   IL-10
   TH-1
   TH-2
   CD8
   CD8 becomes T-cytotoxic cells
   CD-3
   For what?
   Signal transduction

   CD-2
   For what?
   Adherence
   T helper cells
   T cytotoxic cells
   Myeloperoxidase
   NADPH
   Will kill ALL Gr+ve
     Ex..Hydrogen peroxide kills gr+
   Clue 4x7=28

   CD-4
   B-7
   CD-28
   Increased Chylomicron
   Deficiency of Lipoprotein lipase enzyme
   Defect in liver only
 Increased LDL
 Two types IIa and IIb
 Type IIa Receptor deficiency for LDL or missing
  B-100
 Type II-b (LDL and VLD...
   Increased IDL
   Receptor problem for APO-E
   Increased VLDL
   Lipoprotein lipase enzyme deficiency at adipose
    tissue
   Combination of Types 1&4
   Increased Chylomicron and VLDL
   Enzyme and receptor deficiency at C-II
   Most common...
   Deposition of Cholesterol on elbows
   Can cause what?
   CAD
   Deposition of Triglycerides on eyelids, face
   Can cause what?
   Pancreatitis
   Little red spots w/ bright red margins
   Sandpapery
   RF- Jones critera
   Lymes disease
   Target lesions (bulls eye)
   Morbiliform rash
   Preceded by cough
   conjunctiivitis
   Fever x 2 day
   Followed by rash
   ONLY ONE WITH RASH FOLLOWING FEVER
    (HHV 6)
   Anterior aspect of leg
   Redness
   Tender nodules
   Red macules, target lesions
   Causes: allergy, viruses
   Mild: MCC virus, #2 drugs (sulfas)
   Moderate: Stevens-...
   Scaly skin with oily shine on headline
   Stuck on warts
   Due to aging
   HLA-B27
   Extensor surfaces
   Silvery white plaques
   Scaly skin
   Pitted nails
   STAGES
   Red macules
   Papules
   Vesicles
   Pustules then scabs
   Different stages may appear at same time
   Rash and blisters on ant. thighs
   Assoc. with diarrhea
   Assoc. with flare up of celiac sprue
   SEEN WITH SALMONEALLA INFXN
   Rose spots assoc. with intestinal fire
   Heliotropic rash
   Reddened area on skin w/ raised borders
   DOES NOT BLANCH
   Redness
   Itchy groin
 Herald patch= dry skin patches that follow skin
  lines
 HHV 7
   Hypopigmented macules on upper back
   Presents in a V pattern
   A.K.A. upside down christmas tree
   Tx: Griseofu...
   Linear excoriations on belt line and finger webs
   What is the tx?
   Lindane
   Permethrin
   DiGeorges
   What ion imbalance will they have?
   Hypokalemia
   What did not form?
   3rd and 4th pharyngeal pou...
   HIV
   Also B-cell but less so
   NOT A FUNGUS
   Non-Hodgkins form of cutaneous T-cell
    lymphoma
   Transport TG’s from GI to liver and endothelium
   Transports TG’s from liver to adipose
   Transports TG’s from adipose to tissue
   ONLY ONE THAT CARRIES CHOLESTEROL
   XANTHELASMA

   Where are they located?
   On eyelids and eyebrows
   Xanthomas

   Where are they located?
   elbows
   ONLY ONE MADE IN THE LIVER
   ARE BREAK DOWN PRODUCTS OF VLDL
   Gram -/+?
   Pleomorphic gram (-) rods
   What pattern?
   “school of fish pattern”
   What type is most common?
...
   Capsule or no capsule?
   non-encapsulated
   Invasive or non invasive?
   non-invasive
   Most common cause of what?
   Sinusitis
   Otitis
   Bronchitis
   What is the 2nd most common type?
   TYPE B
     20%
   Encapsulated or non encapsulated?
   Encapsulated
   What...
   Invasive or non invasive?
   Invasive
   What does it cause most often?
   #1 cause of epiglottitis
   What are th...
   0-2 months?
   #1. Group B strep (agalactiae)
   #2. E. coli
   #3. Listera
   2 Months- 10 years?
   #1. strep pneumonia
   #2. n. meningitides
   (adolescent years only)
   10yrs- 21 yrs?
   #1. n. meningitides
   > 21 years old?
   #1 S. pneumoniae
   At what age is it given?
   Given at 2,4,6 months
   What strain does it cover?
   Covers 23 strains (98% cases)
   Indications?
   Anyone> 65y/o
   Anyone splenectomized
     Sickle cell anemia
   Anyone with end-organ damage
   ...
   MCC of all throat infections
   #2 MCC of all what?
   Skin infections except lines
   St. aureus?
   Gold pigment
   St. epidermidis?
   White pigment
   St. saprophyticus?
   No pigment
   Strep. Pneumonia
     pneumococcus
   Skin Infections?
   Say Staph. Aureus

   Throat Infections?
   Say Strep. Pyogenes

   Small Intestine Infections...
   Job Syndrome:
   IL-4
   Hyper IgE
   What do they look like?
   Red hair
   Fair complexion
   Female
   NADPH-OXIDASE DEF (CGD)
   NEUTROPENIA
   MYLOPEROXIDASE
   Job-Buckley Syndrome
   HbC antigen
   HbS antigen
   HbC antigen
   HbS antigen
   HbC antibody
   HbS antigen ONLY
   HbS antibody ONLY
   HbC antibody
   HbS antibody
   HbS antigen
   IgG
   HbS antigen for >6months
   Can be with or without HbS antibody
   HbE antigen
   HbE antibody
   NEGATIVE HbS antigen
   POSITIVE HbS antigen
   HbE antibody
   IgM HbC antibody

   What disappears?
   HbS antigen
   4 to 26 wks
   Average @ 8wks
   4 to 12 wks
   4 to 20 wks
   YEARS
   MC infection?
   CMV
   MCC of death?
   PCP
   What is p41 used for?
   Just a marker
   What does Gp120 do?
   Attachment to CD4
   What is Pol used for?
   Integration
   What is reverse transcriptase ...
 What is the normal CD4 count?
 800-1200
 What can the CD4 count be up to in children?
 1500
 When do you begin treat...
   AIDS is defined as a CD4 count of what?
   <200
   With a CD4 count of <200 what do you tx for?
   PCP
   What do ...
   Vitamin E
     #1
   Vitamin A
   Vitamin C
   Betakertine
   Parathyroid

   Along with what other cofactor?
   Mg+
   Hyperparathyroid
     Increase Ca+
     Decrease Phosphate
   What will be the symptoms?
   Goans
   Moans
   Bo...
   Pseudotumor Cerebri
     Increase CSF production from Chorichoid Plexus
   Pseucotumor cerebri
   Nightvision problems/nightblindness

   Hypoparathyroidism
     Decrease Ca+
     Increase Phosphate
   THIAMINE

   What do you get with a decrease in thiamine?
   Beri Beri

   What is the most common cause in US?
  ...
   Wet Berry Berry
   With heart failure

   Dry Berry Berry
   Without heart failure
   Wernicke’s Encephalopathy

   Wernicke’s Korsakoff
   Alcoholic thymine deficiency of the Temporal
    Lobe
   3 Dehydrogenases
   Pyruvate dehydrogenase
   Alpha ketoglutarate dehydrogenase
   Branch chain amino acid dehydrog...
   Riboflavin

   What is a physical sign of this deficiency?
   Angular stomatitis
   Angular cheliosis
   Corneal N...
   Milk
   Also from FAD
   Niacin

   What is the clue?
   Diarrhea
   Dermatitis
   Dementia
   Death
   Hartnup Disease

   What is deficient in this disease?
   Tyrptophan

   What is typtophan needed for?
   Needed f...
   Lipoic acid

   What is the deficiency caused by this vitamin?
   Not one
   Pantothenic acid

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

   What is the deficiency caused by this vitamin?
   Neuropathy
   Seizures

   Who do you need to giv...
   Sideroblastic
   ALL transaminases
   Cyanocobalamine

   What is the deficiency caused by this vitamin?
   Pernicious anemia
   Neuropathy
   Pernicious anemia
   Methylmalonyl CoA Mutase
   Homocysteine Methyl Transferase
   Neuropathy

   Why?
   Because it recycles myelin
   Megaloblastic anemia

   What else is this enzyme needed for?
   Nucleotide synthesis
   VITAMIN B2- RIBOFLAVIN deficiency
   DIARRHEA
   DERMATITIS
   DEMENTIA
   DEATH
   PYRIDOXINE B6
   B12 CYANOCOBALAMINE
   Folate
   Megaloblastic anemia

   With neuropathy?
   NO NEUROPHATHY

   What else is Folate used for?
   Nucleotide syntha...
   Ascorbate acid
   Collagen synthesis
   Scurvy
   Bleeding gums
   Bleeding hair follicles
   Diet deficient in citrus fruit
   Diet deficient in green vegetables
   Over cooked green vegetables
   Controls Ca+
   Absorbes Ca+ from GI
   Reabsorbs Ca+ in Kidneys

   Controls osteoblastic activity
   Ricketts

   What does it cause in ADULTS?
   Osteomalcia
   Lateral Bowing of the Legs
   X-linked dominant
   Hair
   Skin
   Eyes
   Protection against free radicals
   #1 antioxidant
   Retinopathy
   Folate
   Vitamin K
     90%
   Biotin
   Panothenic acid
   Helps with absorption of B12
   1972
   Protein C
   Protein S
   Which one has the shortest half-life?
   Protein C
   Which one has the 2nd sho...
   Chromium
   Selenium
   Manganese Molebdenum
   Tin
   Insulin action
   Heart
   Manganese Molebdenum
   Hair
   Dysguzia
   Decrease sperm
   Dry hair
   Dry skin
   Mg+
   Biotin
   Pyridoxine
     B6
   ALL carboxylases
   ALL kinases
   Parathyroid along with Vitamin A
   Muscle contraction
   Axonal transport
   2nd messengers
   Dorsal Columns
   Cortical Spinal Tracts

   Why are these affected?
   Because they are the longest
   Because th...
   Maganese Molebdenum
   By the liver
   Always Hepatotoxic
   By the kidney
   Always nephrotoxic
   Pain
   Pallor
   Paresthesia
   Pulselessness
   Poikilothermia
   Lympangitis
   Impetigo (not bullous)
   Necrotizing fascitis
   Erysepelas
   Scarlet fever
   Lympangitis
   Impetigo (not bullous)
   Necrotizing fascitis
   Erysepelas
   Scarlet fever
   Staph epidermitis
   Staph aureus
   Absorption of Vit. B12
   Synthesis of:
     -Vitamin K
     -Biotin
     -Folate
     -Pantothenic acid
       ▪...
   Trypsin cuts where?
   cuts to R of
   Arg
   Lys
   Chymotrypsin cuts where?
   cuts to R of bulky aa’s (aromati...
   Elastase cuts where?
   Cuts to R of (“SAG”)
   Ser
   Ala
   Gly

   CNBr cuts where?
   Cuts to R of
   Methi...
   Aminopeptidase cuts where?
   Cuts to R of
   amino acid terminal

   Caboxypeptidase cuts where?
   Cuts to L of
...
   MMR
   MMR & INFLUENZA
   Hepatitis B
   Hib
   Diphtheria
   Pertussis
   Strain 12
   Myeloperoxidase
   NADPH Oxidase
   NADPH Oxidase

   Which means they only kill what?
   Kills only G -ve
   IL-1
   IL-6??
   DDI>DDC
   Pancreatitis
   Leigh’s Disease
   What is another name?
   Subacute necrotizing encephalomyelopathy
   What are the signs & sympto...
   Leber’s Hereditary Optic Atrophy (LHON)
   They all die
 Listeria

   What part is toxic?
   Lipid A

   Does it cross the placenta?
   Yes
   T-cells & Macrophages, therefore, have
    granulomas
   Raw cabbage
   Spoiled milk
   Migrant workers
   Birth – 2 months
   4 – 7 years old
   Puberty
   DiGeorge’s Syndrome
   Lysine
   Arginine
   Glutamate
   Aspartate
   Phenylalanine
   Isoleucine
   Trptophan
   Threonine
   Phenylalanin
   Tyrosine
   Tryptophan
   Met
   Cyst
   Proline
   Gly
   Serine
   Threonine
   Tyrosine
   Asparagine
   Glutamine
   Leu
   Iso
   Val
   Leu
   Lys
   Psoriasis (with arthritis)
   Ankylosing Spondylitis
   Irritable Bowel Syndrome
   Reiter’s Syndrome
   Psoriasis with out arthritis
   Strep. Pneumoniae
   H. influenza
   Neisseria catarrhalis
   Histaminase
   Arylsulfatase
   Heparin
   Major Basic Protein
   In an Acute Reaction?
   Histamine

   In a Late Reaction   ?
   SRS-A
   ECF-A
   0 – 2 months?
   chlamydia pneumonia
   Intersitital pneumonia
   High temperature with NORMAL pulse rate!

(This should never be! Each degree ↑ in temp. → 10
  beats/min ↑ in pulse ra...
 FEVER
 NONSPECIFIC ILLNESS
 RECRUITS TH CELLS for LINKING with MHC II
  COMPLEX
 SECRETED BY MACROPHAGES
 MOST POTENT OF THE Interleukins
 RECRUITS EVERYBODY
 MOST POWERFUL CHEMO-ATTRACTANT
 MUST BE INACTIVATED
 When must ...
 ENERGIZED MACROPHAGES
 CAUSES B-CELL PROLIFERATION
 LABELED BY THYMIDINE (USE POKEWEED
  MITOGEN OR ENDOTOXIN)
 SECRE...
   B-CELL DIFFERENTIATION
   RESPONSIBLE FOR CLASS SWITCHING
   SECRETED BY TH2 CELLS
   They do exactly what IL-1 thru IL4
 SUPPRESSES CELL-MEDIATED RESPONSE (tells
  macrophages and fibroblasts to stay away if
  bacterial)
 INHIBITS MAC ACTIV...
 PROMOTES CELL-MEDIATED RESPONSE
  (recruits macs & fibroblasts if NOT bacterial)
 ACTIVATES NK CELLS TO SECRETE IF-γ
 ...
   Where is it from?
   LEUKOCYTES
   ↓VIRAL REPLICATION AND TUMOR GROWTH
   ↑ NK ACTVITY
     secretes perforins and...
   Increase NK activity
   Increase MHC class I & II
   Decrease protein synthesis
   Decrease viral replication and g...
   Where is it from?
    FIBROBLASTS
   Increase NK activity
   Increase MHC class I & II
   Decrease protein synthes...
 Where is it from?
 T-CELLS & NK CELLS
 ↑ NK ACTIVITY
 ↑MHC CLASS I & II
 ↑ MACROPHAGE ACTIVITY
 CO-STIMULATES B-CEL...
   Where is it from?
   MONOCYTES & MACROPHAGES
   What is another name for TNF-alpha?
   CACHECTIN
   INDUCES IL-1
...
   Where is it from?
   T-CELLS

   What is another name for it?
   LYMPHOTOXIN

   CYTOTOXIC FACTOR
   Where is it from?
   SOLID TUMORS (CARCINOMA > SARCOMA)
   MONOCYTES

   What is another name for it?
   TRANSFORM...
   What does it INDUCE?
   ANGIOGENESIS
   KERATINOCYTE PROLIFERATION
   BONE RESORPTION
   TUMOR GROWTH

   What is...
   Where is it from?
   PLATELETS
   PLACENTA
   KIDNEY
   BONE
   T & B CELLS
   What INDUCES it?
   FIBROBLAST PROLIFERATION
   COLLAGEN
   FIBRONECTIN SYNTHESIS
   What INHIBITS it?
   NK
   LAK
   CTL
   T & B CELL PROLIFERATION
   What ENHANCES it?
   WOUND HEALING
   ANGIOGENESIS
   What does it suppress?
   SUPPRESSES IR AFTER INFECTION &
    PROMOTES HEALING PROCESS

   What is it mainly for?
 ...
   LYMPHOKINE ACTIVATED KILLER CELLS
   CYTOTOXIC T-LYMPHOCYTES
   CNS
   Heart
   Skeletal muscle

   Why does it affect these particular places?
   Due to uneven cytokinesis durin...
   Who are affected?
   All offspring

   Who passes the disease?
   MOM

   Who has no transmission?
   Dad
   Who does it show in?
   Not parents
   Siblings/uncles may show disease
   When is onset?
   Early in life (childh...
   How are they acquired?
   Almost ALL are inborn error of metabolism

   When does it occur?
   Only when both allel...
   How is it transmitted?
   Horizontal Tm

   Are there malformations present?
   Physical malformations are uncommon...
   Who does it affect the most?
   M=F

   How does it manifest?
   Heterozygote state

   Who can transmit the disea...
   Where is the new mutation?
   Often in germ cells of older fathers

   When is onset?
   Often delayed (adult diagn...
   What is penetrance?
   Reduced penetrance

   How is it expressed?
   Variable expressin
     Different in each in...
   How is it transmitted?
   Vertical TM

   Is there malformation present?
   Physical malformation common

   What ...
   Maternal grandfather
   Maternal uncle
   What happens <24hrs?
   Swelling

   What happens at 24 hrs?
   Neutrophils show up

   What happens at day 3?
  ...
   What happens at day 4?
   T cells and Macrophages show up

   What happens at day 7?
   Fibroblasts show up

   Wh...
   What happens at 3-6 months?
   Fibroblasts are gone
   Lysosomal Inclusion Bodies
   Gauchers
   Fabrys
   Krabbe
   Tay Sachs
   Sandhoffs
   Hurlers
   Hunters
   Neiman Pick
   Metachromatic L...
   Beta-Glucocerberosidase

   What Accumulates?
   Glucocebroside

   Where?
   Brain
   Liver
   Bone Marrow
   ...
   Ask. Jew
   Gargols
   Gaucher cells
     Macrophages looking like Crinkeled paper
   Erlin myoflask legs
   Pseu...
   Alpha-galactosidase

   What accumulates?
   Ceramide Trihexoside
   X-Linked recessive
   Presents with cataracts as a child
   Presents with renal failure as a child
   Galactosylceramide B-Galactosidase

   What accumulates?
   Galactocerebrosidase

   Where?
   Brain
   Early death
   Globoid bodies
     Fat cells
   Hexoseaminidase A

   What accumulates?
   GM2 Ganglioside
   Ask. Jews
   Cherry red macula
   Death by 3
   Hexoseaminadase A & B
   Iduronidase
   Corneal Clouding
   Mental Retardation
   Iduronate Sulfatase
   Mild mental retardation
   No corneal clouding
   Mild form of Hurlers
   X-linked recessive
   Spingomyelinase

   What accumulates?
   Spingomyelin
   Cholesterol
   Zebra bodies
   Cherrry red macula
   Die by 3
   Arylsulfatase A
   Visual Disturbance
   Presents like MS in 5 to 10 years of age
   Von Gierkes
   Andersons
   Corys
   McCardles
   Pompes
   Hers
   G-6-Pase Deficiency
   Big Liver
   Big Kidney
   Severe hypoglycemia
   Can NEVER raise their blood sugar
   Branching enzyme deficiency
   Glycogen will be ALL LONG chains on liver
    biopsy
   Debranching enzyme
   Glycogen from liver biopsy will be ALL SHORT
    branches
   Muscle phosporalase
   Severe muscle cramps when exercising
   High CPK
   Cardiac alpha-1,4 glucocydase
   Heart problems
   Die early
   Liver phosphoralase
   Big Liver
   NO big kidney
   Intraductal Ca
   AV Fistula
   Vasodilation
   Tay Sachs
   Sandhoffs
   Niemann Pick
   CML
   Ewing’s sarcoma
   Burketts lymphoma
   Follicular lymphoma
   Sarcoid
   Amyloid
   Hemochromatosis
   Cancer
   Fibrosis

   Thanks STAN!!
   Shistocytes
     Burr cells
     Helmet cells
   Splenomagely
   Adrenal
   Liver
   G6PD
   Lead poisoning
   Iron deficiency
   Anemia of Chronic disease
   Lead poisoning
   Hemoglobinopathy
   Thallasemia’s
   Sideroblas...
   Genetic
   AD
   Blood transfusions
   Hereditary Spherocytosis
   Acute hemorrhage
   Anemia of Chronic Disease
   Hypothyrodism
     Early
   Renal Failure
   Folate deficiency
   B12 deficiency
   Reticulocytosis
   ETOH
   Hemolytic Anemias
   Chemo Treatment
   Antico...
   Phenytoin
   Ethusuximide
   Carbamyazapine
   Valproate
   Sideroblastic anemia
   Something is wrong with the RBC membrane
     Extravascular
   Heridatary Ellitocytosis
   Increased RET count
   Wilson’s Disease
   Hepato/Lenticular Degeneration
   Kayser Fleishner Rings
     Copper in eyes


   Hepato = Liver
   Lenticular = M...
   Collagen synthesis
   Minky Kinky Hair Syndrome
   Epinephrine
   Norepinephrine
   Dopamine
   Tyrosine
   Adrenal Pheochromocytoma
   Blocks DNA gyrase (topoisomerase II)
   Inhibits p450
   All Gram + including staph auerus
   All Gram –
   Atypicals
   Chlamydia
   Ureoplasma
   Mycoplasma
   Legionella
   Cortisol
   Epinephrine
   Glucagon
   Glycosaminoglycan chain that helps form
    proteoglycans
   Glycosaminoglycan chain that helps form
    proteoglycans
   Inhibits dihydrofolate reductase
   Inhibits DNA synthesis in the S phase of cycle.
   Prevents reduction of folic a...
   Purine nucleotide synthesis
   Methylation of dUMP to for dTMP
   Obstructs one carbon methylation which
    deprives DNA polymerase of essential substrates
   CF
   Galactosemia
   Defects in Glycolysis
   Defects in Hexose Monophosphate Shunt
   B12
   B12
   Vitamin B6
   Vitamin C
   Occurs in the synthesis of Blood Clotting factors
   Requires Vitamin K
   Thiamine
   Vitamin D
   Vitamin A
   Thiamine
   Olfactory
   What is its function?
   Sensory for smell
   What if lesioned?
   Anosmia
   Where does it Exit/Ent...
   Optic
   What is its function?
   Sensory for sight
   What if lesioned?
   Anopsia
     Visual field defect
   ...
   Where does it Exit/Enter the Cranium?
   Optic Canal

   What does it innervate?
   Orbit
   Occulomotor
   What are the functions?
   Motor
   Moves the eyeball in ALL directions
   Adduction Most important...
   What if lesioned?
   Diplopia
   Loss of parallel gaze
   Dilated pupil
   Loss of light reflex
   Loss of near r...
   Where does it Exit/Enter the Cranium?
   Superior Orbital Fissure

   What does it innervate?
   Orbit
   Trochlear
   What is its function?
   Motor
   Superior Oblique
   Depresses and abducts the eyeballs
   Intorts
   What if lesioned?
   Weakness looking down w/ adducted eye
   Trouble going down stairs
   Head tilts away from les...
   What does it innervate?
   Orbit
   Trigeminal
   V1?
   Opthalmic

   V2?
   Maxillary

   V3?
   Mandibular
   Mixed
   General sensation (touch, pain, temperature) of the
    forehead, scalp, & cornea
   What if lesioned?
   ...
   What does it innervate?
   Orbit
   Scalp
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