USMLE STEP 1 REVIEW

STUDY GUIDE
2013 EDITION
BRIAN JENKINS, MD
Doctors In Training.com: USMLE Step 1 Review, 2013 edition
Author: Brian Jenkins, MD
Copyright 2013 Doctors In Training.com, LLC
www.doctorsintraining.com
Doctors In Training.com, LLC
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All Rights Reserved. This text is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or
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ERRORS OR OMISSIONS THAT MAY BE MADE. THE AUTHOR MAKES NO WARRANTY, EXPRESS OR IMPLIED, AS TO THE COMPLETENESS, CUR-
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AS SPECIFIC INSTRUCTIONS FOR INDIVIDUAL PATIENTS. MANUFACTURERS PRODUCT INFORMATION AND PACKAGE INSERTS SHOULD BE
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For problems, questions, or concerns, you may contact the author at support@doctorsintraining.com .
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TABLE OF CONTENTS
[ i ]
I FOUNDATIONS
1. EMBRYOLOGY PART 1 3
2. EMBRYOLOGY PART 2 4
3. CELLULAR ORDER 6
4. CYTOSKELETON AND OTHER CELLULAR COMPONENTS 10
5. PLASMA MEMBRANE 12
6. CELLULAR SUFFERING AND DEATH 15
7. INFLAMMATION 17
8. CONTROL OF THE EXTRACELLULAR ENVIRONMENT 19
9. CELLULAR ADAPTATIONS 21
II NEUROLOGY
1. BRAIN EMBRYOLOGY 25
2. ORGANIZATION OF THE BRAIN 26
3. HYPOTHALAMUS 28
4. SLEEP 29
5. CRANIAL NERVES 31
6. BRANCHIAL APPARATUS 34
7. REGIONS OF THE BRAIN 35
8. BRAINSTEM IN CROSS SECTION 37
9. OCCLUSION SYNDROMES 41
10. VASCULAR EVENTS 44
11. MOVEMENT 47
12. BASAL GANGLIA 53
13. SPINAL CORD AND LESIONS 55
14. BRACHIAL PLEXUS AND UPPER EXTREMITY NERVES 58
15. LOWER EXTREMITY & SKELETAL MUSCLE 64
16. SENSATION 67
17. EYE 69
18. EAR 72
19. DELIRIUM AND DEMENTIA 74
20. HEADACHE 76
21. BRAIN TUMORS 79
22. ANESTHETICS 81
23. SEIZURES 83
III PHARM BASICS
1. PARASYMPATHETIC ACTIVATION 89
2. PARASYMPATHETIC INHIBITION 91
3. CELLULAR COMMUNICATION 93
4. SYMPATHETIC ACTIVATION 96
5. SYMPATHETIC INHIBITION 98
6. PHARMACOKINETICS 99
7. DRUG METABOLISM 104
8. DRUG SIDE EFFECTS 107
9. ANTIDOTES 110
IV ENDOCRINE
1. ENDOCRINE OVERVIEW 112
2. PITUITARY 114
3. ADRENAL STEROID SYNTHESIS 116
4. GLUCOCORTICOIDS AND CUSHING SYNDROME 119
5. OTHER ADRENAL PATHOLOGY 121
6. THYROID BASICS AND HYPERTHYROIDISM 123
7. HYPOTHYROIDISM AND THYROID CANCER 125
8. DIABETES 127
9. DKA AND DIABETES TREATMENT 128
10. OBESITY 130
11. CALCIUM METABOLISM 132
TABLE OF CONTENTS
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V GI
1. OROPHARYNX 137
2. ESOPHAGUS 139
3. STOMACH 142
4. UPPER GI PATH 144
5. DUODENUM 146
6. PANCREAS 148
7. ENTEROCYTES AND ABSORPTION 150
8. DISEASES OF SMALL INTESTINE 152
9. HEPATOCYTES AND CIRRHOSIS 154
10. LIVER PATHOLOGY 156
11. HEPATITIS 158
12. BILIARY TRACT 160
13. LARGE INTESTINE PART 1 162
14. LARGE INTESTINE PART 2 164
VI IMMUNOLOGY
1. IMMUNOLOGY BASICS 169
2. ANTIGEN PRESENTATION 170
3. T CELLS 172
4. MONOCYTES AND MACROPHAGES 173
5. B CELLS AND ANTIBODIES 175
6. IMMUNIZATION AND AUTOANTIBODIES 177
7. GRANULOCYTES, CYTOKINES, AND IMMUNOSUPPRESSANTS 178
8. COMPLEMENT AND HYPERSENSITIVITY 180
9. IMMUNODEFICIENCIES 182
VII BIOCHEM
1. RNA 189
2. PROTEIN 193
3. GLUCOSE 194
4. GLYCOGEN 197
5. ENERGY 199
6. HMP SHUNT AND OTHER SUGARS 203
7. FUEL USE 204
8. LIPIDS 207
9. AMINO ACIDS AND NITROGEN 210
10. AMINO ACID DISORDERS 212
11. DNA BASICS 213
12. DNA REPLICATION, MUTATION, AND REPAIR 215
13. MINERALS 217
14. FAT-SOLUBLE VITAMINS AND ANTIOXIDANTS 219
15. WATER-SOLUBLE VITAMINS 225
16. GENETIC LAB TECHNIQUES 231
17. INHERITANCE 234
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VIII MICRO
1. HIV 239
2. HIV DRUGS 241
3. ENTEROBACTERIACEAE, DIARRHEA, AND FOOD POISONING 243
4. PROTOZOA 246
5. HELMINTHS AND ECTOPARASITES 248
6. BACTERIAL BASICS 250
7. BACTERIAL TOXINS 252
8. STAPHYLOCOCCUS 254
9. STREPTOCOCCUS 256
10. OTHER GRAM POSITIVES 258
11. PENICILLINS 260
12. CEPHALOSPORINS 263
13. OTHER CELL WALL INHIBITORS 265
14. TB AND TB DRUGS 267
15. SPIROCHETES AND ZOONOTICS 270
16. NONSTAINING BACTERIA 272
17. MYCOLOGY 274
18. ANTIFUNGALS 276
19. UTI 278
20. OTHER GRAM NEGATIVE BACTERIA 280
21. PROTEIN SYNTHESIS INHIBITORS 283
22. VIRAL BASICS 286
23. HERPES VIRUSES 288
24. OTHER DNA VIRUSES 290
25. RNA VIRUSES PART 1 292
26. RNA VIRUSES PART 2 294
27. MICRO BY SYSTEMS PART 1 297
28. MICRO BY SYSTEMS PART 2 300
IX HEME
1. CLOTTING FACTORS 305
2. RBCS 307
3. NONHEMOLYTIC ANEMIAS 309
4. HEMOLYTIC ANEMIAS 311
5. PLATELETS 314
6. CANCERS OF BLOOD 316
X ONCOLOGY
1. GENETICS OF CANCER 321
2. CANCER RISK FACTORS 323
3. NEOPLASTIC PROGRESSION 325
4. CANCER PREVENTION AND HOST DEFENSE 327
5. CANCER DRUGS 330
XI MEDICINE IN SOCIETY
1. STUDIES AND DIAGNOSTIC TESTS 335
2. APPLICATION OF TEST DATA 337
3. BIAS AND ERROR 338
4. CONFIDENCE INTERVAL 341
5. PUBLIC HEALTH 343
6. GERIATRICS 345
7. HEALTHCARE SYSTEM 347
8. ETHICS 353
TABLE OF CONTENTS
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XII PULMONARY
1. ANATOMY AND PHYSIOLOGY 357
2. LUNG VOLUMES AND PULMONARY CIRCULATION 359
3. OXYGEN AND HEMOGLOBIN 362
4. OXYGENATION AND VENTILATION 364
5. EXTREME ENVIRONMENTS 367
6. PE AND DVT 370
7. COPD AND ASTHMA 372
8. RESTRICTIVE LUNG DISEASE 374
9. LUNG CANCER AND INFECTIONS 376
XIII CARDIOVASCULAR
1. EMBRYOLOGY 381
2. DEVELOPMENTAL PATHOLOGY 384
3. CARDIAC OUTPUT 386
4. HEART FAILURE 388
5. EDEMA AND SHOCK 390
6. CARDIAC CYCLE 392
7. HEART MURMURS 394
8. ELECTROPHYSIOLOGY 396
9. ANTIARRHYTHMICS 397
10. ELECTROCARDIOGRAPHY 398
11. ARRHYTHMIAS 400
12. REGULATION OF BP 404
13. HYPERTENSION 406
14. ANTIHYPERTENSIVES 408
15. ATHEROSCLEROSIS 411
16. ANTIANGINAL THERAPY AND LIPID-LOWERING AGENTS 414
17. MYOCARDIAL INFARCTION 416
18. CARDIOMYOPATHIES AND ENDOCARDITIS 419
19. OTHER CARDIAC PATHOLOGY 421
20. VASCULAR DISEASES 432
XIV RHEUM & DERM
1. BONE AND BONE DISORDERS 429
2. JOINT BASICS 432
3. JOINT DISEASES 434
4. SYSTEMIC DISORDERS 436
5. DERMATOLOGY 439
XV PSYCH
1. PSYCHOLOGY 445
2. CHILD PSYCH 448
3. ALCOHOL ABUSE 451
4. SUBSTANCE ABUSE 453
5. PSYCHOSIS 455
6. BIPOLAR DISORDER 457
7. DEPRESSION 458
8. ANTIDEPRESSANTS 460
9. ANXIETY AND SOMATOFORM DISORDERS 462
10. EGO DEFENSE MECHANISMS AND PERSONALITY DISORDERS 464
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XVI RENAL
1. RENAL BASICS 469
2. NEPHRON PHYSIOLOGY 471
3. DIURETICS 475
4. METABOLIC DISORDERS 477
5. GLOMERULAR PATHOLOGY 480
6. OTHER RENAL PATHOLOGY 482
XVII REPRODUCTION
1. ANATOMY & EMBRYOLOGY 487
2. ANDROGENS 489
3. TESTICULAR PATHOLOGY 490
4. PENIS AND PROSTATE PATHOLOGY 492
5. FEMALE REPRODUCTIVE CYCLE 495
6. BIRTH CONTROL AND MENOPAUSE 497
7. VAGINAL AND CERVICAL PATHOLOGY 499
8. UTERINE PATHOLOGY 501
9. OVARIAN PATHOLOGY 503
10. PREGNANCY PART 1 506
11. PREGNANCY PART 2 509
12. CHROMOSOMAL DISORDERS 511
13. GENETIC DISORDERS: AD AND TRINUCLEOTIDE REPEATS 513
14. GENETIC DISORDERS: AR AND X-LINKED 515
15. BREAST 518
XVIII PEDIATRICS
1. PEDIATRIC REVIEW 522
NOTES
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KEY TO ABBREVIATIONS
This Study Guide contains page references to several medical educational resources.
Below is a key to the abbreviations that accompany the various page number references
appearing in this text.
FA13
Le, T, Bhushan, V, et al. First Aid for the USMLE Step 1 2013. New
York, NY: McGraw-Hill; 2013.
FA12
Le, T, Bhushan, V, et al. First Aid for the USMLE Step 1 2012. New
York, NY: McGraw-Hill; 2012.
SU13
Jenkins, B, et al. Step-Up to USMLE Step 1 2013. Philadelphia, PA:
Lippincott Williams & Wilkins; 2013
Phys
Hall, JE. Guyton and Hall Textbook of Medical Physiology. 12th ed.
Philadelphia, PA: Saunders Elsevier; 2011.
R
Kumar, V, Abbas, AK, et al. Robbins and Cotran Pathologic Basis of
Disease. 8th ed. Philadelphia, PA: Saunders Elsevier; 2010.
COA
Moore, KL, Dalley, AF, & Agur, AMR. Clinically Oriented Anatomy.
6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010.
H
Longo, DL, Fauci, AS, Kasper, DL, Hauser, SL, Jameson, JL, Loscalzo,
J, eds. Harrisons Principles of Internal Medicine. Vol. 2. 18th ed. New
York, NY: McGraw-Hill; 2012.
GG
Brunton, LL, Chabner, BA, & Knollman, BC, eds. Goodman & Gilmans The
Pharmacological Basis of Therapeutics. 12th ed. New York, NY: McGraw-
Hill; 2011.
Neither the Doctors In Training USMLE Step 1 Review Course, nor this Study Guide, is endorsed by or
affliated with any of the medical education resources referenced in the course. However, numerous images
contained in the course have been licensed from Lippincott Williams and Wilkins.
COURSE VIEWING OPTIONS
Part 2 consists of 205 videos. Examples of 12, 15, 19, 21, and 25 day plans are provid-
ed below for maximum fexibility to meet your personal study needs.
No. of Videos/Day Video Runtime/Day*
12-day plan 17 Approx. 6. 5 hrs
15-day plan 14 Approx. 5. 5 hrs
19-day plan 11 Approx. 4. 5 hrs
21-day plan 10 Approx. 4 hrs
25-day plan 8 Approx. 3 hrs
*Does not include study breaks or time spent annotating and answering questions.
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RECOMMENDED COURSE ORDER
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1. FOUNDATIONS 1 - EMBRYOLOGY PART 1
2. FOUNDATIONS 2 - EMBRYOLOGY PART 2
3. FOUNDATIONS 3 - CELLULAR ORDER
4. FOUNDATIONS 4 - CYTOSKELETON AND
OTHER CELLULAR COMPONENTS
5. FOUNDATIONS 5 - PLASMA MEMBRANE
6. FOUNDATIONS 6 - CELLULAR SUFFERING AND
DEATH
7. FOUNDATIONS 7 - INFLAMMATION
8. FOUNDATIONS 8 - CONTROL OF THE
EXTRACELLULAR ENVIRONMENT
9. FOUNDATIONS 9 - CELLULAR ADAPTATIONS
10. NEURO 1 - BRAIN EMBRYOLOGY
11. NEURO 2 - ORGANIZATION OF THE BRAIN
12. NEURO 3 - HYPOTHALAMUS
13. NEURO 4 - SLEEP
14. NEURO 5 - CRANIAL NERVES
15. NEURO 6 - BRAINSTEM AND BRANCHIAL
APPARATUS
16. PHARM BASICS 1 - PARASYMPATHETIC
ACTIVATION
17. PHARM BASICS 2 - PARASYMPATHETIC
INHIBITION
18. PHARM BASICS 3 - CELLULAR
COMMUNICATION
19. ENDOCRINE 1 - ENDOCRINE OVERVIEW
20. ENDOCRINE 2 - PITUITARY
21. ENDOCRINE 3 - ADRENAL STEROID SYNTHESIS
22. ENDOCRINE 4 - GLUCOCORTICOIDS AND
CUSHING SYNDROME
23. ENDOCRINE 5 - OTHER ADRENAL
PATHOLOGY
24. PHARM BASICS 4 - SYMPATHETIC ACTIVATION
25. PHARM BASICS 5 - SYMPATHETIC INHIBITION
26. GI 1 - OROPHARYNX
27. ENDOCRINE 6 - THYROID BASICS AND
HYPERTHYROIDISM
28. ENDOCRINE 7 - HYPOTHYROIDISM AND
THYROID CANCER
29. IMMUNOLOGY 1 - IMMUNOLOGY BASICS
30. IMMUNOLOGY 2 - ANTIGEN PRESENTATION
31. IMMUNOLOGY 3 - T CELLS
ALTHOUGH YOU HAVE THE FLEXIBILITY TO VIEW THE VIDEOS IN ANY ORDER, WE STRONGLY RECOMMEND
THAT YOU WATCH THE VIDEOS IN THE ORDER IN WHICH YOUR PERSONALIZED DASHBOARD PRESENTS THEM
REGARDLESS OF HOW MANY VIDEOS YOU VIEW IN A DAY.
32. IMMUNOLOGY 4 - MONOCYTES AND
MACROPHAGES
33. BIOCHEM 1 - RNA
34. BIOCHEM 2 - PROTEIN
35. IMMUNOLOGY 5 - B CELLS AND ANTIBODIES
36. IMMUNOLOGY 6 - IMMUNIZATION AND
AUTOANTIBODIES
37. IMMUNOLOGY 7 - GRANULOCYTES,
CYTOKINES, AND IMMUNOSUPPRESSANTS
38. IMMUNOLOGY 8 - COMPLEMENT AND
HYPERSENSITIVITY
39. IMMUNOLOGY 9 - IMMUNODEFICIENCIES
40. MICRO 1 - HIV
41. MICRO 2 - HIV DRUGS
42. GI 2- ESOPHAGUS
43. GI 3 - STOMACH
44. PHARM BASICS 6 - PHARMACOKINETICS
45. GI 4 - UPPER GI PATH
46. GI 5 - DUODENUM
47. GI 6 - PANCREAS
48. ENDOCRINE 8 - DIABETES
49. ENDOCRINE 9 - DKA AND DIABETES
TREATMENT
50. GI 7 - ENTEROCYTES AND ABSORPTION
51. GI 8 - DISEASES OF SMALL INTESTINE
52. BIOCHEM 3 - GLUCOSE
53. BIOCHEM 4 - GLYCOGEN
54. BIOCHEM 5 - ENERGY
55. BIOCHEM 6 - HMP SHUNT AND OTHER
SUGARS
56. BIOCHEM 7 - FUEL USE
57. ENDOCRINE 10 - OBESITY
58. GI 9 - HEPATOCYTES AND CIRRHOSIS
59. GI 10 - LIVER PATHOLOGY
60. GI 11 - HEPATITIS
61. GI 12 - BILIARY TRACT
62. BIOCHEM 8 - LIPIDS
63. BIOCHEM 9 - AMINO ACIDS AND
NITROGEN
64. BIOCHEM 10 - AMINO ACID DISORDERS
65. PHARM BASICS 7 - DRUG METABOLISM
RECOMMENDED COURSE ORDER
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66. HEME 1 - CLOTTING FACTORS
67. HEME 2 - RBCS
68. BIOCHEM 11 - DNA BASICS
69. BIOCHEM 12 - DNA REPLICATION,
MUTATION, AND REPAIR
70. BIOCHEM 13 - MINERALS
71. HEME 3 - NONHEMOLYTIC ANEMIAS
72. HEME 4 - HEMOLYTIC ANEMIAS
73. HEME 5 - PLATELETS
74. HEME 6 - CANCERS OF BLOOD
75. BIOCHEM 14 - FAT-SOLUBLE VITAMINS AND
ANTIOXIDANTS
76. BIOCHEM 15 - WATER-SOLUBLE VITAMINS
77. GI 13 - LARGE INTESTINE 1
78. GI 14 - LARGE INTESTINE 2
79. MICRO 3 - ENTEROBACTERIACEAE, DIARRHEA,
AND FOOD POISONING
80. MICRO 4 - PROTOZOA
81. MICRO 5 - HELMINTHS AND ECTOPARASITES
82. ONCOLOGY 1 - GENETICS OF CANCER
83. ONCOLOGY 2 - CANCER RISK FACTORS
84. ONCOLOGY 3 - NEOPLASTIC PROGRESSION
85. ONCOLOGY 4 - CANCER PREVENTION AND
HOST DEFENSE
86. ONCOLOGY 5 - CANCER DRUGS
87. MEDICINE IN SOCIETY 1 - STUDIES AND
DIAGNOSTIC TESTS
88. MEDICINE IN SOCIETY 2 - APPLICATION OF
TEST DATA
89. MEDICINE IN SOCIETY 3 - BIAS AND ERROR
90. MEDICINE IN SOCIETY 4 - CONFIDENCE
INTERVAL
91. MEDICINE IN SOCIETY 5 - PUBLIC HEALTH
92. MEDICINE IN SOCIETY 6 - GERIATRICS
93. MEDICINE IN SOCIETY 7 - HEALTHCARE
SYSTEM
94. MEDICINE IN SOCIETY 8 - ETHICS
95. PULMONARY 1 - ANATOMY AND PHYSIOLOGY
96. PULMONARY 2 - LUNG VOLUMES AND
PULMONARY CIRCULATION
97. PULMONARY 3 - OXYGEN AND HEMOGLOBIN
98. PULMONARY 4 - OXYGENATION AND
VENTILATION
99. PULMONARY 5 - EXTREME ENVIRONMENTS
100. PULMONARY 6 - PE AND DVT
101. PULMONARY 7 - COPD AND ASTHMA
102. PULMONARY 8 - RESTRICTIVE LUNG DISEASE
103. PULMONARY 9 - LUNG CANCER AND
INFECTIONS
104. MICRO 6 - BACTERIAL BASICS
105. MICRO 7 - BACTERIAL TOXINS
106. MICRO 8 - STAPHYLOCOCCUS
107. MICRO 9 - STREPTOCOCCUS
108. MICRO 10 - OTHER GRAM POSITIVES
109. MICRO 11 - PENICILLINS
110. MICRO 12 - CEPHALOSPORINS
111. MICRO 13 - OTHER CELL WALL INHIBITORS
112. MICRO 14 - TB AND TB DRUGS
113. MICRO 15 - SPIROCHETES AND W
114. MICRO 16 - NONSTAINING BACTERIA
115. CARDIOVASCULAR 1 - EMBRYOLOGY
116. CARDIOVASCULAR 2 - DEVELOPMENTAL
PATHOLOGY
117. CARDIOVASCULAR 3 - CARDIAC OUTPUT
118. CARDIOVASCULAR 4 - HEART FAILURE
119. CARDIOVASCULAR 5 - EDEMA AND SHOCK
120. CARDIOVASCULAR 6 - CARDIAC CYCLE
121. CARDIOVASCULAR 7 - HEART MURMURS
122. CARDIOVASCULAR 8 - ELECTROPHYSIOLOGY
123. CARDIOVASCULAR 9 - ANTIARRHYTHMICS
124. CARDIOVASCULAR 10 -
ELECTROCARDIOGRAPHY
125. CARDIOVASCULAR 11 - ARRHYTHMIAS
126. CARDIOVASCULAR 12 - REGULATION OF BP
127. CARDIOVASCULAR 13 - HYPERTENSION
128. CARDIOVASCULAR 14 - ANTIHYPERTENSIVES
129. CARDIOVASCULAR 15 - ATHEROSCLEROSIS
130. CARDIOVASCULAR 16 - ANTIANGINAL
THERAPY AND LIPID-LOWERING AGENTS
131. CARDIOVASCULAR 17 - MYOCARDIAL
INFARCTION
132. CARDIOVASCULAR 18 - CARDIOMYOPATHIES
AND ENDOCARDITIS
133. CARDIOVASCULAR 19 - OTHER CARDIAC
PATHOLOGY
134. CARDIOVASCULAR 20 - VASCULAR DISEASES
135. NEURO 7 - REGIONS OF THE BRAIN
136. NEURO 8 - BRAINSTEM IN CROSS SECTION
137. NEURO 9 - OCCLUSION SYNDROMES
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138. NEURO 10 - VASCULAR EVENTS
139. NEURO 11 - MOVEMENT
140. NEURO 12 - BASAL GANGLIA
141. NEURO 13 - SPINAL CORD AND LESIONS
142. NEURO 14 - BRACHIAL PLEXUS AND UPPER
EXTREMITY NERVES
143. NEURO 15 - LOWER EXTREMITY & SKELETAL
MUSCLE
144. RHEUM & DERM 1 - BONE AND BONE
DISORDERS
145. ENDOCRINE 11 - CALCIUM METABOLISM
146. RHEUM & DERM 2 - JOINT BASICS
147. RHEUM & DERM 3 - JOINT DISEASES
148. RHEUM & DERM 4 - SYSTEMIC DISORDERS
149. NEURO 16 - SENSATION
150. RHEUM & DERM 5 - DERMATOLOGY
151. MICRO 17 - MYCOLOGY
152. MICRO 18 - ANTIFUNGALS
153. NEURO 17 - EYE
154. NEURO 18 - EAR
155. PSYCH 1 - PSYCHOLOGY
156. PSYCH 2 - CHILD PSYCH
157. PSYCH 3 - ALCOHOL ABUSE
158. PSYCH 4 - SUBSTANCE ABUSE
159. NEURO 19 - DELIRIUM AND DEMENTIA
160. NEURO 20 - HEADACHE
161. NEURO 21 - BRAIN TUMORS
162. NEURO 22 - ANESTHETICS
163. NEURO 23 - SEIZURES
164. PSYCH 5 - PSYCHOSIS
165. PSYCH 6 - BIPOLAR DISORDER
166. PSYCH 7 - DEPRESSION
167. PSYCH 8 - ANTIDEPRESSANTS
168. PSYCH 9 - ANXIETY AND SOMATOFORM
DISORDERS
169. PSYCH 10 - EGO DEFENSE MECHANISMS AND
PERSONALITY DISORDERS
170. RENAL 1 - RENAL BASICS
171. RENAL 2 - NEPHRON PHYSIOLOGY
172. RENAL 3 - DIURETICS
173. RENAL 4 - METABOLIC DISORDERS
174. RENAL 5 - GLOMERULAR PATHOLOGY
175. RENAL 6 - OTHER RENAL PATHOLOGY
176. MICRO 19 - UTI
177. MICRO 20 - OTHER GRAM NEGATIVE
BACTERIA
178. MICRO 21 - PROTEIN SYNTHESIS INHIBITORS
179. MICRO 22 - VIRAL BASICS
180. MICRO 23 - HERPES VIRUSES
181. MICRO 24 - OTHER DNA VIRUSES
182. MICRO 25 - RNA VIRUSES PART 1
183. MICRO 26 - RNA VIRUSES PART 2
184. MICRO 27 - MICRO BY SYSTEMS PART 1
185. MICRO 28 - MICRO BY SYSTEMS PART 2
186. PHARM BASICS 8 - DRUG SIDE EFFECTS
187. PHARM BASICS 9 - ANTIDOTES
188. REPRODUCTION 1 - ANATOMY &
EMBRYOLOGY
189. REPRODUCTION 2 - ANDROGENS
190. REPRODUCTION 3 - TESTICULAR
PATHOLOGY
191. REPRODUCTION 4 - PENIS AND PROSTATE
PATHOLOGY
192. REPRODUCTION 5 - FEMALE REPRODUCTIVE
CYCLE
193. REPRODUCTION 6 - BIRTH CONTROL AND
MENOPAUSE
194. REPRODUCTION 7 - VAGINAL AND
CERVICAL PATHOLOGY
195. REPRODUCTION 8 - UTERINE PATHOLOGY
196. REPRODUCTION 9 - OVARIAN PATHOLOGY
197. REPRODUCTION 10 - PREGNANCY PART 1
198. REPRODUCTION 11 - PREGNANCY PART 2
199. REPRODUCTION 12 - CHROMOSOMAL
DISORDERS
200. REPRODUCTION 13 - GENETIC DISORDERS:
AD AND TRINUCLEOTIDE REPEATS
201. REPRODUCTION 14 - GENETIC DISORDERS:
AR AND X-LINKED
202. BIOCHEM 16 - GENETIC LABORATORY
TECHNIQUES
203. BIOCHEM 17 - INHERITANCE
204. REPRODUCTION 15 - BREAST
205. PEDIATRICS - PEDIATRIC REVIEW
[ 1 ]
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FOUNDATIONS
1 EMBRYOLOGY PART 1
2 EMBRYOLOGY PART 2
3 CELLULAR ORDER
4 CYTOSKELETON AND OTHER
CELLULAR COMPONENTS
5 PLASMA MEMBRANE
6 CELLULAR SUFFERING AND DEATH
7 INFLAMMATION
8 CONTROL OF THE EXTRACELLULAR
ENVIRONMENT
9 CELLULAR ADAPTATIONS
FROM EMBRYOLOGY TO THE
FUNDAMENTALS OF CELL
BIOLOGY, INFLAMMATION,
AND APOPTOSIS, THIS
SECTION REVIEWS SOME OF
THE BASIC SCIENCE THAT
FORMS THE FOUNDATIONAL
UNDERPINNINGS OF
MUCH OF OUR MEDICAL
KNOWLEDGE.
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EMBRYOLOGY PART 1
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Fetal landmarks (FA12 p124) (FA13 p504)
Early fetal development (FA13 p114) (FA13 p504)
1. What tissues are derived from ectoderm, mesoderm and ectoderm?
2. What is the formula for Gibbs free energy?
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3. What developmental structure matches the following description?
(FA12 p129) (FA13 p508)
Fetal placental structure that secretes hCG
Maternal component of the placenta

4. Order the following molecules by how much energy they contain that can be
made available to fuel endergonic reactions:
pyruvate, adenosine monophosphate, glucose, adenosine, adenosine triphosphate.
5. What are the stages of an embryo between conception and an inner cell mass?
(FA12 p124) (FA13 p504)
[ 4 ]
4. What neural crest derivatives are found in each of the following adult structures?
Peripheral nervous system
Ear
Eye
Adrenal gland
Mouth
Heart
Digestive system
Thyroid
Skin
5. Homeobox (HOX) Genes
Blueprint for skeletal morphology
Code for transcription regulators
Mutation in Homeobox HOXD-13 synpolydactyly (extra fused digit between 3rd and
4th fngers)
Retinoic acid alters HOX gene expression
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3 QUESTION WARM-UP
1. What embryonic structure (derived from the hypoblast) serves as a secondary
energy source?
2. What embryonic structure serves as a reservoir of nonspecialized
(undifferentiated) stem cells?
3. What are the 3 germ layers that derive from the epiblast? (FA12 p125) (FA13 p504)
EMBRYOLOGY PART 2
GG: Chapter 23, 66
Fetal landmarks (FA12 p124) (FA13 p504)
Embryologic derivatives (FA12 p126) (FA13 p505)
Neural development (FA12 p125) (FA13 p408) (SU13 p44-45)
Teratogens (FA12 p127) (FA13 p506) (SU13 p34) (GG p1845)
Important genes of embryogenesis (FA12 p124) (FA13 p504) (SU13 p222-225)
Fetal alcohol syndrome (FA12 p128) (FA13 p507) (GG p641)
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6. A patient with an aganglionic colon and other neural crest derivative defciencies.
What other fndings would you expect to see? (SU13 p140)

7. List as many drugs as you can that are contraindicated in pregnancy.
(FA12 p127) (FA13 p506)
8. What is the relationship between the notochord, the neural plate, the neural
tube, and the neural crest cells? (FA12 p125)
9. What is the embryologic origin of the following adult structures? (FA12 p126) (FA13 p505)
Anterior pituitary
Cornea
Lens
Retina
Olfactory epithelium
Mammary glands
Salivary glands
Sweat glands
RAPID-FIRE FACTS
Most common cause of neural tube
defects
Most common cause of congenital
malformations in the US
Most common cause of congenital mental
retardation in the US
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[ 6 ]
CELLULAR ORDER
Phys: Chapter 2
R: Chapter 3
Nucleus (SU13 p15)
Cell cycle phases (FA12 p79) (FA13 p74) (SU13 p12)
Endoplasmic Reticulum and Golgi (FA12 p79, 80) (FA13 p74-75) (SU13 p15)
Rough ER (FA12 p79) (FA13 p74) (SU13 p256)
Smooth ER (FA12 p79) (FA13 p74) (SU13 p256)
Golgi apparatus (FA12 p80) (FA13 p75)
Cell Traffcking (FA12 p80) (FA13 p75)
Enzyme Terminology (FA12 p101) (FA13 p96) (SU13 p156)
Protein Degradation
- Proteasome (FA12 p80) (FA13 p75) (SU13 p15)
- Lysosome
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3 QUESTION WARM-UP
1. What is the embryologic origin of the tissue just proximal to the pectinate line?
What is the origin of the tissue just distal to the anal canal?
(FA12 p126) (FA13 p505) (SU13 p138)
2. What effect might the following teratogens have on a developing fetus?
(FA12 p127) (FA13 p506)
ACE inhibitors
Aminoglycosides
Diethylstilbestrol
Tetracyclines
Valproic acid
3. Which vitamin should not be supplemented in large amounts during pregnancy?
(FA12 p127) (FA13 p506) (SU13 p364)
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4. Nuclear Localization Signals
Amino acids sequences: 4-8 amino acids; rich in lysine, arginine, and protein
Essential component of proteins bound for or residing in the nucleus (e.g., histones)
Nuclear pores recognize these signals and transport proteins into the nucleus via ATPase
A mutation in a single amino acid may prevent nuclear transport
5. Cell Cycle Basics (FA12 p79) (FA13 p74) (SU13 p12)
Cyclins + cyclin-dependent kinases (CDK) phosphorylate target proteins to drive the cell cycle
All cyclins are degraded by ubiquitin protein ligase when their cell-cycle specifc job is
complete
p21, p27, and p57 bind to and inactivate cyclin-CDK complexes (p53 controls the activation of p21)
G1 S
Cyclin D binds/activates CDK4 phosphorylation of Rb protein Rb protein is released
from transcription factor E2F with E2F unbound, the cell is free to transcribe/synthesize
components needed for progression through the S phase (cyclin E, DNA polymerase,
thymidine kinase, dihydrofolate reductase)
Cyclin E binds/activates CDK2 the cell is allowed to progress into S phase
G2 M
Cyclin A CDK2 complex mitotic prophase
Cyclin B CDK1 complex activated by cdc25 breakdown of nuclear envelope (nuclear
lamin breakdown) and initiation of mitosis
6. I-cell disease (FA12 p80) (FA13 p75) (SU13 p297)
Defciency in mannose phosphorylation
No mannose-6-phosphate to target lysosomal proteins secretion out of cell instead of
into lysosomes
Death by age 8
(+) Corneal clouding, coarse facies, HSM, skeletal abnormalities, restricted joint movement,
+/- MR
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[ 8 ]
7. Clathrin
A mutant LDL
receptor lacks the
coated-pit binding
site but retains a
functioning LDL-
binding site. As a
result, cells with
mutant receptors
are able to bind
LDL normally but
are unable to ingest
it. Individuals with
this mutation have a
higher risk of dying
prematurely from a
myocardial infarction.
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END OF SESSION QUIZ
8. What must be present on a protein in order for that protein to gain entry into
the nucleus?
9. Which types of proteins are responsible for fostering the progression through
the cell cycle? (FA12 p79) (FA13 p74)
10. Which cyclin-CDK complexes assist in the progression from GI phase to S
phase?
11. Which cyclin-CDK complexes assist in the progression from G2 phase to
M phase?

12. What molecule targets proteins in the endoplasmic reticulum for lysosomes?
(FA12 p80) (FA13 p75)

13. What are the different methods that a cell uses to break down proteins
(proteolysis)?
14. Which cell types are rich in smooth ER? (FA12 p79) (FA13 p74)
7. Clathrin
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CYTOSKELETON AND OTHER CELLULAR COMPONENTS
Phys : Chapter 2
Cytoskeleton
- Cytoskeletal elements (FA12 p81) (FA13 p76)
- Immunohistochemical stains (FA12 p82) (FA13 p76)
- Microtubule (FA12 p81) (FA13 p76)
- Cilia structure (FA12 p81) (FA13 p76) (SU13 p83)
- Kartagener syndrome (FA12 p81) (FA13 p76) (SU13 p83)
Free soluble cytoplasmic elements
- Free ribosomes
- Enzymes
- Water, elements (potassium), organic molecules (amino acids, glucose)
- Cytoskeleton
Insoluble cytoplasmic inclusions
- Glycogen
- Lipid droplets
Sarcoplasmic reticulum
Mitochondria (Phys p16)
Peroxisome
3 QUESTION WARM-UP
1. Which amino acids are found in nuclear localization signals?

2. What is the most common cause of mental retardation in infants?
(FA12 p128) (FA13 p506) (SU13 p45)

3. How do Rb protein and p53 regulate the cell cycle? (FA12 p79) (FA13 p74)
4. Intermediate Filament Structures
Intermediate Filaments Structural Component of:
Vimentin
Support cellular membranes
Keep certain organelles fxed in
cytoplasm
Connective tissue
(fbroblasts, leukocytes, endothelium)
Desmin Muscle cells (smooth, skeletal, heart)
Cytokeratin Epithelial cells (keratin in desmosomes and
hemidesmosomes)
Glial fbrillary acid proteins (GFAP) Astrocytes, Schwann cells, other neuroglia
Peripherin Neurons
Neuroflaments
(L, M, H molecular weight)
Axons within neurons
Nuclear lamins (A, B,C) Nuclear envelope and DNA within
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END OF SESSION QUIZ
5. What drugs act on microtubules? (FA12 p81) (FA13 p76) (SU13 p262, 319)
6. What two fundamental substances are required to make most things work inside
the cell?

7. Which organelle is responsible for the breakdown of very long-chain fatty acids?
(FA12 p80) (FA13 p75)

8. What are the intermediate flaments for the following tissue types and cellular
structures? (FA12 p82) (FA13 p79)
Connective tissue
Muscle tissue
Epithelial tissue
Axons
9. What are the defects seen in Kartagener syndrome?
(FA12 p81) (FA13 p76) (SU13 p83, 124)
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PLASMA MEMBRANE
Phys: Chapters 2, 4
R: Chapter 2
Plasma membrane
- Composition
- Sodium pump
- Sodium-mediated diffusion (Phys p54)
Arachidonic acid (R p58)
3 QUESTION WARM-UP
1. During what weeks of fetal development does organogenesis take place? (FA12 p124)
(FA13 p504)
2. What molecules provide the structural framework for DNA and the nuclear envelope?
3. What is defcient in I-cell disease? (FA12 p80) (FA13 p75) (SU13 p297)
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5. Tyrosine kinase receptor
Transmembrane receptors that bind an extracellular ligand then intracellularly transfer a
phosphate group (phosphorylate) from ATP to selected tyrosine side chains on specifc
cellular proteins including itself (autophosphorylation). The frst step in the signaling cascade
that is initiated by tyrosine kinase receptors is autophosphorylation.
PDGF and other growth factor receptors: single-pass transmembrane protein
Insulin and IGF-1 receptors:
- 2 subunits (bound by disulfde bonds) bind extracellular ligand
- 2 subunits tyrosine kinase activity
4. List the steps outlining the derivatives of arachidonic acid. (FA12 p429) (FA13 p404)
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END OF SESSION QUIZ
6. Which arachidonic acid product causes each of the following effects?
(FA12 p429) (FA13 p404) (SU13 p272)
Increased bronchial tone
Decreased bronchial tone
Increased platelet aggregation
Decreased platelet aggregation
Increased uterine tone
Decreased uterine tone
Increased vascular tone
Decreased vascular tone
7. What are the two most abundant substances in plasma membranes?
(FA12 p81) (FA13 p76)
8. What drugs act on the arachidonic acid product pathway? What enzymes do
they affect? (FA12 p429) (FA13 p404)
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4. Intrinsic Pathway of Apoptosis (FA12 p244) (FA13 p212)
Bcl-2 is the major anti-apoptotic regulator of mitochondrial permeability
DNA damage or apoptotic signal activates Bax (pro-apoptotic)
Bax creates channels in mitochondrial membrane
Cytochrome C moves from the mitochondria into the cytosol and activates caspases
Caspases are primary initiator of apoptosis

5. Extrinsic Pathways of Apoptosis
Death receptor
- TNF receptor and Fas receptor are located on cell membrane
- TNF- and Fas ligand activate the receptors
- Activated receptors will lead to activation of caspases
Cytotoxic T Lymphocyte
- Cytotoxic T cells recognize foreign or infected cell
- CTLs release perforin and granzyme B
- Perforin punches holes in membrane
- Granzyme B enters and activates caspases

CELLULAR SUFFERING AND DEATH
R: Chapter 1
Apoptosis (FA12 p244) (FA13 p212)
- Intrinsic pathway
- Extrinsic pathway
Necrosis (FA12 p244) (FA13 p212)
Reversible vs. irreversible injury (FA12 p245) (FA13 p213)
Mechanisms of cell injury
Defects in membrane permeability
Red vs. pale infarcts (FA12 p245) (FA13 p213) (SU13 p103, 104)
3 QUESTION WARM-UP
1. What drug inhibits the cellular sodium-potassium ATPase? (FA12 p82) (FA13 p77)
2. What drugs interfere with microtubule functioning? (FA12 p81) (FA13 p76) (SU13 p319)
3. Which cell types are constantly regenerating themselves due to an absence of
the G0 phase and a short G1 phase? (FA12 p79) (FA13 p74)
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END OF SESSION QUIZ
8. What histologic features are seen in apoptotic liver cells? (FA12 p244) (FA13 p212)
9. What substances do cytotoxic T cells and NK cells use to induce apoptosis in the
cells infected with virus? (FA12 p244) (FA13 p212) (SU13 p289)
10. What highly damaging events can cause irreversible cell injury?
(FA12 p245) (FA13 p213)
11. What cellular enzymes are responsible for handling oxygen free radicals? (R p21)
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6. Mechanisms of Cell Injury
ATP depletion: due to decreased oxygen/nutrients and toxins (cyanide)
Mitochondrial damage: impairs ATP production and can induce apoptosis
Infux of calcium: increases mitochondrial permeability and can activate phospholipases,
proteases, endonucleases and ATPases
Accumulation of oxygen-derived free radicals: cell dame through membrane lipid
peroxidation, protein modifcation and DNA breakage. Multiple causes like radiation
exposure, metabolism of drugs, redox reaction, nitric oxide, transition metals, leukocyte
oxidative burst, iron overdose and reperfusion injury.
7. What cellular byproducts might you detect in the serum when the following cell
types are injured?
Cardiac myocytes
Skeletal myocytes
Hepatocytes
Salivary gland cells
Pancreatic exocrine cells
RBCs
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INFLAMMATION
R : Chapter 2
Infammation (FA12 p246) (FA13 p214)
- Acute infammation
- Leukocyte extravasation (FA12 p247) (FA13 p215) (SU13 p118)
Transudate vs. exudate (FA12 p248) (FA13 p216) (SU13 p113)
Patterns of infammation (R p66)
Chronic infammation
- Granulomatous diseases (FA12 p246) (FA13 p214)
Markers of infammation
- Erythrocyte sedimentation rate (FA12 p248) (FA13 p217)
- C-reactive protein (R p74)
- Systemic effects (R p74)
3 QUESTION WARM-UP
1. What are the characteristic features of a cell undergoing apoptosis?
(FA12 p244) (FA13 p212)
2. What are some of the substances that can trigger apoptosis?
3. What neural crest derivatives are found in each of the following adult structures?
(FA12 p126) (FA13 p505)
Peripheral Nervous System
Ear
Eye
Adrenal Gland
Mouth
Heart
Digestive System
Thyroid
Skin
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[ 18 ]
END OF SESSION QUIZ
6. Describe the process of leukocyte extravasation. (FA12 p247) (FA13 p215)
7. What cytokine is particularly important in the formation of granulomas? (FA12 p248)
(FA13 p216)
8. What cell type plays a role in infammation by generating fbrinogen and
C-reactive protein?

9. What cell is most responsible for the acute phase of infammation?
4. Elevated ESR (FA12 p248) (FA13 p217)
Polymyalgia rheumatica
Temporal arteritis
Disease activity in RA and SLE
Infection, Infammation (e.g., osteomyelitis)
Malignancy
5. C-Reactive Protein (R p498)
Acute-phase reactant synthesized by the liver
Part of the innate immune response: opsonizes bacteria and activates complement
Can be secreted from cells within atherosclerotic plaques to activate local endothelial cells
to induce a prothrombotic state and increase the adhesiveness of the endothelium to
leukocytes
Elevations are a strong predictor of MI, stroke, PAD, and sudden cardiac death
CRP can be lowered by smoking cessation, exercise, weight loss, and statins
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4. Epithelial Wound Healing
0-3 hours - Hemorrhage and clotting
12-24 hours - Acute infammation (PMN)
2-4 days - Macrophage infltration and epithelial cell migration
3-5 days - Granulation tissue (especially at wound edges)
Months - Collagen production (type III then type I)
CONTROL OF THE EXTRACELLULAR ENVIRONMENT
R: Chapter 3
Collagen (R p95)
Collagen synthesis and structure (FA12 p83) (FA13 p78) (SU13 p256)
Fibroblasts
Osteogenesis imperfecta (FA12 p83) (FA13 p78) (SU13 p258)
Ehlers-Danlos syndrome (FA12 p83) (FA13 p78) (SU13 p265)
Alport syndrome (FA12 p84) (FA13 p79) (SU13 p178)
Elastin (FA12 p84) (FA13 p79) (SU13 p256)
Mechanisms of angiogenesis (R p99)
Cutaneous wound healing (FA12 p248) (FA13 p216) (R p102)
3 QUESTION WARM-UP
1. What protein is involved in transporting an endocytosed vesicle from the plasma
membrane to the endosome? (FA12 p80) (FA13 p75)
2. Which metals are known to facilitate the generation of oxygen free radicals?
3. Which tumor suppressor proteins prevent the progression of the cell into S phase?
(FA12 p79) (FA13 p76)
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END OF SESSION QUIZ
5. What fndings are associated with Ehlers-Danlos syndrome? (FA12 p83) (FA13 p78)

6. What are the different types of collagen, and where can they be found?
(FA12 p82) (FA13 p79)

7. Which amino acids are found in large concentrations in collagen? In elastin?
(FA12 p83-84) (FA13 p78-79)
8. What is the role of vitamin C in collagen production? (FA12 p83) (FA13 p78)
8
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RAPID-FIRE FACTS
Hyperfexible joints, arachnodactyly, aortic
dissection, lens dislocation
Hereditary nephritis, cataracts,
sensorineural hearing loss
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CELLULAR ADAPTATIONS
R : Chapter 1, 3
Hypertrophy vs. hyperplasia (R p6)
Replacement
- Stem cells (R p82)
- Liver regeneration (R p93)
Metaplasia
Atrophy (FA12 p246) (FA13 p214) (R p9)
Cellular aging (R p39-40)
3 QUESTION WARM-UP
1. What is the underlying dysfunction in Chdiak-Higashi syndrome?
(FA12 p81) (FA13 p16)
2. How does having a high cholesterol content in the plasma membrane affect the
function of the plasma membrane? (FA12 p81) (FA13 p76)
3. What area of the colon is most susceptible to ischemic damage?
(FA12 p245) (FA13 p213)
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[ 22 ]
END OF SESSION QUIZ
4. Does the compensatory growth of muscle fbers occur primarily as a result of
hyperplasia or hypertrophy? (R p6)
5. Does myometrial growth in pregnancy occur primarily as a result of hyperplasia
or hypertrophy? (R p7)

6. What can happen to the cells of the lower esophagus in response to chronic acid
refux? (FA12 p352) (FA13 p325) (SU13 p142) (R p10)
7. What is actually occurring at the cellular level during atrophy? (R p10)
8. What is a lipofuscin granule? (R p10)
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NEUROLOGY
1 BRAIN EMBRYOLOGY
2 ORGANIZATION OF THE BRAIN
3 HYPOTHALAMUS
4 SLEEP
5 CRANIAL NERVES
6 BRANCHIAL APPARATUS
7 REGIONS OF THE BRAIN
8 BRAINSTEM IN CROSS SECTION
9 OCCLUSION SYNDROMES
10 VASCULAR EVENTS
11 MOVEMENT
12 BASAL GANGLIA
13 SPINAL CORD AND LESIONS
14 BRACHIAL PLEXUS AND UPPER EXTREMITY NERVES
15 LOWER EXTREMITY AND SKELETAL MUSCLE
16 SENSATION
17 EYE
18 EAR
19 DELIRIUM AND DEMENTIA
20 HEADACHE
21 BRAIN TUMORS
22 ANESTHETICS
23 SEIZURES
NEUROANATOMY AND
NEUROSCIENCE ARE SO
IMPORTANT AND AT THE
SAME TIME SO IMPOSING
THAT WE PREFER TO
DOLE IT OUT IN DISCREET
BUNDLES THAT ARE SPACED
THROUGHOUT THE PART
2 VIDEOS. WE STRONGLY
RECOMMEND THAT YOU
FOLLOW THE COURSE IN
THE PRESCRIBED ORDER,
WHICH OUR PHYSICIAN
EDUCATORS WILL EXPLAIN
AS THE COURSE UNFOLDS.
[ 25 ]
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BRAIN EMBRYOLOGY
R: Chapter 28
Developing brain (FA12 p133) (FA13 p408) (SU13 p44)
Neural tube defects (FA12 p133) (FA13 p409) (SU13 p45) (R p1284)
Forebrain anomalies (FA12 p134) (FA13 p409) (SU13 p45)
Posterior fossa malformations (FA12 p134) (FA13 p409) (SU13 p45)
Syringomyelia (FA12 p134) (FA13 p410) (R p1286) (H p3373)
3 QUESTION WARM-UP
1. What adult cell types arise from neural crest cells? (FA12 p126) (FA13 p505) (SU13 p44)
2. Which amino acids are modifed in the Golgi apparatus? (FA12 p80) (FA13 p75) (SU13 p15)
3. Failure of what process results in I-cell disease? (FA12 p80) (FA13 p75)
END OF SESSION QUIZ
4. What abnormalities are often found with an Arnold-Chiari malformation?
(FA12 p134) (FA13 p409) (SU13 p45)
5. What are the classic presenting symptoms of a syringomyelia? (FA12 p134) (FA13 p410)
6. What amniotic fuid lab abnormality might point you to a diagnosis of
anencephaly? (FA12 p134) (FA13 p409) (SU13 p45)
1
[ 26 ]
4. What are the 4 major dopaminergic pathways, and what is the result of blocking
these pathways?
Major pathway Result of blocking
Mesocortical pathway
Mesolimbic pathway
Nigrostriatal pathway
Tuberoinfundibular
pathway
O
R
G
A
N
I
Z
A
T
I
O
N

O
F

T
H
E

B
R
A
I
N
ORGANIZATION OF THE BRAIN
R: Chapter 28
GG: Chapter 14
Phys: Chapter 45
Cells of the nervous system (FA12 p434) (FA13 p411)
Blood-brain barrier (FA12 p436) (FA13 p413) (SU13 p48)
Neurotransmitters (FA12 p435) (FA13 p413) (GG p376) (Phys p550)
3 QUESTION WARM-UP
1. What organelle becomes hypertrophied in hepatocytes with chronic
phenobarbital use? (R p7)
2. What enzyme mitigates the aging effects of cellular division by maintaining
chromosomal length? (R p40)
3. What is currently the known as the most effective way of prolonging life span? (R p41)
2
[ 27 ]
N
E
U
R
O
L
O
G
Y
5. What disorder is thought to arise from reduced norepinephrine activity? Increased
norepinephrine activity?
6. What disease is associated with the degeneration of the basal nucleus of Meynert
and less CNS acetylcholine?
O
R
G
A
N
I
Z
A
T
I
O
N

O
F

T
H
E

B
R
A
I
N
END OF SESSION QUIZ
7. Which nervous system cell matches each of the following descriptions?
(FA12 p434, 436) (FA13 p411-413)
Look like fried eggs under histologic staining
Form multinucleated giant cells in the CNS when infected with HIV
Myelinates multiple CNS axons
Myelinates one PNS axon
Damaged in Guillain-Barr syndrome
Damaged in multiple sclerosis
Macrophages of the CNS
Cells of the blood brain barrier
8. In which neurological diseases is acetylcholine altered? (FA12 p435) (FA13 p413)
9. What is the main inhibitory neurotransmitter of the CNS? In which diseases are
levels altered? (FA12 p435) (FA13 p413)
10. What are the components of the blood-brain barrier? (FA12 p436) (FA13 p413) (SU13 p48)
2
[ 28 ]
H
Y
P
O
T
H
A
L
A
M
U
S
HYPOTHALAMUS
Phys: Chapter 58
Organization of the cerebrum
- Limbic system (FA12 p437) (FA13 p415) (SU13 p59)
Nuclei of the hypothalamus (FA12 p436) (FA13 p414) (SU13 p60)
Posterior pituitary (FA12 p436) (FA13 p414)
Oxytocin (Phys p905)
Melatonin
3 QUESTION WARM-UP
1. Which neurotransmitters have altered levels in anxiety disorder?
(FA12 p435) (FA13 p413)
2. What arachidonic acid product has actions that oppose that of prostacyclin?
(FA12 p429) (FA13 p404)
3. What organelle and cytochrome are particularly important in intrinsic apoptosis?
(FA12 p244) (FA13 p212)
END OF SESSION QUIZ
4. Which nucleus of the hypothalamus fts each of the following descriptions?
(FA12 p436) (FA13 p414)
Considered the master clock for most of our circadian rhythms
Regulates the parasympathetic NS
Destruction results in hyperthermia
Regulates the sympathetic NS
Produces antidiuretic hormone (ADH) to regulate water balance
Receives input from the retina
Savage behavior and obesity result from stimulation
Savage behavior and obesity result from destruction
Stimulation leads to eating and destruction leads to starvation
Regulates the release of gonadotropic hormones (i.e., LH and FSH)
Responsible for sweating and cutaneous vasodilation in hot temperatures
Responsible for shivering and decreased cutaneous blood fow in the cold
Destruction results in neurogenic diabetes insipidus
Destruction results in inability to stay warm
Releases hormones affecting the anterior pituitary
3
[ 29 ]
N
E
U
R
O
L
O
G
Y
S
L
E
E
P
SLEEP
Phys: Chapter 59
H: Chapter 27
Sleep stages (FA12 p64) (FA13 p61) (SU13 p63-64)
Common Sleep Disorders
- Insomnia (SU13 p64)
- Restless leg syndrome (SU13 p64)
- Night Terrors (FA12 p65) (FA13 p62) (SU13 p64)
- Obstructive sleep apnea
- Narcolepsy (FA12 p65) (FA13 p62) (SU13 p64)
- Nocturnal enuresis (SU13 p64)
Sleep patterns of depressed patients (FA12 p64) (FA13 p62)
Medications for insomnia
3 QUESTION WARM-UP
1. What effect might aminoglycosides have on a developing fetus? (FA12 p127) (FA13 p506)
2. What molecule targets proteins in the endoplasmic reticulum for lysosomes?
3. Which amino acids are found in nuclear localization signals?
4. What medications are common in the treatment of insomnia? What makes each
one unique?
Melatonin Non-addictive, OTC, vivid dreams, safe for < 3
months
Valerian OTC herbal remedy, studies show no beneft
Antihistamines (Benadryl,
Tylenol PM, doxylamine)
Commonly used by patients frst-line, associated
with poor sleep quality, not for long-term use,
anticholinergic side effects (avoid in the elderly)
Trazodone Antidepressant, increases REM sleep, small risk of
priapism
TCAs such as amitriptyline,
doxepin
Antidepressant, small risk of arrhythmias (obtain
EKG prior to use), anticholinergic side-effects
(avoid in the elderly)
Long acting benzodiazepines
such as temazepam,
lorazepam, clonazepam,
diazepam, chlordiazepoxide
Addictive, short-term only (< 35 days)
Zolpidem (Ambien), zaleplon
(Sonata)
Act at the benzo receptor, short-term only (< 35
days), rebound insomnia when discontinued
Eszopiclone (Lunesta) May be used long-term (FDA 2004)
Ramelteon (Rozerem) Non-addictive because it works at melatonin
receptors instead of GABA/benzo receptors;
avoid if hepatic insuffciency; long-term studies
are lacking
4
[ 30 ]
END OF SESSION QUIZ
6. What EEG waveforms correspond to the different stages of sleep? (SU13 p64)
7. What drugs are used to shorten Stage N3 sleep?
8. What is the key to initiating sleep? What is the principle neurotransmitter involved
in REM? (SU13 p63)
9. What is the pathway by which retinal information induces the release of
melatonin? (FA12 p65) (FA13 p65)
S
L
E
E
P
5. What is the treatment for narcolepsy? (H p220)
Avoidance of drugs that cause sleepiness
Scheduled naps (once or twice a day for 10-20 min)
Stimulants modafnil is frst-line
Support group attendance
If cataplexy then use venlafaxine, fuoxetine, or atomoxetine
Sodium oxybate (GHB) can assist in sleep and reduce cataplexy
4
[ 31 ]
N
E
U
R
O
L
O
G
Y
C
R
A
N
I
A
L

N
E
R
V
E
S
CRANIAL NERVES
COA: Chapter 7
Cranial nerves (FA12 p465) (FA13 p434) (SU13 p61-62)
Cranial nerve refexes (FA12 p465) (FA13 p434)
Cranial nerve nuclei (FA12 p456) (FA13 p434)
Extraocular muscles and nerves (FA12 p462) (FA13 p439) (SU13 p58)
Cavernous sinus (FA12 p458) (FA13 p436) (SU13 p63)
Reticular activating system
Vagal nuclei (FA12 p457) (FA13 p435)
Horner syndrome (FA12 p453) (FA13 p431) (SU13 p137)
3 QUESTION WARM-UP
1. What brain structure is responsible for extraocular movements during REM sleep?
(FA12 p64) (FA13 p617)
2. Name 7 teratogens. (FA12 p127) (FA13 p507)
3. Which areas of the hypothalamus regulate the autonomic nervous system?
(FA12 p436) (FA13 p414)
5
[ 32 ]
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I
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L

N
E
R
V
E
S

5
4. Label the cranial nerves as they come off the brainstem: (FA12 p455) (FA13 p432-433)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
Q.
R.
S.
T.
U.
V.
W.
X.
Y.
[ 33 ]
N
E
U
R
O
L
O
G
Y
END OF SESSION QUIZ
5. Which cranial nerves have their nuclei located in the medulla?
(FA12 p456) (FA13 p434)
6. Which cranial nerves have their nuclei in the pons? (FA12 p456) (FA13 p434)
7. Which cranial nerves have their nuclei in the midbrain? (FA12 p456) (FA13 p434)
8 A 19-year-old patient presents with a furuncle on his philtrum, and the cavernous
sinus becomes infected. What neurological defcits might you see in this patient?
(FA12 p458) (FA13 p436)
9. What are the muscles of mastication? (FA12 p459) (FA13 p437)
RAPID-FIRE FACTS
Unilateral facial drooping involving the
forehead
Ptosis, miosis and anhidrosis
5
C
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L

N
E
R
V
E
S
[ 34 ]
BRANCHIAL APPARATUS
Branchial apparatus (FA12 p135) (FA13 p509) (SU13 p254)
Branchial cleft derivatives (FA12 p136) (FA13 p509)
Branchial pouch derivatives (FA12 p137) (FA13 p511)
Branchial arch derivatives (FA12 p136) (FA13 p510) (SU13 p254)
3 QUESTION WARM-UP
1. Which cranial nerve is responsible for each of the following actions? (FA12 p456) (FA13 p434)
Eyelid opening
Taste from anterior 2/3 of tongue
Head turning
Tongue movement
Muscles of mastication
Balance
Monitoring carotid body and sinus chemo- and baroreceptors
2. A woman involved in an accident cannot turn head to the left and has a right
shoulder droop. What structure is damaged?
3 During what sleep stage would a man have variable BP, penile tumescence, and
variable EEG? (SU13 p64)
END OF SESSION QUIZ
4. What nerves innervate the branchial arches? Later, what structures are derived
from these arches? (FA12 p136) (FA13 p510)
5. From which branchial pouch are each of the following structures derived?
(FA12 p137) (FA13 p511)
Middle ear and eustachian tubes
Superior parathyroids
Inferior parathyroids
Epithelial lining of the palatine tonsil
Thymus
6
B
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C
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A
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A
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U
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[ 87 ]
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S
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PHARM BASICS
1 PARASYMPATHETIC ACTIVATION
2 PARASYMPATHETIC INHIBITION
3 CELLULAR COMMUNICATION
4 SYMPATHETIC ACTIVATION
5 SYMPATHETIC INHIBITION
6 PHARMACOKINETICS
7 DRUG METABOLISM
8 DRUG SIDE EFFECTS
9 ANTIDOTES
MOST PHARMACO-
THERAPEUTICS ARE
DISCUSSED THROUGHOUT
THE PART 2 VIDEOS,
ALONGSIDE THE DISEASES
THEY TREAT. THE PHARM
BASICS SECTION COVERS
THE AUTONOMIC NERVOUS
SYSTEM AND DRUGS THAT
MODULATE IT, CELLULAR
MESSENGER SYSTEMS, DRUG
METABOLISM AND THE
FOUR PHARMACOKINETIC
EQUATIONS THAT
ABSOLUTELY MUST BE
UNDERSTOOD IN ORDER TO
SURVIVE YOUR EXAM. THIS
SECTION ALSO INCLUDES
MATERIAL ON TOXICOLOGY
AND IMPORTANT DRUG SIDE
EFFECTS.
[ 89 ]
P
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A
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P
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A
C
T
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V
A
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I
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N
3 QUESTION WARM-UP
1. Which collagen is typically defcient in Ehlers-Danlos syndrome? In osteogenesis
imperfecta? (FA12 p83) (FA13 p78) (SU13 p265)
2. What regulates the progression of G1 phase of the cell cycle to S phase?
(FA12 p79) (FA13 p74)
3. What cranial nerves innervate the tongue in the following ways?
(FA12 p137) (FA13 p410)
Taste in the anterior 2/3
Taste in posterior 1/3 (main innervation)
Motor
Sensation in the anterior 2/3
Sensation in the posterior 1/3
PARASYMPATHETIC ACTIVATION
GG: Chapters 8-10
Phys: Chapter 60
Autonomic nervous system (FA12 p262) (FA13 p230)
Nicotinic vs. muscarinic receptors (FA12 p262) (FA13 p230)
Parasympathetic activation (SU13 p46)
Cholinergic agonists (FA12 p265) (FA13 p233)
Alzheimer disease
Myasthenia gravis (FA12 p422) (FA13 p394)
4. What are the symptoms of excess parasympathetic activity?
(FA12 p265) (FA13 p233) (SU13 p46)
5. Alzheimer disease anticholinesterases
Donepezil
Galantamine
Rivastigmine
1
[ 90 ]
END OF SESSION QUIZ
7. How does the parasympathetic nervous system affect the following body
structures?
Heart
Eye
Salivary glands
Bronchiolar smooth muscle
Bladder
Male GU
GI tract
8. What drug regenerates acetylcholinesterases after organophosphate poisoning?
(FA12 p265) (FA13 p233) (SU13 p29, 379)
9. What is the antidote for organophosphate poisoning?
(FA12 p265) (FA13 p233) (SU13 p29)
10. Which anticholinesterases are used in the treatment of Alzheimer disease?
P
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A
S
Y
M
P
A
T
H
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A
C
T
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V
A
T
I
O
N
6. Myasthenia Gravis (FA12 p422) (FA13 p394)
Antibodies to the acetylcholine receptor
Most common board question presentation: that
worsens throughout the day
Tensilon test
Thymus pathology:
- 50% associated with thymic
- 20% associated with thymic
- 15% associated with thymic
Myasthenic crisis - rapidly progressing weakness esp. in muscles
Rx: , , ,
RAPID-FIRE FACTS
Amyloid deposits in gray matter of the
brain
Drooling farmer
1
[ 91 ]
P
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M

B
A
S
I
C
S
4. What are the symptoms of inhibiting parasympathetic activity?
(FA12 p266) (FA13 p234)
5. What drugs inhibit parasympathetic activity? What are their uses?
(FA12 p266) (FA13 p233)
6. What anticholinergics are used in the treatment of urge type urinary incontinence?
Oxybutynin
Tolterodine
Darifenacin and solifenacin
Trospium
P
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S
Y
M
P
A
T
H
E
T
I
C

I
N
H
I
B
I
T
I
O
N
3 QUESTION WARM-UP
1. What are the symptoms of excess parasympathetic activity? (FA12 p265) (FA13 p233)
2. Atropine is not effective in reversal of organophosphate poisoning. What drug
would best help this patient?
3. What are the components of the blood-brain barrier? (FA12 p436) (FA13 p413)
PARASYMPATHETIC INHIBITION
GG: Chapters 9, 11
Parasympathetic activation review
Parasympathetic inhibition
Muscarinic antagonists (FA12 p266) (FA13 p234)
Other drugs with anticholinergic side effects
2
[ 92 ]
END OF SESSION QUIZ
9. Identify the following drugs as a direct cholinergic agonist, anticholinesterase, anti-
muscarinic, or cholinesterase regenerator:
Physostigmine
Pilocarpine
Oxybutynin
Atropine
Donepezil
Pralidoxime
Bethanechol
Neostigmine
Darifenacin
Ipratropium
10. Which of the muscarinic antagonists discussed could be used to improve FEV1 in
a patient with COPD?
P
A
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A
S
Y
M
P
A
T
H
E
T
I
C

I
N
H
I
B
I
T
I
O
N
7. In what patient populations is atropine contraindicated?
(FA12 p266) (FA13 p234) (SU13 p340)
8. What other medications have anticholinergic side effects?
First generation H1 blockers: diphenhydramine (Benadryl), doxylamine (Unisom),
chlorpheniramine
Neuroleptics
Tricyclic antidepressants
Amantadine
Tropicamide
Benztropine
Scopolamine
Edrophonium
Tolterodine
Trospium
Rivastigmine
Homatropine
Pyridostigmine
Carbachol
2
[ 93 ]
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B
A
S
I
C
S
4. Fill in the diagram of acetylcholine synthesis and neurotransmission:
C
E
L
L
U
L
A
R

C
O
M
M
U
N
I
C
A
T
I
O
N
3 QUESTION WARM-UP
1. Which agents are often used in the treatment of urge incontinence?
2. What group of genes is responsible for skeletal development?
(FA12 p124) (FA13 p504)
3. Which cell types are derived from the neural crest?
(FA12 p126) (FA13 p505) (SU13 p44-45)
CELLULAR COMMUNICATION
GG: Chapter 3, 8
Phys: Chapter 45, 60
R: Chapter 3
Cholinergic neurotransmission (FA12 p264) (FA13 p232) (SU13 p47) (GG p182) (Phys p731)
Catecholamine synthesis (FA12 p112) (FA13 p108)
Noradrenergic neurotransmission (FA12 p264) (FA13 p232) (SU13 p47)
G protein second messengers (FA12 p263) (FA13 p231) (SU13 p46, 197) (Phys p548) (R p90-91) (GG p52)
3
[ 94 ]
6. Fill the signal transmission pathways:
5. Fill in the diagram of norepinephrine synthesis and neurotransmission:
C
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L
U
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A
R

C
O
M
M
U
N
I
C
A
T
I
O
N
3
[ 95 ]
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L
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A
R

C
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M
U
N
I
C
A
T
I
O
N
END OF SESSION QUIZ
7. What substances inhibit the reuptake of norepinephrine?
(FA12 p264) (FA13 p232) (SU13 p47)
8. What substances stimulate the release of norepinephrine from neurons?
(FA12 p264) (FA13 p232) (SU13 p47)
9. What G protein class does each of the following receptors stimulate?
(FA12 p263) (FA13 p231) (SU13 p197)




M
M
M
D
10. Outline the pathway by which stimulation of a Gs receptor activates protein
kinase A. (FA12 p263) (FA13 p231) (SU13 p197)
3
[ 96 ]
SYMPATHETIC ACTIVATION
3 QUESTION WARM-UP
1. What are the symptoms of organophosphate poisoning? What are the
symptoms of atropine overdose? (FA12 p265-266) (FA13 p234) (SU13 p340)
2. What are the 3 different G proteins and what are their downstream effects?
Which receptors use these G proteins? (FA12 p263) (FA13 p231) (SU13 p197)
3. What regulates prolactin secretion from the pituitary?
(FA12 p317) (FA13 p290) (SU13 p195)
Autonomic nervous system review
Adrenergic receptors (FA12 p263) (FA13 p231) (SU13 p46)
Sympathomimetics (FA12 p266) (FA13 p235)
S
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A
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T
I
V
A
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I
O
N
4
[ 97 ]
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A
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V
A
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I
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N
END OF SESSION QUIZ
4. Which receptors are stimulated by each of the following sympathomimetics?
(FA12 p266-267) (FA13 p235-236)
Clonidine
Dopamine
Phenylephrine
Albuterol
Norepinephrine
Isoproterenol
Epinephrine
Dobutamine
Terbutaline
5. Which sympathomimetic matches each of the following statements?
(FA12 p266-267) (FA13 p235-236)
Given as a nebulizer for asthma
Drug of choice for anaphylaxis
Most common frst line agent for patients in cardiogenic shock
Most common frst line agent for patients in septic shock
Given subQ for asthma
Used by ENT to vasoconstrict nasal vessels
4
[ 98 ]
GG: Chapter 12
Alpha-blockers (FA12 p268) (FA13 p237) (SU13 p97-98)
Beta-blockers (FA12 p269) (FA13 p238) (SU13 p99-100)
A2 adrenergic agonists (FA12 p267) (FA13 p235)
S
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M
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A
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H
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T
I
C

I
N
H
I
B
I
T
I
O
N
SYMPATHETIC INHIBITION
3 QUESTION WARM-UP
1. What is the main inhibitory neurotransmitter of the CNS? In which diseases are
levels altered? (FA12 p435) (FA13 p413) (SU13 p47, 74-76)
2. What are the classic presenting symptoms of syringomyelia?
(FA12 p134) (FA13 p410) (SU13 p60)
3. What drug inhibits the cellular sodium-potassium ATPase?
(FA12 p82) (FA13 p77) (SU13 p106)
END OF SESSION QUIZ
4. How does blood pressure response to phenylephrine administration change if
an -blocker is administered beforehand? Why is this different than the change
seen when epinephrine is used rather than phenylephrine? (FA12 p268) (FA13 p238)
5. What are the common side effects of -blockers? Which patient populations
should use caution when taking -blockers? (FA12 p269) (FA13 p238) (SU13 p99-100)
6. What are the various clinical applications of beta-blockers?
(FA12 p269) (FA13 p238) (SU13 p99-100)
5
[ 111 ]
E
N
D
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R
I
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E
1 ENDOCRINE OVERVIEW
2 PITUITARY
3 ADRENAL STEROID SYNTHESIS
4 GLUCOCORTICOIDS AND CUSHING SYNDROME
5 OTHER ADRENAL PATHOLOGY
6 THYROID BASICS AND HYPERTHYROIDISM
7 HYPOTHYROIDISM AND THYROID CANCER
8 DIABETES
9 DKA AND DIABETES TREATMENT
10 OBESITY
11 CALCIUM METABOLISM
ENDOCRINE
THE ENDOCRINOLOGY
QUESTIONS ON BOARD
EXAMS TEND TO BE FAIRLY
STRAIGHTFORWARD, BUT
THERE IS A WIDE AND
COMPLEX VARIETY OF
SYSTEMS TO UNDERSTAND:
PITUITARY, ADRENALS,
THYROID, PARATHYROIDS,
AND THE ENDOCRINE
PANCREAS. PAY SPECIAL
ATTENTION TO DIABETES
MELLITUS, A DISEASE WITH A
HIGH PREVALENCE IN BOTH
THE CLINIC AND ON THE
EXAM.
[ 112 ]
3 QUESTION WARM-UP
1. Which cytokine is particularly important in maintaining granulomas? (FA12 p248) (FA13 p216)
2. What is the function of the lysosome? (FA12 p80) (FA13 p75)
3. Outline the pathway by which stimulation of a Gq receptor activates protein
kinase C. (FA12 p263) (FA13 p231)
4. What hormone has each of the following action(s)?
Stimulates bone and muscle growth
Stimulates milk production and secretion
Stimulates milk secretion during lactation
Responsible for female secondary sex characteristics
Stimulates metabolic activity
Increases blood glucose level and decreases protein synthesis
Responsible for male secondary sex characteristics
Prepares endometrium for implantation / maintenance of pregnancy
Stimulates adrenal cortex to synthesize and secrete cortisol
Stimulates follicle maturation in females and spermatogenesis in males
Increases plasma calcium, increases bone resorption
Decreases plasma calcium, increases bone formation
Stimulates ovulation in females and testosterone synthesis in males
Stimulates thyroid to produce TH and uptake iodine
E
N
D
O
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I
N
E

O
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E
W
ENDOCRINE OVERVIEW
Phys: Chapter 74
H: Chapter 338
Signaling pathways of endocrine hormones (FA12 p321) (FA13 p294) (Phys p886) (H p2869)
Signaling pathways of steroid hormones (FA12 p322) (FA13 p295) (Phys p891)
Review of hormone actions and origins (Phys p883)
1
[ 113 ]
E
N
D
O
C
R
I
N
E
Thyroid-stimulating hormone (TSH)
Epinephrine and norepinephrine
Insulin
Estradiol
Estriol
Estrone
Estrogen in males
Parathyroid hormone (PTH)
Somatostatin
Luteinizing hormone (LH)
Mineralocorticoids (aldosterone)
Adrenocorticotropic hormone (ACTH)
5. From where is each of the following hormones secreted?
Growth hormone (GH)
Thyroid hormone
Glucocorticoids (cortisol)
Progesterone
Prolactin
Oxytocin
Atrial natriuretic hormone (ANH)
Glucagon
Testosterone
Follicle-stimulating hormone (FSH)
Vasopressin (ADH)
Calcitonin
E
N
D
O
C
R
I
N
E

O
V
E
R
V
I
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W
END OF SESSION QUIZ
6. In what part of the cell would you fnd steroid hormone receptors?
7. What clinical fnding would you expect to fnd in a man with high sex hormone
binding globulin?
8. What clinical fnding would you expect to fnd in a woman with low sex hormone
binding globulin?
1
4. What hormone has each of the following action(s)?
Stimulates bone and muscle growth
Stimulates milk production and secretion
Stimulates milk secretion during lactation
Responsible for female secondary sex characteristics
Stimulates metabolic activity
Increases blood glucose level and decreases protein synthesis
Responsible for male secondary sex characteristics
Prepares endometrium for implantation / maintenance of pregnancy
Stimulates adrenal cortex to synthesize and secrete cortisol
Stimulates follicle maturation in females and spermatogenesis in males
Increases plasma calcium, increases bone resorption
Decreases plasma calcium, increases bone formation
Stimulates ovulation in females and testosterone synthesis in males
Stimulates thyroid to produce TH and uptake iodine
[ 114 ]
P
I
T
U
I
T
A
R
Y
PITUITARY
3 QUESTION WARM-UP
1. A gardener presents with shortness of breath, salivation, miosis, and diarrhea. What
caused this? What is the mechanism of action? (FA12 p265) (FA13 p233)
2. What enzyme catalyses the conversion of tyrosine to dopa? (FA12 p112) (FA13 p108)
3. A 30-year-old schizophrenic man now has urinary retention due to his neuroleptic.
What do you treat it with? (FA12 p265) (FA13 p233) (SU13 p341)
R: Chapter 24
Phys: Chapter 75
H: Chapter 339
Posterior pituitary (FA12 p314) (FA13 p287) (SU13 p89)
- Antidiuretic hormone
- Oxytocin
Anterior pituitary (FA12 p314) (FA13 p287) (SU13 p193)
- Luteinizing hormone
- Follicle stimulating hormone
- Adrenocorticotropic hormone
- Melanocyte-stimulating hormone
- Thyroid stimulating hormone
- Growth hormone
- Prolactin
Hyperprolactinemia (FA12 p317, 538) (FA13 p290, 523) (SU13 p208, 220) (H p2887)
Pituitary adenoma (FA12 p328) (FA13 p301) (SU13 p208)
Acromegaly (FA12 p328) (FA13 p301) (SU13 p208)
Somatostatin (FA12 p334, 346) (FA13 p306, 319) (SU13 p139, 194, 198)
Sheehan syndrome (FA12 p328) (FA13 p301) (SU13 p208)
4. ACTH and MSH (SU13 p210) (H p2896)
ACTH is synthesized as part of a large precursor called proopiomelanocortin (POMC),
which also contains the sequences for other hormonal peptides, including the lipotropins,
melanocyte-stimulating hormones (MSH) and beta-endorphin.
5. Hyperprolactinemia (FA12 p317, 538) (FA13 p290, 523) (SU13 p208, 220) (H p2887)
Causes
- Pregnancy/nipple stimulation
- Stress (physical or psychological)
- Prolactinoma (associated with bitemporal hemianopia)
- Dopamine antagonists: antipsychotics (haloperidol, risperidone), domperidone,
metoclopramide, methyldopa
Premenopausal female symptoms hypogonadism infertility, oligo/amenorrhea; rarely
galactorrhea
Postmenopausal female symptoms none since already hypogonadal
Male symptoms hypogonadism (low testosterone) decreased libido, impotence,
infertility (low sperm counts), gynecomastia, rarely galactorrhea
2
[ 115 ]
E
N
D
O
C
R
I
N
E
6. Somatostatin (FA12 p334, 346) (FA13 p306, 319) (SU13 p139, 194, 198)
Produced throughout the GI tract but notably by D cells in gut mucosa and pancreatic islet
cells
Also produced throughout the nervous system
In the CNS, PNS, and peripheral organs somatostatin decreases endocrine and exocrine
secretion, reduces splanchnic blood fow, reduces gastrointestinal motility and gallbladder
contraction, and inhibits secretion of most gastrointestinal hormones
Clinical Uses for somatostatin analogs (octreotide, somatostatin LAR, and lanreotide-P):
- Pituitary excesses: acromegaly, thyrotropinoma, ACTH-secreting tumors
- GI endocrine excess: Zollinger-Ellison Syndrome, carcinoid syndrome, VIPoma (AKA
pancreatic cholera), glucagonoma, insulinoma
- Certain diarrheal diseases
- Need to reduce splanchnic circulation: portal hypertension (bleeding varices), bleeding
peptic ulcers
P
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T
U
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T
A
R
Y
END OF SESSION QUIZ
7. A patients MRI reveals replacement of tissue in the sella turcica with CSF. What is
the most likely clinical presentation?
8. Which hormones share a common alpha subunit?
9. What is the most common presentation of hyperprolactinemia in a female patient?
10. What are some of the possible clinical features of acromegaly?
(FA12 p328) (FA13 p301) (SU13 p208)
RAPID-FIRE FACTS
Inability to breastfeed, amenorrhea, cold
intolerance
Infertility, galactorrhea and bitemporal
hemianopsia
2
[ 116 ]
3 QUESTION WARM-UP
1. What is the precursor molecule of ACTH synthesis?
2. What is required for a molecule to enter into the nucleus through a nuclear pore?
3. What are the various clinical applications of atropine? (FA12 p266) (FA13 p234) (SU13 p340)
R: Chapter 24
Phys: Chapter 77
H: Chapter 342
Adrenal anatomy (FA12 p314) (FA13 p286) (R p1148) (Phys p921)
Fetal adrenal gland (FA12 p314) (FA13 p286)
Steroid synthesis (FA12 p318) (FA13 p291) (SU13 p210) (Phys p923) (H p2940)
Congenital adrenal hyperplasia (FA12 p318) (FA13 p291) (SU13 p209-210) (R p1152) (H p2959)
ADRENAL STEROID SYNTHESIS
A
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R
E
N
A
L

S
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E
R
O
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D

S
Y
N
T
H
E
S
I
S
3
[ 117 ]
E
N
D
O
C
R
I
N
E
5. What features characterize a defciency in 3-hydroxysteroid dehydrogenase?
Inability to produce


6. What features characterize a defciency in 17-hydroxylase?
Inability to produce sex hormones and cortisol
Increased production of mineralocorticoids (i.e. aldosterone) sodium and fuid retention
7. What features characterize a defciency in 21-hydroxylase?
Inability to produce cortisol
Inability to produce mineralocorticoids
Increased production of sex hormones
A
D
R
E
N
A
L

S
T
E
R
O
I
D

S
Y
N
T
H
E
S
I
S
4. Complete the steroid synthesis pathway:
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
Q.
R.
S.
T.
U.
V.
W.
X.
Y.
Z.
3
[ 118 ]
8. What features characterize a defciency in 11-hydroxylase?
Inability to produce
Increased production of deoxycorticosterone (a weak mineralocorticoid)
Increased production of sex hormones
END OF SESSION QUIZ
9. What are the symptoms of 21-hydroxylase defciency? (FA12 p318) (FA13 p291)
(SU13 p210)
10. What are the symptoms of 11-hydroxylase defciency? (FA12 p318) (FA13 p291)
(SU13 p210)
11. What food substance is an essential starting point in the synthesis of adrenal steroids?
(FA12 p318) (FA13 p291) (SU13 p210)
A
D
R
E
N
A
L

S
T
E
R
O
I
D

S
Y
N
T
H
E
S
I
S
3
[ 119 ]
E
N
D
O
C
R
I
N
E
R: Chapter 24
Phys: Chapter 77
H: Chapter 342
Cortisol (FA12 p323) (FA13 p292)
Glucocorticoids (FA12 p334) (FA13 p306) (SU13 p213)
Cushing syndrome (FA12 p323) (FA13 p296) (SU13 p209-212) (R p1148) (H p2945)
GLUCOCORTICOIDS AND CUSHING SYNDROME
3 QUESTION WARM-UP
1. What are the symptoms of inhibiting parasympathetic activity?
(FA12 p266) (FA13 p234) (SU13 p340)
2. Outline the pathway for the generation of norepinephrine from tyrosine.
(FA12 p112) (FA13 p108) (SU13 p47)
3. What hormones arise from the anterior pituitary? (FA12 p314) (FA13 p287) (SU13 p193-195)
G
L
U
C
O
C
O
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T
I
C
O
I
D
S

A
N
D

C
U
S
H
I
N
G

S
Y
N
D
R
O
M
E
4
[ 120 ]
END OF SESSION QUIZ
4. An adult male with elevated serum cortisol levels and signs of Cushing syndrome
undergoes a dexamethasone suppression test. 1 mg of dexamethasone does not
decrease cortisol levels, but 8 mg does. What is the diagnosis?
(FA12 p323) (FA13 p296) (SU13 p212)
5. What effect does cortisol have on bone formation and immune system functioning?
(FA12 p319) (FA13 p292) (SU13 p193, 349)
6. What are the potential side effects of glucocorticoid use?
(FA12 p334) (FA13 p306) (SU13 p259)
G
L
U
C
O
C
O
R
T
I
C
O
I
D
S

A
N
D

C
U
S
H
I
N
G

S
Y
N
D
R
O
M
E
RAPID-FIRE FACTS
Most common causes of Cushing syndrome
4
[ 121 ]
E
N
D
O
C
R
I
N
E
OTHER ADRENAL PATHOLOGY
R: Chapter 24
Phys: Chapter 77
H: Chapters 342, 343, 351
Aldosterone (Phys p924)
Hyperaldosteronism (FA12 p323) (FA13 p296) (SU13 p209-210) (R p1151) (H p2949)
Adrenal insuffciency (R p1154) (H p2954)
- Primary: Addison disease (FA12 p324) (FA13 p297) (R p1155)
- Primary: Waterhouse-Friderichsen syndrome (FA12 p324) (FA13 p297) (SU13 p210) (R p1155)
- Secondary (FA12 p324) (FA13 p297) (R p1157)
- Tertiary
Pheochromocytoma (FA12 p324) (FA13 p294) (SU13 p211) (R p1159) (H p2962)
Neuroblastoma (FA12 p324) (FA13 p297) (SU13 p211)
MEN (FA12 p332) (FA13 p304) (SU13 p218) (R p1161) (H p3072)
3 QUESTION WARM-UP
1. What hormone has the following action(s)? (SU13 p192-194)
Stimulates milk secretion during lactation
Stimulates metabolic activity
Increases blood glucose level and decreases protein synthesis
Stimulates ovulation in females and testosterone synthesis in males
2. What enzymes are used in the catabolism of norepinephrine? (FA12 p112) (FA13 p108)
3. A 50-year-old woman complains of double vision, amenorrhea, and headaches.
What is the most likely diagnosis? (FA12 p328) (FA13 p301) (SU13 p208)
O
T
H
E
R

A
D
R
E
N
A
L

P
A
T
H
O
L
O
G
Y
5
[ 122 ]
END OF SESSION QUIZ
4. What are the clinical manifestations of Addison disease? What is the cause of
Addison disease? (FA12 p324) (FA13 p297) (SU13 p210)
5. What tumor locations are associated with the 3 different types of multiple endocrine
neoplasia? (FA12 p332) (FA13 p304) (SU13 p219)
6. What might a lab detect in the urine of a patient with pheochromocytoma?
(FA12 p324) (FA13 p297) (SU13 p211)
7. A very tan child with a pale mother presents to your clinic and is found to be
hypotensive. What is the most likely diagnosis? (FA12 p234) (FA13 p297) (SU13 p210)
O
T
H
E
R

A
D
R
E
N
A
L

P
A
T
H
O
L
O
G
Y
RAPID-FIRE FACTS
Most common tumor of the adrenal
Most common tumor of the adrenal
medulla (in adults)
Most common tumor of the adrenal
medulla (in kids)
Most common cause of primary
hyperaldosteronism
Medical treatment for hyperaldosteronism
Medical treatment for
pheochromocytoma
Pheochromocytoma, medullary thyroid
cancer, and hyperparathyroidism
Pheochromocytoma, medullary thyroid
cancer, and mucosal neuromas
Adrenal disease associated with skin
hyperpigmentation
HTN, hypokalemia, metabolic alkalosis
5
[ 123 ]
E
N
D
O
C
R
I
N
E
3 QUESTION WARM-UP
1. What primary hormone is increased or decreased in the following diseases?
(FA12 p323-324)
Disease Hormone that is increased or decreased
Cushing syndrome
Conn syndrome
Addison disease
2. What is the drug of choice for anaphylactic shock? Cardiogenic shock? Septic
shock? (FA12 p266) (FA13 p235)
3. What cancers are associated with RET gene mutation? (FA12 p232) (FA13 p304)
THYROID BASICS AND HYPERTHYROIDISM
R: Chapter 24
Phys: Chapter 75
H: Chapter 341
Thyroid development (FA12 p138) (FA13 p286)
Formation of thyroid hormone (FA12 p322) (FA13 p295)
Hyperthyroidism (FA12 p325-326) (FA13 p286) (SU13 p215-217)
Graves disease (FA12 p326) (FA13 p299) (SU13 p215)
Other causes of hyperthyroidism (FA12 p326) (FA13 p299)
Approach to thyrotoxicosis (SU13 p217)
T
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Y
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O
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D

B
A
S
I
C
S

A
N
D

H
Y
P
E
R
T
H
Y
R
O
I
D
I
S
M
6
[ 124 ]
END OF SESSION QUIZ
4. A 35-year-old woman presents with diffuse goiter and hyperthyroidism. What are
the most likely relative values of TSH and thyroid hormones?
(FA12 p326) (FA13 p299) (SU13 p215-216)
5. What would you suspect to be the cause of hyperthyroidism in a patient presenting
with the symptoms of hyperthyroidism in addition to each of the following fndings?
(FA12 p325-326) (FA13 p298-299) (SU13 p214-217)
Extremely tender thyroid gland
Pretibial myxedema
Pride in recent weight loss, medical professional
Palpation of single thyroid nodule
Palpation of multiple thyroid nodules
Recent study using IV contrast (iodine)
Eye changes: proptosis, edema, injection
History of thyroidectomy or radioablation of thyroid
6. What is the most common location for ectopic thyroid tissue? (FA12 p138) (FA13 p286)
7. How would pregnancy affect serum thyroid hormone levels? (FA12 p322) (FA13 p295)
T
H
Y
R
O
I
D

B
A
S
I
C
S

A
N
D

H
Y
P
E
R
T
H
Y
R
O
I
D
I
S
M
6
[ 125 ]
E
N
D
O
C
R
I
N
E
R: Chapter 24
Phys: Chapter 77
H: Chapter 341
Hypothyroidism (FA12 p325) (FA13 p298) (SU13 p214)
Causes of hypothyroidism (FA12 p325) (FA13 p298)
Thyroid cancer (FA12 p326) (FA13 p299) (SU13 p218)
Recurrent laryngeal nerve injury
HYPOTHYROIDISM AND THYROID CANCER
3 QUESTION WARM-UP
1. In the dark, both pupils are dilated. (see image) In the light, the control pupil is miotic
while the pupil given drug X remains mydriatic. What is drug X?
(FA12 p266) (FA13 p234-235) (SU13 p46, 340)
2. What are some of the clinical uses for somatostatin?
(FA12 p334, 367) (FA13 p306, 340) (SU13 p287)
3. What is the name given to a thyroid hormone-secreting teratoma?
(FA12 p546) (FA13 p331) (SU13 p238)
H
Y
P
O
T
H
Y
R
O
I
D
I
S
M

A
N
D

T
H
Y
R
O
I
D

C
A
N
C
E
R
7
[ 126 ]
END OF SESSION QUIZ
4. What type of thyroid cancer matches each of the following statements?
(FA12 p326) (FA13 p299) (SU13 p218)
Most common type of thyroid cancer (70-75%)
Second most common type of thyroid cancer (10%)
Activation of receptor tyrosine kinases
Hashimoto thyroiditis is a risk factor
Cancer arising from parafollicular C cells
Commonly associated with either a RAS mutation or a PAX8-PPAR gamma 1
rearrangement
Commonly associated with rearrangements in RET oncogene or NTRK1
Most common mutation in the BRAF gene (serine/threonine kinase)
5. What is the mechanism of action of propylthiouracil? What other drug works like
PTU? What are their side effects? (FA12 p334) (FA13 p306) (SU13 p216)
H
Y
P
O
T
H
Y
R
O
I
D
I
S
M

A
N
D

T
H
Y
R
O
I
D

C
A
N
C
E
R
RAPID-FIRE FACTS
Most common thyroid cancer
Cold intolerance
Enlarged thyroid cells with ground-glass
nuclei
7
[ 135 ]
G
I
GI
1 OROPHARYNX
2 ESOPHAGUS
3 STOMACH
4 UPPER GI PATH
5 DUODENUM
6 PANCREAS
7 ENTEROCYTES AND ABSORPTION
8 DISEASES OF THE SMALL INTESTINE
9 HEPATOCYTES AND CIRRHOSIS
10 LIVER PATHOLOGY
11 HEPATITIS
12 BILIARY TRACT
13 LARGE INTESTINE 1
14 LARGE INTESTINE 2
JOIN US ON A JOURNEY
THROUGH THE
GASTROINTESTINAL TRACT,
FROM THE MOUTH TO THE
ANUS, AND ALL POINTS IN
BETWEEN! ENJOY SCENIC
EXCURSIONS INTO THE
HEPATOBILIARY SYSTEM AND
PANCREAS! FOLLOWING
THE RECOMMENDED COURSE
ORDER, THIS CHAPTER ALSO
SERVES AS THE STEPPING-
OFF POINT FOR THE
BIOCHEMISTRY OF ENERGY
METABOLISM AND NUTRIENT
UTILIZATION.
[ 137 ]
G
I
3 QUESTION WARM-UP
1. Place the following agents in the appropriate categories:
(FA12 p265-269) (FA13 p233-238)
norepinephrine, metoprolol, timolol, scopolamine, phenoxybenzamine, bethanechol,
isoproterenol, donepezil, prazosin, atropine, propranolol, labetalol, hexamethonium,
atenolol, terbutaline, dopamine, pilocarpine, carbachol, edrophonium, phenylephrine,
glycopyrrolate, phentolamine, neostigmine, benztropine, terazosin, pralidoxime,
echothiophate, ipratropium, epinephrine, esmolol, oxybutynin
Direct cholinergic agonists:
Cholinergic antagonists:
Sympathomimetics:
1 2 1 2 agonist
1 2 1 agonist
D1 = D2 > 1 > 1 agonist
1 = 2 agonist
2 > 1 agonist
a1 > a2 agonist
Indirect cholinergic agonists
(anti-acetylcholinesterases)
OROPHARYNX
R: Chapter 16
Phys: Chapter 64
H: Chapter 317
Tongue development (FA12 p137) (FA13 p410) (SU13 p59)
Tongue pathology
Salivary glands (FA12 p347) (FA13 p320)
Salivary gland pathology
Tumors of the salivary glands (FA12 p350) (FA13 p324)
Cleft lip and cleft palate (FA12 p138) (FA13 p511)
Nose
Paranasal sinuses
Tonsils and adenoids
O
R
O
P
H
A
R
Y
N
X
Nicotinic antagonist
Cholinesterase regenerator
-adrenergic antagonists (-blockers)
-adrenergic antagonists (-blockers)
Nonselective
(2 = 1)
1 selective
1
(continued)
[ 138 ]
END OF SESSION QUIZ
4. What is the most common location of salivary gland tumors?
5. What is the most common salivary gland tumor? What is the histological appearance
of this tumor? (SU13 p141)
6. What is the second most common benign salivary gland tumor? (SU13 p141)
7. What is the most common malignant salivary gland tumor (the second most
common tumor overall of the salivary gland)?
8. What medication is often used in the treatment of allergic rhinitis, nasal polyps, and
Eustachian tube dysfunction?
3 QUESTION WARM-UP - CONT
2. Which portions of the hypothalamus are inhibited by Leptin? Which are
stimulated? (FA12 p436) (FA13 p414) (SU13 p194)
3. Which cranial nerve relays the following types of information?
(FA12 p456) (FA13 p434) (SU13 p61-62)
Hypoxia measured by the carotid body
Motor information for swallowing
Blood pressure from the aortic arch
Salivation from the sublingual glands
Salivation from the parotid gland
Blood pressure from the carotid
O
R
O
P
H
A
R
Y
N
X
1
[ 167 ]
I
M
M
U
N
O
L
O
G
Y
IMMUNOLOGY
1 IMMUNOLOGY BASICS
2 ANTIGEN PRESENTATION
3 T CELLS
4 MONOCYTES AND MACROPHAGES
5 B CELLS AND ANTIBODIES
6 IMMUNIZATION AND AUTOANTIBODIES
7 GRANULOCYTES, CYTOKINES, AND
IMMUNOSUPPRESSANTS
8 COMPLEMENT AND HYPERSENSITIVITY
9 IMMUNODEFICIENCIES
MANY MEDICAL STUDENTS
SEEM TO VIEW THE IMMUNE
SYSTEM AS A COMPLETELY
UNFATHOMABLE AND
UNKNOWABLE MYSTERY,
A DEEP OCEAN OF
INFORMATION WHOSE
DEPTHS ARE NEVER TO BE
PLUMBED. BUT FEAR NOT!
OUR PHYSICIAN EDUCATORS
WILL BREAK IT DOWN
SYSTEMATICALLY, ADDING
LAYERS OF KNOWLEDGE
THAT FOCUS ON THE
PRECISE FACTS YOU NEED TO
MASTER FOR YOUR EXAM.
[ 169 ]
I
M
M
U
N
O
L
O
G
Y
3 QUESTION WARM-UP
1. What would you suspect to be the cause of hyperthyroidism in a patient
presenting with the symptoms of hyperthyroidism in addition to each of the
following fndings? (FA12 p326) (FA13 p299) (SU13 p215-218)
Extremely tender thyroid gland
Palpation of single thyroid nodule
Palpation of multiple thyroid nodules
Recent study using IV contrast dye (iodine)
Eye changes: proptosis, edema, injection

2. What are the differences between oligodendroglia and Schwann cells?
(FA12 p434-435) (FA13 p412) (SU13 p44)
3. Describe the sensory innervation of the tongue. (FA12 p137) (FA13 p410) (SU13 p59)
I
M
M
U
N
O
L
O
G
Y

B
A
S
I
C
S
R: Chapter 6
H: Chapter 314
MALT (SU13 p287) (H p2675)
Lymph nodes (FA12 p222) (FA13 p192) (SU13 p286) (R p189)
Lymph drainage (FA12 p222) (FA13 p192) (SU13 p286) (COA p44)
Innate vs. adaptive immunity (FA12 p223 ) (FA13 p193) (R p184)
T lymphocytes (FA12 p375) (FA13 p347) (SU13 p288-289) (R p186)
IMMUNOLOGY BASICS
END OF SESSION QUIZ
4. To which lymph nodes do the sigmoid colon and the rectum drain?
(FA12 p222) (FA13 p192)
5. Where can B cells and T cells be found in the lymph nodes? (FA12 p222) (FA13 p192)
6. Which MHC are found in T helper cells? Which MHC are found on cytotoxic T
cells? (FA12 p226) (FA13 p196) (SU13 p288)
1
[ 170 ]
R: Chapter 6
MHC 1 and 11 (FA12 p224) (FA13 p194) (SU13 p288) (R p190)
HLA subtypes (FA12 p224) (FA13 p194) (R p193)
Dendritic cells (FA12 p374) (FA13 p346) (R p187)
Langerhans cell histiocytosis (FA12 p394) (FA13 p266) (R p631)
ANTIGEN PRESENTATION
A
N
T
I
G
E
N

P
R
E
S
E
N
T
A
T
I
O
N
3 QUESTION WARM-UP
1. A 48-year-old woman has been suffering with progressive lethargy and extreme
sensitivity to cold temperatures. What is the most likely diagnosis?
2. What is the most common salivary gland tumor?
3. What are the different sinuses that can become infected and cause sinusitis?
4. Dendritic Cells (FA12 p374) (FA13 p346)
Covered with long membranous extensions that resemble the dendrites of nerve cells
All display both class I and II MHC, B7 family of co-stimulatory molecules, CD80 and CD86
All also have CD40 which can infuence T cells by way of interaction with a complementary
ligand
Purpose: antigen capture at one location and presentation at another location. This is
accomplished by migration to lymph nodes for presentation at T cells
When acting as peripheral sentinels (immature or antigen-capturing state), antigens are
captured by 3 different mechanisms:
- Phagocytosis
- Receptor mediated endocytosis
- Pinocytosis
Immature sentinels make a transition into a new type of cell (antigen-presenting state) that
can travel into circulation and into a cell that has maximal capacity to present to Th cells
(increased expression of class II MHC and co-stimulatory molecules)
Different types:
- Langerhans (from immature epithelial tissue): in epidermal layers of skin (= Cutaneous-
associated lymphoid tissue, CALT)
- Interstitial (from immature nonepithelial, interstitial tissue): in interstitial spaces of
virtually all organs (except brain)
- Monocyte-derived (from monocytes (which also give rise to macrophages)): migrated
from bloodstream into tissues migrate from tissues to blood and lymph and lymph
nodes
- Plasmacytoid derived (from plasmacytoid): APCs in the innate immune response
2
[ 171 ]
I
M
M
U
N
O
L
O
G
Y
5. Follicular Dendritic Cells
Do not arise from bone marrow like the dendritic cells
Do not express class II MHC do not present antigen to Th cells
Exclusively reside in lymph follicles
Important in the maturation and diversifcation of B cells
A
N
T
I
G
E
N

P
R
E
S
E
N
T
A
T
I
O
N
END OF SESSION QUIZ
6. What characteristic fnding would you see on electron microscopy of a dendritic
cell with Langerhans cell histiocytosis? (FA12 p394) (FA13 p366)
7. What molecules are expressed on the surface of antigen presenting dendritic
cells? (FA12 p374) (FA13 p366)
8. What are 3 cell types that are known for presenting antigens to T cells?
(FA12 p226) (FA13 p196)
2
[ 172 ]
R: Chapter 6
H: Chapter 314
T cell differentiation (FA12 p225) (FA13 p195) (SU13 p289) (R p195)
Helper T cells (FA12 p226 ) (FA13 p196) (R p186)
Thymus (FA12 p223) (FA13 p193) (SU13 p286) (R p635)
T cell activation (FA12 p226) (FA13 p196) (R p195)
Cytotoxic T cells (FA12 p227) (FA13 p197) (SU13 p288-289) (R p207)
Regulatory T cells (FA12 p227) (FA13 p197)
NK cells (FA12 p224) (FA13 p194) (R p188)
T CELLS
T

C
E
L
L
S
3 QUESTION WARM-UP
1. What are the various clinical uses for the following sympathomimetics?
(FA12 p266-267) (FA13 p235)
Dopamine
Clonidine
Amphetamine
Terbutaline
Epinephrine
2. Where can you fnd nicotinic acetylcholine receptors in the body?
(FA12 p262) (FA13 p230) (Phys p733) (GG p255-258)
3. What structures are derived from the branchial pouches? (FA12 p137) (FA13 p511)
END OF SESSION QUIZ
4. Which cytokines are produced by Th1 cells? Which cytokines are produced by
Th2 cells? (FA12 p226) (FA13 p196)
5. Which cytokines inhibit Th1 cells? Which inhibit Th2 cells? (FA12 p226) (FA13 p196)
6. How do cytotoxic T cells kill virus-infected cells and neoplastic cells?
(FA12 p227) (FA13 p197)
3
[ 173 ]
I
M
M
U
N
O
L
O
G
Y
M
O
N
O
C
Y
T
E
S

A
N
D

M
A
C
R
O
P
H
A
G
E
S
MONOCYTES AND MACROPHAGES
3 QUESTION WARM-UP
1. What are the common side effects of -blockers?
(FA12 p269) (FA13 p238) (SU13 p99-100)
2. What is the medication of choice for the treatment of atrial fbrillation due to
hyperthyroidism?
3. What is the precursor molecule of ACTH synthesis?
4. Monocytes (FA12 p373) (FA13 p345) (SU13 p285)
Leave bone marrow for blood circulate 8 hours to mature migrate into tissues to
become macrophages
Blood, alveoli, intestines macrophages
Connective tissue histiocytes
Liver Kupffer cells
Kidney mesangial cells
Brain microglia
Bone osteoclasts
4
R: Chapter 6
Phys: Chapter 33
Monocytes (FA12 p373) (FA13 p345) (SU13 p285) (Phys p426) (H p2654)
Macrophages (FA12 p373) (FA13 p345) (SU13 p285) (R p188)
Interferons (FA12 p230) (FA13 p200-201) (SU13 p292) (R p195)
Acute phase cytokines (FA12 p230) (FA13 p200) (SU13 p292) (R p61, 193, 200)
Spleen (FA12 p223) (FA13 p193) (SU13 p286) (R p632)
[ 174 ]
END OF SESSION QUIZ
5. Which cytokine more than any other should be known as the macrophage-
activating cytokine? (FA12 p373) (FA13 p345) (SU13 p285)
6. What are the acute phase cytokines that are produced by macrophages?
(FA12 p231) (FA13 p200) (SU13 p292)
7. What is the function of macrophages in the spleen?
(FA12 p223) (FA13 p193)
8. What name is given to RBCs partially digested by splenic macrophages?
(FA12 p378-379) (FA13 p350-351)
M
O
N
O
C
Y
T
E
S

A
N
D

M
A
C
R
O
P
H
A
G
E
S
4