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The document contains notes on various topics related to pharmacology, pathophysiology, microbiology, immunology, biostatistics, embryology, and cardiovascular system. It includes information on drugs like loratidine, calcineurin inhibitors, and nitrates. It also discusses concepts such as absolute risk reduction, bias, validity, reliability, and 95% confidence intervals. Conditions mentioned include diphtheria, hepatitis B, rheumatic fever, transposition of great arteries, myocardial infarction, and hibernating myocardium. Pathophysiological processes described involve ischemia, inflammation, coagulation necrosis, and congestive heart failure.
The document contains notes on various topics related to pharmacology, pathophysiology, microbiology, immunology, biostatistics, embryology, and cardiovascular system. It includes information on drugs like loratidine, calcineurin inhibitors, and nitrates. It also discusses concepts such as absolute risk reduction, bias, validity, reliability, and 95% confidence intervals. Conditions mentioned include diphtheria, hepatitis B, rheumatic fever, transposition of great arteries, myocardial infarction, and hibernating myocardium. Pathophysiological processes described involve ischemia, inflammation, coagulation necrosis, and congestive heart failure.
The document contains notes on various topics related to pharmacology, pathophysiology, microbiology, immunology, biostatistics, embryology, and cardiovascular system. It includes information on drugs like loratidine, calcineurin inhibitors, and nitrates. It also discusses concepts such as absolute risk reduction, bias, validity, reliability, and 95% confidence intervals. Conditions mentioned include diphtheria, hepatitis B, rheumatic fever, transposition of great arteries, myocardial infarction, and hibernating myocardium. Pathophysiological processes described involve ischemia, inflammation, coagulation necrosis, and congestive heart failure.
Id 174 Pharmacology Allergy & Immunology Loratidine is 2nd gen antihistamine and safe in elderly coz no fall problems Hep B itself is not hepatotoxic but CD8+ repsonse to HBsAg and HBcAg will cause 375 Pathophysiology Allergy & Immunology damage Protein M is the main virulence of strep pyogenous as it inactivates phagocytosis, 723 Microbiology Allergy & Immunology complement activation and permit bacterial adherence. It is also the target of humoral response to the infection Streptolysin O will lyse RBCs amd PMNs Calcineurin activate IL2 which permit T cell proliferation. Hence the use of 1155 Immunology Allergy & Immunology Calcineurin inhibitors in transplants If a child has diphteria give antitoxin (passive immunization; most efficient), penicilin 1388 Microbiology Allergy & Immunology or erythromycin and vaccine. Otherwise prevent with vaccine (active immunization) Not all diphteria will cause pseudomembranous pharyngitis but need Tox gene to 1389 Microbiology Allergy & Immunology produce its exptoxin AB 2068 Immunology Allergy & Immunology Tryptase is a specific marker for mast cells amd is useful in anaphylaxis After IgE bind to receptors on Basophils and Mast cells these aggregate and cause 2069 Immunology Allergy & Immunology degranulation of substances. 1175 Biostatistics Biostatistics & Epidemiology Absolute Risk Reduction= Event Rate % (A) - Event Rate % (B) 1183 Biostatistics Biostatistics & Epidemiology Mode is the most frequent value on statistics, it the least affected by outliers When choosing two groups of same age and sex and race you are reducing the 1189 Biostatistics Biostatistics & Epidemiology chance of confounding bias. While selection bias occurs when you don't choose a representative sample of the population P value is called type I error: Probability that the difference ovserve is due to chance alone. Type II error is measured with the power: Beta (probabiity of concluding that 1204 Biostatistics Biostatistics & Epidemiology there is no difference when there is actually one) The power is 1 - Beta; meaning that is the pobability of concluding that there is a difference when there is actually one 1274 Biostatistics Biostatistics & Epidemiology A result is considered legit if the 95% CI does not cross 0, so p value is less than 0.05 Validity (accuracy) is when a test gives very similar results than gold standard 1278 Biostatistics Biostatistics & Epidemiology Reliability refers to reproducibility of test (similar values all the time) Effect modification is when smoking increases HRT risks of DVT compared to just 1279 Biostatistics Biostatistics & Epidemiology smoker, while HRT alone do not increase the risk of DVT 1282 Biostatistics Biostatistics & Epidemiology In skewed graphs the hill is the Mean, then the Median and uphill is the Mode 1286 Biostatistics Biostatistics & Epidemiology Lung cancer has been increasing a lot recently in women 95% CI that value is between X+/- Y Y is 1.96 (SD/rootsquare N) aka (SE) if it is as 1299 Biostatistics Biostatistics & Epidemiology 99% CI it becomes 2.58 SE Berkson's bias: The bias of choosing hospitalized patient in the study Hathorne effect (observer effect): The tendency of subject to change their behavior as a result of 1302 Biostatistics Biostatistics & Epidemiology awareness that they are being studied Pygmalion effect: the effect of researcher's belief on outcome Ecological study are like cross sectional study, but in ecological study you want to 10570 Biostatistics Biostatistics & Epidemiology measure a certain geographical population habits or whatever. Used to make hypotheses about populations Transposition of Great Arteries is failite of Aorticoopulmonary spiral septum to 35 Embryology Cardiovascular System undergo septation. 0-4 hr post mi the myocardium is normal on histology. 4-12: coagulation necrosis, 40 Pathology Cardiovascular System edema hemorrhage, wavy fibers 1-5 days neutrophils 5-10 macrophae 10-14 granulation tissue then scar with collagen 42 Pathophysiology Cardiovascular System Myocyte will stop contracting 1 min after total ischemia but it reversible until 30 mins Hibernating myocardium refers to the presence of ledt ventricular systolic dysfunction 43 Pathology Cardiovascular System due to reduced coronary blood flow at rest that is partially or completely reversible by coronary revascularisation In dilated Myopathy (also in ischemic myopathy): Contractile function is decrease but 92 Pathology Cardiovascular System normal diastolic funciton (normal compliance) it is the opposite in HTN and hypertrophic cardiomyopathy 96 Pathophysiology Cardiovascular System Constrictive pericarditis is chronic 136 Pharmacology Cardiovascular System NO will induce high cGMP which put myosin light chain in their inactive conformation 141 Pharmacology Cardiovascular System In HOCM we use bb ccb disopyramide and diuretics or dilators 142 Pharmacology Cardiovascular System Patients taking nitrates shld have a nitrate free period daily to avoid tolerance Both cardiac and smooth muscles are activated starting with extracellular Ca2+, 144 Physiology Cardiovascular System therefore CCB's work on them, unlike in skeletal muscles Digoxin: AV block (parasympathetik) so helpful in Afib while in CAD its effect is helful 155 Pharmacology Cardiovascular System coz of increase co tractolity ( DI goxi. So two functions) 160 Pharmacology Cardiovascular System Prevent NIACIN FLushing BY NSAIDS LHF will cause RHF by congestion pulmonary veins leading to vasoconstriction of 198 Pathophysiology Cardiovascular System pulmonary artey and intimal thickening with media hypertrophy S3 is caused by increased preload and it can lead to functional mitral regurg that is 200 Pathophysiology Cardiovascular System eliminted by preload reduction Pulmonary HTN cause irreversible damage to pulmonary arteries while RV 201 Pathophysiology Cardiovascular System hypertrophy can be reversible with correcting the HTN PFO (failure of septum primum and secundum to fuse) and ASD (aplasia of either 202 Embryology Cardiovascular System septum secundum most commonly or septum primum) can both cause stroke from venous clot but the difference is that PFO does not cause murmur. IE: vegetations on valve cups along with degeneration Rhemuatic fever: fibrous 232 Pathology Cardiovascular System thickening and distortion of mitral valve with commissural fusion at leaflet edges 240 Histology Cardiovascular System Aschoff bodies are seen in heart rheumatic fever In tubes velocities: V1A1=V2A2=Cte (considering incompressible tubes, assuming 245 Physiology Cardiovascular System vessels are not compressible we can apply this rule) 296 Pathophysiology Cardiovascular System Metastatic calcification occurs in cell necrosis (like in old aortic valve) Atheros plaques involve platelets (PDGF) macrophages that will promote migration 446 Pathophysiology Cardiovascular System of smooth muscels In mild HTN u get hyaline arteriosclerosis ( deposition in intima and media of vessels) 449 Pathology Cardiovascular System In severe HTN u get onion like concentric thickening of the wall 474 Pathology Cardiovascular System In Varicose vein we morry most about skin ulceratio not DVT and stuff Permissive effect of cortisol: (it permits others to work at their best) On its own it 551 Physiology Cardiovascular System doesnt do anything But increase sensitivity of vessels and bronchial tissues to catecholamines and increase glucose response to Glucagon 679 Microbiology Cardiovascular System only Aureus is coagulase + among the Staphes ACE inhibitor can cause hypotension in first doses therefore started gradually 693 Pharmacology Cardiovascular System (dosage) 778 Pharmacology Cardiovascular System Statins and fibrates have fucked up effects on muscles 898 Pharmacology Cardiovascular System In PSVT adenosine will cause chest burning and flushing Amiodarone (class III K+ channel blocker of cardiac pacemaker cells so decrease repolarization and increase AP so imcrease depo and repo time hence increase QT 899 Pharmacology Cardiovascular System but less associated with Torsades maybe coz of more homogeneous repolarization. So eventhough Amiodarone is BAD it has a GOod Side of the Force. Adenosine increase K+ conductance in AV and cause delay Lidocine (IB) bind rapidly depolarizing cells (like cocaine is rapid). Ischemic heart is 900 Pharmacology Cardiovascular System depolarized, so Lidocaine likes it. SO LIDOCAINE IS GOOD IN MI 944 Pathophysiology Cardiovascular System MR is severed with volume overload so when have S3 u know MR is at its max In exercise, tachycardia will reduce Diastolic time, so this is the limiting factor in Heart 951 Physiology Cardiovascular System perfusion Viridans are acquired after dental procedure if have cardiac structural abdnormaloties, and take glucose from out of cells and transform it into dextran to 1003 Microbiology Cardiovascular System integrate it into its polysaccharide cell wall, and also permits it to adhere to fibrin. So Viridans adhere to fibrin and platelets that are deposited at site of endothelial trauma in the valves and cause infection there. Doxorubicin cause dose related dilated cardiomyopathy by creating free radicals.. 1014 Pharmacology Cardiovascular System Radiation cause myopathies by perocardial fibrosis (viral and surgery.) 1080 Pharmacology Cardiovascular System Cilostazol is used in PAD, reduce,atelt activation and cause vasodilation Diphteria toxin (AB exotoxin) ribosylate and therefore inhibit EF-2, so will inhibit 1094 Microbiology Cardiovascular System protein synthesis causing cell death 1118 Pharmacology Cardiovascular System ANP, BNP, NO --> increase cGMP --> relaxation of smooth muscle 1166 Pharmacology Cardiovascular System if have cough with ACE go for ARBs When comparing the efficiency of a new drug mortality benifit over another standard drug, the NNT (number to treat), represents the ammount of people needed to be 1174 Biostatistics Cardiovascular System treated to prevent on event compared to standard drug: 1/ARR(2.5%(risk of deaths of old drug)-1% (risk of death of new drug)) Arteriolar vasodilator like hydralazine and minoxidil will cause reflex tachycardia and 1252 Pharmacology Cardiovascular System fluid retention Dobutamine affects B1 and lesser B2 and A1. So increase HR and Contractility 1344 Pharmacology Cardiovascular System hence increase Demand of O2 1444 Pharmacology Cardiovascular System FLAT CHAMP INCREASE cAMP In fluid loss even if BP is low TPR is high due to Sympathetic activation. But Fluid infusion will increase preload and increase End-Diastolic sarcomere length and will 1512 Physiology Cardiovascular System increase Volume status decreasing Sympathetik stimulation and decrease TPR Remember SBP= CO.TPR, so in Hypovolemia CO is super low and even with sympathtic compensation to increase TPR, SBP stays LOW Cardiac electrical transmission speed: PAVA: Fastest --> Slowest: Purkinje fibers --> 1513 Physiology Cardiovascular System Atrial muscles --> Ventricular muscles --> AV node PSVT: Do Carotid massage (XI -> X), Valsalva or Adenosine and this will prolong AV 1515 Physiology Cardiovascular System node refractory period In mitral valve stenosis we have a snap (indicating that the stenosed valve is trying to 1517 Physiology Cardiovascular System open but is finding difficulties) then a dyastolic rumbling murmur because of turbulent flow across this damaged valve. At rest or exercise both systemic and pulmonary circulations have similar blood flows since both systems are continuous and same amount of blood going from the LV is 1528 Physiology Cardiovascular System going from the RV ( both systems differ in r and l of the equation but end up equal in Q since they are continuous) 1529 Physiology Cardiovascular System CO= O2 consumption/ AV O2 difference S3 sounds in people >40 is abnormal and indicate LV enlargement (MR, AR, Dilated or Ischemic Cardiomyopathy). It is Increased in End of Expiration (LV fills more), Left lateral Decubitus (Higher Flow in LV), and Heard with the Bell of Steth in Cardiac 1557 Physiology Cardiovascular System Apex in Early Diastole. Amyl Nitrite (Vasodilation, Decrease Bp, Decrease Venous return), Furosemide (Diuresis, lower LV Volume),Valsalva or Standing (lower V return) all Decrease S3 In exercise PaO2 and PaCO2 do not change but CO and HR increase to 1589 Physiology Cardiovascular System accomodate for tissue's demand PE --> Hyperventilation = Lower PaCO2 Flow (Q)= dP/R Remember U=R.I R= v.L/r4 Q=r4.(dP/v.L) So if flow decrease by X in 1621 Physiology Cardiovascular System a medium of same property this means that the radius is decreased by X root 4 But Velocity relation is A1V1=A2V2 and has a r2 relatioship change with velocity In the Cardiac output, Venous return curve its easy. If an event decreases venous return like anaphylaxis for example lower the venous return curve. MI will lower the 1624 Physiology Cardiovascular System Cardiac output curve maximum and slope. Anemia would higher it since we will have tachycardia In Heart PV curve, the lowest horizontal curve where heart receives blood, the slight increase in P is preload whereas in the upper horizontal line which demonstrates 1652 Physiology Cardiovascular System heart emptying, the slight increase in P is Afterload. Nitroprosside will decrease both Preload and Afterload by Vasodilating Both Veins And Arteries. Pulsus Paradoxus usually happens in Tamponade but can also happen in Constrictive Pericarditis, Asthma COPD, or Hypovolemic Shock. In Tamponade, 1782 Physiology Cardiovascular System increased pericardial fluid will compress LV, and during Inspiration increased venous return in RV will move InterVentricular Septum towards LV, making it even smaller, thus a >10% decrease in SBP. The Inferior wall of left Ventricle lies on the Diaphragm and is supplied by the 1871 Anatomy Cardiovascular System Posterior descending artery (from RCA) Prior to myochte relaxation Ca2+ leave cells through Ca2+ ATPases and Na+/Ca2+ exchange (3 to 1, and does not require ATP) Besides its action in Smooth Muscle 1931 Physiology Cardiovascular System contraction, Calmodulin plays a role in Cardiac Ca2+ efflux, by binding Ca2+ ATPases and activating it. Phentolamine is competetive alha blocker wheras phenoxybenzamine is a non 1947 Pharmacology Cardiovascular System competitive irreversible antagonist CCB's slow Diastolic depolarization of Pacemaker cells. (phase 0) they also decrease intracellular Ca2+, affecting excitation-contraction of these cells, therefore 1973 Physiology Cardiovascular System decreasing Contractility. But when question is about antiarrythmitic studies choose the Antiarrythmic action of CCB's. ACh and Adenosine reduce phase 4 of spontaneous depolarisation, in cardiac 1975 Physiology Cardiovascular System pacemaker cells. Desynchronization between P and QRS means 3rd degree AV Block. This means Atria contract from SA node but the impulse does not make it to AV node on time 1976 Physiology Cardiovascular System most probably due to circuit abnormality, so AV node will take over to contract ventricles and will get narrow QRS (since it supraventricular firing, so AV node will filter the impulse sent) Holosystolic murmur, that increase during inspiration is only tricuspid regurgitation since the right heart will fill on inspiration. Left sided holosystolic murmurs and VSD are not affected by inspiration since it does not increase left V load. Tricuspid 1983 Physiology Cardiovascular System murmur: left sternal border, 3rd and 4th intercostal space Mitral murmur: Apex of heart Aortic stenosis: Diamond shape (since aorta is most important and every old person has diamonds) 2002 Pharmacology Cardiovascular System Thiazide increase GLUC Glucose, LDL, Uric Acid, Ca The heart has the highest oxygen extraction rate. (6075%) During exercise only increasing coronary flow by Vasodilation which is mediated by Adenosine and NO will 2009 Physiology Cardiovascular System accommodate for the increase oxygen demand since extraction is already almost maximal. A Afib can be induce systemic illness (HTN, Geart failure, Hyperthyroid), Increased Sympathetic tone and Excessive alcohol consumption. Get irregularly irregular fast rythm with absent P waves and often Narrow QRS. on EKG. High QRS amplitude is 2055 Physiology Cardiovascular System due to ventricular hypertrophy often due to HTN. Prolonged QT can be congenital and associated with Torsades De Pointes and can also be dure to chronic alcohol use (not one episode of bunge drinking, which can cause Afib) Most common cause of aortic rupture in MVC is at the Aortic Isthmus; the site of 2130 Anatomy Cardiovascular System ligamentum arteriosum just dital to right subclavian 7640 Pharmacology Cardiovascular System Class III will increase QT, while digoxin will cause AV block 8711 Histology Cardiovascular System Thpe I Collagen is the most abundant overall and is the one we find in scars. BNP (natriuretic peptide) is released in response to atrial and ventricular stretching --> Natriuresis, Diuresis, Vasodilatory (antagonize vasoconstriction action of RAAS) effect and protects against heart remodeling. BNP then inhibits RAAS system and 11745 Physiology Cardiovascular System renin levels. Neprisylin metalloproteases, degrades BNP, bradykinins, oxytocin and bradykinin. Neprisylin inhibitors are then good in Heart failure --> increase BNP and in turn decrease Renin In cardiac cath, when trying to reach the femoral artery, if cannulation is done above 11764 Anatomy Cardiovascular System the inguinal ligament you can induce RETROPERITONEAL HEMORRHAGE (CARDIOLOGIST ARE SCARED OF THIS) In right MI have stiffness of RV so increase CVP (backup of blood) but low RV output 11833 Pathophysiology Cardiovascular System so Low PCWP In Afib clots form in left atrial appendage its a motionless part of the atria (ma ela 11842 Anatomy Cardiovascular System 3aze) 876 Pathology Dermatology Dermatitis herpetiform usually appear at 40-50 Eczema can occur after some food 1061 Biochemistry Dermatology Zinc deficiency causes acrodermatitis enteropathica, infertility and Growth retardation Apocrine glands secrete by cel lysis and content exretion like pimple glands (sebacious and meibomian) Apocrine secrete membrane bound vesicles (breast) 1106 Anatomy Dermatology while Merocrine secrete via exocytosis like salivry, eccrine and apocrine sweat glands (named this way coz thought to be apocrine in nature ) DA FUCK bass CV u wont be confused Vitiligo: loss of melanocyte (autoimmune pooly understood) in albinism have 1110 Pathology Dermatology melanocyte but cannot produce melanin (unlike vitiligo where melanocytes are fucked up) Leprosy is attacked by CD4+ Th1 cell mediated response (like other Mycobacterium) 1314 Pathology Dermatology so skin lesions are due to IL2 and IFN Gamma In Hartnup disease you have decrease Tryptophan absorption in guts and 1334 Biochemistry Dermatology reabsorption in kidneys. So you will eventually have decreased niacin and pallegra GVHD occur also with liver transplant because it is rich in lymphocytes and occurs a 1613 Immunology Dermatology week later (around), Acute and chronic rejection are usually Host vs Graft (also T cell mediated) Acyclovir valcyclovir gancyclovir and those are nucleoside analogues that require both cellular and herpes kinases for conversion to their active nucleotide 1641 Pharmacology Dermatology triphosphate form Cidofovir is a nucleoside monophosphate only require host cellular kinase Post auricular lymphadenopathy makes us more suspicious towards rubella rather 1669 Microbiology Dermatology than measle 1725 Genetics Dermatology Androgenic alopecia have Polygenic Inheritance patterns 1937 Pathology Dermatology Lymhedema (like post mastectomy) increase risk of Angiosarcoma 2037 Biochemistry Dermatology In tRNA we have a CCA site where amino acids bind Psoriasis is often treated with with topical vit D analogs; calcipotrieme that bind 8569 Pharmacology Dermatology vitamin D recptor, inhibits keratinocytes proliferation and stimulate their differentiation Accessory nipples are the most common congenital anomaly and fluctuate with menstrual cycle, unlike nevi. On the other hand Neurofibroma are composed of 8904 Pathophysiology Dermatology Shwann cells and neural fibroblasts and can sometimes retract to subcutaneous tissue when pushed down. 11738 Pathology Dermatology TGF beta is responsible for fibroblast migration proliferation and CT synthesis 11852 Pathology Dermatology opioids, contrast, and vanco.. can trigger mast cell degranulation Cleft lip: maxillary prominence fail to fuse with intermaxillary segment(below nasal septum) Cleft palate: Failure of palatine shelves to fuse with one another or with 1740 Embryology Ear, Nose & Throat (ENT) primary palate Occur in 5-6 week of embryo development. Cam occur together or in isolation. Cholesteatoas are collection of squamous cell debris that form behind tempanic 11628 Pathophysiology Ear, Nose & Throat (ENT) membrane, can be congenital or acquired following infection, trauma.. cause hearing loss due to ossicle erosion Psterior bleeding with sphenopalatine bleed is usually uncontrollable with bleed and 11783 Anatomy Ear, Nose & Throat (ENT) occur with HTN Fibric acids (gemfibrozil..) decrease triglyceride production while Cholestyramine Endocrine, Diabetes & 163 Pharmacology (bile acid sequestrant) cause hypertriglyceride and gallstones ( cause decrease bile Metabolism acid reuptake so new cholesterol is put in bile u know..) Endocrine, Diabetes & Gemfibrozil are the most efficient for triglyceride so the best in pancreatitis induced 166 Pharmacology Metabolism by triglycerides Endocrine, Diabetes & In addition to DERMATITIS of NIACIN Add GOUT (hyperuricemia; part of dermatitis 167 Pharmacology Metabolism ;) ) Endocrine, Diabetes & 209 Pharmacology GnRH agonist: at first act as GnRH but then in contrary coz not pulsatile Metabolism Sertoli cells secrete Inhibin B to feedback inhibit FSH. Leydig cells secrete Testos that feedback inhibit LH. Sertoli cells also secrete Androgen binding proteins to bind Endocrine, Diabetes & 216 Physiology Testosterone and trap it there since it needs it for spermatogenesis. This is different Metabolism from Sex binding protein which let testosterone circulate in the blood and is produced by liver Acute hemorrhage into the pituitary (pituitary apoplexy) is usually aassociated with Endocrine, Diabetes & Pituitary Adenoma Severe Headache, Cranial Nerve Involvement (bitemporal 225 Pathology Metabolism hemianospia, ophtalmoplegia) and meningeal irritation. Cardiac Collapse is due to adrenal insuficiency Endocrine, Diabetes & Increase AFP (Dating error most commonly) Patau Gastroschisis, Omphalocele, 342 Embryology Metabolism Neural tube defect, and Multiple gestation. Decreased levels in Trisomy 21, 18. Endocrine, Diabetes & Pioglitazone and stuff work on PPAR gamma in fat so make u FAT not only by fat but 599 Pharmacology Metabolism also by increasing Na absorption in Collecting Tubules Cortisol produced in the cortex will pass through the veins that will go the medulla Endocrine, Diabetes & 602 Biochemistry and enhance the PNMT (phenylethanolamine N methytransferase) enzyme that Metabolism converts Norepi to Epi (Makes sense right) Endocrine, Diabetes & 603 Pharmacology Pioglitazone affect transcription factor and gene involvement so takes time Metabolism Gliflozin are SGLT2 inhibitors (sodium glucose cotransporter in PCT) cause Endocrine, Diabetes & glucosuria so possible UTI and genital mycotic infection. Also cause osmotic diuresis. 604 Pharmacology Metabolism In Pple with renal impairement, the meds will not work well and can have increase adverse effects Endocrine, Diabetes & 605 Pharmacology PPAR gamma is a nuclear receptor affected by Pioglitazone and Rioglitazone .. Metabolism Endocrine, Diabetes & hyperPTH leads to Osteitis Fibrosa Cystica where we have subperiosteal eiosions 631 Pathophysiology Metabolism affecting phallanges of hand, "salt and pepper" skull, and brown tumor bone cysts. Endocrine, Diabetes & High dose of Iodine will inhibit iodine uptake by follicular cells (used if have 767 Pathophysiology Metabolism radioactive iodine intoxication, T4 is not efficient coz it takes days to work) du quervain: mixed cellular infiltrate with occasional multinuclear giant cells (post Endocrine, Diabetes & 769 Pathology URI) Hashimoto: lymphocytic infilitrate with germinal centers and Hurthle cells Metabolism surrounding residual follicles (large oxyphilic cells filled with granular cytoplasm) TSH stimulate I-(Iodide) absorption (Na+I- symporter) in Follicular cells and is competitively inhibited by Perchlorate and Pertechnetate, then goes in the colloid. I- Endocrine, Diabetes & is converted to I2 (Iodine) in the colloid (catalysed by Peroxidase). Thyroglobulin is 770 Physiology Metabolism synthesized in Follicules then go to colloid too, where its tyrosine residues bind to I2 (Peroxidase). MIT and DIT are phagocytosed in follicular cells then those who are not deiodinated join and T3, T4 form and are released Endocrine, Diabetes & Neural crest: PNS, Adrenal Medulla and Parafollicular pf thyroids (both are 771 Embryology Metabolism chromaffin cells) Endocrine, Diabetes & 920 Pharmacology Glitazones PPAR GAMMA STUFF reduce insulin resistance Metabolism Endocrine, Diabetes & 980 Biochemistry Remember Thiazide and HyperGLUC Metabolism Endocrine, Diabetes & 7-dehydrocholesterol -(UV)-> CholeCalciferol (D3) (1st step) then 25-OH in Liver 990 Physiology Metabolism then 1-OH in Kidney Steroid, Thyroid hormones, VitD: Intrareceptor with DNA domain (to alter DNA expression when go in nucleus) Ligand-gated ion channels (Na+,K+,Ca2+,Cl-) Endocrine, Diabetes & across membrane for membrane potential etc. Intrinsic Phosphorylation: Insulin and 992 Physiology Metabolism Insulin like GF JAK STAT: GH, Prolactin, EPO Hypercalcemia Hypocalciuria (AD since all family has it): Defective Ca2+ sensing G (THINK C, G LOOK ALIKE) proteins coupled receptors in PT gland and kidney that regulate circulating Ca2+ levels. Endocrine, Diabetes & Glucagon, beta adrenergic, PTH and TSH receptors work through Protein Kinase A 994 Biochemistry Metabolism responsible for the G protein/ Adenylate cyclase secondary messenger system Beta cells: Glucose enters pancreas through GLUT 2 transporter undergoes glycolysis and produces ATP which will bind ATP-sensitive K+ channels (opened at Endocrine, Diabetes & rest and maintains K+ efflux keeping cell hyperpolarized) and close them. This will 1009 Physiology Metabolism depolarize cell, which will open Voltage-dependent Ca2+ channels, increasing Ca2+ intracellularly and inducing insulin release. If KATP channels do not respond to ATP we will have DM. Sulfonylurea bind KATP, close them irrespectively of ATP Endocrine, Diabetes & Glucokinase will control glucose entry in Glycolysis in pancreas and liver and hence 1010 Biochemistry Metabolism stimulate insulin release. If non functional you can have DM predisposition Endocrine, Diabetes & 1012 Pathology DM I : Islet leukocytic infiltration DM II: Islet amyloid deposition Metabolism Endocrine, Diabetes & Smoking cessation is by far the most effective preventive intervention to avoid 1013 Biostatistics Metabolism Cardiac events gluconeogenesis requiring conversion of oxaloacetate to PEP uses GTP as a source Endocrine, Diabetes & 1022 Biochemistry of energy and this GTP comes from the conversion of Succinyl CoA to Succinate in Metabolism the Krab Cycle. COOL Hein Endocrine, Diabetes & Fructose 2,6 biphosphate favors Insulin effect and decreasing conversion of 1031 Biochemistry Metabolism pyruvate to Glucose ( decrease cAMP) in contrary to Glucagon Endocrine, Diabetes & High Acetyl CoA level is the main Allosteric Actiator of Gluconeogenesis Increasing 1034 Biochemistry Metabolism the activity of Pyruvate Carboxylase, Converting Pyruvate into Oxaloacetate Endocrine, Diabetes & Panthothenic acid is B5 and is used to synthesize CoA used in TCA cycle especialy 1044 Biochemistry Metabolism in first step reaction Pentose phosphate reactions are all in Cytoplasm (coz only 5 carbona WTF) First Endocrine, Diabetes & 1119 Biochemistry step of Gluconeogenesis consisting of Puruvate to Pxaloacetate requires B1 and is in Metabolism Mitochondria Endocrine, Diabetes & In Cushing we HyperPlasia of Zona Fasciculata (Not Hypertrophy) ... think that ure 1163 Pathophysiology Metabolism producing an adenoma NON SENSE BUT STILL Endocrine, Diabetes & 1324 Pharmacology Alpha stimulation is dominant over beta thats why epinephrine decrease insulin Metabolism Endocrine, Diabetes & In DM, Infection, Pain and Sleep Deprivation can cause Hyperglycemia, while 1325 Physiology Metabolism Exercise can induce Hypoglycemia. Endocrine, Diabetes & Serine and threonine phosphorylation of insulin receptor lead to insulin resistanec 1326 Pathophysiology Metabolism (mediated by TNF alpha, catechols, steroids and glucagon) Elevated free fatty acid levels contribute to insuline resistance (impair insulin Endocrine, Diabetes & 1328 Pathophysiology dependant glucose uptake and increase hepatic gluconeogenesis and insulin Metabolism secretion) and DM II Glucose is transported in the D-Glucose form. Glut 4 is insulin mediated and Endocrine, Diabetes & transports it into fat and muscle tissues whereas Glut 2 tranports Glucose from Liver, 1355 Physiology Metabolism SI and Kidneys into blood circulation and helps regulates insulin secretion from pancreas. Glut transport Glucose via Carrier-mediated transport (Active transport) Insulin has no effect in Glucose reabsorption in kidneys, but Increase Na+ Renal Absorption increasing blood volume and BP. Insulin also inhibits glucose release Endocrine, Diabetes & 1540 Physiology from liver, and Inhibits Glucagon secretion by directly acting on Alpha cells. It is Metabolism Anabolic (Glycogen, Protein Synthesis) and inhibits Glycogenolysis, Lipolysis and other Catabolic reactions. Endocrine, Diabetes & 1615 Physiology Thyroid produce mainly T4, which is converted to T3 (active hormone) rT3 (inactive) Metabolism Endocrine, Diabetes & 1660 Pathology RAT (activating mutation) in Men RAS is follicular thyroid Metabolism Insulin synthesis: Insulin translation starts in ribosomes to yield PreProInsulin. Then translation continues in RER Ribosomes (the same ribosome translocates). In the Endocrine, Diabetes & RER first the N terminal is cleaved giving Proinsulin then 3 disulfides bonds in the 1768 Physiology Metabolism Insulin parts form. The ProInsulin is sent to the Golgi Apparatus and is cleaved by endopeptidases, but both Insulin and C peptides are stored in granules and secreted from Beta cells. But C peptide's half life is only 35 mins Endocrine, Diabetes & In metabolic acidosis (E.g DKA) u hyperventilat but in DKA u have lung edema so u 1979 Pathophysiology Metabolism go in respiratory failure not only because of exhaustion Endocrine, Diabetes & Severe hypoglycemia (patient not conscious so cannot swallow) so give Glucagon (if 1984 Pharmacology Metabolism outsode hospital) and Sugar per IV (in Hospital) Orotic acid converts to UMP, UDP --> TMP, CTP (pyrimidine). If the enzyme Orotate Endocrine, Diabetes & 2066 Biochemistry phosphorybosyl transferase is missing, you won't be able to convert orotic acid. But if Metabolism you supplement patient with Uridine you negatively feedback the reaction Endocrine, Diabetes & 2081 Pathology In CAH give Steroids to supress ACTH Metabolism Endocrine, Diabetes & 8531 Pathology Sulfonylurea can cause Severe Hypoglycemia Metabolism Endocrine, Diabetes & 11565 Pharmacology Sulfonylurea can cause Hypoglycemia Metabolism Endocrine, Diabetes & 11634 Pharmacology Ezetemibe is like fenofibrate but decrease absorption of cholesterol, not bile acids Metabolism For ovulation induction you can use Menotropin (mimics FSH) then HCG (mimics LH, Female Reproductive 207 Physiology same alpha subunit. Similar subunit with FSH too but not that much, and not the System & Breast point here) Female Reproductive 258 Pathology PCOS have increased risk of endometrial ca and DM II System & Breast Female Reproductive Upon withdrawal of Progesterone, Endometrial cells undergo Apoptosis around 5 299 Physiology System & Breast days later, causing Menses Female Reproductive Koilocyte seen in HPV are cells with dense nucleus (pyknotic: dense DNA, as part of 1015 Histology System & Breast apoptosis first step) and perinuclear halo clearing Female Reproductive Comedocarcinoma (DCIS): solid sheet of pleomorphic, high grade cells with central 1057 Pathology System & Breast necrosis Granuloas cell tumor of ovary: Call Exner (cuboidal cells in rosette pattern with bean Female Reproductive 1158 Pathology nuclei) and yellow theca cells with lipids Large unilateral adnexal mass with increase System & Breast Estrogen and inhibin Herpes facial palsy is HSV 1 (oral not genital) HSV 2 resides in dorsal root ganglia in Female Reproductive 1549 Pathophysiology sacral ganglia and be reactivated and give recurrent genital ulcer VZV also goes in System & Breast dosal root but in trigerminal ganglia Theca interna: Cholesterol -(LH)-> progesterone + Androgen --> Granulosa Female Reproductive (Aromatase): Androgen -(FSH)-> Estrogen. This actually explains why LH and 1560 Physiology System & Breast Progesterone are not null during Follicular phase. Theca externa serve as supportive connective structure. Ovary is innervated by Ovarian artery, vein, lymphatic and nerves which are Female Reproductive 1632 Anatomy contained in suspensory ligament as the suspensory ligament hold the ovaries in System & Breast suspension in the abdomen Pudendal block is sometimes use if epidural was not used. It is intravaginal medial to Female Reproductive 1739 Anatomy ischial spine and will num the perineum the genitals, and motor og urthra sphincter System & Breast and external anal sphincter (S2-S4) Female Reproductive In contrast to Androgen insensitive patient those with Vagina agenesis (upper vagina 1809 Embryology System & Breast and sometimes uterus, it's Mullerian defect) ave Pubic hair etc. Female Reproductive 1831 Embryology Bicornuate nucleus: Incomplete lateral fusion of paramesonephroc duct System & Breast Anovulation is common in first years of menarche (Immature axis, so follicle does not become corpus luteum) and last years before menopause, it manifests with Female Reproductive menstrual variability, spots Complex atypical endometrial hyperplasia occurs with 1899 Physiology System & Breast prolonged unopposed estrogen, it can happen with chronic anovulatory cycles (where you only have estrogen without progesterone), HRT without progesterone or Obese old women. Atrophic endometrium occurs in menopause (also get spotting Female Reproductive 2056 Pathology Ovary is cuboidal cells System & Breast Female Reproductive Turner's have abnormal ovary but normal Uterus so can get pregnant with donation 8556 Genetics System & Breast etc. Female Reproductive Ureter injury will cause leakage of urine irritating the bowel causing ileus, flank pain 11781 Anatomy System & Breast and fever but no urinary incontinence Female Reproductive KOH is used to diagnose gardenella While trichonoma protozoa with flagella are 11802 Microbiology System & Breast seen on wet mount Internal urinary sphincter are parasympathetic innervation while external one ( distal) Female Reproductive 11820 Anatomy is pudendal voluntary Kegel exercice target levator ani ( think of how u contract ur System & Breast perineum) 47 Microbiology Gastrointestinal & Nutrition hep B give hep D a capsule giving it its virulence and ability to invade hepatocyte Aflatoxin G->T mutation in p53, increasing risk of HCC. Found in grains corns 57 Pathology Gastrointestinal & Nutrition soybeans peanuts where fungi are grown 62 Microbiology Gastrointestinal & Nutrition Liver abscess can be caused by Staph throgh hematogenous route MESH GHALAT In infections Beta glucoronidase are released by hepatocytes and unconjugate 70 Biochemistry Gastrointestinal & Nutrition conjugated bilirubin causing it to precipitate and causing brown stones cholesterol makes bile less soluble while bile salts and phosphatidylcholine makes it 78 Pathophysiology Gastrointestinal & Nutrition more soluble Acid secretion: 3 phases Cephalic: Vagal and cholinergic: stimulated by thought, sight, smell and taste of food Gastric phase: Chemicals in food and gastric distention; Gastrin-->Histamine (Enterochromafin like cells; ECL) --> Acid secretion Intestinal 126 Physiology Gastrointestinal & Nutrition phase: proteins in Ileum and Colon will produce Peptide YY which will bind to ECL and inhibit gastrin stimulated histamine release from these cells When acid is secreted Bicarb and Cl- decrease in circulation (predictable) 133 Pathophysiology Gastrointestinal & Nutrition Can diagnose Lactase deficiency by decreased pH of stool Statins decrese cholesterol formation SURE, BUT BUTTT cholestyramine will bind 165 Pharmacology Gastrointestinal & Nutrition bile acids and cause increase excretion so liver will produce more cholesterol to throw in bile 280 Pathology Gastrointestinal & Nutrition Esophageal spasm is due to imparied neural inhibition within the myenteric plexus 290 Pathology Gastrointestinal & Nutrition Erosion does not cross Muscularis Mucosa While Ulcer Do Cross it Mastocytosis will increase Histamine and cause Gastric Hypersecretion (EZ) 306 Pathophysiology Gastrointestinal & Nutrition (Associated with KIT receptor Tyrosine Kinase Mutation) Duodenal atresia is due to recanalization failure while Jejunal/Ileal atresia is due to 319 Embryology Gastrointestinal & Nutrition vascular injuries Imperforate anus, is most commonly associated with urogenital abnormalities 320 Embryology Gastrointestinal & Nutrition (fistulas and stuff). Then you think of VACTREL Vertebral, Anus, Cardiac, TE, Eosophageal atresia, Renal, Limbs Meckels diverticulum is part of vitelline (omphalocele) duct remnant (in embryo connects midgut to yolk sac but obliterated in 7th week) If not obliterate it can cause 322 Embryology Gastrointestinal & Nutrition vitelline diverticulum where meconium passe through it into the umilibcal cord, or we can just have a band or a cyst. Meckels diverticulum is a true one and is composed of all layers; mucosa, 328 Embryology Gastrointestinal & Nutrition submucosa and muscular layers Inhaled halothane can cause fulminant hepatitis (looks like viral hep) and will have 369 Pathophysiology Gastrointestinal & Nutrition high ALT AST, and decrease hepatic function so failure so prolonged PT and stuff but no hepatic HTN Alcohol inhibits Free FA Oxidation and Gluconeogenesis coz have INCREASED 370 Pathology Gastrointestinal & Nutrition NADH Children <6 yrs usually get asymptomatic Hep A. They don't get anti IgM antibody 373 Immunology Gastrointestinal & Nutrition since no disease 374 Microbiology Gastrointestinal & Nutrition Hel B is a ds DNA but replicate via reverse transcription (+RNA template) 406 Pathology Gastrointestinal & Nutrition Crohn Th1 (terminal ileum) UC Th2 407 Pathology Gastrointestinal & Nutrition in UC the rectum is always involved 410 Pathology Gastrointestinal & Nutrition Toxic megacolon is UC is diagnosed by Xray Crohn, ileum involvement, bile acid will not be reabsorbed so bile will have less bile 412 Pathophysiology Gastrointestinal & Nutrition acids and will be more cholesterolous hence gallstones Traction Diverticula is True Diverticula and due to inflammation and stuff While 415 Pathology Gastrointestinal & Nutrition pulsion Diverticula is False (like sigmoidal Diverticula) Outpouching of the mucosa and submucosa through the muscularis 431 Pathology Gastrointestinal & Nutrition Polyp were shown to be involved with COX2, thats why we give aspirin for colon CA Tenesmus is seen in rectal adenoCA not colon righ colon: occult bleed iron 432 Pathology Gastrointestinal & Nutrition deficiency Left colon: obstruction and often hematochezia Pancreatic pseudocyst wall is not lined by epithelium but by granulation and fibrous tissues Serous cyst have glycogen rich cuboidal cells epithelium Mucinous cysts 435 Pathology Gastrointestinal & Nutrition habe columnar mucinous epithelium Atypical papillary projections are seen in AdenoCa Pancreas Embryology: Dorsal bud Tail, Neck most of Body, Accessory Duct Ventral bud: Uncinate, Inferior Posterior Moreover, Inferoposterior aspect of Head and Major Duct In Pancreatic Divisum (5% of population) the two buds fail to fuse fiving two 437 Embryology Gastrointestinal & Nutrition seperate ducts with independant drainage. Ventral duct (will be smaller) drain into major papillae, Dorsal duct (major) drain into smaller papillae. Cery rarely this can cause chronic Pancreatitis Ig's attach Phagocytic cells through Fc portions and attach Complements through 539 Immunology Gastrointestinal & Nutrition hinge portion 589 Immunology Gastrointestinal & Nutrition Secretory IgA come in a dimer form where both Fc portions are attached by a J chain Cells with decreased MHC1 expression like virus infected cells and tumor cells, are 745 Immunology Gastrointestinal & Nutrition targeted by NK cells to kills them 755 Biochemistry Gastrointestinal & Nutrition 1g of Proteins and Carbs produces 4 Calories while 1 g of Fat produces 9 Calories The MAP kimase pathway (including Growth hormone) uses Ras protein and GTP 790 Biochemistry Gastrointestinal & Nutrition (active) and GDP (inactove) Arsenic is found in insecticides, contaminated water and cause abd pain,vomiting, 841 Pharmacology Gastrointestinal & Nutrition diarrhea, hypotension and garlic odor breath. Treat with DIMERCARPOL 1018 Physiology Gastrointestinal & Nutrition Fat is absorbed in Jejunem, While B12 and Bile salts are absorbed in Ileum Shiga toxin (shiga like also) inactivates 60s ribosome by removing adenine from rRNA, and inhibit protein synthesis in colon mucosa and renal endothelial (EHEC: 1100 Microbiology Gastrointestinal & Nutrition only e coli that does not produce glucuronidase and does not ferment sorbitol) While ETEC and Yersinia enterotoxin increase cellular cGMP leading to diarrhea Only enteroinvasive EIEC invade mucosa hence the I 1136 Microbiology Gastrointestinal & Nutrition Shigella need 10-500 bacteria to infect Very BadAss 1156 Pharmacology Gastrointestinal & Nutrition Iron poisoning will cause diarrhea while lead will cause constipation NPV and PPV depend on disease prevalence irrespectively of test sensitivity and 1169 Biostatistics Gastrointestinal & Nutrition specifictiy Trypsinogen is converted to Trypsin in duodenal of epithelium and in turn activates 1251 Biochemistry Gastrointestinal & Nutrition other digestion proteins 1258 Pharmacology Gastrointestinal & Nutrition Morphine cause smooth muscle contraction in sphincter of Oddi Diphenoxylate (opioid and act on mu receptors ) given with diarrhea, but is given with 1290 Pharmacology Gastrointestinal & Nutrition atropine to produce bad effects and discourage abuse and tolerance Pseudomembranous colitis (C diff): White/yellow plaques membrane like on colono 1396 Pathology Gastrointestinal & Nutrition composed of fibrin and inflamatorry Undercooked meat: cysticercosis : Seizures, SC nodules, IM calcifications C diff toxins A: intestinal inflamation and fluid secretion B: Cytotoxic (affect actin 1397 Microbiology Gastrointestinal & Nutrition cytoskeletal structures an intracellular signaling) 1398 Microbiology Gastrointestinal & Nutrition Clostridium mostly attack people with disturbed GI microbiome Sabin (oral polio vaccine) has better IgA activity than Salk doing a better job at 1467 Immunology Gastrointestinal & Nutrition mucosal entries 1525 Anatomy Gastrointestinal & Nutrition Air in Biliary tree means GB, SB fistula for STEP 1 Unlike other parasites, Giardia is all about IgA defense and not eosinophils (involved 1596 Immunology Gastrointestinal & Nutrition in Helminthic infections) Riboflavin B2 is used in TCA cycle by transforming Succinate to ketoglutarate 1807 Biochemistry Gastrointestinal & Nutrition forming FADH2 while the reaction before of Succinyl CoA to Succinate forms 1 GTP used in Gluconeogenesis Viral Hepatitis: hepatocyte necrosis (cellular swelling and cytoplasmic emptying cused by loss of ATP and loss filament in the meshwork) and apoptosis ( in 1863 Pathology Gastrointestinal & Nutrition apoptosis there cellular shrinking with nuclear fragmentation and esoniphilia (Councilman body)with moninuclear infiltration Atrophic Gastritis Affect the Body of stomach while H pylori zffects the Antrum first 1918 Pathology Gastrointestinal & Nutrition then the Body Viral Hepatitis cause Apoptotic Hepatocytites so get round acidophilic Councilman 1927 Pathology Gastrointestinal & Nutrition BODIES (eosinophilic ) also seen in Yellow fever Motilin is produced by Duodenal mucosa ans stimulates Smooth Muscle contraction in Upper GI. erythromycin acts as a Motilin Agonist, causing Diarrhea. Ghrelin (Hunger): Increase in Fasting, Decrease after Eating. Glucagonoma: DM, NEC 1938 Physiology Gastrointestinal & Nutrition VIPoma (Pancreatic Islet Gumor): increase Cl- loss in stools, and excess H2O, Na+ and K+ follow, leading to Diarrhea. It also inhibits Gastric acid secretion. treated with Somatostatin Gastrin: acid secretion and growth of gastric mucosa Secretin, secreted by Duodenal S-cells in response to H+ in the duodenum, will 1971 Physiology Gastrointestinal & Nutrition stimulate Bicarb secretion from pancreas. On the other ither hand, pancretic enzymes are secreted following Vagal and CCK stimulus (like Gallbladder) Linkage disequilibrium is when the frequency of alleles independently do not match 8283 Genetics Gastrointestinal & Nutrition the frequency of having both alleles at the same time In hepatic encephalopathy, excess ammonia will deplete alpha ketoglutarate, and glutamate to convnert them into glutamine. Glutamine is bad for the cells and 8578 Biochemistry Gastrointestinal & Nutrition accumulated, glutamate which is excitatory is no longer here, and alpha keto which is needed for respiration is depleted too. Do the math. 10401 Microbiology Gastrointestinal & Nutrition Fidaxomicin is used in resistant C diff The portal triad (Hepatic artery, portal vein and CBD ) run through the 10583 Anatomy Gastrointestinal & Nutrition hepatoduodenal ligament so if there is bleeding we clamp the ligament to rule in or rule out any other cause of bleed In gerd Dysphagia is more consistent with ulceration while dysphagia and obsturction 11591 Pathophysiology Gastrointestinal & Nutrition goes more with strictures Behavioral As a physician be RADICALLY AGAINST Herbal products especially if you are sure 11629 Gastrointestinal & Nutrition science they are bad Pudendal nerve which (S2-S4) which numbs the perineumand genitals also numbs area when want to do external Hemorrhoids removal (Gives inferior rectal nerve). 11771 Anatomy Gastrointestinal & Nutrition Internal Hemorrhoids are innervated by Autonomic Inferior Hypogastric Plexus and do not sense pain or temperature. 11782 Anatomy Gastrointestinal & Nutrition The appendix is best identified by the converence of the 3 Taeniae Coli of the colon Chronic pancreatitis can cause splenic vein thrombosis causing short gastric vein 11795 Anatomy Gastrointestinal & Nutrition varicoses (Dr levi style) 11860 Pathophysiology Gastrointestinal & Nutrition Bacteria in guts produce not only Vit K but also Folate Free ribosome translation destination: Cytosol, Nucleosol, Mitochondria ( nuclear proteins) and Peroxisome ( involve in anabolism and catabolism of fat (very long 757 Physiology General Principles chain FA) and also produce bile) RER destination: Membrane (cell membrane, nuclear membrane), ER, Golgi, Lysosome --> Prepare to go out of cells During exercice the Ca2+ release in muscles will also activate glycogen pathway and 1028 Biochemistry General Principles glycogenolysis hence the parallel association between muscle contraction and gycogenolysis Rota and influenza like genetic shift through reassortment thats why they are 1469 Genetics General Principles common and need to vaccinate many times (more efficient virulence than genetic drift: pt mutation) Shift is Sudden wheras Drift is graDual (less killer machine) B6 is involved in transamination reaction where an amino group from an amino acid 1482 Biochemistry General Principles goes to an alpha ketoacid making it an amino acid. B6 is involved in decaboxylation reaction Circuit in Parallel: 1/Rt = 1/R1 + 1/R2 + 1/R3 (Think how circulation in the body which 1616 Physiology General Principles is mainly in Parallel wants to be efficient) In series: Rt = R1 + R2 + R3 1712 Pharmacology General Principles Isoniazid metabolism by acetylation so we have fast and slow acetylators. 1714 Pharmacology General Principles T1/2:0.7xVd/Cl 1715 Pharmacology General Principles Lipophilic deug prefer liver exretion Mante2 1728 Genetics General Principles Lesh nyhan is X linked recessive while Galactosemia is AR Thayer and Martin are selective and only ahve sex together but culture neisseria 1912 Microbiology General Principles BADDEEE 1970 Genetics General Principles Pleiotropy = One mutation and many many consequences Enhancers/Repressors can be anywhere in relation to the gene involved, while 2025 Genetics General Principles promoter are 25-70 base pair upstream to start of gene 2029 Genetics General Principles Stop codon UAA UAG UGA are recognised by Realeasing Factor 1 TATA box is a promotor (25 bases upstream) that bind to transcription factor and 2030 Genetics General Principles RNA polymerase II (in Eukaryote, binding RNA polymerase alone is not enough) for transcription initiation.CAAt box is also a promotor but 85 bases upstream 2031 Genetics General Principles N myc is a transcription factor and bind DNA Postranscriptional modification: (occur in nucleus) 5' capping Poly A tail (3' end): when AAUUAAA (transcribed from DNA) is detected the cap is added (cap is not 2033 Genetics General Principles transcribed from DNA), protects mRNA from degradation in chtoplasm Splicing: Introns removal Methylation of Cytosine in DNA is implicated in gene silencing and hence in 7791 Genetics General Principles Imprinting of disease ( why silent in mom not in kids for ex) 11514 Pathology General Principles Hand Hygiene is best way to prevent hospital infections Ubiquitin proteasome pathway: ubiquitin tag bad particles (like viral particles), 11674 Immunology General Principles proteasomes come degrade them then they a presented on cell surface bound to MHCI for presentation to cytotoxic CD8 cells Behavioral Preventable adverse event is defined as injury to a patient due to failure to follow 11847 General Principles science evidence based test practice guidelines Hep C (RNA virus) lacks reverse transcriptase and does not integrate into genome 58 Pathology Hematology & Oncology ulnike DNA Hep B that do integrate VWF --> GP Ib (Bernard) --> GP IIb-IIIa (Glanzman). If you add ristocetin you will activate GP Ib receptors on platelets and make it available for vWF binding. If still no 346 Biochemistry Hematology & Oncology response then vWF vs GP Ib. If normal plasma is added and still no reponse to ristocetin it is Bernard (coz vWF is contained in normal plasma) 465 Pathology Hematology & Oncology Factor V is when factor V is resistent to protein C deactivation Wiskott Aldrich is triad of Eczema, Thrombocytopenia (both appear early) and B, T 537 Immunology Hematology & Oncology cells immunodeficiency appearing at 6-12 months. C1 binds to IgG and IgM (Pentameric, so binds better) to activate complement 540 Immunology Hematology & Oncology system, at the hinge point of the heavy chain 559 Immunology Hematology & Oncology Immature T lymphocytes in Thymus cortex, express both CD4 and CD8 614 Pathology Hematology & Oncology Glioblastoma: Necrosis and vascular proliferation Hpecidin, secreted by liver will decrease intestinal Iron rate absorption. It is increased 787 Physiology Hematology & Oncology in Inflammation, and high iron levels. It is decreased in hypoxia and erythropoeisis. Low Hepcidin, increase intestinal absorption and release from Macrophage. RBC dont do oxidative phosphorylation since they dont have ATP, and they dont even produce enough ATP in Glycolysis coz they sacrifice 1,3 BPG (which usually 1029 Biochemistry Hematology & Oncology gives ATP by turning into 3-phosphoglycerate), by turning it into 2,3 BPG (LOGICAL YA?) NADPH can be synthesised through the oxidative pathway of HMP shunt but can 1035 Biochemistry Hematology & Oncology also be formed from the non oxidative pathway through Transketolase and Transaldolase from Fructose6P instead of G6P 1039 Pathology Hematology & Oncology TNF alpha cause cachexia Heparin attaches on AT III and and enhances its activity by inhibiting Xa and 1077 Pharmacology Hematology & Oncology thrombin, LMWH IS MORE SPECIFIC FOR Xa In HbS valine take the place of glutamate in 6th position of the beta chain causing 1242 Biochemistry Hematology & Oncology new hydrophobic interactions hence sickling Opioids has many sode effects like constipation nausea vomiting.. But build 1257 Pharmacology Hematology & Oncology to,erance to all and dont get side ffects anymore except for CONSTIPATION AND MIOSIS In acute porphyria, you can give heme which will inhibit ALAminuvic acid synthetase 1338 Biochemistry Hematology & Oncology and decrease accumulation of D ALA and porphorynohenc 1403 Genetics Hematology & Oncology AML M3 (15:17), and Retinoic acid receptor are malfounctional 1405 Pathology Hematology & Oncology AML (15-17t): Auer rods In CN poisoining: (bind cytochrome a-a3) Nitrites bind Fe2+ --> Fe3+ (higher affinity to CN and prevent its release to mitochondria) Another Antidote is Sodium 1415 Biochemistry Hematology & Oncology Thiosulfate which combines with CN forming Thiocyanate which is less toxic and excreted in urine In RBC, Heme is produced in Mitochondria firs 3 reactions, then cytosol. So when 1455 Biochemistry Hematology & Oncology RBC mature and lose their mitochondria, u cannot synthesize anymore heme RBC cannot produce heme coz they dnt have Mitonchondria responsible for first and 1455 Biochemistry Hematology & Oncology last step of production Radiation therapy works through breaking Double Strand DNA, and creating free 1474 Genetics Hematology & Oncology radicals too 1476 Biochemistry Hematology & Oncology Thymidine dimers are usually corrected by endonucleases I know its weird but Aplastic Crisis affect only RBC while Aplastic Anemia affects all 1496 Microbiology Hematology & Oncology lines CO poising will increase Carboxyhemoglobin (CO bound Hemoglobin) but does not affect PaO2 since it competes with O2 in Hemoglobin not in plasma. It will not affect 1545 Physiology Hematology & Oncology Methemoglobin (Iron oxidized to Fe3+ due to Dapsone, Nitrite, Enzyme deficiencies or Hemoglobinopathies) . CO poisoning will cause a Left Shift (Decreased O2 tendency to unload) 1614 Immunology Hematology & Oncology Isotype sworching occurs in germinal centers of LN Ganciclovir can cause NEUTROPENIA. its effect increase with TMP SMX or 1647 Pharmacology Hematology & Oncology ZiDoVuDine coz also can cause BM supression Patients who receive more than 5L/24 hrs of PRBC will have high levels of Citrate 1654 Physiology Hematology & Oncology (used to store blood), which in turn chelates Ca2+ and Mg2+, lowering their blood level, causing parastheisa 1683 Immunology Hematology & Oncology Rhogam is an IgG antibody Rb is active HypoPhosphorylated (its in kidss so we dont like much phosphorylation,,, 1717 Pathology Hematology & Oncology ) In Dysplasia there is reversible change in epithelial. Once the dysplastic cells have 1753 Pathology Hematology & Oncology breached the basement membrane it os no longer reversible Lymphocyte bnign vs malignant: Monoclona T cell vs Polyclonal in infection (makes 1754 Pathology Hematology & Oncology sense) bcl2 (oncogene on chromo 18) It inhibits apoptosis of tumor cells and facilitates neoplastic growth.. In follicular lymphoma (B cell tumor) bcl-2 goes to ch 14 and is 1758 Pathology Hematology & Oncology over4 expressed RAS: component of MAP kinase path, transmits signals from cell surface to nucleus (pancreatic, GB, colon, endometrium, thyroid ,lung cancers) DNA mismatch repair: in Lynch syndrome (colon and stuff) Pure red Cell aplasia is seen in : Thymoma, Lymphocytic Leukemia, and Parvovirus 1786 Pathology Hematology & Oncology B19 infection 1788 Genetics Hematology & Oncology Hemophilia is X-recessive Erythropetein have bluish cytoplasm reticular precipitates of rRNA and is larger (also 1796 Pathology Hematology & Oncology lacks a nucleus) Mosto Carcinogens enter body as inactive but P450 (monooxygenase) make them 1797 Pathology Hematology & Oncology so, and it depends on this system to determine succeptibility of individual MDD1 code for a P glycoprotein a transmembrane ATP dependant efflux pump that 1819 Pharmacology Hematology & Oncology increase efflux of drugs and decrease influx of these chemo agents making the cells resistant to chemo 1847 Biochemistry Hematology & Oncology Folate i s needed for Thymidine formation Aplastic anemia (Thrombocytopenia, Anemia, and absent hematopoietic cell in 1861 Pathology Hematology & Oncology marrow) will have BM with fat infiltrate Integrin bind cells to basement membrane by attaching it to FIBRONECTIN, 1872 Pathology Hematology & Oncology COLLAGEN, And LAMININin Extracelullar matrix VEGF and Fibroblast Growth factor cause angiogenesis while epidermal growth 1873 Pathology Hematology & Oncology factor affect mitogenesis of hepatocytes and fibroblasts 1877 Pathology Hematology & Oncology Peau dorange is due to lymphatic obstruction 6-MP -(HGPRT)-> Active Metabolites 6-MP -(Xanthine Oxidase)-> Inactive 1890 Pharmacology Hematology & Oncology Metabolites (that why allopurinol will increase dose of 6-MP) 1911 Genetics Hematology & Oncology Follicular lymphoma 14:18 translocation causes Bcl2 overexpression 2018 Pharmacology Hematology & Oncology ETOPOS(second)ide block TOPOisomerase Second (II) Thalassemia intermedia is associated with a muation three bases upstream from the 2086 Biochemistry Hematology & Oncology start codon (AUG) exchanging a puring with a pyrimidine Thrombin II inhibtors will affect TT (throbin time) also PT PTT Xa inhibitor will affect 2133 Pathophysiology Hematology & Oncology both in theory (in practice PT is barely affected coz of heparin neutralizer in the PT reagent) In EBV you get atypical CD8 T cells in circulation (large with eccentric nucleus) to 7643 Immunology Hematology & Oncology attack B cells infected (you also get atypical B cells but in much smaller proportion) 8276 Biochemistry Hematology & Oncology In Alternative Splicing, same gene will give different mRNA in different tissues 8371 Pharmacology Hematology & Oncology ralTEGRAvir: Inhibits HIV inTEGRAse, so that its DNA will no be well incorporated 11728 Pharmacology Hematology & Oncology In chemo induced nausea inhibiting Neurokunin is good too (Tfayli's talk) 11750 Pathology Hematology & Oncology Hairy cell leukemia will cause marrow fibrosis 11754 Pathology Hematology & Oncology Sclerotic means osteoblastic 11816 Biochemistry Hematology & Oncology Lead: ALA D, Ferrochelatase are affected B6: ALA S is affected Hep C envelope changes a lot coz its RNa dependant RNA polymerase has no 44 Microbiology Infectious Diseases proofreading 3"-->5" exonuclease activity Hep B acquired by the fetus (transplacentally) or at birth (more commonly) is very common if mom is HbeAg positive. They have very high replication rate and higher 46 Microbiology Infectious Diseases rate of progression to chronic disease (the younger the higher the risk). On the other hand they are rarely symptomatik and have mildly elevated LFTs Local Candida is controlled by T cell (seen in HIV) wheras disseminated Candida is 112 Immunology Infectious Diseases controlled by neutrophils (seen in neutropenic) 376 Microbiology Infectious Diseases Atypical lymphocytes can be seen in Hep B, EBV and CMV and are non specific.. 390 Pathology Infectious Diseases in 95% of pple hem B will resolve after acute attack Aspiration pneumonitis is like aspiration pneumonia but resolves on its own and 532 Microbiology Infectious Diseases occur few hours after aspiration not days like pneumonia. Occurs by aspiration of oral anaerobes not gastric!!!! 676 Immunology Infectious Diseases In TSST-1, the toxins which are superantigens activate T cells and Macrophage 819 Pharmacology Infectious Diseases Protease inhibitors navir cause metabolic stuff 822 Pathophysiology Infectious Diseases Hep B are associated with HCC coz of the integration of DNA into host genome H. flu are blood loving, but needs factor X and NAD+ for growth. So wont grow on 963 Microbiology Infectious Diseases sheep blood agar unless cultured with Staph that will povide her with NAD+ Oxidase + comma shaped bacteria: cholera: grow in alkaline (so PPI or decrease 977 Microbiology Infectious Diseases acidity will promote its proliferation) pylori: In acidic coz produce urease Campylo: in 42 degree They are all special 1091 Pharmacology Infectious Diseases In Tazocin, Tazobactam role is to decrease Piperacilin destruction (like Carbidopa) Hib, in young children cause: MEningitis, pneumonia, bacteremia and epiglotitis (BIG 1103 Microbiology Infectious Diseases SHIT) While Sinusitis and OM are caused By NON TYPABLE H. flu Salmonella Vi antigen (its virulence factor) makes it resistant to opsonization and 1137 Microbiology Infectious Diseases phagocytosis Mycolic acid in Mycobacterium cell wall, is part of its virulence will make it acid fast as in when then dye is given the bacteria will stain red on carbolfushin and is resistant to decoloration when acid-alcohol decolorizing agent are given because of proper cell 1309 Microbiology Infectious Diseases wall. When Isoniazid is given it inhibits mycolic acid synthesis, so the bacteria will lose its acid fast property and decolorize KatG (bacterial peroxidase) will tranform INH to its active element. Listeria (food borne) frows well on cold tpragure and can contaminate refregirated 1392 Microbiology Infectious Diseases food. It is a gram + with tumbling motility 1393 Pharmacology Infectious Diseases Losteria is nod responsive to ceftriaxone so also give ampicillin the Herepsviruses family get their membrane from nuclear membrane of cells (unlike 1408 Microbiology Infectious Diseases the rest, get it for cell membrane.. NICE StufF) IFN alpha and beta are secreted in response to viral particles and decrease their 1468 Immunology Infectious Diseases protein synthesis capacity and replication, promoting apoptosis In primary herpes, a week course of acyclovir will reduce the disease but not prevent 1550 Microbiology Infectious Diseases recurrence (latent in sacral ganglia S2 S3 S4). On the other hand prophylaxis daily valacyclovir will do the job 1551 Pharmacology Infectious Diseases Acyclovir (nucleoside analogs) coz like Adenosine 1593 Microbiology Infectious Diseases CMV is EBV with (-) heterophile test (as in fail to agglutinate horse erythrocyte) 1645 Pharmacology Infectious Diseases Acyclovir and ovirs are to be phosphorylated to become in their active forms In Influenza it is Antibodies against Hemaglutinin that primary protects against 1649 Immunology Infectious Diseases infection 1670 Microbiology Infectious Diseases The 3 C's of measle + fever are prodromal to the rash Primaquine is given to kill liver stage malaria hypnozoite and thus preventing relapse. 1965 Pharmacology Infectious Diseases Malaria consists of fever and sweating in a 48 h cycle 2110 Pharmacology Infectious Diseases Penicilln and Ceohalosporins bind to cell membrane proteins such as transpeptidase Cephalosporins resitance mechanis, by changing in penicilin binding protein structure ( some of the protein remain normal so still have some binding) whereas in 2111 Pharmacology Infectious Diseases beta lactamase in case of penicillin there is no binding at all coz antibiotics will all be disabeled) Daptomycin (cover gram + and MRSA) work by depolarizing bacteria Ceels and 8288 Pharmacology Infectious Diseases therefore inhibits DNA RNA fprmation and protein synthesis, but cause myopathy and increase CPK 8593 Microbiology Infectious Diseases Alcohols are antisceptic coz they disrupt cell membranes.. Dengue fever has 4 serotypes. Chill infections vs Bad ones are due to diferrent 11395 Microbiology Infectious Diseases serotypes IFN Gamma are produced by NK (T cells, stimulated IL12 from macrophage) and 11525 Microbiology Infectious Diseases again activate macrophage to kill phagocytosed pathogens Cat bite: barto, pasteurella Dog: pasteur, strep, staph aureus Human: anaerobes, 11547 Microbiology Infectious Diseases strep, eikenella 11590 Pharmacology Infectious Diseases Abacavir (nrti) is associated with hypersensitivity in 10% of pple with HLA B57 Parotitis can occur in elederly (weird presentation: pre/postauricular swelling that 11596 Microbiology Infectious Diseases extends to mandible) which are dehydrated and intubated. But here it caused by Staph most commonly and diagnosed by imaging and amylase levels 11670 Microbiology Infectious Diseases Neurocysticercosis (taenia solium) cystic brain lesion in Central america 11729 Pharmacology Infectious Diseases Acyclovir: viral inhibition of DNA polymerase 11766 Microbiology Infectious Diseases E coli is lactose fermenting, INDOLE (+) (coz they are indolent) 11822 Microbiology Infectious Diseases Roseola (HHV6): 3-5 days of fever (often have febrile seizures) than truncal rash 343 Genetics Male Reproductive System Klienfelter 46 XXY, tall male with boobs aazospermia and mild mental retardation CF patient are Infertile due to absent Vas Deferens bilaterally. In Kartegner sperm 807 Genetics Male Reproductive System are immotile but we have Vas SRY --> TDF --> Testes develop --> Sertoli (Secrete MIF --> Paramesonephric duct PMD involute) Leydig cells (Produce Testosterone --> Transform Wolffian duct into Male internal Genitalia; Epididymis, Vas Deferens) Testosterone --> DHT --> 1449 Embryology Male Reproductive System Transform Genital Tubercle and Urogenital Sinus into Male external Genitalia (Penis, Prostate) IN XY, IF NO SERTOLI CELLS YOU WOULD HAVE BOTH FEMALE AND MALE INTERNAL GENITALIA BUT MALE EXTERNAL GENITALIA (coz MIG is not here to involute PMD 11747 Anatomy Male Reproductive System Prostate Ca spreads to bone through prostatic venous plexus first Deep ring: Internal Spermatic Fascia (coming from transversalis fascia) Superficial ring: External Spermatic Fascia (External Oblique) COZ Deep Internal So in Crypto 11762 Anatomy Male Reproductive System need to bring testicle from superficial ring which its opining is mainly External spermatic fascia (coming from external oblique) Miscellaneous Bilateral renal angiomyolipoma associated with Tuberous Sclerosi (AD, with Brain 6 Pathology (Multisystem) Hamartoma and Ash leave spots) Miscellaneous 701 Genetics Achondroplasia is AD (Multisystem) Miscellaneous In Homocyteinuria, homocysteine is not metabolised to cysteine due to cystathione 1332 Biochemistry (Multisystem) reductase problem Alkaptonuria is a problem in converting Tyrosine to Fumarate (its TCA intermediate Miscellaneous equivalent) so its like the next step after Phenylketonuria. Homogentisic acid 1502 Biochemistry (Multisystem) dioxygenase deficiency so homogentisate (next step after tyrosine) accumulate. Get Black urine, pigmentated face and other organs, arthropathy. Miscellaneous Many patients with Homocytinuria benefit from B6 as it will drive the reaction forward 1504 Biochemistry (Multisystem) to Cysthathione Behavioral Miscellaneous 11531 Always get a translator when it is not very clear science (Multisystem) Behavioral Miscellaneous 11532 Physician's burnout (emotional stress) while Physician fatigue refers to lack of sleep science (Multisystem) Behavioral Miscellaneous 11533 Cane and walker do not decrease the risk of fall according to studies. Just assist science (Multisystem) Behavioral Miscellaneous For a nurse to show that she has understood the order she should repeat everything 11549 science (Multisystem) and even the route of administration Behavioral Miscellaneous An elderly for discharge is best instructed with a checklist discharge list in case he 11550 science (Multisystem) has no family members living with him Behavioral Miscellaneous 11602 Medicare cover people above 65 or younger with disabilities science (Multisystem) Miscellaneous Most common site of compartment syndrome is Anterior compartment innervated by 11635 Anatomy (Multisystem) Deep peroneal nerve Miscellaneous 11678 Pharmacology [Drug]=mg given/Vd (Multisystem) Behavioral Miscellaneous Communication problem during patient patient handoff (teslime) is a major cause of 11757 science (Multisystem) stupid errors in Hypoxic ischemic encephalopathy (in arrest) hippocampus is first damaged, then 18 Pathology Nervous System neocortex and Purkinje of cerebellum In brain infarcts, neutrophils come in the first 24-48 hrs, do not phagocytose 20 Histology Nervous System anything. Microglia (3-5 days later they deposit), then Astrocyte will cause peripheral glial scar and get central cyst instead of necrosis if HTN and lacunar stroke and dont appear directly on CT but later it is due to HTN 22 Pathology Nervous System arteriosclerosis and not Charcoud bouchard rupture that wld appear directly on CT In abscence followed up by generalised tonic clonic ethosuximide wont help. Use 249 Pharmacology Nervous System Valproic acid Carbidopa is given with levodopa to inhibits levodopa conversion into dopamine 262 Pharmacology Nervous System outside CNS (by being itself metabolised) but with carbidopa we will have more dopamin in CNS and more SE like agitation and anxiety.. subdural hemorrhage in babies is sign of abuse (shaken baby syndrome) and have 347 Pathology Nervous System retinal hemorrhage 348 Pharmacology Nervous System Ramelteon, a melatonin agonist is used for insomnia in elderly. Blotchy red muscles fibers on Gomori trichome stain = Mitochondrial Myopathies (Maternal Inheritance) --> Abnormal Mitochondria (increased in number, enlarged, abnormally shaped) accumulate in the fibers making them look irregular in size and 357 Genetics Nervous System shape. "Red Fagged Fiber" Examples: Myoclonic epilepsy with red ragged fibers (MERRF), Leber optic neuropathy (Blindness), Mitochondrial encephalopathy (stroke-like episodes) and lactic acidosis (MELAS) 397 Pathology Nervous System Slit lamp exam to Diagnose Kayser Fleisher The most common cause of spontaneous lobar hemorrhage in the elderly is 499 Pathology Nervous System Cerebral Amyloid Angiopathy (same amyloid seen in Alzhemer) and most commonly occurs in occipital and parietal lobes If acetylcholinesterase is found in amniotic fluid (shld be contained in neural tissues) 502 Embryology Nervous System it means that there is neural tube defect with failure of fusion and hence this enzyme is spilled in sac ETHosuximide block T type calcium cahnnels in THalamus. Used for Abscence 509 Pharmacology Nervous System seizure Pancoast cause ipsi Horner and ipsi shoulder and arm weakness and areflexia due 566 Anatomy Nervous System to brachial plexus involvement Alzheimer: Neurofibrillary tangles and A-Beta amyloid plaques. In Down syndrome 590 Genetics Nervous System there is 3 copies of The Amyloid precursor protein gene. Stuff involved in Alzheimer: APP on chr21 Prenisilin 1 on chr14 Prenisllin 2 on chr1 591 Genetics Nervous System ApopE4 involved in late onset familial Alzheimer In alzheimer, decrease acetylcholine in Meynert nucleus in hipoccampus (decreased 593 Pathology Nervous System activity of acetyltransferase) 595 Pathology Nervous System Paraneoplastic process is autoimmune In thiamine deficiency u can get necrosis and hemorrhage of mamillary bodies, B1 598 Biochemistry Nervous System will affect the activity of transketolase (main prob) and Pyruvate and Ketoglutarate dehydrogenase In anesthetic if have high venoarterial difference then drug will directly go to muscle 660 Pharmacology Nervous System and adipocytes then slower effect on brain Whereas potency is determined by MAC Ataxia telengiectasia: (AR), defect in DNA repair genes Cerebellar ataxis, 673 Immunology Nervous System Oculicutaneous telengiectasia, repeated sinopulmonary infection and increased incidemce of malignancy Neisseia: Bean Shaped Gram - cocci in pairs(<60 especially in camps, dorms..) VS. 735 Microbiology Nervous System Strep pneumo: Lancet shaped, Gram + cocci in paiars (more common in pple >60) 775 Physiology Nervous System POMC is a polypeptide that give rise to ADH, MSH and Beta Endorphins. When Morphine binds to mu receptors it can will cwuse hyperpolarisation of the cell in two ways: First and most importantly it will cause G coupled activation of K+ 776 Physiology Nervous System channel, increasing K+ efflux out of the cell, hyperpolarizing the cell. Secondly it will decrease Ca+ influx into the cell (Think morphine acts like K(C)arl) 794 Pathology Nervous System Hippocampus atrophy is seen in Alzheimer 840 Genetics Nervous System Huntingtin proteins prevents acetylation of DNA making it more mute Potency of Anasthetic is related to MAC (minimal alveolar concentration) (concentration at which 50% of people pass out) High blood/air partition coefficient 851 Pharmacology Nervous System means high solubility so slower onset of action (coz stay in blood dont go to brain) Potency: drugs needed to achieve a certain effect related to km Efficacy: maximal effect 852 Pharmacology Nervous System Inhaled anesthetic will directly redistribute in muscles skeletal and fat IV anesthetic effect wean off after a short time because of redistribution of drug in 856 Pharmacology Nervous System body Dantrolene is only used to treat heat stroke and malignant hyperthermia, not high 866 Pharmacology Nervous System fever 871 Pathology Nervous System Liquefactive Necrosis: Lysosmal digestion of the tissue 913 Pathology Nervous System PMR: fatigue, fever, wight loss + Proximal muscle stifness 969 Pathology Nervous System Tetanus is diagnosed clinically In Neisseria CApsular Polysaccharide resist phagocytosis and stuff, but Outer 1006 Microbiology Nervous System membrane Lipooligosaccaride (LOS or LPS) is the endotoxin associated with fucked up disease 1048 Biochemistry Nervous System Vit A OD: Pseudotumor Cerebri, skin changes and Hepatosplenomegaly 1058 Pathology Nervous System Endomysial Inflammation: Poliomyositis Endoneural Inflammation: Guillain Barre 1149 Anatomy Nervous System Superficial peroneal: Eversion Deep Peroneal: Dorsiflexion Meningioma often occur in dural reflection. In falx cerebri patient can have leg 1150 Anatomy Nervous System symtoms (beco it is in the medial homunculus) Craniopharyngoma arising from anterior pituitary are calcified cysts containing 1152 Pathology Nervous System cholesterols crystals Posterior fossa tumor in kids Medullo: Sheets of primitive cells(basophilic nuclei and scant; small round blue cell, cystoplasm) with many mitotic figures Pilocytic 1259 Pathology Nervous System astrocytoma: Most common, Rosenthal fibers (are low grade and have better prognosis) Ependymoma: walls of venticles and can cause hydrocephalus, they form gland like structures called rosettes Neuronal properties: Time constant: time it takes for membrane to achieve 63% of new membrane potential Length constant: time it takes for impulse to go a certain 1318 Physiology Nervous System distance. Demyelination will decrease both, by Increasing axon Conductance and having less Saltatory Conduction 1320 Pharmacology Nervous System In mysathemia crisis we shld increase dose of neostigmine Organophosphate irreversibly inhibit cholinesterase in musc and nicot synapses so if 1323 Pharmacology Nervous System give atropine (only musc) u wont be helping muscular effects In Maple syrup, avoid branched chain amino acid leucine Isolucine and Valine (defect in alpha ketoacid dehydrogenase with deficient conversion of Leucine to 1335 Biochemistry Nervous System Acetyl CoA or Valine and Isoleucine to Propionyl CoA then Methylmalonyl then Succinyl CoA) 1368 Pharmacology Nervous System Uterine relaxation is by B2 like in lungs.. Listeria which is a B hemolytic gram + that moves and reproduce well in low 1391 Microbiology Nervous System temperatures is common in children less than 3 months coz of their immature cell mediated immunity 1399 Microbiology Nervous System TCA affect muscarinic not nicotinic Rabies virus goes in skin, then motor axon (and retrograde to cNS) then salivary 1402 Microbiology Nervous System gland (thats why transmitted through bites) Fragile X: CGG repeat --> Hypermethylation of Cytosine amd inactivation of 1421 Genetics Nervous System subsequent genes 1428 Biochemistry Nervous System In tRNA, the 3 ' part is responsible for amino acid attachement site (since t and 3) Behavioral Conversion disorder is experiencing neurological symptoms that are not explained by 1433 Nervous System science tests or exam, and is due to a stressor 1442 Pharmacology Nervous System Donepezil Cholinesterase inhibitor is used in Alzheimer 1443 Pharmacology Nervous System Benzo increase FREQuENCY of Cl channels not DURATION 1534 Embryology Nervous System NF is a neural crest tumor since it is a Schwann cells tumor. Like in Melanoma 1536 Histology Nervous System Thight junction is responsible of the nonfenestrated endothelial in BBB (cest logique) Musculucutaneous innervates biceps and suppinator (like when I do Dumbels) and 1636 Anatomy Nervous System supply sensory lateral Forearm Ulnar nerve functions: Wrist flexion/adduction, fingers adduction/abduction and 1743 Anatomy Nervous System sensation in 1.5 last fingers and flexion of 4th/5th digit Median nerve is sandwiched between Flexor digitorum superficialis and Flexor 1749 Anatomy Nervous System Digitorum Profundus (easy since Median innervates digits) Holding a branch like a monkey can cause lower trunk of brachial plexus injury 1829 Anatomy Nervous System affecting radial and ulnar nerves and muscles of hands immunity agaisnt neisseria mengitidis is antibodies against their polysaccaride 1853 Microbiology Nervous System capsule 1966 Microbiology Nervous System enterovirus is most common cause of asceptic meningitis Botulinsm toxin inhibit Ach release wheras rabies bind on the recptors (toxin is killed 1997 Microbiology Nervous System by heat) 2082 Microbiology Nervous System Treat toxo with pyrimethamine and sulfadiazine (clinda if sulfa allergy) 2083 Microbiology Nervous System Cns lymphoma are B cells CYPROHEPATADINE, is an antihistamine with anti serotonergic, so used in excess 2089 Pharmacology Nervous System serotonin syndrome Behavioral 2123 Nervous System Acute stress disorder happen 3 days to 1 month from a bad event science Rabies G(accumulate in open wound) lycoprotein spikes bind nicotine acetylcholine 8324 Microbiology Nervous System receptors, activate them. And go to CNS in retrograde 8385 Biochemistry Nervous System Impairement of Ubiquitin proteasome system is involved in Parkinson and Alzheimer 8476 Pharmacology Nervous System Tryptans are serotonic agonist Staph epidedermis virulence is synthesis of an extracellular polysaccharide matric, 8533 Microbiology Nervous System (adherent biofilms) when foreign bodies are inserted through skin (skin flora) 8564 Anatomy Nervous System IVH is bleed in germinal matrix Behavioral In Narcolepsy or Cataplexy Hypocretin (1 or 2) which are secreted by the lateeral 8878 Nervous System science Hypothlamus and usually promote wakefulness and inhibit REM sleep, are usually low 11458 Pharmacology Nervous System Baclofen, GABA B receptor agonist used for spasticity even of central cause like MS Parkinson pple benefit from deep brain stimulation inhibiting Subthalamus eventually 11462 Pathology Nervous System increasing Thalamus inout HIV associated dementia is suspected in AIDS patients with progressive cognitive 11568 Pathology Nervous System decline. Microglial nodules and groupd of activated macrophages/microglial cells around necrosis that may fuse to form multinucleated giant cells 11574 Pathology Nervous System Damage to brainstem below or at level of red nucleus will cause decerebrate position 11576 Pathology Nervous System In brain calcification do not happen afer infarcts but in TUMORS Overshooting is when lateral cerebellar is affected, when vermis (central) is affected 11632 Pathology Nervous System u get truncal ataxia 11665 Pharmacology Nervous System Treat status (even if febrile seizure) with lorazepam Infraiebital nerve runs along the orbital floor so in such a fracture causing 11742 Anatomy Nervous System parasthesia in upper cheek, upper lip and upper gingiva and inferior rectus muscle gets entrapped causing vertical nystagmus GABa activation cause Chloride channel to open and causing a chloride flux inside 11755 Physiology Nervous System (passive down normal gradient)the cell hyper-polarizing its resting potential XI injury: Trapezius injury: Droopin gof shoulder, impaired abduction above 11772 Anatomy Nervous System horizontal and Winging of Scapula (weird things) Femoral nerve passes through the Inguinal crease not the Femoral rin and canal 11777 Anatomy Nervous System which contains lymphatic, vessels and lymph nodes During intubation, beware of atlantoaxial instability that can cause subluxation of the 11793 Anatomy Nervous System vertebra and compression of SC and Vertebral arteries--> Paralysis 1646 Pharmacology Ophthalmology AIDS CD4<50 CMV Retinitis 11551 Microbiology Ophthalmology CMV cause chorioretinitis when in congenital infection 11841 Pharmacology Ophthalmology In glaucoma, prostaglandin will increase outflow of humor.. Aspirin OD Fever, Tinnitus, Tachypnes): Mixed Resp Alkalosis (Stimulates medullary centers, leading do Hyperventilation) with Anion Gap Met Acidosis (begin shortly Poisoning & Environmental Afterward, as Aspirin Increase Lipolysis, Uncouples Oxidative Phosphorylation, and 1544 Physiology Exposure Inhibits Citric Acid Cycle --> Ketoacid, Lactate and Phruvate Accumulation). So you get Normal pH with low pCO2 and low HCO3-. in compensation, pH will not return to Normal but gets close to Normal Range. Unlike what seems intuitive Complete mole (46, XX or XY only paternal DNA) does not contain fetal tissues and has a HONEY COMB or SNOWTORM appeance, Pregnancy, Childbirth & 792 Pathophysiology associated with preeclampsia, before 20 weeks, Hyperemesis, Hyperthyroid Partial Puerperium Mole are XXY or XXX but has mom and 2 papa sets so have fetal tissuesand only presents with vaginal bleed and lower risk of malignancy In Aromatase deficiency female will have ambiguous genitalia and the excess of Pregnancy, Childbirth & 955 Genetics Androgen that cannot be converted, will go to mom's circulation causing her Puerperium deepening of voice etc. unlike 21 hydroxylase deficiency that does not affect mommy Pregnancy, Childbirth & Live vaccines: Smallpox, chickenpox, yellow fever, Rota, Intanasal Influenza, Sabin 1464 Microbiology Puerperium for polio, MMR, Pregnancy, Childbirth & 1772 Embryology In fertilization, BHCG is detectable in serum 8 days later but 14 days later in urine Puerperium Pregnancy, Childbirth & Patau: cleft lip,palate, omphalocele, holoprosencephaly, polydactyly, rocker bottom 1822 Genetics Puerperium feet Patau 13: Cleft palate, Poly/Syndactyly, Omphalocele Edwards 18: Small brain Pregnancy, Childbirth & 1823 Genetics (prominent occipit), Small ears, Small mandible, Small sternum, Small clenched Puerperium hands + Eyes, Cardiac, GI defects (HE is small, so low HCG and Estriol) Pregnancy, Childbirth & Complete hydatiform mole is 46 XX or XY only from father while partial is triploidy 2/3 1830 Genetics Puerperium from father During pregnancy, prolactin steadily increase along pregnancy but Progesterone and Pregnancy, Childbirth & 1987 Physiology Estrogen do not permit lactogenesis and promote Breast Growth and Development Puerperium with minor help of Peolactin Pregnancy, Childbirth & Congenital torticolis is 2-4 week after bitch it is due to malposition of head of abby in 8325 Pathology Puerperium utero or birth trauma. they resolve with stretching Maternal diabetes is due to HPL which increases proteolysis, lipolysis, insulin Pregnancy, Childbirth & 8330 Physiology resistance and decrease gluconeogenesis. Estrogen, progesterone and cortisone Puerperium also play a role in maternal diabetes. Pregnancy, Childbirth & False twins are always Di Di in indentical twins land,arks are: 0-4: Di C Di A 4-8: 8406 Embryology Puerperium Mono C Di A 8-12: Mono Mono >12: Conjoined (4-8-12 landmarks) Behavioral Psychiatric/Behavioral & Buspirone has a slow onset of action and is not a muscle relaxant, hence not 247 science Substance Abuse addictive Behavioral Psychiatric/Behavioral & Tardive dyskinesia occur with lip smacking and many ticks due to antipsychotic 511 science Substance Abuse medications Psychiatric/Behavioral & Lithium toxicity (ataxia, confusion, neuromuscular exitability) can be precipitated by 519 Pharmacology Substance Abuse volume depletion, like with thiazide, ACE and with NSAIDS too Psychiatric/Behavioral & 706 Pharmacology Trazodone is gd in patient with insomnia (think of erection while sleeping) Substance Abuse Behavioral Psychiatric/Behavioral & 1046 Bulimia patients, remain with their normal wights and do not have medical problems. science Substance Abuse Behavioral Psychiatric/Behavioral & PCP abuse will most likely result to trauma (fight etc.) more than seizure or cardiac 1165 science Substance Abuse event Behavioral Psychiatric/Behavioral & Displacement: I am getting a divorce and am angry, so I shout at my daughter who 1234 science Substance Abuse fogot to throw the garbage Behavioral Psychiatric/Behavioral & Reaction formation is when you act oppositely than what you feel. Splitting is when 1350 science Substance Abuse you perceive people as either good or bad Supression is a mature defense mechanism involving a conscious choice not to dwell Behavioral Psychiatric/Behavioral & on a particular thought or feeling. Rationalisation involve making excuses for 1351 science Substance Abuse unacceptable feelings ; like a student explaining that poor performance was due to trickiness of the exam Behavioral Psychiatric/Behavioral & Triazolam is a short acting benzo best used for sleep, Lorazepam is intermediate the 1352 science Substance Abuse other DFC are long acting A boy whose parents are having a divorce and thinks that his dad is angry at him is Behavioral Psychiatric/Behavioral & experiencing Projection, since he is likely angry at his parents he will think they are 1429 science Substance Abuse angry at him too. This is common in peple who lack insight or their emotions, motivations and feelings Behavioral Psychiatric/Behavioral & PPtm blues last maximum 10 days otherwise it is PPtm depression and require 1430 science Substance Abuse treamtent (antidepressant, psychotherapy) Psychiatric/Behavioral & 2001 Pharmacology Cocaine inhibit reuptake of dopamine Substance Abuse Behavioral Psychiatric/Behavioral & Delusional disorder is one step worse than Paranoid disorder, its like a paranoid man 2046 science Substance Abuse who constantly think people are poisoning him Behavioral Psychiatric/Behavioral & Transference is when ur transfer your emotions associated with a significant person 2053 science Substance Abuse to the person in the present Psychiatric/Behavioral & drugs with Serotonin Syndrome: antidepressant with serotonin stuff, Tramadol 8327 Pharmacology Substance Abuse Ondansetron Linezolid (DA FUCK) Triptans (SURE) Behavioral Psychiatric/Behavioral & 8954 Most cases of OD's are due to prescribed Opioids science Substance Abuse A patient requiring antibiotic for viral infection, don't tell them that it will cause Behavioral Psychiatric/Behavioral & 10458 resistance, be sensitive and tell about the side effects and that other treatment are science Substance Abuse better Behavioral Psychiatric/Behavioral & Children under the age of 6 do not understand death, so it is normal for them to hae 10465 science Substance Abuse psychotic symptoms like seeing their grandma Behavioral Psychiatric/Behavioral & 11587 Bipolar I means only one criteria needed which is MANIA science Substance Abuse Behavioral Psychiatric/Behavioral & 11603 Phobia is treated with Exposure-based behavioral therapy science Substance Abuse Behavioral Psychiatric/Behavioral & 11618 Previous suicide attempt is the worse prognosis for people attempting suicide science Substance Abuse Behavioral Psychiatric/Behavioral & Persistent depressive disorder is when Major depressive disorder and Dysthemia 11622 science Substance Abuse happen for more than 2 years Behavioral Psychiatric/Behavioral & Adjustment disorder is applicable for only 3 months following the stressor, beyond 11737 science Substance Abuse that find another explanation Behavioral Psychiatric/Behavioral & In treatment-resistant schizophrenia use Clozapine. Beware of agranulocytosis so 11743 science Substance Abuse monitor neutrophil count Behavioral Psychiatric/Behavioral & 11746 Cocaine withdrawal can cause psychosis, hyperphagia, hypersomnia science Substance Abuse Behavioral Psychiatric/Behavioral & With adolescence non compliant to insulin, finding a peer that need to take insulin 11785 science Substance Abuse would increase compliance Stages of change (stopping alcohol) Precontemplation (denial) -> Contemplation Behavioral Psychiatric/Behavioral & 11787 (realising the problem but not ready to act) -> Preparation (planning behavior science Substance Abuse modification) -> Action -> Maintenance (maintening new behaviors) Behavioral Psychiatric/Behavioral & Factitious is inducing sickness to assume sick role, while malingering is pretending to 11792 science Substance Abuse be sick or exaggerating symptoms to get drugs or whatever Behavioral Psychiatric/Behavioral & 11807 Bulimia nervosa is treated by Fluoxetine, nutritional changes and psychotherapy science Substance Abuse Behavioral Psychiatric/Behavioral & If someone tells u he wants Tramal and that Drs used to give him, first of all make 11829 science Substance Abuse sure of the old prescriptions and stuff Behavioral Psychiatric/Behavioral & 11846 PTSD: SSRI + CBT science Substance Abuse Behavioral Psychiatric/Behavioral & 11848 OLANZAPINE CLOZAPINE (2nd generation): METABOLIC SYNDROME science Substance Abuse When aspergillus cause fungus ball in a cavity in lung it is colonizing and can be 108 Microbiology Pulmonary & Critical Care asymptomatik 114 Microbiology Pulmonary & Critical Care Cryptococcus most commonly cause meningoencephelitis Cryptococcus capsule is the only fungus capsule made of polysaccharide and stains 117 Microbiology Pulmonary & Critical Care red on Muciramine and show a clear zone on silver stain Usually use india ink for cryptococcus abscess formation is due to lysosomal ensyme release from neutrophils and macrophage IFN gamma secreted by T helper after IL 12 (from neutrophils) is 302 Pathology Pulmonary & Critical Care secreted: make phagolysozome formation, NO release and granuloma and caseous necrosis formation According to Laplace law, small elastic spheres are more likely to collapse than bigger ones with same surface tension. Think of distal small alveoli who receive the least amount of air who are most prone to collapse. But Surfactant are most 477 Physiology Pulmonary & Critical Care concentrated in small alveoli coz of smaller areas and protect them from collapse by increasing surface tension, this will establish equilibrium between alveoli of different radius. Submucosal serous and mucous glands (and Goblet cells) are present where there is cartilage therefore end where at the smallest bronchi are absent in bronchiole and 480 Histology Pulmonary & Critical Care further. And at this level epithelial will be completely changed from pseudostratified columnar to simple cuboidal.on the other hand we can still find cilia until the level of alveoli where they disappear and macrophage usually takes care of foreign bodies Airway Resistance: 50% of resistance is in nares trachea etc. This Resistance Increase in Medium sized Bronchi due to Turbulence of flow, but then decreased significantly (lower than upper tract too) in Small Terminal Bronchiole <2mm due to 481 Physiology Pulmonary & Critical Care massive increase in summated surface area that will slow the flow and permit a more laminar one. (Bronchitis patients seem more in respiratory distress than Pneumonia patients, since there already high resistence in upper bronchi) Upper airways Pseudostratified columnar mucus secreting cells: nose, nasopharynx, sinuses, tracheobronchial tree, Vestibular folds (false vocal cords) and laryngeal 483 Histology Pulmonary & Critical Care vestibule are the lower half of posterior epiglottis and are columnar too Stratified squamous: Mouth, oropharynx, laryngopharyns, anterior epiglottis, upper posterior epiglottis, true vocal cords In lungs Elastases are secreted by neutrophils and alveolar Macrophages. These 484 Histology Pulmonary & Critical Care can cause terminal lung parenchyma (emphysema) if very high or left unchecked by antiproteases activity (in alpha antitripsin deficiency) 486 Pathology Pulmonary & Critical Care PCWP increase reviel Cardio problem and exlude Lungs NICEEE 488 Histology Pulmonary & Critical Care In COPD we have Neutrophils and Alveolar Macrophages, releasing proteinases CO2 level in ABG indicated ventilation status (if have upper obstruction no ventilation 528 Pathophysiology Pulmonary & Critical Care so hypercapnia) Peptistreptococcus, pervotella, bacteroides and fusobacterium are the aneprbes pf 533 Pathology Pulmonary & Critical Care the mouth that cause aspiration pneumonia Lung tranplant: Hyperacute rejection: graft blood vessel spasm, diffuse intravascular coagulation and ischemia Acute:1-2 weeks later, Cell mediated CD8 with macrophage. Vascular damage, perivascular and peribronchial lymphocytic 534 Pathology Pulmonary & Critical Care infiltrates. Dyspnea, cough, fever, Perihilar and lobar opacities (CXR) Chronic: bronchiolitis obliterans (small ones) Inflammation fibrosis of bronchiolar wall (in Chronic renal transplant it is vascular unlike here) Bronchiolitis Obliterans: Chronic lung rejection (obstructive pattern) Lymphocytic 535 Pathology Pulmonary & Critical Care infiltrate, fibrosis and bronchiole destruction Lung Hamartomas: most common benign tumor is 50-60s and are peripheral coin 552 Pathology Pulmonary & Critical Care lesion. Disorganised cartilage, fibrous andd adipose tissue 565 Pathology Pulmonary & Critical Care Mediastinal tumor cause IVC syndrome not superior sulcus (pancoast) NZT blue test in CGD is also called Dihydrodamine and can be positive by inducating 571 Immunology Pulmonary & Critical Care abscence green color in neutrophils 650 Pathology Pulmonary & Critical Care Small cell of lung is thought to have a neuroendocrine origin In Silicosis there is ineffective Macrophage Phagolysosomes, making those patients 670 Pathophysiology Pulmonary & Critical Care more susceptible to TB 746 Immunology Pulmonary & Critical Care MHCI is composed of MHCI and Beta2 microglobulin In order for naive T cells to turn into TH1 cells they need IL12. In turn, TH1 secrete 762 Immunology Pulmonary & Critical Care IgN Gamma to activate macrophage. So if you domt have Il12 you are susceptible to TB so give IFN Gamma 796 Immunology Pulmonary & Critical Care In Sarcoid it is mainly CD4 T cells involvement Sarcoidosis is Th1 response where IL2 and IFN gamma play a role in granuloma 797 Immunology Pulmonary & Critical Care formation while Th2 involve IL4 (Activate B cells and secrete IgE) and IL5 (Eosinophils and IgA formation) Complications of ob stuff: O2 use for ARDS in fetus: can cause upregulation of VEGF and retinal vessel proliferation (neovascularixzation) potentially causing retinal 799 Pathology Pulmonary & Critical Care detachment and blindness Surfactant treatment complications: Hypoxia, HypoTN, blockage of ET tube and pulmonary hemorrhage Terbutaline (tocolisis) to delay labor: IVH, Hypoglycemia, Hypocalcemia and ileus 800 Embryology Pulmonary & Critical Care By week 35 L/S ratio becomes 2:1 (lecithin is also known as phosphatidylcholine) In CF disfunctional protein do not undergo Post translational modification and we get 802 Genetics Pulmonary & Critical Care no CFTR and it is sent to proteasome In CF (CFTR) gene, Lungs GI: (normally) have high content of Cl- and 804 Pathophysiology Pulmonary & Critical Care Na+(decreased absorption) Sweat gland: (normally) low content so if have CF u have high salts in glands bu the contrary in resp and GI (fun haa) Bosentan: Antagonist of endothelial receptors, used for idiopathic pulmonary 903 Pharmacology Pulmonary & Critical Care hypertension Clumping of RBC at low Temperature means there is cold Agglutinins formation 958 Microbiology Pulmonary & Critical Care (Mycoplasma, EBV..) Legionella (pneumonia, diarrhea, high fever) cannot be detected on gram stain (think 960 Microbiology Pulmonary & Critical Care of that syrian guy in Bassile, but need urine IgM) and is common in COPDers Hib vaccine contains PRP and diphteria toxoid to produce AB against RPR, a 962 Microbiology Pulmonary & Critical Care component of its capsule (think that when u say PRP u move ur epiglottis LoLllllll) 964 Microbiology Pulmonary & Critical Care Nontypable H flu dont have capsule MMAKES SENSE 1195 Pharmacology Pulmonary & Critical Care Oropharyngeal candidiasis: Nystatin Rhinovirus is (+) SS RNA so directly produce toxin (even if only RNA is injected) 1373 Microbiology Pulmonary & Critical Care whereas RSV and Influenaza are (-) SS RNA so need a specific Viral RNA Polymerase to produce its (+) counterpart Envolope voruses have bilayer lipid outer membranes and destroyed by ether or 1377 Microbiology Pulmonary & Critical Care organic solvents When CO2 enters RBC it produce HCO3- that is released again in Plasma. In order 1414 Physiology Pulmonary & Critical Care to maintain neutrality of Plasma, Cl- enter RBC, which explains higher Cl- content in Arteries than in Veins. In obstructive sleep apnea (obesity, tonsillar hypertrophy, hypothyroid), ABG during 1460 Pathophysiology Pulmonary & Critical Care the day are normal, can have erythrocytosis, can lead to Pulm HTN and RHF Hyperventilation will cause Hypocapnea, that will constrict Cerebral Blood Vessels, decreasing cerebral blood flow (hence the symptoms of dizziness, blurred vision), 1494 Physiology Pulmonary & Critical Care since the brain is tricked and thinks its having good circulation getting rid of CO2. Cerebral Blood Flow is Dependent on both O2 and CO2 contents. 1514 Physiology Pulmonary & Critical Care CFTFR (chromosome 7) is a transmembrane ATP gated chloride channel Lung physiology. After regular expiration FRV is left in the lungs and the pleural pressure is at its lowest (absolute value) of -5, due to chest wall position creating a negative pressure and alveolar elasticity causing a positive alveoli transmural 1519 Physiology Pulmonary & Critical Care pressures (remember lungs tends to collapse) OUT - IN is pleural pressure, at this instance alveolar pressure is null hence no air movement. Only in case of pneumothorax when pleura is in contact with atmosphere, its pressure i In Obstructive pattern Residual Volume is increased (look at them, they barreled 1521 Physiology Pulmonary & Critical Care chest) In PE (poor alveolar perfusion) the alveolar composition is close to that of the trachea since no exchange is happening. Usually O2 should decrease and CO2 increase when going down the tree due to exchange. Exchange is perfusion limited, 1522 Physiology Pulmonary & Critical Care since exchange is easily established across membrane except in fibrosis and emphysema where wall is damaged and diffusion is difficult. In this case O2 in alveoli is high since it is not going to the blood, but CO2 is not affected (high DC) To induce asthmatic change in PFT's Exercice, histamine, cold air inhalation and Metacholine (metacholine, cholinergic agonist) will cause airway constriction and 1523 Pharmacology Pulmonary & Critical Care increase secretion. A decrease of >20% of FEV1 is diagnostic of asthma after metacholine test. PAO2 is derived from an equation and does not exactly accurately represents O2 1526 Physiology Pulmonary & Critical Care content in all alveoli, therefore we get a normal PAO2 in Obstructive patients, with a high PAO2-PaO2 value. Pain from diaphragmatic and mediastinal pleura are carried out by phrenic nerve; so 1535 Anatomy Pulmonary & Critical Care get neck and choulder referred pain ( think of the map; like an inverted T) the rest is carried out by intercostal nerves Interstitial lung disease (restrictive): both FEV1 and FVC are decreased, but FVC decrease much more which explains the increase in FEV1/FVC ration. FEV1 is not 1543 Physiology Pulmonary & Critical Care decreased that much coz interstitial fibrosis will cause traction of alveolar wall (increased lung elastic recoil) causing supernormal expiratory flow when correcting for lung volume. Respiratory particles in bronchioles are cleared by mucociliary system. Beyond terminal bronchioles, Macrophage do the job. Mucus-Secreting cells (Goblet cells) 1548 Physiology Pulmonary & Critical Care are all along the respiratory trat but not in terminal bronchiole and farther where surfactant line the walls. 1563 Physiology Pulmonary & Critical Care Minute ventilation = TV . RR Alveolar ventilation = (TV - Dead space) . RR In transplant patients, ds DNA CMV (Intracellular and ctyplasmic incusion bodies) 1576 Microbiology Pulmonary & Critical Care pneumonia can happen Hypoxemia: Normally pAO2: 104, paO2: 100 (we have complete diffusion but difference is due to bronchial deoxygenated vein that drain in pulmonary veins) Normal Alveolar-arterial gradient (10-15, since both are low, so alveolar problem): 1582 Physiology Pulmonary & Critical Care hypoventilation, high altitudes (low O2 content) or decrease inspiratory capacity (MGravis, Obesity) High A-a gradient (only arterial O2 is low): limited diffusion, R to L shunt (cyanotic heart), V/Q mismatch (PE, pneumonia, Obstructive diseas In COPD it js O2 that conteols Respiratory Drive and unlike what I Thought it is Peripheral Chemoreceptors that controls that (carotid and aortic arch) Central 1583 Physiology Pulmonary & Critical Care chemoreceptors are regulated by decrease pH not (but still low effect coz brain is barely permeable to H+) In LV heart failure, fluid accumulate in Lungs and decrease their Compliance. 1585 Physiology Pulmonary & Critical Care Nothing to do with Alveolar Surface Tension and Surfactants. Kartagener syndrome (ciliary dyskenesia due to Dynein arms defect) Is triad of 1611 Immunology Pulmonary & Critical Care Chronic Sinusitis, Bronchitis and Situs Inversus Pulmonary vascular resistance is lowest at FRC and it's also at FRC that alveolar pressure is 0. Alveolar - pressure (inspiration) will narrow the vessels and lengthen 1620 Physiology Pulmonary & Critical Care them causing pressure, while expiration will increase intrathoracic pressure also increasing pressure in vessels. 1666 Microbiology Pulmonary & Critical Care In patients > 65, post flu pneumonia is common and cause by Strep, Staph and Hib M. Pneumonia require cholesterol to grow on artificial media coz have no cell wall or 1679 Microbiology Pulmonary & Critical Care capsule so cholesterol to integrate in their cell membrane Hib vaccine is conjugated with diphteria protein to switch immune reaction to T cell 1764 Immunology Pulmonary & Critical Care independant to T cell dependant 1779 Microbiology Pulmonary & Critical Care Spore forming bacteria resist heat IL 1,6 and TNF alpha are the mediator of sytemic inflattion and stimulate liver 1801 Pathology Pulmonary & Critical Care secretion of fibrinogen which increase ESR In pneumonia, green sputum is due to myeloperoxidase, a blue-green heme-based 1910 Pathophysiology Pulmonary & Critical Care enzyme that is released from neutrophil azurophilic granules and forms hypocholorous acid 1925 Pathology Pulmonary & Critical Care Allergens are stronger than cold air to induce an asthma ttack High altitude AB: First low FiO2 will cause hypoxemia, which will result in Hyperventilation subsequently Respiratory Alkalosis. Within 48 hours, kidneys will 1980 Physiology Pulmonary & Critical Care respond causing Compensatory Metabolic Alkalosis. Therefore pH will be high (Hyperventilation Respiratory Acidosis), pO2 low (Hypoxemia), pCo2 high (Hyperventilation) and Bicarb low(metabolic acidosis) 1981 Physiology Pulmonary & Critical Care PE: Hypoxemia + Respiratory Alkalosis (Hyperventilation Reaction) 1985 Pathophysiology Pulmonary & Critical Care OSA can lead to pulmonary hypertension RNA polym I: rRNA II: mRNA, microRNA (silencor, think of it like methylation) 2039 Genetics Pulmonary & Critical Care smallRNA (involve in regulation and splicing) III: tRNA 8257 Microbiology Pulmonary & Critical Care Legionella does not stain well on Gram stain and cause hyponatremia Air flow resistance: COPD, asthma, emphysema, or goiter obstruction: in these patient the frequency of breathing will increase work of breathing, so they breathe 8260 Pathophysiology Pulmonary & Critical Care long and slowly to adjust While alveolar and elastic problems: the work of breathing increase with increase TV so they breathe shallow and fast This is manifested by the trough work of breathing on RR curve that is either lower or higher than 15 8519 Biostatistics Pulmonary & Critical Care Analysis of variance is ANOVA When someone swallows a bone it can get lodged in piriform recess just behind the epiglottis. Behinf the recess there is the Internal Branch of the Superior Laryngeal 8703 Anatomy Pulmonary & Critical Care Nerve and mediates the afferent of The cough Reflex. THINK OF SOMEONE TRYING TO COUGH SO MUCH TO REMOVE THE BONE BUT THEN COULDNT COUGH ANYMORE Nocadia (Lungs, CNS, Cutaneous) occurs also in uper lobes like TB, and are 11638 Microbiology Pulmonary & Critical Care branching Gram (+) confusing with fungi Contracted by spore inhalation or traumatic inoculation on skin Renal, Urinary Systems & In post strep glomerulonephritis we see Granular deposit in mesangium of basement 8 Histology Electrolytes membrane with IgG, IgM and C3 deposition "Starry sky appearance" Renal, Urinary Systems & Goodpasture is part of RPG ( pasteur, with a RPG) so expect Crescent changes and 9 Histology Electrolytes IgG and C3 in basement membrane Renal, Urinary Systems & Post strep Glomerulonephritis: Hugh ASO, anti DNase B titers, Low C3 and total 12 Pathology Electrolytes complement levels (normal C4) and presence of cryoglobulin Renal, Urinary Systems & In nephrotoc u lose a lot of albumin so liver increase albumin production. U retain a 28 Pathology Electrolytes lot of spdium coz of increase aldosterone Renal, Urinary Systems & Partial Vs Complete Nephrogenic DI: In partial Urine osm with ADH urine OSM 211 Pathology Electrolytes recovers till 500, but in complete it does not recover at all Renal, Urinary Systems & 229 Pathology In IE glomerulonephritis can happen and it is an Immune complex mediated injury Electrolytes Amphotericin is nephrotoxic so can cause anemia (low EPO) and will cause increase Renal, Urinary Systems & 275 Pharmacology permeability of distal tubules so will have HYPOKALEMIA AND HYPOMG and Electrolytes possible heart problems Furosemide works on Na-K-2Cl channels in TAL and also work by stimulating Renal Renal, Urinary Systems & Prostaglandin Release (which normally dilate Afferent arteriole--> Increase RBP and 684 Physiology Electrolytes GFR and enhance drug Delivery). If you give NSAID you will constrict Afferents and decrease delivery, resuming ascites or pleural effusion Renal, Urinary Systems & 685 Pharmacology Autotoxic: Furosemide, Aspirin, Aminoglycoside, cisplatin, Vanco Electrolytes Renal, Urinary Systems & In chronic renal graft rejection you see vascular changes, tubular atrophy and 744 Immunology Electrolytes fibrosis, but neutrophils are not involved Renal, Urinary Systems & In parasitic infection IgE will bind to parasite then their Fc portions bind eosinophils 750 Immunology Electrolytes that will in turn degranulate This is called Antibody-dependent- cell mediated toxicity Renal, Urinary Systems & Idiopathic hypercalciuria is the most common cause of calcium kidney stones (NL 813 Pathophysiology Electrolytes serum Ca2+) Renal, Urinary Systems & Vit B6 decrease Oxalate production and decrease chance of CAlcium Oxalate 816 Pathology Electrolytes formation Renal, Urinary Systems & 835 Pathology Beta lactam can cause acute interstitial nephritis Electrolytes Renal, Urinary Systems & In recovery of ATN all electrolytes are low du to slowly recovering despite increase 886 Pathology Electrolytes UO Renal, Urinary Systems & Ethylene glycol: tubular necrosis with balooning and vacuolisation of PCT + Ca 887 Pathology Electrolytes Oxalate stones Renal, Urinary Systems & 1049 Pathology Chronic NSAIDS wil cause CHronic Interstitial Nephrtis Electrolytes Renal, Urinary Systems & 1053 Pathology In recovery of ATN we get reepithelization of tubules Electrolytes Renal, Urinary Systems & Bence jones are large eosinophilic casts While in Hypersensitivity interstitial nephritis 1054 Pathology Electrolytes we see eosinophils in blood ADH works on Cortical and Medullary portions of Collecting ducts but Cortical Renal, Urinary Systems & 1161 Physiology segment is not involve in urea reabsorption but Medullary segment reabsorbs both Electrolytes H2O and Urea Renal, Urinary Systems & 1211 Pharmacology Bethanecol given for post op ileus (cholinergic): BEDNA NEKOL POST OP Electrolytes Renal, Urinary Systems & 1524 Anatomy Regardless of a patient's status, reabsorption occur in proximal tubule. Electrolytes Liver: Angiotensinogen -(Renin produced in Juxtaglomerular cells in Kidneys)-> ATI Renal, Urinary Systems & 1532 Physiology Lungs: ATI -(ACE)-> ATII (cause vasoconstriction in systemic arterioles) Adrenal Electrolytes Glands: ATII Stimulates Aldosterone Production and Secretion Hypokalemia cause K+ reabsorption by a-intercalated discs in cortical portion of collecting tubules, through K+/H+ ATPases (K+ in, H+ out; stimulated by Aldo in Renal, Urinary Systems & HypoK; the reason why HypoK causes Alkalosis)(Apical), while Normal to High K+ 1554 Physiology Electrolytes level will permit K+ excretion through K+ channels (Apical) in Principal cells, with help of Na+/K+ pump basolaterally which is activated with high K+ levels and Aldosterone (also enhance Na+(in) and K+(out) channels permeabilities) Clearance=UrineConcentration.UrineFlowRate/PlasmaConcentration ClearanceCr(or Renal, Urinary Systems & 1555 Physiology Inulin)=GFR ClearancePAH=RPF FF=GFR/RPF UrineFlowRate is the same so it Electrolytes cancels in the Nominator and Denominator Renal, Urinary Systems & RPF (PAH clearance) reprensents plasma flow, but since plasma represents one 1556 Physiology Electrolytes pprtion of blood, to get RBF, we divide RPF/(1-HCT), and here we get the Actual RBF Renal Excreation: Inulin and Mannitol: only Filteres, not secreted or reabsorbed Glucose, Amino Acids, Na+, Urea: Filtered then most of it reabsorbed PAH, Creatine: Renal, Urinary Systems & 1559 Physiology Filtered and Secreted (Cr is not exactly all secreted) FF (20%)= GFR/RPF with GFR: Electrolytes Inulin clearance and RPF: PAH clearance (not very accurate coz Adipose tissues in kidney do not filter or secrete RPH so this will underestimate RPF by 10%) Renal, Urinary Systems & Glomerulus filters a substance into Bowman's capsule which is the start of the 1588 Physiology Electrolytes journey of filtered substance (filtration does not occur there) Proximal tubules substance concentration depends on wether water is reabsorbed faster than them. So we have an increase by growing order of Na, K, Cl, Urea, Inulin, Renal, Urinary Systems & 1617 Physiology Cr and PAH (The last 3 are almost not absorbed) While HCO3 (Actively reabsorbed Electrolytes due to Carbonic Anhydrase), AA and Glucose (These 2 are vividly actively reabsorbed) decrease significantly PAH is freely filtered in the glomerulus but it also secreted from peritubular capillaries (proximal tubule) through a carrier transport (reabsorption is carrier mediated too Renal, Urinary Systems & and can be saturated) and this process can be saturated, but filtration will remain. 1619 Physiology Electrolytes Since PAH is usually fully filtered and secreted its clearance is used to calculate Renal Plasma Flow (RPH: that usually decrease with afferent or efferent constriction; Epi, Norepi, ATII) Foscarnet (pyrrophosphate analogue) chelates calcium and cause magnesium Renal, Urinary Systems & 1643 Pharmacology wasting in kidneys, hence decrease PTH and further decrease in Ca. Low Ca and Electrolytes and Mg can cause seizures Renal, Urinary Systems & 1651 Physiology Filtration Fraction = GFR / Renal Plasma Flow Electrolytes Kidney development: Intermediate mesoderm will form: Pronephros (disappear), Mesonephros (give Wolffian ducts in male and Vestibular Gartner's ducts in females), Metanephros duct (Collecting ducts, Minor and Majors Calyces, Renal Renal, Urinary Systems & 1736 Embryology pelvis, Ureters) arising from caudal Mesonephros. Mentanephros duct (ureteric bud) Electrolytes will induce formation of Metanephros Blastema in sacrum (Metanephros mesoderm: Glomeruli, Bowmans's space, Proximal tubule, Loopf of Henle, Distal collecting tubules) Fabri, deficiency in alpha galactosidase A and globoside ceramde trihexoside will Renal, Urinary Systems & 1989 Biochemistry accumulate in tissues. First get angiokeratomas, hypohidrosis and acroparesthesia. Electrolytes In late phase if enzyme is not replaced GET RENAL FAILURE COZ FABRENAL Urea is reabsorbed in the collecting duct through ADH effect on V2 receptors Renal, Urinary Systems & 2012 Physiology (increase water and urea permeability). Urea will go in the medulla and permit the Electrolytes concentration ability of kidneys. Membranous nephropathy is associated with IgG4 antibodies to phospholipases A2 Renal, Urinary Systems & receptor, which play a role in dvlpmnt of the disease (it the class V lupus nephritis) In 2131 Pathology Electrolytes cryoglobulinemia: there is IgM deposits in glomerulus leading to basement mmbrane thickening and cellular proliferation Renal, Urinary Systems & 8530 Immunology T helper produce IL2 which activates CD4, CD8 T cells, NK cells and monocytes Electrolytes Renal, Urinary Systems & 8541 Microbiology Shistozoma are contracted by Snails (makes sense) Electrolytes Renal, Urinary Systems & 8881 Physiology Serum Cr and GFR have an negative log function. Electrolytes Renal, Urinary Systems & In diabetic urinary incontinence bladder ant sense full bladder and u wont void all 11040 Pathophysiology Electrolytes content, so have a large post void residue Renal, Urinary Systems & Clacineurin inhibitors mediated toxicity: see vacuolization (yea NOT BAD) If Acute 11064 Pathophysiology Electrolytes rejection: See lymphocytic infiltrations Renal, Urinary Systems & Sirolimus bind to FKBP and this complex inhibits mTOR (signaling transduction) 11786 Immunology Electrolytes hence inhibiting IL2 production Rheumatology/Orthopedics 239 Pathology Rheumatic Fever kills by Pancarditis not MS & Sports Rheumatology/Orthopedics 457 Pathology PAN and hep B BIG DEAL & Sports Genetic Factors are the Strongest Prognostic factors for Osteoporosis (Being black is Rheumatology/Orthopedics 627 Physiology the best protective factors, as it will give you better bone density than if you take & Sports extra Ca2+ or Exercice) Black women have higher Bone Density and have lower risks of Fractures (Of Rheumatology/Orthopedics 628 Physiology course). Lower BMI have lower Bone Density and higher risk of fracture (not what I & Sports thought) Rheumatology/Orthopedics 634 Pathology Hemiballism involves extremties & Sports Indicators of: Osteoblastic activity: Bone-specific Alkaline Phosphatase Osteoclastic Rheumatology/Orthopedics 638 Physiology activity: Tartrate-resistant acid phosphatase, Urinary Hydroxyproline and Urinary & Sports Deoxypyridinoline (most accurate one) Paget disease: increased numbers of abnormal osteoclasts, excessive bone turnover and abnormal bone remodeling (osteoblast here plays its role, but the initial problem Rheumatology/Orthopedics is in osteoclast) Osteoclast are multinucleated (2-5 but 100's in Paget) cells arising 639 Physiology & Sports from the fusion of many mononuclear phagocytic cells due to Macrophage colony-stimulating factors (M-CSF) and Receptor for Activated Nuclear Factor kappa-B Ligand (RANK-L) which are produced by Osteoblasts and BM stemal cels Rheumatology/Orthopedics 646 Microbiology Kids get osteomylitis with staph & Sports Rheumatology/Orthopedics Churg Strauss also cause Mononeuritis due to involvement of the epineural vessels 667 Pathology & Sports of peripheral nerves Rheumatology/Orthopedics 699 Pharmacology Bisphosphonate are pyrophosphate analogues and inhibits oscteoclasts & Sports Rheumatology/Orthopedics 719 Pharmacology In RA DMARDs take a lot to work whereas Steroid and NSAIDs are about rapid relief & Sports Rheumatology/Orthopedics 721 Pathology Osteomylitis affect metaphysis of long bones (in children hematogenous osteo) & Sports Serum sickness is a type III hypersensitivity associated with monoclonal antibodies or non-human Immunoglobulin (e.g: antitoxin) and sometimes with non-protein drugs Rheumatology/Orthopedics 741 Immunology (penicillin, cefaclor, TMP-SMX). It is complement induced and get & Sports Hypocomplemtemia, and C5a will induce neutrophil chemotaxis, marginalization, hence neutropenia. Rheumatology/Orthopedics 752 Immunology HLA associated in diseases and stuf autoimmune are of class I. (HLA=MHC) & Sports Rheumatology/Orthopedics Monitor Ankylosing spondilitis by chest wall expansion (that is limited with advanced 753 Pathophysiology & Sports disease leading to hypoventilation) Rheumatology/Orthopedics Rheumatoid factor: Secreted IgM from plasma cells, against Fc receptors of IgG. 754 Immunology & Sports Immune complex will deposit then Rheumatology/Orthopedics 858 Pharmacology Colchicine inhibit tubulin polymerization hence inhibit lymphocyte migration & Sports Rheumatology/Orthopedics 982 Pathophysiology In Osteoporosis: Calcium, PO4 and PTH are Normal & Sports Rheumatology/Orthopedics Paget disease (increase osteoclast activity): bone pain, Increased ALKPhosph with 987 Physiology & Sports mosaic pattern of lamellar bone. Rheumatology/Orthopedics 1159 Histology Osteocyte connect together through Gap Junctions & Sports Rheumatology/Orthopedics 1168 Pharmacology Colchicine will cause GI symptoms (coz like chemo, inhibits microtubules) & Sports Rheumatology/Orthopedics Resting membrane potential is established by the high K+ Efflux and minimal Na+ 1382 Physiology & Sports influx. (Through non-gated channels) Rheumatology/Orthopedics When have gas gangrene, its clostridiu perfringens and also can cause food 1394 Microbiology & Sports poisonong (reheated meat) reheated rice: B. cerus Rheumatology/Orthopedics 1450 Pathophysiology Gout is associated with Myeloproliferative disorders (e.g: polycythemia vera..) & Sports On electron micrograph the Z line appears much darker than the M line. And only the Rheumatology/Orthopedics H band contains purely thich filament. And only the A band (corresponds to the 1664 Physiology & Sports whole length of thick filament) is not variable in size and does not change during muscle contraction Rheumatology/Orthopedics In Oustretched hand fall u can have Scaphoid fracture or Lunate dislocation 1682 Anatomy & Sports compressing Median nerve causing Numbness of hand Rheumatology/Orthopedics Caudal agenesis (sacral agenesis): lower extremety paralysis (are smaller), Urinary 1684 Embryology & Sports incontinence SEEN IN DM MOTHERS Muscle: Type I fibers: Slow twitch, Require low level sustained force, have high Myoglobin and Mitochondria so look red (rely on aerobic respiration); Postural Rheumatology/Orthopedics 1858 Physiology muscles like Soleus, Paraspinal, Type II: Rapid Forceful movements. IIb: Anaerobic & Sports Glycogenolysis then Glycolysis (High Glycogen content). IIa: Fast twitch but with Aerobic Respiration (Intermediate between Type I and Type IIb) Rheumatology/Orthopedics 1874 Pathology Contracture: Fibroblasts with increase metalloproteinase & Sports Rheumatology/Orthopedics 1896 Pathology Parvo can imitate RA but is self limiting & Sports Rheumatology/Orthopedics 1956 Anatomy Femoral head is supplied by Medial Circumflex femoral Artery & Sports Rheumatology/Orthopedics 1969 Anatomy the fibula is lateral, and ACL goes towards inside (out to in) & Sports In Myastemia Gravis, the antibodies (act like Curare) will bind the Acholine receptors and preventing ACh of opening cation channels (Na+, K+; they are within the ACh Rheumatology/Orthopedics receptor), therefore we have a reduced motor-end plate potential. Unlike 2061 Physiology & Sports Eaton-Lambert or Botulism (Block release. Of ACh from presynaptic terminal) the synaptic ACh concentration is normal. Hemicholinium: block reuptake of choline into presynapse depleting ACh stores in presynapse In Mysthemia Gravis, the use of Cholinesterase Inhibitors is non selective therefore increase the activity of ACh in muscarinic receptors too (Unwanted side effect). Rheumatology/Orthopedics 2062 Physiology Therefore Scopalamine (so is Hyosciamine) is given which is a selective Muscarinic & Sports ACh receptor Antagonist (such as the gut, cramp, nausea, diarrhea, sweating). Pilocarpine is a non selective ACh receptor agonist and reduces the side effects. Rheumatology/Orthopedics If someone has increased PRPP production he will have increased purines and then 2090 Biochemistry & Sports uric acid and gout Skeletal muscle contraction: ACh will bind post synaptic receptors, opens post-synaptic ligand-gated ion channels causing depolarization of muscle cells. Then Rheumatology/Orthopedics Ca2+ is released from SR. Ca2+ will bind to Troponin on the C site (Troponin C: 7592 Physiology & Sports Ca2+ binding site, Troponin T: attaches Troponin to Tropomyosin, Troponin I: attaches Troponin-Tropomyosin complex to Actin) When bound to Ca2+, it will rotate tropomyosin exposing Actin's myosin binding site allow Actin-Myosin interaction Golgi tendons system (at muscle-tendon junction) are sensitive for Active stretch in Rheumatology/Orthopedics Muscles , and is a feedback system that monitor and maintains muscle force. (not 8266 Physiology & Sports passive ones).they are responsible for the involuntary release of weights when hitting the gym, to prevent muscular injury. Rheumatology/Orthopedics 8523 Pharmacology mab: Monoclonal AB cept: reCEPTor molecule nih: kinase INHbitor & Sports Annular ligament is fucked up when a childs arm is being stretched in extended Rheumatology/Orthopedics 8579 Anatomy pronated position like i used to do to Karim. Patient will be in extended pronated arm & Sports position, wont be able to move it again. Reduce it by flexing and supinating Rheumatology/Orthopedics Scaphoid fracture in outstrectched hand can lead to avascular necrosis and it is the 8670 Anatomy & Sports most common complication Rheumatology/Orthopedics 10930 Pharmacology Calcium bicarb when given need acidic invironment for Ca to be absorbed & Sports Dronate inhibit osteoclast mediated resorption (similar to pyrrophosphate and bind to Rheumatology/Orthopedics 11564 Pharmacology hydroxyapatite) so osteoclast that is eating bone takes dronates andd dont adhere & Sports on more bone for resorption Rheumatology/Orthopedics in polymyositis: have ANA ANTI JO-1 (aka anti histidyl tRNA synthestase DAA 11646 Pathophysiology & Sports FUCKKKKKKK) Rheumatology/Orthopedics MC cune albright: mutatuin in GNAS gene CAfe au lait, precocious puberty and 11653 Pathology & Sports fibrous dysplasisa Rheumatology/Orthopedics 11684 Anatomy Extensor muscle of the wrist attach on lateral epicondyle it is a bit intuitive & Sports In sciatica there is compression of the sciatic nerve in the Greater sciatic foramen Rheumatology/Orthopedics 11727 Anatomy often due to HYPERTROPHY OF PIRIFORMIS MUSCLE (passes in the canal; & Sports involved in extrnal hip rotation) Rheumatology/Orthopedics 11749 Pharmacology Azathiprine-> 6MP-> purine metabolism so if give ALLopurinolu inhibit this & Sports Rheumatology/Orthopedics 11770 Pathophysiology Temporal arteritis is cell mediated with production of cytokines (IL6..) & Sports Rheumatology/Orthopedics 11799 Anatomy Injury of ankle (inversion) think only of talofibular & Sports Rheumatology/Orthopedics Penis drains in superficial inguinal nodes excpet for gland which drain into deep (coz 11830 Anatomy & Sports very sensitive and goes deeeep) Behavioral Social Sciences 1125 A woman having tubal ligation is not required to have her partner's consent science (Ethics/Legal/Professional) Behavioral Social Sciences PCP should educate about exercice, smoking cessation etc. while the attending at 1235 science (Ethics/Legal/Professional) hospital should DNR DNI objectives to very sick patients Behavioral Social Sciences When a patient refuses to know his diagnosis before directly accepting dig further 1237 science (Ethics/Legal/Professional) and ask why Behavioral Social Sciences Eventhough people have full authorities on themselves you are to report suicidal 1238 science (Ethics/Legal/Professional) plans, or someone with EBV willing to play rugby (risk of splenic rupture) Behavioral Social Sciences Eventhough pregnancy stuff are not be adressed to parents in minor, abortions 2057 science (Ethics/Legal/Professional) should be adressed to parents. Behavioral Social Sciences 2058 Drunk people who want to leave the ER are not allowed to do so until they get sober science (Ethics/Legal/Professional) Behavioral Social Sciences 2059 Patient has the right not to know informations science (Ethics/Legal/Professional) Behavioral Social Sciences If Dr. is not comfortable with patient's decision he has the right to refer to another Dr. 7767 science (Ethics/Legal/Professional) who is comfortable with doing what the patient wants. (like Abortions) Behavioral Social Sciences 10290 Hospice care is for people with life expectancy of less than 6 months from now science (Ethics/Legal/Professional) Behavioral Social Sciences 10463 Drs. should not receive gifts, unless of token values (less than 10$; cookies etc.) science (Ethics/Legal/Professional) Behavioral Social Sciences Romantic relationships with patient is inapropriate and it is even inapropriate to ask 10464 science (Ethics/Legal/Professional) the patient to change Dr. then date her. Behavioral Social Sciences 10488 Dont rely on a translator if hes not professional when it comes to consents and stuff science (Ethics/Legal/Professional) If a colleague asks you about a patient in the elevator, tell him that you'll discuss it Behavioral Social Sciences 10509 later with him, but don't demean him by telling him that you cannot discuss it and that science (Ethics/Legal/Professional) it is against policy Behavioral Social Sciences In minors Call Ethic Commity if it is really not clear what to do, but if it's clear get a 10533 science (Ethics/Legal/Professional) court mandate to go for treatment Behavioral Social Sciences A health care proxy (signed on paper) beats any relative or person when taking 10534 science (Ethics/Legal/Professional) decision to unconscious patient If someone passed out and his friend said that the patient doesn't want resuscitation Behavioral Social Sciences 10542 don't believe him unless he has an official note from him or he is designated the science (Ethics/Legal/Professional) health proxy Unlike real life, consent forms should be obtained by the physician performing the Behavioral Social Sciences 10545 procedure as he is most qualified to describe the procedure, its complications and to science (Ethics/Legal/Professional) answer the patient's questions Behavioral Social Sciences If you can't educate an illeterate (or low education level) patient about his disease 11518 science (Ethics/Legal/Professional) use alternative learning methods like visual recources