Step 1 Uworld

Question Main Division Id

Sub Division

Notes

174

Pharmacology

Allergy & Immunology

Loratidine is 2nd gen antihistamine and safe in elderly coz no fall problems

375

Pathophysiology Allergy & Immunology

Hep B itself is not hepatotoxic but CD8+ repsonse to HBsAg and HBcAg will cause damage

723

Microbiology


Protein M is the main virulence of strep pyogenous as it inactivates phagocytosis, complement activation and permit bacterial adherence. It is also the target of humoral response to the infection Streptolysin O will lyse RBCs amd PMNs

1155

Immunology


Calcineurin activate IL2 which permit T cell proliferation. Hence the use of Calcineurin inhibitors in transplants

1388

Microbiology


If a child has diphteria give antitoxin (passive immunization; most efficient), penicilin or erythromycin and vaccine. Otherwise prevent with vaccine (active immunization)

1389

Microbiology


Not all diphteria will cause pseudomembranous pharyngitis but need Tox gene to produce its exptoxin AB

2068

Immunology


Tryptase is a specific marker for mast cells amd is useful in anaphylaxis

2069

Immunology


After IgE bind to receptors on Basophils and Mast cells these aggregate and cause 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

1189

Biostatistics

When choosing two groups of same age and sex and race you are reducing the Biostatistics & Epidemiology chance of confounding bias. While selection bias occurs when you don't choose a representative sample of the population

1204

Biostatistics

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 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

1278

Biostatistics

Biostatistics & Epidemiology

Validity (accuracy) is when a test gives very similar results than gold standard Reliability refers to reproducibility of test (similar values all the time)

1279

Biostatistics


Effect modification is when smoking increases HRT risks of DVT compared to just smoker, while HRT alone do not increase the risk of DVT

1282

Biostatistics

Biostatistics & Epidemiology In skewed graphs the hill is the Mean, then the Median and uphill is the Mode

1286

Biostatistics

Biostatistics & Epidemiology Lung cancer has been increasing a lot recently in women

1299

Biostatistics


95% CI that value is between X+/- Y Y is 1.96 (SD/rootsquare N) aka (SE) if it is as 99% CI it becomes 2.58 SE

1302

Biostatistics


Berkson's bias: The bias of choosing hospitalized patient in the study Hathorne effect (observer effect): The tendency of subject to change their behavior as a result of awareness that they are being studied Pygmalion effect: the effect of researcher's belief on outcome

10570

Biostatistics

Ecological study are like cross sectional study, but in ecological study you want to Biostatistics & Epidemiology measure a certain geographical population habits or whatever. Used to make hypotheses about populations

35

Embryology

Cardiovascular System

Transposition of Great Arteries is failite of Aorticoopulmonary spiral septum to undergo septation.

40

Pathology


0-4 hr post mi the myocardium is normal on histology. 4-12: coagulation necrosis, 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

43

Pathology


Hibernating myocardium refers to the presence of ledt ventricular systolic dysfunction due to reduced coronary blood flow at rest that is partially or completely reversible by coronary revascularisation

92

Pathology


In dilated Myopathy (also in ischemic myopathy): Contractile function is decrease but normal diastolic funciton (normal compliance) it is the opposite in HTN and hypertrophic cardiomyopathy

96


Constrictive pericarditis is chronic

136

Pharmacology


NO will induce high cGMP which put myosin light chain in their inactive conformation

141

Pharmacology


In HOCM we use bb ccb disopyramide and diuretics or dilators

142

Pharmacology


Patients taking nitrates shld have a nitrate free period daily to avoid tolerance

144

Physiology


Both cardiac and smooth muscles are activated starting with extracellular Ca2+, therefore CCB's work on them, unlike in skeletal muscles

155

Pharmacology


Digoxin: AV block (parasympathetik) so helpful in Afib while in CAD its effect is helful coz of increase co tractolity ( DI goxi. So two functions)

160

Pharmacology


Prevent NIACIN FLushing BY NSAIDS

198


LHF will cause RHF by congestion pulmonary veins leading to vasoconstriction of pulmonary artey and intimal thickening with media hypertrophy

200


S3 is caused by increased preload and it can lead to functional mitral regurg that is eliminted by preload reduction

201


Pulmonary HTN cause irreversible damage to pulmonary arteries while RV hypertrophy can be reversible with correcting the HTN

202

Embryology


PFO (failure of septum primum and secundum to fuse) and ASD (aplasia of either septum secundum most commonly or septum primum) can both cause stroke from venous clot but the difference is that PFO does not cause murmur.

232

Pathology


IE: vegetations on valve cups along with degeneration Rhemuatic fever: fibrous thickening and distortion of mitral valve with commissural fusion at leaflet edges

240

Histology


Aschoff bodies are seen in heart rheumatic fever

245

Physiology


In tubes velocities: V1A1=V2A2=Cte (considering incompressible tubes, assuming vessels are not compressible we can apply this rule)

296


Metastatic calcification occurs in cell necrosis (like in old aortic valve)

446


Atheros plaques involve platelets (PDGF) macrophages that will promote migration of smooth muscels

449

Pathology


In mild HTN u get hyaline arteriosclerosis ( deposition in intima and media of vessels) In severe HTN u get onion like concentric thickening of the wall

474

Pathology


In Varicose vein we morry most about skin ulceratio not DVT and stuff

551

Physiology


Permissive effect of cortisol: (it permits others to work at their best) On its own it doesnt do anything But increase sensitivity of vessels and bronchial tissues to catecholamines and increase glucose response to Glucagon

679

Microbiology


only Aureus is coagulase + among the Staphes

693

Pharmacology


ACE inhibitor can cause hypotension in first doses therefore started gradually (dosage)

778

Pharmacology


Statins and fibrates have fucked up effects on muscles

898

Pharmacology


In PSVT adenosine will cause chest burning and flushing

899

Pharmacology


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 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

900

Pharmacology


Lidocine (IB) bind rapidly depolarizing cells (like cocaine is rapid). Ischemic heart is depolarized, so Lidocaine likes it. SO LIDOCAINE IS GOOD IN MI

944


MR is severed with volume overload so when have S3 u know MR is at its max

951

Physiology


In exercise, tachycardia will reduce Diastolic time, so this is the limiting factor in Heart perfusion

1003

Microbiology


Viridans are acquired after dental procedure if have cardiac structural abdnormaloties, and take glucose from out of cells and transform it into dextran to 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.

1014

Pharmacology


Doxorubicin cause dose related dilated cardiomyopathy by creating free radicals.. Radiation cause myopathies by perocardial fibrosis (viral and surgery.)

1080

Pharmacology


Cilostazol is used in PAD, reduce,atelt activation and cause vasodilation

1094

Microbiology


Diphteria toxin (AB exotoxin) ribosylate and therefore inhibit EF-2, so will inhibit protein synthesis causing cell death

1118

Pharmacology


ANP, BNP, NO --> increase cGMP --> relaxation of smooth muscle

1166

Pharmacology


if have cough with ACE go for ARBs

1174

Biostatistics


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 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))

1252

Pharmacology


Arteriolar vasodilator like hydralazine and minoxidil will cause reflex tachycardia and fluid retention

1344

Pharmacology


Dobutamine affects B1 and lesser B2 and A1. So increase HR and Contractility hence increase Demand of O2

1444

Pharmacology


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 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

1512

Physiology

1513

Physiology


Cardiac electrical transmission speed: PAVA: Fastest --> Slowest: Purkinje fibers --> Atrial muscles --> Ventricular muscles --> AV node

1515

Physiology


PSVT: Do Carotid massage (XI -> X), Valsalva or Adenosine and this will prolong AV node refractory period

1517

Physiology


In mitral valve stenosis we have a snap (indicating that the stenosed valve is trying to open but is finding difficulties) then a dyastolic rumbling murmur because of turbulent flow across this damaged valve.

1528

Physiology


At rest or exercise both systemic and pulmonary circulations have similar blood flows since both systems are continuous and same amount of blood going from the LV is going from the RV ( both systems differ in r and l of the equation but end up equal in Q since they are continuous)

1529

Physiology


CO= O2 consumption/ AV O2 difference

1557

Physiology


S3 sounds in people >40 is abnormal and indicate LV enlargement (MR, AR, Dilated or Ischemic Cardiomyopathy). It is Increased in End of Expiration (LV fills more), Left lateral Decubitus (Higher Flow in LV), and Heard with the Bell of Steth in Cardiac Apex in Early Diastole. Amyl Nitrite (Vasodilation, Decrease Bp, Decrease Venous return), Furosemide (Diuresis, lower LV Volume),Valsalva or Standing (lower V return) all Decrease S3

1589

Physiology


In exercise PaO2 and PaCO2 do not change but CO and HR increase to accomodate for tissue's demand PE --> Hyperventilation = Lower PaCO2

1621

Physiology


Flow (Q)= dP/R Remember U=R.I R= v.L/r4 Q=r4.(dP/v.L) So if flow decrease by X in 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

1624

Physiology


In the Cardiac output, Venous return curve its easy. If an event decreases venous return like anaphylaxis for example lower the venous return curve. MI will lower the Cardiac output curve maximum and slope. Anemia would higher it since we will have tachycardia


In Heart PV curve, the lowest horizontal curve where heart receives blood, the slight increase in P is preload whereas in the upper horizontal line which demonstrates heart emptying, the slight increase in P is Afterload. Nitroprosside will decrease both Preload and Afterload by Vasodilating Both Veins And Arteries.

1652

Physiology

1782

Physiology


Pulsus Paradoxus usually happens in Tamponade but can also happen in Constrictive Pericarditis, Asthma COPD, or Hypovolemic Shock. In Tamponade, 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.

1871

Anatomy


The Inferior wall of left Ventricle lies on the Diaphragm and is supplied by the Posterior descending artery (from RCA)

1931

Physiology


Prior to myochte relaxation Ca2+ leave cells through Ca2+ ATPases and Na+/Ca2+ exchange (3 to 1, and does not require ATP) Besides its action in Smooth Muscle contraction, Calmodulin plays a role in Cardiac Ca2+ efflux, by binding Ca2+ ATPases and activating it.

1947

Pharmacology


Phentolamine is competetive alha blocker wheras phenoxybenzamine is a non competitive irreversible antagonist

1973

Physiology


CCB's slow Diastolic depolarization of Pacemaker cells. (phase 0) they also decrease intracellular Ca2+, affecting excitation-contraction of these cells, therefore decreasing Contractility. But when question is about antiarrythmitic studies choose the Antiarrythmic action of CCB's.

1975

Physiology


ACh and Adenosine reduce phase 4 of spontaneous depolarisation, in cardiac pacemaker cells.


Desynchronization between P and QRS means 3rd degree AV Block. This means Atria contract from SA node but the impulse does not make it to AV node on time 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)

1976

Physiology

1983

Physiology


Holosystolic murmur, that increase during inspiration is only tricuspid regurgitation since the right heart will fill on inspiration. Left sided holosystolic murmurs and VSD are not affected by inspiration since it does not increase left V load. Tricuspid murmur: left sternal border, 3rd and 4th intercostal space Mitral murmur: Apex of heart Aortic stenosis: Diamond shape (since aorta is most important and every old person has diamonds)

2002

Pharmacology


Thiazide increase GLUC Glucose, LDL, Uric Acid, Ca


The heart has the highest oxygen extraction rate. (6075%) During exercise only increasing coronary flow by Vasodilation which is mediated by Adenosine and NO will accommodate for the increase oxygen demand since extraction is already almost maximal. A

2009

Physiology

2055

Physiology


Afib can be induce systemic illness (HTN, Geart failure, Hyperthyroid), Increased Sympathetic tone and Excessive alcohol consumption. Get irregularly irregular fast rythm with absent P waves and often Narrow QRS. on EKG. High QRS amplitude is due to ventricular hypertrophy often due to HTN. Prolonged QT can be congenital and associated with Torsades De Pointes and can also be dure to chronic alcohol use (not one episode of bunge drinking, which can cause Afib)

2130

Anatomy


Most common cause of aortic rupture in MVC is at the Aortic Isthmus; the site of ligamentum arteriosum just dital to right subclavian

7640

Pharmacology


Class III will increase QT, while digoxin will cause AV block

8711

Histology


Thpe I Collagen is the most abundant overall and is the one we find in scars.

11745

Physiology


BNP (natriuretic peptide) is released in response to atrial and ventricular stretching --> Natriuresis, Diuresis, Vasodilatory (antagonize vasoconstriction action of RAAS) effect and protects against heart remodeling. BNP then inhibits RAAS system and renin levels. Neprisylin metalloproteases, degrades BNP, bradykinins, oxytocin and bradykinin. Neprisylin inhibitors are then good in Heart failure --> increase BNP and in turn decrease Renin

11764

Anatomy


In cardiac cath, when trying to reach the femoral artery, if cannulation is done above the inguinal ligament you can induce RETROPERITONEAL HEMORRHAGE (CARDIOLOGIST ARE SCARED OF THIS)

11833


In right MI have stiffness of RV so increase CVP (backup of blood) but low RV output so Low PCWP

11842

Anatomy


In Afib clots form in left atrial appendage its a motionless part of the atria (ma ela 3aze)

876

Pathology

Dermatology

Dermatitis herpetiform usually appear at 40-50 Eczema can occur after some food

1061

Biochemistry

Dermatology

Zinc deficiency causes acrodermatitis enteropathica, infertility and Growth retardation

1106

Anatomy

Dermatology

Apocrine glands secrete by cel lysis and content exretion like pimple glands (sebacious and meibomian) Apocrine secrete membrane bound vesicles (breast) 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

1110

Pathology

Dermatology

Vitiligo: loss of melanocyte (autoimmune pooly understood) in albinism have melanocyte but cannot produce melanin (unlike vitiligo where melanocytes are fucked up)

1314

Pathology

Dermatology

Leprosy is attacked by CD4+ Th1 cell mediated response (like other Mycobacterium) so skin lesions are due to IL2 and IFN Gamma

1334

Biochemistry

Dermatology

In Hartnup disease you have decrease Tryptophan absorption in guts and reabsorption in kidneys. So you will eventually have decreased niacin and pallegra

1613

Immunology

Dermatology

GVHD occur also with liver transplant because it is rich in lymphocytes and occurs a week later (around), Acute and chronic rejection are usually Host vs Graft (also T cell mediated)

1641

Pharmacology

Dermatology

Acyclovir valcyclovir gancyclovir and those are nucleoside analogues that require both cellular and herpes kinases for conversion to their active nucleotide triphosphate form Cidofovir is a nucleoside monophosphate only require host cellular kinase

1669

Microbiology

Dermatology

Post auricular lymphadenopathy makes us more suspicious towards rubella rather 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

8569

Pharmacology

Dermatology

Psoriasis is often treated with with topical vit D analogs; calcipotrieme that bind vitamin D recptor, inhibits keratinocytes proliferation and stimulate their differentiation

8904

Pathophysiology Dermatology

Accessory nipples are the most common congenital anomaly and fluctuate with menstrual cycle, unlike nevi. On the other hand Neurofibroma are composed of 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

Ear, Nose & Throat (ENT)

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 primary palate Occur in 5-6 week of embryo development. Cam occur together or in isolation.

1740

Embryology

11628

Pathophysiology Ear, Nose & Throat (ENT)

Cholesteatoas are collection of squamous cell debris that form behind tempanic membrane, can be congenital or acquired following infection, trauma.. cause hearing loss due to ossicle erosion

11783

Anatomy

Ear, Nose & Throat (ENT)

Psterior bleeding with sphenopalatine bleed is usually uncontrollable with bleed and occur with HTN

163

Pharmacology

Endocrine, Diabetes & Metabolism

Fibric acids (gemfibrozil..) decrease triglyceride production while Cholestyramine (bile acid sequestrant) cause hypertriglyceride and gallstones ( cause decrease bile acid reuptake so new cholesterol is put in bile u know..)

166

Pharmacology


Gemfibrozil are the most efficient for triglyceride so the best in pancreatitis induced by triglycerides

167

Pharmacology


In addition to DERMATITIS of NIACIN Add GOUT (hyperuricemia; part of dermatitis ;) )

209

Pharmacology


GnRH agonist: at first act as GnRH but then in contrary coz not pulsatile

216

Physiology


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 Testosterone and trap it there since it needs it for spermatogenesis. This is different from Sex binding protein which let testosterone circulate in the blood and is produced by liver

225

Pathology


Acute hemorrhage into the pituitary (pituitary apoplexy) is usually aassociated with Pituitary Adenoma Severe Headache, Cranial Nerve Involvement (bitemporal hemianospia, ophtalmoplegia) and meningeal irritation. Cardiac Collapse is due to adrenal insuficiency

342

Embryology


Increase AFP (Dating error most commonly) Patau Gastroschisis, Omphalocele, Neural tube defect, and Multiple gestation. Decreased levels in Trisomy 21, 18.

599

Pharmacology


Pioglitazone and stuff work on PPAR gamma in fat so make u FAT not only by fat but also by increasing Na absorption in Collecting Tubules

602

Biochemistry


Cortisol produced in the cortex will pass through the veins that will go the medulla and enhance the PNMT (phenylethanolamine N methytransferase) enzyme that converts Norepi to Epi (Makes sense right)

603

Pharmacology


Pioglitazone affect transcription factor and gene involvement so takes time

604

Pharmacology


Gliflozin are SGLT2 inhibitors (sodium glucose cotransporter in PCT) cause glucosuria so possible UTI and genital mycotic infection. Also cause osmotic diuresis. In Pple with renal impairement, the meds will not work well and can have increase adverse effects

605

Pharmacology


PPAR gamma is a nuclear receptor affected by Pioglitazone and Rioglitazone ..

631

Pathophysiology


hyperPTH leads to Osteitis Fibrosa Cystica where we have subperiosteal eiosions affecting phallanges of hand, "salt and pepper" skull, and brown tumor bone cysts.

767

Pathophysiology


High dose of Iodine will inhibit iodine uptake by follicular cells (used if have radioactive iodine intoxication, T4 is not efficient coz it takes days to work)

769

Pathology


du quervain: mixed cellular infiltrate with occasional multinuclear giant cells (post URI) Hashimoto: lymphocytic infilitrate with germinal centers and Hurthle cells surrounding residual follicles (large oxyphilic cells filled with granular cytoplasm)

770

Physiology


TSH stimulate I-(Iodide) absorption (Na+I- symporter) in Follicular cells and is competitively inhibited by Perchlorate and Pertechnetate, then goes in the colloid. Iis converted to I2 (Iodine) in the colloid (catalysed by Peroxidase). Thyroglobulin is 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

771

Embryology


Neural crest: PNS, Adrenal Medulla and Parafollicular pf thyroids (both are chromaffin cells)

920

Pharmacology


Glitazones PPAR GAMMA STUFF reduce insulin resistance

980

Biochemistry


Remember Thiazide and HyperGLUC

990

Physiology


7-dehydrocholesterol -(UV)-> CholeCalciferol (D3) (1st step) then 25-OH in Liver then 1-OH in Kidney

992

Physiology


Steroid, Thyroid hormones, VitD: Intrareceptor with DNA domain (to alter DNA expression when go in nucleus) Ligand-gated ion channels (Na+,K+,Ca2+,Cl-) across membrane for membrane potential etc. Intrinsic Phosphorylation: Insulin and 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.

994

Biochemistry


Glucagon, beta adrenergic, PTH and TSH receptors work through Protein Kinase A responsible for the G protein/ Adenylate cyclase secondary messenger system

1009

Physiology


Beta cells: Glucose enters pancreas through GLUT 2 transporter undergoes glycolysis and produces ATP which will bind ATP-sensitive K+ channels (opened at rest and maintains K+ efflux keeping cell hyperpolarized) and close them. This will 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

1010

Biochemistry


Glucokinase will control glucose entry in Glycolysis in pancreas and liver and hence stimulate insulin release. If non functional you can have DM predisposition

1012

Pathology


DM I : Islet leukocytic infiltration DM II: Islet amyloid deposition

1013

Biostatistics


Smoking cessation is by far the most effective preventive intervention to avoid Cardiac events

1022

Biochemistry


gluconeogenesis requiring conversion of oxaloacetate to PEP uses GTP as a source of energy and this GTP comes from the conversion of Succinyl CoA to Succinate in the Krab Cycle. COOL Hein

1031

Biochemistry


Fructose 2,6 biphosphate favors Insulin effect and decreasing conversion of pyruvate to Glucose ( decrease cAMP) in contrary to Glucagon

1034

Biochemistry


High Acetyl CoA level is the main Allosteric Actiator of Gluconeogenesis Increasing the activity of Pyruvate Carboxylase, Converting Pyruvate into Oxaloacetate

1044

Biochemistry


Panthothenic acid is B5 and is used to synthesize CoA used in TCA cycle especialy in first step reaction

1119

Biochemistry


Pentose phosphate reactions are all in Cytoplasm (coz only 5 carbona WTF) First step of Gluconeogenesis consisting of Puruvate to Pxaloacetate requires B1 and is in Mitochondria

1163

Pathophysiology


In Cushing we HyperPlasia of Zona Fasciculata (Not Hypertrophy) ... think that ure producing an adenoma NON SENSE BUT STILL

1324

Pharmacology


Alpha stimulation is dominant over beta thats why epinephrine decrease insulin

1325

Physiology


In DM, Infection, Pain and Sleep Deprivation can cause Hyperglycemia, while Exercise can induce Hypoglycemia.

1326

Pathophysiology


Serine and threonine phosphorylation of insulin receptor lead to insulin resistanec (mediated by TNF alpha, catechols, steroids and glucagon)

1328

Pathophysiology


Elevated free fatty acid levels contribute to insuline resistance (impair insulin dependant glucose uptake and increase hepatic gluconeogenesis and insulin secretion) and DM II

Physiology


Glucose is transported in the D-Glucose form. Glut 4 is insulin mediated and transports it into fat and muscle tissues whereas Glut 2 tranports Glucose from Liver, SI and Kidneys into blood circulation and helps regulates insulin secretion from pancreas. Glut transport Glucose via Carrier-mediated transport (Active transport)

1540

Physiology


Insulin has no effect in Glucose reabsorption in kidneys, but Increase Na+ Renal Absorption increasing blood volume and BP. Insulin also inhibits glucose release from liver, and Inhibits Glucagon secretion by directly acting on Alpha cells. It is Anabolic (Glycogen, Protein Synthesis) and inhibits Glycogenolysis, Lipolysis and other Catabolic reactions.

1615

Physiology


Thyroid produce mainly T4, which is converted to T3 (active hormone) rT3 (inactive)

1660

Pathology


RAT (activating mutation) in Men RAS is follicular thyroid

1355

1768

Physiology


Insulin synthesis: Insulin translation starts in ribosomes to yield PreProInsulin. Then translation continues in RER Ribosomes (the same ribosome translocates). In the RER first the N terminal is cleaved giving Proinsulin then 3 disulfides bonds in the 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

1979

Pathophysiology


In metabolic acidosis (E.g DKA) u hyperventilat but in DKA u have lung edema so u go in respiratory failure not only because of exhaustion

1984

Pharmacology


Severe hypoglycemia (patient not conscious so cannot swallow) so give Glucagon (if outsode hospital) and Sugar per IV (in Hospital)

2066

Biochemistry


Orotic acid converts to UMP, UDP --> TMP, CTP (pyrimidine). If the enzyme Orotate phosphorybosyl transferase is missing, you won't be able to convert orotic acid. But if you supplement patient with Uridine you negatively feedback the reaction

2081

Pathology


In CAH give Steroids to supress ACTH

8531

Pathology


Sulfonylurea can cause Severe Hypoglycemia

11565

Pharmacology


Sulfonylurea can cause Hypoglycemia

11634

Pharmacology


Ezetemibe is like fenofibrate but decrease absorption of cholesterol, not bile acids

207

Physiology

Female Reproductive System & Breast

For ovulation induction you can use Menotropin (mimics FSH) then HCG (mimics LH, same alpha subunit. Similar subunit with FSH too but not that much, and not the point here)

258

Pathology


PCOS have increased risk of endometrial ca and DM II

299

Physiology


Upon withdrawal of Progesterone, Endometrial cells undergo Apoptosis around 5 days later, causing Menses

1015

Histology


Koilocyte seen in HPV are cells with dense nucleus (pyknotic: dense DNA, as part of apoptosis first step) and perinuclear halo clearing

1057

Pathology


Comedocarcinoma (DCIS): solid sheet of pleomorphic, high grade cells with central necrosis

1158

Pathology


Granuloas cell tumor of ovary: Call Exner (cuboidal cells in rosette pattern with bean nuclei) and yellow theca cells with lipids Large unilateral adnexal mass with increase Estrogen and inhibin

1549

Pathophysiology


Herpes facial palsy is HSV 1 (oral not genital) HSV 2 resides in dorsal root ganglia in sacral ganglia and be reactivated and give recurrent genital ulcer VZV also goes in dosal root but in trigerminal ganglia

1560

Physiology


Theca interna: Cholesterol -(LH)-> progesterone + Androgen --> Granulosa (Aromatase): Androgen -(FSH)-> Estrogen. This actually explains why LH and Progesterone are not null during Follicular phase. Theca externa serve as supportive connective structure.

1632

Anatomy


Ovary is innervated by Ovarian artery, vein, lymphatic and nerves which are contained in suspensory ligament as the suspensory ligament hold the ovaries in suspension in the abdomen

1739

Anatomy


Pudendal block is sometimes use if epidural was not used. It is intravaginal medial to ischial spine and will num the perineum the genitals, and motor og urthra sphincter and external anal sphincter (S2-S4)

1809

Embryology


In contrast to Androgen insensitive patient those with Vagina agenesis (upper vagina and sometimes uterus, it's Mullerian defect) ave Pubic hair etc.

1831

Embryology


Bicornuate nucleus: Incomplete lateral fusion of paramesonephroc duct

1899

Physiology


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 menstrual variability, spots Complex atypical endometrial hyperplasia occurs with 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

2056

Pathology


Ovary is cuboidal cells

8556

Genetics


Turner's have abnormal ovary but normal Uterus so can get pregnant with donation etc.

11781

Anatomy


Ureter injury will cause leakage of urine irritating the bowel causing ileus, flank pain and fever but no urinary incontinence

11802

Microbiology


KOH is used to diagnose gardenella While trichonoma protozoa with flagella are seen on wet mount

11820

Anatomy


Internal urinary sphincter are parasympathetic innervation while external one ( distal) is pudendal voluntary Kegel exercice target levator ani ( think of how u contract ur perineum)

47

Microbiology

Gastrointestinal & Nutrition

hep B give hep D a capsule giving it its virulence and ability to invade hepatocyte

57

Pathology


Aflatoxin G->T mutation in p53, increasing risk of HCC. Found in grains corns soybeans peanuts where fungi are grown

62

Microbiology


Liver abscess can be caused by Staph throgh hematogenous route MESH GHALAT

70

Biochemistry


In infections Beta glucoronidase are released by hepatocytes and unconjugate conjugated bilirubin causing it to precipitate and causing brown stones

78

Pathophysiology Gastrointestinal & Nutrition

cholesterol makes bile less soluble while bile salts and phosphatidylcholine makes it more soluble

Physiology

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 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)

126


133


Can diagnose Lactase deficiency by decreased pH of stool

165

Pharmacology


Statins decrese cholesterol formation SURE, BUT BUTTT cholestyramine will bind bile acids and cause increase excretion so liver will produce more cholesterol to throw in bile

280

Pathology


Esophageal spasm is due to imparied neural inhibition within the myenteric plexus

290

Pathology


Erosion does not cross Muscularis Mucosa While Ulcer Do Cross it

306


Mastocytosis will increase Histamine and cause Gastric Hypersecretion (EZ) (Associated with KIT receptor Tyrosine Kinase Mutation)

319

Embryology


Duodenal atresia is due to recanalization failure while Jejunal/Ileal atresia is due to vascular injuries

320

Embryology


Imperforate anus, is most commonly associated with urogenital abnormalities (fistulas and stuff). Then you think of VACTREL Vertebral, Anus, Cardiac, TE, Eosophageal atresia, Renal, Limbs

322

Embryology


Meckels diverticulum is part of vitelline (omphalocele) duct remnant (in embryo connects midgut to yolk sac but obliterated in 7th week) If not obliterate it can cause vitelline diverticulum where meconium passe through it into the umilibcal cord, or we can just have a band or a cyst.

328

Embryology


Meckels diverticulum is a true one and is composed of all layers; mucosa, submucosa and muscular layers

369


Inhaled halothane can cause fulminant hepatitis (looks like viral hep) and will have high ALT AST, and decrease hepatic function so failure so prolonged PT and stuff but no hepatic HTN

370

Pathology


Alcohol inhibits Free FA Oxidation and Gluconeogenesis coz have INCREASED NADH

373

Immunology


Children <6 yrs usually get asymptomatic Hep A. They don't get anti IgM antibody since no disease

374

Microbiology


Hel B is a ds DNA but replicate via reverse transcription (+RNA template)

406

Pathology


Crohn Th1 (terminal ileum) UC Th2

407

Pathology


in UC the rectum is always involved

410

Pathology


Toxic megacolon is UC is diagnosed by Xray

412


Crohn, ileum involvement, bile acid will not be reabsorbed so bile will have less bile acids and will be more cholesterolous hence gallstones

415

Pathology


Traction Diverticula is True Diverticula and due to inflammation and stuff While pulsion Diverticula is False (like sigmoidal Diverticula) Outpouching of the mucosa and submucosa through the muscularis

431

Pathology


Polyp were shown to be involved with COX2, thats why we give aspirin for colon CA

432

Pathology


Tenesmus is seen in rectal adenoCA not colon righ colon: occult bleed iron deficiency Left colon: obstruction and often hematochezia

435

Pathology


Pancreatic pseudocyst wall is not lined by epithelium but by granulation and fibrous tissues Serous cyst have glycogen rich cuboidal cells epithelium Mucinous cysts habe columnar mucinous epithelium Atypical papillary projections are seen in AdenoCa

437

Embryology


Pancreas Embryology: Dorsal bud Tail, Neck most of Body, Accessory Duct Ventral bud: Uncinate, Inferior Posterior Moreover, Inferoposterior aspect of Head and Major Duct In Pancreatic Divisum (5% of population) the two buds fail to fuse fiving two seperate ducts with independant drainage. Ventral duct (will be smaller) drain into major papillae, Dorsal duct (major) drain into smaller papillae. Cery rarely this can cause chronic Pancreatitis

539

Immunology


Ig's attach Phagocytic cells through Fc portions and attach Complements through hinge portion

589

Immunology


Secretory IgA come in a dimer form where both Fc portions are attached by a J chain

745

Immunology


Cells with decreased MHC1 expression like virus infected cells and tumor cells, are targeted by NK cells to kills them

755

Biochemistry


1g of Proteins and Carbs produces 4 Calories while 1 g of Fat produces 9 Calories

790

Biochemistry


The MAP kimase pathway (including Growth hormone) uses Ras protein and GTP (active) and GDP (inactove)

841

Pharmacology


Arsenic is found in insecticides, contaminated water and cause abd pain,vomiting, diarrhea, hypotension and garlic odor breath. Treat with DIMERCARPOL

1018

Physiology


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: 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

1100

Microbiology

1136

Microbiology


Shigella need 10-500 bacteria to infect Very BadAss

1156

Pharmacology


Iron poisoning will cause diarrhea while lead will cause constipation

1169

Biostatistics


NPV and PPV depend on disease prevalence irrespectively of test sensitivity and specifictiy

1251

Biochemistry


Trypsinogen is converted to Trypsin in duodenal of epithelium and in turn activates other digestion proteins

1258

Pharmacology


Morphine cause smooth muscle contraction in sphincter of Oddi

1290

Pharmacology


Diphenoxylate (opioid and act on mu receptors ) given with diarrhea, but is given with atropine to produce bad effects and discourage abuse and tolerance

1396

Pathology


Pseudomembranous colitis (C diff): White/yellow plaques membrane like on colono composed of fibrin and inflamatorry Undercooked meat: cysticercosis : Seizures, SC nodules, IM calcifications

1397

Microbiology


C diff toxins A: intestinal inflamation and fluid secretion B: Cytotoxic (affect actin cytoskeletal structures an intracellular signaling)

1398

Microbiology


Clostridium mostly attack people with disturbed GI microbiome

1467

Immunology


Sabin (oral polio vaccine) has better IgA activity than Salk doing a better job at mucosal entries

1525

Anatomy


Air in Biliary tree means GB, SB fistula for STEP 1

1596

Immunology


Unlike other parasites, Giardia is all about IgA defense and not eosinophils (involved in Helminthic infections)

1807

Biochemistry


Riboflavin B2 is used in TCA cycle by transforming Succinate to ketoglutarate forming FADH2 while the reaction before of Succinyl CoA to Succinate forms 1 GTP used in Gluconeogenesis

1863

Pathology


Viral Hepatitis: hepatocyte necrosis (cellular swelling and cytoplasmic emptying cused by loss of ATP and loss filament in the meshwork) and apoptosis ( in apoptosis there cellular shrinking with nuclear fragmentation and esoniphilia (Councilman body)with moninuclear infiltration

1918

Pathology


Atrophic Gastritis Affect the Body of stomach while H pylori zffects the Antrum first then the Body

1927

Pathology


Viral Hepatitis cause Apoptotic Hepatocytites so get round acidophilic Councilman BODIES (eosinophilic ) also seen in Yellow fever

1938

Physiology


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 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

1971

Physiology


Secretin, secreted by Duodenal S-cells in response to H+ in the duodenum, will stimulate Bicarb secretion from pancreas. On the other ither hand, pancretic enzymes are secreted following Vagal and CCK stimulus (like Gallbladder)

8283

Genetics


Linkage disequilibrium is when the frequency of alleles independently do not match the frequency of having both alleles at the same time

8578

Biochemistry


In hepatic encephalopathy, excess ammonia will deplete alpha ketoglutarate, and glutamate to convnert them into glutamine. Glutamine is bad for the cells and accumulated, glutamate which is excitatory is no longer here, and alpha keto which is needed for respiration is depleted too. Do the math.

10401

Microbiology


Fidaxomicin is used in resistant C diff

10583

Anatomy


The portal triad (Hepatic artery, portal vein and CBD ) run through the hepatoduodenal ligament so if there is bleeding we clamp the ligament to rule in or rule out any other cause of bleed

11591


In gerd Dysphagia is more consistent with ulceration while dysphagia and obsturction goes more with strictures

11629

Behavioral science


As a physician be RADICALLY AGAINST Herbal products especially if you are sure they are bad

11771

Anatomy


Pudendal nerve which (S2-S4) which numbs the perineumand genitals also numbs area when want to do external Hemorrhoids removal (Gives inferior rectal nerve). Internal Hemorrhoids are innervated by Autonomic Inferior Hypogastric Plexus and do not sense pain or temperature.

11782

Anatomy


The appendix is best identified by the converence of the 3 Taeniae Coli of the colon

11795

Anatomy


Chronic pancreatitis can cause splenic vein thrombosis causing short gastric vein varicoses (Dr levi style)

11860


Bacteria in guts produce not only Vit K but also Folate

757

Physiology

General Principles

Free ribosome translation destination: Cytosol, Nucleosol, Mitochondria ( nuclear proteins) and Peroxisome ( involve in anabolism and catabolism of fat (very long chain FA) and also produce bile) RER destination: Membrane (cell membrane, nuclear membrane), ER, Golgi, Lysosome --> Prepare to go out of cells

1028

Biochemistry

General Principles

During exercice the Ca2+ release in muscles will also activate glycogen pathway and glycogenolysis hence the parallel association between muscle contraction and gycogenolysis

1469

Genetics

General Principles

Rota and influenza like genetic shift through reassortment thats why they are 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)

1482

Biochemistry

General Principles

B6 is involved in transamination reaction where an amino group from an amino acid goes to an alpha ketoacid making it an amino acid. B6 is involved in decaboxylation reaction

1616

Physiology

General Principles

Circuit in Parallel: 1/Rt = 1/R1 + 1/R2 + 1/R3 (Think how circulation in the body which 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

1912

Microbiology

General Principles

Thayer and Martin are selective and only ahve sex together but culture neisseria BADDEEE

1970

Genetics

General Principles

Pleiotropy = One mutation and many many consequences

2025

Genetics

General Principles

Enhancers/Repressors can be anywhere in relation to the gene involved, while 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

2030

Genetics

General Principles

TATA box is a promotor (25 bases upstream) that bind to transcription factor and 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

2033

Genetics

General Principles

Postranscriptional modification: (occur in nucleus) 5' capping Poly A tail (3' end): when AAUUAAA (transcribed from DNA) is detected the cap is added (cap is not transcribed from DNA), protects mRNA from degradation in chtoplasm Splicing: Introns removal

7791

Genetics

General Principles

Methylation of Cytosine in DNA is implicated in gene silencing and hence in Imprinting of disease ( why silent in mom not in kids for ex)

11514

Pathology

General Principles

Hand Hygiene is best way to prevent hospital infections

11674

Immunology

General Principles

Ubiquitin proteasome pathway: ubiquitin tag bad particles (like viral particles), proteasomes come degrade them then they a presented on cell surface bound to MHCI for presentation to cytotoxic CD8 cells

11847

Behavioral science

General Principles

Preventable adverse event is defined as injury to a patient due to failure to follow evidence based test practice guidelines

58

Pathology

Hematology & Oncology

Hep C (RNA virus) lacks reverse transcriptase and does not integrate into genome ulnike DNA Hep B that do integrate

346

Biochemistry


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 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


Factor V is when factor V is resistent to protein C deactivation

537

Immunology


Wiskott Aldrich is triad of Eczema, Thrombocytopenia (both appear early) and B, T cells immunodeficiency appearing at 6-12 months.

540

Immunology


C1 binds to IgG and IgM (Pentameric, so binds better) to activate complement system, at the hinge point of the heavy chain

559

Immunology


Immature T lymphocytes in Thymus cortex, express both CD4 and CD8

614

Pathology


Glioblastoma: Necrosis and vascular proliferation

787

Physiology


Hpecidin, secreted by liver will decrease intestinal Iron rate absorption. It is increased in Inflammation, and high iron levels. It is decreased in hypoxia and erythropoeisis. Low Hepcidin, increase intestinal absorption and release from Macrophage.

1029

Biochemistry


RBC dont do oxidative phosphorylation since they dont have ATP, and they dont even produce enough ATP in Glycolysis coz they sacrifice 1,3 BPG (which usually gives ATP by turning into 3-phosphoglycerate), by turning it into 2,3 BPG (LOGICAL YA?)

1035

Biochemistry


NADPH can be synthesised through the oxidative pathway of HMP shunt but can also be formed from the non oxidative pathway through Transketolase and Transaldolase from Fructose6P instead of G6P

1039

Pathology


TNF alpha cause cachexia

1077

Pharmacology


Heparin attaches on AT III and and enhances its activity by inhibiting Xa and thrombin, LMWH IS MORE SPECIFIC FOR Xa

1242

Biochemistry


In HbS valine take the place of glutamate in 6th position of the beta chain causing new hydrophobic interactions hence sickling

1257

Pharmacology


Opioids has many sode effects like constipation nausea vomiting.. But build to,erance to all and dont get side ffects anymore except for CONSTIPATION AND MIOSIS

1338

Biochemistry


In acute porphyria, you can give heme which will inhibit ALAminuvic acid synthetase and decrease accumulation of D ALA and porphorynohenc

1403

Genetics


AML M3 (15:17), and Retinoic acid receptor are malfounctional

1405

Pathology


AML (15-17t): Auer rods

1415

Biochemistry


In CN poisoining: (bind cytochrome a-a3) Nitrites bind Fe2+ --> Fe3+ (higher affinity to CN and prevent its release to mitochondria) Another Antidote is Sodium Thiosulfate which combines with CN forming Thiocyanate which is less toxic and excreted in urine

1455

Biochemistry


In RBC, Heme is produced in Mitochondria firs 3 reactions, then cytosol. So when RBC mature and lose their mitochondria, u cannot synthesize anymore heme

1455

Biochemistry


RBC cannot produce heme coz they dnt have Mitonchondria responsible for first and last step of production

1474

Genetics


Radiation therapy works through breaking Double Strand DNA, and creating free radicals too

1476

Biochemistry


Thymidine dimers are usually corrected by endonucleases

1496

Microbiology


I know its weird but Aplastic Crisis affect only RBC while Aplastic Anemia affects all lines

1545

Physiology


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 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


Isotype sworching occurs in germinal centers of LN

1647

Pharmacology


Ganciclovir can cause NEUTROPENIA. its effect increase with TMP SMX or ZiDoVuDine coz also can cause BM supression

1654

Physiology


Patients who receive more than 5L/24 hrs of PRBC will have high levels of Citrate (used to store blood), which in turn chelates Ca2+ and Mg2+, lowering their blood level, causing parastheisa

1683

Immunology


Rhogam is an IgG antibody

1717

Pathology


Rb is active HypoPhosphorylated (its in kidss so we dont like much phosphorylation,,, )

1753

Pathology


In Dysplasia there is reversible change in epithelial. Once the dysplastic cells have breached the basement membrane it os no longer reversible

1754

Pathology


Lymphocyte bnign vs malignant: Monoclona T cell vs Polyclonal in infection (makes sense)

1758

Pathology


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 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)

1786

Pathology


Pure red Cell aplasia is seen in : Thymoma, Lymphocytic Leukemia, and Parvovirus B19 infection

1788

Genetics


Hemophilia is X-recessive

1796

Pathology


Erythropetein have bluish cytoplasm reticular precipitates of rRNA and is larger (also lacks a nucleus)

1797

Pathology


Mosto Carcinogens enter body as inactive but P450 (monooxygenase) make them so, and it depends on this system to determine succeptibility of individual

1819

Pharmacology


MDD1 code for a P glycoprotein a transmembrane ATP dependant efflux pump that increase efflux of drugs and decrease influx of these chemo agents making the cells resistant to chemo

1847

Biochemistry


Folate i s needed for Thymidine formation

1861

Pathology


Aplastic anemia (Thrombocytopenia, Anemia, and absent hematopoietic cell in marrow) will have BM with fat infiltrate

1872

Pathology


Integrin bind cells to basement membrane by attaching it to FIBRONECTIN, COLLAGEN, And LAMININin Extracelullar matrix

1873

Pathology


VEGF and Fibroblast Growth factor cause angiogenesis while epidermal growth factor affect mitogenesis of hepatocytes and fibroblasts

1877

Pathology


Peau dorange is due to lymphatic obstruction

1890

Pharmacology


6-MP -(HGPRT)-> Active Metabolites 6-MP -(Xanthine Oxidase)-> Inactive Metabolites (that why allopurinol will increase dose of 6-MP)

1911

Genetics


Follicular lymphoma 14:18 translocation causes Bcl2 overexpression

2018

Pharmacology


ETOPOS(second)ide block TOPOisomerase Second (II)

2086

Biochemistry


Thalassemia intermedia is associated with a muation three bases upstream from the start codon (AUG) exchanging a puring with a pyrimidine

2133

Pathophysiology Hematology & Oncology

Thrombin II inhibtors will affect TT (throbin time) also PT PTT Xa inhibitor will affect both in theory (in practice PT is barely affected coz of heparin neutralizer in the PT reagent)

7643

Immunology


In EBV you get atypical CD8 T cells in circulation (large with eccentric nucleus) to attack B cells infected (you also get atypical B cells but in much smaller proportion)

8276

Biochemistry


In Alternative Splicing, same gene will give different mRNA in different tissues

8371

Pharmacology


ralTEGRAvir: Inhibits HIV inTEGRAse, so that its DNA will no be well incorporated

11728

Pharmacology


In chemo induced nausea inhibiting Neurokunin is good too (Tfayli's talk)

11750

Pathology


Hairy cell leukemia will cause marrow fibrosis

11754

Pathology


Sclerotic means osteoblastic

11816

Biochemistry


Lead: ALA D, Ferrochelatase are affected B6: ALA S is affected

44

Microbiology

Infectious Diseases

Hep C envelope changes a lot coz its RNa dependant RNA polymerase has no proofreading 3"-->5" exonuclease activity

46

Microbiology

Infectious Diseases

Hep B acquired by the fetus (transplacentally) or at birth (more commonly) is very common if mom is HbeAg positive. They have very high replication rate and higher rate of progression to chronic disease (the younger the higher the risk). On the other hand they are rarely symptomatik and have mildly elevated LFTs

112

Immunology

Infectious Diseases

Local Candida is controlled by T cell (seen in HIV) wheras disseminated Candida is 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

532

Microbiology

Infectious Diseases

Aspiration pneumonitis is like aspiration pneumonia but resolves on its own and 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

963

Microbiology

Infectious Diseases

H. flu are blood loving, but needs factor X and NAD+ for growth. So wont grow on sheep blood agar unless cultured with Staph that will povide her with NAD+

977

Microbiology

Infectious Diseases

Oxidase + comma shaped bacteria: cholera: grow in alkaline (so PPI or decrease 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)

1103

Microbiology

Infectious Diseases

Hib, in young children cause: MEningitis, pneumonia, bacteremia and epiglotitis (BIG SHIT) While Sinusitis and OM are caused By NON TYPABLE H. flu

1137

Microbiology

Infectious Diseases

Salmonella Vi antigen (its virulence factor) makes it resistant to opsonization and phagocytosis

1309

Microbiology

Infectious Diseases

Mycolic acid in Mycobacterium cell wall, is part of its virulence will make it acid fast as in when then dye is given the bacteria will stain red on carbolfushin and is resistant to decoloration when acid-alcohol decolorizing agent are given because of proper cell wall. When Isoniazid is given it inhibits mycolic acid synthesis, so the bacteria will lose its acid fast property and decolorize KatG (bacterial peroxidase) will tranform INH to its active element.

1392

Microbiology

Infectious Diseases

Listeria (food borne) frows well on cold tpragure and can contaminate refregirated food. It is a gram + with tumbling motility

1393

Pharmacology

Infectious Diseases

Losteria is nod responsive to ceftriaxone so also give ampicillin

1408

Microbiology

Infectious Diseases

the Herepsviruses family get their membrane from nuclear membrane of cells (unlike the rest, get it for cell membrane.. NICE StufF)

1468

Immunology

Infectious Diseases

IFN alpha and beta are secreted in response to viral particles and decrease their protein synthesis capacity and replication, promoting apoptosis

1550

Microbiology

Infectious Diseases

In primary herpes, a week course of acyclovir will reduce the disease but not prevent 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

1649

Immunology

Infectious Diseases

In Influenza it is Antibodies against Hemaglutinin that primary protects against infection

1670

Microbiology

Infectious Diseases

The 3 C's of measle + fever are prodromal to the rash

1965

Pharmacology

Infectious Diseases

Primaquine is given to kill liver stage malaria hypnozoite and thus preventing relapse. 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

2111

Pharmacology

Infectious Diseases

Cephalosporins resitance mechanis, by changing in penicilin binding protein structure ( some of the protein remain normal so still have some binding) whereas in beta lactamase in case of penicillin there is no binding at all coz antibiotics will all be disabeled)

8288

Pharmacology

Infectious Diseases

Daptomycin (cover gram + and MRSA) work by depolarizing bacteria Ceels and 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..

11395

Microbiology

Infectious Diseases

Dengue fever has 4 serotypes. Chill infections vs Bad ones are due to diferrent serotypes

11525

Microbiology

Infectious Diseases

IFN Gamma are produced by NK (T cells, stimulated IL12 from macrophage) and again activate macrophage to kill phagocytosed pathogens

11547

Microbiology

Infectious Diseases

Cat bite: barto, pasteurella Dog: pasteur, strep, staph aureus Human: anaerobes, strep, eikenella

11590

Pharmacology

Infectious Diseases

Abacavir (nrti) is associated with hypersensitivity in 10% of pple with HLA B57

11596

Microbiology

Infectious Diseases

Parotitis can occur in elederly (weird presentation: pre/postauricular swelling that 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

807

Genetics

Male Reproductive System

1449

Embryology

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 --> 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

11762

Anatomy

Deep ring: Internal Spermatic Fascia (coming from transversalis fascia) Superficial ring: External Spermatic Fascia (External Oblique) COZ Deep Internal So in Crypto Male Reproductive System need to bring testicle from superficial ring which its opining is mainly External spermatic fascia (coming from external oblique)

6

Pathology

Miscellaneous (Multisystem)

Bilateral renal angiomyolipoma associated with Tuberous Sclerosi (AD, with Brain Hamartoma and Ash leave spots)

701

Genetics


Achondroplasia is AD

1332

Biochemistry


In Homocyteinuria, homocysteine is not metabolised to cysteine due to cystathione reductase problem

1502

Biochemistry


Alkaptonuria is a problem in converting Tyrosine to Fumarate (its TCA intermediate equivalent) so its like the next step after Phenylketonuria. Homogentisic acid dioxygenase deficiency so homogentisate (next step after tyrosine) accumulate. Get Black urine, pigmentated face and other organs, arthropathy.

1504

Biochemistry


Many patients with Homocytinuria benefit from B6 as it will drive the reaction forward to Cysthathione

11531

Behavioral science


Always get a translator when it is not very clear

11532

Behavioral science


Physician's burnout (emotional stress) while Physician fatigue refers to lack of sleep

11533

Behavioral science


Cane and walker do not decrease the risk of fall according to studies. Just assist

CF patient are Infertile due to absent Vas Deferens bilaterally. In Kartegner sperm are immotile but we have Vas

11549

Behavioral science


For a nurse to show that she has understood the order she should repeat everything and even the route of administration

11550

Behavioral science


An elderly for discharge is best instructed with a checklist discharge list in case he has no family members living with him

11602

Behavioral science


Medicare cover people above 65 or younger with disabilities

11635

Anatomy


Most common site of compartment syndrome is Anterior compartment innervated by Deep peroneal nerve

11678

Pharmacology


[Drug]=mg given/Vd

11757

Behavioral science


Communication problem during patient patient handoff (teslime) is a major cause of stupid errors

18

Pathology

Nervous System

in Hypoxic ischemic encephalopathy (in arrest) hippocampus is first damaged, then neocortex and Purkinje of cerebellum

20

Histology

Nervous System

In brain infarcts, neutrophils come in the first 24-48 hrs, do not phagocytose anything. Microglia (3-5 days later they deposit), then Astrocyte will cause peripheral glial scar and get central cyst instead of necrosis

22

Pathology

Nervous System

if HTN and lacunar stroke and dont appear directly on CT but later it is due to HTN arteriosclerosis and not Charcoud bouchard rupture that wld appear directly on CT

249

Pharmacology

Nervous System

In abscence followed up by generalised tonic clonic ethosuximide wont help. Use Valproic acid

262

Pharmacology

Nervous System

Carbidopa is given with levodopa to inhibits levodopa conversion into dopamine outside CNS (by being itself metabolised) but with carbidopa we will have more dopamin in CNS and more SE like agitation and anxiety..

347

Pathology

Nervous System

subdural hemorrhage in babies is sign of abuse (shaken baby syndrome) and have retinal hemorrhage

348

Pharmacology

Nervous System

Ramelteon, a melatonin agonist is used for insomnia in elderly.

357

Genetics

Nervous System

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 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

499

Pathology

Nervous System

The most common cause of spontaneous lobar hemorrhage in the elderly is Cerebral Amyloid Angiopathy (same amyloid seen in Alzhemer) and most commonly occurs in occipital and parietal lobes

502

Embryology

Nervous System

If acetylcholinesterase is found in amniotic fluid (shld be contained in neural tissues) it means that there is neural tube defect with failure of fusion and hence this enzyme is spilled in sac

509

Pharmacology

Nervous System

ETHosuximide block T type calcium cahnnels in THalamus. Used for Abscence seizure

566

Anatomy

Nervous System

Pancoast cause ipsi Horner and ipsi shoulder and arm weakness and areflexia due to brachial plexus involvement

590

Genetics

Nervous System

Alzheimer: Neurofibrillary tangles and A-Beta amyloid plaques. In Down syndrome there is 3 copies of The Amyloid precursor protein gene.

591

Genetics

Nervous System

Stuff involved in Alzheimer: APP on chr21 Prenisilin 1 on chr14 Prenisllin 2 on chr1 ApopE4 involved in late onset familial Alzheimer

593

Pathology

Nervous System

In alzheimer, decrease acetylcholine in Meynert nucleus in hipoccampus (decreased activity of acetyltransferase)

595

Pathology

Nervous System

Paraneoplastic process is autoimmune

598

Biochemistry

Nervous System

In thiamine deficiency u can get necrosis and hemorrhage of mamillary bodies, B1 will affect the activity of transketolase (main prob) and Pyruvate and Ketoglutarate dehydrogenase

660

Pharmacology

Nervous System

In anesthetic if have high venoarterial difference then drug will directly go to muscle and adipocytes then slower effect on brain Whereas potency is determined by MAC

673

Immunology

Nervous System

Ataxia telengiectasia: (AR), defect in DNA repair genes Cerebellar ataxis, Oculicutaneous telengiectasia, repeated sinopulmonary infection and increased incidemce of malignancy

735

Microbiology

Nervous System

Neisseia: Bean Shaped Gram - cocci in pairs(<60 especially in camps, dorms..) VS. 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.

776

Physiology

Nervous System

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+ 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

851

Pharmacology

Nervous System

Potency of Anasthetic is related to MAC (minimal alveolar concentration) (concentration at which 50% of people pass out) High blood/air partition coefficient 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

856

Pharmacology

Nervous System

IV anesthetic effect wean off after a short time because of redistribution of drug in body

866

Pharmacology

Nervous System

Dantrolene is only used to treat heat stroke and malignant hyperthermia, not high fever

871

Pathology

Nervous System

Liquefactive Necrosis: Lysosmal digestion of the tissue

913

Pathology

Nervous System

PMR: fatigue, fever, wight loss + Proximal muscle stifness

969

Pathology

Nervous System

Tetanus is diagnosed clinically

1006

Microbiology

Nervous System

In Neisseria CApsular Polysaccharide resist phagocytosis and stuff, but Outer 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

1150

Anatomy

Nervous System

Meningioma often occur in dural reflection. In falx cerebri patient can have leg symtoms (beco it is in the medial homunculus)

1152

Pathology

Nervous System

Craniopharyngoma arising from anterior pituitary are calcified cysts containing cholesterols crystals

1259

Pathology

Nervous System

Posterior fossa tumor in kids Medullo: Sheets of primitive cells(basophilic nuclei and scant; small round blue cell, cystoplasm) with many mitotic figures Pilocytic 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

1318

Physiology

Nervous System

Neuronal properties: Time constant: time it takes for membrane to achieve 63% of new membrane potential Length constant: time it takes for impulse to go a certain distance. Demyelination will decrease both, by Increasing axon Conductance and having less Saltatory Conduction

1320

Pharmacology

Nervous System

In mysathemia crisis we shld increase dose of neostigmine

1323

Pharmacology

Nervous System

Organophosphate irreversibly inhibit cholinesterase in musc and nicot synapses so if give atropine (only musc) u wont be helping muscular effects

1335

Biochemistry

Nervous System

In Maple syrup, avoid branched chain amino acid leucine Isolucine and Valine (defect in alpha ketoacid dehydrogenase with deficient conversion of Leucine to 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..

1391

Microbiology

Nervous System

Listeria which is a B hemolytic gram + that moves and reproduce well in low 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

1402

Microbiology

Nervous System

Rabies virus goes in skin, then motor axon (and retrograde to cNS) then salivary gland (thats why transmitted through bites)

1421

Genetics

Nervous System

Fragile X: CGG repeat --> Hypermethylation of Cytosine amd inactivation of subsequent genes

1428

Biochemistry

Nervous System

In tRNA, the 3 ' part is responsible for amino acid attachement site (since t and 3)

1433

Behavioral science

Nervous System

Conversion disorder is experiencing neurological symptoms that are not explained by 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)

1636

Anatomy

Nervous System

Musculucutaneous innervates biceps and suppinator (like when I do Dumbels) and supply sensory lateral Forearm

1743

Anatomy

Nervous System

Ulnar nerve functions: Wrist flexion/adduction, fingers adduction/abduction and sensation in 1.5 last fingers and flexion of 4th/5th digit

1749

Anatomy

Nervous System

Median nerve is sandwiched between Flexor digitorum superficialis and Flexor Digitorum Profundus (easy since Median innervates digits)

1829

Anatomy

Nervous System

Holding a branch like a monkey can cause lower trunk of brachial plexus injury affecting radial and ulnar nerves and muscles of hands

1853

Microbiology

Nervous System

immunity agaisnt neisseria mengitidis is antibodies against their polysaccaride capsule

1966

Microbiology

Nervous System

enterovirus is most common cause of asceptic meningitis

1997

Microbiology

Nervous System

Botulinsm toxin inhibit Ach release wheras rabies bind on the recptors (toxin is killed by heat)

2082

Microbiology

Nervous System

Treat toxo with pyrimethamine and sulfadiazine (clinda if sulfa allergy)

2083

Microbiology

Nervous System

Cns lymphoma are B cells

2089

Pharmacology

Nervous System

CYPROHEPATADINE, is an antihistamine with anti serotonergic, so used in excess serotonin syndrome

2123

Behavioral science

Nervous System

Acute stress disorder happen 3 days to 1 month from a bad event

8324

Microbiology

Nervous System

Rabies G(accumulate in open wound) lycoprotein spikes bind nicotine acetylcholine receptors, activate them. And go to CNS in retrograde

8385

Biochemistry

Nervous System

Impairement of Ubiquitin proteasome system is involved in Parkinson and Alzheimer

8476

Pharmacology

Nervous System

Tryptans are serotonic agonist

8533

Microbiology

Nervous System

Staph epidedermis virulence is synthesis of an extracellular polysaccharide matric, (adherent biofilms) when foreign bodies are inserted through skin (skin flora)

8564

Anatomy

Nervous System

IVH is bleed in germinal matrix

8878

Behavioral science

Nervous System

In Narcolepsy or Cataplexy Hypocretin (1 or 2) which are secreted by the lateeral 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

11462

Pathology

Nervous System

Parkinson pple benefit from deep brain stimulation inhibiting Subthalamus eventually increasing Thalamus inout

11568

Pathology

Nervous System

HIV associated dementia is suspected in AIDS patients with progressive cognitive 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

11632

Pathology

Nervous System

Overshooting is when lateral cerebellar is affected, when vermis (central) is affected u get truncal ataxia

11665

Pharmacology

Nervous System

Treat status (even if febrile seizure) with lorazepam

11742

Anatomy

Nervous System

Infraiebital nerve runs along the orbital floor so in such a fracture causing parasthesia in upper cheek, upper lip and upper gingiva and inferior rectus muscle gets entrapped causing vertical nystagmus

11755

Physiology

Nervous System

GABa activation cause Chloride channel to open and causing a chloride flux inside (passive down normal gradient)the cell hyper-polarizing its resting potential

11772

Anatomy

Nervous System

XI injury: Trapezius injury: Droopin gof shoulder, impaired abduction above horizontal and Winging of Scapula (weird things)

11777

Anatomy

Nervous System

Femoral nerve passes through the Inguinal crease not the Femoral rin and canal which contains lymphatic, vessels and lymph nodes

11793

Anatomy

Nervous System

During intubation, beware of atlantoaxial instability that can cause subluxation of the vertebra and compression of SC and Vertebral arteries--> Paralysis

1646

Pharmacology

Ophthalmology

AIDS CD4<50 CMV Retinitis

11551

Microbiology

Ophthalmology

CMV cause chorioretinitis when in congenital infection

11841

Pharmacology

Ophthalmology

In glaucoma, prostaglandin will increase outflow of humor..

Physiology

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 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.

1544

792

Pathophysiology

Pregnancy, Childbirth & Puerperium

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, associated with preeclampsia, before 20 weeks, Hyperemesis, Hyperthyroid Partial 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

955

Genetics


In Aromatase deficiency female will have ambiguous genitalia and the excess of Androgen that cannot be converted, will go to mom's circulation causing her deepening of voice etc. unlike 21 hydroxylase deficiency that does not affect mommy

1464

Microbiology


Live vaccines: Smallpox, chickenpox, yellow fever, Rota, Intanasal Influenza, Sabin for polio, MMR,

1772

Embryology


In fertilization, BHCG is detectable in serum 8 days later but 14 days later in urine

1822

Genetics


Patau: cleft lip,palate, omphalocele, holoprosencephaly, polydactyly, rocker bottom feet

1823

Genetics


Patau 13: Cleft palate, Poly/Syndactyly, Omphalocele Edwards 18: Small brain (prominent occipit), Small ears, Small mandible, Small sternum, Small clenched hands + Eyes, Cardiac, GI defects (HE is small, so low HCG and Estriol)

1830

Genetics


Complete hydatiform mole is 46 XX or XY only from father while partial is triploidy 2/3 from father

1987

Physiology


During pregnancy, prolactin steadily increase along pregnancy but Progesterone and Estrogen do not permit lactogenesis and promote Breast Growth and Development with minor help of Peolactin

8325

Pathology


Congenital torticolis is 2-4 week after bitch it is due to malposition of head of abby in utero or birth trauma. they resolve with stretching

8330

Physiology


Maternal diabetes is due to HPL which increases proteolysis, lipolysis, insulin resistance and decrease gluconeogenesis. Estrogen, progesterone and cortisone also play a role in maternal diabetes.

8406

Embryology


False twins are always Di Di in indentical twins land,arks are: 0-4: Di C Di A 4-8: Mono C Di A 8-12: Mono Mono >12: Conjoined (4-8-12 landmarks)

247

Behavioral science

Psychiatric/Behavioral & Substance Abuse

Buspirone has a slow onset of action and is not a muscle relaxant, hence not addictive

511

Behavioral science


Tardive dyskinesia occur with lip smacking and many ticks due to antipsychotic medications

519

Pharmacology


Lithium toxicity (ataxia, confusion, neuromuscular exitability) can be precipitated by volume depletion, like with thiazide, ACE and with NSAIDS too

706

Pharmacology


Trazodone is gd in patient with insomnia (think of erection while sleeping)

1046

Behavioral science


Bulimia patients, remain with their normal wights and do not have medical problems.

1165

Behavioral science


PCP abuse will most likely result to trauma (fight etc.) more than seizure or cardiac event

1234

Behavioral science


Displacement: I am getting a divorce and am angry, so I shout at my daughter who fogot to throw the garbage

1350

Behavioral science


Reaction formation is when you act oppositely than what you feel. Splitting is when you perceive people as either good or bad

1351

Behavioral science


Supression is a mature defense mechanism involving a conscious choice not to dwell on a particular thought or feeling. Rationalisation involve making excuses for unacceptable feelings ; like a student explaining that poor performance was due to trickiness of the exam

1352

Behavioral science


Triazolam is a short acting benzo best used for sleep, Lorazepam is intermediate the other DFC are long acting

1429

Behavioral science


A boy whose parents are having a divorce and thinks that his dad is angry at him is experiencing Projection, since he is likely angry at his parents he will think they are angry at him too. This is common in peple who lack insight or their emotions, motivations and feelings

1430

Behavioral science


PPtm blues last maximum 10 days otherwise it is PPtm depression and require treamtent (antidepressant, psychotherapy)

2001

Pharmacology


Cocaine inhibit reuptake of dopamine

2046

Behavioral science


Delusional disorder is one step worse than Paranoid disorder, its like a paranoid man who constantly think people are poisoning him

2053

Behavioral science


Transference is when ur transfer your emotions associated with a significant person to the person in the present

8327

Pharmacology


drugs with Serotonin Syndrome: antidepressant with serotonin stuff, Tramadol Ondansetron Linezolid (DA FUCK) Triptans (SURE)

8954

Behavioral science


Most cases of OD's are due to prescribed Opioids

10458

Behavioral science


A patient requiring antibiotic for viral infection, don't tell them that it will cause resistance, be sensitive and tell about the side effects and that other treatment are better

10465

Behavioral science


Children under the age of 6 do not understand death, so it is normal for them to hae psychotic symptoms like seeing their grandma

11587

Behavioral science


Bipolar I means only one criteria needed which is MANIA

11603

Behavioral science


Phobia is treated with Exposure-based behavioral therapy

11618

Behavioral science


Previous suicide attempt is the worse prognosis for people attempting suicide

11622

Behavioral science


Persistent depressive disorder is when Major depressive disorder and Dysthemia happen for more than 2 years

11737

Behavioral science


Adjustment disorder is applicable for only 3 months following the stressor, beyond that find another explanation

11743

Behavioral science


In treatment-resistant schizophrenia use Clozapine. Beware of agranulocytosis so monitor neutrophil count

11746

Behavioral science


Cocaine withdrawal can cause psychosis, hyperphagia, hypersomnia

11785

Behavioral science


With adolescence non compliant to insulin, finding a peer that need to take insulin would increase compliance

11787

Behavioral science


Stages of change (stopping alcohol) Precontemplation (denial) -> Contemplation (realising the problem but not ready to act) -> Preparation (planning behavior modification) -> Action -> Maintenance (maintening new behaviors)

11792

Behavioral science


Factitious is inducing sickness to assume sick role, while malingering is pretending to be sick or exaggerating symptoms to get drugs or whatever

11807

Behavioral science


Bulimia nervosa is treated by Fluoxetine, nutritional changes and psychotherapy

11829

Behavioral science


If someone tells u he wants Tramal and that Drs used to give him, first of all make sure of the old prescriptions and stuff

11846

Behavioral science


PTSD: SSRI + CBT

11848

Behavioral science


OLANZAPINE CLOZAPINE (2nd generation): METABOLIC SYNDROME

108

Microbiology

Pulmonary & Critical Care

When aspergillus cause fungus ball in a cavity in lung it is colonizing and can be asymptomatik

114

Microbiology


Cryptococcus most commonly cause meningoencephelitis

117

Microbiology


Cryptococcus capsule is the only fungus capsule made of polysaccharide and stains 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 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 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 further. And at this level epithelial will be completely changed from pseudostratified columnar to simple cuboidal.on the other hand we can still find cilia until the level of alveoli where they disappear and macrophage usually takes care of foreign bodies


Airway Resistance: 50% of resistance is in nares trachea etc. This Resistance Increase in Medium sized Bronchi due to Turbulence of flow, but then decreased significantly (lower than upper tract too) in Small Terminal Bronchiole <2mm due to massive increase in summated surface area that will slow the flow and permit a more laminar one. (Bronchitis patients seem more in respiratory distress than Pneumonia patients, since there already high resistence in upper bronchi)

302

477

480

481

Pathology

Physiology

Histology

Physiology

483

Histology


Upper airways Pseudostratified columnar mucus secreting cells: nose, nasopharynx, sinuses, tracheobronchial tree, Vestibular folds (false vocal cords) and laryngeal 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

484

Histology


In lungs Elastases are secreted by neutrophils and alveolar Macrophages. These can cause terminal lung parenchyma (emphysema) if very high or left unchecked by antiproteases activity (in alpha antitripsin deficiency)

486

Pathology


PCWP increase reviel Cardio problem and exlude Lungs NICEEE

488

Histology


In COPD we have Neutrophils and Alveolar Macrophages, releasing proteinases

528

Pathophysiology Pulmonary & Critical Care

CO2 level in ABG indicated ventilation status (if have upper obstruction no ventilation so hypercapnia)

533

Pathology


Peptistreptococcus, pervotella, bacteroides and fusobacterium are the aneprbes pf the mouth that cause aspiration pneumonia

534

Pathology


Lung tranplant: Hyperacute rejection: graft blood vessel spasm, diffuse intravascular coagulation and ischemia Acute:1-2 weeks later, Cell mediated CD8 with macrophage. Vascular damage, perivascular and peribronchial lymphocytic infiltrates. Dyspnea, cough, fever, Perihilar and lobar opacities (CXR) Chronic: bronchiolitis obliterans (small ones) Inflammation fibrosis of bronchiolar wall (in Chronic renal transplant it is vascular unlike here)

535

Pathology


Bronchiolitis Obliterans: Chronic lung rejection (obstructive pattern) Lymphocytic infiltrate, fibrosis and bronchiole destruction

552

Pathology


Lung Hamartomas: most common benign tumor is 50-60s and are peripheral coin lesion. Disorganised cartilage, fibrous andd adipose tissue

565

Pathology


Mediastinal tumor cause IVC syndrome not superior sulcus (pancoast)

571

Immunology


NZT blue test in CGD is also called Dihydrodamine and can be positive by inducating abscence green color in neutrophils

650

Pathology


Small cell of lung is thought to have a neuroendocrine origin

670


In Silicosis there is ineffective Macrophage Phagolysosomes, making those patients more susceptible to TB

746

Immunology


MHCI is composed of MHCI and Beta2 microglobulin

762

Immunology


In order for naive T cells to turn into TH1 cells they need IL12. In turn, TH1 secrete IgN Gamma to activate macrophage. So if you domt have Il12 you are susceptible to TB so give IFN Gamma

796

Immunology


In Sarcoid it is mainly CD4 T cells involvement

797

Immunology


Sarcoidosis is Th1 response where IL2 and IFN gamma play a role in granuloma formation while Th2 involve IL4 (Activate B cells and secrete IgE) and IL5 (Eosinophils and IgA formation)

799

Pathology


Complications of ob stuff: O2 use for ARDS in fetus: can cause upregulation of VEGF and retinal vessel proliferation (neovascularixzation) potentially causing retinal 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


By week 35 L/S ratio becomes 2:1 (lecithin is also known as phosphatidylcholine)

802

Genetics


In CF disfunctional protein do not undergo Post translational modification and we get no CFTR and it is sent to proteasome

804


In CF (CFTR) gene, Lungs GI: (normally) have high content of Cl- and 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)

903

Pharmacology


Bosentan: Antagonist of endothelial receptors, used for idiopathic pulmonary hypertension

958

Microbiology


Clumping of RBC at low Temperature means there is cold Agglutinins formation (Mycoplasma, EBV..)

960

Microbiology


Legionella (pneumonia, diarrhea, high fever) cannot be detected on gram stain (think of that syrian guy in Bassile, but need urine IgM) and is common in COPDers

962

Microbiology


Hib vaccine contains PRP and diphteria toxoid to produce AB against RPR, a component of its capsule (think that when u say PRP u move ur epiglottis LoLllllll)

964

Microbiology


Nontypable H flu dont have capsule MMAKES SENSE

1195

Pharmacology


Oropharyngeal candidiasis: Nystatin

1373

Microbiology


Rhinovirus is (+) SS RNA so directly produce toxin (even if only RNA is injected) whereas RSV and Influenaza are (-) SS RNA so need a specific Viral RNA Polymerase to produce its (+) counterpart

1377

Microbiology


Envolope voruses have bilayer lipid outer membranes and destroyed by ether or organic solvents

1414

Physiology


When CO2 enters RBC it produce HCO3- that is released again in Plasma. In order to maintain neutrality of Plasma, Cl- enter RBC, which explains higher Cl- content in Arteries than in Veins.

1460


In obstructive sleep apnea (obesity, tonsillar hypertrophy, hypothyroid), ABG during the day are normal, can have erythrocytosis, can lead to Pulm HTN and RHF

1494

Physiology


Hyperventilation will cause Hypocapnea, that will constrict Cerebral Blood Vessels, decreasing cerebral blood flow (hence the symptoms of dizziness, blurred vision), since the brain is tricked and thinks its having good circulation getting rid of CO2. Cerebral Blood Flow is Dependent on both O2 and CO2 contents.

1514

Physiology


CFTFR (chromosome 7) is a transmembrane ATP gated chloride channel

1519

Physiology


Lung physiology. After regular expiration FRV is left in the lungs and the pleural pressure is at its lowest (absolute value) of -5, due to chest wall position creating a negative pressure and alveolar elasticity causing a positive alveoli transmural pressures (remember lungs tends to collapse) OUT - IN is pleural pressure, at this instance alveolar pressure is null hence no air movement. Only in case of pneumothorax when pleura is in contact with atmosphere, its pressure i

1521

Physiology


In Obstructive pattern Residual Volume is increased (look at them, they barreled chest)

1522

Physiology


In PE (poor alveolar perfusion) the alveolar composition is close to that of the trachea since no exchange is happening. Usually O2 should decrease and CO2 increase when going down the tree due to exchange. Exchange is perfusion limited, since exchange is easily established across membrane except in fibrosis and emphysema where wall is damaged and diffusion is difficult. In this case O2 in alveoli is high since it is not going to the blood, but CO2 is not affected (high DC)

1523

Pharmacology


To induce asthmatic change in PFT's Exercice, histamine, cold air inhalation and Metacholine (metacholine, cholinergic agonist) will cause airway constriction and increase secretion. A decrease of >20% of FEV1 is diagnostic of asthma after metacholine test.

1526

Physiology


PAO2 is derived from an equation and does not exactly accurately represents O2 content in all alveoli, therefore we get a normal PAO2 in Obstructive patients, with a high PAO2-PaO2 value.

1535

Anatomy


Pain from diaphragmatic and mediastinal pleura are carried out by phrenic nerve; so 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 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.

1543

Physiology

1548

Physiology


Respiratory particles in bronchioles are cleared by mucociliary system. Beyond terminal bronchioles, Macrophage do the job. Mucus-Secreting cells (Goblet cells) are all along the respiratory trat but not in terminal bronchiole and farther where surfactant line the walls.

1563

Physiology


Minute ventilation = TV . RR Alveolar ventilation = (TV - Dead space) . RR

1576

Microbiology


In transplant patients, ds DNA CMV (Intracellular and ctyplasmic incusion bodies) pneumonia can happen

1582

Physiology


Hypoxemia: Normally pAO2: 104, paO2: 100 (we have complete diffusion but difference is due to bronchial deoxygenated vein that drain in pulmonary veins) Normal Alveolar-arterial gradient (10-15, since both are low, so alveolar problem): hypoventilation, high altitudes (low O2 content) or decrease inspiratory capacity (MGravis, Obesity) High A-a gradient (only arterial O2 is low): limited diffusion, R to L shunt (cyanotic heart), V/Q mismatch (PE, pneumonia, Obstructive diseas

1583

Physiology


In COPD it js O2 that conteols Respiratory Drive and unlike what I Thought it is Peripheral Chemoreceptors that controls that (carotid and aortic arch) Central chemoreceptors are regulated by decrease pH not (but still low effect coz brain is barely permeable to H+)

1585

Physiology


In LV heart failure, fluid accumulate in Lungs and decrease their Compliance. Nothing to do with Alveolar Surface Tension and Surfactants.

1611

Immunology


Kartagener syndrome (ciliary dyskenesia due to Dynein arms defect) Is triad of Chronic Sinusitis, Bronchitis and Situs Inversus

1620

Physiology


Pulmonary vascular resistance is lowest at FRC and it's also at FRC that alveolar pressure is 0. Alveolar - pressure (inspiration) will narrow the vessels and lengthen them causing pressure, while expiration will increase intrathoracic pressure also increasing pressure in vessels.

1666

Microbiology


In patients > 65, post flu pneumonia is common and cause by Strep, Staph and Hib

1679

Microbiology


M. Pneumonia require cholesterol to grow on artificial media coz have no cell wall or capsule so cholesterol to integrate in their cell membrane

1764

Immunology


Hib vaccine is conjugated with diphteria protein to switch immune reaction to T cell independant to T cell dependant

1779

Microbiology


Spore forming bacteria resist heat

1801

Pathology


IL 1,6 and TNF alpha are the mediator of sytemic inflattion and stimulate liver secretion of fibrinogen which increase ESR

1910


In pneumonia, green sputum is due to myeloperoxidase, a blue-green heme-based enzyme that is released from neutrophil azurophilic granules and forms hypocholorous acid

1925

Pathology


Allergens are stronger than cold air to induce an asthma ttack

1980

Physiology


High altitude AB: First low FiO2 will cause hypoxemia, which will result in Hyperventilation subsequently Respiratory Alkalosis. Within 48 hours, kidneys will 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


PE: Hypoxemia + Respiratory Alkalosis (Hyperventilation Reaction)

1985


OSA can lead to pulmonary hypertension

2039

Genetics


RNA polym I: rRNA II: mRNA, microRNA (silencor, think of it like methylation) smallRNA (involve in regulation and splicing) III: tRNA

8257

Microbiology


Legionella does not stain well on Gram stain and cause hyponatremia

8260


Air flow resistance: COPD, asthma, emphysema, or goiter obstruction: in these patient the frequency of breathing will increase work of breathing, so they breathe 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


Analysis of variance is ANOVA

8703

Anatomy


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 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

11638

Microbiology


Nocadia (Lungs, CNS, Cutaneous) occurs also in uper lobes like TB, and are branching Gram (+) confusing with fungi Contracted by spore inhalation or traumatic inoculation on skin

8

Histology

Renal, Urinary Systems & Electrolytes

In post strep glomerulonephritis we see Granular deposit in mesangium of basement membrane with IgG, IgM and C3 deposition "Starry sky appearance"

9

Histology


Goodpasture is part of RPG ( pasteur, with a RPG) so expect Crescent changes and IgG and C3 in basement membrane

12

Pathology


Post strep Glomerulonephritis: Hugh ASO, anti DNase B titers, Low C3 and total complement levels (normal C4) and presence of cryoglobulin

28

Pathology


In nephrotoc u lose a lot of albumin so liver increase albumin production. U retain a lot of spdium coz of increase aldosterone

211

Pathology


Partial Vs Complete Nephrogenic DI: In partial Urine osm with ADH urine OSM recovers till 500, but in complete it does not recover at all

229

Pathology


In IE glomerulonephritis can happen and it is an Immune complex mediated injury

275

Pharmacology


Amphotericin is nephrotoxic so can cause anemia (low EPO) and will cause increase permeability of distal tubules so will have HYPOKALEMIA AND HYPOMG and possible heart problems

684

Physiology


Furosemide works on Na-K-2Cl channels in TAL and also work by stimulating Renal Prostaglandin Release (which normally dilate Afferent arteriole--> Increase RBP and GFR and enhance drug Delivery). If you give NSAID you will constrict Afferents and decrease delivery, resuming ascites or pleural effusion

685

Pharmacology


Autotoxic: Furosemide, Aspirin, Aminoglycoside, cisplatin, Vanco

744

Immunology


In chronic renal graft rejection you see vascular changes, tubular atrophy and fibrosis, but neutrophils are not involved

750

Immunology


In parasitic infection IgE will bind to parasite then their Fc portions bind eosinophils that will in turn degranulate This is called Antibody-dependent- cell mediated toxicity

813

Pathophysiology


Idiopathic hypercalciuria is the most common cause of calcium kidney stones (NL serum Ca2+)

816

Pathology


Vit B6 decrease Oxalate production and decrease chance of CAlcium Oxalate formation

835

Pathology


Beta lactam can cause acute interstitial nephritis

886

Pathology


In recovery of ATN all electrolytes are low du to slowly recovering despite increase UO

887

Pathology


Ethylene glycol: tubular necrosis with balooning and vacuolisation of PCT + Ca Oxalate stones

1049

Pathology


Chronic NSAIDS wil cause CHronic Interstitial Nephrtis

1053

Pathology


In recovery of ATN we get reepithelization of tubules

1054

Pathology


Bence jones are large eosinophilic casts While in Hypersensitivity interstitial nephritis we see eosinophils in blood

1161

Physiology


ADH works on Cortical and Medullary portions of Collecting ducts but Cortical segment is not involve in urea reabsorption but Medullary segment reabsorbs both H2O and Urea

1211

Pharmacology


Bethanecol given for post op ileus (cholinergic): BEDNA NEKOL POST OP

1524

Anatomy


Regardless of a patient's status, reabsorption occur in proximal tubule.

1532

Physiology


Liver: Angiotensinogen -(Renin produced in Juxtaglomerular cells in Kidneys)-> ATI Lungs: ATI -(ACE)-> ATII (cause vasoconstriction in systemic arterioles) Adrenal Glands: ATII Stimulates Aldosterone Production and Secretion

1554

Physiology


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 HypoK; the reason why HypoK causes Alkalosis)(Apical), while Normal to High K+ 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)

1555

Physiology


Clearance=UrineConcentration.UrineFlowRate/PlasmaConcentration ClearanceCr(or Inulin)=GFR ClearancePAH=RPF FF=GFR/RPF UrineFlowRate is the same so it cancels in the Nominator and Denominator

1556

Physiology


RPF (PAH clearance) reprensents plasma flow, but since plasma represents one pprtion of blood, to get RBF, we divide RPF/(1-HCT), and here we get the Actual RBF

1559

Physiology


Renal Excreation: Inulin and Mannitol: only Filteres, not secreted or reabsorbed Glucose, Amino Acids, Na+, Urea: Filtered then most of it reabsorbed PAH, Creatine: Filtered and Secreted (Cr is not exactly all secreted) FF (20%)= GFR/RPF with GFR: 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%)

1588

Physiology


Glomerulus filters a substance into Bowman's capsule which is the start of the 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, Cr and PAH (The last 3 are almost not absorbed) While HCO3 (Actively reabsorbed due to Carbonic Anhydrase), AA and Glucose (These 2 are vividly actively reabsorbed) decrease significantly

1617

Physiology

1619

Physiology


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 and can be saturated) and this process can be saturated, but filtration will remain. 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)

1643

Pharmacology


Foscarnet (pyrrophosphate analogue) chelates calcium and cause magnesium wasting in kidneys, hence decrease PTH and further decrease in Ca. Low Ca and and Mg can cause seizures

1651

Physiology


Filtration Fraction = GFR / Renal Plasma Flow

1736

Embryology


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 pelvis, Ureters) arising from caudal Mesonephros. Mentanephros duct (ureteric bud) will induce formation of Metanephros Blastema in sacrum (Metanephros mesoderm: Glomeruli, Bowmans's space, Proximal tubule, Loopf of Henle, Distal collecting tubules)

1989

Biochemistry


Fabri, deficiency in alpha galactosidase A and globoside ceramde trihexoside will accumulate in tissues. First get angiokeratomas, hypohidrosis and acroparesthesia. In late phase if enzyme is not replaced GET RENAL FAILURE COZ FABRENAL

2012

Physiology


Urea is reabsorbed in the collecting duct through ADH effect on V2 receptors (increase water and urea permeability). Urea will go in the medulla and permit the concentration ability of kidneys.

2131

Pathology


Membranous nephropathy is associated with IgG4 antibodies to phospholipases A2 receptor, which play a role in dvlpmnt of the disease (it the class V lupus nephritis) In cryoglobulinemia: there is IgM deposits in glomerulus leading to basement mmbrane thickening and cellular proliferation

8530

Immunology


T helper produce IL2 which activates CD4, CD8 T cells, NK cells and monocytes

8541

Microbiology


Shistozoma are contracted by Snails (makes sense)

8881

Physiology


Serum Cr and GFR have an negative log function.

11040

Pathophysiology


In diabetic urinary incontinence bladder ant sense full bladder and u wont void all content, so have a large post void residue

11064

Pathophysiology


Clacineurin inhibitors mediated toxicity: see vacuolization (yea NOT BAD) If Acute rejection: See lymphocytic infiltrations

11786

Immunology


Sirolimus bind to FKBP and this complex inhibits mTOR (signaling transduction) hence inhibiting IL2 production

239

Pathology

Rheumatology/Orthopedics Rheumatic Fever kills by Pancarditis not MS & Sports

457

Pathology

Rheumatology/Orthopedics PAN and hep B BIG DEAL & Sports

627

Physiology

Genetic Factors are the Strongest Prognostic factors for Osteoporosis (Being black is Rheumatology/Orthopedics the best protective factors, as it will give you better bone density than if you take & Sports extra Ca2+ or Exercice)

628

Physiology

Black women have higher Bone Density and have lower risks of Fractures (Of Rheumatology/Orthopedics course). Lower BMI have lower Bone Density and higher risk of fracture (not what I & Sports thought)

634

Pathology

Rheumatology/Orthopedics Hemiballism involves extremties & Sports

638

Physiology

Indicators of: Osteoblastic activity: Bone-specific Alkaline Phosphatase Osteoclastic Rheumatology/Orthopedics activity: Tartrate-resistant acid phosphatase, Urinary Hydroxyproline and Urinary & Sports Deoxypyridinoline (most accurate one)

639

Physiology

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 & Sports from the fusion of many mononuclear phagocytic cells due to Macrophage colony-stimulating factors (M-CSF) and Receptor for Activated Nuclear Factor kappa-B Ligand (RANK-L) which are produced by Osteoblasts and BM stemal cels

646

Microbiology

Rheumatology/Orthopedics Kids get osteomylitis with staph & Sports

667

Pathology

Rheumatology/Orthopedics Churg Strauss also cause Mononeuritis due to involvement of the epineural vessels & Sports of peripheral nerves

699

Pharmacology

Rheumatology/Orthopedics Bisphosphonate are pyrophosphate analogues and inhibits oscteoclasts & Sports

719

Pharmacology

Rheumatology/Orthopedics In RA DMARDs take a lot to work whereas Steroid and NSAIDs are about rapid relief & Sports

721

Pathology

Rheumatology/Orthopedics Osteomylitis affect metaphysis of long bones (in children hematogenous osteo) & Sports

741

Immunology

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 (penicillin, cefaclor, TMP-SMX). It is complement induced and get & Sports Hypocomplemtemia, and C5a will induce neutrophil chemotaxis, marginalization, hence neutropenia.

752

Immunology

Rheumatology/Orthopedics HLA associated in diseases and stuf autoimmune are of class I. (HLA=MHC) & Sports

753

Pathophysiology

Rheumatology/Orthopedics Monitor Ankylosing spondilitis by chest wall expansion (that is limited with advanced & Sports disease leading to hypoventilation)

754

Immunology

Rheumatology/Orthopedics Rheumatoid factor: Secreted IgM from plasma cells, against Fc receptors of IgG. & Sports Immune complex will deposit then

858

Pharmacology

Rheumatology/Orthopedics Colchicine inhibit tubulin polymerization hence inhibit lymphocyte migration & Sports

982

Pathophysiology

Rheumatology/Orthopedics In Osteoporosis: Calcium, PO4 and PTH are Normal & Sports

987

Physiology

Rheumatology/Orthopedics Paget disease (increase osteoclast activity): bone pain, Increased ALKPhosph with & Sports mosaic pattern of lamellar bone.

1159

Histology

Rheumatology/Orthopedics Osteocyte connect together through Gap Junctions & Sports

1168

Pharmacology

Rheumatology/Orthopedics Colchicine will cause GI symptoms (coz like chemo, inhibits microtubules) & Sports

1382

Physiology

Rheumatology/Orthopedics Resting membrane potential is established by the high K+ Efflux and minimal Na+ & Sports influx. (Through non-gated channels)

1394

Microbiology

Rheumatology/Orthopedics When have gas gangrene, its clostridiu perfringens and also can cause food & Sports poisonong (reheated meat) reheated rice: B. cerus

1450

Pathophysiology

Rheumatology/Orthopedics Gout is associated with Myeloproliferative disorders (e.g: polycythemia vera..) & Sports

1664

Physiology

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 & Sports whole length of thick filament) is not variable in size and does not change during muscle contraction

1682

Anatomy

Rheumatology/Orthopedics In Oustretched hand fall u can have Scaphoid fracture or Lunate dislocation & Sports compressing Median nerve causing Numbness of hand

1684

Embryology

Rheumatology/Orthopedics Caudal agenesis (sacral agenesis): lower extremety paralysis (are smaller), Urinary & Sports incontinence SEEN IN DM MOTHERS

1858

Physiology

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 muscles like Soleus, Paraspinal, Type II: Rapid Forceful movements. IIb: Anaerobic & Sports Glycogenolysis then Glycolysis (High Glycogen content). IIa: Fast twitch but with Aerobic Respiration (Intermediate between Type I and Type IIb)

1874

Pathology

Rheumatology/Orthopedics Contracture: Fibroblasts with increase metalloproteinase & Sports

1896

Pathology

Rheumatology/Orthopedics Parvo can imitate RA but is self limiting & Sports

1956

Anatomy

Rheumatology/Orthopedics Femoral head is supplied by Medial Circumflex femoral Artery & Sports

1969

Anatomy

Rheumatology/Orthopedics the fibula is lateral, and ACL goes towards inside (out to in) & Sports

Physiology

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 & 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

2062

Physiology

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 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.

2090

Biochemistry

Rheumatology/Orthopedics If someone has increased PRPP production he will have increased purines and then & Sports uric acid and gout

Physiology

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: & 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

8266

Physiology

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 & Sports passive ones).they are responsible for the involuntary release of weights when hitting the gym, to prevent muscular injury.

8523

Pharmacology

Rheumatology/Orthopedics mab: Monoclonal AB cept: reCEPTor molecule nih: kinase INHbitor & Sports

8579

Anatomy

Annular ligament is fucked up when a childs arm is being stretched in extended Rheumatology/Orthopedics 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

8670

Anatomy

Rheumatology/Orthopedics Scaphoid fracture in outstrectched hand can lead to avascular necrosis and it is the & Sports most common complication

10930

Pharmacology

Rheumatology/Orthopedics Calcium bicarb when given need acidic invironment for Ca to be absorbed & Sports

11564

Pharmacology

Dronate inhibit osteoclast mediated resorption (similar to pyrrophosphate and bind to Rheumatology/Orthopedics hydroxyapatite) so osteoclast that is eating bone takes dronates andd dont adhere & Sports on more bone for resorption

11646

Pathophysiology

Rheumatology/Orthopedics in polymyositis: have ANA ANTI JO-1 (aka anti histidyl tRNA synthestase DAA & Sports FUCKKKKKKK)

11653

Pathology

Rheumatology/Orthopedics MC cune albright: mutatuin in GNAS gene CAfe au lait, precocious puberty and & Sports fibrous dysplasisa

11684

Anatomy

Rheumatology/Orthopedics Extensor muscle of the wrist attach on lateral epicondyle it is a bit intuitive & Sports

2061

7592

11727

Anatomy

In sciatica there is compression of the sciatic nerve in the Greater sciatic foramen Rheumatology/Orthopedics often due to HYPERTROPHY OF PIRIFORMIS MUSCLE (passes in the canal; & Sports involved in extrnal hip rotation)

11749

Pharmacology

Rheumatology/Orthopedics Azathiprine-> 6MP-> purine metabolism so if give ALLopurinolu inhibit this & Sports

11770

Pathophysiology

Rheumatology/Orthopedics Temporal arteritis is cell mediated with production of cytokines (IL6..) & Sports

11799

Anatomy

Rheumatology/Orthopedics Injury of ankle (inversion) think only of talofibular & Sports

11830

Anatomy

Rheumatology/Orthopedics Penis drains in superficial inguinal nodes excpet for gland which drain into deep (coz & Sports very sensitive and goes deeeep)

1125

Behavioral science

Social Sciences (Ethics/Legal/Professional)

A woman having tubal ligation is not required to have her partner's consent

1235

Behavioral science


PCP should educate about exercice, smoking cessation etc. while the attending at hospital should DNR DNI objectives to very sick patients

1237

Behavioral science


When a patient refuses to know his diagnosis before directly accepting dig further and ask why

1238

Behavioral science


Eventhough people have full authorities on themselves you are to report suicidal plans, or someone with EBV willing to play rugby (risk of splenic rupture)

2057

Behavioral science


Eventhough pregnancy stuff are not be adressed to parents in minor, abortions should be adressed to parents.

2058

Behavioral science


Drunk people who want to leave the ER are not allowed to do so until they get sober

2059

Behavioral science


Patient has the right not to know informations

7767

Behavioral science


If Dr. is not comfortable with patient's decision he has the right to refer to another Dr. who is comfortable with doing what the patient wants. (like Abortions)

10290

Behavioral science


Hospice care is for people with life expectancy of less than 6 months from now

10463

Behavioral science


Drs. should not receive gifts, unless of token values (less than 10$; cookies etc.)

10464

Behavioral science


Romantic relationships with patient is inapropriate and it is even inapropriate to ask the patient to change Dr. then date her.

10488

Behavioral science


Dont rely on a translator if hes not professional when it comes to consents and stuff

10509

Behavioral science


If a colleague asks you about a patient in the elevator, tell him that you'll discuss it later with him, but don't demean him by telling him that you cannot discuss it and that it is against policy

10533

Behavioral science


In minors Call Ethic Commity if it is really not clear what to do, but if it's clear get a court mandate to go for treatment

10534

Behavioral science


A health care proxy (signed on paper) beats any relative or person when taking decision to unconscious patient

10542

Behavioral science


If someone passed out and his friend said that the patient doesn't want resuscitation don't believe him unless he has an official note from him or he is designated the health proxy

10545

Behavioral science


Unlike real life, consent forms should be obtained by the physician performing the procedure as he is most qualified to describe the procedure, its complications and to answer the patient's questions

11518

Behavioral science


If you can't educate an illeterate (or low education level) patient about his disease use alternative learning methods like visual recources

Step 1 Uworld

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