April 21

Test 1 - 78
Aortic regurgitation - best hear when pt is leaning forward and end of expiration
caudal regression syndrome - caused by maternal diabeties
pregnancy or OCP - increase TBH = increase T4 pool
Tuberous sclerosis - Read until memorized
Kussmal sign - seen in pericarditis
Th1 differentiation - INF gamma and IL12
maternal postauricular lymphadenopathy = rubella
BRCA1 and 2 - involved in DNA repair, cellular differentiation, checkpoint control of the
cell cycle and transcription factor regulation
malignant otitis externa - serious ear infection in elderly diabetic pt - cause is pseudomonas
rubella (toga family) - cough, coryzaand conjunctivitis + rash from face moving down
methotrexate SE - mouth ulcers, stomatitis and liver function abnormalities
Test 2 - 67
alturism - avoiding negative feelings by helping others
uniparental disomy - 2 copies of homologous chromosomes from one parent and none from
other
parental disomy in complete hydatidiform mole
rT3 - inactive form, peripherally converted from T4
neurphysins - proteins involved in posttranslational processing of oxytocin and vasopressin;
present in vesicle and secreted with hormone
acyl-CoA dehydrogenase deficiency - inability to form ketones from fatty acids; lethargy
seizure, coma after fasting, tx - avoid fasting
hartnups disease - decrease absorption of neurtal aa (alanine, serine, threonine, valine,
leucine, isoleucine, phenylalanine, tyrosine tryptophan and histidine) - cause niacin def cause
tryptophan needed for niacin synthesis = pelegra like sypmtoms
April 28
MS - myelination increases the length constant and decreases the time constant = axonal
conduction speed
IL5 - secreted by Th2 - recruit and activate eosinophils - asthma
shigella - dont produce H2S
RANK-L and M-CSF play a big role in osteoclast differentiation
ST elevation of leads II, III, aVF = RCA occlusion
HBsAg must coat HDAg before it can infect hepatocytes.
April 29 - FA qbook
class IA antiarrthymics - increase AP and ERP duration
VZV - thymidine kinase activate acyclovir
methotrexats - used for choriocarcinoma and abortion
asprin tox- bicarb alkalanize urine = increased acid excretion
thiazides = metabolic alkalosis

lipid lowering agent that has greatest decrease in triglycerides = fibrates

"monday disease" = reexposure to nitroglycerine, severe se - cardiac arrest
PTU = block periperhal conversion of T4 to T3 and iodide to iodine (ogranification)
esophageal dysmotility = primary treatment is motility agents (metoclopromide)
beta blockers effect on EDV = increase due to increase filling time
ship yard = asbestosis = bronchogenic carcinoma > mesothelioma
CMV = large intranuclear inclusions
struvite stones = staghorn calculi and in pH
ADPKD = mc mutation in ch 16 (type 1) with earlier onset
plasma cells = secrete IgG, main function of IgG is to opsonize bacteria and neutralize toxins
after meningitis hydrocephalus = impaired csf resorption due to arachnoid granulations
becoming scarred
erythroblastosis fetalis = type II hypersensitivity response
SLE = diffuse proliferatice GN - wire loop of capillaries and subendothelial deposits
pt with juvenile rheumatoid arthritis are more likely to have systemic symptoms and large
joint involvement
anti-proteinase 3 antibodies = wegeners
anti-myeloperoxidase antibodies = microscopic polyangitis
anticentromere antibodies = CREST syndrome
acute organ rejection = due to CD8+ cells
GBStrep = mcc for neonatal meningitis, tx is penicillin
staph aureus = mcc of osteomylitis
gullian barre = muscle weakness after self limiting gastroenteritis, c. jejuni (grow at 42 C)
loffler medium = c. diptheriae
h. pylori = urease, catalase and oxidase positive
rubella = congenital PDA (bounding pusles and wide pulse pressure)
koplik spots (blue-white centers) = measles aka rubeola

April 30
EBV - hetrophile antibody positive
pheochromocytoma = alpha block then beta block
thyroglossal duct cyst origin = pharynx
BHP = finesteride
glucagonoma symps = hyperglycemia not cured by oral hypoglycemics, necrolytic migratory
erythema (skin rashe with painful, puritic erythematous papules that blister, erode and crust
over)
hypokalemic periodic paralysis = episodes of paralysis/weakness by hypokalemia
haloperidol = block D2 - galactorhea
SCC ling secrete ADH = hyponatremia - seizures
diabetic mc lose sense of = vibration - pacinian corpuscle
pressure LV same as RV = during isovolumetric contraction
pericarditis etiologies

o viral (coxsackie, echovirus, adenovirus, and HIV)

o bacterial( TB, strep pneumo or aureus with endocarditis, pneumonia and post-cardiac
surgery)
o neoplasia
o autoimmune
o uremic
o cardiovascular
o idiopathic
hypertrophic obstructive cardiomyopathy = mutation in carcomere gene such as myosinbinding protein C
sublingual nifidepine = dangerous fluctuations in blood pressure that are difficult to control
wolf-parkinson white syndrome tx = amioderone or procanamide

May 1
pergylated interferon = cytokine derivative to improve body's antiviral respinse, used for
HBV and HCV
shiga toxin = HUS (cleave host RNS and enhanse cytokine release) - renail fail,
thrombocytopenia, microangiopathic hemolytic anemia
Acute pancreatitis = pancreatic pseudocysts (MC complication)
genfibrozil can cause = gallstones
wilsons = can present with parkinsonion symptoms
H2 blockes vs. ppi = ppi in severe cases, H2 in mild cases
alinine dyes = transitional bladder cancer
revrese thrombolytics with = aminocaproic acid
waldenstrom mactoglobulinemia vs. MGUS = walden has increase plasma cells more then
10%; both have M spike
molluscum contaginosum = localized infection of non-erythematous, pearly, dome-shaped
papules; mc in children or immunosuppressed; self limiting
anti-jo-1 = for polymyositis and dermatomyositis
most common lateral foot ligament = anterior talofibular lig
erythema nodosum = 436
acondroplasia = defect in endocondrial ossification
unhappy triad = ACL, MCL and lateral meniscus
ewring sacroma = made up of anaplastic blue cells
polio = can be fecal-oral transmited; in small children will present as nonclinical diarrhea and
fever, infect peyers patches; in older childern will present as meningitis
tennis elbow = over use of superficial extensor muscles (including extensor carpi radilalis
which inserts into lat epicondyle)

Actinomycin D: inhibits RNA polymerase in both prokaryotes and eukaryotes.

Acyclovir, Gancyclovir (viral) Rifampin (antibacterial) and Cytarabine (Neoplastic) are all drugs
that effect DNA polymerase
Recombinant cytokine: Romiplostim, eltrombopag ---> Thrombocytopenia
Therapeutic Antibodies: Ranibizumab, bevacizumab:
Target -->VEGF
Uses: Neovascular age-related macular degeneration
Edrophonium: Historically, diagnosis of myasthenia gravis (extremely short acting).
Myasthenia now diagnosed by anti-AChR Ab (antiacetylcholine receptor antibody) test.
Hyoscyamine, dicyclomine: GI --> Antispasmodics for irritable bowel syndrome.
Nephrotoxicity/ ototoxicity:
Aminoglycosides, vancomycin, loop diuretics, cisplatin. Cisplatin toxicity may respond to
amifostine
Macrolides (except azithromycin) ...for P-450 Inhibitors
AV nodelocated in posteroinferior part of interatrial septum. Blood supply usually
from RCA. 100-msec delay allows time for ventricular filling.
MI Complications:
Ventricular pseudoaneurysm formation (contained free wall rupture) CO, risk of
arrhythmia, embolus from mural thrombus; greatest risk approximately 314 days post-MI (as
with rupture).
True ventricular aneurysm outward bulge during contraction (dyskinesia), associated
with fibrosis; arises 2 weeks to several months after MI.
CCB: - Clevidipine : hypertensive urgency or emergency.
GHRH: Increases GH --> Analog (tesamorelin) used to treat HIV-associated lipodystrophy
Growth Hormone: Released in pulses in response to growth hormonereleasing hormone
(GHRH). Secretion during exercise and sleep. Secretion inhibited by glucose and somatostatin
release via negative feedback by somatomedin.
PTH:
Increased production of macrophage colony-stimulating factor and RANK-L (receptor activator
of NF-B ligand). RANK-L (ligand) secreted by osteoblasts and osteocytes binds RANK
(receptor) on osteoclasts and their precursors to stimulate osteoclasts and increase Ca2+.
Intermittent PTH release can stimulate bone formation.
Receptor-associated tyrosine kinase:
Prolactin, Immunomodulators (e.g., cytokines IL-2, IL-6, IFN), GH, G-CSF, Erythropoietin,
Thrombopoietin
JAK/STAT pathway
Think acidophils and cytokines
PIGG L ET
Congenital hypothyroidism (cretinism):
Severe fetal hypothyroidism due to maternal hypothyroidism, thyroid agenesis, thyroid
dysgenesis (most common cause in U.S.), iodine deficiency, dyshormonogenetic goiter.
Riedel's Thyroiditis:
Considered a manifestation of IgG4-related systemic disease (e.g., autoimmune pancreatitis,
retroperitoneal fibrosis, noninfectious aortitis).
Graves: retro-orbital fibroblasts (exophthalmos: proptosis, extraocular muscle swelling), and
dermal fibroblasts (pretibial myxedema).

Familial hypocalciuric hypercalcemia:

Defective Ca2+-sensing receptor on parathyroid cells.
PTH cannot be suppressed by an increase in Ca2+ level --> mild hypercalcemia with normal to
increased PTH levels.
Osteitis fibrosa cystica: cystic bone spaces filled with brown fibrous tissue (brown tumor
consisting of deposited hemosiderin from hemorrhages; causes bone pain).
Treatment for prolactinoma: dopamine agonists (bromocriptine or cabergoline), transsphenoidal
resection.
Acromegaly: Increased risk of colorectal polyps and cancer.
SIADH: Correct slowly to prevent osmotic demyelination syndrome (formerly known as central
pontine myelinolysis).
Hypopituitarism: Pituitary apoplexysudden hemorrhage of pituitary gland, often in the
presence of an existing pituitary adenoma
Diabetes Mellitus: Rarely, can be caused by unopposed secretion of GH and epinephrine. Also
seen in patients on glucocorticoid therapy (steroid diabetes).
DKA: Usually occurs in type 1 diabetes, as endogenous insulin in type 2 diabetes usually
prevents lipolysis.
Glucagonoma: Tumor of pancreatic cells --> overproduction of glucagon. Presents with
dermatitis (necrolytic migratory erythema), diabetes (hyperglycemia), DVT, and depression.
Insulinoma: May see Whipple triad: low blood glucose, symptoms of hypoglycemia (e.g.,
lethargy, syncope, diplopia), and resolution of symptoms after normalization of glucose levels.
ZES: Positive secretin stimulation test: gastrin levels remain elevated after administration of
secretin, which normally inhibits gastrin release
MEN 1: Associated with mutation of MEN1 gene (menin, a tumor suppressor)
MEN 2A & 2B: Associated with marfanoid habitus; mutation in RET gene (codes for receptor
tyrosine kinase)
Glitazones: Weight gain, edema. Hepatotoxicity, HF, Increased risk of fractures
SGLT-2 inhibitors (Canagliflozin):
Action - Block reabsorption of glucose in PCT. Uses - Type 2 DM.
Toxicity - Glucosuria, UTIs, vaginal yeast infections.
Levothyroxine (T4), triiodothyronine (T3): Uses - Hypothyroidism, myxedema. Used off-label
as weight loss supplements.
Cinacalcet:
Mechanism: Sensitizes Ca2+-sensing receptor (CaSR) in parathyroid gland to circulating Ca2+
--> decrease PTH.
Use: Hypercalcemia due to 1 or 2 hyperparathyroidism.
Toxicity: Hypocalcemia.
Pancreas divisumventral and dorsal parts fail to fuse at 8 weeks. Common anomaly; mostly
asymptomatic, but may cause chronic abdominal pain and/or pancreatitis
Above pectinate line: Lymphatic drainage to internal iliac lymph nodes
Gastrin:
Source: G cells (antrum of stomach, duodenum )
Notes: Increase in chronic atrophic gastritis (e.g. H. Pylori)
Somatostatin:
Notes: Inhibits secretion of GH, insulin, and other hormones (encourages somato-stasis).

Octreotide is an analog used to treat acromegaly, insulinoma, carcinoid syndrome, and variceal
bleeding.
Gastric Acid:
Notes: Gastrinoma: gastrin-secreting tumor that causes high levels of acid and ulcers refractory
to medical therapy (i.e., PPI).
Trypsinogen:
Notes: Converted to trypsin by enterokinase/ enteropeptidase, a brush-border enzyme on
duodenal and jejunal mucosa
Bilirubin: Heme is metabolized by heme oxygenase to biliverdin, which is subsequently reduced
to bilirubin. Unconjugated bilirubin is removed from blood by liver , conjugated with
glucuronate, and excreted in bile.
Achalasia: 2 achalasia may arise from Chagas disease (T. cruzi infection) or malignancies
(mass effect or paraneoplastic).
Plummer-Vinson syndrome:
Triad of Dysphagia, Iron deficiency anemia, and Esophageal webs. May be associated with
glossitis. Increased risk of esophageal squamous cell carcinoma (Plumbers DIE).
Stomach Cancer: Diffusenot associated with H. pylori; signet ring cells (mucin-filled cells
with peripheral nuclei)
Celiac Disease: decreased mucosal absorption primarily affects distal duodenum and/or
proximal jejunum.
Crohns:
Complications: Strictures (leading to obstruction), fistulas (including enterovesical fistulae,
which can cause recurrent polymicrobial UTIs), perianal disease, malabsorption, nutritional
depletion, colorectal cancer, gallstones.
U.Colitis:
Treatment: 5-aminosalicylic preparations (e.g., mesalamine), 6-mercaptopurine, infliximab,
colectomy.
Malrotation:
Anomaly of midgut rotation during fetal development --> improper positioning of bowel,
formation of fibrous bands (Ladd bands). Can lead to volvulus, duodenal obstruction.
Colorectal Cancer: Presentation: Right side bleeds; left side obstructs.
Cirrhosis:
Portosystemic shunts partially alleviate portal hypertension:
- Esophageal varices
- Caput medusae
- Anorectal varices
Other Live Tumors:
Metastases - GI malignancies, breast and lung cancer. Most common overall.
Alpha 1 Antitrypsin Deficiency:
In lungs, decreased 1-antitrypsin --> uninhibited elastase in alveoli --> decreased elastic tissue
--> panacinar emphysema.
Wilson Disease: Treatment includes chelation with penicillamine or trientine, oral zinc
Treatment of hereditary hemochromatosis: repeated phlebotomy, chelation with deferasirox,
deferoxamine, deferiprone (oral)
Biliary tract disease:
May present with pruritus, jaundice, dark urine, light-colored stool, hepatosplenomegaly.

Typically with cholestatic pattern of LFTs ( Increased conjugated bilirubin, Increased cholesterol,
Increased ALP).
Gallstones:
Pigment stones (black = radiopaque, Ca2+ bilirubinate, hemolysis; brown = radiolucent,
infection) seen in patients with chronic hemolysis, alcoholic cirrhosis, advanced age, biliary
infections, total parenteral nutrition (TPN).
Chronic pancreatitis:
Chronic inflammation, atrophy, calcification of the pancreas A . Major causes are alcohol abuse
and idiopathic. Mutations in CFTR (cystic fibrosis) can cause chronic pancreatic insufficiency.
Pancreatic Adenocarcinoma: Average survival 1 year after diagnosis. Very aggressive tumor
arising from pancreatic ducts (disorganized glandular structure with cellular infiltration)
Ondansetron:
Mechanism: 5-HT3 antagonist; decreases vagal stimulation. Powerful central-acting antiemetic.
Toxicity: Headache, constipation, QT interval prolongation.
Heme Section:
Neutrophil: Important neutrophil chemotactic agents: C5a, IL-8, LTB4, kallikrein, plateletactivating factor.
Macrophage: Lipid A from bacterial LPS binds CD14 on macrophages to initiate septic shock
Eosinophil: Produces histaminase and major basic protein (MBP, a helminthotoxin)
Mast Cell: Mediates allergic reaction in local tissues. Mast cells contain basophilic granules and
originate from the same precursor as basophils but are not the same cell type
Thrombogenesis: Abciximab, eptifibatide, and tirofiban inhibit GpIIb/IIIa directly.
Waldenstrm macroglobulinemia --> M spike = IgM -->hyperviscosity syndrome (e.g.,
blurred vision, Raynaud phenomenon); no CRAB findings.
SLL: Age: > 60 years. Most common adult leukemia. CD20+, CD5+ B-cell neoplasm. Often
asymptomatic, progresses slowly ; smudge cells B in peripheral blood smear; autoimmune
hemolytic anemia.
Hairy Cell Leukemia: Treatment: cladribine, pentostatin
Myelofibrosis:
Obliteration of bone marrow due to increased fibroblast activity in response to proliferation of
monoclonal cell lines. Teardrop RBCs and immature forms of the myeloid line. Bone marrow
is crying because its fibrosed and is a dry tap. Often associated with massive splenomegaly.
Methotrexate:
Toxicity: Mucositis (e.g., mouth ulcers). Pulmonary fibrosis.
Azathioprine, 6-mercaptopurine (6-MP), 6-thioguanine (6-TG):
Clinical Use: Preventing organ rejection, rheumatoid arthritis, IBD, SLE; used to wean patients
off steroids in chronic disease and to treat steroid-refractory chronic disease.
Increased toxicity with allopurinol or febuxostat.
Bleomycin: Toxicity:
Pulmonary fibrosis, skin hyperpigmentation, mucositis. Minimal myelosuppression
Nitrosureas: Toxicity: CNS toxicity (convulsions, dizziness, ataxia).
Vincristine/ Vinblastine:
Clinical Use: Solid tumors, leukemias, Hodgkin (vinblastine) and non-Hodgkin (vincristine)
lymphomas.
Prednisone, prednisolone
Mechanism: Various; bind intracytoplasmic receptor; alter gene transcription.

Bevacizumab:
Toxicity: Hemorrhage, blood clots, and impaired wound healing.
Rituximab: Uses: Non-Hodgkin lymphoma, CLL, IBD, rheumatoid arthritis.
Supraspinatus (suprascapular nerve) abducts arm initially (before the action of the
deltoid); most common rotator cuff injury, assessed by empty/full can test
Carpal Tunnel Syndrome:
Entrapment of median nerve in carpal tunnel; nerve compression --> paresthesia, pain, and
numbness in distribution of median nerve. Associated with pregnancy, rheumatoid arthritis,
hypothyroidism; may be associated with repetitive use.
Median (C5-T1):
Supracondylar fracture of humerus (proximal lesion); carpal tunnel syndrome and wrist
laceration (distal lesion)
Ape hand and Popes blessing
Loss of wrist flexion, flexion of lateral fingers, thumb opposition, lumbricals of 2nd and 3rd
digits
Loss of sensation over thenar eminence and dorsal and palmar aspects of lateral 312 fingers with
proximal lesion
Tinel sign (tingling on percussion) in carpal tunnel syndrome
Ulnar (C8-T1):
Fracture of medial epicondyle of humerus funny bone (proximal lesion); fractured hook of
hamate (distal lesion)
Ulnar claw on digit extension
Radial deviation of wrist upon flexion (proximal lesion)
Loss of wrist flexion, flexion of medial fingers, abduction and adduction of fingers (interossei),
actions of medial 2 lumbrical muscles
Loss of sensation over medial 11/2 fingers including hypothenar eminence
Recurrent branch of median nerve (C5-T1):
Superficial laceration of palm
Ape hand
Loss of thenar muscle group: opposition, abduction, and flexion of thumb
No loss of sensation
Cause of Injury:
Obturator: pelvic surgery:
Tibial: Baker cyst (proximal lesion); Tarsal Tunnel Syndrome (distal lesion)
Superior Gluteal: Iatrogenic injury during IM injection to upper medial gluteal region