6135075-USMLE-Pass-Program-Clue.pdf

Pass Program

Clues

“You ain’t told me squat till you tell me the CLUE!!!”

What are the 5 bacteria causing Heart Block? • Lyme Disease • Salmonella typhii (typhoid) • Chagas Disease (Whipple’s) • Legionella • Diptheria • Lets Stop Doing Long Contractions

What bacteria cause Reiter’s Syndrome? • Shigella • IBD – Crohn’s

• Chlamydia • Yersina • Reiter & Crohn Saw Yersina and got Chlamyia

What are the Low Complement bugs causing Cryoglobuniemia? • Influenzae • Adenovirus • Mycoplasma • Hepatitis C • EBV • I AM HE

What are the drugs induced SLE? • Hydralazine • INH • Phenytoin • Procainamide • Penicillamine • Ethosuximide • H I PPPE

What are the drugs that Blast the BM? • AZT • Benzene • Chloramphenicol • Vinblastine • Vinblastine Anilate Bone Cells

What are the Comma Shaped bugs? • Vibrio • Campylobacter • Listeria • H. pylori • Campylobacter Has Very Long Comma Genes

What is the cresent shaped protozoa? • Giardia lamblia

What bacteria looks like Chinese letters? • Corynebacter

What are the TB Rx? • Rifampin • Pyrazinamide • INH • Ethambutanol • Streptomycin •R E S P I

What are the 6 Low Complement assocs. with Nephrotic Syndrome?

• Serum Sickness • PSGN • SLE • SBE • Cryoglobinemia • MPGN II

What drugs Induce p450? • BAG 4 CPR QTS • Car Grabs Queens •

Tets to Rev Up Alcoholic doing drugs and stinking up car

• Barbiturates • Alcohol • Griseofulvin • Carbamazapine • Rifampin • Quinidine • Tetracycline • Sulfa drugs

What drugs Inhibit p450? • I Do SMACK Quinolones

• INH • Dapsone • Spirolactones • Macrolides • Amiodarone • Cimetidine • Ketoconazole • Quinilones

What drugs are P450 Dependent? • Warfarin • Estrogen • Phenytoin • Theophylline • Digoxin • Theo came from war & dig inside WDEPT taking Estrogen & now is Phenytoin

What disease is a Neutophil Deficiency? • CGD

What is another name for CGD? • Chronic Granulomatous disease • NADPH Oxidase deficiency

What are the Side effects of Statins? • Myositis • Hepatitis • Increased liver enzymes

What are the painful genital Lesions? • Chancroid • Herpes • Lymphogranuloma inguinale

What is the painful chancroid lesion due to? • Hemophilus ducreyi

What are the 4 hormones with disulfide bonds? • Prolactin • Insulin • Inhibin • GH • I PIG on BONDS

What are the Hookworms? • Necatur americanis • Enterobius vermicularis • Ankylostoma duodenale • Trichuris trichurium • Ascaris lumbercoides • Strongyloides • Hooks AS NEAT

What are the X-Linked enzyme Deficiencies? • G6-PD • CGD • Pyruvate dehydrogenase Def. • Fabry’s • Hunter’s • Lesch-nyhan • Lesch-Nyhan Hunter Puts Fabrys on G6 Clothes

What diseases do we screen for at birth? • Please • Check • Before • Going • Home

• PKU • CAH(Congential

Adrenal Hyperplasia) • Biotinidase • Galactosemia • Hypothyroidism

HLA-Antigens • HLA-DR2= Narcolepsy, Allergy,

Goodpasture’s, MS • HLA-DR3= DM, Chronic Active Hepatitis, Sjogren’s, SLE, Celiac Sprue • HLA-DR3 & 4= IDDM(Type I) • HLA-DR4= Rheumatoid Arthritis, Pemphigus Vulgaris • HLA-DR5= JRA, Pernicious Anemia • HLA-DR7= Nephrotic Syndrome(Steroid induced)

HLA-Antigens • HLA-DR 3 & B8=Celiac Disease • HLA-A3= Hemochromatosis(chromo. 6, point mut.-cysteine>tyrosine) • HLA-B8=MG • HLA-B13= Psoriasis • HLA-B27= Psoriais(only if w/arthritis) Ankylosing Spondylitis, IBD, Reiter’s, Postgonococcal Arthritis • HLA-BW 47= 21 alpha Hydroxylas def.(Vit.D)

What are the actions of Steroids? • Kills helper T-cells & eosinophils • Inhibits Macrophage migration • Inhibits Mast cell degranulation • Inhibits Phospholipase A • Stimulates protein synthesis • Stablizes endothelium

What are the causes of Monocytosis? • Salmonella (typhoid) • TB • EBV • Listeria • Syphillis

E. Coli is the most common cause of what? • UTI • Spontaneous bacterial peritonitis • Abdominal abscess • Cholecystitis • Ascending cholangitis • Appendicitis

What are the one dose treatments for Gonorrhea? • Ceftriaxone • Cefixime • Cefoxine • Ciprofloxin • Oflaxacin • Gatifolxacin

What is the one dose treatment for Chlamydia? • Azithromycin

What are the “Big Mama” anaerobes? • Strep bovis • Clostridium melanogosepticus • Bacteriodes fragilis

What are the “Big Mama” Rx? • Clindamycin • Metranidazole • Cefoxitin

What “big mama” bugs are associated with colon cancer? • Strep. Bovis • Clostridium melanogosepticus

What do you see in the serum with low volume state? • K+? • Decreases • Na+? • Decreases • Cl-? • Decreases • pH? • Increases • BP? • Increases

What are psammoma bodies? • Calcified CA’s

In what diseases are Psammoa Bodies present? • Papillary carcinoma of the Thyroid • Serous cystadenocarcinoma of the ovary • Meningioma • Mesothelioma

What are the Urease (+) Bacteria? • Proteus • Pseudomonas • Ureaplasma urealyticum • Nocardia species • Cryptococcus neoformans • H. pylori

What types of stones are formed from Proteus? • Struvite (90%)

What type of motility do Proteus have? • swarming

What are 5 indications of Surgery? • Intractable pain • Hemorrhage (massive) • Obstruction (from scarring) • Perforation

What drugs cause Cardiac Fibrosis? • Adriamycin (Doxyrubicin) • Phen-fen

What drug is used to tx cardiac fibrosis? • Dozaroxsin

What is the MCC of any …. penia? • #1 = Virus • #2 = Drugs

What is seen in the Salmonella Triad? • High Fever • Rose spots (rash) • Intestinal fire

What drugs cause Myositis? • Rifampin • INH • Predinsone • Statins

What are the 7 Gram -encapsulated bacteria? • • • • • • •

Some Strange Killers Have Pretty Nice Capsules

• Salmonella • Strep. Pneumo (gr+) • Klebsiella • H. influenza • Pseudomonas • Neisseria • Cryptococcus

What is the Jones Criteria for Rheumatic Fever? • SubQ nodules • Polyarthritis • Erythema marginatum • Carditis • Chorea

What are the causes of Eosinophilla? • Neoplasms • Allergies/Asthma • Addison’s Dz • Collagen Vascular Dz • Parasites

What are the Risk Factors for Liver CA? • • • • • • • • • •

Hep B,C,D Aflatoxin Vinyl chloride Ethanol Carbon Tetrachloride Anyline Dyes Smoking Hemochromatosis Benzene Schistomiasis

What are the 9 Live Vaccines? • Measles • Mumps • Rubella • Oral Polio (sabin) • Rotavirus • Small pox • BCG • Yellow fever • Varicella

What are the Killed Vaccines? • SIR Hep A

• Salk (polio) • Influenza • Rubella • Hepatitis A

What are the IgA Nephropathies? • Henoch-Schoenlein P. (HSP) • Alport’s • Berger’s

What are the Drugs that cause Autoimmune hemolytic anemia? • PCN • α-methyldopa • Cephalosporins • Sulfa • PTU • Anti-malarials • Dapsone

What are the drugs that cause Autoimmune thrombocytopenia? • ASA • Heparin • Quinidine

What are the enzymes that show after an MI? • Troponin I • CKMB • LDH

What is the first MI enzyme to appear? • Troponin I • Appears • Peaks • Gone

• 2 hrs • 2 days • 7 days

What is the 2 to appear?

nd

• CK-MB • Appears • Peaks • Gone

MI enzyme

• 6 hrs • 12 hrs • 24 hrs

What is the 3 MI enzyme to appear? rd

• LDH • Appears • Peaks • Gone

• 1 day • 2 days • 3 days

What bacteria have Silver Stains? • Legionella • Pneumocysitis carinii • H. pylori • Bartonella henseslae (lymph node) • Candida (yeast)

What are the sulfa containing drugs? • Sulfonamides • Sulfonylurea • Celebrex

What is another name for celebrex? • Celecoxib

What type of inhibitor is Celebrex? • COX 2 specific

What COX-2 specific drug can you give to a pt with sulfa allergy? • Vioxx (Rofecoxib)

What drugs inhibit dihydrofolate reductase? • Pyremethamin/Sulfadiazine • Trimethoprim/Sulfamethoxazole

What drugs cause Pulmonary Fibrosis? • Bleomycin • Bulsufan • Amiodarone • Tocainide

What are the macrophage deficiency diseases? • Chediak-Higashi • NADPH-oxidase deficiency

What are the SE of Loops and Thiazides? • Hyperglycemia • Hyperuricemia • Hypovolemia • Hypokalemia

What are the SE of Loop diuretics? • OH DANG

• Ototoxicity • Hypokalemia • Dehydration • Allergy • Nephritis (interstitial) • Gout

What are the only 3 Pansystolic Murmurs and when are they heard? • MR • TR • VSD

• Decrease on

inspiration (^exp) • Increase on inspiration • Decrease on inspiration (^exp)

Macrophages in various organs • • • • • • • • •

Brain Lung Liver Spleen Kidney Lymph nodes Skin Bone CT

• • • • • • • • • • •

Mircoglia Type I pneumocyte Kupffer cell RES Mesangial Dendritic Langerhans Osteoclasts Histiocytes or Giant cells or Epithelioid cells

What are the 7 Rashes of the Palms & Soles? • TSS • Rocky Mountain Spotted Fever • Coxsackie A (Hand/Foot & mouth dz) • Kawasaki • Syphillis • Scarlet Fever • Staph Scalded Skin Syndrome

What is seen in every restrictive lung dz and low volume state? • Tachypnea • Decrease pCO2 • Decrease pO2 • Increase pH

What are the different 2nd messenger systems? • cAMP • cGMP • IP3/DAG • Ca:Calmodulin • Ca+ • Tyrosine kinase • NO

What is the clue for cAMP? • It is the 90% • Sympathetic • CRH (cortisol) • Catabolic

What is the clue for cGMP? • Parasympathetic • Anabolic

What are the clues for IP3/DAG? • Neurotransmitter • GHRH • All hypothalamic hormones xc

cortisol • Used by what and for what? • Smooth muscle for contraction

What is the clue for Ca:Calmodulin? • Used by smooth muscle for contraction by distention

What is the clue for Ca+? • Used by Gastrin only

What is the clue for Tyrosine Kinase? • Used by Insulins • Used by ALL growth factors

What is the clue for NO? • Nitrates • Viagra • ANP • LPS

What are the T & B cell deficiencies? • WAS • SCID • CVID • HIV • HTLV-1

What are the CLUES for WAS? • Thrombocytopenia • IL-4 • Infection • Eczema • Decrease IgM • IgE???

What are the CLUES for SCID? • Framshift/Nonsense mutation • Adenosine deaminase deficiency • T-cell>B-cell • Bacterial infections • Fungal infections

What are the CLUES for CVID? • Late onset • Frameshift/Missense mutation • Tyrosine Kinase deficiency

What are the CLUES for HIV & HTLV-1? • T-cell>B-cell • CD4 rich • Brain • Testicles • Cervix • Blood vessels

What are the inhibitors of Complex 1 of the ETC? • Amytal • Rotenone

What are the inhibitors of Complex 2 of the ETC? • Malonate

What are the inhibitors of Complex 3 of the ETC? • Antimycin D

What are the inhibitors of Complex 4 of the ETC? • CN• CO • Chloramphenicol

What are the inhibitors of Complex 5 of the ETC? • Oligomycin

What are the ETC chemical uncouplers? • DNP • Free Fatty acids • Aspirin

What type of uncoupler is Aspirin? • Physical uncoupler

What are the 4 sources of Renal Acid? • Plasma • Urea cycle • Collecting ducts • Glutaminase

What is the one dose tx for Hemophilus ducreyi? • Azithromycin 1 gram po • Ceftriazone 250 mg im

What is the one dose tx for Chlaymdia? • Azithromycin 1 gram po

What is the one dose tx for Candidiasis? • Ketoconazole 150mg

What is the one dose tx for Vaginal Candidiasis? • Difluccan 1 pill

What is the one dose tx for Trichomonas? • Metronidazole 2 grams

What is the one dose tx for Gardnerella? • Metronidazole 2 grams

What are the 3 cephalosporins & doses used as one dose treatments for Gonorrhea?

• Ceftriaxone 250 mg im • Cefixime 400 mg po • Cefoxitin 400 mg po

What are the 3 Quinolones & doses used as one dose treatments for Gonorrhea?

• Ciprofloxacin 500 mg po • Ofloxacin 400 mg po • Gatifloxacin 400 mg im

What are the 4 enzymes needed to break down glycogen?

• Phosphorylase (Pi) • Debranching enzyme • Alpha-1,6 –Glucosidase • Phosphatase

What are the 2 enzymes needed to make glycogen? • Glycogen synthase • Branching enzyme

What are the branching enzymes? • Glycogen alpha-1,4 glycosyl transferase • Glycogen alpha-1,6 glycosyl transferase

What is the rate limiting enzyme in the break down of glycogen? • Phosphorylase (Pi)

What values do you see in obstructive pulmonary dz? • pO2? Normal • pCO2? Normal or increased • pH? Decreased

What values do you see in restrictive pulmonary dz? • pO2? Decreased • pCO2? Decreased • pH? Increased

What type of acidosis do you see with obstructive pulmonary dz? • Respiratory acidosis

What are the Lysosomal Storage Disease & what is the deficiency? • • • • • • • •

Fabry’s Krabbe’s Gaucher’s Niemann – Pick Tay-Sachs Metachromatic leukodystrophy Hurler’s Hunter’s

• • • • • • • •

α – galactosidase Galactosylceramide β – glucocerebrosidase Sphingomyelinase Hexosaminidase Arylsulfatase α – L – iduronidase Iduronidase sulfatase

What dz’s are associated with HLA B27? • Psoriasis • Ankylosing spondylitis • IBD (Ulcerative colitis) • Reiter’s Syndrome

What HLA is Psorisis w/RA associated with? • HLA-13

What are the Glycogen Storage Diseases & the deficiency? • Von Gierke’s

• Glucose – 6 – phosphate

• Pompe’s • α – 1 – 4 glucosidase

• Cori’s • McArdle’s

• Debranching enzyme • Glycogen

phosphorylase

What are 6 places of the TCA cycle where amino acids feed in/out? • • • •

Pyruvate? Glycine Alanine Serine

• • • • • • •

Acetyl CoA ? Phenylalanine Isoleucine Threonine Tryptophan Lysine Leucine

What are 6 places of the TCA cycle where amino acids feed in/out?

• Alpha-KG ? • Glutamate • Glutamine • Succinyl CoA? • Phenylalanine • Tryptophan • Tyrosine

What are 6 places of the TCA cycle where amino acids feed in/out?

• Fumerate ? • Proline • Oxaloacetate? • Aspartate • Asparigine

What are the 4 steps of Boxidation? • Oxidation – 7 NADH – 21 ATP • Hydration • Oxidation - 7FADH – 14 ATP • Thiolysis – 8 AcCoA – 96ATP 131 ATP – 2 (to bring it in)

What are the blood gases in neuromuscular disease (= restrictive blood gases)? • pO2? • • • • •

Decreased pCO2? Decreased PCWP? Decreased (b/c it’s a pressure problem) Respiratory Rate? Increased pH? Increased SZ? Increased

What are 5 Hormones produced by small cell (oat cell) lung CA?

• ACTH • ADH • PTH • TSH • ANP

What Autoimmune Disease has the following Autoimmune Antibodies?

•Anti-smith •Anti cardiolipin •Anti-ds DNA •SLE

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti – histone? • Drug induced SLE

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-topoisomerase? • PSS (Progressive Systemic Sclerosis)

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti TSH receptors? • Graves

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-centromere? • CREST

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-GBM? • Goodpasture’s

What does Goodpastures have antibody to? • Type IV collagen

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-mitochondria? • Primary biliary cirrhosis

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-hair follicle? • Alopecia areata

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-IgG? • Rheumatoid arthritis

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-myelin receptors? • MS

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-gliaden? • Anti-gluten? • Celiac sprue

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-islet cell receptor? • DM Type I

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-melanocyte? • Viteligo

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-ACh receptor? • MG

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-ribonuclear protein? • Mixed Connective Tissue dz (MCTD)

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-parietal cell receptor? • Pernicious anemia

What does Pernicious Anemia have antibody to? • Intrinsic factor

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-epidermal anchoring protein receptors?

• Pemphigus vulgaris

What does Pemphigus vulgaris have antibody to? • Intercelluar junctions of epidermal cells

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-epidermal basement membrane protein?

• Bullous pemphigoid

What do you see with bullous pemphigoid?

• IgG sub-epidermal blisters • Oral blisters

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-platelet? • ITP

What does ITP have antibody to? • Glycoprotein IIb/IIIa

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-thyroglobulin? • Anti-microsomal? • Hashimoto’s

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-smooth muscle? • Anti-scl-70? • Scleroderma

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-rho (SS-A)? • Anti-la? • Sjogren’s

What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-proteinase? • C-ANCA? • Wegener’s

What Autoimmune Disease has the following Autoimmune Antibodies? • P-ANCA? • Polyarteritis nodosa

What antigen & immunoglobulin is Polyarteritis nodosa associated with? •Hepatitis B antigen •IgM

What are the viruses that directly cause CA and which CA do they cause? • Papilloma virus?

Cervical CA • EBV? Burkitts Nasopharyngeal CA • HepB & C? Liver CA • HIV? Kaposi’s Sarcoma

What are the 7 Nephrotic Patterns seen with every Vasculitis? • Clot in front of renal artery? Renal artery stenosis

• Clot off whole renal artery? Renal failure

• Inflamed glomeruli? Glumerulo nephritis

• Clot in papilla?

Papillary necrosis

• Clot off medulla?

Interstitial nephritis

• Clot off pieces of nephron? Focal segmental GN (HIV, drug use association)

• Clot off lots of nephrons? Rapidly Progressive GN

What is the most common nephrotic disease seen in kids and when does it occur?

• Min. change disease • 2 wks post URI

vasculitity leading to rapidly progressive glomerulonephrosis? • Goodpasture’s

What is the most common malignant renal tumor in children? • Wilm’s tumor

What is the most common malignant renal tumor in adults? • Adenocarcinoma

What is the most common renal mass? • Cyst

What is the most common renal disease in Blacks/Hispanics? • Focal Segmental GN

What is the most common nephrotic disease in adults? • Membranous GN

Thrombolytics & Inhibitors • What does tPA, Streptokinase, Urokinase inhibit? • Aminocaproic acid • What doe Warfarin inhibit? • Vitamin K • What does Heparin inhibit? • Protamine Sulfate

What is the dosage of tPA? • IV push? • 20mg • Drip? • 40mg

What is the dosage for Streptokinase? • IV push? • 750K • Drip? • 750K

What is Urokinase used for? • Used ONLY for such things as: • Feeding tubes • Central lines • Fistulas

What is Alopecia Areata? • Loss of a patch of hair

What is Alopecia Totalis? • Loss of ALL hair on head “bald”

What is Alopecia Universalis? • Loss of hair on entire body “hairless”

What is Loffler syndrome? • Pneumonitis with endocarditis = pulmonary infiltrate with severe eosinophilia

What is Loffler syndrome also known as? • PIE syndrome

What are the 5 Parasites associated with Loffler Syndrome?

• Necator americanus • Ankylostoma duodenale • Shistosomiasis • Strongyloides • Ascaris lumbricoides

What happens when a patient is on prednisone for > 7 days?

•Immunocompromised

What are 2 enzymes used by B12? • Homocystine methyl transferase • Methyl malonyl-coA mutase

What does Mitochondrial inheritance mean? • No male transmission • All females pass it on

Who are 4 pt’s who would be susceptable to pseudomonas and staph infxns?

• Burn patients • Cystic fibrosis • DM • Neutropenic patients

In a neutropenic patient, what do you cover for? • cover 1x for Staph aureus during 1st week • cover 2x for Pseudo after 2nd week

What are the 3 main concepts causing a widened S2 splitting? • Increased pO2 • Delayed opening/closing of the pulmonary value • Increased volume in the right ventricle

What are causes for a widened S2 splitting?

• • • • • • • • • • • • •

Blood transfusion Increased Tidal Volume Giving O2 Right sided heart failure Pregnancy due to increase volume IV fluids ASD/VSD Deep breathing Hypernateremia SIADH Pulmonary regurge Pulmonary stenosis Right bundle branch block

What are the 8 common cavities of blood loss? • Pericardium • Intracranial • Mediastinum • Pleural cavity • Thighs • Retroperitoneum • Abdominal cavity • Pelvis

What is the special list for Penicillin? • Gram + • Basement membrane suppressor • Works on simple anaerobes • The #1 cause of anaphylaxis • Causes interstial nepritits • Causes nonspecific rashes • Acts as a hapten causing hemolytic anemia

What is the #1 cause of anaphylaxis? • Penicillin

What are the Chron’s Gifts? • Granuloma • Ileum • Fistula • Transmural • Skip Lesion

What are the negativestranded RNA Clues? • Prodromal period before symptoms = 1-3 weeks • Why is there a prodromal period? • Because must switch to positive stranded before replication

What are the clues for positive stranded RNA? • Symptoms within 1 week or less • EXCEPTIONS: • Hanta • Ebola • Yellow fever • They are -ve stranded = don’t have to switch to positive before replicating

What are the Most common cyanotic heart diseases? • Transposition of the great arteries • Tetrology of Fallot • Truncus Arteriosus • Tricuspid Atresia • Total anomalous pulmunary Venous Return

• Hypoplastic Left heart syndrome • Ebstein’s anomaly • Aortic atresia • Pulmonary atresia

What cyanotic heart disease is – boot shaped? • Tetrology of Fallot

What cyanotic heart disease is associated with mom taking lithium during pregnancy? • Ebstein’s Anomaly

What things make the membrane less likely to depolarize? • Hypokalemia • Hypermagnesemia • Hypercalcemia (except atrium) • Hypernatremia

What things make the membrane more likely to depolarize? • Hyperkalemia • Hypomagnasemia • Hypocalcemia (except atrium) • Hyponatremia

What is Plan F? • TPP – Thiamin – B1 • Lipoic Acid – B4 • CoA – Pantothenic acid – B5 • FAD – Riboflavin – B2 • NAD – Niacin – B3

What are the 8 x-linked inherited diseases? • Bruton’s Agammaglobulinemia • CGD (NADPH def) • DMD • Color Blindness • G6PD • Hemophilia • Lesch-Nyhan • Vit D resist. Rickets (X-linked dominant) • Fabrys • Hunters

What are the 7 B-cell deficiencies? • Bruton’s agammaglobulinemia • CVID (Common Variant Imm. Def) • Leukemias • Lymphomas • SCID • WAS • Job Buckley Syndrome

What is the Tyrosine kinase deficiency? • Bruton’s agammaglobulinemia

What are the B-cell deficiencies with T-cell overlap? • SCID • WAS • Job Buckley Syndrome

What are the 4 itchiest rashes? • Scabies • Lichen Planus • Urticaria • Dermatitis Herpetiformis

Tumor Markers/Oncongenes I • L-myc? • Small cell lung Ca • •

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

• • •

N-myc? Neuroblastoma Small cell lung CA

• • •

C-able? CML ALL

Tumor Markers/Oncongenes II • C-myb? • Colon CA • AML • C-sis ? • Osteosarcoma • Glioma • Fibrosarcoma

Tumor Markers/Oncongenes III • C-erb B2? • Epidermal growth factor receptors • CSF-1 ? • Breast

Tumor Markers/Oncongenes IV • • • •

Erb-B2? Breast CA Ovarian CA Gastric CA

• • • •

Ret? Medullary CA of thyroid Men II & III Papillary carcinoma

Tumor Markers/Oncongenes V • Ki-ras? • Lung CA • Colon CA • Bcl-2? • Burkitts • Follicular lymphoma • Erb? • Retinoblastoma

What are 6 Hormones produced by the placenta? • hCG • Inhibin • Human placental lactogen (HPL) • Oxytocin (drug lactation, pit gland prod it also) • Progesterone • Estrogen • Relaxin

What is cancer grading? • Severity of microscopic change • Degree of differentiation

What is cancer staging? • Degree of dissemination of tumor • What the surgeon sees

What are the rashes associated with cancer and what cancer are they associated with? • Urticaria/Hives?

• Any CA, especially lymphoma • Pagets Ds (ulcers around nipples)

• Seborrheic keratosis (waxy warts)? • • •

Colon CA HIV if sudden increase in number Normal with aging

What are the rashes associated with cancer and what cancer are they associated with? • Actinic keratosis?

– Dry scaly plaques on sun-exposed skin

• Squamous Cell CA of skin • Dermatomyositis?

– violacious, heliotropic rash, malar area

• Colon CA

What are the rashes associated with Cancer and the cancer they are associated with? • Akanthosis nigricans? – dark lines in skin folds

• Any visceral CA • End organ damage

• Erythema nodosum?

– ant aspect of legs, tender nodules

• Anything granulomatous • NOT assoc. w/ bacteria

What is carried by HDL? • Apo E • Apo A • Apo CII • L-CAT – lecithin cholesterol acetyl transferase

• Cholesterol – from periphery to liver

What is carried by VLDL? • Apo B-100 • Apo E • Apo C II • Triglcyerides (95%) • Cholesterol (5%)

What is carried by IDL? • Apo B-100 • Apo E • Apo CII • Triglycerides (< VLDL) • Cholesterol (>VLDL)

What is carried by LDL? • Apo B-100 • Cholesterol – from liver to tissue

• NOT a good thing!!!!!

What do chylomicrons carry? • Apo A • Apo B-48 • Apo E • Apo C II • Triglycerides from:

• GI to liver (25% of the time) • GI to endothelium (75% of the time)

Which lipoprotein carries the most cholesterol?

•LDL

Where are the AVMs? • Clue = HEAL • Heart?

• Machinery murmur

• Elbow?

• Fistula from dialysis in renal disease

• Abdomen/Brain?

• Von Hippel-Lindau = clot off with coils • Increase incidence of Renal cell CA on chrom 3

• Lungs?

• Osler Weber Rendu Syndrome

What is the Ranson’s criteria for acute pancreatitis (at admission)? • Glucose > 200 • Age > 55 • LDH >350 • AST > 250 • WBC > 16,000

What is the Ranson’s criteria for acute pancreatitis (at less than 48 hrs)? • Calcium 10% • O2 < 60 (PaO2) • Base deficit > 4 • BUN > 5 mg/dl • Sequestration > 6L

What 2 diseases is pilocarpine used for? • CF • Glaucoma – Painful, red, teary eye

What is dysguzia? • Problem with sense of taste

What are 3 causes of dysgusia? • Metronidazole • Clarithromycin • Zinc deficiency

What is the triad of Carcinoid syndrome? • Flushing • Wheezing • diarrhea

What do you measure for carcinoid syndrome? • Serotonin – 5-HIAA

Where are the 2 most common places a carcinoid tumor is found? • Pancreas • Ileum

What are the phage mediated toxins? • Mnemonic: BEDS • Botulinum • Erythrogenic toxin – from strep pyogenes

• Diptheria • Salmonella – Has O antigen

What is the story used to remember the segmented RNA viruses? • I sprayed ORTHO on my BUNYA at the ARENA down in REO to kill SEGMENTED WORMS

Name the 3 major types of adhesion molecules • ICAMs • Integrins • Selectins

What does IgCam do? • Bind proteins

What do integrins do? • Stop the leukocytes

What do selectins do? • Bind carbohydrates • Mediate the rolling to slow leukocytes down

What are the functions of adhesion molecules? • Homing of lymphocytes – tells lymphocytes where to go

• Inflammation • Cell-cell interaction

Primary allergic response is due to what? • Contact

What cells are present in the first 3 days? • Neutrophils • The next cells to show up are? • B-cells • What do B-cells make? • IgM

What day does IgM show up? • Three • IgM peaks at what day? • 14 • When does IgM leave? • In 2 months

What shows up in 2 wks (14 days)? • IgG • When does IgG peak? • In 2 months • When does IgG leave? • In 1 year

What is Secondary Allergic response is due to? • MEMORY

What shows up at day 3? • IgG with 5x concentration • Has the highest affinity • When does IgG peak? • In 5 years • When does IgG leave? • In 10 years

What Ig has the hightest affinity? • IgG

What are the risk factors for Esophageal/Gastric CA? • Smoking • Alcohol • Nitrites • Japanese

What are the risk factors for bladder CA? • • • • • • • • •

Smoking Aniline dyes Benzene Aflatoxin Cyclophosphamide Schistosomiasis 2 diseases: Von Hippel-Lindau Tubular sclerosis

What is the NBT test? • Nitro Blue Tetrazolium test • What is it used for? • Screening CGD • What does a –ve test indicate? • +ve for the disease

What disease corresponds with the following inclusion bodies? • Howell-Jolly? • Sickle cell • Heinz? • G-6-P-D • Zebra? • Niemann pick

What disease corresponds with the following inclusion bodies? • Donovan? • Leishmaniasis • Mallory? • Alcoholism • Negri? • Rabies

What disease corresponds with the following inclusion bodies? • Councilman? • Yellow fever • Call-exner? • Ovarian tumors – granulosa origin

What disease corresponds with the following inclusion bodies? • Lewy? • Parkinsons • Pick? • Pick’s disease • Barr body? • Normal female

What disease corresponds with the following inclusion bodies? • Aschoff? • Rheumatic fever • Cowdry type A inclusions? • Herpes virus • Auer rods? • AML

What disease corresponds with the following inclusion bodies? • Globoid? • Krabbe’s lysosomal storage disease • Russell? • Multiple myeloma

What disease corresponds with the following inclusion bodies? • Schiller-Duvall? • Yolk sac tumor • Basal bodies? • Only found in smooth mm

What are the 4 types of hypersensitivities? • Mnemonic? • ACID • Type I • Anaphylaxis/Atopic • Type II • Cytotoxic (Humoral) • Type III • Immune complex mediation • Type IV • Delayed hypersensitivity/Cell mediated

What are the Characteristics of Type I hypersensitivity? • Atopic • IgE (Asthma) binds to mast cell • IgA activates IP3 cascade degrading mast cells

What are the Characteristics of Type II hypersensitivity? • Humoral • What are examples of type II? • Rh disease • Goodpastures • Autoimmune hemolytic Anemia • All Autoimmune diseases – except RA and SLE

What are the Characteristics of Type III hypersensitivity? • Ag-Ab complement • What are examples of Type III? • RA • SLE • Vasculitides • Some GN?

What are the Characteristics of Type IV hypersensitivity? • Cell mediated • What are examples of Type IV? • TB skin test • Contact dermatitis • Transplant rejection

What structures have no known function? • Appendix • Epithalamus • Palmaris longus – muscle

• Pancreatic polypeptide – hormones in F-cells

What diseases can progress to RPGN? • Goodpastures • Wegeners • DM • HTN

What are causes of papillary necrosis? • Vasculitis • AIDS

Cytic fibrosis Questions? • • •

Tx? Pilocarpine also used for glaucoma

• Test used to detect CF? • Pilocarpine sweat test • •

What ion does this test measure? Cl-

• Definitive presence of disease has a test value of •

what? >60

Cytic fibrosis Questions? • What is the value in a normal person? • 20

• Fractional Na+ excertion • 40

What do you see in Renal failure and what are the values? • BUN • 10-15

• Fractional Na+ excretion • >2% • Creatinine • 21 years old? • #1 S. pneumoniae

Answer the following about the Strep. Pneumonia vaccine. • At what age is it given? • Given at 2,4,6 months • What strain does it cover? • Covers 23 strains (98% cases)

Answer the following about the Strep. Pneumonia vaccine. • Indications? • Anyone> 65y/o • Anyone splenectomized – Sickle cell anemia

• Anyone with end-organ damage – – –

CF RF Nephrotic Syndrome

STREP PYOGENES is the most common cause of what? • MCC of all throat infections • #2 MCC of all what? • Skin infections except lines

What are the STAPHYLOCOCCUS PIGMENTS? • St. aureus? • Gold pigment • St. epidermidis? • White pigment • St. saprophyticus? • No pigment

What is the clue for RUSTY COLORED SPUTUM? • Strep. Pneumonia – pneumococcus

Clues for GENERAL INFECTIONS • Skin Infections? • Say Staph. Aureus • Throat Infections? • Say Strep. Pyogenes • Small Intestine Infections? • Say E. coli

What disease is a NEUTROPHIL DEFICIENCY & T,B cell deficiency? • Job Syndrome: • IL-4 • Hyper IgE • What do they look like? • Red hair • Fair complexion • Female

What are the NEUTROPHIL DEFICIENCY? • NADPH-OXIDASE DEF (CGD) • NEUTROPENIA • MYLOPEROXIDASE • Job-Buckley Syndrome

What Hepatitis B antigen is found with an acute/recent infection? • HbC antigen • HbS antigen

What Hepatitis B antigen & antibody is found with an acute/recent infection? • HbC antigen • HbS antigen • HbC antibody

What Hepatitis B antigen is found with Recent immunization within the past 2wks? • HbS antigen ONLY

What Hepatitis B antibody is found with Recent immunization two wks after and can be due to vaccination immunity from a long time ago?

• HbS antibody ONLY

What Hepatitis B antibody & antigen is found with past disease but now immune? • HbC antibody • HbS antibody • HbS antigen

What Immunogloblin is found in Hepatitis B immunity? • IgG

What Hepatitis B antigen/antibody is found in the chronic carrier state? • HbS antigen for >6months • Can be with or without HbS antibody

What Hepatitis B antigen is found with the infectious state? • HbE antigen

What Hepatitis B antibody is found with the non-infectious state? • HbE antibody

If patient has recovered from Hepatitis B what antigen will they have? • NEGATIVE HbS antigen

If patient is a chronic carrier what antigen will they have? • POSITIVE HbS antigen

What does the “window period” build in Hepatitis B? • HbE antibody • IgM HbC antibody • What disappears? • HbS antigen

What is the incubation period for Hepatitis B? • 4 to 26 wks • Average @ 8wks

How long is the acute disease period in Hepatitis B? • 4 to 12 wks

How long is the convalescence period in Hepatitis B? • 4 to 20 wks

How long is the recovery period for Hepatitis B? • YEARS

Answer the following about HIV? • MC infection? • CMV • MCC of death? • PCP • What is p41 used for? • Just a marker

Answer the following questions about HIV? • What does Gp120 do? • Attachment to CD4 • What is Pol used for? • Integration • What is reverse transcriptase used for? • Transcription • What are p17 & p24 antigens used for? • Assembly

Answer the following questions about HIV? • What is the normal CD4 count? • 800-1200 • What can the CD4 count be up to in

children? • 1500 • When do you begin treating with 2 nucleotide inhibitors and 1 protease inhibitor? •