Usmle Clues

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

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

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What bacteria cause Reiter’s Syndrome? • Shigella • IBD – Crohn’s • Chlamydia • Yersina • • Reiter & Crohn Saw Yersina and got Chlamyia

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

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

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

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What are the Comma Shaped bugs? • Vibrio • Campylobacter • Listeria • H. pylori

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• • Campylobacter Has Very Long Comma Genes 8

What is the cresent shaped protozoa? • Giardia lamblia

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What bacteria looks like Chinese letters? • Corynebacter

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What are the TB Rx? • Rifampin • Pyrazinamide • INH • Ethambutanol • Streptomycin • • RESPI

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What are the 6 Low Complement assocs. with Nephrotic Syndrome? • Serum Sickness • PSGN • SLE • SBE • Cryoglobinemia • MPGN II •

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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

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Estrogen Phenytoin Theophylline Digoxin Theo came from war & dig inside WDEPT taking Estrogen & now is Phenytoin

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What disease is a Neutophil Deficiency? • CGD

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

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

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

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

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

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

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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

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What diseases do we screen for at birth? • Please • Check • Before • Going • Home • PKU • CAH(Congential Adrenal Hyperplasia) • Biotinidase • Galactosemia • Hypothyroidism

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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) •

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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) •

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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

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

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

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• Cholecystitis • Ascending cholangitis • Appendicitis 29

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

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What is the one dose treatment for Chlamydia? • Azithromycin

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

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

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

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What do you see in the serum with low volume state? • K+? • Decreases • Na+? • Decreases • • • • • • • •

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Cl-? Decreases pH? Increases BP? Increases

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What are psammoma bodies? • Calcified CA’s

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In what diseases are Psammoa Bodies present?

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Papillary carcinoma of the Thyroid Serous cystadenocarcinoma of the ovary Meningioma Mesothelioma

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

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

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What type of motility do Proteus have? • swarming

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

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

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What drug is used to tx cardiac fibrosis? • Dozaroxsin

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

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

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

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What are the 7 Gram -encapsulated bacteria? • Some • Strange • Killers • Have

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Pretty Nice Capsules Salmonella Strep. Pneumo (gr+) Klebsiella H. influenza Pseudomonas Neisseria Cryptococcus

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

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

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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 •

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What are the Killed Vaccines? • SIR Hep A • Salk (polio) • Influenza • Rubella • Hepatitis A

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

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

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

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

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What is the first MI enzyme to appear? • Troponin I • Appears • Peaks • Gone • • 2 hrs • 2 days • 7 days What is the 2nd MI enzyme to appear? • CK-MB • Appears • Peaks • Gone • • 6 hrs • 12 hrs • 24 hrs What is the 3rd MI enzyme to appear?

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LDH Appears Peaks Gone

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• • 1 day • 2 days • 3 days

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

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

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What is another name for celebrex? • Celecoxib

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What type of inhibitor is Celebrex? • COX 2 specific

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

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

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

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

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

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What are the SE of Loop diuretics? • OH DANG • Ototoxicity • Hypokalemia

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Dehydration Allergy Nephritis (interstitial) Gout

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

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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

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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

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

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

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

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What is the clue for cGMP? • Parasympathetic • Anabolic •

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What are the clues for IP3/DAG? • Neurotransmitter • GHRH • All hypothalamic hormones xc cortisol • Used by what and for what? • Smooth muscle for contraction

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

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

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

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

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

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What are the CLUES for WAS? • Thrombocytopenia • IL-4 • Infection

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• Eczema • Decrease IgM • IgE??? 83

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

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

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

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

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

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

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

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

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

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What type of uncoupler is Aspirin? • Physical uncoupler

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

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

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

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

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

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

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

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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

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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

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What are the 4 enzymes needed to break down glycogen? • Phosphorylase (Pi) • Debranching enzyme • Alpha-1,6 –Glucosidase • Phosphatase

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

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

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• Glycogen alpha-1,6 glycosyl transferase 105

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

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

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

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

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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

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

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

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

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• Pompe’s • Cori’s

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• McArdle’s • Glucose – 6 – phosphate

• α – 1 – 4 glucosidase • Debranching enzyme • • Glycogen phosphorylase 113

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

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What are 6 places of the TCA cycle where amino acids feed in/out? • Alpha-KG ? • Glutamate • Glutamine • • • • •

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Acetyl CoA ? Phenylalanine Isoleucine Threonine Tryptophan Lysine Leucine

Succinyl CoA? Phenylalanine Tryptophan Tyrosine

What are 6 places of the TCA cycle where amino acids feed in/out? • Fumerate ? • Proline • Oxaloacetate? • Aspartate • Asparigine

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What are the 4 steps of B-oxidation? • • Oxidation – 7 NADH – 21 ATP • Hydration

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• Oxidation - 7FADH – 14 ATP • Thiolysis – 8 AcCoA – 96ATP 131 ATP – 2 (to bring it

in)

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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

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What are 5 Hormones produced by small cell (oat cell) lung CA? • ACTH • ADH • PTH • TSH • ANP

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What Autoimmune Disease has the following Autoimmune Antibodies? • Anti-smith • Anti cardiolipin • Anti-ds DNA • SLE

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

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

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

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

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

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What does Goodpastures have antibody to? • Type IV collagen

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

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

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

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

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

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

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

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

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• MG • 134

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

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

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What does Pernicious Anemia have antibody to? • Intrinsic factor

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

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

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

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What do you see with bullous pemphigoid? • IgG sub-epidermal blisters • Oral blisters •

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

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

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

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

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• Anti-scl-70? • Scleroderma • 145

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

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

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

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

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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

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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)

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• Clot off lots of nephrons? Rapidly Progressive GN 151

What is the most common nephrotic disease seen in kids and when does it occur? • Min. change disease • • 2 wks post URI

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What is the most common vasculitity leading to rapidly progressive glomerulonephrosis? • Goodpasture’s •

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

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

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What is the most common renal mass? • Cyst

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

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

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

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

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

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

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• Central lines • Fistulas 162

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

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

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

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

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What is Loffler syndrome also known as? • PIE syndrome

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What are the 5 Parasites associated with Loffler Syndrome? • Necator americanus • Ankylostoma duodenale • Shistosomiasis • Strongyloides • Ascaris lumbricoides

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

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

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

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Who are 4 pt’s who would be susceptable to pseudomonas and staph infxns? • Burn patients • Cystic fibrosis • DM • Neutropenic patients

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

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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

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What are causes for a widened S2 splitting? • Blood transfusion

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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

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

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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

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What is the #1 cause of anaphylaxis? • Penicillin

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

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

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What are the clues for positive stranded RNA? • Symptoms within 1 week or less • EXCEPTIONS: • Hanta • Ebola • Yellow fever

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• They are -ve stranded = don’t have to switch to positive before replicating 181

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

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

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

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

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

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

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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

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What are the 7 B-cell deficiencies?

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Bruton’s agammaglobulinemia CVID (Common Variant Imm. Def) Leukemias Lymphomas SCID WAS Job Buckley Syndrome

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

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

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

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

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N-myc? Neuroblastoma Small cell lung CA C-able? CML ALL

Tumor Markers/Oncongenes II • C-myb? • Colon CA • AML • • • •

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

C-sis ? Osteosarcoma Glioma Fibrosarcoma

Tumor Markers/Oncongenes III

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• • • • •

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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

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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 •

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

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What is cancer staging?

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• Degree of dissemination of tumor • What the surgeon sees 200

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

201

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 • 202

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 •

203

What is carried by HDL? • Apo E • Apo A • Apo CII • L-CAT – lecithin cholesterol acetyl transferase • Cholesterol – from periphery to liver

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204

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

205

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

206

What is carried by LDL? • Apo B-100 • • Cholesterol – from liver to tissue • • NOT a good thing!!!!!

207

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)

208

Which lipoprotein carries the most cholesterol? • • • LDL •

209

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

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• Lungs? • Osler Weber Rendu Syndrome 210

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

211

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

212

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

213

What is dysguzia? • Problem with sense of taste

214

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

215

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

216

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

217

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

218

What are the phage mediated toxins? • Mnemonic: BEDS • Botulinum • Erythrogenic toxin – from strep pyogenes • Diptheria • Salmonella – Has O antigen •

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219

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

220

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

221

What does IgCam do? • Bind proteins

222

What do integrins do? • Stop the leukocytes

223

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

224

What are the functions of adhesion molecules? • Homing of lymphocytes – tells lymphocytes where to go • Inflammation • Cell-cell interaction •

225

Primary allergic response is due to what? • Contact

226

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

227

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

228

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

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• When does IgG leave? • In 1 year 229

What is Secondary Allergic response is due to? • MEMORY •

230

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

231

What Ig has the hightest affinity? • IgG

232

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

233

What are the risk factors for bladder CA? • Smoking • Aniline dyes • Benzene • Aflatoxin • Cyclophosphamide • Schistosomiasis • 2 diseases: • Von Hippel-Lindau • Tubular sclerosis

234

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

235

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

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• Niemann pick 236

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

237

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

238

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

239

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

240

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

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• 241

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

242

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

243

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

244

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 •

245

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

246

What are the Characteristics of Type IV hypersensitivity? • Cell mediated

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• • • •

What are examples of Type IV? TB skin test Contact dermatitis Transplant rejection

247

What structures have no known function? • Appendix • Epithalamus • Palmaris longus – muscle • Pancreatic polypeptide – hormones in F-cells

248

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

249

What are causes of papillary necrosis? • Vasculitis • AIDS

250

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

251

Cytic fibrosis Questions? • What is the value in a normal person? • 20 • Fractional Na+ excertion • 40

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324

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 522

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)

523

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

524

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

525

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

526

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

527

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

528

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

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• Female 529

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

530

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

531

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

532

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

533

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

534

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

535

What Immunogloblin is found in Hepatitis B immunity? • • IgG

536

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

537

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

538

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

539

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

540

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

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• • POSITIVE HbS antigen 541

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

542

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

543

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

544

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

545

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

546

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

547

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 •

548

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

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