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Question

IdMain Division Sub Division Notes

174 Pharmacology Allergy & Immunology Loratidine is 2nd gen antihistamine and safe in elderly coz no fall problems

375 Pathophysiology Allergy & ImmunologyHep B itself is not hepatotoxic but CD8+ repsonse to HBsAg and HBcAg will causedamage

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

1155 Immunology Allergy & ImmunologyCalcineurin activate IL2 which permit T cell proliferation. Hence the use ofCalcineurin inhibitors in transplants

1388 Microbiology Allergy & Immunology If a child has diphteria give antitoxin (passive immunization; most efficient), penicilinor erythromycin and vaccine. Otherwise prevent with vaccine (active immunization)

1389 Microbiology Allergy & ImmunologyNot all diphteria will cause pseudomembranous pharyngitis but need Tox gene toproduce its exptoxin AB

2068 Immunology Allergy & Immunology Tryptase is a specif ic marker for mast cells amd is useful in anaphylaxis

2069 Immunology Allergy & Immunology After IgE bind to receptors on Basophils and Mast cells these aggregate and causedegranulation of substances.

1175 Biostatistics Biostatistics & Epidemiology Absolute Risk Reduction= Event Rate % (A) - Event Rate % (B)

1183 Biostatistics Biostatistics & Epidemiology Mode is the most frequent value on statistics, it the least affected by outliers

1189 Biostatistics Biostatistics & EpidemiologyWhen choosing two groups of same age and sex and race you are reducing thechance of confounding bias. While selection bias occurs when you don't choose arepresentative sample of the population

1204 Biostatistics Biostatistics & Epidemiology

P value is called type I error: Probability that the difference ovserve is due to chancealone. Type II error is measured with the power: Beta (probabiity of concluding thatthere is no difference when there is actually one) The power is 1 - Beta; meaningthat is the pobability of concluding that there is a difference when there is actually one

1274 Biostatistics Biostatistics & Epidemiology A result is considered legit if the 95% CI does not cross 0, so p value is less than 0.05

1278 Biostatistics Biostatistics & EpidemiologyValidity (accuracy) is when a test gives very similar results than gold standardReliability refers to reproducibility of test (similar values all the time)

1279 Biostatistics Biostatistics & EpidemiologyEffect modification is when smoking increases HRT risks of DVT compared to justsmoker, while HRT alone do not increase the risk of DVT

1282 Biostatistics Biostatistics & Epidemiology In skewed graphs the hill is the Mean, then the Median and uphill is the Mode

1286 Biostatistics Biostatistics & Epidemiology Lung cancer has been increasing a lot recently in women

1299 Biostatistics Biostatistics & Epidemiology95% CI that value is between X+/- Y Y is 1.96 (SD/rootsquare N) aka (SE) if it is as

99% CI it becomes 2.58 SE

1302 Biostatistics Biostatistics & Epidemiology

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

10570 Biostatistics Biostatistics & EpidemiologyEcological study are like cross sectional study, but in ecological study you want tomeasure a certain geographical population habits or whatever. Used to makehypotheses about populations

35 Embryology Cardiovascular SystemTransposition of Great Arteries is failite of Aorticoopulmonary spiral septum toundergo septation.

40 Pathology Cardiovascular System0-4 hr post mi the myocardium is normal on histology. 4-12: coagulation necrosis,edema hemorrhage, wavy fibers 1-5 days neutrophils 5-10 macrophae 10-14granulation tissue then scar with collagen

42 Pathophysiology Cardiovascular System Myocyte will stop contracting 1 min after total ischemia but it reversible until 30 mins

43 Pathology Cardiovascular SystemHibernating myocardium refers to the presence of ledt ventricular systolic dysfunctiondue to reduced coronary blood flow at rest that is partially or completely reversible bycoronary revascularisation

92 Pathology Cardiovascular SystemIn dilated Myopathy (also in ischemic myopathy): Contractile function is decrease butnormal diastolic funciton (normal compliance) it is the opposite in HTN andhypertrophic cardiomyopathy

96 Pathophysiology Cardiovascular System Constrictive pericarditis is chronic

136 Pharmacology Cardiovascular System NO will induce high cGMP which put myosin light chain in their inactive conformation

141 Pharmacology Cardiovascular System In HOCM we use bb ccb disopyramide and diuretics or dilators

142 Pharmacology Cardiovascular System Patients taking nitrates shld have a nitrate free period daily to avoid tolerance

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

155 Pharmacology Cardiovascular SystemDigoxin: AV block (parasympathetik) so helpful in Afib while in CAD its effect is helfulcoz of increase co tractolity ( DI goxi. So two functions)

160 Pharmacology Cardiovascular System Prevent NIACIN FLushing BY NSAIDS


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198 Pathophysiology Cardiovascular SystemLHF will cause RHF by congestion pulmonary veins leading to vasoconstriction ofpulmonary artey and intimal thickening with media hypertrophy

200 Pathophysiology Cardiovascular SystemS3 is caused by increased preload and it can lead to functional mitral regurg that iseliminted by preload reduction

201 Pathophysiology Cardiovascular SystemPulmonary HTN cause irreversible damage to pulmonary arteries while RVhypertrophy can be reversible with correcting the HTN

202 Embryology Cardiovascular SystemPFO (failure of septum primum and secundum to fuse) and ASD (aplasia of eitherseptum secundum most commonly or septum primum) can both cause stroke fromvenous clot but the difference is that PFO does not cause murmur.

232 Pathology Cardiovascular SystemIE: vegetations on valve cups along with degeneration Rhemuatic fever: fibrousthickening and distortion of mitral valve with commissural fusion at leaflet edges

240 Histology Cardiovascular System Aschoff bodies are seen in heart rheumatic fever

245 Physiology Cardiovascular SystemIn tubes velocities: V1A1=V2A2=Cte (considering incompressible tubes, assumingvessels are not compressible we can apply this rule)

296 Pathophysiology Cardiovascular System Metastatic calcification occurs in cell necrosis (like in old aortic valve)

446 Pathophysiology Cardiovascular System Atheros plaques involve platelets (PDGF) macrophages that will promote migrationof smooth muscels

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

474 Pathology Cardiovascular System In Varicose vein we morry most about skin ulceratio not DVT and stuff

551 Physiology Cardiovascular SystemPermissive effect of cortisol: (it permits others to work at their best) On its own itdoesnt do anything But increase sensitivity of vessels and bronchial tissues to

catecholamines and increase glucose response to Glucagon679 Microbiology Cardiovascular System only Aureus is coagulase + among the Staphes

693 Pharmacology Cardiovascular System ACE inhibitor can cause hypotension in first doses therefore started gradually(dosage)

778 Pharmacology Cardiovascular System Statins and fibrates have fucked up effects on muscles

898 Pharmacology Cardiovascular System In PSVT adenosine will cause chest burning and flushing

899 Pharmacology Cardiovascular System

Amiodarone (class III K+ channel blocker of cardiac pacemaker cells so decreaserepolarization and increase AP so imcrease depo and repo time hence increase QTbut less associated with Torsades maybe coz of more homogeneous repolarization.So eventhough Amiodarone is BAD it has a GOod Side of the Force. Adenosineincrease K+ conductance in AV and cause delay

900 Pharmacology Cardiovascular SystemLidocine (IB) bind rapidly depolarizing cells (like cocaine is rapid). Ischemic heart is

depolarized, so Lidocaine likes it. SO LIDOCAINE IS GOOD IN MI944 Pathophysiology Cardiovascular System MR is severed with volume overload so when have S3 u know MR is at its max

951 Physiology Cardiovascular SystemIn exercise, tachycardia will reduce Diastolic time, so this is the limiting factor in Heartperfusion

1003 Microbiology Cardiovascular System

Viridans are acquired after dental procedure if have cardiac structuralabdnormaloties, and take glucose from out of cells and transform it into dextran tointegrate it into its polysaccharide cell wall, and also permits it to adhere to fibrin. SoViridans adhere to fibrin and platelets that are deposited at site of endothelial traumain the valves and cause infection there.

1014 Pharmacology Cardiovascular SystemDoxorubicin cause dose related dilated cardiomyopathy by creating free radicals..Radiation cause myopathies by perocardial fibrosis (viral and surgery.)

1080 Pharmacology Cardiovascular System Cilostazol is used in PAD, reduce,atelt activation and cause vasodilation

1094 Microbiology Cardiovascular SystemDiphteria toxin (AB exotoxin) ribosylate and therefore inhibit EF-2, so will inhibitprotein synthesis causing cell death

1118 Pharmacology Cardiovascular System ANP, BNP, NO --> increase cGMP --> relaxation of smooth muscle

1166 Pharmacology Cardiovascular System if have cough with ACE go for ARBs

1174 Biostatistics Cardiovascular System

When comparing the efficiency of a new drug mortality benifit over another standarddrug, the NNT (number to treat), represents the ammount of people needed to betreated to prevent on event compared to standard drug: 1/ARR(2.5%(risk of deathsof old drug)-1% (risk of death of new drug))

1252 Pharmacology Cardiovascular System Arteriolar vasodilator like hydralazine and minoxidil will cause reflex tachycardia andfluid retention

1344 Pharmacology Cardiovascular SystemDobutamine affects B1 and lesser B2 and A1. So increase HR and Contractilityhence increase Demand of O2

1444 Pharmacology Cardiovascular System FLAT CHAMP INCREASE cAMP

1512 Physiology Cardiovascular System

In fluid loss even if BP is low TPR is high due to Sympathetic activation. But Fluidinfusion will increase preload and increase End-Diastolic sarcomere length and willincrease Volume status decreasing Sympathetik stimulation and decrease TPRRemember SBP= CO.TPR, so in Hypovolemia CO is super low and even withsympathtic compensation to increase TPR, SBP stays LOW


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1513 Physiology Cardiovascular SystemCardiac electrical transmission speed: PAVA: Fastest --> Slowest: Purkinje fibers --> Atrial muscles --> Ventricular muscles --> AV node

1515 Physiology Cardiovascular SystemPSVT: Do Carotid massage (XI -> X), Valsalva or Adenosine and this will prolong AVnode refractory period

1517 Physiology Cardiovascular SystemIn mitral valve stenosis we have a snap (indicating that the stenosed valve is trying toopen but is finding difficulties) then a dyastolic rumbling murmur because of turbulentflow across this damaged valve.


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

1529 Physiology Cardiovascular System CO= O2 consumption/ AV O2 dif ference


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

1589 Physiology Cardiovascular SystemIn exercise PaO2 and PaCO2 do not change but CO and HR increase toaccomodate for tissue's demand PE --> Hyperventilation = Lower PaCO2

1621 Physiology Cardiovascular SystemFlow (Q)= dP/R Remember U=R.I R= v.L/r4 Q=r4.(dP/v.L) So if flow decrease by X ina medium of same property this means that the radius is decreased by X root 4 ButVelocity relation is A1V1=A2V2 and has a r2 relatioship change with velocity

1624 Physiology Cardiovascular SystemIn the Cardiac output, Venous return curve its easy. If an event decreases venousreturn like anaphylaxis for example lower the venous return curve. MI will lower theCardiac output curve maximum and slope. Anemia would higher it since we will havetachycardia


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


Pulsus Paradoxus usually happens in Tamponade but can also happen inConstrictive Pericarditis, Asthma COPD, or Hypovolemic Shock. In Tamponade,increased pericardial fluid will compress LV, and during Inspiration increased venousreturn in RV will move InterVentricular Septum towards LV, making it even smaller,thus a >10% decrease in SBP.

1871 Anatomy Cardiovascular SystemThe Inferior wall of left Ventricle lies on the Diaphragm and is supplied by thePosterior descending artery (from RCA)


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

1947 Pharmacology Cardiovascular SystemPhentolamine is competetive alha blocker wheras phenoxybenzamine is a noncompetitive irreversible antagonist


CCB's slow Diastolic depolarization of Pacemaker cells. (phase 0) they also decreaseintracellular Ca2+, affecting excitation-contraction of these cells, thereforedecreasing Contractility. But when question is about antiarrythmitic studies choosethe Antiarrythmic action of CCB's.

1975 Physiology Cardiovascular System ACh and Adenosine reduce phase 4 of spontaneous depolarisation, in cardiac

pacemaker cells.


Desynchronization between P and QRS means 3rd degree AV Block. This means Atria contract from SA node but the impulse does not make it to AV node on timemost probably due to circuit abnormality, so AV node will take over to contractventricles and will get narrow QRS (since it supraventricular firing, so AV node willfilter the impulse sent)


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

2002 Pharmacology Cardiovascular System Thiazide increase GLUC Glucose, LDL, Uric Acid, Ca

2009 Physiology Cardiovascular SystemThe heart has the highest oxygen extraction rate. (6075%) During exercise onlyincreasing coronary flow by Vasodilation which is mediated by Adenosine and NO willaccommodate for the increase oxygen demand since extraction is already almostmaximal. A


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

2130 Anatomy Cardiovascular SystemMost common cause of aortic rupture in MVC is at the Aortic Isthmus; the site ofligamentum arteriosum just dital to right subclavian

7640 Pharmacology Cardiovascular System Class III will increase QT, while digoxin will cause AV block

8711 Histology Cardiovascular System Thpe I Collagen is the most abundant overall and is the one we find in scars.


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

11764 Anatomy Cardiovascular SystemIn cardiac cath, when trying to reach the femoral artery, if cannulation is done abovethe inguinal ligament you can induce RETROPERITONEAL HEMORRHAGE(CARDIOLOGIST ARE SCARED OF THIS)

11833 Pathophysiology Cardiovascular SystemIn right MI have stiffness of RV so increase CVP (backup of blood) but low RV outputso Low PCWP

11842 Anatomy Cardiovascular SystemIn Afib clots form in left atrial appendage its a motionless part of the atria (ma ela3aze)

876 Pathology Dermatology Dermatitis herpetiform usually appear at 40-50 Eczema can occur after some food1061 Biochemistry Dermatology Zinc deficiency causes acrodermatitis enteropathica, infertility and Growth retardation

1106 Anatomy Dermatology

Apocrine glands secrete by cel lysis and content exretion like pimple glands(sebacious and meibomian) Apocrine secrete membrane bound vesicles (breast)while Merocrine secrete via exocytosis like salivry, eccrine and apocrine sweatglands (named this way coz thought to be apocrine in nature ) DA FUCK bass CV uwont be confused

1110 Pathology DermatologyVitiligo: loss of melanocyte (autoimmune pooly understood) in albinism havemelanocyte but cannot produce melanin (unlike vitiligo where melanocytes arefucked up)

1314 Pathology DermatologyLeprosy is attacked by CD4+ Th1 cell mediated response (like other Mycobacterium)so skin lesions are due to IL2 and IFN Gamma

1334 Biochemistry Dermatology

In Hartnup disease you have decrease Tryptophan absorption in guts and

reabsorption in kidneys. So you will eventually have decreased niacin and pallegra

1613 Immunology DermatologyGVHD occur also with liver transplant because it is rich in lymphocytes and occurs aweek later (around), Acute and chronic rejection are usually Host vs Graft (also T cellmediated)

1641 Pharmacology Dermatology

Acyclovir valcyclovir gancyclovir and those are nucleoside analogues that requireboth cellular and herpes kinases for conversion to their active nucleotidetriphosphate form Cidofovir is a nucleoside monophosphate only require host cellularkinase

1669 Microbiology DermatologyPost auricular lymphadenopathy makes us more suspicious towards rubella ratherthan measle

1725 Genetics Dermatology Androgenic alopecia have Polygenic Inheritance patterns

1937 Pathology Dermatology Lymhedema (like post mastectomy) increase risk of Angiosarcoma

2037 Biochemistry Dermatology In tRNA we have a CCA site where amino acids bind

8569 Pharmacology DermatologyPsoriasis is often treated with with topical vit D analogs; calcipotrieme that bindvitamin D recptor, inhibits keratinocytes proliferation and stimulate their differentiation

8904 Pathophysiology Dermatology

Accessory nipples are the most common congenital anomaly and fluctuate withmenstrual cycle, unlike nevi. On the other hand Neurofibroma are composed ofShwann cells and neural fibroblasts and can sometimes retract to subcutaneoustissue when pushed down.

11738 Pathology Dermatology TGF beta is responsible for fibroblast migration proliferation and CT synthesis

11852 Pathology Dermatology opioids, contrast, and vanco.. can trigger mast cell degranulation

1740 Embryology Ear, Nose & Throat (ENT)

Cleft lip: maxillary prominence fail to fuse with intermaxillary segment(below nasalseptum) Cleft palate: Failure of palatine shelves to fuse with one another or withprimary palate Occur in 5-6 week of embryo development. Cam occur together or inisolation.

11628 Pathophysiology Ear, Nose & Throat (ENT)Cholesteatoas are collection of squamous cell debris that form behind tempanicmembrane, can be congenital or acquired following infection, trauma.. cause hearingloss due to ossicle erosion


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11783 Anatomy Ear, Nose & Throat (ENT)Psterior bleeding with sphenopalatine bleed is usually uncontrollable with bleed andoccur with HTN

163 PharmacologyEndocrine, Diabetes &Metabolism

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


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


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


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

216 PhysiologyEndocrine, Diabetes &Metabolism

Sertoli cells secrete Inhibin B to feedback inhibit FSH. Leydig cells secrete Testosthat feedback inhibit LH. Sertoli cells also secrete Androgen binding proteins to bindTestosterone and trap it there since it needs it for spermatogenesis. This is differentfrom Sex binding protein which let testosterone circulate in the blood and is producedby liver

225 PathologyEndocrine, Diabetes &Metabolism

Acute hemorrhage into the pituitary (pituitary apoplexy) is usually aassociated withPituitary Adenoma Severe Headache, Cranial Nerve Involvement (bitemporalhemianospia, ophtalmoplegia) and meningeal irritation. Cardiac Collapse is due toadrenal insuficiency

342 EmbryologyEndocrine, Diabetes &Metabolism

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

599 PharmacologyEndocrine, Diabetes &

Metabolism

Pioglitazone and stuff work on PPAR gamma in fat so make u FAT not only by fat but

also by increasing Na absorption in Collecting Tubules

602 BiochemistryEndocrine, Diabetes &Metabolism

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


Pioglitazone affect transcription factor and gene involvement so takes time


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


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

631 Pathophysiology

Endocrine, Diabetes &

Metabolism

hyperPTH leads to Osteitis Fibrosa Cystica where we have subperiosteal eiosions

affecting phallanges of hand, "salt and pepper" skull, and brown tumor bone cysts.

767 PathophysiologyEndocrine, Diabetes &Metabolism

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


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


TSH stimulate I-(Iodide) absorption (Na+I- symporter) in Follicular cells and iscompetitively inhibited by Perchlorate and Pertechnetate, then goes in the colloid. I-is converted to I2 (Iodine) in the colloid (catalysed by Peroxidase). Thyroglobulin issynthesized in Follicules then go to colloid too, where its tyrosine residues bind to I2(Peroxidase). MIT and DIT are phagocytosed in follicular cells then those who arenot deiodinated join and T3, T4 form and are released

771 Embryology


Metabolism

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

chromaffin cells)


Glitazones PPAR GAMMA STUFF reduce insulin resistance


Remember Thiazide and HyperGLUC


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


Steroid, Thyroid hormones, VitD: Intrareceptor with DNA domain (to alter DNAexpression when go in nucleus) Ligand-gated ion channels (Na+,K+,Ca2+,Cl-)across membrane for membrane potential etc. Intrinsic Phosphorylation: Insulin andInsulin like GF JAK STAT: GH, Prolactin, EPO Hypercalcemia Hypocalciuria (ADsince all family has it): Defective Ca2+ sensing G (THINK C, G LOOK ALIKE) proteinscoupled receptors in PT gland and kidney that regulate circulating Ca2+ levels.


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


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Beta cells: Glucose enters pancreas through GLUT 2 transporter undergoesglycolysis and produces ATP which will bind ATP-sensitive K+ channels (opened atrest and maintains K+ efflux keeping cell hyperpolarized) and close them. This willdepolarize cell, which will open Voltage-dependent Ca2+ channels, increasing Ca2+intracellularly and inducing insulin release. If KATP channels do not respond to ATPwe will have DM. Sulfonylurea bind KATP, close them irrespectively of ATP


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


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

1013 Biostatistics


Metabolism

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

Cardiac events


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


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


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


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


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

Mitochondria


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


Alpha stimulation is dominant over beta thats why epinephrine decrease insulin


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


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


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


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


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


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


RAT (activating mutation) in Men RAS is follicular thyroid


Insulin synthesis: Insulin translation starts in ribosomes to yield PreProInsulin. Thentranslation continues in RER Ribosomes (the same ribosome translocates). In theRER first the N terminal is cleaved giving Proinsulin then 3 disulfides bonds in theInsulin parts form. The ProInsulin is sent to the Golgi Apparatus and is cleaved byendopeptidases, but both Insulin and C peptides are stored in granules and secretedfrom Beta cells. But C peptide's half life is only 35 mins


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


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


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

2081 Pathology Endocrine, Diabetes &Metabolism In CAH give Steroids to supress ACTH


Sulfonylurea can cause Severe Hypoglycemia


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Sulfonylurea can cause Hypoglycemia


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

207 PhysiologyFemale ReproductiveSystem & Breast

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

258 PathologyFemale ReproductiveSystem & Breast

PCOS have increased risk of endometrial ca and DM II


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

1015 HistologyFemale ReproductiveSystem & Breast

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


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


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

1549 PathophysiologyFemale ReproductiveSystem & Breast

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

1560 PhysiologyFemale Reproductive

System & Breast

Theca interna: Cholesterol -(LH)-> progesterone + Androgen --> Granulosa(Aromatase): Androgen -(FSH)-> Estrogen. This actually explains why LH and

Progesterone are not null during Follicular phase. Theca externa serve as supportiveconnective structure.

1632 AnatomyFemale ReproductiveSystem & Breast

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


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

1809 EmbryologyFemale ReproductiveSystem & Breast

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

1831 EmbryologyFemale ReproductiveSystem & Breast

Bicornuate nucleus: Incomplete lateral fusion of paramesonephroc duct


Anovulation is common in first years of menarche (Immature axis, so follicle does notbecome corpus luteum) and last years before menopause, it manifests withmenstrual variability, spots Complex atypical endometrial hyperplasia occurs withprolonged unopposed estrogen, it can happen with chronic anovulatory cycles(where you only have estrogen without progesterone), HRT without progesterone orObese old women. Atrophic endometrium occurs in menopause (also get spotting


Ovary is cuboidal cells

8556 GeneticsFemale ReproductiveSystem & Breast

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


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

11802 MicrobiologyFemale Reproductive

System & Breast

KOH is used to diagnose gardenella While trichonoma protozoa with flagella are

seen on wet mount


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

47 Microbiology Gastrointestinal & Nutrition hep B give hep D a capsule giving it its virulence and ability to invade hepatocyte

57 Pathology Gastrointestinal & Nutrition Aflatoxin G->T mutation in p53, increasing r isk of HCC. Found in grains cornssoybeans peanuts where fungi are grown

62 Microbiology Gastrointestinal & Nutrition Liver abscess can be caused by Staph throgh hematogenous route MESH GHALAT

70 Biochemistry Gastrointestinal & NutritionIn infections Beta glucoronidase are released by hepatocytes and unconjugateconjugated bilirubin causing it to precipitate and causing brown stones

78 Pathophysiology Gastrointestinal & Nutritioncholesterol makes bile less soluble while bile salts and phosphatidylcholine makes itmore soluble

126 Physiology Gastrointestinal & Nutrition

Acid secretion: 3 phases Cephalic: Vagal and cholinergic: stimulated by thought,sight, smell and taste of food Gastric phase: Chemicals in food and gastric distention;Gastrin-->Histamine (Enterochromafin like cells; ECL) --> Acid secretion Intestinalphase: proteins in Ileum and Colon will produce Peptide YY which will bind to ECLand inhibit gastrin stimulated histamine release from these cells When acid issecreted Bicarb and Cl- decrease in circulation (predictable)


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133 Pathophysiology Gastrointestinal & Nutrition Can diagnose Lactase deficiency by decreased pH of stool

165 Pharmacology Gastrointestinal & NutritionStatins decrese cholesterol formation SURE, BUT BUTTT cholestyramine will bindbile acids and cause increase excretion so liver will produce more cholesterol tothrow in bile

280 Pathology Gastrointestinal & Nutrition Esophageal spasm is due to imparied neural inhibition within the myenteric plexus

290 Pathology Gastrointestinal & Nutr ition Erosion does not cross Muscularis Mucosa While Ulcer Do Cross it

306 Pathophysiology Gastrointestinal & NutritionMastocytosis will increase Histamine and cause Gastric Hypersecretion (EZ)(Associated with KIT receptor Tyrosine Kinase Mutation)

319 Embryology Gastrointestinal & NutritionDuodenal atresia is due to recanalization failure while Jejunal/Ileal atresia is due tovascular injuries

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

322 Embryology Gastrointestinal & Nutrition

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

328 Embryology Gastrointestinal & NutritionMeckels diverticulum is a true one and is composed of all layers; mucosa,submucosa and muscular layers

369 Pathophysiology Gastrointestinal & NutritionInhaled halothane can cause fulminant hepatitis (looks like viral hep) and will havehigh ALT AST, and decrease hepatic function so failure so prolonged PT and stuffbut no hepatic HTN

370 Pathology Gastrointestinal & Nutrition Alcohol inhibits Free FA Oxidation and Gluconeogenesis coz have INCREASEDNADH

373 Immunology Gastrointestinal & NutritionChildren


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1136 Microbiology Gastrointestinal & Nutrition Shigella need 10-500 bacteria to infect Very BadAss

1156 Pharmacology Gastrointestinal & Nutrition Iron poisoning will cause diarrhea while lead will cause constipation

1169 Biostatistics Gastrointestinal & NutritionNPV and PPV depend on disease prevalence irrespectively of test sensitivity andspecifictiy

1251 Biochemistry Gastrointestinal & NutritionTrypsinogen is converted to Trypsin in duodenal of epithelium and in turn activatesother digestion proteins

1258 Pharmacology Gastrointestinal & Nutrition Morphine cause smooth muscle contraction in sphincter of Oddi

1290 Pharmacology Gastrointestinal & NutritionDiphenoxylate (opioid and act on mu receptors ) given with diarrhea, but is given withatropine to produce bad effects and discourage abuse and tolerance

1396 Pathology Gastrointestinal & Nutrition

Pseudomembranous colitis (C diff): White/yellow plaques membrane like on colono

composed of fibrin and inflamatorry Undercooked meat: cysticercosis : Seizures, SCnodules, IM calcifications

1397 Microbiology Gastrointestinal & NutritionC diff toxins A: intestinal inflamation and fluid secretion B: Cytotoxic (affect actincytoskeletal structures an intracellular signaling)

1398 Microbiology Gastrointestinal & Nutrition Clostridium mostly attack people with disturbed GI microbiome

1467 Immunology Gastrointestinal & NutritionSabin (oral polio vaccine) has better IgA activity than Salk doing a better job atmucosal entries

1525 Anatomy Gastrointestinal & Nutr ition Air in Biliary tree means GB, SB f istula for STEP 1

1596 Immunology Gastrointestinal & NutritionUnlike other parasites, Giardia is all about IgA defense and not eosinophils (involvedin Helminthic infections)

1807 Biochemistry Gastrointestinal & NutritionRiboflavin B2 is used in TCA cycle by transforming Succinate to ketoglutarateforming FADH2 while the reaction before of Succinyl CoA to Succinate forms 1 GTP

used in Gluconeogenesis

1863 Pathology Gastrointestinal & Nutrition

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

1918 Pathology Gastrointestinal & Nutrition Atrophic Gastr itis Affect the Body of stomach while H pylori zffects the Antrum firstthen the Body

1927 Pathology Gastrointestinal & NutritionViral Hepatitis cause Apoptotic Hepatocytites so get round acidophilic CouncilmanBODIES (eosinophilic ) also seen in Yellow fever

1938 Physiology Gastrointestinal & Nutrition

Motilin is produced by Duodenal mucosa ans stimulates Smooth Muscle contractionin Upper GI. erythromycin acts as a Motilin Agonist, causing Diarrhea. Ghrelin(Hunger): Increase in Fasting, Decrease after Eating. Glucagonoma: DM, NECVIPoma (Pancreatic Islet Gumor): increase Cl- loss in stools, and excess H2O, Na+

and K+ follow, leading to Diarrhea. It also inhibits Gastric acid secretion. treated withSomatostatin Gastrin: acid secretion and growth of gastric mucosa

1971 Physiology Gastrointestinal & NutritionSecretin, secreted by Duodenal S-cells in response to H+ in the duodenum, willstimulate Bicarb secretion from pancreas. On the other ither hand, pancreticenzymes are secreted following Vagal and CCK stimulus (like Gallbladder)

8283 Genetics Gastrointestinal & NutritionLinkage disequilibrium is when the frequency of alleles independently do not matchthe frequency of having both alleles at the same time

8578 Biochemistry Gastrointestinal & Nutrition

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

10401 Microbiology Gastrointestinal & Nutrition Fidaxomicin is used in resistant C diff

10583 Anatomy Gastrointestinal & Nutrition The portal triad (Hepatic artery, portal vein and CBD ) run through thehepatoduodenal ligament so if there is bleeding we clamp the ligament to rule in orrule out any other cause of bleed

11591 Pathophysiology Gastrointestinal & NutritionIn gerd Dysphagia is more consistent with ulceration while dysphagia and obsturctiongoes more with strictures

11629Behavioralscience

Gastrointestinal & Nutrition As a physician be RADICALLY AGAINST Herbal products especially if you are surethey are bad

11771 Anatomy Gastrointestinal & Nutrition

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

11782 Anatomy Gastrointestinal & Nutrition The appendix is best identified by the converence of the 3 Taeniae Coli of the colon

11795 Anatomy Gastrointestinal & Nutrition

Chronic pancreatitis can cause splenic vein thrombosis causing short gastric vein

varicoses (Dr levi style)

11860 Pathophysiology Gastrointestinal & Nutrition Bacteria in guts produce not only Vit K but also Folate


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757 Physiology General Principles

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

1028 Biochemistry General PrinciplesDuring exercice the Ca2+ release in muscles will also activate glycogen pathway andglycogenolysis hence the parallel association between muscle contraction andgycogenolysis

1469 Genetics General PrinciplesRota and influenza like genetic shift through reassortment thats why they arecommon and need to vaccinate many times (more efficient virulence than geneticdrift: pt mutation) Shift is Sudden wheras Drift is graDual (less killer machine)

1482 Biochemistry General Principles

B6 is involved in transamination reaction where an amino group from an amino acid

goes to an alpha ketoacid making it an amino acid. B6 is involved in decaboxylationreaction

1616 Physiology General PrinciplesCircuit in Parallel: 1/Rt = 1/R1 + 1/R2 + 1/R3 (Think how circulation in the body whichis mainly in Parallel wants to be efficient) In series: Rt = R1 + R2 + R3

1712 Pharmacology General Principles Isoniazid metabolism by acetylation so we have fast and slow acetylators.

1714 Pharmacology General Principles T1/2:0.7xVd/Cl

1715 Pharmacology General Principles Lipophilic deug prefer liver exretion Mante2

1728 Genetics General Principles Lesh nyhan is X linked recessive while Galactosemia is AR

1912 Microbiology General PrinciplesThayer and Martin are selective and only ahve sex together but culture neisseriaBADDEEE

1970 Genetics General Principles Pleiotropy = One mutation and many many consequences

2025 Genetics General Principles Enhancers/Repressors can be anywhere in relation to the gene involved, whilepromoter are 25-70 base pair upstream to start of gene

2029 Genetics General Principles Stop codon UAA UAG UGA are recognised by Realeasing Factor 1

2030 Genetics General PrinciplesTATA box is a promotor (25 bases upstream) that bind to transcription factor andRNA polymerase II (in Eukaryote, binding RNA polymerase alone is not enough) fortranscription initiation.CAAt box is also a promotor but 85 bases upstream

2031 Genetics General Principles N myc is a transcription factor and bind DNA

2033 Genetics General Principles

Postranscriptional modification: (occur in nucleus) 5' capping Poly A tail (3' end):when AAUUAAA (transcribed from DNA) is detected the cap is added (cap is nottranscribed from DNA), protects mRNA from degradation in chtoplasm Splicing:Introns removal

7791 Genetics General PrinciplesMethylation of Cytosine in DNA is implicated in gene silencing and hence inImprinting of disease ( why silent in mom not in kids for ex)

11514 Pathology General Principles Hand Hygiene is best way to prevent hospital infections

11674 Immunology General PrinciplesUbiquitin proteasome pathway: ubiquitin tag bad particles (like viral particles),proteasomes come degrade them then they a presented on cell surface bound toMHCI for presentation to cytotoxic CD8 cells


General PrinciplesPreventable adverse event is defined as injury to a patient due to failure to followevidence based test practice guidelines

58 Pathology Hematology & OncologyHep C (RNA virus) lacks reverse transcriptase and does not integrate into genomeulnike DNA Hep B that do integrate

346 Biochemistry Hematology & Oncology

VWF --> GP Ib (Bernard) --> GP IIb-IIIa (Glanzman). If you add ristocetin you willactivate GP Ib receptors on platelets and make it available for vWF binding. If still noresponse then vWF vs GP Ib. If normal plasma is added and still no reponse toristocetin it is Bernard (coz vWF is contained in normal plasma)

465 Pathology Hematology & Oncology Factor V is when factor V is resistent to protein C deactivation

537 Immunology Hematology & OncologyWiskott Aldrich is triad of Eczema, Thrombocytopenia (both appear early) and B, Tcells immunodeficiency appearing at 6-12 months.

540 Immunology Hematology & OncologyC1 binds to IgG and IgM (Pentameric, so binds better) to activate complementsystem, at the hinge point of the heavy chain

559 Immunology Hematology & Oncology Immature T lymphocytes in Thymus cortex, express both CD4 and CD8

614 Pathology Hematology & Oncology Glioblastoma: Necrosis and vascular proliferation

787 Physiology Hematology & OncologyHpecidin, secreted by liver will decrease intestinal Iron rate absorption. It is increasedin Inflammation, and high iron levels. It is decreased in hypoxia and erythropoeisis.Low Hepcidin, increase intestinal absorption and release from Macrophage.


RBC dont do oxidative phosphorylation since they dont have ATP, and they donteven produce enough ATP in Glycolysis coz they sacrifice 1,3 BPG (which usually

gives ATP by turning into 3-phosphoglycerate), by turning it into 2,3 BPG (LOGICALYA?)

1035 Biochemistry Hematology & OncologyNADPH can be synthesised through the oxidative pathway of HMP shunt but canalso be formed from the non oxidative pathway through Transketolase andTransaldolase from Fructose6P instead of G6P


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1039 Pathology Hematology & Oncology TNF alpha cause cachexia

1077 Pharmacology Hematology & OncologyHeparin attaches on AT III and and enhances its activity by inhibiting Xa andthrombin, LMWH IS MORE SPECIFIC FOR Xa

1242 Biochemistry Hematology & OncologyIn HbS valine take the place of glutamate in 6th position of the beta chain causingnew hydrophobic interactions hence sickling

1257 Pharmacology Hematology & OncologyOpioids has many sode effects like constipation nausea vomiting.. But buildto,erance to all and dont get side ffects anymore except for CONSTIPATION ANDMIOSIS

1338 Biochemistry Hematology & OncologyIn acute porphyria, you can give heme which will inhibit ALAminuvic acid synthetaseand decrease accumulation of D ALA and porphorynohenc

1403 Genetics Hematology & Oncology AML M3 (15:17), and Retinoic acid receptor are malfounctional1405 Pathology Hematology & Oncology AML (15-17t): Auer rods


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

1455 Biochemistry Hematology & OncologyIn RBC, Heme is produced in Mitochondria firs 3 reactions, then cytosol. So whenRBC mature and lose their mitochondria, u cannot synthesize anymore heme

1455 Biochemistry Hematology & OncologyRBC cannot produce heme coz they dnt have Mitonchondria responsible for first andlast step of production

1474 Genetics Hematology & OncologyRadiation therapy works through breaking Double Strand DNA, and creating freeradicals too

1476 Biochemistry Hematology & Oncology Thymidine dimers are usually corrected by endonucleases

1496 Microbiology Hematology & OncologyI know its weird but Aplastic Crisis affect only RBC while Aplastic Anemia affects alllines

1545 Physiology Hematology & Oncology

CO poising will increase Carboxyhemoglobin (CO bound Hemoglobin) but does notaffect PaO2 since it competes with O2 in Hemoglobin not in plasma. It will not affectMethemoglobin (Iron oxidized to Fe3+ due to Dapsone, Nitrite, Enzyme deficienciesor Hemoglobinopathies) . CO poisoning will cause a Left Shift (Decreased O2tendency to unload)

1614 Immunology Hematology & Oncology Isotype sworching occurs in germinal centers of LN

1647 Pharmacology Hematology & OncologyGanciclovir can cause NEUTROPENIA. its effect increase with TMP SMX orZiDoVuDine coz also can cause BM supression

1654 Physiology Hematology & OncologyPatients who receive more than 5L/24 hrs of PRBC will have high levels of Citrate(used to store blood), which in turn chelates Ca2+ and Mg2+, lowering their blood

level, causing parastheisa

1683 Immunology Hematology & Oncology Rhogam is an IgG antibody

1717 Pathology Hematology & OncologyRb is active HypoPhosphorylated (its in kidss so we dont like much phosphorylation,,,)

1753 Pathology Hematology & OncologyIn Dysplasia there is reversible change in epithelial. Once the dysplastic cells havebreached the basement membrane it os no longer reversible

1754 Pathology Hematology & OncologyLymphocyte bnign vs malignant: Monoclona T cell vs Polyclonal in infection (makessense)

1758 Pathology Hematology & Oncology

bcl2 (oncogene on chromo 18) It inhibits apoptosis of tumor cells and facilitatesneoplastic growth.. In follicular lymphoma (B cell tumor) bcl-2 goes to ch 14 and isover4 expressed RAS: component of MAP kinase path, transmits signals from cellsurface to nucleus (pancreatic, GB, colon, endometrium, thyroid ,lung cancers) DNA

mismatch repair: in Lynch syndrome (colon and stuff)

1786 Pathology Hematology & OncologyPure red Cell aplasia is seen in : Thymoma, Lymphocytic Leukemia, and ParvovirusB19 infection

1788 Genetics Hematology & Oncology Hemophilia is X-recessive

1796 Pathology Hematology & OncologyErythropetein have bluish cytoplasm reticular precipitates of rRNA and is larger (alsolacks a nucleus)

1797 Pathology Hematology & OncologyMosto Carcinogens enter body as inactive but P450 (monooxygenase) make themso, and it depends on this system to determine succeptibility of individual

1819 Pharmacology Hematology & OncologyMDD1 code for a P glycoprotein a transmembrane ATP dependant efflux pump thatincrease efflux of drugs and decrease influx of these chemo agents making the cellsresistant to chemo

1847 Biochemistry Hematology & Oncology Folate i s needed for Thymidine formation

1861 Pathology Hematology & Oncology Aplastic anemia (Thrombocytopenia, Anemia, and absent hematopoietic cell inmarrow) will have BM with fat infiltrate

1872 Pathology Hematology & OncologyIntegrin bind cells to basement membrane by attaching it to FIBRONECTIN,COLLAGEN, And LAMININin Extracelullar matrix


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1873 Pathology Hematology & OncologyVEGF and Fibroblast Growth factor cause angiogenesis while epidermal growthfactor affect mitogenesis of hepatocytes and fibroblasts

1877 Pathology Hematology & Oncology Peau dorange is due to lymphatic obstruction

1890 Pharmacology Hematology & Oncology6-MP -(HGPRT)-> Active Metabolites 6-MP -(Xanthine Oxidase)-> InactiveMetabolites (that why allopurinol will increase dose of 6-MP)

1911 Genetics Hematology & Oncology Follicular lymphoma 14:18 translocation causes Bcl2 overexpression

2018 Pharmacology Hematology & Oncology ETOPOS(second)ide block TOPOisomerase Second (II)

2086 Biochemistry Hematology & OncologyThalassemia intermedia is associated with a muation three bases upstream from thestart codon (AUG) exchanging a puring with a pyrimidine

2133 Pathophysiology Hematology & Oncology

Thrombin II inhibtors will affect TT (throbin time) also PT PTT Xa inhibitor will affect

both in theory (in practice PT is barely affected coz of heparin neutralizer in the PTreagent)

7643 Immunology Hematology & OncologyIn EBV you get atypical CD8 T cells in circulation (large with eccentric nucleus) toattack B cells infected (you also get atypical B cells but in much smaller proportion)

8276 Biochemistry Hematology & Oncology In Alternative Splicing, same gene will give different mRNA in different tissues

8371 Pharmacology Hematology & Oncology ralTEGRAvir: Inhibits HIV inTEGRAse, so that its DNA will no be well incorporated

11728 Pharmacology Hematology & Oncology In chemo induced nausea inhibiting Neurokunin is good too (Tfayli's talk)

11750 Pathology Hematology & Oncology Hairy cell leukemia will cause marrow fibrosis

11754 Pathology Hematology & Oncology Sclerotic means osteoblastic

11816 Biochemistry Hematology & Oncology Lead: ALA D, Ferrochelatase are affected B6: ALA S is affected

44 Microbiology Infectious DiseasesHep C envelope changes a lot coz its RNa dependant RNA polymerase has no

proofreading 3"-->5" exonuclease activity

46 Microbiology Infectious Diseases

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

112 Immunology Infectious DiseasesLocal Candida is controlled by T cell (seen in HIV) wheras disseminated Candida iscontrolled by neutrophils (seen in neutropenic)

376 Microbiology Infectious Diseases Atypical lymphocytes can be seen in Hep B, EBV and CMV and are non specific..

390 Pathology Infectious Diseases in 95% of pple hem B will resolve after acute attack

532 Microbiology Infectious Diseases Aspiration pneumonitis is like aspiration pneumonia but resolves on its own andoccur few hours after aspiration not days like pneumonia. Occurs by aspiration oforal anaerobes not gastric!!!!

676 Immunology Infectious Diseases In TSST-1, the toxins which are superantigens activate T cells and Macrophage819 Pharmacology Infectious Diseases Protease inhibitors navir cause metabolic stuff

822 Pathophysiology Infectious Diseases Hep B are associated with HCC coz of the integration of DNA into host genome

963 Microbiology Infectious DiseasesH. flu are blood loving, but needs factor X and NAD+ for growth. So wont grow onsheep blood agar unless cultured with Staph that will povide her with NAD+

977 Microbiology Infectious DiseasesOxidase + comma shaped bacteria: cholera: grow in alkaline (so PPI or decreaseacidity will promote its proliferation) pylori: In acidic coz produce urease Campylo: in42 degree They are all special

1091 Pharmacology Infectious Diseases In Tazocin, Tazobactam role is to decrease Piperacilin destruction (like Carbidopa)

1103 Microbiology Infectious DiseasesHib, in young children cause: MEningitis, pneumonia, bacteremia and epiglotitis (BIGSHIT) While Sinusitis and OM are caused By NON TYPABLE H. flu

1137 Microbiology Infectious DiseasesSalmonella Vi antigen (its virulence factor) makes it resistant to opsonization and

phagocytosis

1309 Microbiology Infectious Diseases

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

1392 Microbiology Infectious DiseasesListeria (food borne) frows well on cold tpragure and can contaminate refregiratedfood. It is a gram + with tumbling motility

1393 Pharmacology Infectious Diseases Loster ia is nod responsive to ceftr iaxone so also give ampicillin

1408 Microbiology Infectious Diseasesthe Herepsviruses family get their membrane from nuclear membrane of cells (unlikethe rest, get it for cell membrane.. NICE StufF)

1468 Immunology Infectious Diseases

IFN alpha and beta are secreted in response to viral particles and decrease their

protein synthesis capacity and replication, promoting apoptosis

1550 Microbiology Infectious DiseasesIn primary herpes, a week course of acyclovir will reduce the disease but not preventrecurrence (latent in sacral ganglia S2 S3 S4). On the other hand prophylaxis dailyvalacyclovir will do the job

1551 Pharmacology Infectious Diseases Acyclovir (nucleoside analogs) coz like Adenosine


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1593 Microbiology Infectious Diseases CMV is EBV with (-) heterophile test (as in fail to agglutinate horse erythrocyte)

1645 Pharmacology Infectious Diseases Acyclovir and ovirs are to be phosphorylated to become in their act ive forms

1649 Immunology Infectious DiseasesIn Influenza it is Antibodies against Hemaglutinin that primary protects againstinfection

1670 Microbiology Infectious Diseases The 3 C's of measle + fever are prodromal to the rash

1965 Pharmacology Infectious DiseasesPrimaquine is given to kill liver stage malaria hypnozoite and thus preventing relapse.Malaria consists of fever and sweating in a 48 h cycle

2110 Pharmacology Infectious Diseases Penicilln and Ceohalosporins bind to cell membrane proteins such as transpeptidase

2111 Pharmacology Infectious Diseases

Cephalosporins resitance mechanis, by changing in penicilin binding proteinstructure ( some of the protein remain normal so still have some binding) whereas in

beta lactamase in case of penicillin there is no binding at all coz antibiotics will all bedisabeled)

8288 Pharmacology Infectious DiseasesDaptomycin (cover gram + and MRSA) work by depolarizing bacteria Ceels andtherefore inhibits DNA RNA fprmation and protein synthesis, but cause myopathyand increase CPK

8593 Microbiology Infectious Diseases Alcohols are antisceptic coz they disrupt cell membranes..

11395 Microbiology Infectious DiseasesDengue fever has 4 serotypes. Chill infections vs Bad ones are due to diferrentserotypes

11525 Microbiology Infectious DiseasesIFN Gamma are produced by NK (T cells, stimulated IL12 from macrophage) andagain activate macrophage to kill phagocytosed pathogens

11547 Microbiology Infectious DiseasesCat bite: barto, pasteurella Dog: pasteur, strep, staph aureus Human: anaerobes,strep, eikenella

11590 Pharmacology Infectious Diseases Abacavir (nrti) is associated with hypersensitivity in 10% of pple with HLA B57

11596 Microbiology Infectious DiseasesParotitis can occur in elederly (weird presentation: pre/postauricular swelling thatextends to mandible) which are dehydrated and intubated. But here it caused byStaph most commonly and diagnosed by imaging and amylase levels

11670 Microbiology Infectious Diseases Neurocysticercosis (taenia solium) cystic brain lesion in Central america

11729 Pharmacology Infectious Diseases Acyclovir: viral inhibition of DNA polymerase

11766 Microbiology Infectious Diseases E coli is lactose fermenting, INDOLE (+) (coz they are indolent)

11822 Microbiology Infectious Diseases Roseola (HHV6): 3-5 days of fever (often have febrile seizures) than truncal rash

343 Genetics Male Reproductive System Klienfelter 46 XXY, tall male with boobs aazospermia and mild mental retardation

807 Genetics Male Reproductive SystemCF patient are Infertile due to absent Vas Deferens bilaterally. In Kartegner spermare immotile but we have Vas

1449 Embryology Male Reproductive System

SRY --> TDF --> Testes develop --> Sertoli (Secrete MIF --> Paramesonephric ductPMD involute) Leydig cells (Produce Testosterone --> Transform Wolffian duct intoMale internal Genitalia; Epididymis, Vas Deferens) Testosterone --> DHT -->Transform Genital Tubercle and Urogenital Sinus into Male external Genitalia (Penis,Prostate) IN XY, IF NO SERTOLI CELLS YOU WOULD HAVE BOTH FEMALE ANDMALE INTERNAL GENITALIA BUT MALE EXTERNAL GENITALIA (coz MIG is nothere to involute PMD

11747 Anatomy Male Reproductive System Prostate Ca spreads to bone through prostatic venous plexus first

11762 Anatomy Male Reproductive System

Deep ring: Internal Spermatic Fascia (coming from transversalis fascia) Superficialring: External Spermatic Fascia (External Oblique) COZ Deep Internal So in Cryptoneed to bring testicle from superficial ring which its opining is mainly Externalspermatic fascia (coming from external oblique)

6 PathologyMiscellaneous(Multisystem)

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

701 GeneticsMiscellaneous(Multisystem)

Achondroplasia is AD

1332 BiochemistryMiscellaneous(Multisystem)

In Homocyteinuria, homocysteine is not metabolised to cysteine due to cystathionereductase problem


Alkaptonuria is a problem in converting Tyrosine to Fumarate (its TCA intermediateequivalent) so its like the next step after Phenylketonuria. Homogentisic aciddioxygenase deficiency so homogentisate (next step after tyrosine) accumulate. GetBlack urine, pigmentated face and other organs, arthropathy.


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


Miscellaneous(Multisystem)

Always get a translator when it is not very clear

11532 Behavioralscience


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



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


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



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



Medicare cover people above 65 or younger with disabilities

11635 AnatomyMiscellaneous(Multisystem)

Most common site of compartment syndrome is Anterior compartment innervated byDeep peroneal nerve

11678 PharmacologyMiscellaneous(Multisystem)

[Drug]=mg given/Vd

11757 Behavioralscience


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

18 Pathology Nervous Systemin Hypoxic ischemic encephalopathy (in arrest) hippocampus is first damaged, thenneocortex and Purkinje of cerebellum

20 Histology Nervous SystemIn brain infarcts, neutrophils come in the first 24-48 hrs, do not phagocytoseanything. Microglia (3-5 days later they deposit), then Astrocyte will cause peripheralglial scar and get central cyst instead of necrosis

22 Pathology Nervous Systemif HTN and lacunar stroke and dont appear directly on CT but later it is due to HTNarteriosclerosis and not Charcoud bouchard rupture that wld appear directly on CT

249 Pharmacology Nervous SystemIn abscence followed up by generalised tonic clonic ethosuximide wont help. UseValproic acid

262 Pharmacology Nervous SystemCarbidopa is given with levodopa to inhibits levodopa conversion into dopamineoutside CNS (by being itself metabolised) but with carbidopa we will have moredopamin in CNS and more SE like agitation and anxiety..

347 Pathology Nervous Systemsubdural hemorrhage in babies is sign of abuse (shaken baby syndrome) and haveretinal hemorrhage

348 Pharmacology Nervous System Ramelteon, a melatonin agonist is used for insomnia in elderly.

357 Genetics Nervous System

Blotchy red muscles fibers on Gomori trichome stain = Mitochondrial Myopathies(Maternal Inheritance) --> Abnormal Mitochondria (increased in number, enlarged,abnormally shaped) accumulate in the fibers making them look irregular in size andshape. "Red Fagged Fiber" Examples: Myoclonic epilepsy with red ragged fibers(MERRF), Leber optic neuropathy (Blindness), Mitochondrial encephalopathy(stroke-like episodes) and lactic acidosis (MELAS)

397 Pathology Nervous System Slit lamp exam to Diagnose Kayser Fleisher

499 Pathology Nervous System

The most common cause of spontaneous lobar hemorrhage in the elderly is

Cerebral Amyloid Angiopathy (same amyloid seen in Alzhemer) and most commonlyoccurs in occipital and parietal lobes

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

509 Pharmacology Nervous SystemETHosuximide block T type calcium cahnnels in THalamus. Used for Abscenceseizure

566 Anatomy Nervous SystemPancoast cause ipsi Horner and ipsi shoulder and arm weakness and areflexia dueto brachial plexus involvement

590 Genetics Nervous System Alzheimer: Neurofibrillary tangles and A-Beta amyloid plaques. In Down syndromethere is 3 copies of The Amyloid precursor protein gene.

591 Genetics Nervous SystemStuff involved in Alzheimer: APP on chr21 Prenisilin 1 on chr14 Prenisllin 2 on chr1 ApopE4 involved in late onset familial Alzheimer

593 Pathology Nervous SystemIn alzheimer, decrease acetylcholine in Meynert nucleus in hipoccampus (decreasedactivity of acetyltransferase)

595 Pathology Nervous System Paraneoplastic process is autoimmune

598 Biochemistry Nervous SystemIn thiamine deficiency u can get necrosis and hemorrhage of mamillary bodies, B1will affect the activity of transketolase (main prob) and Pyruvate and Ketoglutaratedehydrogenase

660 Pharmacology Nervous SystemIn anesthetic if have high venoarterial difference then drug will directly go to muscleand adipocytes then slower effect on brain Whereas potency is determined by MAC

673 Immunology Nervous System Ataxia telengiectasia: (AR), defect in DNA repair genes Cerebellar ataxis,Oculicutaneous telengiectasia, repeated sinopulmonary infection and increasedincidemce of malignancy

735 Microbiology Nervous System

Neisseia: Bean Shaped Gram - cocci in pairs(60)

775 Physiology Nervous System POMC is a polypeptide that give rise to ADH, MSH and Beta Endorphins.


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776 Physiology Nervous System

When Morphine binds to mu receptors it can will cwuse hyperpolarisation of the cellin two ways: First and most importantly it will cause G coupled activation of K+channel, increasing K+ efflux out of the cell, hyperpolarizing the cell. Secondly it willdecrease Ca+ influx into the cell (Think morphine acts like K(C)arl)

794 Pathology Nervous System Hippocampus atrophy is seen in Alzheimer

840 Genetics Nervous System Huntingtin proteins prevents acetylation of DNA making it more mute

851 Pharmacology Nervous System

Potency of Anasthetic is related to MAC (minimal alveolar concentration)(concentration at which 50% of people pass out) High blood/air partition coefficientmeans high solubility so slower onset of action (coz stay in blood dont go to brain)Potency: drugs needed to achieve a certain effect related to km Efficacy: maximaleffect

852 Pharmacology Nervous System Inhaled anesthetic will directly redistribute in muscles skeletal and fat

856 Pharmacology Nervous SystemIV anesthetic effect wean off after a short time because of redistribution of drug inbody

866 Pharmacology Nervous SystemDantrolene is only used to treat heat stroke and malignant hyperthermia, not highfever

871 Pathology Nervous System Liquefactive Necrosis: Lysosmal digestion of the tissue

913 Pathology Nervous System PMR: fatigue, fever, wight loss + Proximal muscle stifness

969 Pathology Nervous System Tetanus is diagnosed clinically

1006 Microbiology Nervous SystemIn Neisseria CApsular Polysaccharide resist phagocytosis and stuff, but Outermembrane Lipooligosaccaride (LOS or LPS) is the endotoxin associated with fuckedup disease

1048 Biochemistry Nervous System Vit A OD: Pseudotumor Cerebri, skin changes and Hepatosplenomegaly1058 Pathology Nervous System Endomysial Inflammation: Poliomyositis Endoneural Inflammation: Guillain Barre

1149 Anatomy Nervous System Superficial peroneal: Eversion Deep Peroneal: Dorsiflexion

1150 Anatomy Nervous SystemMeningioma often occur in dural reflection. In falx cerebri patient can have legsymtoms (beco it is in the medial homunculus)

1152 Pathology Nervous SystemCraniopharyngoma arising from anterior pituitary are calcified cysts containingcholesterols crystals

1259 Pathology Nervous System

Posterior fossa tumor in kids Medullo: Sheets of primitive cells(basophilic nuclei andscant; small round blue cell, cystoplasm) with many mitotic figures Pilocyticastrocytoma: Most common, Rosenthal fibers (are low grade and have betterprognosis) Ependymoma: walls of venticles and can cause hydrocephalus, they formgland like structures called rosettes

1318 Physiology Nervous SystemNeuronal properties: Time constant: time it takes for membrane to achieve 63% ofnew membrane potential Length constant: time it takes for impulse to go a certaindistance. Demyelination will decrease both, by Increasing axon Conductance andhaving less Saltatory Conduction

1320 Pharmacology Nervous System In mysathemia crisis we shld increase dose of neostigmine

1323 Pharmacology Nervous SystemOrganophosphate irreversibly inhibit cholinesterase in musc and nicot synapses so ifgive atropine (only musc) u wont be helping muscular effects

1335 Biochemistry Nervous System

In Maple syrup, avoid branched chain amino acid leucine Isolucine and Valine(defect in alpha ketoacid dehydrogenase with deficient conversion of Leucine to Acetyl CoA or Valine and Isoleucine to Propionyl CoA then Methylmalonyl thenSuccinyl CoA)

1368 Pharmacology Nervous System Uterine relaxation is by B2 like in lungs..

1391 Microbiology Nervous System

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

temperatures is common in children less than 3 months coz of their immature cellmediated immunity

1399 Microbiology Nervous System TCA affect muscarinic not nicotinic

1402 Microbiology Nervous SystemRabies virus goes in skin, then motor axon (and retrograde to cNS) then salivarygland (thats why transmitted through bites)

1421 Genetics Nervous SystemFragile X: CGG repeat --> Hypermethylation of Cytosine amd inactivation ofsubsequent genes

1428 Biochemistry Nervous System In tRNA, the 3 ' part is responsible for amino acid attachement site (since t and 3)


Nervous SystemConversion disorder is experiencing neurological symptoms that are not explained bytests or exam, and is due to a stressor

1442 Pharmacology Nervous System Donepezil Cholinesterase inhibitor is used in Alzheimer

1443 Pharmacology Nervous System Benzo increase FREQuENCY of Cl channels not DURATION

1534 Embryology Nervous System NF is a neural crest tumor since it is a Schwann cells tumor. Like in Melanoma

1536 Histology Nervous System Thight junction is responsible of the nonfenestrated endothelial in BBB (cest logique)

1636 Anatomy Nervous SystemMusculucutaneous innervates biceps and suppinator (like when I do Dumbels) andsupply sensory lateral Forearm


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1743 Anatomy Nervous SystemUlnar nerve functions: Wrist flexion/adduction, fingers adduction/abduction andsensation in 1.5 last fingers and flexion of 4th/5th digit

1749 Anatomy Nervous SystemMedian nerve is sandwiched between Flexor digitorum superficialis and FlexorDigitorum Profundus (easy since Median innervates digits)

1829 Anatomy Nervous SystemHolding a branch like a monkey can cause lower trunk of brachial plexus injuryaffecting radial and ulnar nerves and muscles of hands

1853 Microbiology Nervous Systemimmunity agaisnt neisseria mengitidis is antibodies against their polysaccaridecapsule

1966 Microbiology Nervous System enterovirus is most common cause of asceptic meningitis

1997 Microbiology Nervous SystemBotulinsm toxin inhibit Ach release wheras rabies bind on the recptors (toxin is killed

by heat)2082 Microbiology Nervous System Treat toxo with pyrimethamine and sulfadiazine (clinda if sulfa allergy)

2083 Microbiology Nervous System Cns lymphoma are B cells

2089 Pharmacology Nervous SystemCYPROHEPATADINE, is an antihistamine with anti serotonergic, so used in excessserotonin syndrome


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

8324 Microbiology Nervous SystemRabies G(accumulate in open wound) lycoprotein spikes bind nicotine acetylcholinereceptors, activate them. And go to CNS in retrograde

8385 Biochemistry Nervous System Impairement of Ubiquitin proteasome system is involved in Parkinson and Alzheimer

8476 Pharmacology Nervous System Tryptans are serotonic agonist

8533 Microbiology Nervous SystemStaph epidedermis virulence is synthesis of an extracellular polysaccharide matric,(adherent biofilms) when foreign bodies are inserted through skin (skin flora)

8564 Anatomy Nervous System IVH is bleed in germinal matrix


Nervous SystemIn Narcolepsy or Cataplexy Hypocretin (1 or 2) which are secreted by the lateeralHypothlamus and usually promote wakefulness and inhibit REM sleep, are usually low

11458 Pharmacology Nervous System Baclofen, GABA B receptor agonist used for spasticity even of central cause like MS

11462 Pathology Nervous SystemParkinson pple benefit from deep brain stimulation inhibiting Subthalamus eventuallyincreasing Thalamus inout

11568 Pathology Nervous SystemHIV associated dementia is suspected in AIDS patients with progressive cognitivedecline. Microglial nodules and groupd of activated macrophages/microglial cellsaround necrosis that may fuse to form multinucleated giant cells

11574 Pathology Nervous System Damage to brainstem below or at level of red nucleus will cause decerebrate position

11576 Pathology Nervous System In brain calcification do not happen afer infarcts but in TUMORS

11632 Pathology Nervous SystemOvershooting is when lateral cerebellar is affected, when vermis (central) is affectedu get truncal ataxia

11665 Pharmacology Nervous System Treat status (even if febrile seizure) with lorazepam

11742 Anatomy Nervous SystemInfraiebital nerve runs along the orbital floor so in such a fracture causingparasthesia in upper cheek, upper lip and upper gingiva and inferior rectus musclegets entrapped causing vertical nystagmus

11755 Physiology Nervous SystemGABa activation cause Chloride channel to open and causing a chloride flux inside(passive down normal gradient)the cell hyper-polarizing its resting potential

11772 Anatomy Nervous SystemXI injury: Trapezius injury: Droopin gof shoulder, impaired abduction abovehorizontal and Winging of Scapula (weird things)

11777 Anatomy Nervous SystemFemoral nerve passes through the Inguinal crease not the Femoral rin and canalwhich contains lymphatic, vessels and lymph nodes

11793 Anatomy Nervous SystemDuring intubation, beware of atlantoaxial instability that can cause subluxation of thevertebra and compression of SC and Vertebral arteries--> Paralysis

1646 Pharmacology Ophthalmology AIDS CD4 Ketoacid, Lactate and Phruvate Accumulation). So youget Normal pH with low pCO2 and low HCO3-. in compensation, pH will not return toNormal but gets close to Normal Range.

792 PathophysiologyPregnancy, Childbirth &Puerperium

Unlike what seems intuitive Complete mole (46, XX or XY only paternal DNA) does

not contain fetal tissues and has a HONEY COMB or SNOWTORM appeance,associated with preeclampsia, before 20 weeks, Hyperemesis, Hyperthyroid PartialMole are XXY or XXX but has mom and 2 papa sets so have fetal tissuesand onlypresents with vaginal bleed and lower risk of malignancy


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955 GeneticsPregnancy, Childbirth &Puerperium

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

1464 MicrobiologyPregnancy, Childbirth &Puerperium

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

1772 EmbryologyPregnancy, Childbirth &Puerperium

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


Patau: cleft lip,palate, omphalocele, holoprosencephaly, polydactyly, rocker bottomfeet

1823 GeneticsPregnancy, Childbirth &

Puerperium

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


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

1987 PhysiologyPregnancy, Childbirth &Puerperium

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

8325 PathologyPregnancy, Childbirth &Puerperium

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

8330 PhysiologyPregnancy, Childbirth &Puerperium

Maternal diabetes is due to HPL which increases proteolysis, lipolysis, insulinresistance and decrease gluconeogenesis. Estrogen, progesterone and cortisonealso play a role in maternal diabetes.

8406 EmbryologyPregnancy, Childbirth &

Puerperium

False twins are always Di Di in indentical twins land,arks are: 0-4: Di C Di A 4-8:

Mono C Di A 8-12: Mono Mono >12: Conjoined (4-8-12 landmarks)


Psychiatric/Behavioral &Substance Abuse

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



Tardive dyskinesia occur with lip smacking and many ticks due to antipsychoticmedications

519 PharmacologyPsychiatric/Behavioral &Substance Abuse

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


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



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

1165Behavioral

science

Psychiatric/Behavioral &

Substance Abuse

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

event



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



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



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



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

1429

Behavioral

science

Psychiatric/Behavioral &

Substance Abuse

A boy whose parents are having a divorce and thinks that his dad is angry at him isexperiencing Projection, since he is likely angry at his parents he will think they are

angry at him too. This is common in peple who lack insight or their emotions,motivations and feelings



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


Cocaine inhibit reuptake of dopamine



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



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

8327 PharmacologyPsychi

step 1 uworld

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