5 Heart Block (LSD Loves Company) x Lyme Disease x Salmonella x Diphtheria x Legionella x Chagas Reiter's Syndrome (SCICY) x Shigella x Chlamydia x IBD x Crohn's x Yersinia Low Complement Bugs (I AM HE) x Influenza x Adenovirus x Mycoplasma x Hepatitis B & C x EBV Drug Induced SLE (HIPPPE) x Hydralazine x INH x Procainamide x Penicillamine x Phenytoin x Ethosuximide Drugs that blast BM x AZT x Benzene x Chloramphenicol x Vinblastine Comma Shaped Bugs x Vibrio x Campylobacter x Listeria x H. pylori Chinese Letters x Corynebacterium Crescent Shaped Protozoa x Giardia Lamblia TB Treatments (RIPES) x Rifampin x INH x Pyrazinamide x Ethambutol x Streptomycin

6 Low Complement Associated Nephrotic Syndromes x SLE x SBE x PSGN x MPGN II x Cryoglobulinemia x Serum Sickness Induce P450 (ABC G PQRST) x Alcohol x Barbiturates x Carbamazepine x Griseofulvin x Phenytoin x Quinidine x Rifampin x Spironolactone x Tetracycline Inhibit P450 (PICK EGS) x Protease Inhibitors x INH x Cimetidine x Ketoconazole x Erythromycin x Grapefruit juice x Sulfonamides P450 Dependent (WEPTeD) x Warfarin x Estrogen x Phenytoin x Theophylline x Digoxin SE of Statins x Myositis x Hepatitis Painful Genital Lesions x Herpes x Chancroid (H.ducreyi) x Lymphogranuloma

venereum x Granuloma inguinale Disulfide Bonds x Prolactin x Inhibin x GH x Insulin

Hookworms (EAT SANd) x Enterobius Vermicularis x Ascaris Lumbriocoides x Trichuris Trichurium x Strongyloides x Ankylostoma Duodenale x Necatur Americanis X-linked Enzyme Deficiencies (Fabry and Lesch go Hunting for Candy, Gum, and Advil) x Fabry’s x Lesch-Nyhan x Hunter's x CGD x G6PD x Adrenoleukodystrophy Screen Newborns (Please Check Before Going Home, TI) x PKU x CAH x Biotidinase x Galactosemia x Hypothyroidism x Transglutaminase x Immune reactive trypsin Action of Steroids (KIIISS) x Kill T-cells and eosinophil x Inhibit MØ migration x Inhibit Phospholipase A x Inhibit mast cell

degranulation x Stabilize endothelium x Stimulate protein synthesis Causes of Severe Monocytosis (STELS) x Salmonella x TB x EBV x Listeria x Syphilis Macrolides x Azithromycin x Clarithromycin x Erythromycin 1 dose TX for Chlamydia x Azithromycin “Big  Mama"  Anaerobes x Strep. Bovis x Bacteroides fragilis

x C. melanogospeticus x C. difficile *If blood cultures show S. bovis or C. melanogo-septicus = rule out colon cancer. TX  for  "Big  Mama”  anaerobes x Metronidazole x Clindamycin x Cefoxitin Serum Values for Low Volume State x K+ ↓ x Na+ ↓ x Cl– ↓ x pH ↑ x BP ↑ 1 dose TX for Gonorrhea x Ceftriaxone x Cefixime x Cefoxitin x Ciprofloxacin Psammoma Bodies (PSaMMoma) x Papillary CA of Thyroid x Serous Cystadenoma of

ovary x Meningioma x Mesothelioma Drugs that Cause Cardiac Fibrosis x Adriamycin x Phen-Fen Urease +ive Bacteria (PPUNCHES) x Proteus x Pseudomonas x Ureaplasma urealyticum x Nocardia x Cryptococcus neoformans x H. pylori x S. saprophyticus Drugs that Cause Pulmonary Fibrosis (BBAT) x Bleomycin x Busulfan x Amiodarone x Tocainide

Salmonella Typhix High fever x Rose spots x Intestinal fire x Monocytosis x Heart block Drugs cause Myositis (RIPS) x Rifampin x INH x Prednisone x Statins Encapsulated Bacteria (SHiNKS PC) x S. pneumonia (g+) x H. influenza B x Neisseria x Klebsiella x Salmonella x Pseudomonas x Citrobacter Encapsulated Yeast x Cryptococcus Jones Criteria (J♥NES) x Polyarthritis (joints) x Carditis (♥) x Nodules (sub-q) x Erythema marginatum x Sydenham Chorea IgA Nephropathies x Henoch-Schönlein

Purpura (HSP) x Berger's x Alport's Massive Eosinophilia (NAACP) x Neoplasms x Allergies/Asthma x Addison's x Collagen Vascular Disease x Parasites Risk Factors for Primary Liver Cancer x Hep B and C x Aflatoxin x Vinyl Chloride x Alcohol x Carbon Tetrachloride x Aniline dyes x Smoking x Hemochromatosis

x Benzene x Schistosomiasis 9 Live Vaccines x MMR x Oral Polio x Rotavirus x Small Pox x BCG x Yellow Fever x Varicella Autoimmune Hemolytic Anemia x PTU x Cephalosporin x α-methyldopa x Sulfa drugs x Anti-malarial x Penicillin Autoimmune Thrombocytopenia x Aspirin x Heparin x Quinidine Pansystolic Murmurs x Mitral Regurg. x Tricuspid Regurg. x Ventricular Septal Defect Dihydrofolate Reductase Inhibitors x Pyremethamine/Sulfa-

diazine x TMP/SMX x Methotrexate

Sulfa Containing Drugs x Sulfonamides x Sulfonylureas x Celecoxib Silver Staining Bugs x Legionella x Pneumocystis x H. pylori x Bartonella henselae x Candida Blood Gas w Restrictive Lung Disease x Tachypnea x ↓ pCO2 x ↓ pO2 x ↑ pH

Blood Gas w Obstructive Lung Disease x ↑ or Normal pO2 x ↑ pCO2 x ↓ pH MI – Enzymes Troponin I - appears 2 hrs - peaks 2 days - gone 7 days CKMB - appears 6 hrs - peaks 12 hrs - gone 2 days LDH - appears 1 day - peaks 2 days - gone 3 days MØ Deficiency x Chediak-Higashi x NADPH-oxidase def 1Dose TX H. ducreyi x Azithromycin x Ceftriaxone 1 Dose TX Gardnerella x Metronidazole SE of Thiazides and Loop diuretics x Hyperglycemia x Hyperuricemia x Hypovolemia x Hypokalemia MØ in Various Tissues Brain Microglia Lung Type I Pneumo Liver Kupffer Spleen RES cells Kidney Mesangial LN Dendritic Skin Langerhans Bone Osteoclasts CT Histiocytes

Giant cells Epithelioid

Rashes of Palm & Soles (TRiCKSSS) x TSS (Toxic Shock) x Rocky Mt. Spotted Fever x Coxsackie A x Kawasaki x Scarlet Fever x Syphilis x Staph. Scalded Skin 4 Sources of Renal Acid x Plasma (RTA)

x Ammonia production in the collecting duct – 10% of Urea Cycle

x Glutaminase x Carbonic Anhydrase Hormones Produced by Small Cell CA of Lung x ACTH (MC) x ADH x PTH x TSH x ANP 1 Dose TX Candidiasis Ketoconazole 1 Dose TX Vaginal Candidiasis Diflucan 1 Dose TX Trichomonas Metronidazole TRAP Test + x Hairy cell leukemia x Fragile X x Paget’s  disease Immunoprivileged Tissue x Thymus x Testes x Brain x Cancer TX S. aureus x Nafcillin x Oxicillin x Cloxillin x Dicloxillin Causes of Death by Age x 2-3: MVA x 5-10: Pedestrian inj,

sports injuries x 10-19: MVA,

homicides, suicide x 20-44: AIDs x 44-70: Heart dz, cancer,

stroke x >71: Cancer, heart dz,

stroke Rhabdomyolysis x Hypothyroidism x RIPS (drugs) x Cushing’s x Trichnella spiralis

Viruses Related to CA EBV Lymphoma HVB Liver carcinoma HVC Liver carcinoma HIV Kaposi HPV Cervical cancer NM Disease Concept x Restrictive Blood Gas x ↓pO2 ↓pCO2 ↑pH x ↑ RR x ↑ Risk for Seizures x ↓ Pulmonary Capillary

wedge pressure PIE Syndrome (Pulmonary Infiltrate w Eosinophilia) NASSA x Necator Americanus x Ascaris Lumbricoides x Schistosomiasis x Strongyloides x Ankylostoma Enzymes used by B12 x Methyl Malonyl CoA

mutase x Homocystine methyl

transferase Increased Susceptibility to Pseudomonas and S.aureus (ABCD) x Absolute Neutropenia x Burn patients x Cystic Fibrosis x Diabetes Crohn's Disease ("GIFTS") x Granuloma x Ileum x Fistula x Transmural x Skip Lesions Causes of Widened S2 x ↑ pO2 x ↑ volume Rt. Ventricle x Blood transfusion x Supplemental O2 x Rt. sided heart failure x Pregnancy x I.V. Fluids x ASD (fixed) x Deep breathing

Cavities of Blood Loss x Intracranial x Pericardium x Mediastinum x Pleural cavity x Retroperitoneum x Abdominal x Pelvis x Thighs Negative Stranded RNA x 1-3 week prodromal

period before Si/Sx x Must switch to positive

stranded before it can replicate

Positive Stranded RNA x Symptoms occur within

1 week or less x Don't have to switch

before replicating x Exceptions – Hanta,

Ebola and Yellow Fever which are negative stranded

Cyanotic Heart Diseases (5T HEAP) x Transposition of great

arteries x Tetralogy of Fallot x Truncus Arteriosus x Tricuspid Atresia x Total Anomalous

Pulmonary Venous Return

x Hypoplastic Left Heart Syndrome

x Ebstein's Anomaly x Aortic Atresia x Pulmonic Atresia LL to Depolarize x Hypermagnesemia x Hypercalcemia x Hypokalemia x Hypernatremia ML to Depolarize x Hypomagnesemia x Hypocalcemia x Hyperkalemia x Hyponatremia Hormones produced by the Placenta x hCG x Inhibin

x HPL x Oxytocin x Progesterone x Estrogen Uses for Pilocarpine x Cystic Fibrosis x Closed angle glaucoma Cause Dysguzia x Metronidazole x Clarithromycin x Zinc deficiency Carcinoid Triad x Flushing x Wheezing x Diarrhea **Dx: measure 5-HIAA in the urine** **Most common primary location = appendix** **Most common metastatic location = pancreas, ileum** AVMs machinery murmur x Heart: PDA x Elbow: dialysis fistula x Brain: Von Hippel-Lindau x Lungs: Osler-Weber-Rendu Haemophilus Influenza x Gram negative rods x Pleomorphic x "School of Fish" x Type A: non-encapsulated,

non-invasive, MCC of sinusitis, otitis, bronchitis

x Type B: encapsulated, invasive, IgA protease, MCC of epiglottitis

Rust Colored Sputum x Strep. pneumo S. epidermidis Most common infection of shunts and central lines Catalase positive Staph (by pigment) Aureus Gold Epidermidis White Saprophyticus None Strep. pyogenes x MCC: all throat infections,

lymphangitis, impetigo,

necrotizing fasciitis, erysipelas, scarlet fever

x 2nd MCC: all other skin infections

Neutrophil Deficiencies x Job-Buckley Syn. x NADPH Oxidase defic. x Neutropenia x Myeloperoxidase defic. Compartment Syndrome x Pain (always first) x Pallor x Poikilothermia x Parasthesia x Pulselessness (always last) Itchiest Rashes x Scabies x Lichen planus x Urticaria x Dermatitis herpetiformis

Oddities about Listeria x Only gram Positive w/

endotoxin x Crosses placenta x Lipid A is toxic Part x Causes granulomas x Causes sepsis in neonates x Raw cabbage, spoiled milk Abnormal Class Switching x Defective class switch. x IL-4 deficiency x CD40L deficiency x Tyrosine kinase def. B Vitamins B1 – Thiamine x Beriberi x Wernicke’s x Korsakoff B2 – Riboflavin x Angular stomatitis B3 – Niacin x Pellagra x 4 d's B4 – Lipoic acid B5 – Pantothenic acid B6 – Pyridoxine x Seizures B9 – Folate Bl2 – Cobalamine x Pernicious anemia x Neuropathy

Periods of rapid growth x Birth – 2months x 4 –7 years x Puberty Only immune deficiency with Low Calcium DiGeorge's Syndrome Bugs with IgA Protease x S. Pneumonia x H. Influenza x Neisseria (are resistant

to IgA) Secretions of Mast Cells x Histamine x Slow Reacting Substance

of Anaphylaxis x Eosinophil Chemotactic

Factor of Anaphylaxis Secretions of Eosinophil x Histaminase x Arylsulfatase x Heparin Actions of E. coli x Secrete Vitamin K x Secrete Biotin x Secrete Folate x Secrete Pantothenic acid x Aid in absorption of B12 Heart Block x Increased body temperature

with a normal heart rate. x HR should increase by

10bpm per 1 degree increase in temperature

Macrophages Release MHC II TH1 Secrete x IL-2 x IF-γ TH2 Secrete x IL-4 x IL-5 x IL-6 x IL-10 T-Cytotoxic Cells x CD-8 positive x CD-4 negative x Recognize MHC I x Also have markers

CD-2 and CD-3

T-Helper Cells x CD-4 positive x CD-8 negative x Recognize MHC II x Also have marker CD-2

and CD-3 Elevated Cholesterol x Xanthomas on extensor

surfaces x ↑ risk for CAD Elevated Triglycerides x Xanthelasmas on

eyelids and face x ↑ risk of Pancreatitis 4 Causes of Severe Abdominal Pain x Pancreatitis (EtOH) x Kidney Stones (bloody

urine) x AAA (ripping, tearing

pain) x Ischemic Bowel (bloody

diarrhea) 5 Causes of SIADH (SIADH) x Small Cell Carcinoma x ↑ intracranial pressure x A Pain x Drugs x Hypoxia Neural Crest Cells (POT CLAMPSS) x Parafollicular cells x Odontoblast x Tracheal cartilage x Chromaffin cells x Laryngeal cartilage x All Ganglion cells x Melanocytes x Pseudounipolar cells x Spiral membrane (♥) x Schwann cells Ions and the EKG x P-wave = Ca++ x QRS complex = Na+ x S-T Interval = Ca++ x T-wave = K+ x U-wave = Na+ Maximum Sinus Rate 220 – age in years Tri-Nucleotide Repeats x Huntington's

x Fragile X x Myotonic dystrophy x Spinal/bulbar muscular

atrophy (rare) Low volume states with acidosis (not alkalosis) x RTA x Diarrhea MCC Croup & Bronchiolitis x Parainfluenza x RSV (ER this is #1) x Adenovirus x Influenza 4 D's of Pellagra x Dermatitis x Diarrhea x Dementia x Death Types of Kidney Stones x Calcium oxalate – 80% x Struvite x Uric Acid x Cysteine x Oxalate Pseudogout x Ca++ pyrophosphate x Birefringent crystals x Rhomboid crystals x MC older patients x Seen equally in both

genders x TX = Colchicine MC Non-cyanotic Congenital Heart Dz x VSD x ASD x PDA x Coarctation of aorta Enzymes NEVER seen in Glycolysis x Pyruvate carboxylase x PEP carboxykinase x Fructose-1,6-phosphatase x Glucose-6-phosphatase Enzymes ONLY seen in Glycolysis x Hexokinase x Phosphofructokinase-1 x Pyruvate kinase

Acid Fast Organisms x Mycoplasma x Nocardia (partially gr+) x Cryptosporidium (Partially

protozoa) Causes of Microsteatosis x Acetaminophen x Reye Syndrome x Pregnancy Causes of Macrosteatosis x Alcohol Bacteria with Elastase x Staph. aureus x Pseudomonas Bacteria with toxins that inhibit EF-2 x Pseudomonas x Diphtheria Phage Mediated Toxins (Oh BED) x “O”  antigen (Salmonella) x Botulinum x Erythrogenic toxin x Diphtheria Segmented Viruses (I sprayed ORTHO on BUNYA at the ARENA down in REO to kill SEGMENTED viruses) x Orthovirdiae x Bunyavirdiae x Arenavirdiae x Reovirdiae Functions of Adhesion Molecules x Lymphocyte homing x Inflammation x Cell-cell interaction Esophageal/Gastric CA Risk Factors x Smoking x Alcohol x Nitrates x Japanese Bladder CA Risk Factors x Smoking x Aniline dyes x Benzene x Aflatoxin x Cyclophosphamide

x Schistosomiasis x Von Hippel-Lindau x Tuberous Sclerosis Structures with No Known Function x Epithalamus x Palmaris longus x Pancreatic Polypeptide Progressing to RPGN x Goodpasture's (#1) x Diabetes Mellitus x Hypertension x Wegener's Causes of Papillary Necrosis x Vasculitis x AIDS Gram Positive Spore Formers x Bacillus anthracis x Clostridium perfrigens x Clostridium tetani Used for Cold Agglutinin Testing x Strep. salivarius Drugs that Cause Disulfram Reaction (CLAM) x Chlorpropamide x Lactams x Antabuse x Metronidazole 3 Toxins of Bacillus x Lethal factor x Protective factor x Edema factor Beta Blockers x β1 Selective: A-M

(except C & L) x Nonselective: N-Z, C, L Fanconi Syndrome x Defect in proximal tubule x Can't reabsorb x Low energy state x Can be caused by old

tetracycline Glutaminase x In collecting duct x Absorbs ammonia in the

liver

x Cause of hepato-renal syndrome

3 Anatomical Narrowings of Ureter x Hilum x Pelvic Brim x Entrance of bladder Odd MCC of Death SLE, endometrial and cervical cancer – renal failure Methotrexate Uses x DX Fragile X x TX Molar Pregnancy x TX Fast growing CA x TX Steroid resistant

disease

Group D Streptococcus x Viridans – green

pigment, SBE x Mutans – Cavities x Sanguis x Salivaris x Bovis Nephritic Syndrome x Hypertension x Hematuria x RBC casts Nephrotic Syndrome x Edema x Hyperlipidemia x Hypercholesterolemia x Hypercoagulability x ↓ serum albumin x ↑ urine albumin MCC of Airway Infection (Sinusitis, otitis, bronchitis, pneumonia) #1 – S. pneumonia #2 – H. influenza #3 – N. meningitides Gastroenteritis within 8 hours of eating (Pre-formed toxin) x S. aureus (potato salads) x C. perfringens (holiday

turkey/ham) x B. cereus (fried rice) Citrobacter Cause of multiple cerebral abscesses in newborns

MCC of UTI #1 – E. coli #2 – Proteus #3 – Klebsiella Most Frequent in Females 5-10 yrs and 18-24 yrs S. saprophyticus b/c they stick things inside themselves S. aureus x MCC of osteomyelitis x MCC of infection in

burn patients MCC of Newborn Meningitis x Group B Strep x E. coli x Listeria Bacteria Associated with Colon Cancer x C. melanogosepticus x S. bovis Gram – that are strict anaerobes x H. flu x Neisseria Pre-renal Failure x Serum BUN > 20 x Serum Cr > 40 x Fractional Na exc. < 1% Renal Failure x Serum BUN – 10 to 15 x Serum Cr < 20 x Fractional Na exc. > 2% Extravasation x Pavementing x Margination x Diapedesis x Migration If Cell Mediated is defective - TX for x Viral x Fungal x Mycobacterium x Protozoa x Parasite x Neoplasm

Herpes Viruses x HHV1 – oral x HHV 2 – genital x HHV 3 – VZV x HHV 4 – EBV x HHV 5 – CMV x HHV 6 – Roseola x HHV 7 – Pityriasis rosea x HHV 8 – Kaposi's Disease Picked up During Delivery x Group B strep x S. pneumonia x Herpes x N. gonorrhea x Chlamydia TORCHHeS x Toxoplasma x parvOvirus B19 x Rubella x CMV x Herpes simplex x HIV x Syphilis Neonatal Toxoplasma x Chorioretinitis x Hydrocephalus x Intracran calcifications Neonatal PVB19 x Hydrops fetalis Neonatal Rubella x PDA x Cataracts x Deafness x Blueberry muffin rash Neonatal CMV x Unilat. Hearing loss x Seizures x Petechiae Neonatal Herpes x Temp encephalitis x Vesicles Neonatal HIV x Recurrent infections x Chronic diarrhea Neonatal Syphilis x Saddle nose x Saber shins x Hydrops fetalis x Notched teeth x Short maxilla

Male Cancers Most prevalent 1. Prostate 2. Lung 3. Colon Most mortality 1. Lung 2. Prostate 3. Colon

Female Cancers Most prevalent 1. Breast 2. Lung 3. Colon

Most mortality 1. Lung 2. Breast 3. Colon Gynecologic Cancers Most prevalent 1. Endometrial 2. Ovarian 3. Cervical Most mortality 1. Ovarian 2. Endometrial 3. Cervical

Cephalosporin’s that block Vitamin K x Cefotetan x Cefamandole x Cefoperazone x Moxalactam Common bile duct stone x Pancreatitis x Alkaline phosphatase x High white count TX for Gout x Most effective – Colchicine

x 1st line – Indomethacin x 3rd line – IA steroids TX for Neuropathy x Amitriptyline x Gabapentin (heart dz) x Carbamazepine (shooting

pain)

T & B-cell Deficiencies x WAS – Thrombocytopenia, IL-4, Eczema, ↓ IgM x SCID – Adenosine deaminase deficiency, T>B,

frameshift/nonsense mutation, ↑ bacterial & fungal infx. x CVID –Tyrosine kinase deficiency, late onset, frameshift/

missense mutation x HIV (HTLV-l) – Effects CD-4 rich tissues (brain, testicles,

cervix, rectum, blood vessels), T>B x Job-Buckley Syndrome – red headed female, tyrosine kinase

deficiency B-Cell Deficiencies x Bruton's Agammaglobulinemia – Tyrosine kinase deficiency x Leukemia x Lymphomas x See above for those with T-cell overlap T-Cell Deficiencies x DiGeorge’s – hypocalcemia, problem with 3rd and 4th

pharyngeal pouches, deletion of chromosome 22 x HIV x See above for those with B-cell overlap Electron Transport Chain Poisons x Complex I Sodium amytal, Rotenone x Complex II Malonate x Complex III Antimycin x Complex IV CN, CO, Chloramphenicol x Complex V Oligomycin Chemical Uncouplers x DNP x Free Fatty Acids Physical Uncouplers x Aspirin Places where Amino Acids feed in/out of TCA Cycle x Pyruvate Gly, Ala, Ser x Acetyl CoA Phe, Iso, Thr, Tyr, Lys, Leu x α-KG Glu, Gln x Succinyl CoA Phe, Ttp, Tyr x Fumerate Pro x Oxaloacetate Asp, Asn

Amino Acid Deficiencies x PKU – Phenylalanine hydroxylase deficiency, needed to

make tyrosine, leads to a lack of Dopamine, Epi and Norepi, melanin

x Maple Syrup Urine Disease – deficiency in branched amino acids (Iso, Leu, Val), defective transport in the kidneys (I Love Vermont Maple Syrup)

x Cystinuria – Cystathione synthase deficiency; cysteine, ornithine, lysine and arginine; end up in urine, stones

Glycine Gly Threonine Thr Alanine Ala Cysteine Cys Valine Val Tyrosine Tyr Leucine Leu Asparagine Asn Isoleucine Iso Glutamine Gln Methionine Met Aspartic Acid Asp Phenylalanine Phe Glutamic Acid Glu Tryptophan Trp Lysine Lys Proline Pro Arginine Arg Serine Ser Histidine His Amino Acid Subgroups Acidic: Asp, Glu Basic: Arg, Lys Sulfur Bonds: Cys, Met O-Bonds: Ser, Thr, Trp N-Bonds: Asp, Gln Branched: Iso, Leu, Val Bulky (Aromatic): Phe, Thr, Trp Smallest: Gly Responsible for Bends: Pro Ketogenic: Lys, Leu Gluco-& Ketogenic: Phe, Iso, Thr, Trp Glucogenic: His, Arg, Glu, Asp, Asn, Tyr, Cys, Pro. Val, Ala, Gly Essential Amino Acids (PVT TIM HALL) Phe Trp His Val Iso Arg Thr Met Leu

Lys If there is a deficiency in Phe, then Tyr becomes essential (like in PKU). If there is a deficiency in Met then Cys becomes essential

Restriction Enzymes (Cut to the right unless otherwise specified) Trypsin Arg, Lys Chymotrypsin Phe, Tyr, Trp Elastase Gly, Ser, Ala Mercaptoethanol Met, Cys Aminopeptidase Amino terminal Carboxypeptidase Left of carboxy terminal Cyanobromide Met 2nd Messengers x cAMP Sympathetic, catabolic, CRH x cGMP Parasympathetic, anabolic x IP3/DAG Smooth muscle contraction by horm/NT.

All hypothalamic hormones (except CRH) x Ca-Calmodulin Smooth muscle contraction by distention x Ca++ Gastrin x Tyrosine Kinase Insulin and all growth factors x NO Nitrates, Viagra, ANP and LPS Co-factors for PDH, α-KG DH &Branched Chain DH (TLC For Nana) x TPP Thiamin (B1) x Lipoic Acid B4 x CoA Pantothenic Acid (B5) x FAD Riboflavin (B2) x NAD Niacin (B3) Diseases with X-linked Inheritance Recessive x Burton' s Agammaglobulinemia x CGD (NADPH Oxidase deficiency) x Duchene’s Muscular Dystrophy x Color Blindness x Hemophilia x G6PD x Lesch-Nyhan x Pyruvate DH deficiency x Fabry's x Hunter's Dominant x Rett Syndrome x Vitamin D resistant Rickets Nephrotic Patterns of Vasculitis x Renal Artery Stenosis – Clot in front of renal artery x Renal Failure – Clot off entire renal artery x GN – Inflamed glomeruli x Papillary Necrosis – Clot in papilla x Interstitial Nephritis – Clot of medulla x Focal Segmental GN – Clot off pieces of nephron x Rapidly Progressive GN – Clot off lots of nephrons x MC Nephrotic Disease in Adults – Membranous GN x MC Renal Dz in Blacks/Hispanics – Focal Segmental GN x MC Renal Disease in HIV/IVDA – Focal Segmental GN x MC Renal Mass – Cyst x MC Malignant Renal tumor in adults – Adenocarcinoma x MC Malignant Renal tumor in kids – Wilm's tumor x MCC of Rapidly Progressive GN – Goodpasture's x MC Nephrotic Disease in kids – Minimal Change Disease

**RPGN - crescent formations ***Minimal Change Disease - 2 weeks post URI Thrombolytic and Rescues x tPa Amioncaproic acid x Streptokinase Aminocaproic acid x Warfarin Vitamin K x Heparin Protamine Sulfate x If active hemorrhage give Fresh Frozen Plasma (FFP) Autoimmune Antibodies Disease Anti-

SLE Smith Double stranded DNA Cardiolipin

Drug Induced SLE Histone Progressive Systemic Sclerosis Topoisomerase Graves TSH Receptor CREST Centromere Goodpasture’s Type IV Collagen Primary Biliary Cirrhosis Mitochondria Alopecia Areata Hair follicle Rheumatoid Arthritis IgG Multiple Sclerosis Myelin Receptors Celiac Sprue Gliaden/gluten Type I Diabetes Islet cell receptor Vitiligo Melanocyte Myasthenia Gravis Acetylcholine receptor Mixed Connective Tissue Disease Ribonuclear protein Pernicious anemia Intrinsic factor Pemphigus vulgaris Desmosome Bullous pemphigoid Hemidesmosome

Hashimoto's Thyroglobulin Microsomal

Scleroderma Smooth Muscle SCL-70

Sjogren's Rho La

Wegener’s Proteinase c-ANCA

Polyarteritis Nodosa p-ANCA Idiopathic Thrombocytic Purpura Glycoprotein IIb/IIIa Indications for Pneumovax x Covers MC 23 strains x Given at 2, 4 & 6 months x Given to anyone over 65 years old x Anyone who is asplenic x Anyone with end organ damage (CF, RF, Nephrotic) Rashes Associated with Cancer x Urticaria (hives) Any, but especially lymphoma x Paget's Disease Intraductal carcinoma x Seborrheic keratosis Colon cancer (HIV is sudden ↑) x Actinic keratosis Squamous cell carcinoma of skin x Dermatomyositis Colon cancer x Acanthosis nigricans Visceral CA & end organ damage x Erythema nodosum Granulomatous (nonbacterial)

Cancer Grading – Severity of microscopic changes Cancer Staging – Degree of dissemination of tumor Tumor Markers/Oncogenes l-myc Small cell carcinoma of the lung c-myc Burkitt’s  Lymphoma n-myc Neuroblastoma c-abl CML, ALL c-myb Colon, AML c-sls Osteosarcoma, glioma, fibroscarcoma ret MENII, MENIII k-ras Lung, Colon

bcl-2 Follicular lymphoma (can show up in Burkitt’s  – pick follicular first)

Rb Retinoblastoma CEA Colon, Pancreas s-100 Melanoma HER-II, Neu, Erb, BRCA I & II, p53, CSF-I

Breast

Translocations x 9:22 Philadelphia Chromosome (CML) x 8:14 Burkitt’s  Lymphoma x 14:18 Follicular Lymphoma x 15:17 Promyeloblastic leukemia x 11:14 Mantle Cell Lymphoma x 11:22 Ewing's Sarcoma x 17:22 Neurofibromatosis Enzymes Needed to Make Glycogen x Glycogen synthase x Branching enzymes

o glycogen α-1,4 glycosyl transferase o glycogen α-1,6 glycosyl transferase

Enzymes Needed to Break Down Glycogen x Phosphorylase x Debranching enzyme x α-1,6-Glucosidase x Phosphatase Lipoprotein Transport x Chylomicrons: takes triglycerides from GI to liver &

endothelium x VLDL: takes triglycerides from liver to adipose x IDL: takes triglycerides from adipose to tissue x LDL: only one to carry cholesterol x VLDL: only made in the liver x IDL + LDL: break down products of VLDL Meningitis (MCC) x 0-2 mos Group B strep

E. coli Listeria

x 2mos-10 years S. pneumonia Neisseria meningitides

x 10-21 years Neisseria meningitides x Over 2l years S. pneumonia

HIV x MC Infection CMV x MCC of death PCP x p4l Surface marker x GP120 Attachment to CD4 x Pol Transcription x Reverse transcriptase Integration x pI7 and p24 antigens Assembly Normal CD4 count: 800-1200 in adults x <500: begin TX with 2 nucleotide inhibitors and 1 protease

inhibitor (<750 in kids) x <200: AIDs, add TX for PCP x <100: add TX for MAC Characteristics of Autosomal Dominant Inheritance x Affects males and females equally x Manifests in heterozygous state x Can be transmitted by either parent x Often delayed onset (adult dx) x Vertical transmission x New mutations occur in germ cells of older fathers x Can exhibit reduced penetrance & variable expressivity x Usually structural defects Characteristics of Autosomal Recessive Inheritance x Disease usually does not affect parents x Disease may be seen in siblings and uncles x Often early onset (early dx) x Disease only present when both alleles are mutant x Horizontal transmission x Usually enzyme defects (Inborn errors of metabolism) Characteristics of Mitochondrial Inheritance x All females will pass on the disease x No males will pass on the disease x All offspring of affected females will be affected x Often affects CNS, heart and skeletal muscle x Due to uneven cytokinesis during meiosis/oogenesis Immune System Timeline x < 24 hours → Swelling x At 24 hours → Neutrophils arrive x Day 3 → Neutrophils peak x Day 4 → T-cells and MØ arrive x Day 7 → Fibroblasts arrive x 1 month → Fibroblasts peak x 3-6 months → Fibroblasts are gone Mitochondrial Diseases x Leigh’s Disease: subacute necrotizing

encephalomyelopathy, progressive ↓ IQ, seizures, ataxia, cytochrome oxidase deficiency

x Leber’s  Disease:  hereditary optic atrophy TX for Hypercholesterolemia x Statins: o P – Pravastatin (only one renally excreted)

o A – Atorvastatin o L – Lovastatin liver enzymes every 3 months o S – Simvastatin

x MoA: Inhibit HMG CoA reductase o Most active around 8pm o Must take at night for max efficiency

Atrial Action Potential x Phase 0 – depolarization x Phase 1 – No name x Phase 2 – Plateau (AV Node) x Phase 3 – Repolarization x Phase 4 – Automaticity (SA Node) Pneumonia (MCC) x 6 wks-18 yrs.: RSV (infants only)

Mycoplasma Chlamydia Pneumonia S. Pneumonia

x 18-40 yrs.: Mycoplasma Chlamydia Pneumonia S. Pneumonia

x 40-65 yrs.: S. Pneumonia H. influenza Anaerobes Viruses Mycoplasma

x Elderly: S. pneumonia Viruses Anaerobes H. influenza Gram negative rods

Oxalate Stones x In 3 y.o. white female – Cystic Fibrosis x In 5 y.o. black female – Celiac Sprue x In Adult female – Whipple's Disease x In Adult male or female – Crohn's Disease Pituitary Hormones Anterior: x GH (acidophilic) x Prolactin (acidophilic) x TSH (basoophilic) x ACTH (basoophilic) x LH (basoophilic) x FSH (basoophilic) Posterior: x ADH (supraoptic nucleus) x Oxytocin (paraventricular nucleus) Sub-Acute Bacterial Endocarditis x MC bacteria are Strep. viridans x Roth Spots x Janeway lesions (toes) x Osler's nodes (fingers) x Splinter hemorrhages x Endocarditis x Mycotic aneurysm (septic emboli)

Emphysema Types x Bullous #1 – S. aureus

#2 – Pseudomonas x Centroacinar Due to smoking x Distalacinar Due to normal aging x Panacinar Due to α-1antitrypsin deficiency Erythropoiesis x 4 months gestation Yolk Sac x 6 months gestation Spleen, Liver, Flat Bones x 8 months gestation Long Bones x 1 year of age Long Bones **If long bones become damaged, the spleen can take over, resulting in splenomegaly** Diphtheria x It's toxin ADP-ribosylates EF-2 x Stops cell synthesis x Gram positive x Acquired exotoxin from a virus via transduction x Causes heart block x Never scrape the membrane b/c it is highly vascular, so it

will bleed and will also release toxin Cystic Fibrosis x Sweat Test: o >60 – definitive positive o <20 – Normal o 30-60 – Heterozygous

x 2nd messenger is IP3/DAG x Gene is on chromosome 7 x Pilocarpine can be used to treat Inclusion Bodies Howell-Jolly Sickle Cell Heinz G6PD Zebra Niemann Pick Donovan Leishmaniasis Mallory Alcoholism Negri Rabies Councilman Yellow Fever Call-Exner Ovarian tumors Lewy Parkinson’s Pick Pick's Disease Barr Bodies Female Aschoff Rheumatic Fever Cowdry Type A Herpes Auer Rods AML Globoid Krabbe's Disease Russell Multiple myeloma Schiller-Duvall Yolk Sac tumor Basal Bodies Smooth Muscle

Allergic Response Primary – CONTACT x Neutrophils work in the first 3 days x Then B-cells produce IgM o Shows up at 3 days o Peaks at 14 days o Gone in 2 months

x IgG o Show up at 2 weeks o Peaks in 2 months o Gone in 1 year

Secondary – MEMORY x IgG shows up at day 3 with 5x the concentration x Highest affinity for antigen x Peaks in 5 years x Stays for 10 years Amyloidosis

AL Portion homologous with Ig Light chain

Primary amyloidosis, multiple myeloma

AA Unique N-terminal sequence

Chronic active disease, Hodgkin's disease

Prealbumin/ transthyretin

Single amino acid substitution

Hereditary neuropathy, nephropathy and cardiopathy

AB B2 microglobin Cerebral artery amyloid, Alzheimer’s, Downs

AE Endocrine Aging AP Universally associated with all amyloids Chelators x Methylene Blue Methemoglobinemia x Sodium Thiosulfate Cyanide x Ca-EDTA Lead (to test) x Penicillamine Lead (in plasma) x Dimeraprol Lead (in bone marrow) TX for cyanide poisoning: x Amyl Nitrate x Sodium thiosulfate x Methylene Blue x Transfusion Renal Tubular Acidosis Type I High urine pH

Acidosis Frequent UTI Stones Babies die <1 year

Type II Low urine pH (2) Hypokalemia NO carbonic anhydrase

Type III Combo of Type I and II Normal urine pH Hypokalemia

Type IV Diabetics Hyperkalemia NO aldosterone (Infarcted JG apparatus)

Hemolytic Properties of Streptococcus α Partial hemolysis Green zone β Complete hemolysis Clear zone γ No hemolysis Red zone Transduction Bacteria becomes deadly when a virus injects its DNA

Transformation In a hospital or nursing home, the bacteria has become deadly by this mechanism Conjugation Only occurs if bacteria has PILI Coumadin vs Heparin Extrinsic Intrinsic Tissue Blood PT PTT Factor s 2, 7, 9, 10 Factor 3 PO IV 8-10 hrs delay Immediate C2 in pregnancy Ok in pregnancy Inhib. Vit K dependent factor DOC for DVT (Keep the PeT outside - extrinsic) (PeT is Cujo who bites - PO) Hepatitis B Incubation: 4-26 weeks (8 wk. average) Acute Disease: 4-12 weeks Convalescence: 4-20 weeks Recovery: years Acute recent infection HBcAg+, HBsAg+, (HBcAb +/-) Recent immunization (previous 2 weeks) HBsAg+ only

Immunization ( >2 weeks previous) HBsAb+ only

Previous infection, now immune HBcAb+, HBsAb+, HBsAg-

Infectious HBeAg+ Non-infectious HBeAg-

Chronic carrier HBsAg+ for more than 6 months (HBsAb+/-)

Window period HBeAb+, HBcAb+, HBsAg- Hypersensitivities (ACID) x Type I – Anaphylaxis o IgE binds to mast cells – degranulates mast cells o IgA activates IP3 cascade – degrades mast cells

x Type II – Cytotoxic (humoral); Goodpasture’s,  Autoimmune    hemolytic anemia

x Type III – Immune Complex mediated; Rheumatoid arthritis, SLE

x Type IV – Delayed (cell mediated); TB skin test, contact dermatitis, transplant rejection

Hyperlipidemias Type Deficiency Comp ↑ Notes

I Lipoprotein Lipase – liver type only Chylomicrons

II Receptor or receptor enzyme – IIa, IIb, or B100

LDL Most common

III APO E receptor IDL

IV Lipoprotein Lipase – adipose type only VLDL

V Enzyme and receptor defect – APO CII

Chylomicrons & VLDL

Associated c DM

RASHES

Erythema marginatum Small red spots with bright red margins, sand papery; Rheumatic fever Erythema chronicum migrans Target lesion, bulls eye; Lyme disease Measles Morbiliform rash, preceded by cough and conjunctivitis Roseola Fever for 2 days then rash pops up (rash only after fever is gone), HHV 6 Erythema nodosum Tender nodules and redness on the anterior aspect of the legs

Erythema multiforme

Red macules, target lesions, allergy and viruses x Mild – Most common cause is viral (2nd is drugs) x Moderate – Stevens Johnson Syndrome x Severe – Toxic Epidermal Necrolysis

Seborrheic dermatitis Scaly skin with oily skin on the hairline Seborrheic keratosis Stuck on wart appearance Psoriasis Silvery white plaques on extensor surfaces, scaly skin, pitted nails

Varicella Zoster Red macules, papules, vesicles, pustules then scabs; different stages at the same time, HHV3

Dermatitis herpetiformis Rash/blisters on anterior thigh, associated with diarrhea due to Celiac Sprue flare up Typhoid fever Rose spots associated with "intestinal fire", Salmonella Typhi Dermatomyositis Heliotropic rash Erysipelas Reddened area with raised borders, does not blanch Tinea cruris Redness, itchy groin Pityriasis rosea Herald patch: dry skin patched that follow skin lines, HHV 7 Tinea versicolor Hypo-pigmented macules on the upper back  in  a  “V”  pattern Scabies Linear excoriation on belt line and finger webs HLA Markers HLA Markers Diseases Pneumonic DR-2 MS,  SLE,  Hay  Fever,  Goodpasture’s Multiple  Slackers  Say  “Hay,  Goodbye” DR-3 Sjogren's, SLE, Celiac Sprue, Chronic Active Hepatitis 3 S's and Chronic Active Hepatitis DR-3 & 4 IDDM Type I DR-4 Rheumatoid Arthritis, Pemphigus vulgaris RAP DR-5 Juvenile RA, Pernicious Anemia,  Hashimoto’s JRAP DR-7 Steroid Induced Nephrotic Syndrome DR-3 & B-8 Celiac Disease A-3 Hemochromatosis B-8 Myasthenia Gravis B-13 Psoriasis w/o arthritis

B-27 Psoriasis w/ arthritis, Ankylosing Spondylitis, IBD, Reiter's, Post-gonococcal arthritis 2PAIR

BW-47 1-α-Hydroxylase deficiency (Vitamin D) EKG Breakdown Portion of EKG Portion of Heart Phase of Action Potential P-wave Atrium 0 P-R interval AV node 2 Q-wave Septum 2 R-upstroke Anterior wall 2 S-downstroke Posterior wall 2 S-T interval Ventricle 2 T-wave Ventricle 3 U-wave Ventricle 4

Immunoglobulins

IgA Monomer in the blood Dimer in secretions Protects the mucosal surfaces and body secretions

IgD Only known function is as a surface marker on mature B -cells

IgE

Mediator of Type I hypersensitivity (anaphylaxis) Parasite defense Responsible for allergies Fc portion binds to mast cells and basophils Does not fix complement

IgG

Second to be produced during the primary immune response Only one to be produced during the secondary immune response In memory (secondary) response x Shows up a 3 days with 5x the concentration of primary response x Peaks around 5 years x Some remain in circulation for l0 years Has 4 subclasses (antigenic differences in heavy chains and with disulfide bonds) x IgGl – crosses the placenta due to Fc portion x IgG2 – most common deficiency, susceptible to encapsulated organisms x IgG3 – Most memory antibodies x IgG4 – Only one that does not fix complement

IgM Present only in the primary immune response Most effective in agglutination and complement fixation Defense against bacteria and viruses

Adhesion Molecules

IgCAM

ICAM-1, ICAL-2, ICAM-3

x Homing of lymph nodes to site of inflammation x Found on T-cells, endothelial cells, dendritic cells

BINDING PROTEINS LFA-3 x Mediate T-cell interactions x Found on lymphocytes, APC

LFA-2 (CD2) x Found on T-cells, NK cells

Integrins

VLA-1 (β1) x Migration thru extracellular matrix x Widely distributed

STOPS THE LEUKOCYTES

LFA-1 (β2) x Tight binding to endothelium x Found on lymphocytes

CR3 (β2)

x Tight binding to epithelium x Phagocytosis x Mac-1 x CD1l/CD18

CR4 (β2) x Phagocytosis x Opsonin receptor

Selectins

E-selectins x Leukocyte migration and homing x Found on activated endothelium BIND CARBOHYDRATES

MEDIATES “ROLLING” (slows leukocytes)

L-selectins x Initial binding to endothelium x Found on leukocytes

P-selectins x Leukocyte migration to inflammatory sites x Found on activated endothelium and platelets

Causes of Methemoglobinemia (SAMI) x Sulfa drugs x Antimalarials x Metronidazole x INH

Interleukins and Other Inflammatory Mediators

IL-1 Secreted by macrophages Causes fever and other non-specific symptoms of illness Recruits THELPER cells

IL-2

Secreted by T cells Most potent Most powerful chemotactic factor (recruits everyone) Must be inactivated prior to transplantation

IL-3 Secreted by T cells Causes B cell proliferation Labeled by Thymidine

IL-4 Secreted by T cells Causes B cell differentiation Responsible for class switching to IgG and IgE

IL-5 Secreted by T cells Responsible for class switching to IgA

IL-8 Neutrophil Chemotactic factor

IL-10 Suppresses cell mediated response Tells macrophages and T-cells to stay away if there is a bacterial infection

IL-12

Promotes cell mediated response If infection is non-bacterial, it is released to recruit macrophages and T cells Activates NK cells to secrete IFN-y Inhibits IL-4 induced IgE secretions Changes TH cells into TH1 cells

IFN-α

Secreted by Leukocytes Inhibits viral replication and tumor growth Increases NK activity Increases MHC (class I and II) expression Interferes with protein synthesis

IFN-β Secreted by fibroblasts Same actions as IFN-α

IFN-γ

Secreted by T-cells and NK cells Increases NK activity Increases MHC (class I and II) activity Increases macrophage activity Co-stimulates B-cell growth and differentiation Decreases IgE secretion

TNF-α

aka Cachectin Secreted by monocytes and macrophages Induces IL-1 Increases adhesion molecules and MHC class Is a pyogen Induces secretion of IFN-γ Cytotoxic/Cytostatic

TNF-β aka Lymphotoxin Secreted by T-cells Cytotoxic

TGF-α Secreted by solid tumors (carcinoma<sarcoma) and monocytes Induces angiogenesis, keratinocyte proliferation, bone resorption and tumor growth

TGF-β

Secreted by platelets, placenta, kidney, bone, T-cells and B-cells Induces fibroblast proliferation, collagen synthesis and fibronectin synthesis Inhibits NK, Lymphokine Activated Killer Cells, Cytotoxic T Lymphocytes, T cell & B cell proliferation Enhances wound healing and angiogenesis

**IL = Interleukin**IFN = Interferon**TNF = Tumor Necrosis Factor** TGF = Transforming Growth Factor**

Mechanisms of Actions

Drug Mechanism 5FU Inhibits thymidylate Methotrexate Inhibits dihydrofolate reductase Hydroxyurea Inhibits ribonucleotide reductase Vincristine/Vinblastine Inhibit microtubule formation Paclitaxel Inhibits microtubules from migrating Levamisole Stimulates Natural Killer (NK) cells

Steroids

1. Kills T-cell and Eosinophils 2. Inhibits macrophage migration 3. Inhibits phospholipase A 4. Inhibits mast cell degranulation 5. Stabilizes endothelium

Statins Inhibit HMG CoA reductase Niacin Decreases VLDL production in the liver

Sulfonylureas 1st generation - Block potassium channels in the islet cells preventing insulin release 2nd generation - Promote insulin release and inhibit gluconeogenesis in the liver

Miglitol/Acarbose Inhibit glucose absorption from the GI Metformin Stops gluconeogenesis in the liver Pioglitazone Increases the sensitivity of insulin receptors Anti-psychotics Block dopamine receptors Aspirin Irreversible inhibitor of cyclooxygenase K+ Sparing Diuretics Competitive aldosterone receptor antagonist Topical Anesthetics Block Na+ channels Quinolones Block topoisomerase (supercoils) Aminoglycosides Blocks Initiation Factor (IF) 2 on the 30S subunit Tetracyclines Blocks tRNA binding on the 30S subunit Rifampin Blocks beta subunit of RNA polymerase Sulfa Drugs Block Para-Amino Benzoic Acid (PABA) Cephalosporins Inhibit the cell wall Penicillins Block transpeptidase Chloramphenicol Blocks peptidyl transferase on the 50S subunit Clindamycin/Lincomycin Block translocase on the 50S subunit Macrolides Blocks translocase on the 50S subunit Metronidazole Increases production of free radicals Vancomycin Blocks cell wall (phopholipid) Benzodiazepines Increase the frequency of the GABA receptors via Cl- channels Barbiturates Increase the duration of the GABA channels via Cl- channels TCAs Block  reuptake  of  catecholamine’s,  AV  conduction and alpha receptors SSRIs Block reuptake of Serotonin MAOIs Inhibit MAO Lithium MOA is unknown but is suspected to be related to mimicking of Na+ Valproic Acid Blocks Na+ and sometimes Ca2+ Carbamazepine Blocks Na+ and Ca2+ Epinephrine Blocks Beta (2>1) receptors and then Alpha receptors

Antihistamines 1st generation - blocks H1 and H2receptors (H1>H2) 2nd generation - blocks H2 only

Decongestants Alpha agonists

Bacterial Endotoxins causing diarrhea x V. cholera x ETEC x S. aureus x Salmonella x Shigella Acute Phase Cytokines x TNF-α x IL-1 x IL-6 Bugs  that  don’t  Gram  stain x Treponema x Rickettsia x Mycobacteria x Mycoplasma x Legionella x Chlamydia Uses for 1st Cephalosporins (PEcK) x Proteus x E. coli x Klebsiella Uses for 2nd Cephalosporins (HEN PEcKS) x H. influenza x Enterobacter x Neisseria x Proteus

x E. coli x Klebsiella x Serratia Uses for Tetracyclines (VACUUM THe BedRoom) x V. cholera x Acne x Chlamydia x Ureaplasma Urealyticum x M. pneumo x Tularemia x Borrelia x Rickettsia Uses for Macrolides (PUS) x Pneumonia (atypical) x UTIs x STDs TX for UTIs x Aminopenicillins x Cephalosporin x Nitrofurantoin x Sulfonamides Photosensitivity (SAT for photo) x Sulfonamides x Amiodarone x Tetracyclines

SE of Aminoglycosides (NOT) x Nephrotoxicity x Ototoxicity x Teratogen Infections c birds x Histoplasmosis x Cryptococcus x Chlamydia psittaci x Avian influenza x West Nile Virus Lethal for neonates x Group B Strep x E. coli x Listeria Vaginitis Candidiasis x ↓ pH x Cottage cheese x Budding yeast Trichomonas x ↑ pH x Strawberry cervix Gardnerella x ↑ pH x Fishy smell x Clue cells Pseudomonas Infxn (PSEUDOmonas) x Pneumonia (in CF) x Sepsis

x External otitis x UTIs x Diabetic Osteomyelitis Uses for Metronidazole (GET GAP on the Metro) x Giardia x Entamoeba x Trichomonas x Gardnerella x Anaerobes x Pylori (H) 3  C’s  of  Measles x Cough x Coryza x Conjunctivitis Uses for Aminopenicillins (HELPS) x H. influenza x E. coli x Listeria x Proteus x Salmonella 4  R’s  of  Rifampin x RNA pol inhibitor x Revs up P450 x Red body fluids x Rapid resistance Causes of Stevens-Johnsons x Penicillin x Sulfa drugs

x Seizure TX: o Ethosuximide o Lamotrigene o Carbamazepine o Phenobarbital o Phenytoin

Rickettsial Triad x Rash x Fever x Headache H. pylori TX x PPI x Clarithromycin x Amoxicillin x Metronidazole Group A Strep x Pharyngitis x Scarlet fever x Rheumatic fever x Acute GN Chronic Hypoxia x Polycythemia (↑  EPO) x New mitochondria x Angiogenesis 5 Pathways in both Mito and Cytosol x Gluconeogenesis x Urea cycle x Heme synthesis x Pyrimidine synthesis x Fatty acid synthesis Feet and Trisomy’s x Down’s:  widely  spaced  

1st/2nd toes x Edward’s: rocker bottom x Patau’s: polydactyly Vit D, PTH, Ca, and PO4 x ↑ Vit D = ↑Ca and ↑PO4 x ↑ PTH = ↑Ca and ↓PO4 Vit K Dep Clotting Factors (Disco 1972) x Protein S x Protein C x Factor 10 x Factor 9 x Factor 7 x Factor 2 Necrosis x Purulent: bacteria x Fibrinous: vasculitides,

uremia, TB

x Caseous: TB x Fat: pancreatitis, blunt

trauma to breast x Hemorrhagic: Organ c >2

blood supplies Fat Soluble x Small x High concentration grad x Uncharged/basic x Thin membrane x ↑surface area x ↑flux x ↑ pH x ↑ volume of distribution x Metabolized by liver x ↑ t ½ x CNS toxicity CREST Syndrome x Calcinosis (dystrophic) x Raynaud’s x Esophageal dysmotility x Sclerodactyly x Telangiectasia Side Effects of Sulfur x Anaphylaxis x Nonspecific rash x Interstitial nephritis x Drug-induced SLE x Methemoglobinemia x Hemolytic anemia x Kidney stones Don’t  need  parental  consent x STDs x Oral contraceptives x Pregnancy x Psych problems x Substance abuse x Abortion Seizure TX x Adult general: Phenytoin x Child general: Phenobarb x Tonic: Carbamazepine x Absence: Ethosuximide x Temporal: Carbamazepine x Infantile spasms: ACTH x Myotonic: Valproate x Febrile: Tylenol x Status epi: Diazepam Chromosome 22 x DiGeorge’s x NF2

SE Muscarinic Antagonists x Hot as a hare x Dry as a bone x Red as a beet x Blind as a bat x Mad as a hatter x Bloated as a toad DUMBBELSS x Diarrhea x Urination x Miosis x Bronchospasm x Bradycardia x Excitation x Lacrimation x Sweating x Salivation TX for Shock x Anaphylaxis: Epinephrine x Sepsis: Norepinephrine x Cardiogenic:

Dobutamine x Shock c renal perfusion:

Dopamine

Dilated Cardiomyopathy x A – Alcohol, Adriamycin x B – Beriberi, B1 def. x C – Coxsackie B, cocaine,

Chagas x D – Doxorubicin, Diphtheria Organs don’t  need  Insulin (BRICKLE) x Brain x RBC x Intestine x Cornea x Kidney x Liver x Exercising muscle Prolonged QT Interval x Jervell & Lange-Nielsen x Macrolides x Haloperidol x K Channel blockers x Chloroquin x Protease inhibitors x Disopyramide x Methadone

Teratogens and Infections Teratogen Defect ACE Inhibitor Renal damage Alcohol Mental retardation, FAS Alkylating Agents Absence of digits Aminoglycosides CN VIII toxicity Aminopterin IUGR, CNS and skeletal abn. Androgens Masculinization Busulfan Hypoplastic organs, cleft palate CMV Cerebral calcifications Cocaine Placental abruption DES Vaginal clear cell adenoCA Folate antagonist Neural tube defects HSV Retinal dysplasia Iodide Goiter or hypothyroidism Lithium Ebstein’s  anomaly Maternal diabetes mellitus Caudal regression, transposition Methotrexate Skeletal abnormalities Phenytoin Fetal hydantoin, phalangeal

hypoplasia Rubella CHD, deafness, cataracts Smoking IUGR, ADHD Tetracycline Discolored teeth Thalidomide Amelia, phocomelia,

hypoplastic bones Toxoplasma Cerebral calcifications Treponema Deafness, hydrocephalus Valproate Neural tube defects Vitamin A excess Cleft palate, cardiac defects VZV Muscle atrophy Warfarin Fetal hemorrhage, bone defects X-rays Multiple anomalies