Contents Biochem .................................................................................................................................................................................. 1

Musculo-Skeletal ..................................................................................................................................................................... 2

Pharmacology ......................................................................................................................................................................... 3

Gastrointestinal ....................................................................................................................................................................... 4

Endocrine ................................................................................................................................................................................ 5

Cardiovascular ......................................................................................................................................................................... 5

Repro ....................................................................................................................................................................................... 6

Renal ....................................................................................................................................................................................... 7

Neuro ...................................................................................................................................................................................... 7

Microbiology ........................................................................................................................................................................... 7

Bacteria ............................................................................................................................................................................... 7

Viruses ............................................................................................................................................................................... 11

Antibiotics ......................................................................................................................................................................... 12

Multiple ................................................................................................................................................................................. 13

Biochem Uric acid precipitates at acidic pHs

elevated urine galactose + bilateral lens opacities o Galactokinase deficiency

After 16-24 hours of starvation: o breakdown of TG in adipocytes -> release free FA -> liver mitochondria beta oxidize into ketone bodies

each round = 1 NADH, 1 FADH2, a acetyl-CoA acetyal-CoA enters TCA cycle => 3 NADH, 1 FADH2, 1 GTP, CO2

o Failure to produce ketone bodies during fasting (low plasma ketone level during fasting) is a problem of beta oxidation

often problem of acyl-CoA dehydrogenase defect FA synthesis

o During fed state, Acetyl-CoA carboxylase mediates rate-limiting step in fA synthesis

HMP Shunt = Pentose Phosphate Pathway o ALL reactions occur in the cytoplasm o nonoxidative reactions : reversible

enzymes: transketolase and transaldolase transketolase requires TPP

all cells use this portion of the shunt to make fructose-6-phosphate, which can subsequently be turned into ribose

or going the other way, fructose-6-phosphate can enter glycolysis o oxidative portion: glucose-6-phosphate -> ribulose-5-phosphate

produces 2 NADPH enzymes: glucose-6-phosphate DH (rate-limiting step), 6-phosphogluconate DH active in: liver, adrenal cortex, gonads, adipose tissue, RBCs

Musculo-Skeletal Muscle Relaxers

o succinylcholine like acetylcholine, binds nicotinic Ach receptors at neuromuscular junction, but unlike Ach, is not

degraded by Achesterase -> once Na channels depolarize and inactivate, cannot reactivate as long as membrane is depolarized (phase I block)

in phase II block, nicotinic Ach receptors eventually become desensitized to succinylcholine, and membrane repolarizes.

the nicotinic Ach receptor is a non-selective ion channel -> also permist potassium release

o can have life-threatening hyperkalemia and arrhythmias in patients with: crush or burn injuries, denervating injuries (quadrapeligia, Guillian-Barre), myopathies

in these patients, use non-depolarizing agents: vecuronium or rocuronium

o atracurium: non-depolarizing neuromuscular blocker releases histamine, can produce hypotension, flushing, bronchoconstriction metabolite laudanosine can produce seizures

o Baclofen: affects GABAB receptors at SC o Dantrolene: effective in malignant hyperthermia

acts on ryanodine receptors on SR and prevents release of Ca into muscle fiber cytoplasm Carpal Tunnel associations

o pregnancy -> fluid accumulation o hypothyroidism -> glycosaminoglycans build up o diabetes -> CT thickens o rheumatoid arthritis -> tendon inflammation o hemodialysis (long history) -> deposition of beta2- microglobulin (dialysis associated amyloidosis)

Auto-Antibodies and associated conditions o anti-cyclic citrullinated peptide (anti-CCP)

confirms RA clinical diagnosis, highly specific for RA o anti-centromere Ab

CREST syndrome o Rheumatoid factor = anti-Fc portion of IgG Ab

Rheumatoid Arthritis, 10% of healthy people, 30% of SLE pts, and many other inflammatory conditions

o Anti-Nuclear Ab = nuclear basic proteins many CT disorders, often I RA but less often than Rheumatoid factor

o Antiphospholipid Ab SLE, antiphospholipid Ab syndrome causes hypercoagulability, paradoxical PTT prolongation, recurrent miscarriages

Erythema Nodosum o extremely non-specifc, can be cused by:

Strep pyogenes pharyngitis Staph aureus, fungi, chlamydia Chrons, sarcoidosis, other inflammatory conditions

Endomysial inflammatory infiltrate is found on muscle biopsy in polymyositis o presents with proximal muscle weakness

Glomangioma o benign glomus tumor. has bluish tint o glomus = modified smooth muscle cells that control thermoregulatory functions of dermal glomus

bodies o one of 2 tumors that may appear under the nail bed, other being melanoma

Radial nerve

o Gives off posterior cutaneous nerve of the arm o Posterior cutaneous nerve of forearm arises in spiral groove o At lateral epicondyle of humerus (pt of articulation with Radius) splits into

Superficial branch cutaneous sensation on radial dorsal hand Deep branch extensor compartment

Injury -> wrist drop

Nursemaids elbow (pulling child up by arm) = radial head subluxation o Can damage deep branch of radial nerve

Median nerve o Carpal tunnel syndrome -> dysfx fine motor control of thumb

Ulnar nerve o passes between hook of hamate and psiform (Guyons canal)

pinched here -> dysesthesias of ulnar side of hand + weakness of intrinsic muscles of the hand Axillary nerve

o can be damaged with surgical neck humerus fx -> paralysis of deltoid and teres minor + lost sensation on lateral upper arm

Reactive arthritis: HLA-B27 positive, associated with Chlamydia, Shigella, Salmonella, Yersinia, Campylobacter o accompanied by urethritis and conjunctivits

Internal branch of Superior Laryngela nerve (CN X) is located in the piriform recess above the esophagus, only covered by thin mucosa. this nerve carries sensory and autonomic fibers.

o damaged -> afferent limb of cough reflex gone

Gag reflex -> afferent limb mediated by CN IX, efferent limb by CN X

Taste from anterior tongue CN VII

Taste from posterior tongue CN IX

Pharmacology Halothane = a halogenated inhalation anesthetic (enflurane, isofllurane, sevoflurane)

o rare complication: Massive hepatic necrosis appears two days to 4 weeks after exposure histology shows massive centrilobular hepatic necrosis

Nitrates -> transformed to NO at vascular smooth muscle cell membrane -> increased cGMP -> decreased intracellular Ca and myosin dephosphorylation

atypical antipsychotics o SE: hyperglycemia

potency of a gaseous anesthetic o determined by minimal alveolar concentration that produces desired effect in 50% of patients o potent anesthetics require lower partial pressures to be effective

Beta1 receptors are found on renal juxtaglomerular cells

taking lithium during pregnancy predisposes to Ebsteins anomaly

Cholinergics o facial flushing + mydriasis = common anticholinergic effects from meds o Cholinergic receptors:

Nicotinic neuronal ganglion (sympathethic and parasympathetic)

skeletal muscle neuromuscular junction Muscarinic

blockage -> flushed skin + mydriasis

most toxic effects of anticholinergis are from muscarianic blockade o inhibition of sweat glands -> fever + cutaneous vasodilation o inhibition of pupillary constrictor + ciliary muscles -> mydriasis

meds with antimuscarinnic effects: o atropine

o TCAs, ike amitriptyline o H1 receptor antagonists like diphenhydramine o neuroleptics o antiparkinson drugs

H1 receptor antagonists (anti-histamines) taken for allergic rhinitis, often cause anticholinergic effects

H2 receptor antagonists block gastric acid secretion from parietal cells

Thiazide diuretic adverse effects: HYPER o Hyperuricemia o Hypercalcemia decrease urine calcium concentration, so useful in treating nephrolithiasis 2o to

hypercalciuria o Hyperglycemia o Hyperlipidemia elevated cholesterol and LDL o HYPO

Hypokalemia Hypotension

Meds associated with osteoporotic fractures o Vitamin D catabolism

Anticonvulsants that induce CYP: phenobarbital, phenytoin, carbamazepin o Estrogen suppressors

Aromatase inhibitors Medroxyprogesterone

o Testosterone and Estrogen suppressors GnRH agonists

o Decrease Calcium absorption PPIs

o Decrease bone formation Glucocorticoids Unfractionated heparin Thiazolidinediones

5-HT3 receptor is ligand-gated cation chanel o all other 5-HT receptors are G protein coupled

MDR1 multi drug resistant gene found in cancer cells is an ATP-dependent pump that spits out chemo drugs o codes for p-glycoprotein, which is found normally in some cells in kidney, bbb o Drugs that inhibit the pump: verapamil, diltiazem, ketoconazole

NE extravasation o blanching of vein into which NE is being infused with pallor of surrounding tissue signifies NE

extravasation -> resulting vasoconstriction o treat with local injection of alpha1 blocker like phentolamine to prevent tissue necrosis

Isoproterenol activates beta2 receptors o -> vasodilation in striated muscle, renal, mesenteric vascular beds o not helpful in subcutaneous vessels

When giving statins, monitor LFTs o discontinue statins if liver enzymes exceed 3x upper limit of normal

Gastrointestinal VIPoma

o tumor of pancreatic islet (non-beta) cells o increases intestinal chloride loss into stool -> excess loss of water, Na, and K o inhibits gastric acid secretion -> chlorhydria o treat with octreotide (somatostatin)

CD21 is B cell receptor for C3d complement

C. diff o Common antibiotics that precede C diff:

clindamycin, fluoroquinolones, penicillins, cephalosporins o Toxins: bind intestinal mucosa receptors and are internalized

-> both inactivate Rho proteins involved in actin maintenance -> disrupt intercellular tight junctions

enterotoxin: toxin A cytotoxin: toxin B more virulent bind receptors

Endocrine Thyrotoxicosis Treatment

o Minimize thyroid hormone synthesis and release propylthiouracil inhibits thyroid peroxidase methimazole inhibits thyroid peroxidase Iodide inhibits secretion of T3 and T4 and inhibits import of iodide (?) Percholarate and Pertechnetate inhibit entry of iodide into thyroid cell

o Block peripheral conversion of T4 -> T3 propylthiouracil beta blockers Ipodate

o Minimize sympathetic outflow beta blockers

Klinefelter Syndrome o progressive destruction/hyalinization of seminiferous tubules -> small/firm testes, infertile o Sertoli cell damage -> decreased serum inhibin levels o dysfunctional Leydig cells -> decreased testosterone levels o loss of feedback inhibition -> elevated FSH/LH o gonadotropin excess -> increased aromatase activity -> high estrogen levels, gynecomastia

Cystic Fibrosis -> inspissated, obstructed pancreatic ducts -> pancreatic insufficiency

Cardiovascular Normal Pressures Min Max

Right Atrium 0 8

Right Ventricle 4 25

Pulmonary Artery 9 25

Left Atrium 2 12

Left Ventricle 9 130

Aorta 70 130

Drug Mechanism Major Lipid Effects

Side Effects

Statins inhib HMG-CoA reductase decrease LDL decrease TG increase HDL

hepatotoxicity muscle toxicity

Fibrates Gemofibrozil Fenofibrate

Activate PPAR decrease TG decrease LDL increase HDL

Muscle toxicity gallstones

Bile Acid Sequestrants Cholestyramine Colestipol Colesevelam

binds bile acids in intestine decrease LDL nausea, cramping impaired drug and fat soluble absorption

Niacin decrease FA release decrease VLDL synthesis decrease HDL clearance

increase HDL decrease HDL decrease TG

flushing and pruritis hepatotoxicity

Ezetimibe decrease intestinal cholesterol absorption

decrease LDL increase hepatotoxicity if given with statins

Omega 3 FA decrease TG synthesis decrease TG nausea

Effects of drugs on Cardiac Pacemakers o Adenosine activates K channels -> prolongs membrane in negative potetial

also inhibits L-type Ca channels o Acetylcholine opens K channels and decreases slow inward Na and Ca during phase 4 o Norepi faciliates opening of Ca channels and Na channels in phase 4

Mitral stenosis o a shorter interval between A2 (of s2) and Opening Snap of mitral valve means fluid overload in the left

atrium is raising LA pressure, and thus means more severe disease

a VSD with a loud murmur is less serious than a softer murmur. A soft murmur from a VSD reflects reduced interventricular pressure gradient because of the amount of blood that is able to flow through the VSD

Dilated cardiomyopathy o can be caused by Doxorubicin (or epirubicin, daunorubicin, idarubicin)

can present months after discontinuation of drug, early sign is SR swelling presentation: dyspnea on exertion, orthopnea, peripheral edema prevention method: dexrazoxane iron chelating agent prevents O2 free radicals

Repro Patau syndrome (trisomy 13)

o severe cleft lip/palate, microophthalmia, anophthalmia, coloboma, cyclops, malformed nose, deafness, scalp defecs

o CNS: severe mental retardation, microcephaly, holoprosencephaly, absent olfactory bulb, neural tube defects

o Extremities: polydactyly, rocker-bottom feet o Cardiac: PDA, ASD, VSD o Renal: PCKD o GI: abd wall defects, pyloric stenosis

Downs trisomy 21 o CNS: hearing impairment o Head/neck: upslanting palpebral fissures, epicanthal folds, speckled iris (Brushfield spots), flat nasal

bridge, open mouth with protruding tongue o msk: hypotonia, atlanto-axial instability, short hands w/single palmar crease o cardiac: endocardial cushion defects (AV septal defect), VSD, ASD, PDA, ToF o GI: duodenal atresia, TEF, annular pancreas, Hirschsprungs disease, omphalocele, imperforate anus o Immune: impaired cellular immunity, high incidence of infections, autoimmune disorders o Heme: 500x increased risk of AML-M7, 10-20x increased risk of ALL o Endocrine: hypo or hyper thyroidism, DMI, infertility in males

Edwards Syndrome trisomy 18 o prominent occiput, micrognathia, small mouth, low set malformed ears o rocker bottom feet, clenched hands with overriding index and fifth finger o Meckels diverticulum and malrotation

When treating for N. gonorrhoaea (with third gen cephalosporin), MUST treat with azithro or doxy also for possible Chlamydia co-infection

o if untreated -> can cause scarring in fallopian tubes, infertility, ectopic pregnancy

ToRCHES o Congenital Rubella infection is assoc with PDA

Endometriosis: presence of normal endometrial tissue in locations outside the uterus o cause cyclic pelvic pain due to local inflammation/fibrosis

Adenomyosis: presence of endometrial glandular tissue in the myometrium o symptoms: menorrhagia and dysmenorrhea, uniformly enlarged uterus on exam -> from uterine smooth

muscle hypertrophy and hyperplasia in response to the ectopic endometrial tissue

Estrone o made by peripheral tissue from adrenal and ovarian androstenedione by aromatase -> may be normal in

menopausal women

Measure serum FSH to confirm menopuase, should be > 30 U/L o serum LH will also rise, but it rises later and less prominently

Renal Filtration Fraction = GFR/ Renal Plasma Flow

o RPF = RBF x (1-hematocrit) o filtration fraction = fraction of plasma flowing through glomerulus that is filtered across the glomerular

capillaries

Kidney o PAH is completely secreted, clearance approximates renal plasma flow o Inulin is purely filtered, not reabsorbed nor secreted o Urea: 40-50% of filtered urea is reabsorbed by PT, variable further reabsorption or secretion

Neuro Lithium SE: Hypothyroidism (weight gain, dry skin, hair loss, constipation, bradycardia)

o constantly measure TSH, blood Lithium levels and renal function o Lithium is renally excreted, can ccause nephrogenic diabetes insipidus o teratogen -> Ebsteins anomaly

Carbamazepine -> aplastic anemia

Citalopram (SSRI)-> sexual dysfunction

Clozapine (atypical antipyschotic) -> agranulocytosis, seizures

Lamotrigine -> rash, even SJS

Risperidone (atypical antipsychotic) -> hyperprolactinemia

Trazadone -> priapism, orthostatic hypotension, sedation

Morphine o opioid agonist, selectively binds mu opioid receptors -> GPCR -> major pathway is potassium

conductance -> K efflux -> hyperpolarization of

Microbiology Bacteria

Microbe Toxin MOA, effects

B. anthracis Anthrax exotoxin

Edema: adenylate cyclase mimic -> elev cAMP -> edema + phag dysfx

lethal: zinc-dependent protease inhibits MAPK signaling -> apoptosis

B pertussis Pertussis Gi ADP-ribosylation -> elev cAMP -> edema +phag dysfx

Adenylate cyclase adenylate cyclase mimic -> elev cAMP -> edema + phag dysfx

C. botulinum Botulinum blocks presynaptic Ach release at neuromuscular junction

C. difficile Toxin A recruits/activates N -> cytokine release -> mucosal inflam, diarrhea

Toxin B depolymerizes actin -> mucosal cell death -> bowel wall necrosis

S. dysenteriae Shiga toxin disables 60s ribosome subunit -> intestinal epithelial cell death/diarrhea

S. pyogenes Pyrogenic exotoxin superantigen, assoc with scarlet fever and strep TSS

Streptolysin O, S damages RBC membranes -> beta hemolysis

Catalase Positive (aside from S. aureus)

o Pseudomonas G- rod o Listeria G+ rod o Aspergillus o Candida o E. coli G- rod o Serratia G- rod

Cold Agglutinins: Mycoplasma pneumoniae or EBV

Capsules o Bacillus anthracis glutamic acid capsule

Urease Positive (P SCHUNKS) o Proteus o S. epidermidis o S. saprophyticus o Cryptococcus o H. pylori o Ureaplasma o Nocardia o Klebsiella

Toxins o Protein A -> bound to Staph. aureus cell wall, binds IgG Fc near its hinges o Hemolysin -> secreted factor produced by Staph -> causes hemolysis, destruction of neutrophils,

macrophages, platelets o IgA proteases:

Strep pneumo Neisseria gonorrhoeae

o ETEC LT -> activates adenylate cyclase ST -> activates guanylate cyclase

so does Yersinia enterocolitica entertoxin

-> watery diarrhea + electrolyte loss o O157:H7 E. coli

do not ferment sorbitol, unlike 80% of other E. coli strains toxin is identica to the Shiga toxin (Shigella dysenteriae)

phage encoded

production enhanced by iron deficiency

inactivate 60s ribosomal subunit -> inhibit protein synthesis -> cell death o Corynebacterium diphtheriae

diphtheria toxin -> inactivate EF-2 o Pseudomonase aeruginosa

Exotoxin A -> inactivate EF-2 o C. diff

cytotoxin B -> disrupts cytoskeleton to treat recurrent cases: fidaxomicin

has less effect on normal GI flora than metronidazole or vanco, and has least systemic absorption

metronidazole for initial infection o greater systemic absorption, lower drug delivery to distal colon

oral vanco for severe C diff o Ecthyma gangrenosum: multiple skin patches with ulcerated appearance and occasional necrotic center

characteristic for P. aureginosa bacteremia possible in neutropenic patients neutropenic pts are more susceptible to bacteremia by Gram negatives

ulcerations caused by release of virulence factors that destroy tissue and -> insufficient blood flow

exotoxin A (inhibit protein synthesis)

elastase (degrades elastin in blood vessels)

phospholipase C (degrades cellular membranes)

pyocyanin (generates ROS)

CAP o Strep pneumo

polysaccharide capsule, IgA protease, adhesins, pneumolysin o Haemophilus influenzae o Moraxella catarrhalis o Klebsiella pneumo o Staph aureus

Atypical pneumonia o Mycoplasma pneumoniae o Chlamydophila pneumoniae o Legionella

Respiratory Pathogen G- rods: o Haemophilus o Legionella o Bordetella

Post-influenza Secondary Bacterial pneumonia, pathogens most often responsible: o Strep. pneumo o Staph. aureus o Haemophilus influenzae

Strep Pneumo o two vaccines available, very young and very old are at risk

Pneumococcal polysaccharide vaccine covers more strains

evokes T-cell independent B cell response to the capsule

this kind of vaccine also available for Neisseria meningitidis and Haemophilus influenzae Pneumococcal conjugate vaccine

more effective in elderly and children Staph

Coagulase positive Staph aureus

o coagulase positive (binds fibrinogen) o protein A binds Fc of IgG o exofoliatin is an exotoxin, causes SSSS by toxin, not by bacterial invasion

Coagulase neg Novobiocin sensitive

o S. epidermidis

Novobiocin resistant o S. saprophyticus

o Catalase negative -> Strep Alpha hemolytic

Optochin resistant, bile insoluble o Viridans strep

dental caries SBE after dentist

make insoluble extracellular polysaccharides (dextrans) from sucrose optochin sensitive, bile soluble

o Strep pneumo LANCET (sensitive about its chin, will hide in bile) shaped diplococci

pneumonia meningitis otitis media sinusitis

Beta hemolytic PYR pos, bacitracin sensitive

o Strep pyogenes (GAS) cellulitis pharyngitis erysipelas has M protein (antiphagocytic, binds fibrinogen)

PPYR neg, CAMP pos o Strep agalactiae (GBS)

neonatal sepsis pneumonia meningitis UTI

Gamma hemolytic Grow in bile and 6.5% NaCl, PYR pos

o Enterococci IE after GU procedure UTI wound infection

Grow in bile but not 6.5 NaCl, PYR neg o Strep bovis

bacteremia/IE in colon cancer Impetigo

o caused by Staph aureus, less frequently Strep pyogenes o Signs:

pustular skin lesions -> broke to form thick scabs in lower extremities facial puffiness + hematuria -> post-strep glomerulonephritis

this means it was Strep pyogenes (not staph) o another complication of pyogenes could be acute Rheumatic fever, but assoc.

with pharyngitis, not skin infection o cellulitis and erysipelas can also preceed post-strep GN

Haemophilus influenzae o type B -> has capsule made of polyribitol phosphate - pentose monosaccharides rest of H. i strains have

hexose sugar capsules PRP capsule prevents phagocytosis -> can invade vasculature and spread to distant sites vaccine is against type B

hyaluronidase o produced by: staphylococci, Group A strep, C. diff o digests extracellular substances -> enhanced ability to spread

Strep pyogenes o catalase negative, beta hemolytic, gram positive cocci in chains o unique among beta hemolytics in that it is susceptible to bacitracin

bacitracin test has been replaced by pyrrolidonyl arylamidase (PYR) test Strep pyogenes is pyrrolidonyl arylamidase positive

Bartonella henselae

o causes cat-scratch fever and o -> Bacillary angiomatosis in immunocompromised patients: red-purple papular skin lesions, can also find

vascular proliferations in the viscera fatal if untreated

o -> culture negative infective endocarditis

Viruses Parvovirus -> erythema infectiosum (fifth disease), slapped cheek rash

o after facial rash fades, lace like rash appears on trunk and extremities o replicates in bone marrow

aplastic crisis in sickle cell pts o hydrops fetalis in fetus o highly tropic for RBCs - to blood group P Ag (globoside) acts as parvovirus receptor and is found in high

concentrations on RBCs and erythrocyte progenitors

Pharyngo-conjunctival fever -> adenovirus

Epidemic viral gastroenteritis -> Norwalk virus (Calicivirus)

Paramyxoviruses: o Parainfluenzae -> croup (laryngotracheobronchitis) o RSV -> bronchiolitis in infants o Measles -> Rubeolla

Koplik spots: white spots on erythematous base on buccal mucosa Koplik spots accompanied by cough, coryza, conjunctivitis: measles virus very likely -> 1-2 days later: maculopapular rash

o Mumps -> parotitis

In a mono-like illness (lymphocytosis with 30% atypical lymphocytes): o EBV is most common cause: heterophile Ab, pharyngitis o CMV is second most common: more likely to have no assoc pharyngitis nor LAD, does not agglutinate

heterophile Ab

prevent placental transmission of HIV: o Zidovudine: a retroviral reverse transcriptase inhibitor o placental HIV transmission presets as oral thrush, interstitial pneumonia, and severe lymphopneia

during first year of life

Fungi o Histo = central/eastern US, along Ohio and Mississipi river valley o Blasto = east of Mississippi

Parasites o Treat toxoplasma gondii with pyrimethamine and sulfadiazine

or, if sulfa allergy, pyrimethamine and clindamycin AND leucovorin

o Schistosoma requires fresh water snails to incubate infectious larvae S. japonicum, S. mansoni -> intestinal (ulceration -> IDA) and hepatic schistosomiasis (portal

HTN)

japonicum: asia, china, philippines, japan

mansoni: sub-saharan africa, middle east, SA, caribbean S. haematobium -> urinary schistosomiases (dysuria, hydrnephrosis, squamos cell carcinoma of

bladder)

North africa, sub-saharan africa, middle east o Freshwater fish as incubater: Diphyllobothrium latum

Sx: B12 deficiency, megaloblastic anemia ingested as larvae

o Most common cause of hydatid cysts in humans: dog tapeworm Echinococcus granulosus

foods contaminated with dog feces sheep are intermediate host

Antibiotics MOA of disinfectants:

o alcohol disrupt cell membranes (+ denature proteins) o Chlorhexidine disrupt cell membranes (+coagulation of cytoplasm) o Hydrogen Peroxide free radical production

kills spores o Iodine halogenates proteins and nucleic acids

kills spores in parasitic infection, eosinophils bind Fc portion of IgG and IgE that are bound to parasite -> triggers

degranulation and release of major basic protein and ROS => Antibody-dependent cell-mediated cytotoxicity

Clindamycin is the antibiotic of choice for lung abscesses: o good activity against anaerobic oral flora good for pneumonia in alcoholics and ALSO covers Gram

positives like Strep pneumo o Bacteroides, Prebotella, Fusobacterium, Peptostreptococcus from increase in distal tubular membrane permeability

hypokalemia -> arrhythmias, T-wave flattenig, ST depression, prominent U waves, premature atrial or ventricular contractions

profound hypokalemia -> ventricular tachycardia, fibrillation Anti-fungals

o Azoles inhibit demethylation of lanosterol into ergosterol (membrane compon ent) o Amphotericin B binds erogsterol and creates a pore in the membrane o Terbinafine accumulates in skin and nails, inhibits fungal enzyme squalene-2,3-epoxidase -> decreases

synthesis of ergosterol o Griseofulvin binds and inhibits microtubules in fungal cells o Caspofungin blocks glucan synthesis -> 1,3-beta-D-glucan is a major polysaccharide component of fungal

cell wall o Flucytosine inhibits synthesis of DNA and RNA in fungal cells, often used synergistically with

amphotericin B, especially against cryptococcal meningitis

Multiple adult onset asthma, eosinophilia, p-ANCA (anti-myeloperoxidase) = Churg-Strauss

o + hx of allergy, mono/polyneuropathy, migratory/transient pulmonary infiltrates, paranasal sinus abnormalities

Goodpasture Syndrome o Ab against alpha3 chain of collagen IV

SLE o ANA are sensitive for SLE, but not specific o anti-dsDNA Ab are highly specific for SLE but not sensitive (only 60% of SLErs have it) o anti-Smith Ab are highly specific for SLE, but only found in 20-30% of cases of SLE

1. Cyclophosphamide MOA 2. rectal bleeding + ulcers -> tx? amoxicillin, bismuth subsalicylate, loperamide, sulfasalazine 3. cholesterol decreasing drug that inhibits transport of cholesterol through intestinal wall: cholestyramine,

ezetimibe, gemfibrozil, niacin, simvastatin 4. What is the MOA of drug for ADHD -> selective inhibition of uptake of serotonin at nerve terminals, increased

release of dopamine and norepi, NOT enhanced action of GABA at GABA receptor 5. Patient getting liposuction develops hyperthermia, tachycardia, muscle rigidity -> give drug with what

mechanism? a. decrease Ca release from SR b. NOT enhace renal tubular excretion of Ca c. increase plasma Ca concentration d. open cell membrane Ca and Na channels e. shift Ca from extracellular to intracellular

6. old guy with A fib, given IV ibutilide, what is his greatest risk in next 6 hours? a. NOT av block b. AV nodal reentry c. sinus arrest d. sinus tachycardia e. torsades de pointes

7. What can you give for allergies to a crane operator a. brompheniramine, hydroxyzine, loratadine

8. stage IV colon cancer, severe diarrhea with fluorouracil, leucovorin, irinotecan, Dr gives WHAT opioid antidiarrheal with no CNS effects?

a. Loperamide? 9. What binds 30 s ribosome to block protein synthe

a. amox, erythro, getamicin, sulfamethoxazole 10. Heparin induced thrombocytopenia 11. Prednisone suppresses: Ab binding, Mast cell degranulation, neutrophil function, t-lymph function 12. Alendronate for bone density MOA?

Microbiology 1. man with high fever, muscle aches, malaise, anorexia, nonproductive cough, same with his wife and two kids. x

ray and CBC normal. virus replicates in nucleus: a. influenza

2. round shiny bumps in area of eczema, smooth umbilicated papules a. adeno, flavi, paramyxo, pox (molluscum contagiosum

3. otherwise healthy 6 yo boy keeps getting Neisseria menin a. absolute neutrophil count b. CD4 count c. serum IgA d. total hemolytic complement conc

4. brazillian old edema of LE + SOB, myofiber necrosis + inflam infiltrate neutrophils, T, macophages, eosin a. toxocara canis, trichinella spiralis, trypan brucei , t. cruzi, wuchereria bancrofti

5. girl with bilateral interstitial infiltrate, blood aglutinates sontaneoulsy, why a. IgA, D, E, M COLD AGGLUTINATION

6. after africa trip -> fever abd discomfort, dot shit in RBCs a. babesiosis, malaria, toxoplasmosis, NOT trypanosomes

7. woman with fever, malaise, abd pain, vag discharge, ectopic preg 1 year ago. bilateral lower quadrant tenderness, bilateral adnexal tenderness, 18k leuks

a. appendicitis, NOT bacterial vag, chancroid, diverticulitis, gonorrhea, herpes, trichomoniasis 8. How does prednisone blocking T Lymph help in chrons 9. poorly controlled DMII, ESRD, HTN, subclavian cath below right clavicale -> nonhemolytic, catalase neg Gram +

cocci in pairs/chains a. Enterococcus faecalis

OTHERS

small cell lung carcinoma lamer-eaton

mallory hyaline in alcoholic liver

hypotensive old low BP cant up with IV fluids, high CO, low PCWP, low SVR o septic shock? o GI bleed? o hypothyroid? o massive PE? o