Pass Program Clue

8/6/2019 Pass Program Clue

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Pass ProgramPass Program CluesClues““ You ain’t told me squat till You ain’t told me squat till

you tell me the CLUE!!!”you tell me the CLUE!!!”



What are the 5 bacteriaWhat are the 5 bacteria

causing Heart Block?causing Heart Block?• Lyme DiseaseLyme Disease• Salmonella typhii (typhoid)Salmonella typhii (typhoid)• Chagas Disease (Whipple’s)Chagas Disease (Whipple’s)• LegionellaLegionella

• DiptheriaDiptheria

• Lets Stop Doing Long ContractionsLets Stop Doing Long Contractions



What bacteria causeWhat bacteria cause

Reiter’s Syndrome?Reiter’s Syndrome?• ShigellaShigella• IBDIBD

– Crohn’sCrohn’s• ChlamydiaChlamydia• Yersina Yersina

• Reiter & Crohn Saw Yersina and gotReiter & Crohn Saw Yersina and gotChlamyiaChlamyia



What are the Low ComplementWhat are the Low Complementbugs causingbugs causingCryoglobuniemia?Cryoglobuniemia?• InfluenzaeInfluenzae• AdenovirusAdenovirus• MycoplasmaMycoplasma• Hepatitis CHepatitis C

• EBVEBV

• I AM HEI AM HE



What are the drugs inducedWhat are the drugs induced

SLE?SLE?• HydralazineHydralazine• INHINH

• PhenytoinPhenytoin• ProcainamideProcainamide• PenicillaminePenicillamine

• EthosuximideEthosuximide

• H I PPPEH I PPPE



What are the drugs thatWhat are the drugs that

Blast the BM?Blast the BM?• AZTAZT• BenzeneBenzene• ChloramphenicolChloramphenicol• VinblastineVinblastine

• Vinblastine Anilate Bone CellsVinblastine Anilate Bone Cells



What are the CommaWhat are the Comma

Shaped bugs?Shaped bugs?• VibrioVibrio• CampylobacterCampylobacter• ListeriaListeria• H. pyloriH. pylori

• Campylobacter Has Very LongCampylobacter Has Very LongComma GenesComma Genes



What is the cresent shapedWhat is the cresent shaped

protozoa?protozoa?• Giardia lambliaGiardia lamblia



What bacteria looks likeWhat bacteria looks like

Chinese letters?Chinese letters?• CorynebacterCorynebacter



What are the TB Rx?What are the TB Rx?

• RifampinRifampin• PyrazinamidePyrazinamide

• INHINH• EthambutanolEthambutanol

•StreptomycinStreptomycin

• R E S P IR E S P I



What are the 6 Low ComplementWhat are the 6 Low Complementassocs. with Nephrotic Syndrome?assocs. with Nephrotic Syndrome?

• Serum SicknessSerum Sickness• PSGNPSGN

• SLESLE• SBESBE

•CryoglobinemiaCryoglobinemia

• MPGN IIMPGN II



What drugs are P450What drugs are P450

Dependent?Dependent?• WarfarinWarfarin• EstrogenEstrogen

• PhenytoinPhenytoin• Theophylline Theophylline• DigoxinDigoxin

• Theo came from war & dig inside WDEPT Theo came from war & dig inside WDEPTtaking Estrogen & now is Phenytointaking Estrogen & now is Phenytoin



What disease is a NeutophilWhat disease is a Neutophil

Deficiency?Deficiency?• CGDCGD



What are the Side effects of What are the Side effects of

Statins?Statins?• MyositisMyositis• HepatitisHepatitis

• Increased liver enzymesIncreased liver enzymes



What are the painful genitalWhat are the painful genital

Lesions?Lesions?• ChancroidChancroid• HerpesHerpes

• Lymphogranuloma inguinaleLymphogranuloma inguinale



What is the painfulWhat is the painful

chancroid lesion due to?chancroid lesion due to?• Hemophilus ducreyiHemophilus ducreyi



What are the 4 hormones withWhat are the 4 hormones withdisulfide bonds?disulfide bonds?

• ProlactinProlactin• InsulinInsulin

• InhibinInhibin• GHGH

• I PIG on BONDSI PIG on BONDS



What are the Hookworms?What are the Hookworms?

• Necatur americanisNecatur americanis• Enterobius vermicularisEnterobius vermicularis

• Ankylostoma duodenaleAnkylostoma duodenale• Trichuris trichurium Trichuris trichurium• Ascaris lumbercoidesAscaris lumbercoides

• StrongyloidesStrongyloides

• Hooks AS NEATHooks AS NEAT



What are the X-LinkedWhat are the X-Linked

enzyme Deficiencies?enzyme Deficiencies?• G6-PDG6-PD• CGDCGD

• Pyruvate dehydrogenase Def.Pyruvate dehydrogenase Def.• Fabry’sFabry’s• Hunter’sHunter’s

• Lesch-nyhanLesch-nyhan• Lesch-Nyhan Hunter Puts Fabrys on G6Lesch-Nyhan Hunter Puts Fabrys on G6

ClothesClothes



What diseases do we screenWhat diseases do we screen

for at birth?for at birth?• PleasePlease• CheckCheck

• BeforeBefore• GoingGoing• HomeHome

• PKUPKU• CAH(CongentialCAH(Congential

AdrenalAdrenalHyperplasia)Hyperplasia)• BiotinidaseBiotinidase• GalactosemiaGalactosemia• HypothyroidismHypothyroidism



HLA-AntigensHLA-Antigens

• HLA-DR2HLA-DR2 == Narcolepsy, Allergy,Narcolepsy, Allergy,Goodpasture’s, MSGoodpasture’s, MS

• HLA-DR3HLA-DR3 == DM, Chronic Active Hepatitis,DM, Chronic Active Hepatitis,Sjogren’s, SLE, Celiac SprueSjogren’s, SLE, Celiac Sprue

• HLA-DR3 & 4HLA-DR3 & 4 == IDDM(Type I)IDDM(Type I)• HLA-DR4HLA-DR4 == Rheumatoid Arthritis,Rheumatoid Arthritis,

Pemphigus VulgarisPemphigus Vulgaris• HLA-DR5HLA-DR5 == JRA, Pernicious Anemia JRA, Pernicious Anemia• HLA-DR7HLA-DR7 = Nephrotic Syndrome(Steroid= Nephrotic Syndrome(Steroid

induced)induced)



HLA-AntigensHLA-Antigens

• HLA-DR 3 & B8=HLA-DR 3 & B8= Celiac DiseaseCeliac Disease• HLA-A3=HLA-A3= Hemochromatosis(chromo. 6,Hemochromatosis(chromo. 6,

point mut.-cysteine>tyrosine)point mut.-cysteine>tyrosine)• HLA-B8=HLA-B8= MGMG• HLA-B13= PsoriasisHLA-B13= Psoriasis• HLA-B27= Psoriais(only if w/arthritis)HLA-B27= Psoriais(only if w/arthritis)

Ankylosing Spondylitis, IBD, Reiter’s,Ankylosing Spondylitis, IBD, Reiter’s,Postgonococcal ArthritisPostgonococcal Arthritis• HLA-BW 47= 21 alpha HydroxylasHLA-BW 47= 21 alpha Hydroxylas

def.(Vit.D)def.(Vit.D)



What are the actions of What are the actions of

Steroids?Steroids?• Kills helper T-cells & eosinophilsKills helper T-cells & eosinophils• Inhibits Macrophage migrationInhibits Macrophage migration

• Inhibits Mast cell degranulationInhibits Mast cell degranulation• Inhibits Phospholipase AInhibits Phospholipase A• Stimulates protein synthesisStimulates protein synthesis• Stablizes endotheliumStablizes endothelium



What are the causes of What are the causes of

Monocytosis?Monocytosis?• Salmonella (typhoid)Salmonella (typhoid)• TB TB

• EBVEBV• ListeriaListeria• SyphillisSyphillis



E. Coli is the most commonE. Coli is the most common

cause of what?cause of what?• UTIUTI• Spontaneous bacterial peritonitisSpontaneous bacterial peritonitis

• Abdominal abscessAbdominal abscess• CholecystitisCholecystitis• Ascending cholangitisAscending cholangitis• AppendicitisAppendicitis



What are the one doseWhat are the one dosetreatments for Gonorrhea?treatments for Gonorrhea?

• CeftriaxoneCeftriaxone• CefiximeCefixime

• CefoxineCefoxine• CiprofloxinCiprofloxin• OflaxacinOflaxacin• GatifolxacinGatifolxacin



What is the one doseWhat is the one dosetreatment for Chlamydia?treatment for Chlamydia?

• AzithromycinAzithromycin



What are the “Big Mama”What are the “Big Mama”

anaerobes?anaerobes?• Strep bovisStrep bovis• Clostridium melanogosepticusClostridium melanogosepticus

• Bacteriodes fragilisBacteriodes fragilis



What are the “Big Mama”What are the “Big Mama”

Rx?Rx?• ClindamycinClindamycin• MetranidazoleMetranidazole

• CefoxitinCefoxitin



What “big mama” bugs areWhat “big mama” bugs areassociated with colon cancer?associated with colon cancer?

• Strep. BovisStrep. Bovis• Clostridium melanogosepticusClostridium melanogosepticus



What do you see in the serumWhat do you see in the serumwith low volume state?with low volume state?• K+?K+?• DecreasesDecreases

• Na+?Na+?

• DecreasesDecreases• Cl-?Cl-?• DecreasesDecreases

• pH?pH?

• IncreasesIncreases

• BP?BP?• IncreasesIncreases



What are psammomaWhat are psammoma

bodies?bodies?• Calcified CA’sCalcified CA’s



In what diseases areIn what diseases are

Psammoa Bodies present?Psammoa Bodies present?• Papillary carcinoma of the ThyroidPapillary carcinoma of the Thyroid• Serous cystadenocarcinoma of theSerous cystadenocarcinoma of the

ovaryovary• MeningiomaMeningioma• MesotheliomaMesothelioma



What are the Urease (+)What are the Urease (+)

Bacteria?Bacteria?• ProteusProteus• PseudomonasPseudomonas

• Ureaplasma urealyticumUreaplasma urealyticum• Nocardia speciesNocardia species• Cryptococcus neoformansCryptococcus neoformans• H. pyloriH. pylori



What types of stones areWhat types of stones are

formed from Proteus?formed from Proteus?• Struvite (90%)Struvite (90%)



What type of motility doWhat type of motility do

Proteus have?Proteus have?• swarmingswarming



What are 5 indications of What are 5 indications of

Surgery?Surgery?• Intractable painIntractable pain• Hemorrhage (massive)Hemorrhage (massive)

• Obstruction (from scarring)Obstruction (from scarring)• PerforationPerforation



What drugs cause CardiacWhat drugs cause Cardiac

Fibrosis?Fibrosis?• Adriamycin (Doxyrubicin)Adriamycin (Doxyrubicin)• Phen-fenPhen-fen



What drug is used to txWhat drug is used to tx

cardiac fibrosis?cardiac fibrosis?• DozaroxsinDozaroxsin



What is the MCC of any ….What is the MCC of any ….

penia?penia?• #1 = Virus#1 = Virus• #2 = Drugs#2 = Drugs



What is seen in theWhat is seen in the

Salmonella Triad?Salmonella Triad?• High FeverHigh Fever• Rose spots (rash)Rose spots (rash)

• Intestinal fireIntestinal fire



What drugs cause Myositis?What drugs cause Myositis?

• RifampinRifampin• INHINH

• PredinsonePredinsone• StatinsStatins



What are the 7 GramWhat are the 7 Gram

-encapsulated bacteria?-encapsulated bacteria?• SomeSome• StrangeStrange• KillersKillers• HaveHave• PrettyPretty• NiceNice

• CapsulesCapsules

• SalmonellaSalmonella• Strep. PneumoStrep. Pneumo

(gr+)(gr+)• KlebsiellaKlebsiella• H. influenzaH. influenza• PseudomonasPseudomonas• NeisseriaNeisseria• CryptococcusCryptococcus



What is the Jones Criteria forWhat is the Jones Criteria forRheumatic Fever?Rheumatic Fever?

• SubQ nodulesSubQ nodules• PolyarthritisPolyarthritis

• Erythema marginatumErythema marginatum• CarditisCarditis• ChoreaChorea



What are the Risk FactorsWhat are the Risk Factors

for Liver CA?for Liver CA?• Hep B,C,DHep B,C,D• AflatoxinAflatoxin• Vinyl chlorideVinyl chloride

• EthanolEthanol• Carbon TetrachlorideCarbon Tetrachloride• Anyline DyesAnyline Dyes• SmokingSmoking

• HemochromatosisHemochromatosis• BenzeneBenzene• SchistomiasisSchistomiasis



What are the 9 LiveWhat are the 9 LiveVaccines?Vaccines?• MeaslesMeasles• MumpsMumps• RubellaRubella• Oral Polio (sabin)Oral Polio (sabin)• RotavirusRotavirus• Small poxSmall pox• BCGBCG• Yellow fever Yellow fever• VaricellaVaricella



What are the KilledWhat are the KilledVaccines?Vaccines?• SIR Hep ASIR Hep A • Salk (polio)Salk (polio)

• InfluenzaInfluenza

• RubellaRubella• Hepatitis AHepatitis A



What are the IgAWhat are the IgANephropathies?Nephropathies?• Henoch-Schoenlein P. (HSP)Henoch-Schoenlein P. (HSP)• Alport’sAlport’s

• Berger’sBerger’s



What are the Drugs that causeWhat are the Drugs that causeAutoimmune hemolytic anemia?Autoimmune hemolytic anemia?

• PCNPCN• αα -methyldopa-methyldopa

• CephalosporinsCephalosporins• SulfaSulfa• PTUPTU

• Anti-malarialsAnti-malarials• DapsoneDapsone

What are the drugs that causeWhat are the drugs that cause



What are the drugs that causeWhat are the drugs that causeAutoimmuneAutoimmune

thrombocytopenia?thrombocytopenia?• ASAASA• HeparinHeparin

• QuinidineQuinidine



What are the enzymes thatWhat are the enzymes thatshow after an MI?show after an MI?

• Troponin I Troponin I• CKMBCKMB

• LDHLDH



What is the 2What is the 2 ndnd MI enzymeMI enzymeto appear?to appear?• CK-MBCK-MB• AppearsAppears

• PeaksPeaks• GoneGone

• 6 hrs6 hrs

• 12 hrs12 hrs• 24 hrs24 hrs



What is the 3What is the 3 rdrd MI enzyme toMI enzyme toappear?appear?• LDHLDH• AppearsAppears

• PeaksPeaks• GoneGone

• 1 day1 day

• 2 days2 days• 3 days3 days



What bacteria have SilverWhat bacteria have SilverStains?Stains?

• LegionellaLegionella• Pneumocysitis cariniiPneumocysitis carinii

• H. pyloriH. pylori• Bartonella henseslae (lymph node)Bartonella henseslae (lymph node)• Candida (yeast)Candida (yeast)



What are the sulfa containingWhat are the sulfa containingdrugs?drugs?

• SulfonamidesSulfonamides• SulfonylureaSulfonylurea

• CelebrexCelebrex



What is another name forWhat is another name forcelebrex?celebrex?

• CelecoxibCelecoxib



What type of inhibitor isWhat type of inhibitor isCelebrex?Celebrex?

• COX 2 specificCOX 2 specific

What COX-2 specific drug canWhat COX-2 specific drug can



What COX-2 specific drug canWhat COX 2 specific drug canyou give to a pt with sulfayou give to a pt with sulfa

allergy?allergy?• Vioxx (Rofecoxib)Vioxx (Rofecoxib)



What drugs inhibitWhat drugs inhibitdihydrofolate reductase?dihydrofolate reductase?

• Pyremethamin/SulfadiazinePyremethamin/Sulfadiazine• Trimethoprim/Sulfamethoxazole Trimethoprim/Sulfamethoxazole



What drugs cause PulmonaryWhat drugs cause PulmonaryFibrosis?Fibrosis?

• BleomycinBleomycin• BulsufanBulsufan

• AmiodaroneAmiodarone• Tocainide Tocainide



What are the macrophageWhat are the macrophagedeficiency diseases?deficiency diseases?

• Chediak-HigashiChediak-Higashi• NADPH-oxidase deficiencyNADPH-oxidase deficiency



What are the SE of Loops andWhat are the SE of Loops and Thiazides? Thiazides?

• HyperglycemiaHyperglycemia• HyperuricemiaHyperuricemia

• HypovolemiaHypovolemia• HypokalemiaHypokalemia

f



What are the SE of LoopWhat are the SE of Loopdiuretics?diuretics?• OH DANGOH DANG • OtotoxicityOtotoxicity

• HypokalemiaHypokalemia

• DehydrationDehydration• AllergyAllergy• NephritisNephritis

(interstitial)(interstitial)• GoutGout

What are the only 3 PansystolicWhat are the only 3 Pansystolic



What are the only 3 PansystolicWhat are the only 3 PansystolicMurmurs and when are theyMurmurs and when are they

heard?heard?• MRMR

• TR TR

• VSDVSD

• Decrease onDecrease oninspiration (êxp)inspiration (êxp)

• Increase onIncrease oninspirationinspiration

• Decrease onDecrease oninspiration (êxp)inspiration (êxp)

M h i iM h i i



Macrophages in variousMacrophages in variousorgansorgans• BrainBrain• LungLung• LiverLiver• SpleenSpleen• KidneyKidney• Lymph nodesLymph nodes• SkinSkin• BoneBone• CTCT

• MircogliaMircoglia• Type I pneumocyte Type I pneumocyte• Kupffer cellKupffer cell• RESRES

• MesangialMesangial• DendriticDendritic• LangerhansLangerhans• OsteoclastsOsteoclasts• Histiocytes orHistiocytes or• Giant cells orGiant cells or• Epithelioid cellsEpithelioid cells

h h h f hWh h 7 R h f h



What are the 7 Rashes of theWhat are the 7 Rashes of thePalms & Soles?Palms & Soles?

• TSS TSS• Rocky Mountain Spotted FeverRocky Mountain Spotted Fever

• Coxsackie A (Hand/Foot & mouth dz)Coxsackie A (Hand/Foot & mouth dz)• KawasakiKawasaki• SyphillisSyphillis• Scarlet FeverScarlet Fever• Staph Scalded Skin SyndromeStaph Scalded Skin Syndrome

What is seen in everyWhat is seen in every



What is seen in everyWhat is seen in everyrestrictive lung dz and lowrestrictive lung dz and low

volume state?volume state?• Tachypnea Tachypnea• Decrease pCO2Decrease pCO2

• Decrease pO2Decrease pO2• Increase pHIncrease pH

h h diff 2Wh h diff 2 dd



What are the different 2What are the different 2 ndnd messenger systems?messenger systems?

• cAMPcAMP• cGMPcGMP

• IP3/DAGIP3/DAG• Ca:CalmodulinCa:Calmodulin• Ca+Ca+• Tyrosine kinase Tyrosine kinase• NONO



What is the clue for cAMP?What is the clue for cAMP?

• It is the 90%It is the 90%• SympatheticSympathetic

• CRH (cortisol)CRH (cortisol)• CatabolicCatabolic



What is the clue for cGMP?What is the clue for cGMP?

• ParasympatheticParasympathetic• AnabolicAnabolic

Wh h l fWh t th l f



What are the clues forWhat are the clues forIP3/DAG?IP3/DAG?

• NeurotransmitterNeurotransmitter• GHRHGHRH

• All hypothalamic hormones xcAll hypothalamic hormones xccortisolcortisol

• Used by what and for what?Used by what and for what?

• Smooth muscle for contractionSmooth muscle for contraction

Wh i h l fWh t i th l f



What is the clue forWhat is the clue forCa:Calmodulin?Ca:Calmodulin?

• Used by smooth muscle forUsed by smooth muscle forcontraction by distentioncontraction by distention



What is the clue for Ca+?What is the clue for Ca+?

• Used by Gastrin onlyUsed by Gastrin only

Wh t i th l f T iWh t i th l f T i



What is the clue for TyrosineWhat is the clue for TyrosineKinase?Kinase?

• Used by InsulinsUsed by Insulins• Used by ALL growth factorsUsed by ALL growth factors



What is the clue for NO?What is the clue for NO?

• NitratesNitrates• ViagraViagra

• ANPANP• LPSLPS

Wh t th T & B llWh t th T & B ll



What are the T & B cellWhat are the T & B celldeficiencies?deficiencies?

• WASWAS• SCIDSCID

• CVIDCVID• HIVHIV• HTLV-1HTLV-1

What are the CLUES forWhat are the CLUES for



What are the CLUES forWhat are the CLUES forWAS?WAS?• Thrombocytopenia Thrombocytopenia• IL-4IL-4

• InfectionInfection• EczemaEczema• Decrease IgMDecrease IgM• IgE???IgE???




What are the CLUES forWhat are the CLUES forSCID?SCID?• Framshift/Nonsense mutationFramshift/Nonsense mutation• Adenosine deaminase deficiencyAdenosine deaminase deficiency

• T-cell>B-cell T-cell>B-cell• Bacterial infectionsBacterial infections• Fungal infectionsFungal infections




What are the CLUES forWhat are the CLUES forCVID?CVID?• Late onsetLate onset• Frameshift/Missense mutationFrameshift/Missense mutation

• Tyrosine Kinase deficiency Tyrosine Kinase deficiency

What are the CLUES for HIV &What are the CLUES for HIV &



What are the CLUES for HIV &What are the CLUES for HIV &HTLV-1?HTLV-1?

• T-cell>B-cell T-cell>B-cell• CD4 richCD4 rich

• BrainBrain• Testicles Testicles• CervixCervix• Blood vesselsBlood vessels

What are the inhibitors ofWhat are the inhibitors of



What are the inhibitors of What are the inhibitors of Complex 1 of the ETC?Complex 1 of the ETC?

• AmytalAmytal• RotenoneRotenone





• MalonateMalonate





• Antimycin DAntimycin D





• CN-CN-• COCO

• ChloramphenicolChloramphenicol





• OligomycinOligomycin

What are the ETC chemicalWhat are the ETC chemical



What are the ETC chemicalWhat are the ETC chemicaluncouplers?uncouplers?

• DNPDNP• Free Fatty acidsFree Fatty acids

• AspirinAspirin

What type of uncoupler isWhat type of uncoupler is



What type of uncoupler isWhat type of uncoupler isAspirin?Aspirin?

• Physical uncouplerPhysical uncoupler



What is the one dose tx forWhat is the one dose tx for



What is the one dose tx forWhat is the one dose tx forHemophilus ducreyi?Hemophilus ducreyi?

• AzithromycinAzithromycin1 gram po1 gram po

• CeftriazoneCeftriazone250 mg im250 mg im




What is the one dose tx forWhat is the one dose tx forChlaymdia?Chlaymdia?

• AzithromycinAzithromycin1 gram po1 gram po




What is the one dose tx forWhat is the one dose tx forCandidiasis?Candidiasis?

• KetoconazoleKetoconazole150mg150mg




What is the one dose tx forWhat is the one dose tx forVaginal Candidiasis?Vaginal Candidiasis?

• DifluccanDifluccan1 pill1 pill



What is the one dose tx forWhat is the one dose tx forGardnerella?Gardnerella?

• MetronidazoleMetronidazole2 grams2 grams

What are the 3 cephalosporins &What are the 3 cephalosporins &



doses used as one dosedoses used as one dose

treatments for Gonorrhea?treatments for Gonorrhea?• CeftriaxoneCeftriaxone250 mg im250 mg im

• CefiximeCefixime400 mg po400 mg po

• CefoxitinCefoxitin400 mg po400 mg po

What are the 3 Quinolones &What are the 3 Quinolones &



doses used as one dosedoses used as one dose

treatments for Gonorrhea?treatments for Gonorrhea?• CiprofloxacinCiprofloxacin500 mg po500 mg po

• OfloxacinOfloxacin400 mg po400 mg po

• GatifloxacinGatifloxacin400 mg im400 mg im

What are the 4 enzymes neededWhat are the 4 enzymes needed



What are the 4 enzymes neededWhat are the 4 enzymes neededto break down glycogen?to break down glycogen?

• Phosphorylase (Pi)Phosphorylase (Pi)• Debranching enzymeDebranching enzyme

• Alpha-1,6 –GlucosidaseAlpha-1,6 –Glucosidase• PhosphatasePhosphatase

What are the 2 enzymesWhat are the 2 enzymes



What are the 2 enzymesWhat are the 2 enzymesneeded to make glycogen?needed to make glycogen?

• Glycogen synthaseGlycogen synthase• Branching enzymeBranching enzyme



What values do you see inWhat values do you see in



What values do you see inWhat values do you see inobstructive pulmonary dz?obstructive pulmonary dz?

• pO2?pO2?NormalNormal

• pCO2?pCO2?Normal or increasedNormal or increased

• pH?pH?DecreasedDecreased

What values do you see inWhat values do you see in



What values do you see inWhat values do you see inrestrictive pulmonary dz?restrictive pulmonary dz?

• pO2?pO2?DecreasedDecreased

• pCO2?pCO2?DecreasedDecreased

• pH?pH?IncreasedIncreased

What type of acidosis do youWhat type of acidosis do youh b li h b i l



see with obstructive pulmonarysee with obstructive pulmonary

dz?dz?• Respiratory acidosisRespiratory acidosis

What are the Lysosomal StorageWhat are the Lysosomal Storage



What are the Lysosomal StorageWhat are the Lysosomal StorageDisease & what is the deficiency?Disease & what is the deficiency?

• Fabry’sFabry’s• Krabbe’sKrabbe’s• Gaucher’sGaucher’s

• Niemann – PickNiemann – Pick• Tay-Sachs Tay-Sachs• MetachromaticMetachromatic

leukodystrophyleukodystrophy• Hurler’sHurler’s• Hunter’sHunter’s

• αα – galactosidase– galactosidase• GalactosylceramideGalactosylceramide• ββ – glucocerebrosidase– glucocerebrosidase

• SphingomyelinaseSphingomyelinase• HexosaminidaseHexosaminidase• ArylsulfataseArylsulfatase• αα – L – iduronidase– L – iduronidase• Iduronidase sulfataseIduronidase sulfatase

What dz’s are associated withWhat dz’s are associated with



What dz s are associated withHLA B27?HLA B27?

• PsoriasisPsoriasis• Ankylosing spondylitisAnkylosing spondylitis

• IBD (Ulcerative colitis)IBD (Ulcerative colitis)• Reiter’s SyndromeReiter’s Syndrome

What HLA is Psorisis w/RAWhat HLA is Psorisis w/RA



What HLA is Psorisis w/RAassociated with?associated with?

• HLA-13HLA-13

What are the Glycogen StorageWhat are the Glycogen Storage



What are the Glycogen Storagey g gDiseases & the deficiency?Diseases & the deficiency?

• Von Gierke’sVon Gierke’s

• Pompe’sPompe’s

• Cori’sCori’s

• McArdle’sMcArdle’s

• Glucose – 6 –Glucose – 6 –phosphatephosphate

• αα – 1 – 4 glucosidase– 1 – 4 glucosidase

• Debranching enzymeDebranching enzyme

• GlycogenGlycogenphosphorylasephosphorylase

What are 6 places of the TCA cycleWhat are 6 places of the TCA cycle



W at a e 6 p aces o t e C cyc ep ywhere amino acids feed in/out?where amino acids feed in/out?

• Pyruvate?Pyruvate?• GlycineGlycine• AlanineAlanine• SerineSerine

• Acetyl CoAAcetyl CoA ??• PhenylalaninePhenylalanine• IsoleucineIsoleucine• Threonine Threonine• Tryptophan Tryptophan• LysineLysine• LeucineLeucine



What are 6 places of the TCA cycleWhat are 6 places of the TCA cycle



p yp ywhere amino acids feed in/out?where amino acids feed in/out?

• FumerateFumerate ??• ProlineProline

• Oxaloacetate?Oxaloacetate?• AspartateAspartate

• AsparigineAsparigine



What are the blood gases inWhat are the blood gases inl di (neuromuscular disease (=



neuromuscular disease (=neuromuscular disease (=

restrictive blood gases)?restrictive blood gases)?• pO2?pO2?

DecreasedDecreased• pCO2?pCO2?

DecreasedDecreased

• PCWP?PCWP?DecreasedDecreased (b/c it’s a pressure problem)(b/c it’s a pressure problem)

• Respiratory Rate?Respiratory Rate?IncreasedIncreased

• pH?pH?IncreasedIncreased

• SZ?SZ?IncreasedIncreased

What are 5 Hormones produced byWhat are 5 Hormones produced by



p yp ysmall cell (oat cell) lung CA?small cell (oat cell) lung CA?

• ACTHACTH• ADHADH

• PTHPTH• TSH TSH• ANPANP

What Autoimmune Disease hasWhat Autoimmune Disease hasth f ll i g A t ithe following Autoimmune



the following Autoimmunethe following Autoimmune

Antibodies?Antibodies?• Anti-smithAnti-smith

• Anti cardiolipinAnti cardiolipin• Anti-ds DNAAnti-ds DNA • SLESLE



What Autoimmune Disease hasWhat Autoimmune Disease hasthe following Autoimmunethe following Autoimmune




Antibodies?Antibodies?• Anti-topoisomerase?Anti-topoisomerase?

• PSS (Progressive Systemic Sclerosis)PSS (Progressive Systemic Sclerosis)





Antibodies?Antibodies?• Anti TSH receptors?Anti TSH receptors?

• GravesGraves





Antibodies?Antibodies?• Anti-centromere?Anti-centromere?

• CRESTCREST





Antibodies?Antibodies?• Anti-GBM?Anti-GBM?

• Goodpasture’sGoodpasture’s

What does Goodpastures haveWhat does Goodpastures have



antibody to?antibody to?

• Type IV collagen Type IV collagen





Antibodies?Antibodies?• Anti-mitochondria?Anti-mitochondria?

• Primary biliary cirrhosisPrimary biliary cirrhosis





Antibodies?Antibodies?• Anti-hair follicle?Anti-hair follicle?

• Alopecia areataAlopecia areata





Antibodies?Antibodies?• Anti-IgG?Anti-IgG?

• Rheumatoid arthritisRheumatoid arthritis

a u o mmune sease asthe following Autoimmunethe following Autoimmune



Antibodies?Antibodies?

• Anti-myelin receptors?Anti-myelin receptors?

• MSMS





Antibodies?Antibodies?• Anti-gliaden?Anti-gliaden?• Anti-gluten?Anti-gluten?

• Celiac sprueCeliac sprue





Antibodies?Antibodies?• Anti-islet cell receptor?Anti-islet cell receptor?

• DM Type IDM Type I





Antibodies?Antibodies?• Anti-melanocyte?Anti-melanocyte?

• ViteligoViteligo





Antibodies?Antibodies?• Anti-ACh receptor?Anti-ACh receptor?

• MGMG





Antibodies?Antibodies?• Anti-ribonuclear protein?Anti-ribonuclear protein?

• Mixed Connective Tissue dz (MCTD)Mixed Connective Tissue dz (MCTD)





Antibodies?Antibodies?• Anti-parietal cell receptor?Anti-parietal cell receptor?

• Pernicious anemiaPernicious anemia

What does Pernicious AnemiaWhat does Pernicious Anemia



have antibody to?have antibody to?

• Intrinsic factorIntrinsic factor





Antibodies?Antibodies?• Anti-epidermal anchoring proteinAnti-epidermal anchoring proteinreceptors?receptors?

• Pemphigus vulgarisPemphigus vulgaris

What does Pemphigus vulgarisWhat does Pemphigus vulgaris



have antibody to?have antibody to?

• Intercelluar junctions of epidermalIntercelluar junctions of epidermalcellscells





Antibodies?Antibodies?• Anti-epidermal basement membraneAnti-epidermal basement membraneprotein?protein?

• Bullous pemphigoidBullous pemphigoid

What do you see with bullousWhat do you see with bulloush d



pemphigoid?pemphigoid?

• IgG sub-epidermal blistersIgG sub-epidermal blisters• Oral blistersOral blisters





Antibodies?Antibodies?• Anti-platelet?Anti-platelet?

• ITPITP

What does ITP have antibodyWhat does ITP have antibody?



to?to?

• Glycoprotein IIb/IIIaGlycoprotein IIb/IIIa





Antibodies?Antibodies?• Anti-thyroglobulin?Anti-thyroglobulin?• Anti-microsomal?Anti-microsomal?

• Hashimoto’sHashimoto’s





Antibodies?Antibodies?• Anti-smooth muscle?Anti-smooth muscle?• Anti-scl-70?Anti-scl-70?

• SclerodermaScleroderma




the following Autoimmuneg

Antibodies?Antibodies?• Anti-rho (SS-A)?Anti-rho (SS-A)?• Anti-la?Anti-la?

• Sjogren’sSjogren’s




the following Autoimmuneg

Antibodies?Antibodies?• Anti-proteinase?Anti-proteinase?• C-ANCA?C-ANCA?

• Wegener’sWegener’s




t e o ow g uto u eg

Antibodies?Antibodies?• P-ANCA?P-ANCA?

• Polyarteritis nodosaPolyarteritis nodosa

What antigen &What antigen &immunoglobulin is Polyarteritisimmunoglobulin is Polyarteritis



g yg y

nodosa associated with?nodosa associated with?• Hepatitis B antigenHepatitis B antigen• IgMIgM

What are the viruses that directlyWhat are the viruses that directlycause CA and which CA do theycause CA and which CA do they



yycause?cause?• Papilloma virusPapilloma virus ??

Cervical CACervical CA• EBVEBV ??

BurkittsBurkittsNasopharyngeal CANasopharyngeal CA• HepB & CHepB & C ??

Liver CALiver CA

• HIVHIV ??Kaposi’s SarcomaKaposi’s Sarcoma



What is the most commonWhat is the most commonnephrotic disease seen in kidsnephrotic disease seen in kids



pp

and when does it occur?and when does it occur?• Min. change diseaseMin. change disease

• 2 wks post URI2 wks post URI



What is the most commonWhat is the most commonmalignant renal tumor inmalignant renal tumor in



gg

children?children?• Wilm’s tumorWilm’s tumor



What is the most commonWhat is the most commonrenal mass?renal mass?



renal mass?renal mass?

• CystCyst

What is the most commonWhat is the most commonrenal disease inrenal disease in



Blacks/Hispanics?Blacks/Hispanics?• Focal Segmental GNFocal Segmental GN

What is the most commonWhat is the most commonnephrotic disease in adults?nephrotic disease in adults?



nephrotic disease in adults?nephrotic disease in adults?

• Membranous GNMembranous GN

Thrombolytics & Inhibitors Thrombolytics & Inhibitors



yy

• What does tPA, Streptokinase,What does tPA, Streptokinase,Urokinase inhibit?Urokinase inhibit?

• Aminocaproic acidAminocaproic acid• What doe Warfarin inhibit?What doe Warfarin inhibit?• Vitamin K Vitamin K

• What does Heparin inhibit?What does Heparin inhibit?• Protamine SulfateProtamine Sulfate

What is the dosage of tPA?What is the dosage of tPA?



gg

• IV push?IV push?• 20mg20mg

• Drip?Drip?• 40mg40mg



What is Urokinase used for?What is Urokinase used for?



• Used ONLY for such things as:Used ONLY for such things as:• Feeding tubesFeeding tubes

• Central linesCentral lines• FistulasFistulas

What is Alopecia Areata?What is Alopecia Areata?



p

• Loss of a patch of hairLoss of a patch of hair

What is Alopecia Totalis?What is Alopecia Totalis?



p

• Loss of ALL hair on head “bald”Loss of ALL hair on head “bald”

What is AlopeciaWhat is AlopeciaUniversalis?Universalis?



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

What is Loffler syndrome?What is Loffler syndrome?



• Pneumonitis with endocarditis =Pneumonitis with endocarditis =pulmonary infiltrate with severepulmonary infiltrate with severeeosinophiliaeosinophilia

What is Loffler syndrome alsoWhat is Loffler syndrome alsoknown as?known as?



known as?known as?

• PIE syndromePIE syndrome

What are the 5 ParasitesWhat are the 5 Parasitesassociated withassociated with LofflerLoffler



Syndrome?Syndrome?• Necator americanusNecator americanus• Ankylostoma duodenaleAnkylostoma duodenale

• ShistosomiasisShistosomiasis• StrongyloidesStrongyloides

• Ascaris lumbricoidesAscaris lumbricoides

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



is on prednisone for > 7 days?is on prednisone for > 7 days?

• ImmunocompromisedImmunocompromised

What are 2 enzymes used byWhat are 2 enzymes used byB12?B12?



B12?B12?

• Homocystine methyl transferaseHomocystine methyl transferase• Methyl malonyl-coA mutaseMethyl malonyl-coA mutase

What does MitochondrialWhat does Mitochondrialinheritance mean?inheritance mean?



inheritance mean?inheritance mean?• No male transmissionNo male transmission• All females pass it onAll females pass it on

Who are 4 pt’s who would beWho are 4 pt’s who would besusceptable to pseudomonassusceptable to pseudomonas



and staph infxns?and staph infxns?• Burn patientsBurn patients• Cystic fibrosisCystic fibrosis

• DMDM• Neutropenic patientsNeutropenic patients

In a neutropenic patient, whatIn a neutropenic patient, whatdo you cover for?do you cover for?



do you cover for?do you cover for?

• cover 1x for Staph aureus during 1stcover 1x for Staph aureus during 1stweekweek

• cover 2x for Pseudo after 2nd weekcover 2x for Pseudo after 2nd week

What are the 3 main conceptsWhat are the 3 main conceptscausing a widened S2 splitting?causing a widened S2 splitting?



causing a widened S2 splitting?causing a widened S2 splitting?

• Increased pO2Increased pO2• Delayed opening/closing of theDelayed opening/closing of the

pulmonary valuepulmonary value• Increased volume in the rightIncreased volume in the right

ventricleventricle

What are causes for aWhat are causes for awidened S2 splitting?widened S2 splitting?

• Blood transfusionBlood transfusion



• Blood transfusionBlood transfusion

• Increased Tidal VolumeIncreased Tidal Volume• Giving O2Giving O2• Right sided heart failureRight sided heart failure• Pregnancy due to increase volumePregnancy due to increase volume• IV fluidsIV fluids• ASD/VSDASD/VSD• Deep breathingDeep breathing• HypernateremiaHypernateremia• SIADHSIADH

• Pulmonary regurgePulmonary regurge• Pulmonary stenosisPulmonary stenosis• Right bundle branch blockRight bundle branch block

What are the 8 commonWhat are the 8 commoncavities of blood loss?cavities of blood loss?



cavities of blood loss?cavities of blood loss?

• PP ericardiumericardium• IIntracranialntracranial• MM ediastinumediastinum

• PP leural cavityleural cavity• TT highshighs• RR etroperitoneumetroperitoneum• AAbdominal cavitybdominal cavity

• PP elviselvis

What is the special list forWhat is the special list forPenicillin?Penicillin?



Penicillin?Penicillin?• Gram +Gram +• Basement membrane suppressorBasement membrane suppressor• Works on simple anaerobesWorks on simple anaerobes• The #1 cause of anaphylaxis The #1 cause of anaphylaxis• Causes interstial neprititsCauses interstial nepritits• Causes nonspecific rashesCauses nonspecific rashes

• Acts as a hapten causing hemolyticActs as a hapten causing hemolyticanemiaanemia



What are the Chron’s Gifts?What are the Chron’s Gifts?



• GranulomaGranuloma• IleumIleum

• FistulaFistula• Transmural Transmural• Skip LesionSkip Lesion

What are the negative-What are the negative-stranded RNA Clues?stranded RNA Clues?



stranded RNA Clues?stranded RNA Clues?• Prodromal periodProdromal period before symptomsbefore symptoms

= 1-3 weeks= 1-3 weeks• Why is there a prodromal period?Why is there a prodromal period?• Because must switch to positiveBecause must switch to positive

stranded before replicationstranded before replication



What are the Most commonWhat are the Most commoncyanotic heart diseases?cyanotic heart diseases?



cyanotic heart diseases?y• Transposition of the great arteries Transposition of the great arteries• Tetrology of Fallot Tetrology of Fallot• Truncus Arteriosus Truncus Arteriosus

• Tricuspid Atresia Tricuspid Atresia• Total anomalous pulmunary Venous Total anomalous pulmunary VenousReturnReturn

• Hypoplastic Left heart syndromeHypoplastic Left heart syndrome• Ebstein’s anomalyEbstein’s anomaly• Aortic atresiaAortic atresia• Pulmonary atresiaPulmonary atresia

What cyanotic heart disease isWhat cyanotic heart disease is– boot shaped?– boot shaped?



boot s aped?p

• Tetrology of Fallot Tetrology of Fallot



What things make theWhat things make themembrane less likely tomembrane less likely tod l i ?d l i ?



depolarize?depolarize?• HypokalemiaHypokalemia• HypermagnesemiaHypermagnesemia

• Hypercalcemia (except atrium)Hypercalcemia (except atrium)• HypernatremiaHypernatremia

What things make theWhat things make themembrane more likely tomembrane more likely tod l i ?d l i ?



depolarize?depolarize?• HyperkalemiaHyperkalemia• HypomagnasemiaHypomagnasemia

• Hypocalcemia (except atrium)Hypocalcemia (except atrium)• HyponatremiaHyponatremia

What is Plan F?What is Plan F?



• T TPP P – Thiamin – B1P – Thiamin – B1• LL ipoic Acid – B4ipoic Acid – B4

• CoCo AA – Pantothenic acid – B5– Pantothenic acid – B5• FF AD – Riboflavin – B2AD – Riboflavin – B2• N AD – Niacin – B3AD – Niacin – B3

What are the 8 x-linkedWhat are the 8 x-linkedinherited diseases?inherited diseases?



• Bruton’s AgammaglobulinemiaBruton’s Agammaglobulinemia• CGD (NADPH def)CGD (NADPH def)• DMDDMD

• Color BlindnessColor Blindness• G6PDG6PD• HemophiliaHemophilia• Lesch-NyhanLesch-Nyhan

• Vit D resist. Rickets (X-linked dominant)Vit D resist. Rickets (X-linked dominant)• FabrysFabrys• HuntersHunters



What is the Tyrosine kinaseWhat is the Tyrosine kinasedeficiency?deficiency?



yy

• Bruton’s agammaglobulinemiaBruton’s agammaglobulinemia

What are the B-cellWhat are the B-celldeficiencies with T-celldeficiencies with T-cello erlap?overlap?



overlap?overlap?• SCIDSCID• WASWAS

• Job Buckley Syndrome Job Buckley Syndrome

What are the 4 itchiestWhat are the 4 itchiestrashes?rashes?



• ScabiesScabies• Lichen PlanusLichen Planus

• UrticariaUrticaria• Dermatitis HerpetiformisDermatitis Herpetiformis

Tumor Markers/Oncongenes Tumor Markers/OncongenesII



• L-myc?L-myc? • Small cell lung CaSmall cell lung Ca

• C-myc?C-myc?

• Promyelocytic leukemia (Burkitt’s lymphoma)Promyelocytic leukemia (Burkitt’s lymphoma)

• N-myc?N-myc?• NeuroblastomaNeuroblastoma

• Small cell lung CASmall cell lung CA

• C-able?C-able?• CMLCML• ALLALL

Tumor Markers/Oncongenes Tumor Markers/OncongenesIIII



• C-myb?C-myb?• Colon CAColon CA• AMLAML

• C-sis ?C-sis ?• OsteosarcomaOsteosarcoma

• GliomaGlioma• FibrosarcomaFibrosarcoma

Tumor Markers/Oncongenes Tumor Markers/OncongenesIIIIII



• C-erb B2?C-erb B2?• Epidermal growth factor receptorsEpidermal growth factor receptors

• CSF-1 ?CSF-1 ?• BreastBreast

Tumor Markers/Oncongenes Tumor Markers/OncongenesIVIV



• Erb-B2?Erb-B2?• Breast CABreast CA• Ovarian CAOvarian CA• Gastric CAGastric CA

• Ret?Ret?• Medullary CA of thyroidMedullary CA of thyroid• Men II & IIIMen II & III• Papillary carcinomaPapillary carcinoma

Tumor Markers/Oncongenes Tumor Markers/OncongenesVV



• Ki-ras?Ki-ras?• Lung CALung CA• Colon CAColon CA

• Bcl-2?Bcl-2?• BurkittsBurkitts• Follicular lymphomaFollicular lymphoma

• Erb?Erb?• RetinoblastomaRetinoblastoma

What are 6 HormonesWhat are 6 Hormonesproduced by the placenta?produced by the placenta?



p y pp y p• hCGhCG• InhibinInhibin• Human placental lactogen (HPL)Human placental lactogen (HPL)

• Oxytocin (drug lactation, pit glandOxytocin (drug lactation, pit glandprod it also)prod it also)• ProgesteroneProgesterone

• EstrogenEstrogen

• RelaxinRelaxin

What is cancer grading?What is cancer grading?



• Severity of microscopic changeSeverity of microscopic change• Degree of differentiationDegree of differentiation



What are the rashes associatedWhat are the rashes associatedwith cancer and what cancerwith cancer and what cancerare they associated with?are they associated with?



are they associated with?are they associated with?

• Urticaria/Hives?Urticaria/Hives?• Any CA, especially lymphomaAny CA, especially lymphoma• Pagets Ds (ulcers around nipples)Pagets Ds (ulcers around nipples)

• Seborrheic keratosis (waxy warts)?Seborrheic keratosis (waxy warts)?• Colon CAColon CA• HIV if sudden increase in numberHIV if sudden increase in number

• Normal with agingNormal with aging

What are the rashes associatedWhat are the rashes associatedwith cancer and what cancerwith cancer and what cancerare they associated with?are they associated with?



are they associated with?are they associated with?

• Actinic keratosis?Actinic keratosis? – Dry scaly plaques on sun-exposed skinDry scaly plaques on sun-exposed skin

• Squamous Cell CA of skinSquamous Cell CA of skin

• Dermatomyositis?Dermatomyositis? – violacious, heliotropic rash, malar areaviolacious, heliotropic rash, malar area

• Colon CAColon CA

What are the rashes associatedWhat are the rashes associatedwith Cancer and the cancerwith Cancer and the cancerthey are associated with?they are associated with?



they are associated with?they are associated with?

• Akanthosis nigricans?Akanthosis nigricans? – dark lines in skin foldsdark lines in skin folds

• Any visceral CAAny visceral CA

• End organ damageEnd organ damage

• Erythema nodosum?Erythema nodosum? – ant aspect of legs, tender nodulesant aspect of legs, tender nodules

• Anything granulomatousAnything granulomatous

• NOT assoc. w/ bacteriaNOT assoc. w/ bacteria

What is carried by HDL?What is carried by HDL?



• Apo EApo E• Apo AApo A

• Apo CIIApo CII

• L-CATL-CAT

– lecithin cholesterol acetyl transferaselecithin cholesterol acetyl transferase• CholesterolCholesterol– from periphery to liverfrom periphery to liver

What is carried by VLDL?What is carried by VLDL?



• Apo B-100Apo B-100• Apo EApo E• Apo C IIApo C II

• Triglcyerides (95%) Triglcyerides (95%)• Cholesterol (5%)Cholesterol (5%)

What is carried by IDL?What is carried by IDL?



• Apo B-100Apo B-100• Apo EApo E

• Apo CIIApo CII

• Triglycerides (< VLDL) Triglycerides (< VLDL)

• Cholesterol (>VLDL)Cholesterol (>VLDL)

What is carried by LDL?What is carried by LDL?



• Apo B-100Apo B-100

• CholesterolCholesterol– from liver to tissuefrom liver to tissue

• NOT a good thing!!!!!NOT a good thing!!!!!

What do chylomicronsWhat do chylomicronscarry?carry?



• Apo AApo A• Apo B-48Apo B-48• Apo EApo E

• Apo C IIApo C II

• Triglycerides from: Triglycerides from:• GI to liver (25% of the time)GI to liver (25% of the time)

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

Which lipoprotein carriesWhich lipoprotein carriesthe most cholesterol?the most cholesterol?



• LDLLDL

Where are the AVMs?Where are the AVMs?



• Clue = HEALClue = HEAL• Heart?Heart?• Machinery murmurMachinery murmur

• Elbow?Elbow?• Fistula from dialysis in renal diseaseFistula from dialysis in renal disease

• Abdomen/Brain?Abdomen/Brain?• Von Hippel-Lindau = clot off with coilsVon Hippel-Lindau = clot off with coils• Increase incidence of Renal cell CA on chrom 3Increase incidence of Renal cell CA on chrom 3

• Lungs?Lungs?• Osler Weber Rendu SyndromeOsler Weber Rendu Syndrome

What is the Ranson’s criteriaWhat is the Ranson’s criteriafor acute pancreatitis (for acute pancreatitis ( atatadmissionadmission )?)?



admissionadmission )?)?• Glucose > 200Glucose > 200• Age > 55Age > 55

• LDH >350LDH >350• AST > 250AST > 250• WBC > 16,000WBC > 16,000



What is dysguzia?What is dysguzia?



• Problem with sense of tasteProblem with sense of taste

What are 3 causes of What are 3 causes of dysgusia?dysgusia?



• MetronidazoleMetronidazole• ClarithromycinClarithromycin

• Zinc deficiencyZinc deficiency



What do you measure forWhat do you measure forcarcinoid syndrome?carcinoid syndrome?



• SerotoninSerotonin– 5-HIAA5-HIAA

Where are the 2 mostWhere are the 2 mostcommon places a carcinoidcommon places a carcinoidtumor is found?tumor is found?



tumor is found?tumor is found?• PancreasPancreas• IleumIleum

What are the phageWhat are the phagemediated toxins?mediated toxins?



• MnemonicMnemonic : BEDS: BEDS• BotulinumBotulinum

• Erythrogenic toxinErythrogenic toxin– from strep pyogenesfrom strep pyogenes

• DiptheriaDiptheria

• SalmonellaSalmonella– Has O antigenHas O antigen

What is the story used toWhat is the story used toremember the segmented RNAremember the segmented RNAviruses?viruses?



• I sprayedI sprayed ORTHOORTHO on myon my BUNYABUNYA atatthethe ARENAARENA down indown in REOREO to killto killSEGMENTED WORMSSEGMENTED WORMS

Name the 3 major types of Name the 3 major types of adhesion moleculesadhesion molecules



• ICAMsICAMs• IntegrinsIntegrins

•SelectinsSelectins

What does IgCam do?What does IgCam do?



• Bind proteinsBind proteins

What do integrins do?What do integrins do?



• Stop the leukocytesStop the leukocytes

What do selectins do?What do selectins do?



• Bind carbohydratesBind carbohydrates• Mediate the rolling to slowMediate the rolling to slow

leukocytes downleukocytes down

What are the functions of What are the functions of adhesion molecules?adhesion molecules?



• Homing of lymphocytesHoming of lymphocytes– tells lymphocytes where to gotells lymphocytes where to go

• InflammationInflammation• Cell-cell interactionCell-cell interaction

Primary allergic response isPrimary allergic response isdue to what?due to what?



• ContactContact

What cells are present in theWhat cells are present in thefirst 3 days?first 3 days?



• NeutrophilsNeutrophils

• The next cells to show up are? The next cells to show up are?• B-cellsB-cells

• What do B-cells make?What do B-cells make?• IgMIgM

What day does IgM showWhat day does IgM showup?up?



• Three Three

• IgM peaks at what day?IgM peaks at what day?• 1414

• When does IgM leave?When does IgM leave?• In 2 monthsIn 2 months



What is Secondary AllergicWhat is Secondary Allergicresponse is due to?response is due to?



• MEMORY MEMORY

What shows up at day 3?What shows up at day 3?



• IgG with 5x concentrationIgG with 5x concentration• Has the highest affinityHas the highest affinity

• When does IgG peak?When does IgG peak?• In 5 yearsIn 5 years

• When does IgG leave?When does IgG leave?• In 10 yearsIn 10 years

What Ig has the hightestWhat Ig has the hightestaffinity?affinity?



• IgGIgG

What are the risk factors forWhat are the risk factors forEsophageal/Gastric CA?Esophageal/Gastric CA?



• SmokingSmoking• AlcoholAlcohol• NitritesNitrites• Japanese Japanese

What are the risk factors forWhat are the risk factors forbladder CA?bladder CA?



• SmokingSmoking• Aniline dyesAniline dyes• BenzeneBenzene• AflatoxinAflatoxin

• CyclophosphamideCyclophosphamide• SchistosomiasisSchistosomiasis• 2 diseases:2 diseases:• Von Hippel-LindauVon Hippel-Lindau

• Tubular sclerosis Tubular sclerosis

What is the NBT test?What is the NBT test?



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

What disease corresponds withWhat disease corresponds withthe following inclusion bodies?the following inclusion bodies?



• Howell-Jolly?Howell-Jolly?• Sickle cellSickle cell

• Heinz?Heinz?

• G-6-P-DG-6-P-D

• Zebra?Zebra?• Niemann pickNiemann pick




• Donovan?Donovan?• LeishmaniasisLeishmaniasis

• Mallory?Mallory?• AlcoholismAlcoholism

• Negri?Negri?

• RabiesRabies




• Councilman?Councilman?• Yellow fever Yellow fever

• Call-exner?Call-exner?• Ovarian tumorsOvarian tumors

– granulosa origingranulosa origin




• Lewy?Lewy?• ParkinsonsParkinsons

• Pick?Pick?• Pick’s diseasePick’s disease

• Barr body?Barr body?• Normal femaleNormal female




• Aschoff?Aschoff?• Rheumatic feverRheumatic fever

• Cowdry type A inclusions?Cowdry type A inclusions?• Herpes virusHerpes virus

• Auer rods?Auer rods?• AMLAML




• Globoid?Globoid?• Krabbe’s lysosomal storage diseaseKrabbe’s lysosomal storage disease

• Russell?Russell?• Multiple myelomaMultiple myeloma




• Schiller-Duvall?Schiller-Duvall?• Yolk sac tumor Yolk sac tumor

• Basal bodies?Basal bodies?• Only found in smooth mmOnly found in smooth mm

What are the 4 types of What are the 4 types of hypersensitivities?hypersensitivities?



• Mnemonic?Mnemonic?• ACIDACID

• Type I Type I• Anaphylaxis/AtopicAnaphylaxis/Atopic

• Type II Type II• Cytotoxic (Humoral)Cytotoxic (Humoral)

• Type III Type III• Immune complex mediationImmune complex mediation

• Type IV Type IV• Delayed hypersensitivity/Cell mediatedDelayed hypersensitivity/Cell mediated

What are the CharacteristicsWhat are the Characteristicsof Type I hypersensitivity?of Type I hypersensitivity?



• AtopicAtopic• IgE (Asthma) binds to mast cellIgE (Asthma) binds to mast cell• IgA activates IP3 cascade degradingIgA activates IP3 cascade degrading

mast cellsmast cells

What are the CharacteristicsWhat are the Characteristicsof Type II hypersensitivity?of Type II hypersensitivity?



• HumoralHumoral• What are examples of type II?What are examples of type II?• Rh diseaseRh disease• GoodpasturesGoodpastures• Autoimmune hemolytic AnemiaAutoimmune hemolytic Anemia

• All Autoimmune diseasesAll Autoimmune diseases– except RA and SLEexcept RA and SLE

What are the CharacteristicsWhat are the Characteristicsof Type III hypersensitivity?of Type III hypersensitivity?



• Ag-Ab complementAg-Ab complement• What are examples of Type III?What are examples of Type III?• RARA• SLESLE• VasculitidesVasculitides

• Some GN?Some GN?

What are the CharacteristicsWhat are the Characteristicsof Type IV hypersensitivity?of Type IV hypersensitivity?



• Cell mediatedCell mediated• What are examples of Type IV?What are examples of Type IV?• TB skin test TB skin test• Contact dermatitisContact dermatitis• Transplant rejection Transplant rejection

What structures have noWhat structures have noknown function?known function?



• AppendixAppendix• EpithalamusEpithalamus• Palmaris longusPalmaris longus

– musclemuscle

• Pancreatic polypeptidePancreatic polypeptide– hormones in F-cellshormones in F-cells

What diseases can progressWhat diseases can progressto RPGN?to RPGN?



• GoodpasturesGoodpastures• WegenersWegeners• DMDM• HTNHTN

What are causes of papillaryWhat are causes of papillarynecrosis?necrosis?



• VasculitisVasculitis• AIDSAIDS

Cytic fibrosis Questions?Cytic fibrosis Questions?



• Tx? Tx?• PilocarpinePilocarpine• also used for glaucomaalso used for glaucoma

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

• What ion does this test measure?What ion does this test measure?• Cl-Cl-

• Definitive presence of disease has a test value of Definitive presence of disease has a test value of what?what?

• >60>60

Cytic fibrosis Questions?Cytic fibrosis Questions?

h h l lh h l l



• What is the value in a normal person?What is the value in a normal person?• <20<20

• What is the value in a heterozygous person?What is the value in a heterozygous person?

• 30 – 6030 – 60• What chromosome is the CF gene on?What chromosome is the CF gene on?• Chrom 7Chrom 7

• What Second messenger is used?What Second messenger is used?• IP3/DAGIP3/DAG

What are the gram +ve sporeWhat are the gram +ve sporeformers?formers?



• Bacillus anthracisBacillus anthracis• Clostridium perfringensClostridium perfringens• Clostridium tetaniClostridium tetani• Clostridium melangosepticusClostridium melangosepticus

• What is the chemical in spores?What is the chemical in spores?• Calcium dipocholinateCalcium dipocholinate

What does strep mutansWhat does strep mutansferment?ferment?

dd



• Lactic acidLactic acid

What type of receptors do allWhat type of receptors do allsphincters in the body have?sphincters in the body have?

l hl h



• Alpha-receptorsAlpha-receptors

Strep. Salivarius ag is usedStrep. Salivarius ag is usedfor what test?for what test?

C ld l i i iC ld l i i i



• Cold agglutinin testingCold agglutinin testing– IgMIgM



Types of amyloid found in various Types of amyloid found in variousSystemicSystemic amyloidoses:amyloidoses:

P lb i / h i ?P lb i / h i ?



• Pre-albumin/transthyretin?Pre-albumin/transthyretin?• Cardiomyopathic hereditary formsCardiomyopathic hereditary forms

– senile systemic amyloidosissenile systemic amyloidosis

• Neuropathic hereditary syndromesNeuropathic hereditary syndromes

Types of amyloid found in Types of amyloid found invariousvarious LocalLocal amyloidoses:amyloidoses:

ANP fib il d b ?ANP fib il d b ?



• ANP fibrils are caused by?ANP fibrils are caused by?• Senile cardiac amyloisosisSenile cardiac amyloisosis

• Cerebral amyloid in Alzheimer’sCerebral amyloid in Alzheimer’sdisease/Down’s?disease/Down’s?• Cerebral amyloidosisCerebral amyloidosis

Types of amyloid found in Types of amyloid found invariousvarious LocalLocal amyloidoses:amyloidoses:

C l it i ?C l it i ?



• Calcitonin precursors?Calcitonin precursors?• Medullary CA of thyroidMedullary CA of thyroid

• AL from light chains?AL from light chains?• Isolated, massive, nodular depositsIsolated, massive, nodular deposits– lung, skin, urogenital tractlung, skin, urogenital tract

What type of dementia doWhat type of dementia doyou get in Pick’s dis?you get in Pick’s dis?

F t t l d tiF t t l d ti



• Frontotemporal dementiaFrontotemporal dementia

Describe Pick’s diseaseDescribe Pick’s disease

At h f f t l d t lAt h f f t l d t l



• Atrophy of frontal and temporalAtrophy of frontal and temporalcortex with sparing of remainingcortex with sparing of remainingneocortical regionsneocortical regions

What 3 things do PickWhat 3 things do Pickbodies contain?bodies contain?

Alt d fil tAlt d fil t



• Altered neurofilamentsAltered neurofilaments• Tau protein Tau protein• ubiquitinubiquitin

What drugs can cause aWhat drugs can cause adisulfiram reaction?disulfiram reaction?

M i ?M i ?



• Mnemonic?Mnemonic?• CLAMCLAM

• ChloramphenicolChloramphenicol• LactamsLactams

– CefamandoleCefamandole

– CefoperazoneCefoperazone• AntabuseAntabuse

– disulfiramdisulfiram

What is the mode of action of theWhat is the mode of action of theClostridium botulinum toxin?Clostridium botulinum toxin?

P t ti l f A hP t ti l f A h



• Prevents pre-synaptic release of AchPrevents pre-synaptic release of Ach

• How do babies get it?How do babies get it?• From spores in honey or molassesFrom spores in honey or molasses

• How do adults get it?How do adults get it?• From canned foodFrom canned food

What are 3 Toxins of What are 3 Toxins of Bacillus?Bacillus?

L th l f t (bl k i )L th l f t (bl k i )



• Lethal factor – (black necrosis)Lethal factor – (black necrosis)• Protective factorProtective factor• Edema factorEdema factor

Who has Poly-D GlutamicWho has Poly-D Glutamicacid?acid?

AnthracisAnthracis



• AnthracisAnthracis• CereusCereus

Name that B-blocker:Name that B-blocker:

B1 selective?B1 selective?



• B1-selective?B1-selective?• A – MA – M• Non-selective?Non-selective?

• N – ZN – Z• Exceptions?Exceptions?• Carbetalol and Labetolol are non-Carbetalol and Labetolol are non-

selectiveselective

What are the 4 facts of FanconiWhat are the 4 facts of FanconiSyndrome?Syndrome?

Problem in proximal tubuleProblem in proximal tubule



• Problem in proximal tubuleProblem in proximal tubule• Can’t reabsorbCan’t reabsorb• Low energy state causing anemiaLow energy state causing anemia• Can be due to old tetracyclineCan be due to old tetracycline

Where is glutaminaseWhere is glutaminasefound?found?

In the collecting duct of the kidneyIn the collecting duct of the kidney



• In the collecting duct of the kidneyIn the collecting duct of the kidney

• What does glutmainase help theWhat does glutmainase help thekidney absorb?kidney absorb?

• Ammonia if the liver failsAmmonia if the liver fails

Name 3 anatomical spotsName 3 anatomical spotswhere renal stones get stuck:where renal stones get stuck:

HilumHilum



• HilumHilum• Pelvic brimPelvic brim• Entering the bladderEntering the bladder

Renal failure is the mostRenal failure is the mostcommon cause of death incommon cause of death inwhat 3 diseases?what 3 diseases?

SLESLE



• SLESLE• Endometrial CAEndometrial CA• Cervical CACervical CA

What is the rate-limitingWhat is the rate-limitingenzyme in the urea cycle?enzyme in the urea cycle?

• Carbamoyl synthase ICarbamoyl synthase I



• Carbamoyl synthase ICarbamoyl synthase I

• Where is it found 90% of the time?Where is it found 90% of the time?• LiverLiver

• Where is it found 10% of the time?Where is it found 10% of the time?• Collecting duct of the kidneyCollecting duct of the kidney

What type of charge doesWhat type of charge doesheparin have?heparin have?

hh



• -ve charge-ve charge

What type of charge doesWhat type of charge doesprotamine sulfate have?protamine sulfate have?

hh



• +ve charge+ve charge

• What is it used for?What is it used for?• Reversing the effects of heparinReversing the effects of heparin

What is commonly seen inWhat is commonly seen inall vasculitides?all vasculitides?

• T-cells and macrophagesT-cells and macrophages



• T-cells and macrophages T-cells and macrophages• SchistocytesSchistocytes• Decreased plateletsDecreased platelets• Decreased RBCsDecreased RBCs

• Bleeding from mucosal surfacesBleeding from mucosal surfaces• Bleeding from skin and GIBleeding from skin and GI• PetechiaePetechiae• EcchymosesEcchymoses

What happens if you exposeWhat happens if you exposethe blood to the basementthe blood to the basementmembrane?membrane?• The following deveop:The following deveop:



• The following deveop: The following deveop:• ClotsClots• DICDIC

• Pulmonary embolismPulmonary embolism• DVTDVT• MIMI

• StrokeStroke

Signs and symptoms in allSigns and symptoms in allvasculitidesvasculitides

• Tachypnea and SOBTachypnea and SOB



• Tachypnea and SOB Tachypnea and SOB

• Most common cause of death?Most common cause of death?• Heart failureHeart failure

What is the MOA of What is the MOA of Erythromycin?Erythromycin?

• Inhibits the translocation step ofInhibits the translocation step ofb l h



• Inhibits the translocation step of Inhibits the translocation step of ribosomal protein synthesisribosomal protein synthesis

What is the MOA of What is the MOA of Chloramphenicol?Chloramphenicol?

• Inhibits ribosomal peptidylInhibits ribosomal peptidyl



• Inhibits ribosomal peptidylInhibits ribosomal peptidyltransferase in prokaryotestransferase in prokaryotes

What is the MOA of What is the MOA of Puromycin?Puromycin?

• Inhibits elongation by binding to “A”Inhibits elongation by binding to “A”



• Inhibits elongation by binding to AInhibits elongation by binding to Asite and prematurely terminatingsite and prematurely terminatingchain growth in pro and eukaryoteschain growth in pro and eukaryotes

What is the MOA of What is the MOA of Streptomycin?Streptomycin?

• Causes misreading of code duringCauses misreading of code during



• Causes misreading of code duringCauses misreading of code duringinitiation in prokaryotesinitiation in prokaryotes

What is the MOA of What is the MOA of Tetracycline? Tetracycline?

• Prevents binding of aminoacyl-t-RNAPrevents binding of aminoacyl-t-RNA



• Prevents binding of aminoacyl-t-RNAPrevents binding of aminoacyl-t-RNAto ribosome on prokaryotes thereforeto ribosome on prokaryotes thereforeinhibiting initiationinhibiting initiation

What is the MOA of What is the MOA of Cyclohexamide?Cyclohexamide?

• Inhibits ribosomal peptidylInhibits ribosomal peptidyl



• Inhibits ribosomal peptidylInhibits ribosomal peptidyltransferase in eukaryotestransferase in eukaryotes– cell wall inhibitorcell wall inhibitor

What is the MOA of What is the MOA of Rifampin?Rifampin?

• Blocks B-subunit of RNA polymeraseBlocks B-subunit of RNA polymerase



• Blocks B subunit of RNA polymeraseBlocks B subunit of RNA polymerase• Prophylaxis for contacts of N.Prophylaxis for contacts of N.

meningitidismeningitidis

What is the MOA of What is the MOA of Vancomycin?Vancomycin?

• Cell wall inhibitorCell wall inhibitor



• Cell wall inhibitorCell wall inhibitor• Binds irreversibly to PhopholipaseBinds irreversibly to Phopholipase

carriercarrier

• BacteriacidalBacteriacidal• Covers all gram +vesCovers all gram +ves• LinezolidLinezolid

What is the MOA of What is the MOA of Warfarin?Warfarin?

• Blocks vitamin k dependent gamma-Blocks vitamin k dependent gamma-



• Blocks vitamin k dependent gammaBlocks vitamin k dependent gammacarboxylation of prothrombin andcarboxylation of prothrombin andfactors 2, 7, 9, 10, proteins C & Sfactors 2, 7, 9, 10, proteins C & S

What is the MOA of What is the MOA of Clindamycin?Clindamycin?

• Blocks translation by binding the 50SBlocks translation by binding the 50S



• Blocks translation by binding the 50SBlocks translation by binding the 50Ssubunitsubunit

Hemolytic properties of Hemolytic properties of Streptococcus:Streptococcus:

• What type of hemolysis is alphaWhat type of hemolysis is alphahemolysis?hemolysis?



W at type o e o ys s s a p aW at type o e o ys s s a p ahemolysis?hemolysis?• Partial hemolysisPartial hemolysis

• What color is it’s zone?What color is it’s zone?• GreenGreen

• What type of hemolysis is beta-hemolysis?What type of hemolysis is beta-hemolysis?

• Complete hemolysisComplete hemolysis

Hemolytic properties of Hemolytic properties of Streptococcus:Streptococcus:

• What color is it’s zoneWhat color is it’s zone



What color is it s zoneWhat color is it s zone• ClearClear

– eg. Streptokinaseeg. Streptokinase

• What type of hemolysis is gamma-What type of hemolysis is gamma-hemolysis?hemolysis?

• No hemolysisNo hemolysis

• What color is it’s zone?What color is it’s zone?• RedRed

What are the 5 notableWhat are the 5 notablethings about RTA I?things about RTA I?

• High urine PH (??????not sure aboutHigh urine PH (??????not sure about



High urine PH (??????not sure aboutHigh urine PH (??????not sure aboutthis)this)

• AcidosisAcidosis

• UTI sUTI s• StonesStones• Babies die < 1 yr oldBabies die < 1 yr old

What are 3 notable thingsWhat are 3 notable thingsabout RTA II?about RTA II?

• AcidosisAcidosis



AcidosisAcidosis– urine PH = 2, normal is 5-6urine PH = 2, normal is 5-6

• HypokalmiaHypokalmia

• Patients have NO carbonic anhydrasePatients have NO carbonic anhydrase

What are 3 notable thingsWhat are 3 notable thingsabout RTA III?about RTA III?

• It is a combination of RTA I & IIIIt is a combination of RTA I & III



It is a combination of RTA I & IIIIt is a combination of RTA I & III• Normal urine pHNormal urine pH• HypokalemiaHypokalemia

What are 3 notable thingsWhat are 3 notable thingsabout RTA IV?about RTA IV?

• Seen in diabeticsSeen in diabetics



Seen in diabeticsSeen in diabetics• HyperkalemiaHyperkalemia• NO aldosterone b/c JG apparatus hasNO aldosterone b/c JG apparatus has

infarctedinfarcted

What are the members of What are the members of Streptococcus Group D?Streptococcus Group D?

• ViridansViridans



ViridansViridans• MutansMutans• SanguisSanguis• SalivariusSalivarius• BovisBovis

What Steptococcus hasWhat Steptococcus hasgreen pigment?green pigment?




V da sV da s

What Streptococcus causesWhat Streptococcus causesSBE?SBE?




What Streptococcus causesWhat Streptococcus causescavities?cavities?

• MutansMutans



What do you see inWhat do you see inNephritic Syndrome?Nephritic Syndrome?

• HTNHTN



• HematuriaHematuria• RBC castsRBC casts

What do you see inWhat do you see inNephrotic Syndrome?Nephrotic Syndrome?

• Increase EdemaIncrease Edema



• Increase LipidemiaIncrease Lipidemia• Increase CholesterolemiaIncrease Cholesterolemia

• Increase CoagulabilityIncrease Coagulability• Decrease serum AlbuminDecrease serum Albumin

•Increase urinary AlbuminIncrease urinary Albumin

What is the #1 cause of What is the #1 cause of Sinusitis, Otitis, Bronchitis,Sinusitis, Otitis, Bronchitis,Pneumonia?Pneumonia?• Strep. PneumoStrep. Pneumo



pp

• What is the #2 cause?What is the #2 cause?

• Hemophilus influenzaHemophilus influenza

•What is the #3 cause?What is the #3 cause?

• Neisseria meningitidesNeisseria meningitides

What is the #1 method toWhat is the #1 method toparalyze cilia?paralyze cilia?

• VirusesViruses



• Which are secondary to what?Which are secondary to what?

• Bacterial infectionsBacterial infections

• What is the #2 method to paralyzeWhat is the #2 method to paralyzecilia?cilia?

• SmokingSmoking

If you develop gastroenteritisIf you develop gastroenteritiswithin 8hrs of eating what arewithin 8hrs of eating what arethe most common likely bugs?the most common likely bugs?• Staph aureusStaph aureus



pp• Clostridium perfringensClostridium perfringens• Bacillus cereus….from what?Bacillus cereus….from what?

• Fried riceFried rice

Gastroenteritis within 8hrs of Gastroenteritis within 8hrs of eating what toxin?eating what toxin?

• PreformedPreformed



What does Clostridum tetaniWhat does Clostridum tetaniinhibit?inhibit?

• Release of glycine from spinal cordRelease of glycine from spinal cord



• What physical finding would you see?What physical finding would you see?• Lock jawLock jaw

• What is the tx?What is the tx?• Antitoxin and ToxoidAntitoxin and Toxoid

• Where is it injected?Where is it injected?• Injected in different areas of bodyInjected in different areas of body

The Most common cause of UTI The Most common cause of UTIis?is?

• E. coliE. coli



• Followed by?Followed by?

• ProteusProteus

• Followed by?Followed by?• KlebsiellaKlebsiella



Staph aureus is the mostStaph aureus is the mostcommon cause of whatcommon cause of whatbone disease?bone disease?• OsteomyelitisOsteomyelitis



yy

• Because of what?Because of what?

• CollagenaseCollagenase

What is the Most CommonWhat is the Most Commoncause of infections one weekcause of infections one weekpost burn injury?post burn injury?



• Staph. aureusStaph. aureus

What is the triad of SSSS?What is the triad of SSSS?

• ShockShock



• RashRash• HypotensionHypotension

Most common cause of UTI?Most common cause of UTI?

• E. coliE. coli



• Then? Then?• ProteusProteus

• Then? Then?• KlebsiellaKlebsiella

Newborn meningitis isNewborn meningitis iscaused by?caused by?

• Group B Strep (agalactiae)Group B Strep (agalactiae)



• E. coliE. coli• ListeriaListeria

What is normal rectal floraWhat is normal rectal florafrom momfrom mom

• Group B Strep (Strep. Agalactiae)Group B Strep (Strep. Agalactiae)



• E. coliE. coli• ListeriaListeria

What is associated withWhat is associated withcolon CA?colon CA?

• Clostridium melanogosepticusClostridium melanogosepticusb



• Strep bovisStrep bovis

• What color pigment is produced?What color pigment is produced?• BlackBlack

What Ig do you look for withWhat Ig do you look for withaffinity?affinity?

• IgGIgG



• What about Avidity?What about Avidity?

• IgMIgM

What is transductionWhat is transduction

• Virus inject it’s DNA into bacteriaVirus inject it’s DNA into bacteria



What is transformation?What is transformation?

• Virus injects it’s DNA into it bacteriaVirus injects it’s DNA into it bacteriain a hospital or nursing home settingin a hospital or nursing home setting



in a hospital or nursing home setting,in a hospital or nursing home setting,then becomes deadly.then becomes deadly.

Conjuction occurs only withConjuction occurs only withwhat?what?

• Bacteria with PiliBacteria with Pili



What causes mutiple cerebralWhat causes mutiple cerebralabscesses in newborns?abscesses in newborns?

• CitrobacterCitrobacter



What are the 2 gram –ves thatWhat are the 2 gram –ves thatare strict anaerobes?are strict anaerobes?

• Hemophilus influenzaHemophilus influenzaN i iN i i



• NeisseriaNeisseria

a ype o comp emenproblem do you have inproblem do you have inrecurrent infections withrecurrent infections withencapsulated organisms?encapsulated organisms?

C3C3



• C3C3

What does complementWhat does complementfight against?fight against?

• G ti b t iG g ti b t i



• Gram negative bacteriaGram negative bacteria

What do you see in serum withWhat do you see in serum withprerenal failure and what areprerenal failure and what arethe values?the values?• BUNBUN• >20>20



>20>20

• Fractional Na+ excertionFractional Na+ excertion• <1%<1%

• CreatineCreatine• >40>40

What do you see in RenalWhat do you see in Renalfailure and what are thefailure and what are thevalues?values?• BUNBUN• 10-1510-15



10-1510 15

• Fractional Na+ excretionFractional Na+ excretion• >2%>2%

• CreatinineCreatinine• <20<20

What is the extravasationWhat is the extravasationorder?order?

• PavementingPavementing• M gi tiMargination



• MarginationMargination• DiapediesisDiapediesis

• MigrationMigration

What is the rate limitingWhat is the rate limitingenzyme for Glycolysis?enzyme for Glycolysis?

• PFK 1PFK 1



• PFK-1PFK-1

What is the rate limitingWhat is the rate limitingenzyme of Gluconeogenesis?enzyme of Gluconeogenesis?

• Pyruvate CarboxlyasePyruvate Carboxlyase



• Pyruvate CarboxlyasePyruvate Carboxlyase

rea ng a sease ainitiates the cell mediatedinitiates the cell mediatedresponse, what are youresponse, what are youtreating first?treating first?• ViralViral



• If resistant to tx, what next?If resistant to tx, what next?

• FungalFungal• MycobacteriumMycobacterium• ProtozoaProtozoa

• ParasiteParasite• NeoplasmNeoplasm

What bugs can you pick upWhat bugs can you pick upduring birth?during birth?

• Step. Group BStep. Group B– Strep agalactiaeStrep agalactiae



Strep agalactiaeStrep agalactiae

• Strep. PneumoniaStrep. Pneumonia

• Herpes simplex virusHerpes simplex virus• Neisseria gonorrheaNeisseria gonorrhea• ChlyamydiaChlyamydia

What is another name forWhat is another name forAdenoma sebaceum?Adenoma sebaceum?

• Perivascular angiofibromataPerivascular angiofibromata



• Perivascular angiofibromataPerivascular angiofibromata

What is another name forWhat is another name forAddison’s?Addison’s?

• Primary Adrenocoritcal InsufficiencyPrimary Adrenocoritcal Insufficiency



What is another name forWhat is another name forAlkaptonuria?Alkaptonuria?

• OchronosisOchronosis



What is another name forWhat is another name forChurg-Strauss?Churg-Strauss?

• Allergic GranulomatosisAllergic Granulomatosis• AngiitisAngiitis



• AngiitisAngiitis

What is another name forWhat is another name forCraniopharyngioma?Craniopharyngioma?

• AmeloblastomaAmeloblastoma



• What is Ameloblast?What is Ameloblast?

• Tooth material Tooth material

What is another name forWhat is another name forChrons?Chrons?

• Regional enteritisRegional enteritis• Granulomatous ileitisGranulomatous ileitis



• Granulomatous ileitisGranulomatous ileitis• IleocolitisIleocolitis



What is another name forWhat is another name forIntraductal Ca?Intraductal Ca?

• Comedo CaComedo Ca



What is another name for I-What is another name for I-Cell Disease?Cell Disease?

• Mucolipidosis IIMucolipidosis II



What is another name forWhat is another name forKawassaki Disease?Kawassaki Disease?

• MLNSMLNS• Mucocutaneous Lymph NodeMucocutaneous Lymph Node



Mucocutaneous Lymph NodeMucocutaneous Lymph NodeSyndromeSyndrome

What is another name forWhat is another name forLeydig cells?Leydig cells?

• Interstitial cellsInterstitial cells



What is another name forWhat is another name forSertoli cells?Sertoli cells?

• Sustentacular cellsSustentacular cells



What is another name forWhat is another name forWaldenstrom’sWaldenstrom’smacroglobulinemia?macroglobulinemia?

• Hyperviscosity syndromeHyperviscosity syndrome



HHV I causes?HHV I causes?

• OralOral• Trigeminal gangliaTrigeminal ganglia



Trigeminal ganglia Trigeminal ganglia

HHV II causes?HHV II causes?

• GenitalGenital• Sacral plexusSacral plexus



Sacral plexusSacral plexus



HHV IV causes?HHV IV causes?

• EBVEBV• MononucleosisMononucleosis



Mononucleosis• Burkitt’sBurkitt’s

HHV V causes?HHV V causes?

• CMVCMV• Inclusion bodiesInclusion bodies



c us o bod es

HHV VI causes?HHV VI causes?

• RoseolaRoseola• Duke DiseaseDuke Disease



• Exanthem subitumExanthem subitum

HHV VII causes?HHV VII causes?

• Pityriasis roseaPityriasis rosea



HHV VIII causes?HHV VIII causes?

• Kaposi’s sarcomaKaposi’s sarcoma



Answer the following questionsAnswer the following questionsabout Coumadin/Warfarin.about Coumadin/Warfarin.

• What is the MOA?What is the MOA?• Interferes with normal synthesis andInterferes with normal synthesis andf



gama carboxylation of Vit. K gama carboxylation of Vit. K dependent clotting factors viadependent clotting factors viavitamin K antagonism.vitamin K antagonism.

• Is it long or short acting?Is it long or short acting?

• Long half-lifeLong half-life• 8-10 hours to act8-10 hours to act


• Clinical use?Clinical use?• Chronic anticoagulationChronic anticoagulation



gg

• Contra-indication?Contra-indication?• Pregnancy because it can cross thePregnancy because it can cross the

placentaplacenta


• What pathway does it affect?What pathway does it affect?• Extrinsic pathwayExtrinsic pathway



p yp y

• What does it do to PT?What does it do to PT?• ProlongsProlongs

• PTPT


• What are the toxicities?What are the toxicities?• BleedingBleeding



gg• Teratogenic Teratogenic

• Drug-drug interactionsDrug-drug interactions

• How is it activatied?How is it activatied?• Tissue activated Tissue activated


• Administration?Administration?• popo



What are the Vitamin K What are the Vitamin K dependent clotting factors?dependent clotting factors?

• IIII• VIIVII



• IXIX

• XX• Protein CProtein C• Protein SProtein S

Answer the following questionsAnswer the following questionsabout Heparin.about Heparin.

• What is the MOA?What is the MOA?• Catalyzes the activation of antithrombin IIICatalyzes the activation of antithrombin III



• Decreases thrombin and XaDecreases thrombin and Xa

• Is it long or short acting?Is it long or short acting?• Short half-lifeShort half-life• Acts immediatelyActs immediately


• Clinical use?Clinical use?• Immediate anticoagulation of Immediate anticoagulation of



pulmonary embolism, stroke, angina,pulmonary embolism, stroke, angina,

MI, DVT.MI, DVT.

• Contra-indication?Contra-indication?

• Can be used during pregnancyCan be used during pregnancybecause it does not cross thebecause it does not cross theplacentaplacenta


• What pathway does it affect?What pathway does it affect?• Intrinsic pathwayIntrinsic pathway



• What value should you follow?What value should you follow?• PTTPTT


• What are the toxicities?What are the toxicities?• BleedingBleeding



• Thrombocytopenia Thrombocytopenia

• Drug-drug interactionsDrug-drug interactions

• How is it activatied?How is it activatied?• Blood activatedBlood activated


• Administration?Administration?• I.V.I.V.



• Drug of choice for what?Drug of choice for what?• DVTDVT



What do you use for rapidWhat do you use for rapidreversal of heparinization?reversal of heparinization?

• Protamine sulfateProtamine sulfate



How do you treatHow do you treatBenzodiazepine poisoning?Benzodiazepine poisoning?

• FlumazenilFlumazenil



How do you treatHow do you treatAnticholinesterase poisoning?Anticholinesterase poisoning?

• PralidoximePralidoxime



How do you treat IronHow do you treat Ironpoisoning?poisoning?

• DeferoxamineDeferoxamine



How do you treat OpioidHow do you treat Opioidpoisoning?poisoning?

• NaloxeneNaloxene



How do you treat BarbituateHow do you treat Barbituatepoisoning?poisoning?

• BicarbonateBicarbonate



• DoxapramDoxapram

What does Doxapram do?What does Doxapram do?

• Activates the respiratory center inActivates the respiratory center inthe brainthe brain



What is the treatment forWhat is the treatment forHypercholesterolemia?Hypercholesterolemia?

• ProvostatinProvostatin• AtrovastatinAtrovastatin



• LovastatinLovastatin

• SimvastatinSimvastatin

What statin is renallyWhat statin is renallyexcreted?excreted?

• ProvastatinProvastatin



What statins do you have toWhat statins do you have tofollow liver enzymes every 3follow liver enzymes every 3months?months?

• AtrovastatinAtrovastatin• LovastatinLovastatin



• SimvastatinSimvastatin

What do statins inhibit?What do statins inhibit?

• HMG-CoA reductaseHMG-CoA reductase



• When is it most active?When is it most active?

• 8:00pm on8:00pm on

If statins are insufficient whatIf statins are insufficient whatdo you add?do you add?

• CholestipolCholestipol• CholestyramineCholestyramine



• If nothing works what do you give?If nothing works what do you give?• ProbucolProbucol• NiacinNiacin

What are the side effects of What are the side effects of Niacin?Niacin?

• FlushingFlushing• ItchingItching



What 2 statins bind bileWhat 2 statins bind bilesalts?salts?

• CholestipolCholestipol• CholestyramineCholestyramine



What are 4 causes of severeWhat are 4 causes of severepain (in order)?pain (in order)?

1.Pancreatitis1.Pancreatitis• Due to What?Due to What?• ETOHETOH



ETOHETOH

2.Kidney stones2.Kid ney stones • Due to What?Due to What?• AlcoholAlcohol

What are 4 causes of severeWhat are 4 causes of severepain (in order)?pain (in order)?

3.AAA3.AAA• How is this described?How is this described?



• Ripping pain down backRipping pain down back

4.Ischemic bowel4.Ischemic bowel• What is symptom?What is symptom?

• Bloody diarrheaBloody diarrhea

What are 5 causes of What are 5 causes of SIADH?SIADH?

• Small cell Ca of lungSmall cell Ca of lung• Increased intracranial pressureIncreased intracranial pressure( )



• Pain (most common)Pain (most common)

• DrugsDrugs• Hypoxic Lung Disease/RestrictiveHypoxic Lung Disease/Restrictive

Lung diseaseLung disease

What drug causes SIADH?What drug causes SIADH?

• CarbamazepineCarbamazepine



What are the cells of neuralWhat are the cells of neuralcrest origin?crest origin?• Parafollicular cells of thyroidParafollicular cells of thyroid• Odontoblasts (predentin)Odontoblasts (predentin)• Pseudounipolar cellsPseudounipolar cells



pp• Spiral membrane of heartSpiral membrane of heart

• Chromaffin cellsChromaffin cells• All Ganglion cells (Schwann, AdrenalAll Ganglion cells (Schwann, Adrenal

medulla)medulla)

•MelanocytesMelanocytes

• Laryngeal/Tracheal cartilageLaryngeal/Tracheal cartilage

What are the triple repeatWhat are the triple repeatdiseases?diseases?

• Huntington’sHuntington’s• Fragile XFragile XhM i D h



• Myotonic DystrophyMyotonic Dystrophy

• Prauder WilliePrauder Willie• Spinal/bulbar muscular atrophySpinal/bulbar muscular atrophy

(Fredicks ataxia)(Fredicks ataxia)

How do you determine theHow do you determine themaximum sinus rate?maximum sinus rate?

• 220 - age220 - age



What are the 3 low volumeWhat are the 3 low volumestates with acidosis rather thanstates with acidosis rather thanalkalosis?alkalosis?

• RTARTA• DiarrheaDiarrheaDi b i k id i (DKA)Di b i k id i (DKA)



• Diabetic ketoacidosis (DKA)Diabetic ketoacidosis (DKA)

What are the causes of What are the causes of Croup & Bronchiolities?Croup & Bronchiolities?

• ParainfluenzaParainfluenza• AdenovirusAdenovirusI flI fl



• InfluenzaInfluenza

• RSVRSV

What is asthma in a childWhat is asthma in a childless than 2 called?less than 2 called?

• BronchiolitisBronchiolitis



What are the 4 D’s of What are the 4 D’s of Pellagra?Pellagra?

• DiarrheaDiarrhea• DermatitisDermatitisD iD ti



• DementiaDementia

• DeathDeath

What are the uric acidWhat are the uric acidstones?stones?

• CysteineCysteine• OrnithineOrnithine• L iL i



• LysineLysine

• ArginineArginine

What is happening in theWhat is happening in theAtrium?Atrium?• Phase 0?Phase 0?• DepolarizationDepolarization



• Phase 1?Phase 1?• No nameNo name

• Phase 2?Phase 2?

• Plateau phase (A-V node)Plateau phase (A-V node)

What is happening in theWhat is happening in theAtrium?Atrium?

• Phase 3?Phase 3?• RepolarizationRepolarization



Repolarizationp

• Phase 4?Phase 4?• Automaticity (S-A node)Automaticity (S-A node)

What do Na+ channels doWhat do Na+ channels doto the EKG?to the EKG?

• Wider QRSWider QRS



What does Ca+ do to theWhat does Ca+ do to theEKG?EKG?

• Wider P-waveWider P-wave• Longer PR intervalLonger PR interval



What are the types of What are the types of kidney stones?kidney stones?

• Calcium oxalate (phosphate) stonesCalcium oxalate (phosphate) stones• Struvite stonesStruvite stones• Uric acid stonesUric acid stones



• Uric acid stonesUric acid stones

• Cysteine stonesCysteine stones• Oxalate stonesOxalate stones

What percent of kidney stonesWhat percent of kidney stonesare calcium oxalate?are calcium oxalate?

• 80%80%



If you find oxalate stones in theIf you find oxalate stones in thefollowing what should youfollowing what should youthink of?think of?• 3 y/o white male?3 y/o white male?• CFCF



• 5 y/o black male?5 y/o black male?• Celiac SprueCeliac Sprue

If you find oxalate stones in theIf you find oxalate stones in thefollowing what should youfollowing what should youthink of?think of?• Adult male?Adult male?• Whipple’sWhipple’s



• Adult male or female?Adult male or female?• Crohn’sCrohn’s

If oxalate stones found in CFIf oxalate stones found in CFwhat is the most commonwhat is the most commoncause?cause?

• In 0-20 y/o?In 0-20 y/o?• MalabsorptinMalabsorptin



• What age do they die?What age do they die?• Young Young

Answer the following questionsAnswer the following questionsabout pseudogout?about pseudogout?

• What type of crystals areWhat type of crystals arepresent?present?

• Calcium pyrophosphateCalcium pyrophosphate



• Where are they found?Where are they found?• Joint spaces Joint spaces

Answer the following questionsAnswer the following questionsabout pseudogout?about pseudogout?

• Who gets it?Who gets it?

• Older patients M=FOlder patients M=F



• Tx? Tx?• ColchicineColchicine

What are the most commonWhat are the most commonnon-cyanotic heart disease?non-cyanotic heart disease?

• VSDVSD• ASDASD• PDAPDA



• PDAPDA

• CoarctationCoarctation

What murmur increases onWhat murmur increases onexpiration?expiration?

• VSDVSD• MitralMitral



What murmur has fixedWhat murmur has fixedwide splitting?wide splitting?

• ASDASD



What murmur has boundingWhat murmur has boundingpulses?pulses?

• PDAPDA



What gives you differenitalWhat gives you differenitalpulses?pulses?




What is increased incidenceWhat is increased incidencein Turners?in Turners?




What are 4 enzymes neverWhat are 4 enzymes neverseen in glycolysis?seen in glycolysis?

• Pyruvate carboxylasePyruvate carboxylase• PEP carboxykinasePEP carboxykinase• F-1 6 dPhosphataseF-1 6 dPhosphatase



F 1,6 dPhosphataseF 1,6 dPhosphatase

• G-6-PhosphataseG-6-Phosphatase

What are 3 enzymes seenWhat are 3 enzymes seenONLY in glycolysis?ONLY in glycolysis?

• HexokinaseHexokinase• PFK-1PFK-1• Pyruvate kinasePyruvate kinase



Pyruvate kinasePyruvate kinase

What are 2 hormones thatWhat are 2 hormones thatare acidophilic?are acidophilic?

• ProlactinProlactin• GHGH



What are the partially acidWhat are the partially acidfast Gram +ve?fast Gram +ve?

• NocardiaNocardia



What are the partially acidWhat are the partially acidfast Protozoa?fast Protozoa?

• CryptosporidiumCryptosporidium



What are the septic emboliWhat are the septic emboliof SBE?of SBE?

• Mycotic aneurysmMycotic aneurysm• Roth spotsRoth spots• Janeway lesionsJaneway lesions



Janeway lesions Janeway lesions

• Osler’s nodesOsler’s nodes• Splinter hemorrhagesSplinter hemorrhages• EndocarditisEndocarditis

Where are the followingWhere are the followinglesions found?lesions found?• Janeway lesions? Janeway lesions?• Toes Toes



• Osler’s nodes?Osler’s nodes?• FingersFingers

• Roth spots?Roth spots?

• RetinaRetina

What is the most commonWhat is the most commoncause of endocarditis?cause of endocarditis?

• Strep. viridansStrep. viridans



What causesWhat causesmicrosteatosis?microsteatosis?

• AcetaminophenAcetaminophen• Reye SyndromeReye Syndrome• PregnancyPregnancy



eg a cyg y

What causesWhat causesmacrosteatosis?macrosteatosis?

• AlcoholAlcohol



What are 2 bacteria thatWhat are 2 bacteria thatrelease elastase?release elastase?

• Staph. AureusStaph. Aureus• PseudomonasPseudomonas



What are the 2 bacteria withWhat are the 2 bacteria withtoxins that inhibit EF-2?toxins that inhibit EF-2?

• PseudomonasPseudomonas• DiptheriaDiptheria



How does Diptheria work?How does Diptheria work?

• It ADP ribosylates EF2 inhibiting proteinIt ADP ribosylates EF2 inhibiting proteinsynthesissynthesis

• I it G +/ ?Is it Gram +/ ?



• Is it Gram +/-?Is it Gram +/-?

• ++

• Where and how does it get its exotoxin?Where and how does it get its exotoxin?

• From virus via transductionFrom virus via transduction

How does Diptheria work?How does Diptheria work?

• What does it cause?What does it cause?• Heart blockHeart block



• What do you give for Tx?What do you give for Tx?• AntitoxinAntitoxin

• Never scrape membraneNever scrape membrane

What are the different types of What are the different types of Emphysema and their causes?Emphysema and their causes?

• Bullous?Bullous?

• Staph aureusStaph aureus• PseudomonasPseudomonas



• Centroacinar?Centroacinar?

• SmokingSmoking

What are the different types of What are the different types of Emphysema and their causes?Emphysema and their causes?

• Distalacinar?Distalacinar?• AgingAging



• Panacinar?Panacinar?• Alpha-1 antitrypsin def Alpha-1 antitrypsin def

What are the stages of What are the stages of erythropoiesis?erythropoiesis?• 4 mo gestation?4 mo gestation?• Yolk sac Yolk sac

• 6 mo gestation?6 mo gestation?



• 6 mo gestation?6 mo gestation?

• Spleen, liver, flat bonesSpleen, liver, flat bones

What are the stages of What are the stages of erythropoiesis?erythropoiesis?• 8 mo gestation?8 mo gestation?• Long bonesLong bones

• 1 ld?1 ld?



• 1 yr old?1 yr old?• Long bonesLong bones

If long bones become damagedIf long bones become damagedafter 1 yr what takes over?after 1 yr what takes over?

• Spleen can resume erythropoiesesSpleen can resume erythropoiesescausing splenomegalycausing splenomegaly



What ions correspond withWhat ions correspond withthe following EKG?the following EKG?• P-wave?P-wave?• Ca+Ca+

l



• QRS complex?QRS complex?

• Na+Na+

• S-T?S-T?• Ca+Ca+

What ions correspond withWhat ions correspond withthe following EKG?the following EKG?

• T-wave? T-wave?• K+K+



• U-wave?U-wave?• Na+Na+

What do Na+ channelWhat do Na+ channelblockers do to the EKG?blockers do to the EKG?

• QRSQRS



What do Ca+ channelWhat do Ca+ channelblockers do to the EKG?blockers do to the EKG?

• Widens P-waveWidens P-wave

• PR interval longerPR interval longer



P.P. Clue 4 Bio StatP.P. Clue 4 Bio Stat

C+DC _

A+BB+

WD

A

D



ALLB+DA+CSensitivity A/A+CSpecificity D/B+DPPV A/A+BNPV D/C+DOR AD/BC

RR (A/All) / (C/All)

AR (A/All)- (C/All)

Sensitivity: Truly D iseased PeopleSpecificity: Truly W ell People+ Predictive Value: Test + ve With DZ

- Predictive Value: Tested – ve w/o DZOR: Odds RatioRR: Relative RiskAR: Attributed Risk

Always in thenumerator

A&D

In EKG P-wave Represents?In EKG P-wave Represents?

•Atrium contractionAtrium contraction

• Phase zeroPhase zero• CalciumCalcium



In EKG P-R Interval means?In EKG P-R Interval means?

•AV NodeAV Node

• Phase 2Phase 2• SodiumSodium



In EKG R-upstoke means?In EKG R-upstoke means?

• Anterior wallAnterior wall• Phase 2Phase 2• SodiumSodium



In EKG S-down strokeIn EKG S-down strokemeans?means?• Posterior wallPosterior wall• Phase 2Phase 2• SodiumSodium



In EKG S-T Interval means?In EKG S-T Interval means?

• VentricleVentricle• Phase 2Phase 2• CalciumCalcium



In EKG T-wave means?In EKG T-wave means?

• VentricleVentricle• Phase 3Phase 3• PotassiumPotassium



In EKG U-wave meansIn EKG U-wave means

• VentricleVentricle• Phase 4Phase 4• SodiumSodium



4 DZ associated with HLA-4 DZ associated with HLA-DR 2?DR 2?• NarcolepsyNarcolepsy• Allergy (hay fever)Allergy (hay fever)• GoodpastureGoodpasture



• MSMS

5 DZ associated with HLA-5 DZ associated with HLA-DR 3?DR 3?• DMDM• Chronic active HepititisChronic active Hepititis• SjogrensSjogrens



• SLESLE• Celiac sprueCeliac sprue

DZ associated with HLA-DRDZ associated with HLA-DR3&4?3&4?

• IDDM (DM Type 1)IDDM (DM Type 1)



DZ associated with HLA-DRDZ associated with HLA-DR4?4?• Rheumatoid ArthritisRheumatoid Arthritis• Pemphigus VulgarisPemphigus Vulgaris



DZ associated with HLA-DRDZ associated with HLA-DR55• JRA (JUV RA) JRA (JUV RA)• Pernicious anemiaPernicious anemia



DZ associated with HLA-DRDZ associated with HLA-DR7?7?• Nephrotic syndrome (SteroidNephrotic syndrome (Steroid

induced)induced)



DZ associated with HLA-DRDZ associated with HLA-DR3 and HLA-B 8?3 and HLA-B 8?• Celiac DiseaseCeliac Disease



DZ Associated with HLA-A3?DZ Associated with HLA-A3?

• HemochromatosisHemochromatosis– chromosome 6chromosome 6– point mutation Cystine to Tyrosinepoint mutation Cystine to Tyrosine



DZ Associated with HLA-ADZ Associated with HLA-A3?3?• Myasthenia gravisMyasthenia gravis



DZ Associated with HLA-BDZ Associated with HLA-B13?13?• PsoriasisPsoriasis



5 DZ Associated with HLA-B5 DZ Associated with HLA-B27?27?

• PsoriasisPsoriasis– only if with arthritisonly if with arthritis

• Ankylosing SpondylitiesAnkylosing Spondylities



• IBDIBD– Ulcerative CholitisUlcerative Cholitis

• Reiter’sReiter’s

• Post gonococcal arthritisPost gonococcal arthritis

DZ Associated to HLA-BWDZ Associated to HLA-BW4747• 21 alpha hydroxylase deficiency21 alpha hydroxylase deficiency

– Vit. DVit. D



Facts about DiphtheriaFacts about Diphtheria

• ADP ribosylates EF-2ADP ribosylates EF-2• Stops cell synthesisStops cell synthesis• Gr +veGr +ve• Gets exotoxin from virus viaGets exotoxin from virus via



Gets exotoxin from virus viaGets exotoxin from virus viatransductiontransduction

• Heart blockHeart block• Its toxoid therefore give antitoxinIts toxoid therefore give antitoxin



MCC Pneumonia in 18 yrs to 40MCC Pneumonia in 18 yrs to 40yrs of age?yrs of age?

• MycoplasmaMycoplasma• Chlamydia pneumoniaChlamydia pneumonia• Strep. PneumoniaStrep. Pneumonia



MCC of Pneumonia in 40 yrsMCC of Pneumonia in 40 yrsto 65 yrs of age?to 65 yrs of age?• Strep pneumoniaStrep pneumonia• H. influenzaH. influenza• AnaerobesAnaerobes



MCC of pneumonia in theMCC of pneumonia in theElderly?Elderly?

• Strep pneumoniaStrep pneumonia• VirusesViruses• AnaerobesAnaerobes



• H.influenzaH.influenza• Gr –ve rodsGr –ve rods

What are 4 Clues for IgA?What are 4 Clues for IgA?

• Monomer in bloodMonomer in blood• Dimer in secretionDimer in secretion• Located on mucosal surfaceLocated on mucosal surface



• Found in secretionFound in secretion

What are Clues for IgD?What are Clues for IgD?

• Only functions as surface marker forOnly functions as surface marker forMature B-CellMature B-Cell



What are Clues for IgE?What are Clues for IgE?

• ImmediateImmediatehypersensitivity/anaphylaxishypersensitivity/anaphylaxis

• Parasite defenseParasite defense• WormsWorms



• Fc region binds to mast cells andFc region binds to mast cells andbasophilsbasophils

• AllergiesAllergies

• Does Not fix complementDoes Not fix complement

What are Clues for IgG?What are Clues for IgG?• Highest affinityHighest affinity

• Memory respond atMemory respond at day 3

day 3 five times thefive times theconcentrationconcentration• Peaks in 5 years last for 10 yearsPeaks in 5 years last for 10 years• OpsonizesOpsonizes• Activates complementActivates complement



Activates complementct vates co p e e t• 22 ndnd to show up in primary responseto show up in primary response• Only one to show up for secondary respondOnly one to show up for secondary respond• Most abundant Ig in newbornMost abundant Ig in newborn• Antigenic differences in heavy chain and site of Antigenic differences in heavy chain and site of

di-sulfide bonddi-sulfide bond• 4 subclasses G1 to G44 subclasses G1 to G4

What are Clues for IgG1?What are Clues for IgG1?

• Crosses placenta due to fc portionCrosses placenta due to fc portion




• Most common sub-class deficiencyMost common sub-class deficiency• Patient susceptible to encapsulatedPatient susceptible to encapsulated

organismsorganisms




• MostMost memorymemory antibodyantibody




• Only IgG NOT fixing complementOnly IgG NOT fixing complement



What are Clues for IgM?What are Clues for IgM?

• Responds in primary responseResponds in primary response• Most efficient in agglutination andMost efficient in agglutination and

complement fixationcomplement fixation• Defenses against bacteria andDefenses against bacteria and



Defenses against bacteria andDefenses against bacteria andvirusesviruses

What do MacrophagesWhat do Macrophagesrelease?release?• MHC IIMHC II



What does TH1 secrete?What does TH1 secrete?

• IL-2IL-2• IF- GammaIF- Gamma



What does TH2 Secrete?What does TH2 Secrete?

• IL-4IL-4• IL-5IL-5• IL-6IL-6



• IL-10IL-10

What does TH-0 secrete?What does TH-0 secrete?

• TH-1 TH-1• TH-2 TH-2



MHC-1 are also called what?MHC-1 are also called what?

• CD8CD8• CD8 becomes T-cytotoxic cellsCD8 becomes T-cytotoxic cells



All T-Cells express what?All T-Cells express what?

• CD-3CD-3• For what?For what?• Signal transductionSignal transduction



• CD-2CD-2• For what?For what?

• AdherenceAdherence

What do CD-4 cellsWhat do CD-4 cellsBecome?Become?• T helper cells T helper cells



What do CD-8 cellsWhat do CD-8 cellsBecome?Become?• T cytotoxic cells T cytotoxic cells



Neutrophils produce whatNeutrophils produce whatenzymes and what is theirenzymes and what is theiraction?action?• MyeloperoxidaseMyeloperoxidase• NADPHNADPH• Will kill ALL Gr+veWill kill ALL Gr+ve

– Ex..Hydrogen peroxide kills gr+Ex..Hydrogen peroxide kills gr+



Ex..Hydrogen peroxide kills gry g p g

What do T-cells stimulate?What do T-cells stimulate?

• Clue 4x7=28Clue 4x7=28

• CD-4CD-4



• B-7B-7• CD-28CD-28

What are the Clues for Type-1What are the Clues for Type-1Hyperlipidemia?Hyperlipidemia?

• Increased ChylomicronIncreased Chylomicron• Deficiency of Lipoprotein lipaseDeficiency of Lipoprotein lipase

enzymeenzyme• Defect in liver onlyDefect in liver only



yy



What are the Clues for Type-5What are the Clues for Type-5hyperlipedimia?hyperlipedimia?

• Combination of Types 1&4Combination of Types 1&4• Increased Chylomicron and VLDLIncreased Chylomicron and VLDL• Enzyme and receptor deficiency atEnzyme and receptor deficiency at

C-IIC-II



• Most common in diabeticsMost common in diabetics

What is a Xanthoma?What is a Xanthoma?

• Deposition of Cholesterol on elbowsDeposition of Cholesterol on elbows• Can cause what?Can cause what?• CADCAD



What is a Xanthelasma?What is a Xanthelasma?

• Deposition of Triglycerides onDeposition of Triglycerides oneyelids, faceeyelids, face

• Can cause what?Can cause what?• PancreatitisPancreatitis



ERYTHEMA MARGINATUMERYTHEMA MARGINATUM• Little red spots w/ bright red marginsLittle red spots w/ bright red margins

• SandpaperySandpapery• RF- Jones criteraRF- Jones critera



ERYTHEMIA CHRONICUMERYTHEMIA CHRONICUMMIGRANSMIGRANS• Lymes diseaseLymes disease• Target lesions (bulls eye) Target lesions (bulls eye)



MEASLESMEASLES

• Morbiliform rashMorbiliform rash• Preceded by coughPreceded by cough• conjunctiivitisconjunctiivitis



ROSEOLAROSEOLA

• Fever x 2 dayFever x 2 day• Followed by rashFollowed by rash• ONLY ONE WITH RASH FOLLOWINGONLY ONE WITH RASH FOLLOWING

FEVER (HHV 6)FEVER (HHV 6)



ERYTHEMA NODOSUMERYTHEMA NODOSUM

• Anterior aspect of legAnterior aspect of leg• RednessRedness• Tender nodules Tender nodules



Erythema multiformeErythema multiforme• Red macules, target lesionsRed macules, target lesions

• Causes: allergy, virusesCauses: allergy, viruses• Mild:Mild: MCC virus, #2 drugs (sulfas)MCC virus, #2 drugs (sulfas)• Moderate:Moderate: Stevens-JohnsonsStevens-Johnsons



SyndromeSyndrome• Severe:Severe: Toxic epidermal necrolysis , Toxic epidermal necrolysis ,

skin peels off skin peels off

SEBORRHEIC DERMATITISSEBORRHEIC DERMATITIS

• Scaly skin with oily shine on headlineScaly skin with oily shine on headline



SEBORRHEIC KERATOSISSEBORRHEIC KERATOSIS

• Stuck on wartsStuck on warts• Due to agingDue to aging



PSORIASISPSORIASIS

• HLA-B27HLA-B27• Extensor surfacesExtensor surfaces• Silvery white plaquesSilvery white plaques



• Scaly skinScaly skin• Pitted nailsPitted nails

VARICELLA ZOSTER HHV 3VARICELLA ZOSTER HHV 3• STAGESSTAGES

• Red maculesRed macules• PapulesPapules• VesiclesVesicles



• Pustules then scabsPustules then scabs• Different stages may appear atDifferent stages may appear at

same timesame time

DERMATITISDERMATITISHERPATIFORMISHERPATIFORMIS• Rash and blisters on ant. thighsRash and blisters on ant. thighs• Assoc. with diarrheaAssoc. with diarrhea• Assoc. with flare up of celiac sprueAssoc. with flare up of celiac sprue



TYPHOID FEVER TYPHOID FEVER

• SEEN WITH SALMONEALLA INFXNSEEN WITH SALMONEALLA INFXN• Rose spots assoc. with intestinal fireRose spots assoc. with intestinal fire



DERMATOMYOSITISDERMATOMYOSITIS

• Heliotropic rashHeliotropic rash



ERYSIPELASERYSIPELAS

• Reddened area on skin w/ raisedReddened area on skin w/ raisedbordersborders

• DOES NOT BLANCHDOES NOT BLANCH



TINEEA CRURIS TINEEA CRURIS

• RednessRedness• Itchy groinItchy groin



PITYRIASIS ROSEAPITYRIASIS ROSEA

• Herald patch= dry skin patches thatHerald patch= dry skin patches thatfollow skin linesfollow skin lines

• HHV 7HHV 7



TINEA VERSICOLOR TINEA VERSICOLOR

• Hypopigmented macules on upperHypopigmented macules on upperbackback

• Presents in a V patternPresents in a V pattern• A.K.A. upside down christmas treeA.K.A. upside down christmas tree



• Tx: Griseofulvin Tx: Griseofulvin

What do you see inWhat do you see inSCABIES?SCABIES?• Linear excoriations on belt line andLinear excoriations on belt line and

finger websfinger webs• What is the tx?What is the tx?• LindaneLindane



• PermethrinPermethrin

What is a T-CELL DEFICIENCY?What is a T-CELL DEFICIENCY?

• DiGeorgesDiGeorges• What ion imbalance will they have?What ion imbalance will they have?• HypokalemiaHypokalemia

Wh did f ?What did not form?



• What did not form?• 33 rdrd and 4and 4 thth pharyngeal pouchpharyngeal pouch• What chromosome?What chromosome?

• Deletion on chromosome 22Deletion on chromosome 22

T-CELL DEFICIENCY T-CELL DEFICIENCY

• HIVHIV• Also B-cell but less soAlso B-cell but less so



What is MYCOSISWhat is MYCOSISFUNGOIDES?FUNGOIDES?• NOT A FUNGUSNOT A FUNGUS• Non-Hodgkins form of cutaneous T-Non-Hodgkins form of cutaneous T-

cell lymphomacell lymphoma



What is the job of What is the job of CHYLOMICRONS?CHYLOMICRONS?

• Transport TG’s from GI to liver and Transport TG’s from GI to liver andendotheliumendothelium



What is the job of VLDL?What is the job of VLDL?

• Transports TG’s from liver to adipose Transports TG’s from liver to adipose



What is the job of IDL?What is the job of IDL?

• Transports TG’s from adipose to Transports TG’s from adipose totissuetissue



What is special about LDL’s?What is special about LDL’s?

• ONLY ONE THAT CARRIESONLY ONE THAT CARRIESCHOLESTEROLCHOLESTEROL



What do you develop withWhat do you develop withHYPERTRIGLYCERIDEMA?HYPERTRIGLYCERIDEMA?

• XANTHELASMAXANTHELASMA

• Where are they located?Where are they located?

On eyelids and eyebrowsOn eyelids and eyebrows



• On eyelids and eyebrows

What do you develop withWhat do you develop withHYPERCHOLESTEROLEMIA?HYPERCHOLESTEROLEMIA?

• XanthomasXanthomas

• Where are they located?Where are they located?

elbowselbows



• elbows

Where is VLDL made?Where is VLDL made?• ONLY ONE MADE IN THE LIVERONLY ONE MADE IN THE LIVER



What are the clues forWhat are the clues forHEMOPHILIUS INFLUENZA?HEMOPHILIUS INFLUENZA?

• Gram -/+?Gram -/+?

• Pleomorphic gram (-) rodsPleomorphic gram (-) rods• What pattern?What pattern?• ““school of fish pattern”school of fish pattern”

What type is most common?What type is most common?



• What type is most common?What type is most common?• Type A Type A

– 80%80%


• Capsule or no capsule?Capsule or no capsule?

• non-encapsulatednon-encapsulated• Invasive or non invasive?Invasive or non invasive?• non-invasivenon-invasive




• Most common cause of what?Most common cause of what?

• SinusitisSinusitis• OtitisOtitis• BronchitisBronchitis



What are the clues forWhat are the clues forHEMOPHILIUS INFLUENZA?HEMOPHILIUS INFLUENZA?• What is the 2What is the 2 ndnd most common type?most common type?

• TYPE B TYPE B– 20%20%• Encapsulated or non encapsulated?Encapsulated or non encapsulated?• EncapsulatedEncapsulated

• What does it have in its capsule?What does it have in its capsule?



• What does it have in its capsule?What does it have in its capsule?• Polyribosyl phosphate in capsulePolyribosyl phosphate in capsule• Contains IgA proteaseContains IgA protease


• Invasive or non invasive?Invasive or non invasive?• InvasiveInvasive• What does it cause most often?What does it cause most often?• #1 cause of epiglottitis#1 cause of epiglottitis

• What are the signs of epiglottitis?What are the signs of epiglottitis?



• What are the signs of epiglottitis?What are the signs of epiglottitis?• StridorStridor• FeverFever• Thumb sign on xray Thumb sign on xray

a are e mos commoncauses of MENINGITIScauses of MENINGITIScorresponding with thecorresponding with thefollowing ages?following ages?• 0-2 months?0-2 months?

• #1. Group B strep (agalactiae)#1. Group B strep (agalactiae)• #2. E. coli#2. E. coli• #3. Listera#3. Listera



a are e mos common

causes of MENINGITIScauses of MENINGITIScorresponding with thecorresponding with thefollowing ages?following ages?• 2 Months- 10 years?2 Months- 10 years?

• #1. strep pneumonia#1. strep pneumonia• #2. n. meningitides#2. n. meningitides• (adolescent years only)(adolescent years only)



a are e mos common

causes of MENINGITIScauses of MENINGITIScorresponding with thecorresponding with thefollowing ages?following ages?• 10yrs- 21 yrs?10yrs- 21 yrs?

• #1. n. meningitides#1. n. meningitides



a are e mos common

causes of MENINGITIScauses of MENINGITIScorresponding with thecorresponding with thefollowing ages?following ages?• > 21 years old?> 21 years old?

• #1 S. pneumoniae#1 S. pneumoniae



Answer the following about theAnswer the following about theStrep. Pneumonia vaccine.Strep. Pneumonia vaccine.

• At what age is it given?At what age is it given?

• Given at 2,4,6 monthsGiven at 2,4,6 months• What strain does it cover?What strain does it cover?• Covers 23 strains (98% cases)Covers 23 strains (98% cases)



Answer the following about theAnswer the following about theStrep. Pneumonia vaccine.Strep. Pneumonia vaccine.

• Indications?Indications?

• Anyone> 65y/oAnyone> 65y/o• Anyone splenectomizedAnyone splenectomized

– Sickle cell anemiaSickle cell anemia

• Anyone with end-organ damageAnyone with end-organ damage



• Anyone with end-organ damageAnyone with end-organ damage– CFCF– RFRF

– Nephrotic SyndromeNephrotic Syndrome

STREP PYOGENES is the mostSTREP PYOGENES is the mostcommon cause of what?common cause of what?

• MCC of all throat infectionsMCC of all throat infections

• #2 MCC of all what?#2 MCC of all what?• Skin infections except linesSkin infections except lines



What are theWhat are theSTAPHYLOCOCCUS PIGMENTS?STAPHYLOCOCCUS PIGMENTS?

• St. aureus?St. aureus?

• Gold pigmentGold pigment• St. epidermidis?St. epidermidis?• White pigmentWhite pigment

St h ti ?St h ti ?



• St. saprophyticus?St. saprophyticus?• No pigmentNo pigment

What is the clue for RUSTYWhat is the clue for RUSTYCOLORED SPUTUM?COLORED SPUTUM?

• Strep. PneumoniaStrep. Pneumonia– pneumococcuspneumococcus



Clues for GENERALClues for GENERALINFECTIONSINFECTIONS• Skin Infections?Skin Infections?

• Say Staph. AureusSay Staph. Aureus

• Throat Infections? Throat Infections?

• Say Strep. PyogenesSay Strep. Pyogenes



Say Strep. PyogenesSay Strep. Pyogenes

• Small Intestine Infections?Small Intestine Infections?

• Say E. coliSay E. coli

What disease is a NEUTROPHILWhat disease is a NEUTROPHIL

DEFICIENCY & T,B cellDEFICIENCY & T,B celldeficiency?deficiency?• Job Syndrome: Job Syndrome:

• IL-4IL-4• Hyper IgEHyper IgE• What do they look like?What do they look like?• R d h iRed hair



• Red hairRed hair• Fair complexionFair complexion

• FemaleFemale

What are the NEUTROPHILWhat are the NEUTROPHILDEFICIENCY?DEFICIENCY?

• NADPH-OXIDASE DEF (CGD)NADPH-OXIDASE DEF (CGD)

• NEUTROPENIANEUTROPENIA• MYLOPEROXIDASEMYLOPEROXIDASE• Job-Buckley Syndrome Job-Buckley Syndrome



What Hepatitis B antigen isWhat Hepatitis B antigen is

found with an acute/recentfound with an acute/recentinfection?infection?• HbC antigenHbC antigen

• HbS antigenHbS antigen



What Hepatitis B antigen &What Hepatitis B antigen &

antibody is found with anantibody is found with anacute/recent infection?acute/recent infection?

• HbC antigenHbC antigen• HbS antigenHbS antigen• HbC antibodyHbC antibody



a epa s an gen s

found with Recentfound with Recentimmunization within the pastimmunization within the past2wks?2wks?

• HbS antigen ONLYHbS antigen ONLY



What Hepatitis B antibody is found withWhat Hepatitis B antibody is found withRecent immunization two wks after and canRecent immunization two wks after and canbe due to vaccination immunity from a longbe due to vaccination immunity from a longtime ago?time ago?

• HbS antibody ONLYHbS antibody ONLY



What Immunogloblin is foundWhat Immunogloblin is foundin Hepatitis B immunity?in Hepatitis B immunity?

• IgGIgG



What Hepatitis BWhat Hepatitis B

antigen/antibody is found inantigen/antibody is found inthe chronic carrier state?the chronic carrier state?

• HbS antigen for >6monthsHbS antigen for >6months• Can be with or without HbS antibodyCan be with or without HbS antibody



What Hepatitis B antigen isWhat Hepatitis B antigen isfound with the infectious state?found with the infectious state?

• HbE antigenHbE antigen



What Hepatitis B antibody isWhat Hepatitis B antibody is

found with the non-infectiousfound with the non-infectiousstate?state?

• HbE antibodyHbE antibody



If patient has recovered fromIf patient has recovered from

Hepatitis B what antigen willHepatitis B what antigen willthey have?they have?

• NEGATIVE HbS antigenNEGATIVE HbS antigen



If patient is a chronic carrierIf patient is a chronic carrierwhat antigen will they have?what antigen will they have?

• POSITIVE HbS antigenPOSITIVE HbS antigen



What does the “windowWhat does the “windowperiod” build in Hepatitis B?period” build in Hepatitis B?

• HbE antibodyHbE antibody• IgM HbC antibodyIgM HbC antibody

• What disappears?What disappears?



What disappears?What disappears?• HbS antigenHbS antigen

What is the incubation periodWhat is the incubation periodfor Hepatitis B?for Hepatitis B?

• 4 to 26 wks4 to 26 wks• Average @ 8wksAverage @ 8wks



How long is the convalescenceHow long is the convalescenceperiod in Hepatitis B?period in Hepatitis B?

• 4 to 20 wks4 to 20 wks



Answer the following aboutAnswer the following aboutHIV?HIV?• MC infection?MC infection?

• CMVCMV• MCC of death?MCC of death?• PCPPCP

• What is p41 used for?What is p41 used for?J kJ t k



• Just a marker Just a marker

Answer the following questionsAnswer the following questionsabout HIV?about HIV?• What does Gp120 do?What does Gp120 do?

• Attachment to CD4Attachment to CD4• What is Pol used for?What is Pol used for?• IntegrationIntegration

• What is reverse transcriptase used for?What is reverse transcriptase used for?• T i tiT i ti



• Transcription Transcription• What are p17 & p24 antigens used for?What are p17 & p24 antigens used for?

• AssemblyAssembly

Answer the following questionsAnswer the following questionsabout HIV?about HIV?• What is the normal CD4 count?What is the normal CD4 count?

• 800-1200800-1200• What can the CD4 count be up to inWhat can the CD4 count be up to in

children?children?

• 15001500• When do you begin treating with 2When do you begin treating with 2



• When do you begin treating with 2When do you begin treating with 2nucleotide inhibitors and 1 proteasenucleotide inhibitors and 1 proteaseinhibitor?inhibitor?

• <500<500– (child at 750)(child at 750)

Answer the following questionsAnswer the following questionsabout HIV?about HIV?• AIDS is defined as a CD4 count of AIDS is defined as a CD4 count of

what?what?• <200<200• With a CD4 count of <200 what doWith a CD4 count of <200 what do

you tx for?you tx for?• PCPPCP



yy• PCPPCP• What do you treat for when CD countWhat do you treat for when CD count

is <100?is <100?• Mycobacterium aviam intracellularMycobacterium aviam intracellular

What are the Antioxidants?What are the Antioxidants?• Vitamin EVitamin E

– #1#1• Vitamin AVitamin A• Vitamin CVitamin C• BetakertineBetakertine



What is Vitamin A a cofactorWhat is Vitamin A a cofactorfor?for?

• ParathyroidParathyroid

• Along with what other cofactor?Along with what other cofactor?• Mg+Mg+



Too much Vitamin A will cause Too much Vitamin A will causewhat?what?• HyperparathyroidHyperparathyroid

– Increase Ca+Increase Ca+– Decrease PhosphateDecrease Phosphate

• What will be the symptoms?What will be the symptoms?

•GoansGoans

• MoansMoans



Moans• BonesBones• StonesStones

Too much Vitamin A will cause Too much Vitamin A will causewhat?what?

• Pseudotumor CerebriPseudotumor Cerebri– Increase CSF production from ChorichoidIncrease CSF production from Chorichoid

PlexusPlexus



What is the only cause of ICPWhat is the only cause of ICP

that does not causethat does not causeherniation?herniation?• Pseucotumor cerebriPseucotumor cerebri



What does Vitamin AWhat does Vitamin Adeficiency cause?deficiency cause?

• Nightvision problems/nightblindnessNightvision problems/nightblindness

• HypoparathyroidismHypoparathyroidism– Decrease Ca+Decrease Ca+



– Increase PhosphateIncrease Phosphate

What is Vitamin B1?What is Vitamin B1?• THIAMINE THIAMINE

• What do you get with a decrease inWhat do you get with a decrease inthiamine?thiamine?

• Beri BeriBeri Beri



• What is the most common cause in US?What is the most common cause in US?• ETOHETOH

What do you get with VitaminWhat do you get with VitaminB1 deficiency?B1 deficiency?

• Wet Berry BerryWet Berry Berry

• With heart failureWith heart failure

• Dry Berry BerryDry Berry Berry• Without heart failureWithout heart failure



What do you get with VitaminWhat do you get with VitaminB1 deficiency?B1 deficiency?

• Wernicke’s EncephalopathyWernicke’s Encephalopathy

• Wernicke’s Korsakoff Wernicke’s Korsakoff



What is Wernicke’sWhat is Wernicke’sEncephalopathy?Encephalopathy?

• Alcoholic thymine deficiency of theAlcoholic thymine deficiency of the Temporal Lobe Temporal Lobe



What is Wernicke’sWhat is Wernicke’sKorsakoff?Korsakoff?



What needs B1 as aWhat needs B1 as aCofactor?Cofactor?• 3 Dehydrogenases3 Dehydrogenases

• Pyruvate dehydrogenasePyruvate dehydrogenase• Alpha ketoglutarate dehydrogenaseAlpha ketoglutarate dehydrogenase• Branch chain amino acidBranch chain amino acid

dehydrogenasedehydrogenase



• Transketolase Transketolase



What is the best source of What is the best source of B2?B2?• MilkMilk

• Also from FADAlso from FAD



What is the disease thatWhat is the disease thatpresents like B3 deficiency?presents like B3 deficiency?

• Hartnup DiseaseHartnup Disease

• What is deficient in this disease?What is deficient in this disease?• Tyrptophan Tyrptophan



• What is typtophan needed for?What is typtophan needed for?

• Needed for niacin formationNeeded for niacin formation

What is B4?What is B4?

• Lipoic acidLipoic acid

• What is the deficiency caused by thisWhat is the deficiency caused by thisvitamin?vitamin?

• Not oneNot one



What is B5?What is B5?• Pantothenic acidPantothenic acid


• You guessed it…nothing You guessed it…nothing



What is B6?What is B6?• PyridoxinePyridoxine


• NeuropathyNeuropathy• SeizuresSeizures



• Who do you need to give B6 to?Who do you need to give B6 to?• Patient on INHPatient on INH

What type of anemia is seenWhat type of anemia is seenwith B6 Deficiency?with B6 Deficiency?

• SideroblasticSideroblastic



What needs B6 as aWhat needs B6 as acofactor?cofactor?• ALL transaminasesALL transaminases



What is B12?What is B12?• CyanocobalamineCyanocobalamine


• Pernicious anemiaPernicious anemia



• NeuropathyNeuropathy

What is the most commonWhat is the most common

cause of vitamin B12cause of vitamin B12deficiency?deficiency?• Pernicious anemiaPernicious anemia



What 2 enzymes are neededWhat 2 enzymes are neededfor synthesis of B12?for synthesis of B12?• Methylmalonyl CoA MutaseMethylmalonyl CoA Mutase

• Homocysteine Methyl TransferaseHomocysteine Methyl Transferase



Deficiency in MethylmalonylDeficiency in MethylmalonylCoA Mutase leads to what?CoA Mutase leads to what?

• NeuropathyNeuropathy

• Why?Why?• Because it recycles myelinBecause it recycles myelin



Deficiency in HomocystieneDeficiency in Homocystiene

Methyl Transferase leads toMethyl Transferase leads towhat?what?• Megaloblastic anemiaMegaloblastic anemia

• What else is this enzyme needed for?What else is this enzyme needed for?• Nucleotide synthesisNucleotide synthesis



When is ANGULAREWhen is ANGULARESTOMATOSIS seen?STOMATOSIS seen?• VITAMIN B2- RIBOFLAVIN deficiencyVITAMIN B2- RIBOFLAVIN deficiency



What are the 4 D’S of What are the 4 D’S of pellegra?pellegra?• DIARRHEADIARRHEA

• DERMATITISDERMATITIS• DEMENTIADEMENTIA• DEATHDEATH



What causes aWhat causes aNEUROPATHY WHENNEUROPATHY WHENDEFICIENT & alsoDEFICIENT & alsoneeds TRANSAMINASE?needs TRANSAMINASE?

• PYRIDOXINE B6PYRIDOXINE B6



What vitamin isWhat vitamin is

deficient withdeficient withPERNICIOUS ANEMIA &PERNICIOUS ANEMIA &NEUROPATHY?NEUROPATHY?

• B12 CYANOCOBALAMINEB12 CYANOCOBALAMINE



What is the first vitamin to runWhat is the first vitamin to run

out with disease of rapidlyout with disease of rapidlydividing cells?dividing cells?

• FolateFolate



What type of anemia is seenWhat type of anemia is seenwith Folate deficiency?with Folate deficiency?• Megaloblastic anemiaMegaloblastic anemia

• With neuropathy?With neuropathy?• NO NEUROPHATHYNO NEUROPHATHY



• What else is Folate used for?What else is Folate used for?

• Nucleotide synthase (THF)Nucleotide synthase (THF)

What is another name forWhat is another name forVitamin C?Vitamin C?• Ascorbate acidAscorbate acid



What is Vitamin C neededWhat is Vitamin C neededfor?for?• Collagen synthesisCollagen synthesis



What happens with Vitamin CWhat happens with Vitamin Cdeficiency?deficiency?• ScurvyScurvy



What is the CLUE forWhat is the CLUE forScurvy?Scurvy?• Bleeding gumsBleeding gums

• Bleeding hair folliclesBleeding hair follicles



What is the most commonWhat is the most commoncause of Vitamin C deficiency?cause of Vitamin C deficiency?• Diet deficient in citrus fruitDiet deficient in citrus fruit

• Diet deficient in green vegetablesDiet deficient in green vegetables• Over cooked green vegetablesOver cooked green vegetables



What does Vitamin D do withWhat does Vitamin D do withCa+?Ca+?• Controls Ca+Controls Ca+

• Absorbes Ca+ from GIAbsorbes Ca+ from GI• Reabsorbs Ca+ in KidneysReabsorbs Ca+ in Kidneys

• Controls osteoblastic activityControls osteoblastic activity



What does Vitamin DWhat does Vitamin Ddeficiency cause in Children?deficiency cause in Children?• RickettsRicketts

• What does it cause in ADULTS?What does it cause in ADULTS?• OsteomalciaOsteomalcia



What is the CLUE forWhat is the CLUE forRICKETTS?RICKETTS?• Lateral Bowing of the LegsLateral Bowing of the Legs

• X-linked dominantX-linked dominant



What is Vitamin E neededWhat is Vitamin E neededfor?for?• HairHair

• SkinSkin• EyesEyes• Protection against free radicalsProtection against free radicals

• #1 antioxidant#1 antioxidant



What does a deficiency of What does a deficiency of Vitamin E cause in newborns?Vitamin E cause in newborns?

• RetinopathyRetinopathy



What are the vitamins from GIWhat are the vitamins from GIthat are normal flora?that are normal flora?• FolateFolate

• Vitamin K Vitamin K – 90%90%

• BiotinBiotin

• Panothenic acidPanothenic acid• Helps with absorption of B12Helps with absorption of B12



• Helps with absorption of B12Helps with absorption of B12

What are the Vitamin K What are the Vitamin K dependent clotting factors?dependent clotting factors?• 19721972• Protein CProtein C• Protein SProtein S

• Which one has the shortest half-life?Which one has the shortest half-life?

• Protein CProtein C• Which one has the 2Which one has the 2 ndnd shortest half life?shortest half life?



• Which one has the 2Which one has the 2 ndnd shortest half-life?shortest half-life?• 77

What are the TRACEWhat are the TRACEelements?elements?• ChromiumChromium

• SeleniumSelenium• Manganese MolebdenumManganese Molebdenum• Tin Tin



What is Chromium neededWhat is Chromium neededfor?for?• Insulin actionInsulin action



What organ needsWhat organ needsSelenium?Selenium?• HeartHeart



What trace element is anWhat trace element is anenzyme in glycolsis?enzyme in glycolsis?• Manganese MolebdenumManganese Molebdenum



What organ needs Tin?What organ needs Tin?• HairHair



What does a deficiency in ZincWhat does a deficiency in Zinccause?cause?• DysguziaDysguzia

• Decrease spermDecrease sperm• Dry hairDry hair• Dry skinDry skin



Cofactor for ALL Kinases?Cofactor for ALL Kinases?• Mg+Mg+



Cofactor for ALLCofactor for ALLCarboxylases?Carboxylases?• BiotinBiotin



Cofactor for ALLCofactor for ALL Transaminases? Transaminases?• PyridoxinePyridoxine

– B6B6



What is Biotin a cofactorWhat is Biotin a cofactorfor?for?• ALL carboxylasesALL carboxylases



What is Mg+ a cofactor for?What is Mg+ a cofactor for?• ALL kinasesALL kinases

• Parathyroid along with Vitamin AParathyroid along with Vitamin A



What is Ca+ needed for?What is Ca+ needed for?• Muscle contractionMuscle contraction

• Axonal transportAxonal transport• 22 ndnd messengersmessengers



What tracts are affected due toWhat tracts are affected due to

deficiency in Methyl Malonyldeficiency in Methyl MalonylCoA Mutase?CoA Mutase?

• Dorsal ColumnsDorsal Columns• Cortical Spinal TractsCortical Spinal Tracts

• Why are these affected?Why are these affected?• Because they are the longestBecause they are the longest



• Because they are the longestBecause they are the longest• Because they need the most myelinBecause they need the most myelin

What enzyme does ZantheinWhat enzyme does ZantheinOxidase need?Oxidase need?

• Maganese MolebdenumMaganese Molebdenum



How are drugs that areHow are drugs that arebioavailable ALWAYS excreted?bioavailable ALWAYS excreted?• By the liverBy the liver

• Always HepatotoxicAlways Hepatotoxic



How are soluble drugs ALWAYSHow are soluble drugs ALWAYSexcreted?excreted?• By the kidneyBy the kidney

• Always nephrotoxicAlways nephrotoxic



What are the 5 P’S OFWhat are the 5 P’S OFCOMPARTMENT SYNDROME?COMPARTMENT SYNDROME?• PainPain

• PallorPallor• ParesthesiaParesthesia• PulselessnessPulselessness

• PoikilothermiaPoikilothermia



What are 5 skin infectionsWhat are 5 skin infections

were Strep. Pyogenes is thewere Strep. Pyogenes is thenumber one cause?number one cause?• LympangitisLympangitis

• Impetigo (not bullous)Impetigo (not bullous)• Necrotizing fascitisNecrotizing fascitis• ErysepelasErysepelas

• Scarlet feverScarlet fever



What are 5 skin infections wereWhat are 5 skin infections were

Staph. aureus is the numberStaph. aureus is the numbertwo cause?two cause?• LympangitisLympangitis

• Impetigo (not bullous)Impetigo (not bullous)• Necrotizing fascitisNecrotizing fascitis• ErysepelasErysepelas

• Scarlet feverScarlet fever



What is the #1 bacteriaWhat is the #1 bacteria

causing infection associated incausing infection associated inshunts and central lines?shunts and central lines?

• Staph epidermitisStaph epidermitis



What is the #1 bacteriaWhat is the #1 bacteria

causing infection in peripheralcausing infection in peripherallines?lines?• Staph aureusStaph aureus



Why do we need E. COLI in theWhy do we need E. COLI in thegut?gut?• Absorption of Absorption of Vit. B12Vit. B12

• Synthesis of Synthesis of ::• -Vitamin K -Vitamin K • -Biotin-Biotin

• -Folate-Folate• -Pantothenic acid-Pantothenic acid



Pantothenic acidPantothenic acid– B5B5

Answer the following questionsAnswer the following questionsabout RESTRICTION ENZYMES?about RESTRICTION ENZYMES?• Trypsin cuts where? Trypsin cuts where?• cuts to R of cuts to R of • ArgArg• LysLys

• Chymotrypsin cuts where?Chymotrypsin cuts where?

• cuts to R of bulky aa’scuts to R of bulky aa’s (aromatics)(aromatics)• PhePhe• TyrTyr



Tyr Tyr• Trp Trp

Answer the following questionsAnswer the following questionsabout RESTRICTION ENZYMES?about RESTRICTION ENZYMES?• Elastase cuts where?Elastase cuts where?

• Cuts to R of (“SAG”)Cuts to R of (“SAG”)• SS erer• AA lala• GG lyly

• CNBr cuts where?CNBr cuts where?• Cuts to R of Cuts to R of



• MethionineMethionine

Answer the following questionsAnswer the following questionsabout RESTRICTION ENZYMES?about RESTRICTION ENZYMES?• Mercaptoethanol cuts where?Mercaptoethanol cuts where?

• Cuts to R of: disulfide bondsCuts to R of: disulfide bonds– CysteineCysteine– methioninemethionine



Answer the following questionsAnswer the following questionsabout RESTRICTION ENZYMES?about RESTRICTION ENZYMES?• Aminopeptidase cuts where?Aminopeptidase cuts where?

• Cuts to R of Cuts to R of • amino acid terminalamino acid terminal

• Caboxypeptidase cuts where?Caboxypeptidase cuts where?• Cuts to L of Cuts to L of b l



• carboxy terminalcarboxy terminal

What is THEWhat is THE ONLY LIVEONLY LIVE

VACCINE INDICATED INVACCINE INDICATED IN AIDSAIDSPATIENTS?PATIENTS?• MMRMMR



What VACCINE isWhat VACCINE is NOTNOT GIVEN IFGIVEN IFpt. is Allergic to EGG?pt. is Allergic to EGG?• MMR & INFLUENZAMMR & INFLUENZA



What VACCINE isWhat VACCINE is NOTNOT GIVENGIVEN

IF patient HAS YEASTIF patient HAS YEASTALLERGIES?ALLERGIES?• Hepatitis BHepatitis B



What 3 VACCINES DROP OUTWhat 3 VACCINES DROP OUTAFTER 6 YEARS OF AGE?AFTER 6 YEARS OF AGE?• HibHib

• DiphtheriaDiphtheria• PertussisPertussis



What is the MC STRAIN OFWhat is the MC STRAIN OF

STREP PYOGENES TO CAUSESTREP PYOGENES TO CAUSEGN?GN?• Strain 12Strain 12



What 2 substances are inWhat 2 substances are inNEUTROPHILS?NEUTROPHILS?• MyeloperoxidaseMyeloperoxidase

• NADPH OxidaseNADPH Oxidase



MACROPHAGES CONTAIN whatMACROPHAGES CONTAIN whatSUBSTANCE?SUBSTANCE?• NADPH OxidaseNADPH Oxidase

• Which means they only kill what?Which means they only kill what?• Kills only G -veKills only G -ve



What do MACROPHAGESWhat do MACROPHAGESSECRETE?SECRETE?• IL-1IL-1

• IL-6??IL-6??



What DRUGS CAUSE PAINFULWhat DRUGS CAUSE PAINFULNEUROPATHY?NEUROPATHY?• DDI>DDCDDI>DDC

• PancreatitisPancreatitis



What are the MITOCHONDRIALWhat are the MITOCHONDRIALDISEASES?DISEASES?• Leigh’s DiseaseLeigh’s Disease• What is another name?What is another name?

• Subacute necrotizing encephalomyelopathySubacute necrotizing encephalomyelopathy• What are the signs & symptoms?What are the signs & symptoms?• Progressively decreasing IQProgressively decreasing IQ• SeizureSeizure

•AtaxiaAtaxia

• What is the deficiency?What is the deficiency?• Cytochrome oxidase deficiencyCytochrome oxidase deficiency



What are the MITOCHONDRIALWhat are the MITOCHONDRIALDISEASES?DISEASES?• Leber’s Hereditary Optic Atrophy (LHON)Leber’s Hereditary Optic Atrophy (LHON)• They all die They all die



What is theWhat is the ONLY ONLY G +ve WITHG +ve WITHENDOTOXIN?ENDOTOXIN?• ListeriaListeria

• What part is toxic?What part is toxic?• Lipid ALipid A

• Does it cross the placenta?Does it cross the placenta?



pp• Yes Yes

What does ListeriaWhat does Listeria

activate?activate?

• T-cells & Macrophages, T-cells & Macrophages, therefore,therefore,have granulomashave granulomas



What are the Associations inWhat are the Associations in

contracting the Listeria bug?contracting the Listeria bug?• Raw cabbageRaw cabbage

• Spoiled milkSpoiled milk• Migrant workersMigrant workers



What are the PERIODS OFWhat are the PERIODS OF

RAPID GROWTH/RAPIDLYRAPID GROWTH/RAPIDLYDIVIDING CELLS?DIVIDING CELLS?

• Birth – 2 monthsBirth – 2 months• 4 – 7 years old4 – 7 years old• PubertyPuberty



What is THEWhat is THE ONLY ONLY IMMUNEIMMUNE

DEFICIENCY WITHDEFICIENCY WITH

LOW CALCIUMLOW CALCIUM

and Increase Phosphate?and Increase Phosphate?• DiGeorge’s SyndromeDiGeorge’s Syndrome



What are the BASIC AMINOWhat are the BASIC AMINOACIDS?ACIDS?• LysineLysine

• ArginineArginine



What are the ACIDIC AMINOWhat are the ACIDIC AMINOACIDS?ACIDS?• GlutamateGlutamate

• AspartateAspartate



What are the Ketogenic +What are the Ketogenic +Glucogenic Amino Acids?Glucogenic Amino Acids?• PhenylalaninePhenylalanine

• IsoleucineIsoleucine• Trptophan Trptophan• Threonine Threonine



What are the AROMATICWhat are the AROMATICAMINO ACIDS?AMINO ACIDS?• PhenylalaninPhenylalanin

• Tyrosine Tyrosine• Tryptophan Tryptophan



What are the AMINO ACIDSWhat are the AMINO ACIDSwith DISULFIDE BONDS?with DISULFIDE BONDS?• MetMet

• CystCyst



What are the “KINKY” AMINOWhat are the “KINKY” AMINOACID?ACID?• ProlineProline



What are the AMINO ACIDSWhat are the AMINO ACIDSwith O-BONDS?with O-BONDS?• SerineSerine

• Threonine Threonine• Tyrosine Tyrosine



What are the AMINO ACIDSWhat are the AMINO ACIDSwith N-BONDS?with N-BONDS?• AsparagineAsparagine

• GlutamineGlutamine



What are the BRANCHED-What are the BRANCHED-CHAIN AMINO ACIDS?CHAIN AMINO ACIDS?• LeuLeu

• IsoIso• ValVal



What are the KETOGENICWhat are the KETOGENICAMINO ACIDS?AMINO ACIDS?• LeuLeu

• LysLys



What CONDITIONS areWhat CONDITIONS are

ASSOCIATED WITHASSOCIATED WITHHLA-B27?HLA-B27?• Psoriasis (with arthritis)Psoriasis (with arthritis)

• Ankylosing SpondylitisAnkylosing Spondylitis• Irritable Bowel SyndromeIrritable Bowel Syndrome• Reiter’s SyndromeReiter’s Syndrome



What are the ORGANISMSWhat are the ORGANISMS

WITH IgA PROTEASEWITH IgA PROTEASE (resistant to(resistant to

IgA)IgA) ??• Strep. PneumoniaeStrep. Pneumoniae

• H. influenzaH. influenza• Neisseria catarrhalisNeisseria catarrhalis



What do EOSINOPHILSWhat do EOSINOPHILSSECRETE?SECRETE?• HistaminaseHistaminase

• ArylsulfataseArylsulfatase• HeparinHeparin• Major Basic ProteinMajor Basic Protein



What do MAST CELLSWhat do MAST CELLS

SECRETE?SECRETE?• In an Acute Reaction?In an Acute Reaction?

• HistamineHistamine

• In a Late ReactionIn a Late Reaction ??

• SRS-ASRS-A• ECF-AECF-A



What is the MCC of ATYPICALWhat is the MCC of ATYPICAL

PNEUMONIA?PNEUMONIA?• 0 – 2 months?0 – 2 months?

• chlamydia pneumoniachlamydia pneumonia



What does chlamydiaWhat does chlamydia

pneumonia cause?pneumonia cause?• Intersitital pneumoniaIntersitital pneumonia



What is the CLUE for HEARTWhat is the CLUE for HEART

BLOCK?BLOCK?• High temperature withHigh temperature with NORMALNORMAL

pulse rate!pulse rate!

((This should never be!This should never be! Each degreeEach degree ↑ in temp. →↑ in temp. →10 beats/min ↑ in pulse rate)10 beats/min ↑ in pulse rate)



What are the clues for IL-1?What are the clues for IL-1?• FEVERFEVER

• NONSPECIFIC ILLNESSNONSPECIFIC ILLNESS• RECRUITS TH CELLS for LINKING withRECRUITS TH CELLS for LINKING withMHC II COMPLEXMHC II COMPLEX

• SECRETED BY MACROPHAGESSECRETED BY MACROPHAGES



What are the clues for IL-2?What are the clues for IL-2?• MOST POTENT OF THE InterleukinsMOST POTENT OF THE Interleukins• RECRUITS EVERYBODYRECRUITS EVERYBODY• MOST POWERFULMOST POWERFUL CHEMO-ATTRACTANTCHEMO-ATTRACTANT• MUSTMUST BE INACTIVATEDBE INACTIVATED• When must you inactivate it?When must you inactivate it?• PRIOR TO TRANSPLANTATIONPRIOR TO TRANSPLANTATION

by cyclosporinby cyclosporin• SECRETED BY TH1 CELLSSECRETED BY TH1 CELLS



• SECRETED BY TH1 CELLSSECRETED BY TH1 CELLS

What are the clues for IL-3?What are the clues for IL-3?• ENERGIZED MACROPHAGESENERGIZED MACROPHAGES

• CAUSES B-CELL PROLIFERATIONCAUSES B-CELL PROLIFERATION• LABELED BY THYMIDINE (USELABELED BY THYMIDINE (USEPOKEWEED MITOGEN ORPOKEWEED MITOGEN OR

ENDOTOXIN)ENDOTOXIN)• SECRETED BY ACTIVATED T CELLSSECRETED BY ACTIVATED T CELLS



What are the clues for IL-4?What are the clues for IL-4?• B-CELL DIFFERENTIATIONB-CELL DIFFERENTIATION

• RESPONSIBLE FOR CLASS SWITCHINGRESPONSIBLE FOR CLASS SWITCHING• SECRETED BY TH2 CELLSSECRETED BY TH2 CELLS



What are the clues for IL-5 thruWhat are the clues for IL-5 thru

14?14?• They do exactly what IL-1 thru IL4 They do exactly what IL-1 thru IL4



What are the clues for IL-What are the clues for IL-10?10?• SUPPRESSES CELL-MEDIATEDSUPPRESSES CELL-MEDIATED

RESPONSE (tells macrophages andRESPONSE (tells macrophages andfibroblasts to stay away if bacterial)fibroblasts to stay away if bacterial)• INHIBITSINHIBITS MACMAC ACTIVATIONACTIVATION



What are the clues for IL-What are the clues for IL-12?12?• PROMOTES CELL-MEDIATED RESPONSEPROMOTES CELL-MEDIATED RESPONSE

(recruits macs & fibroblasts if NOT(recruits macs & fibroblasts if NOTbacterial)bacterial)

• ACTIVATESACTIVATES NK NK CELLS TO SECRETE IF-CELLS TO SECRETE IF- γγ• INHIBITS IL-4 INDUCED IgE SECRETIONINHIBITS IL-4 INDUCED IgE SECRETION

• CHANGES TH CELLS to TH1 CELLSCHANGES TH CELLS to TH1 CELLS– secretes IL-2 & IF-secretes IL-2 & IF- γγ → inhib. TH2, therefore, ↑→ inhib. TH2, therefore, ↑

host defenses against delayed hypersensitivityhost defenses against delayed hypersensitivity



What are the clues for IF-What are the clues for IF- αα ??• Where is it from?Where is it from?• LEUKOCYTESLEUKOCYTES• ↓↓ VIRAL REPLICATION AND TUMORVIRAL REPLICATION AND TUMOR

GROWTHGROWTH• ↑↑ NK NK ACTVITYACTVITY

–secretes perforins and granzymes to killsecretes perforins and granzymes to killinfected cellinfected cell

• ↑↑ MHC CLASS I & II EXPRESSIONMHC CLASS I & II EXPRESSION• ↓↓ PROTEIN SYNTHESISPROTEIN SYNTHESIS



↓↓ PROTEIN SYNTHESISPROTEIN SYNTHESIS

– translation inhibited, therefore, defectivetranslation inhibited, therefore, defectiveprotein synthesisprotein synthesis

Summary of clues for IF-Summary of clues for IF- αα ??• Increase NK activityIncrease NK activity

• Increase MHC class I & IIIncrease MHC class I & II• Decrease protein synthesisDecrease protein synthesis• Decrease viral replication and growthDecrease viral replication and growth



What are the clues for IF-B?What are the clues for IF-B?

• Where is it from?Where is it from?

• FIBROBLASTSFIBROBLASTS• Increase NK activityIncrease NK activity• Increase MHC class I & IIIncrease MHC class I & II

• Decrease protein synthesisDecrease protein synthesis• Decrease viral replication and growthDecrease viral replication and growth



What are the clues for IF-What are the clues for IF-gama?gama?• Where is it from?Where is it from?• T-CELLS & NK CELLST-CELLS & NK CELLS• ↑↑ NK NK ACTIVITYACTIVITY• ↑↑ MHCMHC CLASS I & IICLASS I & II• ↑↑ MACROPHAGE ACTIVITYMACROPHAGE ACTIVITY• CO-STIMULATES B-CELL GROWTH &CO-STIMULATES B-CELL GROWTH &

DIFFERENTIATIONDIFFERENTIATION• ↓↓ IgE SECRETIONIgE SECRETION



• ↓↓ IgE SECRETIONIgE SECRETION

What are the clues for TNF-What are the clues for TNF-

alpha?alpha?• Where is it from?Where is it from?• MONOCYTES &MONOCYTES & MACROPHAGESMACROPHAGES

• What is another name for TNF-alpha?What is another name for TNF-alpha?• CACHECTINCACHECTIN• INDUCESINDUCES IL-1IL-1• ↑↑ ADHESION MOLECULES & MHC CLASS I ONADHESION MOLECULES & MHC CLASS I ON

ENDOTHELIAL CELLSENDOTHELIAL CELLS• PYROGENPYROGEN• INDUCES IF-INDUCES IF- γγ SECRETIONSECRETION• CYTOTOXICCYTOTOXIC /CYTOSTATIC EFFECT/CYTOSTATIC EFFECT



CYTOTOXICCYTOTOXIC /CYTOSTATIC EFFECT/CYTOSTATIC EFFECT

What are the clues for TNF-What are the clues for TNF-

beta?beta?• Where is it from?Where is it from?

• T-CELLST-CELLS

• What is another name for it?What is another name for it?

• LYMPHOTOXINLYMPHOTOXIN

• CYTOTOXIC FACTORCYTOTOXIC FACTOR



• CYTOTOXIC FACTORCYTOTOXIC FACTOR

What are the clues for TGF-What are the clues for TGF-

αα ??• Where is it from?Where is it from?

• SOLID TUMORSSOLID TUMORS (CARCINOMA >(CARCINOMA >SARCOMA)SARCOMA)• MONOCYTESMONOCYTES

• What is another name for it?What is another name for it?• TRANSFORMING GROWTH FACTORSTRANSFORMING GROWTH FACTORS



TRANSFORMING GROWTH FACTORS TRANSFORMING GROWTH FACTORS


αα ??• What does it INDUCE?What does it INDUCE?• ANGIOGENESISANGIOGENESIS• KERATINOCYTE PROLIFERATIONKERATINOCYTE PROLIFERATION• BONE RESORPTIONBONE RESORPTION• TUMOR GROWTH TUMOR GROWTH

• What is it mainly for?What is it mainly for?• MAINLY FOR TUMOR GROWTHMAINLY FOR TUMOR GROWTH



• MAINLY FOR TUMOR GROWTHMAINLY FOR TUMOR GROWTH


ββ ??• Where is it from?Where is it from?

• PLATELETSPLATELETS• PLACENTAPLACENTA• KIDNEY KIDNEY

• BONEBONE• T & B CELLST & B CELLS




ββ ??

• WhatWhat INDUCES it?INDUCES it?• FIBROBLAST PROLIFERATIONFIBROBLAST PROLIFERATION• COLLAGENCOLLAGEN

• FIBRONECTIN SYNTHESISFIBRONECTIN SYNTHESIS




ββ ??• What INHIBITS it?What INHIBITS it?

• NK NK • LAK LAK • CTLCTL

• T & B CELL PROLIFERATION T & B CELL PROLIFERATION




ββ ??• What ENHANCES it?What ENHANCES it?

• WOUND HEALINGWOUND HEALING• ANGIOGENESISANGIOGENESIS




ββ ??• What does it suppress?What does it suppress?

• SUPPRESSES IR AFTER INFECTION &SUPPRESSES IR AFTER INFECTION &PROMOTES HEALING PROCESSPROMOTES HEALING PROCESS

• What is it mainly for?What is it mainly for?• MAINLY FOR WOUND HEALINGMAINLY FOR WOUND HEALING



What does LAK stand for?What does LAK stand for?

• LYMPHOKINE ACTIVATED KILLERLYMPHOKINE ACTIVATED KILLERCELLSCELLS



What does CTL stand for?What does CTL stand for?

• CYTOTOXIC T-LYMPHOCYTESCYTOTOXIC T-LYMPHOCYTES



What does mitochondrialWhat does mitochondrial

inheritance affect?inheritance affect?• CNSCNS

• HeartHeart• Skeletal muscleSkeletal muscle

• Why does it affect these particularWhy does it affect these particularplaces?places?

• Due to uneven cytokinesis duringDue to uneven cytokinesis during



y gy g

meiosis or oogenesismeiosis or oogenesis



Answer the following aboutAnswer the following aboutAutosomal RecessiveAutosomal Recessiveinheritance?inheritance?• Who does it show in?Who does it show in?• Not parentsNot parents

• Siblings/uncles may show diseaseSiblings/uncles may show disease

• When is onset?When is onset?• Early in life (childhood diagnosis)Early in life (childhood diagnosis)

• Is it complete on incomplete penetrance?Is it complete on incomplete penetrance?• COMPLETECOMPLETE



Answer the following aboutAnswer the following aboutAutosomal RecessiveAutosomal Recessiveinheritance?inheritance?• How are they acquired?How are they acquired?

• Almost ALL are inborn error of Almost ALL are inborn error of metabolismmetabolism

• When does it occur?When does it occur?• Only when both alleles at a locus areOnly when both alleles at a locus are

mutantmutant



Answer the following aboutAnswer the following aboutAutosomal RecessiveAutosomal Recessiveinheritance?inheritance?• How is it transmitted?How is it transmitted?• Horizontal TmHorizontal Tm

• Are there malformations present?Are there malformations present?• Physical malformations are uncommonPhysical malformations are uncommon

• What type of defect?What type of defect?• Enzyme defectEnzyme defect



Enzyme defectEnzyme defect

Answer the following aboutAnswer the following aboutAutosomal DominantAutosomal Dominantinheritance?inheritance?• Who does it affect the most?Who does it affect the most?• M=FM=F

• How does it manifest?How does it manifest?• Heterozygote stateHeterozygote state

• Who can transmit the disease?Who can transmit the disease?• Both parentsBoth parents



Both parentsBoth parents

Answer the following aboutAnswer the following aboutAutosomal DominantAutosomal Dominantinheritance?inheritance?• Where is the new mutation?Where is the new mutation?

• Often in germ cells of older fathersOften in germ cells of older fathers

• When is onset?When is onset?

• Often delayed (adult diagnosis)Often delayed (adult diagnosis)– Example = Huntington’sExample = Huntington’s



Answer the following aboutAnswer the following aboutAutosomal DominantAutosomal Dominantinheritance?inheritance?• What is penetrance?What is penetrance?

• Reduced penetranceReduced penetrance

• How is it expressed?How is it expressed?

• Variable expressinVariable expressin– Different in each individualDifferent in each individual



Answer the following aboutAnswer the following aboutAutosomal DominantAutosomal Dominantinheritance?inheritance?• How is it transmitted?How is it transmitted?• Vertical TMVertical TM

• Is there malformation present?Is there malformation present?• Physical malformation commonPhysical malformation common

• What type of defect?What type of defect?• StructuralStructural



StructuralStructural

Who is affected in the familyWho is affected in the family

with an X-Linked disease?with an X-Linked disease?

• Maternal grandfatherMaternal grandfather• Maternal uncleMaternal uncle



Immune System Time Line forImmune System Time Line for

viral & cell-mediated.viral & cell-mediated.• What happens <24hrs?What happens <24hrs?• SwellingSwelling

• What happens at 24 hrs?What happens at 24 hrs?• Neutrophils show upNeutrophils show up

• What happens at day 3?What happens at day 3?• Neutrophils peakNeutrophils peak



Neutrophils peakp p


viral & cell-mediated.viral & cell-mediated.• What happens at day 4?What happens at day 4?• T cells and Macrophages show up T cells and Macrophages show up

• What happens at day 7?What happens at day 7?• Fibroblasts show upFibroblasts show up

• What happens in 1 month?What happens in 1 month?• Fibroblast peakFibroblast peak



Fibroblast peakp


viral & cell-mediated.viral & cell-mediated.• What happens at 3-6 months?What happens at 3-6 months?

• Fibroblasts are goneFibroblasts are gone



What is the general CLUE forWhat is the general CLUE forany Lysosomal Storageany Lysosomal StorageDisease?Disease?

• Lysosomal Inclusion BodiesLysosomal Inclusion Bodies



What are the LysosomalWhat are the Lysosomal

Storage diseases?Storage diseases?• GauchersGauchers• FabrysFabrys

• KrabbeKrabbe• Tay Sachs Tay Sachs• SandhoffsSandhoffs• HurlersHurlers• HuntersHunters• Neiman PickNeiman Pick• Metachromatic LeukodystropyMetachromatic Leukodystropy



What is missing inWhat is missing in

Gauchers?Gauchers?• Beta-GlucocerberosidaseBeta-Glucocerberosidase

• What Accumulates?What Accumulates?• GlucocebrosideGlucocebroside

• Where?Where?

• BrainBrain• LiverLiver• Bone MarrowBone Marrow• SpleenSpleen




Gauchers?Gauchers?• Ask. JewAsk. Jew

• GargolsGargols• Gaucher cellsGaucher cells– Macrophages looking like CrinkeledMacrophages looking like Crinkeled

paperpaper

• Erlin myoflask legsErlin myoflask legs• PseudohypertrophyPseudohypertrophy



What is missing in Fabrys?What is missing in Fabrys?

• Alpha-galactosidaseAlpha-galactosidase

• What accumulates?What accumulates?• Ceramide TrihexosideCeramide Trihexoside




Fabrys?Fabrys?• X-Linked recessiveX-Linked recessive

• Presents with cataracts as a childPresents with cataracts as a child• Presents with renal failure as a childPresents with renal failure as a child



What is missing in Krabbes?What is missing in Krabbes?

• Galactosylceramide B-GalactosidaseGalactosylceramide B-Galactosidase

• What accumulates?What accumulates?• GalactocerebrosidaseGalactocerebrosidase

• Where?Where?• BrainBrain




Krabbes?Krabbes?• Early deathEarly death

• Globoid bodiesGloboid bodies– Fat cellsFat cells



What is missing in TayWhat is missing in Tay

Sachs?Sachs?• Hexoseaminidase AHexoseaminidase A

• What accumulates?What accumulates?• GM2 GangliosideGM2 Ganglioside



What is the CLUE for TayWhat is the CLUE for Tay

Sachs?Sachs?• Ask. JewsAsk. Jews

• Cherry red maculaCherry red macula• Death by 3Death by 3




Sandhoffs?Sandhoffs?• Hexoseaminadase A & BHexoseaminadase A & B



What is missing in Hurlers?What is missing in Hurlers?

• IduronidaseIduronidase




Hurlers?Hurlers?• Corneal CloudingCorneal Clouding

• Mental RetardationMental Retardation



What is missing in Hunters?What is missing in Hunters?

• Iduronate SulfataseIduronate Sulfatase




Hunters?Hunters?• Mild mental retardationMild mental retardation

• No corneal cloudingNo corneal clouding• Mild form of HurlersMild form of Hurlers• X-linked recessiveX-linked recessive



What is missing in NiemannWhat is missing in Niemann

Picks?Picks?• SpingomyelinaseSpingomyelinase

• What accumulates?What accumulates?• SpingomyelinSpingomyelin

• CholesterolCholesterol




Niemann Picks?Niemann Picks?• Zebra bodiesZebra bodies

• Cherrry red maculaCherrry red macula• Die by 3Die by 3



What is missing inWhat is missing inMetachromaticMetachromaticLeukodystrophy?Leukodystrophy?• Arylsulfatase AArylsulfatase A



What is the CLUE forWhat is the CLUE forMetachromaticMetachromaticLeukodystrophy?Leukodystrophy?• Visual DisturbanceVisual Disturbance

• Presents like MS in 5 to 10 years of Presents like MS in 5 to 10 years of ageage



What are the Glycogen StorageWhat are the Glycogen Storage

Diseases?Diseases?• Von GierkesVon Gierkes

• AndersonsAndersons• CorysCorys• McCardlesMcCardles

• PompesPompes• HersHers



What is deficient in VonWhat is deficient in Von

Gierkes?Gierkes?• G-6-Pase DeficiencyG-6-Pase Deficiency



What is the CLUE for VonWhat is the CLUE for Von

Gierkes?Gierkes?• Big LiverBig Liver

• Big KidneyBig Kidney• Severe hypoglycemiaSevere hypoglycemia• Can NEVER raise their blood sugarCan NEVER raise their blood sugar



What is deficient inWhat is deficient in

Andersons?Andersons?• Branching enzyme deficiencyBranching enzyme deficiency



What is the CLUE forWhat is the CLUE for

Andersons?Andersons?• Glycogen will be ALL LONG chains onGlycogen will be ALL LONG chains on

liver biopsyliver biopsy



What is missing in Corys?What is missing in Corys?

• Debranching enzymeDebranching enzyme



What is the CLUE for Corys?What is the CLUE for Corys?

• Glycogen from liver biopsy will beGlycogen from liver biopsy will beALL SHORT branchesALL SHORT branches




McCardles?McCardles?• Muscle phosporalaseMuscle phosporalase




McCardles?McCardles?• Severe muscle cramps whenSevere muscle cramps when

exercisingexercising• High CPK High CPK



What is missing in Pompes?What is missing in Pompes?

• Cardiac alpha-1,4 glucocydaseCardiac alpha-1,4 glucocydase




Pompes?Pompes?• Heart problemsHeart problems

• Die earlyDie early



What is missing in Hers?What is missing in Hers?

• Liver phosphoralaseLiver phosphoralase



What is the CLUE for Hers?What is the CLUE for Hers?

• Big LiverBig Liver

• NO big kidneyNO big kidney



What MUST you rule out with aWhat MUST you rule out with a

decrease AVO2?decrease AVO2?

•AV FistulaAV Fistula

• VasodilationVasodilation



What diseases have a cherryWhat diseases have a cherry

red macula?red macula?

• Tay Sachs Tay Sachs• SandhoffsSandhoffs• Niemann PickNiemann Pick



What is translocation 9;22?What is translocation 9;22?

• CMLCML




• Ewing’s sarcomaEwing’s sarcoma




• Burketts lymphomaBurketts lymphoma




• Follicular lymphomaFollicular lymphoma



What are the causes of What are the causes of

restrictive cardiomyopathy?restrictive cardiomyopathy?• SarcoidSarcoid• AmyloidAmyloid• HemochromatosisHemochromatosis• CancerCancer

• FibrosisFibrosis

• Thanks STAN!! Thanks STAN!!



What are the CLUES forWhat are the CLUES forVasulitis or IntravascularVasulitis or IntravascularHemolysis?Hemolysis?• ShistocytesShistocytes

– Burr cellsBurr cells– Helmet cellsHelmet cells




Extravascular Hemolysis?Extravascular Hemolysis?• SplenomagelySplenomagely



Where is Glucose 6-PaseWhere is Glucose 6-Pase

present?present?• AdrenalAdrenal• LiverLiver



What is the Heinz bodyWhat is the Heinz body

CLUE?CLUE?• G6PDG6PD



If you see the CLUE basophilicIf you see the CLUE basophilicstippling, what should you bestippling, what should you bethinking?thinking?

• Lead poisoningLead poisoning



What are the MicrocyticWhat are the Microcytic

Hypochromic Anemias?Hypochromic Anemias?• Iron deficiencyIron deficiency• Anemia of Chronic diseaseAnemia of Chronic disease• Lead poisoningLead poisoning• HemoglobinopathyHemoglobinopathy

• Thallasemia’s Thallasemia’s• Sideroblastic anemiaSideroblastic anemia



What is primary sideroblasticWhat is primary sideroblastic

anemia due to?anemia due to?• GeneticGenetic• ADAD



What is secondaryWhat is secondary

Sideroblastic anemia due to?Sideroblastic anemia due to?• Blood transfusionsBlood transfusions



What are the MicrocyticWhat are the Microcytic

Hyperchromic Anemia’s?Hyperchromic Anemia’s?• Hereditary SpherocytosisHereditary Spherocytosis



What are the NormocyticWhat are the Normocytic

Normochromic Anemia’s?Normochromic Anemia’s?• Acute hemorrhageAcute hemorrhage• Anemia of Chronic DiseaseAnemia of Chronic Disease• HypothyrodismHypothyrodism

– EarlyEarly

• Renal FailureRenal Failure



What are the MacrocyticWhat are the Macrocytic

anemia’s?anemia’s?• Folate deficiencyFolate deficiency• B12 deficiencyB12 deficiency

• ReticulocytosisReticulocytosis• ETOHETOH• Hemolytic AnemiasHemolytic Anemias

• Chemo TreatmentChemo Treatment• AnticonvulsantsAnticonvulsants• MyelodysplasiaMyelodysplasia



What are the anticonvulsantsWhat are the anticonvulsants

causing a Macrocytic Anemia?causing a Macrocytic Anemia?• PhenytoinPhenytoin• EthusuximideEthusuximide• CarbamyazapineCarbamyazapine• ValproateValproate



What anemia is caused byWhat anemia is caused by

blood transfusions?blood transfusions?• Sideroblastic anemiaSideroblastic anemia



What is the problem if you seeWhat is the problem if you see

Eliptocytes?Eliptocytes?• Something is wrong with the RBCSomething is wrong with the RBC

membranemembrane– ExtravascularExtravascular

• Heridatary EllitocytosisHeridatary Ellitocytosis• Increased RET countIncreased RET count



What disease do you get if youWhat disease do you get if you

have an EXCESS in Cu+?have an EXCESS in Cu+?• Wilson’s DiseaseWilson’s Disease



What is the CLUE for Wilson’sWhat is the CLUE for Wilson’s

Disease?Disease?• Hepato/Lenticular DegenerationHepato/Lenticular Degeneration• Kayser Fleishner RingsKayser Fleishner Rings

– Copper in eyesCopper in eyes

• Hepato = LiverHepato = Liver• Lenticular = Movement problemLenticular = Movement problem



What is Copper needed for?What is Copper needed for?

• Collagen synthesisCollagen synthesis



What disease manifest withWhat disease manifest with

Cu+ deficiency?Cu+ deficiency?• Minky Kinky Hair SyndromeMinky Kinky Hair Syndrome



What are the plasmaWhat are the plasma

catecholamines?catecholamines?• EpinephrineEpinephrine• NorepinephrineNorepinephrine• DopamineDopamine



What are PlasmaWhat are Plasma

Catecholamines derived from?Catecholamines derived from?• Tyrosine Tyrosine



A patient with episodic HTN leading toA patient with episodic HTN leading toheadache with arrhythmias leading toheadache with arrhythmias leading topalpitations most likely is diagnosedpalpitations most likely is diagnosedwith?with?

• Adrenal PheochromocytomaAdrenal Pheochromocytoma



What is the MOA forWhat is the MOA for

Fluroquinolones?Fluroquinolones?• Blocks DNA gyrase (topoisomerase II)Blocks DNA gyrase (topoisomerase II)• Inhibits p450Inhibits p450



What do FluroquinolonesWhat do Fluroquinolones

cover?cover?• All Gram + including staph auerusAll Gram + including staph auerus• All Gram –All Gram –• AtypicalsAtypicals



What are the atypicals?What are the atypicals?

• ChlamydiaChlamydia• UreoplasmaUreoplasma• MycoplasmaMycoplasma• LegionellaLegionella



What is Dermatan Sulfate?What is Dermatan Sulfate?

• Glycosaminoglycan chain that helpsGlycosaminoglycan chain that helpsform proteoglycansform proteoglycans



What is the MOA of What is the MOA of

Methotrexate?Methotrexate?• Inhibits dihydrofolate reductaseInhibits dihydrofolate reductase• Inhibits DNA synthesis in the S phaseInhibits DNA synthesis in the S phase

of cycle.of cycle.• Prevents reduction of folic acidPrevents reduction of folic acid

needed to produce THFneeded to produce THF



What are THF derivatives usedWhat are THF derivatives used

in?in?• Purine nucleotide synthesisPurine nucleotide synthesis• Methylation of dUMP to for dTMPMethylation of dUMP to for dTMP



What happens whenWhat happens whenDihydrofolate Reductase isDihydrofolate Reductase isinhibited?inhibited?• Obstructs one carbon methylationObstructs one carbon methylation

which deprives DNA polymerase of which deprives DNA polymerase of essential substratesessential substrates



What diseases present asWhat diseases present as

Failure to Thrive?Failure to Thrive?

• CFCF• GalactosemiaGalactosemia



In general, what should youIn general, what should youalways associate Hemolyticalways associate HemolyticAnemia’s with?Anemia’s with?

• Defects in GlycolysisDefects in Glycolysis• Defects in Hexose MonophosphateDefects in Hexose Monophosphate

ShuntShunt



What is required for theWhat is required for theconversion of Homocysteine toconversion of Homocysteine toMethionine?Methionine?

• B12B12



What is required for theWhat is required for theconversion of methylmalonylconversion of methylmalonylCoA to Succinyl CoA?CoA to Succinyl CoA?

• B12B12



What is required for theWhat is required for the

degradation of cystathionine?degradation of cystathionine?• Vitamin B6Vitamin B6



What does the hydroxalation of What does the hydroxalation of

Purines require?Purines require?• Vitamin CVitamin C



en oes e car oxya a onof Glutamic acid occurs andof Glutamic acid occurs and

what is required for thiswhat is required for thiscarboxyalation?carboxyalation?

• Occurs in the synthesis of BloodOccurs in the synthesis of BloodClotting factorsClotting factors

• Requires Vitamin K Requires Vitamin K



Decarboxylation of alpha-Decarboxylation of alpha-

ketoacids requires what?ketoacids requires what?

• Thiamine Thiamine



Synthesis of 1,25-d-Synthesis of 1,25-d-hydroxycholecalciferol requireshydroxycholecalciferol requireswhat?what?

• Vitamin DVitamin D



Synthesis of RhodopsinSynthesis of Rhodopsin

requires what?requires what?

• Vitamin AVitamin A



Pyruvate DecarboxylasePyruvate Decarboxylase

requires what as a cofactor?requires what as a cofactor?• Thiamine Thiamine



What is CN1?What is CN1?

• OlfactoryOlfactory• What is its function?What is its function?

• Sensory for smellSensory for smell• What if lesioned?What if lesioned?• AnosmiaAnosmia• Where does it Exit/Enter the Cranium?Where does it Exit/Enter the Cranium?

• Cribriform plateCribriform plate• What does it innervate?What does it innervate?• Nasal CavityNasal Cavity




• OpticOptic• What is its function?What is its function?

• Sensory for sightSensory for sight• What if lesioned?What if lesioned?• AnopsiaAnopsia

– Visual field defectVisual field defect• Loss of light reflex with CN IIILoss of light reflex with CN III• Only nerve affected by MSOnly nerve affected by MS



Cont. CN2Cont. CN2

• Where does it Exit/Enter theWhere does it Exit/Enter theCranium?Cranium?

• Optic CanalOptic Canal

• What does it innervate?What does it innervate?• OrbitOrbit




• OcculomotorOcculomotor• What are the functions?What are the functions?

• MotorMotor• Moves the eyeball in ALL directionsMoves the eyeball in ALL directions• Adduction Most important action (MR)Adduction Most important action (MR)

• Constricts the pupil (Spincter Pupillae)Constricts the pupil (Spincter Pupillae)• Accomodates (Cililary Muscle)Accomodates (Cililary Muscle)• Raises eyelid (Levator Palpebrae)Raises eyelid (Levator Palpebrae)



Cont. CN 3Cont. CN 3

• What if lesioned?What if lesioned?• DiplopiaDiplopia• Loss of parallel gazeLoss of parallel gaze• Dilated pupilDilated pupil

• Loss of light reflexLoss of light reflex• Loss of near responseLoss of near response• PtosisPtosis





• Superior Orbital FissureSuperior Orbital Fissure





• What if lesioned?What if lesioned?• Weakness looking down w/ adductedWeakness looking down w/ adducted

eyeeye• Trouble going down stairs Trouble going down stairs• Head tilts away from lesioned sideHead tilts away from lesioned side

• Where does it Exit/Enter theWhere does it Exit/Enter the

Cranium?Cranium?

•



C a u ?•





What is CN 5?What is CN 5?

• Trigeminal Trigeminal



What are the differentWhat are the different

branches of CN 5?branches of CN 5?• V1?V1?• OpthalmicOpthalmic

• V2?V2?• MaxillaryMaxillary

• V3?V3?• MandibularMandibular



What is the function of CN V1?What is the function of CN V1?

• MixedMixed• General sensation (touch, pain, temperature) of General sensation (touch, pain, temperature) of

the forehead, scalp, & corneathe forehead, scalp, & cornea

• What if lesioned?What if lesioned?• Loss of general sensation of the forehead/scalpLoss of general sensation of the forehead/scalp• Loss of blink reflex w/ VIILoss of blink reflex w/ VII

• Where does it Exit/Enter the Cranium?Where does it Exit/Enter the Cranium?• Superior orbital FissureSuperior orbital Fissure

– Ophthalmic divisionOphthalmic division



Cont. CN V1Cont. CN V1

• What does it innervate?What does it innervate?• OrbitOrbit• ScalpScalp



What is the function of CNWhat is the function of CN

V2?V2?• MixedMixed• General sensation of Palat, NasalGeneral sensation of Palat, Nasal

cavity, Maxillary face, and Maxillarycavity, Maxillary face, and Maxillaryteethteeth

• What if lesioned?What if lesioned?• Loss of general sensation in skin overLoss of general sensation in skin over

maxilla & maxillary teethmaxilla & maxillary teeth





• Foramen RotundumForamen Rotundum

• What does it innervate?What does it innervate?• PterygopalatinePterygopalatine

– Leaves by openings to face, oral & nasalLeaves by openings to face, oral & nasalcavitycavity



What is the function of CNWhat is the function of CN

V3?V3?• What is its function?What is its function?• MixedMixed

• General sensation of anterior 2/3 of General sensation of anterior 2/3 of tongue, mandibular face & mandibulartongue, mandibular face & mandibularteethteeth

• MotorMotor

• Muscles of Mastication and anterior bellyMuscles of Mastication and anterior bellyof digastric, mylohyoid, tensor tympani,of digastric, mylohyoid, tensor tympani,tensor palatitensor palati




• What if lesioned?What if lesioned?• Loss of general sensation in skin overLoss of general sensation in skin over

mandible, mandibular teeth, tongue,mandible, mandibular teeth, tongue,weakness in chewingweakness in chewing

• Jaw deviation to weak side Jaw deviation to weak side

• Trigeminal neuralgia Trigeminal neuralgia– Intractable pain in V2 or V3 territoryIntractable pain in V2 or V3 territory





• Foramen OvaleForamen Ovale

• What does it innervate?What does it innervate?• Infratemporal FossaInfratemporal Fossa



What is CN VI?What is CN VI?

• AbducensAbducens

• What is its function?What is its function?• MotorMotor

• Lateral rectusLateral rectus– Abducts eyeAbducts eye



What is CN VII?What is CN VII?

• FacialFacial• What is its function?What is its function?• MixedMixed• To muscles of facial expression To muscles of facial expression• Posterior belly of diagastricPosterior belly of diagastric• Stylohyoid & StapediusStylohyoid & Stapedius• Tastes anterior 2/3 of tongue/palate Tastes anterior 2/3 of tongue/palate• Salivates (submandibular & sublingual glands)Salivates (submandibular & sublingual glands)• Tears (Lacrimal glands) Tears (Lacrimal glands)• Makes mucous (nasal & palatine glands)Makes mucous (nasal & palatine glands)



Cont. CN VIICont. CN VII

• What if lesioned?What if lesioned?• Corner of mouth droopsCorner of mouth droops• Can’t close eyeCan’t close eye• Can’t wrinkle foreheadCan’t wrinkle forehead• Loss of blink reflexLoss of blink reflex• HypeacusisHypeacusis• Loss or alteration of taste (ageusia)Loss or alteration of taste (ageusia)• Eye dry and redEye dry and red• Bell PalsyBell Palsy

– Lesion of nerve in facial canalLesion of nerve in facial canal



Cont. CN VIICont. CN VII


• Internal Auditory meatusInternal Auditory meatus

• What does it innervate?What does it innervate?

• FaceFace• Nasal & oral cavityNasal & oral cavity

– Branches leave skull in stylomastoidBranches leave skull in stylomastoidforamen, petrotympanic fissure, orforamen, petrotympanic fissure, orHiatus of facial canalHiatus of facial canal



What is CN VIII?What is CN VIII?

• VestibulocochlearVestibulocochlear

• What is its function?What is its function?• SensorySensory

• HearsHears

• Linear acceleration (Gravity)Linear acceleration (Gravity)• Angular acceleration (Head Turning)Angular acceleration (Head Turning)



Cont. CN VIIICont. CN VIII

• What if lesioned?What if lesioned?• Loss of BalanceLoss of Balance• NystagmusNystagmus

• Where does it Exit/Enter the Cranium?Where does it Exit/Enter the Cranium?• Internal Auditory MeatusInternal Auditory Meatus

• What does it innervate?What does it innervate?• Inner earInner ear



What is CN IX?What is CN IX?

• GlossopharyngealGlossopharyngeal

• What is its function?What is its function?• MixedMixed• Sense PharynxSense Pharynx

• Carotid sinus/bodyCarotid sinus/body• Salivates (parotid glands)Salivates (parotid glands)• Tastes and senses posterior 1/3 of tongue Tastes and senses posterior 1/3 of tongue



Cont. CN IXCont. CN IX

• What is its function?What is its function?• To one muscle only (stylopharyngeus) To one muscle only (stylopharyngeus)

• What if lesioned?What if lesioned?• Loss of Gag Reflex with XLoss of Gag Reflex with X

• Where does it Exit/Enter the Cranium?Where does it Exit/Enter the Cranium?• Jugular Foramen Jugular Foramen



Cont. CN IXCont. CN IX

• What does it innervate?What does it innervate?• NeckNeck• Pharynx/TonguePharynx/Tongue



What is CN X?What is CN X?

• VagusVagus• What is its function?What is its function?

• MixedMixed• To muscles of palate & pharynx for To muscles of palate & pharynx forswallowing except tensor palate (V) &swallowing except tensor palate (V) &Stylopharynegeus (IX)Stylopharynegeus (IX)

• To all muscles of Larynx (phonates) To all muscles of Larynx (phonates)• Senses Larynx & LaryngopharynxSenses Larynx & Laryngopharynx• Senses Larynx & GI tractSenses Larynx & GI tract

• To GI tract smooth muscle & glands in To GI tract smooth muscle & glands inforgut & midgutforgut & midgut



Cont. CN XCont. CN X

• What if lesioned?What if lesioned?• Nasal speechNasal speech• Nasal regurgitationNasal regurgitation• DysphagiaDysphagia• Palate dropPalate drop• Uvula points away from pathologyUvula points away from pathology

• Hoarseness/fixed vocal cordHoarseness/fixed vocal cord• Loss of gag reflex w/ IXLoss of gag reflex w/ IX• Loss of cough reflexLoss of cough reflex





• Jugular Foramen Jugular Foramen

• What does it innervate?What does it innervate?• NeckNeck• Pharynx/LarynzPharynx/Larynz

• Thorax/Abdo Thorax/Abdo




• What if lesioned?What if lesioned?• Horner syndromeHorner syndrome

– Eyelid droop (ptosis)Eyelid droop (ptosis)– Constricted pupil (miosis)Constricted pupil (miosis)– Loss of sweating (anhydrosis)Loss of sweating (anhydrosis)

– Flushed faceFlushed face





• Carotid canal on internal carotidCarotid canal on internal carotidarteryartery

• What does it innervate?What does it innervate?• OrbitOrbit• FaceFace•



What is CN XI?What is CN XI?

• AccessoryAccessory

• What is its function?What is its function?• Turns head to opposite side Turns head to opposite side

– sternocleidomastoidsternocleidomastoid

• Elevates & Rotates scapulaElevates & Rotates scapula– Trapezius Trapezius



Cont. CN XICont. CN XI

• What if lesioned?What if lesioned?• Weakness turning head to opposite sideWeakness turning head to opposite side• Shoulder droopShoulder droop

• Where does it Exit/Enter the Cranium?Where does it Exit/Enter the Cranium?• Jugular Foramen Jugular Foramen

• What does it innervate?What does it innervate?• NeckNeck



What is CN XII?What is CN XII?

• HypoglossalHypoglossal

• What is its function?What is its function?• Moves tongueMoves tongue

• What if lesioned?What if lesioned?• Tongue points toward pathology on Tongue points toward pathology on

protrusionprotrusion



What is CN XII?What is CN XII?


• Hypoglossal CanalHypoglossal Canal

• What does it innervate?What does it innervate?• Tongue Tongue



What are the muscles of What are the muscles of

mastication?mastication?

• Temporalis Temporalis• MasseterMasseter

• Medial PterygoidsMedial Pterygoids• Lateral PterygoidsLateral Pterygoids



What part of the brain dealsWhat part of the brain dealswith problem solving?with problem solving?

• Frontal LobeFrontal Lobe



What happens if there is aWhat happens if there is alesion to the Optic nerve?lesion to the Optic nerve?

• Unilateral BlindnessUnilateral Blindness



What happens if there is aWhat happens if there is alesion to the Optic Chiasm?lesion to the Optic Chiasm?

• Bitemporal HemianopiaBitemporal Hemianopia



What is a Berry Aneurysm dueWhat is a Berry Aneurysm dueto in the Circle of Willis?to in the Circle of Willis?

• SUBARACHNOID HemorrhageSUBARACHNOID Hemorrhage



What is a CLUE forWhat is a CLUE forSUBARACHNOID Hemorrhage?SUBARACHNOID Hemorrhage?

• The worse headache of my life The worse headache of my life



What does the diencephalonWhat does the diencephalonoriginate from?originate from?

• ForebrainForebrain



What originates from theWhat originates from theDiencephalon?Diencephalon?

• Thalamus Thalamus• 33 rdrd VentricleVentricle



Where does the TelencephalonWhere does the Telencephalonoriginate from?originate from?

• ForebrainForebrain– ProsencephalonProsencephalon



What originates from theWhat originates from the Telencephalon? Telencephalon?

• Cerebral HemispheresCerebral Hemispheres• Lateral VentriclesLateral Ventricles



What originates from theWhat originates from theMesencephalon?Mesencephalon?

• MidbrainMidbrain• AqueductAqueduct



What originates from theWhat originates from theHindbrain?Hindbrain?

• MetencephalonMetencephalon• MyerencephalonMyerencephalon



What originates from theWhat originates from theMetencephalon?Metencephalon?

• PonsPons• CerebrumCerebrum



What originates from theWhat originates from theMyerencephalon?Myerencephalon?

• MedullaMedulla



What does the Jugular ForamenWhat does the Jugular Foramencontain?contain?

• CN IXCN IX• CN XCN X

• CN XICN XI• Internal Jugular VeinInternal Jugular Vein• Spinal accessory nervesSpinal accessory nerves



What does the Foramen OvaleWhat does the Foramen Ovalecontain?contain?

• CN V3CN V3



What does the ForamenWhat does the ForamenMagnum contain?Magnum contain?

• Vertebral arteriesVertebral arteries• Brain stemBrain stem

• Spinal roots of CN XISpinal roots of CN XI• Spinal cordSpinal cord



What does the Optic CanalWhat does the Optic Canalcontain?contain?

• Opthalmic arteryOpthalmic artery

• Central retinal veinCentral retinal vein• CN IICN II



What does the HypoglossalWhat does the HypoglossalCanal contain?Canal contain?

• CN XIICN XII• Hypoglossal nerveHypoglossal nerve



What does the Carotid CanalWhat does the Carotid Canalcontain?contain?

• Internal Carotid arteryInternal Carotid artery



What does the PosteriorWhat does the PosteriorCondylar Canal contain?Condylar Canal contain?

• Large Emissary VeinLarge Emissary Vein



What are signs of an UPPERWhat are signs of an UPPERmotor neuron damage?motor neuron damage?

• + Babinski sign+ Babinski sign• Spastic ParalysisSpastic Paralysis

• Hyperactive Deep Tendon ReflexesHyperactive Deep Tendon Reflexes



What are signs of a lowerWhat are signs of a lowermotor neuron defect?motor neuron defect?

• AtrophyAtrophy

• FasciullationsFasciullations• Flaccid ParalysisFlaccid Paralysis• Loss of deep tendon reflexesLoss of deep tendon reflexes



What does it mean to see aWhat does it mean to see aphysis on radiograph?physis on radiograph?

• Means the skeleton is not fullyMeans the skeleton is not fullymaturemature



When does PhysisWhen does Physis

disappear?disappear?• Once growth is completeOnce growth is complete



What is a nonunionWhat is a nonunion

fracture?fracture?• Fracture that does not heal with in 6Fracture that does not heal with in 6

monthsmonths



What does Malunion mean?What does Malunion mean?

• A fracture that heals in an AbnormanA fracture that heals in an Abnormanpositionposition



What is a characteristic featureWhat is a characteristic featureof cancellous (spongy) bone?of cancellous (spongy) bone?

• Trabeculae Trabeculae



Which CN’s control eyeWhich CN’s control eyemovement?movement?

• CN IIICN III– Oculomotor nerveOculomotor nerve

• CN IVCN IV– Trochlear nerve Trochlear nerve

• CN VICN VI– Abducens nerveAbducens nerve

Wh t CN i ibl fWhat CN is responsible for



What CN is responsible forWhat CN is responsible forturning the head andturning the head and

shrugging the shoulders?shrugging the shoulders?

• CN XICN XI– Accessory nerveAccessory nerve

Wh t CN h fib fWhat CN has sensory fibers for



What CN has sensory fibers forWhat CN has sensory fibers forFace and Motor fibers forFace and Motor fibers for

muscles of mastication?muscles of mastication?

• CN VCN V– Tigeminal Nerve Tigeminal Nerve



What CN controls sensoryWhat CN controls sensoryfibers for Visonfibers for Vison

• CN IICN II– Optic nerveOptic nerve



What CN senses fiber forWhat CN senses fiber forsmelling?smelling?

• CN ICN I– OlfactoryOlfactory



What does the MesentericWhat does the MesentericArtery Supply?Artery Supply?

• Distal 1/3 of transverse colonDistal 1/3 of transverse colon

• Descending colonDescending colon• Sigmoid colonSigmoid colon• Upper Portion of RectumUpper Portion of Rectum



What does the SuperiorWhat does the SuperiorMesenteric Artery Supply?Mesenteric Artery Supply?

• DuodenumDuodenum• Jejunum Jejunum

• IleumIleum• CecumCecum• AppendixAppendix• Ascending colonAscending colon• Proximal 2/3 of transverse colonProximal 2/3 of transverse colon



What does the common IliacWhat does the common Iliacartery supply?artery supply?

• PelvisPelvis

• PerineumPerineum• LegLeg



What does the Celiac trunckWhat does the Celiac trunckgive rise to?give rise to?

• Left gastric arteryLeft gastric artery• Splenic arterySplenic artery

• Common hepatic arteryCommon hepatic artery

a o e e as r c



a o e e . as r c.Artery, Splenic Artery, &Artery, Splenic Artery, &Common Hepatic arteryCommon Hepatic arterysupply?supply?

• EsophagusaEsophagusa

• StomachStomach• DuodenumDuodenum• LiverLiver• GallbladderGallbladder• PancreasPancreas

If there is a lesion in the frontalIf there is a lesion in the frontal



If there is a lesion in the frontalIf there is a lesion in the frontallobe will you have motor orlobe will you have motor or

sensory defects?sensory defects?

• MotorMotor

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