Usmle Guide Note

7/21/2019 Usmle Guide Note

1/51

Second Aid: USMLE mnemonics

Thisis a list of medical mnemonics, side-notes, and generalizations I wrote down while

going through m !"#" $irst Aid %oo& while su''lementing with !"#! $alcon, (a'lan,

and a %it of )ol*an+ I sto''ed at around three-uarters of the tet %ecause I got tired andfelt li&e not man 'eo'le would %e interested./Update: sorr, %ut I0m too %us to go

%ac& and t'e the rest1 234+

5+S+ If ou want to find a to'ic fast, I suggest 6trl7$

Varicocele: clin +/- ache(pain) in testicle, feel of heaviness, visbile palpable enlargd

vein. PE bag worsl !ass of enlarged vein that develops in speratic cord. cc

"#-$#% &eft sided varicocele or bilatersl s'spect renal vein throbosis seen in reneal

cell carcinoa or neprotic sndroe

rt ligate of affected speratic vein. ransill'inate negative

hdrocele-fl'id in t'nica vaginalis or if congentinal it is incoplete obliteration

(f'sion)*)of process's vaginalisoe% painless enlarged scrot'. lined to indirecting'inal hernia

pospidiasis-incoplete f'sion of 'rethral folds

ehavioral cience:

Statistical distri%ution:

5ositi8e s&ew 9 me0n2me1ian2m2de

5ositi8e s&ew 9 al'ha%etical from greatest to least

e'orta%le diseases:;It was re'orted that studl Mr+ Shigella ate salmon, chic&en, and li8er;:

;It was E5I)ELLA aT? Salmon, 6hic&en, and Li8er;

ST=s: AI=s, )onorrhea, S'hilis, 6hlamdia /@IB14

MM: Measles, Mum's, u%ella

Shigella

T?

Salmonella

6hic&en 5o >e'atits A, ?, 6

>ealth care 'ament:

6AE for the Elderl, AI= the destitute

Medicare - elderl, Medicaid - low income 'eo'le

Earl de8elo'mental milestones:
http://julieyumi.tumblr.com/post/22267813238/second-aid-usmle-mnemonicshttp://julieyumi.tumblr.com/post/22267813238/second-aid-usmle-mnemonics%22HYPERLINK%20http://tmblr.co/Z_yDayKlGzrshttp://julieyumi.tumblr.com/post/22267813238/second-aid-usmle-mnemonics%22HYPERLINK%20http://tmblr.co/Z_yDayKlGzrshttp://julieyumi.tumblr.com/post/22267813238/second-aid-usmle-mnemonics


2/51

C of %loc&s stac&ed 9 age in ears @ D

! word sentences at !

;'ee at three; triccle at three

;four-suare at four; 9 can ho' at four

drawings:

Do 9 circle

Fo 9 7

Go 9 suare

Ho 9 triangle

See reference

iocheistr:

Sto' codons: U)A, UAA, UA)

U )o Awa, U Are Awa, U Are )one


3/51

E'ress Eons, Itrons are I the wa

5roto-oncogenes:Mi&e0s sis returned with her two new %reasts she was a%le to grow %ecause of her%s+

;MJ60s SIS ETurned with >E!eu %reasts she AS A?Le To-)row ?6l of hE?s+;

Mc

sis

ret

>er!Kneu

ras

a%l

T)$al'ha

%cl!

E?-?#, ?!

6ollagen: The higher the num%er, the smaller and softer it gets

T'e # - bone/s&in4 -


4/51

5rader-Nilli 9 5aternal deletion

AngelMan0s 9 Maternal deletion

)enetics:Autosomal =ominant: ha8e familial or hereditar in name 7

;A ?rain =warf named Marfan 8on >i''el-Lindau hired ME to >unt for 5otatoes+; ?rain 9 eurofi%romatosis#, !

=warf 9 Achondro'lasia

Marfan

8on >i''el-Lindau

ME#, !a, !%

>untingtons

5otato 9 Tu%erous sclerosis

-lin&ed recessi8e:

;=u&e $a%r0s ?rutal )o'her >unter, Lesch, Nas-Actuall a $ragile Al%ino>emo'hiliac+;

=u&e 9 =uchenne0s

$a%r

?rutal 9 ?ruton0s

)o'her 2 )H5her 9 )H5= deficienc

>unter 9 >unter0s

Lesch-han

Nas-Actuall 9 Nis&ott-Aldrich

$ragile

ocular Al%inism

>emo'hilia A, ?

$ragile 9 tra large testes, *aws, ears

$ra)ile 9 c)g trinucleotide re'eat

moTonic dstro'h 9 cTg trinucleotide re'eatAutosomal trisomies: 5at Ed =own 9 #D, #O, !#5u%ert at #D, Election at #O, =rin&ing at !#

=own sndrome is associated with ALL /and AML4 and ALzheimers and decreased

AL'ha-feto'rotein 2 ALL fall =


5/51

6eliac =isease /associated with dermatitis her'etiformis4

Annular 5ancreas

>irsch'rung congenital megacolon /failure of neural crest cell migration: no

Auer%ach or Meissner0s 'leus 2 consti'ationKmeconium ileus4

Edward0s: watch PP %alloons

5atau0s: roc&er %ottom 5edalsKfeet, cleft li'K5alate, holo5rosence'hal /sonic hedgehog

deficienc4, 5oldactl

Nilliam0s sndrome: Nill $arrell in Elf: elfin faces, mental retardation, well-de8elo'ed8er%al s&ills, etreme friendliness

=i)eorge sndrome: 6AT6>-!!

6left 'alate

A%normal facies

Thmic a'lasia /T-cell deficienc4 6ardiac defects

>'ocalcemia /secondar to 'arathroid a'lasia remem%er third 'harngeal

'ouch: inferior 'arathroids are grown with thmus and descend together4

microdeletion at chromosome !!##

Bitamin ?#: Thiamine

Thiamine 'ro'hos'hate /T554 is needed for a num%er of enzmes, %ut is rarel reuiredalone+ Nhene8er ou need ?#, ou usuall need $A= /?!4, A= /?D4, 6oA /?G4, and

Li'oic Acid, so *ust grou' them together: ",$,3,#+&0.Enzmes that use ?#, !, D, G 7 LA:

)lcolsisKT6A: 5=> / 9 lactic acidosis T: &etogenic Leucine, Lsine 7 high

fat diet4

T6A: al'ha()=>

>M5: trans&etolase

%ranched chain AA=> / 9 Ma'le Sru' Urine =isease 2 se8ere 6S defects,

M, and death4

elated 'ro%lems:

Li'oic acid is antagonized % Arsenic, which causes rice water diarrhea and garlic

%reath+

?# deficienc in alcoholics 2 Nernic&e-(orsa&off, %eri%eri

5=> deficiencKdsfunction 2 ina%ilit to continue T6A 2 di8ersion to lactic

acidosis %rain star8es for energ 2 neurologic defects+ To &ee' %rain from

star8ing, T with &etogenic amino acids LEU6IE and LJSIE and high fat diet/%eta oidation of fats will 'roduce acetl 6oA 2 T6AK&etogenesis4+
http://www.youtube.com/watch?v=th6Njr-qkq0http://www.youtube.com/watch?v=th6Njr-qkq0


6/51

Bitamin ?H: 5ridoine

Ma*or 'athwas that use ?H:

)lcogenolsis LS: )lcogen 2 )#5 8ia glcogen 'hos'horlase

>eme snthesis LS: Succinl 6oA /T6A4 7 )lcine 2 delta aminole8ulinic acid

/ALA4 8ia deltaaminole8ulinic acid snthase

6steine snthesis: >omocsteine 7 Serine 2 6stathione 8ia 6stathione snthase

/ 9 homocsteinuria: Marfanoid S7M7atherosclerosis4

ote: 6stinuria due to 56T rea%sor'tion defect 2 staghorn cstine &idnestones T: acetazolamide to al&alinize urine

ALTKAST transamination:

Alanine7al'ha()/T6A43ALT25ru8ate/glcolsis47glutamateAs'artate/Urea ccle47al'ha()/T6A43AST2lmalonl6oA 2 Succinl 6oA 8ia methlmalonl6oA isomerase

homocsteine 7 -MET>lT>$ 2 MET>ionine 7 T>$ 8ia homocsteinemethltransferase

A%sor%ed in the ileum /6rohn0s, gastric %'ass, s'rue, =i'hllo%othrium latum4 with I$

/'ernicious anemia4 use Schilling test to determine if it0s inta&eKa%sor'tion or lac& of I$

'ro%lem+ ?#! stores last for JEAS+ =eficienc causes an increase in methlmalonic

acid /'eri'heral neuro'ath4 and homocsteine /megalo%lastic anemia4+


7/51

A8idin in egg-whites A8idl %inds ?Q+

Bitamin 6: Ascor%ic Acid

Iron a%sor'tion and $e!7 state maintenance

6ollagen snthesis: hdrolation of 'roline and lsine within fi%ro%last E 3

S6UBJdo'amine 2 E 8ia do'amine %eta hdrolase, %loc&ed % eser'ine

Bitamin =: the longest name with a #: /#,!G-/4!=D4 6alcitriol 9 acti8e form /Pstimulates con8ersion of li8er0s !G8itamin = to #,!G-/4!=D in idne% "alphahdro4lase4

Bitamin E: E is for Erthroctes it0s an antioidant that 're8ents hemoltic anemia andneurodsfunction

Bitamin (: in*ect new%orns with it to ma&e sure the0re o( /'re8ent hemorrhage4deficienc 9 normal %leeding time, %ut increased 5T and a5TT

ote:

'latelet dsfunction 2 ?T

etrinsic /shorter4 'athwa 2 5T /shorter name4 BII monitor wK Narfarin

intrinsic /longer4 'athwa 2 5TT /longer name4 monitor wK >e'arin

6ar%amol 'hos'hate snthetase: U5 #, !+

Urea ccle LS: 65S"

Primidine snthesis LS: 65S$

>M)6oA RRR:

;Jou alwas want to E=U6E our 6>M)6oA snthase 9 &etogenesis /our %rain wants to SJT>ESIE

(ETM5 shuntK5entose 5hos'hate 5athwa:

)H5 2 i%uloseG5 7 !A=5> 8ia LS )H5=>


8/51

i%uloseG5 2 i%oseG5 2 'urine snthesis

A=5>:

fatt acid and steroid snthesis

oidati8e %urst /A=5> oidase 9 6hronic )ranulomatous =isease4

'FG"

glutathione reductase A(A ?6 antioidation

)H5= deficienc 9 /-r4 2 no A=5> 9 no glutathione reductase 9 oidati8e damage

9 hemoltic anemia /%ite cells - ?6s 'artiall eaten % macro'hages /M"0s4, >einz

%odies - oidized >% that 'reci'itated in ?6s4

=rugs that cause hemoltic anemia in )H5= deficienc:;5rima had to ta&e As'irin when she I>aled her I+?+5rofessor =a'sone0s Sulfurous

$a8a %ean itro$arts+;

5rima 9 5rimauine

As'irin

I> /Isoniazid4

I+?+5rofessor 9 I%u'rofen

=a'sone

Sulfurous 9 Sulfonamides

$a8a %ean

itro$arts 9 itrofurantoin

6)= /chronic granulomatous disease, =: negati8e itro%lue tetrazolium reduction4 9

A=5> oidase deficienc 2 susce'ti%le to 6atalase7 organisms:;The recoiling ed As' wasn0t Sorr towards the moaning 6at %ecause it had oheart+;

recoiling 9 E+coli

red 9 Serratia

As' 9 As'ergillus

Sorr 9 S+ Aureus

moaning 9 5seudomonas

6at 9 6atalase 7 organism

o>eart 9 ocardia

=isorders of RR meta%olism:RR-&inase is the enzme that immediatel follows the %rea&down of RR:

)lucose 2 )H5 8ia )luco/>eo4&inase

$ructose 2 $#5 8ia $ructo&inase


9/51

)alactose 2 )al#5 8ia )alacto&inase

=eficiencies of $ructo and )alacto&inases causes MIL= sm'toms /res'ecti8e sugars are'resent in urine4+ The SEcond ste's cause SE8ere sm'toms /Aldolase? and Uridl

transferase, res'ecti8el4+

Natch out when ou see AL= /6ATAA6TS4

ote: Sor%itol 2 $ructose 8ia Sor%itol=>

)alactose 2 )alactilol 8ia Aldose eductase 7 A=5> /6ATAA6TS4

$ructose#5 2 )lceraldehide and =ihdroacetone5 8ia Aldolase ?

/$U6TEJLALAIE/$4, Isoleucine/I4,

Leucine/L4, Methionine/M4, >istidine/>4, TJ5TA/N4, A)IIE/4,

LJSIE/(44

egati8el charged amino acids:

egati8e e'erience to %e %urned % Acid:

As'artic acid and glutamic acidote: As'artate and )lutamate /as -acetl glutamate4 are in8ol8ed in Urea ccle

elimination of ammonia

Amino acids with three titrata%le >7:ic& 6an0t >ate E=

(J 6 > E=

Arginine/4 - #!+G

Lsine/(4 - #"+G

Trosine/J4 - #"+#

6steine/64 - O+!

>istidine/>4 - H

As'artic acid/E4 - F+D

)lutamic acid/=4 - D+Q

The num%ers aren0t im'ortant ece't for >istidine+ ust &now the order and that it goes in

descending '>0s+ $JI: 6


10/51

Urea ccle enzme deficienc 2 decreased T6A intermediates 2 T6A I>I?ITIJ5EAMMF7 ecretion4+

S: asteriis, slurred s'eech, somnolence, %lurr 8ision, 8omitingT: less 'rotein in diet 7 ?enzoateK5henl%utrate /%ind a+a+2ecrete4

drolaseKBit6, %loc&ed % eser'ine42 6E

/5MTKSAM42Epinephrine

rptophan/ in >artnu'0s4:

/?H42 6iacin732 601+/601P+/ 9 5ellagra4

/?>F42 erotonin2 !elatonin/slee'4

Lsosomal storage diseases:

Ta-Sa 9 >eosaminidase A 2 incr )M!: no he'atos'len cherr macula,

onion s&in lsosomes

;$a%-)al is into 6eramics;

$a%r0s 9 al'ha)ALactosidase A 2 incr 6eramide triheose: 'eri'heral

neuro'ath, angio&eratoma, 6BKrenal disease

;)auched out m femur when I was on a sugar high;

)aucher, $emur ecrosis, Sugar >igh 9 )luco6ere%rosidase

)aucher0s 9 %eta)lucocere%rosidase 2 incr glucocere%roside: ase'tic femurnecrosis, he'atos'lenomegal, crum'led tissue 'a'er cto'lasm

?lind Intelligent Intergalactic 6ra%

Intelligent Intergalactic 9 )alactocere%roside(ra%%e0s 9 )alactocere%rosidase 2 incr galactocere%roside: %lindness,

'eri'heral neuro'ath, de8elo'mental dela, glo%oid cells


11/51

iemann 5ic&0s his nose with his'hinger

iemann-5ic& 9 S'hingomelinase 2 incr S'hingomelin: cherr macula with

he'atos'lenomegal, neurodegeneration, foam cells

;Sulfur tides are multicolored;

Sulfur tide 9 Sulfatide

Multicolored 9 MetachromicMetachromic leu&odstro'h 9 Arl sulfatase A 2 incr Sulfatides: central and

'eri'heral demelination with ataia, dementia

Muco'olsaccharidoses:

>urLer0s 9 al'ha-L-iduronidase 2 incr he'aran sulfate, dermatan sulfate:

corneal clouding, gargolism, airwa o%struction

>unter0s 9 iduronate sulfatase 2 incr he'aran sulfate, dermatan sulfate: utchinson0s teeth 7 Mul%err Molars 7 frontal %ossing4


13/51

Maternal =ia%etes: h'erglcemia 2 incr fetal insulin 2 decr lung

de8elo'ment 9 can0t %reathe mermaids also can0t %reathe air 2

maternal dia%etes causes A=s and sirenomeliaKanal atresia /also, trans'osition ofgreat 8essels4

Um%ilical cord:

Allantois: ! arteries, # 8ein /arteries is ! as long as 8ein4

Allatois /urachus42 media um%ilical ligament

Um%iLical arter 2 mediaL um%ilical ligament

Um%ilical 8ein - ligamentum teres he'atis

Allantois 2 Urachus /w&D4: urachus failure to o%literate 9 %ladder to na8el connection:

um%ilical urination or %ladder out'ouching


14/51

6left 9 ectoderm /Veternal hollow s'aces4

Arches 9 mesoderm /Vmuscles4

5ouches 9 endoderm /Vimmune organs a%o8e the nec&4

?ranchial 6LE$T - ectoderm: Veternal hollow s'aces

6left #: eternal auditor meatus

6lefts !-F: tem'orar cer8ical sinus /fail to o%literate 9 lateral nec& %ranchial cleft

cst4

?ranchial cleft cst /lateral nec&4 8s Throglossal duct cst /midline nec&, mo8es withswallowing %ecause attached to tongue4

?ranchial A6> - mesoderm: Vmuscles

The ner8es that su''l the %ranchial arches are all ? motor and sensor:;Some/I4 Sa/II4 Marr/III4 Mone/IB4 ?ut/B4 M/BI4 ?rother/BII4 Sas/BIII4 ?ig/I4

?rains/4 Matter/I4 Most/II4; /S 9 sensor, M 9 motor, ? 9 %oth4

@@L MUS6LES MA(E U5 N>ATA6>@@ or use the following mnemonic:

;6hewing made me grimace so I swallowed, cho&ed, then called for hel'+;

chewing 9 arch # /B!,D4 9 muscles of mastication, ant+ !KD tongue 7

malleusKincusKtensor tm'ani

grimace 9 arch ! /BII4 9 facial e'ression 7 sta'esKsta'edius /defect 9 Treacher

6ollins0 mandi%ular h'o'lasia and facial a%normalities4

swallowed 9 arch D /I49 stlo'harngeus /defect 9 fissure from nec& to tonsils4

cho&ed 9 arch F /, su' larngeal49 'harngeal constrictors and cricothroid

called for hel' 9 arch H /, inf larngeal49 intrinsic larn muscles ece'tcricothroid

ote: Arch FWH ma&e u' 'ost+ #KD tongue

?ranchial 5 - endoderm: Vimmune organs a%o8e the nec& 7 middle ear

5ouch # 9 auditor tu%e, middle ear, mastoid air cells

5ouch ! 9 tonsils and tonsillar sinus

5ouch D 9 inferior 'arathroid 7 thmus /the descend together4

5ouch F 9 su'erior 'arathroid 7 'arafollicular 6 cells of throid

$ailure of Drd and Fth 5ouch 9 =i)eorge0s: no thmus /9 T cell deficienc4, no'arathroids /9 h'ocalcemia 2 tetan4

;6D, F, G &ee's the dia'hragm ali8e+;

(idne em%rolog: main 'laer 9 Metane'hros:

Ureteric ?ud 9 ureter2'el8is2collecting ducts


15/51

Metane'hric Mesenchme 9 glomerulus2=6T

=efecti8e ureteric %ud 9 renal agenesis ?KL renal agenesis 2 oligohdramnios 25otter0s: 'ulmonar h'o'lasia 7 faceKlim% deformities

@@M6 site of o%struction 9 Uretero'el8ic *unction with &idne 2 fetal hdrone'hrosis

)enital em%rolog:

Male 9 Mesone'hric

5emale 9 5aramesone'hric

;Men are Nol8es; 9 ;Nolffian ducts; 2 ;SEBE; in ;SEBE U5; /Seminal

8esicles, E'ididmis, Bas deferens, E*aculator duct, 9 nothing4

;Nomen Mull o8er 'ast arguments; 9 ;Mullerian ducts; 2 fallo'ian tu%es,

uterus, and u''er #KD of 8agina /lower !KD from urogenital sinus of endoderm4

$emale 9 default genitals

>ormone o8er8iew: 5rolactin stimulates =o'amine inhi%its 5rolactin

5rolactin inhi%its )n>

)n> 2 incr $S>, L>

L in L> and Ledig: L> stimulates Ledig cells to 'roduce testosterone 2

de8elo' Nolffian duct

S in $S>, Sertoli, and S'erm: $S> stimulates Sertoli cells to 'roduce S'erm,

Inhi%in, and Mullerian inhi%iting factor /MI$4 MI$ inhi%its female'aramesone'hric duct de8elo'ment

)enital homologues:

Urogenital sinus:

ul%ourethral glands 9 artholins greater 8esti%ular glands

'rotate gland 9 &ene urethral and 'araurethral glands

Etro'h of %ladder is associated with E'is'adias /fault 'ositioning of genital tu%ercle4

8s+ >'os'adias 9 more common, failure of urethral fold closure, incr ris& of UTI

!icrobiolog:

Enca'sulated organisms: /7Xuellung reaction: uell ma&es ca'sules swell4

;6laustro'ho%ic 5astor Salmon Echoed ?ac&: Jersinful 6r't-dar& Stri' 6lu%s are5seudo->omes to ice Men $rancis and ?ruce+;

6laustro'ho%ic 9 6lostridium

5astor 9 5asturella

Salmon 9 Salmonella

Echoed 9 E+coli


16/51

?ac& 9 ?acillus anthracis /=-glutamate4

Jersinful 9 Jersinia

6r't-dar& 9 6r'tococcus /India In&, narrow-%ased %udding in meningitis4

Stri' 9 Stre'tococcus

6lu%s 9 (le%siella

5seudo 9 5seudomonas

>omes 9 >aemo'hilus

ice men 9 eisseria meningitidis

$rancis 9 $rancisella

?ruce 9 ?rucella

;?A=; - acillus 0nthracis0 uniue ca'sule contains 1-glutamate

;Staff of gra'es; 9 Sta'hlococcus is in clustersBS+ Stre'tococcus 9 'airsKchains

S'irochetes: S'iraling ?oris Le't then Tri''ed

S'iraling 9 S'irochetes

?oris 9 ?orrelia /)iemsa stain 9 aniline de rela'sing fe8er 9 result of antigenic

8ariation4

Le't 9 Le'tos'ira

Tri''ed 9 Tre'onema /=ar& $ield Microsco', B=L cardioli'in screening,

$TA-A?S confirmation4

Mco'lasma 8s Mco%acteria

?acteria ha8e cell walls /Mco%acteria ha8e mcolic acid in their cell walls that

stain acid-fast4

5lasma mem%ranes ha8e sterols /Mco'lasma ha8e sterols and no cell wall4

Stains:

)iemsA stains ?orreliA, MalariA, 6hlamdiA, Tr'anosomA

5ASs the sugar and whi' cream /5AS stains glcogen and = Nhi''le0s disease4

;Legions who Sustained in*uries get Sil8er stars;: Legionella, grow with 6steine,

sil8er stain water source

S'ecial 6ulture:

;ice >omes ha8e chocolate;: eisseria and >aemo'hilus grow on 6hocolate

agar 7:

eisseria 9 Thaer Martin media: Bancomcin /8s )74, 5olmin /8s

g-4, statin /8s fungi4


17/51

>aemo'hilus 9 B /A=74 and /hematin4

;If I Tell-U the 6orn *o&e ight, ou0ll Laugh;:

TellUight 9 tellurite agar

6orn 9 6orne%acterium

Laugh 9 Lofflers media

;T? and ;: M+ tu%erculosis on lowenstEI-ensen agar /ta&es D-F wee&s to grow,

%ut diagnostic4


18/51

Tum%le 9 Listeria

In 9 intracellular

M 9 Mco%acterium

ote: intracellular 'athogens reuire cell-mediated immunit /6MI4, so neonates are at

ris& /E+)+, Listeria 2 neonatal meningitis: tum%les, has endotoin, and a narrow zoneof %eta hemolsis4

?acterial 8irulence factors:

'rotein A for sta'h+ Aureus: %inds $c of Ig to 're8ent o'sonization and

'hagoctosis

M 'rotein /'re8ents 'hagoctosis4 2 stre'+ 'ogene0s rheuMatic fe8er /S:

su%cutaneous 'laues, 'olarthritis, erthema marginatum, chorea, carditis4

IgA 'rotease /to colonize res'irator mucosa4 7 anti'hagoctic ca'sule /infects

0P&E6;9'atients %Kc decr M" and IgMKcom'lement 6D acti8ation /E+)+,

Sic&le 6ell autos'lenectom44 7 causes meningitis 9 S>iote: can also undergo transformation /'ic& u' =A from en8ironment4

tre' 'neumo

+ influenza t'e ? /? 'olsaccharide4

6eisseria meningitidis

Eotoin 8s Endotoin:

Eotoin 9 from Eogenous source /'lasmid or %acterio'hage4 and Ecreted

from %acteria, Etremel toic /e8en small dose4, Eact effects /different toins'roduce different sm'toms4 Vheat-la%ile

E=


19/51

e'losi8e release of I$gamma and IL! /non-s'ecific immune res'onse4:

S+ aureus 9 TSST-# 2 Toic Shoc& Sndrome /fe8er, rash, shoc&4

S+ 'ogenes 9 Erthrogenic toin 2 Scarlet fe8er with Toic-Shoc&-li&e

sm'toms

ote: S+ 'ogenes also has Stre'tolsin < /lses ?64 =: heumatic $e8erwith anti-Stre'tolsin-< anti%od /ASE6 "#GQ:>Q - clea8es host cell rAKinacti8ates H"S also,

incr cto&ines 2 >US

otulinum toin - inhi%its A6h 8esicle release from 'resna'tic neuron 2

flaccid 'aralsis

9holera toin - acti8ates )s 2 incr cAM5 2 incr 6l- secretion into gut 9 decr

a7 a%sor'tion 2 water diarrhea

1i'theria toin - A=5-ri%oslating A-? toin /li&e 5seudomonas eotoin A4 - ?

%inds, A enters and ri%oslates E$! 2 no more 'rotein snthesis 2 cell death'seudomem%rane formation

Erthrogenic /su'erantigen4 toin of Stre'+ 'ogenes 2 Scarlet $e8er -

acti8ates %oth T>#/6=F4 and M>6II 2 incr I$gamma 7 IL! 2 incr M" andT-cell non-s'ecific immune res'onse 2 VToic Shoc&

)ram 5ositi8es: crstal 8iolet 7 iodine 9 %lue

6oag negati8e Sta'h: SEsiti8e: ta'h+ E'i 9 6o8o%iocin SESITIBE /BS+

Sta'h+ sa'ro'hticus 9 o8o%iocin resistant4

al'ha hemoltic Stre':


20/51

E'osureK5IMAJ T?:

)hon com'le 9 )hon focus of Ls pil's protein undergoesantigenic variation114

ote:-+ meningitidis 9 res'iratorKoral s'read 2 meningococcemia and Naterhouse-

$riderichsen adrenal hemorrhage /h'otension and =I64

-+ gonorrhea 9 ST=2 high fe8er, se'tic arthritis, neonatal con*uncti8itis, 5I=,$itz->ugh-6urtis /cer8icitis2sal'ingitis2li8er ca'sule infection4

Entero%acteriae: 6A5SULE 9 BIULE6E $A6Te&toen Agar4 7 motile /flagellar > antigen4:

5roteus /swarming, urease7, staghorn ammonium stru8ite stones4,

Salmonella

ote: Salmonella and Shigella %oth in8ade mucosa 2 %lood diarrhea

Salmonella is motile /wK $ flagellar antigen variants4 and 'roduces >!S,

S+ t'hi of T'hoid fe8er causes a%dominal rose s'ots and can remain

chronicall in gall%ladder Shigella is more 8irulent, mo8es % actin'olmerization and H"S deacti8ating toin induces >US+

oidase 7 organisms: when ou go 6am'ing at a uiet 5asture ou0d Moan More with

ice Bi%rators

6am'ing 9 6am'lo%acter

5asture 9 5asturella

Moan 9 5seudomonas

More 9 Moraella

ice 9 eisseria Bi%rators 9 Bi%rio

B=L false 'ositi8es: B=L

B 9 8iruses: E?B, he'atitis

= 9 drugs

9 heumatic fe8er /= wK S+ 'ogenes AS< titers4


21/51

L 9 Lu'us and Le'ros

6hlamdia: = 8ia )iemsa stain /6hlamdiA, MalariA, ?orreliA 7 Tr'anosomA4

Elementar %od is Enfectious and Enters cells 8ia Endoctosis

eticulate %od e'licates in cell % fission

;Tric& =ic&;: 8;99 serot'es 1?@:

2 M6 5I=, cer8icitis, ecto'ic 'regnanc

2 $itz->ugh-6urtis li8er ca'sule infection /from s'read of 5I=4 7

8iolin string adhesions of 'arietal 'eritoneum to li8er

2 neonatal 'neumonalKcon*uncti8itis

2 8E;E8>: 6an0t see, can0t 'ee, can0t clim% a tree 9

con*uncti8itis, urethritis, arthritis

BS+ tr09hoa9 serot'es A-6 2 blindness

BS+ L#-LD 9 &phogran'loa vener': ulcers 2 lm'hadeno'ath, rectalstrict'resmista&en for 5I=

T: mothers and infants with 6hlamdia with Erthromcin estolate, though there

is a ris& of maternal acute cholestatic he'atitis

At'ical /wal&ing4 'neumonias: M 6lamm Legion wal&ed T: macrolides

M 9 Mcoplasa/IgM 9 cold agglutinins 2 agglutinate or lse ?6s grown

on Eaton0s agar T: tetraccline or macrolide4

6lamm 9 6hlamdia /T: tetraccline or macrolide4

Legion 9 Legionella /T: macrolide4

$ungi:

=imor'hic: cold 9 mold, heat 9 ea/s4t 7 ?last >is 6oc& 9 East 6oast to Nest 6oast/T: (etoconazole4

?last 9 ?lastomcosis 9 east of Mississi''i i8er

>is 9 >isto'lasmosis 9 Mississi''i i8er and is Nood'ec&er ?lasted Nood into =ust;:

>is Nood'ec&er 9 >isto'lasmosis from %irdK%at dro''ings 9 macro'hage filled

with round east >isto >ides within macro'hages

?lasted Nood 9 lastomcosis in wood 9 road-ased-udding fungi the

handle of a base%all bat loo&s li&e it0s budding off the shaft4

=ust 9 6occidiomcosis 9 large s'herule filled with endos'ores %arrel-sha'ed

arthroconidia 9oc& is filled with 'erm, 9occidio is filled with 'ores

Actinomces 9 Acute Angles, Se'tate


22/51

/BS+ MucormcosisKhizo'us 9 Nide angles, non-se'tate Vin =ia%etics4

>elminth drugs:

Norms 9 ?endazole

5raziuantel 9 foods: 5or&, $ish, 6ra%, Snails

5or& 9 Taenia

$ish 9 =i'hllo, 6lonorchis

6ra% 9 5aragonimus

Snails 9 Schistosoma

Antigenic shift 8s+ drift: S5E=

Shift /reassortment 8ia segmented 8iruses4 9 5andemic

E'idemic 9 =rift /random mutations4

Baccines: Li8e: See MM+ Sa%in0s small ellow chic&ens li8e+

MM 9 Measles, Mum's, u%ella

Sa%in /5olio, oral4

small 'o

ellow fe8er

chic&en 'oKshingles

(illed: I5 Alwas

a%ies

Influenza

5olio /Sal( 9 (illed, in*ected4

Adeno8irus

ecom%inant: >RB

Norms 9 ?endazole

5raziuantel 9 foods: 5or&, $ish, 6ra%, Snails

Biruses:=A 8iruses: ee Po5a 5arAde: first three 9 en8elo'ed

>e 9 >er'es

>e 9 >e'a=A />?B carries s'ecial T: =Ad=A'4

5o 9 5o /small'o, molluscum contagiosum carries =AdA' and re'licates

in cto'lasm4


23/51

5a 9 5a'illoma />5B: /H,##4: condlomata acuminataKgenital warts,

&oiloctes9suamous cell with 'erinuclear cto'lasmic halo /#H,#O4: 6I anal

suamous cell 6A4 7 5oloma /6, 5ML demelinating ence'halo'ath4

5ar 9 5ar8o 9 ?#PKErthema infectiosum /ss=A4

Ade 9 Adeno8irus /swimming 'ool con*uncti8itis, gastroenteritis4>er'es: ! Sim'le 6hic&ens ?arred Sight from ose 5atches

! Sim'le 9 >SB#,!

6hic&ens 9 >>BD: 6hic&en 'o /truncal rash 2 etremities lesions of different

age4Kshingles

arred 9 >>BF: EB /mono, ur&itt0s, large cell non->odg&ins Naldeer0s

ring, naso'harngeal 6A, hair leu&o'la&ia on lateral tongue infects cells 8ia

91$"-E?B rece'tor4

Sight 9 >>BG: 6MB /retinitis, negati8e mono-s'ot mono, T %oth

intranuclear owl-ee and cto'lasmic inclusion %odies4

ose 9 >>BH: oseolaKErthema su%itum /high fe8er 2 rash4

5atches 9 >>BO: (a'osi-sarcoma

A 8iruses:

7A 9 5io5la9o6a: middle D 9 en8elo'ed

5i 9 5icoA 9 5E6onA:

5 9 5olio /%oth colonizes naso'harn and causes meningitis li&e >i% 2

malgia and 'aralsis4

E 9 Echo8irus: swimming 'ool ase'tic meningitisKmocarditis

6 9 6osac&ie: ase'tic meningitisKmocarditis, hand-foot-mouth /'alm

and sole 8esicular rash also seen in secondar s'hilis and ic&ettsial

oc& Mountain S'otted $e8er4

n 9 >I


24/51

ellow fe8er causes ellowing s&in /*aundice4 and %lac& 8omit

6o 9 6orona /common cold, SAS4

6a 9 6alici 9 orwal&, 6A 6ruises /gastroenteritis from cruises4

-A 9 all en8elo'ed 7 AdA'ol

eo8irus 9 dsA, segmented: e'E8irus 9 >EB /water e'idemic, onl dangerous if 'regnant4

of 'urine snthesis AE: hemoltic

anemia, teratogen4 or SB5 Liz where 5 Liz 9 5ali8izuma% which%inds 5aramo $ 'rotein, 're8enting res'irator e'ithelial snctia

formation

M! 9 Measles and Mum's:

Measles: A 5AA U?J weasles caught SS5Ecial Measles 9

'aramo, ru%eola, SS5E com'lication, Measles0 D 60s 9 cough,corza, con*uncti8itis 7 (o'li& s'ots rash from head down li&e

u%ella

Mum's: 'arotitis, orchitis, ase'tic meningitis

Segmented 8iruses: ?anta hemorrhagic fe8er4

< 9 AB 9 5icorna /7A4 fecal-oral /ice cu%es, shellfish4

>?B 9 >e'a=A /en8, ds=A4 %lood /renal dialsis, needle stic&4, se, mother

=: 56

>6B 9 $la8i /en8, 7A4 %lood /IB=A, transfusion4 =: T-56

>=B 9 =elta /defecti8e en8, -A4 infects with >?B

>EB 9 >e'E8irus /7A4 fecal-oral /water e'idemic4

To6>S: he'atos'lenomegal, *aundice, throm%octo'enia, growth retardation


25/51

T 9 Too'lasma: TooTriad: intracranial calcifications, chorioretinitis,

hdroce'halus 9 SAME TIA= AS 6MB11 from cat feces, ring-enhancing %rain

a%scess4 T: Sulfadiazine75rimethamine

9 u%ella /Toga8irus, 7A4: 5=A, cataracts, deaf, %lue%err muffin rash

maternal rash and arthritis

6 9 6MB: Too'lasma triad /intracranial calcification, chorioretinitis,

hdroce'halus4 7 UILATEAL hearing loss, seizures

> 9 >SB /7>IB4: tem'oral lo%e ence'halitis, her'etic lesions /fingers4

S 9 S'hilis: hdro's fetalis still%irth 2 >utchinson teeth, saddle nose, sa%er shins

ote: ?#P also causes hdro's fetalis

?actericidal drugs /all else 9 %acteriostatic4: Se'hiroth Met Bancou8er 5en'al Amina in$lorida, then (ILLE= >E =:

Se'h/iroth4 9 6e'halos'orin

Met 9 Metronidazole

Bancou8er 9 Bancomcin

5en'al 9 5enicillin

Amina 9 Aminoglcosides

$lorida 9 $luorouinolones

Antimicro%ial drugs:

inhi%its 5) cross-lin&ing 2 no cell wall: 6e'h 6hills-in Zam watching 5)mo8ies:

6e'h 9 6e'halos'orin

6hills-in 9 Zcillins /%inds 5?5, %loc& trans'e'tidase cross-lin&ing 5enicillin 9

endocarditis 'ro'hlais /%efore surgerKdental4, s'hilis 'ro'hlais4

[am 9 AztreoAM /%inds 5?5D for 5encillin-allerg 'ts 8s SEE(5seudomonas- Serratia, E+coli, Entero%acter, (le%siella, 5seudomonas4,

Mero'eEM and Imi'eEM76ilastatin /Mer'enemKImi'enem 8s+

e8erthing, es'+ Entero%acter, %ut causes SEIUES 6ilastatin inhi%itsrenal dihdro'e'tidase I to inhi%it renal tu%ule Imi'inem inacti8ation4

%loc&s 5) snthesis:

?acitracin /8s+ S+ 'ogenes /)AS44Bancomcin /%inds =-Ala-=-Ala and interferes with 5)-elongating

transglcoslase

8s+ resistant )7 inc, !80 and 9.diffAA

;T


26/51

8s+ g- % disru'ting cell mem%ranes: 5olmins /neos'orin4 - detergent 8s cell

mem%rane AE: neurotoicit, acute renal tu%ular necrosis

8s+ )7Kg- % %loc&ing folate 2 no nucleotide snthesis /megalo%lastic anemia4:

Sulfonamides /com' inhi%it 5A?A for dihdro'teroate snthetase 2 no

=>$ snthesis AE: infant &ernicterus /a8oid in 'regnanc4, S,ne'hroto, )H5= hemolsis4

Sulfamethoazole-Trimetho'rim /TM5-SM4 8s UTI, 5+ *iro8ecii

'ro'hlais in AI=S

Sulfadiazine75rimethamine 8s Too'lasma

Sulfadoin75rimethamine 8s Malaria

Trimetho'rim, 5rimethamine /=>$dihdrofolate reductase2T>$ li&e

Methotreate4

8s+ UIs /S+ 'neumo4, UTIs, )ITIs, and 5seudomonas % %loc&ing to'oII /=A

grase4 and IB: $luorouinolones /AE: cartilageKtendon ru'ture, incr XT, )H5=

hemolsis4

8s+ Mco%acterum, 'ro'hlais for >i% and +men % %loc&ing =AdA' 9 no

transcri'tion: ifam'in

5rotein snthesis inhi%itors: Xuinn get in Line and ta&e G"M60s to D"ST:

Xuinn, Line G"M60s 9 Xuin-=alfo, Linezolid, Macrolides,

6hloram'henicolK6lindamcin %loc& G"S

Xuin-=alfo /stre'togramins4: Xuinu'ristin 're8ents elongation,

=alfo'ristin changes G"S conformation for %etter Xuin-%inding

Linezolid: %inds G"S 5-site and %loc&s Q"S assem%l

T: Xuin-=alfo and Linezolid is good for ALL ESISTAT?A6TEIA: BE, MSA

MA6rolidEs /A6Emcin 9 Azithro, 6larithro, Erthromcin4:MacroLI=Es 're8ent sLI=ing of mA 9 inhi%it translocation

% %inding to !DS of G"S

T: 5US - at'ical 5neumonia, UI0s, ST=s

AE: 5+ flu, + men, Stre'+'neumo4 AE: a'lastic anemia and gra %a% resistance 8ia

A6ETJLATI


27/51

AE: 5seudomem%ranous colitis li&e Am'icillin

D"ST 9 Stre'tomcin /aminoglcosides4, Tetraccline %loc& D"S

;Amina didn0t hear the )ATS %ecause she was %us reading;:

Aminoglcosides /)ATS 9 )enta, eo, Ami&acin, To%ra, and

Stretomcins4 cause ototoicit /and ne'hroto4 and act % %indingto #HS and causing mA misreading 8s+ g- rods EXUIES

U5TA(E so ineffecti8e against anaero%es resistance 8ia

modification of D"S /acetlation, etc4

etracclines %loc& A from %inding A-site and discolors

eethK%ones

caion-chelator, do ?edoom - Bi%rio, acne, 6hlamdia,urea'lasma, urealticum, Mco'lasma 'neumonia,Tularemia, >+ 'lori, ?orrelia, ic&ettsia

resistance 8ia decr u'ta&e, incr e'ort

EL5S &ill5seudomonas with Sul%actamK6la8ulanic acid /%eta lactamase inhi%itor4:

> 9 >aemo'hilus

E 9 E+ coli L 9 Listeria

5 9 5roteus

S 9 Salmonella

ote: Am'icillin 9 intra'artum in*ection, )?S 'ro'hlais

;T65 Ta&es 6are of 5seudomonas;:

Ticarcillin

6ar%enicillin

5i'eracillin

6e'halos'orins:

#st generation /cefa4: )7 7 5Ec(: 5roteus, E+coli, (le%siella

!nd generation /fur fo fo0tetan4: )7 7 >E-5Ec(S: >aemo'hilus,

Entero%acter, eisseria, 5roteus, E+ coli, (le%siella, Serratia

;$ur ca'; - 6efuroime for 6ommunit Acuired 5neumonia


28/51

;Linda ?rought a $ragile $o fo0Tito; - 6lindamcin, ?+ fragilis,

6efuroime, 6efotetan

Drd generation /tri ta taz4: Meningitis, )onorrhea, T'hoid fe8er

/Salmonella4

6eftriaone 9 C# 6efTAidime is for 5seudomonas li&e TAo%actam75i'eracillin /%ut

causes neutro'enia4

Fth generation /6efe'ime4 9 )7 7 'seudomonas

Metronidazole: forms toic meta%olite that damages =A T: )ET )A5 on theMET+ 5lori /7 %ismuth 7 amoicillinKtetraccline4

Anti-T?: I>-S5IE: AE: he'atotoic

I> 9 Isoniazid /inacti8ates mcolic acid snthesis enzmes enol-acl carrier

'rotein reductase /InhA o8ere'ression 9 resistance4 and

%eta&etoaclA65snthase /(asA4 (at) gene encodes catalase 'eroidase that

acti8ates I>4 solo-T? 'ro'hlais AE: he'atotoicit, neurotoicit /'re8ented

% ?H4, drug-induced lu'us /anti-histone A%4 S 9 Stre'tomcin /aminoglcoside 8s D"S mA reading4

5 9 5razinamide - acti8e in acidic '>, inhi%its mco%acterial growth in M" AE:

h'eruricemiaKgout

/I 9 I>4

9 ifam'in - inhi%its =A-dA' 9 no transcri'tion /ra'id resistance4 A=

%loc&s 'ac&aging and assem%l of 8iruses induces c'FG" 'ro'hlais for +

men and >i% AE: red secretions, sto' thera' with 'ur'ura, %one marrow

su''ression

E 9 Etham%utol - AE: o'tic neuro'ath /red green color%lindness4

Antifungal:

Am'hotericin ?:

Am'hoTEAicin TEAS holes in fungal mem%rane /%inds ergosterol and

forms 'ores4

Am'hoTEi%le: AE: fe8erKchills, h'otension, ne'hroto, arrhthmia,


29/51

anemia, IB 'hle%itis

Anti8iral:

;AM! cure A $LU; 9 0mantadine imantidine %loc& M! 'rotein /8iral

uncoating4 8s+ Influenza 0 AE: 0tai0

>er'es 9 6clo8ir0s /8irall acti8ated guanosine analogs4 7 Trifluridine/thmidine analog4

6MB 9 6id0s )ang lo8ed seeing $oam Scarlet 9 6idofo8ir /6tosine analog 7

5ro%enicid to 're8ent ecretion4, )anciclo8ir /intraocular im'lant4, $omi8irsen/intraocular in*ection, anti-sense A thera'4, $


30/51

?-cells are alwas found in /white4 $ollicles closer to the outside of the L or s'leen

BS+ T-cells are found in the dee'er medulla/L4K5ALS/s'leen4

Lm'h drainage:

rectum a%o8e 'ectinate line 9 internal iliac

um%ilicus to legs /inc, su'erficial genitals and anal canal %elow 'ectinate line4 9su'erficial inguinal

testes 9 'ara-aortic

M>6 I and II: ule of O0s

#@O 9 M>6I 6=O 9 O

!@F 9 M>6II 6=F 9 O

atural (iller cells: detects M>6I

;)otta (IL to sur8i8e; /(I 7 (IL 9 sur8i8e4

(I onl 9 release 'erforins and granzmes 2 a'o'tosis

Anti%od clea8age:

5a'ain clea8es A% into D 'ieces: 5a 5a In /e8enl s'lits into D4

5rotease clea8es A% into ! 'ieces: 5rot Ease /e8enl s'lits into ! com'lement can

still %ind hinge4

6to&ines: >ot T-?one stEA&

IL# /and ILH4: hot 9 fe8er secreted % M"

IL!: T 9 T-cell 'roliferation secreted % Th#

ILD: ?one 9 ?one marrow stimulation /acts li&e )M-6S$4 secreted % T cells

ILF: E 9 IgE /and Ig)4 class switching secreted % Th!

ILG: A 9 IgA /and eosino'hil4 'roduction secreted % Th!

eutro'hil chemotais: 6IL(: 6Ga, ILO, LT?F, (alli&rein

ILO: O loo&s li&e multilo%ed nucleus of neutro'hil 9 5M chemotais

LT?F0s ? also loo&s li&e neutro'hil multilo%ed nucleus

Immunosu''ression 8s+ IL!: /IL4! 5ro-6clists Secreted Tac&s in es'onse to

SeriousKSirius =a 're8ent trans'lant re*ection

8s+ 'roduction: 6clos'orin /8ia inhi%it calcineurin4

8s+ secretion: Tacrolimus /8ia %inding $(-'rotein4

8s+ res'onse to: Sirolimus /8ia MT


31/51

8s T$: T: heumatoid arthritis

8s+ T$: Infliima%

8s+ T$ rece'tor: Adalimuma%

fa&e T$ rece'tor: Etanerce't

6om'lement:

6Rafor ana'hlais /histamine release 2 edema 2 h'otension, ana'hlais4

6Rbfor binding bacteria /o'sonizes and forms 'ores4

;low D causes D;: 6D deficienc causes >SIII /immune com'le de'osit4, seenes'eciall in glomerulone'hritis susce'ti%le to S+ 'neumo and >i% 2 se8ere recurrent

'ogenic sinus and res'irator tract infections

@@emem%er S>i: S/tre'+ 'neumo4 7 >i/%4 9 6D deficienc /eisseria4 9 6G-6PKMA6 deficienc

5assi8e immunit: To ?e >ealed a'idl - Tetanus ?otulism >B, a%iesK/SB in

'remies e8er winter month4

Immune deficiencies:

ruton0s agammaglo%ulinemia 9 /-r4 os with T( /trosine &inase4 defect

2 loc&ed -cell differentiation: recurrent acterial infection after H months/when mom0s Ig) disa''ears4 %Kc no Ig0s

Selecti8e Ig/04 deficienc: mil& 0llergies, %lood 'roduct 0na'hlais, giardi0

infections IgA is missing in mucus so recurrent sinus and lung infections@@ote: IgA deficienc also seen in 0ta4ia-elangiectasia:defecti8e =A re'air

enzmes, sensiti8e to ionizing radiation, cere%ellar atro'h 2 ataia, s'ider

angiomas /telangiectasias4 assoc+ wK lm'homas and acute leu&emias

>'er-IgEKo%0s Sndrome: I0m >'er Ecited for m $ATEd o%

>'er Ecited 9 'er IgE

$ 9 coarse 5acies

A 9 cold, noninflamed Sta'h 0%cesses

T 9 retained 'rimar eeth

E 9 Eczema

o% 9 o%0s

6hedia&->igashi /a-r4: )rand'a Al couldn0t eat Eastern food with his fingers+

)rand'a 9 )ram 'ositi8e cocci infections: Sta'h and Stre'

Al 9 'artial al%inism

couldn0t eat 9 defecti8e microtu%ules 9 defecti8e 'hagoctosis and

lsosomal fusion

Eastern 9 >igashi /higashi means East in a'anese4


32/51

with his fingers 9 'eri'heral neuro'ath

Pharacolog:

(om'etiti8e inhi%itors incr (m, decrease affinitK'otenc /amount of drug needed for

effect4 sigmoid effect cur8e shifts right Linewea8er-?ur&e lines cross at J-ais

/BS non-com'etiti8e inhi%itors decr Bm, decrease efficac /maimal effect of drug4sigmoid effect cur8e0s 8ertical maimum effect is reduced Linewea8er-?ur&e lines *oin

at -ais4

ero-order elimination: constant amount of drug eliminated 'er unit time 9 5EA -5hentoin, Ethanol, As'irin

Urine '> and drug elimination: medicine gets tra''ed in o''osite urine '>:

acid /'heno%ar%, MT, T6A, as'irin4 tra''ed in %asic %icar%onate

@@ote: Acetazolamide al&alinizes urine % getting rid of %icar%onate T:

csteine stones and altitude sic&ness /h'er8entilation 2 res'irator al&alosis4

%ase /am'hetamine4 tra''ed in acidic ammonium chloride

5hase I 8s 5hase II meta%olism: # red o went ! con*ugate 'olar %ears+

5hase #: c'FG" red-o /7 hdrolsis4 geriatrics lose 'hase # first

5hase !: con*ugation /acetlation, glucuronidation, sulfation4 2 ields 8er

'olar renall ecreted inacti8e meta%olites

Thera'eutic inde: TILE= with ;9 &=CKE1C and the C0s adding u' to #"" saferdrugs ha8e higher TI0s

)-'rotein-lin&ed !nd messenger:

)s 9 adenll cclase 2 AT5-to-cAM5 2 5(A 2 cascade

)i 9 inhi%it adenll cclase 2 decr cAM5 2 decr 5(A

) 9 'hos'holi'ase 6 2 li'ids-to-5I5! 2 I5D incr intracellular 6a!7, =A)

stim 5(6 2 cascade

;(iss and (ic& Ztil ou0re Sic& of Se;

;XISS XIX SIX SXS;

) 9 al'ha #: ! contraction, driasis% incr stolic and 1iastolic P

)i 9 al'ha !: decr 6, decr ins'lin

)s 9 %eta #: incr heart rateand contractilit, incr renin, incr li'olsis

)s 9 %eta !: decr 1iastolic P, 8asoKbronchodilation, incr heart rate,contractilit, incr li'olsis, incr ins'lin release /thin& eta! stimulates eta

islet cells of 'ancreas4,decr 'terine tone

) 9 M#: 6S, enteric ner8ous sstem

)i 9 M!: decr >, decr atrial contractilit

) 9 MD: incr secretions, 'eristalsis, miosis, accommodation /ciliar muscle


33/51

contraction4

)s 9 1": renal perf'sion /renal arter dilation4

)i 9 =!: %rain neurotransmitter

) 9 >#: 'ruritusK'ain, incr nasalK%ronchial mucus, contract %ronchioles

)s 9 $: incr gastric acid secretion/inhi%ited % -idines4

) 9 B#: incr 8ascular SM contraction

)s 9 B!: incr >!< rea%sor'tion in &idnes 6= /A=> action4

Signaling 'athwas:

cAM5 /)s, )i4: $LAT 6>AM5 7 calcitonin 7 glucagon

$ 9 $S>

L 9 L>

A 9 A6T>

T 9 TS>

6 9 6>

> 9 h6)

A 9 A=> /B!4

M 9 MS>

5 9 5T>

calcitonin

glucagon /incr cAM5 2 acti8ates 5(A 2 incr $#H?5ase 2

gluconeogenesis LS4

I5D /)4: hI5Dothalamic ))>

)n>

otocin

A=> /B#4

T>c)M5: 8asodilators

A5

< /< 8enodilates decreasing 'reload BS %eta-%loc&ers arteriodilate and reduce

afterload4

trosine &inase: the T( )rows In Mil&


34/51

)>

I)$-#

$)$

5=)$

Insulin

5rolactin

steroid rece'tor: cto'lasmic /ece't throid hormone 9 intranuclear4

/Adrenal corte:4 Aldosterone, )lucocorticoid, Testosterone, Estrogen

5rogesterone

Bitamin =

TFKTD /intranuclear rece'tor4

)laucoma drugs: AA??6=$

009 0l'ha 0gonist: 8asoconstriction 2 decr a humor snthesis /notfor

closed angle glaucoma4

9 eta loc&er /Timolol4: decr a humor secretion

99 9holinomimetic /6ar%achol, 5ilocar'ine 5hs is for the Ees

5hsostigmine, Echothio'hate4: incr outflow /contract ciliar muscle and o'entra%ecular meshwor& into canal of Schlemm4

19 1iuretic: Acetazolamide /car%onic anhdrase inhi%itor4, Mannitol: decr a

humor secretion

59 5)5!al'ha /Latano'rost4: incr u8eoscleral outflow AE: des irises %rown

6holinomimetics:

?ethanechol: )i8e ?eth-ann-a-call if ou want our 5S stimulated: T: 'ost-

o' neurogenic ileus and urinar retention

Anticholinesterases 9 -stigmines 7 Edro'honium 7 Echothio'hate


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Sali8ation

Sweating

Atro'ine 'oisoning: what would ha''en if ou got lost in the desert: >ot, =r, ed,?lind /cclo'legia4, Mad /delirium4, urinar retention/Kconsti'ation4

>eamethonium: 5ut a >e on re$LE %radcardia - >eamethonium 're8ents Erefle %radcardia % %loc&ing all icotinic rece'tors /ganglion %loc&er inhi%its aK(

ligand-gated channels4

A6h rece'tors:

icotinic 9 aK( ligand-gated channels /AS and M4

/>eamethoniumKMecamlamine %loc&s these4

Muscarinic 9 )-cou'led rece'tors M#,!,D9XIX /Atro'ine %loc&s these4

S'ecific antidontes:

=e$Eoamine T0s $e /iron4

;6hildren Suc& on Lead 'encils;: Succimer T0s Lead 'oisoning in children /T

is 6aE=TA in adults4

=iMEca'rol T0s MEcur, arsenic, gold

;6o''er 5enn;: 6o''er, arsenic, gold T wK 5EIcillamine

ITo'russide turns into 6anide which is T0d wK ITite, hdrooco%alamin,

and thiosulfate

MET>lene %lue and Bit6 T0s MET>emoglo%in

ET>AA loo&s li&e a 5roton;: 5e'arin toicit

=rug reactions:

T6A0s D 60s: 6ardiotoicit, 6on8ulsions, 6oma

6utaneous flushing: BA6 9 Bancomcin, Adenosine, iacin, 6a!7 channel

%loc&ers

1ilated cardiomo'ath 9 1ooru%icin and 1aunoru%icin

Torsades de 5ointes: The Method to get D#Awesome XT0s is to wear a >alo and

is'er that ou %ought a Macro-5Ie from Xuinn+

Method 9 Methadone

D#Awesome 9 6lass III, 6lass Ia antiarrhthmics

>alo 9 halo'eridol

is'er 9 ris'eridone

Macro 9 macrolide


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5I 9 >IB 'rotease inhi%itors

Xuinn 9 6hlorouineKMeflouine

A'lastic anemia: 6hlora SAI= 5tue to Meth:

6hlora 9 6hloram'henical

SAI= 9 SAI=

5TUe 9 5TU /antithroid4

Meth 9 Methimazole /antithroid4

>emolsis in )H5=: 5rima had to ta&e As'irin after I>aling her I+?+5rofessor

=a'sone0s Sulfurous $a8a ?ean itrofarts

5rimauine

As'irin

I> I%u'rofen

=a'sone

Sulfonamides

$a8a %ean

itrofurantoin

;5seudomem%ranous colitis ma&es ou want to 6lAm' our ass;: 6Lindamcin,

AM5icillin

5hotosensiti8it: SAT for a 5hoto:

S 9 Sulfonamides

A 9 Amiodarone

T 9 Tetracclines

Ste8ens-ohnson rash: ZSeizures, Sulfa0s, and 6illins 7 Allo'urinol

Seizure drugs: ethosuimide, lamotrigine, car%amaze'ine, 'heno%ar%ital,

'hentoin

Sulfa drugs

5enicillin

Allo'urinol

SLE-li&e sndrome: S>I55

Sulfonamides

>dralazine />dra0s nec& Loo's /Lu'us4 around in circles4


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I>

5hentoin

5rocainamide

=isulfiram-li&e reaction: =run& 6e'h said he was 5ro-6ar /o&a to dri8e4 at

ight, %ut to a8oid a )ruesome accident, 6hlora made him Suffer the Metro+

6e'h 9 6e'halos'orin

5rocar 9 5rocar%azine

ight 9 itrofurantoin

)ruesome 9 )riseoful8in

6hlora 9 6hloram'henicol

Suffer 9 Sulfonlureas

Metro 9 Metronidazole


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'FG" inhi%itors: Nithout a (e, (im was inhi%ited from 5IES and uice

(e 9 (etoconazole

(im 9 6imetidine

inhi%ited

5I 9 >IB 5rotease Inhi%itors

E 9 Erthromcin

S 9 Sulfonamides

uice 9 gra'efruit *uice

See reference:

ima g e

Toicit %ear: 6umulati8el Toic =rugs and their escues

As'aragine: neurotoicit

6is'latin: ototoicKne'hrotoic T: Amifostine

BincristineKBin%lastine: 6hrist m ner8es, ?last m %ones - Bincristine

9 'eri'heral neuro'ath, Bin%lastine 9 melosu''ression

?leomcin: 'ulmonar fi%rosis

=ooru%icin: cardiotoic T =erozoane /for cardiotoicit4,

=imethl-sul'hoide /for 5 6a!7 channel %loc&ers


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>eart murmurs:

;M+ ASS and MS+ A=; 9

M 9 mitral regurg

AS 9 aortic stenosis

S 9 sstolic murmurs

and

MS 9 mitral stenosis

A 9 aortic regurg

= 9 diastolic murmurs

holosstolic 9 all regurg0s 7 BS=

murmurs that increase with %reathing:

rIght murmurs increase with Ins'iration

lEft murmurs increase with E'iration

;Nolf 9 Lone 6anis; - Nolff-5ar&inson-Nhite is treated with amioda


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2#" das: ris& for 8entricular aneursm /%ulging scar %ecause fi%rosis made it

lose its a%ilit to contract4 38entricular remodeling can %e 're8ented with A6E-

I0s

?acterial endocarditis: $T76>$ /decreases %oth 'reload and afterload4 >T7=M /protectiveagainst =ia%etic ne'hro'ath4

Antih'ertensi8e thera': A?6=:

A6E-IKA?s

?eta %loc&ers

6alcium channel %loc&ers


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=iuretics /L

L>

A6T>

TS>

5rolactin

endor'hins /share 5 and MS>4

)>

?aso'hilic 9 ?-$LAT: ?aso'hilic-$S>, L>, A6T>, TS> /BS Acido'hils-5rolactin,


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)>4

6euroh'o'hsis 9 5osterior 'ituitar /6eural tu%e of ectoderm4: secretes h'othalamicsu%stances: A 5air of 4

Adrenal steroids: In an enzme deficienc, if the first digit is a #, then the 'atient will %e

h'ertensi8e+ If the second digit is a #, then the 'atient will loo& male+

#Qal'ha hdrolase deficienc: >T, feminine

!# hdrolase deficienc /M64: h'otension, masculine

## %eta hdrolase deficienc: >T, masculine

5T> 9 'hos'hate trashing hormone /note: decreased free serum Mg!7, decreases 5T>

secretion common causes of decr Mg!7 9 alcohol, aminoglcosides, diarrhea, diuretics4

9alcitonin 9 from 'arafollicular 9cells of throid 9 neural 9rest deri8ati8e, secreted inmedullar throid 9ancer /MEII4

/Signaling 'athwa mnemonics were co8ered earlier4

Throid hormone functions: TD 9 G?0s

?rain /6S4 maturation /defect 9 mental retardation seen in 6retinism4

?one growth /snergism with )> defect 9 6retinism4

?eta# adrenergic effects /Throid Storm: incr >, contractilit 2 arrhthmia

T with 'ro'anolol or 5TU /


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mass ma in8ade into an inter8erte%ral e'idural s'ace and loo& li&e a dum%%ell

>''er'arathroidK>'erthroid

Iatrogenic: Thiazides

Multi'le meloma

5aget0s disease /when 'atients are immo%ilized, normall normocalcemic4

Addison0s disease

eo'lasms /e+g+, %reast cancer 9 osteoltic4

ollinger-Ellison sndrome /'ancreatic tumor 2 incr gastrin associated with

MEI /'arathroid tumor4

Ecess 8itamin =

Ecess 8itamin A /incr %one resor'tion 2 incr 6a!74

Sarcoidosis /or granulomatous disease4

>'er'arathroidism:

5rimar: 2 %one lesions

>'ocalcemia signs:

6 9 9h8oste& sign 9 9hee& ta''ing 2 facial muscle 9ontraction

T 9 rosseau0s sign 9 ight ?5 cuff 2 hand etan /s'asm4

=eamethasone 8s =emecloccline 8s =esmo'ressin:

=eamethasone 9 steroid to = A6T> diseaseKsndrome

=emeclo6J6Line 9 tetraccline A=> antagonist 8s 6J6Lo'hos'hamide-

induced SIA=> T: SIA=>

=esmo5ESSI 9 8aso5ESSI /A=>4 analog T: central =ia%etes insi'idus

/ote: ne'hrogenic =I is treated % hdrochlorothiazide /6a!7 s'aring diuretic4,indomethacin /decr renal %lood flow4, or amiloride /(7 s'aring aldosterone

rece'tor antagonist diuretic that closes a7 channels that also rea%sor%s Li to T

Li-induced =I4

Multi'le endocrine neo'lasias /ME4: /A-=4

MEI /Nermer0s4: D50s


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'ancreatic - Vollinger-Ellison gastrinoma - 'e'tic ulcers

'arathroid - incr 5T> - h'ercalcemia

'ituitar - V'rolactin or )> - amenorrhea, lactation

MEIIa /Si''le0s4: !50s

'arathroid - incr 5T> - h'ercalcemia

566 - incr catecholamines /E'iKor4, urine BMA and Metane'hrine

medullar throid /'arafollicular 64 - 'olgonal, incr calcitonin -

h'ocalcemia

MEII%: #5

566 - incr catecholamines, urine BMAKmetane'hrine

medullar throid /'arafollicular 64 - incr calcitonin - h'ocalcemia

Marfan0s ha%itus 7 oralKintestinal mucosal neuromas ote: MEII0s are associated with ret oncogene

Also, the II in MEII stands for the !60s in 566

=ia%etic drugs:

;Metformin )litters in Sunn )li'tin Tides;

!etforin9 incr gl'cose 'ptaein muscle and fat 8ia )LUTF /a&a incr

ins'lin sensitivitin 'eri'heral tissue4 and decr li8er glucose 'roduction 8ia incrAM5( and decr 5E56( /


45/51

/glcolsis4

glucose 2 decreases cAM5 2 decreases 6A5-cAM5 %inding of lac o'eron 9

A 'olmerase can0t %ind to 'romoter

Bastrointestinal:

etro'eritoneal structures: I AS( =+ 56

5rimar retro'eritoneal /ne8er 'ushed into sac4:

IB6

A% aorta

Su'rarenal glands

(idnesKUreters

Secondar retro'eritoneal /'ushed into sac, %ut esca'ed4:

=uodenum /!, D, F4

ectum

5ancreas /head, %od4

6olon /ascending, descending4

e ma&es me feel ;nferiora%out m 'perficiala''earance %


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'o&ing near ell-b'ttonso I Eat &ess+

ectal anastomoses: /9hemorrhoids4

!;'perioris an 0ss:

Sstemic: !iddle and ;nferior ectal

to

5ortal: 'perior 8ectal

Um%ilical anastomoses: /9ca'ut medusae4

;nferiora%out m 'perficiala''earance % 'o&ing near ell-b'tton:

Sstemic: ;nferior, 'perficialE'igastricto

5ortal: Para'bilical

Eso'hageal anastomoses: /9eso'hageal 8arices4

Eat &ess: / 9 eso'hageal 8arices4

Sstemic: Eso'hageal /azgos4

to

5ortal: &eft )astric

Li8er anatom: #A?6

;#A?6;:

one" 90'ical surface of he'atoctes face ile 9analiculi 9 'eri'ortal

zone

Also, when ou thin& of A?6, ou should thin& of >e'atitis A, ?, 6.

one # 9 first affected % 8iral he'atitis %ecause closest to he'atic arter

/emem%er: 5ortal triad 9 %ile duct, he'atic arter, and 'ortal 8ein4

;The Drd letter in the al'ha%et 9 6;:

one 39 9entrilo%ular /'eri9entral 8ein4 9 where %lood drains into the

he'atic 8ein

%ecause it0s so far from the he'atic arter, it0s the first 'lace to suffer from

ischemia

also, since %lood 'ools in 8eins, ou can thin& of drugsK'oisons 'ooling

there, too

?ottom line: Cone " 7 s'sceptible to vir'ses, Cone 3 7 s'sceptible to

dr'gs/ischeia

$emoral region: ABEL with the Benous near the 5enis

Lateral to medial: er8e, Arter, Bein, Em't s'ace, /dee' inguinal4

Lm'haticsKLacunar ligament

ote: femoral sheath does notcontain femoral ner8e

Inguinal canal: ;6ternal /dee'4 inguinal ring 9 ;6direct hernia that ma go ;6to the

scrotum 9 lateral to inferior e'igastric 8essels

BS+ an alien 1irectl %ursting from our stomach 9 directhernia 9 'rotrudes from


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abdoinal wall edialto inferior e'igastric 8essels:thi s iswor se th a n a her ni ath o u g h

or M=0s don0t LIe: Medial 9 =irect, Lateral 9 Indirect

;$em-$em;: femoral hernias occur more often in females /and is the leading cause of

%owel incarceration4

)I secretor 'roducts:

;I$ ou 5ATJ too hard, ou0ll 8omit out a lot of )ASTI6 A6I=+;:

5arietal cells secrete I$ /intrinsic factor4 and >6l /gastric acid4

;5e'-'e' to the 6hief;:6hief cells ma&e 5e'sin

BitaminKMineral a%sor'tion:

=uodenum: $E= 9 $e /iron4 in =uodenum

e*unum: The ester is a $at $ool 9 e*unum a%sor%s most $ats and $olate

Ileum: The ileum is the last 'art of the small intestine it0s where ou sa ?e

?e to the SI: ?le acid, ?#!KI$ is rea%sor%ed in the Ileum

?iliru%in:

ules of thum%:

The two-named diseases don0t go together

The one named diseases are milder

;6direct 9 U6con*ugated 9 water ;6solu%le: 6rigler-a**ar, )il%ert 9

;(I) (


48/51

water-solu%leKecreta%le form V )lucuronl transferase deficienc

1irect 9 con*ugated 9 Datersolu%le: 1'bin-ohnson, 8otor[s 9

1'bin-ohnsoncalled 8otor-rooter to fi his DaterPipes+

Jou get direct %iliru%inemia when there0s a 'ro%lem with %ile PipesKecretion

/E+)+, %iliar tree o%struction4

ote: =u%in-ohnson is worse than otor0s in that the li8er is 'igmented %lac&

Achalasia: AA??66

0chalasia

loss of 0uer%ach[s menteric 'leus

irds %ea& on arium swallow

associated with 9haga0s and 9EST

oerhaavesndrome 9 een-eaving transmural com'lication of Mallor-Neiss

088ett0s eso'hagus 9 ecomes 0denocarcinoma, 8esults from 8eflu

Eso'hageal cancer ris& factors: A?6=E$)>

Alcohol, Achalasia

?arrett0s eso'hagus

6igarettes

=i8erticuli /e+g+, en&er0s4

Eso'hageal we% /e+g+, 5lummer-Binson4, Eso'hagitis

$amilial

)E=

>ot dogs /nitrosamines4

Eso'hageal cancer e'idemiolog and locations:

uamous cell 9 'read out worldwide /most 're8alent worldwide4 u''er !KDs

/where striated muscle can %e found4

0denocarcinoma 9 most 're8alent in 0merica /lower #KD, location of 'ure smooth

muscle4

)astritis:

Acute gastritis /erosi8e4:

;?urned % 6urling iron;: 6urling0s ulcer 9 stress ulcer from %urns:

decr 'lasma 8olume 2 sloughing of gastric mucosa

;6ushion the %rain;: 6ushing0s ulcer 9 stress ulcer from head in*ur:

incr I65 2 incr 8agal stimulation 2 incr A6h 2 incr >74

6hronic gastritis /non-erosi8e4: A?-'airing


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T'e A /fundusKod4 9 0utoimmuneK0nemia:

AutoA% to 'arietal cells, 'ernicious anemia /A% to I$4, achlorhdria

T'e ? /0ntrum4 9 acterial:

>+'lori infection /duodenal 2 stomach ulcer4, increased ris& of MALT

lm'homa

5e'tic ulcer disease:

Bastric ulcer 'ain 9 Breater with food

1uodenal ulcer 'ain 9 1ecreases with food /will see h'ertro'h of ?runner0s

glands and clean 'unched out margins unli&e carcinoma raisedKirregularmargins4

Inflammator %owel disease /I?=4: 6rohn0s 8s Ulcerati8e 6olitis

6rohn0s: A 6ree' $at old 6rone /)rann4 went S&i''ing on 6o%%lestones

while 'um'ing her Arthritic $ist in the air+

6ree' $at 9 6ree'ing fat

6rone 9 6rohn0s disease

/)rann4 non-caseating )ranulomas

S&i''ing 9 trans'ralS&i' lesions

6o%%lestone 9 6o%%lestone mucosa

Arthritic 9 Migrator 'olarthritis

$ist 9 $istulas

;)um to ?um; lesions and e4traintestinal anifestations/sstemic4 li&e

erthema nodosum /Vshins4, an&losing s'ondlitis, and u8eitis

ote: this is disordered res'onse to intestinal %acteria

Ulcerati8e colitis: If ou ha8e a Lead 5i'e *ammed u' our ectum, ou0ll get

?lood =iarrhea+

Lead 5i'e 9 loss of haustra leads to lead 'i'e a''earance on imaging

ectum 9 U6 alwas in8ol8es the rectal mucosaKsu%mucosa and 'rocedes

continuousl u' unli&e 6rohn0s which tends to s'are the rectum

?lood diarrhea /another trait not shared with 6rohn0s4

ote: this is autoimmune

U6 is also associated with fria%le 'seudo'ol's, 'oderma gangrenosum,

and 'rimar sclerosing cholangitis

Mec&el0s di8erticulum: ule of !0s

! inches long

! feet from ileocecal 8al8e


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!Y of 'o'ulation

!o /or ounger4

! t'es of ecto'ic e'ithelia: gastric or 'ancreatic

6olonic 'ol's: BILLous 9 BILLain566KLnch which doesn0t ha8e man 'ol's and in8ol8es the5664

=ementia

Ence'halo'ath

$anconi0s Sndrome: defecti8e 56T rea%sor'tion

)allstones /cholelithiasis4: is& factors 9 F$0s:

$at

$ertile

$emale

$ort


51/51

Acute 'ancreatitis causes: )ET SMAS>E= 2 =I6, A=S.

)allstones

Ethanol

Trauma

Steroids

Mum's

Autoimmune disease

Scor'ion Sting

>'ercalcemia, >'erli'idemia

E65

=rugs /E+)+, Sulfa drugs4

Antacid ad8erse effects:

Al 9 Alu!;6;!U!amount of feces: consti'ation

!g9 !ust Bo to the %athroom: diarrhea

Usmle Guide Note

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