Docstoc

Microbiology Immunology

Document Sample
Microbiology Immunology Powered By Docstoc
					Kaplan – Qbank – High Yield                                                                      -1-

Anatomy –
      Drainage of ovaries/testes : left gonadal  left renal vein  IVC • right gonadal vein  IVC •
       same situation occurs for left & right adrenal veins
      Cervix drainage : cervical vein  uterine vein  internal iliac
      Uterine tubes drainage : pampiniform plexus  ovarian vein  IVC
      Radial nerve injury : inability to extend the wrist • digits (= wrist drop) • weakness of grip •
       anesthesia of dorsal surface of the arm, forearm and hand
      Axillary nerve injury : fracture at the surgical neck of humerus • supplies teres minor , deltoid and
       skin of shoulder
      Musculocutaneous nerve injury : innervates the flexors of the arm • weakness of arm flexion at
       the shoulder (biceps, brachialis, coracobrachialis )• anesthesia of lateral forearm skin
      CNS locations : pyriform cortex :primary olfactory cortex • postcentral gyrus : primary sensory
       cortex •precentral gyrus : primary motor cortex • insula :primary gustatory cortex
      Friedreich’s ataxia : ataxia,tremor, kyphoscoliosis,foot deformities • death by 40 yrs old • AR •
       atrophy of spinal cord – spinocereblellar tracts, corticospinal tracts and posterior columns
Behavioral –
      Cooperative play : after 4 yrs •
      Regression :automatic retreat to a less mature level of behavior in times of stress
      Sublimation : turning socially unacceptable impulses into acceptable or more benign forms to allow
       their expression
      Minor with STD  no need to inform the parents • go ahead and treat !
      Alprazolam is intermediate acting BSD • primarily used for panic attacks
      Diazepam & lorazepam : status epilepticus
      Toilet training : not possible befor the age of 18 months
Biostatistics –

Biochemistry –
      PDH deficiency : pyruvate will be used in other pathways • alanine & lactate will be elevated •
       alanine aminotransferase converts pyruvate to alanine • LDH converts pyruvate to lactate
      Leigh’s disease :(subacute necrotizing encephalomyopathy) : defective form of cytochrome C
       oxidase • symmetric necrosis that affects central arease of the nervous sytem from the thalamus to
       the spinal cord •
      Glucagon inhibits fatty acid synthesis by a cAMP-dependent phosphorylation of acetyl-CoA
       carboxylase
      High carbohydrate & low fat diet would stimulate fatty acid synthesis
      cDNA library is synthesized from the mRNA of a cell using the enzyme reverse transcriptase • it is
       used to study the DNA and the RNA message from which proteins are transcribed
      Fluorescence activated cell sorting (FACS) uses antibodies coupled to fluorescent markers to
       determine cell surface molecules of whole cells
      Genomic library is the chromosomal sequence of a gene including coding and non-coding regions
       • it is synthesized directly from the DNA of a cell and it is used to study both the coding regions &
       the areas such as promoters, enhancers, and introns of a gene
      Deletions are detected by two methods : 1) Southern Blot 2) PCR ( 3. restriction enzymes)
      Glutamate carboxylase : catalyzes the carboxylation of glutamic acid side chains in several
       clotting factors ( II, VII, IX, X, protein C, S) • vitamin K acts as co-enzyme
      Hemolytic anemia in newborn : as a result of vitamin E –tocopherol- deficiency
      Vitamin B12 is required for two reactions in human body : methylation of homocysteine to
       methionine • conversion of methylmalonyl CoA  succinyl CoA (methylomalonyl CoA mutase)
      Vitamin C excess can lead to : decreased absorption of B12 • increased estrogen levels in women
       on estrogen replacement therapy • kidney stones •
      Vitamin A : necessary for retinal pigments  nyctalopia
      Glucose transporters are integral membrane proteins with 12 spanning domains
Kaplan – Qbank – High Yield                                                                        -2-
      Beta-adrenergic receptors for Epinephrine have 7 transmembrane segments
      Hexosaminidase A hydrolyzes a bond between N-acetylglucosamine and galactose in the polar
       head of ganglioside GM2
      Propionic aciduria : deficiency in biotin • propionyl CoA carboxylase
      Galactosemia : the only clinical significant complication is cataract
      Fabry’s :a-galactosidase def • renal failure • telangiectasias • skin rash • ceramide trihexoside
       accumulation
      Farber disease : ceramidase def • hoarseness, dermatitis, skeletal deformations, mental
       retardation, hepatomegaly
      Niemann-Pick : def of sphingomyelinase • mental retardation, hepatosplenomegaly, foam cells in
       bone marrow, cherry red spots in macula (40%) • death by 3 yrs of age
      Von Gierke’s disease : glucose 6-phosphatase def • glucose 6P trapped in the liver cell is
       degraded to lactate & pyruvate  released into serum • high serum lactate + high serum pyruvate
      Ketone bodies : acetone, acetoacetate , b-hydroxybutyrate • produced by the liver by beta
       oxidation of free fatty acids • occurs as follows :insulin deficiency  activated lipolysis  increased
       plasma free fatty acids  increased hepatic fatty acids  accelerated ketogenesis
      Malate shuttle : used to transport cytoplasmic NADH into mitochondria
      Southwestern blotting :involves DNA-protein interactions. • a protein sample is subjected to
       electrophoresis, transferred to a filter, and exposed to labeled DNA
      UDP glucose phosphorylase :important in glycogen synthesis • glycogen synthase is the rate
       limiting step in glycogen synthesis
      Alkaptonuria :def of homogentisic acid oxidase (degradation of tyrosine) dark urine • dark
       connective tissue  ear cartilage may appear bluish
      Northern Blot : best test to determine whether a gene is expressed in a particular cell type
      DNA sequencing & Southern Blot examine the DNA of the cell
      Biochemical testing is usually used to detect a defective enzyme or a reduced amount of normal
       enzyme • used in the detection of carriers of AR diseases such as Tay Sachs, sickle cell,
       thalassemias
      Vitamin C def : perifollicular hemorrhages, ecchymoses , splinter hemorrhages, hemorrhages into
       muscle
      Von Gierkes’s lab : increased lactate , cholesterol, TG, and uric acid
      Wernicke’s : ataxia (= difficulty walking), dementia, paralysis of lateral gaze (= opthalmoplegia) •
       thiamine deficiency
      Transaminases require pyridoxal phosphate (vitamin B6)
      Thiolase converts acetoacetyl-CoA into acetyl CoA
      Abetalipoproteinemia : absence of apo-proteins • leads to fat malabsorption • complete absence
       of chylomicrons • patient’s RBC’s are deformed (acanthocytosis)
      Glycine is not hydroxylated • abundant in fibroblasts • constitutes every third aminoacid in collagen
       structure
      Proline is hydroxylated  hydroxyproline •
      Serine, threonine, tyrosine can be phosphorylated post-translationally
      Cystathionine synthetase :catalyzes the conversion of homocysteine  cystathionine 
       cystein • if enzyme is deficient  homocysteine accumulates, is methylated  methionine •
       patients with homocystinuria are vulnerable to thrombotic episodes



Genetics –
      Fragile X : enlarged testes + mental retardation • expansion of CGG trinucleotide repeat located
       on X chromosome
                          th
                                                                                                   nd
       Edwards syndrome : trisomy 18 • rocker bottom feet, micrognathia, mental retardation, 2 and 5
                    rd
                                                                                                          th

       finger over 3 and 4 , congenital heart disease, death within a month
      Patau syndrome : trisomy 13 • mental retardation, cleftlip/palate, polydactyly, rocker bottom feet
Kaplan – Qbank – High Yield                                                                       -3-
      Smith Lemli Opitz syndrome :ambiguous genitalia • failure to metabolize 7 dehydrocholesterol to
       cholesterol • pyloric stenosis • syndactyly
      Mosaic in trisomy 21 : 1% of children • some of their cells are normal • these individuals show only
       a mild expression of the trisomy 21 phenotype
      Locus heterogeneity : refers to the situation in which the same phenotype is caused by defects in
       different genes • commonly seen in syndromes resulting from failures in a complex pathway, such
       as hearing • - deaf parents produce nomrla hearing children,suggesting that the parents have
       defects in different genes. The children are heterozygous at both loci and so have normal hearing
      Pleiotropy : is observed in retinoblastoma • carriers may develop other cancers such as
       osteosarcoma • inactivation of Rb suppressor gene in chromosome 13
      SXD disorder with 60% penetrance • daughters have 60% chance to be affected

Histology / Cellular Biology –
      Major basic protein : found in eosinophils •crystalline core of granules in eosinophils •destruction
       of parasites • eosinophils contain also : histaminase, arylsulfatase
      Histamine is produced by basophils & mast cells • eosinophil secretes histaminase
      Circulating RBC’s : 60 days life span
      Peroxisomes : single membrane bound organelles • important in alcohol detoxification & long
       chain fatty acid metabolism • Degradation of ethanol to acetaldehyde occurs in humans in both
       peroxisomes & smooth endoplasmic reticulum (P450) • aldehyde dehydrogenase –blocked by
       disulfiram- occurs in mitochondria
      Sialic acid : is a terminal glycosylation product added to proteins (usually those destined for
       secretion) in the Golgi apparatus
      P450 :located in SER •in chronic alcoholism  growth
      Spleen : white pulp  contains collections of lymphocytes arranged around a central artery in a
       configuration called the periarterial lymphatic sheath (PALS).germinal centers may occur within the
       sheath in reaction to antigen exposure • red pulp  consists of splenic cords and splenic sinuses,
       filters the blood
      Ito cells: found in the perisinusoidal space (space of Disse) Ito cells are hepatic adipose cells and
       provide primary storage site for vitamin A
      Kupfeer cells :are found in liver sinusoids and belong to the mononuclear phagocytic system
       •greatly increased function after splenectomy • final breakdown of senili RBC’s
      Hemosiderin, a denatured form of ferritin, appears microscopically as yellow brown granules in
       cytoplasm •
      Masson’s trichrome is a connective tissue stain • blue :nuclei • green : connective tissue • red
       :blood
      Karyorrhexis : pattern of nuclear degradation • pyknotic nucleus undergoes degradation followed
       by complete lysis • this pattern is common in neutrophils present in acute inflammation
      Liquefactive necrosis :abcess • CNS infarct



Microbiology / Immunology –
      Neonate with widespread granulomas = Listeria monocytogenes (granulomatis infantiseptica)
      Neisseria gonorrhea transmitted via birth canal • opthalmia neonatorum
      Chediak –Higashi : small doses of vitamin C may effectively treat this disorder
      Sporothrix schenkii : hyphae with rosettes of conidia : transmission form • unequal budding yeast
       found in clinical speciment from a patient with sporotrichosis • Rx : KI or itraconazole
      Tinea pedis /athlete’s foot :colorless, branching hyphae with cross walls and arthroconidia • rx :
       topical azole
      Malassezia furfur : pityriasis versicolor • short curved hyphae, and round yeasts = ― spapghetti and
       meatball ― •
      Common variable immunodeficiency : decreased number of plasma cells • NORMAL number of
       B-cells • low levels of all antibody classes • lymph node architecture is unaltered in common
       variable immunodeficiency
Kaplan – Qbank – High Yield                                                                    -4-
      Giardia lamblia : infects the small intestine • if biopsy : crescent shaped protozoa • if smear :
       flagellated organism with face like appearance • prolonged diarrhea • may have low serum IgA •
       river streams in mountains  giardia
      Entamoeaba histolytica : affects the large intestine • may liver abcess
      Scalded skin syndrome : Staphylococcus aureus • exfoliative toxin • splitting of the epidermis at
       the level of the stratum granulosum, causing global denudation of the skin
      Impetigo & post-streptococcal glomerulonephritis : group A b hemolytic streptococci •eroded
       pustules covered by honey colored crusts
      IgA deficiency :some patients with IgG2 deficiency also have IgA deficiency and may develop
       anaphylaxis if given IgA-containing blood products
      C4 deficiency : SLE like syndrome
      DiGeorge : tetany (facial muscles first sign  Chvostek’s sign) •absent thymus •low set ears
       recurrent candidal infections
      Hyper IgM syndrome : high IgM, low all other classes • helper T cells defect in surface protein
       CD40L that interacts with CD40 on B-cell surface •often form antibodies to neutrophils,platelets,
       and tissue antigens
      Ataxia telangiectasia :prominent telangiectasias around the eyes • AR • chromosomal breakage
       syndrome • increased number of translocations • chromosome 11 related
      Molluscum contagiosum :cytoplasmic inclusions in the epidermal cells are pathognomonic •
       babies & AIDS • poxvirus
      Mycobacterium & Treponema cause chronic meningitis • lymphocytic infiltrate
      Enterococcus faecalis : cause UTI’s –often nosocomial & classically in ICU- • do NOT produce
       nitrites from nitrates •
      Nitrites + :usually a gram negative organism (enterobacteria) such as Klebsiella, pseudomonas,
       E.Coli, Enterobacter sp. •
      Omcogenesis in HPV : cervical intraepithelial neoplasia is associated with HP infection (types
       16,18) • produce E6 & E7 proteins inhibiting p53
      Progressive multifocal leukoencephalopathy : JC virus (papova virus) • infects
       oligondendroglial cells in the brain • eosinophilic inclusions • AIDS-defining • only white matter
       affected
      Subacute sclerosing panencephalitis • may follow previous measles infection • gray matter &
       white are affected • occurs usually before the age of 18
      Yersinia pestis & plague : any previously healthy person in the Southwestern US who develops
       septic shcok or sever pulmonary disease shold be evaluated for plague
      Aspergilloma may be formed by tuberculosis, tumor, bronchiectasis • surgically resection
       •antibiotics are ineffective
      Syngeneic graft : transfer of tissue between genetically identical individuals (identical twins)
      Allograft /homograft : graft between genetically different members of the same species
      Xenograft : e.g pig heart valve
      C5a & IL 8 most powerful chemotactic factors for neutrophils • LTB4 also
      IgG subclass 2 is directed against polysaccharide antigens and is involved in the host defense
       against encapsulated bacteria
      C 3 nephritic factor = IgG autoantibody that binds to C 3 convertase making it resistant to
       inactivation • persistently low serum complement levels • Type II MPGN
      Scalded skin syndrome (Staphylococcus aureus phage II group ) : involves the very superficial
       squamus cells just beneath the granular layer
      Type II hypersensitivity : are mediated by IgG or IgM antibodies to fixed cell bound antigens •
       this response may lead to cell destruction or cell dysfunction • important in the pathogenesis of
       transfusion reactions, graft rejection, Graves disease, myasthenia gravis
      Type III hypersensitivity :formation of circulating immune complexes • may precipitate in small
       blood vessels  fix complement and incite an inflammatory reaction • glomerulonephritis,
       vasculitides, collagen vascular diseases
      Type IV hypersensitivity :sensitized T lymphocytes • either CD4+ (helper) T lympocytes or CD8+
       (cytotoxic) T lymphocytes take part in this response • granulomas
Kaplan – Qbank – High Yield                                                                       -5-
      IFNγ produced by T1 helper cells instructs macrophages to become epithelioid cells
      Aspirin-induced asthma : inhibition of cyclooxygenase/ but not lipooxygenase  decreased ratio
       between PG’s (bronchodilators) and leukotrienes (bronchoconstrictors)
      Germ tube test :diagnostic test for candida albicans
      Cervical exudates  gram negative diplococci within neutrophils = Neisseria gonorrhea 1000%
      Cervical exudates  gram negative cocci : 1) neisseria gonorrhea 2) acinetobacter (normal
       flora) • use DNA probe to distinquish
      Leptospirosis : abrupt onset of headache (98%) , fever, chills, conjunctivitis, muscle aches, GI
       symptoms, rash, hypotension • this phase lasts 3-7 days • asymptomatic period  recurrence of
       fever & generalized symptoms
      Neisseria gonorrhea arthritis : patients are continuously susceptible to reinfection b/c of antigenic
       variation of the pili

Molecular biology –

Pathology –
      Subcortical leukoencephalopathy (Binswanger’s disease) : diffuse loss of deep hemispheric
       white matter • associated with hypertension • widespread gliosis
      Yolk sac tumor a.k.a = infantile embryonal carcinoma/= endodermal sinus tumor : b/c of presence
       of endodermal sinuses that resemble primitive glomeruli • cytoplasmic granules that contain alpha
       fetoprotein. • can be used as a serum marker for recurrent disease
      Still’s disease : a.ka juvenile rheumatoid arthritis • affects children younger than 16 yrs old , 1-3
       yrs of age • female predominance •fever, splenomegaly, general lymphadenopathy, leukocytosis •
       rheumatoid factor is usually negative • if +  poorer prognosis
      Henoch Schonlein purpura : preceded by an URI • vasculitis, arthritis, purpura, GI pain & blood in
       stool , kidney  nephritic syndrome
      Kawasaki’s disease : fever, conjunctivitis, erosion of oral mucosa, lymphadenopathy, rash ,
       coronary & aortic vasculitis  death
      Fibrinous pericarditis : post MI • loud pericardial friction rub, chest pain,fever, symptoms of CHF
      Caseous pericardtitis TB
      Conn’s syndrome : hyperplasia of zona glomerulosa • hypertension secondary to sodium retention
       • hypokalemia •decreased serum rennin (negative feedback of increased blood pressure on rennin
       secretion)
      Secondary aldosteronism :increased levels of rennin • due to renal ischemia
      Dermatitis herpetiformis : associated with celiac sprue • type III hypersensitivity reaction •
       immunocomplexes igA + complement
      Discoid lupus erythematosous : localized cutaneous form of SLE • type III hypersensitivity
       reaction
      Urticaria : IgE mediated • type I hypersensitivity
      ASD :prominent right ventricular cardiac impulse • systolic ejection murmur heard in the pulmonic
                                                                      nd
       area & along the left sternal border • fixed splitting of the 2 heart sound
      Melasma :irregular patches of hyperpigmentation on the face •occurs in pregnancy • may not regress
      Primary sclerosing cholangitis : beaded appearance on ERCP of biliary tree •
      Osteosarcoma : XRay : bone destruction /soft tissue with ―sunburst appearance ― / Codman’s
       triangle (=periostal elevation) • Histo : anaplastic cells with osteoid
      Exostoses (=osteochondromas), debaceous cysts, dermoid tumor’s, colonic polyps = Gardner’s
      Lymph node structure & disease :
             a. Viral infection – expansion of germinal centers without loss of normal architecture
             b. AIDS – progressive transformation of germinal centers • not paracortical hyperplasia
             c. Lymphomas – destroy the architecture of the lymph node
      Complete hydatiform mole : elevated b-hCG •grape like cystic structures filling the uterus • no
       embryo • the genotype of a complete hydatiform mole is purely paternal (XY), caused by
       fertilization of an egg that has lost its chromosomes • danger : choriocarcinoma
Kaplan – Qbank – High Yield                                                                         -6-
      Partial moles : triploidy / tetraploidy • fertilization of an egg with two different sperm • one with X
       & one with Y
      AFP : hepatocellular carcinoma • yolk sac tumors • embryonal tumors in men
      Irritable bowel syndrome : alternating constipation / diarrhea • more common in young females •
       no organic changes are evident
      Hypoaldosteronism :decrease in serum sodium increase in serum K+ • retain of H+ ions 
       metabolic acidosis with low serum bicarbonate
      Bernard Soulier disease : prolonged BT • normal PLT • dysfunction in glycoprotein Ib-IX complex •
       only treatment in acute emergency : transfusion of PLT’s
      Henoch-Schonlein : URI + purpura + abdominal pain + hematuria + child
      Cryoprecipitate would help in a case of vWF disease
      Hyaline droplets (dark staining droplets ) are found in the epithelium of PCT in cases of
       proteinuria
      Spongiosis : intercellular edema of the epidermis • fluid accumulates between the cells, pulling the
       apart
      Adult form of aortic coarctation :stenosis distal to the left subclavian artery • collateral circulation
       by intercostal & internal mammary artery •notching of inferior margins of ribs •
      Infantile form of aortic coarctation is associated with patent ductus arteriosus
      Aortic stenosis : systolic hypotension throughout the body • recurrent syncope • hypertrophe /
       dilatation of LV
      Takayasu arteritis : a.k.a pulseless disease • vasculitis of the aortic arch and its branches 
       stenosis of these arteries • signs & symptoms of ischemia to the upper part of the body • radial
       pulses are weak/ absent = pulseless disease
      Vascular proliferating skin lesions :hemangiomas • Kaposi • bacillary angiomatosis
      Malignant mixed mullerian tumor : tumor with 2 components : stromal & epithelial (endometrial
       glands) • both are malignant but only the epithelial metastizes • stromal component may contain
       metaplastic components such as cartilage & bone
      Endometrial carcinoma is derived form epithelial glandular component of endometrium • abnormal
       bleeding is the usual presentation •
      Small parietal lobe abcesses : septic emboli from infective endocarditis
      Albinism & associated skin cancer : squamus cell carcinoma (multiple)
      Rheumatoid nodules are composed histologically of areas of fibrinoid necrosis surrounded by
       palisading epithelioid cells
      Thalassemia & sickle cell anemia do not usually present until about the 6 months of age ,when
       fetal hemoglobin production ceases
      Celiac disease : limited to proximal small bowel • anti-gliadin antibodies • granular deposits of
       IgA and C3 in dermal papillary tips • gluten free diet as Rx • tropical sprue affects the entire
       small bowel ( ETEC infection) •
      Basal cell carcinoma : ―pearly papules‖ on sun exposed skin • almoste never metastize •
       palisading of the cell nuclei •
      Resistance to thyroid hormone (Refetoff’s syndrome ): mutation in thyroid hormone receptor
       gene • affects also the cells in pituitary  ―no‖ negative feedback  increased plasma TSH 
       increase in serum T4
      Low T3 syndrome (euthyroid sick syndrome) occurs with certain systemic illnesses such
       pneumonia or septicemia,afterm major surgery and with malnutrition or starvation • decrease of 5’
       monodeiodinase activity • decreased levels of T3
      Addison’s disease : decreased secretion of cortisol, aldosterone and adrenal androgens •
       hypotension may be present b/c arterioles are less responsive to the constrictor effects of
       catecholamines in the absence of cortisol • hyperkalemia & hyponatremia due to lak of cortisol
      Nelson’s syndrome : usually post-adrenalectomy for Cushing • extreme hyperpigmentation due to
       hypersecretion of ACTH from pituitary adenoma that is no longer being restrained by the
       supressibve effect of cortisol
      Head & neck (particularly nose,nasopharynx and orbit is the most frequent site for embryonal
       rhabdomyosarcoma • other sites are the genitourinary tract
Kaplan – Qbank – High Yield                                                                             -7-
      Hereditary factor XIII deficiency :presentation at birth when the umbilical stump bleeds
       excessively • factor XIII is necessary to stabilize clot formation ; in its absence clots will rapidly lyse
       • spontaneous abortion in women is common
      Complications of MVP :atrial thrombosis, caclcification, infective endocarditis, emboli to the brain,
       rupture of chordae, mitral regurgitation,,arrythmias, and premature ventricular contractions
      Conn’s syndrome : hypertension, hypernatremia, hypokalemia, low rennin levels, metabolic
       alkalosis
      Vitamin K dependent factors : II (prothrombin), VII, IX, X, C, S • deficiency in protein C would
       cause thrombosis NOT bleeding • check hemorrhagic skin necrosis by warfarin
      Prostatic hyperplasia : periurethral zone
      Reye’s syndrome : fatty liver with encephalopathy • Hx : viral illness, severe vomiting, irritability,
       hepatomegaly, elevation of serum ammonia • aquired mitochondrial abnormality •may occur also
       without exposure to salicylates • esp after influenza and cickenpox • mortality rate 50%

Pharmacology –
      DMARDS for RA : MTX • azathiprine • penicillamine •hydroxycholroquine • chloroquine • organic
       gold compounds • sulfasalazine
      Glucocorticoids SE : hypocalcemia, fluid retention, hypokalemia, hyperglycemia, hypernatremia ,
       adrenal suppression, muscle weakness & atrophy, gastrtits, Cushingoid state, immunosuppression,
       hypertension, psychosis , osteoporosis, glaucoma, cataract
      N acetylcyteine : mucolytic used in CF to thin mucous •splits disulfide linkages between these
       mucoproteins  ↓ mucous viscosity
      Dextromethorphan is a cough depressant
      Pentamidine : used in HIV patients with PCP
      Metoclopramide :stimulates motility of intestinal tract • contraindicated in patients with bowel
       obstruction  danger for perforation
      Anticholinergic drugs : may precipitate attacks of narrow angle glaucoma b/c muscarinic
       receptors on the papillary constrictor muscle of the iris are blocked • TCA’s – imipramine,
       amitryptiline, nortriptyline, desipramine, clomipramine,doxepine- can do that !
      Decrease of blood levels of a drug : 1 half life  50 % • 2 half lifes  25 % left in blood • 3 half
       lifes  12,5 % left • 4 half lifes  6,25% left in blood • levels decrease by half every half life
      Retarded ejaculation : can be improved by admin a SSRI • fluexitine, sertraline,citalopram,
       paroxetine.
      β-blockers are used in treatment of hypertrophic cardiomyopathy • β1-blockers : atenolol,
       betaxolol, esmolol, acebutolol, metoprolol
      Bretylium : class III anti-arrythmic • indicated for treatment of ventricular fibrillation and ventricular
       tachycardia
      Digoxin :used in atrial fibrillation • atrial flutter • CHF
      Lidocaine : class Ib antiarrythmic • used in Rx of ventricular tachycardia
      Ventricular tachycardia : amiodarone • bretylium • lidocaine
      Succinylcholine : depolarizing skeletal muscle relaxant • can cause hyperkalemia • PR
       prolongation , widening of QRS , peaked T waves
      Acute interstitial nephritis : caused by ibuprofen, indomethacin, methicillin, cephalothin,
       sulfonamides,thiazides, furosemide, cimeridine,methyldopa •Clinical : ARF ( ↑ BUN, creatinine 0,6-
       1,2 ) fever, maculopapular rash, EOSINOPHILIA !, periorbital edema, wheezing
      Acarbose : delays glucose absoption from GI
      Metformin : causes lactic acidosis • increases the binding of insulin to its receptor
      Oxybutynin : inhibits muscarinic action on smooth muscle (antimuscarinic action) • Rx for bladder
       instability – incontinence, persistent urinary urgency-
      Betanechol : used in urinary retention to contraction of detrusor muscle •
      Gabapentin : used to treat neuropathic pain in diabetic patients • antiepileptic
      Primidone : anticonvulsant • has two active metabolites 1) ohenobarbital 2) phenethylmalonamide •
       associated with cross- hypersensitivity to Phenobarbital
Kaplan – Qbank – High Yield                                                                       -8-
      T3 therapy : increases serum T3 levels • but NOT serum T4 b/c T3 is not converted peripherally to
       T4 • TSH will be low due to feedback inhibition by T3 • decrease of TSH causes also decrease in T4
      Salicylate intoxication : dizziness, tinnitus, hearing impairment , nausea, vomiting,
       hyperventilation , flushing, sweating, metabolic acidosis • agents that acidify urine , such as NH4Cl
       are known dramatically decrease salicylate excretion and subsequently increase salicylic acid
       blood levels • Rx : sodium bicarbonate, sodium lactate
      Jimson weed contains anti-muscarinic agents • in overdose : agitation,mydriasis, hot dry skin,
       tachycardia , decreased bowel sounds
      Stimulants : best way to differentiate stimulatnt overdose from anticholinergic overdose is the skin
       • sweaty  stimulants • dry  anticholinergics
      Opioid intoxication : sleepiness, lethargy, miosis, cool skin , hypoventilation, hypotension,
       bradycardia, decreased bowel sounds •
                          rd
       Cefoperazone : 3 generation cephalosporin •can cause vitamin K deficiency • disulfiram like
       reaction with alcohol • DOC in people with impaired renal function b/c 60% is eliminated by the
       biliary route
      Ticarcillin : β—lactamase sensitive • causes a large salt load  salt retention and hypokalemia
      Carbidopa blocks a pyridoxal dependent decarboxylase located in the mucosa of the GI tract and
       in systemic circulation
      Heparin is the most common cause of drug induced thrombocytopenia •risk for development
       thrombocytopenia increases as the duration of therapy increases (more than 10days e.g) • no skin
       necrosis
      Warfarin & hemorrhagic skin necrosis : associated protein C deficiency in the patient • presents
            rd     th
       on 3 - 10 day of therapy • may lead to necrosis of skin (typically on breast, thighs, and buttocks) •
       heterozygote carriers for protein C become homozygote when given warfarin in 6~8 hrs when the
       half life of previously γ-carboxylated protein C disappears.Now the patient is hypercoagulable •
       warfarin is used for prophylaxis and treatment of thromboembolic complications associated with
       cardiac valve replacement and atrial fibrillation, as well as the prophylaxis and treatment of venous
       thrombosis and pulmonary embolism •
      Aminoglycosides & nonoliguric RF : some patients develop a non-oliguric form of renal failure
       when treated with aminoglycosides such as gentamycin • elevation of creatinine •
      Cephalothin/Methicillin interstitial nephritis : fever + rash + acute renal failure + eosinophilia
      Central pontine myelinolysis : demyelination affecting the central region of basis pontis • in
       severe malnourished & dehydrated alcoholics • from rapid correction of hyponatermia
      Hydrocarbon exposure  scrotal carcinoma
      Zolpidem : non-benzodiazepine • hypnotic agent
      Buspirone : non-benzodiazepine •anxiolytic • devoid of sedative ,hypnotic,anticonvulsant and
       muscle relaxant properties
      Obsessive compulsive disorder : clomipramine (TCA) or SSRI (e.g fluexitine)
      Nortriptyline  hyperplrolactinemia (methyl dopa, phenothiazines also)
      Diabetic with sulfa allergy : contraindicated sulfonylureas (chlorpropamide,
       tolbutamide,glyburide,glipizide)
      Methamphetamine : indirect- acting agonist • acts inducing dopamine, NE, and 5HT release •
       dopamine is believed to play an important role in the reward system of the brain and is thought to
       be a significant factor in the reinforcing effects of stimulants ( area involved in reward system :
       ventral tegmental area of midbrain to the nucleus accumbens of the forebrain)
      Hydrocortisone suppositories : indicated for treatment of distal ulcerative colitis • sulfasalazine is
       also used in treatment of UC
      Metronidazole gold standard for pseudomembranous colitis • vancomycin is another option
      Hyoscyamine : anticholinergic • Rx : irritable bowel syndrome • administered before the meal
      Prednisone for treatment of acute flare ups of Crohn’s
      Megestrol acetate & leuprolide : for prostate cancer • GnRH analogs
      Cyclobenzaprine : centrally acting skeletal muscle relaxant • structurally related to tricyclic
       antidepressants • is has anticholinergic side effects ( blurred vision, urinary retention,
       constipation,tachycardia etc)
Kaplan – Qbank – High Yield                                                                     -9-
      Baclofen :centrally acting skeletal muscle relaxant • inhibition of both monosynaptic and
       polysynaptic reflexes • indicated for treatment of spasticity resulting from multiple sclerosis or
       secondary to spinal cord injuries • also Rx for trigeminal neuralgia • fatigue & hypotension
      Traveler;s diarrhea Rx : most cases of traveler’s diarrhea are caused by ETEC, Shigella species
       and Campylobacter jejuni • treat with fluoroquinolones ( ciprofloxacin,ofloxacin, norfloxacin) •
       TMP/SFX is used for children !
      Mebendazole : used for elminths such as Enterobius, Trichuris trichiura, Ascaris lumbricoides
      Diabetic with hypertension : ACE inhibitors • ca2+ blockers
                                   st
       Cefazolin & Cefadroxil : 1 generation cephalosporins • used surgical prophylaxis
      SIADH & drugs : carbamazapine • vincristine,vinblastine • cyclophosphamide • chlorpropamide •
       TCA
   



Physiology –
      Glycoprotein hormones : EPO, LH, FSH, hCG, TSH • bind at cell surface receptors ↑ cAMP levels
      Catecholamine hormones : epinephrine, norepinephrine, dopamine
      Oligopeptide hormones : endorphins, ADH, oxytocin, TRH, GnRH, SS, CCK, secretin, VIP, GIP
      Polypeptide hormones : PTH, calcitonin, insulin, glucagons, pancreatic polypeptide, gastrin,
       ACTH, IGF’s, EGF, FGF, NGF
      Baroreceptor reflex (patient stands up from supine condition) :patient stands up  less blood
       to brain  less firing to baroreceptors  sympathetic stimulation  increase in HR, conduction
       velocity and myocardial contractility  constriction of all arterioles  ↑ TPR  sympathetic
       stimulation of renal vasculature  decrease in renal blood flow  constriction of large veins 
       increases venus return to the heart  ↑ preload
      Transcutaneous electrical nerve stimulation is a method used to lessen severe,chronic pain by
       overly stimulating the involved neurons • gate theory of pain