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USMLE STEP 1 REVIEW

STUDY GUIDE
2013 edition

Brian Jenkins, Md

Doctors In Training.com: USMLE Step 1 Review, 2013 edition

Author: Brian Jenkins, MD

Copyright 2013 Doctors In Training.com, LLC


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Table

Table of ConTenTs

of

II

III

IV

FOUNDATIONS

1.
2.
3.
4.
5.
6.
7.
8.
9.

eMBryology part 1
eMBryology part 2
Cellular o rder
Cytoskeleton and o ther Cellular CoMponents
plasMa M eMBrane
Cellular s uffering and d eath
i nflaMMation
Control of the e xtraCellular environMent
Cellular a daptations

NEUROLOGY

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.

B rain eMBryology
o rganization of the B rain
hypothalaMus
s leep
Cranial n erves
B ranChial a pparatus
r egions of the B rain
B rainsteM in Cross s eCtion
oCClusion syndroMes
vasCular events
M oveMent
Basal ganglia
s pinal Cord and l esions
B raChial plexus and u pper e xtreMity n erves
lower e xtreMity & s keletal M usCle
s ensation
eye
e ar
d eliriuM and d eMentia
h eadaChe
B rain tuMors
a nesthetiCs
s eizures

PHARM BASICS

1.
2.
3.
4.
5.
6.
7.
8.
9.

parasyMpathetiC aCtivation
parasyMpathetiC i nhiBition
Cellular CoMMuniCation
syMpathetiC aCtivation
syMpathetiC i nhiBition
pharMaCokinetiCs
d rug M etaBolisM
d rug s ide effeCts
a ntidotes

ENDOCRINE

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

endoCrine overview
pituitary
a drenal steroid synthesis
g luCoCortiCoids and Cushing syndroMe
o ther a drenal pathology
thyroid BasiCs and hyperthyroidisM
hypothyroidisM and thyroid C anCer
d iaBetes
dka and d iaBetes treatMent
o Besity
C alCiuM M etaBolisM

3
4
6
10
12
15
17
19
21

ConTenTs

25
26
28
29
31
34
35
37
41
44
47
53
55
58
64
67
69
72
74
76
79
81
83
89
91
93
96
98
99
104
107
110
112
114
116
119
121
123
125
127
128
130
132

[i]

ConTenTs
Table

of

Table of ConTenTs
V

VI

VII

[ ii ]

GI

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.

o ropharynx
e sophagus
stoMaCh
u pper gi path
d uodenuM
panCreas
enteroCytes and a Bsorption
d iseases of s Mall i ntestine
h epatoCytes and Cirrhosis
l iver pathology
h epatitis
B iliary traCt
l arge i ntestine part 1
l arge i ntestine part 2

IMMUNOLOGY

1.
2.
3.
4.
5.
6.
7.
8.
9.

i MMunology BasiCs
a ntigen presentation
t Cells
M onoCytes and MaCrophages
B Cells and a ntiBodies
i MMunization and autoantiBodies
g ranuloCytes , Cytokines , and i MMunosuppressants
CoMpleMent and hypersensitivity
i MMunodefiCienCies

BIOCHEM

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.

rna
protein
g luCose
g lyCogen
energy
hMp s hunt and o ther s ugars
fuel use
l ipids
a Mino aCids and n itrogen
a Mino aCid d isorders
dna BasiCs
dna r epliCation , M utation , and r epair
M inerals
fat-soluBle vitaMins and a ntioxidants
water-soluBle vitaMins
g enetiC l aB teChniques
i nheritanCe

137
139
142
144
146
148
150
152
154
156
158
160
162
164
169
170
172
173
175
177
178
180
182
189
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199
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204
207
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212
213
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219
225
231
234

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IX

XI

MICRO

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.

hiv
hiv d rugs
enteroBaCteriaCeae , d iarrhea , and food poisoning
protozoa
h elMinths and eCtoparasites
BaCterial BasiCs
BaCterial toxins
staphyloCoCCus
streptoCoCCus
o ther g raM positives
peniCillins
Cephalosporins
o ther Cell wall i nhiBitors
tB and tB drugs
s piroChetes and zoonotiCs
n onstaining BaCteria
MyCology
a ntifungals
uti
o ther g raM n egative BaCteria
protein synthesis i nhiBitors
viral BasiCs
h erpes viruses
o ther dna viruses
rna viruses part 1
rna viruses part 2
M iCro By systeMs part 1
M iCro By systeMs part 2

HEME

1.
2.
3.
4.
5.
6.

Clotting faCtors
rBC s
n onheMolytiC a neMias
h eMolytiC a neMias
platelets
C anCers of B lood

ONCOLOGY

1.
2.
3.
4.
5.

g enetiCs of C anCer
C anCer r isk faCtors
n eoplastiC progression
C anCer prevention and host d efense
C anCer d rugs

MEDICINE IN SOCIETY

1.
2.
3.
4.
5.
6.
7.
8.

studies and d iagnostiC tests


a ppliCation of test data
B ias and error
ConfidenCe i nterval
p uBliC h ealth
g eriatriCs
h ealthCare systeM
ethiCs

239
241
243
246
248
250
252
254
256
258
260
263
265
267
270
272
274
276
278
280
283
286
288
290
292
294
297
300

ConTenTs

VIII

305
307
309
311
314
316
321
323
325
327
330
335
337
338
341
343
345
347
353
[ iii ]

ConTenTs
Table

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Table of ConTenTs
XII

XIII

XIV

XV

[ iv ]

PULMONARY

1.
2.
3.
4.
5.
6.
7.
8.
9.

a natoMy and physiology


lung voluMes and p ulMonary CirCulation
oxygen and h eMogloBin
oxygenation and ventilation
e xtreMe environMents
pe and dvt
Copd and a sthMa
r estriCtive lung d isease
lung C anCer and i nfeCtions

CARDIOVASCULAR

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.

eMBryology
d evelopMental pathology
C ardiaC o utput
h eart failure
edeMa and s hoCk
C ardiaC CyCle
h eart M urMurs
eleCtrophysiology
a ntiarrhythMiCs
eleCtroCardiography
a rrhythMias
r egulation of Bp
hypertension
a ntihypertensives
atherosClerosis
a ntianginal therapy and l ipid -lowering agents
MyoCardial i nfarCtion
C ardioMyopathies and endoCarditis
o ther C ardiaC pathology
vasCular d iseases

RHEUM & DERM

1.
2.
3.
4.
5.

B one and B one d isorders


J oint BasiCs
J oint d iseases
systeMiC d isorders
d erMatology

PSYCH

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

psyChology
Child psyCh
a lCohol a Buse
s uBstanCe a Buse
psyChosis
B ipolar d isorder
d epression
a ntidepressants
a nxiety and soMatoforM d isorders
ego d efense M eChanisMs and personality d isorders

357
359
362
364
367
370
372
374
376
381
384
386
388
390
392
394
396
397
398
400
404
406
408
411
414
416
419
421
432
429
432
434
436
439
445
448
451
453
455
457
458
460
462
464

Table

Table of ConTenTs

of

RENAL

1.
2.
3.
4.
5.
6.

r enal BasiCs
n ephron physiology
d iuretiCs
M etaBoliC d isorders
g loMerular pathology
o ther r enal pathology

XVII REPRODUCTION
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

a natoMy & eMBryology


a ndrogens
testiCular pathology
penis and prostate pathology
feMale r eproduCtive CyCle
B irth Control and M enopause
vaginal and CerviCal pathology
u terine pathology
ovarian pathology
pregnanCy part 1
pregnanCy part 2
ChroMosoMal d isorders
g enetiC d isorders: ad and trinuCleotide r epeats
g enetiC d isorders: ar and x-l inked
B reast

XVIII PEDIATRICS
1.

pediatriC r eview

469
471
475
477
480
482

ConTenTs

XVI

487
489
490
492
495
497
499
501
503
506
509
511
513
515
518
522

[v]

Notes

Notes
key to aBBreviations

This Study Guide contains page references to several medical educational resources.
Below is a key to the abbreviations that accompany the various page number references
appearing in this text.

FA13

Le, T, Bhushan, V, et al. First Aid for the USMLE Step 1 2013. New
York, NY: McGraw-Hill; 2013.

FA12

Le, T, Bhushan, V, et al. First Aid for the USMLE Step 1 2012. New
York, NY: McGraw-Hill; 2012.

SU13

Jenkins, B, et al. Step-Up to USMLE Step 1 2013. Philadelphia, PA:


Lippincott Williams & Wilkins; 2013

Phys

Hall, JE. Guyton and Hall Textbook of Medical Physiology. 12th ed.
Philadelphia, PA: Saunders Elsevier; 2011.

Kumar, V, Abbas, AK, et al. Robbins and Cotran Pathologic Basis of


Disease. 8th ed. Philadelphia, PA: Saunders Elsevier; 2010.

COA

Moore, KL, Dalley, AF, & Agur, AMR. Clinically Oriented Anatomy.
6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010.

Longo, DL, Fauci, AS, Kasper, DL, Hauser, SL, Jameson, JL, Loscalzo,
J, eds. Harrisons Principles of Internal Medicine. Vol. 2. 18th ed. New
York, NY: McGraw-Hill; 2012.

GG

Brunton, LL, Chabner, BA, & Knollman, BC, eds. Goodman & Gilmans The
Pharmacological Basis of Therapeutics. 12th ed. New York, NY: McGrawHill; 2011.

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[ vi ]

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foundations 1 - eMBryology part 1


foundations 2 - eMBryology part 2
foundations 3 - Cellular o rder
foundations 4 - Cytoskeleton and
o ther Cellular CoMponents
foundations 5 - plasMa M eMBrane
foundations 6 - Cellular s uffering and
d eath
foundations 7 - i nflaMMation
foundations 8 - Control of the
e xtraCellular environMent
foundations 9 - Cellular a daptations
n euro 1 - B rain eMBryology
n euro 2 - o rganization of the B rain
n euro 3 - hypothalaMus
n euro 4 - s leep
n euro 5 - Cranial n erves
n euro 6 - B rainsteM and B ranChial
a pparatus
pharM BasiCs 1 - parasyMpathetiC
aCtivation
pharM BasiCs 2 - parasyMpathetiC
i nhiBition
pharM BasiCs 3 - Cellular
CoMMuniCation
endoCrine 1 - endoCrine overview
endoCrine 2 - pituitary
endoCrine 3 - a drenal steroid synthesis
endoCrine 4 - g luCoCortiCoids and
Cushing syndroMe
endoCrine 5 - o ther a drenal
pathology
pharM BasiCs 4 - syMpathetiC aCtivation
pharM BasiCs 5 - syMpathetiC i nhiBition
gi 1 - o ropharynx
endoCrine 6 - thyroid BasiCs and
hyperthyroidisM
endoCrine 7 - hypothyroidisM and
thyroid C anCer
i MMunology 1 - i MMunology BasiCs
i MMunology 2 - a ntigen presentation
i MMunology 3 - t Cells

32. i MMunology 4 - MonoCytes and


MaCrophages
33. B ioCheM 1 - rna
34. B ioCheM 2 - protein
35. i MMunology 5 - B Cells and a ntiBodies
36. i MMunology 6 - i MMunization and
autoantiBodies
37. i MMunology 7 - g ranuloCytes ,
Cytokines , and i MMunosuppressants
38. i MMunology 8 - CoMpleMent and
hypersensitivity
39. i MMunology 9 - i MMunodefiCienCies
40. M iCro 1 - hiv
41. M iCro 2 - hiv d rugs
42. gi 2- e sophagus
43. gi 3 - stoMaCh
44. pharM BasiCs 6 - pharMaCokinetiCs
45. gi 4 - u pper gi path
46. gi 5 - d uodenuM
47. gi 6 - panCreas
48. endoCrine 8 - d iaBetes
49. endoCrine 9 - dka and d iaBetes
treatMent
50. gi 7 - enteroCytes and a Bsorption
51. gi 8 - d iseases of s Mall i ntestine
52. B ioCheM 3 - g luCose
53. B ioCheM 4 - g lyCogen
54. B ioCheM 5 - energy
55. B ioCheM 6 - hMp s hunt and o ther
s ugars
56. B ioCheM 7 - fuel use
57. endoCrine 10 - o Besity
58. gi 9 - h epatoCytes and Cirrhosis
59. gi 10 - l iver pathology
60. gi 11 - h epatitis
61. gi 12 - B iliary traCt
62. B ioCheM 8 - l ipids
63. B ioCheM 9 - a Mino aCids and
n itrogen
64. B ioCheM 10 - a Mino aCid d isorders
65. pharM BasiCs 7 - d rug M etaBolisM

R ecommended couRse o RdeR

Recommended couRse oRdeR

[ vii ]

R ecommended couRse o RdeR

Recommended couRse oRdeR


66.
67.
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[ viii ]

99.
100.

h eMe 1 - Clotting faCtors


h eMe 2 - rBC s
B ioCheM 11 - dna BasiCs
B ioCheM 12 - dna r epliCation ,
M utation , and r epair
B ioCheM 13 - M inerals
h eMe 3 - n onheMolytiC a neMias
h eMe 4 - h eMolytiC a neMias
h eMe 5 - platelets
h eMe 6 - C anCers of B lood
B ioCheM 14 - fat-soluBle vitaMins and
a ntioxidants
B ioCheM 15 - water-soluBle vitaMins
gi 13 - l arge i ntestine 1
gi 14 - l arge i ntestine 2
M iCro 3 - enteroBaCteriaCeae , d iarrhea ,
and f ood poisoning
M iCro 4 - protozoa
M iCro 5 - h elMinths and eCtoparasites
o nCology 1 - g enetiCs of C anCer
o nCology 2 - C anCer r isk faCtors
o nCology 3 - n eoplastiC progression
o nCology 4 - C anCer prevention and
h ost d efense
o nCology 5 - C anCer d rugs
M ediCine in soCiety 1 - studies and
d iagnostiC tests
M ediCine in soCiety 2 - a ppliCation of
test data
M ediCine in soCiety 3 - B ias and error
M ediCine in soCiety 4 - ConfidenCe
i nterval
M ediCine in soCiety 5 - p uBliC h ealth
M ediCine in soCiety 6 - g eriatriCs
M ediCine in soCiety 7 - h ealthCare
systeM
M ediCine in soCiety 8 - ethiCs
p ulMonary 1 - a natoMy and physiology
p ulMonary 2 - lung voluMes and
p ulMonary CirCulation
p ulMonary 3 - oxygen and h eMogloBin
p ulMonary 4 - oxygenation and
ventilation
p ulMonary 5 - e xtreMe environMents
p ulMonary 6 - pe and dvt

101. p ulMonary 7 - Copd and a sthMa


102. p ulMonary 8 - r estriCtive lung d isease
103. p ulMonary 9 - lung C anCer and
i nfeCtions
104. M iCro 6 - BaCterial BasiCs
105. M iCro 7 - BaCterial toxins
106. M iCro 8 - staphyloCoCCus
107. M iCro 9 - streptoCoCCus
108. M iCro 10 - o ther g raM positives
109. M iCro 11 - peniCillins
110. M iCro 12 - Cephalosporins
111. M iCro 13 - o ther Cell wall i nhiBitors
112. M iCro 14 - tB and tB drugs
113. M iCro 15 - s piroChetes and w
114. M iCro 16 - n onstaining BaCteria
115. C ardiovasCular 1 - eMBryology
116. C ardiovasCular 2 - d evelopMental
pathology
117. C ardiovasCular 3 - C ardiaC o utput
118. C ardiovasCular 4 - h eart failure
119. C ardiovasCular 5 - edeMa and s hoCk
120. C ardiovasCular 6 - C ardiaC CyCle
121. C ardiovasCular 7 - h eart M urMurs
122. C ardiovasCular 8 - eleCtrophysiology
123. C ardiovasCular 9 - a ntiarrhythMiCs
124. C ardiovasCular 10 eleCtroCardiography
125. C ardiovasCular 11 - a rrhythMias
126. C ardiovasCular 12 - r egulation of Bp
127. C ardiovasCular 13 - hypertension
128. C ardiovasCular 14 - a ntihypertensives
129. C ardiovasCular 15 - atherosClerosis
130. C ardiovasCular 16 - a ntianginal
therapy and l ipid -lowering agents
131. C ardiovasCular 17 - MyoCardial
i nfarCtion
132. C ardiovasCular 18 - C ardioMyopathies
and e ndoCarditis
133. C ardiovasCular 19 - o ther C ardiaC
pathology
134. C ardiovasCular 20 - vasCular d iseases
135. n euro 7 - r egions of the B rain
136. n euro 8 - B rainsteM in Cross s eCtion
137. n euro 9 - oCClusion syndroMes

138.
139.
140.
141.
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164.
165.
166.
167.
168.
169.
170.
171.
172.
173.
174.
175.
176.

n euro 10 - vasCular events


n euro 11 - MoveMent
n euro 12 - Basal ganglia
n euro 13 - s pinal Cord and l esions
n euro 14 - B raChial plexus and u pper
e xtreMity n erves
n euro 15 - lower e xtreMity & s keletal
M usCle
r heuM & d erM 1 - B one and B one
d isorders
endoCrine 11 - C alCiuM M etaBolisM
r heuM & d erM 2 - J oint BasiCs
r heuM & d erM 3 - J oint d iseases
r heuM & d erM 4 - systeMiC d isorders
n euro 16 - s ensation
r heuM & d erM 5 - d erMatology
M iCro 17 - MyCology
M iCro 18 - a ntifungals
n euro 17 - eye
n euro 18 - e ar
psyCh 1 - psyChology
psyCh 2 - Child psyCh
psyCh 3 - a lCohol a Buse
psyCh 4 - s uBstanCe a Buse
n euro 19 - d eliriuM and d eMentia
n euro 20 - h eadaChe
n euro 21 - B rain tuMors
n euro 22 - a nesthetiCs
n euro 23 - s eizures
psyCh 5 - psyChosis
psyCh 6 - B ipolar d isorder
psyCh 7 - d epression
psyCh 8 - a ntidepressants
psyCh 9 - a nxiety and soMatoforM
d isorders
psyCh 10 - ego d efense M eChanisMs and
personality d isorders
r enal 1 - r enal BasiCs
r enal 2 - n ephron physiology
r enal 3 - d iuretiCs
r enal 4 - M etaBoliC d isorders
r enal 5 - g loMerular pathology
r enal 6 - o ther r enal pathology
M iCro 19 - uti

177. M iCro 20 - o ther g raM n egative


BaCteria
178. M iCro 21 - protein synthesis i nhiBitors
179. M iCro 22 - viral BasiCs
180. M iCro 23 - h erpes viruses
181. M iCro 24 - o ther dna viruses
182. M iCro 25 - rna viruses part 1
183. M iCro 26 - rna viruses part 2
184. M iCro 27 - M iCro By systeMs part 1
185. M iCro 28 - M iCro By systeMs part 2
186. pharM BasiCs 8 - d rug s ide effeCts
187. pharM BasiCs 9 - a ntidotes
188. r eproduCtion 1 - a natoMy &
eMBryology
189. r eproduCtion 2 - a ndrogens
190. r eproduCtion 3 - testiCular
pathology
191. r eproduCtion 4 - penis and prostate
pathology
192. r eproduCtion 5 - feMale r eproduCtive
CyCle
193. r eproduCtion 6 - B irth Control and
M enopause
194. r eproduCtion 7 - vaginal and
CerviCal pathology
195. r eproduCtion 8 - u terine pathology
196. r eproduCtion 9 - o varian pathology
197. r eproduCtion 10 - pregnanCy part 1
198. r eproduCtion 11 - pregnanCy part 2
199. r eproduCtion 12 - ChroMosoMal
d isorders
200. r eproduCtion 13 - g enetiC d isorders:
ad and trinuCleotide r epeats
201. r eproduCtion 14 - g enetiC d isorders:
ar and x-l inked
202. B ioCheM 16 - g enetiC l aBoratory
teChniques
203. B ioCheM 17 - i nheritanCe
204. r eproduCtion 15 - B reast
205. pediatriCs - pediatriC r eview

R ecommended couRse o RdeR

Recommended couRse oRdeR

[ ix ]

froM

eMBryology to the

fundaMentals of Cell
Biology, inflaMMation ,

1 eMBryology

PART 1

2 eMBryology

PART 2

and apoptosis , this


seCtion reviews soMe of
the BasiC sCienCe that
forMs the foundational
underpinnings of

3 Cellular order

MuCh of our MediCal

4 Cytoskeleton and other


Cellular CoMponents

knowledge.

5 plasMa MeMBrane
6 Cellular suffering

and

death

7 inflaMMation
8 Control of the e xtraCellular
environMent
9 Cellular adaptations

[1]

FOUNDATIONS

foundations

What tissues are derived from ectoderm, mesoderm and ectoderm?

part

1.

FOUNDATIONS

Fetal landmarks (FA12 p124) (FA13 p504)


Early fetal development (FA13 p114) (FA13 p504)

eMBryology

eMBryology part 1

2. What is the formula for Gibbs free energy?

END OF SESSION QUIZ


3. What developmental structure matches the following description?
(FA12 p129) (FA13 p508)

Fetal placental structure that secretes hCG


Maternal component of the placenta

4. Order the following molecules by how much energy they contain that can be
made available to fuel endergonic reactions:

5. What are the stages of an embryo between conception and an inner cell mass?
(FA12 p124) (FA13 p504)

[3]

2
part

eMBryology

eMBryology part 2
GG: Chapter 23, 66
Fetal landmarks (FA12 p124) (FA13 p504)
Embryologic derivatives (FA12 p126) (FA13 p505)
Neural development (FA12 p125) (FA13 p408) (SU13 p44-45)
Teratogens (FA12 p127) (FA13 p506) (SU13 p34) (GG p1845)
Important genes of embryogenesis (FA12 p124) (FA13 p504) (SU13 p222-225)
Fetal alcohol syndrome (FA12 p128) (FA13 p507) (GG p641)

3 QUESTION WARM-UP
1.

What embryonic structure (derived from the hypoblast) serves as a secondary


energy source?

2. What embryonic structure serves as a reservoir of nonspecialized


(undifferentiated) stem cells?

3. What are the 3 germ layers that derive from the epiblast? (FA12 p125) (FA13 p504)

4. What neural crest derivatives are found in each of the following adult structures?
Peripheral nervous system
Ear
Eye
Adrenal gland
Mouth
Heart
Digestive system
Thyroid
Skin

5. Homeobox (HOX) Genes


Blueprint for skeletal morphology
Code for transcription regulators
Mutation in Homeobox HOXD-13
[4]

synpolydactyly (extra fused digit between 3rd and

Retinoic acid alters HOX gene expression

FOUNDATIONS

part

(SU13 p140)

eMBryology

END OF SESSION QUIZ

7.

List as many drugs as you can that are contraindicated in pregnancy.


(FA12 p127) (FA13 p506)

8. What is the relationship between the notochord, the neural plate, the neural
tube, and the neural crest cells? (FA12 p125)

9.

What is the embryologic origin of the following adult structures? (FA12 p126) (FA13 p505)

Anterior pituitary
Cornea
Lens
Retina
Olfactory epithelium
Mammary glands
Salivary glands
Sweat glands

rapid-fire faCts
Most common cause of neural tube
defects
Most common cause of congenital
malformations in the US
Most common cause of congenital mental
retardation in the US

[5]

Cellular o rder

Cellular order
Phys: Chapter 2
R: Chapter 3
Nucleus (SU13 p15)
Cell cycle phases (FA12 p79) (FA13 p74) (SU13 p12)
Endoplasmic Reticulum and Golgi (FA12 p79, 80) (FA13 p74-75) (SU13 p15)
Rough ER (FA12 p79) (FA13 p74) (SU13 p256)
Smooth ER (FA12 p79) (FA13 p74) (SU13 p256)
Golgi apparatus (FA12 p80) (FA13 p75)
Enzyme Terminology (FA12 p101) (FA13 p96) (SU13 p156)
Protein Degradation
- Proteasome (FA12 p80) (FA13 p75) (SU13 p15)
- Lysosome

3 QUESTION WARM-UP
1.

What is the embryologic origin of the tissue just proximal to the pectinate line?
What is the origin of the tissue just distal to the anal canal?
(FA12 p126) (FA13 p505) (SU13 p138)

2. What effect might the following teratogens have on a developing fetus?


(FA12 p127) (FA13 p506)

ACE inhibitors
Aminoglycosides
Diethylstilbestrol
Tetracyclines
Valproic acid

3. Which vitamin should not be supplemented in large amounts during pregnancy?


(FA12 p127) (FA13 p506) (SU13 p364)

[6]

Amino acids sequences: 4-8 amino acids; rich in lysine, arginine, and protein
Essential component of proteins bound for or residing in the nucleus (e.g., histones)
Nuclear pores recognize these signals and transport proteins into the nucleus via ATPase
A mutation in a single amino acid may prevent nuclear transport

FOUNDATIONS

Cellular o rder

4. Nuclear Localization Signals

5. Cell Cycle Basics (FA12 p79) (FA13 p74) (SU13 p12)


Cyclins + cyclin-dependent kinases (CDK) phosphorylate target proteins to drive the cell cycle

complete
p21, p27, and p57 bind to and inactivate cyclin-CDK complexes (p53 controls the activation of p21)

G1 S

Cyclin D binds/activates CDK4 phosphorylation of Rb protein Rb protein is released


from transcription factor E2F with E2F unbound, the cell is free to transcribe/synthesize
components needed for progression through the S phase (cyclin E, DNA polymerase,
thymidine kinase, dihydrofolate reductase)
Cyclin E binds/activates CDK2 the cell is allowed to progress into S phase

G2 M

Cyclin A CDK2 complex mitotic prophase


Cyclin B CDK1 complex activated by cdc25 breakdown of nuclear envelope (nuclear
lamin breakdown) and initiation of mitosis

6. I-cell disease (FA12 p80) (FA13 p75) (SU13 p297)

No mannose-6-phosphate to target lysosomal proteins secretion out of cell instead of


into lysosomes
Death by age 8
(+) Corneal clouding, coarse facies, HSM, skeletal abnormalities, restricted joint movement,
+/- MR

[7]

Cellular o rder
A mutant LDL
receptor lacks the
coated-pit binding
site but retains a
functioning LDLbinding site. As a
result, cells with
mutant receptors
are able to bind
LDL normally but
are unable to ingest
it. Individuals with
this mutation have a
higher risk of dying
prematurely from a
myocardial infarction.

[8]

7.

Clathrin

9.

FOUNDATIONS

8. What must be present on a protein in order for that protein to gain entry into
the nucleus?

Cellular o rder

END OF SESSION QUIZ

Which types of proteins are responsible for fostering the progression through
the cell cycle? (FA12 p79) (FA13 p74)

10. Which cyclin-CDK complexes assist in the progression from GI phase to S


phase?

11. Which cyclin-CDK complexes assist in the progression from G2 phase to


M phase?

12. What molecule targets proteins in the endoplasmic reticulum for lysosomes?
(FA12 p80) (FA13 p75)

13. What are the different methods that a cell uses to break down proteins
(proteolysis)?

14. Which cell types are rich in smooth ER? (FA12 p79) (FA13 p74)

[9]

o ther Cellular CoMponents


and

Cytoskeleton

Cytoskeleton and other Cellular CoMponents


Phys : Chapter 2
Cytoskeleton
- Cytoskeletal elements (FA12 p81) (FA13 p76)
- Immunohistochemical stains (FA12 p82) (FA13 p76)
- Microtubule (FA12 p81) (FA13 p76)
- Cilia structure (FA12 p81) (FA13 p76) (SU13 p83)
- Kartagener syndrome (FA12 p81) (FA13 p76) (SU13 p83)
Free soluble cytoplasmic elements
- Free ribosomes
- Enzymes
- Water, elements (potassium), organic molecules (amino acids, glucose)
- Cytoskeleton
Insoluble cytoplasmic inclusions
- Glycogen
- Lipid droplets
Sarcoplasmic reticulum
Mitochondria (Phys p16)
Peroxisome

3 QUESTION WARM-UP

1.

Which amino acids are found in nuclear localization signals?

2. What is the most common cause of mental retardation in infants?


(FA12 p128) (FA13 p506) (SU13 p45)

3. How do Rb protein and p53 regulate the cell cycle? (FA12 p79) (FA13 p74)
4. Intermediate Filament Structures
Intermediate Filaments

Structural Component of:

Vimentin
Support cellular membranes

cytoplasm

Connective tissue

Desmin

Muscle cells (smooth, skeletal, heart)

Cytokeratin

Epithelial cells (keratin in desmosomes and


hemidesmosomes)
Astrocytes, Schwann cells, other neuroglia

Peripherin
(L, M, H molecular weight)
Nuclear lamins (A, B,C)
[ 10 ]

Neurons
Axons within neurons
Nuclear envelope and DNA within

and

FOUNDATIONS

5. What drugs act on microtubules? (FA12 p81) (FA13 p76) (SU13 p262, 319)

Cytoskeleton

END OF SESSION QUIZ

7.

Which organelle is responsible for the breakdown of very long-chain fatty acids?
(FA12 p80) (FA13 p75)

o ther Cellular CoMponents

6. What two fundamental substances are required to make most things work inside
the cell?

structures? (FA12 p82) (FA13 p79)

9.

Connective tissue
Muscle tissue
Epithelial tissue
Axons

What are the defects seen in Kartagener syndrome?


(FA12 p81) (FA13 p76) (SU13 p83, 124)

[ 11 ]

plasMa M eMBrane

plasMa MeMBrane
Phys: Chapters 2, 4
R: Chapter 2
Plasma membrane
- Composition
- Sodium pump
- Sodium-mediated diffusion (Phys p54)
Arachidonic acid (R p58)

3 QUESTION WARM-UP
1.

During what weeks of fetal development does organogenesis take place? (FA12 p124)
(FA13 p504)

2. What molecules provide the structural framework for DNA and the nuclear envelope?

(FA12 p80) (FA13 p75) (SU13 p297)

[ 12 ]

J.

B.

K.

C.

L.

D.

M.

E.

N.

F.

O.

G.

P.

H.

Q.

I.

R.

FOUNDATIONS

A.

plasMa M eMBrane

4. List the steps outlining the derivatives of arachidonic acid. (FA12 p429) (FA13 p404)

5. Tyrosine kinase receptor


Transmembrane receptors that bind an extracellular ligand then intracellularly transfer a
that is initiated by tyrosine kinase receptors is autophosphorylation.
PDGF and other growth factor receptors: single-pass transmembrane protein
Insulin and IGF-1 receptors:
- 2
- 2 subunits tyrosine kinase activity

[ 13 ]

plasMa M eMBrane

END OF SESSION QUIZ


6. Which arachidonic acid product causes each of the following effects?
(FA12 p429) (FA13 p404) (SU13 p272)

7.

Increased bronchial tone


Decreased bronchial tone
Increased platelet aggregation
Decreased platelet aggregation
Increased uterine tone
Decreased uterine tone
Increased vascular tone
Decreased vascular tone

What are the two most abundant substances in plasma membranes?


(FA12 p81) (FA13 p76)

8. What drugs act on the arachidonic acid product pathway? What enzymes do
they affect? (FA12 p429) (FA13 p404)

5
[ 14 ]

d eath

Defects in membrane permeability

and

Apoptosis (FA12 p244) (FA13 p212)


- Intrinsic pathway
- Extrinsic pathway
Necrosis (FA12 p244) (FA13 p212)

FOUNDATIONS

R: Chapter 1

Cellular s uffering

Cellular suffering and death

3 QUESTION WARM-UP
1.

What drug inhibits the cellular sodium-potassium ATPase? (FA12 p82) (FA13 p77)

2. What drugs interfere with microtubule functioning? (FA12 p81) (FA13 p76) (SU13 p319)

3. Which cell types are constantly regenerating themselves due to an absence of


the G0 phase and a short G1 phase? (FA12 p79) (FA13 p74)

4. Intrinsic Pathway of Apoptosis (FA12 p244) (FA13 p212)

Bcl-2 is the major anti-apoptotic regulator of mitochondrial permeability


DNA damage or apoptotic signal activates Bax (pro-apoptotic)
Bax creates channels in mitochondrial membrane
Cytochrome C moves from the mitochondria into the cytosol and activates caspases
Caspases are primary initiator of apoptosis

5. Extrinsic Pathways of Apoptosis


Death receptor
- TNF receptor and Fas receptor are located on cell membrane
- TNF- and Fas ligand activate the receptors
- Activated receptors will lead to activation of caspases
Cytotoxic T Lymphocyte
- Cytotoxic T cells recognize foreign or infected cell
- CTLs release perforin and granzyme B
- Perforin punches holes in membrane
- Granzyme B enters and activates caspases

[ 15 ]

ATP depletion: due to decreased oxygen/nutrients and toxins (cyanide)


Mitochondrial damage: impairs ATP production and can induce apoptosis

proteases, endonucleases and ATPases


Accumulation of oxygen-derived free radicals: cell dame through membrane lipid

Cellular s uffering

and

d eath

6. Mechanisms of Cell Injury

exposure, metabolism of drugs, redox reaction, nitric oxide, transition metals, leukocyte
oxidative burst, iron overdose and reperfusion injury.

7.

What cellular byproducts might you detect in the serum when the following cell
types are injured?
Cardiac myocytes
Skeletal myocytes
Hepatocytes
Salivary gland cells
Pancreatic exocrine cells

RBCs

END OF SESSION QUIZ


8. What histologic features are seen in apoptotic liver cells? (FA12 p244) (FA13 p212)

9.

What substances do cytotoxic T cells and NK cells use to induce apoptosis in the
cells infected with virus? (FA12 p244) (FA13 p212) (SU13 p289)

10. What highly damaging events can cause irreversible cell injury?
(FA12 p245) (FA13 p213)

11. What cellular enzymes are responsible for handling oxygen free radicals? (R p21)

[ 16 ]

FOUNDATIONS

R : Chapter 2

i nflaMMation

inflaMMation
- Leukocyte extravasation (FA12 p247) (FA13 p215) (SU13 p118)

- Granulomatous diseases (FA12 p246) (FA13 p214)


- Erythrocyte sedimentation rate (FA12 p248) (FA13 p217)
- C-reactive protein (R p74)
- Systemic effects (R p74)

3 QUESTION WARM-UP
1.

What are the characteristic features of a cell undergoing apoptosis?


(FA12 p244) (FA13 p212)

2. What are some of the substances that can trigger apoptosis?

3. What neural crest derivatives are found in each of the following adult structures?
(FA12 p126) (FA13 p505)

Peripheral Nervous System


Ear
Eye
Adrenal Gland
Mouth
Heart
Digestive System
Thyroid
Skin

[ 17 ]

i nflaMMation

4. Elevated ESR (FA12 p248) (FA13 p217)

Polymyalgia rheumatica
Temporal arteritis
Disease activity in RA and SLE
Malignancy

5. C-Reactive Protein (R p498)


Acute-phase reactant synthesized by the liver
Part of the innate immune response: opsonizes bacteria and activates complement
Can be secreted from cells within atherosclerotic plaques to activate local endothelial cells
to induce a prothrombotic state and increase the adhesiveness of the endothelium to
leukocytes
Elevations are a strong predictor of MI, stroke, PAD, and sudden cardiac death
CRP can be lowered by smoking cessation, exercise, weight loss, and statins

END OF SESSION QUIZ

6. Describe the process of leukocyte extravasation. (FA12 p247) (FA13 p215)

7.

What cytokine is particularly important in the formation of granulomas? (FA12 p248)


(FA13 p216)

C-reactive protein?

[ 18 ]

1.

FOUNDATIONS

3 QUESTION WARM-UP

e xtraCellular environMent

Collagen (R p95)
Collagen synthesis and structure (FA12 p83) (FA13 p78) (SU13 p256)
Fibroblasts
Osteogenesis imperfecta (FA12 p83) (FA13 p78) (SU13 p258)
Ehlers-Danlos syndrome (FA12 p83) (FA13 p78) (SU13 p265)
Alport syndrome (FA12 p84) (FA13 p79) (SU13 p178)
Elastin (FA12 p84) (FA13 p79) (SU13 p256)
Mechanisms of angiogenesis (R p99)
Cutaneous wound healing (FA12 p248) (FA13 p216) (R p102)

of the

R: Chapter 3

Control

Control of the extraCellular environMent

What protein is involved in transporting an endocytosed vesicle from the plasma


membrane to the endosome? (FA12 p80) (FA13 p75)

2. Which metals are known to facilitate the generation of oxygen free radicals?

3. Which tumor suppressor proteins prevent the progression of the cell into S phase?
(FA12 p79) (FA13 p76)

4. Epithelial Wound Healing


0-3 hours

3-5 days
Months

- Hemorrhage and clotting

- Granulation tissue (especially at wound edges)


- Collagen production (type III then type I)

[ 19 ]

e xtraCellular environMent

(FA12 p83) (FA13 p78)

6. What are the different types of collagen, and where can they be found?
(FA12 p82) (FA13 p79)

Control

of the

END OF SESSION QUIZ

7.

Which amino acids are found in large concentrations in collagen? In elastin?


(FA12 p83-84) (FA13 p78-79)

8. What is the role of vitamin C in collagen production? (FA12 p83) (FA13 p78)

rapid-fire faCts
dissection, lens dislocation
Hereditary nephritis, cataracts,
sensorineural hearing loss

[ 20 ]

Replacement
- Stem cells (R p82)
- Liver regeneration (R p93)
Metaplasia
Atrophy (FA12 p246) (FA13 p214) (R p9)
Cellular aging (R p39-40)

FOUNDATIONS

R : Chapter 1, 3

Cellular a daptations

Cellular adaptations

3 QUESTION WARM-UP
1.

What is the underlying dysfunction in Chdiak-Higashi syndrome?


(FA12 p81) (FA13 p16)

2. How does having a high cholesterol content in the plasma membrane affect the
function of the plasma membrane? (FA12 p81) (FA13 p76)

3. What area of the colon is most susceptible to ischemic damage?


(FA12 p245) (FA13 p213)

[ 21 ]

Cellular a daptations

END OF SESSION QUIZ


hyperplasia or hypertrophy? (R p6)

5. Does myometrial growth in pregnancy occur primarily as a result of hyperplasia


or hypertrophy? (R p7)

6. What can happen to the cells of the lower esophagus in response to chronic acid
(FA12 p352) (FA13 p325) (SU13 p142) (R p10)

7.

What is actually occurring at the cellular level during atrophy? (R p10)

8. What is a lipofuscin granule? (R p10)

[ 22 ]

neurology

neuroanatoMy

neurosCienCe are so
iMportant

of the

B rain

dole it out in disCreet

we

follow the Course in


the presCriBed order ,

6 B ranChial apparatus

whiCh our physiCian

B rain

eduCators will explain

Cross seCtion

as the Course unfolds .

9 oCClusion syndroMes
10 vasCular events
11 MoveMent
12 Basal ganglia
13 spinal Cord

and

lesions

14 BraChial plexus and upper extreMity nerves


15 lower e xtreMity

and

skeletal MusCle

16 sensation
17 eye
18 e ar
19 deliriuM

and

deMentia

20 headaChe
21 B rain tuMors
22 anesthetiCs
23 seizures

strongly

reCoMMend that you

5 Cranial nerves

in

videos .

part

[ 23 ]

NEUROLOGY

8 B rainsteM

that we prefer to

throughout the

4 sleep

of the

and at the

Bundles that are spaCed

3 hypothalaMus

7 r egions

saMe tiMe so iMposing

1 B rain eMBryology
2 organization

and

R: Chapter 28
Developing brain (FA12 p133) (FA13 p408) (SU13 p44)
Neural tube defects (FA12 p133) (FA13 p409) (SU13 p45) (R p1284)
Forebrain anomalies (FA12 p134) (FA13 p409) (SU13 p45)
Posterior fossa malformations (FA12 p134) (FA13 p409) (SU13 p45)
Syringomyelia (FA12 p134) (FA13 p410) (R p1286) (H p3373)

B rain eMBryology

Brain eMBryology

1.

NEUROLOGY

3 QUESTION WARM-UP
What adult cell types arise from neural crest cells? (FA12 p126) (FA13 p505) (SU13 p44)

(FA12 p80) (FA13 p75) (SU13 p15)

3. Failure of what process results in I-cell disease? (FA12 p80) (FA13 p75)

END OF SESSION QUIZ


4. What abnormalities are often found with an Arnold-Chiari malformation?
(FA12 p134) (FA13 p409) (SU13 p45)

5. What are the classic presenting symptoms of a syringomyelia? (FA12 p134) (FA13 p410)

anencephaly? (FA12 p134) (FA13 p409) (SU13 p45)

[ 25 ]

B rain
of the

o rganization

organization of the Brain


R: Chapter 28
GG: Chapter 14
Phys: Chapter 45
Cells of the nervous system (FA12 p434) (FA13 p411)
Blood-brain barrier (FA12 p436) (FA13 p413) (SU13 p48)
Neurotransmitters (FA12 p435) (FA13 p413) (GG p376) (Phys p550)

3 QUESTION WARM-UP
1.

What organelle becomes hypertrophied in hepatocytes with chronic


phenobarbital use? (R p7)

2. What enzyme mitigates the aging effects of cellular division by maintaining


chromosomal length? (R p40)

3. What is currently the known as the most effective way of prolonging life span? (R p41)

4. What are the 4 major dopaminergic pathways, and what is the result of blocking
these pathways?
Major pathway
Mesocortical pathway

Mesolimbic pathway

Nigrostriatal pathway

Tuberoinfundibular
pathway

[ 26 ]

Result of blocking

of the

B rain

6. What disease is associated with the degeneration of the basal nucleus of Meynert
and less CNS acetylcholine?

o rganization

5. What disorder is thought to arise from reduced norepinephrine activity? Increased


norepinephrine activity?

NEUROLOGY

END OF SESSION QUIZ


7.

Which nervous system cell matches each of the following descriptions?


(FA12 p434, 436) (FA13 p411-413)

Look like fried eggs under histologic staining


Form multinucleated giant cells in the CNS when infected with HIV
Myelinates multiple CNS axons
Myelinates one PNS axon
Damaged in Guillain-Barr syndrome
Damaged in multiple sclerosis
Macrophages of the CNS
Cells of the blood brain barrier

8. In which neurological diseases is acetylcholine altered? (FA12 p435) (FA13 p413)

9.

What is the main inhibitory neurotransmitter of the CNS? In which diseases are
levels altered? (FA12 p435) (FA13 p413)

10. What are the components of the blood-brain barrier? (FA12 p436) (FA13 p413) (SU13 p48)

[ 27 ]

hypothalaMus

hypothalaMus
Phys: Chapter 58
Organization of the cerebrum
- Limbic system (FA12 p437) (FA13 p415) (SU13 p59)
Nuclei of the hypothalamus (FA12 p436) (FA13 p414) (SU13 p60)
Posterior pituitary (FA12 p436) (FA13 p414)
Oxytocin (Phys p905)
Melatonin

3 QUESTION WARM-UP
1.

Which neurotransmitters have altered levels in anxiety disorder?


(FA12 p435) (FA13 p413)

2. What arachidonic acid product has actions that oppose that of prostacyclin?
(FA12 p429) (FA13 p404)

3. What organelle and cytochrome are particularly important in intrinsic apoptosis?


(FA12 p244) (FA13 p212)

END OF SESSION QUIZ


(FA12 p436) (FA13 p414)

[ 28 ]

Considered the master clock for most of our circadian rhythms


Regulates the parasympathetic NS
Destruction results in hyperthermia
Regulates the sympathetic NS
Produces antidiuretic hormone (ADH) to regulate water balance

Receives input from the retina


Savage behavior and obesity result from stimulation
Savage behavior and obesity result from destruction
Stimulation leads to eating and destruction leads to starvation
Regulates the release of gonadotropic hormones (i.e., LH and FSH)

Responsible for sweating and cutaneous vasodilation in hot temperatures


Destruction results in neurogenic diabetes insipidus
Destruction results in inability to stay warm
Releases hormones affecting the anterior pituitary

s leep

sleep
Phys: Chapter 59
H: Chapter 27

NEUROLOGY

Sleep stages (FA12 p64) (FA13 p61) (SU13 p63-64)


Common Sleep Disorders
- Insomnia (SU13 p64)
- Restless leg syndrome (SU13 p64)
- Night Terrors (FA12 p65) (FA13 p62) (SU13 p64)
- Obstructive sleep apnea
- Narcolepsy (FA12 p65) (FA13 p62) (SU13 p64)
- Nocturnal enuresis (SU13 p64)
Sleep patterns of depressed patients (FA12 p64) (FA13 p62)
Medications for insomnia

3 QUESTION WARM-UP
1.

What effect might aminoglycosides have on a developing fetus? (FA12 p127) (FA13 p506)

2. What molecule targets proteins in the endoplasmic reticulum for lysosomes?

3. Which amino acids are found in nuclear localization signals?

4. What medications are common in the treatment of insomnia? What makes each
one unique?
Melatonin
Valerian
Antihistamines (Benadryl,
Tylenol PM, doxylamine)
Trazodone
TCAs such as amitriptyline,
doxepin
Long acting benzodiazepines
such as temazepam,
lorazepam, clonazepam,
diazepam, chlordiazepoxide
Zolpidem (Ambien), zaleplon
(Sonata)
Eszopiclone (Lunesta)
Ramelteon (Rozerem)

Non-addictive, OTC, vivid dreams, safe for < 3


months

with poor sleep quality, not for long-term use,


anticholinergic side effects (avoid in the elderly)
Antidepressant, increases REM sleep, small risk of
priapism
Antidepressant, small risk of arrhythmias (obtain
EKG prior to use), anticholinergic side-effects
(avoid in the elderly)
Addictive, short-term only (< 35 days)

Act at the benzo receptor, short-term only (< 35


days), rebound insomnia when discontinued
May be used long-term (FDA 2004)
Non-addictive because it works at melatonin
receptors instead of GABA/benzo receptors;
are lacking

[ 29 ]

s leep

5. What is the treatment for narcolepsy? (H p220)

Avoidance of drugs that cause sleepiness


Scheduled naps (once or twice a day for 10-20 min)
Support group attendance
Sodium oxybate (GHB) can assist in sleep and reduce cataplexy

END OF SESSION QUIZ


6. What EEG waveforms correspond to the different stages of sleep? (SU13 p64)

7.

What drugs are used to shorten Stage N3 sleep?

8. What is the key to initiating sleep? What is the principle neurotransmitter involved
in REM? (SU13 p63)

9.

[ 30 ]

What is the pathway by which retinal information induces the release of


melatonin? (FA12 p65) (FA13 p65)

COA: Chapter 7
Cranial nerves (FA12 p465) (FA13 p434) (SU13 p61-62)

Cranial n erves

Cranial nerves
Cranial nerve nuclei (FA12 p456) (FA13 p434)
Extraocular muscles and nerves (FA12 p462) (FA13 p439) (SU13 p58)
Cavernous sinus (FA12 p458) (FA13 p436) (SU13 p63)
Reticular activating system
Vagal nuclei (FA12 p457) (FA13 p435)
Horner syndrome (FA12 p453) (FA13 p431) (SU13 p137)

NEUROLOGY

3 QUESTION WARM-UP
1.

What brain structure is responsible for extraocular movements during REM sleep?
(FA12 p64) (FA13 p617)

2. Name 7 teratogens. (FA12 p127) (FA13 p507)

3. Which areas of the hypothalamus regulate the autonomic nervous system?


(FA12 p436) (FA13 p414)

[ 31 ]

Cranial n erves

4. Label the cranial nerves as they come off the brainstem: (FA12 p455) (FA13 p432-433)

A.

N.

B.

O.

C.

P.

D.

Q.

E.

R.

F.

S.

G.

T.

H.

U.

I.

V.

J.

W.

K.

X.

L.

Y.

M.

[ 32 ]

5. Which cranial nerves have their nuclei located in the medulla?


(FA12 p456) (FA13 p434)

Cranial n erves

END OF SESSION QUIZ

6. Which cranial nerves have their nuclei in the pons? (FA12 p456) (FA13 p434)

Which cranial nerves have their nuclei in the midbrain? (FA12 p456) (FA13 p434)

A 19-year-old patient presents with a furuncle on his philtrum, and the cavernous

NEUROLOGY

7.

(FA12 p458) (FA13 p436)

9.

What are the muscles of mastication? (FA12 p459) (FA13 p437)

rapid-fire faCts
Unilateral facial drooping involving the
forehead
Ptosis, miosis and anhidrosis

[ 33 ]

B ranChial a pparatus

BranChial apparatus
Branchial apparatus (FA12 p135) (FA13 p509) (SU13 p254)
Branchial cleft derivatives (FA12 p136) (FA13 p509)
Branchial pouch derivatives (FA12 p137) (FA13 p511)
Branchial arch derivatives (FA12 p136) (FA13 p510) (SU13 p254)

3 QUESTION WARM-UP
1.

Which cranial nerve is responsible for each of the following actions? (FA12 p456) (FA13 p434)

Eyelid opening
Taste from anterior 2/3 of tongue
Head turning
Tongue movement
Muscles of mastication
Balance
Monitoring carotid body and sinus chemo- and baroreceptors

2. A woman involved in an accident cannot turn head to the left and has a right
shoulder droop. What structure is damaged?

During what sleep stage would a man have variable BP, penile tumescence, and
variable EEG? (SU13 p64)

END OF SESSION QUIZ


4. What nerves innervate the branchial arches? Later, what structures are derived
from these arches? (FA12 p136) (FA13 p510)

5. From which branchial pouch are each of the following structures derived?
(FA12 p137) (FA13 p511)

[ 34 ]

Middle ear and eustachian tubes


Superior parathyroids
Inferior parathyroids
Epithelial lining of the palatine tonsil
Thymus

pharM BasiCs

Most

pharMaCo -

therapeutiCs are
disCussed throughout

1 parasyMpathetiC aCtivation
2 parasyMpathetiC inhiBition
3 Cellular CoMMuniCation
4 syMpathetiC aCtivation
5 syMpathetiC inhiBition
6 pharMaCokinetiCs

8 drug side effeCts


9 antidotes

part 2

videos ,

alongside the diseases


they treat.

BasiCs

the pharM

seCtion Covers

the autonoMiC nervous


systeM and drugs that
Modulate it, Cellular
Messenger systeMs , drug
MetaBolisM and the
four pharMaCokinetiC
equations that
aBsolutely Must Be
understood in order to
survive your exaM .

this

seCtion also inCludes


Material on toxiCology
and iMportant drug side
effeCts .

[ 87 ]

PHARM BASICS

7 drug MetaBolisM

the

GG: Chapters 8-10


Phys: Chapter 60
Autonomic nervous system (FA12 p262) (FA13 p230)
Parasympathetic activation (SU13 p46)
Cholinergic agonists (FA12 p265) (FA13 p233)
Alzheimer disease
Myasthenia gravis (FA12 p422) (FA13 p394)

parasyMpathetiC aCtivation

parasyMpathetiC aCtivation

3 QUESTION WARM-UP
imperfecta? (FA12 p83) (FA13 p78) (SU13 p265)

2. What regulates the progression of G1 phase of the cell cycle to S phase?

3. What cranial nerves innervate the tongue in the following ways?


(FA12 p137) (FA13 p410)

Taste in the anterior 2/3


Taste in posterior 1/3 (main innervation)
Motor
Sensation in the anterior 2/3
Sensation in the posterior 1/3

4. What are the symptoms of excess parasympathetic activity?


(FA12 p265) (FA13 p233) (SU13 p46)

5. Alzheimer disease anticholinesterases


Donepezil
Galantamine
Rivastigmine

[ 89 ]

PHARM BASICS

(FA12 p79) (FA13 p74)

parasyMpathetiC aCtivation

6. Myasthenia Gravis (FA12 p422) (FA13 p394)


Antibodies to the acetylcholine receptor
Most common board question presentation:
worsens throughout the day
Tensilon test
Thymus pathology:
- 50% associated with thymic
- 20% associated with thymic
- 15% associated with thymic
Myasthenic crisis - rapidly progressing weakness esp. in
Rx:
,
,

that

muscles

END OF SESSION QUIZ


7.

How does the parasympathetic nervous system affect the following body
structures?

Heart
Eye
Salivary glands
Bronchiolar smooth muscle
Bladder
Male GU
GI tract

8. What drug regenerates acetylcholinesterases after organophosphate poisoning?


(FA12 p265) (FA13 p233) (SU13 p29, 379)

9.

What is the antidote for organophosphate poisoning?


(FA12 p265) (FA13 p233) (SU13 p29)

10. Which anticholinesterases are used in the treatment of Alzheimer disease?

rapid-fire faCts
Amyloid deposits in gray matter of the
brain
Drooling farmer
[ 90 ]

GG: Chapters 9, 11
Parasympathetic activation review
Parasympathetic inhibition
Muscarinic antagonists (FA12 p266) (FA13 p234)
Other drugs with anticholinergic side effects

parasyMpathetiC i nhiBition

parasyMpathetiC inhiBition

3 QUESTION WARM-UP
1.

What are the symptoms of excess parasympathetic activity? (FA12 p265) (FA13 p233)

2. Atropine is not effective in reversal of organophosphate poisoning. What drug


would best help this patient?

4. What are the symptoms of inhibiting parasympathetic activity?


(FA12 p266) (FA13 p234)

5. What drugs inhibit parasympathetic activity? What are their uses?


(FA12 p266) (FA13 p233)

6. What anticholinergics are used in the treatment of urge type urinary incontinence?

Oxybutynin
Tolterodine
Darifenacin and solifenacin
Trospium

[ 91 ]

PHARM BASICS

3. What are the components of the blood-brain barrier? (FA12 p436) (FA13 p413)

parasyMpathetiC i nhiBition

7.

In what patient populations is atropine contraindicated?


(FA12 p266) (FA13 p234) (SU13 p340)

8. What other medications have anticholinergic side effects?


First generation H1 blockers: diphenhydramine (Benadryl), doxylamine (Unisom),
chlorpheniramine
Neuroleptics
Tricyclic antidepressants
Amantadine

END OF SESSION QUIZ


9.

Identify the following drugs as a direct cholinergic agonist, anticholinesterase, antimuscarinic, or cholinesterase regenerator:

Physostigmine
Pilocarpine
Oxybutynin
Atropine
Donepezil
Pralidoxime
Bethanechol
Neostigmine
Darifenacin
Ipratropium

Tropicamide
Benztropine
Scopolamine
Edrophonium
Tolterodine
Trospium
Rivastigmine
Homatropine
Pyridostigmine
Carbachol

10. Which of the muscarinic antagonists discussed could be used to improve FEV1 in
a patient with COPD?

[ 92 ]

GG: Chapter 3, 8
Phys: Chapter 45, 60
R: Chapter 3
Cholinergic neurotransmission (FA12 p264) (FA13 p232) (SU13 p47) (GG p182) (Phys p731)
Catecholamine synthesis (FA12 p112) (FA13 p108)
Noradrenergic neurotransmission (FA12 p264) (FA13 p232) (SU13 p47)
G protein second messengers (FA12 p263) (FA13 p231) (SU13 p46, 197) (Phys p548) (R p90-91) (GG p52)

Cellular CoMMuniCation

Cellular CoMMuniCation

3 QUESTION WARM-UP
1.

Which agents are often used in the treatment of urge incontinence?

2. What group of genes is responsible for skeletal development?

3. Which cell types are derived from the neural crest?


(FA12 p126) (FA13 p505) (SU13 p44-45)

4. Fill in the diagram of acetylcholine synthesis and neurotransmission:

[ 93 ]

PHARM BASICS

(FA12 p124) (FA13 p504)

Cellular CoMMuniCation

5. Fill in the diagram of norepinephrine synthesis and neurotransmission:

6. Fill the signal transmission pathways:

3
[ 94 ]

7.

What substances inhibit the reuptake of norepinephrine?


(FA12 p264) (FA13 p232) (SU13 p47)

Cellular CoMMuniCation

END OF SESSION QUIZ

8. What substances stimulate the release of norepinephrine from neurons?


(FA12 p264) (FA13 p232) (SU13 p47)

9.

What G protein class does each of the following receptors stimulate?


(FA12 p263) (FA13 p231) (SU13 p197)

1
2
1
2
M1
M2
M3
D2

10. Outline the pathway by which stimulation of a Gs receptor activates protein


kinase A. (FA12 p263) (FA13 p231) (SU13 p197)

[ 95 ]

PHARM BASICS

syMpathetiC aCtivation

syMpathetiC aCtivation
Autonomic nervous system review
Adrenergic receptors (FA12 p263) (FA13 p231) (SU13 p46)
Sympathomimetics (FA12 p266) (FA13 p235)

3 QUESTION WARM-UP
1.

What are the symptoms of organophosphate poisoning? What are the


symptoms of atropine overdose? (FA12 p265-266) (FA13 p234) (SU13 p340)

2. What are the 3 different G proteins and what are their downstream effects?
Which receptors use these G proteins? (FA12 p263) (FA13 p231) (SU13 p197)

3. What regulates prolactin secretion from the pituitary?


(FA12 p317) (FA13 p290) (SU13 p195)

[ 96 ]

4. Which receptors are stimulated by each of the following sympathomimetics?


(FA12 p266-267) (FA13 p235-236)

Clonidine
Dopamine
Phenylephrine
Albuterol
Norepinephrine
Isoproterenol
Epinephrine
Dobutamine
Terbutaline

syMpathetiC aCtivation

END OF SESSION QUIZ

5. Which sympathomimetic matches each of the following statements?


(FA12 p266-267) (FA13 p235-236)

Given as a nebulizer for asthma


Drug of choice for anaphylaxis

Given subQ for asthma


Used by ENT to vasoconstrict nasal vessels

[ 97 ]

PHARM BASICS

syMpathetiC i nhiBition

syMpathetiC inhiBition
GG: Chapter 12
Alpha-blockers (FA12 p268) (FA13 p237) (SU13 p97-98)
Beta-blockers (FA12 p269) (FA13 p238) (SU13 p99-100)
A2 adrenergic agonists (FA12 p267) (FA13 p235)

3 QUESTION WARM-UP
1.

What is the main inhibitory neurotransmitter of the CNS? In which diseases are
levels altered? (FA12 p435) (FA13 p413) (SU13 p47, 74-76)

2. What are the classic presenting symptoms of syringomyelia?


(FA12 p134) (FA13 p410) (SU13 p60)

3. What drug inhibits the cellular sodium-potassium ATPase?

(FA12 p82) (FA13 p77) (SU13 p106)

END OF SESSION QUIZ


4. How does blood pressure response to phenylephrine administration change if
an -blocker is administered beforehand? Why is this different than the change
seen when epinephrine is used rather than phenylephrine? (FA12 p268) (FA13 p238)

5. What are the common side effects of -blockers? Which patient populations
should use caution when taking -blockers? (FA12 p269) (FA13 p238) (SU13 p99-100)

6. What are the various clinical applications of beta-blockers?


(FA12 p269) (FA13 p238) (SU13 p99-100)

[ 98 ]

endoCrine

the

endoCrinology

questions on Board
exaMs tend to Be fairly
straightforward, But

1 endoCrine overview

there is a wide and

2 pituitary

CoMplex variety of

3 adrenal steroid synthesis


4 g luCoCortiCoids

and

Cushing syndroMe

5 other adrenal pathology


6 thyroid BasiCs

and

7 hypothyroidisM

hyperthyroidisM

and

thyroid C anCer

and

pituitary, adrenals ,
thyroid, parathyroids ,
and the endoCrine
panCreas .

pay

speCial

attention to diaBetes
Mellitus , a disease with a
high prevalenCe in Both
the CliniC and on the

8 diaBetes
9 dka

systeMs to understand:

diaBetes treatMent

exaM .

10 oBesity
11 C alCiuM MetaBolisM
ENDOCRINE

[ 111 ]

endoCrine overview

endoCrine overview
Phys: Chapter 74
H: Chapter 338
Signaling pathways of endocrine hormones (FA12 p321) (FA13 p294) (Phys p886) (H p2869)
Signaling pathways of steroid hormones (FA12 p322) (FA13 p295) (Phys p891)
Review of hormone actions and origins (Phys p883)

3 QUESTION WARM-UP
1.

Which cytokine is particularly important in maintaining granulomas? (FA12 p248) (FA13 p216)

2. What is the function of the lysosome? (FA12 p80) (FA13 p75)

3. Outline the pathway by which stimulation of a Gq receptor activates protein


kinase C. (FA12 p263) (FA13 p231)

4. What hormone has each of the following action(s)?

[ 112 ]

Stimulates bone and muscle growth


Stimulates milk production and secretion
Stimulates milk secretion during lactation
Responsible for female secondary sex characteristics
Stimulates metabolic activity
Increases blood glucose level and decreases protein synthesis
Responsible for male secondary sex characteristics
Prepares endometrium for implantation / maintenance of pregnancy
Stimulates adrenal cortex to synthesize and secrete cortisol
Stimulates follicle maturation in females and spermatogenesis in males
Increases plasma calcium, increases bone resorption
Decreases plasma calcium, increases bone formation
Stimulates ovulation in females and testosterone synthesis in males
Stimulates thyroid to produce TH and uptake iodine

Growth hormone (GH)


Thyroid hormone
Glucocorticoids (cortisol)
Progesterone
Prolactin
Oxytocin
Atrial natriuretic hormone (ANH)
Glucagon
Testosterone
Follicle-stimulating hormone (FSH)
Vasopressin (ADH)
Calcitonin

Thyroid-stimulating hormone (TSH)


Epinephrine and norepinephrine
Insulin
Estradiol
Estriol
Estrone
Estrogen in males
Parathyroid hormone (PTH)
Somatostatin
Luteinizing hormone (LH)
Mineralocorticoids (aldosterone)
Adrenocorticotropic hormone (ACTH)

endoCrine overview

5. From where is each of the following hormones secreted?

END OF SESSION QUIZ

binding globulin?

[ 113 ]

ENDOCRINE

binding globulin?

pituitary

pituitary
R: Chapter 24
Phys: Chapter 75
H: Chapter 339
Posterior pituitary (FA12 p314) (FA13 p287) (SU13 p89)
- Antidiuretic hormone
- Oxytocin
Anterior pituitary (FA12 p314) (FA13 p287) (SU13 p193)
- Luteinizing hormone
- Follicle stimulating hormone
- Adrenocorticotropic hormone
- Melanocyte-stimulating hormone
- Thyroid stimulating hormone
- Growth hormone
- Prolactin
Hyperprolactinemia (FA12 p317, 538) (FA13 p290, 523) (SU13 p208, 220) (H p2887)
Pituitary adenoma (FA12 p328) (FA13 p301) (SU13 p208)
Acromegaly (FA12 p328) (FA13 p301) (SU13 p208)
Somatostatin (FA12 p334, 346) (FA13 p306, 319) (SU13 p139, 194, 198)
Sheehan syndrome (FA12 p328) (FA13 p301) (SU13 p208)

3 QUESTION WARM-UP

1.

A gardener presents with shortness of breath, salivation, miosis, and diarrhea. What
caused this? What is the mechanism of action? (FA12 p265) (FA13 p233)

2. What enzyme catalyses the conversion of tyrosine to dopa? (FA12 p112) (FA13 p108)

3. A 30-year-old schizophrenic man now has urinary retention due to his neuroleptic.
What do you treat it with? (FA12 p265) (FA13 p233) (SU13 p341)

4. ACTH and MSH (SU13 p210) (H p2896)


ACTH is synthesized as part of a large precursor called proopiomelanocortin (POMC),
which also contains the sequences for other hormonal peptides, including the lipotropins,
melanocyte-stimulating hormones (MSH) and beta-endorphin.

5. Hyperprolactinemia (FA12 p317, 538) (FA13 p290, 523) (SU13 p208, 220) (H p2887)
Causes
- Pregnancy/nipple stimulation
- Stress (physical or psychological)
- Prolactinoma (associated with bitemporal hemianopia)
- Dopamine antagonists: antipsychotics (haloperidol, risperidone), domperidone,
metoclopramide, methyldopa
Premenopausal female symptoms hypogonadism
infertility, oligo/amenorrhea; rarely
galactorrhea
Postmenopausal female symptoms none since already hypogonadal
Male symptoms hypogonadism (low testosterone)
decreased libido, impotence,
infertility (low sperm counts), gynecomastia, rarely galactorrhea
[ 114 ]

Produced throughout the GI tract but notably by D cells in gut mucosa and pancreatic islet
cells
Also produced throughout the nervous system
In the CNS, PNS, and peripheral organs somatostatin decreases endocrine and exocrine

pituitary

6. Somatostatin (FA12 p334, 346) (FA13 p306, 319) (SU13 p139, 194, 198)

contraction, and inhibits secretion of most gastrointestinal hormones


Clinical Uses for somatostatin analogs (octreotide, somatostatin LAR, and lanreotide-P):
- Pituitary excesses: acromegaly, thyrotropinoma, ACTH-secreting tumors
- GI endocrine excess: Zollinger-Ellison Syndrome, carcinoid syndrome, VIPoma (AKA
pancreatic cholera), glucagonoma, insulinoma
- Certain diarrheal diseases
- Need to reduce splanchnic circulation: portal hypertension (bleeding varices), bleeding
peptic ulcers

END OF SESSION QUIZ


7.

A patients MRI reveals replacement of tissue in the sella turcica with CSF. What is
the most likely clinical presentation?

9.

What is the most common presentation of hyperprolactinemia in a female patient?

10. What are some of the possible clinical features of acromegaly?


(FA12 p328) (FA13 p301) (SU13 p208)

rapid-fire faCts
Inability to breastfeed, amenorrhea, cold
intolerance
Infertility, galactorrhea and bitemporal
hemianopsia

[ 115 ]

ENDOCRINE

8. Which hormones share a common alpha subunit?

a drenal steroid synthesis

adrenal steroid synthesis


R: Chapter 24
Phys: Chapter 77
H: Chapter 342
Adrenal anatomy (FA12 p314) (FA13 p286) (R p1148) (Phys p921)
Fetal adrenal gland (FA12 p314) (FA13 p286)
Steroid synthesis (FA12 p318) (FA13 p291) (SU13 p210) (Phys p923) (H p2940)
Congenital adrenal hyperplasia (FA12 p318) (FA13 p291) (SU13 p209-210) (R p1152) (H p2959)

3 QUESTION WARM-UP
1.

What is the precursor molecule of ACTH synthesis?

2. What is required for a molecule to enter into the nucleus through a nuclear pore?

3. What are the various clinical applications of atropine? (FA12 p266) (FA13 p234) (SU13 p340)

[ 116 ]

a drenal steroid synthesis

4. Complete the steroid synthesis pathway:

N.

B.

O.

C.

P.

D.

Q.

E.

R.

F.

S.

G.

T.

H.

U.

I.

V.

J.

W.

K.

X.

L.

Y.

M.

Z.

-hydroxysteroid dehydrogenase?
Inability to produce

-hydroxylase?
Inability to produce sex hormones and cortisol
Increased production of mineralocorticoids (i.e. aldosterone)

-hydroxylase?
Inability to produce cortisol
Inability to produce mineralocorticoids
Increased production of sex hormones
[ 117 ]

ENDOCRINE

A.

a drenal steroid synthesis

-hydroxylase?
Inability to produce
Increased production of deoxycorticosterone (a weak mineralocorticoid)
Increased production of sex hormones

END OF SESSION QUIZ


9.

What are the symptoms of 21

FA12 p318) (FA13 p291)

(SU13 p210)

10. What are the symptoms of 11

(FA12 p318) (FA13 p291)

(SU13 p210)

11. What food substance is an essential starting point in the synthesis of adrenal steroids?
(FA12 p318) (FA13 p291) (SU13 p210)

[ 118 ]

R: Chapter 24
Phys: Chapter 77
H: Chapter 342

1.

What are the symptoms of inhibiting parasympathetic activity?


(FA12 p266) (FA13 p234) (SU13 p340)

Cushing syndroMe

3 QUESTION WARM-UP

and

Cortisol (FA12 p323) (FA13 p292)


Glucocorticoids (FA12 p334) (FA13 p306) (SU13 p213)
Cushing syndrome (FA12 p323) (FA13 p296) (SU13 p209-212) (R p1148) (H p2945)

g luCoCortiCoids

gluCoCortiCoids and Cushing syndroMe

(FA12 p112) (FA13 p108) (SU13 p47)

3. What hormones arise from the anterior pituitary? (FA12 p314) (FA13 p287) (SU13 p193-195)

[ 119 ]

ENDOCRINE

2. Outline the pathway for the generation of norepinephrine from tyrosine.

Cushing syndroMe
and

g luCoCortiCoids

END OF SESSION QUIZ


4. An adult male with elevated serum cortisol levels and signs of Cushing syndrome
undergoes a dexamethasone suppression test. 1 mg of dexamethasone does not
decrease cortisol levels, but 8 mg does. What is the diagnosis?
(FA12 p323) (FA13 p296) (SU13 p212)

5. What effect does cortisol have on bone formation and immune system functioning?
(FA12 p319) (FA13 p292) (SU13 p193, 349)

6. What are the potential side effects of glucocorticoid use?


(FA12 p334) (FA13 p306) (SU13 p259)

rapid-fire faCts

Most common causes of Cushing syndrome

[ 120 ]

R: Chapter 24
Phys: Chapter 77
H: Chapters 342, 343, 351
Aldosterone (Phys p924)
Hyperaldosteronism (FA12 p323) (FA13 p296) (SU13 p209-210) (R p1151) (H p2949)
- Primary: Addison disease (FA12 p324) (FA13 p297) (R p1155)
- Primary: Waterhouse-Friderichsen syndrome (FA12 p324) (FA13 p297) (SU13 p210) (R p1155)
- Secondary (FA12 p324) (FA13 p297) (R p1157)
- Tertiary
Pheochromocytoma (FA12 p324) (FA13 p294) (SU13 p211) (R p1159) (H p2962)
Neuroblastoma (FA12 p324) (FA13 p297) (SU13 p211)
MEN (FA12 p332) (FA13 p304) (SU13 p218) (R p1161) (H p3072)

o ther a drenal pathology

other adrenal pathology

3 QUESTION WARM-UP
1.

What hormone has the following action(s)? (SU13 p192-194)

Stimulates milk secretion during lactation


Stimulates metabolic activity
Increases blood glucose level and decreases protein synthesis
Stimulates ovulation in females and testosterone synthesis in males

3. A 50-year-old woman complains of double vision, amenorrhea, and headaches.


What is the most likely diagnosis? (FA12 p328) (FA13 p301) (SU13 p208)

[ 121 ]

ENDOCRINE

2. What enzymes are used in the catabolism of norepinephrine? (FA12 p112) (FA13 p108)

o ther a drenal pathology

END OF SESSION QUIZ


4. What are the clinical manifestations of Addison disease? What is the cause of
Addison disease? (FA12 p324) (FA13 p297) (SU13 p210)

5. What tumor locations are associated with the 3 different types of multiple endocrine
neoplasia? (FA12 p332) (FA13 p304) (SU13 p219)

6. What might a lab detect in the urine of a patient with pheochromocytoma?


(FA12 p324) (FA13 p297) (SU13 p211)

7.

A very tan child with a pale mother presents to your clinic and is found to be
hypotensive. What is the most likely diagnosis? (FA12 p234) (FA13 p297) (SU13 p210)

rapid-fire faCts
Most common tumor of the adrenal
Most common tumor of the adrenal
medulla (in adults)
Most common tumor of the adrenal
medulla (in kids)
Most common cause of primary
hyperaldosteronism
Medical treatment for hyperaldosteronism
Medical treatment for
pheochromocytoma
Pheochromocytoma, medullary thyroid
cancer, and hyperparathyroidism
Pheochromocytoma, medullary thyroid
cancer, and mucosal neuromas
Adrenal disease associated with skin
hyperpigmentation
[ 122 ]

HTN, hypokalemia, metabolic alkalosis

hyperthyroidisM

Thyroid development (FA12 p138) (FA13 p286)


Formation of thyroid hormone (FA12 p322) (FA13 p295)
Hyperthyroidism (FA12 p325-326) (FA13 p286) (SU13 p215-217)
Graves disease (FA12 p326) (FA13 p299) (SU13 p215)
Other causes of hyperthyroidism (FA12 p326) (FA13 p299)
Approach to thyrotoxicosis (SU13 p217)

and

R: Chapter 24
Phys: Chapter 75
H: Chapter 341

thyroid BasiCs

thyroid BasiCs and hyperthyroidisM

3 QUESTION WARM-UP
1.

What primary hormone is increased or decreased in the following diseases?


(FA12 p323-324)

Disease
Cushing syndrome
Conn syndrome
Addison disease

Hormone that is increased or decreased

3. What cancers are associated with RET gene mutation? (FA12 p232) (FA13 p304)

[ 123 ]

ENDOCRINE

2. What is the drug of choice for anaphylactic shock? Cardiogenic shock? Septic
shock? (FA12 p266) (FA13 p235)

4. A 35-year-old woman presents with diffuse goiter and hyperthyroidism. What are
the most likely relative values of TSH and thyroid hormones?
(FA12 p326) (FA13 p299) (SU13 p215-216)

thyroid BasiCs

and

hyperthyroidisM

END OF SESSION QUIZ

5. What would you suspect to be the cause of hyperthyroidism in a patient presenting


(FA12 p325-326) (FA13 p298-299) (SU13 p214-217)

Extremely tender thyroid gland


Pretibial myxedema
Pride in recent weight loss, medical professional
Palpation of single thyroid nodule
Palpation of multiple thyroid nodules
Recent study using IV contrast (iodine)
Eye changes: proptosis, edema, injection
History of thyroidectomy or radioablation of thyroid

6. What is the most common location for ectopic thyroid tissue? (FA12 p138) (FA13 p286)

7.

[ 124 ]

How would pregnancy affect serum thyroid hormone levels? (FA12 p322) (FA13 p295)

R: Chapter 24
Phys: Chapter 77
H: Chapter 341

1.

thyroid C anCer

3 QUESTION WARM-UP

and

Hypothyroidism (FA12 p325) (FA13 p298) (SU13 p214)


Causes of hypothyroidism (FA12 p325) (FA13 p298)
Thyroid cancer (FA12 p326) (FA13 p299) (SU13 p218)

hypothyroidisM

hypothyroidisM and thyroid CanCer

In the dark, both pupils are dilated. (see image) In the light, the control pupil is miotic
while the pupil given drug X remains mydriatic. What is drug X?
(FA12 p266) (FA13 p234-235) (SU13 p46, 340)

2. What are some of the clinical uses for somatostatin?

3. What is the name given to a thyroid hormone-secreting teratoma?


(FA12 p546) (FA13 p331) (SU13 p238)

[ 125 ]

ENDOCRINE

(FA12 p334, 367) (FA13 p306, 340) (SU13 p287)

thyroid C anCer
and

hypothyroidisM

END OF SESSION QUIZ


4. What type of thyroid cancer matches each of the following statements?
(FA12 p326) (FA13 p299) (SU13 p218)

Most common type of thyroid cancer (70-75%)


Second most common type of thyroid cancer (10%)
Activation of receptor tyrosine kinases
Hashimoto thyroiditis is a risk factor
Cancer arising from parafollicular C cells
Commonly associated with either a RAS mutation or a PAX8-PPAR gamma 1
rearrangement
Commonly associated with rearrangements in RET oncogene or NTRK1
Most common mutation in the BRAF gene (serine/threonine kinase)

5. What is the mechanism of action of propylthiouracil? What other drug works like
PTU? What are their side effects? (FA12 p334) (FA13 p306) (SU13 p216)

rapid-fire faCts
Most common thyroid cancer
Cold intolerance
Enlarged thyroid cells with ground-glass
nuclei

[ 126 ]

gi

Join

us on a Journey

through the
gastrointestinal traCt,
froM the Mouth to the

1 oropharynx

anus , and all points in


Between !

2 esophagus

enJoy

sCeniC

exCursions into the

3 stoMaCh

hepatoBiliary systeM and

4 upper gi path

the reCoMMended Course

panCreas !

order , this Chapter also


serves as the stepping -

5 duodenuM

off point for the


BioCheMistry of energy

6 panCreas
7 enteroCytes
8 diseases

MetaBolisM and nutrient


and

of the

9 hepatoCytes

following

aBsorption

utilization .

sMall intestine

and

Cirrhosis

10 l iver pathology
11 hepatitis
12 B iliary traCt
GI

13 l arge intestine 1
14 l arge intestine 2

[ 135 ]

R: Chapter 16
Phys: Chapter 64
H: Chapter 317

o ropharynx

oropharynx
Tongue development (FA12 p137) (FA13 p410) (SU13 p59)
Tongue pathology
Salivary glands (FA12 p347) (FA13 p320)
Salivary gland pathology
Tumors of the salivary glands (FA12 p350) (FA13 p324)
Cleft lip and cleft palate (FA12 p138) (FA13 p511)
Nose
Paranasal sinuses
Tonsils and adenoids

3 QUESTION WARM-UP
1.

Place the following agents in the appropriate categories:


(FA12 p265-269) (FA13 p233-238)

norepinephrine, metoprolol, timolol, scopolamine, phenoxybenzamine, bethanechol,


isoproterenol, donepezil, prazosin, atropine, propranolol, labetalol, hexamethonium,
atenolol, terbutaline, dopamine, pilocarpine, carbachol, edrophonium, phenylephrine,
glycopyrrolate, phentolamine, neostigmine, benztropine, terazosin, pralidoxime,
echothiophate, ipratropium, epinephrine, esmolol, oxybutynin
Direct cholinergic agonists:

Nicotinic antagonist
Cholinesterase regenerator

Cholinergic antagonists:

-adrenergic antagonists (-blockers)

Sympathomimetics:

-adrenergic antagonists (-blockers)

1 2 1 2 agonist
D1 = D2 > 1 > 1 agonist

GI

1 2 1 agonist

Nonselective
(2 = 1)

1 = 2 agonist
2 > 1 agonist
a1 > a2 agonist

1 selective

Indirect cholinergic agonists


(anti-acetylcholinesterases)

(continued)

[ 137 ]

o ropharynx

3 QUESTION WARM-UP - CONT


2. Which portions of the hypothalamus are inhibited by Leptin? Which are
stimulated? (FA12 p436) (FA13 p414) (SU13 p194)

3. Which cranial nerve relays the following types of information?


(FA12 p456) (FA13 p434) (SU13 p61-62)

Hypoxia measured by the carotid body


Motor information for swallowing
Blood pressure from the aortic arch
Salivation from the sublingual glands
Salivation from the parotid gland
Blood pressure from the carotid

END OF SESSION QUIZ

4. What is the most common location of salivary gland tumors?

5. What is the most common salivary gland tumor? What is the histological appearance
of this tumor? (SU13 p141)

6. What is the second most common benign salivary gland tumor? (SU13 p141)

7.

What is the most common malignant salivary gland tumor (the second most
common tumor overall of the salivary gland)?

8. What medication is often used in the treatment of allergic rhinitis, nasal polyps, and
Eustachian tube dysfunction?

[ 138 ]

iMMunology

Many

MediCal students

seeM to view the iMMune


systeM as a CoMpletely
unfathoMaBle and

1 iMMunology BasiCs

unknowaBle Mystery,

2 antigen presentation

a deep oCean of

3 t Cells

depths are never to Be

inforMation whose
pluMBed.

4 MonoCytes

and

5 B Cells

antiBodies

and

6 iMMunization

MaCrophages

and

8 CoMpleMent

and

fear not !

physiCian eduCators

will Break it down


systeMatiCally, adding
layers of knowledge

autoantiBodies

7 g ranuloCytes , Cytokines ,
iMMunosuppressants

our

B ut

and

that foCus on the


preCise faCts you need to
Master for your exaM .

hypersensitivity

9 iMMunodefiCienCies

IMMUNOLOGY

[ 167 ]

R: Chapter 6
H: Chapter 314
MALT (SU13 p287) (H p2675)
Lymph nodes (FA12 p222) (FA13 p192) (SU13 p286) (R p189)
Lymph drainage (FA12 p222) (FA13 p192) (SU13 p286) (COA p44)

i MMunology BasiCs

iMMunology BasiCs

T lymphocytes (FA12 p375) (FA13 p347) (SU13 p288-289) (R p186)

3 QUESTION WARM-UP
1.

What would you suspect to be the cause of hyperthyroidism in a patient


presenting with the symptoms of hyperthyroidism in addition to each of the
(FA12 p326) (FA13 p299) (SU13 p215-218)

Extremely tender thyroid gland


Palpation of single thyroid nodule
Palpation of multiple thyroid nodules
Recent study using IV contrast dye (iodine)
Eye changes: proptosis, edema, injection

2. What are the differences between oligodendroglia and Schwann cells?


(FA12 p434-435) (FA13 p412) (SU13 p44)

3. Describe the sensory innervation of the tongue. (FA12 p137) (FA13 p410) (SU13 p59)

END OF SESSION QUIZ


4. To which lymph nodes do the sigmoid colon and the rectum drain?
(FA12 p222) (FA13 p192)

5. Where can B cells and T cells be found in the lymph nodes? (FA12 p222) (FA13 p192)

IMMUNOLOGY

6. Which MHC are found in T helper cells? Which MHC are found on cytotoxic T
cells? (FA12 p226) (FA13 p196) (SU13 p288)

[ 169 ]

a ntigen presentation

antigen presentation
R: Chapter 6
MHC 1 and 11 (FA12 p224) (FA13 p194) (SU13 p288) (R p190)
HLA subtypes (FA12 p224) (FA13 p194) (R p193)
Dendritic cells (FA12 p374) (FA13 p346) (R p187)
Langerhans cell histiocytosis (FA12 p394) (FA13 p266) (R p631)

3 QUESTION WARM-UP
1.

A 48-year-old woman has been suffering with progressive lethargy and extreme
sensitivity to cold temperatures. What is the most likely diagnosis?

2. What is the most common salivary gland tumor?

3. What are the different sinuses that can become infected and cause sinusitis?

4. Dendritic Cells (FA12 p374) (FA13 p346)


Covered with long membranous extensions that resemble the dendrites of nerve cells
All display both class I and II MHC, B7 family of co-stimulatory molecules, CD80 and CD86

ligand
Purpose: antigen capture at one location and presentation at another location. This is
accomplished by migration to lymph nodes for presentation at T cells
When acting as peripheral sentinels (immature or antigen-capturing state), antigens are
captured by 3 different mechanisms:
- Phagocytosis
- Receptor mediated endocytosis
- Pinocytosis
Immature sentinels make a transition into a new type of cell (antigen-presenting state) that
can travel into circulation and into a cell that has maximal capacity to present to Th cells
(increased expression of class II MHC and co-stimulatory molecules)
Different types:
- Langerhans (from immature epithelial tissue): in epidermal layers of skin (= Cutaneousassociated lymphoid tissue, CALT)
- Interstitial (from immature nonepithelial, interstitial tissue): in interstitial spaces of
virtually all organs (except brain)
- Monocyte-derived (from monocytes (which also give rise to macrophages)): migrated
from bloodstream into tissues
migrate from tissues to blood and lymph and lymph
nodes
- Plasmacytoid derived (from plasmacytoid): APCs in the innate immune response

[ 170 ]

Do not arise from bone marrow like the dendritic cells


Do not express class II MHC
do not present antigen to Th cells
Exclusively reside in lymph follicles

a ntigen presentation

5. Follicular Dendritic Cells

END OF SESSION QUIZ


cell with Langerhans cell histiocytosis? (FA12 p394) (FA13 p366)

7.

What molecules are expressed on the surface of antigen presenting dendritic


cells? (FA12 p374) (FA13 p366)

8. What are 3 cell types that are known for presenting antigens to T cells?

(FA12 p226) (FA13 p196)

IMMUNOLOGY

[ 171 ]

t Cells

t Cells
R: Chapter 6
H: Chapter 314
T cell differentiation (FA12 p225) (FA13 p195) (SU13 p289) (R p195)
Helper T cells (FA12 p226 ) (FA13 p196) (R p186)
Thymus (FA12 p223) (FA13 p193) (SU13 p286) (R p635)
T cell activation (FA12 p226) (FA13 p196) (R p195)
Cytotoxic T cells (FA12 p227) (FA13 p197) (SU13 p288-289) (R p207)
Regulatory T cells (FA12 p227) (FA13 p197)
NK cells (FA12 p224) (FA13 p194) (R p188)

3 QUESTION WARM-UP
1.

What are the various clinical uses for the following sympathomimetics?
(FA12 p266-267) (FA13 p235)

Dopamine
Clonidine
Amphetamine
Terbutaline
Epinephrine

(FA12 p262) (FA13 p230) (Phys p733) (GG p255-258)

3. What structures are derived from the branchial pouches? (FA12 p137) (FA13 p511)

END OF SESSION QUIZ


4. Which cytokines are produced by Th1 cells? Which cytokines are produced by
Th2 cells? (FA12 p226) (FA13 p196)

5. Which cytokines inhibit Th1 cells? Which inhibit Th2 cells? (FA12 p226) (FA13 p196)

6. How do cytotoxic T cells kill virus-infected cells and neoplastic cells?


(FA12 p227) (FA13 p197)

[ 172 ]

MaCrophages

Monocytes (FA12 p373) (FA13 p345) (SU13 p285) (Phys p426) (H p2654)
Macrophages (FA12 p373) (FA13 p345) (SU13 p285) (R p188)
Interferons (FA12 p230) (FA13 p200-201) (SU13 p292) (R p195)
Acute phase cytokines (FA12 p230) (FA13 p200) (SU13 p292) (R p61, 193, 200)
Spleen (FA12 p223) (FA13 p193) (SU13 p286) (R p632)

and

R: Chapter 6
Phys: Chapter 33

M onoCytes

MonoCytes and MaCrophages

3 QUESTION WARM-UP
1.

What are the common side effects of -blockers?


(FA12 p269) (FA13 p238) (SU13 p99-100)

hyperthyroidism?

3. What is the precursor molecule of ACTH synthesis?

4. Monocytes (FA12 p373) (FA13 p345) (SU13 p285)


Leave bone marrow for blood
circulate 8 hours to mature
become macrophages
Blood, alveoli, intestines macrophages
Connective tissue histiocytes
Liver Kupffer cells
Kidney mesangial cells
Brain microglia
Bone osteoclasts

migrate into tissues to

IMMUNOLOGY

[ 173 ]

MaCrophages
and

M onoCytes

END OF SESSION QUIZ


5. Which cytokine more than any other should be known as the macrophageactivating cytokine? (FA12 p373) (FA13 p345) (SU13 p285)

6. What are the acute phase cytokines that are produced by macrophages?
(FA12 p231) (FA13 p200) (SU13 p292)

7.

What is the function of macrophages in the spleen?


(FA12 p223) (FA13 p193)

8. What name is given to RBCs partially digested by splenic macrophages?


(FA12 p378-379) (FA13 p350-351)

[ 174 ]