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STUDY GUIDE
2013 edition
Brian Jenkins, Md
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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
193
194
197
199
203
204
207
210
212
213
215
217
219
225
231
234
Table
Table of ConTenTs
of
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.
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
of
Table of ConTenTs
XII
XIII
XIV
XV
[ iv ]
PULMONARY
1.
2.
3.
4.
5.
6.
7.
8.
9.
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
1.
2.
3.
4.
5.
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.
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
Phys
Hall, JE. Guyton and Hall Textbook of Medical Physiology. 12th ed.
Philadelphia, PA: Saunders Elsevier; 2011.
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.
Neither the Doctors In Training USMLE Step 1 Review Course, nor this Study Guide, is endorsed by or
Part 2 consists of 205 videos. Examples of 12, 15, 19, 21, and 25 day plans are provid-
No. of Videos/Day
Video Runtime/Day*
12-day plan
17
15-day plan
14
19-day plan
11
21-day plan
10
Approx. 4 hrs
25-day plan
Approx. 3 hrs
*Does not include study breaks or time spent annotating and answering questions.
[ vi ]
a lthough
you have the flexiBility to view the videos in any order , we strongly reCoMMend
that you watCh the videos in the order in whiCh your personalized dashBoard presents theM
regardless of how Many videos you view in a day.
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.
29.
30.
31.
[ vii ]
[ viii ]
99.
100.
138.
139.
140.
141.
142.
143.
144.
145.
146.
147.
148.
149.
150.
151.
152.
153.
154.
155.
156.
157.
158.
159.
160.
161.
162.
163.
164.
165.
166.
167.
168.
169.
170.
171.
172.
173.
174.
175.
176.
[ ix ]
froM
eMBryology to the
fundaMentals of Cell
Biology, inflaMMation ,
1 eMBryology
PART 1
2 eMBryology
PART 2
3 Cellular order
knowledge.
5 plasMa MeMBrane
6 Cellular suffering
and
death
7 inflaMMation
8 Control of the e xtraCellular
environMent
9 Cellular adaptations
[1]
FOUNDATIONS
foundations
part
1.
FOUNDATIONS
eMBryology
eMBryology part 1
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.
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
FOUNDATIONS
part
(SU13 p140)
eMBryology
7.
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)
ACE inhibitors
Aminoglycosides
Diethylstilbestrol
Tetracyclines
Valproic acid
[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
complete
p21, p27, and p57 bind to and inactivate cyclin-CDK complexes (p53 controls the activation of p21)
G1 S
G2 M
[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
Which types of proteins are responsible for fostering the progression through
the cell cycle? (FA12 p79) (FA13 p74)
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]
Cytoskeleton
3 QUESTION WARM-UP
1.
3. How do Rb protein and p53 regulate the cell cycle? (FA12 p79) (FA13 p74)
4. Intermediate Filament Structures
Intermediate Filaments
Vimentin
Support cellular membranes
cytoplasm
Connective tissue
Desmin
Cytokeratin
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
7.
Which organelle is responsible for the breakdown of very long-chain fatty acids?
(FA12 p80) (FA13 p75)
6. What two fundamental substances are required to make most things work inside
the cell?
9.
Connective tissue
Muscle tissue
Epithelial tissue
Axons
[ 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?
[ 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)
[ 13 ]
plasMa M eMBrane
7.
8. What drugs act on the arachidonic acid product pathway? What enzymes do
they affect? (FA12 p429) (FA13 p404)
5
[ 14 ]
d eath
and
FOUNDATIONS
R: Chapter 1
Cellular s uffering
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)
[ 15 ]
Cellular s uffering
and
d eath
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
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)
3 QUESTION WARM-UP
1.
3. What neural crest derivatives are found in each of the following adult structures?
(FA12 p126) (FA13 p505)
[ 17 ]
i nflaMMation
Polymyalgia rheumatica
Temporal arteritis
Disease activity in RA and SLE
Malignancy
7.
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
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)
3-5 days
Months
[ 19 ]
e xtraCellular environMent
6. What are the different types of collagen, and where can they be found?
(FA12 p82) (FA13 p79)
Control
of the
7.
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.
2. How does having a high cholesterol content in the plasma membrane affect the
function of the plasma membrane? (FA12 p81) (FA13 p76)
[ 21 ]
Cellular a daptations
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.
[ 22 ]
neurology
neuroanatoMy
neurosCienCe are so
iMportant
of the
B rain
we
6 B ranChial apparatus
B rain
Cross seCtion
9 oCClusion syndroMes
10 vasCular events
11 MoveMent
12 Basal ganglia
13 spinal Cord
and
lesions
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
5 Cranial nerves
in
videos .
part
[ 23 ]
NEUROLOGY
8 B rainsteM
that we prefer to
throughout the
4 sleep
of the
and at the
3 hypothalaMus
7 r egions
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)
3. Failure of what process results in I-cell disease? (FA12 p80) (FA13 p75)
5. What are the classic presenting symptoms of a syringomyelia? (FA12 p134) (FA13 p410)
[ 25 ]
B rain
of the
o rganization
3 QUESTION WARM-UP
1.
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
NEUROLOGY
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.
2. What arachidonic acid product has actions that oppose that of prostacyclin?
(FA12 p429) (FA13 p404)
[ 28 ]
s leep
sleep
Phys: Chapter 59
H: Chapter 27
NEUROLOGY
3 QUESTION WARM-UP
1.
What effect might aminoglycosides have on a developing fetus? (FA12 p127) (FA13 p506)
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)
[ 29 ]
s leep
7.
8. What is the key to initiating sleep? What is the principle neurotransmitter involved
in REM? (SU13 p63)
9.
[ 30 ]
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)
[ 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 ]
Cranial n erves
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.
9.
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)
5. From which branchial pouch are each of the following structures derived?
(FA12 p137) (FA13 p511)
[ 34 ]
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
part 2
videos ,
BasiCs
the pharM
seCtion Covers
this
[ 87 ]
PHARM BASICS
7 drug MetaBolisM
the
parasyMpathetiC aCtivation
parasyMpathetiC aCtivation
3 QUESTION WARM-UP
imperfecta? (FA12 p83) (FA13 p78) (SU13 p265)
[ 89 ]
PHARM BASICS
parasyMpathetiC aCtivation
that
muscles
How does the parasympathetic nervous system affect the following body
structures?
Heart
Eye
Salivary glands
Bronchiolar smooth muscle
Bladder
Male GU
GI tract
9.
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)
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.
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.
[ 93 ]
PHARM BASICS
Cellular CoMMuniCation
3
[ 94 ]
7.
Cellular CoMMuniCation
9.
1
2
1
2
M1
M2
M3
D2
[ 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.
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)
[ 96 ]
Clonidine
Dopamine
Phenylephrine
Albuterol
Norepinephrine
Isoproterenol
Epinephrine
Dobutamine
Terbutaline
syMpathetiC aCtivation
[ 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)
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)
[ 98 ]
endoCrine
the
endoCrinology
questions on Board
exaMs tend to Be fairly
straightforward, But
1 endoCrine overview
2 pituitary
CoMplex variety of
and
Cushing syndroMe
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)
[ 112 ]
endoCrine overview
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)
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)
A patients MRI reveals replacement of tissue in the sella turcica with CSF. What is
the most likely clinical presentation?
9.
rapid-fire faCts
Inability to breastfeed, amenorrhea, cold
intolerance
Infertility, galactorrhea and bitemporal
hemianopsia
[ 115 ]
ENDOCRINE
3 QUESTION WARM-UP
1.
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 ]
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.
-hydroxylase?
Inability to produce
Increased production of deoxycorticosterone (a weak mineralocorticoid)
Increased production of sex hormones
(SU13 p210)
(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.
Cushing syndroMe
3 QUESTION WARM-UP
and
g luCoCortiCoids
3. What hormones arise from the anterior pituitary? (FA12 p314) (FA13 p287) (SU13 p193-195)
[ 119 ]
ENDOCRINE
Cushing syndroMe
and
g luCoCortiCoids
5. What effect does cortisol have on bone formation and immune system functioning?
(FA12 p319) (FA13 p292) (SU13 p193, 349)
rapid-fire faCts
[ 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)
3 QUESTION WARM-UP
1.
[ 121 ]
ENDOCRINE
2. What enzymes are used in the catabolism of norepinephrine? (FA12 p112) (FA13 p108)
5. What tumor locations are associated with the 3 different types of multiple endocrine
neoplasia? (FA12 p332) (FA13 p304) (SU13 p219)
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 ]
hyperthyroidisM
and
R: Chapter 24
Phys: Chapter 75
H: Chapter 341
thyroid BasiCs
3 QUESTION WARM-UP
1.
Disease
Cushing syndrome
Conn syndrome
Addison disease
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
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
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)
[ 125 ]
ENDOCRINE
thyroid C anCer
and
hypothyroidisM
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
2 esophagus
enJoy
sCeniC
3 stoMaCh
4 upper gi path
panCreas !
5 duodenuM
6 panCreas
7 enteroCytes
8 diseases
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.
Nicotinic antagonist
Cholinesterase regenerator
Cholinergic antagonists:
Sympathomimetics:
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
(continued)
[ 137 ]
o ropharynx
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
1 iMMunology BasiCs
unknowaBle Mystery,
2 antigen presentation
a deep oCean of
3 t Cells
inforMation whose
pluMBed.
4 MonoCytes
and
5 B Cells
antiBodies
and
6 iMMunization
MaCrophages
and
8 CoMpleMent
and
fear not !
physiCian eduCators
autoantiBodies
7 g ranuloCytes , Cytokines ,
iMMunosuppressants
our
B ut
and
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
3 QUESTION WARM-UP
1.
3. Describe the sensory innervation of the tongue. (FA12 p137) (FA13 p410) (SU13 p59)
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?
3. What are the different sinuses that can become infected and cause sinusitis?
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 ]
a ntigen presentation
7.
8. What are 3 cell types that are known for presenting antigens to T cells?
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
3. What structures are derived from the branchial pouches? (FA12 p137) (FA13 p511)
5. Which cytokines inhibit Th1 cells? Which inhibit Th2 cells? (FA12 p226) (FA13 p196)
[ 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
3 QUESTION WARM-UP
1.
hyperthyroidism?
IMMUNOLOGY
[ 173 ]
MaCrophages
and
M onoCytes
6. What are the acute phase cytokines that are produced by macrophages?
(FA12 p231) (FA13 p200) (SU13 p292)
7.
[ 174 ]