OriginalAlphabetical

Diabeticneuropathysymptoms
Numbnessandtinglingofextremities
Dysesthesia(abnormalsensationtoabodypart)
Diarrhea
Erectiledysfunction
Urinaryincontinence(lossofbladdercontrol)
Facial,mouthandeyeliddrooping
Visionchanges
Dizziness
Muscleweakness
Difficultyswallowing
Speechimpairment
Fasciculation(musclecontractions)
Anorgasmia
*Burningorelectricpain*

Glipizide
Secondgenerationsulfonylurea
CloseK+channelincellmembrane,socelldepolarizes
+triggeringofinsulinreleaseviaCa2+influx.
Stimulatereleaseofendogenousinsulinintype2DM.Require
someisletfunction,souselessintype1DM
Toxicity:Hypoglycemia

NFB
Activationoccurswhenit'sinhibitor,IB,isphosphorylatedby
specificproteinkinase(IKK)&degraded
Leadstosynthesisofprostaglandinsandleukotrienes

I B
ReleasesNFBafterundergoingphosphorylation

Insulinsecretion
1.GlucosebindsGlut2receptoroncells
2.GlucoseoxidizestoATPclosesKchannelsincell
membranedepolarizationofcells

3.DepolerizatinoopensCachannelsintracellular[Ca]
[nameofthiscard]

Glucokinase
Liverandcellsofpancreas
Lowaffinity(HighKm),highcapacity(HighVm)
Inducedbyinsulin
It'sa*glu*tonhashighVmaxb/citcan'tbesatisfied
Atlowglucoseconcentration,hexokinasesequestersglucosein
thetissues.
Ahhighglucoseconcentration,excessglucoseisstoredinthe
liver

Glucose6phosphatase
InER
Glucose6PGlucose
Liver(Notpresentinmuscle)
Probablystimulatedbyglucacon
DeficientinVonGierke'sdisease
Severefastinghypoglycemia
glycogeninliver
bloodlactate
hepatomegaly

Glycogenphosphorylase
Ratedeterminingenzymeforglycogenolysis
SkeletalcomponentdeficientinMcArdle'sdisease
glycogeninmuscle,butcan'tbreakitdown
Painfulmusclecramps,myoglobinuriaw/strenuousexercise

Phosphoenolpyruvatecarboxykinase
IrreversibleenzymeinGluconeogenesis

Phosphorylasekinase
AnearlycomponentofGluconeogenesis

Branchialapparatus

CAPCoversoutsidefrominside
Clefts=ectoderm
Arches=mesoderm
Pouches=endoderm

1stBrachialarch
Cartilage:
Meckel's(Mandible,Malleus,Mandibular)
Muscles:
Musclesofmastication(Masseter,medialpterygoids,
Mylohyoid)
Neves:
CNV2,V3
Chew

TreacherCollinsSyndrome
1starchneuralcrestfailstomigrate
Mandibularhypoplasia
Facialabnormalities

2ndBrachialarch
Cartilage:
Reichert's(Stapes,Styloid,Stylohyoid)
Muscles:
Stapedius,Stylohyoid
Nerves:
CNVII
Smaile

3rdBrachialarch
Cartilage:
Greaterhornofhyoid
Muscles:
Stylopharyngeus
Stylopharyngeusinnervatedbyglossopharyngealnerve
Nerves:

CNIX
Swallowstylishly

Congentiopharyngocutaneousfistula
Persistenceofcleftandpouchfistulabetweentonsillararea,
cleftinlateralneck

4th6thBrachialarches
Cartilage:
Thyroid,cricoid,
Muscles:
4=pharynhealconstrictors
6=intrinsicmusclesoflarynx
Nerves:
4=CNX(superiorlaryngealbranch)
Simplyswallow
6=CNX(recurrentlaryngealbranch)
Speak

Arches3&4
Posterior1/3oftongue

BrachialArches(Pneumonic)
Whenatthegoldenarches,
1.Chew
2.Smile
3.swallowstylishlyor4.simplyswallow
6.speak
Thereisno5!

micrognathia
Jawisundersized

glossoptosis
Downwarddisplacementorretractionofthetongue

S.pyogenes(GroupA)

Thebacteriabehindpoststreptococcalglomerulonephritis
PHaryngitiscanresultsinPHever&glomerulonePHritis

Stratification
Strataareconstructedbasedonvaluesofprognosticvariables
andarandomizationschemeisperformedseparatelywithin
eachstratum
Putanotherway:
Achievedbyperformingaseparaterandomisationprocedure
withineachoftwoormoresubsetsofparticipants

Trapeziumbone
Formstheradialborderofthecarpeltunnel
DistaltotheScaphoid
Somemightsayitisincloseproximityto
Abductorpollicislongus
Extensorpollicisbrevis
Thatbeingside,isnottherightanswerforthequestionthatyou
seek!

Scaphoidbone
Mostcommonlyfracturedcarpelbone
Pronetoavascularnecrosisduetoretrogradebloodsupply
Receivesitsbloodprimarilyfromthedistalend
Failureofthefracturetoheal("nonunion")canresultinlossof
bloodsupplytotheproximalpole
Canresultinavascularnecrosisoftheproximalsegment.

SNoWDRoP
Southern=DNA
Northern=RNA
Western=Protein

Southwesternblot
IdentifiesDNAbindingproteins

Affinitycolumnchromatography
Methodofseparatingbiochemicalmixtures
Basedonahighlyspecificinteractionsuchasthatbetween
antigenandantibody,enzymeandsubstrate,orreceptorand
ligand.
Canbeusedto.
1.Purifyandconcentrateasubstancefromamixtureintoa
bufferingsolution
2.Reducetheamountofasubstanceinamixture
3.Discernwhatbiologicalcompoundsbindtoaparticular
substance
4.Purifyandconcentrateanenzymesolution.

DensityGradientCentrifuge
Usedtoseparatecertainorganellesfromwholecellsforfurther
analysisofspecificpartsofcells
1.Atissuesampleisfirsthomogenisedtobreakthecell
membranesandmixupthecellcontents.
2.Thehomogenateisthensubjectedtorepeatedcentrifugations,
eachtimeremovingthepelletandincreasingthecentrifugal
force.
3.Finally,purificationmaybedonethroughequilibrium
sedimentation,andthedesiredlayerisextractedforfurther
analysis.

Immunohistochemistry
Processofdetectingantigens(e.g.,proteins)incellsofatissue
sectionbyexploitingtheprincipleofantibodiesbinding
specificallytoantigensinbiologicaltissues

Incidence
Looksatnewincidents

Prevalence
Looksatallcurrentcases

Imatinib
Asmallmolecularinhibitorofbcrabltyrosinekinase
TreatmentofCML
TradenameGleevec

Hydroxyurea
InhibitsribonucleotidereductaseDNASynthesis(Sphase
specific)
Usedwith:
Melanoma,CML,Sicklecelldisease(HbF)
Toxicity:
Bonemarrowsuppression
GIupset

Cytarabine
PyrimidineanaloginhibitionofDNApolymerase
Usedwith:
Leukemia,lymphomas
Toxicity:
Leukopenia
Thrombocytopenia
Megaloblasticanemia

IL5
FromThcell
PromotesdifferentiationofBcell
EnhancesclassswitchingofIgA.
Stimulatesthegrowthofanddifferentiationofeosinophils

Interferons
Proteinsthatplaceuninfectedcellsinanantiviralstate
Induceproductionofribonucleasethatinhibitsviralprotein
synthesisbydegradingviralmRNA(butnothostmRNA)
&:inhibitviralproteinsynthesis
:MHCI&IIexpressionandantigenpresentationinallcells
ActivateNKcellstokillvirusinfectedcells

Leukemia
Unregulatedgrowthofleukocytesin*bonemarrow*
orin#ofcirculatingleukocytesinblood

Marrowfailureanemia(RBC),infections(WBC),
hemorrhage(platelets)
Infiltratesinliver,spleen,andlymphnodespossible

Lymphoma
Discretetumormassesarisingfromlymphnodes.

Chronicmyelogenousleukemia(CML)
3060yearolds
Myeloidstemcellproliferation
neutrophils,metamyelocytes,basophils
t(9;22)
Lowleukocytealkalinephosphatase(asopposedtoleukemoid
reaction)

Leukemoidreaction
Acuteinflammatoryresponsetoinfection
WBCcountwithneutrophilsandneutrophilprecursorssuch
asbandcells
leukocytealkalinephosphatase

Deoxyhemoglobin
BetterbufferforHthanoxyhemoglobin
Advantageousthathemoglobinhasbeendeoxygenatedbythe
timeitreachesthevenousendofthecapillaries

Carbaminohemoglobin
COboundtohemoglobin
AccountforverysmallamountofCOinblood

Loadingdose
CpxVd
(mass/volume)x(volume)
Remember:
IfvolumeofdistributionisgiveninL/kg

Needtomultiplybybodyweighttofindactualvolume
distribution

Maintenancedose
CpxCL/F
Cp=targetplasmaconcentration
Remember:
IfvolumeofdistributionisgiveninL/kg
Needtomultiplybybodyweighttofindactualvolume
distribution

Oxytocin
Stimulateslabour
Uterinecontraction
Milkletdown
Controlsuterinehemorrhage

H1(Histamine)
Foundonsmoothmuscle,endothelium,andcentralnervous
systemtissue
Causes:
Bronchoconstriction
Bronchialsmoothmusclecontraction
Vasodilation
Separationofendothelialcells(responsibleforhives)
Painanditchingduetoinsectstings;
theprimaryreceptorsinvolvedinallergicrhinitissymptomsand
motionsickness;
sleepandappetitesuppression.

H2(Histamine)
Locatedonparietalcellsandvascularsmoothmusclecells
Causes:
Primarilyinvolvedinvasodilation
Alsostimulategastricacidsecretion

Salmonellaenterica

Mostcasesofsalmonellosisarecausedbyfoodinfectedwithw/
thisbacteria,whichofteninfectscattleandpoultry
Aremarkablelargenumberoffimbrialandnonfimbrial
adhesinsarepresentinSalmonella
Mediatebiofilmformationandcontacttohostcells
Secretedproteinsarealsoinvolvedinhostcellinvasionand
intracellularproliferation
TwohallmarksofSalmonellapathogenesis
UsuallydoesnotneedABs(Onlyifcomplicatedinpeopleat
risksuchasinfants,smallchildren,theelderly)
Willleadtoprolongedfecalexcretionofbacteria

Carnitinedeficiency
InabilitytotransportLCFA(Longchainfattyacids)into
mitochondria
Resultsintoxicaccumulationinthecytoplasm
Causesweakness,hypotonia,hypoketotichypoglycemia

Phytanicacid
Branchedchainfattyacidthathumanscanobtainthroughthe
consumptionofdairyproducts,ruminantanimalfats,and
certainfish
Undergoesoxidationintheperoxisome,whereitisconverted
intopristanicacidbytheremovalofonecarbon

Peroxisome
Membraneenclosedorganelleinvolvedincatabolismofvery
longfattyacids(VLFA)&aminoacids

Pipecolicacid
AccumulatesinPipecolicacidemia
Veryrareautosomalrecessivemetabolicdisorderthatis
causedbyaperoxisomaldefect

Hypokinesis
Diminishedorabnormallyslowmovement

RightCoronaryArtery

Suppliesbloodtorightventricle&2530%ofleftventricle
In85%ofpatients,givesoffposteriordescendingartery
SuppliesSAnodalarteryin60%ofpatients
Giveoffbranchtorightmarginalartery
Iflungsarecleartoauscultation,noLVF.ThinkRVF!

Hypoxemia
DecreaseinarterialPo

Aagradient
Usedtocomparecausesofhypoxemia
PAoPao
Normal<10
Onormallyequilibratesbetweenalveolargasandarterial
blood(PAo~Pao)(Highaltitude,hypoventilation)
If>10
Odoesnotequilibratebetweenalveolargasandarterialblood
(diffusiondefect,V/Qdefect,righttoleftshunt)

Hypoxia
DecreasedOdeliverytotissues
Odelivery=CadiacoutputxOcontentofblood
Dependeson:
Hemoglobinconcentration
Obindingcapacityofhemoglobin
%saturationofhemoglobinbyO(DependsonPo)
Canbecausedby:
cardiacoutput
Obindingcapacityofhemoglobin
arterialPo

cardiacoutput
bloodflowhypoxia

Hypoxemia
Paocauses%saturationofhemoglobinhypoxia

Anemia
HbconcentrationcausesOcontentofbloodhypoxia

Carbonmonoxidepoisoning
Ocontentofbloodhypoxia

Cyanidepoisoning
Outilizationbytissueshypoxia

Mesoblasticnephroma
Typeofkidneytumorthatisusuallyfoundbeforebirthby
ultrasoundorwithinthefirst3monthsoflife.
Itcontainsfibroblasticcells(connectivetissuecells),andmay
spreadtotheotherkidneyortonearbytissue

Nephroblastoma(Wilmstumor)
Mostcommonrenalmalignancyofearlychildhood(Age24)
Containsembryonicglomerularstructure
Presentswithhugeflankmass/hematuria
DeletionofWT1onchromosome11
Canbehypervascular....

Tannerstages
I.Childhood(9andunder)
II.Pubichairappears;breastbudforms
III.Pubichairdarkensandbecomescurly;penissize/length;
breastenlarges
IV.Peniswidth,darkerscrotalskin,developedglans;raised
areolae
V.Adult;areolaearenolongerraised(14andover)

Anabolicsteroids

Leadstosexhormonebindingglobulinfreetestosterone
Gynecomastiaresults

Ubiquitin
Tagsproteinsfordestructionbyproteasome

pVHL
AnE3ligasethatubiquitinatesHIF1andcausesits
degradationbytheproteasome.
InlowoxygenconditionsorincasesofVHLdiseasewherethe
VHLgeneismutated
pVHLdoesnotbindtoHIF1.
ThisallowsthesubunittodimerisewithHIF1andactivate
thetranscriptionofanumberofgenes(vascularendothelial
growthfactor,plateletderivedgrowthfactorB,erythropoietin
andgenesinvolvedinglucoseupatakeandmetabolism)

TypeIerror
Statingthereisaneffectwhennoneexist

TypeIIerror
Statingthereisnotaneffectwhenthereisone

Fluoxetine
SSRI
Use:
Depression,generalizedanxietydisorder,panicdisorder,OCD,
bulimia,socialphobias,PTSD

Lorazepam
FacilitatesGABAaactionbyfrequencyofClchannel
opening
Use:
Anxiety
Spasticity
Statusepilepticus
Detoxification

Olanzapine

Atypicalantipsychotic
Use:
Schizophreniaboth+veandve
Bipolar,OCD,anxietydisorder,depression,mania
Fewerextrapyramidalsideeffectsthantraditional
antipsychotics

Valproicacid
Awidespectrumseizuremedication
1stlinefortonicclonic
Notforstatusepilepticus

MedialLongitudinalfaciculus
PairoftractsthatallowforcrosstalkbetweenCNVI&CN
VIIInuclei
Coordinatebotheyestomoveinthesamehorizontaldirection
Highlymyelinated(Communicatequicklysoeye'smoveatthe
sametime)
Lesion:
LackofcommunicationsuchthatwhenCNVInucleusactivates
ipsilateralrectus,contralateralCNIIInucleusdoesnotstimulate
medialrectustofire(impairedabduction)
Abductingeyeget'snystagmus(CNVIoverfirestostimulate
CNIII)
Convergencenormal

Albinism
Congenitaldeficiencyin:
Tyrosinase
Defectivetyrosinetransporter(tyrosinemelanin)
Canresultfromlackofmigrationofneuralcrestcells
Lackofmelaninresultsinriskofskincancer

Slippedstrandmispairing

DenaturationanddisplacementoftheDNAstrands,resultingin
mispairingofthecomplementarybases.
Canresultineitherinsertionsordeletions.
Insertionsarethoughttobeselfaccelerating:asrepeatsgrow
longer,theprobabilityofsubsequentmispairingevents
increases

Testosterone
Preperipubertal:
Causesgrowthspurt/acceleratedbonematuration
Pubertal:
Completionofbonematuration/terminationofgrowth

Hyperparathyroidism
Stone,Bones,andGroans
Hypercalcemia
Hypercalciuria(Stones)
Hypophosphatemia
PTH,AlkPhos,cAMPinurine

PTH
Ca+resorptionfromKidney(InhibitsPO4resorption)
StimulatesVitD.synth
IncreasedCa+absorbedfromintestine
Ca+releasefrombone
serumcalcium

Histonedeacetylase
RemovesacetylgroupsfromAA
AllowshistonestowrapDNAmoretightly
Actionsareoppositetothatofhistoneacetyltransferase
ThesewouldaffecttranscriptionofDNA!!!!

Internalurethralorifice
Openingoftheurinarybladderintotheurethra

Uretericorifice
Placedattheposterolateralanglesofthetrigonumvesicae,and
areusuallyslitlikeinform

Supraspinatus
Abductionofthearmattheshoulderjoint
Mainagonistmuscleforthismovementduringthefirst1015
degreesofitsarc
Cantest:
Shoulderat90%
Emptycan(Wristspronated)

Woundhealing
1.Inflammatory(immediate)
Platelets,neutrophils,macrophages
2.Proliferative(23daysafterwound)
Fibroblasts,myofibroblasts,endothelialcells,keratinocytes,
macrophages
Granulationtissuedepostion,angiogenesis,woundcontraction
(mediatedbymyofibroblasts)
3.Remodeling(1weekafterwound)
Fibroblasts
TypeIIIcollagenreplacedbytypeIcollagen

Myofibroblast
Cellthatisinbetweenafibroblastandasmoothmusclecellin
differentiation
Cancontractbyusingsmoothmuscletypeactinmyosin
complex,richinaformofactincalledalphasmoothmuscle
actin
Thesecellsarethencapableofspeedingwoundrepairby
contractingtheedgesofthewound

Scurvy
Swollengums
Bruising
Hemarthrosis

Anemia
Poorwoundhealing

VitaminC
Requiredfrothehydroxylationofspecificpurineandlysine
residues
Ifdeficient,willcausescurvy
Inadequatehydroxylationofcollagenpeptides

IrradiatedpackedRBCs
DestroysDNAinWBCs
Preventsgraftvshostdiseaseoccurringfromtransfusion
Importantiftransfusionisfrom:
1.Closefamilyrelation
2.Someonewhoisimmunocompromised(DiGeorge
Syndrome,WiskottAldrich,andSCID)

PackedRBCswithadeninesalineadded
Allowsthebloodtoflowreadilywithouttheadditionofsaline

WashedpackedRBCs
RBCswashedinsterilesalinetoremove:
WBCs
Lyticmediators
Nonselfantigens
MostusefulinIgAdeficientpersonswhohavecirculatinganti
IgAAbs
Usefebrile,urticarialandanaphylacticreactions

Wholeblood
Bloodthatisunmodifiedexceptforthepresenceofan
anticoagulant
Usuallynotusedbecausetheextraplasmacancontributeto
transfusionassociatedcirculatoryoverload(TACO),a
potentiallydangerouscomplication

TransfusionassociatedGVH
ResultsfromtransfusionofimmunocompetentTcellscapable
ofengraftingandinitiatinganimmuneresponseagainst
recipientantigens

Themostsusceptiblepatientgroupsarethosewhoareseverely
immunocompromised
Gammairradiationabolishestheproliferativeactivityofthe
lymphocytesinthedonorblood.
Freshfrozenplasmaandcryoprecipitatedonotcontainviable
lymphocytesandthusdonotneedtobeirradiated

1stBrachialPouch
Middleearcavity
Eustachiantube
Mastoidaircells

2ndBrachialPouch
Epithelialliningofpalatinetonsil

3rdBrachialPouch
Dorsalwings
Inferiorparathyroids
Ventralwings
Thymus
3structures
Thymus,right&leftparathyroids

4thBrachialPouch
Dorsalwings
Superiorparathyroid

Brachialpouchpneumonic
Ear,tonsils,bottomtotop
1(ear)
2(tonsils)
3dorsal(bottomforinferiorparathyroid)
3ventral(to=thymus)
4(top=superiorparathyroids)

DiGeorgesyndrome

Aberrantdevelopmentof3rd&4thpouches:
Tcelldeficiency(thymicaplasia)
Hypocalcemia(failureofparathyroiddevelopment)

Homonymoushemianopsia
Visualfieldlossthatrespectstheverticalmidline,andusually
affectsbotheyes
Vascularandneoplastic(malignantorbenigntumours)lesions
fromtheoptictract,tovisualcortexcancause
Iflesionisinoptictract,willbepupillaryreflexproblem!
Themoreposteriorthecerebrallesion,themoresymmetric
(congruous)symptomswillbe
1.Personwhohasalesionoftherightoptictractwillnolonger
seeobjectsonhisleftside
2.Personwhohasastroketotherightoccipitallobewillhave
thesamevisualfielddefect,usuallymorecongruentbetween
thetwoeyes,andtheremaybemacularsparing

Hemispatialneglect
Resultsmostcommonlyfrombraininjurytotherightcerebral
hemisphere,causingvisualneglectofthelefthandsideofspace
Astrokeaffectingtherightparietallobeofthebraincanleadto
neglectfortheleftsideofthevisualfield,causingapatientwith
neglecttobehaveasiftheleftsideofsensoryspaceis
nonexistent(althoughtheycanstillturnleft)
Extremecase,apatientwithneglectmightfailtoeatthefood
onthelefthalfoftheirplate,eventhoughtheycomplainof
beinghungry
Someonewithneglectisaskedtodrawaclock,theirdrawing
mightshowonlynumbers12to6,orall12numbersononehalf
oftheclockface,theothersidebeingdistortedorleftblank

Temporallobelesion
Upperquadranticanopia

Parietallobelesion
Lowerquadranticanopia

Opticchiasmlesion

Bitemporalanopia

Aplasia
Lackofgrowth

Excesslymphoblasts
Age<15
Foundinacutelymphoblasticleukemia(ALL)
TdT+(Markerofpret&prebcells)
CALLA+
t(12;21)=goodprognosis
IncreasedincidenceinpeoplewithDownSyndrome

Megaloblastosis(Megaloblasticanemia)
ResultsfrominhibitionofDNAsynthesisinredbloodcell
production
Mostoftenduetohypovitaminosis,specificallyadeficiencyof
vitaminB12and/orfolicacid
Characterizedby:
Manylargeimmatureanddysfunctionalredbloodcells
(megaloblasts)inthebonemarrow
Hypersegmentedneutrophils(thoseexhibitingfiveormore
nuclearlobes("segments"),withuptofourlobesbeingnormal)

Parvovirusinclusions
Fifthdisease
Developtheillnessafteranincubationperiodoffourto
fourteendays.
Feverandmalaisewhilethevirusismostabundantinthe
bloodstream
Patientsareusuallynolongerinfectiousoncethecharacteristic
rashofthisdiseasehasappeared
ParvovirusB19isacauseofchronicanemiainindividualswho
haveAIDS
Aplasticanemia
Patientshaveanarrestoferythropoiesis(productionofred
bloodcells)duringinfection

Patientswhohavesicklecellanemiaorhereditary
spherocytosisareheavilydependentonerythropoeisisdueto
thereducedlifespanoftheredcells
Infectioninpregnantwomenisassociatedwithhydropsfetalis
duetoseverefetalanemia

Ringedsideroblasts
Bodyhasironavailablebutcannotincorporateitinto
hemoglobin,whichredbloodcellsneedtotransportoxygen
efficiently
Abnormalnucleatederythroblasts(precursorstomaturered
bloodcells)withgranulesofironaccumulatedinperinuclear
mitochondria
Seeninaspiratesofbonemarrow
Mostcommoncauseofisexcessivealcoholuse
Primarypathophysiology=failuretocompletelyformheme
molecules(whosebiosynthesistakesplacepartlyinthe
mitochondrion)

Rouleauxformation
Stacksofredbloodcells(RBCs)whichformbecauseofthe
uniquediscoidshapeofthecellsinvertebrates
Conditionswhichcause:
Infections
Multiplemyeloma
Inflammatoryandconnectivetissuedisorders
Cancers
Occursindiabetesmellitus(oneofthecausativefactorsfor
microvascularocclusionindiabeticretinopathy)

SLECriteria
4outof11ofthefollowing
1.Malarrash
2.Discoidrash
3.Serositis:PleurisyorPericarditis
4.Oralulcers
5.Arthritis

6.Photosensitivity
7.Blooddisorder:Hemolyticanemia,leukopenia,lymphopenia,
thombocytopenia,~hypocomplementemia
8.Renaldisorder
9.ANA+ve
10.Immunologicdisorder
11.Neurologicdisorder

CaseControl
Twoexistinggroupsdifferinginoutcomeareidentifiedand
comparedonthebasisofsomesupposedcausalattribute

Caseseries
Medicalresearchdescriptivestudythat:
1.Trackspatientswithaknownexposuregivensimilar
treatment
2.Examinestheirmedicalrecordsforexposureandoutcome
Canberetrospectiveorprospective
Usuallyinvolvesasmallernumberofpatientsthanmore
powerfulcasecontrolstudiesorrandomizedcontrolledtrials
Maybeconsecutiveornonconsecutive
Dependsonwhetherallcasespresentingtothereporting
authorsoveraperiodwereincluded,oronlyaselection
Maybeconfoundedbyselectionbias
Limitsstatementsonthecausalityofcorrelationsobserved
Physicianswholookatpatientswithacertainillnessanda
suspectedlinkedexposurewillhaveaselectionbiasinthatthey
havedrawntheirpatientsfromanarrowselection(Their
hospital)

ARDS
Inflammationofthelungparenchymaleadstoimpairedgas
exchangewithsystemicreleaseofinflammatorymediators,
causing:
Inflammation
Hypoxemia
Frequentlymultipleorganfailure.
Conditionhasa90%deathrateinuntreatedpatients.With

treatment,usuallymechanicalventilationinanintensivecare
unit,thedeathrateis50%.
Alesssevereformiscalledacutelunginjury(ALI)
3mainclinicalcauses
1.Sepsis(mostimportant)
2.Severemultipletrauma
3.Aspirationofsaliva/gastriccontents
Anycardiogeniccauseofpulmonaryedemashouldbeexcluded
Donebyplacingapulmonaryarterycatheterformeasuringthe
pulmonaryarterywedgepressure
4maincriteriaforARDS:
1.Acuteonset
2.ChestXRay:Bilateraldiffuseinfiltratesofthelungs
3.Nocardiovascularlesion
4.Noevidenceofleftatrialhypertension:PaO2/FiO2ratio
equaltoorlessthan200mmHg.

Alveolarventilation
Thevolumeofgasperunittimethatreachesthealveoli

Leftsidedheartfailuresigns
Tachypnea(increasedrateofbreathing)
Increasedworkofbreathing(nonspecificsignsofrespiratory
distress)
Ralesorcrackles,heardinitiallyinthelungbases,andwhen
severe,throughoutthelungfields
Suggestthedevelopmentofpulmonaryedema(fluidinthe
alveoli)
Cyanosiswhichsuggestsseverehypoxemia,isalatesignof
extremelyseverepulmonaryedema.

PaO2/FiO2ratio
Theratioofpartialpressurearterialoxygenandfractionof
inspiredoxygen
Comparisonbetweentheoxygenlevelinthebloodandthe
oxygenconcentrationthatisbreathed
Helpstodeterminethedegreeofanyproblemswithhowthe

lungstransferoxygentotheblood
Ifequaltoorlessthan200mmHgisonecriteriafordiagnosing
ARDS

Erythropoietin
Itsprimaryeffectonredbloodcellprogenitorsandprecursors
(whicharefoundinthebonemarrowinhumans)ispromoting
theirsurvivalthroughprotectingthesecellsfromapoptosis

Bacillussubtilis
Grampositive,catalasepositivebacterium
Rodshaped
Hastheabilitytoformatough,protectiveendospore,allowing
theorganismtotolerateextremeenvironmentalconditions
Onlyknowntocausediseaseinseverelyimmunocompromised
patients

Bacteroidesfagilis
Gramnegativebacillusbacteriumspecies
Involvedin90%ofanaerobicperitonealinfections
Predominatesinbacteremiaassociatedwithintraabdominal
infections,peritonitisandabscessesfollowingruptureofviscus,
andsubcutaneousabscessesorburnsneartheanus

Clostridiumperfringens
Grampositive,rodshaped,anaerobic,sporeformingbacterium
Infectionsshowevidenceoftissuenecrosis,bacteremia,
emphysematouscholecystitis,andgasgangrene
Toxininvolvedingasgangreneisknownastoxin
Insertsintotheplasmamembraneofcells,producinggapsin
themembranethatdisruptnormalcellularfunction

Staphylococcusaureus
FacultativeanaerobicGrampositivecoccalbacterium
Appearsasgrapelikeclusterswhenviewedthrougha
microscope,andhaslarge,round,goldenyellowcolonies,often
withhemolysis,whengrownonbloodagarplates

Catalasepositive
Abletoconverthydrogenperoxide(H2O2)towaterand
oxygen
Virulencefactors:
Enzymes
Coagulaseclotsplasmaandcoatsthebacterialcellwhich
probablypreventphagocytosis
Hyaluronidasebreakdownhyaluronicacidandhelpin
spreading
Toxins
Superantigens(TSST1)inducetoxicshocksyndrome(TSS),
usuallyfromprolongedtamponuse.Causenonspecific
activationofTcellsresultinginpolyclonalTcellactivationand
massivecytokinerelease(IFN)
Enterotoxinthatisthecausativeofgastroenteritisthatisself
limiting,characterizedbyvomitinganddiarrheaonetosix
hoursafteringestionofthetoxinwithrecoveryineightto24
hours.Symptomsincludenausea,vomiting,diarrhea,andmajor
abdominalpain.
Exfoliativetoxinsimplicatedin(SSSS),whichoccursmost
commonlyininfantsandyoungchildren.Proteaseactivityof
theexfoliativetoxinscausespeelingoftheskinobservedwith
SSSS.
Other
ProteinA,anIgGbindingprotein,bindstotheFcregionofan
antibody

Listeriamonocytogenes
Grampositivebacterium
Motileviaflagellaat30Candbelow
Canmovewithineukaryoticcellsbyexplosivepolymerization
ofactinfilaments(knownascomettailsoractinrockets).
Facultativeanaerobicbacterium(Capableofsurvivinginthe
presenceofoxygen)
Cangrowandreproduceinsidethehost'scells
Oneofthemostvirulentfoodbornepathogens,with20to30
percentofclinicalinfectionsresultingindeath
Duetoitsfrequentpathogenicity,causingmeningitisin
newborns(acquiredtransvaginally),pregnantmothersareoften
advisednottoeatsoftcheeses
Itisthethirdmostcommoncauseofmeningitisinnewborns

Partialhydatidiformmole
Occurswhenaneggisfertilizedbytwospermorbyonesperm
whichreduplicatesitselfyieldingthegenotypesof69,XXY

Completehydatidiformmole
Causedbyasingle(90%)ortwo(10%)spermcombiningwith
aneggwhichhaslostitsDNA
Thegenotypeistypically46,XX(diploid)

Placentaaccreta
Abnormallydeepattachmentoftheplacentatothemyometrium
withoutpenetratingit.
Placentagrowscompletelythroughtheendometrium
Greatriskofhaemorrhageduringplacentalremoval
Commonlyrequiressurgerytostemthebleedingandfully
removetheplacenta
Insevereformscanoftenleadtoahysterectomyorbefatal

Wernicke'saphasia
Fluentaphasiawithimpairedcomprehension.
Wernicke'sareasuperiortemporalgyrusoftemporallobe.
Wordy,butmakesnosense

Broca'saphasia
Nonfluentaphasiawithintactcomprehension.

Diaphoresis
Excessivesweating

ALAdehydratase
Leadpoisoning
Accumulates:
Protoporphyrin,ALA
Microcyticanemia,GIandkidneydisease.
Childrenexposuretoleadpaint+mentaldeterioration

Adultsenvironmentalexposure(battery/ammunition/radiator
factory)+headache,memoryloss,demyelination

ALAsynthase
Sideroblasticanemia

Ferrochelatase
Leadpoisoning
Accumulates:
Protoporphyrin,ALA
Microcyticanemia,GIandkidneydisease.
Childrenexposuretoleadpaint+mentaldeterioration
Adultsenvironmentalexposure(battery/ammunition/radiator
factory)+headache,memoryloss,demyelination

Porphobilinogendeaminase
Acuteintermittentporphyria
Accumulates:
Porphobilinogen,ALA,uroporphyrin
5P's
1.Painfulabdomen
2.Portwinecoloredurine
3.Polyneuropathy
4.Psychologicaldisturbances
5.Precipitatedbydrugs

Uroporphyrinogendecarboxylase
Porphyriacutaneatarda
Accumulates:
Uroporphyrin(teacoloredurine)
Blisteringcutaneousphotosensitivity.Mostcommonporphyria.

Holosystolicmurmur
Tricuspidinsufficiency
Bestheardoverthefourthleftsternalborder,radiatestoright
sternalborder

Intensitycanbeaccentuatedfollowinginspiration
Duetoincreasedregurgitantflowinrightventricularvolume
mostoftensecondarytopulmonaryhypertension
Mitralregurgitation
Bestheardattheapexwithdiaphragm,radiatestowardaxilla
Nointensificationuponinspiration
Differenceinpressureextendsthroughoutsystoleandcaneven
continueaftertheaorticvalvehasclosed
Ventricularseptaldefect
Bestheardovertheleftthirdandfourthintercostalspacesand
alongthesternalborder
S2Normal(Distinguishfrompulmonarystenosis,whichhasa
widesplittingS2)
Nointensificationuponinspiration

Hyperammonia
Canbeacquired(e.g.,liverdisease)orhereditary(e.g.,urea
cycleenzymedeficiencies)
excessNH4+depletesaketoglutarateinhibitionofTCA
cycle
Rx:limitproteinindiet

RTA1("distal",Renaltubularacidosis)
Defectincollectingtubule'sabilitytoexcreteH+
urinepH>5.5
hypokalemia
riskforcalciumphosphatekidneystonesasaresultofurine
pHandboneresorption

RTA2("proximal",Renaltubularacidosis)
DefectinproximaltubuleHC03reabsorption
Fanconi'ssyndrome
urinepH<5.5
hypokalemia
riskforhypophosphatemicrickets

RTA4("hyperkalemic",Renaltubularacidosis)

Hypoaldosteronismorlackofcollectingtubuleresponseto
aldosterone
Resultinghyperkalemiaimpairsammoniagenesisinthe
proximaltubule
bufferingcapacityandurinepH

Ammoniagenesis
Occurswithinproximaltubularcells
Glutaminemadeintheliver,isreceivedfromperitubular
capillariesandismetabolizedinto
1.Alphaketoglutarate(MetabolizedfurtherintotwoHCO3
ions,whichthenleavethecellandentersystemiccirculationby
crossingthebasolateralmembrane)
2.NH4+(Secretedintorenaltubules)

CNIIIPalsy
eyeis"downandout"withptosisandpupildilation

PosteriorCommunicatingArtery
Commonsiteofsaccular(berry)aneurysm.
CNIIIPalsy:Eyeis"downandout"withptosisandpupil
dilation
Lesionsaretypicallyaneurysms,notstrokes

AvoidantPersonalityDisorder
Displayapervasivepatternofsocialinhibition,feelingsof
inadequacy,extremesensitivitytonegativeevaluation,and
avoidanceofsocialinteraction
Considerthemselvestobesociallyineptorpersonally
unappealingandavoidsocialinteractionforfearofbeing
ridiculed,humiliated,rejected,ordisliked

Dysthymicdisorder
Mooddisorderconsistingofthesamecognitiveandphysical
problemsasindepression,withlessseverebutlongerlasting
symptoms,whichmaypersistforatleast2years

Aseriousstateofchronicdepression,whichpersistsforatleast
2years;itislessacuteandseverethanmajordepressive
disorder
Sufferersmayexperiencesymptomsformanyyearsbeforeitis
diagnosed,ifdiagnosisoccursatall

Majordepressivedisorder
Characterizedbyepisodesofallencompassinglowmood
accompaniedbylowselfesteemandlossofinterestorpleasure
innormallyenjoyableactivities
Presenceofaseverelydepressedmoodthatpersistsforatleast
twoweeks

Narcissisticpersonalitydisorder
Beingexcessivelypreoccupiedwithissuesofpersonal
adequacy,power,prestigeandvanity

Obsessivecompulsivedisorder
Characterizedbyintrusivethoughtsthatproduceuneasiness,
apprehension,fear,orworry

Schizotypal personality disorder

Characterizedbyaneedforsocialisolation,anxietyinsocialsituations,oddbehavior
andthinking,andoftenunconventionalbeliefs
Mayfeelextremediscomfortwithmaintainingcloserelationshipswithpeople,and
thereforetheyoftendonot
Maydisplaypeculiarmannersoftalkinganddressingandoftenhavedifficultyin
formingrelationships.
Mayreactoddlyinconversations,notrespondortalktothemselves
Frequentlymisinterpretsituationsasbeingstrangeorhavingunusualmeaningfor
them;paranormalandsuperstitiousbeliefsarenotuncommon

Peptic ulcers
Chronic inflammation due to Helicobacter pylori that colonizes the
antral mucosa
NSAIDs
Some studies have found correlations between smoking and ulcer
formation
Caffeine and coffee, also commonly thought to cause or exacerbate
ulcers, have not been found to affect ulcers to any significant exten

Substance Abuse Teratogens

Alcohol:
Leading cause of birth defects and mental retardation; fetal alcohol
syndrome
Cocaine:
Abnormal fetal development and fetal addiction; placental abruption
Smoking:
Preterm labor, placental problems, IUGR, ADI-ID

Prenatal cocaine effects

Associated with premature birth, birth defects, attention deficit
disorder

Absence seizure
Brief (usually less than 20 seconds), generalized epileptic seizures of
sudden onset and termination
Clinically, the impairment of consciousness (absence)
Electroencephalography (EEG) shows generalized spike-and-slow
wave discharges ~3Hz

Absence seizure
Brief (usually less than 20 seconds), generalized epileptic seizures of
sudden onset and termination
Clinically, the impairment of consciousness (absence)
Electroencephalography (EEG) shows generalized spike-and-slow
wave discharges ~3Hz

Complex partial seizure

Often preceded by a seizure aura.
-A simple partial seizure.
Aura may manifest itself as a feeling of dj vu, jamais vu, fear,
euphoria or depersonalization.
Seizure aura might also occur as a visual disturbance, such as tunnel
vision or a change in the size of objects (macropsia or micropsia).
Once consciousness is impaired, the person may display
automatisms such as lip smacking, chewing or swallowing.
There may also be loss of memory (amnesia) surrounding the seizure
event.
Person may still be able to perform routine tasks such as walking,
although such movements are not purposeful or planned.
Witnesses may not recognize that anything is wrong.

Generalized tonic clonic

Generalized seizure that affects the entire brain
Divided into two phases, the tonic phase and the clonic phase.
Preceded by aura

Tonic = skeletal muscles tense

Clonic = Rapid contraction and relaxation of muscles

Simple partial seizures

Consciousness is not impaired
Often precursors to larger seizures, where the abnormal electrical
activity spreads to a larger area of (or all of) the brain, usually
resulting in a complex partial seizure or a tonic-clonic seizure
-In this case they are often known as an aura

Leukocidin
Type of cytotoxin created by some types of bacteria
Is a type of pore forming toxin
Get their names by killing ("-cide") leukocytes
Associated with increased virulence of certain strains (isolates) of
Staphylococcus aureus
Cause of necrotic lesions involving the skin or mucosa, including
necrotic hemorrhagic pneumonia

Staph -toxin
The major cytotoxic agent released by bacterium Staphylococcus
aureus and the first identified member of the pore forming betabarrel toxin family

Muscarinic ACh receptor

Receptors that form G protein-receptor complexes in the cell
membranes of certain neurons and other cells

Play several roles, including acting as the main end-receptor

stimulated by acetylcholine released from postganglionic fibers in the
parasympathetic nervous system

Nicotinic ACh receptor

Receptors that form ligand-gated ion channels in the plasma
membranes of certain neurons and on the postsynaptic side of the
neuromuscular junction
As ionotropic receptors, these are directly linked to ion channels and
do not use second messengers (as metabotropic receptors do).

Dysostosis multiplex
Hereditary disease (autosomal recessive) consisting of an error is
mucopolysaccharide metabolism
Characterized by severe abnormalities in development of skeletal
cartilage and bone and mental retardation

Lysosomal storage disease

Caused by lysosomal dysfunction usually as a consequence of
deficiency of a single enzyme required for the metabolism of lipids,
glycoproteins (sugar containing proteins) or so-called
mucopolysaccharides
When a particular lysosomal enzyme exists in too small an amount or
is missing altogether, substances accumulate in the cell.
In other words, when the lysosome doesn't function normally, excess
products destined for breakdown and recycling are stored in the cell.

inclusion cell disease (I-cell disease)

Inherited lysosomal storage disorder

Failure of addition of mannose-6-phosphate to lysosome proteins
-Enzymes are secreted outside the cell instead of being targeted to
the lysosome
Presentation:
Coarse facial features
Clouded corneas
Restricted joint movement
High plasma levels of lysosomal enzymes

Inferior mesenteric lymph nodes

Sigmoid colin Colic
Ends up in these lymph nodes

Internal iliac lymph nodes

Rectum (lower portion) of anal canal (Above pectenate line)
Ends up in these lymph nodes

Superficial inguinal lymph nodes

Anal canal (below pectenate line)
Scrotum
Thighs
Ends up in these lymph nodes

Internal iliac lymph nodes

Receive lymphatics from:
All the pelvic viscera

Deeper parts of the perineum

-membranous and cavernous portions of the urethra
Buttock and back of the thigh
Cervix!
Not: Ovary, testis, or superior half of the rectum
Gonads drain to the paraaortic lymph nodes
Superior half of the rectum drains to the pararectal lymph nodes