Sample

COPYRIGHTED MATERIAL
SUBJECT OR CONDITION
1,25 di OH D3
1,25 di OH D3
1,25 di OH D3
1,25 di OH D3
4-hydroxyphenylpyruvate
4-hydroxyphenylpyruvate
5-alpha Reductase Deficiency
5-lipoxygenase Pathway Inhibitor
7-helix trasmembrane receptor
8 Months Old Baby
8 Months Old Baby
10 - 18 Months Old Baby
11 Beta-Hydrolase Deficiency
17 Alpha-Hydroxylase Deficiency
21 Beta-Hydrolase Deficiency
24 hours urine catecholamine
24 hours urine free cortisol
ABO incompatibility
A.C.E. inhibitor
A.C.E. inhibitor
A.C.E. inhibitor
A.C.E. inhibitor
A.C.E. inhibitor
A.C.E. inhibitor
A.C.T.H
A.C.T.H
A.C.T.H
A.C.T.H. Feedback
A.D.H.
A.D.H.
A.D.H.
A.D.H.
A.D.H.
A.D.H.
A.D.H.
A.D.H.
A.D.H. Secretion
A.D.H.D
A.D.H.D
A.D.H.D
A.D.H.D
A.D.H.D
A.F.P
A.I.D.S.
A.I.D.S.
A.I.D.S. Dementia
A.R.D.S.
A.R.D.S.
A.R.D.S.
A.R.D.S.
A.R.D.S.
A.R.D.S.
A.R.D.S.
A.R.D.S.
A.R.D.S.
A.R.D.S.
A.R.D.S.
A.R.D.S.
A.R.D.S.
A.R.D.S.
A.S.C.U.S
Abdominal Aortic Aneurysm (AAA)
Abdominal Aortic Aneurysm (AAA)
Abdominal Fistula
Abdominal Fistula
Abductor Digiti Minimi
Abruptio placentae
Abruptio placentae
Absolute Neutrophils Count
Acanthosis Nigricans
ACCURACY VS. PRECISION
Acetaldehyde
Acetaldehyde
Acetaminophen Vs. Aspirin
Acetaminophen Intoxication
Acetazolamide
Acetazolamide
Acetazolamide
Acetoacetic Acid
Acethylcoline
Acethylcoline
Acethylcoline
Acethylcoline
Acethylcoline
Acethylcoline
Acethylcoline
Acethylcoline
Acethylcoline
Acethylcoline
Acethylcoline, Muscarinic
Acetylcholine, Nicotinic
Achalasia
Achalasia
Achondroplasia
Achondroplasia
Achondroplasia
Achondroplasia
Achondroplasia
Achondroplasia
Achondroplasia
Achondroplasia
Acid Basic Compensation
Acid Basic Status (ABS)
Acinetobacter baumannii.
Acne
Acne
Acne Vulgaris
Acoustic neuroma
Acoustic neuroma
Acquired Arteriovenous Fistula
Acrodermatitis enteropathica
Acromegaly
Acromegaly
Acromegaly
Acromegaly
Acromegaly
Actinic Keratosis
Actinic Keratosis
Actinic Keratosis
Actinic Keratosis
Actinic Keratosis
Actinic Keratosis
Actinic Keratosis
Actinomyces israelli
Action Potential
Action Potential
Action Potential
Action Potential
Action Potential
Action Potential
Action Potential
Action Potential
Action Potential
Action Potential
Action Potential
Action Potential
Action Potential
Action Potential
Action Potential
Action Potential
Acummulation of Uremic Toxic
Acute Adrenal Crisis
Acute Adrenal Insuficiency
Acute Alcohol Intake
Acute Anal fissures
Acute Anterior Myocardial Infarction
Acute Appendicitis
Acute Appendicitis
Acute Atrial Flutter
Acute Atrial Flutter
Acute Bacterial Endocarditis
Acute Bacterial Endocarditis
Acute Bacterial Meningitis
Acute Bleeding
Acute Bronchitis
Acute Bronchitis
Acute Bronchitis
Acute Bronchopulmonary Aspergillosis
Acute Burning
Acute Cholangitis
Acute Cholangitis
Acute Cholangitis
Acute Cholangitis
Acute Cholecystitis
Acute Cholecystitis
Acute Cholecystitis
Acute Cytomegalovirus (CMV)
Acute Erosive Gastritis
Acute Epidydimitis
Acute Inflammation
Acute Inflammation
Acute Inflammation
Acute Inflammation
Acute Inflammation
Acute Intermittent Porphyria
Acute Interstitial Nephritis
Acute Laryngotracheobronchitis
Acute Lymphocitic Leukemia (ALL)
Acute Myelogenous Leukemia
Acute Nephrolithiasis
Acute Osteomyelitis
Acute Otitis Media
Acute Otitis Media
Acute Otitis Media
Acute Pancreatitis
Acute Pancreatitis
Acute Pancreatitis
Acute Pancreatitis
Acute Pancreatitis
Acute Pancreatitis
Acute Pancreatitis
Acute Pancreatitis
Acute Pancreatitis
Acute Pancreatitis
Acute Pancreatitis
Acute Pericarditis
Acute Pericarditis
Acute Pericarditis
Acute Pericarditis
Acute Pericarditis
Acute Pericarditis
Acute Pharyngotonsilitis
Acute Pharyngotonsilitis
Acute Pleuritis
Acute Pneumonia
Acute Pneumonia
Acute Post-Strep Glomerulonephritis
Acute Prostatitis
Acute Pyelonephritis
Acute Pyelonephritis
Acute Renal Failure (A.R.F.)
Acute Subendocardial Infarct
Acute Transmural Infarct
Acute Tubular Necrosis
Acute Tubular Necrosis
Acute Vasoocclusive Crisis
Acyclovir
Acyclovir
Acyclovir
Acyclovir
Acyclovir
Acyclovir
Acyclovir
Acyclovir
Acyclovir
Acyclovir
Acyclovir
Adam Test
Addison Disease
Addison Disease
Addison Disease
Addison Disease
Addison Disease
Addison Disease
Addison Disease
Adenocarcinoma of the Breast
Adenocarcinoma of the Colon
Adenocarcinoma of the Vagina
Adenoma of the Liver
Adenosine Deaminase Deficiency
Adjustment Disorder
Adjustment Disorder
Adjustment Disorder
Adrenal Abnormalities function
Adrenal Abnorma Vs. Pituitary Abnorma
Adrenal Abnorma Vs. Pituitary Abnorma
Adrenal Cortex and Medulla
Adrenal Enzyme Deficiencies
Adrenal Insufficiency
Adrenal Medullary Secretion
Adrenal Nodule
Adrenergic Agonist
Adrenergic Agonist
Adrenergic Agonist
Adrenergic Agonist
Adrenergic Agonist
Adrenergic Agonist
Adrenocortical Insuf, Primary
Adrenocortical Insuf, Primary
Adrenocortical Insuf, Secondary
Adrenocortical Insur, Secondary
Adrenogenital Syndrome
Adrenoleukodystrophy
Adrenoceptor Drug Target
Adrenoceptor Sensitvity
Adrenoceptor Sensitvity
Adult Polycystic Kidney Disease
Adult Still's Disease

Adult Still's Disease
Adult T cell Leukemia
Adult T cell Leukemia
Agammaglobulinemia of Bruton
Age-Related Macular Degeneration
Agoraphobia
Agoraphobia
Agglutination test
Agglutination test
Agglutination test
Agglutination test
Agglutination test
Agglutination test
Agglutination test
Agglutination test
Agglutination test
Agglutinins (Coombs Test)
Agglutinins (Coombs Test)
Agranulocytosis
Akathisia
Akathisia
Alanine
Alanine
Alanine
Albinism
Albinism
Albinism
Albinism
Albinism
Albinism type 2
Albumin
Albuminuria
Albuterol
Albuterol
Albuterol
Albuterol
Alcian Blue
Alcohol
Alcohol
Alcohol Fetal Syndrome
Alcohol Fetal Syndrome
Alcoholic Hepatitis
Alcoholic Hepatitis
Alcoholic Hepatitis
Alcoholic Hepatitis
Alcoholism
Alcoholism
Alcoholism
Alcoholism
Alcoholism
Alcoholism
Alcoholism
Alcoholism
Aldosterone
Aldosterone
Aldosterone
Aldosterone
Aldosterone
Aldosterone
Aldosterone
Aldosterone
Alopecia Areata
Alkaline Phosphatase
Alkaptonuria
Alkaptonuria
Alkaptonuria
Alkaptonuria
Alkaptonuria
Allele
Allergic Broncho Pulmonary Asperg.
Allergic disorders
Allergic Contact Dermatitis
Allergic Contact Dermatitis
Allergic Interstitial Nephritis
Allergic Interstitial Nephritis
Allergic Rhinitis
Allergic Rhinitis
Allergic Rhinitis
Allopurinol
Allopurinol
Allopurinol
Alpha 1 Adrenoceptor Activation
Alpha 1 adrenergic receptor
Alpha 1 Antitrypsin Deficiency
Alpha 1 Receptor Blockers
Alpha 1 Receptor Blockers
Alpha Cell Tumor
Alpha Galactoridase
Alpha Hydroxylase Pathway
Alpha Interferon
Alport Syndrome
Alprazolam
Alprazolam
Altruism
Alveolar Ventilation
Alzheimer Disease
Alzheimer Disease
Alzheimer Disease
Alzheimer Disease
Alzheimer Disease
Alzheimer Disease
Alzheimer Disease
Amanita Muscaria
Amantadine
Amaurosis Fugax
Amebic Liver Abscess
Amenorrhea
Ames Test
Ames Test
Ames Test
Aminoacid
Aminoacid
Aminoacid
Aminoacid
Aminoacid
Aminoacid
Aminoacid
Aminoacid
Aminoacid
Aminoacid
Aminoacid Derivates
Aminoacid Derivates
Aminoacid Derivates
Aminoacid Derivates
Aminoacid Derivates
Aminoacid Electric Charges
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Aminoglycosides
Amiodarone
Amiodarone
Amiodarone
Amiodarone-induce lung disease
Amitriptyline
Amitriptyline
Amitriptyline
Amitriptyline
Amnesia types
Amnesia types
Amnesia types
Amnesia types
Amnesia types
Amniocentesis Risks Factors
Amniocentesis Vs. C.V.S.
Amniotic Fluid (A.F.)
Aminotic Fluid (A.F.)
Aminotic Fluid (A.F.)
Amniotic fluid embolism
Amonia
Amonia-Forming Bacteria
Amoxicillin
Amphetamines
Amphetamines
Amphetamines
Amphotericinin B
Amphotericinin B
Amphotericinin B
Amphotericinin B
Amphotericinin B
Amphotericinin B
Amphotericinin B
Amphotericinin B
Ampicillin
Ampicillin
Amthrax
Amyloid
Amyloid
Amyloid
Amyloid protein AA
Amyloid protein AA
Amyloid protein AA
Amyloid protein alphabetha2
Amyloid protein alphabetha2
Amyloid protein AL
Amyloid protein ATTR
Amyloidosis
Amyloidosis
Amyloidosis
Amyloidosis
Amyloidosis
Amyloidosis
Amyloidosis
Amyloidosis
Amyloidosis, Localized
Amyloidosis, Secundary
Amyloidosis, Secundary
Amyloidosis, Systemic
Amynoglycoside
Amynoglycoside Toxicity
Amyotrophic Lateral Sclerosis (ALS)
Anabolic hormones
Anaerobes
Anaerobic Glycolysis
Anal fissure
Anal fissure
Anal fissure
Analgesic Nephropathy
Analysis of Variance
Anaphase
Anaplasma phagocytophilum
Ancylostoma duodenale
Chediak-Higashi syndrome
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Golgi Apparatus
Hyperproinsulinemia
Hyperproinsulinemia
I - Cell Disease
I - Cell Disease
Kartagener Syndrome
Kartagener Syndrome
Kartagener Syndrome
Kartagener Syndrome
Muscle Tissue
Muscle Tissue
Muscle Tissue
Muscle Tissue
Muscle Tissue
Muscle Tissue
Muscle Tissue
Muscle Tissue
Muscle Tissue
Muscle Tissue
Muscle Tissue
Muscle Tissue
Muscle Tissue
Muscle Tissue
Muscle Tissue
Muscle Tissue
Muscle Tissue
Muscle Tissue
Muscle Tissue
Peroxisomes
Peroxisomes
Peroxisomes
Peroxisomes
Peroxisomes
Peroxisomes
Peroxisomes
Andersen's Disease
Andersen's Disease
Androgen insensitivity Sx
Androgens
Androgens
Androgen-Binding Protein (ABP)
Anemia
Anemia
Anemia
Anemia
Anemia
Anemia
Anemia
Anemia
Anemia
Anemia
Anemia
Anemia
TYPE OF ANEMIA
Iron Deficiency
Anemia of Chronic Disease
Sideroblastic Anemia
Thalasemia
TYPE OF ANEMIA
Iron Deficiency
Anemia of Chronic Disease
Sideroblastic Anemia
Thalasemia
Anemia, Macrocytic (MCV > 100)

Anemia, Macrocytic (MCV > 100)
Anemia, Microcytic (MCV < 80)
Vitamin B6 (Piridoxine) Deficiency

** Microcytic Hypochromic
** Increase Iron in Mitocondria
** Ringed Sideroblasts in Bone Marrow
** Can not have Porphyrin
** Protoporphyrin: ↓
** Gamma-ALA: ↓
** Ferritin: ↑
** Serum Iron: ↑
CAUSES
** Isoniazid for tuberculosis. Antidote Vit B6
Anemia, Normocytic
Anemia, Normocytic
Anemia, Normocytic
Anemia, Normocytic
Anemia, Normocytic
Anemia, Normocytic
Anemic Patient
Anemic Patient
Anemic Patient
Anemic Patient
Anesthesia
Anesthesic
Anesthesic
Anesthesic
Anesthesic
Anesthesic, General
Anesthesic, General
Anesthesic, General
Anesthesic, Local
Anesthesic, Local
Anesthesic, Local
Anesthesic, Local
Angina Pectoris (STABLE)
Angina Testing
Angina Testing
Angina Testing
Angina Testing
Angina Unstable
Angina Unstable
Angina Variant
Angina Variant
Angioedema
Angiomyolipoma
Angiosarcoma of Liver
Angiotensin II
Angiotensin II
Angiotensin II
Angiotensin II
Animal bite
Animal bite
Animal bite
Animal bite
Animal bite
Anion GAP
C.N.A.G.M.A.
C.N.A.G.M.A.
Renal Loss of Bicarbonate
G.I. Loss of Bicarbonate

C.I.A.G.M.A
C.I.A.G.M.A
** Lactic Acidosis
Ankle Sprain
Ankle Sprain
Ankle Sprain
Ankle Sprain
Ankle Sprain
Ankle Sprain
Ankylosing spondylitis
Anorexia Pt.
Anorgasmia
Anosagnosia
Anosagnosia
Anserine Bursitis
Anterior Body Wall
Anterior Cerebral Artery Damage
Anterior Pituitary Insuficiency
Anterior Uveitis
Anti-CD 11 Monoclonal
Anti-centromere Antibodies
Anti-ds DNA
Anti-ds DNA
Anti-endomysial Antibodies
Anti-glomerular basement membrane antibody
Anti-HBc
Anti-HEV IgM antibodies
Anti-histone antibodies
Anti-Ig G
Anti-Ig G
Anti-jo Antibodies
Anti-RNP antibodies
Anti-Ro Antibodies
Anti-Ro Antibodies
Anti-Ro Antibodies
Anti-SCL 70
Anti-Smith Antibodies
Antiarrhythmics - Class I
Antiarrhythmics - Class IA
Antiarrhythmics - Class IB
Antiarrhythmics - Class IC
Antiarrhythmics - Class II
Antiarrhythmics - Class II
Antiarrhythmics - Class III
Antiarrhythmics - Class III
Antiarrhythmics - Class IV
Antiarrhythmics - Class IV
Antiarrhythmics - Others
Antiarrhythmics - Others
Antibiotics, Quinolone
Antibodies
Antibodies
Antibodies
Antibodies
Antibodies
Antibodies
Antibodies
Antibodies
Antibodies
Antibodies
Antibodies
Antibodies
Antibodies Antinuclear (ANA)
Antibodies Anti-Jo-1
Antibodies Anti-Ro
Antibodies Anticentromere
Antibodies Antihistone
Antibodies, Opsonic
Anticardiolipin Antibodies
Anticholinergic Delirium
Anticholinergic Delirium
Anticholinergic Drugs
Anticholinergic Effects
Anticholinergic Effects
Anticholinesterase Inhibitor Toxicity
Antidigoxin Fab fragments
Antihistamines
Antihistamines
Antihistamines
Antihistamines
Antihistamines
Antimicrobial Therapy
Antinuclear Antibody Test
Antiphospholipid Antibodies
Antisocial Personality Disorder
Anterior Cord Syndrome
Anterior Cord Syndrome
Anxiety Disorder
Anxiety Disorder
Anxiety Disorder
Aortic Aneurysm
Aortic Arch Derivatives
Aortic Dissection
Aortic Dissection
Aortic Dissection
Aortic Dissection
Aortic Insuficiency
Aortic Insuficiency
Aortic Insuficiency
Aortic Stenosis
Aortic Stenosis
Aortic Stenosis
Aortic Stenosis
Aortic Stenosis
Aortic Stenosis
Aortic Stenosis
Aortic Regurgitation
APGAR
APGAR
APGAR
APGAR
APGAR
Apert's Syndrome
Aphasia, Arcuate Fasciculus
Aphasia, Arcuate Fasciculus
Aphasia, Broca
Aphasia, Broca
Aphasia, Broca
Aphasia, Broca
Aphasia, Broca
Aphasia, Wernicke
Aphasia, Wernicke
Aphasia, Wernicke
Aphasia, Wernicke
Aplastic Anemia
Aplastic Anemia
Aplastic Anemia
Aplastic Anemia
Aplastic Anemia
Aplastic Anemia
Aplastic Anemia
Aplastic Anemia
Apnea of Prematurity
Apo B-100 receptor
Apolipoprotein CII
Apolipoprotein CII
Apoptosis
Apoptosis
Apoptosis
Apoptosis
Apoptosis
Apoptotic Cell
Apoptotic Cell
Apoptotic Cell
Apoptosis Gene
Apoptosis Gene
Arginine Vasopressin Secretion
Arnold-Chiari Malformation
Arrythmias
Artery
Artery
Artery
Artery
Artery
Artery
Artery
Artery
Artery
Artery
Artery
Artery
Artery
Artery
Artery
Artery
Artery Changes
Artery Changes
Artery Changes
Artery Changes
Artery Changes
Artery Changes
Artery Changes
Artery Changes
Arterial Compliance
Arteriogram
Arterioles
Arteriovenous Fistula
ArterioVenous Malformation
ArterioVenous Malformation
Artherosclerosis
Artherosclerosis Hyaline
Artherosclerosis Hyperplastic
Artheriosclerotic Disease
Artheriosclerotic Lesion
Asbestosis
Asbestosis
Asbestosis
Asbestosis
Asbestosis
Asbestosis
Asbestosis
Asbestosis
Asbestosis
Asbestosis
Asbestosis
Ascaris lumbricoides
Ascaris lumbricoides
Ascertainment Bias
Ascites
Ascites
Aseptic Meningtis
Asherman Syndrome
Asherman Syndrome
Ashkenazic Jews
Aspartic Amino Acids
Aspergilioma
Aspergiliosis
Aspergilius fumigatus
Aspergilius fumigatus
Aspiration of Meconium
Aspiration Pneumonia
Aspiration Pneumonia
Aspiration Pneumonia (Foreign body)
Aspriation Pneumonitis
Aspiration Pneumonitis
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin Toxicity
Aspirin Toxicity
Aspirin Toxicity
Asthma Attack
Asthma Attack
Asthma Attack
Asthma Bronchial
Asthma Bronchial
Asthma Bronchial
Asthma Induced Exercise
Asthma Induced Exercise
Asthma Mild and Intermittent
Asthma Moderate
Asthma Moderate and Persistant
Asthma Moderate to Severe
Asthma Pharmacotherapy
Bronchodilation
BRONCHIAL TONE
Ach Adenosine
Muscarinic Antagonists Theophylline
Bronchoconstriction
Astrocytoma
Astrocytoma
Astrocytos
Asymptomatic Bacteriuria
Ataxia-Telangeiectasia
Ataxia
Ataxia
Ataxia
Atelectasis
Atelectasis
Atenolol
Atenolol
Atlantoaxis Joints destruction
Atlantoaxis Joints destruction
Atrial Fibrillation
Atrial Fibrillation
Atrial Fibrillation
Atrial Fibrillation
Atrial Fibrillation
Atrial Fibrillation
Atrial Flutter
Atrial Flutter
Atrial Natriuretic Peptide (ANP)
Atrial Septal Defect
Atrioventricuar Node Fibers
Atrioventricuar Node Fibers
Atopic Dermatitis
Atopic Dermatitis
Atropine
Atropine
Atropine
Atropine
Atropine
Atropine
Atropine
Atropine
Atrophic Vaginitis
Atrophic Vaginitis
Atrophic Vaginitis
Atypical Antipsychotic Medications
Auditory Pathway
Auditory Pathway
Auditory Pathway
Auditory Pathway
Auditory System Central Pathway
Auer Rods
Auer Rods
Autistic Disorder
Autistic Disorder
Autistic Disorder
Autoantibodies
Autoantibodies
Autoantibodies
Autoantibodies
Autoantibodies
Autoantibodies
Autoantibodies
Autoimmune Disease
Autoimmune Disease
Autonomic Neuropathy
Autopsy Founding
Autopsy Founding
Autopsy Founding
Autopsy Founding
Autopsy Founding
Autopsy Founding
Autopsy Founding
Autopsy Founding
Autopsy Founding
Autosomal Trisomies
Autosomal Trisomies
Autosomal Trisomies
Autosomal Trisomies
Autosomal Trisomies
Autosomal Trisomies
Autosomal Trisomies
Axillary Nerve
Azathioprine
Azithromycin
Aztreonam
Aztreonam
Aztreonam
Aztreonam
Aztreonam
B-Cell
B-Cell
B-Cell Lymphoma
B-Cell Lymphoma
B cell Vs. T cell
B cell Vs. T cell
bcl-gene
bcl-gene
bcl-gene
B.M.I.
B.M.I.
B.P.H
B.P.P.V
B.U.N./Creatinine Ratio
Babesia microti (B.M.)
Bacillus Ceruleus
Baclofen
Bacteria Replication
Bacterial Growth Curve
Bacterial Meningitis
Bacterial Meningitis
Bacterial Pneumonia
Bacterial Skin Infections
Bacterial Vaginosis
Bacterial Vaginosis
Bacterial Vaginosis
Bacterial Vaginosis
Bacterial Vaginosis
Bacteroides Fragilis
Barbiturates Withdrawal
Barium Enema
Barium Swallow
Barium Swallow
Baroreceptor Reflex
Barr Body
Barrett Esophagitis
Barrett Esophagitis
Barrett Esophagus
Barrett Esophagus
Barrett Esophagus
Bartonella Henselae
Bartonella Henselae
Bartter's Syndrome
Basal Cell Carcinoma
Basal Ganglia
Basal Ganglia
Basal Ganglia
Basal Ganglia
Basal Ganglia
Basal Ganglia
Basal Ganglia
Basal Ganglia
Basal Ganglia
Basal Ganglia
Basal Ganglia
Base of Skull Fx
Base of Skull Fx
Basic Fibroblast Growth Factor
Basilar Angiomatosis
Beck Triad
Becker Muscular dystrophy
Becker Vs. Duchenne
Becker Vs. Duchenne
Becker Vs. Duchenne
Becker Vs. Duchenne
Becker Vs. Duchenne
Beckwith-Wiedermann Syndrome
Beclomethasone Inhaler
Beevor's Sign

BIAS
BIAS
BIAS
BIAS
BIAS
BIAS
BIAS
CASE VIGNETTES
CASE VIGNETTES
CASE VIGNETTES
CASE VIGNETTES
CASE VIGNETTES
CASE VIGNETTES
CASE VIGNETTES
CASE VIGNETTES
CASE VIGNETTES
CASE VIGNETTES
CASE VIGNETTES
CASE VIGNETTES
CASE VIGNETTES
CASE VIGNETTES
CASE VIGNETTES
CLINICAL TRIAL
DEFENSE MECHANISMS
DEFENSE MECHANISMS
DEFENSE MECHANISMS
DEFENSE MECHANISMS
DEFENSE MECHANISMS
DEFENSE MECHANISMS
DEFENSE MECHANISMS
DEFENSE MECHANISMS
DEFENSE MECHANISMS
DEFENSE MECHANISMS
DEFENSE MECHANISMS
DEFENSE MECHANISMS
DEFENSE MECHANISMS
DEFENSE MECHANISMS
DEFENSE MECHANISMS
DEFENSE MECHANISMS
NARCISSISTIC DEFENSES
IMMATURE DEFENSE
ANXIETY DEFENSE
(NEUROSIS DEFENSE)
MATURE DEFENSES
Learning and Behavior Modification

META-ANALYSIS
OBSERVATIONAL STUDY
POWER
POWER
POWER
PRECISION VS. ACCURACY
PREDICTIVE VALUE, POSITIVE
PREDICTIVE VALUE, POSITIVE
PREDICTIVE VALUE, NEGATIVE
PREDICTIVE VALUE, NEGATIVE
PREDICTIVE VALUE
PREDICTIVE VALUE
PREVALENCE VS. INCIDENCE
RELIABILITY AND VALIDITY
SENSITIVITY
SENSITIVITY
SENSITIVITY
SENSITIVITY
SPECIFICITY
SPECIFICITY
SPECIFICITY
STANDARD DEVIATION VS ERROR
STATISTICAL DISTRIBUTION
STATISTICAL HYPOTHESES
STUDY, CASE-CONTROL
STUDY, CASE-CONTROL
STUDY, COHORT
STUDY, COHORT
TYPE I ERROR (ALPHA)
TYPE II ERROR (BETA)
VALIDITY AND RELIABILITY
Behcet Syndrome
Behcet Syndrome
Bell's Palsy
Bell's Palsy
Bell's Palsy
Bence Jones Protein
Benign Reactive Lymphadenitis
Benign Reactive Lymphadenitis
Benjel
Benztropine
Berger Disease
Bernard-Soulier Syndrome
Berry Aneurysms
Berry Aneurysms
Berry Aneurysms
Berry Aneurysms
Beta adrenergic receptors
Beta 1 adrenergic receptors
Beta 1 adrenergic receptors
Beta 1 adrenoceptor Activation
Beta Agonists
Beta Blockers
Beta Blockers
Beta Blockers
Beta Blockers
Beta Blockers
Beta Blockers
Beta Blockers
Beta Blockers
Beta Galactoridase
Beta Glucocerebrosidase
Bethanechol
Bethanechol
Bethanechol
Bias
Bias
Bias
Bias
Biceps
Biceps
Biceps
Bicuspid Aortic Valve
Bilateral Schwannomas
Bilateral Adrenal Hemorrage
Bile Duct
Bile Duct
Biliary Cirrhosis
Billroth II Gastrojejunoanastomosis
Billroth II Gastrojejunoanastomosis
Binding Protein (Bi. Pr.)
Binding Protein (Bi. Pr.)
Biopsy of the edge of the lesion
Biopsy with wide excision
Biphosphonates
Bipolar Disorder
Bipolar Disorder
Birth Abnormalities
Birth Abnormalities
Birth Abnormalities
Birth Abnormalities
Birth Abnormalities
Birth Abnormalities
Black Widow Spider Bites
Black Widow Spider Bites
Blastomyces Dermatiditis
Blastomycosis
Bleeding Time
Bleomycin
Bleomycin
Bleomycin
Blockage Muscarinic Acetylcholine
Blockage of Alpha-Adrenergic
Blockage of the C.R.
Blockage of the P.R.
Blockage of the P.C.P.P
Blocking
Blocking
Blocking
Blocking
Blocking
Blocking
Blocking
Blocking
Blood Brain Barrier
Blood Brain Barrier
Blood Brain Barrier
Blood Brain Barrier
Blood Cell Differentiation
Bloody Diarrhea
Blood Preassure Recommendation
Bloom's Syndrome
Blue Rubber Bled Nevus Sx.
Blurred Vison
Body Dysmorphic Disorder
Body Mass Index
Body Mass Index
Bone Marrow Iron Stain
Bone Marrow Transplantation
Bone Marrow Transplantation
Borderline Personality Disorder
Bordetella Hensenlae
Bordetella Pertusis
Bordetella Pertusis
Bordetella Pertusis
Bordetella Pertusis
Bordetella Pertusis
Bodies, Aschoff
Bodies, Aschoff
Bodies, Aschoff
Bodies, Weibel-Palade
Bodies, Mallory
Bodies, Lewy
Borrelia Burgdorferi
Botox
Botox
Botulism
Botulism
Botulism
Botulism, Infant
Botulism, Infant
Bowen Disease
Brachial Plexus
Brachial Plexus
Brachial Plexus
Brachial Plexus
Brachial Plexus
Brachial Plexus
Brachial Plexus
Brachial Plexus
Brachial Plexus
Brachial Plexus
Brachial Plexus
Brachial Plexus
Brachial Plexus
Brachial Plexus Upper trunk
Brachial Plexus Lateral trunk
Brachial Plexus Lateral trunk
Brachial Plexus Lower trunk
Brachial Plexus Lower trunk
Brain Abscess
Brain Abscess
Brain Abscess
Brain Abscess
Brain Abscess
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Blood Supply
Brain Cortex
Brain Cortex
Brain Cortex
Brain Cortex
Brain Cortex
Brain Cortex
Brain Death
Brain Death
Brain Embryonic Structure
Brain M.R.I. Image
Brain M.R.I. Image
Brain Metastasis
Brain Stem Glioma
Brain Stem Glioma
Brain Tumor
Brain Tumor
Brain Tumor
Brain Tumor
Brain Tumor
Brain Tumor
Brain Tumor
Brain Tumor
Branchial Apparatus
Branchial Arches
Branchial Arches 1 and 2
Branchial Arch Innervation
Branchial Arch Innervation
Branchial Cleft Derivates
Branchial Cleft Derivates
Branchial Pouch Derivates
Breaking bad news
Breaking bad news
Breaking bad news
Breaking bad news
Breaking bad news
Breaking bad news
Breaking bad news
Breast Abscess
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Diseases
Breast Cancer
Breast Cancer
Breast Cancer
Breast Cancer
Breast Cancer
Breast Cancer
Breast Cancer
Breast Cancer
Breast Cancer
Breast Cancer
Breast Cancer
Breast Cancer
Breast Cancer
Breast Cancer Paget disease
Breast Cancer Inflamatory type
Breast Cancer Metastasis
Breast Cancer Metastasis
Breast Carcinoma
Breast Carcinoma
Breast Carcinoma
Breast Carcinoma
Breast Carcinoma
Breast Carcinoma
Breast Carcinoma
Breast Carcinoma
Breast Carcinoma
Breast Milk
Bronchial Asthma
Bronchial Asthma
Bronchiectasis
Bronchiectasis
Bronchiectasis
Bronchiolitis Obliterans
Bronchoalveolar Lavage
Bronchogenic Lung Cancer
Bronchoscopy
Bronchoscopy
Bronchoscopy
Bronchoscopy
Bronchospam
Bronchospam
Bromocriptine
Bromocriptine
Brucella Abortus
Brucella Abortus
Brucella Abortus
Brudzinski's sign
Bruton Inmunodeficiency
Buboes
Budd-Chiari Syndrome
Budd-Chiari Syndrome
Buerger's Disease
Bulbus Cordis
Bulimia
Bulimia Nervosa
Bulimia Nervosa
Bulimia Nervosa
Bulimia Nervosa
Bulimia Nervosa
Bullous pemphigoid
Bupropion
Bupropion
Bupropion
Bupropion
Bupropion
Burger's Syndrome
Burkitt Lymphoma
Burkitt Lymphoma
Burkitt Lymphoma
Burkitt Lymphoma
Burn Patient
Burn patient
Burn Patient First Degree
Burn Patient Second Degree
Burn Patient Third Degree
Buspirone
Buspirone
Buspirone
Buspirone
Bx of the center of the lesion
Bx of the edge of the lesion
Bx wide excison
C1q
C1q
C3b
C3b
C3b
C3b
C4
C5
C5a
C-Factor B
C-Factor B
CA-125
CA-19-9
C.A.B.G.
C.A.B.G.
C.A.B.G.
CAGCTG Sequence
CAGCTG Sequence
CAGCTG Sequence
CAGCTG Sequence
CAGCTG Sequence
CAGCTG Sequence
c AMP
c AMP levels
Ca Na 2 EDTA
Ca Na 2 EDTA
C.C.R. 5 coreceptor
C.C.R. 5 coreceptor
CD 3 marker
CD 3 marker
CD 3 marker
CD 3 marker
CD 4 marker
CD 4 marker
CD 4 marker
CD 4 marker
CD 4 marker
CD 4 marker
CD 4 marker
CD 4 marker
CD 8 marker
CD 8 marker
CD 8 marker
CD 16 marker
CD 16 marker
CD 19 marker
CD 20 marker
CD 28 marker
CD 28 marker
CD 56 marker
CD 56 marker
CD 56 marker
C.H.F
C.K.-MB
C.M.V. in AIDS PT
C.M.V. in AIDS PT
C.M.V. in AIDS PT
C.M.V. in AIDS PT
C.M.V. polyradiculopathy
C.O.2 (Carbonic Dioxide)
C.O.P.D
C.O.P.D
C.O.P.D
C.O.P.D
C.O.P.D exacerbation
C.R.E.S.T Syndrome
C.S.F Purulent Composition
C.S.F Composition
C.S.F Finding
C.V.S. Vs.Amniocentesis
C.T. Scan of the Chest
Café-eu-laid Spots
Calcium Channel Blockers
Calcium Levels
Ca2+ Phosphate Alkaline Phosphate
Hyperparathyroidism ↑ ↓ ↑
Paget's Disease of Bone N/↑ N ↑↑↑
Vitamin D Intoxication ↑ ↑ N/↑
Osteoporosis N N N
Renal Insufficiency ↓ ↑ N
Calcium Oxalate Stones

Calcitonin Levels
California encephalitis
California encephalitis
Calymmatobacterium granulomatis
Campylobacter jejuni
Cancer
Cancer-Associated Anorexia
Cancer of the Ampulla of Vater
Cancer of the Ampulla of Vater
Cancer, Paraneoplastic Effects
Cancer Treatment
Cancer Treatment
Candida Albicans
Candida Albicans
Candida Albicans
Candida Albicans
Candida Albicans
Candida Vulvovaginitis
Candida Vulvovaginitis
Candidiasis
Candidiasis
Cannabis (Marijuana) (TCH)
Capillaries
Capillaries
Capillaries
Capillaries
Capillaries
Capillaries
Capillaries
Caplan Syndrome
Captopril
Captopril
Captopril
Captopril
Captopril Renal Scan
Carbamazepine
Carbamazepine
Carbamazepine
Carbamoyl Phospahte Synthetase
The NH4+come from Glutamine.
N-ACETYLGLUTAMATE (+)
Obligate Activator
** Citrullline enters the cytoplasm, and ornithine returns to the mitochondria

** Carbamoyl phosphate synthetase and ornithine transcarbamoylase are mitocondrial enzymes
** Aspartate enters the cycle in the cytoplasm and leaves the cycle (minus its amino group)
as fumarate. If gluconeogenesis is active, fumarate can be converted to glucose.
** The product urea is formed in the cytoplasm and enters the blood for delivery to the kidney.
Carbohydrate-Deficient Transferrin
Carbon Monoxide Poisoning
Carbon Monoxide Poisoning
Carbuncule
Carcinoid Syndrome
Carcinoid Syndrome
Carcinoid Syndrome
Carcinoid Syndrome
Carcinoid Syndrome
Carcinoid Syndrome
Carcinoid Tumor
Carcinoma of the Vagina
Cardiac Action Potential
Cardiac Arrest
Cardiac Block EKG
Cardiac Block EKG
Cardiac Block EKG
Cardiac Block EKG
Cardiac Block EKG
Cardiac Block EKG
Cardiac Cycle
Cardiac Cycle
Cardiac Electric Velocity Cell
Cardiac Muscle
Cardiac Muscle
Cardiac Muscle
Cardiac Muscle
Cardiac Muscle Cell
Cardiac Muscle Cell
Cardiac Muscle Cell
Cardiac Output (C.O.)

Cardiac Tamponade
Cardiac Tamponade
Cardiac Tamponade
Cardiac Tamponade
Cardiac Tamponade
Cardiac Troponins
Cardiac Thrombus
Cardiotoxicity Cumulative Drug
Cardiotoxicity Cumulative Drug
Cardiovascular Disease
Cardioversion Asynchronous
Cardioversion Synchronous
Carnitine
Carnitine
Carnitine
Carnitine
Carnitine
Carnitine
Carnitine
Carnitine
Caroli Disease
Caroli Disease
Carotid Artery
Carotid Massage (Ca.Ma)
Carotid Massage (Ca.Ma)
Carotid Sheath
Carpal Tunnel Syndrome
Cataplexy
Cataplexy
Catatonia
Catatonia
Cascade, COAGULATION
Case Control Studies

Cast
Cauda Equina Syndrome
Caudate Nucleus
Caudate Nucleus
Cavernous Sinus Thrombosis
Cavitation on the lung
Cavitation on the lung
Cefaclor
Cefaclor
Cefaclor
Cefaclor
Cefazolin
Cefotaxime
Ceftazidime
Ceftriaxone
Ceftriaxone + Gentamicin
Ceftriaxone + Gentamicin
Ceftriaxone + Vancomycin
Celiac Disease
Celiac Disease
Celiac Disease
Celiac Sprue
Celiac Sprue
Celiac Sprue
Cell
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle
Cell Cycle regulator in disease
Cell Differentiation
Cell Injury
Cell Injury
Cell Injury
Cell Injury
Cell Injury
Cellular Eosinophilia
Central and Peripheral Nervous System
Central Pontine Myelinolysis
Central Pontine Myelinolysis
Central Retinal Artery Occlusion
Central Retinal Vein Occlusion
Centrioles
Centrioles
Cerclage
Cerclage
Cerclage
Cerebral Amlyoid Angiopathy
Cereberal Abscess
Cereberal Infarct
Cerebelum Hematoma
Cervical Cancer
Cervical Dysplasia
Cervical Root Inervations
Cervical Spondylosis
Cervical Spondylotic Myelopathy
Cervical Sympathetic Chain Lesion
Cervical Squamous Cell Carcinoma
Cesarean Delivery
Cesarean Delivery
Cessation of Alcohol
Chagas Disease
Chagas Disease
Chagas Disease
Chlamydial Conjuctivitis
Charcoat-Marie-Tooth Disease
Charcoat-Marie-Tooth Disease
Charcot's Triad
CHARGE Syndrome
CHARGE Syndrome
Chemotherapy
Chest Pain
Chest Pain
Chest Pain Post-OP
Chest Tube Insertion
Chi-Square Test
Chickenpox
Childhood Abscense Epilepsy
Childhood Development Milestone
AGE GROSS MOTOR FINE MOTOR LANGUAGE SOCIAL / COGN

2 Months Lifts head/chest Tracks past midline Alerts to sounds, coss Recognizes parents
when prone Social smile
4-5 Months Rolls front to back, Grasps rattle Orients to voice: Enjoys looking arou
and back to front (5 mos) "ah-goo" razzes Laughs.
6 Months Sits Unassisted Transfers objects, raking grasp Babbles Stranger Anxiety
9 - 10 Months Crawls, pulls to stand Use 3 finger grasp Say mama/dada (nonspecific) Waves bye-bye, p
12 Months Cruises (11 mos), walks alone Use 2 finger grasp Say mama/dada (specific) Imitates actions.
15 Months Walks backward Uses cup Uses 4 - 6 words Temper tantrums
18 Months Runs, kicks a ball Build tower of 2 - 4 cubes Names common objects Copies parent in t
2 Years Walks up/ down steps Builds tower of 6 cubes Uses 2-words phrases Follow 2-step com
with help, jumps throwing the ball overhead
3 Years Ride tricycle, climbs stairs Copies a circle, use utensils. Uses 3-word sentences Brushes teethes
with alternating feet (3-4 years) washes/drie
4 Years Hops Copies a cross Counts to ten Cooperative pla
Childhood Obesity
Chlamydia Trachomatis
Chlorambucil
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloramphenicol
Chloride Depletion
Chlorpromazine
Chlorpromazine
Choanal Atresia
Choanal Atresia
Choanal Atresia
Cholangiocarcinoma
Cholangiocarcinoma
Cholangiocarcinoma
Cholangiocarcinoma
Cholangiocarcinoma
Cholelithiasis
Cholelithiasis
Cholelithiasis
Cholelithiasis
Cholera
Cholera Toxin
Cholera Toxin
Cholera Toxin
Cholesteatoma
Cholesteatoma
Cholesterol
THINGS TO REMEMBER:
Type I = Familial Hyperchylomicronemia = Lipoprotein Lipase Deficiency = ↑ Chylomicrons and blood levels of
Type IIa = Familial Hypercholesterolemia = LDL receptor Deficiency = ↑ LDL, Cholesterol but VLDL and TG
Type IIb = Familial Combined Hyperlipidemia = Hepatic increased synthesis of VLDL = ↑ LDL, VLDL, TG and Cholesterol. In
Type III = Familial dysbetalipoproteinemia = Altered Apoprotein E = ↑ IDL, VLDL, TG and Cholesterol. G
Type IV = Familial Hypertriglyceridmia = Hepatic overproduction of VLDL = ↑ VLDL, TG but LDL and Cholestero
Type V = Mixed Hypertriglyceridemia = Deficient Apoprotein CII = Greatly ↑ of TG, ↑ of VLDL, chylomic
Cholestyramine
Cholestyramine
Cholestyramine
Cholinergic Receptor Blocker
Cholinergic Receptor Mechanisms
Cholinesterase Inhibitor Poisoning
Cholinesterase Inhibitor Poisoning
Cholinomimetics Direct-Acting
Cholinomimetics Indirect-Acting
Chondrodystrophy
Chondrosarcoma
Chondrosarcoma
Chondrosarcoma
Chorda Timpani
Chorioammnonitis
Chromatin
Chromosomal Abnormalities Risk
Chromosomal Abnormalities Risk
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome
Chromosome 3
Chromosome 4
Chromosome 4
Chromosome 4;11
Chromosome 5
Chromosome 5
Chromosome 5
Chromosome 5
Chromosome 7
Chromosome 7
Chromosome 8;14
Chromosome 8;21
Chromosome 9;22
Chromosome 11
Chromosome 11;14
Chromosome 11;22
Chromosome 11;22
Chromosome 12;21
Chromosome 12;21
Chromosome 13
Chromosome 13
Chromosome 13
Chromosome 14;18
Chromosome 15;17
Chromosome 16
Chromosome 16
Chromosome 16
Chromosome 17
Chromosome 17
Chromosome 17
Chromosome 17
Chromosome 17
Chromosome 19
Chromosome 19
Chromosome 22
Chromosome 22q11
Chromosome 22q11
Chromosome, Mammalian
Chromosome X
Chromosome rearrangement
Chromosome Sex Disorder
Chronic Alcoholism
Chronic Alcoholism
Chronic Bronchitis
Chronic Bronchitis
Chronic Diabetic Neuropathic
Chronic Granulomatous Diseases
Chonic Hemolytic Anemia
Chronic Lymphocytic Leukemia
Chronic Myelogenus Leukemia
Chronic Otitis Media
Chronic Pancreatitis
Chronic Pyelonephritis
Chronic Renal Disease
Chronic Renal Failure
Chronic Severe Abdominal Pain
Chronic Stable Atrial Flutter
Chronic Subdural Hematoma
Chronic Tubulointerstitial Nephritis
Chronic Tubulointerstitial Nephritis
Churg-Strauss Syndrome
Chvostek Sign
Cigarrete Smoking
Cilastatin
Ciliary ganglion
Ciliary ganglion
Cimetidine
Cimetidine
Cimetidine
Ciprofloxacin
Circulating C3 Nephritic Factor
Circulation
Circunflex Artery
Cirrhosis
Cirrhosis
Cirrhosis
Cirrhosis
Cirrhosis
Cirrhosis
Cirrhosis
Cirrhosis
Cirrhosis
Cirrhosis
Cirrhosis
Cisapride
Cistoscopy
Citrate
Clanging
Clarithromycin
Clarithromycin
Clarithromycin
Clarithromycin
Class II antigens
Class II antigens
Class II antigens
Class II antigens
Class II antigens
Class II antigens
Classic Galactosemia
Classic Uterine Scar
Classical Conditioning
Clavicule Fracture
Clavicule Injuries
Clear Cell Adenocarcinoma
Clearance of Drug
Clearance of Drug
Clearance of Drug
Clearance of Free Water
Clearance of Glucose
Clearance of Glucose
Clearance of Inulin
Clearance of Inulin
Clearance of Inulin
Clearance of PAH
Clearance of PAH
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clindamycin
Clinitest Reaction
Clomipramide
Clomipramide
Clonazepam
Clonazepam
Clonidine
Clonorchis Sinensis
Clonorchis Sinensis
Close Angle Glaucoma
Closed Traumatic Pneumothorax
Clostridium
Clostridium
Clostridium Botulinum
Clostridium difficile
Clostridium Perfringens
Clostridium Ramosum
Clostridium Tetani
Clostridium Tetani
Clostridium Tetani
Clostridium Tetani
Clostridium Tetani
Clostridium Tetani
Clostridium Tetani
Clostridium Tetani
Clostridium Tetani
Clostridium Tetani
Clostridium Tetani
Clostridium Tetani
Clostridium Tetani
Clostridium Tetani
Clostridium Tetani
Clotrimazole Troches
Clozapin
Clozapin
Clozapin
Clubbing
Clubbing
Cluster Headache
Cluster Headache
Coagulation Cascade
Coagulation Cascade
Coagulation Factor Deficiency
Coagulopathias
Vit K Deficiency
Von Willebrand Disease.
Hemophilia A
Liver Disorder
Coarctation of the Aorta

Coat's Syndrome
Cocaine Intoxication
Cocaine Intoxication
Cocaine Overdose
Cocaine Overdose
Cocaine Overdose
Cocaine Overdose
Cocaine Overdose
Cocaine Withdrawal
Coccidioides immitis
Coccidioidomycosis
Coccidioidomycosis
Coccidioidomycosis
Coccidioidomycosis
Cognitive Behavior Therapy
Cognitive Disorder
Cold Sores
Cold Sores
Collagen Type
Collagen Type 1
Collagen Type 2
Collagen Type 3
Collagen Type 4
Collagen Type 5
Colloid Cyst
Colloid Cyst
Colchicine I.V.
Cold Autoinmune Hemolitic Anemia
Cold Nodule
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon Cancer
Colon, Descending
Combined Hyperlipidemia
Common Multifactorial Diseases
Common Variable Immunodeficiency
Community-Adquired Pneumonia
Competent Patient
Competent Patient
Competitive Inhibitor
Competitive Inhibitor Vs. Non-Competitive

Complement
Complement Factor Deficiency
Complete Androgen resistance
Compression Fx
Condoms
Condroblastoma
Conductive Hearing Loss
Condyloma
Condyloma
Condyloma Acuminata
Confidence Interval
Confined Placental Mosaicism
Confunder
Confunding
Confunding
Congenital Adrenal Hyperplasia
Congenital Arteriovenous Fistula
Congenital Cataract
Congenital Cardiac Defect
Cogenital Cardiac Malformations
Congenital Hip Dislocation
Congenital Heart Disease
Congenital Hypothyroidism
Congenital Hypothyroidism
Congenital Infections
Congenital Rubella Sx
Congenital Syphillis
Congenital Syphillis
Congenital Toxoplamosis
Congestive Cardiomiopathy
Congestive Heart Failure
Congestive Heart Failure
Conjugated Hyperbilirubinemia
Conn Disease
Conn Disease
Conn Disease
Conn Disease
Conn Disease
Contact Dermatitis
Contraception
Contralateral hemianopia
Constipation
Constrictive Pericarditis
Conversion Disorder
Conversion Disorder
Coombs' Test
Coombs' Test
Coombs' Test
Cooper
Cooper
Cooper
Cooper
Cooper
Cooper
Cooper
Cooper
Cooper
Cooper
Cooper
Cooper
Cooper
Cooper
Cooper
Cooper
Cooper
Cori's Disease
Cori's Disease
Cori's Disease
Cori's Disease
Corneal Vesicles
Coronary Angiogram
Coronary Artery Aneurysm
Coronary Artery, Right
Coronary Artery, Right
Coronary Circulation
Coronary Circulation
Coronary Heart Disease
Coronary Vasospam
Coronary Vasospam
Coronary Vasospam
Corpus Luteus Cysts
Correlation Coefficient
Corrigan Pulses
Corrigan Pulses
Corticosteroids
Corticosteroids
Corticosteroids
Corticosteroids
Corticosteroids
Corticosteroids
Corticosteroids
Corticosteroids
Cortisol
Cortisol
Cortisol
Cortisol
Cortisol Secretion
Cortisol Secretion
Cortisol Secretion
Cortisol Secretion
Cortisol Secretion
Cortisol Secretion
Corynebacteria Diphtheriae
Costimulatory signal
Costochondritis
Cotard's Syndrome
Cotard's Syndrome
Cotrimoxazole
Coumadin
Coumadin
Coumadin, Overdose
Courvoisier Sign
Cowden Syndrome
Coxiella Burnetii
Coxsackie Virus
Coxsackie Virus
Coxsackie Virus
Coxsackie Virus
Craniotabes
Craneal Nerves
Craneal Nerves
Craneal Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves
Cranial Nerves and Passageways
Craniopharyngioma
Craniopharyngioma
Craniopharyngioma
Craniopharyngioma
Craniopharyngioma
Creatinine
Creatinine
Creatinine Reabsorption
Cremaster Muscle
Cremaster Muscle
Cretinism
Cretinism
Creutzfeldt-Jakod Disease
Creutzfeldt-Jakob Disease
Creutzfeldt-Jakob Disease, Variant
Creutzfeldt-Jakob Disease, Variant
Cri-du-chat
Crigler-Najjar Syndrome
Crohn Disease
Crohn Disease
Crohn Disease
Crohn Disease
Crohn Disease
Crohn Disease
Crohn Disease
Crohn Disease
Crohn Disease
Crohn Disease
Crohn Disease
Crohn Disease
Crohn Disease
Crohn Disease
Crohn Disease
Crohn Disease
Crohn Disease
Crohn Disease
Crohn Disease
Cromolyn Sodium (Cr.Na)
Cronkite-Canada
Cryptococcal Infection
Cryptococcal Infection
Cryptococcal Meningoencephalitis
Cryptococcus Neoformans
Crystosporidium parvum
Cubital Tunnel Syndrome
Culdocentesis
Culture of the Ascitis Fluid
Cultures
Cultures
Cultures
Cultures
Cultures
Cultures
Cultures
Cultures
Cultures
Cultures
Cultures
Cushing Disease (C.D.)
Cushing Syndrome
Cushing Syndrome
Cushing Syndrome
Cushing Syndrome
Cushing Syndrome
Cushing Syndrome
Cushing Syndrome
Cushing Syndrome
Cushing Syndrome
Cushing Syndrome
Cushing Reflex
Cushing Reflex
Cyanide Poisoning
Cyanide Poisoning
Cyanide Poisoning
Cyanide Poisoning
Cyanide Poisoning
Cyanosis
Cyanosis
Cyanosis
Cyclin B/cdc2 complex
Cyclobenzaprine
Cyclophosphamide
Cyclophosphamide
Cyclophosphamide
Cyclophosphamide
Cyclophosphamide Pulse IV
Cyclothymic Disorder
Cytochalasin B
Cytochalasin B
Cytogenetic
Cytogenetic
Cytogenetic
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytokines
Cytomegalovirus (CMV)
Cytomegalovirus Colitis
Cytomegalovirus Colitis
Cytopenia
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytoskeleton
Cytosol Vs Mitocondria
Cytotoxic T cells
Cystic Duct Syndrome
Cystic Fibrosis
Cystic Fibrosis
Cystic Fibrosis
Cystic Fibrosis
Cystic Fibrosis
Cystic Fibrosis
Cystic Fibrosis
Cystic Fibrosis
Cystic Fibrosis
Cystic Fibrosis
Cystic Fibrosis
Cystic Fibrosis
Cystic Fibrosis
Cystic Fibrosis
Cystic Fibrosis
Cystic Fibrosis
Cystic Fibrosis
Cystic Fibrosis
Cystic Fibrosis
Cystic Fibrosis
Cystinuria
Cystinuria
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WHAT IS? --- CHARACTERISTIC --- S/S --- NSTX, NSMX, NSDX, ETC.
Under normal conditions Vit D acts to raise plasma Ca+ and phosphate
Vit D promotes bone deposition, as follow: 1) 1,25 di OH D3, increases the absorption of Ca+ and phosphate by the GI
2) 1,25 di OH D3 increases the reabsorption of Ca+ by renal distal tubule.
3) At high activity levels 1,25 di OH D3 increases the resorption of Ca+ and phosphate from bone.
Dioxygenase Deficiency causes Tyrosinemia, but not bleeding
Dioxygenase Differential Dx with Vit C Deficiency + normal prothombin time cause HYPERTYROSINEMIA (low Prolyl hydro
And ↑ testosterone: Dihydrotestorone (DHT) ratio are Dx of Male Undervirilization (also called Pseudovaginal Perineoscrotal
In utero differentiaton of Wolffian ducts into the normal male phenotyc internal reproductive tract requires testosterone, but not dihydr
On the other hand, differentiation of the indifferent external genital slit into the penis, prostate, and scrotum does require dihydrostesto
A congenital absence of 5alpha-reductase in these tissues will result Feminization (Male Undervirilization)
If left untreated, the affected individuals are generally phenotypic females until puberty,at which time, ↑ amounts of testoreone=Viriliza
If discovered early, a male gender assignment can be supported w/administration of dihydrostestosterone to ↑ penis size.
If discovered after infancy, a female gender assignment can be supported with estrogen substitution therapy and prophylactic
It is use in the Asthma Tx. Call Zileuton blocks conversion of arachidonic acid to leukotrienes.
Is located in the cell's plasma membrane, where it binds extracellular ligands and transduces as signal, usually via a G-prot
" A fear of Stranger" will be the correct answer about behavior patterns.
" A fear of Stranger" also call in the test = Developmental Stage-Linked Anxiety Response.
" Separation Anxiety" will be the correct answer about behavior patterns.
Tissues affected: Zona Glomerulosa, Zona Fasciculata and Zona Reticularis.
Tissues affected: Zona Fasciculata and Zona Reticularis. Testes. Ovaries
M.C. Andrenal Enzyme Deficiency. (Mineralocorticoids ↓ = ↓ B.P). Tissues affected: Zona Glomerulosa, Fasciculata and R
"Attacks" of headache, sweating, palpitation, nausea and chest paint that release expontaneously = Pheochromocytoma (this S/S occurs 5
The best screening test for Cushing Sx. (P.E.: BUFFALO HUMP, MOON FACIES, TRUNCAL OBESITY AND CUTANEOUS S
Can cause fetal anemia but it is not as severe of hydrops fetalis.
Captopril is use in Hypertension Diabetes Patient. M.C. Side Effect CHRONIC COUGH
Captopril, Lisinopril, Enalapril, Fosinopril, Benazepril. Also Losartan that is the only one that can not produce COUGH.
Chronic Cough = Cause by the accumulation of Kinins, and possible by the activation of the Arachidonic Acid Pathway.
We can use on first Post-Infarction Day. Can cause ANGIOEDEMA.
Lower both Systemic Blood Pressure and Intraglomerular Pressure. Lessen the amount of Proteinuria and Sclerosis in D
Use in Tx of M.I. and C.H.F because indirectly decrease the release of aldosterone and arginine vasopressin.
↑ in Cushing and Ectopic ACTH production. ↓ in Exogenous Glucorticoid administration,bilateral adrenal hyperplasia + adrena
Stimulation produce ↑ DHEA because ↑ sensitivity of the adrenal gland to ACTH. Like in POLYCISTIC OVARIAN DISEASE.
Stimulate production of CORTISOL, when Cortisol is release it feeds back to the pituitary to inhibit further ACTH secretion.
↓ cause ↓ of CORTISOL. This feeds back to inhibit further secretion of CRH (Corticotropin releasing hormone) and ACTH. W/O feedb
If we found ↑ it will because ↑ plasma osmolarity. An obligatory loss of water the body continues to occur even when a person is in wa
The loss of water from the body tends to concentrate the extracellular fluid, causing it to become HYPERTONIC CONCENTRA
Both the ↓ in extracellular fluid and ↑ in osmolarity act as stimuli for ↑ thirst and secretion of ADH
The ↓ in extracellular fluid volume also tends to ↓ arterial pressure, which in turn ↑ plasma renin activity AND aldosterone in
Water deprivation tends to decrease left atrial pressure.
Lithium inhibits the action of ADH on the V2 receptors in the Collecting Duct that regulate the permeability of water.
Therefore, Lithium will ↓ water permeability in the collecting duct, which will ↑ Urine Flow Rate and ↓ Urine Osmolarity
A.D.H. won't affect fractional clearance of sodium and the osmolar clearance
It is a major controller of WATER EXCRETION and ECF volume. Also control OSMOLARITY. Osmoreceptors are very sensit
Attention-Deficit Hyperactivity Disorder. 25% change to develop Antisocial Personality Disorder. No association with schizophren
The prevalence of ADHD is estimated to decline by 50% every 5 years until the mid-20's. Older the children get, less likely will develo
The impulsivity and hyperactivity ↓ as the child grows older but the level of INATTENTION will ↑.
Heterozygous females (sister of males Fragile X) frequently have developmental and behavioral problems such as ADHD.
Next step work out in this Pts will be Cytogenetic Testing. They may also have bordeline or mild mental retardation
Alpha fetoprotein (up to 500ng/mL), Tumor marker of Hepatocellular Carcinoma (H.C.C).
Persistent, Watery Diarrhea first negative result in Stool cultures. NSDx is MODIFIED ACID-FAST STAIN OF THE STOOL
Adrenal Insuficiency can be cause by fungal infection M.C. Coccidioidomycosis and CMV infection.
S/S progressive memory loss, alterations in fine motor control, urinary incontinence, and altered mental status.
Adult respiratory distress syndrome can occur in Acute Pancreatitis Tx include Positive end expiratory pressure (PEEP)
Bilateral infiltrates + Air Bronchograms + Minimal Pleural Effusions. We can see DIFFUSE ALVEOLAR DAMAGE (Sepsis, Bur
Pt. with this problem have REDUCED LUNG COMPLIANCE, LOW PCO2.
In diffuse alveolar damage we will see hyaline membranes within the alveolar cavities. A.R.D.S also call Hyaline Membrane
Criteria for Dx: 1) PCWP less than 18 mmHg. (normal value) favors Dx of A.R.D.S over Cardiogenic Pulmonary Edema
2) PaO2 to FiO2 ratio of 200 mmHg or Less, regardless of the level of PEEP. 3) Diffuse, bilateral infiltrates on Chest X-ray.
Can we see in Acute Pancreatitis because the reduction of the CIRCULATING PHOSPHOLIPASE.
In neonates can be produce by lacking of surfactant. To prevent this we give little glucocorticoids to the mother.
It is a massive atelectasis (colapse of the ariways) usually because is not surfactant in the alveolar.
Colapsing pressure = surface tension / radius of the airway. If we ↓ the denominator (radius) like in A.R.D.S, collapsing pres
In pregnant woman to stimulate surfactant they give little of glucocorticoids. Surfactant produce diminish surfance tensi
USMLE if glucocorticoids are not in the options other substance that ↑ surfactant are: thyroxine and prolactin.
We can see A.R.D.S in: Diabetic pregnant Pt, and C-section (because lack of stress).
In the hospital we can have Septic Shock, assoc. w/ A.R.D.S (first day), and D.I.C (after 48 hours).
Atypical Squamous Cells of Undetermined Significance (ASCUS). NSTx Repeat Pap Smear in 3 Months.
Most Cost-effective screening test for a Suspected AAA is ULTRASOUND.
CT of Abdomen with IV contrast is more expensive have little benefit over the U/S
Between Urinary Bladder and Sigmoid the NSDx is with CT scan. After this we can do Cytoscopy and Sigmodoscopy can be h
in the Abdominal Wall after Surgery we need to restablish the fluids and the fistula will close by itself.
Separate 5th toe away from 4th. Inervate by lateral Plantar Nerve."Spring" on the sole during walking. Insert from calcaneus
Uterine bleeding in 80% of cases because the retroplacental bleeding may be concealed.
Vaginal bleeding, abdominal pain, + uterine contractions (or increased uterine tone). Fetal distress is seen in more than 50% of cases
W.B.C. / Neuthrophils % = LESS THAN 500 = Suspect of PSEUDOMONA AURIGINOSA
Brown plaques with a velvety surface in flexural regions of neck, axilla and groin.
NSDx IS Blood glucose measurement. Related to obesity, diabetes, underlying cancer (adenocarcinomas of chest or abdom
In elderly patient can be underlying malignancy, M.C. gastric cancer, 2nd M.C. lung cancer.
Associated with Cushing Syndrome, Hyperthyroidism and Glucose Intolerance
Accuracy is the trueness of test measurements. SYSTEMIC ERROR reduced the Accuracy in a test
Precision is: 1. The consistency and reproducibility of a test (reliability). 2. The Absence of random variation in a test.
RANDOM ERROR reduced the precision in a test
Disulfiram inhibits the effect of alchohol dehydrogenase, resulting in a buildup of acetaldehyde.
Acetaldehyde causes "hangover" effects: facial flushing, tachycardia, hypotension, dyspnea, nausea, vomiting, headache, blurred vis
In contrast to aspirin, HAS NO ANTI-INFLAMMATORY EFFECTS. Acetaminophen is NSAIDs (Non-Steroid Anti-inflammatory
Its use in clinical forms of arthritis presumably is secondary to its analgesic effects.
In pharmacological concentrations does not inhibit either COX-I or COX-II but, rather, has activity against a variant of the former gen
This form (COX III) is expressed in the C.N.S and accounts for the antipyretic effect of Acetaminophen.
Like aspirin, however, acetaminophen does not lower a normal body temperature. Aspirin lower body temperature
Unlike aspiring, there is no assoc of Acetaminophen w/ Reye Syndrome. Aspirin is assoc w/ Reye Syndrome.
Tylenol is ACETAMINOPHEN. It is a poison because FREE RADICALS. Can be neutralized by Superoxide Bismutate.
Antidote is N-acetyl cystein (N-AC). Based on 4 hours post ingestion Adult Pt. should be given N-Ac if she/he took > 7.5 grm
The Mechanism of Action (Mch of Ac) of N-Acetyl cystein is to keep Up GLUTATHIONE to take care of FREE RADICALS
Also we can include activated charcoal (to absorb residual drug in the intestine) and N-acetylcysteine Tx is most effective within 10 hours after ingestion
In overdose, the metabolism of the drug results in the formation of MERCAPTURIC ACID, a metabolites can be excreted safely if con
When Glutathione levels are depleted, reactive metabolites are instead formed that bind covalently to hepatocytes and cause cell ly
Glutathione come from the Hexopentophosphate Shunt, main function to neutralize free radical specially the one to come from Pero
all these process that may be lead to FULMINANT HEPATIC FAILURE (Damage is around the central vein)
Use in the Tx of Narrow-angle Glaucoma

First line medical Tx for IDIOPATIC BENIGN INTRACRANIAL HYPERTENSION. (PSEUDOTUMOR-CEREBRI)
It is a Carbonic Anhydrase Inhibitor. Acetozolamide also inhibit choroid plexus (carbonic anhydrase) thus ↓ CSF.
In starvation stages will be expected to be ELEVATED.
Ach or VAGAL STIMULATION DECREASED the SLOPE OF PHASE 4 of Slow fiber (pacemaker cell) found in SA or AV noda
Presynaptic Neurons frequently have receptors for the transmitter that they release, the receptor autoregulate the amount of
Cholinergic neurons are found in the Cerebral Cortex and Anterior horn of the spinal cord.
All preganglionic neurons in the A.N.S (parasympathetic and sympathetic divisions) release Ach.
Postganglionic neurons of the parasympathetic branch are also cholinergic.
Also we can see in the postganglionic sympathetic area (eccrine sweat glands and blood vessels).
Have MUSCARINIC and NICOTINIC effects by stimulation of the corresponding receptors.
There are several types of muscarinic receptor M1, M2, M3, M4 and M5 coupled to G proteins.
M1 and M3 couple to phospholipase C with induce a rise of inositol-triphosphate (IP3), diaglycerol (DAG) in the present of C
M2 receptors are coupled to K+ channels and to Adenylcyclase whose activity they reduce.
Muscarinic effect are INHIBITED BY ATROPINE. Muscarinic effect are the following:
Cardiac Effects, Vascular effects, Effects on Smooth muscles (visceral), Effect on secretions (M3), Effect on the eye (M3) and Centr
Cardiac Effects: The innervation of auricles is much more important than that of the myocardium
Cardiac Effects: An injection of acetylcholine or the stimulation of the parasympathetic (vagal) include:
Cardiac Effects: Bradycardia, ↓ of atrioventricular conduction, ↓ of the strength of atrium contractions.
Cardiac Effects: Cardiac slowing explained partly by cellular HYPERPOLARISATION.
Cardiac Effects: Hyperpolarisation results from opening of K+ channels linked to the G proteins and K+ exit cell, inducing and ↑ in p
Cardiac Effects: The ↓ of the force of contration comes from a ↓ of Ca2+ entry in the cell, probably by inhibition of adenylcy
Vascular Effects: Vessels have muscarinic receptor but DO NOT receive cholinergic innervation.
Vascular Effects: Acethylcholine injection induces an arteriolar vasodilatation by release by the endothelium of a vasodilator c
Vascular Effects: This vasodilator compound is call EDRF (Endothelium Derived Relaxing Factor) then identified as Nitric
Vascular Effects: The paradoxical vasoconstriction induce by Ach on coronary vessels presenting atherosclerotic lesion is explained as
In Coronary artheriosclerotic vessels it's absence of EDRF release by damaged or absent endothelial cells and direct stimulation of the sm
Effects on Smooth Muscle: except vascular: By stimulation of phospholipase C, Acetylcholine elicits:
** Intestine: ↑in tone w/sometimes and ↑ in the peristaltic contractions. Nausea and vomiting testify to this stimulative action.
** Ureters: Increase in tone. Use in URINARY RETENTION PROBLEMS
** Bronchi: Bronchoconstriction. An aerosol of acethylcholine can cause an attack of asthma.
Effects on the secretions (M3 receptors): Ach increases, by activation of C phospholipase the following:
** Digestive (abundant saliva), Bronchial, Cutaneous (sweat) and Lacrimal Secretions.
Effects on the Eye (M3 receptors): Ach induces a decrease of iris diameter or MIOSIS.
Effects on the Eye (M3 receptors): MIOSIS facilitates the flow of the aqueous humor and tends to lower the intra-ocular pres
Central Effects: Muscarinic effects in the C.N.S are complex and not well characterized.
Central Effects: According to conditions, the stimulation of the post-synaptic muscarinic receptors elicits a depolarization or an hype
Nicotinic Effects: we will se in the Autonomic Ganglia Effects, N.M.J effects and Central Nervous System Effects.
The nicotinic effects of Ach resemble those of nicotine and result from activation of acetylcholine nicotinic receptors.
Nicotinic receptor (receptor-channels) in activated state let Na+ and Ca2+ enter into cells, creating a DEPOLARIZATION.
Nicotinic receptor-channels are member of the ligand-gate ion-channel family, also called IONOTROPIC RECEPTORS.
Two molecules of Ach are needed for activation of one receptor and opening the channel. They have a fast response.
Ach, by its nicotinic effects, is responsible for synaptic transmission.
Strikingly dilated esophagus with marked narrowing at the lower esophageal sphincter. Aperistalsis.↑ pressure in the esophageal sp
Acquired Achalasia can be cause by CHAGAS DISEASE in which the distal 3rd of the esophagus dilates because of loss of its intrins
Autosomal dominant cell signaling defect of fibroblast growth factor (FGF) receptor 3.
Results in dwarfism; short limbs, but head and trunk are normal size. The genetical explanation is Cell signaling
Abnormal gene product in FIBROBLAST GROWTH FACTOR (FGF) RECEPTOR 3.
If the Parents have normal kids w/Acondroplastic Kid the reason for that is NEW MUTATION IN THE PATERNAL GAMETE
Is an Autsomal Dominant condition in which more than 80% of the observed cases occurs as a resul of a NEW MUTATION.
Usually the "paternal age effect" is the observed association between the occurrence of new mutations.
Resulting in the average age of the fathers of such offspring at the time of conception.
Mutation rates in spermatogenesis and oogenesis are not equal, when one compares the number of cell divisions (opportunities to copying
The following formulas give appropriate compensations for a single disorder. If the formula doesn't match the actual values, suspect a
METABOLIC ACIDOSIS: Winter Formula: PCO2 = 1.5 (HCO3-) + 8 ± 2
METABOLIC ALKALOSIS: PCO2 ↑ 0.7 mmHg for every ↑ 1 mEq/L HCO3-.
REPIRATORY ACIDOSIS ACUTE: ↑ 1 mEq/L HCO3- for every ↑ 10 mm Hg PCO2
REPIRATORY ACIDOSIS CHRONIC: ↑ 3.5 mEq/L HCO3- for every ↑ 10 mm Hg PCO2
REPIRATORY ALKALOSIS ACUTE: ↓ 2 mEq/L HCO3- for every ↓ 10 mm Hg PCO2
REPIRATORY ALKALOSIS CHRONIC: ↓ 1 mEq/L HCO3- for every ↓ 10 mm Hg PCO2
pH and pCO2 are the best picture of ABS of any patient.
ACID BASIC METABOLISM

METABOLIC ACIDOSIS
METABOLIC ALKALOSIS
MIXED ACIDOSIS
MIXED ALKALOSIS
RESPIRATORY ACIDOSIS
RESPIRATORY ALKALOSIS
If the pH is normal and HCO3 and PCO2 are HIGH = Fully compensated RESPIRATORY ACIDOSIS e.g. C.O.P.D Pt
If the pH is normal and HCO3 and PCO2 are LOW = Fully compensated RESPIRATORY ALKALOSIS
Intracellular (K+)
Non-Ionized = Lipid Soluble

Ionized = Water Soluble
M.C. pathogen in Nosocomial Pneumonia. NSTx Levofloxacine if they are resistant we use Imipenem or Meropenem.
Moderate to Severe. NSTx Isotretinoin: Oral Retinoid. Effective in Tx of nodulocystic-type acne + Scar. Also Antibiotic (Tetrac
Mild Inflammatory Can: 1) topical benzylperoxide. 2) Antibiotic (Erythromycin, Clyndamycin, Tetracycline) Topical.
The Tx depend of the intensitivity. We start with topical application of comedolytic agents. Severe case we use Isotretionin by
Tumor of the cerebellopontine angle. Sensory hearing loss+facial nerve palsy+cerebellar dysfunction on the affected side+headach
Hearing Loss + Tinnitus + Vertigo + Facial S/S
Needs to be suspected in any Pt. with previous Abdominal Surgery that have S/S dizzines, fatigue because ↓ of peripheral resistance and ↑ o
Hemorrhagic dermatitis around the eyes, nose, mouth, anus and other distal parts see in Zinc Deficiency.
Overproduction of Growth Hormone. Voice Change, Growth Tongue, hands (Carpal Tunnel Sx), feet and Craniofacial Skeleto
NSDx Measurement of: 1) Insulin-like growth factor 2) Growth Hormone levels Following Glucose Suppression Test.
Pharmacologic agents for acromegaly include: Somatostatin analogues such as Octreotide and Lanreotide.
Also include: Dopamine agonist such as CARBEGOLINE and Growth Hormone Receptor Antagonists
Radiation Treatment is used only if both Surgical Tx and Pharmacologic Tx are ineffective in lowering growth hormone levels.
Ultraviolet sun damage. Small, flesh-colored or slightly pigmented papules that have a characteristic sandpaper-like surface.
It is a premalignant lesion which transform in Squamous Cell Carcinoma in 1 of 1000 cases.
Sun exposure area (check) develops an erythematous, slightly raised, 2 cm patch.
The involved area, has rough, very adherent, yellow-brown scale sometimes white superficial scaling.
Bx: Demostrate atypical basal cells w/eosinophilic cytoplasm but persistent intercellular bridges.
Also in Bx: The stratum corneum is thickened, and parakeratosis is present; remainder of the epidermis is thinned.
In the Dermis we will see Blue-gray elastic fibers = Damage to elastic fibers of the superficial dermis
Normal inhabitant of the GI tract grow under anaerobic and microaerophilic conditions.
It's a gram positive w/ yellow colonies (sulfur granules) that are found in low-oxygen niches like the tonsils and in actinomyco
It is a gram +, banching, beaded rod. The A.I.'s pus contains yellow granules (sulfur), which turn out to be clumps of A.I. in a Calcium Phos
We will compare Pacemaker Action Potential (P.A.P) to Ventricular Action Potential (V.A.P.)
Pacemaker Action Potential: Occurs in the SA and AV nodes. Key differences from the Ventricular Action Potential Include:
Phase 0: UPSTROKE - Opening of Voltage-gated Ca2+ Channels. These cells lack fast Voltage-gated Na+ Channels.
Phase 0: UPSTROKE - Results in a slow conduction velocity that is used by the AV node to prolong transmission from the atria to ve
Phase 2: PLATEAU is Absent
Phase 4: SLOW DIASTOLIC DEPOLARIZATION - Membrane Potential spontaneously depolarizes as Na+ conductance ↑.
Phase 4: Accounts for automaticity of SA and AV nodes. The slope of phase 4 in the SA node determines heart rate
Phase 4: Ach ↓ and the catecholamines ↑ the rate of diastolic depolarization, decreasing or increasing heart rate, respecti
Ventricular Action Potential: Occurs in Atrial and Ventricular Myocytes and Purkinje Fibers. V.A.P. has the following phases:
Phase 0: Rapid Upstroke - Voltage-gated Na+ Channels Open
Phase 1: Initial Repolarization - Inactivation of Voltage-gated Na+ Channels. Voltage-gated K+ channels begin to open.
Phase 2: Plateau - Ca2+ Influx through voltage-gated Ca2+ channels balances K+ efflux.
Phase 2: Plateau - Ca2+ influx triggers another Ca2+ release from sarcoplasmic reticulum and myocyte contraction
Phase 3: Rapid Repolarization - Massive K+ efflux due to opening of Voltage-Gated slow K+ channels and closure of voltage-gated Ca2+ c
Phase 4: Resting Potential - High K+ permeability through K+ channels
Chloride Channel permeability does not change during an action potential
Uremic encephalopathy, peripheral neuropathy, and uremic pericarditis. Renal replacement therapy to eliminate uremic toxins
U.T.I + weaknees +Abdominal pain + vomiting + diarrhea + Skin hyperpigmentation (elbow and Knee).
Also we see U/A pyuria + hypoglycemia + hyponatremia + hyperkalemia
NSTx CORTISOL LEVEL DETERMINATION.
A POTENTIAL LETHAL POSTOPERATIVE COMPLICATION. Nausea, vomiting, Abd. Pain, hypoglycema and hypotension
Can reduce the risk of Hepatic Injury by the Acetaminophen intoxication.
Acute or Chronic Tx = dietary modification (high-fiber diet and large amount of fluids) along with a stool softener and local ane
Acute ST segment elevation in Anterior Leads
Rowsing's sign (Abdominal Pain RLQ) + Anorexia +Vomiting. NSTx Appendectomy
The pathogenesis of Acute Apendicitis and Acute Diverticulitis is the same (fecallitos in the lumen of the intestine)
Unstable Hemodynamics or hemodynamic instability = Cardioversion . Hemodynamic Stable we use Rate Control.
In Chronic case we use Rate Control with Calcium Channel Blockers, Beta Blockers or in new onset will be Digoxin
We can see JANEWAY LESIONS = Painless macules in Palms and Soles
Loud Holosystolic Murmur + Fever + Chills + Malaise.
NSTx is I.V. ceftriaxone + ampicillin + Vancomycin.
Begin parenteral administration of large volumes of normal saline solutions (crystaloid)
Cough, Fever and Yellow sputum in an otherwise healthy young man is most consistent with Acute Bronchitis.
in a healthy Pt w/no other medical conditions is often due to a viral infection that is usually self-limited.
If the symptoms persistent more than a week, a macrolide antibiotic may be given.
Tx of choice Oral prednisolone. We can give oral itraconazole to reduce steroid requirement improves pulmonary functions
Begin parenteral administration of large volumes of Colloid Solution
Infection of the common bile duct secondary to obstruction of the common bile duct.
NSTx supporative care, broad-spectrum antibiotics and billiary drainage w/Endoscopic Retrograde Cholangiopancreatography
CHARCOT TRIAD = Fever + Abdominal pain + Jaundice produce by gallstone in the common biled duct. M.C.produce by G
LAB: Elevated Bilirubin (mostly direct) and High Serum Alkaline Phosphate (hundreds) = Choledocolithiasis + Cholangitis.
Antibiotics and I.V. fluids are required to "cool down" an episode of acute cholecystitis.
Abdominal pain R.U.Q. rad to the back and right shoulder + fever + leukocytosis.
Biliary colic + R.U.Q. rad to Right Shoulder + related to gallstone impacted in the cystic duct.
Sore throat + fever + malaise + pharyngitis and tonsilitis + cervical lymphadenopathy+ splenomegaly + heterophil antibody te
Also call "stress" can result from Burn pt 65% of body surface
NSTx Scrotal Sonogram + Antibiotics.
LFA-1 and ICAM-1 responsible of the response.
LFA-1(Beta 2 integrin family) strong binding between monocytes. ICAM-1 (Ig superfamily) interact together.
Rubor (Histamine vasoarterial dilatation), Hot (calor) (Histamine related), Tumor (Histamine Venal vasopermeability), Dolor (hurt) (Bradikinin related)
Ig M is the immunoglobulin most involve with Acute Inflamation. But in Chronic Inflammation is Ig G
Because the Antigen Recognition Side properties also is a potent activator of the Complement Cascade
Present with severe abdominal pain.
(RENAL DAMAGE) Fever, Rash, Blood EOSINOPHILIA, and LEUKOCYTURIA with eosinophils. Usually cause by AMPICILLIN toxicity
Also can be cause by NSAIDs (ibuprofen and indomethacin), beta-lactam antibiotics, such as cephalothin and methicillin, sulfonamides an
Diuretics like furosemide and thiazides diuretics, and drugs like phenytoin, cimetidine and methyldopa can cause A.I.N.
S/S develop acute renal failure, fever, maculopapular rash, and eosinophilia also can have periorbital edema and wheezing
or Viral Croup affects children younger than 3 years and has symptoms of barking cough and inspiratory stridor. No fever and often
Pancytopenia. Strong ASSOC. with Down Syndrome (Trisomy 21)
Marked Thrombocytopenia , petechiae, purpura, ecchymoses, bleeding gums, epistaxis and hemorrhage. (GRANULOCYTOP
Most Serious Complication in Childhood with Varicella infection is PNEUMONIA.
and Pt w/AML also present w/Pancytopenia.
Detection of TdT (terminal deoxynucleotidyl transferase), a nuclear protein, is see in more than 95% of Pt w/ ALL
Is negative for Sudan black stain and Myeloperoxidase
ALL translocations include: t(1;19), t(4;11), t(9;22), t(11;29), and t(12;21).
Translocation t(1;19): Occurs in 5% of precursor B-ALL cases and has roughly neutral prognosis.
Translocation t(4;11) and t(11;29) are translocations involving 11q23, which codes for the MLL gene product, and convey a
Translocation t(9;22) involves BCR-ABL and conveys a poor prognosis.
Translocation t(12;21) is the M.C. genetic abnormality see in childhood with ALL involves the TEL-AML1 Fusion Gene.
This abnormality in the TEL-AML1 Fusion gene occurs only in B-precursor ALL and confers and excellent prognosis.
Remember: The B-cell ;ineage can be indicated by antigens expressed either in the cytoplasm (CD79 or IgM) of leukemic
Also B-cell lineage can be indicated by antigens expressed on the surface membrane (CD19 or CD20) of leukemic cells
The precursor nature of the blast cells can be demonstrated with further marker studies like positivity for TdT (a nuclear enz
Also the precursor nature of the blast cells can be demonstrated with further marker studies like surface markers CD10 and C
Mieloid Blasts + Auer Rods. Subtype M3 can be complicated with DIC during TX. Also call Acute PROMYELOCYTIC leu
It is classified by FAB (French American British), AML is a translocation. The classification is: M1, M2, M3, M4, M5, M6 and M
M1 and M7 are very very rare.
M2 or Myeloblastic Leukemia w/maturation has blast more than 30%, w/ more 50% of the blasts being myeloblasts and promy
In M2 we can see mature forms. Eosinophils may be heavy in some cases.
M3 or Hypergranular Promyelocytic Leukemia has Blast more than 30%.
In M3 the majority of cells have a promyelocytic appearance w/kidney-shaped nuclei. Auer rods are usually seen in the c
M4 or Myelomonocytic Leukemia has Blast more than 30% with promonocyts and monocytes accounting for more than 20% of the bone marrow a
M5 or Monocytic Leukemia, is divided into differentiated and poorly differentiated.
M5 has more than 30% blasts, the granulocyte component is less than 10% of marrow cells.
In M5 the monocytes can be detected cytochemically with the fluoride-sensitive esterase reaction.
M6 have Blasts more than 30% of which more than 50% are erythroblasts. 50% of AML patients have elevated WBCs.
M6 S/S malaise, pallor, low grade fever and weight loss.
Can be Tx with Retinoid Acid (Vit A). Because Vit A mature the blast in that way the malignant cell become benign.
After a Pt. passed a stone w/o any other medical history. NSMx Maintenance of large urine volumes via copious water consum
History of IV drug abuse + ↑ grade fever + Bony Point Tenderness. NSDx = Three phase technetium scan is the test of choic
REDUCED TYMPANIC MEMBRANE MOBILITY S/S that correlates the most. NSTx is Oral Amoxicillin
2 years old has protracted irritability, crying, and loss of appetite, sore throat with little fever.
In recurrent case or causing hearing loss or persisting longer than 3 months NSTx is Myringotomy and Ventilation Tubes.
M.C.C. is Alcohol Abuse. 2nd M.C.C is Gallstone and 3rd M.C.C is Endoscopic Retograde Cholangipancreatography (E
Criteria that adversely affect the survival of Pts w/Acute Pancreatitis were developed by Ranson and Imrie are divide into 2
Findings at admission or diagnosis (F.a.A.o.Dx.) , and Finding in the initial 48 hours. (F.i.i 48 h)
F.a.A.o.Dx = Over 55 years old, Leukocytosis above 16,000/uL; Hyperglycemia above 200 mg/dL; Serum Lactate Dehydrogenase ab
F.a.A.o.Dx = and Serum Aspartate Aminotransferase above 250 IU/L. Amylase levels are not correlated w/the severity of the d
Although triglycerides, bilirubin and trypsin are ↑ in some case of Acute Pancreatitis, these factors DO NOT influence surviv
↑Serum Amylase Level (around thousands) confirm the Dx. Type I and V hyperlipoproteinemias predispone to A.P.
X-ray Sign = SENTINENTAL - LOOP (Air-Filled Loop of Small Bowel in the L.U.Q.). Epigastric pain radiating to the back.
Severe cases destroy large parts of both the endocrine and exocrine pancreas.
Destruction of the exocrine pancreas can release many enzymatically or physiologically active substance that can cause local or dista
In severe cases pulmonary complications include Pleural effusion secondary to chemical irritation of the diaphragm and also A
Ecocardiography is a sensitive diganostic tool. Leans forward release the pain.
The ECG show: Diffuse concave ST elevation, PR depression and occasionally flipped "outright"or "upright" T waves
RENAL FAILURE is the M.C.C of Acute Pericarditis (Uremic Pericarditis ↑ BUN more 100 mg/dL)
S/S Friction Rub is practically Dx of PERICARDITIS. NSDx EXCERSIVE ECG.
Diffuse Concave ST elevation, PR depression and occasionally flipped T waves will be present on the ECG (Best Dx Test of A
The pain is related to breathing this is a important different between the pain of dissecting aortic aneurysms in which the pain is unrelated to bre
Sore throat + fever + anorexia + Repeat episodes in the past several years + anterior cevical lymph node tender + Rapid str
NSTx Symptomatic Tx and oral penicillin V (Group A ß hemolytic Streptococcus).Cause purulent exudate on the oropharyngeal m
Lateralized chest pain increase with deep breating. Pleural effusion and pleuritic rub are present
M.C.C. is Pneumococcus. X-ray shows lobar consolidation + Gram + Diplococci in Sputum. NSTx PENICILLIN
If pt. is allergic we can use CEFAZOLIN, highly resistent VANCOMICIN
Occurs 10-20 days after streptoccal throat or skin infection. S/S hematuria, hypertension, red cell casts and mild proteinuria
Chills, fevers, and L.B.P. and perineal pain. Urgency and dysuria. Malaise, arthralgias and myalgias. Prostate is exqusitely tender, wa
Best Tx is I.V. Ampicillin + aminoglycoside (gentamicin). U/A shows: Red blood cells, White blood cells and Proteins
Acute onset of dysuria, frequency, profound malaise, and shaking chills + fever + tenderness in costovertebral angle.
Secondary to Prerenal or Renal Cause (Intrinsic). Intrinsic Cause of A.R.F. M.C is Acute Tubular Necrosis
A.R.F. = Acute Tubular Necrosis = Renal Ischemia (shock), Crush Injury (myoglobulinuria, rhabdomyolysis), Toxins.
PRERENAL A.R.F. is the M.C. form of KIDNEY FAILURE in USA. Four general processes lead to prerenal A.R.F, as folo
HYPOVOLEMIA, LOW CARDIAC OUTPUT, SYTEMIC VASODILATATION and SELECTIVE RENAL VASOCONSTRICTION.
URETERIC OBSTRUCTION produces POSTRENAL A.R.F. In the USMLE it is use as a distractor.
ST segment depression and Q-waves don't develop.
Development of Q-waves proceed by ST segment elevation.
M.C. intrinsic (renal) cause of Acute Renal Failure (A.R.F.). Reversible, but lethal if left untrated. Death often happen in oligu
M.C.C of A.R.F. Assoc. w/ renal ischemia (shock) , crush injury (myoglobulinuria, rhabdomyolysis), toxins. Recovery 2 -3 week
Complication of Sickle Cell anemia may cause stroke, priapism or intractable pain. NSTx Exchange Transfusion.
Cause crystalluria with renal tubular obstruction during high-dose, parenteral therapy, specially in inadequate hydrated patients
Acyclovir is recommended to prevent the outbreaks and Tx in Herpes Genitalis. Acyclovir inhibits viral DNA synthesis.
It is use in the Tx of HERPES ENCEPHALITIS (Leading cause of Sporadic Necrotizing Encephalitis)
In this cases Acyclovir acts doing the following reaction:
Acyclovir is an acyclic analogue of the natural nucleoside Guanosine.
Acyclovir is efficiently phosphorlyated at a rapid rate by virus-specifick THYMIDINE KINASE (TdK), but is slowly phosphorylated by
The affinity of acyclovir for TdK produce by normal host cells is approx 250 times less than for the TdK induced by Herpes Simplex
This selective affinity results in the activation and concentration of Acyclovir in virus-infected cells.
Once Acyclovir is converted into acyclovir monophosphate by the viral TdK, it is further converted to acyclovir thriphosphate by o
Acyclovir triphosphate competes w/ deoxyguanosine thriphosphate for binding to the HSV DNA polymerase.
When it is incorporated into the viral DNA, it prevents further elongation of the chain.
Forward Bending, is the best ways to screen for SCOLIOSIS. Radiographs of the spine is the Gold Standard for Dx and Precis
Autoinmune destruction of the Adrenal Glands, evidenced by lymphocytic infiltration and progressive atrophy of the adrena
Syndrome de Hypocortisolism, chronic weakness, menstrual disturbances, skin melanosis, hypotension, hyponatremia and K
The areola and vagina have bluish-black discoloration (HYPERPIGMENTATION). Non-Anion Gap METABOLIC ACIDOSIS
ECG changes (↓ voltage and prolonged PR) EEG (slowing of alpha Rhytm)
Hypoaldosteronism. Non-Anion Gap METABOLIC ACIDOSIS. No Aldosterone. (lossing Na in the URINE)
Hypotension, Hyponatremia, Hyperkalemia, Hyperpigmentation + Non-Anion Gap Metabolic Acidosis
Distinguish from Secundary Hypoaldosteronism or Hypocortisolism in which has NO hyperpigmentation (Pituitary ACTH pro
Variety Morphologic subtypes. Tubular carcinoma has excellent prognosis. The rest subtypes prognosis depends of the time of disco
Iron Deficiency Anemia due to Chronic Blood Loss. "Apple Core" Lesion consistent w/ colon cancer
CLEAR CELL TYPE can be cause by in UTERO DIETHYLSTILBESTROL (DES) EXPOSURE.
Intraperitoneal hemorrhage due to rupture may constitute a life-threatening first presentation. O.C.P + anabolic steroids predispone t
Presents in babyhood with severe combined immunodeficiency.(Autosomal Recessive Variant)
Also call SEVERE COMBINED IMMUNODEFICIENCY. Can be recessive or dominant. Purine salvage Deficiencies
NSTx. Bone Marrow transplant, and very recently, gene transfer, are used to treat this otherwise fatal condition.
SCID is Assoc. with deficiencies of both B and T cells due to defect in differentiation on an early stem cell.
50% are caused by defect X chromosome, resulting in a defective IL - 2 receptor (Autosomal Recessive Pattern).
Deficiency of Adenosine Deaminase that toxic B and T cells. Pt usually die within the first 2 years of life.
Is a set of behavioral or emotionals S/S that develop as a response to an identifiable stressor within 3 months after exposure to the st
S/S are significantly in excess of what one would expect from the exposure and cause marked impairment in social functioni
Also Pt with difficulty adjusting to new lifestyle manifesting feeling of sadness and mental and physical S/S of anxiety = A.D
Consequences of loss of adrenal function
In the Zona glomeruolsa will be:
Absence of the Mineralocorticoid, ALDOSTERONE.
Loss of Na+, decrease volume of the ECF, low B.P., circulatory shock and death.
Mineralocorticoid is generally required for survival.
In Zona fasciculata, and Zona reticularis.
Absence of the Glucocorticoid, CORTISOL. Without Cortisol, Glucagon can not act again Hypoglycemia
Contributes to the circulatory failure, because cathecolamines are not stimulate.
Energy sources (glucose and free fatty acids) cannot be readily mobilized
Not life threatening under normal living conditions
Stressful situations severe problems can arise. For example, fasting can result in fatal hypoglycemia
In the Medulla will cause
Absence of the catecholamine, EPINEPHRINE. But Adrenal Medulla is not essential for survival
Loss Pituitary Function the mineralocorticoid activity is INTACT because is regulate by ANGIOTENSIN II.
Loss Pituitary Function the glucocorticoid acitivity is compromise you can survive w/ normal condition but not w/ stressful s
From outside to inside we have the following: Anatomy Structure, Primary Regulatory Control (P.R.C.) and Secretory Produc
Zona Glomerulosa: P.R.C. by Renin-Angiotensin. Secretes: ALDOSTERONE
Zona Fasciculada: P.R.C by ACTH, Hypotalamic CRH. Secretes: CORTISOL and sex hormones
Zona Reticularis: P.R.C by ACTH, Hypotalamic CRH. Secretes: SEX HORMONES (e.g. androgens).
THE MEDULLA. P.R.C by Preganglionic Sympathetic Fibers. Secretes: CATECHOLAMINES (Epi, NE).
Pnemonic for remember: Z.G.- Aldosterone (Salt), Z.F. - Cortisol (glucocorticoids) (Sugar), and Z.R. - Androgens (Sex).
"The deeper you go, the sweeter it gets"
Are Characteristics of: Congenital problem, Cortisol Decreased, ACTH elevated and Hyperplasia
Deficiency Glucocorticoid ACTH Blood Pressure Mineralocorticoid Androgen Estrog
21 Beta LOW HIGH LOW LOW HIGH -----
11 Beta LOW HIGH HIGH LOW HIGH -----
17 Alpha LOW HIGH HIGH LOW LOW LOW
Pt w AIDS are prone to developing adrenal insufficiency like any other immunocompromised Pt.
The adrenal glands often show adrenalitis due to CMV, Mycobacterium avium-intracellulare, or Cryptococci.
Adrenal Insufficiency may also due to metastatic Kaposi Sarcoma. S/S in HIV pt is lethargy, hypotension, and hyperkalemia
80% of the hormonal secretions epinephrine, and 20% is norepinephrine.
Most Circulating epinephrine arises from the adrenal medulla.
Most Circulating norepinephrine arises from Postganglionic Sympathetic Neurons.
The Adrenal Medulla is not ESSENTIAL FOR LIFE.
Plasma Norepinephrine levels double when one goes from a lying to a standying position.
Exercise, Emergenices, Exposure to cold and Severe Hypoglycemia rapidly increseases Adrenal Medullary Secretion
Benign Apperance and CT Scan accidentaly finding NSMx Leave it alone. Usually is Hypodensive w regular countours signs
Ephedrine is a mixed-action adrenergic agent.
Ephedrine releases stored NE from nerve endings, and it directly sitmulates both alpha and beta adrenergic receptors.
Clonidine, dopamine and ritodrine are direct-acting adrenergic agents that directly bind alpha or beta adrenergic receptor
All these are producing effects similar to those that follow stimulation of sympathetic nerves or release of the hormone Epinephrine from the
Amphetamine and Tyramine are Indirect-acting agonists that cause the release of NE from the cytoplasm or vesicles of adrenerg
The NE release traverses the synapse and stimulates the alpha and beta adrenergic receptors.
Addison's Disease = Hyponatremia, Hyperkalemia, Acanthosis Nigricans and Acidosis. M.C.C. is autoinmune adrenalitis
The remaning case are secondary to tuberculosis or fungal infectations or metastatic disease involving both adrenals
Differs from the primary for two reasons: 1) it is cuased by disorders affecting the pituitary gland or hypothalamus and leading to ↓ AC
2) it is not ASSOC. W /SKIN HYPERPIGMENTATION. Because it is not a increased of the ACTH precursor which stimulate melanocy
ABNORMALITY 21-HYDROLASE DEFICIENCY 11-HYDROLASE DEFICIENCY 17-HYDROLASE DE
Ambigous genitalia Male NO NO YES (femal
no ma
Male pseud
Ambigous genitalia female Female Pseudohermaphrodite Female Pseudohermaphrodite NO
Salt lose w/ volume depletion YES NO NO
Salt retention w/hypertension NO YES YES
Plasma ACTH Increased Increased Increased
Hypocortisolism YES YES YES
Urine 17-ketosteroids Increased Increased Decreased
Urine 17-hydroxycorticoids Decreased Increased Decreased
X-linked hereditary disorder resulting in accumulation of very long chain fatty acids in the adrenals, testes and CNS.
MOBILE POOL: Indirect acting sypathomimetics (e.g. amphetamines, ephedrine, tyramine) displace NE , enhancing postjunction
UPTAKE 1: Inhibited by some Indirect-acting sympathomimetics (e.g. cocaine). Increasing postjunctional actions of NE.
Prejunctional Alpha Receptor (ALPHA 2):Activators (e.g. clonidine alpha metyldopa) cause inhibition of tyrosine hydroxylase (↓ NE release from ending)
GRANULAR UPTAKE of NE: Blocker (e.g. reserpine) decrease prejunctional levels of NE available for release.
NE release from Granules: Blocker (e.g guanethidine) decrease postjunctional acions of NE.
Postjunctional Receptors: Activated by many direct-acting sympathomimetics and are also" targets" for antagonist drugs.
Beta receptors usually more sensitive to activator than alpha receptors.
W/ drugs that activate both receptors (e.g. epinephrine) the beta responses are dominant at low doses; at higher doses the alpha respons
Autosomal Dominant polycystic kidney disease. Multisystemic and progressive disorder.
Pathophysiology is: DEFECT IN EPITHELIAL CELL DIFFERENTIATION
S/S. Around 40s, Hypertension ( renin production), Renal Failure ( BUN and creatinine).
S/S Anemia (Secondary to a Failure of renal eryhtropietin production).
Associated with Hepatic Cysts, Berry Aneuryms in the circle of Willis (Subarachnoid Hemorrhage).
Hypertension cases in this Pt will best Tx with ACE inhibitors.
S/S High Spinking Fever (nocturnal) + Evanescent Salmon Colored Maculopapular rash in trunk and ext.+Arthralgias and
This is a variant of Rheumatoid Arthritis onset 20 - 30 years of age.
It can be preventing w/vaccine taregeted against an oncogenic virus. (USMLE) This disease is edemic in Japan.
It is cause by human T-cell leukemia virus known as HTLV-1
Agammaglobulinemia of Bruton, a syndrome characterized by inability of pre-Bcell precursors to mature into B lymphocytes.
Painless sudden unilateral blindness + Pigmentary changes with or without new vessel formation behind the retina.
Old definiton=Fear of open spaces.NSTx Behavior Therapy and Antidepresants w/ Coexisting Depression Pt. Panic Attack rather than Anxie
Moderm defintion is a fear of panic, attacks in situations from which it would be difficult to gracefully remove oneself.
W/ Animal Red Blood Cell is another name for heterophil antibody test = Use in the Dx of Infectious Mononucleosis (E.B.
Agglutination of Swarming Organisms Test will be use in the Dx of Rocky Mountain Spotter Fever (Rickettsia rickettsii)
Agglutination of autologous eryhtrocytes at 4 C describes the nonspecific test employed in the Dx Mycoplasma pneumon
Agglutination of mammalian cardiolipin describes the nonspecific test employed in the screening for Teponema pallidum (
Agglutination of sheep RBC describes the nonspecific test to screen for infectious, heterophile-+ mononucleosis (E.B.V.). = Monospot T
We have a special test call Quellung Test
Quellung test = Is the specific antibody test that can be used in Dx of infections of C.S.F.
Quellung test measures capsular swelling of organism such as Pneumococcus and Haemophilus w/ specific antibodies.
Quellung test is used to indentify the causative serotypes of organism causing meningitis
IgG or Warm agglutinims are use in the Dx of lymphomas, drugs and autoimmune diseases such as SLE. (INDIRECT COOM
IgM or Cold agglutinims are use in the Dx of Mycoplasma pneumoniae, infection or lymphomas.
Side effect of Clozapin, Propylthiouracil. S/S Sore throat and fever plus abnormal cell blood count.
Sense of Restlessness and pshychomotor agitation.
Cause by overdose of Atypical Antipsychotic Medications: Olanzapine, Quetiapine, Ziprasidone, risperidone.
The amount of alanine released from Skeletal Muscle is greater than the amount that can be accounted for in Muscle Prote
The catabolism of many Amino Acids in muscle involves the transamination of alpha-amino groups from amino acids to pyruvate, producin
Thus, the Carbon Skeleton of much of the Alanine released from Muscle is derived from glucose via the Glycolytic Pathway.
Inherited condition characterized by a complete lack of melanin pigmentation of the skin, hair and eyes
Autsomomal Recessive Disorder, high incidence of SQUAMOUS CELL CARCINOMA. And also Basal Cell Carcinoma.
If a tyrosinase-negative oculocutaneous Albinism (autosomoal recessive disease caused by mutation in the tyrosinase locus on chromo
mate witha woman who has tyrosinase-positive oculocutaneous albinism (caused by mutations in the P gene on chromos
if they ask us about the percentage of their offspring will be affected is ZERO %. Because they are two different recessive mut
Abnormal transfer of melanosomes is seen in oculocutaneous albinism type 2, formely known as "tyrosinase positive albin
When the levels are down cause SERUM CALCIUM CONCENTRATION FALLS.
is a EARLY indicator for DIABETIC NEPRHOPATHY. Permanent renal damage can develop in as little as 5 years after D.
Overdose produce tachyarrhythmias. Bronchodilator use in Tx of Asthma and Bronchospasm.
Use in Asthma. S/S include S.O.B or chest tightness with exertion, exposure to cold, irritating inhalents or emotional exercise.
First line tx involves beta-adrenergic agonists like albuterol. We use Chromolin Sodium when the Pt is a child.
This class of medications is the mainstray of Tx in acute and chronic asthma. Beta agonists alone can terminate an asthma attack in
it is the stain to demostrate MUCOPOLYSACCHARIDES
Alcohol comsuption in pregnancy the level is unknown considerate safe during pregnancy.
Improves the tremor but it is not used for tx purposes.
Growth restriction, Midfacial hypoplasia, Microcephaly, and marked CNS dysfunction including the frequent occurren
Highly associated with Atrial Septal Defect in the newborn.
AST/ALT ratio grater or equal of 2.5 support the Dx. Abdominal pain, nausea, mild jaundice, low-grade fever, malaise.
Example of Eubiquination Process is the Mallory Bodies. The Intermediate Filament damage is KERATIN. Gamma glutamil transfa
Hypercholesterolemia, also ↑ of Alkaline phosphate, light color stool, and itching.
Acethaldehyde attach w/protein chaning the process to storage Vit A to process to form collagen (fibrosis) = Mechanism that damag
Endoscopy shows several lacerations in the mucosa near the gatroesophageal junction
History of Epigastric pain + Elevated Amylase and Lipase + Bulky, foul-smelling stools + Calcifications in the Pancreatic Reg
Can Cause Rhabdomyolisis (MYOGLOBINURIA = positive dispstick for blood but no RBC in microscopic examination)
M.C. Vitamin Deficiency in alcoholics is FOLATE DEFICIENCY.
M.C. metal Deficiency in alcoholics is MAGNESIUM
We can see AST higher that ALT and ↑ of Gamma Glutamyl Transfarase (Even Alkaline phosphate is ↑)
Alcohol abuse is Dx when a individual demonstrates repetitive problems w/alcohol in any of the following 4 life areas:
1) Inability to fulfill major obligations. 2) Use in harzadous situations. 3) Legal problems. 4) Social or interpersonal difficulties.
Primary Target tissue is the Kidney. Most important action to↑ Na+ reabsorption by Collecting Ducts
Water is Reabsorbed Along with the Na+.Considered to control the amount of Na+ Rather than the Concentration of Na+ in
Promotes the Secretion and Excretion of H+ by the Collecting Duct.
Promotes the Secretion and Excretion of K+ by the Collecting Duct
Affects also seen on the Distal Colon.
Loss of 4 L of intestinal fluid cause ↓Extracellular Fluid (E.C.F.) = ↓ of Cardiac Output (C.O.) = ↓ B.P. = ↓ Renal Blood Flow (R.B
↓ of R.B.F. activates the renin-angiotensin system = ↑ the Angiotensin II that stimulate the secretion of ALDOSTERONE
↑ Aldosterone = ↑ Reabsorption of Salt (Sodium) and Water by the Kidney.
NSTX Topical Injection of Corticosteroids
↑ found in bone, liver and placental tissue. It is two sources: Gama-glutamyl Transpeptidase (GGT) or 5 nucleotidase test
S/S: Severe stiffness and pain on hips, back and knees. Bluish-gray discoloration of ear cartilage and sclerae and ↓ joint m
Spinal X-ray shows disk degeneration combined w/dense calcification, particulary in the lumbar area
HOMOGENTISIC OXIDASE ENZYME DEFICIENCY, which is in the phynylalanine-tyrosine pathway blocking the degradation of HOMOG
or Ochronosis. S/S Arthritis early age and Urine turns black upon standing.
The Deficiency Enzyme in this disorder is HOMOGENTISIC ACID OXIDASE
Two or more different forms of the same GENE. Can Be Normal or Mutant
Dx Features: 1)Asthma like symptoms, 2) ↑ Ig E. 3)Hyperesoniophilia, 4)Central brochiectasis 5)Positive Aspergillus Skin Test.
NSDx is Allergen skin testing, and Serum IgE assays (RAST or ELISA)
Type IV Hypersensitivity reaction to a variety of allergens. Substance can trigger that condition.
Erythema, edema, pruritus, tiny vesicle and weepy and crusted lesion 24 -48 hours after contact.
Type IV Hypersensitivity reaction (cell mediated delayed type). Is following of ingestion of Nephrotoxic Drugs.
Triad of Fever, Petechial Rash, Peripheral Eosinphilia with Azotemia.
Nasal Congestion, Rhinorrhea,pruritus, nasal obstruction and sneezing. Nasal Mucosal is pale or blush
P.E. Dark puffy eyelid and red crease on the lower half of the nose. Bluish mucosa and clear discharge
NSTx Topical Steroids and possible use of Cromolyn Sodium Nasal Solution.
Use between attacks of GOUTY ARTHRITIS (intercritical periods). Side effect Rash due to Hypersensitivity also Vasculitis and Hep
Inhibit Xanthine Oxidase. Usually administered at 100mg/day. The dose is increase until the urate level is within normal limits. HYP
Prophylatic to prevent gout (Overproduction of Uric Acid) = Hyperuricinemia = We can use in Tumor Lysis Syndrome.
Receptor Alpha 1 = Eyeradial (DILATADOR) muscle = Contraction - Mydriasis.(Sympathetic) Remember: Parasympathetic caus
Receptor Alpha 1 = Arterioles (Skin, Visceral) = Contraction - ↑ PVR and Afterload
Receptor Alpha 1 = Veins = Contraction, Increase Return and PRELOAD
Receptor Alpha 1 = Bladder trigone & Sphinter = Contraction - Urinary retention (blocking it will be easy to urinate)
Receptor Alpha 1 = Male Sex Organs = Vas deferens.
Receptor Alpha 1 = Liver = Glycogenolysis
Activate phospholipase C via the G protein Gq. Phospholipase C cleaves the membrane phospholipid
This membrane phospholipid (phosphatidylinositol 4,5 biphosphate) produce, inositol triphosphate (IP3) and diacylglycerol (DA
IP3 releases intracellular calcium form the endoplasmic reticulum, and would therefore generate a robust signal.
DAG activates protein kinase C
M.C.C of Hepatocellular Carcinoma in Childrens. In adults cause Panacinar emphysema.
It's different types. One that you don't produce any Alpha 1 Antitrypsin in this case you end as young adult w/Panacinar em
Another type: Defected Alpha 1 Antitrypsin it can't get out of the hepatocytes. In this case damage liver predispone to Cancer
Assoc. with HEPATIC CIRRHOSIS in Childhood. Family history of the diseases would also be expected.
It's a rare hereditary disease that causes emphysema and liver disease. Smoker who have this deficiency develop disease a y
Cause Severe EMPHYSEMA and CIRRHOSIS OF THE LIVER. In the Lung cause PANACINAR EMPHYSEMA.
First appear as Acute Hepatitis w/impressive jaundice, ↑ Serum Transaminases, and compromised blood clotting, especially
Prazosin, Terazosin, or Doxazosin can be used for the Tx of both Hypertension and BPH.
The drugs relax smooth muscle in the prostatic urethra and thereby reduce the functional component of urethral obstruction assoc w/
Receptor Alpha 2 = Prejunctional Nerve Terminal = ↓ Transmiter release and NE synthesis
Receptor Alpha 2 = 1) Platelet aggreation and 2) In pancreas decreases insulin release.
Of Islets of Langerhans will INCREASED HEPATIC GLUCONEOGENESIS as a excessive hormone secretion
Deficiency = Fabry's Disease = produce a BUILD UP OF TRIHEXOSYLCERAMIDE. Assoc w/Renal failure
It is the pathway that metabolized Phythanic Acid.
Phytanic Acid is converted to Pristanic Acid in Peroxisomes by the decarboxylation of the hydroxylated intermediate.
Pristanic Acid can then be used as a substrate for beta-oxidation, as can linoleic acid, arachidonic acid, palmitic acid and dec
Phytanic Acid is toxic if it not metabolized.
with Rivabirin antiviral medications is the current state-of-the-art treatment for HEPATITIS C.
Hereditary nephritis. S/S: Hematuria, Renal Failure and Deafness. Family History of Hematuria is positive.
Short-acting benzodiazepine w/rapid onset of action and a relatively short half-life.
Abrupt discontinuation may result in withdrawal delirium, seizures and death
Defense Mechanisms. Minimizing one's own internal fears or anxiety by giving service to others.
The equation AV = VC02 / PACO2. doubling AV will cause PACO2 to halve.
If we need to Calculate PAO2 can be calculated using the alveolar gas equation:
PAO2 = PIO2 - (PACO2/R) where PAO2 = alveolar PO2 and PIO2 = inspired PO2
USMLE problem: is AV double, the exchange ratio R of 1.0 and PACO2 of 40 mm Hg the Alveolar PO2 will increase by 20
The explanation of this problem in USMLE is. Before Hyperventilation PAO2 = 150 mm Hg - (40 mm Hg/1) = 110 mm Hg
After Hyperventilation PAO2 = 150 mm Hg - (20 mmHg/1) = 130 mm Hg. Therefore, PAO2 will increase by 20mm Hg
It is very important also to know the Alveolar Oxygen/Arterial Oxygen gradient = A/A gradient. Normal volume are: 5% o
Alteration in the A/A gradient = LUNG DAMAGE. Remember Perfusion is better in lower lobes and Ventilation is better in uppe
USMLE when you deal a pt w/hypoxemia remember the A/A gradient. Any disease w/ normal A/A gradient the problem is not in the
Another Formula: Alveolar Ventilation = Respiratory Rate x (Tidal Volume (OUTPUT) - dead space).
NSDx is M.R.I. studies (diffuse cerebral atrophy). Most frequent form of dementia should be suspected in any case of memo
Malnourished (skin turgor)+Dehidrated (dry mouth)+ unable to Communicate = HYPERNATREMIA. NSTx I.V. 5% D/W (replac
Diffuse cortical atrophy with relative sparing of primary motor and sensory areas. Degenerative Dementing Disorder.
Deficit of ACETYLCHOLINE cause COGNITIVE DEFICITS.
Cognitive Deficits physiopathology Degeneration of basal forebrain projection to cortex and limbic structures
Cognitive Deficits we see Modulate Attention, Novelty Seeking and Short Time Memory impared.
Common neuropathologic feature Amyloid Plaques and Hippocampal Neurofibrillary Tangles.
It is a mushroom that causes MUSCARINC EFFECTS on the nervous system (i.e. Sweating, Narrow Pupils, a ↓ heart rate a
Use in Mild Parkinsonism. Side Effect are: Depression, Postural Hypotension, Cardiac Arrhytmias
"Curtain Passing Vertically" - Unilateral, Transit, Loss of Vision
R.U.Q. Pain And fever. U/S, CT, MRI demostrates the location and size of the lesion.
Conventional Antipsychotics (e.g. Risperidone) are clearly assoc. w/↑ in plasma of Prolactin due to blockage in the TUBEROINFUNDIBULAR DOPAMINERGIC P
AMES TEST it measures damage to DNA and correlates well with carcinogenicity in vitro
AMES TEST is relatively inexpensive to perform, compared to other carcinogenicity test.
AMES TEST M.C. use in test for potential CARCINOGENS.
Aspargine: N-glycosylation of proteins occurs on Asparagine Chain.
After proteins are synthesized (translated), many are glycosylated in the lumen of the endoplasmic reticulum and the Golgi co
Oligosaccharides are attached to proteins by N-glycosylation of aspargine side chains or by O-glycosylation of Serine and Threonine
The transfer of oligosaccharides is mediated by an activated lipid carrier, dolichol phosphate.
For each amino acid, HIGH-ENERGY BONDS (ATP or GTP) are needed at 4 steps:
1) 1 ATP is needed to form aminoacyl-tRNA
2) 1 GTP is needed to bind the aminoacyl-tRNA
3) 1 GTP is needed to form the peptide bond
4) 1 GTP is needed for translocation of the chain
If the questions ask about how many energy bonds you need to elongate a protein you multiple the # of aminoacid by 4 (1 ATP
Phenylalanine - Tyrosine - Thryoxine and Dopa. Dopa - Dopamine - Norepinephrine, Epinephrine and Melanin.
Tryptophan - Niacin (NAD/NADP), Serotonin, Melatonin
Histidine - Histamine
Glycine - Porphyrin - Heme
Arginine - Creatine, Urea and Nitric Oxide
Aspartate - Have a net negative charge (so it travels to the positive pole). Electrophoresis is perfomed at pH 7
Aspartate - have one NH3 group with positive charge, and two COOH groups have a negative charge
Arginine - Is a basic amino acid and would move toward the negative pole
Glycine - Is a neutral amino acid that would stay at the origin
Histidine - Is a basic amino acid and would move toward the negative pole
Valine - Is a neutral amino acid that would stay at the origin
Are bactericidal, accumulated intracellularly in microorganisms via O2-dependent uptake --> anaerobes are innately resista
Useful spectrum includes gram-negative rods; GENTAMICIN, TOBRAMYCIN, and AMIKACIN. Also STREPTOMYCIN and NE
Synergistic actions occurs for infections caused by entreococci (with penicillin G or ampicillin).
Synergistic actions occurs for infections caused by P. Aeruginosa (w. an extended-spectrum penicillin or third-generation
Streptomycin used in tuberculosis; is the DOC for bubonic plague tularemia.
Neomycin too toxic for sytemic use; used topically.
Pharmacokinetis: a) Are polar compounds, not absorbed orally or widely distributed into tissues.
b) Renal elimination proportional to GFR, and major dose reduction needed in renal dysfunction.
Side effects: Nephrotoxicity (6 to 7 % incidence) includes proteinuria, hypokalemia, acidosis, and acute tubular necrosis. Us
It is use w. Vancomycin, amphotericin B, cisplatin and cyclosporine the nephrotoxicity of the aminoglycosides will be enchance
Ototoxicity (2% incidence) from hair cell damage; includes deafness (irreversible) and vestibular dysfunction (reversible)
It is use w. Loop Diuretics ototoxicity of aminoglycosides will be enhanced.
Neuromuscular blockade with decrease release of Ach, may enhance effects of skeletal muscle relaxants
Contact Dermatitis in the case of Neomycin.
SUMMARY OF MECHANISMS OF PROTEIN SYNTHESIS INHIBITION IN ANTIBACTERI
EVENT ANTIBIOTIC (S) AND BINDING SITE (S) MECHANISM (S)
1. Formation of AMINOGLYCOSIDES (30S) Interfere with initiation co

intiation complex LINEZOLID (50S) (block assoc of 50 S ribs
mRNA-30 S (static)
(aminoglycosides o
wrong amino acid (-

mRNA-30 S (static)
(aminoglycosides o
wrong amino acid (-
2. Amino-Acid incorporation TETRACYCLINES (30S) Block the attachment of am

DALFOPRISTIN/QUINUPRISTIN (50S) to accepter site (-static).
3. Formation of peptide bond Cholamphenicol (50S) Inhibit the activity of Pept
4. Translocation Macrolides and Clindamycin (50S) Inhibit translocation of pe

acceptor to donor s
Class III antiarrhytmic. Side effect= PULMONARY FIBROSIS, HYPERTHYRODISM,CORNEAL DEPOSISTS + BLUISH-SLAT
PULMONARY TOXICITY, THYROID DYSFUNCTION, HEPATOTOXICITY, CORNEAL DEPOSITS, SKIN REACTIONS.
Used in Atrial and Ventricular Arrhytmias, but watch out for HYPOTENSION
Foamy changes in lamellar inclusions on bronchoalveolar lavage (BAL) are characteristics for amiodarone-induced disease
with Gabapentin is the Tx of choice of POSTHERPETIC NEURALGIA.
Amitriptyline is T.C.A. use in Parkinson Pts with depression because it has very strong anticholinergic properties
In general, most of the T.C.A. have strong anticholinergic properties.
The anticholinergic effects include mydriasis, tachycardia,impaired sweating with flushed skin, dry mouth, constipation and mu
We have: Anterograde, Korsakoff's and Retrograde
Anterograde amnesia is the inability to remember things that occurred AFTER a CNS insult (no new memory)
Korsakoff's amnesia is a classic anterograde amnesia that's caused by thiamine deficiency (bilateral destruction of the mam
Korsakoff's amnesia is seen in alcoholics, and is associated with confabulations.
Retrograde amnesia is inability to remember things that occurred BEFORE a CNS insult. Complication of E.C.T.
Include: Fetal Loss Rate approx. 0.5%, Vaginal spotting or amniotic fluid leakage 1 to 2 %, and chorioamnionitis in < 0.1% of
C.V.S = Chorionic Villi Sampling
Amniocentesis: is among the M.C performed, invasive prenatal Dx procedure. Provides more information than C.V.S
Amniocentesis: is usually performed in the second trimester of pregnancy.
Amniocentesis: The chromosome analysis is usually completed 1 to 2 weeks after the procedure is performed.
Amniocentesis: Additional testing such as biochemical analyses and DNA testing usually take and additional 2 to 4 weeks.
C.V.S: Is a test perfomed to detect specific genetic abnormalities ealier in pregnancy, it is generally done at 10 to 13 weeks. (Provides gene
C.V.S: Also, it can provide all of the data that amniocentesis provides except for information about neural tube defects
C.V.S: Also carries a slightly higher risk of miscarriage.
Oligohydramnios = Reduced of Aminotic fluid = Renal Agenesis.
Conditions assoc w/Oligohydramnios are: Lung Hypoplasia, Clubfoot (skeletal defects) because inadequate space for normal dev
Polyhydramnos = Excess of Amniotic Fluid = Esophageal Atresia and Obstruction of th esophagus prevent fetus from swallowing
Usually occurs during labor
The kidney tubule in the acid-base homeostasis secrete amonia as one of the mechanisms to excrete acid.
We can reduce this with Lactulose Treatment, Low protein Diet and Aminoglucosid Antibiotics.
Good cover of STREPTOCOCCUS.
or Stimulants. The intoxication manifests with hyperactivity, irritability, delirium, hallucinations, psychosis, mydriasis.
Also can cause hyperpyrexia, hypertension, arrhytmias, vomiting and diarrhea.
Is an indirect-acting sympathomimetic agent. It is assoc with marked tolerance (tachyphylaxis)
Assoc with HYPOKALEMIA, There is presence of "U" waves in the ECG, also increase "QT" interval and flat "T" waves.
I.V. is Tx of disseminated Histoplasmosis + lifelong Tx with itraconazole
We can use in Cryptococcal Meningoencephalitis in AIDS Pt. w/headache, vomiting and delirium.
Use in the Tx of Mucormycosis, a devastating fungal infection that is seen in debilitated Pt and in Diabetics. Also we can do a surgic
M. of Action: Binds ergosterol (unique to fungi); forms membrane pores that allow leakage of electrolytes and disrupt ho
Clinical Use: Used for wide spectrum of systemic mycoses. Cryptococcus, Blastomyces, Coccidioides, Aspergillus, Histoplasma, Can
Clinical Use: Intrathecally for fungal meningitis; does not cross blood-brain barrier.
Toxicity: Fever/chills ("shake and bake"), hypotension, nephrotoxicity, arrhythmias ("amphoterrible").
Toxicity cause ACUTE INTERSTITIAL NEPHRITIS (eosinophilia-renal damage)
Patients w Mono Tx. w/ Ampicillin or its analogues commonly develop a generalized, erythematous, morbiliform exanthem on the 7th to 10th
Gram + encapsulated rods, exposure to cows or sheeps.
Is a pathologic proeinaceous substance composed: 95% Primary Fibril Protein. 5% Amyloid P protein, organized in Beta-pleated
Is composed of nonbranching fibrils (paired fibers) of indefinite length (95%) and nonprotein minor compounds (5%), including comp
Component P, proteoglycans, and sulfated glycosaminoglycans. All types of amyloid have an identical EM structure and are found as Beta
It's involved in 2nd amyloidosis. This type of amyloid's derived from serum amyloid-assoc-protein or SAA which is an acute p
Secondary amyloidosis is a complication assoc w/chronic infections like tuberculosis and bronchiectasis (and various non-infectious inflam
In the test they give you a history of foul-smelling sputum and the massively dilated ariways suggesting BRONCHIECTASIS.
are amyloid protein deposits may be important in ALZHEIMER'S DISEASE.
TYPE M amyloid protein is seen in CHRONIC DIALYSIS PATIENTS
Is derived from IMMUNOGLOBULIN LIGHT CHAINS, is involved in PRIMARY AMYLOIDOSIS
this one is derived from TRANSTHYRETIN, is involved in the pathogenesis of familial or SENILE AMYLOIDOSIS
Can be cause by LONG STANDING RHEUMATIC ARTHRITIS
Skin plaques around axillary folds + macroglossia + hepatosplenomegaly + Pitting edema of the legs + peripheral neuropathy
NSDx Biopsy of skin, rectal mucosa, abdominal fat.
In Echocardiogram reveals ventricular walls with a "speckled pattern".
Amyloid deposits appear similar by light and electron microscopy, but actually represent a heterogeneous population of pro
This proteins have common tertiary structure forming a beta-pleated sheet.
Questions about the type of amyloid seen in different disease states (even though the type is usually not determined clinically)
We can see two types of amyloid changes: LOCALIZED and SYSTEMIC.
Senile cardiac amyloidosis = Atrial natriuretic peptide-related fibrils
Cerebral amyloid in Alzheimer disease, DOWN SYNDROME = AB protein from B protein precursor (on chromosome 21)
Medullary Carcinoma of Thyroid = Calcitonin precursors
Isolated, massive, nodular deposits (skin, lung urogenital tract) = AL from light chains.
Is Assoc w/ the following diseases: Renal Cell Carcioma, Chronic Heroin Abuse, Hodgkin's Disease, and Rheumatoid Ar
All the conditions assoc. w/secondary amyloidosis have large amounts of inflammation and cell death. (CHRONIC INFLAM
Chronic active disease = AA amyloid from serum amyloid-associated (SAA) protein from liver
Myelomas and related disease = AL amyloid from immunoglobulin light chain.
Chronic hemodialysis = Beta2microglobulin (related to high plasma levels)
Nephropathic hereditary forms (familial mediterranean fever) = AA amyloid from SAA.
Cardiomyopathic hereditary forms (senile systemic amyloidosis) = Preallbumin/transthyretin
Neuropathic hereditary syndromes = Prealbumin/transthyretin
Serum Levels is requisite for the systemic use of this drugs because their therapeutic index is low, and toxicity manifes
Renal failure due to acute tubular necrosis. FRNa > 1%. BUN:Cr Ratio < 20.
Muscle Weakness + Foot Drop + Fasciculation. 5 -10 % of cases are familial (autosomal dominant).
Infantile presentation is call SPINAL MUSCULAR ATROPHY (PERONEAL MUSCULAR ATROPHY - LOU GHERING DISEAS
This is a progressive motor neuron disease that presents w/ a combination of Lower and Upper Motor Neuron Findings.
The median survival after Diagnosis is 3 to 5 years, with death usually occuring from respiratory failure.
Hint in USMLE, Pt with MOTOR DYSFUNCTION (PROGRESSIVE WEAKNESS) but NO SENSORY DYSFUNCTION W/ NOR
They are: Growth hormone, Insulin, Thyroid Hormones and Androgens. All of them are require for normal growth.
M.C. organism in Alcoholic that vomit gastric contents and develops FOUL-SMELLING SPUTUM
Conversion of Pyruvate to Lactate
Ischemic myocardium in M.I. must TURN ON Anaerobic Glycolysis, which is energetically inefficient compared to respiration
One of the enzyme that will be activate in M.I. (Anaerobic Glycolysis) is GLYCERALDEHYDE-3-PHOSPHATE DEHYDROGEN
Is a tear in the lining of the anal canal distal to the dentate line that occurs most often on the POSTERIOR midline.
Pts. Complain of sever tearing pain assoc w/ the passage of bowel moments. There may be a skin tag on physical examinatio
Anal fissures are associated with LOW-FIBER DIETS and CONSTIPATION.
Radiologic Papillary Necrosis (rings shadows in the renal papillae). Long use of NSAIDs.
Is use to compare the MEANS of three or more VARIABLES.
The two siter chromatids separate into independent chromosomes
cause Ehrlichiosis. S/S R.M.S.F-type (absent rash) and the presence-like clusters (morulae) inside neutrophils is Dx.
S/S: Asymptomatic. But some people have allergic rash (site of entry), pneumonitis (larval migration) and microcytic hypoc
Heavy worm burdens may result in weight loss, fatigue, and mental or physical retardation.
Tx: Pyrantel pamoate or Mebendazole used to kill worms. Prev: involves wearing shoes, education about transmission and pr
ANATOMY PEARLS (RAPID FIRE STYLE)
Autosomal recesive disorder, a lysosomal defect is responsible for hypopigmented skin lesions in this disorder
Characterized by oculocutaneous albinism and immunologic deficiency, including defective phagocyte, lymphocyte and natura
Defective chemotactic response would made Pts more susceptible to infections by bacteria such as Staph and Strep
Provides supportive network of tubules and filaments in the cytoplasm of eukaryotic cells
It is composed of microtubules, intermediate filaments, and microfilaments
Microtubules: Found in the cytoplasmic matrix of all eukaryotic cells. They are compose of TUBULIN.
Microtubules: Tubulin is a protein dimer composed of two differents polypeptides: Alpha-tubulin and Beta-Tubulin
Microtubules: Play a role in the following:
Microtubules: Assambly is an important event in the SPINDLE FORMATION in chromosomal movement during meiosis and m
Microtubules: Intracellular vesicles and organelle transport. Two specific microtubule-dependent ATPases, Kinesisn and
Microtubules: Kinesin and dynein are involved in generating the force that drives transport (passive intracellular transport).
Microtubules: Also plays roles in Ciliary and flagellar movement.
Intermediate filaments: About 10 nn of diameter between microtubules and microfilaments.
Intermediate filaments: Contain tissue-specific proteins, like: Cytokeratins, Desmin, Vimentin, Neurofilaments and GFA.
Intermediate filaments: Cytokeratins: Found in the Epithelial Tissue
Intermediate filaments: Desmin: Found in the Smooth Muscle; Z disks of Skeletal and Cardiac Muscles.
Intermediate filaments: Vimentin: Found in Cells of Mesenchymal origin (endothelial cells, fibroblast, chondroblasts, vascular smoo
Intermediate filaments: Neurofilaments: Founds in neurons.
Intermediate filaments: Glial Fibrillary Acidic Protein (GFA): Found in Astrocytes.
Microfilaments: Have a diameter of 6 nn and are composed of ACTIN.
Microfilaments: They are associate with 2 types of movements:
Microfilaments: Local movements takes advantage of the polymerization and depolymerization properties of microfilaments
Microfilaments: Sliding filament movement is generated by the interaction of actin filaments with myosin filaments
Breakdown in the Glycoproteins process cause 2 diseases: I-cell disease and Hyperproinsulinemia
Characterized by ↑ levels of proinsulin. Because the failure of a peptidase to cleave proinsulin to insulin and c-peptide in the Golg
The clinical manifestations are similar to those seen in Pts w/noninsulin-dependent diabetes
Deficiency in N-aceylglucosamine-phosphotransferase (failure to phosphorylation of mannose) = Mucolipidosis II
The absence of the mannose-6-phosphate on the hydrolases results in their secretion rather than their incorporation into Ly
Absent or aberrant DYNEIN arms are found in the cilia and flagella = Immotile Cilia Syndrome
S/S: Chronic Sinusitis and bronchiectasis, as well as infertility and, in some cases, situs inversus.
it is due to a dynein arm defect. IMMOTILE CILIA. Male and female infertility, bronchietais, recurrent sinusitis. Assoc. with Si
It is clearly assoc. with DEXTROCARDIA (Normal heart in the right side)
General Cytologic Features of the Three Types of Muscle.
Skeletal Cardiac Smooth
Striated, Unbranched Fibers Striated, Branched Fibers Nonstriated, Fusiform Fibers
Multinuclear Single Nucleus Single Nucleus
Strong, quick, discontinuous, Strong, quick, continuous Weak, slow,
Voluntary contraction Involuntary Contraction Involuntary Contraction
Ultrastructure Comparison of the Three Types of Muscle
Skeletal Cardiac Smooth
Overlapping Actin and Myosin Filaments Overlapping Actin and Myosin Filaments Actin and Myosin Do not for
forming a characteristic banding pattern forming a characteristic banding pattern banding pattern
T Tubules form Triadic contacts with SR T Tubules form dyadic contacts with SR Lack of T tubules; have limited
at A - I junction near Z line.
Sarcolemma lacks junctional Junctinal complexes between fibers Gap junctions
complexes between fibers (intercalated discs), including
Gap junctions.
Troponin Troponin Calmodulin
Z disks - Intermediate Filament Z disks - Intermediate Filament Dense bodies in intermediate filam
protein is DESMIN protein is DESMIN protein is DESMIN or VIMENTIN
in vascular SMOOTH MUSCLE.
Are heterogenous group of small, spherical organelles with a single membrane and diameter ranges approx. 0.15 to 0.5 um.
Functions are: 1) Synthesis and degradation of Hydrogen Peroxide. 2) BETA-Oxidation of very long chain fatty acids (> C2
3) Phospolipid Exchange (convert Phosphatidylserine and Phosphatidylethanolamine) and 4) BILE ACID SYNTHESIS.
Genetic Diseases are assoc with IMPAIRMENT or ABSENCE of peroxisomes. They are:
1) Zellweger (Cerebrohepatorenal) Syndrome. 2) Neonatal Adrenoleukodystrophy
3) Infantile Refsum Disease and 4) Hyperpipecolatemia.
All these Patients fail to oxidize very long chain fatty acids and accumulate bile acid precursors.
END OF ANATOMY PEARLS (RAPID FIRE STYLE)

Type IV Glycogen Storage Disease (G.S.D.) is caused by a Deficiency of GLYCOSYL 4:6 TRANSFERASE.
It is the only one G.S.D. involved in Glycogen Synthesis. The rest are involve in Glycogen degradation.
or Testicular feminization syndrome. Genotypically male 46,XY but phenotypically female because defect that prevent normal androgen re
Pts are amenorrheic and have no internal female structures. Testes rather than ovaries are present. Minimal axillary and pubic
Pts are tall with big hands and feet and long arms. Testes should be removed after pubertal development is completed.
Phenotypic girl + Karyotyping 46, XY this happen because the Pt have a deletionof the DNA-binding domain of theANDROGEN
In both men and women, growth of axillary and pubic hair is stimulated by androgens. Androgens also responsible for LIBIDO
Excessive production in a female would have resulted in VIRILIZATION.
Ensures that TESTOTERONE in seminiferous tubule is HIGH.
The CBC and The Reticulocyte Count (T.R.C) can divide the anemias in: T.R.C < 2.5 = R.B.C Morphology Anemias.
T.R.C > 2.5 = Hemolysis/Hemorrhage Anemias
Morphology Anemias we divide according with M.C.V. (Mean Corpuscular Volume): Normal Value 80-100 ųm³.
In that way we can have the following Morphology Anemias: Normocytic Normochromic, Micro or Macrocytic.
Normocytic Normochromic (Hypoproliferative) can be: 1) Marrow Damage: Infiltration/Fibrosis, Aplasia. 2) Iron Deficiency.
3) Decrease Stimulation: Inflammation, Metabolic Defect, Renal Disease.
Micro or Macrocytic Anemias (Maturation Disorder) we have: 1) Cytoplasmic Defects and 2) Nuclear Defects
Cytoplasmic Defects examples are: Iron deficency Anemia, Thalasemias, Sideroblastic Anemia.
Nuclear Defects examples are: Folate Deficiency, Vit B12 deficiency, Drug Toxicity, Refractory Anemia.
Most of Macrocytic Anemias are caused by Processes that interfere with normal DNA synthesis and replication.
Hemolysis/Hemorrhage Anemias = Hemolityc Anemias (T.R.C >2.5). Can have different causes, like: Blood Loss, Intravascular Hem
Another causes of Hemolytic: Metabolic Defect, Membrane Abnormality, Hemoglobinopathy, Autoimmune Defect, Fragmentatio
EMIA SERUM Fe TIBC (TRANSFERRIN) Serum Ferritin Other

y Low High Low * Look for Blood Loss.
onic Disease Low Low Normal/High * May be Normocytic and Lost of Weight
Anemia High Normal/High High * Give Pyridoxine (B6) to see if responsive
Normal/High Normal/High Normal/High * Check HbA2, HbF levels.

EMIA SERUM Fe TIBC (TRANSFERRIN) Serum Ferritin Other
y Low High Low * Look for Blood Loss.
onic Disease Low Low Normal/High * May be Normocytic and Lost of Weight
Anemia High Normal/High High * Give Pyridoxine (B6) to see if responsive
Normal/High Normal/High Normal/High * Check HbA2, HbF levels.
Megaloblastic - Vit B 12/ Folate Deficiency, Drugs that block DNA synthesis (e.g sulfa drugs, AZT).
Marked reticulocytosis. Vit B12 / Folate Deficiency are assoc w/hypersegmented PMNs. Vit B12 is assoc w/neurologic problem
They have a ↓ of Hemoglobin: Iron Deficiency, Anemia of Chronic Disease, Thalasemias (target cells), Lead Poisoning, Sideroblastic
Remember Hemoglobin Molecule: Heme + globin . Heme = Iron + Protoporphirin. Globin: Alpha, Beta, Delta, Gamma.
Mechanism of Action: In Iron Deficiency No Iron to form Heme therefore it is not Hemoglobin. Serum Iron and frerritin ↓, TIBC
Anemia of Chronic Disease same mechanism of Iron Deficiency. But the Iron deposit (Ferritin) is ↑ (macrophages in bone ma
Sideroblastic Anemia: We must do a Bone Marrow Bx with Pursian Stain to do the sideroblastic disc/
Sideroblastic Anemia: Causes: 1) Alcohol, 2) B6 Deficiency, 3) Lead Poisoning (denature protein).
Thalasemias: Alpha (Asian and Black) Autosomal Recessive. Alpha globin chain problem. Hemoglobin Electrophoresis is No
Thalasemias: Do not given the IRON in alpha
Thalasemias: Betha (Black, Greek and Italian) Stop Codon. It wil show in Hemoglobin Electrophoresis. NSTx in mild case is
Vit B6 Deficiency: Microcytic Hypochromic, Increase Fe+ in Mitochondria, like Lead Poisoning also shows Ringed siderob
Vit B6 Deficiency: Lab. Result are: Protoporphyrin and Gamma-ALA: Decreased; Ferritin and Serum Iron: Increased
in B6 (Piridoxine) Deficiency Iron Deficiency Lead Poisoning

rocytic Hypochromic ** Microcytic Hypochromic ** Microcytic
ease Iron in Mitocondria ** No Iron in Mitocondria ** Coarse basophilic stippling in eryth
ged Sideroblasts in Bone Marrow ** No Ringed Sideroblasts in Bone Marrow ** Ringed Sideroblasts in Bone Marro
n not have Porphyrin ** Iron is not inserted in Prophyrin ** Iron is not inserted in Prophyrin
toporphyrin: ↓ ** Protoporphyrin: ↑ ** Protoporphyrin: ↑
mma-ALA: ↓ ** Gamma-ALA: Normal ** Gamma-ALA: ↑
ritin: ↑ ** Ferritin: ↓ ** Ferritin: ↑
um Iron: ↑ ** Serum Iron: ↓ ** Serum Iron: ↑
ES CAUSES CAUSES
niazid for tuberculosis. Antidote Vit B6 ** Direct iron insufficient to compensate for ** Lead paint, Pottery glaze, batteries.
normal loss Dx: Measuring blood lead levels.
We have the following:

1) Acute hemorrhage, 2) Enzyme defects (e.g. G6PD deficiency, PK deficiency). 3) RBC membrane defects (e.g. hereditary spherocy
4) Bone marrow disorders (e.g. aplastic anemia, leukemia). 5) Hemoglobinopathies (e.g. sickle cell disease)
6) Autoimmune hemolytic Anemia, 7) Anemia of chronic disease (ACD) - TIBC ↓, Ferritin ↑, Sotrage iron in marrow macrophag
THINGS TO REMEMBER: Serum haptoglobin ↓ and serum LDH ↑ indicate RBC hemolysis.
THINGS TO REMEMBER: Coombs' test is used to distinguish between immune vs non-immune mediated RBC hemoly
Anemic Pt compare to Normal Pt = Arterial PO2 is likely to be similar for both.
Anemia reduces the oxygen-carrying capacity of the blood but does not affect arterial oxygen tension.
Thus, oxygen delivery is decreased and venous oxygen has a lower partial pressure at rest and during exercise in the anemic
The anemic Pt has oxygen content reduced for every level of PO2.
May reduce uterine activity if administered in the Latent Phase (Anesthesia in active phase will has the opposite effect)
If an anesthesic has a high blood/gas partition coefficient means the anesthetic should be delivered at a low concentration
High blood/gas partition coefficient = it's very soluble in blood and is eliminated from the bloodstream into the alveolar air re
High blood/gas partition coefficient = This tends to prolong recovery time.
Minimum Alveolar Concentration (MAC) is the concentration of anesthetic at 1 atm that produce immobility in 50% of Pts exposed to a noxi
Ketamine is an I.V. general anesthesic. It is also a dissociative anesthetic in that Pts appear awake but are unconcscious an
Ketamine is not widely used because it increases cerebral blood flow and induces Post-op hallucinations.
Halothane, Ether and Nitrous Oxide are inhaled general anesthetics. Used primarily for the maintenance of anesthesia after administrati
Procaine and Lidocaine are local anesthetics. They are applied locally and block nerve conduction of sensory impulses from the p
Are WEAK BASES that cross the neuronal membrane in the noinonized form.
Once inside, they block the voltage-gated sodium channels in their ionized form.
This is in contrast to toxins such as tetrodotoxin and saxitoxin, which block these channels from the extracellular side
Ischemic Attacks, Excersive ECG usuallly shows ST Depression. ECG at rest won't show any abnormalities
Chest pain, sensation of precordial thightness, occurs after physcial exertion and relieve by rest.
Repeat episodes typically cause gradual loss of myocytes, which is seen pathologically as SMALL PATCHES OF FIBROSIS
Also we can see pathologically VACUOLIZATION of damaged myocytes, typically in subendocardial locations (which are relatively
Exercise EKG = Indicated in the risk stratification of Pt w/C.A.D. (STABLE ANGINA) = STRESS TEST.
Coronary Angiogram = Indicated in Pt. who have abnormal Stress Testing.
Dobutamine Stress Echo: In Pt. who can't do sufficient Exercise
Myocardial Perfusion Testing = In Pt. at high risk of Developing complications w/exercise or Dobutamine (established C.A.D
The pathophysiology underlying is INTERMITTENT THROMBUS FORMATION AND LYSIS.
Do not put the Pt in a treadmill, it will cause death.
or Prinzmetal. Pathophysiology underlying is CORONARY VASOSPASM = Transient ischemia = Transient S-T segment resp
Transient S-T segment elevation in the inferior leads.= Trasmural Ischemia.
Follow of infection,dental procedures or trauma. Deficiency of C1 esterease inhibitor that producing edema and elevation C
Rare tumor of a mix of hypertension + microscopic hematuria + bilateral kidney enlargement.
Vinyl chloride and Arsenic the M.C. factor that produce this Cancer.
Stimulate Na Reabsorption in Proximal and Distal tubules, Stimulate Aldosterone, and Constrict Efferent Arterioles ( peritubula
Most powerful Sodium-retaining hormone of the body. Can be inhibit by Losartan (ACE inhibitor).
Potent Vasoconstrictor, Release of Aldosterone from the adrenal cortex, Release of ADH from posterior pituitary, Stimulate
RECEPTORS are block by Saralasin and Losartan
In a 6 y. old Pt bit for a cat we give Amoxicillin-clavulate acid. We suspected an infection of P. multocida or S. Aureus
Ampicillin is an effective Tx of P. multocida but not for S. aureus
Clindamycin is a effective Tx of S. aureus but is ineffective to P. multocida.
Tetracycline is a effective Tx of P. multocida but it should not be given to children younger than 8 years
TMS is not adequate on its own. When is combined with clyndamycin, however it is an alterantive Tx if the Pt is allergic to pen
Formula: Na - ( HCO3 + Cl). Normal Value: 8 -12.
ANION GAP
In any case of METABOLIC ACIDOSIS we must determinate ANION GAP
CAUSE OF NORMAL ANION GAP METABOLIC ACIDOSIS (HYPERCHLOREMIC METABOLIC ACIDOSIS)
Renal Loss of Bicarbonate and Gastrointestinal Loss of Bicarbonate
Renal Tubular Acidosis
Moderate Renal Failure (GFR more than 20 ml/min = Normal AG acidosis)
Carbonic Anhydrase Inhibitors (Acetazolamide)
Diarrhea, Ureterosigmoidostomy and Pancreatic Fistula.
CAUSE OF INCREASE ANION GAP METABOLIC ACIDOSIS = CAUSE OF ANION GAP METABOLIC ACIDOSIS.
Lactic Acidosis (Secondary to circulatory or respitratory failure drugs, toxins, enzyme defects)
Ketoacidosis (Diabetic, Starvation or Alcholic).
Metanol Ingestion
Ethylene Glycol Ingestion
Salicylate Poisoning
Uremia (ESRD).
Piruvate + NADH + H = Lactace + NAD. Lactate will tend to ↑ when Piruvate concentration ↑ and when ratio of NADH to NAD
"rolled his ankle over", No Snap or Crack at the time of the injury. Walks slight limp. Swelling in bilateral side of the ankle.
"Drawer test" Normal, "Talar Tilt" test reveals increased excursion in the injury side. No Tenderness in Lateral Malleolus.
NSTx in Acute Ankle Sprain: NSAIDs with Rehabilitation within 72 hours.
NSTx P.R.I.C.E. Protection (splinting or immobilizing),Rest of the injured joint,Ice application several times daily,Confinded w/a
M.C. type is LATERAL, which occurs as a result of excesive inversion of the foot and plantar flexion of the ankle.
The Calcaneofibular, The Anterior Talofibular and Posterior Talofibular Ligaments constitute the LATERAL ligament of
Onset before 40, progressive ankylosis of the sacroiliac joints. Assoc. with HLA-B27. Young pt. w/chronic lower back pain S/S w
Bilateral tendernes over the sacroiliac joints, reduction in spina flexion movements, and mild bilateral knee effusions. Aortic Regu
Associate with CROHN DISEASE, PERIPHERAL ARTHRITIS, PSORIASIS, REITER DISEASES.
Young Pt, ocurrence of pain at night, negativity of R.F. and especially, bilateral involvement of sacroiliac joints.
You can see HYPERCAROTENEMIA.
Side effect of PAROXETINE, along with other SSRI, ↓ libido and difficulties to reaching orgasm. Amitriptyline ↓ libido but no org
Refers to a deficit in cognition about one's illness, or the lack of awareness that one is suffering from a certain condition.
It is related to large lesions of the nondominant parietal lobe, causing the Pt to be confused, and unaware of motor and sensor
Present with medial knee pain just below the joint line (TIBIAL PLATTEAU)
Failure to develop is result of Incomplete fusion of the lateral body folds around the 4th week of development.
Paresis of the contralateral lower extremity resulting from injury to the paracentral lobule.
Post-op the M.C. dangerous hormonal deficiencies involve GLUCOCORTICOIDS and THYROID HORMONE. Pt need to be prepare
M.C.C of red eye in Pt. with Ankylosing Spondylitis.
is used to diagnose LEUKOCYTE ADHESION DEFICIENCY.
Are sensitive and specific for CREST. Antinuclear Antibodies are also positive in 90% of these patients (and nonspecific)
POSITIVE results exclude de posibility of DISCOID LUPUS ERYTHEMATOSAUS unfortunable no all S.L.E. develop this antib
Antibodies are primarily involved in the pathogenesis of LUPUS NEFRITIS.
Seen in Dermatitis Herpetiforme (Ig A deposits in the dermis + gluten sensitive enteropathy)
The autoantibody is typically IgG we see in Rapidly Progressive Glomerulonephritis (RPGN)
is antibody to the core antigen and generally appears at the onset of clinical illness and then declines slowly.
You can ordered when a Pt. come from Burna + Jaundice + L.F.T. ↑
They are formed in drug induced-lupus erythematosus cases. Procainamide + Hydralazine are the offending agents M.C. d
See in Rheumatoid Arthritis, and the autoantibody is Rheumatoid Factor.
the R.F. is usually is a IgM or IgG (less common IgA) directed against the constant region of autologous IgG
You can order for Polymyositis
You can order for Mixed Connective Tissue Disorder.
Are detected in subacuate cutaneous lupus erythematosus, neonatal lupus erythematosus, and Sjögren Syndrome. (anti S-S)
In any case should be valued in the context of clinicopathologic correlation
Can cross the placenta a produce a baby w/complete heart block
Is assoc w/ systemic form of SCLERODERMA
It is highly specific for S.L.E. Young middle age women with skin involvement occurs in 80% of cases and is likely helpful in making th
or Na + Channel Blokers = ↑ AP (Action Potential) duration, Effective Refratory Period (ERP) and QT interval. Divide in subtypes: A
Quinidine, Amiodarone, Procainamide ,Disopyramide. M of A: ↑ AP duration, ERP and QT interval. Use in A. and V. arrhyt
Lidocaine, Mexiletine, Tocainide. M of A: ↓ AP duration. Use in V. arrhytmias post M-I and in digitalis-induced arrhytmias.
Flecainide, Encainide, Propafenome. No effect on AP duration. Use in V-tachs that progress to VF and in intractable SVT.
or Beta Blockers : Propanolol, Esmolol, Metroprolol, Atenolol, Timolol. M. of A. ↓ cAMP, Ca2+ currents. AV node sensitive
Also supress abnormal pacemakers by ↓ slope of phase 4. ↑ PR interval. Esmolol very short acting.
or K + Channel blockers: Sotalol, Ibutilide, Bretylium, Amiodarone, Dofetilide. Same M. of A like Class I.
Toxicity: Sotalol (Torsade de Pointes). Amiodarone (Pulmonary Fibrosis, Hepatotoxicity, Hypothyroidism, Hyperthyroidism)
or Ca2+ channel blockers: Verapamil, Diltiazem. M.of A. ↓ conduction velocity in the AV nodal cells, ↑ E.R.P, PR interval.
Used in prevention of nodal arrhythmias (e.g. SVT). Toxicity: Constipation, Flusing, Edema, CV effects (CHF, AV block, sinus mode d
1) Adenosine: Diagnosing/abolishing AV nodal arrhythmias. 2) K+: Depresses ectopic pacemakers, especially in digoxin toxic
3) Mg +: Effective in Torsades de Pointes and Digoxin Toxicity.
M.C. way of Tx Septic Pts w/ P. aeruginosa infections.
RULE: In Agammaglobulinemias increased the risk for infections caused by Extracellular Bacteria.
Have 2 active ends: Fab and Fc. The Fab (for antigen binding) portion binds specifically to one antigen.
If the antibody is attached to the immature B cells that synthesized it, binding of the antigen to the Fab portion can lead to activation
Free antibodies in the blood can bind to bacteria or their toxins.
The macrophages or other cells can ingest the antibody-antigen complexes using Fc receptors for recognition
The Fc (for constant) portion is responsible for the effector functions of antibodies.
It binds to Fc receptors on neutrophils or macrophages to trigger phagocytosis of the antibody-antigen complex.
Bound antibodies that cross-link their Fc portion can trigger the classical complement pathway
Antibody-dependent, cell-mediated cytotoxicity occurs when antibodies attach to specific antigens on tumor cells (or other cells recognized
All these cells are designate to be killed by either Natural Killer (NK) cells or macrophages.
The NK cells and macrophages have Fc receptors that allow them to identify the cells that are to be killed.
The Fc portions of cross-linked antibodies can trigger the complement cascade and lead to the destruction of bacteria that the antibodies have bo
It is use for the Dx of Lupus Erytemathosus.
It is use for the DX of Dermatomyositis
It is use for Dx of Subacute Cutaneous Lupus Erythematosus, Neonatal Lupus Erythematosus and Sjogren Syndrome
It is use for the Dx of CREST.
It is use for the Dx of Drug-Induced Lupus Erythematosus (Procainamide and Hydralazine)
Play a major role in the Acquired Immunity to infection of NEISSERIA MENINGITIDIS, GROUP A
Seen in Antyphospholipid antibody Syndrome
Can be cause bye TCAs. The S/S can be present even w/usual doses. Skin can be warm and dry, constipation, urinary retenti
Others S/S dry mouth, elevated temperature, dry flushed skin, worsening of glaucoma, and tachycardia
We have Diphenhydramine (Antihistaminic Agent) and Benztropine.
CONTRAINDICATED IN Narrow Angle Glaucoma, Prostatic Hyperplasia, Gastrointestinal Obstruction
Also call: Parasympathlytics or Cholinergic Blockers or Anticholinergic. Acts in two sites: Muscarinic and Nicotinic
MUSCARINIC: The M.C and important is ATROPINE (anticholinergic effects): In the eye produce Mydriasis and Cyclopeg
MUSCARINIC: Other drugs we have Benztropine, use in Parkinson's; Scopolamine, use in Motion Sickness, and Ipatropium, use in As
MUSCARINIC: ATROPINE SIDE EFFECT = "Hot as a hare, Dry as a bone, Red as a beet, Blind as a bat and Mad as a ha
NICOTINIC: We have 2 types: Ganglion Nicotinic Receptor Blocker, Skeletal Muscle Receptor Blocker
NICOTINIC: GANGLION: Reduce the Autonomic Nerve System (Sympathetic and Parasympathetic stimulation)
NICOTINIC: GANGLION: We have Hexamethonium (prototype), mecamylamine, trimethaphan.
NICOTINIC: SKELETAL MUSCLE: We have 2 types: 1) Nondepolarizing (blocker or antagonist competitive)
NICOTINIC: SKELETAL MUSCLE. 2) Depolarizing. (Succinylcholine)
NICOTINIC: SKELETAL MUSCLE: Nondepolarizing: - Competitive antagonist at NM receptor of muscle endoplate.
NICOTINIC: SKELETAL MUSCLE: Nondepolarizing: - Reversible by AchE inhibitors
NICOTINIC: SKELETAL MUSCLE: Nondepolarizing: - Include tubocuranine, atracurium and Pancuronium.
NICOTINIC: SKELETAL MUSCLE: Depolarizing: Agonist at NM receptors (Succinylcholine)
NICOTINIC: SKELETAL MUSCLE: Depolarizing: Initial fasciculation, then paralysis through persistent membrane depolariza
NICOTINIC: SKELETAL MUSCLE: Depolarizing: Not reversed by AChE inhibitors.
NICOTINIC: Hexamethonium (Nicotinic Ach receptor antagonist) Ganglionic Blocker.
NICOTINIC: Hexamethonium used to prevents Reflex Bradycardia caused by NE.
Mydriasis (blurred vision), Tachycardia, impaired sweating with flushed skin, dry mouth, constipation, urinary retention and mus
Decrease SLUDG (mnemonic). Salivation, Lacrimation, Urination, Defecation and Gastrointestinal Motility
Symptoms of cholinergic excess via activation of both Muscarinic and Nicotinic receptors include:
Pupillary constriction, Stimulation of GI and Urinary tracts, Bronchoconstriction, Increased glandular secretions.
Bradycardia & hypotension, Skeletal muscle fasiculations - then paralysis, CNS effects.
A.I.T = Cholinesterase Inhibitor Poisoning: S/S DUMBBELSS, it is stand for: Diarrhea, Urination, Miosis (pupil contraction),
Bronchospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating, and Salivation (also abdominal c
A.I.T = Organophosphorate Toxicity = NSMx: Atropine (enters CNS), acts in the muscarinic side, no nicotinic side.
Also we can use Pralidoxime (2-PAM) which regenerate phosphorylated Acetilcholinesterase enzyme.
are used in the Tx of Digitalis Overdose.
Have some potential to cause tachycardia and palpitations because of their ANITMUSCARINIC ACTIVITY.
The risk of arrhtymias can be assoc with Pt that receive ERYTHROMYCIN, KETOCONAZOLE and ITRACONAZOLE.
We have Diphenhydramine, Clemastine, Chlorpheniramine and Loratadine are free of these interaccion with erythromycin, and a
Like Terfenadine and Astemizole, nonsedating antihistamines may prolong the QT interval of a ECG and cause cardiac arrhytm
Erythromycin, Ketoconazole, and itraconazole may inhibit the metabolism of terfenadine, resulting in ↑blood levels and incrase
Mechanism of action Drugs
1) Block cell wall synthesis by inhibition
of Peptidoglycan cross-linking Penicillin, Ampicillin, Ticarcillin, Piperacillin, Imipenem, Aztreonam, Cephalosporins
2) Block Peptidoglycan Synthesis Bacitracin, Vancomycin, Cycloserine
3) Block protein synthesis at 50 S
ribosomal subunit Chloramphenicol, Erythromycin/macrolides, lincomycin, Clindamycin, Streptogramins, Lin
4) Block protein synthesis at 30 S
ribosomal subunit Amynoglycosides, tetracyclines.
5) Block nucleotide synthesis Sulfonamides, Trimethropin
6) Block DNA topoisomerases Quinolones
7) Block mRNA synthesis Rifampin
8) Bactericidal antibiotics Penicillin, Cephalosporins, Vancomycin, Aminoglycosides fluoroquinolones, metronidazo
9) Disrupt bacterial/fungal cell membrane Polymyxins
10) Disrupt fungal cell membrane Amphotericin B, Nystatin, Fluconazole/azoles
11) Unknown Pentamidine
POSITIVE results you will see always in S.L.E. but also in up to 10 % of DISCOID LUPUS PATIENTS.
Usually ↑ in S.L.E. assoc with mild to moderate anemia, low leukocytes count and low platelet count.
Occasionaly, anemia is due to autoantibodies to RBC
Syndrome the NSTx: Lifelong anticoagulation with warfarin targeting and INR of 2.0 to 3.0 is the cornerstone of Tx of this
Operates in opposition to society's rule and customs. Criminal behavior is common.
Spinal Shock after a injury will show in a few days loss of motor function, loss of pain and temp on both sides distal to the injur
The loss of pain and temp on both side distal to the injury with preservation of vibratory and positional sense.
Generalized Anxiety Disorder (G.A.D.): Uncontrollable anxiety unrelated to a specific person, situation, or event.
G.A.D. S/S: G.I. symptoms, fatigue, and difficulty concentrating are common.
NSTx: Considerate Buspirone. Also we can use Benzodiazepines.
Rupture in the Abdomen S/S hypotension+Abd. Pain+CT scan show enlarge sillouhete can be comfirm with U/S. NSTx Immed
1st Arch - Part of the Maxillary Artery
2nd Arch - Stapedial Artery and Hyoid Artery
3rd Arch - Common Carotid Artery and Proximal part of Internal Carotid Artery (I.C.A.)
4th Arch - On Left, Aortic Arch; on Right, Proximal Part of Right Subclavian Artery
6th Arch - Proximal part of Pulmonary Arteries and (on left only) Ductus Arteriosus
Double Aortic Arch result from ABNORMAL persistence of the Right Dorsal Aorta
Right 7th Intersegmental Artery forms the Distal Part of the Right Subclavian Artery that come from Right 4th Aortic Arch
Sudden onset of tearing chest pain that seems to originate in the anterior chest and radiate to the back in the interscapular reg
Chest X-ray excellent Dx tool (Widening of the Mediastinum). Kills patient fast but it is SURGICAL TREATABLE.
We can see in Marfan Sx. (chromose 15 defect in fibrillin, autsomal dominant), assoc. with mitral valve prolapse
Also we can see in Ehlers-Danlos Sx and in Pregnancy (because the excess of plasma volume)
Aortic Valve is not closing properly causing retrograde flood into the Ventricule. ↑ E.V.D and Filling Pressures. ↓ Aortic Diasto
Soft Diastolic Insuficiency Decrescendo Murmur is hear along the Left Sternal Border. Also a ↑ in Pulse Pressure
Advice Antibiotic prophylaxis before dental work to reduce the risk of SUBACUTE BACTERIAL ENDOCARDITIS.
Murmur between S1 and S2 is a Aortic Stenosis (Systolic Murmur) = Ejection Murmur.
Blow flow in Coronary Arteries is increase because increased cardiac tissue ADENOSINE CONCENTRATION.
<50 years old is usually due a congenital abnormal aortic valve. Systolic Murmur along the left sternal border rad. To the
>50 years old is usually due a Calcification of aortic valve cusps. Dyspnea on exertion, precordial pain ECG changes L.V.
A.S. will be a mayor resistance point of the sytemic vasculation causing lose of sytemic pressure and ↑ in Ventricular.
Any change in PRELOAD of the Left Ventricule will change the intensitive of the EJECTION MURMUR in Aortic Stenosis.
These murmur characteristic is very important clinically to differentiate from Hyperthrophic Cardiomyopaty
Assoc. with Diastolic murmur and wide differential between systolic and diastolic pressure = PULSUS PRESSURE = 17
We have a high amplitude cardiac upstroke pulse
The high amplitude means (extra blood) must be pushed into the aorta to compensate for backflow into the during diastole
Color of Newborn: 0 = Body and ext. are blue/pale; 1 = body is pink and ext are blue; 2 = body and ext are pink
Heart Rate: 0 = No Heart rate; 1 = < 100 beats/min; 2 = > 100 beats/min
Reaction to Nasal Stimulation: 0 = No response; 1 = grimace; 2 = Active Cough.
Tone/Activity: 0 = Limp; 1 = Some flexion of ext.; 2 = Active flexion of ext.
Respirations: 0 = Completely absent; 1 = Slow and irregular; 2 = good respiratory effort.
Congenital abnormality consist in Cranial Deformities with fusion of fingers and toe assoc. with Ventricular Septal Defect.
Lesion in the Arcuate Fasciculus that communicate Broca and Wernicke Areas.
Conduction Aphasia. Poor Repetition w/ good comprehension, fluent speech.
Also call Expressive Aphasia. Is a disorder primarily of language output.
Speech is slow and effortful phrase length is short and the Pt tends to use only common nouns, verbs and, occasionall
Comprehension is relatively intact. Repetition is generally disturbed comparable to the amount of spontaneous outpu
It is produced by a lesion of Broca's area. Motor Expresssive aphasi w/ good comprehension.
Broca's area is located in the Posterior Part of the Inferior Frontal Gyrus of the Language-Dominant Hemisphere. (moto
S/S: Higher than normal language output and frequent paraphasic errors.
S/S: Comprehension of auditory and visual language is severly disturbed. Inability to repeat language
Or Receptive aphasia. It is caused by lesion in Wernicke's area. Sensory (fluent/receptive) aphasia w/ poor comprehe
Wernicke's area is located in the Posterior part of the Superior Temporal Gyrus of the Language-Dominant Hemisphere
Can be cause by Drugs and Infection (Parvovirus and Hepatitis C) and radiation
Chloramphenicol produce aplastic anemia. You can use Chloramphenicol in Rocky Mountain Spotted Fever.
Hepatitis C is the M.C.C of Aplastic Anemia secondary to a infection we will see PANCITOPENIA.
If we see only RBC destroy involve w/ Aplastic anemia think about PARVOVIRUS
Pale + Multiple purpura in extremeties + all blood cells have normal form + Bx of bone marrow shows predominantely fat
It will be a manifestation of FIFTH DISEASE (Erythema infectiousum rash"slappedcheek"+malaise). Usually cause by PARVOVIR
Decreased of MIXED VENOUS PO2. Increased 2,3 DPG, cardiac output, Red Blood Cell H + concentration, Arterial PO2.
You also find in Bone Marrow Minimal Hematologic Elements. Between the causes: Idiopathic, Chemicals (Benzene), radiation and s
Most Common Appropiate Pharmacotherapy is THEOPHYLLINE.
It is a gene product in the hepatocyte cell membrane that need to be increase in successful therapy of familial hypercholestero
Abnormalities is seen in Hyperlipoproteinemia type V, elevation of cholesterol and triglycerids.
ApoCII is major component of VLDL and is removed in the conversion of VLDL into LDL.
is a form of cell death that serves to elimiante unwanted cells during development, maintain cell numbers in intact organs or tis
Eliminate immune cells after an immune response has fade. Also occurs in response to noxious agents and in the aging proce
Also we can see PERIPHERAL AGREGATION OF CHROMATIN. In necrosis, the chromatin may become more pale (karylo
In necrosis we can see irregular clumps and the nuclues itself may shrink into a dense pyknotic body that is not seen in Apop
Mayor mechanism to KILL Cancer Cells, also in HEPATITIS (kill cell without inflamation), also in the development of glands
Morphology caractheristic: 1) Cytoplasmic blebbing, 2) Nuclear blebbing, shows same irregular type of blebs or protrusions.
The first part to be degraded in this cell is 10nm fiber of DNA
10nm fiber of DNA is the most "unwound" DNA for enzymatic degradation in eukaryotic cell death occuring during apoptosis
Genes that control Cell Death Processes. Embriology of orgasms in general are example of APOPTOSIS GENES
All these have a signals calls KASPAPTOSIS (Kaspaptosis enzymes can be trigger by chemistry reaction) that will start the AP
Deficiency produces Central DiabetesInsipidus. Resistance to AVP at the kidney level is termed Nephrogenic Diabetes I
Type 2 may lead to OBSTRUCTIVE HYDROCEPHALUS.
The obstructive hydrocephalus is due to compression of the 4th ventricle by the downward displacement of the cerebellar vermis
Type 2 all this displacement leas to obstruction of the CSF flow and hydrocephalus.
Type 2 important association abnormalities include myelomeningocele and syringomyelia.
Type 1 malformation is definely more frequent thant the type 2 malformation. Usually asymptomatic.
in Type 1 is a Downward Displacement of the cerebral tonsils throught the forament magnum.
Can Cause Syncope in Pt. with ectopic beats, heart disease WITOUT ANY WARNING SIGNS.
Internal Iliac Arteries (I.I.A.) arise from the Common Iliac Artery. Gives Vesicular Branchs that supplies blood to the URINARY BLAD
External Iliac Arteries (E.I.A.) arises from the Common Iliac Artery.
Inferior Epigastric Artery (I.E.A.) is a branch fo the External Iliac Artery. Serves as a landmark in the Inguinal Region
Inferior Epigastric: Indirect Inguinal hernias lie lateral to the I.E.A, whereas direct inguinal hernias lie medial to these ves
Internal Pudendal Artery (I.P.A) is a branch of the Anterior division of the I.I.A.
Internal Pudendal Artery (I.P.A) gives rise to the inferior rectal artery, perineal artery, artery of the bulb in men.
Internal Pudendal Artery (I.P.A) also gives rise urethral artery, deep artery of the penis or clitoris and dorsal artery of the penis or clit
Lateral Sacral Artery (L.S.A) is a branch of the Posterior Division of I.I.A. It supplies sacral structures.
Right Gastroepiploic Artery arise from the Gastroduodenal Artery supplies the RIGHT half of the greater curvature of the stom
Right Gastroepiploic Artery: Any Ulcer perforacion close to the Pyloric sphincter can involve this vessel.
Left Gastroepiploic Artery arise from the Splenic artery supplies the LEFT half of the greater curvature of the stomach
Left Gastric Artery arise from CELIAC TRUNK, supplies the LEFT half of the lesser curvature of the stomach.
Right Gastric Artery arise from Hepatic Artery, supplies the RIGHT half of the lesser curvature of the stomach
Short Gastric Artery arise from Splenic Artery ocassionally from the Left Gastroepiploic.
Short Gastric Artery supplies the fundus of the stomach which is most distant from the Pyloric Sphincter
Any Artery occluded 50%(e.i. atherosclerotic coronary artery) the maximal blood flow through this artery is reduced by 1
Hyperplastic arteriolosclerosis = " Onion skinning" = Thickening of the Artery wall with porliferation of smooth muscle cells.
Hyperplastic arteriolosclerosis = Affected vessels may also show necrotizing arteriolitis, with acute vessel wall necrosis a
Hyperplastic arteriolosclerosis = This type of vessel change is a hallmark of severe (malignant) hypertension.
Hyperplastic arteriolosclerosis = Can damage arterioles throughout the body, notably in the kidneys, intestine and gallbladd
Arteriosclerosis = produce luminal narrowing by plaques.
Hyaline arterioslosclerosis = Partial replacement of arterial wall by homogenous, pink material
Monckeberg's arteriosclerosis = Characterized bye medial calcification of smaller arteries
Polyarteritis nodosa = characterizased by focal acute inflammation of smaller arteries.
Decrease of this will result in HIGH PULSE PRESSURE.
Can be done in a Gunshot wound in the leg w/o compromise S/S.
It is the place that the greatest decrease in mean blood pressure occurs. Entering pressure is 80 to 90 . Exit pressure is ar
Large one in the left subclavian will produce a INCREASED IN THE RESTING CARDIAC OUTPUT
Bruit and the Resting Pulse Rate are virtually pathognomonic. Particulary in view of the history of untreated penetrating trauma
↓ Systemic vascular resistance and Diastolic B.P., ↑ Mixed Venous oxygen content we will see in large arteriovenous fistula
Produce Painless Colonic Bleeding. M.C. is communication between arteriole and venule in cecum.
NSTx. Colonoscopy, intraoperative endoscopy, and visceral angiography
Produce luminal narrowing by plaques
Produce partial replacement of arterial walls by homogenous, pink material
Produce a concentric, laminated thickening of arteriolar wall due to proliferation of smooth muscle cells. = "ONION SKINNING
In severe cases with lactic acidosis we can have a UNRECOGNIZED BOWEL ISCHEMIA.
Finding of LINES OF ZAHN in the artherosclerotic plaque indicate that it has become a complicated lesion.
Occupational history of working in shipyards always raises the suspicion of asbestosis.
S/S Dysnea, chronic dry cough, recurrent respiratory infection and weight loss.
S/S Progresses gradually and have diffuse and bilateral interstitial fibrosis
The finding of pleural calcifications is virtually pathognomonic for asbestosis, which causes restrictive lung disease.
is a risk factor for malignant mesothelioma, as well as for lung adenocarcinoma (more common).
X-ray often reveals hyperinflamation of the normal parenchyma leading to "honeycombing"
Calcified parietal pleural plaques are aslo commonly present. Secondary bronchiectasis may complicate the picture.
Asbestosis and cigarette smoking are synergistic risk factors for lung carcinoma.
M.C. pulmonary lesion assoc with this is Fibrosis Plaque of the Pleura (benign). The M.C. cancer assoc is Primary Lung Ca
The second M.C. cancer assoc with this is a MESOTHELIOMA (smoking is not related by itself enhancing with the risk of mes
Mesothelioma takes like 25 to 30 years to develop, Primary Lung cancer take 10 years to develop that is why it is Most Comm
Pneumonitis is symptom resulting from the larvae lung migration. Bowel obstructions and malnutrition can result from larg
Tx with Pyrantel pamoate or Mebendazole. Prevention involves proper human waste disposal and personal hygiene.
We have no information how the cases were ascertained in this study
Occurs in Pt w/cirrhosis, other liver diseases and in Right Heart Failure.
Portal hypertension, Increase of capillary hydrostatic pressure within the splanchnic bed are factors to predispose Asci
Viral, tuberculosis and fungal. CSF finding= lymphocytic/monocytic predominance, WBC ↓ 250 cell/mm, protein ↓150 mg/dL, and normal glu
is the conditon in which menstrual periods do not occur because the uterine cavite has become obliterated with ADEHESIONS
These Pts do not respond to PROGESTERONA to produce menses.
Assoc. with TAY-SACHS AND TYPE I GLYCOGEN STORAGE DISEASE = GAUCHER'S DISEASE.
Glutamic acid and Aspartic Acid are acidic amino acids that are negatively charged at normal pH
Lysine is a basic amino acid that is positively charged at normal pH.
Proline and Isoleucine are aminoacids w/nonpolar side chains. They have NO NET CHARGE at normal pH
Usually indicate of a mobile cavitary mass in the lung + intermittent hemoptysis (opportunistic infection of fungae)
Immunosupressed Pt + Solid Mass X-ray, radioluscent crescent (Monod's Sign).
Present in the respiratory tract as an opportunistic pathogen. Can Cause: Aspergillioma, Vaso invase disease (thrombosis),
However, fungus balls are generally seen in pre-existing cavities (e.g. bronchiectasis, TB) not in the tonsils.
or stained amniotic fluid, resulting in fetal distress, may occur in utero or, more often with the first breath. Small airway obstruc
Typical CXR shows patchy infiltrates, coarsely straked bilateral lung fields, ↑ anteroposterior diameter, and flattering of the dia
Infants with aspiration syndromes may require more O2, greater tachypnea and lethargy than those with Transit Tachypnea of
In Patient with Seizure the M.C. pathogen are: Bacteroides Melaninogenicus, Fusobacterium Nucleatum and Anaerobic Strept
NSTx is Clindamycin, Peperacillin/tazobactam, Cefoxitin and may also we use Penicillin G.
If you are standing or sitting the foreign body will go to the posterior segment of the right lower lobe
If you are lying down that is the M.C. position to aspirate things go to the superior segment of the right lower lobe
If you are lying over your right side go to two places: To the middle lobe or To the posterior segment of the right upper lob
If you are lying over your left side will go to the lingulae.
Emergency Tracheostomy should be the last option and should be undertaken only by a physician trained to perform the proce
Pt regardless their age that can cough and breathe, it's best to initallly observe and allow spontaneous resolution,since interve
If the patient is under 1 year of age we can do Back Blows.
is major cause of anesthesia-related death in obstetrics. Pregnant Pt are at greater risk for aspiration because of the delayed gastric
After Pregnant woman receive a epidural anesthesia NSTx it will give her a Antiacid.
The hypersensitivity involves urticaria, bronchial hyperreactivity, pruritus.
And other S/S of a non-IgE mediated anaphylactoid-like phenomenon.
The hypersensitivity is possible due to shuttling of arachidonic acid via lipoxygenase pathway
The hypersensitivity results in cross-tolerance to most other NSAIDs execpt ACETAMINOPHEN
Block Platelet Cyclooxygenase preventing Platelets aggregation. This reaction is irreversible.
The other NSAID'S reactions are reversible. (48 hours).
in Adults patients with salicylate toxicity your can expect MIXED METABOLIC ACIDOSIS + RESPIRATORY ALKALOSIS.
PH = 7.36, PCO2 = 22, HCO3 = 12. Also can cause TINNITUS
In children cause PRIMARY METABOLIC ACIDOSIS W/ COMPENSATORY RESPIRATORY ALKALOSIS
Low FVC, low FEV-1, high TLC.
When bronchospam is determinated in a severe asthma attack we can use Hydrocortisone (I.V. steroidal agent).
Beclomethasone inhaler appropiate therapy to maintain remission between asthmatic attacks.
In pulmonary function test will have an airway obstruction. ↓ FEV1/FVC ratio. Total Lung Capacity ↑ and DLCO2 normal.
DLCO2 (diffuse level of CO2) normal which indicate that lung parenchyma is not affected
Esoinophils are involved in the mechanism
Beta agonist and mast cell stabilizers both play an important role in the management.
Can be prevented w/ the use of Inhaled Cromolyn pre-exercise, which will act to stabilize the mast cells.
with FEV1/FVC that is 80% or more of predicted. The NSMx is use ALBUTEROL.
Use beta-2-agonist, such as albuterol, as a brochodilator. Administering it in a nebulizer allow distal delivery of the medication
The best way to treat is using a combination of an inhaled corticosteroid (e.g. FLUNISOLIDE) and a long-acting, beta-2 agonist (e.g. SALME
We can use FOMOTEROL is Long-Acting, inhaled beta-2-agonist.
The present of PULSUS PARADOXUS ( low in B.P. in Deep inspiration) is a sign of a SEVERE asthmatic attack.
Hypertension, loud Wheezing, Prolonged Expiratory Phase, and Tachycardia may be seen in Pt. during asthmatic attack are n
if the Pt is not doing better we can repeat a second dose of beta-agonists but we need to be prepared to intubate.
Nonspecfic: Isoproterenol - Nonselective Beta agonist. Relaxes bronchial smooth muscle (B2). B-Agonists adverse effect is tachycardia (B1
B2 agonists: Albuterol - relaxes bronchial smooth muscle (B2). Use during exacerbation.
B2 agonists: Salmeterol - Long -acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Methylxanthines: Theophylline - Likely cause bronchodilation by inhibitin phosphodiesterase. Thereby ↓ cAMP hydrolysis
Methylxanthines: Theophylline - Usage is limited because of narrow therapeutic index (cardiotoxicity, neurotoxicity).
Muscarinic antagonists: Ipratropium - Competitive block of muscarinic receptors, preventing bronchoconstriction.
Muscarinic antagonists: Cromolyn - Prevents release of mediator form mast cells. Effective only for the prophylaxis of asthma
Muscarinic antagonists: Cromolyn - Not effective during an acute asthmatic attack. Toxicity is rare.
Corticosteroids: Beclomethasone, Prednisone - inhibit the syntehsis of virtually all cytokines. Inactive NF-kB. First line therapy for C
Corticosteroids: Inactive the NF-kB, the transciption factor that induces the production of TNF-alpha, among other inflamma
Antileukotrienes - Zileuton - A 5-lipoxygenase pathway inhibitor. Blocks conversion of arachidonic acid to leukotrienes.
Antileukotrienes - Zafirlukast, Montelukast - Block leukotriene receptors.
Exposure to antigen (dust, pollen,etc)
Antigen and IgE on Mast Cells
Mediators (leukotienes, histamine, etc.)
Late Response: Inflamation Early Response: Bronchoconstriction
Bronchial Hyperreactivity Symptoms.

ATP
AC Beta-agonists
Bronchodilation
+ cAMP
BRONCHIAL TONE
Theophylline
Ach Adenosine PDE
+ AMP
Antagonists Theophylline
Bronchoconstriction
Headache worse in the morning + Language difficulty + seizures. High-grade Astrocytomas tend to enhance diffusely in im
GFAP (Glial Fibrillary Acidic Protein) use to confirm the Dx. Ki-67 use to confirm about the proliferation activity
The Homologus in the General Tissue is the FIBROBLAST
Asymptomatic bacteriuria (20,000 to 100,000 organism/mL). 5% of pregnant women are affected by this.
Asymptomatic bacteriuria places pregnant woman at risk of developing over U.T.I and pyelonephritis.
Pyelonephritis, in particular, places pregnant woman at risk to sepsis, ARDS and preterm delivery.
Others medication can be use in asymptomatic bacteriuria like: amoxicillin, ampicillin, cephalosporins, nitrofurantoin, TMS(avoid in th
S/S Autosomal recessive Disease. Ataxia, telangectasia, mental retardation, Lack or ↓ Ig A and Ig E.
Leukemias, brain cancer and gastric cancer are asocciated to this disease.
B an T Cell deficiencies: Severe Combined Immunodeficiency, Wiskott-Aldrich Sx and Ataxia-telangectasia.
Defect in DNA repair enzymes w/assoc IgA defiency. Present w/cerebellar problems (ataxia) and spider angiomas (telangie
From Greek word "a taxis" meaning "without order or incordination". Cerebellar and Spinocerebellar degeneration cause
An inability to coordinate muscular movements that is symptomatic of some nervous disorders.e.g Frederick's Ataxia
Ataxia can also be acquired e.g. Stroke, Multiple Sclerosis, Tumor or Lesion of C.N.S or Spinal Cord, Alcoholism, Peripheral neuropathy, Vit
Can present soon after surgery with a low grade fever, decreasing O2 saturations. NSMx Bronchoscopy to remove the Muc
Produce HYPOXIA than can produce CONFUSION and DISORIENTATION. NSMx. Place the Pt on supplemental oxygen.
Overdose produce bradycardia and varying degrees of AV block. It is a beta 1 adrenergic receptor blocker.
Is a beta-1-antagonist and would therefore prevent actions of norepinephrine on the heart.
Inflammation and Destruction is seen in Long and Severe Rheumathoid Arthritis
P.E. ↑ tone in both lower limbs,bilateral pathologically brisk reflexes in the U.+ L. limbs, ankle clonus, Babinski sign (+
We can use QUINIDINE. Atrial Fibrilation may be the first sign of HYPERTHYROIDISM.
Digoxin and Calcium Channel Blocker should not be used
with Wolf Parkinson White NSTX IS PROCAINAMIDE OR DISOPYRAMIDE.
Resistent to pharmacological Tx. Ecocardiogram is negative the NSMx is Measurement T3,T4 and TSH.
in Mitral Stenosis is due to LEFT ATRIAL DILATATION
When Assoc. w/hemodynamic compromise (absent "P" waves and irregular heart rate). NSTx is CARDIOVERSION ( 100-200
Unsteable hemodynamics = Cardiovesion.
Causes by Valve Stenosis, Hypertension, Pumonary Embolism, CAD, Pericarditis, Post-Cardiac Surgery and COPD.
ANP increases sodium loss (natriuresis) and water loss by kidney. It is release by increase the pressure in Right Atriu
Increase in G.F.R. and tends to antagonize the effects of Angiotensin II and ADH (Antiduretic hormone)
Functions: 1) Opposite of Angiotensin II 2) Inhibition of ADH release, 3) Inhibits Angiotensin II efect on stimulation thrist.
4) Inhibits aldosterone secretion. 5) Inhibits renal reabsorption of Na+ (direct effect; loss of Na+ in urine
6) Inhibits renin release 7) Vasodilatation of the peripheral resistance vessels.
ASD is the M.C Congenital Heart Disease presentation of heart murmur in the adolescence. M.C. Congenital Heart Diseas
S/S Systolic ejection murmur at the upper left sternal border and mid-diastolic murmur at the lower left sternal border.
S2 is widely split. Pulmonary artery enlargement, SVC shadow may not be visible in X-ray. Pulmonary vascular marking are
If you have a case of Parodoxical Embolism think in Atrial Septal Defect
with Patent Ductus Arteriosus is good point to keep O2 saturation % in Cyanotic cases of Tetralogy of Fallot
Histologically most closely resemble CARDIAC MUSCLE fibers. Actually they are modify Cardiac Muscle Fibers
They contain abundant myofibrils and some, such as Purkinje fibers, contain large amount of GLYCOGEN
Constantly scratching and rubbing involved areas.
Dry Rash, erythematous, an scaly, and chiefly involves face + dorsal sufaces of hands and feet. Alternanting periods of remission and
It is a MUSCARINIC CHOLINORECEPTOR BLOCKER = MUSCARINIC ANTAGONIST. (BLOCKING CHOLINERGIC EFFEC
USE in CHOLINESTERASE INHIBITOR POISONING=ORGANOSPHOSPHATE TOXICITY=ANTICHOLINESTERASE INHIBITOR T
In large dose may abolish the parasympathetic imput that normally maintains a relatively slow heart rate.
Indeed, atropine is often used intraoperatively and in emergencies to INCREASE HEART RATE.
Inhibits secretions from salivary, lacrimal, bronchial and sweat glands.
It causes mydriasis (dilatation of the pupil) and cyclopegia
It has no effect on skeletal muscle in which neuromuscular transmission involves acethylcholin and nicotinic, not muscarinic
Can dilate the pupila narrowsen the glaucoma. It should be avoid. Sometimes, mydriatic agents like atropine can precipitate g
Pale Vaginal mucosa with no rugage present, dry with no discharge. KOH and normal saline wet preparation is negative. Due to Strog
Pt w/o Uterus (histerectomy) NSTx. Estrogens later we should balance with MDP. Pt w/Uterus NStx. Medroxyprogestrona (MDP)
Pt. not willing to take oral hormones. NSTx Premarin (Estrogen) cream twice daily may be used.
Olanzapine, Quetiapine, Ziprasidone, Risperidone. Overdose: akathisia (sense of restlessness and psychomotor agitation)
The sequence of the auditory pathway as follow:
Organ of Corti --> Spiral Ganglion in the cochlea --> Vestibulocochlear nerve (CN VIII) --> Cochlear Nuclei (dorsal and ventra
Superior Olivary Nuclei --> Lateral Lemniscus --> Inferior Colliculus --> Medial Geniculate Nucleus of the Thalamus (M
Primary Auditory Cortex (Heschl's gyrus).
The sequence is as follow:
1) Spiral Ganglion cells send fibers, via Vestiblocochlear Nerve (CN VIII), to the dorsal and ventral Cochlear Nuclei
2) Neurons of the Cochlear Nuclei send projections to the Superior Olivary Nuclei (some decussate via the Trapezoid body
3) These projections go to the Inferior Colliculus of the Midbrain (ICofM) via the Lateral Lemniscus (LL).
4) The Inferior Colliculus sends projections to the medial geniculate body of the thalamus, which, in turn, innervates the primary audito
Patognomonic of Acute Myelogenous Leukemia. Contain enzymes normaly found in Azurophilic granules and type M3 cells.
During chemotherapy Auer Rods can release this enzimes and produce rapid lysis trigger a DIC
will have more difficulty in the INTERPERSONAL RELATIONS and SOCIAL BEHAVIOR IMPAIRMENT.
Also call in the board PERVASIVE DEVELOPMENTAL DISORDER (P.D.D) = Impared social interaction, impairments of communication of a
The impariment communication including non-verbal communication such as gestures and a severly restricted repertoire of behaviors and in
Directed against Glycoprotein IIb/IIIa receptor = Thrombocytopenia
Directed against Acetylcholine receptor = Myasthemia Gravis
Directed against Erythrocyte Membrane Proteins Receptors = Autoimmune Hemolytic Anemia
Directed Intrinsic factor = Pernicious anemia
Directed in Type IV colagen = Goodpasteure Syndrome
Directed against IgG = Rheumatoid Arthritis. The autoantibody is rheumatoid factor.
The rheumatoid factor is usually an IgM or IgG (or less commonly IgA) directed against the constant region of autologous I
If forbidden clones are not deleted during T cell development the Pt will develop an autoimmune disease
Forbidden clones supply of cells that can recognize self-antigens and stimulate both humoral and cell-mediated immune response, leading t
May lead to a denervated bladder, resulting in overflow incontinence. Postvoidal residual will be High.
Atrophy of the spinal cord = FRIEDERICH'S ATAXIA (involve spinocerebellar tracts, corticospinal tracts and posterior columns
Atrophy od the Caudate = HUNTINGTON'S DISEASE (choreoathetosis, dementia and eventual death). Autosomal Dominant
Depigmentation of the substancia nigra = PARKINSON'S DISEASE (rigidity, bradykinesia and slow resting tremor)
Diffuse cortical atrophy = ALZHEIMER'S DISEASE (cause of dementia in the aged population).
Selective frontal and temporal lobe atrophy = PICK'S DISEASE (severe dementing disease)
Spongiform Degeneration = CREUTZFELDT-JACOB DISEASE.
Macrophages with metachromatic material = METACHROMATIC LEUKODYSTROPHY.
Whorls of meningeal cells = MENINGIOMA
Bizarre, enlarged astrocytes = ANAPLASTIC ASTROCYTOMA or GLIOBLASTOMA MULTIFORME
Down Syndrome (Trisomy 21) 1:700, Edward's Trisomy (Trisomy 18) 1:8000, and Patau's Syndrome (Trisomy 13) 1:6000
Down Sx: M.C.C. of congenital mental retardation. 95% due to meiotic nondisjunction of homologus chromosomes; assoc. w/ advanced maternal age.
Other causes of Down syndrome include: 4% due to Robertsonian translocation and 1% due to mosaicism (no maternal ass
Edward's Trisomy: Severe mental retardation, rocker bottom feet, low-set ears, micrognathia, cogenital heart disease. Death arou
Edward's Trisomy also have clenched hand (flexion of fingers), prominent occiput.
Patau's Trisomy: Severe Mental Retardation, microphtalmia, microcephaly, cleft lip/palate, abnormal forebrain structures.
Patau's also have: polydactyly, congential heart disease. Death occurs with in 1 year of birth.
An injury of this nerve can denervated the muscles arises form the clavicle and acromion.
it is use in maintenance or remission therapy + Corticosteroids in Pt with Wegener Granulomatosis (after the use of cyclophospha
Used for penicillin-allergic patients with primary syphilis
It is an Antibiotic. Mechanism: A monobactam resistant to Beta-lactamases, Inhibits cell wall synthesis (binds to PBP3).
Synergistic with aminoglycosides. No cross-allergenicity with penicillins
Clinical Uses: Gram negative rods - Klebsiella spp, Pseudomonas spp., Seratia spp. No Activity against Gram + or ana
For penicillin-allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides.
Toxicity: Usually nontoxic; occasional GI upset.
The first event that occurs in the differentiation sequence of human B cells is Immunoglobulin heavy chain rearragement in the b
The best marker for indentification of B cells are CD19, CD20, CD21. The CD21 marker is a receptor for EBV (Epstein-Barr V
We must suspect of this in any HIV Pt that is suspected to have Toxoplasmosis w/o responding to the Tx.
and Toxoplasmosis are well defined intracraneal mass (Ring-enhancing lesion in MRI).
Both T cells and B cells develop in the bone marrow.
B cells also mature in them marrow, whereas T cells migrate to the thymus for maturation.
Suppresses apoptosis by different mechanism. Indicate abnormal activation in low grade lymphomas pathogenesis
Tumor, Oncogenes = bcl-2 = Follicular and Undifferentiated Lymphoma (inhibits apoptosis)
Chromosome 14;18 Translocation we see in FOLLICULAR LYMPHOMA = M.C. Non-Hodgkin in adult (BCL-2 Activation
Weight kilograms/Height (meter)². Obesity we considerated over 30. Normal is 19 - 25 kg/m²
Good weight gain in pregnancy will be 25 -35 lbrs. Pt. usually gain about 5 -10 pounds in the first 20 weeks and 1 pound /week in the
Benign Prostate Hyperplasia NSTx Tamsulosin (alpha-1blocker). Side effects like Orthostatic Hypotension, Headache, Dizzines and Rhinitis do not occur
Benign Paroxysmal Positional Vertigo = Dizzines with head movement + no Tinnitus + No Hearing Loss
Prerenal azotemia and Renal failure can be separate with this ratio. In USMLE they give you the values of B.U.N and creatinin
B.U.N. = Blood Urea Nitrogen and Creatinine it is the end produt of the creatine metabolism.
B.U.N./Creatinine Ratio = 10 to 1. Prerenal Azotemia (increase 15 to 1) nothing wrong w/kidney. Cardiac Output ↓= GFR ↓
B.U.N./Creatinine Ratio = Proportional increase of both (10 to 1) = Renal Failure
Clues to suspect infection of B.M. 1) One week incubation period. 2) Eastern seabord clue, 3) Intra-erythrocyte parasites.
The clinical disease is call BABESIOSIS. This protozoan is related to Plasmodium, transmitted by the bite of Ixodes dammini
Most Pt are asymptomatic, symptomatic cases have fever, headache, chills, fatigue. Blood smear shows protozoa within R
Severe case can present with severe hemolysis (up to 30% of RBCs) with subsequent hemoglobinuria, hemolysis and renal fa
20% of Pt w/ Lyme Disease can be infected w/Babesiosis because it is the same deer tick can have B. Burdoferi and Babesi
In food like rice, it is heat stable produce S/S = nausea + vomitng 1 to 6 hours after ingestion. Reheated rice common sourc
Use in M.S., Spinal Cord injuries and Trigeminal Neuralgia. Side effects include drowsiness, fatigue and hypotension.
During a LAG TIME will not increase the number. During GENERATIVE TIME will increase the number.
Have 4 phases: Lag, Log ,Stationary and Death
Lag - metabolic acitivity wihtout division
Log - rapid cell division.
Stationary - nutrient depletion slows growth
Death - prolonged nutrient depletion and buildup of waste products lead to death.
Cause Meningismus (CSF profile with neuthrophil-predominant and Glucose ↓)
Elevated protein level, increased WBC count w/predominant neutrophils, low glucose level and positive gram stain.
is the M.C. Pneumonia in AIDS patient
NSDx is Bacterial cultures of skin scrapings.
S/S: Excessive Discharge and Odor. Produce By Gardenella Vaginalis (Gram-negative anaerobic rod).
Also can be cause by Peptostrep Species, Mycoplasma Hominis, ureaplasma urealyticum, and Mobiluncus species.
50% may be asymtomatic, 50-70% complain of a unpleasant, fishy or musty odor. A thin, grayish-white vaginal discharge
The pH vaginal is greater than 4.7 When one drop of KOH is added to the discharge, an intense amine odor produces a positive Wh
NSTx is Metronidazole. Increasing experience suggests that vaginal therapy with metronidazole gel or clindamycin cream is a
U.T.I. + Peritonitis + Intraabdominal Abscess
Known as "downers, barbs, pink ladies, red devils, rainbows, and yellow jackets", produce mild to moderate toxicity that mimics alcoho
S/S: Tremors, insomnia, sweating, and generalized anxiety. Also delirious, disoriented and eventually goes into shock.
Other S/S Respiratory depression, Hypotension, Coma, Hypothermia, Ataxia and Poor muscle coordiantion.
Conversely, symptoms of withdrawal (as seen in this patient) include anxiety leading to insomnia, tremors, delirium, convulsions, and
The serious, life-threatening nature of these symptoms are strongly suggestive of barbiturate withdrawal.
Is not longer the test of choice in Diverticulitis because the risk of leakage to the peritoneal cavity
In Pyloric Stenosis we see "String" Sign = Narrowing of Barium Stream passing through the duodenum
Also in Pyloric Stenosis we can see "umbrella Sign" = Hold-up of Barium in the Stomach.
If elicited or stimulate we will see a ↓ Sympathetic Outflow and ↑ Parasympathetic Outflow, resulting in ↓ Heart Rate and
Inactivated X Chromosome presence in Klinefelter's Syndrome. Absence in Turner's Syndrome. We can see in Buccal Muco
It is a pre cancer condition.Pts w/biopsy-proven Barret esophagitis should undergo regular surveillance biopsies.
The regular surveillance biopsies are to dectect progression to malignancy ( 2 to 5 years surveillance Tx)
Esophagel Manometry w/pH monitoring show ↓ pressure of the lower esophageal sphincter and the presenced of acid in th
Very Irregular Gastroesophageal Junction with long 'fingers" of redness mucosa extending above the lower esophageal sph
In Barrett's esophagus the columnar epithelium replaces the squamous epithelium.
M.C. pathogen after 1 week of a CAT BITE
Produce lymph node with numerous granulomas filled with neutrophils and necrotic debris.
Polydispsia, Polyuria, Growth Abnormalities, Hypokalemia, Metabolic Alkalosis, Normal BP and ↑ Urine Chloride Concentrati
Extensive Sunlight Exposure. M.C. skin cancer. Excision may be needed to avoid metastasis.
Excision of the B.C.C needs only 1 or 2 mm of margins. Melanomas needs at least 2 cm.
Affects sun-exposed areas, particularly the mid and upper face, in Pts. lacking of protective pigmentation.
Morphology caractheristic: indolent, pale, raised, waxy, grows very slowyly and doesn't metastasize to lymph nodes.
Important in voluntary movements and making postural adjustments. Initiation of movement and also "gross" control movement of sk
Different from Cerebellum that it is more for fine tuning of the movement
They are 2 paralelal process that operate simultaneously: Direct (facilitates pathway) and Indirect (inhibits pathway using the subtha
The basal glangia have a receptor that is localated in the Straidum (Putamen, Caudeus Nucleus).
Imput comes to Receptor (Straidum) from Cerebral Cortex. The next Structure is the Globus Pallidum (Internal and external)
Also influence in Motor function (outflow) goes to Motor Cortex throught the V.A. and V.L. nucleus of the Thalamus
Regarding Neurotransmitors: Dopamine stimulates Direct Pathway and inhibits Indirect Pathway.
Regarding Neurotransmitors: Acethylcoline stimulates Indirect Pathway and inhibits Direct Pathway.
Any abnormalities in Basal Ganglia we will see: Chorea, Athetosis and Hemiballismus.
Parkinson Disease that is a lesion of the Direct Pathway (motor cortex hypoactivity) (Tremor at rest).
Lesion of the Indirect Pathway (motor cortex hyperactivity) e.g. Huntington's disease, Athetosis and Hemiballismus.
in the P.E. we can see a sizable hematoma behind the ear and that clear fluid dripping from the ear canal.
In a very significant trauma to the head. The integrity of the cervical spine has to be ascertained. NSDx CT san of the head an
bFGF is a powerful ANGIOGENIC AGENT, both in vitro and in vivo, and is produced by many different types of cells.
bFGFis also a potent mitogen for cells of mesenchymal, neural, and epithelial origin.
Overexpression of bFGF can result in tumor production.
Skin lesion in AIDS pt, look like Kaposi but it is produce by Bordetella Hensenlae, we can see it w/ Silver Stain. Tx w/ Sulfa
Seen in Cardiac Tamponade: Hypertension, Distant Heart Sounds, and JVD.
Mental Retardation, Western Blot analysis of muscle Bx show DYSTROPHIN ↓ or abnormal size. The rest is similar to Duche
The explanation that Becker is not as severe of Duchenne is because:
In-frame-deletions or insertions in the Becker from; frameshit deletions or insertions in the Duchenne form
Insert or deletions are produce an altered protein product (dystrophin).
Frame shifts usually produce an truncated protein because a stop codon is eventually encountered.
The truncated protein is degrated, resulting in an absence of dystrophin and a more severe disease phenotype.
Assoc. w/ hypoglycemia, carosomia, omphalocele, and macroglossia.
Most appropiate therapy to maintain remission between asthmatic attacks.
Lower Abdominal muscles are weaker than upper abdominal muscles, causing a strikingly positive Beevor's sign, physical sign fairly specifi
BEHAVIORAL PEARLS (RAPID FIRE STYLE)
Ways to reduce Bias: 1) Blind Studies (Single Vs. Double). 2) Placebo responses. 3) Crossover Studies (each subject acts as
4) Randomization
Different types: Late-look, Sampling, Selection and Recall.
LATE-LOOK BIAS: Information gathered at an inappropriate time
SAMPLING BIAS: Subjects are not representative; therefore the results are not generalizable.
SELECTION BIAS: Subjects choose group.
RECALL BIAS: Knowledge of presence of disorder alters recall by subjects
Woman w/anxiety about a OBGYN exam is told to relax and to imagine going through the steps of the exam = SYTEMIC DES
65 y.old man w/incurable metastatic pancreatic adenocarcinoma. Family ask you no to tell the Pt. what will be the NSMx
Answer: NSMx Assess wheter telling Pt will negativelly affect his health, if not, tell him
Pt w/chest pain medicated for Ventricular Tachycardia. Next day he does 50 pushups to show the nurses he has not had a heart attac
A large group of people is followed over 10 yrs. Every 2 yrs, it's determined who develops heart disease and who does not = COHOR
Girl can speak in complete sentences, has an immaginary friend, and considers boy "yucky" how old is she? = 6 -11 yrs. old
Man has flashbacks about his gf's death 2 months following a hit-and-run accident. He often cries and wishes for the deaht of the culprit = Normal bereavem
During a particular stage of sleep, man has a variable blood pressure, penile tumescence and variable EEG = REM SLEEP S
15 yrs old girl of normal height and weight for age has enlarged paroid glands but no other complaints, uses laxatives = BULIM
11 yrs old girl exhibits Tanner stage 4 sexual development (almost full breast and pubic hair) What is the Dx? Advanced Stage, Early
4 yrs old girl complains of a burning feeling in her genitalia, no other S/S. Smear of discharge shows N.gonorrhoeae. How was she infected?
Person demands only the best and most famous doctor in town. What is the personality disorder? NARCISSISM.
Nurse has episodes of hypoglycemia; blood analysis reveals no elevation in C-protein. What is the Dx? Factitious disorder, self-scr
55 y.old businessman w/lack of successful sexual contacts w/women and lack of ability to reach full erection. 2 y ago he had a
what might be the cause of his problem? = Fear of sudden death during intercourse.
Experimental Study. Compares therapeutic benefit of 2 or more treatments, or treatment and placebo.
Altruism, Denial, Displacement, Dissociation, Identification, Reaction formation, Denial, Sublimation, Supression, etc.
Denial: is when a person behaves as if he does not know something he might reasonably be expected to know.
Displacement: Is an unconscious defense mechanism in which one's feelings or desires are unconsciously transferred
Displacement: This unconsciously tranferred is from their original object to a more acceptable substitute
Dissociation: Can manifest itself in many forms, but all are linked by the notion of recognizing the experience, while separatin it from
Dissociation: The "out of body" experience, sleep walking or psychogenic fugue (amnesia w/ travel) are all example of disso
Identification: which is the unconscious adoption of the characteristics or activities of another person.
Identification: It often is a mechanism for reducing the pain of separation or loss.
Identification: Another example would be a widow who takes over her husband's voluntary work after he dies.
Rationalization: Is the offering of a false but acceptable explanation for behavior.
Reaction formation: Is the adoption of behavior opposite to that of one's true feelings.
Regression: Is a return to an earlier (often infantile) stage of development
Regression: That occurs in many mental illnesses and in normal individuals experiencing tragic or extremely stressful events
Splitting: Is a primitive defense mechanism in which objects or people are thought of as either "all bad" or "all good"
Sublimation: Is the diversion of unacceptable impulses into acceptables outlets.
They are 4 clusters: Narcissistic Defense, Immature Defense, Anxiety (Neurosis) Defenses, and Mature Defenses
PROJECTION: See in the inside in the outside. Important Assoc. PARANOID BEHAVIOR.
DENIAL: Saying It is not so. Important Assoc: SUSBSTANCE ABUSE, REACTION TO DEATH
SPLITTING: The world compose of polar opposite. Good vs. Evil. Important Assoc: BORDERLINE PERSONALITY DISORDER
BLOCKING: Transcient inability to remember. Important Assoc: MOMENTARY LAPSE
REGRESSION: Returning to a early stage of development. Important Assoc: ENURESIS, PRIMITIVE BEHAVIORS
SOMATIZATION: Physical symptoms for psychological reasons. Important Assoc: SOMATOFORN DISORDERS
INTROJECTION: The Outside becomes inside. Important Assoc: SUPEREGO, BEING LIKE PARENTS.
DISPLACEMENT: Source stay the same, Target changes. Important Assoc: REDIRECT EMOTION, PHOBIAS, SCAPEGOAT.
REPRESSION: Forgetting so it is nonretrievalbe. Most basic defense mechanisms. Important Assoc: FORGET AND FORGET
ISOLATION OF AFFECT: Fact without feeling. Important Assoc: BLAND AFFECT OF SCHIZOPHRENIC, LA BELLE INDIFFERE
INTELLECTUALIZATION: Affect replaced by academic content. Important Assoc: OBSSESSIVE-COMPULSIVE ANXIETY DIS
ACTING OUT: Affect covered up by excessive action or senation. Important Assoc:BORDERLINE AND ANTISOCIAL PERSON
DISORDER, SUBSTANCE ABUSE, FIGHTING, GAMBLING
RATIONALIZATION: Why the unacceptable is OK in this instance. Important Assoc: OBSESSIVE-COMPULSIVE BEHAVIOR
JUSTIFICATION, STRING OF REASONS.
REACTION FORMATION: Unacceptable transformed into its oppostie. Important Assoc: LOVE BECOMES HATE.
IN MANY ANXIETY DIISORDERS
UNDOING:Action to symbolically reverse the unacceptable. Important Assoc: FIXING OR REPARING, OBSESSIVE-COMPUL
BEHAVIOR.
PASSIVE-AGGRESSIVE: Passive nonperformance after promise. Important Assoc: BORDERLINE PERSONALITY DISORDE
UNCONSCIOUS, INDIRECT HOSTILITY
DISSOCIATION: Separating self rom one's own experience. Important Assoc: FUGUE, DEPERSONALIZATION, AMNESIA,
MULTIPLE PERSONALITY DISORDER
We have the following types: two main ones (classical and operant) and one supplemental (modeling)
a) CLASSICAL CONDITIONING, b) OPERANT OR INSTRUMENTAL CONDITIONING, c) MODELING, OBSERVATIONAL or SOCIAL LEA
In Classical Conditioning we have:
** Unconditoned Stimulus (UCS) to Unconditioned Response (UCR)
** Conditioned Stimulus (CS) to Conditioned Response (CR)
** Stimulus Generalization: An organism's tendency to respon to a similar stimuli with the similar response.
** Extinction: Removal of the pairing between the UCS and the CS results in a ↓ probability that the CR will be made
In Operant or Instrumental Conditioning we have:
** A new response is emitted, perhaps randomly at first, which results in a consequence (new behavior)
** A new response occurs to an old stimulus. Note the triggering stimulus (REINFORCEMENT) occurs after the response
** Reinforcer is defined by its effects. Any Stimulus is a reinforcer if it increases the probability of a response.
** Types of reinforcers: Positive, Negative, Punishment and Extinction.
STIMULUS: (S)
ADD REMOVE
STOPS PUNISHMENT EXTINCTION

BEHAVIOR: (R)
INCREASES POSITIVE REINFORCEMENT NEGATIVE REINFORCEMENT
STIMULUS: (S)
ADD REMOVE

BEHAVIOR: (R)
** Reinforcement Schedules: We have 2 schedules: Continuous Reinforcement and Intermittent (or Partial) Reinforcem
** Continous reinforcement: Every response is followed by a reinforcement.
** Continous reinforcement: Results in fast learning (acquisition)
** Continous reinforcement: Results in fast extinction when reinforcement is STOPPED.
** Intermittent (or partial) Reinforcement: Not every response is REINFORCED.
** Intermittent (or partial) Reinforcement: Learning is Slower. Reponse is HARDER to extinguish.
** Intermittent (or partial) Reinforcement: We have: INTERVAL SCHEDULES and RATIO SCHEDULES.
** Intermittent (or partial) Reinforcement = Interval Schedules, they based on the passage on time before reinforcement i
1) FIXED INTERVAL SCHEDULE: Example: Working extra hard before bonus at the holidays
2) VARIABLE INTERVAL SCHEDULE: Example: Pop quizzes or Surprise bonuses at work.
** Intermittent (or patial) Reinforcement = Ratio Schedules,they based on the # of behaviors elicited before reinforcemen
1) FIXED RATIO SCHEDULE: Example: Paying workers on a piecework basis.
2) VARIABLE RATIO SCHEDULE: Example: Slot Machines.
CONTINGENCY
TIME BEHAVIORS
CONSTANT FIXED INTERVAL (FI) FIXED RATIO (FR)

SCHEDULE:
CHANGING VARIABLE INTERVAL (VI) VARIABLE RATIO (VR)
In Modeling, Observational, or Social Learning, we have:

1. Watching someone else get Reinforcement is enough to change behavior
2. Follows the same principles as in OPERANT CONDITIONING
3. Correlating the effects of watching violence on television with committing violence "in the real world" stems from this concep
4. Part of why group therapy works.
5. Other applications: Assertivenesss training, social skills training, preparing children for various frightening or painful medical or sugical procedures.
Pooling data from several stuies (often via a literature search) to achieve greater statistical power
We have 2 types: Case-Control Study and Cohort Study
Probability of REJECTING Null Hypothesis when it is in fact false. It depends on:
1. Total number of end points experienced by population.
2. Difference in compliance between treatment groups (differences in the mean values between groups).
Number of TRUE POSITIVES divided by number of people who tested POSITIVE for the disease.
The probability of having a CONDITION, given a POSITIVE TEST.
NPV = Number of TRUE NEGATIVES divided by number of people who tested NEGATIVE for the DISEASE
The probability of no having the condition, given a NEGATIVE TEST.
Unlike SENSITIVITY and SPECIFICITY, PREDICTIVE VALUES are dependent on the PREVALENCE OF THE DISEASE
The HIGHER the PREVALENCE of a Disease, the HIGHER the POSITIVE PREDICTIVE VALUE of the test.
Prevalence is the total number of cases in a population at a given time
Incidence is the number of new cases in a population per unit time
Prevalence = Incidence x Disease Duration
Prevalence > Incidence for Chronic Disease (e.g., Diabetes).
Prevalence = Incidence for Acute Disease (e.g., Common Cold).
Prevalence = True positive + False Negative / Total # of Cases.
Reliability - Reproducibility (dependability) of a test.
Test is reliable if repeat measurements are the same.
Validity - Whether the test TRULY MEASURES WHAT IT PURPORTS TO MEASURE. Appropriatenes of a test
Test is valid if measures what it is supposed to measure.
Number of TRUE POSITIVES divided by number of all people with the disease. PID = Positive In Disease.(SICK PEOPLE)
PID is a Sensitive Topic. FALSE NEGATIVE RATIO is equal to 1 - sensitivity.
High Sensitivity is desirable for a SCREENING TEST.
USMLE asks for DIAGNOSTIC TEST = SCREENING TEST. The answer is SENSITIVITY
Number of TRUE NEGATIVE divided by number of all people without the disease (HEALTHY PEOPLE)
FALSE NEGATIVE RATIO is equal to 1 - specificity
High Specificity is desirable for a COMFIRMATORY TEST.
n = Sample size
δ = Standard deviation
SEM = Standard error of the mean
SEM = δ/ n.
Therefore, SEM < δ and SEM decreases as n increases
Confidence interval = mean 1.96 (SEM)
If the confidence interval includes 0, the null hypothesis is accepted
Mean
68 %
95 %
99.7 %
Terms that describe statistical distributions, are follow:

Normal ≈ Gaussian ≈ bell-shaped (mean = median = mode).(1)
Bimodal is simply 2 humps (2)
Positive Skew is asymmetry with tail on the right (mean > median > mode) (3)
Negative Skew that tail on the left (mean < median < mode) (4)
Null (Ho) = Hypothesis of no difference (e.g. there is no assoc. between the disease and the risk factor in the populati
Alternative (H1) = Hypothesis that there is some difference (e.g. there is some assoc between the disease an the risk factor in the population)
Power (1-β) Alpha
Observational Study. Sample chosen based on presence (cases) or absence (controls) of disease.
Information collected about risk factors. OFTEN RETROSPECTIVE. We use Odds Ratios (OR) for Case-Control Studies
Observational Study. Sample chosen based on presence or absence of risk factors. We use Relative Risk (RR) for Cohort
Subjects followed over time for development of disease. e.g. FRAMINGHAN Heart Study was a large prospective cohort study
Stating that there IS and effect or difference when non exists (to mistakenly accept the experimental hypothesis and reject the null hy
Alpha is a preset level of significance, usually p < .05. (p = probability of making a type I error)
If p < .05; then there is less than a 5% chance that the data will show something that is no really there
Alpha = you "saw" a difference that did not exist - for example, convicting a innocent man.
Stating that there IS NOT an effect or difference when one exists (to fail to reject the null hypothesis when in fact Ho is false
Beta = is the probability of making a type II error
Beta = you did "see" a difference that does exist - for example, setting a guilty man free
Validity - Whether the test TRULY MEASURES WHAT IT PURPORTS TO MEASURE. Appropriatenes of a test
Test is valid if measures what it is supposed to measure.
Reliability - Reproducibility (dependability) of a test.
Test is reliable if repeat measurements are the same.
BEHAVIORAL PEARLS (RAPID FIRE STYLE) - END

Oral Ulcers + Genitalia Ulcer (aphtous Ulcer) + Tzanck Smear (-) + ESR ↑ + Apha-2 and Gamma globulins ↑ + mild Leukocyto
painful oral ulcer + genital ulcer + ocular disease (iridiocyclitis + photophobia) + skin lesions (foliliculitis) + mild arthritis of large joints.
Facial Paralysis, is idiopathic. Abrupt onset, weakness in the first 48 hours.
it is a post infectious allergic or immune deymelinating facial neuritis. Assoc with E.B.V, H.S.V, Lyme Disease and Mumps.
It is sudden onset, if slowly developing paralysis on one side is suggestive of a tumor.
Para Protein seen in 50% of Multiple Myeloma Pt. that develop renal insuficiency.
Bx = Normal lymph node w/multiple germinal centers.
Many macrophages containing debris from ingested lymphocytes are present (tingible body macrophages).
Endemic Syphilis, M.C in Central Africa. Occurs in children infected by Treponema Pallidum. S/S Secondary syphilis symptom
Anticholinergic drug. Used initially and effective in alleviating tremor and rigidity in PARKINSON DISEASE.
U.R.I. + Proteinuria + Hematuria (Gross Hematuria) + IgA ↑. Renal Bx will show Ig A in the mesangium. M.C. type of Nephri
Present in Infancy is characterized by very large platelets.
Is an Autosomal Recessive Disease of Platelet Adhesion that cause prolonged bleeding times in the presence of nomal platel
These Pts' platelets cannot bind to subendothelial collagen properly because of a deficiency or dysfunction of the glycoprotein Ib-IX c
S/S Pts have impaired hemostasis and recurrent severe mucosal hemorrhage.
The only Tx for an acute episode is a transfusion of normal platelets. This Pt has a slightly ↓ hemoglobin because of bloo
Occurs at the bifurcations in the CIRCLE OF WILLIS. M.C. site is bifurcation of the ANTERIOR COMMUNICATING ARTERY.
Rupture (M.C.Complication) leads to hemorrhagic stroke/subarachnoid hemorrhage. (SUBARACHNOID HEMORRHAGE
Assoc w/: Adult Polycystic Kidney Disease, Ehlers-Danlos Syndrome, and Marfan's Syndrome.
High assoc w/ mitral valve prolapse and diverticulosis.
Beta-Adrenergic receptors bind catecholamines (e.g. Epinephrine and Isoproterenol)
Cathecholamines activate Adenylate Cyclase and elevate levels of cAMP within a cell.
There are 2 types of Beta-adrenergic receptors: Typically Beta 1 and Beta 2 receptors.
Beta-1-receptors bind catecholamines, and the order of affinities is Isoproterenol>NE>epinephrine.
Beta-2-receptors bind cathecolamines, and the order of affinities is Isoproterenol>Epinephrine>NE.
Beta-1-receptors are located on cardiac muscle cells, whereas B2-receptors are found on smooth muscle cells in bronchi
Upon agonist binding, B1-receptors induce increased heart rate and contractility.
This effect can be blocked by antagonists (e.g. Practolol, a known Beta-blocker) to slow heart contraction in Pts w/ cardiac arrhythmia
Beta-2-Agonists (e.g. Terbutaline) open air passages in Pts w/asthma by relaxing bronchial smooth muscle.
Stimulate Adenylate Cyclase via the G protein Gs.
This is leading to an incrase in intracellular cAMP. All beta adrenergic receptors share a common mechanism of action.
Receptor B1 = SA node = Increase Heart Rate (Remember Ach ↓and NE ↑ activity of the heart)
Receptor B1 = AV node = Increase Conduction Velocity.
Receptor B1 = Heart Muscle = Increase force of contraction, CO and O2 consumption.
Receptor B1 = His-Purkinje = Increase automaticity and conduction velocity.
Receptor B1 = Kidney = Increase Release Renin
Receptor B2 = Blood Vessels = Vasodilation - decrease PVR, diastolic pressure and afterload.
Receptor B2 = Uterus = Relaxation
Receptor B2 = Bronchioles = Dilation.
Receptor B2 = Skeletal Muscle = Increase glycogenolysis-contractility (tremor)
Receptor B2 = Liver = Increase glycogenolysis
Receptor B2 = Pancreas = Increase Insulin secretion.
And Mast Cell Stabilizers both play an important role in the management of Exercise-Induced Asthma.
Can be add after 6 month of M.I. Decrease Infarct size and mortality. Monotherapy Recommended.
Use in the Tx of uncomplicated hypertension without detectable end-organ damage in diabetic Patients.
like Atenolol is contraindicated in diabetics because of masking the signs of HYPOGLYCEMIA.
Give to Non-Cardiac Surgical Pts. who are at risk of Cardiac Events are Assoc. w/more good outcome in terms of Post op Cardiovascular morbidity and morta
Are particularly good agents in Pts w C.A.D, for whom they have proven mortality benefits. They should be avoided in Pts w/ reactive airways disease if possi
Pt w/hypertension and C.A.D first line of Tx (lowering B.P., Heart rate and strain on the heart and ↑ myocardial perfusion).
like Propanolol is considered to be relatively contraindicated in Pt. w/peripheral claudication.
May predispone to arterial vasoconstriction peripherally.
Deficiency = Krabbe's Diseases = Produce build up of GALACTOCEREBROSIDE/SULFATIDE RATIO. Relate with optic atro
Deficiency = Gaucher's Diseases = Inability to degrade Sphingolipids, Mental Retardation and Ataxia.
Is direct-acting cholinergic stimulant effective in reducing the peripheral anticholinergic effect of some psychotropic medica
Can be use I.M., orally, or subcutaneously to efficiently relieve the symptoms of urinary retention but NO URINARY INCONTIN
Is a MUSCARINIC AGONIST and would cause constriction of the detrusor muscle and relaxation of the trigone and sphincter.
Ascertainment = We have no information how the cause were ascertaned in this study
Observer = Misclassification of the outcome due to the flows in the decision of study
Recall = Potential problem for case-control studies leading to misclassification of the EXPOSURE STATUS
Selective = Loss to follow up
Rupture of the tendon of the long head of the biceps.This tendon arise from the suplagenoid tubercle above the glenoid fossa of the s
This tendon passes into the bicipital groove between the greater and lesser tuberosities of the humerous.
At this site this tendon, it is vulnerable of abrasion, which may cuase bicipital tenosynovitis and may eventually rupture.
Common congenital anomaly.It's aymptomatic or may cause modest noncyanotic obstruction related to stenosis. Assoc w/ dias
Patognomonic of neurofibromatosis type 2 (central type) associated with this kind of intracraneal tumors.
Cause Cortisol decreased and ACTH ↑. Because it is not response of the Adrenal Gland to produce Cortisol.
Form the medial border of the Lesser Omentum. The superior border of the lesser Omentum is form by the Fissure of th
The Inferior lateral border of the Lesser Omentum is the lesser curvature of the stomach
Destruction of intrahepatic tubes. Autoimune disease also Antibodies againts mitochondria are present in 95 % of cases
Afferent loop syndrome and Dumping Sx. are complications that develop shortly after the surgery. Late complications usually a
One of the later complication after years of the surgery will be Bacterial Overgrowth.
Transferrin is the Bi.Pr of Iron. Albumin is the Bi.Pr. Of Calcium. Transcortin is the Bi.Pr. Of Crotisol.
Cerulopasmin is the Bi.Pr of Cooper. Tyroglobulinbinding Protein is the Bi.Pr of TSH.
It is the best Mx to distinguish between basal cell carcinoma, squamous cell carcinoma or even melanoma.
Basal cell carcinoma needs only 1 or 2 mm of margins. Melanoma should have at least 2 cm.
Use in Severe and symptomatic cases of Hypercalcemia.
In a Maniac episode we can use Valproate, Carbamazepine, Lithium
M.C likely symptoms are Euphoria and Racing Thoughts.
We have: Malformations, Dysplasias, Deformation and Syndrome.
Malformation are due to intrinsic processes, and they include abnormalities e.g. CLEFT LIP
Dysplasias often have genetic causes, but they involve abnormalities of cells or tissues rahter than organs e.g PHACOMATO
Deformations and Disruptions are caused by EXTRINSIC FACTORS e.g. COMPRESSION and TERATOGENS, respectival
Examples include CLUBFOOT (Deformation = Compression) and AMINIOTIC BANDS (Disruption = Teratogens).
Syndrome is a pattern of abnormalities with one cause, whereas an assoc does not have a single cause.
NSTx. For Acute Abd(cramps): Calcium Gluconate, For Hypertensive Episode: Nitroprussiate, For Muscle Spam: Diazepane or Da
It is a Neurotoxin. NSTx to reduce the Extend of Local Necrosis: in G6PD Deficiency we use DAPSONE.
Is a respiratory pathogen that is seen as thick-walled yeasts within granulomas.
Present in the EAST of Mississippi River and Central America. Characteristic of Big, Broad-Based, Budding.
It is control by Platelets. Nothing to do with coagulation factors.
M. of Action: Induces formation of free radicals, which cause breaks in DNA strands. Similar to the M. of Action of DACTIN
Clinical Uses: Testicular Cancer, Lymphomas. Side effects DYSPNEA, NEUMONITIS, PLEURA FIBROSIS
Toxicity: Pulmonary fibrosis, skin changes, Minimal Myelosuppression.
Receptor cause MYDRIASIS (BLURRED VISION). It is assoc. with TCAs. Also can cause DRY MOUTH. (XEROSTOMIA)
Receptor cause ORTHOSTATIC HYPOTENSION. It is assoc. with TCAs.
Blockade of the Cholinergic Receptor we have Prienzepine. Use Tx of P.U.D.
Blockade of the Prostaglandin Receptor - Misoprostol (stimulated Prostaglandin E2 receptors). Use Tx of P.U.D.
Blockade of the parietal Cell Proton Pump - Omeprazole. Use Tx of P.U.D.
Immature Defense Mechanisms. E.g.: Although student prepared well for an exam, he was unable to recall the answers until the ex
IMMATURE
DEFENSE
Former w/: 1) Choroid Plexus Epithelium, 2) Intracerebral Capillary Endothelium, 3) Arachnoid.

Glucose and Amino Acid cross by carrier-mediated transport mechanism. Astrocytes are the most abundant cells.
Nonpolar/lipid-soluble substances cross more readily than do polar/water-soluble ones.
L-dopa, rather than dopamine, is used to treat Parkinsonism because dopamine does not cross the blood-brain barrier
Erythrocyte: Source of Energy GLUCOSE (90% Anaerobically degraded to LACTATE, 10% by HMP shunt)
Erythrocyte: Survival time 120 days. Membrane has Chloride-bicarbonate antiport important in the "physiologic chloride sh
Erythrocyte: Anucleate, biconcave → large surface area: volume ratio → easy gas exchange (O2 and CO2).
Leukocyte: Types: granulocytes (basophils, eosinophils, neutrophils) and mononuclear cells (lymphocytes, monocytes).
Leukocye: Responsible for defense against infections. Normally 4,000 - 10,000 per microliter.
Basophil: Mediates allergic reaction. < 1% of all leukocytes. Bilobate nucleus. Steaining readily with BASIC STAINS. Found i
Basophil: Densely basophilic granules containing: HEPARIN (Anticoagulant), HISTAMINE (Vasodilator) and other Vasoactive amines, and
Mast Cell: Mediates allergic reaction. Degranulation - Histamine, Heparin, and Eosinophil chemotactic release factors.
Mast Cell: Can bing IgE to membrane. Mast Cells resemble basophils structurally and functionally but are not the same cell type. Fou
Mast Cell: Involved in Type I hypersensitivity reaction. Cromolyn Sodium prevents mast cell degranulation
Eosinophil: 1-6% Bilobate nucleus. Packed large eosinophils granules of uniform size. Highly phagocytic for Antigen-Antibody C
Eosinophil: Defends against helminthic and protozoan infections (Major Basic Protein).
Eosinophil: Produces HISTAMINE and ARYLSUFATASE.
Eosinophil: Cause of Eosinophilia = Neoplastic, Asthma, Allergic Processes, Collagen vascular disease, Parasites
Neutrophil: Acute Inflammatory response cell. 40 - 75 % WBCs. Phagocytic. Multilobed nucleus. Large, spherical, azurophilic 1° granules (
Neutrophil: The Lysosomes contain Hydrolytic Enzymes, Lysozyme, Myeloperoxidase, and Lactoferrin
Neutrophil: Hypersegmented polys are seen in Vit. B12 / Folate Deficiency
Monocyte: 2 - 10% of Leukocytes. Large. Kidney-shaped nucleus. Extensive "frosted glass" cytoplasm.
Monocyte: Differentiates into MACROPHAGES in tissues.
Macrophage: Phagocytes bacteria, cell debris, and senescrent red cells and scavenges damged cells and tissues
Macrophage: Long life in tissues. Macrophages differentiate from circulating blood MONOCYTES. Acitvated by gamma-inte
Macrophage: Can function as antigen presenting cell (APC) via MHC II.
Lymphocyte: Small, round, densely staining nucleus. Small amount of pale cytoplasm. B Lymphocytes produce antibodies
Lymphocyte: T Lymphocytes manifest the cellular immune response as well as regulate B Lymphocytes and Macroph
B Lymphocyte: Part of humoral immune response. Arises from stem cell in bone marrow. Matures in Marrow.
B Lymphocyte: Migrates to peripheral lymphoid tissue (follicles of lymph nodes, white pulp of spleen, unencapsulated lymphoi
B Lymphocyte: In the present of antigen differentiate into PLASMA CELL and produce antibodies. Has Memory
B Lymphocyte: Can function as antigen-presenting cell (APC) via MHC II.
Plasma Cell: Off-center nucleus, clock-face chromatin distribution, abundant RER and well-developed Golgi apparatus.
Plasma Cell: B cells differentiate into plasma cells, which can produce large amounts of antibody specific to a particular antige
T Lymphocyte: mediates cellular immune response. Originates from Stem Cells in the bone marrow, but matures in the thymu
T Lymphocyte: Cytotoxic T cells (MHC I,CD 3 and 8), Helper T cells (MHC II,CD 3 and 4), Suppressor T cells, and Delayed Hypersensit
Dendritic Cells: Professional APCs. Express MHC II and Fc receptor (FcR) on surface.
Dendritic Cells: Main inducers of 1° antibody response. Called Langerhan's cells on skin.
Microglia: CNS Phagocytes. Mesodermal Origin. Not readily discernible in NISSL STAIN.
Microglia: Have small irregular nuclei and relatively little cytoplasm.
Microgila: In response to tissue damage, transform into large ameboid phagocytic cells
Microgila: HIV-infected microglia fuse to form multinucleated giant cells in the CNS.
Oligodendroglia: Function to myelinate multiple CNS axons. In NISSL STAIN, they appear as small nuclei with dark chormatin and l
Oligodendroglia: Predominant type of glial cell in white matter. These cells are destroyed in MULTIPLE SCLEROSIS
Schwann Cells: Each Schwann cell functions to myelinate only 1 PNS axon. Schwann cells promote axonal regeneration.
Schwann Cells: Acoustic neuroma is an example of a Schwannoma.
Schwann Cells: Location commonly assoc w/internal acoustic meatus (CN 7 and 8).
Produce by: Campylobacter jejuni, Enteroinvasive Escherichia Coli, Salmonella Species, Shigella species.
> 180 / > 110 ==> Evaluate or refer witnin 1 week.
160 - 179/ 100 - 109 ==> Evaluate or refer within 1 month.
140 - 159/ 90 - 99 ==> Recheck within 2 months
130 - 139/ 85 - 90 ==> Recheck in 1 year.
< 130 / < 85 ==> Recheck in 2 years.
Autosomal Recessive Disorder. Assoc w/small body size, immunodeficiency, light-sensitive facial erythema,and a major predisposi
Congenital Vascular disorder that may be inherited in an autosomal-dominant manner or appear sporadically. Variant of Cavernous h
They are present as a soft, compressible, bluish-purple (violaceous), ruberry nodules located in the dermis and subcutaneous
The lesions are frequently tender or frankly painful. There is a frequent assoc. with G.I. angiomas that bleed readily, causing a
The cutaneous lesions are blue, 0.1 to 5 centimeter compressible nodules that may be present anywhere, most commonly on the trunk or ar
is an Antimuscarinic Effect. BLOCKAGE of MUSCARINIC acetylcholine RECEPTORS cause MYDRIASIS (pupilary dilatation) resulting in
is the belief that a body part is abnormal, misshapen, or defective. See in Anorexia Nervosa
You calculated weight in Kg/height in squared meter. Normal value 19-25 kg/m². Obesity is considered more than 30 kg/m².
In Pregnancy normal weight gain of 25-35 lbrs. (5-10 pounds in the first 20 weeks of pregnancy and one pound per week for the fina
Is the most definite way to Dx Iron Deficiency Anemia
Complication are: Infection, failure of graft survival, recurrent leukemia and graft-versus-host disease.(G.v.H.d.)
To ↓ G.v.H.d. need to remove T cells from the donor marrow using monoclonal antibodies, rosetting techniques or mechanica
Short Term psycothic episodes, self mutilation, SPLITTING, persons into the "good-bad" extremes on continum, unstable interperson
Is a pervasive pattern of instability of interpersonal relationships, affects, or self-image beginning early adulthood.
Efforts to avoid abandonment, pattern of unstable relationships alternating between idealization and devaluation.
Also we have unstable self-image, impulsivity, recurrent suicidal behavior, chronic feeling of emptiness, inappropirate intense a
we can see transient paranoid ideation, and effective instability are typical symptoms of this disorders, too.
Two Defense Mechanisms most often present in this condition are: Passive-aggressive and Splitting
Involved in Cat-scratch disease.In AIDS pt cause Basilar Angiomatosis looks like Kaposi. We can see with Silver Stain. Tx w
In children with paroxyms of cough, which can last up to 2 weeks. Severe cough can cause rectal prolapse + pneumothorace
Subconjunctival hemorrhage and extensive subcutaneous emphysema over the anterior chest. (BOUTS OF COUGHING)
Rarely causes 2nd Attacks. When it does, the course of disease tends to be mild = HIGH DEGREE OF IMMUNITY TO REINF
Bordetella Toxin activates Adenylate cyclase by turning off the Gi Protein via ADP-ribosylation.
This organism cause whooping cough and Lymphocytosis.
Seen in Rheumatic Carditis. These bodies have a central region of degenerated collagen surrounded by histiocytes.
Many of these histiocytes are multinucleated or have central stripes of chromatin within their nucleus (hence, the term caterp
Rheumatic endocarditis is typically associated w/pancarditis, chorea, erythema marginatum, and migratory polyarthritis
Are rod-shaped, cytoplasmic organelles seen by electron microscopy in endothelial cells.
Are eosinophilic intracytoplasmic inclusions seen in liver cells.
Are eosinophilic round to elongated inclusions found in cholinergic cells of the basal nucelus of Meynert.
Spirochete Zoonotic Bacteria that cause LYME DISEASE.
M.C. used comestically to reduce glabellar frown lines by inducing specific facial muscle weakness w/o affecting facial sensory
This mechanism is best explain as PREVENTITION the fusion of motor neuron secretory vesicles with the nerve membr
Clostridium Botulinum in contaminated food. Blurred vision + diplopia + difficulty to swallowing.
Also we see Gastrointestinal + paralysis of limb, cranial and respiratory muscles
Sudden developed of diplopia, dyspagia, and nasal speech, followed by paralysis of respiratory muscles and limbs.
Ingests spores that germinate and colonize the large instestine. HONEY has become notorious sources of the spores (und
M.C. source is the soil or less frequent honey. S/S = "Floppy baby Syndrome" = Lethargy, diminished suck, constipation, weakness
Squamous Cell Carcinoma in situ. It is present for long time differently the Keratoacanthomas grow inside within weeks or m
It has 5 roots: C5, C6, C7, C8 and T1.
it has 3 Trunks: Upper (form by C5 and C6), Middle (form by C7), Lower (form by C8, T1)
it has 3 Cords: Lateral , Posterior, Medial.
Lateral = Forms by the fusion of Upper and Middle Trunks Fibers
Posterior = Forms by the fusion of Upper, Middle and Lower Trunk Fibers
Medial = Forms by fibers of the Lower Trunk only
Lateral Cord forms the Musculocutaneous Nerve.
Posterior Cord forms the Axilar and Radial Nerve.
Medial Cord froms the Ulnar nerve
Lateral Cord fibers and Medial Cord fiber form the Medial Nerve
Lower Trunk forms by itself the Medial Cord that forms the Ulnar nerve
Compression of Left C6 nerve root: S/S Left Radial forearm and thumb are numb to the touch (↓sensation to light touc
Compression of Left C6 nerve root = ↓ LEFT brachioradialis reflex and slight weakness of LEFT wrist extensor
TRACTION INJURY. "Erb's Palsy". 5th and 6th cervical root involved. Palm facing posteriorly.
Innervate muscles of the anterior compartment of the arm and forearm.
Cutaneous sensory distribution of these sensory fibers is to lateral forearm and palm.
Contians never fibers from the C8 and T1. These inerve intrinsic muscles of the hand, including the interosseous muscle
the interosseous muscle is responsible for abduction and adduction of the digits, and the opponenes muscle. (opposition of th
High Fever + Headache+Focal Neurologic Complaints+Seizures. CT scan shows ring-enhancing lesion + edema and mass
IV drug users are prone to has it because the bacteremia. They afebrile + progressive neurologic dysfunction.
in the Frontal Lobe is assoc. with sinusitis and reflects oral flora. M.C pathogens as follow:
1) It can produce and abscess by aspiration M.C pathogens are Alpha hemolytic streptococcus and Mixed Anaerobes.
2) Of otic origin are produce by BACTEROIDES FRAGILIS.
Anterior: Is compromised of the Internal Carotid Artery (I.C.A) with its branches the paired Anterior and Middle Cerebral Arteri
Posterior: Is compromised o the paried Vertebral Arteries which form the Basilar Artery, which furhter divides into the paired Posterior Cere
Lateral Striate Arteries (L.S.A.) are penetrating branches of the Middle Cerebral Artery (M.C.A.).
M.C.A supply the caudate, putamen, globus pallidus, and internal capsule.
Lacunar infarcts (Lac. Infar.), small cavitary lesions that commonly occur in the distribution of the L.S.A and Lenticulostriate
In Long-standing Hypertension Lac. Infarc. are relatively common. The basal ganglia and thalamus are favorite sites for
Anterior Cerebral Artery (A.C.A) supplies the medial surface of the cerebral hemispheres(frontal pole to the parieto-occi
Anterior Cerebral Artery supplies the leg and foot area of the motor and sensory cortices.
Anterior Choroidal Artery arises from the Internal Carotid Artery and is not part of the circle of Willis.
Anterior Choroidal Artery perfuses the lateral ventricular choroid plexus, the hippocampus, parts of the globus pallidu
Anterior Choroidal Artery supplies also to the posterior limb of the internal capsule
Anterior Communicating Artery connects the 2 Anterior Cerebral Arteries. M.C. site of aneurysm in the circle of Willis
Anterior Communicating Artery may cause aphasia, abulia (impaired initiative), and hemiparesis.
Posterior Cerebral Artery supplies the occipital lobe, which contains the visual cortex.
Occlusion of P.C.A. results in Contralateral Hemianopia w/macular sparing. Also provide blood supply to the midbrian.
P.C.A also supplies the inferior surface of the temporal lobe (which contains the hippocampal formation) and the thala
Middle Cerebral Artery supplies the lateral convexity of the cerebral hemisphere, including Broca's and Wernicke's spe
Middle Cerebral Artery supplies the face and arm areas of the motor and sensory cortices.
Middle Cerebral Artery gives rise to the lateral striate arteries, which supply the internal capsule, caudate, putamen, and globu
Middle Cerebral Artery is the M.C. site of STROKE.
Superior Cerebellar Artery (S.C.A) supplies the sup. cerebellar peduncle, the superior surface of the cerebellum,
S.C.A also supplies the deep cerebellar nuclei, dorsolateral tegmentum of the rostral pons.
Vertebral Artery a branch of the Subclavian Artery gives rise to the Posterior Inferior Cerebellar Artery (PICA) and the Anterior
PICA supplies the dorsolateral quadrant of the medulla and the inferior surface of the cerebellum.
Occlusion of PICA may result in Wallenberg Syndrome: Cerebellar ataxia, hypotonia, loss of pain and temperature sensation of the i
Walleberg Sx also has:Absence of corneal reflex ipsilaterally,contralateral loss of pain and temperature sensation in the limb
Walleberg Sx also present: Nystamus, Ipsilatral Horner Syndrome and dysphagia and dysphonia
Anterior Spinal Artery supplies the Anterior 2/3 of the Spinal Cord.
Posterior Communicating Artery is the 2nd M.C. aneurysm of the circle of the Willis (Anterior Communicating Artery is
Posterior Communicating Artery can result in 3rd Cranial Nerve Palsy (Paralysis) = CN III = Oculomotor Nerve Paralys
The POSTCENTRAL GYRUS = PRIMARY SENSORY CORTEX
The PRECENTRAL GYRUS = PRIMARY MOTOR CORTEX
The INSULA = PRIMARY GUSTATORY CORTEX
The PYRIFORM CORTEX = PRIMARY OLFATORY CORTEX
The HESCHL'S GYURS = PRIMARY AUDITORY CORTEX
The nucleus ambigus provide the special visceral efferent fibers carried by the glossopharyngeal and vagus nerve.
No Cortical and brain stem functions are present. The spinal cord can still function,therefore, DEEP TENDON REFLEX may
The present of either posturing or Brain Stem Function (pupillary or corneal reflex) exclude Brain Death criteria.
DIENCEPHALON, which Derived from PROSENCEPHALON, develops into thalamus, hypothalamus, epithalamus subtha
DIENCEPHALON, also include THE PULVINAR is a thalamic nucleus
DIENCEPHALON, also develops Posterior lobe of Pituitary (Neuroectoderm) and Neural Retina.
MESENCEPHALON, or MIDBRAIN, is the only brain vesicle that does not produce a secondary vesicle, it remains the mesen
MESENCEPHALON, the midbrain include: TECTUM, TEGMENTUM, SUP.AND INF. COLLICULI and SUBSTANTIA NIGRA.
METENCEPHALON, develops the CEREBELLUM. Any Lesion here will have: Ataxia, Dysmetria, Dysarthria, Hypotonia an
METENCEPHALON, also include THE PONS
MYELENCEPHALON, wich is derived from the ROMBENCEPHALON, develops into the MEDULLA OBLONGATA
TELENCEPHALON, which is derived from the PROSENCEPHALON, develops into the CEREBELAR HEMIPHERES
TELENCEPHALON, cerebral hemispheres include: Cerebral Cortex, Basal ganglia, Hippocampus and Deep White Matter
From Front to Back position we have as follow:
Head of the caudate, Putamen, Globus pallidus, Thalamus, Lateral Ventricule and the Splenium of the corpus callosum
Only one (usually gray-white matter) SURGICAL RESECTION . Multiple RADIATION THERAPY
Childhood presentation. Develop Diplopia Right-sided Unilateral esotropia., right side facial weakness which includes the foreh
MRI scan shows marked enlargement of the pons, displacing but not occluding the fourth ventricle.
S/S: Progresive, Severe, Generalized Headache that began monhts ago and lately been accompanied by projectile vomiti
PINEAL GLAND: S/S of brain tumor + Loss of Upper Gaze (sunset eyes)
PINEAL GLAND: Sunset Eyes = The upper part of the sclera is visible above the downward-looking irises.
FRONTAL LOBE: S/S + Social Behavior and Olfatory and Visual deficits.
PITUITARY APOPLEXY: Occur when bleeding into adenoma destroys the pituitary gland.
PITUITARY APOPLEXY: Sudden headache, the most notable finding woud be shock from ADRENAL INSUFFICIENCY.
POSTERIOR FOSSA TUMOR: Affecting equilibrium and gait, in addition to producing visual S/S
M.C. primary brain tumor location in children: Cerebellum (Cerebellar astrocytoma # 1, Medulloblastoma is # 2). USML
Or also call Pharyngeal Apparatus: We have CLEFT (Ectoderm); ARCHES (Mesoderm and Neural Crest); POUCHES (Endo
We have Arch 1, Arch 2, Arch 3, Arch 4 and Arch 5
Arch 1 rise to the Maxillary Artery and Arch 2 rise the Stapedial Artery. Arch 3 raise ICA billaterally.
Arch 4 rise the arch of the aorta and L and R subclavian artery. All this give branch to the Circle of Willis
Arch 5 degenerates early in fetal development and Arch 6 rise the Pulmonary Arteries and the Ductus Arteriosus.
Arch 1 derivates supplied by CN V2 and V3. Arch 2 derivates supplied by CN VII. Arch 3 derivates supplied by CN IX.
Arch 4 and 6 derivates supplied by CN X.
1st cleft develops into EXTERNAL AUDITORY MEATUS.
2nd through 4th clefts from temporary cervical sinuses, which are obliterated by proliferation of 2nd arch mesenchyne or p
1st pouch develops into MIDDLE EAR CAVITY, eustachian tube, mastoid air cells.
2nd pouch develops into EPITHELIAL LINING OF PALATINE TONSIL.
3rd pouch (dorsal wings) develops into INFERIOR PARATHYROIDS.
3rd pouch (ventral wings) develops into THYMUS.
4th pouch develops into SUPERIOR PARATHYROIDS
We need to follow this steps:
1) Start off appropriately (private setting w the support that the Pt. desires, i.e. family and friend).
2) Determine how much the patient already knows ("What have you made of the illness so far?)
3) Find out the level of information that the patient wants ("Would you like me to tell you the full detail of the Dx).
4) Share the information in clear language, not using medical jargo. Reinforce and clarify information, provide education, and answer
5) Respond to Pt's feelings
6) Establish a plan, summarize the conversation, and make a contract for future discussions/treatments.
Red, hot, tender breast, usually around lactation. Fever and Leukocytosis
The following Type: Fibrocystic disease, Benign tumors, Malignant tumors (carcinoma). We also talk about RISK FACTO
FIBROCYSTIC DISEASE
Present w/diffuse breast pain and multiple lesions, often bilateral. Bx shows: Fibrocystic Elements.
Usually does not indicate ↑ risk of carcinoma. Histologic types:
1) Fibrosis (hyperplasia of breast stroma). 2) Cystic (fluid filled). 3) Sclerosing (↑ acini and intralobular fibrosis).
4) Epithelial hyperplasia: ↑ Risk of carcinoma w/atypical cells. Occurs > 30 years.
BENIGN TUMORS
FIBROADENOMA: M.C. tumor < 25 years. Small, mobile, firm mass w/sharp edges. ↑ size and tenderness w/pregnancy.
FIBROADENOMA: Not a precursos to BREAST CANCER.
CYSTOSARCOMA PHYLLODES: Large, bulky mass of connective tissue and cysts. Tumor may have "leaflike" projections.
INTRADUCTAL PAPILLOMA: Tumor of lactiferous ducts; presents w/nipple discharge
MALIGNANT TUMORS (CARCINOMAS)
Common postmenopause. Arise from mammary duct epithelium or lobular glands.
Overexpression of estrogen/progesterone receptros or erb-B2 (HER-2 and EGF receptor) is common; affect therapy and prog
Histologic types:
1) Ductal Carcinoma in Situ (DCIS): early malignancy w/o basement membrane penetration.
2) Invasive Ductal, no specific type: Firm, fibrous mass. Common.
3) Comedocarciona: Ductal, wi/cheesy consistency due to central necrosis.
4) Inflammatory: Lymphatic involvement; poor prognosis.
5) Invasive Lobular: Often multiple, bilateral
6) Medullary: Fleshy, cellular, lymphocytic infiltrate. Good prognosis
7) Paget's disease of the breast: Eczematous patches on nipple. Paget cells - large cells w/clear halo; suggest underlying ca
RISK FACTORS
Gender, age, early 1st menarche (12 years old), delayed 1 st pregnancy (>30 years old), late menopause (>50 years old).
Family History of 1 st-degree relative w/breast cancer at a young age. Risk is NOT ↑ by fibroadenoma or nonhyperplastic cyst
MISCELLANEOUS
Mammary Duct Ectasia: May simulate cancer clinically. It's disorde of premenopausal age that manifests often w/nipple r
Mammary Duct Ectasia: Also we can have Inversion of the nipple w/nipple discharge.
Mammary Duct Ectasia: Histologic features include marked dilatation (ectasia) of large ducts w/fibrosis and chronic infla
Mammary Duct Ectasia: The pathogenesis is obscure but may be a reaction to stagnant colostrum.
In USMLE Breast Cancer located laterally usually the metastasis will be in the Axillary Nodes.
In USMLE Breast Cancer located medially usually the metastasis will be in the Parasternal nodes.
Can present as an axillary mass or as PAGET DISEASE OF THE NIPPLE.
With upper back pain, tender to direct palpation, neurologic weakness in lower extremeties, mild hyperreflexia. = BONE META
X-rays show a lytic lesion with an absent pedicle on T4 without collapse of the Vertebral body. NSMx MRI of thoracic area.
A strong family history of breast cancer she wants screening for BRCA 1 mutations, we recommend counseling before screen
in Small Breast,after Bx shows a intraductal carcinoma in elderly pt. NSTx Modified Radical Mastectomy including axillary sam
In Large Breast, NSTx is Lumpectomy, axillary sampling and post-op radiation.
Radical Matectomy is no longer used for the Tx. Of breast cancer. It offers no survival advantage over the less mutilating modi
in Advance case NSTx local radiation plus systemic chemotherapy. The mass can be reduce and we can do a paliative maste
Epithelial hyperplasia = Fibrocystic changes = "lumpy-bumpy" texture = Histopathology sign means to↑ the risk for b
Sclerosing adenosis is a histological changes that implies and increased risk of subsequently developing invasive carcinoma
Sclerosing adenosis is a type of proliferative fibrocystic disease = Fibrocystic changes will implied future malignancy
Paget disease of the breast is a form of ductal carcinoma in situ in which neoplastic cells involve the squamous epithelim o
S/S ulceration lesion of the nipple oozing serous fluid, sourrounding the area of nipple ulcerations with erythema.
Bx of the nipple and sunurrounding tissue reveals = Large clear mucin filled cell with abundant cytoplasm.
Additional finding in Bx shows malignant cells invade the epidermis.
Histologic changes are: DERMAL LYMPHATIC INVASION BY CANCER CELLS.
If we have breast cancer metastasis (S/S weakness, LBP, and urinary incontinence) to the spine administer HIGH-DOSE S
to bone and MRI reveals lytic lesion in vertebra and lower leg (femur). We need to schedule her for radiation therapy to the L
Acute inflammation in Breast carcinoma = is are RARE finding may be assoc with secondary infection or abscess.
Chronic inflammation in Breast Carcinoma = is a non-specific finding. In medullary breast cancer we can see this changes
Chronic inflammation in Breast Carcinoma = Medullary breast cancer = it is a type o invasive ductal carcinoma (better pro
Dermal lymphatic invasion by cancer cells = Inflammatory breast cancer is a patter of invasive breast cancer
Dermal lymphatic invasion by cancer cells = The neoplastic cells infiltrate widely throught the breast tissue
Dermal lymphatic invasion by cancer cells = we see lymphedema and "peau d'oragne". S/S swollen, red and tender of
Epidermal invasion by cancer cells = is a poor prognostic indicator. Intraepidermal malignant cells are called Paget cells
Epidermal invasion by cancer cells = Paget Disease of the nipple = Ductal carcinoma
Fat Necrosis = is often seen following trauma to the breast but is not specifically assoc with a particular type of breast cancer
have IgA, lactoglobulin, maternal macrophages that protect the infant from infections
In pulmonary function test will have a airway obstruction.
also have ↓ FEV1/FVC ratio. Total Lung Capacity ↑ and DLCO2 normal which indicate that lung parenchyma is not affected
It is likely assoc with Cystic Fibrosis, Necrotizing pneumonia, Intralobular sequestration of the lung and Kartagener's S
Is a result of a chronic necrotizing infection of bronchi and bronchioles leading to abnormal dilatation of these airways, which
Alpha-1-antitrypsin deficiency is not likely to be assoc with or a cause of bronchiectasis.
The complete name is this disease is Bronchiolitis Obliterans Organizing Pneumonia (BOOP)
It can be differentiated from Usual Intestitial Pneumonia (UIP) by the length of time over which the S/S develop.
BOOP generally develops less than a couple of months. Also, BOOP tends to have a ground-glass appearance on CXR.
UIP in CXR has a reticular or reticulonodular appearance see in UIP
UIP is characterized by a patchy and temporally heterogeneous pattern of injury on examination of the lung Bx
Lung Bx in UIP shows Mononuclear Cell Infiltrate and Interstitial Scarring w/ Honeycombing.
UIP also known as Idiopathic Pulmonary Fibrosis. This disease responds to steroid therapy in only a relatively small percen
UIP is frequently assoc w/connective tissue disease.
Foamy changes is likely to see in Amiodarona-induced Lung Disease
Increased eosinophils are seen in Eosinophilic Pneumonia
Increased lymphocytes can be found in Hypersensitivity Pneumonitis and in Sarcoidosis.
Langherhans cells are found in Eosinophilic Granulomatosis (Histiocytosis X)
Turbic, PAS-positive material is seen in Alveolar Proteinosis
Incrased neutrophils can be see in number of different conditions, such as Idiopathic Pulmonary Fibrosis, Collagen Vasc
We also see increased neutrophils also in Asbestosis, Suppurative Infections, Acute Respiratory Distress Syndrome a
Hemosiderin-laden macrophages or Heart Failure cells obviously seen in C.H.F, no exlcusive of this conditon.
Rhomboid-shaped crystals or Charcoat Leyden Crystal found in allergic asthma.
Single, roughly sphenical structures than stain with Silver Stains (Metheamine Silver) found in Penumocystis Infection
Ciliated brochial epithelial cells are NORMAL FINDING.
Encapsulated pairs of small cocci found in pneumococcus infections.
Buffered charcoal yeast extract (BCYE) demostrates coccobacillary pathogen (Legionella pneumophilia)
Pt w/Cushing's syndrome (weight gain, buffalo hump, moon facies) + hoarseness + cough (6months) + smoking =Broncho
With a good clinical history the Best Tests to stablish the Dx are: Dexamethasone suppression test and Chest X-Ray.
Small Cell Carcinoma of the Lung most common than squamous cell strong association with SMOKING.
HYPERCALCEMIA is a coomon Paraneoplastic Sx that is seen w/bronchogenic tumors, specially w/ Squamous Cell Carcin
Hypokalemia, Hyperaldostroinsm, and Hypermagnesemia are not condicitons that are commonly associated with cancer.
HYPERCORTISOLISM (Cushing's Syndrome) = ↑ Cortisol level are also assoc w/cancer, especially Small Cell Carcinoma
Rigid endoscopy (Rd.En.) under general anesthesia is the procedure of choice in managing foreign body aspirations in chil
Rd.En. provide greater access to the subglottic airways and ensures oxygenation and easy passage of the telescope and grasping forceps during extraction
Flexible endoscopy is use in adults.
Is the BEST test to evaluate the CT scan finding of a solitary lung mass. Usually it is Bronchoscopic w/ Biopsy.
Triad of Shortness of Breath, Nonproductive Cough and Wheezing.
The mechanism involved in an asthmatic attack are bronchospasm and airway obstruction due to reversible inflamation.
Dopamine Agonists use for PARKINSON. Use before LEVODOPA.CONTRAINDICATED IN: Neurosychiatric disturbances, recent M.I. or
Also use in PROLACTINOMA, small version of pituitary microadenoma (too small to produce visual fields defects). S/S Amenorrhea + G
Chronic ganulomatous disease w/caseating granulomas. M.C in TX, CA, FL. S/S malaise, chills, malodorous sweats, fatigue w
Most cases of BRUCELLOSIS produce mild disease or fevers of unknown origin. However, can cause ENDOCARDITIS.
ENDOCARDITIS is seen in severe cases, the aortic valve is most commonly involved, followed by the mitral valve and then bo
Pain elicited by touching the chin to the chest. Usually indicates inflamation of the meninges.
Tendernes + erythema in a joint. X-LINKED HYPOGAMMAGLOBULINEMIA The M.C. pathogen in infectious arthritis is MYCO
Low or absent number of B cells, leading to a panhypogammaglobulinemia. Cellular immunity is intact.
Present w/recurrent pyogenic infections, particularly of the lungs, sinuses and bones.
NSTx Life-long immunoglobulin therapy + aggressive Antibiotic Mx
Abscent B cells and normal numbers of T cells. Also call X-Linked Immunodeficiency. Occur in infancy.
Differs clincially from COMMON VARIABLE IMMUNODEFICIENCY by the presence of lower than normal B cell levels.
In the lymph nodes the germinal follicules will be absent. (B-Cell areas)
Multiple enlarged, abscessed lymph nodes draining thorugh the skin via indolent sinuses = LYMPHOGRANULOMA VENERU
Thrombosis of the major veins in the Liver. Hepatic Vein the M.C. location. NSDx is Hepatic Venography.
Assoc with Myeloproliferative Disorder, Polycythemia Vera, Sickle Cell Diseases, Paroxysmal Nocturnal hemoglobinemia
The triad of occlusive disease of the arteries, migratory superficial thrombophlebitis, and Raynaud's phenomenon in a smoke
Produce the Smooth Part of the R.V. (conus arteriosus) and the Smooth part of the L.V. (aortic vestibule)
NSTx is Fluoxetine (S.S.R.I.). Bupropion is contraindicated because of its lowering of the seizure threshold with eating disord
A Pt. may be Dx with bulimia nervosa even if his or her weight is NORMAL.
In Anorexa Nervosa the Dx is made when a person's weight is at or below 85% of the ideal and the person has unrealistic concern about gaining weight
S/S: Binge eating and compensatory behaviors like purging by self-induced vomiting, laxative abuse, others (fasting and excesive
And Anorexa Nervosa are more common in women than in men, usually in late adolescence or early adulthood.
Social factor play a role in development of eating disorders, genetic factors are also important.
Benign pruritic disease, tense blisters, oral lesion very rare. Immunofluorescence show Ig G and C 3 deposits in epidermal junct
Use in SMOKING CESSATION PROGRAM. Act VIA DOPAMINE REUPTAKE INHIBITION. Side effect: Seizures and aggravation o
Antidepressant w/both dopaminergic and noradrenergic properties. Essentially help w/ improve depression + cognitive def
Instruction to the Pt regarding smoking cessaton once medication Tx has started include:
Gradual discontinuation of smoking during the 2nd week of Tx while the dose is titrated up.
Becareful in Pt with Bulimia or Anorexia nervosa because higher incidence of seizures.
Migratory Superficial Thrombophlebitis + Occlusive disease of the arteries + Raynaud's phenomenon in smoker male = BURGER'S
Assoc. with Epstein-Barr virus in U.S.A. Pts. Present with intra-abdominal tumors. "Starry Sky" parttern describe below.
Bx Small lymphocytes w/interspersed macrophages surrounded by clear spaces. Assoc. with C-MYC ACTIVATION.
Assoc with t(8;14)(myc and IgH) but sometimes with t(2;8)(kappa immunoglobulin light chain and myc).C-myc Chromosome
also assoc t(8;22)(lambda immunoglobulin light chain and myc).
Low Urinary Output, and Low CVP indication of the Pt. NEEDS FLUIDS.
This condition can have a diffuse alveolar damage that can see in ARDS of result of sepsis.
The epidermis is involved. Area is painful, blisters are not present, and capillary refill is intact.
The epidermis and superficial dermis are involved. Area is painful and blisters are present.
The epidermis and dermis are involved. Area is painless, white and charred.
With Venlafaxine are use as Antianxiety Drugs.
It is a 5-HT1a (SEROTONIN) partial agonist. Used for GAD (General Anxiety Disorder) and to augment depression/OCD tr
DO NOT USE IN PANIC DISORDER. Unlike Benzodiazepines, buspirone does not cause tolerance, depende, or withdrawal.
Few side effects and NO TOLERANCE, DEPENDANCE or WITHDRAWAL. Do not use with MAOIs.
Do not give clues that are found at the interface between the tumor and the normal skin. In large lesion will show necrotic in t
it is recommended to differentiate basal cell cancer from squamous cell carcinoma, or even a melanoma.
Dx tool. Risks doing to much.(Basal cell cancer needs only 1 or 2 mm of margins) or to little (a melanoma should have at least
It is component of the classical pathway. It functions as an enzyme in the early complement cascade.
It is not involve in the opsonization or removal of the immuno complexes.
Attaches to bacterial surfaces for opsonization by phagocytes. It is the most abudant protein of all the complement.
It is also critical in the removal of immune complex from the serum.
Immune complex glomerulonephritis (ICGN) is common in many infection disease.
In ICGN the chronic persistance of antigen/antibody damage the small vasculature by immune complex-mediated hypersens
Deficiency of the complement protein C4 would inhibit the completion of the classical pathway to the splitting of C3
It is responsible for lysis of the bacteria. Also it is a protein that split in C5b, C6, C7, C8 and polymerization of C9.
Is a strong chemotactic molecule and factor for neutrophils and results in stimulation of the inflammatory response.
Is a activator protein of the alternative pathway. It combines with C3b to form C3bBb is the C3 convertase of the alternative p
Since the alterantive pathway is turned on by the surfaces of bacteria, and this is a viral infection, factor B is unlikely to be invo
Screening + Vaginal Ultrasound in Pt. at higher the average risk of ovarian cancer. (Women with BRCA1 or BRCA2 mutatio
Screening for PANCREATIC CANCER
Coronary Artery Bypass Grafting NSTx in 80 % Stenosis of L.M.C.A (Left Main Coronary Artery)
Complicaton is Mediastinits = Chest pain , breathlessness and mediastinal widening on chest x-ray.
NSTx is Thoracotomy for debridement, drainage and antibiotic therapy.
Result from Pvu II CAGCTG a original palindromic sequence (ie. CAGCTG base pair with GTCGAC)
C bonds w/G and A bounds w/T. Purines (A, G) have 2 rings. Pyrimidines (C, T, U) have 1 ring.
Start and stop codons: AUG (or rarely GUC) is the mRNA initiation codon.
Eukaryotes: AUG codes for methionine, which may be removed before translocation is completed.
Prokaryotes: The initial AUG codes for a formylmethionine (f-met). Stop Codons: UGA, UAA, UAG.
In the USMLE watch the Position of 5' and 3' ends.
Cyclic Adenosine Monophosphate is the second messenger for the action of Parathyroid Hormone (PTH) on the kidney
↓ w/ the stimulation of Alpha 2 adrenergic receptor (coupled to Gi). ↑ w/ stimulation of beta 1 adrenergic receptor (coupled to G
Edetate calcium disodium. Forms stable complexes w/lead that are then excreted in the urine
Although this product is indicated for the Tx of Acute and Chronic lead poisoning, it is administrated by I.V or I.M. only
Defective copies of this gene encoding made Pt. resistant to HIV infection.
They are 15 known coreceptor (CCR5 and CXCR4 are the best characterized).
Present on all T cells with either a CD4 or CD8 marker. This is the marker that is used to indetify total T cell count in a blood
Keep in your mind that CD3 labels ALL T LYMPHOCYTES
CD3 marker is use for signal TRANSDUCTION IN THE DIFFERENT T CELLS.
Is a five-polypeptide cluster that represents the nonvariable part of the T-cell receptor complex. NK cells are CD-3 negative
Is used to indentify T HELPER CELLS.
Keep in your mind that CD4 labels T helper lymphocytes
These are the cellls that recognize exogenous peptides present on MHC class II molecules by macrophages.
Involved in cell-mediated delayed hypersensitivity. Also in ANGIOEDEMA CASES where CD4 is decreased
Production of cytokines for stimulation of antibody production by B cells,and stimulation of macrophages
In USMLE, if the ask you about the Granulomas Tuberculosus. The cells in the periphery of the granuloma are HELPER T C
What is the rol of CD4? The answer is: CD4 is the molecule that stabilizes the interaction between T-cell antigen receptor a
Also CD4 is the RECEPTOR FOR THE HUMAN IMMUNODEFICIENCY VIRUS
Is used to indetify CYTOTOXIC T CELLS. Keep in your mind that CD8 labels Cytotoxic T Cells
If you need to evaluated a attenuated virus vaccine (like MMR vaccine) the fluorescence test will be + in CD3 and CD8
These are the cell that recognize viral epitopes attached to the MHC class I molecules of a viraly infected cell
Is a cell surface marker used to indentify natural killer (NK) cells (lymphocyts lacking T and B cell markers).
Is an Fc receptor for IgG, allowing the NK cells to bind to the coated target cell during ADCC, facilitating LYSIS.
Best markers of an identification of B cells. CD 20 and 21 also are used. CD21 marker is a receptor for EBV.
Keep in your mind that CD 20 labels B Lymphocytes.
Interact with the B7 molecule on the cell surface of the antigen-presenting cell reacts with the CD 28 molecule
This reaction take place on the T cells surface for maximun COSTIMULATORY SIGNALS
is used to indentify NK (Natural Killer) cells. These cells are important in innate host deffense.
Is not involved with ADCC (antibody-dependent, cell-mediated citotoxicity)
NK specializing in killing virally infected cells and tumor cells by secreting GRANZYMES and PERFORINS.
In a 4 weeks infant the acute treatment drug will be FUROSEMIDE
NSDx of M.I. Begins to rise 4 -6 hrs after M.I. and returns to baseline within 48 - 72 hrs. Biomarker of choice for Dx of M.I.
Solitary esophageal ulcer, signs of colitis and retinitis in a Pt w. HIV suggest disseminated CMV infection.
Tx is w Ganciclovir w or w/o Foscarnet. Other available pharmacologic is CEDOFOVIR.
NSDx. Is confirmed w culture in BUFFY COAT SMEAR.
S/S: Chorioretinitis, Esophagatis, Colitis, Pneumonitis, Encephalitis, Hepatitis, Etc.
may simulate HIV myelopathy and is a relatively frequent complication of AIDS. In CSF shows NEUTROPHILIC PLEOCYTOS
In exercise the Carbonic dioxide most important method for tranporting is AS BICARBONATE in SERUM.
The RBC contain the enzyme Carbonic Anhydrase, which catalyzes the intracellular convertion of CO2 to bicarbonate and
Most of the bicarbonate in the RBC is exhange across the plasmalemma for CHLORIDE ION.
This means that although the bulk of the production of bicarbonate occurs in the RBC, the bulk of the actual transport occurs i
Risk of COPD w/various degrees of Emphysema or Chronic Bronchitis is strongly assoc w/smoking and exposure to irritatin
Chronic Obstructive Pulmonary Disease = RESPIRATORY ACIDOSIS
Long history of C.O.P.D. with evidence of C.A.P. the M.C. pathogen Strep. Pneumonia, Haemophilus influenzae, Moraxella
x-rays finding: Flattening of the diaphragm, increase retrosternal air space and long narrow heart shadow.
Systemic steroids and antibiotics. Watch up for glucose increase.
Calcinosis cutis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly and Telangiectasia. Anticentromere antibo
Bacterial Meningitis = Marked Neutrophilia, Increased protein concentration and reduced glucose
Viral Meningitis = Marked Lymphocytosis
Meningococcus Meningitis
C.V.S = Chorionic Villi Sampling
Amniocentesis: is among the M.C performed, invasive prenatal Dx procedure. Provides more information than C.V.S
Amniocentesis: is usually performed in the second trimester of pregnancy.
Amniocentesis: The chromosome analysis is usually completed 1 to 2 weeks after the procedure is performed.
Amniocentesis: Additional testing such as biochemical analyses and DNA testing usually take and additional 2 to 4 weeks.
C.V.S: Is a test perfomed to detect specific genetic abnormalities ealier in pregnancy, it is generally done at 10 to 13 weeks. (Provides gene
C.V.S: Also, it can provide all of the data that amniocentesis provides except for information about neural tube defects
C.V.S: Also carries a slightly higher risk of miscarriage.
Smoker w/Chest X-ray (+) of lung consolidation + recurent attack of pneumonia (pneumonitis). Follow CT scan w/Bronch
Peutz-Jeger Syndrome, McCuna-Albright Syndrome, neurofibromatosis.
Excellent for Tx Atrial Fibrilation when there is no Hemodynamic Compromise.
First-line antihypertensive agents in ASTHMA, MIGRAINE OR URINARY INCONTINENCE PATIENTS.
(VERAPAMIL) INTOXICATION is treated with Calcium Chloride. S/S bradycardia, hypotension, AV block.
Excellent to treat Essential Hypertension (Systolic Hypertension). Also can be use to treat RAYNAUD PHENOMENA and mi
Produce Smooth muscle relaxation, which occurs form Ca+ flux inhibition, is believed to ↓ the vasospasm underlying Rayanud Phenomena a
M.C.C of HYPERCALCE
Ca2+ Phosphate Alkaline Phosphate (MISHAP)
↑ ↓ ↑ Malignancy
ne N/↑ N ↑↑↑ Intoxication with Vit. D
↑ ↑ N/↑ Sarcoidosis
N N N Hyperparathyroidism
↓ ↑ N Alkali Syndrome
Paget's Disease of bone
80 % of all stones. Hypercalciuria is present and may be idiopathic or secondary to some other causes.
To prevent recurrence NSTx Initiaton of Thiazide diuretic therapy.
When dietary measures are not effective in ↓ calciuria, then a T.D. ↑ calcium rabsorption by the kidney.
Are use in the Dx of Medullary Thyroid Carcinoma
Arbovirus infection transmitted by mosquitoes. M.C. cases children under 10 y.old of age.
S/S fever, headache, photophobia, nausea, vomiting, Myalgias and arthralgias. Also we can see seizure activities.
Cause Donovanosis formely called granuloma inguinale.
This is an encapsulated, gram-negative. S/S Painless papule that eventually ulcerates over the course of days or weeks.
The papule does not develop until after a lengthy incubation period that can last from 2 to 6 months.
Ulcers have a sharply defined borders and a significant amount of velvety granulation tissue.
NSDx demostrating Donovan bodies on a Wright or Giemsa-stained tissue preparation.
These Donovan bodies are monocytes that contain significant numbers of organism. NSTx TMS or doxycyline for 3 weeks
M.C.C bacterial diarrhea in U.S.A. Last for several days. Have been linked with GUILLIAN-BARRE SYNDROME.
Gam Negative, microaerophilic, curved rod w/polar flagella, and a "seagull" or "comma" appearance. Diarrhea occurs 8 hours a
It is M.C.C of invasive bacterial enterocolitis in the U.S. It is acquired by eating contaminated food (poultry in 50-70% of th
Also it is acquired by drinking contaminated milk or water
M.C.C. of fever in Malignancy is Gram Negative Infection (e.g. E. Coli, Pseudonomona). M.C.C of Death in Cancer is INF
The drug of choice is NEGESTROL ACETATE
In early obstruciton of biliary tract w/bleeding = Endoscopic examination of the duodenum = Alkaline phosphate 4 times higher, ↑ bilirru
Also we can see a dilatation of the intra and extra hepatic ducts.
Hyponatremia + Cushing Sx. = Small Cell Carcinoma of Lung (origin in Neuro Crest Cells). Hormones relate are ADH and A
Hypercalcemia + Secundary Polycitemia = Renal Adeno Carcinoma. Hormones related are PTH-like hormone and Erythropo
Hypoglycemia + Secundary Polycitemia = Papilocellular Carcinoma. Hormones related are Insulin-like hormone and Erythro
Hypocalcemia + Cushing Sx = Medullary Ca of Thyroid. The tumor marker is Calcitonin that can be converted in Amyloid
Have different Stages: Diagnosis, Treatment, Remission, Recurrence and Terminal phase
Terminal phase is short-term focus, when palliation of pain and support of the Pts is paramount.
Grows in Sabouraud's agar as a yeast at room temp as well as at 35 degrees C.
Diabetic Patient with lesion in Esophagus cover by WHITE, CURDY CHEESE-LIKE MATERIAL
Normal inhabitant of the oral cavity, would present as whitish plaques (trust) and would appear microscopically as budding y
M.C. of Diaper Dermatitis. C. albicans grows as an oval yeast w/ Pseudophyphae and true hyphae.
In culture, C. albicans grows as oval yeast. However, when exposed to a protein solution at 37 C, C.albicans forms GERM TU
Repeat episodes NSMx SCREEN FOR DIABETES. S/S thick, white vaginal discharge cause vulvar and vaginal erythema.
A Potassium hydroxide (KOH) smear shows pseudohyphae; the normal saline smear is negative.
Recurrent Candidiasis may simple indicate a resistant or poorly treated strain but SEVERE case you need GLUCOSE LEVEL = DIABETES
Produce Vaginal Candidiasis that usually the pH is 4 -5. Produce Pseuohyphae. Tx with Metronidazole.
Social withdrawal, euphoria, anxiety, conjuctival injection, dry mouth, tachicardia and increased apetite.
Fenestrated capillaries have circular pores (fenestrae) 60 to 100 nm in diameter that may be partially surrounded by PERICY
Like nonfenestrated capillaries, their basal lamina is continuous.
Only sinusoid capillaries (located in the spleen, liver and bone marrow) have discontinuous basal lamina.
Fenestrated capillaries are present where there is a great deal of molecular exchange w/blood(e.g. kidneys, small intestine, endocrine glands, chor
Exocrine glands contain nonfenestrated capillaries.
The fenestrae are often spanned by a slit diaphragm, which is filamentous and thus does not possess a unit membrane
Although glomerular capillaries are fenestrated, they lack the slit diaphragm, rather, a thick basement membrane forms the filtra
Rheumatoid nodules (hard as rock in R.A. pt) in the lung + co-worker pneumoconiosis or silicosis or asbestosis.
Standart Tx of C.H.F. Prevent to delay the progression of this condition by protecting the ventricle from remodeling.
Also cause vasodilation and blocks the detrimental neurohormonal activity assoc. with C.H.F.
Commoly cause cough, rash fever and hyperkalemia. Contraindicated in Bilateral renal artery stenosis and pregnancy.
After M.I. can produce a dry no productive cough.
Useful in the RENAL ARTERY STENOSIS (R.A.S.) Dx. If the isotope uptake levels ↓ after captopril administration,a Dx of R.A.S can
Use in Maniac episode in bipolar disorder.
Second drug of choice in Genarilized Tonic-Clonic Seizure.
Like Valproid Acid is useful for Tx of Seizure Disorders and Bipolar Disorder
and Ornithine transcarbamoylase are mitochondrial enzymes. Both participate in the UREA CYCLE
Any UREA CYCLE deficiency is caractherized by HYPERAMMONEMIA, ELEVATED BLOOD GLUTAMINE and DECREASED
Carbamoyl Phosphate Synthetase and Ornithine Transcarbamoylase are two conditions can be distinguished by an ↑ in orotic
This ↑ of orotic acid and uracil occurs in ornithine transcarbamoylase deficiency but no in the deficiency of carbamoyl phospha
Carbamoyl Phosphate Synthetase Deficiency Ornithine Transcarbamoylase Deficiency
↑ (NH4+); hyperammonemia ↑ (NH4+); hyperammonemia
Blood glutamine is increased Blood glutamine is increased
BUN is decreased BUN is decreased
No increase in uracil or orotic acid Increase uracil or orotic acid in blood and urine
Cerebral Edema Cerebral Edema
Lethargy, convulsions, coma, death Lethargy, convulsions, coma, death
Carbamoyl Phosphate Synthetase Deficiency Ornithine Transcarbamoylase Deficiency
↑ (NH4+); hyperammonemia ↑ (NH4+); hyperammonemia
Blood glutamine is increased Blood glutamine is increased
BUN is decreased BUN is decreased
No increase in uracil or orotic acid Increase uracil or orotic acid in blood and urine
Cerebral Edema Cerebral Edema
Lethargy, convulsions, coma, death Lethargy, convulsions, coma, death
The NH4+come from Glutamine.
ACETYLGLUTAMATE (+)
Obligate Activator
Mitochondrial
Matix
Cytoplasm
sm, and ornithine returns to the mitochondria

etase and ornithine transcarbamoylase are mitocondrial enzymes
the cytoplasm and leaves the cycle (minus its amino group)
s is active, fumarate can be converted to glucose.
n the cytoplasm and enters the blood for delivery to the kidney.
Blood test to monitoring the Alcohol abuse patient in compliance with the treatment.
Confusion, headaches, dizzines, nausea, abdominal discomfort and the presence of pinkish-red skin line on examination.
The Toxic effects are by REDUCING the ability of OXYHEMOGLOBIN to deliver O2 in peripheral circulation
Collection of multiple confluent furuncles with separate heads. The lesion has a central necrosis. Common site are the neck, axillae, a
Flushing + Watery Diarrhea + Valvular Heart Disease. NSDx is URIANALYSIS FOR 5-HIAAA (Alterate Metabolism of the tryp
S/S Flushing + Diarrrhea + Wheezing + ↓Food Intake + Abdominal Distention + Pain + Apical Systolic Murmur + Telangiectasia
Pts w/this condition are at risk of developing niacin deficiency (PELLAGRA) owing to ↑ formation of SEROTONIN FROM TRY
Also we can determinated Serum Serotonin level and Urinary 5-HIAAA for better Dx. Urinary 5-hydroxyindoleacetic Acid (5-
The two heart lesion associated w/Carcinoid Sx are: Tricuspid Insuficiency and Pulmonary Stenosis.
Terminal Ileum is the M.C. place of Carcinoid Tumor that can produce a Carcinoid Syndrome
Is the M.C. tumor of the apendix. The neoplastic cells show neuroendrocrine differentiation.
Accounts for 20% of genital malignancies.
Comparation of SA Node and Ventricular Action Potential.
Remember de "Funny Na Channel in SA Node" and the "Inward rectitying channel, iK1 in Ventricular Action Potential."
The "Funny Na Channel in SA Node" are Channel Voltage dependent, but it opens when the cell repolarizes and closes when
The "Inward rectifiying channel of K" are Channel Voltage dependent open under resting conditons, and close in depolarization and main
"If"stand for the "funny channels of Na"
Moderate Hypothermia to 33.0 c (91.4 F) core temperature might ultimately improve neurologic outcome of Pt.
High-grade AV block is assoc. by blockage of several P waves (skipped beats).
High-grade AV block is also assoc w/normal PR and normal QRS complex when P wave is conducted to the ventricles.
Second degree AV block, Mobitz type II, is assoc. by single skipped beats w/o a prolonged PR interval and frequently a wide QR
Left bundle branch block is characterized by a Long QRS complex w/ a tall R wave in V6 and a deep S wave in V1.
First-degree AV block is assoc w/ prolonged PR interval but a normal QRS complex
Complete Heart Block is assoc with a Narrow QRS.
140
Phases:
1. Isovolumetric Contraction - Perio
120 between Mitral Valve Closure and A
3. Isovolumetric Relaxation
Valve Opening, Period of HIGHEST

1. Isovolumetric Contraction
100 Consumption.
2. Systolic Ejection - Period Betwee
Pressure Valve Opening and Closing.
80
3. Isovolumetric Relaxation - Period
between Aortic Valve Closing and M
60 Valve Opening.
4. Rapid Filling - Period just after M
40 Valve Opening.
5. Slow Filling - Period just before M
20 Valve Closure.
Mitral Valves Opens
Normal Conditions: 1/3 of the cardiac cycle is spent in systole and 2/3 spent in diastole.
As heart rate ↑ dramatically, the time spent in diastole falls precipitously but the time spent in sistole falls to a lesser extent.
Slowest Conduction Velocity: AV node cells. Fastest Conduction Velocity: Purkinje Fibers Cells
Systolic performance acutally means the overall force generated by the ventricular muscle during systole.
This is determined by the number of cross-bridge cycling during contraction.
The greater the number of cross-bridge cycling, the greater the force of contraction
The number of cross-bridges cycling is determined by two independent variables: the amount of preload on the muscle an
RULE: Concentric Hyperthrophic = Afterload (TPR ↑) Problem. Concentric Hyperthrophic + Dilatation =Preload (Exces
The resting potential is approx - 90 mV, normal transport move 3 Sodium into the cell in exchange of one calcium moving out o
This move a NET POSITIVE CHARGE into the cell cytosol. Remember Sodium has a valence of + 1 whereas calcium has a valen
= Mean Arterial Pressure (MAP) / Total Peripheral Resistance (TPR). Also = STROKE VOLUME X HEART RATE.
Rate of O2 consumption/Arterial O2 Content - Venous O2 Content
SYNOPSIS OF THE FORMULAS AND ABREVIATIONS

CARDIAC OUTPUT = C.O. MEAN ARTERIAL PRESSURE = M.A.P.
TOTAL PERIPHERAL RESISTANCE = T.P.R. PULSE PRESSURE = P.P.
STROKE VOLUME = S.V. HEART RATE = H.R.
END DIASTOLIC VOLUME = E.D.V. END SYSTOLIC VOLUME = E.S.V.
EJECTION FRACTION = E.F.
FORMULAS:
M.A.P = C.O. x T.P.R.
C.O. = M.A.P. / T.P.R.
T.P.R. = M.A.P. / C.O.
C.O. = S.V. x H.R.
M.A.P. = 1/2 SYTOLIC + 2/3 DIASTOLIC
P.P. = SYSTOLIC - DIASTOLIC
P.P. = S.V.
S.V. = C.O. / H.R. = E.D.V. - E.S.V.
E.F. = S.V. / E.D.V. x 100% (normal > or = 55%)
Stroke Volume (S.V.) affected by Contractility (c), Afterload (a), and Preload (p). If S.V.↑, when ↑ (p), ↓ (a), or ↑ ( c)
S.V. ↑ with: Catecholamines, ↑ intracelllular calcium, ↓ extracellular sodium, Digitalis (↑ intracellular Na +, resulting in ↑ Ca 2
S.V. ↓ with: Beta 1 blockade, Heart Failure, Acidosis, Hypoxia/hypercapnea.
↑ Resting C.O. we can see in large fistulas that involves the major artery such Aorta,Subclavian,Femoral,Common Carotid or
Relationship with Pulmonary Vascular Response (P.V.R.). Usually P.V.R. responds passively to changes in blood flow.
↑ in C.O. pushes the Pulmonary Blood Vessels open (distention) and ↑ the number of Blood Vessels that are perfused (r
↑ in C.O. caused by exercise therefore ↓ Pulmonary Vascular Resistance (P.V.R.) and ↑ Pulmonary Artery Pressure (P.A.P
↓ in C.O. caused ↑ Pulmonary Vascular Resistance (P.V.R.) and ↓ Pulmonary Artery Pressure (P.A.P).
The Most important factor to match L.V. output to R.V. output is the LENGTH-TENSION relationship of Cardiac Muscle.
↑ in Contractility cause of ↓ in Preload
↓ in Contractility cause of ↑ in Preload
↑ in Heart Rate will not cause a Significant increase in C.O. unless Venous Return is also Increased.
C.O. = to the product of S.V. and H.R. and because and increase in H.R. alone cannot increase C.O. We can concluce as follo
That a 2-fold increase in H.R. will cause 50% reduction in S.V.
Can happen in neoplastic diseases, idiopathic pericarditis and uremia, but also result form bleeding into the pericardial space after ca
Also present after trauma or ventricular rupture. NSTx is Pericardiocentesis.
S/S 1) decreased arterial pressure, 2) increased systemic veous pressure, 3) a small, quiet heart.
Also Hypotension, tachynea, tachycardia and ↑ J.V.P. Kussmaul sign (a rise in the systemic venous pressure upon inspiration)
PULSUS PARADOXUS is characteristic. If catheterization is performed, the x-decent (but no the y-descent) of the JVP is usually pro
T and I are proteins that control the interaction of Actin and Myosin. They're specific for CARDIAC INJURY. E 4-6 hrs and remain ↑ fo
Any time that you see a WHITE MURAL THROMBUS in Left Ventricle think in CEREBRAL INFARCTS complications.
The only one is DOXORUBICIN
Digoxin, Etoposide, Ifosfamide or Procarbazine side effect can be stop when we stop the drug administration (NO CUMULATI
Is the M.C.C. of death in DIALYSIS PATIENTS.
Use in Pt with Ventricular Tachycardia hemodynamically unstable (loss of consciousness). Usually w/ 200 joules of energies
Use in Pt with Ventricular Tachycardia hemodynamically STABLE.
It is a methylated derivate of LYSINE that is used in the enzyme carnitine palmitlythrasferase.
This enzyme catalyzes the movement of a long chain fatty acyl group from CoA carnitine.
After this the fatty acid attached to carnitine is carried across the inner mitochondrial membrane and into the inner mitochondri
Within the mitochondrion, fatty acyl CoA is regenerated and undergoes beta oxidation.
This enzyme is obtained, to some degree, from the diet and to greater degree by endogenous synthesis.
Carnitine deficiency can result from either↑ demand (e.g Ketosis) coupled within inadequate diet,or from defects in the carnitine meta
In addition Carnitine deficiency may cause fatty liver, lipid sotrage myopathy, and confusion.
Carnitine deficiency also can cause persistent hypoglycemia, hyperammonemia, skeletal muscle weakness, and myoglobinuri
Bulbous dilations of the intrahepatic bile ducts with a relatively normal appearing extrahepatic biliary tree.
Predispose Cholangiocarcinoma and biliary Cirrhosis. Associated with Polycistic Kidney Disease.
With Intimal Flap injury NSMx is Surgery. Can be detected by Angiograms. Usually after neck trauma.
Decrease of B.P., Heart Rate and Firing Rate of Vagal (X) Nerve. Increase of Firing Rate of Glossopharyngeal (IX) Nerv
In High Blood Pressure Pts receiving a Ca.Ma. we see ↓sympathetic ouflow and ↑ parasympathetic outflow, leading to ↓ B.P. and
3 structures inside: 1. Internal jugular Vein (lateral). 2. Common Carotid Artery (medial). 3. Vagus Nerve (Posterior).
Rheumatic Arthritis pt + tingling + pain worst at night + focal numbness of one hand + palmar aspect of the thumb and fingers excep
Tinnel sign (positive). In pregnancy Tingling on the first three fingers.
Give Burning and Tingling sensation that increase in the dorsiflexion of the hand.
Loss of muscular tone, tipically after emotion. Similar episode on awakening is called "SLEEP PARALYSIS".
Ppx RAPID EYEMOVEMNT (REM) sleep related phenomenom. Narcolepsy such as daytime somnolence and hypnogogic ha
May be associated with schizophrenia (catatonic type), mood disorders (which catatonic features), or general medical conditio
S/S of Catatonia include stupor, negativism, rigidity, posturing, mutism, stereotypies, mannerisms, waxy flexibility, and catatoni
INTRINSIC PATHWAY (PTT) = Heparin Therapy Guidance EXTRINSIC PATHWAY (PT) = Coumadin Therapy G
XII XIIa VII

I
Tissue F
XI XIa VIIa + Tissue Factor
Calcium
IX IXa
Calcium,
Phospholipid
X Xa
Calcium, Phospholipid
Protombin (II) Thrombin (IIa)
Fibrinogen (I) Fibrin (Ia)
IIa
XIIIa
Ca
Cross-Linked
Fibrin
use Matching (cases and control have similar distribution of some important confounding variables).Control CONFOUNDING (RAND
It begin w/the selection of cases of a disease and disease free controls.
Both groups are followed backward in time to determine exposure to the putative risk factor (parental history)
Observational Study. Sample chosen based on presence (cases) or absence (controls) of disease
Information collected about risk factors. Often RESTROSPECTIVE
Renal tubular necrosis (renal tubular necrosis cast), Acute pyelonefritis (white blood cell cast), are example of casts.
Sudden onset of pain + saddle anesthesia + bowel/bladder incontinence.
it will be affected in any tumor of the lateral ventricles specially the one that involve the choroid plexus like choroid plexus papi
Is a c shaped structure that comprises part of the wall of the lateral ventricle throughout its extent.
Present w/swollen, protruding eye and retro-orbital headache. Ptosis, Proptosis, chemosis and Ocular muscle paralysis beyond isola
Can be see in Tuberculosis (Apex). Lower part of the upper lobe (primary Tb). Also we can see cavitations in Histoplasmosi
Cancer also can produce cavitation like SQUAMOUS CELL CARCINOMA. Also Bacteria can cause cavitation = KLEBSIELLA (Big mucos
Is a second-generation cephalosporin used to treat a variety of upper and lower respiratory infections.
This antibiotic has been assoc w/ the development of a serum-like sickness.
This serum-like sickness presents usually when cefaclor is administered to infants and young adults.
The serum-like sickness S/S are: Urticaria, pruritus, morbilliform eruptions, eosinophilia, joint pain, swelling and fever.
Good cover of Atypical Bacteria and Gram Negative Rods
Third generation cephalosporin (cefotaxime, ceftriaxone or ceftaxidime). Use in the Tx of KLEBSIELLA PNEUMONIA.
Indicated in Pt w/chemotherapy that have a NEUTROPENIC FEVER. It is 1st line therapy because of its broad coverage and action PSEUDO
Use in the Tx of NEISSERIA GONORRHEA.
Is used for gram negative pneumonia (klebsiella, E.Coli, Proteus) often occurs in elderly people with rapidly progressive cou
In gram negative Pneumonia the Sputum may be a mixture of pus and blood (Current Jelly)
Empiric Tx of Pneumococcal Meningitis in children and adults.
For lifethreatening infection such as meningitis caused by s. pneumoniae, adding vancomycin to either ceftriaxone or cefotaxime is re
If the culture result reveals susceptible pneumococcus the vancomycin may be discontinued.
Rifampin is used if Pt is Vancomycin-allergic or people with contact with a Meningococcal infection.
Chronic Diarrhea + Malabsorption. NSDx is Gluten-free diet Trial. Suspect in malabsorption + iron deficiency anemia.
Assoc. with anti-endomysial antibodies. Serological Studies like ELISA for Ig A antibodies to Gliadin.
Gluten intolerance, in the Pathophysiology we will see FLATTENED INTESTINAL VILLI PROXIMAL SMALL BOWEL
Caused by sensitivity to gluten, present in wheat, rye, oats and barley. The active ingredient in gluten is GLIADIN, a protein rich in
The present of Gliadin in the Small Intestine triggers ENTERITIS characterized by FLATTENED or SCALLOPED mucosa of norma
S/S: Diarrhea, Fatigue, Flatulence, Anorexia, Weight Loss, Amenorrhea as long GLUTEN is present in the diet
CELL CYCLE
X = G1 phase
Y = S phase
Cell cycle (Mammalian Cells)diaghram W = M phase (Mitotic)
and chemotherapy agent relationship Z = G2 phase
Cyclin Proteins controls the entry in S p
Cyclin B controls the entry in M phase
Type of cells: LIABLE, STABLE and PERMANENT (cardiac cells and neurons)
Go is a special marked by departure from the cycle by cells that have differentiated, this cycle departure is always from the G
The cells can remain in Go phase for weeks or even years
Thus, X must mark the G1 phase, and since the S phase follow the G1 phase, in this diagram, Y designates the S phase.
DNA replication by the semiconservative mechanism occurs in the S phase, this requires the NOVO synthesis of DNA.
Methothrexate inhibits dihydrofolate reductase, preventig the reduction of folic acid to produce tetrahydrofolate.
Tetrahydrofolate derivates are used as a source of one-carbon moieties in purine nucloetide synthesis and in the methylation of dUM
Thus,by inhibition dihydrofolate reductase, methotrexate also obstructs one-carbon metabolis,and deprives DNA polymerase of essen
As, consequence, methotrexate is an antimetabolite that inhibits DNA synthesis in the S phase of the cycle.
The S phase is also the primary interval during which the other antimetabolites used in cancer chemotherapy act.
These include: mercaptopurine and thioguanine (both purine analogues that inhibit purine synthesis)
Azacytidine (limits pyrimidine synthesis by inhibiting orotidylate decarboxylase).
Hydroxyurea (inhibits formation of deoxyRNA from ribonucleotides)
5-fluorouracil (inhibits thymidylate synthase) and cytarabine (AKA cytosine arabinoside which inhibits DNA polymerase).
Go is the differentiated phase; it lies outside the cycle, and as long as cells remain in the Go phase, they cannot divide.
With respect of Go phase, there are three general types of mammalian cells: Permanent, Stable and Labile.
W = is the mitotic phase, because it precedes the G1 phase. This represents the time interval during which the cell divides to form two dau
Since this is the phase in which cell division occurs, all the other phases in the cycle are part of the interphase
X = as noted from its relation to the Go phase, is the G1 phase. This is the time period during which the cell prepares for entry into t
Specific members of a group of proteins called cyclins control entry into the S phase.
CELL CYCLE
X = G1 phase
Y = S phase
Cell cycle (Mammalian Cells) diaghram W = M phase (Mitotic)
and chemotherapy agent relationship Z = G2 phase
Cyclin Proteins controls the entry in S p
Cyclin B controls the entry in M phase
One protein, Cyclin D, working in conjunction with other regulatory factors, is a serine protein kinase that phosphorylates the retinoblastoma
Mutation in the Rb protein cause retinoblastoma, the most prevalent childhood cancer of the eye
Z = represents G2 phase that follow the S phase. During this time period, the cell prepare for mitosis. Cyclin B controls entry into the M
Inactivation of the p53 suppressor gene is assoc w/unrestricted passage of the cell from the G2 phase into S phase (cell cycle altera
P53 suppresor gene produces a protein product that has an inhibitory effect on the kinases that control the movement from one phase to the next in the cell c
Replication of the nuclear DNA usually occupies only a portion of interphase, called the S phase of the cell cycle.
The interval between the end of DNA synthesis and the beginning of mitosis is the G2 phase.
The G2 phase provides a safety gap, allowing the cell to ensure that DNA replication is complete before going into mitosi
Mitosis, or M phase, is the next phase. Nuclear division occurs during this phase, leading up to the moment of cell division
The interval between the completion of mitosis and the beginning of DNA synthesis is the G1 phase.
During the G1 phase, the cell monitors its environment and its own size.
when the time is right, the cell takes the step that commits it to DNA replication and completion of the division cycle.
DNA damage checkpoints occur at the G1/S transition, the S phase, and the G2/M transition point.
Phases S, G2, M and G1 are the subdivisions of the standard cell cycle.
Cellular proteins involved in regulating the cell cycle are often mutated in human cancers.
Dysregulation of cell cycle caused by activation of proto-oncogenes and/or loss of tumor suppressor proteins leads to unregulated cell growth(cancer)
Mutations in p53 are the M.C. genetic abnormalities in human cancer.
Li-Fraumeni Sx is caused by germline mutations in the p53 gene. It’s characterized by multiple primary tumor development, usually
These tumors include breast and colon carcinomas, leukemia, osteosarcomas and soft tissue sarcomas.
Neurofibromatosis (NF) type I,characterized by café au lait spots and neurofibromas,caused by a mutation in NEUROFIBROMIN (tumor su
NF type II, characterized by acoustic neuromas bilaterally, is caused by a genetic defect on chromosome 22.
Familial adenomatous polyposis coli characterized by large numbers of percancerous polyps in the colon.
Familial Adenomatous Polyposis coli is caused by mutations in the APC gene (tumor suppressor gene).
Disease states caused by mutations in mismatch repair genes include Hereditary Nonpolyposis Colorectal Cancer and Xeroderma Pig
Cacinoma of the uterus caused by HPV is primarily caused by the E6 and E7 genes of HPV, which interfere w/cellular tumor suppr
We have: Anaplasia, Desmoplasia, Dysplasia, Hyperplasia, Metaplasia
Anaplasia: Is a loss of cell diferentiation and tissue organization. It is assoc w/malignancy and is an ominous prognos
Desmoplasia: Is excessive fibrous tissue formation in tumor stroma.
Dysplasia: Is abnormal atypical cellular proliferation.
Hyperplasia: is an increase in the number of cells.
Metaplasia: is a reversible change of one cell type to another, usually in response to irritation.
Can produce Reversible and Irreversible Microscopic changes, the Reversible changes are:
1) Plasma membrane alterations including blebbing and loosening of intracellular attachments
2) Swelling of mitochondria, and 3) dilation of the endoplasmic reticulum.
The Irriversible cell injury are: 1) Cell shrinkage, 2) Chromatin Condensation, 3) Severe blebbing of cytoplasmic membrane
4) Formation of apoptotic bodies.
Is seen in necrotic tissue and is caused by REDUCTION IN CELLULAR RNA CONTENT
We have: Parasympathetic, Sympathetic and Somatic
Medulla --> Ach and N --> Ach and M (Cardiac and smooth muscle, gland cells, nerve terminals) --> PARASYMPATHET
SYMPATHETIC have 4 ways:
Spinal Cord --> Ach and N --> Ach and M (Sweat glands) --> SYMPATHETIC
Spinal Cord --> Ach and N --> NE, Alpha, Beta (Cardiac and Smooth muscle, gland cells, nerve terminals) --> SYMPATH
Spinal Cord --> Ach and N --> D1 (Renal Vascular Smooth Muscle) --> SYMPATHETIC
Spinal Cord --> Ach and N (Adrenal Gland) --> Epi, NE --> SYMPATHETIC
The las part is the somatic part that will be express as follow:
Spinal Cord --> Ach and N --> Skeletal Muscle --> SOMATIC
Cause by Rapid Correction of Hyponatremia, You can see in Quadriplegic and mute patient to be able to communicate by SLOW EYE BLINKING
We have also seizures and neurologic manifestations.
The pupil fails to constricting in the affected eye. But the light go to the opposite eye, the affected eye's pupil constricts briskly
Painless sudden unilateral blindness. Ophtalmoscopy desmonstrate pale, opaque fundus with a red fovea (cherry red spo
Arteries are markedly attenuated. Pt. may have underlying Atherosclerosis, Endocarditis or Temporal Arteritis
Painless unilateral blindness but tends to develop a little more slowly than C.R.A.O.
Are replicated in the S phase. Centrioles are made of nine tubular triplets.
They function in mitotic spindle formation and in the production of cilia and flagella.
Use for cervical incompetence (painless cervical dilatation in the second trimester) difference from PRETERM LABOR (painful cont
Two types: Level of the internal os (SHIRODKAR CERCLAGE). Or suture that is placed as high as possible (Mcdonald cercl
Propylactic is place at 12 -16 weeks. Emergency cerclage that is place based on findings of cervical dilation w/bulging membr
Occur 60s. Deposition of AlphaBeta Amyloid in the small arteries. Intracerebral bleeding occurs in the neocortex in a lobar distributi
60% are cause by Otitis media. Also can be cause by Sinusitis, bacterial meningitis (subdural empyema) or following tooth extraction
ischemic necrosis produce inflamation generaly in the brain, NSTx Corticosteroids
Acute onset of Headache, nausea + sudden loss of balance + good Muscular strength and no sensory defect + Consciousness pres
Factors that ↑ are: Multiple sexual partners, early age at first intercourse, S.T.D and cervical dysplasia History, HIV,Genital Warts,Ciga
Always related to Human Papillomavirus.
As follow:
CERVICAL ROOTS INERVATION

C5 mediates flexion abduction, and lateral rotation of the shoulder and flexion
of the elbow.
C5 and C6 mediate extension of the elbow.
C6 and C7 mediate flexion of the wrist.
C7 and C8 mediate extension of the shoulder, extension of the finger and
pronation of the elbow
C7 is not involved in abduction of the arm.
Degenerative Joint Disease involving the Cervical column. NSDx X-ray of the Cervical Spine.
M.C.C. Cervical Spinal Cord Compression in an adult onset is typically after the age of 50. (Degenerative Arthritis)
Produce Horner's syndrome = Ptosis, Miosis (Contraction pupillary), and often Anhidrosis (lack of sweating)
Assoc with POST-COITAL bleeding. (Except after the very first intercourse)
Risk of uterine rupture is increased. Vertical Uterine Incision give you 12 % of risk Uterine rupture. Low transverse Uterine incision th
Newborns delivered by cesarean have a higher rate of transient tachypnea compared with newborns delivered via vaginal de
Staying on a low purine diet are important meassure in the prevention of future attacks in patients with acute gouty arthritis.
Produce MYOCARDITIS due to TRYPANOSOMA CRUZI, it is edemic in vast areas of South America.
This protozoon can cause dysmotility of hollow orgams, such esophagus, colon and ureter.
Chagas disease can produce and ADQUIRED ACHALASIA, megacolon and megaureter
NSTx is Systemic Erythromicin. Dose of 50mg/kg.day/6 hours. A second course in about 20% of treated newborn will be neces
Hereditary, duplicated locus on Chromosome 17 p11.2 -Muscular weakness and wasting Assoc. with sensory changes
Autosomal DOMINANT polyneruopathy, manifesting w/ depressed tendon reflexes, reduced sensation, paresthesias, and burning
Fever, Jaundice, RUQ pain = choledocholithiasis M.C. place of the gallstone location is in the COMMON BILE DUCT.
Colobomas, Heart Defects, Choanal Atresia, Retardation, Genitourinary Abnormalities, and Ear Abnormalities.
If we have 4 abnormalities, an Echocardiogram is NSMx. The Ethiology is unknown.
Autosomal recesive disorder, a lysosomal defect is responsible for hypopigmented skin lesions in this disorder
characterized by oculocutaneous albinism and immunologic deficiency, including defective phagocyte, lymphocyte and natural
Defective chemotactic response would made Pts more susceptible to infections by bacteria such as Staph and Strep
Nausea and vomiting associated NSTx Dimehydrinate, Ondansetron and Metoclopramida
Non-Cardiac Origin: Muscular,costochondritis (Tietze Syndrome) or gastroesophageal reflux.
Non-Cardiac Origin: NSTx Oral Anti-inflamtory Tx and Prevention of muscle overuse
Suspect of Myocardial Infarction ( 2 -3 days after), Pulmonary Embolism ( 5 -7 days after) w/ distended neck veins. NSDx CPK-MB
Large Pleura Effusion is the treatment of choice
Used to compare proportions of categorized outcome.
Varicella is produce by the Varicella-zoster Virus. The best screen is VZIG (varicella-zoster virus immune globulin).
Drugs of choice are: Ethosuximide and Valproic Acid.
We will see correlations of age, groos motor, fine motor, language and social /cognitive
Childhood Development Milestone .
OSS MOTOR FINE MOTOR LANGUAGE SOCIAL / COGNITIVE

head/chest Tracks past midline Alerts to sounds, coss Recognizes parents,
hen prone Social smile
front to back, Grasps rattle Orients to voice: Enjoys looking around,

d back to front (5 mos) "ah-goo" razzes Laughs.
Unassisted Transfers objects, raking grasp Babbles Stranger Anxiety
s, pulls to stand Use 3 finger grasp Say mama/dada (nonspecific) Waves bye-bye, plays pat-a-cake
es (11 mos), walks alone Use 2 finger grasp Say mama/dada (specific) Imitates actions.
s backward Uses cup Uses 4 - 6 words Temper tantrums
kicks a ball Build tower of 2 - 4 cubes Names common objects Copies parent in tasks (e.g. sweeping)
up/ down steps Builds tower of 6 cubes Uses 2-words phrases Follow 2-step commands, remove clothes
with help, jumps throwing the ball overhead
ricycle, climbs stairs Copies a circle, use utensils. Uses 3-word sentences Brushes teethes w/help,
h alternating feet (3-4 years) washes/dries hands
ps Copies a cross Counts to ten Cooperative play.
Risk factor for DM2 later in life.

Causes a sexually-transmitted disease which is seen 5 to 25 % of pregnant woman
Approx one half to two third of children exposed during birth acquire C. Trachomatis infections.
Roughly half of the infected infants develop clinical evidence of inclusion conjunctivitis.
The infective form of the organism is the elementary body. The reticulate body is what is seen as inclusion body and is demonstrated by
However, the organism is best identified by cultures or antigen detection tests.
NSTx is Azithromycin in Pregnancy. S/S in newborn Steccato Cough, with infection in the eyes (2nd week).
Is the M.C. of nongonococcal urethritis. This organism exist in 2 forms:
1) Reticulate bodies, which are the metabolically active intracellular form.
2) Elementary bodies, which are the extracellular infectious form.
The organism is spread by sexual contact, and it may exist in asymptomatic women. Untreated carriers may continue to reinfect t
In some men, the disease may cause a triad of symptoms, including conjunctivitis, polyarthritis, and genital infection (Reiter's S
It is also capable of causing serious harm to women, including salpingitis and P.I.D., which can lead to infertility, ectopic pregnancy, an
Tetracycline and other antibiotics (e.g. erythromycin, doxycycline) that can penetrate into eukaryotic cells are appropiate
Because this organism is metabolically active only inside cells, tetracycline, erythromycin, doxycycline act really good in t
Chlamydia are intracellular pathogens, and thus elicit TH1 lymphocytes resonse and stimulation of CD8 + lymphocyte eff
The damage and scarring of the fallopian tubes, therefore, is a least in part due to the development of a Type IV hypersen
In other words Chlamydia cause a CYTOTOXIC T LYMPHOCYTE-MEDIATED CYTOLYSIS
Standart Inicial Tx. For symptomatic Chronic Lymphocytic Leukemia
Can cause a BONE MARROW SUPPRESSION (dose-dependent); APLASTIC ANEMIA rare (1 in 35,000)
Also cause "Gray Baby" Syndrome in neonates ( ↓ glucuronosyl transferase)
Activity and clincal uses:

- Bacteriostatic with a wide spectrum of activity
- Currently a backup drug of infections due to Salmonella typhi, B. fragilis, Rickettsia, and possible in bacterial meni
Pharmacokinetics:
- Orally effective, with good tissue distribution, including CSF.
- Metabolized by hepatic glucuronidation, and dose reudctions are needed in liver dysfunction and in neonates
- Inhibition of cytochrome P450.

mRNA-30 S (static)
(aminoglycosides o
wrong amino acid (-

3. Formation of peptide bond Cholamphenicol (50S) Inhibit the activity of Pept

acceptor to donor s
Pt.with vomiting is a common cause of METABOLIC ALKALOSIS. It is due the loss of CHLORIDE in VOMITING.
Side effect is NEUTROPENIA less 1500/mm³.
Is a phenotiazine antipsychotic that might be used initially to sedate MANIAC PTS.
Presence of a congenital membrane between the nose and the pharynx. Unilateral atresia may not cause S/S.
Most of newborns are obligate nose breathers, spells of crying force mouth breathing improving ventilation.
Intubation via the oropharynx will provide immediate relief and then, surgery should be performed to correct the atresia
Complication of Primary Sclerosing Cholangitis especially in presence of ULCERATIVE COLITIS and SMOKING
The primary liver tumor is characterized by mulitple white nodules involving the right lobe of the liver.
Cholangiocarcinomas, which are adenocarcinomas derived from the bile ducts.
Cholangiocarcinomas tend to track along the normal biliary system of the liver, forming multiple nodules along the arborizing b
The white nodules reflect this propensity. These tumors are extremely aggressive neoplams and frequently cause obstructiv
The pain may be relieve by walking and may be referred to the right scapula.
A important factor in the pathogenesis is: The hypomotility of the gallbladder leads to the acumulation of biliary sludge, important precursor of stone formatio
Cholesterol stones are formed when an imbalance between bile acid secretion and cholesterol output occurs.
w/ fever, ↑ WBC = acute infection (Enterococci, E. Coli, Klebsiella and Clostridium are commonly occuring enteric patho
The diarrhea produce a "isotonic contraction" = Decreased of Extracellular fluid volume (ECFV) w/o sginifcant efect ICFV.
Binds to a G-PROTEIN that activates ADENYLATE CYCLASE, thus INCREASED cAMP and causing massive fluid secreti
Can affect cells by blocking the guanosine triphosphatase (GTPase) activity of their Gs proteins.
On a cellular level, Inhibiting the activity of the Adenylate Cyclase in the cell would be helpful in reducing the harmful effects of
Related to Otitis Media. Painless ear discharge + marginal perforation of the Timpanic membrane+canal filled w/mucous, pus and gra
Also unresposive to Tx w/antibiotics.
3-Hydroxy-3-methylgutaryl coenzyme A reductase catalyzes the rate-limiting step in the biosynthesis of cholesterol.
al Hyperchylomicronemia = Lipoprotein Lipase Deficiency = ↑ Chylomicrons and blood levels of TG and Cholesterol is normal. No risk
al Hypercholesterolemia = LDL receptor Deficiency = ↑ LDL, Cholesterol but VLDL and TG are normal. Great risk of CAD
ial Combined Hyperlipidemia = Hepatic increased synthesis of VLDL = ↑ LDL, VLDL, TG and Cholesterol. Increase risk of CAD
al dysbetalipoproteinemia = Altered Apoprotein E = ↑ IDL, VLDL, TG and Cholesterol. Great risk of CAD
ial Hypertriglyceridmia = Hepatic overproduction of VLDL = ↑ VLDL, TG but LDL and Cholesterol are normal. Increase risk of CAD
d Hypertriglyceridemia = Deficient Apoprotein CII = Greatly ↑ of TG, ↑ of VLDL, chylomicrones, slightly ↑ of Cholesterol. No ris
w or w/o Phenobarbital or Ursodeoxycholate use to Tx Intrahepatic Cholestasis of Pregnancy.

A bile-sequestering agent, ↓ the absorption of other lipid-soluble (propanolol and furosemide) from the GI tract ↑ Hypertension Prob
Side effects are constipation, fecal impaction, hemorroids and abdominal pain. Should be take 4 hours prior to any other Tx
Post junctional Cholinergic Receptors. Target both activating drugs (direct-acting cholinomimetics) and cholinorecptor antagon
Nicotinic (Nn): Hexamethonium, mecamylamine
Nicotinic (Nm): Tubocurarine, atracurium, succinnylcholine
Muscarinic: Atropine, Benztropine, Glycopyrrolate, Scopolamine.
M1 and M3 = The 2nd Messenger is Gq coupled = ↑ DAB & IP3 w/intracellular Ca+.
M2 = The 2nd Messenger is Gi coupled = ↓ Adenylyl cyclase and cAMP. (e.g. Vagal estimulation slow the hea
Nn and Nm = No second messenger = Activation (opening) of Na/K channels.
S/S Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating, a
Also produce Abdominal Cramping. Antidote = ATROPINE (muscarinic antagonist) + PRALIDOXIME (used to regenerate active cho
Ach = Activitiy in M & N = AChE hydrolysis = Clinical Use: Short half-life (No Clinical Use)
Betanechol = Activity in M = No AChE hydrolysis = Rx Ileus (Post-op/neurogenic, urinary
Methacholine = Activity in M > N = Little AChE hydrolysis = Dx - bronchial hyper-reactivity
Pilocarpine = Acitivity in M = No AchE Hydrolysis = Rx- glaucoma (topical) xerostomia
The Indirect-acting Cholinomimetics are the inhibitor or Anticholinesterase
EDROPHONIUM = SHORT ACTING = DIFFERENTIATES MYASTHEMIA FROM CHOLINERGIC
PHYSOSTIGMINE = TETRARY AMINE (ENTER CNS), INTERMEDIATE-ACTING = RX- GLAUCOMA; ANTIDOTE IN ATRO
NEOSTIGMINE, PYRIDOSTIGMINE = QUATERNARY AMINES (NO CNS ENTRY) INTERMEDIATE-ACTING = RX- ILEUS, URINARY RET
NEOSTIGMINE, PYRIDOSTIGMINE = RX- MYASTHENIA, REVERSAL OF NON-DEPOLARIZING NM BLOCKERS
DONEPEZIL, TACRINE = LIPID SOLUBLE (CNS ENTRY) = RX - ALZHEIMER'S DISEASE.
ORGANOPHOSPHATES = LIPID-SOLUBLE, LONG-ACTING IRREVERSIBLE INHIBITORS = INSECTICIDES (MALATHION, PARATHION) e.g. NERVE G
Concave outlines of the distal ends of the bones no evidence of fraying.
S/S: Slowly enlarging, hard mass, older mass; and central calcification (implying that most of the mass is not calcified).
Osteosarcoma differential Dx is Osteosarcoma usually have more diffuse calcification, even if it poorly differentiated.
Chondrosarcoma have focal calcification and it is disease of older adults, osteosarcoma is a disease of young adults.
it is a branch of the facial nerve (CN VII) controls salivation form both the sumandibular and sublingual glands
Give Gentamicin to the Pt and should not give Tocolysis.
Contain chromosomal material (chromosome, histone, nucleosomes) in nondviding eukaryotic cells.
35 y. old pregnant woman with previous uncomplicated pregnancy in the 38 th week gestation = 1 in 200
35 y. old pregnant woman with previous uncomplicated pregnancy in midtrimester the answer will be 1 in 132.
The center of the Chromosome we call Centromere if the Centromere is like in the center we call Metacentric.
If the Centromere is close to the end we call Acrocentric. If the centromere is in the middle of the center and the end we call Subme
Describing Chromosomes: Centromere - constricted area toward center. Telomere - tips of chromosomes. Long arm - q; short arm
Metacentric - arms of equal length; Acrocentric - Centromere near one telomere; Submetacentric - centromere between middle an
The Short arm is call the "p" arm and the Longer arm is call the "q" arm.
Things that can be wrong with chromosome are numerically or structurally.
Numerical Chromosome Abnormalities: Euploidy - Cell has a multiple of 23 chromosome
Also we can have Haploid (one number of each pair) - Gametes. Diploid (two copies of each pair) - Somatic Cells
Triploid - 3 copies of each, 69 total (eggs fertilize by 2 sperms): 1 in 10,000 births, do not survive
Tetraploid - 4 copies of each (92 total): - very rare, fethal. - egg fertilized by 3 sperms.
Aneuploidy - Deviation from the normal number of chromosomes due to loss or gain of specific chromosomes
Aneuploidy - Generally caused by nondisjunction during meiosis. All Autosomal monosomies (one chromosome missing) are
Aneuploidy - Trisomies (three chromosomes) compatible w/survival to term w/chromoses 13, 18 and 21
Aneuploidies Sex Chromosomes: Turner Syndrome (45,X) and Klinefelter Syndrome (47, XXY).
Structural Chromosome Abnormalities (S.C.A.) : Clastogens may break chromosomes. Balanced alterations result in no loss or gain of ge
S.C.A.: Unbalanced alterations result in loss or gain of genetic material. Those that happen in germline can be transmitted to o
S.C.A.: Those that happen in somatic cells can cause cancer.
S.C.A.: The abnormality is XX (male) and XY (female). Because the SRY Gene (male).
S.C.A.: Reciprocal Translocation:2 Chromosome exchange pieces w/ each other.The abnormality will be show in the next ge
S.C.A.: Reciprocal Translocation: Of # 9 and # 22 (Produce Philadelphia Chromosome). Alters abl oncogene, leads to
S.C.A.: Reciprocal Translocation: Of # 8 and # 14. Results in overproduction of myc oncogene leads to Burkitt's Lympho
S.C.A.: Robersonian Translocation: Occurs only between Acrocentric Chromosome. Example # 14 and # 21.
S.C.A.: Deletion: Piece of Chromosome is missing. Can be Interstitial Deletion meaning the missing part it's from the middle of the
S.C.A.: Prader Willi and Angelman Syndrome (Chromosome # 15) is a example of Interstitial Deletion w/ Imprinting
S.C.A.: Terminal Deletion: When the end of chromosome is missing. Like Cri du Chat (Chromosome # 5).
S.C.A.: Chromosome Inversions: Gene are there but in different order. Pericentric Inversions include the centromere
S.C.A.: Chromosome Inversions: Paracentric inversions do not include the centromere
S.C.A.: Ring Chromosome: Occurs of the 2 ends of a single chromosome attach together.
S.C.A.: Isochromosome: 2 copies of one arm can be "p" arm or "q" arm, none of the other.
In the studies of cytogenetic we have this technics: Fluorescence In Situ Hybridazation (FISH) and Spectral Karyotyping
Fluorescence In Situ Hybridization (FISH): Chromosome-specific DNA segment is labeled w/a fluorescent tag to create a pr
Fluorescence In Situ Hybridization (FISH): Probe is hybridized w/patient's chromosome.
Spectral Karyotyping (S.K.): Like made a lot of FISH at once.
Deletion of VHL gene (tumor suppressor) related to VON-HIPPEL-LINDAU DISEASE assoc with HEMANGIOBLASTOMAS
Defect in Chromosome 4 cause depression, choreiform movement = HUNTINGTON'S DISEASE. Onset between 20 and 50 y
Defect in long arm of Chromosome 4 is related to FASCIOSCAPULOHUMERAL MUSCULAR DISTROPHY
M.C. oncogenic translocation in Acute Myelogenous Leukemia also see in Chromosome 6;11.
Related to Familial Adenomatous Polyposis = Colon becomes covered with adenomatous polyps after puberty = Deletion in Chro
also related to Cri-du-chat syndrome = Congenital deletion of short arm of chromosome 5 (46,XX or XY, 5p-).
Findings in Cri-du-chat syndrome are microcephaly,severe mental retardation,high-pitched crying/mewing, epicanthal folds, cardiac
Site of the Suppresor Gene APC, which is involve in the pathogenesis of colon cancer and familial adenomatous polypo
with defect in CFTR gene related to CYSTIC FIBROSIS (AUTOSOMAL-RECESSIVE).
CYSTIC FRIBROSIS (AUTOSOMAL-RECESSIVE) Malfunctioning of Cl channels. Pt w/ recurrent pulmonary infection and pan
Translocation = BURKITT'S LYMPHOMA (C-MYC activation). Also see in Non-Cleaved Cell Lymphoma
(q22; q22) translocation is Assoc with ACUTE MYELOGENOUS LEUKEMIA (M2)
(q34:q11) Translocation = PHILADELPHIA CHROMOSOME. Present in CHRONIC MYELOGENOUS LEUKEMIA (BCR-ABL
Site of the WILMS TUMOR SUPPRESOR GENE (WT-1). Wilms tumor is derivate mesoneprhic mesoderm can include bone, c
Translocation see in MANTLE CELL LYMPHOMA.
Translocation see in EWING'S SARCOMA (concentric deposition of circumferential reactive periosteal bone = onion sk
EWING'S SARCOMA in Bx material stained with hematoxylin and esoin reveals small uniform blue round cells.
The M.C. genetic abnormality see in childhood (B-cell Acute Lymphoblastic Leukemia) involves TEL-AML 1 Fusion Gene.
The TEL-AML1 Fusion Gene, which is created by translocation t(12;21). This abnormality occurs only in B-precursor ALL an
Is the site of the TUMOR SUPPRESSOR GENE for Retinoblastoma and Osteosarcoma.
Is the site of the TUMOR SUPPRESSOR GENE BRCA-2 GENE for Breast Cancer.
About 20% of Pts w/chromosome 13 abnormalities develop Retinoblastoma.
Translocation we see in FOLLICULAR LYMPHOMA= M.C. Non-Hodgkin in adult (BCL-2 Activation)
Translocation see in M3 type of AML (responsive to all-trans retinoic acid).
with mutation of APKD1 related to ADULT POLYCYSTIC KIDNEY DISEASE assoc. with BERRY ANEURISM
Approx half of all SPONTANEOUS ABORTIONS are of fetuses with major chromosomal defects, M.C.C TRISOMY 16 and trip
The triploidy is due to fertilization of an egg by two sperms. Trisomy 16 and triploidy don't produce viable offspring, unlike 45X,0
Long arm of Chromosome 17 related to NEUROFIBROMATOSIS TYPE 1 (VON RECKLINGHAUNSENS'S DISEASE)
Charcoat-Marie-Tooth Disease = Hereditary, duplicated locus on Chromosome 17 p11.2 .
it is the site of the TUMOR SUPPRESSOR GENE p53 (involved in most human cancer).
it is the site of the TUMOR SUPPRESSOR GENE NF-1 = Neurofibromatosis type I.
it is the site of the TUMOR SUPPRESSOR GENE BRCA-1 = Breast and Ovarian Cancer
Cause Myotonic Muscular Dystrophy, which is an autosomal dominant disease; the affected gene has been localized to chr
Myotonic dystrophy is assoc with cataracts, testicular atrophy, heart disease, dementia, and baldness in addition to muscular w
Defect on TUMOR SUPPRESSOR NF2 GENE related to NEUROFIBROMATOSIS TYPE 2 assoc. w/ bilateral acoustic neu
CATCH 22 = Cleft palate, Abnormal facies, Thymic aplasia, Cardiac defects, Hypocalcemia (microdeletion of chromosome
Variable presentation as DiGeorge Syndrome
Mammalian DNA uses only about 7% of the genome to transcribe RNA.
Inactive DNA, or heterochromatin, is tightly wound in an organized fashion in conjunction w/ nucleosomes.
Inactive DNA is also methylated at CG islands, but the exact relation between inactivation and methylation is not clear.
Active segments of DNA are called EUCHROMATIN. Euchromatin is not wound as tightly and is less protein-bound than HETEROC
Because it is less organized, euchromatin also happens to be more sensitive to enzymatic digestion by DNase I.
DNase I can be used to determine active regions of DNA
X- linked recessive inheritance pattern = DUCHENNE'S MUSCULAR DYSTROPHY.
Also call INVERSION in which the central segment produced by two breaks is inverted prior to repair of the breaks.
PERICENTRIC INVERSION are the one that include the CENTROMERE
PARACENTRIC INVERSION are the one that NOT include the CENTROMERE
Klinefelter's Syndrome (Male XXY) 1:850 . S/S Testicular atrophy, eunuchoid body shape, tall, long extremeties, gynecomas
Also in Klinefelter we see female hair distribution. Presence of inactivated X chromosome (Barr Body).
Turner's Syndrome (female X0) 1:3000. Short stature, ovarian dysgenesis (streak ovary), webbing of neck, coarctation of th
Tuner's Syndrome is the M.C. cause of primary amenorrhea. No Barr Body
Double Y males, male XYY, 1:1000 Phenotypically normal, very tall, severe acne, antisocial behavior (seen in 1-2% XYY male
Pseudohermaphroditism: Disagreement between the Phenotypie (external genitalia) and Gonadal (testes vs. ovaries) sex
Female Pseudohermaphroditism (FPSH) (XX) = Ovaries present, but external genitalia are virilized or ambiguous.
FPSH due to excessive and inappropriate exposure to androgenic steroids during early gestation
FPSH's inappropriate exposure will see in congenital adrenal hyperplasia or exogenous administration of androgens during pr
Male Pseudohermaphroditism (MPSH) (XY) = Teste present, but external genitalia are female or ambiguous.
MPSH is the M.C. form is androgen insensitivity syndrome (Testicular Feminization = Androgen Insensitivity Syndrome)
True Hermaphrodite (46, XX or 47,XXY) = Both ovary and testicular tissue present; ambiguous genitalia. Very rare.
Androgen Insensitivity Syndrome = A.I.S. = (46, XY) = Defect in androgen receptor resulting in nomal-appearing female.
A.I.S. has female external genitalia with rudimentary vagina; uterus uterine tubes generally absent; develops testes.
In A.I.S. the testes are often found in labia majora; surgically removed to prevent malginancy.
In A.I.S. the levels of TESTOSTERONE, ESTROGEN, and LH are all HIGH.
5 Alpha-reductase Deficiency (5-A.R.D.) = Unable to convert testosterone to DHT.
5-A.R.D. = Ambiguous genitali until puberty, when ↑ testosterone causes masculnization of genitalia.
5-A.R.D. = Testosterone/estrogen levels are normal; LH is normal or ↑.
Fragile X Syndrome = X-linked defect affecting the methylation and expression of the FMRI gene.
Fragile X Syndrome = Is the Second M.C.C of Genetic Mental Retardation.
Fragile X Syndrome = Assoc. with macro-orchidism (enlarged testes), long face with a large jaw, large evert ears, and auti
Cerebral Vermis Atrophy. Fatigue + Weakness. Hypocalcemia + Hypokalemia + Hypomagnesium
Risk factor FOR THE DEVELOPMENT OF GOUT.
Cough Productive wih 5 to 10 ml of sputum each morning. + hemoptysis. X-ray film is CLEAR. Middle Age. Smoker.
The hemoglobin and hematocrit levels are often elevated to compensate for the chonic hypoxia due to hypoventilatio
NSTx Gabapentine + TCA's (Amitriptyline or Desipramine)
Deficiency of NADPH oxidase in neutrophils, resulting in loss of the first step of the Myeloperoxidase system (Absence of Respira
Recurrent or unusual lymphadenitis, hepatic abscesses, osteomyelitis at multiple site, or unusual infections with catalase + org
M.C. catalase + organisms (S. aureous, S. marcescens, B. cepacia, and Aspergillus Sp.).
NSDx by NITROBLUE TETRAZOLIUM (NBT) SLIDE TEST
Other test of Dx are: Flow cytometry or cytochrome C reduction. NSTx Daily TMS and gamma-interferon three times a wee
Neutrophil cytochrome B Deficiency is common in this disease.
Recurrent infection with S. aureus and Aspergillus spp suggest CGD. Defect in NADPH oxidase of neutrophils.
Pt can Kill Strep because Catalase Negative but Staph is Catalase positive can not be kill.
M.C.Complication are: C.H.F, Severe Infection by Encapsulated Organisms, Chronic Liver Failure, and Cardiac Arrhyth
CD 19 and CD 20 are the markers present on the abnormal cells and can be use to specifically indentify such cells in a flow cytometr
Lymphocytes are accumulate progressively in the marrow and blood because of inactivation of the apoptosis-inhibiting Bc
B-Lymphocytes neoplastic disorder. Lymphocytes look-mature. Pt with Lymphocytosis and lymphadenopathy (STAGE I) No Tx
Stage II (Progresive fatigue and organomegaly), Stage III (Severe Anemia), Stage IV (Thrombocytopenia) NSTx is CHLORA
Uncommon below the age of 40. S/S in blood are: Pale RBC, very dark blue mature lymphocytes and pink, crushed lymphocytes (sm
In USMLE, CLL is uncommon in persons younger than 40 years of age it is usually seen in Pts older than 50 years of age
It is found more frequently in men than in women. CLL is a clonal expansion of neoplastic B lymphocytes in more than 95% o
These cells commonly have trisomy 12 alone or have additional chromosomal abnormalities.
Most Patients with CLL develop some degree of hypogammaglobulinemia.
Metamyelocytes + Alkaline phosphatase ↓ + ↑ Uric Acid + Philadelphia Chromosome (chromosome 9,22) in W.B.C
C.M.L. NSDx Philadelphia Chromosome + Low Leukocyte Alkaline Phosphatase. Small Mature lymphocytes w/o blast for
Leukocytosis is the most prominent laboratory finding. Bone Marrow Bx usually reveals almost 100% cells.
Accompanying the leukocytosis of CML is a marked ↑ of Serum Vit B12 levels and an ↑ Serum Vit B12-binding capacity.
Elevated levels in serum of Pts w/CML are caused by the turnover of the increased granulocytic mass.
The age-adjusted incidence of CML is higher among men than among women.
Purulent aural discharge, tympanic membrane appears thickened w/calcific patches and perforations.
Malabsorption Steatorrhea, Loss of parenchyma and calcification of the pancreas, related with ALCHOHOLISM.
NSDx will be CT scan of the upper abdomen give information for possible, pseudocyts, dilated ducts, calculi, or areas amenab
If surgery is contemplated, ERCP wil then be needed. ERCP would not preced CT scan in the initial evaluation.
Sonogram is excellent way to follow the size of pseudocysts that are being observed
Scar tissue and blunting of the calix you can see in I.V. pyelogram.
Impaired ammonia excretion is the principal mechanism of METABOLIC ACIDOSIS in Chronic Renal Disease.
Improve prognosis u give PROTEIN RESTRICTION and ACE INHIBITORS. Stop ACE Inhibitors if Creatinine level ↑ 3 - 3.5
Definition: B.U.N/Creatinine Ratio more than 10 to 1 for more than 3 months. No Erythropoeitin
Metabolic Acidosis w/ increase anion gap, bone buffering the excess of hydrogen and we can ending w/osteoporosis.
We can see Osteomalacia, causing Secondary Hyperparathyroidism.
INTERMITENT PORPHYRIA = NSDx URINE PORPHOBILINOGEN
Is best treated with: Rate Control which is Best Achieved w/either Calcium Channel Blockers or Beta Blockers.
Tearing of briding veins, slowly enlarge and compress the brain resulting in DEMENTIA. NSDx CT/MRI studies.
In I.V.P. shows " RING SHADOW" defects at the tips of Renal Papillae
You can see in Long History of Painful OsteoArthritis use of NSAIDs
U.R.I. + Glomerulonephritis + c-ANCA + Marked Eosinophilic
Also known as Allergic Granulomatosis and Angiitis is charactherized by necrotizing vascular lesions similar to those o
It's assoc with asthma and eosinophilia. Additionally, granulomatous involvement of lungs, peripheral nerves or skin also comm
Facial Muscle twitching used as a marker for the tendecy to tetany that is produce by hypocalcemia. It can be see in post-Thyroid S
The M.C. Consistent reversible risk factor for pancreatic cancer.
Inhibitor of renal dihydropeptidase I, always give with IMIPENEN (drug of choice for ENTEROBACTER) to ↓ inactivation in re
Whose fibers travel w/C.N.III (the oculomotor), provide PNS supply to the pupillary sphincter (which contracts the pupil whe
Dysfunction of the PNS stimulus (main function of the Ciliary Ganglion) produce ANISOCORIA.
Can cause psychiatric effects of clinical significance, inlcuding delusions and psychosis. The mechanism is unknown
NSTx is reduce the dosage of the medication, and discontinue it, if an alternative therapy is available.
It is H2 receptor antagonist, also a potent hepatic enzyme inhibitor can ↓ the metabolism of the hepatically metabolized medication lik
Is a QUINOLONE that inhibits DNA gyrase, thus interfering w/bacterial DNA synthesis
Pathogenetic mechanism seen in Type 2 MembranoProfilerative Glomerulonephritis (nephritic or combined nephritic/nephrotic
ECG changes: V5-V6, I and aVL

It's always diffuse never focal. Regenerative nodules are abundant in Pts w/cirrhosis. This condition predispone to Hepatocellula
We need to keep on eye on these following scenarios: Effect of Portal Hypertension and Effects of Liver Cell failure.
Effect of Portal Hypertension Effects of Liver Cell failure
Esophageal varices (hematemesis) Coma, Scleral ictrus
Peptic Ulcer (melena) Fetor hepaticus (breath smells like a freshly openend co
Splenomegaly Spider nevi, Gynecomastia, Jaundice
Caput Medusae Loss of sexual hair
Ascites Liver "flap" = Asterixis (coarse hand tremor)
Testicular atrophy Bleeding Tendency (decreased prothrombin)
Hemorrhoids Anemia, Ankle edema.
Portacaval shunt between splenic vein and left renal vein may relieve portal hypertension.
Inhibit cytochrome P450 3A4 can interact w/erythromycin causing Torsades de pointes, QT prolongation, Ventricular tachycardia and Ventr
Old Pt + Hematuria and the rest of P.E. unremarkable must be schedule for a CISTOSCOPY.
Or Isocitrate is a potent Acitivator of Acetyl CoA carboxylase for the process of fatty acid synthesis
Assoc words similar in sound but no in meaning. (clang association). Like: "killin, chillin and thrillin".
Give for Tx of Pt w/Communicty-acquired penumonia who does not need Hospitalization
Give w/ Ceftriaxone to Pt w/Community-Acquired Penumonia who does need Hospitalization.
Is a macrolid antibiotic that inhibits hepatic enzymes, including those that metabolize WARFARIN.
Coadministration of warfarin and clarithromycin results in enhanced warfarin activity, pronounced anticoagulation and hematur
We have DR2, DR3, DR4, DR5, DR7
DR2 is closely associated w/ HAY FEVER (relative risk 19). DR2 is also assoc. w/ NARCOLEPSY and MULTIPLE SCLEROS
DR3 is assoc w/ GOODPASTURE'S SYNDROME, CELIAC SPRUE, TYPE 1 DIABETES and S.L.E.
DR4 is assoc w/ PHEMPHIGUS VULGARIS, RHEUMATOID ARTHRITIS, and TYPE 1 DIABETES.
DR5 is assoc w. PERNICIOUS ANEMIA and JUVENILE RHEUMATOID ARTHRITIS
DR7 is assoc w STEROID NEPHROTIC SYNDROME
Autosomal Recessive, caused by Galactose-1-phosphate Uridyl Transferase. (G-1-PUT) that aid in the conversion of Galactose-1-phos
Deficiency of G-1-PUT results in buildup of Galactose-1-Phosphate, Galactose, and Galactitol. These substance are toxic to Kidney, Liv
S/S: Infants has: Nonspecific findings, including lethargy, irritability, feeding difficulties, poor weight gain, jaundice.
Also other finding are: Hepatomegaly, ascites, splenomegaly, convulsions, cataracts and mental retardation
Lab Findings: Hypoglycemia, aminoaciduria, galactosuria, markedly reduced galactose-1-phosphate uridyl transferase
Major contraindication to a vaginal birth after cesarean (VBAC). Pt w/previous Classic Cesarean Delivery have 10% risk of ute
It is one of the two main LEARNING and BEHAVIOR MODIFICATION. The other main is OPERANT or INSTRUMENTAL CON
We have 3 types in Learning and behavior modification two main ones (classical and operant) and one supplemental (mo
a) CLASSICAL CONDITIONING, b) OPERANT OR INSTRUMENTAL CONDITIONING, c) MODELING, OBSERVATIONAL or SOCIAL LEA
In Classical Conditioning we have:
** Unconditoned Stimulus (UCS) to Unconditioned Response (UCR)
** Conditioned Stimulus (CS) to Conditioned Response (CR)
** Stimulus Generalization: An organism's tendency to respon to a similar stimuli with the similar response.
** Extinction: Removal of the pairing between the UCS and the CS results in a ↓ probability that the CR will be made
In Operant or Instrumental Conditioning we have:
** A new response is emitted, perhaps randomly at first, which results in a consequence (new behavior)
** A new response occurs to an old stimulus. Note the triggering stimulus (REINFORCEMENT) occurs after the response
** Reinforcer is defined by its effects. Any Stimulus is a reinforcer if it increases the probability of a response.
** Types of reinforcers: Positive, Negative, Punishment and Extinction.
STIMULUS: (S)
ADD REMOVE

BEHAVIOR: (R)
** Reinforcement Schedules: We have 2 schedules: Continuous Reinforcement and Intermittent (or Partial) Reinforcem
** Continous reinforcement: Every response is followed by a reinforcement.
** Continous reinforcement: Results in fast learning (acquisition)
** Continous reinforcement: Results in fast extinction when reinforcement is STOPPED.
** Intermittent (or partial) Reinforcement: Not every response is REINFORCED.
** Intermittent (or partial) Reinforcement: Learning is Slower. Reponse is HARDER to extinguish.
** Intermittent (or partial) Reinforcement: We have: INTERVAL SCHEDULES and RATIO SCHEDULES.
** Intermittent (or partial) Reinforcement = Interval Schedules, they based on the passage on time before reinforcement i
1) FIXED INTERVAL SCHEDULE: Example: Working extra hard before bonus at the holidays
2) VARIABLE INTERVAL SCHEDULE: Example: Pop quizzes or Surprise bonuses at work.
** Intermittent (or patial) Reinforcement = Ratio Schedules,they based on the # of behaviors elicited before reinforcemen
1) FIXED RATIO SCHEDULE: Example: Paying workers on a piecework basis.
2) VARIABLE RATIO SCHEDULE: Example: Slot Machines.
CONTINGENCY
TIME BEHAVIORS
CONSTANT FIXED INTERVAL (FI) FIXED RATIO (FR)

SCHEDULE:
CHANGING VARIABLE INTERVAL (VI) VARIABLE RATIO (VR)
In Modeling, Observational, or Social Learning, we have:

1. Watching someone else get Reinforcement is enough to change behavior
2. Follows the same principles as in OPERANT CONDITIONING
3. Correlating the effects of watching violence on television with committing violence "in the real world" stems from this concep
4. Part of why group therapy works.
5. Other applications: Assertivenesss training, social skills training, preparing children for various frightening or painful medic
NSTx Immobilization by a Figure Eight Device.
Occurs and a bruit is present and arterial injury must be rule out with an angiogram.
of Vagina and Cervix = D.E.S. + pregnant woman offspring increase the risk to have it
Rate of elimiantion of drug / Plasma drug concentration.
Clearance (CL) - Relates the rate of Elimination to the plasma concentration
Clearance (CL) - Rate of elimination of drug / Plasma drug concentration
If the urine osmorality was 300 mOsm/L (isotonic urine), free water clearance would be zero = ISOTONIC URINE.
Positive Free Water Clearance = Hypotonic Urine is formed (osmolarity < 300 mOsm/L)
Negative Free Water Clearance = Hypertonic Urine is formed (osmolarity > 300 mOsm/L).
CH2O = V - Cosm, V = Urine Flow Rate (U.F.R.) ; Cosm = Uosm V/P osm
Glucose at normal level is compeltely reabsorbed in PROXIMAL TUBULE.
At plasma glucose of 200 mg/dL, glucosuria begins (thresold). At 350 mg/dL, transport mechanism is saturated ™
As an index of GFR and Renal Function. We can explain as follow:
The segment of the nephron with the highest concentration of inulin is the terminal collecting duct
The segment of the nephron w/ the lowest concentration of inulin is Bowman's capsule
Renal Blood Flow = ERPF / 1 - Hct.
If Renal plasma flow is 600 ml/min and the Hct is 50%, renal blood flow is 1200 ml/min.
Is a protein synthesis inhibitor. It binds to 50S bacterial ribosomal subunit, acts to inhibit the formation of the initiation co
It is NOT a Macrolide. Also inhibits the translocation of the aminoacyl peptide during protein synthesis.
Is effective against some anaerobes (e.g. Bacteroides species) as well as against some gram-positive cocci (Streptococc
It is used to treat severe anaerobic infections above the diaphragm (e.g. aspiration pneumonia, lung abscess).
Also it is use for endocarditis prophylasis before dental procedures in patients with valvular heart disease.
Side effects: Nausea; Skin rashes, Impared liver function; Pseudomembranous colitis (C. difficile overgrowth).

mRNA-30 S (static)
(aminoglycosides o
wrong amino acid (-

3. Formation of peptide bond Chloramphenicol (50S) Inhibit the activity of Pepti

acceptor to donor s
GLUCOSE, GALACTOSE AND FRUCTOSE are all reducing sugars, and ↑ of all of these sugars can be detected wit this test
Can cause MANIA
Is a second line of Tx in O.C.D.
Is a long-acting benzodiazepine that can be used to start detoxification from short-acting benzodiazepine or to control S/S of a
Has intermediate length of action and is used to treat absence seizure and panic disorders.
Alpha 2 receptor agonists, directly inhibit pancreatic insulin secretion, thereby also decreasing secretion of the proinsulin-derived C
Irregular large organism swimming in the bile duct. Clonorchis Sinensis lives in the Bile ducts
Cause the LIVER FLUKE, different from the Schistosoma japonicum (S.J.) because S.J. lives in blood vessels
Rapid onset of visual problems, headache, nausea and vomiting. NSTx I.V. Acetazolamide
After placement of a catheter in subclavian vein NSTx Needle Thoracostomy in the Second Intercostal space
Genus Features: Gram-positive rods, Spore forming, Anaerobic.
Clostridium Species: Botulinum, Difficile, Perfringens, Tetani.
cause BOTULISM
Endoscopy shows colitis + pseudomembranes covering much of the distal colon surface
Associate with PSEUDOMEMBRANOUS COLITIS. NSTx Metronidazole or Vancomycin
Clindamycin, Ampicillin, Amoxicillin, and Cephalosporins have a high incidence of Causing the DIARRHEA and predispone an infecti
causes GAS GANGRENE. Sometimes mild gastroenteritis 6 - 24 hours.
causes intra-abdominal infections after bowel perforation
Distingusihing Features: Large gram-positive, spore-forming rods, Anaerobes, Produces Tetaus toxin. Causes Tetanus
Reservoir: Soil. Transmission: Puncture wounds/trauma (human bites), requires low tissue oxygenation (Eh)
The Pathogenesis is as follow:
** Spores germinate in the tissues, producing tetanus toxin (and exotoxin also called tetano-spasmin)
** Carried intra-axonally to CNS
** Binds to ganglioside receptors
** Blocks release of inhibitory mediators (glycine and GABA) at spinal synapses
** Exitatory neurons are unoppposed --> extreme muscle spam
** One of the most toxic substances known.
Disease: Tetanus = Risus sardonicus, Opisthotonus, Extreme muscle spams.
Diagnosis: Primarily a clinical diagnosis; organism is rarely isolated.
Tx of Actual tetanus: Hiperimmune human glublin (TIG) to neutralize toxin plus metronidazole or penicillin.
Tx of Actual tetanus: Spasmoytic drugs (diazepam); debride; delay closure
Prevention: Toxoid is formaldehyde-inactivated toxin. Important because disinfectants have poor sporicidal action.
Prevention: Care of wounds: proper wound cleansing and care plus treatment.
NSTx in Oral Candidiasis it is often first manifestation of HIV infection.
Atypical Antipsychotics Side effect AGRANULOCYTOSIS, also can produce MYOCARDITIS, Hepatitis, hyperglycemia.
It is use when the Tx with Risperidone felt. It exert and antagonistic effect on D1 and D4 receptors,
it is also antagonists on the alpha-adrenergic, histaminergic, serotonergic, and cholinergic systems.
Enlargement of the distal segments of the fingers and toes due to proliferation of conective tissue.
Assoc. with Lung Cancer, mesothelioma, bronchiectasis, and hepatic cirrhosis.
paroxysmal, short-lasting, nonthrobbing with Periorbital headache + Awake the patient or onset of sleep + Ipsilateral Rhinorrhe
Unilateral headache (usually around orbits) assoc w/ marked autonomic S/S like conjunctival injection, lacrimation, rhinorrhea, nasal congest
The extrinsic pathway is activated by a LIPOPROTEIN called TISSUE FACTOR
The intrinsic pathway is activated by CONTACT W/FOREIGN SURFACES
Late Rebleeding it is going to be the problem, no cutting from superficial wounds.
As follow:
COAGULOPATHIAS .
Normal Decrease Increase Variable
Platelet Count, Bleeding time PT PTT
PT Factor VIII Bleeding Time, PTT
PT, Bleeding Time Factor VIII PTT
Bleeding Time PTT, PT
ECG shows Left Ventricular Hypertrophy, X-ray films shows notching of the inferior margins of the ribs
Discrepancy in B.P. of upper extremeties w/lower extremeties. X-ray shows Rib Notching from enlargement of the intercostal
X-ray in Infants with severe leads to cardiac enlargement and increased pulmonary vascular markings.
INFANTILE TYPE = Aortic stenosis proximal to insertion of ductus arteriosus (preductal).
ADULT TYPE = Stenosis distal to ductus arteriosus (postductal).
ADULT TYPE = Associated w/ notching of the ribs, hypertension in upper extremities, weak pulses in lower extremeties.
In fully compensated (growth and developmental are normal), blow flow is normal in the upper and lower body despite and ↑ arteri
In fully compensated cases we will see a decrease in the vascular resistance in the lower body.
The ↑ arterial pressure (about 50% higher) in the upper body compared the pressure in the lower body.
This is because resistance = pressure/blood flow, it's clear that resistance must be↓ in lower portion of the body.
We have also Pre-ductal type that occurs in TURNER Sx.
The Post-ductal type are not present at birth. It will occur as in adult, they are surgical correction.
Hypertension in these patients is common. This Hypertension acitved of the RENIN SYSTEM.
But after surgical correction the hypertension will be corrected to with reduction of the RENIN.
Rare Pts w/retinal vascular abnormalitites can develop retinal exudation leading to retinal detachment (Coat's Sx). We can see in Pts
Cause behavioral changes, psychotic phenomena, and elevations in vital signs.
However, Dysarthria, Ataxia and nystagmus are not usually assoc. w/cocaine intoxication.
Euphoria, estimulation of C.N.S w/restlessness, excitement, agitation, ↑ motor activity, mydriasis, ↑ respiratory rate and hyperte
Often the Pt complaint of chest pain secondary to Myocardial injury that ranges form agina pectoris to M.I.
Also cause nausea, insominia, and emaciation in the chronic user.
Complication include C.V.A secondary to hypertension, rhabdomyolysis, pulmonary edema with alveolar hemorrhage (hemorrhagic
Another complication are pneumomediastinum or pneumothorax. Cardiomyopathy in chronic users may lead to depressed cardiac functi
Cause dysphoric mood and incrased appetite. No dry mouth, no injected conjuntivis
Sputum Gram shows multiple hyphae, common in Southwest. Lung auscultation fine dry rales, Chest X-ray show diffuse infiltra
Pulmonary fungal infection endemic to the Southwestern U.S. (San Joaquin Valley, CA, New Mexico, Arizona). Known the "gr
S/S: flu-like illness or acute pneumonia and involve extrapulmonary sites, including bone, CNS and skin.
Also S/S: Fever, anorexia, headache, chest pain, non-productive cough, dyspnea, arthralgia, and night sweats.
CXR finding may be normal or may show infiltrates, nodule, cavity, mediastinal or hilar adenopathy, or pleural effusion.
Use in panic Disorder, effective Tx inolves the use of C-B Th exposing the patient to disturbing stimuli in attempt to develop coping
Like Delirium, Dementia, Amnestic Disorder most likely symptoms are confusion and disorientation
Are cause by the HSV, which usually infects the lips, philtrum, and the areas around the nares of affected individuals.
After the primary infection, HSV establishes a latent state in the ganglia of CN V where the 2nd (CN V2) and 3rd (CN V3) bra
There are also many types of collagen but the most important are follow:
Is found in skin, bone, tendons and most other organs.
It is usually destroyed in osteoarthritis in elderly pt. This type of collagen is found in cartilage (and also in vitreous humor).
Is found in blood vessels, uterus and skin
Is found makes basement membranes
is a minor component of interstitial tissues and blood vessels.
Location is usually in the 3rd ventricule, blocking the foramen of Monro.
Bx of the cyst consists a single layer of mucin-producing columnar ephithelium with a ciliated apical surface.
First choice in Acute attacks of GOUTY ARTHRITIS. Oral Tx w/Indomethacin no side effects.
Dark Urine+shaking chills+Scleral icterus+ enlarged Spleen+Acral Cyanosis + Livedo Reticularis pattern on Pt's legs.
Common in the elderly assoc with mycoplasma infection + Indirect Bilirrubin and LDH ↑ + Serum HAPTOGLOBIN ↓. Direct Co
NSDx is COLD AGGLUTININ TITRATION
In older woman M.C. is 80 % BENIGN (15-20% of malignancy). Cold nodule in Man, young woman, or Child usually is MA
REMEMBER: Right Side Colon Cancer Bleed. Left side Colon Cancer Obstruct.
Weight Loss + Pencil thin Stools + Pale apperance + Elevated Heart Rate + Occult blood test (+) + Hematocrit (25%) ↓
NSDx COLONOSCOPY. Related to Carcinoembryonic Antigen (CEA).
Marantic Vegetation are present in cardiac valve in Pt. w/Cancer Colon.
Things to REMEMBER about POLYPS:
Juvenile polyps, located in the rectum usually come out in the anus, M.C. in young people. They are no malignant
Pt. w/ familial polyposis don't have polyps at birth and all the manifestation are later in life.
Because Autosomal Dominant disease have late manifestation, penetration and variable expression
We can see: Tubular Adenoma, Hyperplastic and Villous Adenoma Polyps
Tubular adenoma (Strawberry) polyps are pre-cancer lesion for COLON CANCER
Tubular adenoma: Pedunculated polyp w/a cauliflower- like neoplasm attached to the colonic mucosa by a thin stalk.
Tubular adenoma: These neoplastic polyps contain dysplatic colonic glands and may be precursors to Colonic Adenocarcinom
Tubular adenoma: Malignant transformation is related to the size, severity of dysplasia and amount of villous architecture on histolog
M.C. polyps in the GI tract is a hyperplastic polyps, little polyps (hamartomas) no neoplastic M.C. located in the sigmoid co
Hyperplastic polyps: Are small, sessile proliferations of hyperplastic epithelium.
Hyperplastic polyps: They lack stalks and are smooth, hemispheric mucosal protusions.
Villous Adenoma: are sessile (based tumor with a finger), like, brushy surface resembling a "Sea Amenone"
Villous Adenoma (look like small intestine). M.C. in sigmoid. 50% to be malignant if they do they have the greatest maligna
Things to REMEMBER about POLYP'S DISEASES.
Turcot's Syndrome, Gardner Syndrome, Peutz-Jeghers, Multiple Harmatoma Sydnrome (Cowden Syndrome), and Cronkite-Ca
Supplied by the L. Colic Branch of the Inferior Mesenteric Artery (arises from the Aorta at L3 between the Gonadal Art. and the bi
The defect underlying combined hyperlipidemias is unknown. Research studies suggest a deficiency in apoprotein CII.
In this disorder, serum levels of very-low-density lipoproteins (VLDLs) and chylomicrons are ↑, leading to a COMBINED HYPE
Alcoholism, diabetes mellitus, and oral contraceptives are also capable of elevating levels of VLDLs and chylomicrons
Coronary Heart Disease, Cancer, Diabetes, Alzheimer Disease.
Heterogeneous complex(usually acquired rather than congenital).Onset of recurrent bacterial infections. ↓ antibody levels. Occurs 2n
Normal B cells (distinguish from X-linked agammaglobulinemia). Cellular immunity intact, variable T cell defects, Other autoinmun
Hypogammaglobulinemia w/markedly ↓ IgG, recurrent pyogenic infections of the Upper Respiratory Tract and intestinal giardi
Also we can see failure of lymphocytes to differentiate into plasma cells. IgA and IgM are also decreased.
These Pts have a ↑ risk for B-Cell Lymphomas, Gastric Carcinoma and Skin Cancer. NSTx Monthly I.V. of Immune Globulin
Is actually a heterogeneous complex (usually acquired rather than congenital)disease of differing etiology that share a similar c
An important distinguished feature from X-linked agammaglobulinemia is that the number of B cells is normal.
This clinical profile is characterized by the onset of recurrent bacterial infections secondary to markedly decrease antibody leve
Tipycally becomes clinically evident in the second or third decade of life.
Some patients have intact cellular immunity, while others have variable T cell defects.
Other autoimmune conditions (notably Addison's disease, thyroiditis, and rheumatiod arthritis) are common in these Pts and th
GI S/S = nodular lymphoid hyperplasia in the GI tract, other features are bronchiectasis, carcinoma, and lymphomas
Newer antineumococcal quinolonas, like levofloxacin or gatifloxacin are the drugs of choice.
For outpatient therapy either Azithromycin or Doxycyline can be used
In hospital settings we use Azithromycin + Ceftriaxone or Clarithromycin in allergic Pt.
Cefepime and ciprofloxacin are recommended for Tx of CAP in SEVERE cases. (suspected of Pseudomonas aeruginosa inf
1) Quinolonas (Levofloxacin or Gatifloxacin). 2) Macrolide (Azithromycin or Clarithromycin). 3) CAP in hospital Clarithromycin + Ceftr
M.C. Pathogens are: Strep Pneumonia, Haemophilus Influenzae, Moraxella Catarrhalis, Chlamydia pneumonia and Legionella.
Have the right to make all Tx decision for themselves. If you can access the patient's wishes by direct conversation, any Tx can be done (e.g
We can expalin after Pt.recovery about 1) Nature of the procedure 2) the purpose or rationale, 3) the benefits,4) the risks 5) availabili
It will be an INCREASE in the Km with NO CHANGE in the Vmax
In Non-Competitive Inhibitor NO CHANGE in the Km with DECREASED in the Vmax
CURVE A: Represents a shift of the dose-response curve to the left, indicating a

A increase in the potency of drug X, which does not occur in the presence of a n
antagonist.
CURVE B: DOSE RESPONSE OF DRUG X.
CURVE C: Describe a NONCOMPETITIVE ANTAGONIST.
CURVE D: Represents the effects of a PARTIAL AGONIST on the drug's dose re
partial agonist causes less of a response than does a full agonist by itself an
weak competitive antagonist, shifting the dose-response curve to the right.
CURVE E: Represents a shift of dose response to the right, which occurs in the
COMPETITIVE ANTAGONIST.
A COMPETITIVE ANTAGONIST (CURVE E) SHIFT THE DOSE REPONSE CURVE (CURVE B) TO THE RIGHT.
A NONCOMPETITIVE ANTAGONIST (CURVE C) SHIFT THE DOSE REPONSE CURVE (CURVE B) DOWNWARD.
A PARTIAL AGONIST = LESS RESPONSE OF FULL AGONIST = WEAK COMPETITIVE ANTAGONIST = CURVE D
A INCREASE POTENCY OF THE DRUG = CURVE A
Complement levels are normal in IgA nephropaty and diffuse prolifertaive glomerulonephritis (post-streptococcal glomerulonephritis after the first 10 day
C6, C7 and C8 characterized by recurrent Neisseria Meningitis Infections. Deficiency of C1q produce a combined Immunodeficiency w/ SLE-like syndrome.
Deficiency of C1rs, C1s, C4 or C2 produce and SLE-like syndrome and glomerulonephritis.
Deficiency of C3, or C5 produce tendency to pyogenic infections. No disease has yet assoc. with C9 Deficiency.
(C.A.R.) = Individual has an XY karyotype and testes (probably abdominal), but because of C.A.R develop a female phenotype in ute
In the absence of androgen recetpors, the indifferent external genital slit will defferentiate into vagina w/ clitoris and labia
The vagina will end as a blind sac because Mullerian regression factor secreted by the testes will prevent the formation of uterus and
The Wolffian ducts will also degenerate in the absecense of androgen receptors.
At puberty, the testes will respond to the increase LH by increasing testosterone secretion.
Masculiniation is not possible because of the absence of androgen receptors.
Significant gonadal or peripheral aromatization of testosterone to estrogen produce breast enlargement and other female 2nd sex ch
LH will remain high because of the absence of negative feedback by the testosterone.
Pubic and axillary hair development, which is also androgen-driven, will not occur
Can be seen in long therapy of Glucocorticoides (like in Temporal Arteritis), can cause OSTEOPOROSIS not obvious precedin
Good choice in women that have multiple sexual partners, migraine, pelvic inflammatory disease.
It is rare Tumor. M.C. place is in the pelvis. You can see in Bx Malignant Spindle Cell.
is one of the type of Hearing Loss we have 2 types: Sensorineural Hearing Loss (S.H.L.) and Conductive Hearing Loss (C.H.L
In a Conductive Hearing Loss is the amplification system to the cochlea is disrupted.
Conductive Hearing Loss (C.H.L) cause by pathology between the external ear and the cochlea.
C.H.L. can be caused by pathology between the external ear canal, tympanic membrane, middle ear space or ossicles).
C.H.L. examples: Cerumen impaction, tympanic membrane perforation, middle ear fluid.
C.H.L. also include ossicular disruption and otosclerosis, a process causing decreased mobility of the ossicles.
IN WEBER TEST: A Pt. with normal hearing will perceive sound in the midline
IN WEBER TEST: A Pt. with S.H.L will perceive sound on the opposite or nomal side.
IN WEBER TEST: A Pt. w/ C.H.L, the Pt. perceives the sound to be louder in the affected ear.
This results in C.H.L. Weber test is because background noise that may interfere w/ perception of the sound is ↓ in the ear with the conductive hearing loss
In a Pt with Traumatic Right-Sided Tympanic membrane perforation (conductive) we will have in Weber Test a Lateralization of sound to th
large, soft, fleshy, cauliflower-like excrescences around the vulva, urethral orifice, anus and perineum. Cause by HPV
Tx include Podophyllin, Cryosurgery, application of caustic agentes, electrodesiccation, surgical excision, and laser ablation.
"warts" multiple, small, raised lesions and a few larger cauliflower-like lesions on vulva and posterior fourchette. HPV related
The computation of a confidence interval (CI) for the mean. The formula for CI is: CI = mean plusor minus 2.5 x (standartd error of t
Suspect in any Growth Fetal Retardation with normal Karyotype.
RELATED to Exposure and Outcome. Also should be a CONTROLLER for in the analysis.
Ways to control in the design of study are: Matching, Restriction, Randonization.
Way to control in the Analysis of the study are: Stratification and modeling
Severe dehydration in a neonate in the presence of hyponatremia, hyperkalemia, hypoglycemia and metabolic acidosis
or SALT WASTING 21-HYDROXYLASE DEFICIENCY. Serum 17-OH progesteron is Markedly INCREASED.
SALT Retention 17 alpha Hydroxylase Deficiency. ACTH very HIGH.
Deficiency of 21-Hydroxylase enzyme results in low or absent plasma cortisol and aldosterone and compensatory ACTH eleva
The ↓ secretion of aldosterone results in salt loss w/ Na+ ↓ and K+ ↑. ↑ 17-hydroxyprogestone are Dx of 21-hydroxylase deficiency relat
We will have Oxygen content ↑ because by-passed the tissues.
M.C. reason for Positive White Reflex. Refered Pt. to ophtalmologist to rule out retinoblastoma.
DEFECT ASSOCIATION: DISORDER DEFECT
22 q11 Syndrome Truncus Areriosus, Tetralogy of Fallot
Down Syndrome ASD, VSD, Endocardial Cushiong Defect
Congenital rubella Septal defects, PDA
Turner's Syndrome Coartation of Aorta
Offspring of Diabetic mother Transposition of great vessels
Fragile X sindrome Mitral Valve Prolapse, Aortic root dilatation
Tausing-Bing Malformation, which is considered to be a variant of transposition of the great arteries because the aorta arise from the morphologic right ventric
Tausing-Bing Malformation the pulmonary overrides a Ventricular septal defect
"Common Pattern" Of transposition, the aorta arises from morphologic right ventricle on the right side of the heart
"Common Pattern" Of transposition, the pulmonary artery arises from morphologic left ventricle on the left side of the heart.
"Corrected Pattern" Of transposition, the aorta arises from a morphologic right ventricle of the left side of the heart
"Corrected Pattern" Of transposition, the pulmonary artery arises from a morphologic left ventricle on the right side of the h
Tetralogy of Fallot the aorta overlies a septal defect and the proximal pulmonary artery is stenotic
Truncus Arteriosus, a single large vessel overlies a ventricular septal defect.
Do ultrasounds exams. X-rays will be a waste of time. NSMx Pavlik Abduction splint.
"Blue babies" = Early Cyanosis = Rigth to left shunts = Tetralogy of Fallot (M.C.C of early cyanosis).
Other examples of right to left shunts are: Transposition of great vessels and Truncus arteriosus.
" Blue kids" = Late Cyanosis = Left to right shunts = VSD (M.C.Congenital cardiac anomaly), ASD (loud S1, fixed split S2),
Difficult feeding, Somnolence, Failure to Thrive, Constipation (CRETINISM SYNDROME). ↓ T4, ↑ TSH. M.C. complication is MENTAL RETA
NSDx is Measure total T4 and thyrotropin levels. Umbilical Hernia and Generalized Hypotonia.
General S/S: Premature delivery, CNS abnormalities, anemia, jaundice, heatosplenomegaly, and growth retardation.
M.C. pathogens are: TORCHeS: Toxoplasma, Others (HIV, parvovirus, varicella, etc.), Rubella, CMV, HV, and Syphilis
In toxoplasmosis (transplacental transmission), w/primary infection via consumption of raw meat or contact with cat feces.
In toxoplasmosis we will find hydrocephalus, intracraneal calcifications, chorioretinitis and ring-enhancing lesions on h
In Others: HIV, parvovirus, varicella, Listeria, TB, malaria, fungi
In Rubella: Transplacental transmission in the first trimester. Specific findings include a purpuric "blueberry muffin" rash.
In Rubella we also find cataracts, mental retardation, hearing loss, and patent ductus arteriosus.
In C.M.V.: The M.C.Congential Infection, primarily transmitted transplacentally.
In C.M.V. we will see a petechial rash (similar to "blueberry muffin" rash) and periventricular calcifications.
In C.M.V you can cultivate the microorganism in URINE.
In Herpes: Intrapartum transmission if mom has active lesions. Can cause skin, eye, and mouth infections.
In Herpes can also cause life-threatening C.N.S./systemic infection.
In Syphilis: Primarily intrapartum transmission. Specific findings include maculopapular skin rash, hepatomegaly, lymphadeno
In Syphilis we also see "snuffles" (mucopurulent rhinitis), and osteitis.
In Syphilis we have bone deformities because reactive periostal deposition of bone e.g. "saber shin", "saddle nose" and gu
In Syphilis: Gummas, in which a central necrotic focus is surrounded by layers of granulomatous and nonspecific chronic infla
In late congenital syphilis the child is characterized by saber shins, saddle nose, CNS involvement
In late congenital syphilis have Hutchinson's triad: peg-shaped upper central incisors, deafness and interstitial keratitis (photophobi
NSTx of Toxoplasmosis is Pyrimethamine, Sulfadiazine, Spiramycin (for pregnant woman)
NSTx of Syphilis is Penicillin
NSTx of HSV is Acyclovir
NSTx of CMV is Ganciclovir
is a triad of: Deafness, Cataracts and Cardiac Defects.
Presents in the 1 year of ife.
S/S intermittent fever,osteitis and osteochondritis,mucocutaneos lesions,lymphadenopathy,hepatomegaly and persistent rhiniti
is a triad of: Chorioretinitis, Hydrocephalus and Intracranial Calcifications.
Also call Dilated Cardiomiopathy. It is a right and left heart failure. You will see in Alcoholism, Postpartum Pts, and Drugs.
Jugular Veins distended + bags under eyes + Pulmonary rales + S3 + Tense and enlargement of the Abdomen + Pitting Edem
Stable Pt with small noninfectious, nonmalignnat pleural effusion w or w/o S/S of C.H.F. NSTx Furosemide w/ salt restrictions
Increase of Directed Bilirrubin. We see in: Dubin Johnson Sx and Rotor's Sx.
Primary Aldosteronism. Caractherized by episodic weakness, paresthesias, transient paralysis, tetany + diastolic hyperten
Primary Aldosteronism (HYPERALDOSTERONISM) due to an aldosterone-producing adenoma. S/S: Hypertension and Head
Lab Finding are Hypokalemia and Hypernatremia. Metabolic Alkalosis is commnon. Aldosterone HIGH. RENIN LEVELS ARE
↑ of the Aldosterone which can be cause by adrenal hyperplasia or an adenoma. Hypertension and Hypokalemia are typically
NSTx is Spironolactone (Aldosterone receptor antagonists) in bilateral adrenal hyperplasia case. If unilateral Surgery is Tx of
SPONGIOTIC DERMATITIS is present in Bx lesion of affected areas in C.D by poison ivy exposure. Skin has a weepy apperance w/
Above 15 y.old donot requiere parental conset if they want contraception, pre-natal care, Tx for STD or substance drug abuse
Unilateral lesion of occipital lobe
In the elderly NSTx Increase the fiber if we don't have any result we use Psyllim (Bulking agent, Calcium Policarbopenil).
Diffuse Tickening of the Pericardium due to inflammation. Diastolic pressures are equal in all four chambers of the heart like in Card
Jugular veins distended indicating systemic venous hypertension. This distention increase in inspiration (KUSSMAUL'S SIGN
S1 and S2 are reduced in intensity and clinical finding of right-sided failure (ascities, jaundice, edema) are more prominent that l
is the experience of 1 or more nerulogic S/S in response to a psychologic stressor. This patient's S/S do not pertain to the nerv
S/S affecting voluntary motor or sensory function suggesting a neurologic condition. It is precipitad by psychological stressors.
Is used to distinguish between immune vs. non-immune mediated RBC hemolysis.
THINGS TO REMEMBER: Serum haptoglobin ↓ and Serum LDH ↑ indicate RBC HEMOLYSIS
Coomb's test positive = Immulogic cause of Hemolytic Anemias. Coomb's test negative = No immulogic cause of Hemolytic
Is a cofactor in many enzymes that are involved in oxidation-reduction reactions that bind and directly react w/oxygen.
Plasma levels are normally increased in pregnancy, inflammation, a w/ O.C.P.
It is bound to ceruloplasmin, which is synthesized in the liver.
It is a cofactor in the following enzymes:
Lysyl Oxidase: forms cross- links in collagen and elastic tissue to increase tensile strength.
Cytochrome c Oxidase: Electron-transport system.
Superoxide Dismutase: Antioxidant that neutralizes oxygen free radicals.
Ferroxidase: Converts iron to +3 so it can bind to transferrin.
Tyrosinase: Conversion of tyrosine to DOPA in melanin synthesis.
Deficiency assoc w/ the following: 1) Microcytic Hypochromic Anemia (cannot bind to transferrin).
2) Skeletal Abnormalities (defective collagen); 3) Osteoporosis; 4) Skin depigmentation (problem w/tyrosinase).
5) Dissectin aortic aneurysms (defective collagen and elastic tissue).
6) Mencke's Kinky Hair Syndrome: Rare sex-linked recessive disease w/impaired utilization of cooper.
Cooper Toxicity is assoc w/ Wilson's Disease (W.D.)
W.D. an autosomal recessive disease w/ a defect in the excretion of cooper into bile.
W.D. leads to liver damage and eventual deposition of free cooper into the eye (Kayser-Fleishcer ring) and lenticular nuclei i
In W.D. the total cooper levels are ↓ owing to a ↓ in ceruloplasmin synthesis by the damaged liver, but free cooper levels
Type III Glycogen Storage Disease, which is due to a Deficiency of the DEBRANCHING ENZYME
This DEBRANCHING ENZYME catalyze transfer of a short terminal oligasaccharide branch to another glucose brain.
S/S: Enlarged Liver with mild to moderate HYPOGLYCEMIA on fasting. Liver Bx shows accumulation of GLYCOGEN GRAN
Biochemical analysis reveals that the glycogen molecules in the granules have short outer branches assoc w/DEFICIENCY OF THE DEBRANCHING ENZYM
and Dendritic Ulcers = HERPES SIMPLEX KERATITIS. Frequent cause of corneal blindness in U.S. Pain, photophobia, blurred vision, tea
Indicated in Pt w arrhytmia who have ABNORMAL STRESS TESTING.
May occurs in Pt. w/KAWASAKI DISEASE.
The RCA supplies the POSTERIOR MEDIAL papillary muscle of the MITRAL VALVE and 95% of the AV node.
Second M.C. place of block in an Acute Myocardial Infarction. The first M.C. place of block is LAD (Left Anterior Descendin
Has the LARGEST ARTERIOVENOUS O2 difference of any major organ during resting condition
The explanation for that is the SMALLEST RATIO OF BLOOD FLOW TO O2 consumption.
It is a common multifactorial disease. LDL receptor-associated Familial Hypercholesterolemia.
Autosomal dominant, affects 1 in 500 individuals. Mutations in LDL receptor cause increased circulating LDL levels.
Accelerated atherosclerosis and risk of M.I. Xanthomas in skin, eyelids and tendons.
Homozygotes (1 in 1'000,000) usually die before age of 30.
S/S variant angina, induces transient ischemia and S-T segment elvation. R.C.A cause transient inferior ischemia.
Assoc.w/vascular phenomena (Raynaud phenomenon or migraines).
S-T segment elevation to response to nitroglycerin in M.I. transmural don't response.
Very often find in the first trimester of pregnancy. Usually resolve by the second trimester.
Shows strength and the direction (positive, negative) of linear association between two variables. It doesn't necessarily imp
Rapid raise and fall of peripheral pulses.
See in: HYPERTHYROIDISM, LARGE ARTERIOVENOUS FISTULAS, BERIBERI, PATENT DUCTUS ARTERIOSUS.
Goljan's pearls: Block Phospolipase A2 that STOP the production of PROSTAGLANDINS and LEUKOTRINS blocking Acute inflammatio
Also cause deficiency of the adhesion factor of the neutrophils that is why we have ↑ of neutrophils in bloodstream.
Any Pt will have Lymphocites (B Cell and T cell) and Eosinophils are DECREASED.
Use in ischemic necrosis that produce inflamation generaly in the brain
Chronic use like in S.L.E can produce COMPRESSION FRACTURE IN THE LUMBAR SPINE. Pain usually not radiate to Low
Mechanism of action to produce Fx: Increased Osteoclastic bone resorption and decreased osteoblastic bone formation
are known to lead to more difficult glucose control in diabetic women.
Blood Glucose level should be checked periodically specially in a D.M. type 1 pregnant woman with preterm labor.
Secretion is estimulated by ACTH. If cortisol secretion is impaired, ACTH levels would be ELEVATED.
Binds to an intracellular receptor and increase liver synthesis of GLYCOGEN.
Is a hydrophobic steroid that acts via an intracellular receptor and increase protein synthesis.
Within hepatocytes, GLYCOGEN SYNTHASE is increased by CORTISOL, with INCREASE GLYCOGEN DEPOSITION.
Name Plasma Cortisol Plasma ACTH
Primary Hypercotisolism HIGH LOW = Primary Hyperaldosteronism (Conn's Sy
Secondary Hypercortisolism HIGH HIGH = Secondary Hyperaldosteronism
Primary Hypocortisolism LOW HIGH = Primary Hyperaldosteronism (Addison's
Secondary Hypocortisolism LOW LOW = Secondary Hypocortisolism
Steroid Administration LOW LOW (Plasma CRH is LOW, No Hyperpigmentation
It is a gram positive rod. The disease present with gray-white membrane in the oropharynx.
Also present with a large colonies would not be appreciated. (EXPRESSION USE IN THE TEST).
Infection of Corynebacteria Diphtheriae is similar to the pathogenesis and apperance of inflammation assoc w/Clostridium difficile-induc
Is recognized by its unusual "Chinese letter" shape. Tx include disposal of the infecting organism and administration of the appropia
We will see in the reaction between B7 molecules and CD 28, as we explain as follow:
The B7 molecule on the cell surface of the antigen-presenting cell reacts with the CD 28 molecule
This reaction take place on the T cells surface for maximun COSTIMULATORY SIGNALS
known TIETZE SYNDROME. Inflamation of the condrocostal juntions wich are swollen and sore.
or Nihilistic Delusional Disorder, is Dx when Pts complain of not only having lost their possessions, status or strength but also their inn
Seen in Schizophrenic or Depressive episodes.
Contains the synergistic antibiotics Sulfamethoxazole and Trimethoprim, which inhibit different steps in the prokaryotic synt
PT ↑, PTT normal, Platelets ↓ (inhibits coagulation EXTRINSIC PATHWAY). Therapy Guidance Test is P.T.
or Dicumarol (Warfarin) is a natural product that competitively inhibits the Vit K - dependent - Gamma - Carboxylation of several casacade proteins
NSTx is Fresh Frozen Plasma in lifethreatining situation. Vit K take 6 to 8 hours to be active.
Distended palpable gallbladder associate with jaundice it is suggestive of cancer.
Multiple Hamartoma Syndrome, GI tract Hamartomas + breast CA + thyroid CA + Nodular gingival hyperplasia
Cause Rickettsial infection.It causes of Q FEVER. Incubation of 1 to 2 weeks. S/S fever, muscle pain, cough and patchy infiltra
M.C. viral cause endocarditis and pericarditis. Also M.C. cause of mouth-hand disease.
Transfection with the naked nuclei acid will result in active viral replication
With the Picornavirus are positive sense RNA viruses. They can act as messenger RNA
Also they can be read directly by ribosomes of mammalian cells to produce the proteins essential for viral propagation
Ping-pong ball sensation, frog possition very common in RICKETS.
III dysfunction = Ptosis, Mydriasis.
V dysfunction = Absent Corneal Reflex
VI dysfunction = Lateral gaze palsy
Nerve CN Function Type Mnemonic
Olfactory I Smell Sensory Some
Optic II Sight Sensory Say
Oculomotor III Eye movement, pupil constriction, Motor Marry
accomodation, eyelid opening
Trochlear IV Eye movement Motor Money
Trigeminal V Mastication, facial sensation Both But
Abducens VI Eye movement Motor My
Facial VII Facial movement, anterior 2/3 taste, lacrimation Both Brother
salivation (submaxillary and submandibular salivary glands)
Vestibulocochlear VIII Hearing, balance Sensory Says
Glossopharyngeal IX Posterior 1/3 taste, swallowing, salivation (parotid gland), Both Big
monitoring carotid body and sinus.
Vagus X Taste, swallowing, palate elevation, talking, Both Butts
thoracoabdominal viscera
Accessory XI Head turning, shoulder shrugging Motor Matter
Hypoglossal XII Tongue Movements Motor Most
Lesion of the Right Trigeminal = CN V = Right Facial numbness, decreased bulk of the right masseter and temporalis
Lesion of Right Abducens = CN VI = Diplopia, decreased abduction of the right eye.
Lesion of the Right Facial = CN VII = Weakness of all facial muscles on the right.
Cribiform plate -----------------------------------------------> I
Optic Canal ---------------------------------------------------> II, Ophtalmic Artery
Superior orbital fissure ------------------------------------> III, IV, V1 (Ophtalmic nerve), VI
Foramen Rotundum ----------------------------------------> V2 (Maxillary Nerve)
Foramen Ovale ----------------------------------------------> V3 (Mandibular nerve)
Foramen Spinosum ----------------------------------------> The Middle Meningeal Artery, no cranial nerve
Internal Auditory Meatus ----------------------------------> VII, VIII
Jugular Foramen --------------------------------------------> IX, X, XI
Hypoglossal Canal ------------------------------------------> XII
Brain tumors of children. Arise from epithelial rests derived from Rathke's pouch, which is an oral invagination (anterior pituitary glan
Resemble Ameloblastomas derived from dental epithelium. Multicystic tumor and Viscuous yellow fluid.
Occur in supra sellar region, and produce endocrine symptoms. Shows calcifications in the suprasellar region.
Can produce panhypopituitarism that will be assoc w/decreased of TSH, ACTH, FSH, LH, prolactin and growth hormone
Also related to: Weight gain, sluggishness, and depression are all signs of hypothyroidism, resulting from the decreased
0.6 -1.2 mg/dL. High Values indicate RENAL INSUFFICIENCY. Rising occurs little later AFTER significant ↓ in G.F.R.
Is Freely Filtered (greater than inulin) and Partially secreted (less than PAH = Para-aminohippuric acid).
Is deficiency in both Prerenal Azotemia and Renal (Intrinsic) Azotemia.
Contraction cause slight elevation of the testicle, as a result of stroking the skin of the upper medial thigh constitutes the CREMASTE
Testing the contraction shows integrity of the GENITOFEMORAL NERVE (L1, L2)
Infantile Hypothyrodism. Abnormal development of the Thyroid Gland. Lack of Thyroid Hormone in developing child.
Mental Retardation, pot-billed, pale with puffy face and enlarged tongue. Can be cause by Deficiency of Iodine in the diet of
Prions, protein devoid of nucleic acid that are infectious, are assoc w/ Creutzfeldt-Jakob Dementia.
Onset 50 -70 y. old. Rapid progressive form of DEMENTIA+ Abnormal Myoclonic Movements + EEG characteristic changes.
MRI doesn't reveal significant cerebral atrophy.High Voltage complexes on EEG a family history is usually absent different between HUNTIN
Sporadic Disorder. Myoclonic jerk can be elicited by sudden acousti stimuli, such as hand clamping = STARTLE MYOCLONU
May be related to bovine-spongiform encephalopathy. Bovine to Humans. Onset around 29 y. of age. EEG abnormal but no high volta
Related with MAD COW DISEASE.
Deletion of the short arm of chromose 5. 1/4 of this Pt. will have a Ventricular Septal Defect
Inherited Liver enzymatic abnormality cause serious unconjuated hyperbilirubinemia.Liver disease SEVERE GLUCONYLTRANSFERAS
Autosomal recessive fatal age 1, in a somewhat milder Autosomal dominant form that permits survival into adulthood
Type 1: Unconjugated hyperbilirrubinemia of 8 - 30 mg/Dl.
Type 1: MOST SEVERE, Normal Liver enzymes and histology, ↑ rates of Kernicterus, no response to Phenobarbital
Type 2: Unconjugated hyperbilirubinemia of , 20 mg/dL.
Type 2: Normal liver enzymes and hystology, or kernicterus 25% ↓ in bilirubin levels w/Phenobarbital
S/S Crypt Abscess, Abd. Pain + "bloody diarrhea". Disease from terminal ileum to rectum, pseudopolyps and non-caseating g
Associate with ANKYLOSING SPONDYLITIS, PERIPHERAL ARTHRITIS
Non-Bloody Diarrhea + Abdominal pain + Cramps + Malaise. BX will see small granulomas in colonic mucosa.
Histologic reveals transmural chronic inflamation and scattered noncaseating granulomas.
Rectal sparing, Fistula formation, noncaseatingranulomas in Bx, transmural lesions and skip lesions are all characteristic of Cr
S/S Persistent fever, arthritis, mouth ulcers, skin manifestations (erythema nodosum), weigth loss, malaise and growth retarda
Also known as a REGIONAL ENTERITIS. (another name use in USMLE Test)
Rectal Bleeding +/- in Ulcerative Colitis ++
Rectal disease + in Ulcerative Colitis ++++
Ileal Involment ++ in Ulcerative Colitis None
Perianal Disease ++ in Ulcerative Colitis None
Strictures ++ in Ulcerative colitis None
Fistula ++ in Ulcerative Colitis None
Skip Lesion ++ in Ulcerative Colitis None
Transmural involvement +++ in Ulcerative Colitis None
Risk for Colon Cancer Slight ↑ in Ulcerative Colitis ↑↑↑
Mouth Ulcers ++ in Ulcerative Colitis None
In USMLE, Creeping Fat = Small granuloma at the base of the colonic gland is helpful in confirming the diagnosis.
Pts w/ short-bowel Sx require Vit and mineral supplements, particularly ZINC and the FAT-SOLUBLE Vit. (A,D,E,K)
Mechanism of action is UNCLEAR. But Cr.Na. inhibits degranulation of mast cells (in poorly understood ways) stopping release of inflamm
Juvenile-type polyps + Ectodermal abnormalities + Alopecia + Hyperpigmentation + Nail Lose.
S/S Headache, low grade fever, CSF pressure of 205, india ink encapsulated yeasts
NSTx is I.V. Amphotericin + 5-fluorocystosine (5-FU) (C.N.S infection in AIDS Pt.).
AIDS Pt. + Headache + Vomiting + Delirium + No Focal Neurological S/S.
CSF mild lymphocytosis + mildly increased protein + crytococcal antigen greater 1:5000,000
Best NSTx is AMPHOTERICIN B. Always we can find an elevation of the CSF pressure ( normal 70 -180 mmHg)
Aids Pt + stiff neck + confusion + vomiting + encapsulated yeast in CSF. = Moderate to Severe Stage
Initial Tx for this stage (moderate to severe infection due to brain-related S/S): Amphotericin B and 5-fluorocystosine (5-FU
After initial Tx, another blood test and/or spinal tap is performed to check for cryptococcus.
If the test is positive, combination Tx will be continue.
If the tests are negative, both drugs are stopped and fluconazole is started to prevent recurrences.
It is currently recommended that fluconazole be continued for the rest of a patient's life.
In India Ink shows YEAST form. The mechanism of spread is by hematogenous route. M.C.C of meningitis in AIDS and immnocomprom
A.I.D.S Pt + Weight loss + Persistent, watery, nonbloody diarrhea + loss of appetite + Numerous acid-fast cysts in stool s
Compress ULNAR NERVE at elbow, producing NUMBNESS + PARESTHESIAS of the RING and LITTLE fingers.
Procedure use in Ectopic Pregnancy. Needdle is place into te posterior cul-de-sac to determine whether there is nonclotting b
You will order in a Pt w/ Liver Alcohol Cirrhosis + Ascitis + Fever + Leukocytosis.
Are special media used for isolation of microorganism. We see as follow
Bug Media for isolation
H. Influenza Chocolate agar with factor V (NAD) and X (hematin)
N. gonorrhoeae Thayer-Martin (VCN) media also is a chocolate agar.
B. pertusis Border-Gengou (potalo) agar
C. diphtheriae Tellurtie plate, Loffler's medium, blood agar
M. Tuberculosis Lowenstein-Jensen agar
Lactose-fermenting Pink colonies on MacConkey's agar
Legionella pneumophila Charcoal yeast extract agar buffered with increased iron and cysteine
Fungi Saboruraud's agar
DO NOT CONFUSE WITH STAINS.
Dexamethasone suppression test very specific. S/S: Abdominal striae, hypertension, glucose intolerance and reduced resistance
Hypercortisolism due to a pituitary Adenoma. Characterized by Rounded facies, Buffalo hump, muscle wasting, thin skin (purp
Hypersecretion of ACTH by the Pituitary Gland. Dexamethasone Supression Test is positive in Normal individual but is not
Pt w/Cushing syndrome they are predispose to catarats because corticosteroids levels are high.
M.C.C is a Pt in long treatment of steroids like in Pt in renal transplant, Lupus Pts.
It may be 2nd to abnormal hypothalamic function w/excessive release of corticotropin-releasing factor (CRF).
Hypercortisolism (Increased Cortisol) due to variety of causes. The Ethiologies include as follow:
1. Cushing's disease (Primary pituitary Adenoma); ACTH INCREASED.
2. Primary Adrenal (Hyperplasia/Neoplasia); ACTH DECREASED.
3. Ectopic ACTH production (e.g. Small Cell Carcinoma of the Lung) ACTH INCREASED
4. Iatrogenic; ACTH DECREASED
S/S includes Hypertension, Weight gain, moon facies, truncal obesity, buffalo hump, hyperglycemia (insulin resitance)
Also include skin changes (thinning, striae), osteoporosis amenorrhea, and immune suppression.
Brain tumor w/increased I.C.P.(Intracraneal Pressure) S/S = Hypertension, Bradycardia.
The brain has run out a compesatory mechanisms to minimize the I.C.P. At this point death is imminent.
CYANIDE POISONING you will treat as follow:
Step 1: NITRATES: Helps to Convert Fe2+ in Fe3+:
OxyHb = Cyanomethehemoglobin and MetHb.
Step 2: THIOSULFATE
Step 3: METHYLENE BLUE. That helps MetHb to come back to OxyHb
Early Cyanosis can be produced by: Common Pattern trasposition of the great arteries, Tricuspid Atresia and Truncus arterios
Late Cyanosis can be produce by uncorrected Patent Ductus Arteriosus.
Tetralogy of Fallot can produce a early or late cyanosis all depends of the magnitude of the congenital damage.
Also known as cyclin B-cdel controls entry into MITOSIS.
During the S phase, cyclin B is synthesized, reaching its maximal level at G2 phase of the cell cycle, when most cyclin B
Destruction of cyclin B inactivates the cyclin B/cdc 2 kinase activity, and newly synthesized cyclin B allows reactivation of
The cyclin B/cdc2 complex is the phosphorylated and dephosphorylated in a complex series of events to reach activation and drive the ce
The threonine-161 residue must be phosphorylated and the tyrosine-14 and threonine-15 residue must be dephosphorylated for cyclin B
The cyclin B/cdc2 complex is deactivated at the end of mitosis by the destrucgtion of the cyclin B of the complex.
The cyclin B/cdc2 complex has no role in the G1 phase of the cell cycle.
Side Effects: Somnolence, Xerostomia (Dry mouth), Mydriasis and Tachycardia. Almost same side effects of AMIPTRIPTY
with Corticosteroid (Prednisone) Use in the Tx of Wegener Granulomatosis.
Follow for maintenance or remission in Wegener Granulomatosis we can use Azathioprine or Methotrexate with corticost
Is an alkylating agent that cross-link tumor cell DNA. It may be give I.V or orally and is activated and metabolized in the liv
Its side effects include myelosuppression, hemorrhagic cystitis (prevent by MESNA) ureteritis, nausea and vomiting.
NSTx for aggressive SYSTEMIC LUPUS ERYTHEMATOUS w/ NEPHRITIS. (TYPE IV LUPUS NEPHRITIS)
Is characterized by recurrent and chronic episodes of hypomania and dysthymia. It is less severe from of bipolar disease.
It is a Actin-Binding Drug that interfere with the POLYMERIZATION-DEPOLYMERIZATION cycle of MICROFILAMENTS.
Processes such as Endocytosis, Phagocytosis, Cytokinesis and Cytoplasmic and Ameboid Movements are all inhibited by Cytocha
Study of microscopically observable alterations in chromosomes.
1 in 150 live births, leading cause of mental retardation
Majority lost prenatally: this is the major cause of pregnancy loss.
Also in the board are describe as INTERLEUKINS. We are going to describe as follow:
IL-1 Secreted by MACROPHAGES. Stimulates T cells, B cells, neuthrophils, fibroblasts, and epithelial cells to grow, diff
IL-1 Also stimulated synthesize specific products. IL-1 is an ENDOGENOUS PYROGEN. (FEVER, HOT).
IL-1 is an endogenous pyrogen involved in the acute phase of inflammation.
IL-1 is involve in ACUTE PHASE RESPONSE with IL-6 and TNF(Tumor Necrosis Factor)-alpha.
IL-2 secreted by HELPER T CELL (more Th1). Stimulates Growth of HELPER and CYTOTOXIC T CELLS.
IL-2 induce T cell proliferation (more Th1).
IL-3 secreted by Activated T cells.Supports the growth and differentiation of bone marrow stem cells.
IL-3 has a function similar to GM-CSF
IL-4 Secreted by HELPER T CELLS. Promotes growth of B cells. Enhances the synthesis of IgE, and IgG.
IL-4 is related to Type I hypersensitivity reaction.
IL-5 secreted by HELPER T CELLS (more Th2). Promotes differentiation of B cells. Enhances the synthesis of IgA.
IL-5 Stimulates production and activation of eosinophils.
IL-5 is a esoniphils stimulator factor.
IL-6 is a endogenous pyrogen and stimulator of B cells. But NOT and inducer of isotype switch IgE production.
IL-8 Major chemotactic factor for NEUTROPHILS. Produce by Macrophages
IL-10 Produced by T HELPER 2 and inhibit by T HELPER 1.
IL-10 inhibit T HELPER 1 that mean ↓ Stimulated Cell Mediated Immunity and ↓ Delated Hypersensitivity
ALPHA-INTERFERON: Product of LEUKOCYTES that inhibits viral replication. No action in a intracellular bacterial infecti
BETA-INTERFERON: Product of FIBROBLASTS that inhibits viral replication. No action in a intracellular bacterial infectio
GAMMA-INTERFERON is produced by T HELPER 1 and inhibit T HELPER 2.
GAMMA-INTERFERON is secreted by HELPER T CELLS. Stimulates MACROPHAGES and NATURAL KILLER CELLS.
TNF - alpha (Involve in Caquexia) is secreted by MACROPHAGES. Stimulates IL-2 receptor synthesis by Helper T Cells.
TNF - alpha stimulate also B-cell proliferation. Attracts and activates NEUTROPHILS.
TNF - beta secreted by activated T LYMPHOCYTES. Functions similar to those of TNF-alpha.
Cause Rethinitis in AIDS patient with CD4 + T cell low. Atypical Lymphocytes (basophilic lymphocytes with vacuolated app
Is a Herpesvirus producing a variety of infections. Higher in the list in a Dx with mononucleosis-like symptoms.
In infectious esophagitis Bx shows small numbers of cells w/markedly enlarged nuclei.
Also in careful observation may show both cytoplasmic and nuclear viral inclusions in biopsy
Ganciclovir and Foscarnet can be used in the Tx (or prophylaxis) of Cytomegalovirus (CMV) infections.
However, Foscarnet would cause a potentially lethal hypocalcemia in Pt on Pentamidine Therapy.
Therefore, Ganciclovir must be chosen, despite the fact that will cause further LEUKOPENIA
Ganciclovir is an ANTIVIRAL DRUG that interferes with DNA synthesis of CMV.
Doubled-Stranded DNA, enveloped, icosaedral virus. Basophilic intranuclear inclusion body in the urinary sediment = OWL EY
M.C. infection after a Blood Transfution here in USA is CMV infection. M.C. postransfution hepatitis is Hepatitis C.
Develop in HIV Pts, w the CD4 count falls below 50. S/S: LLQ pain, Bloody Diarrhea, Urgency and Tenesmus.
NSDx Sigmoidoscopy show deep ulcers with proctosigmoiditis.
Affecting at least two blood cell lines associate with hypercellular bone marrow are characteristic of Myelodysplastic Syndrom
Provides supportive network of tubules and filaments in the cytoplasm of eukaryotic cells
It is composed of microtubules, intermediate filaments, and microfilaments
Microtubules: Found in the cytoplasmic matrix of all eukaryotic cells. They are compose of TUBULIN.
Microtubules: Tubulin is a protein dimer composed of two differents polypeptides: Alpha-tubulin and Beta-Tubulin
Microtubules: Play a role in the following:
Microtubules: Assambly is an important event in the SPINDLE FORMATION in chromosomal movement during meiosis and m
Microtubules: Intracellular vesicles and organelle transport. Two specific microtubule-dependent ATPases, Kinesisn and
Microtubules: Kinesin and dynein are involved in generating the force that drives transport (passive intracellular transport).
Microtubules: Also plays roles in Ciliary and flagellar movement.
Intermediate filaments: About 10 nn of diameter between microtubules and microfilaments.
Intermediate filaments: Contain tissue-specific proteins, like: Cytokeratins, Desmin, Vimentin, Neurofilaments and GFA.
Intermediate filaments: Cytokeratins: Found in the Epithelial Tissue
Intermediate filaments: Desmin: Found in the Smooth Muscle; Z disks of Skeletal and Cardiac Muscles.
Intermediate filaments: Vimentin: Found in Cells of Mesenchymal origin (endothelial cells, fibroblast, chondroblasts, vascular smoo
Intermediate filaments: Neurofilaments: Founds in neurons.
Intermediate filaments: Glial Fibrillary Acidic Protein (GFA): Found in Astrocytes.
Microfilaments: Have a diameter of 6 nn and are composed of ACTIN.
Microfilaments: They are associate with 2 types of movements:
Microfilaments: Local movements takes advantage of the polymerization and depolymerization properties of microfilaments
Microfilaments: Sliding filament movement is generated by the interaction of actin filaments with myosin filaments
Gluconeogenesis and Urea Synthesis occur in both Cytosol and Mitochondria.
Oxidative phrophorylatin and fatty acid oxidation occur in the Mitochondria
Glycolysis and Fatty Acid Synthesis occur in the Cytosol.
Gangliosides and other complex lipid-carbohydrate molecules are degraded in the Acidic Lysosome.
CD8 + cells recognize their targets by peptide antigen association with a groove in the CLASS I MHC molecule.
Dyspeptic Symptoms (Upper Abdominal Discomfort, Nausea, Bloating, and Flatulance) usually after meals are caused by biliary
Develop: 1) PRE-CHOLECYSTECTOMY, resulting from obstruction of the cystic duct by fribrosis or kinking
2) POST-CHOLECYSTECTOMY (due to incorrect dx) = Neuroma of the cystic duct stump, Foreign Body Granuloma, and Common bile du
Therapy of C.F. include give supplement of Amylase, Lipase and Protease that is why they are not longer dying of malnu
Repeated episodes of bronchopneumonia can cause permanent bronchial dilation know as BRONCHIECTASIS.
If the Pt survive to late teenager years will present a severe ankle edema that suggests COR PULMONALE.
M.C.C of recurrent pneumonia is Pseudomona Aeruginosa (sputum bluish-green coloration), also these is the M.C.C of
Must receive influenza vaccine. May receive pneumococcal vaccine because rarely infected with streptococcus pneumanie.
NSDx Sweat Chloride Test. Best antimicrobial Tx. Is CEFAZIDIME AND TOBRAMYCIN.
Chromosome 7 defect. Malfunctioning of Cl channels. Pt w/ recurrent pulmonary infection and pancreatic insufficiency in chil
Failure to thrive and frequent malodorous stools. Phenylalanine (amino acid) Defect. (golgi apparatus)
The NSDx is Fecal Fat Exam that confirm the Malabsorption Sx and after that the sweat chloride test evaluate for C.F.
Is a defect in the cystic fibrosis transmembrane conductance regulator (CFTR) protein, which is code by a gene on the long arm of C
Na+ will be ↑ in the sweat (salty). Sweat production can be stimulate by drug like pilocarpine or small electrical current (iontop
The underlying biochemical defect is a TRANSMEMBRANE ION CHANNEL.
Also a Pt w Cystic Fibrosis usually is a compound hererozygote for 2 disease-producing alleles. Homozygote has 1/200 risk to
Is an Autosomal Reccesive disease w/an incidence of 1/1,600 in the white population.
The frequency of the cystic fibrosis gene is 1/40, that is the square root of the INCIDENCE.
Remembering the Hardy-Weinberg Law, the gene frequency is equal to the square root of the incidence (q²).
If the incidence = q² = 1/1,600, the square root of the incidence, the gene frequency (q) = 1/40
In USMLE, What will be a great statements concerning potential strategies to fix this gene defect, the answer will be:
The Mutant Protein in C.F. would able to function normally if it could be inserted in the membrane.
In USMLE, if the ask you about Vitamin Deficiency in Cystic Fibrosis Cases think about all the fat-soluble Vitamins: A,D,E
Is a relatively common disorder in which a defective transporter for dibasic amino acids (Cystine, Ornithine, Lysine, Arginin
All these aminoacids leads to saturation of the urine w/cystine, which is not very soluble in urine, and precipitates out to for
FEEDBACK BETWEEN:
+
ACTH CORTISOL
CRH (Corticotrophin-releasing hormone)
-
SYNOPSIS OF
ACETAMINOPHEN
INTOXICATION
MANAGMENT
ACID BASIC STATUS SYPNOSIS
HENDERSON-HASSELBACH EQUATION: pH = pKa + log [HCO3-] / 0.0
PLASMA PH (N = 7.35 - 7.45) HCO3 (N = 22 - 28 mEq/L) PCO2 (N= 33 - 45 mm Hg)

LOW LOW LOW
HIGH HIGH HIGH
LOW LOW HIGH
HIGH HIGH LOW
LOW HIGH HIGH
HIGH LOW LOW
Plasma (K+)
Renal K + excretion
K+ Balance
% Non-Ionized Form…...
Drug
Renal Clearance of the
MAJOR EXTERNAL COMPLICATIONS OF ADULT POLYCYSTIC KIDNEY DISEASE (ADPKD)
1) Cerebral Aneurysms ( seen in 4 to 10 % of patients).
2) Hepatic Cysts (seen in 10 % of patients)
3) Cardiac Valve disease (seen 25 to 30 %: most often mitral valve prolapse and aortic regurgitation)
4) Colonic Diverticula and Abdominal wall and inguinal hernia.
AVOIDANCE
CROMOLYN, STEROIDS
BETA-AGONIST, THEOPHYLLINE,
STEROIDS
MUSCARINIC ANTAGONISTS
AC = Acetyl-CoA
Ach = Acethylcoline
PDE = Phosphodiesterase
HUMOR: A pleasant release from anxiety. Important Assoc: LAUGHTER HIDES THE PAIN
SUBLIMATION: Unacceptable impulse into acceptable channel. The most Mature Defense Mechanism.
Important Assoc: ART, LITERATURE, MENTORING
SUPPRESSION: Forgetting but it is retrievalbe. Important Assoc: FORGET AND REMEMBER.

2
4
3
1
Study Results
Reality
Ho
H1
H1
Ho
BLOCKING: Transcient inability to remember. Important Assoc: MOMENTARY LAPSE
REGRESSION: Returning to a early stage of development. Important Assoc: ENURESIS, PRIMITIVE BEHAVIORS
SOMATIZATION: Physical symptoms for psychological reasons. Important Assoc: SOMATOFORN DISORDERS
INTROJECTION: The Outside becomes inside. Important Assoc: SUPEREGO, BEING LIKE PARENTS.
UREA CYCLE
NH4+ + HCO3- + 2 ATP

HEPATOCYTE
Carbamoyl
Phosphate
Synthetase I
Carbamoyl Phosphate
Ornithine
Transcarbamoylase
Ornithine
Citrulline
Citrulline
Ornithine
Aspartate
ATP
Argininosuccinate
AMP + PPi
Synthetase
Argininosuccinate
Argininosuccinate
Fumarate
Lyase
Arginase
Arginine
UREA
Ventricular Action Potential
Aortic Valves Closes
2. Ejection
Aortic Valves Opens
Stroke Volume
(EDV - ESV)
4 & 5 Ventricular Filling

Mitral Valves Closes
130
85
40
VENTRICULAR VOLUME (mL)
W
Z
X
Go
Y
W
Z
X
Go
Y
B
D
E
C
(+)
Time of day input
from suprachiasmatic
Hypothalamic corticotropin
nucleus
releasing(SCN)
hormone = CRH
Peak: Early morning
Low: Late evening
CRH
(-)
Optic
(+)
Stress
Chiasm
Anterior
pituitary
corticotrophs
(-)synthesize
and release
Posterior
Pituitary
Pro-opiomelanocortin
BETA-LIPOTROPIN (Active Peptide)

ACTH
Cortisol
Beta-MSH
Endorphins
(module pain)
ACID - BASE EFFECTS ON POTASSIUM BALANCE
Chronic
Acute Acidosis
Alkalosis
Alkalosis
Acidosis
NEGATIVE
POSITIVE
NEGATIVE
Acidification of Urine = Increases Ionization of Weak Base = Increases Renal Elimination
Weak Base
Acidify: NH4Cl, Vit C,
80
Cramberry Juice
60
40
Alkalinize: NaHCO3,
acetazolamide
20
Alkalinization of Urine = Increases Ionization of Weak Acid = Increases Renal Elimination
Weak Acid
Weak Acid
-2 -1 0 +1 +2
Weak Acid R-COOH R-COOH + H
(Crosses membranes) (Better Cleared)
Weak Base R-NH3 R-NH 2 +H

(Better Cleared) (Crosses membranes)

Sample

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Adult Still's Disease

Anemia of Chronic Disease

Anemia of Chronic Disease

Anemia, Macrocytic (MCV > 100)

Vitamin B6 (Piridoxine) Deficiency

G.I. Loss of Bicarbonate

Muscarinic Antagonists Theophylline

ACCURACY VS. PRECISION

Learning and Behavior Modification

Calcium Oxalate Stones

The NH4+come from Glutamine.

** Citrullline enters the cytoplasm, and ornithine returns to the mitochondria

Cardiac Output (C.O.)

Case Control Studies

AGE GROSS MOTOR FINE MOTOR LANGUAGE SOCIAL / COGN

15 Months Walks backward Uses cup Uses 4 - 6 words Temper tantrums

4 Years Hops Copies a cross Counts to ten Cooperative pla

Coarctation of the Aorta

Competitive Inhibitor Vs. Non-Competitive

Use in the Tx of Narrow-angle Glaucoma

ACID BASIC METABOLISM

Non-Ionized = Lipid Soluble

EVENT ANTIBIOTIC (S) AND BINDING SITE (S) MECHANISM (S)

1. Formation of AMINOGLYCOSIDES (30S) Interfere with initiation co

1. Formation of AMINOGLYCOSIDES (30S) Interfere with initiation co

2. Amino-Acid incorporation TETRACYCLINES (30S) Block the attachment of am

3. Formation of peptide bond Cholamphenicol (50S) Inhibit the activity of Pept

4. Translocation Macrolides and Clindamycin (50S) Inhibit translocation of pe

END OF ANATOMY PEARLS (RAPID FIRE STYLE)

EMIA SERUM Fe TIBC (TRANSFERRIN) Serum Ferritin Other

Anemia High Normal/High High * Give Pyridoxine (B6) to see if responsive

Normal/High Normal/High Normal/High * Check HbA2, HbF levels.

Anemia High Normal/High High * Give Pyridoxine (B6) to see if responsive

Normal/High Normal/High Normal/High * Check HbA2, HbF levels.

in B6 (Piridoxine) Deficiency Iron Deficiency Lead Poisoning

We have the following:

Exposure to antigen (dust, pollen,etc)

Antigen and IgE on Mast Cells

Mediators (leukotienes, histamine, etc.)

Late Response: Inflamation Early Response: Bronchoconstriction

Bronchial Hyperreactivity Symptoms.

BLOCKING: Transcient inability to remember. Important Assoc: MOMENTARY LAPSE

STOPS PUNISHMENT EXTINCTION

STOPS PUNISHMENT EXTINCTION

CONSTANT FIXED INTERVAL (FI) FIXED RATIO (FR)

In Modeling, Observational, or Social Learning, we have:

Terms that describe statistical distributions, are follow:

Power (1-β) Alpha

BEHAVIORAL PEARLS (RAPID FIRE STYLE) - END

Former w/: 1) Choroid Plexus Epithelium, 2) Intracerebral Capillary Endothelium, 3) Arachnoid.

The NH4+come from Glutamine.

sm, and ornithine returns to the mitochondria

"If"stand for the "funny channels of Na"

Valve Opening, Period of HIGHEST

Mitral Valves Opens

SYNOPSIS OF THE FORMULAS AND ABREVIATIONS

XII XIIa VII

Fibrinogen (I) Fibrin (Ia)

CERVICAL ROOTS INERVATION

OSS MOTOR FINE MOTOR LANGUAGE SOCIAL / COGNITIVE

front to back, Grasps rattle Orients to voice: Enjoys looking around,

Unassisted Transfers objects, raking grasp Babbles Stranger Anxiety