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174PharmacologyAllergy & ImmunologyLoratidine is 2nd gen antihistamine and safe in elderly coz no fall problems375PathophysiologyAllergy & ImmunologyHep B itself is not hepatotoxic but CD8+ repsonse to HBsAg and HBcAg will cause damage723MicrobiologyAllergy & ImmunologyProtein M is the main virulence of strep pyogenous as it inactivates phagocytosis, complement activation and permit bacterial adherence. It is also the target of humoral response to the infection Streptolysin O will lyse RBCs amd PMNs1155ImmunologyAllergy & ImmunologyCalcineurin activate IL2 which permit T cell proliferation. Hence the use of Calcineurin inhibitors in transplants1388MicrobiologyAllergy & ImmunologyIf a child has diphteria give antitoxin (passive immunization; most efficient), penicilin or erythromycin and vaccine. Otherwise prevent with vaccine (active immunization)1389MicrobiologyAllergy & ImmunologyNot all diphteria will cause pseudomembranous pharyngitis but need Tox gene to produce its exptoxin AB2068ImmunologyAllergy & ImmunologyTryptase is a specific marker for mast cells amd is useful in anaphylaxis2069ImmunologyAllergy & Immunology After IgE bind to receptors on Basophils and Mast cells these aggregate and cause degranulation of substances.1175BiostatisticsBiostatistics & EpidemiologyAbsolute Risk Reduction= Event Rate % (A) - Event Rate % (B)1183BiostatisticsBiostatistics & EpidemiologyMode is the most frequent value on statistics, it the least affected by outliers 1189BiostatisticsBiostatistics & EpidemiologyWhen choosing two groups of same age and sex and race you are reducing the chance of confounding bias. While selection bias occurs when you don't choose a representative sample of the population1204BiostatisticsBiostatistics & EpidemiologyP value is called type I error: Probability that the difference ovserve is due to chance alone. Type II error is measured with the power: Beta (probabiity of concluding that there is no difference when there is actually one) The power is 1 - Beta; meaning that is the pobability of concluding that there is a difference when there is actually one1274BiostatisticsBiostatistics & EpidemiologyA result is considered legit if the 95% CI does not cross 0, so p value is less than 0.051278BiostatisticsBiostatistics & EpidemiologyValidity (accuracy) is when a test gives very similar results than gold standard Reliability refers to reproducibility of test (similar values all the time)1279BiostatisticsBiostatistics & EpidemiologyEffect modification is when smoking increases HRT risks of DVT compared to just smoker, while HRT alone do not increase the risk of DVT1282BiostatisticsBiostatistics & EpidemiologyIn skewed graphs the hill is the Mean, then the Median and uphill is the Mode1286BiostatisticsBiostatistics & EpidemiologyLung cancer has been increasing a lot recently in women1299BiostatisticsBiostatistics & Epidemiology95% CI that value is between X+/- Y Y is 1.96 (SD/rootsquare N) aka (SE) if it is as 99% CI it becomes 2.58 SE1302BiostatisticsBiostatistics & EpidemiologyBerkson's bias: The bias of choosing hospitalized patient in the study Hathorne effect (observer effect): The tendency of subject to change their behavior as a result of awareness that they are being studied Pygmalion effect: the effect of researcher's belief on outcome10570BiostatisticsBiostatistics & EpidemiologyEcological study are like cross sectional study, but in ecological study you want to measure a certain geographical population habits or whatever. Used to make hypotheses about populations35EmbryologyCardiovascular System Transposition of Great Arteries is failite of Aorticoopulmonary spiral septum to undergo septation.40PathologyCardiovascular System 0-4 hr post mi the myocardium is normal on histology. 4-12: coagulation necrosis, edema hemorrhage, wavy fibers 1-5 days neutrophils 5-10 macrophae 10-14 granulation tissue then scar with collagen42PathophysiologyCardiovascular System Myocyte will stop contracting 1 min after total ischemia but it reversible until 30 mins43PathologyCardiovascular System Hibernating myocardium refers to the presence of ledt ventricular systolic dysfunction due to reduced coronary blood flow at rest that is partially or completely reversible by coronary revascularisation92PathologyCardiovascular System In dilated Myopathy (also in ischemic myopathy): Contractile function is decrease but normal diastolic funciton (normal compliance) it is the opposite in HTN and hypertrophic cardiomyopathy96PathophysiologyCardiovascular System Constrictive pericarditis is chronic136PharmacologyCardiovascular System NO will induce high cGMP which put myosin light chain in their inactive conformation141PharmacologyCardiovascular System In HOCM we use bb ccb disopyramide and diuretics or dilators142PharmacologyCardiovascular System Patients taking nitrates shld have a nitrate free period daily to avoid tolerance144PhysiologyCardiovascular System Both cardiac and smooth muscles are activated starting with extracellular Ca2+, therefore CCB's work on them, unlike in skeletal muscles155PharmacologyCardiovascular System Digoxin: AV block (parasympathetik) so helpful in Afib while in CAD its effect is helful coz of increase co tractolity ( DI goxi. So two functions)160PharmacologyCardiovascular System Prevent NIACIN FLushing BY NSAIDS

198PathophysiologyCardiovascular System LHF will cause RHF by congestion pulmonary veins leading to vasoconstriction of pulmonary artey and intimal thickening with media hypertrophy200PathophysiologyCardiovascular System S3 is caused by increased preload and it can lead to functional mitral regurg that is eliminted by preload reduction201PathophysiologyCardiovascular System Pulmonary HTN cause irreversible damage to pulmonary arteries while RV hypertrophy can be reversible with correcting the HTN202EmbryologyCardiovascular System PFO (failure of septum primum and secundum to fuse) and ASD (aplasia of either septum secundum most commonly or septum primum) can both cause stroke from venous clot but the difference is that PFO does not cause murmur.232PathologyCardiovascular System IE: vegetations on valve cups along with degeneration Rhemuatic fever: fibrous thickening and distortion of mitral valve with commissural fusion at leaflet edges240HistologyCardiovascular System Aschoff bodies are seen in heart rheumatic fever 245PhysiologyCardiovascular System In tubes velocities: V1A1=V2A2=Cte (considering incompressible tubes, assuming vessels are not compressible we can apply this rule)296PathophysiologyCardiovascular System Metastatic calcification occurs in cell necrosis (like in old aortic valve)446PathophysiologyCardiovascular System Atheros plaques involve platelets (PDGF) macrophages that will promote migration of smooth muscels449PathologyCardiovascular System In mild HTN u get hyaline arteriosclerosis ( deposition in intima and media of vessels) In severe HTN u get onion like concentric thickening of the wall474PathologyCardiovascular System In Varicose vein we morry most about skin ulceratio not DVT and stuff 551PhysiologyCardiovascular System Permissive effect of cortisol: (it permits others to work at their best) On its own it doesnt do anything But increase sensitivity of vessels and bronchial tissues to catecholamines and increase glucose response to Glucagon679MicrobiologyCardiovascular System only Aureus is coagulase + among the Staphes 693PharmacologyCardiovascular System ACE inhibitor can cause hypotension in first doses therefore started gradually (dosage)778PharmacologyCardiovascular System Statins and fibrates have fucked up effects on muscles898PharmacologyCardiovascular System In PSVT adenosine will cause chest burning and flushing899PharmacologyCardiovascular System Amiodarone (class III K+ channel blocker of cardiac pacemaker cells so decrease repolarization and increase AP so imcrease depo and repo time hence increase QT but less associated with Torsades maybe coz of more homogeneous repolarization. So eventhough Amiodarone is BAD it has a GOod Side of the Force. Adenosine increase K+ conductance in AV and cause delay900PharmacologyCardiovascular System Lidocine (IB) bind rapidly depolarizing cells (like cocaine is rapid). Ischemic heart is depolarized, so Lidocaine likes it. SO LIDOCAINE IS GOOD IN MI944PathophysiologyCardiovascular System MR is severed with volume overload so when have S3 u know MR is at its max951PhysiologyCardiovascular System In exercise, tachycardia will reduce Diastolic time, so this is the limiting factor in Heart perfusion1003MicrobiologyCardiovascular System Viridans are acquired after dental procedure if have cardiac structural abdnormaloties, and take glucose from out of cells and transform it into dextran to integrate it into its polysaccharide cell wall, and also permits it to adhere to fibrin. So Viridans adhere to fibrin and platelets that are deposited at site of endothelial trauma in the valves and cause infection there.1014PharmacologyCardiovascular System Doxorubicin cause dose related dilated cardiomyopathy by creating free radicals.. Radiation cause myopathies by perocardial fibrosis (viral and surgery.)1080PharmacologyCardiovascular System Cilostazol is used in PAD, reduce,atelt activation and cause vasodilation1094MicrobiologyCardiovascular System Diphteria toxin (AB exotoxin) ribosylate and therefore inhibit EF-2, so will inhibit protein synthesis causing cell death1118PharmacologyCardiovascular System ANP, BNP, NO --> increase cGMP --> relaxation of smooth muscle1166PharmacologyCardiovascular System if have cough with ACE go for ARBs1174BiostatisticsCardiovascular System When comparing the efficiency of a new drug mortality benifit over another standard drug, the NNT (number to treat), represents the ammount of people needed to be treated to prevent on event compared to standard drug: 1/ARR(2.5%(risk of deaths of old drug)-1% (risk of death of new drug))1252PharmacologyCardiovascular System Arteriolar vasodilator like hydralazine and minoxidil will cause reflex tachycardia and fluid retention1344PharmacologyCardiovascular System Dobutamine affects B1 and lesser B2 and A1. So increase HR and Contractility hence increase Demand of O21444PharmacologyCardiovascular System FLAT CHAMP INCREASE cAMP1512PhysiologyCardiovascular System In fluid loss even if BP is low TPR is high due to Sympathetic activation. But Fluid infusion will increase preload and increase End-Diastolic sarcomere length and will increase Volume status decreasing Sympathetik stimulation and decrease TPR Remember SBP= CO.TPR, so in Hypovolemia CO is super low and even with sympathtic compensation to increase TPR, SBP stays LOW

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1513PhysiologyCardiovascular System Cardiac electrical transmission speed: PAVA: Fastest --> Slowest: Purkinje fibers --> Atrial muscles --> Ventricular muscles --> AV node1515PhysiologyCardiovascular System PSVT: Do Carotid massage (XI -> X), Valsalva or Adenosine and this will prolong AV node refractory period1517PhysiologyCardiovascular System In mitral valve stenosis we have a snap (indicating that the stenosed valve is trying to open but is finding difficulties) then a dyastolic rumbling murmur because of turbulent flow across this damaged valve.1528PhysiologyCardiovascular System At rest or exercise both systemic and pulmonary circulations have similar blood flows since both systems are continuous and same amount of blood going from the LV is going from the RV ( both systems differ in r and l of the equation but end up equal in Q since they are continuous)1529PhysiologyCardiovascular System CO= O2 consumption/ AV O2 difference1557PhysiologyCardiovascular System S3 sounds in people >40 is abnormal and indicate LV enlargement (MR, AR, Dilated or Ischemic Cardiomyopathy). It is Increased in End of Expiration (LV fills more), Left lateral Decubitus (Higher Flow in LV), and Heard with the Bell of Steth in Cardiac Apex in Early Diastole. Amyl Nitrite (Vasodilation, Decrease Bp, Decrease Venous return), Furosemide (Diuresis, lower LV Volume),Valsalva or Standing (lower V return) all Decrease S31589PhysiologyCardiovascular System In exercise PaO2 and PaCO2 do not change but CO and HR increase to accomodate for tissue's demand PE --> Hyperventilation = Lower PaCO21621PhysiologyCardiovascular System Flow (Q)= dP/R Remember U=R.I R= v.L/r4 Q=r4.(dP/v.L) So if flow decrease by X in a medium of same property this means that the radius is decreased by X root 4 But Velocity relation is A1V1=A2V2 and has a r2 relatioship change with velocity1624PhysiologyCardiovascular System In the Cardiac output, Venous return curve its easy. If an event decreases venous return like anaphylaxis for example lower the venous return curve. MI will lower the Cardiac output curve maximum and slope. Anemia would higher it since we will have tachycardia1652PhysiologyCardiovascular System In Heart PV curve, the lowest horizontal curve where heart receives blood, the slight increase in P is preload whereas in the upper horizontal line which demonstrates heart emptying, the slight increase in P is Afterload. Nitroprosside will decrease both Preload and Afterload by Vasodilating Both Veins And Arteries.1782PhysiologyCardiovascular System Pulsus Paradoxus usually happens in Tamponade but can also happen in Constrictive Pericarditis, Asthma COPD, or Hypovolemic Shock. In Tamponade, increased pericardial fluid will compress LV, and during Inspiration increased venous return in RV will move InterVentricular Septum towards LV, making it even smaller, thus a >10% decrease in SBP.1871AnatomyCardiovascular System The Inferior wall of left Ventricle lies on the Diaphragm and is supplied by the Posterior descending artery (from RCA)1931PhysiologyCardiovascular System Prior to myochte relaxation Ca2+ leave cells through Ca2+ ATPases and Na+/Ca2+ exchange (3 to 1, and does not require ATP) Besides its action in Smooth Muscle contraction, Calmodulin plays a role in Cardiac Ca2+ efflux, by binding Ca2+ ATPases and activating it.1947PharmacologyCardiovascular System Phentolamine is competetive alha blocker wheras phenoxybenzamine is a non competitive irreversible antagonist1973PhysiologyCardiovascular System CCB's slow Diastolic depolarization of Pacemaker cells. (phase 0) they also decrease intracellular Ca2+, affecting excitation-contraction of these cells, therefore decreasing Contractility. But when question is about antiarrythmitic studies choose the Antiarrythmic action of CCB's.1975PhysiologyCardiovascular System ACh and Adenosine reduce phase 4 of spontaneous depolarisation, in cardiac pacemaker cells.1976PhysiologyCardiovascular System Desynchronization between P and QRS means 3rd degree AV Block. This means Atria contract from SA node but the impulse does not make it to AV node on time most probably due to circuit abnormality, so AV node will take over to contract ventricles and will get narrow QRS (since it supraventricular firing, so AV node will filter the impulse sent)1983PhysiologyCardiovascular System Holosystolic murmur, that increase during inspiration is only tricuspid regurgitation since the right heart will fill on inspiration. Left sided holosystolic murmurs and VSD are not affected by inspiration since it does not increase left V load. Tricuspid murmur: left sternal border, 3rd and 4th intercostal space Mitral murmur: Apex of heart Aortic stenosis: Diamond shape (since aorta is most important and every old person has diamonds)2002PharmacologyCardiovascular System Thiazide increase GLUC Glucose, LDL, Uric Acid, Ca2009PhysiologyCardiovascular System The heart has the highest oxygen extraction rate. (6075%) During exercise only increasing coronary flow by Vasodilation which is mediated by Adenosine and NO will accommodate for the increase oxygen demand since extraction is already almost maximal. A

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2055PhysiologyCardiovascular System Afib can be induce systemic illness (HTN, Geart failure, Hyperthyroid), Increased Sympathetic tone and Excessive alcohol consumption. Get irregularly irregular fast rythm with absent P waves and often Narrow QRS. on EKG. High QRS amplitude is due to ventricular hypertrophy often due to HTN. Prolonged QT can be congenital and associated with Torsades De Pointes and can also be dure to chronic alcohol use (not one episode of bunge drinking, which can cause Afib)2130AnatomyCardiovascular System Most common cause of aortic rupture in MVC is at the Aortic Isthmus; the site of ligamentum arteriosum just dital to right subclavian7640PharmacologyCardiovascular System Class III will increase QT, while digoxin will cause AV block8711HistologyCardiovascular System Thpe I Collagen is the most abundant overall and is the one we find in scars.11745PhysiologyCardiovascular System BNP (natriuretic peptide) is released in response to atrial and ventricular stretching --> Natriuresis, Diuresis, Vasodilatory (antagonize vasoconstriction action of RAAS) effect and protects against heart remodeling. BNP then inhibits RAAS system and renin levels. Neprisylin metalloproteases, degrades BNP, bradykinins, oxytocin and bradykinin. Neprisylin inhibitors are then good in Heart failure --> increase BNP and in turn decrease Renin11764AnatomyCardiovascular System In cardiac cath, when trying to reach the femoral artery, if cannulation is done above the inguinal ligament you can induce RETROPERITONEAL HEMORRHAGE (CARDIOLOGIST ARE SCARED OF THIS)11833PathophysiologyCardiovascular System In right MI have stiffness of RV so increase CVP (backup of blood) but low RV output so Low PCWP 11842AnatomyCardiovascular System In Afib clots form in left atrial appendage its a motionless part of the atria (ma ela 3aze)876PathologyDermatologyDermatitis herpetiform usually appear at 40-50 Eczema can occur after some food1061BiochemistryDermatologyZinc deficiency causes acrodermatitis enteropathica, infertility and Growth retardation1106AnatomyDermatology Apocrine glands secrete by cel lysis and content exretion like pimple glands (sebacious and meibomian) Apocrine secrete membrane bound vesicles (breast) while Merocrine secrete via exocytosis like salivry, eccrine and apocrine sweat glands (named this way coz thought to be apocrine in nature ) DA FUCK bass CV u wont be confused1110PathologyDermatologyVitiligo: loss of melanocyte (autoimmune pooly understood) in albinism have melanocyte but cannot produce melanin (unlike vitiligo where melanocytes are fucked up)1314PathologyDermatologyLeprosy is attacked by CD4+ Th1 cell mediated response (like other Mycobacterium) so skin lesions are due to IL2 and IFN Gamma1334BiochemistryDermatologyIn Hartnup disease you have decrease Tryptophan absorption in guts and reabsorption in kidneys. So you will eventually have decreased niacin and pallegra1613ImmunologyDermatologyGVHD occur also with liver transplant because it is rich in lymphocytes and occurs a week later (around), Acute and chronic rejection are usually Host vs Graft (also T cell mediated)1641PharmacologyDermatology Acyclovir valcyclovir gancyclovir and those are nucleoside analogues that require both cellular and herpes kinases for conversion to their active nucleotide triphosphate form Cidofovir is a nucleoside monophosphate only require host cellular kinase1669MicrobiologyDermatologyPost auricular lymphadenopathy makes us more suspicious towards rubella rather than measle1725GeneticsDermatologyAndrogenic alopecia have Polygenic Inheritance patterns1937PathologyDermatologyLymhedema (like post mastectomy) increase risk of Angiosarcoma2037BiochemistryDermatologyIn tRNA we have a CCA site where amino acids bind8569PharmacologyDermatologyPsoriasis is often treated with with topical vit D analogs; calcipotrieme that bind vitamin D recptor, inhibits keratinocytes proliferation and stimulate their differentiation8904PathophysiologyDermatology Accessory nipples are the most common congenital anomaly and fluctuate with menstrual cycle, unlike nevi. On the other hand Neurofibroma are composed of Shwann cells and neural fibroblasts and can sometimes retract to subcutaneous tissue when pushed down.11738PathologyDermatologyTGF beta is responsible for fibroblast migration proliferation and CT synthesis11852PathologyDermatologyopioids, contrast, and vanco.. can trigger mast cell degranulation1740EmbryologyEar, Nose & Throat (ENT)Cleft lip: maxillary prominence fail to fuse with intermaxillary segment(below nasal septum) Cleft palate: Failure of palatine shelves to fuse with one another or with primary palate Occur in 5-6 week of embryo development. Cam occur together or in isolation.11628PathophysiologyEar, Nose & Throat (ENT)Cholesteatoas are collection of squamous cell debris that form behind tempanic membrane, can be congenital or acquired following infection, trauma.. cause hearing loss due to ossicle erosion

11783AnatomyEar, Nose & Throat (ENT)Psterior bleeding with sphenopalatine bleed is usually uncontrollable with bleed and occur with HTN163PharmacologyEndocrine, Diabetes & MetabolismFibric acids (gemfibrozil..) decrease triglyceride production while Cholestyramine (bile acid sequestrant) cause hypertriglyceride and gallstones ( cause decrease bile acid reuptake so new cholesterol is put in bile u know..)166PharmacologyEndocrine, Diabetes & MetabolismGemfibrozil are the most efficient for triglyceride so the best in pancreatitis induced by triglycerides167PharmacologyEndocrine, Diabetes & MetabolismIn addition to DERMATITIS of NIACIN Add GOUT (hyperuricemia; part of dermatitis ;) )209PharmacologyEndocrine, Diabetes & MetabolismGnRH agonist: at first act as GnRH but then in contrary coz not pulsatile216PhysiologyEndocrine, Diabetes & MetabolismSertoli cells secrete Inhibin B to feedback inhibit FSH. Leydig cells secrete Testos that feedback inhibit LH. Sertoli cells also secrete Androgen binding proteins to bind Testosterone and trap it there since it needs it for spermatogenesis. This is different from Sex binding protein which let testosterone circulate in the blood and is produced by liver 225PathologyEndocrine, Diabetes & Metabolism Acute hemorrhage into the pituitary (pituitary apoplexy) is usually aassociated with Pituitary Adenoma Severe Headache, Cranial Nerve Involvement (bitemporal hemianospia, ophtalmoplegia) and meningeal irritation. Cardiac Collapse is due to adrenal insuficiency342EmbryologyEndocrine, Diabetes & MetabolismIncrease AFP (Dating error most commonly) Patau Gastroschisis, Omphalocele, Neural tube defect, and Multiple gestation. Decreased levels in Trisomy 21, 18.599PharmacologyEndocrine, Diabetes & MetabolismPioglitazone and stuff work on PPAR gamma in fat so make u FAT not only by fat but also by increasing Na absorption in Collecting Tubules602BiochemistryEndocrine, Diabetes & MetabolismCortisol produced in the cortex will pass through the veins that will go the medulla and enhance the PNMT (phenylethanolamine N methytransferase) enzyme that converts Norepi to Epi (Makes sense right)603PharmacologyEndocrine, Diabetes & MetabolismPioglitazone affect transcription factor and gene involvement so takes time604PharmacologyEndocrine, Diabetes & MetabolismGliflozin are SGLT2 inhibitors (sodium glucose cotransporter in PCT) cause glucosuria so possible UTI and genital mycotic infection. Also cause osmotic diuresis. In Pple with renal impairement, the meds will not work well and can have increase adverse effects605PharmacologyEndocrine, Diabetes & MetabolismPPAR gamma is a nuclear receptor affected by Pioglitazone and Rioglitazone ..631PathophysiologyEndocrine, Diabetes & MetabolismhyperPTH leads to Osteitis Fibrosa Cystica where we have subperiosteal eiosions affecting phallanges of hand, "salt and pepper" skull, and brown tumor bone cysts.767PathophysiologyEndocrine, Diabetes & MetabolismHigh dose of Iodine will inhibit iodine uptake by follicular cells (used if have radioactive iodine intoxication, T4 is not efficient coz it takes days to work)769PathologyEndocrine, Diabetes & Metabolismdu quervain: mixed cellular infiltrate with occasional multinuclear giant cells (post URI) Hashimoto: lymphocytic infilitrate with germinal centers and Hurthle cells surrounding residual follicles (large oxyphilic cells filled with granular cytoplasm)770PhysiologyEndocrine, Diabetes & MetabolismTSH stimulate I-(Iodide) absorption (Na+I- symporter) in Follicular cells and is competitively inhibited by Perchlorate and Pertechnetate, then goes in the colloid. I- is converted to I2 (Iodine) in the colloid (catalysed by Peroxidase). Thyroglobulin is synthesized in Follicules then go to colloid too, where its tyrosine residues bind to I2 (Peroxidase). MIT and DIT are phagocytosed in follicular cells then those who are not deiodinated join and T3, T4 form and are released771EmbryologyEndocrine, Diabetes & MetabolismNeural crest: PNS, Adrenal Medulla and Parafollicular pf thyroids (both are chromaffin cells)920PharmacologyEndocrine, Diabetes & MetabolismGlitazones PPAR GAMMA STUFF reduce insulin resistance980BiochemistryEndocrine, Diabetes & MetabolismRemember Thiazide and HyperGLUC990PhysiologyEndocrine, Diabetes & Metabolism7-dehydrocholesterol -(UV)-> CholeCalciferol (D3) (1st step) then 25-OH in Liver then 1-OH in Kidney992PhysiologyEndocrine, Diabetes & MetabolismSteroid, Thyroid hormones, VitD: Intrareceptor with DNA domain (to alter DNA expression when go in nucleus) Ligand-gated ion channels (Na+,K+,Ca2+,Cl-) across membrane for membrane potential etc. Intrinsic Phosphorylation: Insulin and Insulin like GF JAK STAT: GH, Prolactin, EPO Hypercalcemia Hypocalciuria (AD since all family has it): Defective Ca2+ sensing G (THINK C, G LOOK ALIKE) proteins coupled receptors in PT gland and kidney that regulate circulating Ca2+ levels.994BiochemistryEndocrine, Diabetes & MetabolismGlucagon, beta adrenergic, PTH and TSH receptors work through Protein Kinase A responsible for the G protein/ Adenylate cyclase secondary messenger system

1009PhysiologyEndocrine, Diabetes & MetabolismBeta cells: Glucose enters pancreas through GLUT 2 transporter undergoes glycolysis and produces ATP which will bind ATP-sensitive K+ channels (opened at rest and maintains K+ efflux keeping cell hyperpolarized) and close them. This will depolarize cell, which will open Voltage-dependent Ca2+ channels, increasing Ca2+ intracellularly and inducing insulin release. If KATP channels do not respond to ATP we will have DM. Sulfonylurea bind KATP, close them irrespectively of ATP1010BiochemistryEndocrine, Diabetes & MetabolismGlucokinase will control glucose entry in Glycolysis in pancreas and liver and hence stimulate insulin release. If non functional you can have DM predisposition1012PathologyEndocrine, Diabetes & MetabolismDM I : Islet leukocytic infiltration DM II: Islet amyloid deposition1013BiostatisticsEndocrine, Diabetes & MetabolismSmoking cessation is by far the most effective preventive intervention to avoid Cardiac events1022BiochemistryEndocrine, Diabetes & Metabolismgluconeogenesis requiring conversion of oxaloacetate to PEP uses GTP as a source of energy and this GTP comes from the conversion of Succinyl CoA to Succinate in the Krab Cycle. COOL Hein1031BiochemistryEndocrine, Diabetes & MetabolismFructose 2,6 biphosphate favors Insulin effect and decreasing conversion of pyruvate to Glucose ( decrease cAMP) in contrary to Glucagon1034BiochemistryEndocrine, Diabetes & MetabolismHigh Acetyl CoA level is the main Allosteric Actiator of Gluconeogenesis Increasing the activity of Pyruvate Carboxylase, Converting Pyruvate into Oxaloacetate1044BiochemistryEndocrine, Diabetes & MetabolismPanthothenic acid is B5 and is used to synthesize CoA used in TCA cycle especialy in first step reaction1119BiochemistryEndocrine, Diabetes & MetabolismPentose phosphate reactions are all in Cytoplasm (coz only 5 carbona WTF) First step of Gluconeogenesis consisting of Puruvate to Pxaloacetate requires B1 and is in Mitochondria1163PathophysiologyEndocrine, Diabetes & MetabolismIn Cushing we HyperPlasia of Zona Fasciculata (Not Hypertrophy) ... think that ure producing an adenoma NON SENSE BUT STILL1324PharmacologyEndocrine, Diabetes & Metabolism Alpha stimulation is dominant over beta thats why epinephrine decrease insulin1325PhysiologyEndocrine, Diabetes & MetabolismIn DM, Infection, Pain and Sleep Deprivation can cause Hyperglycemia, while Exercise can induce Hypoglycemia.1326PathophysiologyEndocrine, Diabetes & MetabolismSerine and threonine phosphorylation of insulin receptor lead to insulin resistanec (mediated by TNF alpha, catechols, steroids and glucagon)1328PathophysiologyEndocrine, Diabetes & MetabolismElevated free fatty acid levels contribute to insuline resistance (impair insulin dependant glucose uptake and increase hepatic gluconeogenesis and insulin secretion) and DM II 1355PhysiologyEndocrine, Diabetes & MetabolismGlucose is transported in the D-Glucose form. Glut 4 is insulin mediated and transports it into fat and muscle tissues whereas Glut 2 tranports Glucose from Liver, SI and Kidneys into blood circulation and helps regulates insulin secretion from pancreas. Glut transport Glucose via Carrier-mediated transport (Active transport)1540PhysiologyEndocrine, Diabetes & MetabolismInsulin has no effect in Glucose reabsorption in kidneys, but Increase Na+ Renal Absorption increasing blood volume and BP. Insulin also inhibits glucose release from liver, and Inhibits Glucagon secretion by directly acting on Alpha cells. It is Anabolic (Glycogen, Protein Synthesis) and inhibits Glycogenolysis, Lipolysis and other Catabolic reactions.1615PhysiologyEndocrine, Diabetes & MetabolismThyroid produce mainly T4, which is converted to T3 (active hormone) rT3 (inactive)1660PathologyEndocrine, Diabetes & MetabolismRAT (activating mutation) in Men RAS is follicular thyroid 1768PhysiologyEndocrine, Diabetes & MetabolismInsulin synthesis: Insulin translation starts in ribosomes to yield PreProInsulin. Then translation continues in RER Ribosomes (the same ribosome translocates). In the RER first the N terminal is cleaved giving Proinsulin then 3 disulfides bonds in the Insulin parts form. The ProInsulin is sent to the Golgi Apparatus and is cleaved by endopeptidases, but both Insulin and C peptides are stored in granules and secreted from Beta cells. But C peptide's half life is only 35 mins1979PathophysiologyEndocrine, Diabetes & MetabolismIn metabolic acidosis (E.g DKA) u hyperventilat but in DKA u have lung edema so u go in respiratory failure not only because of exhaustion1984PharmacologyEndocrine, Diabetes & MetabolismSevere hypoglycemia (patient not conscious so cannot swallow) so give Glucagon (if outsode hospital) and Sugar per IV (in Hospital)2066BiochemistryEndocrine, Diabetes & MetabolismOrotic acid converts to UMP, UDP --> TMP, CTP (pyrimidine). If the enzyme Orotate phosphorybosyl transferase is missing, you won't be able to convert orotic acid. But if you supplement patient with Uridine you negatively feedback the reaction2081PathologyEndocrine, Diabetes & MetabolismIn CAH give Steroids to supress ACTH8531PathologyEndocrine, Diabetes & MetabolismSulfonylurea can cause Severe Hypoglycemia

11565PharmacologyEndocrine, Diabetes & MetabolismSulfonylurea can cause Hypoglycemia11634PharmacologyEndocrine, Diabetes & MetabolismEzetemibe is like fenofibrate but decrease absorption of cholesterol, not bile acids207PhysiologyFemale Reproductive System & Breast For ovulation induction you can use Menotropin (mimics FSH) then HCG (mimics LH, same alpha subunit. Similar subunit with FSH too but not that much, and not the point here)258PathologyFemale Reproductive System & Breast PCOS have increased risk of endometrial ca and DM II299PhysiologyFemale Reproductive System & Breast Upon withdrawal of Progesterone, Endometrial cells undergo Apoptosis around 5 days later, causing Menses1015HistologyFemale Reproductive System & Breast Koilocyte seen in HPV are cells with dense nucleus (pyknotic: dense DNA, as part of apoptosis first step) and perinuclear halo clearing1057PathologyFemale Reproductive System & Breast Comedocarcinoma (DCIS): solid sheet of pleomorphic, high grade cells with central necrosis1158PathologyFemale Reproductive System & Breast Granuloas cell tumor of ovary: Call Exner (cuboidal cells in rosette pattern with bean nuclei) and yellow theca cells with lipids Large unilateral adnexal mass with increase Estrogen and inhibin1549PathophysiologyFemale Reproductive System & Breast Herpes facial palsy is HSV 1 (oral not genital) HSV 2 resides in dorsal root ganglia in sacral ganglia and be reactivated and give recurrent genital ulcer VZV also goes in dosal root but in trigerminal ganglia1560PhysiologyFemale Reproductive System & Breast Theca interna: Cholesterol -(LH)-> progesterone + Androgen --> Granulosa (Aromatase): Androgen -(FSH)-> Estrogen. This actually explains why LH and Progesterone are not null during Follicular phase. Theca externa serve as supportive connective structure.1632AnatomyFemale Reproductive System & Breast Ovary is innervated by Ovarian artery, vein, lymphatic and nerves which are contained in suspensory ligament as the suspensory ligament hold the ovaries in suspension in the abdomen1739AnatomyFemale Reproductive System & Breast Pudendal block is sometimes use if epidural was not used. It is intravaginal medial to ischial spine and will num the perineum the genitals, and motor og urthra sphincter and external anal sphincter (S2-S4)1809EmbryologyFemale Reproductive System & Breast In contrast to Androgen insensitive patient those with Vagina agenesis (upper vagina and sometimes uterus, it's Mullerian defect) ave Pubic hair etc.1831EmbryologyFemale Reproductive System & Breast Bicornuate nucleus: Incomplete lateral fusion of paramesonephroc duct1899PhysiologyFemale Reproductive System & Breast Anovulation is common in first years of menarche (Immature axis, so follicle does not become corpus luteum) and last years before menopause, it manifests with menstrual variability, spots Complex atypical endometrial hyperplasia occurs with prolonged unopposed estrogen, it can happen with chronic anovulatory cycles (where you only have estrogen without progesterone), HRT without progesterone or Obese old women. Atrophic endometrium occurs in menopause (also get spotting2056PathologyFemale Reproductive System & Breast Ovary is cuboidal cells8556GeneticsFemale Reproductive System & Breast Turner's have abnormal ovary but normal Uterus so can get pregnant with donation etc.11781AnatomyFemale Reproductive System & Breast Ureter injury will cause leakage of urine irritating the bowel causing ileus, flank pain and fever but no urinary incontinence11802MicrobiologyFemale Reproductive System & Breast KOH is used to diagnose gardenella While trichonoma protozoa with flagella are seen on wet mount11820AnatomyFemale Reproductive System & Breast Internal urinary sphincter are parasympathetic innervation while external one ( distal) is pudendal voluntary Kegel exercice target levator ani ( think of how u contract ur perineum)47MicrobiologyGastrointestinal & Nutritionhep B give hep D a capsule giving it its virulence and ability to invade hepatocyte57PathologyGastrointestinal & Nutrition Aflatoxin G->T mutation in p53, increasing risk of HCC. Found in grains corns soybeans peanuts where fungi are grown62MicrobiologyGastrointestinal & NutritionLiver abscess can be caused by Staph throgh hematogenous route MESH GHALAT70BiochemistryGastrointestinal & NutritionIn infections Beta glucoronidase are released by hepatocytes and unconjugate conjugated bilirubin causing it to precipitate and causing brown stones78PathophysiologyGastrointestinal & Nutritioncholesterol makes bile less soluble while bile salts and phosphatidylcholine makes it more soluble126PhysiologyGastrointestinal & Nutrition Acid secretion: 3 phases Cephalic: Vagal and cholinergic: stimulated by thought, sight, smell and taste of food Gastric phase: Chemicals in food and gastric distention; Gastrin-->Histamine (Enterochromafin like cells; ECL) --> Acid secretion Intestinal phase: proteins in Ileum and Colon will produce Peptide YY which will bind to ECL and inhibit gastrin stimulated histamine release from these cells When acid is secreted Bicarb and Cl- decrease in circulation (predictable)

133PathophysiologyGastrointestinal & NutritionCan diagnose Lactase deficiency by decreased pH of stool165PharmacologyGastrointestinal & NutritionStatins decrese cholesterol formation SURE, BUT BUTTT cholestyramine will bind bile acids and cause increase excretion so liver will produce more cholesterol to throw in bile280PathologyGastrointestinal & NutritionEsophageal spasm is due to imparied neural inhibition within the myenteric plexus290PathologyGastrointestinal & NutritionErosion does not cross Muscularis Mucosa While Ulcer Do Cross it306PathophysiologyGastrointestinal & NutritionMastocytosis will increase Histamine and cause Gastric Hypersecretion (EZ) (Associated with KIT receptor Tyrosine Kinase Mutation)319EmbryologyGastrointestinal & NutritionDuodenal atresia is due to recanalization failure while Jejunal/Ileal atresia is due to vascular injuries320EmbryologyGastrointestinal & NutritionImperforate anus, is most commonly associated with urogenital abnormalities (fistulas and stuff). Then you think of VACTREL Vertebral, Anus, Cardiac, TE, Eosophageal atresia, Renal, Limbs322EmbryologyGastrointestinal & NutritionMeckels diverticulum is part of vitelline (omphalocele) duct remnant (in embryo connects midgut to yolk sac but obliterated in 7th week) If not obliterate it can cause vitelline diverticulum where meconium passe through it into the umilibcal cord, or we can just have a band or a cyst.328EmbryologyGastrointestinal & NutritionMeckels diverticulum is a true one and is composed of all layers; mucosa, submucosa and muscular layers369PathophysiologyGastrointestinal & NutritionInhaled halothane can cause fulminant hepatitis (looks like viral hep) and will have high ALT AST, and decrease hepatic function so failure so prolonged PT and stuff but no hepatic HTN370PathologyGastrointestinal & Nutrition Alcohol inhibits Free FA Oxidation and Gluconeogenesis coz have INCREASED NADH373ImmunologyGastrointestinal & NutritionChildren <6 yrs usually get asymptomatic Hep A. They don't get anti IgM antibody since no disease374MicrobiologyGastrointestinal & NutritionHel B is a ds DNA but replicate via reverse transcription (+RNA template)406PathologyGastrointestinal & NutritionCrohn Th1 (terminal ileum) UC Th2407PathologyGastrointestinal & Nutritionin UC the rectum is always involved410PathologyGastrointestinal & NutritionToxic megacolon is UC is diagnosed by Xray412PathophysiologyGastrointestinal & NutritionCrohn, ileum involvement, bile acid will not be reabsorbed so bile will have less bile acids and will be more cholesterolous hence gallstones415PathologyGastrointestinal & NutritionTraction Diverticula is True Diverticula and due to inflammation and stuff While pulsion Diverticula is False (like sigmoidal Diverticula) Outpouching of the mucosa and submucosa through the muscularis431PathologyGastrointestinal & NutritionPolyp were shown to be involved with COX2, thats why we give aspirin for colon CA432PathologyGastrointestinal & NutritionTenesmus is seen in rectal adenoCA not colon righ colon: occult bleed iron deficiency Left colon: obstruction and often hematochezia435PathologyGastrointestinal & NutritionPancreatic pseudocyst wall is not lined by epithelium but by granulation and fibrous tissues Serous cyst have glycogen rich cuboidal cells epithelium Mucinous cysts habe columnar mucinous epithelium Atypical papillary projections are seen in AdenoCa437EmbryologyGastrointestinal & NutritionPancreas Embryology: Dorsal bud Tail, Neck most of Body, Accessory Duct Ventral bud: Uncinate, Inferior Posterior Moreover, Inferoposterior aspect of Head and Major Duct In Pancreatic Divisum (5% of population) the two buds fail to fuse fiving two seperate ducts with independant drainage. Ventral duct (will be smaller) drain into major papillae, Dorsal duct (major) drain into smaller papillae. Cery rarely this can cause chronic Pancreatitis539ImmunologyGastrointestinal & NutritionIg's attach Phagocytic cells through Fc portions and attach Complements through hinge portion589ImmunologyGastrointestinal & NutritionSecretory IgA come in a dimer form where both Fc portions are attached by a J chain745ImmunologyGastrointestinal & NutritionCells with decreased MHC1 expression like virus infected cells and tumor cells, are targeted by NK cells to kills them755BiochemistryGastrointestinal & Nutrition1g of Proteins and Carbs produces 4 Calories while 1 g of Fat produces 9 Calories790BiochemistryGastrointestinal & NutritionThe MAP kimase pathway (including Growth hormone) uses Ras protein and GTP (active) and GDP (inactove)841PharmacologyGastrointestinal & Nutrition Arsenic is found in insecticides, contaminated water and cause abd pain,vomiting, diarrhea, hypotension and garlic odor breath. Treat with DIMERCARPOL1018PhysiologyGastrointestinal & NutritionFat is absorbed in Jejunem, While B12 and Bile salts are absorbed in Ileum1100MicrobiologyGastrointestinal & NutritionShiga toxin (shiga like also) inactivates 60s ribosome by removing adenine from rRNA, and inhibit protein synthesis in colon mucosa and renal endothelial (EHEC: only e coli that does not produce glucuronidase and does not ferment sorbitol) While ETEC and Yersinia enterotoxin increase cellular cGMP leading to diarrhea Only enteroinvasive EIEC invade mucosa hence the I

1136MicrobiologyGastrointestinal & NutritionShigella need 10-500 bacteria to infect Very BadAss1156PharmacologyGastrointestinal & NutritionIron poisoning will cause diarrhea while lead will cause constipation1169BiostatisticsGastrointestinal & NutritionNPV and PPV depend on disease prevalence irrespectively of test sensitivity and specifictiy1251BiochemistryGastrointestinal & NutritionTrypsinogen is converted to Trypsin in duodenal of epithelium and in turn activates other digestion proteins1258PharmacologyGastrointestinal & NutritionMorphine cause smooth muscle contraction in sphincter of Oddi1290PharmacologyGastrointestinal & NutritionDiphenoxylate (opioid and act on mu receptors ) given with diarrhea, but is given with atropine to produce bad effects and discourage abuse and tolerance1396PathologyGastrointestinal & NutritionPseudomembranous colitis (C diff): White/yellow plaques membrane like on colono composed of fibrin and inflamatorry Undercooked meat: cysticercosis : Seizures, SC nodules, IM calcifications1397MicrobiologyGastrointestinal & NutritionC diff toxins A: intestinal inflamation and fluid secretion B: Cytotoxic (affect actin cytoskeletal structures an intracellular signaling)1398MicrobiologyGastrointestinal & NutritionClostridium mostly attack people with disturbed GI microbiome1467ImmunologyGastrointestinal & NutritionSabin (oral polio vaccine) has better IgA activity than Salk doing a better job at mucosal entries1525AnatomyGastrointestinal & NutritionAir in Biliary tree means GB, SB fistula for STEP 11596ImmunologyGastrointestinal & NutritionUnlike other parasites, Giardia is all about IgA defense and not eosinophils (involved in Helminthic infections)1807BiochemistryGastrointestinal & NutritionRiboflavin B2 is used in TCA cycle by transforming Succinate to ketoglutarate forming FADH2 while the reaction before of Succinyl CoA to Succinate forms 1 GTP used in Gluconeogenesis1863PathologyGastrointestinal & NutritionViral Hepatitis: hepatocyte necrosis (cellular swelling and cytoplasmic emptying cused by loss of ATP and loss filament in the meshwork) and apoptosis ( in apoptosis there cellular shrinking with nuclear fragmentation and esoniphilia (Councilman body)with moninuclear infiltration1918PathologyGastrointestinal & Nutrition Atrophic Gastritis Affect the Body of stomach while H pylori zffects the Antrum first then the Body1927PathologyGastrointestinal & NutritionViral Hepatitis cause Apoptotic Hepatocytites so get round acidophilic Councilman BODIES (eosinophilic ) also seen in Yellow fever 1938PhysiologyGastrointestinal & NutritionMotilin is produced by Duodenal mucosa ans stimulates Smooth Muscle contraction in Upper GI. erythromycin acts as a Motilin Agonist, causing Diarrhea. Ghrelin (Hunger): Increase in Fasting, Decrease after Eating. Glucagonoma: DM, NEC VIPoma (Pancreatic Islet Gumor): increase Cl- loss in stools, and excess H2O, Na+ and K+ follow, leading to Diarrhea. It also inhibits Gastric acid secretion. treated with Somatostatin Gastrin: acid secretion and growth of gastric mucosa1971PhysiologyGastrointestinal & NutritionSecretin, secreted by Duodenal S-cells in response to H+ in the duodenum, will stimulate Bicarb secretion from pancreas. On the other ither hand, pancretic enzymes are secreted following Vagal and CCK stimulus (like Gallbladder)8283GeneticsGastrointestinal & NutritionLinkage disequilibrium is when the frequency of alleles independently do not match the frequency of having both alleles at the same time8578BiochemistryGastrointestinal & NutritionIn hepatic encephalopathy, excess ammonia will deplete alpha ketoglutarate, and glutamate to convnert them into glutamine. Glutamine is bad for the cells and accumulated, glutamate which is excitatory is no longer here, and alpha keto which is needed for respiration is depleted too. Do the math.10401MicrobiologyGastrointestinal & NutritionFidaxomicin is used in resistant C diff 10583AnatomyGastrointestinal & NutritionThe portal triad (Hepatic artery, portal vein and CBD ) run through the hepatoduodenal ligament so if there is bleeding we clamp the ligament to rule in or rule out any other cause of bleed11591PathophysiologyGastrointestinal & NutritionIn gerd Dysphagia is more consistent with ulceration while dysphagia and obsturction goes more with strictures11629Behavioral scienceGastrointestinal & Nutrition As a physician be RADICALLY AGAINST Herbal products especially if you are sure they are bad11771AnatomyGastrointestinal & NutritionPudendal nerve which (S2-S4) which numbs the perineumand genitals also numbs area when want to do external Hemorrhoids removal (Gives inferior rectal nerve). Internal Hemorrhoids are innervated by Autonomic Inferior Hypogastric Plexus and do not sense pain or temperature.11782AnatomyGastrointestinal & NutritionThe appendix is best identified by the converence of the 3 Taeniae Coli of the colon 11795AnatomyGastrointestinal & NutritionChronic pancreatitis can cause splenic vein thrombosis causing short gastric vein varicoses (Dr levi style)11860PathophysiologyGastrointestinal & NutritionBacteria in guts produce not only Vit K but also Folate

757PhysiologyGeneral PrinciplesFree ribosome translation destination: Cytosol, Nucleosol, Mitochondria ( nuclear proteins) and Peroxisome ( involve in anabolism and catabolism of fat (very long chain FA) and also produce bile) RER destination: Membrane (cell membrane, nuclear membrane), ER, Golgi, Lysosome --> Prepare to go out of cells1028BiochemistryGeneral PrinciplesDuring exercice the Ca2+ release in muscles will also activate glycogen pathway and glycogenolysis hence the parallel association between muscle contraction and gycogenolysis1469GeneticsGeneral PrinciplesRota and influenza like genetic shift through reassortment thats why they are common and need to vaccinate many times (more efficient virulence than genetic drift: pt mutation) Shift is Sudden wheras Drift is graDual (less killer machine)1482BiochemistryGeneral PrinciplesB6 is involved in transamination reaction where an amino group from an amino acid goes to an alpha ketoacid making it an amino acid. B6 is involved in decaboxylation reaction1616PhysiologyGeneral PrinciplesCircuit in Parallel: 1/Rt = 1/R1 + 1/R2 + 1/R3 (Think how circulation in the body which is mainly in Parallel wants to be efficient) In series: Rt = R1 + R2 + R31712PharmacologyGeneral PrinciplesIsoniazid metabolism by acetylation so we have fast and slow acetylators.1714PharmacologyGeneral PrinciplesT1/2:0.7xVd/Cl1715PharmacologyGeneral PrinciplesLipophilic deug prefer liver exretion Mante21728GeneticsGeneral PrinciplesLesh nyhan is X linked recessive while Galactosemia is AR1912MicrobiologyGeneral PrinciplesThayer and Martin are selective and only ahve sex together but culture neisseria BADDEEE1970GeneticsGeneral PrinciplesPleiotropy = One mutation and many many consequences2025GeneticsGeneral PrinciplesEnhancers/Repressors can be anywhere in relation to the gene involved, while promoter are 25-70 base pair upstream to start of gene2029GeneticsGeneral PrinciplesStop codon UAA UAG UGA are recognised by Realeasing Factor 12030GeneticsGeneral PrinciplesTATA box is a promotor (25 bases upstream) that bind to transcription factor and RNA polymerase II (in Eukaryote, binding RNA polymerase alone is not enough) for transcription initiation.CAAt box is also a promotor but 85 bases upstream2031GeneticsGeneral PrinciplesN myc is a transcription factor and bind DNA2033GeneticsGeneral PrinciplesPostranscriptional modification: (occur in nucleus) 5' capping Poly A tail (3' end): when AAUUAAA (transcribed from DNA) is detected the cap is added (cap is not transcribed from DNA), protects mRNA from degradation in chtoplasm Splicing: Introns removal7791GeneticsGeneral PrinciplesMethylation of Cytosine in DNA is implicated in gene silencing and hence in Imprinting of disease ( why silent in mom not in kids for ex)11514PathologyGeneral PrinciplesHand Hygiene is best way to prevent hospital infections11674ImmunologyGeneral PrinciplesUbiquitin proteasome pathway: ubiquitin tag bad particles (like viral particles), proteasomes come degrade them then they a presented on cell surface bound to MHCI for presentation to cytotoxic CD8 cells11847Behavioral scienceGeneral PrinciplesPreventable adverse event is defined as injury to a patient due to failure to follow evidence based test practice guidelines58PathologyHematology & OncologyHep C (RNA virus) lacks reverse transcriptase and does not integrate into genome ulnike DNA Hep B that do integrate346BiochemistryHematology & OncologyVWF --> GP Ib (Bernard) --> GP IIb-IIIa (Glanzman). If you add ristocetin you will activate GP Ib receptors on platelets and make it available for vWF binding. If still no response then vWF vs GP Ib. If normal plasma is added and still no reponse to ristocetin it is Bernard (coz vWF is contained in normal plasma)465PathologyHematology & OncologyFactor V is when factor V is resistent to protein C deactivation537ImmunologyHematology & OncologyWiskott Aldrich is triad of Eczema, Thrombocytopenia (both appear early) and B, T cells immunodeficiency appearing at 6-12 months.540ImmunologyHematology & OncologyC1 binds to IgG and IgM (Pentameric, so binds better) to activate complement system, at the hinge point of the heavy chain559ImmunologyHematology & OncologyImmature T lymphocytes in Thymus cortex, express both CD4 and CD8614PathologyHematology & OncologyGlioblastoma: Necrosis and vascular proliferation787PhysiologyHematology & OncologyHpecidin, secreted by liver will decrease intestinal Iron rate absorption. It is increased in Inflammation, and high iron levels. It is decreased in hypoxia and erythropoeisis. Low Hepcidin, increase intestinal absorption and release from Macrophage.1029BiochemistryHematology & OncologyRBC dont do oxidative phosphorylation since they dont have ATP, and they dont even produce enough ATP in Glycolysis coz they sacrifice 1,3 BPG (which usually gives ATP by turning into 3-phosphoglycerate), by turning it into 2,3 BPG (LOGICAL YA?)1035BiochemistryHematology & OncologyNADPH can be synthesised through the oxidative pathway of HMP shunt but can also be formed from the non oxidative pathway through Transketolase and Transaldolase from Fructose6P instead of G6P

1039PathologyHematology & OncologyTNF alpha cause cachexia1077PharmacologyHematology & OncologyHeparin attaches on AT III and and enhances its activity by inhibiting Xa and thrombin, LMWH IS MORE SPECIFIC FOR Xa1242BiochemistryHematology & OncologyIn HbS valine take the place of glutamate in 6th position of the beta chain causing new hydrophobic interactions hence sickling1257PharmacologyHematology & OncologyOpioids has many sode effects like constipation nausea vomiting.. But build to,erance to all and dont get side ffects anymore except for CONSTIPATION AND MIOSIS1338BiochemistryHematology & OncologyIn acute porphyria, you can give heme which will inhibit ALAminuvic acid synthetase and decrease accumulation of D ALA and porphorynohenc1403GeneticsHematology & OncologyAML M3 (15:17), and Retinoic acid receptor are malfounctional1405PathologyHematology & OncologyAML (15-17t): Auer rods1415BiochemistryHematology & OncologyIn CN poisoining: (bind cytochrome a-a3) Nitrites bind Fe2+ --> Fe3+ (higher affinity to CN and prevent its release to mitochondria) Another Antidote is Sodium Thiosulfate which combines with CN forming Thiocyanate which is less toxic and excreted in urine 1455BiochemistryHematology & OncologyIn RBC, Heme is produced in Mitochondria firs 3 reactions, then cytosol. So when RBC mature and lose their mitochondria, u cannot synthesize anymore heme1455BiochemistryHematology & OncologyRBC cannot produce heme coz they dnt have Mitonchondria responsible for first and last step of production1474GeneticsHematology & OncologyRadiation therapy works through breaking Double Strand DNA, and creating free radicals too1476BiochemistryHematology & OncologyThymidine dimers are usually corrected by endonucleases1496MicrobiologyHematology & OncologyI know its weird but Aplastic Crisis affect only RBC while Aplastic Anemia affects all lines1545PhysiologyHematology & OncologyCO poising will increase Carboxyhemoglobin (CO bound Hemoglobin) but does not affect PaO2 since it competes with O2 in Hemoglobin not in plasma. It will not affect Methemoglobin (Iron oxidized to Fe3+ due to Dapsone, Nitrite, Enzyme deficiencies or Hemoglobinopathies) . CO poisoning will cause a Left Shift (Decreased O2 tendency to unload)1614ImmunologyHematology & OncologyIsotype sworching occurs in germinal centers of LN1647PharmacologyHematology & OncologyGanciclovir can cause NEUTROPENIA. its effect increase with TMP SMX or ZiDoVuDine coz also can cause BM supression1654PhysiologyHematology & OncologyPatients who receive more than 5L/24 hrs of PRBC will have high levels of Citrate (used to store blood), which in turn chelates Ca2+ and Mg2+, lowering their blood level, causing parastheisa1683ImmunologyHematology & OncologyRhogam is an IgG antibody1717PathologyHematology & OncologyRb is active HypoPhosphorylated (its in kidss so we dont like much phosphorylation,,, )1753PathologyHematology & OncologyIn Dysplasia there is reversible change in epithelial. Once the dysplastic cells have breached the basement membrane it os no longer reversible1754PathologyHematology & OncologyLymphocyte bnign vs malignant: Monoclona T cell vs Polyclonal in infection (makes sense)1758PathologyHematology & Oncologybcl2 (oncogene on chromo 18) It inhibits apoptosis of tumor cells and facilitates neoplastic growth.. In follicular lymphoma (B cell tumor) bcl-2 goes to ch 14 and is over4 expressed RAS: component of MAP kinase path, transmits signals from cell surface to nucleus (pancreatic, GB, colon, endometrium, thyroid ,lung cancers) DNA mismatch repair: in Lynch syndrome (colon and stuff)1786PathologyHematology & OncologyPure red Cell aplasia is seen in : Thymoma, Lymphocytic Leukemia, and Parvovirus B19 infection1788GeneticsHematology & OncologyHemophilia is X-recessive1796PathologyHematology & OncologyErythropetein have bluish cytoplasm reticular precipitates of rRNA and is larger (also lacks a nucleus)1797PathologyHematology & OncologyMosto Carcinogens enter body as inactive but P450 (monooxygenase) make them so, and it depends on this system to determine succeptibility of individual1819PharmacologyHematology & OncologyMDD1 code for a P glycoprotein a transmembrane ATP dependant efflux pump that increase efflux of drugs and decrease influx of these chemo agents making the cells resistant to chemo1847BiochemistryHematology & OncologyFolate i s needed for Thymidine formation1861PathologyHematology & Oncology Aplastic anemia (Thrombocytopenia, Anemia, and absent hematopoietic cell in marrow) will have BM with fat infiltrate1872PathologyHematology & OncologyIntegrin bind cells to basement membrane by attaching it to FIBRONECTIN, COLLAGEN, And LAMININin Extracelullar matrix

1873PathologyHematology & OncologyVEGF and Fibroblast Growth factor cause angiogenesis while epidermal growth factor affect mitogenesis of hepatocytes and fibroblasts1877PathologyHematology & OncologyPeau dorange is due to lymphatic obstruction1890PharmacologyHematology & Oncology6-MP -(HGPRT)-> Active Metabolites 6-MP -(Xanthine Oxidase)-> Inactive Metabolites (that why allopurinol will increase dose of 6-MP)1911GeneticsHematology & OncologyFollicular lymphoma 14:18 translocation causes Bcl2 overexpression2018PharmacologyHematology & OncologyETOPOS(second)ide block TOPOisomerase Second (II)2086BiochemistryHematology & OncologyThalassemia intermedia is associated with a muation three bases upstream from the start codon (AUG) exchanging a puring with a pyrimidine2133PathophysiologyHematology & OncologyThrombin II inhibtors will affect TT (throbin time) also PT PTT Xa inhibitor will affect both in theory (in practice PT is barely affected coz of heparin neutralizer in the PT reagent) 7643ImmunologyHematology & OncologyIn EBV you get atypical CD8 T cells in circulation (large with eccentric nucleus) to attack B cells infected (you also get atypical B cells but in much smaller proportion)8276BiochemistryHematology & OncologyIn Alternative Splicing, same gene will give different mRNA in different tissues8371PharmacologyHematology & OncologyralTEGRAvir: Inhibits HIV inTEGRAse, so that its DNA will no be well incorporated11728PharmacologyHematology & OncologyIn chemo induced nausea inhibiting Neurokunin is good too (Tfayli's talk)11750PathologyHematology & OncologyHairy cell leukemia will cause marrow fibrosis11754PathologyHematology & OncologySclerotic means osteoblastic11816BiochemistryHematology & OncologyLead: ALA D, Ferrochelatase are affected B6: ALA S is affected44MicrobiologyInfectious DiseasesHep C envelope changes a lot coz its RNa dependant RNA polymerase has no proofreading 3"-->5" exonuclease activity46MicrobiologyInfectious DiseasesHep B acquired by the fetus (transplacentally) or at birth (more commonly) is very common if mom is HbeAg positive. They have very high replication rate and higher rate of progression to chronic disease (the younger the higher the risk). On the other hand they are rarely symptomatik and have mildly elevated LFTs112ImmunologyInfectious DiseasesLocal Candida is controlled by T cell (seen in HIV) wheras disseminated Candida is controlled by neutrophils (seen in neutropenic)376MicrobiologyInfectious DiseasesAtypical lymphocytes can be seen in Hep B, EBV and CMV and are non specific..390PathologyInfectious Diseasesin 95% of pple hem B will resolve after acute attack532MicrobiologyInfectious Diseases Aspiration pneumonitis is like aspiration pneumonia but resolves on its own and occur few hours after aspiration not days like pneumonia. Occurs by aspiration of oral anaerobes not gastric!!!!676ImmunologyInfectious DiseasesIn TSST-1, the toxins which are superantigens activate T cells and Macrophage819PharmacologyInfectious DiseasesProtease inhibitors navir cause metabolic stuff 822PathophysiologyInfectious DiseasesHep B are associated with HCC coz of the integration of DNA into host genome963MicrobiologyInfectious DiseasesH. flu are blood loving, but needs factor X and NAD+ for growth. So wont grow on sheep blood agar unless cultured with Staph that will povide her with NAD+977MicrobiologyInfectious DiseasesOxidase + comma shaped bacteria: cholera: grow in alkaline (so PPI or decrease acidity will promote its proliferation) pylori: In acidic coz produce urease Campylo: in 42 degree They are all special1091PharmacologyInfectious DiseasesIn Tazocin, Tazobactam role is to decrease Piperacilin destruction (like Carbidopa)1103MicrobiologyInfectious DiseasesHib, in young children cause: MEningitis, pneumonia, bacteremia and epiglotitis (BIG SHIT) While Sinusitis and OM are caused By NON TYPABLE H. flu1137MicrobiologyInfectious DiseasesSalmonella Vi antigen (its virulence factor) makes it resistant to opsonization and phagocytosis1309MicrobiologyInfectious DiseasesMycolic acid in Mycobacterium cell wall, is part of its virulence will make it acid fast as in when then dye is given the bacteria will stain red on carbolfushin and is resistant to decoloration when acid-alcohol decolorizing agent are given because of proper cell wall. When Isoniazid is given it inhibits mycolic acid synthesis, so the bacteria will lose its acid fast property and decolorize KatG (bacterial peroxidase) will tranform INH to its active element. 1392MicrobiologyInfectious DiseasesListeria (food borne) frows well on cold tpragure and can contaminate refregirated food. It is a gram + with tumbling motility1393PharmacologyInfectious DiseasesLosteria is nod responsive to ceftriaxone so also give ampicillin1408MicrobiologyInfectious Diseasesthe Herepsviruses family get their membrane from nuclear membrane of cells (unlike the rest, get it for cell membrane.. NICE StufF)1468ImmunologyInfectious DiseasesIFN alpha and beta are secreted in response to viral particles and decrease their protein synthesis capacity and replication, promoting apoptosis1550MicrobiologyInfectious DiseasesIn primary herpes, a week course of acyclovir will reduce the disease but not prevent recurrence (latent in sacral ganglia S2 S3 S4). On the other hand prophylaxis daily valacyclovir will do the job1551PharmacologyInfectious DiseasesAcyclovir (nucleoside analogs) coz like Adenosine

1593MicrobiologyInfectious DiseasesCMV is EBV with (-) heterophile test (as in fail to agglutinate horse erythrocyte)1645PharmacologyInfectious DiseasesAcyclovir and ovirs are to be phosphorylated to become in their active forms1649ImmunologyInfectious DiseasesIn Influenza it is Antibodies against Hemaglutinin that primary protects against infection1670MicrobiologyInfectious DiseasesThe 3 C's of measle + fever are prodromal to the rash1965PharmacologyInfectious DiseasesPrimaquine is given to kill liver stage malaria hypnozoite and thus preventing relapse. Malaria consists of fever and sweating in a 48 h cycle2110PharmacologyInfectious DiseasesPenicilln and Ceohalosporins bind to cell membrane proteins such as transpeptidase2111PharmacologyInfectious DiseasesCephalosporins resitance mechanis, by changing in penicilin binding protein structure ( some of the protein remain normal so still have some binding) whereas in beta lactamase in case of penicillin there is no binding at all coz antibiotics will all be disabeled)8288PharmacologyInfectious DiseasesDaptomycin (cover gram + and MRSA) work by depolarizing bacteria Ceels and therefore inhibits DNA RNA fprmation and protein synthesis, but cause myopathy and increase CPK8593MicrobiologyInfectious DiseasesAlcohols are antisceptic coz they disrupt cell membranes..11395MicrobiologyInfectious DiseasesDengue fever has 4 serotypes. Chill infections vs Bad ones are due to diferrent serotypes11525MicrobiologyInfectious DiseasesIFN Gamma are produced by NK (T cells, stimulated IL12 from macrophage) and again activate macrophage to kill phagocytosed pathogens11547MicrobiologyInfectious DiseasesCat bite: barto, pasteurella Dog: pasteur, strep, staph aureus Human: anaerobes, strep, eikenella11590PharmacologyInfectious DiseasesAbacavir (nrti) is associated with hypersensitivity in 10% of pple with HLA B5711596MicrobiologyInfectious DiseasesParotitis can occur in elederly (weird presentation: pre/postauricular swelling that extends to mandible) which are dehydrated and intubated. But here it caused by Staph most commonly and diagnosed by imaging and amylase levels11670MicrobiologyInfectious DiseasesNeurocysticercosis (taenia solium) cystic brain lesion in Central america11729PharmacologyInfectious DiseasesAcyclovir: viral inhibition of DNA polymerase11766MicrobiologyInfectious DiseasesE coli is lactose fermenting, INDOLE (+) (coz they are indolent)11822MicrobiologyInfectious DiseasesRoseola (HHV6): 3-5 days of fever (often have febrile seizures) than truncal rash343GeneticsMale Reproductive SystemKlienfelter 46 XXY, tall male with boobs aazospermia and mild mental retardation807GeneticsMale Reproductive SystemCF patient are Infertile due to absent Vas Deferens bilaterally. In Kartegner sperm are immotile but we have Vas1449EmbryologyMale Reproductive SystemSRY --> TDF --> Testes develop --> Sertoli (Secrete MIF --> Paramesonephric duct PMD involute) Leydig cells (Produce Testosterone --> Transform Wolffian duct into Male internal Genitalia; Epididymis, Vas Deferens) Testosterone --> DHT --> Transform Genital Tubercle and Urogenital Sinus into Male external Genitalia (Penis, Prostate) IN XY, IF NO SERTOLI CELLS YOU WOULD HAVE BOTH FEMALE AND MALE INTERNAL GENITALIA BUT MALE EXTERNAL GENITALIA (coz MIG is not here to involute PMD11747AnatomyMale Reproductive SystemProstate Ca spreads to bone through prostatic venous plexus first11762AnatomyMale Reproductive SystemDeep ring: Internal Spermatic Fascia (coming from transversalis fascia) Superficial ring: External Spermatic Fascia (External Oblique) COZ Deep Internal So in Crypto need to bring testicle from superficial ring which its opining is mainly External spermatic fascia (coming from external oblique)6PathologyMiscellaneous (Multisystem)Bilateral renal angiomyolipoma associated with Tuberous Sclerosi (AD, with Brain Hamartoma and Ash leave spots)701GeneticsMiscellaneous (Multisystem) Achondroplasia is AD1332BiochemistryMiscellaneous (Multisystem)In Homocyteinuria, homocysteine is not metabolised to cysteine due to cystathione reductase problem1502BiochemistryMiscellaneous (Multisystem) Alkaptonuria is a problem in converting Tyrosine to Fumarate (its TCA intermediate equivalent) so its like the next step after Phenylketonuria. Homogentisic acid dioxygenase deficiency so homogentisate (next step after tyrosine) accumulate. Get Black urine, pigmentated face and other organs, arthropathy.1504BiochemistryMiscellaneous (Multisystem)Many patients with Homocytinuria benefit from B6 as it will drive the reaction forward to Cysthathione 11531Behavioral scienceMiscellaneous (Multisystem) Always get a translator when it is not very clear 11532Behavioral scienceMiscellaneous (Multisystem)Physician's burnout (emotional stress) while Physician fatigue refers to lack of sleep11533Behavioral scienceMiscellaneous (Multisystem)Cane and walker do not decrease the risk of fall according to studies. Just assist

11549Behavioral scienceMiscellaneous (Multisystem)For a nurse to show that she has understood the order she should repeat everything and even the route of administration11550Behavioral scienceMiscellaneous (Multisystem) An elderly for discharge is best instructed with a checklist discharge list in case he has no family members living with him11602Behavioral scienceMiscellaneous (Multisystem)Medicare cover people above 65 or younger with disabilities11635AnatomyMiscellaneous (Multisystem)Most common site of compartment syndrome is Anterior compartment innervated by Deep peroneal nerve11678PharmacologyMiscellaneous (Multisystem)[Drug]=mg given/Vd11757Behavioral scienceMiscellaneous (Multisystem)Communication problem during patient patient handoff (teslime) is a major cause of stupid errors18PathologyNervous Systemin Hypoxic ischemic encephalopathy (in arrest) hippocampus is first damaged, then neocortex and Purkinje of cerebellum20HistologyNervous SystemIn brain infarcts, neutrophils come in the first 24-48 hrs, do not phagocytose anything. Microglia (3-5 days later they deposit), then Astrocyte will cause peripheral glial scar and get central cyst instead of necrosis22PathologyNervous Systemif HTN and lacunar stroke and dont appear directly on CT but later it is due to HTN arteriosclerosis and not Charcoud bouchard rupture that wld appear directly on CT249PharmacologyNervous SystemIn abscence followed up by generalised tonic clonic ethosuximide wont help. Use Valproic acid262PharmacologyNervous SystemCarbidopa is given with levodopa to inhibits levodopa conversion into dopamine outside CNS (by being itself metabolised) but with carbidopa we will have more dopamin in CNS and more SE like agitation and anxiety..347PathologyNervous Systemsubdural hemorrhage in babies is sign of abuse (shaken baby syndrome) and have retinal hemorrhage348PharmacologyNervous SystemRamelteon, a melatonin agonist is used for insomnia in elderly.357GeneticsNervous SystemBlotchy red muscles fibers on Gomori trichome stain = Mitochondrial Myopathies (Maternal Inheritance) --> Abnormal Mitochondria (increased in number, enlarged, abnormally shaped) accumulate in the fibers making them look irregular in size and shape. "Red Fagged Fiber" Examples: Myoclonic epilepsy with red ragged fibers (MERRF), Leber optic neuropathy (Blindness), Mitochondrial encephalopathy (stroke-like episodes) and lactic acidosis (MELAS)397PathologyNervous SystemSlit lamp exam to Diagnose Kayser Fleisher 499PathologyNervous SystemThe most common cause of spontaneous lobar hemorrhage in the elderly is Cerebral Amyloid Angiopathy (same amyloid seen in Alzhemer) and most commonly occurs in occipital and parietal lobes502EmbryologyNervous SystemIf acetylcholinesterase is found in amniotic fluid (shld be contained in neural tissues) it means that there is neural tube defect with failure of fusion and hence this enzyme is spilled in sac509PharmacologyNervous SystemETHosuximide block T type calcium cahnnels in THalamus. Used for Abscence seizure566AnatomyNervous SystemPancoast cause ipsi Horner and ipsi shoulder and arm weakness and areflexia due to brachial plexus involvement590GeneticsNervous System Alzheimer: Neurofibrillary tangles and A-Beta amyloid plaques. In Down syndrome there is 3 copies of The Amyloid precursor protein gene.591GeneticsNervous SystemStuff involved in Alzheimer: APP on chr21 Prenisilin 1 on chr14 Prenisllin 2 on chr1 ApopE4 involved in late onset familial Alzheimer 593PathologyNervous SystemIn alzheimer, decrease acetylcholine in Meynert nucleus in hipoccampus (decreased activity of acetyltransferase)595PathologyNervous SystemParaneoplastic process is autoimmune598BiochemistryNervous SystemIn thiamine deficiency u can get necrosis and hemorrhage of mamillary bodies, B1 will affect the activity of transketolase (main prob) and Pyruvate and Ketoglutarate dehydrogenase660PharmacologyNervous SystemIn anesthetic if have high venoarterial difference then drug will directly go to muscle and adipocytes then slower effect on brain Whereas potency is determined by MAC673ImmunologyNervous System Ataxia telengiectasia: (AR), defect in DNA repair genes Cerebellar ataxis, Oculicutaneous telengiectasia, repeated sinopulmonary infection and increased incidemce of malignancy735MicrobiologyNervous SystemNeisseia: Bean Shaped Gram - cocci in pairs(<60 especially in camps, dorms..) VS. Strep pneumo: Lancet shaped, Gram + cocci in paiars (more common in pple >60)775PhysiologyNervous SystemPOMC is a polypeptide that give rise to ADH, MSH and Beta Endorphins.

776PhysiologyNervous SystemWhen Morphine binds to mu receptors it can will cwuse hyperpolarisation of the cell in two ways: First and most importantly it will cause G coupled activation of K+ channel, increasing K+ efflux out of the cell, hyperpolarizing the cell. Secondly it will decrease Ca+ influx into the cell (Think morphine acts like K(C)arl)794PathologyNervous SystemHippocampus atrophy is seen in Alzheimer 840GeneticsNervous SystemHuntingtin proteins prevents acetylation of DNA making it more mute851PharmacologyNervous SystemPotency of Anasthetic is related to MAC (minimal alveolar concentration) (concentration at which 50% of people pass out) High blood/air partition coefficient means high solubility so slower onset of action (coz stay in blood dont go to brain) Potency: drugs needed to achieve a certain effect related to km Efficacy: maximal effect852PharmacologyNervous SystemInhaled anesthetic will directly redistribute in muscles skeletal and fat856PharmacologyNervous SystemIV anesthetic effect wean off after a short time because of redistribution of drug in body866PharmacologyNervous SystemDantrolene is only used to treat heat stroke and malignant hyperthermia, not high fever 871PathologyNervous SystemLiquefactive Necrosis: Lysosmal digestion of the tissue913PathologyNervous SystemPMR: fatigue, fever, wight loss + Proximal muscle stifness969PathologyNervous SystemTetanus is diagnosed clinically1006MicrobiologyNervous SystemIn Neisseria CApsular Polysaccharide resist phagocytosis and stuff, but Outer membrane Lipooligosaccaride (LOS or LPS) is the endotoxin associated with fucked up disease1048BiochemistryNervous SystemVit A OD: Pseudotumor Cerebri, skin changes and Hepatosplenomegaly1058PathologyNervous SystemEndomysial Inflammation: Poliomyositis Endoneural Inflammation: Guillain Barre1149AnatomyNervous SystemSuperficial peroneal: Eversion Deep Peroneal: Dorsiflexion1150AnatomyNervous SystemMeningioma often occur in dural reflection. In falx cerebri patient can have leg symtoms (beco it is in the medial homunculus)1152PathologyNervous SystemCraniopharyngoma arising from anterior pituitary are calcified cysts containing cholesterols crystals1259PathologyNervous SystemPosterior fossa tumor in kids Medullo: Sheets of primitive cells(basophilic nuclei and scant; small round blue cell, cystoplasm) with many mitotic figures Pilocytic astrocytoma: Most common, Rosenthal fibers (are low grade and have better prognosis) Ependymoma: walls of venticles and can cause hydrocephalus, they form gland like structures called rosettes1318PhysiologyNervous SystemNeuronal properties: Time constant: time it takes for membrane to achieve 63% of new membrane potential Length constant: time it takes for impulse to go a certain distance. Demyelination will decrease both, by Increasing axon Conductance and having less Saltatory Conduction1320PharmacologyNervous SystemIn mysathemia crisis we shld increase dose of neostigmine1323PharmacologyNervous SystemOrganophosphate irreversibly inhibit cholinesterase in musc and nicot synapses so if give atropine (only musc) u wont be helping muscular effects1335BiochemistryNervous SystemIn Maple syrup, avoid branched chain amino acid leucine Isolucine and Valine (defect in alpha ketoacid dehydrogenase with deficient conversion of Leucine to Acetyl CoA or Valine and Isoleucine to Propionyl CoA then Methylmalonyl then Succinyl CoA)1368PharmacologyNervous SystemUterine relaxation is by B2 like in lungs..1391MicrobiologyNervous SystemListeria which is a B hemolytic gram + that moves and reproduce well in low temperatures is common in children less than 3 months coz of their immature cell mediated immunity1399MicrobiologyNervous SystemTCA affect muscarinic not nicotinic1402MicrobiologyNervous SystemRabies virus goes in skin, then motor axon (and retrograde to cNS) then salivary gland (thats why transmitted through bites)1421GeneticsNervous SystemFragile X: CGG repeat --> Hypermethylation of Cytosine amd inactivation of subsequent genes1428BiochemistryNervous SystemIn tRNA, the 3 ' part is responsible for amino acid attachement site (since t and 3)1433Behavioral scienceNervous SystemConversion disorder is experiencing neurological symptoms that are not explained by tests or exam, and is due to a stressor 1442PharmacologyNervous SystemDonepezil Cholinesterase inhibitor is used in Alzheimer 1443PharmacologyNervous SystemBenzo increase FREQuENCY of Cl channels not DURATION1534EmbryologyNervous SystemNF is a neural crest tumor since it is a Schwann cells tumor. Like in Melanoma1536HistologyNervous SystemThight junction is responsible of the nonfenestrated endothelial in BBB (cest logique)1636AnatomyNervous SystemMusculucutaneous innervates biceps and suppinator (like when I do Dumbels) and supply sensory lateral Forearm

1743AnatomyNervous SystemUlnar nerve functions: Wrist flexion/adduction, fingers adduction/abduction and sensation in 1.5 last fingers and flexion of 4th/5th digit1749AnatomyNervous SystemMedian nerve is sandwiched between Flexor digitorum superficialis and Flexor Digitorum Profundus (easy since Median innervates digits)1829AnatomyNervous SystemHolding a branch like a monkey can cause lower trunk of brachial plexus injury affecting radial and ulnar nerves and muscles of hands1853MicrobiologyNervous Systemimmunity agaisnt neisseria mengitidis is antibodies against their polysaccaride capsule1966MicrobiologyNervous Systementerovirus is most common cause of asceptic meningitis1997MicrobiologyNervous SystemBotulinsm toxin inhibit Ach release wheras rabies bind on the recptors (toxin is killed by heat)2082MicrobiologyNervous SystemTreat toxo with pyrimethamine and sulfadiazine (clinda if sulfa allergy)2083MicrobiologyNervous SystemCns lymphoma are B cells2089PharmacologyNervous SystemCYPROHEPATADINE, is an antihistamine with anti serotonergic, so used in excess serotonin syndrome2123Behavioral scienceNervous SystemAcute stress disorder happen 3 days to 1 month from a bad event8324MicrobiologyNervous SystemRabies G(accumulate in open wound) lycoprotein spikes bind nicotine acetylcholine receptors, activate them. And go to CNS in retrograde8385BiochemistryNervous SystemImpairement of Ubiquitin proteasome system is involved in Parkinson and Alzheimer 8476PharmacologyNervous SystemTryptans are serotonic agonist8533MicrobiologyNervous SystemStaph epidedermis virulence is synthesis of an extracellular polysaccharide matric, (adherent biofilms) when foreign bodies are inserted through skin (skin flora)8564AnatomyNervous SystemIVH is bleed in germinal matrix8878Behavioral scienceNervous SystemIn Narcolepsy or Cataplexy Hypocretin (1 or 2) which are secreted by the lateeral Hypothlamus and usually promote wakefulness and inhibit REM sleep, are usually low11458PharmacologyNervous SystemBaclofen, GABA B receptor agonist used for spasticity even of central cause like MS11462PathologyNervous SystemParkinson pple benefit from deep brain stimulation inhibiting Subthalamus eventually increasing Thalamus inout 11568PathologyNervous SystemHIV associated dementia is suspected in AIDS patients with progressive cognitive decline. Microglial nodules and groupd of activated macrophages/microglial cells around necrosis that may fuse to form multinucleated giant cells11574PathologyNervous SystemDamage to brainstem below or at level of red nucleus will cause decerebrate position11576PathologyNervous SystemIn brain calcification do not happen afer infarcts but in TUMORS11632PathologyNervous SystemOvershooting is when lateral cerebellar is affected, when vermis (central) is affected u get truncal ataxia11665PharmacologyNervous SystemTreat status (even if febrile seizure) with lorazepam11742AnatomyNervous SystemInfraiebital nerve runs along the orbital floor so in such a fracture causing parasthesia in upper cheek, upper lip and upper gingiva and inferior rectus muscle gets entrapped causing vertical nystagmus11755PhysiologyNervous SystemGABa activation cause Chloride channel to open and causing a chloride flux inside (passive down normal gradient)the cell hyper-polarizing its resting potential11772AnatomyNervous SystemXI injury: Trapezius injury: Droopin gof shoulder, impaired abduction above horizontal and Winging of Scapula (weird things)11777AnatomyNervous SystemFemoral nerve passes through the Inguinal crease not the Femoral rin and canal which contains lymphatic, vessels and lymph nodes11793AnatomyNervous SystemDuring intubation, beware of atlantoaxial instability that can cause subluxation of the vertebra and compression of SC and Vertebral arteries--> Paralysis1646PharmacologyOphthalmologyAIDS CD4<50 CMV Retinitis11551MicrobiologyOphthalmologyCMV cause chorioretinitis when in congenital infection11841PharmacologyOphthalmologyIn glaucoma, prostaglandin will increase outflow of humor..1544PhysiologyPoisoning & Environmental Exposure Aspirin OD Fever, Tinnitus, Tachypnes): Mixed Resp Alkalosis (Stimulates medullary centers, leading do Hyperventilation) with Anion Gap Met Acidosis (begin shortly Afterward, as Aspirin Increase Lipolysis, Uncouples Oxidative Phosphorylation, and Inhibits Citric Acid Cycle --> Ketoacid, Lactate and Phruvate Accumulation). So you get Normal pH with low pCO2 and low HCO3-. in compensation, pH will not return to Normal but gets close to Normal Range.792PathophysiologyPregnancy, Childbirth & Puerperium Unlike what seems intuitive Complete mole (46, XX or XY only paternal DNA) does not contain fetal tissues and has a HONEY COMB or SNOWTORM appeance, associated with preeclampsia, before 20 weeks, Hyperemesis, Hyperthyroid Partial Mole are XXY or XXX but has mom and 2 papa sets so have fetal tissuesand only presents with vaginal bleed and lower risk of malignancy

955GeneticsPregnancy, Childbirth & Puerperium In Aromatase deficiency female will have ambiguous genitalia and the excess of Androgen that cannot be converted, will go to mom's circulation causing her deepening of voice etc. unlike 21 hydroxylase deficiency that does not affect mommy1464MicrobiologyPregnancy, Childbirth & Puerperium Live vaccines: Smallpox, chickenpox, yellow fever, Rota, Intanasal Influenza, Sabin for polio, MMR, 1772EmbryologyPregnancy, Childbirth & Puerperium In fertilization, BHCG is detectable in serum 8 days later but 14 days later in urine1822GeneticsPregnancy, Childbirth & Puerperium Patau: cleft lip,palate, omphalocele, holoprosencephaly, polydactyly, rocker bottom feet1823GeneticsPregnancy, Childbirth & Puerperium Patau 13: Cleft palate, Poly/Syndactyly, Omphalocele Edwards 18: Small brain (prominent occipit), Small ears, Small mandible, Small sternum, Small clenched hands + Eyes, Cardiac, GI defects (HE is small, so low HCG and Estriol)1830GeneticsPregnancy, Childbirth & Puerperium Complete hydatiform mole is 46 XX or XY only from father while partial is triploidy 2/3 from father 1987PhysiologyPregnancy, Childbirth & Puerperium During pregnancy, prolactin steadily increase along pregnancy but Progesterone and Estrogen do not permit lactogenesis and promote Breast Growth and Development with minor help of Peolactin8325PathologyPregnancy, Childbirth & Puerperium Congenital torticolis is 2-4 week after bitch it is due to malposition of head of abby in utero or birth trauma. they resolve with stretching8330PhysiologyPregnancy, Childbirth & Puerperium Maternal diabetes is due to HPL which increases proteolysis, lipolysis, insulin resistance and decrease gluconeogenesis. Estrogen, progesterone and cortisone also play a role in maternal diabetes.8406EmbryologyPregnancy, Childbirth & Puerperium False twins are always Di Di in indentical twins land,arks are: 0-4: Di C Di A 4-8: Mono C Di A 8-12: Mono Mono >12: Conjoined (4-8-12 landmarks)247Behavioral sciencePsychiatric/Behavioral & Substance AbuseBuspirone has a slow onset of action and is not a muscle relaxant, hence not addictive511Behavioral sciencePsychiatric/Behavioral & Substance AbuseTardive dyskinesia occur with lip smacking and many ticks due to antipsychotic medications519PharmacologyPsychiatric/Behavioral & Substance AbuseLithium toxicity (ataxia, confusion, neuromuscular exitability) can be precipitated by volume depletion, like with thiazide, ACE and with NSAIDS too706PharmacologyPsychiatric/Behavioral & Substance AbuseTrazodone is gd in patient with insomnia (think of erection while sleeping)1046Behavioral sciencePsychiatric/Behavioral & Substance AbuseBulimia patients, remain with their normal wights and do not have medical problems.1165Behavioral sciencePsychiatric/Behavioral & Substance AbusePCP abuse will most likely result to trauma (fight etc.) more than seizure or cardiac event1234Behavioral sciencePsychiatric/Behavioral & Substance AbuseDisplacement: I am getting a divorce and am angry, so I shout at my daughter who fogot to throw the garbage1350Behavioral sciencePsychiatric/Behavioral & Substance AbuseReaction formation is when you act oppositely than what you feel. Splitting is when you perceive people as either good or bad1351Behavioral sciencePsychiatric/Behavioral & Substance AbuseSupression is a mature defense mechanism involving a conscious choice not to dwell on a particular thought or feeling. Rationalisation involve making excuses for unacceptable feelings ; like a student explaining that poor performance was due to trickiness of the exam1352Behavioral sciencePsychiatric/Behavioral & Substance AbuseTriazolam is a short acting benzo best used for sleep, Lorazepam is intermediate the other DFC are long acting1429Behavioral sciencePsychiatric/Behavioral & Substance Abuse A boy whose parents are having a divorce and thinks that his dad is angry at him is experiencing Projection, since he is likely angry at his parents he will think they are angry at him too. This is common in peple who lack insight or their emotions, motivations and feelings1430Behavioral sciencePsychiatric/Behavioral & Substance AbusePPtm blues last maximum 10 days otherwise it is PPtm depression and require treamtent (antidepressant, psychotherapy)2001PharmacologyPsychiatric/Behavioral & Substance AbuseCocaine inhibit reuptake of dopamine2046Behavioral sciencePsychiatric/Behavioral & Substance AbuseDelusional disorder is one step worse than Paranoid disorder, its like a paranoid man who constantly think people are poisoning him2053Behavioral sciencePsychiatric/Behavioral & Substance AbuseTransference is when ur transfer your emotions associated with a significant person to the person in the present8327PharmacologyPsychiatric/Behavioral & Substance Abusedrugs with Serotonin Syndrome: antidepressant with serotonin stuff, Tramadol Ondansetron Linezolid (DA FUCK) Triptans (SURE)8954Behavioral sciencePsychiatric/Behavioral & Substance AbuseMost cases of OD's are due to prescribed Opioids10458Behavioral sciencePsychiatric/Behavioral & Substance Abuse A patient requiring antibiotic for viral infection, don't tell them that it will cause resistance, be sensitive and tell about the side effects and that other treatment are better

10465Behavioral sciencePsychiatric/Behavioral & Substance AbuseChildren under the age of 6 do not understand death, so it is normal for them to hae psychotic symptoms like seeing their grandma11587Behavioral sciencePsychiatric/Behavioral & Substance AbuseBipolar I means only one criteria needed which is MANIA11603Behavioral sciencePsychiatric/Behavioral & Substance AbusePhobia is treated with Exposure-based behavioral therapy11618Behavioral sciencePsychiatric/Behavioral & Substance AbusePrevious suicide attempt is the worse prognosis for people attempting suicide11622Behavioral sciencePsychiatric/Behavioral & Substance AbusePersistent depressive disorder is when Major depressive disorder and Dysthemia happen for more than 2 years11737Behavioral sciencePsychiatric/Behavioral & Substance Abuse Adjustment disorder is applicable for only 3 months following the stressor, beyond that find another explanation11743Behavioral sciencePsychiatric/Behavioral & Substance AbuseIn treatment-resistant schizophrenia use Clozapine. Beware of agranulocytosis so monitor neutrophil count11746Behavioral sciencePsychiatric/Behavioral & Substance AbuseCocaine withdrawal can cause psychosis, hyperphagia, hypersomnia11785Behavioral sciencePsychiatric/Behavioral & Substance AbuseWith adolescence non compliant to insulin, finding a peer that need to take insulin would increase compliance11787Behavioral sciencePsychiatric/Behavioral & Substance AbuseStages of change (stopping alcohol) Precontemplation (denial) -> Contemplation (realising the problem but not ready to act) -> Preparation (planning behavior modification) -> Action -> Maintenance (maintening new behaviors)11792Behavioral sciencePsychiatric/Behavioral & Substance AbuseFactitious is inducing sickness to assume sick role, while malingering is pretending to be sick or exaggerating symptoms to get drugs or whatever 11807Behavioral sciencePsychiatric/Behavioral & Substance AbuseBulimia nervosa is treated by Fluoxetine, nutritional changes and psychotherapy11829Behavioral sciencePsychiatric/Behavioral & Substance AbuseIf someone tells u he wants Tramal and that Drs used to give him, first of all make sure of the old prescriptions and stuff 11846Behavioral sciencePsychiatric/Behavioral & Substance AbusePTSD: SSRI + CBT11848Behavioral sciencePsychiatric/Behavioral & Substance AbuseOLANZAPINE CLOZAPINE (2nd generation): METABOLIC SYNDROME108MicrobiologyPulmonary & Critical CareWhen aspergillus cause fungus ball in a cavity in lung it is colonizing and can be asymptomatik114MicrobiologyPulmonary & Critical CareCryptococcus most commonly cause meningoencephelitis117MicrobiologyPulmonary & Critical CareCryptococcus capsule is the only fungus capsule made of polysaccharide and stains red on Muciramine and show a clear zone on silver stain Usually use india ink for cryptococcus302PathologyPulmonary & Critical Careabscess formation is due to lysosomal ensyme release from neutrophils and macrophage IFN gamma secreted by T helper after IL 12 (from neutrophils) is secreted: make phagolysozome formation, NO release and granuloma and caseous necrosis formation 477PhysiologyPulmonary & Critical Care According to Laplace law, small elastic spheres are more likely to collapse than bigger ones with same surface tension. Think of distal small alveoli who receive the least amount of air who are most prone to collapse. But Surfactant are most concentrated in small alveoli coz of smaller areas and protect them from collapse by increasing surface tension, this will establish equilibrium between alveoli of different radius.480HistologyPulmonary & Critical CareSubmucosal serous and mucous glands (and Goblet cells) are present where there is cartilage therefore end where at the smallest bronchi are absent in bronchiole and further. And at this level epithelial will be completely changed from pseudostratified columnar to simple cuboidal.on the other hand we can still find cilia until the level of alveoli where they disappear and macrophage usually takes care of foreign bodies481PhysiologyPulmonary & Critical Care Airway Resistance: 50% of resistance is in nares trachea etc. This Resistance Increase in Medium sized Bronchi due to Turbulence of flow, but then decreased significantly (lower than upper tract too) in Small Terminal Bronchiole <2mm due to massive increase in summated surface area that will slow the flow and permit a more laminar one. (Bronchitis patients seem more in respiratory distress than Pneumonia patients, since there already high resistence in upper bronchi)483HistologyPulmonary & Critical CareUpper airways Pseudostratified columnar mucus secreting cells: nose, nasopharynx, sinuses, tracheobronchial tree, Vestibular folds (false vocal cords) and laryngeal vestibule are the lower half of posterior epiglottis and are columnar too Stratified squamous: Mouth, oropharynx, laryngopharyns, anterior epiglottis, upper posterior epiglottis, true vocal cords484HistologyPulmonary & Critical CareIn lungs Elastases are secreted by neutrophils and alveolar Macrophages. These can cause terminal lung parenchyma (emphysema) if very high or left unchecked by antiproteases activity (in alpha antitripsin deficiency)

486PathologyPulmonary & Critical CarePCWP increase reviel Cardio problem and exlude Lungs NICEEE488HistologyPulmonary & Critical CareIn COPD we have Neutrophils and Alveolar Macrophages, releasing proteinases528PathophysiologyPulmonary & Critical CareCO2 level in ABG indicated ventilation status (if have upper obstruction no ventilation so hypercapnia)533PathologyPulmonary & Critical CarePeptistreptococcus, pervotella, bacteroides and fusobacterium are the aneprbes pf the mouth that cause aspiration pneumonia534PathologyPulmonary & Critical CareLung tranplant: Hyperacute rejection: graft blood vessel spasm, diffuse intravascular coagulation and ischemia Acute:1-2 weeks later, Cell mediated CD8 with macrophage. Vascular damage, perivascular and peribronchial lymphocytic infiltrates. Dyspnea, cough, fever, Perihilar and lobar opacities (CXR) Chronic: bronchiolitis obliterans (small ones) Inflammation fibrosis of bronchiolar wall (in Chronic renal transplant it is vascular unlike here)535PathologyPulmonary & Critical CareBronchiolitis Obliterans: Chronic lung rejection (obstructive pattern) Lymphocytic infiltrate, fibrosis and bronchiole destruction552PathologyPulmonary & Critical CareLung Hamartomas: most common benign tumor is 50-60s and are peripheral coin lesion. Disorganised cartilage, fibrous andd adipose tissue565PathologyPulmonary & Critical CareMediastinal tumor cause IVC syndrome not superior sulcus (pancoast)571ImmunologyPulmonary & Critical CareNZT blue test in CGD is also called Dihydrodamine and can be positive by inducating abscence green color in neutrophils650PathologyPulmonary & Critical CareSmall cell of lung is thought to have a neuroendocrine origin670PathophysiologyPulmonary & Critical CareIn Silicosis there is ineffective Macrophage Phagolysosomes, making those patients more susceptible to TB746ImmunologyPulmonary & Critical CareMHCI is composed of MHCI and Beta2 microglobulin762ImmunologyPulmonary & Critical CareIn order for naive T cells to turn into TH1 cells they need IL12. In turn, TH1 secrete IgN Gamma to activate macrophage. So if you domt have Il12 you are susceptible to TB so give IFN Gamma796ImmunologyPulmonary & Critical CareIn Sarcoid it is mainly CD4 T cells involvement797ImmunologyPulmonary & Critical CareSarcoidosis is Th1 response where IL2 and IFN gamma play a role in granuloma formation while Th2 involve IL4 (Activate B cells and secrete IgE) and IL5 (Eosinophils and IgA formation)799PathologyPulmonary & Critical CareComplications of ob stuff: O2 use for ARDS in fetus: can cause upregulation of VEGF and retinal vessel proliferation (neovascularixzation) potentially causing retinal detachment and blindness Surfactant treatment complications: Hypoxia, HypoTN, blockage of ET tube and pulmonary hemorrhage Terbutaline (tocolisis) to delay labor: IVH, Hypoglycemia, Hypocalcemia and ileus800EmbryologyPulmonary & Critical CareBy week 35 L/S ratio becomes 2:1 (lecithin is also known as phosphatidylcholine)802GeneticsPulmonary & Critical CareIn CF disfunctional protein do not undergo Post translational modification and we get no CFTR and it is sent to proteasome804PathophysiologyPulmonary & Critical CareIn CF (CFTR) gene, Lungs GI: (normally) have high content of Cl- and Na+(decreased absorption) Sweat gland: (normally) low content so if have CF u have high salts in glands bu the contrary in resp and GI (fun haa)903PharmacologyPulmonary & Critical CareBosentan: Antagonist of endothelial receptors, used for idiopathic pulmonary hypertension958MicrobiologyPulmonary & Critical CareClumping of RBC at low Temperature means there is cold Agglutinins formation (Mycoplasma, EBV..)960MicrobiologyPulmonary & Critical CareLegionella (pneumonia, diarrhea, high fever) cannot be detected on gram stain (think of that syrian guy in Bassile, but need urine IgM) and is common in COPDers962MicrobiologyPulmonary & Critical CareHib vaccine contains PRP and diphteria toxoid to produce AB against RPR, a component of its capsule (think that when u say PRP u move ur epiglottis LoLllllll)964MicrobiologyPulmonary & Critical CareNontypable H flu dont have capsule MMAKES SENSE1195PharmacologyPulmonary & Critical CareOropharyngeal candidiasis: Nystatin1373MicrobiologyPulmonary & Critical CareRhinovirus is (+) SS RNA so directly produce toxin (even if only RNA is injected) whereas RSV and Influenaza are (-) SS RNA so need a specific Viral RNA Polymerase to produce its (+) counterpart1377MicrobiologyPulmonary & Critical CareEnvolope voruses have bilayer lipid outer membranes and destroyed by ether or organic solvents1414PhysiologyPulmonary & Critical CareWhen CO2 enters RBC it produce HCO3- that is released again in Plasma. In order to maintain neutrality of Plasma, Cl- enter RBC, which explains higher Cl- content in Arteries than in Veins.1460PathophysiologyPulmonary & Critical CareIn obstructive sleep apnea (obesity, tonsillar hypertrophy, hypothyroid), ABG during the day are normal, can have erythrocytosis, can lead to Pulm HTN and RHF

1494PhysiologyPulmonary & Critical CareHyperventilation will cause Hypocapnea, that will constrict Cerebral Blood Vessels, decreasing cerebral blood flow (hence the symptoms of dizziness, blurred vision), since the brain is tricked and thinks its having good circulation getting rid of CO2. Cerebral Blood Flow is Dependent on both O2 and CO2 contents.1514PhysiologyPulmonary & Critical CareCFTFR (chromosome 7) is a transmembrane ATP gated chloride channel1519PhysiologyPulmonary & Critical CareLung physiology. After regular expiration FRV is left in the lungs and the pleural pressure is at its lowest (absolute value) of -5, due to chest wall position creating a negative pressure and alveolar elasticity causing a positive alveoli transmural pressures (remember lungs tends to collapse) OUT - IN is pleural pressure, at this instance alveolar pressure is null hence no air movement. Only in case of pneumothorax when pleura is in contact with atmosphere, its pressure i1521PhysiologyPulmonary & Critical CareIn Obstructive pattern Residual Volume is increased (look at them, they barreled chest)1522PhysiologyPulmonary & Critical CareIn PE (poor alveolar perfusion) the alveolar composition is close to that of the trachea since no exchange is happening. Usually O2 should decrease and CO2 increase when going down the tree due to exchange. Exchange is perfusion limited, since exchange is easily established across membrane except in fibrosis and emphysema where wall is damaged and diffusion is difficult. In this case O2 in alveoli is high since it is not going to the blood, but CO2 is not affected (high DC)1523PharmacologyPulmonary & Critical CareTo induce asthmatic change in PFT's Exercice, histamine, cold air inhalation and Metacholine (metacholine, cholinergic agonist) will cause airway constriction and increase secretion. A decrease of >20% of FEV1 is diagnostic of asthma after metacholine test.1526PhysiologyPulmonary & Critical CarePAO2 is derived from an equation and does not exactly accurately represents O2 content in all alveoli, therefore we get a normal PAO2 in Obstructive patients, with a high PAO2-PaO2 value.1535AnatomyPulmonary & Critical CarePain from diaphragmatic and mediastinal pleura are carried out by phrenic nerve; so get neck and choulder referred pain ( think of the map; like an inverted T) the rest is carried out by intercostal nerves1543PhysiologyPulmonary & Critical CareInterstitial lung disease (restrictive): both FEV1 and FVC are decreased, but FVC decrease much more which explains the increase in FEV1/FVC ration. FEV1 is not decreased that much coz interstitial fibrosis will cause traction of alveolar wall (increased lung elastic recoil) causing supernormal expiratory flow when correcting for lung volume.1548PhysiologyPulmonary & Critical CareRespiratory particles in bronchioles are cleared by mucociliary system. Beyond terminal bronchioles, Macrophage do the job. Mucus-Secreting cells (Goblet cells) are all along the respiratory trat but not in terminal bronchiole and farther where surfactant line the walls.1563PhysiologyPulmonary & Critical CareMinute ventilation = TV . RR Alveolar ventilation = (TV - Dead space) . RR1576MicrobiologyPulmonary & Critical CareIn transplant patients, ds DNA CMV (Intracellular and ctyplasmic incusion bodies) pneumonia can happen 1582PhysiologyPulmonary & Critical CareHypoxemia: Normally pAO2: 104, paO2: 100 (we have complete diffusion but difference is due to bronchial deoxygenated vein that drain in pulmonary veins) Normal Alveolar-arterial gradient (10-15, since both are low, so alveolar problem): hypoventilation, high altitudes (low O2 content) or decrease inspiratory capacity (MGravis, Obesity) High A-a gradient (only arterial O2 is low): limited diffusion, R to L shunt (cyanotic heart), V/Q mismatch (PE, pneumonia, Obstructive diseas1583PhysiologyPulmonary & Critical CareIn COPD it js O2 that conteols Respiratory Drive and unlike what I Thought it is Peripheral Chemoreceptors that controls that (carotid and aortic arch) Central chemoreceptors are regulated by decrease pH not (but still low effect coz brain is barely permeable to H+)1585PhysiologyPulmonary & Critical CareIn LV heart failure, fluid accumulate in Lungs and decrease their Compliance. Nothing to do with Alveolar Surface Tension and Surfactants.1611ImmunologyPulmonary & Critical CareKartagener syndrome (ciliary dyskenesia due to Dynein arms defect) Is triad of Chronic Sinusitis, Bronchitis and Situs Inversus1620PhysiologyPulmonary & Critical CarePulmonary vascular resistance is lowest at FRC and it's also at FRC that alveolar pressure is 0. Alveolar - pressure (inspiration) will narrow the vessels and lengthen them causing pressure, while expiration will increase intrathoracic pressure also increasing pressure in vessels.1666MicrobiologyPulmonary & Critical CareIn patients > 65, post flu pneumonia is common and cause by Strep, Staph and Hib1679MicrobiologyPulmonary & Critical CareM. Pneumonia require cholesterol to grow on artificial media coz have no cell wall or capsule so cholesterol to integrate in their cell membrane1764ImmunologyPulmonary & Critical CareHib vaccine is conjugated with diphteria protein to switch immune reaction to T cell independant to T cell dependant1779MicrobiologyPulmonary & Critical CareSpore forming bacteria resist heat1801PathologyPulmonary & Critical CareIL 1,6 and TNF alpha are the mediator of sytemic inflattion and stimulate liver secretion of fibrinogen which increase ESR

1910PathophysiologyPulmonary & Critical CareIn pneumonia, green sputum is due to myeloperoxidase, a blue-green heme-based enzyme that is released from neutrophil azurophilic granules and forms hypocholorous acid1925PathologyPulmonary & Critical CareAllergens are stronger than cold air to induce an asthma ttack1980PhysiologyPulmonary & Critical CareHigh altitude AB: First low FiO2 will cause hypoxemia, which will result in Hyperventilation subsequently Respiratory Alkalosis. Within 48 hours, kidneys will respond causing Compensatory Metabolic Alkalosis. Therefore pH will be high (Hyperventilation Respiratory Acidosis), pO2 low (Hypoxemia), pCo2 high (Hyperventilation) and Bicarb low(metabolic acidosis)1981PhysiologyPulmonary & Critical CarePE: Hypoxemia + Respiratory Alkalosis (Hyperventilation Reaction)1985PathophysiologyPulmonary & Critical CareOSA can lead to pulmonary hypertension2039GeneticsPulmonary & Critical CareRNA polym I: rRNA II: mRNA, microRNA (silencor, think of it like methylation) smallRNA (involve in regulation and splicing) III: tRNA8257MicrobiologyPulmonary & Critical CareLegionella does not stain well on Gram stain and cause hyponatremia8260PathophysiologyPulmonary & Critical Care Air flow resistance: COPD, asthma, emphysema, or goiter obstruction: in these patient the frequency of breathing will increase work of breathing, so they breathe long and slowly to adjust While alveolar and elastic problems: the work of breathing increase with increase TV so they breathe shallow and fast This is manifested by the trough work of breathing on RR curve that is either lower or higher than 158519BiostatisticsPulmonary & Critical CareAnalysis of variance is ANOVA8703AnatomyPulmonary & Critical CareWhen someone swallows a bone it can get lodged in piriform recess just behind the epiglottis. Behinf the recess there is the Internal Branch of the Superior Laryngeal Nerve and mediates the afferent of The cough Reflex. THINK OF SOMEONE TRYING TO COUGH SO MUCH TO REMOVE THE BONE BUT THEN COULDNT COUGH ANYMORE 11638MicrobiologyPulmonary & Critical CareNocadia (Lungs, CNS, Cutaneous) occurs also in uper lobes like TB, and are branching Gram (+) confusing with fungi Contracted by spore inhalation or traumatic inoculation on skin8HistologyRenal, Urinary Systems & ElectrolytesIn post strep glomerulonephritis we see Granular deposit in mesangium of basement membrane with IgG, IgM and C3 deposition "Starry sky appearance"9HistologyRenal, Urinary Systems & ElectrolytesGoodpasture is part of RPG ( pasteur, with a RPG) so expect Crescent changes and IgG and C3 in basement membrane12PathologyRenal, Urinary Systems & ElectrolytesPost strep Glomerulonephritis: Hugh ASO, anti DNase B titers, Low C3 and total complement levels (normal C4) and presence of cryoglobulin28PathologyRenal, Urinary Systems & ElectrolytesIn nephrotoc u lose a lot of albumin so liver increase albumin production. U retain a lot of spdium coz of increase aldosterone211PathologyRenal, Urinary Systems & ElectrolytesPartial Vs Complete Nephrogenic DI: In partial Urine osm with ADH urine OSM recovers till 500, but in complete it does not recover at all 229PathologyRenal, Urinary Systems & ElectrolytesIn IE glomerulonephritis can happen and it is an Immune complex mediated injury275PharmacologyRenal, Urinary Systems & Electrolytes Amphotericin is nephrotoxic so can cause anemia (low EPO) and will cause increase permeability of distal tubules so will have HYPOKALEMIA AND HYPOMG and possible heart problems684PhysiologyRenal, Urinary Systems & ElectrolytesFurosemide works on Na-K-2Cl channels in TAL and also work by stimulating Renal Prostaglandin Release (which normally dilate Afferent arteriole--> Increase RBP and GFR and enhance drug Delivery). If you give NSAID you will constrict Afferents and decrease delivery, resuming ascites or pleural effusion685PharmacologyRenal, Urinary Systems & Electrolytes Autotoxic: Furosemide, Aspirin, Aminoglycoside, cisplatin, Vanco744ImmunologyRenal, Urinary Systems & ElectrolytesIn chronic renal graft rejection you see vascular changes, tubular atrophy and fibrosis, but neutrophils are not involved750ImmunologyRenal, Urinary Systems & ElectrolytesIn parasitic infection IgE will bind to parasite then their Fc portions bind eosinophils that will in turn degranulate This is called Antibody-dependent- cell mediated toxicity813PathophysiologyRenal, Urinary Systems & ElectrolytesIdiopathic hypercalciuria is the most common cause of calcium kidney stones (NL serum Ca2+)816PathologyRenal, Urinary Systems & ElectrolytesVit B6 decrease Oxalate production and decrease chance of CAlcium Oxalate formation835PathologyRenal, Urinary Systems & ElectrolytesBeta lactam can cause acute interstitial nephritis886PathologyRenal, Urinary Systems & ElectrolytesIn recovery of ATN all electrolytes are low du to slowly recovering despite increase UO887PathologyRenal, Urinary Systems & ElectrolytesEthylene glycol: tubular necrosis with balooning and vacuolisation of PCT + Ca Oxalate stones1049PathologyRenal, Urinary Systems & ElectrolytesChronic NSAIDS wil cause CHronic Interstitial Nephrtis

1053PathologyRenal, Urinary Systems & ElectrolytesIn recovery of ATN we get reepithelization of tubules1054PathologyRenal, Urinary Systems & ElectrolytesBence jones are large eosinophilic casts While in Hypersensitivity interstitial nephritis we see eosinophils in blood1161PhysiologyRenal, Urinary Systems & Electrolytes ADH works on Cortical and Medullary portions of Collecting ducts but Cortical segment is not involve in urea reabsorption but Medullary segment reabsorbs both H2O and Urea1211PharmacologyRenal, Urinary Systems & ElectrolytesBethanecol given for post op ileus (cholinergic): BEDNA NEKOL POST OP1524AnatomyRenal, Urinary Systems & ElectrolytesRegardless of a patient's status, reabsorption occur in proximal tubule.1532PhysiologyRenal, Urinary Systems & ElectrolytesLiver: Angiotensinogen -(Renin produced in Juxtaglomerular cells in Kidneys)-> ATI Lungs: ATI -(ACE)-> ATII (cause vasoconstriction in systemic arterioles) Adrenal Glands: ATII Stimulates Aldosterone Production and Secretion1554PhysiologyRenal, Urinary Systems & ElectrolytesHypokalemia cause K+ reabsorption by a-intercalated discs in cortical portion of collecting tubules, through K+/H+ ATPases (K+ in, H+ out; stimulated by Aldo in HypoK; the reason why HypoK causes Alkalosis)(Apical), while Normal to High K+ level will permit K+ excretion through K+ channels (Apical) in Principal cells, with help of Na+/K+ pump basolaterally which is activated with high K+ levels and Aldosterone (also enhance Na+(in) and K+(out) channels permeabilities)1555PhysiologyRenal, Urinary Systems & ElectrolytesClearance=UrineConcentration.UrineFlowRate/PlasmaConcentration ClearanceCr(or Inulin)=GFR ClearancePAH=RPF FF=GFR/RPF UrineFlowRate is the same so it cancels in the Nominator and Denominator 1556PhysiologyRenal, Urinary Systems & ElectrolytesRPF (PAH clearance) reprensents plasma flow, but since plasma represents one pprtion of blood, to get RBF, we divide RPF/(1-HCT), and here we get the Actual RBF1559PhysiologyRenal, Urinary Systems & ElectrolytesRenal Excreation: Inulin and Mannitol: only Filteres, not secreted or reabsorbed Glucose, Amino Acids, Na+, Urea: Filtered then most of it reabsorbed PAH, Creatine: Filtered and Secreted (Cr is not exactly all secreted) FF (20%)= GFR/RPF with GFR: Inulin clearance and RPF: PAH clearance (not very accurate coz Adipose tissues in kidney do not filter or secrete RPH so this will underestimate RPF by 10%)1588PhysiologyRenal, Urinary Systems & ElectrolytesGlomerulus filters a substance into Bowman's capsule which is the start of the journey of filtered substance (filtration does not occur there)1617PhysiologyRenal, Urinary Systems & ElectrolytesProximal tubules substance concentration depends on wether water is reabsorbed faster than them. So we have an increase by growing order of Na, K, Cl, Urea, Inulin, Cr and PAH (The last 3 are almost not absorbed) While HCO3 (Actively reabsorbed due to Carbonic Anhydrase), AA and Glucose (These 2 are vividly actively reabsorbed) decrease significantly1619PhysiologyRenal, Urinary Systems & ElectrolytesPAH is freely filtered in the glomerulus but it also secreted from peritubular capillaries (proximal tubule) through a carrier transport (reabsorption is carrier mediated too and can be saturated) and this process can be saturated, but filtration will remain. Since PAH is usually fully filtered and secreted its clearance is used to calculate Renal Plasma Flow (RPH: that usually decrease with afferent or efferent constriction; Epi, Norepi, ATII)1643PharmacologyRenal, Urinary Systems & ElectrolytesFoscarnet (pyrrophosphate analogue) chelates calcium and cause magnesium wasting in kidneys, hence decrease PTH and further decrease in Ca. Low Ca and and Mg can cause seizures1651PhysiologyRenal, Urinary Systems & ElectrolytesFiltration Fraction = GFR / Renal Plasma Flow1736EmbryologyRenal, Urinary Systems & ElectrolytesKidney development: Intermediate mesoderm will form: Pronephros (disappear), Mesonephros (give Wolffian ducts in male and Vestibular Gartner's ducts in females), Metanephros duct (Collecting ducts, Minor and Majors Calyces, Renal pelvis, Ureters) arising from caudal Mesonephros. Mentanephros duct (ureteric bud) will induce formation of Metanephros Blastema in sacrum (Metanephros mesoderm: Glomeruli, Bowmans's space, Proximal tubule, Loopf of Henle, Distal collecting tubules)1989BiochemistryRenal, Urinary Systems & ElectrolytesFabri, deficiency in alpha galactosidase A and globoside ceramde trihexoside will accumulate in tissues. First get angiokeratomas, hypohidrosis and acroparesthesia. In late phase if enzyme is not replaced GET RENAL FAILURE COZ FABRENAL2012PhysiologyRenal, Urinary Systems & ElectrolytesUrea is reabsorbed in the collecting duct through ADH effect on V2 receptors (increase water and urea permeability). Urea will go in the medulla and permit the concentration ability of kidneys.2131PathologyRenal, Urinary Systems & ElectrolytesMembranous nephropathy is associated with IgG4 antibodies to phospholipases A2 receptor, which play a role in dvlpmnt of the disease (it the class V lupus nephritis) In cryoglobulinemia: there is IgM deposits in glomerulus leading to basement mmbrane thickening and cellular proliferation8530ImmunologyRenal, Urinary Systems & ElectrolytesT helper produce IL2 which activates CD4, CD8 T cells, NK cells and monocytes

8541MicrobiologyRenal, Urinary Systems & ElectrolytesShistozoma are contracted by Snails (makes sense)8881PhysiologyRenal, Urinary Systems & ElectrolytesSerum Cr and GFR have an negative log function.11040PathophysiologyRenal, Urinary Systems & ElectrolytesIn diabetic urinary incontinence bladder ant sense full bladder and u wont void all content, so have a large post void residue 11064PathophysiologyRenal, Urinary Systems & ElectrolytesClacineurin inhibitors mediated toxicity: see vacuolization (yea NOT BAD) If Acute rejection: See lymphocytic infiltrations11786ImmunologyRenal, Urinary Systems & ElectrolytesSirolimus bind to FKBP and this complex inhibits mTOR (signaling transduction) hence inhibiting IL2 production239PathologyRheumatology/Orthopedics & SportsRheumatic Fever kills by Pancarditis not MS457PathologyRheumatology/Orthopedics & SportsPAN and hep B BIG DEAL627PhysiologyRheumatology/Orthopedics & SportsGenetic Factors are the Strongest Prognostic factors for Osteoporosis (Being black is the best protective factors, as it will give you better bone density than if you take extra Ca2+ or Exercice)628PhysiologyRheumatology/Orthopedics & SportsBlack women have higher Bone Density and have lower risks of Fractures (Of course). Lower BMI have lower Bone Density and higher risk of fracture (not what I thought)634PathologyRheumatology/Orthopedics & SportsHemiballism involves extremties638PhysiologyRheumatology/Orthopedics & SportsIndicators of: Osteoblastic activity: Bone-specific Alkaline Phosphatase Osteoclastic activity: Tartrate-resistant acid phosphatase, Urinary Hydroxyproline and Urinary Deoxypyridinoline (most accurate one)639PhysiologyRheumatology/Orthopedics & SportsPaget disease: increased numbers of abnormal osteoclasts, excessive bone turnover and abnormal bone remodeling (osteoblast here plays its role, but the initial problem is in osteoclast) Osteoclast are multinucleated (2-5 but 100's in Paget) cells arising from the fusion of many mononuclear phagocytic cells due to Macrophage colony-stimulating factors (M-CSF) and Receptor for Activated Nuclear Factor kappa-B Ligand (RANK-L) which are produced by Osteoblasts and BM stemal cels646MicrobiologyRheumatology/Orthopedics & SportsKids get osteomylitis with staph667PathologyRheumatology/Orthopedics & SportsChurg Strauss also cause Mononeuritis due to involvement of the epineural vessels of peripheral nerves 699PharmacologyRheumatology/Orthopedics & SportsBisphosphonate are pyrophosphate analogues and inhibits oscteoclasts719PharmacologyRheumatology/Orthopedics & SportsIn RA DMARDs take a lot to work whereas Steroid and NSAIDs are about rapid relief 721PathologyRheumatology/Orthopedics & SportsOsteomylitis affect metaphysis of long bones (in children hematogenous osteo)741ImmunologyRheumatology/Orthopedics & SportsSerum sickness is a type III hypersensitivity associated with monoclonal antibodies or non-human Immunoglobulin (e.g: antitoxin) and sometimes with non-protein drugs (penicillin, cefaclor, TMP-SMX). It is complement induced and get Hypocomplemtemia, and C5a will induce neutrophil chemotaxis, marginalization, hence neutropenia.752ImmunologyRheumatology/Orthopedics & SportsHLA associated in diseases and stuf autoimmune are of class I. (HLA=MHC)753PathophysiologyRheumatology/Orthopedics & SportsMonitor Ankylosing spondilitis by chest wall expansion (that is limited with advanced disease leading to hypoventilation)754ImmunologyRheumatology/Orthopedics & SportsRheumatoid factor: Secreted IgM from plasma cells, against Fc receptors of IgG. Immune complex will deposit then858PharmacologyRheumatology/Orthopedics & SportsColchicine inhibit tubulin polymerization hence inhibit lymphocyte migration982PathophysiologyRheumatology/Orthopedics & SportsIn Osteoporosis: Calcium, PO4 and PTH are Normal987PhysiologyRheumatology/Orthopedics & SportsPaget disease (increase osteoclast activity): bone pain, Increased ALKPhosph with mosaic pattern of lamellar bone.1159HistologyRheumatology/Orthopedics & SportsOsteocyte connect together through Gap Junctions1168PharmacologyRheumatology/Orthopedics & SportsColchicine will cause GI symptoms (coz like chemo, inhibits microtubules)1382PhysiologyRheumatology/Orthopedics & SportsResting membrane potential is established by the high K+ Efflux and minimal Na+ influx. (Through non-gated channels)

1394MicrobiologyRheumatology/Orthopedics & SportsWhen have gas gangrene, its clostridiu perfringens and also can cause food poisonong (reheated meat) reheated rice: B. cerus1450PathophysiologyRheumatology/Orthopedics & SportsGout is associated with Myeloproliferative disorders (e.g: polycythemia vera..)1664PhysiologyRheumatology/Orthopedics & SportsOn electron micrograph the Z line appears much darker than the M line. And only the H band contains purely thich filament. And only the A band (corresponds to the whole length of thick filament) is not variable in size and does not change during muscle contraction1682AnatomyRheumatology/Orthopedics & SportsIn Oustretched hand fall u can have Scaphoid fracture or Lunate dislocation compressing Median nerve causing Numbness of hand1684EmbryologyRheumatology/Orthopedics & SportsCaudal agenesis (sacral agenesis): lower extremety paralysis (are smaller), Urinary incontinence SEEN IN DM MOTHERS1858PhysiologyRheumatology/Orthopedics & SportsMuscle: Type I fibers: Slow twitch, Require low level sustained force, have high Myoglobin and Mitochondria so look red (rely on aerobic respiration); Postural muscles like Soleus, Paraspinal, Type II: Rapid Forceful movements. IIb: Anaerobic Glycogenolysis then Glycolysis (High Glycogen content). IIa: Fast twitch but with Aerobic Respiration (Intermediate between Type I and Type IIb)1874PathologyRheumatology/Orthopedics & SportsContracture: Fibroblasts with increase metalloproteinase1896PathologyRheumatology/Orthopedics & SportsParvo can imitate RA but is self limiting1956AnatomyRheumatology/Orthopedics & SportsFemoral head is supplied by Medial Circumflex femoral Artery1969AnatomyRheumatology/Orthopedics & Sportsthe fibula is lateral, and ACL goes towards inside (out to in)2061PhysiologyRheumatology/Orthopedics & SportsIn Myastemia Gravis, the antibodies (act like Curare) will bind the Acholine receptors and preventing ACh of opening cation channels (Na+, K+; they are within the ACh receptor), therefore we have a reduced motor-end plate potential. Unlike Eaton-Lambert or Botulism (Block release. Of ACh from presynaptic terminal) the synaptic ACh concentration is normal. Hemicholinium: block reuptake of choline into presynapse depleting ACh stores in presynapse2062PhysiologyRheumatology/Orthopedics & SportsIn Mysthemia Gravis, the use of Cholinesterase Inhibitors is non selective therefore increase the activity of ACh in muscarinic receptors too (Unwanted side effect). Therefore Scopalamine (so is Hyosciamine) is given which is a selective Muscarinic ACh receptor Antagonist (such as the gut, cramp, nausea, diarrhea, sweating). Pilocarpine is a non selective ACh receptor agonist and reduces the side effects.2090BiochemistryRheumatology/Orthopedics & SportsIf someone has increased PRPP production he will have increased purines and then uric acid and gout7592PhysiologyRheumatology/Orthopedics & SportsSkeletal muscle contraction: ACh will bind post synaptic receptors, opens post-synaptic ligand-gated ion channels causing depolarization of muscle cells. Then Ca2+ is released from SR. Ca2+ will bind to Troponin on the C site (Troponin C: Ca2+ binding site, Troponin T: attaches Troponin to Tropomyosin, Troponin I: attaches Troponin-Tropomyosin complex to Actin) When bound to Ca2+, it will rotate tropomyosin exposing Actin's myosin binding site allow Actin-Myosin interaction8266PhysiologyRheumatology/Orthopedics & SportsGolgi tendons system (at muscle-tendon junction) are sensitive for Active stretch in Muscles , and is a feedback system that monitor and maintains muscle force. (not passive ones).they are responsible for the involuntary release of weights when hitting the gym, to prevent muscular injury.8523PharmacologyRheumatology/Orthopedics & Sportsmab: Monoclonal AB cept: reCEPTor molecule nih: kinase INHbitor 8579AnatomyRheumatology/Orthopedics & Sports Annular ligament is fucked up when a childs arm is being stretched in extended pronated position like i used to do to Karim. Patient will be in extended pronated arm position, wont be able to move it again. Reduce it by flexing and supinating8670AnatomyRheumatology/Orthopedics & SportsScaphoid fracture in outstrectched hand can lead to avascular necrosis and it is the most common complication10930PharmacologyRheumatology/Orthopedics & SportsCalcium bicarb when given need acidic invironment for Ca to be absorbed11564PharmacologyRheumatology/Orthopedics & SportsDronate inhibit osteoclast mediated resorption (similar to pyrrophosphate and bind to hydroxyapatite) so osteoclast that is eating bone takes dronates andd dont adhere on more bone for resorption11646PathophysiologyRheumatology/Orthopedics & Sportsin polymyositis: have ANA ANTI JO-1 (aka anti histidyl tRNA synthestase DAA FUCKKKKKKK)11653PathologyRheumatology/Orthopedics & SportsMC cune albright: mutatuin in GNAS gene CAfe au lait, precocious puberty and fibrous dysplasisa11684AnatomyRheumatology/Orthopedics & SportsExtensor muscle of the wrist attach on lateral epicondyle it is a bit intuitive

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11727AnatomyRheumatology/Orthopedics & SportsIn sciatica there is compression of the sciatic nerve in the Greater sciatic foramen often due to HYPERTROPHY OF PIRIFORMIS MUSCLE (passes in the canal; involved in extrnal hip rotation)11749PharmacologyRheumatology/Orthopedics & Sports Azathiprine-> 6MP-> purine metabolism so if give ALLopurinolu inhibit this11770PathophysiologyRheumatology/Orthopedics & SportsTemporal arteritis is cell mediated with production of cytokines (IL6..)11799AnatomyRheumatology/Orthopedics & SportsInjury of ankle (inversion) think only of talofibular 11830AnatomyRheumatology/Orthopedics & SportsPenis drains in superficial inguinal nodes excpet for gland which drain into deep (coz very sensitive and goes deeeep)1125Behavioral scienceSocial Sciences (Ethics/Legal/Professional) A woman having tubal ligation is not required to have her partner's consent1235Behavioral scienceSocial Sciences (Ethics/Legal/Professional)PCP should educate about exercice, smoking cessation etc. while the attending at hospital should DNR DNI objectives to very sick patients1237Behavioral scienceSocial Sciences (Ethics/Legal/Professional)When a patient refuses to know his diagnosis before directly accepting dig further and ask why1238Behavioral scienceSocial Sciences (Ethics/Legal/Professional)Eventhough people have full authorities on themselves you are to report suicidal plans, or someone with EBV willing to play rugby (risk of splenic rupture)2057Behavioral scienceSocial Sciences (Ethics/Legal/Professional)Eventhough pregnancy stuff are not be adressed to parents in minor, abortions should be adressed to parents.2058Behavioral scienceSocial Sciences (Ethics/Legal/Professional)Drunk people who want to leave the ER are not allowed to do so until they get sober 2059Behavioral scienceSocial Sciences (Ethics/Legal/Professional)Patient has the right not to know informations7767Behavioral scienceSocial Sciences (Ethics/Legal/Professional)If Dr. is not comfortable with patient's decision he has the right to refer to another Dr. who is comfortable with doing what the patient wants. (like Abortions)10290Behavioral scienceSocial Sciences (Ethics/Legal/Professional)Hospice care is for people with life expectancy of less than 6 months from now10463Behavioral scienceSocial Sciences (Ethics/Legal/Professional)Drs. should not receive gifts, unless of token values (less than 10$; cookies etc.)10464Behavioral scienceSocial Sciences (Ethics/Legal/Professional)Romantic relationships with patient is inapropriate and it is even inapropriate to ask the patient to change Dr. then date her.10488Behavioral scienceSocial Sciences (Ethics/Legal/Professional)Dont rely on a translator if hes not professional when it comes to consents and stuff 10509Behavioral scienceSocial Sciences (Ethics/Legal/Professional)If a colleague asks you about a patient in the elevator, tell him that you'll discuss it later with him, but don't demean him by telling him that you cannot discuss it and that it is against policy10533Behavioral scienceSocial Sciences (Ethics/Legal/Professional)In minors Call Ethic Commity if it is really not clear what to do, but if it's clear get a court mandate to go for treatment10534Behavioral scienceSocial Sciences (Ethics/Legal/Professional) A health care proxy (signed on paper) beats any relative or person when taking decision to unconscious patient10542Behavioral scienceSocial Sciences (Ethics/Legal/Professional)If someone passed out and his friend said that the patient doesn't want resuscitation don't believe him unless he has an official note from him or he is designated the health proxy10545Behavioral scienceSocial Sciences (Ethics/Legal/Professional)Unlike real life, consent forms should be obtained by the physician performing the procedure as he is most qualified to describe the procedure, its complications and to answer the patient's questions11518Behavioral scienceSocial Sciences (Ethics/Legal/Professional)If you can't educate an illeterate (or low education level) patient about his disease use alternative learning methods like visual recources

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