Date: 02/13/2009

Self Discussion Questions Microbiology:

* Viruses: 1. Give name of RNA & DNA viruses (+) RNA viruses DNA viruses () RNA viruses - Paramyxovirus - Calcivirus - Herpes virus - Orthomyxovirus - Picornavirus - Hep B virus - Rhabdovirus - Flavivirus - Papova virus - Filovirus - Togavirus - Parvovirus - Bunyavirus - Coronavirus - Poxvirus - Arenavirus - Retrovirus (HIV) - Reovirus - Delta virus 2. How will you identify different viruses? 3. Which is the only (+) sense RNA virus with helical shaped? 4. Which is the only () sense RNA virus with icosahedral shaped? 5. Shape of all DNA viruses and exception to this 6. Which three RNA viruses are non-envelope? 7. Envelope DNA viruses 8. Which is the only RNA virus with double stranded RNA? 9. Which is the only DNA virus with single stranded DNA? 10. Which two RNA and two DNA viruses have circular nucleic acid? 11. What is the difference b/w positive sense and negative sense RNA viruses? 12. Name of segmented viruses 13. What is an importance of segmented viruses? 14. The site of viral replication 15. Which DNA virus replicates in cytoplasm? 16. Which two RNA viruses replicate in nucleus? 17. How replications in DNA viruses occur? 18. Which DNA virus has self coded envelope? 19. Give name of an important viruses in Calcivirus family 20. Give name of an important viruses in Flavivirus family 21. Give name of an important viruses in Paramyxovirus family 22. Give name of an important viruses in Picornavirus family 23. Give name of an important viruses in Herpes family 24. Clue words to diagnose important viruses from inclusion bodies * Intracytoplasmic inclusion body Rabies Poxvirus HPV Chlamydia * Intranuclear inclusion body Herpes * Both Intracytoplasmic & Intranuclear inclusion bodies: CMV

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25. Important points to know about Rabies virus (Rhabdovirus family) Bullet shaped carrier (dogs, bat, skunk) hydrophobia fatal once developed Dx: Negri bodies (Intracytoplasmic inclusion in brain tissue) 26. Most common cause of Aseptic meningitis [Sign & Symptoms of meningitis (headache, stiff neck) but patient appears less toxic] 27. Most common cause of viral encephalitis. Most common site. 28. Most common cause of viral pink eye 29. Causes of diarrhea due to virus diarrhea in Infants (2 yrs) diarrhea in kids & adults 30. Cause of Hand Foot Mouth disease 31. Most common cause of acute Pericarditis 32. Give the name of virus family of Measles (Rubeola) & Rubella (German Measles) 33. Clues to diagnose Measles (Rubeola) 34. Which vitamin should supplement in measles 35. Clues to diagnose Mumps 36. Clues to diagnose Rubella (German Measles) 37. Clues to diagnose Roseola (Exanthema Subitum) 38. Virus causes Roseola 39. Clues to diagnose Varicella (chicken pox) 40. Clues to diagnose Molluscum Contagiosum 41. TORCH infections 42. Clinical importance of Papova virus (HPV) 43. For which virus we do Tzank test? What are we looking for in Tzank test? 44. What does Monospot test check? Is it specific? 45. What is an importance of different Hep-B markers? [HBsAg, Anti-HBcAb, HBeAg, Anti-HBeAb, Anti-HBsAb] HBsAg: Anti-HBcAb: HBeAg: Anti-HBeAb: Anti-HBsAb: Hep-B markers appear in following sequence [From first to last:] 46. What is a window period? How do we diagnose Hep-B and HIV infection when patient is in window period? 47. Diagnosis of acute infection (current infection) due to important Hepatitis viruses Hep-B: Hep-A: Hep-C: 48. What does Anti-HCV Ab indicate? 49. Most common virus causes hepatocellular CA 50. Transmission of different Hepatitis viruses Hep-A: Hep-B:

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Hep-C: Hep-D: Hep-E: 51. Important points to know about Hep-D virus Delta virus, incomplete virus, co-infection with Hep B required / super infection in previously infected with Hep B, In combination with Hep B, it has highest mortality rate of all the hepatitis infections 52. Which hepatitis virus has highest mortality in pregnant women? 53. Which virus is a causative agent for Kaposi sarcoma? 54. Common feature of all hemorrhagic fever [Ebola, Dengue, Yellow fever] Fever + bleeding diathesis [Low platelet counts, DIC, shock] 55. Diagnosis of HIV ELISA screening test (screen for antibody against HIV in patients serum) Western blot test confirmatory test (check antibody against p24, p17, gp120 and gp41), should demonstrate presence of antibody to atleast 2 out of 3 antigens [p24, gp41 and gp120]; if antibody to only one antigen present, then consider it negative and order HIV PCR to confirm the diagnosis 56. Which is the capsid protein in HIV? Importance of it 57. Give name of envelope proteins. Which envelope protein binds to CD4+ cells? 58. Which HIV gene down regulates host cells immunity (MHC-1, MHC-2)? 59. Which gene is responsible for production of important viral enzymes? Function of these enzymes Reverse transcriptase: Integrase: Protease: 60. Clinical presentation of Hantavirus (Bunyavirus family) Myalgia, fever & ARDS, carrier common deer mice 61. Clinical presentation of Lassfever (Arenavirus family) Non-specific symptoms like fever, retro-sternal pain, mucosal bleeding, proteinuria, etc, 15-20% mortality; reservoir rodents; spread through inhalation of tiny particle of rodents excretion, personperson transmission; Dx: ELISA, Tx: Ribavirin; Complications: deafness, spontaneous abortion 62. What are eclipse period and latent period? Eclipse period Latent period * 1. 2. 3. 4. 5. 6. 7. Parasites: What is the difference b/w intermediate host and definitive host? What happen when men as an intermediate host Give an example of conditions in which men as an intermediate host Parasite causing Sparganosis; Clinical importance of it Carrier of Toxoplasmosis (T. gondii) Which form of Toxoplasma can cross placenta Which form of maternal toxoplasmosis can infect fetus?

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8. Presence of IgM against Toxoplasma in newborn indicates what? Clinical importance of it 9. Parasite causing Chagas disease. Vector (disease transmitting agent) of it. [common in Brazil] 10. Important sign specific to Chagas disease 11. Parasite causing African sleeping sickness. Vector of it. 12. Parasite causing Kala-azar. Vector of it. 13. Which form of L. Donovani is present in liver & spleen? 14. Parasite causing Babesiosis [Similar to malaria; it causes hemolysis] 15. Parasite causing Giardiasis. Route of transmission 16. Parasite causing amoebiasis. Route of transmission 17. Parasite causing vaginosis. Route of transmission 18. Which free living amoeba present in contact lens solution causes keratitis & granulomatous Amoebic Meningitis? 19. Which free living amoeba present in fresh warm water causes Amoebic Meningitis? 20. Mosquitoes inject which form of plasmodia in human blood? 21. Which form of plasmodia causes relapse? 22. Which form of plasmodia is responsible for malarial paroxysm? 23. Which form is picked up by mosquitoes from patient infected with malaria? 24. Name of liver and bladder flukes. How do they transmit to our body? 25. Name of parasite causing cancer 26. Buzz word for pinworm infection [Enterobius Vermicularis] 27. How do you diagnose pinworm infestation? 28. Which worm causing rectal prolapse? 29. Life cycle of round worm [Ascaris lumbricoides] 30. How does hookworm [Necator Americans] transmit? 31. Which anemia occurs in hookworm manifestation? 32. Clues to diagnose Cryptosporidium [Causing diarrhea in patient with AIDS] 33. Clues to diagnose Trichinella spiralis * Fungi: 1. Which fungus is found in reticular endothelial system cells like macrophage? 2. Clues to diagnose Coccidioidomycosis [California, Arizona] 3. Clues to diagnose Blastomycosis 4. Clues to diagnose Cryptococcosis 5. Clues to diagnose Pneumocystis Carinii Pneumonia (PCP) 6. Clues to diagnose Aspergillosis 7. Clues to diagnose Candida 8. Clues to diagnose Sporothrix schenkii 9. Clues to diagnose Paracoccidioides 10. Clues to diagnose tinea infections 11. Clues to diagnose tinea versicolor 12. Causative agent for tinea versicolor 13. When should we start prophylaxis for PCP and Cryptococcosis in HIV patient 14. Difference b/w bacteria, virus, fungi and parasites * 1. 2. 3. Bacteria: What is unique to gram (+) bacteria only? What is unique to gram () bacteria only? What forms capsule in bacteria? Clinical importance of it.

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4. 5. 6. 7. 8.

Where do metabolic process / electron transport take place in bacteria? What is the purpose of Porins? What is responsible for shock in gram () bacterial infection? Which factor in streptococci is responsible for rheumatic fever? Color of gram (+) & gram () bacteria Gram (+) Purple/Blue [same color as Non-Acid Fast bacteria] Gram () Pink/Red [same color as Acid Fast bacilli]

9. Important characteristics of all Staph? How is it differing from Strep? 10. How would you differentiate Staph aureus from other staph? 11. How would you differentiate Staph Epidermidis from Staph Saprophytics? 12. Which staph is beta hemolytic? 13. How does staph aureus evade phagocytosis? 14. How would you differentiate Strep Pyogens from Strep Agalactiae? 15. What is the similarity b/w strep agalactiae and [Link] 16. How would you differentiate Viridans group (Strep mutans) from strep pneumonia? 17. How would you differentiate Enterococcus fecalis from Strep Bovis? 18. What are alpha, beta & gamma hemolysis? Alpha hemolysis reduction of iron in hemoglobin giving green color on blood agar; Examples: Strep Viridans group and Strep Pneumonia Beta hemolysis complete rupture of red blood cells, giving distinct, wide, clear areas around bacterial colonies on blood agar; Examples: Strep Pyogens and Strep Agalactiae Gamma hemolysis: no hemolysis take place; Examples: Enterococcus fecalis and Strep bovis 19. On what basis we classify strep in class A, B, D, etc? 20. Clinical importance of all streptococci written below Strep Pyogens: Strep Agalactiae: Strep Viridans: Strep Pneumonia: Enterococcus fecalis: UTI [Dipstick test positive leukocyte esterase & negative nitrite test. (Nitrite test is positive in [Link])] Strep Bovis: affect tricuspid valve in colon cancer patient 21. How will you differentiate UTI due to [Link] and Enterococcus fecalis? 22. Characteristics of Bacillus Obligate Aerobes, rod-shaped, beta-hemolytic, Catalase positive, substantial portion usually contain an oval endospores at one end, making it bulge [spore forming bacteria] 23. Clinical importance of Bacillus Anthrax Cutaneous anthrax Inhalational anthrax Ingestion 24. Clues to diagnose B. cereus 25. Clinical importance of Listeria monocytogen 26. Characteristic of Listeria and Tx of its infection 27. Source of Listeria infection in humans

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28. Clue to diagnose diphtheria 29. How does diphtheria toxin work? Which toxin is similar to diphtheria toxin? 30. Which important organ is affected in diphtheria? 31. Give name of selective and differential cultural media for diphtheria 32. Clue to diagnose Actinomycosis. Treatment of it 33. Clue to diagnose Nocardia. Treatment for it 34. Clue to diagnose Cl. Botulinum infection in infant 35. Clue to diagnose Pseudomembranous colitis [caused by Cl. Difficile] 36. Clinical importance of Cl. Perfringens 37. How does tetanus toxin work? 38. Which two factors are we looking for when we give Tetanus Toxoid (TT)? 39. Clue to diagnose Mycoplasma 40. Characteristics of Mycoplasma. Treatment of its infection 41. Clue to diagnose Acute Epiglottitis 42. Characteristics of H. Influenzae 43. Which type of H. influenzae cause epiglottis & meningitis and which type cause conjunctivitis, sinusitis & otitis media? 44. Characteristic of Neisseria 45. Clinical importance of Neisseria N. Meningitides: N. gonococcus: 46. Important characteristics of N. gonococcus 47. Clinical importance of Moraxella Catarrhalis. Treatment of infection causing by it 48. How would you differentiate Enterobacteriaceae from other gram () bacteria? 49. Give name of bacteria in enterobacteriaceae Citrobacter, Escherichia, Enterobacter, Klebsiella, Shigella, Yersinia, Proteus, Salmonella 50. Which enterobacteriaceae bacteria doesnt have flageller antigen (H)? 51. Clue for diagnosis of Proteus infection 52. Which is the only bacterium from enterobacteriaceae catalase negative? 53. Give name of important non-lactose fermenting enterobacteriaceae bacteria 54. Give name of important lactose fermenting enterobacteriaceae bacteria 55. Clinical importance of Yersinia 56. Patients with Hemochromatosis are susceptible to which organisms? 57. Diarrhea producing different [Link] and their clinical importance Enterotoxigenic [Link] [ETEC]: Enteropathogenic E. coli (EPEC): Enteroinvasive [Link] [EIEC]: Enterohemorrhagic [Link] [EHEC]: 58. Which capsular antigen do E coli possess? 59. Which capsular antigen do salmonella possess? 60. Reservoir / Transmission of important bacteria S typhi: S enterica: Campylobacter jejunii:

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H pylori: Legionella: Francisella (tularemia): Chlamydia psittaci: Coxiella Burnetti: Borrelia burgdorferi: R rickettsii: R prowazakii: R typhi: Bartonella Henselae: Brucella: 61. Clue to diagnose Klebsiella 62. Clinical importance of H pylori 63. Clinical importance of C jejunii 64. Clue to diagnose Legionella 65. Clue to diagnose Pseudomonas 66. Clinical importance of Pseudomonas 67. What is an Alpha toxin? Give name of bacteria that produce it 68. Important points to remember about Mycobacterium Tuberculosis Produce Niacin; waxy envelope (responsible for Caseous necrosis) Cord factor (trehalose dimycolate): Interferes with phagocytosis by macrophages by preventing the fusion of the phagosome with the lysosome [It also present in Nocardia] Tuberculin + mycolic acid: delayed HS, damage is done by immune system. No endotoxin / exotoxin 69. When will you consider PPD test positive? 70. Clue to diagnose Francisella (tularemia). Treatment of it. 71. Clue to diagnose Chlamydia 72. Which inclusion body form of Chlamydia is infectious? 73. Characteristics of Chlamydia 74. Clue to diagnose Lyme disease (Borrelia burgdorferi) 75. Organism present in Human bite / animal bite. Treatment of it. 76. How would you identify different Rickettsia infection easily? 77. Clue to diagnose Bartonella Henselae 78. Clue to diagnose Bordetella Pertusis 79. Which stage in Pertusis is infectious? 80. How does Pertusis toxin work? 81. Which other toxin work by increasing cAMP? 82. Clue to diagnose Vibrio cholera 83. Cultural media to grow cholera 84. Give name of Urease positive organism 85. Importance of Lysogenic phage conversion. Give name of bacteria that undergoes Lysogenic phage conversion 86. Organism causing Scarlet fever. Clue to diagnose it. Treatment for the same. 87. Important points to remember about Mycobacterium Avium intracellularae 88. Clue to diagnose Primary Syphilis 89. How would you differentiate Chancroid from Primary syphilis, Lymphogranuloma venerum and Granuloma Inguinale?

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90. Important points to remember about granuloma Inguinale Papule rapidly evolves into painless ulcer characterized by irregular border and brief red granular base 91. Important points to remember about Lymphogranuloma venerum Painless shallow ulcer and associated with nonspecific symptoms. Inguinal lymphadenopathy is inflammatory & does not appear at the same time as the ulcer 92. Which important infectious agents are not killed by Autoclave? 93. Clinical importance of Prion 94. Clue to diagnose Creutzfeldt-Jacob disease 95. What are conjugation, transformation and transduction? Conjugation Transformation Transduction - General transduction - Site-specific transduction Examples of Bacteria which are able to Transform 96. What is the difference b/w direct and indirect fluorescence antibody (Ab) test? 97. Organism responsible for rat bite fever in US

Immunology:
1. What happen when organism enter to the body? 2. Chemotaxis factors 3. Phagocytic cells 4. Factors require for opsonization 5. Antigen presenting cells; How do they handle organisms? 6. How does killing occur in Neutrophils 7. Who kill extracellular organisms and how? 8. Who kill intracellular organism and how? 9. How CD 4 T-cell handle organism? 10. How CD 8 T-cell handle organism? 11. Importance of interferon 12. How does oxygen dependent & oxygen independent killing work? 13. How does killing occur in NADPH oxidase and Myeloperoxidase disease? 14. Between Strep & Staph, which one is still killed by patient with deficiency of Myeloperoxidase? 15. Important CD markers on different cells and their functions CD Markers CD 3 CD 2 CD 4 CD 28 CD 40 ligand CD 14 CD 16, CD 56, CD 2 Different Cells Functions

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CD 19, CD 20, CD 21, CD 40 CD 15, CD 30 16. Important antigen receptors on different cells TCR: BCR: MHC-1: MHC-2: 17. How does signal transduction occur in B & T cells B-cells T-cells 18. What are human leukocyte antigens? How many different classes? 19. Where do MHC-1 & MHC-2 antigens located? 20. Function of MHC-1 & MHC-2 antigens 21. How do MHC-1 & MHC-2 antigens differ? 22. What prevents interaction b/w endogenously produced peptide and MHC-2 molecules intracellularly? 23. How do MHC-1 & MHC-2 handle organisms? 24. How do ADCC [Antibody Dependent Cellular Cytotoxicity] and NK cells mediated cytotoxicity differed? 25. How do classical & alternative pathways of complement system differ? 26. Function of complement system C3b C3a,C4a,C5a C5b,6,7,8,9 27. Which is the only antibody where class switching is not required? 28. What happened if thymus [T-cells] is not involved in cell mediated immunity? 29. Which is the only antibody cross placenta? 30. Which is the main antibody in primary immune response? 31. Which is the main antibody in secondary immune system? 32. Which antibody is capable of opsonization? 33. Which is the largest antibody? 34. Which is the first antibody to appear in the blood after antigen exposure? 35. Which antibody is effective in complement fixation? 36. Which antibody is present in breast milk? 37. Which antibody is present in tears, saliva and GI secretion? 38. Which antibody is involved in allergic response? 39. Which antibody is involved in type-1 HS? 40. Which antibody is involved in type-2 HS? 41. What is the difference b/w papain & pepsin? 42. What is antigen specificity? 43. What are Allotype & Idiotype? 44. Important interleukins, other immune system cells & their functions IL-4 IL-5

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Macrophage IL-10 interferon Th1 Th2 IL-1 IL-6 IL-3 IL-7 IL-2 45. Mechanism of type-I HS (hyper sensitivity) and example 46. Two types of type-II HS and their examples 47. Mechanism of type-III HS and example 48. Mechanism of type-IV HS and example 49. What are Allograft, Isograft, Autograft and Xenograft? 50. What is Graft-vs-Host Disease? Which HS is Graft Vs Host disease? 51. T-cells come from where in graft-Vs-host disease? 52. What is hyperacute rejection? Which type of HS is it? 53. What is acute rejection? Which type of HS is it? 54. What is chronic rejection? Which type of HS is it? 55. What is accelerated rejection? Which type of HS is it? 56. What are Hyperacute, acute, chronic and accelerated rejections? 57. Important HLA association with different diseases HLA-A3 HLA-B27 HLA-DR2 HLA-DR2,DR3 HLA-DR3 HLA-DR3,DR4 HLA-DR4 HLA-DR5 HLA-DR7 58. What is responsible for killing of pathogen intra-macrophage? 59. Which T-cells are involved in T-cells mediated cytotoxicity & Type-4 HS? 60. How would you determine that complement system is working fine? 61. What is the difference b/w rheumatic fever & rheumatoid arthritis? 62. What is the defect in Paroxysmal Nocturnal Hemoglobinuria (PNH)? Clue to diagnose it. 63. How does destruction occur in TB? 64. Which is deficient in Brutons Agammaglobulinemia? 65. Which malignancy is associated with Wiskott-Aldrich syndrome? 66. Triad of Wiskott-Aldrich syndrome 67. Name of X-linked recessive immune deficiency syndrome 68. Clue to diagnose chronic granulomatous disease 69. Clue to diagnose Chediak-Higashi syndrome 70. What is the defect in DiGeorge Syndrome 71. Why hypocalcemia is seen in DiGeorge Syndrome?

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72. Which enzyme is deficient in SCID? (severe combined immune deficiency) 73. What will be different immunoglobulin level in patient with CD40 ligand deficiency? 74. Deficiency of different complements C1 esterase deficiency C3 deficiency C1,C4 or C2 deficiency C5-8 deficiency 75. Clue to diagnose leukocyte adhesion defect 76. Presentation of selective IgA deficiency 77. Which HS reaction is responsible for symptoms of nematodes infection? 78. Which HS reaction is responsible for destruction of filaria? 79. How does destruction of Toxoplasma occur? 80. How does CD8 & CD4 T-cells differentiate in thymus? 81. What are first & last events in maturation of B-cells? 82. What is normal ratio for T-cells to B-cells? 83. What are primary & secondary immune responses? 84. What are natural, acquired active and passive immunities? 85. How does Superantigen work? 86. What do we check in HIV screening & confirmatory test? 87. When do we consider western blot test positive? 88. Important autoantibodies in different diseases Autoantibodies Antiacetylcholine receptor Anti-basement membrane Anticentromere Antiendomysial & Antigliadin Anti-insulin,Anti-islet cell Anti-intrinsic factor, Anti-parietal cell Antimicrosomal Antimitochondreal p-ANCA c-ANCA Antiribonucleoprotein Anti-TSH receptor Anti-Scl-70 Anti-SS-A, Anti-SS-B Anti-smith, Anti-ds-DNA, ANA (antinuclear antibody) Anti-histone antibody Disease

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Pharmacology:
* General Pharmacology: 1. Which form of the drug contributes to concentration gradient? Only free drug forms contribute to the concentration gradient 2. Which form of the drug can cross cell membranes? Only non-ionized (uncharged) form of a drug crosses biomembranes 3. How PH and P will affect drugs? Ka Ka PH and P will help us determine if drugs are in non-ionized form or ionized form. If PH P value is negative, weak acid acids are in non-ionized form and can absorb better. For example, if PH Ka P value is -2, 99% of weak acids are in non-ionized form means they can cross cell membrane easily. If value is 0, 50% of drugs are in non-ionized form and 50% of drugs are in ionized form. Ka If PH P value is positive, weak bases are in non-ionized form and can absorb better. 4. In which medium weak acid will cross cell membrane? 5. In which medium weak base will cross cell membrane? 6. Which drug form is reabsorbed from the kidney? 7. How acidification and alkalization of urine will affect elimination of drug? 8. What are the things we use to acidify and alkalize urine? 9. Which route has 100% bioavailability (f)? 10. What is the relationship b/w distribution of drug (Vd) and plasma concentration of drug? 11. What should I remember for drug with high Vd? 12. What is loading dose? How will it affected by bioavailability? 13. What is the renal clearance of drug? 14. What is an infusion rate? 15. What is a maintenance rate? 16. What is elimination constant? 17. What is elimination half life? 18. What is steady state and on what it depends? 19. What is zero order elimination? Give 2 important examples 20. What is first order elimination? How it differs from zero order? 21. What happen to elimination when you increase drug dose in first order elimination? 22. What is potency? What is efficacy? 23. What is full agonist? What is partial agonist? 24. What happen if partial agonist is given to the patient who already received full agonist? 25. What is antagonist? Competitive, Non-competitive? 26. What are the difference b/w physiological antagonist and pharmacological antagonist? 27. What is therapeutic index (TI)? Importance of it? Give 2 examples of drugs with low TI 28. How intracellular receptors differ from membrane bounded receptors? 29. Give examples of receptors that directly couple with ion channels 30. Give examples of receptors that linked via protein to ion channels 31. What is the difference b/w Gs & Gi protein? Give examples of both 32. How Gq protein works? Give examples of receptors that use this pathway 33. Give examples of receptors that use cGMP 34. Give examples of receptors that work through transmembrane enzymes. How? 35. How cytokines work?
Ka

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* ANS (Autonomic Nervous System): 36. What are the ANS receptors and neurotransmitters? Where are they located? Nicotinic, Muscarinic, Alpha & Beta receptors Neurotransmitters: ACh (act on nicotinic and muscarinic receptors), Epinephrine & Norepinephrine (act on alpha and beta receptors) NN Cell bodies in ganglia of both PANS & SANS & in the adrenal Medulla NM - Skeletal muscles M1-3 Located on the organ & tissues innervated by PANS & on thermoregulatory sweat glands which are innervated by SANS Alpha & Beta Located on the organ & tissues innervated by SANS Easy way to remember important Muscarinic location: only Heart has M2, all other places have M3, GI glands have M1; Now remember M2 is operated through Gi so it has inhibitory effect on the organ. So whenever ACh stimulate M2 it causes decrease in heart rate and decrease in conduction velocity (AV block); M1-3 operated through Gq so they have stimulating effect whenever they are stimulated through ACh [Location of M3 Eye: Miosis (constriction of pupils) through contraction of sphincter muscles of pupil and Accommodation for near vision through contraction of Ciliary muscles; Bladder: voiding of urine through contraction of detrusor muscles; Sphincters: contraction of all sphincters in the body except LES (lower esophageal sphincter) which relax; Blood vessels: dilation of blood vessels through nitrous oxide and EDRF; GIT: increase motility of stomach, increase secretions of GI glands Easy way to remember important Alpha receptors location: 2 present at only three locations 3P [Platelets, Pancreas & Pre-junctional nerve terminal] All other places have 1 Now remember 2 works through Gi so whenever they stimulate they have inhibitory effects. So they decrease norepinephrine secretion at pre-junctional nerve terminals, decrease release of pancreas and causes aggregation of platelets 1 receptors works opposite to ACh so they produce Mydriasis (dilatation of pupils), vasoconstrictions and urinary retention; other important location vas deference in male Easy way to remember important Beta receptors location: 1 presents on heart and kidney; all other places have 2 Now remember both beta receptors work through Gs so they have stimulatory effect on the organ whenever they are stimulated; 1 increases every thing means it increases heart rate, conduction velocity, force of contraction and release of renin Stimulation of 2 receptors causes vasodilation, relaxation of uterus, bronchial dilation; other important location skeletal muscles (increase contractility tremors), liver (increase glyconeogenesis) and pancreas (increase insulin secretion) Cholinergic Miosis (all cholinergic action occur through M3 except in heart where it is M2) AV block Anti-Ch Mydriasis Atropine enter in CNS will produce confusion, hallucination Urinary Urinary NE 1 Receptor Mydriasis 2 Receptor insulin secretion 1 Receptor 2 Receptor Increase insulin everything secretion (HR, force of contraction, conduction velocity Renin secretion.) Dilation of

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(M2) Vasodilation Voiding of urine

retention

retention Constriction of vessels

bronchi vasodilation Relaxation of uterus

Dry mouth

Agonist of above receptors produce same effect as above receptors Indirect agonist produce same effect as agonist but different mechanism Antagonist of above receptors produce opposite effects than above receptors 37. What is an important thing about thermoregulatory gland and which ANS receptors are present there? 38. Which neurotransmitter is present at pre-ganglionic fibers of both PANS & SANS? 39. What are the neurotransmitters for post-ganglionic fibers of PANS & SANS? Post-ganglionic PANS Post-ganglionic SANS 40. Which is dominant in the tissue with dual innervation? (PANS & SANS) What is an exception to this rule? 41. Synthesis & Degradation of ACh 42. Which drug inhibits choline uptake? 43. Which drug inhibits Ach release? 44. Give the name of drugs which directly stimulates Ach receptors 45. Give the name of indirectly acting cholinomimetics drugs 46. Give the name of Muscarinic receptor antagonist 47. Give the name of Nicotinic receptor antagonist (Ganglion blockers) 48. Give the name of Neuromuscular blockers 49. Difference b/w succinylcholine and other neuromuscular blockers 50. Why do we use pilocarpine in acute angle closure glaucoma? 51. Use of drugs that directly stimulate Ach receptors Pilocarpine: Bethanechol: Methacholine: 52. Use of drugs that indirectly stimulate Ach receptors (AchE inhibitors) Physostigmine: Neostigmine, Pyridostigmine: Edrophonium: Donepezil, Tacrine (enter in CNS): 53. Use of anti-cholinergic drugs Atropine (enter in CNS): Ipratropium: Scopolamine: 54. Use of neuromuscular blockers 55. Important side effects of succinylcholine 56. Important side effects of Atracurium

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57. Treatment of overdose of non-depolarizing neuromuscular blockers 58. Difference b/w Physostigmine & Neostigmine, Pyridostigmine 59. Treatment of AchE Inhibitors poisoning. 60. How anti-cholinergic drugs are helpful in Parkinsonism? Which symptom is not improved by anticholinergic drugs? 61. What is the difference b/w Atropine and Phenylephrine when it comes to use for eye dilatation? 62. How ANS work to control BP 63. Difference b/w Norepinephrine & Epinephrine 64. What is Epinephrine reversal 65. Use of epinephrine 66. Give Name of Alpha & Beta receptors agonist 1 agonist: 2 agonist: 2 agonist: 67. Give Name of Alpha & Beta receptors antagonist 1 antagonist: 2 antagonist: n-selective antagonist: Non-selective antagonist: Selective 1 antagonist: 68. Use of Alpha agonists: Methoxamine: Phenylephrine: Clonidine: Methyldopa 69. Use of Alpha antagonist: Phenoxybenzamine: Doxazosin: Yohimbine: 70. Use of Beta agonist: Salmeterol, Salbutamol: Terbutaline, Ritodrine: 71. Use of Beta antagonist: 72. Important side effect of Clonidine Rebound HTN on abrupt withdrawal 73. Important side effect of alpha blocker First dose syncope 74. Important contraindications of beta blockers Bronchial Asthma, COPD, PVD

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75. Important side effects of non-selective beta blockers Sexual dysfunction, delayed hypoglycemia, alter plasma lipids, fatigue, heart block, depression 76. Dopamine receptor locations: 77. Difference b/w Dopamine & Dobutamine 78. What is an important thing to remember about indirect acting adrenoceptor agonist? Indirect agonist act only on effector tissues innervated by SANS. Denervated tissues are nonresponsive. (e.g. If Heart is transplanted , then SANS fibers are not present there , so in that pt. indirect acting adrenoceptor agonist give no response) 79. What is tachyphylaxis? 80. What is the main difference b/w Phenoxybenzamine & Phentolamine? 81. Name of non-selective beta blockers with ISA (intrinsic Sympathomimetic action) 82. Name of selective beta-1 antagonist with ISA 83. Usefulness of beta-blockers with ISA 84. Drugs with both alpha-1 & beta blocking activity * CVS (Cardiovascular System): 85. Mechanism of different classes of Antiarrhythmic drugs Class 1: Class 2: Class 3: Class 4: 86. Name of drugs according to different classes [class 1 to 4] Class 1a: Class 1b: Class 1c: Class 2: Calss 3: Class 4: 87. What are important characteristics of quinidine? 88. Use of quinidine 89. Important AE (adverse effects) of quinidine 90. Important use of Procainamide 91. What is the characteristic of Lidocaine? 92. Use & AE of Lidocaine 93. Anti-arrhythmic use of Phenytoin 94. What are important points I should remember about Amiodarone? Mimic all 4 classes, long half lives AE: Interstitial lung disease (pulmonary fibrosis), Thyroid dysfunction (hypothyroidism / hyperthyroidism), Increase LDL, Torsade de pointes 95. What is an important point I should remember about Sotalol? 96. What is the main difference b/w Verapamil and Nifedepine 97. Where shouldnt we use calcium channel blockers (CCB)? 98. Mechanism & Use of Adenosine

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99. Drugs causing Torsade. Treatment of Torsade 100. Safe anti-hypertensive drug in Pregnancy & renal dysfunction 101. Anti-hypertensive (HTN) drug that is contraindicated in pregnancy 102. Mechanism of water retention when we use anti-HTN drugs 103. Between alpha & beta blockers which affect plasma lipid level 104. Name & Mechanism of vasodilators 105. Drugs for HTN emergency 106. Side effect of Hydralazine 107. Side effects of Nitroprusside 108. Side effect of Minoxidil for which this drug is used clinically 109. Side effect of Diazoxide for which this drug is used clinically 110. Which CCB is used in subarachnoid hemorrhage? 111. Name of ACEI and AT-1 receptor blockers 112. Which are the most important side effects of ACE inhibitors? 113. Contraindication of ACEI 114. What is the difference b/w ACEI and AT-1 receptor blocker? 115. What are the side effects of Loop & Thiazide diuretics in regards to pH & Potassium? 116. What are the side effects of Carbonic anhydrase (CA) diuretics in regards to pH & Potassium? 117. What are the side effects of K+ sparing diuretics in regards to pH & Potassium? 118. What is the mechanism of action of Mannitol? Important uses 119. In which condition Mannitol is C/I? 120. What is the site of action of CA inhibitors? Important uses & AE 121. What is the mechanism and site of action of Loop diuretics? Important AE 122. What is the mechanism and site of action of Thiazide diuretics? 123. What is the relationship b/w GFR & thiazide diuretic? 124. How will I identify loop & thiazide diuretics from urine analysis? 125. What is the mechanism and site of action of K+ sparing diuretics? Important AE of Spironolactone 126. What is the main difference b/w mechanism of action of Reserpine & Guanethidine? 127. Important side effect of Reserpine 128. Important side effect of Guanethidine 129. What is the MA of ACEI in CHF? 130. What is the mechanism of action (MA) of digitalis? 131. Is digitalis prolongs survival of patient with CHF? 132. Uses of digitalis. (Vagomimetic effect) 133. Symptoms of digitalis toxicity; treatment of the same 134. What increases digitalis toxicity? 135. In which condition CCB & digitalis should avoid? 136. Which drug has shown to reduce mortality in patient with CHF when use in conjunction with ACEI? 137. What is the MA of Nitrates? What is the MA of Sildenafil (Viagra)? 138. What happen if we use Viagra and Nitrates together? 139. Use of Sildenafil besides erectile dysfunction 140. What is the half life of Nitrates? 141. Are beta-blockers helpful in Prinzmetal angina? 142. What is the MA of CCB in angina? 143. Which drugs are useful in hyper-TGs? 144. Which is the only statins lower TG?

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145. 146. 147. 148. *

What is the MA & side effect of bile acid sequesters? What are the main AE of HMG-CoA reductase inhibitors? What are the important effects of Nicotinic acid? Important AE What are the MA & important AE of gemfibrozil?

CNS (Central Nervous System): 149. MA of Barbiturates and Benzodiazepines 150. Which benzodiazepines metabolized outside of liver (means doesnt require phase-1 metabolism)? Whats the advantage of it? 151. Non-benzodiazepine drugs that activate benzodiazepine receptors 152. Drug use in barbiturates withdrawal 153. DOC for status epileptics 154. Important C/I of barbiturates 155. M/A of Buspirone and Indication 156. DOC for social and performance anxiety 157. DOC for alcohol overdose. M/A of it 158. Reason for giving Ethanol in Methanol poisoning 159. M/A of Disulfiram. Use of it. Drug causing Disulfiram like reaction when use with alcohol 160. M/A of different anti-epileptic drugs 161. Safe anti-epileptic drug during pregnancy 162. DOC for Absence (Petitmal) seizure 163. Usually a DOC for all other seizure 164. Important drug interaction of all anticonvulsants 165. Important AE of all anticonvulsants Phenytoin: horizontal nystagmus, gingival overgrowth, Megaloblastic anemia (folic acid depletion), Fetal hydantoin syndrome (teratogenic) Carbamazapine: SIADH, teratogenic (supply folic acid) Valproic acid: thrombocytopenia Ethosuximide: GI distress 166. 167. DOC for trigeminal neuralgia M/A of newer anticonvulsants Block AMPA receptor Block NMDA receptor M/A of general anesthetics Importance of Blood-gas ratio for inhaled anesthetics High blood-gas ratio quick redistribution in adipose tissue Quick redistribution in fat require high dose to maintain blood level High dose late recovery Importance: High blood-gas ratio late recovery, Low blood-gas ratio fast recovery

168. 169.

170. Important AE of Halothane and Tx of that adverse reaction. M/A of drug that used to Tx adverse reaction of Halothane 171. Which inhaled anesthetic produce dose related depression of myocardial contractility? 172. Name and uses of IV anesthetics 173. What is a neuroleptic anesthesia? 174. Which drug produce dissociative anesthesia? 175. M/A of local anesthetics. Two groups of local anesthetics

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176. 177. 178. 179. 180. 181. 182. *

How pH affect action of local anesthetics What is the main AE of amino ester group of local anesthetic C/I of Morphine Important characteristic of Morphine Name of partial opioid agonist Which drug is an exception to all opioids? How? DOC for opioid overdose

Anti-Microbial Drugs: 183. Best initial antibiotics for different microorganisms Staph Aureus: If patient is allergic to first line groups If patient has MRSA Streptococcus: Strep Pneumonia: Strep Viridans: Strep Pyogens: Strep Meningitis: Listeria Monocytogens: Legionella Pneumonia: Rickettsia in children: Rickettsia in adults: Lyme disease in children < 9yrs of age: Lyme disease in children >9 yrs of age and adults: Lyme disease in Pregnant women: Disseminated Lyme disease [Bells palsy, Cardiac involvement, CNS involvement]: Syphilis: Gonococcus: Chlamydia, Mycoplasma: [Link]: H Influenzae: E coli: Pseudomonas: Klebsiella: Cryptococcus: (severe), (prophylaxis) Candida: Dermatophytes: (oral) / (local) PCP: Actinomycetes: Nocardia: Anaerobes: Penicillin and Aminoglycosides have synergistic effects so combination of both (Penicillin + Aminoglycosides) is used in Enterobacteraceae and Pseudomonas infections 184. 185. 186. 187. M/A of Penicillins Mechanism of resistance to Penicillins Difference b/w Benzathine penicillin and Benzylpenicillin (Penicillin G) Important AE of Penicillins. What is JarischHerxheimer Reaction?

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188. 189.

Name of beta lactamase resistant penicillin Name of cephalosporins according to different generation First Generation: Second Generation: Third Generation: Fourth Generation: Coverage of all generation of cephalosporin First: Second: Third: Fourth: M/A of Cephalosporin / Mechanism of resistance Important AE of Cephalosporin Which drug group should we use in patient allergic to Penicillins and Cephalosporins For Gram (+) infection For Gram (-) infection Reason for using Cilastatin with Imipenem. AE of Imipenem M/A of Vancomycin. Mechanism of resistance to Vancomycin Can Vancomycin penetrate CNS? Important use & AE of Vancomycin Is cephalosporin & Penicillins has cross-allergenicity? What is an important feature of Aztreonam? M/A of Macrolides / Mechanism of resistance of macrolies Should erythromycin dose be reduced in patient with renal dysfunction? Is Macrolide has any effect on P450 metabolism system? Important AE of Macrolide Name of important antimicrobial agents that should be avoided in pregnancy M/A of Tetracycline / Mechanism of resistance Important organism coverage of tetracycline Important use of Demeclocycline Effect of antacid on absorption of tetracycline Which tetracycline can use safely in renal dysfunction? Important AE of tetracyclines Important AE of Clindamycin Important use of clindamycin M/A and resistance of Aminoglycosides Why anaerobes are resistant to Aminoglycosides? Use of neomycin. Is it useful systemically? Name important Nephrotoxic antimicrobial drugs Use of Aminoglycosides M/A and resistance of Chloramphenicol AE of Chloramphenicol. Is dose reduction required in LIVER dysfunction Drugs use for Vancomycin resistant organisms M/A of sulfa drugs Uses & Important AE of Sulfa drugs

190.

191. 192. 193.

194. 195. 196. 197. 198. 199. 200. 201. 202. 203. 204. 205. 206. 207. 208. 209. 210. 211. 212. 213. 214. 215. 216. 217. 218. 219. 220. 221. 222.

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223.

Which other drugs have sulfa component? Thiazide diuretics, Celecoxib and Glipizide/Glyburide M/A of Trimethoprim & Pyrimethamine M/A of Fluoroquinolones Important side effect in adults Effect of antacid on absorption M/A of Amphotericin B and Nystatin How can we prevent AE of Amphotericin M/A of Azoles AE of Ketoconazole Important use of Fluconazole Which is the only azole that can penetrate in CNS? Drug use for topical fungal infection What is the M/A of Flucytosin? AE of Flucytosin What are M/A and AE of Gresiofulvin? What is the M/A of Terbinafine? M/A and Uses of Metronidazole Important AE of anti-tubercular drugs Rifampin: INH: Ethambutol: Pyrazinamide:

224. 225. 226. 227. 228. 229. 230. 231. 232. 233. 234. 235. 236. 237. 238. 239. 240.

241. M/A anti-tubercular drugs 242. M/A and use of acyclovir 243. Is acyclovir has any effect on post herpetic neuralgia? 244. Drugs use in shingles 245. M/A of ganciclovir 246. What are the characteristics of Foscarnet? 247. Important AE of Foscarnet when it is used with Pentamidine 248. Difference b/w NRTI & Non-NRTI 249. Important AE of Zidovudine 250. Drugs that increase Zidovudine toxicity 251. Use of Lamivudin 252. M/A and Important AE of protease inhibitors 253. Only teratogenic anti-HIV drug name 254. M/A of Amantadine. Other use of Amantadine. Is Amantadine useful against Influenza B? AE of Amantadine 255. Difference b/w Amantadine and Zenamivir & Oseltamivir 256. M/A and Use of Ribavirin. Is it used in Hep C? 257. Important Anti-Protozoal drugs Mebendazole, Albendazole: Pyrantel Pamoate: Anti-Leishmaniasis: Praziquantel: Anti-malarial drugs: Prophylaxis:

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* Anticoagulants, Thrombolytics & Anti-platelets: 258. M/A and important AE of Heparin 259. Drug use in heparin induced thrombocytopenia 260. Can heparin be used in pregnancy? 261. How we monitor patient on Heparin / Warfarin 262. Antagonist of Heparin & Warfarin 263. M/A of Warfarin 264. Most important AE to keep in mind when we give Warfarin 265. M/A of thrombolytics. Difference b/w Streptokinase & Alteplase 266. Antagonist of thrombolytics 267. Difference b/w Aspirin, Clopidogrel and Abciximab * Endocrine Pharmacology: 268. M/A of Propyl thiouracil (PTU) & Methimazole? 269. Which one is safe in pregnancy out of above two drugs? 270. AE of PTU 271. Use of Propranolol in hyperthyroidism 272. M/A and important AE of 131I 273. Name & use of GH agonist 274. Name & use of Somatostatin 275. Name & use of ACTH agonist 276. Name & use of GNRH agonist 277. Name & use of Prolactin inhibiting hormones (Dopamine agonist) 278. Use of oxytocin 279. Use of Vasopressin 280. M/A and use of Cyproheptadine 281. Use of Megestrol acetate 282. Name of drugs that block steroid receptors 283. Name of drugs that inhibit steroid synthesis 284. Important AE of Estrogen, Progesterone & Androgens 285. Name & M/A of anti-androgens 286. M/A & use of Anastrozole, Danazol, Clomiphen citrate, Tamoxifen and Raloxifen. Difference b/w Tamoxifen & Raloxifen 287. Insulin forms that can be used as IV 288. M/A of Sulfonylureas 289. Important AE of Chlorpropamide (1st generation sulfonylurea) 290. M/A & important AE of Metformin 291. M/A of Acarbose 292. M/A of Thiazolidinediones 293. M/A of Repaglinide 294. M/A of Bisphosphonates 295. Important AE of Alendronate / why do we ask patient to take alendronate with full glass of water * Anti-cancer Drugs: 296. Is anticancer drugs kill fix percentage of tumor cells or fix number of tumor cells? 297. Drugs known as spindle poisons 298. AE of Methotraxate, Cyclophosphamide and Doxorubicin. How can we prevent it? 299. M/A of Azathioprine, 6-MP & 5-FU

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300. 301. *

M/A & use of cyclosporine M/A and AE of Bleomycin

Drugs for Gout: 302. Give name of drugs that used in acute gouty attack (NSAID) 303. M/A & Important AE of Colchicine 304. Difference b/w Allopurinol and Probenecid 305. Relationship b/w Probenecid & GFR 306. Is Allopurinol has any effect on 6-MP metabolism Drugs for Asthma: 307. Name of drugs that used in treatment of Asthma 308. M/A of Theophylline 309. M/A of Cromolyn. Is Cromolyn useful in acute attack of asthma? 310. Difference b/w Zafirlukast & Ziluton. Uses of both Miscellaneous: 311. Name & use of different PGs PGE1: Alprostadil; PGE2: Dinoprostone; PGE2: Carboprost; 312. 313. 314. 315. 316. 317. 318. 319. 320. Difference b/w Aspirin (ASA) & other NSAID Reason for using low Aspirin How Aspirin eliminate from the body at high toxic dose Symptoms specific for Salicylism Treatment of Aspirin overdose Give name of selective COX-2 inhibitor and advantage of it over other NSAID Difference b/w Acetaminophen & other NSAID Tx of acetaminophen overdose Name of anti-emetic drugs according to different groups 5-HT3 antagonist DA antagonist H1 antagonist M antagonist Use of Cisapride. Why is it withdrawn from market? M/A of Sucralfate. Important things to remember about it

321. 322.

GOOD LUCK

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