WRONG NBMES:

NBME 13:
 Sleeve compression is the most effective way to treat lymphedema post
mastectomy.
 Paraganglionoma Is carotid body tumor


 Muscle atrophy after not using it bcz of dec protein production and increase protein
degradation.
 Nitric oxide can be used as treatment for infant pul HTN
 Tumor size is not a factor In staging unless it is invasive.
 Sibutamine: inhibit reuptake of serotonin and NE for weight loss
 Sumatriptan a serotonin agonist cause vasoconstriction, inhibit trigeminal activation
and VAP release to treat migraine.
 Harsh holosystolic murmur  loudest at trigeminal area.
 Cancer induced by virus e.g HPV will cause higher immune response and higher level
of Abs.
 Overweight are encouraged to decrease calori intake to reduce risk for diabetes.
 IL 1 aka osteoclast activating factor and it will be higher in osteoporosis.
 As the day go MG pt muscles become weaker and weaker and can involve
diaohragm.
 Insulin imp for lipoprotein lipase and with resistance it cause inc in TAG



AMBOSS

 3-2-1 rule of Lynch syndrome: cancer in 3 affected family members, within 2 generations, and
in 1 relative under 50 years of age.
 covalent bonds between adjacent thymine and cytosine bases creates pyrimidine dimers that
cause gain function of BRAF gene.
 lack of a difference in the dose-corrected area under the curves for oral and intravenous
administration indicates that the drug is virtually entirely absorbed into systemic circulation (∼
100% bioavailability).
 Fluoroquinolones are a first-line empiric treatment of uncomplicated pyelonephritis.
 Daptomycin is used as an alternative to vancomycin to treat MRSA bacteremia, AE:
rhabdomylitis.
 fever, sore throat, enlarged tonsils with exudates, palatal petechiae,
cervical lymphadenopathy, and lack of cough suggest GAS infection with M protein that inhibit
phagocytosis.
  During pregnancy, increased estrogen levels cause increased secretion of lithogenic bile (rich
in cholesterol), resulting in the formation of cholesterol gallstones.
Increased progesterone levels cause smooth muscle relaxation, decreased and
impaired gallbladder contraction, and subsequent bile stasis and formation of gallstones

USMLE RX
 palindromic sequence is a sequence on double-stranded DNA or RNA where reading
5' to 3' forward on one strand is identical to reading 5' to 3' on the complementary
strand.
 Oxygenated HbS has the same oxygen-hemoglobin dissociation curve as HbA when
HbS is in low concentrations or when PO2 is high. During an acute pain episode in
sickle cell crisis, however, deoxygenated HbS forms a polymer that has less affinity
for oxygen, and the oxygen-hemoglobin dissociation curve is shifted to the right,
facilitating the unloading of oxygen to tissues.
 Lead poisoning can manifest with fatigue, abdominal pain, peripheral
neuropathy, and headache.
 Pancytopenia C/p: “dizzy spells” and the “funny feeling” in his chest are
presyncope and palpitations caused by anemia (RBCs). His bleeding gums and
nosebleeds are a symptom of thrombocytopenia (platelets), while his frequent
infections suggest leukocytopenia (WBCs).
 Somatostatin and vasopressin analogs are used in the treatment of acute variceal
hemorrhages. Both hormones bind with GPCRs on cell membranes.
 deficiency in phenylalanine could cause a lack of thyroid hormone production
 β-Blockers are absolutely contraindicated for patients with MI who are also
cocaine users because of the resulting unopposed alpha effects leading to
unopposed vascular smooth muscle contraction. Vessel contraction would cause
an increase in blood pressure and further coronary artery ischemia. Note: cocain
cause block presynaptic NE reuptake and inc adrenal catecholamine release.
 Long-term exercise has been shown to upregulate expression of GLUT4 as well
as increase the GLUT4 found on the cell membrane which facilitates glucose
uptake and increases insulin sensitivity
 Measles can cause vit A deficiency.
 A single-nucleotide substitution in a noncoding intervening region (or intron)
may cause aberrant mRNA splicing, resulting in no protein synthesis or synthesis
of a nonfunctional gene product and note that Mutation of a splice donor site
would result in inclusion of an intron, whereas mutation of an acceptor site
would result in exclusion of an exon.
 Gilbert syndrome caused by a mutation in the promoter region of
the UGT1A1 gene
 Deletion of 11p13 is associated with the WAGR complex, which includes Wilms
tumor, aniridia, genitourinary abnormalities, and intellectual disability
(historically called mental retardation)
 NRDS newborn Tx: exogenous surfactant phosphatidylcholine improves
outcomes in infants, but for preterm mother at risk we treat with GC.
 Li Fraumeni syndrome caused by an autosomal dominant mutation of the tumor
suppressor p53 gene on ch 17
 The diagnostic criteria for Li-Fraumeni syndrome are:

1. Age <45 years.

2. A first-degree relative diagnosed with any cancer at age <45 years.
 3. Another first- or second-degree relative diagnosed with any cancer at age <
45 years or with a sarcoma at any age

 Fructose-1,6-bisphosphatase is one of the rate-determining enzymes in renal

gluconeogenesis
 The kidneys produce this glucose largely through gluconeogenesis and to lesser
extend by glycogenolysis.
 nausea, vomiting, abdominal pain, altered mental status, and hyperventilation.
Inc lactic acidosis and hypoglycemia  alcoholic ketoacidosis
Micro:
 erythema nodosum, which is characterized by tender red nodules, often on the
shins. Erythema nodosum can be seen in many conditions including
streptococcal infections, TB, Epstein-Barr virus, Coccidioides immitis, Behçet
disease, sarcoidosis, and some cancers. It is type IV HS
 Pt with latent TB should be also treated.
 Infection with CAP bacteria can be confirmed by a positive Quellung test result,
which uses an anti-capsular antibody to elicit a “swelling” or “halo” surrounding the
organism on microscopy. (This result also rules out a diagnosis of tuberculosis.)
 C. trachomatis infection induces a predominantly immunologic reaction, with
only a few polymorphonuclear leukocytes (PMNs), whereas N.
gonorrhoeae induces predominantly nonimmunologic inflammation, with a
PMN-rich infiltrate.
 Needlestick exposures carry a risk for exposure to blood-borne pathogens. Of
these, HIV has a relatively low risk of infection, hepatitis B is vaccine-
preventable, and hepatitis C poses the highest risk of infection during a
needlestick exposure.
 Intravenous drug use is a major risk factor for osteomyelitis caused
by Pseudomonas.
 E granulosus treatment: Albendazole can be used on its own for single-
compartment cysts <5 cm or in combination with puncture, aspiration, injection,
and reaspiration (PAIR) for single-compartment cysts > 5 cm.
Multicompartment cysts can be treated with catheterization or with surgery
combined with medical therapy.
 Antibodies against Legionella can cross-react with host ADAMTS 13, the enzyme
responsible for von Willebrand factor degradation.
 Coagulase enables the conversion of fibrinogen to fibrin. The formation of fibrin
clots around S. aureus can lead to abscess formation
 Common oral anaerobes include Peptostreptococcus, Bacteroides fragilis,
and Prevotella can cause anaerobic aspiration pneumonia present with foul
smelling sputum caused by poor dentation. Intravenous ampicillin plus
sulbactam, in addition to metronidazole, are usually the first-line treatments for
aspiration pneumonia.
 H. influenzae type b capsule is composed of polyribosylribitol
phosphate polysaccharide (PRP) which binds to and
becomes coated with the host’s serum factor H, a complement mediator
that degrades C3b.
 Hantavirus is contracted through exposure to deer mouse droppings or
urine. Hantavirus causes hantavirus pulmonary syndrome, which starts
 with fevers, headaches, severe myalgias, gastrointestinal upset, and
dizziness. As the disease progresses, the virus causes capillary leak
syndrome in the lungs resulting in pulmonary edema.
 HBV is much more likely to cause HCC without preceding cirrhosis than
is hepatitis C virus (HCV).
 Treatment of Salmonella-mediated gastroenteritis with antibiotics in the
absence of bacteremia can both prolong the symptomatic course of the disease
and increase the risk of relapse. However, in patients with evidence of S.
typhi bacteremia or focal infection, antibiotics are indicated.
 Prophylactic azithromycin is administered to patients to prevent MAC infections.
 Typical induction treatment of Cryptococcus meningitis includes 2 weeks of
intravenous amphotericin B, with or without oral flucytosine. If the patient's
condition appears to be improving, the consolidation phase is started, and
amphotericin B and flucytosine are discontinued and replaced with an oral azole
(fluconazole) for 8 weeks.
 artemisinin-based combination therapy as first-line therapy for P. falciparum
 watery diarrhea after travel to Mexico is likely to be caused by (ETEC).
Treatment for ETEC includes fluoroquinolones and macrolides (eg,
azithromycin).
 First-line empiric treatment of a burn infection is piperacillin/tazobactam +
 Like AIDS, HIV is now a reportable illness in all states.
 patients with severe sulfa allergy and PJP, alternative Tx is atovaquone,
primaquine-clindamycin, trimethoprim-dapsone, or pentamidine.
 negative purified protein derivative test result, is insufficient to rule out
tuberculosis (pulmonary or extrapulmonary) in a patient with advanced HIV
infection. This is because the suppression of CD4+ cells by HIV infection can
result in anergy toward the tuberculin antigen.
 PottsLike pulmonary tuberculosis, it is treated with combination
antimycobacterial therapy: isoniazid, rifampin (or rifabutin), and pyrazinamide.
 Streptococcus pneumoniae is the most common cause of otitis media but not
otitis externa ( but pseudomonoas 1st one)
 norovirus is now the most common cause of viral gastroenteritis in children in
resource-rich countries
 EG liver cyst first line Tx if less than 5 cm: albendazole If larger surgical removal.
 CMV is an enveloped, double stranded linear DNA virus that is latent in
mononuclear cells.
 antibodies against hemagglutinin is the most important component of protection
from influenza
 HSV-1 encephalitis specifically is likely in this case given the bloody CSF tap and
the patient’s immunocompromised state
 Haemophilus ducreyi (G- coccibacilli) Tx ceftriaxone or oral
azithromycin
 major basic protein, a potent helminthotoxin.
 Flu-like symptoms + lymphadenopathy + splenomegaly = EBV
 Neuraminidase inhibitors can be used as prophylaxis against influenza A and B
in high-risk patient
  For patients with CF who are older than 21 years of age, Pseudomonas is the
most common cause of pneumonia. In patients younger than 21 with CF, the
most common infective organism causing pneumonia is Staphylococcus aureus.
 Katayama fever due to schistosomal infection acquired in Iraq.
 Drugs that bind albumin can displace unconjugated bilirubin, resulting in adverse
effects for the fetus.
 Military tb present with multiple granulomas.
 acyclovir, can cause a crystal-induced acute kidney injury. Other drugs that can
result in accumulation of crystals in the renal tubules include protease inhibitors,
methotrexate, and sulfonamides.
 Paneth cells found in the crypts of Lieberkühn in the small intestine have an
immunologic function in clearing pathogens such as C. difficile. Paneth
cells release α-defensins (antibacterial and antifungal peptides) as well as
lysozymes and tumor necrosis factor (TNF).
 S. pneumoniae secretes IgA protease and pneumolysin. IgA protease is an enzyme
that cleaves IgA, thus allowing the bacteria to colonize mucous membranes.
Pneumolysin is a cytotoxin similar to the streptolysin O in S. pyogenes. It binds
cholesterol in the host cell membrane and creates pores that can destroy the ciliated
epithelial cells and phagocytic cells. Note the capsule protect from phagocytosis but
doesn’t help In colonization.
 C. diff cytotoxin B is more potent than toxin A and cause apoptosis.
 Pts with reduced consciousness are prone to aspiration events because they
have an impaired glottic reflex.
 Symptoms of neurosyphilis can be remembered by the mnemonic DORSALIS
o Dorsal column degeneration
o Orthopedic pain (charcot joints)
o Reflexes decreased (deep tendon)
o Shooting pain
o Argyll-Robertson pupils
o Locomotor ataxia
o Impaired proprioception
o Syphilis
 Neurosyphilis common in HIV pt.

pathology:

 HTLV-1, an oncogenic virus that causes adult T-lymphocyte leukemia, is also responsible
for HTLV-1-associated myelopathy, characterized by myelin destruction within the
spinal cord and brain. It manifests with a gradual, unremitting course that includes
lower extremity weakness, back pain, urinary incontinence, and eventual spastic
paraplegia.
 Li-Fraumeni cancer syndrome is an autosomal dominant disorder in which one
copy of the p53 tumor suppressor gene is mutated, leading to a significant risk of
cancer, including osteosarcomas, soft tissue sarcomas, breast cancer,
adrenocortical tumors, and leukemias.
 Aniline dyes are used as coloring agents in textiles is RF for TCC.
 G-CSF is used to stimulate granulocyte production in patients
with neutropenia.
  In chronic bronchitis, monocytes and CD8+ cells are the main responders, whereas
CD4+ cells are less commonly seen.
 Turcot syndrome: seizure, headaches that worsen when lying down,
bloody stools, and a soft systolic murmur that disappears when the
patient rises from a supine position
 Drug that inhibits the function of the microtubules, kinesins, kinetochores, or
centromeres would severely impair the assembly of the spindle apparatus and
force the cells to arrest in prophase.
 Osteomas are commonly seen in patients with Gardner syndrome, but they are
not considered malignant. Medulloblastoma is malignant
 CEA levels are often drawn prior to surgery to establish a baseline level and to
put future CEA levels in context
 Ras proteins are G-proteins linked to receptor tyrosine kinases.
 Electromyography can be used to confirm the diagnosis of MG.
 BRCA1 and NF1 are both found on chromosome 17,
 BRCA1 mutation because it is more strongly associated with ovarian cancer than
BRCA2,
 G-CSF binds a cytoplasmic receptor
 p21 protein is a cyclin-dependent kinase inhibitor
 Li-Fraumeni syndrome: SBLA cancer syndrome: Sarcoma, Breast, Leukemia,
and Adrenal gland cancers
 Eccrine glands secrete a watery solution and are stimulated by direct
sympathetic innervation. Apocrine glands, which secrete oily, viscous fluid, are
stimulated by catecholamines
 Eye drops that alter norepinephrine levels at the neuromuscular synapse can be
used to localize the site of the lesion in Horner syndrome. A sympathetically
denervated eye always dilates poorly or not at all in response to cocaine, but
reacts differently to amphetamine, depending on whether the lesion is
preganglionic (dilation as expected) or postganglionic (no effect).
 In patients with impaired renal or hepatic function affecting the metabolism or
excretion of a medication, the loading dose of the medication should remain the
same as for other patients. Bcz it depend on Vd, but the maintenance dose should
be reduced.
 ACEI decreased activity of phospholipase C in vascular smooth muscle cells in
the efferent renal arteriole.
 Hypoglycemia: tremor, palpitations, anxiety (adrenergic symptoms resulting
from the catecholamine response to hypoglycemia), and cold sweats, hunger,
and paresthesias (cholinergic symptoms resulting from the acetylcholine
response to hypoglycemia)
 The primary site of cocaine’s action is the nucleus accumbens (the dorsal portion
of the ventral striatum).

Cardio:
 Hydralazine should not be prescribed for patients with coronary artery disease.
 IN ventricular tachycardia If defibrillation fails to convert to sinus rhythm,
epinephrine is given followed by amiodarone, according to the advanced
cardiovascular life support (ACLS) protocol.
 central line, the emergency physician should aim the needle lateral to the
common carotid artery because the line should be placed within the internal
jugular vein.
 juxtaductal coarctation of the aorta can result in a small left arm because of
compromised blood flow.
 Sodium nitroprusside is an initial first-line treatment for cardiogenic shock
secondary to papillary muscle rupture. Cardiac output is increased via afterload
reduction, that will increase anterograde flow.
 Presence of asymmetric pulses suggests the involvement of the aortic arch (and
possibly the ascending aorta). The right brachiocephalic artery may be affected,
while the left subclavian artery is spared.
 Cardiac tamponade is a dangerous complication of aortic dissection that leads to
mortality.
 Both esmolol and metoprolol can be adminstered intravenously.
 Mitral stenosis is MC late complication of RHD, with thicker leaflet “fish mouth” and
commissure fusion and thicken chordea tendinea but regurgitation is a sign of early
acute RF. (note: remember it is RF that become RHD).
 Aerobic exercise, weight loss and high-intensity statin therapy are interventions
that have proven benefits for reducing mortality and adverse cardiovascular
events.
 Cardiac amyloidosis is a leading cause of restrictive cardiomyopathy.
 cardiogenic shock, as evidenced by his hypotension (systolic blood pressure ≤90
mm Hg)
 β-receptor antagonists decrease the slope of phase 4 and phase 0
 hyperkalemia, peaked T waves on ECG.
 systolic blood pressure >139 mm Hg or a diastolic blood pressure >89 mm Hg
 essential hypertension (a systolic blood pressure >139 mm Hg or a diastolic
blood pressure >89 mm Hg
 ɑ-Methyldopa is indicated for gestational hypertension, or hypertension (blood
pressure >140/90 mm Hg) that occurs during pregnancy after 20 weeks
gestation. But Amlodipine or labetalolol ( especially if also migraine with
pregnancy) used for essential hypetension in pregnancy.
 young man with a family history of heart disease complaining of syncope and
palpitations, structural heart disease, such as hypertrophic obstructive
cardiomyopathy or conduction disorders, such as Wolff-Parkinson White
syndrome
 WPW decreased filling time of the ventricles during diastole
 Bupivacaine: produce arrhythmias and hypotension if administered
intravenously and can cause Mobtiz II heart block.
 diltiazem has more of an effect on the sinoatrial and AV nodes than it does on
cells of the atria, ventricles, and Purkinje system.
 decreases heart rate, which allows more time for diastolic filling and systolic
ejection (increasing ejection time).
 Clonidine acts used to manage refractory hypertension. And associated with
rebound hypertension on abrupt withdrawal.
 calcium paradox occurs after MI reperfusion, causing release of (ROS) and
activation of phospholipases (PLs) -> inc intracellular Ca release.
 Beta blocker overdose can present with symptoms of cardiogenic shock
 Diltiazem dec slope of phase 0 and Bb dec the slope of phase 4.
 Aortic root dilation can be also caused by Marfan and cause regurgitation.
 RF and RHD can be prevented by Ab use but glomerulonephritis not.
 coronary arteries (eg, left circumflex artery) are the narrowest of the answer
choices and are thus more predisposed to the effects of atherosclerotic plaque
formation
 B blocker block tachy caused by hyperglycemia by HHS
 Procainamide can induce lupus-like symptoms, such as serositis.
 Compensated Aortic stenosis with normal CO and EF by inc wall thickness pt will
have inc. afterload only with normal LV pressure, wall stress and preload.
 When a narrowing or blockage occurs in the subclavian artery proximal to the
vertebral artery, vascular demand from the ipsilateral upper extremity can cause
blood to flow in a retrograde fashion. The blood flows down the vertebral artery
to the distal subclavian artery; this is called the subclavian steal syndrome.
 B blockers cause decrease heart rate allows which increase diastolic filling,
resulting in increased end-diastolic volume and preload, ultimately increasing
stroke volume.
 One possible cause of congestive heart failure is dilated cardiomyopathy, which
has many etiologies, including virally-mediated autoimmune damage, ischemia,
 Diuresis with a loop diuretic, such as furosemide, is considered to be first-line
treatment for pulmonary edema caused by a congestive heart failure
exacerbation.
 Septic shock, evidenced in part by failure to recover blood pressure with
hydration.
 digoxin's toxic effects, cause supraventricular tachycardia, and atrioventricular
block.
 Ventilation on one lung results in decreased respiratory volume as well as higher
pressure resulting in decreased compliance.
 Loop diuretics can be used in the treatment of patients with dilated
cardiomyopathy.
 Treatment of Spironolactone In conn syndrome (primary hyperaldosteronism).
 CAH will present at birth with vrillaization and salt wasting BUT non-classical CAH
have 50% normal 21a hydroxylase and will present later with milder symptoms.
 Left renal art stenosis will cause inc renin in left kindey, dec renin in right
kidney but overall inc level of renin in plasma.
 Metabolic acidosis In diabetic patient it can be: DKA with ketones or lactic (which is
usually a side effect of metformin for DM2, which can be predisposed by HF, Liver
failure, renal failure, inc alcohol intake).
 Metformin should be stopped 48 hours before surgery because it can cause lactic
acidosis bcz of surgery stress.
 ELISA is the test of choice to Dx Graves disease.
 VIP will stimulate intestinal secretions that cause watery diarrhea and hypokalemia.
And inhibit gastic acid production that cause achlorhydia.
 Pt with chronic pancreatitis can use octreotide as it inhibit pancreatic secretions.
 CAH cause elevated 17a hydroxylase.
 Drugs that work to inc insulin release cause hypoglycemia.
 Glyburide the only oral sulfonylurea
  disulfiram-like reaction: severe headache, blurry vision, dyspnea, vomiting,
hypotension, tachycardia, and facial flushing
 hyperthyroidism Tx: symptom control: propranolol, dec. endogenous thyroxine
production, definitive treatment: radioactive iodine, or surgery.
 Acromegaly: large tongue cause obstructive sleep apnea.
 Lactic acidosis presentation: abdominal or stomach discomfort, decreased appetite,
diarrhea, fast and shallow breathing (Kussmaul respirations), muscle pain or cramping,
and fatigue.
 Although multifactorial, psychogenic polydypsia is thought to be due to altered
hypothalamic-pituitary axis feedback regulation due to chronic intake of excess
fluid in the presence of a psychiatric disorder and typically presents in patients
with schizophrenia receiving long-term neuroleptic treatment.
 male-pattern baldness caused by DHT that has great affinity for androgenic
receptors so finastertide can treat it.
 thyrotoxicosis factitia, or factitious thyrotoxicosis with little to no radionuclide
uptake on RAIU testing caused by excessive levothyroxine uptake.
 G-CSF inc. neutrophils by acting on intra-cytoplasmic receptor, used as neutropenic
fever prophylaxis with chemotherapy.
 ketoconazole and mitotane can be used to mitigate the progression to centripetal
obesity and Cushingoid appearance
 Glucokinase gene mutation is a common cause of maturity-onset diabetes of the
young (MODY), that usually present initially with yeast infection and blurry
vision.
 nervous system and bones are underdeveloped because of her thyroid hormone
deficiency
 tingling around her mouth, diffuse bone pain, muscle weakness, and brisk
tendon reflexes, which are signs and symptoms consistent with the laboratory
findings of hypocalcemia and hyperphosphatemia.
 urinary albumin excretion to screen for diabetic nephropathy (DN)
 Adverse effects of metoclopramide (used for diabetic gastropresis) include
extrapyramidal symptoms
 neurophysin I is essential for the transport of oxytocin from the paraventricular
nucleus. Female mice without the protein are unable to release oxytocin and thus
have absent let-down reflex

GASTRO:
 Fluoroquinolones should not be taken with calcium carbonate, which decreases
absorption of these antibiotics.
 Lymphocytic destruction of the liver is seen in autoimmune hepatitis. Circulating ANA
and anti-smooth muscle (in Type 1 autoimmune hepatitis) or liver/kidney microsomes
(Type 2 autoimmune hepatitis) autoantibodies mediate the activation of T-lymphocytes.
 Chest pain is not that severe in achalasia that DES, and DES is episodic not progressive
achalasia.
 Eosinophilia is not associated with E histolytica
 Octerotide can be used in chronic pancreatitis to dec pain
 choledocholithiasis. Cause elevation in ALP more than AST/ALT (opposite liver
inflammation) and ascending cholangitis cause more sever symptoms and more
fever).
 Cholangitis is treated initially with IV fluids and antibiotics.
 Primary biliary cirrhosis, which may initially be treated with ursodeoxycholic
acid.
 In a medical abortion, the patient is first given mifepristone, a progesterone
antagonist, to make the uterus an uninhabitable/unsustainable environment for
the fetus. Misoprostol, a prostaglandin E1 agonist, is taken 24–48 hours later; this
drug causes uterine contraction and expulsion of the uterine contents.
 In children, the most common cause of appendiceal obstruction is lymphoid
hyperplasia caused by a viral infection.
 Dermatitis herpetiformis is characteristically an erythematous, vesicular rash
 Osteomas are commonly seen in patients with Gardner syndrome, but osteomas
are benign. But Turcot syndrome associated with medulloblastoma which is
malignant.
 Slow waves are precisely timed, rhythmic depolarizations and repolarizations of
the muscularis propria, but peristalsis characterstic by alternating circular and
longitudinal muscles contraction.
 milk-alkali syndrome (with signs of hypercalcemia, metabolic alkalosis, and
renal insufficiency).
 Lynch syndrome increase the risk for endometrial cancer. But note that FAP is
not associated with other cancers.
 Antibodies against cytokeratin can be used as an immunohistochemical stain to
detect adenocarcinoma of the esophagus.
 Paneth cells release α-defensins (antibacterial and antifungal peptides) as well
as lysozymes and tumor necrosis factor (TNF).
 Necrolytic migratory erythema is a characteristic skin finding, identified by the
pruritic and painful, small erythematous plaques
 Diverticula occur through attenuated muscularis propria (thinner)
 Retroperitoneal bleeds can go undetected until they begin to compress nearby
structures, such as the aorta, inferior vena cava, duodenum, pancreas, adrenal
glands, kidneys, ureters, colon, or nearby nerves. The L2-L4 nerve roots of the
femoral nerve, posterior to the psoas muscle may be affected. This clinically can
present as an absent or diminished patellar reflex caused by femoral nerve
innervation of the quadriceps femoris muscle group.
 Dyspnea and cyanosis and bowel sounds instead of breathing sounds in the chest
suggest congenital diaphragmatic hernia
 Diverticulitis is treated with ciprofloxacin and metronidazole. After the episode
has resolved, the patient should undergo colonoscopy to rule out malignancy. But
it countraindicated during diverticulitis.
 First-line treatment for ulcerative colitis consists of mesalamine or sulfasalazine.
Severe cases should be treated with infliximab; colectomy should be considered
a final option
 The ilioinguinal nerve arises from L1, passes through the inguinal ligament, and
lies on top of the spermatic cord. It supplies cutaneous sensation to the
scrotum/labia and medial aspect of the thigh. But genitofemoral  genital
branch that is responsible for cremasteric reflex pass within the spermatic cord.
 Biliary atresia is due to fibro-obliteration of the extrahepatic bile ducts resulting
in cholestasis.
 PPI work to inc. intragastric PH so no more stimulation for somastatin release that dec
it’s inhibtion on gastrin  casue hypergastrinemia.
  HBV common in Asia region
 Colitis-associated CRC has an increased risk of multifocal lesions (due to
widespread inflammation) as compared to sporadic CRC.
 A corkscrew appearance of the duodenum is evidence of malrotation.
 Drugs that bind albumin can displace unconjugated bilirubin, resulting in
adverse effects for the fetus. In kernicterus, deposition of bilirubin in the basal
ganglia leads to irreversible neurologic sequelae
 less bile acid and lacks the ability to effectively eliminate cholesterol  cause
cholesterol stone.
 In whipple disease, macrophages contain partially digested bacteria and disease
initially present with migratory arthralgia (that can be confused with seronegative
arthralgia) then present with diarrhea.
 In crohn disease decrease bile acid absorption can cause a significant decrease in
the amount of circulating bile acids, which can cause impaired lipid absorption
and steatorrhea.
 To confirm steatorrhea, the most appropriate first step would be a qualitative
assay with Sudan III staining, this is the best first step given its high sensitivity
 The arterial supply for Meckel diverticulum comes from the superior mesenteric
artery, as this vessel supplies part of the gastrointestinal tract derived from
midgut
 pyoderma gangrenosum would be best addressed by administration of oral
corticosteroids to treat Crohn disease.
 Trousseau syndrome is a migratory thrombophlebitis that can result from
liberation of tissue factor by advanced pancreatic tumors.
 IGF-1 first pass into hepatic vein.
 HCC is spread via hematogenous dissemination
 In congenital diaphragmtic hernia  Pulmonary hypoplasia is the most common
cause of death in these patients, but pulmonary hypertension may also be seen.
 cells in the Peyer patches take up antigens from the intestinal tract and present
them to B cells
 ranitidine does not have the antiandrogenic effects of cimetidine.
 Zone 3 in liver contain the highest concentration of CYP450 and in acetaminophen
overdose it metabolize it into toxic products.
 Pulmonary diseases including pneumonia can cause SIADH

HEMATOLOGY
 Levodopa can cause autoimmune hemolytic anemia
 Hydrops fetalis charac. by: hepatosplenomegaly, ascites, peripheral edema and
pupura.
 Bleomycin is a first-line treatment for testicular carcinoma work by inducing free
radicals formation.
 Best immediate treatment for an infant with hemolytic disease of the newborn is
to exchange the Rh-positive blood with Rh-negative blood.
 Factor V Leiden, the most common cause of inherited thrombophilia and 2nd MC
mutation in the prothrombin G20210A gene
 Hydrops fetalis occur in a thalassemia but not b
 Sickle cell trait pt can have episodic hematuria and splenic infarction at high altitude.
 LMWH is the treatment of choice for acute PE than unfractionated heparin bcz it
has lower side effects, but both can cause HIT so platelet count should be
motinored.
 CLL increase risk for AIHA and infection.
 Direct factor Xa inhibitors have replaced warfarin as the medication of choice for
long-term anticoagulation in patients with AF.
 clopidogrel, an ADP receptor inhibitor used to treat acute coronary syndrome
and stenting.
 Uremic platelet dysfunction can be seen in the setting of renal insufficiency,
where unfiltered uremic toxins cause poor platelet function prevent platelet-
endothelial and platelet-platelet aggregation.
 Filgrastim is a G-CSF that can be used to promote bone marrow recovery (and
therefore prevent infections) in patients receiving myelosuppressive
chemotherapy.
 Idiopathic thrombocytopenic purpura (ITP) is immune mediated destruction of
platelets, commonly occurring in children weeks after an upper respiratory
infection.
 APL if not probably treated it can result in DIC
 Systemic primary amyloidosis, in which amyloid is deposited in mesangium and
subendothelial space
 Treatment for ALL is divided into three phases: induction, consolidation, and
maintenance. Induction is designed to put the patient in remission and usually
consists of treatment with vincristine, L-asparaginase, and prednisone.
 DLBCL large cells with open chromatin and prominent nuclei can rise from SLL with
CD+5.
 Mediastinal lymphadenopathy is a classic finding of Hodgkin
lymphoma, particularly the nodular-sclerosing subtype
 In a patient presenting with erythrocytosis, it is helpful to take an algorithmic
approach to determine its cause.

Step 1: Determine if the patient has absolute or relative erythrocytosis.

An increased RBC mass indicates absolute erythrocytosis, and a RBC mass within
reference ranges indicates relative erythrocytosis.

Step 2: Determine if the patient has primary versus secondary erythrocytosis. By

measuring EPO level.

 In addition to warfarin, other first-line drugs for managing chronic AF

include direct thrombin inhibitors (eg, dabigatran, argatroban) and anti-factor Xa
inhibitors (eg, rivaroxaban, apixaban).
 The excess IgM interferes with microvascular and cellular processes, causing
blood vessel damage(resulting in spontaneous bleeding), impaired (resulting
in headaches), and impaired ocular blood flow (resulting in visual disturbances).
 Histocytosis present with raised, tender, lytic bone lesions; hepatosplenomegaly;
lymphadenopathy; dyspnea; cough; and papular rashes. A chest CT scan will
show nodular and cystic regions of the upper lung lobes and interstitial
thickening.
 cr-abl fusion protein, the product of an oncogene.
 Gingival bleeding with lack of pupura and brusies make pure platelet disorder
less likely
 Antiphospholipid antibodies bind to platelet phospholipids, make platelets
accessible to clotting factors and leading to recurrent venous and arterial
thrombosis. Because the partial thromboplastin time (PTT) assays use
exogenous phospholipids, the antibodies inhibit their function and paradoxically
show an increase in coagulation time (hence the name lupus anticoagulant).
 Homan sign (pain on dorsiflexion on the foot) on physical exam is a classic
finding for deep venous thrombosis (DVT).
 Warm reactive AIHA intial treatment is corticosteroid if no response 
retoximab ( make ADCC against autoreactive B cells)
 Both ranibizumab and bevacizumab are monoclonal antibodies that act on
vascular endothelial growth factor (VEGF)
 anemia due to the infant’s diet. If infant only breast feed with no complimentary
that shoul be started at 6 months in meet iron requirement.
 Multiple myeloma cause pancytopenia with de reticulocyte count.
 Fanconi anemia AR cause pancytopenia an BM failure TX: BM transplant.
 DLBCL risk factor: immunosuppression.
 Methotrexate is a folic acid analog that can be used as an immunosuppressant
agent, an antineoplastic agent, or as an abortifacient in the treatment of ectopic
pregnancy and choriocarcinoma. But PGE1 analogue used to terminate 1st
trimester pregnancy.
 Warfarin in pregnancy can cause dany walker syndrome.
 Phenytoin, a common antiepileptic medication, blocks absorption of folate and
increases utilization of folate by the body, leading to folate deficiency.
 Treatment for ischemic stroke includes thrombolytics (if given <4.5 hours after
stroke onset), antiplatelet agents such as aspirin, and anticoagulants such as
warfarin.
 G-CSF is a glycoprotein growth factor that stimulates immature neutrophils to
differentiate in the bone marrow by binding a cytoplasmic receptor.
 ABVD regimen (Adriamycin [doxorubicin], Bleomycin, Vinblastine,
and Dacarbazine) used to treat Hodgkin lymphoma. OR
OPP regimen: Mechlorethamine, Oncovin (vincristine), Procarbazine,
and Prednisone.
 sickle cell disease complicated by folate deficiency, likely due to increased folate
demand caused by high RBC turnover.

MSK:
 remember SLE is associated with AIHA a type 2 HS.
 Reactive arthritis can be preceded by a genitourinary infection or enteritis.
Sacroiliac joint involvement (sacroiliitis) is common
 L2-L4 nerve roots of the femoral nerve, posterior to the psoas muscle may be
affected in retroperitoneal bleeding. This clinically can present as an absent
or diminished patellar reflex caused by femoral nerve innervation of the
quadriceps femoris muscle group
 Femoral mononeuropathy is characterized by acute, severe pain in the thigh,
groin and abdomen, pain with hip extension and paresthesias of the medial
 thigh and anteromedial calf. As a result, patients have weakness, difficulty
ambulating upstairs, and fall frequently.
 Femoral nerve travel posterior to psoap major.
 Poor controlled diabetes can cause renal failure  secondary
hyperparathyroidism.
 Aspirin overdose: cause tinnitus, nausea and vomiting, lethargy, diaphoresis,
fever, and tachypnea after taking a large quantity of painkillers
 Rotator cuff are innervated by C5 and C6.
 Melanocytes come from neural crest cells from neuroectoderm.
 Radial nerve for supination and median for pronation.
 Patellar tendonitis cause pain in quadriceps insertion on inferior patellar pole but
OSD pain in tibial tubercle.
 S1 disc herniation associated with lowe back pain but sciatica doNOT this how to
differentiate between them.
 Red flags for child abuse history inconsistent with physical exam findings, a
vague history lacking detail, a history in which details change with repeated
telling, conflicting histories provided by other family members, an injury
blamed on siblings, a history that requires actions by the child beyond
developmental capability, or a history that is implausible
 Abuse brun injuries usually have regular margins and symmetrical opposite
accidental injuries.
 NSAIDs are 1st line for MSK pain e.g Naproxen.
 Tx of atopic dermatitis: includes application of emollients and moisturizing
creams.
 Desmin is an intermediate filament found near the Z-line in sarcomeres.
 Vimentin is an intermediate filament protein that is expressed in
mesenchymal cells and connective tissue. It is used to stain for various
sarcomas, endometrial carcinoma, renal cell carcinoma, and meningiomas.
 Cytokeratin is expressed by cells of epithelial origin.
 denervation atrophy of skeletal muscle appears as small muscle fibers with
decreased cross-sectional area, which are angulated or triangular and
arranged in small groups.
 Achondroplasia defect in FGFR-3 that affect chondrocytes.
 Patients receiving long-term corticosteroid therapy for conditions such as
SLE are at higher risk for development of osteoporosis. Therefore vitamin D
and calcium supplements are commonly prescribed to prevent bone mineral
loss.
 Osteonecrosis can be result of bisphosphate and tooth extraction.
 Bisphosphate can be used as a lytic lesion of multiple myeloma.
 CREST syndrome can be complicated by vascular endothelial hyperplasia similar
to genetic PAH (secondary to BMPR2 gene mutations)
 HRT has benefits, including alleviation of symptoms of menopause and a
decrease in the risk of colorectal cancer and osteoporotic fractures, it is used
on a short-term, rather than a long-term, basis because of its serious adverse
effects, such as increased risk of myocardial infarction, stroke, venous
thromboembolism, and invasive breast cancer.
 Inability to abduct shoulder AND extend the wrist  POSTERIOR CORD injury.
  NSAID and GC used to treat acute symptoms of RA, but methotrexate and
etanercept can be used to modify the disease as long term management.
 Osteoarthritis has no systemic symptoms.
 Pt with PUD and gout: you can treat the acute symptoms with NSAIDs you have
to use cholchicine.
 Tumor lysis syndrome: high K and low Ca cause cardiac arrythemia.
 Adductor pollicis brevis innervate by ulnar nerve bcz except of 5 muscle of the
hand innervate by median nerve all the rest are innervated by ulnar nerve.
 Fecal incontinence can occur during vaginal delivery due to damage to the
perineal body and the external anal sphincter
 The superficial arch (a continuation of the ulnar artery) and the deep arch (a
continuation of the radial artery) ensure good collateral flow to the hand
when the radial or ulnar artery becomes occluded.
 Systemic lupus erythematosus (SLE) often manifests with mucosal
ulcerations that are usually painless
 Osteomalacia charac by areas of increased unmineralized osteoid adjacent to
normal trabeculae.
 There is no C1 dorsal root ganglion, as the nerves supply the suboccipital
skeletal muscles.
 Coagulase enables the conversion of fibrinogen to fibrin.
 Remember melanoma can metastasize to the CNS cause inc ICP.
 Adverse effects of topical corticosteroid use include thinning of skin (dermal
atrophy or lichenification
 Thymomas are associated with various paraneoplastic syndromes, such as
normocytic anemia.
 With NSAID administration, the afferent arteriole will constrict and GFR will
decrease
 Azathiroprine cause aplastic anemia when given with allopurinol.
 Dermatitis herpetiformis is characteristically an erythematous, vesicular
rash similar to herpes and can progress into T cell lymphoma.
 Acetaminophen overdose presenr with nausea, vomiting, RUQ pain, sclera
icterus.
 Opioids, radiocontrast agents, NSAIDs, and certain antibiotics (vancomycin)
can trigger anaphylactoid reactions via IgE-independent mast cell
degranulation. Opiates like morphine cause direct activation and
degranulation of mast cells by binding to their G-protein-coupled receptors
located on the mast cell surface.
 The exotoxins that are released by S aureus bind to a molecule within the
desmosome called desmoglein 1, thereby disrupting cell adhesion.
 Congenital torticollis – Congenital torticollis is a postural deformity of the neck because of
Sternocleidomastoid injury and fibrosis that develops due to Birth trauma (

NEURO
 PCP intoxication Tx: benzodiazepine and in severe cases: haloperidol.
 Enflurane cause is les potent than halothane but more rapid
 Cocaine cause: mydriasis, tactile hallucinations, and agitation,
 Livedo reticularis is caused by swelling of the venules due to small blood clots
forming in the capillaries.
 unsteady gait, slurred speech, and respiratory depression, pointing
to benzodiazepine intoxication. Flumazenil is a competitive antagonist that can be
used in the case that work by displacing the drug from the binding site.
 PCP is an illicit dissociative anesthetic that acts as an antagonist at N-methyl-d-
aspartate (NMDA) receptors and as an agonist at a-receptors
 In ALS muscle biopsy will show small angular fibers bcz of atrophy.
 Delirium tremens is an extreme and life-threatening form of withdrawal that
peaks 2–4 days after the patient’s last drink and is characterized by autonomic
hyperactivity (tachycardia, hypertension, hyperthermia, diaphoresis), agitation,
hallucination, and disorientation.
 Naltrexone used to reduce alcohol relapse.
 opiate-induced IgE-independent mast cell degranulation mediated by direct
activation of the opioid receptors on mast cells.
 Opioid receptors are inhibitory G-protein-coupled receptors (GPCRs). That is
found also in mast cells and can cause degranulation.
 Baclofen is first-line therapy for spasticity in patients with MS. The drug works
by activating GABAB
 Amantadine is used to treat Parkinson disease and is believed to increase
dopamine release and inhibit dopamine reuptake.
 Amantadine increase dopamine release and inhibit uptake. It is also an antiviral.
 Treatment is emergent administration of an IV benzodiazepine (diazepam or
lorazepam) followed by IV phenytoin. The benzodiazepine serves to rapidly
control and abort the seizure, while phenytoin acts to prevent recurrence a
 although rare, one of the adverse effects of levodopa is drug-induced immune
hemolytic anemia
 Bupivacaine is a long-acting amide-based anesthetic capable of causing cardiac
arrhythmias and hypotension.
 Celecoxib and NSAIDs both cause afferent arterioles constriction.
 Cataplexy is defined as brief episodes of bilateral weakness brought on by strong
emotions such as laughing or fear, without alteration in consciousness.
 Modafinil, an atypical dopamine reuptake blocker, is used to treat narcolepsy,
although its exact mechanism of action is unknown.
 Cocaine specifically inhibits the presynaptic neuronal reuptake of NE, 5-HT, and
dopamine.
 Loperamide can cause toxic megacolon.
 Homer-Wright rosettes consist of small blue cells surrounded neutrophils.
 Rod-shaped blepharoplasts (basal ciliary bodies) are typical of ependymomas.
 Open NTDs (neural tube defects)usually result from defective primary neurulation,
whereas closed NTDs are the result of defective secondary neurulation.
 FFP is used for rapid reversal in warfarin toxicity. And Aminocarporic acid
reverse tPA bleeding (by blocking plasminogen converting into plasmin)
 Eccrine sweat glands are distributed throughout the skin. However, they are
stimulated by direct sympathetic autonomic innervation; apocrine glands are
stimulated by circulating catecholamines.
 myoclonic epilepsy with ragged red fibers characterized by myoclonus, typically
as the first symptom, and is associated with generalized epilepsy, ataxia, and
myopathy. Muscle biopsy show ragged red fibers
  Cytomegalovirus (CMV) encephalitis can mimic the appearance of PML, but
would be more likely associated with enhancing periventricular white matter
lesions in cortical and subependymal regions.
 stylopharyngeus muscle is the only muscle of the pharynx innervated by the
glossopharyngeal nerve.
 GBS tx: plasmaphoresis and IvIg.
 Abdominal aorta aneurysm surgery increase the risk for ant spinal cord syndrome
injury.
 L1-L2 — “testicles move” (cremaster reflex)
S3-S4 — “winks galore” (anal wink reflex)
 Long- and short-term memory loss that includes a patient forgetting his
name would be seen in dissociative amnesia. Memory for self is strongly affected
in dissociative amnesia.
 Myotonic dystrophy is characterized by proximal muscle weakness and delayed
muscle relaxation, which may manifest in childhood or adulthood, depending on
the type. Type 2 is caused by a nucleotide expansion of CTG and is frequently
associated with cataracts, mild glucose intolerance, and normal cognitive function.
 . An upward moving great toe with fanning of the other toes when the bottom of
the foot is stroked describes the Babinski sign, which is seen in children before
12 months of age.
 The pudendal nerve fibers are derived from S2-S4 and function to provide
sensation of the genitals and perineum
 adult botulism cause descending paralysis, which typically
begins with the development of diplopia and dysphagia. affect
both nicotinic and cholinergic nerve terminals.
 HIV encephalitis is caused by infection of macrophages and microglia in the brain,
where the infected microglia fuse to form multinucleated giant cells. Common
manifestations include severe impairment in cognition and the inability to perform
activities of daily living.
 PD resting tremor resolve with movement.
 Seizures in an otherwise healthy child under 5 years old is a febrile seizure.
 Criteria for a simple febrile seizure includes age (6 months to 5 years), seizure
type (generalized clonic or generalized tonic-clonic), duration (a single episode
lasting <15 min), and a lack of underlying neurologic disease.
 Subacute sclerosing panencephalitis: slow progression and affect oligodendrocytes
and neurons. ( so both white and gray matter)

RENAL:
 Intracellular proteins e.g Hg in rbcs are the first immediate method to buffer the
excess H is acidosis then it come buffering by ammoniogenesis and titratable acid
excretion.
 Urge incontenince associated with UTI and neurological disorders.
 A normal anion gap is roughly three times the serum albumin.
 Iron toxicity cause nausea, vomiting, METABOLIC ACIDOSIS with anion gap (Iron
toxicity causes direct damage to the mitochondrial DNA, leading to a decreased
number and quality of mitochondria and an increased production of lactate)
 MCC cause of hypoalbuminemia in heathy man is hemodilution.
  Acute shortness of breath bcz of pulmonary edema in CHF Tx  loop diuritics.
 Metformin cause lactic it Inhibition of mitochondrial enzymes by metformin
increases intestinal production of lactate (due to increased anaerobic glycolysis)
and reduces hepatic metabolism of lactate (due to decreased gluconeogenesis).
 ACE inh. decreased activation of Gq and decreased activity of phospholipase C in
vascular smooth muscle cells.
 PSGN in children should be managed with supportive care, and most cases will
resolve on their own.
 pathogen listed that can cause nosocomial UTI and is associated with the
development of endocarditis is Enterococcus faecalis.
 Uterine prolapse can progress to pyelonephritis.
 Low doses of dopamine and bradykinin act to increase renal blood flow
 Sepsis can result in the systemic inflammatory response syndrome (SIRS), which
is defined by the presence of two or more of the following findings: (1) heart rate
>90/min, (2) respiratory rate >20/min, (3) WBC count <4000 or >12,000, or (4)
temperature <36°C or >38°C.
 The negative charge of filtration slits is the major cause for repelling the
negatively charged albumin molecules
 Milk-alkali syndrome (with signs of hypercalcemia, metabolic alkalosis, and
renal insufficiency) caused by antacid e.g Calcium carbonate, If antacid use
continues, severe renal complications (eg, nephrolithiasis) can occur
 Step-wise, to treat hyperkalemia,
o Give calcium gluconate to stabilize the cardiac cell membranes and
prevent arrhythmias.
o Determine the cause of the hyperkalemia.
o Utilize short-term pharmacotherapy (insulin + glucose, ß-agonists,
sodium bicarbonate) to shift K+ back into the intracellular environment
o Increase K+ excretion by giving normal saline with a loop diuretic, via a
cation-exchange resin like sodium-polystyrene or by hemodialysis
 AT II stimulates HCO3- reabsorption in the proximal tubule by increasing the rate
of H+ recycling across the luminal cell membrane.
 Chronic diabetes is associated with neurogenic bladder requiring
catheterization, which can lead to chronic pyelonephritis, with kidneys that
exhibit uneven scarring along with blunting and dilation of the calyces.
Overfilling of the bladder resulting in vesicoureteral reflux can also play a role in
renal damage when a bacterial urinary tract infection is superimposed.

REPRODUCTIVE
 ovaries are the most common site of ectopic tissue in endometriosis, other sites
such as the posterior cul-de-sac( rectovaginal pouch), where it may cause
dyschezia, along with dysmenorrhea and dyspareunia.
 history of avulsed umbilical cord during delivery, a placenta delivered in pieces,
and a soft, non-contracted uterus on exam, the most likely etiology of her
postpartum bleeding is retained placental tissue.
 Uterine atony: managed with uterine massage and uterotonics
 Mumps treated with supportive care with intravenous fluids, administration of
analgesics.
 Enterococcus is a common cause of catheter-associated and other nosocomial
UTIs, which present with fever and lower abdominal pain. Nitrites will be absent
on urinalysis and the pathogen can be cultured on bile esculin agar.
 classically made based on the presence (abruptio placentae) or absence (placenta
previa) of pain and fetus may also show signs of distress when abruptio placentae
has occurred; no signs of fetal distress have been detected in this patient.
 The pathogenesis of primary dysmenorrhea is linked to increased prostaglandin
production. NSAIDs and oral contraceptives are the first-line treatment.
 BPH caused by proliferation of glandular cells in the periurethral and transitional
zones of the prostate.
 Complications of uterine prolapse (which presents with suprapubic abdominal
pressure, dysuria, polyuria include bilateral hydronephrosis and ultimately,
pyelonephritis.
 Most girls will experience their most rapid growth spurt during Tanner stage 3
 During Tanner stage 3 the breasts will begin to widen
 Fibrocystic breast changes are one of the most common causes of breast lumps in
young women, presenting as multiple bilateral lesions that tend to fluctuate in size
with menstruation.
 rapid increase in PSA over the course of a year warrants further consideration
 At rest, the vocal folds are in a paramedian position. During speech, both vocal
cords adduct to the midline.
 The external laryngeal nerve innervates the cricothyroid muscle, which helps in
increasing pitch
 In the treatment of endometritis, gentamicin may be used in combination with
clindamycin with or without ampicillin.
 Hand tremors are one of the earliest physical manifestations of alcohol
withdrawal.
 genitofemoral nerve, whose genital branch runs within the spermatic cord rather
than on top of it (ilioinguinal).
 Low-grade cervical intraepithelial neoplasia (CIN): atypical cells occupy up to
one-third of the cervical epithelium.
 High-grade CIN: atypical cells occupy more than a third of the cervical epithelium.
 A major complication of preeclampsia is disseminated intravascular coagulation
(DIC), confirmed and monitored by fibrin split products (eg, D-dimers)
 When precocious puberty is suspected, the initial work-up involves radiography
of the hands and wrists to determine the bone age.
 Loss of deep tendon reflexes (hyporeflexia) is one of the first signs of Mg sulfate
toxicity that is used for seizures prophylaxis.
 stapedius muscle is to stabilize the stapes bone in the middle ear.
 Damage to V nerve leads to hypoacusis to low-pitched sound bcz of loss of tensor
tympani
 common invasive tumor is infiltrative ductal carcinoma, made up of anastomosing
sheets of pleomorphic cells that invade the stroma
 paget disease will shows large cells with prominent nucleoli and pale to clear ″halos″
of cytoplasm in the epidermis.
 Molar pregnancy increase the risk for hyperthyroidism.
 The SRY gene encodes testis-determining factor, which induces the gene expression
responsible for testicular development. Individuals with mutated SRY genes will
 present with the female phenotype cause absence in the function of Sertoli AND
Leyding cells, so internal female organs will be present but underdeveloped.
 increased total estrogen increases TBG by increasing the glycosylation of TBG
and slowing its serum clearance.
 SHH is involved in tissue patterning; however, a mutation would cause a form of
holoprosencephaly.

RESPIRATORY
 Curschmann spirals (mucoid exudate forming a cast of the airways).
 Charcot-Leyden crystals (collections of crystalloid made up of eosinophil
membrane protein)
 Differentiating viral atypical pneumonia from M. pneumoniae can be done
through detection of an elevated cold agglutinin titer in the serum
 Direct Xa inhibitor can be given orally.
 LMWH is preferred over heparin bcz no monitoring is required and can be given for
outpatient.
 While patients with asthma present with an entirely reversible obstructive airway
defect, airway remodeling associated with severe chronic asthma can lead to
irreversible airway thickening and obstruction that cannot be entirely reversed with
inhaled β-2 agonist therapy.
 In ARDs Endothelial cell damage leads to increased permeability, Further
endothelial damage decreases the clearance of alveolar fluid and lung epithelial
cell damage decreases surfactant production.  alveoli collapse  increasing
the work required to breath.
 ARDs tX: High positive expiratory end-pressure (PEEP) settings prevent alveolar
collapse combined with a low tidal volume (VT) to prevent barotrauma.
 Pseudomonas aeruginosa infection, a common cause of ventilator-associated
pneumonia (VAP).
 Ceftazidime is a third-generation cephalosporin that has activity against
Pseudomonas
 The IVC is the only structure that directly passes through the central tendon of
the diaphragm muscle.
 in the case of Goodpasture syndrome, the excess hemoglobin present due to
alveolar hemorrhage binds more carbon monoxide than could normally be
bound by the capillaries in restrictive diseased lungs, giving a falsely elevated
DLCO.
 acute PE usually have respiratory alkalosis with hypoxemia and hypocapnia due to
tachypnea.
 Centrally located H1-receptors, although rarely involved in seasonal allergies, play
an important role in wakefulness or alertness
 Lung abscesses secondary to aspiration pneumonia should 1) have good
penetration into the lung parenchyma and 2) target both strict anaerobes and
facultatively anaerobic streptococci  ampicillin-sulbactam or
amoxicillin/clavulanic acid
 Mechanical ventilation decreases the work of breathing and increases alveolar
ventilation
 CD8+ cells (CD8+ lymphocytes) and macrophages would most likely be the
predominant cell types in chronic bronchitis.
 A normal Reid index is <0.4;
 Essential thrombocythemia symptoms include epistaxis, thrombosis, bruising,
bleeding, mild splenomegaly, erythromelalgia, and transient ischemic attacks.
 HbS has the same oxygen-hemoglobin dissociation curve as normal hemoglobin,
or hemoglobin A (HbA). HbS also has the same oxygen-hemoglobin dissociation
curve as HbA at high PO2. During a crisis, however, deoxygenated HbS forms a
polymer that has less affinity for oxygen, and the curve is shifted to the right.
 Dapsone can cause methhemoglobinemia.
 foreign body aspiration. Aspiration into the right lung occurs in 52% of cases
owing to the acute angle of the right mainstem bronchus.
 Persistent pulmonary hypertension of the newborn usually presents in a term
infant with respiratory distress. Treatment includes PEEP and supplemental
oxygen with iNO being the first-line pharmacological treatment
