The 27! Reviewed

Turns Testosterone → Dihydrotestosterone (DHT)

• Used for external male genitalia

What does 5alpha-reductase do?

• Hypercapnia: Vasodilates → Increased CBF

• Hypocapnia: Vasoconstricts → Decreased CBF

What happens to cerebral blood flow (CBF) under the following conditions?:

• Hypercapnia

• Hypocapnia

Cryptosporidium!

What bug is causing this?

Unopposed estrogen!

What is the strongest predisposing factor for endometrial adenocarcinoma?

Lactic acidosis!

How would someone die from a metformin overdose?

A. Aortic valve

B. Pulmonic valve

C. Tricuspid

D. Mitral

What are these valves?

Monoclonal overproduction of ONE specific Immunoglobulin

What does an M-Protein spike indicate?

FALSE!:

• Multiple Myeloma = cancer of PLASMA CELLS (mature B cells that produce antibodies)

• Myelogenous Leukemia: Cancer of myeloid progenitor cells → like neutrophils, eosinophils, basophils, RBCs, platelets

True or False: Multiple myeloma and myelogenous leukemia (acute or chronic) are the same thing

Progesterone, Estrogen, Testosterone, Cortisol, Aldosterone, T3/T4, and Vitamin D

• PET CAT in TV

*Intracellular means in the cytoplasm or nucleus

Who has intracellular receptors? What does that even mean?

What are the mnemonics for each?

1. HHV-1 & 2 = Herpes

2. HHV-3 = VZV

3. HHV-4 = EBV

4. HHV-5 = CMV

5. HHV-6 & 7 = Roseola

6. HHV-8 = Kaposi sarcoma

Tell me the names for HHV 1-8

Hyperventilating!!

• Which could be induced by breathing in low pO2 gas

What kind of situation would CAUSE someone to go from point Y to point Z?

• Supraspinatus: Abducts the arm → attaches to the SUPERIOR facet of the greater tubercle

• Infraspinatus and teres minor → Externally rotates the arm → attaches to the greater tubercle

• Subscapularis → Internally rotates the arm → attaches to the lesser tubercle of the humerus

*Remember the story, the subscapsularis is the superior rich kid, the infraspinatus and teres minor are extraverted friends who always hang out, and the subscapularis is the introverted subdweller

What are the rotator cuffs and their actions?

It inhibits phagolysosome fusion

• So macrophages can engulf the TB into a phagosome but the phagosome DOESN’T become a phagolysosome

• So basically TB can stay inside the phagosome and even multiply in there

What protects TB from being destroyed by macrophages?

Bacillary angiomatosis

• Bartonella = cat scratch disease

What is this?

• Remodeling = Matrix metalloproteinases

• Scar formation = Transforming growth factor - Beta (TGF-Beta)

Remodelling of a scar is mediated by what? What about the scar formation itself?

It increases!

• There is an increased venous return because of decreased SVR → which increases stroke volume

What happens to cardiac output in instances of an AV fistula?

Increased tactile fremitus = there is something increasing the density of lung tissue

• Pneumonia

Decreased tactile fremitus = there is something in-between the lung tissue and the chest wall causing there to be a decrease in lung vibrations

• Pneumothorax or

• Pleural effusion

What does tactile fremitus tell us? Tell me the MCC of increased vs decreased tactile fremitus.

Peroxisome Proliferator-Activated Receptors:

• Drugs like Pioglitazone and Gemfibrozil use them to improve insulin sensitivity and lower triglyceride levels, respectively

What are PPARs?

• PPAR-alpha: Found in the liver, muscle, kidney, and heart → increases fatty acid oxidation and LPL activity (increases HDL synthesis)

  • Fibrates

• PPAR-gamma: Found in the adipose tissue → increases insulin sensitivity

  • -tazones (i.e. pioglitazone and rosiglitazone)

What are the different types of PPAR? Which drugs use them as a MOA?

• Fibronectin

  • Key indicator of ECM production in pathological states

• Collagen

  • The structural protein of the ECM

What are the two main components of extracellular matrix?

Dysdiadokokinesia

What is another way to say “unable to do rapid alternating movements”

The person has carpal tunnel!

What does a positive Tinel sign tell us?

• Hyperopia: Farsightedness

• Myopia: Nearsightedness

• Nuclear sclerosis: Age-related cataract

• Presbyopia: Age-related gradual loss of the eye’s ability to focus on close objects

Give me another name for the following:

• Hyperopia

• Myopia

• Nuclear sclerosis

• Presbyopia

A. Neck cell → produces gastric mucus

B. Parietal cell → produce gastrin (You can tell because of their intensely acidophilic cytoplasm)

C. Chief cell → produce pepsin (have a basophilic cytoplasm)

D. Vascular endothelial cell (it’s literally lining a capillary)

E. Perivascular fibroblast

Glycosaminoglycans!

• aka mucopolysaccharides

What is dermatan sulfate and heparan sulfate?

Either Hunter syndrome or Hurler syndrome!

An accumulation of mucopolysaccharides is suggestive of what kind of diseases?

Porphobilinogen deaminase

What enzyme mutation causes acute intermittent porphyria?

TRUE!

• It presents with acute onset joint pain, erythema, swelling, refusal to bear weight, and the signs/symptoms of sepsis

True or False: Septic arthritis is a common surgical emergency in the pediatric population

A fluoroquinolone!

• Inhibits bacterial topoisomerases (i.e. DNA gyrase)

What kind of drug is ciprofloxacin?

Postinfection glomerulonephritis!

“Proliferative glomerulonephritis” is a common way to describe what?

Tremors and arrythmias

What are the side effects of B2 agonists?

• Plasminogen -→ plasmin

  • CLEAVES FIBRIN! ✂

• Prothrombin → Thrombin & Fibrinogen → Fibrin

  • Forms CLOTS ❤

Okay so we know the following:

• Plasminogen -→ plasmin

• Fibrinogen → Fibrin

• Prothrombin → Thrombin

What are their roles?

Neisseria gonorrhea, chlamydia, and HSV

• Give erythromycin (a macrolide that binds to the 50s subunit)

Neonatal conjunctivitis is most commonly caused by what? What should ALL babies get as a topical prophylaxis?

Fluoroquinolones!

“An antibiotic is causing a tendinopathy” what drug are we talking about here?

Intrinsic:

• p53 → Bax/Bak → Bcl-2 → CYTOCHROME C

Extrinsic:

• TNF-alpha/TNFR and FasL/Fas

Who is signaling for apoptosis in the intrinsic pathway? What about the extrinsic pathway?

They stimulate endogenous release of insulin from the pancreatic beta cells

Okay so Glipizide is a sulfonylurea… how does it work?

HHV-6 aka ROSEOLA!

What is going on here?

Scabies!

What is going on here? Note: they are on the armpits, both hands and feet, and groin

The Posterior cerebral artery

What artery are we pointing at here?

You get contralateral homonymous hemianopsia with macular sparing!

What happens when you infarct the posterior cerebral artery?

Pulmonary blood flow increases!

• B/c there is a reversal of the pressure gradient between the pulmonary and systemic circulation

What happens to pulmonary blood flow in the first few minutes after birth?

Leukocyte adhesion!

What is CD18 used for?

• Histamine

• Prostaglandin-E2

• Bradykinin

What are the primary inflammatory mediators?

Neostigmine!

• Because succinycholine is an ACh receptor AGONIST! and Neostigmine is a cholinesterase INHIBITOR!

*Basically, we increase the amount of ACh available which competitively binds to the ACh receptors (causing succinylcholine concentrations to decrease)

What drug would reverse the effects of succinylcholine?

Dantrolene!

• A ryanodine receptor antagonist → prevents the release of Ca2+ from the sarcoplasmic reticulum

QUICK! Someone is experiencing malignant hyperthermia. What do we administer? What is its MOA?

Androgens!

• We will see Hirsutism

*The effects of a Sertoli-Leydig cell tumor is less dramatic in males though b/c they are already producing these but yeah they occur in the testes of males

What does a Sertoli-Leydig cell tumor produce?

• 5alpha-Dehydrogenase: Making DHT

• 1alpha-Hydroxylase: Makes the active form of vitamin D

• 21-Hydroxylase: Deficiency is seen in CAH

• 11Beta-hydroxysteroid dehydrogenase type II: Inhibition of this causes excess cortisol

• 3-Oxosteroid delta4-Dehydrogenase: Seen in bile acid synthesis

Tell me… what processes do you see the following enzymes in?:

• 5alpha-Dehydrogenase

• 1alpha-Hydroxylase

• 21-Hydroxylase

• 11Beta-hydroxysteroid dehydrogenase type II

• 3-Oxosteroid delta4-Dehydrogenase

Decreased peak bone accretion!

• aka their bones will have low mineral density → increases risk of osteoporosis

What are the immediate effects of low calcium to a pre-pubescent child?

CD18!

• LAD = LFA-1 integrin (CD18) deficiency

*Look for late separation of umbilical cord

What is another name for B2 integrin?

Cigarette smoking!

What is the greatest risk factor for pancreatic cancer?

mRNA: AUG → UAC (anticodon)

So we know that mRNA’s start codon is AUG, what would be the matching sequence on tRNA?

• Enteropeptidase: Converts trypsinogen → trypsin

• Aminopeptidase: an EXOpeptidase → actually snip amino acid chains

• Carboxy peptidase A: an EXOpeptidase → actually snip amino acid chains

• Chymotrypsin: breaks down amino acids (basics, i.e. Arginine and Lysine)

• Trypsin: breaks down amino acids (aromatics)

What do the following do?:

• Enteropeptidase:

• Aminopeptidase:

• Carboxy peptidase A:

• Chymotrypsin:

• Trypsin:

Scleroderma! → CREST syndrome

Immediately what is this?

What does CREST syndrome stand for?

TRUE!

• The lower esophageal sphinctor is fibrosed which means it’s scarred and can’t contract = decreased tone

True or False: in CREST syndrome LES tone is decreased

• A: LE Dorsal column → Fine touch, vibration, proprioception

• B: UE Dorsal column → Fine touch, vibration, proprioception

• C: Lateral Cortical spinal tract: Voluntary movement (contralateral)

• D: Lateral Spinothalamic tract → Pain and temperature (contralateral)

  • NOTE!!! This is NOT the spinocerebellar which is on the EDGE EDGE

• E: Anterior Corticospinal Tract → Voluntary movement (ipsilateral)

What is ABCDE?

• Spinothalamic: Spinal Cord

• Dorsal column: Medulla

• Lateral corticospinal tract: Medulla

Where do the following decussate?:

• Spinothalamic:

• Dorsal column:

• Lateral corticospinal tract:

Celiac trunk branches:

• Common hepatic

• Splenic artery

• Left gastric artery

What are the branches of the celiac trunk? Which one is associated with esophageal varices?

Femoral artery → External iliac → Internal iliac → Uterine Artery

How can you get from the femoral artery to the uterine artery?

• Cardiogenic shock: Inability for heart to pump blood

  • Seen in a MASSIVE MI

• Hypovolemic shock: Inadequate tissue perfusion due to critical reduction of bodily volume

Define the following:

• Cardiogenic shock:

• Hypovolemic shock:

FALSE!

• Abraham Lincoln had Marfans and was smart enough to become president

• This helps differentiate Marfans from Homocystinuria which DOES have intellectual disability

True or False: Marfan’s is associated with intellectual disability

• Homocysteine methyltransferase

• Cystathionine synthase

What are the two main enzymes that can be effected in Homocystinuria?

NNT = 1/ARR

How do you calculate the NNT?

FALSE! DUH!

• Fibrin is the final product of the coagulation cascade (think making a fibrin mash)

• Platelets are the primary response to stop bleeding

True or False: Fibrin and platelets are the same thing

TRUE!

• Therefore, in von Willebrand disease we will see a moderately suppressed activity of factor VIII with a normal PTT time

True or false: vWF typically stabilizes factor VIII, allowing it to do its job

• Glycine

• Proline (which gets converted to hydroxyproline)

• Lysine (which gets converted to hydroxylysine)

What are the three amino acids you should be thinking about in collagen synthesis?

33%!

• Every 1/3 amino acids in collagen is glycine

What is the glycine content in collagen?

• Proline → Hydroxyproline

  • Makes the kinks for triple helix formation

• Lysine → hydroxylysine

  • Formation of cross-links

*Please do not forget that vitamin C is required for hydroxylation!

What is the role of proline in collagen synthesis? What about lysine?

Sudden reduced blood flow to the heart

What is acute coronary syndrome?

• Thiazides: Distal tubule

• Spironolactone: Collecting ducts

What part of the nephron do the following act on?:

• Thiazides:

• Aldosterone inhibitors (i.e. spironolactone):

A form of estrogen produced by adipose tissue, ovaries, and adrenal glands

What the heck is “Estrone”

30mL/h

What is normal urine output?

Enteropeptidase

• Converts trypsinogen → trypsin

Enterokinase is aka what? What is the function?

• ACh: Stimulates M3 receptors on gasdtric parietal cells = gastric acid secretion

• Cholecystokinin: produced by duodenal and jejunal I-cells → stimulates pancreatic secretion and relaxation of the sphincter of Oddi, contraction of the gallbladder, and delay of further gastric emptying

• Enterokinase: converts Trypsinogen → trypsin

• Histamine: Produced by enterochromaffin-like cells → stimulates parietal cells to produce gastric acid

• Secretin: Produced by duodenal S cells → promotes release of bicarb-rich pancreatic secretions and bile → INHIBITS gastric acid production

What do the following do in GI:

• ACh:

• Cholecystokinin:

• Enterokinase:

• Histamine:

• Secretin:

FALSE!

• p53 is a transcription factor that effects RNA polymerase!

True or False: p53 is a transcription factor that effects DNA polymerase

TRUE!

True or false: The TATA sequence can be found in the promotor region

A fluoroquinolone!

• I.e. Levofloxacin (-FLOXACIN)

“After taking an antibiotic, he got an Achilles tendon rupture” What was the antibiotic?

Making the patient hyperventilate

When using a ventilator, if you “increase the frequency at constant tidal volume” you are essentially doing what?

• Testosterone: Promotes the speeding up of bone growth during puberty

• Estrogen: Promotes the slowing down or stopping of bone growth (epiphyseal plate closures)

How do testosterone and estrogen play a role in bone growth during puberty?

There is a problem with peroxisomes and beta-oxidation

“Serum studies show increased concentrations of very-long-chain fatty acids” What should we immediately be thinking is wrong?

It is a serotoninergic receptor antagonist!

How does Ondansetron work as an anti-emetic?

• Mucus production: Increases

• Activity of airway cilia: Decreases

• Alveolar macrophage function: Decreases

*Smoking disrupts the ability of the lungs to clear mucus and foreign debris!

What does smoking do to the following:

• Mucus production

• Activity of airway cilia

• Alveolar macrophage function

Eosinophilic Granulomatosis with Polyangiitis

• A vasculitis with eosinophilia and granulomas

What is another name for Churgg-Strauss syndrome? How does it present?

Granulomatosis with Polyangiitis

• A vasculitis that has necrotizing granulomas and vasculitis effecting the respiratory tract and kidneys (associated with ANCA → anti-neutrophil cytoplasmic antibodies)

What is another name for Wegener granulomatosis?

Urothelial carcinoma!

• Highest risk = cigarette smoking

what is this

3 hours!

• It took 3 hours for the drug to get from [20] to [10]

What is the half-life of this drug?

TRUE!

• It is a viral protein produces by the HPV (a VIRUS!)

True or False: the E6 protein seen in HPV 16 is a non-human antigen

Because it is a partial agonist of dopamine receptors

Apriprazole has a decreased chance of causing drug-induced parkinsonism… why?

The Trapezius!

• Innervation: CN XI

What muscle elevates the shoulder? What is it’s innervation?

Talk to me about ApoA-E

INGESTION!

What is the route of transmission for toxoplasma gondii?

21-hydroxylase deficiency!!

• CAH!

“INCREASED concentration of 17-hydroxyprogesterone and androstenedione” is signaling what disease?

Schwann cells and macrophages

During Wallerian degeneration, who clears the debris?

Satellite cells give nutrition and support to astrocytes

What do satellite cells do?

Oligodendrocytes: CNS → Multiple axons

Schwann cells: PNS → ONE axon

How many axons are myelinated with Schwann cells? What about oligodendrocytes?

• CO2- will accumulate in RBCs

• HCO3- will have a decreased concentration in RBCs AND the plasma

• Cl- will have a lower concentration in the RBCs and a HIGHER concentration in the plasma (compensating for less bicarb leaving the RBCs)

*RESPIRATORY ACIDOSIS!*

If you knock out carbonic anhydrase in RBCs, what will happen?