P450 interactions

up
barbiturates
neuro drugs are for phenytoin
those who act up
carbamazepine
griseofulvin
ramp up
rifampin
chronic EtOH use
St. John's Wort
quinidine

down
sulfonamides
erythromycin
cimetidine
ketoconazole
isoniazid
acute EtOH use
grapefruit juice
HIV protease inhibitors

inhibits enzyme

torsades
class III, IA
dilated CM
doxorubacin (amiodarone), daunarubicin
aplastic anemia
chloramphenicol, benzene, NSAIDs, propylthiouracil, methimazole, carbamazepin
hemolysis in G6PDINH, sulfonamides, antimalarials, aspirin, ibuprofen, nitrofurantoin
nephro-/oto-toxic aminoglycosides, cisplatin, vancomycin, loop diuretics
disulfiram-like rxn cephalosporins, metronidazole, 1G sulfonylureas (tolbutamide, chlorpropamide),

himazole, carbamazepine

mide, chlorpropamide), procarbazine

ending
-afil
-ane
-azepam
-zolam
-azine
-azole
-barbital
-caine
-cycline
-etine
-ipramine
-navir
-operidol
-oxin
-phylline
-terol
-tidine
-triptan
-triptyline

function
erectile dysfunction
inhalational general anesthetic
BDZ
BDZ
phenothiazine (neuroleptic, antiemetic)
antifungal
barbiturate
local anesthetic
protein synth inhibiting abx
SSRI
TCA
protease inhibitor
butyrophenone (neuroleptic)
glycoside (inotrope)
methylxnthine
2 ag
H2 ant
5HT1B/1D ag (migrane)
TCA

example
sildenafil
halothane
diazepam
alprazolam
chlorpromazine
ketoconazole
phenobarbital
lidocaine
tetracycline
fluoxetine
imipramine
saquinavir
haloperidol
digoxin
theophylline
albuterol
cimetidine
sumatriptan
amitriptyline

Drug
penicillin

Class
B-lactam

nafcillin
dicloxacillin
methicillin
ampicillin
amoxicillin
ticarcillin
piperacillin
carbenicillin
clavulanic acid
sulbactam
tazobactam
cefazolin
cephalexin
cefoxitin
cefalcor
cefuroxime
ceftriaxone

PCNase-resistant
PCN, narrow
spectra

ceftazidime
cefipime
aztreonam

3G ceph
4G ceph
monobactam

imipenem/cilastatin
meropenem
vancomycin

carbapenem
carbapenem
glycopeptide

gentamicin
amikacin
tobramycin
neomycin
tetracycline

AG
AG
AG
AG
tetracycline

doxycycline
demeclocycline
minocycline
erythromycin
clarithromycin
azithromycin
chloramphenicol

tetracycline
tetracycline
tetracycline
macrolide
macrolide
macrolide

clinda-/linco-mycin

lincosamide

aminoPCN, wide
spectrum
extended
spectrum PCN
B-lactamase
inhibitor
1G
1G
2G
2G
2G
3G

ceph
ceph
ceph
ceph
ceph
ceph

sulfaSMX
trimethoprim
nitrofurantoin
ciprofloxacin
enoxacin
metronidazole
colistimethane
dapsone
clofazimine
rifampin

sulfonamide
sulfonamide
I
+SMX

FQ
FQ

polymyxin

INH (isoniazid)
pyrazinamide
ethambutol
pentamidine (aerosolized)
linezolid
quinupristin
streptogramin
dalfopristin
streptogramin
amphotericin B

flucytosine
nystatin
miconazole
ketoconazole

azole
azole

fluconazole
caspofungin
terbinafine
griseofulvin

azole

suramin
melacortin
nifurtimox
Na stibogluconate
chloroquine
mefloquine
quinine

antiprotozoan
antiprotozoan
antiprotozoan
antiprotozoan
antiprotozoan
antiprotozoan
antiprotozoan

pyrimethamine
mebendazole
albendazole
pyrantel pamoate
ivermectin
diethylcarbamazine
praziquantel
amantidine
rimantidine
zanamivir
oseltamivir
palivizumab
ribavirin
acyclovir
famciclovir
gangciclovir
foscarnet

antiprotozoan
antihelminth
antihelminth
antihelminth
antihelminth
antihelminth
antihelminth

saquiNAVIR
indiNAVIR
stavudine (d4T)
zalcitabine (ddC)
didanosine (ddI)
zidovudine (ZDV)
nevirapine
efavirenz
delaviridine
enfuvirtide

protease I
protease I
nucleoside
reverse
transcriptase
inhibitor

IFN-

recombinant

IFN-
IFN-

recombinant
recombinant

Drug
cyclosporine

Class

NNRTI
NNRTI
NNRTI
fusion inhibitor

tacrolimus
sirolimus (rapamycin)
daclizumab
azathioprine
muromonab-CD3 (OKT-3)
aldesleukin
erythropoietin
filgrastim
sargramostim
oprelvekin
thrombopoietin
digoxin immune Fab

recombinant
recombinant
recombinant
recombinant
recombinant
recombinant
therapeutic ab

Drug
metyrosine
guanethidine
bethanechol
neostigmine

Class

edrophonium
pyridostigmine
physostigmine

AChEI
AChEI
AChEI

direct ACh ag
AChEI

atropine

ACh ant

pralidoxime
scopolamine
oxybutynin
glycopyrrolate
hexamethonium

ACh ant
ACh ant
ACh ant
nicotinic ag

epinephrine

Symp ag

NE
DA
dobutamine
phenylephrine
ephedrine
cocaine

Symp
Symp
Symp
Symp

clonidine
-methyldopa
ergonovine
phenoxybenzamine
phentolamine
(praz)-osin
carvedilol
labetalol
nadolol
pindolol
acebutolol
betaxolol
propranolol
timolol
esmolol
atenolol
metoprolol
hydralazine
verapamil (non-DHP)
diltiazem (non-DHP)
nife-/amlo-dipine (DHP)
nitroglycerin
isosorbide dinitrate
nitroprusside

ag
ag
ag
ag

AND class II antiarrhythmics

vasodilator
(L-type) CCB and
type IV
antiarrhythmic
(L-type) CCB
venodilator
venodilator

fenoldopam
diazoxide
K-ch opener
-statin
HMG-CoA RI
niacin (also see vitamin B3
section)
cholestyramine
colesevelam
ezetimibe
gemfibrozil
digoxin

bile acid resin

fibrate
cardiac glycoside

class I antiarrhythmics

Na ch blockers

disopyramide
quinidine
procainamide
mexiletine
lidocaine
tocainide
moricizine/encainide
flecainide
propafenone
sotalol
ibutilide
bretylium
dofetilide
amiodarone

class IA antiarrhythmics

adenosine

antiarrhythmic

K
Mg

antiarrhythmic
antiarrhythmic

Drug
bromocriptine
cabergoline
methimazole
propylthiouracil
octreotide

Class

desmopressin (ddAVP)
lispro
aspart
insulin
NPH
glargine
detemir
tolbutamide
chlorpropamide
glyburide
glimepiride
glipizide
metformin

class IB antiarrhythmics
class IC antiarrhythmics
class III antiarrhythmics: Kchannel blockers

rapid-acting
insulin (SPeedy)
intermediate
long-acting insulin
1G sulfonyl-urea
2G sulfonyl-urea

biguanide

pioglitazone
rosiglitazone
acarbose
miglitol
pramlintide
exenatide
levothyroxine
triiodothyronine
GH
oxytocin
hydrocortisone
beclomethasone
dexamethasone
prednisone

thiazolidinediones

Drug
methscopolamine
pirenzepine
propantheline
famoTIDINE
raniTIDINE
cimeTIDINE
nizaTIDINE
omeprazole
lansoprazole
bismuth
sucralfate

Class
ACh ant
ACh ant
ACh ant

-glucosidase
inhibitor
amylin mimetic
GLP-1 analog

synthetic
glucocorticoid

PPI

misoprostol
Al(OH)3
Mg(OH)2
CaCO3

antacid

sulfasalazine
etanercept
adalimumab
infliximab

recombinant
therapeutic ab
therapeutic ab

ondansetron
metoclopramide

Drug
heme and glucose

Class

vitamin A (xs)
heparin

enoxaparin

LMW heparin

(bival)-IRUDIN
warfarin

hirudin

tPA
urokinase
streptokinase
anistreplase
clopidogrel
ticlopidine
abciximab

methotrexate (MTX)

therapeutic ab

antimetabolite (all
work on S-phase)

5-FU

6-MP
6-thioguanine (6TG)
cytarabine (ara-C)
dactinomycin

antitumor abx
(mostly G2)

doxorubicin (adriamycin)
daunorubicin
bleomycin
(eto)-POSIDE (VP-16)
nitrosurea
(-mustines)
cyclophosphamide
ifosfamide
procarbazine
busulfan
vincristine
vinblastine
paclitaxel
-TAXOLs

alkylating agents

microtubule
inhibitor (Mphase)

(cis/carbo)-PLATIN
amifostine
hydroxyurea
(S-phase)
trastuzumab (herceptin) therapeutic ab
imatinib (Gleevec)
rituximab

NOT AN Ab
therapeutic ab

Drug
aspirin (ASA)

Class
NSAIDs

ibuprofen
naproxen
ketorolac
indomethacin
celecoxib
acetaminophen

(etid)-RONATE
zoledronate (IV)
colchicine

bisphos-phonates

probenecid
allopurinol

Drug
riluzole
latanoprost
brimonidine
carbachol
pilocarpine
echothiophate
tropicamide
morphine
codeine
heroin
meperidine
dextromethorphan
loperamide

Class

direct ACh ag
direct ACh ag
AChEI
ACh ant
opioid, R
opioid
opioid
opioid
opioid
opioid

diphenoxylate
fentanyl
methadone
enkephalin
dynorphin
tramadol
butorphanol
buprenorphine
phenytoin

opioid
opioid
opioid
opioid, R
opioid, R
opioid
opioid
opioid
also IB antiarrhythmic

fosfentoin
carbamazepine

parenteral
mood stabilizer

lamotrigine
gabapentin
topiramate
phenobarbital

barbiturate

thiopental

barbiturate (IV)

valproate

mood stabilizer

ethosuximide
tiagabine
vigabatrin
levetiracetam
MgSO4
triazolam
oxazepam
alprazolam
chlordiazepoxide
lorazepam
diazepam
zolpidem
zaleplon
eszopiclone

short-acting BDZ

BDZ

non-BDZ hypnotic

halothane
enflurane
methoxyflurane
phencyclidine
ketamine
propofol
succinylcholine

arylcyclohexylamine
motor nACh-R
blocker

tubocurarine
pancuronium
dantrolene
bromocriptine
pramipexole
ropinirole
amantidine
levodopa/carbidopa
ente-/tol-capone
benztropine
reserpine
tetrabenazine
memantine
rivastigmine
donepezil
galantamine
sumatriptan

Drug
thioridazine
chlorpromazine
trifluoperazine
fluphenazine
haloperidol
quetiapine
reisperidone
aripiprazole
ziprasidone
clozapine
olanzapine

Class
antipsychotic
(typical,
neuroleptic)

atypical
antipsycotics

lithium

buspirone
amitriptyline
notriptyline
desipramine
imipramine
clomipramine
(par/flu)-oxetine
sertraline
citalopram
venlafaxine
duloxetine
atomoxitene
phenelzine
tranylcypromine
isocarboxazid
selegiline
varenicline
bupropion
mirtazapine
maprotiline
trazodone
methylphenidate
amphetamine
dexedrine
Drug/Type
Depressants
acute EtOH
chronic EtOH
Stimulants
caffeine
nicotine
Hallucinogens
PCP
LSD
marijuana

Drug
mannitol

mood stabilizer

tricyclic antidepressants

SSRI

SNRI

MAOI

atypical antidepressants

CNS stimulant
amphetamine
Withdrawal
anxiety, tremor, seizures, insomnia
severe: DT (life threatening, peaks 2-5d after last drink, ANS
hyperactivity [tachycardia, seizures], psychosis, confusion)
crash, depression, lethargy, wt gain, headache
irritability, anxiety, craving
depression, anxiety, irritability, restlessness, anergia, thought/sleep
disturbances
irritability, depression, insomnia, N, anorexia; peak in 48h, last up to
7days; can be detected in urine for up to 1 month
Class

acetazolamide
ethacrynic acid
furosemide

loop diuretic

hydrochlorothiazide

thiazide

eplerenone
spironolactone
triamterine
amiloride
captopril
lisinopril
enalapril

K-sparing diuretics

ACEI

Drug
leuprolide
methyltestosterone

finasteride
flutamide
ethinyl estradiol
mestranol
diethylstilbestrol
clomiphene
tamoxifen
raloxifene
HRT

Class
GnRH ag

estrogen

SERM

exemestane
anastrozole
progestin
mifepristone (RU-486)
dinoprostone
terbutaline
ritodrine
tamsulosin

Symp ag

sildenafil
vardenafil
Drug
diphenhydramine
chlorpheniramine
loratadine
fexofenadine
desloratadine
certirizine
methacholine
ipratropium
isoproterenol
metaproterenol
albuterol
salmeterol
theophylline
cromolyn
zileuton
(zafir)-lukast

Class
1G H1 blockers
2G H1 blockers

direct ACh ag
ACh ant
Symp ag
Symp ag

methylxanthine
antiLT

guaifenesin
N-acetylcysteine
bosentan
Name
retinol

Vitamin
A

calcitriol (D3)

vitamin E

vitamin K

thimine

B1

riboflavin
niacin

B2
B3

pantothenate
pyridoxal P

B5
B6

cobalamin

B12

folate

biotin

(B7)

ascorbic acid

Zn

drug
class
salicylate
iron (hemochromatosis)
lead
mercury
arsenic
gold
copper (Wilson's)

cyanide
methemoglobin
CO
methanol
ethylene glycol
benzene
ouabain
Amanita phalloides
(poison mushroom)
antimycin A
rotenone
oligomycin
2,4-DNP
organophosphates

Micro
Use
GP (not Staph), Syph
S. aureus (not MRSA)

certain GPs (Listeria, enterococci) and GNRs

(Proteus, H. flu, E. coli, Salmonella)
Pseudomonas (+AG) and GNR
Pseudomonas (+AG) and GNR
Pseudomonas (+AG) and GNR

GPC, Proteus, E. coli, K. pneumo (think UTI)

GPC, Proteus, E. coli, K. pneumo, H. flu,
Enterobacter, Neisseria, Serratia (think more UTIs,
gonorrhea)
H. flu meningitis, Neisseria, gonorrhea prophylaxis
Pseudomonas
Pseudomonas and GP
GNRs ONLY, synergistic w/ AGs
GPC, GNR, anaerobes; broad spectrum, Blactamase resistant
GPs ONLY, esp MDR (MRSA, Enterococci, and C.
diff)
GNR, synergistic w/ B-lactams
GNR, synergistic w/ B-lactams
GNR, synergistic w/ B-lactams
bowel surgery
intracellulars: B. burgdorferi, H. pylori, M. pneumo,
Rickettsia, Chlamydia (no CNS penetration)
+ADH antagonist (diuretic in SIADH)
+meningococcal prophylaxis (2nd line)
atypical pneumonia (Legionella, M. pneumo,
Chlamydia), URI, STD, cocci (GP/Neisseria)
+ MAC prophylaxis (AIDS)
meningitis (H. flu, N. meningitides, S. pneumo)
anaerobes in aspiration pneumonia

GP, GN, Nocardia, Chlamydia

+UTI
UTIs (tx or prophylactic for recurrent), Shigella,
Salmonella, PCP (tx/prophylaxis)
UTIs (esp E. coli), used in pregnancy
GNR (esp of UTI/GI infxn), Neisseria, some GPs
GI protozoa (Giardia, Entamoeba), vaginal
(Trichomonas, Gardnerella), anaerobes
resistant GNs
M. leprae (oral, long term), PCP
M. leprae (added to dapsone)
M. leprae (delays resistance to dapsone),
prophylactic for H. flu and N. meningitides; M. TB
(quad tx)
M. TB (quad tx and prophylaxis)
M. TB (quad tx)
M. TB (quad tx)
PCP (prophylaxis, second line, after bactrim)
VRE
VRE
VRE
serious systemic mycoses: Histoplasma,
Blastomyces, Coccidioides, Aspergillus, Candida,
Mucor
systemic infxn along with Amphotericin B
Candida (thrush, diaper rash, vaginal)
topical (esp tinea)
Candida, Histoplasma, Blastomyces, PCOS
(hirsutism), Coccidioides, hypercortisolism
Cryptococcal meningitis in AIDS, Candida
Invasive Aspergillosis
dermatophytes (esp onychomycosis)
oral tx of superficial infxn, esp dermatophytes
(tinea, ringworm)
Trypanosomes, no CNS penetration
Trypanosomes, CNS penetration
T. cruzi
Leishmaniasis
Plasmodium
Plasmodium (resistant to chloroquine)
chloroquine-resistant Plasmodium (+ pyrimethamine and sulfonamide); Babesia

P. falciparum, + sulfadiazine=toxo
GI, neurocysticercosis
Echinococcus
Enterobius, Ascaris, hookworms
Onchocerca, Strongyloides
Loa loa, Wuchereria bancrofti, Toxocara canis
tapeworms and flukes
Influenza A (tx and prophylaxis), Parkinson's dz

influenza A and B
RSV
RSV, chronic hep C
HSV (tx and prophylaxis), VZV, EBV
herpes zoster
CMV (mostly in immunocompromised)
gangciclovir-resistant CMV retinitis, acyclovirresistant HSV

HIV
HIV
HIV
HIV
HIV
HIV (tx, prophylaxis, pregnancy)
HIV
HIV
HIV
HIV (used in pts w/ persistent viral replication
despite HAART)
chronic hep B/C, Kaposi's sarcoma, leukemias,
malignant melanoma
MS
NADPH oxidase deficiency
Immune
Mechanism
Binds cyclophilins, inhibits calcineurin preventing
IL-2 and IL-2R production
Binds FK-BP, inhibits IL-2 and IL-2R production
(and other cytokines)
inhibits mTOR and TC response to IL-2
MAb w/ high affinity for IL-2R on activated TC
antimetabolite precursor to 6-MP (interferes w/
nucleic acid synth)
MAb that binds CD3 (epsilon chain) on TC, blocks
signal transduction
IL-2
epoetin
Granulocyte Colony Stimulating Factor
Granulocyte/Macrophage-CSF
IL-11
thrombopoetin
Pharm/Cardio
Mechanism
inhibits tyrosine hydroxylase (makes DOPA)
inhibits NE release (replaces it in vescicles)
ACh ag, resistant to AChE
no CNS penetration
no CNS penetration, extremely short acting
no CNS penetration, long acting
CNS penetration

regenerates AChE
regenerates AChE
CNS
GU
ganglionic blocker
vasoconstriction decreases aq humor production;
low dose: >; high: >
>1
D>>, inotropic and chronotropic
1>2, inotropic
1>2
release stored catecholamines
catecholamine reuptake inhibitor, inactivates Na
channels
central 2 ag, decrease central adrenergic outflow
peripheral alpha agonist (and DA, 5HT)
irreversible nonselective -blocker
reversible nonselective -blocker
1-blocker (smooth m relaxation)
nonselective - and -blocker
nonselective - and -blocker
nonselective -blocker
nonselective partial -agonist
1 partial agonist (>2)
selective 1-blocker
nonselective -blocker
nonselective -blocker
selective 1-blocker, short-acting
selective 1-blocker
selective 1-blocker
increased cGMP, relaxing smooth m;
arterioles>veins, afterload reduction
reduce mm contractility, ventricle>>vessels; blocker-like antianginal
reduce mm contractility, ventricle=vessels
vasodilator, ventricle<<vessels; nitrate-like
antianginal (little effect on contractility)
release NO in smooth m causing increased cGMP,
veins>aa, decrease preload
short acting, same as nitroglycerin

D1 ag, relaxes renal vascular smooth m

hyperpolarizes/relaxes vascular smooth m
inhibits chlsl to mevalonate
decreases hepatic VLDL secretion into circ, inhibit
lipolysis in adipose tissue
prevents intestinal reabs of bile acids, liver uses
chlsl to make more
prevents chlsl reabs at small intestine brush
upregulate LPL causing increased TG Cl.
inhibition of Na/K ATPase causes indirect inhibition
of Na/Ca exchanger, increases [Ca]i, positive
inotropy; stimulates vagus (suppresses AV node)

affect on AP: phase 1=BAC (B is unchanged);

phase 3=BCA (C is unchanged)
increase AP duration, effective refractory period,
and QT; big gap in phase 3 from normal;
intermediate dissociation speed
decrease AP duration (no effect on QRS),
preferentially target ischemic/depolarized
Purkinje/ventricular tissue; fast dissociation
no effect on AP duration, slow dissociation, so
significantly prolongs refractory period in AV node
increase AP duration, increased effective
refractory period, and increased QT interval; big
gap in phase 3 from normal; sotalol is also mild
beta blocker

transient AV block (A1R=Gq); endothelial

dependent smooth m relaxation
depress ectopic pacemakers in hypokalemia
Endocrine
Mechanism
DA ag, inhibits PRL secretion
DA ag, inhibits PRL secretion
inhibits peroxidase-coupling of MIT/DIT and thyroid
hormone synthesis
somatostatin analog (in stomach, inhibit ECL cell
secretion of histamine)
ADH analog; releases endothelial vWF store
bind insulin receptor; liver: increased glycogen
synthesis; muscle: increased glycogen and protein
synthesis, K uptake; fat: aids TG storage

close K-channel in -cell membrane, causes cell

depolarization and triggers Ca influx and insulin
release

decreases gluconeogenesis, increase glycolysis

and peripheral glucose uptake

increase peripheral insulin sensitivity, binds PPAR

inhibit intestinal brush border enzymes, delays
sugar hydrolysis/absorption
decrease glucagon
increse insulin, decrease glucagon
thyroxine replacement
hormone replacement
hormone replacement
inhibits virtually all cytokines by inactivating NFB (TNF- transcription factor)
+ triggers apoptosis
GI
Mechanism
block M1R on ECL cells (decrease histamine) and
M3R on parietal cells (decrease H secretion)
reversible block of H2R on gastric parietal cells
causes decreased H secretion (cimetidine=also
antiandrogenic)
irreversibly inhibit H/K ATPase in parietal cells
bind to ulcer base, provides physical protection,
allows HCO3 secretion
PGE1 analog, increased production of gastric
mucous, decreased H+ production
can affect absorption, bioavailability, and
excretion of other drugs (alters pH or delaying
gastric emptying)
sulfa- antibiotic + 5-aminosalicylate (antiinflammatory), activated by bacteria
form of TNF-R (sequesters TNF)
anti-TNF-
anti-TNF-
5HT3 ant, powerful central antiemetic
D2R ant causes increased LES tone, motility,
contractility, decreased pyloric S tone
Heme/Onc
Mechanism
inhibits ALA synthase (RLS of heme synth)

for PML: inhibits retinoic acid receptor causing

promyelocyte differentiation
activates antithrombin, acts most on Xa and
thrombin; very short t1/2; watch PTT
acts more on Xa, better bioavailability, longer t1/2;
subQ, fine if unmonitored
directly inhibit thrombin
inhibit activation (-carboxylation) of vit Kdependent facotrs (II, VII, IX, X, proteins C and S)
convert plasminogen to plasmin, which degrades
fibrinogen and fibrin
bind w/ plasminogen, activate plasminogen
streptokinase bound to plasminogen
binds ADPR on platelets, inhibits GpIIb/IIIa
expression, inhibits fibrinogen binding
GpIIb/IIIa Ab for activated platelets

folic acid analog, inhibits DHFR, decreasing dTMP

and DNA/protein synth
pyrimidine analog, activated to 5F-dUMP,
covalently binds DHFR, which inhibits thymidylate
synthase, decreasing dTMP
purine analog, inhibits de novo purine synth,
activated by HGPRT
pyrimidine analog, inhibits DNA Pol
intercalates in DNA
anthracyclines: noncovalently intercalate in DNA
causing breaks; generate free radicals
free radical formation, breaks DNA
inhibits topoisomerase II (S and G2)
require bioactivation, cross BBB
covalently cross-link DNA at guanine N7, require
activation by liver
alkylates DNA
alkylates DNA
bind tubulin, block polymerization, inhibit mitotic
spindle formation
hyperstabilize polymerized microtubules, inhibit
mitotic spindle degradation

cross-link DNA
cytoprotective free radical scavenger
ribonucleotide reductase inhibitor
Ab against HER-2 (erb-B2); possibly kills through
Ab-dependent cytotoxicity
bcr-abl tyrosine kinase inhibitor
Ab against CD-20 (on most BC neoplasms)
Musculoskeletal
Mechanism
irreversibly acetylates COX (1 and 2), prevents
conversion of AA to TXA2, PGE2, PGI2

reversibly inhibit COX (1 and 2), blocks

prostaglandin synthesis; COX-1 maintains gastric
mucosa, COX-2 in inflammatory cells and vascular
endothelium
reversibly inhibit COX-2
reversibly binds COX, mostly in CNS (peripherally
inactivated)
inhibits osteoclast activity, reduce resorption +
formation of hydroxyapatite
binds and stabilizes tubulin, impairing chemotaxis
and degranulation
inhibits reabsorption of uric acid in PCT, inhibits
secretion of PCN
inhibits xanthine oxidase, decreased conversion of
xanthine to uric acid
Neuro
Mechanism
decreases presynaptic glutamate release
PGF2a (increases outflow of aq humor)
ag (think clonidine)
contract ciliary m, increase aq humor outflow
+ AChE resistant, more potent
CNS penetration
in eye
decrease synaptic transmission by opening K-ch
and closing Ca-ch; inhibits release of ACh, NE,
5HT, glu, substance P; induces NO synthase
expression, lowers preload

5HT, glu, substance P; induces NO synthase

expression, lowers preload

very weak opioid, SNRI

opioid, partial agonist at -R, agonist at -R
opioid, partial ag
increased Na channel inactivation (increased
refractory period), inhibits presynaptic excitatory
glutamate release
increased Na channel inactivation
blocks voltage-gated Na channels
CCB (designed as GABA analog)
blocks Na channels, propagates GABA action
propagates GABAA action by increasing duration
Cl channel is open
high potency, highly lipid soluble; decreases
cerebral blood flow
increased Na channel inactivation, increase GABA
concentration
blocks thalamic T-type Ca channels
inhibit GABA reuptake
irreversibly inhibit GABA transaminase
unknown
increase frequency of Cl channel opening
causing propagation of GABAA action; decrease
REM

act via BZ1 receptor subtype; reversed by

flumazenil

unknown; high blood solubility=slower induction

and recovery time; high lipid solubility=high
potency=lower MAC
(aka PCP) blocks NDMA-R
potentiates GABAA
phase I=prolonged depol (no antidote, potentiated
by neostigmine); II=repol but blocked
(antidote=neostigmine)
compete for AChRs, reversible w/ cholinesterase
inhibitors
prevents release of Ca from sarcoplasmic
reticulum of skeletal mm (uncoupled)
DA ag (ergot derivative)
DA ag (non-ergot derivative, so preferred)
increases DA release
converted to DA in CNS; carbidopa= peripheral
dopa-decarboxylase inhibitor
COMTI
antimuscarinic (atropine)
inhibits DA, NE, and 5HT into vescicles (amine
depleting)
amine depleting (DA)
NMDA-R ant (prevent excitotoxicity)
AChEI

5HT1B, 1D ag causes vasoconstriction, inhibits V

activation and VIP release
Psych
Mechanism
block D2R, but can also block muscarinic, , and
histamine receptors, all low potency; highly lipid
soluble (long t1/2)
block D2R, high potency; highly lipid soluble (long
t1/2)
block 5-HT2, DA, , and H1 receptors

unknown (maybe inhibits PI3 cascade), ADH

antagonist; exclusively excreted by kidneys, most
reabsorbed at PCT with Na
5HT1A agonist
SNRI-like mechanism; amitriptyline=3 (most
anticholinergic); notriptyline=2 (least
anticholinergic)

usually takes 2-4 weeks for antidepressant effects

5-HT>NE reuptake inhibitor

5-HT<NE reuptake inhibitor
5-HT and NE reuptake inhibitor, nonstimulant
nonselective MAOI, increase NE, 5HT, DA

selective MAO-BI (main metabolyzer of DA)

nAChR partial agonist
increased NE and DA
5HT2&3 and 2-blocker (increased NE and DA)
blocks NE reuptake
blocks 5HT reuptake
release stored catecholamines

Addiction

wal
remor, seizures, insomnia
T (life threatening, peaks 2-5d after last drink, ANS
vity [tachycardia, seizures], psychosis, confusion)

pression, lethargy, wt gain, headache

y, anxiety, craving

on, anxiety, irritability, restlessness, anergia, thought/sleep

ces

y, depression, insomnia, N, anorexia; peak in 48h, last up to

an be detected in urine for up to 1 month
Renal
Mechanism
osmotic diuretic

carbonic anhydrase inhibitor

phenoxyacetate derivative, same as Lasix
inhibit cotransport of NaK2Cl; lose hyper-tonicity
of medulla, increase Ca excretion
inhibit NaCl reabs in distal tubule, low Ca
excretion
competitive aldoR ant
+ mild testosterone R ant
block ENaC in DCT
inhibit inactivation of bradykinin (vasodilator);
causes renin release by loss of feedback inhibition

Repro
Mechanism
pulsatile=agonist, continuous=antagonist
T agonist at androgen receptors

5-reductase inhibitor, lower DHT

nonsteroidal competitive T-receptor ant
Estrogen receptor antagonist

inhibits negative feedback on hypthalamus

ag: bone, endometrium; antag: breast
ag: bone; antag: endometrium, breast

aromatase inhibitor
reduce growth and vascularization of
endometrium
competitive progesterone inhibitor
PGE2 analog (dilation, uterine contraction)
2
1A,DR ant (on prostate, 1BR on vessels)
inhibit cGMP PDE5I
Respiratory
Mechanism
reversible inhibitors of H1 histamine R

inhaled, causes bronchoconstriction

competitive block of MACh-R

selective 2 ag (2>>1)

PDEI (decreases cAMP hydrolysis)

stabilizes mast cell granules
5-lipoxygenase inhibitor (AA to LTs)
LT receptor antagonist

mucolytic, glutathione precursor

endothelin-1 receptor antagonist (lower PVR)
Biochem
Function
antioxidant, used in vision pigment, cell
differentiation (tx AML M3), also used to treat
measles
increase intestinal absorption of Ca and PO4
antioxidant (RBCs and cell membranes)
catalyzes -carboxylation of glutamate on clotting
factors (II, VII, IX, X, protein C, S)
cofactor for PDH, -KGDH, transketolase (HMP
shunt), branched chain AA DH
cofactor in redox (FADH2)
made from tryptophan and B6
CoA (acyl transfers and FA synth)
used in a ton of rxns (make niacin from trp);
deficiency caused by INH, OCPs
homocysteine methyltransferase (regeneration of
methionine after SAM) and methylmalonyl-CoA
mutase (generation of succinyl CoA from
catabolism) cofactor
nucleic acid synth, methyl transfers (SAM); most
common deficiency in US (alcoholics and
pregnancy)
cofactor for carboxylations (pyruvate, acetyl-CoA,
propionyl CoA)
antioxidant, facilitates Fe absorption, collagen
synthesis, DA to NE
essential for 100+ enzymes, transcription factors
(Zn fingers)
Toxins/Antidotes
antidote
NaHCO3 (alkalinize urine), dialysis
deferoxamine
1st line: CaEDTA and dimercaprol, 2nd: penicillamine; succimer for kids
dimercaprol (BAL), succimer
dimercaprol (BAL), succimer, penicillamine
penicillamine

nitrite, hydroxocobalamin, thiosulfate

methylene blue, vitamin C
100% O2, hyperbaric O2
ethanol, fomepizole, dialysis

atropine

Micro
Mechanism
Bind PBP, inhibit transpeptidase cross-linking of cell
wall, and activate autolytic enzymes
Same as PCN, but bulkier R group

Same as PCN, wider spectrum, PCNase sensitive (use

with clavulanic acid)
Same as PCN, PCNase sensitive (use with clavulanic
acid)

B-lactam, but less susceptible to PCN-ases,

bactericidal

for serious gram negative infxn

inhibits cell wall synth (binds PBP3), B-lactamaseresistant, synergistic w/ AGs

cilastatin=renal dehydropeptidase I inhibitor, decreases inactivation of drug; seizures, GI distress, ras

dehydropeptidase I stable, lower risk of seizures; GI distress, skin rash
inhibits cell wall mucopeptide formation by binding
D-ala D-ala portion of precursors
bind 30S, inhibit initiation complex, cause
misreading of mRNA; require O2 for uptake (no
anaerobes); modifying transferase enzymes
(acetylation, eg) can lead to resistance
binds 30S and prevents attachment of AA-tRNA;
resistance by decreased uptake or increased efflux
by pumps (plasmid-encoded); do not take w/ milk,
antacids, or Fe (divalent cations inhibit absorption)
binds 23S or 50S and inhibits translocation

inhibits 50S peptidyltransferase; plasmid-encoded

acetyltransferase inactivates drug
binds 50S and inhibits translocation

PABA antimetabolytes inhibit DHpteroate synthetase

(DHpteroate=DHF precursor); resistance=all
mechanisms
bacterial DHFRase I
bacterial DNA damage
topoisomerase II inhibitor; resistance=mutated DNA
gyrase; do not take w/ antacids
free radical toxic metabolites that damage DNA
disrupts membranes (basic cations=detergent)

DNA-dep RNA pol inhibitor

decreased synth of mycolic acid, activated by

bacterial catalase-peroxidase

binds 50S and inhibits translocation

binds ergosterol, forms pores in membrane; does not

cross BBB (intrathecal for meningitis)
converted to 5-FU, inhibits DNA synth
same as amphotericin B
inhibit fungal ergosterol synthesis by inhibiting P450
enzyme (lanosterol 14--demethylase); for systemic
mycoses; ketoconazole also inhibits human enzyme
desmolase (T-synth)
-glucan cell wall synthesis inhibitor
squaline epoxidase I (ergosterol precursor)
microtubule inhibitor, deposits in keratin-containing
tissues
inhibits energy metabolism enzymes
inhibits sulfhydryl enzymes
forms intracellular oxygen radicals
inhibits glycolysis at PFK
blocks plasmodium heme polymerase (buildup of
toxic hemoglobin products)

methamine and sulfonamide); Babesia

inhibits plasmodial DHFRase

inhibits glucose uptake and microtubule synth
inhibits glucose uptake and microtubule synth
stimulates depolarization-induced paralysis by stimulating nicotinic receptors at NMJ
amplifies GABA-mediated inhibition leading to immobilization; doesn't cross BBB (no effect on humans
increases membrane permeability to Ca (contraction, paralysis)
blocks viral penetration/uncoating (M2); also causes
release of DA from intact nerves;
resistance=mutated M2 (90% of flu A resistant)
inhibit neuraminidase
neutralizes F-protein
inhibit IMPDH (guanine synthesis)
guanosine analog: monophosphorylated by viral
thymidine kinase, triphosphate made in human cells;
leads to chain termination
viral DNA pol inhibitor, binds to PP-binding site, no
activation required

prevents cleavage of polypeptide products of pol

gene, thus inhibiting virion assembly
competitively inhibit nucleotide binding site on RT
causing DNA chain termination; must be activated
first by viral thymidine kinase
bind to RT at site different from NRTIs, do not require
phosphorylation
bind gp41: inhibit conformational change necessary
for fusion with CD4 cells
synthesized by viral infected cells to block replication
of DNA and RNA viruses

Immune
Use
some autoimmune disorders, suppresses organ
rejection
suppresses organ rejection (very strong
immunosuppressant)
kidney transplant (+ cyclosporine and steroids)
kidney transplant
kidney transplant, autoimmune disorders (including
GN, hemolytic anemia, UC)
kidney transplant
RCC, metastatic melanoma
anemias (esp renal failure)
bone marrow recovery
bone marrow recovery
thrombocytopenia
thrombocytopenia
antidote for digoxin intoxication
Pharm/Cardio
Use
htn from pheo (prevents catecholamine synth)
htn
neurogenic ileus/urinary retention and postop
neurogenic ileus/urinary retention and postop
(reversal of NMJ block), myasthenia gravis
dx of myasthenia gravis
tx of myasthenia gravis
glaucoma and atropine OD

causes mydriasis and cycloplegia, tx of ACh

poisoning (organophosphates)
with atropine, for cholinesterase poisoning
motion sickness
reduce urgency in mild cystitis and reduce bladder
spasms
used in experiments only
anaphylaxis, open angle glaucoma, asthma,
hypotension
hypotension (but decreases renal perfusion)
shock (increases renal perfusion), CHF
CHF, cardiac stress testing
pupillary dilation, vasoconstriction, nasal decongestion
nasal decongestant, urinary incontinence, hypotensio
causes vasoconstriction, local anesthesia

htn, esp. in renal disease (no decrease in renal blood

flow), DM, 1st line in preg (+ hydralazine)
dx of Prinzmetal's angina, placental delivery
pre-op on pheo
htn, urinary retention in BPH
htn (decrease CO, decrease renin secretion [
blockade on JGA cells]), angina (decrease afterload,
decrease HR and contractility [via calcium channels]
causing decreased O2 consumption), MI and CHF
(decrease mortality [esp carvedilol], slow
progression), glaucoma (timolol, carve-dilol,
betaxolol, decrease secretion of aqueous humor),
antiarrhythmics (SVT, VT, AFib; decrease cAMP, Ca
currents, and AV conduction velocity, increase PR);
headache, essential tremor (propranolol)

htn in pregnancy (1st line, with methyldopa), severe

htn, CHF
htn, angina (no unstable for DHP), Raynaud's,
arrhythmias (non-DHPs; nodal arrhythmias [SVT,
AFib]: slow conduction velocity, increase refractory
period and PR, decrease slope of phases 1 and 2)
angina, pulmonary edema, aphrodisiac, erection
enhancer, esophageal spasm
malignant htn

malignant htn
malignant htn, insulinoma
lower LDL>>TG, raise HDL a little
lower LDL>TG, raise HDL a bunch
lower LDL, slightly raise HDL and TG
lower LDL
lower TG>>>LDL, raise HDL a little
CHF (decrease morbidity, not mortality), AFib
(depresses SA node, slow AV nodal conduction);
75% bioavailable, 20-40% protein bound, t1/2=40h,
urinary excretion

mnemonic: Double Quarter Pounder, Lettuce Tomato

Mayo, Extra/More Fries Please
good for atrial and ventricular arrhythmias,
especially reentrant and ectopic SVT, and VT
acute ventricular arrhythmias (esp post-MI) and
digitalis-induced arrhythmias (lidocaine)
VT (esp that go to VFib), intractible SVT, last resort in
refractory tachyarrhythmias, only in pts w/o
structural abnormalities
used when other arrhythmics fail; amiodarone has
class I, II, III, and IV effects bc it alters the lipid
membrane

dx/tx of SVT, dx of CAD, very short acting (~15s)

digoxin toxicity
torsades and digoxin toxicity
Endocrine
Use
PRLoma, Parkinsons, neuroleptic malignant sz
PRLoma
hyperthyroidism
GHoma, NET, gastrinoma, glucagonoma, acute
variceal bleed, VIPoma, carcinoid tumor
central DI, von Willebrand's dz
DM, gestational DM, life-threatening hyperkalemia,
stress-induced hyperglycemia

T2DM (stimulates endogenous release of insulin,

need some -cell function, so useless in T1DM)

oral, can be used in pts w/o islet function (T1 or 2DM)

T2DM (monotherapy or combo)

T2DM (monotherapy or combo)
T2DM
T2DM
hypothyroidism, myxedema
GH deficiency, Turner's
stimulates labor, uterine contractions, milk let-down, controls uterine hemorrhage
Addison's, inflammation, immune suppression
(Crohn's), asthma (1st line for chronic)
+ dx of Cushing's dz (suppression test)
+ CLL, Hodgkins
GI
Use
peptic ulcers (rarely used)

PUD, gastritis, mild esophageal reflux

PUD, gastritis, esophageal reflux, Zollinger-Ellison Sz,

H. pylori (+ clari, metro/amoxi)
improved ulcer healing, traveller's diarrhea, +
metronidazole + amoxicillin (or tetracycline) for H.
pylori
prevention of NSAID-induced ulcer, induce labor,
maintenance of ductus arteriosus
all cause hypokalemia

UC, Crohn's
Crohn's, RA, psoriatic arthritis
Crohn's, RA, psoriatic arthritis
Crohn's, RA, psoriatic arthritis, ankylosing spondylitis
decrease vomiting (post-op, chemo)
antiemetic, gastroparesis (DM or post-surgery), does
not influence colon transport time
Heme/Onc
Use
acute intermittent porphyria

acne, measles, PML (AML M3)

immediate anticoagulation: PE, CVA, acute coronary
sz, MI, DVT; safe for pregnancy

heparin alternative in pts w/ hx of HIT

chronic anticoagulation, oral

early MI, early ischemic stroke

acute coronary sz, coronary stenting, decrease risk of

thrombotic stroke
prevent cardiac ischemia in unstable angina and in
pts txed w/ percutaneous coronary intervention,
acute coronary sz
leukemia, lymphoma, chorioca, sarcomas; abortion,
ectopic pregnancy, RA, psoriasis
solid tumors, topical for basal cell ca, synergistic w/
MTX
leukemia or lymphoma (not CLL or HL), UC
ALL
AML, ALL, high grade NHL
Ewing's sarcoma, rhabdomyosarcoma, childhood
tumors (Wilm's)
Hodgkins, myelomas, sarcomas, solid tumors

testicular and Hodgkins

SCC of lung/prostate, testicular
brain tumors (including glioblastoma multiforme)
NHL, breast, ovarian; also good immunosuppressants
Hodgkin's, brain tumors
CML, pre-marrow-transplant marrow ablation
Hodgkins, Wilm's, chorioca
ovarian and breast

testicular, bladder, ovary, lung

prevent nephrotoxicity and xerostomia, given with
platinum and alkylating agents
melanoma, CML; sickle-cell (increase HbF)
HER-2-overexpressing breast cancer
CML (Philadelphia chr., main target), GIST
BC non-Hodgkin's lymphoma, RA (+ MTX)
Musculoskeletal
Use
low dose (<300mg/day, TXA2): antiplatelet; intermed
dose (300-2400mg/day, PGE2): antipyretic and
analgesic; high dose (2400-4000mg/day): antiinflammatory
antipyretic, analgesic, anti-inflammatory, acute gout
(w/ colchicine, esp indomethacin), migranes
+ induces closure of PDA, nephrogenic DI
RA, OA, pts w/ gastritis/ulcers
antipyretic, analgesic, NO anti-inflammatory

malignancy-associated hypercalcemia, Paget's dz of

bone, postmenopausal osteoporosis
acute gout (with NSAIDs, esp indomethacin)
chronic gout, also given w/ PCN to prolong t 1/2
chronic gout; lymphoma/leukemia w/ chemo to
prevent tumor lysis urate nephropathy
Neuro
Use
ALS
glaucoma
glaucoma
glaucoma, causes miosis, relieve IOP
glaucoma emergency, ups sweat, tears, saliva
glaucoma
causes mydriasis and cyclopegia
pain, acute pulmonary edema

+ cough suppression
+ diarrhea (no CNS sfx)

+ diarrhea (CNS sfx)

(stronger than morphine)
(partial ag, long acting) heroin detox
endogenous
endogenous
chronic pain
pain
pain, opioid addiction, used w/ naloxone
seizures (all but absence), first line for tonic clonic or
status seizure prophylaxis, arrhythmias (IB)
partial, tonic clonic (1st line), trigeminal neuralgia
(1st line), bipolar
partial and tonic clonic
partial and tonic clonic, peripheral neuropathy,
bipolar
partial and tonic clonic
partial + tonic clonic (esp in pregnancy/kids),
anxiety, insomnia, Crigler-Najjar Sz type II
induction of anesthesia (decrease cerebral blood
flow)
seizures (all but status, first line in tonic clonic),
myoclonic seizures, bipolar
absence (first line)
partial seizures
partial seizures
partial and tonic clonic
eclamptic seizures (1st line), torsades
anxiety, panic disorder, GAD, detox (esp EtOH
withdrawal and DT), cocaine OD, night terrors,
sleepwalking, insomnia, general anesthetic,
spasticity
+ acute status epilepticus (first line) or eclamptic
seizures (after MgSO4)
insomnia

inhaled anesthetic (increase cerebral blood flow,

depress CV/resp)
dissociative anesthetic
rapid anesthesia induction
depolarizing paralytic (for pts on a mechanical vent
or during surgery)
non-depolarizing paralytic
malignant hyperthermia and neuroleptic malignant
syndrome, mm relaxant
Parkinson , PRLoma, neuroleptic malignant sz
Parkinson
Parkinson; influenza A, rubella
Parkinson (ODISIA)

Parkinson (tremor and rigidity, not bradykinesia)

Huntington (also haloperidol to tx)

Alzheimer's ("GRiM Dz")

Migrane, cluster headache; short t1/2 (<2h)

Psych
Use
schizophrenia (mostly positive sx), psychosis, mania
(acute), Tourette's (esp haloperidol)

+ Huntington
schizophrenia (positive and negative sx)

+ OCD, anxiety, depression, mania, Tourette's

bipolar, blocks relapse and acute manic events;

SIADH
GAD, anxiety
major depression, fibromyalgia, panic disorder

+ bedwetting (decreases stage 4 sleep)

+ OCD
OCD, social phobia, specific phobia, panic disorder,
PTSD, GAD, anorexia/bulimia, anxiety, depression
(typical or atypical)
depression, GAD
depression, diabetic peripheral neuropathy
ADHD
atypical depression, anxiety, hyperchondriasis

+ Parkinson (use w/ L-dopa)

smoking cessation
bipolar, depression, smoking cessation
bipolar, depression + insomnia
bipolar, depression
insomnia, depression (very high doses)
narcolepsy, obesity, ADHD
ADHD
Addiction

Intoxication
mood elevation, decreased anxiety, sedation, behavioral disinhibition, respiratory depression
emotional lability, ataxia, coma, serum GGT (sensitive EtOH use), AST>2*ALT; acute EtOH=P450 down
gynecomastia; assn w/ periventricular hemorrhage/necrosis of mammillary bodies
mood elevation, psychomotor agitation, insomnia, arrhythmias, tachycardia, anxiety
restlessness, diuresis, muscle twitching
restlessness

homocidality, delerium, belligerence, fever, nystagmus, tachycardia, psychomotor agitation, impulsive

flashbacks, pupillary dilation, marked anxiety/depression, delusions, visual hallucinations
paranoid delusions, slowed time perception, social withdrawal, dry mouth, hallucinations
Renal
Use
shock, drug OD, increased ICP/IOP

urinary alk (TCA/bartbiturate/salicylate OD,

cystinuria), MAlk, altitude sickness, glaucoma
diuresis in sulfa-allergies or gout pts
edema (CHF, cirrhosis, nephrotic sz, pulmonary
edema), htn, hypercalcemia
htn, CHF, idiopathic hypercalciuria, nephrogenic DI
hyperaldo, K-depletion, CHF, hirsutism
(spironolactone)
+ nephrogenic DI
htn, CHF, diabetic renal dz

Repro
Use
infertility, prostate ca (+ flutamide), fibroids
hypogonadism, develop 2 sex characteristics, burn
pts (promotes anabolism)
BPH, male pattern baldness
prostate cancer (+ leuprolide)
hypogonadism, POF, menstrual abnormailities,
postmenopausal HRT, androgen-dependent prostate
cancer
ovulation induction
breast cancer (ER-positive), prevent osteoporosis
menopausal sx (hot flashes, vaginal atrophy,
osteoporosis [E2 decreases osteoclast activity])
ER-positive breast cancer in postmenopausal women
oral contraceptives, endometrial cancer, abnormal
uterine bleeding
pregnancy termination (+ misoprostol)
labor inducer
reduce premature uterine contractions
BPH (inhibits only prostatic smooth m)
ED
Respiratory
Use
allergy, motion sickness, sleep aid
allergy

challenge test for dx of asthma

asthma, COPD
lowers BP (not used), asthma
acute asthma
acute asthma
long term asthma (attack prophylaxis)
asthma, adenosine toxicity
only for asthma/allergy prophylaxis, not tx
asthma
asthma (especially aspirin-induced)

expectorant
loosen plugs (CF), acetaminophen OD
pulmonary htn
Biochem
Deficiency
nyctalopia (night blindness), dry skin

rickets (kids), osteomalacia, hypocalcemic tetany,

breast milk is low in vitamin D
hemolytic anemia, mm weakness, posterior column
and spinocerebellar demyelination
neonatal hemorrhage w/ increased PT and PTT,
normal bleeding time; warfarin, cephalosporin
Wernicke-Korsakoff or Beriberi (wet=dry + high
output cardiac failure; dry=polyneuritis, symmetrical
mm wasting); glucose can worsen
cheilosis (inflammation of lips), corneal vascularization
glossitis; severe=pellagra (diarrhea, dermatitis
[Casal's collar], dementia)
dermatitis, enteritis, alopecia, adrenal insuff
convulsions, hyperirritability, peripheral neuropathy,
sideroblastic anemia, pellagra
megaloblastic anemia, hypersegmented PMNs, neuro
sx; from malabsorption in terminal ileum (Crohn's,
sprue, enteritis, D. latum) or lack of intrinsic factor
(PA, gastric bypass)
megaloblastic anemia, no neuro sx, but teratogenic
(neural tube defects); can be from drugs (phenytoin,
MTX, sulfonamides)
dermatitis, alopecia, enteritis; rare: excessive
ingestion of raw eggs (avidin) or abx use
scurvy: swollen gums, bruising, hemarthrosis,
anemia, poor wound healing, weak immune
poor wound healing, hypogonadism, decreased adult
hair, dysgeysia, anosmia, risk of cirrhosis

Toxins/Antidotes
SFX/other
not for gout (need too high of a dose)
acute: gastric bleeding; chronic: MAc, GI scarring
enicillamine; succimer for kids
vomiting, rice water stool, garlic breath; SqCC

can be from nitroprusside (tx for malignant htn)

created by nitrite bc it binds CN strongly

aplastic anemia
hepatotoxicity/necrosis

SFx/Other
bacteriocidal; G=IV, V=oral; can cause hypersensitivity rxn (all PCNs) or
hemolytic anemia, SJS
same as PCN
+ interstitial nephritis
pseudomembranous colitis
+ higher oral availability; rash

Hypersensitivity (cross hypersensitivity with PCNs in 5-10%), vitamin K

deficiency, disulfiram-like rxn with EtOH (only in some cephalosporins), increase
nephrotoxicity of aminoglycosides

no cross-allergenicity w/ PCN or cephalosporins, good in renal insufficiency;

occasional GI upset

, decreases inactivation of drug; seizures, GI distress, rash

ures; GI distress, skin rash
rarely SFx: nephrotoxicity + ototoxicity, thrombophlebitis, "red man syndrome"
(preventable by slow infusion)
nephrotoxic (especially when used w/ cephalosporins), ototoxic (especially
when used w/ loop diuretics), teratogenic (CN VIII agenesis)

GI distress, teratogen (teeth discoloration), bone growth inhibition in kids,

hypersensitivity; expired causes Fanconi's, photosensitivity
+fecally eliminated (can be used in pts w/ renal failure)
+diabetes insipidus
prolonged QT, GI discomfort, acute cholestatic hepatitis (avoid in liver disease),
eosinophilia, skin rashes; P450 down (increases efficacy of theophylline and oral
anticoagulants)
anemia (dose dependent), aplastic anemia (dose ind), gray baby sz (in
preemies because they lack UDP-glucuronyl transferase)
pseudomembranous colitis, fever, diarrhea

hypersensitivity, SJS, hemolysis (G6PDD), nephrotoxic (tubulo-interstitial

nephritis), teratogen (kernicterus), photosensitive, megaloblastic anemia, P450
down
pancytopenia (leuko-, granulocyto-, megaloblastic anemia; may alleviate w/
supplemental folinic acid [leucovorin rescue])
can be used in pregnancy, hemolysis in G6PD deficiency
GI upset, superinfxns, tendonitis/rupture (not for pregnant women/kids),
headache, dizziness, rash
metallic taste, disulfiram-like effect w/ EtOH, headache, mutagenesis
neurotoxic, nephrotoxic (acute tubular necrosis)
hemolysis (in G6PDD), methemoglobimemia, agranulocytosis
orange body fluids, minor hepatotoxicity, ups P450

neurotoxic (seizures), hepatitis, lupus; pyridoxine (B6) can prevent neurotoxicity

and lupus; hemolytic in G6PD deficiency, P450 down

fever/chills, hypotension, nephrotoxicity (reduced by hydration), arrhythmias, IV

phlebitis, anemia
N/V/D/bone marrow suppression, nonmegaloblastic macrocytic anemia
topical (too toxic for oral)
liver dysfunction (P450 inhibitor), fever, chills
+ hypocortisolism (blocks hormone synthesis in adrenals), gynecomastia,
amenorrhea
+ can cross BBB
GI upset, flushing
teratogen, carcinogen, confusion, headache, increase P450 and warfarin
metabolism

hemolytic anemia in G6PD deficiency

cinchonism (flushing, sweating, headache, confusion, blurred vision, vertigo,
tinnitus, rash, abdominal pain, N/V/D)

by stimulating nicotinic receptors at NMJ

to immobilization; doesn't cross BBB (no effect on humans)

ntraction, paralysis)
ataxia, dizziness, slurred speech
doesn't cross BBB, fewer CNS SFx
m

hemolytic anemia, teratogen (severe)

no effect on latent virus; resistance=lack of viral thymidine kinase
thrombocyto-/leuko-/neutro-penia, nephrotoxic
nephrotoxic, hypo-Ca/PO4/K/Mg; resistance by mutated DNA pol

hyperglycemia, N/D, lipodystrophy, P450 inhibition

+ thrombocytopenia
bone marrow suppression (can be reversed with GCSF and erythropoietin),
peripheral neuropathy, lactic acidosis
+ pancreatitis
+ megaloblastic anemia
bone marrow suppression (can be reversed with GCSF and erythropoietin),
peripheral neuropathy, rash (SJS)
hypersensitivity, increased risk of bacterial pneumonia
neutropenia
neutropenia
neutropenia
SFx/Other
nephrotoxic (prevented by mannitol diuretic), higher risk for viral infxn and
lymphoma
significant: hyperglycemia, htn, nephrotoxicity, peripheral neuropathy, pleural
effusion
hyperlipidemia, thrombocytopenia, leukopenia
bone marrow suppression, worsened w/ allopurinol (6-MP broken down by
xanthine oxidase), nonmegaloblastic macrocytic anemia
cytokine release syndrome, hypersensitivity rxn

SFx/Other

exacerbation of COPD/asthma (M3), and peptic ulcers (M1 and M3); severe/OD
on AChEI: DUMBBELS=diarrhea, urination, miosis, bradycardia, bronchospasm,
excitation of CNS and skeletal mm, lacrimation, sweating, salivation

constipated, urine retention, mydriasis, cyclopegia, acute angle closure

glaucoma, bronchodilation, tachycardia, disorientation, increased T, and dry
eyes, skin, and mouth (hot, dry, red, blind, mad, all analogies)
tx OD w/ physostigmine salicylate

severe orthostatic hypotension, blurred vision, constipation, sexual dysfunction

DONT use in closed angle: causes mydriasis and can block angle more

congestion
tachyphylaxis (rebound congestion/continence[?])
fetal abnormalities, fetal addiction, placental abruption, coronary vasospasm;
OD: pupil dilation, hallucinations (esp tactile), paranoia, angina, tx=BDZ;
withdrawal: suicidal, hypersomnolent, malaise
direct Coombs-positive hemolytic anemia
ergotism
orthostatic hypotension, reflex tachycardia
1st dose orthostatic hypotension, dizziness, headache
impotence, exacerbation of asthma, CV effects (bradycardia, AV block, CHF),
CNS effects (sedation, sleep alteration), caution in DM (tx OD w/ glucagon),
partial agonists (pindolol and acebutolol) contraindicated in angina; metoprolol
can cause dyslipidemia

mnemonics class II antiarrhythmics: help with Most suPrAvEnTriculars=

metoprolol, propranolol, atenolol, esmolol, timolol; Partial agonists: pindolol,
acebutolol; selective 1: A-M (atenolol, acebutolol, betaxolol, esmolol,
metoprolol); nonselective: N-Z (nadolol, pindolol, propranolol, timolol)
reflex tachycardia (contraindicated in angina/CAD, commonly given w/ blocker), Lupus-like sz
cutaneous flushing, cardiac depression, AV block (careful in WPW), peripheral
edema, dizziness, constipation, gingival hyperplasia
+ peripheral edema, reflex tachycardia
reflex tachycardia, hypotension, flushing, dizziness, headache (esp in industrial
exposure: "Monday Dz", tolerance common)
cyanide toxicity

hyperglycemia (reduces insulin release)

hepatotoxicity, rhabdomyolysis
cutaneous flushing (esp face), hyperglycemia, acanthosis nigricans,
hyperuricemia
pts hate it: tastes bad, constipation, decreased abs of fat soluble vitamins, chlsl
gallstones
rare increase in LFT
myositis, hepatotoxicity (LFT), chlsl gallstones
gynecomastia, cholinergic (N/V/D), blurry yellow vision, ECG (high PR, low QT,
scooping, inverted-T, arrhythmia), hyperK; OD worse w hypoK, renal failure, and
quinidine (decreased clearance); tx OD w/ digoxin immune Fab, slowly
normalize K, lidocaine, cardiac pacer, Mg

toxicity increased w/ hyperkalemia

Torsades, cinchonism (tinnitus, headache), thrombocytopenia

Lupus-like sz
CNS stimulation/depression, CV depression

proarrhythmic, esp post MI (contraindication)

Torsades, excessive -block

torsades
new arrhythmias, hypotension (emergency use only)
pulmonary fibrosis, hepatotoxicity, thyroid dysfunction (40% I by wt),
hypersensitivity, corneal deposits, photodermatitis, blue/gray skin deposits,
CNS effects, constipation, CV effects (bradycardia, heart block, CHF, NOT
TORSADES)
cutaneous flushing, hypotension, chest pain (blocked by theophylline)

SFX/other

skin rash, aplastic anemia, agranulocytosis (rare)

+ hepatotoxicity
nausea, cramps, steatorrhea
given intranasal for DI
hypoglycemia, hypersensitivity (very rare)

disulfiram-like effect w/ EtOH, hypoglycemia

hypoglycemia

lactic acidosis (contraindicated in renal failure)

weight gain, edema, hepatotoxicity, CV toxicity

diarrhea
hypoglycemia, N/D
N/V, pancreatitis
tachycardia, heat intolerance, tremors, arrhythmias

et-down, controls uterine hemorrhage

iatrogenic Cushing's (incl. osteoporosis [contraindication], peptic ulcers, and
DM), adrenal insufficiency when drug stopped after chronic use

SFX/other
tx OD w/ physostigmine salicylate; tachycardia, dry mouth, difficulty focusing
eyes
none (most H2 blockers); cimetidine: P450 down, gynecomastia
(antiandrogenic, PRL release, impotence, decreased libido), can cross BBB
(confusion, dizziness, headaches); ranitidine and cimetidine: decrease renal
excretion of creatinine

black tongue, stool

diarrhea, abortifacient
constipation, hypophosphatemia, mm weakness, osteodystrophy, seizure
diarrhea, hyporeflexia, hypotn, cardiac arrest
hyperCa, rebound acid level, chelates other drugs
malaise, nausea, sulfa, reversible oligospermia

respiratory infxn (reactivation of latent TB bc TNF- maintains granulomas),

fever, hypotension
headache, constipation
Parkinsonian, restlessness, drowsiness, depression, N/D; interacts w/ digoxin
and diabetic agents; contraindicated in SI obstruction
SFX/other

teratogen (spontaneous abortion, cleft palate, cardiac abnormalities); when

txing PML, can release Auer rods and cause DIC
follow PTT; bleeding, thrombocytopenia/clotting (HITT, binds PF4 [platelet factor
4, natural CXCR4L]), osteoporosis; antidote= protamine sulfate (positive, binds)
not easily reversible, similar sfx

monitor PT, metabolized by P450; antidote=vitamin K; for more rapid reversal,

give FFP; skin/tissue necrosis; teratogen (bone deformities, fetal hemorrhage,
abortion)
bleeding, treat toxicity with aminocaproic acid or tranexamic acid (plasminogen
activation inhibitors)

neutropenia
bleeding, thrombocytopenia

myelosuppression (leucovorin rescue), macrovescicular fatty liver, mucositis

(aphthous ulcer), teratogenic; tx OD by alkalinizing urine
myelosuppression (non-megaloblastic microcytic anemia, thymidine rescue),
photosensitivity
nonmegaloblastic macrocytic, GI, liver; increased toxicity w/ allopurinol
marrow depression, can be given w/ allopurinol
leukopenia, thrombocytopenia, megaloblastic anemia
myelosuppression
cardiotoxicity (dilated CM, protected by dexrazoxane [Fe-chelation]),
myelosuppression, alopecia; toxic to tissues with extravasation
pulmonary fibrosis, skin changes, minimal myelosuppression
myelosuppression, GI irritation, alopecia
CNS toxicity; all alkylating agents: teratogen (missing digits), aplastic anemia
myelosuppression, hemorrhagic cystitis (lessened by mesna, better control w/
ifosfamide); SIADH for cyclophosphamide
disulfiram-like effect w/ EtOH
pulmonary fibrosis, hyperpigmentation
neurotoxic (areflexia, peripheral neuritis), paralytic ileus
bone marrow suppression
myelosuppression, hypersensitivity

nephrotoxic, ototoxic

nonmegaloblastic macrocytic anemia, GI upset

cardiotoxic
fluid retention

SFX/other
all NSAIDs: inhibit dilation of afferent arteriole, drop GFR (acute renal failure),
intersitial nephritis, gastric upset/ulceration/bleed, and aplastic anemia;
hemolytic anemia in G6PDD, CN VIII issues, mixed RAlk (hyperpnea) and MAc;
Reye's syndrome in kids (esp w/ viral infxn)
all NSAIDs: inhibit dilation of afferent arteriole, drop GFR (acute renal failure),
intersitial nephritis, gastric upset/ulceration/bleed, and aplastic anemia; fluid
retention; ibuprofen: hemolytic anemia in G6PDD
higher risk of thrombosis, sulfa allergy, lower incidence of GI sfx
no Reye's sz, but OD causes hepatic necrosis (metabolyte depletes glutathione
and forms toxins in liver), N-acetylcysteine is antidote; chronic use can cause
renal papillary necrosis
corrosive esophagitis, N/D, osteonecrosis of jaw
no corrosive esophagitis (IV)
GI side effects, agranulocytosis
sulfa allergy
SJS, increases concentrations of azathioprine and 6-MP (both metabolyzed by
xanthine oxidase, give 6-tG instead of 6-MP)
SFX/other
darkens iris
exacerbation of COPD, asthma, and peptic ulcers; severe/OD on AChEI:
DUMBBELS=diarrhea, urination, miosis, bradycardia, bronchospasm, excitation
of CNS and skeletal mm, lacrimation, sweating, salivation
Respiratory depression, miosis (pinpoint pupils), additive CNS depression with
other drugs (EtOH, BDZ, barbiturates, 1B antiarrhythmics), addiction,
constipation, N/V; tolerance does not develop to miosis and constipation; do not
use morphine in renal failure, acute respiratory depression, high ICP (can
worsen respiratory depression), biliary colic
-OD (lifethreatening) txed w/ naloxone or naltrexone (opioid ant)

threatening) txed w/ naloxone or naltrexone (opioid ant)

-withdrawal: flu-like (sweating, dilated pupils,
piloerection ["cold turkey"], fever, rhinorrhea, N/D/stomach cramps);
symptomatic tx
-heroin: high risk for hepatitis, abscess, OD, hemorrhoids, AIDS, RHF
similar to opioids, decreases seizure threshold
less respiratory depression, causes withdrawal if on full ag
Lupus-like sz, SJS, peripheral neuropathy, megaloblastic anemia (low folate
absorption), nystagmus, diplopia, ataxia, sedation, teratogen (fetal hydantoin
sz=IUGR), gingival hyperplasia, hirsutism, P450 up
diplopia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), liver
toxicity, teratogenic, P-450 induction, SIADH, SJS
SJS
sedation, ataxia
sedation, mental dulling, kidney stones, weight loss
sedation, tolerance, dependence, P-450 induction (contraindicated in
porphyria), CNS depression (additive w/ EtOH), SJS; OD: respiratory/ cardiac
depression (can cause death), supporative tx and HCO 3- (alkalinize urine);
withdrawal: delerium, CV collapse (life-threatening)
GI distress, hepatotoxicity/necrosis (can be fatal, measure LFTs), teratogen
(neural tube defects), tremor, weight gain
fatigue, GI distress, headache, urticaria, SJS

much larger safety margin than barbiturates, and less respiratory depression;
usually long t1/2 and active metabolites (short acting BDZs have higher
addictive potential); sedation, tolerance, dependence, CNS depression (additive
w/ EtOH); OD: ataxia, minor respiratory depression; tx=flumazenil (competitive
antagonist at GABA-R)
short t1/2 (rapidly degraded in liver), so less day-after SFX; ataxia, headaches,
confusion; lower dependence risk than BDZ

hepatotoxicity/necrosis, malignant hyperthermia (all but N2O)

proconvulsant
nephrotoxicity
CV stimulant, disorientation, hallucinations, bad dreams, increase cerebral BF
less post-op nausea than thiopental
can cause hyperCa, hyperK, malignant hyperthermia

reversal: AChEI (neostigmine, edrophonium)

can cause ataxia

arrhythmias from peripheral conversion to DA; long term can cause dyskinesia
following dose, akinesia between doses

Parkinson-like sz

dizziness, confusion, hallucinations

N/V, dizziness, insomnia

coronary vasospasm (don't use in pts with CAD or Prinzmetals angina), mild
tingling
SFX/other
atropine-like: dry, constipation, hypotn, sedation; corneal (chlorprom-) or retinal
(thiorid-) deposits; both: neuroleptic malignant sz: autonomic instability,
myoglobinuria, rigidity, hyperpyrexia, encephalopathy
extrapyramidal (4h=dystonia [mm spasm]; 4d=akinesia [parkinsonian];
4wk=akathisia [restlessness]; 4mo=tardive dyskinesia [irreversible stereotypic
oral-facial movements from long-term use]), hyperPRL
far fewer extrapyramidal and anticholinergic SFx than neuroleptics

wt gain, agranulocytosis (requires weekly WBC monitor)

wt gain

teratogen (atrialized RV [Ebstein's anomaly, malformation of great vessels]),

hypothyroid, nephrogenic DI, sedation, edema, heart block, tremor; narrow
therapeutic window
no sedation, addiction, tolerance, EtOH interaction (BDZ/barbiturates)
sedation (least=desipramine), convulsions (most=desipramine), -blocking and
anticholinergic (tachycardia, arrhythmias, urinary retention, confusion,
hallucinations; 3>>>2), hyperpyrexia; tx OD w/ NaHCO3 (alkalinize urine)

less than TCAs: GI distress, sexual dysfunction, "Seratonin sz" (drug

interactions, too much 5-HT causes HyperThermia, HyperTonism, CV collapse,
flushing, diarrhea, seizures; tx=cyprohepadine [5HT 2 ant])
stimulant effects (htn most common), sedation, nausea

htnsive crisis (w/ tyramine ingestion and -ag), CNS stimulation,

contraindicated w/ SSRIs or meperidine (prevent seratonin sz)
+ may enhance SFX from levodopa
abnormal dreams, change in taste, flatulence/constipation, suicide
stimulant effects (tachycardia, insomnia), headache, seizure in bulimia
sedation, increased appetite, dry mouth, increased serum cholesterol
sedation, orthostatic hypotension
sedation, nausea, priapism, postural hypotension
OD: pupil dilation, prolonged wakefulness, delusions, hallucinations, fever;
withdrawal: stomach cramps, hunger, hypersomnolent

n, behavioral disinhibition, respiratory depression

(sensitive EtOH use), AST>2*ALT; acute EtOH=P450 down; chronic EtOH=P450 up,
rrhage/necrosis of mammillary bodies

mnia, arrhythmias, tachycardia, anxiety

teratogen (preterm labor, placental problems, IUGR, ADHD)

nystagmus, tachycardia, psychomotor agitation, impulsiveness

y/depression, delusions, visual hallucinations

social withdrawal, dry mouth, hallucinations

SFX/other
pulmonary edema, dehydration, contraindicated in anuria and CHF

hyperchloremic (nAG) MAc, neuropathy, NH3 toxicity, sulfa

ototoxicity, hypokalemia, dehydration, interstitial nephritis
+ sulfa allergy and gout
hypokalemic MAlk, hyponatremia (low big 3), hyperglycemia, hyperlipidemia,
hyperuricemia (gout), hypercalcemia, sulfa allergy
hyperkalemia, MAc
endocrine SFx (antiandrogen, gynecomastia, amenorrhea)
hyperkalemia, MAc
cough (not ARBs), angioedema (lip/larynx edema), teratogen (renal damage),
proteinuria, taste change, hypotn, hyperK; NOT in bilateral renal a stenosis
(decrease GFR by preventing efferent constriction)

SFX/other
antiandrogen, N/V
masculinization in females, reduces intratesticular testosterone in males
(inhibits LH) causing gonadal atrophy, premature closure of epiphyseal plates,
raise LDL, lower HDL
gynecomastia
endometrial cancer, postmenopausal bleeding, VTE; contraindications: ERpositive breast cancer, hx of DVTs
teratogen (vaginal clear cell adenoC)
hot flashes, ovarian enlargement, multiple pregnancies, visual disturbances
endometrial carcinoma, hot flashes
unopposed estrogen RT increases the risk of endometrial cancer (P added),
possible increased CV risk
masculinization, premature epiphysial plate closure

heavy bleeding, N/V, anorexia, abdominal pain

headache, flushing, dyspepsia, impaired blue-green color vision, lifethreatening hypotn in pts taking nitrates
SFX/other
sedation, antimuscarinic, anti--adrenergic
less entry to CNS than 1G, so far less sedation

anti-DUMBBELSS
tachycardia

tremor, arrhythmia
narrow TI (OD=-blocker), cardio-/neuro-toxic, metabolized by P450

does not suppress cough reflex

Excess
acute: N/V/dizziness, blurred vision; chronic: hepatotoxicity, increased ICP,
papilledema, arthralgias, fatigue, headaches, skin changes, sore throat,
alopecia; teratogenic (cardiac abnormalities, cleft palate)
hypercalcemia (delerium, stupor, stones), loss of appetite; seen in sarcoid:
activated macrophages pump out vit D

cularization
facial flushing (tx of hyperlipidemia), acanthosis nigricans, hyperuricemia

Mechanism
peroxidation of membrane lipids

inhibits lipoic acid (pyruvate and -KG DH complexes)

electron transport inhibitor

electron transport inhibitor
inhibit alcohol dehydrogenase

inhibits Na/K ATPase (bind K site)

-amantin inhibits RNA Pol II
electron transport inhibitor
electron transport inhibitor
mitochondrial ATPase inhibitor
uncoupling agent
irreversible AChEI (AChE regenerated by atropine)

collagen one=90%, bONE, skin, tendon, dentin, fascia, cornea, late wound repair; II=cartilage, vitreus, n
III (reticulin)=skin, vessels, uterus, fetal tissue, granulation tissue (think Ehlers-Danlos); IV=BM
Kwashiorkor: protein malnutrition (lesions, belly); marasmus: energy malnutrition (wasting)
essential fructosuria: AR fructokinase def, fructose doesn't enter cells, asxatic except for fructosuria

fructose intolerance: AR aldolase B deficiency, F1P accumulation, depletion of P, inhibition of glycogenol

gluconeogenesis; sx: hypoglycemia, jaundice, cirrhosis, V; tx: no fructose/sucrose intake
galactokinase deficiency: AR, relatively mild, accumulation of galactitol (infantile cataracts), galactosuria
classic galactosemia: AR gal-1-P UT def; sx: infantile cataracts, FTT, jaundice, HM, retardation; tx: no lact

alkaptonuria (ochronosis): AR homogentisic acid oxidase def, degrades Tyr to fumarate; sx: mostly benig
black on standing, dark connective tissue/sclera, older get arthralgias (HGA toxic to cartilige)
MSUD: -ketoacid DH def, no degradation of branched AAs (Ile, Val, Leu); organic acidemia, sweet odor

homocystinuria (HCU): excess HC, C becomes essential, 3 forms (cystathione synthase deficiency [tx=hi
B12/folate/diet=hi cys low met], low affinity of cystathione synthase for B6 [tx=high B6], HC methyltrans
deficiency); sx: HCU, mental retardation, osteoporosis, kyphosis, marfanoid habitus, inferonasal sublux o
atherosclerosis (stroke, MI);; cystinuria: defect of renal tubular positive-AA transporter (cysteine, ornithin
arginine); sx: cystine kidney stones (staghorn); tx: acetazolamide (alkalinize urine)
fraGile X: 2nd most common cause of M retardation; (CGG) repeat, methylation and underexpression of F
macroochidism, long face, large jaw, big ears, MVP; karyotype in folate def medium=discontinuous stain

ionizing radiation causes dsDNA breaks, end-joining enzyme repair (no sequence homology necessary)
deamination causes abnormal bases, glycosylation makes AP site, AP endonuclease, DNA Pol, and ligase

UV makes T-T, UV-specific endonucleases cause site specific strand break, exonuclease removal, Pol/ligas
DNA Pol III has 3'-5' exonuclease proofreading activity for mismatch repair (def=HNPCC)
biotin for carboxylation rxns (pyruvate to OAA, [AAs to] propionyl CoA to succinyl CoA); def=organic acid
KG/P/KADH cofactors: B1, 2, 3, 5, lipoate (LA inhibited by arsenic [vomiting, rice water stool, garlic bre
PDH def: lactic MAc, neuro sx, hemolytic anemia; can be congenital or acquired (B1 def); tx=fatty/lys/leu
CF: AR CFTR (7) mutation (commonly Phe 508, abnormal folding, degradation), normally secretes Cl in lu
resorbs in sweat glands (high Cl in sweat=dxtic); infertility in M (bilateral agenesis of vas), mucus plugs
lungs (Pseudomonas/S. aureus, chronic bronchitis, bronchiectasis, panc insufficiency, ADEK malabs, FTT,
meconium in newborns); tx=N-acetylcysteine (breaks glycoprotein S-S bonds)

OTC def: XLR, most common urea cycle disorder (others AR), usually early onset (can be late), xs carbam
sx: orotic aciduria, low BUN, hyperNH3 (cerebral edema, blurry vision, tremor, V, speech slurring)

carnitine def: inability to transport LCFAs into mitochondria; sx: hypoketotic hypoglycemia, hypotonia, we
acyl-CoA DH def: hypoketotic hypoglycemia with dicarboxylic acid-emia/-uria (substrate of deficient enzy

embryonic craniocaudal segmentation caused by homeobox gene, AP-patterning from sonic hedgehog (f
Wnt-7 (from AER), limb lengthening induced by FGF (from AER, stimulates mesoderm mitosis)

notochord induces overlying ectoderm to neural plate; neural plate becomes neural tube and neural cres
notochord becomes nucleus pulposis of intervertebral disks; cardinal vv become SVC
allantois: contains umbilical aa & vv, urachus (bladder-yolk sac), vitelline duct (midgut-yolk sac, "yolk sta
erythropoiesis wk3-8=yolk sac (Gower Hb=22); wk6-30=liver and spleen (9-28, HbF); wk28+=bone ma

indomethacin helps close PDA, PGs (decrease with increase in O2) keep PDA open (PDA=continuous mur
neural tube defect: high AFP; anencephaly: high AFP, polyhydramnios (no swallowing center)

branchial apparatus cleft=ectoderm (1=external auditory meatus; 2-4 form temporary cervical sinuses,
arch=mesoderm, pouch=endoderm (1=ear, 2=tonsils, 3=thymus, 3/4=inf/superior parathyroid)
failure of fusion cleft lip=maxillary, medial nasal; palate=lateral palatines, medial palatine, nasal septum

wk6: midgut herniates through umbilical ring, returns and rotates around SMA wk10; gastroschisis=extru
contents through folds, not covered by peritoneum; omphalocele=into umbilical cord, peritoneal cover

wk6: midgut herniates through umbilical ring, returns and rotates around SMA wk10; gastroschisis=extru
contents through folds, not covered by peritoneum; omphalocele=into umbilical cord, peritoneal cover
pancreas: dorsal and ventral buds contribute to head, main duct; rest is only dorsal; fusion at wk8

metanephros appears wk5, ureteric bud from caudal end of mesonephros forms ureter, pelvices, calyces
and induces metanephric mesenchyme differentiation (glomeruli to DCT); ureteropelvic jctn=last site to
common site of obstruction causing fetal hydronephrosis

internal genitalia F=paramesonephric (Mullerian) duct, will fuse; M=mesonephric (Wolffian) duct; extern
tubercle=penis or clit/bulbs, UG sinus forms glands (including prostate), labioscrotal swelling forms cove
gubernaculum: F=ovarian/round lig, M=anchors testis; processus vaginalis becomes tunica in M (nothing
Down Sz: duodenal atresia, ASD, VSD, AVSD (endocardial cushion defect), Hirschsprung dz, AML, ALL; low

TNF/IL-1 inducers: teichoic acid (GP) and lipid A (GN); major Ag: peptidoglycan (GP) and LPS (GN)
GPR: "BaCCiLuM"=Bacillus, Corynebacterium, Clostridium, Listeria, Mycobacteria (mycolic acid in cell wa

intracellular obligate=Rickettsia, Chlamydia; facultative=Legionella, Neisseria, Mycobacteria (bird), Bruc

Listeria (cow), Francisella (rabbit), Yersinia (prairie dog), Salmonella (reptiles)
capsule (polysaccharide): S. pneumo, H. flu, N. meningitides, K. pneumo, Salmonella, B. anthracis (D-glu

virulence factors Protein A (S. aureus, binds Ig Fc), IgA protease (S. pneumo, H. flu, N. meningitides), M p
pyogenes, prevents phagocytosis); E. coli: fimbriae (pyelo/cystitis), H=flagella, K=capsule (meningitis, p
O=LPS; paramyxovirus: F-protein (causes respiratory epithelial cells to fuse to multinucleated cells)

exotoxins ADP-ribosylating: B=binding, A=active (enzymatic); C. diphtheriae/Pseudomonas exotoxin: in

cholerae (activates Gs), B. pertussis (inactivates Gi), E. coli heat labile toxin (directly) all stimulate aden
anthracis toxin ["edema factor"] is an adenylate cyclase); other exotoxins: C. perfringes ( toxin=lecithin
(inhibits GABA and glycine), C. botulinum (inhibits ACh release), S. pyogenes (streptolysin O, erythrog
Shigella/E. coli O157:H7 (cleaves 60S rRNA) [bold coded on phages]

endotoxin macrophages [IL-1 (fever), TNF (fever, hemorrhagic tissue necrosis), NO (hypotn)]; XII (coagul
and DIC); alternate complement pathway [C3 (hypotn, edema), C5 (chemotaxis), both anaphylactic]
S. pyogenes: rheumatic fever=subQ nodules, migratory polyarthritis, erythema marginatum, chorea, car
VDRL: Ab to beef cardiolipin, false positives=viral (EBV, hepatitis), drugs, rheumatic fever, lupus, leprosy
Weil-Felix rxn: anti-Rickettsia Abs (not Q-fever) agglutinate w/ Proteus O Ags; monospot=sheep RBCs

C. trachomatis serotypes: A-C=African follicular conjunctivits; L1-L3=lymphogranuloma venereum (ulcer

LAD); D-K=urethritis, subacute PID, ectopic, neonatal pneumonia/conjunctivitis

histo: in macrophages; blasto: broad-based buds; coccidioidomycosis: spherule (not yeast) in tissue; Can
pseudohyphae, germ tube at 37; M. furfur: "spaghetti and meatballs"; dermatophytes: mold hyphae on K
invasive in chronic granulomatous dz, acute-branching septate hyphae; C. neoformans: heavy capsule, y
based buds; Mucor/Rhizopus: irregular, non-septate hyphae, frontal lobe in DM

Plasmodia schizont to hepatocyte to merozoite to RBC to trophozoite, gametocyte to mosquito; headach

splenomegaly; malariae: 72hr cyclic fever; vivax/ovale: 48hr cycle, dormant hypnozoite in liver (tx=prim
falciparum: daily fever, RBC occlude capillaries (brain, kidney, lung); Babesia: maltese cross

vax live (no booster)=VZV, Sabins polio, MMR, smallpox, yellow fever; killed (only humoral immunity)=S
Rabies, flu, HAV; recombinant=HPV, HBV; H. flu=conjugated capsular polysaccharide/diphtheria toxoid

non-infxous genomes dsRNA (reo-) and (-) ssRNA (Always Bring Polymerase Or Fail Replication: Arena, Bu
Orthomyxo, Flavi, Rhabdo); segmented: Arena (2), Bunya (3), Orthomyxo (8), Reo (10)

exceptions RNA: nuclear replication=orthomyxo and retro, non-encapsulated=enterovirus: calici (norwal

hepe (HEV), picorna (HAV); DNA: encapsulated=hepadna (think of HCV/HDV, circular), herpes, pox

HepB HBe is in the core, indicates viral replication, high transmissibility; anti-HBe=low transmissibility; te
(infxn-mo2)=HBs; prodrome/acute (mo2-5)=HBs or anti-HBc; convalescent: early (equivalence/ window p
6.5)=anti-HBc, late=anti-HBs; HBe has a window period 1-2mo before HBs; vax=anti-HBs
HIV: env=gp120 (attachment to TC) and gp41 (fusion); pol=RTase; gag=p24 (capsid protein); CCR5 and

osteomyelitis: usually in children, bone pain and elevated APRs (CRP, ESR), S. aureus usually; can be N.
(usually from septic arthritis), P. aeruginosa (DM/IVDU), Salmonella (sickle cell), Pasteurella (bite)
UTI: dysuria, frequency, urgency, suprapubic pain, WBCs, no casts; leukocyte esterase=bacterial, NO 2-=G
saprophyticus, K. pneumo; nosocomial: Serratia, Enterobacter, Pseudomonas; Proteus=struvite stones

ToRCHeS jaundice, HSN, thrombocytopenia, growth retardation; Toxo: chorioretinitis, hydrocephalus, and
calcifications; Rubella: (PDA/pulmonary a stenosis, septal def), cataracts, deafness blueberry muffin ra
loss, seizures, petechial rash; HIV: recurrent infxn/diarrhea; HSV: temporal enceph-alitis; Syphilis: hydrop
abnormalities (saber shins, Hutchinson's teeth, saddle nose), CN VIII deafness
superficial vascular proliferation in HIV lymphocytes=Kaposi's, PMNs=bacillary angiomatosis, from Barto

Bug (special medium): B. pertussis (Bordet-Gengou agar), M. TB (Lowenstein-Jensen agar), H. flu (chocol
and X [hematin]), M. pneumo (Eaton's agar), N. gonorrhea (Thayer-Martin/VPN), C. diphtheriae (Tellurite
media), E. coli (EMB), yeast (Sabouraud's agar), Legionella (charcoal yeast extract, cysteine, Fe); Bugs (s
Trophyerma whippelii (PAS), C. neoformans (mucicaramine or India ink), Legionella/fungi (silver), acid fas
Borrelia/chlamydia/Plasmodium/trypanosomes (Giemsa)
bacterioSTaTEC: SMX, Trimethoprim, Tetracyclines, Erythromycin, Clindamycin, Chloramphenicol
non-dimorphic fungi mold: Aspergillus (acute angles), dermatophytes; yeast: C. neoformans (capsule), P
Candida=germ tubes @ 37C; mucor/rhizopus=nonseptate; coccidioides=spherule; histoplasma=intrace
ability to take environmental DNA=competence, SHiN; transduction=w/ viruses, lysogenic=specialized (
adenovirus: conjunctivitis, cystitis, febrile pharyngitis, pneumonia, intussusception (in young, older=mas

LNs paracortex: high-endothelial venules; cortex: BC; medulla: cords (lymphocytes, plasma cells), sinuse
Spleen red pulp: RBC; marginal zone: APCs; white pulp: follicles (BCs) and PALS (TCs); lymph drainage: a
line to internal iliacs, below pectinate line/superficial thigh/scrotum to superficial inguinals, testes to sup
plexuses to paraaortic

TC maturation precursor from bone marrow to thymus; CD4+CD8+TC in cortex, (positive selection), CMJ
medulla (negative selection, Hassall's corpuscles, epithelial reticular cells express AIRE, TC differentiate
lineage); TC activation CD8: 1=MHC1, 2=IL-2; CD4: 1=MHC2 from APC, 2=B7 (sensed by CD28)
Th1: induced by IL-12, regulates cell-mediated response, secretes IL-2, -3, and IFN-, inhibited by IL-10
Th2: induced by IL-4, regulates humoral response, secretes IL-3, -4, -5, -6, -10, inhibited by IFN-
BC: 1=IL from Th2, 2=CD40L; IL-4=IgG (crosses placenta) and IgE; IL-5=IgA (breast milk, mono-/di-mer);

complement C1-4=viral neutralization, C3b=opsonize, C3a or C5a=anaphylaxis, C5a=chemotaxis; defic

autoimmune protectors=C1 esterase (hereditary angioedema) and decay accelerating factor/GPI (PNH);
recurrent pyogenic sinus/RTI, increased type III hypersensitivity; C5-8=Neisseria bacteremia

cell surface proteins TC: TCR, CD3 (signal transduction, OKT-3 blocks), CD28 (signal 2), CD40L (only Th2)
BC: CD19 (on all BC lymphomas), CD20 (rituximab), CD21 (EBV), CD40 (signal 2), B7; macrophages: B7,
(endotoxin-R), FcR, C3bR, CCR5 (HIV, mutation=immunity); NK: CD56 (marker), CD16 (IgG Fc)
preformed Abs given after exposure to rabies, tetanus, HBV, botulinum toxin
Bruton's agammaglobulinemia: BTK defect (tyrosine kinase) blocks pre-BC to immature BC, normal pro-B
Hyper-IgM: defective CD40L on Th2, inability to class switch, causes severe pyogenic infxns early
selective Ig def: IgA most common, sinus/lung infxn, milk allergy, anaphylaxis w/ transfusion
common variable ID: BC maturation def, acquired in 20s, assn w/ autoimmune dzs, lymphoma, low Ig/pla
IL-12R def: Th1 def, low IFN-, causes disseminated mycobacterial infxn

hyper-IgE (Job's Sz): no IFN- causes no neutrophil response to chemotactic stimuli; sx: coarse facies, "co
retained primary teeth, hyper-IgE, derm problems (eczema, eg)
SCID: can be IL-2R def (most common, XL), adenosine deaminase def, MHC2 mutations; tx=marrow tran
ataxia-telangiectasia: DNA repair (ds breaks) def causes cerebellar defects, IgA def, and spider angiomas
Wiskott-Aldrich: XLR, deletion of B and TC; thrombocytopenic purpura, infxns, eczema; high IgE, IgA, low

leukocyte adhesion def: defect in LFA-1 integrin (CD18) on phagocytes (binds ICAM-1 on endothelium an
recurrent bacterial infxns, no pus formation, delayed separation of the umbilicus, neutrophilia

chronic granulomatous dz: NADPH oxidase def causes absent respiratory burst in PMNs, high susceptibili
positive organisms (S. aureus, E. coli, Aspergillus), negative nitroblue tetrazolium dye reduction test

apoptosis intrinsic: up Bax, down Bcl-2 cause increased mitochondrial permeability, cytochrome c releas
(CD95)-FasL or perforin/granzyme (+granulysin in CTC) attack; both cause Ca influx, activating caspases
basophilia/shrinkage (pyknosis), fragmentation (karyorrhexis), fading (karyolysis), blebs
granulation tissue: vascular, replaces fibrin in wound; granuloma: wall of macrophages, maintained by T
diapedesis rolling: E-/P-selectins (vessel) bind Sialyl-Lewis X (Leukocyte); tight binding: ICAM-1 (v) binds L
integrin, L); diapedesis: PECAM-1 (CD31, both); migration: bacterial products, C5a, IL-8, LT B4, Kallekrein
free radical injury: common in prematurity (retinopathy, BPD), drugs (Fe, acetaminophen, CCl 4), reperfus

ESR: inflammatory products coat RBC, cause aggregates (fall at higher rate); low=sickle cell, polycythem

tuberous sclerosis: AD, giant cell astrocytoma, angiomyolipoma, cardiac rhabdomyoma, adenoma sebace
hamartomas (CNS=seizures), ash leaf spots, shagreen patch; autoimmune diseases ass'd w/ lymphoma

tumor markers AFP: HCC, nonseminomatous germ cell tumors of testis; S-100: melanoma, neural tumor
hydatidaform mole, choriocarcinoma, gestational trophoblastic tumor; CA-125: ovarian, malignant epithe
tartrate-resistant acid phosphatase (TRAP): Hairy cell leukemia; CA-19-9: pancreatic cancer
chemical carcinogens aflatoxin (from Aspergillus): HCC; vinyl chloride: liver angiosarcoma; CCl 4: centrilob
fatty change; nitrosamines (smoked foods): stomach and esophagus; naphthalene/analine: bladder

chemical carcinogens aflatoxin (from Aspergillus): HCC; vinyl chloride: liver angiosarcoma; CCl 4: centrilob
fatty change; nitrosamines (smoked foods): stomach and esophagus; naphthalene/analine: bladder
Psammoma bodies: thyroid papillary adeno, ovarian serous papillary cystadeno, meningioma, mesothelio

mets to brain: lung>RCC>melanoma>breast>GI; liver: colon>stomach>panc>breast>lung; bone: prost

breast (blastic and lytic), lung (lytic), thyroid, testis, kidney

paraneoplastics Cushing's (ACTH): SCLC; SIADH (ADH): SCLC, intracranial tumor; hypercalcemia (PTHrP):
breast ca; polycythemia (erythropoietin): RCC, hemangioblastoma, HCC, pheo; Lambert-Eaton (Abs again
Ca channels at NMJ): thymoma, SCLC; gout or urate nephropathy (hyperuricemia due to excess nucleic a
leukemias and lymphomas; acanthosis nigricans: adenocarcinoma (usually stomach)

Pharm
infusion at constant-rate reaches steady state after 4-5*t 1/2 ; t1/2=0.7*(Vd/CL); 0-order: phenytoin, EtOH, a

efficacy: maximal effect a drug can produce; potency: amount of a drug needed for a given effect
NACh: ligand-gated Na/K ch, found in all ANS presynaptic ganglia and skeletal mm; MACh: GPCR, M1-5
GPCRs Gs: stimulates adenylyl cyclase, increasing cAMP, which activates PKA; Gi inhibits adenylyl cyclas
PLC which cleaves membrane PIP2 to IP3 (increases intracellular Ca) and DAG, both activate PKC

synapses ACh: vesamicol=packaging I, hemicholinum=reuptake I (choline), botulinum=release I; NE: res

packaging I, cocaine/TCA/amphetamine=reuptake I, guanethidine=release I; NE's presynaptic Rs: M2, AI

adrenergic agonism 1 causes increase in BP not 1 (2 effect stronger than 1, so if only , net drop
means that agonists drop BP via 2 and blockers also drop BP, via 2 and decreased CO])
CO=SV x HR; SV=EDV-ESV; MAP=CO x TPR=(2/3) x dias P + (1/3) x sys P; PP=sys-dias, is proportional to
O2 consumption = [a(O2)-v(O2)] x CO; during exercise, CO increases first from SV, then from HR

SV increased by high preload, low afterload, and high contractility (catecholamines [increase SR Ca pum
increased [Ca]in/[Ca]out, or digitalis [indirectly inhibit Na/Ca exchanger]; decreased in acidosis)
normally, EF>55%; isovolumetric contraction=highest O 2 consumption; resistance proportional to viscos

JVP: a wave=atrial contraction, c wave=RV contraction, v wave=systolic filling against closed tricuspid v

S2 splitting normal: A2 before P2, increased on inspiration; wide: A2 much before P2, small increase on i
pulmonic stenosis/RBBB; fixed: A2 always much before P2, no change on inspiration, from ASD; paradoxi
before A2, decreased on inspiration, from aortic stenosis/LBBB
S3: normal in children and pregnancy, abnormal in DCM, "slosh-ing-in"; S4: HCM, "a-stiff-wall"

murmur enhanced by decreased venous return (Valsalva, standing): MVP (lax chordae, but increased w/
HOCM (decreased filling, more obstruction, but decreased w/ hand grip, and no midsystolic click)
aortic stenosis: ejection click, pulsus parvus et tardus, LVP>>BP, later peaking (fastest flow rate) is wors
pacemaker AP phase 0=Cav, slow; no plateau; 4=slow diastolic depol as Na conductance increases (I f)

ECG 5x5 box=200ms x 0.5mV; atrial repol is under QRS; PR (beginning of P to beginning of QRS)<200ms
of Q to end of T)<400ms; QRS<120ms; U-wave: hypoK, hyperCa, hyperT4, bradycardia
AFib: irregularly irregular, no discrete P waves, II or IV and warfarin; AFlutter: sawtooth, IA, IC, III (cardiov

AV blocks 1: long PR, asxatic; 2, type I=Wenckebach: progressive PR lengthening until dropped beat, asx
dropped beats w/o change in PR, may lead to 3; 3=complete: A and V beat independently, tx=pacemake
ANP: high atrial P, dilates renal afferents, constricts efferents (cGMP) causing aldo-independent diuresis
aortic arch responds only to high BP; carotid and aortic bodies respond to pO 2, pCO2, and pH; central onl
pCO2 and pH, not pO2 (causes Cushing's triad: high ICP constricts arterioles causing ischemia, causing re
bradycardia, respiratory depression)

cyanotic ToF: pulmonary stenosis (prognostically most important), RVH, overriding aorta, VSD, "boot-shap
CXR, cyanotic spells (improved w/ squatting, decreases R to L shunt); ToGV: failure of AP septum to spira
systemic and pulmonary circulations (aorta leaves RV), incompatible w/ life unless mixing (VSD, big ASD
maternal DM; truncus arteriosus: AP septal agenesis; tricuspid atresia: no AV connection, causes hypopla
ASD and VSD; TAPVR: pulmonary vv drain to RA, requires ASD
late cyanosis Eisenmenger; VSD (commonest CHD)>ASD>PDA (uncorrected can cause differential [LE] c

aortic coarctation infantile: preductal, assn w/ Turner's, weak femoral pulses; adult: postductal, rib notch

arteriosclerosis Monckeberg: medial calcifications (esp radial or ulnar), no obstruction; arteroilosclerosis:

thickening of small aa (htn, DM), hyperplastic "onion-skin" in malignant htn; atherosclerosis: elastic, L-M
endothelial dysfunction causes macrophage/LDL accumulation, forms foam cells (make fatty streaks), PD
induce smooth mm migration making a fibrous plaque and complex atheroma

MI complications CHF (most deaths), arrhythmia (common acutely, through first few days), rupture (wall,
muscle, day 3-5=maximal), aneurysm formation, fibrinous pericarditis (3-5d post-MI), Dressler's sz

dilated/congestive/eccentric CM: from adriamycin, wet Beriberi, Cocksackie myocarditis, cocaine, Chagas
daunorubicin, EtOH; HCM: Freidrich's ataxia; restrictive/obliterative CM: granulomatous, hemochromatos
fibroelastosis (<2yo, assn w/ viruses [esp mumps and Cocksackie]), Loffler's Sz (eosinophils)

non-Staph endocarditis: infectious (S. bovis=colon cancer, culture negative=HACEK [H. flu, Actinobacillu
Cardiobacterium, Eikenella, Kingella], Pseudomonas or Candida in IVDU) or non (Libman-Sacks [SLE, war
marantic [hypercoagulable, as in Trousseau's])
Kussmaul's sign: increased JVD on inspiration; RHF, constrictive pericarditis, restrictive CM (not tampona

acute pericarditis: sharp pleuritic pain, better on leaning forward, friction rub; from MI, RF, virus, uremia;
constrictive pericarditis: rapid jugular y-descent (spiked down), pericardial knock, pulsus paradoxus
tamponade: diastolic P equilibration of all chambers; sx: hypotn, JVD, distant heart sounds, pulsus parad

pulsus paradoxus systemic BP drops by >10mmHg during inspiration; 1. increased pulmonary capacity/l
2. increased RV filling causes septal deviation and reduced LV filling (pericarditis, tamponade); 3. highl
intrathoracic P decreases transmural P, increasing afterload (asthma, COPD, croup, apnea)

RF: Ab to M protein of S. pyogenes; subQ nodules, polyarthritis (migratory), erythema marginatum, cardi
Anitschkow's cells (activated histiocytes) coalesce to form Aschoff bodies (giant cells w/i granuloma)

benign vascular tumors hemangiomas: strawberry (infancy, spontaneously regress), cherry (elderly, doe
pyogenic (polypoid capillary hemangioma, can ulcerate and bleed, assn w/ trauma and pregnancy); othe
hygroma (cavernous lymphangioma of neck, assn w/ Turner's sz), glomus tumor (painful, red-blue under
smooth mm), bacillary angiomatosis (Bartonella henselae, PMNs)
malignant vascular tumors angiosarcoma (liver, highly lethal, assn w/ vinyl chloride, As, Thorotrast [ThO
lymphangiosarcoma (caused by persistent lymphedema, post-radical mastectomy, eg), Kaposi's (lympho
CABG LAD only=L internal mammary (thoracic); multiple=great saphenous (medial foot to inf. pubic tube

neurophysins=carrier proteins from hypothalamus to posterior pit; -subunit identical for TSH, FSH, LH,
pancreas: more endocrine cells in tail, s peripherally, s centrally, s interspersed; TRH -[+]> TSH and

insulin inhibits glucagon release, increases glucose transport (GLUT-4=insulin-responsive, in adipose and
GLUT-1=RBC and brain; GLUT-2=liver, small intestine, cornea, kidney, -cells), increases Na retention, in
K uptake; enters -cell via GLUT-2, aerobic respiration (RLS=glucokinase), ATP binds to K channel and cl
depolarization and Ca channel opening, causing exocytosis of insulin

DM type 1: assn w HLA-D3/4, anti-glutamate decarboxylase Abs; acute sx: DKA (higher insulin requireme
causes ketosis; Kussmaul breathing, N/V, abd pain, psychosis/delerium, dehydration, fruity breath odor, A
hyperkalemia [depleted intracellular]); chronic sx: small vessels (BM thickening causing retinopathy, neo
glaucoma, nephropathy [nodular sclerosis, proteinuria, CRF, htn, Kimmelstiel-Wilson nodules]), large ves
gangrene), osmotic damage (neuropathy, sorbitol cataracts)

adrenals vertical: chlsl -[desmolase]-> /(17-OH)/pregnenolone -[3-OHsteroid DH]-> /(17-OH)/progestero

> 11-deoxycorti-/(sol)/costerone -[11--OHase]-> corti-/(sol)/costerone -[aldo synthase]-> aldo; DHEA to
(can be converted peripherally to estrone and estradiol) to testosterone (converted by 5-reductase to D
to estradiol); desmolase activated by ACTH, inhibited by ketoconazole

cortisol: increases gluconeogenesis, lipolysis, proteolysis, and -1 on arterioles (maintains BP), decrease
and immune function, anti-inflammatory; excess tested by dexamethasone suppression test

hyperaldo primary=Conn's: aldo-secreting tumor, htn, hypokalemia, MAlk, may be bilateral; secondary: a
to perceive low V (renal artery stenosis, CHF, CRF, cirrhosis, nephrotic sz), so secretes high renin

adrenal insufficiency 1: (acute=Waterhouse-Friderichsen Sz: hemorrhage from N. meningitidis sepsis, D

usually chronic=Addison's dz: can be from atrophy or destruction, def of aldo and cortisol, sx=hypotn, hy
skin hyperpigmentation (from high ACTH binding to MSHRs); 2: low CRH or ACTH production: no skin hy
no hyperK; corticosteroid withdrawal can cause acute or chronic insufficiency

neuroblastoma: kids, can be anywhere along sympathetic chain, elevated HVA in urine, less likely to hav
myc=worse prognosis; pheo: adults, high urine VMA, episodic htn, headache, perspiration, palpitations, t
pallor, assn w/ NFM, MEN 2A/B, 10%: malignant, bilateral, extra-adrenal, calcify, kids, familial
PTH chief cells of paraT, PTH inhibited by low Mg (diarrhea, rxs [AG, EtOH, diuretics]); renal PO 4 resorptio
renal Ca resorption (DCT), stimulates osteoblasts (secrete RANK-L [stimulates osteoclasts, ups bone reso
blood Ca and PO4] and M-CSF), stimulates kidney 1-OHase (inhibited by calcitriol)
vit D D2=ergocalciferol, from plants; D3=cholecalciferol, from sun, 24,25-(OH)2 vit D=inactive; 1,25-(OH)2
increases intestinal Ca and PO4 absorption and stimulates osteoblasts in the same way as PTH

hyperPTH 1: usually adenoma, hypercalcemia, stones, hypoPO4, high alk phos, high cAMP in urine, can
fibrosa cystica (cystic bone spaces filled w brown fibrous tissue); 2: decreased gut Ca absorption, high p
(usually from chronic kidney failure) causes hyperplasia, sx=hypocalcemia, hyperPO4, high alk phos; 3
hyperPTH from chronic renal dz, hypercalcemia; 2/3 can cause renal osteodystrophy

hyperPTH 1: usually adenoma, hypercalcemia, stones, hypoPO4, high alk phos, high cAMP in urine, can
fibrosa cystica (cystic bone spaces filled w brown fibrous tissue); 2: decreased gut Ca absorption, high p
(usually from chronic kidney failure) causes hyperplasia, sx=hypocalcemia, hyperPO4, high alk phos; 3
hyperPTH from chronic renal dz, hypercalcemia; 2/3 can cause renal osteodystrophy

hypoPTH usually from accidental excision, autoimmune, or DiGeorge; hypocalcemia, tetany, Chvostek's s
facial n causes mm contraction), Trousseau's sign (occlusion of brachial a w/ BP cuff causes carpal spasm
pseudohypoPTH=Albright's hereditary osteodystrophy: AD kidney unresponsiveness to PTH
calcitonin: parafollicular (C-) cells of thyroid, decrease bone resorption of Ca, not important physiological

DI no ADH response, USG<1.006, serum>290mOsM; central (from supraoptic nuc): pit tumor, trauma, su
histiocytosis X, responds to desmopressin; nephrogenic: hereditary, 2 to hypercalcemia, demeclocycline
respond to desmopressin; ADH responds to Osm before V, acts in medullary collecting duct

SIADH: excessive water retention, hypoNa, urine Osm>serum Osm, low aldo; can be from ectopic produc
trauma, pulmonary dz, or rxs (carbamazepine, cyclophosphamide); tx=demeclocycline, water restriction
pit adenoma usually PRL (amenorrhea, galactorrhea), then GH (insulin resistance, dx=glucose suppressio

NET: most common tumor of appendix, secrete 5-HT, high 5-HIAA in urine, 1/3 (met, multiple, present w/
malignancy); carcinoid sz: recurrent diarrhea, cutaneous flushing, asthmatic wheezing, R-sided valvular d
metastatic NETs from small bowel, not seen if tumor vessels go to liver (5-HT eliminated first pass)
Zollinger-Ellison Sz: gastrin-secreting tumor of pancreas or duodenum, acid hypersecretion, thickened ru
ulcers, assn w/ MEN 1; VIPoma: panc tumor, copious diarrhea (sphincter relaxation, H 2O excretion)

fetal umbilical vein becomes ligamentum teres (in falciform), hepatoduodenal lig contains portal triad
submucosal plexus=Meissner's; myenteric plexus=Auerbach's (inner circular, outer longitudinal mm fibe

duodenum: Brunner's (submucosal) glands, crypts of Lieberkuhn (continue into ileum); [goblet cells] high
aorta: T12=celiac; L1=SMA, renal aa (L=lower); L2=gonadal aa (L=higher); L3=IMA; L4=bifurcation

short gastric aa: from splenic a, supply fundus, poor anastamoses; block of abdominal aorta can use thes
S epigastric (internal thoracic) to inf epigastric (external iliac), S pancreaticoduodenal (celiac) to inf. PD (
colic (SMA) to left colic (IMA), superior rectal (IMA) to middle rectal (internal iliac)
femoral lateral to medial to find NAVEL; triangle (made of SAIL) has all, but sheath doesn't contain the ne

hernias diaphragmatic: (congenital=pleuroperitoneal membrane defect), usually hiatal (stomach; sliding

displaced] or paraesophageal [cardia into thorax]); direct: through inguinal (Hesselbach's) triangle (med
epigastric a), goes through external inguinal ring; indirect: M>F, congenital, through deep inguinal ring,
processus vaginalis to close, can form hydrocele; femoral: F>M, thru femoral canal

saliva parotid (serous), sublingual (mucinous); stimulated by parasympathetic (VII, IX) and superior cervi
3); -amylase/ptyalin (-1,4 hydrolysis get disaccharides [maltose & -limit dextrins], inactivated by low pH), bicarb
(lubrication), antibacterial, epithelial GFs; low flow rate=hypotonic (reabsorb NaCl)

salivary gland tumors usually in parotid; pleomorphic adenoma: most common, painless, movable, high
recurrance; Warthin's tumor: benign, heterotopic salivary tissue in LN; mucoepidermoid carcinoma
gastric acid secretion: H/K ATPase, H produced by carbonic anhydrase, bicarb exchanged for Cl basolater

pancreas -amylase & lipase secreted in active form, colipase (activated by trypsin) necessary for lipase to be effe
kinase/-peptidase (duodenal excretion) activates trypsinogen, which activates all proteases

oligosaccharides: hydrolases at brush border of intestine, RLS in carb digestion, makes monosaccharides
glucose and galactose by SGLT1 (Na dependent), fructose by GLUT-5; all basolaterally use GLUT-2
Peyer's patches: unencapsulated, specialized M cells take up Ag, BCs differentiate to IgA-secreting; bile:
conjugated to glycine or taurine), phospholipids, chlsl (only method of excretion), bilirubin, water

esophagus varices: painless bleeding of submucosal veis; achalasia: loss of myenteric plexus, NO implica
CREST; Mallory-Weiss Sz: mucosal lacerations at GE jctn from severe vomiting (alcoholics, bulemics), hem
Boerhaave Sz: transmural esophageal rupture from violent retching; Plummer-Vinson: webs (dysphagia),
anemia; Barrett's: intestinal metaplasia; esophagitis: from bisphosphonates

esophageal cancer risk factors: achalasia, Barrett's, cigarettes, diverticuli, EtOH/esophageal web/esopha
common worldwide) mostly upper-middle 1/3, adenoca (most common US) mostly lower 1/3

malabsorption abetalipoproteinemia; pancreatic insufficiency: CF, obstruction, chronic panc; disaccharida

diarrhea, can be self-limited after insult; Whipple's dz; tropical sprue: similar to celiac sprue, but respond
affects whole small bowel; celiac sprue: auto-Abs to gluten (gliadin, prolamin) and TTG (tissue transgluta
blunting of vili, crypt hyperplasia, and lymphocyte infiltrate (lamina propria) in proximal bowel, associate
herpetiformis and increased risk of TC lymphoma

gastritis acute/erosive: NSAIDs (RA), EtOH, uremia, burns (Curling's), brain injury (Cushing's); chronic: ty
(body/fundus: Abs to parietal cells) and type B (antrum: most common, H. pylori infxn, increased risk of M

PUD clean margins; gastric: decreased mucosal protection, greater pain w/ meals, H. pylori in 70%; duod
gastric secretion and decreased mucosal protection, pain decreased with meals, H. pylori in 100%

stomach cancer: 95% adenoca, early spread locally and mets to LNs/liver (Virchow's node=L supraclavic
Krukenberg's tumor=bilateral mets to ovaries; Sister Mary Joseph's nodule=subQ periumbilical met); ass
nitrosamines, achlorhydria, chronic gastritis; signet ring cells, acanthosis nigricans; linitis plastica=diffus

appy: kids=lymphoid hyperplasia after viral infxn, adults=fecalith; ddx: ectopic, Y. enterocolitis, diverticu
fever, leukocytosis, BRBPR, can cause colovesical fistula [pneumaturia, cystitis], peritonitis; tx=abx)

Meckel's diverticulum: most common congenital GI anomaly, yolk stalk persistence, 2" long, 2' from ileoc
pop, commonly presents in first 2y, may contain 2 mucosae (gastric/panc); dx=pertechnetate study
intussusception: usually kids (adenovirus), in adults=intraluminal tumor; volvulus: usually elderly

Hirschsprung dz: failure of neural crest cells to migrate, causes congenital megacolon, always involves re
angiodysplasia: tortuous dilation of vessels, bleed; usually ileum/R-sided, older pts

polyps 90% are non-neoplastic; neoplastic: adenomatous, villous, juvenile polyposis sz, Peutz-Jeghers Sz
hamartomas throughout GI, hyperpigmented mouth, lips, hands, genitals, increased risk of CRC), FAP (AD
pancolonic, always involves rectum; Gardner's, Turcot's), HNPCC (aka Lynch Sz, AD DNA mismatch repair
involves proximal colon); distal=obstruction, hematochezia; proximal=dull pain, anemia

CRC: higher risk with IBD, S. bovis sepsis, use CEA tumor marker; 1. microsatellite instability (by mismat
mutations); 2. APC mutation (decreased cellular adhesion, increased prolif via -catenin), KRAS mutation
intercellular signal transduction) causes adenoma, loss of p53 marks carcinoma
micronodular cirrhosis: <3mm nodules, from metabolic insult (EtOH, macrolides); macronodular: >3mm
significant liver injury causing hepatic necrosis (infxn, halothane, acetaminophen, valproate), HCC

EtOH hepatic steatosis: moderate intake causes short term, macrovescicular change, reversible; hepatiti
EtOH, swollen/necrotic hepatocytes, PMN infiltrates, Mallory bodies (intracytoplasmic eosinophilic inclusi
rope"); cirrhosis: micronodular "hobnail", sclerosis around central vein (zone III)
HCC: jaundice, tender HSM, ascites, hypoglycemia, polycythemia, Budd-Chiari; spreads hematogenously

1-AT def: misfolded gene product, decreased elasticity of lungs (panacinar emphysema) and PAS-positi
the liver (cirrhosis and liver failure); codominant trait

hemochromatosis=dz caused by hemosiderosis (Fe deposition)=micronodular cirrhosis, "bronze diabetes

pigmentation), CHF, HCC; may be 1 (AR HFE mutation, transferrin R on basolateral enterocyte, binds pla
to sense blood Fe concentrations, adjust abs) or 2 (chronic transfusions); assn w/ HLA-A3

biliary tract dz sx=pruritis, jaundice, dark urine, light stools, HSM; labs=high direct bilirubin, chlsl, GGTP,
idiopathic concentric "onion skinning" fibrosis causes "beads on a string" of any bile ducts, assn w/ hype
colitis; PBC: anti-mitochondrial Abs causes PMN infiltrate, granulomas; SBC: high intraductal pressure fro
causes fibrosis and stasis, complication=ascending cholangitis

cholelithiasis 4Fs, high chlsl/bilirubin, low bile salts, stasis; chlsl: 80% of stones, radiolucent (but 15% are
pigment: radiopaque, assd w/ chronic hemolysis, alcoholic cirrhosis, biliary infxn (Clonorchis, Salmonella
cholecystitis (Murphy's sign), ascending cholangitis (Charcot's triad: jaundice, fever, RUQ pain), pancreat
(can be painless in DM), fistulas, gallstone ileus (usually ileocecal jctn)

eosinophils: major basic protein (anti-helminth), histaminase and arylsulfatase (limit reaction after mast
degranulation); eosinophilia=NAACP: neoplasm, allergy, asthma, collagen vascular dz, parasites (Loffler'
basophil: granules of heparin, histamine, and vasoactive amines (LT); mast cell: + eosinophil chemokine
agranulocytosis=granulocytopenia: PTU/methimazole, colchicine, carbamazepine, clozapine, dapsone
platelet plug formation vWF binds subendothelial collagen, platelets bind vWF (GpIb), release dense gran
[necessary for coagulation cascade], ADP [helps platelets adhere to endothelium and induces GpIIb/IIIa t
surface]), fibrinogen binds GpIIb/IIIa, links platelets; aggregation: pro=TXA 2 (platelets), anti=PGI2

coagulation cascade XIIa activates XI and prokallikrein; kallikrein=serine protease, breaks down HMWK (
bradykinin [vasodilation, pain]) and plasminogen (to plasmin, which activates C3a and degrades fibrin);
phospholipid needed for all factor activation but XII, VIII, V, and I; IIa=thrombin, Ia=fibrin; protein S activ
which inactivates Va, VIIIa; tPA + vWF from endothelial cells, vWF protects VIII
coagulopathy hemophilia: A=VIII, B=IX; vit K def/warfarin=loss of cofactor for -carboxyglutamation rxn,
IX, X, C, S; Bernard-Soulier: GpIb def; Glanzmann thrombasthenia: def GpIIb/IIIa; ITP: anti-GpIIb/IIIa Abs, i
megakaryocytes; TTP: ADAMTS 13 def (vWF metalloprotease), vWF multimers, clots, schistocytes, penta
fever, thrombocytopenia, microangiopathic hemolytic anemia; vW dz: mild, AD; factor V Leiden: Va resist
def: risk of thrombotic skin necrosis/hemorrhage w warfarin

DIC causes: sepsis (GN), trauma, OB complications, acute pancreatitis, malignancy, nephrotic sz, transfu

microcytic hypochromic anemia MCV<80, basophilic stippling of RBCs; Fe deficiency (duodenal abs), ane
dz, thalassemia (: 3 mutations=HbH (4); : high HbF, minor [asxatic, high HbA2] or major [severe ane
hemochromatosis, marrow expansion, chipmunk facies]), Pb poisoning, sideroblastic anemia

macrocytic anemia MCV>100, macroovalocytic RBCs, impaired DNA synth; megaloblastic: hypersegmen
glossitis, high homocysteine; folate def: jejunal abs, normal methylmalonate, seen w/ MTX, TMP, hemoly
pregnancy; B12 def: Schilling test, ileal abs, D. latum, causes neuro sx (subacute combined degeneration
columns, peripheral nerves, lateral corticospinal, dementia), koilonychia; also orotic aciduria, phenytoin,
nonmegaloblastic: liver dz, alcoholism, reticulocytosis, metabolic disorder (nucleotide synthesis def, orni
transcarbamoylase def), AZT, 5-FU, flucytosine, hydroxyurea

normocytic, normochromic anemia aplastic anemia (destruction of myeloid stem cells causes severe pan
normal cell morphology, hypocellular marrow with fatty infiltrate; radiation, drugs [benzene, chloramphe
PTU/methimazole, antimetabolytes], viral [B19, EBV, HIV, HCV], Fanconi's anemia [congenital], idiopathic
mediated, may follow acute hepatitis]), kidney dz, anemia of chronic dz, HA

abnormal RBCs acanthocyte: liver dz (abetalipoproteinemia); target cell: high SA:V ratio (high membrane
heme=HbC, asplenia, liver dz, thalassemia); Heinz bodies: ferric heme pption, in -thalassemia, G6PDD
porphyria glycine + succinyl-CoA -[B6, -ALA synthase, RLS (sideroblastic anemia)]-> -aminolevulinic a
[-ALA dehydratase (Pb poisoning)]-> porphobilinogen -[porphobilinogen deaminase (acute intermittent
>hydroxymethylbilane->uroporphyrinogen III-[uroporphyrinogen decarboxylase (porphyria cutanea tarda
coproporphyrinogen III -> protoporphyrin -[+ Fe, ferrochelatase (Pb poisoning)]-> heme (feeds back onto
synthase); porphobilinogen & uroporphyrinogen are converted to uroporphyrin

P. cutanea tarda: most common, tea-colored urine, blistering cutaneous photosensitivity; acute intermitt
colored urine, abd pain, polyneuropathy, psych disturbances, ppted by rxs, tx=glucose and heme

Hodgkin's: contiguous spread through nodes, constitutional B sxs, mediastinal LAD, M>F, good prognosis
few Reed-Sternberg cells (binucleate, "owl eye", CD30+, CD15+); nodular sclerosing (most common, RS
collagen banding surrounding nodules), mixed cellularity (more RSCs), lymphocyte predominant (rare), ly
depleted (very rare, high RS to lymphocyte ratio, older men, poor prognosis)
lymphoma diffuse large cell lymphoma: most common NHL, usually in elderly (20% kids), mostly BC (20%
Burkitt's: young, starry sky appearance (sheets of lymphs, interspersed macrophages); mantle cell: olde
CD5+; follicular: bcl-2, indolent; TC: adult TC: HTLV1, aggressive, cutaneous lesions; Sezary sz

multiple myeloma: commonest 1 bone tumor, monoclonal plasma cell (fried egg), IgG>IgA, infxn-prone
lesions (hypercalcemia), M-spike, anemia, renal failure (Bence Jones proteins, AL [1 amyloid]), rouleaux
Waldenstrom's macroglobulinemia: hyperIgM, hyperviscosity sx; MGUS: monoclonal expansion, no sx

ALL: kids, marrow involvement/mediastinal mass, lymphoblasts, TdT+ (pre-T/-BC), CALLA+, therapy resp
t(12;21)); hairy cell: middle aged; CLL: >60yo, asxatic, smudge cells in smear; Small LL: no lymphocytos

AML: Auer rods (fused granules), myeloblasts; AML M3: responds to all-trans vit A (induces differentiation
Philadelphia chromosome=t(9;22), bcr-abl, granulocytosis, metamyelocytes, SM, can have blast crisis (A
alk phos (differentiate from leukemoid rxn), responds to imatinib (TK inhibitor)
Langerhans cell histiocytosis: S-100+, CD1a+, Birbeck granules (tennis rackets) on EM; can cause DI
chronic myeloproliferative disorders (other than CML) all have JAK2 mutations in stem cell; polycythemia
in early cell, pancytosis; essential thrombocytosis: specific for megakaryocytosis; myelofibrosis: fibrotic o
marrow, teardrop RBCs, anemia, platelets/WBCs variable, megakaryocytes implicated

zona occludens: claudins & occludins; zona adherens (intermediate jctn): below occludens, cadherins bin
dependent); macula adherens (desmosome): cadherens bind intermediate filaments; integrins to BM

rotator cuff: supraspinatus (abduction before deltoid, most common cuff injury), subscapularis (adduction
rotation), infraspinatus and teres minor (adduction and lateral rotation)

other nerve lesions Erb's palsy (waiter's tip): upper trunk (C5-6), paralysis of abductors, lateral rotators,
pronated); posterior cord; deltoid paralysis + wrist drop; long thoracic n: winged scapula; thoracic outlet
Klumpke's palsy and disappearance of radial pulse on moving head ipsilaterally

other nerve lesions Erb's palsy (waiter's tip): upper trunk (C5-6), paralysis of abductors, lateral rotators,
pronated); posterior cord; deltoid paralysis + wrist drop; long thoracic n: winged scapula; thoracic outlet
Klumpke's palsy and disappearance of radial pulse on moving head ipsilaterally

skeletal/cardiac mm contraction nAChR causes depol, travels down T-tubule, activates DHPR, lets in Ca,
ryanodine R on SR, more Ca release, Ca binds troponin C, moves tropomyosin from myosin-binding sites
bands shrink, A doesn't; type 1=slow, red; type 2=fast, white (hypertrophy, don't switch)
smooth mm contraction membrane depol, Cav (DHP, L-type) open, Ca binds calmodulin, activates myosin
kinase (MLCK), P-ation, cross bridge formation; cGMP inhibits MLCK, MCLPhosphorylase inactivates

achondroplasia: constitutive FGFR3 inhibits chondrocyte prolif, failure of long bone growth (endochondra
short limbs), membranous ossification fine (big head); AD, but 85% sporadic (hi paternal age)
nl bone labs osteoporosis: reduction of spongy bone mass despite normal bone mineralization; I=menop
vertebral crush fracture, femoral neck, distal radius (Colle's); corticosteroids, heparin, homocystinuria

nl bone labs (cont'd) osteopetrosis: carbonic anhydrase II def, no osteoclast fctn, failure of nl resorption,
to breaks), pancytopenia (low marrow space, extramedullary hematopoiesis), CN impingement

high alk phos Paget's dz (osteitis deformans): increased osteo-clast, then -blast activity causes "mosaic"
architecture, possibly viral origin (paramyxo-), chalk-stick fractures, AV shunts (high-output cardiac failur
(increased hat size, CN impingement, 2 osteosarcoma/fibrosarcoma); also think 1 hyperPTH

osteomalacia/Rickets: defective mineralization, from vitamin D def, usually high PTH, alk phos, low Ca an

polyostotic fibrous dysplasia: fibroblasts, collagen, and irregular trabeculae replace bone; McCune-Albrig

OA: mechanical destruction of articular cartilage, ; sx: pain after use, medial before lateral, no systemic s
inflammatory); can get subchondral cysts, osteophytes, Heberden's nodes (DIP), Bouchard's nodes (PIP)

RA: synovial joints, MCP/PIP pannus formation, subQ nodules (fibrinoid necrosis surrounded by palisading
DIP INVOLVEMENT, ulnar deviation, subluxation, Baker's cyst; type III hypersensitivity, 80% rheumatoid f
IgG; anti-CCP=less sensitive, more specific), HLA-DR4; improves w/ use, systemic sx
seronegative spondyloarthropathies no RF, assn w/ HLA-B27, M>F; psoriatic arthritis: pencil-in-cup, dacty
fingers), minority of psoriatic pts; ankylosing spondylitis: spine and sacroiliac inflammation, bamboo spin
regurg; IBD; Reactive arthritis: conjunctivitis/uveitis, urethritis, arthritis

Sicca sz: dryness, chronic bronchitis, reflux esophagitis; Sjogren's: dry eyes/mouth, arthritis, anti-RNP (Ro
gout: MSU crystalization in joints (negatively birefringent=yellow crystals on parallel), M>F, 90% from un
(diuretics), 10% overproduction (Lesch-Nyhan, PRPP excess, high cell turnover, von Gierke's Dz); sx: asym
red, painful, big toe MTP (podagra), tophi in external ear, olecranon bursa, Achilles), attacks common aft
EtOH binge; acute=NSAIDs, colchicine; chronic=allopurinol, uricosurics

pseudogout: CaPP crystals (blue when parallel, rhomboid, weakly positively birefringent), large joint (kne
infectious arthritis septic: S. aureus, Strep, N. gonorrhea common, monoarticular, migratory, can be syno
affect tendons (tenosynovitis); chronic: TB, Lyme

SLE 90% F 14-45, black, die of renal failure and infxn; wire-loop kidney lesions (nephritic), false positive
antiphospholipid Ab="Lupus anticoagulant", pro-thrombotic in vivo, causes miscarriages), assn w/ Rayna
endocarditis, hilar LAD; sx: skin (malar, discoid, photosensitivity, mucositis), organ (neuro, renal, serositi
arthritis), and lab tests (anti-phospholipid, ANA [sensitive, not specific], anti-Smith [specific, not prognos
[specific, bad prognosis], anti-histone [drug-induced])

sarcoid: immune-mediated non-caseating granulomas, elevated ACE levels, hypergammaglobulinemia, a

uveoparotitis, hypercalcemia (macrophage-production of 1-hydroxylase), Schaumann (giant cell inclusi
granulomas, calcium and protein, concentric whorls) and asteroid bodies (urchin-like); tx=steroids

connective tissue dzs polymyalgia rheumatica: stiffness/pain in shoulders/hips (NO weakness), malaise,
labs nl (high ESR), assn w/ giant cell arteritis; polymyositis: CD8 TC injury to myofibers, symmetric progr
mm weakness (shoulders), high CK, aldolase, positive ANA, anti-Jo-1; dermatomyositis: polymyositi
papules (extensor surfaces), mechanic's hands, malar/shawl/heliotrope (racoon eyes) rash, high risk of m
dx=mm biopsy w/ evidence of perifascicular inflammation; tx=steroids

scleroderma: excess fibrosis and collagen deposition; CREST=anti-centromere, diffuse=anti-topoisomera

non-infxous derm atopic dermatitis (eczema): pruritic eruption, usually in flexures; ephelis: freckle; psori
(spinosum hyperplasia), parakeratosis (retained nuclei in corneum), hyperkeratosis (thickened corneum)
granulosum, Auspitz sign; albinism: normal # of melanocytes; vitiligo: decreased # of melanocytes; mel
hyperpigmentation assc'd w/ pregnancy/OCP; pemphigus vulgaris: anti-desmosome, reticular IF, acantho
sign (skin separates on stroking); bullous pemphigoid: linear IF stain, eosinophils, spares oral mucosa; de
herpetiformis: IgA deposits; eryhtema multiforme: drugs (sulfa, -lactams, phenytoin) or infxn (HSV, M. p
planus: sawtooth infiltrate of lymphs at dermal-epidermal jctn, pruritis, purple, assn w/ hep C; erythema
panniculitis, ant. shins, assc'd w/ coccidioi-, histoplasma, TB, leprosy, strep, sarcoid; keratoses: actinic=p
seborrheic=benign neoplasm; acanthosis nigricans: hyperinsulin, visceral malign'cy, B3; pityriasis rosea:
pine tree
photosensitivity: sulfonamides, amiodarone, tetracyclines, SLE, porphyria cutanea tarda, Weil's Sz

gingival hyperplasia: anti-epileptics (phenytoin), CCBs, cyclosporin, vitamin C deficiency, I-cell dz

Breakdown products: (HuMVee DEN) DA to HVA, NE to VMA (vanillylmandelic acid), Epi to metanephrine
UMN lesion: spastic paralysis, clasp-knife spasticity, no atrophy; LMN: fasciculation (twitching), atrophy
pain/T: C-fibers=unmyelinated, A=lightly myelinated; large myelinated: Meissner (dynamic fine touch,
Pacinian (vib/pressure, lower dermis), Merkel's disk (small, around hair follicles, static touch)

spinal cord goes to L1-2, subarachnoid goes to S2, LP usually L3-4/4-5 (level of cauda equina)
basal nucleus of Meynert (substantia innominata): ACh-rich, degenerate in Alzheimer's and Huntington's
nucleus accumbens: GABA synthesis, central in reward, pleasure, addiction, low in anxiety and Huntingto
BBB: infarct destroys endothelial tight jctns, causing vasogenic edema; no BBB in OVLT (organum vascul
lamina terminalis), area postrema, or neurosecretory areas (pit, eg), all 3 act on hypothalamus

hypothalamus supraoptic nuc makes ADH, paraventricular nuc makes oxytocin; lateral area: hunger, inh
ventromedial area: satiety (craniopharyngioma can destroy VMA, cause hyperphagia); anterior: cooling,
posterior: heating, sympathetic; suprachiasmatic nucleus: circadian rhythm

thalamus VPL=peripheral sensation, VPM=face sensation/taste, to somatosensory cortex; LGN=eyes, MG

limbic system cingulate gyrus, hippocampus, fornix, mammillary bodies, septal nuc, for the 5 F's
cerebellum contralateral cortical input via middle peduncle, ipsilateral proprioceptive via inferior pedunc
input=climbing and mossy fibers, output to stimulate contralateral cortex (Purkinje fibers to deep cerebe
superior peduncle; deep nuclei: ("Ladies Demand Exceptional Generosity From Men") (Lateral [extremitie
Emboliform, Globose, Fastigial (Medial [truncal coordination, fall ipsilaterally])

basal ganglia DA from SNc to striatum (caudate=cognitive, putamen=motor, ACh-modulation causes ton
direct: D1 activates, striatum inhibits GPi/SNr (GABA/substance P), which breaks tonic inhibition of thalam
inhibits, breaks striatum inhibition (GABA, enkephalin) on GPe, GPe inhibits subthalamic nuc, which break
activation of GPi, which stops inhibiting thalamus; both cause motion

myoclonus=hiccup; dystonia=cramp; chorea (sudden) and athetosis (slow) classic for basal ganglia lesio
precentral gyrus=motor, postcentral=sensory; medial-lateral: foot, leg, arm, hand, face (top to bottom),
brain lesions reticular activating system (midbrain): reduced arousal and wakefulness (coma); STN: contr
hemiballismus; hippocampi: anterograde amnesia (no new); paramedian pontine reticular formation: eye
lesion (also responsible for EOMs in REM); frontal eye fields: eyes look towards lesion

rapid correction of hyponatremia causes central pontine myelinolysis: acute paralysis, dysarthria, dyspha
loss of consciousness, axial T1 image shows increased signal in the pons

posterior cricoarytenoids: open cords; recurrent laryngeal n injury loses all mm except cricothyroid (vagu
vertebral/anterior spinal a (medial medullary sz): pyramid (contralateral LE hemiparesis), medial lemnisc
contralateral proprioception), hypoglossal fibers (ipsilateral tongue paresis)

PICA (lateral medullary sz): lateral spinothalamic tract (contralateral pain/T), nucleus ambiguus (efferent
dysphagia, hoarseness, no gag reflex), VIII (vertigo, diplopia, nystagmus, N/V), descending sympathetics
Horner's), V nucleus and tract (ipsilateral facial sensation), ICP (ipsilateral ataxia)
AICA (lateral pontine sz): V and VII (ipsilateral face), VIII (nystagmus), ICP and MCP (ipsilateral dystaxia)
posterior cerebral a: contralateral hemianopia w/ macular sparing (supplies occipital cortex)
middle cerebral a: contralateral paralysis (lower half of face down, upper extremities>lowers) & sensory
upper>lower), aphasia/L-sided neglect, anosognosia (no knowledge of disease)

anterior cerebral a: leg-foot motor/sensory defects; watershed: severe hypotn, proximal limb weakness
lateral striate: divisions of MCA that supply basal ganglia; posterior limb of internal capsule=pure motor
ant. comm. a: most common site of Circle of Willis aneurism, visual field defects; post. comm. a: III palsy
ant. circle=motor, aphasia; post. circle=CN deficits, coma, cerebellar deficits, aphasia/unilateral neglect
aneurysms: assn w/ ADPKD, Ehlers-Danlos, Marfans, age, htn, smoking, blacks; most commonly hemorrh
ischemia: irreversible after 5m, most sensitive=hippocampus, neocortex, cerebellum, watershed; red ne
necrosis + PMNs (1-3d), macrophages (3-5d), reactive gliosis/vascular prolif (1-2w), glial scar (>2w)

ischemia: irreversible after 5m, most sensitive=hippocampus, neocortex, cerebellum, watershed; red ne
necrosis + PMNs (1-3d), macrophages (3-5d), reactive gliosis/vascular prolif (1-2w), glial scar (>2w)

stroke: bright on diffusion-weighted MRI (5m-10d), dark on non-contrast CT (24h, bright=hemorrhage, no

hydrocephalus communicating=decreased absorption; non-communicating=obstruction; NPH: incontinen
dementia (wet, wobbly, wacky), ventricular expansion distorts corona radiata, nl subarachnoid V

MLF Sz seen in MS; VI nuc projects to ipsilateral abducens and contralateral MLF, which sends fibers to II
to the left, w/ R MLF damage, R eye doesn't move, L eye has R-beating nystagmus

reflexes Achilles=S1-2; patella=L3-4; biceps=C5-6; triceps=C7-8; Moro: abduct/extend limbs when start
together, gone by 3mo; Babinski: dorsiflexion of big toe, fanning of other toes, if after 15mo=UMN lesion

midbrain (III, IV), pons (V-VIII), medulla (IX-XII); lateral=sensory, from alar plate; medial=motor, basal pla
nuc of X Solitarius: Sensory; aMbiguus: Motor; dorsal motor: autonomics; PS to lacrimal via VII, pupil via
retinitis: retinal necrosis + edema=atrophic scar; iritis=systemic inflammation; CRAO: acute painless LOV
light enters retina, II, bilateral pretectal nuclei, Edinger-Westphal nuclei, III, bilateral pupil constriction
Marcus-Gunn: more constriction on consensual reflex than direct (optic n damage, retinal detachment)
III: ocular mm output is central (affected by vascular dz), surrounded by PS output (affected by compress
LUQ anopia=Meyer's loop (temporal lobe), LLQ anopia=dorsal optic radiation (parietal lobe); both MCA
brain lesions ring-enhancing: mets, abscess, toxo, AIDS lymphoma; uniformly enhancing: lymphoma, me
heterogeneously enhancing: GBM; can cause cingulate (subfalcine) herniation

uncal herniation: ipsilateral Horner (stretch III), contralateral homonomous hemianopia (PCA compression
paresis (Kernohan's notch, crus cerebri compression), duret hemorrhages (push brain stem down)

dementia Alzheimer's, multi-infarct, Pick's dz, Lewy body dementia, CJD, syphilis, HIV, B12def, Wilson's d
seizure synchronized, high-f firing; partial: 1 area of brain, usually medial temporal lobe, can generalize,
(consciousness intact) or complex; generalized: absence (petit mal, no post-ictal confusion), myo-clonic,
(grand mal), tonic, or atonic; epilepsy: recurrent seizures (non-febrile); in kids: genetic, febrile, trauma, c
metabolic; adults: tumor, trauma, stroke, infxn; old: stroke, tumor, trauma, metabolic, infxn; drugs: INH,
imipenem/cilastatin

headache migrane: unilateral, 4-72h, pulsating, N, photo-/phono-phobia, from irritation of V and release
CGRP, vasoactive peptides (vasodilators); tension: bilateral, >30m, steady pain, no aura/photo-/phono-p
lacrimation, Horner's, rhinorrhea, M>>F, tx=sumatriptan or hyperbaric O 2

diseases/NTs anxiety=SONIGO; depression=SODONO; Parkinson's: ODISIA; Schizophrenia: ID; Alzheimer'

hospitalism/anaclitic depression: infant depression from to separation, withdrawn/unresponsive baby
childhood dzs ADHD: normal intelligence, commonly continue into adulthood, low frontal lobe V; conduct
personality disorder <18yo; oppositional defiant dzd: no serious violations; Tourette's: assn w/ OCD, mov
separation anxiety dzd: may have factitious physical sx

Autism: language/social impairment; Asperger's: social impairment, no cognitive/verbal defects; Rett's: F

regression, loss of development/verbal/motor abilities, hand-wringing; childhood disintegrative dzd: mult
regression after 2y of normal development, M>F, usually presents between 3-4yo

delerium: acute onset waxing/waning consciousness, visual hallucinations, illusions, abnormal EEG; dem
decreased cognition, no psychosis, normal EEG, depression=pseudodementia

hallucination: no stim; illusion: misinterpretat'n of stim; delusion: false belief; loose ass'n: disordered tho
hallucinations audio=schizophrenia, olfactory=aura, tactile=DT/cocaine; hypno-gog-/-pomp-ic: falling/ge
schizophrenia genetic>environmental, 1.5% lifetime prevalence; pick 2: delusion, hallucination, loose as
disorganized/catatonic behavior, negative sx (flat affect, social withdrawal, lack of speech or thought); lo
branching; brief psychotic dzd (stress related)<1mo<schizophreniform<6mo<schizophrenia; suicide

schizoaffective dzd: >2w of stable mood w psychotic sx + a major depressive, manic, or mixed episode
dissociative identity dzd: multiple personalities, ass'd w/ sexual abuse; depersonalization dzd: persistent
detachment/estrangement; dissociative fugue: abrupt change in geographic location w/ amnesia

bipolar 1 manic (bipolar I) or hypomanic (II) episode, depression always occurs eventually; high suicide r
dysthymia: mild depression, >2yr; cyclothymic dzd: + hypomania, mild bipolar>2yr
manic >1wk, pick 3: distractable, irresponsible (hedonism), grandiose, flight of ideas, agitation (high act
sleeplessness (no need), talkativeness (pressured speech); hypomanic: no impairment or psychoses

depression self-limited, episode lasts 6-12mo, lifetime prevalence: F=20%, M=10%; 2+ wk of pick 5: sle
(early morning awakening most important), loss of interest (anhedonia, necessary), worthless/ guilt, low
concentration, change in appetite, psychomotor sx, suicidal ideation, depressed mood; MDD: 2 episodes
atypical depression: hypersomnia, overeating, mood reactivity; postpartum depression: 15% incidence, d
anxiety, poor concentration, lasts 2w-2mo; refractory=ECT tx

suicide sex (M), age (teen/elderly), depression, previous attempt, EtOH/drugs, rational thinking, sickness
medical illness), organized plan, no spouse/lack of social support; F try more, M succeed more

panic dzd recurrent, intense fear, peaks in 10m, pick 4: palpitations, parasthesias, abd distress, N, fear o
control, light-headed, chest pain, chills, choking, sweating, shaking, SOB, disconnectedness
GAD: >6mo, uncontrolled anxiety, sleep disturbance, fatigue, GI sx, difficulty concentrating; adjustment
specific stressor, usually <6mo; PTSD: reexperiencing traumatic event: acute stress dzd<1mo<PTSD

conscious faking: malingering=2 gain (miss work, get drugs), avoid tx; factitious dzd: to assume sick ro
invasive txs, Munchausen (chronic, predominantly physical sx, by proxy=child abuse)

somatoform dzd physical sx, no identifiable cause, unconscious, F>M; somatization: multiple organ syste
conversion: pt is aware but indifferent to sx ("la belle indifference"); hypochondria: fear of having serious
tests; body dysmorphic dzd: minor/imagined defect, repeated cosmetic surgery; pain dzd

substances dependence: pick 3 in 1yr: tolerance, withdrawal, more than desired, desire to cut down, too
spent getting, using, or recovering from, important activities reduced, continued use in spite of insight; a
fulfill major obligations, physically hazardous situations, legal problems, CUIS of insight

DT: ANS hyperactivity (hi HR, tremor, anxiety, seizure), then psychosis (hallucination, delusion), then con

bias selection: nonrandom group assignment; late-look: inappropriate time for observation; lead-time: ea
confused w/ increased survival; Pygmalion effect: researcher's belief in efficacy changes outcome; Hawth
group studied changes behavior; sampling: nonrepresentative to pop. (not generalizable)

prevention 1: prevent occurance (vax); 2: early detection (screening); 3: reduce disability from dz (tx)
reportable dzs: Hep, AIDS, gonorrhea, syphilis, TB, MMR, salmonella, shigella, VZV; HIV varies by state
Medicare >65, ESRD, etc; A=inpatient, hospitals, hospice, home health; B=outpatient, drs services, PT/O
D=rxs; Medicaid: health assistance for very low income

Advance directives living will: txs refusal (DNR); durable power of attorney: appointing a medical surroga
APGAR (1): appearance (trunk pink), pulse (<100), grimace (2=grimace + cough), activity (some), resp (
sleep spend most time in stage 2 (bruxisms); stage 3-4 (delta)=enuresis, night terror, sleep walking; rap
in initiating; NE reduces REM (depression, decreased latency, increased total, repeated awakening); narc
with REM sleep, can have cataplexy (fainting goats) or hypna-gog/pomp-ic hallucinations

60% water by wt (40L), 2/3 intracellular, 1/3 ECF (inulin, 1/5 plasma [radiolabeled albumin], 4/5 interstiti
glomerular filtration: fenestrated capillaries (size), podocyte foot processes, fused BM w/ heparin SO 4 (ch
Cx=VUx/Px; GFR=Cinulin<CCr (CCr=slight overestimation); ERPF=CPAH (underestimates RPF by 10%); RBF=RP
filtered load=GFR(Px); FF=GFR/RPF (high: efferent constriction, low Pprotein; low: ureter constriction, high P

PCT basal Na/K ATPase creates low [Na]i, powers everything: symports (glucose, PO 4 [PTH inhibits], AAs [
from intracellular CA, combines w luminal bicarb, brush border CA catalyzes back to resorbed CO2, bicar
basolaterally, [Na/K pump stimulated by AII, contraction alk]), Cl resorbed paracellular, ammoniagenesis
KG [broken down & absorbed as 2bicarb] each generates an ammonium ion)

TF/P graph Cl and urea more quickly absorbed in distal 2/3 of PCT, so hyperbolic up and right; phosphate
mirror below y=1; glucose=160-200, glucosuria begins, 350, all transporters fully saturated
ALOH basal: Na/K ATPase, passive K and Cl chs; NKCC (Na/K/2Cl symport), paracellular Mg and Ca resorp
DCT basal: Na/K ATPase, Na/Ca antiport (induced by PTH); luminal Na/Cl symport (thiazide) and Ca ch
CT principal cell: basal V2R (ADH) inserts aquaporins luminally; ENaC (aldo induced) absorbs Na in excha
intercalated cells: =secretes H (K/H antiport, H ATPase, basal HCO3/Cl antiport), =backward

RAS renin (from JG): low BP (JG cells), low Na delivery (MD), high 1; ACE: converts AI, degrades bradyki
AII: vascular smooth mm constriction (BP up), constricts efferent arteriole (raise FF to preserve GFR in low
secretion (increases ENaC, Na/K, and Kch in principal cells, intercalated H ch [all retain Na, excrete K and
secretion, upregulate PCT Na/H antiport (contraction alk), ups thirst, limits baroR-mediated reflex bradyc
aldo regulates V, ADH regulates Osm; PGE2: dilates afferents

ANP: high atrial P, increases GFR and Na filtration, no compensatory distal Na or water resorption
exocrine EPO: secreted by interstitial fibroblasts after peritubular capillary hypoxia, ectopic EPO secretio
inappropriate absolute polycythemia: HCC, RCC, Wilm's, hydronephrosis; 1,25-D: made by PCT

respiratory compensation for MAc: PCO2=1.5(HCO3)+8; for MAlk: PCO2 up 0.7 for every +1 HCO3
acidoses/alkaloses RAc: hypoventilation; RAlk: hyperventilation or aspirin ingestion (early); MAlk: vomitin
(contraction), antacids, hyperaldo; MAc, check the AG (anion gap=Na-(Cl+bicarb), nl=8-12); nAGMAc (hy
(bicarb loss), glue sniffing, RTA; hAGMAc (extra anions): drugs (Fe OD, INH, paraldehyde, metformin, salic
ingestion (MeOH [formate], ethylene glycol [oxalate]), metabolic (uremia, DKA, lactic)

RTAs T1 (distal): intercalated cell def, inability to secrete H, causes hypokalemia, risk for Ca-stones; T2
be from Fanconi's/expired tetracyclines, PCT bicarb resorption def, hypokalemia, hypoPO4mic rickets (XL
excretion); T4 (hypoaldo): hyperK causes cellular H/K antiport (make K out normal causes intracellular alka
ammoniagenesis (low urine pH & buffering capacity), nAGMAc (mild)

casts hyaline: nothing; RBC: GN, ischemia, malignant htn; WBC: tubulointerstitial inflammation, acute py
rejection; granular: ATN; waxy: advanced renal dz/CRF; Bence Jones protein: multiple myeloma

RCC: renal tubular cells become polygonal clear cells; vHL, smoking, and obesity; hematuria, mass, flank
polycythemia (other neoplastics too: ACTH, PTHrP, PRL); spreads hematogenously (IVC) to bone/lung
Wilm's tumor (nephroblastoma): contains embryonic glomerular structures; huge mass, hematuria, WT1
suppressor, 11p) deletion; can be part of WAGR complex (Aniridia, GU malformation, Retardation)

transitional CC: painless hematuria=bladder cancer; phenacetin, smoking, aniline dye, cyclophosphamid
pyelo acute: affects cortex, spares glomeruli/vessels; fever, CVA tenderness, N/V, WBC casts; chronic: co
corticomedullary scarring, blunted calyx, dilated/atrophic tubules contain eosinophil casts (thyroidization

interstitial nephritis: drug induced, usually 1-2wk after rx (diuretics, NSAIDs, PCNs [esp methacillin], rifam
sulfonamides); haptens; hematuria, pyuria (eos), azotemia, fever, rash, CVA tenderness, normal tubules

diffuse cortical necrosis: cortical infarct of both kidneys, usually DIC (esp pregnancy) and vasospasm
ATN: most common cause of ARF in hospital, reversible, fatal if untxed, oliguric phase most dangerous, g
brown) casts; ass'd w/ ischemia (shock/sepsis), crush injuries (myoglobinuria), toxins

papillary necrosis: gross hematuria/proteinuria; assn w DM, acute pyelo, chronic phenacetin use, HbS
ARF abrupt decline in renal function w/ high Cr and BUN over days; prerenal: low RBF and GFR (hypotn);
ATN, less commonly acute GN (RPGN, eg), patchy necrosis causes obstruction and backflow across tubul
epithelial/granular casts, impaired resorption; postrenal: bilateral obstruction (BPH, eg)

renal failure: Na/water retention, hyperK, MAc, uremia (can cause N/anorexia, pericarditis, asterixis, plate
encephalopathy), anemia, renal osteodystrophy (2 hyperPTH), dyslipidemia (esp hyperTGemia)

cysts ADPKD (assn w/ polycystic liver dz, berry aneurysms, MVP, htn), ARPKD (infantile, assn w/ hepatic fi

ligaments suspensory L of ovary: ovary to wall, houses ovarian vessels; L of ovary: ovary to uterus, no ve
uterus to labia majora; cardinal L: cervix to pelvis, houses uterine vessels; all within broad L

pudendal nerve block given at ischial spine; ureters go under uterine a/ductus deferens (retroperitoneal)
ovary=simple cuboidal, uterus=simple columnar, pseudostratified, tubular glands; prostate=*
NE causes increased intracellular Ca, smooth mm contraction, vasoconstriction, and antierectile (NO=pro
Sertoli cells: FSHR (secrete inhibin and ABP [high local T levels]), secrete AMH (sex organ development),
testis barrier, support spermatozoa, regulate spermatogenesis; Leydig cells: LHR, secrete T

spermatogenesis spermatogonium (maintain germ pool) make 1 spermatocytes, 2 spermatocytes, spe

spermiogenesis spermatid to spermatozoa; acrosome=Golgi, flagellum=centriole, middle piece=mitocho

T induces internal structure differentiation from Wolffian duct; DHT: external structures + prostate (UG si
M genitalia spermatic cord: 3aa (cremaster, testicular, to ductus deferens), 3nn (genital branch of genito
sympathetics), 3 fascial layers (cremasteric [int. oblique], external [ext. obl.]/internal [transversalis] sper
(pampiniform plexus, vas, lymphatics); scrotal layers: (some damn englishman called it the testes) skin,
spermatic fascia, cremaster m, internal, tunica vaginalis/albuginea

estrogendevelopment of F 2 sex characteristics, growth of follicle, endometrial prolif, increased myome

upregulation of Rs (E, P, LH), stimulates PRL secretion but blocks its effect at breast, increase in transpor
TBG), increase HDL, lower LDL; LH activates desmolase in theca cells (chlsl to androstenedione), FSH act
in granulosa cell (androstenedione to E); during pregnancy, estradiol (most potent) and estrone (less) up
(least potent) up 1000x (indicates fetal well-being)

progesterone stimulates endometrial glandular secretions, spiral a development, maintains pregnancy, d

myometrial excitability, makes thick cervical mucous to prevent sperm into uterus, ups body T, uterine t
(prevents contractions), decrease ER expressivity; at birth, drop in P causes lactation

cycle day0=basal endometrial layer, proliferative phase for 2 wk (FSH, follicular growth fastest in wk2), d
ovulation, corpus luteum secretes progesterone; day21: no implantation, corpus regresses, menses

polymenorrhea<21d<nl<35d<oligomenorrhea; metrorrhagia=irregular bleeding; menorrhagia=heavy b

oogenesis (oogonium to 1 oocytes) meiosis I starts in fetal life, arrested in prophase until ovulation (2 o
II arrested in metaphase until fertilization (ovum)

fertilization usually 1d after ovulation at ampulla of fallopian tube (middle 1/3); suckling maintains lactat
n stimulation (increases oxytocin [milk letdown] and PRL [lower reproductive function])

Klinefelter's (XXY) disgenesis of seminiferous tubules (low inhibin, high FSH, low T, high LH, high E, testic
eunuchoid body, tall, long extremities, gynecomastia, female hair distribution, can have develop-mental
common cause of hypogonad; XYY: phenotypically normal, tall, bad acne, antisocial

Turner's (XO) short stature, ovarian dysgenesis (normal fetal ovarian development, bt follicles lost by 2yo
shield chest, bicuspid aortic valve, neck webbing (cystic hygroma), preductal coarctation of aorta, aortic
common cause of 1 amenorrhea (high FSH and LH), no Barr body

pseudohermaphroditism external gender doesnt match internal genitalia; XX=virilization, excess androg
def, exogenous); XY=usually androgen insensitivity sz (normal-appearing F, rudimentary vagina, testes f
removed to prevent malignancy); true hermaphrodite: both ovary and testis, very rare

5Rase def: AR, limited to XY, ambiguous genitalia until puberty, then masculinization; LH may be high
hydatidiform mole cystic swelling of chroinic villi, prolif of trophoblast (chorionic epithelium), "cluster of g
snowstorm on sonogram, present w/ abnormal vaginal bleeding, tx=D/C and MTX, monitor hCG; comple
XY), 2 sperm + an empty egg, VERY HIGH hCG, increased uterine size (risk of rupture), 2% convert to c
malignant trophoblastic dz, no fetal parts; partial: 69XXY, moderately high hCG, 2 sperm + 1 egg, low ris
malignancy, contains fetal parts

common causes of recurrent miscarraige 1st wk=low P levels (no response to hCG); 1st trimester=chrom
abnormality (robertsonian translocation); 2nd trimester=bicornate uterus (paramesonephric fusion failur

preeclampsia htn, proteinuria, edema, must be >20wk pregnant, ass'd w/ htn, DM, autoimmune dzs, chr
impaired vasodilation of spiral aa causes placental ischemia, causing increased vascular tone; other sx: h
blurred vision, abd pain, altered mentation, hyperreflexia, hyperuricemia, low platelets; tx=delivery, bed
restriction, MgSO4, diazepam

HELLP sz: hemolysis, elevated LFTs, low platelets, VERY BAD (can cause cerebral hemorrhage and ARDS)
maternal DM: caudal regression sz (anal atresia/sirenomelia), macrosomia, NRDS, postnatal hypoglycem
ectopic pregnancy: usually in fallopian tubes, high hCG w/ sudden lower abd pain, dx=US; risk=hx of infe
salpingitis/PID, ruptured appendix, prior tubal surgery, prior ectopic

fibrocystic dz most common cause of breast lumps 25-menopause, premenstrual pain, fluctuates in size,
risk for cancer, multiple/bilateral; fibrosis: hyperplasia of stroma; cystic: ductal dilation, blue dome; scler
increased acini and intralobular fibrosis, calcifications common; epithelial hyperplasia: increase in cell la
duct lobule, >30yo, if atypical cells=increased risk for ca

other common conditions acute mastitis: abscess, S. aureus most common, usually during breast feeding
painless, from injury (usually not reported/remembered); gynecomastia: hyperestrogenism (age, cirrhosi
tumor), XXY, rxs (E, psychoactive drugs, dig, cimetidine, ketoconazole, spironolactone)

malignant breast tumors: common post-menopause, from mammary duct epithelium or lobular glands; o
erb-B2 (EGF-R) common; most important prognostic factor=axillary LN involvement; risk factors: high E,
live birth, obesity (adipose tissue has aromatase, so increases E exposure)

prostate -itis: dysuria, frequency, urgency, low back pain (acute=bacterial, chronic is usually abacterial);
hyperplasia of lateral/middle lobes, dysuria, frequency, nocturia, hesitancy, high PSA; adenoca: posterio
by DRE, high PSA, low fraction of free PSA, osteoblastic mets to bone (high alk phos), PAP
penis CIS Bowen's dz: gray crusty plaque, 50s, progresses to SqCC <10%; erythroplasia of Queyrat: red
Bowenoid papulosis: multiple papules, younger, usually noninvasive

varicocele: dilated vv, can cause infertility, bag of worms, cant be transilluminated (others can); hydroce

type II pneumocytes: secrete surfactant (lecithin=dipalmitoyl phophatidylcholine, constitutive excretions

during lung damage, lamellar bodies; lecithin/sphingomyelin>2.0 in amniotic fluid=lung maturity

clara: nonciliated columnar, secretory granules (component of surfactant, degrades toxins), reserve
aspiration: upright=lower portion of RLL, supine=superior portion of RLL; A to B (artery to bronchus): RA
external intercostals used for active inpiration, fibers point down; other active inspiratory mm: scalene, S
surfactant: raises compliance (change in V/P, reciprocal of elastance [lowered]), deficient in neonatal RD
Law of Laplace: P favoring collapse=2(surface tension)/r (so low surfactant or low radius tends to collaps
lung produces ACE (inactivates bradykinin) and kallikrein (activates); ACEI causes increased lung bradyk
dead space=TV(PaCO2-PeCO2)/PaCO2; biggest contributor in healthy ppl is apices (fewer deeper breaths
Hb: taut has low O2 affinity, favored by exercise (increased T, [H], pCO2, altitude, 2,3DPG); 2,3DPG: byp
glycolysis, marker of cell activity, binds less avidly to HbF; P 50(nl)=26; 75% sat=hypoxemia, 50%=cyano

methemoglobin: oxidized form (Fe3+), very high affinity for CN, so in CN poisoning, nitrites (amyl nitrite)
Fe to bind CN (prevents cytochrome oxidase dysfunction); thiosulfate then given to bind and excrete ren
formed as a side effect of dapsone; dark blue/brown color
carboxyHb: bound to CO, lower binding capacity, L-shift (stays in relaxed form), ETC inhibitor, hyperbaric
diffusion-limited: CO, O2 in emphysema and fibrosis (doesn't equilibrate by end of capillary); everything
limited (equilibrates early on); emphysema lowers SA, fibrosis increases thickness
pulmonary htn: >25mmHg at rest or >35 during exercise, causes atherosclerosis, medial hypertrophy, in
1=inactivating mutation of BMPR2 (normally inhibits smooth m prolif, poor prognosis); 2=(COPD, mitra
emboli, autoimmune (diffuse scleroderma), L to R shunt, apnea), causes cor pulmonale

alveolar gas eq: PAO2=PIO2-PaCO2/0.8; normally, PIO2=150; A-a gradient=PAO2-PaO2=10-15 (high in h

VQ mismatch, shunting, fibrosis); R=respiratory quotient=CO2 produced/O2 consumed
hypoxemia=low PaO2, hypoxia=low O2 delivery to tissue (anemia, low cardiac output), ischemia=loss of
ventilation and perfusion are greater at the lung base, but V/Q=0.6; shunt: 100% O2 doesn't improve PO
CO2 back to lungs: bound to Hb at N terminus as carbaminoHb (5%), dissolved (5%), bicarb (90%, H pro
heme; O2 binding at lung promotes dissociation of H-Hb and CO2 formation [Haldane effect])

DVT: Homans' sign=tender calf on dorsiflexion of foot; Virchow's triad: stasis, hypercoag, endothelial dam

COPD chronic bronchitis: mucus-gland hypertrophy (high Reid index), small airway dz, wheezing, crackle
causes early-onset hypoxemia, late-onset dyspnea; emphysema: destruction of alveolar walls, large air s
elasticity, pursed-lip breathing, decreased breath sounds, tachycardia, early onset dyspnea, late onset h
capillary beds); asthma: bronchial hyperresponsiveness, Cushmann's spirals (shed epithelium on mucou
ratio, pulsus paradoxus; bronchiectasis: chronic infxn of bronchi causes permanent airway dilation, hemo
aspergillosis, from CF, Kartagener's

emphysema centriacinar=smoking; panacinar=1AT; paraseptal=bullae, rupture=spontaneous pneumo

asbestosis: ivory white calified pleural plaques, asbestos bodies in macrophages, bronchogenic ca, LLs
upper lobes: coal miner's (cor pulmonale), silicosis (macrophages release fibrogenic factors, hilar LN egg

(pathology)
XLR diseases (XLD=hypophosphatemic rickets)
2 blood dzs
G6PDD
2 binomial dzs
Lesch-Nyhan
2 B's
Becker's MD (+DMD)
2 O's
Ocular albinism
2 LSDs
Fabry's
Amino acids (GluM HArV, PITT)
Essential Ketogenic
Glucogenic
Both
Acidic
Glutamate, Aspartate
Basic
Lysine, Arginine (most

Hemophilia (A and B)
Wiskott-Aldrich
Bruton's agammaglobulinem
OTC deficiency
Hunter's

Leucine, Lysine
Methionine, Valine, Arginine, Histidine
Phenylalanine, Isoleucine, Threonine, Tryptophan
basic), Histidine (no charge at body pH)

Lipid transport
Particle
Chylomicron
VLDL
IDL
Proteins B-48, C-2, E
B-100, C-2, E
B-100, E
LCAT: lecithin-chlsl acyltransferase, in HDL and LDL, esterifies 2/3 of plasma chlsl
CETP: chlslester transfer protein, takes chlsl from HDL to LDL/VLDL, TG back to HDL

hyperchylomicronemia (I): LPL def or altered apoC-II (cofactor) causes high TG and chl
pancreatitis, HSM, eruptive xanthomas, no increased risk for atherosclerosis

familial hyperchlslemia (IIa): AD, absent LDL-R causes increased LDL, chlsl, tendon (Ac
xanthomas, accelerated atherosclerosis (MI<20yo), corneal arcus
hyperTGemia (IV): hepatic VLDL overproduction causes increased TG, pancreatitis

abetalipoproteinemia: AR, MTP (microsomal TAG transfer protein, loads apoB with lipid
causes inabilty to synthesize VLDL/chylo; sx: FTT, ataxia, steatorrhea, malabsorption,
nyctalopia, acanthocytosis, intestinal biopsy full of lipid

PKU: Phe OHase or THB def, Tyr is essential, screened for 2-3d after birth (normal at bi
from maternal enzyme); sx: mental/growth retardation, seizures, musty body odor, fair
eczema; maternal PKU: microcephaly, mental/growth retardation, CHD

branched/VLCFA cant undergo -ox, so degraded in peroxisomes (def causes improper

myelination)

mbryo
Fetal landmarks
wk1
d3=morula; d6=blastocyst implantation, hCG secretion begins
wk2
bilaminar disk (epi-/hypo-blast), placenta (syncytio-/cyto-trophoblast)
wk3
gastrulation/primitive streak; d18=notochord; d21=neural tube closure
wk4
heartbeat, limb buds form (4 chambers, 4 limbs)
wks3-8
embryonic period: organogenesis, most susceptible to teratogens
wk8
fetal period: movement, looks like baby
wk10
genitalia have M/F characteristics
Embryologic derivatives
surface
ectoderm

epidermis, adenohypophysis, lens, salivary/sweat/mammilary glands,

oral/olfactory epithelium, sensory organs of inner ear

neuroectoderm

CNS (brain, neurohypophysis, oligodendrocytes, astrocytes, ependymal ce

spinal cord), retina

neural
crest

PNS (incl. chromaffin cells of adrenal medulla), AP septum, pia, arachnoid,

bones, odontoblasts, C-cells of thyroid, melanocytes

Vertebral, Anal atresia, Cardiac, Tracheo-Esophageal fistula, Renal, Limb;

meso-derm mm, connective tissue/dura, spleen, GU, Eustachian tube

endo-derm gut tube epithelium and derivatives (lungs, liver, panc, thymus, parathyro
estriol, high -hCG and inhibin A, increased nuchal translucency; 95% from meiotic nondisjunction

Micro

Bacteria
pus, empyema, abscess
S. aureus
asplenic/Sickle cell
Capsule, esp S. pneumo, H. flu, N. meningitides
pneumonia in CF, burn infxn
Pseudomonas aeruginosa
traumatic open wound
C. perfringes (gas gangrene)
surgical wound
S. aureus
dog/cat bite
Pasteurella multocida
currant jelly sputum
Klebsiella
PAS
Trophyerma whippelii
meningitis/sepsis in newborn
S. agalactiae (group B)
health care provider
HBV (needle stick)
fungal infxn in DM
Mucor/Rhizopus
chronic granulomatous dz
catalase (+): S. aureus, Nocardia, Aspergillus
neutropenic patients
Candida (systemic), Aspergillus
bilateral Bell's palsy
Borrelia burgorferi (Ixodes, so is Erlichia & Babesia)
stroke w/o htn
syphilis
pediatric infxn (incl. epiglotitis)
H. flu
oral infxn, branching rods, sulfur granules
Actinomyces israelii
Parasites
brain cysts, seizures
liver cysts
B12 def
biliary tract dz, cholangioca
hematuria, SqC bladder cancer
portal htn
hemoptysis
microcytic anemia
perianal pruritis
periorbital edema/m inflamed
hyperpigmentation, blindness
Protozoa
horseshoe-crab shaped
liver abscess
fever, HSM, pancytopenia
Pneumonia

Taenia solium (cysticercosis)

Echinococcus granulosus
Diphyllobothrum latum
Clonorchis sinensis
Schistosoma hematobium
Schistosoma mansoni
Paragonimus westermani
Ancyclostoma, Necator
Enterobius (pinworms)
Trichinella spiralis
Onchocerca volvulus
Giardia or Trichomonas
Entamoeba
Leishmania

neonates
S. agalactiae
E. coli

Meningitis
neonates
S. agalactiae
E. coli
L. monocytogenes

children
S. pneumo
RSV/other viruses
C. pneumo
M. pneumo

adults
S. pneumo
C. pneumo
M. pneumo
H. flu
anaerobes/viruses

children
S. pneumo
enteroviruses
N. meningitides
H. flu (unvax'ed)

adults
S. pneumo
enteroviruses
N. meningitides
HSV

meningism (nuchal rigidity, photophobia, headache), Kernig's sign (flex hip, rigidity on
extension), Brudzinski's sign (prone, head lifted, feet lift involuntarily)

mune
HLA/disease associations
A3
Hemochromatosis
B8
Graves' Dz
B27
Sero(-) spondyloarthropathies
DR2
hay fever, anti-GBM, SLE, MS
Cytokines
IL-1
IL-2
IL-3
IL-4
IL-5
IL-6
IL-7
IL-8
IL-9
IL-10
IL-11
IL-12
TNF-
IFN-

DR3
DR4
DR5
DR7

DM type I
RA, DM type I
pernicious anemia, Hashimo
steroid-responisve nephrotic

(Mnemonic: "Hot D8, My GoodnEss, A Hot/Cute Lynn Comes")

MP
pyrogen, induces endothelial adhesion molecules/chemokines
Th1
activates CD8 (signal 2)
TCs
hematopoietic cells to become myeloid precursors
Th2
differentiation to Th2, and class switching to IgG and IgE
Th2
differentiation of BC, class switch to IgA, eosinophil maturation
MP/Th2
pyrogen, induces acute phase reactants
lots
hematopoietic cells to become lymphoid precursors
MP
chemotactic
Th2
acts on hematopoietic cells, anti-apoptotic, pro-growth
Th2, Treg activates Th2, inhibits activated TC and Th1
?
hematopoietic cells to become megakaryocytes, bone prolif
MP, BC
differentiation to Th1, activates NK
MP
mediates septic shock, activates endothelium, leaky
Th1
activates macrophages and Th1, inhibits Th2, ups MHC1 and 2

AutoAbs and associated disorder

antidz
histone
drug-induced lupus
IgG
RA
Scl-70
scleroderma (diffuse)
U1-RNP
mixed connective tissue
smooth m autoimmune hepatitis
BP-180
bullous pemphigoid
Jo-1
polymyositis/dermatomyositis

antiglu decarboxylase
gliadin/endomysial
centromere
microsomal/thyroG
mitochondrial
desmoglein
c-ANCA

Path

Amyloid: -sheet, Congo red stain, apple green birefringence, gross=waxy

Primary
AL
from Ig light chains (multiple myeloma, BJ proteins)
Secondary
AA
serum amyloid-ass'd protein (chronic inflammation
Senile cardiac
AF
from transthyretin
DM type 2
AE
from amylin
thyroid medullary ca
A-CAL
from calcitonin
Alzheimer's
-amyloid from amyloid precursor protein
dialysis-associated
2-G
from MHC I proteins
Oncogenes: one mutation needed
gene
tumors (gene product)
abl (9)
CML (TK)
bcl-2
follicular, undiff. lymphomas
HER-2 or
erb-B2

breast, ovarian, and gastric

adenocarcinomas (TK)

Tumor suppressors: two mutations ne

gene
tumors (gene product)
Rb (13q) retinoblastoma, osteosarcom
p53 (17p) most cancers, Li-Fraumeni S
BRCA1 (17 q) breast and ovarian cance

HER-2 or
erb-B2
ras
c-myc
l-myc
n-myc
ret
c-kit

breast, ovarian, and gastric

adenocarcinomas (TK)
colon cancer (small GTPase)
Burkitt's lymphoma (TF)
lung tumor (TF)
neuroblastoma (TF)
MEN 2A and 2B (TK)
GIST (cytokine receptor)

BRCA2 (13
p16 (9p)
APC (5q)
WT1 (11p)
NF1 (17q)
NF2 (22p)
DPC (18q)
DCC (18q)

q) breast ca (DNA repair pro

melanoma
colorectal cancer (assn w/ FA
Wilms' tumor
NFM type 1
NFM type 2
pancreatic cancer
colon cancer

eart is mostly 1, M2)

GP-linked
1 (q)
2 (i)
1 (s)
2 (s)
M1 (q)
M2 (i)
M3 (q)
D1 (s)
D2 (i)
H1 (q)
H2 (s)
V1 (q)
V2 (s)
Murmurs
Type
mitral
regurg

2nd messengers
vascular smooth m contraction (1B), sphincter m contraction, mydriasis
decrease sympathetic outflow and insulin release
increases HR, contractility, lipolysis, renin release
same as 1 (insulin, not renin), vaso-/broncho-dilation, drops uterine t
in CNS, postsynaptic autonomic ganglia, gastric (ECL)/salivary secretion
decrease HR and contractility of atria
gut peristalsis, bladder contraction, eye (miosis, accomodation),
bronchoconstriction, increased exocrine secretion (DUMBLS)
relaxes renal vascular smooth m, brain
esp in brain, modulates transmitter release
increased mucous production, bronchiole contraction, pruritis, pain
increased gastric acid secretion
increased vascular smooth m contraction
increased water reuptake in collecting tubules of kidney

Timing
|===|

Loudest
apex

Radiation
axilla

Increased intensity
hi TPR (squatting), hi
LV return (expir)

TR
MVP most
common

|===|
| c<|

LSB
apex

RSB
midsys
click

hi RV return (inspir)
low venous return, hi
TPR (hand grip)

aortic
stenosis

|<>| late aortic

peak=bad

carotids or louder w/ squatting,

apex
softer w/ Valsalva

MS
AR/PR

|
|

open snap hi LA return (expir)

bounding lower w vasodilator
pulses
(AR)

VSD
PDA

|===|
tricuspid
|===|=== S2

Angina/MI
ST-dep
ST-elev
Stage
Early
Stage I
Intermed

angina, subendocardial infarct

Prinzmetal's angina, transmural infarct
Age
Criteria
mins
tall T, normal ST and R
<6hr
STE (tombstone), R nl, small Q
>6hr
STE, T-inversion, Q, loss of R

| s== apex
|<>== LSB

harsh
machine-like

Stage II
Stage III

days
residual

T-inversion, Q, ST normalizes
persistent Q, loss of R, T nl

Localizing MI using ECG (gold standard w/i 6h)

aVF | rV4
III | aVL
I | II
+ |
| +
|
apical (LAD)
|
|
|
anteroseptal (LAD)
+
|
|
+
|
anterolateral (LCX)
|
+ |
+ |
posterolateral (LCX)
| +
+ |
+ |
inferior (RCA/PD)
|
+ |
+ | +
RV (acute marginal)

V1 | V2
+ | +
+ | +

|
|
|
|

MI markers
troponin I most specific (also PE, myocarditis), rises after 4h, peak 12h, stays 7-10d
CK-MB
non-specific, good for reinfarction on top of acute MI, gone by 3d
AST
least specific, peaks at 2d, stays for a while

Evolution
Age
Microscopic Changes
day 1
4h: early coagulative necrosis; 12-24h:
contraction bands, early PMN infiltrate

Gross
dark, mottled, pale w
tetrazolium dye

day 2-4

extensive coagulative necrosis, acute

inflammation in tissue surrounding infarct,
dilated vessels, PMN infiltrate

hyperemic

day 5-10

ingrowth of granulation tissue as macrophages degrade old structure and induce

scar formation

hyperemic border,
centrally yellow-brown

wk 7

scar

grey white

docrine

Signalling pathways of hormones

cAMP
Ca (PTH, calcitonin), ADH (V2R)/-subunits (FSH, LH, TSH, -hCG), melanot
(ACTH, MSH), pancreatic (glucagon), GHRH
IP3
cGMP
NO, ANP
-subunitRH (GnRH, TRH), posterior pit (oxytocin, A
nuclear
T3/T4
cytosolic all steroids but T3/4: DHT, P, E2, D3, cortisol, aldo
intrinsic TK (MAP kinase)
-GF: FGF, PDGF, IGF-1, insulin (with IGF-1);; TK P-at
(inhibited by TNF-) recruits SOS protein, Ras hydrolyzes GTP and becomes activated
receptor TK (JAK/STAT)
GH, PRL, IL's, CSF
DM dx
HbA1C

Fasting glucose
Normal
<6.0%
<110
Pre-diabetic
6.0-6.4%
110-126
Diabetic
>6.5%
>126
or sx of hyperglycemia and a casual (random) plasma glucose >200
CAH (all have enlarged adrenal glands due to low cortisol
Deficiency Epidem Sex Hrmns
Aldo
BP
21-OHase 95%
high
low
low
11OHase 5%
high
low
high
17OHase rare
low
high
high

and thus high ACTH)

Other
hypovolemic shock in newbo
masculinization, as w 21-OH
M=pseudoherm, F=sexual i

Multiple endocrine neoplasias (MEN)

MEN 1 (Wermer's)
parathyroid (kidney stones), pituitary (usually PRL or GH), and
pancreas tumors (Zollinger-Ellison, so stomach ulcers)
MEN 2A (Sipple's)
medullary thyroid cancer, pheo, parathyroid (kidney stones)
MEN 2B
medullary thyroid cancer, pheo, oral or intestinal ganglioneuro
(marfanoid habitus)
MEN 2A and MEN 2B associated w/ ret gene (oncogene, tyrosine kinase)

T3/T4: synthesized by peroxidase from I + tyrosine (inhibited by anions and PTU or

methimazole); bone growth, CNS maturation, increased 1 in heart, increased metabo
TBG increases in OCP-use and pregnancy

hyperT3 pretibial myxedema; toxic multinodular goiter: hot nodule, mutated TSH-R, ra
malignant; Grave's: presents during stress, type II hypersensitivity; thyrotoxicosis:
complication of hyperT3, stress-induced catecholamine surge, death by arrhythmia; Jo

hyperT3 pretibial myxedema; toxic multinodular goiter: hot nodule, mutated TSH-R, ra
malignant; Grave's: presents during stress, type II hypersensitivity; thyrotoxicosis:
complication of hyperT3, stress-induced catecholamine surge, death by arrhythmia; Jo
Basedow: thyrotoxicosis if a pt w/ I-def goiter is made I-replete

hypoT3 myxedema (facial/periorbital), severe=myxedema coma (hypothermia and alte

mental status), can be a side effect of lithium or amiodarone; Hashimoto's: thyroiditis,
be hyperT3 early, autoimmune (antimicrosomal antithyroglobulin Ab, HLA-DR5), Hurth
lymphocytic infiltrate w/ germinal centers; cretinism: severe fetal hypoT3, co-endemic
goiter, pot-bellied, pale, puffy faced, protruding umbilicus, protuberant tongue; subacu
thyroiditis (de Quervain's): self-limited, following flu-like illness, jaw pain, early inflamm
(granulomatous), tender; Riedel's thyroiditis: replaced by fibrous tissue, rock-hard

thyroid cancer papillary: most common, excellent prognosis, "Orphan Annie" nuclei (gr
glass), nuclear grooves, psammoma bodies; follicular: uniform follicles, good prognosis
medullary: from C cells, sheets in amyloid stroma, assn w/ MEN2A/B;
undifferentiated/anaplastic: very poor; lymphoma: assn w/ Hashimoto's
low T4 to T3: PTU, glucocorticoids, amiodarone, iopanoate, non-selective -blockers
GI
GI hormones/secretions
Hormone
Source
Regulation
gastrin
G cells
up: AAs, peptides,
(antrum) stomach distention/
alkalinizat'n, vagal
stimulation (GRP)

Action
up: (ECL) gastric H+
secretion, mucosal
growth, motility, &
parietal hyperplasia

secretin

S cells (D) up: acid/FAs in

duodenum

up: bile and panc

bicarb secretion;
down: H+ secretion

GIP

up: FA, AAs, oral

K cells
glucose
(D/J)
I cells (D/J) up: FA, AAs

up: insulin secret'n;

down: H+ secretion
up: panc secretion, GB
contract'n, tone of
pyloric sphincter

CCK

somatostatin

cells
(panc/GI)

up: acid; down: vagal down: everything

stimulation

VIP

paraS
ganglia

up: distention, vagal

stimulation

Motilin
intrinsic
factor

Sm bowel up: fasting state

parietal
cells

gastric acid parietal

cells
pepsin
bicarb

up: sphincter relaxation, water excret'n

makes MMCs
B12 binding protein
(uptake in ileum)

up: M3R (ACh), H2R, decreases stomach pH

gastrin; down: SS, GIP,
PG, secretin
chief cells up: local H+, vagal
protein digestion
stimulation
mucosa,
up: secretin (acts on neutralize acid
Brunner's pancreatic and biliary
glands
secretions)

IBD
Location

Crohn's (disordered response to flora)

usually terminal ileum, skip lesions, rectal
sparing

UC (autoimmune)
continuous, always involves

Gross

cobblestone mucosa, creeping fat, bowel wall friable mucosal pseudopolyp

thickening, linear ulcers/fistulas
of haustra

Microscopic

transmural inflammation, noncaseating

granulomas, lymphoid aggregates

Complications

malabsorption, strictures, fistulas, colo-rectal malnutrition, toxic megacolo

cancer (minorly increased risk)
colorectal carcinoma (hi risk

Sx

diarrhea blood, erythema nodosum,

migratory polyarthritis, immunologic
disorders

tx

corticosteriods, infliximab

sub-/mucosal inflammation
crypt abscesses/ulcers

bloody diarrhea, PSC, pyode

gangrenosum, ankylosing
spondylitis, uveitis

ASA, 6-MP, infliximab, cole

drugs causing GI path: macrolides=acute cholestatic hepatitis; INH=hepatitis; hepatic

necrosis: halothane, valproate, acetaminophen, Amanita mushroom poisoning

GI pathology
Marker
Use
Aminotransferases
hepatocyte damage (virus: ALT>AST; alcohol: AST>ALT), MI (AS
GGT (glut cholestasis, >2x ULN
transpep- w/ heavy EtOH
tidase)
consumption
alk phos

bone dz, cholestasis

(biliary dz/obstruction, macrolides)

amylase
acute panc, mumps
lipase
acute panc (specific)
Jaundice
pre-HC (hemolysis)
low (all unconj)
conj blood bilirubin
low (not soluble)
urine bilirubin
high
urine bilinogen

hepatocellular
some (some unconj)
high (some conj)
nl/low

heme to unconjugated bilirubin in macrophage, albumin carries (complex=indirect bili

to liver, conjugated by UDP glucuronyl transferase to direct bilirubin, into biliary lumen
glucuronyl transferase, and broken down in gut to urobilinogen

pancreatitis acute: autodigestion; obstruction (gallstones, ERCP), overworked (EtOH,

hypercalcemia, hyperTGemia), mumps, trauma, autoimmune, drugs (sulfa, steroids); s
epigastric abd pain radiating to back, anorexia, N, elevated lipase (more specific) and
amylase; can cause DIC, ARDS, diffuse fat necrosis, hypoCa, pseudocyst, infxn, hemor
multiorgan failure; chronic: can cause pancreatic insufficiency (ADEK deficiency, steato
DM), calcified assoc'd w/ EtOH, smoking, pancreatic cancer

pancreatic adenoca: CEA and CA-19-9 markers, NOT assoc'd w/ EtOH; sx: abd pain rad
back, weight loss, Trousseau's, jaundice, palpable GB (Courvoisier's sign)

acute calculus cholecystitis: obstruction, chemical irritation, mucous disruption, bile ac

attack on mucosa, PG release, hypomotility, distension, ischemia, bacteria

me/Onc
Hemolytic anemia (high LDH)
Intravascular: low haptoglobin, Hb in urine, not usually jaundiced
G6PDD
trigger: fava beans, infxn, INH, sulfa, anti-malarial, aspirin, ibuprofen,
nitrofurantoin; back pain, Heinz bodies, and bite cells
PNH

glycophosphatidyl inositol links decay accelerating factor onto RBC memb

prevents complement cascade; high urine hemosiderin

angiopathic

schistocytes; micro-: from DIC, HUS (Shiga toxin), SLE, malignant htn; mac
prosthetic valves, aortic stenosis

infxn
malaria, Babesia
Extravascular: cleared in spleen; high unconjugated bilirubin, jaundice; (Wilsons)
sickle cell glu to val on gene; marrow expansion, aplastic crisis (B19), bone crises,
(HbS)
papillary necrosis/microhematuria, splenic sequestration crisis, autosplene
(Howell-Jolly bodies, Salmonella osteomyelitis)
HbC def
spherocytosis

glu to lys, compound heterozygotes w/ HbSC have milder dz than HbSS

hereditary def in cytoskeletal elements (ankyrin, band 3.1, spectrin); high
high RDW, SM, aplastic crises; tx=splenectomy (Howell-Jolly body)

PK def

AR, pyruvate kinase def, low ATP, rigid RBC membrane; HA in newborn

autoimmune

spherocyte; warm=IgG: SLE, CLL, -methyldopa; cold=IgM: CLL, mono, M.

pneumo; hydrops fetalis; usually Coomb's positive (direct=anti-IgG Ab)

Hemoglobin types
Variant
Make-up
22
HbA
22
HbA1C
22
HbA2
2C2
HbC
2E2
HbE
22
HbF
4
Barts
2S2
HbS
22
Gower 1
22
Gower 2

When present
normally 95% of Hb
non-enzymatic glycation of normal Hb, <6%, higher in DM
normally 3% of Hb, higher in beta-thal minor
beta variant, mild hemolytic anemia
beta variant, mild hemolytic anemia
normal in fetal, higher in sickle cell
alpha-thal
beta variant, sickle cell
early embryonic stage
late embryonic stage

Lab values in anemia: primary cause in red

Serum Fe Transferrin or TIBC
("tissue need")
Fe deficiency
low
high
chronic dz
low
low
hemochromatosis
high
low
pregnancy/OCPs
nl
high
lead poisoning
high
low

Ferritin
(storage)
low
high
high
nl
nl

Pb poisoning: microcytic/sideroblastic anemia, basophilic stippling of RBCs, renal, GI dz

neuro deterioration, wrist/foot drop, Pb lines on gums/long bones (XR), abd pain; adult
(usually work-related): headache, memory loss, demyelination
Translocations
Leukemia/lymphoma
Translocation
Activated product

AML M3
CML
t(15;17)
t(9;22)
bcr-abl

Burkitt's
t(8;14)
c-myc

Polycythemia primary cause in red

plasma V RBC mass O2 sat
relative
low
nl
nl
appropriate absolute
nl
high
low
inappropriate abs.
nl
high
nl
polycythemia vera
high
high
nl

Follicular
t(14;18)
bcl-2

EPO
nl
high
high
low

loskeletal
Upper extremity nerve lesions
Nerve
Root
Motor Deficit
Axillary
C5-6
shoulder abduction
(deltoid)

Sensory Deficit
over shoulder

MusCutan

lateral forearm

C5-7

elbow flexion

Radial

C5-8

extensors, brachioradialis, supinator

posterior arm, dorsal

hand/thumb

Median
(distal)

C5-T1

thumb opposition,
lateral MCP flex'n

dorsal + palmar
lateral 3 1/2 fingers

Median
(proxim.)

C5-T1

+ lateral DIP/PIP
flexion, wrist flex'n

dorsal + palmar
lateral 3 1/2 fingers

Ulnar
(distal)

C8-T1

interossei, thumb adduction, lumbricals 4 and

5; sensory: medial 1 1/2 fingers

Ulnar
(proxim.)

C8-T1

Klumpke

C8-T1

+ wrist flexion

medial 1 1/2 fingers

+all lumbricals; sensory: medial forearm

Lower extremity nerve lesions

Nerve
Root
Motor Deficit
Obtruator L2-4
thigh adduction
Femoral
L2-4
flex thigh, extend leg
Common
L4-S2
foot eversion/dorsiperoneal
flexion, toe extens'n

Sensory Deficit
medial thigh
ant./medial thigh
anterolateral leg,
dorsal foot

Tibial

L4-S2

foot inversion/plantarflexion, toe flex'n

sole of foot

In. gluteal
S. gluteal

L5-S2
L4-S1

hip extension (stairs)

Trendelenburg

Bone tumors
Benign
osteochondroma
(exostosis)

Epidem.
M, <25yo

Description
most common benign bone tumor; mature bone w/
cartilage cap; from metaphyses; transformation rar

enchondroma
osteoid osteoma

M, <25yo
M, <25yo

intramedullary bone, usually distal extremities

trabeculae of woven bone surrounded by osteoblas
(lytic), <2cm, usually proximal tibia/femur

osteoblastoma

M, <25yo

trabeculae of woven bone surrounded by osteoblas

>2cm, usually in vertebrae

osteoclastoma (giant
cell tumor)

20-40yo

epiphyseal plates of long bones (esp knee); locally

aggressive; XR='soap bubbles'; spindle-shaped cel

osteoma
Malignant
osteosarcoma
(osteogenic sarcoma)

Gardner's
Epidem.
M, 10-20;
bad prog.

new piece of bone growing on another, often in sku

Description
2nd most common 1 malignancy (MM); XR=Codm
triangle or sunburst pattern, from metaphyses (esp
risk: Paget's, bone infarcts, radiation, Rb

Ewing's sarcoma

M, <15yo

extremely aggressive, early mets, chemo-responsiv

XR=onion-skin; anaplastic small blue cells, t(11;22)

chondrosarcoma

M, 30-60

may be from osteochondroma; intramedullary

Arachidonic acid products

PGE1
keeps PDA open; misoprostol=agonist
PGE2
up: pain, uterine tone, temperature; down: vascular tone
PGI2
"prostacycline", down: platelet aggregation, vascular tone, uterine tone
TXA2
up: platelet aggregation, vascular tone
LTB4
neutrophil chemotaxis
LTC/D/E4
up: smooth m tone, vascular tone/permeability, bronchial tone (-lukast=I)
Infectious
impetigo
cellulitis
necrotizin
fasciitis

derm
honey-crusting, very superficial, highly contageous
acute, painful, dermal and subcutaneous tissues
deeper tissue injury, causes crepitus (from methane and
CO2)

SJS-TEN: anti-psychotic/anti-epilepsy (ethosuxamide, lamotrigine, carbamazepine,

phenobarbital, phenytoin), abx (sulfa, PCN), anti-gout (allopurinol), analgesics (NSAIDs
NNRTIs (efavirens, nevirapine); Nikolski's sign, mucosal involvement

euro

Spinal cord: inferior is lateral to superior on LCST and STT

Tract/Function
1st Order Neuron/Synapse
2nd Order/Synapse/3rd Orde
Dorsal column/ medial sensory n ending, cell body in
2=decussates in medulla, a
lemniscus (ascending dorsal root ganglion, ascends
contralaterally in medial lem
sensation), from alar
ipsilateral dorsal column;
S=VPL of thalamus; 3=sens
plate (embryo)
S=ipsilateral nucleus cuneatus or cortex
gracilis (medulla)
Spinothalamic tract
(ascending pain and
temperature)

sensory n ending (C and A), cell

body in dorsal root ganglion,
enters spinal cord; S=ipsilateral
gray matter

2=decussates at anterior wh
commisure, ascends
contralaterally; S=VPL of th
3=sensory cortex

lateral corticospinal
tract (voluntary
motion), from basal
plate (embryo)

UMN: cell body in 1 motor

cortex, descends ipsilaterally in
internal capsule, decussate at
pyramid (caudal medulla),
descends contralaterally

first synapse=cell body of a

horn (spinal cord); LMN: leav
spine, to NMJ (synapse 2)

sympathetics to
pupillary dilator m

cell body in hypothalamus,

descend in the cord; S=lateral
horn at T1

2=ascend on internal caroti

S=sup. cervical ganglion; 3=
carotid to long ciliary n (V1)

Hemorrhages
epidural
subdural
subarachnoid

Spinal cord lesions

poliomyelitis

will cross falx, tentorium, not suture lines, rapid expansion

bridging v rupture, elderly/shaken baby, crescent-shaped
worst headache of life, ruptured aneurysm, yellow/red spinal ta
vasospasm 2-3d later (blood breakdown products, tx=CCB)

mucosa to blood to CNS, destroys anterior horn; nonspecific sx

to LMN signs; virus recovered from stool or throat

Werdnig-Hoffman
syringomyelia
Tabes dorsalis

AR, degeneration of anterior horns, floppy baby, young death

anterior white commissure lesion, usually C8-T1; assn w Chiari
3 syphilis, dorsal root and column degen; locomotor/sensory a
Charcot joint, shooting pain, no DTRs, positive Romberg

B12 neuropathy or
vitamin E deficiency

demyelination of lateral corticospinal, spinocerebellar, and dor

columns; ataxic gait, hyperreflexia, impaired vib/position

Friedreich's ataxia

staggering, frequent falls, nystagmus, dysarthria, pes cavus, h

toes, HCM (cause of death), childhood kyphoscoliosis

anterior spinal a.
occlusion

spares dorsal columns and posterolateral tract (of Lissauer); up

thoracic ASA is watershed (a of Ademkiewicz below T8)

ALS

both UMN and LMN signs, no sensory, cognitive, or oculomotor

defects, can be from superoxide dismutase 1; tx=Riluzole

MS: immunosuppression and -IFN

autoimmune inflammation and demyelination of CNS, white F,

scanning speech, intention tremor, MLF sz (internuclear
ophthalmolegia), incontinence, nystagmus, optic neuritis,
hemisensory/paresis, relapsing/remitting; MRI for dx, high IgG
(oligoclonal bands=dxtic), periventricular plaques (oligodendro
loss, reactive gliosis, axon preservation)

pression and -IFN

scanning speech, intention tremor, MLF sz (internuclear

ophthalmolegia), incontinence, nystagmus, optic neuritis,
hemisensory/paresis, relapsing/remitting; MRI for dx, high IgG
(oligoclonal bands=dxtic), periventricular plaques (oligodendro
loss, reactive gliosis, axon preservation)

Brain tumors 50% are mets; presentation due to mass effect (seizure, dementia, etc)
Childhood d Craniopharyngioma
supratentorial, benign, confused w/ pit adenoma, calcifications
Pilocytic astrocytoma well circumscribed, low grade, cystic + solid, GFAP [+], may be
supratentorial; Rosenthal fibers: eosinophilic corkscrews
Medulloblastoma
(radiosensitive)
Ependymoma

malignant, primitive neuroectoderm, can compress 4 th ventricl

(hydrocephalus); pseudorosettes or rosettes, small blue cells
poor prognosis, usually 4th ventricle (hydrocephalus); blepharo
(rods, basal ciliary bodies), pseudorosettes

Hemangioblastoma
Adult d GBM (grade IV
astrocytoma)

can produce EPO, ass'd w/ vHL; foamy cells, highly vascular

most common 1, cerebral hemispheres, can cross corpus, GFA
pleomorphic, pseudopalisading, around areas of necrosis

Meningioma
Schwannoma
Oligodendroglioma

from arachnoid cells, whorled spindle cells, psammoma bodies

commonly on VIII (esp NFM), resectable, S-100 [+]
rare, slow growing, frontal lobe; chicken-wire capillary pattern
surrounding fried egg cells, can be calcified

Pit adenoma
usually PRL, hyper/hypo-pit, bitemporal hemianopia
Demyelinating dzs (also Charcot-Marie-Tooth)
PML
oligodendrocyte destruction, assc'd w/ JC virus, 2-4% of AIDS, rapidly fatal
metachromic
AR lysosomal storage dz, arylsulfatase A def, buildup of sulfatid
leukodystrophy
impaired production of myelin sheath
acute disseminated (post-infxous) perivenular inflammation and demyelination, after
encephalomyelitis
(VZV, measles) or vax (rabies, smallpox)

vertigo peripheral: more common, positional testing=delayed horizontal nystagmus; c

brain stem/cerebellum, testing=immediate nystagmus, any direction

zd=disorder)

Ego defenses
Pathologic conversion
manifestation as physical sx (grief causes "blindness", hysteria
denial, delusional/extreme projection, distortion, splitting (all good/all bad)
Immature projection
impulses attributed to external source
fixation
remaining partially at a more childish level
acting out, fantasy, idealization, identification (modeling after power, not admiration)
Neurotic displacement
feelings transferred to safer outlet, scapegoating
regression
going back to childish level
dissociation, rationalization (excuses), isolation of affect, repression, rxn formation
Mature suppression
voluntary withholding from conscious awareness
sublimation
unacceptable impulses in an acceptable way (aggression/boxe
humor, altruism
Personality dzds (weird, wild, worried)
Cluster A: odd/eccentric, no meaningful relationships; assc'd w/ schizophrenia
Paranoid
pervasive distrust, projection
Schizoid
voluntary social withdrawal, limited emotional expression
Schizotypal
+ eccentric beliefs/appearance, magical thinking, awkward

Cluster B: dramatic, emotional; associated w/ mood disorders and substance abuse

Antisocial
disregard for rights of others, criminal, M>F >18, (conduct dzd
Borderline
unstable, impulsive, self-mutilating, emptiness, F>M; splitting
Histrionic
excessively emotional, attention seeking, overly sexual
Narcissistic
grandiose, sense of entitlement, lacks empathy
Cluster C: anxious, fearful; associated w/ anxiety dzds
Avoidant
hypersensitivity to rejection, inhibited, desires relationships
OCPD
perfectionist, ego syntonic (OCD=dystonic, ass'd w Tourette's)
Dependent
submissive, clingy, low self confidence
Psych txs
EtOH withdrawal/cocaine OD
ADHD
schizophrenia
Tourette's
depression
atypical depression
depression + insomnia
bipolar dzd
anorexia/bulemia
anxiety
OCD
PTSD
social phobia

BDZ
methylphenidate, amphetamines (dexedrine)
antipsychotics
antipsychotics (esp haloperidol)
SSRIs, SNRIs, TCAs
MAOIs, SSRIs
Mirtazapine
stabilizers (valproate, Li, carbamazepine), atypicals
SSRIs
BDZ, buspirone, SSRIs
SSRIs, TCAs, BDZs
SSRIs
SSRIs

ral Science

Early developmental milestones

Infant <3mo
rooting reflex
orients to voice
3-6mo
holds head up, Moro reflex disappears
social smile
6-9mo
sits alone, crawls
stranger anxiety
12mo
walks, Babinski disappears
separation anxiety, few wor
Toddler 1-2yr
climb stairs, stack 3-6 blocks
object permanence, 200 wo
2-3yr
stack 6-9 blocks, toilet training
gender identity, parallel pla
Preschool 3-4yr
rides tricycle, copies line drawing
900 words, complete senten
4yr
cooperative play, imaginary friends, grooms self, buttons and zips
Tanner 1=childhood; 2=adrenarche (pubic hair, breasts); 3=hair darkens, curls, penis
4=penis wider, scrotum darkens, raised areolae; 5=adult, areolae not raised
circadian rhythm driven by suprachiasmatic nuc of hypothalamus, regulated by light

enal
Electrolyte disturbances
Low
Na
disorientation, stupor, coma
K
EKG changes (U-waves, flat T's),
arrhythmia, paralysis

High
irritability, delirium, coma
EKG changes (peaked T's, wide QRS),
arrhythmias

Ca
Mg
PO4 (IP)

delerium, renal stones, abd pain, stupor

delerium, low DTRs, cardiopulm arrest
renal stones, metastatic calcifications

tetany, NM irritability
NM irritability, arrhythmias
osteomalacia

Nephrotic lost heparin sulfate causes massive proteinuria (>3.5g/d, thromboemboli,

hyperlipidemia, edema), fatty casts, can lose Igs (infxn risk); FSGS: most common GN
adults and HIV pts; Minimal change dz: aka lipoid nephrosis, in kids, triggered by recen
tx=steroids, LM=no change; amyloid; DMGN: (type III) drugs, infxn, SLE, tumors, thicke
GBM/capillaries, EM="spike-and-dome"; MPGN: can be nephritic too, type 1="tram tra
(HBV/HCV related), type 2=dense deposits (EM, assc'd w/ C3 nephritic factor); diabetic
glomerulonephropathy: non-enzymatic glycosylation (NEG) of GBM causes thickening a
increased permeability, NEG of efferent increases GFR causing mesangial expansion, n
glomerulosclerosis (KW lesions)

Nephritic inflammation of glomeruli causes (PHAROH) proteinuria (<3.5g), hematuria,

azotemia, RBC casts, oliguria, htn; IgA nephropathy (Berger's dz): increased IgA synth,
presents after URI or acute gastroenteritis, assc'd w/ Henoch-Schonlein; acute poststre
(postinfxous): in kids, glomeruli enlarged/hypercellular, "lumpy-bumpy", periorbital/pe
edema, resolves spontaneously; rapidly progressive (crescent) GN: crescents of fibrin,
proteins, parietal cells, monocytes, & macrophages, poor prognosis, from Goodpasture
Wegeners, or microscopic polyangiitis; Alport's: split BM; diffuse proliferative: from SLE
MPGN, "wire-looping" of capillaries
Immune deposits
Sub-epithelial
Membranous GN (DMGN)
Postinfectious GN
Immunofluorescence Pattern
Granular
Membranous GN
Postinfectious GN
MPGN
Other Characteristics
Diffuse glomerular proliferation
Postinfectious GN
MPGN
SLE

Sub-endothelial
Cryoglobulinemia
MPGN

Mesangial
Berger's Dz (IgA nephropath

Linear
Goodpastures

Light and Dark Areas

Berger's Dz (IgA nephropath

Low Complement
Postinfectious GN
MPGN
Cryoglobulinemia

Kidney stones
Ca
CaOx most common, can be from ethylene glycol or vit C abuse; hyperPTH
NH4MgPO4 infxn w/ urease bugs (Proteus, eg), can be staghorn, worse w/ alkaluria
Urate
radiolucent, strong assn w/ hyperuricemia (gout, B3), high cell turnover
Cystine
hexagonal crystals, usually 2 to cystinuria, tx=alkalinize urine
ARF (acute kidney injury)
U(Osm)
U(Na)
FeNa
Serum BUN/Cr
Prerenal
>500
<10
<1%
>20
Renal
<350
>20
>2%
<15
Postrenal
<350
>40
>4%
>15
tal htn, Potter's), dialysis, simple, medullary (can lead to fibrosis/insufficiency, atrophic kidney)

oductive

Placental pregnancy complications

Abruptio
3rd trimester, painful bleeding; premature detachment of placenta; fetal d
placenta
can cause DIC; risk: smoking, htn, cocaine use

Abruptio
placenta

3rd trimester, painful bleeding; premature detachment of placenta; fetal d

can cause DIC; risk: smoking, htn, cocaine use

Placenta
previa

any trimester, painless bleeding; placental attachment to lower uterine se

may occlude os; risk: multiparity or prior C-section

Placenta
accreta

after delivery, massive bleed; defective decidua (placental attachment to

myometrium), no separation; risk: prior C-section, placenta previa

Retained
after delivery, may cause hemorrhage
endometriosis: ectopic endometrial glands, nonneoplastic, cyclic bleeding/pain or choc
cysts, usually in ovary/peritoneum; adenomyosis: w/i myometrium

endometrial hyperplasia (excess E, sx=postmenopausal bleeding; risk=anovulatory cy

HRT, PCOS, granulosa cell tumor) biggest risk for endometrial carcinoma
endometrial carcinoma: most common gynecologic malignancy; sx=vaginal bleeding;
risk=obesity, DM, htn, nulliparity, late menopause, PCOS, endometrial hyperplasia

myometrial tumors leiomyoma=fibroid, most common tumor in F, usually multiple, we

demarcated, benign, E-sensitive (grows w/ pregnancy), 30yo; asxatic, abnormal uterin
bleeding, Fe def anemia, miscarriage; whorled pattern of smooth mm bundles;
leiomyosarcoma: irregular shape, necrosis, recur, aggressive, usually middle-aged

anovulation PCOS, obesity, HPO abnormalities, POF (menopause before 40, follicular a
hyperPRL, thyroid/eating dzd, Cushing's, adrenal insufficiency

PCOS: high LH causes anovulation, hyperandrogenism (androstenedione from theca ce

low FSH, high T, enlarged bilateral cystic ovaries, amenorrhea, hirsutism, and obesity;
insulin resistance; higher risk of endometrial cancer

cysts follicular cyst=unruptured Graffian follicle; corpus luteum cyst=hemorrhage into

persistent CL, regresses spontaneously; theca-lutein cyst=bilateral/multiple, from Gn
stimulation, assn w chorioca and moles; chocolate cysts=endometriosis

M and F

Ovarian tumors: Germ cell (most common in adolescents)

Teratoma
90% of ovarian germ cell tumors; cells from 2-3 germ layers;
mature=benign, immature=aggressive; struma ovarii=hyperT3
Dysgerminoma

malignant, eq to but rarer than male seminoma; uniform sheet

cells, large nuclei; tumor marker: hCG, LDH

Choriocarcinoma
(hematogen. spread)

can develop in pregnancy in mother or baby; hyperchromatic,

nuclei; increase frequency of theca-lutein cysts; hCG

Yolk sac (endodermal

sinus)

in testes, ovaries, or sacrococcygeal area of kids; yellow, friabl

masses; 50% have Schiller Duval bodies; AFP

Ovarian tumors: Non-germ cell (CA-125=general ovarian cancer marker)

Serous cystadenoma most common benign ovarian tumor, fallopian-tube epithelium
Serous cystadenoca
50% of all ovarian tumors; malignant, frequently bilateral; BRC
HNPCC (FHx is most important risk factor)
Mucins cystadenoma
Mucins cystadenoca
Brenner tumor
Fibromas
Granulosa cell tumor

mulitlocular cyst, benign, intestine-like tissue

pseudomyxoma peritonei: intraperitoneal mucus accumulation
benign, looks like bladder
bundles of spindle-shaped fibroblasts, part of Meigs' Sz
secretes E (precocious puberty, endometrial hyperplasia/ca),
abnormal uterine bleeding Call-Exner bodies (red, exracellular)

Krukenberg tumor
GI malignancy that mets to both ovaries, mucin-secreting
vaginal sarcoma botryoides (rhabdo variant): <4yo, spindle-shaped, desmin-positive
Testicular tumors: Germ cell (95% of testicular tumors, can be mixed, all malignant
Seminoma
painless, homogenous test, enlargement; most common test. t
25yo, radiosensitive, late mets; lobules, clear cytoplasm

Embryonal ca

painful, worse prognosis, often glandular/papillary, can differen

other tumors; can have AFP/hCG tumor markers

Teratoma
mature teratoma is most likely malignant
Testicular tumors: Non-germ cell (5%, mostly benign)
Leydig cell
contains Reinke crystals; gynecomastia, precocious puberty
Sertoli cell
androblastoma from sex cord stroma
Testicular lymphoma
common in older men
Benign breast tumors
Fibroadenoma
most common tumor <35yo; small, mobile, firm, sharp edges;
responds to estrogen (pregnancy, menstruation); not pre-malig

Intraduct papilloma
serous or bloody nipple discharge, slight increased risk for ca
Phyllodes tumor
most common in 60s; big, leaf-like projections; may transform
Malignant breast tumors
Invasive ductal
most common, worst; firm, fibrous, sharp margins, small cells
Invasive lobular
orderly rows of cells, often multiple and bilateral
Medullary
fleshy, cellular, lymphocyte infiltrate, good prognosis
Comedocarcinoma
ductal, caseous necrosis, DCIS subtype
Inflammatory
dermal lymphatic invasion by ca and block (Peau d'orange)
Paget's dz
eczematous nipple, large cells w/ clear halo, underlying tumor
ed fluid 2 to incomplete fusion of processus vaginalis; spermatocele: dilated epididymal duct
piratory
Lung volumes
inspiratory capacity=IRV + TV
FEV1=after full inspiration, V forcibly expired
in the first second; low in restrictive, very low
in obstructive
FVC=after full inspiration, total V forcibly
expired; low in obstructive, very low in
restrictive
FEV1/FVC=hallmarks: obstructive<70%,
restrictive>80%
O2 in the blood
O2 content
binding capacity
dissolved O2

Equation
BC + dissolved O2
1.34 * Hb * % sat
PO2 * 0.3%

Nl value
20.4g/mL
20.1g/mL
0.3g/mL

Changed by
any change in BC or DO2
down: anemia
up: 100% O2

Lung cancer
Type
SqCC (smoking)
Small CC

Location
central
central

Characteristics
cavitation, PTHrP; keratin pearls, intercell'ar bridgin
very aggressive; ACTH, ADH, Lambert-Eaton, chem
responsive, inoperable; NET (Kulchitsky cells=dark)

bronchial adenoca
bronchioalveolar

periph
periph

Large CC

periph

prior pulmonary injury site; nonsmokers

grows along airways (pneumonia-like),
can cause hypertrophic osteoarthropathy
highly anaplastic, surgical tx, poor prognosis; giant
w/ leukocyte fragments in cytoplasm

pneumonic "coin" lesion on XR, noncalcified nodule on CT; mets to brain (epilepsy), liv
(jaundice, HM), adrenal, bone (break); met from breast, colon, prostate, bladder

pneumonic "coin" lesion on XR, noncalcified nodule on CT; mets to brain (epilepsy), liv
(jaundice, HM), adrenal, bone (break); met from breast, colon, prostate, bladder
complications: SVC Sz, Pancoast (Horner's), paraneoplastic, effusions, hoarseness

ARDS: diffuse alveolar damage, protein-rich leakage into alveoli, forms haline membra
initial damage from PMNs, coagulation cascade, or free radicals; from intravascular (se
shock, uremia, amniotic fluid embolism) or extravascular (trauma, gastric aspiration, a
panc) cause; NRDS: persistently low O2 increases risk of PDA; therapeutic O2 causes
retinopathy of prematurity

cations; silica disrupts phagolysosome, impairs macrophages, increased susceptibility to TB)

ophilia (A and B)
ott-Aldrich
on's agammaglobulinemia
deficiency
er's

, Histidine
hreonine, Tryptophan

at body pH)

LDL
HDL
B-100
A-1, A-2
2/3 of plasma chlsl
LDL, TG back to HDL

causes high TG and chlsl;

herosclerosis

d LDL, chlsl, tendon (Achilles)

us
ed TG, pancreatitis

n, loads apoB with lipids) def

orrhea, malabsorption,

after birth (normal at birth

s, musty body odor, fair skin,
on, CHD

es (def causes improper CNS

etion begins
-/cyto-trophoblast)
=neural tube closure

e to teratogens

mammilary glands,
ar

trocytes, ependymal cells,

septum, pia, arachnoid, skull

s

eal fistula, Renal, Limb; bone,

n tube

anc, thymus, parathyroid)

isjunction

flu, N. meningitides

ardia, Aspergillus
llus
so is Erlichia & Babesia)

u
nomyces israelii

mebendazole
albendazole
raw fish
raw fish
inflamed spleen/ liver,
granulomas
from bacterial infxn
hookworms
nematode
raw pork
microfilaria allergy
steatorrhea/STD
dysentery
amastigotes too

elderly
S. pneumo
viruses (flu)
anaerobes
H. flu
GNR

elderly
S. pneumo
GNR
L. monocytogenes

ign (flex hip, rigidity on knee

ntarily)

ype I
DM type I
icious anemia, Hashimoto's
oid-responisve nephrotic sz

n Comes")
molecules/chemokines

precursors
ng to IgG and IgE
, eosinophil maturation
s
d precursors

otic, pro-growth
Th1
ryocytes, bone prolif

helium, leaky
s Th2, ups MHC1 and 2

dz
DM type 1
Celiac
CREST
Hashimoto's
PBC
pemphigus vulgaris
Wegener's

gross=waxy
e myeloma, BJ proteins)
n (chronic inflammation)

ein

ssors: two mutations needed

ors (gene product)
oblastoma, osteosarcoma
t cancers, Li-Fraumeni Sz
reast and ovarian cancer

east ca (DNA repair protein)

anoma
rectal cancer (assn w/ FAP)
ms' tumor
type 1
type 2
reatic cancer
n cancer

ontraction, mydriasis

dilation, drops uterine tone

CL)/salivary secretion

comodation),
DUMBLS)

on, pruritis, pain

dney

Cause
RF (MR and TR), MVP,
ischemia, LV dilation
dilation, endocarditis
myxomatous degen, RF,
chordae rupture
age calcifications,
bicuspid aortic valve
RF (vast majority)
root dilation, RF,
bicuspid valve
rubella, prematurity

V3 | V4
+ | +
+ |

|
|
|
|

V5 | V6

+
+

peak 12h, stays 7-10d

MI, gone by 3d

|
|
|
|
|
|

+
+

s
Risk
, mottled, pale w arrhythmia
zolium dye

eremic

arrhythmia
or rupture
(day 4)

eremic border,
rupture
rally yellow-brown (wall,
chordae)
white

aneurysm

H, TSH, -hCG), melanotropic

posterior pit (oxytocin, ADH)

, E2, D3, cortisol, aldo
lin (with IGF-1);; TK P-ation
nd becomes activated

2h glucose tolerance
<140
140-200
>200

>200

thus high ACTH)

Other
ovolemic shock in newborn
culinization, as w 21-OHase
seudoherm, F=sexual infant

usually PRL or GH), and

tomach ulcers)
yroid (kidney stones)

intestinal ganglioneuromatosis

e kinase)

y anions and PTU or

eart, increased metabolic rate;

dule, mutated TSH-R, rarely

vity; thyrotoxicosis:
death by arrhythmia; Jod-

a (hypothermia and altered

Hashimoto's: thyroiditis, so may
lin Ab, HLA-DR5), Hurthle cells,
tal hypoT3, co-endemic with
uberant tongue; subacute
jaw pain, early inflammation
us tissue, rock-hard

Orphan Annie" nuclei (ground

follicles, good prognosis;
2A/B;
himoto's
-selective -blockers

Other
ectopic production=
Zollinger-Ellison Sz;
AAs: Phe and Try are
potent stimulators

incretin
acts on neural
muscarinic pathways to
stimulate the panc
anti-GH effects
VIPoma: panc tumor,
copious diarrhea
agonists useful
autoimmune attack=
chronic gastritis/PA

pepsinogen to pepsin
by H+
bicarb is trapped in
mucous that covers
gastric epithelium

autoimmune)
inuous, always involves rectum

le mucosal pseudopolyps, loss

austra

/mucosal inflammation only,

t abscesses/ulcers

nutrition, toxic megacolon,

rectal carcinoma (hi risk)

dy diarrhea, PSC, pyoderma

grenosum, ankylosing
dylitis, uveitis

A, 6-MP, infliximab, colectomy

INH=hepatitis; hepatic
room poisoning

cohol: AST>ALT), MI (AST)

post-HC (obstructive)
high
highest
low

s (complex=indirect bilirubin)
rubin, into biliary lumen by

P), overworked (EtOH,

drugs (sulfa, steroids); sx:
ase (more specific) and
eudocyst, infxn, hemorrhage,
ADEK deficiency, steatorrhea,

EtOH; sx: abd pain radiates to

ier's sign)

ucous disruption, bile acid

ia, bacteria

ed
aspirin, ibuprofen,
lls

factor onto RBC membrane,

erin

SLE, malignant htn; macro:

aundice; (Wilsons)
isis (B19), bone crises, renal
ration crisis, autosplenectomy

milder dz than HbSS

and 3.1, spectrin); high MCHC,
owell-Jolly body)

ane; HA in newborn

old=IgM: CLL, mono, M.

(direct=anti-IgG Ab)

<6%, higher in DM
minor

% transferrin sat
(serum Fe/TIBC)
low
nl
high
low
high

ing of RBCs, renal, GI dz; kids:

es (XR), abd pain; adults

Mantle
Ewing's
t(11;14)
t(11;22)
-

associated dzs
lung dz, CHD, altitude
ectopic erythropoietin

Injury
humerus dislocation,
surgical neck break
upper trunk

hum. midshaft break,

Saturday night palsy
carpal tunnel, lunate
dislocation
supracondylar humerus
fracture
fracture of the hook of
the hamate
medial epicondyle of
humerus, funny bone
lower trunk (birth)

Injury
ant. hip dislocation
pelvic fracture
fibular neck fracture,
lateral leg trauma
knee trauma
post. hip dislocation
+ polio

tumor; mature bone w/

yses; transformation rare

y distal extremities
urrounded by osteoblasts
mal tibia/femur

urrounded by osteoblasts,

ones (esp knee); locally

es'; spindle-shaped cells

on another, often in skull

nancy (MM); XR=Codmans

, from metaphyses (esp knee);
radiation, Rb

mets, chemo-responsive;
mall blue cells, t(11;22)

ma; intramedullary

r tone
ar tone, uterine tone

onchial tone (-lukast=I)

S. aureus, S. pyogenes
S. aureus, S. pyogenes
S. pyogenes or
anaerobes

ne, carbamazepine,
nol), analgesics (NSAIDs),
ment

Order/Synapse/3rd Order
ecussates in medulla, ascends
ralaterally in medial lemniscus;
PL of thalamus; 3=sensory
ex

ecussates at anterior white

misure, ascends
ralaterally; S=VPL of thalamus;
ensory cortex

synapse=cell body of anterior

(spinal cord); LMN: leaves
e, to NMJ (synapse 2)

scend on internal carotid;

up. cervical ganglion; 3=int.
tid to long ciliary n (V1)

es, rapid expansion

, crescent-shaped
sm, yellow/red spinal tap,
n products, tx=CCB)

ior horn; nonspecific sx going

l or throat

py baby, young death

lly C8-T1; assn w Chiari
en; locomotor/sensory ataxia,
ositive Romberg

pinocerebellar, and doral

aired vib/position

dysarthria, pes cavus, hammer

kyphoscoliosis

al tract (of Lissauer); upper

ewicz below T8)

ognitive, or oculomotor
ase 1; tx=Riluzole

nation of CNS, white F, 20-30;

sz (internuclear
mus, optic neuritis,
g; MRI for dx, high IgG in CSF
ar plaques (oligodendrocyte
)

(seizure, dementia, etc)

adenoma, calcifications
solid, GFAP [+], may be
philic corkscrews

an compress 4 th ventricle
ettes, small blue cells
ydrocephalus); blepharoplasts
ttes

cells, highly vascular

s, can cross corpus, GFAP [+];
areas of necrosis

ells, psammoma bodies

, S-100 [+]
n-wire capillary pattern
ified
hemianopia

% of AIDS, rapidly fatal

A def, buildup of sulfatides,

nd demyelination, after infxn

es, smallpox)

horizontal nystagmus; central:

ection

es "blindness", hysteria)
ood/all bad)

evel
power, not admiration)
pegoating

ssion, rxn formation

wareness
e way (aggression/boxer)

schizophrenia

otional expression
al thinking, awkward

nd substance abuse
M>F >18, (conduct dzd)
ptiness, F>M; splitting
g, overly sexual
empathy

desires relationships
nic, ass'd w Tourette's)

mines (dexedrine)

dol)

rbamazepine), atypicals

nts to voice
al smile
nger anxiety
ration anxiety, few words
ct permanence, 200 words
der identity, parallel play
words, complete sentences
uttons and zips
ir darkens, curls, penis longer;
ae not raised

us, regulated by light

um, coma
eaked T's, wide QRS),

stones, abd pain, stupor

TRs, cardiopulm arrest
etastatic calcifications

5g/d, thromboemboli,
SGS: most common GN in
kids, triggered by recent infxn,
nfxn, SLE, tumors, thickened
c too, type 1="tram track"
ephritic factor); diabetic
GBM causes thickening and
mesangial expansion, nodular

ria (<3.5g), hematuria,

z): increased IgA synth, often
chonlein; acute poststrep
-bumpy", periorbital/peripheral
GN: crescents of fibrin, plasma
nosis, from Goodpastures,
e proliferative: from SLE or

angial
er's Dz (IgA nephropathy)

t and Dark Areas

er's Dz (IgA nephropathy)

nt
N

r vit C abuse; hyperPTH

n, worse w/ alkaluria
3), high cell turnover
alinize urine
Epidemiology
community
hospital
BPH/cancer mets

idney)

ment of placenta; fetal death,

ment to lower uterine segment,

lacental attachment to
placenta previa

ic bleeding/pain or chocolate
um

ng; risk=anovulatory cycles,

arcinoma

; sx=vaginal bleeding;
metrial hyperplasia

F, usually multiple, wellsxatic, abnormal uterine

th mm bundles;
sually middle-aged

e before 40, follicular atresia),

enedione from theca cells);

hirsutism, and obesity; assn w

cyst=hemorrhage into
eral/multiple, from Gn
metriosis

from 2-3 germ layers;

; struma ovarii=hyperT3

minoma; uniform sheets of

LDH

baby; hyperchromatic, large

in cysts; hCG

ea of kids; yellow, friable, solid

s; AFP

ancer marker)
allopian-tube epithelium
requently bilateral; BRCA-1,
or)

tissue
eal mucus accumulation

part of Meigs' Sz
etrial hyperplasia/ca),
odies (red, exracellular)

s, mucin-secreting
aped, desmin-positive
be mixed, all malignant)
nt; most common test. tumor,
, clear cytoplasm

ar/papillary, can differentiate to

markers

nt

, precocious puberty

bile, firm, sharp edges;

struation); not pre-malig.

t increased risk for ca

ections; may transform

rp margins, small cells

bilateral
ood prognosis

ock (Peau d'orange)

halo, underlying tumor
duct

nged by
change in BC or DO2
n: anemia
100% O2

earls, intercell'ar bridging

H, Lambert-Eaton, chemo(Kulchitsky cells=dark)

nonsmokers
monia-like),
eoarthropathy
x, poor prognosis;
ytoplasm

Clara cell,
multiple
densities
giant cells

s to brain (epilepsy), liver

prostate, bladder

usions, hoarseness

i, forms haline membrane,

s; from intravascular (sepsis,
ma, gastric aspiration, acute
herapeutic O2 causes
TB)

Name
Addison's Dz
Albright's hereditary
osteodystrophy
Alport's Sz
Alzheimer's Dz
Andersen's Dz
Angelman's Sz
Becker's MD
Berger's Dz
Boerhaave Sz
Broca's aphasia
Budd-Chiari Sz
Buerger's Sz
Caplan's Sz
Chagas' Dz
Charcot-Bouchard Sz
Charcot-Marie-Tooth Sz
Chediak-Higashi Sz
Cheyne Stokes breaths
Chiari malformation
Churg-Strauss Sz
Conn's Sz
Cori's Dz
Creutzfeldt-Jakob Dz
Cri-du-chat Sz
Crigler-Najjar Sz, type 1
Crigler-Najjar Sz, type 2
Curling's ulcer
Cushing's ulcer
Dandy-Walker Sz
DiGeorge Sz
Dressler's Sz
Dubin-Johnson Sz
Duchenne's MD

Edwards' Sz

Ehlers-Danlos Sz
Eisenmenger's Sz
Endemic Typhus
Epidemic Typhus
Fabry's Dz
Fanconi's anemia
Fanconi's Sz
Fitz-Hugh-Curtis Sz
Friedrich's ataxia

Gardner's Sz
Gaucher's Dz
Gerstmann Sz
Gilbert Sz
Glanzmann's
thrombasthenia
Guillan-Barre Sz

Hartnup Dz
Henoch-Schonlein purpura
Hirschsprung Dz
Hunter's Sz
Huntington's Dz
Hurler's Sz
I-cell (inclusion) dz
Jarisch-Herxheimer rxn
Jervell and Lange-Nielsen
Sz
Job's Sz
Kallmann Sz
Kartagener's Sz
Kawasaki's Dz
Kluver-Bucy Sz
Krabbe's Dz
Krukenberg's tumor

Lambert-Eaton Sz
Lesch-Nyhan Sz
Leser-Trelat Sign
Lewy Body dementia
Libman Sachs
Li-Fraumeni Sz
Loffler's Sz
Lynch Sz
Mallory-Weiss Sz
Marfan's Sz

McArdle's Dz
McCune-Albright Sz

Meigs' Sz
Menetrier's Dz
Meniere's Dz
Myasthenia Gravis
Neimann-Pick Dz
Osler-Weber-Rendu Sz
Paget's Dz
Parinaud Sz
Parkinson's Dz
Patau's Sz
Peutz-Jeghers Sz
Pick's Dz
Plummer-Vinson Sz
Pompe's Dz
Potter's Sz
Pott's Dz
Prader-Willi Sz
Reiter's Sz
Reye's Sz
Riedel's thyroiditis

Rotor's Sz
Samter's triad
Sezary Sz
Sheehan Sz
Shwartzman rxn
Sturge-Weber Dz
Takayasu's arteritis
Tay-Sach's Dz
Temporal arteritis
Treacher-Collins Sz
Trousseau's Sz
Turcot's Sz
Typhoid fever
von Gierke's Dz
von Hippel-Lindau Dz
Waldenstrom's
macroglobulinemia
Wallenberg's Sz

Waterhouse-Friderichsen
Sz
Wegener's granulomatosis
Weil's Dz
Wenckebach
Werdnig-Hoffman Sz
Wernicke-Korsakoff Sz
Wernicke-Korsakof Sz
Wernicke's aphasia
Whipple's Dz
William's Sz
Wilson's Dz
Wiskott-Aldrich Sz
Wolff-Parkinson-White

Sx
hypotn, hyperkalemia, acidosis, skin hyperpigmentation
hypocalcemia, tetany, shortened 4th/5th digits, short stature
progressive heridetary nephritis, deafness, and cataracts
dementia, can get intracranial hemorrhage, cortical atrophy, intracellular
neurofibrillary tangles (hyperphosphorylated tau)
cirrhosis and death w/i 5y
retardation, seizures, ataxia, inappropriate laughter
mm weakness, presents in early adulthood
nephritic sz (PHAROH), mesangial immune deposits
transmural esophageal rupture
nonfluent, intact comprehension
congestive liver disease: HSM, ascites, abd pain, liver failure, varices, NO
JVD
intermittent claudication, severe pain, superficial nodular phlebitis,
Raynaud's, can cause gangrene and autoamputation
cough, SOB, joint inflammation (RA)
dilated CM, megacolon, megaesophagus
microaneurysms in small vessels (basal ganglia, thalamus)
aka hereditary motor and sensory neuropathy (HMSN)
recurrent pyogenic infxn, partial albinism, peripheral neuropathy, large
lysosomal vescicles in phagocytes
oscillating slow/fast breathing
II: assn w/ aqueductal stenosis, hydrocephaly, syringomyelia, lumbar
meningomyelocele
usually asthma, sinusitis, skin lesions, peripheral neurophathy (wrist/foot
drop); can also hit heart, GI, kidneys
htn, hypokalemia, MAlk
mild form of von Gierke's (gluconeogenesis intact), no LAc
rapidly progressive dementia with myoclonus
microcephaly, retardation, epicantal folds, cardiac problems
early death, jaundice, kernicterus, high indirect bilirubin
high indirect bilirubin, can be treated with phenobarbital
acute gastritis and ulcer
acute gastritis and ulcer
assn w/ hydrocephalus, spina bifida, posterior fossa enlargement
parathyroid/thymic aplasia (hypoCa/TC def), cardiac defects (TOF, truncus
arteriosus)
low grade fever, pleuritic chest pain, pericarditis (self-limited)
conjugated hyperbilirubinemia, grossly black liver, benign
mm weakness, begins in pelvig girdle, progresses superiorly,
pseudohypertrophy of calf/delt, DCM, Gowers' maneuver (use of arms to
stand), presents <5yo, high CPK
microcephaly, rocker-bottom feet, clenched hands, heart defect

hyperextensible skin, bleeding tendency/aneurysms/organ rupture,

hypermobile joints/dislocations
PAH, late cyanosis, clubbing, polycythemia
rash starts centrally and spreads outward, fever, headache
rash starts centrally and spreads outward, fever, headache
peripheral neuropathy (esp hands and feet), angiokeratomas,
cardiovascular and renal diseases
aplastic anemia, short stature, tumors/AML (high risk)
polyuria, acidosis, growth failure, electrolyte imbalances
acute RUQ pain, referred to R shoulder, "violin string" appearance
staggering gait, frequent falls, nystagmus, dysarthria, pes cavus, hammer
toes, HCM (cause of death), presents as childhood kyphoscoliosis
CRC, osteomas, and soft tissue tumors, retinal hyperplasia
HSM, osteoporosis, aseptic necrosis of femur/bone crises, mental retard.,
Gaucher's cells (macrophages look like crumpled paper)
acalculia, agraphia, finger agnosia, L/R disorientation
benign mild jaundice with stress/fasting
increased bleeding time, normal platelet count, smear shows no clumping
symmetric,rapidly-ascending mm weakness, begins in distal LE, facial
paralysis in 50%, papilledema, autonomic dysfunction not uncommon
(htn, eg); usually resolves wks-mos
pellagra (diarrhea, dermatitis, dementia) from low tryptophan
skin rash (palpable purpura) on buttocks and legs, arthralgias, intestinal
hemorrhage, abdominal pain, melena
congenital megacolon, constipation, failure to pass meconium
mild Hurler's, no corneal clouding, aggressive behavior
chorea, athetosis (writhing fingers), dementia, aggression, depression
(mistaken for substance
abuse sometimes)
developmental
delay, gargoylism,
airway obstruction, corneal clouding,
HSM
coarse facial features, clouded corneas, restricted joint movement, high
plasma
levelsheadache,
of lysosomal
proteins
fever, chills,
myalgia
after syphilis tx
long QT, sensorineural hearing loss
coarse facies, "cold" abscesses, retained primary teeth, hyper-IgE, derm
problems (eczema), recurrent colds
lack of 2 sex characteristics (hypogonadotropic), anosmia
infertility, bronchiectasis, recurrent sinusitis, situs inversus
fever, conjunctivitis, strawberry tongue, lymphadenitis, desquam-ative
skin rash, can develop coronary aneurisms (esp if untxed)
hyperorality, hypersexuality, disinhibited behavior
galactocerebrosidase def causes galactocerebroside accumulation
abundant mucous, signet ring cells

difficulty climbing stairs, rising from chair, eye sx come later (as opposed
to MG where they are early), no reversal w/ AChEIs
retardation, self-mutilation, aggression, hyperuricemia, gout,
choreoathetosis
sudden appearance of multiple seborrheic keratoses
Parkinsonism w/ dementia and hallucinations
sterile endocarditis, usually benign
sarcomas at a young age, many cancers while young
80% progress to CRC, proximal colon always involved
hematemesis
tall, long extremities, pectus excavatum, hyperextensive joints,
arachnodactyly, aortic regurg/dissecting aortic aneurysms (cystic medial
necrosis of aorta), MVP, superotemporal lens subluxation
cramps, myoglobinuria w/ exercise
multiple unilateral bone lesions and caf-au-lait spots, endocrine
abnormalities (PRL/GHoma, precocious puberty, hyperthyroid) ovarian
cysts
ovarian fibroma, ascites, pleural effusion (usually R sided transudate), pulling sensation in groin
cerebriform rugae, edema, wt loss, precancerous
vertigo (relapsing/remitting), hearing loss, tinnitus
dyplopia, ptosis, reversal w/ AChEI
progressive neurodegeneration, developmental delay, cherry red macula,
foam cells, HSM
telangiectasias, recurrent epistaxis, skin discolorations, AVMs
increased hat size, CN impingement, chalk-stick fractures, high output
cardiac failure (increased AV shunts), mosaic patterning
paralysis of conjugate vertical gaze
pill-rolling tremor (at rest), cogwheel rigidity, brady-/a-kinesia, postural
instability, Lewy bodies (intracellular -synuclein)
microcephaly, rocker-bottom feet, cleft lip/palate, holoprosencephaly,
polydactyly, congenital heart dz
GI hamartomas (polyps), hyperpigmentation of mouth/feet/hands
dementia, aphasia, Parkinsonian, change in personality, Pick bodies
(hyperphosphorylated intracellular tau)
anemia, atrophic glossitis, dysphagia (esophageal webs)
cardiomegaly/restrictive CM, exercise intolerance, neuro sx
limb/facial deformities, pulmonary hypoplasia, oligohydramnios
vertebral narrowing/collapse, spinal mass, back pain
retardation, hyperphagia, obesity, hypogonadism, hypotonia
conjunctivitis/anterior uveitis, urethritis, arthritis (large joint)
mitochondrial abnormalities, microvescicular fatty liver, hypoglycemia,
coma, hepatoencephalopathy
rock-hard, non-tender goiter, hypothyroidism

very mild conjugated hyperbilirubinemia

asthma attack, hypersensitivity, nasal polyps
cutaneous patches and nodules, indolent CD4+ TC lymphoma
(postpartum) no lactation, absent menstruation, cold intolerance
vasculitis from exposure to endotoxin causing glomerular thrombi
facial port-wine stain (nevus flammeus), pheo, ipsilateral leptomeningioma (intracerebral AVM), seizures, early-onset glaucoma
fever, night sweats, high ESR, myalgias, arthritis, ocular disturbances,
weak pulses in upper extremities
progressive neurodegeneration, developmental delay, cherry red macula,
lysosomes w/ onion skin, no HSM
unilateral headache, jaw claudication, impaired vision (occlusion of
ophthalmic artery), high ESR
mandibular hypoplasia, facial abnormalities, hearing loss
migratory thrombophlebitis
colon and malignant CNS tumors
fever, diarrhea, headache, rose spots on abdomen
severe fasting hypoglycemia, increased glycogen in liver, hepatomegaly,
lactic acidosis, gout
hemangioblastomas of retina/cerebellum/medulla, bilateral RCC, pheo, etc
M spike on electrophoresis, hyperIgM, hyperviscosity sx, no lytic bone
lesions (like in multiple myeloma)
contralateral pain/T loss, ipsilateral dysphagia, hoarseness, no gag reflex,
vertigo/diplopia, ipsilateral Horner's, ipsilateral face sensation loss,
ipsilateral ataxia
organ failure, coma, death, hypotn, shock, DIC, no meningitis
cough, dyspnea, hemoptysis, hematuria/red cell casts, chronic sinusitis,
otitis media, mastoiditis
jaundice, azotemia, hemorrhage, anemia, fever, photophobia
usually asxatic
floppy baby at birth, tongue fasciculations, death by 7mo
confusion, ophthalmoplegia, ataxia
anterograde amnesia, confabulation, personality changes
fluent, impaired comprehension
arthralgias, cardiac and neuro involvement
elfin facies, retardation, hyperCa, overly friendly, CV problems
Kayser-Fleischer rings, hemolytic anemia, cirrhosis, asterixis, HCC, basal
ganglia degeneration, dementia, dyskinesia, dysarthria
thrombocytopenic purpura, infxns, eczema; high IgE/A, low IgM
ventricles partially depolarize earlier, delta-wave on ECG

Pathophys
chronic primary adrenal insufficiency (atrophy or destruction)
AD bilateral renal unresponsiveness to PTH
abnormal type IV collagen
APP degradation by -/-secretase yields N-APP (DR6L) or A40/42 (cell death
signal or aggregate into plaques), decreased ACh
branching enzyme def, glycogen pptation
deletion of maternal chromosome 15
XLR mutated dystrophin gene
presents/flares w/ URI or acute gastroenteritis, assn w Henoch Schonlein
violent retching (alcoholics, bulemics)
inferior frontal gyrus
occlusion of IVC or hepatic veins causes centrilobular congestion and necrosis;
assn w polycythemia, HCC, pregnancy, hypercoaguable state
medium-sized vessels, idiopathic segmental thrombosing vasculitis; seen in
heavy smokers
pneumoconiosis + rheumatoid arthritis
Trypanosoma cruzi (protist), from reduviid bug
associated w chronic htn
defective protein production, presents in childhood
microtubule polymerization defect causes decreased phagocytosis
central apnea in CHF or high ICP
cerebellar tonsil herniation; I: asxatic; II: large vermian displacement
p-ANCA, granulomatous vasculitis w/ eosinophilia
aldosterone secreting tumor, can be bilateral
debranching enzyme (-1,6-glucosidase) def
prions cause -helix to -sheet transformation
congenital microdeletion of 5p
absent UDPGT causes large increase in unconjugated bilirubin
low UDPGT causes large increase in unconjugated bilirubin
burns cause low plasma volume, causing sloughing of the gastric mucosa
brain injury causes increased vagal stimulation, increasing H + production
absence of cerebellar vermis, large fourth ventricle
22q11 microdeletion causes aberrant development of 3rd and 4th branchial
pouches
autoimmune fibrinous pericarditis, several weeks post-MI
liver glucuronyl transferase deficiency (excretion of conjugated bilirubin)
XLR frameshift mutation, deletion of dystrophin gene, fibrofatty displacement of
mm
trisomy 18 (after 21, most common trisomy resulting in live birth)

faulty collagen synthesis (usually type III, sometimes I, 6 types)

uncorrected VSD, ASD, or PDA causes RVH and shunt reversal
Rickettsia typhi (fleas)
Rickettsia prowazekii (lice)
-galactosidase A def causes ceramide trihexose accumulation
AR, DNA repair gene mutations (ubiquitinization of damaged DNA)
proximal tubule resorption defect
inflammation from PID (esp N. gonorrhea) spreads to liver capsule
AR (GAA) repeat in frataxin causes mitochondrial impairment

FAP + osseous and soft tissue tumors, retinal hyperplasia

-glucocerebrosidase def causes glucocerebrosidase accumulation
dominant parietal lobe lesion
mildly low UDPGT or bili uptake, in stress, elevated unconjugated bilirubin
GpIIb/IIIa def, no platelet plug formation
inflammation and demyelination of peripheral nn (motor>sensory), infiltrate in
endoneurium, C. jejuni and HSV are common antecedents, type IV
hypersensitivity, high CSF protein, nl cell count
defective neutral AA transporter on intestinal and renal epithelium
small vessel vasculitis, IgA immune complexes, assn w/ IgA nephropathy;
commonly follows URI
failure of migration of neural crest cells; no plexuses in intestines
iduronate sulfatase def causes heparin sulfate and dermatan sulfate
accumulation
NMDA excitotoxicity causes atrophy of striatal nuclei (loss of ACh and GABA)
cause
loss of motion
inhibitors
-L-iduronidase
def causes
heparin sulfate and dermatan sulfate accumulation
failure of addition of M6P to lysosome proteins, so they are excreted instead
lysis of spirochetes causes toxin release
K channel mutation
IFN- deficiency, neutrophils don't respond to chemotactic stimuli
no migration/development of neural cells
dynein arm defect causes immotile cilia
medium-sized vessels, self-limited necrotizing vasculitis in infants/kids, esp
asians
bilateral amygdala lesion
peripheral neuropathy, developmental delay, optic atrophy, globoid cells
gastric adenocarcinoma mets bilaterally to ovaries

Abs against presynaptic Ca channels at NMJ, can be paraneoplastic

defective HGPRT (purine salvage pathway) causing buildup of uric acid
underlying malignancy (mostly GI adenocarcinomas)
-synuclein defect
wart-like vegetations, from SLE
AD, mutations in p53 cause increased susceptibility to cancers
eosinophilic infiltrate and endocardial fibrosis or parasitic pneumonia
AD mutation of DNA mismatch repair gene
vomiting (alcoholics, bulemics) causes mucosal laceration at GE junction
fibrillin defect (scaffold for tropoelastin, makes elastin), lack of elasticity

muscle glycogen phosphorylase def

type of polyostotic fibrous dysplasia (bone replaced by fibroblasts, collagen,
irregular trabeculae, many bones affected)

ate), pulling sensation in groin

increased gastric mucosal secretion, protein loss, parietal cell atrophy
hydrops in labrynth
Abs against postsynaptic AChR, worsen w/ muscle use, assn w/ thymoma
sphingomyelinase def causes sphingomyelin accumulation
AD inherited disorder of blood vessels
high osteoblast and osteoclast activity, abnormal bone architecture; high alk
phos, normal Ca and PO4
lesion in superior colliculi (pinealoma)
loss of DAergic neurons in substantia nigra pars compacta cause unchecked
inhibitory input on thalamus (ACh)
trisomy 13
AD, increased risk of CRC/other visceral malignancies
frontotemporal atrophy (spares parietal lobe and posterior 2/3 of central gyrus)
iron deficiency
lysosomal -1,4-glucosidase def
bilateral renal agenesis (usually ureteric bud malformation) or posterior urethral
valves (M, imperforate urethra)
TB infxn of 2 adjacent vertebral bodies causes avascularity of disc
deletion of paternal chromosome 15
post-GI or chlamydia infxn
viral infxn (esp VZV/flu) txed w/ salicylates, aspirin metabolytes decrease -ox by
reversible inhibition of mitochondrial enzyme
thyroid replaced by fibrous tissue

low liver glucuronyl transferase (excretion of conjugated bilirubin)

trigger=aspirin to an asthmatic
pituitary infarct
more common during birth (N. meningitides)
congenital vasculitis, small vessels, sporadic
granulomatous thickening of proximal great vessels, seen mostly in Asian F<40
hexosaminidase A def causes GM2 ganglioside accumulation
focal granulomatous inflammation of large vessels, seen mostly in elderly F; half
of pts have polymyalgia rheumatica
failure of migration of neural crest cells of 1st branchial arch
paraneoplastic (esp GI adenocarcinoma)
FAP + malignant CNS tumors
Salmonella typhi, can remain in GB chronically
glucose-6-Pase deficiency
deletion of VHL (tumor suppressor) on ch. 3 cuses constitutive expression of HIF
(hypoxia-inducible factor) causing angiogenesis

lateral medullary syndrome (PICA); lateral spinothalamic, nuc ambiguus, VIII,

sympathetics, spinal tract and nuc of V, inferior cerebellar peduncle
acute primary adrenal insufficiency from adrenal hemorrhage; from N.
meningitides sepsis, DIC, endotoxic shock
c-ANCA positive, focal necrotizing vasculitis (small vessels), necrotizing
granulomas of the lung/upper airway, and necrotizing GN
icterohemorrhagic leptospirosis (spirochete); surfers in the tropics
progressive lengthening of PR until beat is dropped
AR degeneration of anterior horns (LMN only)
bilateral mammillary body lesion (B1 def)
bilateral mammillary body lesion (B1 def)
superior temporal gyrus
Tropheryme whippelii (GP, PAS positive, in macrophages)
congenital microdeletion of 7q (includes elastin)
inadequate Cu excretion, low ceruloplasmin (conjugated, plasma-safe version of
Cu); accumulation everywhere
XLR, progressive deletion of BC and TC
accessory conduction band (bundle of Kent) bypasses AV node

Other
aka pseudohypoPTH
usually XLR
early=APP, presenilin-1/-2; late=ApoE4;
ApoE2=protective (degrades plaques)
ABCD: Andersen's=branching
less severe than DMD
aka IgA glomerulonephropathy, adults

tx=nifurtimox

ABCD: Cori's=debranching
spongiform cortex
tx=plasmapheresis, phototherapy

6 types, severity and inheritance vary

XLR

high CSF protein w/ nl cell count=

albuminocytologic dissociation; tx=IVIG,
respiratory support, plasmapheresis
AR
mnemonic: Jenock-S P=Joints, Skin, Panc;
commonest childhood systemic vasculitis
assn w/ Down's Sz
chromosome
4, AD (CAG)n expansion,
XLR
anticipation

often fatal in childhood, similar to Hurlers

AR, rare

tx=IVIG, aspirin

XLR

aka HNPCC

McArdle's for Muscle

mnemonic: POOCH= pit tumors, ovarian cysts,
osteomalacia, caf-au-lait spots, hyperthyroid

most common NMJ disorder

aka osteitis deformans

rx-induced: metoclopramide, reserpine,

haloperidol/chlorpromazine

polyps can cause obstruction

aka frontotemporal dementia

Pompe's hits the pump

aka reactive arthritis

rare, often fatal

aka mycosis fungoides

aka pulseless dz

aka giant cell arteritis

GSD mnemonics: 1-5=VP CAM; PoLys:

Pompe's=lysosomal

tx: cyclophosphamide, corticosteroid

aka Mobitz type I 2nd degree heart block

aka infantile spinal muscular atrophy
stranger would notice
friends would notice
older men usually
aka hepatolenticular degeneration;
tx=penicillamine
can lead to reentry SVT

Name
Huntington

Sx
agression, depression, dementia, chorea, athetosis
(writhing fingers)

Parkinson

pill-rolling tremor (at rest), cogwheel rigidity,

brady-/a-kinesia, postural instability

Alzheimer

dementia, can get intracranial hemorrhage

Pick's Dz (FTD)

dementia, aphasia, Parkinsonian, change in

personality

Lewy Body dementia

Creutzfeldt-Jakob Dz
normal pressure
hydrocephalus

Parkinsonism w/ dementia and hallucinations

rapidly progressive dementia with myoclonus
urinary incontinence, ataxia, dementia

MS

internuclear ophthalmoplegia (nystagmus, dyplopia),

scanning speech, intention tremor, incontinence,
optic neuritis (loss of vision), hemisensory sx;
relapsing/remitting

ammonia intoxication

tremor, slurring speech, somnolence, vomiting,

cerebral edema, blurred vision

pellagra

diarrhea, dementia, dermatitis (glossitis)

Sub-epithelial
Membranous GN
Postinfectious GN
Lupus nephritis V

Granular
Membranous nephropathy
Postinfectious GN
Membranoproliferative GN

Difuse Glomerular Proliferation

Postinfections GN
Membranoproliferative GN
SLE

Name
von Gierke's Dz (type I)

Pathophys
glucose-6-Pase deficiency

Pompe's Dz (II)
Cori's Dz (III)
Andersen's Dz (IV)
McArdle's Dz (V)
Gaucher's Dz

lysosomal -1,4-glucosidase def

debranching enzyme (-1,6-glucosidase) def
branching enzyme def, glycogen pptation
muscle glycogen phosphorylase def
-glucocerebrosidase def causes glucocerebrosidase
accumulation

Krabbe's Dz

galactocerebrosidase def causes galactocerebroside

accumulation

Fabry's Dz

-galactosidase A def causes ceramide trihexose

accumulation

Tay-Sach's Dz

hexosaminidase A def causes GM2 ganglioside

accumulation

Neimann-Pick Dz

sphingomyelinase def causes sphingomyelin

accumulation

Hurler's Sz

-L-iduronidase def causes heparin sulfate and

dermatan sulfate accumulation

Hunter's Sz

iduronate sulfatase def causes heparin sulfate and

dermatan sulfate accumulation

I-cell (inclusion) dz

failure of addition of M6P to lysosome proteins, so

they are excreted instead

metachromic leukodystrophy arylsulfatase A deficiency causes cerebroside sulfate

accumulation
Name
Wegener's granulomatosis

Pathophys
focal necrotizing: vasculitis, granulomas of upper
airways/lung, and GN; c-ANCA

microscopic polyangiitis
primary pauci-immune
crescentic GN

same as Wegener's, lacks granulomas; p-ANCA

vasculitis only of kidneys

Churg-Strauss

granulomatous small-vessel vasculitis w/

eosinophilia; p-ANCA

Sturge-Weber

congenital vascular disorder, small vessels

Henoch-Schonlein purpura

IgA immune complexes, assn w/ IgA nephropathy

Buerger's dz

idiopathic segmental thrombosing vasculitis of

medium vessels, seen in heavy smokers

Kawasaki's Dz

acute, self-limited necrotizing middle-sized vasculitis,

in infants/kids, esp asians

Takayasu's arteritis

granulomatous thickening of proximal great vessels;

Asian F<40, high ESR

temporal arteritis

focal granulomatous inflammation of large a

Neuro
Pathophys
NMDA excitotoxicity causes atrophy of striatal nuclei (loss of
ACh and GABA) cause loss of motion inhibitors
loss of DAergic neurons in substantia nigra pars compacta cause
increased inhibitory input on thalamus
APP degradation by -/-secretase yields N-APP (DR6L) or
A40/42 (cell death signal or aggregate into plaques)
frontotemporal atrophy (spares parietal lobe and posterior 2/3
of central gyrus)
-synuclein defect
prions cause -helix to -sheet transformation
expanding ventricles cause corona radiata distortion (no
increase in subarachnoid space volume)
autoimmune inflammation and demyelination of CNS;
commonly hits MLF, optic nerve, spinal cord

NH4 depletes -KG, inhibiting TCA cycle; OTC is most common

urea cycle disorder
B3 def (can be from Hartnup's, carcinoid sz, low B6)
Renal
Immune deposits
Sub-endothelial
Cryoglobulinemia
Membranoproliferative GN
Lupus nephritis III-V
Immunofluorescence Pattern
Linear
Goodpasture's

Other Characteristics
Low Complement
Postinfectious GN
Membranoproliferative GN
Cryoglobulinemia
SLE
Microbio
Sx
severe fasting hypoglycemia, increased glycogen in liver,
hepatomegaly, lactic acidosis, gout,

cardiomegaly, muscular, neuro sx

mild form of von Gierke's (gluconeogenesis intact)
cirrhosis and death w/i 5y
cramps, myoglobinuria w/ exercise
HSM, aseptic necrosis of femur/bone crises, Gaucher's cells
(macrophages look like crumpled paper)
peripheral neuropathy, developmental delay, optic atrophy,
globoid cells
peripheral neuropathy (esp hands and feet), angiokeratomas,
cardiovascular and renal diseases
progressive neurodegeneration, developmental delay, cherry
red macula, lysosomes w/ onion skin, no HSM
progressive neurodegeneration, developmental delay, cherry
red macula, foam cells, HSM
developmental delay, gargoylism, airway obstruction, corneal
clouding, HSM
mild Hurler's, no corneal clouding, aggressive behavior
Hurler's, + restricted joint movement, high plasma levels of
lysosomal proteins, gingival hyperplasia
cerntral and peripheral demyelination with ataxia, dementia
Vasculitides
Sx
cough, dyspnea, hemoptysis, chronic sinusitis, otitis media,
hematuria/RBC casts, mastoiditis

usually asthma, sinusitis, skin lesions, peripheral nephropathy;

can also involve heart, GI, kidneys
facial port-wine stain (nevus flammeus), ipsilateral
leptomeningeal angiomatosis, seizures, early glaucoma
palpable purpura on thighs/butt, arthralgias, intestinal
hemorrhage, abdominal pain, melena
intermittent claudication, superficial nodular phlebitis,
Raynaud's, severe pain, can cause gangrene
fever, conjunctivitis, strawberry tongue, lymphadenitis,
desquamative skin lesions, can cause coronary aneurisms
fever, night sweats, myalgia, arthtiris, skin nodules, weak
pulses in UE, ocular disturbances
jaw claudication, unilateral headache, vision disturbance

Other
chromosome 4, AD (CAG)n expansion, anticipation; drug-induced:
haloperidol/chlorpromazine, reserpine, metoclopramide
Lewy bodies (-synuclein intracellular inclusions)
cortical atrophy, decreased ACh, intracellular neurofibrillary tangles
(hyperphosphorylated tau); early onset=APP, presenilin-1/-2; late=ApoE4;
ApoE2=protective (degrades plaques)
aka frontotemporal dementia; Pick bodies (hyperphosphorylated
intracellular tau)
spongiform cortex

CSF: increased protein (IgG, oligoclonal bands are dxtic); periventricular

plaques (oligodendrocyte loss, reactive gliosis), preservation of axons; tx:
-IFN, immunosuppression, sxatic tx for neurogenic bladder, spasticity,
pain
tx: benzoate, lactulose, or phenylbutyrate (bind AAs and lead to excretion
in urine)

Mesangial
Berger's Dz (IgA nephropathy)
Lupus nephritis II-V

tern
Light and Dark Areas
Berger's Dz (IgA nephropathy)

Other
GSD mnemonics: 1-5=VP CAM

Pompe's hits the pump; PoLys: Pompe's=lysosomal

ABCD: Andersen's=branching, Cori's=debranching
McArdle's for Muscle
most common

XLR

XLR

most common childhood systemic vasculitis

aka thromboangiitis obliteralns
tx=IVIG, aspirin
aka pulseless disease
high ESR, mostly in elderly F, half of pts have polymyalgia rheumatica

Cardio
disease
essential htn
htn in CHF
htn in DM
malignant htn
angina
AFib
AFlutter
SVT
VT

tx
diuretics, ACEI, ARBs, CCB
diuretics, ACEI, ARBs, CCB, blockers
ACEI, ARBs, CCB, diuretics, -blocker, -blocker
nitroprusside, fenoldopam, diazoxide
nitrates and -blockers
digoxin, -blockers, anticoag, non-DHP
ablation, anticoag, non-DHP
class IA/C, class II, class IV, adenosine
class I, class II
Neuro

disease
tonic clonic seizure
absence seizure
status seizure

tx
first line: phenytoin, carbamazepine, valproate
first line: ethosuximide; otherwise, valproate
acute: BDZ; prophylaxis: phenytoin

Cardio
other
no blockers in decompensated CHF, esp K-sparing diuretics
ACEI protective against diabetic nephropathy

Neuro
first line in pregnancy and children: phenobarbital

-statin
-TAXOLs
(bival)-IRUDIN
(cis/carbo)-PLATIN
(etid)-RONATE
(eto)-POSIDE (VP-16)
(par/flu)-oxetine
(praz)-osin
(zafir)-lukast
2,4-DNP
5-FU
6-MP
6-thioguanine (6TG)
abciximab
acarbose
acebutolol
acetaminophen
acetazolamide
acute EtOH
acyclovir
adalimumab
adenosine
Al(OH)3
albendazole
albuterol
aldesleukin
allopurinol
alprazolam
Amanita phalloides
(poison mushroom)
amantidine
amantidine
amifostine
amikacin
amiloride
amiodarone
amitriptyline
amoxicillin
amphetamine
amphotericin B
ampicillin
anastrozole
anistreplase
antimycin A
aripiprazole

arsenic
ascorbic acid
aspart
aspirin (ASA)
atenolol
atomoxitene
atropine
azathioprine
azithromycin
aztreonam
beclomethasone
benzene
benztropine
betaxolol
bethanechol
biotin
bismuth
bleomycin
bosentan
bretylium
brimonidine
bromocriptine
bromocriptine
buprenorphine
bupropion
buspirone
busulfan
butorphanol
cabergoline
CaCO3
caffeine
calcitriol (D3)
captopril
carbachol
carbamazepine
carbenicillin
carvedilol
caspofungin
cefalcor
cefazolin
cefipime
cefoxitin
ceftazidime
ceftriaxone
cefuroxime

celecoxib
cephalexin
certirizine
chloramphenicol
chlordiazepoxide
chloroquine
chlorpheniramine
chlorpromazine
chlorpropamide
cholestyramine
chronic EtOH
cimeTIDINE
ciprofloxacin
citalopram
clarithromycin
class I antiarrhythmics
clavulanic acid
clinda-/linco-mycin
clofazimine
clomiphene
clomipramine
clonidine
clopidogrel
clozapine
CO
cobalamin
cocaine
codeine
colchicine
colesevelam
colistimethane
copper (Wilson's)
cromolyn
cyanide
cyclophosphamide
cyclosporine
cytarabine (ara-C)
DA
daclizumab
dactinomycin
dalfopristin
dantrolene
dapsone
daunorubicin

delaviridine
demeclocycline
Depressants
desipramine
desloratadine
desmopressin (ddAVP)
detemir
dexamethasone
dexedrine
dextromethorphan
diazepam
diazoxide
dicloxacillin
didanosine (ddI)
diethylcarbamazine
diethylstilbestrol
digoxin
digoxin immune Fab
diltiazem (non-DHP)
dinoprostone
diphenhydramine
diphenoxylate
disopyramide
dobutamine
dofetilide
donepezil
doxorubicin (adriamycin)
doxycycline
Drug
Drug
Drug
Drug
Drug
Drug
Drug
Drug
Drug
Drug
Drug
Drug
drug
Drug/Type
duloxetine
dynorphin

echothiophate
edrophonium
efavirenz
enalapril
enflurane
enfuvirtide
enkephalin
enoxacin
enoxaparin
ente-/tol-capone
ephedrine
epinephrine
eplerenone
ergonovine
erythromycin
erythropoietin
esmolol
eszopiclone
etanercept
ethacrynic acid
ethambutol
ethinyl estradiol
ethosuximide
ethylene glycol
exemestane
exenatide
ezetimibe
famciclovir
famoTIDINE
fenoldopam
fentanyl
fexofenadine
filgrastim
finasteride
flecainide
fluconazole
flucytosine
fluphenazine
flutamide
folate
foscarnet
fosfentoin
furosemide
gabapentin
galantamine

gangciclovir
gemfibrozil
gentamicin
GH
glargine
glimepiride
glipizide
glyburide
glycopyrrolate
gold
griseofulvin
guaifenesin
guanethidine
Hallucinogens
haloperidol
halothane
heme and glucose
heparin
heroin
hexamethonium
HRT
hydralazine
hydrochlorothiazide
hydrocortisone
hydroxyurea
ibuprofen
ibutilide
IFN-
IFN-
IFN-
ifosfamide
imatinib (Gleevec)
imipenem/cilastatin
imipramine
indiNAVIR
indomethacin
infliximab
INH (isoniazid)
insulin
ipratropium
iron (hemochromatosis)
isocarboxazid
isoproterenol
isosorbide dinitrate
ivermectin

K
ketamine
ketoconazole
ketorolac
labetalol
lamotrigine
lansoprazole
latanoprost
lead
leuprolide
levetiracetam
levodopa/carbidopa
levothyroxine
lidocaine
linezolid
lisinopril
lispro
lithium
loperamide
loratadine
lorazepam
LSD
mannitol
maprotiline
marijuana
mebendazole
mefloquine
melacortin
memantine
meperidine
mercury
meropenem
mestranol
metaproterenol
metformin
methacholine
methadone
methanol
methemoglobin
methicillin
methimazole
methotrexate (MTX)
methoxyflurane
methscopolamine
methylphenidate

methyltestosterone
metoclopramide
metoprolol
metronidazole
metyrosine
mexiletine
Mg
Mg(OH)2
MgSO4
miconazole
mifepristone (RU-486)
miglitol
minocycline
mirtazapine
misoprostol
moricizine/encainide
morphine
muromonab-CD3 (OKT-3)
Na stibogluconate
N-acetylcysteine
nadolol
nafcillin
Name
naproxen
NE
neomycin
neostigmine
nevirapine
niacin
niacin (also see vitamin
section)
nicotine
nife-/amlo-dipine (DHP)
nifurtimox
nitrofurantoin
nitroglycerin
nitroprusside
nitrosurea
(-mustines)
nizaTIDINE
notriptyline
NPH
nystatin

octreotide
olanzapine
oligomycin
omeprazole
ondansetron
oprelvekin
organophosphates
oseltamivir
ouabain
oxazepam
oxybutynin
oxytocin
paclitaxel
palivizumab
pancuronium
pantothenate
PCP
penicillin
pentamidine (aerosolized)
phencyclidine
phenelzine
phenobarbital
phenoxybenzamine
phentolamine
phenylephrine
phenytoin
physostigmine
pilocarpine
pindolol
pioglitazone
piperacillin
pirenzepine
pralidoxime
pramipexole
pramlintide
praziquantel
prednisone
probenecid
procainamide
procarbazine
progestin
propafenone
propantheline
propofol
propranolol

propylthiouracil
pyrantel pamoate
pyrazinamide
pyridostigmine
pyridoxal P
pyrimethamine
quetiapine
quinidine
quinine
quinupristin
raloxifene
raniTIDINE
reisperidone
reserpine
retinol
ribavirin
riboflavin
rifampin
riluzole
rimantidine
ritodrine
rituximab
rivastigmine
ropinirole
rosiglitazone
rotenone
salicylate
salmeterol
saquiNAVIR
sargramostim
scopolamine
selegiline
sertraline
sildenafil
sirolimus (rapamycin)
SMX
sotalol
spironolactone
stavudine (d4T)
Stimulants
streptokinase
succinylcholine
sucralfate
sulbactam
sulfa-

sulfasalazine
sumatriptan
suramin
tacrolimus
tamoxifen
tamsulosin
tazobactam
terbinafine
terbutaline
tetrabenazine
tetracycline
theophylline
thimine
thiopental
thioridazine
thrombopoietin
tiagabine
ticarcillin
ticlopidine
timolol
tobramycin
tocainide
tolbutamide
topiramate
tPA
tramadol
tranylcypromine
trastuzumab (herceptin)
trazodone
triamterine
triazolam
trifluoperazine
triiodothyronine
trimethoprim
tropicamide
tubocurarine
urokinase
valproate
vancomycin
vardenafil
varenicline
venlafaxine
verapamil (non-DHP)
vigabatrin

vinblastine
vincristine
vitamin A (xs)
vitamin E
vitamin K
warfarin
zalcitabine (ddC)
zaleplon
zanamivir
zidovudine (ZDV)
zileuton
ziprasidone
Zn
zoledronate (IV)
zolpidem
-methyldopa