USMLE Step 1 Preparation 2012

A Resource forUSMLE Step 1 Preparation 2011 - 2012 Compiled by the TTUHSC School of Medicine Office of Student Affairs Purpose of this book Congratulations on making it to Year 2 of medical school! You are that much closer to having your Doctor of Medicine degree. If you want to PRACTICE medicine, however, you have to be licensed, and in order to be licensed you must first pass all four United States Medical Licensing Exams. This book is intended as a starting point in your preparation for getting past the first hurdle, Step 1. It contains study tips, suggestions, resources, and advice. Please remember, however, that no single approach to studying is right for everyone. USMLE – What is it for? In order to become a licensed physician in the United States, individuals must pass a series of examinations conducted by the National Board of Medical Examiners (NBME). These examinations are the United States Medical Licensing Examinations, or USMLE. Currently there are four separate exams which must be passed in order to be eligible for medical licensure:  Step 1, usually taken after the completion of the second year of medical school;  Step 2 Clinical Knowledge (CK), per TTUHSC School of Medicine (SOM) policy, must be taken by December 31st of Year 4;  Step 2 Clinical Skills (CS), per TTUHSC SOM policy, must be taken by December 31st of Year 4; and  Step 3, typically taken during the first (intern) year of post graduate training. Requirements other than passing all of the above mentioned steps for licensure in each state are set by each state’s medical licensing board. For example, each state board determines the maximum number of times that a person may take each Step exam and still remain eligible for licensure. In Texas, individuals are limited to three attempts at each Step exam. Some states allow more attempts, some allow fewer. Our goal is for all of our students to be eligible for licensure in every state. Step 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning. Step 2 Clinical Knowledge (CK) assesses whether you can apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes emphasis on health promotion and disease prevention. Step 2 ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and competent practice of medicine. Step 2 Clinical Skills (CS) A clinical skills examination was part of the original design of USMLE. The NBME was charged with including a test of clinical skills using standardized patients when such an examination was shown to be valid, reliable, and practical. NBME research and the work of other organizations administering clinical skills examinations demonstrate that clinical skills examinations 1 measure skill sets different from those measured by traditional multiple-choice questions. Mastery of clinical and communication skills, as well as cognitive skills, by individuals seeking medical licensure is important to the protection of the public. The clinical skills examination began in June 2004 and is a separately administered component of Step 2. USMLE Step 2 CS is currently administered at five regional test centers (CSEC Centers) in the United States: Philadelphia, PA; Atlanta, GA; Chicago, IL; Houston, TX; and Los Angeles, CA. Step 3 assesses whether you can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care. The Comprehensive Basic Sciences Exam The NBME’s Comprehensive Basic Sciences Exam (CBSE) is a cumulative exam that covers all of the material taught during the first two years of the curriculum. It is a 4-hour computer-based test intended to give you experience taking a multiple-hour computer exam. TTUHSC SOM uses the CBSE as both a measure of readiness to be promoted from Year 2 to Year 3 of the curriculum and also as a measure of readiness to pass USMLE Step 1. The CBSE is administered by the SOM 3 times: once in March between Blocks 3 and 4; once during the week following the end of the Spring semester; and once in June. Students must achieve a minimum CBSE score that is determined by the Office of Academic Affairs in order to be promoted (in addition to meeting other promotion criteria) to Year Three. Students will not be required to retake the CBSE once they have achieved the minimum passing score. Students may elect, however, to take additional administrations of the CBSE for practice. Students who do not achieve the minimum passing score on the CBSE after 3 attempts may be subject to the following requirements: 1. Meet with the Student Promotions and Professional Conduct Committee (SPPCC) 2. Take a short-term leave of absence and delay the start of the Year 3 in order to prepare for and take Step 1 *Students who delay taking Step 1 beyond the official start of Year 3 (generally early July) for any reason must receive a passing score on Step 1 BEFORE beginning the third year curriculum (e.g.,, not just take Step 1 but also receive a passing score before being allowed to begin Year 3 clerkships) 2 2. 9. Passing scores must be documented no later than May 1st of the year graduating. 9. individuals must have passed all 4 USMLE Step exams – Step 1. Policy Regarding USMLE Step 2 Clinical Knowledge and Clinical Skills Exams 10. 9. In Texas individuals are limited to three (3) attempts on each Step.S. Step 2 Clinical Knowledge (CK). Each state’s medical licensing board determines the number of attempts individuals may make at each Step in order to remain eligible for licensure. allopathic medical schools have increased their class sizes in an effort to improve Americans’ access to healthcare. Step 2 Clinical Skills (CS). Appeals regarding this issue will be handled as outlined in Sections 6.4 Students who fail USMLE Step 1 on their initial attempt will be assigned to Independent Study to prepare for and retake Step 1. do not have the requisite score on the NBME Comprehensive Basic Science Exam (CBSE).5 Inability to pass Step 1 within 12 months of the completion of Year 2 is grounds for dismissal and will result in review by the SPPCC per Section 4. 7. Initial attempts at Step 2 exams (CK and CS) must be taken by December 31st of the year preceding graduation. In the last few years.1 Students are expected to take Step 1 of USMLE by June 30 th prior to the start of Year 3. How important is your Step 1 score? Residency positions are becoming more and more competitive.2 All students who take the USMLE Step 1 prior to the scheduled start of Year 3 will be eligible to start the Year 3 clerkship rotations. Students who fail to do so will not be allowed to continue in clinical rotations until these exams are taken. Policy Regarding USMLE-Step I Exam.Texas Tech’s USMLE Policies Excerpts from the TTUHSC SOM Student Handbook… 9. 3 . The number of residency positions during this same time period. and Step 3. Students may return to the Year 3 curriculum upon passage of Step 1. Students may request a delay in taking Step 1 if they are remediating a block. and 8 of the Grading and Promotions policy. however. 9. has remained relatively constant thus making it more and more difficult for medical students to be successful in their residency matches. 9. 10. Failure to document a passing score for either Step 2 exam by May 1st will result in a delay in graduation.1 Passage of Step 2 Clinical Knowledge (CK) and Step 2 Clinical Skills (CS) are required for graduation. or have other circumstances or concerns regarding their readiness to take Step 1 and proceed to Year 3. U.2.3 Passage of USMLE Step 1 is required for students to proceed in Year 3 beyond the end of the July – August rotation (Period 1). In order to become fully licensed to practice medicine in the United States. What does this mean for you? It means that Step 1 has become an even higher high stakes exam.. How is Step 1 scored? Step 1 is a computer based test.Scary statistic – for the 2011 Match slightly more then 8. The more competitive the specialty (i. 4 . senior medical students were not successfully matched into a Year 1 position through either the regular NRMP Match or ―Scramble‖ to secure a residency position for the 2011-2012 academic year. Step 1 has therefore become the one objective measure common to all residency program applicants that program directors feel they can rely on to help them compare and assess applicants. then “NBME Licensing Examination Services Website”. the combination of blocks of items on any given Step 1 exam creates a form that is comparable in content to all other forms.org. How do I apply for Step 1? The initial application for Step 1 is done online. Blocks of items on Step 1 are constructed to meet specific content specifications. a score of 188 is needed to pass Step 1.although Step 1 is only one of many criteria that will be used in evaluating your residency application. however. regardless of what type of specialty training you may choose to pursue. What is the minimum passing score? In December 2009.S. examinees typically must answer 60 to 70% of items correctly to achieve a passing score. The percentage of correctly answered items required to pass Step 1 varies slightly from form to form. Most Step 1 scores fall between 140 and 260. Orthopedics). Grade inflation is also widely accepted as a reality. Grading systems in medical schools are not consistent and thus not comparable. residency programs place a great deal of importance on Step 1 scores when assessing applicants.  Go to www. it is definitely in your best interest to do all you can to maximize your chances of doing well. Click on “Licensing Exam Services”. A very good performance on Step 1 can definitely help when it comes to securing a top-rate residency.e. Dermatology. Currently. After your test ends. the more likely that programs will use Step 1 scores to screen residency applicants for interviews. the computer records your responses. and a poor score can hurt by limiting your options. Plastic Surgery. When you take Step 1. The number of test items you answer correctly is converted to a three-digit score scale. A failure on Step 1 can likewise all but eliminate the possibility of some residencies altogether. your responses are transmitted to the NBME for scoring. For better or worse. Your score report will include the mean and standard deviation for recent administrations of the Step exam. the USMLE’s Step 1 Committee raised the minimum three-digit passing score from 185 to 188.nbme.800 U. Bottom line . As a result. The mean score for first-time examinees from accredited medical school programs in the United States is in the range of 215 to 235 with a standard deviation of approximately 20. Your Scheduling Permit will include the following information: your name. The Scheduling Permit specifies the three-month eligibility period during which you must take Step 1. during which you prefer to take Step 1. About a week later. 5 . How do I schedule my test? When applying for Step 1. you are able to contact Prometric immediately to schedule a test date. After obtaining your Scheduling Permit.  The form is then taken to the Registrar’s Office (2C400 – across from the Synergistic Center) to have the TTUHSC SOM seal put on it. We recommend that you apply no later than early February. you must select a three-month period. If your application is submitted more than six months in advance of your requested eligibility period. such as June-July-August. allow up to approximately four weeks for processing of your application.  As part of the application. your eligibility period. During peak periods (May – July). Bring the form to the Student Affairs Office for signature. the sooner you can schedule your test date. you will receive an email from NBME notifying you that your application is complete. the examination for which you registered. In the yellow LOG IN box. When should I apply? The earlier your application is submitted. Prometric schedules testing appointments for Steps 1 and 2 CK up to six months in advance. you will indicate a 90-day eligibility period during which you plan to take the exam. A Scheduling Permit with instructions for making an appointment at a Prometric Test Center will be issued to you after your registration application is processed and you are determined to be eligible to take the exam. but your Scheduling Permit will be issued no more than six months before your assigned eligibility period begins. click on “First time user” and follow the instructions. it will be processed. this message will include instructions for accessing the electronic scheduling permit using the registration entity's interactive website. Instead. Payment is also required at this time ($535). Once your application has been processed. please note you do not have a USMLE ID number yet. you will receive a second email from NBME notifying you that your Scheduling Permit is available.  You are ready to mail your application form in.  Print out the application form which will require your signature and a picture. You should verify the information on your Scheduling Permit before scheduling your appointment. People who wait until mid-spring will have difficulty getting their first choice of test dates. Step 1 and Step 2 CK are given around the world at Prometric Test Centers (PTCs). Note: Your Scheduling Number is needed when you contact Prometric to schedule test dates. you will need to reapply and pay an additional fee. Not all Prometric centers are open on weekends. Please note that May through July are one of the busiest periods for these testing centers because of the large USMLE demand during that time – PLAN AHEAD! Please keep the following in mind:  You must have your Scheduling Permit before you contact Prometric to schedule a testing appointment. You will not be able to take the test if you do not bring your Scheduling Permit to the test center. Note: PRINT OUT YOUR SCHEDULING PERMIT AS SOON AS YOU RECEIVE IT and keep it in a safe place. provides scheduling and test centers for the computer-based components of USMLE. If you must reschedule outside the approved eligibility period. you should contact Prometric to schedule as soon as possible after you receive your Scheduling Permit.  Your Scheduling Permit includes specific information for contacting Prometric to schedule your test date(s) at the test center of your choice. first-served" basis. you may schedule your test online at www. which is your private key. therefore. Where do I take the test? Thomson Prometric. your Scheduling Number.  Appointments are assigned on a "first-come. You will be able to change your test date after you have scheduled it IF your new test date is still within the 90day eligibility period. your Candidate Identification Number (CIN). 6 . a part of The Thomson Corporation. Scheduling Test Dates Once you’ve gotten your permit. Prometric does not have access to your CIN. It differs from your Candidate Identification Number (CIN). A FEE WILL BE ASSESSED IF YOU RESCHEDULE YOUR TEST DATE LESS THAN 30 DAYS BEFORE YOUR ORIGINALLY SCHEDULED DATE. and USMLE exams are not necessarily offered every day the centers are open.com for any available test date that is within your approved 90-day eligibility period.your testing region.prometric. You MUST bring it with you to the test center on the day of your test. and is needed to test. This allows an average of 1 minute. Don’t panic if your first block happens to be a more difficult one.S. for a total of 322 questions. There will be anywhere from 3 to 5 answer choices. 7 . At the same time the total number of questions was reduced from 350 to 322.  The number of Step 1 questions NOT in a clinical vignette format was REDUCED in May 2010.  The exam includes some auditory and video questions.  Some blocks are harder than others. etc. a group of pharmacology questions.  The questions are random. etc.  Some questions will include pictures – histology. There are 46 questions per block.  Other questions consist of extended matching – a list of items from which you must choose the one best answer that corresponds with the numbered items or questions located below the list. 15 seconds per question. CT images. In Texas there are centers in:  Abilene  Amarillo  Austin (2)  Beaumont  Bedford (2)  Corpus Christi  Dallas (2)  El Paso  Houston (3)  Lubbock  McAllen  Midland  San Antonio (2)  Tyler  Waco  Wichita Falls What is the format of the test? The exam contains 7 one-hour blocks of questions and up to 1 hour of break time. gross pathology.Prometric test centers are located throughout the U. THIS IS NOT AN ADAPATIVE TEST – the content DOES NOT CHANGE based on your performance of questions you’ve already answered. This is the same approximate amount of time you are allowed on your block and NBME exams.  Approximately 75% of the questions are SINGLE BEST ANSWER. so don’t expect a block of pathology questions.  Performance on a USMLE Practice Session cannot be used to approximate performance on a USMLE Step examination. You can practice by downloading software from the NBME website www.  NO NEW SAMPLE TEST MATERIALS ARE PRESENTED AT PRACTICE SESSIONS. 2.  There are no items with associated multimedia on the Practice Sessions.5 hours and is divided into 3 1-hour blocks of 46-50 multiple choice test items each. It does not provide an opportunity to practice. prior to beginning the test.  Practice Sessions are administered using an older version of the NBME Test Delivery Software (FRED V1). When you complete the session.usmle. and test center staff are not authorized to provide instruction on use of the software. and are not administered using the new version of the NBME Test Delivery Software (FREDv2). A brief tutorial on the test day provides a review of the test software. such as video or audio clips. Please note that Practice Sessions are not available on major local holidays and during the first two weeks of January. This link also has more information about the test content and the question format. You can schedule a practice test at a Prometric Test Center If you registered for USMLE Step 1. you are eligible to register to take a Practice Session for that examination at a Prometric Test Center. The Practice Session is a maximum of 3. Step 2 CK. Some practice items may include multimedia files. Before deciding to register for a Practice Session. please be aware of the following:  Practice Sessions are provided PRIMARILY to give examinees the opportunity to become familiar with the Prometric test center environment. You may take only one session per exam registration and must take it in the same testing region as your Step exam. 8 .org/Orientation/2011/Menu. including navigation tools and examination format. 1. or Step 3 and received your Scheduling Permit. you will receive a printed percent correct score.Can I practice taking the test? You should acquaint yourself with the USMLE test software well before your test date(s).html The NBME software you install has over 100 practice test items and a software tutorial. Practice time is not available on the test day. Upon receipt of your Practice Session Scheduling Permit. The NBME website offers 6 different online versions of the Comprehensive Basic Sciences Self-Assessment Exam (CBSSA) for Step 1. you should be aware of the potential consequences of accessing materials from individuals or companies who claim to have ―actual‖ USMLE questions. a corresponding Scheduling Permit will be issued to you within seven business days. NBME. ―Retired‖ items are on the USMLE website in the form of practice questions along with a tutorial of how the exam looks and works. the scores on these exams have a very high correlation with actual Step 1 scores.org/pdf/nsas/NSAS_Program_Information_Guide. you may contact Prometric to schedule an appointment and pay the Practice Session fee via credit card ($52). participated in. provides access to. and you may be subject to further sanctions. FSMB. These are NOT the same tests as the Comprehensive Basic Sciences Exam (CBSE).org/Orientation/2011/menu. Information on such courses is not available from the ECFMG. or medical licensing authorities. your registration and/or testing may be canceled. ***IMPROTANT NOTICE – PLEASE READ!*** The USMLE website states: ―There are no test preparation courses affiliated with or sanctioned by the USMLE program. Like the CBSE.pdf What’s on the test? The Comprehensive Basic Sciences Exam (CBSE) is the closest thing we have to the real exam that NBME will let anyone see.nbme. or used any test preparation program or service that distributes. Test preparation courses and materials are available from individuals and companies not associated with USMLE. regardless of whether your exposure to USMLE content was advertent or inadvertent: If there is evidence that you enrolled. however. your scores on the USMLE may be withheld or canceled. If you are involved with any enterprise that disseminates USMLE content. or otherwise provide access to questions or answers from actual USMLE exams. You can find the practice items at www. you should be aware of the consequences to you. Since ALL of the items written by NBME are copyrighted.If you register for a Practice Session. You are strongly encouraged to take one of these self-assessments before you begin your intense Step 1 preparation and another about one week prior to your scheduled Step 1 test date. 3. READ MORE ABOUT WEB-BASED SELF-ASSESSMENT EXAMS www. It is unlawful for any test preparation service or program to use. disclose.‖ 9 . or uses USMLE questions or answers.html .usmle. or provides a forum for others to share such information. distribute. USMLE Secretariat. and clinicians with recognized prominence in their respective fields. such as nutrition. pharmacology. Committee members are selected to provide broad representation from the academic. interdisciplinary topics. The categorizations and content coverage are subject to change. teachers. biochemistry. Broadly based learning that establishes a strong general understanding of concepts and principles in the basic sciences is the best preparation for the examination. physiology. and shifts in emphasis. overall content coverage is comparable in the various examination forms that will be taken by different examinees. and aging. microbiology. pathology. While not all topics listed in the content outline are included in every examination. pharmacology. and licensing communities across the United States and Canada.Step 1 Content described on the USMLE website: ―Step 1 consists of multiple-choice questions prepared by examination committees composed of faculty members. Some questions test the examinee's fund of information per se. Test questions are classified in one of these major areas depending on whether they focus on concepts and principles that are important across organ systems or within individual organ systems. behavioral sciences. immunology. pathology. emerging content domains. genetics. investigators. nutrition.‖ Step 1 includes test items in the following content areas:         anatomy. It provides a flexible structure for test construction that can readily accommodate new topics. Each examination covers content related to the traditionally defined disciplines of anatomy. behavioral sciences. biochemistry. as well as to interdisciplinary areas including genetics. and to solve problems through application of basic science principles. and environmental considerations. The Step 1 content outline describes the scope of the examination in detail but is not intended as a curriculum development or study guide. aging. and physiology. but the majority of questions require the examinee to interpret graphic and tabular material. The test is designed to measure basic science knowledge. cultural. Step 1 is constructed from an integrated content outline that organizes basic science content according to general principles and individual organ systems. and psychosocial. practice. Sections focusing on individual organ systems are subdivided according to normal and abnormal processes. principles of therapy. to identify gross and microscopic pathologic and normal specimens. 10 . microbiology. and molecular and cell biology. integrated examination. Step 1 classifies test items along two dimensions: system and process. occupational. Use this as an outline to make sure you are covering all of these topics in your study plan. as shown below under Step 1 Specifications: The NBME offers the following specifications* of the content areas on the test: System** 25%-35% General principles 65%-75% Individual organ systems • hematopoietic/lymphoreticular • nervous/special senses • skin/connective tissue • musculoskeletal • respiratory • cardiovascular • gastrointestinal • renal/urinary • reproductive • endocrine • immune Process 20%-30% Normal structure and function 40%-50% Abnormal processes 15%-25% Principles of therapeutics 10%-20% Psychosocial. NBME also publishes a more detailed outline of the topics covered on the Step 1 exam. Test items commonly require you to perform one or more of the following tasks:    interpret graphic and tabular material.org/bulletin/exam-content/ 11 . Categories for individual organ systems include test items concerning those normal and abnormal processes that are system specific. and environmental considerations * Percentages are subject to change at any time. cultural.usmle. See the USMLE website for the most up-todate information. apply basic science knowledge to clinical problems. ** The general principles category includes test items concerning those normal and abnormal processes that are not limited to specific organ systems. identify gross and microscopic pathologic and normal specimens. www.Step 1 is a broadly based. Some people seem to instinctively know how to answer multiple choice questions correctly. MAKE a study schedule and stick to it. They also offer a full-length Mock Board Exam.How do I prepare for Step 1? Several things have been proven to help students prepare to do their best of Step 1: 1. This is a critical step in successful Step 1 5. and the extent to which you are able to narrow down your choices to two good answers.jolleytestprep. please go to www. Explain concepts out loud to a study partner. performance on questions which rely on strict definitions or precise interpretation of technical vocabulary. figuring out an answer you consider to be a high probability response. Approximately 70% of the questions on the exam are likely to use or combine information in ways that you have not seen before. Jolley Test Prep (formerly Blanc Education Services) offers online diagnostic testing of your ability to take multiple choice tests and measures variables such: as the amount of time spent on different types of questions. Although you will have approximately 8 weeks from the time Year 2 ends to the deadline for taking Step 1 (June 30th). You can’t do that with MEMORIZED material. 2. and actually lost ground with their studying (they ―peaked‖ before actually taking Step 1). LEARN the material you are currently studying in your classes. preparation. there is no hard and fast rule regarding amount of study time and everyone works at a different pace. Many students who have taken longer than 6 weeks to prepare later said they felt they took too much time. but not too much. KNOW how to approach multiple choice questions and PRACTICE. but you can do it using material that you have LEARNED. correlations between the length of a question and the likelihood of answering it successfully. Just remember everyone works at a different pace and your preparation should be individualized to your study style and needs. Spending 10 hours a day passively reading study guides or old notes is much less effective than spending half that amount of time in active study.com 3. and the extent to which your second choices are correct. however. If you always feel that your performance on multiple choice tests doesn’t equate with your mastery of the material. Please note. you might think about having your test taking analyzed. PRACTICE. based on that. STUDY smart. PRACTICE. practice answering questions by explaining why the right answers are right and 12 . There are test-taking skills that you can learn to help you answer these kinds of exam questions. It is the purpose of the testing agency to see how adept you are at taking partial information and. others of us not so much. 4. For details and how to order a test. the vast majority of our students throughout the years reported that they spent between four to six weeks of intense study following the end of Year 2 preparing for Step 1. ALLOW enough time to prepare. misreading or misinterpreting questions Additional random advice from other medical school’s websites… A Plan for Success on the USMLE Step 1. Use the questions you miss to give yourself focused directions for review.     2. You cannot passively read over material and expect to remember it. Start using a laminated sheet and Expo 2 pen for interacting with the questions. not understanding the material 4.edu/ugme/oess/study_skills/how_to_study_actively/ Mistakes most commonly made when preparing for Step 1: 1. memorizing. If concept mapping works for you. Minimally. This form of passive studying can really fool you into thinking that you KNOW the material. 2 and 3 Examinations 5 Steps for Success 1. do it. It is very difficult to improve greatly by trying to clarify weaknesses but strengthening your strengths will ensure that you do not let yourself give away what you have coming conceptually. By definition you are going to miss 4 out of every 10 questions on the USMLE (around 62% is the mean). ACTIVE VS. PASSIVE STUDYING Repetitively reading over your notes is not an efficient or effective way of studying. Remember . inappropriate test day strategies 5. passive studying 2. Practice for the event. Make certain that the questions you use have explanations. Evaluate yourself with a diagnostic test. Get used to making decisions about which questions to let go of 13 . insufficient practice with questions 3. find at least 15 to 30 minutes daily.the wrong answers are wrong.ucsd. use them. you need to engage in active studying. when really all you are doing is RECOGNIZING it as you read it. In order to really learn information.you are looking to clearly identify your relative strengths and weaknesses and to focus on your strengths. Do some questions every day. If there are other methods that work for you. or at least references to a reliable source so that you can confirm any misperceptions you may have.    Find out qualitatively and quantitatively where you need to spend more time. One good resource for improving study skills can be found at: meded. 3.   4. Give yourself another diagnostic test. Do a 20 to 30 minute.  Concentrate on what you know rather than spending time catastrophizing about the unpleasant consequences of possibly failing the exam. 14 . Slow steady breaths will help you stay calm. Energy wasted on blaming the test/test maker is energy spent in the wrong direction. .  Practice a muscle relaxation exercise. This is a pace of 70 seconds per question which is what the boards allow. the task becomes much more difficult. sit for a full day mock board on a computer.   5. One month before your exam. What food got you through the day? When do you need to take breaks? What did you have for breakfast? Did you use earplugs? Did you remember to write on the laminated sheets? If you had difficulties. Two weeks before the exam. timed practice set every day.  Do not fight the exam! The exam is the same for everyone and no one is out to get you.3 months to go before your test date. You are working to predictably answer 25 questions in each 30 minute period. inhale on three counts.D.  Regard lapses of memory as normal.  Visualize yourself completing the test successfully. Ph. See attached exercise.UC Davis Counseling Center  Excessive tension and anxiety will interfere with performance when studying and during the test.and which questions to spend time on thoughtfully. hold for two counts and exhale for three counts. Start pacing exercises when you have 2 . what are you going to do? ____________________________________________________ TEST TAKING STRATEGIES: A PSYCHOLOGIST’S PERSPECTIVES Emil Rodolfa. What in your study plan is working? What is not? Adjust your schedule to ensure you are focused on questions in multiple areas. go through another self-assessment. The "trick" is to not miss 5 out of 10. Reduce anxiety and stay alert and focused. To what extent have you corrected previous error patterns. Spend an additional 10 to 15 minutes looking up the answers to the questions you miss. If you can’t see yourself accomplishing the task.   Plan for and follow through on a testing schedule. key the question and return to it later.  Do a brief relaxation exercise: For instance. When you prepare your own study schedule. Make a study schedule. as some accomplish more per study day than others.  Don’t rush and don’t spend too much time on any one question. you must first look at your own diagnostic test results and prepare your schedule with more time allotted to weaker subjects. Anxiety might cause you to jump from question to question. you will need to schedule breaks. Our recommended schedule for the exam is: Question Block Break time at end of Block Block 1 Block 2 Block 3 Block 4 No break 5 minute break 5 minute break 30 minute lunch break 15 . Focus on only one question at a time. Remember that you have a total of seven hours to complete 322 questions. There are many sample schedule templates that can be found that you can use as a guide for preparing your own. NBME. Individual study pace also needs to be factored in. You will be given a locker to store your personal items and then assigned a computer station. Arrive at the Prometric Test Center 30 minutes early so you are not rushed and have time to get organized.‖ 2. Self-assessment. and a total of one hour to be used throughout the day for breaks and lunch. Experts agree that the first thing you need to do is take some sort of diagnostic test to see where your areas of strength and weakness are.  Be aware of the worry cycle and intervene if it is activated: So where do I start? 1. To cope with fatigue. Diagnostic tests are available from Kaplan. Kaplan’s Tips for test day… 1. and a variety of other online sources that are listed later under ―Other Resources. and less time to stronger subjects. 2. and mentally prepare yourself for the next block of questions. Know how much you have left. relax. If you have a spare moment. your odds of changing a correct answer to a wrong one are so much higher than the reverse that it is simply not worth the risk. If you change an answer. During the breaks between question blocks. Checking almost always leads to changing and tends to reduce your score. You simply may not have time to go back and look at questions you have marked. 4. you need to consider after each block whether you want to take a bathroom break. Limit your use of the marking feature to no more than two or three questions per block. You should also be aware that if you leave the exam room during a block. The desire to recall questions is strong. 8. especially if you mark a lot of them. Focus on relaxing and making the most of your break. Skipping around wastes time and can end up confusing you. you will never see them again. it will be marked as an irregularity in your testing session. In general. marking causes you to not give a question your full attention the first time around. Remember. Misused.Block 5 Block 6 Block 7 No break 10 minute break Done! This allows you 10 minutes extra to use as needed. you should not be squeezed for time at the end. Remember that you will need to sign in and out when you take breaks. Sit. The idea here is to get into a rhythm that will help create what one psychologist calls a "Flow" experience. and move on to the next question. If you don't know it when you come to it. The flow experience is a state of optimal concentration and maximal performance. Deal with each question as you come to it. 9. 5. Focus on the questions to come. Those questions are in the past. you will always tend to remember those questions you get wrong. 6. make sure that you have entered an answer for every question in the block and then. go back and "check" only those answers that you have previously marked. you are not likely to know it later. Do not skip any questions. The marking feature lets you return to review and reconsider questions if you have time left over. Used correctly. try to relax and not think back over the exam. answer it as best you can. Start with the beginning of the question block and work your way to the end. Monitor your time. take a break. Therefore. marking will help you revisit questions where you have a high probability of getting the answer correct. not the ones that are past. 3. Check your watch every 10 questions to make sure you are on the correct pace to finish. 16 . If you finish a question block with time left over. 7. Of course you should answer each question as you come to it. If you pace yourself throughout the block. so you do not find yourself rushed at the end. Stay with it unless some clear insight occurs to you. but not helpful. but you may want to double-check yourself on a few questions. Relax. you are most likely making it wrong! Your first impulse is usually the correct one. Work on your pacing from the beginning of the question block. Be cautious about changing answers. Course price is $795. Use First Aid as a scaffold – it really is helpful for recall association. If you fall behind. for example.doctorsintraining. Live sessions are held in Dallas at a hotel. 4-6 weeks worked for me.falconreviews. they’ll probably just show you a blood smear. ―buzzwords‖ are not typically used on Step 1. I caution you to take what your classmates say about their exam with a grain of salt. and try not to become overwhelmed with all available resources. See the website for more detailed information on both the live and the online courses.‖ What about review courses? Some students find the structure and discipline of a review course very helpful as part of their Step 1 preparation. you’ll have a hard time getting through everything and still being able to review material. FALCON REVIEWS http://www. NOTE – Providing the following information does not represent an endorsement from TTUHSC SOM or the Office of Student Affairs! In alphabetical order: DOCTORS IN TRAINING http://www. use the High Yield books. stick to a schedule. Also. here is some information on review courses that are available. But be prepared mentally for the anxiety the week before the test – focus on easier subjects to review.‖ ―Do not use First Aid or the all-inclusive books as the sole study aid. Pick a couple for each subject because in my experience you cannot absorb it all.com/ Online and live review courses available. Rather than use the words ―smudge cells‖. If possible.AND FINALLY SOME PREP ADVICE FROM TTUHSC SOM STUDENTS… ―I’d recommend studying no more than about 5 weeks. because every exam is different. Any more and you will start forgetting things you learned earlier. Nevertheless. The price of 17 .‖ ―Start early. A live course will be offered in Fort Worth from May 14th – June 1st. Unfortunately some programs schedule their courses at times of the year that don’t coincide with most first-time takers’ preparation efforts.‖ ―Have a planned study schedule that you stick to. 2012.‖ ―The last week/few days before Step are very distracting – don’t give yourself too much time to study.com Online and live review courses available. usmleconsult. Robbins Question Bank + Rapid Review Physiology 30 Days $75.00 90 Days $185.$6. USMLE CONSULT http://www. See the Falcon Review website for pricing details. Edward Goljan and John Pelley…” Step 1 Question Bank* + Robbins Pathology Question Bank BEST VALUE! Step 1 Premium Review* Step 1 Question Bank. and $2. diagnostic test analysis. ―Classroom Anywhere‖ (live online). and strictly web-based review courses.00 60 Days — 90 Days $135. Currently there are no live courses available whose dates would work with your semester scheduling.the live course includes the hotel room and costs more for a single occupancy room.00 90 Days $165.399 .com Kaplan offers live.500 questions written and reviewed by Drs. Cost for the 3 month online course is $2.399.00 365 Days $485.00 365 Days — *Purchase includes FREE access to the USMLE Consult Step 1 Scorrelator. KAPLAN www.499 for single occupancy.$4.00 365 Days $395. You can register for a free trial online.00 30 Days $115. Visit Kaplan’s website for details of the other course offerings. an assessment tool that generates a score indicative of what you can expect on the actual USMLE Step 1 or COMLEX Level I exams. Step 1 Question Bank* Per USMLE Consult website.kaplanmedical. “More than 2.999 for double occupancy 2012 Dates for Falcon’s Dallas Location (prior to June 30th)  April 30th – June 15th  May 14th – June 1st Falcon also offers an online course (―Online‖) as well as an online course delivered to your mobile device (―2go‖).599 .00 30 Days $95.com This product from the textbook publishers Elsevier includes question banks.00 60 Days $115. and other features. Prices for the live review course range from: $3. 18 .00 60 Days $145. passprogram. ______________________________________________ Other Study Resources… Please check out the MANY great resources available to you at no charge through the Preston Smith Library of the Health Sciences.__________________________________________________________________ Physician Assisted Student Success Program (PASS Program) – Champaign. You can create practice exams and you can select the topics. IL http://www. There are certainly many more websites and books available than those listed here. end of 7th or during last week of program Instructor monitors students' progress weekly and intervenes.net/program-format. please forward it to Karen Turner so we can include it in our list of resources. What works for one person may not work for another. 4 and 7 60 day paid subscription to USMLEWORLD. end of 4th week.100 8-week Program          1st 4 weeks – same as standard 4 week program. or COMBANK account 3 NBME practice exams: first day of class. you also have FREE access to EXAM MASTER for your Step 1 (and Step 2 CK) preparation. In addition to numerous online texts. so pick out the few that seem to work best with your style of studying and learning and go with it. except there are 4 tutoring sessions/week In 2nd 4 weeks there are 5 tutoring sessions/week Diagnostic Test during week 1.asp 4-week Program       Classroom lectures during the four weeks 2 guaranteed one-on-one sessions per week (additional one-on-one sessions may be purchased if needed) USMLE practice questions and simulated exams Unlimited use of the computer lab (during Center hours) 2 NBME practice exams: first day of class and end of 3rd week Tuition: $4. Kaplan Qbank.800 See PASS Program website for 2012 4-week and 8-week session calendars. so be careful about using a 19 . Remember that you can easily get overwhelmed by using too many resources as you study. If you find a book or website that you find helpful. if necessary If you do not pass the USMLE exam. you may return for 4 weeks for FREE!! (returning students are responsible for housing/living expenses) Unlimited use of computer lab (during Center hours) Tuition:$7. Just a few of the online question banks: www.usmleasy.com www. move on to something that does.htm www.com/medstudent/  http://www.com/wdsentry/ttuhsc-1.lww. Systems-Based Review for USMLE Step 1  USMLE Step 1 Recall: Buzzwords for the Boards  High-Yield Comprehensive USMLE Step 1 Review  Kaplan QBook  First Aid Cases for USMLE Step 1  USMLE Step 1 Secrets  First Aid Q&A for USMLE Step 1  Goljan’s Rapid Review of Pathology  Robbins Review of Pathology  Princeton Review USMLE Review  Blueprints – Step 1 Q&A  Appleton & Lange USMLE Step 1  Platinum Vignettes (Elsevier)  Rapid Review Series .usmlerx.com http://www.USMLE Step 1 Lastly.com And a few more books:  NMS Review for Step 1  High-Yield Pathology  Step Up: A High-Yield.cws_home?pubtype=Any&boost=true &needs_keyword=true&adv=false&keywords=usmle&action=product_search 20 . Try it for yourself – if it doesn’t fit you. A number of books are available for check-out in the Student Affairs Office library.score95.exammaster2.com/wps/find/simple_search.elsevier.book just because someone else said it worked for them. visit the following publishers’ websites for more resources:  http://www. What’s the BOTTOM LINE??? 1) Start studying NOW. a Bug-A-Day. Any studying you do for Step 1 will help you with your current classes and vice-versa. 4) Be aware of all the resources available. 2) Do a self-assessment to determine your strengths and weaknesses. You can use other people’s schedules as a template. but you must tailor your schedule to your own needs. PRACTICE. Remember you must create your own study schedule based on YOUR individual needs. Everybody has their own idea of what works for them and what doesn’t. PRACTICE. Pick the ones that work for you and stick with them. 3) Develop a reasonable study schedule. or what topics need to be studied more.you need to have a starting point. Bottom line . 5) PRACTICE. but don’t get overwhelmed trying to use all of them. 7 days a week for weeks on end. Also. Nobody can effectively study 15 hours a day.STUDY SCHEDULES One of the biggest pieces of advice that students and experts alike give surrounds the idea of developing and sticking to a study schedule. check out the following – one is a set of 3 different things to study for Step 1 on a daily basis: a Drug-A-Day. There are tons of questions out there – use them and LEARN from them. 6) Take this very seriously but DON’T PANIC!! You can’t think straight in that state of mind. The other is a list of high-yield topics for Step 1. 21 . and a Disease-A-Day. Neisseria meningiditis N. prowazekii R. B19 virus 24-May 25-May 26-May 27-May 28-May Parainfluenza 31-May 1-Jun 2-Jun 3-Jun 4-Jun Influenza A Measles Mumps Rubella virus RSV Hepatitis A HIV (HTLV III) Rabies virus Poliovirus Coxsackie A & B Dengue virus Rhinovirus Hepatitis C . tetani C. pneumoniae S. trachomatis M. gonorrhoeae Bacillus anthracis B. Serratia marcescens Klebsiella pneumonia Haemophilus influenza H. perfringens C. bovis Enterococcus grp. avium-intracellularis complex 10-May 11-May 12-May 13-May 14-May Varicella-zoster Treponema pallidum C. parahemolyticus Helicobacter pylori Bacteroides fragilis Proteus vulgaris Pseudomonas aeruginosa Legionella pneumophila Bordetella pertussis Brucella abortus Francisella tularensis Yersinia pestis Borrelia burgdorferi DATE 12-Apr 13-Apr 14-Apr 15-Apr 16-Apr 19-Apr 20-Apr 21-Apr 22-Apr 23-Apr BUG Rickettsii rickettsii R. typhi Coxiella burnetii Bartonella henselae Mycoplasma pneumoniae Actinomyces israelii Nocardia asteroides Mycobacteria tuberculosis B. leprae hepatitis B & delta virus BK & JC virus Smallpox Herpes simplex I & II Epstein-Barr Cytomegalovirus Human papilloma virus Adenovirus 17-May 18-May 19-May 20-May 21-May Parvo. psittaci C. agalactiae S. saprophyticus S. Salmonella Sp.BUG-A-DAY DATE 15-Feb 16-Feb 17-Feb 18-Feb 19-Feb 22-Feb 23-Feb 24-Feb 25-Feb 26-Feb 1-Mar 2-Mar 3-Mar 4-Mar 5-Mar 8-Mar 9-Mar 10-Mar 11-Mar 12-Mar 15-Mar 16-Mar 17-Mar 18-Mar 19-Mar 22-Mar 23-Mar 24-Mar 25-Mar 26-Mar 29-Mar 30-Mar 31-Mar 1-Apr 2-Apr 5-Apr 6-Apr 7-Apr 8-Apr 9-Apr BUG Staph. pyogenes S. viridans grp. epidermidis S. recurrentis 26-Apr 27-Apr 28-Apr 29-Apr 30-Apr Leptospira interrogans 3-May 4-May 5-May 6-May 7-May M. cereus Clostridium botulinum C. aegyptius Campylobacter jejuni Vibrio cholera V. S. aureus Strep. difficile Corynebacterium diphtheriae Listeria monocytogenes Escherichia coli Shigella Sp. ducreyi H. DRUG-A-DAY DATE DRUG 1 15-Feb 16-Feb 17-Feb 18-Feb 19-Feb Cyclophosphamide 22-Feb 23-Feb 24-Feb 25-Feb 26-Feb Methotrexate 1-Mar 2-Mar 3-Mar 4-Mar 5-Mar Streptokinase 8-Mar 9-Mar 10-Mar 11-Mar 12-Mar 15-Mar 16-Mar 17-Mar 18-Mar 19-Mar 22-Mar 23-Mar 24-Mar 25-Mar 26-Mar 29-Mar 30-Mar 31-Mar 1-Apr 2-Apr 5-Apr 6-Apr 7-Apr 8-Apr 9-Apr Tetracycline DRUG 2 Chloramphenicol Ciprofloxacin Paclitaxel Vinblastine Insulin Glyburide Aspirin Lovastatin Heparin Allopurinol Warfarin Probenecid Clomiphene Oxytocin Acetaminophen Acetylcystine Epinephrine Amiloride Hydrochlorthiazide Mannitol Spironolactone Neostigmine Organophosphates Hydralazine Propranolol Nitroglycerine Nitroprusside a-Methyl Dopa Cimetidine Misoprostal Sucralfate Terbutaline Bleomycin Ephedrine Ipratropium d-Tubocurarine Propylthiouracil Dexamethasone Metyrapone Aminoglutethimide Methysergide Prednisone Na-Dantrolene Dopamine DRUG 1 12-Apr 13-Apr 14-Apr 15-Apr 16-Apr Ampicillin 19-Apr 20-Apr 21-Apr 22-Apr 23-Apr 26-Apr 27-Apr 28-Apr 29-Apr 30-Apr 3-May 4-May 5-May 6-May 7-May Atropine Scopolamine Furosemide DATE Dobutamine Ziduvodine DRUG 2 Dideoxyinosine Acyclovir Chloroquine Amphoteracin B Metronidazole Primaquine Griseofulvin Trimethoprim Sulfamethoxazole Rifampin Isoniazid Clindamycin Gentamicin Cyclosporine Cefaclor Phenytoin Carbamazepine Lithium Fluoxetine Amphetamine Cocaine Imipramine Amitriptyline Haloperidol Clozapine Ketamine Thiopental Tamoxifen Diltiazem Verapamil Imipenem Vancomycin Quinidine Procainamide 10-May 11-May 12-May 13-May 14-May Indomethacin 17-May 18-May 19-May 20-May 21-May Dimercaprol Deferoxamine Bethanechol Carbidopa Amlodipine Nifedipine 24-May 25-May 26-May 27-May 28-May 31-May 1-Jun 2-Jun 3-Jun 4-Jun Methadone Morphine Naloxone Amiodarone Digoxin Halothane Metolazone Enalapril Captopril Metoprolol Prazosin Rosiglitizone Phencyclidine Diazepam Amoxicillin Clavulanic Acid 5-Fluorouracil Cisplatin Finasteride Abciximab Ethambutol Losartan Cholestyramine . Tuberculosis Renal Artery Stenosis Deep Vein Thrombosis Crohn's Ds. Analgesic Abuse Multiple Myeloma no review today . Heart Failure Abruptio Placentae Nephrolithiasis Complete Heart Block Inguinal Hernia Myasthenia Gravis Aortic Stenosis 14-Apr 15-Apr 16-Apr 17-Apr 18-Apr 24-Feb 25-Feb 26-Feb 27-Feb 28-Feb Hydrocephalus Mesenteric Infarction Acute Pancreatitis Celiac's Ds. Hemophilia A Cobra Venom Lead Poisoning Galactosemia alpha-Thallasemia Tay Sachs Von Willebrand's Dz. Spotted Fev Giardiasis Hepatitis C Necrotizing fasciitis Toxoplasmosis Congenital Syphilis IgA Deficiency Bruton's Agammaglob. Chediak-Higashi PATHOLOGY Contact Dermatitis Leiomyoma Turner's Synd. Stress Do. Somatoform Do. Scurvy Adult Polycystic Kidney Phenylketonuria Starvation 31-Mar 1-Apr 2-Apr 3-Apr 4-Apr 10-Feb 11-Feb 12-Feb 13-Feb 14-Feb Pernicious Anemia Duchenne's Musc Dyst Hypothyroidism Diabetes Mellitus Pemphigus Vulgaris ANATOMY & PHYSIOLOGY Membranous GN Goodpastures Synd. 24-Mar 25-Mar 26-Mar 27-Mar 28-Mar 3-Feb 4-Feb 5-Feb 6-Feb 7-Feb 2. Bacterial Meningitis Abd Aortic Aneurysm Cervical Carcinoma Polyarteritis Nodosa Familial Polyposis Pneumonia Acute Lymph Leukemia Epidural Hematoma Breast Cancer Good Friday PHARMACOLOGY Essential Hypertension Schizophrenia Hypercholesterolemia Angina Pectoris Coccidioidomycosis Atrial Fibrillation AID's Appendicitis Hodgkin's Lymphoma no preview today Glaucoma Pheochromocytoma Gen. Malignant Melanoma G-6-PD Deficiency Alzheimer's Ds. 28-Apr 29-Apr 30-Apr 1-May 2-May 10-Mar 11-Mar 12-Mar 13-Mar 14-Mar ARDS Silicosis Emphysema Influenza A "the flu" Gastroenteritis Prolactinoma Bronchogenic CA Wegener's Granulomat. Steven's Johnson Synd Epilepsy Trichinosis Salicylate tox. Failure) Ectopic Pregnancy Psoriasis Multiple Sclerosis Minimal Change Ds.Disease-A-Day-2003 DATE 19-Jan 20-Jan 21-Jan 22-Jan 23-Jan 24-Jan PREVIEW BIOCHEMISTRY Sickle Cell Disease Diphtheria Von Gierke's Dz. Familial Hypercholest. Acute Post Strep GN. Graft vs Host Ds. Endometriosis Parathion Toxicity Chron Granulomatous Ds Toxic Shock Synd SCID Syndrome DiGeorge Synd. Alcoholic Hepatitis Zollinger-Ellison Synd. Wallenberg's Synd Graves Ds. 21-Apr 22-Apr 23-Apr 24-Apr 25-Apr 3-Mar 4-Mar 5-Mar 6-Mar 7-Mar Spina Bifida Carpal Tunnel Synd.'s Post Traum. Anaphylactic Shock Defense Mechanisms BEHAVIORAL SCIENCE Anorexia Nervosa Major Depression Amnesia Obsess/Compul Do. Peptic Ulcer Ds. Acute Tubular Necrosis 7-Apr 8-Apr 9-Apr 10-Apr 11-Apr 17-Feb 18-Feb 19-Feb 20-Feb 21-Feb WPW Syndrome ACL rupture Myotonic Dystrophy Congest. Separation Anxiety Pathologic Grief Do.4-Dinitrophenol tox.O. Osteogenesis Imperfecta Methemoglobinemia REVIEW DATE beta-Thallasemia Cystic Fibrosis Pompe's Dz. Anxiety D. Rhabdomyosarcoma Insulinoma 17-Mar 18-Mar 19-Mar 20-Mar 21-Mar 27-Jan 28-Jan 29-Jan 30-Jan 31-Jan McArdles Syndrome Lesch-Nyan Synd. Papillary Necrosis Uremia (Ren. More Defense Mech. Kartagener's Synd. Menopause Asthma Trigeminal Neuralgia Bell's Palsy Guillain-Barre Synd Addison's Ds. Chronic Bronchitis Hemochromatosis PREVIEW REVIEW MICROBIOLOGY & IMMUNOLOGY Chlamydial Inf's Hemolytic-Uremic Synd Mononucleosis Rocky Mtn. USMLE STEP 1 and USMLE STEP 2 Highly tested topics The Complete Gold Collection Page 1 . moon face. Hereditary nephritis with nerve deafness (antibodies to intrinsic factor or parietal cells → ↓IF → ↓Vit B12 → megaloblastic anemia) 5. not a deficiency. skip lesions. Psychological: multiple physical complaints without physical pathology 23. Curling’s Ulcer Cushing’s 47. Progressive dementia 6.6 glucosidase def. Can progress to Kernicterus Less severe form will respond to Phenobarbital therapy IBD.constant gastroesophageal reflux 12. Post-hepatic venous thrombosis = ab pain. Defect in platelet adhesion (abnormally large platelets & lack of platelet-surface glycoprotein) 17. lymphocytic infiltrate. mucosa & submucosa. Prion infection → cerebellar & cerebral degeneration 40. granulomas (contrast to UC: limited to colon. Primary Aldosteronism: HTN. crypt abscesses. 42. albinism. 32. Acute inflammation of medium and small arteries of extremities → painful ischemia → gangrene Seen almost exclusively in young and middle-aged men who smoke. Similar to Duchenne.cardiomegaly with apical atrophy. Motor Aphasia (area 44 & 45) intact comprehension 24. Type III Glycogenosis – Glycogen storage disease (debranching enz: amylo 1. retain Na+ & H2O. 44. young girls 4. UMN / ipsi loss of consc. Syndrome: hypercorticism of all other causes (1° adrenal or ectopic) 49. Hyperreninemia 13. Recurrences of rickettsia prowazaki up to 50 yrs later 21. but less severe 14. Hemisection of cord (contralateral loss of pain & temp / ipsilateral loss of fine touch. 33. in dystrophin protein) (entire face. 28. Small noncleaved cell lymphoma EBV 8:14 translocation Seen commonly in jaws. Disease: Hypercorticism 2° to ↑ ACTH from pituitary (basophilic adenoma) 48. These ’PEARLS’ will appear on your boards exams! Diseases Addison’s Disease Addisonian Anemia Albright’s Syndrome Alport’s Syndrome Alzheimer’s Argyll-Robertson Pupil Arnold-Chiari Malformation Barrett’s Bartter’s Syndrome Becker’s Muscular Dystrophy Bell’s Palsy Berger’s Disease Bernard-Soulier Disease Berry Aneurysm Bowen’s Disease Brill-Zinsser Disease Briquet’s Syndrome Broca’s Aphasia Brown-Sequard Bruton’s Disease Budd-Chiari Buerger’s Disease Burkitt’s Lymphoma Caisson Disease Chagas’ Disease Chediak-Higashi Disease Conn’s Syndrome Cori’s Disease Creutzfeldt-Jakob Crigler-Najjar Syndrome Crohn’s 1. retroperitoneal soft tissues Starry sky appearance Nitric gas emboli 34. 7. (AR) Phagocyte Deficiency = defect in microtubule polymerization 36. café au lait spots. hirsutism. 30. achlasia 35. Often associated with ADPKD 19. fistulae b/t intestinal loops & abd structures 46. Pernicious anemia 3. 41. recall that UMN lesion only affects lower face) 15. liver failure 27. hypokalemia (causing alkalosis).USMLE E-BOOK This is the GOLD collection of highly tested USMLE Step 1 and USMLE Step 2 topics listed in tables for easy review. ascites. short stature. 29. purple striae. Polyostotic fibrous dysplasia. 43. . 31. Congenital hyperbilirubinemia (unconjugated) Glucuronyl transferase deficiency. fever. abdomen. ↓ renin 38. Acute gastric ulcer associated with severe burns 45. cranial & peripheral neuropathy & repeated infections w/ strep & staph 37. Neutropenia. Primary adrenocortical deficiency 2. 8. usually following infection 16. cobblestones. Columnar metaplasia of lower esophagus (↑ risk of adenocarcinoma). transmural. pseudopolyps. X-linked agammaglobinemia (↓ B cells) 26. buffalo hump. 10. ileocecum. hepatomegaly. CNVII palsy (mutation. ↑ Glycogen) 39. 9. HTN. Loss of light reflex constriction (contralateral or bilateral) “Prostitute’s Eye” – accommodates but does not react Pathognomonic for 3°Syphilis Lesion pretectal region of superior colliculus Cerebellar tonsil herniation through foramen magnum = see thoracolumbar meningomyelocele 11. IgA nephropathy causing hematuria in kids. Trypansoma infection . Carcinoma in situ on shaft of penis (↑ risk of visceral ca) [compare w/ Queyrat] 20. malabsorption. Circle of Willis (subarachnoid bleed) Anterior Communicating artery 18. ↑ colon cancer risk) Clinically: ab pain & diarrhea. portal HTN. precocious puberty. hyperglycemia Page 2 . Somatization disorder 22. Proprio) 25. XXY: Long arms. Mucocutaneous lymph node syndrome in kids (acute necrotizing vasculitis of lips. Adenocarcinoma with signet-ring cells (typically originating from the stomach) metastases to 95. Autoimmune: ab’s to glomerular & alveolar basement membranes. small lower jaw. oral mucosa) 92. Defective collagen 63. sterility 91. systemic acidosis) 68. Trisomy 18 61. Low TSH & TRH – High T3 / T4 76. 47. miosis. situs inversus. neutropenia. 3. arthralgias. Hepatosplenomegaly. anemia 72.Cushing’s Ulcer de Quervain’s Thyroiditis DiGeorge’s Syndrome Down’s Syndrome Dressler’s Syndrome Dubin-Johnson Syndrome Duchenne Muscular Dystrophy Edwards’ Syndrome Ehler’s-Danlos Eisenmenger’s Complex Erb-Duchenne Palsy Ewing Sarcoma Eyrthroplasia of Queyrat Fanconi’s Syndrome Felty’s Syndrome Gardner’s Syndrome Gaucher’s Disease Gilbert’s Syndrome Glanzmann’s Thrombasthenia Goodpasture’s Grave’s Disease Guillain-Barre Hamman-Rich Syndrome Hand-Schuller-Christian Hashimoto’s Thyroiditis Hashitoxicosis Henoch-Schonlein purpura Hirschprung’s Disease Horner’s Syndrome Huntington’s (Chromosome 4) Jacksonian Seizures Job’s Syndrome Kaposi Sarcoma Kartagener’s Syndrome Kawasaki Disease Klinefelter’s Syndrome Kluver-Bucy Krukenberg Tumor Laennec’s Cirrhosis Lesch-Nyhan Letterer-Siwe Libman-Sacks 50. Rocker-bottom feet. Lysosomal Storage Disease glucocerebrosidase deficiency – glucocerebroside accumulation 71. Endocarditis with small vegetations on valve leaflets 101. Ptosis. oral behavior) 94. femoral head & long bone erosion. retardation. Initial hyperthyroidism in Hashimoto’s Thyroiditis that precedes hypothyroidism 81. Can see honey comb lung.t11. Immotile cilia 2° to defective dynein arms infection. GI & renal involvement) Associated with upper respiratory infections Aganglionic megacolon 85. Deficiency of dystrophin protein → MD X-linked recessive 60. hyperphosphaturia. 53. aminoaciduria. HGPRT deficiency 98. Trauma to superior trunk of brachial plexus Waiter’s Tip 65. Sterile. 78. low ears. Idiopathic pulmonary fibrosis. self-mutilation 99. Chronic progressive histiocytosis 79. Epileptic events originating in the primary motor cortex (area 4) 1. Hemmorhagic urticaria (with fever. osteomas & soft tissue tumors 70. 89. Acute disseminated Langerhans’ cell histiocytosis 100. usually self-limiting) 77. 2.22 66. AD = adenomatous polyps of colon. heart disease 62. Defective glycoproteins on platelets = deficient platelet aggregation 74. 82. 84. Impaired proximal tubular reabsorption 2° to lead poisoning or Tetracycline (glycosuria. ASD. Associated with SLE Page 3 . Acute gastric ulcer associated with CNS trauma 51. anhidrosis (lesion of cervical sympathetic nerves often 2° to a Pancoast tumor) 86. splenomegaly 69. Gout. 83. May have transient hyperthyroidism. Carcinoma in situ on glans penis 67. AD: Progressive degeneration of caudate nucleus. Hypogonadism 93. 54. 88. putamen (striatum) & frontal cortex ↓ GABA 87. 55. Malignant undifferentiated round cell tumor of bone in boys <15yoa . Hypersensivity vasculitis = allergic purpura. Bilateral lesions of amygdala (hypersexuality. or PDA 64. Low T3 /T4 & High TSH 80. Post-MI Fibrinous Pericarditis autoimmune 57. Polyneuritis following viral infection/ autoimmune (ascending muscle weakness & paralysis. Lesions have the same age. Congenital hyperbilirubinemia (conjugated) = bilirubin transposrt is defective not conjugation 58. Autoimmune hypothyroidism. Self-limiting focal destruction (subacute thyroiditis) 52. the ovaries 96. Benign congenital hyperbilirubinemia (unconjugated) = ↓d glucuronyl transferase activity 73. Autoimmune hyperthyroidism (TSI): IgG Ab reactive w/ TSH receptors. Immune deficiency: neutrophils fail to respond to chemotactic stimuli Defective neutrophilic chemotactic response = repeated infections Commonly seen in light-skinned. red-haired girls ↑’d IgE levels Malignant vascular tumor (HHV8 in homosexual men) 90. Failure of 3rd & 4th pharyngeal pouches formation: Thymus & Parathyroid Thymic hypoplasia → T-cell deficiency Hypoparathyroidism ! Tetany Trisomy 21 or translocation – Simian Crease 56. Rheumatoid arthritis. Striking brown-to-black discoloration of the liver 59. Seen in men in their 20’s 75. Late cyanotic shunt (R→L) pulmonary HTN & RVH 2° to long-standing VSD. Alcoholic cirrhosis 97. Postpartum pituitary necrosis = hemorrhage & shock usually occurred during delivery 140. 2° to aspirin ingestion in children following viral illness. Tuberculous osteomyelitis of the vertebrae 128. both motor and vocal Txt w/ Pimozide 154. Amyotrophic Lateral Sclerosis degeneration of upper & lower motor neurons 103.VSD. Constrictive pericarditis – sequel to mediastinal tuberculosis Calcium-frosting. Factitious disorder (consciously creates symptoms. conjunctivitis. 149. 150. 116. Common in young Asian females Gangliosidosis (hexosaminidase A deficiency → GM2 ganglioside) Cherry Red Spots of the Macula 152. Phenomenon: 2° to underlying disease (SLE or scleroderma) 131. Disease: recurrent vasospasm in extremities = seen in young. Colon adenomatous polyps plus CNS tumors 155. Hereditary Hemorrhagic Telangiectasia.Glycogen storage disease (muscle phosphorylase deficiency = ↑ Glycogen) 106. subluxation of lenses 105. especially VZV 134. Connective tissue defect: defective Fibrillin gene Dissecting aortic aneurysm. 2 feet from the ileocecum. Aluminum inhalation → lung fibrosis 139. Page 4 . Calcification of the media (usually radial & ulnar aa. Seen in the Mormon’s of Utah. Triad: ovarian fibroma. XO = most common cause of Primary Amenorrhea. Polycystic ovary: see amenorrhea. Embryonic duct origin. thyroid medullary CA. healthy women 130. defects in extremities 129. Juvenile melanoma (always benign) 145. infertility. MEN type IIa = pheochromocytoma.) 111. Type II Glycogenosis – Glycogen storage disease → cardiomegaly (α 1. Abnormal bone architecture (thickened. malaise. 123. Melanin pigmentation of lips. Pituitary cachexia – can occur from either pituitary tumors or Sheehan’s 142. hirsutism = ↑↑LH secretion 146. Giant hypertrophic gastritis (enlarged rugae. absence of eye signs (Plummer’s = Grave’s . Bronchogenic tumor with superior sulcus involvement → Horner’s Syndrome 118. Night sweats. Bleeding from esophagogastric lacerations 2° to wretching (alcoholics) 104. genitalia + hamartomatous polyps of small intestine 120. in 2% of the population 107. arthritis ↑ risk of B-cell lymphoma 144. 1° Adrenal Cushings → surgical removal of adrenals → loss of negative feedback to pituitary → Pituitary Adenoma 113. Esophageal webs & iron-deficiency anemia. Renal agenesis → oligohydramnios → hypoplastic lungs. Aortic arch syndrome Loss of carotid. Urethritis. plasma protein loss) 110. 124. dry mouth. unyielding layer – heart chambers may be unable to dilate to receive blood during diastole Hyperthyroidism. Involuntary actions.right ventricular hypertrophy 153. Lysosomal Storage Disease (sphingomyelinase deficiency – sphingomyelin accumulation) 114. may have ectopic tissue: gastric/pancreatic remnant of vitteline duct/yolk stalk 108. hand. arthritis non-infectious (but often follows infections). radial or ulnar pulses = pulseless disease. hyperparathyroidism 143. 151.4 Glucosidase deficiency: ↑ Glycogen) 127. 122. but doesn’t know why) 112. Leukemic form of cutaneous T-cell lymphoma (mycosis fungoides) 138. Similar to Dubin-Johnson. HLA-B27. No Barr body on buccal smear.overriding aorta. polyarticular 132. Progressive dementia similar to Alzheimer’s 1. numerous fractures → pain) 117. Parkinsonism with autonomic dysfunction & orthostatic hypotension 141. Type V Glycogenosis . 1. nodular goiter. 45. fever. Microvesicular fatty liver change & encephalopathy 133. Juvenile rheumatoid arthritis (absence of rheumatoid factor) 148.pulmonary artery stenosis. mucosal ulceration (often 2° to infection = mycoplasma or sulfa drugs) 147. 2. Triad: dry eyes. 3. ascites. Erythema multiforme. obesity. Subcutaneous fibrosis of dorsum of penis 121. 4. Idiopathic fibrous replacement of thyroid 135. but no discoloration of the liver 137. Rule of 2’s: 2 inches long. hydrothorax – associated w/ fibroma of ovaries 109. mouth. spoon-shaped nails. “Foamy histiocytes” 115. Dopamine depletion in nigrostriatal tracts 119.eye signs) 125. Congenital hyperbilirubinemia (conjugated) 136. 1.Lou Gehrig’s Mallory-Weis Syndrome Marfan’s McArdle’s Disease Meckel’s Diverticulum Meig’s Syndrome Menetrier’s Disease Monckeberg’s Arteriosclerosis Munchausen Syndrome Nelson’s Syndrome Niemann-Pick Osler-Weber-Rendu Syndrome Paget’s Disease Pancoast Tumor Parkinson’s Peutz-Jegher’s Syndrome (AD) Peyronie’s Disease Pick’s Disease – 2 Different Diseases Plummer’s Syndrome Plummer-Vinson Pompe’s Disease Pott’s Disease Potter’s Complex Raynaud’s Reiter’s Syndrome Reye’s Syndrome Riedel’s Thyroiditis Rotor Syndrome Sezary Syndrome Shaver’s Disease Sheehan’s Syndrome Shy-Drager Simmond’s Disease Sipple’s Syndrome Sjogren’s Syndrome Spitz Nevus Stein-Leventhal Stevens-Johnson Syndrome Still’s Disease Takayasu’s arteritis Tay-Sachs (AR) Tetralogy of Fallot Tourette’s Syndrome Turcot’s Syndrome Turner’s Syndrome 102. ↑ SCCA of esophagus 126. etc. Contralateral: body pain & temp Adrenal insufficiency 2° to DIC DIC 2° to meningiococcemia Paramedian Infarct of Midbrain Ipsilateral: mydriasis. pancreatic islets. UMN lesion 204. Histiocytosis X (eosinophilic granuloma) 208. Contralateral: UMN paralysis (lower face & body) Necrotizing granulomatous vasculitis of paranasal sinuses. Combination of septum secundum atrial septal defect w/ mitral stenosis 191. Autoimmnue thyroid Disease (Hashimoto’s ) & insulin-dependent diabetes Hallmark Findings Albumino-Cytologic Dissociation Antiplatelet Antibodies Arachnodactyly Aschoff Bodies Auer Rods Autosplenectomy Babinski Basophilic Stippling of RBCs Bence Jones Protein Birbeck Granules Blue Bloater 192. 168. Idiopathic thrombocytopenic purpura 194. adrenal cortex. brain stem. Salmonella osteomyelitis 201. Floppy vale syndrome – women b/t 20-40 yoa 189. Multiple myeloma free light chains (either kappa or lambda) 206. 169. Defect in platelet adhesion 2° to deficiency in vWF. bilateral mamillary bodies (mediodorsal nucleua) (confusion. Waldenstrom’s macroglobinemia 207. Low O2 ↑ sickling 199. Osteitis fibrosa cystica (“brown tumor”) 2° to hyperparathyroidism = osteoclastic resorption w/ 163. Chronic Bronchitis (at least 3 months for at least 2 years of ecessive mucus secretion & chronic recurrent productive cough) Page 5 . 161. MEN type I = thyroid.Vincent’s Infection Von Gierke’s Disease Von Hippel-Lindau Von Recklinghausen’s Von Recklinghausen’s Disease of Bone Von Willebrand’s Disease (AD) Waldenstrom’s macroglobinemia Wallenberg’s Syndrome Waterhouse-Friderichsen Weber’s Syndrome Wegener’s Granulomatosis Weil’s Disease Wermer’s Syndrome Wernicke’s Aphasia Wernicke-Korsakoff Syndrome Whipple’s Disease Wilson’s Disease Wiskott-Aldrich Syndrome Wolff-Chaikoff Effect Zenker’s Diverticulum Zollinger-Ellison Roger’s Disease Barlow’s Syndrome Bracht-Wachter Lesions Lutembacher’s Syndrome Schmidt’s Syndrome 156. Type I Glycogenosis – Glycogen storage disease (G6Ptase deficiency) – Glycogen accumulaiton 158. 184. Esophageal. pituitary 176. ↑ Bleed time 165. lungs. 170. Lead poisoning 205. ophthalmoplegia) 178. fibrous replacement 164. cricopharyngeal muscles above UES 186. Interventricular septal defect 188. parathyroid. 160. & retina Adenomas of the viscera. facial pain & temp. Malabsorption syndrome (with bacteria-laden macrophages) & polyarthritis 179. Dark field microscopy for dx 175. PAS(+) Dutcher bodies 166.&T-cell deficiency (thrombocytopenia & eczema) ↓ IgM w/ ↑ IgA High iodine level (−)’s thyroid hormone synthesis 185. Vaso-occlusive painful crisises 202. Minute abscesses found in subacute bacterial endocarditis 190. 180. ↑aPPT. 183. Gastrin-secreting tumor of pancreas (or intestine) → ↑ acid → recurrent ulcers 187. ataxia. Acute promyelocytic leukemia (AML type M3) 197. Sensory Aphasia impaired comprehension 177. Hepatolenticular degeneration (copper accumulation [Txt w/ Penicillamine ] & decrease in ceruloplasmin) Mallory Bodies in the Liver & also w/ alcoholic hepatitis & Hyaline change Chromosome 13 Immunodeficiency: combined B. 181. Hydroxyurea as Txt (↑ HbF) & Bone marrow transplant 203. Icteric Leptospirosis non-icteric prgresses to renal failure & myocarditis 174. Aplastic crisis w/ B19 (Parvovirus ssDNA) infection 200. Guillain-Barre (markedly increased protein in CSF with only modest increase in cell count) 193. Proliferation of IgM-producing lymphoid cells in men 50-70 yoa. especially ↑ Renal Cell Carcinoma Chromosome 3p Neurofibromatosis & café au lait spots & Lisch nodules (Chromosome 17) 162. “Trench mouth” – acute necrotizing ulcerative gingivitis due to Fusobacterium 157. Posterior Inferior Cerebellar Artery (PICA) thrombosis “Medullary Syndrome” Ipsilateral: ataxia. kidneys. Sickle cell anemia: switch a glu ! val in β chain 198. 172. Rheumatic fever 196. Hemangioma (or hemangioblastoma) = cerebellum. 167. 159. 173. 171. Thiamine deficiency in alcoholics. 182. Marfan’s 195. Bronchial asthma 221. Wilson’s 257. cytoid bodies seen w/ SLE (yellowish cotton wool fundal lesions) 232. Acidosis / Diabetic Ketoacidosis 255. Lyme Disease 241. HTN 231. New coffee flavor at Bagel & Bagel 230. Haemophilus ducreyi 219. Gardnerella vaginitis 225. Syphilis over-aggressive treatment of an asymptomatic pt. Alcoholism 242. Bronchial asthma Depigmentation Of Substantia Nigra 236. Infectious mononucleosis (EBV) 249. Iron-deficiency anemia or β Thalassemia 252. Megaloblastic anemia 251. intention tremor. Parkinson’s Donovan Bodies Eburnation Ectopia Lentis Erythema Chronicum Migrans Fatty Liver Ferruginous Bodies Ghon Focus / Complex Glitter Cells Gower’s Maneuver Heberden’s Nodes Heinz Bodies Heterophil Antibodies Hirano Bodies Hypersegmented PMNs Hypochromic Microcytic RBCs Jarisch-Herxheimer Reaction Joint Mice Kaussmaul Breathing Keratin Pearls Keyser-Fleischer Ring Kimmelstiel-Wilson Nodules Koilocytes Koplik Spots Lewy Bodies Lines of Zahn Lisch Nodules 237. Mycoplasma pneumoniae 227. HPV 6 & 11 (condyloma acuminatum . Endometriosis 223.& Iron laden 243. Osteoarthritis use of arms to stand (Distal IP joint of the fingers) 247. Alzheimer’s 250.benign) and HPV 16 & 18 (malignant association) 259. scanning speech 220. Measles 260. Hyperparathyroidism 213. that causes symptoms 2° to rapid lysis 253. 1° Syphilis 218. Arterial thrombus 262. ivory-like appearance of bone) 239. Aka. Tetralogy of Fallot 210. Multiple sclerosis = nystagmus. Osteosarcoma 226. Tuberculosis (1° & 2°. Asbestosis . Duchenne’s MD 246. respectively) 244. Granuloma-Theca cell tumor 216. Osteoarthritis (Proximal IP joint of the fingers) 211. Cerebral lesion 222. Rapidly progressive (crescentic glomerulonephritis) 234. Squamous Cell CA of skin Actinic Keratosis is a precursor 256. Parkinson’s (eosinophilic inclusions in damaged substantia nigra cells) 261. G6PDH Deficiency 248. Hypocalcemia facial spasm in tetany 224. Osteoarthritis (fractured osteophytes) 254. Chagas’ Disease 217. Acute Pyelonephritis 245. Klebsiella 235. Rheumatoid arthritis flex proximal & extend distal IP joints 212. Neurofibromatosis (von Recklinhausen’s disease) = pigmented iris hamartomas Page 6 . 2° Syphilis 229. Diabetic nephropathy: Nodular Glomerulosclerosis nodules of mesangial matrix 258. Marfan’s 240.Boot-Shaped Heart Bouchard’s Nodes Boutonniere’s Deformity Brown Tumor Brushfield Spots Call-Exner Bodies Cardiomegaly with Apical Atrophy Chancre Chancroid Charcot Triad Charcot-Leyden Crystals Cheyne-Stokes Breathing Chocolate Cysts Chvostek’s Sign Clue Cells Codman’s Triangle Cold Agglutinins Condyloma Lata Cotton Wool Spots Councilman Bodies Crescents In Bowman’s Capsule Currant-Jelly Sputum Curschmann’s Spirals 209. Granulosa cell tumor: associated w/ endometrial hyperplasia & carcinoma 215. Granuloma inguinale (STD) 238. Osteoarthritis (polished. Down’s 214. Infectious mononucleosis 228. Dying hepatocytes – HepB 233. also see morning stiffnes that ↓ w/ joint use. Malakoplakia lesion on bladder due to macros & calcospherites (M-G Bodies): usually due to E. SLE (also anti-dsDNA) Malar Rash. Pancreatic CA (head) 281. Paroxysmal nocturnal hemoglobinuria. CMV 278. Hemangioma 290. Hodgkin’s Disease 302. Neisseria meningitidis impressive rash with bugs 311. LV Failure 308. HLA-DR4 282. L→R Shunt (VSD. RMSF 299. Spike = basement membrane material & Dome = immune complex deposits (IgG orC3) 318. Emphysema Centroacinar – smoking 288. Blue Bloater – Type B: Bronchitis 287. Serous papillary cystadenocarcinoma of the ovary 293. Alzheimer’s 272. Poststreptococcal glomerulonephritis – prototype of nephritic syndrome 264. Meningioma 294. Thalassemia in α Thalassemia w/ no α gene: Hydrops Fetalis & Intrauterine death associations = HbBarts Page 7 . Alzheimer’s 273. Pink Puffer – Type A: Emphysema 286. Anthrax Toxin 275. Aschoff cells seen w/ Rheumatic Fever 280. Chronic bronchitis = ↑d ratio of bronchial gland to bronchial wall thickness 303. Myxedema 274. Leydig cell tumor 304. Rheumatoid arthritis. Multiple myeloma 297. You would use Ham’s test to confirm. Appendicitis (McBurney’s Point is 2/3 of the way from the umbilicus to anterior superior iliac spine) 266. Hydralazine = SLE-like syndrome Giant cell tumor of bone 316. Pulmonary HTN 310. due to ↑ fat 296. Wire loop kidney lesions. Reed Sternburg Cells (Hodkins Lymphoma) 279. Hypothyroidism this is called the M protein (usually IgG or IgA) 270. Pulmonary Stenosis 309. Gout (MP joint of hallux) Panacinar . Coxsackie virus infection: Hand-Foot-Mouth Disease 300. Papillary adenocarcinoma of the thyroid 292. 2° Syphilis 298. ASD) 306. Joint pain. CHF = causing congested liver 277. PDA. Tearing of the ACL 291. Procainamide. False (+) syphilis test (VDRL) 90% 14-45 yo females also seen w/ use of INH. Mesothelioma 295. CML 284. 313. MGUS 269. Coli 267. Pick’s Disease 285. Multiple myeloma RBC’s stacked as poker chips 305. Mitral Regurg 307. Membranous glomerulonephritis = Nephrotic syndrome 317. Seen w/ Duchenne muscular dystrophy @ the claf muscles. Crohn’s bowel wall thickening 319. 314. Mycosis fungoides (cutaneous T-cell lymphoma). 312. Rabies 271. Multiple myeloma 268.α1-antitrypsin deficiency 289. 301. Alcoholic hepatitis 265.Lumpy-Bumpy IF Glomeruli Mallory Bodies McBurney’s Sign Michealis-Gutmann Bodies Monoclonal Antibody Spike Myxedema Negri Bodies Neuritic Plaques Neurofibrillary Tangles Non-pitting Edema Notching of Ribs Nutmeg Liver Owls Eye Cells Painless Jaundice Pannus Pautrier’s Microabscesses Philadelphia Chromosome Pick Bodies 2 types of COPD Podagra Port-Wine Stain Posterior Anterior Drawer Sign Psammoma Bodies Pseudohypertrophy Punched-Out Bone Lesions Rash on Palms & Soles Red Morning Urine Reed-Sternberg Cells Reid Index Increased Reinke Crystals Rouleaux Formation S3 Heart Sound S4 Heart Sound Schwartzman Reaction Smith Antigen Soap Bubble on X-Ray Spike & Dome Glomeruli String Sign on X-ray Target Cells 263. 315. Coarctation of Aorta 276. Sezary 283. Leukoderma (congenital facial white spots or macules): angiofibromas 353. Taste & Smell 367. Seizures. Intention tremors of the arm 360. Virchow’s Node Warthin-Finkeldey Giant Cells WBC Casts Whipple’s Triad Wire Loop Glomeruli ↑ AFP in amniotic fluid or mother’s serum ↑ Uric Acid ↓ FEV1/FVC “Ground Glass” on chest x-ray (Hyaline) Honey Combing of the lung Crescents Linear Ig Deposits 45 Degree Branch Points PAS(+) Dutcher Bodies “Ground Glass” in Abdomen(Hyaline) “Signet Ring” Cells Ground Glass Appearance (Hyaline) Congo Red Meningiomas & Progesterone Tuberous Sclerosis Triad Cowdry A Inclusions Devic’s Syndrome c-erb B2 Foster-Kennedy Syndrome Hoffman’s Sign Red Nucleus Destruction Ventral Spinocerebellar tr. Gout 335. Pain & Temperature sensation 365. Chronic pyelonephritis 322. Seen in the hepatocytes of healthy carriers of HBsAg in liver biopsies 347. Familial Hypercholesterolemia 321. Conscious proprioception of the body 364. Edinger Westphal = parasympathetic eye innervation 371. Seen w/ Asbestosis (a restrictive lung disease) 342. type IV (diffuse proliferative form) 332. Anencephaly 334. Myeloproliferative Disorders 337. Vision. due to Krukenberg’s tumor that has metastasized from the stomach 348. Cells that replace the ovaries. Mental retardation. Gout 323. Carotid Body & Sinus innervation 370. Dorsal Column Lateral Spinothalamic tr. Supraclavicular node enlargement by metastatic carcinoma of the stomach 328. Lupus nephropathy. Seen w/ Atelectasia 341. Aspergillosis 345. Spina Bifida 333. Hearing. Breast Cancer association 357. These are two entirely different disease processes and different signs.Tendinous Xanthomas Thyroidization of Kidney Tophi Tram-Track Glomeruli Trousseau’s Sign 320. Shows amyloid deposition in plaques & vascular walls 351. Unconscious proprioception & fine motor movements of upper extremities 363. Waldenstrom’s Macroglobulinemia = ↑IgM = Hyperviscosity 346. Pyelonephritis 330. Measles 329. Unconscious proprioception of lower extremities 361. Light touch perception 366. Seen w/ Progressive Multifocal Leukoencephalopathy oligodendrocytes 349. Some meningiomas have Progesterone receptors = rapid growth in pregnancy can occur 352. Membranoproliferative GN: Nephritic syndrome – 324. Sensation of tongue. Seen w/ Herpes Simplex Encephalitis – in oligodendroglia 354. soft palate. Hypocalcemia (carpal spasm) basement membrane is duplicated into 2 layers (migratory thrombophlebitis) 326. Unconscious prorpioception & fine motor movements 362. Equilibrium 369. A tumor causing blindness & loss of smell w/ papilloedema 358. Diuretics (Loop & Thiazides) 338. CNS disfunction – Hypoglycemic episodes – glu injection reverses CNS Sympt’s 331. Goodpastures syndrome (pneumonia w/ hemoptysis & rapidly progressive glomerulonephritis) 343. Nuclei seen in Papillary CA of the thyroid (malignant) 350. Lesch Nyhan 336. A variant of multiple sclerosis: rapid demyelination of the optic nerve & spinal cord w/ paraplegia 356. classically pancreatic 325. Cuneocerebellar tr. Ventral Spinothalamic tr. Flicking of the middle finger’s nail 359. COPD 339. Goodpastures syndrome 344. Muscles of the eye & of the tongue 368. “Neuromyelitis Optica” 355. SVA GSE SSA GVA GVE 327. Due to Pneumocystis carinii 340. Gland innervation = secretions Page 8 . but they unfortunately have the same name. Visceral ca. Dorsal Spinocerebellar tr. Pallor/Diaphoresis 391. Pain & temperature of face 374. Fibrocystic Change: premenopausic women (Carcinoma is the most common in post-menopausal women) 412. Medulloblastoma (cerebellum) 409. Can have hemorrhages as seen in Wernicke’s Encephalopathy 388. Controls circadian rhythm 384. Papilloma 400. Brown Sequard 382. Mature(Native) Teratoma = benign dermatoid 402. Neuroblastoma 392. Poliomyelitis 378. Lipoma 403. Tabes Dorsalis (Neurosyphilis) 380. Palpitations. Fibroadenoma 404. Staph aureus 413. Viscera 373. E. RBSc w/ spiny projections. Pain (Headache). Astrocytoma (including Glioblastoma Multiforme) then: mets. coli / Group BStrep. Savage behavior & obesity when lesioned 385. Innervation of muscles of masticaiton. Starvation when lesioned 386. hospitalized pneumonia pt 389. ALS = Lou Gherig’s Disease 381. Anterior Spinal artery Occlusion 383. facial expressions. Strep pneumoniae & in young adults = Neisseria meningitidis 396. Seen in Abetalipoproteinemia. Adenomatoid 401. Herpes simplex 393. Metasteses from Breast & Prostate 408. meningioma. larynx & pharynx 376. Releases PIF (dopa-ergic neurons) 387. Hib 399. Neisseria meningitidis 397. Klebsiella Page 9 .GSA SVE LMN Lesion Sensory Pathway Lesion Both UMN & LMN Lesion Both Sensory & Motor Lesion Suprachiasmatic Nucleus Ventromedial Nucleus Lateral Nucleus Arcuate Nucleus Mamillary Body Acanthocytes 372. Invasive Duct Carcinoma 411. Satiety center. Perspiration. Werndig Hoffman (progressive infantile muscular atrophy) 377. Leiomyoma: estrogen sinsitive: changes size during pregnancy & menopause 407. Hemangioma 405. Most Common… 1o Tumor arising from bone in adults Adrenal Medullary Tumor – Adults Adrenal Medullary Tumor – Children Agent of severe viral encephalitis Aggressive lung tumor Associated with gallstones Bacterial Meningitis – adults Bacterial Meningitis – elderly Bacterial Meningitis – newborns Bacterial Meningitis – toddlers Benign epithelial tumor of oral mucosa Benign fallopian tube tumor Benign ovarian tumor Benign tumor of soft tissue Benign tumor of the breast <25yoa Benign tumor of the liver Benign tumor of the vulva Benign uterine tumor Bone Tumors Brain Tumor – Child Brain Tumor –Adult Breast Carcinoma Breast Mass Bug in Acute Endocarditis Bug in debilitated. Induces eating. 398. Osteosarcoma 390. Sensation of external ear 375. Schwannoma 410. Hidroadenoma 406. Adenocarinoma 395. Pheochromocytoma: 5 P’s: ↑ Pressure. Small cell or oat cell 394. Subacute Combined Degeneration = Friedrich’s Ataxia = B12 deficiency 379. E.C) 451. N. 1ry ACTH. long term txt w/ cyclophosphamide) 420. Ectopic ACTH) 431. Alzheimer’s 436. Down’s 446. Dilated (Congestive) Cardiomyopathy: Alcohol. Myxoma: “Ball Valve” 421. NRDS = hyaline membrane disease 434. βnaphthylamine. BeriBeri. Metasteses 423. Alcohol consumption 444. Doxorubicin 424. analine dyes. Strep Viridans 419.Ba. Small Cell Carcinoma of the Lung 454. Multi-Infarct Dementia 437. coli) 416. TB 429. Hib 415. Alcohol 450.B. ghonorrhea 449. Transitional cell CA (assoc. Pneumonia 432. 21 hydroxylase deficiency 448. Coxsackie B. Bacteroides (2nd – E. Chlamydia (serotypes A. COPD 452. BPHyperplasia Page 10 . Renal disease 453. 11. Acute leukemia 445. Cause of Dementia Cause of Dementia (2nd most common) Cause of Dwarfism Cause of Food poisoning Cause of Hematosalpynga Cause of Hypoparathyroidism Cause of Hypothyroidism Cause of Kidney infections Cause of Liver disease in US Cause of Malignancy in children Cause of Mental retardation Cause of Mental retardation (2nd most common) Cause of NaCl loss and Hypotension Cause of PID Cause of Portal cirrhosis Cause of Preventable Blindness Cause of Pulmonary HTN Cause of Secondary Hypertension Cause of SIADH Cause of UT Obstruction in men 414. Staph aureus 439. Fragile X 447. Autoimmune (2nd – infection) 427. Staph aureus 417. Gonnorrhoeae 418. Adrenal Adenoma. Exogenous Steroid Therapy (then. coli 443. Rhabdomyoma – associated w/ Tuberous sclerosis 422. N.Bug in Epiglottitis Bug in GI Tract Bug in IV drug user bacteremia / pneumonia Bug in PID Bug in Subacute Endocarditis CA of urinary collecting system Cardiac 1ry Tumor – Adults Cardiac 1ry Tumor – Child Cardiac Tumor – Adults Cardiomyopathy Cause of 2ry HTN Cause of Addison’s Cause of breast lumps Cause of chronic endometriosis Cause of Congenital Adrenal Hyperplasia Cause of Cushings Cause of Death in Alzheimer pts Cause of Death in Diabetics Cause of Death in premature Cause of Death in SLE pts. Cocaine use. MI 433. Ectopic pregnancy 440. Lupus Nephropathy Type IV (Diffuse Proliferative) = Renal Disease 435. Achondroplasia 438. Corrective surgery I31 treatment 442. Throidectomy 441. w/ benzidine. 21-Hydroxylase Deficiency: NaCl lost & Hypotension (then. CA of the breast 428. Systolic Dysfunction 425.NaCl retention & HTN) 430. Renal Disease 426. Mitral 480. Berry aneurysms. Below Tentorium 493. Txt: Methysergide (5HT antagonist) 459. Periventricular plaques w/ ↓ Oligodenrocytes 464. intention tremor. Endometrial Carcinoma 477. Odontoma 466. Carcinoid tumor: flushing. Prolactin 484. Head (99%) 491. Lung (2nd breast) 497. malignant or benign Lung Tumor. Multiple Sclerosis: (Charcot Triad = nystagmus. bronchospasm. Tetralogy of Fallot =right to left shunt 461. Iron 467. LAD artery: MI 462. RHeart valvular lesions 458. VSD (membranous > muscular) 460. Optic Neuritis. Malignant 494. Chronic atrophic gastritis = no production of intrinsic factor 456. Mitral prolapse 485. primary or secondary Lysosomal Storage Disease Malignancy in Women Malignancy of the Larynx 455. Tricuspid 481. Insulinoma = β cell tumor 488. Mitral Valve Prolapse 479. Cystic Fibrosis (chromosome 7q) 472. Ulceroglandular 475. Mitral then Aortic 482. Fibrocystic disease 468. Glioblastoma mulitforme 487. Immunologic (Bence Jones protein in multiple myeloma is also called the Amyloid Light Chain) 474. bladder incontinence 465. Glottic CA (squamous cell) Page 11 . Seminoma (analogous to dysgerminoma of ovaries) 476. ↑ IgG in CSF. Alcoholic Liver Disease 490. Adult polycystic kidney disease: associated w/ polycystic liver. Above Tentorium 492. Endometrial CA 478. CMV (Pneumocystis carinii is most common overall) 469. Down’s 457.Cause Pernicious Anemia Chromosomal Disorder Common Tumor of the Appendix Congenital Cardiac Anomaly Congenital Early Cyanosis Coronary Artery Thrombosis Demyelinating Disease Dental Tumor Dietary Deficiency Disease of the Breast Disseminated Opportunistic Infection in AIDS Esophageal Cancer Fallopian Tube Malignancy Fatal Genetic Defect in Caucasians Female Tumor Form of Amyloidosis Form of Tularemia Germ Cell Tumor of Testes Gynecological Malignancy Gynecological Finding Heart Murmur Heart Valve in Bacterial Endocarditis Heart Valve in Bacterial Endocarditis in IV drug users Heart Valve involved in Rheumatic Fever Hereditary Bleeding Disorder Hormone secreted in Pituitary Adenoma Inherited disease of the Kidney Intracranial tumor in adults Islet Tumor Liver 1ry Tumor Liver Disease Location of Adenocarcinoma of the Pancreas Location of Adult Brain Tumors Location of Childhood Brain Tumors Lung Tumor. Hepatoma 489. APD1 – chromosome 16 486. SCCA 470. AdenoCA 471. MLF Syndorme = Internuclear Ophthalmoplegia. Leimyoma 473. Gaucher’s 496. scanning speech) 463. Von Willebrand’s Disease 483. Secondary 495. diarrhea. Duchenne’s: Dystrophin deletion. Young male 520. Hepatocellular CA 502. Pleomorphic adenoma 533.Adult over 60 / CML – Adult 35-50 519. Hypocalcemia of Chronic Renal Failure 534. Adenomas (followed by: hyperplasia. then carcinoma) 526. Osteosarcoma 527. Adenocarcinoma 499. Medulloblastoma of brain (cerebellum) 507. Chlamydia (sero types D-K) 535. PCP 515. Prolactinoma (2nd – Somatotropic “Acidophilic” Adenoma) 522. Mid 1/3 523. Sigmoid Colon Page 12 .Malignancy of the Small Intestine Malignancy Vulva Malignant Eye Tumor in Kids Malignant Tumor of the Liver Motor Neuron Disease Muscular Dystrophy Nasal Tumor Neoplasm – Child Neoplasm – Child (2nd most common) Neoplasm of the West Neoplastic Polyp Nephrotic Syndrome in Adults Nephrotic Syndrome in Children Non Hodgkin’s Lymphoma Number of Deaths per year in Women Skin tumor Opportunistic infection in AIDS Ovarian Malignancy Ovarian Tumor Pancreatic Tumor Patient with ALL / CLL / AML / CML Patient with Goodpasture’s Patient with Reiter’s Pituitary Tumor Place for Primary Squamous Cell CA of esophagus Place for Peptic Ulcer Disease Primary Benign Salivary Tumor Primary Hyperparathyroidism Primary Malignancy of Bone Primary Malignancy of Small Intestine Pt. Young Male (except Nodular Sclerosis type – Female) 529. Leukemia 506. with Hodgkin’s Pt. Adeno (usually in the head) 518. Membranous Glomerulonephritis 510. Squamous cell CA 500. Follicular small clear cell 512. Presents <5yoa weakness at pelvic girdles w/ upward progression 504. Retinoblastoma 501. Squamous cell CA 505. Minimal Change (Lipoid Nephrosis) Disease (responds well to steroid txt) 511. Wilm’s tumor (neohroblastoma) – chromosome 11p 532. Hamartoma 517. Basal cell CA 514. with Minimal Change Disease Renal Malignancy Renal Malignancy of Early Childhood Salivary Tumor Secondary Hyperparathyroidism Sexually Transmitted Disease Site of Diverticula 498. Male 521. Renal cell CA 531. Pleomorphic Adenoma (Mixed) – 90% localized to the parotid 525. ALL – Child / CLL – Adult over 60 / AML . Young Child 530. Lesser curvuture in antrum – associated w/ blood group O 524. Lymphoma 528. Serous Cystadenocarcinoma 516. Adeno CA of the rectum and/or colon 508. Lung CA 513. ALS 503. Tubular adenoma 509. Temporal Arteritis (branch of Carotid Artery) 556. HSV 557. Malignant melanoma 541. WIPSI (ages 4-6) 567. Middle cerebral aa: contralateral paralysis. Mixed Cellularity (versus: lymphocytic predominance. Shigella Type 536. Follicular. CA of stomach (adeno CA) 551. Germ cell tumor 549. Adeno – associated w/ blood group A 544. Liver 539. Pneumoniae 573. Pneumoniae 560. Israelli 574.Site of Embolic Occlusion Site of Metastasis Site of Metastasis (2nd most common) Sites of Atherosclerosis Skin CA of Fair Skinned People Skin Cancer Small Intestine Congenital Anomaly Stomach Cancer Testicular Tumor Thyroid Anomaly Thyroid CA Tracheoesophageal Fistula Tumor in men <20 Tumor of Infancy Tumor of the Stomach >50 years of age Type of Hodgkin’s Type of Non-Hodgkin’s Type of Portal Cirrhosis Type of Soft Tissue Tumor of Childhood Vasculitis (of medium & small arteries) Viral Encephalitis Worm Infection in US Worst Prognosis in Thyroid Cas Cause of Lobar Pneumonia Cause of Death b/t 24-44 yoa Cause of Pneumonia in Cystic Fibrosis Cause of Osteomyelitis in IV Drug Users Cause of Infection in Burn Pts Mental Problem in Males Intelligence Test Paraphilia Metabolite seen w/ Pheochromocytoma Severe Shigella Bug in Otitis Media & Sinusitis in Kids Cause of a Solitary Brain Abscess Cause of Bacterial Diarrhea in U. Lower esophagus joins trachea / upper esophagus – blind pouch – polyhydramnios association 548. A. Seminoma = malignant painless testes growth 545. VMA: vanillylmandelic acid (NE metabolite) 571. Pinworm (2nd – Ascaris) 558. lymphocytic depletion. aphasias. Benign vascular tumor = port wine stain = Hemangioma 550. Thryoglossal duct cyst 546. Specific phobia 565. Meckel’s diverticulum 543. S. WISK-R (for ages 6-17) 568. Campylobacter jejuni 575. Follicular CA 559. Pseudomonas 562. Strep. Pedophilia 570. Pseudomonas 564. Papillary CA 547. WAIS-R (for > 17 yoa) 569.S. Dysenteriae 572. motor & sensory loss 537. Regional Lymph Nodes 538. small cleaved 553. Pseudomonas 563. Rhabdomyosarcoma 555. Stanford Binet (ages 6 & under) 566. AIDS 561. Basal Cell Carcinoma 542. nodular sclerosis) 552. Strep. Abdominal aorta > coronary > popliteal > carotid 540. Micronodular 554. Sonnei Page 13 . Cause of Non-Ghonococcal Urethritis Pneumonia Urethritis Cause of Glomerulonephritis Cause of Viral Pneumonia Complication of COPD Cause of Death w/ SLE Atrial Septal Defect Warm Antibody 576. Chlamydia trichomonas 577. Strep. Pneumoniae 578. N. ghonorrhea 579. IgA Nephropathy = Berger’s Disease 580. RSV – infants 581. Parainfluenza – kids 582. Influenza virus – adults 583. Adeno virus – military recruits 584. Pulmonary infections 585. Renal failure 586. Ostium Secundum Type 587. Most common form of immune hemolytic anemia 588. IgG auto antibodies to RBC 589. See spherocytosis; (+) Coombs’ test; complication to CLL 590. IgA Deficiency Immunodeficiency Congenital GIT Anomaly Cause of Congenital Malformation 591. Meckel’s Diverticulum: persistence of vitelline duct/yolk sac stalk 592. Fetal Alcohol Syndrome Pharmacology Autonomic Nervous System Epinephrine Norepinephrine GABA Muscarinic-r Bethanechol Pilocarpine Isoflurophate Pralidoxime Neostigmine Myasthenia Gravis Tubocurium Trimethaphan Pancurium Succinylcholine α1 & Eye M-r & Eye Sympathetic Parasym. M3-r & Eye M2-r & Heart M3-r & Lung M3-r & GI Tacrine Atropine Glycoperrolate Pirenzepine 1. α1, α2, β1, β2 2. α1, α2, β1 (no β2 activity) 3. Causes an inhibitory cell hyperpolarization 4. 5. 6. Uses DAG & IP3 as 2nd messengers Parasympathetic control Cholinergic. ↑ GI & Bladder motility. Txt atonic bladder post-op 7. 8. 9. Cholinergic. Pupillary constriciton= miosis. Ciliary constriction= accomodation. Txt acute glaucoma Organophosphate. Irreversible acetylcholinesterase (-)r 10. “2PAM”. Reverses organophosphate binding to acetylcholinesterase 11. Reversible acetylcholinesterase (-)r 12. Txt Myasthenia Gravis 13. Anitbodies to Ach-r. ↑’g muscular weakness due to Ach’s weak postsynaptic effect @ NMJ. Inactivates-r 14. 15. 16. 17. Nondepol. Competitive cholinergic N-r (-)r. Prevents Ach binding but does not activate NMJ ↑ Histamine release= ↓ BP & ↑ bronchospasm Nonselectively binds N-r of the PS- and SNS 18. More potent than tubocurium w/o histamine release 19. Depol. Non competitive (-)r of muscle aciton 20. Opens Na Ch.= fasciculations. Closes Na Ch.= paralysis. Continuous infusion. 21. Mydriasis due to norepinephrine. Prazosin (-). 22. Miosis due to Ach. Atropine (-). 23. Post ganglionic symapthetic fibers releases norepinephrine 24. Post ganglionic parasympathetic fibers release Ach 25. Contracts sphincter = miosis. Contracts ciliary = accomodation. 26. Negative chronotropy: ↓ HR = vagal arrest 27. Negative inotropy: ↓ contractility 28. Bronchospasm ↑secretions 29. ↑ motility (cramps & diarrhea). Involuntary defecation 30. Acetylcholine esterase (-)r. Txt Alzheimer’s 31. DOC w/ vagal arrest 32. M-r(-). Antispasmodic. Txt peptic ulcers. 33. M-r(-). Antispasmodic. Txt peptic ulcers. Page 14 34. Most potent competitive non-depol NMJ (-)r. No cardiovascular side effects. No Histamine release. Doxacurium β bungarotoxin α bungarotoxin α1 & Eye α1 & Arterioles α1 & Venules α1 & Sex Function ↑ Diastolic ↓ Diastolic β1 & Heart 35. Prevent the releasal of Ach from vesicles @ the pre synaptic nerve ending 36. Irreversible N-r (-)r = ↓ action potentials 37. Contracts radial muscle = mydriasis (pupil dilation) 38. Constiction: ↑TPR = ↑ Diastolic pressure = ↑ Afterload 39. Constriction: ↑ Venous return = ↑ Preload 40. Ejaculation 41. ↑ α1 = ↑TPR 42. ↑ β2; Direct acting vasodilators; (+)Cholinergics Phenylephrine β2(+) Asma Drugs Ritodrine/Turbutaline Phentolamine Terazosin Yohimbine Cardioselective NMJ Ecothiophate Pyridostigmine 43. 44. 45. 46. (+)chronotropism = ↑HR. (+)inotropism = ↑ contractility; ↑SV; ↑CO; ↑O2 consumption. ↑ conduction velocity α1 (+) Nasal decongestant. 47. Metaproterenol; Albuterol; Terbutaline; Ritodrine; Salmeterol 48. Relaxes myometrium used in pre-mature labor pains 49. Epi reversal. Blocks α, vasodilation occurs. Pt goes from HyperTN to HypoTN. 50. Txt pheochromocytoma = ↓BP 51. Txt BPH 52. ↑ sympathetic outflow = α2 (-). Txt impotence. 53. Pancuronium = ↑HR due to atropine-like anti muscarinic vagolytic effect & Gallamine (-)r 54. Irreversible cholinesterase (-)r. 55. Cholinomimetic that ↑s M & N-r effects. (-) acetylcholinesterase & plasma cholinesterase 56. DOC for the oral Txt of MG Cardiology Digoxin Diltiazem Quinidine Verapamil Propranolol Diazoxide Niroprusside Reserpine Dobutamine Dopamine Esmolol Captopril Digoxin Dig. Toxicity Quinidine Lidocaine Flecanide Amiodarone NE Ach Atenolol Bretylium Nimodipine Atropine Nitrates Propranolol Verapamil Aspirin 1. ↓ AV nodal conduction/ inh. Na/K/Atpase = inc. Ca conc. in heart cells = inc. contraction force 2. Txt black men. Txt AV nodal re entrance 3. ↓ AV nodal conduction. Cinchonism. Anticholinergic= aggravate MG. Hypotension= α block 4. ↓ AV nodal conduction. ↓ BP. Negative inotrope= no CHF use 5. ↓ AV nodal conduction. ↓ BP. Negative inotrope(= β block) Aggravates Asthma and Diabetes Melitus via β2 block. 6. Balanced vasodilator. 7. Balanced vasodilator. Unloads heart. ↑s cyanide= pre-txt w/ thiosulfate. Txt Acute HTN’v Crisis 8. Txt severe & resistant HTN. Depletes CA. See stuffy nose. No to pts w/ peptic ulcers. 9. At high doses β2(+) offsets α1 = β1 ↑ CO w/o systemic vascular resistance 10. At low doses Txt Shock= dilates renal and mesenteric aa= maintain urine output 11. Short acting β(-) 12. Balanced vasodilator. Txt Outpt. CHF see dry cough(bradykinin induced) 13. Txt CHF & Atrial Flutter - inotropic - ↓ K+ levels= dig. Toxicity 14. Fatal ventricular arrhythmias w/ sever AV block 15. ClassIa anti arrhythmic. Moderate Na Ch. Block 16. ClassIb anit arrhythmic. Normalizes conduction. Txt initial MI= control arrhythmias 17. ClassIc anti arrhythmic. Marked conduction slowing 18. Long t1/2= need potent doses to obtain desired level for action. See blue skin, ocular deposits, Pulmonary Fibrosis. 19. ↑ AV nodal conduction via β1. Metoprolol(-) β1 20. ↓ AV nodal conduction via M receptor. Atorpine(-) M-r 21. Controls catecholamine induced arrhythmias 22. Txt Malignant Ventricular Arrhythmias but causes passing catecholamine release that can aggravate arrhythmias briefly 23. Txt Acute subarachnoid hemorrhage by preventing post hemorrhagic vasospasm 24. ↓ excess vagal tone as seen in Sinus Bradycardia 25. ↓ preload= venous pooling. ↓ MVO2= reflex tachy. ↑ ventr work= dec O2 demand 26. Blocks reflex tachy but causes excess brady= ↑ diastole time= ↑ EDV 27. ↑ O2 supply via ↓ in vasospasm Txt Prinzmetal’s variant angina 28. Prevents arterial platelet adhesion (not DVThrombi). Inactivates COX= ↓ platelet production of TxA2, a potent vasoconstictor Page 15 Warfarin Heparin TPA Streptokinase Urokinase Colestipol Lovastatin Losartan Diazoxide Clonidine Methyldopa Phenytoin Procainamide Indopamide Thiazides β(-) ACEIs Epinephrine Norepi. Methyldopa Quinidine pre-txt ClassII “Gray man” Beperidil ACEIs Adenosine Enoxaparin Isoproterenol Variant angina Contraindicated in CHF 29. (-)Vit. K dependent gamma carboxylation of clotting factors= anticoagulation state 30. Dependent on Antithrombin III activation 31. Binds to fibrin clots & activates plasminogen on the spot. Short t1/2, given IV. 32. Does not discriminate b/t fibrin-based clots= bleeding & stroke complications arise 33. From bacteria= allergies arise. Can see excess bleeding in post-op pts. 34. Human source. ↑ plasmin. Can see excess bleeding in post-op pts. 35. Bile acid sequestrants. Interrupt bile acid reabsorption= ↑↑ LDL uptake. Cholestyramine same MOA. 36. HMGCoA reductase(-)= ↑ LDL-r synthesis. Pravastatin/ Mevastatin same MOA. 37. ↓ Aldosterone. ↑ Renin 2-3x’s 38. Txt insulinomas. Not balanced vasodilator= onlt dilates arterial smooth muscle 39. Central α2(+). ↓ TPR via ↓ symapthetic effect 40. Central α2(+). (++) Coombs= Hemolytic anemia 41. ClassIb. Reverses mild AV block due to digitoxin toxicity 42. ClassIa. SLE like syndrome. 43. Only Thiazide that will have no effect on cholesterol levels 44. Older black men w/ HTN due to ↑ Renin. 45. Young white men w/o asthma (cause bronchospasm) 46. 47. 48. 49. 50. 51. 52. 53. (-) change AI ! AII. (-) Bradykinin inactivation. Captopril/ Enalapril Cause renal failure = use w/ caution in the elderly ↑ contraction rate & force via β1. ↑ systolic but ↓ diastolic BP. ↓ peripheral resistance via β2 vasodilaiton ↑ heart rate and ↑ systolic and diastolic BP ↑ peripheral blood vessel resistance DOC for pregnancy induced HTN 54. Atrial arrhythmia pretxt w/ a drug that will ↓ ventricular response: Dig.;β(-); Ca Ch.(-) 55. β(-) ↓risk fo reinfarction & sudden death following MI 56. Amiodarone: ClassIII antiarrhythmia 57. Ca Ch(-). Limited clinical use due to Torsades de Pointes 58. 59. 60. 61. 62. Vasodilate renal efferents > than afferent arterioles: ↓GFR & Filtration pressure ↓ Diabetic renal failure progression Its receptor is blocked by Methylxanthines (ie… Theophyline) Favored for the Txt of Reentrant Supra Ventricular Tachycardia Low molecular weight heparin = Oral anticoagulant 63. ↑HR & ↓MAP 64. Use Ca Ch. (-)r ie… Nifedipine 65. β (-)r = you don’t want to ↓ the heart’s pumping strength CNS “TOM” Butyrophenone Atypical D4 Flumazenil Methylphenidate Phenytoin Thiopental Carbamazepine Atypical D4-r Pimozide Risperidone Thioridazine Haloperidol 1. 2. 3. 4. 5. Short –acting BDZs: Triazolam Onazelam Midazolam Haloperidol & Droperidol 6. Clozapine – Thioridazine – Olanzepine – Risperidone = Do not cause EPS 7. BDZ antidote for OD 8. Txt attention deficit disorder 9. Causes aplastic anemia/ gingival hyperplasia/ cleft lip & palate 10. Short acting Barb 11. DOC trigeminal neuralgia. Txt lennox gestaut seizures in kids 12. Thioridazine; Olamzapine; Clozapine 13. Txt Tourette’s 14. Good for negative symptoms 15. Most anti cholinergic neuroleptic 16. Neuroleptic malignant hyperthermia due to chronic D2 block. give Dantrolene and Bromocriptine Page 16 No effect on HR. with head trauma 34. Dissociative anesthetic 51. Txt OCD See aggressive behavior w/ use 19. 57. Constipation. Supraspinal analgesia. 26. especially seen with the use of Paroxetine or Fluoxetine (SSRIs) and Tranylcypromine (MAOI) 71. Short acting Barb. Ant M w/ some DA reuptake (-). +respiratory depression. µ(+) used in renal failure 37. 32. Dysphoria. ↓ seizure focus= Barbs & BDZs 43. Induces amnesia 56. 54. Part κ(+) & part µ(-) 42. 27. 49. Part κ(+) & part µ(-) 40. 25. Mepivaciane.Imirpamine Clomirpramine Trazadone Bupropion SSRIs Fluoxetine Phenelzine Lithium Alprazolam Propranolol κ-r µ-r Morphine & O2 Morphine Morphine OD Meperidine Hydromorphone Tramadol Naloxone Pentazocine Butorphenol Nalbuphene ↓ GABA ↓ Fast Na Ch. 31. Meperidine & Nalbuphine Page 17 . Can cause ventricular extrasystoles & Malignant hyperthermia & Hepatitis 48. Has mild alpha block Can be used on combo w/ Droperidol for neuroleptoanalgesic effect Used transdermally for chronic pain Pre anesthetic. Can cause livido reticularis= skin mottling. 60. Can cause bronchospasm 47. Bupivaciane. 50. to severe pain 38. Good for negative symptoms 23. Helps to quit smoking 21. Part κ(+) & part µ(-) 41. Used w/ L-Dopa for “on-off” phenomenon of Parkinson’s 64. DOC for Absence seizures 69. 33. ↓ DA reuptake. Biotransformed to Phenobarb. ↑ ICP = do not give to pt. Parkinson’s txt 63.↓’d respiraiton 3. 53. Needs low MAC for anesthetic induction. Priapism 20. Can cause tonic/clonic muscle spasms 46. Txt opioid OD. ↓ electrical activity spread = Phenytoin & Carbamazepine 44. Etidocaine= “i” before “caine” always an amide Metabolized in the liver DA reuptake (-)’r. can stop breathing. Irreversible MAOI 24. 55. MAOI. Methoxyflurane Enflurane Isoflurane Halothane Nitric Oxide Thiopental Kentamine Droperidol Fentanyl Midazolam Primidone C & A delta Fibers Esters Amides Amphetamine Bromocriptine Benztropine Amantidine Diphenhydramine Pergolide Ethosuximide Tranylcypromine SSRI & MAOI Labor opioids 17. 45. 61. Can be used in combo w/ Fentanyl for neuroleptoanalgesic effect Neuroleptic tranquilizer. Parkinson’s txt 65. Txt early Parkinson’s stages 67.pinpoint pupils 2. Admin. Ambulatory txt for mod. First fibers to be blocked w/ anesthesia 58. 59. Txt manic phase of Bipolar Disorder Causes goiter by (-) conversion of T4 to T3 Nephrogenic diabetes insipidus Low salt diet will lead to Li toxicity DOC stage fright 29. D2(+). 1.coma 35. Procaine. Needs high MAC for anesthetic induction. Anesthetic used during labor 36. Primarily used for OCD 22. Reverses respiratory depression 39. is contraindicated to pts on morphine sedation= ↓ CO2 sensitivity and O2 admin. Social phobia 30. ++sedation. 52. Can be nephrotoxic. ++euphoria. 28. Spinal analgesia. Fatal combo. Tetracaine. Benzocaine Broken down and make PABA (allergen) Lidocaine. Enurisis 18. Euphoria. 66. MAOI = antidepressant 70. > Effective & longer acting than Bromocriptine 68. +sedation. 62. 36. 20. Malaria profylaxis Used for extraerythrocytic forms Plasmodium vivax or P. Txt for Malaria when inside RBC Page 18 . Txt Leishmaniasis & Amebiasis Good for anaerobic bacteria = Bacteroides fragilis DOC Trichomoniasis DOC Giardia lamblia TMP-SMX & Pentamidine 43. 44. 41. 5. 39. 26. Piperacillin 16. 32. Txt Chloroquine resistant strains = P. Txt fungal encephalitis 52. Accumulates in keratinized layers of the skin = used in dermatomycoses infections 55. PABA structural analogs Inhibit Folic acid synthesis Should not be used in anuric pt due to production of (-) Nitrogen balance & ↑d BUN levels. 27. 11. Txt Schistosomiasis (trematode [fluke] infections) 49. 10. Usually combined w/ Rifampin and/or Ethambutol Pre Txt w/ Pyridoxine (Vit B6) can prevent peripheral neuritis‘ Txt of Hookworm disease Depolarizing NMJ (-)r A = Aminoglycosides T = Tetracyclines C = Chloramphenicol E = Erythromycin (macrolide) L = Clindamycin L = Lincomycin Txt intraabdominal infections (ie… w/ Bacteroides fragilis) Traditional txt has been Clindamycin & Gentamycin Broad spectrum antibiotic Bone marrow depression (common) – Aplastic anemia (rare) Gray baby syndrome (chloramphenicol cannot be conjugated) DOC Typhoid Fever (symptomatic Salmonella infection) DOC HiB meningitis in kids – especially resistant strain to ampicillin Txt trypanosomiasis 38. 6. (-) fungal ergosterol synthesis = disrupts membrane 54. 9. 35. Most commonly used drug for TB.Desipramine causes 72. 21. anuria & the exception Ceftriazone Streptomycin (aminoglycoside) Isoniazid Pyrantel Pamoate Buy “AT” 30. 13. 18. 23. 31. Polyene antifingal 53. falciparum 57. Txt of Brucellosis & Cholera Txt Rocky Mountain Spotted Fever Txt spirochete infections = Lyme disease (Borrelia burgdorferi) (-) dihydrofolate reductase activity Primaquine Ciporfloxacin Sulfonamides Tertacyclines. “CELL” at 50 Cefoxitin Chloramphenicol Nifurtimox Metronidazole Txt P. ovale Quinolone derivative Hepatic coma DOC 7. 40. Doxycycline is the exception 3rd generation cephalosporin DOC for bacterial meningitis in kids (ie… HiB) One dose txt of gonorrhea Neomycin (aminoglycoside) – it supresses the normal flora = ↓g NH4 production = ↓g free nitrogen levels in the bloodstream. 29. 25. 37. Txt Leishmaniasis 51. Irreversible (-)r of β lactamases. 8. 12. 22. Long duration of action = given once every 3-4 weeks for Txt of Syphilis 48. Sudden cardaic death in children Anti-Infective 4. 24. 46. but ot of transpeptidase = use w/ a β lactamase sensitive penicillin Txt Pseudomonas aeruginosa & Klebsiella Broad spectrum antibiotic Txt Mycobacterium tuberculosis 19. 42. 33. 17. 14. 30. 28. carinii Tetracycline TMP-SMX Benzathine Penicillin G Praziquantel Melarsoprol Stibogluconate Fluconazole Amphotericin B Ketoconazole MOA Griseofulvin MOA Mefloquine Chloroquine 47. Anti malarial 56. Txt Trypanosomiasis that has neurological symptoms 50. 34. Clavulanic acid 15. 45. 82. 106. 70. 89. 110. Used for ovarian CA Page 19 .58. 66. 112. Pneumonitis & pulmonary fibrosis 88. 76. 62. Protects against rejections from organ transplants Does not induce bone marrow depression Alkylating agent of both purine & pyrimidine bases of DNA Txt CLL Nephro. 96. 79. Aureus) “Red neck”: due to histamine release causes facial flushing used w/ Cilastatin Does not cause seizures (cf w/ Imipenem) Only penicillin that does not need dose adjustment in renal impairment 72. Used in organ transplantation = kidney allografts Allopurinol can ↑ its activity by (-) its biotransformation to xanthine oxidase Chemotherapy used in the txt of Hodgkin’s disease M = Mechlorethamine – nitrogen mustard O = Oncovin (Vincristine) – prevents microtubule assembly P = Procarbazine P = Prednisone – glucocorticoid. 104. 91. 90. 108. 102. 103. DOC Chagas disease due to Trypanosoma cruzi Nifurtimox Erythromycin Nystatin Acyclovir 59. 69. inducing apoptosis (-) estrogen receptor Txt of breast tumors. 84. 63. Can block/reduce Methotrexate = ↑ folic acid via a reduced folate 87. 105. 107. 77. 92.& Ototoxicity 85. Imipenem Cefoperazone side effects Vancomycin Meropenem Nafcillin Peripheral neuropathy Guanine analog Txt Herpes infections Used w/ Cilastatin Can cause seizures Bleeding due to vit K level alterations Contraindicated in pts w/ bleeding disorders Used for MRSS (methicillin resistant Staph. Antimetabolite of folic acid: (-)dihydrofolate reductase 86. 78.N. 99.” for gonorrhea 75. 81. 94. 101. 97. Seen w/ use of: 73. 68.E. Topical txt of superficial mycotic infections = Candidiasis 61. 64. 111. can see associated endometrial CA Antiandrogenic Used w/ Leuprolide (LH-RH analog) Txt prostatic CA (-) progesterone receptor Txt endometrial CA Androgenic steroid Txt mammary CA in postmenopausal women Folic acid analog that (-) tetrahydrofolate synthesis by (-) dihydrofolate reductase Txt of ALL Txt of Psoriasis Lomustine Carmustine – Causes pulmonary fibrosis Attaches to β cells Txt of pancreatic insulinomas Pyrimidine analog DOC for AML Used for Wilms tumor & rhabdomyosarcoma 114. 65. Used in pts allergic to penicillins 60. Ribavirin Fluoroquinolones used in a one dose deal for gonorrhea: O = Ofloxacin N = Norfloxacin E = Enoxacin Txt RSV (Respiratory Syncytial Virus) Anti-Neoplastics Cyclosporine Cyclophosphamide Cisplatin’s toxicities Methotrexate Leucovorin Rescue Bleomycin toxicities Azathiorine MOPP Tamoxifen Flutamide Megestrol Fluoxymesterone Methotrexate Brain tumor Txt Streptozocin Cytarabine (AraC) Dactinomycin Etoposide Paclitaxel 80. 93. Metronidazole – Isoniazid – Vincristine – ddI – AZT – Allopurinol 74. 98. Used for oat cell CA 115. Kernicterus can occur Sulfonamides & newborns “O. 109. 113. 67. 71. 83. 100. 95. Petehial hemorrhages are seen on kidney surfaces = Flea-Bitten surface = young black men 146. erythematous lesions of palms & soles. 126. 121. viral (Coxsackie) infection. Minimal Change (Lipoid nephrosis) disease 149. Hematuria & HTN also present. Edema 148. 129. 123. 157. 155. Hemosiderin (pigment w/ Fe3-) covered macrophages that have been pahgocytised 166. Usually due to anterior MI. LA contraction 122. 118. IgM & C3 deposits 161. 151. 143. TB in the lymph nodes 164. Eosinophilic bands of necrotic myocytes.Amifostine 116. naked icosahedral capsid) 139. 140. Can ↓ nephrotoxicity due to chronic use of Cisplatin Pathology Mobitz I Mobitz II P wave a wave T wave Wavy fibers Janeway’s lesions Osler’s nodes Thiamine defcy Fibrinous Pericarditis Serous Pericarditis Friction Rub Hemorrhagic Pericarditis Restrictive Cardiomyopathy PML’s infectious agent Edema Adult Polycystic Kidney Disease Malignant HTN & Kidneys Nephritic signs Nephrotic signs Podocyte Effacement seen w/ ASO seen in Crescentic GN Hereditary Nephritis Membranoproliferative GN TypeI Membrano Proliferative GN deposits TypeII Membrano Proliferative GN deposits Focal segmental glomerulosclerosis deposits Cold agglutinins Scrofula Aspirin-Asthma Triad Ferruginous bodies Pancoast’s tumor causes 117. Associated w/ TB or neoplasm 135. Vetricular repol. BBB association. JC Virus (Papovavirus = dsDNA. It is IgM Ab with specificity for I Ag on adult RBCs 163. 128. Ulnar nerve pain & Horner’s syndrome Page 20 . immunologic reaction. 120. Associated w/ nonbacterial. 144. confusion. confabulation. Subacute bacterial endocarditis. 3 cysts in ea. also see schaumann & asteroid bodies in young (<25 yoa). Only C3 deposits 159. Acute bacterial endocarditis. Txt w/ Atropine or Isoproterenol. ↑Pc (more seeps out) ↓πc (less reabsorbed) ↑ permeability Block lymphatic drainage Commonly see liver cysts & Berry aneurysms along w/ kidney cysts. 133. Seen in atypical pneumonia 162. X linked Renal disease w/ deafness & ocualr abnormalities Can be secondary to complement deficiency. HTN 147. Rarely goes into 3rd degree block. 141. Nontender. chronic infections. 150. Pericarditis association 134. Tender lesions of fingers & toes. 119. 137. 130. 125. Early sign of MI. Nasal polyps – Rhinitis – bronchoconstriction 165. 153. Acute post-streptococcal GN (due to βHGASrtep) Anti streptolysin O Rapidly progressive GN – nephritic syndrome Associated w/ multi system disease or post-strep/post infectious glomerular nephritis Alport’s syndrome. Hypoalbuminemia. 138. Dilated (congested) cardiomyopathy due to chronic alcohol consumption Dyr Beri Beri = peripheral neuropathy Wernicke-Korsakoff = ataxia. Proteinuria. 142. 154. Hematuria. RBC casts. memory loss Associated w/ MI: Dressler’s 132. Wet Beri Beri heart. Aka Dense deposit disease 160. Aka infiltrative cardiomyopathy that stiffens the heart Due to amyloidosis in the elderly Due to . 152. Usually due to inferior MI. 124. 136. Atrial depol. CLL See tram tracking C3 & IgG deposits 158. Often goes to 3rd degree AV block. 127. 156. 131. Kidney w/ + family history confirms diagnosis 145. Hutchinson’s teeth. 180. spleen Combination of both coagulation & liquefaction necrosis Seen w/ M. Associated w/ Angiosarcoma of the liver 204. Neural tube defects 200. Stippling of the basophils 217. 193. Small head. Involving intervertebral disks = Ankylosing Spondilitis = Poker spine 212. 178. Contains dioxin 205. polyarteritis nodosa. Gingival line & lead line in bones: x-ray 218. interstitial keratitis 226. 195. Retinoblastoma 202. 183. kanasasii & M. Saber shin. bed ridden pt. 191. Saddle nose. funnel chest. 170.Fatty degeneration Cloudy swelling Hydropic degeneration Liquefaction necrosis Coagulation necrosis Caseation necrosis Fibrinoid necrosis Fat necrosis Hemoptysis Pulmonary embolism Phlebothrombosis Saddle embolus Paradoxical embolism Tuberculoid granuloma Cellulitis PSA ↑↑5-HT ↑ αFeto Protein CEA Chromosome 13 Chromosome 11p Vinyl Chloride Agent Orange Parasites & CA Ochronosis Lead poisoning Heroin OD. 172. Liquefied TB lesions similar to pyogenic abscesses but lacking acute inflammation 223. 181. but most common is due to saprophyticus 225. See dark urine. 179. spleen Page 21 . S. kidney. small eyes. Acid fast inclusion bodies 214. 190. 185. nerve deafness. tuberculosis & Histoplasma capsulatum infection Seen in the walls of small arteries Associated w/ malignant hypertension. 188. 192. Lumpy jaw (from chewing grain) & PID (IUD). tendons. ASD. Schistosoma haematobium = Urinary bladder CA 207. Syphilis. of a pregnant uterus. and hirsutism 221. clinically Fetal alcohol syndrome Atypical mycobacterium Cold abscesses Actinomyces isrealli Congenital Syphilis Warthin-Finkeledy cells 167.s disease. avium intracellulare 222. Implicated as a cause of Hodgkin. 169. txt w/ Methysergide (5HT antagonist) 198. 184. M. Made up primarily of triglycerides Most commonly due to alcoholism which commonly leads to hepatic cirrhosis Associated w/ CCl4Failure of cellular Na pump Seen in Fatty degeneration of the liver and in Hydropic (Vacuolar) degeneration of the liver Severe form of cloudy swelling Seen with hypokalemia induced by vomitting/diarrhea Rapid enzymatic break down of lipids Seen commonly in Brain & Spinal cord (CNS) injuries Seen in suppurative infections = pus formation Result of sudden ischemia Seen in organs w/ end arteries limited collateral circulation) = heart. 175. 168. Alkaptonuria 210. Massive pulmonary edema w/ frothy fluid from the nostrils 220. Wilms tumor of the kidney 203. From a vein of lower extremities. cartilage 213. 171. 174. Carcinoembryonic Antigen = elevated in Colon CA 201. 177. mansoni = Colon CA 208. immune mediated vasculitis Result of lipase actions liberated from pancreatic enzymes Seen w/ Acute pancreatitis = saponification results Blood in sputum 186. 173. Hepatocarcinoma 199. non-Hodgkin’s lymphoma & soft tissue sarcomas 206. Farmers infection 224. Reticuloendothelial giant cells on tonsils. in Congestive heart failure. Brucellosis and Leprotic infections Spreading infection due to streptococcus 196. mental deficiency. In cases of metastatic carcinoid. 176. Anemia: microcytic/ hypochromic 216. ↑ urinary coproprophyrin 215. 182. dark coloration of sclera. Error in tyrosine metabolism due to Homogentisic acid (oxidizes tyrosine) 211. Mental retardation 219. Most commonly thrombus from lower extremity vein 187. lung. As a complicaiton in a pt w/ Pancreatic CA due to ↑d blood coagulability Embolus lodged in bifurcation of pulmonary trunks ↑↑ RV strain = RV & RA dilate = Acute cor Pulmonale Right to Left shunt allows a venous embolism to enter arterial circulation Patent ovale foramen or Atrial septal defect Collection of macrophages w/o caseation Seen w/ Sarcoidosis (non-caseating). Prostate Specific Antigen = elevated in prostatic CA 197. 194. Aspergillus flavus = potent hepatocarcinogen 209. 189. lymph nodes. Lytic lesions of flat bones (“salt & pepper lesions”) = vertebrae. Sudden right ventricular strain due to a massive pulmonary embolism 243. Pseudomonas aeruginosa. Crypt abscess in the crypts of Lieberkuhn 277. Seen with Rubeola (measles) due to paramyxovirus 228. Half of the immune complexes have Hepatitis B Ag 268. Sickle Cell Anemia 263. fibrinous pleuritis. Abscess formation is common 246.slitlike cysts = Medial Cystic Necrosis of Erdheim 241. Supparation associated 252. E. Due to M. especially in apical part of interventricular septum 236. Hypercalcemia. β Hemolytic Streptococci. Marfan’s Collagen disease 240. muscle aches 269. Branch of the Left Coronary artery 234. Celiac disease due to a gluten-induced enteropathy = small intestine villi are blunted 270. Neural cest cells from which carcinoids arise = of the Bronchi. Due to Strep. Due to Micropolyspora faeni (thermophilic actinomycetes) 257. ribs. Occlusion = MI of posterior/lateral wall of the LV 238. Malignant neoplasm of the lymph nodes causing pruritis. Intestinal Lipodystrophy = malabsorption syndrome 274. Permanent dilatation of the bronchi – predisposed by chronic sinusitis and post nasal drip 251. Tapeworm infection causing megaloblastic anemia by consuming large amount of vit B12 in the host 229. Klebsiella. Due to Staph aureus. Association w/ Arthritis.Diphyllobothrium latum Subacute Bacterial Endocarditis Acute Bacterial Endocarditis Mitral Insufficiency Left Anterior Descending branch Left Circumflex branch Dissecting Aneurysm Cor Pulmonale Acute Cor Pulmonale Bronchopneumonia Lobar pneumonia Bronchiectasis Cold Agglutinins Panlobular Emphysema Bulla Farmer’s Lung Bagassosis Silo-Filler’s Lung G6PDH Deficiency HbF ↑↑ Multiple Myeloma Hodgkin’s Disease Polyarteritis Nodosa Sprue Regional Enteritis Whipple’s Disease Kulchitsky cells Ulcerative Colitis Vaginal Adenosis Scirrhous Carcinoma Hofbauer Cells 227. HTN. MI = anterior wall of the LV. Uveitis. Immune complex disease of Ag-Ab complexes on blood vessel wall 267. Heinz Bodies appear in RBCs 262. Not transmural involvement 279. Highest frequency of thrombotic occlusion 235. Lipid laden macrophages seen in villi of Erythroblastosis Fetalis Page 22 . Infiltrating Duct Carcinoma w/ fibrosis – most common type of breast carcinoma 282. atherosclerotic disease. associated w/ right ventricular hypertrophy 242. Lower lobe > than upper lobe involvement 253. Sex-linked chronic hemolytic anemia w/o challenge or after eating fava beans 261. Associated w/ Emphysema = “Bleb” = outpouching . Complicaitons: pleural effusion. ↓ wt. Inhalation of sugar cane dust 259. Erythema Nodosum 273. empyema. causing elastase ↑ = ↑ compliance in the lung 255. Common among drug addicts & diabetics 232. Women exposed to DES (Diethylstilbesterol) in utero before the 18th week of pregnancy 280.pain. abd. atelectasia. vulgaris (actinomycetes) 258. Can see fever. fever = looks like an acute infection 265. Pancreas 275. also seen w/ familial hyperlipidemia. False aneurysm: it is splitting of the media of the aorta 239. Branch of the Left Coronary artery 237. Usually accompanied w/ long history of severe hypertension. fibrinous pericarditis. Ruptured papillary muscle 233. Crohn’s Disease 272. Some develop clear cell adenocarcinoma of the vagina & cervix 281. Gray Hepatization: days 3-8 of untreated pneumonia 249. Red Hepatization: days 1-3 of the pneumonia 248. Pseudopolyps when ulcers are deep 278. Zones of medial necrosis +/.If it ruptures causes Pneumothorax 256. coli 231. Reed Sternberg cells 266. α1 – antitrypsin deficiency. Found w/ Mycoplasma pneumoniae 254. coli 245. GIT. viridans) = usually in pt w/ pre-existing heart problem 230. skull. Inflammatory disease of the colon w/ ↑ colon CA incidence 276. Due to Nitrogen dioxide from nitrates in corn 260. High titers of anti-gliadin Abs & ↑ IgA levels 271. Bence-Jones protein casts 264. E. Staph aureus. Pneumoniae infection (5% due to Klebsiella) 247. otitis media 250. Lobular (rather than lobar) 244. α Hemolytic Streptococci (S. Right ventricular strain. 22) Langerhan Cell Histiocytosis Myeloid Metaplasia Multiple Myeloma T(14. If given blood w/ IgA = develop severe. Predilection for lenticulostriate arteries = putamen & internal capsule hemorrhages 318. Eosinophilic Granuloma 303. HLA-DR3 frequent. See Bitot’s spots in the eyes = gray plaques = thickened. SLE. NH Lymphoma = bcl2 proto-oncogene overexpression seen w/ Small Cleaved Cell (Follicualr) Lymphoma 310. Alkaline phosphatase ↑/normal compare to CML = low to absent 305. Membranoproliferative GN. If Mono is treated w/ Ampicillin. Gonorrhoeae. Autoimmune disease. Burkitt’s lymphoma = c-myc oncogene overexpression 301. wt. small head. many fingers 324. arthritis. Rheumatoid arthritis. Nearly always associated w/ death due to damage to the vital centers in these areas 317. Myocardium. splenomegaly. proteinuria. Suspending RBCs in a low O2 content solution 294. Hypercalcemia (↑ bone destruction) 309. LDH1 higher than LDH2 = Myocardial Infarction 290. recurrent infection.18) Focal Segmental GN exs Nephrotic Syndrome exs Schistosoma Haematobium Penicillin Resistant PID Duret Hemorrhages Hypertensive Hemorrhage Cerebral Embolism from Neurosyphilis 5pTrisomy 13 Acute Cold Agglutinaiton Chronic Cold Agglutinaiton RBC Osmotic Fragility Non-Hodgkin’s Lymphomas Singer’s Nodules Paraseptal emphysema 283. platelets > 1 million = extensive extra-medullary hematopoiesis 306. loss. Atrial Fib Thrombi = Marantic thrombi. Retrolental Fibroplasia = cause of bindness in premies due to high O2 concentrations 284.14) T(9. See agglutination & hemolysis in tissue exposed to cold. Complication of EBV or Mycoplasma pneumoniae infections 326. Weakness. Associated w/ blebs (large subpleural bullae) that can rupture and cause pneumothorax Page 23 . anemia. Focal (Segmental) GN. EBV infection. a rash will occur. Associated w/ portal HTN due to intrahepatic obstruction 314. Syphilis. Patau’s: small head & eyes. Small Cleaved cell (Follicualr): low grade B cell lymphoma of the elderly. but if unresponsive to penicillin think of Bacteroides species 315. cleft lip & palate. PID is usually due to N. Large Cell 331. Dry eyes & dry mouth. Infection is assocaited w/ Squamous cell CA of the Bladder (most common Bladder CA is transitional cell type) 313. low set ears. Due to EBV infeciton 299. cat-like cry 323. Related to CLL. Abs to I blood group Ag. Paradoxical Embolism of septal defect 319. Mediated by IgM Abs 325. Membranous GN. T(8. Schonlein-Henoch purpura (anaphylactoid purpura) 311. Syphilitic meningitis 321. See Helmet cells 297. Lymphoblastic: high grade T cell lymphoma of kids progressing to T-ALL 332. ataxia. Serum M protein spike – most often of IgG or IgA 308. Associated w/lymphoid neoplasms. Hereditary Spherocytosis 328. Anemia. Liver cells 292. Small Lymphocytic: low grade B cell lymphoma of the elderly. fatal anaphylaxis reaction 286. SLE. Argyl Robertson pupils 320. RA association shows HLA-DR4 289. 300. Penicillamine 312. Small Non Cleaved = Burkitt’s: high grade B cell lymphoma. Birbeck granules are present = tennis racket shape 304. 329. Letter Siwe syndrome. ↑ risk for B cell lymphoma. Stain for Burkitt’s lymphoma 298. wide set eyes. Cri di Chat: mental retardation. ↑ proliferation of plasma cells in BM = plasma cell dx 307. 287. L-sided Bacterial Endocarditis.14) c-myc proto-oncogene. Lung tissue 291. IgM Abs 327. Hand Schuller Christian Disease. Benign laryngeal polyps associated w/ smoking & overuse of the voice 334. Related to B-ALL 333. or systemic sclerosis association 288.18) bcl-2 oncogene 330. Can be due to Hemolyitc Uremic Syndrome & Thrombotic Thrombocytopenic Purpura (TTP) 296. Tabes Dorsalis = ↓ joint position sensation. Paretic neurosyphilis 322. Severe Vit A deficiency. thinking that it is a strep pharyngitis. IgA Focal GN = Berger’s disease. MI w/ Mural Thrombi. T(14. Pt has recurrent infections & diarrhea w/ ↑ respiratory tract allergy & autoimmune diseases 285. Starry sky histo appearance. which sickles in low O2 295. ↓ pain sensation. Can detect Hemoglobin S. keratinized ET 293. Severe ↑ in ICP w/ downward diplacement of cerebellar tonsils into Foramen Magnum causing a compression on the brainstem w/ hemorrhaging into the pons & midbrain 316. Hep B. PAN. Lipoid (Minimal Change) GN.Retinopathy of Prematurity IgA deficiency Priamry Sjorgen’s Secondary Sjorgen’s LDH1 & LDH2 LDH3 LDH4 & LDH5 Keratomalacia Metabisfite Test Microangiopathic Hemolytic Anemia Wright’s stain Mononucleosis T(8. CML = c-abl/bcr gene formation = Philadelphia translocation 302. LTC4. 353. F VII: PT 368. +/-↑ Protein. PGD2. ↑ Galactose 1 Phosphate 380. Hereditary Hemorrhagic Telengectasia (Osler-Weber-Rendu) 385. Marfan’s Syndrome 388. itching. Somatotrophs = GH 349. PAF 363. autoimmune diseases 338. PAF 365. 2 or more sprems fertilized 1 ovum: triploidy/tetraploidy occurs 346. [Opposite: hot & do take up iodine] 347. ↑ Neutrophils. PAF 362. Small/focal aa occlusions. Specific gravity < 1. 336. collagen. Associated to oral cancer. LTE4. PGE2. Paternal derivation only. ↑d Vascular Permeability: Hist. LTC4. Von Hippel Lindau Disease 391. ↓ Glucose. PGE2. radiation to the back 343. Associated w/ Helicobacter (Campylobacter) pylori infection. Adult Poly Cystic Kidney Disease 383. PGD2. F XII (Hagman): APTT 367. Tuberous Sclerosis 390. LTD4. Specific gravity > 1. Tay-Sachs 392. Hereditary Spherocytosis 386. ↑ serum amylase 342. Embryo. ↑ Pressure 356. Severe epigastric ab pain. Adhesion 373. Involved in Chemotaxis (for Neutrophils) 359. Hypoplastic Goiter nodules that do not take up radio active iodine. Motor: lesion of internal capsule 355. sapponification = hypocalcemia. Lysosomal storage disease α L Iduronidase – Heparan/Dermatan Sulfate accumulation 379.. No embryo. 90% of duodenal ulcer 339. Prostacyclin (PGI2) 366. ↑ pancreatic enzymes = fat necrosis. Chronic pancreatitis 344. Vasoconstriction: TxA2. Osteoporosis: Albers-Schonberd Disease = inspite of ↑d bone density. hypercholesterolemia (can see cutaneous xanthomas) 341. many fractures = ↓ osteoclasts 358.020 – high protein 378. Margination 371. Purely motor or sensory. Deficiency: Phenylalanine Hydroxylase. Thrombin. Vasodilation: PGI2. Post mortem clots 370. Jaundice. prostration. LTE4. 5HT. Familial Hypercholestrolemia Disease 384. Corticotrophs = ACTH & FSH 352. ↑ Lymphocytes 357. Antibodies to parietal cells. anti-mitochondrial Abs 340. Pavementing 372. Phagocytosis 375. Gonadotrophs = LH 351. PGF2α.Superior Vena Cava Syndrome Betel nuts Fundal (Type A) Gastritis Antral (Type B) Gastritis Primary Biliary Cirrhosis Acute Pancreatitis Radiating Back Pain Complete Hydatidiform Mole Partial Hydatidiform Mole Cold Nodules Acidophils Basophils Lacunar Strokes CSF of Bacterial Meningitis CSF of Viral Meningitis Marble Bone Disease C5a C3b Anaphylotoxins Vasoactive Mediators Platelet Aggregation Platelet Antagonist Intrinsic Pathway Extrinsic Pathway Lines of Zahn Currant Jelly appearance Emigration: Chemotaxis Transudate Exudate Hurler’s Galactosemia Phenylketonuria Autosomal Dominant Diseases Autosomal Recessive Diseases 335. Chemotaxis 374. Normal Glucose.012 – low protein 377. 46XX 345. Sensory: lesion of thalamus 354. Neurofibromatosis (von Recklinghausen’s) 389. Epinephrine. Involved in Opsonization (& IgG) 360. Causing swollen face & cyanosis. PAF 364. TxA2. Thyrotrophs = TSH 350. ↑ Phenyalanine & degradation products 381. Huntington’s Disease (chromosome 4p) 387. Bradykinin. Gaucher’s Page 24 . Intracellular microbial killing 376. Deficiency of Galactose 1 Phosphate Uridyl Transferase. ↑ Protein. 337. C3a & C5a (mediate Histamine release from Basophils & Mast cells) 361. Obstructed due to bronchogenic carcinoma. Autoimmune origin. PGF2α. Mammotrophs = Prolactin 348. Bradykinin. middle aged women. Aterial thrombi = pale red colored (dark red is venous thrombi) 369. pernicious anemia. Mousy body odor 382. ADP. LTD4. Cori’s 398. Arthus Reaction. F8 Gene on X chromosome is bad. Hunter’s Syndrome (L-Iduronosulfate Sulfatase deficincy. Alcaptonuria 402. Type II (Cytotoxic): Warm Ab autoimmune hemolytic anemia. Chronic Rejection = occurs months to years of transplant. Hives 409. Galactosemia 400. Hyperacute Rejection = occurs w/in minutes of transplant. PKU 401. ↑ Ceremide Trihexoside) 408. Tumor cell killing. 414. Type IV (Delayed = Cell mediated immunity): Delayed hypersensitivity. Niemann-Pick 394. Carcinoma. Von Gierke’s 396. Exs: Serum sickness. ↑ Ceremide Trihexoside) 405. Hurler’s 395. 413. Erythroblastosis Fetalis. Allergic asthma. exception – renal cell CA: early venous invasion 417. hemolytic transfusion reactions. Incomplete fusion of lateral palatine process w/ each other & median nasal prominence & medial palatine prominence 416. Pompe’s 397. Sarcoma.usually calcified Inolved in Vision relay Involved in Hearing relay Glandular: 5-17 fetal weeks Canalicular 13-25 fetal weeks Terminal Sac 24 weeks to birth Alveolar period birth-8yoa 21-22 days Mouth ! Common Bile Duct . 2ry to Temporal bone fracture β: “Setting the guilty free” – fail to reject the null hypotesis when it was false 1-β TP/TP + FN TN/TN + FP TP/TP + FP TN/TN + FN ad/bc DIC Disorder of thought content Skip from topic to topic Denial – Anger – Bargaining – Depression – Acceptance Page 25 . Fabry’s Disease (α Galactosidase A deficiency. Polyarteritis Nodosa. just below Common Bile Duct ! Splenic flexure of the Colon supplied by Superior Mesenteric artery Splenic Flexure ! Butt crack ! supplied by Inferior Mesenteric Artery Narcolepsy α: “Convicting the innocent” – accepting experimental hypothesis/rejecting null hypothesis Ruptured cerebral bridging veins Ruptured middle meningeal artery “intervals of lucidness”. McArdle’s 399. exception – renal cell CA: early venous invasion 416.X Linked Recessive Diseases Hypersensitivity Reactions “ACID” Transplant Rejections Blood Metastasis Lymph Metastasis Aflatoxin Cleft Lip Cleft Palate Craniopharyngioma Lateral Geniculate Nucleus Medial Geniculate Body Lung Development Heart’s 1st Beat Foregut Midgut Hindgut Hypnagogic Hallucinaitons Type I Error Subdural Hematoma Epidural Hematoma Type II Error Power Sensitivity Specificity Positive Predictive Value Negative Predictive Value Odds Ratio d-Dimers Delusion Loose Association 5 Stages of Death 393. SLE. Contact dermatitis. Involves memory cells. 415. Pituitary tumor . ↑ Ceremide trihexoside) 407. Ab mediated. G6Phosphatase deficiency (G6PDH deficiency. Ab mediates vascular damage. Exs: Hay Fever. Exs: Tuberculin reaction. Lymphocytes & macrophages. Seen w/ Aspergillus. Immune Complex Mediated Glomerular Disease 411. Grave’s Disease. Acute Rejection = occurs w/in days to months of transplant. Lisch-Nyhan Syndrome (HGPRT deficiency. Goodpastures 410. ↑ Uric acid) 406. Type III (Immune Complex): Insoluble complement bound aggregates of Ag-Ab complexes. Duchenne’s Muscular Dystrophy (Dystrophin deficinecy. Virally infected cell killing 412. Type I (Anaphylactic): IgE mediated. ↑ risk for Hepatocellular CA 418.supplied by Celiac Artery Duodenum. ↑ Ceremide Trihexoside) 404. Classic Hemophilia A (Factor VIII deficiency. Incomplete fusion of maxillary prominence w/ median nasal prominence 419. ↑ Heparan/Dermatan Sulfate) 403. Only rejection type that can be treated w/ therapy. Lesion of the sub thalamic nucleus In the Golgi In the RER Internuclear Ophthalmoplegia: medial rectus palsy on lateral gaze.1st Branchial Arch 2nd Branchial Arch Median nerve lesion Radial nerve lesion Common peroneal lesion Diract inguinal hernia Indirect inguinal hernia @ Diaphragm T8. High sensitivity. L2. Nystagmus on abducting eye. No dorsiflexion or eversion of the foot Goes through superficial inguinal ring. Medial to inferior epigastric artery Seen in older men Goes through deep & superficial inguinal ring Lateral to inferior epigastric artery Seen in young boys – processus vaginalis did not close T8 = Inferior vena cava T10 = Esophagus/ Vagus T12 = Aorta/ Thoracic duct/ Azygous vein Wild flailing of 1 arm. T10. Directly gives rise to Ecto. only takes place in the liver. from which Meso & Endo come from. Isoleucine Feeds FA into the mitochondria for their consumption Keeps muscles working anaerobically. Necrotizing arteritis of the caudate. thalamus Chlamydia trachomatis types L1. Dermatitis. Concentrated in the fovea. Active mind – also seen in REM. L3 = Lymphogranuloma venereum Page 26 . Trytophan. Contain Rhodopsin pigment. Valine. Contain Iodopsin = Red-Blue-Green specific pigment. Awake. Seen @ 3rd week: Ecto. For acuity. kidney & GI epithelium Diarrhea. Threonine. Dementia Niacin Deficiency (Vit B3 deficiency) Hartnup’s Disease Malignant Carcinoid Syndrome INH use Needed as co-factor for Pyruvate DH complex & α Ketoglutarate DH complex Esterification of cholesterol: lecithin cholesterol acetyltransferase Lecithin = Phosphatidylcholine. Meso & Endo @ 2nd week: forms the primitive streak. Transfers lactate to the liver to make glucose which is sent back into the muscles for energy use Ouabain [(-) K+ pump] Vanadate [(-) phosphorylation] Digoxin [↑ heart contractility] “Citric Acid Is Krebs Starting Substrate For Mitochondrial Oxidation” Citrate ! Aconitate ! Isocitrate ! α Ketoglutarate ! Succinyl ! Succinate ! Fumarate ! Malate !OAA Color vision. Post streptococcal infection. T12 Hemiballism O Linked Oligosaccharide N Linked Oligosaccharide MLF Syndrome ADA Deficiency Raphe Nucleus β waves Irreversible Glycolysis Enzymes Irreversible Gluconeogenesis Enzymes Pellagra TLCFN LCAT or PCAT HMGCoA Reductase Ketogenic amino acids Glucogenic amino acids Keto & Gluco amino acids Carnitine Shuttle Cori Cycle (-) Na+ Pump (ATPase) TCA Cycle Products Cones Rods Gastrula Epiblast Sydenham’s Chorea (+) Frei Test Meckel’s cartillage – gives rise to incus/malleus bones of ear Reichert’s cartillage – gives rise to stapes bone of ear No pronation Wrist drop – seen w/ humerus fracture Foot drop. Seen w/ MS SCID Initiation of sleep via 5HT predominance Alert. therefore phosphotidylcholine acetyltransferase Rate limiting step in cholesterol synthesis Changes HMGCoA ! Mevalonate (-) by Lovastatin Leucine & Lysine Methionine. Night vision.6 BiPhosphatase Glucose 6 Phosphatase **muscle dose not take part in Gluconeogenesis. putamen. therefore we say “paradoxical sleep” Hexokinase PhosphoFructo Kinase = Rate Limiting Step Pyruvate Kinase Pyruvate Dehydrogenase PyruvateCarboxy Kinase PEPCarboxyKinase Fructose 1. Arginine. Histadine Phenylalanine. Agranulocytosis Aplastic Anemia Atropine-like Side Effects Cardiotoxicity Cartilage Damage in Children Cinchonism Cough Nephrogenic Diabetes Insipidus Disulfiram-like Effect Extrapyramidal Side Effects Fanconi’s Syndrome Fatal Hepatotoxicity (necrosis) Gingival Hyperplasia Gray Baby Syndrome Gynecomastia Hemolytic Anemia in G6PD-deficiency Hepatitis Hot Flashes. 452. Niacin Tamoxifen Ca++ Channel Blockers Barbiturates – Phenobarbital Phenytoin Carbamazepine Rifampin Cimetidine Ketoconazole Methicillin NSAIDs (except Aspirin) Furosemide Sulfonamides Nitroglycerin Industrial exposure → tolerance during week → loss of tolerance during weekend → headache. - Orange Body Fluids 464. 441. ACE Inhibitors 430. Quinidine 429. 423. Tetracycline 435. Valproic Acid Halothane Acetaminophen Phenytoin 439. autism. 422. 456. 454. Skin pigmentation = due to ↑ Fe3+ deposition Highly Tested Drug Side Effects 420. Telangiectasis Sporadic: bad T4 phosphorylation or developmental failure of thyroid formation Endemic: no Iodine in diet: protruding belly & belly button Micronodular pigment cirrhosis. 459. 451. 448. Haloperidol. 455. 437. 457. large everted ears. Flushing Induce CP450 Inhibit CP450 Interstitial Nephritis ach. Clozapine. long face. Lithium (Txt w/ Amiloride) 431. 432. Raynauds. 424. large jaw. 427. 426. Cimetidine Azoles Spironolactone Digitalis Sulfonamides Isoniazid Aspirin Ibuprofen Primaquine Isoniazid Monday Disease 450. 433. Metronidazole Sulfonylureas (1st generation) Antipsychotics (Thioridazine. Chloramphenical 421. 444. 445. 442. 446. dizziness upon re-exposure Rifampin Page 27 . 443. 449. 453. mental retardation Present in Kleinfelters: Male: XXY Not present in Turner’s: Female: XO Traube Sign = Pistol shot sound over the femoral vessels Corrigan pulse = water hammer pulse over coratid artery = aortic regurgitation Calcinosis. Bronze Diabetes. 462. 461. Sclerodactyl. 447. Chloramphenicol 440. 458. 460. 438. Chloramphenicol NSAIDs Benzene Tricyclics 425. Chlorpromazine) 434. 436.Sabouraud’s Agar FMR1 Gene Defect Barr Body Aortic Insufficiency Signs Scleroderma :”CREST” Cretinism Hemochromatosis Triad Culture for all Fungi ie…Culture Cryptococcus neofromans which is found in pigeon droppings Fragile X Syndrome: macro-orchidism. 463. Doxorubicin Daunorubicin Fluoroquinolones (Ciprofloxacin & Norfloxacin) 428. Esophageal. 26. 14. 28. 33. 37. 41. 36. 467. 35. Haemophilus. 6. Bleomycin Amiodarone Vancomycin 471. pneumoniae 43. S. 477. 32. 8. Pneumoniae Klebsiella HiB Pseudamona Aeroginosa Neisseria meningitis Cryptococcus neoformans (only encapsulated fungal pathogen) “Can Also Have Both Shapes” Cocciodes Aspergillus Histolpasma Blastomyces Sprothrix schenkii “OBED” O = Salmonella B = Botulinum E = Erythrogenic strep D = Diptheria Bacilus & Clostridium (have calcium di-picolinate) 42. 19. 10. Vi Salmunella Ags Page 28 . 466. 38. Neisseria. 478. Procainamide Hydralazine INH Antipsychotics (Thioridazine. 30.coli (LT enterotoxin) “Some killers have pretty nice capsules” Strep. 13. H. 470. 15.Coli (K1 capsule most important) Klebsiella “SHYPS” Motile: Shigella make H2S Yersinia enterolytica (AKA Pestis) Proteus Non Motile: noH2S Salmonella “These rascals may microscopically lack color”: Treponema Ricksetta Mycobacterium Mycoplasma Legionella Chlamydia “CAPE” Cholera Anthracis (Poly D glutamate capsule) Pertusis (via Gi) E. MAOIs 472. 39. 4. Haloperidol. 24.Osteoporosis Positive Coombs’ Test Pulmonary Fibrosis Red Man Syndrome Severe HTN with Tyramine SLE-like Syndrome Tardive Dyskinesia Tinnitus 465. 29. 3. Salmonella (Salmonella begins in the ileocecal region) agglutination indicates Abs to O. 473. 17. 12. 7. 34. 18. 20. 16. 23. 475. Heparin Corticosteroids Methyldopa 468. “CEEK” Citrobacter Enterobacter E. 22. Chlorpromazine) Clozapine: only antipsychotic to not give you tardive dyskinesia Aspirin Quinidine Microbiology Lactose formers Non lactose formers May lack color ↑ cAMP Have Capsules [ie… are Quellung Reaction (+)] Dimorphic Fungi Have β Prophage Spore Forming Bacteria IgA Proteases Widal Test 1. 40. 476. 27. 5. 21. 474. 31. 469. 9. 11. 2. 25. 64. Spaghetti & meat ball Page 29 . Vesicular – contact w/ bad water 75. Isospora 56. Txt: Praziquantel 77. Lung fluke – eating raw fish. Swimmer’s itch – contact w/ bad water 76. coli – irredescent green sheen Pneumococci – lancet shaped diplococci Neisseria – kidney bean shaped diplococci Camphylobacter – gulls’ wings/comas Vibrio Cholera – coma shaped Corneybacterium D – club shaped (nonmotile. all Rickettsia except Roachalimea (make suficient ATP to survive) 89. Sheep – eating raw fish. No cell wall. X = Protoporphyrin & V = NAD 92. Actinomyces. Giant intestinal flukes – eating raw fish. Trypanosoma Cruzi 90. Txt: Praziquantel 79. Borrelia. A Protein. 65. 57. 96. Babesin. Chlamydia Pistacci (Chlamydia do not make own ATP).stones): alkaline urine Ureaplasma Campylobacter pylori (Helicobacter) Cryptococcus Nocardia Staph A & Yersenia pestis 88. Clostridium. Serratia – red (can cause pseudohemoptysis) Pseudomonas A – piocyanin blue/green Staph Aureus – yellow – Protein A Mycobacteria – photo/scoto chromogenic – caritinoid – yellow/orange Corneybacterium D – black/gray – pseudomembrane plaque in throat Bacteroides (Porphyromonas) melaninogenicus – black (heme) E. Neiserria and most Gram (-)s 81. Txt: Praziquantel 80. Mycobacterium. Yersinia 45. Pseudomonas & Mycobacterium 51. Predisposes to septicemia 47. 67. Mycoplasma pneumoniae has fried egg colonies on Eaton agar (needs cholesterol) 94. Mycobacterium Leprae. All Proteus – can cause Staghorn/Struvite calculi (NH4. Chinese liver fluke – eating raw fish. Plasmodium. 86. Legionella micdadei. Bacteroides 52. Gram (+) except for Neisseria & Moraxella 93. 60. Leishmania. Membrane has cholesterol. Person to person cf w/ Bubonic plaque that was via infected flea 46. Treponema. 70. 68. Cryptosporidium. P1 protein inhs ciliary action Fried egg colonies Atypical pneumonia – young adults Fungal media 99. Treponema palidum & Pneumocystis Carinii (cannot be cultured on inert media but can be found extra cellularly in the body) 91. Txt: Praziquantel 78. 85. Corenybacterium D & Nocardia 55. Catalase +/ Coagulase + 53.Wayson’s Stain Pneumonic Plaque Transmission Splenectomy Invasins Fusiform S. 97. Camphylobacter & Helicobacter 82. 72. 83. Dextran mediated adherence 50. 63. G+Rod) Yersinia – safety pin seen in Wayson’s stain Rabies – Negri bodies – intracytoplasmic Pox virus – Guarnieri – intracytoplasmic & acidophilic CMV – Owl’s eyes – intracytoplasmic & intranuclear HSV – Cowdry bodies – intranuclear Intestinal – contact w/ bad water 74. 69. 84. 98. 71. 95. 62. 61. Smallest living bacteria. 58. Vincent’s trench mouth 49. viridans Obligate Aerobes Obligate Anaerobes Staph aureus Spirochetes Non Motile Gram (+) Rods Acid Fast Organisms Pigment Producing Bacteria Bacterial Morphology Inclusion Bodies Schistosoma Japonicum Monsoni Schistosoma Haematolium Non Human Schistosom Clonorchichis Fasciola Hepatica Fasciola Biski Paragonimus Westermani Oxidase (+) Micro Aerophilic Urease (+) Coagulase (+) Obligate Intracellular Bacteria Protozoa Obligate Non Intracellular Parasites Haemophilus Factors All cocci are “Eaton Fried Eggs” Mycoplasma Sabrands Malassazia furfur 44. Yersinia pseudotuberculosis 48. 87. Leptospira 54.Mg2. 59. 66. Toxoplasma ghondi. 73. Nocardia (partially). “Ella likes cysteine”: Francisella Brucella Legionella Pasturella Gram (-): N. Brucella 152. aeroginosa infection Contact lens’ infection Cat Bites Undulant Fever Bordet Gengou Agar Lowenstein-Jensen medium Cat Scratch Disease 100. Colonization in the nasal passages after swimming 107. non-motile. Gram (+): Bacillus & Clostridium – made up of dipicolinate & Keratin 115. Neisseria ID 140. M proteins. Novobiocin Resistant (UTIs) 121. 127. 133. Saprophyticus Staph. Cryptococcus neoformans 106. Bacillus Cereus 131. Actinomyces israelli 117. Ceftriazone 141. seen w/ Endospores G(+) Multi Brain Abscess Single Brain Abscess ↑ risk for Strep pneum Infection α Hemolysis/Optochin Sensitive α Hemolysis/Optochin Resistant Staph. EIEC – EHEC – Shigella . Leion can resemble Kaposi’s sarcoma. Can also have photophobia 101. 110. 136. Agalactiae (Diabetes predisposes to infection) 125. Target shaped skin lesions w/ a black center and red ring surrounding the lesion 114. 129. 108. Related w/ neonateal meningitis 142. Page 30 . Bismuth salts. Strep. gonorrhoeae K1 E. Sickle cell anemia. Coli Capsular Ag The A’s of Klebsiella Rice H2O Diarrhea Raw seafood intoxicaiton Helicobacter Txt ↑ risk of P. Nocardia 116. Tetracycline (or amoxicillin) 148. Pseudomonas aeroginosa 150. DOC: Penicillin 130. Endotoxin A 124. Viridans (Subacute Endocarditis) 120. Hyaluronic capsule. Strep. Bordetella pertusis ID 153. Rheumatic fever)) 123. Epidermidis β Hemolysis/Bacitracin Sensitive β Hemolysis/Bacitracin Resistant EFII Ribosylation Bacillus Anthracis: 3 toxins (work via adenylate cyclase) Woolsorter’s Disease Grows in Rice Clostridium Perfringens Clostridium Difficile Spastic Paralysis toxin Clostridium Botulinum Infant Botulinum Thayer Martin Agar DOC for N. Asplenic. Pneumoniae 119.Measles’ 3C’s Non Motile Bacilli & Clostridium Bloody diarrhea agents YW-135CA Indian Ink Naegleria causes Need Cysyeine for growth Endotoxins. 109. Pasteurella multocida 151. Vibrio parahemolyticus 147. Strep.Yersenia enterocolitica – Entaemeba histolytica – Salmonella – Campylobacter jejuni 104. Diphtheria toxin & Pseudomonas exotoxon A 126. Pseudomonas aeroginosa. impetigo. May lead to subacute Sclerosing Panencephalitis 102. Pyogenes (pharyngitis. Strep. Cough – Coryza – Conjunctivitis. M. G(+) or G(-) Ecthyma Gangrenosum. 128. B. Burn patients & Cystic fibrosis 149. Scarlet fever. 111. Double Zone β Hemolysis (test) Lecithinase: α toxin = lyses RBCs 80% of gas gangrene (myonecrosis) cases 2 Toxins: Enterotoxin (Exotoxin A) & Cytotoxin (Exotoxin B) Pseudomembranous colitis (can be precipitated by clindamycin/ampicillin) Clostridium Tetani toxin 137. 144. Novobiocin sensitive (Endocarditis in IVDUs) 122. 145. meningitidis vaccine capsualr polysaccharide strains 105. Perfringens 103. Floppy Baby Syndrome. Protective Antigen (PA) Lethal Factor = toxic to macrophages Edema Factor = ↑ cAMP Bacillus anthracis. 134. Bad canned foods have neurotoxin = flaccid paralysis (block Ach release) 138. Pre formed toxin in honey 139. 135. N. cellulitis. 132. meningitidis 113. Anthracis & C. Bartonella henselae. Alcoholics Aspiration pneumonia Abscesses in the lungs Vibrio Cholera: metabolic acidosis 146. 112. tuberculosis ID 154. immunocompromising illness 118. Metronidazole. 143. from the Arbovirus. Linked w/ sicle cell anemia 162. indicates higher risk of transmitting the disease Disappears before HbsAg is gone Present in beginning of clinical illness Seen in the “window phase” Actinomycetes = Nocardia. California 208. 175. Adenovirus (type 8) 157. In the immunosuppressed. Reticulate Body: made from elementary body. Trypansoma cruzi: Chagas’ Disease 200.Pink Eye True Hemaphrodite Pseudo Hemaphrodite Male Pseudo Hemaphrodite HLA Genes Location Parvovirus B19 Interferon MOA Acute Hemorrhagic Conjunctivitis Parainfluenza Causes… Swimming Pool Conjunctivitis RSV Removed tonsils. find what virus Bone Fever HbsAg HbeAg Anti-Hbc Filamentous Bacteria Listeria contaminates Shiga like Toxin Necrotizing Fasciitis Relapsing Fever Loffler’s Medium Chlamydiae Developmental Cycle Trench Fever “Spotted Fever” Members Thrush Txt Rose Bush Thorns Contact lens solution infection Filiariasis Causant Freshwater lake infection Reduviid bug bite Schistosoma Haematobium causes Schistosoma Mansoni causes Snail. Malaria 204. Croup (Laryngotracheobronchitis) 165. splenomagaly. W/ infection you will see Glycogen containing inclusions 184. transmitted by mosquitos 169. 173. Inhibits viral replication (translation or transcription) 163. sibirica (tick typhus in China) & R. Trypansoma brucei gambiense & rhodiense: African Sleeping Sickness 201. activation can occur 168. donovani & Dermal Leishman by L. Elementary Body: infeccious particle that Enters the cell 182. Rickettssia rickettsii (RMSF) & R. Babesia microt 199. External genitalia does not coincide w/ gonads 159. Adenovirus (types 3 & 4) 166. Adenovirus. Group A Streptococci 179. Nystatin txts candidiasis of the mouth 189. australis (typhus in Australia) 188. Testes & Ovaries are present 158. Ohio. Infect Ketoacidotic Diabetics. Babesia (clinically rembles malaria) & Borelia burgdorferi 198. Rochalimaea quintana 186. 170. Misouri River valleys 207. Milk. Babesia microti: Babesiosis & Borrelia burgdorferi: Lyme Disease 203. Causes amebic meningoencephalitis due to Naegleria fowleri 193. Presinusoidal HTN. States east of Mississippi River Page 31 . before onset of acute illness Disappears w/in 4-6 months after the start of clinical illness Appears early acute phase. Cell wall lacks muramic acid 185. Mississippi. Bladder calcificaiton & cancer 195. Corneybacterium diphtheriae 181. In 80%. 206. Wucheria bancrofti (infection aka elephantitis & wucheriasis 192. Fifth Disease: Erythema Infectiosum (ssDNA). 187. differentiates and releases elementary bodies to infect other cells 183. tropica. Appears in blood soon after infection. Testicular Feminization 160. braziliensis & Visceral Disease by L. 6p 161. Dengue: Group B Togavirus. E. Seen w/ infections from Enterovirus & Coxsackie A 164. Acanthamoeba 191. intermediate host of… Ixodes scapularis transmits Nantucket Protozoa Infection by Reduviid Bug Infection by TseTse Fly Infection by Sandfly Infection by Ixodes Tick Infection by Anopheles Mosquito Trophozoites w/ “Face-Like” Appearance Nonseptate Hyphae Histoplasmosis Geography Coocidioidomycosis Geography Blastomycosis Geography 155. Schistosomiasis 197. Streptomyces 176. Only mycosis w/o septate. Borrelia recurrentis 180. Transmits Trypanoma cruzi (Chagas’ disease): Romana’s Sign 194. esophageal varices 196. mexicana. Southwestern deserts. Toxoplasmosis 156. Leishmaniasis: Mucocutaneous Diseases by L. akari (rickettsial pox) in the U. Zygomycosis: Rhizopus & Mucor.S. 174. Actinomyces. Replicates. Bronchiolitis in infants 167. peruviana 202. Giardia lamblia 205. vegetables (coleslaw) in recent infections 177. 171. R. Coli 0157/H7: Hemorrhagic colitis & Hemorrhagic uremic syndrome 178. 172. Have Sporothrix schenckii 190. cheese. β Prophage encodes the exotoxin 236. Louis Encephalitis – no hepatitis or hemorrhage 226. DNA or RNA + Structural proteins Membrane. Rhino. Mumps 217. Reovirus 243. N. Latin America 210. distress syndrome 229. Spike Glycoproteins (peplomeres): HA = Hemagluttinin & NA = Neuraminidase.ico Rep in Nuc Page 32 A = Adeno H = Herpes H= Hepadna P = Pox P = Parvo . but has reverse transcriptase 246. Pneumoniae 231. Granules (metachromatic) 240. 213. enveloped 221. Nucleocapsid + Glycoprotein Non virus specific. Works by RNA endonuclease = digests viral DNA + inh viral prot synth Gag. Echo. Papovavirus. Influenza A & B 215. Croup(Parainfluenza virus) 218. Diphtheria 238. env Tat. –ssRNA. W/ this activity these bugs are able to colonize the oral mucosa. Encephalitis viruses: Alphaviruses: Eastern (more severe) and Western Equine Encephalitis 223. Hep A 221. These peplomeres are what give the virus antigenis variation 214. Parvovirus: “Part of a virus” 241. Hantavirus – hemorrhagic fever w/ acute resp. –RNA. pol. 3 Day Measles: German Measles: Rubella/ Rubivirus 222. Strep. enveloped. H. enveloped virus. “Naked for CPR”: Calcivirus. Corneybacteria is Club shaped 237. nef Transmembrane Surface Matrix Capsid Nucleocapsid E Brick. Adenopathy 235. “RepeatOvirus” 242. No. Rep In Cyto AH H PPP --. Most common cause of respiratory infections in kids 216. RSV 220. aka Herpangina Orthomyxovirus Paramyxovirus Togavirus Flaviviris Bunyavirus IgA Protease Activity Diphtheria: ABCDEFG Only ssDNA Only dsRNA Naked RNA 2 circular DNAs BK Hepadna. Filovirus & Bunyavirus (Hantavirus) All are RNA: Orthomyxo. Extracellular virus found Nucleocapsid. Papovavirus & Hepadnavirus 244. “Hand-Foot-and-Mouth” Disease: Coxsackie A (Picornavirus +ssRNA) 212. 234. Arena. Reo No internal virus. Rubeola(Measles virus) 219. enveloped 227. Exanthema Subitum: “Sixth Disease” (Human Herpes Virus-6 dsDNA. Reovirus. Poiliovirus. Coxsackie. N. Elongation Factor II 239. +ssRNA. Yellow fever 225. Seen in kidney transplant patients (causes renal disease) 245. California Encephalitis – severe bifrontal headaches 228. Retrovirus? Picornovirus: “PERCH” Hemorrhagic Fevers Segmented viruses Eclipse Phase Latent Phase Naked Capsid Virus Enveloped Virus Interferon AIDS structural prots AIDS regulatory prots AIDS gp41 env prot AIDS gp120 env prot AIDS p17 gag prot AIDS p24 gag prot AIDS p7p9 gag prot DNA Viruses 209. rev. meningitidis 232. 1 total virus per cell No external virus. gonnorhoae 233. Influenzae (needs factors V & X for growth) 230. St. Dengue Fever – icterus & hemorrhage w/ blac vomit 224.Paracoccidioidomycosis Geography Roseola Infection. enveloped) 211. Bunya. Picornovirus. –ssRNA. (-) E Helical Linear. Microcondida w/ tuberculate macrocondida. C3a + C4b ! C5 Quintana Sporozoites: from blood to liver Primary tissue schizont Trophozoites: in RBC Erythrocytic schizont Merozoite: ruptured RBC Gametozyte Zygote: inside the mosquito Star shaped cysts Nonseptate. asoc’d w/ cystic fibrosis & burns pt Hyphae in wild. capsular halos Monomorphic Yeast normally. When it is w/ C3a. indian in. filamentous. Ground glass Page 33 . Bb. Pneumonia in alcoholics. Rep in Cyto Helical R-Tase & Rep in Nuc 8 (-) RNA Viruses 2 3 F O R P A B ---. C3b + C3a ! C5 Classic: 2b. F = Filo O = Orthomyxo R = Rhabdo P = Paramyxo A = Arena B = Bunya Bullet Anti sense Hepatitis Window Period Hepatitis A Picorna Downey Type II cells Infection by Aedes Mosquito “Hot T-Bone stEAk”: ILs ILs Secreted by CD4s ILs Secreted by Macrophages C5a C5 Convertase Only Richettssia not Intracellular Plasmodium Life Cycle Acanthamoeba Mucor.ico (+) Linear. Kills type I pneumo cells. Hyphae in wild Hypahe in wild. participates in anaphylaxis When both Alternative and Classic pathways come together Alternative: C3b. Potas iodide in milk. pseudo & true hyphae in tissue infections 45 degree branching point. Sherules w/ endospores Hyphae in wild. IFN gamma IL1 & TNF α Neutral chemotaxis. Absidia Cryptococcus Neoformans Candida Aspergillus Fumigatum Cocciodes Histoplasma Cap Blastomycosis Sporothrix Schenkii PCP After HbsAg disappears & Before HbsAb appears B Hepadna EBV C Flavi D Delta E Calici Yellow Fever: Flavivirus: Black vomit.SS P = Papova Circ E (+) RNA Viruses C = Calici P = Picorno R = Reo F = Flavi T = Toga C = Corona C P R F T C -----. In the tissue it’s a yeast w/ a small neck. No segment. 90 degree branching. IL5. IL4. jaundice. Non seg. high fever IL1 = ↑ Temp: HOT IL2 = stimulate T cells IL3 = stimulate Bone Marrow stem cells’ growth & differentiation (GM CSF) IL4 = stimulate IgE (& IgG) IL5 = stimulate IgA (& eosinophils) IL2. Obligate parasite. Arthocondida & Hyphae. Artroconidia. Fac intracellular. 3b. Rhizopus. Fastest growing tumor – Burkitt’s 2. so if you can palpate the gallbladder you’e probably looking at cancer. Monocytes. Histolitica Giardia Cryptosporidium Balantium C. mirabilis 11. PE’s are found in half of all autopsies 3. Fever Cysts Cysts Cysts Cysts Trophozoites Trichophyton: SHN Microsporium: SH Epidermophyton: SN Tinea tavus: permanent hair loss Diagnosis Fever Spike Trophozoites or cysts in stool Trophozoites or cysts in stool Acid fast oocysts Trophozoites or cysts in stool Motile trophozoites Vivax Benign 3 degrees 48h Enlarged Host Cell Ovale Benign 3 degrees 48h Oval/Jagged Malariae 4 degrees of Malarial 72hrregular Crescent Falciparum Malignant 3 degrees Miscellaneous 1. but obstructing gallstones do not (too much scarring). T cells. Coli. Treponema pallidum (Syphilis) tests: 1)VDRL 2)FTA-Abs: most widely used 3)TPI (immobilization test – most expensive but the Gold Standard) Cytokine IL 1 IL 2 IL 3 IL 4 IL 5 IL 6 IFN α IFN β IFN gamma TNF α TNF β Source 12. cytotoxicity Tumor Suppressor Genes Genes VHL APC WT-1 Chrom. Macrophages. Renal Cell CA 5p Familial adenomatous polyposis. Only DNA virus to replicate in cytoplasm: Pox 5. monocytes 18. Bordetella Pertussis Gram (-) Bugs w/ Exotoxins Dermatophytes Transmission E. ↑ HLA II Ags T cell prolif. cytotoxicity T cell prolif. T cells Function Stimulates T cell proliferation & IL2 produciton Stim prolif of B. Trichomonas V. Only RNA virus to replicate in nucleus: Influenza 6. 10. Cholera. macrophages 19. IL 2 prod. IL 2 prod. B cells. T & NK cells 14. Courvoisier’s Law: tumors that obstruct the common bile duct cause enlarged gallbladders. except that Cryptococcus lacks the prominent nucleoli. (+) macrophages.E. Bordetella pertussis (Whooping Cough) elicits lymphocytosis rather than granulocytosis 8. T cells 16. looks just like Pneumycistis carinii. macrophages 13. Bronchioalveolar carcinomas grow without destroying the normal architecture of the lung 9. Colon CA 11p Wilm’s tumor Page 34 . T & NK cell GF of tissue mast cells & hematopoietic stem cells ↑ growth of B & T cells/ ↑ HLA II Ags Maturation of B ! plasma cell Maturation of B & T cell/ (-) fibroblasts Antiviral activity Antiviral activity Antiviral activity. T cells 17. T cells 15. Macrophages. when stained with GMS. T & NK cells 22. Cryptococcus neoformans often lacks a capsule and. rickettssi & (+)Proteus vulgaris & P. Bacillus anthracis has the only protein capsule 7. Weil Felix reaction: (+)R. Fibroblasts 20. V. 4. Associated Tumors 3p Von Hippel Lindau. T & NK cells 21. 8 or 1 O 2consumed . Osteosarcoma Breast CA Most human Cas Neurofibromatosis type 1 Breast CA. Exchange Ratio Page 35 CO 2 produced ≅ . Of CO2 R = Resp. Ovarian CA Colon & Stomach CA Pancreatic CA Neurofibromatosis type 2 = bilateral acoustic neuroma Physiology Equations Resistance in Series: Add all Resistance in Parallel: Invert the answer RENAL: Filtration Fraction = GFR RPF GFR: Glomerular Filtration Rate RPF: Renal Plasma Flow Filtered Load = GFR x [Conc] Clearance = Excretion Rate = [Urine] x VelUrine [Urine]xVel (Urine) Excretion or [ Plasma] [Plasma] Renal Blood Flow = ERPF 1 − Hct Clearance of PAH = [ERPF] Free Water Clearance = VelUrine - ERPF: Eff renal plasma flow Urine(osm) xVel (urine) P(osm) CARDIO: CO = HR x SV CO = O 2(consumed ) PulmonaryA − VO 2difference MAP = Diastolic + 1/3 Pulse Pressure CO = MAP TPR Pulse Pressure = Systolic – Diastolic MAP = TPR x CO F= P1 − P 2 R LUNGS: PAO2 = (760 – 47) FO2 - PACO2 R Where: FO2 = [O2] PACO2 = Alv. Press.Rb BRCA-2 p53 NF-1 BRCA-1 DCC DPC NF-2 13q 13q 17p 17q 17q 18q 18q 22q Retinoblastoma. 0 = Va/Q New PCO2 = 20 Page 36 Diffusing Capacity = New PO2 = 170 COuptake PACO 2 .Flow = O 2consumed AtoVO2difference Velgas Diffusion = Area x Gas Diffusion Constant x Difference of Partial Thickness Press VentTot = VentTidal x #of Respirations Compliance = Vol Pr ess P= Tension Radius Resp Doubles: 150mmHg & 40mmHg VentAlv = (VentTidal – VentDead) x # of Respirations 1.